1. A 75-year-old man with isolated systolic hypertension, who also has urinary incontinence, gout and asthma, attends outpatients with a blood pressure reading of 190/86 mmHg. Which of the following drugs would you initiate for this patient?
A. Amlodipine
B Atenolol
C Bendrofluazide
D Doxazosin
E Valsartan
Answer: A
Amlodipine, a dihydropyridine calcium-channel blocker, is the drug of choice for the treatment of isolated systolic hypertension in the elderly, especially if thiazides are contraindicated in a patient, as in this man. Doxazosin is contraindicated in patients with urinary incontinence and, similarly, asthma negates the use of ß-blockers.
2. Following a severe stroke, a 52-year-old man complains of difficulty in remembering events, people's names and daily activities. He can remember events that occurred prior to his stroke, but appear unable to form new long-term memories. On neuropsychological testing, he is able to perform tasks such as solving puzzles, visual discriminations and skilled eye–hand co-ordination movements. However, he is unable to consolidate any new information for immediate explicit recall. What would be the most appropriate description of his present condition?
A Retrograde amnesia
B Simple amnesia
C Reverse amnesia
D Anterograde amnesia
E Brain amnesia
Answer: D
Failure to acquire and consolidate new information after trauma, eg severe disease, injury, surgery or malnutrition, is called 'anterograde amnesia'. Although other cognitive abilities remain intact, the patient cannot cope with daily life without help: this is due to major cognitive failure to store immediate learning experiences for long-term memory. The patient's language skills do not seem to be affected since he can carry on a conversation about general events, although he cannot recall them afterwards. The patient can also count backwards and forwards. Such patients tend to require constant care and supervision.
3. Calcium homeostasis is dependent on the fact that:
A. Most of the serum calcium exists as free calcium ions
B. Body calcium content is mainly regulated by kidneys
C. 99% of filtered Ca is reabsorbed in the kidneys
D. Calcitonin increases renal calcium excretion
E. Decreased renal excretion leads to hypercalcaemia in Sarcoidosis
Answer: C
In serum, most of the calcium ion is bound to albumin. Less than 50% of calcium is in the ionised form in serum, the rest being bound to protein and other anions like phosphate, citrate etc. The ionised form is most important in regulation of body functions. Intestinal absorption of calcium is the main regulator of calcium content. This is activated by 1, 25 (OH) 2 D3. Most of the calcium that is filtered by the kidneys is reabsorbed throughout the nephron, around 55% in the proximal convoluted tubule. Calcitonin is the most important factor regulating calcium excretion. Secreted by the parafollicular cells of the thyroid gland, this hormone responds to raised calcium levels by inhibiting bone resorption and increasing renal excretion. Increased intestinal absorption is the main cause for raised calcium levels in Sarcoidosis.
4. A 67-year-old man is referred to the hospital diabetes clinic with a new diagnosis of type-2 diabetes mellitus. He has a BMI of 29. Creatinine level is 150 nmol/l and he has 1+ protein on urinalysis. He has a past history of heart failure. Which of the following drugs are you most likely to prescribe?
A Chlorpropamide
B Gliclazide
C Pioglitazone
D Rosiglitazone
E Metformin
Answer: B
Gliclazide is a sulphonylurea and can be used alone or in combination therapy for type-2 diabetes mellitus. It acts by increasing insulin release from the pancreatic ß-cell. It can be used in mild to moderate renal failure. Pioglitazone and rosiglitazone are thiazolidinediones, which promotes insulin sensitivity by their action on the PPARg receptor (peroxisome proliferator activated receptor-g).They are associated with fluid retention and are contraindicated in heart failure. Chlorpropamide, a sulphonylurea, is rarely used now and is excreted by the kidney. Metformin is a biguanide and, although its mechanism of action is not entirely clear, it reduces insulin resistance and hepatic glucose production. It is thought to be able to cause lactic acidosis in certain circumstances and its use is contraindicated in patients with renal, hepatic or cardiac failure.
5. A 25-year-old man presents to A&E with an acute exacerbation of asthma that is failing to respond to inhaled bronchodilators. As part of the medical team on call you are asked to review him, and you decide to treat him with intravenous magnesium. Which of the following statements is true?
A. The usual dose is 2 mg
B. Magnesium increases acetylcholine release
C. Hypertension is commonly seen after treatment
D. Magnesium relaxes bronchial smooth muscle
E. Drowsiness and coma are features of hypomagnesaemia
Answer: D
Intravenous magnesium (2 g) is now indicated in the management of severe life-threatening acute asthma attacks. Its principal actions are to inhibit acetylcholine release at the neuromuscular junction, relax bronchial smooth muscle and stabilise mast cells. Unwanted effects are uncommon following single-dose therapy, although a slight decrease in blood pressure can be noticed and flushing can occur. Symptoms of Hypomagnesaemia include nausea, diarrhoea, flushing, hypertension, confusion, coma and loss of tendon reflexes.
6. A 27-year-old woman who had previously undergone a terminal ileal and limited right-colon resection for Crohn's disease was seen in clinic. She reported increased diarrhoea but was otherwise well. Investigations showed: CRP < 5 mg/dl; Hb 13.2 g/dl; WCC 8.6 × 109/l; platelets 244 x 109/l. Repeat colonoscopy was normal to the neoterminal ileum; a barium follow-through showed a normal mucosa; and a lactose hydrogen breath test was normal. What is the most likely cause of her diarrhoea?
A Bile-salt malabsorption
B Collagenous colitis
C Mesalazine
D Primary sclerosing cholangitis
E Small-bowel bacterial overgrowth
Answer: A
Bile-salt malabsorption causes a secretory diarrhoea. Bile salts usually undergo enterohepatic circulation, being reabsorbed in the terminal ileum. Post-surgery, this system fails and so malabsorption occurs. There is a theoretical failure of absorption of fat-soluble vitamins; however, this rarely becomes clinically significant. Treatment is with a bile-salt binder (cholestyramine).
Collagenous colitis is a thickening of the subepithelial collagen band resulting in diarrhoea. It is associated with Coeliac disease. Mesalazine can cause bowel frequency, but rarely true diarrhoea. Primary sclerosing cholangitis is not a cause of diarrhoea. Bacterial small-bowel overgrowth is rare but may occur after surgery. The lack of an early peak on the breath test counts against this.
7. A 40-year-old diabetic is receiving insulin. Which of the following enzymes is most likely to be inhibited by insulin?
A Glucose 6-phosphate dehydrogenase
B Pyruvate carboxylase
C Glycogen synthetase
D Acetyl-CoA carboxylase
E ATP citrate lyase
Answer: B
Insulin inhibits gluconeogenesis by inhibiting the enzymes involved in the process. Pyruvate carboxylase is an enzyme involved in gluconeogenesis, hence its action is inhibited by insulin. Insulin increases glycogenesis in the liver and muscle by stimulating glycogen synthetase. Insulin activates the hexose monophosphate (HMP) shunt by inducing the synthesis of glucose 6-phosphate dehydrogenase. Both acetyl-CoA carboxylase and ATP citrate lyase are stimulated to increase the synthesis of fatty acids.
8. A 19-year-old man is being treated for tuberculosis and complains of numb feet. Nerve conduction studies (NCS) show: Sural sensory action potential 8 mV (> 15 mV)
Median sensory action potential 9 mV (> 20 mV)
Common peroneal nerve action potential 50 m/s (> 45 m/s)
What drug is most likely to have caused this problem?
A Rifampicin
B Isoniazid
C Pyrazinamide
D Ethambutol
E Paracetamol
Answer: B
The NCS values above are consistent with an axonal neuropathy that is classically caused by isoniazid.
9. A 26-year-old Asian woman complains of back pain and tenderness in her thighs. She also mentions that she finds it difficult to climb stairs. She has never smoked and does not drink alcohol. She has well-controlled asthma and takes a low-dose inhaled corticosteroid only. Her full blood count is normal. She has an alkaline phosphatase level of 250 U/l (normal, 40–125 U/l); her plasma calcium concentration is 1.98 mmol/l (normal, 2.12–2.62 mmol/l). Her liver and kidney function tests are normal. What would you expect her pelvic radiograph to show?
A Decreased bone density
B Translucent bands
C Punched-out osteolytic lesions
D Bone expansion and sun-ray appearance
E Layers of periosteal new bone formation
Answer: B
This woman has osteomalacia, which is characterised by translucent bands (Looser's zones or pseudofractures) at points of stress. Osteomalacia is characterised by back pain, muscle weakness and bone tenderness. It is due to vitamin D deficiency. Biochemical abnormalities are a raised alkaline phosphatase and low calcium and phosphate levels.
10. A woman who has recently used cocaine presents to A&E saying she can feel insects crawling under her skin. What is this symptom known as?
A. Illusion
B. Haptic hallucination
C. Visual hallucination
D. Delusion of infestation
E. Auditory hallucination
Answer: B
This is the sensation of feeling insects in the absence of a stimulus, and is therefore a haptic hallucination. Haptic hallucinations can be interpreted in a delusional way and can lead on to delusional beliefs of infestation. This sensation of crawling insects is also known as the ‘cocaine bug’ and is associated with the ingestion of high doses of cocaine. Cocaine use can also lead to an acute toxic psychosis, with marked agitation, paranoia, auditory and visual hallucinations.
Sunday, 23 March 2008
Sunday, 17 February 2008
Hypoactive delirium
103. A psychiatric consultation was sought to evauate depression in a 56-year-old male with pancreatic cancer. His severe back pain was being well-treated with morphine. The patient was noted by the inpatient staff to be more withdrawn, disengaged, and quiet, making poor eye contact and sleeping most of the day. On examination, the psychiatric consultant found the man to be difficult to arouse and to be mildly confused and disoriented. His speech was slow and his thought process disorganized. He admitted to intermittently experiencing visual hallucinations that he had been too embarrassed to report earlier to the nursing staff. The man was diagnosed with a hypoactive delirium secondary to opioid medications. Which of the following is the most appropriate next step in his management?
A. Decrease dose of morphine.
B. Decrease frequency of morphine.
C. Discontinue morphine.
D. Do nothing.
E. Add an antipsychotic.
A. Decrease dose of morphine.
B. Decrease frequency of morphine.
C. Discontinue morphine.
D. Do nothing.
E. Add an antipsychotic.
1. you are called for to consult on a 42-year-old woman with alcohol dependence who is complaining of severe depressive symptoms despite 5 days of abstinence. In the initial stage of the interview she noted that she had “ always been depressed” and believed that she “drank to cope with the depression”. Her current complaint included a prominent sadness that had persisted for several weeks, difficulties concentrating, initial and terminal insomnia, and a feeling of hopelessness and guilt. What is the most approximate next step to distinguish between alcohol-induced depression and an independent major depressive episode?
A. Antidepressant treatment.
B. Intensive psychotherapy.
C. Proton emission tomography(PET)scan.
D. Chronological history.
E. Trial of ECT.
2. After initiating lithium therapy when should the plasma level be checked?
A. 12 hours
B. 12–24 hours
C. 24–48 hours
D. 3–5 days
E. 5–7 days
3. Which of the following statements relates to buspirone?
A. Is a cyclopyrrolone compound
B. Side-effects include sedation
C. Can cause hyperprolactinaemia
D. Can be administered to patients with epilepsy
E. Is useful in the treatment of panic disorder
4. A 2-year-old young girl uses only one word – 'Daddy' – to everyone she encounters. You are asked to diagnose if she has any delay in language development or any other psychological factor causing this behaviour. It does not appear to be a form of stammering or stuttering. She has normal psychomotor development and the examination is otherwise entirely normal. How would you best describe her present state of language?
A. Over-extension
B.Under-extension
C. Telegraphic word
D. Holophrases
E. Grammatical morphemes
A. Antidepressant treatment.
B. Intensive psychotherapy.
C. Proton emission tomography(PET)scan.
D. Chronological history.
E. Trial of ECT.
2. After initiating lithium therapy when should the plasma level be checked?
A. 12 hours
B. 12–24 hours
C. 24–48 hours
D. 3–5 days
E. 5–7 days
3. Which of the following statements relates to buspirone?
A. Is a cyclopyrrolone compound
B. Side-effects include sedation
C. Can cause hyperprolactinaemia
D. Can be administered to patients with epilepsy
E. Is useful in the treatment of panic disorder
4. A 2-year-old young girl uses only one word – 'Daddy' – to everyone she encounters. You are asked to diagnose if she has any delay in language development or any other psychological factor causing this behaviour. It does not appear to be a form of stammering or stuttering. She has normal psychomotor development and the examination is otherwise entirely normal. How would you best describe her present state of language?
A. Over-extension
B.Under-extension
C. Telegraphic word
D. Holophrases
E. Grammatical morphemes
Sunday, 20 January 2008
1. Beliefs and symptoms may reach delusional intensity
A. Hypochondriasis.
B. Body Dysmorphic Syndrome.
C. Both.
D. Neither.
2. The first sign of beginning cerebral disease is impairment of
A. Recent memory.
B. Remote memory.
C. Long-term memory.
D. Immediate memory.
E. None.
3. Retention of information over the past few months, like current events
A. Immediate memory.
B. Semantic Memory.
C. Implicit memory.
D. Recent past memory.
E. Episodic memory.
4. 95. Which of the following is not a healthy defence mechanism?
A. Denial.
B. Humor.
C. Altruism.
D. Suppression.
E. Sublimation.
5. Delusional disorder
A. Is caused by frontal lobe lesions.
B. Is an early stage of Schizophrenia.
C. Usually begins by age 20.
D. Is less common that schizophrenia.
E. Is more common in men that in women.
A. Hypochondriasis.
B. Body Dysmorphic Syndrome.
C. Both.
D. Neither.
2. The first sign of beginning cerebral disease is impairment of
A. Recent memory.
B. Remote memory.
C. Long-term memory.
D. Immediate memory.
E. None.
3. Retention of information over the past few months, like current events
A. Immediate memory.
B. Semantic Memory.
C. Implicit memory.
D. Recent past memory.
E. Episodic memory.
4. 95. Which of the following is not a healthy defence mechanism?
A. Denial.
B. Humor.
C. Altruism.
D. Suppression.
E. Sublimation.
5. Delusional disorder
A. Is caused by frontal lobe lesions.
B. Is an early stage of Schizophrenia.
C. Usually begins by age 20.
D. Is less common that schizophrenia.
E. Is more common in men that in women.
Saturday, 5 January 2008
Competition 'tough' for NHS posts
By Branwen Jeffreys Health correspondent, BBC News
Junior doctors across the UK are being warned the competition they will face this year for specialist training jobs in the NHS will be tougher than ever.
As recruitment begins for August, the NHS employers body says there may be an average of three applicants per post.
Many applicants will be NHS doctors who qualified outside the EU, after the government failed in a 2007 legal bid to give UK medical graduates priority.
Without a training post a junior doctor cannot become a consultant or GP.
It is a good thing for patients that there is competition for jobs - it should mean they get the best doctors wherever they live Sian Thomas NHS Employers
After a computer fiasco and complaints of unfairness when a new system was introduced for 2007, the process for this year has been changed.
The controversial system - known as the medical training application service (MTAS) - was shelved by ministers.
Doctors complained about a lack of posts, poorly designed recruitment forms, and technical failures with the online application system.
In the wake of the controversy, BMA chairman James Johnson resigned amid accusations that he had failed to put across the feelings of doctors about the system.
Now, thousands of applications will be handled by local medical deaneries and there is no limit to the number of applications an individual doctor can make.
In England there will be around 9,000 places on speciality training programmes and employers expect there may be as many as 23,000 applications.
Competition welcomed
Sian Thomas, from NHS Employers, said young doctors needed to make realistic decisions.
In some popular specialities, such as surgery, there may be as many as 10 applications for each training post, she said.
"It is a good thing for patients that there is competition for jobs - it should mean they get the best doctors wherever they live."
One reason the competition for jobs is expected to be intense is the large number of overseas doctors who want specialist training in the UK.
Our concern is that without adequate planning, the levels of competition could result in a lottery Ram Moorthy BMA Junior Doctors Committee
In 2008 it is expected that doctors who qualified outside the EU may make up half the applications for training posts.
But UK medical schools have also increased the number of doctors they are training, at an estimated cost to the taxpayer of £250,000 for every medical graduate.
Pressure group Remedy UK has launched a specialist website to help doctors with their job search.
Remedy UK's Chris McCullough said: "Our view is that the system is essentially appalling.
"Doctors aren't afraid of competition, but what we have this year is doctors facing a one-in-19 chance of getting a job in some areas."
The Department of Health tried to give UK medical graduates priority in the recruitment process this year, but that was overturned after a legal challenge.
Now the government is appealing to the House of Lords but any decision will be too late to affect the rules for 2008.
Fears of unfairness
A Department of Health spokesman said: "Doctors from outside Europe have made and continue to make a huge contribution to the NHS.
"The issue is not, and never has been, whether they can continue to work as NHS doctors - which they can - but whether the taxpayer should be investing in training them instead of UK medical graduates."
The British Medical Association is worried that the volume of applications this year could overwhelm medical deaneries.
It said it would be monitoring the process to ensure fairness.
Ram Moorthy, chairman of the BMA junior doctors committee, said: "Our concern is that without adequate planning, the levels of competition could result in a lottery.
"Trusts need to get their recruitment practices in order, and start preparing now to ensure that there is no unfairness, and no negative impact on patient care."
Junior doctors across the UK are being warned the competition they will face this year for specialist training jobs in the NHS will be tougher than ever.
As recruitment begins for August, the NHS employers body says there may be an average of three applicants per post.
Many applicants will be NHS doctors who qualified outside the EU, after the government failed in a 2007 legal bid to give UK medical graduates priority.
Without a training post a junior doctor cannot become a consultant or GP.
It is a good thing for patients that there is competition for jobs - it should mean they get the best doctors wherever they live Sian Thomas NHS Employers
After a computer fiasco and complaints of unfairness when a new system was introduced for 2007, the process for this year has been changed.
The controversial system - known as the medical training application service (MTAS) - was shelved by ministers.
Doctors complained about a lack of posts, poorly designed recruitment forms, and technical failures with the online application system.
In the wake of the controversy, BMA chairman James Johnson resigned amid accusations that he had failed to put across the feelings of doctors about the system.
Now, thousands of applications will be handled by local medical deaneries and there is no limit to the number of applications an individual doctor can make.
In England there will be around 9,000 places on speciality training programmes and employers expect there may be as many as 23,000 applications.
Competition welcomed
Sian Thomas, from NHS Employers, said young doctors needed to make realistic decisions.
In some popular specialities, such as surgery, there may be as many as 10 applications for each training post, she said.
"It is a good thing for patients that there is competition for jobs - it should mean they get the best doctors wherever they live."
One reason the competition for jobs is expected to be intense is the large number of overseas doctors who want specialist training in the UK.
Our concern is that without adequate planning, the levels of competition could result in a lottery Ram Moorthy BMA Junior Doctors Committee
In 2008 it is expected that doctors who qualified outside the EU may make up half the applications for training posts.
But UK medical schools have also increased the number of doctors they are training, at an estimated cost to the taxpayer of £250,000 for every medical graduate.
Pressure group Remedy UK has launched a specialist website to help doctors with their job search.
Remedy UK's Chris McCullough said: "Our view is that the system is essentially appalling.
"Doctors aren't afraid of competition, but what we have this year is doctors facing a one-in-19 chance of getting a job in some areas."
The Department of Health tried to give UK medical graduates priority in the recruitment process this year, but that was overturned after a legal challenge.
Now the government is appealing to the House of Lords but any decision will be too late to affect the rules for 2008.
Fears of unfairness
A Department of Health spokesman said: "Doctors from outside Europe have made and continue to make a huge contribution to the NHS.
"The issue is not, and never has been, whether they can continue to work as NHS doctors - which they can - but whether the taxpayer should be investing in training them instead of UK medical graduates."
The British Medical Association is worried that the volume of applications this year could overwhelm medical deaneries.
It said it would be monitoring the process to ensure fairness.
Ram Moorthy, chairman of the BMA junior doctors committee, said: "Our concern is that without adequate planning, the levels of competition could result in a lottery.
"Trusts need to get their recruitment practices in order, and start preparing now to ensure that there is no unfairness, and no negative impact on patient care."
1. A 23-year-old woman complains that her mother is selfish, stupid and cunning. At the same time, she praises another relative whom she describes as kind, wise and helpful. Which defence mechanism is suggested by this behaviour?
A. Conversion
B. Idealisation
C. Symbolisation
D. Splitting
E.Projection
2. A 9-year-old boy constantly disobeys his parents and teachers. He gets along well with his peers and completes projects that he likes. His developmental milestones are normal and he has no history of fighting, theft or destruction of property. Mental status examination reveals an assertive child who tells the examiner that he does not wish to discuss his problems. What is the most likely diagnosis?
A. Oppositional defiant disorder
B. Mental retardation
C. Conduct disorder
D. Childhood disintegrative disorder
E. Attention-deficit hyperactivity disorder
3. A teenage girl complains that her mother interferes in every aspect of her life and tries to control her. The girl no longer speaks to her parents or eats meals with them. The mother has increased her efforts to maintain control. What condition could arise from this situation?
A. Anorexia nervosa
B. Dissociative identity disorder
C. Narcissistic personality disorder
D. Schizophrenia
E. Separation anxiety disorder
4. after an automobile accident that kills her child but leaves her with only minor injuries, a mother appears very calm and says that she has no emotion. What mechanism is she using?
A. Derealisation
B. Isolation
C. Depersonalisation
D. Disorientation
E. Intellectualisation
5. CT scan image that shows enlargement of the ventricles due to atrophy of the head of the Caudate Nucleus is usually found in:
A. Lewy body dementia.
B. Alzheimer’s disease.
C. Pick’s disease.
D. Huntington’s disease.
E. Parkinson’s disease.
6. Which of the following is not one of the basic elements of the Insanity Defence?
A. Finding of incompetence to stand trial.
B. Presence of a defect of reason.
C. Presence of a mental disorder.
D. Incapacity to refrain from the act.
E. Lack of knowledge of the nature of the act.
A. Conversion
B. Idealisation
C. Symbolisation
D. Splitting
E.Projection
2. A 9-year-old boy constantly disobeys his parents and teachers. He gets along well with his peers and completes projects that he likes. His developmental milestones are normal and he has no history of fighting, theft or destruction of property. Mental status examination reveals an assertive child who tells the examiner that he does not wish to discuss his problems. What is the most likely diagnosis?
A. Oppositional defiant disorder
B. Mental retardation
C. Conduct disorder
D. Childhood disintegrative disorder
E. Attention-deficit hyperactivity disorder
3. A teenage girl complains that her mother interferes in every aspect of her life and tries to control her. The girl no longer speaks to her parents or eats meals with them. The mother has increased her efforts to maintain control. What condition could arise from this situation?
A. Anorexia nervosa
B. Dissociative identity disorder
C. Narcissistic personality disorder
D. Schizophrenia
E. Separation anxiety disorder
4. after an automobile accident that kills her child but leaves her with only minor injuries, a mother appears very calm and says that she has no emotion. What mechanism is she using?
A. Derealisation
B. Isolation
C. Depersonalisation
D. Disorientation
E. Intellectualisation
5. CT scan image that shows enlargement of the ventricles due to atrophy of the head of the Caudate Nucleus is usually found in:
A. Lewy body dementia.
B. Alzheimer’s disease.
C. Pick’s disease.
D. Huntington’s disease.
E. Parkinson’s disease.
6. Which of the following is not one of the basic elements of the Insanity Defence?
A. Finding of incompetence to stand trial.
B. Presence of a defect of reason.
C. Presence of a mental disorder.
D. Incapacity to refrain from the act.
E. Lack of knowledge of the nature of the act.
Wednesday, 26 December 2007
1. physiological activity associated with PTSD include all except:
A. Decreased parasympathetic tone.
B. Excessive sweating.
C. Increased blood pressure.
D. Increased circulating thyroxine.
E. Elevated baseline heart rate.
2. A 72 year-old lady with 4 months history of memory loss, urinary incontinence and falls. On examination she has mild memory loss and a broad based, slow gait. Muscle tone is normal and both plantar reflexes are down going. What is the likely diagnosis?
A) Alzheimer's disease
B ) Frontal lobe dementia
C ) Multi-infarct dementia
D ) Normal pressure hydrocephalus
E) Parkinson's disease
3. A 73-year-old man with advanced Parkinson's disease is being treated on the ward for a urinary tract infection. His regular medicationincludes co-careldopa, entacapone, cabergoline, and prn subcutaneousapomorphine injections. His wife tells you that for the last month hisbehaviour has changed and he has become agitated, disinhibited and hekeeps asking her for money. His dyskinesia has also become more
denies having hallucinations and, after probing questioning, you canfind no evidence of delusional thought. Mood assessment shows him tobe cheerful and there are no cognitive or biological features ofdepression. What is the likely physiological cause of the behaviouralchange?
A. Reduced breakdown of dopamine
B. Change in sensitivity to dopamine
C. Confusional state due to urosepsis
D. Direct dopamine agonism
E. Coexisting dementia
4. 15. A 24-year-old man is admitted to the psychiatric ward from home, where he lives alone. His neighbours have been increasingly concerned about rubbish piling up inside his flat and sometimes he isn't seen fordays. His family tell you that over the last year he has become veryodd and isolated. On examination, he is withdrawn and quiet and youfind it difficult to understand his answers as he frequently wandersoff the point, as if he is answering a different question. Althoughspontaneous movements are reduced, there are no neurological signs and
older brothers have both had episodes of major depression. Are thereany features that suggest a favourable outcome from this episode?
A. Young age
B. Insidious onset
C. No favourable features
D. Quiet speech
E. Family history of depression
5. An 83-year-old man is undergoing cognitive assessment in apsychogeriatric clinic. He was referred because of a change in hisbehaviour, and his wife has noticed a few aggressive outbursts overthe past months. His Mini-Mental test score is 18. Which patterns ofcognitive deficit would favour a dementia of subcortical origin?
A. Poor Visuospatial performance
B. Preserved verbal fluency
C. Severe memory disturbance
D. Constructional apraxia
E. Reduced verbal output
6. A 77 year old woman complains of memory loss. Which of the following makes a diagnosis of pseudodementia less likely:-
A. Rapid onset
B. Depressed mood
C. Patchy memory loss
D. Great effort in performing tests
E. Rapid progression
A. Decreased parasympathetic tone.
B. Excessive sweating.
C. Increased blood pressure.
D. Increased circulating thyroxine.
E. Elevated baseline heart rate.
2. A 72 year-old lady with 4 months history of memory loss, urinary incontinence and falls. On examination she has mild memory loss and a broad based, slow gait. Muscle tone is normal and both plantar reflexes are down going. What is the likely diagnosis?
A) Alzheimer's disease
B ) Frontal lobe dementia
C ) Multi-infarct dementia
D ) Normal pressure hydrocephalus
E) Parkinson's disease
3. A 73-year-old man with advanced Parkinson's disease is being treated on the ward for a urinary tract infection. His regular medicationincludes co-careldopa, entacapone, cabergoline, and prn subcutaneousapomorphine injections. His wife tells you that for the last month hisbehaviour has changed and he has become agitated, disinhibited and hekeeps asking her for money. His dyskinesia has also become more
denies having hallucinations and, after probing questioning, you canfind no evidence of delusional thought. Mood assessment shows him tobe cheerful and there are no cognitive or biological features ofdepression. What is the likely physiological cause of the behaviouralchange?
A. Reduced breakdown of dopamine
B. Change in sensitivity to dopamine
C. Confusional state due to urosepsis
D. Direct dopamine agonism
E. Coexisting dementia
4. 15. A 24-year-old man is admitted to the psychiatric ward from home, where he lives alone. His neighbours have been increasingly concerned about rubbish piling up inside his flat and sometimes he isn't seen fordays. His family tell you that over the last year he has become veryodd and isolated. On examination, he is withdrawn and quiet and youfind it difficult to understand his answers as he frequently wandersoff the point, as if he is answering a different question. Althoughspontaneous movements are reduced, there are no neurological signs and
older brothers have both had episodes of major depression. Are thereany features that suggest a favourable outcome from this episode?
A. Young age
B. Insidious onset
C. No favourable features
D. Quiet speech
E. Family history of depression
5. An 83-year-old man is undergoing cognitive assessment in apsychogeriatric clinic. He was referred because of a change in hisbehaviour, and his wife has noticed a few aggressive outbursts overthe past months. His Mini-Mental test score is 18. Which patterns ofcognitive deficit would favour a dementia of subcortical origin?
A. Poor Visuospatial performance
B. Preserved verbal fluency
C. Severe memory disturbance
D. Constructional apraxia
E. Reduced verbal output
6. A 77 year old woman complains of memory loss. Which of the following makes a diagnosis of pseudodementia less likely:-
A. Rapid onset
B. Depressed mood
C. Patchy memory loss
D. Great effort in performing tests
E. Rapid progression
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