Paper 3 EMIs

8/8/2019 Paper 3 EMIs

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Paper 3 EMIs 2005

EMIs from Autumn 2005

SET 1

EMI 1

OPTIONSIncreased physical dependenceBeing in an institutionMale patientMale carerDementiaBeing married to carer

Previous poor relationship with carer

QUESTIONS1) 3 risk factors for abuseDementiaPrevious poor relationship with carerBeing in an institution

2) 3 risk factors for depressionMale patientIncreased physical dependence

Dementia

3) 2 risk factors for carer exhaustionPrevious poor relationship with carerDementia

EMI 2

OPTIONSCitalopramEscitalopram

QuetiapineRisperidoneReboxetineFluoxetineLithiumLamotrigineSertralineDesipramine


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QUESTIONS1) Best treatment for a boy with OCDFluoxetine

2) A man with OCD and depression. Which 2 drugs would he NOT respond to

ReboxetineDesipramine3) Pick 2 add in treatments for a man not responsive to first line treatment

LithiumRisperidone

SET 2EMI 3DRUG CHOICE

A) Flupentixol depotB) RisperidoneC) OlanzapineD) ClozapineE) QuetiapineF) Haloperidol1. Older schizophrenic women, DM, agreed to take medication but irregular compliance andpsychotic. When son reminded her, end up in a quarrel.A) Flupentixol depot2. Psychotic elderly man, persistent psychotic symptoms, not tolerating oral flupentixol. Notresponding to sulpiride and olanzapine.D) Clozapine3. Case of Parkinsons disease. Not on anti-PD drug and antipsychotic nave. Distressed byVH.E) Quetiapine

EMI 4

OLD AGE PSYCHIATRYA) Living in instituteB) Living with another personC) Male carerD) Male patientE) Higher physical dependence in patientF) History of poor relationship with carerG) Carer married to patientH) Diagnosis of dementia


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1. Risk for non-accidental injury from carer (choose 2)A) Living in instituteF) History of poor relationship with carer

2. Risk for carer distress / depress (choose 3)H) Diagnosis of dementiaF) History of poor relationship with carerE) Higher physical dependence in patient

3. Risk for depression of elderly (choose 3)D) Male patientH) Diagnosis of dementiaE) Higher physical dependence in patient

EMI 5STATISTICSA) Chi-square testB) McNemar testC) Fisher's exact testD) Cluster analysisE) ANCOVAF) ANOVAG) Multiple regression

1. Demonstrate association of height (parametric) and ASPD (choose 3)F) ANOVAA) Chi-square testC) Fisher's exact test

2. Relation of conduct disorder and ASPD (choose 2)A) Chi-square testC) Fisher's exact test

3. ASPD vs height and IQ (height and IQ correlated) (choose 2)B) McNemar testF) ANOVA


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EMI 6MEDICATION / MANAGEMENTA) Citalopram

B) DesipramineC) EscitalopramD) FluoxetineE) ReboxetineF) QuetiapineG) SertralineH) Risperidone1. 11 year old developed OCD for 6 months and later depressed mood. (choose 1)D) Fluoxetine

2. OCD in a teacher with sexual obsessions, unlikely to have that antidepressant drug (choose 2)

D) Fluoxetine3. OCD child with SSRI for some time but still Obsessive compulsive behaviour with motor tics.(choose 2)H) RisperidoneD) Fluoxetine

EMI 7MEDICATION / MANAGEMENTA) CardiomyopathyB) Diabetes mellitusC) Lithium toxicityD) Diabetes insipidusE) Serotonin syndromeF) Neuroleptic Malignant SyndromeG) HypothyroidismH) Pulmonary embolismI) HyperthyroidismQuestions:1. Schizophrenia on clozapine. Developed palpitation, SOB and tachycardia. (choose 1)A) Cardiomyopathy

2. BAD on Li, developed polyuria, polydispia and lethargy. Raised sodium level and clinicallydehydrated. (choose 1)D) Diabetes insipidus

3. Started on olanzapine for few days, noticed rigidity, confusion and sweating. (choose 1)F) Neuroleptic Malignant Syndrome


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EMI 8DRUGSCytochrome P450 enzyme inductionEffect on striatal D2 receptor

Effect on meso-limbic D2 receptorEffect on 5HT2 receptorEffect on 5HT3 receptor1. Started St Johns wort and later pregnant despite taking OC pill (choose 1) CytochromeP450 enzyme induction2. On antipsychotic and developed EPSE (choose 1) Effect on striatal D2 receptor3. On fluoxetine, started on Li and became confused (picture of serotonin syndrome). (choose 1)Effect on 5HT2 receptor

EMI 9

BIOCHEMICALA) HyperglycemiaB) HypoglycemiaC) HyponatremiaD) HyperthyroidismE) HyperkalemiaF) Hypercalecemia1. Alcoholism, after binge-drinking, anxious and confused in A&E (choose 1) B) Hypoglycemia2. Depressed middle age gentleman complained of lethargy, nausea, muscle cramp. Recentlystarted on paroxetine (choose 1) C) Hyponatremia3. Schizophrenic patient on clozapine/olanzapine complained of abdominal pain and confusion(choose 1) A) Hyperglycemia[edit]

EMIs from Spring 2005

SET 1EMI 1SIDE EFFECTS1) Neuroleptic malignant syndrome2) Serotonin syndrome3) Diabetes insipidus

4) Diabetes mellitus5) Lithium toxicity6) Hyperthyroidism7) Hypothyroidism8) Cardiomyopathy9) Pulmonary embolusChoose ONE
http://www.mrcpsychrevisionwiki.org/wiki/index.php?title=Paper_3_EMIs_2005&action=edit&section=2http://www.mrcpsychrevisionwiki.org/wiki/index.php?title=Paper_3_EMIs_2005&action=edit&section=2


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1) A lady on lithium for 2 years comes to see you with polyuria, polydipsia, ankle swelling andlethargy. She looks dehydrated and has high sodium.3) Diabetes insipidus

2) A man has been started on Olanzapine. He is found on the ward febrile with labile blood

pressure and increased muscle tone.1) Neuroleptic malignant syndrome

3) A 24 year old man who has been stable on Clozapine for 2 years comes to see you withlethargy, breathlessness and palpitations.8) Cardiomyopathy

EMI 2

CHILDHOOD BEHAVIOURAL DISORDERS1) Methylphenidate

2) Paroxetine3) Venlafaxine4) Logotherapy5) Parenting skills6) Lithium7) Family therapyChoose ONE1) A 4 year old girl who is aggressive towards her mother and has punched her in the stomach onone occasion. She is 'difficult' and refuses to do what she is told.5) Parenting skills

2) A 17 year old boy who has a history of explosive violence and has got in to trouble with thePolice. Otherwise he has no symptoms.7) Family therapy

3) A 13 year old girl has been diagnosed with hyperkinetic disorder by a psychologist. She ishaving systemic therapy but is still hyperactive with poor concentration.1) Methylphenidate

EMI 3THE EEG related to Old Age psychiatric problems1) Normal EEG2) Preserved alpha waves over the occiput in the context of generalised slowing3) Alpha waves >8Hz4) Spike and wave5) Paroxysmal frontal lobe discharge6) Increased Beta Rhythm7) Decreased Beta Rhythm1) A 75 year old woman who has got mroe forgetful over the last 2 year (CHOOSE TWO)


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Decreased Beta RhythmParoxysmal frontal lobe dischargehttp://66.102.9.104/search?q=cache:GhPcdqVmPYcJ:www.emedicine.com/neuro/topic109.htm+Pick%27s+dementia+beta+rhythm&hl=en&ct=clnk&cd=11&gl=pk

Quote "The electrophysiological correlate of polymyoclonus that can be seen in AD and otherpathological states is a bifrontal negativity in the EEG that precedes the myoclonic jerk. Thisnew type of electrophysiological correlate of myoclonus may reflect activity of a subcorticalgenerator".

2) An 80 year old man who has got more miserable and is not sleeping or eating (CHOOSETWO)Normal EEGIncreased Beta Rhythm

3) A 70 year old man who has episodic behavioural change and has started shoplifting(CHOOSE 1)Preserved alpha waves over the occiput in the context of generalised slowingDecreased Beta Rhythm

EMI 4SYNDROMES ASSOCIATED WITH LD1) Rett's syndrome2) Angelman's syndrome3) Down's syndrome4) Prader-Willi syndrome5) Cri du chat syndrome6) Cornelia de Lange syndrome7) Lesch Nyhan Syndrome

Select the ONE most likely diagnosis1) A 4 year old girl with hand wringing and some loss of skillsRett's syndrome

2) A 2 year old boy with impulsive overeatingPrader-Willi syndrome

3) A 6 year old boy with self mutilation, something like bitting (1)Lesch Nyhan Syndrome

EMI 5
http://66.102.9.104/search?q=cache:GhPcdqVmPYcJ:www.emedicine.com/neuro/topic109.htm+Pick%27s+dementia+beta+rhythm&hl=en&ct=clnk&cd=11&gl=pkhttp://66.102.9.104/search?q=cache:GhPcdqVmPYcJ:www.emedicine.com/neuro/topic109.htm+Pick%27s+dementia+beta+rhythm&hl=en&ct=clnk&cd=11&gl=pkhttp://66.102.9.104/search?q=cache:GhPcdqVmPYcJ:www.emedicine.com/neuro/topic109.htm+Pick%27s+dementia+beta+rhythm&hl=en&ct=clnk&cd=11&gl=pkhttp://66.102.9.104/search?q=cache:GhPcdqVmPYcJ:www.emedicine.com/neuro/topic109.htm+Pick%27s+dementia+beta+rhythm&hl=en&ct=clnk&cd=11&gl=pkhttp://66.102.9.104/search?q=cache:GhPcdqVmPYcJ:www.emedicine.com/neuro/topic109.htm+Pick%27s+dementia+beta+rhythm&hl=en&ct=clnk&cd=11&gl=pkhttp://66.102.9.104/search?q=cache:GhPcdqVmPYcJ:www.emedicine.com/neuro/topic109.htm+Pick%27s+dementia+beta+rhythm&hl=en&ct=clnk&cd=11&gl=pk


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ValidityNurse use screening in post-natal ward. select 8 with depression out of 9 having depressionNurse use screening in post-natal ward. select 80 people who do not have depression out of 100who don'tDiagnostic criteria from ICD-10 classification

80% of correlation between GHQ and Becks Depression InventoryNurses A and B check the figures and identify 8 people depressed out of 28 in totalSomething identified Alzheimer's disease well and unwell with some%Using consensus criteria in Lewy Body dementia agreed with neuropathological finding

1. Construct validity (2)Nurse use screening in post-natal ward. select 8 with depression out of 9 having depressionNurse use screening in post-natal ward. select 80 people who do not have depression out of 100who don't

2. Concurrent validity (1)Using consensus criteria in Lewy Body dementia agreed with neuropathological finding80% of correlation between GHQ and Becks Depression Inventory

3. Discrimnant validity (3)Diagnostic criteria from ICD-10 classificationNurses A and B check the figures and identify 8 people depressed out of 28 in totalSomething identified Alzheimer's disease well and unwell with some%

EMI 6Clinical; related to substance misuseCocaineAmphetamineCaffeineKetaminePhenylcyclidineMagic Mushroom (Psylobycin)Volatile substancesCannabisAlcohol

1. 17 year old man, drug abuse for 2 years, went to party last night. Developed tachycardia,dilated pupil, labile BP and mild respiratory depression. (2)AmphetamineAlcohol

2. A 19 year old factory worker with a history of various illicit drugs presented to A & E. He saidhe had a bad trip and on examination he has dilated pupils, tremors and sweating (Select 2options)


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G. Magic mushroomsJ. PhencyclidineRef. Puri and Hall p. 362

A 20 year old man presented to A & E with tachycardia, sweating, tremors and increase in

muscle tone, history of 2 seizures. He has a history of substance use (Select 2 options)A. AlcoholF. Benzodiazepines

EMI 7Defence MechanismsSplittingDenialDenigrationSublimationIdealization

RationalizationReaction formationProjective identification1. A patient who had taken large amytrityline overdoses 3 days ago and admitted to medicalward. SHO wsa asked to assessed him before discharge. SHO appeared very worried he will takeagain and anxious of discharging him. The patient was calm. (1)Denigration

2. A young adult who was found from case notes being neglected by his mother and deprived toinstitutional care. On asking, he felt his mother loved him very much. The reason of institutionalcare was due to money. (1)Denial

3. On a staff meeting, a staff received complaints from a patient. He was told the other day by thesame patient how great he was actually. (1)Splitting

EMI 8Sleep disordersCircadian rhythum disorderObstructive sleep aponeaNacrolepsy with cataplexpyA lot more options!

1. A 25 year old air-hostress finished her transatlantic flights. At daytime, she felt tired. At night,she cannot sleep. (1)Circadian rhythum disorder


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2. A middle-aged man developed daytime sleepiness. He was tired at daytime. His wife could notsleep together with him because of snoring. (1)Obstructive sleep aponea

3. A 30 year old lady cannot concentrate at daytime. She laughed and collapse suddenly likesomething. She had loss pf muscle tone. (1)Nacrolepsy with cataplexpy

EMI 1OptionsLiving in an institutionLiving alonePrevious poor relationship with carerMale carer

Male patientPatient has a diagnosis of dementiaCarer married to patientHigh physical dependency in the patientLead in: Choose the most common associated risk factors for the following:1. Carer stress Choose 2Previous poor relationship with carerPatient has a diagnosis of dementia

2. Depression Choose 1

Living alone

3. Non accidental injury from carer Choose 2Living in an institutionHigh physical dependency in the patient

EMI 2OptionsA ANOVA

B ANCOVAC Mann Whitney U testD Chi squared testE Fishers exact testF t testG paired t testH multiple regression


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In a trial where risk of antisocial personality dissorder is associated with height andIQ:1. Name 3 simple tests to look for relationship between IQ and ASPDD. Chi Squared test, C. Mann Whitney U-test, F. T-test

(Two variables, Categorical data which can be continuous as well, It can be paired orunpaired)2. Give 2 simple tests to look for relationship between (dichotomous variable that Ican't remember) and ASPDH. Multiple Regression and B. ANCOVA3. Is link IQ to ASPD just due to the effect of height (2)H. Multiple Regression and B. ANCOVA

EMI 3

A Family therapyB parent trainingC methylphenidateD lithiumE paroxetine1 A 4 year old thrown out of nursery for attacking other childrenB parent training2 a 17 year old with an order stopping him returning home due to explosive violenceagainst parentsA Family therapy3 An 11 year old diagnosis as hyperkinetic disorder by a psychologistC methylphenidate

EMI 4Theme: Cause of Learning DisabilityA Down syndromeB Fragile-X SyndromeC PhenlyketoneureaD ADHDE Prader Willi SyndromeF Rett's syndromeG Hurlers syndromeScenario: A 4 year old presenting with autistic features; select the most relaventcause / associated condition for the following. (Choose one option for each)1 Maternal uncle and grandfather had LDFragile-X Syndrome2 Difficulty in movements involving crossing midline.


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ADHD3 Binging on foodPrader Willi Syndrome

EMI 5

Theme: Defence MechanismsA Projective identificationB RationalisationC IdealisationD DenigrationE SplittingF DenialChoose one option for each of the following questions:1. A woman who has a history of self harm wants to go home. The SHO is anxiousand the patient is calm.D Denigration

2. A man with severe neglect and physical abuse as a child is taken into care. He sayshis mum was loving and he was only taken into care because of financial problems.F. Denial

3. A care assistant is confused when a patient puts in a complaint about her, who saidshe was the best carer in the world last week.

E Splitting

MIs from Autumn 2006

EMI 1

EEG CHANGES

A. Normal EEG

B. Reduced beta rhythm

C. Increased beta rhythm

D. Paroxysmal frontal lobe discharge

E. Spikes and waves


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F. Generalised slowing with conserved alpha rhythm frontally

G. Triphasic waves

1. An 80 old widower, miserable, not sleeping or eating, appears depressed (ChooseTwo)

A. Normal EEG

C. Increased beta rhythm

http://www.superego-cafe.com/forum/YaBB.pl?num=1156996276/19#19


2. A 75 year old woman, gradually more forgetful over the past 2 years (Choose

Two)

B. Reduced Beta Rhythm

D. Paroxysmal frontal lobe discharge

http://66.102.9.104/search?

q=cache:GhPcdqVmPYcJ:www.emedicine.com/neuro/topic109 .htm+Pick%27s+dementia+beta+rhythm&hl=en&ct=clnk&cd=11&gl=pk

Quote "The electrophysiological correlate of polymyoclonus that can be seen in AD

and other pathological states is a bifrontal negativity in the EEG that precedes the

myoclonic jerk. This new type of electrophysiological correlate of myoclonus may

reflect activity of a subcortical generator".

3. A 70 year old man, with disinhibition, change in personality, mild memory

impairment (Choose Two)

B. Reduced beta rhythm

F. Generalised slowing with conserved alpha rhythm frontally

http://66.102.9.104/search?

q=cache:GhPcdqVmPYcJ:www.emedicine.com/neuro/topic109 .htm+Pick

%27s+dementia+beta+rhythm&hl=en&ct=clnk&cd=11&gl=pk
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Quote "Because the anterior cholinergic system is relatively preserved in Pick

disease, the EEG changes are not prominent frontally."

EMI 2

SIDE EFFECTS FROM MEDICATION

A. Cardiomyopathy

B. Diabetes Insipidus

C. Diabetes Mellitus

D. Lithium Toxicity

E. Hypothyroidism

F. Neuroleptic Malignant Syndrome

G. Pulmonary Embolism

1. Young man, stable on clozapine for 2 years complains for breathlessness,

lethargy and palpitations (one option)

A. Cardiomyopathy

2. Female stable on Lithium for 2 years presents with polyuria and polydipsia. She

looks confused, dehydrated and has high sodium levels (one option)

D. Lithium Toxicity

3. Young man started recently on Risperidone. He is found on the ward febrile with

labile blood pressure, increased muscle tone, sweating and confusion (one option)

F. Neuroleptic Malignant Syndrome

EMI 3

OBSESSIVE COMPULSIVE DISORDER


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A. Fluoxetine

B. Desipramine

C. Risperidone

D. Quetiapine

E. Sertraline

F. Lamotrigine

G. Reboxetine

H. Citalopram

J. Escitalopram

K. Lithium

1. A 15 year old child who has a 5 year history of OCD. He has been found

depressed in the past 6 months (one option)

A. Fluoxetine

2. A 30 year old man with severe OCD has been on 2 different antiobsessional

medications without a significant benefit. What would you suggest as an add-on

treatment (two options)

C,K

3. A 25 year old man with OCD. Which anti-depressants are not helpful (two options)

B, G

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EMI 4

MEDICATION IN CHILDREN

A. Atomoxetine

B. Methylphenidate

C. Melatonin

D. Fluoxetine

E. Diazepam

F. Clonidine

G. Carbamazepine

H. Sodium Valproate

1. A child with pervasive hyperactivity at school and home. Fidgety, hyperactive and

poor attention (three options)

Methylphenidate, Clonidine and Atomoxetine

2. Child with low mood, insomnia, loss of weight and loss of interest (one option)

Fluoxetine

3. 3 year old child with mild learning disability, now presenting with intractableinsomnia persisting even after behavioural intervention (two options)

Melatonin and Diazepam


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EMI 5

GROUP THERAPY

A. Sub-grouping

B. Pairing

C. Interpretation

D. Universality

E. Counterdependence

F. Dependence

G. Free floating discussion

1. Two characteristics of a psychodynamic orientated group

Free floating discussion

Pairing

2. Two features that improve outcome in group therapy

Interpretation and Universality

3. Two features that pose a problem in group therapy

A. Sub-grouping

F. Dependence


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EMI 1

Lesch Nyan Syndrome

Rett's Syndrome

Prader Willi Syndrome

Angelman's Syndrome

1. An 18 year old boy with repeated self harm

Lesch Nyhan Syndrome

http://66.102.9.104/search?

q=cache:ftEMY1ARJCYJ:www.autism.org/sibpaper.html+Sel

f+Injurious+behaviour+learning+disability+cause&hl=en&ct=clnk&cd=2&gl=pk

2. A 7 year old girl with handwringing

Rett's Syndrome

http://66.102.9.104/search?q=cache:G5h7GGXpSNEJ:www.minddisorders.com/Py-

Z/Rett- s-disorder.html+Hand+wringing+causes&hl=en&ct=clnk&cd=1&gl=pk

3. A 2 year old boy with compulsive eating


EMI 2

Options

Systemic Lupus Erythematosus

Huntington's Disease

Temporal Lobe Epilepsy

PCP (Phencyclidine) use

1. 45yr old homeless man with delusions, aggression, unsteady gait, increased tone
http://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://66.102.9.104/search?q=cache:ftEMY1ARJCYJ:www.autism.org/sibpaper.html+Self+Injurious+behaviour+learning+disability+cause&hl=en&ct=clnk&cd=2&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://66.102.9.104/search?q=cache:ftEMY1ARJCYJ:www.autism.org/sibpaper.html+Self+Injurious+behaviour+learning+disability+cause&hl=en&ct=clnk&cd=2&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://66.102.9.104/search?q=cache:ftEMY1ARJCYJ:www.autism.org/sibpaper.html+Self+Injurious+behaviour+learning+disability+cause&hl=en&ct=clnk&cd=2&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://66.102.9.104/search?q=cache:G5h7GGXpSNEJ:www.minddisorders.com/Py-Z/Rett-s-disorder.html+Hand+wringing+causes&hl=en&ct=clnk&cd=1&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://66.102.9.104/search?q=cache:G5h7GGXpSNEJ:www.minddisorders.com/Py-Z/Rett-s-disorder.html+Hand+wringing+causes&hl=en&ct=clnk&cd=1&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://66.102.9.104/search?q=cache:ftEMY1ARJCYJ:www.autism.org/sibpaper.html+Self+Injurious+behaviour+learning+disability+cause&hl=en&ct=clnk&cd=2&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://66.102.9.104/search?q=cache:ftEMY1ARJCYJ:www.autism.org/sibpaper.html+Self+Injurious+behaviour+learning+disability+cause&hl=en&ct=clnk&cd=2&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://66.102.9.104/search?q=cache:ftEMY1ARJCYJ:www.autism.org/sibpaper.html+Self+Injurious+behaviour+learning+disability+cause&hl=en&ct=clnk&cd=2&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://66.102.9.104/search?q=cache:G5h7GGXpSNEJ:www.minddisorders.com/Py-Z/Rett-s-disorder.html+Hand+wringing+causes&hl=en&ct=clnk&cd=1&gl=pkhttp://www.superego-cafe.com/forum/YaBB.pl?action=dereferer;url=http://66.102.9.104/search?q=cache:G5h7GGXpSNEJ:www.minddisorders.com/Py-Z/Rett-s-disorder.html+Hand+wringing+causes&hl=en&ct=clnk&cd=1&gl=pk


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Huntington's Disease

2. A 25yr old man with a history of short lived episodes of bizarre behaviour

Temporal Lobe Epilepsy

3. A lady mild temperature, respiratory infections, lesions on shins

Systemic Lupus Erythematosus

EMI 3

Raclopride

Flumazenil

fMRI

T1MRI

1. Test used to monitor progression of Alzheimer's disease (3)

Flumazenil with PET

fMRI

T1 MRI

2. Hand dominance (2)

Flumazenil with PET

Raclopride with PET

3. Test used to measure neuronal loss (1)

T1 MRI

Set 2


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EMI 4

Options

Diabetes insipidus

Diabetes mellitus

Lithium toxicity

Hyperthyroidism

Hypothyroidism

Cardiomyopathy

NMS

Serotonin syndrome

Lead in: Choose the most appropriate drug adverse effect in the following

1. A 30 year old man who has been on Clozapine for the past 2 years presents with

palpitations, breathlessness and excessive tiredness.

Cardiomyopathy

2. A lady who has been stable on lithium for the past 3 years presents with polyuria,

polydipsia and lethargy. She also has hypernatremia and looks dehydrated.

Diabetes insipidus

3. A 26 year old man has been recently commenced on risperidone. He presents

with high fever, increased muscle tone, labile blood pressure and confusion.

NMS (Neuroleptic Malignant Syndrome)

EMI 5

Options

Living in an institution


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Living alone


Male carer

Male patient

Patient has a diagnosis of dementia

Carer married to patient

High physical dependency in the patient

Lead in: Choose the most common associated risk factors for the following:

1. Carer stress Choose 2


Patient has a diagnosis of dementia

2. Depression Choose 1

Living alone

3. Non accidental injury from carer Choose 2

Living in an institution

High physical dependency in the patient

EMI 6

Options


Angelmans syndrome

Downs syndrome


22/30

Lesch Nyhan syndrome

Retts syndrome

Autism

Lead in: Choose the most appropriate diagnosis in the following

1. 7 year old girl with loss of acquired skills and abnormal hand movements

Retts syndrome

2. 3 year old boy with obesity, compulsive overeating and excessive sleepiness.


3. 7 year old with lip biting and excessive self injurious behaviour.

Lesch Nyhan syndrome

EMI 7

Options

Barnes akathisia scale

Beck's depression inventory

Global impression scale

Edinburgh post natal depression scale

HAMD

MADRS

Simpson Angus scale

Lead in: Choose the best rating scales

1. A 30 year old woman who has post natal depression, has been recently started

on antidepressants by you. Choose two scales to monitor response to treatment.


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Hamilton Depression Rating Scale (HAM-D)

Montgomery Aesburg Depression Rating Scale (MADRS)

http://www.google.com.pk/search?

hl=en&q=MADRS+to+monitor+depression&meta =

http://www.assessments.com/catalog/HAM_D.htm

2. A 25 year old man has been started with antipsychotic medication. Choose one

rating scale to monitor parkinsonian symptoms.

Simpson-Angus Scale

http://64.233.183.104/search?

q=cache:as6muSNYuxgJ:www.medafile.com/zyweb/SAMS.ht

m+Simpson+Angus+Scale&hl=en&ct=clnk&cd=3&gl=pk

3. A 24 year old woman has recently given birth and is suspected to be depressed.

You have asked the health visitor to assess her at home. Choose one scale she can

use in this situation.

Edinburgh post natal depression scale

http://64.233.183.104/search?

q=cache:as6muSNYuxgJ:www.medafile.com/zyweb/SAMS.ht

m+Simpson+Angus+Scale&hl=en&ct=clnk&cd=3&gl=pk
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EMI 8

Options

Fluoxetine

Paroxetine

Clonidine

Melatonin

Diazepam

Methylphenidate

Atomoxetine

Risperidone

Buspirone

Lead in: Choose the best medication for the following conditions

1. A 8 year old is brought by her mother to your clinic with symptoms of

hyperactivity, poor concentration and aggressive behaviour. Choose 3

Methylphenidate

Atomoxetine

Clonidine

2. A 12 year old boy presents with low mood, poor sleep, poor appetite and difficulty

in concentration. Choose 1

Fluoxetine

3. A 8 year old boy with moderate learning difficulty and intractable insomnia.

Choose 2


25/30

Melatonin

Diazepam

EMIs Autumn 2007

EMI 1

Theme: Sleep disorders

Options:

A. Circadian rhythm sleep disorder

B. Shift work sleep disorder

C. Narcolepsy

D. Obstructive sleep apnoea

E. Limb movement disorder

F. Somnambulism

G. Delayed sleep phase syndrome

Select one option in all questions below:

1. A 25 year old female falls asleep in the daytime and loses her balance with

cataplexy

C. Narcolepsy

2. A 40 year old obese man complains of cough during the night.

D. Obstructive Sleep apnoea

3. A 30 year old man has been depressed and is prescribed by his GP flupenthixol

tablets. He later comes back to the GP complaining of sleep disturbance and fatigue

in the daytime.

G. Delayed sleep phase syndrome

EMI 2

Theme: Drug use

Options:

A. Alcohol

B. Amphetamines


26/30

C. Cocane

D. Volatile substances

F. Benzodiazepines

G. Magic mushrooms

H. Caffeine

I. CannabisJ. Phencyclidine

1. A 17 year old man with a 2 year history of drug abuse went on an all night party

and presented to A & E with dilated pupils, tachycardia, tremors and sweating

(Select 2 options)

B. Amphetamines

H. Caffeine

http://www.emedicine.com/emerg/topic23.htm (Diaphoresis)

2. A 19 year old factory worker with a history of various illicit drugs presented to A

& E. He said he had a bad trip and on examination he has dilated pupils, tremorsand sweating (Select 2 options)

G. Magic mushrooms

J. Phencyclidine

Ref. Puri and Hall p. 362

A 20 year old man presented to A & E with tachycardia, sweating, tremors andincrease in muscle tone, history of 2 seizures. He has a history of substance use

(Select 2 options)

A. Alcohol

F. Benzodiazepines
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EMI 3

Theme: Side effects of medications - receptors

Options:

Alpha-1 receptor antagonism

Down regulation of alpha-2 adrenergic receptors

Action at the 5-HT1A receptor

H1 receptor antagonism

CYP450 enzyme induction

CYP450 enzyme inhibition

D2 receptor antagonism

Select one option

1. Patient who has been on risperidone complained of postural instability.

Alpha-1 receptor antagonism

2. A patient who is on carbamazepine says that the oral contraceptives she has

been taking have not been working.

CYP450 enzyme induction

3. Patient on fluoxetine has not been doing well and lithium has been started as an

augmentation and he started having tremors, instability of gait, sweating and

confusion.

Action at the 5-HT1A receptor

Ref. http://www.drugs.com/drug_interactions.php

EMI 4

Theme: Appropriate treatment in child and adolescents
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28/30

Options:

Parental training

Fluoxetine

Citalopram

Methylphenidate

Lithium

Family training

Risperidone

Select one option

1. A 13 year old boy who has been treated under a psychologist for his aggression is

receiving CBT treatment and his psychologist has diagnosed him of having

hyperkinetic disorder.

Methylphenidate

2. A 17 year old boy who has been abandoned by his family because of his

aggression. What is the most appropriate treatment?

Family training

3. A 14 year old boy has been more aggressive after a conflict between his parents

and his mother brought him to hospital complaining that he wouldnt listen to

anything.

Parental training

EMI 5

Theme: Psychotherapy

Options:

Reassurance


29/30

Show empathy

Clarification

Ask to reflect

Link the present state to the childhood relationships

Name the emotion

Listen and think quietly

A 17 year old male comes to the first session of your therapy and he keeps coming

late to the therapy. Recently he broke up with his girlfriend and at one situation he

tries to be angry with you and says that he would like to kill himself. 3 options

Show empathy ,

Ask to reflect ,

Reassurance .

The same person keeps coming regularly to the sessions. After a few sessions he

becomes angry again and starts coming late to the sessions, even though attending

them and when you tell him that the sessions are going to end he says that you are

going to abandon him and that he will die. 2 options

Link the present state to the childhood relationships

Show empathy

The same person keeps coming to the sessions, makes good progress but once

reports to you of a dream in which he was on a train which goes very fast and ends

up in a plane crash. He asks you what does that mean. 1 option

Ask to reflect

EMI 6

Theme: Side effects of medications

Options:

Ebsteins anomaly

Fallots tetrology


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Irritability in newborn

Neural tube defects

Select 1 option

1. Question of pregnant woman taking lithium and possible side effect to the baby.

Ebsteins anomaly

2. Question of pregnant woman on paroxetine and possible side effect to the baby.

Irritability in newborn

3. Question of pregnant woman on sodium valproate and possible side effect to the

baby

Neural tube defects

Please feel free to differ and criticize.

Thanks

Kamran

Paper 3 EMIs

Documents

Transcript of Paper 3 EMIs