ABSTRACT
With regard to the treatment of premenstrual syndrome, all of the following statements are false except:
Danazol worsens mastalgia
Dosing in the luteal phase is less efficacious than treatment throughout the cycle
Fluoxetine is safer than other treatments, as it does not alter the length of the menstrual cycle
SSRIs are efficacious in treating both physiological and psychological symptoms
The onset of improvement following SSRI treatment is much slower than with depressive disorder (APT 2007)
All of the following statements about the withdrawal symptoms seen in neonates due to maternal use of antidepressants are true except:
They are associated with maternal SSRI use in late pregnancy
They are associated with maternal use of tricyclic antidepressants in late gestation
Such symptoms are absent at birth
Such symptoms include tremor and feeding difficulties
Such symptoms usually resolve within 2 weeks (APT 2007)
138All of the following statements about the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) are true except:
The Brief Psychiatric Rating Scale was their measure of primary outcome
They involved double-blind randomised trials
The duration of the study was 18 months
Patients with tardive dyskinesia were excluded from the perphenazine arm
Their proxy for effectiveness was the discontinuation of treatment for any cause (APT 2008)
All of the following were outcomes from the CATIE except:
Discontinuation due to intolerable side-effects was greatest with olanzapine
The initial large improvement from olanzapine was not sustained by the end of the study
Olanzapine treatment was less costly than treatment with perphenazine
The overall rate of discontinuation of the antipsychotics was 74%
There was no significant difference between the drugs with regard to the incidence of extrapyramidal side-effects (APT 2008)
139All of the following were features of the Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS) except:
The clinicians used haloperidol infrequently
The patients on second-generation antipsychotics showed a trend towards greater improvement in terms of quality of life than others
It was a multi-centre trial
It found no clear patient preference with regard to choice of antipsychotics
Its specific hypothesis was that new antipsychotics would be associated with a clinically significant improvement in quality of life for 1 year over that of older drugs (APT 2008)
Mr Allen is to be started on an atypical antipsychotic. He knows that his father suffered from parkinsonism due to having been on a typical antipsychotic. He would like to know what the predisposing factors are for atypical antipsychotic drug-induced parkinsonism. All of the following are predisposing factors except:
A higher than BNF maximum dose
A higher starting dose
Being male
Increasing age
An individual predisposition to a high rate of dopaminergic neuron loss (APT 2008)
140Mr Redbridge has a diagnosis of chronic schizophrenia. You suspect that he has negative symptoms, whilst the neurologist’s opinion is that he has parkinsonian features. All of the following factors support your diagnosis except:
Avoidance of eye contact
Loss of intonation of speech
Preserved articulation of speech
Preserved spontaneous generation of words
Restricted range and depth of mood (APT 2008)
All of the following statements about EEG monitoring of ECT are true except:
A study conducted in India found that 10–15% of its sample had prolonged seizures on EEG
The end point is the most likely point at which the immediate post-ictal tracing begins
The incidence of prolonged ECT was 1% in the Edinburgh ECT clinic
The potential clinical application of ictal EEG does not include a prediction of eventual treatment response
There is a lack of significant correlation between post-ictal suppression and clinical improvement (APT 2007)
To which of the following is the quality of ictal EEG significantly related?
Age
Concurrent medications
Electrode placement
Previous ECT episodes
Threshold dose (APT 2007)
141All of the following statements about ethnicity and psychiatric disorders in the UK are true except:
The EMPIRIC report showed that higher rates of Pakistani women reported common mental disorders compared with the general population
The EMPIRIC report showed that lower rates of Bangladeshi women reported common mental disorders compared with the general population
The EMPIRIC report showed that there was twice as much psychotic illness in people of African and Caribbean origin compared with the general population
People of African and Caribbean origin are more likely to be detained against their will
Young people of African-Caribbean origin continue to be at five times less risk of suicide and self-harm than white British people (APT 2008)
For which of the following herbal remedies does evidence exist for its effectiveness in treating anxiety?
Ginkgo biloba
Lavandula angustifolia
Melissa officinalis
Piper methysticum
Valeriana officinalis (APT 2007)
Which of the following has been shown to be an ineffective remedy for treating depression?
Crocus sativus
Ginkgo biloba
Hypericum perforatum
Lavandula angustifolia
All of the above (APT 2007)
142Which of the following statements about the epidemiology of medically unexplained psychological symptoms is true?
Around 5–10% of all primary care consultations are for medically unexplained psychological symptoms
Less than 25% of patients who have debilitating fatigue lasting more than 6 months also have fibromyalgia
‘Medically unexplained symptom’ is the term preferred by GPs
Most patients with medically unexplained symptoms do not allow their doctors an opportunity to address their psychological needs
The number of such symptoms over a person’s lifetime shows a linear correlation with the number of anxiety but not depressive disorders the person has experienced (APT 2008)
Which of the following statements about the aetiological understanding of medically unexplained symptoms is true?
Children of parents with medically unexplained symptoms are at lower risk of such a presentation than the children of parents with organic conditions
Children with higher academic competence show a higher rate of medically unexplained symptoms
GPs tend to have the attitude that such symptoms should be managed in primary care
Intergenerational transmission is understood purely as social learning
Physical and emotional, but not sexual, abuse in childhood is related to such symptoms (APT 2008)
143Which of the following statements about the treatment of medically unexplained psychological symptoms is true?
The benefits from antidepressant treatment are dependent on the presence of depression
No treatment has been demonstrated to be effective in secondary care
One session of psychological therapy may reduce the number of GP visits
A somatic symptom that lasts for more than 1 year is indicative of a poor prognosis
The reattribution model of treatment has five stages (APT 2008)
With which of the following are passivity phenomena associated?
Hypoactivation of the right inferior parietal cortex
Hypoactivation of the right parietal cortex
Hyperactivation of the supplementary motor area
Reduced grey matter in the dominant parietal lobe
Reduced grey matter in the non-dominant prefrontal cortex (APT 2006)
Which of the following statements about abnormal bodily perceptions and delusions is true?
Somatic hallucinations activate the primary somatosensory and posterior parietal cortex
Body dysmorphic disorder is associated with abnormal putamen circuits
Conversion disorder with motor symptoms is associated with inhibition of the orbitofrontal cortex
They involve hyperperfusion of the left temporo-parietal cortex
Reduced striatal D2-receptor binding occurs in Cotard’s syndrome (APT 2006)
144All of the following observations about self-harm are true except:
Around 40% of the people who attend A&E following self-harm have taken an overdose
Cutting may be twice as prevalent as overdosing in community samples
The majority of the people who self-injure do not go to a hospital
One important factor in not seeking hospital treatment is a previous poor experience in A&E
One quarter of all suicides are preceded by self-harm episodes during the year before they occur (APT 2007)
Which of the following observations about self-injury is true?
Among young adults, significantly more females use self-injury to kill themselves than do males
In a household survey, 5% of the men who were surveyed admitted to self-harm without suicidal intent
People who present with cutting are less likely to present with suicidal intent than people who present with self-poisoning
Repeated self-injury is associated with sexual abuse in women but not in men
The UK has one of the highest incidences of self-injury among schoolchildren of any country (APT 2006)
145All of the following observations about self-injury are true except:
Among children and adolescents, females are more likely than males to say that they have to tried to obtain relief from an unbearable state of mind
Individuals who present with self-cutting behaviour have reported feeling less pain than matched controls
Individuals who poison themselves are more impulsive than those who cut themselves
In females, body shame is positively correlated with self-harming behaviour
Self-poisoning is a strong predictor of suicide in people with schizophrenia (APT 2006)
Which of the following statements about the treatment strategy for self-injury is true?
Manual-assisted CBT is a cost-effective method for reducing self-harming behaviour in patients with borderline personality disorder
Naltrexone at a dose of 50 mg/day can reduce self-harming behaviour when other measures have failed
Self-harming behaviour in borderline personality disorder with dissociative states has been shown to benefit little from dialectical behaviour therapy in secure units
Significant evidence suggests that people grow out of self-harming behaviour
Evidence exists which suggests that safety agreements between staff and patients reduce self-harming behaviour (APT 2006)
146All of the following statements about smoking are true except:
Approximately 50% of smokers with mental illness in the UK have shown a desire to quit smoking
High rates of smoking are significantly associated with an increased risk of other smoking-related illnesses in people with mental illness
People whose mental illness has remitted are at no greater risk of subsequent smoking than people with active disorders
People with mental illness are three times more likely to smoke than the general population
Smoking increases the risk of mental illness even after correcting for major risk indicators of a mental disorder (APT 2008)
EEG in subacute sclerosing panencephalitis shows:
Irregular theta activity
Low-voltage EEG
Triphasic waves
Periodic complex
3 Hz spike and wave (SBN)
With which of the following changes in EEG are negative symptoms in schizophrenia correlated?
Decreased alpha activity
Increased beta activity
Increased delta wave
Low mean alpha frequency
Paroxysmal activity (SBN)
147Which of the following does EEG of autistic spectrum disorders show?
Alpha deficits
Beta deficits
Beta excess
Delta excess
Theta excess (SBN)
All of the following are characteristics of alpha waves except:
They are measured at 8 to 12 Hz
They are attenuated with attention
They are bilateral and frontal
They have a higher amplitude on the dominant side
They are seen in a relaxed state with the eyes closed (SBN)
A generalised epileptiform pattern of EEG is seen with:
Alcohol
Benzodiazepine
Cannabis
Cocaine
Phencyclidine (SBN)
The shoulder is supplied by:
C3
C4
C5
C6
C7 (TN)
148With which of the following are the Ib fibres associated?
Pressure
Primary sensory output from muscle spindles
Secondary sensory terminals of muscle spindles
Sensory fibres of Golgi tendon organs
Touch (TN)
With which of the following fibre types does the fusimotor to intrafusal fibres of muscle spindles function match?
Aβ afferent
Aδ afferent
C afferent
Aα efferent
Aγ efferent (TN)
In which of the following are contralateral pain and temperature sensation loss with ipsilateral weakness and loss of proprioception seen?
Brown–Sequard syndrome
Ependymoma
Syringomyelia
Tabes dorsalis
Spina bifida (TN)
In which of the following are the gyri of Heschl?
Broca’s area
The primary auditory cortex
The primary motor area
The primary somaesthetic area
Wernicke’s area (TN)
149Which of the following statements about the anterolateral system is true?
It is involved in the transmission of discriminative touch
Its first-order neurons are bipolar
Unmyelinated C fibres in the pain pathway transmit sensations that elicit an affective response
Around 15% of its nociceptive fibres project to the thalamus via a relay in the reticular formation
The spinothalamic tract sends inputs to the dorsolateral nucleus of the thalamus (TN)
All of the following statements about the vibration sense are true except:
Decussation is in the medial lemniscus
The cell bodies of first-order neurons are located in the dorsal root ganglion
The cell bodies of second-order neurons are located in the dorsal horn
The VPL nucleus of the thalamus hosts the cell bodies of third-order neurons
Third-order neurons terminate in the postcentral gyrus (TN)
150Which of the following statements about the ascending sensory tracts to the cerebellum is true?
The anterior cerebellar tract terminates in the ipsilateral anterior lobe of the cerebellum
The cell bodies of first-order neurons are located in the dorsal root ganglion
Second-order neuron cell bodies belonging to the cuneocerebellar tract are located in the dorsal horn
Most of the proprioception information reaches conscious levels
The rostral spinocerebellar tract coordinates the movements of the lower limb muscles (TN)
Mr Bainbridge presents with muscle weakness, loss of vibratory sense, two-point discrimination and proprioception. This is due to:
Brown–Sequard syndrome
Friedrich’s ataxia
Subacute combined degeneration
Syringomyelia
Tabes dorsalis (TN)
Mr Bainbridge presents with loss of pain and temperature sensation from the skin of both shoulders and upper extremities, followed by weakness and atrophy of the intrinsic muscles of the hand. This is due to:
Brown–Sequard syndrome
Friedrich’s ataxia
Subacute combined degeneration
Syringomyelia
Tabes dorsalis (TN)
151Which of the following are the afferent fibres that pass through the inferior cerebellar peduncle?
The anterior spinocerebellar tract
The ceruleocerebellar fibres
The rubrocerebellar fibres
The tectocerebellar fibres
The trigeminocerebellar fibres (TN)
From which of the following do the monoaminergic fibres that terminate only in the granular and molecular layers of the cerebellar cortex originate?
The deep cerebellar nuclei
The hypothalamus
The locus coeruleus
The pontine raphe nuclei
The ventral midbrain tegmentum (TN)
Mr Bainbridge presents with an inability to maintain equilibrium. An examination reveals no evidence of ataxia, hypotonia or tremor. He tends to sway from side to side when he walks. The examination also reveals nystagmus. To which of the following is this probably due?
Flocculonodular syndrome
Left hemispheric zone disorder
Paravermal zone disorder
Vermal zone disorder
Right hemispheric zone disorder (TN)
152With which of the following cranial nerves is the pterygopalatine ganglion associated?
III
V
VII
IX
X (TN)
The sensory ganglion belonging to the trigeminal nerve is the:
Ciliary
Geniculate
Gasserian
Scarpa’s
Submandibular (TN)
Which of the following nuclei regulates the release of reproductive hormones from the adenohypophysis?
Arcuate
Lateral preoptic
Periventricular
Preoptic
Supraoptic (TN)
Which of the following is the body’s master clock?
Arcuate
Mamillary
Medial preoptic
Supraoptic
Suprachiasmatic (TN)
153Which of the following is the thalamic nucleus involved in learning and memory?
The anterior
The dorsal midline
The ventral midline
The pulvinar
The parvocellular (TN)
In which of the following is the medial geniculate body involved?
Hearing
The integration of somatosensory information
Sensorimotor integration
Taste
Vision (TN)
Mr Bainbridge presents with allodynia, hyperpathia and dysesthesia. To which of the following is this due?
Brown–Sequard syndrome
Dejerine–Roussy syndrome
Guillain–Barré syndrome
Kluver–Bucy syndrome
Stevens–Johnson syndrome (TN)
Which of the following is a feature of a right-hemisphere lesion?
Acalculia
Alexia without agraphia
Broca’s aphasia
Colour anomia without agraphia
Prosopagnosia (SBN)
154All of the following are features of a left-hemisphere lesion ex cept:
Agraphia without alexia
Alexia with agraphia
Constructional apraxia
Gerstmann’s syndrome
Wernicke’s aphasia (SBN)
All of the following statements about hypothalamic connections are true except that they go:
To the amygdala via the amygdalofugal bundle
To the amygdala via the stria terminalis
To the anterior thalamus via the mammillothalamic tract
To the hippocampus via the fornix
To the septum via the lateral forebrain bundle (SBN)
Which of the following statements about the anatomy of the limbic system is true?
The amygdala lies in the medial aspect of the frontal lobe
The limbic system controls the autonomic nervous system via the medial longitudinal fasciculus
Major output from the mammillary bodies flows to the posterior nucleus of the thalamus
The mammillary bodies receive a number of axons through the stria terminalis
The septal nuclei have reciprocal connections with the hippocampus via the fornix (SBN)
155Which of the following statements about the arousal system is true?
The cholinergic pathways are independent of the arousal system
During relaxed wakefulness, descending reticulospinal projections increase the sensitivity of the stretch reflex arcs
Projections from the reticular nuclei of the thalamus produce a characteristic beta-wave form on an EEG
The reticular formation in the midbrain surrounds the aqueduct of Sylvius
The reticular formation projects to the ventroposterolateral nucleus of the thalamus (SBN)
Which of the following statements about serotonergic receptors is true?
5-HT1A receptors are found in raphe cell bodies
5-HT1c is found in the heart
β-Blockers are agonists at 5-HT1B
LSD is an agonist at 5-HT3
Ritanserin is an agonist at 5-HT2A (SBN)
Which of the following statements about serotonin is true?
Decreasing concentration produces bizarre stereotyped behaviour
High CSF 5-HIAA predicts impulsivity
Increasing concentrations lead to insomnia
The postsynaptic 5-HT1 receptor mediating prolactin release is blunted in depression
Selective uptake blockers cause weight gain (SBN)
156Which of the following statements about opioid receptors is true?
β-Endorphin is an antagonist at the μ-receptor
Enkephalins are endogenous agonists of the δ-receptor
Naloxone is an agonist at the μ-receptor
Naltrexone is an agonist at the μ-receptor
Pentazocine is an antagonist at the κ-receptor (SBN)
All of the following statements about peptides are true except:
CCKA is involved in emotional behaviour
CRH stimulates locus firing
Injections of CRH produce decreased appetite
TRH is three amino acids long
Two different types of CCK receptors have been identified (SBN)
Non-urgent CT is indicated in all of the following except:
Encephalitis
Confusion for which no metabolic or toxic cause has been found
Marked and persistent or variable drowsiness
Schizophrenia developing after the age of 40 years
Progressive cognitive decline developing after the age of 65 years (SBN)
157Mr Bainbridge is a 60-year-old man. He presents with a bitemporal headache which he describes as being a pressure-like pain. He has had a history of migraine and is on medications. The most plausible diagnosis is:
Cluster headache
Cranial arteritis
Malignant hypertension
Migraine
Tension headache (SBN)
Mr Bainbridge presents with a headache on waking which seems to improve with a change of posture. The diagnosis is:
Arteriovenous malformations
Cluster headache
Hypertensive encephalopathy
Obstructive hydrocephalus
Temporal arteritis (SBN)
Mr Bainbridge presents with an occipital headache, vertigo, diplopia, blurring of vision and lethargy. The diagnosis is:
Cluster headache
Cranial arteritis
Hypertensive encephalopathy
Migraine
A space-occupying lesion (SBN)
158An EEG shows a 2/s spike and wave form in a person with a clinical history of absences. The diagnosis is:
Benign rolandic epilepsy
Creutzfeldt–Jacob disease
Huntington’s disease
Lennox–Gastaut syndrome
Temporal-lobe epilepsy (SBN)
All of the following statements about blepharospasm are true except:
It is associated with demyelinating disorders
It is more common in men than in women
l-DOPA can cause blepharospasm
Spontaneous remission occurs in only 10% of patients
Its symptom presents bilaterally (SBN)
All of the following tests form a part of the Halstead–Reitan Battery except:
The Aphasia Screen
The Seashore Rhythm Test
The Stroop Colour–Word Interference Test
The Tactual Performance Test
The Wechsler Adult Intelligence Scale (Revised) (SBN)
All of the following are clinical scales of the Standardised Luria–Nebraska Battery except:
Expressive speech
Motor
Power
Receptive speech
Rhythm (SBN)
159All of the following statements about the timing of the course of events occurring after an occlusion of a cerebral vessel are true except:
Less than 12 hours – no microscopic or macroscopic changes by conventional methods
12 to 24 hours – increasing swelling of damaged area with normal staining of the brain
1 to 3 days – inflammatory cell response
1 to 2 weeks – astrocytosis
Months or years – tissue destruction with remaining astrocytic scar or cavity formation (SBN)
All of the following statements about intracranial haemorrhages are true except:
Extradural haemorrhages are commonly due to a laceration of the middle meningeal artery
Lacunar disease presents more commonly in relation to basal ganglia when it involves grey matter
Oral contraception increases the risk of a subarachnoid haemorrhage
Subacute subdural haematomas are due to the rupturing of the veins that join the superior sagittal sinus
The most common cause of subarachnoid haemorrhages is an extension from a bleed elsewhere within the cranium (SBN)
The most common cause of acute bacterial meningitis in people of any age is:
E. coli
Haemophilus influenzae
Neisseria meningitidis
Staphylococcus aureus
Streptococcus pneumoniae (SBN)
160In the intermediate lobe of the pituitary, all of the following are derived from pro-opiomelanocortin except:
α- Melanocyte-stimulating hormone
Adrenocorticotrophic hormone
β-Endorphin
γ-Lipotrophin
Corticotrophin-like intermediate lobe peptide (SBN)
Guanylate cyclase is activated by:
ACTH
Adenosine
Angiotensin II
Arginine vasopressin
Atrial natriuretic peptide (SBN)
Adenylyl cyclase is inhibited by:
ACTH
Adenosine
Angiotensin II
Arginine vasopressin
Atrial natriuretic peptide (SBN)
Adenylyl cyclase is activated by all of the following except:
Calcitonin
Follicle-stimulating hormone
Glucagon
Insulin
Thyroid-stimulating hormone (SBN)
161Phosphoinositide turnover is controlled by:
Glucagon
Histamine
Human chorionic gonadotropin
Insulin
Thyrotropin-releasing hormone (SBN)
All of the following statements about the genetics of cognitive abilities are true except:
An allele of APOE is associated with cognitive decline in an unselected population of elderly men
Differences in the number of fragile X sequences in the normal range are correlated with the differences in ‘g’
The genes found to be associated with spatial ability are likely to be associated with verbal ability
Heterozygotes for phenylketonuria show slightly lowered IQ scores
There is no genetic link between severe learning disability and normal variations in IQ (PG)
All of the following are autosomal dominant disorders except:
Apert syndrome
Hurler syndrome
Noonan syndrome
Treacher–Collins syndrome
Tuberous sclerosis (PG)
162In which of the following conditions does IQ gradually deteriorate after the age of 2 years?
Apert syndrome
Hurler syndrome
Noonan syndrome
Treacher–Collins syndrome
Tuberous sclerosis (PG)
In which of the following is aphasia seen?
ATR-X syndrome
Coffin–Lowry syndrome
Fragile X syndrome
Rett syndrome
X-linked hydrocephalus (PG)
In which of the following are abnormalities involving MECP2 on Xq28 seen?
ATR-X syndrome
Coffin–Lowry syndrome
Fragile X syndrome
Rett syndrome
X-linked hydrocephalus (PG)
163Which of the following statements about substance misuse is true?
Family influence predominantly influences maintenance more than initiation
Its heritability is greater for females than for males
Sedative use does not have a heritable component
The Vietnam Era Twin Registry Study reported that heroin shows an effect for non-additive genetics
The Virginia Twin Registry Study strongly implicated family environment for cocaine use in men but not in women (PG)
The following genes have been implicated in the cocaine response in mouse models. They have all been correctly matched except for:
5-HT1B – increased locomotor activity
DRDR1 – increased locomotor activity
GABAA Ab3 – increased locomotor activity
Retinoic acid receptors – blunted response
NAChR beta2 – reduced conditioned place preference (PG)
All of the following are ligand-gated ion channels except:
5-HT3
GABAB
GluR6
Glycine
nAChR (N)
164Which of the following statements about the ionic receptor family is true?
Benzodiazepine prolongs the length of time for which the chloride channel is open
The binding site on nAChR is the β-subunit
GABAA subunits do not share homology with nAChR
The GluR1 subunit of AMPA receptors stimulates the growth of dendritic spines on the cortical pyramidal cells
NMDA receptors favour calcium permeation (N)
Which of the following statements about G proteins is true?
Adenylyl cyclase converts cAMP to ATP
GTP binds to the β-subunit
Gs is the second messenger coupled to the GABAB receptor
Gq activates phospholipase C to cleave PIP2
Opioid receptors are coupled to the Gq second-messenger system (N)
All of the following statements about DNA are true except:
Adenine is always paired with thymine
DNA polymerisation occurs in a 5′ to 3′ direction
The human genome consists of 3.3 × 109 bases
Transcription involves the formation of RNA from a DNA template
Around 30% of the bases encode proteins (PG)
165Which of the following statements about the processing of the genetic code is true?
cDNA is the DNA formed from mRNA by the process of reverse transcription
The promoter region is located near the 3′ end of a gene
RNA polymerase I initiates transcription
Splicing involves the removal of exons to produce contiguous mRNA composed only of introns
tRNA has a specific three-base codon sequence (PG)
Which of the following statements about the genetic code is true?
AGU is the initiation codon for polypeptide synthesis
All newly synthesised polypeptides start with methionine
An open reading frame is a translation sequence interrupted by a stop codon
UGG is a stop codon
5′UTR, but not 3′UTR, are not translated (PG)
The sequence of DNA that is situated at a defined position on a chromosome is:
An allele
A gene
A locus
mRNA
tRNA (PG)
166Which of the following statements about mutation is true?
Nonsense mutations are also known as silent mutations
Non-synonymous substitution results in a change of amino acids
The replacement of a DNA sequence with a different one is called an insertion
RNA editing involves changing of the nucleotides in RNA before transcription
When the allele frequency is less than 0.01, the variants are referred to as mutations (PG)
All of the following statements about the 5-HTTLPR gene and depression are true except:
The 5-HTTLPR gene has been associated with neuroticism
Significant interactions take place between the 5-HTTLPR gene and environmental risk among adolescent women but not adolescent men
The ‘l’ allele increases vulnerability to adverse events
The ‘s’ allele reduces the transcriptional efficiency of the serotonin promoter
There is no direct relationship between the 5-HTTLPR gene and the onset of depression (BJP 2006)
167Which of the following statements about adherence therapy is true?
Adherence therapy has a significant advantage over non-specific counselling
Adherence therapy is no more effective than health education for improving quality of life
Adherence rates for prescribed antipsychotic medication are approximately 75%
Clinical interventions for reducing non-adherence are effective in the long term
The relapse rate among a non-adherent sample is twice that of an adherent sample with schizophrenia (BJP 2006)
Which of the following statements about inflammatory response and depression is true?
A reduction in CRP occurs following SSRI treatment among patients whose depression resolves, but not among those whose depression remains unresolved
An increased level of CRP is independent of an increased IL-6 concentration
It involves an increased number of neutrophils but not monocytes
Negative acute-phase proteins are increased
SSRIs have an anti-inflammatory effect (BJP 2006)
168Which of the following statements about manic switch following treatment with antidepressants is true?
Paroxetine has shown a higher switch rate than venlafaxine
The rate of switching to mania or hypomania is greater with bupropion than with desipramine
Switch rates are higher with the newer antidepressants than with tricyclic antidepressants
There is an association between noradrenergic affinity and switch to manic or hypomanic episodes
There is no significant difference between sertraline, venlafaxine and bupropion in causing manic switch (BJP 2006)
Which of the following statements about treatment with aripiprazole is true?
It has no effects on the cognitive symptoms of schizophrenia
It may cause more insomnia than typical antipsychotics
It prolongs QTc intervals more than risperidone does
It is more effective than haloperidol in the treatment of the negative symptoms of schizophrenia
Fewer than 5% of patients who receive this treatment report weight gain (BJP 2006)
169Which of the following statements about personality disorder and depression is true?
The assessment of personality status early in treatment does not predict the outcome
ECT is associated with poorer outcomes as a treatment for depression that is comorbid with personality disorder than are other therapies
Interpersonal therapy for women with depression and personality disorder is associated with better outcomes than other therapies
The odds ratio for poor outcomes in depressive disorder that is comorbid with personality disorder is 2.18
Significant evidence has been found to suggest that psychotherapy is associated with poor treatment for depression that is comorbid with personality disorder (BJP 2006)
Which of the following statements about the neuropathology of schizophrenia is true?
Glial cell densities are reduced when schizophrenia is present
Neuronal density is greater in the left than the right hemisphere when schizophrenia is present
The pyramidal neurons are larger in the left hemisphere when schizophrenia is present
The reversal of asymmetry is most significant in cortical layer 2 when schizophrenia is present
The size and shape of pyramidal neurons do not differ between the two sides in schizophrenia (BJP 2006)
170Robust evidence has been found for an association between urbanisation and all of the following disorders except:
Anorexia nervosa
Bulimia nervosa
Depression
Psychosis
Schizophrenia (BJP 2006)
Which of the following statements about expressed emotion is true?
Critical comments among carers are associated with dependent coping strategies among them
High expressed emotion is an artefact of patient morbidity
A high level of depression in patients is associated with higher levels of expressed emotion among their carers
Hostile but not over-involved family relationships lead to relapses of schizophrenia
Low carer self-esteem is not related to low self-esteem among their patients (BJP 2006)
All of the following statements about the treatment of bipolar disorder with eicosapentaenoic acid (EPA) are true except:
A 1 g dose of ethyl-EPA is less effective than a 2 g dose
EPA may inhibit protein kinase C
The incorporation of EPA into cell membranes inhibits the action of phospholipase A2
More significant improvement is seen on the Hamilton Rating Scale for Depression with adjunctive EPA treatment than with placebo
More significant improvement is seen on adjunctive CGI with EPA than with a placebo (BJP 2006)
171The triad of optic ataxia, oculomotor apraxia and simultagnosia constitutes:
Apperceptive visual agnosia
Anton’s syndrome
Balint’s syndrome
Gerstmann’s syndrome
Central achromatopsia (KS)
Lesions of the dominant parietal lobe cause all of the following except:
Acalculia
Apperceptive visual agnosia
Agraphia
Finger agnosia
Right–left disorientation (KS)
All of the following are derived from the telencephalon except the:
Amygdala
Cerebral cortex
Hippocampus
Striatum
Thalamus (KS)
All of the following are major anatomical structures involved in semantic memory except the:
Anterior thalamic nuclei
Fornix
Inferolateral temporal lobes
Mammillary body
Prefrontal cortex (KS)
172All of the following statements about action potentials are true except:
Activation of K+ channels results in hyperpolarisation
The duration of an action potential in a neuron is 0.1–2 msec
ECl − = −81 mV
ENa + = 97 mV
The spike threshold of a neuron is approximately −55 mV (KS)
Muscarinic receptors can be measured by using:
Fluorine-18
1-hexamethylpropylene amine oxime
Iodine-123
Nitrogen-13
Xenon-133 (KS)
Dopaminergic receptors can be measured by using:
Fluorine-18
l-hexamethylpropylene amine oxime
Iodine-123
Nitrogen-13
Xenon-133 (KS)
A metabolic rate can be measured by using:
Fluorine-18
Oxygen-15
Iodine-123
Nitrogen-13
Xenon-133 (KS)
173An EEG abnormality seen during caffeine withdrawal is:
Decreased alpha activity
A diffuse slowing of delta waves
Increased beta activity
Increased voltage of theta activity
Non-specific change (KS)
An EEG abnormality seen with inhalant use is:
Decreased alpha activity
A diffuse slowing of delta waves
Increased beta activity
Increased voltage of theta activity
Non-specific change (KS)
Which of the following statements about the epidemiology of schizophrenia is true?
Its annual incidence is 0.5 to 1.0 per 10000
The fertility rate for people with schizophrenia is close to that of the general population
The lifetime prevalence of alcoholism within schizophrenia is 25%
Maternal influenza in the third trimester of pregnancy is a risk factor for schizophrenia
Up to 50% of all patients with schizophrenia have significant physical illnesses (KS)
174All of the following statements about gender differences in schizophrenia are true except:
It is equally prevalent in men and women
Less than half of all male patients but only one-third of all female patients are admitted to a psychiatric hospital before the age of 25 years
Men are more likely to experience impairment due to negative symptoms
Its onset is earlier in men than in women
Women show a bimodal distribution, with the second peak occurring in middle age (KS)
In which of the following populations is the prevalence of schizophrenia approximately 12%?
Children of two parents with schizophrenia
Dizygotic twins of parents with schizophrenia
The general population
Monozygotic twins of parents with schizophrenia
Non-twin siblings of patients with schizophrenia (KS)
All of the following are excellent candidate genes for schizophrenia except:
COMT
DISC 1
GRM 3
5-HTTLPR
NRG 1 (KS)
175Which of the following statements about the neuropathology of schizophrenia is true?
Anterior cingulate basal ganglia thalamocortical circuit dysfunction underlies its negative symptom pathology
It involves a decreased number of D2 receptors in the caudate
It involves an increase in the size of the parahippocampal gyrus
The medial dorsal nucleus of the thalamus shows a reduced number of neurons
It involves reduced symmetry of the frontotemporal but not the occipital lobes (KS)
All of the following statements about migration are true except:
Excluding African-Caribbean people, in the UK the risk of bipolar disorder among migrants is reduced to insignificant levels
The mean relative risk of any mood disorder among migrants does not depend on the relative risk among the African-Caribbean population
The mean risk of developing bipolar disorder among migrants is 2.47
The relative risk of developing schizophrenia in people with a family history of migration is 2.9
White people with bipolar disorder present more often with hypomanic symptoms than do others (BJP 2007)
176The presence of mood-incongruent psychotic features increases with evidence for linkage on which of the following chromosomes?
1q21
3q21
9q21
9p21
13q21 (BJP 2007)
All of the following are statements about factors involved in inhibition and timing in cortical circuits except:
Interneuron alterations in schizophrenia are likely to have substantial effects on cognitive processes
The IPSPs generated by non-FS neurons reflect the perisomatic location of the synaptic contacts
Some interneurons contain somatostatin
Some interneurons express the calcium-binding protein calretinin
Synapses formed by PV neurons are found at or close to pyramidal cell bodies (BJP 2007)
All of the following statements about social problem-solving therapy for personality disorders are true except:
It aims to improve social competence
It can be offered as a brief intervention
It has been evaluated as a treatment for self-harm
Problem solving with psychoeducation reduces anger expression
It produces a significant improvement on measures of service use (BJP 2007)
177All of the following statements about bibliotherapy in the treatment of social phobia are true except:
The amount of reading is not related to outcomes of bibliotherapy
Bibliotherapy is a successful treatment for anxiety disorders
People with anxiety disorders prefer to deal with difficulties themselves
Self-help shows sustained benefits in the treatment of social phobia
Therapist-augmented bibliotherapy is effective for social phobia (BJP 2007)
All of the following statements about sleep in affective disorders are true except:
Abnormal sleep patterns are associated with poor responses to psychotherapy
Abnormal sleep patterns involve decreased phasic REM sleep
Depression is associated with an increase in nocturnal arousal
There is an increased core body temperature
There is a reduction in the first period of non-REM sleep (KS)
178Which of the following statements about brain imaging in affective disorders is true?
It involves a decreased frequency of hyperintensities in the subcortical region in depression
A decrease in glucose metabolism is associated with intrusive ruminations during depressive episodes
It involves more greatly decreased metabolism in the right than in the left anterior brain in depression
It involves increased caudate nuclear volume in depression
The right prefrontal cortex is implicated in avoidance behaviours (KS)
The BCR gene is located on chromosome:
18p
21p
22p
21q
22q (KS)
Which of the following statements about dysthymic disorders is true?
Dysthymia is common among 1–2% of the general population
Dysthmic disorders involve increased REM latency
A major defence mechanism is reaction formation
Around 5–10% of those with childhood onset progress to manic or hypomanic episodes post-puberty
Around 10% of those who have dysthmic disorders progress to bipolar type 1 disorder (KS)
179An understanding of childhood disappointments as antecedents to adult depression can be gained through:
Behaviour therapy
Cognitive therapy
Family therapy
Interpersonal therapy
Insight-oriented psychotherapy (KS)
All of the following statements about cyclothymic disorder are true except:
Around 3–5% of all psychiatric outpatients have cyclothymia
Around 25% of all patients with this disorder have an onset between the ages of 15 and 25 years
The cyclothymic state is postulated to be the ego’s attempt to overcome a punitive superego
The female:male ratio for this disorder is 3:2
Its lifetime prevalence is 1% (KS)
Which of the following statements about anxiety disorders is true?
β-Carboline-3-carboxylic acid produces anxiety symptoms through activity on the GABA receptor
CRH activates endocrine programmes for reproduction
The NPY-Y2 receptor is implicated in the anxiogenic effects of neuropeptide Y
Panic disorder is provoked by α2-adrenoceptor agonists
Stress reduces serotonin turnover in the amygdala (KS)
180What is the term used for the requirement that the patient must tell everything that comes into their head?
Analyst as mirror
The fundamental rule
The principle of evenly suspended attention
The rule of abstinence
Transference (KS)
The risk of OCD in the general population is:
0.1–0.5%
0.5–1.0%
1.0–1.5%
1.5–3%
3–5% (KS)
The most effective instruments in biofeedback include all of the following except:
EEG
EMG
GSR
Thermistor
The Visual Analogue Scale (KS)
What is the term used for having patients direct their attention to specific bodily areas and hear themselves think certain phrases that reflect a relaxed state?
Adaptation of progressive muscular relaxation
Applied relaxation
Applied tension
Autogenic therapy
Biofeedback (KS)
181What is the term used for the step of applied relaxation in which patients relax just before entering the target situation, and stay in the situation for 10 to 15 minutes?
Application training
Cue-controlled relaxation
Differential relaxation
Progressive relaxation
Release-only relaxation (KS)
What is the term used for the technique in which patients act out real-life problems under a therapist’s observation or direction?
Assertiveness training
Behaviour rehearsal
Psychodrama
Social skills training
Therapeutic graded exposure (KS)
