4 5764710460515419806
4 5764710460515419806
4 5764710460515419806
CLARE OAKLEY
MB ChB, MRCPsych
Vice Chair, Psychiatric Trainees’ Committee,
Royal College of Psychiatrists
Specialty Registrar in Forensic Psychiatry,
West Midlands Deanery
and
OLIVER WHITE
BMedSci, BM BS, MRCPsych
Chair, Psychiatric Trainees’ Committee,
Royal College of Psychiatrists
Specialist Registrar in Child and Adolescent and Forensic
Psychiatry, Oxford Deanery
Clare Oakley and Oliver White have asserted their right under the Copyright,
Designs and Patents Act 1998 to be identified as the authors of this work.
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reasonable efforts have been made to publish reliable data and information, neither the author[s] nor
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made. The publishers wish to make clear that any views or opinions expressed in this book by
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views/opinions of the publishers. The information or guidance contained in this book is intended for
use by medical, scientific or health-care professionals and is provided strictly as a supplement to the
medical or other professional’s own judgement, their knowledge of the patient’s medical history,
relevant manufacturer’s instructions and the appropriate best practice guidelines. Because of the rapid
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vii
1
Introduction
Background
The structure of the MRCPsych examination has changed signifi-
cantly. The exam will no longer consist of two distinct ‘Parts’ but will
consist of three written papers and one clinical exam. This chapter
outlines these changes, and further details can be found on the website
of the Royal College of Psychiatrists (www.rcpsych.ac.uk). We recom-
mend that candidates check the website carefully before applying to
sit the examinations. This book provides 250 practice MCQs and 100
practice EMIs for paper II.
Examination format
The new written papers will contain 200 questions and will all be three
hours long. The papers will include both ‘single best answer 1 from
5’ style MCQs, and EMIs. The proportion of each type of question in
the exam paper may vary but approximately one-third of the questions
will be EMIs.
There will be a new OSCE-type examination called Clinical
Assessment of Skills and Competencies (CASC). It will consist of two
parts to be completed in one day. One circuit will consist of eight
individual stations of seven minutes with a preceding one minute of
‘preparation’ time. The other circuit will consist of four pairs of linked
stations, with each station lasting ten minutes with two minutes of
preparation time.
1
THE NEW MRCPsych PAPER II PRACTICE MCQs AND EMIs
Examination content
The topics tested in each paper are shown in the table below. Broadly
speaking, paper I can be considered to be similar to the old style Part
1 written paper; paper II has elements similar to the Part 2 basic sci-
ences paper; paper III is similar to the Part 2 clinical sciences paper
with additional critical appraisal and statistics.
2
INTRODUCTION
EMIs
Each option may be used once, more than once, or not at all.
Each question may have more than one answer (this will be
indicated).
It may be helpful to read the question first before reading the
answer options.
EMIs take longer than MCQs to answer – make sure you allow
enough time.
Recommended reading
Candidates will have their own preferences about textbooks and revi-
sion material. We found the following books useful in our preparation
for the Membership exams and they cover most of the material
required. In the explanatory notes that accompany the answers in this
book, there are references to the books below to enable you to read
more fully if you have not understood a topic.
3
THE NEW MRCPsych PAPER II PRACTICE MCQs AND EMIs
General
Fear C. Essential Revision Notes in Psychiatry for MRCPsych. Knutsford:
PasTest; 2004.
Gelder MG, Lopez-Ibor JJ, Andreason N, editors. New Oxford
Textbook of Psychiatry (2 Volume Set). Oxford: Oxford University
Press; 2003.
Johnstone E, Cunningham-Owens DG, Lawrie SM et al., editors.
Companion to Psychiatric Studies. 7th ed. London: Churchill
Livingstone; 2004.
Lawrie SM, McIntosh AM, Rao S. Critical Appraisal for Psychiatry.
Edinburgh: Elsevier Churchill Livingstone; 2000.
Leung WC, Passmore K. Essential Notes in Basic Sciences for the
MRCPsych Part 2. Oxford: Radcliffe Publishing; 2004.
Levi MI. Basic Notes in Psychiatry. 4th ed. Oxford: Radcliffe Publishing;
2005.
Puri BK, Hall AD. Revision Notes in Psychiatry. 2nd revised ed. London:
Hodder Arnold; 2004.
Psychology
Gross R. Psychology: the science of mind and behaviour. 4th revised ed.
London: Hodder Arnold; 2001.
Gupta D, Gupta RM, editors. Psychology for Psychiatrists. Chichester:
John Wiley & Sons; 1999.
Psychopharmacology
Anderson IM, Reid IC, editors. Fundamentals of Clinical
Psychopharmacology. 3rd revised ed. Abingdon: Taylor & Francis;
2006.
Levi MI. Basic Notes in Psychopharmacology. 4th ed. Oxford: Radcliffe
Publishing; 2007.
Taylor D, Paton C, Kerwin R. The Maudsley 2005–2006 Prescribing
Guidelines. Abingdon: Taylor & Francis; 2005.
4
2
Advanced
psychopharmacology and
therapeutics
Questions
MCQs
5
THE NEW MRCPsych PAPER II PRACTICE MCQs AND EMIs
6
ADVANCED PSYCHOPHARMACOLOGY AND THERAPEUTICS: QUESTIONS
7
THE NEW MRCPsych PAPER II PRACTICE MCQs AND EMIs
8
ADVANCED PSYCHOPHARMACOLOGY AND THERAPEUTICS: QUESTIONS
17 What is the level of evidence for the use of fish oils in schizo-
phrenia?
a Case reports
b Expert opinion
c Open label trials
d Double-blind randomised control trials
e Non-blinded randomised control trials
18 Which of the following has the strongest evidence base for use as
clozapine augmentation?
a Sulpiride
b Haloperidol
c Aripiprazole
d Omega-3 triglycerides
e Olanzapine
9
THE NEW MRCPsych PAPER II PRACTICE MCQs AND EMIs
20 A patient asks you about the foods they cannot eat while taking
MAOIs. Which of the following foods is safe to eat when taking an
MAOI?
a Cheddar cheese
b Sherry
c Avocado
d Caviar
e Broccoli
10
ADVANCED PSYCHOPHARMACOLOGY AND THERAPEUTICS: QUESTIONS
11
THE NEW MRCPsych PAPER II PRACTICE MCQs AND EMIs
12
ADVANCED PSYCHOPHARMACOLOGY AND THERAPEUTICS: QUESTIONS
31 You are called to the ward to assess somebody who the nurses
suspect may have neuroleptic malignant syndrome. Which of the
following is not a risk factor for this?
a High-potency typical antipsychotics
b Rapid dose increase
c Rapid dose decrease
d Organic brain disease
e Chronic antipsychotic prescription
13
THE NEW MRCPsych PAPER II PRACTICE MCQs AND EMIs
35 A routine lithium level is elevated and you think that the prescrip-
tion of an additional medication may be the explanation. Which
of the following could be the cause?
a Carbamazepine
b Metoclopramide
c NSAIDs
d Haloperidol
e Metronidazole
14
ADVANCED PSYCHOPHARMACOLOGY AND THERAPEUTICS: QUESTIONS
15
THE NEW MRCPsych PAPER II PRACTICE MCQs AND EMIs
45 You have a patient who is about to have ECT. Which of the fol-
lowing medications may increase the seizure duration?
a Clozapine
b Venlafaxine
c Diazepam
d Semi-sodium valproate
e MAOIs
16
ADVANCED PSYCHOPHARMACOLOGY AND THERAPEUTICS: QUESTIONS
EMIs
1 Receptors:
a 5 HT1A auto receptor
b 5 HT2 receptor
c 5 HT3 receptor
d 5 HT transporter
e Alpha-1 receptor
f Alpha-2 receptor
g GABA-A receptor
h H1 histaminergic receptor
2 Pharmacokinetics:
a Ionisation
b Loading dose
c Rate of elimination
d Passive diffusion
e Rate of absorption
f Phase 1 metabolism
g Phase 2 metabolism
h Protein binding
i Active transport
17
THE NEW MRCPsych PAPER II PRACTICE MCQs AND EMIs
3 This parameter depends on the rate at which the drug can pass
from the gut lumen into the circulation.
3 Atypical antipsychotics:
a Amisulpiride
b Aripiprazole
c Clozapine
d Olanzapine
e Quetiapine
f Risperidone
g Zotepine
h Ziprasidone
18
ADVANCED PSYCHOPHARMACOLOGY AND THERAPEUTICS: QUESTIONS
d Valproate
e Gabapentin
f Vigabatrin
g Topiramate
h Ethosuximide
5 Receptors:
a D3
b Alpha-2
c D1
d 5HT2
e D4
f Alpha-1
g D2
h 5HT1A
i 5HT2A
1 Mirtazapine (2 answers)
2 Haloperidol (1 answer)
3 Clozapine (3 answers)
19
THE NEW MRCPsych PAPER II PRACTICE MCQs AND EMIs
Answers
MCQs
1 d
(Taylor, Paton, Kerwin, pp. 120–1.)
2 c
(Taylor, Paton, Kerwin, p. 202.)
3 b
(Puri, Hall, p. 260.)
4 b
(Puri, Hall, p. 267.)
5 e
6 c
(Anderson, Reid, p. 66.)
7 e
(Puri, Hall, p. 260.)
8 b
(Anderson, Reid, p. 45.)
9 c
Amphetamine increases noradrenaline (NA) release.
10 b
11 e
(Puri, Hall, p. 266.)
20
ADVANCED PSYCHOPHARMACOLOGY AND THERAPEUTICS: ANSWERS
12 d
(Anderson, Reid, p. 66.)
13 e
14 c
15 e
(Anderson, Reid, p. 13.)
16 a
Clozapine commonly causes constipation.
17 d
Many double-blind randomised control trials have shown fish oils are
effective (Taylor, Paton, Kerwin, p. 69).
18 a
There is a randomised control trial supporting sulpiride augmentation
(Taylor, Paton, Kerwin, p. 49).
19 c
(Anderson, Reid, p. 45.)
20 e
(Puri, Hall, p. 368.)
21 e
22 e
23 d
SSRIs are enzyme inhibitors of the CP450 metabolism of antipsychotics
and so cause increased levels of antipsychotics.
21
THE NEW MRCPsych PAPER II PRACTICE MCQs AND EMIs
24 c
Most psychotropic drugs are metabolised in the liver and converted
from lipid-soluble to water-soluble form.
25 d
Carbamazepine and lamotrigine block sodium channels. Valproate
increases the levels of GABA.
26 a
A fine tremor is a side effect of lithium, a coarse tremor occurs in
toxicity (Puri, Hall, pp. 264–5).
27 e
28 a
29 d
Physical observations should be carried out frequently during the ini-
tial titration of clozapine (Taylor, Paton, Kerwin, p. 47).
30 c
Antipsychotics with a low tendency to cause weight gain include
aripiprazole, haloperidol and amisulpride (Taylor, Paton, Kerwin,
p. 83).
31 e
32 b
Sertraline is the drug of choice in this situation (Taylor, Paton, Kerwin,
pp. 166–7).
33 d
Clozapine blood monitoring should occur weekly for 18 weeks, fort-
nightly for the remainder of the year and then monthly (Taylor, Paton,
Kerwin, p. 65).
22
ADVANCED PSYCHOPHARMACOLOGY AND THERAPEUTICS: ANSWERS
34 a
35 c
36 b
Phenytoin decreases clozapine levels via enzyme induction (Taylor,
Paton, Kerwin, p. 48).
37 d
38 d
39 a
They are equally efficacious; the main differences are their side effects
and toxicity.
40 b
41 b
Metallic taste is an acute side effect (Puri, Hall, pp. 264–5).
42 a
43 a
44 d
Naloxone is given in opioid overdose.
45 a
Clozapine is perhaps the most likely antipsychotic to increase the sei-
zure duration (Taylor, Paton, Kerwin, p. 157).
46 c
Adding reboxetine has some evidence behind it, but is considered
a second-line treatment of refractory depression (Taylor, Paton,
Kerwin, pp. 150–5).
23
THE NEW MRCPsych PAPER II PRACTICE MCQs AND EMIs
EMIs
1 1 a
2 c
3 h
2 1 c
2 g
3 e
3 1 f
2 a
3 f
4 c
4 1 b
2 d
3 d
4 b
5 1 b, d
2 g
3 c, d, e
24
3
Genetics
Questions
MCQs
25
THE NEW MRCPsych PAPER II PRACTICE MCQs AND EMIs
4 The mother of one of your patients is very concerned that her son
will end up in prison like his father. Which of these statements
about the genetics of antisocial behaviour is false?
a Heritability of antisocial behaviour is 40%.
b Callous-unemotional traits are highly heritable.
c Low IQ is a risk factor for offending behaviour.
d There is substantial genetic overlap between adult antisocial
behaviour and alcohol and drug dependence.
e Maltreated children who have a genotype conferring high
MAO-A expression are more likely to develop antisocial
problems than those with low MAO-A expression.
26
GENETICS: QUESTIONS
c 60%
d 70%
e 80%
27
THE NEW MRCPsych PAPER II PRACTICE MCQs AND EMIs
28
GENETICS: QUESTIONS
29
THE NEW MRCPsych PAPER II PRACTICE MCQs AND EMIs
30
GENETICS: QUESTIONS
31
THE NEW MRCPsych PAPER II PRACTICE MCQs AND EMIs
32
GENETICS: QUESTIONS
d 13p12
e 16p13
33
THE NEW MRCPsych PAPER II PRACTICE MCQs AND EMIs
34
GENETICS: QUESTIONS
c Infertility is common.
d Libido is frequently normal.
e Congenital heart defects are common.
35
THE NEW MRCPsych PAPER II PRACTICE MCQs AND EMIs
EMIs
1 Clinical syndromes:
a Autosomal recessive inheritance
b X-linked dominant inheritance
c Trisomy 18
d Translocation between 21 and 14
e Autosomal dominant inheritance with incomplete penetrance
f Trisomy 15
g Partial deletion of the short arm of 16
h Trisomy 13
Identify a cause for the following syndromes from the list above.
1 Down’s syndrome
2 Edwards’ syndrome
3 Patau syndrome
2 Genetic disorders:
a Huntington gene
b Frataxin gene
c Presenelin-1
d FMRI gene
e ATP 7B gene
36
GENETICS: QUESTIONS
f Apolipoprotein E
g Hypocretin gene
h Neuregulin-1
i No gene involved
1 Wilson’s disease
3 Huntington’s disease
4 Schizophrenia
3 Clinical features:
a A woman with a slight increase in height and a specific
learning disorder
b Normal child development followed by short-lived plateau
and then a rapid deterioration in motor and speech abilities
c Tall man with hypogonadism, scant facial hair and
gynaecomastia
d Elfin face, peri-orbital fullness, lacy iris pattern, long philtrum
and prominent lips
e An elongated face, enlarged testicles and large ears
f Transverse palmar crease, upslanting palpebral fissures and a
protruding tongue
g Severe learning disability, seizures, prominent jaw and ataxic
gait
h Receding jaw, wide-spaced eyes, broad nose root, occult cleft
palate and external ear anomalies
37
THE NEW MRCPsych PAPER II PRACTICE MCQs AND EMIs
Identify the clinical features from the list above which present with the
following genetic abnormalities:
1 Microdeletion in chromosome 22
2 47XXY
3 Fragile X syndrome
4 Molecular genetics:
a A measure of how often the alleles at two loci are separated
during meiotic recombination
b Polymorphisms at restriction enzyme cleavage sites that can
be used as DNA markers
c DNA fragments are transferred from gel, where
electrophoresis and DNA denaturation have taken place.
d Crossover of genetic information between adjacent alleles
e Cleave DNA only are locations containing specific nucleotide
sequences.
f Two genes close to each other on the same chromosome are
likely to be inherited together.
g Lengths of DNA that are constructed so that they have a
nucleotide sequence complementary to that of a given part of
the genome
h A set of cloned DNA fragments representing all the genes of
an organism or a given chromosome
1 Gene probes
2 Southern blotting
38
GENETICS: ANSWERS
Answers
MCQs
1 b
Prader-Willi is caused by a deletion of chromosome 15.
2 a
3 d
The ears are characteristically large and floppy.
4 e
It is the opposite way round. Data from the Dunedin cohort suggested
that maltreated children with a genotype conferring high levels of
MAO-A activity were less likely to develop antisocial problems.
5 a
6 e
Heritability is the proportion of variance attributable to genetic effects
(Fear, p. 187).
7 b
It is also known as velo-cardio-facial syndrome or di George syn-
drome.
8 a
9 a
10 d
Lod is ‘log of the odds’. It is the common log of the likelihood that the
recombination fraction has a certain value.
11 e
39
THE NEW MRCPsych PAPER II PRACTICE MCQs AND EMIs
12 b
13 e
This results from birth injuries or congenital abnormalities (Puri,
Hall, p. 278).
14 c
(Puri, Hall, p. 279.)
15 b
16 b
17 e
18 c
19 a
The other options are all X-linked recessive disorders (Puri, Hall,
pp. 284–5).
20 d
The other options are all autosomal dominant disorders (Puri, Hall,
p. 282).
21 c
This was shown in a case-control study of over 3000 individuals from
the UK. (Green K, Raybould R, Macgregor S et al. Genetic variation
of brain-derived neurotrophic factor (BDNF) in bipolar disorder:
Case-control study of over 3000 individuals from the UK. Br J
Psychiatry. 2006; 188: 21–5.)
22 a
Mitosis occurs via the following stages: interphase, prophase, meta-
phase, anaphase and telophase (Puri, Hall, p. 274).
40
GENETICS: ANSWERS
23 d
Although mitochondrial genes are passed on from the mother, both
males and females can suffer from the disorder (Leung, Passmore,
p. 33).
24 e
They usually give different results (Puri, Hall, p. 278).
25 c
The presenilin-1 gene is located on chromosome 14 (Leung, Passmore,
p. 39).
26 d
See Tsapakis et al. (Tsapakis EM, Basu A, Aitchison KJ. Clinical
relevance of discoveries in psychopharmacogenetics. Advan Psychiatr
Treat. 2004; 10: 455–65.)
27 e
See O’Brien. (O’Brien G. Behavioural phenotypes: causes and clinical
implications. Advan Psychiatr Treat. 2006; 12: 338–48.)
28 d
See Craddock and Jones. (Craddock N, Jones I. Genetics of Bipolar
Disorder. J Med Genet. 1999; 36: 585–94.)
29 a
30 b
See Tsapakis et al. (Tsapakis EM, Basu A, Aitchison KJ. Clinical
relevance of discoveries in psychopharmacogenetics. Advan Psychiatr
Treat. 2004; 10: 455–65.)
31 c
41
THE NEW MRCPsych PAPER II PRACTICE MCQs AND EMIs
32 d
See Ball D. Genetic approaches to alcohol dependence. Br J Psychiatry.
2004; 185: 449–451.
33 b
34 d
35 a
Webbing of the neck is seen in Turner’s syndrome.
36 e
37 b
This is the definition of penetrance. Epistasis takes place when the
action of one gene is modified by one or more others.
38 c
39 b
This is a difficulty with twin studies (Puri, Hall, p. 278).
40 d
EMIs
1 1 d
2 c
3 h
2 1 e
2 c
42
GENETICS: ANSWERS
3 a
4 h
3 1 h
2 c
3 e
4 g
4 1 g
2 c
3 b
43
4
Neurosciences
Questions
MCQs
45
THE NEW MRCPsych PAPER II PRACTICE MCQs AND EMIs
46
NEUROSCIENCES: QUESTIONS
47
INDEX
Prader-Willi syndrome (Q) 25, (A) 39 genetics and (Q) 26–7, (A) 39
precursor (Q) 8, (A) 21 homicide and (Q) 90, (A) 100
prefrontal cortex (Q) 66, (A) 81; (Q) 71, information processing (Q) 77, (A) 86
(A) 83 neuropathology (Q) 51, (A) 61
premenstrual syndrome (Q) 93, (A) 101 psychological interventions (Q) 69,
presenilin-1 gene (Q) 32, (A) 41 (A) 82
prevalence (of disorder) 89, 95, 100 sex/gender and (Q) 91, (A) 100
period (Q) 93, (A) 101 symptom subgroups (Q) 56, (A) 63
point (Q) 88, (A) 99 school refusal (Q) 94, (A) 101
primary mental abilities (Q) 72, 83 screening tool, primary care (Q) 105–6,
prosopagnosia (Q) 70, (A) 83 (A) 117–8
psychoanalysts (Q) 76, (A) 85 second messenger (Q) 45, (A) 60
psychoses, ethnicity and (Q) 89, (A) 100 selective serotonin reuptake inhibitors
psychotherapy (SSRIs) (Q) 8, (A) 21; (Q) 15, (A) 23
psychodynamic (Q) 80, (A) 86 evaluation (Q) 66, (A) 81
techniques (Q) 76, (A) 84; (Q) 79, side effects (Q) 52, (A) 62
(A) 86 sensitivity (statistics) (Q) 105, (A) 117;
psychotropics (Q) 11, (A) 22 (Q) 109, (A) 119
antiepileptics and (Q) 18, (A) 24 serotinergic nerve cells (Q) 55, (A) 63
punch-drunk syndrome (Q) 51, (A) 62 serotonin (Q) 51, (A) 61
transporter-linked polymorphic
randomised control trial (Q) 109, region (5-HTTLPR) (Q) 33, (A) 41
(A) 119 sertraline (Q) 13, (A) 22
reboxetine (Q) 16, (A) 23 sexual
receptors, see neuroreceptors activity (Q) 46, (A) 60
recombination genetics (Q) 33, (A) 41 disorders (Q) 87, (A) 99
regression analysis (Q) 112, (A) 119 sick role (Q) 67, (A) 81
relative risk (RR) (Q) 110, (A) 119; sleep disorders (Q) 90, (A) 100
(Q) 113, (A) 120 smooth pursuit eye movement (Q) 77,
REM sleep (Q) 55, (A) 63 (A) 85
restriction fragment length social power (Q) 73, (A) 84
polymorphisms (RFLPs) (Q) 29, SoCRATES study (Q) 69, (A) 82
(A) 40; (Q) 38, (A) 43 southern blotting (Q) 38, (A) 43
reticular formation (Q) 50, (A) 61 specificity (statistics) (Q) 106, (A) 117;
Rogers (Q) 79, (A) 86 (Q) 112, (A) 119
St John’s Wort (Q) 58, (A) 64
Schedule for Clinical Assessment in statistical power (Q) 109, (A) 118
Neuropsychiatry (SCAN) (Q) 93, stimulant medication (Q) 16, (A) 23
(A) 101 suicidal ideation (Q) 89, (A) 99
schizophrenia (Q) 37, (A) 42 suicide (Q) 96, (A) 102
antipsychotics and (Q) 12, (A) 22; survival analysis (Q) 111, (A) 119
(Q) 116, (A) 120 synaptic transmission (Q) 53, (A) 62;
births (Q) 93, (A) 101 (Q) 56, (A) 63
cannabis and (Q) 87, (A) 99; (Q) 115,
(A) 120 tardive dyskinesia (Q) 8, (A) 21; (Q) 14,
dopamine theory of see dopamine (A) 23
theory of schizophrenia thalamus (Q) 48, (A) 61
fish oils in treatment (Q) 9, (A) 21 therapeutic alliance (Q) 66, (A) 81
127
INDEX
128