AP Prep 2/

Question 1

Which of the options below is the most effective treatment of spasmodic torticollis?

• Gabapentin
• Topiramate
• Glatiramer acetate
• Levodopa/carbidopa
• Botulinum toxin

Answer 1

Botulinum toxin (decreases presynaptic release of acetylcholine)

Question 2

The parents of a seven-year-old child report that their child has “mood swings” which consist of the child suddenly becoming irritable, angry, and throwing tantrums. When asked what precipitates these episodes, they reply, “When we tell him ‘no’ or he does not get his way.” Based on this information, which diagnosis is most appropriate preliminarily?

Answer 2

Oppositional defiant disorder

Question 3

A university student in good academic standing has test anxiety and starts CBT. The therapist asks, “If you were to fail the upcoming physics exam, what would that mean?” The student replies, “I would then fail the whole course, and I would have to leave school, and no one in my family would want anything to do with me.” The student’s response is best characterized as:

• personalization
• negative focus
• arbitrary inference
• catastrophic thinking
• all-or-nothing thinking

Answer 3

catastrophic thinking

Question 4

Histamine is a neurotransmitter that plays a key role in regulating transition between ___ and wakefulness.

Answer 4

sleep

Question 5

People with idiopathic intracranial hypertension are often ___ and have headache.

Answer 5

obese

Question 6

A 20yo comes to the ED with clouded sensorium, agitation and hyperactivity, mild paranoia, pressured speech, and euphoric though labile mood. Physical exam shows hypertension, tachycardia, and vertical nystagmus. Which of the following substances was most likely used?

• Flunitrazepam
• Phencyclidine
• Gamma-hydroxybutyrate
• LSD
• MDMA

Answer 6

Phencyclidine

Question 7

During a routine exam a 70yo man says, “My wife thinks I should ask you…she thinks I should do something about…it’s our sex life…never mind.” The doctor asks, “Your sex life?” The man says, “Yes, you see…we get started okay, but then…” The patient then stops talking. Which of the following responses by the doctor is most appropriate?

• “You’re doing fine. Go on.”
• “Does your orgasm come too early”
• “Can you get an erection? How long does it last?”
• We don’t have to talk about this if you don’t want to.”
• It appears that talking about sex raises significant conflicts for you.”

Answer 7

“You’re doing fine. Go on.”

Question 8

In doing a QI project to address poor handoffs at shift change, a first step might be to design a protocol to determine the ___ of missed handoffs on the unit.

Answer 8

prevalence

Question 9

Which of the following fine motor tasks involved in dressing does a child typically master last?

• Zipping a jacket
• Buttoning a sweater
• Tying laces on shoes
• Strapping Velcro on boots
• Snapping buttons on a coat

Answer 9

Tying laces on shoes

Question 10

Which of the following disorders carries the greatest global burden of disease according to the World Health Organization’s estimates of years lived with disability?

• Bipolar
• Alcohol use
• Schizophrenia
• Major depressive
• Generalized anxiety

Answer 10

Major depressive

(MDD ranks in the top ten worldwide for greatest burden of disease, as measured by years of life lost due to poor health, disability or premature death;
financial impact is greater for schizophrenia)

Question 11

Deep brain stimulation (the neurosurgeons), hit the subcallosal cingulate for depression (SCC; they like sports and the SEC, but get paid to target the SCC). Transcranial magnetic stimulation typically targets which area of the brain in treating depression?

Answer 11

Left prefrontal cortex (Tina at Northridge is targeting the left PFC!)

Question 12

During the acute initial refeeding phase of treatment for a patient with severe anorexia nervosa, which of the following is the most helpful focus of psychotherapeutic interventions with the patient?

• Framing the use of disordered eating behavior as a maladaptive coping mechanism
• Identifying triggers for relapse and developing plans to prevent relapse
• Exploring developmental, familial, and cultural antecedents to illness
• Challenging cognitive distortions and negative core beliefs
• Coaching, supporting, and providing behavioral reinforcement

Answer 12

Coaching, supporting, and providing behavioral reinforcement

Question 13

A male patient with MDD comes to the ED with suicidal thoughts. The patient is wearing women’s undies. The patient says they used to become sexually aroused while cross-dressing, and thinks often about dressing as a woman. These thoughts cause him significant distress. Which of the diagnoses below best fits this presentation?

• Gender dysphoria
• Fetishistic disorder
• Voyeuristic disorder
• Transvestic disorder
• Exhibitionist disorder

Answer 13

Transvestic disorder

Question 14

A 7yo is seen for anxiety after repeatedly refusing to get on the school bus, and voicing an irrational fear that the bus will crash. Which of the following questions would be most useful for exploring an operant conditional model as an explanation for the child’s anxiety?

• “How do you feel when you’re on the bus?”
• “How often do you suppose buses get into accidents?”
• “Have you ever been in a car accident, even a small one?”
• “Have you ever seen any bad bus accidents on television?”
• “How do your parents respond when you are afraid of the bus?”

Answer 14

“How do your parents respond when you are afraid of the bus?”

[Operant conditioning is a learning process through which the strength of a behavior is modified by reinforcement or punishment.]

Question 15

Current evidence regarding the efficacy of family therapy as treatment for eating disorders reports that it:

• is superior to individual therapy for patients of all ages.
• is efficacious for adults, but adolescents are less likely to respond.
• is superior to individual therapy for adolescents 6-12 months after treatment.
• improves remission rates for adults in anorexia nervosa but not in bulimia nervosa.
• is superior to individual therapy at the end of treatment, but effects are not sustained.

Answer 15

-is superior to individual therapy for adolescents 6-12 months after treatment.

Question 16

A 39yo seeks psychotherapy after his wife threatens to divorce him due to his constant accusations that she is having affairs. The patient acknowledges monitoring his wife’s emails and text messages, and tracing phone calls from numbers he does not recognize on their home phone. The patient asserts that all of the couple’s friends are “on my wife’s side” and refuses to confide in them due to doubts about their loyalty, and belief that shared information will be used against him in divorce proceedings. The patient also refuses communication with his brother who suggested marital therapy several years ago. The patient has no changes in sleep, appetite or energy level. Which of the following is the most likely diagnosis?

• Delusional disorder
• Paranoid personality disorder
• Schizotypal personality disorder
• Chronic paranoid schizophrenia
• Major depressive disorder with psychotic features

Answer 16

Paranoid personality disorder

Question 17

The primary purpose of computed tomography scan in the evaluation of a patient suspected of having an acute ischemic stroke is to ___ the presence of hemorrhage.

Answer 17

exclude

Question 18

A patient with depression complains of low energy, poor concentration, and weight gain. Which of the following medications would be the best choice to prescribe this patient?

• Amitriptyline
• Bupropion
• Mirtazapine
• Phenelzine
• Selegiline

Answer 18

Bupropion

Question 19

The cortical response to inflammation is primarily mediated by ___.

Answer 19

microglia

[Microglia secrete innate proinflammatory cytokines TNF-a and IL-1B in patients with inflammatory conditions that affect the brain.]

Question 20

A 25yo female with a history of heroin dependence has been stabilized on methadone maintenance for the past year. The patient is now three months pregnant, and presents to the psychiatrist to find out what the best treatment approach is for her and her unborn child. Which of the following is the best recommendation for the psychiatrist to make?

• Continue methadone maintenance
• Immediately discontinue methadone
• Use naloxone to facilitate detoxification
• Switch to L-alpha-acetyl-methadone
• Taper and discontinue methadone over the next several weeks

Answer 20

Continue methadone maintenance

Question 21

If a pt expresses interest in an app to help manage their mental health condition, the response supported by literature is “I would like to ___ the app myself. Then we can further discuss the idea.”

Answer 21

review

Question 22

Which of the following symptoms would best support a diagnosis of dissociative identity disorder rather than posttraumatic stress disorder?

• Dissociative flashbacks
• Amnesia for everyday events
• Amnesia for some aspects of trauma
• Reduced awareness of one’s surroundings
• Hyperarousal focused around a traumatic event

Answer 22

Amnesia for everyday events

Question 23

Blockade of which receptor is primarily responsible for the sedative and weight-gaining side effects of many antipsychotic antidepressant medications?

Answer 23

Histamine receptor

Question 24

Which of the following is a core feature of practicing mindfulness?

• Experiencing internal and external stimuli non-judgmentally
• Learning to systematically relax muscles through the body
• Noticing thoughts and discovering which ones are maladaptive
• Practicing regulating the breath to induce a parasympathetic state
• Increasing focus by continually bringing attention back to a chosen point

Answer 24

Experiencing internal and external stimuli non-judgmentally

Question 25

Which of the following is a psychosocial treatment for schizophrenia that focuses on social awareness and basic mental processes, with the aim of helping patients understand their own intellectual capacities, strengths, and limitations?

• Major role therapy
• Social skills training
• Metacognitive therapy
• Psychodynamic therapy
• Assertive community therapy

Answer 25

Metacognitive therapy

Question 26

Which medication was first used as a treatment for gout, and later promoted by John Cade for the treatment of unstable mood?

Answer 26

Lithium

Question 27

The parents of a 6yo report the child has been having difficulty in multiple settings. The child has difficulty taking turns in conversations, frequently monopolizes conversations with topics that are not of interest to peers, and does not follow social norms such as saying “good morning” in response to his teacher’s greeting. In addition, the child has a hard time understanding jokes, often interpreting what is being said quite literally. The parents report that otherwise the child is interested in making friends, has a variety of interests, and is able to adapt to variations in routine. On exam, the child makes good eye contact and speaks with the psychiatrist in a very formal tone. Which of the following is the most likely diagnosis?

• Language disorder
• Speech sound disorder
• Autism spectrum disorder
• Childhood-onset fluency disorder
• Social (pragmatic) communication disorder

Answer 27

Social (pragmatic) communication disorder

Question 28

Which of the following genetic methods best allows for the analysis of rare variation in the population?

• Pedigree analysis
• Standard karyotype
• Affected-sib pair analysis
• Next generation sequencing
• Genome-wide association studies

Answer 28

Next generation sequencing

Question 29

Which of the following chemotherapy agents is most commonly associated with a distal sensory polyneuropathy?

• Cisplatin
• Lapatinib
• Methotrexate
• Gemcitabine
• Temozolomide

Answer 29

Cisplatin

Question 30

The physician directs a patient with a tremor to tap one hand at a different rate to see if the tremor can be entrained to be at the same rate as the tapping hand. This is a method to test for which type of tremor?

Answer 30

Psychogenic

Question 31

A patient has agraphia, acalculia, right-left disorientation, and finger agnosia and is most likely to have a lesion in the region of which part of the dominant hemisphere?

• Precuneus
• Angular gyrus
• Fusiform gyrus (facial recognition)
• Occipital cortex
• Post-central gyrus

Answer 31

Angular gyrus

[The angular gyrus is a region of the brain in the parietal lobe, that lies near the superior edge of the temporal lobe, and immediately posterior to the supramarginal gyrus; it is involved in a number of processes related to language, number processing and spatial cognition, memory retrieval, attention, and theory of mind.]

Question 32

A 16yo comes to the ED for agitation and paranoia. The patient seems to be hallucinating and says, “I’m walking on air.” Physical exam show tachycardia. The clinical picture is most characteristic of:

• cocaine withdrawal
• caffeine intoxication
• marijuana withdrawal
• prescription opioid withdrawal
• dextromethorphan intoxication

Answer 32

dextromethorphan intoxication (creates dissociative feelings, present in many over the count medications such as sleep aids)

Question 33

A psychiatrist is consulted by a local police department to evaluate an officer’s fitness to return to work. The psychiatrist is concerned about being in a double agentry conflict. Which of the following is the most ethical means of addressing this potential conflict?

• Refuse to do the consultation
• Provide informed consent about the limits of confidentiality
• Ask a member of the police department to join the interview
• Avoid asking the officer questions that might reveal impairment
• Conduct a full assessment but allow the officer to edit the report

Answer 33

Provide informed consent about the limits of confidentiality

Question 34

A patient with cocaine addiction has cravings for cocaine whenever passing by a “crack-house.” This reaction exemplifies ___ ___.

Answer 34

classical conditioning

Question 35

A patient c/o excessive daytime sleepiness, morning headaches, and excessive nighttime sweating. These symptoms are consistent with which of the following sleep disorders?

• Insomnia
• Narcolepsy
• Parasomnia
• Restless leg syndrome
• Obstructive sleep apnea

Answer 35

Obstructive sleep apnea (note that with OSA often there is excessive nighttime sweating)

Question 36

A pt in the third month of psychodynamic psychotherapy continues to dismiss any attempt by the psychiatric resident to offer alternative viewpoints to the patient’s assumptions about the cause of interpersonal conflict and the negative effects of it. This type of behavior is most characteristic of which of the following conditions?

• Avoidant personality disorder
• Dissociative identity disorder
• Narcissistic personality disorder
• Obsessive-compulsive disorder
• Schizotypal personality disorder

Answer 36

Narcissistic personality disorder

Question 37

The psychiatrist interview an otherwise healthy 80yo retired surgeon. The patient is most likely to have problems with which of the following tasks?

• Recalling how to suture a wound
• Recalling autobiographical information
• Answering close-ended questions about a recently read book
• Remembering whether he had a haircut before or after lunch yesterday
• Remembering whether he learned about a recent event on TV or in the newspaper

Answer 37

Remembering whether he learned about a recent event on TV or in the newspaper

Question 38

Event-related potentials on electroencephalograph are currently most useful for confirming which of the following diagnoses?

• Schizophrenia
• Panic disorder
• Conversion disorder
• Bipolar affective disorder
• Female orgasmic disorder

Answer 38

Conversion disorder

Question 39

Epigenetic drift refers to a collection of epigenetic changes at certain sites in the genome that diverge as a function of age. Epigenetic drift has been postulated to contribute to which of the following disorders?

• Vascular dementia
• Lewy body dementia
• Frontotemporal dementia
• Early-onset Alzheimer disease
• Late-onset Alzheimer disease

Answer 39

Late-onset Alzheimer disease (APOE*E4)

Question 40

A patient remains depressed despite psychotherapy and multiple adequate medication trials. The psychiatrist isn’t sure what to try next and consults with a supervisor. Which of the following ethical principles is illustrated by this consultation?

• Justice
• Paternalism
• Nonmaleficence
• Conflict of interest
• Respect for autonomy

Answer 40

Nonmaleficence

Question 41

What is a serotonergic antibiotic that if combined with fluoxetine may lead to serotonin syndrome?

Answer 41

Linezolid

Question 42

Which of the following aspects of attention-deficit/hyperactivity disorder is most likely to improve as children age?

• Impulsivity
• Hyperactivity
• Inattention
• Peer relationships
• Academic difficulties

Answer 42

Hyperactivity

Question 43

Circadian rhythms related to sleep behavior are set and maintained in what area?

Answer 43

Suprachiasmatic nucleus

Question 44

A woman with “vaginal spasms” during sex, feels anxious about sex as a result and has become avoidant and dismissive of sexual encounters has a normal gynecologic exam without discomfort. Most likely diagnosis is which of the following?

• Somatic symptom disorder
• Generalized anxiety disorder
• Female orgasmic disorder
• Genito-pelvic pain/penetration disorder
• Female sexual interest/arousal disorder

Answer 44

Genito-pelvic pain/penetration disorder

Question 45

An 82yo presents with depressed mood and cognitive decline. The patient answers the interviewer’s questions with brief, one-word responses and rare spontaneous elaboration. This is an example of which of the following?

• Echolalia (meaningless repetition of another person’s spoken words)
• Loss of goal
• Poverty of speech
• Latency of speech
• Paraphasic speech

Answer 45

Poverty of speech

Question 46

A 25yo is hospitalized for a first episode of psychosis, and the patient’s parents have called the psychiatrist twice asking for advice about how to assist in their son’s care. The patient does not want the team to speak to his parents because he believes that his parents are identical imposters implanted by government agents. According to the federal Health Insurance Portability and Accountability Act (HIPAA) guidance, which of the following best describes the extent to which information can be shared?

• Provide information only with written consent
• Accept a parent’s surrogate consent to release information
• Provide information given the lack of capacity and likely benefit
• Provide information only when the patient retracts the objection
• Receive information from the parents but do not offer information

Answer 46

Provide information given the lack of capacity and likely benefit

Question 47

The psychiatrist is reviewing the literature to find out which antidepressant has the best evidence to treat depression in “real world” settings. The psychiatrist should seek evidence from which of the following types of research studies?

• Efficacy
• Prevalence
• Cross-over
• Effectiveness
• Retrospective

Answer 47

Effectiveness

Question 48

In the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study, which medication was considered most effective due to its low rate of discontinuation, high reduction in psychopathology, and longest time to discontinuation of treatment?

Answer 48

Olanzapine

Question 49

By which age should the corticospinal tracts have completed myelination in typically developing children?

Answer 49

3 years

Question 50

Parents describe their 10yo as a “girly boy.” They state that most of their son’s friends are girls, and he prefers to “play house” and play with dolls. They report no distress or impairment in the teen’s functioning. Which of the following is the most likely diagnosis?

• Anxiety disorder
• Gender dysphoria
• Body dysmorphic disorder
• Separation anxiety disorder
• Nonconformity to gender role

Answer 50

Nonconformity to gender role

Question 51

Patient’s with Parkinson’s Disease may not feel sad, worthless or have SI or be depressed, but rather not have motivation to do anything or have interest in social events due to ___.

Answer 51

apathy

Question 52

Clozapine levels may drop precipitously with psychosis returning for patients with schizophrenia if the patient resume heavy ___.

Answer 52

smoking

[polycyclic aromatic hydrocarbons in cigarrette smoke induce CYP1A2]

Question 53

The Study of Women’s Health Across the Nation compared women ages 42 to 52 years with persistent or recurrent depressive symptoms to those with a single depressive episode. Which of the following risk factors distinguished those with persistent disease?

• Obesity
• Marital status
• Sleep problems
• Menopausal status
• Childhood maltreatment

Answer 53

Sleep problems

Question 54

The decrease late-life prevalence of personality disorders is explained by typical psychosocial ___.

Answer 54

maturation

Question 55

Plasticity in the mammalian brain necessary for learning and memory is best accounted for by which of the following structural changes?

• Neuronal size
• Neuronal number
• Dendritic pruning
• Synaptic connectivity
• Cellular migration and reorganization

Answer 55

Synaptic connectivity

Question 56

DNA methylation regulatory enzymes and proteins have recently been described inside what intracellular feature?
-Vesicles
-Mitochondria
-Golgi apparatus
-Rough endoplasmic reticulum
Smooth endoplasmic reticulum

Answer 56

Mitochondria

[DNA methylation is a process by which methyl groups are added to the DNA molecule. Methylation can change the activity of a DNA segment without changing the sequence. When located in a gene promoter, DNA methylation typically acts to repress gene transcription.]

Question 57

A patient presents with multiple episodes of limb-shaking lasting over three minutes. During these episodes the patient is conscious, talking, and reports the ability to briefly suppress the movements. Which of the following factors is associated with poor prognosis for this patient?

• High intelligence
• Comorbid mood disorder
• Clearly identified stressor
• Insidious onset of symptoms
• Short interval between onset and treatment

Answer 57

Insidious onset of symptoms

Question 58

Light exposure too late in the day with light box can lead to undesirably later sleep ___ and later wakening times.

Answer 58

onset

Question 59

Which of the following is most likely to be free of any significant interaction with other antiepileptic medications?

• Topiramate
• Lamotrigine
• Valproic acid
• Levetiracetam/Keppra
• Oxcarbazepine

Answer 59

Levetiracetam/Keppra

Question 60

Conducting a session after hours in a local coffee bar is an example of a boundary ___.

Answer 60

violation (involves exploitation)

Question 61

The Patient Health Questionnaire-9 is a validated tool to assess the severity of which of the following disorders?

• Bipolar
• Illness anxiety
• Major depressive
• Somatic symptom
• Generalized anxiety

Answer 61

Major depressive

Question 62

Following a normal full-term birth, by what age are circadian (suprachiasmatic nucleus) sleep rhythms similar to those of an adult generally established in the child?

Answer 62

6 months

Question 63

___ is a selective norepinephrine reuptake inhibitor that is FDA approved for both adults and children (6-17yo) in the treatment of attention-deficit/hyperactivity disorder that carries an FDA black box warning for suicidal ideation in children and adolescents.

Answer 63

Atomoxetine/Strattera

Question 64

Boys with which of the following variables are more likely to delay first sexual intercourse until after age 18?

• Anxiety symptoms
• Physical aggression
• Depressive symptoms
• Increased alcohol use
• Higher maternal education level

Answer 64

Anxiety symptoms

Question 65

A 25yo with no PSH has new preoccupation with imagined defects in appearance which is a cause of excessive concern. He has distress over appearance, no other psychiatric or medical findings. Which of the following medications is most appropriate for the patient?

• Quetiapine
• Mirtazapine
• Olanzapine
• Bupropion
• Fluoxetine/Prozac

Answer 65

Fluoxetine/Prozac

Question 66

A college student reports feeling embarrassed at school, particularly when speaking publicly or choosing a seat in the cafeteria, at which time the patient experiences blushing, muscle twitching and a feeling of shame. The patient expresses sadness about not having friends. Which of the following is the most likely diagnosis?

• Panic disorder
• Specific phobia
• Social anxiety disorder
• Major depressive disorder
• Schizoid personality disorder

Answer 66

Social anxiety disorder

Question 67

A 70yo has new onset “confusion”, seems to have trouble speaking and is able to communicate with single words or short sentences but often can’t think of the word he wants to say. Some sentences do not make sense and the patient utters phrases such as, “the snoodle linkered in the yard” when referring to his dog. He is unable to repeat the phrase “no ifs, ands, or buts.” He is able to follow commands, and seems to understand the questions. This type of language disorder is consistent with which type of aphasia?

Answer 67

Broca’s (“Broken Boca”)

Question 68

A female patient in psychotherapy starts to discuss sexual fantasies about the therapist who feels flattered by her interest and is aware of his own feelings of attraction to her. The most appropriate next step for the therapist is to seek ___ with a colleague.

Answer 68

consultation

Question 69

What is the major negative aspect of crossover designs for research studies?

Answer 69

Residual effects

Question 70

The neural circuit that connects the anterolateral orbitofrontal cortex, anterior part of the putamen and thalamus is involved in ___ inhibition.

Answer 70

response

Question 71

There is an increased risk of ___ diagnosis in the relatives of patient with schizotypal personality disorder.

Answer 71

schizophrenia

Question 72

Which of the following diagnostic assessments is administered with a clinical interview rather than self report?

• Symptom Checklist-90
• Brief Symptom Inventory
• Brief Psychiatric Rating Scale
• Millon Clinical Multiaxial Inventory
• Minnesota Multiphasic Personality Inventory

Answer 72

Brief Psychiatric Rating Scale

Question 73

Terminally ill cancer patients who experience concerns about a “bad death” are most typically worried about dying:

• in pain
• in a hospital
• while delirious
• with lifelong regrets
• before feeling ready

Answer 73

in pain

“Bad death” concern = physical PAIN

Question 74

Which of the following neuropsychiatric symptoms is most commonly seen in mild neurocognitive disorder?

• Apathy
• Anxiety
• Irritability
• Delusions
• Depression

Answer 74

Depression

Same for TBI, depression is the most commonly seen comorbid psychiatric symptom

Question 75

Maximum sleepiness in humans occurs when melatonin level reaches its highest point, and which of the following reaches its lowest point?

• Pulse
• Blood pressure
• Respiratory rate
• Body temperature
• Saccadic eye movement

Answer 75

Body temperature [cool the igloo]

Question 76

Coercion ___ informed consent.

Answer 76

invalidates

Question 77

An 8yo recently had the Wechsler Intelligence Scale for Children and received a full-scale IQ score of 60. Which of the following additional tests would determine if the child meets criteria for intellectual disability?

• Test of Nonverbal Intelligence
• Wechsler Individual Achievement Test
• Vineland Adaptive Behavior Scales [IQ AND BEHAVIOR]
• Diagnostic Interview Schedule for Children
• Reitan Indiana Neuropsychological Test Battery

Answer 77

Vineland Adaptive Behavior Scales

[IQ and BEHAVIOR need to both be assessed prior to determination someone meets intellectual disability criteria]

Question 78

The most serious limitation of the candidate gene approach in identifying genetic disorders is the high probability of ___ ___ findings.

Answer 78

false positive

Question 79

A woman is psychiatrically hospitalized with prominent paranoid delusions, auditory hallucinations, and progressive mood lability. She subsequently develops waxing and waning confusion, word-finding difficulty, and periods of mutism. An electroencephalogram detects extreme delta brushing. Anti-NMDA receptor antibody testing is positive (NMDA encephalitis is glutamate based and thus antipsychotic resistant). Which of the following neoplasms is most likely to be detected on further testing?

• Melanoma
• Thymoma
• Ovarian teratoma
• Hodgkin lymphoma
• Small cell lung cancer

Answer 79

Ovarian teratoma

Question 80

A psychiatrist’s neighbor revealed that he was feeling increasingly depressed after his wife’s death. Dissatisfied with his current psychiatrist, he asked for other referral options. The psychiatrist offered the names of several local colleagues. A few weeks later the neighbor mentioned to the psychiatrist that he was diagnosed with depression and now treated with fluoxetine 20 mg. He then asked several questions about the diagnosis, treatment options, and medication information. Subsequently, the neighbor asked for advice about increasing the dose when his provider was out of town.
The psychiatrist advised that this was an acceptable option. Which of the following actions most clearly established a doctor-patient relationship between the psychiatrist and the neighbor?
-Referral to another psychiatrist
-Providing information about the diagnosis
-Advising the increase in medication dose
-Discussing other potential treatment options
-Discussing potential side-effects of medication

Answer 80

Advising the increase in medication dose

Question 81

The methods for estimating the sample size required to detect statistical effects of defined size for variables with well-known variances is referred to as which type of analysis?

Answer 81

Power

Question 82

The ___ nucleus is a hypothalamic nucleus that is key to the integration of neural and nutrient signals with hormonal signals from the small intestine, pancreas, liver, adipose tissue, and brainstem.

Answer 82

arcuate

Question 83

In supportive psychotherapy the clinician is viewed by the patient as a “good parent” and the patient says “I feel so lucky to have found such a wise and compassionate therapist.” The clinician should utilize the transference to ___ the therapeutic alliance.

Answer 83

strengthen

Question 84

A 70yo is prescribed sertraline for depression and within 2 weeks starts to have waxing and waning impairment of alertness, attention and memory. Vitals signs and physical exam are both WNL. Which test would be most helpful in clarifying the etiology of the change in the patient’s mental status?

Answer 84

Serum electrolytes (checking for sodium as there may be hyponatremia here)

Question 85

Which of the following is characteristic of sleep in individuals over the age of 65, as compared to that of young adults?

• Increased total REM
• Increased fragmentation
• Lower frequency of nightmares
• Increased percentage of slow wave sleep
• Lower incidence of restless leg syndrome

Answer 85

Increased fragmentation

Question 86

A 43yo awakens with weakness in the left hand. The patient was at a bar the night before then fell asleep at home with his left arm draped over the armrest of a chair. Exam show weakness of wrist and finger extension, with preserved grip strength. The most likely cause of this weakness is injury to which peripheral nerve?

Answer 86

Radial

Question 87

Which of the following processes involves genetic control by factors other than the DNA sequence?

• Epigenetics
• Transcription
• DNA replication
• mRNA synthesis
• Reverse transcription

Answer 87

Epigenetics

Question 88

Symptoms must be present during the final week of the ___ phase in order to qualify for diagnosis of premenstrual dysphoric disorder.

Answer 88

luteal

Question 89

Which psychodynamic theorist posited that development occurs in sequential, clearly defined stages, and that each stage must be resolved for development to proceed smoothly?

Answer 89

Erik Erikson

• 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)
• Identity vs role confusion (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)

Question 90

Which measure of disease frequency is most appropriate for determining the rate of new cases of a disorder in a given time period?

Answer 90

Incidence

Question 91

*In which stage of Piaget’s theory of cognitive development do children first understand conservation of volume?

Answer 91

Concrete operational

Piaget’s stages of cognitive development:
+Sensorimotor period: birth->2 years

+Preoperational period: 2->7 years (animism, immanent justice, egocentrism, magical thinking)

+Concrete operational stage: 7->12 years (“Conservation of volume in Concrete operational stage + reversibility)

+Formal operational stage: 13->adulthood (able to think abstractly, logically, apply these processes to hypothetical situations)

Question 92

Glucocorticoid receptors are ___ receptors.

Answer 92

nuclear

Question 93

Which of the following medications would be preferable for use in an anxious patient with pulmonary disease?

• Alprazolam
• Bupropion
• Buspirone
• Clonazepam
• Propranolol (Don’t want to close the airways through beta blocker in patient with pulmonary disease!)

Answer 93

Buspirone

Question 94

The main concept of the Mental Health ___ and Addiction Equity Act of 2008 is that mental health insurance benefits cannot be less favorable than medical or surgical insurance benefits.

Answer 94

Parity

Question 95

Typically developing children acquire an understanding of the difference between inner life and outer reality (theory of mind) by what age?

Answer 95

Four years

Question 96

A young girl has marked developmental regression, progressive loss of acquired motor and language skills, stereotyped repetitive hand movements, muscle hypotonia, autonomic dysfunctions, and severe cognitive impairment. Which of the following genes is most likely to be involved in the etiology of these symptoms?

• INPP5E coding for pharbin
• Elastin gene on chromosome 7
• ASXL1 coding for a chromatin-binding protein
• MECP2 coding for methyl CpG-binding protein 2
• Partial deletion of the short arm of chromosome number 5

Answer 96

MECP2 coding for methyl CpG-binding protein 2

Question 97

When used at a therapeutic dose/level during pregnancy, the dose of which of the following medications should be reduced in the immediate post-partum period to minimize the risk of adverse drug effects?

• Lithium
• Lamotrigine
• Carbamazepine
• Topiramate
• Valproate

Answer 97

Lithium

Question 98

A Marine vet coming back from Afghanistan has memory problems. Which of the following findings would support a diagnosis of dissociative amnesia?

• Recent history of closed head injury
• Deterioration of procedural injury
• Presence of both anterograde and retrograde amnesia
• Dense memory deficits limited to a few traumatic episodes
• Vague and inefficient recall of almost all memories since childhood

Answer 98

Dense memory deficits limited to a few traumatic episodes

Question 99

Which type of glial cell assists in forming myelin sheaths in the peripheral nervous system?

Answer 99

Schwann

Question 100

Which type of glial cell assists in forming myelin sheaths in the central nervous system?

Answer 100

Oligodendrocytes

Question 101

Which of the following medication classes is most likely to exacerbate physiologic tremor?

• Barbiturates
• Corticosteroids
• Benzodiazepines
• Calcium channel blockers
• Beta adrenergic antagonists

Answer 101

Corticosteroids

Question 102

Gender identity is typically established by what age?

Answer 102

Three years

Question 103

A researcher examines the relationship between two dichotomous variables, parental depression (yes or no) and child anxiety (yes or no). Which fo the following inferential statistics is best employed in the interpretation of these data?

• T-test
• Chi square test
• Linear regression
• Logistic regression
• Pearson correlation

Answer 103

Chi square test (Categorical)

Question 104

A 69yo with no PMH comes to the ED with a recent, severe “thunderclap” headache. The patient also reports unilateral eye pain and blurred vision. Examination reveals mildly dilated pupils and conjunctival injection. Which of the following tests is most likely to reveal the most likely cause of this patient’s headache?

• Lumbar puncture
• Temporal artery biopsy
• Magnetic resonance angiography
• Intraocular pressure measurement
• Cranial computed tomography without intravenous contrast

Answer 104

Intraocular pressure measurement

Question 105

Which of the following is the most important protective factor in building resilience in children?

• Social skills
• Cognitive ability
• Quality of parenting
• Easy temperament
• Socioeconomic status

Answer 105

Quality of parenting

Question 106

Pituitary adenylate cyclase-activating polypeptide is a potent ___ factor preventing neuronal cell death (apoptosis).

Answer 106

neuroprotective

Question 107

Which of the following is a neuropsychological test of sustained attention?

• Differential Ability Scales
• Wisconsin Card Sorting Test (alternative strategy development in response to feedback, concept formation, concept flexibility, dorsolateral frontal cortex)
• Rey-Osterreith Complex Figure Test
• Conners’ Continuous Performance Test
• Delis-Kaplan Executive Function System

Answer 107

Conners’ Continuous Performance Test (“Conner’s sustained attention!)

Question 108

To convince anti-vaccers, a strategy grounded in social psychological principles and most likely to be successful is to show how vaccination can be ___ with the group’s core values.

Answer 108

congruent

Question 109

A ten-year-old child remains sad and angry about his parents’ divorce but no longer believes that he caused the separation. This cognitive change is an example of ___.

Answer 109

Decentration

Question 110

The ___ ___ is most consistently associated with the rewarding effects of alcohol.

Answer 110

Nucleus accumbens (part of ventral striatum, along with the olfactory tubercle)

(note: the dorsal striatum consists of the caudate and putamen)

Question 111

Which of the following is the greatest risk factor for developing akathisia?

• Male sex
• Younger age
• Rapid dose escalation
• Lower potency agents
• Preponderance of positive symptoms

Answer 111

Rapid dose escalation

Question 112

Estrogen leads to ___ inflammatory cytokine production.

Answer 112

decreased

Question 113

One outcome of mental health courts is that participants access community treatment more ___.

Answer 113

quickly

Question 114

A 79yo man presents with progressive dementia and myoclonus (quick, involuntary muscle jerks) over three months. An electroencephalograph shows periodic sharp waves with a frequency of ___Hz over both hemispheres. After autopsy, there is cytosolic vacuolation of neurons and glia with prion inclusions and the patient is diagnosed with Creutzfeldt-Jakob disease.

Answer 114

1

Question 115

IV ___ is given to a patient prior to triggering the electrical stimulus during ECT to prevent bradycardia and asystole.

Answer 115

atropine (atropine is anticholinergic and thus increases heart rate)

Question 116

When there is a cultural question the first step is generally to ___ more.

Answer 116

learn

Question 117

Genetic copy number variations (CNVs) in people with severe neurodevelopmental disorders display, relative to controls, an ___ in the burden of copy number variations (CNVs).

Answer 117

increase

Question 118

For a psychological test to demonstrate ___ validity it must sample the area of interest adequately.

Answer 118

content

Question 119

Pt has self-reported c/f brain tumor. He has no symptoms suggestive of brain tumor and says, “but I have a cousin who died from a brain tumor.” Physical exam is unremarkable and non-focal. Although he had a negative brain MRI, the patient repeatedly requests a new MRI, still concerned there is an undetected tumor. Which of the following is the most likely diagnosis?

• Delusional disorder
• Illness anxiety disorder
• Somatic symptom disorder
• Generalized anxiety disorder
• Functional neurological symptom disorder

Answer 119

Illness anxiety disorder

Question 120

Due to the slowed growth of neural language synapses, children older than six years of age have more difficulty that younger children with:

• learning a new language
• acquiring new vocabulary words
• decoding non-verbal social cues
• understanding rules for grammar
• inferring word meanings from context

Answer 120

learning a new language

Question 121

Which of the following, secreted by adipose tissue, regulates the fat stores in the body?

• Leptin
• Serotonin
• Dopamine
• Neuropeptide Y
• Cholecystokinin

Answer 121

Leptin (Leptin is released from the adipose tissue and enters the brain to provide a negative feedback signal and reduce food intake)

Question 122

According to the US Preventive Services Task Force, which of the following demographic groups has the highest prevalence of depression?

• Males
• College educated
• Previously married
• White Non-Hispanic
• Persons 65 years or older

Answer 122

Previously married

Question 123

A person who is afraid of loud noises has a panic attack in a grocery store when a shelving unit crashes to the floor. The person needs to take a lorazepam immediately, and goes home. Subsequently, the individual avoids the grocery store due to feeling fearful. According to classical conditioning, what is the conditioned stimulus in this scenario?

Answer 123

Grocery store

[In classical conditioning, the conditioned stimulus is a previously neutral stimulus (eg, grocery store) that, after becoming associated with the unconditioned stimulus (loud noise), eventually comes to trigger a conditioned response (fear).]

Question 124

What genetic mechanism can best account for the high prevalence of diseases such as schizophrenia, autism and intellectual disability, despite the fact that these illnesses are associated with a marked reduction in fertility?

• Aneuploidy (the presence of an abnormal number of chromosomes in a cell, for example a human cell having 45 or 47 chromosomes instead of the usual 46.)
• De novo mutations
• Epigenetic variation
• Dysregulated circular RNA
• Inherited copy number variants

Answer 124

De novo mutations

(de novo: starting from the beginning; anew
A genetic alteration that is present for the first time in one family member as a result of a variant (or mutation) in a germ cell (egg or sperm) of one of the parents, or a variant that arises in the fertilized egg itself during early embryogenesis. Also called de novo variant, new mutation, and new variant)

Question 125

At any given time, approximately what percentage of medical students in the world report having suicidal ideation?

Answer 125

10%

Question 126

Memantine exerts its cognitive preservation effects through ___ NMDA receptor antagonism.

Answer 126

glutamate

[Memantine is used to treat moderate-to-severe Alzheimer disease through NMDA antagonism]

Question 127

According to Winnicott, if a mother is unable to provide a “holding environment” for her infant, what defensive process is likely to arise in the infant?

Answer 127

False self

Question 128

What is the most common triggering factor for malpractice claims arising from psychiatric care?

Answer 128

Suicide

Question 129

Which of the following neurotransmitter effects, when dysfunctional, has been shown to most comprehensively replicate the core symptoms of schizophrenia?

• Serotonin
• Glutamate
• Dopamine
• Acetylcholine
• Norepinephrine

Answer 129

Glutamate (by a wide margin, the most abundant excitatory neurotransmitter in the vertebrate nervous system. Per Dr. Madaan, 85% of all the synapses in the brain are glutamatergic)

Question 130

Which magnetic resonance imaging (MRI) technique is most likely to reveal the abnormalities of ischemic stroke earliest?

Answer 130

Diffusion-weighted MRI (DWI MRI)

Question 131

A patient in long-term psychodynamic psychotherapy verbally attacks the therapist for being controlling and uncaring. This patient’s behavior is most likely an example of what?

Answer 131

Transference

“The patient’s transference”
vs
“The therapist’s countertransference”

Question 132

Which ethnic group in the United States has the lowest 12-month prevalence of alcohol use disorder?

Answer 132

Asian Americans and Pacific Islanders

Question 133

The Freudian stage of latency (6-puberty) is correlated with which of Erikson’s stages?

Answer 133

Erikson’s: industry vs inferiority (6-12yo, school age, the child compares self worth to others)

[Freud’s theory of psychosocial development emphasizes that as humans develop, they become fixated on different and specific objects through their stages of development.
Oral: birth-1yo
Anal: 1-3yo
Phallic: 3-6yo
Latency: 6-puberty (here the drives are seen as dormant and hidden and pleasure is mostly related to secondary process thinking)
Genital: puberty on]

Question 134

What is the name for modulators that enhance receptor function when an agonist is present but do not directly activate the receptor without an agonist present?

Answer 134

positive allosteric modulators

Question 135

Which of the following types of amnesia is most likely to be reversible?

• Anterograde amnesia for the period during anesthesia
• Retrograde amnesia in a patient with Alzheimer disease
• Dissociative amnesia in a patient with major depressive disorder
• Anterograde amnesia in a patient with Wernicke-Korsakoff syndrome

Answer 135

Dissociative amnesia in a patient with major depressive disorder

Question 136

Which of the following disorders is caused by an autosomal microdeletion?

• Rett syndrome
• Down syndrome
• Williams syndrome
• Fragile X syndrome

Answer 136

Williams syndrome (“elfin”, very friendly/happy, mild/mod ID, supravalvular AS)

[Autosomal: Pertaining to a chromosome that is not a sex chromosome. People normally have 22 pairs of autosomes (44 autosomes) in each cell, together with 2 sex chromosomes, X and Y in a male and X and X in a female.]

Question 137

What is the most common fear among preschool-age children who are faced with a terminal illness?

• Losing their toys
• Disappointing caretakers
• What happens after death
• Separation from caretakers

Answer 137

Separation from caretakers

Question 138

What is the earliest age by which 90% of girls in the United States will have reached menarche?

Answer 138

14 years

Question 139

Which of the following must be established in a medical malpractice case for a plaintiff to prevail?

• Malicious intent
• Physical harm to the patient
• Breach of duty causing harm
• Deviation from standard of care

Answer 139

Breach of duty causing harm

Question 140

The psychiatrist suspects the patient may be a poor metabolizer as he has had excessive side effects when on low doses of several antidepressants. Which of the following methods is used to identify CYP enzyme DNA sequence variants that may explain this patient’s intolerance?

• Karyotyping tests
• Microarray assays
• Polymerase chain reactions
• Ligation-dependent probe amplifications

Answer 140

Microarray assays

[Chromosomal microarray analysis looks at smaller segments, assessing for deletions or duplications in sections of DNA. SNPs - single nucleotide polymorphisms are important here too in addition to deletions and duplications and can also be seen through chromosomal microarray analysis testing]

Question 141

By what age can typically developing children answer open-ended questions such as why, when and how?

Answer 141

Five years

Question 142

A patient has a history of assaultive behavior says they have an intention to track someone down and “teach them a lesson they’ll never forget” since they left this person for another man. In most states the psychiatrist has a legal ___ to inform the police that the patient poses a potential danger.

Answer 142

responsibility

Question 143

“If I didn’t smoke, I could use the money for music” is an example of the “change talk” elicited in ___ ___.

Answer 143

motivational interviewing

Question 144

Valproate has epigenetic modifying properties due to its effect on ___ ___.

Answer 144

histone deacetylase

Question 145

Parental loss due to an external cause (suicide, homicide or accident) during childhood most elevates the risk for depression as a young adult when the loss occurs in ___ ___.

Answer 145

early childhood

Question 146

Absent gross negligence, dereliction of duty in a malpractice trial is typically established by which of the following?

• Evidence of a bad outcome
• Testimony of expert witnesses
• Testimony of the injured patient
• Evidence of alternative practice procedures

Answer 146

Testimony of expert witnesses (Dr. Cohen)

Question 147

DNA methylation recruits proteins involved in gene repression or by ___ the binding of transcription factors to DNA.

Answer 147

inhibiting

Question 148

DNA ___ increases expression of genes through transcription activation.

Answer 148

acetylation

Question 149

Which of the following factors has the most evidence to support its protective effect in bereavement following the loss of a spouse?

• Intelligence of the bereaved
• Quality of the couple’s relationship
• Length of the couple’s relationship
• Quality of social support of the bereaved
• Capacity for psychological-mindedness of the bereaved

Answer 149

Quality of social support of the bereaved

Question 150

Central nervous system responses to fear-provoking stimuli are mediated chiefly through the central nucleus of the ___.

Answer 150

amygdala

Question 151

A 27yo female is referred to psychiatrist due to recent onset of episodes of altered behavior that last 1-2 minutes at most. The patient’s spouse notes that when these episodes occur while the patient is cooking, she will place all the clean silverware back in the dishwasher. During the episodes the spouse has observed the patient making chewing movements, and indicates that he is unable to interrupt the patient’s behavior. After the episode, the patient has no recollection of the events. A magnetic resonance imaging scan is normal. Which of the following is the most likely diagnosis?

• Fugue states
• Dissociative states
• Peduncular hallucinosis
• Transient global amnesia
• Complex partial seizures

Answer 151

Complex partial seizures

remember to always consider neurological causes even if the PCP or neurologists think etiology is psychiatric

Question 152

A patient meets their new psychiatrist and says, “You’re going to be just like all the others - no shrinks ever listen to me.” Which of the following would be the best statement for the psychiatrist to make next?

• “Are you always this accusatory with your treatment providers?”
• “I’m sorry you felt unheard in the past. Can you describe that experience?”
• “Tell me about your childhood. Did you feel misunderstood by your parents as well?”
• “We will come back to this, but first I need to know more about your psychiatric history.”
• “I doubt that. I have been in practice for many years, so it shouldn’t be a problem.”

Answer 152

“I’m sorry you felt unheard in the past. Can you describe that experience.”

Question 153

Animal literature has established that maternal licking and grooming behavior has a profound effect on the stress reactivity of offspring. This is due to DNA ___ affecting glucocorticoid receptor expression.

Answer 153

methylation (DNA methylation leads to decreased gene expression)

Question 154

A 20yo with severe borderline personality disorder and over 25 past suicide attempts presents for dialectical behavior therapy (DBT). The therapist asks the patient for a commitment to refrain from self-harm behaviors for one year. The patient replies, “Oh, sure, that won’t be a problem at all, believe me.” Which of the following responses by the therapist would be most consistent with principles of DBT?

• Insist that the patient endorse the agreement in writing
• Suggest that the patient increase the duration of the commitment to two years
• Draw the patient’s attention to the fact that this commitment would be extremely difficult to abide by
• Inform the patient that treatment will be terminated if any acts of self-harm occur within the next year
• Praise the patient for the decision and emphasize that the therapist does indeed believe that the patient will refrain from self-harm

Answer 154

Draw the patient’s attention to the fact that this commitment would be extremely difficult to abide by

Question 155

A 50yo with epilepsy has seizures that are well-controlled on antiepileptic monotherapy, but the patient develops nausea, ataxia and diplopia when treated with erythromycin for a sinus infection. This patient is most likely taking which of the following antiepileptic medications?

• Valproate
• Gabapentin
• Topiramate
• Levetiracetam (interestingly, most likely to be free of any significant interaction with other antiepileptic)
• Carbamazepine

Answer 155

Carbamazepine (an inducer of CYP3A4 and a substrate for the enzyme. Carbamazepine is unique in that it induces its own metabolism; of note it also has a ton of drug intractions)

(Erythromycin is a major inhibitor of CYP3A4 - use caution with any agents with substantial metabolism through the CYP pathway.)

Question 156

The following are the stages of psychosocial development according to whom?

• 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)
• Identity vs role confusion (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)

Answer 156

Erik Erikson

Question 157

In social psychology, the occurrence of a contradiction between two attitudes or between an attitude and a behavior is referred to as what?

Answer 157

Cognitive dissonance

Question 158

Altered functional connectivity between the medial prefrontal cortex and the amygdala has been implicated in the neurology of ___ ___ ___ and obsessive-compulsive disorder

Answer 158

Major depressive disorder

Question 159

Empowering families to ___ in treatment plan decisions is a core characteristic of the “system of care” movement in community mental health.

Answer 159

participate

Question 160

During a neurologic exam a patient is unable to see objects presented in the upper left quadrant of each eye indicating a lesion in the ___ or ___.

Answer 160

Right temporal lobe; Right optic radiation

Question 161

A patient with a history of BPAD comes to ED with immobility, posturing, and echopraxia. What is the first-line treatment for these symptoms?

Answer 161

Lorazepam

Question 162

Dementia/Neurocognitive disorder with Lewy bodies is associated with a fluctuating rate of progression, marked ___ impairment, and early unilateral resting tremor and increased muscle tone in the arm.

Answer 162

visuospatial

{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 + REM sleep behavior disorder.}

Question 163

Back pain, foot drop and weakness of ankle inversion suggests an ___ radiculopathy.

Answer 163

L5

Question 164

A methodological advantage of genome-wide association study in comparing individuals to demographically-matched controls is that it can detect gene variants that have a ___ effect on disease risk.

Answer 164

small

Question 165

A patient with addictive illness and social anxiety disorder discusses with a shrink the painful experience of anxiety when first attending Alcoholics Anonymous. The shrink saying, “You did the most important thing, you went to the meeting. It will get easier” is consistent with ___-___ facilitation therapy.

Answer 165

twelve-step

Question 166

Which of the following is a characteristic change on polysomnogram (AKA sleep study) associated with major depression?

• Short REM latency
• Decreased REM sleep
• Decreased REM density
• Increased slow wave sleep
• Increased overall sleep time

Answer 166

Short REM latency

(Rapid eye movement latency is the time from the sleep onset to the first epoch (the beginning of a distinctive period in the history of someone or something) of REM sleep)

Note REM latency is short in major depression and narcolepsy too, both of which make sense - in the former to sort things out, in the latter to catch up on essential restoration in REM

Question 167

A 40yo male patient comes to the ED complaining of diarrhea of two weeks’ duration. On exam he seems anxious, tremulous and is not oriented to date or time of day. The patient says he is taking “some drug” for bipolar disorder and adds that he doubled his dose a month ago because he “wasn’t getting better fast enough.” He denies the use of alcohol or other drugs. Which of the following medications would most likely cause the symptoms described?

• Carbamazepine
• Valproic acid
• Lithium
• Lamotrigine
• Topiramate

Answer 167

Lithium

Question 168

The strongest predictor of depression after elective abortion is a ___ of pre-pregnancy depression.

Answer 168

history

Question 169

Activation of which receptor is thought to contribute to cell death in Alzheimer disease?

Answer 169

NMDA

[Glutamate, the primary excitatory amino acid in the CNS, may contribute to the pathogenesis of Alzheimer’s disease by overstimulating various glutamate receptors (which make of 85% of all receptors in the brain) leading to excitotoxicity and neuronal cell death.

Memantine is an uncompetitive antagonist of the N-methyl-D-aspartate (NMDA) type of glutamate receptors, located ubiquitously throughout the brain.]

[Memantine is used to treat moderate-to-severe Alzheimer disease through NMDA antagonism]

Question 170

Which of the following is an established risk factor for the development of bulimia nervosa?

• Childhood sexual abuse
• Low academic achievement
• Lower socioeconomic status
• Delayed pubertal maturation
• Thinness in childhood followed by obesity in adolescence

Answer 170

Childhood sexual abuse

Question 171

Which of the following medications, when taken in overdose, is most clearly associated with an increased risk of seizure?

• Duloxetine
• Trazodone
• Fluoxetine
• Mirtazapine
• Clomipramine

Answer 171

Clomipramine (a TCA) (the most serotonergic TCA, sometimes used in OCD)

Question 172

A new instrument is developed to assess for posttraumatic stress disorder. The instrument covers intrusion, avoidance, arousal and cognitive and mood symptoms, but it does not specifically inquire about the presence of a traumatic event. This omission raises concern about which type of validity?

Answer 172

Content

For a psychological test to demonstrate content validity it must sample the area of interest adequately.

Question 173

A disorganized pt comes to the ED after displaying disorganized behavior and yelling at dog-walkers at the local park. The patient asks the psychiatry resident, “Are you a real psychiatrist?” Which of the following is the best response?

• “I think we should focus on why you are here.”
• “Why is it important for you to know the answer to that question?”
• “It seems like you’re upset, Can you talk to me about what is bothering you?”
• “I am still in training. Let me get the attending psychiatrist to interview you instead.”
• “I’m a resident, which means I am a physician who is receiving specialty training in psychiatry.”

Answer 173

“I’m a resident, which means I am a physician who is receiving specialty training in psychiatry.”

Question 174

Which of the following is proposed to be a basic emotion, learned directly or inferred by infants during the first year of life?

• Envy
• Fear
• Shame
• Pride
• Guilt

Answer 174

Fear

Question 175

The Kluver Bucy syndrome, characterized by placidity, hyperorality, hypersexuality and increased food intake, can be induced in animals with bilateral resection of the ___ lobes.

Answer 175

temporal

Question 176

A 12yo patient comes for therapy after summer break. The patient has lost a significant amount of weight and is now at the 20th percentile compared to age group for weight and 60th percentile for height. The patient decided to eat a healthier diet, identifies no concerns about the weight loss, and wants to lose another 5-10 pounds. Previously the patient had consistently been at the 75th percentile for weight, but felt self-conscious about appearance. The parents are concerned because the patient spends much time researching the nutritional content of food and has restricted intake to a limited range of food items. Which of the following is the best description of the patient’s current behaviors?

• Bulimia nervosa
• Anorexia nervosa
• Healthy eating approach
• Body dysmorphic disorder
• Avoidant/restrictive food intake disorder

Answer 176

Anorexia nervosa

Question 177

According to the World Health Organization, which of the following mental disorders ranks in the top ten worldwide for greatest burden of disease, as measured by years of life lost due to poor health, disability or premature death?

• Schizophrenia
• Alcohol use disorder
• Major depressive disorder
• Posttraumatic stress disorder
• Alzheimer disease and other dementias

Answer 177

Major depressive disorder

Question 178

A college student who does well in classes repeatedly seeks reassurance and advice from parents, friends, and roommates. The student’s roommates become exasperated after the fourth question about the font the student is using in a presentation. If the excessive reassurance-seeking is a compensatory strategy, what core belief might this student have?

• Everyone thinks I’m stupid.
• I am a complete failure at everything.
• I am not good at writing presentations.
• My roommates are much smarter than I am.
• I cannot be trusted to make a good decision.

Answer 178

I cannot be trusted to make a good decision.

Question 179

Withdrawal symptoms in chronic heroin users peak after how many hours?

Answer 179

36

Question 180

After a head injury, a patient is observed to have personality changes, including increased impulsivity and euphoria. Which of the following is the most likely site of the injury?

• Amygdala
• Cerebellum
• Ventral striatum (Nucleus accumbens + olfactory tubercle)
• Orbitofrontal cortex
• Anterior cingulate cortex

Answer 180

Orbitofrontal cortex

Question 181

In females, which of the following is typically the first marker of impending puberty?

• Menarche
• Increase in total body fat
• Acceleration of linear growth
• Increase in muscle mass and strength
• Appearance of secondary sexual characteristics

Answer 181

Acceleration of linear growth

Question 182

An adolescent patient is hospitalized on the neurology service for sudden onset loss of vision. Medical workup is negative and the primary team is unsure of the etiology. The resident walks the patient and when they approach a bin in the hall the patient walks around it. What is the most likely diagnosis?

Answer 182

Conversion disorder

Question 183

A pt with chronic migraines that are now daily reports they were previously infrequent and responded to sumatriptan. She has started taking sumatriptan daily with minimal benefit. Twice weekly the patient also takes ibuprofen with minimal benefit. Mood has been OK despite stress about the headaches. Physical exam is unremarkable. What would be the preferred initial approach to this patient’s headaches?

Answer 183

Discontinue sumatriptan

Question 184

The staff on an inpatient unit want to reduce risk of completed suicides while maintaining a therapeutic environment and minimizing staff burden. With this in mind, one reasonable approach could be to ___ the physical space to eliminate potential anchor points for hanging.

Answer 184

redesign

Question 185

___ secrete innate proinflammatory cytokines TNF-a and IL-1B in patients with inflammatory conditions that affect the brain.

Answer 185

Microglia

[The cortical response to inflammation is primarily mediated by microglia]

Question 186

Which of the following biological sampling methods is easiest for the patient to falsify when testing for drugs of abuse?

• Hair
• Blood
• Urine
• Sweat
• Saliva

Answer 186

Urine

Question 187

A 69yo has profound sensory ataxia [a form of ataxia (loss of coordination) caused not by cerebellar dysfunction but by loss of sensory input into the control of movement] with loss of vibratory sensation and cognitive issues described as irritability fluctuating with somnolence. Which of the following is the most likely deficiency associated with these findings?

• Zinc
• Niacin
• Thiamine
• Riboflavin
• Cobalamin

Answer 187

Cobalamin (B12)

Question 188

In an integrated setting with primary care and mental health, which of the following would be a population-based technique used to provide collaborative care?

• Tracking clinic patients in a registry
• Having a care plan for each patient in the clinic
• Using evidence-based mental health treatments
• Ensuring good communication between primary care and mental health
• Having the mental health providers see patients when they are symptomatic

Answer 188

Tracking clinic patients in a registry

Question 189

Which hormone is released from adipose tissue and enters the brain to provide a negative feedback signal and reduce food intake?

Answer 189

Leptin

[Leptin Lowers food intake]

[in contrast, orexin (deficient in some with narcolepsy) increases appetite (and also wakefulness)]

Question 190

Difficulty with which of the following physical tasks would be most concerning if noted in an elementary school-age child?

• Writing legibly
• Playing team sports
• Jumping and hopping
• Playing a musical instrument
• Sewing and using hand tools

Answer 190

Jumping and hopping

Question 191

Which electrolyte abnormality is most typically associated with MDMA/ecstasy use?

Answer 191

Hyponatremia

[Dr. Charlton taught about how at raves people take MDMA/ecstasy, dance and sweat a lot and are also predisposed by the drug to hyponatremia, a combination that can lead to seizure]

Question 192

Which of the following factors increases the lifetime risk of individuals in the United States developing major depressive disorder?

• Being male
• Being married
• Living in a rural area
• Being of non-European descent
• Having low socioeconomic status

Answer 192

In the US, Living in a rural area & Having low socioeconomic status both increase the lifetime risk of developing major depressive disorder.

Question 193

In the assessment of a patient who complains of involuntary myoclonic movements, ___ pre-movement potentials on electromyogram would support the diagnosis of conversion disorder.

Answer 193

rising

Question 194

One mandate of the 2010 Affordable Care Act to increase access to mental health services is ___ on preexisting condition denials due to a history of a mental disorder.

Answer 194

prohibition

Question 195

According to cognitive theory, ___ evaluations of self are a maladaptive schema prominent in depressive disorders.

Answer 195

negative

Question 196

Which of the following medications may be helpful in the treatment of antipsychotic-induced drooling?

• Metoprolol
• Lorazepam
• Mirtazapine
• Glycopyrrolate
• Tetracaine solution

Answer 196

Glycopyrrolate (a muscarinic anticholinergic)

Question 197

Inpatient elopement leading to adverse event is an example of a ___ event as defined by The Joint Commission.

Answer 197

sentinel

Question 198

What is produced when dopamine-hydroxylase modifies dopamine?

Answer 198

*L-Tyrosine (non-essential amino acid, can get in diet and also synthesized from phenylalanine)

is converted by (RLS!!) Tyrosine hydroxylase (RLS!!) to

L-Dihydroxyphenylalanine (L-DOPA)
->
Dopamine

is converted by dopamine hydroxylase to

Norepinephrine
->
Epinephrine

Question 199

The decline in a toddler’s sharing behavior between ages two and three is most closely related to the normal developmental milestone of sense of being an ___ self.

Answer 199

autonomous

Terrible twos, less sharing!

Question 200

Which of the following victim risk factors has been most consistently associated with higher rates of elder abuse?

• Race
• Gender
• Cognitive impairment
• Socioeconomic status
• Number of medical comorbidities

Answer 200

Cognitive impairment

Question 201

___ positives through repeated association tests are a potential complication of genome-wide association studies.

Answer 201

False

Question 202

The parents of a 4yo are concerned that she is unable to tie her shoes. She is able to run, kick a ball, ride a tricycle and zip up her coat. What is the most likely explanation?

Answer 202

Normal development

[Shoe tying is usually reached around 5yo;

Always remember, what we are seeing may be consistent with normal development!]

Question 203

Controlled studies suggest that which of the following is most effective in reducing inpatient hospital use, increasing housing stability, controlling psychiatric symptoms, and improving quality of life for the severally mentally ill?

• Day hospital
• Outpatient group therapy
• Assertive community care
• Family-focused psychoeducation
• Mental health consumer-run organizations

Answer 203

Assertive community care

Question 204

Based on available evidence, which of the following is the most common psychiatric complication in patients with traumatic brain injury?

• Psychosis
• Depression
• Aggression
• Substance use
• Posttraumatic stress disorder

Answer 204

Depression

Question 205

A shrink finds a patient socially appealing and attractive to the point that the shrink is no longer able to think clearly or act in the patient’s best interest. What is the best first step for the shrink to take in dealing with this situation?

Answer 205

Seek supervision from a colleague.

Question 206

In the learned helplessness model, the behavioral deficits found in animals exposed to uncontrollable stress are reversed by which of the following substances?

• Lithium
• Stimulants
• Anxiolytics
• Antipsychotics
• Antidepressants

Answer 206

Antidepressants

Question 207

A 39yo reports episodes of flailing of the arms and tonic postures described as “fencing.” Video/electroencephalogram monitoring confirms electrographic seizure. Which of the following seizure types is most likely associated with this phenomenon.

• Alcohol withdrawal
• Temporal lobe
• Occipital lobe
• Frontal lobe
• Febrile

Answer 207

Frontal lobe

Question 208

Twin studies of patients with schizophrenia have consistently identified substantial proportions of monozygotic twin pairs that are discordant for the illness. The most likely explanation for this is that a “___-___” model of pathogenesis exists in which predisposing environmental factors combine with genetic risk.

Answer 208

two-hit

Question 209

The psychiatrist is consulted by a primary care clinic director who wants to use a self-report instrument taking less than five minutes to complete that improves detection, diagnosis and monitoring of major depressive disorder. Which of the following should the psychiatrist recommend?

• Patient Health Questionnaire
• Hamilton Depression Rating Scale
• Inventory of Depressive Symptomatology
• Mini International Neuropsychiatric Interview
• Psychiatric Diagnostic Screening Questionnaire

Answer 209

Patient Health Questionnaire

Question 210

What genetic syndrome is the most common cause of inherited intellectual disability?

Answer 210

Fragile X

[In contrast, what is the most common genetic cause of intellectual disability? Down Syndrome.]

Question 211

Which of the following childhood environmental factors is most prevalent in patients diagnosed with dissociative identity disorder in the United States, Canada and Europe?

• Physical abuse
• Loss of a parent
• Medical procedures
• Surgical procedures
• Exposure to terrorism

Answer 211

Physical abuse

Question 212

A 39yo with a history of BPAD and a three-day history of dizziness, nausea, vomiting and diarrhea has been stable on lithium for years, was recently diagnosed with hypertension and started on hydrochlorothiazide. On exam the patient has mild coarse tremor in bilateral hands and a mildly ataxic gait. Which of the following is the most likely mechanism of action leading to the clinical presentation?

• Inhibition of absorption
• Reduced renal clearance
• Displacement of protein binding
• Additive pharmacodynamic effects
• Cytochrome P450 enzyme inhibition

Answer 212

Reduced renal clearance (Hydrochlorothiazide reduces renal clearance of lithium)

Question 213

Hypoothalamic-pituitary-adrenal axis-related cortisol production is less active during which of the following sleep-related activities?

• REM sleep
• Sleep onset
• Sleep deprivation
• Morning awakening
• Nocturnal awakening

Answer 213

Sleep onset (makes sense because cortisol level peaks in the morning)

Question 214

Gender identity is believed to be most strongly influenced by which of the following factors?

• Innate feelings
• Parental influence
• Cultural expectations
• Chromosome complement
• Mirroring of the same-sex parent

Answer 214

Innate feelings

Question 215

Which of the following tests primarily measures flexibility in shifting cognitive sets?

• Trails B
• Boston naming
• Digits backwards
• Rey complex figure
• Pantomime use of objects

Answer 215

Trails B

Question 216

Panic disorder typically first manifests during which stage of life?

Answer 216

Late adolescence

Question 217

Chromosomal microdeletions at region q11.2 of human chromosome 22 are most likely to present with symptoms of which adult psychiatric disorder?

Answer 217

Schizophrenia

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.

Question 218

Which of the following psychotropic medications is relatively contraindicated for those with moderate-to-severe renal impairment?

• Clozapine
• Quetiapine
• Olanzapine
• Aripiprazole
• Paliperidone

Answer 218

Paliperidone (Invega)

Question 219

A defendant with BPAD has pleaded guilty to a breaking and entering charge and is being considered for diversion to mental health court. Which of the following patient factors would be crucial to determine whether the patient has capacity to be referred to mental health court?

• Has thoughts of harming others or self
• Is willing to enter a plea of not guilty by reason of insantiy
• Agrees to waive the right to be represented by an attorney
• Has insight into the fact that the crime was the result of a mental disorder
• Understands that the choice of this option involves waiving certain constitutional rights

Answer 219

Understands that the choice of this option involves waiving certain constitutional rights

Question 220

Orexin A (stimulates appetite and wakefulness) is a neuropeptide in the hypothalamus that is ___ in some forms of narcolepsy.

Answer 220

decreased

Question 221

The executive dysfunction observed in patients with traumatic brain injury is most commonly associated with disruption in which of the following pathways?

• Nigro-striatal
• Cortico-spinal
• Corpus callosum
• Arcuate fasciculus
• Fronto-subcortical

Answer 221

Fronto-subcortical

Question 222

Per the National Comorbidity Survey Replication data what is the mean number of years from the start of a mood disorder until diagnosis?

Answer 222

6 to 8 years!

Question 223

A 30yo with no PSH comes to the ED yelling nonsensically, assaulting security, has vomited, has tachycardia, HTN and fever. Urine toxicology and BAL are negative and bath salts/synthetic cathinone is suspected. Which of the following is the most appropriate agent to use to control agitation at this time?

• Lorazepam
• Haloperidol
• Ziprasidone
• Fluphenazine
• Metoclopramide

Answer 223

Lorazepam

Question 224

A school-aged boy does well academically but most of his energy is channeled into basketball, and he states that he hopes to become a professional basketball player. He teases girls at school, but plays mostly with boys. With which of the following of Freud’s psychosexual stages of development do these characteristics correspond?

Answer 224

Latency

[Freud’s Latency (6-puberty) corresponds to Erikson’s Industry vs inferiority (6 to 12 years, school age]

Freud’s theory of psychosocial development emphasizes that as humans develop they become fixated 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)

Question 225

Which of the following neuroimaging/electrophysiological tests is particularly helpful in differentiating neurocognitive disorder due to Alzheimer disease from frontotemporal neurocognitive disorder?

• Evoked potentials
• Magnetoencephalography
• Computed tomography scan
• Magnetic resonance imaging
• Single-photon emission computed tomography scan

Answer 225

Single-photon emission computed tomography scan

[single-Photon Emission computed Tomography scan, PET scan, measures glucose metabolism]

In AD, see parietal and temporal slowing of metabolism. LBD is the same but LBD also has occipital slowing of metabolism, which AD does not.

Question 226

Which of the following SSRIs has the strongest association with birth defects?

• Sertraline
• Citalopram
• Paroxetine
• Fluoxetine
• Fluvoxamine

Answer 226

Paroxetine

[Significant sexual side effect risk + Significant birth defect risk]

Question 227

Per the Health Insurance Portability and Accountability Act (HIPAA) two physicians working together on cases may ___ information about cases.

Answer 227

share

Question 228

Stooped posture and slowed walking are ___ changes in motor function that occur with aging.

Answer 228

normal

Question 229

Parental criminality is a factor associated with increased ___ of developing conduct disorder.

Answer 229

risk

Question 230

A 70yo with visual hallucinations and cognitive decline develops bradykinesia, rigidity and multiple falls. There are episodes of confusion and delirium. Treatment with which of the following can result in worsening of this condition and support the suspected diagnosis?

• Levodopa
• Clozapine
• Haloperidol
• Clonazepam
• Diphenhydramine

Answer 230

Haloperidol

[Patients with Lewy body disease may be more likely to develop severe extrapyramidal side effects from neuroleptics.]

Question 231

___ blood pressure is a side effect that was common in clinical trials investigating ketamine for depression.

Answer 231

Increased

Question 232

Once an ongoing doctor-patient relationship has been established, a physician may not ethically abandon a patient. In which of the following scenarios has the psychiatrist abandoned the patient?

• A patient has seen the psychiatrist once in consultation and the patient wants to transfer care, but the psychiatrist declines.
• A psychiatrist goes on vacation and sets up a new voice mail message that contains contact information for a covering psychiatrist.
• Several months before a planned retirement, a psychiatrist offers all patients the contact information for a colleague who has agreed to take new patients.
• An attending psychiatrist treats a patient on the inpatient unit and then goes off service; when discharge approaches, the patient asks the team to arrange outpatient coverage with the original attending, who declines.
• A patient has seen a psychiatrist once in a consultation at which the psychiatrist provided a prescription; the psychiatrist subsequently spoke to the patient on the phone about symptoms and side effects but declines to take on the patient’s care.

Answer 232

A patient has seen a psychiatrist once in a consultation at which the psychiatrist provided a prescription; the psychiatrist subsequently spoke to the patient on the phone about symptoms and side effects but declines to take on the patient’s care.

Question 233

The ___ and the medial pre-frontal cortex have been shown in animal models to be involved in both fear conditioning and fear extinction.

Answer 233

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]

Question 234

A 4yo has a slim torso, long legs and all 20 primary teeth. The child can walk and run, but does so quickly and intensely, often walking up on toes. The child is ambidextrous and can ride a small bicycle with training wheels although appears a little uncertain when doing so. Which of these physical findings should raise concern about the child’s physical development?

• Ambidexterity
• Walking on toes
• Presence of all baby teeth
• Pace and intensity of walking
• Uncertainty when riding a bicycle

Answer 234

Walking on toes

Question 235

A 28yo woman develops double vision, blurry vision, drooping eyelids, difficulty swallowing. Over the next several days the symptoms worsen and he has severe constipation and progressive weakness of bulbar muscles. Sensation is normal and he is found to have pupils that do not react to light. Which of the following is the most likely toxin to result in this syndrome?

• Ergot
• Anthrax
• Tetanus
• Botulinum
• Diphtheria

Answer 235

Botulinum

Question 236

A patient arrives at ED by ambulance after overdosing on a bottle of prescription medication. The patient acknowledges he was trying to commit suicide, but he doesn’t want psychiatric hospitalization. In making decision to admit or not, which of the following ethical imperatives must the psychiatrist apply?

• Justice
• Veracity
• Beneficence
• Nonmaleficence
• Patient autonomy

Answer 236

Beneficence (the quality or state of doing or producing good)

Question 237

An electroencephalogram for a child who seems to often stare into space and then blink for a few seconds is likely to show the ___ cycles per second spike-and-wave activity characteristic of absence seizures.

Answer 237

three

EEG shows 3 cycles per second, 3Hz spike-and-wave activity in absence seizures

Question 238

Psychoeducation for families of patients with schizophrenia teaches caregivers to encourage ___ with medications.

Answer 238

adherence

Question 239

A research protocol compares two different medications for the treatment of depression. In the study, each subject is randomized in a double-blind fashion to receive one medication for six weeks. This is followed by a four-week “wash-out” period, and then the subject receives the other medication for eight weeks. What study design is implemented in this protocol?

Answer 239

Crossover

[Residual effects are the major negative aspect of crossover designs for research studies.]

Question 240

Parents bring a 15yo noting that, despite having a curfew, she stayed out all night for the fourth time in a month. Over the past year, she has persistently violated parental rules, reacts with rage when attempts are made to address this, and is often edgy and confrontational with the slightest annoyance. She is impatient and unkind to a younger sister, and threatens to hit the father when limits are set. The school reports no concerns about behavior in that setting. There is no history of substance use. In the interview, she is pleasant, easy to engage and cooperative, but admits to minimal regard for her parents’ rules, seeing them as “old school” and unnecessarily limiting. Which is the most likely diagnosis?

• Conduct disorder
• Adjustment disorder
• Oppositional defiant disorder
• Antisocial personality disorder
• Disruptive mood dysregulation disorder

Answer 240

Oppositional defiant disorder

Question 241

Neurogenesis in the adult brain is largely restricted to the ___ ___ of the hippocampus.

Answer 241

dentate gyrus

[The dentate gyrus is thought to contribute to the formation of new episodic memories, the spontaneous exploration of novel environments, and other functions.]

Question 242

Which of the following SSRI augmentation agents would be the best choice for a 59yo female patient with depression and pronounced psychomotor retardation?

• Lithium
• Estrogen
• Olanzapine
• Mirtazapine
• Liothyronine

Answer 242

Liothyronine (synthetic T3)

Question 243

The psychiatrist evaluates patient in ED and determines they require inpatient admission for safety, but the insurance company denies the request and suggests a partial hospital level of care. Which of the following actions should the psychiatrist take next?

• Refer the patient to the partial hospital program
• Give the patient a list of referrals to outpatient providers
• Hold the patient in the emergency department for safety
• Admit the patient to the hospital and appeal the insurance decision
• Add several more risk factors to the report, and resubmit to insurance

Answer 243

Admit the patient to the hospital and appeal the insurance decision

Question 244

What is the principal behavioral technique used in the treatment of patients with obsessive-compulsive disorder?

Answer 244

Exposure and response prevention (Walking away from the car and not going back to check the door!)

Question 245

Which of the following factors predicts a better long-term outcome in posttraumatic stress disorder?

• Female sex
• Military trauma
• Childhood trauma
• Rapid onset of symptoms
• Perception of external locus (from Latin, ‘place’) of control

Answer 245

Rapid onset of symptoms

Question 246

To be eligible for special education services a student must require specific interventions in order to make progress in school and have a ___ disability.

Answer 246

documented

Question 247

The highest concentration of serotonin-producing cells is located in which area?

Answer 247

Raphe nucleus

Question 248

A 16yo girl has periodic fantasies involving degradation and masochism (the tendency to derive pleasure, especially sexual gratification, from one’s own pain or humiliation). She describes these fantasies as disturbing and accompanied by both excitement and anxiety. These fantasies most likely represent which of the following?

• A risk factor for future paraphilic sexual behavior
• Evidence of prior exposure to sexual maltreatment
• A normal precursor to homosexual orientation in adulthood
• Turning against the self as defense against unresolved Oedipal wishes
• Part of the normal process of determining personal sexual behavior patterns

Answer 248

Part of the normal process of determining personal sexual behavior patterns

Question 249

A 30yo is admitted with recurrent episodes of weakness in the arms and legs, decreased tendon reflexes accompanied by severe abdominal pain requiring oxycodone. During the current episode delirium and agitation are noted. Testing for which of the following should be conducted to confirm the suspected diagnosis?

• Opiates
• Cortisol
• Myoglobin
• Heavy metal
• Porphobilinogen

Answer 249

Porphobilinogen

[A patient has psychosis, acute abdominal pain, reduced strength and tendon reflexes. Elevation in Porphobilinogen would explain her symptoms as pt likely has Acute Intermittent Porphyria, AIP.]

Question 250

Which medication used to treat moderate-to-severe Alzheimer disease is a moderate NMDA (glutamate receptor) antagonist?

Answer 250

Memantine

Question 251

Which of the following most seriously threatens the external validity of a research study?

• Placebo responses in the study population
• A study population that is not representative of the population to be treated
• Mortality or differential attrition during the course of treatment during the study
• Maturation due to natural change during the period between baseline and post-test
• Statistical regression or regression toward the mean

Answer 251

A study population that is not representative of the population to be treated

[External validity is the validity of applying the conclusions of a scientific study outside the context of that study. In other words, it is the extent to which the results of a study can be generalized to and across other situations, people, stimuli, and times.]

Question 252

Which biogenic amine is synthesized in the locus coeruleus?

Answer 252

Norepinephrine

[The ‘English’ name locus coeruleus is actually a Latin expression consisting of the noun, locus, place or spot and the adjective coeruleus, dark blue or sky-blue.]

Question 253

Pharmacological treatment in autism spectrum disorder is most likely to have a positive effect on which of the following?

• Aggressiveness
• Gaze aversion
• Prosodic modulation
• Gestural communication
• Pragmatic communication

Answer 253

Aggressiveness

Question 254

According to the principles of operant conditioning, a behavior will most likely decrease in frequency if it is ___ with a behavior that is positively reinforced.

Answer 254

incompatible

Question 255

A key distinction between boundary violations and boundary crossings is that boundary violations are characteristically ___.

Answer 255

exploitative

Question 256

The theory that brain serotonergic systems are dysregulated in posttraumatic stress disorder (PTSD) led to the investigation of genes known to affect that system. Some subsequent studies have found that patients with PTSD have a higher frequency of the homozygous S-SERT genotype. This approach to gene identification is most accurately referred to as which of the following?

• Genetic screening test
• Candidate-gene approach
• Whole genome association
• Parametric linkage analysis
• Identify by descent mapping

Answer 256

Candidate-gene approach

Question 257

Which of the following statistical methods attempts to address the effects of participants dropping out of a study prior to completion?

• Odds ratio
• Meta-analysis
• Power analysis
• Positive predictive value
• Last observation carried forward

Answer 257

Last observation carried forward

[Last observation carried forward (LOCF) is a method of imputing missing data in longitudinal studies. If a person drops out of a study before it ends, then his or her last observed score on the dependent variable is used for all subsequent (i.e., missing) observation points.]

Question 258

A 35yo female patient reports weight loss, easy fatigability, craving salt, nausea, hyperpigmentation and muscle cramps. The patient has moderated depressed mood and looks apathetic. Which of the following is the most likely diagnosis?

• Hyperthyroidism
• Hypothyroidism
• Hypercortisolism
• Adrenocortical insufficiency
• Polycystic ovary syndrome

Answer 258

Adrenocortical insufficiency (JFK)

Question 259

Fluoxetine given concomitantly with hydrocodone ___ analgesic effect.

Answer 259

reduces

fluoxetine increases hydrocodone metabolism

Question 260

Which of the following is the first step when determining whether or not a criminal defendant is not guilty by reason of insanity?

• Evaluate the defendant.
• Ascertain the facts of the case.
• Review the medical and psychiatric records.
• Review observations of the defendant made by others.
• Determine the legal insanity standard to be used.

Answer 260

Determine the legal insanity standard to be used.

Question 261

Functional magnetic resonance imaging studies have shown the highest level of response to anticipated rewards in the nucleus accumbens (ventral striatum along with olfactory tubercle; what’s in the dorsal striatum? caudate + putamen) during which of the following developmental periods?

• Infancy
• Toddlerhood
• Mid-latency
• Adolescence
• Adulthood

Answer 261

Adolescence

[Adolescence is also the stage of development at which dopamine receptor density in the striatum occurs, possibly accounting for increased response to rewards for behavior during this stage.]

Question 262

A 35yo comes to the neurology clinic with a history of double vision, vertigo and vomiting. Examination of the eye movements shows paresis of the medial rectus on attempted lateral gaze, with a course nystagmus in the abducting eye with lateral movements of the eyes in either direction. The findings are characteristic of ___ ___

Answer 262

multiple sclerosis

Question 263

If a patient describes a paranoid delusion, an appropriate response is to acknowledge the patient’s ___ reaction to the delusion.

Answer 263

emotional

Question 264

Fluvoxamine slows its metabolism and thereby ___ clozapine blood levels, which increases risk of seizure.

Answer 264

increases

Fluvoxamine is a CYP 1A2 inhibitor

Clozapine >600mg/day equivelent has much greater risk of seizure (vs agranulocytsosis which is not linked to dose)

Question 265

Which of the following sources of pain is thought to have a primarily central (non-nociceptive) mechanism?

• Cancer pain
• Fibromyalgia
• Osteoarthritis
• Diabetic neuropathy
• Postherpetic neuralgia

Answer 265

Fibromyalgia

Question 266

Highest rates of posttraumatic stress disorder are found in experiencing ___ violence.

Answer 266

sexual

Question 267

During which stage of development does the maximal number of axons and synapses exist?

Answer 267

Infancy

Question 268

A 40yo has new-onset headache. Which of the following would be most suggestive of a mass lesion with increased intracranial pressure?

• Unilateral headache
• Papilledema on eye exam
• Episodic nausea and vomiting
• Flashing lights at onset of headache
• Failure of improvement with acetaminophen

Answer 268

Papilledema on eye exam

[Papilledema is a serious medical condition where the optic nerve at the back of the eye becomes swollen. Symptoms can include visual disturbances, headaches, and nausea. Papilledema occurs when there is a buildup of pressure in or around the brain, which causes the optic nerve to swell.]

Question 269

Which of the following personality traits is an independent risk factor for the development of a high number of somatic symptoms?

• Neuroticism
• Extraversion
• Agreeableness
• Conscientiousness
• Openness to experience

Answer 269

Neuroticism

Question 270

Which of the following is a first-line medication with demonstrated efficacy in multiple, randomize clinical trials for treatment of bipolar depression?

• Paroxetine
• Quetiapine
• Ziprasidone
• Aripiprazole
• Divalproex sodium

Answer 270

Quetiapine

Question 271

In social cognitive neuroscience and the study of social decision making and bias, functional magnetic resonance imaging has been used to show that the brain area consistently activated by subliminal presentation of emotional faces is the ___.

Answer 271

amygdala

[Note, in contrast, the area of the brain primarily responsible for face RECOGNITION is located in the FUSIFORM GYRUS]

Question 272

Piaget’s major contribution to development was a theory that explains how individuals learn about and ___ the world.

Answer 272

understand

[Piaget’s stages 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)]

Question 273

___ ___ signifies the ability to shift back and forth between general concepts and specific examples.

Answer 273

Abstract reasoning

[In Piaget’s stages of cognitive development, abstraction is a major part of the Formal operational stage (13->adulthood) and differentiates it from the Concrete operational stage (7->12 years)]

[Piaget’s stages 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)]

Question 274

The principle that human subject consent is essential for ethically conducted research was first articulated in the ___ ___.

Answer 274

Nuremberg Code

Question 275

A 5yo who mother was in a minor car accident thinks that he is responsible for causing the accident because he yelled “I hate you” in protest when his mother left him with a baby-sitter an hour earlier. This belief represents age-appropriate ___ thinking.

Answer 275

egocentric (Mr. Beard’s final words to his dad)

Question 276

The substantia nigra contains dopaminergic neurons which project to the caudate and putamen, the two parts of the ___ striatum.

Answer 276

dorsal

[What are the two components of the ventral striatum?The Nucleus accumbens and olfactory tubercle]

Question 277

REM sleep is first evident at which stage of development?

Answer 277

In utero

Question 278

A 9yo achieved urinary continence at 4yo, but started wetting the bed again at 6yo. The family has tried various management strategies including waking the child at night, but the patient is difficult to arouse and has enuresis at different times in the night. The patient’s father and paternal uncles wet the bed until they were approximately 10yo. Which of the following points to a possible psychiatric comorbidity?

• Difficulty arousing from sleep
• Positive family history of enuresis
• Resistant to behavioral management
• Enuresis during different sleep stages
• Having a previous period of continence

Answer 278

Having a previous period of continence

Question 279

A patient drawing a clock draws a circle outlining the clock face, but instead of adding numbers or hands continues to trace the circle over and over again. This is an example of which of the following?

• Inattention
• Derailment
• Perseveration
• Thought blocking
• Psychomotor retardation

Answer 279

Perseveration

Question 280

Which of the following is a self-report questionnaire?

• Beck Depression Inventory
• Positive and Negative Symptom Scale
• Clinical Global Impression Scale
• Brief Psychiatric Rating Scale
• Hamilton Rating Scale for Depression

Answer 280

Beck Depression Inventory

Question 281

The area of the brain primarily responsible for face recognition is located in the ___ ___.

Answer 281

fusiform gyrus

Question 282

The psychiatric assessment of a child or adolescent should always include ___ interviews.

Answer 282

parental

Question 283

Synaptic plasticity is often dependent on a calcium mediated long-lasting increase in AMPA receptor signal transmission, a process which is referred to as ___-___ ___.

Answer 283

long-term potentiation

Question 284

Identity diffusion, as defined by Erik Erikson, describes ___ of continuity in how the self is experienced in relationships over time.

Answer 284

lack

Question 285

Anatomical studies in schizophrenia consistently show ___ change in neuronal density.

Answer 285

no

Question 286

Obsessive-compulsive disorder (OCD) with childhood onset has ___ psychiatric comorbidity than that of adult onset.

Answer 286

greater

Question 287

An 18yo is hit by a baseball and loses consciousness. After a short interval of loss of consciousness, he wakes up, but after getting home complains of headache, vomits and looks more and more lethargic. When he gets to the ED he is difficult to arouse. Non-contrast head computer tomography scan shows a hyperdense, somewhat heterogeneous, and sharply demarcated area that is bi-convex (or lentiform) in shape, beneath the squamous part of the temporal bone. What is the diagnosis?

Answer 287

Epidural hemorrhage/hematoma

Question 288

The role of the therapist in motivational interviewing is to point out the ___ between behavior and personal goals in order to motivate change.

Answer 288

discrepancy

Question 289

Children of birth mother’s who die by suicide are at ___ risk of completed suicide.

Answer 289

higher

Question 290

When prompts for tobacco use and treatment are implemented in the electronic health record documentation of tobacco use and referral for cessation counseling both ___.

Answer 290

increase

Question 291

Clinical exome sequencing is most useful for detection of which of the following genetic abnormalities?

• Long insertion variants
• Repetitive DNA sequence
• Single nucleotide substitutions
• Structural chromosomal abnormalities

Answer 291

Single nucleotide substitutions

[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

Exon: a segment of DNA or RNA molecule containing information coding for a protein or peptide sequence]

Question 292

A college graduate recently got married and she and her spouse are facing many decisions like whether to buy a home and when to have children and they argue a lot. She calls her mom a lot for support. She wants her parents’ approval for her decisions and says she is worried she and her husband will make the “wrong” decision on their own. Previously she was a self-described “risk-taker” and had decided to move out of state for college on her own. Which of the following is the most likely diagnosis?

• Phase of life problem
• Generalized anxiety disorder
• Parent-child relational problem
• Dependent personality disorder

Answer 292

Phase of life problem

Question 293

Patients in correctional institutions can be forcibly administered antipsychotics in three circumstances: emergency situations; treatment of symptoms that threaten the safety of self or others, and:

• to help obtain a confession to a capital crime.
• when ordered by a licensed forensic psychiatrist.
• to restore a criminal defendant to competency in order to stand trial.
• when a physician determines that the benefits outweight the risks of medications.

Answer 293

to restore a criminal defendant to competency in order to stand trial.

Question 294

A new patient is a recent immigrant from a culture unfamiliar to the psychiatrist. The patient’s chief complaint statement is vague. Which of the following is the most appropriate question for the psychiatrist to ask next?

• “How would you describe your problem to a family member or friend?”
• “I don’t understand why this is such a problem for you. Can you tell me more?”
• “I don’t know much about your country. Can you tell me about the beliefs of your people?”
• “I know that spirituality is a very important part of your culture. Do you think your problem is really a spiritual one?”

Answer 294

“How would you describe your problem to a family member or friend?”

Question 295

Telepsychiatry licensing requires the psychiatrist hold a medical license only in the state where the ___ is located.

Answer 295

patient

Question 296

___ ___ ___ is effective in detecting rare genetic variants of large effect.

Answer 296

Pedigree linkage analysis

Question 297

Kraepelin viewed psychiatric disorders as categorically ___ “natural disease entities”

Answer 297

distinct

Question 298

Which of the following neurocognitive functions is most likely to show a decline in people over 65 years of age?

• Attention span
• Language function
• Long-term memory
• Simple pattern recognition
• Information processing speed

Answer 298

Information processing speed

Question 299

A set of feelings that a patient reenacts in the therapeutic relationship is referred to as ___.

Answer 299

transference

Question 300

A 30yo female patient has discoid lupus, long controlled with a stable dose of prednisone. She abruptly develops increased fatigue, inflamed joints, and diffuse myalgias. She also exhibits depressed mood and cognitive impairments. She has no past psychiatric history and no focal neurological signs. Which of the following is the most likely etiology?

• Seizure
• Psychological stress
• Metabolic dysfunction
• Corticosteroid toxicity
• Disease-induced cerebritis

Answer 300

Disease-induced cerebritis

Question 301

Children demonstrate a preference for the human voice and speech over other sounds at what age?

Answer 301

Birth

Question 302

A 9yo has been successfully treated for attention-deficit/hyperactivity disorder for years with methylphenidate (ritalin, concerta, etc). During the past two months, the medication has not been as effective despite multiple dose adjustments. It is decided that the child needs a different medication. Which of the following would be the best choice?

• Buspirone
• Atomoxetine
• Desipramine
• Risperidone
• Mixed amphetamine salts

Answer 302

Mixed amphetamine salts (Adderall, etc)

Question 303

On the way to the rail station for a vacation, a 60yo woman begins to behave oddly. Her husband notes that when he speaks to her she answers appropriately with fluent speech, however she seems to have no ability to retain any new information. She repeatedly asks where they are going, even after he has told her multiple times. The episode lasts for about six hours. The following day she is back to normal but has no recollection of the events from the previous day. This episode is most consistent with a diagnosis of ___ ___ ___.

Answer 303

transient global amnesia

[Transient global amnesia is a sudden, temporary episode of memory loss that can’t be attributed to a more common neurological condition, such as epilepsy or stroke. During an episode of transient global amnesia, your recall of recent events simply vanishes, so you can’t remember where you are or how you got there.]

Question 304

An essential tremor diagnosis is supported by patient report of improvement in tremor with drinking ___.

Answer 304

alcohol

Question 305

Per the WHO, mental health prevention measures are universal, selective and indicated. Which of the following would be an indicated intervention?

• Playing the “Good Behavior Game” in the school classroom
• Giving emotional resilience courses for emergency personnel
• Restricting access to tobacco and alcohol to those over a certain age
• Initiating a promotional campaign to discourage unsafe dieting behavior
• Providing parenting training for parents of children with conduct problems

Answer 305

Providing parenting training for parents of children with conduct problems

Question 306

What is the most highly heritable of all mental disorders?

Answer 306

Autism spectrum disorder (young woman at WFM register said her “ENTIRE family” has Autism spectrum disorder, the most highly heritable of all mental disorders)

Question 307

A parent tells the therapist they cursed at their child which makes the therapist feel angry. Within framework of supportive therapy, which of the following should the therapist do next?

• Ignore the negative feelings; countertransference has no place in supportive therapy.
• Reassure the patient that it is hard to parent young children, and normalize the behavior.
• Warn the patient that the behavior was unacceptable and that the therapist may need to call protective services.
• Express appreciation for the patient’s honesty and suggest working together to understand the action and come up with alternatives.
• Tell the patient that her behavior is deeply upsetting and suggest discussing whether or not to continue the therapeutic relationship.

Answer 307

Express appreciation for the patient’s honesty and suggest working together to understand the action and come up with alternatives.

Question 308

Old strokes on computed tomography are ___ than grey matter, whereas bright areas may represent new blood and an acute ischemic hemorrhagic stroke.

Answer 308

darker

Question 309

What terms describes the breakage and removal of a large segment of a chromosome and its subsequent attachment to a different chromosome?

Answer 309

Translocation

Question 310

Co-administration of lamotrigine with valproate requires reducing the usual recommended dosage of lamotrigine by ___ during the initial titration.

Answer 310

half

Question 311

Limitations of Piaget’s model of cognitive development include a failure to adequately include ___ factors relevant to learning.

Answer 311

emotional

[Piaget’s stages 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)]

Question 312

Relative to the general population of suicide completers physicians who die by suicide are ___ likely to be taking antidepressant medications.

Answer 312

less

Question 313

A patient with history of poorly controlled seizures has several months without a seizure, but begins to have the paranoid delusion that the neurologist wants to harm her patients. Which of the following types of seizures does the patient most likely have?

• Absence
• Nonepileptic
• Simple partial
• Complex partial
• Generalized tonic-clonic

Answer 313

Complex partial

Question 314

A 5yo watching his first July 4th parade asks as it begins, “Mommy, will there be clowns in the parade today like at the circus we went to?” This question is most likely the result of use of previous experiences to think ___.

Answer 314

categorically

Question 315

Which of the following acts as an obligate co-agonist with glutamate (the principal excitatory neurotransmitter) at the NMDA receptor?

• Glycine
• Tyramine
• Enkephalin
• Substance P
• Glycoprotein IIb

Answer 315

Glycine (an inhibitory neurotransmitter)

Question 316

Which of the following prevention strategies targets people with an increased risk for a disorder but who currently are asymptomatic?

• Secondary
• Tertiary
• Universal
• Selective
• Indicated

Answer 316

Selective; Indicated

Question 317

Being a first generation immigrant is associated with longer duration of ___, non-affective psychosis.

Answer 317

untreated

Question 318

A typically developing two-year old child is able to demonstrate the language and speech milestone to use ___-word or longer phrases.

Answer 318

two

Question 319

A 17yo comes to the ED with family after inflicting lacerations on the thigh with a plastic knife. On exam, the patient does not make eye contact, has limited facial expression, and postures periodically in a stereotypic manner. Speech is monotone, and the patient covers the ears at times during the interview reporting, “It is too loud.” The patient says the cutting was not a suicide attempt but can’t say more and reports, “My parents can provide additional information.” The parents note the patient has always been intolerant of noise and has also always been “quirky and socially awkward” but has appeared more withdrawn over the past three days since the parents shared a plan to separate. The patient has few friends and prefers solitary activities. There is no previous history of self-injurious behavior. Which of the following is the most likely diagnosis?

• Autism spectrum disorder
• Major depressive disorder
• Social communication disorder
• Schizotypal personality disorder
• Borderline intellectual functioning

Answer 319

Autism spectrum disorder

Question 320

In 2-3yo children the capacity to tolerate frustration is primarily influenced by which of the following:

• Ability to internalize social norms
• Quality of the parent-child attachment
• Ability to use language to describe affect
• Exposure to peer group social interactions
• Resolution of ambivalent feelings towards parents

Answer 320

Quality of the parent-child attachment

Question 321

A 10yo notes he started collecting basketball cards, an interest shared with his dad and friends. He is excited because he is the only one of his friends who has several cards. He says things at home and school are OK. His parents say he is doing well, though his grades in school could be higher. According to Erikson, what developmental task is most relevant for this child?

Answer 321

Industry vs inferiority

Erikson’s stages:

• 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)
• Identity vs role confusion (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)

Question 322

An inpatient unit tracking change in depression score from admission to discharge on a rating tool would be a ___ outcome indicator that is both feasible to measure and relevant to mental health care.

Answer 322

meaningful

Question 323

The American Psychiatric Association feels that individuals who present an increased risk of violence should be banned from owning guns, however ___ that people with mental health diagnoses should be discriminated against in any way.

Answer 323

not

Question 324

A patient with narcolepsy is experiencing episodes described as, “weakness in the arms and legs” brought on with laughter. This symptom is most likely to respond to treatment with which of the following?

• Modafinil
• Melatonin
• Venlafaxine
• Clonazepam
• Methylphenidate

Answer 324

Venlafaxine/Effexor (treats cataplexy!)

Question 325

A 5yo has difficulties adjusting to the first transition from home into a school setting. Teachers are concerned about persistent social withdrawal and the consistent experience that the child does not seek or accept consoling when upset. The child was adopted three years ago after a series of problematic foster placements where care was physically and emotionally inadequate. On exam the child looks shy and initially clings to the mother. Later while playing with blocks the child becomes frustrated. The mother tries to gently intervene which leads to an overly fearful and aggressive response by the child. What is the most likely diagnosis?

Answer 325

Reactive attachment disorder

[Reactive attachment disorder arises from a failure to form normal attachments to primary caregivers in early childhood.]

Question 326

During which stage of development does the maximal pruning of cortical synapses occur?

Answer 326

Adolescence (don’t smoke up in adolescence, will mess up synaptic pruning!)

Question 327

A 14yo broke his nose playing hockey, it is noticeably asymmetric and it has bothered him since. He says he just wants to look normal again. Parents say self-esteem has been low since the break and they hope surgery will help. What is the most likely psychological outcome for this patient following cosmetic surgery?

• An improvement in quality of life
• Continued preoccupation with appearance
• No change in esteem despite less focus on his nose
• Chronic anxiety which will generalize to other stresses
• Relational problems with parents for encouraging the surgery

Answer 327

An improvement in quality of life (Brother Jon)

Question 328

Variable phenotype expression of 15q13 deletion depends on whether the encoding gene is derived from the father or the mother. This phenomenon is commonly referred to as ___ ___.

Answer 328

genomic imprinting

Question 329

Which of the following is a risk factor for somatic symptoms disorder?

• Male sex
• Young adulthood
• College education
• Part-time employment
• Chronic physical illness

Answer 329

Chronic physical illness

Question 330

Which of the following components of the cortical-striatal-pallidal-thalamic cortical circuits is involved with the evaluation of potentially harmful stimuli?

• Motor
• Oculomotor
• Anterior cingulate
• Lateral orbitofrontal
• Dorsolateral prefrontal

Answer 330

Lateral orbitofrontal

Question 331

In the treatment of psychosis, superior efficacy of atypical antipsychotics relative to typical antipsychotics has consistently been demonstrated for which one medication?

Answer 331

Clozapine

Question 332

Constitutional and common law dictate that the mental health care provided to prisoners be at or above the level of services that should be available to them were they in the community. This “necessaries” doctrine is justified by the principle that treatment must be provided to those who are ___ from seeking their own medical care.

Answer 332

prevented

Question 333

A patient has a single glass of wine with dinner and has never had an abuse problem. It is reasonable to tell the patient it is reasonable to continue the alcohol as long as the pattern of use does ___ change.

Answer 333

not

Question 334

The development of brain gray matter volume peaks during which stage of development?

Answer 334

Late childhood

[Makes sense because maximal pruning is in adolescence, immediately after the peak development of gray matter in late childhood!]

Question 335

Which of the following types of studies is most likely to offer relevant information about whether an available genetic test for diagnosing neurodegenerative disorder is accurate enough to warrant use?

• Cohort
• Crossover
• Cross-sectional
• Quasi-experimental
• Randomized controlled

Answer 335

Cross-sectional (Gives a snapshot)

[A cross-sectional study involves looking at data from a population at one specific point in time. The participants in this type of study are selected based on particular variables of interest.]

Question 336

Which of the following areas of the brain is most likely to be active when trying to remember a phone number long enough to make a phone call?

• Amygdala
• Hippocampus
• Parahippocampal gyrus
• Dorsolateral prefrontal cortex
• Ventromedial cingulate cortex

Answer 336

Dorsolateral prefrontal cortex (working memory)

Question 337

Which of the following medications should be stopped or reduced before starting a patient on ECT?

• Haloperidol
• Lithium
• Phenelzine
• Desipramine
• Phenoxybenzamine

Answer 337

Lithium

[By holding lithium 24h before ECT, decrease risk of post-ECT neurocognitive effects]

Question 338

In a patient complaining of chest pain, even if anxiety is in the differential, pay close attention if there is a history of pain on exertion that is ___ by rest.

Answer 338

relieved (this could be cardiovascular disease, don’t assume everything is psychiatric)

Question 339

The majority of research suggests that opioid-dependent offenders are more likely to remain drug abstinent following release from prison if they receive which of the following interventions?

• Methadone maintenance while in prison
• Prison-based Narcotics Anonymous groups
• Injectable sustained release naltrexone while in prison
• Weekly motivational interviewing sessions while in prison
• Transfer to a methadone program following incarceration

Answer 339

Methadone maintenance while in prison

Question 340

At what stage of development does the peak of dopamine receptor density occur in the striatum (ventral striatum consists of nucleus accumbens (and olfactory tubercle; dorsal striatum consists of caudate and putamen), possibly accounting for increased response to rewards for behavior during this stage?

Answer 340

Adolescence

[The highest level of response to anticipated rewards in the nucleus accumbens is during adolescence]

Question 341

A 18yo pt has excessive skin-picking leading to many facial sores. The parents say they spend an hour a day in the bathroom examining and washing facial skin. The patient says they are frustrated with severe acne and discoloration of the facial skin. On exam, there are a few small pimples and no visible discoloration. The facial skin is most notable for excoriations. What is the most likely diagnosis?

• Excoriation disorder
• Illness anxiety disorder
• Body dysmorphic disorder
• Generalized anxiety disorder
• Obsessive-compulsive disorder

Answer 341

Body dysmorphic disorder

Question 342

A 14yo broke his nose playing hockey, it is noticeably asymmetric and it has bothered him since. He says he just wants to look normal again. Parents say self-esteem has been low since the break and they hope surgery will help. What is the most likely psychological outcome for this patient following cosmetic surgery?

• An improvement in quality of life
• Continued preoccupation with appearance
• No change in esteem despite less focus on his nose
• Chronic anxiety which will generalize to other stresses
• Relational problems with parents for encouraging the surgery

Answer 342

An improvement in quality of life (Brother Jon)

Question 343

What is the mechanism of action by which phencyclidine induces psychosis?

Answer 343

Inhibits NMDA (glutamate) receptors

Question 344

In the United States, what is the number one preventable cause of death?

Answer 344

Tobacco use disorder

Question 345

When interviewing an agitated and potentially violent patient, be aware of own body ___ as well as that of the patient.

Answer 345

position

Question 346

Which of the following medications is useful in the management of orthostatic hypotension in Parkinson disease?

• Prednisone
• Levodopa
• Entacapone
• Pramipexole
• Fludrocortisone

Answer 346

Fludrocortisone

Question 347

During which stage of development does the maximal pruning of cortical synapses occur?

Answer 347

Adolescence (don’t smoke up in adolescence, will mess up synaptic pruning!)

Question 348

A 5yo has difficulties adjusting to the first transition from home into a school setting. Teachers are concerned about persistent social withdrawal and the consistent experience that the child does not seek or accept consoling when upset. The child was adopted three years ago after a series of problematic foster placements where care was physically and emotionally inadequate. On exam the child looks shy and initially clings to the mother. Later while playing with blocks the child becomes frustrated. The mother tries to gently intervene which leads to an overly fearful and aggressive response by the child. What is the most likely diagnosis?

Answer 348

Reactive attachment disorder

[Reactive attachment disorder arises from a failure to form normal attachments to primary caregivers in early childhood.]

Question 349

The most likely mechanism for QTc interval prolongation related to antipsychotic medications is ___ channel blockade.

Answer 349

potassium (K)

Question 350

Flavor preference in humans is most strongly influenced by which of the following features of food?

• Food texture
• Calorie density
• Food appearance
• Micronutrient content
• Cognitive associations

Answer 350

Cognitive associations

Question 351

A 10yo notes he started collecting basketball cards, an interest shared with his dad and friends. He is excited because he is the only one of his friends who has several cards. He says things at home and school are OK. His parents say he is doing well, though his grades in school could be higher. According to Erikson, what developmental task is most relevant for this child?

Answer 351

Industry vs inferiority

Erikson’s stages:

• 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)
• Identity vs role confusion (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)

Question 352

Which of the following would be most likely on electroencephalogram (EEG) for patient with delirium?

• Beta activity
• Normal EEG
• Focal delta slowing
• 3-Hz spike wave complexes (absence seizures)
• Generalized theta and delta activity

Answer 352

Generalized theta and delta activity

Question 353

Which DSM edition introduced explicit diagnostic criteria and the multiaxial system?

Answer 353

DSM-III

Question 354

The Food and Drug Administration requires that pharmaceutical companies demonstrate a generic drug is not significantly different from the parent compound in which of the following ways?

• Cost
• Efficacy
• Ingredients
• Bioequivalence
• Side effects

Answer 354

Bioequivalence

Question 355

Which of the following is the leading cause of child maltreatment fatalities?

• Starvation
• Burn injuries
• Head injuries
• Spinal cord injuries
• Retroperitoneal hemorrhages

Answer 355

Head injuries

Question 356

Which of the following neurotransmitters, in addition to dopamine, is most often implicated in the regulation of mammalian brain-reward circuitry?

• GABA
• Glycine
• Serotonin
• Glutamine
• Endocannabinoid

Answer 356

GABA

Question 357

A patient comes to the ED with suicidal thoughts. They sit curled up, rarely look up from the floor and appear tearful. They speak softly, only offering information when directly asked. They appears sad and do not smile, though there is relatively normal prosody to their speech. The patient’s affect is best described as:

• flat
• labile
• euthymic
• constricted
• inappropriate

Answer 357

constricted

Question 358

Which of the following is currently the most significant barrier to widespread use of videoconference-based telepsychiatry?

• Inconvenience
• Time constraints
• Cost effectiveness
• Patient dissatisfaction
• Physician dissatisfaction

Answer 358

Physician dissatisfaction

Question 359

In neuroimaging studies of bipolar disorder there is decreased functional connectivity between the amgydala and the ___ cortex.

Answer 359

prefrontal

Question 360

Which of the following is likely to reduce the lithium level?

• Caffeine
• Lisinopril
• Ibuprofen
• Quetiapine
• Hydrochlorothiazide

Answer 360

Caffeine

Question 361

A 17yo comes to the ED with family after inflicting lacerations on the thigh with a plastic knife. On exam, the patient does not make eye contact, has limited facial expression, and postures periodically in a stereotypic manner. Speech is monotone, and the patient covers the ears at times during the interview reporting, “It is too loud.” The patient says the cutting was not a suicide attempt but can’t say more and reports, “My parents can provide additional information.” The parents note the patient has always been intolerant of noise and has also always been “quirky and socially awkward” but has appeared more withdrawn over the past three days since the parents shared a plan to separate. The patient has few friends and prefers solitary activities. There is no previous history of self-injurious behavior. Which of the following is the most likely diagnosis?

• Autism spectrum disorder
• Major depressive disorder
• Social communication disorder
• Schizotypal personality disorder
• Borderline intellectual functioning

Answer 361

Autism spectrum disorder

Question 362

In 2-3yo children the capacity to tolerate frustration is primarily influenced by which of the following:

• Ability to internalize social norms
• Quality of the parent-child attachment
• Ability to use language to describe affect
• Exposure to peer group social interactions
• Resolution of ambivalent feelings towards parents

Answer 362

Quality of the parent-child attachment

Question 363

Variable phenotypic expression of 15q13 deletion depends on whether the encoding gene is derived from the father or the mother. This phenomenon is commonly referred to as ___ ___.

Answer 363

genomic imprinting

Question 364

An inpatient unit tracking change in depression score from admission to discharge on a rating tool would be a ___ outcome indicator that is both feasible to measure and relevant to mental health care.

Answer 364

meaningful

Question 365

The American Psychiatric Association feels that individuals who present an increased risk of violence should be banned from owning guns, however ___ that people with mental health diagnoses should be discriminated against in any way.

Answer 365

not

Question 366

A patient with narcolepsy is experiencing episodes described as, “weakness in the arms and legs” brought on with laughter. This symptom is most likely to respond to treatment with which of the following?

• Modafinil
• Melatonin
• Venlafaxine
• Clonazepam
• Methylphenidate

Answer 366

Venlafaxine/Effexor (treats cataplexy!)

Question 367

A 5yo has difficulties adjusting to the first transition from home into a school setting. Teachers are concerned about persistent social withdrawal and the consistent experience that the child does not seek or accept consoling when upset. The child was adopted three years ago after a series of problematic foster placements where care was physically and emotionally inadequate. On exam the child looks shy and initially clings to the mother. Later while playing with blocks the child becomes frustrated. The mother tries to gently intervene which leads to an overly fearful and aggressive response by the child. What is the most likely diagnosis?

Answer 367

Reactive attachment disorder

[Reactive attachment disorder arises from a failure to form normal attachments to primary caregivers in early childhood.]

Question 368

During which stage of development does the maximal pruning of cortical synapses occur?

Answer 368

Adolescence (don’t smoke up in adolescence, will mess up synaptic pruning!)

Question 369

A 14yo broke his nose playing hockey, it is noticeably asymmetric and it has bothered him since. He says he just wants to look normal again. Parents say self-esteem has been low since the break and they hope surgery will help. What is the most likely psychological outcome for this patient following cosmetic surgery?

• An improvement in quality of life
• Continued preoccupation with appearance
• No change in esteem despite less focus on his nose
• Chronic anxiety which will generalize to other stresses
• Relational problems with parents for encouraging the surgery

Answer 369

An improvement in quality of life (Brother Jon)

Question 370

Variable phenotype expression of 15q13 deletion depends on whether the encoding gene is derived from the father or the mother. This phenomenon is commonly referred to as ___ ___.

Answer 370

genomic imprinting

Question 371

Which of the following is a risk factor for somatic symptoms disorder?

• Male sex
• Young adulthood
• College education
• Part-time employment
• Chronic physical illness

Answer 371

Chronic physical illness

Question 372

Which of the following components of the cortical-striatal-pallidal-thalamic cortical circuits is involved with the evaluation of potentially harmful stimuli?

• Motor
• Oculomotor
• Anterior cingulate
• Lateral orbitofrontal
• Dorsolateral prefrontal

Answer 372

Lateral orbitofrontal

Question 373

In the treatment of psychosis, superior efficacy of atypical antipsychotics relative to typical antipsychotics has consistently been demonstrated for which one medication?

Answer 373

Clozapine

Question 374

Constitutional and common law dictate that the mental health care provided to prisoners be at or above the level of services that should be available to them were they in the community. This “necessaries” doctrine is justified by the principle that treatment must be provided to those who are ___ from seeking their own medical care.

Answer 374

prevented

Question 375

A patient has a single glass of wine with dinner and has never had an abuse problem. It is reasonable to tell the patient it is reasonable to continue the alcohol as long as the pattern of use does ___ change.

Answer 375

not

Question 376

The development of brain gray matter volume peaks during which stage of development?

Answer 376

Late childhood

[Makes sense because maximal pruning is in adolescence, immediately after the peak development of gray matter in late childhood!]

Question 377

A 69yo has brief episodes of pain in the lower left jaw. The pain is so severe that he winces each time it comes. The pain can also be triggered when he shaves or brushes his teeth. MRI brain shows no abnormalities to explain this. He will most likely benefit from treatment with which medications?

Answer 377

Carbamazepine/Tegretol (for Trigeminal neuralgia/Tic douloureux)

Question 378

A 34yo is seen in consultation for lethargy, mild confusion, and associated excessive thirst and polydipsia. Which is the most likely diagnostic consideration?

• Hypoglycemia
• Hyponatremia
• Hyperthyroidism
• Multiple sclerosis
• Hypertension

Answer 378

Hyponatremia

Question 379

A 5-month-old attempts to get his father’s attention by making gurgling noises, waving his arms, and kicking his feet. The mother responds by gently tickling the baby, who laughs happily. This social interaction is best explained within which of the following developmental concepts?

• Arousal
• Imprinting
• Attachment
• Temperament
• Theory of mind

Answer 379

Attachment

Question 380

The shrink is hired by the community mental health center as a consultant to help it adopt an evidence-based treatment algorithm. Which of the following should the psychiatrist propose to the leaders of the community mental health center in order to maximize chances of a successful consultative process?

• Plan a focused workshop followed by return visits for further training and problem-solving sessions
• Develop a day-long workshop that includes both presentations and interactive workshops on the algorithm
• Help the leaders develop and evidence-based reading list of key articles supporting the use of the algorithm
• Create an online teaching module consisting of didactics and self tests so that the mental health center staff can access the materials at their convenience
• Deemphasize direct contact with the mental health center and, instead, develop transportable lectures that members of the center will be trained to present

Answer 380

Plan a focused workshop followed by return visits for further training and problem-solving sessions

Question 381

Which of the following is required for NMDA receptor ion channel opening, in addition to ligand binding?

• Potassium
• Depolarization
• Phosphorylation
• Enzymatic activation
• G-protein-linked activation

Answer 381

Depolarization

[The NMDA (glutamate) receptor is an excitatory receptor]

Question 382

During a dialectical behavior therapy session, the patient tells the therapist about strong urges to cut that occurred a few days earlier. A therapist using the behavioral analysis strategy would likely respond by saying which of the following?

• “Why would you want to inflict pain on yourself?”
• “Have you thought about how cutting might cause permanent scares?”
• “You were thinking about hurting yourself. Let us see where your mind goes with that.”
• “At what point during the day did you first notice that you were thinking about cutting?”
• “I am glad you were able to use the techniques you learned here to modify those thoughts.”

Answer 382

“At what point during the day did you first notice that you were thinking about cutting?”

Question 383

Ocular jerk movements with optokinetic drum is suggestive of ___ blindness.

Answer 383

psychogenic

Question 384

A 6yo prefers opposite gender clothing and play scenarios. If this child were to develop symptoms of gender dysphoria, what would be the most common course of symptoms?

• Worsens during adolescence
• Remains stable into adulthood
• Continues until reassignment surgery
• Resolves spontaneously by adulthood
• Waxes and wanes throughout adulthood

Answer 384

Resolves spontaneously by adulthood

Question 385

Treatment with clozapine resulted in a Finnish “epidemic” reported in the Lancet in 1975 that involved ___.

Answer 385

agranulocytosis

Question 386

Beginning to ___ peer relationships and pursuing group activities is a developmental task of the school-age stage.

Answer 386

establish

Question 387

Injury to the bilateral parahippocampal cortex and hippocampal formation most typically results in which of the following?

• Ataxia (Impaired balance or coordination, can be due to damage to brain, nerves, or muscles.)
• Apraxia (Difficulty with skilled movements even when a person has the ability and desire to do them.)
• Aggression
• Amnesia
• Alexia (Alexia is a term describing a partial or complete inability to read.)

Answer 387

Amnesia

Question 388

A patient describes feeling detached from his body, as if he were floating above and looking down on himself. What is the term that describes this experience?

Answer 388

Depersonalization

Question 389

Prior childhood adversity is a ___ factor for the development of posttraumatic stress disorder.

Answer 389

risk

Question 390

Which of the following second generation antipsychotic medications has the lowest affinity for the D2 receptor?

• Quetiapine
• Olanzapine
• Ziprasidone
• Paliperidone
• Risperidone

Answer 390

Quetiapine

Question 391

Contralateral leg weakness associated with personality changes can be seen in a stroke in which of the following large artery territories?

• Vertebral
• Middle cerebral
• Anterior cerebral
• Posterior cerebral
• Anterior choroidal

Answer 391

Anterior cerebral

[Note, in a middle cerebral artery stroke, would expect contralateral arm rather than leg weakness because of the homunculus]

Question 392

A shrink graciously accepts flowers from a paranoid patient, thereby helping the patient feel more relaxed in the treatment setting and more willing to discuss symptoms. This demonstrates which of the following behaviors?

• Social skills training
• Empathic reflection
• Boundary crossing
• Behavioral activation
• Therapeutic mirroring

Answer 392

Boundary crossing

[Note, that in contrast to a boundary crossing, a boundary violation involves exploitation of the patient by the provider]

Question 393

A professor reviews a set of extremely positive student evaluations and notes that one of them says, “could leave more time for questions during class.” The professor later tells the psychiatrist, “I am a terrible teacher. I just talk the whole time.” This is an example of which of the following types of cognitive errors?

• Personalization
• Catastrophizing
• Arbitrary inference
• Selective abstraction
• Dichotomous thinking

Answer 393

Selective abstraction

Question 394

A 14yo boy reports he has felt sexually aroused spending time with male friends. The says that consciously he is significantly more attracted to females than males, but wonders if his feelings of arousal mean he is homosexual. Which of the following statements is most accurate to communicate to the patient?

• He is most likely homosexual, but will not fully feel that way for a few years.
• These feelings are common and his sexual preference will continue to solidify.
• If he feels more attracted to females than males then he is, by definition, heterosexual.
• This statement was probably made due to erotic transference and should be carefully explored.
• He is most likely bisexual, and his feelings for people of both genders may change over the next few years.

Answer 394

These feelings are common and his sexual preference will continue to solidify.

Question 395

Untreated depression in pregnancy is associated with poor maternal and infant outcomes, including pregnancy complications, preterm birth, and behavioral problems in the child. Current evidence shows that selective serotonin reuptake inhibitor use in pregnancy is associated with neonatal ___ syndrome.

Answer 395

adaptation

[Neonatal adaptation syndrome generally presents within a few hours following birth and may include a combination of respiratory distress, feeding difficulty, jitteriness, irritability, temperature instability, sleep problems, tremors, shivering, restlessness, jaundice, rigidity, and hypoglycaemia.]

Question 396

A couple in behavioral therapy are currently involved in problem-solving training and agree to “table” their next argument to discuss in their next session. During the session, one partner states the problem by using specific behavioral terms and feeling expressions. What is the next step in the problem-solving process?

• The partners agree to change their problematic behaviors.
• The other partner paraphrases the statement of the problem.
• The partners each acknowledge their own role in the problem.
• The partners evaluate the costs and benefits of possible solutions.
• The couple engages in a brainstorming session about possible solutions.

Answer 396

The other partner paraphrases the statement of the problem. (with Deb!)

Question 397

Which type of aphasia is most commonly associated with lesions involving the posterior third of the left superior temporal gyrus.

Answer 397

Wernicke aphasia

[In Wernicke’s aphasia, the ability to grasp the meaning of spoken words and sentences is impaired, while the ease of producing connected speech is not very affected. Therefore Wernicke’s aphasia is also referred to as ‘fluent aphasia’ or ‘receptive aphasia’.]

Question 398

A finding from studies of neuroimmune mechanisms of depression is that pro-inflammatory cytokines are often ___.

Answer 398

elevated

Question 399

The father of a 3.5yo boy who goes to preschool notes that recently the boy has come into the bathroom when the father is in the shower. He seems happy to see his dad emerge and is very interested in observing his father’s genitals. On one occasion the boy asked, “Why is it so fat?” pointing to his father’s penis. This behavior is most likely an indication of which of the following?

• Normal preschool-age sexual interest
• Inappropriate exposure to adult sexuality
• Sexual molestation by a non-family member
• Response to sex education in preschool curriculum
• An early indication of homosexual or bisexual orientation

Answer 399

Normal preschool-age sexual interest

Question 400

Coordinating physicians do not need patient to sign a consent form and may discuss the case to advance ___ decisions.

Answer 400

treatment

Question 401

Which of the following study designs is most likely to answer the question whether exposure to bupropion increases the risk of patients with schizotypal personality disorder developing psychotic symptoms?

• Cohort
• Crossover
• Case control
• Parallel group
• Cross-sectional

Answer 401

Cohort

Question 402

Which of the following genetic techniques is best suited for analyzing a family pedigree to determine the chromosomal region of a potential susceptibility gene for a given disorder?

• Twin studies
• Adoption studies
• Linkage analysis
• Polygenetic modeling
• Endophenotype analysis

Answer 402

Linkage analysis

Question 403

Which of the following antidepressant medications is indicated for the treatment of neuropathic pain associated with diabetes?

• Bupropion
• Duloxetine
• Paroxetine
• Mirtazapine
• Fluvoxamine

Answer 403

Duloxetine/cymbalta (an SNRI)

Question 404

Which of the following is the most common pattern of obsessions in patients with obsessive-compulsive disorder?

• Hoarding
• Counting
• Aggression
• Contamination
• Need for symmetry

Answer 404

Contamination (wash the hands!)

Question 405

• A double-blind randomized placebo-controlled trial finds that disease progressed in 28% of placebo-treated subjects and in 16% of those treated with the study drug. The difference between these two incidence rates is called:
• relative risk
• hazard ratio
• absolute risk
• attributable risk
• relative probability

Answer 405

*attributable risk

Question 406

There is evidence that neurogenesis occurs in which of the following regions of the adult human brain?

• Thalamus
• Cerebellum
• Hippocampus
• Olfactory bulb
• Fusiform gyrus

Answer 406

Hippocampus

[Neurogenesis in the adult brain is largely restricted to the dentate gyrus of the hippocampus. The dentate gyrus is thought to contribute to the formation of new episodic memories, the spontaneous exploration of novel environments, and other functions.]

Question 407

Throughout the course of psychotherapy a patient with borderline personality disorder reports a history of growing up in an abusive household, wishing to escape abusive parents but also depending on them, and abruptly ending relationships due to “feeling too close to the other person and getting scared.” According to Margaret Mahler’s model this patient’s problems can be formulated as not having worked through which stage?

Answer 407

Rapprochement (establishment or resumption of harmonious relations)

Question 408

Testing for genetic variants by analyzing thousands to millions of genetic markets in individuals with a disease and unaffected controls is known as ___-___ ___ ___.

Answer 408

genome-wide association studies

Question 409

Underlying heart defects are a ___ contraindication to treatment with psychostimulants.

Answer 409

relative

Question 410

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) set forth that for mental health and substance use benefits in group health plan insurance in the United States there must be ___ visit limits for behavioral health and medical conditions in a similar category of coverage.

Answer 410

equalized

Question 411

Which of the following substances is in several OTC cold remedies and is abused to produce a dissociative feeling?

• Ethanol
• Ephedra
• Acetaminophen
• Pseudoephedrine
• Dextromethorphan

Answer 411

Dextromethorphan (“Robo tripping”)

Question 412

Which of the following molecular mechanisms is best supported as a possible explanation for how early life stress could lead to the development of psychiatric disorders in adulthood?

• DNA methylation
• Alternative splicing
• Deletion mutations
• Gene amplification
• Reciprocal translocations

Answer 412

DNA methylation

[DNA methylation decreases gene expression]

Question 413

Deinstitutionalization resulted in a ___ ratio of mentally ill patients in prisons as compared to hospital.

Answer 413

higher

Question 414

A 60yo develops new onset diplopia. On exam he has double vision when looking to the right with decreased abduction of the right eye. On exam later in the day he now has drooping of the left eyelid and difficulty elevating the left eye. The following morning the patient reports awakening without any double vision. This pattern of double vision is typical for which condition?

Answer 414

Myasthenia gravis (symptoms improve with rest)

Question 415

Which of the following decreases in men undergoing andropause (Andropause is a condition that is associated with the decrease in the male hormone testosterone. It is unlike menopause in that the decrease in testosterone and the development of symptoms is more gradual than what occurs in women.)?

• Penile rigidity
• Sexual desire
• Refractory period
• Total sperm count
• Tactile stimulation needed for arousal

Answer 415

Penile rigidity

Question 416

The ___ process used to provide community care to children and youth is best described as an individualized, family-driven and youth-guided team planning process.

Answer 416

wraparound

Question 417

Which vitamin is recommended prior to conception as it may reduce risk of major congenital malformations in women taking antiepileptic medications?

Answer 417

Folic acid/B9

Question 418

Acetylation of lysine residues in histone proteins ___ chromatin structure.

Answer 418

relaxes

[Acetylation increases transcription]

Question 419

When talking to a patient in the pre-contemplative stage of tobacco cessation, which of the following would be the most effective first statement or question?

• “Cigarettes are going to kill you.”
• “You can quit if you really want to.”
• “Are you ready to pick a quit date?”
• “Are you worried about gaining weight if you quit?”
• “Have you heard about the health benefits of quitting?”

Answer 419

“Have you heard about the health benefits of quitting?”

Question 420

The shrink is concerned about a colleague’s behavior and notifies the State’s physician health program, which conducts an intervention. The physician should be referred for professional evaluation/treatment in which of the following scenarios?

• Drinks a glass of cabernet sauvignon with dinner several nights a week
• Has experienced depression in the past and has been hospitalized
• Has bipolar disorder and is euthymic and compliant with medications
• Acknowledges using cocaine occasionally but not habitually on days off and has a negative urine toxicology screen
• Is observed to be aggressive toward patients on three different occasions during shifts in the emergency department

Answer 420

Is observed to be aggressive toward patients on three different occasions during shifts in the emergency department

Question 421

A patient with mDD and GAD expresses concerns that antidepressant therapy will cause sexual side effects. Which of the medications below is least likely to cause treatment-emergent, medication-induced sexual dysfunction?

• Duloxetine
• Escitalopram
• Paroxetine (this one is the worst for sexual side effects and it has the greatest risk among SSRIs of congenital defects for those born to patients taking during pregnancy)
• Sertraline
• Venlafaxine

Answer 421

Escitalopram/Lexapro

Question 422

When a parent dies to facilitate a child’s adaptive mourning process it is essential to give the child opportunities to ___ feelings of loss.

Answer 422

express

Question 423

The dorsolateral-prefrontal cortex and striatum are two parts of a loop circuit that, when overactive, produces worry/obsessive symptoms. Which of the following is the third brain area in this loop circuit?

• Thalamus
• Amygdala
• Locus ceruleus (norepinephrine-producing zone)
• Parabrachial nucleus
• Nucleus accumbens (reward center)

Answer 423

Thalamus

[Striatum: one of the principal components of the basal ganglia, a group of nuclei that have a variety of functions but are best known for their role in facilitating voluntary movement (particularly the dorsal striatum, eg caudate and putamen).

The ventral striatum is made up of the nucleus accumbens and olfactory tubercle.]

Question 424

A 40yo with terminal lung cancer is admitted for difficulty breathing and increased pain. The patient reports a depressed mood, poor appetite, fatigue, and impaired concentration. Death is not imminent, but the prognosis is less than three weeks. Which of the following is the most appropriate treatment for this patient’s depression at this time?

• Sertraline
• Diazepam
• Duloxetine
• Mirtazapine
• Methylphenidate

Answer 424

Methylphenidate

Question 425

Police bring in a 60yo after finding him in the street disheveled, behaving oddly. He stares blankly at the examiner and is mute, but does obey commands. Over the first days of hospitalization the patient starts to speak but can’t offer an identity and can only offer a memory of “walking away from something horrible” as a reason for being found in the state that led to admission. Imaging studies, urine drug screen and electroencephalogram are all negative. Which of the following is the most likely diagnosis?

• Acute stress reaction
• Dissociative amnesia
• Complex partial seizures
• Transient global amnesia
• Dissociative identity disorder

Answer 425

Dissociative amnesia

Question 426

The Trail-Making Test requires rapid and efficient integration of attention, ___ scanning and cognitive sequencing.

Answer 426

visual

Question 427

A patient presents with a history of failure to thrive in infancy, hyperphagia, early obesity, hypogonadism, and obsessive-compulsive disorder. The patient is noted to have short stature with small hands and feet. The patient has pathogenic copy number variants affecting DNA base pairs. Which congenital syndrome is patient likely to have?

Answer 427

Prader-Willi

Question 428

A person works in an office near a railroad. Eventually, the person no longer notices the sounds from passing trains. This is an example of ___, the diminishing of a physiological or emotional response to a frequently repeated stimulus.

Answer 428

habituation

Question 429

___ is a non-associative learning process in which repeated administration of a stimulus results in the progressive amplification of a response.

Answer 429

Sensitization

Question 430

Which of the following patient characteristics best differentiates bulimia nervosa from binge eating disorder?

• Normal BMI
• Duration of symptoms
• History of laxative abuse
• Degree of control over food intake
• History of non-suicidal self-injurious behavior

Answer 430

History of laxative abuse

Question 431

Diffusion tensor imaging is very useful in studying ___ pathways in the brain.

Answer 431

connectivity

Question 432

A person with sustained damage to the hippocampi is still able to learn new skills such as playing tennis because this type of learning involves the ___ ganglia.

Answer 432

basal

[The basal ganglia are a group of subcortical nuclei, of varied origin, in the brains of vertebrates which are situated at the base of the forebrain and top of the midbrain.

The main components of the basal ganglia - as defined functionally - are the striatum (both dorsal striatum (caudate nucleus and putamen) and ventral striatum (nucleus accumbens and olfactory tubercle)), globus pallidus, ventral pallidum, substantia nigra, and subthalamic nucleus.]

Question 433

One model of integrated care is the “Improving Mood-Promoting Access to Collaborative Treatment” (IMPACT), which recommends screening for depression of at least 75% of primary care patients and following through with diagnostic evaluations and treatment management. Compared to treatment as usual, this model ___ the effectiveness of depression treatment.

Answer 433

doubles

Question 434

A 33yo comes to ED c/o blurred and cloudy vision followed by decrease of vision in the left eye. This is followed over the next half hour by feelings of numbness of the lips, face and hands. The patient also says the feels confused. Subsequently the patient develops worsening headache on the right side of the head and intolerance of any kind of odor along with nausea and vomiting. Which of the following is the most likely cause of this patient’s symptoms?

• Cluster headache
• Migraine with aura
• Right occipital stroke
• Subarachnoid hemorrhage
• Partial complex seizure of temporal lobe origin

Answer 434

Migraine with aura

Question 435

A surgeon is evaluated for memory problems contributing to performance issues at work. During cognitive assessment, the surgeon can’t describe the anatomical parts involved in a particular surgical procedure which is part of his daily practice. This is most indicative of impairment of which type of memory?

• Priming
• Episodic
• Semantic
• Procedural
• Perceptual

Answer 435

Semantic

the branch of linguistics concerned with meaning is semantics

Question 436

The blood-brain barrier is primarily composed of ___ cells.

Answer 436

endothelial

Question 437

For a patient stable on lithium for BPAD who develops tremor with lithium initiation, ___ is a good option to manage tremor.

Answer 437

propranolol

Question 438

What is the transmissible element that is likely the cause of progressive cognitive decline and myoclonic jerks in a patient with brain biopsy demonstrating spongiform changes?

Answer 438

Prion

Question 439

A 69yo woman is evaluated for cognitive impairment nad has a 15 month history of decline in function and ability to perform daily activities. She gets confused at times and appears to have a “slowness” to her movements and thinking. She complains of memory challenges, but this is not apparent on exam. Her gait is impaired with imbalance and shortened “shuffling” steps with leaning forward and stooped posture. There is no tremor or cogwheeling appreciated on exam. More recently she has developed episodes of urinary incontinence and is indifferent to these lapses. Most likely disorder is:

• Parkinson disease
• Alzheimer dementia
• dementia with Lewy bodies
• normal pressure hydrocephalus
• medication-induced Parkinsonism

Answer 439

normal pressure hydrocephalus (wet, wacky, wobbly; look at time course of symptoms, overall picture, be wary of trigger words that may lead to not reading the question fully)

Question 440

A child with autism spectrum disorder is placed in a therapeutic foster home where a consistent response is made to a given action with the goal of improving the child’s functioning. This technique derives from which learning theory?

Answer 440

Behaviorism

Question 441

One of the most consistent and specific findings among anatomical volumetric studies has been the associated between increased trait aggression and reduced volume of the ___.

Answer 441

amygdala

Billy Madison has a small amygdala!

Question 442

Which of the following, when added to lithium for treatment-resistant bipolar depression, is the least likely to induce rapid cycling or a mixed state?

• Bupropion
• Duloxetine
• Imipramine
• Venlafaxine
• Desipramine

Answer 442

Bupropion

Question 443

Family beg a 29yo to seek help for isolative behaviors. The patient says they feel very uncomfortable around others and have difficulty making friends unless convinced they will be accepting. Believing that all other acquaintances are highly critical of her, the patient has only two friends from childhood that remain close, and she has never dated. Fears of embarrassment interfere with job seeking, and the patient lives with her parents. Which of the following is the most likely diagnosis?

• Agoraphobia
• Social anxiety disorder
• Separation anxiety disorder
• Avoidant personality disorder
• Dependent personality disorder

Answer 443

Avoidant personality disorder

Question 444

The Wisconsin Card Sorting task measures the ability to generate ___ strategies in response to feedback.

Answer 444

alternative

Question 445

Copy number variations are similar to single-nucleotide polymorphisms in that they both are commonly found in ___ individuals.

Answer 445

healthy

Question 446

A 49yo takes 60mg flouxetine daily for major depressive disorder and is evaluated for worsening migraines. The patient calls the psychiatrist several days later and reports fever, diarrhea and feeling that “my muscles are tightening up.” Which of the following migraine medications is most likely to cause these symptoms when taken with fluoxetine?

• Atenolol
• Ibuprofen
• Magnesium
• Sumatriptan
• Acetaminophen

Answer 446

Sumatriptan

Question 447

Females of which ethnic group report experiencing the highest rates of lifetime intimate partner violence?

Answer 447

Native American

Question 448

The behavioral theory behind why people keep putting money into slot machines even though the machine only sometimes pays out is based upon which schedule of behavioral reinforcement?

Answer 448

Variable ratio

Question 449

The neuropeptide orexin is produced in the hypothalamus. Orexin, from orexis, means “appetite” in Greek and is involved in the stimulation of food intake. In addition, orexin stimulates ___, regulates energy expenditure, and modulates 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 hypothalamic cells that produce it. Venlafaxine/Effexor can treat cataplexy.

Answer 449

wakefulness

Question 450

A case-control study would be appropriate in answering an epidemiological question when the ___ of the disease is low.

Answer 450

incidence

Question 451

A 49yo develops new-onset of speech difficulty with inability to name objects and sometimes is unable to verbally answer simple yes or no questions. The patient cannot repeat the phrase “no ifs, ands, or buts” but is able to follow verbal and written commands. There is no trouble with chewing or swallowing. The speech difficulty is most characteristic of which condition?

Answer 451

Broca’s aphasia

[“broken Boca”; Broca’s area is a functionally defined structure in the left frontal lobe of about 97% of humans (including a large majority of left-handers).]

Question 452

The likely course for development of children after parents’ divorce is that children do ___ in one-parent homes, provided stable parental functioning and financial security.

Answer 452

well

Question 453

When do cortisol levels peak in healthy children?

• Morning
• Afternoon
• Evening
• Night

Answer 453

Morning

Question 454

When compared to patients with somatic symptom disorder, patients with illness anxiety disorder are less likely to:

• be female
• have multiple physical complaints
• develop a major depressive disorder
• display la belle indifference (A condition in which the person is unconcerned with symptoms caused by a conversion disorder. A naive, inappropriate lack of emotion or concern for the perceptions by others of one’s disability, usually seen in persons with conversion disorder.)

Answer 454

have multiple physical complaints

Question 455

A 17yo boy comes in with macroorchidism, long face, large everted ears, prominent jaw, a high arched palate, intellectual disability, frequent hand-flapping. He most likely has which genetic abnormality?

Answer 455

Trinucleotide repeat/expansion in the FMR1 gene

[Fragile X syndrome is the most common cause of INHERITED intellectual disability]

Question 456

Dopamine neurons in the ___ system are primarily implicated in tasks related to cognitive processing?

Answer 456

mesocortical

[In schizophrenia, dopamine is reduced in the mesocortical projection of the dorsolateral prefrontal cortex, which is postulated to be driving negative and depressive symptoms in schizophrenia.

In schizophrenia, there is hyperactivity of dopamine in the mesolimbic pathway (includes the nucleus accumbens and mediates addiction and associated behaviors) which mediates positive psychotic symptoms.

Dopamine blocking antipsychotics decrease pleasure by blocking the mesolimbic dopaminergic pathway.]

Question 457

In Heinz Kohut’s theory of self-psychology, the term “self-objects” means other ___ in the environment who perform particular functions for the self.

Answer 457

people

Question 458

Stress can lead to secretion of ___-releasing-hormone by the hypothalamus.

Answer 458

corticotropin

[CRH -> ACTH -> glucocorticoids, cortisol, mineralocorticoids, DHEA]

Question 459

A patient presents with a history of irresistible episodic sleepiness that is accompanied by a vivid, dreamlike state at the onset of an episode. Which of the following additional sleep symptoms are likely to be present?

• Sleep walking
• Sleep paralysis
• Restless legs
• Apneic episodes

Answer 459

Sleep paralysis (sometimes occurs with narcolepsy)

Question 460

Which of the following recommendations on the use of medication to treat sub-threshold depressive symptoms in patients with cancer is best supported by current evidence?

• Administer a short-acting stimulant
• Start a selective serotonin reuptake inhibitor
• Use anticancer drugs that target the underlying neoplasm
• Delay pharmacologic treatment until the patient meets full-syndrome DSM-5 criteria

Answer 460

Start a selective serotonin reuptake inhibitor

[Note, if cancer patients or others have a very short time to live, such as 2-3 weeks, rather than SSRI, stimulant may be considered for mood]

Question 461

Self-assessment continuing medical education (Carlat quiz) is characterized by covering new knowledge and/or current best practices, offering the correct answer and supporting literature references, and providing information about ___ performance to peers.

Answer 461

comparative

Question 462

What is the risk of individuals developing schizophrenia when a sibling has the disorder but the parents do not?

Answer 462

10%

Question 463

Neurosurgical approaches for the treatment of refractory obsessive-compulsive disorder target cortico-___-thalamo-cortical circuitry.

Answer 463

striatal

[Striatum (one of the principle components of striatum):
Ventral: nucleus accumbens + olfactory tubercle
Dorsal: caudate nucleus + putamen

Note, the dorsolateral PFC is the first part of the circuit listed, cortico-striatal-thalamo-cortical.]

Question 464

In a patient with left hemiparesis, lifting the patient’s left hand above the face and letting it drop (“face-hand test”) assesses for which type of pathology?

Answer 464

Psychogenic

Question 465

Maternal history of puerperal (during or relating to the period of about six weeks after childbirth during which the mother’s reproductive organs return to their original non-pregnant condition) psychiatric illness is a risk factor for development of ___ psychosis.

Answer 465

postpartum

Question 466

Pathogenic copy number variants affecting DNA base pairs are associated with ___-___, which often presents with failure to thrive in infancy, hyperphagia, early obesity, hypogonadism, obsessive-compulsive disorder, short stature, small hands and small feet.

Answer 466

Prader-Willi

[Copy number variations have been identified in the imprinted chromosome 15 region associated with Prader-Willi syndrome and Angelman syndrome. These diseases might be caused by copy number variants due to inversions and deletions in critical genes.]

Question 467

During a session a patient tells the shrink that marital conflicts have resolved. The patient attributes this change to the shrink’s helpfulness and understanding. Which of the following responses is consistent with supportive treatment?

• “Oh, no, you did all the work, I can’t take the credit!”
• “Let’s explore why you felt the need to thank me just now.”
• “I’d like to discuss a homework assignment to further build your interpersonal skills.”
• “I’m happy to hear that things are going well at home and that our work together has been helpful.”

Answer 467

-“I’m happy to hear that things are going well at home and that our work together has been helpful.”

Question 468

Which dopaminergic pathway includes the nucleus accumbens and mediates addiction and associated behaviors?

Answer 468

Mesolimbic

[Dopamine blocking antipsychotics decrease pleasure by blocking the mesolimbic dopaminergic pathway.

In schizophrenia, there is hyperactivity of dopamine in the mesolimbic pathway which mediates positive psychotic symptoms.]