Friday, November 10, 2006

 

BIPOLAR DISORDER OSCE

What is bipolar affective disorder (manic depression)?


Bipolar affective disorder is also known as manic depression or bipolar depression. It is a mood disorder. The sufferer experiences marked mood swings which are beyond what most people experience. These extremes of mood may include the lows of depression as well as the highs of a very elated mood (known as mania). The number and frequency of these periods of depression and mania vary from person to person. It is estimated that about 1 per cent of the population suffer from bipolar affective disorder at some point in their lives. Some people will experience just one or two episodes, whereas others will have many episodes of depression or mania. It is a serious condition but can be helped with the right treatment.What causes bipolar affective disorder?Differences in people's genetic make up can make them more vulnerable to develop bipolar affective disorder. Stressful events, illness or lack of support can trigger individual episodes of illness. What symptoms are involved?What are the symptoms of depression? Feeling depressed or down is a normal reaction to events in our lives. In depressive illness that occurs as part of bipolar disorder, the depressive feelings will be worse, they will go on for longer and they will make it harder to deal with day-to-day problems. Some of these other symptoms may also occur:Feelings of unhappiness that do not go away.
Losing interest in things. Being unable to enjoy things Finding it hard to make even simple decisions.
Change of appetite. Weight loss or gain. Difficulty sleeping or sleeping too much. Going off sex.
Being fidgety or restless. Tiredness and loss of energy. Excessive feelings of worthlessness or guilt.
Being unable to see a positive future. Having trouble thinking or concentrating. Finding it harder to be with people. Having thoughts that one would be better off dead or thoughts about hurting oneself.
Difficulty in performing normal activities such as work, taking care of things at home or getting along with people.What are the symptoms of mania? A period of a week or more during which a person feels abnormally good, high, excited, hyper or irritable. This can be so extreme that the sufferer loses contact with reality and starts to believe strange things, have poor judgement and behave in embarrassing, harmful or even dangerous ways. This may be accompanied by:
An elevated mood, out of keeping with the individual's circumstances. Often the person will appear euphoric with an overwhelming sense of well-being and self-importance.
Increased energy and overactivity.
Increased speech, often rapid and louder than usual, which may be difficult for others to follow.
A reduced need for sleep.
Loss of inhibitions, which may lead to inappropriate and impulsive behaviour.
Very grand, over-optimistic ideas and plans may be expressed.
In severe cases sufferers may develop 'psychotic' symptoms of delusions and hallucinations. The content of these is usually in keeping with the euphoric mood and the unrealistic sense of great self-importance. What can be done to help? If you or someone you know is suffering from the symptoms of this disorder, then it is important to seek medical help. If you have been diagnosed as having bipolar affective disorder (manic depression) it is important to try to avoid relapses in future. This means recognising events that may trigger a period of illness, and trying to avoid these, or seeking help when these occur. It also means seeking help when the early symptoms of illness arise, and taking prescribed medication that will help to prevent relapses. How is the diagnosis made? The diagnosis will be made on the basis of present symptoms and on the history of any previous episodes. How is bipolar affective disorder (manic depression) treated? Depressive episodes are treated in the same way as other episodes of depression. This includes psychological therapy and antidepressant medication.Episodes of mania are usually treated with antipsychotic medication (for example medicines such as chlorpromazine and haloperidol are used). These can cause side effects including stiffness, shakiness, dry mouth and constipation. Other medicines can be given to help with some side effects if they occur.Sometimes sufferers need to be admitted to hospital in order to be treated.Often, during acute episodes of illness, mood-stabilising medicines are used. These are also used for longer-term preventive therapy, the aim of which is to prevent relapses. The most widely used example is lithium. Others include sodium valproate, carbamazepine and olanzapine (Zyprexa).Lithium treatment needs to be monitored with regular blood tests to make sure that there is enough lithium in the body for it to work, but not too much, which can be harmful. What is the outlook? Some people will have only one or two short episodes and then never be unwell again, whereas a very small proportion persistently experiences the symptoms of depression or mania or flit quickly from one extreme to the other. The average is nine episodes of mood disturbance over a lifetime. If I have bipolar disorder will I pass it on to my children? Bipolar disorder can run in families but it can occur in people who have no psychiatric problems in their family. The risk of any child going on to develop bipolar disorder is 1 in 100. This risk is increased in the children of someone with bipolar disorder, but is still only about 8 in 100. Someone close to me has bipolar disorder - what should I do?
Be understanding.
Offer practical help.
Encourage them to seek help if they appear to be becoming unwell.
Contact a doctor or nurse involved in their care yourself if they are becoming more unwell.
Take care of yourself.Seek help immediately if: Your relative or friend is not able to look after him or herself properly.
You find that they are seriously neglecting themselves by not eating or drinking.
They talk of harming or killing themselves.
They are starting to become manic and you notice that they are happier, more irritable, talking faster than usual, sleeping less than normal and especially if they are behaving in an unusually risky way.
Your loved one's mania or depression can be distressing, exhausting and can leave you feeling completely powerless to help. You should seek help and support yourself and do what you can to make sure that you have enough rest, exercise and time just for yourself to allow you to recharge your batteries and so be able to continue to help. I think that I have bipolar disorder. What should I do? Visit your GP. He or she will talk to you to help decide if your fears are correct and will then be able to organise appropriate care.

 

Alzheimer's disease -INFO osce

What is Alzheimer's disease?

Alzheimer's disease is the most common form of dementia, affecting around 500,000 people in the UK. This information sheet outlines the symptoms and causes of Alzheimer's disease, and describes what treatments are currently available.
Alzheimer's disease, first described by the German neurologist Alois Alzheimer, is a physical disease affecting the brain. During the course of the disease 'plaques' and 'tangles' develop in the structure of the brain, leading to the death of brain cells.
We also know that people with Alzheimer's have a shortage of some important chemicals in their brain. These chemicals are involved with the transmission of messages within the brain.
Alzheimer's is a progressive disease, which means that gradually, over time, more parts of the brain are damaged. As this happens, the symptoms become more severe.
SymptomsPeople in the early stages of Alzheimer's disease may experience lapses of memory and have problems finding the right words. As the disease progresses they may:
Become confused, and frequently forget the names of people, places, appointments and recent events.
Experience mood swings. They may feel sad or angry. They may feel scared and frustrated by their increasing memory loss.
Become more withdrawn due either to a loss of confidence or to communication problems.
As the disease progresses, people with Alzheimer's will need more support from those who care for them. Eventually they will need help with all their daily activities.
While there are some common symptoms of Alzheimer's disease, it is important to remember that everyone is unique. No two cases of Alzheimer's are likely to be the same. People always experience illness in their own individual way.
What causes Alzheimer's disease?So far, no one single factor has been identified as a cause for Alzheimer's disease. It is likely that a combination of factors, including age, genetic inheritance, environmental factors, diet and overall general health, are responsible.
AgeAge is the greatest risk factor for dementia. Dementia affects one in 20 people over the age of 65 and one in five over the age of 80. However, Alzheimer's is not restricted to elderly people: there are over 18,000 people under the age of 65 with dementia in the UK.
Genetic inheritanceMany people fear that they may inherit Alzheimer's disease. Scientists are currently investigating the genetic background to Alzheimer's.
We do know that there are a few families where there is a very clear inheritance of the disease from one generation to the next. This is often in families where the disease appears relatively early in life.
In the vast majority of cases, however, the effect of inheritance seems to be small. If a parent or other relative has Alzheimer's disease, your own chances of developing the disease are only a little higher than if there were no cases of Alzheimer's in the immediate family.
Environmental factorsThe environmental factors that may contribute to the onset of Alzheimer's disease have yet to be identified. A few years ago, there were concerns that exposure to aluminium might cause Alzheimer's disease. However, these fears have largely been discounted.
Other factorsBecause of the difference in their chromosomal make-up, people with Down's syndrome who live into their 50s and 60s may develop Alzheimer's disease. People who have had severe head or whiplash injuries appear to be at increased risk of developing dementia. Boxers who receive continual blows to the head are also at risk.
Research has also shown that people who smoke and those who have high blood pressure or high cholesterol levels increase their risk of developing Alzheimer's.
Getting a diagnosis If you are concerned about your own health, or the health of someone close to you, it is important to seek help from a GP.
An early diagnosis will:
Help you plan for the future
Enable the person with dementia to benefit from the treatments that are now available
Help you identify sources of advice and support.
There is no straightforward test for dementia. A diagnosis is usually made by excluding other causes. The GP or specialist will need to rule out infection, vitamin deficiency, thyroid problems, brain tumours, the side-effects of drugs and depression.
SpecialistsYour GP may ask a specialist for help in carrying out a diagnosis. The specialist may be an old-age psychiatrist, a neurologist, a physician in geriatric medicine or a general psychiatrist. Who you see depends on the age of the person being examined, how physically able they are, and how well services are developed in the area.
Tests The person being tested will usually be given a blood test and a full physical examination to rule out or identify any other medical problems. The person's memory will be assessed, initially with questions about recent events and past memories. Their memory and thinking skills may also be assessed in detail by a psychologist.
A brain scan may be carried out to give some clues about the changes taking place in the person's brain. There are a number of different types of scan, including CT (computerised tomography) and MRI (magnetic resonance imaging).
Treatment There is currently no cure for Alzheimer's disease. However, there are a number of drug treatments available that can ameliorate the symptoms or slow down the disease progression in some people.
People with Alzheimer's have been shown to have a shortage of the chemical acetylcholine in their brains. The drugs Aricept, Exelon and Reminyl work by maintaining existing supplies of acetylcholine. These drugs are only helpful for people with mild to moderate dementia. Side-effects may include diarrhoea, nausea, insomnia, fatigue and loss of appetite.
A drug called Ebixa was launched in the UK in 2002. This drug works in a different way to the other three - it prevents the excess entry of calcium ions into brain cells. Excess calcium in the brain cells damages them and prevents them from receiving messages from other brain cells. Ebixa is the only drug that is suitable for use in people in the middle to later stages of dementia. Side-effects may include hallucinations, confusion, dizziness, headaches and tiredness.
These drugs are not a cure, but they may stabilise some of the symptoms of Alzheimer's disease for a limited period of time.
Caring for someone with dementiaMuch can be done at a practical level to ensure that people with Alzheimer's live as independently as possible for as long as possible.
The Alzheimer's Society has a range of information sheets and guides for people with dementia and their carers. Local branches also provide support to carers and people with dementia.

 

psychological factors anorexia

Explore psychological Factors in a 20 year old woman with anorexia nervosa. A diagnosis of anorexia nervosa has already been established. Start with greeting the patient and discuss about her general well being and about her thinking patterns. Presenting Complaints/ Individual Psychopathology Ask about her dietary pattern. Ask about her view about herself in terms of self identity and in terms of body figure. Is she preoccupied with body figure Ask her to draw her body figure Ask about her role models and who does she idealize. Family and Psychosocial History Ask about parents and siblings and relationship with them. Any trouble with them in the past? Ask about how parents get on with each other and how they got on in the past. Ask about friends Ask about current and past relationships and any breach in any relationship. Ask about home atmosphere. Any problem in trusting people. Personal History (Psychodynamics) Ask about her childhood. Any emotional abuse /bullying in childhood. Any physical threats Anything harder than that i.e. any sexual abuse ( may be asked any other kind of abuse). Any separations in childhood. Relation with parents , teachers and peers in childhood.

 

dementia nd parietal lobe

Activities of Daily Living Mnemonic BASICS
B asic abilities Advanced abilities
S afety
Issues

Compensatory strategies
Safety issues and risks

Basic Abilities: include toiletting, dressing , self care and eating.
Advanced abilities include : Shopping, cooking and handling money
Safety Issues include : Gardening, use of electricity, use of gas, vulnerability, driving and awareness and care for security needs
. Compensatory Strategies include: Notes, diaries, mobile phone use and reminders etc.
Social Abilities: include parenting, maintaining relationships and socializing with friends


Dominant lobe: receptive dysphasia
Gerstmann syndrome
Finger agnosia (point to left ring finger with right index finger)
R-L disorientation (touch left ear with right hand)
Dyscalculia (simple arithmetic)
Agraphia (ask patient to write something)
Non-dominant lobe: topographical disorientation (ask if often loses his way) neglect (draw clock face) constructional apraxia (copy intersecting pentagons) prosopagnosia (Queen’s face on banknote) anosognosia (failure to recognise a disabled body part) Bilateral lobe function: astereognosia (identify a coin with eyes closed) agraphagnosia (identify an H drawn on palm of hand with eyes closed) test visual fields for homonymous lower quadrantanopia

 

EMI

Question 1 of 55
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Score: 1 (33.3%)Theme : Drugs used in psychiatry A. Amisulpiride B. Amitryptiline C. Flupenthixol D. Mirtazapine E. Moclobemide F. Olanzapine G. Phenelzine H. Pimozide I. Reboxetine J. Trazodone K. Venlafaxine
Select drug from above list corresponds following descriptions: 1) A selective serotonin noradrenaline reuptake inhibitor can cause SIADH. A. Amisulpiride K. Venlafaxine Note: Venlafazine above mechanism of action can cause SIADH. Other side-effects include Stevens-Johnson syndrome arrythmias.
2) An antidepressant, which can also be used in treatment of neuropathic pain blocks reuptake of both noradrenaline serotonin into presynaptic neurone. A. Amisulpiride B. Amitryptiline Note: Amitriptyline above mechanism of action classed as a tricyclic antidepressant. Similar drugs include dosulepin imipramine.

3) An antipsychotic belongs benzamide family a highly selective blocker of D2 dopamine receptors. A. Amisulpiride Note: Amisulpiride a highly selective blocker of D2-receptors. Older drugs (phenothiazines butyrophenones) are relatively non-selective dopamine antagonists thus have a larger side-effect profile.
Question 2 of 55
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Score: 0 (0%)Theme : Neurosis A. Adjustment disorder B. Generalised anxiety disorder C. Agoraphobia panic attacks D. Social phobia E. Post-traumatic stress disorder F. Mixed anxiety depressive reaction G. Panic attacks H. Factitious disorder I. Acute stress reaction

In following cases, choose likely diagnosis fro list: 1) A 19-year-old man finds it difficult shop because he believes he centre of attention when he goes out. A. Adjustment disorder D. Social phobia Note: Social phobia commonly starts in adolescence. They may be limited eating in public, public speaking, encounters opposite sex diffuse involving almost all social situations outside family circle.

2) A 28-year-old man whose father died 9 months ago in a car accident presents chest pain, dizziness palpitation. He reports symptoms are present of time but are worse when he gets into a car. A. Adjustment disorder B. Generalised anxiety disorder Note: In generalised anxiety disorder sufferer must have primary symptoms of anxiety days at least several weeks at a time usually several months. These symptoms may be triggered by a traumatic experience include apprehension, motor tension autonomic over-activity.

3) A 23-year-old woman difficulty going out supermarket. She reports becoming restless feeling anxious as time approaches her leave finds herself delaying going. A. Adjustment disorder C. Agoraphobia panic attacks Note: In agoraphobia, which commonly associated panic attacks, there may be psychological uteremic symptoms which must be primarily manifestations of anxiety other disorders. It restricted at least two of following situations : crows, public places, travelling away from home travelling alone. Also, there avoidance of phobia

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Score: 1 (20%)Theme : Perception problems A. Alcoholic Delirium B. Autoscopic hallucination C. Charles Bonnet syndrome D. Pareodolia E. Synaesthesia

Which of above disorders are best described by vignettes below?

1) A man experiences seeing spider webs mainly at night A. Alcoholic Delirium Note: Milder states of delirium may be missed but a useful indicator worsening of symptoms at night. In alcoholic delirium in particular, optical hallucinations of fine structures (eg hairs, threads, spiderwebs) occur Gelder MG, Lopez-Ibor JJ, Andreasen NC . (2000) New Oxford Textbook of Psychiatry. Oxford: Oxford University Press p58)

2) A man seeing a profile of Winston Churchill smoking his cigar whenever he looks at a crack in his bathroom wall A. Alcoholic Delirium D. Pareodolia Note: Typically in pareidolic illusion, images are seen from shapes. They are created out of sensory percepts by an admixture imagination (Sims, A. (1999) Symptoms in mind - an introduction descriptive psychopathology (2nd edn). London : Saunders.p82)

3) A patient seeing haunting sound of Miles Davis' trumpet A. Alcoholic Delirium E. Synaesthesia Note: Synaesthesia occurs when a sensory stimulus in one modality perceived as a sensation in another modality (Sims, A. (1999) Symptoms in mind - an introduction descriptive psychopathology (2nd edn). London : Saunders.p 88)

4) A man episodes, which last several days, of seeing images of people moving through an urban setting. He other psychiatric symptoms a level of consciousness. A. Alcoholic Delirium C. Charles Bonnet syndrome Note: The Charles Bonnet Syndrome (phantom visual images) a conditon in which individuals experience complex visual hallucinations without demonstrable psychopathology disturbance of consciousness. Sims, A. (1999) Symptoms in mind - an introduction descriptive psychopathology (2nd edn). London : Saunders.p89

5) A patient seeing his own face, distorted anguished but clearly his face, above him when he was lying in bed A. Alcoholic Delirium B. Autoscopic hallucination Note: Autoscopy a visual perception involving seeing oneself – a visual experience where subjects see an image of themselves in external space viewed from within their own physical body Sims, A. (1999) Symptoms in mind - an introduction descriptive psychopathology (2nd edn). London : Saunders.p89 situation. Question 4 of 55
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Theme : Personality Disorders A. Avoidant B. Borderline C. Dependent (asthenic) D. Dissocial (antisocial) E. Histrionic (narcissistic) F. Obsessional G. Paranoid H. Schizoid I. Schizotypal

Select appropriate diagnosis from list above following cases: 1) A 40-year man suspects his neighbours are spying on him cameras in their garden. He recently broke-up from his third girlfriend in five months after he accused her of having an affair. A. AvoidantB. BorderlineC. Dependent (asthenic)D. Dissocial (antisocial)E. Histrionic (narcissistic)F. ObsessionalG. ParanoidH. SchizoidI. Schizotypal 2) A 22-year newly qualified nurse having difficulty at work. She reluctant work without supervision. She appears cling other members of staff constantly seeks reassurance. A. AvoidantB. BorderlineC. Dependent (asthenic)D. Dissocial (antisocial)E. Histrionic (narcissistic)F. ObsessionalG. ParanoidH. SchizoidI. Schizotypal 3) A 15-year boy arrested 12th time illegal driving. He expelled from school violence blames other people his failings. He constantly lies his parents about his whereabouts. A. AvoidantB. BorderlineC. Dependent (asthenic)D. Dissocial (antisocial)E. Histrionic (narcissistic)F. ObsessionalG. ParanoidH. SchizoidI. Schizotypal

Question 5 of 55
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Score: 1 (33.3%)Theme : Thought Disorder A. Clang association B. Condensation C. Derailment D. Displacement E. Fusion F. Flight of idea G. Over inclusion H. Substitution

From option list, select thought disorder being likely denoted in following description:- 1) Using one idea an associated idea. A. Clang association D. Displacement Note: Displacement a defence mechanism involving re-direction of emotional feelings from their original object a substitute object related original one by a chain of associations. The substitute object may be less threatening than original one displacement may therefore have effect of avoiding reducing anxiety.

2) Deviation of train of thoughts without blocking. A. Clang association C. Derailment Note: Derailment a pattern of thinking closely related loosening of associations in which ideas tend slide from one track onto an unrelated, only indirectly related track. It manifested in speech by idiosyncratic shifts between meaningful sentences clauses, rather than within them.

3) Association directed by sound of words rather than their meaning. A. Clang association Note: In Clang association, association made between words phrases based on their similar sound rather than their associated meaning. An example of this between “claustrophobia” “close February”.

Question 6 of 55
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Score: 1 (20%)Theme : Bodily complaints A. Conversion Disorder B. Dysmorphobia C. Hyperschemazia D. Hypochondriasis E. Narcissism F. Somatisation

Which of following cases best options above

1) A man presents a 10 year history of concern he a stomach cancer. He asked his GP numerous investigations, all of which have yielded results but he insists 'something being missed' A. Conversion Disorder D. Hypochondriasis Note: In Hypochondriacal disorder, there persistent belief of at least one serious physical illness a persistent refusal accept advice reassurance of several different doctors. Sims, A. (1999) Symptoms in mind - an introduction descriptive psychopathology (2nd edn). London : Saunders.p 217

2) A woman presents a loss of sensation tingling feeling in parts of her left arm hands. No organic explanation found affected areas do match any dermatomes A. Conversion Disorder Note: This suggestive of a dissociative (conversion) disorder, more specifically a dissociative anaesthesia sensory loss (ICD10 p 159)

3) Following injury of his left hand, a man feeling this affected hand become as large as a cricket bat A. Conversion Disorder C. Hyperschemazia Note: In hyperschemazia there pathological accentuation of body image. In this case, pain caused affected part of body loom large (Sims, A. (1999) Symptoms in mind - an introduction descriptive psychopathology (2nd edn). London : Saunders.p 235)

4) A 50-year-old man spends a lot of his time money on his appearance, dreading he may look A. Conversion Disorder E. Narcissism Note: Narcissism an exaggerated concern one's self-image, especially personal appearance (Gelder MG, Lopez-Ibor JJ, Andreasen NC . (2000) New Oxford Textbook of Psychiatry. Oxford: Oxford University Press p 66)

5) A man convinced he a white spot on tip of his nose which everyone can see but pretend ignore A. Conversion Disorder B. Dysmorphobia Note: Dysmorphophobia a subjective feeling of ugliness physical defect which patient fells noticeable others, although his appearance within limits (Sims, A. (1999) Symptoms in mind – an introduction descriptive psychopathology (2nd edn). London : Saunders.p 228)

Question 11 of 55
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Score: 0 (0%)Theme : Neuropsychiatry, Neurology, Medicine A. Pill rolling tremor B. Foot drop C. Ptosis D. Unusual epigastric sensations E. Internuclear ophthalmoplegia F. Corneal pigmentation G. Myoclonic jerks H. Optic disc pallor I. Shuffling gait J. Clasp knife rigidity

For each of following diagnoses, choose single likely symptom 1) Intracranial tumour A. Pill rolling tremor H. Optic disc pallor Note: Intracranial tumour raises intracranial pressure. Presentation may be headache, drowsiness, vomiting, seizures trauma. Signs include restlessness, irritability, drowsiness, falling pulse, rising pressure, coma, irregular breathing papilloedema, latter being an unreliable sign as it occurs in other conditions.

2) Temporal lobe epilepsy A. Pill rolling tremor
D. Unusual epigastric sensations Note: Temporal lobe epilepsy a wide range of manifestations, sometimes associated a schizophrenia-like psychosis. The epilepsy usually preceded by an aura which can be an epigastric sensation.

3) Wilson's disease A. Pill rolling tremor F. Corneal pigmentation Note: Wilson's disease a recessively inherited disorder of copper metabolism fatal unless detected treated before serious illness from copper poisoning occurs. Symptoms usually appear in late adolescence these can include a variety of psychiatric disorders including suicidal/homicidal behaviour, depression aggression. copper deposition in liver brain, causes cirrhosis basal ganglia destruction. Examination may reveal muscle wasting, demonstration of copper in tissues e.g. liver cornea. Kayser-Fleischer rings are brown pigmentation in periphery cornea due copper deposits may be viewed by an experienced person using a slit lamp. Other symptoms include jaundice, abdominal swelling, haematemesis difficulty walking, taking swallowing.
Question 12 of 55
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Score: 0 (0%)Theme : Psychopathology A. Auditory hallucination B. Visual hallucination C. Elementary hallucination D. Autoscopy E. Synaesthesia F. Illusion G. Thought echo H. Reflex hallucination I. Extra-campine hallucination

For each of following cases choose one option from list which best symptom:- 1) A man hears sees colour red when he listens music. A. Auditory hallucination E. Synaesthesia Note: In synaesthesia there a sensory stimulus in one modality resulting in sensory experience in another e.g. hearing a fingernail drawn down a blackboard results in a cold feeling down spine. Such states, both heightening of consciousness synaesthesia, may occur in normal, healthy people.

2) A woman hears a bell ringing wherever she goes. A. Auditory hallucination C. Elementary hallucination Note: With elementary hallucinations, patient hears whirring noises rattles, whistles, machinery music. Often noise experienced as very unpleasant frightening

3) A schizophrenic person sees himself outside his body. A. Auditory hallucination D. Autoscopy Note: Autoscopy experience of seeing oneself knowing it oneself. It sometimes called "phantom mirror image". It one of abnormalities of unity of self, but in autoscopy experience necessarily visual. Autoscopy may take form of pseudohallucination. Occurs in schizophrenia, organis states such as temporal lobe epilepsy parietal lobe lesions.

Question 13 of 55
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Score: 1 (50%)Theme : Personality Disorders A. Avoidant B. Borderline C. Dependent (asthenic) D. Dissocial (antisocial) E. Histrionic (narcissistic) F. Obsessional G. Paranoid H. Schizoid I. Schizotypal

Select appropriate diagnosis from list above following cases: 1) A 19-year university student confides in his personal tutor he feels other students are more intelligent than him. He refuses join any societies because he thinks other people will dislike him. A. Avoidant Note: This student a avoidant personality disorder (cluster C –fearful anxious) characterised by persistent feelings of inadequacy social inhibition, which led a restricted lifestyle maintain physical security.

2) An 18-year secretary disciplined at work wearing sexually provocative clothing flirting colleagues. One colleague responded her advances she publicly humiliated him. A. Avoidant E. Histrionic (narcissistic) Note: This lady a histrionic personality disorder (cluster B –flamboyant dramatic) characterised by shallow emotionality, attention seeking, inappropriate sexual seductiveness immaturity




Question 7 of 55
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Score: 1 (33.3%)Theme : Psychometric Testing A. CAGE questionnaire B. GHQ 12 (General Health Questionnaire - 12 Item) C. MADRS (Montgomery-Åsberg Depression Rating Scale) D. MMSE (Mini-Mental State Examination) E. Deck's depression inventory F. WAIS (Wechsler Adult Intelligence Scale) G. Card sorting test H. Eyesink's personality inventory I. MMPI (Minnesota Multiphasic Personality Inventory-2)

Select one psychometric test from list which would be useful following situations: 1) A test used as a self-filling screening test a psychiatric cases A. CAGE questionnaire B. GHQ 12 (General Health Questionnaire - 12 Item) Note: General Health Questionnaire used in primary care identify suitability of referring patients a secondary care.

2) A test used assess severity of depression in patients A. CAGE questionnaire C. MADRS (Montgomery-Åsberg Depression Rating Scale) Note: MADRS an observer rating scale identify severity of depressive illness

3) A test used in alcohol screening A. CAGE questionnaire Note: CAGE questionnaire a simple quick screening tool alcoholism. The test positive if answers of two more questions positive.
Question 8 of 55
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Score: 0 (0%)Theme : Psychiatric Disorders/Psychopharmacology A. Electro convulsive therapy B. Citalopram C. Amitriptyline D. Low dose Haloperidol E. Low dose Risperidone F. Imipramine G. Trifluperazine H. None of above

From option list, choose single appropriate treatment following:- 1) An 84-year-old woman says she horrible visions of people being bludgeoned death other visions are pleasant. A. Electro convulsive therapy E. Low dose Risperidone Note: It a common practice use a small dose of risperidone anxiety, agitation obviously its antipsychotic effect in this case.

2) A 78-year-old woman moderately severe dementia living in a nursing home. Most nights she refuses go bed, but insists on staying up several hours requests cups of tea. She then sleeps during day. On questioning her she denies any of above A. Electro convulsive therapy H. None of above Note: All options given are unlicensed treatment of dementia. Acteylcholinesterase inhibiting drugs are used in treatment of Alzheimer's Disease, especially mild moderate cases. Benefit assessed by repeating cognitive assessment at around 3 months. Up half patients given these drugs will show a lower rate of cognitive decline. Many specialists repeat cognitive assessment 4 6 weeks after discontinuation assess deterioration. If significant deterioration occurs during this period, consideration should be given restarting therapy. In this particular case of agitation nat night, respiridone associated an increased use of CVAs so would be considered. Although haloperidol a reasonable option, first measures would be getting patient stay awake during day through walks exercises etc. If this fails then haloperidol in evening reasonable.

3) An 82-year-old man prostatism low mood, feeling of hopelessness uselessness, loss of appetite (although still overweight), general fatigue anhedonia A. Electro convulsive therapy
B. Citalopram Note: These symptoms are compatible diagnosis of depressive illness. Specific serotonin re-uptake inhibitors (SSRIs) are safer than Tricyclic antidepressants (TCAs) in age, especially in a person prostatism. This mainly because of its anticholinergic effects, which also include urinary problems, dry mouth, constipation, blurred vision, drowsiness, mydriasis, even confusion memory loss.

Question 9 of 55
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Score: 0 (0%)Theme : Cognition A. Selective Abstraction B. Catastrophising C. Mind reading D. Tunnel vision E. Disqualifying positive F. Personalisation G. Over-generalisation H. Magnification/minimisation I. All nothing thinking J. Labelling

From option list, select single appropriate description of following thought processes:- 1) “My husband late so he must have had an accident”. A. Selective Abstraction B. Catastrophising Note: Catastrophising a cognitive distortion, focusing on a negative detail whilst ignoring more possible important features of a situation.

2) “I am good patients, but an important skill.” A. Selective Abstraction E. Disqualifying positive Note: Disqualifying positive a feature of cognitive distortion often seen in depression. It involves magnifying small, bad events minimising major, good events in evaluating performance.

3) “I cannot find anyone friendly talk at this party. This means I do have what it takes make friends.” A. Selective Abstraction G. Over-generalisation Note: Over-generalisation involves drawing a sweeping conclusion on basis of a single event.

Question 10 of 55
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Score: 0 (0%)Theme : Personality Disorders A. Preference solitary activities B. Impressionistic speech C. Grandiose D. Failure plan ahead E. Allusive thinking F. Emotionally aloof G. Parsimony H. Feeling of emptiness boredom

From option list, select single appropriate feature can be seen following personalities:- 1) Obsessive Compulsive Personality A. Preference solitary activities G. Parsimony Note: Obsessive Personality Disorder called Anankastic Personality Disorder in ICD-10. Features include feeling of excessive doubt caution – parsimony, preoccupation details, perfectionism, excessive conscientiousness, adherence social conventions, rigidity insistent thoughts impulses.

2) Histrionic Personality A. Preference solitary activities B. Impressionistic speech Note: Features seen in Historic Personality Disorder include self-dramatisation, exaggerated expression of emotions, suggestibility, labile affect, being centre of attention, inappropriate seductiveness over-concern physical attractiveness.

3) Borderline Personality A. Preference solitary activities H. Feeling of emptiness boredom Note: Features of Borderline Personality Disorder include a tendency act impulsively, affective instability, outbursts of intense anger, unclear goals in life, unstable relationships repeated suicidal threats acts of self-harm.
Question 14 of 55
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Score: 1 (33.3%)Theme : Diagnosis A. Adjustment Disorder Anxiety B. Borderline Personality Disorder C. Cyclothymic Disorder D. Fronto Temporal Dementia E. HIV encephalopathy F. Post Traumatic Stress Disorder G. Rapid Cycling Bipolar Disorder H. Schizophreniform Psychosis

For following cases, select one appropriate diagnosis from option list:- 1) An 85-year-old former serviceman presents irritability avoidant behaviour following a road traffic accident. A. Adjustment Disorder Anxiety F. Post Traumatic Stress Disorder Note: Post Traumatic Stress Disorder (PTSD) diagnosed within 6 months of a traumatic event of exceptional severity. There must be a repetitive intrusive recollection of event in memories, daytime imagery, dreams. In addition, there numbness of feelings, emotional detachment avoidance of any stimuli which might arouse recollection of trauma.

2) A 29-year-old man on lithium bipolar disorder was started on verlafaxine 4 months ago. Since then, he had one episode of depression, mixed affective state mania, in addition a couple of manic episodes. A. Adjustment Disorder Anxiety
G. Rapid Cycling Bipolar Disorder Note: For rapid cycling disorder, recurrent episodes may be depressive manic mixed. The main features are recurrence frequency of episodes (conventionally, at least four distinct episodes a year). Episodes are usually separated by a period of remission a switch an episode of opposite polarity.

3) A 44-year-old school teacher experiences chest pains following a complaint made by a student. On investigation pain found be non-cardiac in origin. A. Adjustment Disorder Anxiety Note: In anxiety, there are cognitive somatic symptoms. Cognitive symptoms include subjective apprehension, fear, worries feeling directed towards future. The somatic symptoms include dyspnoea, palpitation, chest pain, choking sensations, parasthesias, flushes, sweating faintness.
Question 15 of 55
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Score: 1 (33.3%)Theme : Anti-Epileptics A. Valproate B. Carbamazepine C. Topiramate D. Vigabatrin E. Ethosuximide F. Phenytoin G. Diazepam H. Clonazepam I. Lamotrigine J. Phenobarbitone

From option list, select likely drug being described in following examples:- 1) Is indicated in absence seizures but in tonic-clonic seizures, this drug acts by blocking T-type calcium channels. A common side effect gastric disturbance pain, nausea vomiting. A. Valproate E. Ethosuximide Note: Ethosuximide indicated in absence seizures. It sometimes used in myoclonic seizures in atypical absence, atonic tonic seizures. It associated GI intolerance.

2) This drug used in many forms of epilepsy. Its mechanism of action unclear but probably involves combination of sodium channel blockers potentiation of GABA transmission. Side effects include fine tremor, weight gain transient hair loss. A. Valproate Note: Sodium valproate used in absence attacks temporal lobe epilepsy. It inhibits liver enzymes may potentiate other anti-epileptics such as phenytoin. It may cause thrombocytopenia, ataxia, amenorrhoea, alopecia, hepatitis, weight gain, gynaecomastia tremor.

3) This drug effective in tonic-clonic partial seizures. It acts by blocking sodium channels a narrow therapeutic index. Side effects include gingival hyperplasia hirsutism. A. Valproate F. Phenytoin Note: Phenytoin can cause cerebellar signs, slurred speech, ataxia, fits, acne, hirsutism, gum hypertrophy, erythema nodosum, oteomalacia, anaemia hepatitis,

Question 16 of 55
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Score: 1 (20%)Theme : Vitamins A. Megaloblastic anaemia due folate deficiency B. Pellagra C. Pernicious anaemia D. Korsakoff's Psychosis E. Wernicke's Encephalopathy

Match any of options A-E, (one per question) 1) The 40-year-old man suffered from a general deterioration of physical mental health over a number of months, a feeling of subjective incapacity mental physical effort. Thereafter he suffered from anorexia, insomnia, apprehension, dizziness, headache, eventually became severely depressed A. Megaloblastic anaemia due folate deficiency B. Pellagra Note: Pellagra-GI disturbance, dermatological signs, psychiatric states, including those mentioned above

2) This 40-year-old man, a heavy drinker, presented an abducens palsy nystagmus A. Megaloblastic anaemia due folate deficiency E. Wernicke's Encephalopathy Note: Wernicke's encephalopathy represents acute neuropsychiatric reaction severe thiamine deficiency

3) This 40-year-old man presented a sudden onset of mental confusion, staggering gait, marked memory impairment, together nausea, anorexia vomiting A. Megaloblastic anaemia due folate deficiency D. Korsakoff's Psychosis Note: Korsakoff's psychosis requires presence of clear evidence of a marked memory disorder good preservation of other cognitive functions

4) This associated depression, anergia, apathy somnolence A. Megaloblastic anaemia due folate deficiency C. Pernicious anaemia Note: Pernicious anaemia, due Vitamin B12 deficiency, may be accompanied only by neurological complication of subacute degeneration of cord, but also by mental abnormalities (above)

5) This may be associated depression, dementia epilepsy A. Megaloblastic anaemia due folate deficiency Note: Folic acid deficiency, like Vitamin B12 deficiency,may result in megaloblastic anaemia, occurs in pregnancy, elderly, in those suffering from psychiatric disorder
Question 17 of 55
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Score: 0 (0%)Theme : Neuro-anatomy A. Frontal lobe B. Dominant temporal lobe C. Non-dominant parietal lobe D. Dominant parietal lobe E. Occipital lobe F. Basal ganglia G. Pons H. Cerebral cortex

From option list, select probable area of brain causing neurological symptoms in following scenarios:- 1) Constructional apraxia, loss of symmetry distortion of figures. A. Frontal lobe C. Non-dominant parietal lobe Note: In a non-dominant parietal lobe lesion, visuospatial processing impaired. There constructional dressing apraxia as well as contra-lateral sensory inattention central lateral hemisensory loss.

2) Constructional apraxia name a camouflaged object, but being able name it when camouflaged. A. Frontal lobe E. Occipital lobe Note: An occipital lobe lesion also causes a visual field defect (contra-lateral homonymous hemianopia), visual agnosia, visual hallucination, cortical blindness, alexia without agraphia.

3) Problems left-fight orientation A. Frontal lobe D. Dominant parietal lobe Note: In a dominant parietal lobe lesion there sensory impairment, receptive dysphasia, visual field defect apraxia Gerstmann Syndrome. Gerstmann Syndrome a disorder characterised by a tetrad of finger agnosia, dysgrophia, dyscalculia right-left disorientation

Question 18 of 55
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Score: 0 (0%)Theme : Abnormal Movement A. Acute dystonia B. Akathisia C. Athetosis D. Automatism E. Cataplexy F. Catatonia G. Chorea H. Hemiballismus I. Myoclonus J. Sydenhams chorea

From option list, select likely movement disorder being described in following scenarios:- 1) A 72-year-old man recovering from left sided hemiplegia following an intracranial haemorrhage, develops sudden aimless vigorous movements of trunk left arm. A. Acute dystonia H. Hemiballismus Note: Hemiballism involves unilateral, sudden violent flinging movements predominantly affect proximal muscles of shoulder pelvic girdles. It arises from a contralateral subthalamic nucleus lesion. Neuroleptic agents tetrabenazine are used treatment.

2) A middle aged woman complains of an inner restlessness in her legs a compulsion move them. She was recently started on haloperidol 5mg daily paranoid psychosis. A. Acute dystonia B. Akathisia Note: Akathisia develops in 3 – 48% of patients over first few weeks of treatment anti-psychotic drugs. It both an inner sense of motor restlessness motor manifestations resulting from attempts satisfy urge move. It induced by dopamine antagonists. It may respond benzodiazepine propranolol.

3) A 20-year-old student a 4 day history of speaking, eating even moving. Over past few months he become withdrawn had deteriorating grades. He stopped attending college one month ago. He doesn’t appear be hallucinating. A. Acute dystonia F. Catatonia Note: Catatonia means a state of increased tone in muscles at rest, abolished by voluntary activity. It can include negativism, ambitendency, forced grasping, echolalia, echopraxia, waxy flexibility, automatic obedience, catalepsy stupor.
Question 19 of 55
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Score: 1 (33.3%)Theme : Personality Types A. Hystrionic personality B. Anankastic personality C. Paranoid personality D. Dissocial personality E. Borderline personality - unstable F. Borderline personality – impulsive

From option list, choose personality type which best corresponds following scenarios:- 1) A man attends his community psychiatric nurse as he had become very tearful when speaking about his depression, but then changes quickly talking rather loudly about his plans future. A. Hystrionic personality Note: Hystrionic personality disorder characterised by self-dramatisatoin, exaggerated expression of emotion, suggestibility, shallow labile affectivity. People hysterionic personality types frequently seek be centre of attention inappropriate seductiveness in appearance behaviour.

2) A man complains his written complain social worker being ignored. He refuses talk psychiatrist about it stating "She will do anything about it either." A. Hystrionic personality C. Paranoid personality Note: Typically, paranoid personality type exhibits excessive sensitiveness, grudge bearing accompanied by a refusal forgive insults/injuries, suspiciousness a tendency experience excessive self-importance are also characteristic.

3) A woman kept waiting 2 minutes by nurse having take a telephone call. She smashes a window in bedroom about slash herself saying "It's your fault I am doing this." A. Hystrionic personality F. Borderline personality – impulsive Note: The borderline personality disorder, impulsive type, exhibits emotional instability lack of impulsive control. Outbursts of anger, violence threatening behaviour are common, particularly in response criticism by others.

Question 20 of 55
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Score: 0 (0%)Theme : Movement Disorder A. Clasp-knife rigidity B. Pill rolling tremor C. Shuffling gait D. Foot drop E. Optic disc pallor F. Ptosis G. Myoclonic jerks H. Unusual epigastric sensations I. Corneal pigmentation J. Internuclear ophthalmoplegia

From option list, select clinical feature consistent diagnosis:- 1) Myotonic Dystrophy A. Clasp-knife rigidity F. Ptosis Note:
Myotonic dystrophy (DM), also known as Steinert disease, caused by trinucleotide repeat expansion of myotonic dystrophy protein kinase (DMPK) gene located on chromosome 19. It common adult form of muscular dystrophy affecting males females equally. The condition subject “Genetic Anticipation” due unstable expansion of CTG repeats which increases as gene passed on each generation. Anticpiation occurs more frequently when gene passed via maternal line. Presenting symptoms include weakness myotonia (which failure of immediate muscle relaxation after voluntary contraction stopped). The first muscles be affected are those of face, neck, hands, forearms, feet other features include: cataracts, retinal degeneration, frontal baldness, atrophy of testes ovaries, mental impairment, ptosis, sleep apnoea cardiomyopathy resulting in cardiac arrhythmias. In some cases there can be a 20 year gap between first symptoms onset of severe disability. In general, more repeats in affected range someone has, earlier age of onset of symptoms more severe symptoms. However, age on onset & disease progression cannot be predicted reliably.

2) Sporadic Creutzfeld Jakob Disease (CJD) A. Clasp-knife rigidity G. Myoclonic jerks Note: Sporadic Creutzfeld Jakob Disease a transmissible spongiform encephalopathy. It causes rare, rapid dementia (1/106), cerebellar ataxia, myoclonus jerks characteristic EEG.

3) Temporal lobe epilepsy A. Clasp-knife rigidity H. Unusual epigastric sensations Note: Temporal lobe epilepsy a complex partial seizure which may begin impairment of consciousness, it may be preceded by features of simple partial seizure of temporal lobe. Automatism such as lip smacking, chewing swallowing movements, salivation, facial grimacing hand gestures some patients may also become violent aggressive

Question 21 of 55
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Score: 1 (33.3%)Theme : Psychometric Tests A. Bender Gestalt Tests B. Shipley Abstraction Tests C. Raven's Progressive Matrices D. Wechsler Adult Intelligence Scale (WAIS) E. Minnesota Multiphasic Personality Inventory (MMPI) F. Thematic Appreciation Test G. Stroop Colour Ward Tests

From option list, select test being described:- 1) A test of visuo-motor coordination A. Bender Gestalt Tests Note: The Bender Gestalt test was developed by psychiatrist Lauretta Bender in late nineteenth century. It a test of visual-motor functioning visual perception skills used in both children adults. Gestalt psychology based upon idea perceptual experiences depend on patterns formed by stimuli on organisation of experience. This more evident in visuo motor co ordination, whole different from sum of it parts, example when we look at three angles of an equilateral triangle, we see a single large triangle rather than three small angles.

2) A multiple pictorial display. A. Bender Gestalt Tests C. Raven's Progressive Matrices Note: There are Raven’s Progressive Matrices are designed assess a person’s intellectual reasoning ability ability make sense of complex data in order draw meaning from ambiguity perceive think clearly. The test involves diagram completion different tests different age groups. Since they do rely on recall of information are easy use they are less sensitive cultural differences can be used those communication difficulties.

3) A test in which a patient asked construct stories. A. Bender Gestalt Tests F. Thematic Appreciation Test Note: The Thematic Appreciation Test one of projective personality tests in which candidate asked make stories from a series of multithematic pictures. These stories are then studied an overall view of personality can be obtained.
Question 22 of 55
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Score: 0 (0%)Theme : Catatonic Signs A. Cataplexy B. Negativism C. Waxy flexibility D. Catalepsy E. Preservation F. Mannerism G. Confabulation H. Stereotype

Choose one sign from list which best behaviour in each of following cases: 1) A man, after he had his pressure taken, held his hand a prolonged period of time, even after asking him take it off. A. Cataplexy C. Waxy flexibility Note: In waxy flexibility, when limbs of patient are put into a certain position by interviewer, they will be retained position a sustained period of time, maybe a minute of more.

2) A man who was asked have his pressure taken repeatedly salutes nurse. A. Cataplexy F. Mannerism Note: Mannerism a repetitive, spontaneous, complex movement was once purposeful. It a voluntary movement in contrast tics, which are involuntary movements.

3) When a man was asked face doctor consultation, he turned his face away. A. Cataplexy B. Negativism Note: Negativism a motor disorder. The patient's behaviour opposite what he asked do. A schizophrenic patient was interviewed in prison when he was brought doors of doctor's examination room he was invited enter. He then took two steps backwards. To get him enter doctor ask him go away.
Question 23 of 55
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Theme : Clinical assessment A. Agitation B. Agnosia C. Akathisia D. Akinesia E. Alexia F. Alexithymia G. Alogia H. Anosognosia I. Autoprosopagnosia

Which of above terms accurately described by above options

1) On hearing of suicide of his wife, a man becomes easily aroused angry tearful emotions paces rapidly around his house A. AgitationB. AgnosiaC. AkathisiaD. AkinesiaE. AlexiaF. AlexithymiaG. AlogiaH. AnosognosiaI. Autoprosopagnosia 2) A man who lost motor function in his left arm following an accident continues his daily routine as though he only his right arm A. AgitationB. AgnosiaC. AkathisiaD. AkinesiaE. AlexiaF. AlexithymiaG. AlogiaH. AnosognosiaI. Autoprosopagnosia 3) A man who presents a range of psychosomatic problems unable articulate any of his feelings A. AgitationB. AgnosiaC. AkathisiaD. AkinesiaE. AlexiaF. AlexithymiaG. AlogiaH. AnosognosiaI. Autoprosopagnosia 4) An inpatient finds it impossible remain seated standing – he noted be particularly restless in his legs A. AgitationB. AgnosiaC. AkathisiaD. AkinesiaE. AlexiaF. AlexithymiaG. AlogiaH. AnosognosiaI. Autoprosopagnosia 5) an elderly man longer recognizes himself in mirror – instead he responds his image by talking it sometimes becoming fearful of it A. AgitationB. AgnosiaC. AkathisiaD. AkinesiaE. AlexiaF. AlexithymiaG. AlogiaH. AnosognosiaI. Autoprosopagnosia
Question 24 of 55
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Score: 0 (0%)Theme : Geriatrics, Neuropsychiatry A. Dementia B. Transient global amnesia C. Anterograde amnesia D. Dissociative fugue E. Retrograde amnesia F. Factitious disorder G. Korsakoffs syndrome H. Benign senescent forgetfulness

For each of following scenarios, choose single likely disorder from list:- 1) A 70-year-old woman complains of memory loss, which noted be patchy variable. She difficulty recalling personal experiences, but often forgets people's names items shopping. After 6 months her symptoms remain unchanged. A. Dementia H. Benign senescent forgetfulness Note: In benign senescent forgetfulness, memory loss unchanged, progressive screening mini-mental state examination tool doesn't indicate deterioration. The memory loss usually patchy variable. It specific any elements of memory, either short long-term. It does require treatment memory enhancement techniques have used improve memory.

2) A 67-year-old man develops sudden memory loss, repeatedly asking his wife "Where am I?" "What are you doing here?" His memory remote events personal identity preserved, although he doesn't retain new information. He back memory deficit after 6 hours. A. Dementia B. Transient global amnesia Note: Transient global amnesia occurs in middle late life. The clinical picture of sudden onset of isolated anterograde amnesia in a clear sensorium, generally lasting less than 24 hours. The patient appears bewildered requires repeated re-orientation. There disturbance of alertness and, in contrast psychogenic fugue, personal identity retained. Complete recovery, amnesia period of episode, usual recurrence rare.

3) Following a road traffic accident, a 29-year-old male unable remember anything in week preceding accident. A. Dementia E. Retrograde amnesia Note: In retrograde amnesia there loss of memory events experiences before traumatic event incident caused amnesia. This in contrast anterograde amnesia in which memory loss events after traumatic event.

Question 25 of 55
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Score: 1 (33.3%)Theme : Interview Skills A. Clarification B. Closed questioning C. Confrontation D. Empathy E. Eliciting precision F. Facilitation G. Interpretation H. Reflection I. Summarising J. Sympathy

From option list, select interview technique best following means of gathering information:- 1) “What do you mean when you say you have having panic attacks?” A. Clarification Note: Clarification a commonly used interview technique, it used confirm information provided by patient. It also enables you show patient you are interested in his/her story.

2) “Before we talk about panic attacks, can I just go through what you have told me about your depression? Please correct me if I’m wrong.” A. Clarification I. Summarising Note: Summarising a techniques used in psychiatric interview. It a way of gathering together information obtained at interview organising it. Summarising should take place without elaboration of information provided.

3) “I can see things have very tough you recently.” A. Clarification D. Empathy Note: Empathy, as a psychiatric term, means literally ‘feeling oneself into’, as a general concept, it means understanding feelings of others.

Question 26 of 55
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Score: 1 (33.3%)Theme : Psychopathology A. Pareidolic illusion B. Delusional perception C. Extra-campine hallucination D. Functional hallucination E. Visual illusion F. Synaethesia G. Reflex hallucination H. Passivity Phenomena

From list choose single option which best following:- 1) A young man looks out of window sees shape of his fiancee's head in clouds before turning back his book. A. Pareidolic illusion Note: Pareidolia occurs in a considerable proportion of people. It may also be provoked by psychomimetic drugs. Typically, images are seen from shapes in pareidolic illusion, e.g. author used see head of a spaniel in a chip on first paving stone of path.

2) A woman can hear neighbours talking about her ¼ of a mile away in post office. A. Pareidolic illusion C. Extra-campine hallucination Note: Extracampine hallucinations are experienced outside limits of sensory field, outside visual field beyond range of audibility.

3) A man can hear a voice speaking every time he hears water running through tap. A. Pareidolic illusion D. Functional hallucination Note: In functional hallucination, external stimulus necessary provoke hallucinations, but perception of stimulus hallucination in same modality are experienced simultaneously.
Question 27 of 55
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Score: 1 (20%)Theme : Psychiatric syndromes A. Kluwer Bucy Syndrome B. Koro C. Korsakoff Syndrome D. Landau Kleffner E. Latah F. Lesch-Nyhan Syndrome G. Metonym

Which of following cases best above options

1) A patient refers his mother as his 'egg woman' A. Kluwer Bucy Syndrome G. Metonym Note: Metonyms denote an usual use of words (Gelder MG, Lopez-Ibor JJ, Andreasen NC . (2000) New Oxford Textbook of Psychiatry. Oxford: Oxford University Press p 573)

2) A woman presents belief her breasts labia are shrinking into her body A. Kluwer Bucy Syndrome B. Koro Note: Koro 'genital shrinking syndrome'. It a transient state of acute anxiety. The affected male subjectively experiences a shrinking of his penis (Gelder MG, Lopez-Ibor JJ, Andreasen NC . (2000) New Oxford Textbook of Psychiatry. Oxford: Oxford University Press p 1062)

3) A woman presents a history when she startled, she starts repeating what other people say copies their movements A. Kluwer Bucy Syndrome E. Latah Note: The Latah sufferer shows hypersensitivity sudden frights, echopraxia, echolalia, automatic responses commands dissociative behaviour. It similar dissociative phenomena (Wright P, Stern J, Phelan M (eds) (2005) Core Psychiatry. Edinburgh : Elsevier Saunders p 342)

4) The staff on ward note a patient who initially seemed mentally sound, difficulty in remembering past events – in particular chronology of past events A. Kluwer Bucy Syndrome C. Korsakoff Syndrome Note: In Korsakoff Syndrome learning over a more prolonged period severely impaired, there usually a retrograde memory loss which characterstically extends back many years. Gelder MG, Lopez-Ibor JJ, Andreasen NC . (2000) New Oxford Textbook of Psychiatry. Oxford: Oxford University Press p 457

5) A man presents a history of overeating, smoking drinking excessively a voracious sexual appetite A. Kluwer Bucy Syndrome Note: The Kluwer-Bucy syndrome consists of hyperorality, hypersexuality, overattention external stimuli, agnosia, loss of fear amnesia. It caused by bilateral damage medial temporal lobe. Wright P, Stern J, Phelan M (eds) (2005) Core Psychiatry. Edinburgh : Elsevier Saunders p 384
Question 28 of 55
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Score: 1 (33.3%)Theme : Diagnosis A. Depression disorder B. Temporal lobe epilepsy C. Late onset schizophrenia D. Multi-infarct dementia E. Alzheimer's F. Somato form disorder G. Capgras syndrome H. Fregoli syndrome I. Diogenes syndrome

Choose single likely diagnosis in following cases: 1) A 78-year-old man's wife died 4 months ago. It had a flat affect, resulting in self neglect, anhedonia, loss of weight, sleep problems he does leave his house. A. Depression disorder Note: All symptoms in first case are consistent diagnosis of depressive illness

2) A 56-year-old woman was brought in by her husband. She displaying bizarre behaviour over past 3 days. She complains she a strange taste in her mouth smells funny things in house. She agitated at times stupor at other time. She stopped her medication one week ago. A. Depression disorder B. Temporal lobe epilepsy Note: In temporal lobe epilepsy, there a complex partial seizure. This may begin aura, change in behaviour olfactory gustatory hallucionations, automatism such as smacking, chewing, swallong movement, salivation, hand gestures. Some patients may become violent aggressive

3) An 82-year-old lady had memory problems over past 2-3 years. The onset of memory problems was due multiple episodes of short lasting confusions incomplete recovery. After each episode her memory became worse. She a long history of ischaemic heart disease diabetes. A. Depression disorder D. Multi-infarct dementia Note: The third case consistent multi infarct dementia step wise deterioration risk factors vascular problems


Question 29 of 55
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Score: 0 (0%)Theme : Dementia A. Alzheimers Disease B. Multi-infarct dementia C. Picks dementia D. Lewy Body dementia E. Normal pressure hydrocephalus F. Creutzfeld Jakob Disease G. Dementia Pugilistica H. Depressive pseudo dementia I. Huntingtons disease

From option list, select clinical feature consistent diagnosis:- 1) A 58-year-old male ex-professional jockey, developed a progressive dementia some Parkinsonian features. At post mortem, brain pathology was dominated by neurofibrillary tangles. A. Alzheimers Disease G. Dementia Pugilistica Note: Dementia Pugilstica also called chronic traumatic encephalopathy, pugilistic Parkinsons Syndrome, boxer’s syndrome punch drunk syndrome. It a neurological disorder which affects career boxers others who receive multiple dazing blows head. It typically occurs 16 years after starting a career in boxing. Famous suffers include Muhammed Ali. It commonly manifests as dementia declining mental ability Parkinsonism tremors lack of coordination. It can also cause unsteady gait, inappropriate behaviour speech problems. Dementia pugilistica (punch drunk syndrome) develops progress after retirement from ring appears interact effects of age. The principle early features are executive dysfunction, bradyphren, mild dystarthria incoordination, followed by Parkinsonism, spasticity ataxia.

2) A 60-year-old woman presents a 6 month history of cognitive decline. She had mild non-specific gait disturbance some recent urinary incontinence A. Alzheimers Disease E. Normal pressure hydrocephalus Note: Normal pressure hydrocephalus due a decrease in cerebrospinal fluid absorption by arachnoid villi an unexplained cause in majority of cases. There may be a history of subarachnoid haemorrhage, trauma infection. Cardinal symptoms include dementia, ataxia incontinence.

3) A 40-year-old man was referred by his GP a ‘tick’. On assessment unusual movements were more generalised than noted by GP. A family history was available since his father had killed in second world war his mother had committed a mental institution ‘nerves’ at age of 40 years. A. Alzheimers Disease I. Huntingtons disease Note: Huntingtons Disease an autosomal dominant condition. Onset usually in middle age insidious; course relentlessly progressive chorea, personality change, preceding dementia death. Epilepsy also common.
Question 30 of 55
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Score: 1 (20%)Theme : Vitamins A. Megaloblastic anaemia due folate deficiency B. Pellagra C. Pernicious anaemia D. Korsakoff's Psychosis E. Wernicke's Encephalopathy

Match any of options A-E, (one per question) questions 1-5 1) The 40-year-old man suffered from a general deterioration of physical mental health over a number of months, a feeling of subjective incapacity mental physical effort. Thereafter he suffered from anorexia, insomnia, apprehension, dizziness, headache, eventually became severely depressed A. Megaloblastic anaemia due folate deficiency B. Pellagra Note: Pellagra-GI disturbance, dermatological signs, psychiatric states, including those mentioned above

2) This 40-year-old man, a heavy drinker, presented an abducens palsy nystagmus A. Megaloblastic anaemia due folate deficiency E. Wernicke's Encephalopathy Note: Wernicke's encephalopathy represents acute neuropsychiatric reaction severe thiamine deficiency

3) This 40-year-old man presented a sudden onset of mental confusion, staggering gait, marked memory impairment, together nausea, anorexia vomiting A. Megaloblastic anaemia due folate deficiency D. Korsakoff's Psychosis Note: Korsakoff's psychosis requires presence of clear evidence of a marked memory disorder good preservation of other cognitive functions

4) This associated depression, anergia, apathy somnolence A. Megaloblastic anaemia due folate deficiency C. Pernicious anaemia Note: Pernicious anaemia, due Vitamin B12 deficiency, may be accompanied only by neurological complication of subacute degeneration of cord, but also by mental abnormalities (above)

5) This may be associated depression, dementia epilepsy A. Megaloblastic anaemia due folate deficiency Note: Folic acid deficiency, like Vitamin B12 deficiency,may result in megaloblastic anaemia, occurs in pregnancy, elderly, in those suffering from psychiatric disorder
Question 31 of 55
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Score: 0 (0%)Theme : Receptors A. HT transporter B. HT1A auto receptor C. HT2A receptor D. Alpha 1 receptor E. Alpha 2 receptor F. GABA-A receptor G. Muscarinic receptor H. H1 receptor I. H2 receptor J. NMDA Glutamate receptor

For each of following drugs, select one receptor drug acts on: 1) The delayed onset part of antidepressant medication action A. HT transporter B. HT1A auto receptor Note: The delayed action of antidepressants effect due down regulation of HT1A auto-receptors in past synaptic neurons, which due increase in synaptic neurotransmitters.

2) The hypotensive effect of neuroleptics A. HT transporter D. Alpha 1 receptor Note: Effect on Alpha 1 receptor causes decrease in pressure, dizziness, drowsiness ejaculatory failure.

3) Sexual dysfunction which may be experienced use of SSRI (Selective Seretonin Receptor Inhibitors) A. HT transporter C. HT2A receptor Note: HT2A receptor occupancy responsible both sexual sleep problems which located in past synoptic neurons.
Question 32 of 55
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Score: 1 (20%)Theme : Investigations A. CT scan B. Electroencephalography (EEG) C. Magnetic resonance imaging (MRI) D. Mini-Mental State Examination (MMSE) E. National Adult Reading Test (NART) F. Skull radiograph

Which tests are indicated in cases below. Assume they are all available in your clinical setting.

1) During an initial assessment of a patient you suspect his mental functions are severely compromised A. CT scan D. Mini-Mental State Examination (MMSE) Note: The MMSE a very useful broad screening test – it brief, point can be repeated over time guage change Gelder MG, Lopez-Ibor JJ, Andreasen NC . (2000) New Oxford Textbook of Psychiatry. Oxford: Oxford University Press p 95)

2) A man admitted trauma unit a suspected head injury A. CT scan Note: In an acute setting CT preferred investigation its faster acquisition time good visualisation of subdurals extradurals. MRIs cannot be performed if there any magnetic material present in body (eg a pacemaker) attached body Gelder MG, Lopez-Ibor JJ, Andreasen NC . (2000) New Oxford Textbook of Psychiatry. Oxford: Oxford University Press p 442)

3) A man in ward several weeks suspected of having a head injury A. CT scan C. Magnetic resonance imaging (MRI) Note: In post-acute setting MRI a better instrument. Reasons this include a better image resolution, detection of diffuse axonal injury when white matter appears in CT brain imaging Gelder MG, Lopez-Ibor JJ, Andreasen NC . (2000) New Oxford Textbook of Psychiatry. Oxford: Oxford University Press p 442

4) A man admitted several weeks appears have a deteriorating conscious level A. CT scan B. Electroencephalography (EEG) Note: If brain imaging available, role of EEG largely confined investigation of a deteriorating conscious level an unexpectedly prolonged unconscious, as well as unusual behavioural disturbances may be attributable epilepsy. Gelder MG, Lopez-Ibor JJ, Andreasen NC . (2000) New Oxford Textbook of Psychiatry. Oxford: Oxford University Press p 442

5) There concern whether there a drop in a patient's performance becausef of a head injury A. CT scan E. National Adult Reading Test (NART) Note: The NART, people whose first language English, gives a good estimate of preinjury IQ Gelder MG, Lopez-Ibor JJ, Andreasen NC . (2000) New Oxford Textbook of Psychiatry. Oxford: Oxford University Press p 442)
Question 33 of 55
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Score: 0 (0%)Theme : Psychology/Psychopathology A. Isolation B. Intellectualisation C. Displacement D. Splitting E. Idealisation (identification) F. Sublimation G. Repression H. Undoing I. Denial J. Regression

From each of following, select defence mechanism likely manifest each of following:- 1) A man passed over promotion at work. He does get upset while at work, but loses his temper at another driver on way home. A. Isolation C. Displacement Note: Displacement a transfer of emotion from a person, object, situation which it properly associated, another source, e.g. developing spider phobia after a row parents

2) He suggests his anger due his childhood then begins speak about all books he recently read on child rearing across different cultures. A. Isolation B. Intellectualisation Note: This intellectualising rather than regression Here he endeavouring attribute anger childhood any other event justification based upon his read evidence.

3) It suggested him perhaps some of his anger related his relationship boss. He denies this saying "She like a mother me. She's always kind supportive." A. Isolation E. Idealisation (identification) Note: Idealisation unconscious adoption of characteristics activities of another person, often reduce pain of separation loss.
Question 34 of 55
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Score: 0 (0%)Theme : Dementia A. Stepwise progression B. Pica C. Myoclonic jerk D. Incontinence E. Abulia F. Confabulation G. Irritability H. Nominal aphasia I. Prosopagnosia J. Visual hallucination

Choose single likely symptom in each of following disorders:- 1) Korsakoffs psychosis. A. Stepwise progression
F. Confabulation Note: Korsakoff's syndrome a profound inability acquire new memories it may follow Wernicke's encephalopathy. It due thiamine deficiency, e.g. in alcoholics. Patients confabulate fill in gaps in their memory.

2) Normal pressure hydrocephalus A. Stepwise progression D. Incontinence Note: The cardinal features of pressure hydrocephalus are ataxia, incontinence dementia. These clinical features are due pressure on brain structure. The cause remains unexplained in majority of cases, although there a decrease in cerebro-spinal fluid absorption by arachnoid villi. There may be history of sub-arachnoid haemorrhage, trauma infection. Treatment by insertion of a shunt usually successful, following this, ataxia likely improve.

3) Lewy body disease A. Stepwise progression J. Visual hallucination Note: Dementia lewy bodies can be distinguished from Alzheimer's disease by its fluctuating course, marked visual hallucinations motor features Parkinsonism. There often a history of repeated falls, syncope, transient loss of consciousness, delusions hallucinations in other modalities. There extreme sensitivity extra-pyramidal effects of antipsychotic drugs.
Question 35 of 55
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Score: 1 (20%)Theme : Clinical assessment A. Cataplexy B. Catalepsy C. Catatonia D. Confabulation E. Coprolalia F. Copropraxia G. Echopraxia H. Stereotypy

Which of above terms are best described by illustrations below?

1) A patient sits at his bedside hardly moving hours on end A. Cataplexy C. Catatonia Note: Catatonia a disorder characterized by disturbed motility – either excessively decreased (in extreme cases leading catatonic stupor) excessive increased (catatonic excitement) (Gelder MG, Lopez-Ibor JJ, Andreasen NC . (2000) New Oxford Textbook of Psychiatry. Oxford: Oxford University Press p 67)

2) A 26 year man repeatedly swears particularly when he becomes emotionally distressed, despite desperately trying A. Cataplexy E. Coprolalia Note: In coprolalia forced vocalization takes form of obsene words phrases. It occurs in Gilles De La Tourette's Syndrome (Sims, A. (1999) Symptoms in mind - an introduction descriptive psychopathology (2nd edn). London : Saunders.p 341)

3) A patient stands hours on end his arms in posture of a crucifix A. Cataplexy B. Catalepsy Note: Catalepsy an important symptom of catatonia in which uncomfortable postures are maintained against gravity attepts rectify them (Gelder MG, Lopez-Ibor JJ, Andreasen NC . (2000) New Oxford Textbook of Psychiatry. Oxford: Oxford University Press p 67)

4) A man repeatedly opens closes his bedroom door A. Cataplexy H. Stereotypy Note: Stereotypy repetition of actions (Gelder MG, Lopez-Ibor JJ, Andreasen NC . (2000) New Oxford Textbook of Psychiatry. Oxford: Oxford University Press p 67)

5) A woman presents a history of suddenly collapsing ground at times when she emotionally aroused A. Cataplexy Note: In cataplexy subject falls down due a sudden loss of muscle tone provoked by strong emotion. It often associated narcolepsy (Sims, A. (1999) Symptoms in mind - an introduction descriptive psychopathology (2nd edn). London : Saunders.p 43)
Question 36 of 55
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Score: 1 (20%)Theme : Dementias (psychiatry psychiatric disorders) A. Adrenoleukodystrophy B. Alcoholic dementia C. Alzheimer's didease D. Creutzfeldt-Jakob disease E. Dementia Pugilistica F. HIV related dementia G. Huntington's disease H. Kuru I. Metachromatic leucodystrophy J. New variant Creutzfeld-Jakob disease

The following options refer neuropathological genetic processes which can be found in above dementias. Match any of options A-J, (one per question) following: 1) The EEG of 90% of patients this disease shows a reduced background rhythm characteristic triphasic sharp wave complexes at 1-2 Hz. A. Adrenoleukodystrophy D. Creutzfeldt-Jakob disease Note: These EEG changes are fairly characteristic of CJD, are found in new variant disease.

2) This disease caused by an enzyme deficiency which results in deposition of sphingolipid in neurones other cells, in demyelination of neurones. A. Adrenoleukodystrophy I. Metachromatic leucodystrophy Note: . This an autosomal disorder which results in a deficiency of aryl-sulphatase A enzyme. Infantile adult forms occur latter characterised by personality change, behavioural disturbance, psychosis dementia, as well as cerebellar pyramidal symptoms.

3) This disease characterised by anticipation. A. Adrenoleukodystrophy G. Huntington's disease Note: The HD mutation was identified in 1993 as an expansion of a CAG trinucleotide repeat coding glutamine in exon 1 of HD gene. Trinucleotide repeats are unstable vulnerable dynamic mutation, meaning longer repeat sequences are more likely undergo further expansion. This effect called anticipation, it explains why disease tends become more sever have an earlier onset in successive generations of HD families.

4) This dementia associated atrophy of cerebellar vermis A. Adrenoleukodystrophy B. Alcoholic dementia Note: Structural neuroimaging provides evidence of cortical atrophy, dilated ventricles atrophy of cerebellar vermis in up 50% of alcohol-dependent patients.

5) This an X-linked disorder. A. Adrenoleukodystrophy Note: The precise physiology of this disorder unknown. Symptoms include personality change, dementia, pyramidal features, aphasia, apraxia, dysarthria blindness. Subclinical clinical adrenal insufficiency invariably present.

Question 37 of 55
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Score: 0 (0%)Theme : Psychopathology A. Over-valued idea B. Echo de pensee C. de Clerambault's Syndrome D. Fregoli delusion E. Othello Syndrome F. Tangentiality G. Concrete thinking H. Capgras Syndrome

From option list, select single best description of patient’s symptoms:- 1) The patient believes another person can radically change their appearance. A. Over-valued idea D. Fregoli delusion Note: Fregoli Delusion in Fregoli Syndrome, which a very rare delusional disorder. The patient believes a familiar person, who often believed be patient’s persecutor, can take on different appearances. Primary causes include schizophrenia organic disorder.

2) The patient believes their spouse unfaithful. A. Over-valued idea E. Othello Syndrome Note: Othello Syndrome also known as morbid jealousy, erotic jealousy pathological (delusional) jealousy. The patient holds a delusional belief their sexual partner being unfaithful will go great lengths find evidence of infidelity, including searching belongings underclothing.

3) The patient answers a question in an indirect vaguely relevant manner A. Over-valued idea F. Tangentiality Note: Tangentiality responding questions obliquely rather than directly without giving direct answers. It also called tangential speech, so called because responses go off at a tangent questions.
Question 38 of 55
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Score: 0 (0%)Theme : Geriatrics/Psychiatric Disorders A. Adjustment disorder B. Alzheimer's disease C. Amnesic syndrome D. Dissociative amnesia E. Fugue F. Korsakoffs syndrome G. Lewy body dementia H. Multi infarct dementia I. Pseudo dementia

Choose likely diagnosis from list each of following:- 1) A 77-year-old man presents fluctuating, progressive memory decline. He also a history of hypertension falls. A. Adjustment disorder H. Multi infarct dementia Note: In multi-infarct dementia, onset acute patchy stepwise deterioration fluctuations in cognition. Depression may be prominent but personality insight are often preserved until late.

2) The police bring a middle aged male A&E. He appears be unable remember his personal details. He otherwise well all investigations are normal. A. Adjustment disorder E. Fugue Note: In fugue, there are all features of dissociative amnesia plus a purposeful journey away from home. Amnesia exists period of fugue, while self care social interaction are maintained. Recovery abrupt complex.

3) A 67-year-old woman presents memory deficits following death of her husband of 2 months previously. She also complains of lethargy, disturbed sleep weight loss A. Adjustment disorder I. Pseudo dementia Note: Pseudo dementia common in elderly depressed patients. The patient complains of poor memory concentration. "Don't know" responses poor involvement neuro-psychological tests are characteristic. The symptoms at onset are important in order distinguish pseudo-dementia from true dementia.

Score: 0 (0%)Theme : Drugs used in psychiatry A. Amisulpiride B. Amitryptiline C. Flupenthixol D. Mirtazapine E. Moclobemide F. Olanzapine G. Phenelzine H. Pimozide I. Reboxetine J. Trazodone K. Venlafaxine

Select drug from above list corresponds following descriptions: 1) A monoamine oxidase inhibitor (MAOI) can cause a fatal syndrome of throbbing headache hypertension if foods containing large quantities of tyramine are eaten. A. Amisulpiride G. Phenelzine Note: Phenelzine a MAOI can cause this syndrome. MAOIs inhibit breakdown of serotonin (and a lesser extent noradrenaline) at synapse. Tranycypromine another example.

2) A reversible inhibitor of monoamine oxidase-A (RIMA), does interact tyramine. A. Amisulpiride E. Moclobemide Note: Moclobemide a RIMA does interact tyramine. Question 40 of 55
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Score: 1 (33.3%)Theme : Mood Disorder A. Depression B. Complex partial seizure C. Late onset schizophrenia D. Vascular dementia E. Alzheimer's disease F. Persistent somatoform disorder G. Capgras syndrome H. Pick's dementia I. Frontal lobe syndrome J. Personality disorder

Choose single likely diagnosis each of following: 1) A 78-year-old man states he cannot enjoy things anymore. He a flat affect, self-neglect, weight loss disturbed sleep. He does go out of house anymore. His wife died 4 months ago. A. Depression Note: Cardinal symptoms of depression include depressed mood, loss of interest enjoyment reduced energy, leading increased fatigue diminished activity. This in addition loss of interest, lack of emotional feelings, early morning waking, loss of appetite, weight loss reduced libido.

2) A 40-year-old woman brought in hospital by her husband. She behaving bizarrely over last 3 days, associated stupor at times. She complains she a strange taste in her mouth smells funny things in house. She agitated at times reports stopping medication one week ago. A. Depression B. Complex partial seizure Note: A complex partial seizure arises from a localised area of cerebral cortex accompanied by an impairment of consciousness, often arising from foci in temporal lobe.

3) Over last 3 years, an 80-year-old woman suffered multiple episodes of short lasting confusion incomplete recovery between episodes. After each episode her memory worse. She a history of ischaemic heart disease. A. Depression D. Vascular dementia Note: Vascular dementia characterised by stepwise deterioration patch disturbance of neurological neuropsychological deficits. Usually there evidence of vascular disease during examination.
Question 41 of 55
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Score: 1 (20%)Theme : Eating problems A. Anorexia nervosa B. Bulimia nervosa C. Depressive disorder D. Kluwer-Bucy syndrome E. Prader-Willi Syndrome F. Schizophrenia

Which of following clinical situations suggestive of above disorders? Each option may be used once, more than once at all


1) A 51-year-old woman presents overeating, food fads, smoking incessantly increased alcohol consumption. She also become increasingly promiscuous A. Anorexia nervosa D. Kluwer-Bucy syndrome Note: features of Kluwer-Bucy syndrome include hyperorality, blunted affect unrestrained sexuality Gelder MG, Lopez-Ibor JJ, Andreasen NC . (2000) New Oxford Textbook of Psychiatry. Oxford: Oxford University Press p 399

2) A 24-year-old woman losing weight as she believes her food being tampered reluctant eat A. Anorexia nervosa F. Schizophrenia Note: There a persecutory content her thinking, suggestive of a paranoid psychosis

3) A 27-year-old woman whose weight appears presents repeated overeating vomiting A. Anorexia nervosa B. Bulimia nervosa Note: For a more definitive diagnosis, a morbid dread of fatness should also be elicited World Health Organization. (1992) The ICD-10 Classification of Mental Behavioural Disorders Clinical descriptions diagnostic guidelines. : World Health Organization. p 179

4) A 19-year-old woman referred a psychiatric assessment. Although she lost 10kg, she tells you 'there nothing wrong me – my parents are just worriers A. Anorexia nervosa Note: regular feature of anorexia nervosa concealment denial of problem Gelder MG, Lopez-Ibor JJ, Andreasen NC . (2000) New Oxford Textbook of Psychiatry. Oxford: Oxford University Press p 840

5) A 25-year-old woman presents overeating carbohydrate craving during winter A. Anorexia nervosa C. Depressive disorder Note: This suggestive of seasonal depression – further features would be depression in winter weight gain Gelder MG, Lopez-Ibor JJ, Andreasen NC. (2000) New Oxford Textbook of Psychiatry. Oxford: Oxford University Press p 685
Question 42 of 55
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Score: 1 (33.3%)Theme : Defence Mechanism A. Conversion B. Isolation C. Rationalisation D. Identification aggressor E. Intellectualisation F. Projective identification G. Magical undoing H. Splitting I. Denial J. Displacement

From option list, select likely relating following examples:- 1) A 40-year-old man unable post letter in letter box until he walked round box four times. A. Conversion G. Magical undoing Note: Magical undoing a term used in psychoanalysis. It a defence mechanism whereby an emotional conflict associated an action dealt by negating action attempting ‘magically’ cause it have occurred by substituting an approximately opposite action.

2) An 18-year-old woman tells duty psychiatrist in a matter of fact way she took 20 Paracetamol tablets 2 hours ago. A. Conversion B. Isolation Note: Isolation a defence mechanism involving act process of separating placing apart, emotions feelings

3) A boss gets migraines after her secretary made a mistake in double booking her. A. Conversion Note: Conversion a defence mechanism in which an unconscious conflict would otherwise arouse anxiety expressed symbolically. The repressed emotion transformed into a physical symptom, which can vary from a headache paralysis loss of sensation.
Question 43 of 55
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Score: 0 (0%)Theme : Anxiety Disorder A. Obsessive Compulsive Disorder B. Social Phobia C. Panic Disorder D. Generalised Anxiety Disorder E. Agoraphobia F. Simple Phobia G. Adjustment Disorder H. Dissociative Disorder I. Depersonalisation Disorder

From option list, select single appropriate diagnosis each of following scenarios:- 1) A 40-year-old man unable secure a promotion at work. He informed this because he unable speak at board meetings often avoid them. A. Obsessive Compulsive Disorder B. Social Phobia Note: In social phobia, there a fear of scrutiny by other people leading avoidance of social situations. More persuasive social phobias are usually associated low self-esteem fear of criticism. These may present as a complaint of blushing, hand tremor, nausea urgency of micturition. The patient sometimes convinced one of these secondary manifestations of their anxiety primary problem.

2) A 30-year-old woman experiences acute episodes of anxiety, which appear come ‘out of blue’ A. Obsessive Compulsive Disorder C. Panic Disorder Note: The essential feature of panic disorder recurrent attacks of severe anxiety (panic). These are restricted any particular situation set of circumstances therefore unpredictable. Symptoms include sudden onset of palpitations, chest pain, choking sensations, dizziness a feeling of unreality.

3) A 35-year-old woman largely housebound last two years. She can only leave house if her husband sister accompany her. A. Obsessive Compulsive Disorder E. Agoraphobia Note: Agoraphobia a well-defined cluster of phobias embracing fears of leaving home, entering shops, crowds public places, travelling alone in trains, buses planes. Panic disorder a frequent feature of this condition.
Question 44 of 55
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Score: 0 (0%)Theme : Alcohol Drug Related Disorders A. Alcohol withdrawal B. Benzodiazepine dependence C. Cannabis intoxication D. Cannabis withdrawal E. Cocaine intoxication F. Cocaine withdrawal G. LSD intoxication H. Opiate addiction I. Phencyclidine intoxication

Which of above alcohol drug related disorders likely diagnosis in following cases: 1) A young woman was brought into hospital by her boyfriend after having a seizure. She hypertensive, tachycardia noted have nasal congestion. She claims be a Hollywood starlet says you are preventing her from marrying someone famous. Her boyfriend explains she a prostituting herself in order finance her drug habits. A. Alcohol withdrawal E. Cocaine intoxication Note: In cocaine intoxication, there sympathetic hyperactivity, ex. Hypertension, tachycardia mydriasis. There also nasal perforation, grandiose thoughts, paranoid ideas, hallucinations hypersexuality.

2) An 18-year-old man presents a two year history of panic attacks, anxiety vivid flashbacks. He recently become more withdrawn, acted inappropriately showed cognitive difficulties. He a cough conjunctival redness. A. Alcohol withdrawal C. Cannabis intoxication Note: In cannabis intoxication, there can be an eye infection (red eyes), cough due respiratory tract irritation, euphoria relaxation.

3) A young man presents a history of polysubstance abuse. He sweating profusely, agitated, tachycardia claims see colour red while listening his CD. A. Alcohol withdrawal G. LSD intoxication Note: LSD intoxication leads sympathomimetic effects, sweating, hypertension tachycardia. There are flashbacks, hallucinations increasing anxiety.

Question 45 of 55
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Score: 0 (0%)Theme : Side Effects A. Headaches, drowsiness, dry mouth, postural hypotension, dizziness weight gain B. Nausea, vomiting, weight loss, anxiety, insomnia hypersensitivity reaction C. Sedation, diarrhoea, postural hypotension, seizure, muscle weakness agranulocytosis D. Sedation, impotence, diarrhoea, galactorrhoea, high pressure weight loss E. Tremor, polydipsia, oedema, weight gain mental confusion F. Nausea, vomiting, weight gain, sedation, constipation increased libido G. Dry mouth, impotence, bradycardia, goitre, diarrhoea fever H. Sedation, impotence, loss of accommodation, constipation, galactorrhoea, hypotension

From option list, select side effect profile associated following drugs:- 1) Fluoxetine A. Headaches, drowsiness, dry mouth, postural hypotension, dizziness weight gain B. Nausea, vomiting, weight loss, anxiety, insomnia hypersensitivity reaction Note: Specific serotonine re-uptake inhibitors (SSRI's) are less sedating have fewer antimuscarinic cardiotoxic effects than tricyclic antidepressants. The side effects of SSRI include gastro-intestinal effects, diarrhoea, constipation, hallucination, sweating increasing anxiety in first few days of treatment.

2) Chlorpromazine A. Headaches, drowsiness, dry mouth, postural hypotension, dizziness weight gain H. Sedation, impotence, loss of accommodation, constipation, galactorrhoea, hypotension Note: With chlorpromazine there also a risk of contact sensitisation. Health workers should avoid direct contact chlorpromazine. Intramuscular injection may be painful, cause hypotension, tachycardia give rise nodule formation.

3) Lithium A. Headaches, drowsiness, dry mouth, postural hypotension, dizziness weight gain E. Tremor, polydipsia, oedema, weight gain mental confusion Note: Important side effects of lithium include fine tremor, polydipsia, hypothyroidism, leucocytosis, hyperparathyroidism, hypercalcaemia, blurred vision, ataxia, coarse tremor, dysarthria, convulsion, toxic psychosis, raised antidiuretic hormone concentration exacerbation of psoriasis
Question 46 of 55
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Score: 0 (0%)Theme : Movement Disorder A. Hemiballism B. Akathesia C. Cataplexy D. Ataxia E. Acute dystonia F. Cog wheel rigidity G. Tardive dyskinesia H. Complex partial seizure

For each of following scenarios, choose single likely disorder from list:- 1) A 21-year-old woman brought in A&E by her husband complaining of a collapse of sudden onset after emotional excitement. A. Hemiballism C. Cataplexy Note: Cataplexy a sudden loss of muscle tone without loss of consciousness. It leads collapse, immobility a state resembling rapid eye movement sleep without loss of consciousness. It induced by strong emotion, genetic in origin a catatonic symptom.

2) A 54-year-old woman attends clinic complains of repeated mouth lip movement, which noticed more by her family. She on some long-term medication a previous episode of psychosis. A. Hemiballism G. Tardive dyskinesia Note: In tardive dyskinesia, a wide variety of movements can occur, including lip-smacking, tongue protrusion choreiform hand movements. This more common in elderly women, those affective illness those who have had acute extrapyramidal side effects early on in treatment. The time taken develop months years after being on psychotropic medication. Approximately 50% of cases are reversible they are treated by reducing changing medication. In addition, valproate, tetrabenazine clonazepam are being used treat condition.

3) A 22-year-old man complains of acute spasm of his tongue, which very painful stops him speaking. He taking low dose anti-psychotic medication last 3 weeks. A. Hemiballism E. Acute dystonia Note: Acute dystonia a muscle spasm in any part of body, e.g. eye rolling neck/head twisted one side (torticollis). The prevalence of this 10% psychotropic medications. It more common in males, young those taking neuroleptic medication first time. It also more common high potency drugs e.g. haloperidol. The onset of acute dystonia can be just hours after starting antipsychotic therapy. Anticholinergic drugs are used treat condition.
Question 47 of 55
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Score: 0 (0%)Theme : Clinical Features in Cerebral Lobe Dysfunction A. Apraxia without alexia B. Prosopagnosia C. Hemianopia D. Ataxia E. Visual hallucination F. Finger agnosia G. Persevration H. Brocas aphasia I. Wernickes Aphasia J. Pure agraphia

Select one of clinical features which would be apparent in following cases: 1) A 67-year-old man who a lesion of non-dominant hemisphere from a ischaemic stroke. A. Apraxia without alexia B. Prosopagnosia Note: Lesion of non-dominant hemisphere causes visuospatial disorientation, sensory inattention, constructional apraxia, dressing apraxia, anorognesia prosopagnosia

2) A 71-year-old man who complains of weakness in his dominant hand A. Apraxia without alexia H. Brocas aphasia Note: Weakness of dominant hand indicates lesion in dominant frontal lobe where Brocas area located.

3) A 58-year-old woman who a lesion of left posterior parietal lobe following a haemorrhagic stroke A. Apraxia without alexia F. Finger agnosia Note: This part of Gerstmann's syndrome which due a lesion in a dominant parietal lobe.
Question 48 of 55
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Score: 0 (0%)Theme : Mood Disorders A. Bipolar affective disorder, current episode severe depression without psychotic symptoms B. Bipolar affective disorder, current episode severe depression psychotic symptoms C. Prolonged depressive reaction D. Mild depressive disorder E. Moderate depressive disorder F. Organic depressive disorder G. Severe depressive disorder psychotic symptoms

Choose single likely diagnosis from list each of following cases: 1) A 25-year-old lady who lost her job 3 months ago, presents loss of appetite, loss of one stone in weight, sleep problems, lability of mood being able cope her everyday life. A. Bipolar affective disorder, current episode severe depression without psychotic symptoms D. Mild depressive disorder Note: In mild depressive episodes, there depressed mood often accompanied by loss of interest enjoyment increased fatigue. These are usually regarded as typical symptoms of depression at least two of these symptoms, plus at least two of other symptoms, i.e. decrease in concentration, self-esteem appetite, ideas of guilt, pessimistic views, ideas/acts of self-harm suicide disturbed sleep, should usually be present a definite diagnosis. None of symptoms should be present an intense degree. The minimum duration of symptoms approximately 2 weeks.

2) A 45-year-old man who presents having acting bizarrely at home problems sleep loss of weight. He thinks neighbours are poisoning his food intruders were breaking into his house. Eight weeks ago he had bought a new car which was out of his character. A. Bipolar affective disorder, current episode severe depression without psychotic symptoms B. Bipolar affective disorder, current episode severe depression psychotic symptoms Note: For a diagnosis of bipolar affective disorder, a current episode of severe depression accompanied by psychotic symptoms must be evident. In addition there must have at least one hypomanic manic mixed affective episode in past. The latter indicated in this case as buying a car was out of his character.

3) A 75-year-old lady brought A&E by her daughter one month after she had treated a urinary tract infection by her GP. She presents unspecific abdominal pain experience of hearing two voices, first one somebody calling her names other one voice of her dead husband asking her join him. A. Bipolar affective disorder, current episode severe depression without psychotic symptoms G. Severe depressive disorder psychotic symptoms Note: A severe depressive episode psychotic symptoms which meets criteria severe depression, given in ICD categorised under F32.2, in which delusions, hallucinations depressive stupor are present.

Question 49 of 55
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Score: 0 (0%)Theme : Clinical Theory, Medicine A. Acute alcohol intoxication B. Delirium tremens C. Korsakoffs syndrome D. Infection E. Opiate overdose F. Intracranial bleeding G. HIV H. Dementia pugilistica

Choose likely symptom compatible following syndrome:- 1) A 54-year-old man aware part of his body exists. A. Acute alcohol intoxication F. Intracranial bleeding Note: In intra-cranial bleeding, individual may feel a limb actually exists absent. This refers hemisomatognosia a defect in cortical cognitive functions. It occurs in spite of intact sensory pathways sensorium indicative of sensory association area lesion.

2) A 45-year-old man, recently separated from his wife, admitted hospital abdominal pain seeing small animals running around his room. A. Acute alcohol intoxication B. Delirium tremens Note: Delirium tremens associated Lilliputian hallucinations (seeing little men). Typically patient little creatures walking over him. This happens in withdrawal stage of alcohol abuse, from 24 hours 7 days after stopping alcohol intake. Tactile auditory hallucinations may also occur where patient can feel these small creatures' footsteps hear them shouting obscene jokes abusive remarks directed at them.

3) A 23-year-old man seen in Accident Emergency department an infected foot. He had severe infections abscesses in his groin leg in past. A. Acute alcohol intoxication G. HIV Note: Opportunistic infections are common in AIDS. Every system in body affected
Question 50 of 55
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Score: 0 (0%)Theme : Psychopathology A. Delusional perception B. Fregoli syndrome C. Erotomania D. Paredolia E. Autoscopy F. Extracampine hallucination G. Synaesthesia H. Third person hallucination

Which of these above symptoms:- 1) A 40-year-old woman reports when she listens water running from tap she can see colour green. A. Delusional perception G. Synaesthesia Note: When there a sensory stimulus in one modality resulting in sensory experience in another, it called synaesthesiae, e.g. hearing a finger nail drawn down a blackboard results in a cold feeling down spine. Such states may occur in healthy people.

2) A 49-year-old man says he can see a picture of a devil in sky, which plenty of clouds A. Delusional perception D. Paredolia Note: Another example of pareidolia a woman who sees an image of her fiancé in a cloud. This can occur in a considerable number of people. It may also be provoked by psychomimetic drugs. Typically, images are seen from shapes in pareidolic illusion, e.g. author used see head of a dog, in particular, a spaniel, in a chip on first paving stone of path leading house where he lived as a child.

3) A 50-year-old man says he can hear somebody talking him from several miles away. A. Delusional perception F. Extracampine hallucination Note: Extra-campine hallucinations (concrete awareness), e.g. somebody says "I keep hearing them talking about my disease down by Post Office which ½ mile away". These hallucinations are experienced outside limits of sensory field, outside visual field, beyond range of audibility. They are diagnostic as they occur in schizophrenia, epilepsy other organic states.
Question 51 of 55
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Score: 0 (0%)Theme : Psychopharmacology A. Dopamine receptor in basal ganglia B. 5HT3 receptor activation C. 5HT1 agonist D. D2 receptor blockage in striatum E. D2 receptor blockage in hypothalamic pituitary axis F. Polipo protein E receptors G. Dopamine receptor supersensitivity H. Non adrenaline re-uptake inhibitor

From list choose from single likely drug cause following side effects:- 1) Subjective feeling of restlessness of leg need stand up cannot site still. A. Dopamine receptor in basal ganglia D. D2 receptor blockage in striatum Note: Akathesia believed be result of blocking D2 receptor in striatum. This a subjective unpleasant state of inner restlessness where there a strong desire compulsion move.

2) Repetitive mouth lip movement. A. Dopamine receptor in basal ganglia G. Dopamine receptor supersensitivity Note: Dopamine receptor super-sensitivity believed explain tardive dyskinesia. This theory supported by fact administering a strong dopamine agonist e.g. haloperidol, alleviates symptoms however, this a usual practice manage symptoms.

3) Prozac induced nausea, headache diarrhoea. A. Dopamine receptor in basal ganglia B. 5HT3 receptor activation Note: The effect on 5HT1 receptor causes anxiolytic antidepressant effect. 5HT2 antagonism produces reduction in sexual desire sleep disorder. The effects on 5HT3 receptor causes nausea diarrhoea.
Question 52 of 55
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Score: 1 (33.3%)Theme : Organic Disorder A. Wilson's Disease B. Phaeochromocytoma C. Systemic Lupus Erythematosus (SLE) D. AIDS E. Pancreatic Cancer F. Parkinson's Disease G. Porphyria H. Briquet's Syndrome I. Diogens Syndrome J. Korsakoffs Syndrome

From option list, select single likely test being described:- 1) A tendency somatize A. Wilson's Disease H. Briquet's Syndrome Note: The essential feature of Somatization Disorder multiple somatic complaints of long duration, beginning before age of 30 years. A group of psychiatrists in St Louis originally described

2) Explosive anger labile mood. A. Wilson's Disease Note:
A variety of psychiatric disorders can happen in Wilson’s disease, especially mood changes, lability mood problems controlling temper.* Wilson’s disease a recessively inherited disorder of copper metabolism fatal unless detected treated before serious illness from copper poisoning occurs. Copper deposition in liver brain causes cirrhosis basal ganglia destruction. Symptoms usually appear in late adolescence these can include a variety of psychiatric disorders including suicidal/homicidal behaviour, depression aggression which manifest as labile of mood problems controlling temper. Examination may reveal muscle wasting, demonstration of copper in tissues e.g. liver cornea. Kayser-Fleischer rings are brown pigmentation in periphery cornea due copper deposits may be viewed by an experienced person using a slit lamp. Other symptoms include jaundice, abdominal swelling, haematemesis difficulty walking, taking swallowing.

3) A resemblance steroid psychosis. A. Wilson's Disease C. Systemic Lupus Erythematosus (SLE) Note: The effect of Systemic Lupus Erythematosus (SLE) on central nervous system can include depression, psychosis, fits, hemiplegia paraplegia, cranial nerve lesions, cerebellar ataxia, chorea meningitis. There are, however, tests CNS lupus therefore this often very difficult physician diagnose.
Question 53 of 55
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Score: 0 (0%)Theme : biological symptoms A. Cataplexy B. Depressive disorder C. Narcolepsy D. Klein Levin Syndrome E. PTSD

Which of following clinical situations suggestive of above disorders? Each option may be used once, more than once at all 1) A man complains of sleeping excessively, overeating, craving chocolate cakes weight gain in winter A. Cataplexy B. Depressive disorder Note: Depression. Although early morning wakening classic disturbance, early middle insomnia are common Wright P, Stern J, Phelan M (eds) (2005) Core Psychiatry. Edinburgh : Elsevier Saunders p 271

2) A man complains of early, middle late insomnia A. Cataplexy B. Depressive disorder Note: Depression. Although early morning wakening classic disturbance, early middle insomnia are common Wright P, Stern J, Phelan M (eds) (2005) Core Psychiatry. Edinburgh : Elsevier Saunders p 271

3) A man complains of repeated nightmares of an assault which occurred over a year ago A. Cataplexy E. PTSD Note: Depression. This appears be a form of seasonal depression, an atypical form of major depression Gelder MG, Lopez-Ibor JJ, Andreasen NC . (2000) New Oxford Textbook of Psychiatry. Oxford: Oxford University Press p 685

4) A man presents a long term history of feeling sleepy in day time which usually leads him falling asleep. He also sudden weakness of knees when he hears a good joke. A. Cataplexy C. Narcolepsy Note: Narcolepsy. The 2 cardinal symptoms of this condition are excessive day time sleepiness, irresistibly leading a refreshing sleep cataplexy, a sudden loss of muscle tone provoked by strong emotion Gelder MG, Lopez-Ibor JJ, Andreasen NC . (2000) New Oxford Textbook of Psychiatry. Oxford: Oxford University Press p 1011

5) The parents of a 17-year-old youth complain he very sleepy days on end, he overeating he makes inappropriate sexual advances A. Cataplexy D. Klein Levin Syndrome Note: In classical form Klein Levin Syndrome comprises hypersomnia, overeating, hypersexuality other forms of disturbed behaviour Gelder MG, Lopez-Ibor JJ, Andreasen NC . (2000) New Oxford Textbook of Psychiatry. Oxford: Oxford University Press p1803
Question 54 of 55
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Score: 1 (33.3%)Theme : Psychopathology A. Palinopsia B. Hypnagogic hallucination C. Extra campine hallucination D. Visual hallucination E. Haptic hallucination F. Reflex hallucination G. Autoscopy H. Illusion I. Synaesthesia J. Charles Bonnet Syndrome

For each of following cases, choose likely option from above list 1) A 45-year-old woman who claims see trace of objects as they move around. A. Palinopsia Note: Palinopsia a phenomenon in which there perseveration of a visual sensation. Palinacousis ictal phenomenon perseveration of an auditory sensation

2) A 37-year-old woman who claims she hears colour red when she sees it. A. Palinopsia I. Synaesthesia Note: In synaesthesia sensory stimulus in one modality perceived as a sensation in another modality.

3) A 60-year-old man bilateral cataracts, otherwise healthy, says he sees things he could explain. A. Palinopsia J. Charles Bonnet Syndrome Note: Sometimes visual hallucinations do appear be associated other psychiatric abnormality. Phantom visual images a condition in which individuals experience complex visual hallucinations a demonstrable psychopathology. This known as Charles Bonnet syndrome.
Question 55 of 55
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Score: 1 (33.3%)Theme : Psychometry A. 16 personality factor inventory B. Adjustment inventory C. General health questionnaire D. Modified inkblot test E. Neuropsychological battery F. Personality inventory G. Quality of life scale H. Social adjustment scale I. Subjective wellbeing inventory J. Thematic apperception test

From option list, select appropriate description of following tests:- 1) Eysenck A. 16 personality factor inventory F. Personality inventory Note: Eysenck’s theory factor analysis of rating scale data yields orthogonal dimensions, which include neuroticism/stability, extroversion/introversion, psychoticism/stability intelligence. Adjustment inventory was introduced by Bell.

2) Bell A. 16 personality factor inventory B. Adjustment inventory Note: Bell Adjustment inventory assesses an individual’s adjustment a variety of situations, e.g. home health.

3) Cattell A. 16 personality factor inventory Note: Cattell identified 20,000 words describing personality using factor analysis. He derived 16 first order personality factors. Cattell’s 16 personality factor test was devised on basis of this work. Second order factor analysis resulted in three broad dimensions which are sociability (extra/intra), anxiety intelligence.

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