Paper A Mock Exam 9_ Attempt review.pdf.

3/9/23, 8:52 AM Paper A Mock Exam 9: Attempt review
https://spmmcourse.com/mod/quiz/review.php?attempt=964980&cmid=1000&showall=1 1/128
Started on Thursday, 9 March 2023, 8:49 AM
State Finished
Completed on Thursday, 9 March 2023, 8:52 AM
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Grade 0.00 out of 150.00 (0%)
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Question 1
Not answered
Marked out of 3.00
Maladaptive defences
For each of the scenarios below choose the most prominent defence mechanisms used.
Akunna is a 27-year old male university student from southern Nigeria. He was declared missing for 7 days by his
roommates in Birmingham, where he was studying physiotherapy. He was later seen in Dundee, picked up from a
bus station by the police. He appeared fearful and had no knowledge of how he made the journey to Dundee. He
also denied memories of his whereabouts over the past 7 days. He appeared unkempt and exhausted but fully alert
and had no evidence of any substance use. His roommates provided a history of severe academic pressures, and
issues with the patient's scholarship being cancelled imminently. A fugue state was suspected. (ONE)
Ms A was admitted for depression and suicidal thoughts. She was seen repeatedly clutching to a stuffed animal,
and banging her head on her pillow. Whenever a psychiatric interview was attempted, she started crying
uncontrollably and pleaded to be sent home. (ONE)
Harmony, a 14-year-old girl, was initially evaluated after an ankle injury during a gymnastic competition at school.
After 4 weeks, she again presented with new symptoms of tonic- and clonic-like movements lasting up to an hour –
followed by a prolonged inability to move both her legs. She also had trouble recognising some of her school
friends. On occasions, especially when her mother was visiting her, she experienced distributed twitching of several
body parts. Her mother provided a history of a recent escalation in marital conflicts and Harmony had stopped
talking to her mother 5 months before these events. Several video EEG were obtained and she was diagnosed to
have a Somatic Symptoms Disorder with attacks and seizures, also known as psychogenic non-epileptic seizure
disorder. (ONE)
Choose...
Choose...
Choose...
Your answer is incorrect.
Explanation:
Akunna is in a fugue state. Dissociation is the predominant defence seen in dissociative fugue and amnesia. This involves temporarily but
drastically modifying one's sense of personal identity or mental functions to avoid emotional distress. Dissociative amnesia is seen as a
response to trauma or uncertainty, with the inability to remember the past being a psychogenic form of coping with the stressor. When
explaining fugue and amnesia, invoking dissociation is more popular than the Freudian concept of repression (Mangiulli et al., 2021).

Denigration
Omnipotence
Dissociation
Sublimation
Splitting
Rationalisation
Reaction Formation
Introjection
Denial
Conversion
Suppresion
Isolation
Idealisation
Regresion

The behaviour exhibited by the patient Ms. A in this question is better explained by regression, rather than introjection, though both are
mechanisms invoked in psychodynamic theories of depression. According to Freud, regression causes a reversion to an earlier stage of
development (instead of handling unacceptable impulses in a more adult manner). Regression may explain the withdrawal and tearfulness
seen in depression. While it is normal for children to manifest regressive acts to communicate their distress, in adults, reverting to earlier
stages of development, anticipating being rescued by parents, can often be a maladaptive mechanism. Regressive behaviour is especially
problematic in a hospital, as it prolongs hospital stays in the presence of depression (Lokko et al., 2015).
Introjection occurs when our perceptions of significant figures in our lives are internalised where they form part of the structure of the
personality (e.g. someone who was raised by a hostile and critical father may themselves feel persecuted by the introjection of this object but
also may ‘become like’ this object at other times). Freud’s theory on depression suggests that it is caused by introjection of the aspects of others
that make the depressed patient feel anger; leading to ‘anger turned inwards’.
Harmony has a conversion disorder (psychogenic non-epileptic seizures). Conversion refers to the switching of mental conflicts into somatic
symptoms as in this case. Patients with psychogenic non-epileptic seizures are more likely to have a history of lifetime traumatic experiences,
and maladaptive defences such as conversion and dissociative tendencies with lower resilience than their peers (Masi et al., 2020).
Ref: Mangiulli I, et al. A critical review of case studies on dissociative amnesia. Clinical Psychological Science. 2021 Jun 8:21677026211018194.
Lokko HN, Stern TA. Regression: Diagnosis, evaluation, and management. The primary care companion for CNS disorders. 2015 May
14;17(3):27221.
Masi G, et al. Psychopathological features in referred adolescents with psychogenic nonepileptic seizures with or without epilepsy. Epilepsy
Behav 2020; 112: 107431.
The correct answer is:
Akunna is a 27-year old male university student from southern Nigeria. He was declared missing for 7 days by his roommates in Birmingham,
where he was studying physiotherapy. He was later seen in Dundee, picked up from a bus station by the police. He appeared fearful and had
no knowledge of how he made the journey to Dundee. He also denied memories of his whereabouts over the past 7 days. He appeared
unkempt and exhausted but fully alert and had no evidence of any substance use. His roommates provided a history of severe academic
pressures, and issues with the patient's scholarship being cancelled imminently. A fugue state was suspected. (ONE) → Dissociation, Ms A was
admitted for depression and suicidal thoughts. She was seen repeatedly clutching to a stuffed animal, and banging her head on her pillow.
Whenever a psychiatric interview was attempted, she started crying uncontrollably and pleaded to be sent home. (ONE) → Regression,
Harmony, a 14-year-old girl, was initially evaluated after an ankle injury during a gymnastic competition at school. After 4 weeks, she again
presented with new symptoms of tonic- and clonic-like movements lasting up to an hour – followed by a prolonged inability to move both her
legs. She also had trouble recognising some of her school friends. On occasions, especially when her mother was visiting her, she experienced
distributed twitching of several body parts. Her mother provided a history of a recent escalation in marital conflicts and Harmony had stopped
talking to her mother 5 months before these events. Several video EEG were obtained and she was diagnosed to have a Somatic Symptoms
Disorder with attacks and seizures, also known as psychogenic non-epileptic seizure disorder. (ONE) → Conversion


Question 2
Not answered
Marked out of 4.00
Delusions in clinical practice
Which one of the following descriptions below correctly refers to the psychopathological terms above?
A 34-year-old psychotic patient sees two white cars pulling up in front of his home. He is convinced that he is
about to be accused of being a paedophile.
A 40-year-old psychotic patient who believes that parts of the Bible are about him directly.
A 33-year-old man requested admission to a hospital because he had become convinced that God had granted
him the greatest possible sort of mind and that coming into contact with him would cure others of mental
illnesses.
A 34-year-old man with psychotic patient on the ward recalled being anxious and a sense of 'something about
to happen' prior to his admission.
Choose...
Choose...
Choose...
Choose...
Explanation:
A delusional perception is a primary delusion which is recalled as having arisen as a result of a perception (e.g. a patient who, on seeing two
white cars pull up in front of his house, became convinced that he was therefore about to be wrongly accused of being a paedophile). The
percept is a real external object, not a hallucinatory experience.
A delusion of reference is a delusional belief that external events or situations have been arranged in such a way as to have particular
significance for, or to convey a message to, the affected individual. The patient may believe that television news items are referring to them or
that parts of the Bible are about them directly.
A grandiose delusion is a delusional belief that one has special powers or is unusually rich or powerful, or that one has an exceptional destiny
(e.g. a man who requested admission to hospital because he had become convinced that God had granted him ‘the greatest possible sort of
mind’ and that coming into contact with him would cure others of mental illnesses.)
Delusional mood is recalled as arising following a period when there is an abnormal mood state characterised by anticipatory anxiety, a sense
of ‘something is about to happen’ and an increased sense of the significance of minor events. The development of the formed delusion may
come as a relief to the patient in this situation.
Ref: Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul 30. pp. 107, 112.

Delusional mood
Delusional jealousy
Autochthonous delusion
Delusions of reference
Delusional memory
Delusions of grandiosity
Delusions of infestation
Delusional perception
Delusional elaboration
Delusions of control

The correct answer is: A 34-year-old psychotic patient sees two white cars pulling up in front of his home. He is convinced that he is about to be
accused of being a paedophile. → Delusional perception, A 40-year-old psychotic patient who believes that parts of the Bible are about him
directly. → Delusions of reference, A 33-year-old man requested admission to a hospital because he had become convinced that God had
granted him the greatest possible sort of mind and that coming into contact with him would cure others of mental illnesses. → Delusions of
grandiosity, A 34-year-old man with psychotic patient on the ward recalled being anxious and a sense of 'something about to happen' prior to
his admission. → Delusional mood


Question 3
Not answered
Marked out of 4.00
MoK Assessment CXEMI014
Rating scales in clinical use
Identify the relevant rating scales for each of the following conditions
1. Choose TWO observer-rated tests to monitor depression in a woman recently diagnosed with postnatal depression (Choose Two)
 
2. Choose the most appropriate tool to screen for depression in mothers following childbirth

3. Choose one scale to assess EPSEs due to antipsychotic use. 
Explanation:
The Hamilton Depression Rating Scale is a widely used scale for measuring depression, consisting of a list of 17 items, designed to be rated by a
clinician on three-point and five-point scales. The symptoms are: depressed mood, guilt feelings, suicide, insomnia (initial or early), insomnia
(middle), insomnia (terminal or late), disturbed work and activities, psychomotor retardation, psychomotor agitation, anxiety (psychological),
anxiety (somatic), gastrointestinal symptoms, somatic symptoms, sexual dysfunction or menstrual disturbance, hypochondriasis, weight loss,
and lack of insight.
The Montgomery-Asberg Depression Rating Scale (MADRS) is a 10-item observer-rated scale of depression. Each item is rated 0-6, with a total
score obtained.
The Edinburgh Postnatal Depression Scale is a 10-item tool developed for screening postpartum women for depression in outpatient clinics,
home visits, or during postpartum appointments. It contains dimensions of depression, anxiety, anhedonia, and self-harm/suicide.
The Simpson-Angus Scale is a clinical tool commonly used to detect and monitor extrapyramidal symptoms. It rates 10 items from 0 to 4 points,
yielding a total body score divided by 10, and considered normal up to 0.3.
Ref: Colman AM. Oxford Dictionary of Psychology, 4 Edition. 2015.
Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul 30. p. 97.
Smith-Nielsen J et al. Validation of the Edinburgh Postnatal Depression Scale against both DSM-5 and ICD-10 diagnostic criteria for depression.
BMC psychiatry. 2018 Dec;18(1):1-2.
th

Scale for Assessment of Positive Symptoms
Brief Psychiatric Rating scale
Present state examination
Beck's depression inventory
Edinburgh postnatal depression scale
General Health questionaire
Hamilton Depression scale
Montgomery Asberg Depression Rating Scale
Simpson Angus Scale

Blanchet PJ, Rompré PH. Clinimetric evaluation of the Simpson-Angus Scale in older adults with schizophrenia. Journal of clinical
psychopharmacology. 2014 Feb 1;34(1):36-9.
Choose TWO observer-rated tests to monitor depression in a woman recently diagnosed with postnatal depression (Choose Two) - Hamilton
Depression scale, Montgomery Asberg Depression Rating Scale
Choose the most appropriate tool to screen for depression in mothers following childbirth - Edinburgh postnatal depression scale
Choose one scale to assess EPSEs due to antipsychotic use - Simpson-Angus Scale


Question 4
Not answered
Marked out of 5.00
Disorders of perception
Which of the listed descriptive psychopathological terms refers to the following symptoms?
A 34-year-old gentleman in the psychiatric outpatient clinic mentioned 'Just as I was about to fall asleep, I
heard a voice calling my name which then startled me back to wakefulness only to find no one there.'
A 20-year-old university student mentioned that while she was walking across a lonely park at night; she
became anxious on mistaking bushes rustling in the wind as a hidden attacker but later calmed down.
A woman with bilateral cataracts says that she sees a number of her dead relatives walking in the house.
A 46-year-old woman on the psychiatric ward says 'All my blood has dropped into my legs, and I can feel a
water level in my chest.'
A 37-year-old gentleman on the psychiatric ward described 'I thought my life was outside my feet and made
them vibrate.'
Choose...
Choose...
Choose...
Choose...
Choose...
Explanation:
A hypnagogic hallucination is a transient false perception experienced while on the verge of falling asleep. These may have the characteristics
of true or pseudo-hallucinations and are most commonly visual or auditory. While they are sometimes seen in narcolepsy or affective illnesses,
they are not indicative of ill health and are frequently reported by healthy people.
An illusion is a type of false perception in which the perception of a real-world object is combined with internal imagery to produce a false
internal percept. Three types are recognised: affect, completion, and pareidolic illusions. In affect illusion, there is a combination of a
heightened emotion and misperception. Completion illusions rely on our brain’s tendency to ‘fill in’ presumed missing parts of an object to
produce a meaningful percept and are the basis for many types of optical illusions. Both these types of illusions resolve on closer attention.
Pareidolic illusions are meaningful percepts produced when experiencing a poorly defined stimulus (e.g. seeing faces in a fire or clouds).
Charles Bonnet syndrome (phantom visual images) is a condition in which complex visual hallucinations occur in the absence of any
psychopathology and in clear consciousness. It is associated with either central or peripheral reduction in vision. The images may be static or in
motion. They may be enjoyable or distressing. Patients may retain insight.
A hygric hallucination is a tactile hallucination of feeling fluid (such as water running from the head into the stomach).

Charles Bonnet Syndrome
Kinaesthetic hallucination
Hypnopompic hallucination
Reflex Hallucination
Haptic Hallucinations
Pareidolic illusion
Affect illusions
Hygric hallucinations
Hypnagogic hallucination
Compete illusion

Kinaesthetic hallucinations affect the muscles and joints, and the patient feels that their limbs are being twisted, pulled, or moved. Vestibular
sensations such as sinking in the bed or flying through the air can also be hallucinated and are best regarded as a variant of kinaesthetic
hallucinations.
Ref: Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul 30. pp. 112-113.
Casey P, Kelly B. Fish’s clinical pathology: Signs and symptoms in psychiatry, 4 Edition. 2019. pp. 29, 34, 124.
The correct answer is: A 34-year-old gentleman in the psychiatric outpatient clinic mentioned 'Just as I was about to fall asleep, I heard a voice
calling my name which then startled me back to wakefulness only to find no one there.' → Hypnagogic hallucination, A 20-year-old university
student mentioned that while she was walking across a lonely park at night; she became anxious on mistaking bushes rustling in the wind as a
hidden attacker but later calmed down. → Affect illusions, A woman with bilateral cataracts says that she sees a number of her dead relatives
walking in the house. → Charles Bonnet syndrome, A 46-year-old woman on the psychiatric ward says 'All my blood has dropped into my legs,
and I can feel a water level in my chest.' → Hygric hallucinations, A 37-year-old gentleman on the psychiatric ward described 'I thought my life
was outside my feet and made them vibrate.' → Kinaesthetic hallucination
th


Question 5
Not answered
Marked out of 5.00
MoK Assessment CXEMI026
Conflicts and Defences
Choose the best option from the list above for each description below.
1. Which defence mechanisms are used in patients with obsessive-compulsive disorder (Choose three answers) 
 
2. Which defence mechanism is used when a person tries to negate his actions? 
3. Which defence mechanism is used in patients with impulse control disorder? 
Explanation:
Freud coined the term ‘obsessional neurosis’ to describe the present day concept of OCD. He considered obsessional neurosis to be the result
of regression from the Oedipal state to the pre-genital anal-erotic stage of development as a defence against aggressive or sexual (unconscious)
impulses. Associated defences are isolation (obsessional thoughts), undoing (compulsive rituals) and reaction formation. Symptoms occur when
these defences fail to contain the anxiety.
Isolation (of affect) is a defence mechanism in which emotion is detached from an idea and rendered unconscious, leaving the idea bland and
emotionally flat. The mechanisms by which the detachment is effected include repetitive intrusive thoughts and ritualistic behaviour.
Undoing: When a person acts inappropriately, it sometimes produces anxiety. To counter this anxiety, the person may try to negate the original
behaviour. For example, a child who becomes unruly at the dinner table but then offers to help during cleanup.
Reaction Formation: When someone is confronted with disturbing desires or impulses, he or she may actively express the opposite impulse.
This involves openly displaying a particular attitude that is opposite of disturbing repressed traits.
Seeing, hearing or doing, but refusing to acknowledge what one sees, hears or does, and negating these are examples of denial. Denial avoids
becoming aware of some painful aspect of reality.
In acting out, patients directly express unconscious wishes or conflicts through action to avoid being conscious of either the accompanying idea
or the affect.The unconscious fantasy is lived out impulsively in behaviour, thereby gratifying the impulse instead of prohibiting it, seen in
impulse control disorders. Tantrums, apparently motiveless assaults, and pleasureless promiscuity are also typical examples.

Acting out
Denial
Displacement
Dissociation
Undoing
Introjection
Isolation
Passive-aggressive
Projection
Reaction formation

Ref: Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul 30. p. 385.
Boland R, Verduin M. Kaplan and Sadock's Synopsis of Psychiatry, 12th Edition. 2022. pp. 577, 1066.
Isolation of affect. Oxford Reference. Retrieved 4 Mar. 2022, from
https://www.oxfordreference.com/view/10.1093/oi/authority.20110803100012916.
Which defence mechanisms are used in patients with obsessive-compulsive disorder? (Choose three answers) - Undoing, Isolation, Reaction
formation
Which defence mechanism is used when a person tries to negate his actions? - Denial
Which defence mechanism is used in patients with impulse control disorder? - Acting out


Question 6
Not answered
Marked out of 3.00
Types of Mutations
For the following mutations, select the most appropriate term
Creation of a new stop codon
This mutation does not alter the amino acid product
Substitution of a purine for a purine
Choose...
Choose...
Choose...
Explanation:
A nonsense mutation is any mutation that produces one of the stop codons, causing premature termination of protein synthesis by the gene in
which it occurs. In nonsense mutation, the new codon is usually UUA, UGA or UAG, all of which signals 'stop' to the amino acid sequence
resulting in a nonfunctional protein.
A silent mutation is any mutation that has no effect on the phenotype, either because the altered codon happens to specify the same amino
acid as the original one, or because it occurs in an intron that has no genetic function. Thus, a silent mutation causes no change in protein
product.
A point mutation is a mutation involving the alteration of a single base pair in a segment of DNA, whereby substitutions of one base with
another occurs. (Transition = purine replaced by another purine or pyrimidine replaced by another pyrimidine (e.g. A to G); Transversion =
purine replaced by a pyrimidine or vice versa (e.g. A to T)).
In missense mutation, the new mutant codon specifies a different amino acid with variable effects on final protein product. For example,
haemophilia, sickle cell anaemia. In frame shift mutations, the deletion or insertion is not in multiples of three codons e.g. a segment of 5 bases
deletion mutations.
For a short illustrative description see

In frame
Expansion
Transversion
Nonsense
Frameshift
Missense
Silent
Transition

The correct answer is: Creation of a new stop codon → Nonsense, This mutation does not alter the amino acid product → Silent, Substitution of
a purine for a purine → Transition


Question 7
Not answered
Marked out of 6.00
MoK Neurosciences CXEMI012
Cerebral circulation disorders
Identify 3 common symptoms seen in following types of cerebral circulation disorders.
1. Carotid system TIA   
2. Vertebrobasilar system TIA   
Explanation
Carotid system TIA is also called as anterior circulation TIA. It is characterised by amaurosis fugax, aphasia, hemiparesis, hemisensory loss and
hemianopic visual loss due to the involvement of watershed or highly oxygen dependent cortical regions.
Vertebrobasilar system TIA is also called as posterior circulation TIA. It affects brain stem cranial nerve nuclei leading to diplopia, vertigo,
vomiting, choking, dysarthria, and ataxia, alexia without agraphia, hemisensory loss, hemianopic visual loss, transient global amnesia,
quadriparesis and loss of consciousness (rare).
Carotid system TIA - Amaurosis fugax, Hemiparesis, Aphasia,
Vertebrobasilar system TIA - Dysarthria, Ataxia, Diplopia

Dysarthria
Amaurosis Fugax
Hemiparesis
Ataxia
Horner syndrome
Diplopia
Nystagmus
Myoclonus
Aphasia
Agraphria

Question 8
Not answered
Marked out of 5.00
Speech disorder
Identify the correct terms that represent each of the following speech disorders
Decrease in spontaneous talking occurring in depression
Increased quantity of speech seen in early manic states
The patient is mute but remain aware of the environment though cannot move or respond
Difficulty in finding the correct name for an object
Often seen in children who refuse to speak to certain people
Choose...
Choose...
Choose...
Choose...
Choose...
Explanation:
Alogia is poverty of thoughts as observed by the absence of spontaneous speech. It is a negative symptom of schizophrenia and a symptom of
depressive illness.
Logorrhea is excess speech or ‘verbal diarrhoea’. It is a symptom of mania.
In akinetic mutism, which is associated with lesions of the upper midbrain or posterior diencephalon, there is mutism, and the patient appears
to be aware of the environment.
In nominal aphasia the patient cannot name objects, although they have plenty of words at their disposal. Difficulty in finding the correct word
can occur in other varieties of aphasia, but in nominal aphasia it is the outstanding disorder. Nominal aphasia may be found with either diffuse
brain damage or with focal lesions involving the dominant temporoparietal region (e.g. angular gyrus).
Selective mutism may occur in children who refuse to speak to certain people; for example, the child may be mute at school but speak at home.
Casey P, Kelly B. Fish’s clinical pathology: Signs and symptoms in psychiatry, 4 Edition. 2019. pp. 56-59.
th

Akinetic mutism
Syntactical aphasia
Logoclonia
Stammering
Logorrhoea
Alogia
Selective mutism
Palialia
Hysterical mutism
Normal apahsia

The correct answer is: Decrease in spontaneous talking occurring in depression → Alogia, Increased quantity of speech seen in early manic
states → Logorrhoea, The patient is mute but remain aware of the environment though cannot move or respond → Akinetic mutism, Difficulty
in finding the correct name for an object → Nominal aphasia, Often seen in children who refuse to speak to certain people → Selective mutism


Question 9
Not answered
Marked out of 3.00
Chromosomal loci
Select the most appropriate chromosomal locus for each of the scenario given below
A 7-year-old girl has a large mandible and an open-mouthed expression which reveals the tongue. She has severe
intellectual disability, with poor communication skills and little or absent speech. She has an unusual manner of
laughing when stimulated.
A 3-year-old girl repeatedly presents with respiratory infections. On examination, her larynx appears to be
maldeveloped, and she has an unusually small head with a round face and a small chin with folds of skin over her
eyes. The mother recalls a distinctive crying sound that became less noticeable after age 2.
A 4-year-old girl is brought to the A&E with severe breathing problems. On examination, there is excessive drooling,
with reduced muscle tone in her limbs. Developmental history is normal up to the age of 18 months apart from
repeated problems related to gastroesophageal reflux. Growth charts reveal a slowing of head growth beginning at
approximately 5 - 6 months of age.
Choose...
Choose...
Choose...
Explanation:
Angelman (‘happy puppet’) syndrome (Case 1):
Microdeletion 15q11-13 of maternal origin; 80% due to deletion of maternally derived chromosome 15
Incidence: 1:10,000
Clinical features: happy disposition, paroxysmal laughter, absence of speech, hand flapping, clapping, ataxia (jerky limb movements, gait
problems)
Severe/profound ID
Facial features: fair hair, blue eyes, microcephaly, flattened occiput, long face, prominent jaw, wide mouth, widely-spaced teeth, thin upper lip,
and pointed chin
Epilepsy (90%); EEG is highly characteristic with changes noted as early as age 3

Chromosome 5
Chromosome 7
Chromosome 4
Chromosome 15
Chromosome Y
Chromosome X
Chromosome 11
Chromosome 1
Chromosome 21
Chromosome 22
Mitochondria DNA

Cri-du-chat (Case 2):
Partial monosomy; karyotype 5p- (varies from deletion of a small band at 5p15.2 to entire arm of 5p)
About 85% of the deletions arise spontaneously and the majority are of paternal origin
Incidence: 1:35,000
More common in females (4:3)
Infant has a characteristic high-pitched cry that resembles a cat
Hyperactivity is a problem for a substantial proportion of children, but may improve with age
Rett syndrome (Case 3):
Believed to be caused by dominant X-linked gene
Degenerative disorder that almost exclusively affects females
Initially normal development
Between ages 1- 4 years of age: purposeful hand movements and spoken language are lost; stereotypical hand movements (hand-wringing)
and autistic symptoms are seen
Ataxia, facial grimacing, teeth-grinding, and loss of speech
Irregular respiration with episodes of hyperventilation, apnea, and breath-holding
Progressive gait disturbance, scoliosis, and seizures
Boland R, Verduin M. Kaplan and Sadock's Synopsis of Psychiatry, 12th Edition. 2022. p. 103.
The correct answer is: A 7-year-old girl has a large mandible and an open-mouthed expression which reveals the tongue. She has severe
intellectual disability, with poor communication skills and little or absent speech. She has an unusual manner of laughing when stimulated. →
Chromosome 15, A 3-year-old girl repeatedly presents with respiratory infections. On examination, her larynx appears to be maldeveloped, and
she has an unusually small head with a round face and a small chin with folds of skin over her eyes. The mother recalls a distinctive crying
sound that became less noticeable after age 2. → Chromosome 5, A 4-year-old girl is brought to the A&E with severe breathing problems. On
examination, there is excessive drooling, with reduced muscle tone in her limbs. Developmental history is normal up to the age of 18 months
apart from repeated problems related to gastroesophageal reflux. Growth charts reveal a slowing of head growth beginning at approximately 5
- 6 months of age. → Chromosome X


Question 10
Not answered
Marked out of 4.00
Personality tests
For each of the following tests given below, choose their correct names from the list given:
This test measures personality along three dimensions: extraversion, neuroticism, and
psychoticism
It is one of the objective personality tests that includes hypochondriasis as a personality
factor
A projective personality test with pictures of ambiguous persons and scenes to make up a
story
This test is useful to assess premorbid intelligence
Choose...
Choose...
Choose...
Choose...
Explanation:
Eysenck’s Personality Questionnaire is a revised version of the Eysenck Personality Inventory, measuring three major dimensions of personality
- namely extraversion, neuroticism, and psychoticism - and including a lie scale.
The Minnesota Multiphasic Personality Inventory (MMPI) is a self-report questionnaire consisting of 567 questions covering eight areas of
psychopathology and two areas of personality type. The scales are: Hypochondriasis, Depression, Hysteria, Psychopathic deviate, Masculinity-
femininity, Paranoia, Psychasthenia, Schizophrenia, Hypomania, and Social introversion. There are also four additional validity (test-taking
attitude) scales.
The Thematic Apperception Test is a projective personality test. It consists of a series of 10 black-and-white pictures that depict individuals of
both sexes and of different age groups, who are involved in a variety of different activities. The stories that the patient makes up concerning the
pictures, according to the projective hypothesis, reflect the patient’s own needs, thoughts, feelings, stresses, wishes, desires, and views of the
future.
First published in 1982, the 50-item National Adult Reading Test (NART) is a widely adopted method for estimating premorbid intelligence both
for clinical and research purposes.
th

Stroop test
Wisconsin card sorting test
Trail making test
Raven's progressive matrices
Eysenck Personality Questionnaire
Rorschach inkblot test
Thematic apperception test
National adult reading test
Paired association test
Rey Osterreith Test
Minnesota multiphasic personality
inventory

Boland R, Verduin M. Kaplan and Sadock's Synopsis of Psychiatry, 12th Edition. 2022. pp. 59-60.
Bright P et al. The National Adult Reading Test: restandardisation against the Wechsler adult intelligence scale—fourth edition.
Neuropsychological Rehabilitation. 2018 Aug 18;28(6):1019-27.
The correct answer is: This test measures personality along three dimensions: extraversion, neuroticism, and psychoticism → Eysenck
Personality Questionnaire, It is one of the objective personality tests that includes hypochondriasis as a personality factor → Minnesota
multiphasic personality inventory, A projective personality test with pictures of ambiguous persons and scenes to make up a story → Thematic
apperception test, This test is useful to assess premorbid intelligence → National adult reading test


Question 11
Not answered
Marked out of 4.00
Neuropathological features
You are working in a neuroscience department, and you have a special interest in dementias. For each of the definitions given below, identify
the neuropathological terms used to describe them.
Weakly eosinophilic spherical cytoplasmic inclusions
This protein aggregates to form oligomers that turn into Lewy bodies
Ballooned or swollen cortical neurons, with loss of Nissl's substance, oval in shape with peripherally
displaced nucleus
Rounded, homogeneous neuronal inclusions, faintly visible on H&E staining, containing 3Rtau, and strongly
argyrophilic with the Bielschowsky technique
Choose...
Choose...
Choose...
Choose...
Explanation:
Lewy bodies are neuronal cytoplasmic inclusions. Typical (brainstem) Lewy bodies are roughly spherical with an eosinophilic core surrounded
by a paler ‘halo’.
Alpha-synucleinopathies are disorders in which there is accumulation of the membrane-associated, presynaptic, protein alpha-synuclein.
Aggregates may be visible on routine sections; many more are revealed by immunohistochemistry. This group includes Parkinson disease,
other Lewy body diseases, and multiple-system atrophy. In Lewy body dementia, for unknown reasons, alpha-synuclein proteins aggregate to
form oligomers, eventually turning into ‘Lewy bodies’ and Lewy neurites, as neurons degenerate.
Pick disease is characterised by the presence of Pick bodies: rounded, homogeneous neuronal cytoplasmic inclusions, faintly visible on H&E
staining. Immunohistochemical staining shows that these inclusions contain 3Rtau. Pick bodies are also strongly argyrophilic with the
Bielschowsky technique. Ballooned neurons (sometimes referred to as Pick cells) are also frequent. Pick cells are swollen cortical neurons that
are a characteristic, but nonspecific, feature of Pick disease.
Ref: Gray F, Duyckaerts C, de Girolami U. Escourolle and Poirier’s Manual of Basic Neuropathology, 6 Edition. 2019. pp. 6, 187, 192-193.
Stahl SM. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications, 5 Edition. 2021. p. 493.
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Microvacuolation
Prion proteins
Spongiform encephalopathy
Lewy bodies
Alpha-synuclein
Pick bodies
Senile plaques
Pick cells
Hirano bodies

The correct answer is: Weakly eosinophilic spherical cytoplasmic inclusions → Lewy bodies, This protein aggregates to form oligomers that turn
into Lewy bodies → Alpha-synuclein, Ballooned or swollen cortical neurons, with loss of Nissl's substance, oval in shape with peripherally
displaced nucleus → Pick cells, Rounded, homogeneous neuronal inclusions, faintly visible on H&E staining, containing 3Rtau, and strongly
argyrophilic with the Bielschowsky technique → Pick bodies
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Question 12
Not answered
Marked out of 3.00
Less reported adverse effects
For each of the adverse effects given below, identify the most likely drug associated with it.
Severe sweating
Torsades de pointes
Allergic dermatitis and photosensitivity
Choose...
Choose...
Choose...
Explanation:
Adrenergic agents are implicated in causing antidepressant-induced sweating, with adrenergic antidepressants like duloxetine, venlafaxine and
reboxetine having a higher propensity. All antidepressants may induce excessive sweating, though some drugs reportedly have weaker
association (fluvoxamine, bupropion and vortioxetine). SSRIs have a comparable risk, not significantly different from SNRIs. Among SSRIs,
paroxetine and sertraline have a higher risk than others. Both alpha blockers (e.g. clonidine, terazosin) and beta blockers can improve
antidepressant-induced sweating by blocking adrenergic output. The sympathetic postganglionic innervation of sweat glands can also be
blocked with anticholinergics like benztropine or glycopyrrolate. Serotonergic antagonism with cyproheptadine has also been suggested as a
treatment option. Antidepressant induced sweating is estimated to occur in 5-14% of patients. This is not a dose dependent effect.
Several antipsychotic drugs, belonging both to typical and atypical classes (e.g. sertindole, thioridazine, droperidol, and haloperidol) are known
to be associated with an increased risk of QTc prolongation, potentially leading to serious ventricular arrhythmias such as torsades de pointes
and sudden cardiac death. In 1998, droperidol was withdrawn from the market because of its torsadogenic potential and in 2005, thioridazine
was withdrawn from the global market because of the risk of sudden cardiac death. Droperidol has since become available again and is seeing
a resurgence of use in some countries (its initial withdrawal was voluntary, so reintroduction is not prohibited).
Chlorpromazine has the potential to cause skin photosensitivity and patients should avoid undue exposure to sunlight. Allergic dermatitis can
also occur in short term with chlorpromazine. Long-term chlorpromazine use can cause blue-gray discolouration of skin areas exposed to
sunlight. This may be reversible.
References:
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Carbamazepine
Droperidol
Venlafaxine
Lorazepam
Chlorpromazine
Lamotrigine
Mirtazapine
Lithium
Bupropion
Acamprosate
Sildenafil

Question 13
Not answered
Marked out of 3.00
Beyer C, Cappetta K, Johnson JA, et al. Meta-analysis: risk of hyperhidrosis with second-generation antidepressants. Depress Anxiety.
2017;34:1134-1146.
Oteri A et al. Prescribing pattern of antipsychotic drugs during the years 1996–2010: a population‐based database study in Europe with a focus
on torsadogenic drugs. British journal of clinical pharmacology. 2016 Aug;82(2):487-97.
Taylor DM, Barnes TRE, Young AH. The Maudsley Prescribing Guidelines in Psychiatry, 14th Edition. 2021. p. 49.
Stahl SM. Stahl’s Essential Psychopharmacology: Prescriber’s Guide, 7th Edition. 2021. p. 156.
The correct answer is: Severe sweating → Venlafaxine, Torsades de pointes → Droperidol, Allergic dermatitis and photosensitivity →
Chlorpromazine
Plasma steady state
For each of the following drugs, identify the time taken to achieve steady state plasma levels
Lithium
Clozapine
Sodium valproate
Choose...
Choose...
Choose...
Explanation:
Lithium reaches steady state levels in 5 days. Clozapine and valproate both reach steady state levels in 2-3 days.
Ref: Taylor DM, Barnes TRE, Young AH. The Maudsley Prescribing Guidelines in Psychiatry, 14th Edition. 2021. pp. 835-836.
The correct answer is: Lithium → 5 days, Clozapine → 2-3 days, Sodium valproate → 2-3 days
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6 weeks
4 weeks
1 day
2 weeks
2-3days
2 months
3 months
5 days

Question 14
Not answered
Marked out of 1.00
A sudden fright or shock is usually the precipitant for which culture-related syndrome?
Select one:
Koro
Amok
Dhat syndrome
Latah
Windigo
Explanation:
Latah has been found mainly in Malaysian and Indonesian cultures in which a person - after experiencing a sudden fright or shock - displays
abnormal suggestibility accompanied by echolalia, echopraxia, autonomic obedience, and a state resembling a trance. Originally reported as a
common phenomenon among young women in Malaysia, it is becoming less prevalent, (particularly in urban areas) and is now found almost
exclusively among older women who have known of the phenomenon since they were young.
Tseng WS. From peculiar psychiatric disorders through culture-bound syndromes to culture-related specific syndromes. Transcultural
psychiatry. 2006 Dec;43(4):554-76.
The correct answer is: Latah
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Question 15
Not answered
Marked out of 1.00
With respect to vulnerability for depression, poor coping style is best described as which of the following?
Select one:
Modifying factor
Maintaining factor
Precipitating factor
Resilience factor
Protective factor
Brown et al. identified the following factors as maintaining factors for depression: a. Further negative life events b. Persistent poor quality social
support c.Poor coping style characterized by self-blame and helplessness, denial of problems, poor problem-solving ability, blaming others or
external forces d. Inability to obtain adequate social support due to fear of intimacy and e. Low educational level.
The correct answer is: Maintaining factor
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Question 16
Not answered
Marked out of 1.00
Which of the following is not a central antipsychiatry belief?
Select one:
Medication and hospitalisation are harmful to the individual so treated
The scientific method cannot explain the subjective abnormalities of mental disorder as no direct observation can take place
Mental disorder can be best explained by social, ethical and political factors
Mind is a bodily organ and can be diseased
The labelling of individuals as 'ill' is an artificial device used by society to maintain its stability in the face of challenge
Explanation:
Central anti-psychiatry beliefs:
1.The mind is not a bodily organ and so cannot be diseased.
2.The scientific method cannot explain the subjective abnormalities of mental disorder, as no direct observation can take place.
3.Mental disorder can best be explained by social, ethical, or political factors.
4.The labelling of individuals as ‘ill’ is an artificial device used by society to maintain its stability in the face of challenges.
5.Medication and hospitalisation are harmful to the individual so treated.
The correct answer is: Mind is a bodily organ and can be diseased
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Question 17
Not answered
Marked out of 1.00
Which of the following is true with regards to Changing Minds campaign?
Select one:
Is focussed on geriatric mental health issues
Is an initiative from World Health Organisation
Aims to highlight the treatability of mental disorders
Provides a legal clause against stigma
Is an ongoing programme against stigma
Explanation:
The World Health Organization and the World Psychiatric Association both recognise that the stigma and discrimination associated with mental
disorders are strongly linked to suffering, disability, and poverty. Concern about the stigma of mental illness precipitated the Royal College of
Psychiatrists’ 5-year ‘Changing Minds’ campaign (1998-2003) with the aim of promoting positive images of mental illness, challenging
misrepresentations and discrimination, encouraging patient advocacy, and educating the public about the real nature and treatability of mental
disorder.
Luty J et al. Effectiveness of Changing Minds campaign factsheets in reducing stigmatised attitudes towards mental illness. Psychiatric Bulletin.
2007 Oct;31(10):377-81.
The correct answer is: Aims to highlight the treatability of mental disorders
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Question 18
Not answered
Marked out of 1.00
The most common reason for doctors to be taken to the court is
Select one:
Problems in the doctor/patient relationship
Misuse and abuse
Negligence
Not obtaining informed consent
Breaking confidentiality
Negligence: This requires the plaintiff to prove three things 1. That the doctor owed a duty of care to the particular patient 2. That the doctor
was in breach of the appropriate standard of care imposed by the law. 3. That the breach in duty of care caused the patient harm, meriting
compensation.
The correct answer is: Negligence
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Question 19
Not answered
Marked out of 1.00
With respect to population studies, cultural analysis refers to
Select one:
Racial profile of groups
Norms in a group
Beliefs among the group members
Lingual diversity in a group
Geographical clusters of separation
Cultural analysis refers to the study of norms or behavior patterns that are typical of specific cultural groups. These norms are often passed
down from generation to generation by observational learning by the groups gatekeepers - parents, teachers, religious leaders, and peers.
Cultural norms include how people choose marriage partners, attitudes toward alcohol consumption, and acceptance (or rejection) of spanking
children.
The correct answer is: Norms in a group
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Question 20
Not answered
Marked out of 1.00
Which one among the following is not a feature of SSRI discontinuation syndrome
Select one:
Increased dreams
Dizziness
Insomnia
Myoclonic Jerks
Electric shock like sensations
Explanation:


Ref: Gabriel M, Sharma V. Antidepressant discontinuation syndrome. CMAJ. 2017 May 29;189(21):E747.
The correct answer is: Myoclonic Jerks
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Question 21
Not answered
Marked out of 1.00
Which of the following form the basis of official social classification in Britain?
Select one:
Residential status
Land ownership
Financial status
Educational status
Occupational status
Explanation:
In Britain, social class is a derived classification achieved by mapping occupation and employment status to class categories.
Ref: https://sru.soc.surrey.ac.uk/SRU9.html
The correct answer is: Occupational status
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Question 22
Not answered
Marked out of 1.00
Mania is often characterized by the presence of
Select one:
Delusions of control
Delusions of reference
Delusions of love
Delusions of grandiosity
Delusions of pregnancy
Explanation:
Grandiose delusions are most commonly associated with manic psychosis in the context of bipolar affective disorder.
Ref: Casey P, Kelly B. Fish’s clinical pathology: Signs and symptoms in psychiatry, 4 Edition. 2019. pp. 51-52.
The correct answer is: Delusions of grandiosity
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Question 23
Not answered
Marked out of 1.00
Mr. Y is an 83 year old man seen in the outpatient clinic. He is complaining of vivid dreams. His wife reports that he has been having difficulty
with his thinking, though this fluctuates. They no longer sleep in the same bed, as Mr. Y has grabbed his wife in his sleep on a few occasions.
Select one:
Alzheimer dementia
Fronto-temporal dementia
Lewy body dementia
Chronic subdural haematoma
Huntington dementia
Explanation:
Clinical features of dementia with Lewy bodies:
1.Fluctuations are typically delirium-like, occurring as spontaneous alterations in cognition, attention, and arousal
2.Recurrent, complex visual hallucinations (people, children, and animals): up to 80% of cases
3.Spontaneous parkinsonian features (not due to medications or stroke): over 85%
4.REM sleep behaviour disorder: parasomnia manifested by recurrent dream enactment behaviour associated with an absence of normal REM
sleep atonia; occurs in 76% of cases
5.Severe antipsychotic sensitivity is now a supportive, rather than core, feature because reduced prescribing of D2 receptor blocking
antipsychotics limits its diagnostic usefulness
6.New supportive features in the criteria: hypersomnia (usually excessive daytime sleepiness) and hyposmia (occurs earlier in DLB than in AD)
Ref: McKeith IG et al. Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium. Neurology.
2017 Jul 4;89(1):88-100.
The correct answer is: Lewy body dementia
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Question 24
Not answered
Marked out of 1.00
Which ICD-11 diagnosis incorporates the concept of ICD-10 neurasthenia?
Select one:
Complex post-traumatic stress disorder
Bipolar type II disorder
Body integrity dysphoria
Body dysmorphic disorder
Bodily distress disorder
Explanation:
ICD-11 disorders of bodily distress and bodily experience encompass two disorders: bodily distress disorder and body integrity dysphoria. ICD-
11 bodily distress disorder replaces ICD-10 somatoform disorders and also includes the concept of ICD-10 neurasthenia.
Ref: Reed GM et al. Innovations and changes in the ICD‐11 classification of mental, behavioural and neurodevelopmental disorders. World
Psychiatry. 2019 Feb;18(1):3-19.
The correct answer is: Bodily distress disorder
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Question 25
Not answered
Marked out of 1.00
Excessive doubt and distrust in relationships is a characteristic feature of which of the following personality disorder?
Select one:
Schizoid
Antisocial
Schizotypal
Borderline
Paranoid
Explanation:
Persons with paranoid personality disorder have long-standing suspiciousness and mistrust of people in general. Clinical features of patients
with paranoid personality disorder include being suspicious that others are exploiting, harming, or deceiving them; reading hidden demeaning
or threatening meanings into benign remarks/events; holding long-standing grudges; believing that others are not loyal or trustworthy; being
reluctant to confide in others; feeling that others are attacking their character or reputation; having recurrent suspicions of infidelity.
Ref: Boland R, Verduin M. Kaplan and Sadock's Synopsis of Psychiatry, 12th Edition. 2022. pp. 560-562.
The correct answer is: Paranoid 

Question 26
Not answered
Marked out of 1.00
Presence of lymphocytic pleiocytosis with many red cells in the CSF, along with hyperintense appearance of left temporal lobe in T2 weighted
MRI imaging and lateralised periodic discharges in EEG in a semi-conscious patient suggests
Select one:
Pneumococcal meningitis
Creutzfeldt Jakob disease
Temporal lobe malignancy
Subdural haemorrhage
Herpes encephalitis
Brain abnormalities may be visible on CT but are much more consistently seen on MRI with gadolinium (MRI is most sensitive method of
detecting early lesions and is imaging of choice); brain MRI typically shows hyperintensities involving the cortex and white matter in T2
and FLAIR images - areas of contrast enhancement can also be present. While MRI is the preferred modality of imaging, early in the
clinical course of the disease, MRI results may be negative. A negative MRI does not rule out HSV encephalitis.
T2-weighted MRI reveals hyperintensity corresponding to edematous changes in the temporal lobes (see the first two images in the link
http://emedicine.medscape.com/article/341142-overview) with a predilection for the medial temporal lobes.
Cerebrospinal fluid (CSF) examination is the gold standard for diagnosis. CSF polymerase chain reaction (PCR) for HSV has a
sensitivity and specificity of >95%; false negatives can occur in the first 72 hours of onset. CSF pleocytosis (increased lymphocytes) and
raised protein may also be seen.
Ref: Stahl JP, Mailles A. Herpes simplex virus encephalitis update. Current opinion in infectious diseases. 2019 Jun 1;32(3):239-43.
Kapadia RK et al. Encephalitis in adults caused by herpes simplex virus. CMAJ. 2020 Aug 10;192(32):E919-.
The correct answer is: Herpes encephalitis
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Question 27
Not answered
Marked out of 1.00
Degeneration of head of caudate nucleus is associated with
Select one:
Huntington chorea
OCD
Tourette syndrome
Fahr disease
Wilson disease
Explanation:
In Huntington disease (HD), there is commonly mild-moderate cerebral atrophy. The main neuropathological abnormality of HD is atrophy of
the caudate nucleus and putamen.
Ref: Gray F, Duyckaerts C, de Girolami U. Escourolle and Poirier’s Manual of Basic Neuropathology, 6 Edition. 2019. p. 206.
The correct answer is: Huntington chorea
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Question 28
Not answered
Marked out of 1.00
Which one of the following is not a type of primary delusion?
Select one:
Delusional memory
Delusional misidentification
Delusional atmosphere
Delusional perception
Autochthonous delusions
Explanation:
Primary delusions are the direct result of psychopathology, while secondary delusions can be understood as having arisen in response to other
primary psychiatric conditions. Primary delusions can be subdivided by the method by which they are perceived as having arisen, as follows:
1.Autochthonous delusion: arises ‘out of the blue’
2.Delusional perception: arises on seeing a normal percept
3.Delusional memory: arises on recalling a memory
4.Delusional mood or atmosphere: arises on a background of anticipation, odd experiences, and increased awareness
The correct answer is: Delusional misidentification
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Question 29
Not answered
Marked out of 1.00
A 19 year-old university student, seen for first time by a psychiatrist, is very perplexed and claims that he could feel something odd happening
around him. This phenomenon is termed as
Select one:
Sensitive ideas of reference
Delusional mood
Oneiroid state
Vorbeireden
Persecutory delusion
Explanation:
Delusional mood is recalled as arising following a period when there is an abnormal mood state characterised by anticipatory anxiety, a sense
of ‘something is about to happen’ and an increased sense of the significance of minor events. The development of the formed delusion may
come as a relief to the patient in this situation. Delusional mood is a type of Jasperian primary delusion.
The correct answer is: Delusional mood 

Question 30
Not answered
Marked out of 1.00
A teacher rewarded Jimmy with star sticker for his good behaviour. It represents which type of learning?
Select one:
Operant conditioning
Classical conditioning
Social learning
Aversive learning
Cognitive learning
Explanation:
Behaviour modification is based on operant conditioning. The basic principles of operant conditioning are that if a response to a stimulus
produces positive consequences for the individual, it will tend to be repeated, while if it is followed by negative consequences, it will not. Forms
of behavioural modification include the use of secondary reinforcement, such as ‘token economy’, in which socially desirable/acceptable
behaviours are rewarded with tokens that can be exchanged for other material items or privileges, or ‘star charts’ where children’s good
behaviour is rewarded when a certain level is achieved. Rewarding a child with star stickers for good behaviour is an example of positive
reinforcement.
Ref: Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul 30. pp. 907-908.
The correct answer is: Operant conditioning
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Question 31
Not answered
Marked out of 1.00
Mohammed is a 7-year-old boy. His mother told him that he could play outside once he had finished his homework. This is based on which of
the following psychological mechanisms?
Select one:
Premack principle
Operant conditioning
Reciprocal inhibition
Cognitive mapping
Explanation:
The Premack principle asserts that access to a preferred action will reinforce any action that is less preferred. Any behaviour that is preferred to
a second behaviour will theoretically reinforce the second behaviour. This is also known as ‘Grandma‘s rule' – ‘eat the carrot and get the
dessert'.
Ref: Boland R, Verduin M. Kaplan and Sadock's Synopsis of Psychiatry, 12th Edition. 2022. p. 1019.
The correct answer is: Premack principle 

Question 32
Not answered
Marked out of 1.00
A grandmother says to her grandchild "You must eat your greens before you go to play outside". Which psychological mechanism is used here?
Select one:
Premack principle
Counterconditioning
Overt sensitization
Explanation:
The Premack principle asserts that access to a preferred action will reinforce any action that is less preferred. Any behaviour that is preferred to
a second behaviour will theoretically reinforce the second behaviour. The Premack principle is also called relative theory of reinforcement,
often used with young children. It states that more probable behaviour (like play outside) will reinforce less probable behavior (like eating green
leafy vegetables).
The correct answer is: Premack principle 

Question 33
Not answered
Marked out of 1.00
Abnormalities in Stroop test suggests
Select one:
Cortical blindness
Lesion of optic chiasma
Attentional bias
Short term memory disturbance
Damage to occipital cortex
Explanation:
The Stroop effect is the delay and disruption in naming the colours of words printed in non-matching coloured ink, as when the word ‘red’ is
printed in blue ink, the word ‘blue’ in green ink, and so on. To perform the task it is necessary to ignore the meanings of the printed words and
to respond only to the colours in which they are printed, but with experienced adult readers automatic processing tends to occur, causing
interference in the processing of information and a significant increase in the time required to name the colours, compared with the time taken
to name the colours of meaningless strings of letters. Abnormal Stroop effect with the loss of appropriate inhibitory control is seen in frontal
lobe lesions.
The correct answer is: Attentional bias
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Question 34
Not answered
Marked out of 1.00
One of the local newspaper reports that drug addicts carry out muggings. An 83-year-old lady was mugged and the public concluded the
attacker was a drug addict. Select the cognitive heuristic in this case.
Select one:
Framing
Availability
Simulation
Representation
Anchoring
Explanation:
A heuristic is a rough-and-ready procedure or rule of thumb for making a decision, forming a judgement, or solving a problem without the
application of an algorithm or an exhaustive comparison of all available options, and hence without any guarantee of obtaining a correct or
optimal result. The availability heuristic is a cognitive heuristic through which the frequency or probability of an event is judged by the number
of instances of it that can be readily brought to mind. It can generate biased or incorrect judgements.
Ref: Colman AM. Oxford Dictionary of Psychology, 4 Edition. 2015
The correct answer is: Availability
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Question 35
Not answered
Marked out of 1.00
Which of the following is least likely to accompany lesions causing predominantly an impairment of working memory?
Select one:
Procedural memory impairment
Inability to learn new information
Impaired performance on mathematical calculations
Episodic memory impairment
Impaired performance on tests of attention and concentration
Explanation:
The performance of tasks such as typing, swimming, or cutting a loaf of bread are expressions of prior learning that differ from episodic
memory in that there is no active awareness that memory is being searched in undertaking the particular skill. This type of memory is known as
implicit, procedural, or skills memory. Studies of people with injury to the hippocampus suggest that declarative and implicit memory use
different parts of the brain and can function independently. The hippocampus is believed to be the site where explicit (declarative) memory is
stored, while implicit (procedural) memory is thought to reside in the limbic system, the amygdala, and the cerebellum.
Ref: Casey P, Kelly B. Fish’s clinical pathology: Signs and symptoms in psychiatry, 4 Edition. 2019. p. 64.
The correct answer is: Procedural memory impairment
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Question 36
Not answered
Marked out of 1.00
A patient with phobia for spiders is gradually exposed to various grades of anxiety provoking stimuli with simultaneous relaxation training.
Which of the following principles are primarily employed in this therapy?
Select one:
Discriminant learning
Covert desensitisation
Stimulus generalisation
Explanation:
Systematic desensitisation is based on the behavioural principle of reciprocal inhibition (i.e. anxiety and relaxation cannot coexist). It involves
three steps: relaxation training, constructing a hierarchy of anxieties, and desensitisation of the stimulus. The patient is exposed to a graded
hierarchy of anxiety-provoking situations in stepwise fashion while being taught to practice the relaxation techniques (e.g. a young woman with
a spider phobia is taught relaxation techniques and then exposed to experiences starting from the lowest level of her hierarchy of anxieties -
such as going to the cellar where there is the potential to come across a spider - then progressively going up the ladder to the highest - such as
handling a spider).
The correct answer is: Reciprocal inhibition
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Question 37
Not answered
Marked out of 1.00
During psychometric testing by a psychologist, the subject is first asked to copy a complex geometric figure and then to draw from memory
after an interval of 30 minutes? What is this test called as?
Select one:
Wechsler Adult Intelligence Scale
Rivermead Behavioural Memory Test
Wechsler Memory Scale
Halstead-Reitan scale
Rey-Osterrieth test
Explanation:
The Rey-Osterrieth Complex Figure test examines the ability to draw and later recall a complex geometric configuration. It tests visual memory
as well as executive deficits in the development of strategies and planning.
The correct answer is: Rey-Osterrieth test
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Question 38
Not answered
Marked out of 1.00
Many patients with anxiety disorders engage in certain subtle behaviours while in a fearful situation that ultimately maintain the fear. These
behaviours are called
Select one:
Compulsions
Safety behaviours
Mental imagery
Obsessions
Phobic behaviours
Explanation:
Safety behaviours are overt or covert acts intended to prevent a feared outcome or to minimise its consequences. They are found in many
anxiety disorders, including PTSD, OCD, panic disorder, and social anxiety disorder (SAD). Safety behaviours such as avoiding eye contact or
rehearsing sentences before saying them are used in order to prevent feared outcomes such as public embarrassment or humiliation.
However, as the fears are excessive, it has been suggested that a major effect of safety behaviours is that they prevent patients from
disconfirming some of their erroneous beliefs about the feared situation.
Gray E et al. Sub-types of safety behaviours and their effects on social anxiety disorder. Plos one. 2019 Oct 1;14(10):e0223165.
The correct answer is: Safety behaviours
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Question 39
Not answered
Marked out of 1.00
During cognitive examination, a patient correctly states that bicycles have two wheels. What type of memory has been tested?
Select one:
Semantic memory
Episodic memory
Procedural memory
Working memory
Autobiographical memory
Explanation:
Semantic memory is a type of long-term memory for factual information about the world, excluding personal episodes in one’s life. Typical
examples are knowledge of the dates of the world wars and the chemical formula for water. The term is from the Greek ‘semantikos’, so called
because it is necessary for the use of language. Episodic or autobiographic memory involves recalling an 'episode' - the time associated
memory.
The correct answer is: Semantic memory
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Question 40
Not answered
Marked out of 1.00
Sammy Taylor is coming to see you in clinic as an emergency book-in. He is 19 years old and has developed some voice-hearing experiences
and bizarre thoughts regarding the MI5. Which of these might be a precipitating factor?
Select one:
Having lost his adoptive father to a road traffic accident two weeks previously
Having been adopted at the age of 7 months
Having had a traumatic birth
Having a brother who has a diagnosis of schizophrenia
Having dropped out of school prematurely at the age of 15
Explanation:
The others may be contributing factors, but most are predisposing rather than precipitating. A precipitating factor has a strong temporal link to
the onset of the episode of mental illness (e.g. it occurs just before).
Four ‘Ps’ of case formulation:
Predisposing factors: those that put a person at risk of developing a problem; may include genetics, previous life events, or temperament
Precipitating factors: a specific event or trigger to the onset of the current problem
Perpetuating factors: those that maintain the problem once it has become established
Protective factors: strengths that reduce the severity of problems and promote healthy and adaptive functioning
Ref: Racine NM et al. Systematic review: predisposing, precipitating, perpetuating, and present factors predicting anticipatory distress to painful
medical procedures in children. Journal of pediatric psychology. 2016 Mar 1;41(2):159-81.
The correct answer is: Having lost his adoptive father to a road traffic accident two weeks previously
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Question 41
Not answered
Marked out of 1.00
The current international agreement on the research of human subjects is
Select one:
Tuskegee syphilis study
Geneva declaration
Hippocratic oath
Nuremberg code
Helsinki declaration
Explanation:
The World Medical Association (WMA) has developed the Declaration of Helsinki as a statement of ethical principles for medical research
involving human subjects, including research on identifiable human material and data. Adopted by the WMA’s General Assembly in 1964, it is
the most important set of guidelines about research on human participants. It both reflects and shapes the ethos of international research
ethics. It is a living instrument and is reviewed and revised regularly. Its latest revision was in 2013.
Ref: https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/
Malik AY, Foster C. The revised Declaration of Helsinki: cosmetic or real change?. Journal of the Royal Society of Medicine. 2016 May;109(5):184-
9.
The correct answer is: Helsinki declaration


Question 42
Not answered
Marked out of 1.00
An Inuit woman suffers from sudden attacks of shouting, becoming frightened and impulsive running away. She appears dissociated during the
attacks and has total amnesia for the episodes. Probable diagnosis is
Select one:
Windigo
Dhat
Latah
Fag
Piblokto
Explanation:
Piblokto is a culture-specific syndrome found among the Inuit in which individuals present with attacks of screaming, crying, and running naked
through the snow. It is characterised by an initial period of fatigue, social withdrawal, confusion, and irritability lasting for a few hours or days,
leading up to an abrupt episode of dissociation (that usually lasts only minutes) during which the affected person may strip or tear off clothes,
roll in the snow, run about in a frenzied state, shout obscenities, destroy property, engage in other violent, dangerous, or antisocial forms of
behaviour, and manifest pseudolalia, echolalia, and echopraxia, before lapsing into convulsions and losing consciousness. This is followed by
complete amnesia for the dissociative episode.
Ref: Casey P, Kelly B. Fish’s clinical pathology: Signs and symptoms in psychiatry, 4 Edition. 2019. p. 126.
Colman AM. Oxford Dictionary of Psychology, 4 Edition. 2015.
The correct answer is: Piblokto
th
th
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Question 43
Not answered
Marked out of 1.00
A 17-year-old man is using cannabis for last 6 months. His parents worry about his dependence but he is not worried. Which stage of
Prochaska & DiClemente's transtheoretical model of change is he presently in?
Select one:
Pre contemplation
Maintenance
Contemplation
Action
Preparation
Explanation:
The most appropriate stage of change in the transtheoretical model is precontemplation stage, as he is not even ready to think about change
seriously.
Six stages of change:
(1) Precontemplation: not even considering changing behaviour; does not see the behaviour as a problem, minimizes and denies associated
risks, and avoids information to the contrary
(2) Contemplation: has become aware that the behaviour is a problem but is ambivalent about changing, and likely sees equal or more benefits
than costs from the behaviour
(3) Preparation: has made a decision to attempt change
(4) Action: has implemented a plan and is changing the behaviour
(5) Maintenance: maintaining gains made and attempting to improve areas of life that have been harmed
(6) Relapse: return to previous behaviour, but with the possibility of gaining useful strategies to extend the maintenance period on the next
attempt


Question 44
Not answered
Marked out of 1.00
The correct answer is: Pre contemplation
What ethical document, sometimes referred to as the ‘Physician’s Pledge’ or the ‘Modern Hippocratic Oath’, was adopted by the World Medical
Association in 1948?
Select one:
The Declaration of Malta
The Declaration of Tokyo
The Declaration of Taipei
The Declaration of Geneva
The Declaration of Helsinki
Explanation:
The Declaration of Geneva represents the important principles of professional medical conduct in the modern globalised world. It was last
amended in 2017. It is written in the tradition of the Hippocratic Oath, but unlike the Hippocratic Oath it contains no reference to God, no
prohibition of surgery, no explicit restrictions on euthanasia or abortion, but simply a commitment to the ‘utmost respect for human life’. The
Hippocratic Oath prohibits abuse, whilst the Declaration of Geneva prohibits discrimination. The 2017 version of the Geneva Declaration
mentions patient autonomy for the first time. The Helsinki declaration refers to a statement of ethical principles for medical research involving
human subjects. Other options are not relevant for medical ethics.
Ref: Wiesing U. The Hippocratic Oath and the Declaration of Geneva: legitimisation attempts of professional conduct. Medicine, Health Care and
Philosophy. 2020 Mar;23(1):81-6.
The correct answer is: The Declaration of Geneva


Question 45
Not answered
Marked out of 1.00
Which of the following statements is true with regard to public and professional perception of depressive illness?
Select one:
Professionals do not perceive antidepressants to be very helpful for depression
Health professionals and public hold concordant views on management of depression
Public have greater faith in antidepressants than the professionals
Public does not support special diet or nutrition to treat depression
Public perceive psychotropics to be more harmful than helpful
Health professionals give higher ratings than the public to the helpfulness of antidepressants for depression, and of antipsychotics and
admission to a psychiatric ward for schizophrenia. Conversely, the public tended to give much more favourable ratings to vitamins and
minerals and special diets for both depression and schizophrenia, and to reading self-help books for schizophrenia. The beliefs that health
practitioners hold about mental disorders differ greatly from those of the general public. (Retrieved from Jorm AF, Korten AE, et al. Helpfulness
of interventions for mental disorders: beliefs of health professionals compared with the general public. Br J Psychiatry 1997; 171: 233-237)
The correct answer is: Public perceive psychotropics to be more harmful than helpful


Question 46
Not answered
Marked out of 1.00
Which of the following is a component of Kohlberg's conventional stage of morality?
Select one:
Authority
Punishment
Reward
Social contract
Universal ethics
Explanation:
Lawrence Kohlberg integrated Jean Piaget’s concepts and described multiple stages of moral development within three significant levels of
morality. The first level is pre-conventional morality, in which punishment and obedience are the determining factors. The second level is
morality of conventional role-conformity, in which children try to conform to gain approval and maintain good relationships with others and are
also guided by rigid codes of ‘law and order’ (authority orientation). The third and highest level is the morality of self-accepted moral principles
(post-conventional), in which children voluntarily comply with rules based on a concept of universal ethical principles and make exceptions to
rules in certain circumstances.
The correct answer is: Authority
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Question 47
Not answered
Marked out of 1.00
According to Erikson's stages of psychosocial development, at which stage would a four year old be?
Select one:
Initiative vs guilt
Industry vs inferiority
Trust vs mistrust
Autonomy vs shame
Ego identity vs role confusion
Explanation:
Erik Erikson created an original and highly influential theory of psychological development and crisis occurring in periods that extended across
the entire life cycle. Stage 3 takes place from about 3 years to about 5 years. Its focus is initiative versus guilt. The child’s increasing mastery of
locomotor and language skills expands its participation in the outside world and stimulates omnipotent fantasies of broader exploration and
conquest. Guilt over the drive for conquest and anxiety over the anticipated punishment are both assuaged in the child through repression of
the forbidden wishes and development of a superego to regulate its initiative. Success in this stage will result in development of the basic virtue
of purpose.
The correct answer is: Initiative vs guilt


Question 48
Not answered
Marked out of 1.00
Mrs. Kean and her 16-year-old son Henry have been having some disagreements about his future plans. Mrs. Kean has decided which
universities Henry will apply for. He protests, saying he wants to make his own decision, but Mrs. Kean replies saying that the choice is not his,
the decision will be made for him by her and her husband and there's nothing he can do about it. Henry reluctantly concedes. What parenting
style is Mrs. Kean exhibiting?
Select one:
Authoritarian
Boundaried
Authoritative
Neglectful
Permissive
Explanation:
Rutter has clustered parenting into four general styles. The authoritarian style, characterised by strict, inflexible rules, can lead to low self-
esteem, unhappiness, and social withdrawal. Authoritarian parents tend to be restrictive and cold, and their children tend to be withdrawn or
conflicted.
The correct answer is: Authoritarian


Question 49
Not answered
Marked out of 1.00
Melissa and her partner Jakob have recently had a baby. Jakob is looking forward to charting their son's development, and wants to draw up a
time-line so that he can anticipate what new skills his son may be able to master. He is anxious to notice any clues that may suggest his son is
not developing as expected. Which of the following scenarios suggests impaired development?
Select one:
2-3 words at 24 months
Holding head up at 3 months
Able to roll at 9 months
Able to walk at 13 months
Plays with a ball at 16 months
Explanation:
By age 18 months, a child is generally using 20 single words. They will understand up to 150 words. By 24 months, their vocabulary will increase
to up to 270 words.
The correct answer is: 2-3 words at 24 months 

Question 50
Not answered
Marked out of 1.00
What type of attachment is demonstrated by a child who seems unaffected by the mother leaving and carries on playing and also unaffected
by the mother's return?
Select one:
Secure attachment
Anxious-avoidant attachment
Anxious-ambivalent attachment
Anxious-resistant attachment
Disorganised attachment
Explanation:
Mary Ainsworth devised the Strange Situation procedure with 12- to 18-month infants, which categorised infant-parent relationships. The
procedure involves separations and reunions with caregivers and observes response. In anxious-avoidant attachment, the child seems
unconcerned at separation or reunion. It is associated with unresponsive parenting. Mary Ainsworth noted that this type of attachment often
occurred when the child's needs were repeatedly not met and allows the child to maintain some proximity to the parent without experiencing
maternal rejection. Note that the anxious-avoidant, anxious-resistant and disorganised categories are also described as insecure-avoidant,
insecure-resistant (or ambivalent) and insecure-disorganised. Ainsworth preferred classifications using alphabetical notations (A, B, C). The
disorganised category is attributed to Ainsworth's student, Mary Main.
For a short illustrative video see


Ref: Duschinsky R. Mary Ainsworth and the Strange Situation Procedure. In: Cornerstones of Attachment Research. New York, NY: Oxford
University Press; 2020:109-210. https://www.oxfordclinicalpsych.com/view/10.1093/med-psych/9780198842064.001.0001/med-
9780198842064-chapter-2. Accessed March 4, 2022.
The correct answer is: Anxious-avoidant attachment


Question 51
Not answered
Marked out of 1.00
Nina and her mother are spending the afternoon together. Nina's mother has been talking about families. At one point in the conversation
Nina asks her mother 'what would happen if I have a baby brother?' What developmental stage, according to Piaget, is Nina most likely to be
at?
Select one:
Formal Operational
Preoperational
Concrete Operational
Conventional
Sensorimotor
Explanation:
According to Piaget, the stage of formal operations lasts from about 11 years of age through the end of adolescence. The stage is so named
because young persons’ thinking operates in a formal, highly logical, systematic, and symbolic manner. It is characterised by the ability to think
abstractly, to reason deductively, and to define concepts, and also by the emergence of skills for dealing with permutations and combinations.
Adolescents attempt to deal with all possible relations and hypotheses to explain data and events during this stage. They are able to think
abstractly or hypothetically, which is demonstrated by Nina's question.
The correct answer is: Formal Operational


Question 52
Not answered
Marked out of 1.00
Kevin is a young boy who is getting into arguments with other children at school and is occasionally pushing them over. His parents and
teachers have attempted to reason with him but this has not been successful. His behaviour eventually improves when he is told that his
favourite toy will be removed as long as he continues to push others. Which of the following stages of Kohlberg's moral development would
best fit this scenario?
Select one:
Obedience and punishment orientation
Authority and social-order maintaining orientation
Self-interest orientation
Social contract orientation
Interpersonal accord and conformity
Explanation:
Lawrence Kohlberg integrated Jean Piaget’s concepts and described multiple levels of moral development within three significant levels of
morality. The first level is pre-conventional morality, in which punishment and obedience are the determining factors. The second level is
morality of conventional role-conformity, in which children try to conform to gain approval and maintain good relationships with others and are
also guided by rigid codes of ‘law and order’ (authority orientation). The third and highest level is the morality of self-accepted moral principles
(post-conventional), in which children voluntarily comply with rules based on a concept of universal ethical principles and make exceptions to
rules in certain circumstances.
The correct answer is: Obedience and punishment orientation
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Question 53
Not answered
Marked out of 1.00
In the development of vision, which of the following can be seen occurring as early as the first day after birth?
Select one:
Pupil reaction to light
Accommodation
Convergence
Colour vision
Depth perception
The pupillary light reflex (PLR) whereby the diameter of the pupil is controlled according to the intensity of light occurs from birth. Depth
perception, colour vision and accommodation occur at three to five months. Convergence occurs at five to seven months.
The correct answer is: Pupil reaction to light


Question 54
Not answered
Marked out of 1.00
Mrs Molloy has been struggling with feelings of depression and self-blame. She's been talking about her childhood experiences in
psychotherapy and described the way her father would make her follow very strict rules. On one occasion, she returned home only a few
minutes after her curfew, and she was beaten by him with a belt. The parenting style she is describing is known as
Select one:
Authoritarian
Permissive
Indulgent
Neglectful
Secure
Explanation:
Rutter has clustered parenting into four general styles. The authoritarian style, characterised by strict, inflexible rules, can lead to low self-
esteem, unhappiness, and social withdrawal. Authoritarian parents tend to be restrictive and cold, and their children tend to be withdrawn or
conflicted. These children generally tend to grow up with little sense of agency or personal power, with a tendency towards depression, self-
doubt and fear.
The correct answer is: Authoritarian


Question 55
Not answered
Marked out of 1.00
You are about to go to A&E to assess a patient who is feeling suicidal. Which demographic description has got the strongest association with
completed suicide?
Select one:
Middle-aged male
Elderly female
Young female
Widow
Elderly male
Explanation:
In the UK, men aged 45-49 years currently present the highest suicide rate. This is thought to be linked to middle-aged men being more likely
affected in recent years by economic adversity, alcoholism, and social isolation. In most countries, rates of suicide are 2-3 times higher in males
than in females, which could possibly be due to a male preference for higher lethality methods and the reluctance of males to seek help.
Ref: Correia R, Jackson D. Risk to self: identifying and managing risk of suicide and self-harm. BJPsych Advances. 2020:1-11.
Turecki G et al. Suicide and suicide risk. Nature reviews Disease primers. 2019 Oct 24;5(1):1-22.
The correct answer is: Middle-aged male


Question 56
Not answered
Marked out of 1.00
The mode of language designed to provide a means of communication for those with learning difficulties is
Select one:
COPE method
BASDEC method
Jarmen system
Makaton system
Barthel method
Makaton is a simplified sign language, based on British Sign Language but internationally recognised, specifically designed for people with
learning difficulties of all kinds and their parents and carers, developed by the speech therapist Margaret Walker. The revised version contains
approximately 350 signs and associated words. ‘Makaton’ is formed from the initial letters of the first names of its inventor, Margaret Walker,
and the two psychiatric hospital visitors who assisted in its development, Kathy Johnston and Tony Cornforth.
The correct answer is: Makaton system
th
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Question 57
Not answered
Marked out of 1.00
Who proposed a theory of identity development in children, separate from that of their mothers' identity?
Select one:
Freud
Rutter
Margaret Mahler
Spitz
Winnicott
Explanation:
Margaret Mahler proposed a theory to describe how young children acquire a sense of identity separate from that of their mothers’. Her
observations of children and their mothers lead to her theory of separation-individuation.
The correct answer is: Margaret Mahler


Question 58
Not answered
Marked out of 1.00
Which of the following type of parents will not set any limit for child's behaviour but show unpredictable harshness and act aggressively if
boundaries are violated?
Select one:
Authoritarian
Authoritative
Permissive
Good enough parent
Neglectful
Explanation:
Rutter has clustered parenting into four general styles. The indulgent-permissive style, which includes little or no limit-setting coupled with
unpredictable parental harshness, can lead to low self-reliance, poor impulse control, and aggression.
Authoritarian style parents impose strict rules that can be associated with low self-esteem and social withdrawal in the children. The neglectful
style of parenting can lead to poor self-esteem, impaired self-control, and increased aggression. Parents with an authoritative style set firm
rules but share decision-making with their children, creating a warm, loving environment, which promotes self-reliance and positive self-
esteem.
The correct answer is: Permissive


Question 59
Not answered
Marked out of 1.00
A 4-year-old child now recognizes she's a girl and wants to spend more time with her dad. According to Freud she's at what phase of
psychosexual development?
Select one:
Genital phase
Oral phase
Anal phase
Latency phase
Phallic phase
Explanation:
The phallic stage begins sometime during year 3 and continues until approximately the end of year 5. The phallic stage provides the foundation
for an emerging sense of sexual identity, curiosity without embarrassment, initiative without guilt, as well as mastery not only over objects and
persons in the environment but also over internal processes and impulses.
The correct answer is: Phallic phase 

Question 60
Not answered
Marked out of 1.00
Angela Stubbs has been participating in psychotherapy for the past seven months. She has the sense that the process has been helping her
develop a more robust sense of self, a feeling of continuity, and of affiliation with others. What term best describes this process?
Select one:
Individuation
Identity diffusion
Symbiosis
Introjection
Deindividuation
Explanation:
Carl Jung described individuation as “becoming a single, homogeneous being, and, in so far as ‘individuality’ embraces our innermost, last, and
incomparable uniqueness, it also implies becoming one’s own self. We could therefore translate individuation as ‘coming to selfhood’ or ‘self-
actualisation’."
The correct answer is: Individuation
th
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Question 61
Not answered
Marked out of 1.00
Mr. Ellison is a 70-year-old man who was taken to his GP with increasing symptoms of cognitive impairment, resting tremor, limb stiffness and
episodes when he appears to be seeing distressing things. Which of the following is the gene product most likely to be associated with his
diagnosis?
Select one:
Alpha-synuclein
Ubiquitin
Beta-Synuclein
Tau protein
Amyloid A protein
Explanation:
The diagnosis is Lewy body dementia (LBD) and the pathological finding in this condition is the presence of Lewy bodies. The key constituent of
Lewy bodies is alpha-synuclein. The function of alpha-synuclein is not certain, but it is thought to function in cell membrane remodeling at
neuronal terminals. When aggregates of misfolded, overexpressed alpha-synuclein accumulate in neurons or surrounding glial cells, Lewy
bodies are formed.
Ref: Sanford AM. Lewy body dementia. Clinics in geriatric medicine. 2018 Nov 1;34(4):603-15.
The correct answer is: Alpha-synuclein


Question 62
Not answered
Marked out of 1.00
Abdul is a 10-year-old biy who suffers from ADHD. You meet with his parents in your outpatient clinic. They have been reading about Modafinil
on the Internet and are keen to learn more. Through which neurotransmitter does modafinil predominantly exert its effect in ADHD?
Select one:
Dopamine
GABA
Serotonin
Glutamate
Acetylcholine
Explanation:
How modafinil works is unknown, but it is clearly different from classical stimulants such as methylphenidate and amphetamine. Modafinil
binds to and requires the presence of the dopamine transporter; it also requires the presence of alpha-adrenergic receptors. It hypothetically
acts as an inhibitor of the dopamine transporter.
Ref: Stahl SM. Stahl’s Essential Psychopharmacology: Prescriber’s Guide, 7 Edition. 2021. p. 521.
The correct answer is: Dopamine
th


Question 63
Not answered
Marked out of 1.00
The movement of ions is an essential part of the transmission of impulses within the nervous system. Which of the following ions flows into
neurons to propagate action potentials?
Select one:
Sodium
Potassium
Chloride
Phosphate
Calcium
Explanation:
An action potential is the momentary change in the voltage difference across the membrane of a neuron, usually triggered by nerve impulses
from several other neurons at synapses. It is characterised by an influx of positively charged sodium ions through the cell membrane, resulting
in an impulse being propagated along the neuron’s axon, reversing its resting potential of approximately -70 millivolts (mV), the inner surface
being negative relative to the outer surface and the membrane more permeable to potassium ions than to sodium ions, and changing it to
approximately +40 mV, increasing the permeability of the membrane to sodium ions and resulting in the influx of positively charged ions,
thereby propagating the potential from the axon hillock down the axon.
The correct answer is: Sodium
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Question 64
Not answered
Marked out of 1.00
Alzheimer disease is strongly associated with:
Select one:
Presenilin-1 gene on chromosome 1
Presenilin-2 gene on chromosome 2
COMT gene on chromosome 21
CAG repeats on chromosome 4
APO E4 on chromosome 19
Explanation:
Carriers of the apolipoprotein E E4 allele on chromosome 19 are at increased risk of Alzheimer disease (AD). Early onset AD has been
associated with mutations including amyloid precursor protein on chromosome 21, and the genes for presenilin 1 (on chromosome 14) and
presenilin 2 (on chromosome 1).
Boland R, Verduin M. Kaplan and Sadock's Synopsis of Psychiatry, 12th Edition. 2022. p. 993.
The correct answer is: APO E4 on chromosome 19


Question 65
Not answered
Marked out of 1.00
Which of the following is caused by trinucleotide repeat expansion?
Select one:
Down syndrome
Huntington disease
Parkinson disease
Schizophrenia
Lewy body dementia
Explanation:
Huntington disease results from expansion of a CAG trinucleotide repeat in the HTT (huntingtin) gene on the short arm of chromosome 4.
Alleles with 40 or more trinucleotide repeats are fully penetrant.
Ref: Bachoud-Lévi AC et al. International Guidelines for the treatment of Huntington’s Disease. Frontiers in neurology. 2019;10:710.
The correct answer is: Huntington disease


Question 66
Not answered
Marked out of 1.00
A man is brought to the A& E department with akinetic mutism. He has suffered a stroke. Which artery is most likely to be involved?
Select one:
Basilar artery
Subclavian artery
Posterior inferior cerebellar artery
Middle cerebral artery
Bilateral anterior cerebral artery
Explanation:
Damage to the anterior cingulate cortex is known to be a primary cause for akinesia and mutism and has frequently been described in case
reports of patients with bleeding, stroke, or other types of severe brain injury. The most dramatic examples of akinesia and mutism follow
bilateral lesions of the anterior cingulate cortex, such as after bilateral damage to the vascular supply of the anterior cerebral artery territory.
Ref: Arnts H et al. On the pathophysiology and treatment of akinetic mutism. Neuroscience & Biobehavioral Reviews. 2020 May 1;112:270-8.
The correct answer is: Bilateral anterior cerebral artery


Question 67
Not answered
Marked out of 1.00
Communication between the frontal lobes of each side of the brain is mediated through which of the following structures?
Select one:
Fornix
Genu of corpus callosum
Parahippocampal gyrus
Splenium of corpus callosum
Arcuate fasciculus
The corpus callosum forms the major connection by which the hemispheres communicate with one another. The genu of the corpus callosum
contains fibers that pass from the frontal lobe of one side to that of the other.
The correct answer is: Genu of corpus callosum


Question 68
Not answered
Marked out of 1.00
Which of the following structures appears larger on the left side than the right in healthy right-handed man?
Select one:
Frontal lobe
Hippocampus
Inferior temporal gyrus
Caudate nucleus
Heschl's gyrus
Explanation:
Heschl’s gyrus (HG), or the first transverse temporal gyrus, first described by Richard Heschl, is an oblique convolution located on the inferior
surface of the lateral fissure (also known as the Sylvian fissure), which runs transversely (mediolaterally) from near the insula towards the
lateral part of the superior temporal gyrus. HG includes the primary auditory cortex, this being the first cortical relay station of auditory
information in the brain. On average and in healthy populations, HG is large in the left compared to the right hemisphere.
Ref: da Rocha JL et al. TASH: Toolbox for the Automated Segmentation of Heschl’s gyrus. Scientific reports. 2020 Mar 3;10(1):1-5.
The correct answer is: Heschl's gyrus 

Question 69
Not answered
Marked out of 1.00
A 40-year-old man develops depressed mood, anhedonia, initial and terminal insomnia, loss of appetite, a 10-lb weight loss, and difficulty with
sexual arousal. The clinical features of the patient's psychiatric illness suggest dysfunction of the
Select one:
Hippocampus
Corpus callosum
Frontal lobes
Pituitary
Hypothalamus
Clinical studies of patients with major depressive disorders indicate that an intrinsic regulatory defect involving the hypothalamus underlies the
disorder. It also involves the monoamine pathways. The hypothalamic modulation of neuroendocrine activity has been implicated, as have
been the neurotransmitter systems of serotonin and norepinephrine.
The correct answer is: Hypothalamus


Question 70
Not answered
Marked out of 1.00
Which of the following statements about microglia is correct?
Select one:
It is mainly responsible for myelination
It constitutes 70% of glial population in brain
It is sensitive to sodium channel stimulation
It is mesodermal in origin
It is present outside brain and spinal cord
Explanation:
Microglia, which are derived from macrophages, are involved in removing cellular debris following neuronal death. The functions of microglia in
the non-diseased brain probably include a role in synaptic maintenance. Because of their mesodermal origin, microglia share many features
with other myeloid cell types in the body.
Sasaki A. Microglia and brain macrophages: an update. Neuropathology. 2017 Oct;37(5):452-64.
Ginhoux F, Prinz M. Origin of microglia: current concepts and past controversies. Cold Spring Harbor perspectives in biology. 2015 Aug
1;7(8):a020537.
The correct answer is: It is mesodermal in origin


Question 71
Not answered
Marked out of 1.00
Which of the following is the primary mechanism involved in removal of the transmitter at the neuromuscular junction?
Select one:
Reuptake
Enzymatic degradation
Diffusion
Immune complex formation
Renal clearance
Explanation:
A transmitter can be removed from the synaptic cleft through one of the following three modes: (1) enzymatic degradation, (2) reuptake, and (3)
diffusion. In neuromuscular junctions acetylcholine, the primary neurotransmitter, undergoes enzymatic degradation. Acetylcholinesterase is
an essential enzymatic component of the neuromuscular junction where it is responsible for terminating neurotransmission by the cholinergic
motor neurons. The enzyme at the neuromuscular junction is contributed primarily by the skeletal muscle where is it produced at higher levels
in the post-synaptic region of the fibres.
Ref: Rotundo RL. The NMJ as a model synapse: New perspectives on formation, synaptic transmission and maintenance: Acetylcholinesterase at
the neuromuscular junction. Neurosci Lett. 2020 Sep 14;735:135157. doi: 10.1016/j.neulet.2020.135157. Epub 2020 Jun 12. PMID: 32540360.
The correct answer is: Enzymatic degradation


Question 72
Not answered
Marked out of 1.00
Removal of noradrenaline from the region of the synaptic cleft may be achieved by which of the following mechanisms?
Select one:
reuptake only
diffusion only
conversion to adrenaline
enzymatic degradation only
enzymatic degradation, diffusion, and reuptake
Explanation:
Norepinephrine (NE) action is terminated by two principal destructive or catabolic enzymes that turn NE into inactive metabolites. The first is
monoamine oxidase A or B, which is located in mitochondria in the presynaptic neuron and elsewhere. The second is catechol-O-
methyltransferase (COMT), which is thought to be located largely outside of the presynaptic nerve terminal. The action of NE can be terminated
not only by enzymes that destroy NE, but also by a transport pump for NE that removes it from acting in the synapse without destroying it. That
transport pump is sometimes called the ‘NE transporter’ or ‘NET’ and sometimes the ‘NE reuptake pump’.
Ref: Stahl SM. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications, 5 Edition. 2021. pp. 253-254.
The correct answer is: enzymatic degradation, diffusion, and reuptake
th


Question 73
Not answered
Marked out of 1.00
The metabotropic receptors are coupled to
Select one:
Ligand non-dependent regulators of nuclear transcription
G proteins
Ligand dependent regulators of nuclear transcription
Proteins that have intrinsic enzyme activity
Ligand gated channels
Explanation:
Metabotropic receptors are linked to G proteins.
Receptors are categorized into: (1) ionotropic: ligand-gated channels, in which binding of a chemical messenger alters the probability of opening
of transmembrane pores or channels; (2) metabotropic: those in which the receptor proteins are coupled to intracellular G proteins as
transducing elements (3) intrinsic enzymes: those consisting of single membrane-spanning protein units that have intrinsic enzyme activity (for
example, having tyrosine kinase activity; some authors classify them alongside metabotropic receptors); and (4) ligand-dependent regulators of
nuclear transcription (including receptors for corticosteroids such as testosterone)
Ref: Stahl SM. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications, 5 Edition. 2021. p. 100.
The correct answer is: G proteins
th


Question 74
Not answered
Marked out of 1.00
The neurotransmitter involved in the long-term potentiation of memory is
Select one:
Noradrenaline
Dopamine
Acetyl choline
Glutamate
Serotonin
Explanation:
Normally, when glutamate synapses are active, their NMDA receptors trigger an electrical phenomenon known as long-term potentiation (LTP).
With the help of gene products that converge upon glutamate synapses and receptors, ion channels, and the processes of neuroplasticity and
synaptogenesis, LTP normally leads to structural and functional changes of the synapse that make neurotransmission more efficient,
sometimes called ‘strengthening’ of synapses.
The correct answer is: Glutamate
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Question 75
Not answered
Marked out of 1.00
The neurotransmitter which is most widely distributed in the brain is
Select one:
Dopamine
Glutamate
Acetylcholine
Norepinephrine
Serotonin
Explanation:
The most prevalent neurotransmitter in the brain is glutamate. Glutamate is a ubiquitous excitatory neurotransmitter that seems to be able to
excite nearly any neuron in the brain. That is why it is sometimes called the ‘master switch’.
The correct answer is: Glutamate
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Question 76
Not answered
Marked out of 1.00
In a patient being evaluated for neuropsychiatric disturbances, CT scan shows atrophy of head of caudate nucleus. Which of the following is a
likely diagnosis?
Select one:
Alzheimer disease
Wilson disease
Fahr disease
Huntington disease
Pick disease
Explanation:
In Huntington disease (HD), there is commonly mild-moderate cerebral atrophy. The main neuropathological abnormality of HD is atrophy of
the caudate nucleus and putamen.
The correct answer is: Huntington disease
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Question 77
Not answered
Marked out of 1.00
Which of the following neuroimaging finding is most suggestive of new variant CJD?
Select one:
Occipital hypoperfusion on HMPAO- SPECT
Activation of primary auditory cortex on functional MRI
Impaired dorsolateral cortex function
Medial temporal atrophy on structural MRI scan
Increased signal in the pulvinar nucleus of thalamus bilaterally
Explanation:
In variant CJD (vCJD), cranial magnetic resonance imaging (MRI) scans show a symmetrical area of hyperintensity on FLAIR sequences in the
posterior thalamus (the ‘pulvinar sign’), which is highly characteristic and has been incorporated into the clinical diagnostic criteria for vCJD.
The correct answer is: Increased signal in the pulvinar nucleus of thalamus bilaterally
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Question 78
Not answered
Marked out of 1.00
A patient develops viral encephalitis. He exhibits increased oral exploratory behaviour and inappropriate sexuality. This syndrome can be called
Select one:
Kluver Bucy syndrome
Korsakoff syndrome
Lennox Gastaut syndrome
Gerstmann syndrome
Klein Levine syndrome
Explanation:
Kluver-Bucy syndrome is an experimental model of temporal lobe ablation in monkeys. Behaviour in this syndrome is characterised by
hypersexuality, placidity, a tendency to explore the environment with the mouth, inability to recognise the emotional significance of visual
stimuli, and continually shifting attention (‘hypermetamorphosis’). This resembles the presentation of people with bilateral injury to the
temporal lobes after head trauma, cardiac arrest, herpes simplex encephalitis, or Pick disease (frontotemporal dementia).
The correct answer is: Kluver Bucy syndrome 

Question 79
Not answered
Marked out of 1.00
A 44 year old man is treated for long standing asthma with a combination of oral theophylline, prednisolone, inhaled salbutamol and inhaled
budesonide. He appears heavy with purplish striae on abdomen and excessive fat on the nape of his neck. His asthma is under control but he
exhibits behaviours and mental state consistent with hypomania. Which of the following is a possible cause?
Select one:
Late onset bipolar disorder
Theophylline induced epileptiform activity
Hypothyroidism
Cushing syndrome
Secondary diabetes mellitus
Explanation:
The story is consistent with Cushing syndrome. Cushing syndrome most commonly results from exogenous corticosteroids. Physical symptoms
may include diabetes, hypertension, muscle weakness, obesity, and osteopenia. Psychiatric symptoms may appear before physical signs;
depression is most common (50-70% of cases), followed by anxiety, hypomania/mania, psychosis, and cognitive dysfunction. Exogenous
steroids produce more mania than endogenous steroids, often dose-related. This case is most likely due to oral prednisolone, not inhaled
budesonide.
Ref: Tang A et al. Psychiatric symptoms as a clinical presentation of Cushing’s syndrome. Annals of general psychiatry. 2013 Dec;12(1):1-3.
The correct answer is: Cushing syndrome
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Question 80
Not answered
Marked out of 1.00
During EEG recording a resting subject is asked to focus his attention on a cognitive task. Which of the following will be observed?
Select one:
No change in resting EEG
Unilateral change in resting EEG at dominant hemisphere
Appearance of alpha waves on focussing attention
Reduction of alpha waves on focussing attention
Reduction of theta waves on focussing attention
Explanation:
Alpha blocking, a phenomenon where the alpha rhythm is reduced by attention to a visual, auditory, tactile, or cognitive stimulus, is one of the
most prominent features of human EEG signals.
Ref: Hartoyo A et al. Inferring a simple mechanism for alpha-blocking by fitting a neural population model to EEG spectra. PLoS computational
biology. 2020 Apr 30;16(4):e1007662.
The correct answer is: Reduction of alpha waves on focussing attention
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Question 81
Not answered
Marked out of 1.00
In the dementia associated with Alzheimer's disease, the EEG will usually show which of the following?
Select one:
Periodic frontal lobe discharges
Generalized background slowing
Focal slowing
An isoelectric record
Spike-and-wave discharges
Explanation:
Diffuse slowing of the background rhythm of the EEG is the most common EEG abnormality. Diffuse slowing in the EEG can be seen in
dementia.
The correct answer is: Generalized background slowing
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Question 82
Not answered
Marked out of 1.00
Bill Bailey is a 42-year-old man with a diagnosis of schizophrenia, whose functioning has been severely compromised for the past decade,
despite long trials of numerous medications. Three months ago he was commenced on Clozapine, but it hasn't had the ameliorating effects
hoped for. Your team decide to measure Mr Bailey's serum Clozapine level to see whether it falls within a therapeutic range. You might then be
in a position to adjust the dose accordingly. Which one of the following statements is true:
Select one:
A therapeutic range has been established for clozapine
Dose responses for clozapine are not affected by genetic polymorphisms
Nuclear Magnetic Resonance Spectroscopy is the most common method employed in therapeutic drug monitoring
Clozapine has a wide therapeutic index
The use of other psychotropic agents doesn't affect clozapine's therapeutic range
Clozapine plasma levels can be useful in optimising treatment. In those not responding to clozapine, dose should be adjusted to give plasma
levels in the range 350-600ug/L (a range reflecting a consensus in the literature). Plasma levels are generally lower in younger patients, males,
and smokers, and higher in Asians. Much lower doses of clozapine are required in East Asians, Indians, and Bangladeshis. The prevalence of
clozapine poor metabolisers is also higher in East Asians. Plasma levels do seem to predict EEG changes and seizures occur more frequently in
patients with levels above 1000ug/L, so levels should be kept well below this. Other non-neurological clozapine-related adverse effects also
seem to be plasma-level related, as might be expected. An upper limit of concentrations around 600-800ug/L has been proposed.
Ref: Taylor DM, Barnes TRE, Young AH. The Maudsley Prescribing Guidelines in Psychiatry, 14th Edition. 2021. p. 838.
The correct answer is: A therapeutic range has been established for clozapine
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Question 83
Not answered
Marked out of 1.00
Which of the following is most likely to be a feature of l-dopa withdrawal in a patient who has been treated for Parkinson's disease and
associated dementia?
Select one:
Apathy
Mania
Hyperprolactinemia
Hallucinations
Hyperreflexia
Explanation:
After abrupt discontinuation of high-dose levodopa, a state of akinetic mutism can occur. Severe health risks may include stiffness, rigidity,
tremor, and increased risk for thrombosis. When attempting to reduce levodopa dosage, a worsening of motor performance is common due to
its short half-life. Similarly, possible worsening in dysphagia can occur in advanced stages of Parkinson disease. There are also several case
reports of neuroleptic malignant syndrome after discontinuation of levodopa treatment. Changes in personality accentuation have also been
documented, with a trend toward ‘hypodopaminergic’ behaviour with harm-avoiding tendencies, depression, pessimism, and apathy.
Ref: Koschel J et al. Implications of dopaminergic medication withdrawal in Parkinson’s disease. Journal of Neural Transmission. 2021 Jul 29:1-0.
The correct answer is: Apathy
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Question 84
Not answered
Marked out of 1.00
Raymond Williams is a 56-year-old man with a family history of schizophrenia and epilepsy. He had his first epileptic seizure as a teenager, and
then in his early 20s developed a psychotic illness requiring treatment with an antipsychotic. At the time he was commenced on a medication,
which increased his seizure frequency, and so it was stopped. He's since been on a number of different antipsychotic medications. Of the
following, which is least likely to lower the seizure threshold?
Select one:
Haloperidol
Olanzapine
Clozapine
Sulpiride
Chlorpromazine
Of those listed, Haloperidol seems to be less associated with seizures (Ref: Drugs Today 2003(39);7:551-5517) Clozapine is particularly
associated with increased risk of seizures.
The correct answer is: Haloperidol
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Question 85
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Marked out of 1.00
Mr Andrew Cairns is a 70-year-old man who has presented to his GP with tiredness, muscular weakness and marked thirst. He is subsequently
diagnosed with diabetes insipidus. Which of the following is most likely to be seen in his investigations?
Select one:
High plasma osmolality, low urine osmolality
Low plasma osmolality, low urine osmolality
Low plasma osmolality, high urine osmolality
High plasma osmolality, high urine osmolality
High plasma osmolality, normal urine osmolality
Explanation:
A high-normal plasma sodium concentration (>142 mmol/L) in conjunction with a urine osmolality that is lower than plasma osmolality points
towards diabetes insipidus. A low plasma sodium concentration (<137 mmol/L) with a low urine osmolality (e.g. less than half the plasma
osmolality) is usually indicative of water overload due to psychogenic polydipsia.
Ref: Taylor DM, Gaughran F, Pillinger T. The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry. 2021. p. 269.
The correct answer is: High plasma osmolality, low urine osmolality 

Question 86
Not answered
Marked out of 1.00
Ben Bradley is a 27-year-old man, who attends the outpatient clinic. He has a diagnosis of schizophrenia, and takes an antipsychotic
(Haloperidol) to reduce his voice-hearing experience. After a two-year period of not smoking, he tells you that two weeks ago he has taken it up
again, smoking about 15 cigarettes daily. You have in mind that his smoking may alter the effect of his antipsychotic. Which of these is true
regarding smoking and metabolism?
Select one:
It induces Cytochrome P450 (CYP)
It enhances the analgesic effects of some opioids
It reduces the clearance of heparin
It inhibits Alanine Transaminase
It enhances the sedative effects of benzodiazepines
Explanation:
Tobacco smoke contains polycyclic aromatic hydrocarbons that induce (increase the activity of) certain hepatic enzymes (CYP1A2 in particular).
The extent of enzyme induction is determined by the number and type of cigarettes smoked and the degree of smoke inhalation. For some
drugs used in psychiatry, smoking significantly reduces drug plasma levels and higher doses are required than in non-smokers. Smoking may
also affect alcohol metabolism by inducing CYP2E1.
The correct answer is: It induces Cytochrome P450 (CYP)
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Question 87
Not answered
Marked out of 1.00
A drug should satisfy certain criteria to be suitable for therapeutic drug monitoring. Which of the following is a suitable criterion?
Select one:
Narrow therapeutic index
Unknown target concentration range
Predominant hepatic metabolism
Poor relationship between plasma concentrations and clinical effects
Low pharmacokinetic variability
Explanation:
Clear reasons for plasma level monitoring are:
1.To confirm compliance
2.If toxicity is suspected
3.If a pharmacokinetic drug interaction is suspected
4.If clinical response is difficult to assess directly and where a target range of plasma levels has been established
5.If the drug as a narrow therapeutic index and toxicity concerns are considerable
The correct answer is: Narrow therapeutic index
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Question 88
Not answered
Marked out of 1.00
Which of the following is a risk factor for clozapine-induced constipation?
Select one:
Low body weight
Female sex
Low dose, administered once-daily
Using liquid form of preparation
Younger age
Explanation:
Risk factors for developing clozapine-induced constipation include increasing age, female sex, anticholinergic medication, higher clozapine
dose/plasma level, hypercalcaemia, gastrointestinal disease, obesity, diaphoresis, low-fibre diet, poor bowel habit, dehydration (exacerbated by
hypersalivation), diabetes, hypothyroidism, Parkinson disease, multiple sclerosis.
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The correct answer is: Female sex
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Question 89
Not answered
Marked out of 1.00
Which of the following anticonvulsants is most likely associated with agitation and aggression as an adverse effect?
Select one:
Topiramate
Valproate
Carbamazepine
Gabapentin
Zonisamide
Explanation:
Based on available data, levetiracetam and topiramate seem to be associated with increased rates of irritability, hostility, and/or aggression,
particularly in patients with a previous history of psychiatric symptoms. Anti-epileptic drugs with the highest incidence of disrupted behaviours
are topiramate (2-10% have aggression related symptoms), levetiracetam (13% have non-psychotic behavioural symptoms) and vigabatrin
(hyperactivity and restlessness). Psychosis is less common but most frequently seen with zonisamide and topiramate. There are reasonable
data supporting no specific risk of aggression-related behaviour with carbamazepine, gabapentin, lamotrigine, and oxcarbazepine.
Ref: Brodie MJ et al. Epilepsy, antiepileptic drugs, and aggression: an evidence-based review. Pharmacological reviews. 2016 Jul 1;68(3):563-602.
The correct answer is: Topiramate
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Question 90
Not answered
Marked out of 1.00
A 48 year-old woman with bipolar disorder presents for an ECG evaluation for a minor surgical assessment. The automated ECG read-out
shows abnormal patterns. Lithium level is 0.9 mmol/L, with no history of overdose. Which of the following is the most likely ECG abnormality
induced by lithium use?
Select one:
Wenckebach type 1 block
Supraventricular tachycardia
Torsades de pointes
Wellen's syndrome
Wolff-Parkinson-White Syndrome
Most ECG changes in lithium users are innocuous. Common ECG changes in patients taking lithium include T wave inversion - the most
frequently reported ECG finding. Other findings include sinus node dysfunction, sinoatrial blocks, PR prolongation, QT prolongation/dispersion,
and ventricular tachyarrhythmias. These ECG changes are more likely to occur with chronic lithium overdoses than acute overdoses. Sinoatrial
block comprising reversible first and second degree (type I Wenckebach and type II) blocks are typically reported in patients on chronic lithium
therapy for years. Wellens syndrome is also referred to as LAD coronary T-wave syndrome where as T-wave changes are associated with critical
stenosis of the proximal left anterior descending (LAD) coronary artery. It is not a feature of lithium induced ECG changes.
The correct answer is: Wenckebach type 1 block
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Question 91
Not answered
Marked out of 1.00
Dominic has a depressive disorder and willing to take medications. He is worried about sexual side effects. Which of the following
antidepressants is associated with minimal sexual dysfunction?
Select one:
Agomelatine
Venlafaxine
Duloxetine
Fluovoxamine
Paroxetine
Explanation:
Lower risk antidepressants include agomelatine, bupropion, mirtazapine, vilazodone, vortioxetine, and moclobemide. Of these, agomelatine,
bupropion, and vortioxetine have the best evidence supporting a more favourable sexual adverse-effect profile. Rates of sexual dysfunction
with agomelatine may be similar to placebo.
Ref: Taylor DM, Barnes TRE, Young AH. The Maudsley Prescribing Guidelines in Psychiatry, 14th Edition. 2021. pp. 405-406.
The correct answer is: Agomelatine 

Question 92
Not answered
Marked out of 1.00
Naima is a 45-year-old lady with schizophrenia. She is post-menopausal and not sexually active. Since her antipsychotic dose was increased she
has noticed some milky discharge from her breasts, associated with a feeling of fullness. Her psychiatrist arranges some blood tests, which
show a prolactin of 1245 mIU/L. She wants to switch Naima to a different antipsychotic. Which of the following drugs is least likely to be
associated with hyperprolactinemia?
Select one:
Aripiprazole
Risperidone
Amisulpride
Haloperidol
Sulpiride
Explanation:
When D2 antagonists are administered, D2 receptors in the tuberoinfundibular dopamine pathway are blocked. This causes plasma prolactin
concentrations to rise, a condition called hyperprolactinaemia. This can be associated with galactorrhea (i.e. breast secretions), sexual
dysfunction, gynaecomastia (enlargement of the breasts) in men, and amenorrhea (i.e. irregular or lack of menstrual periods) in women.
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Taylor DM, Barnes TRE, Young AH. The Maudsley Prescribing Guidelines in Psychiatry, 14th Edition. 2021. p. 168.
The correct answer is: Aripiprazole
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Question 93
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Marked out of 1.00
Miss Norman is currently being treated for Schizophrenia. She has a history of sudden cardiac death in her family and has read that some
psychiatric medications can increase the risk of prolonged QTc and torsade de pointes. Which of the following antipsychotic is least likely to
cause QTC prolongation?
Select one:
Lurasidone
Haloperidol
Clozapine
Olanzapine
Sulpiride
Explanation:


The correct answer is: Lurasidone
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Question 94
Not answered
Marked out of 1.00
Jennifer has been brought to A&E with a reduced conscious state after a suspected overdose of an unknown substance. Flumazenil is
considered as a possible treatment. Regarding flumazenil, which is the correct mechanism of action:
Select one:
Benzodiazepine antagonist
Benzodiazepine partial agonist
Opioid partial agonist
Serotonin(5HT) 2A antagonist
Muscarinic agonist
Explanation:
Flumazenil is a benzodiazepine receptor antagonist. It blocks benzodiazepine receptors at the GABA-A ligand-gated chloride channel complex,
preventing benzodiazepines from binding there. It has a terminal half-life of 41-79 minutes. It may induce seizures, particularly in patients
tolerant to or dependent on benzodiazepines, or who have overdosed on cyclic antidepressants, received recent/repeated doses of parenteral
benzodiazepines, or have jerking or convulsion during overdose.
Ref: Stahl SM. Stahl’s Essential Psychopharmacology: Prescriber’s Guide, 7 Edition. 2021. pp. 293-294.
The correct answer is: Benzodiazepine antagonist
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Question 95
Not answered
Marked out of 1.00
Which of the following acts as a messenger in the Reticular Activating System and contributes to sleep architecture?
Select one:
Nitric oxide
Vasopressin
Nitrous oxide
Anandamide
Glycine
Explanation:
Numerous lines of evidence have suggested a role for nitric oxide in the regulation of sleep-wake cycles. Neuronal nitric oxide synthase (nNOS)-
expressing neurons occur in several areas that initiate REM sleep. In animal models, microinjection of compounds that release nitric oxide
decreases wakefulness and increases slow-wave sleep compared with controls. Consistent with this, NOS inhibitors show a trend toward
decreasing slow-wave and REM sleep.
The correct answer is: Nitric oxide 

Question 96
Not answered
Marked out of 1.00
Wilfred Williamson is 86 years old. He's been experiencing progressive memory deficits for the past 5 years. His daughter has been reading up
on the neurochemistry of dementia, and understands that the amino acid glycine (or D-serine) acts as a neurotransmitter, as a co-agonist
alongside glutamate. At which of these receptors does glycine exert its action?
Select one:
NMDA receptor
Nicotinic Acetylcholine receptor
GABA receptor
Kainate receptor
5-HT3 receptor
Explanation:
Glutamate systems are curious in that one of the key receptors for glutamate (the NMDA receptor) requires a co-transmitter in addition to
glutamate in order to function. The co-transmitter is either the amino acid glycine or another amino acid, closely related to glycine, known as D-
serine.
The correct answer is: NMDA receptor
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Question 97
Not answered
Marked out of 1.00
Zolpidem is known to have a high affinity for which one of the following receptors?
Select one:
Omega-1 receptor
AMPA receptors
Sigma-1 receptor
Omega-2 receptor
Sigma-2 receptor
Explanation:
Z drugs bind to benzodiazepine-sensitive GABA-A receptors. A different nomenclature (omega system) denotes the specific sites of GABA-A
receptors where these ‘Z’ drugs act as omega-1 receptors. Conventional benzodiazepines interact at both ω1 and ω2 sites, the latter likely
contributing to the cognitive side effects o benzodiazepines.
Zolpidem and zaleplon bind selectively to alpha-1 subunits of these sites. By contrast, benzodiazepines and zopiclone/eszopiclone bind to four
alpha subunits (alpha-1, alpha-2, alpha-3, and alpha-5). The functional significance of alpha-1 selectivity is not yet proven, but may contribute to
lower risk of tolerance and dependence. The alpha-1 subtype is known to be critical for producing sedation and thus is targeted by every
effective GABA-A PAM (positive allosteric modulator) hypnotic, both benzodiazepines and Z-drugs.
Madari S, Golebiowski R, Mansukhani MP, Kolla BP. Pharmacological management of insomnia. Neurotherapeutics. 2021 Jan;18(1):44-52.
The correct answer is: Omega-1 receptor
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Question 98
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Marked out of 1.00
Mr Parker is an 83-year-old man who has been struggling with symptoms of severe depression for the past six weeks. One week ago he
stopped eating, became mute, and now has significantly reduced his fluid intake. You have a conversation with his family about the option of
using ECT. Mr Parker's daughter, who is a laboratory scientist, is interested in the neurochemical effects of ECT. Which of the following
statements about neurochemical findings associated with ECT is correct? There is:
Select one:
Reduction in serotonin (5-HT2) receptor density
Deactivation of dopaminergic neurotransmission
Decreased concentration of brain-derived neurotrophic factor
Increase in blood cortisol levels
Decrease in cerebral acetylcholine
Explanation:
ECT has an effect on almost all the major neurotransmitters in the brain such as serotonin, dopamine, acetylcholine, endogenous opioids,
epinephrine and norepinephrine, etc. Similar to antidepressants, ECT down-regulates 5-HT2 receptors globally in the brain of patients with
MDD. Reduction in 5-HT2 receptor density is suggested to have antidepressant action. ECT has been proposed to modulate dopaminergic
receptors and enhance dopamine neurotransmission in the brain. Differential BDNF expression in different areas of the brain is believed to be
responsible for antidepressant action of electroconvulsive seizures. ECT has also been shown to reduce the cortisol levels to normal among
patients with MDD in due course.
Ref: Singh A, Kar SK. How Electroconvulsive Therapy Works?: Understanding the Neurobiological Mechanisms. Clinical Psychopharmacology and
Neuroscience. 2017 Aug.
The correct answer is: Reduction in serotonin (5-HT2) receptor density
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Question 99
Not answered
Marked out of 1.00
Pindolol is an antihypertensive medication that has also been used as an augmentation treatment in depression. Which of the following best
describes its mechanism of action?
Select one:
5-HT1-A antagonist
5- HT1-B agonist
5-HT2-A agonist
5-HT2-A antagonist
5-HT1-B antagonist
Explanation:
Pindolol is primarily an adrenergic beta-blocking drug, which also blocks serotonin 1A auto-receptors. The co-administration of pindolol with a
serotonergic antidepressant could be expected to result in an immediate increase in serotonin neurotransmission, thus eliminating the delay in
onset of antidepressant response. As well as being used to speed the onset of antidepressant response, pindolol has also been used to
augment the efficacy of antidepressant drugs in acute-phase non-responders and treatment-resistant depression.
Ref: National Institute for Health and Clinical Excellence. The NICE guideline on the treatment and management of depression in adults.
Updated edition 2019.
The correct answer is: 5-HT1-A antagonist
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Question 100
Not answered
Marked out of 1.00
Medications used in Parkinson's disease work via a variety of mechanisms. Which of the following is used to facilitate CNS dopaminergic
transmission through NMDA mediated actions?
Select one:
Amantadine
Levodopa
Carbidopa
Benserazide
Selegiline
Explanation:
Amantadine’s mechanism of action is thought to be weak antagonism of NMDA (n-methyl-D-aspartate) glutamate receptors, possibly leading to
downstream changes in the activity of dopamine in both the direct and indirect striatal motor pathways. Carbidopa and Benserazide is a
peripherally acting DOPA decarboxylase inhibitor, which prevents the breakdown of levodopa and thus increases its availability in the CNS.
Selegiline and Rasagiline are MAO-B inhibitors and reduce the breakdown of dopamine. Levodopa is a precursor of dopamine and can increase
concentrations of this in the CNS when taken orally.
The correct answer is: Amantadine
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Question 101
Not answered
Marked out of 1.00
Jane is a slim 24-year-old lady who has recently been diagnosed with schizophrenia and is under the care of the early intervention service. She
often has low blood pressure and has heard that hypotension can occur with antipsychotics. She is discussing treatment options with you in
the clinic. Which of the following antipsychotics is least likely to cause hypotension?
Select one:
Aripiprazole
Quetiapine
Clozapine
Olanzapine
Chlorpromazine
Explanation:
Antipsychotics with a high affinity for postsynaptic alpha-1-adrenergic receptors are most frequently implicated in postural hypotension.
Among the SGAs, the reported incidence is highest with clozapine, quetiapine, and iloperidone. Lurasidone, asenapine, amisulpride,
aripiprazole, brexipiprazole, and cariprazine are considered low risk for postural hypotension. There are limited quantitative data for FGAs, but
low-potency phenothiazines (e.g. chlorpromazine) are considered most likely to cause orthostatic hypotension.
Ref: Taylor DM, Barnes TRE, Young AH. The Maudsley Prescribing Guidelines in Psychiatry, 14th Edition. 2021. pp. 161, 183.
The correct answer is: Aripiprazole
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Question 102
Not answered
Marked out of 1.00
Propranolol is a commonly used anti-hypertensive, which has applications in a variety of other physical conditions and in managing
performance anxiety. Which of the following best describes its mechanism of action?
Select one:
Beta 1 and beta 2 adrenergic antagonist
Beta 2 adrenergic antagonist
Beta 2 and beta 3 adrenergic antagonist
Beta 1 adrenergic antagonist
Beta 1, beta 2 and beta 3 adrenergic antagonist
Explanation:
Propranolol is a beta 1 and 2 adrenergic antagonist. When used to treat tremor, antagonism of peripheral beta 2 receptors is the proposed
mechanism. When used in PTSD, blockade of beta-1 adrenergic receptors may theoretically prevent fear conditioning and reconsolidation of
fear.
The correct answer is: Beta 1 and beta 2 adrenergic antagonist
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Question 103
Not answered
Marked out of 1.00
Most antidepressants work by acting upon serotonin or noradrenaline functioning in the CNS. Which of the following antidepressants works
upon dopamine activity in the brain?
Select one:
Bupropion
Vortioxetine
Reboxetine
Agomelatine
Mianserin
Explanation:
Bupropion is unique among antidepressants. It is a noradrenergic and dopaminergic reuptake inhibitor. Bupropion is indicated for depression
but is only licensed in the UK for treatment of nicotine dependence.
The correct answer is: Bupropion
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Question 104
Not answered
Marked out of 1.00
Which of the following psychotropic drugs could be potentially affected by acetylator status?
Select one:
Phenothiazines
Lithium
Tricyclic antidepressants
Acetylcholinesterase inhibitor
MAO inhibitors
Though potentially MAO inhibitors can be affected acetylator status, in practical use this is not usually a problem.
The correct answer is: MAO inhibitors
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Question 105
Not answered
Marked out of 1.00
Which one among the following antidementia drugs is mainly renally excreted?
Select one:
Tacrine
Donepezil
Rivastigmine
Galantamine
Memantine
Explanation:
Memantine undergoes little metabolism and is mostly excreted unchanged in the urine. No dose adjustment is needed in mild or moderate
renal impairment. Dose reduction is recommended in severe renal impairment.
Ref: Stahl SM. Stahl’s Essential Psychopharmacology: Prescriber’s Guide, 7 Edition. 2021. pp. 474-475.
The correct answer is: Memantine
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Question 106
Not answered
Marked out of 1.00
Which drug acts as a full agonist at Mu receptor and has a long half life?
Select one:
Buspirone
Buprenorphine
Disulfiram
Methadone
Acamprosate
Explanation:
Methadone is a full agonist at mu opioid receptors and has a long half-life (24 hours).
The correct answer is: Methadone
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Question 107
Not answered
Marked out of 1.00
When swapping MAOIs to SSRIs, what is the optimum wash out period?
Select one:
Minimum 2 days is essential
Minimum 5 days is essential
Minimum 2 months is essential
Minimum 2 weeks is essential
Minimum 5 weeks is essential
MAOI to SSRI- 2 weeks SSRI to MAOI-2 weeks for all, 5 weeks for Fluoxetine TCA to MAOI- 2 weeks MAOI to TCA- 1-2 weeks.
The correct answer is: Minimum 2 weeks is essential
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Question 108
Not answered
Marked out of 1.00
Apparent volume of distribution of haloperidol is
Select one:
1l/kg
0.5l/kg
0.1l/kg
0.25l/kg
more than 2l/kg
Explanation:
The apparent volume of distribution is the theoretical volume of fluid into which the total drug administered would have to be diluted to
produce the concentration in plasma. For example, if 1000 mg of a drug is given and the subsequent plasma concentration is 10 mg/L, that
1000 mg seems to be distributed in 100 L (dose/volume = concentration; 1000 mg/x L = 10 mg/L; therefore, x = 1000 mg/10 mg/L = 100 L). Many
acidic drugs (e.g., warfarin) are highly protein-bound and thus have a small apparent volume of distribution. Many basic drugs (e.g.,
amphetamine) are extensively taken up by tissues and thus have an apparent volume of distribution larger than the volume of the entire body.
Haloperidol is very extensively bound to plasma proteins (90%). The apparent volume of distribution of haloperidol has been found to range
from 9.5-21.7 L/kg. This high volume of distribution is in accordance with its lipophilicity, which also suggests free movement through various
tissues, including the blood-brain barrier.
Ref: https://go.drugbank.com/drugs/DB00502
The correct answer is: more than 2l/kg


Question 109
Not answered
Marked out of 1.00
Among Caucasians who are social drinkers, what percentage of alcohol is metabolized by alcohol dehydrogenase?
Select one:
less than 9
60-79
more than 90%
75-85
40-59
The major site of alcohol metabolism or breakdown (biotransformation) is in the liver. Alcohol dehydrogenase is the rate-limiting enzyme in the
metabolism of alcohol and thus limits the amount of alcohol metabolized. More than 90% of consumed alcohol in Caucasians is metabolized via
this route. Another significant metabolic pathway in the liver is called microsomal ethanol oxidizing system (MEOS). This consists of the
induction of the liver enzyme cytochrome P-450 (CYP2E1) which biotransforms a number of substances including alcohol and barbiturates
The correct answer is: more than 90%


Question 110
Not answered
Marked out of 1.00
Which of the following over-the-counter preparations must be avoided by a patient who is prescribed phenelzine for resistant depression with
social anxiety?
Select one:
Nasal decongestant sprays
Artificial tears
Antacids
Nicotine inhalers
Heat patches
Explanation:
Over-the-counter medications to avoid taking an MAOI such as phenelzine or tranylcypromine include cold and cough preparations, including
those containing dextromethorphan, decongestants (e.g. phenylephrine, pseudoephedrine), hay fever medication, sinus medications, asthma
inhalant medications, weight reducing preparations, and ‘pep’ pills. If MAOIs are taken with decongestants, the patient may experience a life-
threatening rise in blood pressure due to synergistic sympathetic drive.
The correct answer is: Nasal decongestant sprays
th


Question 111
Not answered
Marked out of 1.00
Which of the following statements about lithium is correct?
Select one:
Lithium levels fall within 10 days of starting a thiazide diuretic
NSAIDs can increase the plasma levels of lithium to >400%
A third of patients treated with lithium experience at least one side effect
70% of middle aged women develop hypothyroidism after 6-12 months of treatment
ACE inhibitors cause a reduction in lithium levels
Explanation:
NSAIDs inhibit the synthesis of renal prostaglandins, thereby reducing renal blood flow and possibly increasing renal re-absorption of sodium
and therefore lithium. The magnitude of the rise is unpredictable for any given patient; case reports vary from increases of around 10% to over
400%. The levels of lithium usually increase within ten days of a thiazide diuretic being prescribed. ACE inhibitors can reduce thirst, which can
lead to dehydration, and increase renal sodium loss, leading to increased sodium reabsorption by the kidneys, causing an increase in lithium
plasma levels. About 20% of middle-aged women develop hypothyroidism after 6-12 months of treatment. Approximately two-thirds of patients
treated with lithium experience at least one side effect.
The correct answer is: NSAIDs can increase the plasma levels of lithium to >400%
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