ABSTRACT
With regard to the epidemiology of premenstrual syndrome, which of the following statements is true?
Its diagnosis is associated with smoking and higher educational levels
Fewer than 10% of women with the syndrome miss work
The lifetime rate for comorbid post-traumatic stress disorder is high
Premenstrual dysphoric disorder has a prevalence of between 15% and 20%
Women with this syndrome score as badly as those with dysthymia on the Parental Factor of the Social Adjustment Scale Self-Report (APT 2007)
All of the following statements about the symptoms of antidepressant discontinuation are true except:
The discontinuation syndrome associated with tranylcypromine is more severe than that associated with other antidepressants
Dizziness and nausea are the most common symptoms
Dystonia has been observed with the discontinuation of fluoxetine
Sensory abnormalities are specific to discontinuation of tricyclic antidepressants
Brief bursts of disequilibrium symptoms are associated with primary discontinuation syndrome (APT 2007)
48Which of the following statements about cannabis is true?
Cannabis is the second most commonly used psychoactive drug
Cannabis use is reaching a plateau phase in high-income countries
Cannabis use causes more harm to public health than tobacco use
Approximately one-third of UK adolescents use cannabis at least once
One of the most effective ways to reduce cannabis use among young people is through school-based interventions (APT 2007)
All of the following statements about cannabis are true except:
Between 20% and 70% of people with severe mental illness use cannabis
Cannabis use is more common among people with severe mental illness than in the general population
The tetrahydrocannabinol content of skunk has doubled in the last 10 years
A dose-dependent relationship exists between cannabis use and psychosis
Strong evidence exists that cannabis use at a young age is linked to the development of severe mental illness (APT 2008)
Cannabis use among severely mentally ill people is associated with all of the following except:
Increased criminal activity
Increased rates of suicide
Longer admissions
Poorer physical health
Reduced polysubstance use (APT 2008)
49With regard to the assessment tools for use with patients with cannabis misuse and psychosis, which of the following statements is true?
The Addiction Severity Index does not include psychiatric problems
Patients with schizotypal personality disorder report fewer unpleasant after-effects on the Cannabis Experiences Questionnaire
The Psychiatric Research Interview for Substance and Mental Disorders takes less time to complete than scheduled interviews
The Stages of Change Readiness and Treatment Eagerness Scale is a 15-item self-report measure
The Substance Use Scale for Psychosis can be used to explore patients’ reasons for using drugs (APT 2008)
Examining the evidence base of psychological therapies for cannabis use shows that all of the following statements are correct except:
The DATOS-A showed significant improvement in the reduction of suicidal thoughts and hostility among 11- to 18-year-olds
The DATOS-A shows the superiority of outpatient over inpatient programmes
Motivational enhancement therapy reduces the use of cannabis among 16- to 20-year-olds
Psychological intervention achieves sustained abstinence in 14–22% of its patients for the 12-month period following the interventions
Psychological therapy with contingency management is associated with better outcomes than psychological therapy alone (APT 2008)
50Which of the following statements about the neuropathology of conversion disorders is true?
They involve the impairment of the non-dominant hemisphere only
The impairment that they cause is restricted to sub-cortical functioning
They are associated with PET evidence of high blood flow in the thalamus
They involve a reduction in the activity of the orbitofrontal cortex
Sub-cortical asymmetry resolves with treatment (APT 2006)
Mr Jones suffers from conversion disorder and has been referred to your services by a neurologist. All of the following statements are true except:
Acute conversion symptoms may undergo spontaneous resolution with the use of explanation and suggestion
A high level of psychiatric comorbidity is associated with conversion disorder
RCT showed that the addition of hypnotherapy to a comprehensive hospital treatment programme did not have any additional effect on treatment outcomes
The recovery phase of chronic conversion disorder may reveal an underlying psychosis
There is a lack of evidence to suggest that patients with conversion disorder have above-average hypnosibility (APT 2006)
51Which of the following statements about race, ethnicity, culture and psychotherapy is true?
All therapists should avoid shared projection and acculturation gaps
Ethnicity is a social construct that defines a group by its members’ race, colour, nationality, ethnicity or national origins
Psychotherapists need to be proficient in culture-bound mythology
Race-based transference uses splitting but not projection as a defence mechanism
Empirical evidence suggests that ethnic matching improves outcomes in therapy (APT 2007)
Which of the following statements about the genetic and developmental aspects of schizophrenia is true?
Clinical symptoms in first-degree relatives of patients with schizophrenia are restricted to positive ones
Most people with schizophrenia have an onset in late adolescence or adulthood
Older children without thought disorders tend to score higher on thought-disorder indices than younger children
Schizotaxia is apparent in 10% of first-degree relatives of people with schizophrenia
An underlying vulnerability to disorders in the schizophrenia spectrum begins to manifest with positive symptoms (APT 2007)
52All of the following statements about the prodrome of schizophrenia are true except:
An analysis of the school reports of patients with schizophrenia showed differences in their childhood social behaviour compared with that of the general population
Children at high genetic risk of schizophrenia exhibit deficits in working memory
Children who later develop schizophrenia present with lower premorbid IQ
Deficits in sustained attention are seen in asymptomatic biological relatives of patients with schizophrenia
Studies of children who have mothers with schizophrenia suggest that early development is normal but not sustained (APT 2007)
The client factors that are suitable for long-term psychodynamic psychotherapy include all of the following except:
Treatment-resistant psychosis
The presence of previous severe disruption to personality development
The presence of a lack of consistent problem focus
The presence of unhelpful team reactions that have become obstacles to offering care
Willingness to take responsibility for addressing problems (APT 2008)
The percentage of people who show a steady progression of disability from multiple sclerosis is:
1–4%
5–10%
11–15%
16–20%
21–25% (APT 2006)
53The lifetime risk of multiple sclerosis in the UK is:
1 in 8 000 000
1 in 800 000
1 in 80 000
1 in 8000
1 in 800 (APT 2006)
What is the prevalence of depression among patients with multiple sclerosis as opposed to the rest of the population?
Twofold higher
Threefold higher
Fivefold higher
Tenfold higher
Twenty-fold higher (APT 2006)
The risk factors for suicide among patients with multiple sclerosis include all of the following except:
Female gender
Past history of depression
Social isolation
Substance misuse
Young age of onset (APT 2006)
54All of the following statements about the practice of psychodynamic psychotherapy are true except:
A 5-year follow-up study showed that psychodynamic psychotherapy reduced recovery time
An effect size of 0.76 has been found for all forms of psychological therapy in the treatment of non-psychotic disorders
An effect size of 0.68 has been found post-treatment for psychological therapies in the treatment of depression
CBT shows a slight superiority to short-term psychodynamic psychotherapy in the treatment of depression
Short-term psychodynamic psychotherapy involves no more than 10 sessions (APT 2008)
The levels of attainment of psychodynamic formulation include all of the following except:
Constructing an illness narrative
Identifying transference
Modelling a formulation
Naming the elements
Recognising the psychological dimension (APT 2006)
Which of the following statements about post-traumatic stress disorder is true?
25% of those suffering from it recover within 2 years
Less than a third have a diagnosis after 6 years
The lifetime prevalence is 2%
It is associated with the male gender
Over 50% of PTSD sufferers have another psychiatric disorder (APT 2007)
55Which of the following statements about the neurobiology of PTSD is true?
The amygdala stores exact details of traumatic events
Patients with PTSD have high cortisol levels
The hippocampus mediates unconscious memories
PTSD represents a failure of the amygdala to regulate medial prefrontal activity
Small hippocampal volume is associated with PTSD (APT 2007)
All of the following statements about the treatment of PTSD are true except:
According to NICE, paroxetine is a second-line treatment for PTSD
Augmentation with olanzapine can be considered for treatment-resistant PTSD
Mirtazapine in the treatment of PTSD is associated with weight loss
NICE guidelines recommend that treatment should be considered for at least 1 year
Sertraline is indicated for the treatment of PTSD (APT 2007)
Which of the following statements about dependence on steroids is true?
Dependence is related to monoaminergic systems
Opioid use serves as a gateway for steroid use
Oral intake is the predominant route of administration
Sleepiness is a common withdrawal symptom
Around 10% of users trust information from drug dealers more than they trust information from doctors (APT 2006)
56All of the following statements about the management of neuropsychiatric symptoms associated with hepatitis C are correct except:
Anorexia responds well to paroxetine
Gastrointestinal haemorrhage is known to be caused by antidepressants used for treating neuropsychiatric adverse effects from combination treatment
Interferon-induced anxiety responds to SSRIs
Naltrexone can be useful in the management of cognitive dysfunction
Recombinant human erythropoietin has been useful in the treatment of apathy (APT under submission by the author)
All of the following statements about cognitive impairment and hepatitis C are true except:
Abnormal P300 potentials have been seen in HCV infections
The cognitive adverse effects of interferon include motor incoordination
Cognitive impairment from interferon does not improve with the discontinuation of treatment
Elevations in basal ganglia and white-matter choline/creatinine ratios have been found in HCV patients
Impairment of verbal memory is a recognised adverse effect of interferon treatment (APT under submission by the author)
57Which of the following statements about adverse neuropsychiatric effects of interferon treatment is true?
Apathy is the most common symptom
Anxiety is seen in 5% of patients who are on interferon
Its cognitive side-effects are suggestive of frontosubcortical impairment
Depression is seen in up to 10% of patients on interferon
The prevalence rate of adverse neuropsychiatric effects is up to 10% (APT under submission by the author)
Mrs Taylor presents with dizziness, double vision and difficulty in communication. The diagnosis is:
Acoustic neuroma
Benign paroxysmal positional vertigo
Labyrinthitis
Meniere’s disease
Vertebrobasilar insufficiency (TN)
All of the following statements about treatment with ECT are true except:
Adverse psychological reactions are rare
It produces deficits in autobiographical and impersonal memory
The extent of retrograde amnesia is not significantly correlated with the degree of therapeutic improvement
Midazolam is contraindicated for patients who are agitated in the recovery phase from ECT
Its mortality risk is 1 per 10 000 patients (ECT)
58Which of the following statements about the interaction between ECT and drug treatment is correct?
Clozapine increases the seizure threshold
Lithium increases the seizure threshold
Olanzapine increases the seizure threshold
SSRIs cause prolonged seizures
Tricyclic antidepressants are anticonvulsant (ECT)
All of the following statements about ECT procedure are correct except:
The extent of eventual improvement is associated with the improvement seen during the first few treatments
In bilateral ECT, the initial treatment dose should be at least 100% more than that of the seizure threshold
In unilateral ECT, the initial treatment dose should be at least 200% more than that of the seizure threshold
The optimal technique for using unilateral ECT for mania has not been established
The initial dose for male patients receiving unilateral ECT is 10% (ECT)
The tests of attention and concentration include all of the following except:
The components of the Test of Everyday Attention
The Corsi block-tapping span
The Paused Auditory Serial Addition Test
The reverse-digit span
A timed test involving star cancellation (CA)
59Which of the following is a test of personal memory?
The cued word-association test
The Doors and People Test
Person-based tasks
Tests of verbal knowledge
Warrington’s Recognition Memory Test (CA)
The hypothalamus forms the floor of the:
Cerebellomedullary cistern
Fourth ventricle
Interventricular foramina of Munro
Interpeduncular cistern
Third ventricle (TN)
All of the following statements about the brain’s blood supply are true except:
All of the arteries that supply the brain are paired except for the basilar artery
The carotid artery is flanked by the oculomotor and optic nerves
The brain receives 750 mL of blood per minute
The brain’s large vessels are thin-walled
A loss of blood supply for 10 to 15 seconds results in loss of consciousness (TN)
60Mr Bainbridge presents with miosis, ptosis, vertigo, dysarthria and ipsilateral hemiataxia. This has been caused by stroke involving:
An aneurysm at the origin of the posterior communicating artery
The basilar artery
A Charcot–Bouchard aneurysm
The middle cerebral artery
The posterior inferior cerebellar artery (TN)
The sympathetic supply to the thyroid comes from the:
External carotid nerves
Inferior cervical ganglion
Internal carotid nerves
Middle cervical ganglion
Superior cervical ganglion (TN)
All of the following nerves include a parasympathetic component except:
III
V
VII
IX
X (TN)
61All of the following statements about efferent fibres from the striatum are true except:
Fibres originate from the caudate nucleus
The striatonigral pathway uses substance P
The striatonigral fibres use acetylcholine
The striatopallidal fibres to the external segment use enkephalin
The striatopallidal fibres use glutamate as a neurotransmitter (TN)
Which of the following statements about cortico-thalamic-striatal circuits is true?
Their association loop involves the pars compacta of the substantia nigra
The head of the caudate is involved in the oculomotor loop
The lateral segment of the globus pallidus is involved in the limbic loop
The premotor cortex is part of the oculomotor loop
The ventrolateral nucleus of the thalamus connects to the supplementary motor cortex as part of the sensory–motor loop (TN)
All of the following matches with regard to the neurons in the basal ganglia are true except:
Intrastriatal interneurons – acetylcholinergic neurons that are inhibited by dopaminergic neurons
Neuropeptide-releasing neurons – release GABA and enkephalin from the same neuron
Pars compacta – neurons releasing dopamine have an excitatory effect on the GABA-ergic neurons that project to the lateral segment of the globus pallidus
Striatum – principally composed of GABA-releasing neurons
Subthalamic nucleus – gives rise to glutamate-releasing neurons (TN)
62Mr Bainbridge presents with a lesion involving the ganglia branch of the left posterior cerebral artery. Which of the following statements is true?
Athetosis results from the degeneration of the medial segment of the globus pallidus
Dopaminergic agonists improve its symptoms
Left hypertonicity would be a feature
Primary degeneration of the GABA-ergic neurons ensues
Right hemiballismus would be a symptom (TN)
Mr Bainbridge presents with a wing-beating tremor that manifests following extension of an upper limb. In which of the following is this seen?
Friedreich’s ataxia
Huntington’s disease
Parkinson’s disease
Sydenham’s chorea
Wilson’s disease (TN)
Which of the following statements about reflexes is true?
The afferent limb of the papillary light reflex is transmitted to the superior colliculus without synapsing at the lateral geniculate
The ciliospinal centre involved in the sympathetic pathway of the papillary dilation is situated at cord levels C1–C2
The efferent pathway of the blink reflex involves the nerve VII
In the convergence accommodation pathway, the inferior colliculus sends fibres to the Perlia’s nucleus of the oculomotor complex
The pretectal area sends bilateral projections to the Edinger–Westphal nucleus (TN)
63Which of the following is caused by a lesion of Myer’s loop?
Contralateral homonymous hemianopsia
Contralateral upper homonymous quadrantopsia
Contralateral lower homonymous quadrantopsia
Contralateral homonymous hemianopsia with macular sparing
Ipsilateral nasal hemianopsia (TN)
All of the following statements about auditory pathways are true except:
First-order neurons are bipolar
Fibres from the posteroventral cochlear nucleus terminate in the ventral nucleus of the lateral lemniscus
Hair-receptor cells stimulate the peripheral process of first-order neurons
Inferior olivary nuclei are involved in processing sound frequency
The sound attenuation reflex involves the motor nucleus of the trigeminal nerve (TN)
All of the following cause conduction deafness except:
Cerumen
Jervell–Lange–Nielsen syndrome
Otitis media
Otosclerosis
Perforation of the tympanic membrane (TN)
64All of the following statements about nystagmus are true except:
Extensive damage at the pontomedullary junction causes rotator nystagmus
Horizontal nystagmus is normal
The normal duration of post-rotatory nystagmus during a rotation test is half a minute
Spontaneous nystagmus indicates a lesion affecting the vestibular nuclei
Vertical nystagmus results from damage to the inferior vestibular nucleus (TN)
Mr Bainbridge presents with an inability to recognise complex sounds. Which of the following does the lesion involve?
The bilateral primary auditory area
The bilateral auditory association area
The dominant auditory association area
The dominant primary auditory area
The non-dominant primary auditory area (TN)
A unilateral lesion to his non-dominant hemisphere will lead Mr Bainbridge to present specifically with which of the following?
Amusia
Auditory agnosia
Partial deafness
Receptive aphasia
Total deafness (TN)
65Mr Bainbridge has received a head injury leading to damage to his non-dominant cerebral hemisphere. All of the following domains will be impaired except:
Mathematical skills
Musical skills
Poetry skills
Recognition of faces
Spatial perception (TN)
Which of the following processes is mediated by the dominant hemisphere?
Music
Poetry
Problem solving
Face recognition
Spatial perception (TN)
All of the following statements about the middle cerebral artery are true except:
An infarction of its more posterior branches is associated with visual agnosias
It supplies both Broca’s and Wernicke’s areas
It does not supply a narrow territory close to the sagittal fissure
It supplies the medial surface of the brain
It forms part of the circle of Willis (SBN)
66All of the following types of receptors activate G- protein-coupled mechanisms except:
A2
α2
D1
GABAB
5-HT4 (SBN)
Which of the following neurotransmitter receptors is fast-ion-channel linked?
Adenosine
α1
Dopamine2–4
GABAB
5-HT3 (SBN)
Which of the following statements about excitatory amino acids is true?
At NMDA receptors, glutamate produces rapid trans-synaptic excitatory responses
Glycine partial agonists increase NMDA function
NMDA receptors are activated by phencyclidine
Strychnine-insensitive glycine receptors modulate NMDA receptor function
The synthesis of glutamate that functions as a transmitter is from glucose via Kreb’s cycle (SBN)
67Which of the following statements about GABA is true?
The activators of GAD cause tonic seizures
GABAA receptors presynaptically modulate GABA release
Glutamic acid decarboxylase is a marker of GABA-ergic neurons
Picrotoxin is an antagonist at the GABA receptor
Schizophrenia may be related to decreased GABA activity (SBN)
Which of the following statements about acetylcholine is true?
The action of acetylcholine is blocked by physostigmine
The addictive aspects of nicotine are independent of dopaminergic systems
Cholinergic processes are involved in NREM sleep
Muscarinic receptors are not PI coupled
The neuronal store of acetylcholine is depleted by hemicholinium (SBN)
Mr Bainbridge presents with a head injury, and you want to detect and measure the severity of visual neglect involved. Which of the following is the recommended test?
The Behavioural Assessment of the Dysexecutive Syndrome
The Behavioural Inattention Test
The Delis–Kaplan Executive Function Syndrome
The National Adult Reading Test
Raven’s Progressive Matrices (CA)
68Mr Bainbridge presents with aphasia following a stroke. Which of the following can you use to measure his auditory comprehension?
The Rey Auditory Verbal Learning Test
The Rey–Osterrith Complex Figure Test
The Test for Reception of Grammar
The Token Test
The Trail Making Test (CA)
Mr Bainbridge presents with attentional deficits following a head injury. Which of the following will you use?
The Doors and People Test
The Judgement of Line Orientation Test
The Paced Auditory Serial Addition Test
The Recognition Memory Test
The Visual Object and Space Perception Battery (CA)
Mr Bainbridge has recovered from a head injury. Which of the following will you use to assess the extent of memory impairment recovered?
The National Adult Reading Test
The Pyramids and Palm Trees Test
Raven’s Progressive Matrices
The Recognition Memory Test
The Rivermead Behavioural Memory Test (CA)
69All of the following statements about the Cambridge Cognitive Examination are true except:
It cannot distinguish different forms of dementias
Its cut-off value for dementia is less than or equal to 80
It forms part of CAMDEX
The maximum score on CAMCOG is 100
It is sensitive to mild dementia (CA)
Which of the following is associated with self-mutilation behaviour?
Arnold–Chiari malformation
De Lange malformation
Generalised neurofibromatosis
Tuberous sclerosis
Von Hippel–Lindau disease (SBN)
All of the following statements about neural-tube defects are true except:
Fetal ultrasound and amniotic fluid assay can identify 90% of defects in vivo
Closure of the neural tube occurs within 18 to 26 days after the formation of the zygote
In anencephaly, cerebral hemispheres fail to develop with exposure to diencephalon
Minor neural-tube defects are present in less than 1% of the population without neurological deficits
The recurrence rate for spina bifida in a second baby is 1 in 20 (SBN)
70Which of the following statements about head injury is true?
Being aged between 25 and 30 years is a risk factor for severe head injury
The parietal lobe is the most vulnerable area for contusion damage
Postconcussive symptoms usually resolve within 6 months
Post-traumatic amnesia lasting 1 to 7 days is associated with mild sequelae
The prevalence of severe disability following a head injury among the general population is 50 in 1 000 000 (SBN)
A neuropathological examination reveals anterior temporal cortical atrophy with balloon cells. In which of the following is this seen?
Alzheimer’s disease
Creutzfeldt–Jacob disease
Huntington’s disease
Parkinson’s disease
Pick’s disease (SBN)
All of the following statements about Huntington’s disease are true except:
The cortical form of dementia is seen
Choreiform movements become more pronounced as the disorder progresses
Chromosome 4 is implicated in its aetiology
The initial presentation is often psychiatric
Its onset is usually in the third or fourth decade (SBN)
71In which of the following is glucocerebrosidase deficiency seen?
Gaucher’s disease
Gangliosidosis
Leigh’s disease
Niemann–Pick disease
Wilson’s disease (SBN)
In which of the following is α-1-iduronidase deficiency seen?
Hurler syndrome
Hunter’s syndrome
Leigh’s disease
Niemann–Pick disease
Tay–Sachs disease (SBN)
In which of the following leukodystrophies is X-linked recessive inheritance seen?
Adrenoleukodystrophy
Krabbe’s leukodystrophy
Metachromatic leukodystrophy
Pelizaeus–Merzbacher disease
Sudanophilic leukodystrophy (SBN)
Although leukodystrophies are characterised by the extensive degeneration of myelin, in which type of leukodytrophy can myelins be seen preserved around blood vessels?
Adrenoleukodystrophy
Krabbe’s leukodystrophy
Metachromatic leukodystrophy
Pelizaeus–Merzbacher disease
Sudanophilic leukodystrophy (SBN)
72All of the following conditions are associated with demyelination except:
Cyanocobalamin deficiency
Leigh’s disease
Long-standing cerebral oedema
Marchiafava–Bignami syndrome
Progressive multifocal leucoencephalopathy (SBN)
The paraventricular nucleus is involved in controlling all of the following except:
Corticotrophin-releasing hormone
The dopamine-mediated inhibition of prolactin
Somatostatin
The stimulation of the secretion of growth hormone, mediated through GHRH
Thyrotrophin-releasing hormone (SBN)
All of the following statements about growth hormone (GH) secretion are true except:
Acetylcholine inhibits the release of somatostatin
Growth hormone stimulates the peripheral production of IGF-1
Nocturnal surges of GH occur during sleep stages 3 and 4
Somatostatin has a direct inhibitory effect on GH secretion
Stimulated GH secretion is lower in premenopausal women (SBN)
73All of the following hormonal abnormalities are seen in anorexia nervosa except:
Hypercortisolism with preserved diurnal rhythm
Impaired gonadotrophin secretion
Impaired osmotic regulation of arginine vasopressin
Low total T4
Reduced growth-hormone response to levodopa (SBN)
Polyspikes and wave flattening are seen in:
Absence seizures
Atonic seizures
Clonic seizures
Tonic seizures
Tonic–clonic seizures (SBN)
A regular and symmetrical 3 Hz pattern is seen in:
Absence seizures
Atonic seizures
Clonic seizures
Tonic seizures
Tonic–clonic seizures (SBN)
The lifetime risk of unipolar depression among monozygotic co-twins of a bipolar proband is:
0.5–1.5%
2–5%
6–9%
10–13%
15–25% (PG)
74All of the following statements about the genetic inheritance of bipolar affective disorder are true except:
An allele of a VNTR in intron 2 of the hSERT gene has been implicated in bipolar disorder
Chromosome 12q23-q24 has a LOD score of 2–0-4.9
Individuals with trisomy 21 are more susceptible to mania than the general population
A co-segregation of colour blindness and bipolar affective disorder exists
Tyrosine hydroxylase maps to 11p15 are implicated in bipolar disorder (PG)
All of the following statements about the genetics of bipolar affective disorder are true except:
Lithium responsiveness appears to be familial
A low-activity allele involving COMT polymorphism may be associated with increased susceptibility to rapid cycling
Gene coding for the 5-HT2a receptor has been implicated in rapid cycling disorder
The serotonin transporter gene (hSERT) has been implicated in seasonal affective disorder
Trinucleotide repeat expansion involving CTG18.1 has been implicated in bipolar disorder (PG)
The lifetime risk of schizophrenia-related psychosis among fraternal twins of patients with schizophrenia is:
6%
9%
13%
17%
48% (PG)
75The lifetime risk of developing schizophrenia-related psychosis among the grandchildren of patients with schizophrenia is:
2%
4%
5%
6%
9% (PG)
Which of the following is an agonist at the 5-HT1A receptor?
Buspirone
Ergotamine
LSD
Methiothepin
Sumatriptan (N)
Which of the following statements about acetylcholine is true?
Acetylcholine produces long-term potentiation in the hippocampus by opening the KM channels
All of the pathways of the autonomic system use acetylcholine as a neurotransmitter except for the preganglionic neurons
Cholinergic interneurons are absent in the nucleus accumbens
The laterodorsal tegmental nucleus is an important cholinergic pathway for regulating sleep and wakefulness
The motor neurons in the dorsal horn of the spinal cord are cholinergic (N)
76All of the following statements about acetylcholine are true except:
The supply of acetyl CoA is the rate-limiting step in the synthesis of acetylcholine
The acetylcholine vesicle transporter is coded by the first exon of the ChAT gene
AChE enhances the response of cerebellar neurons to glutamate
The Na+-dependent choline transporter is saturated at plasma choline concentrations
Nicotinic receptors mediate fast-ACh transmission, stimulating the dopamine-reward pathways (N)
Which of the following statements about purines is true?
A1 receptors increase cAMP levels
Adenosine mediates the deleterious effects of oxidative stress on neurons
ATP acts as a transmitter in the CA3 region of the hippocampus
ATP is synaptically activated by an ecto-5’-nucleotidase
The P2y a receptor is an ionotropic cation channel (N)
All of the following statements about peptide and tachykinin neurotransmission are true except:
The mRNA encoding a peptide neurotransmitter is transcripted on ribosomes
Peptides containing vesicles are moved by motor proteins along microtubules
The release of substance P in peripheral terminals results in neurogenic inflammation
Substance P is an excitatory tachykinin
Substance P is the preferred ligand for the NK1 receptor (N)
77The enzyme used in the polymerase chain reaction is:
DNA trinucleotidase
Restriction endonuclease
Reverse transcriptase
RNA polymerase
Taq polymerase (PG)
A micro-array is called:
A DNA chip
A polymerase chain reaction
A primer extension
A restriction fragment length polymorphism
A short tandem repeat polymorphism (PG)
Mr Bainbridge cannot copy an image shown to him. This form of agnosia is:
Apperceptive agnosia
Associative agnosia
Autatopagnosia
Colour agnosia
Mirror agnosia (CA)
NF-1 is caused by a mutation of a gene on the long arm of chromosome:
1
9
11
15
17 (KS)
78The following are true regarding variant Creutzfeldt–Jakob disease except:
Absence of periodic sharp waves on EEG
Delayed neurological signs
Marked accumulation of protease-resistant prion protein
Mean age at death 60 years
Pulvinar sign in more than 75% of cases (SBN)
Which of the following statements about cognitive-stimulation therapy in dementia is true?
CST improves cognition but not depression
It is composed only of reality orientation
CST benefits quality of life but not cognition
RCT evidence is available indicating that social groups improve cognition
A high probability exists that CST is more cost-effective than treatment as usual (BJP 2006)
Which of the following statements about comorbid substance misuse and schizophrenia is true?
Comorbid substance use and less severe negative symptoms have been reported
IQ is not associated with an early age of onset of illness among substance misusers
A negative correlation exists between cannabis use in adolescence and the development of schizophrenia in adulthood
Stimulants and hallucinogens are the most commonly used substances among people who present with schizophrenia
Substance misuse is a risk factor for relapse but not for onset (BJP 2006)
79Which of the following statements about complementary medicines is true?
Around 5–10% of all psychiatric patients rely on complementary medicines
Around 10% of all cancer patients take psychoactive substances
Evidence is available that melatonin can treat tardive dyskinesia
Passionflower is potentially useful as a sedative
Evidence is lacking that selenium complements antidepressant treatment (BJP 2006)
Increased bleeding time is associated with:
Ginkgo
Hydergine
Panax ginseng
Solanaceous plants
Valerian (BJP 2006)
Which of the following drugs interacts with cholinesterase inhibitors?
Ginkgo
Hydergine
Panax ginseng
Solanaceous plants
Valerian (BJP 2006)
80Which of the following statements about the 5-HTTLPR genotype is true?
The SERT-s allele is associated with a 25% reduction in volume of the anterior cingulate
The SERT-l allele is associated with a 25% reduction in volume of the amygdala
Suicide is dependent upon major depression for contributing to the enlargement of the thalamus
The 5-HTTLPR genotype is associated with a 20% reduction in the number of neurons in the pulvinar nucleus
The history of antidepressant treatment is associated with an increase in thalamic volume (BJP 2008)
Which of the following statements about attribution style and depression is true?
Attributional style is not a mediator of the genetic influences on depression
Attributional style is unrelated to current mood
People who are experiencing their first episode of depression are more likely to attribute it to an internal cause than people who are experiencing recurrent depression
People who are likely to view the causes of events as global are less likely to develop depression in future
People who are likely to view the causes of negative events as internal are less likely to develop depression in future (BJP 2008)
81Which of the following statements about neural circuits in OCD is true?
Adults with OCD perform well on motor and interference inhibition but not on task switching
A dysfunction of the frontocerebellar attention networks is evident during the cognitive forms of inhibition
fMRIs show that inhibition failure in adolescents with OCD is associated with mesial frontal over-activation
Frontostriatal over-activation is seen during inhibitory tasks
An improvement in impaired inhibitory performance is a marker of symptom improvement (BJP 2008)
All of the following statements about CBT are true except:
A 12-week comprehensive treatment programme consisting of CBT, body awareness therapy and graded exercise is more effective than antidepressant therapy in chronic fatigue syndrome
According to the Nottingham Study of Neurotic Disorder, cognitive therapy and self-help were more effective for depressed people with comorbid personality disorder than for people without personality disorder
CBT with a problem-solving component has a positive effect on self-harm
People with a personality disorder who respond to cognitive therapy show sustained responses
Schema-focused therapy has been found to reduce self-harm in patients with borderline personality disorder (BJP 2008)
82All of the following statements about schizophrenia are true except:
Any craniofacial/midline anomaly is associated with an increased risk of schizophrenia-spectrum disorder
Febrile seizures are not associated with adult schizophrenia
Impaired extrastriate visual processing of fear is associated with negative symptoms
Increased semantic priming is associated with thought disorders
The recognition of negative facial affect is impaired in people with schizophrenia (BJP 2008)
Which of the following statements about schizophrenia is true?
Atypical antipsychotics are more effective than typical antipsychotics in the treatment of delusional parasitosis
Cognitive remediation therapy is not associated with durable improvements in working memory
Fewer than 1% of the people who harm themselves die in the subsequent year
Patients with positive symptoms show a higher degree of impairment of their mentalisation than do disorganised patients
Population density interacts with poor pre-morbid cognitive functioning (BJP 2007)
All of the following influence caregiver stress in schizophrenia except:
The caregiver being the patient’s parent
The highest burden being in relation to the supervision of the patient
The patient being male
The patient’s marital status
The patient’s symptoms (BJP 2007)
83Which of the following statements about schizophrenia is true?
Awareness of the illness is associated more with impaired working memory
Cortical microstructure disruption is seen in the temporo-occipital lobes
Motor-cortex reactions are weaker in both patients and their twin siblings
Patients who use cannabis show normal anterior cingulate, in contrast to those who do not use it
Age has a positive effect on the integrity of the left superior longitudinal fasciculus (BJP 2007)
All of the following statements about depression are true ex cept:
Ceasing to cohabit with a partner precipitates depression
ECT is the most effective treatment for depression
ECT patients are more medically ill
Personality disorders affect outcomes in depressed people who are being treated with interpersonal therapy
rTMS augments antidepressant treatment (BJP 2007)
Which of the following statements about PTSD is true?
Basal cortisol levels are low in morning samples
Cortisol activates neuronal defensive reactions
Serotonin from the amygdala inhibits the hypothalamus from secreting corticotrophin-releasing hormone
Sexual abuse is associated with higher basal cortisol levels
Trauma-focused CBT is as effective as EMDR (BJP 2007)
84Which of the following statements about neuroleptic malignant syndrome (NMS) is true?
Bromocriptine, but not amantadine, reduces its mortality rate
Dantrolene takes 24 hours to produce a clinical effect
Its mortality rate is less than 10% with NMS from depot antipsychotic medications
Its prevalence is 0.02–2.4%
Untreated symptoms resolve within 7 days (KS)
Mr Bainbridge presents with hyperthermia, muscle rigidity, palpitation, hypotension, rhabdomyolysis and disseminated intravascular coagulation. This can be caused by:
Amphetamine
Atropine
Lead poisoning
Reserpine
Succinylcholine (KS)
In which of the following are β-adrenergic antagonists definitely effective?
Adjunctive therapy for alcohol withdrawal
Adjunctive therapy for aggressive behaviour
Antidepressant augmentation
Antipsychotic augmentation
Lithium-induced tremor (KS)
85The adverse effects of β-adrenergic receptor antagonists include all of the following except:
Diarrhoea
Hypotension
Hyperglycaemia
Impotence
Peyronie’s disease (KS)
All of the following statements about amantadine are true ex cept:
Amantadine coadministered with MAOIs can cause a significant increase in blood pressure
Amantadine is contraindicated in people who are sensitive to anticholinergic effects
Amantadine has benefits in the treatment of ejaculatory inhibition
Amantadine is excreted unmetabolised in urine
Livedo reticularis has been seen in 5% of people taking amantadine (KS)
All of the following statements about psychotic symptoms among the general population are true except:
An excess of apparent hallucinations has been reported among men compared with women
Established psychotic symptoms may be present in milder forms in the general population
A 1-year incidence of around 5% has been reported for hallucinations among the general population
Similarities exist between the risk factors for psychotic symptoms and schizophrenia among the general population
An association exists between baseline neurosis and incident psychotic symptoms among the general population (BJP 2006)
86All of the following are risk factors for self-reported psychotic symptoms among the general population except:
Harmful pattern of drinking
Living in an urban area
More adverse life events
Having a small primary support group
Smoking tobacco (BJP 2006)
All of the following statements about the risk factors for psychiatric illnesses among women from low-income countries are true except:
Being married
Living in a relatively large household
Poverty
Reporting chronic physical illnesses
Use of tobacco (BJP 2006)
The risk factors for severe postpartum psychosis include all of the following except:
Caesarean section
Delivery complications
Delivering a female baby
Multiparity
Having a relatively shorter gestation period (BJP 2006)
87All of the following statements about the neuropathology of hallucinations are true except:
Hallucinations increase N100 in amplitude
The primary auditory cortex is involved
Reduced left temporal responsivity is present
The right cortical area is the most important one for direction discrimination
When Broca’s area alone dominates, inner speech is perceived (BJP 2007)
Dysthymic disorder has a prevalence of:
0.5–1%
1–3%
3–6%
7–8%
9–14% (KS)
The lifetime prevalence of hypomania is:
0–1.2%
1.2–2.4%
2.6–7.8%
8–12.5%
12.8–14.8% (KS)
88All of the following statements about gender differences between affective disorders are true except:
Bipolar type 1 disorder has a higher prevalence among men
Manic episodes are more common in men
Major depressive disorders are twice as prevalent in women as in men
There is a higher rate of rapid cyclers among women
Women present with a more mixed picture than men when presenting with a manic episode (KS)
All of the following are indicators of a good prognosis in depression except:
The absence of a comorbid personality disorder
Early age of onset
Having had no more than one previous hospitalisation
A relatively short hospital stay
Having had strong friendships during adolescence (KS)
Which of the following statements about the course of bipolar disorder is true?
Bipolar type 1 disorder most often starts with mania
The incidence of bipolar disorder in children and adolescents is about 1%
Fewer than 5% of people with bipolar disorder can be classified as rapid cyclers
Around 15% of patients with bipolar type 1 disorder do not have a recurrence of symptoms
Around 30% of patients with bipolar disorder achieve significant control over their symptoms with lithium (KS)
89Positive relationship transference without interpretation is a technique used in which of the following?
Brief psychodynamic approach
Cognitive behavioural therapy
Dialectical behaviour therapy
Interpersonal therapy
Psychodynamic therapy (KS)
Therapists associated with interpersonal therapy include all of the following except:
Jacobson
Klerman
Meyer
Sullivan
Weissman (KS)
All of the following are the patient variables most suited for interpersonal therapy except:
A focused dispute with a partner or significant other
A modest to moderate need for direction and guidance
Pragmatic thinking
Responsiveness to environmental manipulation
Social or communication problems (KS)
90Which of the following is the confirmation of reality by comparing one’s own conceptualisations with those of other members in the group?
Acceptance
Cohesion
Consensual validation
Corrective family experience
Reality testing (KS)
Self-disclosure is also known as:
Catharsis
Contagion
Empathy
Transference
Ventilation (KS)
Which of the following is the process during which the group leader formulates the meaning or significance of a patient’s resistance?
Acceptance
Consensual validation
Identification
Interpretation
Reality testing (KS)
The roles in a psychodrama include all of the following except:
Auxiliary ego
Director
Group
Narrator
Protagonist (KS)
91Which of the following types of family therapy emphasises individual maturation in the context of the family system and is free from unconscious patterns of anxiety and projection rooted in the past?
Bowen model
General systems model
Psychodynamic–experiential model
Social network model
Structural model (KS)
