Welcome to Part II Clinical Topics MCQs

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1)  Features of generalised Anxiety disorder in middle childhood

1. central abdominal pain
2. separation anxiety
3. regression
4. obsessional symptoms
5. manipulative behaviour

2)  Feature of post traumatic stress disorder

1. Emotional numbness
2. counterphobic behaviour
3. situation specific anxiety
4. hypervigilance
5. amnesia

3)  Complication at pregnancy of an opiate addict mother

1. cleft palate
2. abruptio placentae
3. low birth weight
4. multiple births
5. intrauterine death

4)  Characteristic features of borderline personality disorder

1. rigid narcissism
2. feelings of boredom and emptiness
3. impulsive offences
4. outbursts of aggression
5. brief psychotic episodes

5)  Specific reading retardation is associated with

1. conduct disorder
2. glue ear
3. mixed cerebral dominance
4. spelling difficulties
5. higher incidence in boys

6)  Visual hallucinations in the elderly are common in

1. untreated depression
2. acute organic psychosis
3. those treated with antihypertensive drugs
4. paraphrenia
5. post surgical convalescence

7)  In group psychotherapy the therapist aims to

1. intervene only when the group gets out of hand
2. create a small democracy
3. encourage altruism
4. interpretation of idealisation about the therapist
5. encourage pairing

8) In bipolar affective disorder

1. treatment with lithium significantly reduced relapses
2. Schnieders first rank symptoms are common
3. carbamazepine can be used in rapid cycling illness
4. a higher lithium blood level is required for acute exacerbations of mania
5. sodium valproate reduces relapses

9) In Psychodynamic Psychotherapy the patient needs to

1. be of above average intelligence
2. agree with the tenets of psychoanalysis
3. be willing to explore and challenge assumptions about himself
4. be able to deal with increased inner distress
5. be able to be able to do homework

10) Cardiac neurosis

1. can present with sharp left inframammillary pain
2. can presents with syncope on exertion
3. can present with tingling in both hands
4. can present with orthopnoea
5. can present with ectopic beats

11) Features in Kretschmer’s Sensitiver Beziehungswahn or Sensitive Reaction

1. auditory hallucinations
2. sensitive blushing.
3. shameful guilt.
4. ideas of reference.
5. paranoid delusions

12)  Huntington's chorea

1. autosomal dominant
2. choreiform movement can start later than psychiatric manifestations
3. mothers can be carriers
4. father to son transmission can be demonstrated
5. can be effectively treated with haloperidol

13) Korsakov's syndrome

1. Immediate memory is affected
2. There is always a degree of confabulation
3. Clouding of consciousness is characteristic
4. Can be caused by continuous vomiting
5. disorientation is a characteristic feature

1. Sudden onset
2. Incontinence
3. Seizures
4. Progressive agnosia
5. Gait disturbance

15) Guided mourning

1. indicated in healthy bereavement
2. based on phobic model
3. based on Freud¹s idea of cathexis
4. research has shown it to be superior to other treatments
5. e) compatible with the psychoanalytic concept of working through

16) Homework assignments are prescribed in the treatment of

1. personality disorder
2. bulimia nervosa
3. grief reaction
4. depression
5. agoraphobia

1. Most cases have suffered anorexia initially
2. Most cases .have onset in their teens
3. Sex ratio different than in Anorexia
4. Increased incidence in ballet dancers is a spurious finding
5. usually associated with impulsivity

18) Hyperactivity.disorder

1. PET scan shows hypofrontality
2. Have strong genetic influence
3. Diet is effective treatment in most cases.
4. Motor activity declines in adolescence
5. commoner in US than in UK

1. Nystagmus.
2. Ataxia.
3. Increased fast activity in frontal areas in EEG.
4. coma
5. convulsions

20) Alcohol abuse related to

1. carcinoma of oesophagus
2. cardiomyopathy
3. hypertension
4. increased incidence of cirrhosis in females
5. lung cancer

21) Squeezing technique in the treatment of sexual disorders

1. Indicated in impotence
2. Indicated in premature ejaculation.
3. clomipramine. is effective in some cases.
4. At least one third of cases have organic cause.
5. Masters & Johnson desensitisation treatment routinely uses imagery exposure

22) Paraphrenia

1. CAT scans show positive findings
2. Precedes dementia
3. Affects more women than men
4. good response to neuroleptics
5. usually runs a chronic course

23) Dementia

1. some cases improve with antidepressants
2. more than 20% over 65
3. due to normal pressure hydrocephalus is commoner in women
4. treatment with cholinomimetics can be monitored with ADS Cog scale
5. in LB. is the second commonest

1. more likely to be depressed than elated
2. if elated, more likely to have intellectual impairment than if depressed
3. eventually causes dementia
4. neurotic plaques is the main pathological finding
5. demyelination is found scattered in the CNN

1. sexual offences are over represented in those who offend
2. majority of victims of ex-offenders are adult females
3. there is an association with increased rates of personality disorder
4. the offences are associated with sexual naivete and inexperience
5. the level of association with alcohol intoxication is the same as in
   non learning disability offenders

27)  Juvenile delinquency

1. has an established heritability basis
2. is more likely to be associated with psychiatric disorder in girls than boys
3. occurs in more than in 10% of urban teenagers
4. is a common sequel to an attack of encephalitis as a young child
5. predisposes to criminal behaviour in adulthood

28)  Exhibitionism

1. can be treated with shock aversion therapy
2. is usually a sign of psychiatric illness
3. may co-exist with consenting heterosexual behaviour
4. has a low re-conviction rate after a first offence
5. is the commonest sexual offence in males

29) MDMA

1. is a hallucinogenic amphetamine
2. can lead to physical dependence
3. causes excessive drinking after ingestion
4. leads to chronic polyurea
5. causes death due to hyperpyrexia

30)  In group therapy

1. leaders are the same whatever the situation
2. if the leader is autocratic and the leader leaves the group, the group becomes more
   dysfunctional
3. abolishing of hierarchy should be an aim
4. after the first few sessions group will find its own direction and should not be disturbed
5. altruism is a common therapeutic factor

31)  Hyperventilation in panic disorder

1. causes an increase in pCO2
2. causes increased intracerebral blood flow
3. causes unilateral paraesthesia
4. causes hypocalcaemia
5. causes metabolic alkalosis

32)  HIV can present with

1. Alzheimer's type dementia
2. schizophreniform psychosis
3. hypomania
4. transient panic attacks
5. depression

33)  In patients with multiple sclerosis

1. the main cause of depression is psychological
2. demyelinating plaques have a predilection for the optic nerve
3. periventriclar plaques can affect spinal nerve tracts
4. steroids will reverse pathology
5. there is xanthochromia in CSF

34)  Findings in Wilson's Disease include

1. increased copper in urine
2. increased serum copper
3. increased caeruloplasmin
4. autosomal recessive transmission
5. increased liver copper

35)  Severe mental retardation is found in the following conditions

1. fragile X
2. Wilson's disease
3. Prader Willi
4. XXXY
5. thalassaemia

36)  Following are reversible causes of dementia

1. lead poisoning
2. normal pressure hydrocephalus
3. alcoholism
4. opiate abuse
5. parkinsonism

37)  Dissocial personality disorder is characterised by

1. shallow and labile affectivity
2. incapacity to maintain relationships, but no difficulty in establishing them
3. excessive preoccupation with being criticised or rejected in social situations
4. onset after the age of 18
5. marked proneness to blame others for misfortunes and problems

38)  Suicide

1. occurs at a rate of just over 10 per 100,000 of population in UK
2. is most common amongst those over the age of 75
3. is commoner in drug abusers in the UK
4. is more common in women
5. is commonest in social classes III and IV

39)  Following statements are true

1. the term 'anankastic' personality disorder was suggested by Kahn
2. cultural or regional variations in the manifestations of personality disorders is rare
3. it has been suggested that Briquet's syndrome is a female form of personality disorder
4. evidence for a genetic contribution to personality disorder is well established
5. people with dissocial personality disorder tend to have a lower than normal IQ

40)  In relation to attempted suicide (DSH)

1. females outnumber males by two to one
2. up to 2% of people who attempt suicide kill themselves in the year following the attempt
3. 50% of people who attempt suicide repeat the attempt within a year
4. uptake of follow up is 30 - 50%
5. attempted suicide is commonly associated with excessive alcohol consumption

41)  Regarding schizoid personality disorder

1. there is apparent sensitivity to criticism
2. is commoner in only children
3. is readily distinguishable from Asperger's syndrome
4. is associated with a combative and tenacious sense of personal rights
5. is accompanied by feelings of excessive doubt and caution

42)  following statements apply to self- wounding

1. self wounding is strongly associated with anorexia nervosa
2. persistent self wounding is virtually diagnostic of borderline personality disorder
3. a history of incest is common
4. people with mental handicap are more likely than controls to wound themselves
5. self wounding is often prevented by using alcohol

43)  Essential features of sensate focus

1. sequence technique
2. ban on penetration
3. ban on masturbation
4. avoiding interruption
5. graded massage techniques

44)  Pseudoseizures are suggestive if

1. fits lasts longer than 30 mins
2. fits increase when patient is held
3. interictal EEG abnormalities are present
4. incontinence is present
5. they occur at night

45)  Benzodiazepine withdrawal rather than anxiety is suggested by

1. tinnitus
2. hyperawareness of senses
3. a feeling of movement
4. poor sleep
5. metallic taste in the mouth

46)  Regarding drug abuse

1. IV dipipanone is treatment of choice in acute opiate withdrawal
2. withdrawal of amphetamine leads to fits
3. treatment with methadone is associated with long term abstinence
4. 50% of addicts are dead in 4 years
5. use of cocaine leads to formication paraesthesia

47)  Alcohol abuse in women

1. is as common as in men
2. is less likely to be associated with increased family disorder
3. heavy drinking in pregnancy leads to increased risk of still birth
4. there is more risk of cirrhosis than in men
5. there is an association with shoplifting

48)  Asperger's syndrome features include

1. unusual interests
2. stilted speech
3. above average intelligence
4. poor social skills
5. hallucinations

49)  Contingency therapy

1. involves parents leaving to observe and reward behaviour
2. is developed from operant conditioning
3. involves parents gaining self knowledge
4. involves parents giving consistent response
5. is used in the treatment of enuresis

50)  Infanticide

1. automatically leads to prison
2. a mother can be convicted of this after the child is one year of age
3. the father can be charged with this
4. neonaticide often involves a suicide attempt
5. usually the result of delusions about the baby

    

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51)  Fitness to plead

1. a person can be unfit to plead because of delusional beliefs about the crime
2. can be successful because of selective amnesia for the crime
3. can lead to acquittal
4. is decided by the psychiatrist
5. can lead to hospitalisation 

52)  Ejaculatory failure is associated with

1. thioridazine
2. sertraline
3. alpha blockers
4. beta blockers
5. venlafaxine

53)  In convicted prison population

1. IQ level is at least 1 SD below the population mean
2. one third have a mental disorder
3. at least 60% abuse substances
4. epilepsy is commoner than normal population
5. there will be people who will be unfit to plead

54)  In brief psychotherapy

1. rapport should be encouraged
2. patient and the therapist should meet daily
3. regression should be encouraged
4. all attempts by others to prescribe drugs should be resisted
5. counter transference should be ignored

55)  CBT as an out patient

1. will be protracted
2. depends on the use of the Beck depression inventory
3. is as effective as imipramine in the treatment of moderately severe depression
4. is as effective as interpersonal therapy in the treatment of depression
5. involves cognitive restructuring

56)  Treatment of simple phobia

1. the concept of preparedness explains why some objects are the source of phobias
2. phobias occur almost exclusively in women
3. graded exposure is not effective
4. treatment of agoraphobia is more successful than simple phobia
5. involves anxiety reduction by anxiolytic medication

57)  Negative therapeutic reaction

1. is the first sign of transference
2. occurs when the therapist and the patient don't get on at first
3. occurs after a period of apparently successful therapy
4. is a sign of hidden feelings of guilt and shame
5. usually involves excerbation of original symptoms

58)  Following are found more commonly in people with learning difficulties

1. epilepsy
2. schizophrenia
3. anxiety
4. behavioural problems
5. anorexia nervosa

59)  Commonly found in Down's syndrome

1. triradius
2. fits
3. high tone deafness
4. hypomania
5. epicanthic folds

60)  In patients with learning difficulties deliberate self harm is

1. often motivated by the reaction of people around them
2. occurs during the times of understimulation
3. can be successfully reduced by phenobarbitone
4. is particularly common in Cornelia de Lange syndrome
5. can be treated by contingency management

    

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61)  After severe closed head injury

1. at least 10 per cent of patients suffer from post-traumatic epilepsy
2. the best prognostic indicator is post-traumatic amnesia
3. recovery may continue for two years
4. headaches are an invariable sequel
5. progressive dementia is a recognised sequel

62)  Chronic Institutionalised Schizophrenic Patients

1. often underestimate their age
2. are more likely to respond to pimozide than patients with acute schizophrenia
3. often perform poorly on tests of intellectual functioning
4. are indistinguishable from those with severe learning disability
5. may improve during an acute febrile illness

63)  The agorophobic syndrome

1. is equally common in men and women
2. sometimes responds dramatically to ECT
3. in psychodynamic terms is a form of anxiety hysteria
4. usually begins in adolescence
5. is often associated with high generalised anxiety

64)  Tactile hallucinations are a recognised feature of

1. paranoid schizophrenia
2. alcoholic polyneuropathy
3. obsessive hypochondriasis
4. cocaine abuse
5. dermatitis artefacta

65)  Premature ejaculation is

1. one of the easiest sexual problems to treat
2. more common among married than unmarried men
3. likely to respond to anxiolytic medication alone
4. treatable by the pause (stop-start) technique
5. more likely to respond if a programme includes the squeeze technique
6. a common sign of sexual deviation

66)  Guided morning

1. requires the patient to recall episodes and feelings related to his bereavement
2. requires interpretation of transference
3. is compatible with the psychoanalytic concept of "working through"
4. includes systematic desensitisation
5. may include a visit to the grave

67)  Established indices of poor prognosis for behavioural treatment of
obsessive-compulsive states include

1. a longstanding condition
2. onset later in life
3. unmarried status
4. absence of precipitating factors
5. association with other psychiatric symptoms

68)  Unilateral ECT

1. should be administered via the dominant hemisphere
2. requires on average more applications per course than bilateral ECT
3. is contraindicated in patients over 70
4. is less liable to precipitate mania than bilateral ECT
5. is the treatment choice for depersonalisation

69)  Recurrent episodes of clouding of consciousness with lucid intervals are a
recognised feature of

1. carbon monoxide poisoning
2. subdural haematoma
3. Lewy body dementia
4. hepatic failure
5. bronchopneumonia

70)  Fluoxetine

1. selectively blocks the neuronal uptake of noradrenaline
2. is more cardiotoxic than imipramine
3. has an elimination half life of 3 days
4. increases the concentration of tricyclics when concurrently prescribed
5. is associated with nausea and dyspepsia

71)  In childhood

1. fear of ghosts is normal at age 9 yrs
2. seperation anxiety is present at 8 yrs of age
3. lack of theory of mind is a recognised feature before 8yrs
4. intelligence can be demonstrated in a 4 month old infant
5. development of more than one affectional bond is uncommon

72)  Specific reading retardation is associated with

1. intellectual impairment
2. spelling diffilulties
3. poor eyesight
4. hyperkinetic syndrome
5. brain damage

73)  In homicide

1. a family member is not at increased risk
2. 1/3 commit suicide afterwards
3. prevalence is same as suicide in a schizophrenic offender
4. more likely against a family member in a female with puerperal psychosis
5. is commoner in families with high expressed emotion

74)  In UK prison population

1. 45% are epileptic
2. 30% have psychiatric problems
3. personality disorder is the commonest psychiatric diagnosis
4. some are not fit to plead
5. Ganser syndrome is well recognised

75)  With respect to violent crime and psychosis

1. when schizophrenia is associated with violence, it is usually due to
   delusional ideas
2. people with schizophrenia are more likely to commit violent offences
   against victims known to them rather than strangers
3. most people with schizophrenia who commit violent offences are
   receiving actively supervised treatment
4. a violent crime is most likely in the first few weeks of a schizophrenic illness
5. among violent offenders the prevalance of schizophrenia is greater than that of
   the general population

76)  Attachment behaviour in children

1. is the same as shown by adults
2. has a genetic basis
3. involves indiscriminate attention seeking
4. ameliorates negative affect
5. may indicate insecurity if absent

77)  Mental handicap and epilepsy

1. frequently causes schizophreniform psychosis
2. is a cause of violence frequently
3. is difficult to control
4. usually needs more than one drug to control
5. causes intellectual deterioration

78)  First affective disorder in old age

1. has less family history
2. life expectancy is reduced
3. somatic delusions are common
4. treatment with antidepressants may help intellectual impairment
5. may be due to a dementing illness

79)  ECT and memory

1. memory loss can be permanent
2. memory loss is least likely with light anaesthesia
3. memory loss diminishes with treatment
4. memory loss is more with bilateral treatment
5. memory loss is reduced if muscle relaxant is given in minimal dose

80)  Juvenile deliquency

1. has an eastablished heriditary basis
2. often due to early encephalitis
3. there is an increased risk of criminality in adult life
4. deterioration in females is more likely to be associated with
   psychiatric disorder
5. at least 10% of urban teenagers are deliquent