MCQs

Multiple Choice Questions

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Schizophrenia

1. The following concepts are matched correctly with the person that proposed the idea :A. Greisinger - ‘unitary psychosis’ TB. Kraepelin - ‘dementia praecox’ TC. Bleuler - ‘praecox feeling’ FD. Langfeldt - ‘systemic schizophrenia’ FE. Carpenter - ‘deficit syndrome’ T

2. The following are Schneiderian 1st Rank symptoms :A. Thought echo TB. Ideas of reference FC. Somatic hallucinations TD. Delusional mood FE. Flatness of affect F

3. Regarding the epidemiology and associations of schizophrenia:A. Increased rate in Sweden TB. Increased rate in US Hutterites FC. Association with brain injury TD. The positive association with rheumatoid arthritis suggests an immunological basis

F

E. Increased incidence in Afro-Caribbean migrants to the UK T

4. In schizophrenia :A. The risk of bipolar illness is increased in 1st degree relatives of schizophrenic patients

F

B. The risk of schizophrenia is increased in 1st degree relatives of patients with schizoaffective disorder

T

C. Although eye-movement abnormalities are found in relatives of schizophrenics, evoked potentials are normal

F

D. There is a 10 % risk of schizophrenia in siblings of affected individuals

T

E. There is a 25 % risk of schizophrenia in children of affected parents

F

5. Regarding the aetiology of schizophrenia :

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A. The brains of twins discordant for schizophrenia are normal, indicating that brain abnormalities are a significant aetiological factor

F

B. Chromosome 5 has been implicated TC. The D4 dopamine receptor gene is located on chromosome 5 FD. Patients born in winter have an increased risk for the disorder TE. Exposure to the influenza virus in the 1st trimester has been implicated

F

6. Regarding the aetiology of schizophrenia :A. Higher incidence in men FB. Men develop the illness 8-10 years before women FC. Fertility rates among schizophrenic patients are reduced by 25 % TD. Increased prevalence in urban settings, particularly among females

F

E. The ‘Breeder Hypothesis’ was proposed by Farris and Dunham T

7. The following statements are about aetiological concepts :A. Social drift hypothesis suggests that stresses related to deprived areas increase the risk for schizophrenia

F

B. Bateson (1956) implicated the role of the ‘schizophrenogenic mother’

F

C. Lidz (1957) developed ‘Family Schism Theory’ TD. Schizophrenics have more life events in the 6 weeks preceding relapse or admission

F

E. Life events tend to be clustered in the 3 weeks preceding admission

T

8. The following statements relate to findings in schizophrenia :A. The brains of schizophrenics are 6 % lighter and 4 % smaller than normal controls

T

B. There is a reduced number of neurones in the temporal lobes TC. Increased disorganization of neurones in the hippocampus TD. Schizophrenic patients tend to have enlarged 3rd ventricles TE. Enlarged lateral ventricles are correlated with good response to treatment

F

9. Regarding brain changes in Schizophrenia :A. Changes are less evident in the left side of the brain FB. The syndrome of ‘reality distortion’ is associated with decreased blood flow in the left parahippocampal gyrus

F

C. Psychomotor poverty is associated with increased blood flow in the caudate nuclei

T

D. ‘Disorganization’ is associated with decreased blood flow in the right prefrontal cortex, and the right anterior cingulate

F

E. EEGs show decreased theta activity, especially in the acute illness F


10. Biochemical changes found in schizophrenia include :A. Dopamine receptor supersensitivity following antipsychotic treatment

T

B. Dopamine underactivity in the mesolimbic pathways may be responsible for schizophrenia

F

C. Reduced GABA receptors in the temporal lobe TD. Increased GABA receptors in the orbitofrontal cortex TE. Abnormal cholecystokinin (CCK) function T

11. Neuropsychological abnormalities include :A. Defects in verbal learning and memory TB. The Wisconsin Card Sorting Test shows no abnormality in schizophrenic patients

F

C. Impaired short term memory FD. Normal long term memory FE. Impairment of verbal memory and learning suggests left temporal-hippocampal involvement

T

12. Predictors of good outcome in schizophrenia include :A. Florid psychotic presentation TB. Prominent affective symptoms TC. Acute onset TD. Older age at onset FE. Long initial episode F

13. In schizophrenia :A. Less than 5 % of suicides are by schizophrenic patients FB. Suicide usually occurs in the late stages of the illness FC. Illness course may plateau after the first 5 years TD. Overall mortality (removing the increased risk of suicide) is normal

F

E. More benign course in developing countries T

14. Regarding the treatment of schizophrenia:A. Low dose neuroleptics are as effective as other regimes FB. 5 % of patients are treatment-resistant FC. Clozapine is a second line drug for treatment-resistant schizophrenia

F

D. ECT can be useful in catatonic, or depressive states TE. Psychosocial treatments are of little benefit F

15. The following are true of schizoaffective disorder:A. It was first described by Kasanin TB. Schizodepressive subtypes are more related to schizophrenia TC. Schizomanic subtypes are more related to affective disorders TD. Schizophrenic symptoms are associated with a good outcome F


E. Schizomanic patients have an episodic course, with a poorer outcome

F

16. The following are recognized associations with delusional jealousy:A. Depression TB. Alcoholism TC. Impotence FD. Personality disorder TE. Pervasive sense of inadequacy T

General

1. The following conditions are more common in women :A. Schizophrenia FB. Capgras delusion TC. de Clerambault’s syndrome TD. Bipolar Affective Disorder FE. Depression T


2. The following conditions are more common in men :A. Post-traumatic epilepsy TB. Agoraphobia FC. Social Phobia FD. Wernicke’s encephalopathy TE. Dissociative amnesia F

3. The following conditions are more common in upper social classes:A. Anorexia nervosa TB. Schizophrenia FC. Agoraphobia FD. Depression FE. Suicide T

4. The following conditions are more common in urban, or socially deprived areas :A. Schizophrenia TB. Depression TC. Bipolar Affective Disorder TD. Dissociative disorders of movement and sensation TE. Epilepsy ?

5. The following associations with suicide are recognized :A. Peptic ulcer TB. Non-delusional dysmorphophobia TC. Huntington’s chorea TD. Epilepsy TE. Bereavement in childhood T

6. The following conditions usually have their onset before the age of 35 years :A. Schizophrenia TB. Agoraphobia TC. Space phobia FD. Pick’s disease FE. Dissociative convulsions T

7. The following are recognized associations :A. Panic disorder and mitral valve prolapse F ?B. Klinefelter’s disease and epilepsy TC. Phaeochromocytoma and MEN type I syndrome FD. Insulinoma and MEN type II syndrome FE. Alcohol abuse and hepatocellular carcinoma T


8. Regarding suicide :A. Drowning, as a method, is more common among men FB. It is the number one cause of death among young males aged 15-24

F

C. Only 25 % of suicide victims have a mental illness FD. Rate is highest in the winter months FE. Obsessive compulsive disorder is a risk factor F

9. The following conditions are autosomal recessive :A. Leigh disease TB. Huntinton’s chorea FC. Gaucher’s disease TD. Alzheimer’s disease (familial types) FE. Parry type of cerebral ceroid lipofuscinosis F

10. The following conditions are autosomal dominant :A. Tay-Sachs disease FB. Porphyria TC. Phaechromocytoma FD. Metachromatic leucodystrophy FE. Wilson’s disease F


Eating Disorders

1. Regarding Anorexia Nervosa (AN) :A. There has been a recent increase in the incidence in the 11-16 age group.

F

B. Ten times more women are affected than men. TC. Prevalence is of the order of 250 per 100,000 women. TD. Adverse life events are more common in the ‘early onset’ (<25) group.

F

E. Purging has to be present for the diagnosis to be made. F

2. The following are recognized physical complications of AN :A. ‘Pseudoatrophy’ on brain imaging. TB. EEG abnormalities. TC. Increased heart size. FD. Prolongation of the QT interval. TE. Tachycardia F

3. The following are recognized physical complications of AN :A. Hypercholesterolaemia. TB. Increased plasma amylase. T


C. Increased growth hormone secretion. TD. Decreased cortisol secretion, resulting in a positive Dexamethasone Suppression Test (DST)

F

E. Relative Lymphopenia. F

4. The following are recognized physical complications of AN :A. Increased gastric emptying. FB. Diabetes mellitus. FC. Acute pancreatitis. TD. Abnormal secondary sexual hair pattern. FE. Increased perinatal mortality. T

5. The following are abnormal in AN :A. Cholecystokinin (CCK) activity. TB. 5-HT activity. TC. Dopamine activity. FD. Thalamic function. FE. Hypothalamic function. T

6. The following are predictors of good outcome in AN :A. Late age of onset. FB. Short illness duration. TC. Premorbid obesity. FD. Absence of bulimic behaviour. TE. Male sex. F

7. Bulimia Nervosa (BN) :A. Is more common than Anorexia Nervosa (AN). TB. Has an onset later than that of AN. TC. Is more common in developed countries. TD. Often develops with a prior history of AN TE. Affects 10-20 % of female adolescents at any one time. F

8. Physical complications of BN include :A. Hyperkalaemia. FB. Hypocalcaemia. TC. Injury to myenteric plexuses of small bowel FD. Urinary infections. TE. Cardiac arrhythmia. T

9. Associations with BN include :A. Shoplifting. TB. Depression. TC. Decreased sexual activity. FD. History of sexual abuse. T


E. Lower rate of alcohol abuse than anorexia nervosa. F

10. Regarding the aetiology of BN :A. There is increased 5-HT activity. FB. Dopamine abnormalities have been found. TC. There are abnormalities of CCK activity. TD. Increased levels of CSF HVA. FE. MZ:DZ ratios of 10:1 have been found. F

11. The following are true in obesity :A. Increased levels of measurable neuroticism. FB. Increased heat production from brown adipose tissue. FC. Accurate judgement of how much has been eaten. FD. Eating is more related to internal stimuli, such as gastric activity. FE. Response to stress includes bingeing. T

Mood (Affective) Disorders

1. According to Leonhard :A. Bipolar includes only mania FB. Bipolar I is hypomanic episodes FC. Bipolar II is manic episodes FD. Bipolar III is unipolar illness with bipolar disorder in 1st degree relatives

T

E. Unipolar illness can include one episode of mania, but is predominantly depressive

F

2. In the discussion between endogenous vs. reactive depression :A. In psychotic depression, a continuum theory is most likely TB. Paykel (1971) found 6 groups of depressive patients TC. Cyclothymia never becomes major affective disorder FD. Dysthymia and major depressive episodes can occur and are called ‘double depression’

T

E. Cyclothymia is common in relatives of patients with major depressive illness

T

3. The following are specific to a diagnosis of mania (not hypomania) in ICD-10 :A. Flight of ideas TB. Increased sexual energy FC. Inflated self esteem or grandiosity TD. Overfamiliarity FE. Reckless or irresponsible behaviour F


4. The following are true of Bipolar Affective disorder :A. One year prevalence of 1 % TB. Mean age of onset is 21 years TC. Rates are higher in rural areas FD. It is more common in females FE. Marriage has no association with BAD F

5. Regarding the aetiology of Bipolar Affective disorder :A. The ‘genetic loading’ for mood disorder is greater in unipolar depressives than in manic depressives

F

B. The long arm of Chromosome 11 has been implicated FC. The gene for tyrosine hydroxylase is on chromosome 11 TD. The long arm of the X chromosome has been implicated TE. There is an excess of life events preceding depression, but not mania

F

6. Regarding treatment of bipolar affective disorder :A. About 50 % of rapid-cycling patients are lithium resistant FB. About 75 % of bipolar affective patients (non-rapid-cycling) will respond to lithium

T

C. The response rate for carbamazepine is the same as that for lithium

F

D. Valproate may have a role in mixed affective disorder TE. Clozapine has no role in treatment of BAD F

7. The following are true of depressive illness :A. Depression has a lifetime prevalence of about 6 % TB. 25 % of men and 35 % of women have experienced depressive symptoms by the age of 65

F

C. Depressive symptoms have a point prevalence of about 15 % TD. The one-month prevalence is about 2 % TE. Women suffer twice as commonly as men T

8. Regarding the demographics of depression :A. The mean age of onset is 27 years TB. Women have the peak age of onset in their 40s, while men have the peak onset in their 30s

F

C. Lower social groups have a higher incidence of depression TD. There is clear ethnic variation in the UK FE. There is an association between smoking and depression T

9. The following are recognized risk factors for depression :A. Divorce TB. Living in industrialized countries TC. Urban habitation T


D. Obsessional personality traits TE. Neuroticism T

10. Regarding the aetiology of depression :A. An autosomal dominant transmission is suggested by the uniform morbidity risk among parents, children, and siblings

T

B. There is no association with parental discord FC. Parental factors include lack of care and overprotection TD. 25 % of depressive episodes are precipitated by life events FE. The risk of depression is increased sixfold in the six months following threatening life events

T

11. Brown and Harris found the following to be vulnerability factors for depression :A. Three or more children under the age of 15 at home TB. Alcoholic husband FC. Loss of mother before the age of 11 TD. Wide social support network FE. Neurotic personality traits F

12. Regarding the psychological theories of depression :A. Freud said that depression was due to envy FB. Abraham proposed that failure to develop relationships other than the primary love object resulted in depression

F

C. The concept of ‘learned helplessness’ was proposed by Wolpe FD. Klein said that if the depressive position was not negotiated, then depression would be more likely in later life

T

E. ‘Ambivalence’ occurs when feelings of love and hostility are present at the same time

T

13. In Beck’s cognitive theory :A. ‘Arbitary inference’ occurs when conclusions are based on only one incident

F

B. ‘All-or-nothing’ thinking is known as ‘dichotomous reasoning’ TC. ‘Overgeneralization’ are conclusions that are formed in the absence of evidence

F

D. A ‘stress-diathesis’ model is used TE. ‘Selective abstraction’ occurs when a person abstracts from the whole situation and focuses on a single incident

T

14. The following biochemical changes have been observed in depressed patients :A. Decreased platelet 5-HT uptake TB. Decreased 5-HT2 receptor binding in platelets FC. Increased prolactin response to clomipramine FD. Decreased growth hormone release in response to clonidine T


E. Reduced beta-adrenergic receptors in suicide victims F

15. The following biochemical changes have been observed in depressed patients :A. Increased 5-HIAA levels in the CSF of suicide victims FB.

1. The following statements are true:A. Bipolar I is characterized by hypomanic episodes only FB. Bipolar II is characterized by manic episodes and hypomanic episodes

F

C. The term ‘melancholia’ in DSM-IV is equivalent to somatic symptoms in ICD-10

T

D. ‘Endogenous’ depression is characterized by somatic symptoms TE. ‘Reactive’ depression is characterized by anxiety, irritability, and phobias

T

2. Cyclothymia:A. Is more common in males FB. Has a prevalence of around 5 % FC. Has its onset usually between the ages of 15 and 25 TD. Results in a diagnosis of bipolar disorder in around a third of patients

T

E. Antimanic drugs are usually ineffective F

3. Dysthymia:A. Usually presents after the age of 25 FB. Is associated with chronic medical illness TC. Is more common in women, and the unemployed TD. 20 % of patients will develop bipolar disorder TE. Treatment does not involve antidepressant drugs F

4. Bipolar affective disorder is associated with:A. Alcoholism TB. Schizoaffective disorder TC. Obsessive compulsive disorder FD. Anxiety states TE. Cyclothymic personality T


5. Bipolar affective disorder:A. Is more common in males FB. Has a lifetime risk of about 1 % TC. Usually presents in the early 20s TD. Is more common in urban areas TE. Has been associated with higher rates in higher social classes T

6. Regarding the aetiology of bipolar disorder:A. Monozygotic concordance is around 55 % FB. The risk in 1st degree relatives is about 25 % TC. Chromosome 11 has been implicated TD. Chromosome Y has been implicated FE. Excess life events can precipitate manic episodes T

7. Rapid cycling mania:A. Was described by Kendler FB. Has equal incidence in males and females FC. Is associated with good response to lithium FD. Valproate can be effective TE. Is associated with a worse prognosis T

8. Regarding other presentations of depressive illness:A. Agitated depression is more common in the elderly TB. Retardation predicts a poor response to ECT FC. Masked depression is more common with mild/ moderate illness TD. Brief recurrent depression has no link with the menstrual cycle TE. Atypical depression may be characterized by hypersomnia, and overeating

T

9. Regarding the demographics of depression:A. It has an equal sex ratio FB. Lifetime prevalence is about 6 % TC. One month prevalence is 2 % per 100 people TD. Highest 1 year prevalence is in the 45-65 age group FE. Lifetime prevalence increases with age F

10. Depression is more common in:A. Lower social class TB. Urban areas TC. Industrialized countries TD. Those who are cohabiting TE. The unemployed T

11. The following are reported risk factors for depressive illness:A. Neurotic personality T


B. Childhood abuse TC. Loss of father before the age of 11 FD. Three or more children at home above the age of 15 FE. Low self esteem T

12. The following are true of psychoanalytical theories of depression:A. Depression is a defence against mania FB. Depression occurs when love and hostility are present at the same time

T

C. Regression can occur TD. Failure to negotiate the ‘depressive position’ of childhood TE. Learned helplessness was described by Joseph Wolpe F

13. The following drugs are associated with depression:A. Propanolol TB. Methyldopa TC. Reserpine TD. Steroids TE. Valproate F

14. The following are true in depression:A. There is increased plasma tryptophan concentration FB. There is reduced levels of 5-HIAA in the CSF of suicide victims TC. The prolactin response to Clomipramine is reduced TD. The prolactin response to L-Tryptophan is mediated by 5-HT receptors

T

E. CSF HVA levels are reduced T

15. The following are true in depression:A. There is a reduced response to CRH TB. There is reduced GH release in response to Clonidine TC. Somatostatin levels are raised FD. Cortisol levels are suppressed by Dexamethasone FE. There is a blunted TSH response to TRH T

16. The following are true of sleep in depression:A. EEG shows increased stage 3 and 4 sleep FB. Increase in REM sleep towards the end of the night FC. Decreased latency to REM sleep TD. Antidepressant drugs decrease REM sleep time TE. EEG changes always resolve in depressed patients F

17. The following have been observed in depression:A. Enlarged lateral ventricles T


B. Loss of temporal lobe volume TC. Reduction in the size of the caudate nucleus TD. Increased blood flow in the basal ganglia FE. Decreased blood flow in the cingulate cortex T

18. In bipolar disorder:A. Depression is the most common first presentation TB. The first manic episode is usually before the age of 30 FC. Manic episodes last longer than depressive episodes FD. The median length of a manic phase is 3 months TE. The frequency of episodes increases in the first 10 years T

19. In depression:A. 10 % will have chronic, unremitting course TB. 25 % have a recurrence within a year TC. 10 % will eventually have a manic episode TD. Mood incongruent delusions indicate a better prognosis FE. Recurrence is associated with late age of onset F

20. The following are risk factors for bipolar disorder, after a depressive episode:A. Psychotic symptoms TB. Postpartum depression TC. Older age at onset FD. Psychomotor agitation and hyperactivity FE. Feelings of guilt T

Organic Psychiatry

1. The following are true of dementia:A. Incidence is 5 % in the under 65’s FB. Incidence is about 30 % in the over 85’s TC. Alzheimer’s disease is the most common cause TD. Frontal lobe dementia is the second most common cause in the over 65’s

F

E. Reversible dementias account for about 5 % of all dementias T

2. Regarding the aetiology of Alzheimer’s disease:


A. Females are affected twice as commonly as males TB. Familial forms are autosomal dominant TC. The presenilin-2 gene is on chromosome 14 FD. The gene for presenilin-1 is on chromosome 19 FE. Trauma is a risk factor T

3. Regarding the aetiology of Alzheimer’s disease:A. The apolipoprotein gene is on chomosome 19 TB. The Beta-amyloid precursor protein is on chromosome 21 TC. Trisomy 21 is a risk factor TD. Presenilin-1 causes about 50 % of early onset dementias TE. Late onset dementia is associated with alpha-1 macroglobulin F

4. Pathological findings in Alzheimer’s include:A. Loss of cortical neurones TB. Amyloid plaques are the critical pathological feature of AD TC. Relative sparing of the outer 3 layers of cortex FD. Gliosis TE. Granulovacuolar degeneration T

5. Neurochemical findings in Alzheimer’s include:A. Cholinergic loss in the locus coeruleus FB. Serotinergic neuron loss correlates with depression FC. Noradrenergic loss is most marked in early-onset dementia TD. Increased GABA FE. Decreased somatostatin and CK T

6. Clinical features of Alzheimer’s dementia may include:A. Long-term memory loss TB. Disorders of Language and praxis TC. Depression TD. Loss of primitive reflexes FE. Persecutory delusion T

7. Investigations in AD may show:A. Increase in the dominant alpha rhythm on EEG FB. Shortening of the P300 potential FC. Reduced metabolism in the temporal lobes on PET TD. Reduction in the temporal lobe volume TE. Loss of theta and delta activity on EEG F

8. Lewy body dementia:A. Unlike AD, does not result in loss of cholinergic function FB. Is characterized by Lewy bodies in the cortex and substantia nigra TC. Results in increased dopaminergic function F


D. May result in hallucinations and delusions TE. Fluctuations in the presentation exclude this diagnosis F

9. Multi-infarct dementia:A. Is more common in men TB. Has been linked to an autosomal recessive heritability FC. Causes cerebral atrophy and ventriculomegaly TD. Can be rated using the Hatchinski index TE. Can result in seizures T

10. In multi-infarct dementia:A. Depression is rare FB. Shows a slow, gradual deterioration FC. PET shows asymmetric changes in the cortex TD. SPECT shows increased blood flow FE. MRI shows areas of multiple infarction T

11. Binswanger’s disease:A. Is more properly called subcortical arteriosclerotic encephalopathy

T

B. Is characterized by abnormal pyramidal function TC. Gait is normal FD. Sphincter disturbance is common TE. MRI shows high intensity lesions distributed evenly throughout the cortex

F

12. Pick’s disease:A. Is more common in men FB. Has been linked to an autosomal dominant gene TC. Is characterized by changes in personality and behaviour TD. CT shows enlargement of the frontal horns TE. EEG shows abnormalities in a similar pattern to Alzheimer’s F

13. Pathological findings in Pick’s disease may include:A. Atrophy of the frontal and parietal lobes FB. ‘Knife-blade’ atrophy TC. Senile plaques FD. Neurofibrillary tangles FE. Neuronal loss in the outer cortex T

14. Frontal lobe dementia:A. Is a common cause of early-onset dementia TB. Is more common in men TC. There is rarely a family history FD. Is easily seen on EEG F


E. Pathological findings include gliosis and spongiosis T

15. Huntington’s chorea:A. Is more common in men FB. Is due to an autosomal dominant gene TC. Shows incomplete penetrance FD. The gene lies on chromosome 4 TE. Usually presents in the 3rd or 4th decade T

16. Huntington’s chorea:A. Demonstrates ‘imprinting’ TB. Demonstrates ‘anticipation’ TC. The gene codes for GABA FD. Results in reduced levels of GABA in the caudate nucleus TE. Decreased levels of dopamine in the basal ganglia F

17. Clinical features of Huntington’s disease may include:A. Dysarthria TB. Epilepsy TC. Paranoia and schizophreniform illness TD. Increased risk of suicide TE. Depression T

18. Findings in Huntington’s disease include:A. Caudate atrophy TB. Increased blood flow in the neostriatum FC. EEG shows spike-wave activity FD. Reduced striatal metabolism TE. Atrophy of the basal ganglia T

19. Prion diseases:A. Are more common in women FB. Are encoded on chromosome 10 FC. Individuals with the E4 apolipoprotein allele are at reduced risk FD. The familial form is autosomal recessive FE. Usually have a normal EEG F

20. Normal pressure hydrocephalus:A. Is more common in the pre-senium FB. May be preceded by a history of head injury TC. Is characterized by impairment of memory, pyramidal function, and attention

F

D. CT shows periventricular lucencies and abnormal sulci FE. Is due to blockage of the ventricular system F


21. The following are true of head injury:A. The duration of post-traumatic amnesia correlates with the extent of brain injury

T

B. The duration of retrograde amnesia correlates with psychiatric disability

F

C. Frontal lobe syndrome is due to brain damage TD. Depression is due to brain damage FE. Aggressive tendencies are not due to brain damage F

22. Regarding psychiatric illness following head injury:A. Schizophrenia is more common in mild injuries TB. Affective illness is more common TC. There is a higher incidence of hypomania than depressive psychosis

F

D. Suicide is more common TE. Suicide is associated with frontal and temporal lobe damage T

23. In ‘Punch drunk’ syndrome:A. Morbid jealousy is more common TB. Pyramidal signs are characteristic TC. CT scan shows cerebellar atrophy and normal ventricles FD. Pathological changes are similar to normal ageing FE. Commonly occurs in boxers T

24. The following symptoms are commonly seen in frontal lobe lesions:A. Magnetism TB. Contralateral optic atrophy FC. Ipsilateral spastic paresis FD. ‘Witzelsucht’ TE. Dyspraxia F

25. The following are seen in lesions of the non-dominant parietal lobe:A. Dysphasia FB. Prosopagnosia TC. Alexia FD. Constructional dyspraxia TE. Body image disorders F

26. Features of Gerstmann’s syndrome may include:A. Bilateral parietal lobe lesion FB. Right-left disorientation TC. Dysgraphaesthesia FD. Finger agnosia T


E. Dysgraphia T

27. Dominant temporal lobe lesions may cause:A. Impaired visual memory FB. Homonymous hemianopia TC. Impaired verbal memory TD. Impaired visual memory FE. Dysprosody F

28. Bilateral temporal lobe lesions may cause:A. Amnesic syndrome TB. Cortical blindness FC. Hyperorality TD. Hypersexuality TE. Social-emotional agnosia T

29. Features of occipital lobe lesions may include:A. Complex visual hallucinations TB. Visual field defects TC. Anton’s syndrome TD. Sensory neglect FE. Anomia F

30.

Other neurological conditions

1. Regarding Multiple Sclerosis :A. It is more common in women TB. Survival is less in women FC. Survival is greater if onset is at a younger age TD. Lhermitte phenemenon is almost pathognomonic in a young person

T

E. Visual evoked potentials are abnormal in 10 - 20 % F

2. In Multiple sclerosis :A. Depression is about as common as in the general population FB. Dementia can occur TC. IgG ratios are lower than normal FD. Oligoclonal bands are seen in the IgM region on electrophoresis FE. Epilepsy is more common than normal T


3. The following are characteristics of Parkinson’s disease :A. Bradykinesia TB. Intention tremor FC. Cogwheel rigidity TD. Impaired postural reflexes TE. Cognitive impairment F

4. In Parkinson’s disease :A. The risk decreases with age FB. It is more common in females FC. Smoking has a negative association TD. Pesticide exposure is a risk factor TE. There is a loss of axons in the substantia nigra F

5. In Parkinson’s disease :A. Rigidity is due to enhancement of long-latency stretch reflexes TB. Tremor is associated with alpha-gamma co-activation TC. Tremor is present in only 25 % of patients FD. Dementia is seen in 15-20 % TE. Depressive illness is seen in 85 % of patients F

6. Regarding Wilson’s disease :A. It is autosomal recessive TB. Onset is always in childhood FC. Kayser-Fleischer rings are due to copper deposition in the iris FD. Psychiatric symptoms are related to the severity of the hepatic involvement

F

E. Around half of all patients will have psychiatric symptoms T

14. After Cerebrovascular Incidents:A. Residual deficits occur in 90 % TB. Personality change is rare FC. Depression is common with left hemisphere lesions TD. Anxiety is common TE. Emotional lability is more common in those with right temporal lesions

F

15. Multiple sclerosis:A. Is more common in men FB. Is more common in the northern hemisphere TC. Progressive conditions are more common than relapsing-remitting ones

F

D. Depression is common TE. Dementia is not a feature F


16. Regarding the features of MS:A. Epilepsy is less common than in the general population FB. Erectile dysfunction can occur TC. CSF examination shows oligoclonal bands in the IgA region FD. Optic neuritis results in painless visual disturbance FE. Symptoms can be improved by a hot bath F

17. Parkinson’s disease:A. Is less common in women TB. Is associated with pesticide exposure TC. Is less common in non-smokers FD. There is loss of dopaminergic cell bodies in the substantia nigra TE. Lewy bodies are often seen T

18. Clinical features of Parkinson’s disease include:A. Increased rate of blinking FB. Tremor inhibited by purposeful movement TC. Dementia TD. Higher incidence of depressive illness TE. Dementia is less common in men F

1. In Klinefelter’s syndrome :A. The usual karyotype is XYY FB. Urinary gonadotrophin levels are reduced FC. Intelligence is normal FD. Criminal behaviour is an established association FE. EEG shows slowed alpha waves T

2. In Turner’s syndrome :A. There is secondary amenorrhoea FB. Congenital rectal abnormalities are common TC. Verbal intelligence is normal TD. Visuospatial abilities are also normal FE. The incidence of psychotic illness is increased F

3. In Wilson’s disease :A. Most cases present in the first two decades TB. It is an autosomal dominant condition FC. Hepatocytes are forced to store copper due to increased levels of caeruloplasmin

F

D. Diagnosis is by raised plasma caeruloplasmin levels FE. Urinary copper excretion is usually elevated T

4. Symptoms of Wilson’s disease include :A. Changes in personality and behaviour T


B. Epilepsy TC. Rigidity and dystonia TD. Visual symptoms FE. Cognitive impairment T

4. The following are true in Wilson’s disease :A. The ventricles are normal FB. The basal ganglia show lesions on CT TC. Treatment is with penicillamine TD. It is important to avoid vitamin B6 during treatment FE. Neurological disturbance responds better than hepatic disturbance T

5. The following are true for porphyria :A. Haem precursors are readily oxidized to porphyrins TB. All cases are autosomal recessive FC. Abdominal pain and neuropathy are rarely seen FD. Episodes can be precipitated by tricyclic antidepressants TE. EEG is always abnormal F

6. Regarding mitochondrial myopathy :A. Transmission is usually maternal TB. Most cases present after the age of 20 FC. Smooth muscle biopsy (such as from the rectum) is diagnostic FD. Limb weakness can occur on its own TE. It may present as a chronic fatigue syndrome T

7. In Neuroacanthocytosis :A. Red blood cells are abnormal TB. Tics are seen TC. Frontal lobe pictures can be seen TD. Intellectual impairment rules out the diagnosis FE. Shrinkage of the caudate head on CT can differentiate this condition from Huntington’s chorea

F

F. May present with OCD TG. Anxiety and depression are frequent T

8. The following are true for Cerebral Ceroid Lipofuscinosis :A. It is also called Leigh disease FB. It can occur in infancy TC. Only autosomal dominant forms have been recognized FD. It commonly presents as dementia with motor symptoms TE. Death is within 6-12 months F


9. In Subacute Necrotizing Encephalomyopathy :A. It is inherited as an autosomal recessive condition TB. It is due to a disturbance of thiamine metabolism TC. The condition usually presents in adolescence FD. Death is prolonged FE. It can also occur in adults, when it presents as impaired intellect and motor symptoms

T

10. Hallorvorden-Spatz syndrome :A. Is a rare pyramidal disorder FB. Typically presents at a young age TC. Changes in personality also occur TD. EEG is normal FE. CT scan resembles Huntington’s chorea, with prominent atrophy of the basal ganglia

T

11. The following are true of the Sphingolipidoses :A. They are autosomal recessive conditions TB. Patients with Gaucher’s disease have a greatly reduced life-span FC. Most cases of Niemann-Pick disease present in early life TD. Jewish people have a reduced incidence of Niemann-Pick disease FE. Tay Sachs disease usually results in death before the age of 2 T

Metabolic, Biochemical, and Endocrine disorders

1. Regarding hyperthyroidism :A. It is more common in men FB. It usually presents in old age FC. A ‘thyroid storm’ is seen in 3-5 % of all patients TD. Depression is more common than mania FE. Schizophrenic psychoses are more common than mania T

2. Regarding hypothyroidism :A. More common in women TB. It usually presents in the 3rd or 4th decade FC. Auditory hallucinations may be present TD. EEG changes are seen in a third of patients TE. Prognosis is poorer if the presentation has an organic quality F

3. Cushing’s syndrome :A. Is more common in women T


B. Usually presents in the 3rd or 4th decade TC. Only a few cases have psychiatric symptoms FD. Mania is more common than depression FE. Psychoses are usually depressive T

4. Steroid drug treatment :A. Is more commonly associated with depression FB. Symptoms occur after 2-3 months FC. The mental disturbance is related to the dose of the steroids FD. Those with past mental illness are more likely to suffer psychiatric symptoms

F

E. Females are more prone T

5. Adrenocortical deficiency :A. Has equal sex prevalence FB. May be caused by tuberculosis TC. Fatigue, weakness, and apathy are the common symptoms TD. Psychosis is common FE. Both glucocorticoids and mineralocorticoids are needed to reverse the mental symptoms

F

6. Regarding hyperparathyroidism :A. It is seen only in MEN type I syndrome FB. Psychiatric symptoms are due to the effects of elevated PTH levels

F

C. Depression is the most common psychiatric condition TD. The EEG shows widespread slow wave activity TE. Rebound psychosis may occur in the first week after treatment T

7. In hypoparathyroidism :A. Most patients are female TB. Psychiatric features are seen rarely in idiopathic cases FC. Secondary hypoparathyroidism commonly presents as an acute confusional state

T

D. Secondary hypoparathyroidism is suspected if there is symmetrical calcification in the basal ganglia

F

E. Generalized seizures may occur T

8. Regarding pituitary disease :A. Psychosis is common in acromegaly FB. Libido is increased in acromegaly FC. The prevailing mood in hypopituitarism is depression TD. Apathy and anergia are common in hypopituitarism TE. Symptoms of hypopituitarism will fully resolve with treatment F

9. In diabetes mellitus :


A. MAOIs may potentiate the effects of oral hypoglycaemic agents TB. In ketoacidotic coma, the level of consciousness correlates with plasma osmolality

T

C. Hyperosmolar non-ketotic coma is common in the elderly TD. There is a negative correlation between emotional upset and good diabetic control

T

E. Dementia is less common F

10. Diabetes inspidus, insulinoma, and phaeochromcytoma :A. 10 % of beta-cell tumours are malignant TB. Insulinoma is commonest in childhood and old age FC. Lithium therapy can cause cranial diabetes insipidus FD. 50 % of phaeochromocytomas are malignant FE. In 5 % of cases, phaeochromocytomas are seen in MEN type II and are due to autosomal dominant inheritance

T

19. Psychiatric manifestations of hyperthyroidism may include:A. Anxiety TB. Depression TC. Schizophrenia is more common than mania TD. Psychotic depression is more common than mania FE. Cognitive impairment T

20. Psychiatric manifestations of hypothyroidism may include:A. Paranoia TB. Agitation and aggression TC. Mania FD. Hallucinations never occur FE. Slowing of dominant rhythm on EEG T

21. Psychiatric features of Cushing’s syndrome may include:A. Less common in men TB. Decreased risk of suicide FC. Schizophreniform presentation is common FD. Depression is common TE. Paranoid symptoms are rare F

22. Psychiatric illness with steroid treatment is associated with:A. Female TB. Higher dose TC. Longer duration of therapy FD. Previous psychiatric illness FE. Depression of mood F

23. Addison’s disease:


A. Is more common in men FB. Depressive illness is usual presentation TC. Psychosis is common FD. Paranoid symptoms can occur TE. Glucocorticoids have little effect on the mental symptoms F

24. Hyperparathyroidism:A. Is associated with phaeochromocytoma TB. Mood elevation is more common than depression FC. Can cause cognitive impairment TD. Hallucinations and paranoia are associated with high calcium levels

T

E. Rebound psychosis can occur T

25. Hypoparathyroidism:A. Is due to end-organ unresponsiveness to PTH FB. Psychiatric symptoms are seen in almost 100 % of idiopathic cases

T

C. Is associated with papilloedema TD. Can result in psychosis TE. Affective psychoses are common FF. Is associated with calcification of the basal ganglia T

26. Acromegaly:A. Commonly causes psychosis FB. Elation is frequent TC. Libido is reduced TD. Can present with apathy and lack of spontaneity TE. Anxiety is frequent T

26. Hypopituitarism is associated with:A. Sarcoidosis TB. Childbirth TC. Basal skull fracture TD. Intracranial infection TE. Pituitary tumour T

28. Hypopituitarism:A. Generally presents with elevation of mood FB. Schizophreniform psychoses are frequent FC. Impaired drive quickly responds to therapy FD. Can cause reduced libido TE. Symptoms occur in only a few patients F


Disorders of substrates of cerebral metabolism

1. In cerebral anoxia :A. Cells of the 3rd, 4th, and 5th cortical layers are more prone to damage

T

B. Cerebellar Purkinje cells are resistant to damage FC. Subcortical U-fibres are often spared TD. Boundary zone necrosis is most severe in the fronto-temporal areas where the territories of the anterior, middle, and posterior cerebral arteries meet

F

E. Diffuse laminar cortical necrosis does not occur if blood flow is suddenly reduced (e.g. MI)

T

2. In carbon monoxide poisoning :A. Delirium is characteristically seen before unconsciousness FB. Hypotonicity is usually seen FC. Hypertonic forms carry a better prognosis TD. 20 % of patients have a prolonged period of delirium following poisoning with CO

T

E. Following recovery from coma, if there is complete recovery then there is no further change in presentation

F

3. In zinc deficiency :A. Hypogeusia and hyposmia are often seen TB. Cerebellar signs are seen TC. Mania is commonly seen FD. Memory is spared FE. Emotional lability is seen T

4. In Pellagra :A. Nicotinic acid is the main deficiency TB. It is a triad of gastrointestinal symptoms, skin changes, and psychiatric disturbance

T

C. The Betz cells of the motor cortex and other nuclei are spared while the Purkinje cells in the cerebellum undergo degeneration

F

D. There is an increased risk of suicide TE. Memory impairment is uncommon F

5. Regarding other B vitamin deficiencies :A. Panthothenic acid deficiency can lead to seizures FB. Pyridoxine has been linked to depressive illness TC. Riboflavin can cause the ‘burning feet syndrome’ FD. Thiamine deficiency can lead to beri-beri TE. Pyridoxine is a co-enzyme in GABA breakdown F


6. Regarding Wernicke’s encephalopathy :A. The incidence is twice as common in men TB. It is associated with prolonged deprivation of thiamine, with an acute fall in levels (e.g. glucose load)

T

C. Confusion, impaired consciousness, and ophthalmoplegia is the classic triad

T

D. Mental abnormalities are seen in all patients FE. Hallucinations can occur T

7. In Wernicke’s encephalopathy :A. Mamillary bodies are affected TB. The walls of the 3rd ventricle are affected TC. The hippocampus is spared TD. EEG shows diffuse slowing TE. The mortality rate is 20 % T

8. Regarding Korsakoff’s psychosis :A. Females have a higher incidence FB. Females present later than men FC. Mamillary bodies are spared FD. Memory disturbance is associated with involvement of thalamic nuclei

T

E. SPECT scanning shows increased blood flow in the frontal and anterior temporal lobes

F

9. In Vitamin B12 deficiency:A. There is a microcytic anaemia FB. Polyneuropathy can occur TC. Dementia is a feature TD. There is a strong association with depressive illness FE. There may be memory impairment T

10. Folic acid deficiency:A. Can occur in the elderly TB. May present with depression TC. Depressed people have lower levels of folate TD. High levels of folate are seen in dementia FE. May occur with anticonvulsant medication T


Intracranial infections

9. Regarding Syphilis infection:A. Meningovascular infection occurs 10-15 years after infection FB. Meningovascular infection can cause delirium TC. Cranial nerve palsies are seen in meningovascular disease TD. Tabes Dorsalis usually presents in middle age TE. Tabes dorsalis is due to atrophy of the ventral nerve roots and dorsal columns

F

10. Regarding Syphilis infection:A. Tabes dorsalis can result in Argyll-Robertson pupils TB. General paresis causes gliosis and cortical demyelination FC. The dementing picture is most common in GPI TD. Cortical atropy is seen in GPI TE. The grandiose presentation is more common than the depressive presentation

F

11. In Encephalitis:A. The most commonly cause is herpes simplex in the UK TB. Herpes mainly affects the parietal and temporal lobes FC. EEG shows diffuse slow-wave activity TD. Anxiety and depression can result TE. Schizophrenia is common F

12. In Aids dementia complex (ADC):A. Develops in 75 % of those with AIDS FB. There is no cerebral atrophy FC. It occurs in the early stages of the illness FD. Personality changes are frequent TE. Memory and concentration are impaired T

13. Cerebral abscesses:A. Occur more frequently in those with congenital heart disease TB. Are more common in IV drug abusers TC. Seizures may be an early sign TD. Local spread affects the parietal lobes FE. Lumbar puncture is diagnostic F





Mental Retardation

1. The following is true of mental retardation :A. It is more common in males TB. 1/3 of cases are due to Down’s syndrome TC. 15 % of cases are due to an unknown cause TD. There is no greater incidence in the lower classes FE. 95 % of cases have organic pathology diagnosed during life F

2. The following are seen in Patau’s syndrome :A. Trisomy of 17-18 FB. Absent corpus callosum TC. Rocker-bottom feet F


D. Polycystic kidneys TE. Life expectancy is 5-6 years F

3. In Edward’s syndrome :A. There is mental retardation TB. Trisomy 13-15 is seen FC. It is more common in females TD. Mean survival is 10 months TE. Heart lesions are frequent F

4. In Down’s syndrome :A. It is more common in males TB. Simian crease is seen in all cases FC. There is brachycephaly TD. The tongue is enlarged FE. Cataracts can occur T

5. The following are associations of Down’s syndrome :A. A-V canal defects TB. Hirschsprung’s disease TC. Hearing deficits TD. Epilepsy TE. Vascular dementia F

6. The following is true of Fragile X syndrome :A. It was first described by Martin and Bell in 1943 TB. It is an uncommon cause of mental retardation in males FC. Female carriers have normal IQ FD. Autism is associated TE. There is a negative association with ADDH F

7. The following are true in Tuberous sclerosis :A. It is a defect of chromosome 11 FB. It is autosomal recessive FC. Shagreen patches are best examined with Wood’s light FD. Seizures are rare FE. Intelligence is normal F

8. In the mentally handicapped :A. The incidence of schizophrenia is the same as the normal population

F

B. Bipolar Affective disorder is seen in 1 in 20 handicapped in-patients

T

C. Hysterical symptoms are more common than in normal controls TD. Epilepsy is seen in a third of severely handicapped patients T


E. The incidence increases with age, except for Down’s syndrome and autism

F

Epilepsy

1.


Neuroanatomy, neurophysiology, and neuropathology

1. Possible signs of posterior column damage include :A. Negative rombergism FB. Diminished tendon reflexes TC. Hypertonicity FD. Loss of vibration sense TE. Loss of proprioception T

2. Features of Alzheimer’s disease may include :A. Glial proliferation TB. Cystic necrosis and gliosis FC. Granulovacuolar degeneration TD. Multiple micro-infarcts FE. Arteriosclerosis F

3. Features of upper motor neuron lesions could include :A. Clonus TB. Cogwheel rigidity FC. Flexor plantar response FD. Preservation of muscle bulk TE. Increased tendon reflexes T


4. Features of Pick’s disease might include :A. Frontal and parietal lobes mainly affected FB. ‘knife-blade’ atrophy TC. ‘balloon cells’ TD. Absence of fibrous gliosis FE. Pick’s cells T

5. Activation techniques in electroencephalography include :A. Dehydration FB. Sodium valproate FC. Alcohol TD. Hypoventilation FE. Sleep T

6. Features of Creutzfeldt-Jacob disease include :A. Neuronal degeneration TB. Atrophy of caudate and putamen especially FC. Spongeiform changes TD. Does not affect the whole CNS FE. Glial proliferation T

7. Possible features of lower motor neuron disease include :A. Atonic muscles TB. Absent reflexes TC. Loss of 100 % of muscle bulk FD. Clasp-knife rigidity FE. Tardive dyskinesia F

8. Features of multi-infarct dementia could include :A. Senile plaques FB. Neurofibrillary tangles FC. Hypertension TD. Cerebral ischaemia TE. Cerebral infarction T

9. Functions of the non-dominant cerebral hemisphere may include :A. Holistic TB. Ideational FC. Pictorial TD. Geometric TE. Non-linear T

10. Memory defects occur with lesions in :A. Medial-dorsal thalamic nucleus T


B. Wernicke’s area FC. Walls of third ventricle TD. Broca’s area FE. Parietal cortex F

11. The limbic system includes :A. Parahippocampal gyrus TB. Hypothalamus TC. Corpus callosum FD. Anterior nucleus of thalamus TE. Subcallosal gyrus T

12. Diplopia occurs in :A. Neuropathy of oculomotor nerve TB. Parkinson’s disease FC. Neuropathy of facial nerve FD. Huntington’s disease FE. Diabetes insipidus F

13. Associations of benign intracranial hypertension might include:A. Chlortetracycline administration TB. Myxoedema FC. Polycythaemia TD. Oral contraceptives TE. Hypoparathyroidism T

14. Possible structures involved in the accommodation reflex include:A. Pretectal nucleus FB. Edinger-Westphal nucleus (bilaterally) FC. Lateral geniculate body TD. Inferior colliculus FE. Oculomotor nuclei of midbrain T

15. Features of posterior inferior cerebellar artery occlusion might include:A. Contralateral Horner’s syndrome FB. Ipsilateral analgesia (limbs) FC. Contralateral ataxia FD. Dissociated analgesia TE. Ipsilateral analgesia (facial) T

16. Nystagmus occurs in :A. Brain stem lesions T


B. Labyrinthine disease TC. Cerebellar lesions TD. Healthy subjects TE. Rotational stimulation T

17. Features of basilar artery occlusion could include :A. Monoplegia TB. Contralateral cerebellar signs FC. Quadriplegia TD. Hypopyrexia FE. Contralateral cranial nerve palsies F

18. Features of general paresis (GPI) may include :A. ‘Rod cells’ TB. Cortical thickening FC. Thinning of the dura FD. Perivascular lymphocytes TE. Spirochaetes found in the brain T

19. Causes of mononeuritis multiplex include :A. Sarcoidosis TB. Bronchial carcinoma TC. Leprosy TD. Polyarteritis nodosa TE. Trauma F

20. Features of pseudo-bulbar palsy include :A. Exaggerated jaw jerk TB. Emotional lability TC. Wasting of tongue FD. Facial muscles’ fasciculation FE. Dysphonia T

21. Possible causes of sudden blindness include :A. Vitreous haemorrhage TB. Hysterical dissociation FC. Acute glaucoma TD. Methanol TE. Prolapsed intervertebral disc F

22. Principal outputs of the basal ganglia go to :A. Cerebral cortex FB. Red nucleus TC. Tectum TD. Subthalamic nucleus T


E. Substantia nigra T

23. Functions of the limbic system may include :A. Emotional behaviour TB. Motivation TC. Sexual activity TD. Conditioned reflexes TE. Memory T

24. Diencephalic structures might include :A. Pons FB. Pituitary TC. Thalamus TD. Cerebellum FE. Hypothalamus T

25. Functions of the reticular formation could include :A. Arousal TB. Principal input to basal ganglia FC. Sleep TD. Vigilance FE. Principle input to limbic system T

26. Features of the Brown-Sequard syndrome include :A. contralateral loss of conscious kinaesthesia FB. Ipsilateral loss of crude touch FC. Contralateral loss of two-point discrimination FD. Ipsilateral loss of temperature FE. Incomplete lateral hemisection of spinal cord F

27. Branches of the basilar artery include :A. Posterior cerebral artery TB. Anterior cerebral artery FC. Posterior inferior cerebellar arteries FD. Anterior inferior cerebellar arteries TE. Labyrinthine arteries T

28. Possible features of complete spinal cord transection include :A. Reflexes initially hyperactive FB. Loss of all voluntary movement below lesion TC. Development of automatic bladder in first 3 days usually FD. Loss of all perception of sensation below lesion TE. Loss of all reflexes after about three weeks F


29. Possible components of the cerebellum include :A. Caudate nucleus FB. Dentate nucleus TC. Lentiform nucleus FD. Vermis TE. Cingulate gyrus F

30. Features of anterior cerebral artery occlusion could include :A. Contralateral lower limb sensory deficits TB. Contralateral hemianopia FC. Clouding of consciousness TD. Motor aphasia FE. Contralateral lower limb paresis T

31. Dopaminergic cell bodies are situated in :A. ventral tegmental area TB. Substantia nigra TC. Median raphe nucleus FD. Dorsal raphe nucleus FE. Arcuate nucleus of hypothalamus T

32. Telencephalic structures could include :A. Oculomotor nerves FB. Basal ganglia TC. Crura cerebri FD. Optic nerves FE. Cerebral hemispheres T

33. Functions of astrocytes might include :A. Myelin sheath production FB. Filling the role of fibrous tissue TC. Lining the cerebral ventricles FD. Most numerous of the glial cells TE. Lining the spinal canal F

34. Maxillary division branches of the trigeminal ganglion might include :A. Supraorbital nerve FB. Infraorbital nerve TC. Superior alveolar nerve TD. Inferior alveolar nerve FE. Nasociliary nerve F

35. Components of the basal ganglia may include :A. Amygdaloid nucleus F


B. Red nucleus FC. Dentate nucleus FD. Caudate nucleus TE. Subthalamic nucleus F

36. Features of carotid sinus stimulation may include :A. Hyperventilation FB. Hypertension FC. Raised intracranial pressure FD. Peripheral vasodilation TE. Bradycardia T

37. Components of the cerebellum include :A. Flocculonodular node TB. Alveus FC. Stria terminalis FD. Fastigial nucleus TE. Interpositus nucleus T

38. Components of the Papez circuit include :A. Fornix TB. Mamillary body TC. Hippocampus TD. Thalamus TE. Cingulate gyrus T

39. Possible components of the Pons include :A. Abducens nucleus TB. Oculomotor nucleus FC. Trapezoid body TD. Red nucleus FE. Corpora quadrigemina F

40. Characteristic causes of pre-senile dementia include :A. Jakob-Creutzfeldt disease TB. Simple schizophrenia FC. Subacute spongiform encephalopathy TD. Manic-depressive psychosis FE. Punch-drunk syndrome T

41. Possible components of the pyramidal system include :A. Pyramidal tract TB. Vestibular nuclei FC. Anterior horn cells TD. Cerebellum F


E. Cortico-spinal tract T

42. Components of the direct and consensual light reflexes could include :A. Superior colliculus FB. Lateral geniculate body FC. Ciliary ganglion TD. Visual cortex FE. Constrictor muscles of iris T

43. Components of the limbic system may include :A. Internal capsule FB. Median forebrain bundle TC. Corpus striatum FD. Isthmus TE. Medial lemniscus F

44. The circle of Willis is formed by :A. Superior cerebellar artery FB. Posterior spinal artery FC. Posterior communicating artery TD. Middle cerebral artery FE. Anterior inferior cerebellar artery F

45. Posterior cerebral artery occlusions cause :A. Contralateral hemianalgesia TB. Ipsilateral hemianaesthesia FC. Spontaneous pain TD. Ipsilateral hemiplegia FE. Ipsilateral hemianopia F

46. A left homonymous hemianopia may be due to a lesion in :A. Left optic tract FB. Right optic tract TC. Optic chiasma FD. Right lateral geniculate body TE. Left medial geniculate body F

47. Features of cerebellar disease include :A. Pendular nystagmus FB. Dysdiadochokinesis TC. Resting tremor FD. Past pointing TE. Scanning dysarthria T


48. Causes of papilloedema include :A. Central retinal vein thrombosis TB. Hypoparathyroidism TC. Cavernous sinus thrombosis TD. Hypercapnia TE. Cranial arteritis T

49. The following structures are in the pons:A. Reticular formation TB. Substantia nigra FC. Locus coeruleus TD. Trigeminal nerve nucleus TE. Vestibular nuclei T

50. The following structures are in the midbrain:A. Superior colliculus TB. Inferior colliculus TC. Substantia nigra TD. Ventral tegmental area TE. Medical longitudinal fasciculus F


Basic Psychology

1. In behavioural psychotherapy :A. Flooding cannot be achieved in an imaginal way FB. Systematic desensitization is an aspect of aversive conditioning FC. Response prevention is characteristically combined with flooding TD. Physical restraint is no longer used in response prevention FE. Virtuous circles are a factor in most fear-reduction techniques T

2. Simple phobias :A. Are commoner in men FB. Mostly arise de novo in adulthood FC. Are best treated by relaxation training FD. Typically lead to symptoms of depersonalization FE. Are associated with mitral valve prolapse F

3. The following terms are correctly defined :A. Stimulus generalization is when a response learnt in one situation is exhibited in another

F

B. Primary reinforcers are things such as food and water TC. Secondary reinforcers are things such as sex, money, etc FD. Stimulus discrimination is when a learner responds differently to two slightly different stimuli

T

E. Response discrimination refers to the ability to make the same response in the same situation time after time

F

4. The following are true of various types of learning :A. shaping is also known as ‘cognitive dissonance’ FB. backward chaining can be used to teach children to toilet themselves

T

C. observational learning is a type of classical conditioning FD. modelling is a type of observational learning TE. a programme which begins with reinforcement of the last act in a sequence is known as ‘forward chaining’

F

5. Systematic desensitization :A. was developed by Skinner FB. is a form of operant conditioning FC. is the treatment of choice for obsessional thoughts FD. relaxation is an essential part of the treatment TE. drugs can be used to produce relaxation T

6. Variable ratio schedules of reinforcement :A. can only be used in operant conditioning situations FB. need proportionally more trials to achieve a given criteria of F


learningC. increase the resistance to extinction TD. are more likely to produce emotional outbursts during the learning phase

T

E. are less likely to produce emotional outbursts during the extinction phase

T

7. With reference to conditioning models of behaviour :A. it is difficult to label any real life situation as totally operant or totally classical

T

B. in the 1940s, several psychoanalysts applied them successfully to demonstrate Freudian concepts

F

C. they can explain either systematic desensitization or flooding, but not both

F

D. they are increasingly demonstrating how unimportant cognitive factors are in behaviour

F

E. they emphasize the importance of timing and order in any learning situation

T

8. In classical conditioning:A. Thorndike is a key figure FB. Spontaneous recovery only occurs after a short delay FC. The longer the time between extinction and reappearance of CS, the weaker the response

F

D. Forward conditioning is when the CS always precedes the UCS TE. The strength of CR is proportional to the intensity of the UCS T

9. The following statements about classical conditioning are true:A. The learned immune response is an example of classical conditionng

T

B. Taste aversions typify classical conditioning FC. Classical conditioning underlies systematic densitization TD. Second-order conditioning may be a model for the acquisition of phobias

T

E. Incubation means that some stimuli are more likely to become CS than others

F

10. Operant conditioning:A. Is the same as Instrumental conditioning TB. Is associated with B. F. Skinner TC. Extinction and spontaneous recovery do not occur FD. Positive reinforcers are inherently rewarding, e.g. food, sex FE. Negative reinforcers weaken a particular response F

11. The following are true of reinforcement:A. Escape conditioning is an example of negative conditioning T


B. A shuttle-box utilizes avoidance conditioning FC. Behaviour learned through avoidance conditioning is resistant to extinction as it is often reinforced by fear reduction

T

D. Money is a secondary reinforcer TE. Secondary reinforcers are also known as ‘conditioned reinforcers’ T

12. In reinforcement:A. A variable ratio schedule means that reinforcement is given after a variable amount of time

F

B. Gambling is an example of variable-interval conditioning FC. Partial reinforcement is involved in the development of superstitious behaviour

T

D. Variable ratio reinforcement results in quick, stepped responding FE. Behaviour learned through partial reinforcement is very resistant to extinction

T

13. Regarding operant conditioning:A. Punishment is synonymous with penalty FB. Punishment strengthens positive responses FC. Shaping is best used when the complete response desired is simple FD. Toilet training is an example of ‘backward chaining’ TE. ‘Time-out’ is an example of the use of penalty T

14. Regarding cognitive processes in learning:A. Seligman described learned helplessness TB. Insight learning can occur in primates TC. Bandura demonstrated vicarious conditioning TD. Practice of a skill is necessary until the point of almost-correct performance

F

E. Sign-learning theory includes the formation of cognitive maps T

15. The following are true of perceptual theories:A. The ecological view states that the perceptual system constructs detail from clues in the environment

F

B. Constructionism is an example of top-down processing TC. Weber’s law states that as stimulus magnitude increases, larger changes in physical magnitude are required

F

D. Fechner’s law applies to electric shocks FE. Weber’s law does not hold when stimuli are very intense or very weak

T

16. In perceptual organization:A. Camouflage demonstrates reversal of figure and ground FB. Perceptual phenomena demonstrate Gestalt effects TC. Gestalt theories are an example of bottom-up processing FD. Perception of depth and distance illustrate ecological views of T


perceptionE. Perception of movement does not rely on movement of the retinal image

T

17. The following are true:A. Perception of motion depends on interstimulus interval TB. Perceptual sets demonstrate top-down processing TC. Chunking of information facilitates processing TD. The ‘visual cliff’ suggests depth perception develops around six-months of age

F

E. Attention always occurs without conscious effort F

18. The following are true of memory:A. The capacity of short term memory (STM) can be increased by chunking

T

B. Visually-encoded information fades more quickly from STM TC. Decay theory suggests that forgetting is item-dependent FD. Retroactive inhibition suggests that previous learning impairs subsequent learning

F

E. ECT can interrupt consolidation and produce retrograde amnesia T

19. Models of memory include:A. Dual memory theory TB. Perceptual Representation System FC. Transfer-appropriate processing TD. Constructive memory TE. Maintenance rehearsal is more effective than elaborative rehearsal F

20. Regarding the neurophysiology of memory:A. Bilateral damage to the hippocampus produces retrograde amnesia FB. Basal forebrain lesions can result in a Korsakoff’s type memory deficit

T

C. 5-HT agonists impair cognition since acetylcholine release is under inhibitory 5-HT tone

T

D. Endorphins are involved in memory processes TE. RNA is involved in memory transfer T

21. Regarding theories of thought:A. Cognitive maps may exhibit systematic distortion TB. ‘Home’ is a natural concept TC. Scripts are mental representations of concepts FD. Problem solving involves ignoring negative evidence FE. Incubation can help to break mental sets T

22. The following are true about theories of personality:


A. Adler described ‘striving for superiority’ TB. Adler emphasized the importance of sexual urges FC. Jung described ‘introversion’ and ‘extraversion’ TD. Trait theories employ a normothetic approach TE. Eysenck used a ‘dimensional’ approach to personality T

23. Regarding personality:A. Costa and McCrae’s model only holds in Westernized countries FB. John Watson is associated with personality research TC. Bandura described ‘reciprocal determinism’ TD. Carl Rogers described ‘self-actualization’ and ‘self-concepts’ TE. Maslow is associated with ‘conditions of worth’ F

24. The following are true of motivation:A. Drive reduction theory is based on the principle of homeostasis TB. Primary drives are learned desires FC. People perform best when their level of arousal is low FD. ‘Need achievement’ demonstrates clear gender differences TE. Belongingness and love are at the apex of Maslow’s hierarchy of needs

F

25. Regarding emotion:A. Facial movements expressing emotion are controlled by the pyramidal system

F

B. The James-Lange theory emphasized the importance of physiological responses

T

C. The Cannon-Bard theory described ‘transferred excitation’ FD. Social referencing only occurs in brain-damaged patients FE. Facial feedback can drive emotional experience according to the Schacter-Singer theory

F

Social Psychology

1. Regarding social construction of the self and attribution theory:A. Festinger described ‘social comparison’ TB. ‘Relative deprivation’ means that however much we get, it is less than we deserve

T

C. According to attribution theory, in internal attribution, distinctiveness is high, and consensus and consistency are low

F

D. The fundamental attribution error means that we tend to overattribute the behaviour of others to external factors

F

E. The ultimate attribution error means that we attribute others positive actions to external causes, and negative actions to internal causes

T


2. Regarding attitudes:A. Attitudes consist of cognitive, affective, and behavioural components

T

B. Attitudes can only be learned through operant conditioning FC. The ‘mere-exposure effect’ suggests that the more that we are exposed to an object, the more negative our attitudes will be towards it

F

D. The ‘Elaboration-likelihood model’ says that persuasive messages can change people’s attitudes via peripheral and central routes

T

3. The following are true of theories about attitudes:A. Leon Festinger is associated with ‘cognitive dissonance theory’ TB. Cognitive dissonance may be more likely to change attitudes in individualist cultures such as Europe or the USA

T

C. Daryl Bem is associated with ‘Self-perception theory’ TD. ‘Self-perception theory’ suggests that people infer their behaviour to match their attitudes

F

E. People may change their behaviour in situations where they are not sure what their attitudes are

T

4. The following are true of prejudices and stereotypes:A. The ‘authoritarian personality’ may be more likely in people who were not exposed to punishment, and so feel that they do not have to obey or defer to others

F

B. ‘Illusory correlations’ can occur when noticeably objective behaviour is performed by a few members of an easily identified ethnic group

T

C. The ‘contact hypothesis’ suggests that we are more likely to reduce our prejudices when we are exposed to members of the other group who are of a higher status

F

D. Norms can be descriptive (what others approve or disapprove of) or injunctive (indicate what others do)

F

E. Deindividuation may cause people to perform aggressive or illegal acts in certain situations

T

5. The following are true of conformity:A. Compliance occurs when people adjust their behaviour as a result of unspoken group pressure

F

B. Ambiguity of the situation increases the likelihood of conforming to a group norm

T

C. ‘Social impact theory’ holds that the power of a group depends on how important and how close that group is to the person in question

T

D. Women are more likely to conform to a group than men FE. The presence of others who disobey can make someone more likely to be obedient

F


6. The following are true of aggression:A. Freud proposed that aggression is a biological urge, and is due to Thanatos

T

B. The amygdala and hypothalamus are involved in aggression TC. Aggressive behaviour is more likely in collective cultures FD. Immediate reward or punishment can alter the frequency of aggressive acts

T

E. Aggression is more likely to occur following an expected failure than an unexpected one

F

7. In altruistic behaviour:A. The ‘bystander effect’ indicates that the more people who witness an emergency, the less likely it is that someone will help

T

B. The tendency to blame oneself rather than the group is called ‘diffusion of responsibility’

F

C. Task-oriented leaders are more effective when the task is structured

F

D. Person-oriented leaders are most effective when the group is working under time pressure

F

E. ‘Groupthink’ is likely when the group is isolated, and is under time pressure

T

Psychotherapy

1. Ego functions include:A. Reality testing TB. Control of primary drives TC. Object relationships TD. Primary autonomous functions TE. Defence mechanisms T

2. Regarding dynamic theory:A. The manifest content of dreams shows ‘over determinism’ TB. Parapraxes are conscious expressions of ego desires FC. Parapraxes may be completely inhibited TD. Primary process thinking is based on the pleasure principle T


E. Secondary process thinking is unconscious F

3. Defence mechanisms described by Freud include:A. Displacement TB. Projection TC. Splitting FD. Projective identification FE. Turning against the self F

4. The following are true of Freud’s topographical model:A. The ego develops from the Id FB. The preconscious uses ‘primary process’ FC. The unconscious can be seen through dreams and parapraxes TD. The preconscious maintains the ‘censors’ TE. Primary autonomous functions are ego functions F

5. Regarding Freud’s structural model:A. Ego functions include impulse control and object relations TB. The superego causes primitive irrational guilt TC. The superego is conscious FD. Primary processes occur in ego and superego functions FE. Thanatos and eros are described T

6. In libido theory:A. The mother is the primary love object TB. The anal stage occurs between the ages of 3 and 6 FC. The oedipus complex results from superego formation FD. Social relationships and play occur in the latency period TE. Castration anxiety is due to fear of giving up mother F

7. The following are true of other psychodynamic theorists:A. Reich described ‘striving for superiority’ FB. Otto Rank said that neurosis is due to the trauma of birth TC. Horney described ‘penis-envy’ FD. Anna Freud emphasized the importance of ego-defence mechanisms

T

E. Winnicot described attachment theory F

8. The following are neo-Freudians:A. Erica Fromm TB. Bowlby FC. Horney TD. Anna Freud FE. Harry Stack-Sullivan T


9. The following associations are correct:A. Rogers and the Encounter movement TB. Berne and Gestalt therapy FC. Perls and Existential logotherapy FD. Moreno and Psychodrama TE. Maslow and Self-actualization T

10. The following are true:A. Turning against the self occurs in hysteria and depression FB. Obsessions involve displacement TC. Identification occurs in depression TD. Phobias are due to symbolic expression of the wish in the symptom

F

E. Obsessions are due to a rigid and destructive superego T

Clinical Pharmacology

1. The following statements are true:A. Drugs must be ionized to be absorbed by passive diffusion FB. In an acid pH, basic drugs will be poorly absorbed TC. Gastric emptying is delayed by MAOIs TD. Food increases the absorption of diazepam TE. Rectal administration results in extensive 1st pass metabolism F

2. Regarding some aspects of pharmacokinetics:A. Diazepam is 99% protein-bound TB. Ionized drugs cross the blood-brain barrier easily FC. Phase I reactions convert the drug to non-active metabolites FD. Phase II reactions include glucuronidation and sulphation TE. Hydroxylation is autosomal dominant T

3. Regarding Drug interactions:A. Carbamazepine can inhibit the metabolism of TCAs FB. Phenothiazines can induce their own metabolism TC. Haloperidol inhibits the metabolism of TCAs TD. Cytochrome P450 inhibition by cimetidine is an important factor in healthy subjects

F

E. Slow acetylators predominate in Europe and Japan F


4. The following are true:A. In the elderly, there is a reduction in plasma albumin TB. There is a loss of body weight in the elderly FC. In pregnancy, the increase in plasma volume results in an increase in the free fraction of a drug

F

D. First-order kinetics are exponential TE. Alcohol and aspirin undergo zero-order kinetics T

5. The following statements about the distribution of neurotransmitters are correct:A. Acetylcholine is found in the basal ganglia TB. Dopamine cell bodies are found in the limbic system FC. 5-HT predominates in the raphe nuclei in the brainstem TD. Noradrenaline predominates in the locus coeruleus TE. GABA is found in the peri-aqueductal grey matter F

6. The following are true statements about receptors:A. 5-HT2A antagonists improve slow-wave sleep TB. 5-HT1A antagonists are anxiolytic FC. D2 receptors are found in the limbic system TD. Antagonism of alpha-2 adrenoceptors leads to reduced NA release FE. Most antipsychotics are D2 agonists F

7. Regarding benzodiazepines (BZDs):A. BZDs bind to the gamma-2 subunit of the GABAB supramolecular complex

F

B. BZDs can inhibit the effects of other neurotransmitters such as 5-HT

T

C. Oxazepam and Lorazepam are short-acting BZDs FD. The BZ1 receptor mediates the anti-anxiety effect of BZDs FE. The BZ2 receptor is concentrated in the amygdala and septo-hippocampal pathways

T

8. Regarding Benzodiazepines:A. Tolerance develops in 4-6 weeks of therapy FB. Withdrawal can cause rebound insomnia TC. BZDs are effective in phobic states FD. Zopiclone and Zolpidem act upon the BZ2 receptor in a similar way to BZDs

F

E. Withdrawal symptoms peak at 7-8 days T

9. The following are recognized side effects of BZDs:A. Ataxia TB. Drowsiness T


C. Anterograde amnesia TD. Nightmares FE. Insomnia F

10. The following are recognized symptoms of the BZD withdrawal syndrome:A. Tremor TB. Depression TC. Tinnitus TD. Blurred vision TE. Sweating T

11. Factors associated with dependence and withdrawal problems are:A. Short duration of treatment FB. Passive-dependent personality traits TC. Age < 40 years FD. Concurrent use of Buproprion TE. High dose and rapid withdrawal T

12. Regarding Buspirone:A. Buspirone is a 5-HT1A agonist TB. Buspirone has little effect on DA systems FC. Effects are usually evident after 8-12 hours FD. It can cause galactorrhoea TE. Dysphoria has been reported T

13. Regarding the pharmacological treatment of anxiety disorders:A. Placebo-response rate is in the region of 20-30 % FB. CBT is much less effective than drugs for anxiety FC. Beta-blockers can cause anxiety FD. Beta-blockers are associated with nightmares TE. The effect of Beta-blockers usually takes up to a month to develop F

14. The following statements about antidepressants are true:A. Mianserin is an SSRI TB. Reboxetine is a NaSSA FC. Mirtazapine is a NARI FD. Trazodone is an SNRI FE. Nefazodone is an SSRI T

15. Regarding Tricyclic Antidepressants (TCAs):A. Treatment results in subsensitivity of NA and 5-HT receptors on cell bodies

T


B. Tertiary amines have a higher affinity for the 5-HT uptake site TC. Tertiary amines are less sedating FD. Secondary amines have more anticholinergic side effects FE. Tertiary amines have a quicker peak plasma level T

16. The following are true:A. Amoxapine has D2 antagonist properties TB. Amitriptyline is a secondary amine FC. Lofepramine is a tertiary amine TD. Maprotiline is the most selective NA uptake inhibitor of the TCAs TE. Imipramine is more selective for 5-HT than Nortriptyline T

17. Side effects of TCAs include:A. Sinus bradycardia FB. Impairment of memory TC. Postural hypotension due to alpha-1 adrenoceptor antagonism TD. Weight gain due to histamine H1 agonism FE. Negative inotropism T

18. Side effects of TCAs include:A. Prolongation of the PR interval TB. Flattening of T waves TC. Coarse tremor FD. Raising of the seizure threshold FE. Cholestatic jaundice T

19. Contraindications to TCAs include:A. Narrow angle glaucoma TB. Elderly FC. Heart block TD. Previous MI FE. Prostatic hypertrophy T

20. Regarding SSRIs:A. They reach peak levels within 1 hour of ingestion FB. Long-term use results in reduced 5-HT2 function TC. Fluoxetine has a half-life of around 7 days FD. OCD is an indication for their use TE. They should be avoided in people with cardiac disease F

21. Common side effects of SSRIs include:A. Diarrhoea TB. Constipation TC. Loss of appetite TD. Weight gain F


E. Tremor T

22. Common side effects of SSRIs include:A. Anorgasmia TB. Hypertension FC. Tachycardia FD. Alopecia FE. Sweating T

23. Interactions of SSRIs include:A. Use with MAOIs can result in the 5-HT toxicity syndrome TB. Lithium TC. Diazepam and fluoxetine TD. Warfarin TE. Anti-convulsants T

24. Regarding MAOIs:A. Most are selective for MAOI-A FB. Phenelzine has fewer side effects than isocarboxacid FC. Hypotension is a major problem with tranycypramine FD. Fast acetylators metabolize MAOIs at the same rate as slow acetylators

F

E. It is said that atypical depression responds best to MAOIs T

25. Recognized side effects of MAOIs include:A. Mania TB. Seizures TC. Blurred vision TD. Peripheral neuropathy TE. Alopecia F

26. Important interactions with MAOIs can occur with:A. Some cough medicines TB. Oral hypoglycaemics TC. NSAIDs FD. Cheese TE. Calcium antagonists F

27. Contraindications for MAOIs include:A. Renal failure FB. Congestive cardiac failure TC. Concurrent use of TCAs FD. Asthma FE. Phaochromocytoma T


28. Mianserin:A. Is a weak NA reuptake inhibitor TB. Is cardiotoxic FC. Is an antagonist at histamine receptors and can cause weight gain TD. Has no effect on the seizure threshold FE. Can cause agranulocytosis T

29. Mirtazapine:A. Has little effect on histamine receptors FB. Blocks alpha-2 autoreceptors TC. Is alerting in its profile FD. Can reduce appetite FE. Can cause neutropenia T

30. Trazodone:A. Is non-sedating FB. Has 5-HT agonist properties TC. Should be taken with food TD. Can cause priapism TE. Has no effect on cognitive function F

31. Nefazodone:A. Has sedating properties due to alpha-1 adrenoceptor antagonism FB. Dry mouth and dizziness can occur TC. Has a long half-life FD. Can affect the action of propanolol TE. Can increase haloperidol levels T

32. Venlafaxine:A. Is an SNRI TB. Lacks anticholinergic effects TC. Has no effect on the seizure threshold FD. Can be given with MAOIs FE. Can cause hypotension T

33. L-Tryptophan:A. Is an effective antidepressant by itself FB. Should not be used with MAOIs FC. Can cause agranulocytosis FD. Peripheral neuropathy may be a rare side effect TE. Skin sclerosis can occur rarely T

34. Regarding the phenothiazines:A. Group one drugs include thioridazine F


B. Group three drugs include trifluoperazine TC. Group two drugs have high levels of antimuscarinic side effects TD. Group three drugs have low levels of extrapyramidal side effects FE. Other classes of drugs tend to resemble group one phenothiazines F

34. Regarding other antipsychotic drugs:A. Droperidol is a butyrophenone TB. Zuclopenthixol is a thioxanthene TC. Olanzapine is a dibenzodiazepine FD. Risperidone is a dibenzothiazepine FE. Sulpiride is a substituted benzamied T

35. The following are true of movement disorders:A. Young females are at highest risk of acute dystonic reactions FB. Extrapyramidal symptoms tend to occur within a few hours of drug administration

F

C. Extrapyramidal symptoms are due to blockage of D2 receptors in the basal ganglia

T

D. Increasing the dose can sometimes help extrapyramidal side effects

F

E. Tardive dyskinesia is due to D2 receptor hypersensitivity T

36. The following are at increased risk of tardive dyskinesia:A. Female TB. Affective disorders TC. Continuous treatment FD. Organic brain disease TE. Increasing age T

37. Recognized side effects of antipsychotics include:A. Sedation due to muscarinic blockade FB. Nasal congestion TC. Impotence TD. Psoriasis FE. Hypertension F

38. Recognized side effects of antipsychotics include:A. Retinal pigmentation TB. Leucocytosis FC. Prolonged QT interval TD. Weight loss FE. Torsade de pointes T

39. Regarding neuroleptic malignant syndrome:A. Onset occurs after 1-2 months of treatment F


B. Onset is slow and insidious FC. Symptoms include hypertonicity, stupor, and autonomic instability TD. Mortality is 50 % FE. Secondary conditions include thromboembolism, renal failure, and cardivascular collapse

T

40. Risperidone:A. Has high affinity for the 5-HT2A receptor TB. Can cause hyperprolacinaemia TC. Weight loss is frequent FD. Is less effective than conventional antipsychotics FE. Headache and anxiety may occur T

41. Clozapine:A. Has low affinity for D2 receptors TB. Has low affinity for D1 and D4 receptors FC. Has few effects on adrenoceptors FD. Can increase blood levels of warfarin and digoxin TE. Metabolism by the cytochrome P450 system is not significant F

42. Side effects of Clozapine include:A. Bradycardia FB. Weight gain TC. Hypersalivation TD. Increase in seizure threshold FE. Neutropenia and agranulocytosis T

43. Olanzapine:A. Has lower affinity for the D2 and 5-HT2A receptors than Clozapine FB. Has higher affinity for the D1 receptor than Clozapine FC. Causes negligible weight gain FD. Has high levels of Extra-pyramidal side effects FE. Can cause marked sedation T

44. Quetiapine:A. Has a similar binding profile to clozapine TB. Has a high affinity for muscarinic receptors FC. Has lower affinity for all receptors than clozapine TD. Causes less weight gain than olanzapine and clozapine TE. Can cause constipation T

45. Sertindole:A. Has low affinity for the 5-HT2A receptor FB. Specifically targets D2 receptors in the limbic region TC. Causes high levels of EPS FD. May cause orthostatic hypotension T


E. Has been linked to sudden cardiac death T

46. Amisulpride:A. Is a D2/ D3 agonist FB. Blocks autoreceptors at low doses and can increase synaptic dopamine levels

T

C. Does not increase prolactin levels FD. Has a similar level of EPS across the whole dose range FE. Has effects on negative symptoms at low doses F

47. Lithium:A. Has its main effects on noradrenaline systems in the brain FB. Works by affecting secondary messenger systems in the cell TC. Increases the rate of formation of cAMP FD. Works best with rapid-cycling patients FE. Is reabsorbed from the kidney T

48. Side effects of Lithium include:A. Tremor TB. Muscle weakness TC. Decreased urine output FD. Dysgeusia TE. Weight gain more in men F

49. Side effects of lithium include:A. Cranial diabetes insipidus FB. Hypothyroidism TC. Shrinkage of the thyroid gland FD. Hypoparathryoidism FE. Females have thyroid side effects more commonly than men T

50. Side effects of lithium include:A. Leucocytosis TB. Acne TC. Alopecia TD. T wave inversion and QRS narrowing FE. Memory impairment T

51. The following statements are true:A. A rise in plasma sodium results in a rise in plasma lithium levels FB. Dehydration results in a fall in plasma lithium levels FC. Although lithium can treat bipolar illness, it has no effect on the number of relapses

F

D. Thyroid gland disorders do not respond to thryoxine FE. Lithium is distributed widely in the body T


52. Regarding lithium toxicity:A. Fine tremor is an early sign FB. GI upset tends to occur early TC. Neurological signs tend to appear later TD. Hyporeflexia frequently occurs FE. Coma may occur at high levels T

53. The following statements are true:A. Lithium inhibits the release of iodine, and thyroid hormones TB. Lithium induces thyroid autoantibodies TC. Lithium does not cross the placenta FD. Lithium is excreted in breat milk TE. Long term treatment does not seem to affect GFR T

54. Increased lithium levels occur with:A. Bendrofluazide FB. Aspirin FC. Metronidazole TD. NSAIDs TE. ACE-inhibitors T

55. Carbamazepine:A. Is a GABA agonist TB. Affects calcium channels TC. Induces its own metabolism TD. Has a short half life FE. Affects brain 5-HT function T

56. Side effects of carbamazepine include:A. Ataxia TB. Diplopia TC. SIADH TD. Agranulocytosis TE. Leucocytosis F

57. Interactions with carbamazepine include:A. Increased metabolism of tricyclic antidepressants TB. Decreased metabolism of other anticonvulsants FC. Neurotoxicity with lithium TD. Reduced carbamazepine levels with SSRIs TE. Higher levels of oral contraceptives F

58. Sodium Valproate:


A. Is a GABA transaminase inhibitor TB. Is absorbed slowly from the GI tract FC. Should be given with caution in patients with liver disease TD. Has no effects on the foetus FE. Can increase the levels of phenytoin T

59. Side effects of Valproate include:A. GI upset TB. Weight gain TC. Ataxia TD. Thrombocytosis FE. Impaired platelet function T

60. Side effects of Valproate include:A. Acute pancreatitis TB. Renal failure FC. Hepatic enzyme changes TD. Hepatic toxicity and death TE. Valproate should be stopped if jaundice occurs T

Descriptive Psychopathology

1. The borderline syndrome is characterized by:A. Splitting TB. Good impulse control FC. Euphoric affect FD. Primitive idealization TE. Feelings of emptiness T

2. Somatic symptoms of severe anxiety include:A. Impotence TB. Diarrhoea TC. Constipation TD. Hypoventilation FE. Sighing T

3. Symptoms of combat neurosis include:A. Anger T


B. Grandiose ideas FC. Good interpersonal relationships FD. Lack of guilt FE. Flashbacks T

4. Autochthonous delusions are:A. Synonymous with primary delusions TB. Rarely preceded by a delusional atmosphere FC. A source of secondary delusions TD. Pathognomonic of schizophrenia FE. ‘Brain waves’ T

5. The foetal alcohol syndrome:A. Occurs with as few as four drinks per day TB. Causes hydronephrosis TC. Causes severe mental retardation FD. Causes cleft lip and palate TE. Is associated with liver abnormalities F

6. Normal experiences include:A. Jamais vu TB. Delusional perception FC. Derealization TD. Visual hallucinations FE. Deja-vecu T

7. In Briquet’s syndrome:A. There is usually an organic basis FB. Recurrence is unusual FC. Somatic complaints are usually multiple TD. The prognosis is excellent FE. Surgery is treatment of choice F

8. Dissociative states:A. Occur in hysteria TB. May be seen under hypnosis TC. Include fugue states TD. Exclude multiple personalities FE. Are seen in petit-mal seizures F

9. Near-death experiences are:A. Associated with the name Moody TB. Seen in life-threatening experiences TC. A basis for reincarnation FD. Features of altered states of consciousness T


E. Occurrences in life or death F

10. Briquet’s syndrome:A. Is allied to hysteria TB. Occurs in men FC. Is synonymous with somatization disorder TD. Has a prevalence of 1-2 % in women TE. Has sexual symptoms infrequently F

11. Formal though disorder includes:A. Drivelling TB. Condensation TC. Flight of ideas FD. Perseveration FE. Transitory thinking T

12. Concrete thinking:A. Is diagnostic of schizophrenia FB. Is diagnostic of organic brain disease FC. May occur in manic-depressive psychosis FD. Is a defect of conceptual abstract thought TE. Is tested by interpretation of proverbs T

13. Formication:A. Is the medical term for fornication FB. May be seen in delirium TC. Is a passivity phenomenon FD. Is a tactile hallucination TE. May be called the ‘cocaine bug’ T

14. In organic disturbance of mental state:A. Verbal IQ falls off before performance FB. Concrete thinking is unusual FC. Derealization occurs FD. There is altered level of consciousness TE. Visual hallucinations occur T

15. Pseudohallucinations occur in:A. Borderline syndrome FB. Hypnogogic states TC. Hypnopompic states TD. Bereavement TE. Fatigue T


16. Normal experiences include:A. Hypnagogic hallucinations TB. Hypnopompic hallucinations TC. Depersonalization TD. Flight of ideas FE. Over-inclusive thinking F

17. Psychotic depression may be characterized by:A. Delusions of illness TB. Jamais vu FC. Visual hallucinations FD. Nihilistic delusions TE. Circumstantiality F

18. Delirium tremens is characterized by:A. Clouding of consciousness TB. Visual hallucinations TC. Lilliputian hallucinations TD. Olfactory illusions FE. Auditory illusions T

19. Jaspers described the following disorders of emotion:A. Apathy TB. ‘Free-floating’ emotions TC. Loss of feelings TD. Changes in bodily feelings TE. Changes in feelings of competence T

20. Delusional perception:A. Has two stages TB. Is an autochthonous delusion TC. Is often preceded by ‘delusional mood’ TD. Occurs secondary to a hallucination FE. Is a secondary delusion F

21. Pseuodohallucinations:A. Are subject to conscious manipulation FB. Are dependent on environmental stimuli FC. May occur in the real world FD. May possess the vivid quality of normal perceptions FE. Arise in inner space T

22. Depressive psychosis may be characterized by:A. Delusions of filth TB. Delusions of poverty T


C. Delusions of guilt TD. Primary delusions FE. Auditory hallucinations T

23. In the postpartum period:A. The treatment of psychosis is different from psychotic illness at other times

F

B. Psychosis begins within 3 months in 80 % of cases TC. The risk of recurrence in future pregnancies is 1 in 5 TD. Cerebral thrombo-embolic lesions may present as psychosis TE. Transient weepiness is common in the first week T

24. The dysmnesic syndrome occurs in:A. Neurosis FB. Uncomplicated psychosis FC. Korsakoff’s psychosis TD. Mamillary body lesions TE. Thalamic lesions T

25. Pseudodementia may be characterized by:A. Onset with depressive features TB. Abnormal EEG FC. Presence of localizing neurological signs FD. Past or family history of manic-depressive psychosis TE. Chronic course F

26. Echolalia occurs in:A. Catatonic schizophrenia TB. Obsessional neurosis FC. Mental handicap TD. Manic-depressive psychosis FE. Senile dementia T

27. Bromism may present with:A. Hypomania TB. Auditory and visual hallucinations TC. Delusions TD. Depression TE. Bad breath T

28. Encopresis in childhood:A. By definition occurs after age 5 FB. Has equal sex distribution FC. Is more prevalent than enuresis after age 16 FD. Is always due to constipation F


E. May occur in conduct disorder T

29. Features of catatonic schizophrenia include:A. Forced grasping FB. Mitgehen TC. Athetosis FD. Palilalia TE. Logoclonia T

30. Eye to eye conduct:A. Is usually increased in depression FB. Is never a sign of aggression FC. Is an essential part of psychotherapy FD. Is not influenced by cultural factors FE. Is assessed in the mental state examination T

31. The Capgras delusion:A. Is allied to hysteria FB. Usually is associated with organic brain disease FC. Is also called ‘pure erotomania’ FD. Is characterized by a pregnant husband FE. Is also called ‘delusion of doubles’ T

32. First rank symptoms of schizophrenia:A. Are always pathognomonic of schizophrenia FB. Include 2nd or 3rd party hallucinations FC. Incorporate all passivity phenomena TD. Exclude formal thought disorder TE. Include incongruity of affect F

33. In the double-blind situation:A. Two conflicting messages are given simultaneously TB. Experimental evidence is provided for schizophrenia FC. A double-bind situation also occurs FD. Comments on the situation itself are permitted FE. Both messages are always verbal F

34. Features of hypomania may include:A. Hypersomnia FB. Grandiose delusions TC. Wise business investments FD. Decreased libido FE. Poverty of thought F


35. Folie du doute may be characterized by:A. Vacillation TB. Delusions FC. Indecisiveness TD. Hallucinations FE. Persistent doubting T

36. Formication:A. Refers to actual insects crawling on the skin FB. Occurs in ‘delusions of infestation’ FC. Is seen when cocaine is withdrawn only FD. Is a second rank symptom of schizophrenia FE. Is a disorder of thought content F

37. Simple schizophrenia may be characterized by:A. Hallucinations FB. Late onset FC. Gradual deterioration TD. Social isolation TE. Delusions F

38. Hallucinations may occur in:A. Acute confusional states TB. Hysteria FC. Drug withdrawal TD. Petit-mal epilepsy FE. Anxiety states F

39. Stupor may occur in:A. Mania TB. Depression TC. Hysteria FD. Petit-mal epilepsy TE. Gjessing’s periodic catatonia T

40. The dysmnesic syndrome features:A. Paranoid delusions FB. Delusional perception FC. Ataxia TD. Peripheral neuropathy TE. Long-term memory impairment F

41. Hollingshead and Redlich:A. Published ‘Social Class and Mental Health’ TB. Based their studies in New York F


C. Showed that upper class patients tended to use hospitals FD. Showed that lower class patients tended to use outpatient clinics FE. Are psychoanalysts F

42. Mirror gazing occurs in:A. Anorexia nervosa TB. Manic-depressive psychosis FC. Hebephrenia TD. Obsessional neuroses FE. Senile dementia T

43. Pathological excitement occurs in:A. Retarded depression FB. Manic depressive psychosis TC. Catatonic schizophrenia TD. Delirium TE. Normal subjects F

44. Obsessional thoughts:A. Always give rise to compulsions FB. Are ego-alien TC. Rarely are of a sexual nature FD. Are best treated by thought stopping FE. Usually respond to imipramine F

45. Electrical stimulation of the following causes anxiety:A. Vagus FB. Hypothalamus FC. Dorsal raphe nucleus FD. Locus coeruleus TE. Median raphe nucleus F

46. Obsessive rituals:A. Respond well to behaviour therapy FB. Are usually anti-social FC. Are not resisted FD. Are sensibly regarded FE. Reduce anxiety T

47. In psychogenic polydipsia:A. Polydipsia begins before polyuria TB. Vasopressin may relieve thirst FC. Urine flow decreases after hypertonic saline infusion TD. Urine concentration is greater after vasopressin than after fluid deprivation

F


E. Plasma osmolality is lower than normal T

48. Phobias have the following features:A. Viewed as negative compulsions TB. Can be reasoned away FC. Fear proportional to the threat FD. Described by Marks in 1929 FE. Involuntary T

49. The Ganser syndrome occurs in:A. Schizophrenia FB. Manic-depressive psychosis FC. Prisoners awaiting trial TD. Personality disorders FE. Hysteria F

50. Passivity experiences include:A. Made experiences TB. Occur in manic-depressive psychosis FC. Include echo de la pensee FD. Are recognized in obsessional neurosis FE. Exclude thought broadcasting F

51. Characteristic features of anorexia nervosa include:A. Normal BMR FB. Hypothermia TC. Lanugo hair TD. Hypertension FE. Phobia of normal body weight T

52. Agoraphobia is:A. Better treated by flooding than systematic desensitization TB. Mainly seen in middle age TC. A fear specific to open spaces FD. Commoner in women TE. Commonly associated with depersonalization T

53. The experience of depersonalization is:A. Usually pleasant FB. Delusional FC. Recognized as ‘odd’ TD. Treatable with phenobarbitone FE. Recognized as ‘false’ T


54. Animal phobias are:A. Commoner in men FB. Usually occur in middle age FC. Generally non-specific FD. Treatable with behaviour therapy TE. A poor diagnostic group F

55. Anaclitic depression is characterized by:A. Infants deprived of mother in early life TB. Initial vigorous protest TC. Severe despair TD. A phase of detachment TE. A predisposition to manic-depressive psychosis F

56. Social phobia:A. Is usually specific to a few individuals FB. Has an equal sex distribution FC. Is as common as agoraphobia FD. Usually develops before puberty FE. Responds poorly to behaviour therapy F

57. The following statements are true:A. Autoscopy is synonymous with phantom mirror-image TB. Reflex hallucinations occur outside sensory field limits FC. Functional hallucinations are experienced with their stimulus TD. In extra-campine hallucinations, a stimulus in one sensory field produces a hallucination in another

F

E. Functional hallucinations are rare in chronic schizophrenia F

58. Features of shell-shock include:A. Depersonalization TB. Guilty ideation of delusional intensity FC. Derealization TD. Reliving the battle TE. Calmness F

59. The following statements are true:A. Koro is an acute anxiety state TB. Latah is an hysterical reaction to stress TC. Windigo is a depressive psychosis TD. Susto is an hysterical dissociation or depressive state FE. Amok is an acute anxiety state F

60. Auditory pseudohallucinations occur in:A. Schizophrenia F


B. Hysteria TC. Manic-depressive states FD. Drug-induced states TE. Phobic anxiety state F

61. The following statements are true in schizophrenia:A. Schism describes hostility between parents TB. Skew describes a dominant mother and a submissive father TC. Invalidation describes denial of feelings of family members TD. Praecox feeling refers to empathic rapport with the patient TE. Pseudomutuality is a method by which a family system maintains equilibrium

T

62. Evidence for formal thought disorder includes:A. Inflexibility of personal constructs FB. Knight’s move thinking TC. Loosening of personal constructs TD. Nominal aphasia FE. A normal repetory grid F

63. The revolving-door syndrome:A. May be due to cerebellar-vestibular dysfunction FB. Is part of the revolving-room syndrome FC. Refers to the cyclical re-admission of institutionalized patients TD. Generates impressive ‘statistics’ for ‘patient care’ TE. Rotates patients between system components with adequate care F

64. Schizophrenic thought disorder includes:A. ‘Woolly’ thinking TB. Blurring of conceptual boundaries TC. Paranoid delusions FD. Omission TE. Substitutions T

65. Delusions:A. Are held with a certainty that may be shakeable FB. Are reality for the patient TC. Are frequently held by other people FD. Are rarely of personal significance TE. Are usually of a bizarre nature F

66. The following statements are true:A. Mannerisms are non-goal directed repetitive movements FB. Stereotypes are goal directed repetitive movements FC. Opposition is an extreme form of negativism F


D. Athetosis consists of random, jerky movements FE. Chorea consists of slow, writhing movements F

67. In Huntington’s chorea:A. Athetoid movements are usual presenting signs FB. Gross personality change is very unusual FC. Children have a less rapid deterioration FD. The onset of symptoms is usually in childhood FE. 75 % of affected person’s children develop the disease F

68. Illusions include:A. Macropsia TB. Derealization TC. Misinterpretations FD. Depersonalization TE. Micropsia T

69. Features of the Gilles de la Tourette syndrome include:A. Echolalia TB. Coprolalia TC. Coprophagia FD. Flatus FE. Echopraxia T

70. Eidetic images:A. Have been described by Taylor TB. Are visual hallucinations FC. Have never been perceived in relation to a real object FD. May be thought of as ‘photographic memory’ TE. Are a form of exterocepted visual pseudohallucinations T

71. With regard to psychiatric illness in general practice:A. Hysteria is very common FB. Anxiety is relatively uncommon FC. Psychotic illness is not usually referred FD. 50 % of neurotic illness is usually referred FE. Personality disorder is more common than depression F

72. Pseudohallucinations occur in:A. Dreams during sleep FB. Lone prisoners TC. Dreams whilst awake TD. Long distance lorry drivers TE. Sensory deprivation T


73. Treatment of postpartum ‘blues’ includes:A. Antidepressant medication FB. Reassurance only FC. Hypnotic medication FD. Performing a dexamethasone suppression test FE. Involvement of the husband in helping his wife T

74. Verbigeration occurs in:A. Extreme anxiety TB. Ganser syndrome FC. Senile dementia TD. Malingering FE. Catatonic schizophrenia T

75. The following associations are correct:A. Cameron and concrete thinking FB. Schneider and condensation FC. Bleuler and drivelling FD. Goldstein and over-inclusive thinking FE. Bleuler and loosening of associations T

76. The following statements are true:A. Delusions are ego involved TB. Redundancy refers to the predictability of a word appearing TC. Delusions are idiosyncratic TD. Schizophrenic thought has a high level of redundancy FE. Paranoia is another name for paraphrenia F

77. The characteristic hallucinations in alcoholic hallucinosis are:A. Visual TB. Tactile FC. Olfactory FD. Auditory TE. Gustatory F

78. Common associations with anorexia nervosa include:A. Abnormal gastric motility FB. Lassitude FC. Primary amenorrhoea FD. Early morning waking TE. Bulimia T

79. Phantom limb experiences:A. Only occur following limb amputation T


B. Include tactile hallucinations TC. The phantom limb always corresponds in size to the previous limb FD. Occurs in 95 % of all amputations after the age of 6 years TE. Are a presenting feature of schizophrenia F

80. The following are true of culture-bound disorders:A. Latah features penile-retraction into the abdomen FB. Piklokto is a dissociative state in Eskimo women TC. Windigo involves mutation into a cannibalistic monster TD. Koro features automatic obedience, echolalia, and echopraxia FE. Susto involves loss of the soul T

81. Features of normal pressure hydrocephalus include:A. HeadacheB. Memory impairmentC. PapilloedemaD. Physical and mental retardationE. A frequently abnormal EEG

82. Features of Pick’s disease may include:A. Fatuous moodB. ApathyC. General euphoriaD. A frequently abnormal EEGE. Preservation of intellect

83. Features of Alzheimer’s disease might include:A. Anxious moodB. DepressionC. Specific abnormalities on EEGD. A deficiency of GABAE. A deficiency of serotonin

84. Neologisms occur in:A. Manic-depressive psychosisB. Obsessional neurosisC. Organic brain diseaseD. Gilles de la Tourette syndromeE. Schizophrenia

85. Complications of chronic alcoholism may include:A. Paraesthesia and pain in the extremitiesB. An abnormal pyruvate tolerance testC. Weakness of the limbsD. Osteoporosis


E. A decrease in erythrocyte transketolase activity

Neurotic, Stress-related, and somatoform disorders

1. The following are true in anxiety:A. Heart rate shows reduced deceleration after stress TB. There is less beat-to-beat variation in heart rate FC. Increased skin conductance TD. Increased central NA and 5-HT activity TE. Imipramine can induce panic in some people F

2. In hyperventilation there is:A. Bronchodilation FB. Exaggerated sinus rhythm TC. Vasodilation of cerebral arteries FD. Reduced availability of oxyhaemoglobin TE. Irritability of the autonomic nervous system T

3. The following are associated with phobic anxiety disorders:A. Enuresis TB. Sexual problems TC. Schizophrenia FD. Dependent personality traits TE. Major depressive disorder F

4. In agoraphobia:A. A common fear can be confinement TB. Women are affected more than men TC. Panic attacks are uncommon FD. Mean age of onset is in the teens FE. The majority of sufferers are unmarried F

5. In agoraphobia:A. 1st degree relatives of sufferers of panic disorder are at an increased risk of agoraphobia

F

B. Lifetime prevalence is 20 % F


C. Patients tend to have a more unstable home background TD. About 40 % of patients have depression or dysthymia TE. There is an association with social phobia T

6. Regarding social phobia:A. Age of onset is in the late 30s FB. Men are affected more than women FC. Alcohol abuse is more common than in other phobias TD. Six month prevalence is about 5 % FE. There is a possible genetic link T

7. In social phobia:A. Dopamine activity may be abnormal TB. There is a reported association with mitral valve prolapse FC. MAOIs are effective treatments TD. Buspirone is as effective as MAOIs FE. Secondary depression may occur T

8. Regarding specific phobias:A. They are more common in women TB. More men suffer from needle phobias FC. Age of onset is usually in late adolescence FD. They can be under voluntary control FE. Avoidance is uncommon F

9. Regarding specific phobias:A. Boys are more likely to grow out of their phobias TB. Females suffer from animal phobias more commonly FC. Illness phobia is characterized by resistance FD. Blood phobia often has a family history TE. Classical conditioning is not thought to be involved F

10. Space phobia:A. Tends to develop in the late 20s FB. Is frequently accompanied by depressive illness FC. Is associated with a stable personality TD. Nystagmus is frequently to the left TE. Dizziness can occur on turning the head to the right T

11. Panic disorder:A. Has a lifetime prevalence of up to 3 % TB. Average age of onset is 25 TC. Has an equal sex ratio FD. Is usually due to responses to a recognizable danger FE. Anxiety is common between attacks F


12. The following substances can induce panic attacks:A. Flumazenil TB. Cholecystokinin TC. Sodium Lactate TD. Yohimbine TE. MCCP T

13. The following are true in panic disorder:A. There is an association with separation in early life TB. Cognitive behavioural therapy is seldom used FC. Antidepressants may cause over-stimulation during initial treatment

T

D. PET scanning shows abnormalities in the right para-hippocampal area

T

E. Panic attacks are seen psychoanalytically to involve reaction formation

F

14. Generalized anxiety disorder (GAD):A. Is characterized by “free-floating” anxiety TB. Has equal sex prevalence FC. Can present at any age TD. Is more common in the third decade TE. Seldom occurs with depressive symptoms F

15. Regarding the aetiology of GAD:A. GABA dysfunction has been implicated TB. Has no genetic predisposition FC. Has no association with mitral valve prolapse FD. Psychoanalytic theories suggest that anxiety is a symptom of unfulfilled ego desires

F

E. Male relatives of sufferers are more likely to misuse opiates F

16. The following suggest a poorer prognosis:A. Syncopal episodes TB. Hysterical features TC. Openness to therapy FD. Derealization TE. Hysterical features T

17. The Neurodevelopmental subtype of OCD is associated with:A. Late onset of disorder FB. More common in males TC. Less incidence of neurological signs FD. Eating disorders F


E. Good response to SSRIs F

18. The Primary subtype of OCD is associated with:A. Episodic course TB. Mood and anxiety symptoms TC. More severe FD. More common in females TE. Frontal neuropsychological deficits T

19. The following are characteristic of obsessions and compulsions:A. Recognized as originating from outside of the body FB. Resistance to all thoughts or acts FC. With compulsive acts, the act must be a purposeful one TD. Acts can be performed without a set of rules FE. The thoughts or impulses do not have to be unpleasant F

20. Regarding obsessional thoughts, acts, etc.:A. Obsessional images have the quality of hallucinations FB. Obsessional convictions may be delusional in intensity TC. Handwashing is more common in women TD. Obsessional slowness is more common in men TE. Carrying out compulsive rituals results in an increase in anxiety F

21. Regarding obsessive compulsive disorder:A. There is equal sex prevalence TB. Women present later than men FC. Mean age of onset is 20 years TD. Patients tend to present quickly to psychiatric services FE. Studies have shown a cumulative age effect F

22. The following statements about the aetiology of OCD are true:A. MZ concordance suggests a genetic link TB. Abnormal 5-HT function has been identified TC. Many Tourette’s syndrome patients have obsessional symptoms TD. One fifth of OCD patients have tics TE. GABA function is abnormal F

23. The following processes occur in OCD according to psychoanalytic theory:A. Isolation TB. Projection FC. Reaction formation TD. Ambivalence T


E. Denial F

24. Personality traits associated with OCD include:A. High expectations of unpleasant outcomes TB. Anankastic traits TC. Antisocial traits FD. Perfectionism TE. Erroneous perception of threat T

25. Brain imaging shows:A. Increased blood flow in the caudate nucleus TB. Decreased blood flow in the cingulate gyrus FC. Orbitofrontal cortical hypoperfusion FD. Reduced size of caudate nucleus TE. Normalization of findings with pharmacotherapy T

26. The following treatments can be used to treat OCD:A. Response prevention TB. Thought stopping TC. Behavioural therapy is especially effective for obsessional thoughts

F

D. Clomipramine TE. Subcaudate tractotomy T

27. Regarding Post-traumatic Stress Disorder (PTSD):A. Only occurs at a young age FB. Can be diagnosed if symptoms occur 9 months after a major trauma

F

C. Re-experiencing the event, increased arousal, and persistent avoidance are the key symptoms

T

D. A higher prevalence is reported in males FE. Hypersomnia is a common symptom F

28. The following are associated with increased vulnerability to PTSD:A. Childhood trauma TB. Heavy alcohol intake TC. Family psychiatric history TD. Antisocial personality traits TE. Recent stressful life changes T

29. The following have been reported in PTSD:A. Decreased urinary catecholamines FB. Impaired long-term memory FC. Reduced hippocampal volume T


D. Reduced response of the Noradrenaline systems FE. Increased blood and urinary cortisol in chronic PTSD F

30. In Dissociative disorders:A. Primary gain is the benefit that is conferred by the symptoms FB. A clear connection with stressful events is needed for the diagnosis to be made

T

C. Freud proposed that the disorder was due to repressed ideas TD. Kretschmer suggested a role for ‘reflex’ biological mechanisms TE. Are synonymous with Briquet’s syndrome F

31. Dissociative amnesia:A. Is more common in women TB. Is more common in older adults FC. Is associated with multiple sclerosis TD. Is associated with epilepsy TE. There is no history of recent traumatic events F

32. Somatform disorders:A. Is the same as Briquet’s syndrome FB. Can include Da Costa’s syndrome TC. Have equal sex prevalence FD. Includes irritable bowel syndrome TE. Include hypochondriacal disorder T

33. Somatization disorder:A. Usually presents after teenage years FB. Is comorbid with alcoholism TC. Is comorbid with personality disorder TD. The ‘sick role’ was described by Mechanic FE. Illness behaviour was described by Pilowsky T

34. Hypochondriacal disorder:A. Is more common in women FB. Age of onset is usually in the 40s FC. Is frequently comorbid with anxiety and depressive illness TD. Has an increased incidence of suicide FE. Brain imaging shows marked abnormalities F

Alcohol and Drug Misuse

1. The following are characteristic of Alcohol Dependency Syndrome as described by Edwards:


A. Tolerance TB. Withdrawal symptoms TC. Narrowing of repetoire TD. Desire for need to help FE. Salience of drinking T

2. Regarding the epidemiology of alcohol dependence:A. Equal sex prevalence FB. Women tend to present later TC. Women are more likely to develop physical complications TD. Higher rates in the divorced or separated TE. Lower rates in ‘middle’ social groups T

3. The following are true:A. Higher rates of alcoholism among 1st degree relatives of alcoholics

T

B. Higher rates of childhood conduct disorder TC. Adopted sons of alcoholics have no greater risk of developing the disorder

F

D. Associations with the D2 receptor TE. Association with antisocial personality disorder T

4. The following biochemical effects of alcohol are recognized:A. Dopamine release in the nucleus basalis FB. 5-HT antagonism FC. Potentiation of NMDA receptor channels in glutamate receptor FD. Inhibition of GABA receptor complex FE. Craving may be due to Dopamine release T

5. The following are complications of alcohol misuse:A. Gastric carcinoma TB. Colorectal carcinoma TC. Diabetes mellitus TD. Renal agenesis FE. Zieve’s syndrome T

6. The following are recognized neurological complications of alcohol misuse:A. Central pontine myelinolysis TB. Auditory hallucinations in clear consciousness TC. Extra-campine hallucinations FD. Optic atrophy TE. Peripheral neuropathy T

7. The following are features of the Foetal Alcohol Syndrome:


A. Normal IQ FB. Renal abnormalities TC. Cleft palate TD. Congenital heart disease TE. Macrocephaly F

8. The following are recognized psychiatric complications of alcohol misuse:A. Major depressive illness TB. Suicide TC. Schizophrenia TD. Morbid jealousy TE. Dementia T

9. The following are characteristic of Wernicke’s encephalopathy:A. Clouding of consciousness TB. Visual hallucinations FC. Ataxia TD. Ophthalmoplegia TE. Hypertension F

10. Features of Korsakoff’s psychosis may include:A. Amnesia TB. Higher prevalence in women FC. Orientation FD. Confabulation TE. Later onset in women F

11. Structures affected by Korsakoff’s syndrome typically include:A. Nucleus accumbens FB. Mamillary bodies TC. Floor of the third ventricle FD. Thalamic nuclei TE. Frontal lobes T

12. Features of alcoholic pellagra encephalopathy may include:A. Due to niacin deficiency TB. Seizures FC. Confusion TD. Hypersomnia FE. Clasp-knife rigidity F

13. Regarding the epidemiology of drug misuse:


A. More common in men TB. Most cases begin after the age of 18 FC. Most people present after 6-12 months of continuous use FD. Around 15 % of opiate addicts have attempted suicide TE. 75 % of addicts meet criteria for another psychiatric diagnosis T

14. The following have been suggested in the aetiology of drug misuse:A. Abnormalities of 5-HT systems TB. Secondary reinforcement TC. ‘Peer group activation’ TD. Projection FE. Reaction formation F

15. The following statements are true:A. Cocaine acts on the 5-HT system FB. Hallucinogens increase dopamine activity FC. PCP acts on the gluatamate receptor TD. Ecstasy is a 5-HT agonist FE. Cannabinoids bind to the GABA receptor F

16. Features suggestive of a poor outcome in drug misuse may include:A. Episodic use FB. Antisocial personality disorder TC. Late onset of abuse FD. Short history of use FE. Early drop-out from maintenance programs T

Personality disorder

1. According to Kretschmer:A. Pyknic types were prone to manic depression TB. Athletic types were more likely to develop schizophrenia FC. Asthenic types were linked with criminality FD. Athletic types were more likely to develop epilepsy T


E. Asthenic types were more likely to develop a depressive illness F

2. The following incidences among the general population are correct:A. Paranoid personality disorder: 2 % TB. Schizoid personality disorder: 0.5 % TC. Antisocial personality disorder: 3 % of males TD. Borderline personality disorder: 3 % TE. Histrionic personality disorder: 2 % T

3. The following are true:A. Antisocial personality disorder is more common in prisons TB. Narcissistic personality disorder is more common in women FC. Borderline personality disorder has equal sex prevalence FD. Avoidant personality disorder is more common in women FE. Dependent personality disorder has equal sex prevalence T

4. The following are features of paranoid personality disorder:A. Excessive sensitivity to setbacks TB. Tenacious sense of personal rights TC. Indifference to praise and criticism FD. Jealousness TE. Lack of close friendships F

5. The following are features of schizoid personality disorder:A. Humourless TB. Mistrustful FC. Detached TD. Unconventional TE. Unpredictability F

6. The following are features of antisocial personality disorder:A. Irresponsible TB. Explosive in nature FC. Difficulty establishing relationships FD. Lack of guilt TE. Blames self excessively F

7. In antisocial personality disorder:A. There is an increased incidence among MZ twins TB. There is a link with brain injury in childhood FC. EEG abnormalities can be observed TD. There are low levels of 5-HIAA in the CSF of violent individuals TE. Frontal lobe abnormalities are common F


8. The following are features of borderline personality disorder:A. Quarrelsome TB. Poor self image TC. Unstable mood TD. Stable relationships FE. Desultory T

9. The following are features of histrionic personality disorder:A. Shallow and labile affectivity TB. Vanity TC. Pedantic FD. Afraid to trust FE. Said to be due to oedipal conflicts T

10. The following are features of anankastic personality disorder:A. Fear of rejection FB. Dependence FC. Orderliness TD. Preoccupation with productivity TE. Pedantic T

11. The following are features of avoidant personality disorder:A. Restricted life TB. Social avoidance TC. Excessive cautiousness FD. Conscientiousness FE. Afraid to trust others F

12. The following are features of dependent personality disorder:A. Needs admiration FB. Fear of not coping TC. Feelings of helplessness TD. Exploits others FE. Envy of others F


Suicide and Deliberate Self Harm

1. The following are true:A. Durkheim wrote about ecological views on suicide FB. Esquirol suggested a psychiatric viewpoint on suicide TC. Durkheim suggested altruistic, egoistic, and analytic types of suicide

F

D. Thomas Browne coined the term ‘suicide’ TE. In the Health of the Nation UK 1992, the Government set out plans to reduce suicide in the mentally ill by 15 %

F

2. Associations of suicide include:A. Unemployment TB. High rates in winter months FC. Highest rates in lowest social group FD. Low rates in upper social class FE. Increased rates in vets T

3. Increased rates have been reported with:A. Renal dialysiss TB. SLE TC. Epilepsy TD. Patients with high cholesterol FE. Peptic ulcer T

4. Features contributing to higher rates among the prison population include:A. Prisoners convicted of minor crimes FB. Prisoners on remand TC. Previous psychiatric history TD. Short sentence FE. Hanging is least common method F

5. Risk factors in depression include:A. Panic attacks TB. Delusions TC. Persistent insomnia TD. Hopelessness TE. Agitation T

6. Risk factors in schizophrenia include:A. Older patient FB. Low level of premorbid function FC. Ongoing psychosis FD. Akathisia T


E. Short duration of illness F

7. Risk factors in alcohol dependence include:A. Female FB. Younger age (less than 40) FC. Period of abstinence prior to attempt FD. Unemployment TE. Currently married F

8. Risk factors in neurotic illness include:A Obsessive compulsive disorder FB. Panic disorder TC. Anorexia TD. PTSD TE. Bulimia T

9. DSH is more common in:A. Females TB. Lower social classes TC. Asian subcultures TD. Rural areas FE. Over 35 years F

10. Predictors of repetition of DSH include:A. Male sex FB. Personality disorder TC. Alcoholism TD. Previous DSH TE. Intact personality F

Eating Disorders

1. The following are true in anorexia:


A. Females outnumber males by 2:1 FB. Increased incidence in lower social classes FC. More common in occupations associated with food preparation FD. Co-morbidity with depressive illness TE. Incidence rising in recent years T

2. The following have been suggested as aetiological factors in AN:A. Hypothalamic dysfunction TB. Decreased 5-HT activity FC. Regression into pre-puberty TD. Failure to develop autonomy TE. Need to maintain family status quo T

3. Complications of AN include:A. Deranged LFTs TB. Pancreatitis TC. Leucocytosis FD. Cardiomegaly FE. Cerebral atrophy F

4. The following are seen in AN:A. Increased testosterone FB. Decreased Growth hormone FC. Reduced cortisol FD. Lowered cholesterol FE. Increased gonadotrophin F

5. Predictors of poor outcome include:A. Late age of onset TB. Low premorbid body weight FC. Male TD. Short duration of illness FE. Bulimic behaviour T

6. Bulimia nervosa:A. Is more common than AN TB. Has earlier age of onse than AN FC. Is co-morbid with AN TD. Is more common in women TE. Affects up to 1 in 20 men F

7. Physical complications of BN include:A. Renal impairment TB. Seizures T


C. Tetany TD. Cardiac atrophy FE. Muscular weakness T

8. Associations of BN may include:A. Deliberate self harm TB. Child sexual abuse TC. Decreased 5-HT activity TD. Low rates of familial psychiatric illness FE. Depression T

Sleep Disorders

1. The following are associated with wakefulness:A. Hypothalamus TB. TRH TC. 5-HT FD. Somatostatin FE. Noradrenaline T

2. The following are associated with sleep:A. Acetylcholine FB. GABA TC. Raphe nuclei TD. TRH FE. CRH F

3. During sleep:A. GH falls FB. Prolactin rises TC. Cortisol is released FD. Blood pressure is lowest during REM sleep FE. Pulmonary arterial blood pressure falls F

4. The following are true:


A. Sleep spindles occur during stage 1 FB. K complexes occur during stage 2 TC. Nocturnal enuresis is most likely during stage 2 FD. Delta waves can be seen during stages 3 and 4 TE. REM sleep shows high voltage activity F

5. Insomnia:A. Is more common in men FB. Is more common in lower socio-economic groups TC. Is co-morbid with psychiatric illness TD. Is less common in the young TE. Is less common among the separated F

6. The parasomnias include:A. Sleep apnoea FB. Somnambulism TC. Sleep paralysis TD. Jet lag FE. Narcolepsy F

7. Narcolepsy:A. Commonly involves sleep paralysis TB. Hypnagogic hallucinations are common TC. Onset is frequently in middle age FD. The condition often runs in families TE. REM latency at night is frequently seen T

8. The Kleine-Levin syndrome:A. Most cases are in middle-aged men FB. Incontinence during sleep is frequent FC. Visual and auditory hallucinations can occur TD. Plantare reflexes are always normal FE. EEG is abnormal F

9. Somnambulism:A. Has equal sex prevalence FB. Occurs during REM sleep FC. Is associated with enuresis TD. Is commonly seen between the ages of 5 and 12 TE. Never runs in families F

10. In depression:A. There is shortened REM latency TB. There is more REM activity in the second half of the night FC. Antidepressants destroy REM sleep T


D. There is increased slow wave sleep FE. REM sleep rebound occurs after treatment stops T

11. Alcohol:A. Decreases sleep latency TB. Decreases REM sleep TC. Decreases deep sleep FD. Decreases REM sleep in the second half of the night FE. Exacerbates sleep walking T

12. The following are true:A. Schizophrenia is associated with reduced REM sleep TB. Panic disorder is associated with reduced sleep latency FC. Anxiety is associated with reduced stage 1 and 2 sleep FD. REM sleep is reduced in alcoholism FE. REM sleep occurs earlier in the night in depression T

1. The following statements regarding conditioning experiments are correct :a) Operant conditioning may be understood in terms of perceptual

expectanciesb) Intermittent reinforcement in operant conditioning leads to greater

resistance to extinction than continuous reinforcementc) Punishment leads to the diminished probability of the occurrence of a

responsed) The proper control procedure for classical conditioning is one in which

the CS is always presented without the USe) Negative reinforcement is synonymous with punishmentf) Extinction is the process of gradual disappearance of a conditioned

response on discontinuation of an unconditional stimulus2. Classical conditioning takes place irrespective of :

a) The time condition between conditioned stimulus and unconditioned stimulus

b) The genetic potential of the organismc) The organism’s voluntary behaviourd) The schedule of reinforcemente) The nature of the unconditioned stimulus

3. The following statements are true therapies based on exposure and habituation :a) Implosive therapy is synonymous with floodingb) In anxiety disorders, the stronger the conditioned emotional response,

the shorter duration is required for exposure treatmentc) The phenomenon of incubation means that anxiety can arise

spontaneously during exposure therapyd) The success of systematic desensitization for phobias can be explained

by Kamin’s principle of blocking


e) Higher order conditioned responses usually require longer exposure for habituation to occur


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