Q 52. People with emotionally unstable borderline personality disorder are stuck in:
1. Winnicott’s “false self”
2. Klein’s depressed position
3. Klein’s paranoid-schizoid position
3. Klein’s paranoid-schizoid position
Winnicott’s false self relates to schizoid personality disorder and not borderline personality disorder
Q 53. Something that is diagnostic of borderline personality disorder is:
1. Attempts to avoid real or imagined abandonment.
2. Depression
3. Suicide
4. Self-harm
1. Attempts to avoid real or imagined abandonment.
Q 54. A young man is impulsive and has angry outbursts. He has been arrested several times for hitting his partner. His diagnosis is:
1. Dissocial PD
2. Emotionally Unstable PD
3. Paranoid PD
4. Anankastic PD
1. Dissocial Personality Disorder
Q 55. A man comes to your out-patient clinic. He gives you a history in childhood of conduct disorder. He recognises that he has a problem with anger and often gets into fights with his partner. He wishes to prevent this from happening. You interview him and find no evidence of mental illness or active symptoms. You decide:
1. To start no treatment but review him in three months.
2.Start an antipsychotic and review in 3 months.
3. Start an antidepressant and review in 3 months.
4. To discharge him.
1. To start no treatment but review him in three months.
Mood and Anxiety disorders
Q 56. A man comes to your clinic nine months after the death of his mother. You find features of a moderate depressive illness. He occasionally hears her voice calling him. You decide to:
1. Do nothing and reassure him it will all go away.
2. Start an antidepressant and follow him up.
3. Start an antipsychotic and follow him up.
Q 57. Social phobias are most associated with:
1. Generalising to other phobias
2. Avoidance to reduce fear
3. Obsessions
4. Compulsions to reduce anxiety
2. Avoidance to reduce fear
Q 58. In generalised anxiety disorder we see:
1. Briefly punctuated by episodes of depression
2. Rituals
3. Obsessions
4. Suicide
5. Higher dizygotic twin concordance rather than monozygotic.
1. Briefly punctuated by episodes of depression
http://www.cnn.com/HEALTH/library/DS/00502.html
Q 59. A woman comes into your outpatient clinic. She is obsessed with dust and has to wash her hands up to twenty times if she touches anything. The treatment you would recommend would be:
1. Response and Exposure prevention (Not exposure and response prevention!)
2. CBT
3. CAT
4. Psychodynamic therapy
5. Interpersonal therapy
2. CBT
CBT includes Exposure and Response Prevention
Q 60. What would you do for a patient with OCD and no improvement after two months on 50mg of sertraline:
1. Increase the sertraline
2. Change to a different SSRI
3. Add an antipsychotic
4. Switch to venlafaxine
5. Add sodium valproate
1. Increase the sertraline
Addiction Psychiatry
Q 61. You are the substance misuse consultant and are asked to draw up a service for users. The first thing to do will be:
1. Address lifestyle imbalances
1. Address lifestyle imbalances
Q 62. Acamprosate:
1. Can be used with controlled drinking.
2. Is associated with abuse potential.
3. Acts in a dose-dependent fashion.
4. Reduces craving for alcohol.
4. Reduces craving for alcohol.
No. 1 is also true, but 4 is the best fit.
Q 63. You are called to A&E to see a man withdrawing from amphetamines. He is least likely to have:
1. Insomnia
2. Seizures
3. Hypersomnia
4. Agitation
5. Decreased appetite
2. Seizures
Q 64. You are called to A&E to see someone who has taken PCP. The following are true:
1. Gait disturbances are late
2. Visual hallucinations are common
3. None of the above.
1. Gait disturbances are late
Q 65. A 19 year old tells you she takes MDMA. The least likely psychological consequence of this drug is:
1. Anxiety
2. Disinhibition
3. Increased desire to do mental tasks
4. Perceptual disturbances
5. Increased friendliness
1. Anxiety
Q 66. A man who drinks two bottles of vodka a day tries to stop by himself. He is brought into hospital with ataxia, and confusion. The chances that he will develop Korsakov’s are:
1. 10%
2. 20%
3. 50%
4. 80%
5. 100%
3. 80% (SOTP)
Perinatal psychiatry
Q 67. A patient of yours is breastfeeding. She has Bipolar Affective Disorder and came off her medication for her pregnancy. She feels she is about to relapse. What medication is safe in breast feeding:
1. Choral hydrate
2. Lamotrigine
3. Sodium valproate
4. Lorazepam
5. Carbemazepine
3. Sodium valproate
Maudsley Prescribing guidelines
Q 68. A female patient has had several depressive episodes in the past and one episode of hypomania. You decide the best medication to prevent relapse for her is:
1. Lithium
2. carbemazepine
3. Lamotrigine
4. Fluoxetine
5. Sodium valproate
Lithium
Maudsley Prescribing guidelines
Q 69. A woman comes to see you in out-patients. She has a 6month old son and for the last three months she has recurring thoughts of harming him. She does not wish to harm him and these thoughts make her tearful and anxious. The birth was uneventful but she perceives it to have been traumatic. You diagnose:
1.PTSD
2. Postnatal depression
3.OCD
2. Postnatal depression
If tearfulness and so called history of traumatic birth is not there, the answer can also be OCD. But with the history given, it is postnatal depression.
Psychiatry for Older Adults
Q 70. How do you differentiate that a dementia is subcortical not cortical:
1. Calculation is preserved
2. Apathy
Q 71. In an 80 year old patient compared to a 40 year old patient you would expect the half-life of temazepam to be:
1. Reduced by 50%
2. The same
3. Increased by 50%
4. Increased by 100%
5.Increased by 200%
5.Increased by 200%
Starting dose in elderly is 7.5 mg as compared to 15 mg in a 40 year adult.
Rating Scales
Q 72. You have started a patient with postnatal depression on an antidepressant and wish to monitor changes in her symptoms. Which of the following observer rating scales would you use:
1. Zung
2. BDI
3. MADRS
4. Morgan-Russel
5. Edinburgh Depression Scale
3. MADRS
Zung, BDI and EDRS are self rated, Morgan Russell is for anorexia nervosa.
EDRS is a screening tool.
Q 73. A young man in your clinic complains of EPSEs. The scale you would use to measure this is:
1. Simpson-Angus
2. Morgan-Russell
3. Young Mania Scale
4. AIMS (Abnormal Involuntary Movements Scale)
5. PANSS (Positive & Negative Symptom Scale)
1. Simpson-Angus
Q 74. What rating scale would you recommend for a health visitor to use to screen for depression in women after delivery:
1. Zung
2. BDI
3. MADRS
4. Morgan-Russel
5. Edinburgh Depression Scale
Edinburgh Depression Scale
Pharmacology
Q 75. A male patient on clozapine has gained 20kg. Your next step is to:
1. Switch to Quetiapine.
2. Switch to Risperidone
3. Add sodium valproate
4. Dietary Counselling
5. Switch to amisulpiride
44. Dietary counselling
Maudsley Prescribing Guidelines
Other options can be to add amantadine or to switch to ziprasidone, aripiprazole or haloperidol.
Q 76. What drug causes symptoms of inappropriate ADH secretion:
1. Quetiapine
2. Amisulpiride
3. Haloperidol
4. Olanzapine
5. All of above
5. All of above
MAUDSLEY
Q 77. A man with Parkinson’s Disease develops psychotic symptoms. He has never been on antipsychotics before. The best treatment for him is:
1. Quetiapine
2. Amisulpiride
3. Haloperidol
4. Olanzapine
5. Risperidone
1. Quetiapine
Maudsley p.426
Q 78. A female patient has been trialled on Olanzapine and Quetiapine with poor effect. Your next step is to try:
1. Clozapine
2. Amisulpiride
3. Haloperidol
4. Lithium
5. Aripiprazole
1. Clozapine
Set 2
Q 79. Which of the following is commonly associated with microcephaly?
1. Foetal Alcohol Syndrome
2. Hydrocephalus
3. Soto’s Syndrome
4. Down’s Syndrome
5. Fragile X Syndome
1. Foetal Alcohol Syndrome
Q 80. Which of the following is true of offending in the learning disability population?
1. Fire setting is the most commonly committed offence
2. Most offences are committed by those with borderline and mild learning disabilities
3. Moderate LD is strongly associated with homicide
4. Conviction for arson leads to a fixed prison sentence
5. All of above
. Most offences are committed by those with borderline and mild learning disabilities
Q 81. Which of the following increases the risk of Alzeihmer’s Disease in Down’s Syndrome?
1. Positive family history
2. Mild LD
3. Moderate LD
4. Smoking
5. Aluminium exposure
1. Positive family history
Q 82. Which of the following is true of psychotropic medications in the learning disability population?
1. Ethosuxamide is a first line antiepileptic
2. Lamotrigine has mood stabilising effects
3. Valproate leads to weight loss
4. Proprananol is an effective antimanic agent
5. Naltrexone is an effective antidepressant
2. Lamotrigine has mood stabilising effects
Q 83. In Learning disability and psychotherapy:
1. Anxiety management therapy is usually done for people with profound LD.
2. Gradual muscle relaxation is done in group psychodynamic therapy.
3. Patients with LD who have been sexually abused are treated with brief psychodynamic therapy.
4. Unmodified CBT is used in moderate LD.
5. Guided mourning is not useful in mild LD.
Although more studies negate this, there are studies which provide substantial evidence for use of CBT in people with LD.
4. Unmodified CBT is used in moderate LD.
Q 84. Which of the following is most associated with reoffending in paedpophiles?
1. lack of victim empathy
2. psychiatric illness
3. comorbid substance misuse
4. previous violent offending
5. depressed mood
4. lack of victim empathy
The strongest static predictors were
age/gender/race and criminal history, and the strongest dynamic predictors were
"criminogenic need" factors, which they defined as antisocial personality, antisocial
companions, interpersonal conflict, antisocial attitudes, and substance abuse (Gendreau et al.,
1996: 583-584).
Q 85. Which of the following is used as a screening tool on psychiatry?
1. Simpson Angus Scale
2. MADRAS
3. SANS
4. Edinburgh Post Natal Depression Scale
5. BDI
4. Edinburgh Post Natal Depression Scale
Q 86. Which of the following is associated with tall stature?
1. Prader Willi Syndrome
2. Williams Syndrome
3. XXY
4. Foetal Alcohol Syndrome
5. Cornelia De Lange Syndrome
3. XXY
Both XXY and XYY are associated with tall stature. Ref. College Seminars in LD.
Q 87. Which of the following is a recognised symptom of severe depression
1. parasomnia
2. somnambulism
3. hypersomnia
4. narcolepsy
5. night terror
3. hypersomnia
Q 88. One of the following is not a feature of chronic fatigue syndrome
a. Disturbed sleep pattern
b. Feeling tired after rest, relaxation and enjoyment
c. Duration more than 6 months
d. Exercise makes person more tired
e. Muscle aches and pains.
c. Duration more than 6 months
Nowhere mentioned in ICD-10 about duration (F48.0)
Q 89. Bion – principle of container and containment
a. Therapist advises the patient to contain the feelings without letting them out.
b. Patient has to explore the feelings within and relate them to the surroundings.
c. Therapist doesn’t let his feelings out.
c. Therapist identifes and interprets transference and safely reprojects onto the group / client.
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