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MRCPsych Part B - Al-Rashid Hospital > MRCPych Mentor 2 > Flashcards

MRCPych Mentor 2 Flashcards

1
Q

What survey did ECA use?

A

DS

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2
Q

Which country did the ECA take place?

A

USA

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3
Q

Partial defences for murder?

A

Diminished responsibility
Loss of control
Suicide pact

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4
Q

Risk of schizophrenia if cannabis use <18?

A

4 fold

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5
Q

Risk of schizophrenia if cannabis use >18?

A

2 fold

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6
Q

What antidepressant has been shown to be effective or depression if given S/L?

A

Fluoxetine

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7
Q

Who created behavioural activation?

A

Martell

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8
Q

What drug is licensed for opiate detox in pregnancy?

A

Methadone

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9
Q

SSRIs to use in breastfeeding?

A

Paroxetine

Sertraline

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10
Q

SSRIs to use in pregnancy?

A

Fluoxetine
Amitriptyline
Imipramine

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11
Q

Requirements of testamentary capacity

A 
They must know
Extent and value of their property
Who the natural beneficiaries are
The disposition they are making
The plan as to how the property will be distributed
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12
Q

Who coined the term ‘therapeutic community’?

A

Thomas Main

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13
Q

ARR equation?

A

CER - EER

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14
Q

NNT equation?

A

1/ARR

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15
Q

Relative risk reduction equation?

A

ARR/CER

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16
Q

Relative risk equation?

A

EER/CER

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17
Q

What measures inter-rater agreement/reliability?

A

Kappa

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18
Q

Equation for standard error of the mean

A

SD/square root of n

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19
Q

What does standard error of the mean tell us?

A

Spread expected for the mean of the observations i.e. how accurate the calculated mean is based on the true population mean

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20
Q

Calculation for variance?

A

Sum(x - xbar)^2 / n-1

xbar = sample mean

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21
Q

How much of the data lies within 1 SD?

A

68.3%

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22
Q

How much of the data lies within 2 SD?

A

95.4%

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23
Q

How much of the data lies within 3 SD?

A

99.7%

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24
Q

What is GRADE used for?

A

To rate the quality of evidence of systematic reviews and guidelines

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25
Q

What is linear regression used for?

A

To predict how much one variable changes when a 2nd variable is changed

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26
Q

What increases as prevalence falls?

A

NPV

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27
Q

What does cost-effectiveness analysis do?

A

Compares interventions by relating costs to single clinical measure of effectiveness e.g. sx reduction

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28
Q

In which study are results reported as ICER?

A

Cost-effectiveness analysis

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29
Q

What is measured in cost-benefit analysis?

A

Money

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30
Q

What is measured in cost-utility analysis?

A

Multi-dimensional health outcomes such as QALY

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31
Q

Which economic study can compare treatments across conditions?

A

Cost-utility analysis

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32
Q

Sensitivity equation

A

TP/TP+FN

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33
Q

Specificity equation

A

TN/TN+FP

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34
Q

LR+ equation

A

sens/1-spec

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35
Q

LR- equation

A

1-sens/spec

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36
Q

PPV equation

A

TP/TP+FP

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37
Q

NPV equation

A

TN/FN+TN

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38
Q

What is opportunity cost?

A

Value of the next-best alternative that is forgone when a choice is made

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39
Q

How is opportunity cost measured in healthcare?

A

QALY

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40
Q

Define p value

A

Probability of rejecting null hypothesis when it is true

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41
Q

Equation for power

A

1 - beta

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42
Q

How do you find out the lower quartile?

A

(N+1) / 4th value

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43
Q

How do you find the upper quartile?

A

3(n+1)/4

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44
Q

What is the middle line in the box of a box-whisker plot?

A

Median

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45
Q

Define specificity

A

Proportion of patients without the condition who have a negative test result

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46
Q

Define likelihood ratio for a +ve test result

A

How much the odds of the disease increase when a test is positive

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47
Q

Define +ve predictive value

A

The chance that the patient has the condition if the diagnostic test is positive

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48
Q

What does a 95% CI mean?

A

If the study was repeated then the mean value would be within this interval 95% of the time

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49
Q

What happens to SEM as sample size increases?

A

Gets smaller

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50
Q

What type of regression is used for dichotomous variables?

A

Logistic

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51
Q

What is the denominator for the incidence rate?

A

Total person time at risk during specific time period

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52
Q

What rate provides information on the number of new cases of a disease that occur over a period of time and also accounts for people who leave the population during the time period under study?

A

Incidence rate

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53
Q

Analytic techniques used in qualitative studies

A

Content analysis

Constant comparison

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54
Q

Define cumulative incidence

A

Proportion of a candidate population that becomes diseased over a specified period of time

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55
Q

Define incidence rate

A

Occurrence of new cases of disease that arise during person-time observation

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56
Q

Calculation for prevalence

A

Incidence x duration of condition

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57
Q

How can one assess internal consistency?

A

Average inter-item correlation
Average item-total correlation
Split half correlation
Cronbachs alpha

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58
Q

What is attributable risk?

A

the rate in the exposed group minus the rate in the unexposed group.

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59
Q

What is the population attributable risk?

A

the reduction in incidence that would be observed if the population were entirely unexposed.

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60
Q

Methods for assessing validity of qualitative studies

A

Triangulation
Respondent validation/member checking
Bracketing
Reflexivity

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61
Q

Define p value

A

Possibility of obtaining a result at least as extreme, assuming the null hypothesis is true

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62
Q

What is triangulation?

A

Comparing results from 2+ different methods of data collection or sources

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63
Q

What is respondent validation/member checking?

A

When the investigator’s account is compared with the research subjects

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64
Q

What is bracketing?

A

Deliberately putting aside ones own belief about the phenomenon under investigation

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65
Q

What is reflexivity?

A

Sensitive to the ways in which the researcher and research process have shaped the collected data including prior assumptions & experience

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66
Q

What form of analysis for qualitative data is based on grounded theory?

A

Constant comparison

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67
Q

Name the tests used to check for normal distribution

A 
The Kolmogorov-Smirnov (Goodness-of-Fit) Test (when adapted specifically for this purpose it is sometimes referred to as the Lilliefor's test)
Jarque-Bera test
Wilk-Shapiro test
P-plot
Q-plot
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68
Q

Equation for post test probability

A

Pre-test probability/ (1- pre-test probability)

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69
Q

Which cost study uses a single clinical measure of effectiveness?

A

Cost-effectiveness analysis

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70
Q

What is the square root of the variance?

A

SD

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71
Q

Wilson & Junger criteria for sscreening

A

The condition is an important public health problem
There is acceptable treatment for patients with the recognised disease
Facilities for diagnosis and treatment should be available
There should be recognised latent or early sx stage
Natural hx of the condition should be adequately understood
Test/examination should be acceptable to the population
There should be agreed policy on who to treat
Cost of case-finding should be economically balanced in relation to possible expenditure
Case-finding should be a continuous process and not a ‘once and for all’

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72
Q

How many levels in GRADE?

A

7

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73
Q

Level 7 of GRADE?

A

Case reports

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74
Q

Describe GRADE

A

Systematic r/vs and meta-analysis of RCTs w/ definitive results
RCTs w/ definitive results (CI that dont overlap threshold clinically significant effect)
RCTs with non-definitive results
Cohort studies
Case-control studies
Cross sectional surveys
Case reports

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75
Q

Define variance

A

Average of SD from mean

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76
Q

x axis of ROC

A

1- specificity

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77
Q

y axis of ROC

A

sensitivity

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78
Q

What fraction of people who stop clozapine due to neutropenia or agranulocytosis develop a blood dyscrasia on rechallenge?

A

1/3

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79
Q

Who developed group psychotherapy?

A

Moreno

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80
Q

Which antidepressants should be avoided in DM?

A

TCAs

MAOIs

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81
Q

Risk of fatal agranulocytosis?

A

1 in 10,000

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82
Q

Primary metabolite of paracetamol?

A

Benzoquinoneimine

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83
Q

Defence mechanisms of phobias

A

Repression

Displacement

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84
Q

Defence mechanisms of OCD

A

Isolation
Undoing
Reaction formation

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85
Q

Defence mechanisms of BPD

A

Projection

Splitting

86
Q

Defence mechanisms of Narcissistic PD

A

Projection

Splitting

87
Q

Defence mechanisms of Agoraphobia

A

Displacement

88
Q

Antidepressants recommended for post-CVE depression?

A

SSRIs - Fluoxetine
Mirtazapine
Nortriptyline

89
Q

How long should elderly continue antidepressants after remission of depression?

A

2 years

90
Q

Over what time period should SSRIs be stopped?

A

6 weeks

91
Q

Which therapy is based on Otto Kernberg’s theory of BPD?

A

Transference-focused therapy

92
Q

Is clozapine-induced constipation dose-related?

A

Yes

93
Q

Which tool predicts violence?

A

VRAG

94
Q

Which herbal remedy has good evidence for depression?

A

Hypericum perforatum

95
Q

What must be checked prior to px Lithium?

A

Renal
Cardiac
Thyroid function

96
Q

What must you do if amber result for a patient on clozapine?

A

Must have another blood test within a day or two and must have twice weekly blood tests until the result improves.

97
Q

Which psych studies was based exclusively in England, Scotland & Wales?

A

National Psychiatric Morbidity Survey

98
Q

Another name for St Johns Wort

A

Hypericum perforatum

99
Q

Genetics of PKU

A

AR

100
Q

Genetics of Hurlers

A

AR

101
Q

Genetics of Tay-Sachs

A

AR

102
Q

Genetics of Friedrich’s ataxia

A

AR

103
Q

What predicts poor outcome of schizophrenia?

A

Male gender
Early age of onset
Prolonged DUP
Severity of cognitive and -ve sx

104
Q

Which antipsychotic is most likely to cause postural hypotension?

A

Risperidone

105
Q

Kane criteria for treatment-resistant schizophrenia

A

No improvement after 3x periods of treatment with neuroleptics (from 2 or more different chemical classes) in previous 5 years equivalent to 1000mg per day of chlorpromazine for 6 weeks
Pa`tients had had no episodes of good functioning in the previous 5 years

106
Q

What was the first fully structured instrument developed to be used by lay interviewers?

A

DIS

107
Q

What scale is used to help detect Tardive Dyskinesia?

A

AIMS (Abnormal Involuntary Movement Scale)

108
Q

Which diagnostic system divides conduct disorder into <10 (childhood) and >10 (adolescent)

A

DSM V

109
Q

How does ICD 10 divide conduct disorder?

A

Socialised
Unsocialised
Family context only
ODD

110
Q

What is eros?

A

Life instinct

111
Q

Most common anxiety disorder in ECA?

A

Phobia

112
Q

What is Vorbeigehen?

A

Approx answers

113
Q

Which TCAs are associated with discontinuation sx?

A

Amitriptyline

Imipramine

114
Q

TCAs that can be used in pregnancy

A

Amitriptyline
imipramine
Nortriptyline

115
Q

Items on RRASOR: Rapid Risk of assessment for sex offence recidivism

A

Number of past sex offence convictions or charges
<25 years
Gender of victim
Offender is unrelated to victim

116
Q

SCOFF q’s

A

Do you ever make yourself sick because you feel uncomfortably full?
Do you ever worry that have lost control over how much you eat?
Have you recently lost more than one stone in a 3 month period?
Do you believe yourself to be fat when others say you are too thin?
Would you say food dominates you life?

117
Q

Enuresis is normally only diagnosed after what age?

A

5

118
Q

Who is associated with community therapy?

A

Rappaport

119
Q

Which antidepressants shouldnt be used in those at risk of arrhythmia?

A 
Moclobemide
Citalopram
Bupropion
Lofepramine
Venlafaxine
120
Q

Which rec drug blocks dopamine transporters leading to an increase in dopamine levels in the synaptic cleft?

A

Cocaine

121
Q

Which rec drugs target monoamine transporters?

A

Amphetamine
Ecstasy
Cocaine

122
Q

How does GHB work?

A

G coupled receptors

123
Q

Another name for GHB?

A

Y-hydroxybutyrate

124
Q

Which mood stabiliser causes closed angle glaucome?

A

Topiramate

125
Q

Who developed an enhanced form of CBT for ED?

A

Fairburn

126
Q

What is the diagnosis if someone has sx of schizophrenia for >1 month but less than 6 months?

A

ICD: Schizophrenia

DSM V: schizophreniform disorder

127
Q

Percentage of people convicted of homicide in England and Wales (1996-1999), who were psychotic at the time of the offence.

A

5%

128
Q

How many people who commit homicide have an abnormal state of mind at the time of the offence?

A

10%

129
Q

The percentage of people convicted of homicide in England and Wales (1996-1999), who made contact with mental health services within 12 months prior to the offence.

A

9%

130
Q

Rate of any mental disorder in those convicted of homicide

A

34%

131
Q

Rate of schizophrenia in those convicted of homicide

A

5%

132
Q

Rate of affective disorder in those convicted of homicide

A

7%

133
Q

Rate of PD in in those convicted of homicide

A

9%

134
Q

Rate of alcohol dependence in in those convicted of homicide

A

7%

135
Q

Rate of drug dependence in those convicted of homicide

A

6%

136
Q

How many suicides are patient suicides (contact with MH services in 12 months)

A

28%

137
Q

How many patient suicides are IP?

A

10%

138
Q

Most common drug to self-poison for MH patients resulting in suicide?

A

Opiates - 23%

139
Q

How many patient suicides occur within 3 months of d/c?

A

18%

140
Q

Which age group has highest rate of suicide?

A

40-400

141
Q

Most common method of homicide?

A

Use of sharp instrument - 40%

142
Q

Most common relationships of victim to offender in homicides

A

Acquaintance - 42%
Stranger - 26%
Partner - 20%
Other family member - 12%

143
Q

How many perpetrators of homicide have a hx of schizophrenia?

A

6%

144
Q

How many homicide perpetrators were known to MH services in last 12 months?

A

10%

145
Q

Low lvels of what must be excluded in cases of Pica?

A

Iron and Zinc

146
Q

What is geophagia?

A

Clay eating

147
Q

What is amylophagia?

A

Starch eating

148
Q

Equation for SD?

A

Square root of variance

149
Q

Which type of depression involves reverse neurovegetative sx (hyperphagia/hypersomnia)?

A

Bipolar depression

150
Q

1st line medication for bipolar depression

A

Fluoxetine with Olanzapine

Quetiapine on its own

151
Q

2nd line medication for bipolar depression

A

Lamotrigine on its own

152
Q

Medication guidelines for bipolar depression of lithium not working and normal dose level

A

Add Fluoxetine with Olanzapine
Add Quetiapine
Stop additional treatment and add lamotrigine to lithium

153
Q

1st kine medication guidelines for bipolar depression re Maudsley

A

Quetiapine

154
Q

2nd line medication guidelines for bipolar depression re Maudlsey

A

Lathium or valproate

155
Q

3rd line medication guidelines for bipolar depression re Maudsley

A

Lamotrigine

156
Q

4th line medication for bipolar depression re Maudsley

A

Antidepressant + mood stabiliser or antipsychotic (olanzapine & fluoxetine)

157
Q

1st line medication for ADHD in adults

A

Methylphenidate

158
Q

1st line medication for ADHD in adults if concerns re stimulant abuse

A

Atomoxetine

Bupropion

159
Q

Medication guidelines for GAD if no effect with SSRIs or SNRIS

A

Pregabalin

160
Q

How long to continue meds for GAD if successful?

A

1 year

161
Q

1st line meds for panic disorder

A

SSRIS

162
Q

2nd line meds for panic disorder

A

Imipramine

CLomipramine

163
Q

How long should meds be continued for panic disorder if helpful?

A

6 months

164
Q

How long to try meds for panic disorder before switching?

A

12 weeks

165
Q

Meds to use for psychosis in HIV

A

Atypicals - Risperidone

166
Q

SSRI to use in depression with HIV

A

Citalopram

167
Q

2nd line meds for depression in HIV

A

Mirtazapine

Bupropion

168
Q

Meds to use for bipolar in HIV

A

Valproate
Lamotrigine
Gabapentin

169
Q

Which antitretrovials are non-nucleoside reverse-transcriptase inhibitors?

A

efavirenz

nevirapine

170
Q

Which anti-retrovirals are nucleoside reveres-transcriptase inhibitors?

A

abacavir

didanosine

171
Q

Which antiretrovirals are protease inhibitors?

A

retinovir

indinavir

172
Q

Which antiretrovirals cause agitation?

A

Efavirenz

173
Q

Which antiretrovirals cause delusions?

A

Efavirenz

174
Q

Which antiretrovirals cause mania and suicide?

A

Efavirenz

175
Q

How to calculate pre test odds

A

Pre-test probability/1- pre-test probability

176
Q

How to calculate pre-test probability

A

Prevalence

177
Q

How to test post test probability

A

Post test odds/1+post-test odds

178
Q

What is post test probability?

A

Proportion of patients with that test result who have the disease

179
Q

What is post test odds?

A

Odds that the patient has the disorder after the test is done

180
Q

How to calculate post test odds?

A

Pre-test odds x likelihood ratio

181
Q

What mechanisms have been suggested to lead to weight gain from antipsychotics?

A

5HT2C antagonism
H1 antagonism
Hyperprolactinaemia
Increased serum leptin leading to leptin desensitization

182
Q

What is the test for syphilis?

A

VDRL - venereal disease research lab test

183
Q

Which LD has a down turned mouth?

A

Cri du Chat

Wolf Hirschhorn

184
Q

Describe features of Coffi-Lowry

A

Short
Slanting eyes
Broad, short nose
Severe LD

185
Q

Describe systematic sampling

A

Every nth member of population gets selected

186
Q

Name the tool used as structural professional judgement to assess risk of future sexual violence

A

RSVP - risk of sexual violence protocol

187
Q

Which actuarial approach assess future risk of sexual recidivism with just 4 items?

A

RRASOR - rapid risk assessment for sex offence recidivism

188
Q

What are the 4 items in RRASOR?

A

Prior sexual arrests
Age
Ever targeted male victims
Whether victims are unrelated to offender

189
Q

Which sex offender risk tool incorporates PCL-R?

A

SORAG - sex offender risk appraisal guide

190
Q

Name the actuarial tools for risk violence

A 
Risk matrix 2000
Static 99
VRAG
SORAG
PCL-R
RRASOR
191
Q

Which violence risk tool incorporates PCL-R?

A

VRAG

192
Q

Which tool is used on adult male sex ofenders who will be released to the community?

A

Static 99

193
Q

Scales of Risk Matrix 2000

A

Prediction scale for offending
Prediction scale for non-sexual violence
Combination of 1st two to predict sexual or other violence

194
Q

Which risk tool is helpful to characterise an individuals risk and therefore target plans to manage them?

A

SVR-20

195
Q

Terms used in structural therapy

A 
Subsystems
Hierarchy
Boundaries
Alliances
Coalition
196
Q

Terms used in Strategic therapy

A

Task setting

Goal setting

197
Q

Terms used in systemic therapy

A 
Hypothesising
Neutrality
Positive connotation
Paradox/counter-paradox
Interventive questioning
Reflecting teams
198
Q

What concepts make up transgenerational therapy?

A 
Scale of differentiation
Nuclear family emotional system
Family projection processes
Multi-generational transmission processes
Sibling position profiles
Emotional cut-offs
Triangles
199
Q

Who is associated with systemic therapy?

A

Mara Selvini-Palazolli

200
Q

How do systemic therapists view the family?

A

Self-regulating system which controls itself through trial and error

201
Q

What are systemic family therapists interested in?

A

Rule-maintaining of communication and behaviours

202
Q

How do systemic therapists believe sx can change in families?

A

By changing the rules

203
Q

How does systemic therapy work?

A

Therapist questions the entire family, with emphasis on exploring differences between members behaviours and responses

204
Q

What does strategic therapy believe difficulties in families are due to?

A

Distorted hierarchies

205
Q

Who is associated with strategic therapy?

A

Jay Hales

Cloe Madanes

206
Q

Who is associated with structural therapy?

A

Salvador Minuchin

207
Q

Recommended medication for those with Tourettes who have ADHD

A

Atomoxetine

208
Q

How many people with Tourettes have ADHD?

A

70%

209
Q

Suicide rate in prisons in England and Wales?

A

133 per 100,00

210
Q

Antipsychotic of choice in liver impairment

A

Haloperidol

MRCPsych Part B - Al-Rashid Hospital (64 decks)

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