CAP BOARDS 2

Question 1

Beta-2 agents and mixed beta-1/beta-2 agents (non selective) such as propranolol will induce what in asthmatic patients?

Answer 1

bronchospasm

Question 2

Sexual orientation may be a more stable trait in males or females?

Answer 2

males

Question 3

Most common inherited cause of ID in males?

Answer 3

Fragile X

Question 4

what are early signs of autism? (4)

Answer 4

1) absence of social smile by 6 mo of age
2) not babbling or pointing by 12 mo
3) not using single words by 16 mo
4) unable to use 2-word phrases

Question 5

Results of the TEOSS (Early Onset Schizophrenia Spectrum Disorders Study)?

Answer 5

< 50% of patients responded over 8 wks of tx
All tx arms were equally efficacious (risperidone, olanzapine, and molindone)
There were no differences in EPS in the tx arms, but this result was likely influences by the ppx use of cogentin in the molindone group

Question 6

The neurotransmitter principally affected by fluvoxamine is produced in what brain region?

Answer 6

Raphe nuclei (serotonin)

Question 7

Norepinephrine is produced where?

Answer 7

Locus coeruleus

Question 8

What neurotransmitter is produced in the locus coeruleus?

Answer 8

Norepinephrine

Question 9

What neurotransmitter is produced in the raphe nuclei?

Answer 9

Serotonin

Question 10

Where is serotonin produced?

Answer 10

Raphe nuclei

Question 11

Ach is produced where?

Answer 11

Nucleus basalis of Meynert

Question 12

What is produced in the nucleus basalis of Meynert?

Answer 12

Ach

Question 13

Where is histamine produced?

Answer 13

Tuberomammillary nucleus

Question 14

What is produced in the tuberomammillary nucleus?

Answer 14

Histamine

Question 15

Where is dopamine produced? (2)

Answer 15

Substantia nigra and VTA

Question 16

What neurotransmitter is produced in the substantia nigra and the VTA?

Answer 16

Dopamine

Question 17

Risperidone has FDA approval for agitation in autism - age range?

Answer 17

5-16

Question 18

Risperidone has FDA approval for the tx of schizophrenia - age range?

Answer 18

13-17

Question 19

Risperidone has FDA approval for the tx of bipolar d/o - age range?

Answer 19

10-17

Question 20

The ionic gradient necessary for a neuron to generate action potentials is established the distribution of what three ions and how?

Answer 20

K+, Cl-, Na+

High concentrations of Na+ and Cl- outside the cell membrane and high concentrations of K+ inside the cell membrane

At rest, K+ and Cl- channels are open so that K+ and Cl- gradients determine the membrane’s resting potential, which is negative by about -50mV to -75mV. Once depolarized beyond the cell’s threshold potential, voltage-gated Na+ channels open rapidly, depolarizing the membrane. The membrane potential shifts to +50mV quickly.

Question 21

16 month child is sitting with his mother in a room, then walks over to the doorway. he walks just outside the door, looks back at his mother, and begins to cry. It seems as if he wants to explore the next room but is uncertain about leaving his mother. According to Mahler, this child is most likely in which developmental sub-phase?

Answer 21

Rapprochement (15-24 months).

Question 22

According to Mahler, when does hatching occur?

Answer 22

5-9 months. The infant becomes aware that he/she is separate from the mother, notices surroundings, but still uses the mother as the primary reference point for understanding the world.

Question 23

According to Mahler, when does practicing occur?

Answer 23

9-16 months, the infant can physically move about alone

Question 24

MMPI-A can be used in what age range?

Answer 24

14-18.

Question 25

If a patient is already taking valproate, what is the ideal lamotrigine dose?

Answer 25

Initial dose should be divided to half of the normal dose then increased to a therapeutic dose gradually.

Question 26

According to the AACAP Practice Parameters for Cultural Competence, it is more common for minority children and adolescents to engage in mental health care after referral from the court or school for disruptive bx. TRUE or FALSE?

Answer 26

TRUE

Question 27

According to the AACAP Practice Parameters for Cultural Competence, non-hispanic white families are ?x more likely to seek mental health care for their children compared to minority families?

Answer 27

2x

Question 28

School administrators want to create a behavioral intervention plan for an aggressive student. What is the first major step in creating this plan?

Answer 28

Functional behavioral analysis (FBA) - systematic method for describing a problem behavior and identifying “antecedent and consequent events” that cause or contribute to the bx.

Question 29

Abilify is approved to tx irritability in kids with autism - what age range?

Answer 29

6-17

Question 30

a 16M discusses sexual fantasies towards an older cousin during the course of psychotherapy. Which principal justifies leaving out a more descriptive account of the adolescent’s sexual fantasy?

Answer 30

Nonmaleficience, do not harm. It includes not causing physical pain or emotional suffering or depriving others of beneficial things.

Question 31

A recent study found that children with which gene’s variant allele were more likely to become violent and antisocial adults following child abuse?

Answer 31

MAO-A

Question 32

According to the Treatment of SSRI-resistant Depression in Adolescents (TORDIA) trial, after failing a trial of an SSRI, what is the next step?

Answer 32

SSRI or venlafaxine, but venlafacine had more side effects (so the answer is SSRI :)

Question 33

What group did the Treatment of SSRI-resistant Depression in Adolescents (TORDIA) trial look at?

Answer 33

adolescents that had not responded to a previous 2-month course of an SSRI

Question 34

What medications were looked at in the Treatment of SSRI-resistant Depression in Adolescents (TORDIA) trial? (4)

Answer 34

Paroxetine, citalopram, fluoxetine, and venlafaxine

Question 35

In the Treatment of SSRI-resistant Depression in Adolescents (TORDIA) trial, patient who switched to another medication and added CBT had a response rate of?

Answer 35

55% (in comparison to 41% who did not add CBT)

Question 36

In the Treatment of SSRI-resistant Depression in Adolescents (TORDIA) trial, those who switched to another medication (and did not add CBT) had a response rate of?

Answer 36

41% (in comparison to 55% w CBT)

Question 37

Did the Treatment of SSRI-resistant Depression in Adolescents (TORDIA) trial exclude patients who endorsed SI?

Answer 37

No.

Question 38

The Treatment of SSRI-resistant Depression in Adolescents (TORDIA) trial did not exclude patients who endorsed SI. Did the medications reduce SI?

Answer 38

No

Question 39

In the Treatment of SSRI-resistant Depression in Adolescents (TORDIA) trial, what side effects were seen with venlafaxine?

Answer 39

Skin infections and cardiovascular side effects

Question 40

In the Treatment of SSRI-resistant Depression in Adolescents (TORDIA) trial adolescents with a history of what four things were less likely to respond to tx? (4)

Answer 40

1) Chronic depression
2) Severe hopelessness
3) Self-harm bx
4) Family conflict

Question 41

A 12 month old child has begun to walk and moves around the room, still preferring close contact with the mother at all times. According to Mahler, this child is most likely in which developmental sub-phase?

Answer 41

Practicing (9-16 months). The infant can physically move about alone.

Question 42

What protocol is used for therapy tx with adolescents experiencing PTSD and concurrent substance use?

Answer 42

Seeking safety

Question 43

17M is brought to the hospital for hallucinations and bizarre bx. He is screaming that his abdomen hurts. The nurses report that his urine has an unusual color. Dx?

Answer 43

Acute intermittent porphyria

Question 44

Psychosis + abdominal pain + purple urine. Dx?

Answer 44

Acute intermittent porphyria

Question 45

3 sxs of Acute intermittent porphyria?

Answer 45

Psychosis + abdominal pain + purple urine

Question 46

What is Acute intermittent porphyria?

Answer 46

Rare autosomal dominant disease that affects heme production resulting from a deficiency of the porphobilinogen deaminase.

The exact mechanism of acute attacks not clear. The most favored hypothesis is that porpholobilinogen buildup causes a toxic effects on neurons.

Question 47

What cell types produces myelin in the CNS?

Answer 47

Oligodendrocytes.

They are also a type of glial cell.

Question 48

Macroglia are divided into what 5 types?

Answer 48

1) astrocytes
2) oligodendrocytes
3) ependymal cells
4) radial glia
5) Schwann cells

Question 49

Astrocytes are a type of macroglia - function?

Answer 49

Form biochemical support of endothelial cells that form the blood-brain-barrier, provide nutrients to CNS, maintain ion balance, and play a role in the repair and scarring process of the brain and spinal cord

Question 50

Oligodendrocytes are a type of macroglia - function?

Answer 50

Insulate axons in the CNS by providing myelin sheath

Question 51

Ependymal cells are a type of macroglia - function?

Answer 51

Line the ventricles and are part of CSF production

Question 52

Radial glia are a type of macroglia - function?

Answer 52

Primary progenitors capable of becoming neurons, astrocytes, and oligodendrocytes that also serve as a scaffold upon which newborn neurons migrate

Question 53

Schwann cells are a type of macroglia - function?

Answer 53

Myelinate nerves in the PNS (oligodendrocytes are in the CNS)

Question 54

Nonfunctional or reduced function alleles occur in approx 25-30% of Caucasians, resulting in about what percentage of the population having the phenotype associated with abnl metabolism? (CYP2D6)

Answer 54

5-10%

Question 55

Atomoxetine is affected by which CYP?

Answer 55

2D6

Question 56

When is the best time to measure plasma levels of lithium during therapy?

Answer 56

12 hours after the last dose

Question 57

Which law in the US sets forth the basic requirements for an IEP?

Answer 57

Individuals with Disabilities Education Act

Question 58

The Higher Education Act of 1965 was intended for what?

Answer 58

To strengthen the educational resources of our colleges and universities and to provide financial assistance for students in post-secondary and higher education. It increased federal money given to universities, created scholarships, gave low-interest loans for students, and established a National Teachers Corps

Question 59

Section 504 is part of what Act?

Answer 59

Rehabilitation Act of 1973 that prohibits discrimination based upon disability. Section 504 is an anti-discrimination civil rights statute that requires the needs of students with disabilities to be met as adequately as the needs of the non-disabled are met.

Question 60

What percent of patients with autism have Fragile X?

Answer 60

3-5%

Question 61

What is the most common genetic cause of ID in boys?

Answer 61

Fragile X

Question 62

What is the most common genetic cause of ID?

Answer 62

Down syndrome

Question 63

What is imprinting?

Answer 63

A gene is silenced or otherwise altered by one parent, which can influence the offspring (Prader-Willi or Angelman)

Question 64

What is anticipation?

Answer 64

Genetic syndrome that appears to become more pronounced with successive generations. (Fragile X)

Question 65

Example of anticipation?

Answer 65

Fragile X.

Genetic syndrome that appears to become more pronounced with successive generations.

Question 66

Method of training by which successive approximations toward a target bx are reinforced

Answer 66

Shaping

Question 67

Learning process in which an innate response to a potent stimulus comes to be elicited in response to a previously neutral stimulus

Answer 67

Classical conditioning

Question 68

Type of learning in which the strength of a bx is modified by its consequences, such as reward or punishment

Answer 68

Operant conditioning

Question 69

Walks, puts a block in a cup, drinks from a cup, and says “mama” and “dada” specifically - age?

Answer 69

1 year

Question 70

17M w reddened conjunctivae, speaking in hushed tones and has tachycardia and a dry mouth. The patient’s parents are worried about his grades at school, but he says he has “got it all figured out.” Which drug is responsible for his sxs?

Answer 70

Cannabis

also causes paranoia and a slowed sense of time

Question 71

Vertical nystagmus is pathognomonic for what?

Answer 71

PCP intoxication

Question 72

Paranoia, hallucinations, aggression, and vertical nystagmus - drug?

Answer 72

PCP

Question 73

HTN, anxiety, and diaphoresis - drug intoxication?

Answer 73

Cocaine

Question 74

MRI shows large tumors on both VIII cranial nerves. Which syndrome is this child most likely to have?

Answer 74

NF2 (acostic neuromas)

Question 75

MRI shows large tumors on both VIII cranial nerves. Which syndrome is this child most likely to have? inheritance patterN?

Answer 75

NF2 (acostic neuromas)

Autosomal dominant

Question 76

Large spots on the skin (cafe-au-lait-spots), optic gliomas, pigmented raised spots on the iris. Which syndrome is this child most likely to have?

Answer 76

NF1

Question 77

Large spots on the skin (cafe-au-lait-spots), optic gliomas, pigmented raised spots on the iris. Which syndrome is this child most likely to have? Inheritance pattern?

Answer 77

NF1

Autosomal dominant

Question 78

What concept was developed by Bowlby?

Answer 78

Attachment theory

Question 79

Multisystemic therapy (MST) is used for what dx?

Answer 79

Conduct disorder

MST is an intensive family and community-based tx for serious juvenile offenders with possible substance abuse issues and their families. The

Question 80

What are the primary goals of MST?

Answer 80

Decrease youth criminal bx and out-of-home placements.

Indicated for kids w conduct disorder

Question 81

Testing for Fragile X syndrome involves what method?

Answer 81

PCR (# of CGG repeats) followed by Southern Blot (used to distinguish large pre-mutations from full mutations and to measure the degree of methylation of the FMR1 gene

Question 82

A young child is evaluated for ID. His parents note that he frequently attempts to bit and scratch himself, often leaving serious woulds on his arms. They recall having an abnormal genetics evaluation. At that time, they were advised to feed him a special diet. Dx?

Answer 82

Lesch-Nyhan disease

Caused by a mutation on the X chromosome. It causes a build up of uric acid in the body.

It can partially be compensated for with a diet limiting the uric acid production

Question 83

A young child is evaluated for ID. His parents note that he frequently attempts to bit and scratch himself, often leaving serious woulds on his arms. They recall having an abnormal genetics evaluation. At that time, they were advised to feed him a special diet. Caused by a mutation on what?

Answer 83

Lesch-Nyhan disease

Caused by a mutation in the HGPRT gene located on the X chromosome. It causes a build up of uric acid in the body due to the HGPRT deficiency.

It can partially be compensated for with a diet limiting the uric acid production

Question 84

A young child is evaluated for ID. His parents note that he frequently attempts to bit and scratch himself, often leaving serious woulds on his arms. They recall having an abnormal genetics evaluation. At that time, they were advised to feed him a special diet. Causes what?

Answer 84

Lesch-Nyhan disease

Caused by a mutation on the X chromosome. It causes a build up of uric acid in the body.

It can partially be compensated for with a diet limiting the uric acid production

Question 85

A former patient’s father has difficulty paying off their bill and offers his construction services (he is a contractor). In what situation would this exchange be considered ethical?

Answer 85

As long as the work is at fair market value

Question 86

A 16M 2nd generation Mexican American is brought by his parents under court order for a psychiatric evaluation stemming from gang involvement. The patient reports that his grandparents were just “stupid farmers” and “did not understand the world.” He also remarks that “Americans just care about money, and we (the gang) actually care about each other.” Define.

Answer 86

Negative identification: form of marginalization where the youth is openly hostile towards both cultures and may adopt gang culture.

Question 87

Represented by rejection of the host culture and remaining bound to an “ethnic enclave.”

Answer 87

Separation

Question 88

Involves a separation from both cultures and some degree of ethnic identity diffusion.

Answer 88

Marginalization

Question 89

What value tells how likely the result of a study was due to random chance?

Answer 89

P value

Question 90

What does P = 0.01 mean?

Answer 90

That there is a 1 in 100 probability that the positive results of the study were due to chance, rather than due to a real effect of the drug

Question 91

What is absolute risk reduction and how is it calculated?

Answer 91

The difference between the risk of an outcome in the exposed group and the unexposed group.

Mathematic inverse of NNT = control event rate - experimental event rate

NNT = 1 / (control event rate - experimental event rate)

Question 92

A well-designed randomised controlled trial in children with a particular disease found that 20 per cent of the control group developed bad outcomes, compared with only 12 per cent of those receiving treatment. ARR?

Answer 92

20%-12% = 8%
If 100 children were treated, 8 would be prevented from developing bad outcomes.
NNT = 100/8 = ~13. The NNT for one child to benefit is about 13.

Question 93

A well-designed randomised controlled trial in children with a particular disease found that 20 per cent of the control group developed bad outcomes, compared with only 12 per cent of those receiving treatment. ARR?

Answer 93

20%-12% = 8%
If 100 children were treated, 8 would be prevented from developing bad outcomes.

NNT = 100/8 = ~13. The NNT for one child to benefit is about 13.

Question 94

A well-designed randomised controlled trial in children with a particular disease found that 20 per cent of the control group developed bad outcomes, compared with only 12 per cent of those receiving treatment. NNT?

Answer 94

20%-12% = 8% = ARR
If 100 children were treated, 8 would be prevented from developing bad outcomes.

NNT = 100/8 = ~13. The NNT for one child to benefit is about 13.

Question 95

What is the leading known cause of ID?

Answer 95

Fetal alcohol syndrome

Question 96

What is a potential side effect of atomoxetine that affects males only?

Answer 96

Priapism.

Question 97

What % of study subjects with ADHD responded preferentially to 1 of 2 classes of stimulants (methylphenidate vs amphetamine)?

Answer 97

44%

Question 98

What is the initial response rate to stimulants if both stimulant classes are tried (methylphenidate and amphetamine)?

Answer 98

85%

Question 99

A 16M suffering from acute mania and psychosis presents to the ED. The patient is agitated and demands to leave. The psychiatrist gives IM Haldol. Which ethical principal is working here?

Answer 99

Beneficience

Question 100

Runs, stacks 4 blocks, removes garments, says at least 6 words. Age?

Answer 100

18 months

Question 101

What is the correct sequence of infant development as described by Margaret Mahler? (3)

Answer 101

1) Autistic phase (1st few weeks of life)
2) Symbiotic phase (until 5 months of age, recognizes mother but lacks a sense of individuality)
3) Separation-individuation phase
- hatching (increased interest in the outside world)
- practicing (9-16 months, developing the physical ability to separate from mother)
- rapproachement (15-24 months, exploring the outside world but needing mother to be present and offer support)

Question 102

A child is noted to believe in strict rules and is unable to appreciate any exceptions or nuances to rules, such as the mindset of the person or the situation which the person was facing that the time. Which stage of cognitive development is the child most likely at?

Answer 102

Preoperational (concrete in their thinking, will often adopt a rigid belief in rules, and will fail to understand exceptions or motives behind possibly needing to break the rules.

Age 2-7

Question 103

A child is noted to believe in strict rules and is unable to appreciate any exceptions or nuances to rules, such as the mindset of the person or the situation which the person was facing that the time. Age?

Answer 103

Preoperational (concrete in their thinking, will often adopt a rigid belief in rules, and will fail to understand exceptions or motives behind possibly needing to break the rules.

Age 2-7

Question 104

9M is treated for depression. He is American born, but his family is originally from Ecuador. He is generally a good student, but this year his grades have suffered. His mother has a h/o depression that reportedly has responded well to tx with fluoxetine. Of note, the patient is a poor metabolized of fluoxetine. What is the primary consideration when dosing fluoxetine for this boy?

Answer 104

size.

Dosing medication in older children and adolescents mainly relies on differences in body size between child and adults. Fluoxetine is FDA approved for the treatment of depression in children 8 years old +.

Question 105

Approx what percentage of patients with chronic alcohol use disorders have at least one parents with chronic alcohol use disorder?

Answer 105

30%

Question 106

16M expresses resentment towards having to care for his younger child. When he is w his friends, he consistently reports how wonderful it is to be a father. At times, he worries about his capabilities and is concerned that he will not be able to provide for his child. Defense mechanism?

Answer 106

Reaction formation: conversion of unconscious wishes into their opposites.

The bx is the opposite of what one really desires or feels.

Question 107

The unconscious modeling of one’s self after another person’s character and bx

Answer 107

Identification

Question 108

Ensures that what is unacceptable to the conscious mind, and would if recalled arouse anxiety, is prevented from entering into it.

Answer 108

Repression

Question 109

Shift of a sexual or aggressive drive to a more acceptable target

The mind substitutes either a new aim or a new object for goals felt in their original form to be dangerous or unacceptable.

Answer 109

Displacement

Question 110

Separation of a cognitive process from the affect that is associated with it

Answer 110

Isolation of affect

Question 111

Wilson’s disease - inheritance pattern?

Answer 111

autosomal recessive

Question 112

A family h/o sleepwalking or sleep terrors is reported in up to what percentage of patients with sleepwalking disorder?

Answer 112

80%

Question 113

Severe side effects of ecstasy abuse and intoxication? (7)

Answer 113

1) Coagulopathy
2) Acute renal failure
3) Hepatotoxicity
4) Rhabdomyolysis
5) Death
6) convulsions
7) body temp dysregulations

Question 114

Common side effects of MDMA?

Answer 114

1) PMR
2) increased sexual response
3) bruxism
4) trismus
5) anorexia
6) sweating

Question 115

A group of 3.5 y/o children are playing in a sandbox with the same toys. What kind of play behavior are they most likely to exhibit?

Answer 115

Associative play: (around 3 years old)

Individual play starts to overlap. They share the same toys but will still play separately

Question 116

What type of play is commonly seen with 4 y/os.

Answer 116

Cooperative play. Children play with toys and interact with each other.

Question 117

At what age do you commonly see parallel play?

Answer 117

2 y/o

Question 118

Parallel, associative, and cooperative play are the progressive stages of play during what Piaget development period?

Answer 118

Preoperational (preschool age)

Question 119

Rash w facial involvement, mucus membrane involvement, fever, and lymphadenopathy after lamotrigine is a sign of what?

Answer 119

SJS

Question 120

Lamotrigine overdose can be fatal. The most common sxs include stupor, convulsions, and intraventricular delay. Tx?

Answer 120

Supportive

Question 121

A cohort study was designed to examine the Development of MDD in children of divorced parents vs married parents. What measure should the researchers use to express the probability of an event occurring when comparing an exposed group to a non-exposed group.

Answer 121

Relative risk. Expresses the probability of an event occurring when comparing an exposed and a non-exposed group (incidence of exposed over incidence of unexposed). It is used in RCT and cohort studies.

Question 122

Used to calculate risk in a case-control study and signifies the odds of having a disease given an exposure (odds of disease with exposure over odds of disease without exposure).

Answer 122

Odds ratio.

Question 123

For rare diseases, the odds ratio approximates what?

Answer 123

Relative risk

Question 124

Calculated as the # of events over the number of subjects. It is used to calculate several measures, including relative risk and absolute risk reduction.

Answer 124

Event rate

Question 125

Similar to relative risk (expresses the probability of an event occurring when comparing an exposed and non-exposed group), but while relative risk ratios are cumulative over the course of a study, this ratio reflects the instantaneous risk over a specific time period. It is helpful when 2 groups are experiencing events at different rates, even if the overall event rate may be similar.

Answer 125

Hazard ratio

Question 126

17F c/o recent episodes of extreme anxiety, racing pulse, and cold sweats. Her urine vanillyl mandelic acid is elevated. What neurotransmitter is produced in excess?

Answer 126

Norepinephrine

pheochromocytoma

Question 127

17F c/o recent episodes of extreme anxiety, racing pulse, and cold sweats. Her urine vanillyl mandelic acid is elevated. A neurotransmitter is produced in excess - where is it produced?

Answer 127

Norepinephrine - pheochromocytoma

Question 128

17F c/o recent episodes of extreme anxiety, racing pulse, and cold sweats. Her urine vanillyl mandelic acid is elevated. Dx?

Answer 128

pheochromocytoma

Question 129

17F c/o recent episodes of extreme anxiety, racing pulse, and cold sweats. Her urine vanillyl mandelic acid is elevated. Where might you see a mass?

Answer 129

pheochromocytoma

– usually see an adrenal mass

Question 130

In structural family therapy, the therapist first “joins” the family in order to observe what is occurring. After joining, which technique does the therapist typically use next?

Answer 130

Mapping: the therapist makes an assessment of the family’s structure and repetitive patterns of interactions, usually looking for the maladaptive patterns that need to be addressed during restructuring

Question 131

What are the three phases of structural family therapy?

Answer 131

1) Joining
2) Mapping
3) Restructuring

Question 132

What kind of scheduling is a casino using to encourage this gambling bx?

Answer 132

Variable ratio. This schedule provides reinforcement at a varying response rate. The number of game attempts to win at slots varies for each win.

(a variable interval schedule provides reinforcement for responses that occur after varying amts of time)

Question 133

A 4 y/o child presents for an initial evaluation with a h/o of school refusal. Which broad-based rating scale is best suited to evaluate anxiety?

Answer 133

Spence Children’s Anxiety Scale (normed to the age of 2.5, parent report from age 2.5 - 6) and consists of 35-45 items geared towards assessing anxiety.

Question 134

Age range for the SCARED?

Answer 134

8-18. Looks at GAD, social phobia, panic d/o, and separation anxiety.

Question 135

36-item scale used to assess intensity and frequency of aggression and externalizing bxs as well as sxs of ADHD in children age 2-16. This scale was utilized to measure outcomes in PCIT.

Answer 135

Eyeberg Child Bx Inventory (ECBI)

Question 136

Eyeberg Child Bx Inventory (ECBI) = 36-item scale used to assess intensity and frequency of aggression and externalizing bxs as well as sxs of ADHD in children age Range? This scale was utilized to measure outcomes in PCIT.

Answer 136

2-16

Question 137

This type of aggression is a marked and pervasive tendency to perceive that others are acting with hostile intent. It is typically a result of an angry arousal and is impulsive in nature.

Answer 137

Reactive aggression.

Question 138

Reactive aggression = This type of aggression is a marked and pervasive tendency to perceive that others are acting with hostile intent. It is typically a result of an angry arousal and is impulsive in nature. Tx?

Answer 138

Anger management

Question 139

This type of aggression is rooted in a belief that the youth will get what he/she wants and that other strategies will not work. It is deliberate.

Answer 139

Proactive aggression

Question 140

Proactive aggression = This type of aggression is rooted in a belief that the youth will get what he/she wants and that other strategies will not work. It is deliberate. Tx?

Answer 140

Therapeutic modalities that enhance empathy and decrease antisocial attitudes.

Question 141

Primary enuresis - there is a high rate of spontaneous remission when?

Answer 141

Between ages 5-7 and after age 12

Question 142

What gene is associated with tuberous sclerosis and is linked to ASD?

Answer 142

TSC1

Question 143

Medical conditions that cause ASD can be identified in what percent of cases?

Answer 143

<5%

Question 144

What percent of children with severe chronic medical illness survive into adulthood?

Answer 144

90%

Question 145

What features need to be present at some point to dx Tourette’s disorder?

Answer 145

Multiple motor tics and at least 1 vocal tic

Must be present at some time during the illness, although not necessarily concurrently. 1 year. No tic free period of more than 3 consecutive months.

Question 146

Onset of Tourette’s disorder must occur before what age?

Answer 146

18 years

Question 147

Who was the first person to characterize autism spectrum?

Answer 147

Leo Kanner

Question 148

What part of the brain is responsible for arousal?

Answer 148

Pons

Question 149

What part of the brain is responsible for most physiologic regulations, including body temperature?

Answer 149

Hypothalamus

Question 150

Language is controlled by several areas of the brain, including what two lobes?

Answer 150

frontal and temporal

Question 151

A child can hold her head up when sitting in a chair but cannot sit up on her own on the ground. The child will turn and look at sounds but does not yet say any sounds or words other than cooing. She has just started to reach for objects but is unable to pass them back to her parents. Age?

Answer 151

4 months but not quite 6 months (being unable to sit unsupported is the most common indicator).

Question 152

MOA of mirtazapine?

Answer 152

Antagonism of presynaptic alpha-2-adrenergic inhibitory autoreceptors = noradrenergic and serotonergic activity.

Question 153

Bioavailability of mirtazapine?

Answer 153

50% d/t extensive first-pass metabolism.

Question 154

Common side effects of mirtazapine? (6)

Answer 154

1) mildly elevated ALT and triglycerides
2) weight gain
3) somnolence
4) dry mouth
5) asthenia
6) constipation

Question 155

Telencephalon (3)?

Answer 155

1) Cerebral hemispheres
2) Limbic system
3) Basal ganglia

Question 156

Diencephalon (3)?

Answer 156

1) Thalamus
2) Hypothalamus
3) Optic vesicle

Question 157

Mesencephalon (3)?

Answer 157

1) Red nucleus
2) Substantia nigra
3) Periaqueductal gray

Question 158

Melencephalon (2)?

Answer 158

1) Pons

2) Cerebellum

Question 159

Myelencephalon (1)?

Answer 159

Medulla

Question 160

A 6 y/o is struggling to make new friends and reports to his mother that he “can’t do anything right.” Which basic conflict describes this child?

Answer 160

Industry vs inferiority (6-12)

Confidence, competence, social skills

Question 161

In what age group do you see trust vs. mistrust?

Answer 161

Birth to 18 months

Basic trust

Question 162

In what age group do you see autonomy vs shame?

Answer 162

18 months to 3 years

Control and independence

Question 163

In what age group do you see initiative vs guilt?

Answer 163

3 to 6

taking control of the environment, purpose

Question 164

In what age group do you see identity vs role confusion?

Answer 164

12 to 28

Formation of identity, devotion

Question 165

Pica = repeated eating of nonfood substances that are not nutritional for at least how long?

Answer 165

1 month

Question 166

During a family therapy session, the therapist asks the family members to get up and stand physically closer to family members who they felt emotionally closer to and stay distant from those they felt emotionally distant from. This is an example of which technique?

Answer 166

Sculpting

Question 167

First line medication for moderate - severe tics?

Answer 167

Guanfacine or clonidine

Antipsychotics are second line

Question 168

Patients with this personality disorder commonly experience over-involvement and intrusive bx by primary caretakers as a child. They were often socially humiliated during childhood, which leads to doubt in their own ability to function independently of others.

Answer 168

Dependent personality disorder

Question 169

Patients who develop this personality disorder often had parents who were emotionally withholding and overprotective or over-controlling. The were often punished and rarely rewarded. They developed sxs as a strategy to avoid punishment.

Answer 169

OCPD

Question 170

A grandiose sense of self-importance is a sx of what personality disorder?

Answer 170

Narcissistic PD

Question 171

A referral to a child psychiatrist is a typical component of an IEP - TRUE OR FALSE?

Answer 171

FALSE

Question 172

LOT benzos are metabolized by the liver, but primarily via what mechanism?

Answer 172

Conjugation

Question 173

A transition plan is a part of an IEP that help with the transition from HS to adulthood. The transition plan starts at what age?

Answer 173

16

Question 174

Common sleep disorder in teens?

Answer 174

Circadian rhythm disorder, delayed-phase type

Question 175

Children and adolescents dx’d with anxiety disorders are how many more times likely to develop a depressive or anxiety disorder in adultlhood?

Answer 175

2-3x more likely

Question 176

At any time, what % of adolescents report some degree of SI?

Answer 176

15-25%

Question 177

What percent of teens attempt suicide?

Answer 177

1-10%

Question 178

Suicide is the 2nd leading cause of death in adolescents and accounts for what % of all deaths?

Answer 178

11

Question 179

22q11.w is associated with a higher risk of early onset schizophrenia. What is the syndrome?

Answer 179

Velocardiofacial

Question 180

Early onset schizophrenia - lifetime risk of developing the illness is ?x higher in first-degree relatives of affected probands?

Answer 180

5-20x

Question 181

A 7 y/o female enjoys forming clubs with other girls, making shared rules, and collecting dolls. Erickson stage of development?

Answer 181

Industry vs Inferiority

Question 182

An 8 y/o girl is working with her mother, who pours a container of lemonade into 2 differently shaped glasses that hold the same volume The child correctly recognizes that although the glasses are different shapes they hold the same volume. Piaget phase?

Answer 182

Concrete operational (7-11 years old)

Question 183

Piaget stage, starts at age 11, includes the use of abstract and hypothetical thinking. The ability to discern major principals and motivations of ideas, theories, or actions allows individuals in this stage to apply them to new and similar situations.

Answer 183

Formal operations

Question 184

Irritability and aggression occur more frequently in bipolar patients with comorbid ADHD when tx’d with stimulants - true or false?

Answer 184

TRUE

Question 185

What medical condition is common in patients with Down Syndrome and may mimic depression?

Answer 185

Hypothyroidism

Question 186

Patients with down syndrome often experience dementia at what age?

Answer 186

40s and 50s

Question 187

ID is generally profound in down syndrome -true or false?

Answer 187

FALSE - can be variable

Question 188

Which model of family therapy is most concerned with triangulation?

Answer 188

Transgenerational family therapy is primarily concerned with helping an individual to differentiate themselves from the family.

Question 189

What is often used in transgenerational family therapy?

Answer 189

Genograms.

Transgenerational family therapy is primarily concerned with helping an individual to differentiate themselves from the family.

Question 190

What is triangulation?

Answer 190

When 2 family members join together in opposition to another. It is tx’d with tansgenerational family therapy, which is primarily concerned with helping an individual to differentiate themselves from the family.

Question 191

Is light therapy considered an effective tx?

Answer 191

YES.

Question 192

Light therapy carries a risk of activating patients with what dx?

Answer 192

It carries a risk of activating patients with bipolar disorder.

Question 193

What is the most characteristic primitive defense mechanism in OCD?

Answer 193

Undoing: an attempt to undo or somehow reverse an unacceptable thought, feeling , or action that already occurred by doing an opposite bx.

Ex: washing hands multiple times after having an “unclean” thought. By going back and undoing the past, the anxiety over a bx is avoided.

Question 194

A child in the preoperational stage bumps his knee against a desk and kicks the desk, accusing it of hurting him. What is this called?

Answer 194

Animism: the attribution of a soul to plants, inanimate objects, and natural phenomena. The child is egocentric and assumes all of the world thinks as he/she does, including inanimate objects.

Question 195

Most sxs of acute stress will dissipate within 1 month following a tragedy - what % of children will continue to have sxs after a month?

Answer 195

30%

Question 196

What is the general natural history of Tourette’s syndrome?

Answer 196

Peaks at age 12 and then improves

Question 197

Tourette’s resolves by age 18 in about what % of children?

Answer 197

50%

Question 198

Tourette’s syndrome occurs in about what percent of children?

Answer 198

0.5%

Question 199

Tourette’s syndrome affects males more than females by a ratio of?

Answer 199

4:1

Question 200

What mood stabilizer slows cardiac conduction and should be avoided in patients with high-grade atrioventricular block and sinus syndrome?

Answer 200

Carbamazepine

Question 201

SIADH and hyponatremia can occur with which mood stabilizer?

Answer 201

Carbamazepine

Question 202

Norfluoxetine, the metabolite of fluoxetine has a half life of up to how many days?

Answer 202

16

Question 203

Fluoxetine is what percent protein bound?

Answer 203

94.5%

Question 204

Why is fluoxetine contradindication within 5 weeks of thioridazine use?

Answer 204

QTc prolongation

Question 205

Fluoxetine dosing for young children?

Answer 205

5 mg/day, 10 mg/day for older children

Question 206

Form of encouragement that is used to convey the therapist’s high level of confidence in a patient

Answer 206

Exhortation

Question 207

MOA for which mood stabilizer - inhibits glutamate and voltage-gated sodium channels

Answer 207

Lamotrigine

Question 208

What mood stabilizer increases GABA in the brain?

Answer 208

Depakote

Question 209

Which mood stabilizer exerts its effects through the inhibition of voltage-dependent sodium channels and presynaptic sodium channels

Answer 209

Carbamazepine

Question 210

How does the response to ECT vary between adolescents and adults?

Answer 210

Response appears to be similar

Question 211

Before ECT is used, what needs to happen?

Answer 211

2 child and adolescent psychiatrists who are not the primary caregivers for the adolescent should be consulted and should agree that ECT is indicated

Question 212

What is the most common genetic cause of ID?

Answer 212

Down Syndrome

(Fragile X is the most common genetic cause of ID in boys).

Question 213

Which gene is associated with developing psychosis after using cannabis?

Answer 213

AKT1

Question 214

Which gene has been reported to interact with stressful life events and childhood maltreatment in the development of depression?

Answer 214

BDNF

Question 215

Which gene may sensitive the developing brain to the pathogenic effect of CMV in utero, leading to schizophrenia in adulthood?

Answer 215

CTNNA3

Question 216

Which gene, that codes a co-chaperone of the glucocorticoid receptor, was reported to sensitize individuals to developing PTSD after exposure to childhood maltreatment?

Answer 216

FKBP5

Question 217

Which therapy approach to substance abuse in adolescents has the most empirical support?

Answer 217

Family therapy

Question 218

During the Oedipal phase of development, what is characteristic of play? (4)

Answer 218

1) child’s sense of place within the family
2) theories and feelings about babies and their origins
3) anatomical differences between the genders
4) curiosity and excitement associated with genital sensations
4) competition and rivalry

Question 219

A RTC is designed to evaluate the relationship between HTN and differing doses of velafaxine. A linear regression model is plotted with venlafaxine on the X-axis and BP on the Y-axis. R is calculated as 0.6. How should the coefficient of determination be interpreted?

Answer 219

36% of variance in BP can be explained by venlafaxine dose. (calculated by the square of the R value).

Variance in Y that can be explained by X.

Question 220

The TADS study indicated that what percent of depressed youth respond to initial tx w medication?

Answer 220

60%

CBT + meds = 71%

Question 221

A loaded gun at home confers a ?x higher risk in youth without any psychopathology?

Answer 221

30x

Question 222

Psychological factors contributing to suicide risk?

Answer 222

1) impulsive aggression
2) hopelessness
3) neuroticism
4) same-sex attraction

Question 223

patients who have first-degree relatives who have completed suicide have a ?x greater risk for suicide attempt?

Answer 223

4-6x

Question 224

Genetic factors that elevate risk of suicide? (3)

Answer 224

1) altered serotonergic function
2) altered adrenocortical function
3) blunted sleep-stimulated growth hormone secretion

Question 225

A white female can throw a ball overhand - this milestone is achieved by 50-90% of children by what age?

Answer 225

24 months

Question 226

What are the 5 core principles of MI?

Answer 226

1) express empathy
2) develop discrepancy
3) avoid argumentation
4) roll w resistance
5) support self-efficacy

Question 227

Those suffering from this condition have delayed motor development, jerky limb movements, epilepsy, face abnormalities, happy demeanor, and laugh frequently.

Answer 227

Angelman syndrome (maternal ch. 15)

Question 228

Approx what % of Americans have reported PTSD at some point in their lives?

Answer 228

8%

Question 229

Somatic symptom disorder is observed in what percentage of female first-degree relatives of patients with somatic symptom and related disorders?

Answer 229

10-20%

Question 230

Somatic symptom disorder - prevalence in females?

Answer 230

0.2-2%

Question 231

Somatic symptom disorder - prevalence in males?

Answer 231

< 0.2%

Question 232

What cell type forms the blood-brain barrier and aids neuronal migration during development?

Answer 232

Astrocytes: type of glial cells that are responsible for the development and framework of the neurons. They outnumber neurons 5:1 and contiguously tile the entire CNS.

Question 233

What three cellular elements of the brain microvasculature compose the blood-brain barrier?

Answer 233

1) endothelial cells
2) astrocyte end-feet
3) pericytes

Question 234

Aggression in a 5 y/o with autism - only medication approved for this age?

Answer 234

Risperidone

abilify is approved for 6+

Question 235

What condition is considered high risk for associated hearing defects?

Answer 235

Persistent fetal circulation

Question 236

When is a PTSD dx considered “with delayed expression”?

Answer 236

when PTSD criteria is not met until at least 6 months after the event

Question 237

What is the primary reason to decrease psychotropic medication doses in children with liver and kidney disease?

Answer 237

Decreased albumin binding: most psychotropic medications are highly protein bound (with the exception of lithium, methylphenidate, venlafaxine, depakote, gabapentin, and topiramate)

Question 238

Which medications are NOT highly protein bound? (6)

Answer 238

lithium, methylphenidate, venlafaxine, depakote, gabapentin, and topiramate

Question 239

hepatic diseases impact drug distribution through what three ways?

Answer 239

1) changes in blood flow
2) protein binding
3) volume of distribution

Question 240

Uridine glucuronosyltransferase enxymes play a minor role in drug metabolism with the exception of what three medications?

Answer 240

Lamotrigine, morphine, and lorazepam

Question 241

Why do extended release medications have fewer side effects?

Answer 241

Due to more gradual increases in the plasma concentration

Question 242

Common side effects of depakote? (5)

Answer 242

1) alopecia
2) rash
3) GI
4) neurological
5) ophthalmological

Question 243

Absolute contraindications for depakote?

Answer 243

1) hepatic disease
2) known urea cycle disorders
3) pregnancy
4) PCOS in females of child bearing age

Question 244

Does depakote have FDA approval for mania in adolescents?

Answer 244

No, only approved for seizure disorder

Question 245

As many as what percent of boys between ages 8-12 may have transient tics?

Answer 245

15%

Question 246

A 13 y/o F has been dx’d w MDD, single, moderate. TX?

Answer 246

Prozac (8+)

Escitalopram // lexapro (12+)

Question 247

Which two medications are indicated for OCD in children and adolescents?

Answer 247

Sertraline (6+)

Fluvoxamine (8+)

Question 248

6F w OCD, tx?

Answer 248

Sertraline (6+)

When she turns 8… Fluvoxamine (8+)

Question 249

Form of non-associative learning whereby repetitive stimuli elicit weakening behavioral responses if the stimuli do not reinforce or punish the bx

Answer 249

Habituation

Question 250

Form of non-associative learning whereby repetitive stimuli elicit increasingly powerful responses.

Answer 250

Sensitization

Question 251

Puberty occurs how much earlier in females than males?

Answer 251

1.5 years

Question 252

Puberty in females unfolds in what order? (3)

Answer 252

1) breast bud development
2) pubic hair growth
3) menache

Question 253

Clozapine is a pregnancy class B drug - what does this mean

Answer 253

It has not been shown to cause birth defects

Question 254

Lithium: what percent of the dose is excreted unchanged in urine?

Answer 254

90-98%

Question 255

Lithium: in young patients with normal renal function, the volume of distribution is what percent greater in adolescents that for adults?

Answer 255

20%

Question 256

Clozapine - when can drug-induced fever and tachycardia occur?

Answer 256

In the first few days of tx

Question 257

Seizure risk with clozapine tx - what percent of patients on doses > 600 mg/day will have seizures?

Answer 257

4-6%

Question 258

Agranulocytosis occurs mostly when with clozapine?

Answer 258

first 6 months of tx

Question 259

Agranulocytosis is more common in what groups (3)?

Answer 259

1) Ashkenazi Jewish
2) advanced age
3) women

Question 260

Is TD associated with clozapine?

Answer 260

No, the prevalence is low and the severity is relatively mild, with no or mild self-reported discomfort. Can be used as tx/reduce sx if patient is switched to clozapine from another antipsychotic

Question 261

“the extent to which a theory, result, conclusion, or test/measurement is credible and corresponds accurately to the population of interest” describes what statistical term?

Answer 261

Validity

Question 262

The test measured what it was supposed to measure in the initial population

Answer 262

Internal validity

Question 263

The results can be generalized beyond the immediate study to other populations

Answer 263

External validity

Question 264

Determines if a test will measure the problem in question

Answer 264

Construct validity

Question 265

Defined as the overall consistency or reproducibility of a measure

Answer 265

Reliability

Question 266

A test can be _____ without being ____ but a test cannot be ____ unless it is _____

Answer 266

A test can be reliable without being valid but a test cannot be valid unless it is reliable

Question 267

The parents of a student request an evaluation for a 504 plan but then disagree with the school’s findings and want a second opinion. Who pays for the second opinion?

Answer 267

Under section 504, the school has few obligations for second opinions and would not have to pay for any second opinion that the parents might request.

Were it an IEP the school would be required to pay for an IEE.

Question 268

You see a patient in the hospital with conversion disorder. Tx? (2)

Answer 268

1) Reassurance (emphasize to the family that her sxs are involuntary)
2) Reasonable rehabilitation

Confrontation about the sxs is contraindicated. Psychotherapy might be useful but may also be contraindicated if the patient is resistant. Meds could be suggested later for anxiety or depressive sxs.

Question 269

Conversion disorder - duration of sxs?

Answer 269

Usually remits spontaneously within 2 wks in hospitalized patients and it is unlikely to persist more than a year

Question 270

WISC can measure intelligence - age range?

Answer 270

6-16

Question 271

What test assesses academic achievement by testing reading, writing, math, and oral language?

Answer 271

WIAT-II

Question 272

The WIAT-II test assesses academic achievement by testing reading, writing, math, and oral language. Age range?

Answer 272

4-85

Question 273

What test can be paired with the WISC to measure both intelligence and academic achievement to look for any discrepancies?

Answer 273

WIAT-II: assesses academic achievement by testing reading, writing, math, and oral language

Question 274

What is the half life of guanfacine in children?

Answer 274

12-14 hours

Question 275

Guanfacine is typically dosed how many times her day?

Answer 275

2-3 times (half life is 12-14 hours)

Question 276

Half life of clonidine?

Answer 276

8-12 hours

Question 277

Clonidine is dosed how many times per day?

Answer 277

3-4 (half life is 8-12 hours)

Question 278

How long do the behavioral effects of clonidine last?

Answer 278

3-6 hours

Question 279

Hypotension and sedation is worse in clonidine or guanfacine?

Answer 279

Clonidine

Question 280

Ipecac causes cardiac problems through what mechanism?

Answer 280

Damaging myocardial muscle cells. A toxic component of ipecac (emetine) accumulates in the myocardium.

Sxs of ipecac toxicity include chest pain, dyspnea, hypotension, supraventricular tachycardia, atrial premature contractions, flattened or inverted T-waves, prolonged QT and PR intervals, ventricular tachycardia, cardiac failure, pericardial effusion, pulmonary congestion, and cardiac arrest.

Question 281

Side effects of ipecac? (2)

Answer 281

Cardiomyopathy and elevated liver enzymes

Question 282

THe vanderbilt screens for what three disorders?

Answer 282

ADHD, conduct disorder, and ODD

Question 283

The SNAP-IV rating scale screens for what?

Answer 283

ADHD and ODD

Question 284

The SNAP-IV rating scale screens for ADHD and ODD in what age range?

Answer 284

6-18

Question 285

The Attention Deficit Disorders Evaluation Scale (ADDES-3) screens for ADHD - age range?

Answer 285

4-18

Question 286

The genetic syndrome appears to become more pronounced with successive generations. A classic ex is fragile X.

Answer 286

Anticipation

Question 287

Minuchin is the main proponent of what type of family therapy?

Answer 287

Structural

Question 288

Psychoeducational family therapy is associated with what two people?

Answer 288

1) Carol Anderson

2) William McFarlane

Question 289

Behavioral family therapy is associated with what two people?

Answer 289

1) Robert Liberman

2) Lawrence Weathers

Question 290

Narrative family therapy is associated with what two people?

Answer 290

1) Michael White

2) David Epston

Question 291

Systemic family therapy is associated with what two people?

Answer 291

1) Mara Selvini Palazolli

2) Luigi Boscolo

Question 292

What is the most important factor in group therapy related to positive therapeutic effects?

Answer 292

Cohesion - a sense that the group is working together toward a common goal

Question 293

In group therapy, the act of one member helping another, putting another person’s needs before one’s own, and learning that there is value in giving to others

Answer 293

Altruism

Question 294

Prader-Willi syndrome: patients have short stature w hypogonadism, hyperphagia, and obesity. The genetic abnormality in what percent of patients is a deletion at ch. 15?

Answer 294

70%

Question 295

Prader-Willi syndrome: hyper or hypo gonadism?

Answer 295

Hypogonadism

Question 296

The sensorimotor stage of child development occurs at which age, according to Piaget?

Answer 296

Birth through 18-24 months

Question 297

A child is able to jump up and down. This milestone is acheived by 50-90% of children by which age?

Answer 297

24 months

Question 298

What part of the brain is primarily responsible for visual and spatial recognition?

Answer 298

Parietal lobe

Question 299

The parietal lobes are key areas for what three things?

Answer 299

1) Sensory integration
2) Somatosensory function
3) Visual and spatial recognition

Question 300

The temporal lobes are the key areas for the brain for what two things?

Answer 300

1) Hearing

2) Naming

Question 301

The occipital lobe is the key area for what?

Answer 301

Visual functions

Question 302

The frontal lobe is the key area for what 5 things?

Answer 302

1) Executive function
2) Social conduct
3) Judgment
4) Insight
5) some motor function

Question 303

According to Minuchin, which family dynamics predict the development of “psychosomatic families”?

Answer 303

Enmeshment, rigidity, overprotectiveness, and the lack of conflict resolution.

Question 304

Most family therapies of what disorder have been developed based on the classical description of the “psychosomatic” family by Minuchin?

Answer 304

Eating disorder

Enmeshment, rigidity, overprotectiveness, and the lack of conflict resolution.

Question 305

A large retrospective cohort study indicated that children and young adults do or don’t have a higher risk of cardiovascular events?

Answer 305

DO NOT

Question 306

Atomoxetine - contraindications?

Answer 306

patients with a history of serious structural cardiac abnormalities, cardiomyopathy, arrhythmia, and other cardiac issues.

Question 307

Atomoxetine’s effect on HR and BP

Answer 307

Increases

Question 308

Atomoxetine increases HR and BP through what mechanism?

Answer 308

decreasing the reuptake of norepinephrine

Question 309

Guanfacine ER can cause AV block, bradycardia, hypotension, orthostasis, sinus node dysfunction, and syncope. Dose dependent?

Answer 309

YES

Question 310

Guanfacine ER can cause AV block, bradycardia, hypotension, orthostasis, sinus node dysfunction, and syncope. When are the side effects most common?

Answer 310

The first few weeks of treatment

Question 311

What is chronotherapy?

Answer 311

used in people with circadian rhythm sleep disorders. It involves intentionally delaying going to sleep by two to three hours on successive days until you are able to fall asleep at the desired bedtime. This can be difficult to do at home and is sometimes done in a hospital setting. After this, you must strictly enforce this sleep-wake schedule.

Question 312

Which form of child maltreatment confers the highest risk of the child eventually attempting suicide?

Answer 312

Sexual abuse confers the highest risk of a poor outcome for the child. The risk of SA is nearly 10x higher for sexually abused children compared to other types of abuse.

Question 313

The risk of SA is nearly ?x higher for sexually abused children compared to other types of abuse.

Answer 313

10x

Abuse by closer relatives also tends to carry a poorer prognosis.

Question 314

The cerebral hemisphere originate from which of the following developmental divisions of the CNS?

Answer 314

Telencephalon

Question 315

The 6 secondary divisions occur around what week of gestation?

Answer 315

5th

Question 316

According to Mahler, during what age range does hatching occur?

Answer 316

5-9 months

Question 317

Increased rates of persistent pulmonary HTN have been associated with SSRI use at which stage of pregnancy?

Answer 317

Late in pregnancy. The absolute risk was found to be low.

Question 318

What IPT focus area is focused on conflict in significant relationships?

Answer 318

Role dispute

Question 319

The study sample is most representative of the overall population when what time of sampling is used?

Answer 319

Random sampling

Question 320

samples may allow estimations of what in resulting statistics?

Answer 320

Error

Question 321

The “threshold of responsiveness” is a temperamental dimension according to Chess and Thomas - what does it mean?

Answer 321

Indicates the degree of environmental change that must occur to elicit a response from the child.

Question 322

A child is able to sleep with a TV on, in any position in bed, and at a wide range of temperatures. According to Chess and Thomas what is this referring to?

Answer 322

A high “threshold of responsiveness”

Question 323

16M w new-onset paranoid schizophrenia. What is the most characteristic primitive defense mechanism in psychosis?

Answer 323

Projection: attributing undesirable thoughts and feelings to others to avoid facing them or to reduce anxiety around them. In psychosis, individuals may attribute their own thoughts to hallucinations and perceive the hallucinations to be something separate from them, thus making this a form of projection.

Question 324

The most frequently studied genes implicated in the development of substance use disorders, including alcohol use disorder, encode which substances? (2)

Answer 324

1) alcohol dehydrogenase

2) aldehyde dehydrogenase

Question 325

Alcohol dehydrogenase metabolizes what?

Answer 325

ETHANOL TO ACETALDEHYDE

Question 326

Aldehyde dehydrogenase metabolizes what?

Answer 326

Acetaldehyde to acetate

Question 327

Alcohol dehydrogenase and aldehyde dehydrogenase are the most frequently studied genes implicated in the development of substance use disorders. This work has confirmed the role of these genes in what pathway?

Answer 327

Dopamine pathway

Question 328

What converst L-DOPA to dopamine?

Answer 328

DOPA decarboxylase

Question 329

Gain-of-function polymorphisms of the SLC6A4 promoter have been linked to what disorder?

Answer 329

OCD

also alcohol consumption

Question 330

What is the rate limiting step in serotonin synthesis?

Answer 330

Tryptophan hydroxylase

Question 331

Bx that serves a purpose for the individual and is ongoing

Answer 331

Functional bx

Question 332

The MOA for the addictive component of cannabis?

Answer 332

Releases dopamine in the mesolimbic system

Question 333

Cannabis triggers the release of dopamine in what system which causes addiction?

Answer 333

The mesolimbic

Question 334

What is the MOA of cannabis?

Answer 334

Activation of endogenous cannabinoid receptors in the brain.

Question 335

What substances are partial 5HT receptor agonists?

Answer 335

LSD and other hallucinogens

Question 336

4M is noted by his parents to have lost his ability to speak. He was previously healthy and had average language skills for his age. An EEG revealed electrographic seizures, but he has not been noted to have seizures clinically. Dx?

Answer 336

Landau-Kleffner syndrome: infantile acquired aphasia, acquired epileptic ahasia, or aphasia with convulsive d/o.

Question 337

Landau-Kleffner syndrome: 4M is noted by his parents to have lost his ability to speak. He was previously healthy and had average language skills for his age. An EEG revealed electrographic seizures, but he has not been noted to have seizures clinically. Age range of children affected?

Answer 337

3-7 years

Question 338

Landau-Kleffner syndrome: 4M is noted by his parents to have lost his ability to speak. He was previously healthy and had average language skills for his age. An EEG revealed electrographic seizures, but he has not been noted to have seizures clinically. Affects what areas of the brain?

Answer 338

Broca’s and Wernicke’s

Question 339

Landau-Kleffner syndrome: 4M is noted by his parents to have lost his ability to speak. He was previously healthy and had average language skills for his age. An EEG revealed electrographic seizures, but he has not been noted to have seizures clinically. Can be difficult to dx and misdx’d as what?

Answer 339

Autism.

Question 340

Skipping is first seen at what age?

Answer 340

5 y/o

Question 341

Being able to draw a circle - age?

Answer 341

3 y/o

Question 342

Correctly naming 4 colors - age?

Answer 342

5 y/o

Question 343

MR spectroscopy is used to evaluate which parameter?

Answer 343

Biochemical concentrations of brain metabolites.

Several different metabolites can be measured to differentiate between tumor types, including amino acids, lipids, lactate, alanine, N-acetyl aspartate…

Question 344

MR spectroscopy is used to determine the biochemical concentrations of brain metabolites. It is commonly used to evaluate what?

Answer 344

Brain tumors

Question 345

Persistent depressive disorder: depressed or irritable mood + 2 of the following: (6)

Answer 345

1) poor appetite or overeating
2) insomnia or hypersomnia
3) low energy or fatigue
4) low self-esteem
5) poor concentration or difficulty making decisions
6) feelings of helplessness

Question 346

Persistent depressive disorder: depressed or irritable mood + 2 mood sxs for how long?

Answer 346

At least 1 year

Question 347

Test that reveals underlying motives, concerns, and social worldview through the stories a patient makes up about ambiguous pictures of people

Answer 347

Thematic Apperception Test (TAT) - projective psychological test

Question 348

Test that measures a person’s emotional functioning

Answer 348

Rorschach test (“inkblot”)

Question 349

Tests cognitive ability and intelligence

Answer 349

Stanford-Binet Intelligence Scale

Question 350

What percent of offspring are affected when one parent has a h/o prolonged noctural enuresis?

Answer 350

50%

Question 351

What percent of offspring are affected when both parent have a h/o prolonged noctural enuresis?

Answer 351

75%

Question 352

Electrolytes in laxative abuse - sodium?

Answer 352

Increased or normal

Question 353

Electrolytes in laxative abuse - K+?

Answer 353

Decreased

Question 354

Electrolytes in laxative abuse - Cl-?

Answer 354

Increased or decreased

Question 355

Electrolytes in vomiting - sodium?

Answer 355

Increased, decreased, or normal

Question 356

Electrolytes in vomiting - K+?

Answer 356

decreased

Question 357

Electrolytes in vomiting - CL-?

Answer 357

Decreased

Question 358

Electrolytes in vomiting - bicarbonate?

Answer 358

Increased

Question 359

pH in vomiting?

Answer 359

Increased

Question 360

pH when using diuretics?

Answer 360

Increased

Question 361

Sodium when using diuretics?

Answer 361

Decreased or normal

Question 362

K+ when using diuretics?

Answer 362

Decreased

Question 363

Chloride when using diuretics?

Answer 363

Decreased

Question 364

Bicarbonate when using diuretics?

Answer 364

Increased

Question 365

What percentage of preschoolers with poor peer relationships and inadequate problem-solving patterns predictive of impulsive aggression have a h/o physical abuse?

Answer 365

20-25%

Planned aggression starts approx 2 years later and is driven by aggressive role models and a positive valence of aggression rather than the physical abuse.

Question 366

A family complains that their 15 y/o daughter refuses to listen when they ask her to do her homework. During a family therapy session, the therapist asks the parents to pretend to ask their daughter to do her work and for the daughter to pretend to refuse. What technique is being used here?

Answer 366

Paradoxical intervention. The idea is that patients can sometimes believe that such conflicts are out of their control. Having the patients purposely create the situation is voluntary and brings the sx on in a controlled way. This can help patients work through the sx during the sessions and also perhaps come to see it as under voluntary control.

Question 367

A child can walk backwards. This milestone is scheived by 50-90% of children by which age?

Answer 367

16-18 months

Question 368

Mahler’s separation-individuation is subdivided into 3 phases - what are they?

Answer 368

1) hatching
2) practicing
3) rapproachement

Question 369

What are the comparative rate of youth incarceration for children raised in intact families as compared to stepmother families?

Answer 369

1:4

Question 370

Prenatal exposure to what influences human sexual orientation?

Answer 370

Androgenic hormones

Question 371

In exposure with response prevention, immediately following an exposure, what response is being prevented?

Answer 371

Compulsive bxs.

Question 372

What does response prevention mean?

Answer 372

Refraining from compulsions, avoidance, or escape bxs.

The response most commonly prevented is a compulsion that acutely reduces anxiety but perpetuates the disorder by making the sufferer believe that the compulsion is needed to reduce anxiety or some feared consequence of not performing the compulsion by addressing the anxiety or anxious thoughts.

Question 373

What form of therapy specifically states that the goal of the therapist is to initiate what happens during therapy and take direct responsibility for influencing people?

Answer 373

Strategic family therapy

Question 374

A specific form of brief psychotherapy that focuses on providing solutions to practical problems, such as conduct problems and drug use.

Answer 374

Strategic family therapy

Question 375

This type of therapy was founded by Jay Haley and encourages the therapist to take an active role, initiate what will occur during therapy, and take direct responsibility for influencing people.

Answer 375

Strategic family therapy

Question 376

A 4 y/o child presents with diffuse weakness, cerebellar ataxia, partial ophthalmoplegia. Vitamin deficiency?

Answer 376

Vit E.

Question 377

What is the only common vitamin that causes spinocerebellar degeneration? Patients may have myelopathy w posterior column lesions, a positive Babinski sign, and loss of vibration and joint position sense.

Answer 377

Vit E.

Question 378

It takes approx 15-20 years for adults to deplete vit Ed stores, but only 2-3 years for this to occur in children. Deficiency states may be seen in what type of disorders?

Answer 378

Fat malabsorption

Ex: Bassen-kornzweig syndrome, Ataxia with isolated vit E deficiency (AVED)

Question 379

Babies with this vitamin deficiency may have increased intracranial pressure with lethargy, night blindness, and “bitot spots” (white foamy lesions) on the conjunctiva.

Answer 379

Vit A

Question 380

Children with this vit deficiency develop irritability, an exaggerated startle response, and seizures refractory to conventional anticonvulsants. They develop normally one the deficiency is treated.

Answer 380

B6 (pyridoxine)

Question 381

Vitamin B6 (pyridoxine) may be dietary, congenital, or drug-induced - what three medications?

Answer 381

1) isoniazid
2) hydralazine
3) penicillamine

Question 382

This vitamin deficiency manifests as proximal weakness, which may include neck muscles. Patients may have waddling gait. EMG demonstrates short-duration, low-amplitutde, polyphasic motor unit potentials w/o spontaneous activities.

Answer 382

Vit D

Question 383

Vit D deficiency made result from?

Answer 383

1) hyperparathyroidism
2) hypophosphatemia
3) chronic renal failure
4) use of certain anticonvulsants
5) malabsorption
6) low dietary intake
7) lack of sun exposure

Question 384

Lab tests reveal elevated alkaline phosphatase level and a compensatory increase in parathyroid hormone. Vit deficiency?

Answer 384

Vit D

Question 385

Vitamin deficiency: diarrhea, dermatitis, and dementia. Patient may also exhibit spasticity, positive Babinski, gegenhalten, and startle myoclonus. Results from corn as the sole carbohydrate source.

Answer 385

Pellagra: nicotinic acid (niacin) deficiency

Question 386

This vit deficiency may also be associated with alcohol abuse and is suspected when tx with thiamine does not improve cognition.

Answer 386

Pellagra: nicotinic acid (niacin) deficiency

Question 387

What has been shown in one well-designed study to lower the risk of progressing from prodromal psychotic sxs to full blown schizophrenia.

Answer 387

Omega-3 fatty acids

Question 388

An examiner is playing toys with a child and hides the toy. The child begins to look for the toy. Stage?

Answer 388

Sensorimotor.

One of the main accomplishments of this stage was achieving object permanence.

Question 389

Around what age does object permanence occur?

Answer 389

8 months (sensorimotor stage)

Question 390

In a stuporous state, the patient would arouse to response purposefully to what?

Answer 390

Vigorous external stimulation

Question 391

Locked-in syndrome occurs when a focal injury occurs where? A conscious patient is unable to move muscles, but can voluntarily blink and make vertical eye movements.

Answer 391

To the base of the pons.

Question 392

In this state the patient has normal sleep-wake cycles and is arousable but has no awareness or apparent cognitive function. It may occur as a transition between coma and recovery, or between coma and brain death or death.

Answer 392

Persistent vegetative state

Question 393

This occurs when the patient is able to follow with his/her eyes but does not initiate other movements or obey commands

Answer 393

Akinetic mutism

Question 394

A child is able to run but falls occasionally. This milestone is achieved by 50-90% of children by what age?

Answer 394

18 months

Question 395

What percentage of children with oppositional defiant disorder will develop conduct disorder?

Answer 395

30%

Question 396

A lesion of which structure will result in prosopagnosia?

Answer 396

Fusiform gyrus: right and/or left, is associated with face recognition.

The “fusiform face area” is located on the ventral stream on the ventral surface of the temporal lobe, on the lateral side of the fusiform gyrus.

Question 397

Destruction to the inferior parietal lobule of the dominant hemisphere results in what syndrome?

Answer 397

Gerstmann’s syndrome: right-t0-left confusion, finger agnosia, dysgraphia and dyslexia, dyscalculia, contralateral hemianopia, or lower quadrantanopia.

Question 398

Rudimentary gender identity is usually formed around what age?

Answer 398

3

Question 399

Medication approved for ODD?

Answer 399

There is no FDA-approved medication for ODD.

Question 400

In young children (prior to adolescence), is ODD more prevalent in males or females?

Answer 400

Males (1.4:1)

Question 401

In adolescents, is ODD more prevalent in males or females?

Answer 401

Same

Question 402

A pediatric patient is scheduled for follow up care, but has a large outstanding bill. What do you do?

Answer 402

Administer care as needed.

must given reasonable written notice to allow the location of an alternative source of care

Question 403

Fetal alcohol syndrome occurs at a rate of what % per live birth?

Answer 403

1%

Question 404

CNS abnormalities in FAS?

Answer 404

1) abnl brain size and shape
2) smaller cerebellar and ventricular size
3) agenesis of the corpus callosum

Question 405

A broad type of sleep disorders involving difficulty falling or remaining asleep, which can lead to excessive sleepiness during the day due to the reduced quantity, quality or timing of sleep.

Answer 405

Dyssomnia

Question 406

Sleepwalking disorder is what type of disorder?

Answer 406

Parasomnia

Question 407

Sleep-wake disorders include what 10 disorders?

Answer 407

1) insomnia
2) hypersomnolence
3) narcolepsy
4) breathing-related sleep
5) circadian rhythm
6) non-REM sleep arousal
7) REM sleep bx
8) restless legs
9) nightmare
10) substance/medication induced

Question 408

ODD comorbidity with ADHD - what percent?

Answer 408

50%

Question 409

ODD - do most kids with ODD have insight that their bx is problematic?

Answer 409

No

Question 410

9F who is otherwise healthy, is crying after skinning her knee on the playground. She then has sudden onset right-sided face, arm, hand, and leg weakness and numbness, which resolves over the following 25 minutes. Angiogram = stenosis of the supraglenoid ICA and MCA with the development of collateral circulation. Dx?

Answer 410

Moyamoya disease: consists of progressive non-atherosclerotic b/l stenoses of the distal internal carotid arteries and trunks of the anterior and middle cerebral arteries.

Collaterals develop at the base of the brain w a characteristic “puff of smoke” appearance on angiography.

Question 411

This disease is most common in Japanese girls and may have autosomal recessive inheritance. Collaterals develop at the base of the brain w a characteristic “puff of smoke” appearance on angiography. Dx?

Answer 411

Moyamoya disease: consists of progressive non-atherosclerotic b/l stenoses of the distal internal carotid arteries and trunks of the anterior and middle cerebral arteries.

9F who is otherwise healthy, is crying after skinning her knee on the playground. She then has sudden onset right-sided face, arm, hand, and leg weakness and numbness, which resolves over the following 25 minutes.

Question 412

17 minor who has enlisted in the Army arrives at the ED in police custody. He is suspected of ingesting ilicit medications to avoid arrest. The police request a NG aspirate for evidence, the patient refuses. What do you do?

Answer 412

Honor the patient’s wishes and do not proceed with care. The patient is likely emancipated from his parents since he joined the army. He is therefore authorized to consent to medical care.

Question 413

Individuals with ASD have weak central coherence - what does this mean?

Answer 413

Poorly integrate information into meaningful wholes

Question 414

Individuals with ASD typically have deficits in the theory of mind tasks - true or false?

Answer 414

True

Question 415

MRI brain of a patient with ASD shows? (2)

Answer 415

1) larger brains

2) aberrations in white matter tract development

Question 416

Rates of EEG abnormalities and seizures in patients with ASD?

Answer 416

20-25%

Question 417

13F w anxiety. She has a h/o seizures since age 2. She is overly friendly and overly excitable. She has poor language skills and was dx’d w moderate ID? What genetic marker is responsible for this condition?

Answer 417

15q11-13 maternal deletion. Angelman syndrome. “Happy puppet syndrome.”

Question 418

The firing of dopamine-releasing neurons, with cell bodies in the ? and axon terminals in the nucleus accumbens, marks the importance or salience of a reward and signals that a rewarding event is about to occur.

Answer 418

VTA

Question 419

The firing of dopamine-releasing neurons, with cell bodies in the VTA and axon terminals in the ?, marks the importance or salience of a reward and signals that a rewarding event is about to occur.

Answer 419

nucleus accumbens

Question 420

Endogenous opiod neuropeptides are controlling links of the ? and ?.

Answer 420

1) Nucleus accumbens

2) Amygdala

Question 421

A psychiatrist is designing a study comparing the reflexes of subjects before and after they are exposed to dextroamphetamine. The subjects will be asked to tap a screen when a shape appears on the screen, and their reaction time will be recorded. What statistical test will provide the best comparison of the results?

Answer 421

Paired t-test. Best for comparing whether the averages of 2 groups of data are statistically different from each other, specifically when the data are linked together in some way (ex: comparing tx effects in the same group of people before and after exposure to a drug).

In this case, the effects are measured from the same people, so the data are considered linked together.

Question 422

Statistical measure of how close a series of data comes to a calculated regression line. It tells how well data fit along a straight line or curve and is often used for dose-response studies.

Answer 422

R^2

Question 423

R^2 is a statistical measure of how close a series of data comes to a calculated regression line. It tells how well data fit along a straight line or curve and is often used for what type of studies.

Answer 423

dose-response

Question 424

Statistical method used to compare the means of multiple sets of data at once and determine whether they are likely to be different due to chance. This would be useful when comparing the means of multiple groups exposed to multiple different doses.

Answer 424

ANOVA

Question 425

This statistical test is best used for comparing categorical variables - this is usually something like a yes/no question, such as whether a subject is depressed or not.

Answer 425

Chi-squared test

Question 426

Infantile anorexia interferes with which important developmental event?

Answer 426

Somatopsychological differentiation: the ability to differentiate sensations in the body.

Question 427

This disorder usually occurs between 6 months and 3 years and can vary between meals and feedrs. The infant’s feeding is directed by his/her emotional needs instead of physiological sensations of hunger and satiety. He/she fails to develop somatopsychological differentiation, which is the ability to differentiate sensations in the body.

Answer 427

Infantile anorexia

Question 428

Has a pincer grasp - age?

Answer 428

9 months

Question 429

Put hands together, has a social smile, recognizes parents, laughs - age?

Answer 429

3 months

Question 430

Rolls from tummy to back - age?

Answer 430

4 months

Question 431

Sits unsupported, rolls in both directions, begins to crawl, reaches and passes objects from one hand to another, babbles with strings of vowel and consonant sounds - age?

Answer 431

6 months

Question 432

May develop stranger anxiety, stands unassisted, has pincer grasp - age?

Answer 432

9 months

Question 433

walks, says “mama” and “dada” -age?

Answer 433

12 months

Question 434

Runs, stacks 2 cubes, removes clothing, has a 6-word vocabulary - age?

Answer 434

15 months

Question 435

The most effective tx for bullimia overall is what?

Answer 435

CBT

Question 436

What medication is FDA-approved for bullimia?

Answer 436

Fluoxetine (an SSRI alone is not conisdered adequate tx for bullimia - need CBT)

Question 437

For MI, what does OARS stand for?

Answer 437

Open-ended questions
Affirmations
Reflective listening
Summaries

Question 438

The neurotransmitter produced in the tuberomammillary nucleus is responsible for what systemic reaction?

Answer 438

Itching - histamine!

Question 439

Sweating is mediated by what receptors?

Answer 439

Muscarinic Ach receptors (Ach is produced in the nucleus basalis of Meynert).

Question 440

Where is Ach produced?

Answer 440

Nucleus basalis of Meynert

Question 441

Bradycardia is mediated by what receptors?

Answer 441

Muscarinic Ach receptors (Ach is produced in the nucleus basalis of Meynert).

Question 442

Nausea is mediated by what neurotransmitter?

Answer 442

Serotonin, which is produced in the raphe nuclei

Question 443

Where is serotonin produced?

Answer 443

Raphe nuclei

Question 444

Arterial vasoconstriction is mediated by what neurotransmitter?

Answer 444

Norepinephrine, which is produced in the locus coeruleus

Question 445

Where is norepinephrine produced?

Answer 445

Locus coeruleus

Question 446

What factors are most predictive of an ultimate outcome in children with autism? (2)

Answer 446

1) Presence of speech by age 5

2) Severity of ID

Question 447

A child is referred for seizures, ID, developmental delay, and behavioral problems. + Fhx. If the patient’s skin was examined under a Wood’s lamp, which classic finding may be revealed?

Answer 447

Hypopigmented macules (ash leaf spots)

Up to 95% of patients with tuberous sclerosis complex have one of the following lesions: hypopigmented macules, angiofibroma, Shagreen patches, or brown fibrous plaque on forehead.

Question 448

A child is referred for seizures, ID, developmental delay, and behavioral problems. + Fhx. One of the following lesions: one of the following lesions: hypopigmented macules, angiofibroma, Shagreen patches, or brown fibrous plaque on forehead. Dx?

Answer 448

Tuberous sclerosis

Question 449

Most evidence-based therapies for adolescent substance use disorder? (2)

Answer 449

Family-based therapy

Motivational enhancement therapy/brief intervention

Question 450

A child presents for evaluation and is speaking in full sentences with mostly clear pronunciation. The parents report that the child has been riding his tricycle and feeding himself. The child is able to put his shoes on independently, using 10 blocks to build a tower, and copy a circle. The child alternates footsteps up and down the stairs and hops off the last step. Age?

Answer 450

36 months

Question 451

Child is learning to stand independently, can begin dressing, and may also be able to use single words - age?

Answer 451

12 months

Question 452

Child is walking more independently but still occasionally falls and can build towers 3 blocks high. The child is able to understand basic commands. Age?

Answer 452

18 months

Question 453

Child has begun to run and can kick a ball. These children are learning to go up and down stairs independently. Towers composed of about 7 blocks can bow be built. There is also the “no” phase. Children at this age can start pulling on a shirt or pulling up pants. Age?

Answer 453

2 y/o

Question 454

Child is able to skip, draw a person, completely dress and undress, and speak with nearly full fluency. Age?

Answer 454

5 year old

Question 455

EPS occurs in what percent of pediatric patients on first-generation antipsychotics?

Answer 455

75%

Question 456

What is the opposite of enmeshment?

Answer 456

Disengagement

Question 457

In structural family therapy, the therapist goes through 3 techniques - joining, diagnosing, and restructuring. What occurs during restructuring?

Answer 457

The therapist attempts to promote new patterns within the family that will help it to be more flexible and functional.

Therapist promotes growth and encouragement in individuals for the building of family support.

Question 458

Individuals w ASD have decreased formation of what type of cells in the cerebellum?

Answer 458

Purkinje cells

Question 459

Individuals w ASD have decreased formation of Purkinje cells in what part of the brain?

Answer 459

Cerebellum

Question 460

Brain size in patients with ASD?

Answer 460

Increased overall brain size

Question 461

Patients with ASD experience accelerated growth of what during infancy?

Answer 461

the head

Question 462

Abnormalities in the synthesis of what neurotransmitter is seen in patients with ASD?

Answer 462

Serotonin

Question 463

According to Chess and Thomas - what are the three types of children?

Answer 463

Difficult, easy, slow-to-warm up

Question 464

What bx most commonly precedes an adolescent SA?

Answer 464

Confessing suicidal thoughts to friends

Question 465

is there research to indicate that inpatient hospitalization reduces suicidality?

Answer 465

No

Question 466

The increase of SSRI rxs correlated with a significant increase or decrease in completed suicides in teens?

Answer 466

Decreased

Question 467

Most individuals with the DSM dx of “profound ID” have what feature?

Answer 467

Most people have an identified neurological condition that accounts for their ID

Question 468

Which influential child therapist stressed that child development was a continuous cumulative process rather than defined stages, initiating the concept of “developmental lines” ?

Answer 468

Anna Freud
(interaction between internal and environmental influences)

Question 469

This theorist postulated that there are several developmental lines that a child moves along (development between infant and mother, infant and his/her own body).

Answer 469

Anna Freud

Question 470

How often does the FDA recommend following up with a youth started on an antidepressant?

Answer 470

Every week for the first month and then every other week thereafter

Question 471

When ending with a patient, written notice should be given, preferably by certified mail, with a brief explanation for termination of the relationship and an agreement to continue to provide tx and access to services for a reasonable length of time - how much time?

Answer 471

30 days

Question 472

What percentage of patients with ID fit the DSM dx for severe ID?

Answer 472

3-4%

Question 473

What is the most common psychiatric dx in children?

Answer 473

ADHD

Question 474

Prevalence of ADHD dx?

Answer 474

9.4% of children ages 2-17

Question 475

What is the leading inherited cause of ID?

Answer 475

Fragile X

Question 476

What structure is responsible for temperature control?

Answer 476

Hypothalamus

Question 477

What structure is responsible for the physiologic regulation of much of the body - sleep, hydration, and temp.

Answer 477

Hypothalamus

Question 478

What structure in the body controls arousal, sleep-wake cycles, respiration, swallowing… communication been different parts of the brain. Locked in syndrome!

Answer 478

Pons

Question 479

Eyes in opioid intoxication?

Answer 479

Miosis

Question 480

Eyes in opioid w/d?

Answer 480

Mydriasis

Question 481

Standards that apply to > 95% of the time and are based on rigorous empirical evidence and/or overwhelming clinical consensus

Answer 481

Minimal standards

Question 482

What terms means “apply up to 75% of the time and should usually be considered, but there are significant exceptions to their universal application”

Answer 482

Clinical guidelines

Question 483

What establishes a recommendation of “options”?

Answer 483

They are acceptable but not required and may have insufficient empirical evidence

Question 484

Why should atypical neuroleptics (antipsychotics) be tapered slowly? (2)

Answer 484

1) allow for adjustment to lowered dose

2) prevent w/d akathsia

Question 485

When does akathisia typically present?

Answer 485

After a few weeks of tx

Question 486

When does dystonia typically present?

Answer 486

Within the first few days of tx

Question 487

when does TD typically present?

Answer 487

After years of tx

Question 488

A young child presents with a dramatic increase in aggression and seems confused. He eventually has a seizure. Imaging shows diffuse changes in one of the temporal lobes. Cause?

Answer 488

Herpes encephalitis

HIV tends to be more non-specific and Tuberous sclerosis would usually show district lesions

Question 489

Sleep terror disorder usually begins in children in what age range?

Answer 489

4-12 years

Question 490

How old must you be to be dx’d with ASPD

Answer 490

18 years old

Question 491

14M has intense expressions of emotion and chronic feelings of emptiness and anger towards himself for being “a loser” with no purpose in life. The therapist notes that during sessions, she tends to become angry with the patient and even criticize him for his inability to set goals. Which process is occurring?

Answer 491

Projective identification. When a patient projects unwanted or intolerable aspects of himself/herself onto another person, and when he/she induces the other person to take on those characteristics and play the role the patient has assigned to him/her.

In this case, the child has projected feelings of “being a loser” onto the therapist and managed to have her play the role of a critic.

Question 492

This type of therapy is designed to address practical problems that children and adolescents face. It could be used to reduce conduct problems, ODD issues, drug use, or other issues that need more immediate help.

Answer 492

Brief strategic family therapy

Question 493

What disorder is most commonly seen with body dysmorphic disorder?

Answer 493

MDD

social phobia and OCD are often seen with BDD, but MDD is most common

Question 494

Approx 65% of patients with GAD have a comorbid psychiatric disorder. What is the most common?

Answer 494

MDD

Question 495

What percent of patients with OCD also have a comorbid anxiety disorder?

Answer 495

75%

Question 496

What percent of patients with OCD also have a mood disorder?

Answer 496

60% (with MDD being the most common)

Question 497

What percent of patients with OCD also have OCPD?

Answer 497

20-30%

Question 498

At what age is the first comprehensive eye exam recommended?

Answer 498

6 months (between 6 months and 5 years) (infants can accommodate fully and visual acuity is nearly that of an adult.

Question 499

What is the approx ratio of boys to girls in pediatric OCD?

Answer 499

3:2. Boys are approx 50% more likely to be dx’d with OCD than girls and are likely to be dx’d earlier.

Question 500

age? 2 word sentences, 50 word vocab, follows 2 step commands, 50% intelligible

Answer 500

2

Question 501

Age? three word sentences, says name and gender. 75% intelligible

Answer 501

3

Question 502

Age? Names colors, understands adjectives, adult like grammar. 100% intelligible

Answer 502

4

Question 503

Age? Counts, understands opposites, talks about past, present, and imaginary events. 100% intelligible

Answer 503

5

Question 504

Medications approved for bipolar depression in youth?

Answer 504

Seroquel Er
Latuda
Olanzapine/fluoxetine

Question 505

12M w schizophrenia, unusual looking face and has been noted to have episodes of hypocalcemia. He sees a cardiologist for hear defects. Which chr. was likely affected?

Answer 505

22q11.2 deletion syndrome //velocardiofacial syndrome // DiGeorge syndrome (CATCH 22)
Cardiac abnormalities, abnl face, thymic aplasia, cleft palate, hypocalcemia, hypothyroidism

Question 506

Patients with 22q11.2 deletion syndrome //velocardiofacial syndrome // DiGeorge syndrome have a ?x increased chance of developing schizophrenia.

Answer 506

20x

Question 507

PTSD has been associated with alterations in the size of what?

Answer 507

hippocampus (reduced size). Although it is not clear if it is from the trauma or pre-dates the trauma

Question 508

Children with behavioral inhibition are most likely to develop what disorder?

Answer 508

Social anxiety disorder.

Question 509

What is one of the largest risk factors for developing social anxiety disorder?

Answer 509

Behavioral inhibition

Question 510

Compared to adults, weight gain in kids from second generation antipsychotics typically…

Answer 510

is greater

Question 511

Fully structured diagnostic instrument that assesses 34 common psychiatric diagnoses of children and adolescents. It cannot be used to establish a dx for conditions that require the interpretation of specialized test results or substitute for information derived from astute clinical observations. For these reasons, it does not cover diagnoses such as pervasive developmental disorders, speech and language disorders, or the organic brain syndromes.

Answer 511

Diagnostic Interview Schedule for Children (DISC)

Question 512

Consider alt therapy with QTC is > ?

Answer 512

460 msec

Question 513

The Individuals with Disabilities education Act (IDEA) gives what guidelines about the content of an IEP?

Answer 513

It gives guidelines about what topics must be addressed but does not guide the approach to writing it.

Question 514

Mom doubled the DDAVP dose (for bed wetting). The kid has AMS, dizziness, and abdominal pain. What is he at risk for?

Answer 514

Water intoxication and hyponatremia.

Can also present with vomiting and depressed reflexes, hallucinations and seizures

Question 515

What case held that a parent or a guardian can commit a minor to a mental institution if a staff physician certifies the minor should be committed?

Answer 515

Parham v JR

Question 516

A child is placed in restraints on the inpatient unit after becoming very aggressive. How often must vitals be monitored?

Answer 516

Q15 minutes

Question 517

A child is undergoing therapy for self-injurious bx. The parents scolding the child when the self-injurious bx occurs and the undesirable bx decreases. In this scenario, scolding functions as which type of operant conditioning?

Answer 517

positive punishment (the addition of an undesirable stimulus to reduce a specific bx).

Question 518

Removal of an undesirable stimulus to increase a specific bx

Answer 518

negative reinforcement

Question 519

Removal of a desirable stimulus to decrease a specific bx

Answer 519

negative punishment

Question 520

Addition of a desirable stimulus to increase a specific bx

Answer 520

Positive reinforcement

Question 521

Punishment =

Answer 521

Reduce a specific bx

Question 522

Reinforcement =

Answer 522

Increase a specific bx

Question 523

During what stage of sleep do NMs occur?

Answer 523

REM (final 3rd of the night/early morning horus)

Question 524

Sleep terrors occur during what stage of sleep?

Answer 524

non-REM (first 3rd of the night). The child is usually not responsive and does not generally remember the episode later.

Question 525

Initial side effects of bupropion?

Answer 525

headaches, dizziness, dry mouth, anxiety, restlessness, anorexia, nausea, and insomnia

Question 526

Patients with conduct disorder may exhibit polymorphism in what gene?

Answer 526

MAO-A

Question 527

Patients with conduct disorder may exhibit what physiologic differences compared to the general population? (3)

Answer 527

1) lower resting heart rates
2) low skin conductance (electrical)
3) Increased testosterone

Question 528

Damage to the ventrolateral preoptic nucleus (VLPO or VLPN) may cause what?

Answer 528

Disturbed sleep-wake cycles

Question 529

Where is the ventrolateral preoptic nucleus (VLPO or VLPN) located?

Answer 529

Hypothalamus.

Damage = disruption to sleep-wake cycle

Question 530

TCA overdose - EKG shows?

Answer 530

QRS widening

Question 531

Ingestion of grapefruit juice increases clomipramine concentrationthrough inhibition of CYP?

Answer 531

3A4

Question 532

the half life of clomipramine is?

Answer 532

32 hours, but may increase at higher doses

Question 533

Clomipramine is FDA-approved for the tx of what in kids 10+

Answer 533

OCD

Question 534

Clomipramine is FDA-approved for the tx of OCD in what age group?

Answer 534

10 years +

Question 535

Serious side effects of clomipramine include? (7)

Answer 535

Seizures, arrhythmia, syncope, QTC and QRS prolongation, sudden death, hematological issues (neutropenia, agranulocytosis, thrombocytopenia) and jaundice

Question 536

A 14 month old child cries for 1 hour but is consoled when his mother picks him up from his crib. Which basic conflict describes this child?

Answer 536

trust v mistrust (birth to 18 months)

Question 537

What medication is occasionally used with severe/nightly sleepwalking for a few months?

Answer 537

Benzos

Question 538

At what age are most infants able to turn toward the sound of a voice?

Answer 538

3-4 months (hearing is the most sensitive of all senses at birth, depends on increasing neck strength)

Question 539

When is homeostatic sleep drive at its lowest?

Answer 539

When a person wakes up in the morning. It increases throughout the day and lessens once a person is asleep. Circadian sleep drive then takes over for the second half of the night.

Question 540

First degree relatives of a patient with ASPD have a ?x higher risk of being dx’d with ASPD.

Answer 540

5x

Question 541

Prevalence of ASPD is about ?% in males and ?% in females?

Answer 541

3% in males and 1% in females

Question 542

What percent of children with ADHD develop chronic tic disorder?

Answer 542

20%

Question 543

What percent of kids dx’d with chronic tics or Tourette’s syndrome have comorbid ADHD?

Answer 543

50%

Question 544

Desmopressin (DDAVP) results in what 2 things re: urine?

Answer 544

Decreased urine outpt and increased urine osmolality

Question 545

Desmopressin (DDAVP) - side effects?

Answer 545

headaches, nausea, flusing, and mild abd cramps

Question 546

Desmopressin (DDAVP) increases factor ? and what else?

Answer 546

Factor VIII and plasominogen activator in the blood.

Question 547

Desmopressin (DDAVP) - results in a ?% decrease in wet nights?

Answer 547

30-60%

Question 548

Desmopressin (DDAVP) - oral dosing may be titrated as tolerated to how many mg at bedtime?

Answer 548

0.6 mg

Question 549

16M involved in a MVA and sustained head trauma. He is now exhibiting a range of behavioral changes, and the psychiatrist is concerned about his executive functioning. What neuropsychological test would be most appropriate for his assessment?

Answer 549

Wisconsin Card-Sorting Test

(incorrect = WISC measures intelligence and is often used when there is a discrepancy between a child’s intelligence vs performance at school)

Question 550

A child can jump but cannot yet balance on one foot. About 50% of the child’s speech is understandable. The child can stack 6 blocks on top of each other. Age?

Answer 550

24 months

Question 551

Gender identity usually begins to form by which age?

Answer 551

3

Question 552

What term reflects the degree of control an individual exerts over the parts of bx that are driven by emotion?

Answer 552

Constraint

Question 553

Kagan and colleagues have identified 2 distinct temperments in infants - what are they?

Answer 553

inhibited and uninhibited

Question 554

What disorder most commonly occurs in patients with ASD?

Answer 554

Anxiety disorders and may have comorbid OCD.

Question 555

When is social communication disorder dx’d?

Answer 555

If no restricted or repetitive bx patterns are present but other criteria for ASD are met.

Question 556

What brain area has a smaller volume in patients with ADHD compared to controls?

Answer 556

Frontal lobe. In general, the total cerebral volume is smaller in individuals with ADHD than in controls.

Question 557

The risk of major depression for 1st degree relatives of major depression probands who suffered an early age of onset and recurrent episode is more than ?x higher than the risk for relatives of probands who suffered a later onset, single episode.

Answer 557

5x

Question 558

Individuals with panic disorder show increased sensitivity to the anxiogenic effects of substances like? (3)

Answer 558

1) carbon dioxide
2) cholecystokinin
3) lactate

Question 559

What infection is linked to PANDAS?

Answer 559

group A beta-hemolytic streptococcal infections

Question 560

Total sleep deprivation and REM sleep deprivation has been shown to lead to a substantial reduction of sxs in patients suffering from what?

Answer 560

Depression

Question 561

By what age are most children able to hop on one foot?

Answer 561

4 years old

Question 562

What are the most effective behavioral regiments for insomnia? (3)

Answer 562

1) stimulus control
2) sleep restriction
3) multi-component cognitive-behavioral interventions

Question 563

What attributes of violent media when watched as a child can contribute to alter violence and aggression in young adulthood? (2)

Answer 563

1) How realistic the violence

2) Identification with the aggressive character

Question 564

If a young child does all of her chores for a week, she is rewarded with a weekly allowance of $10. What kind of operant conditioning schedule are her parents using?

Answer 564

Fixed interval. Provides reinforcement for a response that occurs after a set amount of time. The child is reinforced at a fixed weekly schedule as long as the bx occurs.

Question 565

This type of schedule provides reinforcement every “n”th response.

Answer 565

Fixed ratio

Question 566

This type of schedule provides reinforcement at a varying response rate.

Answer 566

Variable ratio

Question 567

This type of schedule provides reinforcement for responses that occur after varying amts of time.

Answer 567

Variable interval

Question 568

The visual acuity of a child reaches the adult level of 20/20 by what age?

Answer 568

3-5

Question 569

Myelination of the optic nerves and the development of the visual cortex occur over what time period in kids?

Answer 569

Over the first two years

Question 570

When does myelination begin?

Answer 570

Around 28 weeks gestation

Question 571

Parietal and temporal lobes experience a growth spurt from what age range?

Answer 571

6-13. This growth spurt may correspond with a critical period of language development.

Question 572

What technique is used in IPT to get a sense for what is going on?

Answer 572

An illness (depression) timeline reflecting major mood changes and significant interpersonal events.

Question 573

MOA for PCP?

Answer 573

NMDA receptor antagonist.

Question 574

PCP use in children - sxs?

Answer 574

Nystagmus, blank staring, strange bx, AMS, agitation, choreoathetosis, seizures, and acute psychosis

Question 575

According to Piaget, conservation is achieved during what stage?

Answer 575

Concrete operational

Question 576

According to Piaget, egocentrism and centering are part of what stage?

Answer 576

Preoperational

Question 577

According to Piaget, logical and concrete reasoning occurs during what stage?

Answer 577

Concrete operational

Question 578

According to Piaget, primary/secondary/tertiary circular reasoning occurs during what stage?

Answer 578

Sensorimotor

Question 579

According to Piaget, primary circular reasoning occurs during the sensorimotor stage. What is this?

Answer 579

Primary Circular Reactions (1-4 months): This substage involves coordinating sensation and new schemas. For example, a child may suck his or her thumb by accident and then later intentionally repeat the action. These actions are repeated because the infant finds them pleasurable.

Question 580

According to Piaget, secondary circular reasoning occurs during the sensorimotor stage. What is this?

Answer 580

Secondary Circular Reactions (4-8 months): During this substage, the child becomes more focused on the world and begins to intentionally repeat an action in order to trigger a response in the environment. For example, a child will purposefully pick up a toy in order to put it in his or her mouth.

Question 581

According to Piaget, tertiary circular reasoning occurs during the sensorimotor stage. What is thi

Answer 581

Tertiary Circular Reactions (12-18 months): Children begin a period of trial-and-error experimentation during the fifth substage. For example, a child may try out different sounds or actions as a way of getting attention from a caregiver.

Question 582

CY-BOCS age range?

Answer 582

6-17

Question 583

CY-BOCS is based on three factors - what are they?

Answer 583

1) patient report
2) subjective report from parents
3) observation from clinician

Question 584

The Brief Psychiatric Rating Scale (BPRS) is used to measure psychiatric sxs such as :

Answer 584

depression, anxiety, hallucinations, and unusual bx

Question 585

At high doses trazodone works as a ?

Answer 585

Serotonin agonist

Question 586

At low doses trazodone works as a ?

Answer 586

Serotonin antagonist

Question 587

Trazodone: Oral absorption is ?% higher when taken with food.

Answer 587

20%

Question 588

Trazodone may be arrhythmogenic - true or false?

Answer 588

TRUE

Question 589

The onset of bipolar disorder prior to age 13 carries an especially poor prognosis. What percent of patients with bipolar disorder began to exhibit sxs at age 13 or earlier?

Answer 589

25-30%

Question 590

What percent of individuals dx’d with bipolar disorder as adults had sxs prior to age 20?

Answer 590

60%

Question 591

What percent of individuals dx’d with bipolar disorder as adults had sxs beginning between ages 13 and 18?

Answer 591

40%

Question 592

A 504 plan specifies what but not what?

Answer 592

Specifies accommodations for disabilities but does not specific special education services.

Question 593

In utero exposure to opiate does what to the incidence of SIDS?

Answer 593

It increases incidence of SIDS

Question 594

Who is considered the founder of the strategic family therapy model?

Answer 594

Jay Haley

Question 595

What is the process by which the expression of emotion by a group member stimulates the awareness of a similar emotion in another group member?

Answer 595

Contagion

Question 596

The process of imparting a sense of optimism to group members

Answer 596

Inspiration

Question 597

A study compares the incidence of SAs with BPD vs nl controls. The BPD group has 50 individuals and the control group has 500. The # of SA in the BPD group and the control group is 5. Calculation that determines the suicide risk attributable to BPD?

Answer 597

(5/50)-(5/500) = attributable risk = experimental event rate (events/subjects) = control event rate.

Question 598

A study compares the incidence of SAs with BPD vs nl controls. The BPD group has 50 individuals and the control group has 500. The # of SA in the BPD group and the control group is 5. Calculation for relative risk?

Answer 598

(experimental event rate/control rate) = (5/50)/(5/500)

Question 599

A study compares the incidence of SAs with BPD vs nl controls. The BPD group has 50 individuals and the control group has 500. The # of SA in the BPD group and the control group is 5. Calculation for odds ratio?

Answer 599

(5/45)/(5/495)

Question 600

What is central to any reunification plan for children in foster care?

Answer 600

To support parents in resolving issues that lead to maltreatment and placement.

Question 601

A psychiatrist is a consultant for her local elementary school. She is referred a patient from this school to see on an outpatient basis. Can she accept this patient?

Answer 601

Yes. As long as there is no active solicitation of these patients or other financial conflict of interest.

Question 602

What are correctable causes of cognitive and behavioral disturbance?

Answer 602

Vision and hearing impairment, seizure disorders, recent head injury.

Question 603

The solitary tract is critical for which part of sleep?

Answer 603

NREM sleep. The solitary tract projects ventrally through the basal forebrain to the cortex through the thalamus. It allows progressive hyperpolarization of the corticothalamic circuits during NREM sleep that underly the characteristic delta waves through which “deep sleep” is recognized.

Question 604

What is meant by the term “goodness of fit” as described by Chess and Thomas?

Answer 604

match or mismatch between a person’s temperament and features of his or her environment.

Question 605

What are aspects of “goodness of fit”?

Answer 605

When the properties of the environment and its expectations and demands are in accord with the organism’s own capacities, characteristics and style of behaving. Specific values, cultural differences, and SES must be taken into consideration.

Question 606

3 classic FAS facial features?

Answer 606

1) smooth philtrum
2) thin vermilion border
3) palpebral fissures

Question 607

Features of congenital rubella?

Answer 607

Sensorineural deafness, retinopathy, cataracts, congenital heart disease, microcephaly, micrognathia, and ID

Question 608

Features of Down syndrome?

Answer 608

Upslanting palpebral fissures, epicanthic folds, folded or dysplastic ears, low-set small ears, and a flat nasal bridge

Question 609

Features of congenital hypothyroidism?

Answer 609

lethargy, hoarse cry, feeding problems, myxedematous facies, macroglossia, umbilical hernia

Question 610

Rhythmicity is a dimension of temperament - what does it refer to?

Answer 610

Indicates regularity of timing in the child’s biological functions such as eating and sleeping

Question 611

What is the third stage of Erik Erikson’s therapy of psychosocial development?

Answer 611

Initiative vs. Guilt (age 3-5)

Children begin to plan activities, make up games, and initiate activities with others. If given this opportunity, children develop a sense of initiative and feel secure in their ability to lead others and make decisions.

Conversely, if this tendency is squelched, either through criticism or control, children develop a sense of guilt. The child will often overstep the mark in his forcefulness, and the danger is that the parents will tend to punish the child and restrict his initiatives too much.

Question 612

Initiative vs. Guilt - age range?

Answer 612

3-5

Question 613

Child is 75% understandable, can jump and hop a dn can stack around 8 blocks. Age?

Answer 613

36 months

Question 614

Sxs of acute cocaine w/d?

Answer 614

Mild muscle pain and chills. There is a risk of MI d/t coronary vasospasm

Question 615

How many hours after last drink does alcohol w/d start?

Answer 615

8-10 hours

Question 616

Modafinil activates what area of the brain?

Answer 616

Hypothalamic regions

Question 617

In clinical trials with children, modafinil has proven efficacy in reducing sxs of ADHD. Why did it not get FDA-approval for use in children?

Answer 617

Risk of SJS

Question 618

What are the phenotypic attributes of fetal VPA?

Answer 618

1) epicanthic fold
2) infraorbital groove
3) medial deficiency of eyebrows
4) flat nasal bridge
5) broad nasal root
6) anteverterd nares
7) shallow philitrum
8) long upper lip
9) thick lower lip
10) small downturned mouth

Question 619

Non-episodic irritability in youth has not been shown to increase the risk of bipolar disorder. It carries an associated risk for what disorders?

Answer 619

Anxiety and unipolar depressive disorders

Question 620

MDD has a heritability of what percent?

Answer 620

40-60%

Question 621

AN occur in females what percent of the time?

Answer 621

> 90%

Question 622

The lifetime prevalence of AN in females is ?

Answer 622

0.5%

Question 623

The long-term mortality rate of AN?

Answer 623

> 10%

Question 624

The lifetime prevalence of BN in females is ?

Answer 624

1-3%

Question 625

BN occur in females what percent of the time?

Answer 625

90%

Question 626

Duration of an untreated episode of MDD?

Answer 626

4+ months

Question 627

A father presents with his 6 y/o daughter and asks about bringing her to the funeral of a 9 y/o sibling who died suddenly in a car accident. What factor is most relevant for advising the family?

Answer 627

Availability of supportive adults to provide comfort

Generally, attendance can be helpful