AP Prep 1/ Flashcards
Lack of insight is a strong predictor of ___ to make medical decisions.
incapacity
___-based approaches are powerful for identifying rare high penetrance gene variants.
Pedigree
*Repetitive ___ for the treatment of unipolar depression targets the left prefrontal cortex/dorsolateral prefrontal cortex.
transcranial magnetic stimulation (At NR Tina target’s the left prefrontal cortex/Dorsolateral PFC)
Patients with ___ disorders have attentional bias toward potentially threatening stimuli.
anxiety
Clenching a fist can ___ hypoactive deep tendon reflexes in a leg.
enhance
*___ is the main cause of death in people with SMI.
Heart disease
Topiramate may help migraine ___.
prophylaxis.
Methylation is an epigenetic mechanism that ___ transcriptional machinery from accessing DNA and thus leads to decreased gene transcription.
inhibits
Patients with Lewy body disease may be more likely to develop ___ extrapyramidal side effects from neuroleptics.
severe
Medication overuse is a strong risk factor for development of ___ daily headache in adults.
chronic
Glycine is a predominantly ___ neurotransmitter
inhibitory
___ is the main excitatory neurotransmitter in the central nervous system.
Glutamate
GABA is the main inhibitory ___ in the adult vertebrate brain.
neurotransmitter
Maintenance of ___ is dependent on the ascending reticular activating system.
wakefulness
Intense fear of gaining weight is a necessary feature to ___ anorexia nervosa.
diagnose
Abstraction is a new cognitive capacity gained when children reach the stage of ___ operations.
formal (13-> adulthood)
Prader-Willi syndrome (obesity, ID, short) involves a ___ of genetic material.
microdeletion
The ___ connects the amygdala to the septal area and the hypothalamus.
stria terminalis
Family psychoeducation is a strongly evidence-based practice that reduces ___ and symptoms, and improves medication adherence in schizophrenia.
relapses
Longitudinal follow-up reliably ___ bipolar from unipolar depression in a patient who presents with an initial episode of depression.
differentiates
Elementary school-age children typically start to engage in social activities without their parents, have a best friend, can show ___ though may sometimes impulsively say things to friends that are unkind.
empathy
Schizophrenia is one of the WHO Global Burden of Disease Study top ten conditions for disability in terms of loss of ___ life years for ages 15-44 in men and women.
productive
Advance directives convey a dying patient’s instructions about wishes regarding ___ interventions when the patient is no longer able to make decisions.
medical
Heavy smoking (and polycyclic aromatic hydrocarbons) may lower levels of olanzapine because cigarettes induce CYP___.
1A2
(Olanzapine is metabolized by CYP 450 1A2, 2D6 (minor), and direct glucuronidation; t1/2 1-2 days). CYP 1A2 inhibitors (eg, fluvoxamine) may increase olanzapine bioavailability by 50-100%. Adjust olanzapine dosing in presence of 1A2 inducers or inhibitors).
Veracity is an ethical principle that means ___ or “speaking truly” from “verax.”
accuracy
___ is the most common comorbid psychiatric disorder in patients with epilepsy.
Major depressive disorder
___ neurons regulate sleep and originate in the tuberomammillary brain nuclei.
Histaminergic
A holding environment, per Winnicott’s thoughts on infant development of assertiveness and sense of competence, encourages ___ while protecting the infant from harm.
spontaneity
24/7 mental healthcare coverage is one characteristic of ___ community treatment (ACT) for the treatment of the severely mentally ill.
assertive
Norepinephrine is mostly synthesized in the ___
locus coeruleus
The ___ has the highest concentration of serotonin-producing cells in the brain.
raphe nuclei
Electrocardiogram is appropriate to detect the most common ___ complications associated with myotonic dystrophy.
cardiac
Training ___ how to recognize potential threats is important to protect hospital systems against EMR data breach.
employees
Participating voluntarily is one of the features of ___ consent.
informed
Goodness of fit describes the relevance of understanding ___ in working with parent-child relational problems.
temperament
Gait ___ may be seen in normal pressure hydrocephalus.
apraxia (deficit and, thus, has a cerebral localization. Patients with gait apraxia have a hard time getting started with walking and may have a “magnetic” or shuffling gait. Gait apraxia is commonly seen in dementia (especially vascular dementia) and in NPH.)
Adolescent cortical synapse remodeling is also believed to be associated with preferential loss of ___ synapses.
excitatory
Urea and electrolytes may be helpful studies for a geriatric patient suspected of ___, which can cause confusion and is a potential antidepressant side effect.
hyponatremia
Remember that responses to ___ may at times be normative.
stress
In those with persistent pain the ___ receptor is down-regulated in the ventral striatum.
dopamine
Cholecystokinin is a peptide released in the gastrointestinal tract to convey ___ information to the brain in response to food intake.
satiety
Hypophosphatemia is one of the lab abnormalities that may be seen in ___ syndrome.
refeeding
___ increases formation of tetrahydrobiopterin (BH4) , which increases production of serotonin, norepinephrine, and dopamine which may be how it is an effective augmentation agent for depression.
L-methylfolate
The AMPA receptor is ___ by the presence of glutamate.
stimulated
When Pavlov’s dog drooled on hearing a bell, the drool is the ___ response.
Conditioned
Beginning to develop concern for others and learning to share typically happens at ___ years.
four
___ neurotransmitter system facilitates sexual arousal.
Dopaminergic
In utero exposure to cannabis during neuronal development is associated with cognitive ___ in the infant.
deficits
In children with cancer, ___ prophylaxis of pain and stress during difficult procedures may result in Post traumatic stress disorder.
Inadequate
One in four people born with the ___ deletion develop schizophrenia.
22q11.2
DiGeorge syndrome/22q11.2 deletion syndrome/ velocardiofacial syndrome is a syndrome caused by the deletion of a small segment of chromosome 22. It is characterized by developmental delay, cardiac abnormalities, palate defects, immune deficiency, and an increased risk of schizophrenia.
___ ___ can be used to determine how two independent variables in a study, such as depression and alcohol use disorder, affect the frequency of the occurrence event, such as suicide.
Regression analysis
Per Classical conditioning, to ___ the conditioned stimulus from the unconditioned stimulus, have the dog listen to the bell in the absence of food.
unpair
PharmacoKINETICs is the branch of pharmacology concerned with the ___ of drugs within the body.
movement
PharmacoDynamics is the branch of pharmacology concerned with the ___ of drugs and the mechanism of their action.
effects
Decreased hepatic ___ flow in older adults is a common physiologic change that affects drug pharmacokinetics.
blood
Microglia are implicated in both neural circuit ___ of the developing brain and scavenging for damaged neurons, plaques and infectious agents.
formation
[Microglia secrete innate proinflammatory cytokines TNF-a and IL-1B in patients with inflammatory conditions that affect the brain.]
It is essential that caregivers, for example of Alzheimer patients, take ___ of themselves, for example by continuing to go to their church group that is important to them.
care
Exemption from course requirements is something that may be included as part of an Individualized Education Program, but would not be included in a ___ plan.
504
Reduction in hippocampal volume is associated with ___ memory impairment.
declarative
The multiple sleep ___ test is used to diagnose narcolepsy.
latency
Clear and ___ evidence is the minimal degree of legal certainty that is constitutionally required for an involuntary mental health comitment.
convincing
Donepezil binds and reversibly ___ the cholinesterases, thus inhibiting hydrolysis of acetylcholine. This increases acetylcholine concentrations at cholinergic synapses.
inactivates
oxybutynin (treats overactive bladder) has anticholinergic effects that would ___ with efficacy of cholinesterase inhibitors like donepezil, galantamine, rivastigmine.
inhibit
An 80yo woman presents to the psychiatrist complaining of lack of energy, forgetfulness, difficulty concentrating. Which of the tests below would be of most help initially in formulating diagnosis?
- CT scan
- Sleep study
- Neuropsychological testing
- Electroencephalogram
- Cerebrospinal fluid studies
Neuropsychological testing
Research regarding the process of acculturation reports that formation of a ___ identity is the best adaptational outcome for immigrant youth.
bicultural
___-regulatory elements are mediators of transcriptional activity in gene expression.
Cis
What is the first step to manage behavioral agitation?
Attempt verbal de-escalation
Initial treatment for female ___ disorder usually includes directed masturbatory training.
orgasmic
___ duration of trauma likely predisposes to dissociative amnesia after a traumatic event.
Longer
When considering assessment instruments, ___ is defined as whether the instrument actually measures what it purports to measure.
validity
Tuberous sclerosis is transmitted in an ___ ___ inheritance pattern.
Autosomal dominant
Higher level of education is considered a ___ factor for suicide attempt in transitional-aged youth with schizophrenia.
risk
A ten-year-old child is pervasively irritable and has had four severe temper outbursts weekly for the past two years. The outbursts involve hitting others, throwing tows, screaming and can occur with minimal provocation. The child’s teacher reports that the child is alienating peers and has difficulty functioning in the classroom. Which diagnosis best characterizes this presentation?
Disruptive mood dysregulation disorder
Associated functions of the ___ lobe include:
- Perception and integration of somatosensory information (e.g., touch, pressure, temperature, and pain)
- Visuospatial processing
- Spatial attention
- Spatial mapping
- Number representation
parietal
A genetic researcher wishing to study polymorphisms including short tandem repeats could use ___ to produce many copies of the portion of the genome under study.
polymerase chain reaction
A patient has psychosis, acute abdominal pain, reduced strength and tendon reflexes. Elevation in ___ would explain her symptoms.
Porphobilinogen (Pt has Acute Intermittent Porphyria)
A patient has chiropractic neck manipulation and soon after has dysarthric speech, ataxic gait, numbness over R body. The patient also complains of increased severity of neck pain radiating to the occiput. The symptoms likely caused by:
vertebral artery dissection
A talk show psychiatrist saying at start of show that they aren’t entering a physician-patient relationship with callers who seek his advice is addressing this broad claim that needs to be proven in malpractice cases:
Duty
___ analysis may identify a gene responsible for autistic-like traits displayed by multiple members of a family.
Linkage
Linkage analysis: Study aimed at establishing linkage between genes. Today linkage analysis serves as a way of gene-hunting and genetic testing. Linkage is the tendency for genes and other genetic markers to be inherited together because of their location ___ one another on the same chromosome.
near
Medical anthropological research has shown that, worldwide, dissociative symptoms most commonly represent ___ components of religious and ritual events.
normal
Motivational enhancement therapy for alcoholism focuses on patient ___ as a key treatment target.
ambivalence
Frieda Fromm-Reichman coined the term “___ ___” to capture aberrant qualities of mothering believed at one time to be a pathway to development of schizophrenia.
schizophrenogenic mother
Parental engagement in frequent conversation and thinking aloud is key to a toddler’s ___ development.
language
Greater therapist experience is closely associated with ___ dropout rate in outpatient psychotherapy.
decreased
The initial learning phase of a skilled motor sequence requires recruitment of the ___ and corticocerebellar systems.
corticostriatal
By age four years, most children have developed sufficient language skills to be able to engage in:
- parallel play
- puns and wordplay
- organized arguments
- moral decision-making
- story telling using words
story telling using words
___ circulating levels of GABA have been described in patients with depressive disorders.
Reduced
___gonadism is an adverse effect of maintenance treatment with methadone for opioid dependence.
Hypo
Naturalistic investigations of a treatment’s effects examine which of the following factors?
- Efficacy
- Accuracy
- Precision
- Efficiency
- Effectiveness
Effectiveness
The FDA specifically warns that antipsychotic medications prescribed for dementia-related behavioral disturbances are associated with stroke and increased risk of ___.
death
Confounding efforts to develop effective diagnostic tools and disease-modifying therapies is the realization that Alzheimer’s disease is mixed proteinopathy (amyloid and ___) frequently associated with other age-related processes such as cerebrovascular disease and Lewy body disease.
tau
Tourette syndrome is distinguished from other tic disorders by the presence of multiple motor tics and one or more ___ tics.
vocal
The Simpson-Angus Rating Scale assesses ___ symptoms.
motor
A seven-year-old continues to have enuresis despite monitoring fluid intake, adequate toileting and using a reward system. The pediatrician next suggests using an enuresis alarm. This treatment, also referred to as the bell-and-pad technique, is a form of ___ ___.
Classical conditioning
The human lymphocyte antigen HLA-B1502 is associated with significantly increased risk of Stevens-Johnson syndrome in the context of carbamazepine or lamotrigine use. The HLA-B1502 gene complex is most common among ___ Americans.
Asian
A female patient whose father got an aggressive upper GI tumor, drinks one standard alcoholic drink/day and wants to know if she should stop drinking to decrease her risk of cancer. Long-term abstinence would reduce her risk ___.
significantly
Which of the following represents the greatest vulnerability to development problems in children?
- Maternal non-infectious illness
- Maternal use of antidepressants
- Maternal mental illness diagnosed before child’s birth
- Early childhood infectious illness prior to age five
- Early childhood non-infectious illness prior to age five years
Maternal mental illness diagnosed before child’s birth
*Excessive ___ is the largest contributor to waste in health care.
ADMINISTRATION
Aspects of successful older age include independent living, positive adaptation, mastery, and growth. Which of the following factors is most important in achieving this success?
- Economic security
- Emotional well-being
- Cognitive preservation
- Lack of physical disability
- Active social engagement
Cognitive preservation
A 40yo comes to the ED following euphoria and feeling like they were “flying above the dance floor” at the club. The patient is now showing nystagmus and is socially withdrawn. Which of the drugs below would be most likely to produce this constellation of symptoms?
- Methcathinone
- Cocaine
- Amphetamine
- Ketamine
- Alcohol
Ketamine
What is primary pharmacotherapy indicated for catatonia?
Benzodiazepines (Lorazepam)
___ has a major role in the acute reinforcing effects of drugs of abuse.
Dopamine
Anorexia nervosa has a significant treatment literature supporting the use of structural ___ therapy.
family
In psychodynamic therapy, when a patient takes an action, prior to encouraging, asking or the therapist taking some other action, first ___ the patient’s action.
interpret
Which of the following examples of documentation of medication dosage is considered confusing and dangerous, and is therefore unapproved by the Joint Commission on Accreditation of Healthcare Organizations? 0.1 mg 40 mg 1.0 units 5,000 units 2,000 units
1.0 units is confusing and dangerous
In-person, telephone, or e-mail doctor-to-doctor “curbside” consultations are provided as part of low-intensity ___ mental health services.
telemedicine
___ acetylation activates transcription.
Histone
A 40yo was diagnosed with AIDS four years ago and has new-onset headache and cognitive decline. Brain MRI shows multiple ring-enhancing lesions suggesting ___ ___.
Toxoplasmosis gondii
Offering personal counseling and financial counseling services at the same location for healthcare provider burnout is a good idea to help ensure success by reducing ___.
stigma
For a child with ADHD and oppositional defiant disorder it may be helpful to find out what the child enjoys and create a behavior ___ program at home and at school.
rewards
From a neurodevelopmental perspective, the youngest age at which a child possesses sufficient cognitive ability such that the child is likely to meet the Appelbaum criteria for general healthcare decisision-making capacity is approximately ___ years.
twelve
The predominant site of the endocannabinoid receptor CB1 is the ___ membrane.
presynaptic
___ of patients impedes the process of cohesion with inpatient group therapy.
Turnover
Narcolepsy is associated with a ___-1 deficiency.
hypocretin
Whole ___ sequencing provides a highly efficient method for sequencing all protein-coding regions.
exome
If a patient sleeps 3-4 hours/night for up to two weeks in a row, to identify the mood disturbance contributing to the patient’s sleep pattern it would be helpful to ask “During these periods, how well rested do you ___ during the day?”
feel
A 25-year-old with seizure disorder since childhood is seen for evaluation of poorly controlled seizures. She has adenomas on the face, mostly around the nasolabial folds and cheeks. A fibrotic plaque is found in the lower back. The most likely diagnosis is which of the following:
- neurofibromatosis
- tuberous sclerosis
- Von Hippel Lindau
- Tay Sachs disease
- Sturge Weber syndrome
tuberous sclerosis
Which of the following features of schizophrenia has become less common in Western cultures?
- Alogia (“Without speech”)
- Catatonia
- Stilted speech
- Religious delusions
- Disorganized thought
Catatonia
After a stranger says “hello,” a 12-month-old child turns and looks at his mother before responding. When the mother smiles and nods her head, the infant laughs and smiles in response to the stranger. This behavior is an example of social ___.
referencing
___ is contained in sleep-promoting neurons of the ventrolateral preoptic nucleus.
GABA
A patient with dementia is admitted after a fall and is found to have a fractured wrist. The team recommends surgery, however the patient refuses. Which of the following is the most appropriate next step?
- Watchful waiting
- Seek a surrogate decision maker
- Assess patient’s capacity to refuse
- Perform the necessary procedures
- Contact the court for an emergency guardian
Assess patient’s capacity to refuse
Which of the following is most significantly affected when syringomyelia (cyst or cavity develops in the spinal cord) first presents?
- Proprioception
- Pain perception
- Auditory perception
- Vibratory perception
- Light touch perception
Pain perception
___cardia is an expected side effect for patients prescribed rivastigmine for Alzheimer disease.
Brady (rivastigmine is an anticholinesterase so boosts acetylcholine and is cholinergic, slowing heart rate)
___ is indicated for catatonia, neuroleptic malignant syndrome and major depressive disorder with psychotic features.
ECT
The ability of preschool children to regulate their ___ is strongly enhanced by the development of language.
emotions
The three major ___ mechanisms include DNA methylation (decreases transcription), histone modification (histone acetylation activates transcription) and expression regulation by micro-RNAs.
epigenetic
Which of the following genetic tests is preferred for the detection of Trisomy 21?
- G-banded karyotyping
- Single-nucleotide polymorphism
- Fluorescence in situ hybridization
- Comparative genomic hybridization
G-banded karyotyping
For X-linked dominant inheritance of genetic disorders, females are ___ as likely as males to be affected in a multigenerational pedigree.
twice
A patient with social phobia avoids almost all social gatherings. The avoidance is regulated by a reciprocal connection between the amygdala and the ___ ___ ___ ___ ___ ___.
periaqueductal gray area of the brainstem
Which two of the following compulsions are the most common in adults with obsessive-compulsive disorder?
- Cleaning
- Ordering
- Counting
- Checking
Cleaning and checking are the most common compulsions.
When used in treatment of insomnia, benzodiazepines ___ REM sleep.
decrease
Oral contraceptives containing estrogens ___ serum levels of lamotrigine.
decrease
Maternal ___ use prenatally is a perinatal factor specifically associated with the development of attention-deficit/hyperactivity disorder.
tobacco
Acute alcohol intoxication is likely mediated by ___ receptor antagonism and GABA-A receptor agonism.
NMDA
A 16-year-old is expelled from school for the third time since the beginning of the academic year, this time for bringing a knife. The previous expulsions were for fighting and stealing from the teacher. The adolescent has also been suspended several times for bullying classmates and skipping school. Over the next decade, these types of behaviors will most likely:
- increase
- decrease
- wax and wane
- remain the same
decrease
St. John’s wort is an alternative treatment for depression that carries a risk of ___ mania in patients with bipolar disorder.
inducing
In combination with growth hormone, ___ hormones are required to initiate the adolescent growth spurt.
gonadal (estrogen, progesterone, and testosterone)
The impaired physician who fails to obtain or benefit from treatment may require the services of an administrative psychiatrist skilled in performing fitness-for-duty evaluations. In these situations, the administrative psychiatrist is ___ bound by the usual parameters of confidentiality.
not
Contralateral leg weakness with sparing of the face and arm associated with urinary incontinence and abulia (inability to act decisively) are typical for a stroke in the territory of the ___ cerebral artery.
anterior
Which of the following is the most common comorbidity in a patient with an anxiety disorder?
- A mood disorder
- A personality disorder
- Another anxiety disorder
- A substance use disorder
- An impulse control disorder
Another anxiety disorder
A 60yo man has gastric bypass and a few weeks later develops gait imbalance and numbness in his feet. On exam he has hyperreflexia, spasticity in the legs and absent vibration sensation in the toes. Serum B12 is normal. Deficiency of which of the following is most likely to cause these symptoms?
- Iron
- Folate
- Copper
- Thiamine
- Pyridoxine
Copper
The ___ ___ measures the magnitude of difference between two intervention groups.
effect size
A 30yo has worsening disorientation and suspected delirium after initially having severe headache after starting a high protein, low carbohydrate diet. The patient had slow growth as a child. To definitively diagnose the individual, ___ transcarbamylase sequencing may be helpful.
Ornithine
Schizotypal personality disorder is suspected in patient with odd speech patterns, constricted affect and eccentric appearance. Which of the following additional features would support schizotypal personality disorder?
- Anhedonia
- Paranoid ideation
- Lack of social anxiety
- Auditory hallucinations
- Delusions of reference
Paranoid ideation
Retaining ___ in the relationship distinguishes empathy from identification.
objectivity
The clock drawing neuropsychological test examines both ___ and visuospatial functioning.
executive
*The number of new events in proportion to the population at risk for the event is referred to as ___ ___.
cumulative incidence
An insurance company pays a physician a single, standardized sum for a patient’s care during a one-year period. This is known as what type of payment?
Capitation
___ gender is associated with prolonged or complicated bereavement.
Male
Which of the following antiepileptic drugs reduces the efficacy of oral contraceptives?
- Valproate
- Gabapentin
- Zonisamide
- Levetiracetam
- Carbamazepine
Carbamazepine
DiGeorge syndrome/22q11.2 deletion syndrome/ velocardiofacial syndrome is a syndrome caused by the ___ of a small segment of chromosome 22. It is characterized by developmental delay, cardiac abnormalities, palate defects, immune deficiency, and an increased risk of schizophrenia.
deletion
___ muscle tone on electromyography when seen during REM sleep is suggestive of REM sleep behavior disorder.
Excess
A 12yo’s parents say he is “sleepy” during the day, often dazed and out of it. He is often not hungry and sometimes says he has nausea. On exam he has red eyes, runny nose and red sores around the mouth. He is likely using ___.
aerosols
Medicare Part B is an ___ purchasable benefit for senior citizens.
optional
Which of the following immunomodulators is associated with increased risk of significant depression in patients with cancer?
- Mitoxantrone
- Natalizumab
- Glatiramer
- Interferon
- Fingolimod
Interferon
Which of the following antipsychotics has the lowest risk of QT prolongation?
- Quetiapine
- Haloperidol
- Ziprasidone
- Aripiprazole
- Thioridazine
Aripiprazole
Parents meet with psychiatrist about their teen who has confusion about gender and identity, and the teen refused to come to the appointment. It would be worthwhile to first ask the parents (in this visit where teen is not present and its just the parents), “what ___ do you want me to use when referring to your child.”
pronoun
Personalized dosing according to CYP genotype is best established for which of the following classes of medications?
- Opioids
- Mood stabilizers
- Typical antipsychotics
- Atypical antipsychotics
- Tricyclic antidepressants
Tricyclic antidepressants
Which of the following physical health conditions has the highest risk of suicide?
- Epilepsy
- Back pain
- Brain injury
- COPD
- HIV
Brain injury
A mother’s capacity to understand her infant’s internal states, which is communicated by ___ is called holding.
mirroring
___ community treatment is an appropriate treatment modality option to take care of a patient who has a long history of non-adherence with treatment, multiple hospitalizations, impulsive / violent behaviors and family family members have become reluctant to take care of the patient.
Assertive
Slow-wave sleep enhances the secretion of ___ ___.
growth hormone
In a patient with early-stage cognitive impairment, preserved calculation skills suggest a ___ rather than cortical dementia.
subcortical
___ ___ ___ ___ = 1 / (Absolute risk reduction)
Number needed to treat
Psychodynamic theory, which focuses on the here-and-now interactions between therapist and patient and identifies transference and countertransference as uniquely co-created by patient and therapist together, has its roots in ___-psychology.
self
Which of the following disorders is the most common among patients who complete suicide?
- Mood
- Somatoform
- Anxiety
- Psychotic
- Personality
Mood
Individuals exposed in utero to the 1944-45 Dutch “hunger winter” have elevated rates of disease, including heart disease, breast cancer, obesity, and cognitive function. Robust evidence has implicated differences in DNA ___.
methylation (which decreases transcription)
Which of the following approaches has demonstrated efficacy in the treatment of trichotillomania?
- Group therapy
- Habit reversal therapy
- Relapse prevention therapy
- Interpersonal psychotherapy
- Psychodynamic psychotherapy
Habit reversal therapy
Which of the following infant attachment styles is characterized by paying little overt attention to the parent’s presence?
- Secure
- Avoidant
- Resistant
- Ambivalent
- Disorganized
Avoidant
Magnetic resonance imaging is the most sensitive, non-invasive clinical tool for monitoring ___ in patients with multiple sclerosis.
inflammation
A 30yo patient with diabetes comes in with eyelid ptosis that worsens towards the end of the day. They have double vision while reading. The symptoms improve upon awakening the following morning. The patient denies pain and eye exam is otherwise unremarkable. Likely cause is ___ ___.
Myasthenia gravis
antibodies against postsynaptic acetylcholine receptors
A 30yo with intellectual disability and autism spectrum disorder presents with depression. On exam, the patient has a long face, large everted ears, prominent jaw, macroorchidism and a ___ arched palate as well as frequent hand flapping. The patient likely has Fragile X syndrome (caused by trinucleotide expansion of the FMR1 gene, the most common INHERITED form of intellectual disability).
high
Fragile X syndrome is caused by a (CGG) trinucleotide expansion of the FMR1 gene and is the most common ___ form of intellectual disability.
inherited
Down syndrome is the most common ___ cause of intellectual disability.
genetic
What is the most common genetic cause of intellectual disability?
Down syndrome
What is the most common inherited cause of intellectual disability?
Fragile X syndrome
A 67yo woman notes tearfulness, sadness and intermittent insomnia since the sudden death of her husband seven months ago due to a stroke. She says she still can’t believe he is gone, thinks about him much of the day and while she wishes she were dead so she could be with him, does not have thoughts of harming herself. Which of the following is the most likely diagnosis?
- Normal grief
- Major depressive disorder
- Separation anxiety disorder
- Posttraumatic stress disorder
- Persistent complex bereavement disorder
Normal grief
Between 2001 and 2013 which two of the following groups experienced the greatest increase in high-risk drinking and alcohol use disorder diagnoses?
- Males
- Adolescents
- Older adults
- Majority race/ethnicity
- Higher socioeconomic groups
Adolescents and older adults
Which of the following is most strongly associated with higher frequency of medically certified sick leave from work?
- High workload
- Limited use of skill set
- Limited decision authority
- Unclear workplace policy and procedures
- Perceived poor relationship with supervisor
Perceived poor relationship with supervisor
When initially speaking with a patient who feels sad about recently learning they have end stage disease, feels hopeless, no plan to hurt themself, a fair approach would be to initially ___ the patient as having a normal reaction to an overwhelming situation.
validate
Dialectical behavioral therapy focuses on providing psychoeducation, validating patient’s emotional vulnerability and encouraging ___.
change
Widening concern for the larger social system and differentiation of one’s own social, political and historical system from others primarily occurs primarily during the developmental transition from ___ ___ to ___ ___.
Young adulthood to middle adulthood
In the mesocorticolimbic system dopaminergic neurons originate in the ___ ___ ___.
ventral tegmental area
Which of the following is most often cited by the literature as a significant barrier to adopting an electronic health record (EHR)?
- Age of many practitioners
- Initial cost of introducing a system
- Effects of system on physician autonomy
- Lack of interoperability with other systems
- Ambiguity of Federal and State policies on EHR use
Initial cost of introducing a system
___ is often an appropriate initial step prior to psychotherapy or pharmacotherapy.
Psychoeducation
Using an internet search to gather information about a patient may be appropriate to ___ between the patient’s grandiose delusions and reality.
distinguish
Which of the following antipsychotics is absorbed primarily through the oral mucosa?
- Clozapine
- Asenapine
- Iloperidone
- Aripiprazole
- Ziprasidone
Asenapine/Saphris
What is the rate-limiting enzyme in the synthesis of norepinephrine?
Tyrosine hydroxylase (converts L-Tyrosine to L-Dihydroxyphenylalanine aka L-DOPA)
The ___ cingulate cortex is a key component of the salience network.
anterior
If a patient in remission has a lifetime history of 3 episodes of depression ___ pharmacotherapy is likely appropriate.
maintenance
The Continuous Performance Test measures ___ attention.
sustained
Family-based genetic association studies have the advantage over case-control association studies in that family-based genetic association studies are less affected by ___ population differences.
systematic
*___ ___ is the most common cause of premature death in individuals with schizophrenia.
Cardiovascular disease
___ codes as compared to genetic codes are three-dimensional structures.
Epigenetic
Emotional ___ is an essential parental factor for healthy child development.
attunement
In the first two years of life the motor cortex (front lobe) develops ___ of the sensory cortex (parietal lobe).
ahead
FDA-approved use of deep brain stimulation for treatment-resistant obsessive-compulsive disorder involves stimulation of the ___ ___ ___ ___ ___ ___.
anterior limb of the internal capsule
The ___ ___ cortex is most closely associated with working memory (temporarily storing and manipulating information).
dorsolateral prefrontal
An 80yo presents with severe memory loss, impaired social judgment, restricted interests, and inability to perform activities of daily living independently. The best combination of therapy to reduce decline in attention and global functioning would be donepezil plus ___, which is an uncompetitive antagonist at glutamatergic NMDA receptors.
memantine
Severe dizziness with rolling over in bed and tilting head back is suggestive of ___ ___ ___ ___.
benign paroxysmal positional vertigo
Which of the following augmentation agents has the best evidence for efficacy in patients with obsessive-compulsive disorder who have an inadequate response to a selective serotonin reuptake inhibitor?
- Lithium
- Bupropion
- Quetiapine
- Olanzapine
- Aripiprazole
Aripiprazole
What is the term for clusters of alleles that are in linkage disequilibrium and inherited as a single unit?
Haplotypes
___ ___ refers to the non-random association of alleles at two or more loci in a general population. When alleles are in ### ###, haplotypes (clusters of alleles that are in ### ### and inherited as a single unit) do not occur at the expected frequencies.
Linkage disequilibrium
The neural tube is formed from ___.
Ectoderm
A type ___ error is when the true null hypothesis is erroneously rejected.
1
A 55yo with no PSH develops changes in personality and impulsive, disinhibited behavior. Brain imaging does not suggest any lesion. On positron emission tomography (tracks glucose analog uptake indicating metabolic activity) will likely see ___ perfusion in bilateral lateral temporal lobes.
reduced
A 30yo comes to ED reporting ringing in the ears, nausea, vomiting. Respirations are deep and rapid. Pt overdoses on numerous, unidentified pills, most likely which of the following?
- Aspirin
- Trazodone
- Propranolol
- Lorazepam
- Acetaminophen
Aspirin
A patient reports feeling detached from his surroundings, which seem fantasy-like and bizarre. In the mental status examination the psychiatrist notes the patient has having:
- illusion
- deja vu
- jamais vu
- derealization
- depersonalization
derealization
The Stroop Color Word Test relies on ___ of overlearned behaviors to assess executive function.
inhibition
Restless leg syndrome has been associated with deficiency of which substance?
Iron
Pramipexole, a first-line treatment for restless leg syndrome, is a nonergot dopamine agonist with specificity for the D2 subfamily dopamine receptor and has also been shown to bind to D3 and D4 receptors. By binding to these receptors it is thought that pramipexole can stimulate dopamine activity on the nerves fo the striatum and substantia nigra.
The neurogenic hypothesis of depression postulates that antidepressant efficacy depends on ___ in the hippocampus.
neurogenesis
In cognitive psychology, the process by which a person’s reaction to stimuli decreases with repeated presentation is referred to as ___.
habituation
Which of the following is a risk factor for rapid cycling bipolar disorder?
- Female sex
- Opiate abuse
- Hyperthyroidism
- Age under 25 years
- Narcissistic personality disorder
Female sex
What is the optimal time to conduct amniocentesis for chromosomal analysis of genetic disorders?
- 8 weeks gestation
- 12 weeks gestation
- 20 weeks gestation
- 28 weeks gestation
- 34 weeks gestation
20 weeks gestation
Which of the following psychiatric disorders is the most prevalent in patients with cancer?
- Delirium
- Major depression
- Adjustment disorder
- Brief psychotic disorder
- Generalized anxiety disorder
Adjustment disorder
Antagonism at which of the following neuropeptide receptors promotes analgesic effects?
- Oxytocin
- Endorphin
- Dynorphin
- Nociceptin
- Enkephalin
Nociceptin
Which of the following conditions is held to a stricter confidentiality standard by federal law?
- Suicidality
- Homicidality
- Substance use disorders
- Psychotic disorders
- Treatment with electroconvulsive therapy
Substance use disorders
Which of the following forms of competency requires the highest legal threshold?
- Creating a will
- Driving privileges
- Advanced directives
- Durable power of attorney
- Making financial decisions
Making financial decisions
A patient responds to questions with brief, concrete replies. The patient has poverty of speech and at times repeats the questions asked. ___ is a process of poor thinking inferred from speech and language usage. There may be a general lack of additional, unprompted content seen in normal speech: the replies to questions may be brief and concrete, with a reduction in spontaneous speech.
Alogia (“without” “speech”)
If a child expresses desire to attend a funeral, have someone familiar ___ the child.
accompany
Which of the following is the foundational factor that leads to successful abstinence for individuals participating in Alcoholics Anonymous?
- Believing in God
- Having a sponsor
- Attending weekly meetings
- Receiving chips as a motivation
- Recognizing that they are an alcoholic
Recognizing that they are an alcoholic
A patient who vomits, for example in context of eating disorder, may have elevated serum ___.
amylase
- A 12-year-old child is brought by an exasperated parent for evaluation due to child’s belligerent refusal to do chores or homework. The child constantly talks back, is described as irritable much of the time, and is easily annoyed by others. The child purposely annoys other children and, as a result, does not have any friends. Which of the following diagnoses best characterizes the child’s presentation?
- Conduct disorder
- Bipolar disorder, type 1
- Oppositional defiant disorder
- Attention-deficit/hyperactivity disorder
- Disruptive mood dysregulation disorder
Oppositional defiant disorder
The Clinical Antipsychotic Trials of Intervention Effectiveness - Alzheimer’s Disease (CATIE-AD) demonstrated that, relative to placebo, antipsychotic medication use for the treatment of behavioral disturbance in participants had which of the following effects in the majority of subjects by week 12?
- Improved amotivation
- Improved quality of life
- Reduced suspiciousness
- Improved functional status
- Reduced caregiver burden
Reduced suspiciousness
The four processes that reflect the flow and focus of a motivational interviewing conversation are: engaging, focusing, planning and ___.
evoking
The pleasurable effects of drugs of abuse begin with increased neurotransmitter release in the ___ ___.
nucleus accumbens
Which of the following types of memory is most dependent on medial temporal lobe integrity?
- Implicit
- Working
- Procedural
- Declarative
- Retrospective
Declarative
A questionnaire to screen for major depressive disorder has no inquiries pertaining to depressed mood, but has a few inquiries pertaining to spending sprees. Which of the following forms of validity is most affected?
- Content
- Criterion
- Construct
- Concurrent
- Convergent
Content
For a psychological test to demonstrate content validity it must sample the area of interest adequately.
When a child is having difficulty at school, parents aren’t sure of any stressors, child is reluctant to go in the morning, it is especially important to get child, parent and ___ collateral and so for the latter a release to speak should be obtained.
teacher
Which type of therapy focuses on building self-esteem and a cohesive sense of self, as well as improving interpersonal relationships in individuals with more severe psychopathology?
- Cognitive
- Dialectical
- Behavioral
- Supportive
- Psychodynamic
Supportive
Although physical health and cognitive function may decline in older age, sense of well-being often ___ in older age.
increases
Corticosteroids lead to ___ AMPA glutamate receptor signalling in the hippocampus.
decreased
The neuropsychological finding that best distinguishes Alzheimer dementia from depression is that patients with Alzheimer dementia have memory deficits that do ___ improve with hints or cues.
not
In a geriatric patient with known dementia and at risk of delirium in the hospital, ___ may be a test helpful to delineate between worsening dementia and delirium.
electroencephalogram (EEG)
Which of the following is most associated with an increase in the risk of developing Alzheimer disease in a person with mild cognitive impairment?
- Anxiety
- Tobacco smoking
- Previous head trauma
- College level education
- Elevated blood pressure
Elevated blood pressure
Meperidine is a serotonergic opioid that when added to other serotonergic agents could lead diaphoresis, delirium, psychomotor agitation, hyperactive reflexes, inducible clonus at the ankles, fever, hypertension or in other words, ___ ___.
serotonin syndrome
A parent of a child with a recent suicide attempt is advised to remove firearms and parent declines saying they need them for protection and will secure them. The psychiatrist files a report with child protective services. The ethical conflict that conflicts with this decision is ___.
Autonomy
The Center for Medicare and Medicaid’s Care of Mental, Physical, and Substance-use Syndromes (COMPASS) program tested the effectiveness of the collaborative care model for patients with depression and comorbid cardiovascular disease and/or diabetes. Which of the following factors did nurse case managers report as the biggest challenge they faced during implementation of the program?
- Documentation burdens
- Difficulties enrolling the target sample
- Patient non-adherence or lack of motivation
- Lack of time to accomplish all necessary tasks
- Lack of engagement of the primary care doctor or psychiatrist
Patient non-adherence or lack of motivation
If a psychiatrist is aware of physical abuse and does not report it, this opens liability to legal ___.
sanctions
A geriatric patient is prescribed an SSRI for depression and two week’s later the patient’s family notes they are more lethargic, confused, have headaches and an unsteady gait. Which of the following lab values is most likely to be abnormal in this patient?
- Creatinine
- Serum sodium
- Cardiac enzymes
- Serum glucose
- Liver function studies
Serum sodium
A lawsuit charges that a psychiatric facility prematurely discharged a patient who was not approved for further stay by the managed care company. The final legal responsibility generally falls to the:
- psychiatrist
- managed care company
- managed care reviewer
- psychiatric hospital
- hospital medical director
psychiatrist
The sleep of a healthy 70-year-old is most likely to show a decrease or absence of which of the following?
- REM sleep
- Slow waves
- K complexes
- Alpha waves
- Sleep spindles
Slow waves
Lower birth weight corrected for gestational age most strongly predicts the risk for later development of which of the following?
- Schizophrenia
- Autism spectrum disorder
- Major depressive disorder
- Intellectual developmental disorder
- Attention-deficit/hyperactivity disorder
Attention-deficit/hyperactivity disorder
*An 18yo with BPAD 1 has been euthymic for the past 12 months on lithium therapy, but has had trouble focusing on readings and maintaining attention in school. His parents describe history that aligns with ADHD, inattentive subtype. Addition of methylphenidate may improve the patient’s cognitive symptoms ___ increasing his risk of subsequent mania.
*without
On exam, a patient pursuing slow movement of a finger with the eyes in different directions shows “jerky” eye movements. This finding is suggestive of which of the following?
- Multiple sclerosis
- Parkinson disease
- Wernicke encephalopathy
- Phencyclidine intoxication
- Benzodiazepine intoxication
Parkinson disease
An 11yo is jealous of parents attention to academic success of gifted older sibling. At summer camp, the 11yo gets strongly attached to an older camper who is accomplished martial artist that shows the child some basic skills. When the child returns home he becomes a dedicated martial artist. The parents note he seems less jealous of the older sibling. Which psychodynamic defense mechanism best accounts for the child’s behavior?
- Suppression (conscious, often healthier than repression)
- Repression (unconscious)
- Sublimation
- Displacement
- Isolation of affect
Sublimation
Which of the following cations blocks the NMDA receptor at resting membrane potential?
- Sodium
- Calcium
- Potassium
- Magnesium
- Phosphorus
Magnesium
A patient with recurrent upper GI bleeding develops a moderately severe major depressive episode for which antidepressant treatment is appropriate. Which of the antidepressants below is least likely to increase the risk of bleeding?
- Citalopram
- Mirtazapine
- Venlafaxine
- Nortriptyline
- Escitalopram
Mirtazapine
Which of the following is the most common biological causes of prenatal neurotoxicity linked to the development of intellectual disability?
- Alcohol exposure
- Lead exposure
- Maternal diabetes
- Mercury exposure
- Radiation exposure
Alcohol exposure
Which of the following is the best predictor of later functional and adaptive outcomes in autism spectrum disorder?
- Age of onset
- Verbal ability at age five years
- Hyporeactivity to sensory input
- Presence of highly restricted, fixated interests
- Frequency of stereotyped or repetitive motor movements
Verbal ability at age five years
A pt goes to therapist noting “disturbing thoughts.” They spend 2+ hours each morning to confirm the oven is off, an hour checking CO levels in the children’s rooms each night. They say if they don’t do these things, they constantly worry the family will die of CO poisoning, despite recognition that this is highly unlikely. Which of the following techniques is most commonly used in the treatment of this condition.
- Behavioral activation
- Mindfulness techniques
- Motivational interviewing
- Encouragement to elaborate
- Exposure and response prevention
Exposure and response prevention
A 70yo has a stroke on the left side of the brain resulting in right-sided hemiparesis. Which of the following gait abnormalities is most commonly associated with this type of lesion?
- Ataxic
- Shuffling
- Scissoring
- Paraparetic
- Circumduction
Circumduction (gait in which the leg is stiff, without flexion at knee and ankle, and with each step is rotated away from the body, then towards it, forming a semicircle.)
Disorganization of behavioral and physiological circadian rhythms is caused by ablation of which of the following areas of the brain in primates?
- Red nucleus
- Caudate nucleus
- Lentiform nucleus
- Nucleus accumbens
- Suprachiasmatic nucleus
Suprachiasmatic nucleus
Which of the following magnetic resonance imaging studies would demonstrate an abnormality in mild traumatic brain injury?
- FLAIR
- T1 weighted
- T2 weighted
- Diffusion tensor imaging
- Positron emission tomography
Diffusion tensor imaging
At approximately 18 months, the typically developing child demonstrates which of the following language development milestones?
- Uses verbs in phrases
- Uses word combinations
- Produces meaningful words
- Speaks in complete sentences
- Makes repetitive vowel sounds
Uses word combinations
By what age does core gender identity typically form?
Three years old (3)
Severity of cognitive deficits associated with severe head trauma most closely correlates with:
- mechanism of injury
- premorbid educational status
- anatomic location of brain injury
- duration of posttraumatic amnesia
- severity of Glasgow Coma score at time of injury
duration of posttraumatic amnesia
In the United States, studies examining demographic differences reported the lowest one-year prevalence rate of alcohol use disorders among which group?
- Asian Americans
- Native Americans
- African Americans
- Hispanic Americans
- Non-Hispanic White Americans
Asian Americans
The gag reflex and palatal elevation assess function of which cranial nerve?
The vagus nerve (X)
A typically developing 3yo should be capable of which of the following motor skills?
- Skipping
- Tandem walking
- Copying a triangle
- Pedaling a tricycle
- Following a three-step command
Pedaling a tricycle
Which of the following areas of the hypothalamus have been reported to play a central role in maternal behavior of mothers towards infants?
- Arcuate
- Preoptic
- Paraventricular
- Tuberomamillary
- Suprachiasmatic
Preoptic
“Therapeutic misconception” refers to which of the following with regard to obtaining informed consent in research trials?
- Misconception that patients with dementia cannot give consent
- Assumption by the researcher that the trial’s primary purpose is to help the patient
- Lack of understanding by subjects that they can drop out of the research trial at any time
- Misunderstanding by the researcher that the research participants will benefit from participation
- Assumption by research participants that decisions about their care are being made solely with their benefit in mind
Assumption by research participants that decisions about their care are being made solely with their benefit in mind
The evidence suggests that after completing a course of treatment for insomnia disorder, long-term outcomes are better among patients who were treated with which of the following?
- Zolpidem
- Trazodone
- Biofeedback
- Diphenhydramine
- Cognitive behavioral therapy
Cognitive behavioral therapy
Which of the following most accurately characterizes the neuropsychiatric changes associated with aging?
- It takes longer to learn new material, and complete learning occurs
- New material is learned more quickly, and complete learning occurs
- It takes longer to learn new material, and complete learning does not occur
- There is no difference in the time taken to learn new material, and complete learning occurs
- There is no difference in the time taken to learn new material, but complete learning does not occur
It takes longer to learn new material, and complete learning occurs
A 49yo complains to the neurologist of an urge to move both legs after lying in bed each night. The patient’s spouse reports that during the day and throughout night the patient has limb jerks. The spouse also notes that the patient is becoming depressed. First-line treatment for this condition would be prescribing which of the following medications?
- Tramadol
- Ropinirole
- Gabapentin
- Mirtazapine
- Clonazepam
Ropinirole (dopamine agonist)
Which of the following is the most commonly validated risk factor for autism?
- Birth order
- Vaccination
- Advanced parental age
- Low maternal education
- Low parental socioeconomic status
Advanced parental age
An overweight patient with type 1 diabetes mellitus manipulates insulin dosing in an attempt to lose weight. This behavior is most consistent with a diagnosis of:
- factitious disorder
- conversion disorder
- somatic symptom disorder
- avoidant/restrictive food intake disorder
- psychological factors affecting other medical conditions
psychological factors affecting other medical conditions
Oxytocin suppresses the ___ during emotionally charged situations.
amygdala
Energy homeostasis is thought to be regulated by leptin (inhibits hunger) receptors in which of the following brain regions?
- Midbrain
- Hippocampus
- Hypothalamus
- Periaqueductal grey
- Parabrachial nucleus
Hypothalamus
Which of the following enzymes is the rate-limiting step in the synthesis of dopamine?
- Monoamine oxidase
- Tyrosine hydroxylase
- Phenylalanine hydroxylase
- Catechol-O-methyltransferase
- Dihydroxyphenylalanine decarboxylase
Tyrosine hydroxylase
In biofeedback, the relaxation state coincides with decrease in:
- PaCO2 level
- skin conductance
- finger temperature
- parasympathetic tone
- respiratory heart rate variability
skin conductance
Damage to which of the following structures may account for flapping movements of the limbs seen in carbon monoxide poisoning?
- Caudate
- Amygdala
- Cerebellum
- Globus pallidus
- Substantia nigra
Globus pallidus
Which of the following medications have the best evidence for monotherapy treatment of bipolar depression?
- Bupropion
- Citalopram
- Quetiapine
- Lurasidone
- Ziprasidone
- Lamotrigine
- Aripiprazole
- Olanzapine-Fluoxetine combination
- > Quetiapine
- > Lurasidone
- > Olanzapine-Fluoxetine combination
Which of the following repeat expansion disorders is more commonly associated with greater repeat instability with paternal transmission than with maternal transmission?
- Friedreich ataxia
- Huntington disease
- Fragile X syndrome
- Myotonic dysphrophy type 1
Huntington disease
Which of the following DNA-based discovery techniques can empirically interrogate a genome without any a priori genetic hypothesis?
- Twin studies
- Linkage analysis
- Candidate gene approach
- Genome-wide association studies
Genome-wide association studies
A metabolite of which of the following hormones is a potent allosteric modulator of the GABA-A receptor and has been implicated in depression?
- Cortisol
- Oxytocin
- Estrogen
- Progesterone
Progesterone
In CJD or prion diseases, see dementia, myoclonus and on autopsy cortical stain, cytosolic ___ of neurons and glia with prion inclusions.
vacuolation
Lithium was first approved by the US FDA for treatment of acute mania in 1970. The most important reason why lithium had difficulty entering the US market is that pharmaceutical companies were reluctant to produce a drug that they could not ___.
patent
An 8yo boy is reported by teachers to be sexually seductive to other children, to openly display sexual behavior and to sexualize play activities. This is most likely a manifestation of:
- precocious puberty
- previous sexual abuse
- normal sexual behavior
- borderline intellectual disability
previous sexual abuse
Which of the following factors is the primary contributor to the increased rates of incarceration in the United States since 1990?
- Higher crime rates
- More arrests per crime
- Fewer juveniles arrested and convicted
- Higher use of mandatory minimum sentences
Higher use of mandatory minimum sentences
A recently adopted three-year-old is brought for evaluation of inhibited, emotionally withdrawn behavior. The child rarely seeks or responds to comfort when distressed, and has limited positive affect and emotional responsiveness to others. What additional history is required for the most likely diagnosis?
- Serious neglect
- Restricted interests
- Ritualized behaviors
- Developmental delay
Serious neglect
By the age of about 15 months, typically developing children being to achieve which of the following milesetones?
- Infer others’ emotions and content
- Engage in reciprocal conversation
- Display social smile and gesture in peer interactions
- Understand that others have minds different from their own
Understand that others have minds different from their own
In ___ conditioning, praising the spouse for having picked up dirty dishes would be an example of a positive reinforcer.
operant
In a symptom-free person who has a relative with Alzheimer disease, genetic testing for Alzheimer disease has ___ predictive value.
limited
Which of the following statements best describes current thinking about the relationship between attention-deficity/hyperactivity disorder (ADHD) in children and adults?
- They appear to be separate disorders, although there is some overlap.
- Most adults with ADHD did not have significant symptoms as children.
- A significant number of children with ADHD will go on to become adults with ADHD.
- Adults can receive the diagnosis of ADHD even if they did not have symptoms as children.
A significant number of children with ADHD will go on to become adults with ADHD.
A patient is hospitalized for shortness of breath and chest pain. Further workup reveals lung cancer. The patient asks the physician not to tell the patient’s spouse about the cancer diagnosis but, instead, to indicate the patient has pneumonia so that the spouse will not worry. Which of the following is the most appropriate response by the physician?
- As requested, tell the spouse that the patient has pneumonia.
- Answer the spouse, but only if the spouse directly asks about a cancer diagnosis.
- Let the patient know that it is unethical to lie, and inform the spouse of the diagnosis.
- Tell the spouse that the patient has not given permission to discuss the patient’s care.
Tell the spouse that the patient has not given permission to discuss the patient’s care.
Needle exchange is an example of which of the following types of reduction strategies?
- Harm
- Supply
- Access
- Demand
Harm
___ (inverse agonist and antagonist of 5-HT2A receptors with no dopaminergic receptor affinity) is used to treat hallucinations and delusions associated with Parkinson’s disease psychosis.
Pimavanserin
When prescribed for long-term use, most patients will require a ___ benzodiazepine dose over time.
stable
The ___-___ ___, striatum and thalamus form a circuit that when overactive produces worry/obsessive symptoms. This is why neurosurgical approaches for the treatment of refractory obsessive-compulsive disorder target the cortico-striatal-thalamo-cortical circuitry.
dorsolateral-prefrontal cortex
Decreased dopamine in the ___ projection of the dorsolateral prefrontal cortex is postulated to be responsible for the negative and depressive symptoms of schizophrenia.
mesocortical
Hyperactivity of dopamine in the ___ pathway mediates positive psychotic symptoms.
mesolimbic
What is the most frequently studied deep brain stimulation depression target?
Subcallosal cingulate cortex (The neurosurgeons doing deep brain stimulation aim for the SCC)
___ plays a key role in fine-tuning working memory (temporarily storing and manipulating information such as when doing mental arithmetic) function in the dorsolateral prefrontal cortex.
Dopamine
In response to stress, corticotrophin-releasing hormone (CRH) is released from the ___ ___ of the hypothalamus.
Paraventricular nucleus
Pramipexole is an effective first-line treatment for patients with restless leg syndrome. Pramipexole is a dopamine agonist with specificity for the D2 subfamily dopamine receptor, and has also been shown to bind to D3 and D4 receptors. By binding to these receptors, it is thought that pramipexole can stimulate dopamine activity on the nerves of the striatum and ___ ___.
substantia nigra
Modafinil/Provigil significantly increases dopamine in the brain by ___ dopamine transporters; however, it has a lower affinity for dopamine receptors compared to amphetamines. Labeled indications of modafinil/provigil include narcolepsy, OSA, shift work sleep disorder. Off-label uses of modafinil/provigil include ADHD, cancer-related fatigue, MDD (antidepressant augmentation), multiple sclerosis-related fatigue.
blocking
___ ___ posited that development occurs in sequential, clearly defined stages, and that each stage must be resolved for development to proceed smoothly.
Erik Erikson
Erik Erikson posited that development occurs in sequential, clearly defined stages, and that each stage must be resolved for development to proceed smoothly. Erikson’s stages of development:
- Trust vs mistrust (birth to 18 months)
- Autonomy vs shame and doubt (18 months to 3 years)
- Initiative vs guilt (3 to 6 years)
- Industry vs inferiority (6 to 12 years, school age)
- ____ vs ___ ___ (12 to 18 years; Dr. A-D’s 15yo twins)
- Intimacy vs isolation (19 to 40 years)
- Generativity vs stagnation (40 to 65 years)
- Ego integrity vs despair (65 to death)
Identity vs role confusion
___ effects, when dysfunctional, have been shown to most comprehensively replicate the core symptoms of schizophrenia.
Glutamate (Part of PCP’s MOA is NMDA antagonism which produces acute psychosis that mimics schizophrenia and leads to excess neurotransmitter release that can cause agitation and seizures)
Erik Erikson defined ___ ___ as lack of continuity in how the self if experienced in relationships over time.
identity diffusion
The ___ dopaminergic pathway includes the nucleus accumbens (part of ventral striatum and mediates addiction and associated behaviors).
Mesolimbic (Dopamine blocking antipsychotics decrease pleasure by blocking the mesolimbic pathway)
Following a full-term normal birth, circadian sleep rhythms (suprachiasmatic nucleus) are similar to those of an adult by ___ months.
six (6) months
___ is the stage of development when the maximal number of axons and synapses exist.
Infancy
___ accounts for the brain’s rapid increase in size from birth through the second year of life.
Synaptogenesis
In typically developing children the corticospinal tracts have completed myelination by ___ years of age
three (3) yo
The development of brain grey matter volume peaks during ___ childhood. Adolescence is the stage of development in which maximal pruning of cortical synapses occurs.
late
The development of brain grey matter volume peaks during late childhood. ___ is the stage of development in which maximal pruning of cortical synapses occurs.
Adolescence
Synaptic ___ predominantly occurs during adolescence and young adulthood.
pruning
Freud’s theory of psychosocial development emphasizes that as humans develop they become ___ on different and specific objects through their stages of development.
Oral: birth-1yo (Receiving pleasure through nursing and sucking (stuck? histrionic)
Anal: 1-3yo (The toddler focuses on receiving pleasure in evacuating his bowels (stuck? OCD)
Phallic: 3-6yo (the gratitification is now focused on the phallis) [Eliza Grey attack at 5yo!]
Latency: 6-puberty [Here the drives are seen as dormant and hidden, and pleasure is mostly related to secondary process thinking] [Freud’s latency: 6-puberty, lines up somewhat with Erikson’s Industry vs Inferiority: 6-12yo, school age]
Genital: puberty on -> (There is genital interest, but expressed in love relationships, families, responsibilities of adulthood)
fixated
*DNA ___ recruits proteins involved in gene repression or by inhibiting the binding of transcription factors to DNA.
*methylation
*DNA ___ (generally rapid and reversible) increases expression of genes through transcription activation (acetyl groups cause histone groups to wrap DNA less tightly, so it is more readily accessible/able to be transcribed).
*acetylation (Acetylation of lysine residues in histone proteins relaxes chromatin structure)
The ___ has the highest concentration of serotonin-producing cells in the brain.
Raphe nuclei
The raphe nuclei has the highest concentration of ___-producing cells in the brain.
serotonin
Norepinephrine is mostly synthesized in the ___.
locus coeruleus
___ is mostly synthesized in the locus coeruleus.
Norepinephrine
___ prevention involves methods to detect and address an existing disease prior to the appearance of symptoms.
Secondary prevention
Secondary prevention involves methods to detect and address an existing disease ___ to the appearance of ___.
prior; symptoms
___ prevention involves methods to reduce the harm of symptomatic disease such as disability or death through rehabilitation and treatment (Pt on seroquel gets diabetes mellitus, treat with metformin).
Tertiary prevention
Tertiary prevention involves methods to reduce the harm of ___ disease such as disability or death through rehabilitation and treatment (Pt on seroquel gets diabetes mellitus, treat with metformin).
symptomatic
Tertiary prevention involves methods to ___ the harm of symptomatic disease such as disability or death through rehabilitation and treatment (Pt on seroquel gets diabetes mellitus, treat with metformin).
reduce
Varenicline/Chantix is a partial agonist at ___ nicotinic acetylcholine receptors. Varenicline activates these receptors to a lesser extent than the full agonist nicotine and also prevents nicotine from binding to these receptors. Reward properties of nicotine are most closely associated with nicotinic acetylcholine receptor ___.
alpha4beta2; alpha4beta2
___/___ is a partial agonist at alpha4beta2 (Alpha4Beta2) nicotinic acetylcholine receptors. Varenicline activates these receptors to a lesser extent than the full agonist nicotine and also prevents nicotine from binding to these receptors. Reward properties of nicotine are most closely associated with nicotinic acetylcholine receptor alpha4beta2.
Varenicline/Chantix
Varenicline/Chantix is a ___ agonist at alpha 4 beta 2 (Alpha4Beta2) nicotinic acetylcholine receptors. Varenicline activates these receptors to a lesser extent than the full agonist nicotine and also prevents nicotine from binding to these receptors. Reward properties of nicotine are most closely associated with nicotinic acetylcholine receptor alpha4beta2.
partial
An epigenetic cause of fragile X syndrome involves methylation of the ___ sites of the promoter region of the fragile X mental retardation 1 gene. Fragile X syndrome is the most common cause of inherited intellectual disability (Trinucleotide repeat in FMR1 gene. Long face, large everted ears, prominent jaw, macroorchidism and a high arched palate, frequent hand flapping).
CpG
An epigenetic cause of fragile X syndrome involves methylation of the CpG sites of the ___ region of the fragile X mental retardation 1 gene. Fragile X syndrome is the most common cause of inherited intellectual disability (Trinucleotide repeat in FMR1 gene. Long face, large everted ears, prominent jaw, macroorchidism and a high arched palate, frequent hand flapping).
promoter
An epigenetic cause of fragile X syndrome involves methylation of the CpG sites of the promoter region of the fragile X mental retardation 1 gene. ___ ___ ___ is the most common cause of inherited intellectual disability (Trinucleotide repeat of CGG in FMR1 gene. Long face, large everted ears, prominent jaw, macroorchidism and a high arched palate, frequent hand flapping).
Fragile X syndrome
___’s theory of cognitive development:
+Sensorimotor period: birth->2 years
+Preoperational period: 2->7 years (“they draw on everything”)
+Concrete operational stage: 7->12 years (“they love dinos, collecting things like cards”; they first understand conservation of volume in the concrete operational stage)
+Formal operational stage: 13->adulthood (able to think abstractly, logically, apply these processes to hypothetical situations)
Piaget
Piaget’s theory of cognitive development:
+___ period: birth->2 years
+Preoperational period: 2->7 years (“they draw on everything”)
+Concrete operational stage: 7->12 years (“they love dinos, collecting things like cards”; they first understand conservation of volume in the concrete operational stage)
+Formal operational stage: 13->adulthood (able to think abstractly, logically, apply these processes to hypothetical situations)
Sensorimotor (birth->2 years)
Piaget’s theory of cognitive development:
+Sensorimotor period: birth->2 years
+Preoperational period: 2->7 years (“they draw on everything”)
+___ operational stage: 7->12 years (“they love dinos, collecting things like cards”; they first understand conservation of volume in the concrete operational stage)
+Formal operational stage: 13->adulthood (able to think abstractly, logically, apply these processes to hypothetical situations)
Concrete (7-12yo)
In the United States, what is the number one preventable cause of death?
Tobacco use disorder
Ocular jerk movements with optokinetic ___ suggests psychogenic blindness.
drum
In bipolar affective disorder, neuroimaging shows ___ functional connectivity between amygdala and the prefrontal cortex.
decreased
Pathogenic copy number variants affecting DNA base pairs are associated with ___-___ (hyperphagia, failure to thrive, early obesity, hypogonadism, OCD, short, small hands and small feet).
Prader-Willi
___ ___ are different proteins encoded by the same gene.
Splice variants
Amygdala-___-periaqueductal gray (endorphins) is the neural pathway most consistently found to mediate reactive aggression.
hypothalamus
Amygdala-hypothalamus-periaqueductal gray (endorphins) is the neural pathway most consistently found to mediate reactive ___.
aggression
Amygdala-hypothalamus-___ gray (endorphins) is the neural pathway most consistently found to mediate reactive aggression.
periaqueductal
___ properties of nicotine are most closely associated with nicotinic acetylcholine receptor alpha4beta2.
Reward
Reward properties of nicotine are most closely associated with nicotinic acetylcholine receptor ___.
alpha4beta2
Reward properties of nicotine are most closely associated with ___ acetylcholine receptor alpha4beta2. Varenicline/Chantix is a partial agonist at alpha4beta2 nicotinic acetylcholine receptors. Varenicline activates these receptors to a lesser extent than the full agonist nicotine and also prevents nicotine from binding to these receptors.
nicotinic
___ is a common neuropsychiatric symptom seen in neurocognitive disorder and traumatic brain injury.
Depression
The hypothalamic ___ nucleus is key to integration of neural and nutrient signals with hormonal signals from the small intestine, pancreas, liver, adipose tissue and brainstem.
arcuate
Gender ___ is typically established by 3yo.
identity
___ adenylate cyclase-activating polypeptide is a potent neuroprotective factor preventing neuronal cell death (apoptosis).
Pituitary
Pituitary ___ cyclase-activating polypeptide is a potent neuroprotective factor preventing neuronal cell death (apoptosis).
adenylate
Pituitary adenylate cyclase-activating polypeptide is a potent ___ factor preventing neuronal cell death (apoptosis).
neuroprotective
With regards to neuroinflammation, estrogen leads to ___ inflammatory cytokine production.
decreased
*L-Tyrosine (non-essential amino acid, can get in diet and also synthesized from phenylalanine)
is converted by Tyrosine hydroxylase to
L-Dihydroxyphenylalanine (L-DOPA)
->
Dopamine
is converted by dopamine hydroxylase to
Norepinephrine
->
Epinephrine
What is the rate limiting step in the synthesis of norepinephrine?
Tyrosine hydroxylase
The Wisconsin Card Sorting Task measures the ability to generate ___ strategies in response to feedback.
alternative
The ___ is used to measure concept formation and concept flexibility.
Wisconsin Card Sorting Test
The ___ area of the frontal cortex is most consistently activated during shifting of cognitive sets in the Wisconsin Card Sorting Test.
dorsolateral
The ___ ___ is the area of the brain primarily responsible for face recognition (Its BETO!!!)
fusiform gyrus (think about the name, “fusiform”… ITS BETO!)
Activation of the ___-___ receptor is thought to be responsible for the anti-anxiety, motor-impairing and sedative hypnotic effects of alcohol.
GABA-A
A patient reports insomnia, frequent nighttime awakenings and excessive daytime sleepiness. A sleep study reveals brief lower extremity jerks with brief repeated arousals. The patient is unaware of these movements. Which of the following diagnoses is most consistent with the presentation?
- Narcolepsy
- Primary insomnia
- Sleep terror disorder
- Periodic limb movement disorder
- Circadian rhythm sleep disorder
Periodic limb movement disorder
Which of the following symptoms is considered an irreversible effect of chronic anabolic steroid use?
- Infertility
- Hirsutism
- Impotence
- Gynecomastia
- Testicular atrophy
Hirsutism
An infant who engages in an interactive game of peek-a-boo most closely demonstrates the concept of which of the following cognitive abilities?
- Centering
- Egocentrism
- Conservation
- Object permanence
- Tertiary circular reactions
Object permanence
A 30yo presents with headache and clumsiness of the right hand for several weeks. PE is notable for difficulty with rapid alternating movements of the right hand, an overt intention tremor on finger-to-nose testing, and mildly dysmetric finger-tapping. Cranial nerves are intact and there is no papilledema. Damage is likely to the ___.
Cerebellum
Which of the changes below is supported by the literature for teachers considering “learning styles” when planning curricula?
- Transition all lectures to small group problem-based formats
- Offer several different modalities and allow students to choose
- Make no changes, lecture-based curricula result in higher test scores
- Allow students to self-declare learning styles and opt out of certain requirements
- Use supplemental material designed to address the needs of all types of learners
Use supplemental material designed to address the needs of all types of learners
A high-achieving patient becomes increasingly anxious about the perception of her work. This has led her to work longer hours to produce results that she believes will be viewed positively by her team. The therapist asks the patient whether the long hours are truly needed to be successful. She responds, “I always have to work harder than everyone else to succeed.” In cognitive theory, this statement is an example of:
- a schema
- globalization
- internalization
- an automatic thought
- a compensatory strategy
a schema
Which of the following is the most significant barrier to accessing mental health services in school-based health centers?
- Lower quality of care
- Stricter referral process
- Health insurance restrictions
- Concerns about confidentiality
- Limited access to appointments
Concerns about confidentiality
Which of the following therapies is the most likely to describe a therapeutic goal as “improving ego functioning and self-esteem”?
- Family therapy
- Exposure therapy
- Supportive psychotherapy
- Dialectical behavior therapy
- Interpersonal psychotherapy
Supportive psychotherapy
A 30yo has intermittent muscle twitching. Exam show full strength with normal muscle bulk. Electromyography shows spontaneous discharges which are relatively constant and represent firing of the motor unit. These findings are typical of:
- cramps
- spasms
- myokymia
- fibrillations
- fasciculations
fasciculations (“muscle twitches”)
A pro dancer’s performance and the show won wide acclaim, but she can’t stop replaying a minor misstep she made that was not noticed by the audience or other performers. Despite being congratulated on her performance, she feels that, due to the error, she has let herself down. Which of the following cognitive errors is the patient displaying?
- Minimization
- Personalization
- Overgeneralization
- Selective abstraction
- Dichotomous thinking
Selective abstraction
Which of the following is the primary purpose of mental health courts?
- Adjudicate insanity defense
- Determine fitness to stand trial
- Divert offenders with mental illness away from incarceration
- Provide preliminary rulings on psychiatric malpractice cases
- Civilly commit dangerous mentally ill patients to outpatient treatment
Divert offenders with mental illness away from incarceration
A patient prominently uses the defenses of isolation of affect and intellectualization. The patient’s description of many life events appears to involve reaction formation. Which personality trait is most likely to characterize this patient?
Obsessive-compulsive [associated with disruption in cortico (dorsolateral prefrontal cortex)-striato-thalamo-cortical circuit function]
A researcher follows two groups of people to assess for the development of dementia. One group has a history of lorazepam use and the other does not. What type of study design is being used?
Prospective cohort
Disruption in cortico (dorsolateral prefrontal cortex)-striato-thalamo-cortical circuit function is most closely associated with what group of disorders?
- Mood
- Somatoform
- Schizophrenic
- Posttraumatic stress
- Obsessive-compulsive
Obsessive-compulsive
A patient comes to the ED after a syncopal episode with hyperthermia, headache, flushing, and tachycardia. He has significant hypotension requiring fluid resuscitation. According to the family, the patient has a history of schizophrenia, generalized anxiety disorder and alcohol use disorder. An interaction with which of the following medications is most likely to have caused the patient’s symptoms?
- Amitriptyline
- Disulfiram
- Fluoxetine
- Haloperidol
- Lorazepam
Disulfiram
___ introduced the strange situation experiment to evaluate attachment between a parent and child.
Mary Ainsworth
A 75yo has subacute onset of progressive ataxia of gait and limbs. Lab studies shown anti-Yo antibody in the serum. Which of the following tests should be ordered next?
- PET scan of brain
- CT chest, abdomen, pelvis
- MRI brain
- Serial titers of anti-Yo antibody
- MRI spine
CT chest, abdomen, pelvis (anti-Yo is a paraneoplastic antibody)
A 9yo with attention-deficit/hyperactivity disorder does not respond to methylphenidate. Which of the following medications should be tried next?
- Clonidine
- Fluoxetine
- Bupropion
- Guanfacine
- Dextroamphetamine
Dextroamphetamine
In which of the following ways does sexual health change in older individuals?
- Libido is reduced
- Sperm count decreases
- Refractory period for men increases
- Anxiety surrounding sexuality is increased
- Testosterone production in men is greatly decreased
Refractory period for men increases
Which of the following developmental stages in psychodynamic group therapy is characterized by intimacy?
- Engagement
- Subgrouping
- Termination
- Working group
- Differentiation and individuation
Working group
Over several months, a 45yo with no PSH becomes labile and irritable. They undergo personality changes and are observed to laugh inappropriately when neighborhood kids taunt a stray cat. Within two years, the patient develops a fear of contamination and greatly decreases food intake due to being convinced that all food has germs. Memory is preserved. The patient can no longer work or live independently. Neuropsychiatric testing demonstrates impaired language and attention. Which of the following is the most likely diagnosis?
- Schizophrenia
- Alzheimer disease
- Frontotemporal dementia
- Dementia with Lewy bodies
- Obsessive-compulsive disorder
Frontotemporal dementia
Which of the following is used in biofeedback as a marker of autonomic activity?
- Heart rate variability
- Systolic blood pressure
- Diastolic blood pressure
- Respiratory rate variability
- Circadian core body temperature
Heart rate variability
A 22mo places a wooden block on a toy train track and says, “choo-choo!” while moving the block back and forth along the track. This behavior is most likely an example of which of the following types of play?
- Fantasy
- Parallel
- Symbolic
- Cooperative
- Sensorimotor
Symbolic
Which of the following is associated with increased risk of depression in people with multiple sclerosis?
- Older age
- Female sex
- Type of deficit
- Lesion volume
- Family history of depression
Lesion volume
According to psychoanalytic theory, the term ___ ___ ___ refers to mental activity exemplified by unconscious thoughts that do not maintain logical connections.
primary process thinking
Which of the following infant and toddler temperamental styles has been shown to have the greatest association with the eventual onset of anxiety symptoms in childhood?
- Inhibited
- Irritable
- Hyperactive
- Dysregulated
- Aggressive
Inhibited
The central principle of “The Goldwater Rule” for psychiatrists is that it is unethical for psychiatrists to offer professional opinions on public figures without a ___-___-___ evaluation.
face-to-face
Which of the following is the strongest risk factor for postpartum depression?
- Marital difficulties
- Low socioeconomic status
- Family history of depression
- Level of reproductive hormones
- Untreated depression during pregnancy
Untreated depression during pregnancy
Which of the following hormones is released during sleep, but likely does not have a circadian pattern?
- Melatonin
- Cortisol
- Prolactin
- Oxytocin
- Growth hormone
Growth hormone
Extracorporeal treatment is typically indicated in cases of severe lithium toxicity. Lithium is readily dialyzable due to its:
- high tissue binding
- high protein binding
- low molecular weight
- high volume of distribution
- low proximal tubule resorption
low molecular weight
Which of the following is among the first medications ever approved to treat depression?
- Lithium
- Iproniazid
- Desipramine
- Methylphenidate
- Chlorpromazine
Iproniazid [early ANTIDEPRESSANT, now for tuberculosis!]
A grad student says in exam week the R leg is paralyzed. On PE reflexes are normal, pt is asked to lie down flat and lift the unaffected leg. When he does this, the doctor feels increased pressure under the affected leg. What is the most likely diagnosis?
Conversion disorder
When testing for Babinski reflex, downward scraping of the shin can help the examiner overcome the ___ response by a patient.
withdrawal
A 22yo began psychotherapy due to feeling inadequate and depressed in the setting of working as a barista since graduating from college and deferring medical school acceptance. The patient has been having conflicts with his mom and dad about his ambivalence to become a doctor. What is the most likely developmental task that the patient is struggling with?
Identity (Erik Erikson’s theory of development, Identity vs role confusion: age 12-18. Adolescents experience some role confusion and mixed emotions about the specific ways in which they fit into society. They may experiment with a variety of behaviors and activities before they achieve a sense of identity.)
In malpractice lawsuits, for patient’s to win, doctor-patient ___ must be established.
relationship
The ability to temporarily store and manipulate information, such as when doing mental arithmetic, is referred to as ___ ___.
working memory (dorsolateral prefrontal)
When observed in a young adult, bilateral paresis of the medial rectus muscle of the eye on attempted lateral gaze, with course nystagmus in the abducting eye, is characteristic of which condition?
Multiple sclerosis
Clinical studies of adolescents and young adults have found that physicians can decrease the risk of suicidal events when prescribing antidepressant medication by ___ titrating the antidepressant.
slowly
Ethical standards issued by the American Medical Association prohibit physician involvement in which of the following aspects of a death penalty case unless a commutation (substitution for a lesser sentence) order is in place?
- Assessment of competence to stand trial
- Restoration of competence to be executed
- Rendering an opinion about criminal responsibility
- Serving as a fact witness at the guilt-innocence trial phase
- Treatment of condemned prisoner to reduce mental health symptoms
Restoration of competence to be executed
Hearing one’s name each time the wind rustles the leaves outside the room each morning is an example of an ___.
illusion
A form of learned fear in which a person or an experimental animal learns to respond strongly not only to a harmful stimulus, but also to a subthreshold stimulus refers to:
- avoidance
- sensitization
- habituation
- irrational fear
- learned helplessness
sensitization
Naltrexone is helpful for patients with alcohol ___.
cravings
Which of the following is seen most frequently as a comorbid condition in children with autism spectrum disorder?
- Selective mutism
- Intellectual disability
- Early-onset schizophrenia
- Obsessive-compulsive disorder
- Attention-deficit/hyperactivity disorder
Intellectual disability
The term ___ refers to small insertions and deletions in DNA sequence.
indels (INsertions and DELetionS in DNA sequence)
Pt comes to ED with significant paranoia, is hypervigilant, pacing and responding to unseen others. Which of the following techniques would be most appropriate to build rapport with the patient?
- Make sustained eye contact
- Acknowledge the patient’s fear
- Directly confront the patient’s paranoia
- Agree that the patient’s suspiciousness is justified
- Approach the interview as if the patient is a close friend
Acknowledge the patient’s fear
18yo has been avoiding food for the past four months. Her BMI is less than normal, and she menstruates regularly. Family members say she obsesses about being “fat,” even though she continues to lose weight. On several occasions, they have overheard her vomiting in the bathroom after consuming a large meal. She meets criteria for which of the following diagnoses?
- Bulimia nervosa
- Anorexia nervosa
- Rumination disorder
- Unspecified eating disorder
- Avoidant/restrictive food intake disorder
Anorexia nervosa
The ___ is a small region of the cerebral cortex located deep within the lateral sulcus, which is a large fissure that separates the frontal and parietal lobes from the temporal lobe. Along with the medial pre-frontal cortex, the insula is involved in both fear conditioning and fear extinction.
insula
A patient with schizophrenia is started on clozapine after failing two other antipsychotic trials. His initial absolute neutrophil count is 2200/mm3. How frequently should the psychiatrist order a CBC with differential for this patient?
- Daily
- Three times weekly
- Weekly
- Every two weeks
- Monthly
Weekly
Text messaging and online media to communicate with peers is ___ for modern adolescents socializing with their peer group.
normal
40yo goes to hospital due to concussion after MVC. No abnormalities on PE other than lacerations and ecchymoses. One week later, the patient has generalized pain, dizziness, difficulty sleeping, and recurrent nightmares when able to sleep. The patient now fears driving. Which of the following is the most likely explanation for the development of these symptoms?
- Malingering
- Adjustment disorder
- Acute stress disorder
- Somatic symptom disorder
- Posttraumatic stress disorder
Acute stress disorder
D3 has been found to be effective as an adjunct to antidepressant medications for the treatment of ___.
depression
Which of the following scales is the easiest to use for an initial assessment of delirium in the geriatric population?
- Confusion Assessment Method
- Montreal Cognitive Assessment
- Mini-Mental Status Examination
- Geriatric Mental State Schedule
- Brief Psychiatric Rating Scale
Confusion Assessment Method (ICU “CAM”)
In a properly conducted randomized clinical trial, it is inappropriate to include p values in a table showing baseline characteristics of subjects by treatment group because any differences at baseline must have arisen by chance given ___.
randomization
Which of the following is the best predictor of healthy aging in elderly individuals?
- Adopting a spiritual attitude
- Resisting old age stereotypes
- Avoiding dependency on others
- Remaining in contact with friends
- Taking a passive stance toward obstacles
Remaining in contact with friends
A stroke in which of the following arterial territories would result in an inability to read, but with preserved ability to write?
- Carotid
- Basilar
- Vertebral
- Middle cerebral
- Posterior cerebral
Posterior cerebral
Which of the following genes has been most associated with late-onset neurocognitive disorder due to Alzheimer disease?
- APP
- CR1
- PSEN1
- PSEN2
- APOE*E4
APOE*E4 (eat blueberries, exercise, learn, get connected and stimulated!)
Which psychodynamic theory emphasizes individuals’ ability to understand their own and others’ internal states as explanations for behavior?
Mentalization theory
When the central nervous system responds to an acute cortical insult microglia processes retract, and the cell body ___.
enlarges
[Microglia secrete innate proinflammatory cytokines TNF-a and IL-1B in patients with inflammatory conditions that affect the brain.]
Which of the following is most likely to reduce psychotic symptoms in patients with Parkinson disease without worsening motor symptoms?
- Quetiapine
- Mirtazapine
- Aripiprazole
- Rivastigmine
- Pimavanserin
Pimavanserin (inverse agonist and antagonist with high affinity for 5-HT2A receptors, no affinity for dopaminergic (including D2) receptors)
Which of the following diagnoses is associated with high hypnotizability potential?
- Schizophrenia
- Panic disorder
- Dissociative disorder
- Substance dependence
- Attention-deficit/hyperactivity disorder
Dissociative disorder
Synaptic ___ predominantly occurs during adolescence and young adulthood.
pruning
Grey matter volume development peaks in late ___, before the synaptic pruning time in adolescence/young adulthood.
childhood
Which of the following has been reported regarding the likelihood of escalation of benzodiazepine dose when prescribed for long-term use?
- Most patients will require a higher dose over time
- Most patient will maintain a stable dose over time
- Older patients tend to require a higher dose over time
- Patients with bipolar disorder tend to require a higher dose over time
- Patients with schizophrenia tend to require a higher dose over time
Most patient will maintain a stable dose over time
A 73yo patient developed sudden onset memory loss, and was unaware of how the patient and spouse arrived at the supermarket. The spouse noted that the patient was able to drive without problem, but appeared anxious during much of the trip. The patient was able to appropriately answer questions, but then didn’t remember the conversation. The entire episode lasted three hours, after which time the patient returned to baseline. The most likely diagnosis is:
- presyncope
- complicated migraine
- complex partial seizure
- transient global amnesia
- posterior circulation stroke
transient global amnesia
Which of the following is the best example of a second stage or “self-conscious” emotion, which is believed to develop around the end of the second year of life?
- Envy
- Fear (earlier: within first year)
- Anger
- Altruism
- Empathy
Envy
HIPAA limits disclosure of patient health information information without patient authorization except as necessary for which of the following?
- Research
- Payment
- Education
- Medical licensure
- Medical malpractice
Payment
The validity scales of the Minnesota Multiphasic Personality Inventory-II measure the test-taking ___ of the patient.
attitude
Pt has history of depression and well-controlled epilepsy and has undergone multiple unsuccessful antidepressant trials before responding to bupropion. Pt has yet to try several antidepressants including imipramine, nortriptyline, duloxetine, selegiline. The patient’s insurance company recommends switching to another antidepressant because of bupropion’s well-known tendency to reduce seizure threshold. The psychiatrist should ___ bupropion.
continue
A 20yo comes to the ED following nausea, sweating and hematemesis. They have had recent severe headaches and numbness in the extremities. CT shows generalized brain atrophy. Labs show renal tubular acidosis and a CPK of 3120 mcg/L. The presentation is consistent with chronic use of which of the following substances?
- Phencyclidine
- Amphetamines
- Steroids
- Cocaine
- Inhalants
Inhalants (chronic use->renal tubular acidosis, CPK increase, generalized brain atrophy)
Which of the following is transmitted through the spinothalamic tract?
- Pain and Temperature
- Balance
- Vibration
- Joint position
- Tactile sense
Pain and Temperature
A patient’s managed care insurance company refuses to authorize continued hospitalization for a depressed patient who remains acutely suicidal. The treating inpatient psychiatrist remains concerned about the potential for suicide and does not discharge the patient. The psychiatrist’s actions best illustrate the ethical principle in managed care of responsibility to ___.
treat
___ REM latency on a multiple sleep latency test (MSLT) confirms the diagnosis of narcolepsy. Also see this in depressed patients.
Decreased
___ of neurons accounts for the brain’s rapid increase in size from birth through the second year of life.
Synaptogenesis
Which of the following is the most common reason for patients to discontinue selective serotonin reuptake inhibitors early?
- GI distress
- Sedation
- Agitation
- Insomnia
- Jitteriness
GI distress
Patients with which of the following neurologic disorders have been reported to have the highest prevalence of pathological laughing and crying?
- Multiple sclerosis
- Parkinson disease
- Traumatic brain injury
- Multiple system atrophy
- Amyotrophic lateral sclerosis
Amyotrophic lateral sclerosis (ALS) (pathologic laughing and crying)
Parents are concerned because their 2yo girl is playing with trucks instead of dolls, likes to wear boy’s clothes, and prefers to play with boys instead of girls. The parents have tried to change these behaviors, but the child has been resistant. When interviewed by the physician, the child insists that she is a girl. Which of the following is the most likely diagnosis?
- Gender dysphoria
- Normal development
- Transvestic disorder
- Body dysmorphic disorder
- Oppositional defiant disorder
Normal development
An 80yo in the ICU is awake throughout the night, pulls IV lines, misidentifies nurses as bank employees. In addition to questions of orientation, which of the following components of the Mini-Mental State Examination would be most helpful in confirming the patient’s diagnosis?
- Recall
- Serial 7s
- Metaphors
- Registration
- Sentence completion
Serial 7s (tests attention)
Which of the following neurotransmitters, present in the periaqueductal grey matter, is involved in the mediation of pain?
- Aspartate
- Serotonin
- Endorphins
- Dopamine
- Histamine
Endorphins
Glycogen synthase kinase-3 ___ is a pharmacological effect of lithium.
inhibition
Which of the following stages of development occurs first in female physical development?
- Rise in growth hormone secretion
- Onset of gonadal estrogen production
- Increase in adrenal androgen production
- Surge in luteinizing and follicle-stimulating hormones
- Organization of pulsatile release of gonadotropin-releasing hormone
Increase in adrenal androgen production
Which type of genetic variation is most commonly investigated in genome-wide association studies?
- mRNA abundance
- Translation efficiency
- Insertions or deletions
- Copy number variants
- Single nucleotide polymophisms
Single nucleotide polymorphisms (SNPs) (SNPs are locations within the human genome where the type of nucleotide present (A,T,G, or C) can differ between individuals. SNPs are the most common type of genetic variation found among people.)
What Freudian psychosexual stage of development is characterized by an intensification of libidinal drives, separation from a dependence on one’s parents, and achievement of a mature sense of self?
Genital
Deep brain stimulation targeting what brain region has been most frequently studied for the experimental treatment of depression?
Subcallosal cingulate cortex (SCC targeted by the neurosurgeons)
A 30yo has episodes of irresistible sleepiness, and falls asleep while driving. She reports experiencing episodes of paralysis and hallucinations upon awakening. These symptoms are best explained by a deficiency of ___.
Orexin/Hypocretin
[Orexin, from orexis, meaning “appetite” in Greek, is involved in the stimulation of food intake. In addition, it stimulates wakefulness, regulates energy expenditure and moderates visceral function. The most common form of narcolepsy, in which the sufferer experiences brief losses of muscle tone (cataplexy) is caused by a lack of orexin in the brain due to destruction of the cells that produce it.]
A 29yo with new-onset headache characterized by unilateral, stabbing eye pain has runny nose and conjunctival injection on the same side as the headache during episodes. The episodes occur every night after falling asleep and last up to two hours. The patient most likely has ___ headache.
cluster
Pt that says they often feel they have “no self” and her thoughts are not hers, feels like a robot and as if can’t control her body. She says she knows she has feelings, but can’t feel them instead feels emotionally numb and often feels her head is full of cotton. Recently she started having “out of body” experiences. Which of the following is the most likely diagnosis?
- Illness anxiety disorder
- Dissociative identity disorder
- Posttraumatic stress disorder
- Borderline personality disorder
- Depersonalization/derealization disorder
Depersonalization/derealization disorder
The three main components of “Meaningful use” of electronic medical records (EMR) include the use of certified EMR in a meaningful manner, the use of certified EMR to submit clinical quality measures and electronic exchange of health information to improve ___ of care.
quality
Which of the following neurotransmitters is thought to play a key role in fine-tuning working memory function in the dorsolateral prefrontal cortex?
- Serotonin
- Dopamine
- Nitrous oxide
- Acetylcholine
- Norepinephrine
Dopamine
Current evidence of psychiatrists using pharmacogenomics testing in clinical practice shows promise for clinical utility, but replicated evidence about outcomes is ___.
lacking
To minimize liability for the psychiatrist providing an informal “curbside” consultation for PCP, care of the patient remains under the direction of the PCP who also remains in charge of ___ medications or additional services.
ordering
Which of the following sleep disorders is associated with mild neurocognitive disorder with Lewy bodies (core features: fluctuating cognition, visual hallucinations, “spontaneous” Parkinsonism that started AFTER onset of cognitive decline; suggestive features: Marked sensitivity to side effects of antipsychotic medications + answer to this question)?
- Nocturnal seizures
- Nightmare disorder
- Restless leg syndrome
- Obstructive sleep apnea
- REM sleep behavior disorder
REM sleep behavior disorder
A pt is unable to demonstrate how to blow out a match. Motor and sensory function are normal, and the rest of the neurological exam is unremarkable. The patient’s inability to perform this action is termed ___.
apraxia (The brain is unable to make and deliver correct movement instructions to the body.)
Splice variants are best defined as ___ ___ encoded by the same gene.
different proteins
Which of the following antidepressant medications is safest to use in patients with seizure disorders and depression?
- Amoxapine
- Bupropion (NO!)
- Clomipramine
- Fluoxetine
- Maprotiline
Fluoxetine/prozac
According to Erikson, the predominant emotional issue in typically developing, ___-age children is personal worth and competence.
school
[Industry vs inferiority: age 6 to 12 years.
The child compares self-worth to others (such as in a classroom environment or with other siblings). A child can recognize major disparities in personal abilities relative to other children. The role of the teacher is very important, the teacher should ensure that children do not feel inferior but proud of their individual achievements.]
Which of the following would be considered a boundary violation?
- Investing in a patient’s business
- Treating the town pharmacist in a small rural town
- Accepting a patient’s holiday gift of a hand-knit scarf
- Seeing one patient at a reduced fee while charging others the full rate
- Discussing the patient’s sexual feelings toward the psychiatrist in session
Investing in a patient’s business (boundary violations involve exploitation)
Under the Health Insurance Portability and Accountability Act (HIPAA), a provider must obtain specific consent or authorization from a patient before sharing individually identifiable health information to:
- a third party payer for the purpose of payment
- an investigator for the purpose of conducting epidemiological research
- a health care provider who is taking over the ongoing care of the patient
- a non-clinical hospital administrator for the purpose of quality improvement
- another clinician unfamiliar with the patient for the purpose of medical consultation
An investigator for the purpose of conducting epidemiological research
___ is maximized to ensure that a screening test misses only a small number of individuals with an illness.
Sensitivity
If tyrosine hydroxylase is dramatically decreased due to a specific neurotoxin, which of the following types of neurons are most likely to be impaired by this neurotoxin.
- Dopaminergic
- GABAminergic
- Glutaminergic
- Histaminergic
- Serotonergic
Dopaminergic
*L-Tyrosine (non-essential amino acid, can get in diet and also synthesized from phenylalanine)
is converted by Tyrosine hydroxylase to
L-Dihydroxyphenylalanine (L-DOPA)
->
Dopamine
is converted by dopamine hydroxylase to
Norepinephrine
->
Epinephrine
What is the rate limiting step in the synthesis of norepinephrine? Tyrosine hydroxylase
Which ethical principle, as elucidated in the Belmont Report, underlies the practice of informed consent?
Respect for persons
The frequency of typical sexual behaviors (i.e. self-stimulation, exhibitionism, sexual intrusiveness) exhibited by children of both genders peaks at what age?
five years (Eliza Gray attack!; latter part of Freud’s 3-6yo Phallic phase)
Sleep spindle density most markedly decreases from middle age into old age in which of the following regions of the brain?
- Motor and sensory cortex
- Frontal and occipital lobes
- Parietal lobes and association cortex
- Extended amygdala and insula cortex
- Medial temporal lobes and hippocampus
Frontal and occipital lobes
In epigenetic histone protein amino acid residue modification, acetylation is generally rapid and ___.
reversible
A breastfeeding patient taking sertraline wants to test her breast milk and the baby’s blood for levels of the drug. The physician explains to the patient that testing is not indicated. The rationale is that evidence shows that infants are harmed more by having a ___ mother than being exposed to sertraline.
depressed
A right-handed patient with a history of intractable seizures underwent neurosurgical treatment. In follow-up testing, the blindfolded patient was unable to name objects placed in the left hand, but had no difficulty naming the objects when they were displayed on a screen. What was the site of the surgical intervention?
- Thalamus
- Corpus callosum
- Right parietal lobe
- Left superior temporal lobe
- Bilateral medial temporal lobes
Corpus callosum
[The corpus callosum consists of a large bundle of fibers connecting the right and left hemispheres of the brain. Each hemisphere controls movement in the opposite (contralateral) side of the body and can also specialize in performing specific cognitive and perceptual functions. The corpus callosum allows information to move between hemispheres and is therefore a very important integrative structure.]
Pramipexole is an effective first-line treatment for patients with ___ leg syndrome.
restless
Pramipexole is a nonergot dopamine agonist with specificity for the D2 subfamily dopamine receptor and has also been shown to bind to D3 and D4 receptors. By binding to these receptors it is thought that pramipexole can stimulate dopamine activity on the nerves fo the striatum and substantia nigra.
Degeneration of the dorsal nucleus of the thalamus and the mammillary bodies is found in which of the following disorders?
- Wilson disease
- Alzheimer disease
- Parkinson disease
- Huntington disease
- Wernicke-Korsakoff syndrome
Wernicke-Korsakoff syndrome
Which of the following psychosocial treatment modalities is most relevant and effective for the positive symptoms of schizophrenia?
- Social skills training
- Compliance therapy
- Cognitive remediation
- Supportive employment
- Cognitive behavior therapy
Cognitive behavior therapy
The ___ ___ ___ Test is used to measure concept formation and concept flexibility.
Wisconsin Card Sorting (Dorsolateral frontal cortex activated during shifting of cognitive sets)
The Wisconsin Card Sorting Task measures the ability to generate alternative strategies in response to feedback.
An example of a positive (health promoting) effect of the neuroinflammatory response is ___ propagation of cytokines with associated decreased physical activity in response to a peripheral infection.
microglial
[Microglia secrete innate proinflammatory cytokines TNF-a and IL-1B in patients with inflammatory conditions that affect the brain.]
What is the most prominent lobbying and support organization for families of people with severe psychiatric disorders?
National Alliance for the Mentally Ill (NAMI)
Which of the following sleep changes is often seen in depressive disorders?
- Decreased REM latency
- Increase in total sleep time
- Increase in slow-wave sleep
- Decrease in nocturnal arousal
- Decreased core body temperature
Decreased REM latency (this is seen in depressive disorders and in narcolepsy)
Genetic deletion is involved in the development of ___ syndrome/DiGeorge syndrome/22q11.2 deletion syndrome.
velocardiofacial
DiGeorge syndrome/22q11.2 deletion syndrome/ velocardiofacial syndrome is a syndrome caused by the deletion of a small segment of chromosome 22. It is characterized by developmental delay, cardiac abnormalities, palate defects, immune deficiency, and an increased risk of schizophrenia.
Positron emission tomography scanning measures what?
Glucose metabolism
Glucose “PET”
What proportion of the human genome comprises the “exome”?
2%
[Exon: a segment of a DNA or RNA molecule containing information coding for a protein or peptide sequence]
Pervasive and excessive emotionality and attention-seeking behaviors are the essential features of which personality disorder?
Histrionic (stuck in Freud’s birth-1yo oral stage)
A court has ordered the psychiatrist to complete a “competency to stand trial” evaluation for a person with a history of psychosis who was arrested for shoplifting. Which of the following questions is relevant to competency to stand trial in this scenario?
- Can the person work effectively with counsel?
- What was the person’s intent at the time of the crime?
- If actively psychotic, can the person make treatment decisions?
- Was the person able to waive Miranda rights at the time of arrest?
- At the time of the offense, did the person understand the illegality of the behavior?
Can the person work effectively with counsel?
Guanfacine and clonidine are alpha-2 adrenergic ___.
agonists
___ selectively inhibits the reuptake of norepinephrine with little to no activity at other neuronal reuptake pumps or receptor sites. Of note, it also increases SI and has a black box warning for this.
Atomoxetine
Modafinil has been shown to significantly increase dopamine in the brain by blocking dopamine ___.
transporters
Memantine is an uncompetitive antagonist of the N-methyl-D-aspartate (NMDA) type of ___ receptors, located ubiquitously throughout the brain.
glutamate
A 70yo has fallen multiple times over the past five months. The pt’s mental status is normal. Smooth pursuit and saccadic movements are impaired, more prominently for vertical gaze, but full range of motion is easily elicited by doll’s head maneuvers. The patient has mild symmetric rigidity and bradykinesia. There is no tremor. A brain magnetic resonance imaging scan is unremarkable, as are the results of cerebrospinal fluid and routine laboratories including toxic drug screen. Which of the following is the most likely patient diagnosis?
- Corticobasal degeneration
- Olivopontocerebellar degeneration
- Idiopathic Parkinson disease
- Primary progressive aphasia
- Progressive supranuclear palsy
Progressive supranuclear palsy
The validity of an assessment instrument refers to the extent to which it measures what it ___ to measure.
intends
The recognition of affective behavior by the mirror neuron system involves connections between the anterior mesial frontal cortex and the ___.
insula
The insula is a small region of the cerebral cortex located deep within the lateral sulcus, which is a large fissure that separates the frontal and parietal lobes from the temporal lobe.
Along with the medial pre-frontal cortex, the insula is involved in both fear conditioning and fear extinction.
Obsessive-compulsive disorder is most commonly comorbid with:
- schizophrenia
- mood disorders
- anxiety disorders
- substance use disorders
- trauma and stressor-related disorders
anxiety disorders
During the stress response in humans, corticotropin-releasing hormone (CRH) is released from the ___ ___ of the hypothalamus.
Paraventricular nucleus
The ___ regulates a wide range of behavioral and physiological activities. It controls many autonomic functions such as hunger, thirst, body temperature, and sexual activity. To do this, it integrates information from many different parts of the brain and is responsive to a variety of stimuli including light (it regulates circadian rhythms), odors (eg, pheremones), stress, and arousal (hypothalamic neurons release oxytocin directly into the bloodstream). Other functions it controls include parenting behavior, perspiration, blood pressure, and heart rate.
hypothalamus
A patient’s psychotic symptoms fail to respond to risperidone 8mg/day and lab testing shows drug levels below expected. Assuming medication adherence, genotyping for CYP450 polymorphism should reveal which of the following results?
- Two copies of variant alleles
- Two copies of wild-type alleles
- Multiple copies of wild-type alleles
- One wild-type and one variant allele
Multiple copies of wild-type alleles
The physician should recommend that a child get a hearing test if the child is not able to make two-word sentences by what age?
2 years
A researcher is contemplating a cross-over study in which study subjects serve as their own controls and participate in both arms of the treatment. This design is most likely to cause what aspect of the study to be increased?
- Precision
- Relative cost
- Between-subject variation
- Number of subjects recruited
Precision (the quality, condition, or fact of being exact and accurate.)
What type of nicotininc acetylcholine receptor is most closely associated with the reward properties of nicotine?
a4B2
Varenicline activates a4B2 (alpha4beta2) receptors to a lesser extent than the full agonist nicotine and also prevents nicotine from binding to these receptors.
After a child survives a natural disaster, which of the following social factors is most likely to be protective against developing post-traumatic symptoms?
- The availability of peer support
- Timely relocation to a safer location
- Access to counseling and mental health services
- Validation of the importance of the event through media coverage
The availability of peer support
___ is the emotional reaction of the analyst to the subject’s contribution.
Countertransference
Detection of single nucleotide variants in rare genetic diseases is most likely to occur with which of the following types of genetic study?
- Exome sequencing
- DNA-protein analysis
- Family-based linkage
- RNA sequencing analysis
Exome sequencing
Exon: a segment of DNA or RNA molecule containing information coding for a protein or peptide sequence
When a patient at the end of life requires a transition to a different care setting, presence of an ___ care person is associated with a better transition.
identified
Which of the following individuals is most likely to have legal responsibility for a crime?
- A 23yo who has “consensual sex” with a 15yo after the teen produced fake ID showing age of 20
- A 40yo with severe alcohol use disorder who robs a liquor store to obtain more vodka
- A 45yo man with severe intellectual disability who steals a loaf of bread because his father demanded it
- A 42yo actively psychotic woman who sets fire to the grass outside a church after being instructed to do so by voices in order to save the church from “el diablo”
A 40yo with severe alcohol use disorder who robs a liquor store to obtain more vodka
A patient who takes olanzapine develops diabetes. Treating the patient with metformin is an example of what kind of prevention?
Tertiary (Methods to reduce the harm of symptomatic disease, such as disability or death, through rehabilitation and treatment)
Secondary prevention involves methods to detect and address an existing disease ___ to the appearance of symptoms.
prior
Which of the following methods examines the consistency with which genetic variants are passed from parent to offspring within different families?
- Recombination
- Linkage analysis
- DNA sequencing
- Genome-wide association studies
Linkage analysis
Genetic linkage is the tendency of DNA sequences that are close together on a chromosome to be inherited together during the meiosis phase of sexual reproduction.
A primary rationale for implementing collaborative care is that existing mental health care programs do not have the ___ to provide effective treatment to all patients in need.
capacity
According to ___ ___, a child who perceives the mother as an integrated person who is responsible for both good and bad experiences at the same time is said to be in the depressive position.
Melanie Klein
High voltage delta activity associated with slow eye-rolling movements on polysomnogram is characteristic of the ___ stage of sleep.
N3
Intensive case management is defined as a program with elements of the assertive community treatment model, assertive outreach model, and case management model with a caseload of up to 20 patients. When compared to care as usual, the literature has shown which of the following effects of intensive case management?
- Decreased death by suicide
- Increased patient employment
- Reduced length of hospitalization
- Reduced incidence of metabolic syndrome
Reduced length of hospitalization
