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Paper 3 EMIs 2005
EMIs from Autumn 2005
SET 1
EMI 1
OPTIONSIncreased physical dependenceBeing in an institutionMale patientMale carerDementiaBeing married to carer
Previous poor relationship with carer
QUESTIONS1) 3 risk factors for abuseDementiaPrevious poor relationship with carerBeing in an institution
2) 3 risk factors for depressionMale patientIncreased physical dependence
Dementia
3) 2 risk factors for carer exhaustionPrevious poor relationship with carerDementia
EMI 2
OPTIONSCitalopramEscitalopram
QuetiapineRisperidoneReboxetineFluoxetineLithiumLamotrigineSertralineDesipramine
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QUESTIONS1) Best treatment for a boy with OCDFluoxetine
2) A man with OCD and depression. Which 2 drugs would he NOT respond to
ReboxetineDesipramine3) Pick 2 add in treatments for a man not responsive to first line treatment
LithiumRisperidone
SET 2EMI 3DRUG CHOICE
A) Flupentixol depotB) RisperidoneC) OlanzapineD) ClozapineE) QuetiapineF) Haloperidol1. Older schizophrenic women, DM, agreed to take medication but irregular compliance andpsychotic. When son reminded her, end up in a quarrel.A) Flupentixol depot2. Psychotic elderly man, persistent psychotic symptoms, not tolerating oral flupentixol. Notresponding to sulpiride and olanzapine.D) Clozapine3. Case of Parkinsons disease. Not on anti-PD drug and antipsychotic nave. Distressed byVH.E) Quetiapine
EMI 4
OLD AGE PSYCHIATRYA) Living in instituteB) Living with another personC) Male carerD) Male patientE) Higher physical dependence in patientF) History of poor relationship with carerG) Carer married to patientH) Diagnosis of dementia
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1. Risk for non-accidental injury from carer (choose 2)A) Living in instituteF) History of poor relationship with carer
2. Risk for carer distress / depress (choose 3)H) Diagnosis of dementiaF) History of poor relationship with carerE) Higher physical dependence in patient
3. Risk for depression of elderly (choose 3)D) Male patientH) Diagnosis of dementiaE) Higher physical dependence in patient
EMI 5STATISTICSA) Chi-square testB) McNemar testC) Fisher's exact testD) Cluster analysisE) ANCOVAF) ANOVAG) Multiple regression
1. Demonstrate association of height (parametric) and ASPD (choose 3)F) ANOVAA) Chi-square testC) Fisher's exact test
2. Relation of conduct disorder and ASPD (choose 2)A) Chi-square testC) Fisher's exact test
3. ASPD vs height and IQ (height and IQ correlated) (choose 2)B) McNemar testF) ANOVA
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EMI 6MEDICATION / MANAGEMENTA) Citalopram
B) DesipramineC) EscitalopramD) FluoxetineE) ReboxetineF) QuetiapineG) SertralineH) Risperidone1. 11 year old developed OCD for 6 months and later depressed mood. (choose 1)D) Fluoxetine
2. OCD in a teacher with sexual obsessions, unlikely to have that antidepressant drug (choose 2)
D) Fluoxetine3. OCD child with SSRI for some time but still Obsessive compulsive behaviour with motor tics.(choose 2)H) RisperidoneD) Fluoxetine
EMI 7MEDICATION / MANAGEMENTA) CardiomyopathyB) Diabetes mellitusC) Lithium toxicityD) Diabetes insipidusE) Serotonin syndromeF) Neuroleptic Malignant SyndromeG) HypothyroidismH) Pulmonary embolismI) HyperthyroidismQuestions:1. Schizophrenia on clozapine. Developed palpitation, SOB and tachycardia. (choose 1)A) Cardiomyopathy
2. BAD on Li, developed polyuria, polydispia and lethargy. Raised sodium level and clinicallydehydrated. (choose 1)D) Diabetes insipidus
3. Started on olanzapine for few days, noticed rigidity, confusion and sweating. (choose 1)F) Neuroleptic Malignant Syndrome
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EMI 8DRUGSCytochrome P450 enzyme inductionEffect on striatal D2 receptor
Effect on meso-limbic D2 receptorEffect on 5HT2 receptorEffect on 5HT3 receptor1. Started St Johns wort and later pregnant despite taking OC pill (choose 1) CytochromeP450 enzyme induction2. On antipsychotic and developed EPSE (choose 1) Effect on striatal D2 receptor3. On fluoxetine, started on Li and became confused (picture of serotonin syndrome). (choose 1)Effect on 5HT2 receptor
EMI 9
BIOCHEMICALA) HyperglycemiaB) HypoglycemiaC) HyponatremiaD) HyperthyroidismE) HyperkalemiaF) Hypercalecemia1. Alcoholism, after binge-drinking, anxious and confused in A&E (choose 1) B) Hypoglycemia2. Depressed middle age gentleman complained of lethargy, nausea, muscle cramp. Recentlystarted on paroxetine (choose 1) C) Hyponatremia3. Schizophrenic patient on clozapine/olanzapine complained of abdominal pain and confusion(choose 1) A) Hyperglycemia[edit]
EMIs from Spring 2005
SET 1EMI 1SIDE EFFECTS1) Neuroleptic malignant syndrome2) Serotonin syndrome3) Diabetes insipidus
4) Diabetes mellitus5) Lithium toxicity6) Hyperthyroidism7) Hypothyroidism8) Cardiomyopathy9) Pulmonary embolusChoose ONE
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1) A lady on lithium for 2 years comes to see you with polyuria, polydipsia, ankle swelling andlethargy. She looks dehydrated and has high sodium.3) Diabetes insipidus
2) A man has been started on Olanzapine. He is found on the ward febrile with labile blood
pressure and increased muscle tone.1) Neuroleptic malignant syndrome
3) A 24 year old man who has been stable on Clozapine for 2 years comes to see you withlethargy, breathlessness and palpitations.8) Cardiomyopathy
EMI 2
CHILDHOOD BEHAVIOURAL DISORDERS1) Methylphenidate
2) Paroxetine3) Venlafaxine4) Logotherapy5) Parenting skills6) Lithium7) Family therapyChoose ONE1) A 4 year old girl who is aggressive towards her mother and has punched her in the stomach onone occasion. She is 'difficult' and refuses to do what she is told.5) Parenting skills
2) A 17 year old boy who has a history of explosive violence and has got in to trouble with thePolice. Otherwise he has no symptoms.7) Family therapy
3) A 13 year old girl has been diagnosed with hyperkinetic disorder by a psychologist. She ishaving systemic therapy but is still hyperactive with poor concentration.1) Methylphenidate
EMI 3THE EEG related to Old Age psychiatric problems1) Normal EEG2) Preserved alpha waves over the occiput in the context of generalised slowing3) Alpha waves >8Hz4) Spike and wave5) Paroxysmal frontal lobe discharge6) Increased Beta Rhythm7) Decreased Beta Rhythm1) A 75 year old woman who has got mroe forgetful over the last 2 year (CHOOSE TWO)
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Decreased Beta RhythmParoxysmal frontal lobe dischargehttp://66.102.9.104/search?q=cache:GhPcdqVmPYcJ:www.emedicine.com/neuro/topic109.htm+Pick%27s+dementia+beta+rhythm&hl=en&ct=clnk&cd=11&gl=pk
Quote "The electrophysiological correlate of polymyoclonus that can be seen in AD and otherpathological states is a bifrontal negativity in the EEG that precedes the myoclonic jerk. Thisnew type of electrophysiological correlate of myoclonus may reflect activity of a subcorticalgenerator".
2) An 80 year old man who has got more miserable and is not sleeping or eating (CHOOSETWO)Normal EEGIncreased Beta Rhythm
3) A 70 year old man who has episodic behavioural change and has started shoplifting(CHOOSE 1)Preserved alpha waves over the occiput in the context of generalised slowingDecreased Beta Rhythm
EMI 4SYNDROMES ASSOCIATED WITH LD1) Rett's syndrome2) Angelman's syndrome3) Down's syndrome4) Prader-Willi syndrome5) Cri du chat syndrome6) Cornelia de Lange syndrome7) Lesch Nyhan Syndrome
Select the ONE most likely diagnosis1) A 4 year old girl with hand wringing and some loss of skillsRett's syndrome
2) A 2 year old boy with impulsive overeatingPrader-Willi syndrome
3) A 6 year old boy with self mutilation, something like bitting (1)Lesch Nyhan Syndrome
EMI 5
http://66.102.9.104/search?q=cache:GhPcdqVmPYcJ:www.emedicine.com/neuro/topic109.htm+Pick%27s+dementia+beta+rhythm&hl=en&ct=clnk&cd=11&gl=pkhttp://66.102.9.104/search?q=cache:GhPcdqVmPYcJ:www.emedicine.com/neuro/topic109.htm+Pick%27s+dementia+beta+rhythm&hl=en&ct=clnk&cd=11&gl=pkhttp://66.102.9.104/search?q=cache:GhPcdqVmPYcJ:www.emedicine.com/neuro/topic109.htm+Pick%27s+dementia+beta+rhythm&hl=en&ct=clnk&cd=11&gl=pkhttp://66.102.9.104/search?q=cache:GhPcdqVmPYcJ:www.emedicine.com/neuro/topic109.htm+Pick%27s+dementia+beta+rhythm&hl=en&ct=clnk&cd=11&gl=pkhttp://66.102.9.104/search?q=cache:GhPcdqVmPYcJ:www.emedicine.com/neuro/topic109.htm+Pick%27s+dementia+beta+rhythm&hl=en&ct=clnk&cd=11&gl=pkhttp://66.102.9.104/search?q=cache:GhPcdqVmPYcJ:www.emedicine.com/neuro/topic109.htm+Pick%27s+dementia+beta+rhythm&hl=en&ct=clnk&cd=11&gl=pk8/8/2019 Paper 3 EMIs
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ValidityNurse use screening in post-natal ward. select 8 with depression out of 9 having depressionNurse use screening in post-natal ward. select 80 people who do not have depression out of 100who don'tDiagnostic criteria from ICD-10 classification
80% of correlation between GHQ and Becks Depression InventoryNurses A and B check the figures and identify 8 people depressed out of 28 in totalSomething identified Alzheimer's disease well and unwell with some%Using consensus criteria in Lewy Body dementia agreed with neuropathological finding
1. Construct validity (2)Nurse use screening in post-natal ward. select 8 with depression out of 9 having depressionNurse use screening in post-natal ward. select 80 people who do not have depression out of 100who don't
2. Concurrent validity (1)Using consensus criteria in Lewy Body dementia agreed with neuropathological finding80% of correlation between GHQ and Becks Depression Inventory
3. Discrimnant validity (3)Diagnostic criteria from ICD-10 classificationNurses A and B check the figures and identify 8 people depressed out of 28 in totalSomething identified Alzheimer's disease well and unwell with some%
EMI 6Clinical; related to substance misuseCocaineAmphetamineCaffeineKetaminePhenylcyclidineMagic Mushroom (Psylobycin)Volatile substancesCannabisAlcohol
1. 17 year old man, drug abuse for 2 years, went to party last night. Developed tachycardia,dilated pupil, labile BP and mild respiratory depression. (2)AmphetamineAlcohol
2. A 19 year old factory worker with a history of various illicit drugs presented to A & E. He saidhe had a bad trip and on examination he has dilated pupils, tremors and sweating (Select 2options)
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G. Magic mushroomsJ. PhencyclidineRef. Puri and Hall p. 362
A 20 year old man presented to A & E with tachycardia, sweating, tremors and increase in
muscle tone, history of 2 seizures. He has a history of substance use (Select 2 options)A. AlcoholF. Benzodiazepines
EMI 7Defence MechanismsSplittingDenialDenigrationSublimationIdealization
RationalizationReaction formationProjective identification1. A patient who had taken large amytrityline overdoses 3 days ago and admitted to medicalward. SHO wsa asked to assessed him before discharge. SHO appeared very worried he will takeagain and anxious of discharging him. The patient was calm. (1)Denigration
2. A young adult who was found from case notes being neglected by his mother and deprived toinstitutional care. On asking, he felt his mother loved him very much. The reason of institutionalcare was due to money. (1)Denial
3. On a staff meeting, a staff received complaints from a patient. He was told the other day by thesame patient how great he was actually. (1)Splitting
EMI 8Sleep disordersCircadian rhythum disorderObstructive sleep aponeaNacrolepsy with cataplexpyA lot more options!
1. A 25 year old air-hostress finished her transatlantic flights. At daytime, she felt tired. At night,she cannot sleep. (1)Circadian rhythum disorder
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2. A middle-aged man developed daytime sleepiness. He was tired at daytime. His wife could notsleep together with him because of snoring. (1)Obstructive sleep aponea
3. A 30 year old lady cannot concentrate at daytime. She laughed and collapse suddenly likesomething. She had loss pf muscle tone. (1)Nacrolepsy with cataplexpy
EMI 1OptionsLiving in an institutionLiving alonePrevious poor relationship with carerMale carer
Male patientPatient has a diagnosis of dementiaCarer married to patientHigh physical dependency in the patientLead in: Choose the most common associated risk factors for the following:1. Carer stress Choose 2Previous poor relationship with carerPatient has a diagnosis of dementia
2. Depression Choose 1
Living alone
3. Non accidental injury from carer Choose 2Living in an institutionHigh physical dependency in the patient
EMI 2OptionsA ANOVA
B ANCOVAC Mann Whitney U testD Chi squared testE Fishers exact testF t testG paired t testH multiple regression
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In a trial where risk of antisocial personality dissorder is associated with height andIQ:1. Name 3 simple tests to look for relationship between IQ and ASPDD. Chi Squared test, C. Mann Whitney U-test, F. T-test
(Two variables, Categorical data which can be continuous as well, It can be paired orunpaired)2. Give 2 simple tests to look for relationship between (dichotomous variable that Ican't remember) and ASPDH. Multiple Regression and B. ANCOVA3. Is link IQ to ASPD just due to the effect of height (2)H. Multiple Regression and B. ANCOVA
EMI 3
A Family therapyB parent trainingC methylphenidateD lithiumE paroxetine1 A 4 year old thrown out of nursery for attacking other childrenB parent training2 a 17 year old with an order stopping him returning home due to explosive violenceagainst parentsA Family therapy3 An 11 year old diagnosis as hyperkinetic disorder by a psychologistC methylphenidate
EMI 4Theme: Cause of Learning DisabilityA Down syndromeB Fragile-X SyndromeC PhenlyketoneureaD ADHDE Prader Willi SyndromeF Rett's syndromeG Hurlers syndromeScenario: A 4 year old presenting with autistic features; select the most relaventcause / associated condition for the following. (Choose one option for each)1 Maternal uncle and grandfather had LDFragile-X Syndrome2 Difficulty in movements involving crossing midline.
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ADHD3 Binging on foodPrader Willi Syndrome
EMI 5
Theme: Defence MechanismsA Projective identificationB RationalisationC IdealisationD DenigrationE SplittingF DenialChoose one option for each of the following questions:1. A woman who has a history of self harm wants to go home. The SHO is anxiousand the patient is calm.D Denigration
2. A man with severe neglect and physical abuse as a child is taken into care. He sayshis mum was loving and he was only taken into care because of financial problems.F. Denial
3. A care assistant is confused when a patient puts in a complaint about her, who saidshe was the best carer in the world last week.
E Splitting
MIs from Autumn 2006
EMI 1
EEG CHANGES
A. Normal EEG
B. Reduced beta rhythm
C. Increased beta rhythm
D. Paroxysmal frontal lobe discharge
E. Spikes and waves
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F. Generalised slowing with conserved alpha rhythm frontally
G. Triphasic waves
1. An 80 old widower, miserable, not sleeping or eating, appears depressed (ChooseTwo)
A. Normal EEG
C. Increased beta rhythm
http://www.superego-cafe.com/forum/YaBB.pl?num=1156996276/19#19
http://www.superego-cafe.com/forum/YaBB.pl?num=1172989877/1#1
2. A 75 year old woman, gradually more forgetful over the past 2 years (Choose
Two)
B. Reduced Beta Rhythm
D. Paroxysmal frontal lobe discharge
http://66.102.9.104/search?
q=cache:GhPcdqVmPYcJ:www.emedicine.com/neuro/topic109 .htm+Pick%27s+dementia+beta+rhythm&hl=en&ct=clnk&cd=11&gl=pk
Quote "The electrophysiological correlate of polymyoclonus that can be seen in AD
and other pathological states is a bifrontal negativity in the EEG that precedes the
myoclonic jerk. This new type of electrophysiological correlate of myoclonus may
reflect activity of a subcortical generator".
3. A 70 year old man, with disinhibition, change in personality, mild memory
impairment (Choose Two)
B. Reduced beta rhythm
F. Generalised slowing with conserved alpha rhythm frontally
http://66.102.9.104/search?
q=cache:GhPcdqVmPYcJ:www.emedicine.com/neuro/topic109 .htm+Pick
%27s+dementia+beta+rhythm&hl=en&ct=clnk&cd=11&gl=pk
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Quote "Because the anterior cholinergic system is relatively preserved in Pick
disease, the EEG changes are not prominent frontally."
EMI 2
SIDE EFFECTS FROM MEDICATION
A. Cardiomyopathy
B. Diabetes Insipidus
C. Diabetes Mellitus
D. Lithium Toxicity
E. Hypothyroidism
F. Neuroleptic Malignant Syndrome
G. Pulmonary Embolism
1. Young man, stable on clozapine for 2 years complains for breathlessness,
lethargy and palpitations (one option)
A. Cardiomyopathy
2. Female stable on Lithium for 2 years presents with polyuria and polydipsia. She
looks confused, dehydrated and has high sodium levels (one option)
D. Lithium Toxicity
3. Young man started recently on Risperidone. He is found on the ward febrile with
labile blood pressure, increased muscle tone, sweating and confusion (one option)
F. Neuroleptic Malignant Syndrome
EMI 3
OBSESSIVE COMPULSIVE DISORDER
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A. Fluoxetine
B. Desipramine
C. Risperidone
D. Quetiapine
E. Sertraline
F. Lamotrigine
G. Reboxetine
H. Citalopram
J. Escitalopram
K. Lithium
1. A 15 year old child who has a 5 year history of OCD. He has been found
depressed in the past 6 months (one option)
A. Fluoxetine
2. A 30 year old man with severe OCD has been on 2 different antiobsessional
medications without a significant benefit. What would you suggest as an add-on
treatment (two options)
C,K
3. A 25 year old man with OCD. Which anti-depressants are not helpful (two options)
B, G
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EMI 4
MEDICATION IN CHILDREN
A. Atomoxetine
B. Methylphenidate
C. Melatonin
D. Fluoxetine
E. Diazepam
F. Clonidine
G. Carbamazepine
H. Sodium Valproate
1. A child with pervasive hyperactivity at school and home. Fidgety, hyperactive and
poor attention (three options)
Methylphenidate, Clonidine and Atomoxetine
2. Child with low mood, insomnia, loss of weight and loss of interest (one option)
Fluoxetine
3. 3 year old child with mild learning disability, now presenting with intractableinsomnia persisting even after behavioural intervention (two options)
Melatonin and Diazepam
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EMI 5
GROUP THERAPY
A. Sub-grouping
B. Pairing
C. Interpretation
D. Universality
E. Counterdependence
F. Dependence
G. Free floating discussion
1. Two characteristics of a psychodynamic orientated group
Free floating discussion
Pairing
2. Two features that improve outcome in group therapy
Interpretation and Universality
3. Two features that pose a problem in group therapy
A. Sub-grouping
F. Dependence
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EMI 1
Lesch Nyan Syndrome
Rett's Syndrome
Prader Willi Syndrome
Angelman's Syndrome
1. An 18 year old boy with repeated self harm
Lesch Nyhan Syndrome
http://66.102.9.104/search?
q=cache:ftEMY1ARJCYJ:www.autism.org/sibpaper.html+Sel
f+Injurious+behaviour+learning+disability+cause&hl=en&ct=clnk&cd=2&gl=pk
2. A 7 year old girl with handwringing
Rett's Syndrome
http://66.102.9.104/search?q=cache:G5h7GGXpSNEJ:www.minddisorders.com/Py-
Z/Rett- s-disorder.html+Hand+wringing+causes&hl=en&ct=clnk&cd=1&gl=pk
3. A 2 year old boy with compulsive eating
Prader Willi Syndrome
EMI 2
Options
Systemic Lupus Erythematosus
Huntington's Disease
Temporal Lobe Epilepsy
PCP (Phencyclidine) use
1. 45yr old homeless man with delusions, aggression, unsteady gait, increased tone
http://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://66.102.9.104/search?q=cache:ftEMY1ARJCYJ:www.autism.org/sibpaper.html+Self+Injurious+behaviour+learning+disability+cause&hl=en&ct=clnk&cd=2&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://66.102.9.104/search?q=cache:ftEMY1ARJCYJ:www.autism.org/sibpaper.html+Self+Injurious+behaviour+learning+disability+cause&hl=en&ct=clnk&cd=2&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://66.102.9.104/search?q=cache:ftEMY1ARJCYJ:www.autism.org/sibpaper.html+Self+Injurious+behaviour+learning+disability+cause&hl=en&ct=clnk&cd=2&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://66.102.9.104/search?q=cache:G5h7GGXpSNEJ:www.minddisorders.com/Py-Z/Rett-s-disorder.html+Hand+wringing+causes&hl=en&ct=clnk&cd=1&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://66.102.9.104/search?q=cache:G5h7GGXpSNEJ:www.minddisorders.com/Py-Z/Rett-s-disorder.html+Hand+wringing+causes&hl=en&ct=clnk&cd=1&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://66.102.9.104/search?q=cache:ftEMY1ARJCYJ:www.autism.org/sibpaper.html+Self+Injurious+behaviour+learning+disability+cause&hl=en&ct=clnk&cd=2&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://66.102.9.104/search?q=cache:ftEMY1ARJCYJ:www.autism.org/sibpaper.html+Self+Injurious+behaviour+learning+disability+cause&hl=en&ct=clnk&cd=2&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://66.102.9.104/search?q=cache:ftEMY1ARJCYJ:www.autism.org/sibpaper.html+Self+Injurious+behaviour+learning+disability+cause&hl=en&ct=clnk&cd=2&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://66.102.9.104/search?q=cache:G5h7GGXpSNEJ:www.minddisorders.com/Py-Z/Rett-s-disorder.html+Hand+wringing+causes&hl=en&ct=clnk&cd=1&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://66.102.9.104/search?q=cache:G5h7GGXpSNEJ:www.minddisorders.com/Py-Z/Rett-s-disorder.html+Hand+wringing+causes&hl=en&ct=clnk&cd=1&gl=pk8/8/2019 Paper 3 EMIs
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Huntington's Disease
2. A 25yr old man with a history of short lived episodes of bizarre behaviour
Temporal Lobe Epilepsy
3. A lady mild temperature, respiratory infections, lesions on shins
Systemic Lupus Erythematosus
EMI 3
Raclopride
Flumazenil
fMRI
T1MRI
1. Test used to monitor progression of Alzheimer's disease (3)
Flumazenil with PET
fMRI
T1 MRI
2. Hand dominance (2)
Flumazenil with PET
Raclopride with PET
3. Test used to measure neuronal loss (1)
T1 MRI
Set 2
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EMI 4
Options
Diabetes insipidus
Diabetes mellitus
Lithium toxicity
Hyperthyroidism
Hypothyroidism
Cardiomyopathy
NMS
Serotonin syndrome
Lead in: Choose the most appropriate drug adverse effect in the following
1. A 30 year old man who has been on Clozapine for the past 2 years presents with
palpitations, breathlessness and excessive tiredness.
Cardiomyopathy
2. A lady who has been stable on lithium for the past 3 years presents with polyuria,
polydipsia and lethargy. She also has hypernatremia and looks dehydrated.
Diabetes insipidus
3. A 26 year old man has been recently commenced on risperidone. He presents
with high fever, increased muscle tone, labile blood pressure and confusion.
NMS (Neuroleptic Malignant Syndrome)
EMI 5
Options
Living in an institution
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Living alone
Previous poor relationship with carer
Male carer
Male patient
Patient has a diagnosis of dementia
Carer married to patient
High physical dependency in the patient
Lead in: Choose the most common associated risk factors for the following:
1. Carer stress Choose 2
Previous poor relationship with carer
Patient has a diagnosis of dementia
2. Depression Choose 1
Living alone
3. Non accidental injury from carer Choose 2
Living in an institution
High physical dependency in the patient
EMI 6
Options
Prader Willi Syndrome
Angelmans syndrome
Downs syndrome
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Lesch Nyhan syndrome
Retts syndrome
Autism
Lead in: Choose the most appropriate diagnosis in the following
1. 7 year old girl with loss of acquired skills and abnormal hand movements
Retts syndrome
2. 3 year old boy with obesity, compulsive overeating and excessive sleepiness.
Prader Willi Syndrome
3. 7 year old with lip biting and excessive self injurious behaviour.
Lesch Nyhan syndrome
EMI 7
Options
Barnes akathisia scale
Beck's depression inventory
Global impression scale
Edinburgh post natal depression scale
HAMD
MADRS
Simpson Angus scale
Lead in: Choose the best rating scales
1. A 30 year old woman who has post natal depression, has been recently started
on antidepressants by you. Choose two scales to monitor response to treatment.
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Hamilton Depression Rating Scale (HAM-D)
Montgomery Aesburg Depression Rating Scale (MADRS)
http://www.google.com.pk/search?
hl=en&q=MADRS+to+monitor+depression&meta =
http://www.assessments.com/catalog/HAM_D.htm
2. A 25 year old man has been started with antipsychotic medication. Choose one
rating scale to monitor parkinsonian symptoms.
Simpson-Angus Scale
http://64.233.183.104/search?
q=cache:as6muSNYuxgJ:www.medafile.com/zyweb/SAMS.ht
m+Simpson+Angus+Scale&hl=en&ct=clnk&cd=3&gl=pk
3. A 24 year old woman has recently given birth and is suspected to be depressed.
You have asked the health visitor to assess her at home. Choose one scale she can
use in this situation.
Edinburgh post natal depression scale
http://64.233.183.104/search?
q=cache:as6muSNYuxgJ:www.medafile.com/zyweb/SAMS.ht
m+Simpson+Angus+Scale&hl=en&ct=clnk&cd=3&gl=pk
http://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://www.google.com.pk/search?hl=en&q=MADRS+to+monitor+depression&meta=http://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://www.google.com.pk/search?hl=en&q=MADRS+to+monitor+depression&meta=http://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://www.assessments.com/catalog/HAM_D.htmhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://64.233.183.104/search?q=cache:as6muSNYuxgJ:www.medafile.com/zyweb/SAMS.htm+Simpson+Angus+Scale&hl=en&ct=clnk&cd=3&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://64.233.183.104/search?q=cache:as6muSNYuxgJ:www.medafile.com/zyweb/SAMS.htm+Simpson+Angus+Scale&hl=en&ct=clnk&cd=3&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://64.233.183.104/search?q=cache:as6muSNYuxgJ:www.medafile.com/zyweb/SAMS.htm+Simpson+Angus+Scale&hl=en&ct=clnk&cd=3&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://64.233.183.104/search?q=cache:as6muSNYuxgJ:www.medafile.com/zyweb/SAMS.htm+Simpson+Angus+Scale&hl=en&ct=clnk&cd=3&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://64.233.183.104/search?q=cache:as6muSNYuxgJ:www.medafile.com/zyweb/SAMS.htm+Simpson+Angus+Scale&hl=en&ct=clnk&cd=3&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://64.233.183.104/search?q=cache:as6muSNYuxgJ:www.medafile.com/zyweb/SAMS.htm+Simpson+Angus+Scale&hl=en&ct=clnk&cd=3&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://www.google.com.pk/search?hl=en&q=MADRS+to+monitor+depression&meta=http://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://www.google.com.pk/search?hl=en&q=MADRS+to+monitor+depression&meta=http://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://www.assessments.com/catalog/HAM_D.htmhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://64.233.183.104/search?q=cache:as6muSNYuxgJ:www.medafile.com/zyweb/SAMS.htm+Simpson+Angus+Scale&hl=en&ct=clnk&cd=3&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://64.233.183.104/search?q=cache:as6muSNYuxgJ:www.medafile.com/zyweb/SAMS.htm+Simpson+Angus+Scale&hl=en&ct=clnk&cd=3&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://64.233.183.104/search?q=cache:as6muSNYuxgJ:www.medafile.com/zyweb/SAMS.htm+Simpson+Angus+Scale&hl=en&ct=clnk&cd=3&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://64.233.183.104/search?q=cache:as6muSNYuxgJ:www.medafile.com/zyweb/SAMS.htm+Simpson+Angus+Scale&hl=en&ct=clnk&cd=3&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://64.233.183.104/search?q=cache:as6muSNYuxgJ:www.medafile.com/zyweb/SAMS.htm+Simpson+Angus+Scale&hl=en&ct=clnk&cd=3&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://64.233.183.104/search?q=cache:as6muSNYuxgJ:www.medafile.com/zyweb/SAMS.htm+Simpson+Angus+Scale&hl=en&ct=clnk&cd=3&gl=pk8/8/2019 Paper 3 EMIs
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EMI 8
Options
Fluoxetine
Paroxetine
Clonidine
Melatonin
Diazepam
Methylphenidate
Atomoxetine
Risperidone
Buspirone
Lead in: Choose the best medication for the following conditions
1. A 8 year old is brought by her mother to your clinic with symptoms of
hyperactivity, poor concentration and aggressive behaviour. Choose 3
Methylphenidate
Atomoxetine
Clonidine
2. A 12 year old boy presents with low mood, poor sleep, poor appetite and difficulty
in concentration. Choose 1
Fluoxetine
3. A 8 year old boy with moderate learning difficulty and intractable insomnia.
Choose 2
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Melatonin
Diazepam
EMIs Autumn 2007
EMI 1
Theme: Sleep disorders
Options:
A. Circadian rhythm sleep disorder
B. Shift work sleep disorder
C. Narcolepsy
D. Obstructive sleep apnoea
E. Limb movement disorder
F. Somnambulism
G. Delayed sleep phase syndrome
Select one option in all questions below:
1. A 25 year old female falls asleep in the daytime and loses her balance with
cataplexy
C. Narcolepsy
2. A 40 year old obese man complains of cough during the night.
D. Obstructive Sleep apnoea
3. A 30 year old man has been depressed and is prescribed by his GP flupenthixol
tablets. He later comes back to the GP complaining of sleep disturbance and fatigue
in the daytime.
G. Delayed sleep phase syndrome
EMI 2
Theme: Drug use
Options:
A. Alcohol
B. Amphetamines
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C. Cocane
D. Volatile substances
F. Benzodiazepines
G. Magic mushrooms
H. Caffeine
I. CannabisJ. Phencyclidine
1. A 17 year old man with a 2 year history of drug abuse went on an all night party
and presented to A & E with dilated pupils, tachycardia, tremors and sweating
(Select 2 options)
B. Amphetamines
H. Caffeine
http://www.emedicine.com/emerg/topic23.htm (Diaphoresis)
2. A 19 year old factory worker with a history of various illicit drugs presented to A
& E. He said he had a bad trip and on examination he has dilated pupils, tremorsand sweating (Select 2 options)
G. Magic mushrooms
J. Phencyclidine
Ref. Puri and Hall p. 362
A 20 year old man presented to A & E with tachycardia, sweating, tremors andincrease in muscle tone, history of 2 seizures. He has a history of substance use
(Select 2 options)
A. Alcohol
F. Benzodiazepines
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EMI 3
Theme: Side effects of medications - receptors
Options:
Alpha-1 receptor antagonism
Down regulation of alpha-2 adrenergic receptors
Action at the 5-HT1A receptor
H1 receptor antagonism
CYP450 enzyme induction
CYP450 enzyme inhibition
D2 receptor antagonism
Select one option
1. Patient who has been on risperidone complained of postural instability.
Alpha-1 receptor antagonism
2. A patient who is on carbamazepine says that the oral contraceptives she has
been taking have not been working.
CYP450 enzyme induction
3. Patient on fluoxetine has not been doing well and lithium has been started as an
augmentation and he started having tremors, instability of gait, sweating and
confusion.
Action at the 5-HT1A receptor
Ref. http://www.drugs.com/drug_interactions.php
EMI 4
Theme: Appropriate treatment in child and adolescents
http://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://www.drugs.com/drug_interactions.phphttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://www.drugs.com/drug_interactions.php8/8/2019 Paper 3 EMIs
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Options:
Parental training
Fluoxetine
Citalopram
Methylphenidate
Lithium
Family training
Risperidone
Select one option
1. A 13 year old boy who has been treated under a psychologist for his aggression is
receiving CBT treatment and his psychologist has diagnosed him of having
hyperkinetic disorder.
Methylphenidate
2. A 17 year old boy who has been abandoned by his family because of his
aggression. What is the most appropriate treatment?
Family training
3. A 14 year old boy has been more aggressive after a conflict between his parents
and his mother brought him to hospital complaining that he wouldnt listen to
anything.
Parental training
EMI 5
Theme: Psychotherapy
Options:
Reassurance
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Show empathy
Clarification
Ask to reflect
Link the present state to the childhood relationships
Name the emotion
Listen and think quietly
A 17 year old male comes to the first session of your therapy and he keeps coming
late to the therapy. Recently he broke up with his girlfriend and at one situation he
tries to be angry with you and says that he would like to kill himself. 3 options
Show empathy ,
Ask to reflect ,
Reassurance .
The same person keeps coming regularly to the sessions. After a few sessions he
becomes angry again and starts coming late to the sessions, even though attending
them and when you tell him that the sessions are going to end he says that you are
going to abandon him and that he will die. 2 options
Link the present state to the childhood relationships
Show empathy
The same person keeps coming to the sessions, makes good progress but once
reports to you of a dream in which he was on a train which goes very fast and ends
up in a plane crash. He asks you what does that mean. 1 option
Ask to reflect
EMI 6
Theme: Side effects of medications
Options:
Ebsteins anomaly
Fallots tetrology
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Irritability in newborn
Neural tube defects
Select 1 option
1. Question of pregnant woman taking lithium and possible side effect to the baby.
Ebsteins anomaly
2. Question of pregnant woman on paroxetine and possible side effect to the baby.
Irritability in newborn
3. Question of pregnant woman on sodium valproate and possible side effect to the
baby
Neural tube defects
Please feel free to differ and criticize.
Thanks
Kamran