Académique Documents
Professionnel Documents
Culture Documents
!!!!!!Psychiatry:!
A"core"textbook"for"undergraduates!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
!
Melvyn"WB"Zhang"
Cyrus"SH"Ho"
Roger"CM"Ho"
"
Sanjeev"Sockalingam"
Raed"Hawa"
"
Disclaimer:
"All the MCQs, SAQs and sample OSCEs were written by Dr. Roger Ho only. The objective of this companion book is to
help medical students to revise and understand psychiatry through practice and active learning. This allows medical
students to have a better understanding the exam format and expectations. The authors allow medical students to print
and the authors do not receive any financial incentives. The questions will not be used in the future end of posting tests
or exams."
Questions
1. A 40-year-old man admitted to the medical ward for upper gastrointestinal tract bleeding is a
known patient dependent on alcohol. His amylase level is high. During the interview, he
mentions that, I dont have a problem with alcohol. What is the defence mechanism?
A. Acting out
B. Denial
C. Projection
D. Rationalization
E. Reaction formation.
2. A 50-year-old woman is referred by her family doctor because she suffers from depressive
disorder. During the interview, she has difficulty in verbalizing her emotions. The
phenomenon is BEST described as:
A. Ambivalence
B. Affective flattening
C. Alexithymia
D. Alogia
E. Anhedonia.
A. Alcohol!withdrawal!delirium!!
B. Central!anticholinergic!delirium!!
C. Lewy!body!dementia!
D. Parkinsons!disease!
E. Schizophrenia.!
A. Hypotension
B. Palpitation
C. Shortness of breath
D. Sweating
E. Trembling.
Cognitive assessment!
5. Which of the following is NOT a prominent cognitive feature of cortical dementia such as
Alzheimers disease?
!
!
1
A. Amnesia
B. Anhedonia
C. Apathy
D. Agnosia
E. Apraxia.
Psychiatric epidemiology
6. In the community, the MOST common psychiatric diagnosis over age 65 is:
A. Alzheimers disease
B. Late-onset schizophrenia
C. Mood disorder
D. Delirium
E. Vascular dementia.
7. Which!of!the!following!is!LEAST!LIKELY!to!be!a!risk!factor!for!delusional!disorder?!!
!
A. Anxiety!
B. Increased!age!!
C. Immigration!
D. Sensory!impairment!!
E. Social!isolation.!
!
8. A!female!adolescent!was!raised!by!an!abusive!father!when!she!was!young.!Although!he!
has!changed!and!is!no!longer!abusive!towards!her,!she!still!becomes!anxious!as!soon!as!
she!sees!him.!What!is!the!BEST!explanation!based!on!psychological!theory?!
!
A. Classical!conditioning!
B. Operant!conditioning!
C. Free!association!
D. Reaction!formation!
E. Transference.!
!
9. Which of the following factors is the MOST IMPORTANT predictor of the development of Post-
Traumatic Stress Disorder (PTSD) in a 30-year-old man who has just been involved in a road traffic
accident?
!
!
2
a. Death of a friend in the accident
b. Duration of medical leave
c. His age and gender
d. History of panic disorder
e. History of substance abuse.
10. Paul, a 20-year-old man, suffers from schizophrenia. He has a monozygotic twin brother
called Peter. Based on the findings from genetic studies, what is the risk (in %) that Peter will
develop schizophrenia?
A. 17%
B. 27%
C. 37%
D. 47%
E. 57%.
11. The MOST important predisposing factor for Attention Deficit and Hyperactivity Disorder
(ADHD) is:
12. A 40-year-old widow, said the following, I cant stop thinking about my husband. The pain is
unbearable. Its been eight months and its like it happened yesterday. I still cant believe it. I
cant look at his picture, its too painful. I feel numb. And my friends dont understand. They
still have their husbands. And, I want to kill his doctor. Its his fault my husband died. My life
is completely empty. Its just not fair. Based on her description, what is the MOST correct
diagnosis?
A. Adjustment disorder
B. Antisocial personality disorder
C. Delusional disorder
D. Intense grief reaction
E. Schizophrenia.
13. All!of!the!following!statements!regarding!inpatient!suicide!are!true!EXCEPT:
A. Hanging is a common method used.
B. Inpatient suicide most often occurs during home leave.
C. Male!inpatients!are!at!higher!risk!of!committing!suicide!during!hospitalization.!
D. The!first!week!of!admission!is!a!high!risk!period.!
E. The!risk!for!women!increases!as!they!get!older.!!
!
!
3
14. Which of the following is the MOST important component of maintenance treatment for
schizophrenia?
15. Which!of!the!following!statements!regarding!schizophrenia!is!FALSE?!
A. Eye!movement!dysfunction!may!be!a!trait!marker.!
B. Hallucination!is!pathognomonic!for!schizophrenia.!
C. Intelligence!continues!to!deteriorate!with!the!progression!of!the!disorder.!!
D. Post!schizophrenia!depression!occurs!in!25%!of!patients.!
E. Prodromal!signs!and!symptoms!can!be!nonNspecific.!
!
16. Which!of!the!following!is!NOT!a!sign!or!symptom!of!atypical!depression?!!
!
A. Excessive!guilt!
B. Increased!appetite!
C. Interpersonal!rejection!sensitivity!!
D. Leaden!paralysis!
E. Mood!reactivity.!
!
17. Which of the following change is LEAST likely to occur in anorexia nervosa, binge-
purging type?
a. Hypoestrogenemia
b. Hypomagnesemia
c. Hypokalaemia
d. Hyperamylasemia
e. Hyperphosphatemia.
!
19. A!23TyearTold!medical!student!comes!to!the!clinic!with!a!complaint!of!feeling!worried.!!
He!states!that!he!may!fail!his!clinical!exam!in!Medicine!because!he!is!nervous!about!
presenting!a!case!and!performing!a!physical!examination!in!front!of!examiners.!!When!
he!thinks!about!the!exam,!he!feels!nervous.!!He!skipped!a!lot!of!bedside!teaching!when!
!
!
4
he!knew!it!would!be!his!turn!to!present!a!case!in!front!of!his!classmates!and!tutors.!He!
worries!about!criticism!from!his!classmates!and!tutor.!!The!MOST!likely!diagnosis!is:
A. Agoraphobia
B. Generalized anxiety disorder
C. Normal shyness
D. Panic disorder
E. Social phobia.
Old age psychiatry
20. The!MOST!COMMON!cause!of!psychotic!symptoms!in!elderly!outpatients!in!Singapore!is:!
!
A. Alcohol!abuse!
B. Anxiety!
C. Dementia!
D. Depression!
E. Delirium.!
21. Which!of!the!following!statements!is!TRUE!about!a!76TyearTold!woman!suffering!from!an!
acute!confusional!state!after!a!total!hip!replacement?!!
!
A. Anticholinergic!drug!is!the!treatment!of!choice.!
B. Her!age!and!gender!are!not!a!risk!factor.!
C. She!should!be!allowed!to!leave!the!ward!against!doctor!advice!should!she!wish!to.!
D. Fast,!spike!waves!are!often!seen!on!the!EEG.!!
E. There!is!a!mortality!of!up!to!15%.!!
22. A 65-year-old person is referred for early dementia. Which of the following is classified as
basic activities of daily living?
A. Bathing
B. Doing household chores and laundry
C. Managing medication
D. Preparing food
E. Shopping and managing finances.
23. Which of the following drugs/substances is LEAST likely to be abused by old people?
A. Alcohol
B. Amphetamine
C. Analgesics
D. Anticholinergics
E. Cough mixture.
24. You!are!the!resident!working!at!the!Accident!and!Emergency!Department.!A!70TyearTold!
!
!
5
woman!with!a!history!of!Alzheimers!disease!presents!to!you!after!a!fall.!!She!had!been!
experiencing! difficulty! sleeping! at! night! for! several! months! and! was! increasingly!
suspicious!of!her!husband!for!harming!her.!!You!have!decided!to!start!an!antipsychotic.!
Which!of!the!following!practices!is!MOST!appropriate?
A. Adjust doses of antipsychotics slowly with long intervals between dose increments.
B. Augmentation with benzodiazepine is highly recommended.
C. Prescribe small doses of several different antipsychotics rather than using one
antipsychotic.
D. Use a long-acting injectable antipsychotic to aid adherence.
E. Use a rapid loading dose of antipsychotic to speed up the response.
Child and adolescent psychiatry
25. Which!of!the!following!is!the!MOST!COMMON!disorder!for!children!and!adolescents!to!be!
referred!to!see!a!child!and!adolescent!psychiatrist?!!
!
A. ChildNonset!schizophrenia!
B. Conduct!disorder!!
C. Down!syndrome!
D. Separation!anxiety!disorder!
E. Somatization!disorder.!
26. An 8-year-old boy presents with stereotypies, pronoun reversal, word substitution, social
problems, and echolalia, the most likely diagnosis is:!
!
A. Autism!
B. Attention!deficit!and!hyperactivity!disorder!
C. Conduct!disorder!
D. Retts!syndrome!
E. Separation!anxiety!disorder.!
!
28. Which of the listed disorders is the MOST common co-morbidity with ADHD in children?
A. Autism
B. Learning disorders in mathematics
C. Learning disorders in expressive language
D. Oppositional defiant disorder
E. Gender identity disorder of childhood.
!
!
6
Substance abuse
29. Based on clinical severity, men from which of the following ethnicities are MOST vulnerable
to alcohol dependence in Singapore?
A. Chinese
B. Eurasian
C. Indian
D. Malay
E. Other ethnic groups.
30. The!aspartate!aminotransferase!(AST)!/alanine!aminotransferase!(ALT)!ratio!in!alcohol!hepatitis!
is:!
!
1. <!0.5!
2. 0.6!!0.9!
3. 1!!1.4!
4. 1.5!!1.9!
5. >!2.!
!
31. A 20-year-old man is suspected of acute stimulant intoxication. His symptoms are
MOST LIKELY TO resemble which of the following conditions?
A. Alcohol intoxication
B. Antisocial personality disorder
C. Mania
D. Obsessive-compulsive disorder
E. Panic disorder.
33. A 30-year-old man drinks alcohol and develops flushing and tachycardia. He took disulfiram 2
hours ago. Accumulation of which of the following is accountable for the above
phenomenon?
!
!
7
A. Acetaldehyde
B. Acetylcholine
C. Adrenaline
D. Alanine
E. Aspartic acid.
Psychopharmacology
34. Which of the following tricyclic antidepressants is MOST effective in the treatment of
obsessive compulsive disorder?
A. Amitriptyline
B. Clomipramine
C. Desipramine
D. Doxepin
E. Imipramine.
35. A depressed patient does not want to take medication on a daily basis. The selective
serotonin reuptake inhibitor (SSRI) with the LONGEST half-life is?
A. Escitalporam
B. Fluoxetine
C. Fluvoxamine
D. Paroxetine
E. Sertraline.
36. The antidepressant, mirtazapine is less likely to cause nausea because of its effects on which
of the follow receptors?
38. Which of the following is FALSE regarding the first generation antipsychotics
!
!
8
(FGAs)?
39. All of the following are true of a patient on risperidone 6mg daily who gets parkinsonism side
effects, EXCEPT:
40. Which of the following herbs has been MOST commonly used by patients to treat
mild to moderate depression in developed countries?
!
A. Gingko!
B. Ginseng!
C. Kava!kava!
D. Passion!flower!
E. St.!Johns!Wort.!
!
41. A!40TyearTold!female!patient!with!schizophrenia!has!been!treated!with!haloperidol!and!
trifluoperazine!for!many!years!in!the!past.!!Currently,!she!exhibits!a!nonTrhythmical!
hyperkinetic!movement!disorder!of!the!lips,!jaw!and!tongue.!!The!movement!disorder!
MOST!likely!consistent!with!this!finding!is:!
A. Acute dystonia
B. Akathisia
C. Aphasia
D. Pseudoparkinsonism
E. Tardive dyskinesia.
!
!
9
panicking if another car is near them on the road. Which of the following
medications would be the MOST appropriate for him?
A. Amitriptyline
B. Clonazepam
C. Paroxetine
D. Propranolol
E. Quetiapine.
Psychotherapy
43. A!66TyearTold!man!who!worked!as!an!executive!accountant!previously.!He!has!retired!
recently!and!presents!with!a!major!depressive!disorder.!!What!is!the!best!choice!of!
psychotherapy?!
!
A. Biofeedback!
B. Eye!movement!desensitization!and!reprocessing!
C. Hypnosis!
D. Interpersonal!psychotherapy!
E. Systemic!desensitization.!
44. A 40-year-old man with obsessive-compulsive disorder presents for treatment. He would
prefer not using a medication due to possible side effects. Which of the following
psychological interventions would be the treatment of choice for his disorder?
45. Effective psychotherapy techniques for Borderline Personality Disorder include all of
the following features EXCEPT:
A. A treatment contract should be established in the beginning phase of
psychotherapy.
B. Adverse effects of self-laceration are identified.
C. Focus of treatment is to establish connection between actions and feelings.
D. Therapist is quiet, distant and does not get too involved.
E. Therapist pays careful attention to his or her own feelings in order to manage
countertransference.
!
!
10
concerns about side effects and risks. She would like to try psychotherapy instead.
Her husband disagrees with her. Which of the following ethical principles is MOST
relevant in this situation?
A. Autonomy
B. Beneficence
C. Fiduciary duty
D. Non-maleficence
E. Justice.
47. You!are!the!resident!working!in!the!oncology!ward.!Which!of!the!following!factors!is!
MOST!predictive!of!high!suicide!risk!in!a!palliative!cancer!patient?!
!
A. Alopecia!associated!with!chemotherapy!
B. Low!energy!level!
C. Poor!appetite!
D. Financial!difficulty!
E. Hopelessness.!
!
48. A 40-year-old woman presents with chronic headache and blurred vision. She wants
symptomatic relief but is not concerned about the underlying condition. Which of the
following psychiatric diagnoses is LEAST relevant?
!
A. Conversion!disorder!
B. Moderate!depressive!episode!with!somatic!complaints!
C. Hypochondriasis!
D. Pain!disorder!
E. Somatization!disorder.!
!
Questions Answers!
!
!
11
with alcohol. What is the defence leading to medical complication.
mechanism?
F. Acting out
G. Denial
H. Projection Year: 2013.
I. Rationalization
J. Reaction formation.
Year:!2013!
Explanation:!!As!a!result!of!sympathetic!
F. Hypotension
!
!
12
G. Palpitation drive,!the!patient!may!experience!
H. Shortness of breath hypertension!rather!than!hypotension.!!
I. Sweating
J. Trembling.
!
Year:!2013.!
Cognitive assessment! !
Explanation:!Anhedonia!(loss!of!interest)!
F. Amnesia
G. Anhedonia and!depression!are!more!common!in!
H. Apathy subcortical!dementia.!The!other!4!As:!
I. Agnosia amnesia,!apathy,!agnosia!and!apraxia!are!
J. Apraxia.
common!in!cortical!dementia.!
Year:!2013!
This!is!an!advanced!level!question.!
Psychiatric epidemiology !
D. Delirium
E. Vascular dementia.
Year: 2013
!
!
13
delusional!disorder?!! !
!
Explanation:!The!risk!of!delusional!disorder!
F. Anxiety! increases!with!age.!Hearing!loss!is!a!risk!
G. Increased!age!! factor.!Low!socioeconomic!status!and!severe!
H. Immigration!
stress!are!also!risk!factors.!
I. Sensory!impairment!!
J. Social!isolation.! !
!
!
Year:!2013.!
! !
Year:!2013.!
This!is!an!advancedN!level!question.!
!
!
14
j. History of substance abuse.
Year: 2013.!
Year: 2013.
Explanation:!Foetal!alcohol!syndrome!and!
F. Adverse social economic status
antenatal!exposure!to!nicotine!is!the!most!
G. Development of autism before the
onset of ADHD. important!predisposing!factor!for!ADHD.!
H. Female gender Option!A!is!nonNspecific.!Male!gender,!rather!
I. Prenatal exposure to alcohol and than!female!gender!is!more!common!for!
nicotine by mother. ADHD.!Option!E!is!an!important!predisposing!
J. Presence of antisocial personality factor!for!conduct!disorder.!!
disorder in father.
!
!
!
15
Year: 2013.!
!
Year:!2013.!
!
!
16
treatment and almost 90% relapse in 2 years.
H. Occupational rehabilitation Maintenance on antipsychotic therapy is the
I. Psychosocial rehabilitation single most important factor in preventing
J. Family therapy.
rehospitalisation.
Year: 2013.
F. Excessive!guilt! Explanation:!Excessive!guilt!is!part!of!
G. Increased!appetite! melancholia.!
H. Interpersonal!rejection!sensitivity!!
I. Leaden!paralysis! !
J. Mood!reactivity.!
! !
Year:!2013.!
!
!
17
hypomagnesemia.!
Year:!2013!
This!is!an!advanced!!level!question.!
Year:!2013!
!
!
18
! Explanation:!Dementia!is!the!most!common!
cause!for!psychotic!symptoms!in!elderly!
F. Alcohol!abuse! outpatients.!
G. Anxiety!
H. Dementia! !
I. Depression!
J. Delirium.! !
Year:!2013.!
Year:!2013!
!
!
19
71. Which of the following The!answer!is!B.!
drugs/substances is LEAST likely to be
abused by old people? !
Explanation:!Old!people!are!most!likely!to!
F. Alcohol
G. Amphetamine misuse!alcohol!or!prescribed!drugs!than!
H. Analgesics street/illicit!drugs!such!as!stimulant.!
I. Anticholinergics
J. Cough mixture. !
!
Year:!2013.!
!
!
20
G. Conduct!disorder!! children! and! adolescents! seeing! a!
H. Down!syndrome! psychiatrist! have! conduct! problem.!
I. Separation!anxiety!disorder! Separation! anxiety! disorder! and! Down!
J. Somatization!disorder.!
Syndrome!may!not!need!to!see!a!psychiatrist.!
0.1%! have! psychotic! disorder! and! 1%! have!
somatization!disorder.!
Year:!2013!
Year:!2013!
!
!
21
H. Learning disorders in expressive disorder,!oppositional!defiant!disorder,!
language depression,!anxiety!and!substance!abuse!are!
I. Oppositional defiant disorder
J. Gender identity disorder of common!comorbidity!with!ADHD.!
childhood.
!
Year:!2013.!
Substance abuse !
C. Indian !
D. Malay !
E. Other ethnic groups.
Year:!2013.!
Year:!2013.!!
This!is!an!advanced!level!question.!!
!
!
22
conditions? The syndrome picture of acute cocaine or
amphetamine intoxication can include
hyperawareness, hypersexuality,
F. Alcohol intoxication
hypervigilance, agitation, paranoia, and
G. Antisocial personality disorder
H. Mania delusions. It resembles mania or psychosis.
I. Obsessive-compulsive disorder
J. Panic disorder.
Year: 2013.
!
!
23
G. Acetylcholine accumulation.!
H. Adrenaline
I. Alanine !
J. Aspartic acid.
!
Year:!2013!
This!is!an!advancedNlevel!question.!
Psychopharmacology !
Year:!2013!
Year:!2013!
!
!
24
Year: 2013.
Year: 2013.
Explanation:!The!second!generation!
F. FGAs have high D2 receptor blocking antipsychotics!have!higher!risk!for!metabolic!
effects. syndrome!as!compared!to!the!FGAs.!
G. FGAs have increased risk of
extrapyramidal side effects as !
compared with the second generation
antipsychotics. !
H. FGAs have increased risk of tardive
dyskinesia as compared with the Year:!2013.!
second generation antipsychotics.
I. FGAs have increased risk of causing
metabolic syndrome as compared with
the second generation antipsychotics.
J. FGAs have proven efficacy as
pharmacological treatment for
!
!
25
schizophrenia.
Year:!2013.!
!
!
26
90. A 35-year-old accountant presents The!answer!is!C.!
to a psychiatrist 8 months after a
motor vehicle accident. He has !
difficulty sleeping because he has
frequent nightmares about the Explanation:!SSRIs!are!generally!most!
accident. He has not been able to appropriate!medication!of!choice!for!post!
drive since the accident, and his traumatic!stress!disorder.!Examples!
wife usually drives for him. Even
include!paroxetine,!sertraline!and!
then, he finds it very difficult to be in
a car such as a taxi, after panicking fluoxetine.!
if another car is near them on the
road. Which of the following !
medications would be the MOST
!
appropriate for him?
Year:!2013!
F. Amitriptyline
G. Clonazepam
H. Paroxetine
I. Propranolol
J. Quetiapine.
Psychotherapy !
!
!
27
H. Interpersonal psychotherapy patients!are!exposed!to!the!feared!stimuli!
I. Psychoanalysis and!obsessions!while!rituals!that!typically!
J. Supportive psychotherapy.
serve!to!reduce!anxiety!are!prevented.!!
Year:!2013!
!
!
28
!
!
Year:!2013!
!
!
29
MCQ!exam!(Paper!2):!Questions!
1. Which!of!the!following!is!the!BEST!example!of!inattention?!
A. The!patient!interrupts!the!conversation!to!ask!when!he!will!be!discharged.!
B. The!patient!is!oriented!and!aware!of!his!recent!medical!problems!but!falls!asleep!during!the!
conversation.!
C. The!patient!suddenly!bursts!into!tears!when!you!are!discussing!his!recent!amputation.!
D. The!patient!watches!a!fly!buzzing!on!the!ceiling!while!you!are!discussing!the!prognosis!for!
his!lung!cancer,!then!falls!asleep.!
E. The!patient!cannot!remember!what!you!have!told!him!3!minutes!ago.!Then!he!tries!to!make!
up!the!answer.!
!
2. A!30TyearTold!man!firmly!believes!that!the!alien!has!put!an!implant!in!his!body!and!he!
feels!there!is!a!pushing!sensation!on!his!aorta.!Which!types!of!hallucinations!BEST!
suited!his!description?!
!
A. Auditory!
B. Cenesthetic!
C. Gustatory!
D. Kinesthetic!!
E. Visual.!
!
3. Perseveration!is!MOST!commonly!seen!in!which!of!the!following!disorders?!!!
!
A. Autism!
B. Attention!deficit!and!hyperactivity!disorder!
C. Bipolar!disorder!!
D. Frontal!lobe!dementia!!
E. Obsessive!compulsive!disorder.!
!
4. A patient presents with persistence, perfectionism and body image distortion. Which of the
following disorders is MOST likely to be associated with the above clinical features?
A. Anorexia nervosa
B. Borderline personality disorder
C. Delusional disorder
D. Hypochondriasis
E. Somatization disorder.
Cognitive assessment!
5. Which of the following statement is FALSE about Mini-mental state examination (MMSE)?
!
!
30
B. Assessment of orientation to time and place is part of the MMSE.
C. The MMSE can be administered in Chinese or English.
D. The MMSE can be used to monitor treatment progress after initiation of acetylcholinesterase
inhibitors (AChEIs).
E. The MMSE is the gold standard in establishing the diagnosis of dementia.
Psychiatric epidemiology
6. Which!of!the!following!settings!have!the!HIGHEST!prevalence!of!delirium?!
!
A. Accident!and!emergency!department!
B. Cardiac!surgery!ward!
C. General!surgery!ward!
D. Hospice!with!palliative!advanced!cancer!patients!
E. Nursing!home!looking!after!dementia!patients.!
!!
A. 1%
B. 2.5%
C. 5%
D. 7.5%
E. 10%.
8. Advanced paternal age is a well- established risk factor for which of the following
psychiatry illnesses?
A. Alcoholism
B. Major depressive disorder
C. Obsessive compulsive disorder
D. Generalized anxiety disorder
E. Schizophrenia.
10. Individuals!with!which!one!of!the!following!genes!have!the!HIGHEST!risk!of!
!
!
31
developing!Alzheimers!disease?
11. A!40TyearTold!man!suffered!from!a!heart!attack!under!general!anaesthesia.!The!
doctors!in!the!operation!theatre!successfully!resuscitated!him.!After!recovery,!he!
wants!to!sue!the!hospital!for!causing!him!postTtraumatic!stress!disorder!(PTSD).!He!
claims!the!resuscitation!process!was!!!extremely!traumatic.!Which!of!the!following!is!
the!MOST!IMPORTANT!feature!to!exclude!the!diagnosis!of!PTSD?!!
!
12. Which of the following schizophrenia patients has the HIGHEST suicide risk?
!
A.!An!adolescent!with!prodromal!symptoms!and!vague!paranoid!idea.!
B.!An!elderly!retired!man!with!late!onset!schizophrenia.!
C.!A!middleNaged!man!with!negative!symptoms.!
D.!A!middleNaged!woman!who!suffers!from!simple!schizophrenia.!
E.!A!young!male!university!student!who!once!had!high!expectations.!
13. Which of the following is NOT a recognized alteration of sleep disturbance associated with
major depressive disorder?
14. A 40-year-old woman is staying with her god-brother. She was rejected by her family and
!
!
32
she felt helpless in the past. She needs her god-brother to make decision for her and her
god-brother asks her to be the housekeeper in return. One day, her god-brother needs to
go to Vietnam for 1 week and she feels extremely uncomfortable. Which of the following
personality traits BEST describes this person?
A. Borderline personality
B. Dependent personality
C. Histrionic personality
D. Schizoid personality
E. Schizotypal personality.
15. A 30-year-old man comes to see you and he worries about premature ejaculation. The
MOST appropriate time frame to meet the diagnosis of premature ejaculation is:
A. Ejaculation occurs within 60 seconds following vaginal penetration.
B. Ejaculation occurs within 90 seconds following vaginal penetration.
C. Ejaculation occurs within 120 seconds following vaginal penetration.
D. Ejaculation occurs within 150 seconds following vaginal penetration.
E. Ejaculation occurs within 180 seconds following vaginal penetration.
16. A!30TyearTold!man!suffered!from!eight!episodes!of!mood!disturbances!within!a!single!
year.!These!mood!episodes!met!the!diagnostic!criteria!for!major!depression,!mania!
and!hypomania.!These!episodes!were!separated!by!remission.!Which!of!the!following!
is!the!MOST!likely!diagnosis?
!
A. Cyclothymic!disorder!
B. Emotionally!unstable!personality!disorder!
C. Mixed!affective!disorder!
D. Rapid!cycling!bipolar!disorder!
E. Schizoaffective!disorder.!
17. Which!of!the!following!is!NOT!a!predisposing!factor!for!depression!in!the!elderly?
A. Cerebrovascular accident
B. Poly-pharmacy
C. Looking after a spouse with chronic illness
D. Male gender
E. Widowhood.
18. Dementia!in!general!is!BEST!described!as:!!
!
A. Behavioural!disturbance!
B. Global!impairment!
C. Impaired!memory!for!personal!events!(e.g.!marriage,!past!occupation)!
D. Personality!change!
!
!
33
E. Progressive!deterioration.!
19. A!65TyearTold!man!presents!with!memory!loss,!which!of!the!following!is!the!
LEAST!important!indication!for!a!computerized!tomography!(CT)!scan!for!his!brain:
20. Which!of!the!following!is!THE!MOST!IMPORTANT!predictor!of!bipolar!disorder!in!
adolescent!depression?!
!
A. Diurnal!variation!of!mood!
B. Hypomanic!symptoms!after!taking!antidepressants!
C. Hypersomnia!
D. Increased!weight!
E. Multiple!suicide!attempts.!
21. The!MOST!COMMON!reason!for!children!with!autism!are!brought!to!medical!attention!
by!their!parents!is: !
!
A. Language!delays!!
B. Lack!of!toilet!control!
C. Odd!play!
D. School!difficulties!
E. Stereotyped!behaviour.!
22. Which of the following statements is FALSE regarding separation anxiety disorder?
23. Which of the following symptoms is MOST LIKELY to persist when a young person suffers
from Attention Deficit and Hyperactivity Disorder (ADHD) becoming an adult?
A. Accident risk
B. Hyperactivity
!
!
34
C. Impulsivity
D. Inattention
E. Learning difficulties.
24. A baby is born with low birth weight, microcephaly, small eyes, upturned nose and a smooth,
undeveloped philtrum. He fails to thrive and develops seizures. Which of the following was he MOST
likely exposed to during pregnancy?
A. Alcohol
B. Cocaine
C. LSD
D. Methamphetamine
E. Inhalants.
Substance abuse
25. The!term!which!BEST!describes!!an!altered!physiological!state!and!neuroT!adaptation!
caused!by!repeated!administration!of!a!drug!is:!
!
A. Addiction!
B. Dependence!
C. Misuse!
D. Withdrawal!
E. Tolerance.!
!
26. While!driving,!a!40TyearTold!man!with!no!previous!history!refused!to!stop!for!the!
traffic!police.!He!was!subsequently!brought!into!the!accident!and!emergency!
department!(AED)!by!them.!You!are!the!resident!working!in!the!AED.!!When!you!
assess!him,!he!states!that!he!was!hearing!voices!in!clear!consciousness.!He!admits!to!a!
history!of!alcohol!use.!What!is!the!most!appropriate!diagnosis?!
!
A. Alcoholic!hallucinosis!!
B. Delirium!tremens!
C. Korsakoff!psychosis!
D. Schizophrenia!
E. Wernickes!encephalopathy.!
!
27. Which of the following BEST describes the mechanism of action with naltrexone in the treatment of
alcohol dependence?
!
!
35
28. Which of the following complications is LEAST likely to occur in cocaine abusers?
A. Arrhythmia
B. Hyperthermia
C. Myocardial infarction
D. Phlebitis
E. Seizure.
Psychopharmacology
30. Monoamine oxidase inhibitor (MAOI) is LEAST useful in treating which of the following
disorders?
A. Atypical depression
B. Obsessive compulsive disorder
C. Panic disorder
D. Severe depressive disorder not responding to selective serotonin reuptake inhibitor
E. Severe depressive disorder with hyponatraemia
31. Which! of! the! following! antidepressants! is! LEAST! likely! to! contribute! to! the!
development!of!serotonin!syndrome?!!$
!
A. Bupropion!
B. Fluoxetine!!
C. Moclobemide!
D. Paroxetine!
E. Venlafaxine.!
32. Which of the following antipsychotics exhibit a novel mechanism as a partial antagonist?
A. Aripiprazole
B. Clozapine
C. Olanzapine
D. Quetiapine
E. Ziprasidone.
33. Regarding!lamotrigine,!which!of!the!following!statements!is!FALSE?!!!
A. It!acts!at!voltageNsensitive!sodium!channels.!
!
!
36
B. It!inhibits!the!release!of!excitatory!amino!acid!neurotransmitters.!
C. It!is!not!effective!in!the!treatment!of!bipolar!depression.!!
D. Its!use!can!lead!to!toxic!epidermal!necrolysis.!
E. There!is!no!need!to!monitor!lamotrigine!blood!levels!during!treatment.!
!
A. Bradycardia
B. Constipation
C. Dry mouth
D. Exacerbation of open-angle glaucoma
E. Urinary retention.
35. In a schizophrenia patient without history of asthma, the BEST treatment for chronic
akathisia is:
A. Alprazolam
B. Benzhexol
C. Clonazepam
D. Propranolol
E. Vitamin E.
A. Haloperidol
B. Lithium
C. Olanzapine
D. Valproate
E. Risperidone.
Psychotherapy
37. In! conducting! psychotherapy! with! individuals! who! have! experienced! a! traumatic!
event! and! suffer! from! postTtraumatic! stress! disorder! (PTSD),! the! following! are! all!
recommended!techniques!EXCEPT:!!
!
A. Encouraging!avoidance!of!emotion!!
B. Examining!feelings!of!guilt!
C. Examining!the!patients!response!to!the!trauma!
D. Offering!consolation!
!
!
37
E. Overcoming!avoidance!or!phobia!related!to!the!trauma.!
38. A 30-year-old woman with panic disorder does not respond to an initial treatment with an
selective serotonin reuptake inhibitor (SSRI). Which of the following treatment is
considered the best approach?
A. Benzodiazepine
B. Cognitive behaviour therapy
C. Serotonin-noradrenaline reuptake inhibitor
D. Olanzapine
E. Psychodynamic psychotherapy.
A. Has!been!shown!to!be!efficacious!in!adult!outpatients!suffering!from!depression.!
B. Is!more!efficacious!than!psychodynamic!psychotherapy!
C. Works!as!quickly!as!antidepressant!medication.!
D. Works!best!in!mild!to!moderate!depression.!
E. Works!best!in!people!facing!problems!in!role!transition.!
!
40. A! 23TyearTold! student! is! seen! in! the! University! counselling! centre! because! of!
relationship!problems.!!She!has!had!one!serious!relationship!with!her!boyfriend!that!
lasted!about!six!months.!!She!terminated!the!relationship!because!she!discovered!that!
her!boyfriend!was!seeing!someone!else.!!During!psychotherapy,!she!mentions!that!All!
men!just!cant!be!trusted.!!Which!of!the!following!BEST!describes!this!thinking!error?
A. Arbitrary!inference!
B. Dichotomous!thinking!
C. Magnification!
D. Overgeneralization!
E. Selective!abstraction.!
41. All! medical! students! are! required! to! study! psychiatry! so! that! they! are! qualified! to!
assess! and! manage! common! psychiatric! disorders! after! graduation.! The! compulsory!
psychiatric!training!is!BEST!described!by!which!of!the!following!ethical!principles?!!!
!
A. Autonomy!
B. Beneficence!
C. Morality!
D. Justice!
E. Fiduciary!duty.!
!
!
38
42. You! are! a! medical! resident.! A! 40TyearTold! schizophrenia! patient! was! admitted! as! a!
result! of! polydipsia.! Which! of! the! following! statements! regarding! polydipsia! in!
schizophrenia!is!NOT!true?!!
!
A. It!is!associated!with!low!urine!osmolality.!
B. It!is!associated!with!high!sodium!in!urine.!
C. It!is!associated!with!low!serum!sodium.!!
D. Patients!should!be!investigated!for!Syndrome!of!Inappropriate!Secretion!of!AntiNDiuretic!
Hormone!(SIADH).!!
E. Polydipsia!occurs!in!between!5!to!20%!of!patients!suffering!from!chronic!schizophrenia.!!
!
43. A!40TyearTold!British!man!is!admitted!to!the!medical!ward.!He!tries!to!run!away!from!
the!ward.!He!is!very!aggressive!and!the!security!guards!have!difficulty!to!stop!him.!He!
claims!that!he!is!currently!working!in!the!office.!The!medical!records!show!that!he!has!
been!drinking!half!of!a!bottle!of!whisky!every!night.!You!need!to!order!a!medication!to!
sedate! him.! He! refuses! to! take! any! oral! medication.! ! Which! of! the! following!
medications!is!the!BEST!alternative!in!Singapore?!
!
A. Intramuscular!diazepam!
B. Intramuscular!lorazepam!
C. Intramuscular!olanzapine!
D. Intramuscular!quetiapine!
E. Intramuscular!risperidone.!
!
44. You! are! the! resident! working! for! the! liver! transplant! team.! The! MOST! common!
psychiatric! disorder! in! patients! with! liver! cancer! in! the! week! before! and! after!
transplantation!is:!
!
A. Adjustment!disorder!
B. Delirium!
C. Generalized!anxiety!disorder!!
D. Major!depressive!disorder!
E. Somatoform!pain!disorder.!
!
45. You!are!the!resident!working!in!the!obstetrics!department.!Which!of!the!following!is!
the!BEST!treatment!strategies!to!treat!hyperemesis!during!pregnancy?!
!
A. Benzodiazepines!e.g.!alprazolam!
B. Relaxation!therapy!
C. Psychoanalysis!
D. Selective!serotonin!reuptake!inhibitor!e.g.!fluvoxamine!
E. Stimulus!deprivation.!
!
!
39
!
MCQ!exam!(Paper!2):!Answer!Key!
Year:!2013.!
!
!
40
J. Visual.! cutting!sensation!in!the!bone!
! marrow.!!Bodily!distortion!may!also!
occur.!
!
Year:!2013.!
This!is!an!advancedNlevel!question.!
F. Autism! Explanation:!Perseveration!is!a!
G. Attention!deficit!and!hyperactivity!disorder! persisting!response!to!a!previous!
H. Bipolar!disorder!! stimulus!after!a!new!stimulus!has!
I. Frontal!lobe!dementia!! been!presented;!it!is!often!
J. Obsessive!compulsive!disorder.!
associated!with!frontal!lobe!lesion.!
!
!
Year:!2013!
Year:!2013!
!
!
41
Cognitive assessment! !
Year:!2013!
Psychiatric epidemiology !
Explanation:!The!worldwide!point!
F. 1%
G. 2.5%
prevalence!is!1%!and!Singapore!is!
H. 5% 0.6%.!
I. 7.5%
J. 10%. !
Year:!2013!
!
!
42
Psychiatric aetiology, diagnosis and classification !
Explanation:!Advanced!paternal!age!
F. Alcoholism
G. Major depressive disorder is!a!risk!factor!for!schizophrenia.!
H. Obsessive compulsive disorder
I. Generalized anxiety disorder !
J. Schizophrenia.
!
Year:!2013.!
Year:!2013.
Explanation:!Homozygous!APO!
F. Homozygous apolipoproteins!(APO) E2/E2 E4/E4!increases!the!risk!of!
G. Homozygous APO E4/E4
developing!Alzhimers!disease!by!8!
H. Homozygous APO E6/E6
I. Heterozygous APO E2/E4 times.!
J. Heterozygous APO E2/E6.
!
!
43
!
Year:!2013.!
This!is!an!advanced!!level!question.!
!
!
44
expectations.! !
! !
Year:!2013.!!!
Explanation:!It!should!be!reduction!
F. Difficulty in falling asleep
G. Increase in nocturnal awakening of!latency!of!REM!sleep.!
H. Increase in density of Rapid Eye Movement (REM)
sleep !
I. Increase in the latency of Rapid Eye Movement
(REM) sleep !
J. Reduction of total sleep time.
Year:!2013.!
This!is!an!advanced!level!question.!
Year:!2013!
!
!
45
I. Ejaculation occurs within 150 seconds following it.!
vaginal penetration.
J. Ejaculation occurs within 180 seconds following !
vaginal penetration.
!
Year:!2013!
Year:!2013.!
!
!
46
J. Progressive!deterioration.! one! of! four! other! cognitive!
symptoms! (aphasia,! apraxia,!
agnosia,! impaired! executive!
functioning)! but! it! may! not! be! a!
global! impairment.! Impairment!
memory! for! recent! events! is! more!
common!than!personal!events.!
Year:!2013.!
Year:!2013.!
!
!
47
! Explanation:!Language!delay!is!the!
most!obvious!sign!and!most!
F. Language!delays!! disturbing!to!parents!when!they!
G. Lack!of!toilet!control!
discover!their!children!are!lacking!
H. Odd!play!
I. School!difficulties! behind!in!language!development!
J. Stereotyped!behaviour.! compared!to!other!children.!
Year:!2013.!
Year:!2013!
!
!
48
F. Alcohol description!of!the!facial!features!of!
G. Cocaine foetal!alcohol!syndrome!
H. LSD
I. Methamphetamine
J. Inhalants.
!
Year:!2013.!
Substance abuse !
Year:!2013.!
71. While!driving,!a!40TyearTold!man!with!no! The!answer!is!A.!
previous!history!refused!to!stop!for!the!traffic!
police.!He!was!subsequently!brought!into!the! !
accident!and!emergency!department!(AED)!
by!them.!You!are!the!resident!working!in!the! Explanation:!!Auditory!hallucinosis!
AED.!!When!you!assess!him,!he!states!that!he! is!usually!composed!of!auditory!
was!hearing!voices!in!clear!consciousness.!He! hallucination.!Sensorium!is!clear!and!
admits!to!a!history!of!alcohol!use.!What!is!the! it!is!different!from!delirium!tremens.!
most!appropriate!diagnosis?!
There!are!not!enough!symptoms!to!
!
conclude!that!he!suffers!from!
F. Alcoholic!hallucinosis!! schizophrenia.!
G. Delirium!tremens!
H. Korsakoff!psychosis! !
I. Schizophrenia!
J. Wernickes!encephalopathy.! Year:!2013.!
!
!
!
49
F. Naltrexone acts on the benzodiazepine receptor and Explanation:!Option!A!refers!to!
prevents alcohol withdrawal. benzodiazepine.!Option!C!refers!to!
G. Naltrexone blocks opioid receptors to decrease alcohol
craving. the!action!of!disulfiram.!Option!D!
H. Naltrexone inhibits aldehyde dehydrogenase to decrease and!E!refer!to!the!action!of!
alcohol craving. acamprosate.!!
I. Naltrexone is a GABA agonist and decreases alcohol
craving. !
J. Naltrexone is a glutamate antagonist and decreases
alcohol craving.
!
Year:!2013.!
Year:!2013!
This!is!an!advancedNlevel!question.!
!!
Year:!2013.!
!
!
50
!
Psychopharmacology !
Explanation:!MAOI!is!least!useful!to!
F. Atypical depression
G. Obsessive compulsive disorder treat!OCD.!
H. Panic disorder
I. Severe depressive disorder not responding to !
selective serotonin reuptake inhibitor
J. Severe depressive disorder with hyponatraemia !
Year:!2013.!
This!is!an!advancedNlevel!question.!
Year:!2013.!
!
This!is!an!advancedNlevel!question.!
!
!
51
!
Year:!2013.!
Year:!2013!
This!is!an!advancedNlevel!question.!
Year:!2013.!
!
!
52
Explanation:!Propranolol!(beta!
blocker)!is!the!best!treatment!in!this!
F. Alprazolam
G. Benzhexol patient!without!history!of!asthma!as!
H. Clonazepam it!does!not!cause!dependence!as!in!
I. Propranolol Option!A!and!C.!Beta!blockers!can!
J. Vitamin E.
reduce!restlessness!and!tremor.!!
Option!B!is!more!useful!for!
pseudoparkinsonism.!
Year:!2013.!
Explanation:!Lithium!is!less!effective!
F. Haloperidol
G. Lithium in!preventing!relapse!in!rapid!
H. Olanzapine cycling!bipolar!disorder.!Valproate!
I. Valproate and!carbamazepine!are!preferred!
J. Risperidone.
over!lithium.!
2013!
Psychotherapy !
!
!
53
83. A 30-year-old woman with panic disorder does The!answer!is!B.!
not respond to an initial treatment with an
selective serotonin reuptake inhibitor (SSRI). !
Which of the following treatment is considered
the best approach?
Explanation:!The!effect!of!CBT!is!as!
F. Benzodiazepine efficacious!as!SSRI.!
G. Cognitive behaviour therapy
H. Serotonin-noradrenaline reuptake inhibitor !
I. Olanzapine
J. Psychodynamic psychotherapy. !
Year:!2013.!
!
!
Year:!2013.!
!
!
54
Ethics and laws !
Year:!2013!
!
!
55
Year:!2013.!
This!is!an!advancedNlevel!question.!
! !
89. You! are! the! resident! working! for! the! liver! The!answer!is!B.!
transplant! team.! The! MOST! common!
psychiatric! disorder! in! patients! with! liver! !
cancer! in! the! week! before! and! after! Explanation:!Delirium!is!the!most!
transplantation!is:! common!disorder!and!it!can!be!
! caused!by!systemic!infection,!side!
F. Adjustment!disorder! effect!of!immunosuppressant,!
G. Delirium! impairment!of!liver!function,!hepatic!
H. Generalized!anxiety!disorder!! encephalopathy.!
I. Major!depressive!disorder!
J. Somatoform!pain!disorder.! !
!
!
Year:!2013.!
!
!
56
department.! Which! of! the! following! is! the! !
BEST! treatment! strategies! to! treat! Explanation:!Benzodiazepine!may!
hyperemesis!during!pregnancy?! cause!cleft!palate!in!the!first!
!
trimester.!Psychoanalysis!is!not!for!
F. Benzodiazepines!e.g.!alprazolam! symptomatic!relief.!SSRI!like!
G. Relaxation!therapy! fluvoxamine!is!associated!with!
H. Psychoanalysis! nausea!side!effect.!Hyperemesis!is!
I. Selective! serotonin! reuptake! inhibitor! e.g.! not!associated!with!stimulus.!
fluvoxamine! Relaxation!therapy!is!the!best!
J. Stimulus!deprivation.!
treatment.!!
Year:!2013.!
MCQ!exam!(Paper!3)!:!Questions!
1. A!40TyearTold!woman!is!brought!by!her!husband!brought!to!see!you!as!a!result!of!
abnormal!behaviour.!During!the!interview,!she!laughs!and!cries!with!a!very!short!
period!of!time.!In!your!record,!her!affect!is!BEST!described!as:!
!
!
57
!
A. Apathy!
B. Blunted!affect!
C. Euthymic!affect!
D. Labile!affect!
E. Flat!affect.!
Cognitive assessment!
Psychiatric epidemiology
3. After the age of 65, the prevalence of dementia increases by how many times every 5
years?
A. 2 times
B. 4 times
C. 6 times
D. 8 times
E. 10 times.
Psychiatric aetiology, diagnosis and classification
A. 2 times
B. 4 times
C. 6 times
D. 8 times
E. 10 times.
5. Which of the following neuroanatomical structures is the critical region for fear
conditioning?
A. Amgydala
!
!
58
B. Basal nucleus of Meynert
C. Mesocortical region
D. Nucleus accumbens
E. Raphe nucleus.
B. The pituitary.
E. The amygdala.
Psychopathology
7. Agoraphobia!without!panic!disorder!can!be!described!as:!!!
!
A. A!fear!of!enclosed!spaces!!
B. A!fear!of!speaking!in!public!
C. A!fear!of!height!
D. Avoidance!of!authority!figures!
E. Worrying!excessively!about!physical!health.!
!
8. Uncomplicated!bereavement!is!NOT!characterized!by:!!
A. Anger!
B. Depressive!mood!for!one!month!
C. Feelings!of!worthlessness!!
D. Sensations!of!seeing!or!hearing!the!deceased!
E. Transient!guilt.!
!
!
59
d. Sleep disturbance
e. Lethargy and fatigue
10. A!40TyearTold!airTconditioner!technician!is!referred!to!you!because!of!change!
in!behaviour!and!deterioration!in!functioning.!When!he!feels the gust of cold
air coming from the air-conditioner, he interprets the cold air as poison gas
from Mars. This phenomenon is BEST described as:!
A. Delusional memory
B. Delusional perception
C. Tactile hallucination
D. Primary delusion
E. Secondary delusion.
!
A. Self-induced vomiting
B. Excessive exercise
C. Excessive use of laxative
D. Excessive use of diuretic
E. Excessive use of enema.
12. In!schizophrenia,!which!of!the!following!factors!is!LEAST!Likely!to!restrict!full!
rehabilitation!potential?!
!
A. Florid!delusions!and!hallucinations!!
B. Lack!of!pleasure!from!social!intervention!and!physical!activity!
C. Loss!of!interest!in!rehabilitation!
D. Poor!motivation!
E. Restricted!affect.!
!
13. Somnambulism!(Sleepwalking!disorder)!occurs!in!
!
A. Active!sleep!
B. Earliest!phase!of!sleep!
C. Paradoxical!sleep!
D. Rapid!eye!movement!(REM)!sleep!
E. SlowNwave!sleep.!
!
!
60
!
14. Which!of!the!following!is!a!poor!prognostic!factor!for!schizophrenia?!
!
A. Family!history!of!mood!disorder!
B. Female!gender!
C. Late!onset!
D. Precipitating!factor!
E. Presence!of!neurological!soft!sign.!
!
15. All of the following medical disorders are more common in schizophrenia patients as
compared to the general population EXCEPT?
16. A!40TyearTold!executive!is!afraid!of!flying!by!aeroplane.!She!has!this!problem!since!young.!!As!
a!result,!she!has!to!quit!her!job!because!it!requires!frequent!travelling.!What!is!the!MOST!
LIKELY!diagnosis?!
!
A.!Agoraphobia!
B.!Generalized!anxiety!disorder!
C.!Panic!disorder!
D.!Social!phobia!
E.!Specific!phobia.!
17. Which!is!the!MOST!preferred!antidepressant!in!elderly?!
A. Amitriptyline!
B. Imipramine!
C. Moclobemide!
D. Sertraline!
E. Venlafaxine.!
!
!
61
!
18. Which!of!the!following!statements!is!TRUE!regarding!risk!factors!for!Alzheimers!
disease? !
!
A. APO!E2!genotype!increases!the!risk!of!Alzheimers!disease.!
B. APO!E4!genotype!increases!the!risk!of!Alzheimers!disease.!
C. APO!E6!genotype!increases!the!risk!of!Alzheimers!disease.!!
D. Male!gender!is!a!risk!factor!!
E. Smoking!is!protective!against!Alzheimers!disease.
19. Which!of!the!following!is!the!MOST!common!type!of!hallucination!in!people!suffering!
from!dementia? !
A. Functional!
B. Gustatory!
C. Olfactory!
D. Tactile!
E. Visual.!!!
!
A. Less paranoia
B. More likely to have sensory deficits
C. More loosening of associations
D. More thought disorders
E. More violent behaviour.
21. Which of the following statements about sleep disorders in old people is FALSE?
22. An 80-year-old man presents with terminal insomnia, weight loss, decreased
appetite and pervasive anhedonia. Physical examination, laboratory
investigations and imaging reveal normal findings. The MOST specific symptom
to his likely diagnosis is:
A. Anxiety
B. Decreased concentration
C. Decreased energy
D. Psychomotor changes
!
!
62
E. Suicidal ideation.
23. Which!of!the!following!childhood!psychiatric!disorders!has!the!EARLIEST!mean!age!
of!onset?!
!
A. Attention!deficit!hyperactivity!disorder!
B. Conduct!disorder!
C. Oppositional!defiant!disorder!
D. PostNtraumatic!stress!disorder!
E. Secondary!encopresis.!!
24. Which!of!the!following!is!MOST!CORRECT!about!Aspergers!disorder?!!!
!
A. They!are!good!at!sport.!
B. They!have!a!normal!IQ.!
C. They!have!impaired!nonNverbal!communication.!
D. They!have!delay!in!speech.!
E. They!have!high!intelligence!in!specific!areas.!
Substance abuse
27. A 55-year-old man who has been drinking Chinese wine every night says, I dont
think it is a problem. Which Prochaskas and Diclementes stage of change
BEST describes his current status?
A. Action
B. Contemplation
C. Precontemplation
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!
63
D. Maintenance
E. Relapse.
28. A!23TyearTold!medical!student!is!brought!to!the!Accident!and!Emergency!
Department!by!his!parents.!He!admits!to!having!recently!used!a!recreational!drug!
during!his!overseas!elective!in!the!United!States.!He!returned!two!days!ago.!He!is!
suspicious!and!sensitive!to!what!others!are!saying.!Physical!examination!reveals!
dilated!pupils!and!electrocardiogram!(ECG)!shows!cardiac!arrhythmias.!Which!drug!
is!MOST!likely!to!be!responsible?!!
!
a. Alcohol!
b. Cannabis!
c. Cocaine!!
d. Mescaline!
e. Heroin.!
!
29. A 24-year-old man presents to the Accident and Emergency Department with
fever, hypotension, agitation, tachycardia and odour of alcohol on his breath. His
friend with him stated that he was prescribed a medication by a psychiatrist 4
weeks ago. The most likely medication responsible is:
A. Diazepam
B. Disulfiram
C. Fluoxetine
D. Haloperidol
E. Moclobemide.
31. A!50TyearTold!with!history!of!major!depressive!disorder!and!ischaemic!heart!
disease.!He!has!not!received!any!psychiatric!treatment.!Which!of!the!following!
medications!is!the!BEST!option!to!help!him!to!quit!smoking?!
!
A. Bupropion!
B. Naltrexone!
!
!
64
C. Nicotine!replacement!treatment!
D. Sertraline!
E. Varenicline.!
Psychopharmacology
32. The WEAKEST evidence for efficacy for Post-traumatic Stress Disorder (PTSD) is for
which class of pharmacological agents?
a. Amitriptyline
b. Diazepam
c. Fluoxetine
d. Fluvoxamine
e. Paroxetine.
33. Regarding!escitalopram,!all!of!the!following!are!true!EXCEPT: !
A. Absorption!is!not!affected!by!food.!
B. It!has!better!tolerability!than!other!SSRIs.!
C. It!shows!linear!pharmacokinetics!at!clinically!relevant!doses.!!
D. It!causes!a!lot!of!drug!interaction.!!
E. Peak!plasma!levels!occur!2N4!hours!after!a!single!dose.!
!
34. The MOST common side effect of selective serotonin reuptake inhibitor (SSRI) is:
A. Acne
B. Erectile dysfunction
C. Gastrointestinal disturbances
D. Metabolic syndrome
E. Tinnitus.
35. Which of the following antipsychotic drugs is MOST LIKELY to be associated with
adverse haematological side effects?
A. Clozapine
B. Olanzapine
C. Quetiapine
D. Risperidone
E. Ziprasidone.
36. Which!of!the!following!is!the!LEAST!common!side!effects!of!acetylcholinesterase!
inhibitors?!!!
!
A. Dizziness!
B. Nausea!
C. Nightmares!
!
!
65
D. Seizures!
E. Tachycardia.!
!
37. Priapism is MOST likely to be associated with which of the following medications?
A. Bupoprion
B. Duloxetine
C. Moclobemide
D. Phenelzine
E. Trazodone.
A. Akinesia
B. Akathisia
C. Acute dystonia
D. Parkinsonism
E. Tardive dyskinesia
Psychotherapy
39. At!the!one!year!followTup!of!panic!disorder,!which!of!the!following!treatments!
results!with!the!BEST!outcome!and!the!LEAST!functional!impairment?!!
!
A. Benzodiazepines!
B. BetaNblockers!
C. Brief!dynamic!psychotherapy!
D. Cognitive!behaviour!therapy!$
E. Supportive!psychotherapy.!
40. A 20-year-old with patient suffers from agoraphobia and she has phobia of using
MRT train. Which is the BEST psychological treatment for this patient?
!
!
66
41. Defining!highTrisk!situations,!covert!antecedents,!and!stimulus!control!techniques!
are!a!focus!of!which!of!the!following!therapeutic!modalities?
A. Brief!psychodynamic!psychotherapy
B. Cognitive!behaviour!therapy
C. Supportive!therapy
D. Interpersonal!therapy
E. Relapse!prevention!therapy.
42. A!security!guard!attacks!a!government!building,!killing!3!individuals!and!
significantly!injuring!another!10!before!he!takes!his!own!life.!!Psychologists!from!a!
general!hospital!are!dispatched!to!the!scene!to!provide!immediate!psychological!
debriefing!to!civil!servants!working!in!the!building!to!prevent!postTtraumatic!stress!
disorder!(PTSD)!symptoms.!!Using!an!evidenceTbased!framework,!what!is!the!most!
likely!impact!of!this!intervention!on!direct!survivors?
!
A. It!will!be!ineffective!or!harmful!to!the!direct!survivors.
B. It!will!decrease!the!probability!of!developing!PTSD!symptoms.
C. It!will!decrease!the!severity!of!PTSD!symptoms.
D. It!will!decrease!the!time!period!for!recovery!from!PTSD!symptoms.
E. It!will!delay!the!onset!of!PTSD!symptoms.
Ethics and laws
43. When!managing!a!chronically!suicidal!patient,!respecting!the!patients!preference!to!
remain!at!home!and!not!be!admitted!to!the!psychiatric!unit!for!additional!care!
reflects!which!of!the!following!ethical!principles?
A. Autonomy
B. Beneficence
C. NonNmaleficence
D. Egalitarianism
E. Fiduciary!duty.!
45. You are working as a resident in the weight management programme. A 40-year-old
schizophrenia patient is referred to you for weight management issue. Which of the
following medications has the BEST evidence as an adjunct for reducing weight gain
!
!
67
associated with the second generation antipsychotics:
A. Fluoxetine
B. Metformin
C. Sibutramine
D. Simvastatin
E. Topiramate.
46. In medically ill patients who suffer from psychiatric illness, which of the following
pharmacological properties is MOST appropriate?
47. A!47TyearTold!woman!is!brought!for!a!psychiatric!evaluation!to!assess!recent!
changes!in!her!behaviour.!!Over!the!past!six!months,!she!has!become!increasingly!
disinhibited!and!impulsive!in!her!behaviour.!!Physical!examination!reveals!mild!
dysarthria,!dysphagia,!and!drooling.!!Slit!lamp!examination!of!the!eyes!indicates!the!
presence!of!Kayser!Fleischer!rings.!!Which!of!the!following!BEST!describes!the!
genetic!basis!for!her!illness?
A. Autosomal!recessive!
B. CoNdominant!
C. Mitochondrial!
D. Polygenetic!
E. XNlinked!dominant.!
!
MCQ!exam!(Paper!3)!
!
!
68
J. Flat!affect.! !
Year:!2013.!
Cognitive assessment! !
Option!E!=!Lewy!body!dementia!
Year:!2013.!
This!is!an!advancedNlevel!question.!
Psychiatric epidemiology !
!
!
69
51. An 18-year-old woman presents with The!answer!is!E!
questions about her risk of developing
schizophrenia. She is worried because her !
23-year-old brother has recently been
diagnosed with schizophrenia and required
Explanation:!The!risk!of!general!population!is!
hospitalization for psychosis. There are no
other family members who have a history 1%.!The!risk!of!a!sibling!is!10%.!Hence,!the!
of schizophrenia. Having a sibling with risk!is!increased!by!10!times.!
schizophrenia increases her risk of
developing schizophrenia by? !
!
F. 2 times
G. 4 times
Year:!2013.!
H. 6 times
I. 8 times
J. 10 times.
A. Amgydala Explanation:!Option!B!for!Alzheimers!
B. Basal nucleus of Meynert
disease,!Option!C!for!schizophrenia,!Option!D!
for!addiction!and!Option!E!for!depression.!
C. Mesocortical region
!
D. Nucleus accumbens
!
E. Raphe nucleus.
Year:!2013.!
E. The amygdala.
Year: 2013
!
!
70
Psychopathology !
F. A!fear!of!enclosed!spaces!! Explanation:!A!fear!of!enclosed!space!is!one!of!
G. A!fear!of!speaking!in!public! the!most!common!complaints!among!patients!
H. A!fear!of!height! in!Singapore!(e.g.!crowded!MRT!trains).!
I. Avoidance!of!authority!figures! Option!B!is!social!phobia.!
J. Worrying!excessively!about!physical!health.!
! !
Year:!2013.!
!
!
71
i. Sleep disturbance dysmorphic disorder.
j. Lethargy and fatigue
Year: 2013
Year:!2013!
Year:!2013!
!
!
72
General adult psychiatry !
Year:!2013!
F. Active!sleep! Explanation:!Parasomnia!is!divided!into!slowN
G. Earliest!phase!of!sleep! wave!sleep!disorders!(e.g.!sleep!terrors,!
H. Paradoxical!sleep! sleepwalking!disorder)!and!rapid!eye!
I. Rapid!eye!movement!(REM)!sleep! movement!sleep!disorders!(e.g.!nightmare!
J. SlowNwave!sleep.!
disorder,!REM!behaviour!disorder!such!as!
!
kicking!in!the!middle!of!the!night).!!
!
!
Somnabulism!or!sleepwalking!disorder!is!
associated!with!slow!wave!sleep.!Because!
sleepwalking!disorder!arises!from!SWS!!
sleep,!the!patient!is!difficult!to!be!!
awaken!during!sleepwalking.!
Year:!2013.!
!
!
73
! !
F. Family!history!of!mood!disorder! Explanation:!Option!E!suggests!that!the!aetiology!of!
G. Female!gender! schizophrenia!is!biological!and!resulted!from!a!neurological!
H. Late!onset! lesion.!Hence,!the!prognosis!poor.!Good!prognostic!and!poor!
I. Precipitating!factor! prognostic!factors!are!summarized!as!follows:!
J. Presence!of!neurological!soft!sign.! !
!
Good!Prognosis! ! Poor!Prognosis!
! Late!onset! ! ! Young!onset!
! Obvious!precipitating!factors!No!precipitating!factors!
Acute!onset! ! Insidious!onset!
Good!premorbid!function!! Poor!premorbid!function!
Married! ! !!!!!!!!!!!!!!!!!!!!Single,!divorced,!or!widowed!
Family!history!of!mood!disorders!Family!history!of!
schizophrenia! !
Good!support!systems! Poor!support!systems!
Positive!symptoms! ! Negative!symptoms!
!!
Year:!2013.! ! ! ! !
Year:!2013.!
!
!
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! Explanation:!Fear!of!shadow!is!specific!phobia.!
A.!Agoraphobia! !
B.!Generalized!anxiety!disorder! !
C.!Panic!disorder! Year:!2013.!
D.!Social!phobia!
E.!Specific!phobia.!
Year:!2013!
This!is!an!advancedNlevel!question.!
!
!
75
disease. !
Year:!2013!
Year:!2013!
Explanation:!LateNonset!psychotic!disorder!is!
F. Less paranoia
G. More likely to have sensory deficits more!likely!to!be!associated!with!sensory!
H. More loosening of associations deficit.!
I. More thought disorders
J. More violent behaviour. !
Year:!2013.!
!
!
76
decreased appetite and pervasive
anhedonia. Physical examination,
laboratory investigations and imaging Explanation: This elderly man suffers from
reveal normal findings. The MOST depressive disorder based on the history
specific symptom to his likely provided. Hence, suicidal ideation is the
diagnosis is: most specific symptom.
F. Anxiety
G. Decreased concentration
H. Decreased energy
I. Psychomotor changes Year: 2013.
J. Suicidal ideation.
Year:!2013!
F. They!are!good!at!sport.! Explanation:!They!have!better!verbal!
G. They!have!a!normal!IQ.! communications!as!compared!to!autism!and!
H. They!have!impaired!nonNverbal! no!delay!in!speech.!They!may!have!lower!IQ.!
communication.! Some!have!high!intelligence!in!specific!areas!
I. They!have!delay!in!speech.!
but!not!all.!
J. They!have!high!intelligence!in!specific!
areas.!
!
Year:!2013.!
!
!
77
72. A 15-year-old girl presents with fatigue The!answer!is!B.!
and dehydration. On physical
examination she is noted to have !
swollen salivary glands and calluses
on her knuckles. She is also Explanation:!This!patient!suffers!from!bulimia!
hypokalemic. These findings are nervosa.!She!has!selfNinduced!vomiting!and!
MOST consistent with which of the the!gastric!acid!causes!inflammation!in!the!
following diagnoses?
salivary!glands.!She!uses!her!fingers!to!induce!
F. Anorexia nervosa
G. Bulimia nervosa vomiting!and!leave!calluses!on!her!knuckles,!
H. Chronic fatigue syndrome which!is!known!as!Russells!sign.!Repeated!
I. Obsessive-compulsive disorder selfNinduced!vomiting!is!associated!with!
J. Rumination disorder hypokaelemia.!
Year:!2013.!
Year:!2013!
Substance abuse !
!
!
78
75. A!23TyearTold!medical!student!is!brought! The!answer!is!C.!
to!the!Accident!and!Emergency!
Department!by!his!parents.!He!admits!to! !
having!recently!used!a!recreational!drug!
during!his!overseas!elective!in!the! Explanation:!Dilated!pupil,!arrhythmia,!
United!States.!He!returned!two!days!ago.! nausea!and!suspiciousness!are!common!signs!
He!is!suspicious!and!sensitive!to!what! associated!with!cocaine!intoxication.!
others!are!saying.!Physical!examination!
reveals!dilated!pupils!and! !
electrocardiogram!(ECG)!shows!cardiac!
arrhythmias.!Which!drug!is!MOST!likely! !
to!be!responsible?!!
! Year:!2013.!
f. Alcohol! !
g. Cannabis!
h. Cocaine!! This!is!an!advancedNlevel!question.!
i. Mescaline!
j. Heroin.!
!
!
Year:!2013.!
!
!
79
F. Electroencephalogram (EEG) shows evidence cardiac!arrhythmia!and!results!in!syncope.!
of seizure activity.
G. Liver function tests reveal marked !
transaminitis.
H. Prolonged!QTc!interval !
I. Ultrasound Doppler shows deep vein
thrombosis. Year:!2013!
J. Urine toxicology screen is positive for opioid.
!
This!is!an!advanced!level!question.!
Psychopharmacology !
Year:!2013.!
!
!
80
H. It!shows!linear!pharmacokinetics!at! Explanation:!Escitalopram!causes!the!least!
clinically!relevant!doses.!! drug!interaction!among!all!SSRIs.!Sertralines!!
I. It!causes!a!lot!of!drug!interaction.!! absorption!is!significantly!affected!by!food.!
J. Peak!plasma!levels!occur!2N4!hours!after!a!
Escitalopram!is!better!tolerated!than!other!
single!dose.!
! SSRIs.!Fluoxetine!and!paroxetine!are!the!only!
SSRIs!that!do!not!show!linear!
pharmacokinetics!at!clinically!relevant!doses.!
Year:!2013!
Year:!2013.!
Year:!2013!
!
!
81
I. Seizures! !
J. Tachycardia.!
! Year:!2013.!
This!is!an!advancedNlevel!question!
Year:!2013!
This!is!an!advancedNlevel!question.!
Psychotherapy !
!
!
82
impairment?!! Explanation:!CBT!has!better!outcome!than!
! brief!dynamic!psychotherapy!and!supportive!
psychotherapy.!Benzodiazepines!and!betaN
F. Benzodiazepines!
blockers!only!provide!symptomatic!relief.!
G. BetaNblockers!
H. Brief!dynamic!psychotherapy!
!
I. Cognitive!behaviour!therapy!$
J. Supportive!psychotherapy.! !
Year:!2013.!
Year:!2013.!
!
!
83
!
!
!
84
h. Extrapyramidal side-effects flaccidity.
i. Labile blood pressure
j. Flaccidity.
Year: 2013.
!
!
85
F. Autosomal!recessive! Year:!2013.!
G. CoNdominant!
H. Mitochondrial! !
I. Polygenetic!
J. XNlinked!dominant.! This!is!an!advancedNlevel!question.!
1. You are a medical resident. The nurse informs you that an 80-year-old man who
was admitted for cellulitis seems to be depressed and mentions about passive
!
!
86
suicidal thought. When you assess him, he sees ghost in the ward and expresses
paranoid ideation against nursing staff. Which of the following assessment is
MOST important to establish the diagnosis?
A. Assess orientation
B. Assess judgement
C. Assess recognition
D. Assess registration and short-term recall
E. Assess somatic symptoms.
Cognitive assessment
4. A 35-year-old woman suffers from low mood, low energy, poor sleep, poor
appetite and recurrent suicidal thoughts. She firmly believes that she deserves
the death sentence for minor mistakes made in the past. Which of the following
statements is FALSE?
!
!
87
A. For severe depressive episode with psychotic features, psychotic symptoms usually
occur after manifestation of depressive symptoms.
B. Her psychotic symptoms are considered to be mood congruent.
C. Based on the case scenario, there is enough evidence to suggest that she suffers
from schizoaffective disorder.
D. The prescription of antipsychotic drug should be considered.
E. Electroconvulsive therapy (ECT) is a recognised treatment for his condition.
5. Which of the following disorders has been shown to have the GREATEST degree
of heritability?
A. Alcoholism
B. Attention-deficit/hyperactivity disorder (ADHD)
C. Autism
D. Major depressive disorder
E. Schizophrenia.
A. Sleep apnea
B. Shift work
C. Stimulant use
D. Underlying psychiatric illness
E. Use of sleeping pills.
Psychopathology
!
!
88
9. Which of the following is MOST suggestive of the diagnosis of schizophrenia?
A. Acute onset of psychosis
B. Apathy
C. Cognitive impairment
D. Hearing own thoughts
E. Persistent deterioration of personality.
10. Peter is 27-year-old and lives with his parents. He has been employed as a
delivery man for most of the time since leaving school, but has recently left his
job as a salesman. He has never taken any illicit drugs. His parents state that in
the last three weeks, he has been extremely active, requiring less sleep and not
appearing tired, being over-talkative and disinhibited and on occasions quite
irritable. He claimed to have invented a machine for curing cancer and wished to
go to the U.S. to sell it. When stopped by his parents, he became violent, and they
called the police. Which of the following diagnosis is MOST appropriate for this
patient?
12. Which of the following is LEAST likely to be found in research in the relationship
between depressive disorder and hormones?
!
!
89
D. There is an increased cortisol.
E. There is an increased adrenal sensitivity to ACTH.
14. Rapid eye movement (REM) sleep is associated with all of the following EXCEPT:
A. Adjustment disorder
B. Fetishism
C. Kleptomania
D. Sadomasochism
E. Voyeurism.
16. Which of the following psychiatric disorders is MOST common among patients
with bulimia nervosa?
!
!
90
17. Manic episodes in old people are associated with:
A. Less euphoria
B. Less mixed presentation with depression
C. Less paranoid delusions
D. More hyperactivity
E. More flight of ideas.
18. All of the following statements are true regarding post-operative delirium
EXCEPT:
19. A 70-year-old man with a history of drinking Chinese wine, hepatitis, chronic renal
failure and hypertension was brought by his wife to the hospital for treatment of
an acute cellulitis. He was noted to have tachycardia in the Accident and
Emergency Department. You are the on-call medical resident and this man was
admitted to the medical ward. What is the MOST appropriate first approach?
20. A 70-year-old woman with severe depressive symptoms and strong suicidal
ideation which is not responded to amitriptyline 150mg daily and fluvoxamine
200mg daily. Each medication was tried for 6 months with good adherence. She
has good past health. Her children consult you for further management. The
MOST appropriate treatment which you would recommend is:
!
!
91
B. Electroconvulsive therapy
C. Donepezil
D. Olanzapine
21. You are helping a mother to develop behavioural program to deal with her son
who has oppositional defiant disorder. Which of the following is the MOST
significant component of this program?
A. Extinction
B. Positive reinforcement
C. Punishment
D. School suspension
E. Strict parenting.
22. Which of the following factors are LEAST likely to be the aetiological factors in
attention deficit and hyperactivity disorder (ADHD)?
24. You are a paediatric resident. A 7-year-old boy is suspected to suffer from autism.
You referred this boy to see an education psychologist for assessment. The
!
!
92
education psychologist sends a report to you and you need to explain the
findings to her mother. His strength is MOST likely found in which of the following
areas?
A. Abstract thinking
B. Block design
C. Explain similarities
D. Oral presentation skills
E. Verbal concept formation
Substance abuse
A. Amygdala
B. Basal nucleus of Meynert
C. Nucleus accumbens
D. Hippocampus
E. Raphe nucleus.
27. A common and safe pharmacological treatment for reducing relapse in alcohol
dependence has direct actions upon which receptors?
A. Benzodiazapine
B. Cannabinoid
C. Dopamine
D. -Aminobutyric acid (GABA)
E. Opioid.
!
!
93
28. Which of the following is LEAST consistent with the objective of motivational
interviewing?
Psychopharmacology
29. Which of the following antidepressants is LEAST likely to have sexual side-
effects?
A. Amitriptyline
B. Moclobemide
C. Mirtazapine
D. Fluoxetine
E. Venlafaxine.
!
!
94
33. Tricyclic antidepressants should be avoided with all of the following EXCEPT
A. Patients hospitalized for severe melancholic depression
B. Recent myocardial infarction
C. Right bundle branch block
D. Untreated glaucoma
E. Urinary retention.
35. Which of the following drugs is LEAST likely to increase lithium toxicity?
A. Angiotensin-converting enzyme (ACE) inhibitors
B. Calcium channel blockers
C. Non-steroidal anti-inflammatory drugs (NSAIDS)
D. Sodium valproate
E. Thiazide diuretics.
37. A 30-year-old woman with 3 episodes of major depression in the past 5 years
responds to fluoxetine 40mg every morning. Her last episode was 6 months ago.
In order to minimize the risk of relapse, which of the following treatment
strategies is MOST effective?
!
!
95
E. Stop fluoxetine and start cognitive behaviour therapy.
Psychotherapy
38. Which of the following treatment strategies has the MOST evidence for treating
obsessive compulsive disorder?
A. Fluoxetine and brief dynamic psychotherapy
B. Fluoxetine and exposure and response prevention
C. Fluoxetine and eye movement desensitization and reprocessing
D. Fluoxetine and hypnotherapy
E. Fluoxetine and interpersonal psychotherapy.
A. Catastrophic thinking
B. Magnification
C. Minimization
D. Personalization
E. Selective abstraction.
40. In Singapore, a person who is disturbed and aggressive, with poor insight into his
illness, refusing treatment and threatening family members can be admitted
involuntarily under the:
41. Which of the following medical conditions is LEAST likely to present with panic
attacks?
!
!
96
A. Asthma
B. Cushing syndrome
C. Insulinoma
D. Phaeochromocytoma
E. Thyrotoxicosis.
42. A 50-year-old man suffering from schizophrenia and he has been taken
haloperidol for the past 20 years. His QTc is 550 ms. The medical resident wants
to find the potential medical complication if he continues to take haloperidol.
Which of the following complications is LEAST LIKELY:
A. Myocardial infarction
B. Palpitation
C. Ventricular fibrillation
D. Sudden cardiac death
E. Torsade de pointes.
43. A 40-year-old schizophrenia patient presents with high urine volume, low urine
osmolality, low serum sodium and low urine sodium. Which of the following is the
MOST likely diagnosis?
A. Diabetes mellitus
C. Psychogenic polydipsia
D. Simple hyponatremia
44. You are a resident working in the gynaecology ward. A 35-year-old woman was
admitted for ovarian cystectomy. She suffers from major depressive disorder and
insomnia. She consults a psychiatrist at the Institute of Mental Health (IMH). She
is prescribed with venlafaxine, zolpidem, lorazepam and hydroxyzine. She is due
for discharge today and she wants to go home. She expresses concern that she
cannot see her psychiatrist in the coming weeks due to pain associated with the
operation. She requests to obtain 3-month supply of her psychiatric medications
from you. She also requests a pain killer called tramadol. She threatens that if you
do not give her medication, she will commit suicide. What is the BEST approach
to handle this situation?
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97
A. Do not give her any psychotropic medication and tramadol. Discharge her the same
day.
B. Negotiate with her for shorter duration of psychotropic medications and tramadol.
Obtain earlier appointment at IMH. Discharge her today.
C. Postpone discharge and use this to motivate her not to request for more
psychotropic medications.
D. Give her 3-month supply of psychotropic medications and tramadol. Discharge her
today.
E. Send her to IMH for assessment because she threatens that she will commit suicide.
45. You are a medical resident. The nurse informs The answer is A.
you that an 80-year-old man who was admitted
for cellulitis seems to be depressed and
mentions about passive suicidal thought.
When you assess him, he sees ghost in the Explanation: This man may suffer
ward and expresses paranoid ideation against from delirium and acute
nursing staff. Which of the following confusional state. It is most
assessment is MOST important to establish important to assess orientation.
the diagnosis?
F. Assess orientation
G. Assess judgement Assessing somatic symptoms is
H. Assess recognition not useful as it is caused by
I. Assess registration and short-term recall medical conditions.
J. Assess somatic symptoms.
Year: 2013.
Cognitive assessment
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98
medical record. patient, the patient should be given
I. Inform the patient 3 objects (e.g. Apple, multiple attempts to register the 3
Newspaper and Train) and ask the patient to items before testing short-term
name the 3 objects immediately.
recall in Option E.
J. Inform the patient 3 objects (e.g. Apple,
Newspaper and Train) and ask the patient to
name the 3 objects after 5 minutes.
Year: 2013.
Year: 2013.
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mood congruent. There is not enough evidence to
H. Based on the case scenario, there is enough suggest the diagnosis of
evidence to suggest that she suffers from schizoaffective disorder because
schizoaffective disorder.
her symptoms do not suggest that
I. The prescription of antipsychotic drug should
be considered. she suffers from schizophrenia.
J. Electroconvulsive therapy (ECT) is a
recognised treatment for his condition.
Year: 2013.
Year: 2013.
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F. European women have earlier age of onset Explanation: Current research
than Asian women. findings in schizophrenia show that
G. Current research findings remain men have earlier onset as
inconclusive about the age of onset in
compared to women.
schizophrenia.
H. There is no difference in the age of onset
between men and women.
I. Men usually have earlier age of onset as
compared to women.
J. Women usually have earlier age of onset as
compared to men.
Psychopathology
Year: 2013.
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Year: 2013.
54. Peter is 27-year-old and lives with his parents. The answer is A.
He has been employed as a delivery man for
most of the time since leaving school, but has
recently left his job as a salesman. He has
never taken any illicit drugs. His parents state Explanation: Peter develops
that in the last three weeks, he has been grandiose delusion because he
extremely active, requiring less sleep and not does not have the capacity to
appearing tired, being over-talkative and make a machine to cure cancer
disinhibited and on occasions quite
based on his background. The
irritable. He claimed to have invented a
machine for curing cancer and wished to go to most appropriate diagnosis is
the U.S. to sell it. When stopped by his bipolar disorder with manic
parents, he became violent, and they called features.
the police. Which of the following diagnosis is
MOST appropriate for this patient?
Explanation: There is no
F. Blunted adrenocorticotropic hormone (ACTH) suppression of cortisol with
response to the corticotropin-releasing dexamethasone in research finding
hormone (CRH) in depressive disorder. Option A
G. Blunted thyroid stimulating hormone (TSH)
indicates the failure of negative
response to thyrotropin-releasing hormone
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102
(TRH) feedback and causes an increase
H. Cortisol suppression with dexamethasone in cortisol (Option D and E). Option
I. There is an increased cortisol. B is associated with low T3 or T4
J. There is an increased adrenal sensitivity to
level.
ACTH.
Year: 2013.
This is an advanced-level
question.
Year: 2013.
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sexually aroused by female shoes. He spends
a lot of time fantasizing about female shoes.
He stole multiple pairs of shoes from the shop This man suffers from fetishism
and used them for masturbation. He used to because he derives sexual
be a normal person. He was a hardworking stimulation from an inanimate
student whose main interests were chemistry object (i.e. female shoes) and his
and physics. What is the MOST likely
fetishism causes social and
diagnosis?
occupational dysfunction because
F. Adjustment disorder he spends inordinate time
G. Fetishism fantasizing about female shoes.
H. Kleptomania
I. Sadomasochism
J. Voyeurism.
He stole shoes to satisfy his
fetishism and this is not a case of
kleptomania.
Year: 2013.
Year: 2013.
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Year: 2013.
The answer is A.
Year: 2013.
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105
withdrawal of alcohol and the
prescription of propranolol is not
necessary.
Year: 2013.
D. Olanzapine
Year: 2013.
E. Repetitive transcranial magnetic stimulation.
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106
deficit and hyperactivity disorder (ADHD)?
Explanation: Low birth weight, not
high birth weight is associated with
A. Antenatal exposure to alcohol
the risk of developing ADHD.
B. Antenatal exposure to nicotine
C. Delivery complications
D. High birth weight
E. Traumatic brain injury during infancy Year: 2013.
and early childhood.
Year: 2013.
This is an advanced-level
question.
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107
E. Verbal concept formation
Substance abuse
Year: 2013
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108
72. Which of the following is LEAST consistent The answer is D.
with the objective of motivational
interviewing?
Explanation: Motivational
F. Allow the patient give their inputs without interviewing emphasizes on
interruption. individuals patients needs and
G. Establishing a collaborative patient-therapist avoid empirical advice.
relationship.
H. Identifying appropriate reinforcements.
I. Providing empirical advice.
J. Usage of open-ended questions. Year: 2013
Psychopharmacology
F. Amitriptyline
G. Moclobemide Explanation: Mirtazapine and
H. Mirtazapine bupoprion have relatively low risk
I. Fluoxetine of causing sexual side effects as
J. Venlafaxine. compared to other
antidepressants.
Year: 2013
Year: 2013
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was banned in Singapore due to
diversion and misuse.
Year: 2013.
F. Akathisia is common with high dose of Explanation: The risk for weight
risperidone. gain and metabolic syndrome is
G. Prolactin elevation, probably greater than that lower than olanzapine.
seen with other second generation
antipsychotics.
H. Insomnia, headache and nausea are common.
I. Rhinitis is a possible side effect.
J. The risk for weight gain and the metabolic Year: 2013.
syndrome is higher than olanzapine.
Year: 2013.
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110
directly on the breast tissue. tuberoinfundibular neurons, which
J. Galactorrhoea is caused by the concurrent use normally inhibit prolactin release.
of anticholinergic medication.
Year: 2013
This is an advanced-level
question.
Year: 2013
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111
episodes is considered to be
frequent.
F. Continue fluoxetine 40mg every morning for
five years.
G. Continue fluoxetine 40 mg for six months and
then stop. It is dangerous to reduce the dose
H. Provide intermittent maintenance or stop antidepressant soon.
electroconvulsive therapy.
I. Stop fluoxetine and restart it at the first sign of
relapse.
J. Stop fluoxetine and start cognitive behaviour Year: 2013
therapy.
Psychotherapy
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112
G. Magnification
H. Minimization
I. Personalization
J. Selective abstraction.
D. Phaeochromocytoma
Year: 2013.
E. Thyrotoxicosis.
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113
I. Sudden cardiac death be associated with prolonged QTc.
J. Torsade de pointes.
Year: 2013.
This is an advanced-level
question.
D. Simple hyponatremia
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114
and tramadol. Discharge her the same day. the next best answer.
G. Negotiate with her for shorter duration of
psychotropic medications and tramadol.
Obtain earlier appointment at IMH. Discharge
her today. Option A may cause a relapse of
H. Postpone discharge and use this to motivate her psychiatric illness by not giving
her not to request for more psychotropic her any psychotropic medications.
medications.
I. Give her 3-month supply of psychotropic
medications and tramadol. Discharge her Option C will intensify her
today. disappointment and postpone
J. Send her to IMH for assessment because she
threatens that she will commit suicide. discharge does not offer solution.
Year: 2013
This is an advanced-level
question.
Paper!5:!Questions!
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115
B. Guilt!
C. Incurable!illnesses!
D. Jealousy!
E. SelfNdepreciation.!
2. A!30TyearTold!prisoner!gives!approximate!answers!to!questions.!For!example,!if!it!
is!Thursday,!he!will!say!it!is!Friday!and!claims!a!dog!has!three!legs.!This patient is
MOST likely suffering from:
A. Capgras syndrome
B. Ekboms syndrome
C. Fregolis syndrome
D. Gansers syndrome
E. Othellos syndrome.
3. A psychiatric patient suddenly realises that he is an interpreter for deaf people and tries
to interpret others speech in sign language. He demonstrates strange repetitive
movements. His signs appear to come in threes or fours, occasionally swinging his
shoulders, as if he is conveying a message. Which of the following is the BEST term to
describe his movements?
!
A. Ambitendency!
B. Mannerism!
C. Negativism!
D. Stereotypies!
E. Waxy!flexibility.!
!
!
Cognitive assessment!
4. A 33-year-old man with childhood developmental delay and epilepsy received special
education and now works as a cleaner. He has worked in a tofu factory for three years.
He can only perform simple routine work in the factory. His supervisor reports his work
performance is slow and poor. His family says he cannot live independently and
demonstrated delay in achievement in self-care since young. How would you rate the
level of mental retardation?
Psychiatric epidemiology
5. A 65-year-old retired teacher is concerned about dementia and has assessed online
resources for information. She asks which type of dementia is more common in Asians
as compared to Caucasians. Your answer is:
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116
A. Alzheimers disease
B. Lewy body dementia
C. Pseudodementia
D. Vascular dementia
E. Fronto-temporal lobe dementia.
Psychiatric aetiology, diagnosis and classification
K. Adjustment disorder with depressed mood results from a known stressor, whereas
dysthymic disorder does not.
L. Adjustment disorder with depressed mood shows a genetic pattern, whereas
dysthymic disorder does not.
M. The duration of symptoms is shorter for adjustment disorder with depressed mood
than it is for dysthymic disorder.
N. The co-existence of a major depressive disorder with dysthymic disorder is called
double depression. There is no term for a major depressive disorder complicating
adjustment disorder with depressed mood.
O. Treatment is usually shorter and does not require the use of medication for
adjustment disorder with depressed mood as compared to dysthymic disorder.
7. You are a family doctor. A male and a female schizophrenia patient who stay in the
community have decided to get married and have a child. What is the risk for their child
to develop schizophrenia in the future?
A. 16%
B. 26%
C. 36%
D. 46%
E. 56%.
8. You!are!an!oncology!resident.!!A!60TyearTold!oncology!patient!developed!severe!nausea!as!a!
sideTeffect!during!chemotherapy.!However,!after!completing!treatment!she!continues!to!
experience!nausea!whenever!she!returns!to!the!hospital!for!followTup.!Which!of!the!
following!psychological!theories!BEST!describes!her!experience?
A. Biofeedback
B. Classical conditioning
C. Cognitive learning
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117
D. Operant conditioning
E. Social learning.
A.!Acute!stress!disorder!
B.!Generalized!anxiety!disorder!
C.!Panic!disorder!!
D.!PostNtraumatic!stress!disorder!
E.!Somatization!disorder.!
10. You are an orthopaedic resident managing a 24-year-old motorcyclist who was involved
in a road traffic accident 3 days ago in which he sustained multiple fractures and his
pillion rider died. He is irritable, sleeps poorly and has nightmares and refuses to talk
about the accident. The MOST likely psychiatric diagnosis is:
!
A.!Acute!stress!disorder!!
B.!Adjustment!disorder!with!anxiety!
C.!Depressive!disorder!
D.!Generalized!anxiety!disorder!
E.!PostNtraumatic!stress!disorder.!
11. Based on the current research findings, which of the following statements is CORRECT
regarding the prognosis for a 35-year-old Indonesian man with schizophrenia who lives
in a rural village and treated by risperidone?
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118
!
12. You!are!a!resident!working!in!the!Accident!and!Emergency!Department.!!A!39TyearTold!
English!man!was!married!to!a!Chinese!Singaporean!is!brought!to!the!Emergency!
Department!after!he!attempted!to!hang!himself.!He!is!actively!suicidal!and!has!marital!
problems.!He!has!not!spoken!to!his!wife!for!three!days.!The!hospital!does!not!have!a!
psychiatric!ward!nor!a!stayTin!psychiatric!team.!What!is!the!MOST!appropriate!
management!plan?!
A. Admit Peter to the medical ward of your hospital.
B. Discharge Peter from Emergency Department with follow-up in the polyclinic to reduce the
stigma.
C. Discharge Peter from Emergency Department with an early follow-up in the psychiatric
department.
D. Refer the couple for marital counselling by on-call medical social worker.
E. Transfer Peter to IMH for assessment and consider admission under Mental Health (Care and
Treatment) Act.
13. A 40-year-old single man consulting you in a general practice clinic reveals that since
adolescence he enjoys observing naked people and those involved in sexual activities
as it helps him achieve sexual arousal. The psychiatric condition associated with this
behaviour is:
A. Exhibitionism
B. Fetishism
C. Sadomasochism
D. Transvestism
E. Voyeurism.
14. A 65-year-old retired man consulting you in a general practice clinic reveals that he has
marital problems. His wife complains that he is very fuzzy about cooking. He does not
eat outside nowadays. If he goes to a high class restaurant, he expects that the steak
must be properly done and he is entitled to change the steak if it is poorly done. Now
he finds most steak restaurants in Singapore are not up to his standard. He claims it is
better to cook by himself. If the food is not up to his standard, he has no one to blame.
He likes to go to high-class club in town. He claims to be a special member in the club
due to his unlimited success and donation. Which of the following personality traits
BEST describes this man?
A. Antisocial
B. Avoidant
C. Borderline
D. Histrionic
E. Narcissistic.
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15. A!30TyearTold!executive!complains!that!he!cannot!fall!asleep!at!night.!!Two!months!ago,!his!
life! was! interrupted! by! a! work! trip! to! the! United! States.! ! After! returning! to! Singapore,! he!
can!only!falls!asleep!at!2!to!3!a.m.!and!he!cannot!wake!up!on!time!the!next!morning.!!This!
leads!to!negative!impact!on!his!work.!!What!is!the!MOST!likely!diagnosis?!!
A. Circadian rhythm sleep disorder advanced sleep phase
B. Circadian rhythm sleep disorder delayed sleep phase
C. Excessive daytime sleepiness
D. Kleine-Levin syndrome
E. Random eye movement sleep disorder.
Old age psychiatry
16. A!65TyearTold!lady!with!bipolar!disorder!and!severe!functional!decline!presents!with!threeT
day!history!of!acute!agitation,!suicidal!ideation!and!refusing!to!eat!and!drink.!Her!MiniT
Mental!Status!Examination!(MMSE)!score!was!29/30.!auditory!hallucinations.!She!has!not!
responded!to!sodium!valproate!and!olanzapine.!!The!MOST!appropriate!treatment!at!this!
stage!is:!!!
A. Acetylcholinesterase!inhibitor!
B. Augmentation!with!antidepressant!
C. Augmentation!with!anxiolytics!
D. Change!valproate!to!lithium!
E. Electroconvulsive!therapy.!
17. You!are!public!health!doctor!and!work!in!the!Ministry!of!Health.!The!Ministry!
wants!to!identify!protective!factors!against!the!development!of!Alzheimers!
disease.!Which!of!the!following!is!least!associated!with!the!development!of!
Alzheimers!disease?!!!
A. Consuming!red!meat!on!a!frequent!basis!
B. Female!gender!
C. High!education!level!!
D. High!homocysteine!level!
E. Never!married.!
18. You!are!a!member!of!the!Hospital!Quality!Improvement!Committee.!The!hospital!wants!to!
improve! the! management! of! delirium.! Which! of! the! following! statements! regarding!
delirium!is!FALSE?!
!
A. Around!30%!of!the!elderly!admitted!to!the!medical!ward!will!develop!delirium!during!
hospitalisation.!
B. Delirium!is!often!missed!or!overlooked!by!health!care!professionals!in!the!elderly.!
C. Delirium!occurs!in!10%!of!children!undergoing!day!surgery.!
D. Delirium!usually!clears!within!3!days!of!correcting!underlying!medical!cause.!
E. The!incidence!of!delirium!increases!with!age.!
!
19. You are a geriatric doctor. The manager of a nursing home wants to consult you the
behavior which is most likely correlated with delusions in Alzheimers disease. Your
answer is:
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C. Shadowing
D. Suicide
E. Wandering.
20. You!are!a!paediatric!resident.!You!are!concerned!about!the!mental!health!of!a!50T
yearTold! mother! whose! 12TyearTold! daughter! died! of! leukaemia.! You! are! not!
certain!whether!she!suffers!from!normal!grief!or!pathological!grief.!Normal!grief!is!
NOT!characterized!by:!!
!
A. Denial!
B. Recurrent!suicidal!thoughts!!
C. Searching!for!the!deceased!
D. Sensations!of!seeing!or!hearing!the!deceased!
E. Transient!guilt.!
!
21. You are a geriatric resident reviewing a 75-year-old woman with Alzheimers disease.
Her family is keen for her to take acetylcholinesterase inhibitor. Which of the following
medical conditions is MOST contraindicated?
A. Anaemia
B. Asthma
C. Diabetes
D. Hyperthyroidism
E. Rheumatoid arthritis.
Substance abuse
23. A! 30TyearTold! man! admitted! to! the! medical! ward! has! no! access! to! the! substance!
which! he! used! prior! to! admission.! He! complains! of! nausea! and! muscle! pain.!
Physical!examination!reveals!pupillary!dilation.!Which!of!the!following!substances!
is!MOST!likely!to!cause!the!above!withdrawal!symptoms?!
!
A. Alcohol!
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121
B. Cocaine!
C. Midazolam!
D. Nictoine!
E. Opiate.
24. A female student has returned from Amsterdam after an exchange programme and
admits using cocaine for 1 year. She developed psychotic symptoms. Which of the
following is the MOST IMPORTANT risk factor for the development of psychosis while
using cocaine?
A. An!elevated!body!mass!index!
B. Combination!with!benzodiazepine!
C. Being!a!first!time!user!of!cocaine!
D. Being!female!
E. NonNintravenous!use.!
25. A!30TyearTold!man!who!is!dependent!on!alcohol!enquires!of!his!family!physician!if!
disulfiram!will!help!him!to!reduce!his!alcohol!intake!while!he!still!drinks!in!a!controlled!
manner.!!Which!of!the!following!recommendations!is!CORRECT?!
!
A. Disulfiram!is!recommended!because!it!has!more!evidence!than!other!medications!in!
helping!patients!to!quit!alcohol.!
B. Disulfiram!is!recommended!because!it!will!discourage!him!from!drinking!alcohol.!
C. Disulfiram!is!recommended!because!he!has!motivation!to!reduce!his!drinking.!
D. Disulfiram!is!not!recommended!because!it!may!cause!severe!side!effects!when!it!mixes!
with!alcohol.!
E. Disulfiram!is!not!recommended!because!it!is!indicated!for!opioid!dependence.!
!
Psychopharmacology
26. A!50TyearTold!man!with!a!major!depressive!disorder!did!not!respond!well!to!an!adequate!
trial!of!sertraline!200mg!(a!selective!serotonin!reuptake!inhibitor).!!Neither!did!he!fully!
respond!to!a!subsequent!8Tweek!trial!of!venlafaxine!150mg!(serotonin!noradrenaline!
reuptake!inhibitor).!!Which!of!the!following!is!NOT!RECOMMENDED!for!this!man?!!!
!
A. Augment!SSRI!with!lithium!(a!mood!stabilizer)!
B. Augment!SSRI!with!phenelzine!(a!monoaxmine!oxidase!inhibitor)!
C. Consider!electroconvulsive!therapy!
D. Consider!psychotherapy!
E. Increase!the!dose!of!venlafaxine.!!
F. Bupoprion has a higher incidence of sexual side effects and a lower incidence of
!
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122
sedation and weight gain.
G. Bupoprion has a lower incidence of sexual side effects and a lower incidence of
sedation and weight gain.
H. Bupoprion has a lower incidence of sexual side effects and higher incidence of
sedation and weight gain
I. Bupoprion has lower incidence of sexual side effects and weight gain and a higher
incidence of sedation.
J. Bupoprion has a higher incidence of sexual side effects and sedation and a lower
incidence of weight gain.
28. Besides treatment resistant schizophrenia, another appropriate indication for clozapine
is?
A. Severe agranulocytosis
B. Severe embolism
C. Severe hypersalivation
D. Severe metabolic syndrome
E. Severe tardive dyskinesia.
.
29. A!50TyearTold!cardiac!patient!suffers!from!depression!and!the!psychiatrist!
prescribed!fluoxetine.!Which!of!the!following!statements!about!fluoxetine!is!TRUE?!
!
A. !Fluoxetine!decreases!warfarin!levels.!
B.!!!!!Fluoxetine!increases!metabolism!of!warfarin.!
C. !!!!!Fluoxetine!increases!bruising!while!patient!is!taking!
!!!!!!!!!!!!!!!!warfarin.!
D. He!has!no!increased!risk!of!gastrointestinal!bleeding!with!fluoxetine.!
E. !!!!He!should!not!change!to!paroxetine!because!paroxetine!decreases!anticoagulant!effect!of!
warfarin.!
!
30. Which of the following hypnotic agents causes the LEAST daytime sedation is:
A. Diphenhydramine
B. Diazepam
C. Lorazepam
D. Zopiclone
E. Zolpidem.
31. Which of the following medications has the most convincing evidence for reducing
suicidal behavior in bipolar patients?
A. Clozapine
B. Lamotrigine
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C. Lithium
D. Olanzapine
E. Sodium valproate.
32. An otherwise healthy 50-year-old male patient receiving clozapine 300mg at night for
treatment resistant schizophrenia suddenly dies. The MOST likely cause of death is?
A. Myocarditis
C. Pneumonia
D. Serotonin syndrome
E. Tardive dyskinesia.
A. Aripiprazole
B. Clonazepam
C. Fluoxetine
D. Lithium
E. Olanzapine.
Psychotherapy
34. A 30-year-old woman suffers from obsessive compulsive disorder and washes her hand
50 times a day. Which of the following techniques is the MOST essential in the
psychological treatment of her compulsive hand washing behaviour?
A. Cognitive restructuring
B. Exposure and response prevention
C. Social skill training
D. Systemic desensitization
E. Thought stopping.
35. A!25TyearTold!woman!with!a!panic!disorder!seeks!an!opinion!whether!pharmacotherapy!or!
psychotherapy! is! the! best! treatment! option! for! her.! Which! of! the! following! statements! is!
CORRECT?
A. Adding alprazolam on p.r.n. basis will make exposure therapy ineffective.
B. Adding alprazolam in the first week will lead to dependence and does not improve patients
outcome.
C. Antidepressants such as selective serotonin reuptake inhibitors are not useful to treat panic
disorder.
D. Relaxation therapy is more effective than cognitive behaviour therapy in treating panic
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disorder.
E. Psychotherapy such as cognitive behaviour therapy requires more motivation than taking
medication.
36. A!70TyearTold!man!lodged!a!complaint!against!the!hospital.!!His!wife!died!suddenly!one!
year!ago.!!She!suffered!from!diabetes!and!had!frequent!episodes!hypoglycaemia.!!The!
husband!gave!her!higher!than!prescribed!dose!of!hypoglycaemic!agent!because!he!thought!
this!could!control!her!diabetes.!!His!children!disagreed!with!his!management!but!he!
refused!to!listen.!!The!coroners!report!stated!that!his!wife!died!of!hypoglycaemia.!!The!70T
yearTold!man!is!angry!with!the!endocrinologist!and!thinks!that!it!was!his!fault!to!prescribe!
the!wrong!hypoglycamic!agent!leading!to!his!wifes!death.!!He!demanded!a!written!apology!
from!the!endocrinologist.!!Which!of!the!following!defence!mechanisms!is!demonstrated!by!
this!man?
A. Altruism
B. Displacement
C. Reaction formation
D. Splitting
E. Undoing.
37. For post-traumatic stress disorder, which of the following interventions is LEAST
helpful to patients?
38. You are a resident in plastic surgery. A 24-year-old woman believes her nose is
malformed and always checks her nose in the mirror. She was seen by multiple
doctors and they confirmed that her nose is normal. Which of the following
psychological treatment is the treatment of choice for this patient?
39. A! 40TyearTold! woman! complained! of! headache,! backache,! nausea,! numbness! and! visual!
problems.! ! She! consulted! a! neurologist! whom! she! trusted! to! be! a! good! doctor.! ! The!
neurologist! diagnosed! the! patient! suffering! from! migraine! and! somatisation! disorder.!!
When! the! patient! requested! for! Magnetic! Resonance! Imaging! (MRI),! the! neurologist!
claimed!that!the!patient!had!exaggerated!her!somatic!symptoms!and!insisted!that!the!MRI!
!
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125
scan! should! be! reserved! for! more! severe! patients.! ! Six! months! later,! the! patient! died! of!
brain! tumour.! ! In! addition! to! negligence,! which! of! the! following! ethical! principles! was!
violated!by!the!neurologist?!
!
A. Autonomy!
B. Confidentiality!
C. Fiduciary!duty!
D. NonNmaleficience!
E. Justice.!
40. 40-year-old man arrested for shoplifting is referred for a psychiatric assessment after
he tells the judge he suffers from kleptomania. Which of the following criteria is MOST
important in establishing the diagnosis of kleptomania?
A. Acts reus.
B. Patient informs you that he was diagnosed with kleptomania by a private psychiatrist before
but cannot provide further clinical details.
C. Patient informs you that he cannot control his impulse to steal and he does not want to steal.
D. Patient informs you that he has started stealing since Primary 6.
E. Past history of criminal record of stealing.
41. A medical student has applied for a 3-month research elective and he follows a
professor to conduct research. The professor asks him to conduct a cross-sectional
questionnaire study to assess mood symptoms of cancer patients. He is expected to
recruit 300 patients in 3 months. This project was approved by the ethics committee.
He attempts to obtain consent from an inpatient who has received chemotherapy to
participate in this study. Patient refuses because he feels very lethargic. Thirty minutes
later, he asks the patient to re-consider participating in this study again. The patient
lodges a complaint to the professor about this medical student. Which ethical
principles has the medical student violated?
A. Autonomy!
B. Beneficence!
C. Confidentiality!
D. NonNmaleficence!
E. Justice.!
42. A 50-year-old man who is dependent on alcohol is admitted for observation after a fall when
intoxicated. The ward team is concerned about complications associated with alcohol withdrawal.
Which of the following statements is INCORRECT?
A. Delirium tremens usually occur 6-12 hours after the last drink.
B. Tremors usually occur 6-12 hours after the last drink.
C. Anxiety usually occurs 12-18 hours after the last drink.
D. Convulsion usually occurs 12-18 hours after the last drink.
E. Sleep disturbance usually occurs 12-18 hours after the last drink.
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43. You are a resident in general surgery. A 50-year-old man was admitted last night
after he cut his head, arms and hands during a suicide attempt. He is married
with a 10-year-old child. He works in the field of informational technology.
According to his wife, his elder brother died of gastric cancer 6 months ago. He
believed that he is genetically vulnerable for gastric cancer. He saw multiple
gastroenterologists and gastric surgeons. He went through multiple endoscopies
and biopsies with normal findings. Despite normal findings, he still worries that
he has undiagnosed gastric cancer. He argued with his wife tonight and wanted to
commit suicide. What of the following is the MOST appropriate psychiatric
diagnosis?
44. You have become a consultant physician. A resident called you and informed you
that the parameter of a 20-year-old male psychiatric patient over the phone, His
temperature is 41 degree Celsius. His heart rate is 105 per minutes and blood
pressure fluctuates from 120/70 to 180/100. His breathing is normal and chest is
clear. His abdomen is soft. His creatinine kinase is 800 IU/L (normal <100 IU/L)
and leukocyte count is 10 x109/L (normal range: 1.5-5 x109/L). His limbs are very
rigid and he demonstrates difficulty in swallowing. He was given intravenous
injection of haloperidol 20mg three days ago. What is the MOST likely
diagnosis?
A. Catatonia
B. Meningitis
C. Neuroleptic malignant syndrome
D. Serotonin syndrome
E. Status epilepticus.
45. You are a doctor working in the polyclinic. A 40-year-old man suffers from
bipolar disorder and he takes lithium on a daily basis. His blood pressure is
170/100mmHg. Which of the following medications is the BEST to lower his blood
pressure?
A. Angiotensin-converting-enzyme inhibitor
B. Alpha agonist
C. Benzodiazapine
D. Beta blocker
E. Thiazide diuretic.
46. In medically ill patients with psychiatric illness, which pharmacological properties of a
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127
psychotropic drug is MOST appropriate?
2014!First!Rotation!MCQ!
Year:2014!
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128
49. A psychiatric patient suddenly realises that he is The!answer!is!B.!
an interpreter for deaf people and tries to
interpret others speech in sign language. He !
demonstrates strange repetitive movements.
His signs appear to come in threes or fours,
Explanation:!Mannerism!is!a!goal!!
occasionally swinging his shoulders, as if he is
conveying a message. Which of the following is directed!repetitive!movement!(e.g.!a!
the BEST term to describe his movements? speaker!tries!to!move!his!hands!
! repetitively!to!convey!his!
messages).!
F. Ambitendency!
G. Mannerism! !
H. Negativism!
This!mans!movements!seemed!to!
I. Stereotypies!
J. Waxy!flexibility.! be!goal!directed!because!he!
! attempted!to!show!sign!language!
! but!not!understandable!to!deaf!
people.!
Year!2014!
Cognitive assessment! !
Year!2014!
Psychiatric epidemiology !
!
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129
more common in Asians as compared to !
Caucasians. Your answer is:
Explanation:!Vascular!dementia!
F. Alzheimers disease
(VaD)!is!found!to!be!more!common!
G. Lewy body dementia than!Alzheimers!disease!(AD)!in!
H. Pseudodementia some!Asian!countries.!In!a!study!
I. Vascular dementia conducted!by!National!
J. Fronto-temporal lobe dementia.
Neuroscience!Institute!(Singapore),!
53%!suffered!from!VaD!versus!47%!
from!AD.!The!ethnic!variation!is!due!
to!genetic!variation,!differences!in!
vascular!risk!factors!and!lifestyles.!!
Year:!2014!
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130
53. You are a family doctor. A male and a female The correct answer is D.
schizophrenia patient who stay in the
community have decided to get married and
have a child. What is the risk for their child to
develop schizophrenia in the future? Prevalence of Schizophrenia in
Specific Populations
F.16%
G. 26%
H. 36%
I. 46% Population Prevalence
J. 56%. (%)
General Population 1
Non-twin sibling of a 9
schizophrenic patient
Child with one 13
schizophrenic parent
Dizygotic twin of a 14
schizophrenic patient
Child of two 46
schizophrenic parents
Monozygotic twin of a 46
schizophrenic patient
!
Year: 2014
54. You!are!an!oncology!resident.!!A!60TyearTold! The!answer!is!B.!
oncology!patient!developed!severe!nausea!as!a!
sideTeffect!during!chemotherapy.!However,!after! Explanation:! ! This! phenomenon! is!
completing!treatment!she!continues!to!experience!
known! as! classical! conditioning.!
nausea!whenever!she!returns!to!the!hospital!for!
followTup.!Which!of!the!following!psychological! Chemotherapy! is! an! unconditional!
theories!BEST!describes!her!experience? stimulus! (UCS)! and! the! hospital!
building! is! conditional! stimulus!
F. Biofeedback (CS).! The! conditional! (CR)! and!
G. Classical conditioning
H. Cognitive learning unconditional! response! (UCR)!
I. Operant conditioning include! nausea.! The! pairing! of! CS!
J. Social learning. and! UCR! will! persist! even! UCS! (i.e.!
chemotherapy)!disappears.!
Year:!2014!
!
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131
likely diagnosis? panic!disorder!because!the!anxiety!
! symptoms!are!episodic!with!a!clear!
trigger.!
A.!Acute!stress!disorder!
!
B.!Generalized!anxiety!disorder!
Year:!2014.!
C.!Panic!disorder!!
D.!PostNtraumatic!stress!disorder!
E.!Somatization!disorder.!
D.!Generalized!anxiety!disorder!
E.!PostNtraumatic!stress!disorder.!
!
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132
cope! with! workNrelated! tasks! in!
agricultural! or! village! settings.! There! is!
less!stigma!in!rural!areas.!!
Year:!2014.
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marital problems. His wife complains that he is !
very fuzzy about cooking. He does not eat
outside nowadays. If he goes to a high class Explanation:! ! He! exhibits!
restaurant, he expects that the steak must be
properly done and he is entitled to change the
narcissistic! personality! trait.! He!
steak if it is poorly done. Now he finds most demonstrates! of! sense! of!
steak restaurants in Singapore are not up to his entitlement!and!holds!belief!that!he!
standard. He claims it is better to cook by is! better! than! the! others! (e.g.! chef!
himself. If the food is not up to his standard, he
has no one to blame. He likes to go to high- from! all! steak! restaurants).! He!
class club in town. He claims to be a special preoccupies!with!unlimited!success.!
member in the club due to his unlimited success
and donation. Which of the following !
personality traits BEST describes this man?
Year:!2014!
F. Antisocial
G. Avoidant
H. Borderline
I. Histrionic
J. Narcissistic.
Year: 2014
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134
I. Change!valproate!to!lithium! potential!cognitive!impairment!
J. Electroconvulsive!therapy.! should!not!be!a!relative!
contraindication!for!ECT.!On!the!
other!hand,!her!renal!impairment!is!
a!contraindication!for!lithium.!
Year:!2014!
Protective!factors!include!high!
levels!of!education,!APOE2,!
consuming!fish,!antiN
inflammatories,!statins$,$
bilingualism.!
Year:!2014!
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135
J. The!incidence!of!delirium!increases!with!age.! !
!
Year:!2014!
!
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136
Year:!2014!
Year:!2014!
Substance abuse !
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137
I. Being!female! BMI.!
J. NonNintravenous!use.!
!
Year:!2014!
This!is!an!advanced!level!question.!
Psychopharmacology !
The answer is B.
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138
following ways?
Year:!2014.!
!
!
139
! In!addition,!warfarin!is!metabolized!
via!CYP!3A4!and!fluoxetine!inhibits!
CYP!3A4!and!increases!the!levels!of!
warfarin.!
Year:!2014.!
!
This!is!an!advanced!level!question.!
Diphenhydramine!(halfNlife):!9N12!
hours!
Diazepam:!20N100!hours!
Lorazepam:!9N16!hours!
Zopiclone:!6!hours!
Zolpidem!2N3!hours.!
Year:!2014.!
This!is!an!advanced!level!question.!
Explanation:!Lithium!reduces!
F. Clozapine
G. Lamotrigine suicidal!ideation!in!bipolar!patients.!
H. Lithium
I. Olanzapine !
J. Sodium valproate.
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Year:!2014.!
C. Pneumonia Year:!2014.!
D. Serotonin syndrome !
E. Tardive dyskinesia.
Psychotherapy !
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Year:!2014.!
Year:!2014.!
!!
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wife!death!to!the!endocrinologist.!
Year:!2014.!
This!is!an!advanced!level!question.!
Explanation:!!Group!debriefing!may!
F. Cognitive behaviour therapy
be!harmful!based!on!recent!
G. Eye movement desensitization and reprocessing
H. Immediate group debriefing research!findings.!
I. Relaxation training
J. Supportive psychotherapy !
Year:!2014.!
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143
Magnetic! Resonance! Imaging! (MRI),! the! the!duty!that!a!doctor!(i.e.!
neurologist! claimed! that! the! patient! had! neurologist)!must!act!in!the!
exaggerated! her! somatic! symptoms! and! insisted!
that! the! MRI! scan! should! be! reserved! for! more! patients!best!interest.!The!
severe!patients.!!Six!months!later,!the!patient!died! neurologist!is!in!a!legal!contract!
of!brain!tumour.!!In!addition!to!negligence,!which! with!the!patient!to!provide!best!
of!the!following!ethical!principles!was!violated!by! care.!A!fiduciary!duty!exists!when!
the!neurologist?!
! the!late!patient!places!confidence!in!
F. Autonomy! the!doctor!and!relied!upon!him!to!
G. Confidentiality! exercise!his!expertise!in!diagnosing!
H. Fiduciary!duty! and!managing!her!illness.!
I. NonNmaleficience!
J. Justice.! In!this!case,!the!neurologist!failed!to!
offer!earlier!MRI!scan!despite!
patients!request.!!He!wrongly!
attributed!the!neurological!
symptoms!to!somatisation!disorder!
without!thorough!investigation.!
Year:!2014.!
This!is!an!advanced!level!question.!
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144
shopkifting but we need further clinical
details to establish the diagnosis of
kleptomania.
Year:!2014.!
F. Autonomy! !
G. Beneficence!
H. Confidentiality! Year:!2014.!
I. NonNmaleficence!
J. Justice.! !
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!
!
89. You are a resident in general surgery. A 50-
year-old man was admitted last night after he The!answer!is!D.!
cut his head, arms and hands during a
suicide attempt. He is married with a 10- !
year-old child. He works in the field of Explanation:!This!patient!suffers!
informational technology. According to his from!hypochondriasis!or!illness!
wife, his elder brother died of gastric cancer anxiety!disorder!because!he!worries!
6 months ago. He believed that he is (not!firmly!believes!as!in!delusion)!
genetically vulnerable for gastric cancer. He that!he!suffers!from!gastric!cancer!
saw multiple gastroenterologists and gastric but!not!confirmed!by!multiple!
surgeons. He went through multiple investigations.!
endoscopies and biopsies with normal
findings. Despite normal findings, he still !
worries that he has undiagnosed gastric
There!are!not!enough!symptoms!to!
cancer. He argued with his wife tonight and
support!the!diagnosis!of!
wanted to commit suicide. What of the
schizophrenia!and!abnormal!grief.!
following is the MOST appropriate
psychiatric diagnosis? !
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146
H. Neuroleptic malignant syndrome !
I. Serotonin syndrome
J. Status epilepticus. Year:!2014!
The!best!answer!is!Option!D.!
Year!2014.!!
This!is!an!advanced!level!question!
Year 2014
!
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147
!
Paper 6 - Questions
Psychopathology
1. A 50-year-old woman claims that unfamiliar people whom she met on the street were
her husband. She believes that her husband put on a disguise. What is the diagnosis?
A. Capgras syndrome
B. Charles de Bonnet syndrome
C. DeClerambaults syndrome
D. Fregoli syndrome
E. Ganser syndrome.
2. A 50-year-old woman hears her late mothers voice when she falls asleep. She cannot
recall the content of her mothers speech. This phenomenon is known as:
A. Auditory illusion
B. Hypnopompic hallucination
C. Hypnagogic hallucination
D. Pseudohallucination
E. Third-person auditory hallucination.
3. You are seeing a 70-year-old man who suffers from Parkinsons disease. He
demonstrates a dulled emotional tone and seems to be indifferent to jokes. His family
describes him as being emotionally detached. Which of the following terms BEST
describes his psychopathology?
A. Alexithymia
B. Alogia
C. Anhedonia
D. Apathy
E. Attentional deficit.
4. A 50-year-old Singaporean Chinese man firmly believes that he needs to flee from
Singapore to Russia for his personal safety. He has developed this belief after reading a
newspaper article about Edward Snowden who released national security materials of
the United States (US). This man firmly believes that the newspaper mentions his name
and describes about his role in the leak of US national secrets. Which of the following
terms BEST describe his experience?
A. Delusion of erotomania
B. Delusion of grandiosity
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C. Delusion of guilt
D. Delusion of jealousy
E. Delusion of reference.
Cognitive assessment
6. The Montreal Cognitive Assessment (MOCA) is different from the Mini-Mental State
Examination. Which of the following neuroanatomical structures is specifically
assessed in the MOCA but not the MMSE?
A. Frontal lobe
B. Hippocampus
C. Occipital lobe
D. Parietal lobe
E. Temporal lobe.
7. After 65 years of age, the rate of Alzheimers disease changes approximately by how
many times every 5 years increase in age?
A. 0.5 time
B. 1 time
C. 2 times
D. 3 times
E. 4 times.
A. Basal ganglia
B. Cerebellum
C. Hippocampus
D. Nucleus accumbens
E. Raphe nucleus.
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General adult psychiatry / Psychiatric diagnosis
A. Delusional belief that familiar people have been replaced by their imposters
B. Delusional belief that the spouse is unfaithful
C. Delusional belief that strangers have taken on the psychological identity of a familiar person
D. Delusional belief that a person of higher status falls in love with the patient
E. Nihilistic and hypochondriacal delusions found in psychotic depression.
12. A 40-year-old woman, Ms. Tan has witnessed a road traffic accident. Four hours ago,
an elderly man was knocked down by a taxi and suffered from severe head injury. Ms.
Tan was walking along the street and witnessed the whole accident. She did not suffer
from any injury. The police officer wants to interview Ms. Tan to obtain more
information about the accident. She cannot recall any details related to the accident.
Which of the following is the MOST appropriate explanation for her amnesia?
13. You are a medical officer working in the Army Camp. A 19-year-old man is recently
enlisted for National Service and his parents inform you that he walks around his flat
during sleep. Which of the following recommendations is LEAST appropriate?
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150
A. Safety measures
B. Sleep hygiene
C. Stay out of camp at night
D. Stimulant
E. Supportive psychotherapy.
14. A 25-year-old man believes that he suffers from adult ADHD. Which of the following
criteria is compulsory to establish such diagnosis?
15. All of the following findings are found in anorexia nervosa EXCEPT:
16. You are a family doctor and a 70-year-old man consults you for annual medical
assessment to certify that he is fit to drive. Which of the following is LEAST relevant to
driving?
18. Which of the following statements is FALSE about delirium in old people?
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B. Onset could be insidious
C. Rarely results in full resolution of symptoms in a short period of time
D. Un-medicated old people are at higher risk to develop delirium as compared to old people
treated by multiple medications.
E. Usually persists for weeks or months in old people hospitalized for medical or surgical
reasons.
19. The daughter of an 80-year-old woman with history of bipolar disorder calls you for
advice. Her mother assaulted one helper and the other helper is terrified. They tried to
stop her from leaving the house to buy things. Which of the following is MOST
appropriate management strategy?
20. A 4-year-old boys grandmother died four months ago. The grandmother was one of the
childs primary caregivers. The child still speaks to the grandmother. When he walks, he
still holds her hands up as though holding hands with his grandmother. Which of the
following is CORRECT?
21. Which of the following is the MOST established psychopharmacological treatment for
children and adolescents suffering from autism?
A. Actetylcholinesterase inhibitor
B. Antipsychotic drug
C. Benzodiazepine
D. Omega-3 supplement
E. Stimulant.
Substance abuse
22. You are a resident working at the Accident and Emergency Department. A 21-year-old
man is brought in by police and he is disorientated to time, place and person. He needs
to urinate very often and seems to have urinary incontinence. A package of capsules is
found in his pocket and suspected to be illicit drugs. Which of the following drugs is
MOST likely to cause the above symptoms?
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A. Amphetamine
B. Cannabis
C. Cocaine
D. Ketamine
E. Phencyclidine.
A. AngiotensinNconvertingNenzyme!inhibitors
B. Beta-blockers
C. Benzodiazapine
D. Loop diuretics
E. Thiazide diuretics.
24. Which of the following addiction has the HIGHEST suicide risk?
A, Gambling
B. Internet
C. Sex
E. Stimulant.
25. You are a general practitioner (GP). A 20-year-old university student wants you to prescribe
methylphenidate (ritalin). The student believes that ritalin can enhance his examination
performance and he has been obtaining Ritalin prescribed from another GP. He does not
have history of attention deficit and hyperactivity disorder (ADHD). Which of the following
advices is MOST APPROPRIATE?
A. Advise him to take methylphenidate on the days of examination and stops immediately after
the examination.
B. Advise him to stop taking methylphenidate because it is a controlled drug and not indicated in
his situation.
C. Methylphenidate can enhance his attention if he has family history of ADHD.
D. Methylphenidate can enhance his attention if he has past history of conduct disorder.
E. There is evidence to suggest that methylphenidate can enhance his attention and improve his
examination performance.
Psychopharmacology
26. A 30-year-old man suffers from autism and epilepsy. He has been very aggressive. The
psychiatrist prescribes sodium valproate 1300mg nocte to control his aggression and
epilepsy. His mother concludes the sodium valproate is not effective. The first step of
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management should be:
A. Dyspepsia
B. Flushing
C. Headache
D. Impaired vision
E. Priapism.
28. A 30-year-old man suffers from schizophrenia. He presents a list of drugs which he took
in the past. Which of the following is NOT a second generation antipsychotic drug?
a. Clozapine
b. Flupenthixol
c. Olanzapine
d. Quetiapine
e. Risperidone.
29. A 30-year-old man suffers from insomnia and he sleeps well after taking diazepam. He
worries that he lacks a particular neurotransmitter in the brain and diazepam can
enhance the actions of this neurotransmitter. Which of the following neurotransmitters
is MOST relevant In this case?
A. Acetylcholine
B. Dopamine
C. -Aminobutyric acid
D. Noradrenaline
E. Serotonin.
30. Mrs. Tan is a 65-year-old woman who lost her husband three years ago. She is still
angry with him for not taking better care of his health. He was cremated and she keeps
his ashes in the urn. She is unsure what to do with the ashes. She coped well after her
husbands death, until her son moved to Australia a few months ago. She has long
standing headaches, but these have become worse over the past six months. She also
has new onset of somatic symptoms as well as anxiety symptoms which are
overwhelming and include a fear of dying. Her depression has been partially treated
with fluoxetine 40mg per day, but her anxiety symptoms persist and she feels restless.
Which of the following actions is LEAST appropriate?
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31. Which of the following antidepressants cause MOST SEDATION after potentiation with
benzodiazepine?
A. Agomelatine
B. Escitalopram
C. Fluvoxamine
D. Mirtazapine
E. Venlafaxine.
32. Which of the following factors limits the use of clozapine in treatment-resistant
schizophrenia?
A. Amitriptyline
B. Haloperidol
C. Lithium
D. Risperidone
E. Sodium valproate.
35. The MOST robust effect of lamotrigine is found in which of the following?
a. Bipolar depression
b. Manic episode
c. Mixed episodes
d. Hypomanic episode
e. Cyclothymia.
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36. A 30-year-old woman complains of lack of sexual drive after taking paroxetine. She
wants to change her antidepressant. Which of the following antidepressant is the BEST
option to avoid sexual dysfunction?
A. Amitriptyline
B. Reboxetine
C. Mirtazapine
D. Duloxetine
E. Venlafaxine.
37. Agomelatine,!a!new!antidepressant!!is!BEST!given!in!which!of!the!following!parts!of!
the!day?
!
A. Early morning
B. Late morning
C. Early afternoon
D. Early evening
E. Past mid-night.
Psychotherapy!
38. A! 24TyearTold! depressed! woman! said,! People! in! my! office! try! to! make! my! life!
difficult! and! then! deem! themselves! as! ultimate! smart! to! know! about! me.! I! have!
resigned! as! I! am! uncomfortable! with! the! office! settings.! I! am! aware! that! I! am!
getting! verbally! aggressive! towards! other! people! whenever! they! provoke! me.! I!
want! to! see! a! psychotherapist! because! I! want! to! deal! with! these! people! before! I!
lose! my! selfTidentity.! Which! of! the! following! psychotherapies! is! MOST!
appropriate?!
!!
A. Cognitive!behaviour!therapy!
B. Grief!therapy!
C. Interpersonal!therapy!
D. Relaxation!exercise!
E. Supportive!psychotherapy!
39. You are a family doctor. A 30-year-old woman suffers from schizophrenia. Although she
is free from first rank symptoms, she is affected by weight gain, negative symptoms of
schizophrenia and no interest in sex. Her husband has high sexual drive and he is not
happy with their sexual life. He requests for anti-androgen to reduce his sexual drive.
What is BEST management strategy? !
40. A 40-year-old man suffers from post-traumatic stress disorder (PTSD) and has history
of misusing cannabis. He claims that the government should legalise the sales of
cannabis because cannabis can reduce the PTSD symptoms and helps him to relax.
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What is his defence mechanism?
A. Denial
B. Projection
C. Rationalisation
D. Repression
E. Sublimation.
41. The Mental Health (Care and Treatment) Act in Singapore can be applied at which of the
following hospital(s) for involuntary admission?
42. A 21-year-old woman suffering from body dysmorphic disorder consulted a doctor for
Botulinum toxin (botox) treatment. She was concerned of the smoothness of her face
and spent $10,000 for multiple botox injection. The botox injection caused paralysis of
facial muscles. Botox injection is not indicated for women younger than 30 years and
body dysmorphic disorder. Which of the following ethical principles was violated by
this doctor?
K. Autonomy!
L. Capacity!
M. Confidentiality!
N. NonNmaleficence!
O. Justice.!
43. A 25-year-old man was arrested for murder. According to the police, he shows no
remorse towards his act. He firmly believes that killing one person will not lead to death
sentence. He needs to kill several people to get death sentence. He always carries a
chopper and wants to attack innocent people. If he is released from the prison, he will
kill more people, including his parents. Which of the following diagnoses is MOST
appropriate?
A. Biopathy
B. Egopathy
C. Psychopathy
D. Sociopathy
E. Superegopathy.
Consultation liaison psychiatry
44. You are a resident working in the Children Emergency Department. A 5-year-old boy is
presented for recurrent urinary tract infection and confirmed by raised white blood cell
counts in urine. According to his mother, the boy likes to insert foreign body into his
penis via the urethra meatus. After taking a thorough history and conducting physical
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!
157
examination, you cannot gather any evidence the boy could insert foreign body into his
penis. It is not anatomically and physiologically feasible for the boy to do so. You
cannot exclude the possibility that it could have been done by his mother. History also
reveals that the parents have marital problems and his father is suspected to visit
commercial sex workers frequently. She is very keen to admit her son for further
invasive investigations. What is the MOST likely diagnosis?
A. The!Beck!Anxiety!and!Depression!Inventory!
B. The!General!Health!Questionnaire!
C. The!Hamilton!Anxiety!and!Depression!Rating!Scale!
D. The!Hospital!Anxiety!and!Depression!Scale!
E. The!StateNTrait!Anxiety!Inventory.!
46. You are a resident working in the Accident and Emergency Department (AED). A 26-
year-old woman gave birth one month ago. She is a single mother and broke up with
her boyfriend. She has poor social support and no one helps her to look after the baby.
She has been depressed for 1 month and wanted to jump down from her flat two weeks
ago. She was referred to the womans mental health service. She was referred to a case
manager but no medication was prescribed. She breastfeeds her baby. Today, she
wants to jump again. The mother and her baby are bought to the AED by the case
manager. Which of the following is the BEST management?
A. Admit the mother and her baby to the hospital. The mother will go to the psychiatric ward and
the baby will go to paediatric ward. She will benefit from antidepressant and psychological
intervention.
B. Admit the mother and her baby to the hospital. The mother will go to the psychiatric ward and
the baby will go to paediatric ward. She should receive psychological intervention only
because antidepressants are dangerous for breastfeeding.
C. Discharge the mother and her baby from the AED because she suffers from adjustment
disorder. Her risk is low.
D. Discharge the mother and her baby from the AED because she receives good care from case
manager.
E. Send both mother and her baby to the Institute of Mental Health for compulsory admission.
47. What of the following psychiatric side effects is MOST common in Hepatitis C patients
receiving interferon treatment?
A. Anxiety
B. Cognitive impairment
C. Confusion
D. Depression
E. Hallucination.
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48. The hospital wants to develop the best method to detect and identify delirium in
medically ill patients. Which of the following is the BEST strategy to detect and identify
delirium?
A. Administer Delirium Rating Scale to all patients older than 65 years to screen for delirium.
B. Looking for abnormalities on computerized topography (CT) brain scans for all patients.
C. Looking for abnormalities on magnetic resonance imaging (MRI) brain scans for suspected
patients.
D. Monitor signs of delirium on those patients with laboratory abnormalities.
E. Screen for history of delirium and monitor those patients with history of delirium only.
!
Rotation 2 - 2014
Psychopathology
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159
G. Alogia Detachment is one of the aspects of
H. Anhedonia apathy.
I. Apathy
J. Attentional deficit.
Year: 2014.
F. Delusion of erotomania
G. Delusion of grandiosity Year: 2014.
H. Delusion of guilt
I. Delusion of jealousy
J. Delusion of reference.
Cognitive assessment
Year: 2014.
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160
12. The Montreal Cognitive Assessment (MOCA) The answer is A.
is different from the Mini-Mental State
Examination. Which of the following
neuroanatomical structures is specifically
assessed in the MOCA but not the MMSE? Explanation: MOCA tests the frontal lobe
function by the trail making task. This
task assesses alternating sequencing
F. Frontal lobe
(number and alphabet) and rule out
G. Hippocampus
H. Occipital lobe perservation.
I. Parietal lobe
J. Temporal lobe.
Year: 2014.
Year: 2014
Year: 2014
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161
G. Major depressive disorder suicide among all the options.
H. Generalised anxiety disorder
I. Hypochondriasis/ illness anxiety disorder
J. Schizophrenia.
Year: 2014.
F. Delusional belief that familiar people have been Explanation: Cotards syndrome is a
replaced by their imposters nihilistic delusion in which a person
G. Delusional belief that the spouse is unfaithful believes that their possessions, friends,
H. Delusional belief that strangers have taken on the
or parts of their own body do not exist or
psychological identity of a familiar person
I. Delusional belief that a person of higher status are about to not exist.
falls in love with the patient
J. Nihilistic and hypochondriacal delusions found in
psychotic depression.
Year: 2014.
Year: 2014
F. Generalized anxiety disorder
G. Panic disorder
H. Panic disorder with agoraphobia
I. Post-traumatic stress disorder
J. Social phobia.
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162
Year: 2014
55. You are a medical officer working in the Army The answer is D.
Camp. A 19-year-old man is recently enlisted
for National Service and his parents inform
you that he walks around his flat during sleep.
Which of the following recommendations is Explanation: Stimulant treatment (e.g.
LEAST appropriate? modanfinil) is used to treat narcolepsy
but not sleep-walking.
F. Safety measures
G. Sleep hygiene
H. Stay out of camp at night Year: 2014
I. Stimulant
J. Supportive psychotherapy.
Year: 2014
58. You are a family doctor and a 70-year-old man The answer is E.
consults you for annual medical assessment
to certify that he is fit to drive. Which of the
following is LEAST relevant to driving?
Explanation: Option A, B, C and D
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!
163
assess driving and body systems that are
directly involved in driving. Blood
F. Assess his visual acuity by Snellens Chart pressure is not directly involved in driving
G. Assess his hearing by whispering to his ears
and less likely to influence driving
H. Inquire his driving practice and road safety
records performance.
I. Examine his elbow and knee joints
J. Measure his blood pressure.
Year: 2014
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164
I. Increase the dose of benzodiazepine and review
in1 week
J. Increase the dose of mood stabilizer and review Year: 2014
in 1 week.
Substance abuse
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!
165
I. Ketamine Year: 2014.
J. Phencyclidine.
Year: 2014.
Year: 2014.
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!
166
is MOST APPROPRIATE? tight control of illicit drugs. This student
may have misused methylphenidate as
F. Advise him to take methylphenidate on the days stimulants and see different doctors to
of examination and stops immediately after the obtain methylphenidate. He is
examination.
recommended to stop taking
G. Advise him to stop taking methylphenidate
because it is a controlled drug and not indicated methylphenidate and there is no
in his situation. evidence to suggest that this will help his
H. Methylphenidate can enhance his attention if he examination performance.
has family history of ADHD.
I. Methylphenidate can enhance his attention if he
has past history of conduct disorder.
J. There is evidence to suggest that Year: 2014.
methylphenidate can enhance his attention and
improve his examination performance.
Psychopharmacology
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!
167
70. A 30-year-old man suffers from schizophrenia. The answer is B.
He presents a list of drugs which he took in
the past. Which of the following is NOT a
second generation antipsychotic drug?
f. Clozapine Explanation: Option B is a first-
g. Flupenthixol generation antipsychotic drug.
h. Olanzapine
i. Quetiapine
j. Risperidone.
Year: 2014
72. Mrs. Tan is a 65-year-old woman who lost her The answer is C.
husband three years ago. She is still angry
with him for not taking better care of his
health. He was cremated and she keeps his
ashes in the urn. She is unsure what to do Explanation: increase fluoxetine to 80mg
with the ashes. She coped well after her may worsen anxiety and restlessness.
husbands death, until her son moved to
Australia a few months ago. She has long
standing headaches, but these have become
worse over the past six months. She also has Year: 2014
new onset of somatic symptoms as well as
anxiety symptoms which are overwhelming
and include a fear of dying. Her depression
has been partially treated with fluoxetine This is an advanced level question.
40mg per day, but her anxiety symptoms
persist and she feels restless. Which of the
following actions is LEAST appropriate?
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!
168
73. Which of the following antidepressants cause The answer is D.
MOST SEDATION after potentiation with
benzodiazepine?
Explanation: Mirtazapine is the most
sedative antidepressant. The sedation
F. Agomelatine
effect will be worsen after potentiation
G. Escitalopram
H. Fluvoxamine with benzodiazepine.
I. Mirtazapine
J. Venlafaxine.
Year: 2014.
74. Which of the following factors limits the use The answer is E.
of clozapine in treatment-resistant
schizophrenia?
Year: 2014.
Year: 2014.
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169
Explanation: rTMS does not require
general anaesthesia. rTMS is an
F. rTMS is administered under general anaesthesia. alternative to ECT if patient has medical
G. rTMS is more efficacious than electroconvulsive
or surgical contraindicates to ECT. rTMS
therapy (ECT).
H. rTMS induces seizures with less energy as is not intended to induce seizures and it
compared to ECT. is not related to imaging.
I. rTMS is a new imaging modality in psychiatry.
J. rTMS may be useful in the treatment of
depression.
Year: 2014.
c. Mixed episodes
d. Hypomanic episode
Year: 2014.
e. Cyclothymia.
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!
170
J. Past mid-night. phase).!
Year: 2014.
Psychotherapy! !
This!is!an!advanced!level!question.!
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171
! !
Year:!2014!
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172
85. A 25-year-old man was arrested for murder. The!answer!is!C.!
According to the police, he shows no remorse
towards his act. He firmly believes that killing !
one person will not lead to death sentence. He
needs to kill several people to get death
Explanation:!In!forensic!psychiatry,!
sentence. He always carries a chopper and
wants to attack innocent people. If he is psychopath!represents!the!most!
released from the prison, he will kill more severe!form!of!antisocial!personality!
people, including his parents. Which of the disorder.!People!with!psychopathy!
following diagnoses is MOST appropriate?
demonstrate!extremely!low!level!of!
empathy!and!remorse.!They!have!high!
F. Biopathy chance!of!recidivism.!
G. Egopathy
H. Psychopathy !
I. Sociopathy
J. Superegopathy.
Year:!2014.!
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173
F. The!Beck!Anxiety!and!Depression!Inventory! because!the!items!are!specially!
G. The!General!Health!Questionnaire! constructed!to!enhance!sensitivity!in!
H. The!Hamilton!Anxiety!and!Depression!Rating! detecting!depression!and!anxiety!
Scale!
symptoms!in!medical!patients.!The!
I. The!Hospital!Anxiety!and!Depression!Scale!
J. The!StateNTrait!Anxiety!Inventory.! Beck!depression!and!anxiety!inventory!
and!Hamilton!Anxiety!and!Depression!
Rating!Scale!are!more!suitable!for!
psychiatric!patients.!
Year:!2014.!
!
!
174
H. Confusion well known to be associated with
I. Depression depression.
J. Hallucination.
Year: 2014.
Paper!7!N!Questions!
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!
175
History, mental state exam, psychopathology and risk assessment!
1. You are a resident working in the accident and emergency department (AED).
A 30-year-old schizophrenia patient is brought in by his mother. He suddenly
heard a voice asking him to use a sword to stab himself and open up his
abdomen. His mother stopped him and bought him to the hospital. He does not
have antisocial behaviour. Which of the following BEST describes his current
risk at the AED?
A. High risk due to the possibility that he may attack other people.
B. High risk due to the possibility of damaging internal organs such as aorta and liver if
he stabs himself.
C. Low risk due to the fact that he has informed his mother and the chance to carry out
action is low.
D. Low risk due to the unlikeliness for him to harm himself as a result of disorganized
behaviour seen in schizophrenia patients.
E. Moderate risk due to possibility of superficial cut on abdomen.
2. You are a resident working in the accident and emergency department. A 30-year-old
bank officer is brought in by her supervisors after she has a failed suicide attempt in
the bank. She was recently transferred out from the head office to another branch.
According to her relatives, the patient claims that the Chief Executive Officer (CEO)
fell in love with her. She spent hours waiting for the CEO after work. She tried to stop
his car from leaving the car park. The CEO has never worked with her and does not
know her personally. Which of the following is the correct diagnosis?
A. Capgras!syndrome!
B. Charles!de!Bonnets!syndrome!
C. De!Clrambault's!syndrome!
D. Gansers!syndrome!
E. Othellos!syndrome!
3 Which of the following is NOT a thought disorder found in patients suffering from
schizophrenia?
A. Derailment
B. Echopraxia
C. Loosening of association
D. Knights move thinking
E. Word salad.
Cognitive assessment!
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!
176
A. Problems with articulation
B. Problems with calculation
C. Problems with drawing a clock face
D. Problems with expression of emotion
E. Problems with recognition
5 A 20-year-old woman complains of low mood because she is bullied in her workplace.
She is a factory worker and her supervisor complains that she is very slow at work.
She stays with her family and is able to look after herself. Her mother describes the
patient as simple-minded. When she was young, she exhibited delay in understanding
and learning language. She kept failing the N level examination despite multiple
attempts. Which of the following BEST describes her current level of intelligence?
A. Normal intelligence
B. Mild intellectual disability
C. Moderate intellectual disability
D. Severe intellectual disability
E. Profound intellectual disability.
Psychiatric epidemiology
A. Anxiety disorder
B. Dementia
C. Diabetes
D. Ischaemic heart disease
E. Schizophrenia.
7 Which of the following mood disorders has the HIGHEST rate of co-occurrence with a
substance abuse disorder?
A. Adjustment disorder
B. Seasonal affective disorder
C. Cyclothymia
D. Bipolar disorder
E. Dysthymia.
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!
177
obsessive compulsive disorder?
A. Consumption of hydroxyzine
B. Dementia
C. Mixed anxiety and depression
D. Obstructive sleep apnea
E. Shift work.
11 The mother of a schizophrenia patient wants to consult you the risk of his dizygotic
twin brother in developing schizophrenia. Your answer is:
A. 4%
B. 14%
C. 24%
D. 34%
E. 44%.
General adult psychiatry
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178
the status of her father and he is not contactable. At this moment, she is
MOST likely to develop which of the following psychiatric conditions?
A. Anticipatory grief
B. Compensation neurosis
C. Dissociative state
D. Psychosis
E. Hypochondriasis.
14 Which!of!the!following!statements!concerning!generalized!anxiety!disorder!is!
FALSE?!!
!
A. Alcohol!misuse!is!a!common!comorbidity.!!
B. Cognitive!behaviour!therapy!is!generally!helpful.!
C. Excessive!worries!and!anxiety!symptoms!are!episodic.!
D. ShortNterm!benzodiazepines!can!be!an!effective!treatment!
E. There!is!a!2!to!1!ratio!of!women!to!men!suffering!from!this!disorder.!
15 Which!of!the!following!is!TRUE!regarding!delusional!disorder?!
!!
A. Infrequent!hallucinations!totally!rule!out!the!diagnosis!of!delusional!disorder.!
B. Onset!is!in!adolescence.!!
C. Point!prevalence!is!3%.!
D. From!genetic!point!of!view,!there!is!frequent!crossover!to!other!psychotic!disorders!
such!as!schizophrenia.!
E. The!persecutory!subtype!is!the!most!common.!!
!
16 A 45-year-old man consults you because he is stressed over his daughters eating
disorder. His daughter suffers from anorexia nervosa. He is very concerned about her
condition. He wants to seek your reassurance. Which of the following indicates a
GOOD prognostic factor for his daughter?
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179
A. Early age of onset
B. Past hospitalisation
C. Frequent self-induced vomiting rather than food restriction
D. Very low BMI
E. Perfectionistic personality.
A. Alprazolam
B. Bupropion
C. Mirtazapine
D. Sertraline
E. Hydroxyzine
18 You are a general practitioner. A 30-year-old man comes to the clinic and claims that
he received a diagnosis of bipolar II disorder in the United States. Bipolar II disorder is
best described as:
A. Depressive disorder in elderly is accompanied by a much lower suicide risk than in younger
adults.
B. Depressive disorder in elderly is less likely to be associated with paranoia as compared to
younger adults.
C. Elderly suffering from depressive disorder takes shorter time to respond as compared to
younger adults
D. Mild depressive disorder is more prevalent in elderly women than men.
E. Prevalence of depressive disorder rises sharply with age in the community.
20 Which!of!the!following!is!MOST!commonly!seen!as!a!normal!change!associated!
with!aging?
A. Increase!in!acetylcholine!
B. Increase!in!paranoia!
C. Increase!in!brain!ventricle!size!!
D. Increased!electroencephalogram!(EEG)!frequency!
E. Increased!slowNwave!sleep.!
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180
21 What!is!the!MOST!likely!diagnosis!in!a!75T!yearTold!man!with!declining!cognition,!
visual!hallucinations,!and!parkinsonism!symptoms?!!!
!
A. Alzheimers!disease!
B. Dementia!with!Lewy!Bodies!
C. LateNonset!schizophrenia!
D. FrontoNtemporal!lobe!dementia!
E. Vascular!dementia.!
!
A. 30% or more of the elderly admitted to medical ward will develop delirium
during hospitalisation.
B. Antipsychotic drug is the first-line psychiatric treatment for delirium.
C. Delirium is often overlooked by health care professionals in the elderly.
D. Delirium typically resolves within 3 days after correcting the underlying cause.
E. Incidence of delirium increases with age.
23 If a young boy presents with intellectual disability, autistic features and multiple
maternal relatives are carriers of a genetic condition. Which of the following diagnosis
is MOST likely?
A. Angleman syndrome
B. Down syndrome
C. Prader Willi syndrome
D. Fragile X syndrome
E. Williams syndrome
24 You are an orthopaedic resident. A 22-year-old man suffers from cervical spondylosis
and results in severe neck pain. His pain does not respond to analgesics and
becomes very depressed and suicidal. His mother describes him as being obsessed
with online games. He is an active member of several online game groups. He spends
more around 20 hours per day in the internet caf and becomes very agitated when he
is not allowed to play online games. He has history of alcohol dependence. Which of
the following symptoms found in this patient is MOST important in establishing the
diagnosis of internet addiction?
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!
181
A. Active member of the online group
B. Agitation when not allowed to play online game
C. Cervical spondylosis
D. Depression and suicidal thought
E. History of alcohol abuse.
25 Which of the following is NOT a factor which increases the risk of relapse to cocaine use in a 30-
year-old man who recently became abstinent from cocaine?
A. Action
B. Contemplation
C. Denial
D. Precontemplation
E. Maintenance.
Psychopharmacology
27 Which!of!the!following!neurochemicals!is!metabolized!by!monoamine!oxidase? !
!
A. Acetylcholine!
B. BrainNderived!neutrophic!factor!
C. Histamine!
D. Glutamate!
E. Serotonin.!
28 A 30-year-old man takes mirtazapine every night and experiences significant sedation
at 7.5mg/day. Which of the following neurotransmitter receptors are MOST likely to be
responsible for causing this side effect?
A. Adrenergic receptors
B. Dopamine receptors
C. Glutamate receptors
D. Histamine receptors
E. Nicotinic receptors.
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182
29 Which of the following psychotropic medications is the MOST likely to
raise the prolactin levels in female psychiatric patients?
A. Aripiprazole
B. Clozapine
C. Lithium
D. Olanzapine
E. Risperidone.
A. Hepatotoxicity
B. Hypothyroidism
C. Nephrotoxicity
D. Tremor
E. Weight Gain
33 A 25-year-old woman is treated by bupropion for depressive disorder. She gives you a
list of symptoms and attributes to the side effects of bupropion. Which of the
following symptoms is LEAST likely to be side effect of bupropion?
A. Anxiety
B. Nausea
C. Seizure
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183
D. Transient hallucination
E. Weight gain.
35 Which!of!the!following!is!the!mechanism!of!action!of!memantine,!a!medication!
used!to!slow!cognitive!decline!in!Alzheimers!dementia?
A. Cholinesterase!inhibitor!
B. Dopamine!receptor!blocker!
C. GammaNaminobutyric!acid!receptor!agonist!
D. NNmethylNDNaspartate!receptor!antagonist!
E. Serotonergic!reuptake!inhibitor.!
Psychotherapy
36 A 30-year-old woman with panic disorder does not respond to an initial treatment with
a selective serotonin reuptake inhibitor (SSRI). Which of the following treatment is
considered the best approach?
K. Benzodiazepine
L. Cognitive behaviour therapy
M. Hypnotherapy
N. Olanzapine
O. Psychodynamic psychotherapy.
37 You are a medical officer working in the army. A 22-year-old national serviceman
comes to see you because he is very angry with his male supervisor and wants to see
a psychologist. He also informs you that he is very angry with his own father. He
passed you an emotional 500-word open letter posted on his Facebook account. In his
letter, the patient mentions that his father has been abusive towards him. He finds his
male supervisor is as abusive as his father and the pattern keeps repeating itself.
Which of the following psychotherapy is MOST appropriate in this case?
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!
184
C. Psychodynamic psychotherapy
D. Reminiscence therapy
E. Validation therapy.
38 A"20%year%old"woman"suffers"from"borderline"personality"disorder."She"works"as"a"
clerk." During" psychotherapy" session," she" discloses" that" she" really" hates" the"
psychologist"and"has"thoughts"of"killing"the"psychologist."Her"conviction"to"kill"the"
psychologist" is" 1" out" of" 10" (1" =very" unlikely," 10" =" very" likely)." Furthermore," she"
does"not"have"a"plan"or"not"sure"when"to"kill"the"psychologist."She"has"no"forensic"
history"and"no"history"of"violence."She"admits"the"idea"of"killing"the"psychologist"is"
her" own" thought." She" has" no" command" hallucination." " Which" of" the" following"
BEST"describes"this"phenomenon?
6
39 A 30-year-old man suffers from disseminated gonococcal infection. The medical team
asks him about unprotected sexual activities. He claims he has one stable sexual
partner and practises safe sex all the time. The medical team thinks that his condition
could due to an underlying autoimmune cause because he has no risky behaviour.
Several days later, he finally admits that he has sexual intercourse with commercial
sex worker once per month. Sometimes, he does not use condom to protective
himself. What is the initial defence mechanism used by this patient?
A. Denial
B. Displacement
C. Projection
D. Projective identification
E. Undoing
40 You are a general practitioner. A 30-year-old female secretary complains of low mood,
poor appetite, poor sleep and suicidal thought. She is very depressed over the death
of her son who passed away 26 hours after birth. She has history of depression
without any psychotic feature. She underwent a traumatic delivery because an
obstetrician in private practice performed amniocentesis, induction of labour and
administered syntocinon 3 weeks before the expected date of delivery. The patient
later found out that the obstetrician induced labour because the doctor planned to go
for a holiday. Patient did not fully understand about the procedure and did not agree
with induction of labour which resulted in premature birth of her son. The obstetrician
claims that she does not have capacity to make decision due to history of depression.
She felt that the doctor performed the procedure against her will and the death of her
son was avoidable. Which ethical principle was violated by the obstetrician?
A. Autonomy
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185
B. Beneficence
C. Confidentiality
D. Involuntary treatment
E. Justice.
A. Actus reus
B. Jealousy
C. Automatism
D. Diminished responsibility
E. Mens rea.
Liaison Psychiatry
A. Autonomic instability
B. Diaphoresis
C. Decreased catecholamines in urine
D. Myoglobinuria
E. Rigidity.
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!
186
D. 19 - 24 weeks after delivery
E. 25 31 weeks after delivery.
!
44 A 40-year-old man went to South Korea for skiing and suffered from head
injury. All of the following symptoms are commonly associated with sequelae of
head injury EXCEPT:
A. Breast
B. Nose
C. Genitalia
D. Hair
E. Skin.
46 You are a medical resident. A 40-year-old man is admitted to the medical ward
due to altered mental state and requires further medical investigations. Past
records show a history of substance abuse. He sleeps poorly and paces
around the unit, restless and grumpy on the next day. He appears to be
confused and exhibits tachycardia at 106 beats per minutes. His palms and
forehead are sweaty and his tongue is showing a course tremor. When asked,
the patient says he feels anxious. Which of the following is the CORRECT
diagnosis?
A. Alcohol withdrawal
B. Amphetamine withdrawal
C. Cannabis withdrawal
D. Nicotine withdrawal
E. Opioid withdrawal.
!
Paper!7!N!Questions!
!
!
187
He does not have antisocial behaviour. Which of the at high risk due to two
following BEST describes his current risk at the reasons: 1) command
AED? hallucination 2) the
possibility of damaging the
F. High risk due to the possibility that he may attack other aorta and liver. He may die
people. in 30 seconds if aorta is
G. High risk due to the possibility of damaging internal damaged.
organs such as aorta and liver if he stabs himself.
H. Low risk due to the fact that he has informed his mother
and the chance to carry out action is low.
I. Low risk due to the unlikeliness for him to harm Year: 2014
himself as a result of disorganized behaviour seen in
schizophrenia patients.
J. Moderate risk due to possibility of superficial cut on
abdomen.
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!
188
Year: 2013.!
Cognitive assessment! !
Year: 2014
Year: 2014
Psychiatric epidemiology !
!
!
189
50 By 2020, which of the following illnesses is The!answer!is!D.!
predicted to have higher global disease burden
than depressive disorder? !
Explanation:!Based!on!the!
F. Anxiety disorder prediction!of!WHO,!
G. Dementia ischaemic!heart!disease!will!
H. Diabetes
rank!No.1!while!depressive!
I. Ischaemic heart disease
J. Schizophrenia. disorder!will!rank!No.2!in!
global!disease!burden.!
Year: 2014
Year: 2014
!!
!
!
190
Year: 2014
Year: 2014
Explanation:!The!risk!for!
F. 4%
G. 14% another!dizygotic!twin!to!
H. 24% develop!schizophrenia!is!
I. 34%
!
!
191
J. 44%. 14%.!
Year: 2014
F. Anticipatory grief !
G. Compensation neurosis
H. Dissociative state Year: 2014
I. Psychosis
J. Hypochondriasis. !
Year:!2014!
58 Which!of!the!following!statements!concerning! The!answer!is!C.!
generalized!anxiety!disorder!is!FALSE?!!
!
!
192
! !
F. Alcohol!misuse!is!a!common!comorbidity.!! Explanation:!Option!C!refers!
G. Cognitive!behaviour!therapy!is!generally!helpful.! to!panic!disorder.!
H. Excessive!worries!and!anxiety!symptoms!are!episodic.!
I. ShortNterm!benzodiazepines!can!be!an!effective! !
treatment!
J. There!is!a!2!to!1!ratio!of!women!to!men!suffering!from! Year:!2014!
this!disorder.!
59 Which!of!the!following!is!TRUE!regarding!delusional! The!answer!is!E.!
disorder?!
!! !
F. Infrequent!hallucinations!totally!rule!out!the!diagnosis!of! Explanation:!Delusion!
delusional!disorder.! disorder!is!quite!rare,!from!
G. Onset!is!in!adolescence.!! 0.025!to!0.03%.!The!mean!
H. Point!prevalence!is!3%.! age!of!onset!is!40!years.!
I. From!genetic!point!of!view,!there!is!frequent!crossover!to!
Delusional!disorder!does!not!
other!psychotic!disorders!such!as!schizophrenia.!
J. The!persecutory!subtype!is!the!most!common.!! cross!over!in!family!studies!
! with!schizophrenia!or!mood!
disorder.!Olfactory!
hallucinations!in!a!somatic!
delusion!of!body!odour,!may!
occur.!
!
!
Year:!2014.!
Year:!2014.!!
!
!
193
61 You are a general practitioner. A 25-year-old man with The!answer!is!D.!
history of Aspergers syndrome. He has history of
violent and compulsive behaviour. After recent increase !
in dose of psychotropic medications, his father
discovers that he masturbates less often and seems to
Explanation:!Sertraline!is!A!
develop erectile dysfunction. Which of the following
medications is MOST likely to cause erectile SSRI!and!most!likely!to!cause!
dysfunction? sexual!dysfunction!among!all!
the!choices.!
F. Alprazolam
!
G. Bupropion
H. Mirtazapine
I. Sertraline Year:!2014.!!
J. Hydroxyzine
!
Year: 2013.
!
!
194
elderly!and!there!is!no!sharp!
rise!in!prevalence.!
Year:!2014.!!
64 Which!of!the!following!is!MOST!commonly!seen!as!a! The!answer!is!C.!
normal!change!associated!with!aging?
!
F. Increase!in!acetylcholine! Explanation:!Option!A,!D!and!E!
G. Increase!in!paranoia! should!be!reduced.!Increase!in!
H. Increase!in!brain!ventricle!size!! paranoia!occurs!in!late!onset!
I. Increased!electroencephalogram!(EEG)!frequency!
depression,!bipolar!disorder!
J. Increased!slowNwave!sleep.!
and!schizophrenia!but!not!part!
of!normal!aging.!
Year:!2014!
65 What!is!the!MOST!likely!diagnosis!in!a!75T!yearTold! The!answer!is!B.!
man!with!declining!cognition,!visual!hallucinations,!
and!parkinsonism!symptoms?!!! !
!
Explanation:!The!classical!
F. Alzheimers!disease! triad!of!dementia!with!Lewy!
G. Dementia!with!Lewy!Bodies! Bodies!is!memory!loss,!visual!
H. LateNonset!schizophrenia! hallucination!and!
I. FrontoNtemporal!lobe!dementia!
parkinsonism.!
J. Vascular!dementia.!
!
!
Year:!2014!
!
!
195
correcting the underlying cause.
J. Incidence of delirium increases with age.
Year:!2014!
!
!
196
!
69 Which of the following is NOT a factor which increases the risk The!answer!is!C.!
of relapse to cocaine use in a 30-year-old man who recently
became abstinent from cocaine? !
Explanation:!Seeing!a!
F. Feeling depressed, tired and the need to overeat. counsellor!to!talk!about!the!
G. Going to pubs where ice and special K are available. previous!use!does!not!increase!
H. Seeing a counsellor to talk about the previous use of cocaine. the!risk!of!relapse.!Option!A!
I. Seeing a psychiatrist to complain about attention deficit and try to
obtain methylphenidate. refers!to!crash!from!
J. Spending time with colleagues who use coke. stimulation.!Option!B,!C,!and!E!
will!increase!the!exposure!to!
stimulants.!
Year:!2014!
F. Action !
G. Contemplation
H. Denial Year:!2014!
I. Precontemplation
J. Maintenance. !
Psychopharmacology !
71 Which!of!the!following!neurochemicals!is! The!answer!is!E.!
metabolized!by!monoamine!oxidase? !
! !
F. Acetylcholine! !
G. BrainNderived!neutrophic!factor!
H. Histamine! Explanation:!This!refers!to!
I. Glutamate! pharmacodynamic!action!of!
J. Serotonin.!
!
!
197
MAOI.!
Year:!2014!
Year:!2014!
Year:!2014
Year:!2014
!
!
198
75 Which of the following is NOT a well-established side The!answer!is!A.!
effect of lithium?
!
F. Hepatotoxicity Explanation:!Lithium!is!
G. Hypothyroidism
H. Nephrotoxicity excreted!by!kidney.!It!has!
I. Tremor minimal!effects!on!the!liver.!
J. Weight Gain
!
Year:!2014
Year:!2014
!
!
199
78 A 30-year-old schizophrenia patient receives olanzapine The!answer!is!C.!
20mg per day. He is a chronic smoker and agrees to
cease smoking in the past one month. After he quitted !
smoking, he experiences more side effects associated
with 20mg of olanzapine which include significant
Explanation:!Nicotine!induces!
sedation and weight gain. Which of the following is
MOST likely explanation? the!metabolism!of!olanzapine!
via!cytochrome!P450!1A2!and!
reduces!its!serum!
F. He is not complaint to olanzapine.
G. He took an overdose of olanzapine.
concentration.!After!he!quits!
H. After he stopped smoking, the hepatic metabolism of smoking,!the!serum!
olanzapine reduces. concentration!of!olanzapine!
I. Nicotine reduces the risk of metabolic syndrome. has!increased!and!resulted!in!
J. This is due to the effect of nicotine patch.
more!side!effects.!
Year:!2014.!
79 Which!of!the!following!is!the!mechanism!of!action!of! The!answer!is!D.!
memantine,!a!medication!used!to!slow!cognitive!
decline!in!Alzheimers!dementia? !
Explanation:!Memantine!
F. Cholinesterase!inhibitor! works!on!the!NMDA!
G. Dopamine!receptor!blocker! receptors!and!reduces!the!
H. GammaNaminobutyric!acid!receptor!agonist!
neurotoxicity!caused!by!
I. NNmethylNDNaspartate!receptor!antagonist!
J. Serotonergic!reuptake!inhibitor.! glutamate.!
Year:!2014.!
Psychotherapy !
!
!
200
Year:!2014.!
!
!
201
protective himself. What is the initial defence workers!and!result!in!
mechanism used by this patient? gonorrhoea!infection.!
F. Denial
!
G. Displacement
H. Projection !
I. Projective identification !
J. Undoing
Year:!2014!
F. Autonomy
G. Beneficence
H. Confidentiality Year:!2014.!
I. Involuntary treatment
J. Justice.
!
!
202
interview him, he says, Oh gosh, I cant recall the intoxication,!sleep!walking,!
event which occurred last night. He does not have epilepsy!and!hypoglycaemia.!!
past psychiatric illness. Which of the following
terms BEST describes his behaviour leading to the !
arrest?
Year:!2014.!
A. Actus reus
B. Jealousy
C. Automatism
D. Diminished responsibility
E. Mens rea.
Liaison Psychiatry !
Year:!2014.
!
!
203
head injury EXCEPT: !
Explanation:!Obsession!is!not!a!
F. Light and noise sensitivity
G. Headache common!symptom!of!postN
H. Insomnia concussion!syndrome.!
I. Obsession
!
J. Word finding difficulty.
!
Year:!2014.!
eyes!(20%)!thighs!(20%)!teeth!
(20%).!
Year:!2014.!
!
!
204
!
!
!
205
Paper 8- Questions
1. You are a resident doctor working at the Institute of Mental Health (IMH). The police
officers bought a 39-year-old man charged with possessing a scheduled weapon
and was sent to the IMH for a psychiatric evaluation. Although he speaks English,
you cannot make out what he is saying because his speech becomes diffuse and
unfocused. Which of the following best describes his psychopathology?
A. Circumstantiality
B. Loosening of association
C. Thought insertion
D. Thought withdrawal
E. Tangentiality.
2. You are a resident working at the Accident and Emergency Department (AED). A
35-year-old man was sent to the AED for psychiatric assessment by an ambulance.
He was involved in a road traffic accident. He was a passenger in a taxi. He told the
taxi driver that he was God and threatened the driver to believe that he was the
saviour of the world. The driver found him very irritable and he kept hitting the head
of the driver. The driver stopped the taxi and tried to call the police. The patient
drove the taxi at high speed and crashed the taxi into a lamp post. He was not under
influence of alcohol at the time of accident. You are required to enter a diagnosis
into the AED computerised system. Based on the information provided, which of the
following psychiatric diagnosis is most relevant?
Cognitive assessment
A. Cannot follow the instructions given by her supervisor after she returns to work
B. Cannot recall the password of her email account
C. Cannot remember details of her ex-marriage
D. Difficulty to perform two tasks at one time
E. Unable to calculate.
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!
206
4. You are administering the Serial 7 test to a patient. His answers are listed as follows: 100
7 = 90; 90 7 = 77; 77 7 = 70; 70 7 = 63; 63 7 = 50. What is his score?
A. 0 out of 5
B. 1 out of 5
C. 2 out of 5
D. 3 out of 5
E. 4 out of 5.
Psychiatric epidemiology
A. Alcohol misuse
B. Agoraphobia
C. Avoidant personality disorder
D. Benzodiazapine misuse
E. Generalised anxiety disorder.
Psychiatric aetiology, diagnosis and classification
7. Which of the following is least likely to be a risk factor for delusional disorder?
K. Having a religion
L. Increased age
M. Immigration
N. Sensory impairment
O. Social isolation.
A. Dopamine
!
!
207
B. -Aminobutyric acid (GABA)
C. Glutamate
D. Norephinephrine
E. Serotonin.
9. A 40-year-old patient with schizophrenia presents to the emergency department with
confusion and agitation following an overdose of haloperidol. The patient has a
temperature of 41 degree Celsius, blood pressure of 160/100 mm Hg, and pulse of
120 beats per minute. Physical examination reveals rigidity, hot, wet skin, and
decreased bowel sounds. This patients symptoms, are most likely caused by
blocking of which of the following receptors?
A. Alpha1-adrenergic
B. Dopaminergic
C. Histaminergic
D. Muscurinic cholinergic
E. Nicotinic cholinergic.
General adult psychiatry
10. A 30-year-old man suffers from schizophrenia. He first exhibited first rank symptoms
at the age of 16 and the onset was insidious. He exhibits anhedonia although his
hallucinations are under control by antipsychotic drug. His uncle suffers from
depressive disorder. All of the following are poor prognostic factors except?
A. Anhedonia
B. Exhibition of first rank symptoms at the age of 16
C. Family history of depressive disorder
D. Male gender
E. Insidious onset.
11. You are the resident working in the Accident and Emergency Department. A
schizophrenia patient informs you that he has homicidal thought. Which of the
following sign or symptom is least important in predicting homicide?
A. Command hallucinations
B. Delusion of reference
C. History of previous violence
D. Irresistible urge to attack
E. Need to defend oneself as are result of persecutory delusion.
12. All of the following are poor prognostic signs for obsessive compulsive disorder
except:
A. Bizarre compulsions
B. Childhood onset
C. Episodic course
D. Comorbid major depression
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!
208
E. Succumbing to obsessions and compulsions.
13. You are a general practitioner. A 35-year-old hotel butler came to see you because
his lawyer wants him to be seen by a psychiatrist. He was recently arrested for
installing pinhole camera in the hotel guestrooms. He secretly filmed couples having
sex in the hotel guestrooms. He has filmed more than 100 videos and enjoyed
watching them over and over again. He claims that he has the compulsion to collect
those videos and he feels relieved after the arrest. Which of the following is the most
likely diagnosis?
A. Erotomania
B. Kleptomania
C. Obsessive compulsive disorder
D. Sadomasochism
E. Voyeurism.
14. A 30-year-old woman always believes that she is socially inept and fears of negative
evaluation by other people. Her sisters describe her as timid and insecure. She is
single and stays with two elder sisters. She was admitted to the psychiatric ward due
to nervous breakdown after meeting new colleagues in her workplace. She refuses
to attend family meeting with her sisters because she feels that her sisters do not
like her although they appear to be very concerned about her condition. She is
isolated and has one best friend in her work place. Which of the following personality
best describes this patient?
A. Acidosis
B. Diaphoresis
C. Hyperreflexia
D. Hypothermia
E. Myoclonus.
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!
209
16. You are a resident working in the accident and emergency department
(AED). A single mother was sent to the AED with her 2-year-old daughter.
She was arrested by police because she tried to assault her daughter and
stopped by passer-by. According to the informant, her partner refuses to
marry her due to her drug habit. She does not have past forensic history. She
appears to be agitated and restless. At one moment, she wants to stay in the
AED. At another moment, she wants to walk out of the AED. Physical
examination reveals nystagmus. Which of the following diagnosis is most
relevant?
A. Antisocial personality disorder
B. Cannabis intoxication
C. Delusion of jealousy
D. Paranoid schizophrenia
E. Phencyclidine intoxication
Old age psychiatry
17. You are about to start a selective serotonin reuptake inhibitor (SSRI) for an 80-year-
old man who suffers from depression. Which of the following pharmacokinetic
changes has the least effect on drug therapy in the elderly?
A. Absorption
B. Distribution
C. Excretion
D. Metabolism
E. Protein binding.
A. Melatonin
B. Mirtazapine
C. Risperidone
D. Rivastigmine
E. Sodium valproate.
19. A 70-year-old woman suffering from bipolar disorder and her daughter came to see
you today. Her daughter read about the symptoms of bipolar disorder and found her
mother different from younger adults suffering from the same condition. Which of the
following clinical features is more likely to be found in this 70-year-old woman?
!
!
210
compared to adult patients
E. More spending as compared to adult patients.
20. Which of the following is most important risk factor for vascular dementia?
A. History of depression
B. History of poor academic performance
C. History of hypertension
D. High level of physical activity
E. High level of high density lipoproteins.
21. You are the visiting physician of a nursing home. The nursing home staffs feel very
helpless when handling aggression in dementia patients and they need to seek your
advice. Which of the following psychotropic medication have the most evidence in
managing aggression in patients suffering from dementia?
A. Antipsychotic drug
B. Beta-blocker
C. Benzodiazapine
D. Lithium
E. Stimulant.
A. Adolescent-onset schizophrenia
B. Autism
C. Conduct disorder
D. Obsessive-compulsive disorder
E. School refusal.
23. Children with autism are most comfortable in which of the following situations?
A. Attending a party where there are a lot of surprises and have a chance to meet
different people.
B. Attending drama classes and imagines oneself playing different roles in the drama.
C. Looking for toys in a multi-storey department store from one level to another level.
D. Travelling in a bus when it stops at every bus stop until it reaches the bus terminal.
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!
211
E. Going to school where there are multiple classes to attend in a day and teaching
content varies from subject to subject.
24. Which of the following statements is most correct regarding the impact of divorce on
children?
25. A 15-year-old obese female is brought by her parents for an evaluation as part of the
admission process for a weight management program. The adolescent agrees with
the fact that she is overweight and she is keen to lose weight. Which of the following
is most indicative that she will be successful in the program?
26. Methylene dimethylamphteamine (street name: ecstasy) usually cause people with
which of the following symptom?
a. Amotivation
b. Closeness to others
c. Depression
d. Introversion
e. Phobia.
27. A 30-year-old adult claims to suffer from adult onset attention deficit and
hyperactivity disorder (ADHD). He has been seeing different doctors to obtain
methylphenidate. He claims that he lost all methylphenidate in the bus few days ago
and his wife has noticed that he looks very tired. Which of the following is most
appropriate explanation for his tiredness?
!
!
212
A. To conduct in a group therapy format
B. To apply cognitive behaviour therapy (CBT) as the first approach
C. To combine psychological intervention and pharmacotherapy (e.g. disulfiram)
D. To focus on achieving and maintaining abstinence or reducing alcohol use
E. Explore unresolved psychodynamic conflicts.
Psychopharmacology
29. Which of the following medications is not associated with weight gain?
A. Clozapine
B. Mirtazapine
C. Olanzapine
D. Sodium valproate
E. Topiramate.
A. Agomelatine
B. Duloxetine
C. Fluoxetine
D. Imipramine
E. Mirtazapine
31. Which of the following medications is most likely to be associated with polycystic
ovarian syndrome in female patients?
A. Carbamazapine
B. Lamotrigine
C. Lithium
D. Sodium valproate
E. Topiramate.
A. It causes insomnia.
B. It has a half-life of approximately 12 hours.
C. It is safe for patients suffering from bulimia nervosa.
D. It is an antidepressant used for depressed patients with cardiovascular disease and
!
!
213
habit of smoking.
E. It does not cause weight gain.
33. Mirtazapine is associated with lesser sexual side effects. Which of the following
pharmacodynamics actions explains this phenomenon?
34. Which of the following side effects is least likely to occur in patients taking
quetiapine?
A. Antihistamine effects
B. Orthostatic hypotension
C. Increase in liver transaminase
D. Increase in prolactin
E. Weight gain.
35. Which of the following is the best treatment option for severe depressive episode
with psychotic features?
A. Amitriptyline
B. Cognitive behaviour therapy
C. Lamotrigine
D. Methylphenidate
E. Electroconvulsive therapy.
36. A 35-year-old man suffers from schizophrenia symptoms and his GP has started him
a medication to treat his symptoms. He develops jaundices after taking the
medication. Which of the following medications is most likely to cause jaundice?
A. Clozapine
B. Chlorpromazine
C. Haloperidol
D. Risperidone
E. Sulpiride.
37. A 60-year-old man suffers from depressive disorder and you have increased the
!
!
214
dose of antidepressant. He is seeing you today. His blood pressure is 180/90. Which
of the following medications should be stopped?
A. Diazepam
B. Quetiapine
C. Fluvoxamine
D. Hydroxyzine
E. Venlafaxine.
38. A 25-year-old woman with bipolar disorder is pregnant for the first time. Throughout
the pregnancy, she has been maintained on a mood stabilizer. At the time of birth,
the baby is noted to have Ebsteins anamoly. Which of the following medications is
most responsible for this teratogenic effect?
A. Carbamazepine
B. Lamotrigine
C. Lithium
D. Sodium valproate
E. Topiramate
Psychotherapy and defence mechanisms
39. A 28-year-old woman comes to consult you because she is very upset after being
scolded by her manager. The chief executive officer (CEO) of her company has
raised the standard for annual performance. Her manager is very upset this
arrangement and scolds her for no reason. Which of the following is the defence
mechanism exhibits by the manager?
A. Altruism
B. Denial
C. Displacement
D. Repression
E. Reaction formation.
40. You are a doctor working in polyclinic. A 25-year-old man bought his 55-year-old
mother to see you. He is concerned that his mother suffers from depression but she
refuses to take antidepressant. You realise that the mother and son are enmeshed
as the son is unmarried and not able to work. He claims that he needs to look after
his mother although she has good past health. The mother and son hold very
negative view against the father who is the sole breadwinner of family. There is a
psychologist working in your polyclinic. Which of the following forms of psychological
treatment is most appropriate?
A. Couple therapy
B. Dialectical behaviour therapy
C. Problem solving psychotherapy
D. Supportive psychotherapy
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!
215
E. Family therapy.
A. Affirmation
B. Clarification
C. Empathic validation
D. Observation
E. Interpretation.
42. A medical student used to be very keen to become an orthopaedic surgeon. He has
assisted an orthopaedic surgeon to conduct research since the second year of
medical school. During the residency application, he tells other classmates that he
does not bother whether he is accepted by the orthopaedic residency. He also
encourages other classmates not to apply for orthopaedic surgery as this specialty is
not a good career choice. On the other hand, he is secretly asking his orthopaedic
mentor to prepare him for the orthopaedic residency intake interview. What is his
defence mechanism?
A. Altruism
B. Denial
C. Displacement
D. Repression
E. Reaction formation.
43. Which of the following is the most effective approach for a 30-year-old woman with
obsession about contamination and washes her hands every time she touches
something which she considers dirty?
A. Having the patient place her hands in a container of worms to create extreme phobia
and ability to overcome obsession
B. Having the patient snap her wrist with a rubber band when she thinks about
contamination and about to wash her hands
C. Having the patient touch a dirty object, then not allowing her to wash her hands for
several hours
D. Highlighting to the patient that her obsession is a cognitive error.
E. Providing the patient with message cards to remind herself that the hand washing is
unnecessary.
44. A 30-year-old army officer presents for treatment of post-traumatic stress disorder
after surviving an accident which his tank fell into the river from a bridge. He was
!
!
216
driving a tank on a bridge when it suddenly collapsed. Several army officers were
seriously injured in this accident. As part of the treatment, the psychologist asks the
patient to imagine that he is safely driving his tank over a bridge. Which of the
following best describes this therapeutic intervention?
A. Aversion therapy
B. Cognitive therapy
C. Exposure therapy
D. Interpersonal therapy
E. Supportive therapy.
45. You are a paediatric resident. A 14-year-old girl has stayed in the paediatric ward for
1 week after a suicide attempt by drug overdose. She is due for discharge tomorrow.
At 6 pm, she suddenly claims that her elder sister had physically abused her prior to
admission. Her medical record reveals that she suffers from conduct disorder. She
also made similar reports of physical abuse in the past. The police officer and social
worker found her claims inconclusive and did not investigate further. She is
ambivalent to make a report about the alleged abuse and she is not keen for
discharge. You try to contact the consultant in charge of this case but the consultant
is not contactable. Which of the following is most appropriate action?
46. A 35-year-old man was hospitalised for treatment of severe depressive episode in
September. The inpatient team prescribed two antidepressants for the patient and
then referred the patient to polyclinic. The patient came to the polyclinic for review in
October and November respectively. The patient had a relapse of depression and
committed suicide in December. The computerised record shows that the polyclinic
doctors had forgotten to prescribe antidepressants since the first visit. Which of the
following best describes the above situation based on the Common Law?
A. Battery
B. Diminished responsibility
C. Intentional torts
D. Negligence
E. Tarasoffs rule
47. You are a resident in obstetrics. Which of the following is the safest medication to be
!
!
217
given to a pregnant woman who develops psychosis during pregnancy?
A. Aripiprazole
B. Haloperidol
C. Olanzapine
D. Quetiapine
E. Risperidone
48. A 25-year-old man expresses concerns that he got infected with HIV after visiting
commercial sex workers last week. According to him, he only received hand-genital
stimulation and there was no vaginal intercourse. He also mentions that the
commercial sex worker kissed his body. He has sought his girl-friends forgiveness.
Today, he requests HIV test urgently. He consulted you one year ago for similar
concern after he kissed another lady without informing his girl-friend. What is the
most likely explanation of his behaviour?
A. Underlying depression
B. Underlying guilt
C. Underlying obsession
D. Underlying psychosis
E. Underlying somatic concern
49. You are orthopaedic resident. A 25-year-old construction worker had a fall, fractured
his spine and injured the brain. He develops pain in multiple sites. He has one
episode of epilepsy after the injury. He is depressed but does not have suicidal
thought. Electrocardiogram is normal. Which of the following medication is most
helpful in this situation?
A. Amitriptyline
B. Bupropion
C. Chlorpromazine
D. Duloxetine
D. Moclobemide
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!
218
D. Epilepsy
E. Headache.
!
51. You are a resident doctor working at the Institute The answer is B.
of Mental Health (IMH). The police officers
bought a 39-year-old man charged with
possessing a scheduled weapon and was sent to
the IMH for a psychiatric evaluation. Although he Explanation: Loosening of
speaks English, you cannot make out what he is association is defined as a
saying because his speech becomes diffuse and speech where topics seem to be
unfocused. Which of the following best describes disconnected and it is hard for
his psychopathology?
others to establish a logical link
between topics. The speech
F. Circumstantiality
G. Loosening of association becomes diffuse and unfocused.
H. Thought insertion
I. Thought withdrawal
J. Tangentiality.
Year: 2014.
52. You are a resident working at the Accident and The answer is B
Emergency Department (AED). A 35-year-old
man was sent to the AED for psychiatric
assessment by an ambulance. He was involved
in a road traffic accident. He was a passenger in Explanation: This man suffers
a taxi. He told the taxi driver that he was God and from bipolar disorder, manic
threatened the driver to believe that he was the episode as evidence based by
saviour of the world. The driver found him very grandiose delusion, irritability,
irritable and he kept hitting the head of the driver.
reckless and dangerous
The driver stopped the taxi and tried to call the
police. The patient drove the taxi at high speed behaviour.
and crashed the taxi into a lamp post. He was not
under influence of alcohol at the time of accident.
You are required to enter a diagnosis into the
Year: 2015.
AED computerised system. Based on the
information provided, which of the following
psychiatric diagnosis is most relevant?
!
!
219
I. Dissociative disorder
J. Schizophrenia.
Cognitive assessment
Year: 2015.
70N7!=63!(1!point)!
63N7!=!50!(0!point)!
Total:!2!points!out!of!5!
Year:!2014.!
Psychiatric epidemiology
!
!
220
Explanation: Agoraphobia (40%)
F. Alcohol misuse > alcohol dependence (30%).
G. Agoraphobia
The other options are less likely
H. Avoidant personality disorder
I. Benzodiazapine misuse to be associated with panic
J. Generalised anxiety disorder. disorder.
Year: 2014.
The answer is C.
Year: 2014
!
!
221
factors.
Year: 2014
Year: 2014
F. Alpha1-adrenergic
G. Dopaminergic Year: 2014
H. Histaminergic
I. Muscurinic cholinergic
J. Nicotinic cholinergic.
General adult psychiatry
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222
F. Anhedonia functioning, family history of
G. Exhibition of first rank symptoms at the age of 16 schizophrenia, negative
H. Family history of depressive disorder symptoms, poor support,
I. Male gender
neurological symptoms and poor
J. Insidious onset.
compliance.
Year: 2014
61. You are the resident working in the Accident and The answer is B.
Emergency Department. A schizophrenia patient
informs you that he has homicidal thought. Which
of the following sign or symptom is least
important in predicting homicide? Explanation: Delusion of
reference is not directly related
F. Command hallucinations to violence and carries lower risk
G. Delusion of reference of homicide as compared to
H. History of previous violence
other signs and symptoms.
I. Irresistible urge to attack
J. Need to defend oneself as are result of
persecutory delusion.
Year: 2014
The answer is C.
Year: 2014
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wants him to be seen by a psychiatrist. He was
recently arrested for installing pinhole camera in
the hotel guestrooms. He secretly filmed couples Explanation: Voyeurism is
having sex in the hotel guestrooms. He has defined as recurrent and intense
filmed more than 100 videos and enjoyed sexual arousal from observing
watching them over and over again. He claims other people being naked or
that he has the compulsion to collect those
engaging sexual activity.
videos and he feels relieved after the arrest.
Which of the following is the most likely
diagnosis?
Year: 2014
F. Erotomania
G. Kleptomania
H. Obsessive compulsive disorder
I. Sadomasochism
J. Voyeurism.
Year: 2014
F. Acidosis
G. Diaphoresis Explanation: Serotonin syndrome
H. Hyperreflexia actually causes fever. Metabolic
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!
224
I. Hypothermia acidosis in seen in 9% of
J. Myoclonus. patients.
Year: 2014
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!
225
For metabolism, all psychotropic
medications metabolized in the
liver have their elimination half-
life increased two or three-fold in
the elderly.
Year: 2014
F. Melatonin
G. Mirtazapine
H. Risperidone Year: 2014
I. Rivastigmine
J. Sodium valproate.
The answer is D.
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226
69. A 70-year-old woman suffering from bipolar
disorder and her daughter came to see you
today. Her daughter read about the symptoms of Explanation: Elderly with bipolar
bipolar disorder and found her mother different disorder are more likely to be
from younger adults suffering from the same paranoid and present with mixed
condition. Which of the following clinical features clinical presentations. Elderly are
is more likely to be found in this 70-year-old
less likely to develop flight of
woman?
ideas, hyperactivity and
overspending.
F. Demonstrates less paranoid ideas as compared
to adult patients
G. Demonstrates more flight of ideas as compared
to adult patients Year: 2014
H. More likely to be hyperactive as compared to
adult patients
I. More likely to demonstrate mixed
(depressive/manic) clinical presentations as
compared to adult patients
J. More spending as compared to adult patients.
Year: 2014
71. You are the visiting physician of a nursing home. The answer is A.
The nursing home staffs feel very helpless when
handling aggression in dementia patients and
they need to seek your advice. Which of the
following psychotropic medication have the most Explanation: Antipsychotic drug
evidence in managing aggression in patients (e.g. risperidone) has the most
suffering from dementia? evidence in improving
aggression in dementia patients
F. Antipsychotic drug among all options.
G. Beta-blocker
H. Benzodiazapine
I. Lithium
J. Stimulant. Year: 2014
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!
227
Child and adolescent psychiatry
Year: 2014
!
!
228
process for a weight management program. The
adolescent agrees with the fact that she is
overweight and she is keen to lose weight. Explanation: The patient must
Which of the following is most indicative that she agree to use conservative
will be successful in the program? methods including changing diet
habits, seeing a dietician and
F. Her current BMI is between 26 and 30.
going for exercise to lose weight.
G. Mother suffered from obesity and successfully
lost weight
H. No family history of eating disorders
I. Motivation to take antidepressant Year: 2014
J. Willingness to change her eating habits.
Substance abuse
Year: 2014
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!
229
F. To conduct in a group therapy format Explanation: Achieving
G. To apply cognitive behaviour therapy (CBT) as abstinence or reduction of
the first approach alcohol use is most important
H. To combine psychological intervention and
psychotherapeutic objective.
pharmacotherapy (e.g. disulfiram)
I. To focus on achieving and maintaining
abstinence or reducing alcohol use
J. Explore unresolved psychodynamic conflicts. Year: 2014.
Psychopharmacology
Year: 2014
F. Agomelatine
G. Duloxetine
H. Fluoxetine
I. Imipramine
Year: 2014
J. Mirtazapine
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230
Year: 2014
Year: 2014
84. Which of the following side effects is least likely The answer is D.
to occur in patients taking quetiapine?
Year: 2014
!
!
231
G. Cognitive behaviour therapy depression as compared to other
H. Lamotrigine treatment options.
I. Methylphenidate
J. Electroconvulsive therapy.
Year: 2014
F. Carbamazepine
G. Lamotrigine Year: 2014
H. Lithium
I. Sodium valproate
J. Topiramate
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232
Psychotherapy and defence mechanisms
F. Couple therapy
G. Dialectical behaviour therapy
H. Problem solving psychotherapy
I. Supportive psychotherapy
J. Family therapy.
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!
233
uncaring and trying to find fault in him. The Affirmation refers to confirmation
psychologist says, I wonder if what youve of validity of previous judgement
feeling right now is just like the feeling you have or behaviour in a patient.
in camp, when you attributed the same uncaring
Empathetic validation refers to
attitude toward your father and supervisor in
camp. These repetitive patterns of the situation when the therapist
misunderstanding seem to make you very upset tries to put himself into the
in different situations and affect your life. Which patients shoes and tries to
of the following most accurately describes the understand patients inner state.
psychotherapeutic technique?
F. Affirmation
G. Clarification Year: 2014
H. Empathic validation
I. Observation
J. Interpretation.
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!
234
I. Highlighting to the patient that her obsession is a highlighting the obsessions.
cognitive error. Option B is thought stopped and
J. Providing the patient with message cards to is not as effective as ERP.
remind herself that the hand washing is
unnecessary.
Year: 2014
F. Aversion therapy
G. Cognitive therapy Year: 2014
H. Exposure therapy
I. Interpersonal therapy
J. Supportive therapy.
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!
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J. Discuss with the consultant-in-charge and the
social worker on the next day.
Year: 2014
Year: 2014
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!
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sought his girl-friends forgiveness. Today, he asking for urgent HIV test after
requests HIV test urgently. He consulted you one they engaged in activities which
year ago for similar concern after he kissed did not transmit HIV. The
another lady without informing his girl-friend.
patients request for such test as
What is the most likely explanation of his
behaviour? a result of guilt. It is unlikely to be
caused by obsession as the
patient requests for the HIV test
F. Underlying depression after sexual activity but not a
G. Underlying guilt thought. The patient does not
H. Underlying obsession have any somatic concern.
I. Underlying psychosis
J. Underlying somatic concern
Year: 2014
D. Duloxetine
Year: 2014
D. Moclobemide
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237
F. Anxiety
G. Binge eating
H. Cognitive impairment
I. Epilepsy
J. Headache.
!
SAQ 1
Question 1
A 50-year-old man is admitted to the ward. He complains that there are a lot of bugs on
his skin and he needs to wash hands excessively. His wife wants to consult you how to
differentiate an obsession from a delusion.
3. List TWO (2) features that differentiate an obsession from a delusion (4 marks).
Examiners use only: / 4 marks
4. List TWO (2) types of evidence-based and commonly used treatment for obsessive compulsive
disorder (2 marks).
Examiners use only: / 2 marks
1. List THREE (3) main clinical features which you would look for to support the diagnosis of
autistic disorder (3 marks)
Examiners use only: / 3 marks
2. List TWO other causes for his poor language skills besides autism (2 marks).
Examiners use only: / 2 marks
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!
238
3. Name THREE (3) investigations which you order to establish the underlying cause for language
delay. (3 marks)
4. Name TWO (2) non-pharmacological interventions which are useful for autism. (2 marks)
2. Name TWO (2) psychiatric disorder commonly associated with catatonia.(2 marks)
3. At NAME TWO (2) medical disorders that are known to be associated with catatonia. (2 marks)
4. List ONE (1) most important investigation which you would order to identify the underlying
neurological cause for catatonia.(1 mark)
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!
239
Question 1
A 50-year-old man is admitted to the ward. He complains that there are a lot of bugs on
his skin and he needs to wash hands excessively. His wife wants to consult you how to
differentiate an obsession from a delusion.
!
!
240
7. List TWO (2) features that differentiate an obsession from a delusion (4 marks).
Examiners use only: / 4 marks
Answer may vary. The examiner is advised to use his or her discretion to decide whether marks should be
awarded.
Differences between obsessions and delusions:
obsessions are ego-dystonic (disharmony with ones own ego) while delusions are ego-syntonic (in
harmony with ones own ego) 2 marks or
obsessions involve intact reality testing, whereas in delusions reality testing is impaired (2 marks)
or
obsessions cause anxiety and distress, whereas patients with delusion are usually calm (2marks)
or
obsessions involve compulsive actions to neutralize them, whereas delusions do not (2 marks)
obsessions are not held with absolute certainty whereas delusions are (2 marks).
This is an advanced level question.
8. List TWO (2) types of evidence-based and commonly used treatment for obsessive compulsive
disorder (2 marks).
Examiners use only: / 2 marks
Selective!serotonin!reuptake!inhibitors!!or!name!of!SSRI!e.g.!fluoxetine!(1!mark);!antidepressant!
(0.5!mark);!other!(0!mark)!
Cognitive!behaviour!therapy!(1!mark);!Exposure!and!response!prevention!(0.5!mark);!Other!(0!
mark)!
5. List THREE (3) main clinical features which you would look for to support the diagnosis of
autistic disorder (3 marks)
Examiners use only: / 3 marks
Answer may vary. The examiner is advised to use his or her discretion to decide whether marks should be
awarded.
1. Restricted interests or hobbies or repetitive behaiour.
2. Communication difficulties (both verbal language delay and non-vebal lack of eye contact, failure
to understand emotional cues)
3. Stereotyped movements or social interaction difficulty.
6. List TWO other causes for his poor language skills besides autism (2 marks).
Examiners use only: / 2 marks
Answer may vary. The examiner is advised to use his or her discretion to decide whether marks should be
awarded. Any two of the following:
1. Maltreatment or abuse
2. Mental retardation
!
!
241
3. Neurological injury
4. Hearing impairment
5. Specific language impairment (such as expressive language disorder)
6. Genetic disorders (Fragile X syndrome)
7. Name THREE (3) investigations which you order to establish the underlying cause for language
delay. (3 marks)
8. Name TWO (2) non-pharmacological interventions which are useful for autism. (2 marks)
!
!
242
8. Name TWO (2) psychiatric disorder commonly associated with catatonia.(2 marks)
Schizophrenia
Bipolar disorder
Depressive disorder
Substance abuse with acute intoxication of recreation drugs.
9. At NAME TWO (2) medical disorders that are known to be associated with catatonia. (2 marks)
10. List ONE (1) most important investigation which you would order to identify the underlying
neurological cause for catatonia.(1 mark)
Magnetic Resonance Imaging (MRI) brain scan (1 mark); Computerized Tomography (CT) brain scan
(1 mark); other answer (0 mark)
11. List ONE (1) pharmacological treatment for this patient. (1 mark)
12. Name ONE (1) non-pharmacological management order for this patient (1 mark)
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!
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!
SAQ (Paper 2)
Question 1
You are a General Practitioner. A 30-year-old woman comes to your clinic and she complains of low
mood. You suspect that she suffers from depressive disorder. She read a lot of information on the internet
and has her personal views on treatment. She would like to discuss with you on various treatment options.
1. List Four (4) pieces of information which you would inquire from the history to support the
decision for immediately prescribing an antidepressant to this patient (4 marks).
2. The patient would like to know more about psychotherapy. Name TWO (2) types of
psychotherapy with MOST evidence to demonstrate effectiveness for her condition (2 marks).
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!
244
1. Based on your answer in question 2, select ONE (1) type of psychotherapy and explain
how it works. (4 marks)
Question!2!
You are a general practitioner and looks after a 30-year-old woman who is 14-week pregnant.
She has been drinking alcohol and has poor compliance to antenatal follow-up. Besides alcohol,
she does not use other drug or substance. She feels that it is completely harmless to drink
alcohol during pregnancy. You need to offer psychoeducation to her.
1. What is the name of the syndrome which is of MOST concerned to her foetus? (2 mark)
2. List THREE (3) facial features associated with the syndrome described in Question 1. (3
marks)
3. If her baby is born with the syndrome described in question 1, list THREE (3)
psychiatric impairments which may occur during the childhood of her offspring (3
marks)
4. State TWO (2) specialities which you would refer this patient to consult for her current
problems. Please indicate the reasons for referral. (2 marks)
Question!3!
You!are!a!general!practitioner!(GP)!and!seeing!a!65TyearTold!man!who!complains!of!
memory!loss.!He!also!suffers!from!depression.!!His!daughter!has!read!information!from!
the!internet!that!he!is!at!risk!of!developing!Alzheimers!disease!due!to!his!age.!She!is!not!
certain!about!the!impact!of!depression!on!his!memory.!!
1.!Name!FOUR!(4)!differences!between!dementia!and!pseudodementia!(4!marks)!
!
!
245
! Dementia! Pseudodementia!
Aetiology!
1.! ! !
! !
! !
2.! ! !
! !
! !
3.! ! !
4.! ! !
!
3. You!have!assessed!the!patient!and!he!suffers!from!depression.!You!have!decided!
to!start!fluoxetine.!Name!ONE!(1)!common!electrolyte!abnormality!found!in!old!
people!taking!SSRI.!(2!marks)!
!
!
246
!
4. Four!months!later,!this!patient!has!tried!fluoxetine!and!it!does!not!work.!He!took!
benzodiazepine!from!another!GP!for!insomnia.!He!develops!suicidal!thought.!You!
have!referred!this!case!to!a!geriatric!psychiatrist.!The!geriatric!psychiatrist!
recommends!electroconvulsive!therapy!(ECT).!Based!on!the!clinical!information!
provided,!name!TWO!(2)!factors!which!may!increase!the!seizure!threshold!for!this!
patient!(2!marks)!during!the!ECT.!
!
1. His!daughter!is!concerned!about!memory!impairment!after!ECT.!State!TWO!(2)!
adjustments!which!can!apply!during!the!administration!of!ECT!to!reduce!the!risk!
of!cognitive!impairment.!
Question!4!
You are a specialist working in renal medicine. A 60-year-old woman suffers from chronic
renal failure and she requires life-long hemodialysis. She wants to discontinue dialysis. It is a
long weekend and the psychiatrist is not available in your hospital. You need to determine her
capacity to make a decision to discontinue dialysis.
1. List FOUR (4) questions which you would ask this patient to assess her capacity to
make a decision to discontinue dialysis (4 marks).
2. You are reviewing her past psychiatric record. State FOUR (4) psychiatric disorders
that may affect her capacity to give consent.(4 marks)
3. If this patient is free from psychiatric illness and has the capacity to make decision. You respect
her right to make a decision to discontinue dialysis. State the MOST RELEVANT ethical
principle which support your decision. (2 marks)
SAQ (Paper 2)
!
!
247
Question 1
You are a General Practitioner. A 30-year-old woman comes to your clinic and she complains of low
mood. You suspect that she suffers from depressive disorder. She read a lot of information on the internet
and has her personal views on treatment. She would like to discuss with you on various treatment options.
5. List Four (4) pieces of information which you would inquire from the history to support the
decision for immediately prescribing an antidepressant to this patient (4 marks).
Answer may vary. The examiner is advised to use his or her discretion to decide whether marks should be
awarded.
1. The severity of depression: her symptoms are severe (e.g. with the presence of suicidal thought and a
lot of biological symptoms).
2. Lack of precipitant in her depression: her depression seems to be endogeneous and it is not a reactive
depression.
3. Presence of family history of depression: suggest biological cause of depression.
4. Previous response to antidepressant or previous relapse after stopping antidepressant.
4. Based on your answer in question 2, select ONE (1) type of psychotherapy and explain
how it works. (4 marks)
Answer may vary. The examiner is advised to use his or her discretion to decide whether marks should be
awarded.
The frequency of Cognitive behaviour therapy (CBT) is usually weekly or fortnightly. It requires 12 to 16
sessions. The cognitive therapy involves identifying negative automatic thoughts and use dysfunctional thought
diary to identify pattern between the time, events, negative thoughts and resulted emotions and behaviours. The
psychologist will read the diary and help patients to question the negative automatic thoughts. Behaviour
therapy involves activity scheduling (for those depressed patients with psychomotor retardation), relaxation
techniques (for those patients with mixed anxiety and depression).
For students who chose to explain IPT:
Interpersonal therapy (IPT) is held weekly or fortnightly. It involves 12 to 20 sessions. IPT is indicated for
depressed patients whom precipitating factor is interpersonal problems. The psychologist closely examines
interpersonal relationship and relates depression to the interpersonal event. The therapist helps the patient to
work on one of the interpersonal problem areas: 1) grief; 2) interpersonal role dispute; 3) role transition; 4)
interpersonal deficits. IPT helps the patient to develop new skills to deal with people and life situations
associated with depressive symptpms. IPT works with the patient to look at interpersonal relationship from
another angle to minimise impact on the mood. The therapist also uses role-play to improve communication
skills.
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!
248
Question!2!
You are a general practitioner and looks after a 30-year-old woman who is 14-week pregnant.
She has been drinking alcohol and has poor compliance to antenatal follow-up. Besides alcohol,
she does not use other drug or substance. She feels that it is completely harmless to drink
alcohol during pregnancy. You need to offer psychoeducation to her.
5. What is the name of the syndrome which is of MOST concerned to her foetus? (2 mark)
6. List THREE (3) facial features associated with the syndrome described in Question 1. (3
marks)
Answer may vary. The examiner is advised to use his or her discretion to decide whether marks should be
awarded.
Any three of the following:
Small head
Small eyes
Short nose
Ear lobe abnormality
Short palpebral fissures (measured from inner to outer canthus; reflect underlying brain growth)
Thin upper lip
Long and flat philtrum
7. If her baby is born with the syndrome described in question 1, list THREE (3)
psychiatric impairments which may occur during the childhood of her offspring (3
marks)
Answer may vary. The examiner is advised to use his or her discretion to decide whether marks should be
awarded.
Any three of the following:
intellectual impairment
attention deficit or hyperactivity
difficulty with reasoning
depression
anxiety
oppositional defiant or conduct disorder
8. State TWO (2) specialities which you would refer this patient to consult for her current
problems. Please indicate the reasons for referral. (2 marks)
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!
249
Specialities Reasons for referral
Obstetrics and gynaecology (0.5 mark) Frequent ultrasound monitoring for foetal
abnormalities (0.5 mark)
Psychiatrist or addiction specialist (0.5 mark) For detoxification and treatment of alcohol
dependence (0.5 mark)
For the reasons of referral, the answer may vary. The examiner is advised to use his or her discretion to decide
whether marks should be awarded.
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!
250
!
Question!3!
You!are!a!general!practitioner!(GP)!and!seeing!a!65TyearTold!man!who!complains!of!
memory!loss.!He!also!suffers!from!depression.!!His!daughter!has!read!information!from!
the!internet!that!he!is!at!risk!of!developing!Alzheimers!disease!due!to!his!age.!She!is!not!
certain!about!the!impact!of!depression!on!his!memory.!!
1.!Name!FOUR!(4)!differences!between!dementia!and!pseudodementia!(4!marks)!
! Dementia! Pseudodementia!
Aetiology!
1.! ! !
! !
! !
2.! ! !
! !
! !
3.! ! !
!
!
251
!
4.! ! !
Answer may vary. The examiner is advised to use his or her discretion to decide whether marks should be
awarded.
!
Dementia Pseudo-dementia
Extent of memory Recent memory loss more severe. Equal loss of recent and remote events.
loss (1 mark) (1 mark)
Insight/ performance Deny memory loss or confabulate Focus on cognitive loss(1 mark) or
during Mini Mental to fill up memory gap
State Examination Dont know answer (1 mark)
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!
252
Minimize disability (1 mark)
Variation within a Sun-downer effect (worse in the Diurnal variation (worse in the
day evening) (1 mark) morning) (1 mark)
!
7. You!have!assessed!the!patient!and!he!suffers!from!depression.!You!have!decided!
to!start!fluoxetine.!Name!ONE!(1)!common!electrolyte!abnormality!found!in!old!
people!taking!SSRI.!(2!marks)!
Hyponatremia.!
8. Four!months!later,!this!patient!has!tried!fluoxetine!and!it!does!not!work.!He!took!
benzodiazepine!from!another!GP!for!insomnia.!He!develops!suicidal!thought.!You!
have!referred!this!case!to!a!geriatric!psychiatrist.!The!geriatric!psychiatrist!
recommends!electroconvulsive!therapy!(ECT).!Based!on!the!clinical!information!
provided,!name!TWO!(2)!factors!which!may!increase!the!seizure!threshold!for!this!
patient!(2!marks)!during!the!ECT.!
Any!2!of!the!following:!
2. Old!age!
3. Male!gender!
4. Baldness!
5. Usage!of!benzodiazepine.!
This!is!an!advancedNlevel!question.!
6. His!daughter!is!concerned!about!memory!impairment!after!ECT.!State!TWO!(2)!
adjustments!which!can!apply!during!the!administration!of!ECT!to!reduce!the!risk!
of!cognitive!impairment.!
Any!2!of!the!following:!
1. Unilateral!ECT!
2. Use!lower!energy!level!
3. Reduce!frequency!of!ECT!(two!times!per!week!instead!of!three!times!per!week)!
This!is!an!advancedNlevel!question.!
!
!
253
!
Question!4!
You are a specialist working in renal medicine. A 60-year-old woman suffers from chronic
renal failure and she requires life-long hemodialysis. She wants to discontinue dialysis. It is a
long weekend and the psychiatrist is not available in your hospital. You need to determine her
capacity to make a decision to discontinue dialysis.
4. List FOUR (4) questions which you would ask this patient to assess her capacity to
make a decision to discontinue dialysis (4 marks).
Answer may vary. The examiner is advised to use his or her discretion to decide whether marks should be
awarded. Any three of the following:
1) What is the nature of your medical condition? / What has the treatment team told you about your condition?/
What do you believe is wrong with your health?
2) What is the purpose of the dialysis? / What have you been told about the recommended treatment?
3) Can you tell me the benefits of dialysis? / What have you been told about benefits of dialysis?/ What is the
treatment likely to do for you?
4) Can you tell me the risks/side effects of dialysis? / What have you been told about the risks or discomforts
associated with dialysis?
6) Are there alternative to dialysis? / What have you been told about alternatives to dialysis?
7) Why do you want to discontinue dialysis? / What have you been told about risks and benefits of no
treatment?/ How did you decide to discontinue dialysis?
5. You are reviewing her past psychiatric record. State FOUR (4) psychiatric disorders
that may affect her capacity to give consent.(4 marks)
Answer may vary. The examiner is advised to use his or her discretion to decide whether marks should be
awarded.
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!
254
8. Mental retardation
6. If this patient is free from psychiatric illness and has the capacity to make decision. You respect
her right to make a decision to discontinue dialysis. State the MOST RELEVANT ethical
principle which support your decision. (2 marks)
SAQ!(Paper!3)!!
Question!1!(Total!=!10!marks)!
You are a general practitioner (GP). You are asked to see a 36-year-old woman for the treatment of major depression.
A trial of fluoxetine 40mg every morning by another GP was unsuccessful.
She was very upset with the remarks made by her colleagues. As a result, she quitted her job 6 months ago and
became a housewife. She feels bored as a housewife and has conflicts with her in-laws. She has become more
depressed in the past 6 months. Her husband is supportive and there is no marital conflict. She has a 10-year-old son
and he has good relationship with her. She does not need to worry about his studies as he has done well in school.
She has other chronic medical illnesses and she takes other medications. She forgot to bring the medication and
cannot remember the name of those medications.
1. State THREE (2) MOST RELEVANT points of the history that you would like to clarify regarding previous trial
of fluoxetine? (2 marks) / 2 marks
2. State TWO (2) medications which are used to treat chronic medical illnesses and known to be associated
with depression? (2 marks) / 2 marks
3. Based on the patients background, state THREE (3) common medical conditions from different body
systems that is known to be associated with depression. (3 marks) / 3 marks
4. Based on the patients history, state ONE (1) MOST appropriate and evidence-based psychotherapy that is
suitable for this patient. (1 mark) / 1 mark
5. Based on the patients history, state how the psychotherapy recommended by you (in Question 4) works for
her. (2 marks) /2 marks
Question!2!(Total!=!10!marks)!
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!
255
You are a general practitioner. A 25-year-old man suffering from schizoaffective disorder is bought to the clinic by her mother. He
was diagnosed to suffer from schizoaffective disorder 6 months ago. Her mother is concerned about his recent weight gain of 10 kg
in 3 months. According to her mother, his psychiatrist from a restructured hospital started a new antipsychotic and mood stabilizer
to control his psychiatric symptoms.
1. State TWO (2) antipsychotics which are MOST likely to cause weight gain in this patient. (2 marks) /2 marks
2. State TWO (2) mood stabilizers which are MOST likely to cause weight gain in this patient. (2 marks) /2 marks
3. State THREE (3) MOST relevant blood tests which you would like to order and abnormalities you would like to rule out for
this patient. (3 marks) / 3 marks
Investigations Abnormalities
4. State ONE (1) MOST RELEVANT AND SPECIFIC symptom in schizophrenia which may contribute to obesity (2 marks). !
5. State ONE (1) antipsychotic that has the LOWEST RISK to cause weight gain. (1 mark)
Question 3
You are a paediatric resident working in the Child and Accident Emergency Department. You
are seeing an 11-year-old boy who was brought in by his foster parents. According to his
foster parents, he has a lot of behavioural problems at home and school. He cannot sit still to
do his homework at home. He also breaks school rules. Tonight, he had a fight with his foster
parents. This boy is a victim of child abuse.
1. State TWO (2) MOST RELEVANT diagnoses (2 marks) that this boy may suffer from and
indicate THREE (3) additional clinical features (6 marks) which you will look for to
support your diagnosis. (total 8 marks)
1. 1.
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256
2.
3.
/1 mark /3 marks
2. 1.
2.
3.
/1 mark / 3 marks
2. If you have a chance to speak to the child protection officer, state TWO (2) MOST
relevant psychiatric disorders that his parents may suffer from. (2 marks)
/ 2 marks
Question!4!
You!are!a!geriatric!resident.!A!70NyearNold!man!presents!with!dementia.!His!son!wants!to!find!
out!more!about!the!treatment!for!dementia.!
1. State the name of TWO (2) acetylcholinesterase inhibitors available in Singapore. (2 marks)!
/ 2 marks
!
!
257
2. List TWO (2) types of dementia for which acetylcholinesterase inhibitors are indicated (2
marks) / 2 marks
5. His son wants to know potential benefits that can be expected from treatment with
acetylcholinesterase inhibitors. List TWO (2) potential benefits (2 marks).
/ 2 marks
SAQ!(Paper!3)!!
Question!1!(Total!=!10!marks)!
You are a general practitioner (GP). You are asked to see a 36-year-old woman for the treatment of major depression.
A trial of fluoxetine 40mg every morning by another GP was unsuccessful.
She was very upset with the remarks made by her colleagues. As a result, she quitted her job 6 months ago and
became a housewife. She feels bored as a housewife and has conflicts with her in-laws. She has become more
depressed in the past 6 months. Her husband is supportive and there is no marital conflict. She has a 10-year-old son
and he has good relationship with her. She does not need to worry about his studies as he has done well in school.
She has other chronic medical illnesses and she takes other medications. She forgot to bring the medication and
cannot remember the name of those medications.
6. State THREE (2) MOST RELEVANT points of the history that you would like to clarify regarding previous trial
of fluoxetine? (2 marks) / 2 marks
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7. State TWO (2) medications which are used to treat chronic medical illnesses and known to be associated
with depression? (2 marks) / 2 marks
1) Corticosteroids!/!steroids/!prednisolone!(1!mark)!or!!
2) BetaNblockers!/!atenolol!/!propranolol!(1!mark)!or!!
3) Clonidine!(1!mark)!or!!
4) Metoclopramide!(1!mark)!or!!
5) Theophylline!(1!mark)!or!!
6) Calicium!channel!blockers:!Nifedipine!(1!mark).!
8. Based on the patients background, state THREE (3) common medical conditions from different body
systems that is known to be associated with depression. (3 marks) / 3 marks
Answers may vary. Examiners are advised to use his or her own discretion to decide whether marks should be
awarded. Any three of the following:
1) Cardiovascular disorders: hypertension (1 mark)
2) Endocrine disorders: diabetes, hypothyroidism or Cushing syndrome or Addisons disease (1 mark)
3) Neurological disorders: epilepsy (1 mark)
4) Gastrointestinal system: peptic ulcer or irritable bowel syndrome or inflammatory bowel diseases (1 mark)
5) Immune system: systemic lupus erythematosus (1 mark)
Medical disorders which are more common in older adults or elderly e.g. Parkinsons disease, cerebrovascular accidents,
chronic obstructive pulmonary disease = 0 mark. Myocardial infarction = 0 mark as ECG is normal. If all answers are from one
single system = 1 mark.
9. Based on the patients history, state ONE (1) MOST appropriate and evidence-based psychotherapy that is
suitable for this patient. (1 mark) / 1 mark
Interpersonal psychotherapy
10. Based on the patients history, state how the psychotherapy recommended by you (in Question 4) works for
her. (2 marks) /2 marks
Answers may vary. Examiners are advised to use his or her own discretion to decide whether marks should be
awarded. For students who did not state interpersonal psychotherapy in Q.4, they should only get a maximum of 1
mark for question 5.
Intepersonal psychotherapy can help the patient to analyze previous interpersonal problems in her work place.
Interpersonal psychotherapy involves role play and patient can improve her communication with her in-laws. The role
play can identify previous maladaptive communication patterns. Interpersonal psychotherapy can help her to deal
with the role transition from an administrative person to become a housewife.
Question!2!(Total!=!10!marks)!
You are a general practitioner. A 25-year-old man suffering from schizoaffective disorder is bought to the clinic by her mother. He
was diagnosed to suffer from schizoaffective disorder 6 months ago. Her mother is concerned about his recent weight gain of 10 kg
in 3 months. According to her mother, his psychiatrist from a restructured hospital started a new antipsychotic and mood stabilizer
to control his psychiatric symptoms.
6. State TWO (2) antipsychotics which are MOST likely to cause weight gain in this patient. (2 marks) /2 marks
7. State TWO (2) mood stabilizers which are MOST likely to cause weight gain in this patient. (2 marks) /2 marks
!
!
259
Sodium valproate (1 mark) or
Lamotrigine (1 mark) or
Other mood stabilizers: no mark
8. State THREE (3) MOST relevant blood tests which you would like to order and abnormalities you would like to rule out for
this patient. (3 marks) / 3 marks
Investigations Abnormalities
Investigations Abnormalities
Fasting glucose (0.5 mark) Rule out diabetes (0.5 mark)
Liver function tests (0.5 mark) Rule out raised AST and ALT / fatty liver / liver impairment
(0.5 mark)
Thyroid function test Rule out hypothyroidism and associated weight gain
9. State ONE (1) MOST RELEVANT AND SPECIFIC symptom in schizophrenia which may contribute to obesity (2 marks). !
1. Avolition or ahehdonia or lack of interest to do exercise (2 marks)
2. Negative symptom (1 mark)
3. Other negative symptom e.g. apathy, alogia, attentional deficit (0 mark)
10. State ONE (1) antipsychotic that has the LOWEST RISK to cause weight gain. (1 mark)
Aripiprazole/ haloperidol (1 mark). Other antipsychotic = 0 mark
!
!
260
Question 3
You are a paediatric resident working in the Child and Accident Emergency Department. You
are seeing an 11-year-old boy who was brought in by his foster parents. According to his
foster parents, he has a lot of behavioural problems at home and school. He cannot sit still to
do his homework at home. He also breaks school rules. Tonight, he had a fight with his foster
parents. This boy is a victim of child abuse.
3. State TWO (2) MOST RELEVANT diagnoses (2 marks) that this boy may suffer from and
indicate THREE (3) additional clinical features (6 marks) which you will look for to
support your diagnosis. (total 8 marks)
1. 1.
2.
3.
/1 mark /3 marks
2. 1.
2.
3.
/1 mark / 3 marks
!
!
261
Diagnosis 3 additional clinical features per diagnosis
/ 3 marks
!
!
262
4. If you have a chance to speak to the child protection officer, state TWO (2) MOST
relevant psychiatric disorders that his parents may suffer from. (2 marks)
/ 2 marks
Adult ADHD = 0 mark (It is unlikely MFS needs to foster out the child if parent has adult ADHD).
Question!4!
You!are!a!geriatric!resident.!A!70NyearNold!man!presents!with!dementia.!His!son!wants!to!find!
out!more!about!the!treatment!for!dementia.!
6. State the name of TWO (2) acetylcholinesterase inhibitors available in Singapore. (2 marks)!
/ 2 marks
Any two of the following:
Donepezil (1 mark) or
Rivastigmine (1 mark) or
Galantamine (1 mark).!
7. List TWO (2) types of dementia for which acetylcholinesterase inhibitors are indicated (2
marks) / 2 marks
!
!
263
Any!two!of!the!following:!
Diarrhoea!(excessive!cholinergic!effects)!1!mark!or!!
Difficulty!in!sleeping!(excessive!cholinergic!effects)!1!mark!or!!
Dizziness!1!mark!or!
Feeling!agitated!1!mark!or!
Headache!1!mark!or!
Loss!of!appetite!1!mark!or!
Muscle!cramps!(excessive!cholinergic!effects)!1!mark!or!
Tiredness!1!mark.!
Uncommon!side!effects!like!gastrointestinal!bleeding!or!bradycardia!(0!mark)!
10. His son wants to know potential benefits that can be expected from treatment with
acetylcholinesterase inhibitors. List TWO (2) potential benefits (2 marks).
/ 2 marks
Answers may vary. Examiners are requested to use his or her own discretion to decide whether
marks should be awarded.
!
!
264
SAQ (Paper 4)
Question 1
You are the resident working in the Accident and Emergency Medicine Department. A 50-year-
old man is admitted as a result of paracetamol overdose. He was treated in the Institute of
Mental Health for alcohol dependence 7 years ago.
1. State Four (4) clinical features which you would elicit in this man during history taking
to establish the diagnosis of alcohol dependence. (4 marks) Examiner: /4 marks
2. State TWO (2) medical or surgical disorders from two different body systems which will
result from prolonged alcohol usage. (2 marks) Examiner: /2 marks
/1 mark
3. State TWO (2) physical signs which you will elicit from two different body systems to
support the diagnosis of alcohol dependence. (2 marks) Examiner: /2 marks
/1 mark
!
!
265
Question 3
1. From her history, list FOUR (4) specific risk factors for postpartum depression. (4 marks)
Examiner: /4 marks
2. State TWO (2) MOST important psychotic features which you would elicit as part of the risk
assessment (2 marks) Examiner: /2 marks
1. She has an appointment to see a psychiatrist in one month. She cannot wait and wants to
seek your opinion. She is very keen to continue breastfeeding. If she wants to take an
antidepressant such as a selective serotonin reuptake inhibitor (SSRI) and continues
breastfeeding, state TWO (2) advices to minimize SSRI exposure to the infant. (2 marks)
Examiner: / 2 marks
4. If the patient does not want to take antidepressant, please recommend TWO (2) alternative
treatment options. (2 marks) Examiner: / 2 marks
Question 4
You are a general practitioner. A mother brings her 13-year-old girl to see you. She complains
of low mood, poor sleep, poor appetite and recurrent self-harm. She often cuts her wrist with a
pen knife. She has difficulty to cope with her study in Secondary 1. She often brings a pen
knife to school and cuts herself in the toilet. Her mother breaks into tear in the middle of the
interview because her husband is dependent on alcohol and has history of violence. The
patient is very close to her mother. As a result, the patient and her mother have no
communication with her father.
Question 1: Her mother worries about her personality development. State ONE (1) personality
disorder which she will MOST likely develop if the above pattern continues without any
intervention? (2 marks) Examiner: / 2 marks
Question 2: Based on your answer in Question 1, state TWO (2) MOST relevant comorbid
psychiatric disorders. (2 marks) Examiner: / 2 marks
!
!
266
Question 3 Her mother hopes that you can prescribe a psychotropic medication to
stabilize her. State ONE (1) psychotropic medication which is most suitable to her. (2 marks)
Examiner: / 2 marks
/1 mark /1 mark
Question 4 Besides cognitive behaviour therapy, state TWO (2) MOST relevant
psychotherapy which will benefit this patient. (2 marks)
Examiner: /2 marks
Question 5 Her mother is concerned about her safety in the next few weeks while waiting for
the effect of the medication. List TWO (2) MOST relevant strategies to manage safety issues in
this patient. (2 marks) Examiner: /2 marks
!
!
267
SAQ (Paper 4)
Question 1
You are the resident working in the Accident and Emergency Medicine Department. A 50-year-
old man is admitted as a result of paracetamol overdose. He was treated in the Institute of
Mental Health for alcohol dependence 7 years ago.
5. State Four (4) clinical features which you would elicit in this man during history taking
to establish the diagnosis of alcohol dependence. (4 marks) Examiner: /4 marks
6. State TWO (2) medical or surgical disorders from two different body systems which will
result from prolonged alcohol usage. (2 marks) Examiner: /2 marks
/1 mark
Any 2 of the following (The list is not completed and examiner will use his or her discretion to decide
whether marks should be awarded).
CNS complications: withdrawal fits/epilepsy, head injury as a result of fall, cerebellar damage
Gastrointestinal system: cancer in the oral cavity (e.g. tongue, throat), oesophagitis, gastritis,
gastric cancer.
Hepatobiliary system: pancreatic cancer, liver cirrhosis, alcohol hepatitis.
Peripheral nervous system: peripheral neuropathy
Rheumatology: gouty arthritis
Reproductive system: erectile dysfunction.
!
!
268
7. State TWO (2) physical signs which you will elicit from two different body systems to
support the diagnosis of alcohol dependence. (2 marks) Examiner: /2 marks
/1 mark
Any 2 of the following (The list is not completed and examiner will use his or her discretion to decide
whether marks should be awarded).
This patient suffers from alcohol hepatitis due to AST: ALT ratio > 2.
!
!
269
Question 3
3. From her history, list FOUR (4) specific risk factors for postpartum depression. (4 marks)
Examiner: /4 marks
4. State TWO (2) MOST important psychotic features which you would elicit as part of the risk
assessment (2 marks) Examiner: /2 marks
Answer may vary. Examiner will use his or her discretion to decide whether marks should be
awarded.
2. Command hallucination which asks her to harm herself and her infant.
3. Delusion which suggests that the infant is malformed/abnormal or possessed by demons and
she need to attack the infant.
Other mood congruent delusions e.g. delusion of guilt or nihilistic delusion 0.5 marks
4. She has an appointment to see a psychiatrist in one month. She cannot wait and wants to
seek your opinion. She is very keen to continue breastfeeding. If she wants to take an
antidepressant such as a selective serotonin reuptake inhibitor (SSRI) and continues
!
!
270
breastfeeding, state TWO (2) advices to minimize SSRI exposure to the infant. (2 marks)
Examiner: / 2 marks
Answer may vary. Examiner will use his or her discretion to decide whether marks should be
awarded. Any two of the following:
Other answers:
4. If the patient does not want to take antidepressant, please recommend TWO (2) alternative
treatment options. (2 marks) Examiner: / 2 marks
Question 4
You are a general practitioner. A mother brings her 13-year-old girl to see you. She complains
of low mood, poor sleep, poor appetite and recurrent self-harm. She often cuts her wrist with a
pen knife. She has difficulty to cope with her study in Secondary 1. She often brings a pen
knife to school and cuts herself in the toilet. Her mother breaks into tear in the middle of the
interview because her husband is dependent on alcohol and has history of violence. The
patient is very close to her mother. As a result, the patient and her mother have no
communication with her father.
Question 1: Her mother worries about her personality development. State ONE (1) personality
disorder which she will MOST likely develop if the above pattern continues without any
intervention? (2 marks) Examiner: / 2 marks
Question 2: Based on your answer in Question 1, state TWO (2) MOST relevant comorbid
psychiatric disorders. (2 marks) Examiner: / 2 marks
!
!
271
4. Substance abuse or dependence
Question 3 Her mother hopes that you can prescribe a psychotropic medication to
stabilize her. State ONE (1) psychotropic medication which is most suitable to her. (2 marks)
Examiner: / 2 marks
/1 mark /1 mark
/1 mark /1 mark
Question 4 Besides cognitive behaviour therapy, state TWO (2) MOST relevant
psychotherapy which will benefit this patient. (2 marks)
Examiner: /2 marks
Question 5 Her mother is concerned about her safety in the next few weeks while waiting for
the effect of the medication. List TWO (2) MOST relevant strategies to manage safety issues in
this patient. (2 marks) Examiner: /2 marks
Examiner has to use his or her own discretion to decide whether marks should be awarded. Any two
of the following:
1. Discuss need for her mother and teacher to monitor for changes in behaviour or self-harm at
home and in school.
2. Remove sharp objects, weapons or pen knives or unnecessary medications from home and
school.
3. Provide information and access to crisis services in the emergency department.
4. Her mother needs to supervise and administer antidepressant to patient.
5. Frequent and regular review by doctors to monitor response and side effects
!
!
272
!
2. List TWO (2) medications from different classes that can treat her symptoms? (4
marks)
!
!
273
( /1 mark) ( /1 mark)
( /1 mark) ( /1 mark)
3. She wants to receive psychotherapy. Please state the most evidence based
psychotherapy based on your diagnosis. (1 mark)
4. She wants to know more how psychotherapy works. Based on your answer in
Question 3 and her clinical history, list TWO (2) specific strategies which can
help her. (4 marks)
!
A 40-year-old woman with a bipolar disorder was stable on sodium valproate till a
year ago when she suffered three episodes of relapses. Her psychiatrist recommends
switching to lithium. She uses recreational drugs, sometimes forgets to take her
medication when she is clubbing till 5 am and has had unprotected sex many times in
the past three months. A friend asks her to borrow $10,000 to invest in a food and
beverage business.
Question 1 She wants to know the systemic side effects of lithium when the dose is within
therapeutic range. State FOUR (4) body systems affected by lithium and Name ONE (1) specific
side effect of lithium under each system. (4 marks)
!
!
274
( /0.5 mark) ( /0.5 mark)
Question 2 Based on her history and the possibility of starting lithium, List THREE (3) most
relevant laboratory investigations (3 marks)
( / 3 marks)
Question 3 Based on her current lifestyle, offer THREE (3) MOST relevant advices. (3
marks)
Question 3
!
!
275
Question 1 During your assessment, state FOUR (4) most relevant risk factors
suggesting high suicide risk which you would explore.
( / 4 marks)
Question 2 During your assessment, state TWO (2) most relevant protective factors
against suicide which you would explore.
( / 2 marks)
Question 3 State FOUR (4) most appropriate management orders for this patient in
the Accident and Emergency Department.
( / 4 marks)
A 70-year-old man was bought in by his family because he claims he has been seeing
ghosts for the past few months and is now hearing voices asking him to jump from his
9th floor flat. He has hypertension which is well-controlled and has been in good health.
Question 1 During the assessment, state THREE (3) risk factors for late onset
psychosis. (3 marks)
Question 2 State TWO (2) differences between psychotic features found in an old
!
!
276
person and psychotic features found in a young person suffering from schizophrenia (
/ 2 marks)
Question 3 Based on his history, state THREE (3) most likely psychiatric diagnoses
(3 marks)
Question 4 The family informs you that a family doctor started risperidone and he
developed severe rigidity and tremor. State ONE (1) antipsychotic drug which is MOST
suitable for him. (2 marks)
!
!
!
277
5. What is the most likely diagnosis? (1 mark)
6. List TWO (2) medications from different classes that can treat her symptoms? (4
marks)
( /1 mark) ( /1 mark)
( /1 mark) ( /1 mark)
7. She wants to receive psychotherapy. Please state the most evidence based
psychotherapy based on your diagnosis. (1 mark)
!
!
278
8. She wants to know more how psychotherapy works. Based on your answer in
Question 3 and her clinical history, list TWO (2) specific strategies which can
help her. (4 marks)
!
Other logical answers are acceptable. Examiner is advised to use his or her discretion to
decide whether marks should be awarded.
( / 4 marks)
!
!
!
279
A 40-year-old woman with a bipolar disorder was stable on sodium valproate till a
year ago when she suffered three episodes of relapses. Her psychiatrist recommends
switching to lithium. She uses recreational drugs, sometimes forgets to take her
medication when she is clubbing till 5 am and has had unprotected sex many times in
the past three months. A friend asks her to borrow $10,000 to invest in a food and
beverage business.
Question 1 She wants to know the systemic side effects of lithium when the dose is within
therapeutic range. State FOUR (4) body systems affected by lithium and Name ONE (1) specific
side effect of lithium under each system. (4 marks)
Other logical answers are acceptable. Examiner is advised to use his or her discretion to
decide whether marks should be awarded. Signs of lithium toxicity e.g. ataxia, coarse tremor,
cardiac arrest, respiratory difficulty does not count.
!
!
280
Endocrine system Hypothyroidism
Polyuria
( /0.5 mark)
( /1 mark)
Question 2 Based on her history and the possibility of starting lithium, List THREE (3) most
relevant laboratory investigations (3 marks)
!
!
281
( / 3 marks)
Question 3 Based on her current lifestyle, offer THREE (3) MOST relevant advices. (3
marks)
( / 3 marks)
Question 3
!
!
282
Question 1 During your assessment, state FOUR (4) most relevant risk factors
suggesting high suicide risk which you would explore.
Other logical answers are acceptable. Examiner is advised to use his or her discretion to
decide whether marks should be awarded.
1. Poor relationship with parents and family members (1 mark) or
2. Previous suicidal ideation or attempts (1 mark) or
3. Belief about lethality of paracetamol overdose (1 mark) or
4. Circumstances of suicide (e.g. suicide notes, isolation, avoidance of discover) (1 mark) or
5. Current plans for further suicidality (1 mark) or
6. Strong preoccupation with the relationship/ suicide as a mean to salvage the relationship
(1 mark) or
7. Presence or absence of alcohol intoxication (1 mark) or
8. Family history of psychiatric illness (1 mark) or
9. Current or past history of major depression or other psychiatric illness/or chronic medical
illness (1 mark).
( / 4 marks)
Question 2 During your assessment, state TWO (2) most relevant protective factors
against suicide which you would explore.
Other logical answers are acceptable. Examiner is advised to use his or her discretion to
decide whether marks should be awarded.
1. Religion (1 mark) or
2. Seeing a counsellor or psychologist (1 mark) or
3. Regret over suicide attempt (1 mark) or
4. Positive plan in the near future (e.g. return to study) (1 mark).
( / 2 marks)
Question 3 State FOUR (4) most appropriate management orders for this patient in
the Accident and Emergency Department.
Other logical answers are acceptable. Examiner is advised to use his or her discretion to
decide whether marks should be awarded.
1. Order investigations including Full blood count, liver function tests, renal function
tests, paracetamol levels, urine drug screen, electrocardiogram etc (1 mark) or
2. Activate charcoal to reduce absorption (1 mark) or
3. Suicide precaution (1 mark) or
4. Start N-acetylcystine (NAC) (1 mark) or
5. Inform family about her suicide attempt or to obtain collateral information (1 mark) or
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!
283
6. Inform on-call psychiatrist for assessment (1 mark) or
7. Admit to the medical ward for further management (1 mark).
( / 4 marks)
!
!
284
Question 4 (10 marks)
A 70-year-old man was bought in by his family because he claims he has been seeing
ghosts for the past few months and is now hearing voices asking him to jump from his
9th floor flat. He has hypertension which is well-controlled and has been in good health.
Question 1 During the assessment, state THREE (3) risk factors for late onset
psychosis. (3 marks)
Other logical answers are acceptable. Examiner is advised to use his or her discretion to
decide whether marks should be awarded.
1. Sensory impairment (e.g. deafness) (1 mark) or
2. Social isolation (1 mark) or
3. Paranoid or schizoid or schizotypal personality trait (1 mark) or
4. Past psychiatric illness (e.g. history of schizophrenia/ severe depression/ bipolar
disorder) (1 mark) or
5. Past medical illness or underlying medical illness (e.g. stroke, head injury, brain
tumour) or medication which causes psychosis steroid induced psychosis/
Parkinsons disease (1 mark)
( / 3 marks)
Question 2 State TWO (2) differences between psychotic features found in an old
person and psychotic features found in a young person suffering from schizophrenia (
/ 2 marks)
Other logical answers are acceptable. Examiner is advised to use his or her discretion to
decide whether marks should be awarded.
1. Elderly exhibits less first rank symptoms / the content of psychotic symptoms (e.g.
auditory hallucination) is often less elaborated in elderly (1 mark) or
2. Elderly exhibits less negative symptoms as compared to young people suffering from
chronic schizophrenia (1 mark) or
3. Elderly are more likely to exhibit more paranoid ideas or delusions compared to
young people (1 mark).
Question 3 Based on his history, state THREE (3) most likely psychiatric diagnoses
(3 marks)
!
!
285
3. Late onset bipolar disorder / bipolar disorder with psychotic features (1 mark) or
4. Dementia with psychotic features (1 mark) or
5. Delirium or acute confusional state (1 mark)
Question 4 The family informs you that a family doctor started risperidone and he
developed severe rigidity and tremor. State ONE (1) antipsychotic drug which is MOST
suitable for him. (2 marks)
( / 2 marks)
!
SAQ!!2014!Rotation!2!
Question 1
You are a general practitioner. Depression is a common mental health problem. You are about
to start a patient on an antidepressant.
1. List FOUR (4) factors related to the patients which you would consider in choosing an
antidepressant for a patient suffering from depression (4 marks). ( /4 marks)
Name of antidepressants Other therapeutic effects (besides Specific side effects associated with
antidepressant effect and anxiety antidepressant (besides gastric
reduction effect) discomfort, headache, giddiness)
!
!
286
Question!2!
You!are!a!general!practitioner.!A!25NyearNold!man!presents!with!disorganized!thinking!and!
speech.!You!have!a!few!psychiatric!differential!diagnoses.!
1. State!and!define!ONE!(1)!common!type!of!disorganised!thinking!that!are!found!in!people!
without!any!mental!illness.(4!marks)!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!(!!!!!!!!!!!/4!
marks)!
!
!
!
2. State!and!define!TWO(2)!common!types!of!disorganised!thinking!that!are!found!in!
people!suffering!from!schizophrenia.!(4!marks)!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!(!!!!!!!!!!!
/4!marks)!
!
Type!of!disorganised!thinking! Definition!
! !
! !
(!!!!!!!/1!mark)! (!!!!!!!/1!mark)!
! !
!
(!!!!!!!/1!mark)! ! !
(!!!!!!!/1!mark)!
!
!
3. State!and!define!ONE!(1)!common!type!of!disorganised!thinking!that!is!found!in!people!
suffering!from!bipolar!disorder.!(2!marks)!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!(!!!!!!!!!!!/2!
marks)!
!
Type!of!disorganised!thinking! Definition!
! !
! !
(!!!!!!!/1!mark)! (!!!!!!!/1!mark)!
Question 3
!
!
287
You are a paediatric resident. You are seeing an 11-year-old boy with repetitive eye blinking
and this has caused social dysfunction. He exhibits facial tics and gets frequent facial tics
when he is anxious. He sometimes cannot control his hand movements which affect his
writing.
1. You suspect that he suffers from Tourettes syndrome. State the most APPROPRIATE
question which you would ask to establish the diagnosis of Tourettes syndrome (2
marks) ( / 2 marks)
2. What distinguishes Tourettes disorder from a chronic motor or vocal tic disorder? (2
marks) ( /2 marks)
3. State ONE (1) psychiatric condition often comorbid with Tourettes syndrome. (2
marks) ( /2 marks)
4. State ONE (1) psychiatric medication that can be used to treat Tourettes syndrome. (2
marks) ( /2 marks)
5. State Two (2) psychological interventions that can be used to treat Tourettes
syndrome. (2 marks) ( /2 marks)
Question!4:!
You! are! a! general! practitioner! (GP).! ! The! son! of! a! 60NyearNold! man! is! concerned! because! his!
father!is!taking!a!medication!called,!Flunitrazepam!(Rohypnol)!for!2!years.!The!patient!obtained!
Rohypnol! from! another! GP! who! had! retired! 1! month! ago.! Rophypnol! is! a! very! potent!
benzodiazepine!and!is!a!derivative!of!nitrazepam.!Rophypnol!is!highly!addictive!and!is!listed!as!
a! controlled! drug! by! the! Central! Narcotics! Bureau.! ! His! son! has! noted! the! following!
symptoms:! anxiety,! aggression,! getting! high,! insomnia,! memory! loss,! slurred! speech,!
tremor!in!his!father.!The!patient!was!admitted!to!the!hospital!due!to!fits.!!
!
1. Based! on! the! symptoms! reported! by! his! son! (underlined),! classify! the! symptoms! as!
intoxication!or!withdrawal!symptoms!associated!with!benzodiazepine!(4!marks)!
(!!!!!!!!!!!!!!/!4!marks)!
Intoxication!symptoms! Withdrawal!symptoms!
1.! 1.!
!
!
288
! !
(!!!!!!!!!/!0.5!marks)! (!!!!!!!!!/!0.5!marks)!
2.! 2.!
! !
(!!!!!!!!!/!0.5!marks)! (!!!!!!!!!/!0.5!marks)!
3.! 3.!
! !
(!!!!!!!!!/!0.5!marks)! (!!!!!!!!!/!0.5!marks)!
4.! 4.!
! !
(!!!!!!!!!/!0.5!marks)! (!!!!!!!!!/!0.5!marks)!
2. State! the! MOST! APPROPRIATE! psychotropic! medication! to! treat! his! withdrawals!
(2!marks).!
3. After! stabilisation,! his! son! would! like! you! to! prescribe! a! nonTbenzodiazapine!
medication!to!help!his!father!to!sleep.!Name!ONE!sedative!antidepressant!and!ONE!
other!sedative!medication.!4!marks!! ! ! ! ! ! !(!!!!!!!!!!
/4!marks)!
Sedative!antidepressant
(!!!!!!!!!!/2!marks)
Other!sedative!medication!(nonT
!
!
289
benzodiazapine)
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!(!!!!!!!!!!/2!marks)
SAQ!!2014!Rotation!2!
Question 1
You are a general practitioner. Depression is a common mental health problem. You are about
to start a patient on an antidepressant.
3. List FOUR (4) factors related to the patients which you would consider in choosing an
antidepressant for a patient suffering from depression (4 marks). ( /4 marks)
!
!
290
Underlying medical conditions (1 mark) or
Concurrent medications (1 mark) or
Symptom profile of depression (1 mark) or
Patients preference (1 mark) or
Age of patient (1 mark) or
Pregnancy of patient / breast feeding (1 mark) or
Frequency of dose (only fluoxetine can be given every other day) (1mark) or
Financial status or affordability by patients (1 mark).
Other answers from students: Liver function (more important than kidney function),
current body weight and BMI, occupation (with explanation e.g. drowsiness when driving)
Name of antidepressants Other therapeutic effects (besides Specific side effects associated with
antidepressant effect and anxiety antidepressant (besides gastric
reduction effect) discomfort, headache, giddiness)
Name of antidepressants Other therapeutic effects (besides Specific side effects associated with
antidepressant effect and anxiety antidepressant (besides gastric
reduction effect) discomfort, headache, giddiness)
!
!
291
Question!2!
You!are!a!general!practitioner.!A!25NyearNold!man!presents!with!disorganized!thinking!and!
speech.!You!have!a!few!psychiatric!differential!diagnoses.!
4. State!and!define!ONE!(1)!common!type!of!disorganised!thinking!that!are!found!in!people!
without!any!mental!illness.(4!marks)!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!(!!!!!!!!!!!/4!
marks)!
!
Type!of!disorganised!thinking! Definition!
! !
! !
(!!!!!!!/2!marks)! (!!!!!!!/2!marks)!
!
!
5. State!and!define!TWO(2)!common!types!of!disorganised!thinking!that!are!found!in!
people!suffering!from!schizophrenia.!(4!marks)!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!(!!!!!!!!!!!
/4!marks)!
!
Type!of!disorganised!thinking! Definition!
! !
! !
(!!!!!!!/1!mark)! (!!!!!!!/1!mark)!
! !
!
(!!!!!!!/1!mark)! ! !
(!!!!!!!/1!mark)!
!
!
6. State!and!define!ONE!(1)!common!type!of!disorganised!thinking!that!is!found!in!people!
suffering!from!bipolar!disorder.!(2!marks)!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!(!!!!!!!!!!!/2!
marks)!
!
Type!of!disorganised!thinking! Definition!
! !
! !
!
!
292
(!!!!!!!/1!mark)! (!!!!!!!/1!mark)!
Answers!to!question!2!
1. State!and!define!ONE!(1)!common!types!of!disorganised!thinking!that!are!found!in!
people!without!any!mental!illness.(4!marks)!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!(!!!!!!!!!!!
/4!marks)!
!
Type of disorganised thinking Definition (Other definitions are acceptable. Examiners
will decide on the marks)
(2 marks)
(2 marks)
2. State!and!define!THREE!(3)!specific!types!of!disorganised!thinking!that!are!found!in!
people!suffering!from!schizophrenia.!(6!marks)!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!(!!!!!!!!!!!
/6!marks)!
!
Any!three!of!the!following:!
Type of disorganised thinking Definition
Thought Blocking (1 mark) Cessation or complete interruption in the flow of the stream
of thought (1 mark)
!
!
293
mark)
Thought insertion (1 mark) External thoughts are inserted into the patients mind which
does not belong to the patient. (1 mark)
Thought withdrawal (1 mark) Patients thoughts are being taken away by the others (1
mark)
Thought broadcasting (1 mark) Patients own thoughts are known to the others through
broadcasting like a radio or TV station. (1 mark)
3. State!and!define!ONE!(1)!specific!type!of!disorganised!thinking!that!is!found!in!people!
suffering!from!bipolar!disorder.!(2!marks)!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!(!!!!!!!!!!!/2!
marks)!
!
Type!of!disorganised!thinking! Definition!
! !
Flight!of!ideas! A continuous speech which topics jump rapidly from one
(1!mark)! to another and there is a logical link between ideas.
! (!1!mark)!
Question 3
You are a paediatric resident. You are seeing an 11-year-old boy with repetitive eye blinking
and this has caused social dysfunction. He exhibits facial tics and gets frequent facial tics
when he is anxious. He sometimes cannot control his hand movements which affect his
writing.
6. You suspect that he suffers from Tourettes syndrome. State the most APPROPRIATE
question which you would ask to establish the diagnosis of Tourettes syndrome (2
marks) ( / 2 marks)
!
!
294
7. What distinguishes Tourettes disorder from a chronic motor or vocal tic disorder? (2
marks) ( /2 marks)
Answer: Patients suffering from Tourettes disorder present with both motor and vocal tics.(2
marks)
8. State ONE (1) psychiatric condition often comorbid with Tourettes syndrome. (2
marks) ( /2 marks)
9. State ONE (1) psychiatric medication that can be used to treat Tourettes syndrome. (2
marks) ( /2 marks)
10. State Two (2) psychological interventions that can be used to treat Tourettes
syndrome. (2 marks) ( /2 marks)
Any!two!of!the!following:!
Behaviour!therapy!or!behaviour!modification!(1!mark)!!
Relaxation!exercise!(1!mark)!
Social!skill!training!(1!mark)!
SelfNesteem!building!(1!mark)!
Remedial!academic!help!(1!mark)!
Mass!practice!(1!mark)!
Habit!rehearsal!(1!mark)!
Question!4:!
You! are! a! general! practitioner! (GP).! ! The! son! of! a! 60NyearNold! man! is! concerned! because! his!
father!is!taking!a!medication!called,!Flunitrazepam!(Rohypnol)!for!2!years.!The!patient!obtained!
Rohypnol! from! another! GP! who! had! retired! 1! month! ago.! Rophypnol! is! a! very! potent!
benzodiazepine!and!is!a!derivative!of!nitrazepam.!Rophypnol!is!highly!addictive!and!is!listed!as!
a! controlled! drug! by! the! Central! Narcotics! Bureau.! ! His! son! has! noted! the! following!
symptoms:! anxiety,! aggression,! getting! high,! insomnia,! memory! loss,! slurred! speech,!
tremor!in!his!father.!The!patient!was!admitted!to!the!hospital!due!to!fits.!!
!
4. Based! on! the! symptoms! reported! by! his! son! (underlined),! classify! the! symptoms! as!
intoxication!or!withdrawal!symptoms!associated!with!benzodiazepine!(4!marks)!
(!!!!!!!!!!!!!!/!4!marks)!
!
!
295
Intoxication!symptoms! Withdrawal!symptoms!
1.! 1.!
! !
(!!!!!!!!!/!0.5!marks)! (!!!!!!!!!/!0.5!marks)!
2.! 2.!
! !
(!!!!!!!!!/!0.5!marks)! (!!!!!!!!!/!0.5!marks)!
3.! 3.!
! !
(!!!!!!!!!/!0.5!marks)! (!!!!!!!!!/!0.5!marks)!
4.! 4.!
! !
(!!!!!!!!!/!0.5!marks)! (!!!!!!!!!/!0.5!marks)!
Answers:!
Intoxication!symptoms! Withdrawal!symptoms!
1.!Aggression!(0.5!marks)! 1.!Anxiety!(0.5!marks)!
! !
2.!Getting!high!(euphoria)!(0.5!marks)! 2.!Insomnia!(0.5!marks)!
3.!Memory!loss!(amnesia)!(0.5!marks)! 3.!Tremor!(0.5!marks)!
4.!Slurred!speech!(0.5!marks)! 4.!Fits!(withdrawal!fits)!(0.5!marks)!
!
!
296
!
5. State! the! MOST! APPROPRIATE! psychotropic! medication! to! treat! his! withdrawals!
(2!marks).!
(!!!!!!!!!!!!!!/!2!marks)!
Diazepam!(Valium)!is!the!only!acceptable!answer.!(2!marks)!
6. After! stabilisation,! his! son! would! like! you! to! prescribe! a! nonTbenzodiazapine!
medication!to!help!his!father!to!sleep.!Name!ONE!sedative!antidepressant!and!ONE!
other!sedative!medication.!4!marks!! ! ! ! ! ! !(!!!!!!!!!!
/4!marks)!
Sedative!antidepressant
(!!!!!!!!!!/2!marks)
Other!sedative!medication!(nonT
benzodiazapine)
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!(!!!!!!!!!!/2!marks)
Mirtazapine (2 marks)
Agomelatine (2 marks)
Amitriptyline (2 marks)
Fluvoxamine (2 marks)
Trazodone (2 marks)
Paroxetine (2 marks)
Sertraline (1 mark)
O t h e r a n t id e p r e s s a n t i f a p p r o p r i a t e : 1 m a r k
!
!
297
Fluoxetine/ bupoprion: 0 mark.
Anti-histamine (1 mark)
Melantonin (2 marks)
!
!
298
!
EOPT Rotation 3
Question 1
1. SSRI may cause erectile dysfunction. Can you name ONE (1) antidepressant that
has relatively less sexual side effect as compared to SSRI? (2 marks)
2. If he wants to continue SSRI, state TWO (2) management strategies to improve his
erectile function if he develops SSRI induced erectile dysfunction. (2 marks)
3) He understands that the combination of SSRI and other medication may lead to
high fever. What is the name of such condition? (1 mark)
4) State ONE (1) medication that may cause serotonin syndrome if he takes together
with SSRI (1 mark)
5) State FOUR (4) signs or symptoms associated with serotonin syndrome (4 marks)
Question 2
You are a resident working in the Accident and Emergency Department (AED).
A 25-year-old man is brought in by his mother to see you after he reveals to
her about his great plan to fly to Europe by changing the magnetic pole of the
earth. He is very talkative and appears to be very excited. He disturbs
other patients in the AED.
1) State THREE (3) MOST LIKELY psychiatry diagnoses that you would
consider. (3 marks)
!
!
299
2) You are unable to perform any blood test as he is very agitated. Name TWO
(2) MOST relevant psychotropic medications to sedate this patient at the
AED. (2 marks)
3) List TWO (2) most important laboratory investigations you would do before
beginning lithium (2 marks)
4) State THREE (3) common side effects associated with lithium. (3 marks)
!
Question!3!
You!are!a!resident!working!in!surgery.!A!45TyearTold!man!with!a!dual!diagnosis!of!
schizophrenia!and!alcohol!dependence!is!admitted!to!the!ward!due!to!upper!
gastrointestinal!bleeding.!The!onTcall!consultant!recommends!urgent!
oesophagogastroduodenoscopy!(OGD).!!
1. You!need!to!take!an!informed!consent!from!this!patient.!State!THREE!(3)!important!
pieces!information!you!must!inform!this!patient!before!seeking!his!consent.!(3!
marks)!
!
2. State!THREE!(3)!criteria!which!you!would!like!to!assess!in!order!to!certify!he!has!the!
capacity!to!take!consent.!(3!marks)!
3) After the OGD is done, his wife hopes that he can quit drinking. List Four (4) techniques of
motivational interviewing which you could use to maximize his motivation to quit drinking (4
marks)
!
!
300
EOPT Rotation 3
Question 1
3. SSRI may cause erectile dysfunction. Can you name ONE (1) antidepressant that
has relatively less sexual side effect as compared to SSRI? (2 marks)
4. If he wants to continue SSRI, state TWO (2) management strategies to improve his
erectile function if he develops SSRI induced erectile dysfunction. (2 marks)
Any two of the following:
1) Reduce the dose or prescribe the lowest dose of SSRI (1 mark)
2) Drug holiday or stop SSRI during weekend or take a long acting SSRI on alternate
day (1 mark)
3) Add sildenafil or PDE5 inhibitor (1 mark)
4) Refer patient to sensate focus or sex therapy / vacuum pump (1 mark)
Not grip method for premature ejaculation
3) He understands that the combination of SSRI and other medication may lead to
high fever. What is the name of such condition? (1 mark)
Serotonin syndrome (1 mark) Not Neuroleptic malignant syndrome
!
!
301
4) State ONE (1) medication that may cause serotonin syndrome if he takes together
with SSRI (1 mark)
Monoamine oxidase inhibitor or irreversible monoamine oxidase inhibitor (1 mark),
moclobemide (0.5 mark) MAOI (0.5 mark) (Isocaroxazid, phenelzine irreversible MAOI
1 mark)
5) State FOUR (4) signs or symptoms associated with serotonin syndrome (4 marks)
Any 4 of the following:
Rigidity, myoclonus, uncontrollable shivering
Sweating or tremor or hyperthermia or coma
Hyperkinesia or bradykinesia
High blood pressure, labile blood pressure
hyper-reflexia, headache
dysphagia, dilated pupils
cardiovascular collapse
confusion (delirium)
decreased level of consciousness/mutism
disorientation
status epilepticus
ataxia
Question 2
You are a resident working in the Accident and Emergency Department (AED).
A 25-year-old man is brought in by his mother to see you after he reveals to
her about his great plan to fly to Europe by changing the magnetic pole of the
earth. He is very talkative and appears to be very excited. He disturbs
other patients in the AED.
5) State THREE (3) MOST LIKELY psychiatry diagnoses that you would
consider. (3 marks)
6) You are unable to perform any blood test as he is very agitated. Name TWO
(2) MOST relevant psychotropic medications to sedate this patient at the
AED. (2 marks)
7) List TWO (2) most important laboratory investigations you would do before
beginning lithium (2 marks)
!
!
302
Renal function test (1 mark)
Thyroid function test (1 mark)
!
8) State THREE (3) common side effects associated with lithium. (3 marks)
!
Any!one!of!the!following:!
Polyuria!(1!mark)!or!Nephreogenic!diabetes!insipidus!
Polydipsia!(1!mark)!or!
Weight!gain!(1!mark)!or!
Cognitive!impairment!(1!mark)!or!!
Fine!tremor!(1!mark)!or!
Metallic!taste!(1!mark)!or!
Hypothyroidism!(1!mark)!or!
Sexual!dysfunction!(1!mark)!or!!
Drowsiness!(1!mark)!or!!
Alopecia!(1!mark)!
Question!3!
You!are!a!resident!working!in!surgery.!A!45TyearTold!man!with!a!dual!diagnosis!of!
schizophrenia!and!alcohol!dependence!is!admitted!to!the!ward!due!to!upper!
gastrointestinal!bleeding.!The!onTcall!consultant!recommends!urgent!
oesophagogastroduodenoscopy!(OGD).!!
3. You!need!to!take!an!informed!consent!from!this!patient.!State!THREE!(3)!important!
pieces!information!you!must!inform!this!patient!before!seeking!his!consent.!(3!
marks)!
!
1. Explain the potential diagnosis of Mallory-Weiss syndrome which is associated with alcohol
misuse (1 mark) or
2. Explain purpose and nature of the diagnostic procedure about OGD (e.g. passing an
endoscope to examine the stomach and identify bleeding site, may take some tissues) (1
mark) or
3. Explain risks and benefits of OGD (e.g. small risk of perforation of feeding tube; benefit: can
assist diagnosis) (1 mark) or
4. Alternative investigation (e.g. monitor haemoglobin levels but bleeding may continue) ( 1
mark) or
5. Prognosis if without this investigation (e.g. continue bleeding) (1 mark)
!
!
303
4. State!THREE!(3)!criteria!which!you!would!like!to!assess!in!order!to!certify!he!has!the!
capacity!to!take!consent.!(3!marks)!
!
Any!3!of!the!following:!
1. He has a factual understanding of the information provided. ( 1 mark) or
2. He can appreciate the nature of the condition (1 mark)
3. He can appreciate consequences of accepting OGD (1 mark)
4. He can appreciate consequences of refusing OGD (1 mark)
5. He can manipulate information provided in a rational manner to reach a decision (1 mark).
3) After the OGD is done, his wife hopes that he can quit drinking. List Four (4) techniques of
motivational interviewing which you could use to maximize his motivation to quit drinking (4
marks)
Short!answer!questions!(2014/2015!rotation!4)!
Question!1!(10!marks)!
You!are!a!general!practitioner.!A!65NyearNold!woman!has!taken!haloperidol!for!30!years!is!
concerned!about!a!side!effect!called!tardive!dyskinesia!(TD).!
1. State!FOUR!(4)!risk!factors!for!TD!(4!marks).!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!(!!!!!!!!!!!!/!4!
marks)!
!
!
2. You!are!about!to!perform!a!physical!examination.!State!TWO!(2)!anatomical!structures!
and!ONE!(1)!clinical!feature!under!each!anatomical!structure!which!you!would!look!for!
to!confirm!the!presence!of!TD!(4!marks).!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!(!!!!!!!!!!!!/!4!
marks)!
!
Anatomical!structure! Clinical!feature!
!
!
304
! !
! !
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !
! !
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!(!!!!!!!!!/!1!mark)! (!!!!!!!!!/!1!mark)!
! !
! !
! !
! !
(!!!!!!!!!/!1!mark)! (!!!!!!!!!/!1!mark)!
!!
3. If she indeed suffers from TD, state TWO (2) management strategies (2
marks) ( / 2 marks)
A 68-year-old woman presents with poor sleep and decreased appetite for two months.
She has stopped reading because she cannot concentrate, and she is no longer seeing
friends that she is close to because she does not have the energy. She tells you that her
symptoms started after her son moved out of the house two months ago. Prior to
that, she was an energetic person who took care of her affairs and enjoyed life.
1. Besides major depressive disorder, state ONE (1) other psychiatric diagnosis based
on the above information (1 mark) ( / 1 mark)
!
!
305
2. Based on your diagnosis stated in Q.1, state THREE (3) non-pharmacological
interventions (3 marks) ( /3 marks)
3. State the term which describes the above phenomenon. (2 marks) ( /2 marks)
4. With the additional information, you suspect the patient may suffer from abnormal
grief reaction although she claims she has coped well with the death of her husband.
State FOUR (4) clinical features which are found in abnormal grief but not normal
grief (4 marks) ( /4 marks)
!
The public relation department of your hospital has received queries from a local newspaper. A
reporter wants to write about an article about alcohol misuse. You are invited to address the following
questions raised by the reporter.
1. How does long-term alcohol misuse damage our body systems? Please state FOUR (4)
physiological systems and name ONE (1) complication under each system (4 marks)
( / 4 marks)
!
!
306
2. If an alcoholic stops drinking for 1 day, what would happen to him/her? State TWO (2) common
symptoms. (2 marks) ( / 2 marks)
3. If an alcoholic wants to join peer support group, name ONE (1) organisation which can support
the person (2 marks) ( /2
marks)
4. If an alcoholic wants to be admitted to a hospital to detoxify from alcohol, what are the
indications. State TWO (2) indications. (2 marks) ( / 2 marks)
Question 4
You are a medical resident. The accident and emergency department has sent a 55-year-old man to the
medical ward for further management due to change in mental state. When you assess him, he appears
to be manic.
1. State FIVE (5) neurological disorders which may cause mania. (5 marks) ( / 5marks)
2. State!TWO!(2)!medications!(not!illicit!drugs)!which!may!cause!mania!(2!marks)!!(!!!!!!!/2!
marks)!
3. When!you!are!clerking!the!patient,!he!suddenly!becomes!very!aggressive!and!tries!to!run!
away!from!the!ward.!You!have!tried!verbal!deNescalation!but!fails.!You!need!to!apply!
physical!restraint.!State!THREE!(3)!specific!instructions!to!nursing!staff!to!ensure!the!
physical!restraint!will!be!applied!successfully.!(3!marks)!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!(!!!!!!!!!!!!!!/!3!
marks)!
Short!answer!questions!(2014/2015!rotation!4)!
Question!1!(10!marks)!
You!are!a!general!practitioner.!A!65NyearNold!woman!has!taken!haloperidol!for!30!years!is!
concerned!about!a!side!effect!called!tardive!dyskinesia!(TD).!
!
!
307
4. State!FOUR!(4)!risk!factors!for!TD!(4!marks).!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!(!!!!!!!!!!!!/!4!
marks)!
!
Any!3!of!the!following:!
> Old!age!(1!mark)!or!
> Female!gender!(1!mark)!or!
> Comorbid!affective!disorder!/!alcohol!abuse!(1!mark)!or!
> Comorbid!organic!brain!disorder!(1!mark)!or!
> Long!exposure!to!first!generation!antipsychotic!drug!/!potent!dopamine!receptor!
blockade!(1!mark)!or!!
> Precipitation!by!anticholinergic!drug!(1!mark)!or!
> High!antipsychotic!dose!/!rapid!increment!in!dose!(1!mark)!or!
> Previous!extra!pyramidal!side!effect!/!history!of!tremor!or!Parkinsons!disease!(1!
mark)!or!
> Genetic!predisposition!due!to!hypersensitive!dopamine!receptor!/!Family!history!of!
TD!(1!mark)!or!
> AfroNCaribbean!race!(!1!mark)!
!
5. You!are!about!to!perform!a!physical!examination.!State!TWO!(2)!anatomical!structures!
and!ONE!(1)!clinical!feature!under!each!anatomical!structure!which!you!would!look!for!
to!confirm!the!presence!of!TD!(4!marks).!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!(!!!!!!!!!!!!/!4!
marks)!
!
Anatomical!structure! Clinical!feature!
! !
! !
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !
! !
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!(!!!!!!!!!/!1!mark)! (!!!!!!!!!/!1!mark)!
! !
! !
! !
! !
(!!!!!!!!!/!1!mark)! (!!!!!!!!!/!1!mark)!
!!
Any!two!of!the!following:!
Anatomical!structure! Clinical!feature!
Mouth!!!!!!!!!!!!!!!!!!!!!!!! Mouth!opening!
Eye!brow! Elevation!or!depression!
!
!
308
Eye!lids! Blepharospasm/sustained,!forced,!involuntary!closing!of!the!
eyelids!
Lips! pursuing/retraction!to!lateral!angle/!lip!smacking!
Tongue! Fly!catching,!tongue!protrusion!
Jaw! Abnormal!masticationNlike!movement!/!protrusion!and!
deviation!
Neck! Torticollis!
Upper!limb/!lower! Hypertonia/wrist!flexion/!pilling!rolling!tremor!
limb!
Hand! Choreiform!hand!pill!rolling!movements!
6. If she indeed suffers from TD, state TWO (2) management strategies (2
marks) ( / 2 marks)
Wrong!answers:!
There!is!not!enough!evidence!to!suggest!anticholinergic!as!good!treatment!for!TD.!
Drug!holiday!may!cause!relapse!in!schizophrenia.!
!
!
309
Question 2 (10 marks)
A 68-year-old woman presents with poor sleep and decreased appetite for two months.
She has stopped reading because she cannot concentrate, and she is no longer seeing
friends that she is close to because she does not have the energy. She tells you that her
symptoms started after her son moved out of the house two months ago. Prior to
that, she was an energetic person who took care of her affairs and enjoyed life.
5. Besides major depressive disorder, state ONE (1) other psychiatric diagnosis based
on the above information (1 mark) ( / 1 mark)
!
!
310
Problem solving therapy (1 mark) or
Cognitive behaviour therapy (1 mark) or
Interpersonal therapy (1 mark) or
Attending a day care centre (1 mark) or
Home visit by community psychiatric team (1 mark)
In the later part of interview, she mentions about the death of her husband three years ago.
She admits that she has kept everything in her late husbands room exactly the same since
his death.
7. State the term which describes the above phenomenon. (2 marks) ( /2 marks)
8. With the additional information, you suspect the patient may suffer from abnormal
grief reaction although she claims she has coped well with the death of her husband.
State FOUR (4) clinical features which are found in abnormal grief but not normal
grief (4 marks) ( /4 marks)
Any 4 of the following:
> Prolonged!grief!with!duration!longer!than!6!months!(1!mark)!or!
> Inhibited!grief!at!the!time!of!death!(1!mark)!or!
> Delayed!grief!!(i.e.!no!grief!reaction!at!the!time!of!death!but!appeared!some!time!later)!(1!
mark)!!
> Strong!suicidal!ideation!to!join!the!deceased!(1!mark)!or!!
> Psychotic!experience!other!than!deceased!(1!mark)!or!
> Severe!psychomotor!retardation!(1!mark)!or!
> Severe!feeling!of!worthlessness!or!hopelessness!(1!mark)!
The public relation department of your hospital has received queries from a local newspaper. A
reporter wants to write about an article about alcohol misuse. You are invited to address the following
questions raised by the reporter.
5. How does long-term alcohol misuse damage our body systems? Please state FOUR (4)
physiological systems and name ONE (1) complication under each system (4 marks)
( / 4 marks)
!
!
311
( / 0.5 mark) ( /0.5 mark)
Physiological system Complication (The candidate needs to state one complication under
each physiological system)
Hepatobiliary system Cirrhosis, liver cancer, alcohol hepatitis, fatty liver, pancreatitis,
hepatic encephalopathy
!
!
312
Haematological Macrocytic anaemia
system
6. If an alcoholic stops drinking for 1 day, what would happen to him/her? State TWO (2) common
symptoms. (2 marks) ( / 2 marks)
7. If an alcoholic wants to join peer support group, name ONE (1) organisation which can support
the person (2 marks) ( /2
marks)
8. If an alcoholic wants to be admitted to a hospital to detoxify from alcohol, what are the
indications. State TWO (2) indications. (2 marks) ( / 2 marks)
!
!
313
Question 4
You are a medical resident. The accident and emergency department has sent a 55-year-old man to the
medical ward for further management due to change in mental state. When you assess him, he appears
to be manic.
4. State FIVE (5) neurological disorders which may cause mania. (5 marks) ( / 5marks)
Any!5!of!the!following:!
5. State!TWO!(2)!medications!(not!illicit!drugs)!which!may!cause!mania!(2!marks)!!(!!!!!!!/2!
marks)!
Any!two!of!the!following:!
o Steroid / prednisolone
o Antidepressant
o Anticholinergic drug
o Levodopa / bomocrptine
o Bronchodilator
6. When!you!are!clerking!the!patient,!he!suddenly!becomes!very!aggressive!and!tries!to!run!
away!from!the!ward.!You!have!tried!verbal!deNescalation!but!fails.!You!need!to!apply!
physical!restraint.!State!THREE!(3)!specific!instructions!to!nursing!staff!to!ensure!the!
physical!restraint!will!be!applied!successfully.!(3!marks)!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!(!!!!!!!!!!!!!!/!3!
marks)!
Any!three!of!the!following:!
1. Call!for!additional!manpower!(e.g.!call!security!guards!for!help,!at!least!4!additional!
staff)!(1!mark)!or!
2. Obtain!adequate!physical!restraints!(e.g.!1!body!jacket,!1!restraint!per!limb)!(1!mark)!or!
!
!
314
3. Standby!psychotropic!medication!(e.g.!rapid!dissolvable!antipsychotics!or!intravenous!
lorazepam!/!haloperidol)!(1!mark)!or!
4. The!doctor!will!ensure!the!airway!is!not!blocked.!Other!staffs!will!focus!on!the!body!and!
four!limbs.!(1!mark)!!
Sample!OSCE!
Introduction
Construct: This is a station designed to test the candidates ability to take a history
of oppositional defiant disorder.
Time: 8 minutes
Instructions to Candidates
!
!
315
You are a general practitioner. Mr/Mrs Tan comes to see you. His/her 11-year-old
son exhibits difficult behaviour such as being disrespectful, spiteful and
argumentative at home and school. His behaviour starts to concern his parents and
teachers.
Tasks:
1. Take a history from the parent to establish a diagnosis.
2. Perform a risk assessment
3. At the end of your interview with the parent, please write down your diagnosis
and pass it to the examiner.
Time: 8 minutes
!
!
316
Answer sheet
Please write down the diagnosis of this patient and pass it to your examiner.
___________________________________________________________________
Background
Your name is Ms. Tan. You are married and has a single child, an 11-year-old
son called Jason. You are currently staying in a 3-room HDB flat. You worked as
an administrative officer in a company and your spouse also works as an
administrative staff in another company.
You have a 11-month-old son (Jason). When yourself and your spouse go to
work, he is looking after by a domestic helper at home. He goes to school by
school bus. However, there were no problems in the pregnancy and giving birth.
He has normal development (e.g. normal in speaking, hearing and walking)
Jason has average results from Primary 1 to Primary 4. He did not have
behavioural problems in the past.
He is your first child. Yourself and your spouse cannot afford to have a second
child.
Yourself and your spouse have no past or family history of mental illness.
Yourself and your spouse do not have forensic history.
Symptoms
Main symptoms
Jason currently studies in Primary 5 and he finds the subjects in Primary 5 are
difficult to study. In the past one year, he has been disrespectful to you, your spouse,
domestic helper and his teachers. He is noted to be defiant in almost any situation
(at home, going out with family and school). He finds his temper is bad and worse
than other children of his age. He has been argumentative, spiteful and challenges
you and the teacher the reasons to do homework. He wanted to go for a buffet
dinner last weekend but the family wants to save money and ask him to wait until
next school holiday. He was very anger and throws things at home.
Your spouse is very exhausted and gives in and tells your son that, Yes, you do not
need to do your homework. Jason then argues, There is no need to study. This
type of behaviour, over and over, leaves you and your spouse feeling overwhelmed
and exhausted. Your domestic helper finds Jason very annoying and blames her for
his mistakes.
!
!
317
You met the teacher last week. In this academic year, the teacher finds Jason
struggling in school and keeping his old friends. Jason deliberately annoys his
classmates. The teacher finds him refuse to take responsibility and blame his
classmates for his mistakes. His academic performance was above average last
year and he got a borderline pass this year. His results are similar across subjects.
He does not have a favoured subject. He has no attention problems in school and he
can sit still to do his work. He have not broken any school rule and never being
suspended before.
His mood is normal. He sleeps and eats well. No self-harm and no suicide.
He is not nervous. He always attends school and never skips school.
There is no history of truancy.
He does not have other unusual experiences such as hearing voices or seeing
things that are not there.
He does not use recreational drugs. He does not sniff glue.
His IQ should be normal. He studies in a normal neighbourhood school.
He does not have specific learning problem (e.g. he can read, write, spell and do
mathematics)
He has normal attention and can sit still to study at home and in school.
He has normal development and there is no delay in walking and speaking.
He likes to watch TV and plays computer games. He is not addicted to internet.
Risks
Although his behaviour is difficult to manage, there are some good things
about Jason. Jason does not violate more serious rules like running away
from home or breaking school rules. He has never been physically aggressive
toward other people (parents, classmates) and animals. Jason never initiates
a fight. He does not bully other children. He lies about minor things but never
tells a big lie. He never steals and never damages others properties. He has
no trouble with the police.
He does not harm himself
He does not harm other people.
!
!
318
He seldom has accident. E.g. falling from height due to excessive climbing or
running too fast.
Other points:
You have not consulted any doctor or counsellor on this matter.
You want to seek advice from the GP.
Time: 8 minutes
!
!
319
Instructions to Examiners
!
!
320
EXAMINERS REPORT
!
!
321
Total score: Administrator 1:______________________ Administrator 2: _________________
EXAMINERS REPORT
Explain if student fails or is discussed in the examination board for borderline performance:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
!
!
322
!
Introduction
Time: 8 minutes
Instructions to Candidates
You are a resident working in the Accident and Emergency Department (AED). Ms.
Lim was bought to the AED by police because she tried to attempt suicide by
jumping from height. Your hospital is new and does not have a psychiatric ward.
Tasks:
4. Take a history from Ms Lim to assess her suicide attempt and current suicide
risk.
5. Assess depressive symptoms and obtain further relevant information.
!
!
323
6. At the end of your interview with Ms Lim, please select the MOST
APPROPRIATE management strategy and pass to the examiner.
Time: 8 minutes
Students sticker
Answer sheet
Background:
You are Ms. Gigi Lim, a 35-year-old woman tried to jump down from the roof
of her HDB flat tonight.
You are bought in by the police because someone spotted that you wanted to
jump down from a building and called the police who stopped you.
!
!
324
You are an unemployed, recently tested to be pregnant in urine pregnancy
test 2 weeks ago. This is an unplanned pregnancy. You do not use
contraception.
You are not married with your boyfriend. He is doing odd-job with unstable
income.
Suicide attempt
Why did you want to jump down tonight?
After you had argued with your boyfriend tonight, you wanted to jump from
height. You have thought about jumping for 2 weeks since you know the urine
result is positive.
Your relationship with him is not good in the past 1month. You have thought
of jumping down to end it all because he is not good to you and both of you
have no savings.
You want to get married with him as you are two-week pregnant. You
discovered the urine pregnancy test was positive 2 weeks ago. You have
known this boyfriend for 1 year but relationship has been unstable. He is not
keen to get married. He works as an odd job worker with unstable income.
You feel hopeless because there will not be enough money to support the
baby after the baby is born.
After you had argued with him, your boyfriend left the HDB flat.
As your boyfriend does not look after you and will leave you alone while you
are pregnant, you think there is no way out but to die.
!
!
325
If you are released from the AED, you will jump from height again and die with
your foetus to make your boy friend guilty.
You do not want to be admitted to any hospital and insist to go back on your
own.
!
!
326
No other relationship in the past.
No past trauma
No emptiness
No fear of abandonment
No identity disturbance
No voices
No friend to talk to
Not in contact with family
Behaviour
Depressed; Still suicidal
If doctor says that he needs to transfer you to IMH, you do not look too happy
but you do not violently object.
Time: 8 minutes
Instructions to Examiners
!
!
327
Please keep to the exact time.
!
!
328
EXAMINERS REPORT
!
!
329
Total score: Administrator 1:______________________ Administrator 2: _________________
EXAMINERS REPORT
Explain if student fails or is discussed in the examination board for borderline performance:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
!
!
!
330
!
Introduction
Time: 8 minutes
!
!
331
!
Instructions to Candidates
You are a General Practitioner. A 45-year-old man comes to see you today because
he injured his head after he was assaulted by another man in a pub.
Tasks:
1. Obtain the answer sheet (with your name label on it).
2. Take a brief history (less than 4 minutes) from the patient to assess post-
concussion syndrome, risk assessment and sequelae after head injury.
3. Perform cognitive tasks listed on the left hand side of the table found on your
answer sheet.
4. Fill the right hand side of the table and provide the scores for the patient and
indicate maximum score for each task.
Time: 8 minutes
!
!
332
!
Background of patient
Your name is Mr. Tan, a 45-year-old married person, staying with your spouse and son.
You work as an account manager. You have university education.
You have NO personal or family history of mental illness or dementia.
You have good past health.
You are a non-smoker and a social drinker. You go to drink in a pub once a while.
One month ago, you went to a pub and drank with your friends. You had an argument
with another man in the pub. He used a baseball bat to hit the front part and both sides
of your head.
You had a black-out for 30 minutes and your scalp was bleeding from superficial wound.
Your friends sent you to the hospital immediately. You can remember events before and
after the fight.
You were treated at the Accident and Emergency Department. The doctor said the head
injury was mild. You were not required to stay in the hospital. The brain scan did not
show major internal bleeding in the head. No surgery was required. No bleeding from
ear, nose and throat. No bruising from eyes.
The man who attacked you left the pub and police could not catch him. Insurance
company thinks the injury is mild and refuses to compensate.
After head injury, you find your brain function not very good. You cannot concentrate at
accounting work and often make mistakes. Your supervisor asks you to take no pay
leave to consult a doctor. You cannot plan or make decision.
In your head, you experience headache over the frontal part of your head and giddiness.
You lost your balance a few times after getting up from bed and almost fell down.
For your eyes and ears, you are very sensitive and become irritable to light and noise.
You hear wee sound in your eyes (Tinnitus).
For your mental functions, you are slow in mental speed and cannot think as fast as the
past. You have noticed increased difficulty in finding the right words to express yourself.
You are also unable to play crossword puzzles which you used to enjoy as you are
unable to come up with the right words.
Your memory is failing you: misplacing things (wallet), forgetting recent conversations
you had with your family, forgetting what you just ate for meals.
For your mood, you are sad all the time but sometimes becomes angry for no reason,
poor appetite, poor sleep (4 hours at night, cannot fall asleep), low energy level, loss of
interest (e.g. tennis), loss of sexual drive, poor concentration and attention, feels
hopeless after the head injury. Your mood swings from normal mood to anger.
You do not have suicidal thought. You do not hear voices or see things that are not
there.
You feel nervous most of the time and easily startled. You worry that the head injury
caused a lot of problems in your head. You cannot sit still, need to pace around in the
!
!
333
!
!
!
334
!
Time: 8 minutes
!
!
335
!
Instructions to Examiners
The global rating should be based on the total scores of subsections. The total
mark is 20. A candidate fails the OSCE station if he or she scores less than 10.
!
!
336
!
Students sticker
Answer sheet
2. Please perform the following cognitive assessments and fill the right side of the
table
Assess registration
Patients score:
Maximum score:
Maximum score:
!
!
337
!
recall
Maximum score:
EXAMINERS REPORT
Students are not allowed access to this document
!
!
338
!
DECISION (circle one): Pass / Fail (For failure, the total score must be less than 12.5).
Signature of Examiner: ____________________________ Date: _____________________
EXAMINERS REPORT
Students are not allowed access to this document
Explain if student fails or is discussed in the examination board for borderline performance:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
!
!
339
!
Introduction
Construct: This is a station designed to test the candidates ability to take a history
of borderline personality disorder.
Time: 8 minutes
!
!
340
!
Instructions to Candidates
You are a paediatrician working in a private medical group. A mother bought her 15-
year-old daughter, Angela to see your paediatric colleague because of low body
weight and lethargy. Angela used to be a high academic achiever in school but she
was not able to sit for examination in November last year. Your colleague has
ordered a set of investigations but he needs to go off to attend some urgent matter.
He has asked you to review the laboratory results and electrocardiogram (ECG) on
his behalf.
Tasks:
After entering the room, please review your colleagues record, laboratory results
and ECG and identify abnormalities.
Please double check your name is correct before answering the questions.
Please pass your answer sheet to the circuit administrator at the end of the station.
You are required to stay in the room until the end of the 8th minute. You cannot
leave the room if you finish early.
Time: 8 minutes
!
!
341
!
Outpatient record
(To be placed on the desk of the candidates room)
History:
Angela was bought in by her mother due to low body weight
and lethargy.
Weight: 40 kg
Height: 170 cm
PE:
Her physical examination showed marked malnutrition
and paleness.
Plan:
Order full blood count, liver function test, renal function test,
thyroid function test and electrocardiogram.
!
!
342
!
Laboratory results:
(To be placed on the desk of the candidates room)
Albumin 29 g/L 38 48
!
!
343
!
1. Based on her height and weight, calculate her body mass index (BMI). (2 marks)
(Examiners Use only: /2 marks)
2. Please review the laboratory results and electrocardiogram. Identify THREE (3)
abnormalities. (6 marks) (Examiners Use only: /6 marks)
!
!
344
!
3. Based on the above information, state the MOST LIKELY psychiatric diagnosis. (2 marks)
(Examiners Use only: /2 marks)
5. Based on your psychiatric diagnosis, state FOUR (4) additional clinical signs which you
would look for during physical examination to confirm your diagnosis. (Examiners Use only:
/4 marks)
!
!
345
!
6. Based on your psychiatric diagnosis, state TWO (2) additional investigations which your
colleague forgot to order but relevant to this condition (2 marks) (Examiners Use only:
/2 marks)
!
!
346
!
Instructions to Candidates
You are a resident working at the Accident and Emergency Department (AED). Amy,
a 35-year-old woman comes to see you because she has cut her thighs. Your
colleague has put dressing on her thighs and the wounds are superficial.
Tasks:
7. Take a history from Amy to assess her personality and establish a diagnosis.
8. Assess common psychiatric comorbidity associated with her diagnosis.
9. At the end of your interview with Amy, please write down the most likely
psychiatric diagnosis and pass it to the examiner.
Time: 8 minutes
347!
!
!
Students sticker
Answer sheet
Please write down the most likely psychiatric diagnosis of this patient and
pass it to your examiner.
___________________________________________________________________
348!
!
!
Background:
Your name is Amy, a 35-year-old woman. You live alone in a one-room HDB flat.
You are estranged from your family, being an only child whose father died of
cancer when you were 6 years old, and who has a very difficult relationship with
her mother. You have a history of physical abuse in childhood and her mother
was the perpetuator and she caned you very often for no reason. You are not in
contact with your mother. There is no history of sexual abuse.
You had a number of relatively short-lived jobs in the past as a caregiver for the
elderly in nursing home. You resigned from your last job after an argument with
the manager and have been unemployed for several years.
You consult the accident and emergency department today because you are very
stressed and cut your thigh.
You have no known medical illness. No known family history of mental illness.
Symptoms
Main symptoms:
The doctor may ask you a question how to describe yourself. You tell the doctor
that you dont know how to describe yourself. You are confused about who you
are. You are lost about yourself.
The doctor may ask you how your friends describe you. You tell the doctor that
you have a small number of close female friends, but find that people often let
you down so you do not have a wide social network. You feel that people in
general do not like you. It is very hard to maintain relationship with others.
The reason for cutting yourself is to re-experience the pain. The pain inflicted
by your mother during the childhood abuse. You are not suicidal at this moment.
You always cut your thighs with pen knife. You have no intention to kill yourself.
Relationship: You have a history of brief unstable relationships. You had 10 boy
friends in the past who were physically abusive. You have not been in a close
relationship for several years and no recent sexual activities..
Past suicide attempts: You are well apart from the lacerations, with no significant
medical history. You have scars on your thighs from past superficial lacerations. You
have had several past psychiatric admissions for self-harm or suicidality by drug
overdose across the last few years.
You use emergency A&E services at times. You have recently been admitted with
overdoses twice in the last month. Im just fed up and I cant go on.
Other problems:
You have nightmare, the images of childhood abuse popping up into your mind.
You have binge eating when under stress but no self-induced vomiting.
For your mood, very unpredictable and always have mood swings.
Your sleep, appetite and energy are normal.
You are not in any relationship at this moment and no sexual activity recently.
350!
!
!
No other medical problem. When you were admitted, the blood tests show normal
results.
No difficulty in breathing, no shortness of breath, no panic attack
No fear of losing control
No fear of dying/going to die
No fear of going out of the house. No fear of using MRT or bus.
No fear of going to a shopping mall or crowded place/enclosed space
No fear to centre of attention, no fear of talking to other people.
No fear of blood, height or spider.
No repetitive checking or hand-washing
No repetitive thoughts of contamination
Not hearing voices
Behaviour
You are cooperative during the interview.
Time: 8 minutes
Instructions to Examiners
351!
!
!
Things not to do: use/switch on mobile phone, yawn, teach or prompt.
If observers sit in, marking is not discussed with them. Observers record their own
assessment on separate sheet.
Please use the calculator to add up the marks and write down the score at the
bottom of marking form.
352!
!
!
EXAMINERS REPORT
DECISION (circle one): Pass / Fail (For failure, the total score must be less than 10).
353!
!
!
EXAMINERS REPORT
Explain if student fails or is discussed in the examination board for borderline performance:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
354!
!
Mastering Psychiatry
A Core Textbook for Undergraduates
- Now with a companion guide to help you master your undergraduate exams!
This companion guide includes past exam papers to help you practice for the following
components in the actual exam:
Mul$ple'choice'ques$ons'
Short'Answer'ques$ons'
OSCE'sta$ons'
'
This'book'is'a'joint'eort'between'authors'from'Singapore'&'Authors'from'the'University'of'
Toronto.''
Melvyn'WB'Zhang'MBBS'(Singapore),'Diploma'(Cl'Psychiatry)''(RCP&S'Ireland),'MRPCPsych(UK)'
Resident'(Psychiatry),'Na$onal'Healthcare'Group'
'
Cyrus'SH'Ho'MBBS'(Singapore),'Diploma'(Cl'Psychiatry)''(RCP&S'Ireland),'MRCPsych'(UK)'
Registrar,'Na$onal'University'Healthcare'System'(NUHS)'
'
Roger'CM'Ho'MBBS'(Hong'Kong),'DPM'(Psych)'(Ireland)'Diploma'(Cl'Psychiatry)''(RCP&S'Ireland),'DIP''
(Psychotherapy)'(NUS),''MMed'(Psych)'(Singapore),'MRCPsych'(UK),'FRCPC'
Assistant'Professor'and'Consultant'Psychiatrist,'Department'of'Psychological'Medicine,'
Yong'Loo'Lin'School'of'Medicine,'Na$onal'University'of'Singapore'
'
'
'
Sanjeev'Sockalingam'MD,'FRCPC'
Deputy'Psychiatrist'ion'Chief'(TGH'&'PMH),'Director,'Con$nuing'Professional'and'Prac$ce'
Development'
Assistant'Professor,'Department'of'Psychiatry,'University'of'Toronto'
'
Raed'Hawa'MD,'FRCPC'
Associate'Professor,'Department'of'Psychiatry,'University'of'Toronto'
'
'
'
'
'
'
Our'online'companion:'www.masteringpsychiatry.com'
['Website'QR]''''''''''''''[Apple'Store]'''''''''''''[Android'Store]'''''''
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ISBN'(Book):'978E981E07E0163E5'
ISBN'(DVD):''978E981E07E0164E2'
ISBN'(Ebook/App):''978-981-07-1493-2'
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