1 كويز سيكاتري Question 1 A 54-year-old man presents with a variety of physical symptoms that have been present for the past 9 years. Numerous investigations and review by a variety of specialties have indicated no organic basis for his symptoms. This is an example of: A. Munchausen's syndrome B. Hypochondrial disorder C. Dissociative disorder D. Somatisation disorder E. Conversion disorder Question 2 A 45-year-old man who takes chlorpromazine for schizophrenia presents with severe restlessness. What side-effect of antipsychotic medication is this an example of? A. Akathisia B. Neuroleptic malignant syndrome C. Acute dystonia D. Tardive dyskinesia E. Parkinsonism Question 3 Which one of the following symptoms may indicate mania rather than hypomania? A. Predominately elevated mood B. Delusions of grandeur C. Increased appetite D. Flight of ideas E. Irritability Question 4 Each one of the following is a recognised feature of anorexia nervosa, except: A. Hypokalaemia B. Low LH C. Impaired glucose tolerance D. Low FSH E. Reduced growth hormone levels Question 5 A 25-year-old man demands a CT scan of his abdomen in clinic. He states it is 'obvious' he has cancer despite previous negative investigations. This is an example of a: A. Hypochondrial disorder & B. Conversion disorder · 199, 13;80s "!e ~ C. Munchausen's syndrome D. Dissociative disorder E. Somatisation disorder Question 6 A 34-year-old man confides in you that he experienced childhood sexual abuse. Which one of the following features is not a characteristic feature of post-traumatic stress disorder? A. Hyperarousal B. Emotional numbing C. Nightmares D. Loss of inhibitions E. Avoidance Question 7 An 18-year-old sprinter who is currently preparing for a national athletics meeting asks to see the team doctor due to an unusual sensation in his legs. He describes a numb sensation below his knee. On examination the patient there is apparent sensory loss below the right knee in a non-dermatomal distribution. The team doctor suspects a non-organic cause of his symptoms. This is an example of a: A. Conversion disorder B. Hypochondrial disorder C. Somatisation disorder D. Malingering E. Munchausen's syndrome Question 8 A 23-year-old man asks to be referred to a plastic surgeon. He is concerned that his ears are too big in proportion to his face. He now seldom leaves the house because of this and has lost his job. On examination his ears appear to be within normal limits. What is the most appropriate description of this behavior? A. Hypochondriasis B. Generalised anxiety disorder C. Somatisation D. Malingering E. Dysmorphophobia Question 9 A woman who gave birth 5 days ago presents for review as she is concerned about her mood. She is having difficulty sleeping and feels generally anxious and tearful. Since giving birth she has also found herself snapping at her husband. This is her first pregnancy, she is not breast feeding and there is no history of mental health disorders in the past. What is the most appropriate management? A. Explanation and reassurance B. Cognitive behavioural therapy C. Trial of fluoxetine D. Trial of citalopram E. Discuss with psychiatric team to consider admission to mother and baby unit Question 10 A 23-year-old male presents two weeks after a road traffic accident concerned about increased anxiety levels, lethargy and headache. At the time he had a CT brain which revealed no abnormality. Six months following this episode his symptoms have resolved. What did his original symptoms likely represent? A. Conversion disorder B. Post-traumatic stress disorder C. Somatisation disorder D. Generalised anxiety disorder E. Post-concussion syndrome Question 11 A 68-year-old female is noted to be depressed following a recent admission for an exacerbation of chronic obstructive pulmonary disease. What would be the most appropriate antidepressant to start? A. Flupentixol B. Citalopram C. Venlafaxine D. Paroxetine E. Imipramine Question 12 A 23-year-old man presents as he concerned about a number of recent episodes related to sleep. He finds when he wakes up and less often when he is falling asleep he is 'paralysed' and unable to move. This sometimes associated with what the patient describes as 'hallucinations' such as seeing another person in the room. He is becoming increasingly anxious about these recent episodes. What is the most likely diagnosis? A. Frontal lobe epilepsy B. Generalised anxiety disorder C. Sleep paralysis D. Night terrors E. Acute schizophrenia Question 13 A 34-year-old man originally from West Africa is seen in January with depression. There is no past medical history of note but he is known to smoke cannabis. He has had similar episodes for the past two winters. What is the most likely diagnosis? A. Cyclothymic disorder B. Atypical depression C. Seasonal affective disorder D. Schizophrenia E. Drug-induced depression Question 14 Which one of the following side-effects is more common with atypical than conventional anti-psychotics? A. Akathisia B. Weight gain C. Galactorrhoea D. Parkinsonism E. Tardive dyskinesia Question 15 A 47-year-old woman is brought in by her husband. She has been refusing to go outside for the past 3 months, telling her husband she is afraid of catching avian flu. On exploring this further she is concerned due to the high number of migrating birds she can see in her garden. She reports that the presence of her husbands socks on the washing line in the garden alerted her to this. What is the most likely diagnosis? A. Depression B. Hypochondrial disorder C. Phobic disorder D. Borderline personality disorder E. Acute paranoid schizophrenia Question 16 A 54-year-old man with a history of depression presents for review. He was started on fluoxetine eight weeks ago and is now requesting to stop his medication as he feels so well. What should be recommended regarding his treatment?ia A.AIt should be stopped straight away B. It should be continued for at least 6 weeks C. It should be continued for at least 3 months D. It should be continued for at least 6 months E. It should be continued for at least 12 months Question 17 Which one of the following statements regarding post-partum mental health problems is incorrect? A. Post-natal depression is seen in around 2-3% of women B. Puerperal psychosis has a recurrence rate of around 20% C. Baby-blues are seen in the majority of women D. Post-natal depression usually develops within the first month E. Fluoxetine can be used whilst mothers are breast feeding Question 18 Which of the following conditions is least associated with obsessive compulsive disorder? A. Tourette's syndrome B. Anorexia nervosa C. Schizophrenia D. Depression E. Wilson's disease Question 19 Which one of the following is not associated with a poor prognosis in schizophrenia? A. Acute onset B. Strong family history C. Low IQ D. Premorbid history of social withdrawal E. Lack of obvious precipitant Question 20 A 24-year-old female is reviewed following a course of cognitive behaviour therapy for bulimia. She feels there has been no improvement in her condition and is interested in trying pharmacological treatments. Which one of the following is most suitable? A. Low-dose citalopram B. Low-dose fluoxetine C. Low-dose amitriptyline D. High-dose amitriptyline E. High-dose fluoxetine Question 21 A 24-year-old male is admitted to the Emergency Department complaining of severe abdominal pain. On examination he is shivering and rolling around the trolley. He has previously been investigated for abdominal pain and no cause has been found. He states that unless he is given morphine for the pain he will kill himself. This is an example of: A. Hypochondrial disorder B. Conversion disorder C. Malingering D. Munchausen's syndrome E. Somatisation disorder Question 22 A 29-year-old soldier presents following a recent deployment. He describes recurrent nightmares and flashbacks which have been present for the past 3 months. A diagnosis of post-traumatic stress disorder is suspected. What is the most appropriate first-line treatment? A. Arrange a CT head to exclude an organic cause B. Cognitive behavioral therapy or eye movement desensitisation and reprocessing therapy C. Cognitive behavioral therapy or graded exposure therapy D. Cognitive behavioral therapy or psychodynamic therapy E. Watchful waiting Question 23 A 45-year-old man is admitted due to haematemesis. He drinks 120 units of alcohol a week. What is the peak incidence of seizures following alcohol withdrawal? A. 2 hours B. 6 hours C. 12 hours D. 24 hours E. 36 hours Question 24 A 45-year-old man is admitted due to haematemesis. He drinks 120 units of alcohol a week. What is the peak incidence of seizures following alcohol withdrawal? A.A2 hours B.A6 hours C.A12 hours D.A24 hours E.A36 hours Question 25 A 69-year-old man is diagnosed as having Parkinson's disease. Which one of the following psychiatric problems is most likely to occur in this patient? A. Tics B. Psychosis C. Mania D. Dementia E. Depression Question 26 A 65-year-old female with a history of ischaemic heart disease is noted to be depressed following a recent myocardial infarction. What would be the most appropriate antidepressant to start? A.AParoxetineia B.AImipramineia C.AFlupentixolia D.AVenlafaxineia E.ASertralineia Question 27 Which one of the following statements regarding cognitive behavioral therapy is incorrect? A. May be useful in the management of generalized anxiety disorder B. Can be used for patients already taking antidepressants C. Usually consists of one to two hour sessions once per week D. Should be completed within 4 months E. Patients usually get around 35-40 hours in total Question 28 A 31-year-old woman who gave birth two weeks ago presents for review with her husband. He is worried by her mood as she now seems depressed and is interacting poorly with the baby. He describes her mood 3 days ago being much different, when she was talking in rapid and incoherent fashion about the future. The mother denies any hallucinations but states that her child has been brought into a 'very bad world'. What is the most appropriate management? A. Start fluoxetine B. Reassurance + review by health visitor C. Cognitive behavioral therapy D. Start lithium E. Arrange urgent admission Question 29 The risk of developing schizophrenia if one monozygotic twin is affected is approximately: A. 10% B. 20% C. 50% D. 75% E. >95% Question 30 A 43-year-old man with a history of schizophrenia is taken off chlorpromazine due to troublesome parkinsonian symptoms. Which one of the following atypical antipsychotic is it least suitable to commence? A. Quetiapine B. Amisulpride C. Olanzapine D. Risperidone E. Clozapine Question 31 A 35-year-old man with a history of schizophrenia is brought to the Emergency Department by worried friends due to drowsiness. On examination he is generally rigid. A diagnosis of neuroleptic malignant syndrome is suspected. Each one of the following is a feature of neuroleptic malignant syndrome, except: A. Renal failure B. Pyrexia C. Elevated creatine kinase D. Usually occurs after prolonged treatment E. Tachycardia Question 32 Which one of the following is least recognized as a potential adverse effect of electroconvulsive therapy? A. Shoulder dislocations B. Epilepsy C. Cardiac arrhythmias D. Short term memory impairment E. Headache Question 33 A 34-year-old ex-soldier with a history of post-traumatic stress disorder returns for review. He has had a course of eye movement desensitisation and reprocessing therapy which was not helpful and is reluctant to try cognitive behavioral therapy. Of the options listed, which medication may be useful in such patients? A. Fluoxetine B. Citalopram C. Mirtazapine D. Topiramate E. Bupropion Question 34 A 46-year-old man is seen by an occupation health doctor due to long-term sickness leave. He states chronic lower back pain prevents him from working but examination findings are inconsistent and the doctor suspects a non-organic cause of his symptoms. This is an example of a: A. Conversion disorder B. Munchausen's syndrome C. Malingering D. Hypochondrial disorder E. Somatisation disorder Question 35 A patient with a history of depression presents for review. Which one of the following suggests an increased risk of suicide? A. Young age B. History of arm cutting C. Being married D. Female sex E. Having a busy job 2 كويز سيكاتري Following are classified as paraphilia except Select one: a. Exhibitionalism b. Fetishism c. Homosexuality d. Transvestism Panic disorder is where: Select one: a. There is a fear of panicking in enclosed spaces. b. There is excessive anxiety and worry about many different aspects of life. c. An individual experiences a singular panic attack d. There are recurrent and unexpected panic attacks. Which one of the following side-effects is more common with atypical than conventional anti-psychotics? Select one: a. Tardive dyskinesia b. Weight gain c. Galactorrhoea d. Akathisia e. Parkinsonism 38years old patient is brought to emergency room following traffic accident, the identification in license shows female name, a patient is dressed as woman, however she is found to have male genitalia during physical examination. Which is the most likely diagnosis? Select one: a. Transvestism b. Fetishism c. Transsexualism d. Frotturism Question text you review a 55-year-old woman who has become dependant on temazepam, which was initially prescribed as a hypnotic. She is keen to end her addiction to temazepam and asks for help. Her current dose is 20mg on. What is the most appropriate strategy? Select one: a. Switch to the equivalent zopiclone dose then slowly withdraw over the next 2 weeks b. Switch to the equivalent diazepam dose then slowly withdraw over the next 2 weeks c. Switch to the equivalent zopiclone dose then slowly withdraw over the next 2 months d. Switch to the equivalent chlordiazepoxide dose then slowly withdraw over the next 2 months e. Switch to the equivalent diazepam dose then slowly withdraw over the next 2 months Question text A 17-year-old girl is brought to the clinic by her mother. who says that she has become "increasingly difficult to get along with" since the academic year began 7 months ago. Her daughter is irritable and is having difficulty concentrating on her schoolwork, resulting in some poor grades. The mother has found the patient, who says that she is always tired, tossing in her sleep at night. She recently developed acne and is concerned that her boyfriend might reject her. As a result, she spends lots of time worrying about her appearance and applying makeup to conceal her acne. The patient has always been considered by friends and family to be "high strung." She admits to feeling extremely apprehensive when taking tests at school and "on edge" at her part-time job at a local restaurant. She believes this stems from her naturally competitive nature and her desire to be valedictorian, with the pressure worsening this school year as graduation approaches. The patient obsesses about being accepted at a top university and how her family will pay for monthly expenses in addition to her education. She feels powerless to control her thoughts and wishes that she could change. Which of the following is the most likely diagnosis? Select one: a. Adjustment disorder with anxiety b. Obsessive-compulsive disorder c. Body dysmorphic disorder d. Normal anxiety e. Generalized anxiety disorder f. Social anxiety disorder Question 22 Extrapyramidal symptoms comprises all except Select one: a. Athetosis b. Tics c. Rabbit syndrome d. Akathisia Not a correct match Select one: a. Thought broadcasting – Schizophrenia b. Delusion of infidelity– OCD c. Delusion of grandiosity– Mania d. Auditoryhallucination-Alcoholism Which compulsive behaviour might stem from an obsession with order and symmetry? Select one: a. Repeatedly washing hands. b. Excessive praying. c. Checking the body for signs of sexual arousal. d. Regular rearrangement of furniture in the house to ensure it is all in 'exactly the right place.' Question 8 A 32-year-old man comes for a follow-up visit for his depressive disorder, which has been managed with venlafaxine for several years. He is accompanied by his mother, who is very concerned as he has become increasingly withdrawn. She says he has been behaving strangely for the past 2 weeks, expressing fears that his body is decomposing and hearing the voice of his long-deceased father telling him, "Come to me." Physical examination is unremarkable. On mental status examination, the patient makes poor eye contact and seems distracted, frequently mumbling to himself. At times, he does not answer the doctor or he gives only brief responses. He says, "There is no point to living; my body is dying anyway." However, the patient reports that he is not having suicidal thoughts currently and is able to ignore his father's voice. The decision is made to start risperidone to treat his psychosis. Which of the following is the primary mechanism of action producing this medication's antipsychotic effect? Select one: a. Serotonin 2A and dopamine D2 receptor blockade b. Norepinephrine and dopamine reuptake inhibition c. Serotonin and norepinephrine reuptake inhibition d. Dopamine reuptake inhibition and stimulation of dopamine release e. Alpha-1 adrenergic and histamine-1 receptor blockade Question 9 The symptoms of post-traumatic stress disorder (PTSD) include: Select one: a. Hallucinations and delusions. b. Reliving a traumatic event. c. Worry over many different life events. d. Flight of ideas. Question text A 39-year-old man comes for review. Six months ago he was started on paroxetine for depression. Around five days ago he stopped taking the medication as he felt that it was having no benefit. His only past medical history of note is asthma. For the past two days he has experienced increased anxiety, sweating, headache and the feeling of a needle like sensation in his head. During the consultation he is pacing around the room. What is the most explanation for his symptoms? Select one: a. Migraine b. Bipolar disorder c. Selective serotonin reuptake inhibitor discontinuation syndrome d. Malingering e. Generalised anxiety disorder Mental retardation can be diagnosed in persons with IQ of Select one: a. less than 50 b. less than 60 c. less than 85 d. less than 70 .1.Delusion is a Select one: a. False perception b. False unshakable belief C. Unusual preoccupation with an idea d. False emotion 2.Which is not on ego defence mechanism- Select one: a. Rationalisation b. Identification c. Obsession d. Repression 3.A 34-year-old man confides in you that he experienced childhood sexual abuse. Which one of the following features is not a characteristic feature of post-traumatic stress disorder? b.Emotional numbing a. Avdidance C. Loss of inhibitions d. Hyperarousoal 4.A patient you are looking after is started on imipramine for depression. Which combination of sideeffects is most likely to be seen in a patient taking this class of antidepressants? Select one a. Hypertension+ sweating b.Headache +myoclonus c. Blurred vision + dry mouth d. Dry mouth+ urinary frequency e. Gastrointestinal bleeding+ dyspepsia 5. Which antipsychotic is known to cause the least QT interval prolongation? Select one a. Aripiprazole b. Rispericione C. Haloperidol d. Ziprasidone .88 The frequencyof alpha rhythm in EEG is a. 1-3 Hz b. 4-7 Hz .61 The following is false about panic disorder a. Symptoms begin unexpectedly or out of the blue c. 8-12 Hz d. >12 Hz b. Physical symptoms like tremors, tachycardia and psychological symptoms like hyperarousal, fear of impending doom can be seen c. Sudden onset of symptoms precipitated by some fearful event or stimuli d. It is important to look for medical conditions like hyperthyroidism,hypoglycemia, phaeochromocytoma, cardic disorders before diagnosing panic disorder .11 The degree of awareness and understanding of one's own illness is called a. Judgement b. Reality testing c. Insight d. Abstraction In panic disorder, panic attacks should be recurrent. T In panic disorder what is true a. Must be recurrent b. Can be precipitated only by exposure to a fearful situation c. Tend to occur before agarophopia d. Can be due to a physical illness A 24-year-old male is admitted to the Emergency Department complaining of severe abdominal pain. On examination he is shivering and rolling around the trolley. He has previously been investigated for abdominal pain and no cause has been found. He states that unless he is given morphine for the pain he will kill himself. This is an example of: A. Hypochondrial disorder B. Conversion disorder C. Malingering D. Munchausen's syndrome E. Somatisation disorder ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ مراجع This activity contains 10 questions. A phobia of heights is known as: Microphobia. Aquaphobia. Acrophobia. Hematophobia. Preparedness theory suggests that: Individuals with phobias learn their fears from observing their parents. Everyone has an innate tendency to be afraid of certain animals and situations which stems from evolution. Phobics should be prepared to face their fears. Individuals with phobias develop their fears after being presented with negative information about an animal or situation. Behavioural therapy for phobias may involve the following techniques: Implosion therapy. Systematic sesensitization. Flooding. All of the above. Panic disorder is where: There are recurrent and unexpected panic attacks. There is excessive anxiety and worry about many different aspects of life. An individual experiences a singular panic attack. There is a fear of panicking in enclosed spaces. GAD stands for: Genetic anxiety disease. Generally anxious diagnosis. Global anxiety disorder. Generalised anxiety disorder. Which compulsive behaviour might stem from an obsession with order and symmetry? Checking the body for signs of sexual arousal. Repeatedly washing hands. Excessive praying. Regular rearrangement of furniture in the house to ensure it is all in 'exactly the right place'. Obsessive compulsive disorder (OCD) can be successfully treated using: Antipsychotic medication. Cognitive behavioural therapy. Antidepressant medication. Massage therapy. Catastrophic thinking is common to several anxiety disorders. The term describes: Worrying that the worst will always happen. Taking things very personally. Categorising all experiences as either extremely positive or extremely negative. Focusing on negative events and ignoring positive ones. The symptoms of post-traumatic stress disorder (PTSD) include: Flight of ideas. Worry over many different life events. Hallucinations and delusions. Reliving a traumatic event. Eye movement desensitisation and reprocessing (EMDR) is sometimes used to treat PTSD. This technique involves: Training the client in relaxation techniques. The client being asked to relive the traumatic event in their imagination. The client focusing on the memory, emotions and thoughts of the traumatic events while engaging in therapist-guided eye movements. The administration of an antidepressant. Developmental disorders can be broadly categorised into the following categories: Autism and attention deficit/hyperactivity disorder. Learning difficulties, autism and attention deficit/hyperactivity disorder. Learning difficulties and childhood schizophrenia. Infant depression and attention deficit/hyperactivity disorder. A child with dyslexia but with no other difficulties would be classified as having: A learning difficulty. Autism. Attention deficit/hyperactivity disorder. A specific learning difficulty. The most common causes of learning difficulties are: Deprived upbringing. Perinatal infection (e.g. rubella). Genetics (e.g. Down's syndrome). Postnatal trauma (e.g. encephalitis). Autism is characterised by impairments in which of the following areas: Patterns of behaviour. Social interaction. Communication. All of the above. Which of the following has not been suggested to be a cause of autism? Overproduction of the neurotransmitter serotonin. Genetics. Metal metabolism disorder. The measles,mumps and rubella vaccine. Within attention deficit/hyperactivity disorder, which of the following is notclassified as a problem relating to poor attention? Appears routinely forgetful. Experiences difficulties in waiting in turn. Dislikes tasks involving mental effort, e.g. homework. Easily distracted. Within attention deficit/hyperactivity disorder, which of the following is notclassified as a problem relating to hyperactivity-impulsivity? Experiences difficulties in playing quietly. Doesn't appear to listen when being told something or spoken to. Talks excessively. Rather than sitting still, squirms in seat and fidgets. What is the suggested reason why the prevalence rates of ADHD is higher in the US (5–8%) than in the UK (0.5–1%)? Children in the US watch more TV than those in the UK. ADHD may be underdiagnosed in the UK. Pharmaceutical companies in the US encourage the diagnosis of the disorder. The higher consumption rate of fast food in the US is a primary cause of the disorder. Which of the following areperinatal risk factors associated with ADHD? Low birth weight. Maternal alcohol misuse. Maternal stress. All of the above. The most widely prescribed pharmacological treatment for ADHD is: Risperidone. Ritalin. Lithium. Diazepam. Substanc e misuse has been defined in the DSM as: An increasing tolerance of a particular substance which requires the individual to take more of it to achieve the same effect. A maladaptive pattern of substance use leading to clinically significant impairment or distress. The misuse of substances and a co-occurring mental health problem. An addiction to drugs which causes a clinically significant impairment. One of the key characteristics of substance dependence is that: The individual spends substantial time and effort sourcing the substance. It mainly affects women. The family of the individual quickly notice their relative has substance dependence. It only involves the use of alcohol. According to Hibbell et al. (1997), which country has the highest number of 16-year-olds who have smoked cannabis? Italy. The UK. Greece. The USA. The term psychoactive refers to: A drug-induced hallucination. The psychology of physical activity. A drug that alters mood, cognition and/or behaviour. A particularly active psychopath. Alcohol primarily affects which neurotransmitter? Glutamate. Dopamine. Anandamide. GABA. The UK Government recommends the following alcohol consumption guidelines per week: Both males and females 30 units. Males 11 units, females 7 units. Males 42 units, females 21 units. Males 21 units, females 14 units. Chronic alcoholism may result in which amnesic disorder? Alzheimer's disease. Parkinson's disease. Korsakoff's syndrome. Pick's disease. Polydrug use refers to the use of more than one drug at the same time. The most frequent polydrug use consists of: Nicotine and heroin. Alcohol and nicotine. Cannabis and cocaine. Alcohol and cannabis. According to Prochaska et al. (1992), what is the stage called when an individual questions whether their substance use may be problematic? Engagement. Preparation. Precontemplation. Contemplation. During treatment for alcohol misuse, what behaviours might a client be taught to stop the temptation to drink alcohol again? Respond differently when confronted with alcohol, e.g. choose a soft drink instead. Rearrange a route so as to avoid reminders of alcohol, e.g. pubs. Avoid high-risk situations where alcohol will be present, e.g. a party. All of the above. Paraphilias are characterise d by: An absence of interest in sexual matters. Repeated sexual urges, fantasies and behaviour deemed socially inappropriate. Problems of sexual arousal and response. Normal sexual urges and desires. The most common male sexual problem is: Premature ejaculation. Finding a partner. Lack of pleasure during sex. Erectile dysfunction. Psychological treatment for erectile dysfunction has a focus on: Watching pornographic movies. Encouraging the male to verbalise sexual fantasies. Systematic desensitisation. Reducing the stress associated with sexual activity. Which one of the following is not a common paraphilia? Voyeurism (urge to observe unsuspecting others who are naked). Sadomasochism (being sexually humiliated). Exhibitionism (urge to expose genitalia to an unsuspecting stranger). Zoophilia (sexual interest in animals). The percentage of paedophiles who said that in childhood they received sexual advances from adults has been reported to be: 45% 92% 60% 15% Which of the following is not included in the pathways model of paedophilic behaviour? Deviant sexual scripts. Emotional dysregulation. Intimacy and social skills deficits. Loweducational achievement. According to Doskotch (1995), women fantasise about sex on average: 1.5 times a day. 4.5 times a day. 45 times a day. 90 times a day. What is masturbatory reconditioning? A psychodynamic therapy which focuses on the genital stage of psychosexual development. A cognitive therapy which aims to address inappropriate masturbatory behaviour. An obsession with masturbation. A behavioural therapy which promotes masturbation following exposure to appropriate stimuli and fantasies. In the context of treating paedophilia, what does ADT stand for? Anti-deprivation therapy. Anti-depressant treatment. Androgen deprivation therapy. Aversion distraction treatment. Treating paedophilic urges using an aversive smell paired with a highrisk sexual situation is called: Olfactory conditioning. Cognitive behavioural therapy. Masturbatory reconditioning. Covert sensitisation. . Personality disorders are stable long-term conditions which can affect an individual's: Cognition. Mood. Interpersonal functioning. All of the above. The dimensional approach to personality disorders has the following advantage over categorical models: It recognises that individuals with personality disorders are not clearly distinct from the rest of the population. It can be used as a successful treatment. It is based on how individuals with personality disorder feel about themselves. It provides an explanation of the causes of personality disorders. Symptoms of schizoptypalpersonality disorder include: Auditory hallucinations. Suspiciousness or paranoid ideation. Obsessional thoughts. Social phobia. Symptoms of schizoid personality disorder include: Disorganised speech. Manic phases. Aquaphobia. Emotional coldness. The main difference between schizotypal and schizoid personality disorder is that: Individuals with schizoid personality disorder tend to work in the catering industry whilst those with schizotypal personality disorder are more likely to work in the finance sector. Schizoid personality disorder has a much shorter duration than schizotypal personality disorder. Schizotypal personality disorder is characterised by a fear of social interaction whilst schizoid personality disorder is characterised by a lack of interest in social interaction. Schizotypal personality disorder predominantly affects females whilst schizoid personality disorder predominantly affects males. Which of the following are not symptoms of borderline personality disorder? Risk taking or doing things without thinking of potential consequences. Difficulty making and maintaining relationships. A fear of being abandoned or rejected. Emotions that are consistent and stable. The American Psychiatric Association (APA) defines antisocial personality disorder as: A pervasive pattern of over concern for the welfare of others. A pervasive pattern of disregard for, and violation of, the rights of others. A persistent disregard for individuals who are sociable. A fear of individuals with overbearing personalities. The most widely used psychometric tool to assess psychopathy is the: Psychopathy Assessment Tool (PAT). Measuring Tool for Psychopathy (MTFP). Psychopathy Checklist-Revised (PCL-R). Symptoms of Psychopathy Questionnaire (SoPQ). Which of the following treatments are not used to help individuals with personality disorder? Family and peer interventions. Cognitive therapy. Emotional awareness training. Eye movement desensitisation and reprocessing. What percentage of individuals with substance misuse problems also have a personality disorder? Between 55 and 70% Between 35 and 55% Between 10 and 20% Between 5 and 10% MCQ exam (Paper 4) History and mental state exam 1. You are assessing a 40-year-old woman who worries that she suffers from panic disorder. Which of the following features is MOST important to establish the diagnosis of panic disorder? A) Panic attacks are precipitated by exposure to the fearful situation only. B) Panic attacks are caused by an underlying physical disorder. C) The panic attacks are recurrent. D) Panic attacks occur after the development of agoraphobia. E) There is a secondary gain associated with panic attacks. The answer is C. Panic attacks in a panic disorder are unexpected, recurrent and occurred before the development of agoraphobia. Exclusion criteria for panic disorder is underlying medical illness. Panic disorder is not an abnormal illness behaviour and is not associated with secondary gain. Author: Birit Brokeman Modified by Roger Ho Year: 2013 The answer is A. 2. You are a medical resident. The nurse informs you that an 80-year-old man who Explanation: This man may was admitted for cellulitis seems to be suffer from delirium and acute depressed and mentions about passive suicidal thought. When you assess him, he confusional state. It is most important to assess sees ghost in the ward and expresses orientation. paranoid ideation against nursing staff. Which of the following assessment is Assessing somatic symptoms MOST important to establish the is not useful as it is caused diagnosis? by medical conditions. A. Assess orientation B. Assess judgement Author: Roger C. Assess recognition Ho Year: 2013. D. Assess registration and short-term recall E. Assess somatic symptoms. Cognitive assessment 3. Which of the following cognitive tasks is NOT an assessment of short term or long term memory? A. Ask the patient to name the current Prime Minister of Singapore. B. Ask the patient to name as many animals as possible that can be found in the Singapore Zoo. C. Ask the patient to tell you his or her address and later, you check the answer with patient’s medical record. D. Inform the patient 3 objects (e.g. Apple, Newspaper and Train) and ask the patient to name the 3 objects immediately. E. Inform the patient 3 objects (e.g. Apple, Newspaper and Train) and ask the patient to The answer is B. Explanation: Option B refers to verbal fluency which is part of the frontal lobe assessment. Option D refers to registration and it is an important component before assessing the short-term recall (Option E). To be fair to the patient, the patient should be given multiple attempts to register the 3 items before testing short-term recall in Option E. Author: Roger Ho Year: 2013. name the 3 objects after 5 minutes. Psychiatric, epidemiology, etiology, diagnosis and classification 4. A 20-year-old man with an identical twin The answer is is diagnosed with major depressive disorder. His twin brother asks you to B. Explanation: comment on the chance he will develop depressive disorder. Which of the Family studies show that a following is the CORRECT response to his person has 40-70% chance to twin brother? develop depressive episode if a A. ‘Major depressive disorder is a strongly first degree relative suffer from inheritable disease. You will definitely depressive episode. develop it as well.’ Twin studies show that the B. ‘The likelihood of you developing concordance rate for depressive disorder is higher than other monozygotic twins is 40 – 50% siblings.’ and for dizygotic twins is 20%. C. ‘The likelihood of you developing depressive disorder is same as nonAuthor: Roger identical twins.’ Ho Year: 2013. D. ‘There is only a slightly increased risk that you will become depressed as compared to the general population.’ E. ‘You do not need to worry because environmental factor is an important factor to determine whether you will develop depressive disorder.’ The answer is C. 5. A 35-year-old woman suffers from low mood, low energy, poor sleep, poor appetite and recurrent suicidal thoughts. Explanation: This man suffers She firmly believes that she deserves the from severe depressive disorder death sentence for minor mistakes made with psychotic features. Option A, B, D and E are correct. in the past. Which of the following statements is FALSE? There is not enough evidence to suggest the diagnosis of A. For severe depressive episode with schizoaffective disorder because psychotic features, psychotic symptoms her symptoms do not suggest usually occur after manifestation of that she suffers from depressive symptoms. schizophrenia. B. Her psychotic symptoms are considered to be mood congruent. Author: Roger C. Based on the case scenario, there is Ho Year: 2013. enough evidence to suggest that she suffers from schizoaffective disorder. D. The prescription of antipsychotic drug should be considered. E. Electroconvulsive therapy (ECT) is a recognised treatment for his condition. 6. Which of the following disorders has The answer is C. been shown to have the GREATEST Explanation: degree of heritability? A. Alcoholism Heritability of autism to be B. Attention-deficit/hyperactivity disorder more than 90%. 90% of the (ADHD) differences between autistic C. Autism and non-autistic D. Major depressive disorder individuals is due to E. Schizophrenia. genetic effects. Author: Roger Ho Year: 2013. 7. Which of the following is the MOST common cause of insomnia among psychiatric patients in Singapore? A. Sleep apnea B. Shift work C. Stimulant use D. Underlying psychiatric illness E. Use of sleeping pills. 8. Regarding the age of onset in schizophrenia, which of the following is CORRECT? A. European women have earlier age of onset than Asian women. B. Current research findings remain inconclusive about the age of onset in schizophrenia. C. There is no difference in the age of onset between men and women. D. Men usually have earlier age of onset as compared to women. E. Women usually have earlier age of onset as compared to men. Psychopathology 9. Agoraphobia without panic attack is BEST referred to: A. Concern about physical appearance B. Constant worried about physical health C. Fear of blood and needle D. Fear of collapse in an enclosed space E. Fear of authority figures. 10. Which of the following is MOST suggestive of the diagnosis of schizophrenia? A. Acute onset of psychosis B. Apathy C. Cognitive impairment D. Hearing own thoughts E. Persistent deterioration of personality. The answer is D. Explanation: Underlying psychiatric disorder is the most common cause of insomnia among psychiatric patients. Students should observe this during their clinical attachment. Depressive disorder, bipolar disorder and generalized anxiety disorder are associated with insomnia. Author: Roger Ho The answer is D. Explanation: Current research findings in schizophrenia show that men have earlier onset as compared to women. Author: Roger Ho The answer is D. Explanation: Patients suffering from agoraphobia has fear that they cannot escape from the enclosed space. Author: Roger Ho Year: 2013. The answer is D. Explanation: Hearing own thoughts or echo de la pense only occurs in schizophrenia and is most suggestive of such diagnosis. Option A can occur in brief psychosis or acute/transient psychosis, not necessarily schizophrenia. Option B, D and E occur in both schizophrenia and dementia. 11. A 30-year-old woman mentions that she saw the face of ‘Monkey God’ appears on the tree trunk of a particular tree near her apartment. She can see the face of ‘Monkey God’ every time when she walks past that tree but not on the other trees. This phenomenon is known as: A. Delusional misidentification B. Delusion of reference C. Fantasy D. Illusion E. Visual hallucination. Author: Roger Ho Year: 2013. The answer is D. Explanation: An illusion is an involuntary false perception (i.e. face of Monkey god) in which a transformation of real object (i.e. a specific tree in this case) takes place. Delusional misidentification occurs when a patient misidentifies another person (e.g. Capgras syndrome) but not an object like a tree in this case. Author: Birit Brokeman Modified by Roger Ho Year: 2013. General adult psychiatry 12. Peter is 27-year-old and lives with his The answer is A. parents. He has been employed as a delivery man for most of the time since Explanation: Peter develops leaving school, but has recently left his grandiose delusion because job as a salesman. He has never taken any he does not have the capacity illicit drugs. His parents state that in the to make a machine to cure last three weeks, he has been extremely cancer based on his active, requiring less sleep and not background. The most appearing tired, being over-talkative and appropriate diagnosis is disinhibited and – on occasions – quite bipolar disorder with manic irritable. He claimed to have invented a features. machine for curing cancer and wished to Author: Roger go to the U.S. to sell it. When stopped by his parents, he became violent, and they Ho Year: 2013. called the police. Which of the following diagnosis is MOST appropriate for this patient? A. Bipolar I disorder with manic features B. Bipolar II disorder with hypomanic features C. Cyclothymia D. Mixed affective disorder E. Schizoaffective disorder. 13. Which of the following personality disorders is LEAST likely to be considered as a differential diagnosis to schizophrenia? A. Borderline personality disorder B. Obsessive compulsive personality disorder The answer is B. Explanation: Obsessive compulsive personality disorder is least likely to be associated with psychotic features. C. Paranoid personality disorder D. Schizotypal personality disorder E. Schizoid personality disorder. 14. Which of the following is LEAST likely to be found in research in the relationship between depressive disorder and hormones? A. Blunted adrenocorticotropic hormone (ACTH) response to the corticotropinreleasing hormone (CRH) B. Blunted thyroid stimulating hormone (TSH) response to thyrotropinreleasing hormone (TRH) C. Cortisol suppression with dexamethasone D. There is an increased cortisol. E. There is an increased adrenal sensitivity to ACTH. 15. Which of the following disorders is LEAST likely to be considered as a differential diagnosis of a 35-year-old driver develops nightmare, flashback and hypervigilance after a road traffic accident? A. Factitious disorder B. Generalized anxiety disorder C. Major depressive disorder D. Obsessive compulsive disorder E. Phobic disorder. 16. Rapid eye movement (REM) sleep is associated with all of the following EXCEPT: A. Increased parasympathetic activity B. Increased cerebral blood flow C. Increased complexity of dreams D. Maximal loss of muscle tone E. Transient runs of conjugate eye movements. 17. A 17-year-old male comes to see you because he is experiencing tremendous stress in his new job. He has finished his “O” level examination and waiting to start the National Service in 6 months. He got an offer to work in a shoe shop which specializes in selling female shoes. He realizes that he feels sexually aroused by female shoes. He spends a lot of time fantasizing about female shoes. He stole multiple pairs of shoes from the shop and used them for masturbation. He used to be a normal person. He was a hardworking student whose main interests were Author: Roger Ho Year: 2013 The answer is C. Explanation: There is no suppression of cortisol with dexamethasone in research finding in depressive disorder. Option A indicates the failure of negative feedback and causes an increase in cortisol (Option D and E). Option B is associated with low T3 or T4 level. Author: Roger Ho Year: 2013. This is an advancedlevel question. The answer is D. Explanation: OCD is least likely to share symptoms with post- traumatic stress disorder (PTSD). As a result, OCD is least like to be a DDX of PTSD. Author: Roger Ho Year: 2013. The answer is A. Explanation: REM sleep is associated with an increase in sympathetic activity. Author: Roger Ho Year: 2013. This is an advanced level question. The answer is B. Explanation: This man suffers from fetishism because he derives sexual stimulation from an inanimate object (i.e. female shoes) and his fetishism causes social and occupational dysfunction because he spends inordinate chemistry time fantasizing about female shoes. and physics. What is the MOST likely diagnosis? A. Adjustment disorder B. Fetishism C. Kleptomania D. Sadomasochism E. Voyeurism. 18. Which of the following psychiatric disorders is MOST common among patients with bulimia nervosa? A. Alcohol use disorder B. Major depressive disorder C. Obsessive compulsive disorder D. Panic disorder E. Intermittent explosive disorder. Old age psychiatry 19. Manic episodes in old people are associated with: A. Less euphoria B. Less ‘mixed’ presentation with depression C. Less paranoid delusions D. More hyperactivity E. More flight of ideas. He stole shoes to satisfy his fetishism and this is not a case of kleptomania. Author: Roger Ho Year: 2013. The answer is B. Explanation: Major depressive disorder is the most common psychiatric comorbidity in bulimia nervosa (around 5085%) Author: Roger Ho Year: 2013. The answer is A. Explanation: Mania in old people is associated with less euphoria, less hyperactivity, less flight of ideas but more mixed presentation and more paranoid ideation. Author: Roger Ho Year: 2013. 20. All of the following statements are true regarding post-operative delirium EXCEPT: This is an advanced level question. The answer is A. Explanation: 30% of patients suffering from delirium may have normal laboratory results and no abnormality was found. Delirium can occur in young people who undergo a complicated operation with immunosuppressant. A. Delirium cannot be diagnosed if all laboratory results are normal. B. It can occur in an 80-year-old man after gastrectomy. C. It can occur in a 16-year-old girl after renal transplant. Author: Roger D. Haloperidol is one of the treatments of choice. Ho Year: 2013. E. Physical restraint should be avoided if possible. The answer is B. 21. A 70-year-old man with a history of drinking Chinese wine, hepatitis, chronic Explanation: renal failure and hypertension was This patient is already at a brought by his wife to the hospital for high risk for delirium based on treatment of an acute cellulitis. He was noted to have tachycardia in the Accident his age and medical and Emergency Department. You are the comorbidities, including on-call medical resident and this man was chronic renal failure. admitted to the medical ward. What is the Without adequate collateral MOST appropriate first approach? A. Assess short term recall to rule out dementia on delirium. B. Obtain history from collaterals whether he has in fact been drinking Chinese wine recently. C. Put him on propranolol 10mg three times per day to control tachycardia. D. Start diazepam 5mg three times per day to prevent delirium tremens. E. Start lorazepam 1mg three times per day to prevent delirium tremens. 22. A 70-year-old woman with severe depressive symptoms and strong suicidal ideation which is not responded to amitriptyline 150mg daily and fluvoxamine 200mg daily. Each medication was tried for 6 months with good adherence. She has good past health. Her children consult you for further management. The MOST appropriate treatment which you would recommend is: A. Cognitive behaviour therapy B. Electroconvulsive therapy C. Donepezil D. Olanzapine E. Repetitive transcranial magnetic stimulation. 23. A 75-year-old man presents with prominent neurological signs such as apraxia, gait abnormalities and mild cognitive impairment. He is MOST likely to suffer from: A. Alzheimer’s Disease B. Cortical dementia C. Delirium D. Pseudodementia E. Subcortical dementia. history, providing a high dose regimen of potentially unnecessary benzodiazepine puts the patient at risk of worsened delirium. His elevated heart rate may reflect agitation or pain due to acute cellulitis. Beta blockers most often mask the sympathetic outflow signs of withdrawal of alcohol and the prescription of propranolol is not necessary. Author: Roger Ho Year: 2013. The answer is B. Explanation: This elderly woman suffers from treatment resistant depression and electroconvulsive therapy is the treatment of choice to treat suicidal ideation. Old age is not a contraindication for electroconvulsive therapy. Author: Roger Ho Year: 2013. The answer is E. Explanation: Subcortical dementia is characterized by cognitive deficits and presence of neurological signs. Author: Lai YM Modified by Roger Ho Year: 2013. Child and adolescent psychiatry and intellectual disability 24. You are helping a mother to develop behavioural program to deal with her son who has oppositional defiant disorder. Which of the following is the MOST significant component of this program? A. Extinction The answer is B. Explanation: Positive reinforcement of promoting desirable behaviours through rewards is the most significant component of the program. B. Positive reinforcement C. Punishment D. School suspension E. Strict parenting. 25. An 11-year-old boy presents with motor and vocal tics for 2 years. Which of the following medications is the BEST firstline treatment? A. Fluoxetine B. Lorazepam C. Methylphenidate D. Risperidone E. Sodium valproate. 26. Which of the following factors are LEAST likely to be the aetiological factors in attention deficit and hyperactivity disorder (ADHD)? A. Antenatal exposure to alcohol B. Antenatal exposure to nicotine C. Delivery complications D. High birth weight E. Traumatic brain injury during infancy and early childhood. 27. You are a general practitioner. A 40-yearold woman consults you as a result of high blood pressure. General inspection shows ptosis, a broad neck and indistinct hairline. Her chest appears to be broad. Auscultation reveals cardiac murmurs. She is single and stays with her parents. She completed her education in the Institute of Technological Education (ITE) and works as a store room officer. If chromosome analysis is performed, the MOST likely finding is: A. XO syndrome B. XXY syndrome C. XXXY syndrome D. XYY syndrome E. YO syndrome. Author: Roger Ho Year: 2013. The answer is D. Explanation: The first-line treatments of Tourette's syndrome and chronic tic disorders are antipsychotic medications such as haloperidol or risperidone. Author: Birit Brokeman Modified by Roger Ho Year: 2013. The answer is D. Explanation: Low birth weight, not high birth weight is associated with the risk of developing ADHD. Author: Roger Ho Year: 2013. The answer is A. Explanation: She suffers from Turner’s syndrome (XO syndrome) as evidenced by webbed neck (a broad neck and a low or indistinct hairline), coarctation of aorta (cardiac murmurs, hypertension) and normal /borderline intelligence. She may have infertility. Her single status cannot confirm the infertility but it remains a possibility. Author: Roger Ho Year: 2013. This is an advancedlevel question. 28. You are a paediatric resident. A 7-year-old The answer is B. boy is suspected to suffer from autism. You referred this boy to see an education Explanation: In autism, performance IQ (Block design) psychologist for assessment. The education psychologist sends a report to is higher than verbal IQ. you and you need to explain the findings to her mother. His strength is MOST likely Author: Roger Ho Year: 2013. found in which of the following areas? A. Abstract thinking B. Block design C. Explain similarities D. Oral presentation skills E. Verbal concept formation Substance abuse 29. Which of the following neuroanatomical structures is MOST implicated in substance misuse and dependence? The answer is C. Explanation: Substance abuse and dependence produce additive effects on dopamine release in the nucleus accumbens. A. Amygdala B. Basal nucleus of Meynert C. Nucleus accumbens D. Hippocampus Author: Roger E. Raphe nucleus. Ho Year: 2013 The answer is B. 30. A 50-year-old man is admitted to the hepatobillary ward as a result of pancreatitis. You are the resident on call. Explanation: GGT is an early indicator of alcohol His wife tells you that she has seen him relapse, SENSITIVITY is intoxicated with alcohol in the past few 40-60% and days. The patient denies. Which of the following is the BEST method available in SPECIFICITY is 80%. 4 drinks a general hospital in Singapore to confirm per day for the past 2 weeks will increase GGT. CDT is a very that this patient has been drinking sensitive and specific test but it recently? is not readily available in a general hospital in Singapore. A. Carbohydrate-deficient transferrin (CDT) B. Gamma-glutamyl transferase (GGT) The cost CDT is much higher C. Mean corpuscular volume (MCV) than GGT. D. Serum alcohol level E. Serum amylase. Author: Roger Ho Year: 2013 The answer is E. 31. A common and safe pharmacological treatment for reducing relapse in Explanation: This question alcohol dependence has direct actions refers to naltrexone, a common upon which receptors? and safe pharmacological treatment for reducing relapse A. Benzodiazapine B. Cannabinoid in alcohol dependence. C. Dopamine D. γ-Aminobutyric acid (GABA) Author: Roger E. Opioid. Ho Year: 2013 32. Which of the following is LEAST consistent with the objective of motivational interviewing? A. Allow the patient give their inputs without interruption. B. Establishing a collaborative patienttherapist relationship. The answer is D. Explanation: Motivational interviewing emphasizes on individual’s patient’s needs and avoid empirical advice. Author: Roger Ho C. Identifying appropriate reinforcements. D. Providing empirical advice. E. Usage of open-ended questions. 33. A 23-year-old man is brought by his family members to the Emergency Department for acute onset of bizarre behaviour. He is agitated and very fearful that gangsters are going to kill him. He had locked himself in his bedroom and hid under the bed for ten hours crying and shouting. He has no prior medical or psychiatric history. On examination, the blood pressure is 150/110 mmHg, heart rate is 100 beats per minute, pupils are dilated and deep tendon reflexes are increased. His signs and symptoms are MOST consistent with: A. Alcohol intoxication B. Amphetamine intoxication C. Brief psychotic episode D. Delirium E. Delusional disorder. Psychopharmacology 34. Which of the following antidepressants is LEAST likely to have sexual side-effects? A. Amitriptyline B. Moclobemide C. Mirtazapine D. Fluoxetine E. Venlafaxine. 35. The benzodiazepine with the LONGEST half- life is: A. Clonazepam B. Diazepam C. Flurazepam D. Lorazepam E. Triazolam. 36. Which of the following is NOT an acetylcholinesterase inhibitor? A. Buprenorphine B. Donepezil C. Galantamine D. Rivastigmine E. Tacrine. Year: 2013 The answer is B. Explanation: The patient presents with agitation, paranoia, dilation of pupil and hyper-reflexia. The most likely diagnosis is amphetamine intoxication. Author: Dr. Lai YM Explanation added by Roger Ho Year: 2013. The answer is C. Explanation: Mirtazapine and bupoprion have relatively low risk of causing sexual side effects as compared to other antidepressants. Author: Roger Ho Year: 2013 The answer is B. Explanation: Diazepam has the longest half life which lasts for more than one day. Author: Roger Ho Year: 2013 The answer is A. Explanation: Buprenorphine is a partial opioid agonist which is used in the treatment of opioid dependence but this medication was banned in Singapore due to diversion and misuse. Author: Roger Ho Year: 2013. 37. Which of the following regarding side effects The answer is E. of risperidone is FALSE? A. Akathisia is common with high dose of risperidone. B. Prolactin elevation, probably greater than that seen with other second generation antipsychotics. C. Insomnia, headache and nausea are common. D. Rhinitis is a possible side effect. E. The risk for weight gain and the metabolic syndrome is higher than olanzapine. 38. Tricyclic antidepressants should be avoided with all of the following EXCEPT A. Patients hospitalized for severe melancholic depression B. Recent myocardial infarction C. Right bundle branch block D. Untreated glaucoma E. Urinary retention. 39. Which of the following is CORRECT regarding galactorrhoea induced by antipsychotic drugs? A. Antipsychotic drugs modulate the hypothalamic function and lead to galactorrhoea. B. Antipsychotic drugs cause pituitary adenoma and galactorrhoea. C. Bromocriptine can treat galactorrhoea induced by antipsychotic drugs. D. Galactorrhea is caused by antipsychotics acting directly on the breast tissue. E. Galactorrhoea is caused by the concurrent use of anticholinergic medication. 40. Which of the following drugs is LEAST likely to increase lithium toxicity? A. B. C. D. E. Explanation: The risk for weight gain and metabolic syndrome is lower than olanzapine. Author: Roger Ho Year: 2013. The answer is A. Explanation: TCA may be helpful in severe depression. The other are relative contraindications. Author: Roger Ho Year: 2013. The answer is C. Explanation: Galactorrhoea can be treated with bromocriptine. Galactorrhoea is due to a direct effect on the anterior pituitary by dopamine secreting tuberoinfundibular neurons, which normally inhibit prolactin release. Antipsychotic drugs do not cause pituitary adenoma. Author: Roger Ho Year: 2013 This is an advancedlevel question. The answer is D. Co-administration of valproate and lithium have no effect on the Non-steroidal anti-inflammatory drugs (NSAIDS) steady- state kinetics of lithium. Sodium valproate Author: Roger Thiazide diuretics. Ho Year: 2013 Angiotensin-converting enzyme (ACE) inhibitors Calcium channel blockers 41. Which of the following is FALSE about clozapine? A. It can cause agranulocytosis. B. It has high affinity for D2 receptors. The answer is B. Explanation: It has low affinity for D2 receptors. C. It has low risk of extrapyramidal side effects. D. It is associated with metabolic syndrome. E. It is good for treatment resistant schizophrenia. 42. A 30-year-old woman with 3 episodes of major depression in the past 5 years responds to fluoxetine 40mg every morning. Her last episode was 6 months ago. In order to minimize the risk of relapse, which of the following treatment strategies is MOST effective? Author: Roger Ho Year: 2013 The answer is A. Explanation: This patient has 3 episodes of major depression in the past 5 years and the number of episodes is considered to be frequent. It is dangerous to reduce the A. Continue fluoxetine 40mg every dose or stop antidepressant morning for five years. soon. B. Continue fluoxetine 40 mg for six months and then stop. Author: Roger C. Provide intermittent Ho Year: 2013 maintenance electroconvulsive therapy. D. Stop fluoxetine and restart it at the first sign of relapse. E. Stop fluoxetine and start cognitive behaviour therapy. Psychotherapy The answer is B. 43. Which of the following treatment strategies has the MOST evidence for Explanation: Exposure and treating obsessive compulsive disorder? response prevention is part of A. Fluoxetine and brief the cognitive behaviour therapy dynamic psychotherapy and has the most evidence for B. Fluoxetine and exposure and treating obsessive compulsive response prevention disorder. C. Fluoxetine and eye movement desensitization and Author: Roger reprocessing Ho Year: 2013 D. Fluoxetine and hypnotherapy E. Fluoxetine and interpersonal psychotherapy. The answer is E. 44. You have to study anaesthesia, emergency medicine, obstetrics and Explanation: This student gynaecology, otolaryngology, demonstrate selective ophthalmology and psychiatry in less abstraction: focus on current than two weeks. Your first thought is, “I will never be able to study all six subjects negative aspect but ignore the positive aspects in the past. in such a short time! The upcoming examination is very stressful.” You ignore Author: Roger the fact that you were successful in the previous professional MBBS examinations Ho Year: 2013 and you could handle multiple subjects in one examination in the past. From a cognitive therapy perspective, what is the BEST description of this type of thinking? A. Catastrophic thinking B. Magnification C. Minimization D. Personalization E. Selective abstraction. Ethics and laws 45. In Singapore, a person who is disturbed and aggressive, with poor insight into his illness, refusing treatment and threatening family members can be admitted involuntarily under the: A. Advanced Care Directive B. Mental Health (Care and Treatment) Act C. Mental Capacity Act D. Mental Health Act E. Psychiatric Disorders and Treatment Act. The answer is B. Explanation: Mental Health (Care and Treatment) Act was passed in 2008 and this is the most correct answer. Author: Roger Ho Year: 2013. Liaison and neuropsychiatry 46. Which of the following medical conditions The answer is B. is LEAST likely to present with panic Explanation: Cushing attacks? syndrome is more likely to be A. Asthma associated with depression B. Cushing syndrome rather than panic attacks. C. Insulinoma D. Phaeochromocytoma Author: Roger E. Thyrotoxicosis. Ho Year: 2013. The answer is D. 47. Which of the following statements about management of depression during Explanation: Not all patients will pregnancy is CORRECT? require psychotherapy. There can be good reasons to choose A. All pregnant women suffering from for pharmacotherapy. This depression require psychotherapy. depends on risks and benefits B. All pregnant women suffering from including gestational age, depression require pharmacotherapy. symptoms, and previous C. Lithium is a safe antidepressant to psychiatric history. A treat antenatal depression. psychiatrist will be important to D. Risks and benefits from psychotropic take care of suicidal and acute drug should be considered, including psychotic symptoms, while gestational age, symptoms, a history of working together with an depression and other clinical factors. obstetrician. E. Suicidal ideation and acute psychotic Lithium is associated with symptoms can be managed by the teratogenic effects on the obstetrician without referral to foetus (e.g. Ebstein’s psychiatrist. anomaly). 48. A 50-year-old man suffering from schizophrenia and he has been taken haloperidol for the past 20 years. His QTc is 550 ms. The medical resident wants to find the potential medical complication if he continues to take haloperidol. Which of the following complications is LEAST Author: Birit Brokeman. Modified by Roger Ho Year: 2013. The answer is A. Explanation: A prolonged QTc mainly affects the ventricles, leading to ventricular fibrillation, torsade de pointes and sudden LIKELY: cardiac death. Palpitation is a A. Myocardial infarction B. Palpitation C. Ventricular fibrillation D. Sudden cardiac death E. Torsade de pointes. 49. A 40-year-old schizophrenia patient presents with high urine volume, low urine osmolality, low serum sodium and low urine sodium. Which of the following is the MOST likely diagnosis? A. Diabetes mellitus B. Nephrogenic diabetes insipidus C. Psychogenic polydipsia D. Simple hyponatremia E. Syndrome of inappropriate antidiuretic hormone secretion. recognized complication. Myocardial infarction is unlikely to be associated with prolonged QTc. Author: Roger Ho Year: 2013. This is an advancedlevel question. The answer is C. Explanation: He suffers from psychogenic polydipsia because there is a dilution in urine volume, urine osmolality, serum sodium and urine sodium due to fluid overload and a result of excessive drinking. Author: Roger Ho Year: 2013. 50. You are a resident working in the The answer is B. gynaecology ward. A 35-year-old woman was admitted for ovarian cystectomy. She Explanation: It is reasonable suffers from major depressive disorder that patient may not be able to and insomnia. She consults a psychiatrist see her psychiatrist shortly at the Institute of Mental Health (IMH). after operation. Her suicide risk She is prescribed with venlafaxine, may not be genuine in this case zolpidem, lorazepam and hydroxyzine. because it is after a condition (if She is due for discharge today and she no medication is given). wants to go home. She expresses concern that she cannot see her psychiatrist in In real situation, the best the coming weeks due to pain associated answer is to assess her suicide with the operation. She requests to obtain risk by yourself or your hospital 3- month supply of her psychiatric psychiatrist. This option is not medications from you. She also requests a available and you need to pain killer called tramadol. She threatens choose the next best answer. that if you do not give her medication, she will commit suicide. What is the BEST Option A may cause a relapse of her psychiatric illness by not approach to handle this situation? giving her any psychotropic A. Do not give her any psychotropic medications. medication and tramadol. Discharge her Option C will intensify her the same day. B. Negotiate with her for shorter duration of disappointment and postpone psychotropic medications and tramadol. discharge does not offer Obtain earlier appointment at IMH. solution. Discharge her today. C. Postpone discharge and use this to Option D: 3-month supply motivate her not to request for more medication is too long and it may pose risk to patients. psychotropic medications. D. Give her 3-month supply of psychotropic medications and tramadol. Discharge her Option E will affect therapeutic alliance and it is important to today. E. Send her to IMH for assessment because further assess her suicide risk. she threatens that she will commit She mentions about suicidal suicide. thought as a sign of anger. Author: Roger Ho Year: 2013 This is an advancedlevel question.
