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Tricky questions

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I am posting last 17 MCQs from the paper 3 before we move on to the solution of EMIs. I'll be grateful for the answers, preferrably reference based.

Q 91 / 1. • Stem: What is true about the initial appraisal of an event

Options:

Automatic thoughts being part of primary appraisal

Perception of the magnitude of the threat being part of primary appraisal

Negative automatic thoughts being part of secondary appraisal

Perception of the magnitude of the threat being part of secondary appraisal

Q 93 / 2. • What predicts a good response to therapy?

Options:

Good perception of treatment alliance

Patient can understand things in psychological terms

Previous therapy

Q 102 /3 . • What is the incidence of birth defects in a woman taking valproate?

Options:

1/10

1/50

1/100

1/1000

Q 105 /4 • What characterises GAD

Options:

Avoidance to reduce anxiety

Depressive episodes

Q 110 /5 • Stem: Which class of drug would you use in a boy with ADHD and Tourette’s?

A centrally acting alpha agonist

Beta blocker

Noradrenaline reuptake inhibitor

Q 111 /6 • Stem: Concerning learning disability and offending

Options:

Most offences are committed by those with mild/mod LD

Fire setting is the most common offence

Those with moderate LD are most likely to be convicted of murder

Sexual offending is related to hypersexuality

Q 112 /7 • Stem: Select one correct statement regarding psychotherapy in LD

Options:

Unmodified CBT can be used in severe LD

Guiding mourning has no place in mild LD

Progressive relaxation is part of psychodynamic group therapy

Patients with severe LD who have been traumatized by abuse should have psychodynamic therapy

Behaviour therapy should be used in groups in severe LD

Q 116 /8 • Stem: In children with PANDAs which symptoms are least common?

Options:

Obsessions

Depression

Auditory hallucinations

Anxiety

Q 119 /9 • Stem: Empathy skills are most likely to be delayed in

Options:

A deaf child of deaf parents

A deaf child of hearing parents

A hearing child of deaf parents

A hearing child with one deaf parent

A hearing child adopted at birth

Q 124 /10 • Stem: Huntington’s disease shows which pattern of inheritance

Options:

Autosomal dominant with high penetrance

Autosomal dominant with poor penetrence

Autosomal recessive with low penetrance

X-linked

Q 126 / 11• Stem: Which antidepressant has the best evidence base for its use in post stroke depression?

Options:

Fluoxetine

Citalopram

Reboxetine

Mirtazapine

Sertraline

Q 129 /12 • Stem: Which of the following is most common in delirium?

Options:

Hallucinations

Delusions

Disturbed sleep wake cycle

Labile mood

Increased motor activity

Q 130 /13• Stem: Which of the following are most likely to be seen in anorexia

Option:

High oestrogen

Low cortisol

High white cell count

Low triiodothyronine

Hyperkalaemia

Q 131 / 14 • Stem: The babies of anorexic mothers are most likely to be

Options:

Are large for dates

Have lower APGAR scores

Are born post-term

Have a larger head circumference

Have fetal abnormalities

Q 132 /15 • Stem: Which of the following is least commonly associated with bulimia?

Options:

Oesophageal tears

Dental decay

Peptic ulcer

Parotid gland enlargement

Seizures

Q 133 /16 • Stem: Normal bereavement is most likely to include

Options:

Delusional beliefs that the deceased is still alive

Significant weight loss

Suicidal ideation

Worthlessness

Transient anger to the deceased

Q 136 /17 • Stem: Which of the following is contraindicated in the elderly with psychosis and cognitive impairment?

Options:

Haloperidol

Quetiapine

Olanzapine

Sulpiride

Promazine

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Q 119 /9 • Stem: Empathy skills are most likely to be delayed in

Options:

A deaf child of deaf parents

A deaf child of hearing parents

A hearing child of deaf parents

A hearing child with one deaf parent

A hearing child adopted at birth

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Q 119 /9 • Stem: Empathy skills are most likely to be delayed in

Options:

A deaf child of deaf parents

A deaf child of hearing parents

A hearing child of deaf parents

A hearing child with one deaf parent

A hearing child adopted at birth

A deaf child of hearing parents

http://64.233.183.104/search?q=cache:bJ3CdSLVKDoJ:www.aare.edu.au/96pap/nichs96342.txt+empathy+deaf+child+hearing+parents&hl=en&ct=clnk&cd=13&gl=uk  

http://jdsde.oxfordjournals.org/cgi/content/full/10/4/321

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Q 131 / 14 • Stem: The babies of anorexic mothers are most likely to be

Options:

Are large for dates

Have lower APGAR scores

Are born post-term

Have a larger head circumference

Have fetal abnormalities

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Q 131 / 14 • Stem: The babies of anorexic mothers are most likely to be

Options:

Are large for dates

Have lower APGAR scores

Are born post-term

Have a larger head circumference

Have fetal abnormalities

Ans: have lower APGAR score.

Larger for dates babies are classic of DM or gestational DM

quite unlikely for babies to be post term, if anything expect pre term

They donot normally have a large head circumfrence, unless associated with hydrocephalus.

Babies are nt normally born with congenital abnormalities, the risk in AN is same as for any other pregnancy.

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124 /10 • Stem: Huntington’s disease shows which pattern of inheritance

Options:

Autosomal dominant with high penetrance

Autosomal dominant with poor penetrence

Autosomal recessive with low penetrance

X-linked

Ans: AD with low penetrance

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EMI 5

Universality

Pairing

Dependence

Fight-flight

Cohesiveness

Free floating discussion

Interpreting transference

Counter-dependence

1. Two factors that are curative in groups.

Universality

Cohesiveness

2. Three factors that hinder working in groups (Basic Assumptions)

Pairing

Dependence

Fight-flight

3. Two factors that are found in psychodynamic groups.??????

http://apt.rcpsych.org/cgi/reprint/8/1/34.pdf  

http://apt.rcpsych.org/cgi/content/full/8/1/34?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=Montgomery&fulltext=DYNAMIC+GROUP+tHERAPY&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

Box 2. Yalom's curative factors (Yalom, 1970)

1. Interpersonal learning

2. Catharsis

3. Group cohesiveness

4. Self-understanding

5. &nbsp:lol:evelopment of socialising techniques

6. Existential factors

7. Universality

8. Instillation of hope

9. Altruism

10. Corrective family re-enactment

11. Guidance

12. Identification/imitative behaviour

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EMI 4

Alcoholic hallucinosis

Fahr’s syndrome

Alcoholic delirium

Alcohol withdrawal

Meta-chromatic leucodystorphy

Neuroacanthosis

Systemic Lupus Erythematosis

Complex partial seizures

Post Herpetic encephalopathy

1. A 44 year old homeless man is brought into A&E. he is agitated, psychotic and depressed. The ECG shows decreased alpha activity and his gait is disturbed. MRI shows hypo-intensity of the striatum. Choose ONE.

2. A 25 year old man recently returned from America shows aggressive behaviour. He recently developed seizures and has periods of decreased conciousness. His full blood count and liver functions are normal – Choose ONE.

3. A 30 year old woman has one sided facial nerve palsy and circumscribed lesions on both legs. Choose ONE.

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EMI 5

Universality

Pairing

Dependence

Fight-flight

Cohesiveness

Free floating discussion

Interpreting transference

Counter-dependence

1. Two factors that are curative in groups.

Universality

Cohesiveness

2. Three factors that hinder working in groups (Basic Assumptions)

Pairing

Dependence

Fight-flight

3. Two factors that are found in psychodynamic groups.??????

http://apt.rcpsych.org/cgi/reprint/8/1/34.pdf  

http://apt.rcpsych.org/cgi/content/full/8/1/34?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=Montgomery&fulltext=DYNAMIC+GROUP+tHERAPY&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

[highlight]My Inference from the paper is free floating discussion and interpreting transference[/highlight]

Box 2. Yalom's curative factors (Yalom, 1970)

1. Interpersonal learning

2. Catharsis

3. Group cohesiveness

4. Self-understanding

5. &nbsp:lol:evelopment of socialising techniques

6. Existential factors

7. Universality

8. Instillation of hope

9. Altruism

10. Corrective family re-enactment

11. Guidance

12. Identification/imitative behaviour

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EMI 4

Alcoholic hallucinosis

Fahr’s syndrome

Alcoholic delirium

Alcohol withdrawal

Meta-chromatic leucodystorphy

Neuroacanthosis

Systemic Lupus Erythematosis

Complex partial seizures

Post Herpetic encephalopathy

1. A 44 year old homeless man is brought into A&E. he is agitated, psychotic and depressed. The ECG shows decreased alpha activity and his gait is disturbed. MRI shows hypo-intensity of the striatum. Choose ONE.

2. A 25 year old man recently returned from America shows aggressive behaviour. He recently developed seizures and has periods of decreased conciousness. His full blood count and liver functions are normal – Choose ONE.

post herpetic encephalopathy???

3. A 30 year old woman has one sided facial nerve palsy and circumscribed lesions on both legs. Choose ONE.

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EMI 4

Alcoholic hallucinosis

Fahr’s syndrome

Alcoholic delirium

Alcohol withdrawal

Meta-chromatic leucodystorphy

Neuroacanthosis

Systemic Lupus Erythematosis

Complex partial seizures

Post Herpetic encephalopathy

1. A 44 year old homeless man is brought into A&E. he is agitated, psychotic and depressed. The ECG shows decreased alpha activity and his gait is disturbed. MRI shows hypo-intensity of the striatum. Choose ONE.

Fahr’s syndrome

http://www.ncbi.nlm.nih.gov/pubmed/3765636  

http://books.google.com.pk/books?id=VRBOeASiB8gC&pg=PA159&lpg=PA159&dq=Fahr's+syndrome+hypointensity&source=web&ots=T3IBJii9xg&sig=XFzUZW-1XpCOQbSUl90vBF_lVcU&hl=en#PPA160,M1

2. A 25 year old man recently returned from America shows aggressive behaviour. He recently developed seizures and has periods of decreased conciousness. His full blood count and liver functions are normal – Choose ONE.

Post Herpetic encephalopathy

http://books.google.com.pk/books?id=SEKuPP20eLsC&pg=PA100&lpg=PA100&dq=herpes+encephalopathy+aggression&source=web&ots=mujDjnaz36&sig=3o32x7omrNgUDVqYV1Q7omFo4dM&hl=en  

http://www.emedicine.com/neuro/TOPIC159.HTM

http://nnr.sagepub.com/cgi/content/abstract/9/1/41

3. A 30 year old woman has one sided facial nerve palsy and circumscribed lesions on both legs. Choose ONE.

Post Herpetic encephalopathy

http://en.wikipedia.org/wiki/Herpes_simplex  

http://images.google.com.pk/images?hl=en&rlz=1T4HPEB_en-GBIE256IE256&q=Herpes%20simplex%20%20legs%20%20circumscribed&um=1&ie=UTF-8&sa=N&tab=wi  

4. A 44 year old homeless man is brought into A&E. he is agitated, psychotic and depressed. The ECG shows decreased alpha activity and his gait is disturbed. MRI shows hypo-intensity of the corpus callosum. Choose ONE.

Marchiafava-Bignami Disease

http://www.emedicine.com/NEURO/topic204.htm

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EMI 8

Case-control

Prospective Cohort

Cross sectional survey

Ecological survey

Open Label RCT

Parallel RCT

Cross over trial

Qualitative study

Intention to treat analysis

Which would be the most ethical (choose ONE) for the following:

1. To look at the number of suicides following an overdose.

Prospective Cohort

2. To look at the number of children developing cardiac abnormalities in mothers on lithium

Case-control study

3. To look at obstetric complications and the development of schizophrenia but you wish to avoid attrition bias.

4. To look for exposure and outcome whilst avoiding recall bias

5. To compare treatment vs placebo. The researchers wish to recruit fewer participants.

6. To compare whether a new drug has fewer side effects than another, established drug.

Cross over trial

Gosall and Gosall p. 17

7. To get patient’s perspectives on the quality of care they receive.

Qualitative Study

Gosall and Gosall p. 12

EMI 9

Analysis of covariance

Paired t test

T Test

Chi squared test

Choose ONE:

1. Test to compare an antidepressant against placebo taking into account baseline differences.

2. Test to compare recovery rates in antidepressant vs placebo at three centres

3. Test to compare change in blood pressures in patients before and after a trial drug is given.

 

EMI 10

Options

Buspirone

Citalopram

Desipramine

Escitalopram

Family Therapy

Fluoxetine

Haloperidol

Lithium

Logotherapy

Methylphenidate

Parental skills training

Paroxetine

Quetiapine

Reboxetine

Risperidone

Sertraline

Venlafaxine

None of the above

Lead in: Select one option each for the following

Scenarios

1: A 4 year old girl who is extremely aggressive towards her mother and has punched her in the stomach on one occasion. She hits other children at the nursery. She is ‘difficult’ and refused to do what she is told.

2= A 17 year old boy with a history of frequent aggressive behaviour. Has been in trouble with the police. Parents got an injunction banning him from staying at home. He said he was aggressive almost all the time. Otherwise he has no symptoms.

3= A 13 year old girl who is aggressive and in trouble at school. She was diagnosed by psychologist to have ADHD. She is having multi-systematic therapy but is still hyperactive and has poor attention.

EMI 11

• Options

Angelman syndrome

Down syndrome

Fragile X Syndrome

Leasch Nyhan

Phenlyketonuria

ADHD

Prader Willi Syndrome

Rett syndrome

Hurlers syndrome

Hunter syndrome

Lead in:

A 5 year child presented with autistic symptoms and hyperphagia & hypotonia.

Prada Willi Syndrome

B 5 year old child presented with autistic symptoms and hand wringing

Rett syndrome

C 5 year old child presented with autistic symptoms. His maternal grandfather & maternal uncle had the condition

Fragile X Syndrome

EMI 12

• Terminally ill people are screened for depression with the question ‘Do you think you are depressed?’. This is then compared to a structured diagnostic interview used to diagnose depression. NB Calculators are not allowed.

If you need more options, please add in red

Options

11%

22%

33%

44%

55%

66%

77%

88%

99%

Note: gold standard at top

Interview Depressed Not depressed

Yes to question 11 9

No to question 14 40

Totals 25 49

(1): What was the prevalence of depression in the sample?

(2): What was the sensitivity of the screening?

(3): What was the specificity of the screening?

(4): What proportion of those who screened positive were depressed?

(5): What proportion of those who were depressed screened positive?

6) What was the negative predictive value?

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EMI 8

Case-control study

Prospective Cohort Study

Cross sectional survey

Ecological survey

Open Label RCT

Parallel RCT

Cross over trial

Qualitative study

Intention to treat analysis

Which would be the most ethical (choose ONE) for the following:

1. To look at the number of suicides following an overdose.

Prospective Cohort

2. To look at the number of children developing cardiac abnormalities in mothers on lithium

Case-control study

3. To look at obstetric complications and the development of schizophrenia but you wish to avoid attrition bias.

Case-control study

Ajetunmobi 59

4. To look for exposure and outcome whilst avoiding recall bias

Prospective Cohort Study

Ajetunmobi 59

5. To compare treatment vs placebo. The researchers wish to recruit fewer participants.

Open Label RCT

6. To compare whether a new drug has fewer side effects than another, established drug.

Cross over trial

Gosall and Gosall p. 17

7. To get patient’s perspectives on the quality of care they receive.

Qualitative Study

Gosall and Gosall p. 12

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EMI 12

• Terminally ill people are screened for depression with the question ‘Do you think you are depressed?’. This is then compared to a structured diagnostic interview used to diagnose depression. NB Calculators are not allowed.

If you need more options, please add in red

Options

11%

22%

33%

44%

55%

66%

77%

88%

99%

Note: gold standard at top

Interview Depressed Not depressed

Yes to question 11 9

No to question 14 40

Totals 25 49

(1): What was the prevalence of depression in the sample?

(2): What was the sensitivity of the screening?

(3): What was the specificity of the screening?

(4): What proportion of those who screened positive were depressed?

(5): What proportion of those who were depressed screened positive?

6) What was the negative predictive value?

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My answer will be autosomal dominant with high (full) penetrance.

http://www.emedicine.com/emerg/topic254.htm

I will go for high penetrance as well.

Alleles in the 36-39 CAG range, however, are incompletely penetrant (but not low), while Alleles with more than 40 CAG repeats are completely penetrant.

More over, what's the difference between poor and low penetrance?

http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=gene&partid=1305

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EMI 8

Case-control

Prospective Cohort

Cross sectional survey

Ecological survey

Open Label RCT

Parallel RCT

Cross over trial

Qualitative study

Intention to treat analysis

Which would be the most ethical (choose ONE) for the following:

1. To look at the number of suicides following an overdose.

Prospective Cohort

Would be impossible and [highlight]unethical[/highlight] to do a [highlight]prospective[/highlight] Cohort on this group.

A retrospective cohort would have been a better option or a longitudinal survey.

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Stem: Huntington’s disease shows which pattern of inheritance

Options:

Autosomal dominant with high penetrance

Autosomal dominant with poor penetrence

Autosomal recessive with low penetrance

X-linked

Ans: AD with high penetrance

I agree with this,

The following paper confused me

http://jmg.bmj.com/cgi/content/full/44/3/e68

It is well established that reduced penetrance may occur in Huntington’s disease when the CAG repeat result in the IT15 gene is in the range of 36–39 repeats.

Based on a direct observational study, we suggest that if an individual has a predictive test result in this range, the chance of them being asymptomatic at 65 years of age is at least 40% and the chance of them being asymptomatic at 75 years of age is at least 30%.

Using two reference laboratories, a discrepancy of one CAG repeat occurred in the reporting of the upper allele in a small number of cases.

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Q 102 /3 .  • What is the incidence of birth defects in a woman taking valproate?

Options:

1/10

1/50

1/100

1/1000

Ans: 1/100

Ref: http://www.mentalhealth.com/drug/p30-d02.html

........Risk of foetal malformations is 7.2%, much due to neural tube defects......Maudsley guidelines 8th edition page 109

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Risk of depression in Pregnancy is :

5%

30%

20%

10%

2%

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