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PREVIOUS EXAMS 1What is the most common side effect of electroconvulsive therapy (ECT)? A) Long-term memory loss B) Headache C) Seizures D) Nausea 2.Sexual dysfunction associated with SSRIs is mediated mainly by: a. 5-HT1, etc. receptor stimulation b. 5-HT1, etc. receptor blockade c. 5-HT2, etc. r...

PREVIOUS EXAMS 1What is the most common side effect of electroconvulsive therapy (ECT)? A) Long-term memory loss B) Headache C) Seizures D) Nausea 2.Sexual dysfunction associated with SSRIs is mediated mainly by: a. 5-HT1, etc. receptor stimulation b. 5-HT1, etc. receptor blockade c. 5-HT2, etc. receptor stimulation d. 5-HT2, etc. receptor blockade e. 5-HT3, etc. stimulation 3.Which of the following antipsychotic drugs was shown to be useful in the prophylaxis of delirium? a. Risperidone b. Olanzapine c. Haloperidol d. Quetiapine e. Aripiprazole 4. Use of stimulants is relatively contraindicated in which of the following patients with ADHD? A. 9-year-old child with a family history of ADHD B. 9-year-old child with a family history of psychosis C. 9-year-old child with ADHD and treatment-emergent tics D. 19-year-old with significant residual symptoms of ADHD E. All of the above 5. Which of the following features confers a worse prognosis for a patient with bipolar II disorder? A. Younger age. B. Higher educational level. C. Rapid-cycling pattern. D. “Married” marital status. E. Less severe depressive episodes. 6.Which of the following laboratory studies must be obtained before initiating lithium therapy in a child? A. Complete blood count (CBC), thyroid function tests, electrolytes, blood urea nitrogen (BUN), creatinine, and liver functions tests. B. CBC, thyroid function tests, electrolytes, creatinine, and a pregnancy test in sexually active females. C. CBC, thyroid function tests, liver function tests, electrocardiogram (ECG), and electroencephalogram (EEG). D. CBC, thyroid function tests, electrolytes, BUN, creatinine, urinalysis, ECG, and a pregnancy test in sexually active females. E. CBC, thyroid function tests, BUN, creatinine, and urinalysis. 7. Immediately after a myocardial infarction, a 58-year-old man develops depression of moderate severity and has some deliberate self-harm ideations, but with no suicidal intentions; the preferred antidepressant of choice is: a. Fluoxetine b. Paroxetine c. Sertraline d. Duloxetine e. Lofepramine 8. What is the range of the correlation coefficient? a. 0 to +1 b. -1 to 0 c. 0 to +100 d. -100 to 0 e. -1 to +1 9. If... A = number of people with disease and exposure B = number of people without disease but with exposure C = number of people with disease but without exposure D = number of people without disease and without exposure, which of the following equations will calculate the odds ratio? a. AB divided by CD b. AC divided by BD c. AA divided by BD d. AD divided by BC e. ABD divided by ACB 10. Donna is an active opiate user, who recently found out that she is pregnant. She approaches her GP saying she wants to stop her substance use and is not considering maintenance therapy with methadone. She is worried about withdrawal symptoms. Her GP calls you about the best time for Donna to undergo opiate withdrawal during pregnancy. Which of the following is the most appropriate answer? A. First trimester B. Second trimester C. Third trimester D. Any of the above E. Withdrawal should never be considered during pregnancy 11.How do the depressive episodes associated with bipolar II disorder differ from those associated with bipolar I disorder? A. They are less frequent than those associated with bipolar I disorder. B. They are lengthier than those associated with bipolar I disorder. C. They are less disabling than those associated with bipolar I disorder. D. They are less severe than those associated with bipolar I disorder. E. They are rarely a reason for the patient to seek treatment. 12. In patients with delirium due to hepatic failure which of the following EEG change may be seen? A. Hypsarrythmia B. Spike and wave pattern C. Periodic complexes D. Sleep spindles E. Slow triphasic waves 13. A 48-year-old homeless man is brought to the A&E department in an agitated and confused state by paramedics. He complains of wavering vision and sees double when looking to the side. He needs support on walking and has a disturbed gait. On examination he has nystagmus and conjugate gait paralysis. An MRI scan performed using T2-dependent sequences shows abnormal high-intensity areas surrounding the third ventricles in the massa intermedia, the floor of the third ventricle, the mammillary bodies, the reticular formation and the periaqueductal region. The most appropriate treatment is: a. Intravenous acetylcysteine b. Intravenous naloxone c. Intravenous thiamine d. Intravenous glucose e. Intravenous flumazenil 14. A 42-year-old woman is referred to you with a history of eating excessively and inappropriately after developing herpes encephalitis. There have been some changes in her personality, including increased agitation, and she has gained 12 kg in the last three months. Which of the following explains this presentation? a. Prader –Willi syndrome b. Kluver –Bucy syndrome c. Kleine –Levin syndrome d. Klinefelter syndrome e. Kearns –Sayre syndrome 15. A 28-year-old man is brought to the A&E department complaining of acute onset of confusion. His relatives report that he has complained of a strange smell that others cannot perceive and has said that there is something churning in his stomach and rising towards his throat. He expresses an intense sense of familiarity with you and your surroundings. He also has flushing and tachycardia. The most probable diagnosis is: a. Opioid withdrawal state b. Schizoprenia c. Complex partial seizure d. Somatoform autonomic dysfunction e. Conversion disorder 16. Regarding biological abnormalities in people with personality disorders, all of the following statements are true, except: a. Reduced prefrontal grey matter was observed in people with antisocial personality disorder b. Deficits in the amygdala response to emotional stimuli were observed in people with antisocial personality disorder c. A decreased volume of amygdala was observed in people with sociopathic personalities d. Increased levels of 5-hydroxyindoleacetic acid have been found in the cerebrospinal fluid of people who have committed unpremeditated violence e. 5HT-mediated prolactin release is lower in subjects with histories of impulsive aggressiveness 17. A 34-year-old woman recently diagnosed with multiple sclerosis is developing increasingly severe depressive symptoms after starting treatment. The most probable pharmacological reason for this is treatment with: a. Beta interferon b. Cyclosporine c. Azathioprine d. Methotrexate e. Natalizumab 18. You are asked to assess a 24-year-old man who has been brought to your unit by the police. The police report that he has been involved in several violent crimes. In front of you he appears calm and knowledgeable about psychiatric problems and tells you that the police officers did not do their job properly as they did not arrest the people he was fighting with. When the police officer tries to interrupt him he suddenly becomes violent and kicks the officer. You have a discussion with his mother over the phone and she tells you that her son has had conduct disorder in the past and has low tolerance to frustration and a low threshold for aggression and violence. The most probable diagnosis is: a. Histrionic personality disorder b. Borderline personality disorder c. Attention deficit hyperactivity disorder d. Antisocial personality disorder e. Narcissistic personality disorder 19. Diagnostic criteria for borderline personality disorder include all of the following, except: a. Disturbance in and uncertainty about self-image, aims and internal preferences (including sexual) b. Liability to become involved in intense and unstable relationships, often leading to emotional crisis c. Excessive efforts to avoid abandonment d. Recurrent threats or acts of self-harm e. Chronic feeling of low mood and depression 20. Which of the following is least recommended in the management of antisocial personality disorder? a. Problem-solving counselling to help the patient deal with stressful circumstances that provoke abnormal behaviour or painful feelings b. Psychodynamic counselling to help the patient deal with stressful circumstances that provoke abnormal behaviour or painful feelings c. Antipsychotic drugs to calm the aggressive behaviour arising in response to increased stress d. Antidepressant medications to control the depressive symptoms associated with increased stress e. Anxiolytic drugs to control the mood and anxiety symptoms associated with increased stress 21. In severe obsessive compulsive disorder with obsessional rituals, the most appropriate treatment is: a. Clomipramine b. Exposure and response prevention c. Dynamic psychotherapy with SSRIs d. Neurosurgery e. Exposure and response prevention with SSRIs 22. All of the following statements about social phobia are true, except: a. Patients are often preoccupied with the idea of being observed critically b. It is a predictor of alcohol misuse c. Suicide attempts are more frequent than in the general population d. Positron emission tomography (PET) study of social phobics experiencing anticipatory anxiety found decreased blood flow in the right dorsolateral prefrontal cortex e. Successful treatment with citalopram or cognitive behavioural therapy results in decreased blood flow in the amygdala and related brain areas 23. Which of the following is the psychological treatment of choice for social phobia? a. Exposure and response prevention b. Relaxation training c. Supportive psychotherapy d. Cognitive behavioural therapy e. Dynamic psychotherapy 24. In DSM-IV, the diagnosis of acute stress disorder requires: marked symptoms of anxiety or increased arousal; re-experiencing of the distressing event; and three dissociative symptoms from a list of five. All of the following are included in those dissociative symptoms, except: a. A sense of numbing or detachment b. Increased awareness of the surroundings c. Derealization d. Depersonalization e. Dissociative amnesia 25. All of the following are individual factors that increase vulnerability to the development of post-traumatic stress disorder, except: a. Previous history of trauma b. Female gender c. Neuroticism d. Higher intelligence e. Lack of social support 26. Which of the following is a neurobiological abnormality in post-traumatic stress disorder? a. Low plasma cortisol level b. Increased sensitivity to dexamethasone suppression c. Increased levels of corticotropin-releasing hormone in the cerebrospinal fluid d. Dysregulation of the hypothalamic – pituitary –adrenal axis e. All of the above 27. Regarding the involvement of the monoamine neurotransmitter noradrenaline in the neurobiology of post-traumatic stress disorder (PTSD), all of the following statements are true, except: a. Sympathetic tone is increased in PTSD b. Startle response is increased in PTSD c. MHPG level is decreased in the cerebrospinal fluid d. There is an increased anxiety response to noradrenaline challenge e. There is increased activity in noradrenergic innervation of the amygdala 28. All of the following statements about atypical depression are true, except: a. Variably depressed mood with mood reactivity to positive events occurs b. Symptoms include overeating and oversleeping c. Extreme fatigue and heaviness in the limbs are features d. Pronounced anxiety occurs e. There is a better response to tricyclic antidepressants than to MAOIs and SSRIs 29. All of the following statements are true about rapid cycling disorder, except: a. There should be at least four episodes a year separated by a period of remission or a switch to an episode of opposite polarity b. It occurs more frequently in women c. It can be triggered by antidepressant treatment d. Concomitant hypothyroidism is common e. Lithium is the most effective treatment as a mood stabilizer 30. Which of the following statements is true regarding seasonal affective disorder? a. Onset occurs in autumn or winter and recovery in spring or summer b. Symptoms include hypersomnia c. Increased appetite with a craving for carbohydrate occurs d. An afternoon slump in energy is a feature e. All of the above 31. All of the following statements about mood disorders are true, except: a. The point prevalence of depression is greater than that of bipolar illness b. The mean age of onset is 10 years later in depression than in bipolar illness c. The prevalence of depression and bipolar illness is twice as great in women as men d. The risk of mood disorders is about twice as great in first-degree relatives of bipolar patients e. It has been estimated that 10% of patients presenting with a depressive disorder will eventually have a manic illness 32. Abnormalities in monoamine neurotransmission in depression include all of the following, except: a. Increased plasma tryptophan b. Blunted 5-HT neuroendocrine responses c. Decreased brain 5-HT1A receptor binding d. Decreased brain 5-HT reuptake sites e. Clinical relapse after tryptophan depletion 33. Regarding neurochemical abnormalities of depression, all of the following statements are true, except: a. Drug-free patients with major depression have a consistent reduction in cerebrospinal fluid (CSF) concentrations of 5-hydroxyindoleacetic acid (5-HIAA) b. Blunted noradrenaline-mediated growth hormone release is seen in depression c. Clinical relapse of depression occurs after administration of AMPT d. Decreased homovanillic acid (HVA) levels in the cerebrospinal fluid is seen in depression e. Increased dopamine D2 receptor binding occurs in depression 34. Low CSF 5-HIAA levels in patients who have made impulsive and more dangerous suicide attempts are observed in: a. Depression b. Schizophrenia c. Borderline personality disorder d. Antisocial personality disorder e. All of the above 35. Sleep changes in depression include which of the following? a. Impaired sleep continuity and duration b. Decreased sleep stages 3 and 4 c. Decreased REM sleep latency d. Increase in the proportion of REM sleep in the early part of the night e. All of the above 36. On MRI examination of the brain in depressive subjects, increased deep white matter hyperintensities are associated with: a. Late-onset depression b. Mild depression c. Good treatment response d. Psychomotor agitation e. Personality disorder 37. Neuropathological abnormalities observed in patients with mood disorders include which of the following? a. Increased synaptic markers in the prefrontal cortex b. Increased neuronal size in the prefrontal cortex c. Increased neuronal density in the prefrontal cortex d. Increased glial cell numbers in the cingulate cortex e. None of the above 38. In which of the following is there altered cerebral blood flow in patients with depression? a. Prefrontal cortex b. Anterior cingulate cortex c. Thalamus d. Caudate nucleus e. All of the above 39. Regarding lithium augmentation in depression, which of the following statements is true? a. According to research evidence it is more effective than placebo b. Most people respond with an amelioration of their depressive state within 24–48 hours after commencement of lithium c. Unipolar depressed patients do not respond so well as bipolar patients d. The dexamethasone suppression test is reliable in identifying patients likely to respond to lithium e. It is effective only when lithium is combined with SSRIs 40. A 54-year-old woman is brought to the casualty department with acute onset of confusion and agitation. On examination she appears to be febrile, and has been sweating excessively. She is also found to have myoclonus and nystagmus. A careful history reveals that she has had chronic depression, hypertension and diabetes mellitus. She has been on insulin, phenelzine, atenolol and ramipril, and because of ongoing depressive symptoms clomipramine was added to her prescription recently. The most probable cause of her presentation is: a. Neuroleptic malignant syndrome b. Hypoglycaemia c. Serotonin syndrome d. Urinary tract infection e. Wernicke’s encephalopathy 41. All of the following statements are true regarding velocardiofacial syndrome, except: a. It is also known as DiGeorge syndrome b. It is caused by deletion of one copy of chromosome 21 c. It is associated with cognitive impairment d. 70% of cases are associated with psychosis e. It is a rare cause of schizophrenia 42. All of the following statements are true regarding treatment with clozapine, except: a. Clozapine has proven efficacy in treatment-resistant schizophrenia b. Clozapine reduces mortality with suicide in schizophrenia c. Clozapine may be useful in the first episode of schizophrenia in treatment-naive patients as clear superiority is proven in comparison with chlorpromazine d. Antipsychotic polypharmacy may be justified in clozapine-resistant schizophrenia e. In clozapine-resistant schizophrenia 43. Regarding head injury, all of the following statements are true, except: a. The duration of post-traumatic amnesia (PTA) is a good indicator of the severity of a closed head injury b. PTA of less than 1 week indicates a better chance of returning to work c. Retrograde amnesia is a better predictor of outcome than PTA d. Deposition of beta amyloid may explain the link between head injury and Alzheimer’s disease e. Apolipoprotein E4 genotype may increase the risk of death after head injury 44. All of the following statements regarding postconcussion syndrome are true, except: a. It is associated with anxiety and depression b. It is accompanied by headache and difficulties in concentration c. It occurs only after severe head injury d. It can be of psychological origin e. It mostly resolves without treatment 45. Which of the following statements is true regarding restoration of weight in anorexia nervosa? a. It is usually done as an outpatient b. The aim is to increase body weight by 0.5 kg a week c. It requires an extra 500–1000 calories per day d. The usual target weight is between a healthy weight and a weight the patient thinks is ideal e. All of the above 46. Which of the following statements is true regarding premenstrual syndrome? a. It may present with a craving for food b. There is decreased prevalence in those around 30 years of age c. Lack of oestrogen and excess progesterone have been postulated as an aetiological mechanism d. There is a low response rate to placebo e. Bromocriptine is the only effective treatment 47. In a psychotherapeutic intervention, a patient tells you about her experience of her boss shouting at her because she arrived late at the office on one occasion. You say, ‘It must have been really difficult for you. I can understand why you feel anxious about that.’ This is an example of: a. Interpretation b. Affirmation c. Clarification d. Advice and praise e. Empathic validation 49. Which of the following is not a feature of substance dependence as described by Edwards and Gross? a. Primacy of drug-seeking behaviour b. Widening of drug-taking repertoire c. Signs of withdrawal on attempted abstinence d. Increased tolerance to the effects of the drug e. Rapid reinstatement of previous pattern of drug use after abstinence 50. Which of the following statements best describes the ‘positive predictive value’ of a screening test? a. The proportion of people getting a positive result who will have the disease b. The proportion of people with the disease who test positive c. The proportion of people without the disease who test negative d. The proportion of people getting a negative result who will not have the disease e. The likelihood that those who test positive will have the disease as opposed to not have the disease 51. Which of the following study designs would be most suitable for aetiological studies? a. Cross-sectional studies b. Case-controlled studies c. Randomized controlled trials d. Intervention studies e. None of the above 52. Mr.Smith is diagnosed with alcohol dependence syndrome. He receives an educational session regarding the effects of drinking and the potential benefits of abstinence. He does not make any immediate change in his attitude or behaviour but is prepared to consider altering his drinking habits. Which of the following phases of Prochaska’s transtheoretical model of change is he in? A. Preparation B. Precontemplation C. Contemplation D. Action E. Maintenance 53. The half-life of methadone in a patient with opioid dependence is A. 4–6 hours B. 10–20 hours C. 24–36 hours D. 72–90 hours E. None of the above 54. Lund–Manchester criteria are used in the diagnosis of which of the following conditions? A. Alzheimer’s dementia B. Vascular dementia C. Lewy body dementia D. Frontotemporal dementia E. Huntington’s dementia 55. When a mother knowingly and deceptively reports signs and symptoms of illness in her preschool-aged child, resulting in the child’s hospitalization and subjection to numerous tests and procedures, what diagnosis would be recorded for the child? A. Munchausen syndrome by proxy. B. Factitious disorder by proxy. C. No diagnosis. D. Munchausen syndrome imposed on another. E. Factitious disorder imposed on another 56. Of all reported parasomnias, the one that is more common in females than males is A.Sleep walking B.REM sleep behavioural disorder C.Restless legs syndrome D.Night terrors E.Nightmares 57. Sally is 10-weeks pregnant. She is on 70mg methadone daily and wants to stop taking it. What would you advise her to do? Select one: A.Stop immediately B.Switch to suboxone C.Switch to buprenorphine D.Reduce and stop over next 2 weeks E.Continue on treatment until delivery 58. The blood abnormalities seen in Anorexia Nervosa include; A.Raised MCV B.Eosinophilia C.Macrocytosis D.Reduced MCH E.Normocytic normochromic anaemia 59. Which of the following is true with regard to the association between schizophrenia and recorded crime rates? A. The risk is increased for non-violent crimes only B. The risk is increased for violent but not non-violent crimes C. The risk of crime is increased for narrow diagnosis of schizophrenia rather than broad diagnosis of psychosis D. The association is seen only for less serious violent acts E. The risk is highest for violent crimes for both narrowly defined schizophrenia and broadly defined psychosis 70. A multi-centre double blind pragmatic randomized controlled trial (RCT) reported remission rates for depression of 65% for fluoxetine and 60% for dosulepin. The number of patients that must receive fluoxetine for one patient to achieve the demonstrated beneficial effect is A. 60 B. 20 C. 15 D. 10 E. 5 71. The effectiveness of an intervention is measured by using pragmatic trials. Which trial design is normally employed when carrying out a pragmatic trial? A. RCT B. Meta analysis C. Systematic review D. Cohort study E. Case series 72. Which of the following characters of a pragmatic RCT distinguishes it from an explanatory RCT? A. Pseudo-randomization is practised in pragmatic trials B. Type 1 error level is set to be higher in pragmatic trials C. Descriptive rather than inferential statistics are used to report the outcome of pragmatic trials D. Higher generalizability is achieved in pragmatic trials E. Strict exclusion of patients with comorbid conditions is seen in pragmatic trials 73. A 54-year-old African-Caribbean man had systematized persecutory delusions that prevented him from eating for 5 weeks. Following admission to a medical unit he was started on realimentation, despite which he developed diplopia, bilateral horizontal nystagmus and right sixth cranial nerve palsy. He had no past history of alcohol use. On transfer to a psychiatric ward, he was started on a normal diet but soon his phosphate levels were markedly reduced (0.26 mmol/L). The most likely diagnosis is A. Normal pressure hydrocephalus B. Olanzapine overdose C. Refeeding syndrome D. Laxative abuse E. Hepatic failure 74. Which of the following statements correctly identifies a distinction between primary enuresis and secondary enuresis? A. Secondary enuresis is due to an identified medical condition; primary enuresis has no known etiology. B. Children with secondary enuresis have higher rates of psychiatric comorbidity than do children with primary enuresis. C. Primary enuresis has a typical onset at age 10, much later than the onset of secondary enuresis. D. Primary enuresis is never preceded by a period of continence, whereas secondary enuresis is always preceded by a period of continence. E. Unlike primary enuresis, secondary enuresis tends to persist into late adolescence. 75. A 17-year-old girl is admitted to a medical unit following a prolonged period of repeated bingeing and vomiting. She induces vomiting at least six times a day but does not use laxatives or diuretics. Which of the following laboratory finding is most likely in this patient? A. Low urea levels B. High potassium levels C. Low bicarbonate levels D. Increased thyroxine levels E. High amylase levels 76. Which of the following mechanisms is proposed to underlie hypersalivation seen in patients taking clozapine? A. Muscarinic M1 blockade B. Muscarinic M4 stimulation C. Histaminic H1 blockade E. Serotonergic 5HT2C blockade F. Noradrenergic α1 blockade 77. To be applied successfully the fitness to plead criteria must be found relevant to a defendant at the time of A. The criminal offence B. The trial proceedings C. Being interviewed in custody D. Sentenced imprisonment E. The arrest 78. All of the following are sleep changes associated with depression except A. Reduced REM latency B. Reduced REM density C. Increased duration of first REM period D. Low arousal threshold E. Reduced stage 3 and 4 sleep 79. Hyponatraemia is a troublesome side-effect of treating depression in elderly people. All of the following are true with regard to the above except A. More common in males B. More frequent when diuretics are co-prescribed C. Often related to inappropriate ADH secretion D. Risk increases with increase in age E. Symptoms overlap with primary depressive features 80. The mortality rate in a person being treated for alcohol withdrawal delirium is A. 0–1% B. 10–20% C. 20–30% D. 30–40% E. >50% 81. Failure to diagnose and failure to institute adequate thiamine replacement therapy for Wernicke’s encephalopathy is associated with a mortality of nearly A. 5% B. 10% C. 20% D. 30% E. >50% 81. Martin has been admitted to the addictions unit to undergo detoxification from opiates. He has been known to suffer from low blood pressure. Which of the following would be the best agent to treat his withdrawal symptoms? A. Buprenorphine B. Naloxone C. Clonidine D. Dihydrocodeine E. Lofexidine