High yield MCQ stuff

Question 1

Effect of divorce on chilren

Answer 1

From memory:
most have problems early
most adjust eventually, takes 3-5 years
child’s age and how parents get a long are importan

Question 2

Kubler Ross stages of grief

Answer 2

DABDA

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Question 3

Tx of sleep DO

Answer 3

Cataplexy: 1st line: sodium oxybate, 2nd TCA s esp clomipraine
Sleep paralysis and hypnagogoc Hal: TCA, SSRIS, venlafaxine
enuresis: TCA
Sleep attacks:modafinil
rem sleep behaviour DO: clonazepam

Question 4

Erikson’s stages

Answer 4

1. trust vs mistrust: 0-18 m. Virtue: hope
2. autonomy vs shame and doubt: 18m-3 yrs. will
3. initiative vs guilt: 3-5. purpose
4. industry vs inferiority: 5-13. competence
5. identity vs role confusion: 13-21. fidelity
6. intimacy vs isolation: 21-40. love
7. generativity vs stagnation: 40-60. care
8. integrity vs despair: 60-death. aisdome

Question 5

mirtazapine actions

Answer 5

blocks: H1, Ser 2, 3, alpha 2, increases NA

from memory

Question 6

PKU

Answer 6

AR, purine metabolism

Question 7

lech nyhan

Answer 7

X linked recessive?

hyperuricemia, self mutilation , MR

Question 8

benzo conversion

Answer 8

1 Xanax=10 of diazepam?

Question 9

Prader willi

Answer 9

chromosome 15, dleletion, paternal

Question 10

compare conversion and malingering

Answer 10

-

Question 11

compare depression and grief

Answer 11

-

Question 12

turner’s syndrome

Answer 12

XO

no MR

Question 13

thomas and Chess temperaments

Answer 13

IRAQ TAAAD

approach/withdrawal (response to new situations)
adaptability (to change)
activity level (time spent in activities)
attention span
distractibility
intensity (energy level)
threshold responsiveness (intensity required to get response)
quality of mood
rythmnicity (regulation of functions)

Question 14

mahler

Answer 14

ASD PRO
autism
symbiosis
differentiation
practicing
rapprochement
object constancy

Question 15

GAF for:
SI
delusions, Hal
suicide attemtp

Answer 15

41-50
21-30
11-20

Question 16

stages of change: Prochasca

Answer 16

pre-contemplation
contemplation
preparation/determination
action
maintenance
relapse prevention

Question 17

motivational intrerviewing

Answer 17

DEARS
develop discrepancy
express empathy
avoid arguments
roll with resistance
support self effciacy

Question 18

Cloninger’s 2 types of alcoholism

Answer 18

Type 1= milieu limited: female, over 25, environmental, passive avoidance, harm avoidance low noverly seeking

Type 2=male limited: early onset, male, more criminal activity, high novelty seeking

Question 19

tx of other impulse control DO

Answer 19

i. kleptomania: serotonergic antidepressants
ii. pyromania: anticonvulsants (limited data)
iii. pathological gambling: antidepressants due to link with affective disorders (limited data)
iv. intermittent explosive disorders: carbamazepine, lithium, propranolol, serotonin selective medications (buspirone and SSRIs)
v. paraphilias: antiandrogen medications (medroxyprogesterone and cyproterone), chemical castration (leuprolide, triptorelin), oral estrogen, clomipramine and SSRIs

Question 20

dementia pracox coinedby?

Answer 20

Kraeplin

Question 21

double bind theory

Answer 21

bateson

Question 22

poor prognosis in schiz

Answer 22

early onset
lack of precipitating factors
insidious onset
poor premorbid function
withdrawn, autistic behavior
single, divorced, or widowed
family history of schizophrenia
poor support systems
negative symptoms
neurological signs / symptoms
history of perinatal trauma
no remissions in three years
many relapses
history of assaultiveness

Question 23

good prognosis in schiz

Answer 23

late onset
precipitating factors
acute onset
good premorbid function
mood disorder symptoms
Married
Family history of mood disorder
good support systems
positive symptoms
and apparently having an Ok twin

Question 24

RF for paranoid PPD

Answer 24

minorities
immigrants (like Delusionall DO)
deaf like delusional DO)
(compare to delusional DO RF)

• Does not tend to run in families (unlike delusional DO)
but can have family hx of schizophrenia.
• Men>women (unlike delusional DO)

Question 25

MR

Answer 25

``` DSM-IV had IQ cut-offs for MR: 50-55 to 70 Mild 35-40 to 50-55 Moderate 20-25 to 35-40 Severe Below 20-25 Profound ```

Question 26

prevalence of delusional DO | Paranoid PS

Answer 26

0. 025 (females more) | 0. 5-2.5 (men more than women)

Question 27

delusional DO facts

Answer 27

``` 0.025 more women holds true no relation to mood DO and schiz good functioning starts in 40s usually can have premorbid paranpoid PD traits? ``` ``` RF: advanced age sensory imparement isolation family Hx (but no fam Hx of schizophrenia) personality features recent immigration ```

Question 28

ED criteria for admission

Answer 28

This is from memory: Temperature below 36C Pulse below 40 (near 40 in child, 50 inMCQs) or over 110 Postural changes (increasein HR by 20 BPM, or decrease in BP by 20) BP< 90/60 (lower accepted in children

Question 29

BDD CB

Answer 29

• Likely to be unmarried, history of MDE (90%), anxiety (70%), psychosis (30%)

Question 30

Porphyria

Answer 30

``` Acute Intermittent Porphyria: • Autosomal dominant metabolic disirder • Problem in heme production • Second most common porphyria (1st is cutanea tarda) • 95% of people have abdominal pain • Urinary symptoms (dysuria, dark urine) • Peripheral neuropathy • Proximal motor weakness • Sympathetic nervous symptoms (circulating catecholamines are increased) • Hyponatremia can occur due to SIADH ```

Question 31

Expressive language DO

Answer 31

Expressive Language Disorder K&S p. 1175 • Selective deficit in expressive language development relative to receptive skills and nonverbal intelligence • In IQ testing verbal level may appear depressed compared to IQ • Below expected levels of vocabulary, tense usage, sentence construction, and word recall • Often present as younger than age • Can be developmental (majority) or acquired; usually congenital without an obvious cause • Expressive deficits often occur without receptive, though receptive dysfunction often causes expressive problems • Two to three times more common in boys, and children with fam history of communication issues • High comorbidities: o ADHD (19%) o Anxiety Disorder (10%) o ODD and CD (7%) o Higher risk for speech disorder, receptive d/o, learning d/o o Associated with reading d/o, developmental coordination d/o o Other communication d/o • Delayed motor skills and enuresis are common • Soft neuro signs, depressed vestibular response, EEG abnormalities Boys with severe behaviour issues have high levels of undiagnosed language dysfunction • 50% of children with mild difficulties recover spontaneously without signs of impairment. Children with more sever impairment may continue to display features.

Question 32

Tourette's Disorder

Answer 32

Tourette’s Disorder K&S p. 1235 -Motor component usually emerges by age 7, while vocal by age 11. -M:F = 3:1 -Natural history is a reduction or complete resolution by adolescence -Initially occur in face and neck and over time travel downwards -Up to 50% have ADHD (appears before tics) and 40% OCD (after tics) -OCD is more common in high IQ, and tends to be more symmetry/counting/repetition -Head and neck is most common area. Most frequent initial symptom is eye-blink, then head tic or facial grimace. -Corporlalia occurs in 1/3 of patients, often in adolescence -Older children, ados, and adults often report a “premonitory urge” (unpleasant sensation)

Question 33

Disulfiram precautions

Answer 33

metronidazole alcohol in perfumes high impulsivity, likely to drink while using it, history of psychosis, DM, epilepsy, hepatic dysfunction hypothyroid, renal impairment, rubber contact dermatitis

Question 34

Tests for: Information processing speed motor dexterity Language Executive functions

Answer 34

Information-processing speed 
WAIS-R or WAIS-III Digit Symbol: rapid graphomotor tracking
 Trailmaking Part A: rapid graphomotor tracking
 Stroop A and B: rapid word reading and color naming
 Motor dexterity
 Finger tapping: right and left index finger dexterity
 Language 
Boston Naming Test: word retrieval
 Executive functions
 Trailmaking Part B: rapid alternation between tasks
 Stroop C: inhibition of an overlearned response 
Wisconsin Card Sorting Test: categorization and mental flexibility 
Verbal fluency : rapid word generation
 Design fluency: rapid generation of novel designs

Question 35

biological RF for CD

Answer 35

* Low levels of dopamine beta hydroxylase (converts DA to NE) * High blood serotinin, low CSF 5HIAA * Greater right frontal EEG activity at rest

Question 36

reward in the brain?

Answer 36

VTA | nucleus accumbens

Question 37

part of DA system?

Answer 37

sunstantia nigra nucleus accumbens subthalamic nucleus? apparently not raphe nucleus

Question 38

tuberous sclerosis

Answer 38

second most common of the neurocutaneous syndromes (behind neurofibromatosis which is also AD) - Autosomal dominant – 2/3 of cases are sporadic - mental retardation in 2/3rds of affected people - seizures, adenoma sebaceum and ash-leaf spots, adenomas in ventricles

Question 39

HIV psychiatry

Answer 39

MOst common dx: adjustment DO depression slightly higher than gen pop, less specific sx, increases with progression to AIDS mania same as gen pop in asymptomatic HIV (10 times)