Exam Practice Questions

Question 1

What sleep medication can cause nocturnal eating?

Answer 1

Zolpidem

Question 2

Elderly woman cognitive decline, sees little children, has good and bad days, maybe clumsy. What is the most likely diagnosis?

Answer 2

Major NCD due to LBD

Question 3

Moderate NCD on donepezil 5mg, few days of mild GI symptoms. What do you do?

1. Continue and monitor symptoms
2. Electrolytes, CBC
3. Discontinue donepezil
4. Switch to another cholinesterase inhibitor

Answer 3

Continue and monitor symptoms

Question 4

What is the first step in treating conversion disorder?

1. Patient education
2. EMG
3. Refer for other medical tests
4. Tell the patient he is faking

Answer 4

Patient Education

Question 5

What test should you perform on a bipolar pt with multiple episodes in 1 year?

Answer 5

Thyroid function

Question 6

Contraindications to family therapy?

Answer 6

• Major mental illness, where stirring up affect may lead to decompensation of their illness
• Violence in family
• Inflexible in considering there may be a problem in family
• Therapy counter to family belief systems
• Key members in family don’t participate
• Where FT is not first line treatment; eg. Detoxing or treating a psychosis

Question 7

In OCD, which treatments are second line?

Answer 7

citalopram, clomipramine, venlafaxine, mirtazapine

Question 8

What is the treatment for akathisia?

Answer 8

Propranolol = first line

Benztropine = second line

Benzos = non-responders

Question 9

How to calculate NNT?

Answer 9

NNT = 1/ARR

ARR = CER - EER

Question 10

Key defense mechanism used in OCPD

Answer 10

Reaction Formation - taking an unacceptable impulse, and behaving in the opposite, corrective way

Question 11

Signs of Wernicke’s? Treat with…

Answer 11

IV Thiamine

Question 12

What is the rate of inheritance of bipolar disorder in MZ twins? (note = same as having two first degre relatives with BAD)

Answer 12

45-75%

Question 13

26 yo woman, worried her boyfriend will cheat on her on his business trip. Calls him and checks on him repeatedly. Angry when he does not immediately respond to her text messages. Attachment style?

Answer 13

Preoccupied

Question 14

What is the most common reason a psychiatrist is sued?

Answer 14

Suicide/inadequate safety assessment

Question 15

7 yo kid with ASD and irritability. Parents wanted behavioural interventions initially, but they are not working. What is the best medication option?

Answer 15

Risperidone

Abilify

Question 16

What are the top 4 antipschotics associated with elevated prolactin?

Answer 16

Paliperidone

Risperidone

Amisulpuride

Haldol

Question 17

What has the most noradrenergic side effects of the SNRIs?

1. Levomilnacipran
2. Venlafaxine
3. Duloxetine
4. Desvenlafaxine

Answer 17

Levomilnacipran

• Most SNRIs including venlafaxine, desvenlafaxine, and duloxetine, are several fold more selective for serotonin over norepinephrine, while milnacipran is three times more selective for norepinephrine than serotonin

Question 18

What Eriksonian stage best fits with a mid life crisis?

Answer 18

Generativity vs stagnation

Question 19

Most common psych dx in Cancer

Answer 19

Adjustment disorder with anxiety and depression

Question 20

Most common effect of SSRIs on babies exposed to them in pregnancy

Answer 20

Poor neonatal adaptative syndrome

Question 21

Retionoin can cause

Answer 21

Depression

Suicide risk (case reports)

Psychosis

Question 22

What is the most likely cause of intellectual disablity of a child who did not grow up in Canada, and became progressively impaired?

Answer 22

PKU

Question 23

Man with schizophrenia, first episode. What is highest risk for relapse?

Answer 23

Medication non-compliance

Question 24

What medicatiosn are reccommended for sleep by American Academy of Sleep Medicine Guidelines?

Answer 24

• Zopiclone, Temazepam, Doxepin

Question 25

Which antidepressant is best used in setting of QTC prolongation?

Answer 25

Wellbutrin - does not prolong QT at all

Question 26

Patient is on Lithium, stable dose, doing well. Asks you what OTC medications may interfere with his Lithium should he become ill with a cold/flu?

1. ibuprofen
2. ASA
3. Chlorpheniramine
4. Phenylephrine

Answer 26

Nonsteroidal Anti-Inflammatory Agents:

May increase the serum concentration of Lithium.

Management: Consider reducing the lithium dose when initiating a NSAID

Question 27

In OCD, which treatments are first line?

Answer 27

OCD first line = SSRI (minus citalopram)

Question 28

Do atypicals cause galactorrhea?

Answer 28

Yes, Typicals and Lurasidone and RIsperidone block D2 receptors in pituitary, increasing PL

Question 29

Define personalization

Answer 29

• tendency to self-reference external events without basis

Question 30

What findings in bipolar MRI?

Answer 30

Ventricular enlargement

Reduced voume of corpus callosum

Increased periventricular white matter changes

Question 31

What antipsychotic has the best evidence in schizophrenia and substance use?

Answer 31

Clozapine

Question 32

Transference Neurosis is

Answer 32

Recreation of feelings with interaction with therapist in psychoanalysis

a whole series of psychological experiences are revived not as belonging to the past, but as applying to the person of the analyst at the present moment

Question 33

What to do when patient on clozapine develops catatonia?

Answer 33

Lorazepam

Question 34

PTSD FInding on functional imaging

Answer 34

Amygdala Hyperactivity

Question 35

Which antidepressant would not increase abilify?

1. Paroxetine
2. Wellbutrin
3. Duloxetine
4. Venlafaxine

Answer 35

Venlafaxine

Wellbutron, Paxil, Duloxetine, Setraline all inhibitors of 2D6; Abilify is a 2d6 substrate

Question 36

30 yo woman no psych history or family history. Comes in with abrupt change, paranoia toward neighbors, confusion, jerky movements, history of “flu-like symptoms” a couple weeks ago, as per her mother. What investigation?

Answer 36

Head imaging - CT or MRI - first

Then

Will likely need LP later

Blood culture

Question 37

What is approach to maintenance treatment in BAD?

Answer 37

• Maintenance is whatever worked to get them out of acute symptoms

Question 38

What is true about medication dosing in children vs adults?

1. Children need a higher dose per weight than adults
2. Children metabolize medications more slowly
3. Children have less total body water volume therefore need less drug
4. Children have higher oral absorption than adults

Answer 38

Children need a higher dose per weight than adults

Question 39

Sleep changes in older adults?

Answer 39

Reduced total sleep time

Reduced Sleep efficiency

Decreased SWS

Increased sleep fragmentation

Increased sleep latency

REM declines after age 65

Phase advance (to bed earlier and wake earlier)

Question 40

32 yo woman with schizophrenia, on risperidone. Experiences weight gain, galactorrhea, learns these are side effects of her medication and requests an alternative.

What is the best option?

1. Aripiprazole
2. Lurasidone
3. Typical

Answer 40

Abilify

• Typicals and Lurasidone block D2 receptors in pituitary, increasing PL
• Lurasidone causes ++ weight gain

Question 41

What kind of learning is involved in agoraphobia?

Answer 41

1. Negative reinforcement

Question 42

Young mother, intrusive thoughts of hurting baby, but no intent to do so. Taking care of baby well, requires frequent reassurance from others that she is doing OK, will not hurt baby. What should she work on in CBT?

Answer 42

Exposure to looking after baby and not seeking reassurance

Question 43

Possible side effects of guanfacine?

Answer 43

Nasuea/Vomiting

Bradycardia

Sedation

Hypotension

Question 44

In a patient with LBD (depressed, visual hallucinations, parkinsonism), what is the best treatment of psychosis?

Answer 44

1. Consider cholinesterase inhibitor & Consider lowering dose of antiparkinson med
2. If necessary, can use AP, but only atypical.

RIsk: Limited efficact in LBD, increased risk of death

Question 45

Supportive therapy, your role

1. Maintain positive transference relationship
2. Don’t challenge current defenses
3. Something about here and now

Answer 45

Maintain positive transference relationship

Question 46

In a patient who has failed two antipsychotic trials, what are your next steps?

Answer 46

Confirm compliance

Rule out substance use

Start clozapine

(best if olanzapine was one of meds tried)

Question 47

What is the key distinction between pyromania and ASPD?

Answer 47

In pyromania, fire setting is for pleasure. In ASPD, there woukd have to be a component of vengeance or anger

Question 48

Female university student who did not attend her failed final exam and got doctors note for this. Socially isolated. Unsure of professors expectations of her as she wants to do well. What kind of temperamental style does this girl have?

Answer 48

Harm Avoidance

• a personality trait characterized by excessive worrying; pessimism; shyness; and being fearful, doubtful, and easily fatigued

Question 49

In ECT treatment, if repeatedly cannot get a seizure, do the following:

Answer 49

Assess and reduce or discontinue and anticonvulsant medications

Caffeine

hyperventilation

Question 50

When can you use stimulants with tics?

Answer 50

• Psychostimulants should be used with precautions in patients with tics. Psychostimulant medications are used cautiously in tic spectrum disorders but the Committee agrees that use can be indicated if there is sufficient impairment of the concurrent ADHD. In these cases, the medications for ADHD are often combined with other drugs for tics (e.g., atypical neuroleptics or alpha-2 agonists).

Question 51

Which antipsychotic decreases suicide risk in people with schizophrenia?

Answer 51

Clozapine

Question 52

You want to test a medication in different doses on different patients. What kind of study design?

Answer 52

Experimental

Question 53

What is the treatment of ASPD?

Answer 53

CBT may benefit those with milder forms of the disorder (eg, not physically dangerous) and who possess some insight and reason to improve.

Clinical trials have been negative

Question 54

Most common psych diagnosis in North America

Answer 54

Anxiety Disorders

Question 55

First line treatment for depression in Menopause

Answer 55

Antidepressants

CBT + other first line psychotherapy

Question 56

Criteria for Eating Disorder admission

Answer 56

Unstable Vitals: HR<40, BP 80/60 or symptomatic

Weight <70% IBW or <15 BMI

• Cardiac dysrhythmia
• Heart, renal liver compromise
• Dehydration
• Complications of malnutrition
• Refeeding syndrome
• Poor response to outpatient tx

Question 57

Pregabalin Mechanism of Action

Answer 57

Voltage Gated Calcium Channels

Question 58

What are the contraindications to Naltrexone?

Answer 58

Pregnant

Using Opioids

LFTs 3x upper limit normal or cirrhosis

(needs FU liver enzymes after 3 weeks)

Question 59

Primary Treatment of ODD?

Answer 59

Family Intervention - reinforce more prosocial behaviors and to diminish undesired behaviors at the same time (form of CBT)

Individual Play therapy - sometimes benefit

Question 60

Best treatment for Nightmares and insomnia associated with PTSD?

Answer 60

Prazosin

Question 61

In ASD, what is most impaired part of language?

Answer 61

Pragmatic language

Question 62

13 yo child, parents going through a messy divorce. Developed acute onset of OCD symptoms. Strep infection 2 years ago, admits to occasional use of cannabis. Healthy otherwise. What is the most likely contributor to onset of symptoms?

1. PANDAS
2. Psychosocial stressors
3. Cannabis use

Answer 62

Psychosocial Stressors

Question 63

Define magnification

Answer 63

• overvaluing significance of a particular event

Question 64

Someone becomes disinhibited, impulsive, inappropriate. What brain location most associated with these symptoms?

Answer 64

1. Orbitofrontal cortex

Question 65

Which class of antidepressants prolong QTC the most?

Answer 65

TCAs (but clomipramine less so)

Question 66

What does delirium look like on EEG?

Answer 66

Absent alpha waves

Generalized delta and theta waves

Question 67

Which of the cognitive distortions describes taking a fact out of context?

Answer 67

Selective abstraction

• KS Selective Abstraction: The only events that matter are failures, deprivation, etc. Should measure self by errors, weaknesses, etc.

Question 68

17 yo girl comes to your office with mother. Mom thinks she has OCD. She has excoriations all over face and body. In speaking to the patient privately, she discloses no obsessional thinking but states she feels bugs are crawling under her skin. What is the most likely diagnosis

1. Psychotic disorder
2. Stimulant use
3. Body dysmorphic disorder
4. OCD

Answer 68

Stimulant use

Ddx - delusional infestation

• Substance abuse should be sought especially when delusional infestation presents in younger age groups
• Chronic alcohol use and withdrawal and long-term cocaine and amphetamine abuse are common precipitants
• “cocaine bugs” have been described with acute use as well

Question 69

What is an interoceptive exposure?

Answer 69

It refers to carrying out exercises that bring about the physical sensations of a panic attack, such as hyperventilation and high muscle tension, and in the process removing the patient’s conditioned response that the physical sensations will cause an attack to happen.

Question 70

Define Arbitrary Inference

Answer 70

• Drawing a specific conclusion without sufficient evidence

Question 71

What psychosocial treatments can be reccommended for Bipoalr 1?

Answer 71

Maintenance -

psychoeducation**** reccommend to all pts and fam at disaease onset

cognitive behavioural therapy (CBT)

family-focused therapy (FFT),

IPSRT

Peer Support

Mania - no evidence, no reccommendations

Question 72

What is the most important part of an NCR assessment?

Answer 72

Mental state at the time of the alleged crime

Question 73

Interferon-alpha is responsible for which neuropsychiatric symptoms?

Answer 73

Acute confusion (rapidly after initiation)

Depression (develops more slowly over weeks to months of treatment)

Manic conditions most often characterised by extreme irritability and agitation, but also occasionally by euphoria

Question 74

In elderly, catatonic, dehydrated, deconditioned, depressed. Best treatment?

1. ECT
2. Antipsychotic
3. Lorazepam
4. SSRI

Answer 74

ECT

Question 75

Patient with schizophrenia tells you “ the air around you is quite monicate” What is this an example of?

Answer 75

• Neologism. The invention of new words or phrases or the use of conventionalwords in idiosyncratic ways.

Question 76

Patient in ICU with hyperactive delirium and a prolonged QTc - which antipsychotic to give?

1. Haloperidol
2. Quetiapine
3. Abilify
4. Loxapine

Answer 76

Abilify

Question 77

Epidemiological study of mental disorders. You want to know the number of people with a particular mental disorder at the time of the study. What is this called?

Answer 77

Point prevalence

Question 78

Which antipsychotics dissociate fastest from D2 receptors?

Answer 78

Clozapine Quetiapine

Question 79

What is a safety behaviour?

Answer 79

• SAD ATRC manual “a safety behaviour is an action that is carried out in order to reduce distress or prevent a feared consequence from occurring.”

Question 80

What item is both on MMSE and Mini cog?

Answer 80

3 item recall

Question 81

Indications for Head CT in dementia

Answer 81

• Age < 60 years
• 
Rapid (e.g., over 1–2 months) unexplained decline in cognition or function
• 
Short duration of dementia (< 2 years)
• 
Recent and significant head trauma
• 
Unexplained neurologic symptoms (e.g., new onset of severe headache or seizures)
• 
History of cancer (especially types that metastasize to the brain)
• 
Use of anticoagulants or history of bleeding disorder
• 
History of urinary incontinence and gait disorder early in the course of dementia (as may be found in normal pressure hydrocephalus)
• 
Any new localizing sign (e.g., hemiparesis or a Babinski reflex)


–Unusual or atypical cognitive symptoms or presentation (e.g., progressive aphasia

Question 82

Child with big ears and mid-face hypoplasia. What is the diagnosis?

Answer 82

Fragile X

Question 83

What is sensitivity and how to calculate it?

Answer 83

The sensitivity of that test is calculated as the number of diseased that are correctly classified, divided by all diseased individuals.

Sn = True Positives/Total Diseased

Question 84

Paxil withdrawal symptoms

Answer 84

Nausea, vomiting, insomnia

Question 85

What are MRI findings associated with DLB?

Answer 85

Diffuse atrophy with sparing of medial temporal lobe Swallow Tail Sign in Midbrain

Question 86

How to calculate odds ratio?

Answer 86

OR = odds of disease in exposed / odds of disease in the non-exposed

Question 87

What findings on neuroimaging in schizophrenia?

Answer 87

Reduction in cortical grey matter

Reduced hippocampal volume

Enlarged ventricle size (lat and 3rd)

decreased amygdala and thalamus

↓symmetry,

↓limbic size (e.g. amygdala),

↓thalamus (ind. of tx)

basal ganglia inc volume (englarged caudate)

Question 88

Principle in treating depression/associated suicidality in patients with schizophrenia?

Answer 88

Treat MDD by relevant MDD guidelines

Question 89

Which medication has been shown to help in weight control in patients on clozapine/second generation antipsychotics?

Answer 89

Metformin

• dose of 500 or 1000 mg/d for 12 weeks slightly reduced the body weight and body mass index (BMI) of patients with schizophrenia who were being treated with clozapine and who had preexisting metabolic abnormalities

Question 90

Meds used in Panic Disorder Augmentation

Answer 90

Clonazepam

Alprazolam

Olanzapine

Question 91

Patient in ER, substance use history. Treated for agitation. Remains extremely agitated 12 hours later, with elevated BP. What is the most likely substance?

Answer 91

Stimulant

Question 92

Woman with IBS. She is comes to you for treatment related to fear of elevators. She is also fearful of buses and public, where she fears she will be unable to escape to a bathroom if necessary. She has never had an incident where she hasn’t made it to the bathroom and recognizes the dissonance. She just doesn’t think she can stand the humiliation, should this occur. Most likely diagnosis?

Answer 92

Agoraphobia

Question 93

In OCD, which treatments are first line ADJUNCTIVE?

Answer 93

Risperidone

Question 94

7 yo kid with enuresis 3-4 times per week. Can’t go to sleepovers.

1. Desmopressin
2. Bell and pad
3. Bladder training

Answer 94

Bell and Pad

Question 95

Middle aged woman, feels her husband is being unfaithful, may be poisoning her. Took a sample of her coffee to a lab to get it tested for poison, when negative assumed he was interfering at the lab as well. She is otherwise functioning in other areas of her life including her job. Comes to you as a patient. What is your first step?

1. Validate her distress
2. Do not invite her family as this would agitate her
3. Confront her delusional beliefs

Answer 95

Validate her distress

Question 96

Risk factors for TGA?

Answer 96

Older than 50

RIsk fx for Cardiovascular disease

Sometimes assoc with epilepsy and migraine

Question 97

Main Side Effects of Clozapine

Answer 97

Seizures

Ileus

Agranulocytosis

Myocarditis

Siallorhea

Metabolic

Question 98

What are MRI findings associated with Progressive supranuclear palsy?

Answer 98

Rostral Midbrain Hummingbird Sign

Question 99

What is the key principle in working with forensic patients? re duty to warn

Answer 99

First containment, then duty to warn

Question 100

Glucocorticoids increase the risk of which neuropsychiatric phenomena?

Answer 100

SI (7x)

Depression

mania

delirium

confusion

disorientation

Question 101

What is the most common non-motor side effect of Parkinson’s Disease?

Answer 101

Sleep Disturbance (55-80%)

Question 102

How do you conifrm a diagnosis of factitious disorder?

Answer 102

Prove that they are feigining symptoms

Question 103

Patient with severe renal and liver disease on linezolid. In hospital, what sleep med would you suggest?

1. Temazepam
2. Trazodone
3. Quetiapine
4. Nortriptyline

Answer 103

Temazepam

Do not administer Linezolid with:

TCAS

SSRIs

High tyramine containg foods - bc of risk of serotonin syndrome

Question 104

40 year old male, severe alcohol use, 750 ml whiskey day, history of withdrawal seizures, liver normal, diabetes, HTN (it was clear he needed monitored withdrawal), you are admitting this patient, what should you do?

Answer 104

100mg IM Thiamine

Diazepam 5mg TID OR Chlordiazepoxide 50mg BID or Lorazepam 1mg QID or Oxazepam 15mg BID

NOT prn because pt has hx of withdrawalseizures

Question 105

In a child with social anxiety disoder, what is most likely to develop as an adult?

Answer 105

Future Anxiety Disorders

Question 106

What is risk of lithium + ECT?

Answer 106

• ECT + lithium is associated with 12-fold higher odds of delirium compared to ECT alone
• The odd for cognitive impairment is 542% higher for ECT + lithium compared to ECT only.

Question 107

Type of short term memory loss for brief period (several h in length), improves fully, retained memory of personal identity

Answer 107

Transient Global Amenia

Question 108

What is the best test of executive function?

Answer 108

Trails B

Question 109

Lady pregnant in 3rd trimester. History of bipolar, stable, off meds. Develops depressive symptoms. Wants treatment. Also wants to breastfeed. Best option?

1. Quetiapine
2. Sertraline
3. Lithium
4. Valproate

Answer 109

Quetiapine

• All antipsychotics are pregnancy Category C (except for clozapine, which is B)
• Li, VPA = D
• Lamotrigine C

Question 110

AN, not eating for 6 weeks, in hospital now. Started an IV of saline/dextrose. What do you worry about?

1. Hypophosphatemia
2. Hypomagnesemia
3. Hypokalemia
4. Hyponatremia

Answer 110

Hypophosphatemia (most concerning aspect of refeeding syndrome)

Also:

• Hypokalemia
• Congestive heart failure
• Peripheral edema
• Rhabdomyolysis
• Seizures
• Hemolysis

Question 111

What is first step for child with freqent night terrors?

When to do sleep study?

Answer 111

Reassure they will improve with time

• indications for nocturnal polysomnography (PSG) include
• •Habitual snoring, observed apneas, nocturnal enuresis, or other symptoms suggesting OSA.
• •Significant safety concerns, excessive disruption of the family members’ sleep, or contemplation of pharmacotherapy.
• •Atypical features that raise concern for nocturnal seizures, such as daytime neurologic symptoms, older age group, family history of seizures, and multiple occurrences on a single night

Question 112

What is the best strategy for a family MD managing a pt with somatic symptom disorder who is presenting frequenly with multiple complaints?

Answer 112

Regular appointments, not contingent on symptoms

Question 113

What is the evidence of cannabis in treating PTSD?

Answer 113

marijuana use is associated with worse treatment outcomes

“known risks of marijuana thus currently outweigh unknown benefits for PTSD”

Some evidence for nabilone in treating PTSD nightmares

Question 114

What disorders is catatonia most commonly seen in?

Answer 114

Mood Disorders

(Depression and bipolar)

Question 115

Woman with Bipolar I disorder, stable. Wants treatment for insomnia, starts CBTi. What component of CBTi contraindicated?

Answer 115

Sleep restriction

Question 116

What antidepressant is an off-label tx of ADHD?

Answer 116

Buproprion

Question 117

What is sedative hypnotic anxiolytic withdrawal?

Answer 117

Sedative, Hypnotic, or Anxiolytic Withdrawal causes two or more of the following:

autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm),

hand tremor,

insomnia,

nausea/vomiting,

transient visual/tactile/auditory hallucinations or illusions,

psychomotor agitation,

anxiety, seizures

Question 118

“Remission” in Ham-D

Answer 118

<7

Question 119

12 yo natal female, severe anxiety about puberty. Always conformed to more male gender roles. What to do?

1. GnRH agonist
2. SSRI
3. Testosterone level
4. CBT

Answer 119

GnRH agonist

Question 120

Elderly man with Parkinson’s Disease, history of gambling 30 years ago, suddenly starts gambling again. What is the most likely culprit?

Answer 120

Doapmine Agonist

• DAs as a class are associated with the development of ICDs such as pathologic gambling, compulsive sexual behavior, or compulsive buying, in up to 50 percent of patients with long-term use.

Question 121

Woman who has been on clonazepam for many years for insomnia. Decides to stop taking x 1 night and is unable to sleep. What is happening?

1. Rebound insomnia
2. Recurrence of insomnia
3. Benzodiazepine withdrawal
4. Benzodiazepine use disorder

Answer 121

Rebound insomnia

Question 122

45 yo woman presented last year with depression that was treatment resistant. Lately lashing out at family, irritable, executive function deficits. Strange, jerky motor movements. What is most likely in family history?

Answer 122

Huntington’s

Question 123

Approach to treating insomnia in Parkinson’s Disease

Answer 123

• Insomnia – sleep hygiene
• Melatonin
• Doxepin/trazodone
• Clonazepam = rem sleep disorder

Question 124

What is a component of a mindfulness body scan?

1. Non-judgement
2. Firmly redirecting mind when it wanders
3. Progressive muscle relaxation
4. Focus on relaxing the body

Answer 124

Non-Judgment

Question 125

Someone becomes disinhibited, impulsive, inappropriate. What brain location most associated with these symptoms

Answer 125

Orbitofrontal cortex

Question 126

. 40 year old male, severe alcohol use, 750 ml whiskey day, history of withdrawal seizures, liver normal, diabetes, HTN (it was clear he needed monitored withdrawal), you are admitting this patient, what should you do

1. 1000 mg thiamine PO clonazepam regular
2. 100 mg thiamine IM, Chlordiazepoxide 50 mg BID
3. 100 mg IM thiamine, diazepam 5mg PRN TID
4. 1000 mg po thiamine, Ativan 1-2 mg PRN q4h

Answer 126

100 mg thiamine IM, Chlordiazepoxide 50 mg BID

Question 127

Epidemiological study of mental disorders. You want to know the number of people with a particular mental disorder at the time of the study. What is this called?

Answer 127

Point prevalence

Question 128

Woman with IBS. She is comes to you for treatment related to fear of elevators. She is also fearful of buses and public, where she fears she will be unable to escape to a bathroom if necessary. She has never had an incident where she hasn’t made it to the bathroom and recognizes the dissonance. She just doesn’t think she can stand the humiliation, should this occur. Most likely diagnosis?

Answer 128

Agoraphobia

Question 129

Female university student who did not attend her failed final exam and got doctors note for this. Socially isolated. Unsure of professors expectations of her as she wants to do well. What kind of temperamental style does this girl have?

1. Harm avoidance
2. Reward dependence
3. Novelty seeking
4. Persistence

Answer 129

Harm Avoidance

Question 130

26 yo woman, worried her boyfriend will cheat on her on his business trip. Calls him and checks on him repeatedly. Angry when he does not immediately respond to her text messages. Attachment style?

1. Secure
2. Disorganized
3. Dismissive
4. Preoccupied

Answer 130

Preoccupied

Question 131

60 yo man with longstanding schizophrenia. Haven’t had follow-up for a while. Comes to you and you notice moderate cognitive deficits of executive dysfunction, verbal memory, attention. What can these deficits most likely be attributed to?

Answer 131

Neurocognitive deficits of schizophrenia

Question 132

Which of the cognitive distortions describes taking a fact out of context?

1. Selective abstraction
2. Arbitrary inference
3. Personalization
4. Magnification

Answer 132

Selective Abstraction

Question 133

Elderly man with Parkinson’s Disease, history of gambling 30 years ago, suddenly starts gambling again. What is the most likely culprit?

Answer 133

Dopamine Agonist

Question 134

What kind of learning is involved in agoraphobia?

Answer 134

Negative Reinforcement

Question 135

A man with ADHD and comorbid depression has been on Ritalin for a long time. He also takes bupropion and yohimbine, and was recently started on trazodone for sleep. He complains of erectile dysfunction. Which medication is MOST likely responsible?

1. trazodone
2. yohimbine
3. bupropion
4. methylphenidate

Answer 135

Trazodone

Question 136

Which of the following has been shown to help in weight control in patients on clozapine/second generation antipsychotics?

1. Metformin
2. topiramate/lamotrigine?
3. Stimulant?
4. Unsure

Answer 136

Metformin

Question 137

Person has aphasia and sensory and motor deficits on one side. Where is the stroke?

1. ACA dominant side
2. MCA dominant side
3. ACA non-dominant side
4. MCA non- dominant side

Answer 137

MCA Dominant Stroke

Question 138

What are characteristics of an MCA Dominant /Left hemisphere stroke?

Answer 138

• Right hemiparesis
• R sided sensory loss
• Dysarthria
• Ahpasia***
• Alexia, agraphia, acalculia, apraxia
• Right homonymous hemianopia

Question 139

What are characteristics of a Right Hemisphere / Non-dominant stroke?

Answer 139

• Left hemparesis
• L sided sensory loss
• Dysarthia
• Left sided neglect
• Anosognosia
• Asomatognosia
• Loss of prosody of speech
• Flat affect
• homonymous hemianopia

*** NO aphasia

Question 140

What are characteristics of an ACA stroke?

Question 141

Child with aggression at school and home. Also meets criteria for ADHD. He is on no meds, and no history of meds. What is the best medication to treat aggression?

1. Methylphenidate if long acting
2. Risperidone
3. Clonidine
4. Atomoxetine

Answer 141

Methylphendiate

*principle in treating ODD and ADHD is to optimize treatment for ADHD

Question 142

What are the principles of management of REM Sleep Behaviour Disorder?

Answer 142

• Ensure safety of patient and bed partner
• CLonaz 0.5-2mg QHS (most widely used)
• Mounting evidence for melatonin, case reports dopa-agonist

Question 143

Young female with binge eating disorder. What would be the best treatment long-term?

Answer 143

• CBT, IPT, DBT
• Imipramine, sertraline, citalopram, topiramate (Grade a evidence)
• Vyvanse approved for moderate to severe BED

Question 144

Gentleman with schizophrenia. What’s the biggest risk factor for relapse?

1. Substance use
2. Conflict with family
3. Medication non adherence
4. Low insight

Answer 144

Medication Non-adherence

Question 145

55 year old male who has detoxed from ETOH. GGT 102, ALT 70, CRCL 50. What do you give?

1. Naltrexone
2. Acamprosate
3. Gabapentin
4. Topiramate

Answer 145

Naltrexone

Recall that Normal ALT for men is about 30, Naltrexone contraindicated with >3x upper limit normal ALT

Question 146

Guy has a TBI from car accident. He is in hospital, aggressive, labile affect and leaving unit frequently. What do you treat with?

1. Valproic acid and propranolol
2. Benztropine and zuclopenthixol
3. Lithium and citalopram

Answer 146

Valproic acid and propranolol

Question 147

Lady who is depressed. She is on first line treatment for depression. She is still depressed, and is wanting an augmenting agent. What has the best evidence?

1. Quetiapine
2. Lithium
3. Desipramine
4. T3

Answer 147

Quetiapine

Question 148

There is a girl who sees her psychiatrist and is depressed. She is 16. She says she wants treatment. You are aware that her family is against treatment for cultural reasons. What the most important aspect to consider for the next step?

1. Confidentiality
2. Cultural sensitivity
3. Youth autonomy
4. Parent’s wishes

Answer 148

Autonomy

Question 149

19 year old, BMI 16.5. Back from university. No safety concerns, but family worried. What is the most appropriate intervention? Has a dietary plan from dietician, but patient has no concerns.

1. CBT
2. ACT
3. Family therapy
4. DBT

Answer 149

Family Therapy

Question 150

A young man from a family with high EE. Goes on vacation to Hawaii to be away from the controlling family. Discontinues his antidepressant and drinks EtOH daily and uses drugs (heroin) while there. X3 months He returned a week ago, has not been using EtOH or drugs since he returned, but nonetheless has had high energy, rapid speech, grandiosity and not sleeping since returning. What is the likely cause of his current symptoms?

1. Stopped antidepressant abruptly
2. Family with high EE
3. Travel with change in time zones
4. EtOH and heroin.

Answer 150

Travel with change in time zones

Question 151

. 75 year old male with a history of restless sleep. Arm movements and has hit wife and fallen out of bed. EMG suggests low muscle tone during REM. What is the first line treatment? ***

1. Melatonin
2. Pramipexole
3. Diazepam
4. Zopiclone

Answer 151

Pramipexole

*Because low muscle tone during REM = periodic limb movement disorder, and tx is Pramipexole

Question 152

Middle age man has movements in sleep, has hit wife x1 and fallen out of bed a few times. What do you treat with?

1. Pramipexole
2. Diazepam
3. Melatonin
4. Zopiclone

Answer 152

Melatonin

*because this is a REM movement sleep disorder

Question 153

What main findings on EMG Sleep Study for NREM and REM sleep disorder?

Answer 153

NREM – low resting muscle tone

REM- near paralysis of skeletal muscle (loss of REM atonia)

Question 154

Guy, gets in a fight with father. Comes to hospital, 40 years old, lives with parents still. Speaks in monotone voice. Describes the fight and says his father is controlling and critical. What is the defense mechanism.

1. Reaction formation
2. Denial
3. Displacement
4. Isolation of affect

Answer 154

Isolation of Affect

Question 155

A patient with severe alcohol use disorder in EtOH withdrawal. 5 days since admission (out of window of alcohol withdrawal). He has been managed with high total daily doses of Diazepam (200mg in the last 5 days) and continues to be agitated, confused, inattentive, not oriented, but no more autonomic instability or tremor (normal VS and no tremor). What would you do next? –

1. Continue Diazepam and give carbamazepine
2. Discontinue Diazepam and give risperidone
3. Continue Diazepam and start clonidine
4. Stop Diazepam and give valproate
5. Stop Diazepam and add clonidine
6. Continue Diazepam and add epival

Answer 155

Discontinue Diazepam and give risperidone

(Because not DT, so question is asking you how to treat delirium)

Question 156

Patient is receiving ECT for depression. Setting on machine is maxed out.. He was hyperventilated. Received Propofol for anesthesia and ondansetron for nausea. He is not having good seizures. He only had seizure for 10 sec. What to do to prolong his seizure?

1. Give Midazolam after induction of anesthesia
2. D/c Ondansetron
3. Give more Ondansetron
4. Add Ketamine to propofol
5. Increase Propofol

Answer 156

Add Ketamine to propofol

*As propofol is an anticonvulsant

*Additional procedures to lower the seizure threshold include

• hyperventilation
• administration of 500 to 2,000 mg IV of caffeine sodium benzoate 5 to 10 minutes before the stimulus.

Question 157

Person getting ECT, and has had 8 sessions. Bipolar and is depressed. He is on Lithium, and SSRI. He is now getting confused and can’t find his room in the ward. He is gettings stimulus 1.5 times the seizure threshold and is having 25 sec motor seizure . What is most likely causing the confusion?

1. Lithium
2. Seizures too long
3. Stimulus intensity too high

Answer 157

Lithium

Question 158

. Guy is in a car accident. What makes it most likely that the patient will develop PTSD?

1. Getting acute stress disorder
2. Having a passenger in the car die
3. Having a history of panic attacks

Answer 158

Acute Stress Disorder

Question 159

35 year old male with 9 month old baby. Has symptoms of GAD. Which is the best listed treatment?

1. Imipramine
2. Mirtazapine
3. Venlafaxine
4. Citalopram

Answer 159

Venlafaxine

Question 160

Bipolar I elderly lady with having lifelong anxiety, now more troublesome. Describes GAD- what do you give?

1. Pregabalin
2. Quetiapine
3. Risperidone
4. Bupropion

Answer 160

Quetiapine

• Quetiapine recommended for GAD in bipolar CANMAT
• But pregabalin first line in Katzman, and quetiapine second line

Question 161

13 year old boy. High measles titre IGG. In hospital. 5 month history of headaches. Then bilateral tremor and diplopia. Then having jerking movements. Negative for hepatitis, syphilis. Vaccine status unknown. What is most likely?

1. Sclerosing panencephalitis
2. Progressive supranuclear palsy
3. NMDA encephalitis
4. Progressive leukodystrophy

Answer 161

Sclerosing panencephalitis

Question 162

Guy with schizophrenia. Has taken risperidone, quetiapine in the past but stops because he does not like side effects. Wants an antipsychotic to take once daily with NO extra rules or requirements. What do you suggest?

1. Aripiprazole
2. Lurasidone
3. Ziprasidone
4. Asenapine

Answer 162

1. Aripiprazole

**As Lurasidone – must be given with food, can be decreased up to 50% on empty stomach

Ziprasidone – divided doses

Asenapine – must be given SL, cant eat or drink for 10 mins after, in 2 divided doses

Question 163

A guy with oral-buccal movements on Risperidone. What medication has the best evidence?

1. Clozapine
2. Olanzapine
3. Abilify
4. Benztropine

Answer 163

Clozapine

Question 164

What’s the dose dependent side effect of Clozapine which is most concerning?

Answer 164

Seizure

Question 165

What the most common side effect of rTMS?

Answer 165

Headache

Question 166

What the serious adverse side effect of rTMS?

Answer 166

generalized tonic-clonic seizure

*about the same risk as antidepressants; less than 0.1 to 0.5 percent of patients when safety guidelines regarding patient selection and stimulation parameters are followed

Question 167

67 year old man, in a retirement home. Smiled on approach. Labile affect. Crying and laughing. Says mood is good. What is the most likely diagnosis?

Answer 167

ALS

*pseudobulbar affect, most commonly seen in ALS

Question 168

Kid defies authority, irritable, annoys others, easily annoyed, etc at home and at school since recent separation of parents. What is most likely diagnosis?

1. ODD
2. Adjustment disorder
3. Depression

Answer 168

Adjustment disorder

*because of timeline

Question 169

Child speaking to stuffed animals at a table and acting as though they are speaking back. What Piaget cognitive developmental stage is she at?

1. Preoperational
2. Concrete operational
3. Sensorimotor
4. Formal operational

Answer 169

Preoperational

*ages 2-7

*During this stage, children begin to engage in symbolic play and learn to manipulate symbols. That they do not yet understand concrete logic.

Question 170

. Lady on dopaminergic meds for Parkinson’s. Having visual hallucination “little people dancing around”. Doctors have decreased meds to try and reduce symptoms, but still hallucinating. What is the best treatment for hallucinations in Parkinson’s disorder?

Answer 170

Clozapine

Question 171

Gentleman on LAI risperidone. Having sexual side effects. What LAI can you switch to for sexual side effects?

Answer 171

Aripriprazole

Question 172

A homeless middle-aged man, dishevelled and unkempt, in and out of shelter, isolated, uses EtOH daily and occasionally cocaine, not violent. Talks to himself and sometimes screams at night, which bothers others. The staff at the shelter have secured benefits for him. What services could he benefit from (I think this might have been “what should be the next step)?

1. Adapted addiction services
2. Stable housing
3. Connecting with family and social supports
4. Starting him on antipsychotic

Answer 172

Stable Housing

Question 173

Retired lawyer in his 60s, admitted with a stroke. Wife is in charge of finances for some time. He thinks he has a mortgage of 200,000. He does not in fact have a mortgage and instead owns home outright. He gambles significantly. He scored 25 on MoCA. What makes you most concerned for financial capacity?

1. Wife paying bills for the last 2 years
2. History of gambling disorder
3. Does not know his mortgage situation
4. MoCA score of 25 despite being highly educated

Answer 173

Does not know his mortgage situation

Question 174

Child with autism (symptoms described), what is the best treatment?

1. Applied behavior analysis
2. Parent training
3. Social skills group

Answer 174

Applied behavior analysis

Question 175

Patient with low IQ on standardized testing, what else do you need to test for diagnosis of ID?

1. Adaptive functioning
2. Poor school performance
3. Social communication skills

Answer 175

Adaptive Functioning

Question 176

Patient with dementia, wandering at night and trying to escape, disrupting to wife. What do you do?

1. Restraints to patient at night
2. Cover the exits with disguise
3. Give benzo at night
4. Antipsychotics

Answer 176

Cover the exits with disguise

Question 177

You are a psychiatrist on a short stay psychiatry unit. You see a guy with no psychiatric history. Currently suicidal. He was recently confronted by his boss’s spouse as he was having an affair with his boss. He has now lost his job. This has all happened in the last week. What is the best therapy?

1. Supportive
2. IPT
3. CBT
4. DBT

Answer 177

Supportive

Question 178

What is the most important thing for transition from Child/Adolescent to Adult psychiatry?

1. Overlap of child and adult services
2. Fostering autonomy in the patient
3. Immediate access to adult mental health services

Answer 178

Overlap of child and adult services

Question 179

You’re a locum for 6 months. What is the most important thing to do when you hand back your patient load to the original psychiatrist?

1. Review all outstanding investigations.
2. Tell all the patients about the change in psychiatrist
3. Give comprehensive handover to the psychiatrist
4. Ensure all patients have appointment

Answer 179

Review all outstanding investigations.

Question 180

Physicians commit suicide at twice the rate of the population; what best explains this?

1. Untreated mental illness
2. Substance use
3. Stressful work environment
4. Relationship problems

Question 181

What is the most common comorbidity with gender dysphoria?

Answer 181

Adults

• depression
• anxiety disorders
• suicidality and self-harming behaviors
• substance abuse.

Children

• depressive disorders
• anxiety disorders
• impulse-control disorders.

Question 182

What is most indicative of a 5 year old with developmental concerns?

1. Can’t print his own name
2. Can’t ride a tricycle
3. Can’t use logic
4. Can’t take turns

Answer 182

Can’t ride a tricycle

Question 183

What is common to MiniCog and MMSE?

1. Three word recall
2. Drawing 2 pentagons
3. Orientation
4. Following commands

Answer 183

Three word recall

Question 184

Lady talking about sex in church and only eating white food. MMSE 29/30. Family history includes multiple members with earlier onset dementia. What can you treat with?

1. Citalopram
2. Donepezil
3. Risperidone

Answer 184

Citalopram

*In FTD, Citalopram or Trazodone as initial pharmacotherapy for patients with troubling behavioral symptoms

Question 185

Person with Parkinsons and moderate dementia. Which will improve cognition and ADL’s?

1. Pimavanserin
2. Pramipexole
3. Rivastigmine

Answer 185

Rivastigimine

*Rivastigmine appears to moderately improve cognition and to a lesser extent activities of daily living in patients with PDD

Question 186

Delirious lady in ICU. Aggressive. Team calls you to ask what to give for PRN to facilitate an abdo CT? She has elevated qTC 526ms and is on polypharmacy.

1. Haldol (it did not say PO or IV, just haldol)
2. Abilify
3. Lorazepam
4. Quetiapine

Answer 186

Lorazepam IF goal is just getting them to CT

Abilify IF goal is treating delirium

If it says prolonged QTC, stay away from Haldol*

*Note:Aripiprazole may cause a decrease in the QTc interval. This makes it an attractive option in ICU patients that often have multiple risk factors for QTc interval prolongation

Question 187

Person with IBS, referred by gastroenterology. Patient worried will shit himself in public and although understands this is unlikely (no accidents in years), he avoids public transportation, waiting in line, and elevators. Most likely diagnosis?

1. Agoraphobia
2. Social anxiety
3. Illness anxiety disorder
4. Somatic Symptom disorder

Answer 187

Agoraphobia

Question 188

Woman with IBS, comes to you for tx related to fear of elevators. She is also fearful of buses and public, where she feels she will be unable to escape to a bathroom if necessary. She has never had an incident where she hasn’t made it to the bathroom and recognizes the dissonance. She just doesn’t think she can stand the humiliation should this occur. Most likely dx?

1. Agoraphobia
2. Social anxiety
3. GAD
4. Panic

Answer 188

Agoraphobia

Question 189

Person with trisomy 21. What is expected?

1. Intellectual development normal until 10 years old
2. Intact social skills in early years
3. Behaviour normal until 10
4. Normal language development

Answer 189

Intact social skills in early years

Question 190

How to calculate odds ratio

Answer 190

Question 191

Young University student needing a note for missing a test at school. Social isolation, feels lonely, concerned about meeting expectations of professors. What is the temperament?

1. harm avoidance
2. reward dependent
3. novelty seeking
4. persistence

Answer 191

harm avoidance

Question 192

What is the essential component of brief psychodynamic?

1. early corrective emotional experience by early transference interpretation
2. systematic analysis

Answer 192

Correct: early corrective emotional experience by early transference interpretation

Recall that systematic analysis = psychoanalysis

Question 193

What leads to the most stigma for mental illness in the world?

1. Rural location
2. being in an Islamic country
3. being male
4. having a diagnosis of schizophrenia

Answer 193

Having a diagnosis of schizophrenia

Note that:

• stigma may be lesss sevre in Asian and African countries/ islamic
• Women and people living in rural areas more stigmatized
• men more discrimination in job, women moreso in family/spcial areas

Question 194

Middle aged lady, has OCD and is housebound. Taking Prozac 80mg and somewhat improved. Leaving house to attend CBT but still can’t return to work. What should you use to augment?

1. Aripripazole
2. Clonazepam
3. D-amphetemine
4. Mirtazepine

Answer 194

Aripiprazole

OCD Adjunctive Agents

1st abilify, risperidone

2^nd: quetiapine, topiramate, memantine

3^rd: amisulpride, celecoxib, citalopram, Haldol, IV ketamine, granisetron, ketamine, mirtaz, NAC, olanzapine, odansetron, pindolol, pregabalin, riluzole, zipras

NOT: buspirone, clonza

Question 195

What are first line adjunctive agents in OCD?

Answer 195

Abilify

RIsperidone

Question 196

Bipolar 45 year old gentleman. CKD from long term lithium. No longer taking lithium. Started Epival but is now depressed. You are starting lamictal, what should you do?

1. Halve starting dose of lamictal
2. Double Epival
3. Halve epival
4. double starting dose of Lamictal

Answer 196

Halve starting dose of lamictal

(as epival increases lamotrigine levels)

Question 197

Lady on lithium now requiring anti hypertensive medication. Renal function ok. What would be appropriate?

1. Amlodipine
2. losartan
3. Ramipril
4. HCTZ

Answer 197

Amlodipine (doesnt act on kidney)

*note that thiazides are the worst

Question 198

Which anxiety disorder has the latest (average age of) onset?

1. panic d/o
2. social anxiety disorder
3. specific phobia
4. separation anxiety

Answer 198

Age of onset, as per “the age of onset of anxiety disorders: a meta-analysis” 2017, Canadian Journal of Psychiatry (https://doi.org/10.1177/0706743716640757)

youngest => oldest age of onset:

1. Separation anxiety
2. Specific phobia
3. SAD
4. OCD
5. Panic disorder
6. GAD

Question 199

Gentleman from the army discharged 2 months ago due to behavioural symptoms. Had previously been in combat. Had a concussion. Reports multiple symptoms (note: the stem does not specify symptoms). Which symptom is the best to CLARIFY the diagnosis of PTSD?

1. Nightmares
2. loss of concentration
3. Loss of interest in activities
4. Aggressive outbursts

Answer 199

Nightmares

Question 200

. 6 year old presents with mother. Since infancy, 18 months, has had repetitive, purposeless movements, which involve arm shaking and rotating neck/arms(?). Constant severity. Sometimes seems to enjoy movements. Can be stopped with distraction. Now bullied. What’s the diagnosis?

1. Tourette’s
2. Pure motor tic disorder
3. Stereotypic movement disorder
4. Developmental coordination disorder

Answer 200

Stereotypic movement disorder

*Note

• Stereotypic movement disorder - Repetitive, seemingly driven, and apparently purposeless motor behavior (e.g., hand shaking or waving, body rocking, head banging, self-biting, hitting own body).Interferes, occurs in early developmental period
• DCD - motor skills far below what is expected for developmental age

Question 201

Parkinson’s disease, elderly, severe fluctuating motor symptoms (often immobile, described as “freezing”). He only feels depressed when he has the symptoms above. What is the best choice to treat his depressive symptoms?

1. Pramipexole
2. Bupropion
3. Citalopram
4. Imipramine
5. Seroquel

Answer 201

Pramipexole

Question 202

What medication has most evidence for Parkinson’s Disease hallucinations?

1. Abilify
2. Seroquel
3. Clozapine
4. Risperidone

Answer 202

Clozapine

Question 203

Patient is in contemplative phase of stopping their substance use. What would you do in MI in this stage?

1. Developing discrepancy between current behaviour and ideal
2. Making plans to prevent relapse
3. Making plan to stop using
4. Confronting denial with diplomacy

Answer 203

Developing discrepancy between current behaviour and ideal

Question 204

You have a young teen, on fluoxetine at max dose, for long enough time, and poor results. What is second line for adolescent depression according to CANMAT?

1. Venlafaxine
2. Paroxetine
3. Escitalopram
4. Desipramine

Answer 204

Escitalopram

Question 205

Patient admitted with inability to walk, secondary to pain. During admission she is seen walking across the room to charge her cell phone and did not appear in distress. You later learn that she has a court date in 2 days. Diagnosis?

1. Somatic symptom disorder
2. Factitious disorder
3. Malingering
4. Illness anxiety disorder

Answer 205

Malingering

Question 206

What is not true about how structural family therapy would define a healthy family?

1. Hierarchies and boundaries
2. Triangulation of conflict through the child
3. Absence of alliances crossing intergenerational boundaries

Answer 206

Triangulation of conflict through the child

• In a structural model, families are viewed as single, interrelated systems assessed in terms of significant alliances and splits among family members, hierarchy of power (parents in charge of children), clarity and firmness of boundaries between the generations, and family tolerance for one another. The structural model uses concurrent individual and family therapy.

Question 207

Stem talks about GABA and its dysregulation in schizophrenia. The answers talked about how GABA or glutamate function impact the differing dopamine pathways in the brain to cause symptoms. You can get the answer by knowing where the symptoms are and the dopamine pathway as they are listed in the answer Question- where are negative symptoms?

1. Mesolimbic
2. Mesocoritcal
3. Nigrostriatal
4. Tuberoinfundibular.

Answer 207

Mesocortical = negative symptoms

• Decreased dopamine in the mesocortical projection to the dorsolateral prefrontal cortex is postulated to be responsible for negative and depressive symptoms of schizophrenia
• ++ dopamine in ML  = psychotic symptoms
• Blockade of dopamine in NS – dystonia, parkinsonian symptoms, akathisa
  
  • ++ dopamine in NS – hyperkinetic movements chorea
• Blockade of D2 in TI - hyperprolactinemia

Question 208

A middle age male with 4 weeks of paranoia, agitation, confusion. Also has jaundice, increased LFTs, hemolysis, drooling, and coarse tremor. What would you check to confirm the diagnosis?

1. Ferritin
2. Ceruloplasmin
3. B12

Answer 208

Ceruplasmin

• If you have Wilson disease, your ceruloplasmin level will probably be below 10 mg/dL.

Question 209

Young female lawyer, ADHD, difficulty at work due to inattention. Previously had intolerable side effects on two meds from methylphenidate class. What is the next FIRST LINE treatment you would try?

1. Lisdexamphetamine
2. Atomoxetine
3. Bupropion
4. Methylphenidate IR

Answer 209

Lisdexamphetamine

Question 210

71 M with Bipolar 1, on Li, level 0.65, no side effects from Li. Endorses low mood, anhedonia, low energy. What to do next?

1. Change to DVP
2. Increase Li
3. Add Bupropion
4. add lamotrigine

Answer 210

Increase lithium

Question 211

Tx for trichotillomania?

1. ERP
2. Habit reversal
3. Desensitization

Answer 211

Habit reversal

Question 212

Perimenopausal woman with depressive symptoms and hot flashes. Was started on SSRI (?escitalopram), depression improved, but continues to experience hot flashes. What is the best management?

1. Add HRT
2. Change to SNRI

Answer 212

Add HRT

Question 213

A taxi driver is terrified of running over pedestrians. He constantly checks the rear view mirror to see if he hit anyone. He sometimes drives around the block back to the scene of the “accident” to make sure no one is there. He drives slowly in heavily trafficked areas to reduce the chances of hitting someone. He feels better when there are passengers in the taxi because he figures they would tell him if he hit someone. Which of the following is a safety signal or safety behaviour? (note: this last sentence is word for word what was on the exam, including the “or”).

1. Checking the rear-view mirror.
2. Driving around the block to check.
3. Driving with passengers in the taxi.
4. Driving slowly.

Answer 213

Driving with passengers in the taxi.

Question 214

You are seeing a 35M with Down Syndrome. His mother is concerned because he has been having lapses of memory lately. He is having trouble naming things and recalling recent events. You ask him orientation questions, and he is oriented to year and month. He has never been able to remember the date. What is the most likely diagnosis?

1. Alzheimer’s Dementia.
2. Major depressive disorder.
3. TBI.
4. Delirium.

Answer 214

Alzheimer’s

Question 215

A 28M is coming to see you concerned he has ADHD even though he never had any symptoms as a child. He has been having difficulty focusing at work. His disorganization is severe enough to be impacting his relationships. He completes an ADHD self-assessment tool and scores in the severe range. What is the best next step?

1. Reassure him that he does not have ADHD because he had no childhood symptoms.
2. Complete psychiatric review of systems to screen for comorbid disorders.
3. Start a long-acting stimulant, because if he responds it will confirm the diagnosis of ADHD.

Answer 215

Complete psychiatric review of systems to screen for comorbid disorders.

Question 216

You are seeing a 25F with chronic SI, self-harm, chronic feelings of emptiness, and outbursts of inappropriate anger. She was told recently by her boss that she might be fired due to interpersonal difficulties she is having at work. She is doing DBT. Which of the following is least likely to improve with the DBT?

1. Self-harm.
2. Anger outbursts.
3. Feelings of Emptiness.
4. Work problems

Answer 216

Feelings of Emptiness.

*DBT has no evidence for core features of BPD

Question 217

You receive a call from the mother of a 28F you are following who is under the authority of a criminal review board, after being found NCR following charges of physical assault. The mother is very concerned because the patient expressed HI towards her roommate, who she believes is poisoning her. The patient has been abusing alcohol. She has taken a variety of antipsychotics (or maybe it said she is currently taking a variety of antipsychotics). You admit her involuntarily. What is the most important step to take? (does not say first step, just most important)

1. Inform the review board.
2. Warn the roommate.
3. Treat her alcohol use disorder.
4. Start clozapine.

Answer 217

Tricky question.

If you are the forensic psychiatrist, you would manage the pt for up to a week and if it’s longer than a week you contact RB.

If you are a general psych, you need to contact the fprensic program caring for the patient.

Question 218

Nicotine dependence:

a. Nicotine is an indirect agonist of the dopamine receptor b. Nicotine is a selective agonist of the nicotinic cholinergic receptor
c. Nicotine is a selective antagonist of the nicotinic cholinergic receptor
d. Nicotine is a partial agonist and antagonist of the acetylcholine receptor

Answer 218

Nicotine is a selective agonist of the nicotinic cholinergic receptor

Question 219

In a woman with postpartum psychosis, what is the risk of same in subsequent pregnancies?

Answer 219

40-50% if not treated

Question 220

Which mood stablizer is a) ideal in breastfeeding and b) which is less preferable?

Answer 220

a) Valproate or atypical antipsychotics (ziprasidone and quetiapine less preferable according to ACOG)
b) Lithium - not recommended, but some studies recently showing overall risk to baby is low. If it is used in breastfeeding, must monitor Li levels of fetus as well as mother

Question 221

Least likely to have late onset in anxiety d/o

1. Panic
2. Social phobia
3. GAD
4. Agoraphobia

Answer 221

Panic

Question 222

Man with GAD, partially treated with paroxetine, has mild obesity and Type 2 diabetes controlled by diet, hypercholesterolemia as well as OSA. Couldn’t tolerate SSRI or SNRI. What would you switch to for treatment of GAD?

1. Imipramine
2. Quetiapine
3. lorazepam
4. Buspirone

Answer 222

Buspirone

Question 223

What are the 4 problem areas of focus in IPT?

Answer 223

Grief

Role Dispute

Role Transition

Interpersonal Defiicts

Question 224

What are factors indicating a good candidate for psychodynamic psychotherapy/expressive therapy?

Answer 224

Signfiicant Suffeirng

Strong motivation to understand, persevere and change

Psychological mindedness

Ego Strength

Ability to form relationship

Question 225

In what conditions does IPT have best evidence?

Answer 225

• Depression (acute, recurrent, maintenance, subsyndromal, geriatric, adolescent, HIV+, postpartum, antepartum)
• Adjunctive Tx in BAD
• Bulimia
• Initial/limited evidence in
  
  • Dysthymic disorder
  • Social phobia
  • PTSD

Question 226

What is your approach to management of serotonin syndrome?

Answer 226

• Stop offending agent
• Admit to ICU
  
  • Provide supportive care - airway, fever, fluids
• Involve CL psych early
• Possibly use cyproheptadine (5HT2a-blocker) or benzos

Question 227

You are treating a 34M with schizophrenia. In his last episode of psychosis he stabbed a neighbor who he thought was the devil. He has been stable for the last 6 months on Invega IM q4wks. Recently he has begun to complain of gynecomastia and galactorrhea. You check PRL, which is high. You are convinced that the symptoms are a side-effect of his medication. What is the best initial step?

1. Add Abilify.
2. Switch to Seroquel.
3. Switch to Zuclopenthixol.
4. Repeat PRL in 3 months.

Answer 227

Add Abilify

• Abilify is a partial D2 receptor agonist, has been reported to improve AP-related HPL
• Seroquel is not long acting
• Zuclopenthixol good because long acting, but also can cause HPL
• No need to repeat PRL, as of little clinical benefit, and he is symptomatic

Question 228

You see a 42F who drinks 3 glasses of wine each night. She reports restless sleeps with frequent awakenings. You suggest to her that the alcohol may be to blame and that she should consider abstinence. She says, “I tried that once for a week and my sleep became worse and I was having weird dreams. It got better after I started drinking again.” What is the most likely explanation for this?

1. Resuming alcohol treated mild withdrawal symptoms.
2. She never stopped alcohol and is concealing a substance use disorder.
3. She has insomnia disorder and is therefore overestimating her periods of awakenings and underestimating her periods of sleep.
4. Alcohol reduces her sleep latency.

Answer 228

Resuming alcohol treated mild withdrawal symptoms.

Question 229

How to calculate specificity?

Answer 229

1. Sensitivity: A/(A+C) × 100.
2. Specificity: D/(D+B) × 100.
3. Positive Predictive Value: A/(A+B) × 100.
4. Negative Predictive Value: D/(D+C) × 100.

Question 230

How to calculate sensitivity?

Answer 230

1. Sensitivity: A/(A+C) × 100.
2. Specificity: D/(D+B) × 100.
3. Positive Predictive Value: A/(A+B) × 100.
4. Negative Predictive Value: D/(D+C) × 100.

Question 231

How to calculate Positive predictive value?

Answer 231

1. Sensitivity: A/(A+C) × 100.
2. Specificity: D/(D+B) × 100.
3. Positive Predictive Value: A/(A+B) × 100.
4. Negative Predictive Value: D/(D+C) × 100.

Question 232

How to calculate negative predictive value?

Answer 232

1. Sensitivity: A/(A+C) × 100.
2. Specificity: D/(D+B) × 100.
3. Positive Predictive Value: A/(A+B) × 100.
4. Negative Predictive Value: D/(D+C) × 100.

Question 233

What is the definiton of specificity?

Answer 233

Specificity measures the proportion of negatives that are correctly identified (i.e. the proportion of those who do not have the condition (unaffected) who are correctly identified as not having the condition).

It is a measure of validity.

Question 234

What is the definition of sensitivity?

Answer 234

One measure of test validity is sensitivity, i.e., how accurate the screening test is in identifying disease in people who truly have the disease. When thinking about sensitivity, focus on the individuals who, in fact, really were diseased.

It is a measure of validity.

Question 235

What is the definition of positive predictive value?

Answer 235

Positive predictive value is the probability that subjects with a positive screening test truly have the disease.

Question 236

What is the definition of negative predictive value?

Answer 236

Negative predictive value is the probability that subjects with a negative screening test truly don’t have the disease.

Question 237

What is a test validity?

What is accuracy?

Answer 237

Test validity is the ability of a screening test to accurately identify diseased and non-disease individuals. An ideal screening test is exquisitely sensitive (high probability of detecting disease) and extremely specific (high probability that those without the disease will screen negative).

The validity of a screening test is based on its accuracy in identifying diseased and non-diseased persons, and this can only be determined if the accuracy of the screening test can be compared to some “gold standard” that establishes the true disease status. The gold standard might be a very accurate, but more expensive diagnostic test.

Question 238

A 26F has significant anxiety about eating and drinking in public. On a few occasions she has had episodes of intense fear with palpitations, dizziness, sweating, and trembling. She is avoiding going out in public places because she is embarrassed about these symptoms (I believe this sentence is more or less word for word what was on the exam). What is the best diagnosis?

1. Agoraphobia with panic attacks.
2. ARFID
3. Social anxiety disorder with panic attacks.
4. Panic disorder.

Answer 238

Social anxiety disorder with panic attacks.

Question 239

What is characteristic of EEG tracings at the onset of a true episode of narcolepsy?

1. low voltage high frequency waves.
2. 2-7/sec spikes.
3. generalized slowing of alpha waves.

Answer 239

1. low voltage high frequency waves.

Question 240

Lady in 30s with schizophrenia with onset 3 years ago. Which factor leads to worse prognosis?

1. Avolition
2. Her age of onset
3. Gender
4. Hallucinations

Answer 240

Avolition

Question 241

What factors are associated with a better overall prognosis in schizophrenia?

Answer 241

• being female
• rapid onset of symptoms
• older age at first episode
• predominantly positive > neg symptoms
• presence of mood symptoms
• good pre-illness functioning

Question 242

What is the most common symptom of prepubertal depression?

1. suicidality
2. decreased concentration
3. somatic complaints
4. anhedonia

Answer 242

somatic complaints

Question 243

. Lady with panic symptoms. Treating her in your office by spinning her in a chair to recreate the dizziness of her panic attacks. What is this kind of exposure called?

1. Interoceptive
2. Systematic
3. In vivo
4. In vitro

Answer 243

Interoceptive

Question 244

Lady worries constantly about family. Texting them every hour to see if they are okay. She feels it is straining her relationships. What is the best way to treat symptoms?

1. Exposure response prevention
2. Systematic desensitization
3. Habit reversal

Answer 244

Exposure response prevention

(But best option would be graded exposure if that were an option)

Question 245

Male with symptoms of PTSD, generally well treated on SSRI although continue to have recurrent nightmares. What is the first line treatment approach?

1. Propranolol
2. Prazosin
3. Quetiapine
4. Zopiclone

Answer 245

Prazosin

Question 246

Male on clozapine 600mg. What is dose dependent side effect?

1. Sialorrhea
2. Seizures
3. Torsades de pointes
4. Agranulocytosis

Answer 246

Seizures

Question 247

What is the most common presentation in neonates whose mother used SSRIs during pregnancy?

1. Neonatal adaptation syndrome
2. Persistent pulmonary hypertension of newborns
3. Cardiac defects

Answer 247

Neonatal adaptation syndrome

Question 248

New onset oppositional behaviour (describes it; no conduct features) in a 10 year-old whose parents are recently separated. Diagnosis?

1. ADHD
2. ODD
3. Conduct disorder
4. Adjustment disorder with disturbance of conduct

Answer 248

ODD if over 6 months

Could be adjustment d/o, but based on stem

Question 249

What is most appropriate treatment of anticholingergic toxidrome if it doesn’t improve with supportive care?

1. Flumazenil
2. Physostigmine
3. Dantrolene
4. Cyproheptadine

Answer 249

Physostigmine

Question 250

Woman getting separated, making friends and going to gym, you praise her for doing a good job taking care of herself, how does this fit the supportive framework?

1. Increase insight
2. Build defensive structures
3. Reduce impulsivity
4. Something about emphasizing the importance of relationships

Answer 250

Build defensive structures

Question 251

60 year old woman upset about her kid drinking and having bad friends etc, how do you validate her?

1. Nothing to worry about
2. You should just let your kid live her life!
3. You’re worried about your daughter because you care for her
4. You’re a great mother

Answer 251

You’re worried about your daughter because you care for her

Question 252

22m just out of jail after 18 mo sentence, charming, manipulative, history of legal problems back to his youth (describes ASPD to the letter). What is the most appropriate psychotherapy?

1. Group CBT
2. Group Insight oriented
3. Individual CBT
4. Individual Insight oriented

Answer 252

Group CBT

Question 253

Sudden onset blindness in 26f, what test distinguishes between psychogenic and true blindness?

1. Visual Evoked Potentials
2. EEG
3. MRI of optic chiasm
4. Digital retinal scan

Answer 253

Visual Evoked Potentials

Question 254

Middle aged lady, married. Believes that her husband is poisoning her coffee. Actually had her coffee tested, negative for contaminants. Still suspicious of her husband. Able to maintain employment. What’s the diagnosis?

1. Schizophrenia
2. Delusional disorder
3. Schizophreniform
4. Brief psychotic disorder

Answer 254

Delusional DIsorder

Question 255

Stem described a lady with fever, muscle stiffness, hypertension, tachycardia, etc. She is on St. John’s Wort. She also takes a med for migraines. What medication for her migraines is responsible for her presentation?

1. NSAIDs
2. Triptan
3. Propranolol

Answer 255

Triptans

St John’s wort (SJW) interacts with triptans (sumatriptan, naratriptan, rizatriptan, zolmitriptan) and may lead to increased serotonergic effects with an increased incidence of adverse reactions. If a patient is taking SJW and triptans it is advised that the patient stops taking SJW.

Question 256

Male with rapid cycling bipolar disorder (4 episodes/ year). On epival. Gives level, which is high end of normal. What is the most important thing to check for this case?

1. Liver
2. Thyroid
3. CBC

Answer 256

Thyroid

Question 257

A patient is on Abilify 15mg and Wellbutrin is added for depression. They suddenly develop restlessness and insomnia. What to do next?

1. Stop Wellbutrin
2. Decrease Abilify
3. Add propranolol

Answer 257

Decrease Abilify

Because Abilify is metabolized by CYP2D6, and Bupropion inhibits 2D6, leading to increased level of Abilify.

Question 258

Man with 2 yr history of depressed mood with hopelessness and insomnia most of the time. Several episodes of hypomanic symptoms lasting 2-3 days. Diagnosis?

a) Unspecified bipolar
b) Cyclothymia
c) Bipolar II
d) Other specified bipolar, depressed mood with insufficient symptoms to meet hypomania

Answer 258

Cyclothymia

Question 259

Female patient has episodes of impulsivity/euphoria/lack of sleep that last about 1 day at a time. She also experience recurrent suicidal thoughts, usually in the context of an interpersonal events and has been hearing a voice on/off saying her name for years. What is the most likely diagnosis?

1. Borderline personality disorder
2. Bipolar disorder
3. schizophrenia
4. Schizoaffective disorder

Answer 259

BPD

Question 260

You see a patient in DBT who uses cannabis regularly/alcohol occasionally, self-harms and is often late to sessions. Which of the following is an example of a therapy interfering behaviour?

1. Self-harm
2. Being late to sessions
3. substance use

Answer 260

Being late to sessions

Question 261

A guy with PTSD on Sertraline, is still struggling to sleep. He asks if he can have a prescription for cannabis. What do tell him?

1. You will refer him to a cannabis specialist
2. There is little evidence for cannabis in treating PTSD.
3. Nabilone is better as it’s a synthetic
4. Give him cannabis with low THC:CBD ratio to reduce the psychoactive effects.

Answer 261

There is little evidence for cannabis in treating PTSD.

Question 262

Creator of new psychotherapy for patients with schizophrenia. He uses the new therapy on 50 patients in a study. Another 50 patients receive no treatment. He finds the patients subjected to the psychotherapy respond (statistically significant). What is the major limitation to the study?

1. No active control group
2. Small sample size
3. Only one individual providing the therapy

Answer 262

No active control group

Question 263

What is an aspect of IPT?

1. Communication analysis
2. Supporting defense mechanisms
3. Interpreting transference

Answer 263

Communication Analysis

Question 264

An adolescent girl is admitted with an overdose on acetaminophen. Prior to this she had been defying rules in the household. She and her mother had a fight and are no longer talking. You see them in ER. What do you advise initially?

1. Help her mother show parental warmth
2. Lecture girl
3. Help mother set firm boundaries and consequences

Answer 264

Help mother set firm boundaries and consequences

Question 265

Patient with OCD on fluoxetine, teenager. Best drug to augment?

Answer 265

Risperidone

or Abilify

Question 266

Patient in hospital with depression, on HCTZ, propranolol, clonazepam and warfarin. You want to start citalopram. What is the biggest risk?

1. Bleeding
2. Prolonged QTc
3. Serotonin syndrome

Answer 266

Bleeding

• ROCKET AF trial - no significant increase in bleeding risk when SSRIs were combined with anticoagulant therapy, although there was a suggestion of increased bleeding risk with SSRIs added to warfarin.
• SSRIs have been shown to be associated with an increase in INR when combined with warfarin treatment: https://www2.gov.bc.ca/assets/gov/health/practitioner-pro/bc-guidelines/warfarinmgmt_2015_full.pdf

Question 267

Bipolar patient recovered from manic episode. What is the best psychotherapy to offer?

1. Psychoed
2. IPSRT
3. Peer support
4. MBCT

Answer 267

Psychoeducation

In maintenance, psychoed is first line

In depression, no first line, but CBT and FFT are second line

Question 268

New mother with new onset intrusive thoughts about baby and compulsions and constant reassurance seeking. What is the best treatment?

1. Have her care for baby and prevent reassurance
2. Stop having her care for the baby

Answer 268

Have her care for baby and prevent reassurance

Question 269

Hyperthermia, HTN, tachycardia, anxiety. Likely diagnosis?

1. Hyperthyroidism
2. Hyperparathyroidism

Answer 269

Hyperthyroid

Symptoms of hyperparathyroidism woul include joint pain, muscle weakness, fatigue, brain fog, memory loss, anxiety, depression, heartburn, constipation

Question 270

Lady with cognitive impairment, urinary incontinence and shuffling gait. What is she likely to have in her history?

1. Something medical
2. Hemorrhagic stroke
3. Multiple sexual partners
4. Fam hx of dementia

Answer 270

Hemorrhagic stroke

Normal Pressure Hydrocephalus

Question 271

What is the best epidemiological value to use to estimate new cases of depression in students enrolled in a university?

1. incidence
2. prevalence
3. odds ratio
4. risk ratio

Answer 271

Incidence

Question 272

Patient NCR with conditional discharge and hospital-delegate authority, now non-adherent to meds and breaching conditions of discharge. You assess in emergency room. What do you do?

1. Inform the review board of the breach
2. Admit to hospital using delegate authority

Answer 272

Ugh, bad question. We would admit to hospital, and then inform the forensic dept looking after patient.

Question 273

Child with severe ADHD with lots of impairment as well as tics which are mild and not that bothersome, except some bullying in last 6 months. What do you advise parents?

1. Atomoxetine is 1^st line, long acting stimulants 2^nd line
2. Long acting stimulant still first line
3. Long acting stimulants contraindicated
4. Clonidine

Answer 273

Long acting stimulant still first line

Question 274

What is the first step in treatment for Social Anxiety Disorder?

1. Hierarchy construction
2. Graded exposure
3. Social experiment

Answer 274

Hierarchy construction

Question 275

Lady with zips down her arms, irritability and insomnia. What is happening?

Answer 275

Paroxetine withdrawal

Question 276

Depression, anemia, confusion, neuropathy. What is deficient?

1. B12
2. B6

Answer 276

B12, however is MAOI was involved then it would be B6

Question 277

Man with PKU following proper diet since birth now wanting to have children. What is the risk of transmission to his children?

1. 50%
2. 25%
3. almost zero

Answer 277

almost 0%

Question 278

Child with conduct disorder harming others at school. What do you recommend?

1. Encourage pressing charges
2. Develop a school/home/police resource officer safety plan
3. CBT
4. Insight

Answer 278

Develop a school/home/police resource officer safety plan

Question 279

Young male with severe depression treated with fluoxetine 40 mg. A week ago you added risperidone 1 mg. He now presents with 2 days of mutism, negativity, staring. What do you do?

1. Decrease fluoxetine
2. Increase risperidone
3. Add lorazepam

Answer 279

Add lorazepam

Question 280

Guy exposing himself to the nurses and sexually inappropriate. Has a history of charges for indecent exposure. Nurses want you to treat him. What do you do?

1. Find out how many people he has exposed himself to
2. Treat without permission because this is dangerous
3. Speak to the patient to see if they want treatment/get consent
4. ECG

Answer 280

Discuss with the patient and see if he wants treatment

Question 281

Best benzo in liver failure.

1. Lorazepam
2. Clonazepam
3. Alprazolam
4. Diazepam

Answer 281

Lorazepam

(or any other in LOT)

Question 282

Patient with schizophrenia on risperidone 6mg x 8 weeks, still has symptoms. Previous failed adequate trial of quetiapine. Patient has history of aggression. What next?

Answer 282

Clozapine

Question 283

What is expected in developmental trajectory of child with Down Syndrome.

a) Social skills weakness before age 10
b) Early normal development, then regression
c) Good behaviour at home when young
d) Trouble with math

Answer 283

Good behaviour at home when young

*could also be “language skills are weakness”, “greater degree of behavioural issues after age 10”

Question 284

Patient has been doing psychodynamic x2 years with no improvement. Thinks highly of therapist. This is:

a) Transference neurosis
b) Good transference
c) Decreasing resistance

Answer 284

Transference neurosis

Question 285

Patient with LBD, visual hallucinations, parkinsonism. What to give?

a) Risperidone
b) Citalopram
c) Acetylcholinesterase inhibitor
d) Quetiapine

Answer 285

Acetylcholinesterase inhibitor

(Note that cholinesterase inhibitors are efficacious in DLB, with reported benefit not only in cognition, but also for fluctuations, psychotic symptoms, and parkinsonian symptoms.)

Question 286

Young adult in outpatients has psychotic depression, on risperidone and an SSRI. Now sitting staring into space for hours, posturing. What to do first?

a) Increase risperidone
b) Add lorazepam

Answer 286

Add lorazepam

Question 287

Patient is on VPA. Presents with ataxia, confusion, blurred vision. Ammonia level is high. VPA level is normal. What to do?

a) D/c VPA
b) Increase VPA
c) Thiamine
d) Repeat VPA level

Answer 287

DC VPA

If serum ammonia is increased, epival should be discontinued (straight from monograph)

Question 288

Patient with severe parkinson’s disease requests MAID because suffering from symptoms. Neuro thinks ECT would help, but pt refuses. Hx of MDD, not depressed now. Is French, but living in Canada. Biggest reason not eligible?

a) Death not imminent
b) Refusing ECT
c) Not Canadian citizen

Answer 288

Not Canadian citizen

(You must be eligible for health services in Canada for MAID)

BUT if Canadian resident, “death not imminent” would be acceptable, because CMPA says death should be imminent in 6-12 months

Question 289

What would be seen on neuroimaging in schizophrenia?

a) Increased amygdala
b) Decreased hippocampus
c) Decreased ventricle size

Answer 289

Decreased hippocampus

Question 290

59yo female with hx of schizophrenia has been stable on risperidone for several years. Her family noticed lip puckering. This is highly distressing, and the patient wants it treated. A dose reduction did not help. What has the best evidence?

a) Abilify
b) Clozapine
c) Add Cogentin
d) Add propranolol

Answer 290

Clozapine

Recall Strategies for TD

1. DC agent if possible
2. Clozapine or quetiapine
3. Clonazepam
4. Botox
5. Valbenazine/tetrabenazine
6. Trihexanphenaydl/Cogentin – not usually reccommende

Question 291

66yoF has symptoms of FTD (inappropriate sexual comments, disinhibited). Her mother died in a psychiatric institution at age 69. Her husband is embarrassed to take her outside. Treatment?

a) Citalopram
b) Risperidone
c) Memantine

Answer 291

Citalopram

Question 292

What is an example of a cenesthetic hallucination?

A) Burning in the brain

B) Alien in the bladder

C) Ants crawling on skin

Answer 292

Burning in the brain

Question 293

Girl is high achiever, getting straight As, and participates in many different programs. Staying up late to finish homework. Having difficulty waking up in the AM and falling asleep at breakfast. What is first step?

a) Sleep hygiene

B) Modafinil

C) Melatonin

d) Drug screen

Answer 293

Sleep hygiene

Question 294

What best prevents suicide on inpatients?

a) Decrease ligature access points
b) Reassess before giving passes
c) Constant observation for high risk patients
d) Account for sharps and all medications

Answer 294

Reassess before giving passes

Question 295

What’s not a first-line adjunct for depression?

a) Risperidone
b) Quetiapine
c) Abilify
d) Olanzapine

Answer 295

Olanzapine

Question 296

Middle aged man with hx of BAD type I, previously stable on Li but discontinued medication. Now presents to you as depressed and wanting to get back on treatment. Had eGFR of 50, normal lipids (LDL = 2) and blood sugar, BMI 29. Which option to treat with?

a) Quetiapine
b) Lithium
c) Olanzapine

Answer 296

Lithium – IF lamotrigine not option

If lamotrigine is option, try that.

eGFR) for these patients should be measured at least every 3-6 months.652 Since 37% of patients aged >70 years have an eGFR <60 mL/min per 1.73 m2,823 a strict eGFR cut-off for lithium discontinuation is difficult. The UK National Institute for Healthcare and Excellence (NICE) guidelines for chronic kidney disease (CKD) recommend nephrologist consul- tation if there is rapidly declining eGFR (>5 mL/min per 1.73 m2 in 1 year, or >10 mL/min per 1.73 m2 within 5 years), if the eGFR falls below 45 in two consecutive readings, or if the clinician is concerned

Question 297

Patient announces that she is dropping out of group DBT. Has had poor engagement so far. At last session tells group “I hope you treat the next person as badly as you did me.” Group gets mad. What is this?

a) Projection
b) Abreaction
c) Catharsis
d) Universality

Answer 297

Projection

Question 298

What is abreaction?

Answer 298

the therapeutic process of bringing forgotten or inhibited material (i.e., experiences, memories) from the unconscious into consciousness, with concurrent emotional release and discharge of tension and anxiety.

Question 299

18yo had ADHD. Has been using cannabis daily x 6 months. Doing badly in school. What to do first?

a) Lisdexamphetamine
b) MI
c) Clonidine

Answer 299

Lisdexamphetamine

Recall, In most cases, ADHD and SUD need to be treated concurrently and independently when comorbid. But if it’s cocaine use, then no stimulant.

Question 300

EEG findings in delirium

Answer 300

Decreased alpha and generalized delta theta.

Question 301

Young female pt with gender dysphoria with severe anxiety. Which drug to treat?

a) GnRH agonist
b) Testosterone
c) Trazodone

Answer 301

GNRH agoinist

• Hormonal intervention to suppress puberty
• Youth with feelings of intense gender dysphoria are at risk for adverse psychosocial outcomes.

Question 302

Which is best for patient worried about sexual side effects. Failed SSRI/SNRI, no effect buproprion/mirtazapine.

a) desipramine
b) fluoxetine
c) selegeline
d) duloxetine

Answer 302

Selegeline

• Desipramine >2%
• Selegeline <2%
• Fluox 30%
• Duloxetine >30%
• Mirtazapine >2%
• Buproprion <2%

Question 303

Patient overweight, GI bleed, hypertension, atypical depression. Best antidepressant:

a) venlafaxine
b) moclobemide
c) phenelzineu
d) fluoxetine

Answer 303

Moclobemide

• Venlafaxine and Fluox risk of HTN
• Irreversible MAOIS always risk HTN crisis when ingested with tyrosine
• Venlafax and Flux small risk of GI bleed 1 in 300 pt years
• Atypical depression – MAOs may have superiority
• Still very small risk of htn crisis with Moclobemide even thnogh reversible

Question 304

EEG change prior to narcolepsy attack:

a) 5-7sec/cycle spike
b) decreased amplitude, high frequency waves

Answer 304

Decreased amplitude, high frequency waves

Question 305

Guy with delayed phase sleep disorder, in addition to morning phototherapy, what intervention. May lose job because unable to function in morning?

a) graded increases modafinil
b) melatonin pm

Answer 305

Melatonin PM

• Before modafinil

Question 306

Least anticholinergic antidepressant:

a) doxepine
b) amitriptyline
c) nortiptyline

Answer 306

Nortriptyline

Question 307

Young woman with ADHD, failed 2 long acting methylphenidate medications because loss appetite, insomnia, weight loss. Next FIRST line option

a) atomoxetine
b) Long acting amphetamine (Vyvanse)

Answer 307

Long acting amphetamine (Vyvanse)

Question 308

1. Starting a kid on Atomoxetine, what would you tell parents about this medication, the most important piece of information:
2. Low effect size
3. Increased blood pressure and heart rate
4. Suicidal ideations
5. Helps with tics

Answer 308

SI

Question 309

Talking to parents informed consent re: bipolar disorder in adolescents and valproic acid. You should include:

a) liver toxicity is a common side effect
b) there is little evidence on efficacy of VPA in adolescents
c) there are case studies of polycystic ovarian syndrome
d) prescribed off label in adolescents

Answer 309

PCOS if adolescent girl

Off-label could also be a reasonable answer

Question 310

Which of the following is not a defence mechanism?

a) fixation
b) conversion
c) sublimation

Answer 310

Fixation

Question 311

Woman who is 6 weeks pregnant. 6 months ago she had a 1 month manic episode, she is 6 weeks pregnant. What to do with Lithium?

a) Half lithium dose until second trimester
b) Discontinue Lithium until second trimester
c) Start lamotrigine
d) Continue lithium at therapeutic dose

Answer 311

Continue lithium at therapeutic dose

Question 312

What is risk of lithium during pregnancy?

Answer 312

• Risk of Ebstein Abnormality 1st trimester
• Recently, found that this defect only occurs in less than 1% of exposed children.
• Also been associated with perinatal toxicity, including case reports of hypotonia, cyanosis, neonatal goiter, and diabetes insipidus.
• In severe BD, risk of recurrence may overshadow risk of Ebstein
• For women with significant periods of euthymia and few past mood episodes, slowly tapering off lithium and reintroducing lithium after the first trimester may help reduce the risk of relapse.

Question 313

16 year old adolescent. Repeated depressions and serious suicide attempts, has not responded to pharmacotherapy. Team is curious about ECT. What is true?

a) She will likely respond and has no contraindications to ECT
b) She will likely respond, but require higher stimulus than adults
c) She will not respond

Answer 313

She will likely respond and has no contraindications to ECT

• ECT use in adolescents is considered a highly efficient option for treating several psychiatric disorders, achieving high remission rates, and presenting few and relatively benign adverse effects.
• Increase risk of prolonged seizures, lower seizure threshold – you would not increase stimulus

Question 314

Therapist finds she is looking forward to specific patient’s appointments. Spends extra time getting ready before and always extends appointment by 15 minutes. Realizes she is attracted to patient. Most appropriate next step?

a) consult with colleague
b) transfer patient
c) disclose feelings to patient
d) write feelings in chart

Answer 314

consult with colleague

Question 315

Patient with recent stroke is having episodes of spontaneous crying and is very embarrassed. No depressive symptoms. She is avoiding going out because of episodes. Best treatment?

a) nortiptyline
b) citalopram
c) Risperidone
d) Trazodone

Answer 315

Nortriptyline OR citalopram

Treatment of PBA

TCAs (nortrip, amitrip)

SSRIs fluox, citalopram, setraline

Dextromethorphan-quinidine

Question 316

Patient with ASD has significant irritability. Best intervention?

a) Risperidone
b) Clonidine

Answer 316

Risperidone

Question 317

Best evidence for managing agitation in mild to moderate dementia

a) trazodone
b) risperidone
c) citalopram

Answer 317

Risperidone

(even better than citalopram)

Question 318

Patient with BPD, what will be a component of her management?

Answer 318

Chain Analysis

Question 319

What is part of the initial phase of IPT for role transition?

a) Grieve old role
b) discuss benefits new role
c) identify role transition

Answer 319

identify role transition

Question 320

Patient with antisocial PD released from jail. Best therapy?

a) Mindfulness based stress reduction
b) insight oriented therapy
c) Group CBT
d) group problem solving

Answer 320

Group CBT

Question 321

Indication for supportive therapy?

a) Ego deficits
b) Has high frustration tolerance
c) Has good interpersonal relationships

Answer 321

Ego Deficits

• Supportive psychotherapy is generally indicated for those patients for whom classic psychoanalysis or insight-oriented psychoanalytic psychotherapy is typically contraindicated—those who have poor ego strength and whose potential for decompensation is high

Question 322

24. First step in patient with social anxiety disorder.
    a) graded exposure
    b) systematic hierarchy

Answer 322

systematic hierarchy

Question 323

Patient is taught relaxation techniques which are paired with stimulus of dogs, increasing from thoughts to handling dogs. This is an example of?

a) graded exposure
b) systemic desensitization

Answer 323

systemic desensitization

Question 324

28. Lady looks into mirror and thinks her nose is deformed. Checking repeatedly. Doesn’t interact with others due to feeling that they would make fun of her looks. Functioning impaired. Diagnosis.
    a. BDD
    b. OCD
    c. Delusional Disorder somatic subtype

Answer 324

BDD

Question 325

86. 27♂ paramedic off work, not trying to get back to work, irritable, hearing voices, improving, sleeping, paranoid, aggressive when irritable. Which of the following is the diagnosis?
    a. PTSD

b. Psychosis
c. Malingering

d. MDD

Answer 325

PTSD

Question 326

What is a mono therapy for bipolar depression?

a) Quetiapine
b) Olanzapine
c) Risperidone

Answer 326

Quetiapine

First line monotherapy maintenance, acute, prevention, mania

Question 327

What is the NNT? 50% response rate tx and 30% response rate in untreated

Answer 327

5

• NNT = 1/ARR
• ARR = CER (Control Event Rate) – EER (Experimental Event Rate).

Question 328

Which area is hyperactive during PTSD flashback?

a) Broca
b) Thalamus
c) DLPFC
d) Amygdala

Answer 328

Amygdala

(but also hippocampus)

Question 329

102. Nursing home guy shakes hand, crying, laughing, crying, (emotional incontinence/pseudobulbar affect) anxious.
103. Parkinson’s disease
104. ALS
105. Myotonic dystrophy
106. Temporal Lobe Epilepsy

Answer 329

ALS

Note that PBA is seen in many neurologic disorders

Question 330

9. 45 ♀ changed personality, angry, aggressive, striking her kids, has developed shoulder and arm movement, also memory loss and cognitive impairment, which one of the following disorders is most likely present in her family.
   a. Huntington’s
   b. Alzheimer’s

c. MS
d. FTD

Answer 330

Huntington’s

Depression and irirtability often predate motor symptoms

Question 331

Best evidence to treat visual hallucinations in Parkinson’s’?

Answer 331

CLozapine

Question 332

How to tell between conversion and real blindness?

a) visual evoked potential
b) EEG
c) CT of optic chasm

Answer 332

Visual Evoked Potential

Question 333

Young man who is charged sexual harassment. Is articulate, but cannot understand why it was wrong in behaviour. Told girl he liked her and she said she didn’t want to date him. He says that she is is best friend and likes same things as him. He doesn’t get along with boys because they only like sports

a) conduct
b) ID
c) Gender dysphoria
d) ASD

Answer 333

ASD

Question 334

Hoarding, overeating, OCD and ADHD

a) Prader Willi
b) Williams
c) Angelmann

Answer 334

Prader WIlli

Question 335

Lax joints, machroorchidism. Has ADHD. Large jaw and ears.

a) Fragile X
b) Fetal alcohol

Answer 335

Fragile X

Question 336

Treatment of tic disorder. Best evidence?

a) exposure response prevention
b) habit reversal

Answer 336

Habit Reversal

Question 337

• 16 year old ♂ who is using substantial amounts of the drugs cocaine and amphetamine. Mom notices tics and which are also present while sleeping. He has urge to perform, able to stop voluntarily. In classroom setting he also turns around periodically while shrugging his left shoulder. What are these signs and symptoms collectively called?
• a. Dyskinesia
• b. Dystonia
• c. Tics
  d. Akathesia

Answer 337

Tics, because suppressible

Dyskinesia is more common than tics overall in cocaine use, but not usually supressible

“Possibly one of the most visually dramatic movement disorders induced by cocaine is transient chorea and buccolingual dyskinesias, known in street slang as “crack dancing””

Question 338

6 week onset of OCD and tics. Patient had strep infection 2 months ago. Best option

a) CBT
b) Prophylactic antibiotics
c) Fluoxetine

Answer 338

CBT

(treat disorder, even if you suspect PANDAS)

AACAP treatment guidelines consider CBT or CBT + SSRI medication the first-line treatment of pediatric OCD.

Question 339

Which one doesn’t cause psychosis

a. Sildenafil

b. Interferon α
c. Retinoid
d. Anabolic steroids

e. Isoniazid

Answer 339

Sildenafil

Question 340

Which of the following is linked to a g receptor protein?

a) varenicline
b) donepizil
c) haloperidol
d) . duloxetine

Answer 340

haloperidol

Question 341

Which of the following is associated with allosteric opening of the GABA-A channels.

a) alprazolam
b) buspar
c) baclofen

Answer 341

Alprazolam

• The GABA positive allosteric modulators used in clinical practice fall under four categories: benzodiazepines, barbiturates, ethanol, and induction anesthetics. There are also drugs used to treat insomnia, e.g., zolpidem.
• Baclofen is GABA B

Question 342

Which of the following is not true re: delusional disorder?

a) M>F
b) May be an indicator of neurocog disorder
c) Not increased w/ life stressors

Answer 342

a) M>F

• Slight more F>M, but very similar
• F more likely to have erotomania
• M more likely paranoid
• Pts married and employed
• Some assoc with recent immigration and low SES
• May appear to be delusional disorder, but can be an ealry sign of dementing illness
• Other Risk Factors
  
  • Advanced age
  • sensory impairment
  • isolation
  • fam hx
  • Personality featues (interpersonal sensitivity)

Question 343

Who coined “ambivalence, autism, association, affect”?

a) Bleuler
b) Schneider
c) Kraeplin

Answer 343

Bleuler

First coined the term shcizophrenia

Defined with the 4 As

Question 344

Man on Clozapine x 6 years with BMI 35. Lipids elevated, glucose normal. 1 month fatigue and shortness of breath. Next ix after exam and ECG?

1. echo
2. exercise stress
3. holter

Answer 344

Echo

• Any cardioresp symptoms –> ED
• Myocarditis fatal 1/3 of time

Question 345

Man on Clozapine. What dose dependent side effect after 600 mg?

a) seizures
b) agranulocytosis
c) drooling

Answer 345

Seizures

Question 346

Man on Clozapine started 6 weeks ago. Level 350/1050. Staring unresponsive episodes. Best intervention?

a) Hold Clozapine
b) Give benztropine
c) Give lorazepam

Answer 346

Give Lorazepam

• Side effects not generally warranting discontinuation
• Neutropenia
• Sialorrhea
• Orthostatic Hypotension
• Sedation
• Constipation
• Myoclonus
• Seizures
• Metabolic Abnormalities
• Nocturnal Enuresis
• Clozapine-induced Transaminitis

Question 347

Man with OSA plus punches wife in night. Next intervention?

a) Clonazepam
b) SSRi
c) Melatonin

Answer 347

Melatonin

• This is REM behaviour disorder
• Tx = clonazepam or melatonin
• Clonaz not good for OSA

Question 348

Treatment of somatic symptoms disorder

a) Risperidone
b) Fluoxetine

Answer 348

Fluoxetine

Question 349

Man on Lithium. Given CBZ and Naprosyn and Lamotrigine. What would indicate drug drug interaction?

a) Tender hepatomegaly/ increased liver enzymes
b) Lesions on mucous membranes
c) Dysarthria
d) Fever

Answer 349

Dysarthria

When Naproxen and Li combined can increase Li levels –> confusion, tremor, slurred speech, and vomiting

Question 350

Young male presents from school 3 days ago with hallucinations, agitation and disoriented. Given 3 mg Risperidone. Won’t eat. On 2nd day he falls asleep and wakes up back to normal with hyperphagia.

a) Cocaine intoxication
b) stimulant induced psychotic disorder
c) Bipolar mania

Answer 350

stimulant induced psychotic disorder

Question 351

Male patient with Parkinson’s develops gambling disorder. Is in 60s and hasn’t had issues with gambling since his 30s. Most important factor?

a) DA agonists
b) family history bipolar

Answer 351

Dopamine agonists

Question 352

Which has the most genetic component to predict inheritance (aka heritability)?

a) Bipolar
b) Unipolar
c) OCD

Answer 352

Bipolar Disorder

BAD 60-85% heritability

OCD 48% heritability

Question 353

Which is most likely to influence child’s chances of getting anxiety disorder?

a) parental anxiety
b) life stressor
c) parental separation

Answer 353

parental anxiety

Regardless of the mechanism, children of parents with an anxiety disorder are up to five times more likely to be diagnosed with an anxiety disorder. More specifically, parental panic disorder and major depression are associated with an increased risk for separation anxiety disorder in children

Question 354

Child with separation anxiety, what is he most at risk to develop in adulthood?

a) somatic symptoms disorder
b) GAD

Answer 354

GAD

Kids with separation anxiety disorder are at an increased risk of developing panic disorder with agoraphobia, specific phobia, generalized anxiety disorder, OCD, pain disorder, and alcohol dependence

Question 355

Man on Ability, then started on Buproprion. Depression improved, but then he gets pacing, nausea and dec sleep. What is next step?

a) D/C buproprion
b) Decrease abilify
c) Add propranolol

Answer 355

Decrease abilify

Question 356

Woman on VPA x 6 weeks and OZP. Sx resolve, but develops tremor. Next step?

a) VPA level
b) Propranolol

Answer 356

VPA Level

Approach to VPA Tremor

• Get level
• Reduce VPA dose
• Consider DC Epival
• Propranolol can be helpful (same with Li induced tremor)

Question 357

. What is true about cross over research studies?

a) increased covariate imbalance
b) increased bias after first crossover
c) . repeated measures design

Answer 357

Repeated measures design

Question 358

Which is loosest binding to Dopamine?

a) RIsperidone
b) OZP
c) Abilify
d) Clozapine

Answer 358

Clozapine

Question 359

Woman feels like fact her company had bad quarter is all her fault. Eg. what cog distortion?

a) selective abstraction
b) catastrophizing
c) personalization

Answer 359

personalization

Question 360

Young woman withdrawn, not attending school. Saw another kid get shot last year. Has sx of PTSD. Best tx?

a) Supportive therapy
b) Start sertraline

Answer 360

Sertraline

Question 361

Young man with hypersomnia, irritability and withdrawn. Best treatment?

a) CBT
b) IPT
c) Venlafaxine
d) Paroxetine

Answer 361

CBT

Atypical features, no superiority

Question 362

Woman is 3rd trimerster. Feels depressed, has history of depression. Wants to start something, also plans to breastfeed. Best option?

a) Paroxetine
b) Sertraline
c) Fluoxetine

Answer 362

Setraline

Question 363

What is true of schizophrenia prodrome?

a) Negative symptoms
b) Psychotic sx for >1 week
c) Attenuated positive symptoms

Answer 363

APS or Negative Symptoms

Question 364

. What is true re: adolescents and cannabis?

a) use has decreased
b) use is less than tobacco
c) Cannabis is most common substance
d) Use is perceived to be low risk increasingly more

Answer 364

Use is perceived to be low risk increasingly more

Question 365

How to tell between schizoid and ASD?

a) unusual interactions
b) few relationships
c) no issues in language
d) Problem with changes/insistence on sameness

Answer 365

No issues in language

Question 366

Patient has had no change in symptoms despite seeing therapist several years. Still describes therapist in positive light. Ex of?

a) transference neurosis
b) positive therapeutic process

Answer 366

transference neurosis

Question 367

Main goal of group therapy for social anxiety?

a) Understand universality disease
b) Increased opportunity socialize
c) Learn skills to manage symptoms

Answer 367

Learn skills to manage symptoms

Question 368

95. One guy goes to group, feels now that he is not alone in his diagnosis, which

group therapeutic factor is this?

a. Universality
b. Catharsis
c. Abreaction
d. Altruism

Answer 368

Universality

Question 369

Woman 6 hours of confusion. Started asking husband where they were going, could not retain answer. Had 2 beers night before.

a) transient global amneisa
b) transient epileptic amnesia
c) substance induced amnesia

Answer 369

transient global amnesia

Question 370

Man drinks 12 beers a night, wife threatening to leave. After detox, best option? LFTs are elevated and so is MCV.

a) inpatient rehab
b) Naltrexone and gabapentin
c) Disulfaram given by wife
d) CBT for 16 weeks and relapse prevention

Answer 370

CBT

But depending on how high LFTs are, can give naltrexone (contraindicated in >2x normal)

Question 371

Man with anticholinergic toxicity from OTC sleep aids. What is treatment?

a) Phyostigmine
b) Cyproheptadine
c) flumazenil

Answer 371

Phyostigmine

Question 372

How to tell between NMS and anticholinergic?

a) hyperthermia
b) tachycardia
c) diaphoresis

Answer 372

diaphoresis

Question 373

Decreased perfusion tempoparietal lobe on PET, which disorder?

a) HIV neurocog
b) LBD
c) Alzheimer’s
d) Vascular

Answer 373

Alzheimer’s

Question 374

Man has GI symptoms after few days of Donepezil 5mg. Best next step?

a) increase dose after 4 weeks
b) CBC, RFT, lytes
c) Continue dose and monitor side effects

Answer 374

Continue dose and monitor side effects

Question 375

Man with heroin, BZD, PCP addiction. Comes in tachy, anxious, diaphoresis and hypertensive (other stem included hyperreflexia and muscle rigidity). What is withdrawal from?

a) BZD
b) PCP
c) Heroin

Answer 375

Benzo

Question 376

CEO woman insisting her test be done immediately. Calls head of hospital. Which PD?

a) ASPD
b) narcissistic
c) histrionic

Answer 376

Narcissistic

Question 377

BPD patient makes you feel annoyed and dismissive. Eg what defense?

a) reaction formation
b) projective identification
c) splitting

Answer 377

projective identification

Question 378

32 year old woman started on escitalopram with good response. Her depression is gone, also started on Abilify. Started having gambling she is distressed about. Best option?

a) d/c escitalopram
b) d/c abilify

Answer 378

d/c abilify

Question 379

Patient with schizophrenia, hasn’t had long term follow up. Notice issues with working memory, attention, processing speed. Probably result of?

a) neurocog sx of schizophrenia
b) neurocog disorder plus schizophrenia
c) med side effects
d) negative symptoms

Answer 379

neurocog sx of schizophrenia

Question 380

Called and told patient suicided. Best next step?

a) call malpractice insurance
b) inform team and hold debrief
c) call family and give condolences
d) ask for detailed report from the coroner.

Answer 380

inform team and hold debrief

Question 381

Give you a clock and ask diagnosis?

a) agnosia
b) apraxia
c) executive dysfunction

Answer 381

executive dysfunction

Recall: Anosognosia is when numbers are eg. only on right side becuse of a non-dominant parietal lesion

Question 382

Target for Deep Brain Stimulation in Depression?

Answer 382

subcallosal cingulate

Question 383

Girl is agitated while dancing with friends at party. Substance?

a) heroin
b) GHB
c) MDMA

Answer 383

MDMA

Question 384

Neurotransmitter involved in mechanism of relapse

Answer 384

Glutamate

Question 385

Woman with spinal stenosis and urinary incontinence wants assisted dying. Not depressed and cog intact. What do you tell her?

a) not meet criteria for MAiD
b) admit for suicidality
c) ask for capacity assessment
d) get her to fill out form

Answer 385

not meet criteria for MAiD

*tricky, might also be ask for capacity assessment

Question 386

Man is about to get Maid. What is best theme?

a) autonomy and loss of control
b) ego integrity and despair
c) non-malifence
d) sancitity of life

Answer 386

autonomy and loss of control

Question 387

What best describes fiduciary duty?

Answer 387

Do what is in patient’s best interest

Question 388

Kid has outbursts and mood in between is grumpy. Dx?

a) ODD
b) DMDD
c) CD
d) Intermitten Explosive Disorder

Answer 388

DMDD

Question 389

Patient develops first episode psychosis. Good prognostic factor?

a) young onset
b) family history affective disorder

Answer 389

family history affective disorder

Question 390

Anorexia BMI 14. Eats 400 calories a day. Refuses eat more. HR 52, QTC 453. Best next step?

a) CBT
b) dietary consult
c) inpatient admission

Answer 390

inpatient admission

Question 391

What are criteria for inpatient admission for Eating Disorder?

Answer 391

• <40BPM
• BP <80/60 or presyncope
• QTc >499 or any rhythm other than normal sinus rhythm or sinus bradycardia.
• Wt <70% IBW
• BMI 14-15
• Cardiovascular, hepatic, or renal compromise requiring medical stabilization.
• dehydration.
• Serious medical complication of malnutrition (eg, syncope, seizures, cardiac failure, liver failure, pancreatitis, hypoglycemia, or marked electrolyte disturbance).
• Moderate to severe refeeding syndrome:
  
  • Marked edema
  • Serum phosphorous <2 mg/dL

●Poor response to outpatient treatment

Question 392

Physician had anorexia binge/purge type. Now BMI 19. Lonely , but declines hang out friends and family. Mostly reads and occasionally binge/purge. What is best next focus?

a) weight restoration
b) decrease binges
c) increase interpersonal function

Answer 392

increase interpersonal function

Question 393

80 yo Woman started on Citalopram 40 mg. Has GERD. Most important investigation?

a) ECG
b) Na

Answer 393

ECG

Max dose in elderly 20mg

Question 394

Woman with gait disturbance, mild memory and urinary frequency. Most important ix?

a) CT
b) MRI
c) EEG

Answer 394

MRI

R/O NPH

Question 395

Woman with alcohol use disorder, recently fell. Now agitated, smells of alcohol and confused. Best test?

a) MRI
b) CT
c) EEG

Answer 395

CT

Question 396

Who should get EEG prior starting clozapine?

a) alcohol use disorder
b) Parkinson’s
c) over 65
d) child and adolescent

Answer 396

Child and adolescent

Question 397

All are accepted in structural and systematic family therapy except?

a) no alliances b/w generations
b) good boundaries
c) detouring conflict through the child

Answer 397

detouring conflict through the child

Question 398

Girl with anorexia, mom has anorexia. Following Maudsley family therapy what do you do?

a) externalize ED
b) individuation and separation
c) explore intergenerational dynamics

Answer 398

Externalize ED

Question 399

Which of the following is best shown to decrease relapse in schizophrenia?

a) pt psychoeducation
b) fam psychoeducation
c) CBT
d) social skills

Answer 399

Family Psychoeducation

Question 400

Best predictor of relapse in schizophrenia?

a) med adherence
b) CBT

Answer 400

Med Adherence

Question 401

Man history of ADHD, impulsivity. Mod dep and suicidal because lost job. Best option?

a) Venlafaxine
b) Buproprion
c) Vyvanse

Answer 401

Bupropion

Question 402

Kid who has difficulty communicating and understanding verbal instructions. Gets along with other kids fine. Delayed speech

a) Speech sound disorder
b) Language disorder
c) hearing impairment

Answer 402

Language Disorder

Question 403

Most dopamine in this region of brain

Answer 403

caudate

Question 404

Girl has reactive attachment disorder. 5th foster home. First next step?

a) ensure child safety
b) strengthen caregiver/child bond

Answer 404

ensure child safety

* Most important priority is comprehensive safety assessment

Question 405

Which attachment style most associated with dissociation?

a) disorganized
b) ambivalent
c) anxious

Answer 405

disorganized

Question 406

Changes seen in schizophrenia?

a) Dec ventricle size
b) Inc thalamus
c) inc hippocampus
d) grey matter decreased volume

Answer 406

grey matter decreased volume

Question 407

Token economy is?

a) primary reinforcement
b) secondary reinforcement

Answer 407

Secondary reinforcement

Question 408

Example of inhibition of glucorindation?

a) VPA increasing lamotrigine levels
b) OZP and smoking
c) Clozapine and luvox

Answer 408

VPA increasing lamotrigine levels

Question 409

Man blanks out and has automatisms. What type of seizure is this?

a) complex partial
b) absence
c) GTC

Answer 409

Complex Partial

Question 410

Man with seizure disorder has ECT on phenytoin. Best option re: phenytoin?

a) half dose
b) switch
c) hold night before

Answer 410

Half the dose

Because they are on it for epilepsy. But if on anticonvulsant for bipolar, you stop it.

Question 411

Cocaine mechanism of action?

Answer 411

block Dopamine transport mechanism

Question 412

Psoriatic rash is associated most often with this psychotropic medication

Answer 412

Lithium

Question 413

7 year old who has enuresis. What is tx?

a) desmopressin
b) bell pad treatment
c) bladder retraining

Answer 413

bell pad treatment

Question 414

Man with Lithium level 0.6 who has CHF. Now tremor, ataxia, dysarthria. What is best next step?

a) Hold lithium
b) increase lithium
c) keep lithium same
d) decrease lithium

Answer 414

Hold lithium

Question 415

Which required for fitness to stand trial?

a) mental disorder
b) not understand consequences
c) not act in best interest

Answer 415

not understand consequences

Question 416

What are the McGarry Criteria for Fitness to Stand Trial?

Answer 416

Patient must be able to understand

1. Understand harges & potential consequences
2. Understand and enage in Trial process
3. Capacity to participate with an attorney in a defense
4. Potential for courtroom participation

Question 417

Which is not treatment aggression in BPD?

a) lorazepam
b) AAP
c) mood stabilizer
d) SSRI

Answer 417

Lorazepam

Question 418

What is a test of executive function?

Answer 418

Trails B

Question 419

Woman taking clonazepam x 20 years every night. When she tries to stop one night, has insomnia. Eg of?

a) rebound insomnia
b) abuse
d) recurrence insomnia

Answer 419

rebound insomnia

Question 420

What is true regarding children and adult dosage?

a) Children have lower body water volume so lower doses
b) Children require higher by weight doses than adults

Answer 420

Children require higher by weight doses than adults

Question 421

Patient with schizophrenia needs dialysis. Incapable for psychiatric care. Which would make him incapable for consent dialysis?

a) accepts but has delusional beliefs around dialysis
b) declines but not related to psychiatric disorder
c) needs extra support after decision

Answer 421

accepts but has delusional beliefs around dialysis

Question 422

Patient has weight loss, tremor, anxiety despite increased appetite. Diagnosis?

a) hyperthyroid
b) porphyria
c) hyperparathyroid

Answer 422

hyperthyroid

Question 423

What is most indicative of psychosis in MDD?

a) overvalued ideas of guilt
b) slight loose associations
c) aggressive phobic ideation

Answer 423

overvalued ideas of guilt

Question 424

Which is the least likely predictor violence?3

a) ethnicity
b) age
c) IQ
d) sex

Answer 424

Ethnicity

Question 425

What is most effective at decreasing suicide rate in hospital?

a) decreasing ligature hanging points
b) constant supervision of suicidal patients
c) Assessing before giving pass
d) being careful re: sharps/meds

Answer 425

Assessing before giving pass

Question 426

What is most effective at decreasing suicide rate in community?

a) 24 hour crisis
b) access to inpatient
c) increased proportion psychiatry to population

Answer 426

24 hour crisis

Question 427

Woman with PMDD symptoms. First line treatment?

a) SSRI
b) OCP

Answer 427

SSRI

Unless contraception is a high priority

Question 428

Order of anxieties from most primitive:

superego, castration, disintegration, fear of loss of love, persecutory.

Answer 428

Disintegration

Loss of Love Object

Castration

Superego

Question 429

Which of the following is helpful in bipolar depression, but not in bipolar mania?

a) Lamotrigine
b) Olanzapine
c) Risperidone
d) Lithium

Answer 429

Lamotrigine

Question 430

Woman nervous about eating in public and being judged. Has had panic attacks. Avoids situation because of embarrassment. Dx?

a) agoraphobia
b) social phobia w/ panic
c) panic disorder

Answer 430

Social Phobia with panic

Question 431

Patient is taking tranylcypromine, patient has paresthesia. What deficiency?

a) B3
b) B6
c) B12

Answer 431

B6

Question 432

How long trial of light therapy before can say unsuccessful?

a) 2 weeks
b) 4-6 weeks
c) 3-4 months

Answer 432

4-6 weeks

• CANMAT - The standard protocol is 10,000 lux (light intensity) for 30 minutes per day during the early morning for up to 6 weeks, with response usually seen within 1 to 3 weeks.

Question 433

Multiple depressive episodes, rarely well x 3 years. Periods 2-3 days increased productivity, decreased sleep. Dx?

a) BAD II
b) Other specified bipolar disorder
c) cyclothymia

Answer 433

Other specified bipolar disorder

• Short-duration hypomanic episodes (2–3 days) and major depressive episodes
• Hypomanic episodes with insufficient symptoms and major depressive episodes
• Hypomanic episode without prior major depressive episode
• Short-duration cyclothymia (less than 24 months)

Question 434

Diabetes and schizophrenia:

a) Diabetics without schizophrenia have the same mortality as diabetics with schizophrenia
b) AP choice makes no difference in management
c) Scz less likely get regular monitoring

Answer 434

Scz less likely get regular monitoring

Question 435

What are symptoms of Paxil withdrawal?

a) Nausea, headache, anxiety
b) hallucinations, hyperreflexia
c) Runny nose

Answer 435

Nausea, headache, anxiety

irritability, nausea, feeling dizzy, vomiting, nightmares, headache, and/or paresthesias (prickling, tingling sensation on the skin).

Question 436

You are talking to patient diagnosed with BPD and her family. What do you tell them?

a) minimize suicidal self harm behaviours
b) disclose diagnosis

Answer 436

disclose diagnosis

Question 437

Patient with depression which has all remitted except for insomnia. He had insomnia x 8 years only gone in hospital while on Zopiclone, it was stopped after D/C. What should you do?

a) assess safety/ si assessment
b) restart Zopiclone
c) interview bed partner

Answer 437

interview bed partner

Question 438

Woman on sertraline who had dose increase, having vomiting confusion. What should you check?

a) TSH
b) Na
c) ECG

Answer 438

Na

Question 439

Patient with DID, still has separate states, but seems more adaptive. What is term for this?

a) fusion
b) resolution
c) integration

Answer 439

Resolution

• Fusion/Intergration of states is psychological merging of two or more entities at a point in time, with a subjective experience of loss of all separateness
• Many patients never attain a complete fusion of their personalities but achieve a therapeutic resolution: improved communication, collaboration, and cooperation among self-states leading to relative stability and adequate function

Question 440

Elderly women with schizophrenia are more likely than males to:

a) have hyperprolactinemia
b) more unnatural death
c) more negative symptoms
d) more substance use

Answer 440

have hyperprolactinemia

Question 441

Taxi driver intrusive thought about hitting someone. Always checks rearview mirror and drives back to previous locations. When passenger in the car he is less nervous. What is an example of safety behavior?

A) check mirror

b) driving back
c) having passenger in car

Answer 441

having passenger in car

Question 442

CBT for insomnia in Bipolar disorder, what should you modify?

a) sleep restriction
b) anchor waking time
c) use bedroom for sleep

Answer 442

sleep restriction

Question 443

1. Pseudocyesis - all except
2. Ambivalence re: gender id & having children
3. A reaction to miscarriage
4. Defense against dysparenunia
5. Conflict re: wish for and fear of pregnancy

Answer 443

Defense against dysparenunia

Question 444

1. Which is not a risk factor for Delusional disorder?
2. Sensory impairment
3. Immigration
4. Advanced age
5. MDD

Answer 444

MDD

Question 445

1. Which neurostimulation modality is relatively contraindicated in someone with epilepsy?
2. rTMS
3. DBS
4. VNS
5. ECT

Answer 445

rTMS

Question 446

1. Treatment resistant 37 year old man with OCD, failed with medication which target is area for surgical ablation?
2. Cingulate gyrus
3. Globus pallidus

Answer 446

Cingulate gyrus

Question 447

Which is the associated with late onset neurocognitive disorder?

1. APP
2. PSEN 1
3. PSEN 2
4. APO -E

Answer 447

APO-E

Question 448

1. Which area do you stimulate in rTMS?
2. Broadmann area 25
3. DLPFC
4. Supplementary motor cortex
5. Nucleus accumbens

Answer 448

DLPFC

Question 449

1. Delusional disorder, which is true?
2. Olfactory hallucinations can be present
3. Poorly systematized delusions
4. Personality deteriorates
5. Disorganized behaviour part of presentation

Answer 449

Olfactory hallucinations can be present

(From DSM for DD: Hallucinations, if present, are not prominent and are related to the delusional theme (e.g., the sensation of being infested with insects associated with delusions of infestation).

Question 450

1. Anesthesiologist with h/o of opioid use d/o. Abstinent but does not want substitution rx. What is the best rx?
2. Buprenorphine
3. Naltrexone
4. Clonidine

Answer 450

Naltrexone

(recall that Bup = substitution, clonidine just for withdrawal. Naltrexone is antagonist to prevent relapse)

Question 451

BP2 depression with alcohol use on Lithium, now depressed, incomplete response what do you add?

1. Lamotrigine
2. Bupropion
3. Olanzapine
4. Aripirazole

Answer 451

Lamotrigine

Question 452

What are your options for treating a pregnant patient with Bipolar Depression?

Answer 452

Lurasidone is Preg Category B

Lamotrigine and Quetiapine are Preg Category C

Li and VPA are Preg Category D

Question 453

Man in his 40s, morning headaches, fatigue, gained weight in past year, stable on Lithium and Olanzapine 25mg. Which is the most likely diagnosis?

1. OSA
2. Narcolepsy
3. Hypertension

Answer 453

OSA

Question 454

1. Schizotypal – which is not
2. anhedonia
3. Ideas of reference
4. Inappropriate affect
5. No close friends

Answer 454

anhedonia

Question 455

1. You’re an outpatient clinic manager and want to see if the clinic is following Canadian guidelines, what do you do?
2. Chart review
3. Pareto chart
4. Flowchart algorithm
5. Audit

Answer 455

Chart review

Question 456

1. ASD – risk factor – which IS?
2. Advance parental age
3. Prematurity before 34 weeks
4. Vaccinations

Answer 456

Advance parental age

Prenatal Factors

• advanced maternal and paternal age at birth
• maternal gestational bleeding
• gestational diabetes
• first-born baby

Perinatal Risk Factors

• umbilical cord cx
• birth trauma
• fetal distress
• SGA
• low birth weight
• low 5 min apgar score
• congenital malformation
• ABO/Rh blood factor incompatibility
• hyperbilirubinemia

Question 457

1. Which is an acquired cause of ID?
2. PKU
3. Mat. malnutrition
4. Rubella
5. CMV

Answer 457

PKU

Question 458

1. Which is NOT a r/f for developing SCZ:
2. Rural upbringing
3. Immigration to a non-rural place
4. Exposure to dropinadrol – wtf?
5. Paternal age

Answer 458

Rural Upbringing

Question 459

1. What is the TRUE statement for smoking cessation in SCZ?
2. Groups outperform individual therapy
3. Vareniciline increases suicidal ideation and attempt
4. Bupropion increases psychosis compared to placebo
5. Patients on atypicals do better than typicals in regard to smoking cessation

Answer 459

Patients on atypicals do better than typicals in regard to smoking cessation

Question 460

1. What is best for smoking cessation?
2. Varenicline
3. Bupropion
4. Clonidine

Answer 460

Varenicline

Recall First Line

• Varenicline
• Combo NRT

Question 461

16 year old child coming in out of province with diaphoresis, agitation, restless, muscle ache, vomiting, which substance would resolve symptoms?

1. Clonidine
2. Diazepam
3. Risperidone
4. Buprenorphine

Answer 461

Buprenorphine

Question 462

35 year old man, restless, lacrimation, mydriasis, interrupts you due to vomiting, muscle ache, GI, yawning. What toxidrome is he presenting with?

1. Opioid withdrawal
2. Cocaine intox
3. Benzo withdrawal
4. Amphetamine intox

Answer 462

Opioid withdrawal

Question 463

1. 15 year old ER, brought by police, aggressive, slurred speech, nystagmus, dilated pupil, tremor. What substance is likely causing the intoxication?
2. Amphetamine
3. Psilocybin
4. Volatile Solvent
5. Cannabis

Answer 463

Volatile Solvent

Question 464

Stem of an unwell patient, the differential is between NMS and anticholinergic toxicity. The question is what will help you rule out anticholinergic delirium?

1. Autonomic instability
2. Diaphoresis
3. Delirium

Answer 464

Diaphoresis

Question 465

OCD most common comorbidity?

1. MDD
2. GAD
3. OCPD

Answer 465

MDD

Question 466

1. Which anxiety disorder is least likely to develop in late life?
2. GAD
3. SAD
4. Panic

Answer 466

Panic

Question 467

1. Least common comorbidity with ADHD:
2. ASD
3. ODD
4. Anxiety
5. CD

Answer 467

ASD

Question 468

Kid with ADHD, what is the best treatment for aggression:

1. Risperidone
2. Haldol
3. Carbamazepine
4. Quetiapine

Answer 468

Risperidone

Question 469

1. ADHD + Tics, least likely to help with symptoms of inattention?
2. Clonidine
3. Atomoxetine
4. Risperidone

Answer 469

Risperidone

Question 470

Adult ADHD with side effects to two LA methylphenidate. What is the next step?

1. SA methylphenidate
2. Atomoxetine
3. Bupropion
4. Lisdexamphetamine

Answer 470

Lisdexamphetamine

Question 471

Young female engineer with ADHD, with chronic persistent depressive disorder. Comes to see you as she is about to start a new job. Very excited about the new job, but wants to make sure she performs well, ADHD dx since childhood. What is your approach to pharmacological treatment?

1. Treat both ADHD and depression
2. Treat depression first and overlook ADHD
3. Treat with medication that has indication for both ADHD and depression
4. Treat ADHD first, then reassess for depression

Answer 471

Treat ADHD first, then reassess for depression

(As long as ADHD is worse, and only remote hx of mood disorder)

Question 472

Collaborative care – young psychiatrist about to start practice with young family GP colleague. Which is TRUE regarding collaborative care? (repeat)

1. Co-location of psychiatrist and GP not important for patient
2. Collaborative care alone is not enough to increase knowledge in family physician
3. Providing consultation is enough, you don’t need a specific approach and system
4. Positive long term epression outcomes are not dependent on systematic follow up

Answer 472

Collaborative care alone is not enough to increase knowledge in family physician

Question 473

Stats question. Treatment arm 1% develop disease vs control arm 2%. What is the asbolute risk reduction?

1. 1%
2. 2%
3. 50%
4. 100%

Answer 473

1%

ARR = CER - EER

Question 474

Woman w BP1 previously stable on Lithium & Divalproex. Currently pregnant (10 wks). She had stopped Li and Dival, and now showing depressive sx, irritable, couldn’t sleep, passive suicidal ideation. What is your next step?

1. Restart Lithium
2. Restart Divalproex
3. Start Quetiapine
4. Start Fluoxetine

Answer 474

Start Quetiapine

Question 475

Pregnant female, ruminating about being bad mother towards first child, Bipolar depression, pregnant at 10 weeks, lots of guilt and other depressive symptoms. Which rx has the best risk/benefit ratio for the mother and foetus?

1. Fluoxetine
2. Lamotrigine
3. ECT
4. Aripirazole

Answer 475

ECT

(but quetiapine even better)

Question 476

1. Which is true about postpartum psychosis:
2. Late onset (after 4 weeks of delivery) has better prognosis than early onset
3. Family history of post-partum psychosis predicts recurrence
4. Has a better prognosis than non-puerperal psychosis

Answer 476

Family history of post-partum psychosis predicts OCCURRENCE

Has a better prognosis than non-puerperal psychosis is also true

The risk factors for postpartum psychosis:

●History of postpartum psychosis

●Family history of postpartum psychosis

●History of bipolar disorder, schizophrenia, or schizoaffective disorder

●Family history of bipolar disorder

●First pregnancy

●Discontinuation of psychiatric medications for pregnancy

Question 477

What predicts a better response to Lithium over anticonvulsants in bipolar 1?

1. Male
2. FHx of bipolar d/o
3. Previous history
4. Mixed features

Answer 477

FHx of bipolar d/o

Question 478

Lady on Lithium and Mirtazapine, more frequent episodes, mixed features. What is your next step?

1. Stop Mirtazapine, Start Valproate
2. Continue mirtazapine, start lamotrigine
3. Stop mirtazapine and start T3
4. Continue mirtazapine and start xxx

Answer 478

Stop Mirtazapine, Start Valproate

Question 479

Unipolar depression. Someone on an SSRI with 60% response, what is the best option for add-on treatment?

1. Methylphenidate
2. T3
3. Aripiprazole
4. Lamotrigine

Answer 479

Aripiprazole

Question 480

35F lawyer stabilized on fluoxetine 60mg, starts new degree, recurrence of OCD symptoms, what is your immediate next step?

1. Send her to group psychoeducation for OCD
2. Fluvoxamine
3. Clomipramine
4. Add risperidone

Answer 480

Add risperidone

Question 481

Mailman saw 2 year old run over by car, was having recurrent episodes of witnessing the event in dream-like state (i.e.) dissociation. 2 weeks after, what is the diagnosis?

1. PTSD
2. Dissociative disorder
3. Acute stress disorder
4. Adjustment disorder

Answer 481

Acute Stress Disorder

Question 482

Lady in a life-threatening car accident 2 weeks ago. Now unable to drive kids to school, having flashbacks and other PTSD symptoms. What would you do?

1. Psychoed re: trauma and encourage her to drive
2. SSRI
3. Critical incident debriefing
4. EMDR

Answer 482

Psyched re: trauma and encourage her to drive.

Question 483

1. Most commonly used substance in adolescents?
2. Nicotine
3. ETOH
4. Cannabis

Answer 483

ETOH

Question 484

Most common substance of abuse in children above age 12y?

1. Cannabis
2. Pain killers
3. Tranquilizers
4. Cocaine

Answer 484

Cannabis

Question 485

1. Teenager uses cannabis. You provide education what do you say?
2. Cannabis has been clearly linked to depression
3. Cannabis interference with cognition and learning
4. Cannabis is not linked with schizophrenia
5. Cannabis is used in treatment of anxiety disorders

Answer 485

Cannabis interference with cognition and learning

Question 486

Patient comes to you with BPD and history of child abuse, what do you tell her regarding the link between childhood abuse and BPD?

1. BPD is best formulated as complex PTSD.
2. The risk of childhood abuse is more important for females but not males.
3. Child abuse is one of many risk factors for developing BPD.
4. Given the efficacy of DBT, this suggests an invalidating environment is more important than child abuse in the etiology of BPD

Answer 486

Child abuse is one of many risk factors for developing BPD.

Question 487

Something about behaviour chain analysis in person with BPD who cut wrists after a fight with boyfriend. What does the Behaviour Chain Analysis look like?

1. Examine thoughts, feeling and behaviours linking phone call to cutting incident.
2. Examine just behaviours linking phone call and cutting.
3. Looking at the pattern of recurrent cutting episodes.
4. Looking at consequences following cutting

Answer 487

Examine thoughts, feeling and behaviours linking phone call to cutting incident.

Question 488

Therapist is doing Behavioral chain analysis with BPD patient in individual part of DBT. He reflects back to the patient a statement about her thoughts, feelings and behaviour. This is an example of which technique?

1. Reciprocal communication
2. Validation
3. Dialectics

Answer 488

Validation

Question 489

26 year old with depression and anxiety. He recently started group therapy and comments that he realizes he is not alone in having problems. This is an example of which therapeutic factor?

1. Altruism
2. Universality
3. Identification
4. Catharsis

Answer 489

Universality

Question 490

Woman tells you that her friends say about her that “she sees the glass half empty rather than half full”. This is an example of which cognitive distortion?

1. Overgeneralization
2. Selective abstraction
3. Dichotomous thinking
4. Catastrophization

Answer 490

Selective abstraction

Question 491

ECT strip photocopied on exam sheet. Looking at this EEG strip of bilateral ECT #7 of patient with MDD, the strip demonstrate which of the following feature?

1. Abrupt cessation
2. High amplitude
3. Post ictal suppression
4. Symmetrical termination

Question 492

1. EKG with Torsades de pointes. Which medication was most likely recently added and can cause this rhythm?
2. Olanzapine
3. Ziprasidone
4. Haldol

Answer 492

Ziprasidone

Question 493

LBD vs idiopathic Parkinson’s disease dementia. What clinical feature would favour dementia with Lewy bodies?

1. Visual hallucinations.
2. Bad reaction to olanzapine
3. Depression
4. Normal cognition

Answer 493

Bad reaction to olanzapine (neuroleptics in general)

Question 494

Stem of someone with MMSE 23/30, spontaneous parkinsonism, 6 months of visual hallucinations, dramatic motor side effects in response to olanzapine. What is the most appropriate treatment?

1. AChEI
2. SSRI
3. MDMA antagonist
4. Risperidone

Answer 494

AChEI

Question 495

OCD self-diagnosed with anxiety and depression, washes hands 2 hours a day to prevent harm coming to family members. Two essential components of psychological treatment?

1. Behavioural activation and problem solving
2. Exposure and response prevention
3. Mindfulness and relaxation

Answer 495

Exposure and response prevention

Question 496

38 year old man, 58kg, BMI 16.9, restricts intake, vigorous exercise, binges once/month, purges twice/year. What is the diagnosis?

1. Anorexia, binge purging type
2. Anorexia, restricting type
3. Atypical anorexia
4. ARFID

Answer 496

Anorexia, restricting type

Question 497

Young boy averse to meet, vegetables, fruits, and other type of food, because of fear of choking and dislike of texture. He requires dietary supplements. He has lots of functional impairment. Most likely dx? Doing well academically, and has friends, no concern of body image.

1. SAD
2. ARFID
3. AN
4. ASD

Answer 497

ARFID

Question 498

Kid with aggressive behaviour at school, usually because the other kids won’t play with his rock collection or someone sits in his seat or invade his personal space. Best medication to treat?

1. Aripiprazole
2. Methylphenidate
3. Clonidine
4. Haldol

Answer 498

Aripiprazole

Question 499

Kid who breaks in to school, stealing teachers computer, suspended last year for starting a fight with younger student. Goes into sister’s room when she is away. He is angry and irritable without provocation. Impulsive. Most likely dx?

1. ADHD
2. CD
3. ODD
4. ASD

Answer 499

Conduct Disorder

Question 500

Man thinks his head is too small for his body, repetitive checking behaviours. Significant impairment. In addition to psychotherapy, what is the best pharmacological option for management?

1. Fluoxetine
2. Risperidone
3. Clomipramine
4. Olanzapine + Fluoxetine

Answer 500

Fluoxetine

(Cipralex also first line)

Question 501

Which of the following tasks would you not do in the middle phase of IPT?

1. Interpersonal inventory
2. Linking interpersonal events to mood symptoms.
3. Focusing on affect related to chosen interpersonal focus.
4. Focus on the task specific to the chosen focus.

Answer 501

Interpersonal inventory

Question 502

Guy in psychotherapy for anxiety, He is very vague in his answers. When therapist asks how he feels toward him [therapist], the patient looks down and is again very vague. The vagueness represents which part of Malan’s triangle of conflict?

1. Defense
2. Anxiety
3. Impulse
4. Transference

Answer 502

Defense

Question 503

Which is correct regarding panic-focused psychodynamic therapy?

1. There is no evidence for use in panic disorder
2. Interpreting the transference is key
3. Equivalent to CBT evidence.
4. Therapy focuses on graded exposure

Answer 503

Interpreting the transference is key

Question 504

Process in brief psychodynamic therapy

1. Focus on corrective emotional experience in the transference interpretation early on
2. Free association
3. Key is the work on conflict resolution people outside of therapy

Answer 504

Focus on corrective emotional experience in the transference interpretation early on

Question 505

Group psychodynamic therapy, what do you not instruct participants to do?

1. Spontaneous free association
2. Put feelings into words
3. Use group relationships therapeutically
4. Work actively on problems

Answer 505

Spontaneous free association

Question 506

Lady with 3 past episodes of MDD, now doing trauma-focused-CBT. What do you advise regarding pharmacological treatment of MDD?

1. Will likely need long term meds maintenance
2. Can stop meds when therapy is finished
3. Can stop meds when depression is better

Answer 506

Will likely need long term meds maintenance

Question 507

Child with OCD, what do you tell the parents?

1. Meds are necessary
2. CBT good if can engage
3. Requires both meds + therapy

Answer 507

CBT good if can engage

(PODS study)

Question 508

What antipsychotic has the best evidence for substance use in SCZ?

1. Clozapine
2. Haldol
3. Aripiprazole

Answer 508

Clozapine

Question 509

Man stable on Risperidone for 3 years, now has lip smacking, and tongue movements that impair with his function. What do you do?

1. Add Cogentin
2. Switch to Clozapine
3. Switch to Olanzapine
4. Switch to long acting

Answer 509

Switch to Clozapine

Question 510

Man who drinks alcohol and does not see a reason to stop. How would you manage?

1. Motivational interviewing with pros and cons
2. Refer to AA
3. Naltrexone

Answer 510

Motivational interviewing with pros and cons

Question 511

40 year old with alcohol dependence. He asks for help regarding his craving as he finds AA is not enough. He has chronic renal failure, DM, and hypertension. He is single.

1. Naltrexone
2. Disulfiram
3. Acamprosate
4. Topiramate

Answer 511

Naltrexone

Question 512

What is the Ericksonian stage in a 9 year old who was proud of his A marks, and whose teacher finds he adapts well to school environment?

1. Industry vs. Inferiority
2. Generativity vs. stagnation
3. Identity vs. role confusion
4. Initiative vs. guilt

Answer 512

Industry vs. Inferiority

Question 513

Baby adopted from orphanage. In the infant strange situation, he cries when caregiver is away and doesn’t explore the room. He is angry and irritable when caregiver returns and difficult to soothe, but appears to seek closeness. How would you describe his attachment style?

1. Insecure attachment, ambivalent type
2. Insecure attachment, disorganized type
3. Secure attachment
4. Insecure attachment, avoidant type

Answer 513

Insecure attachment, ambivalent type

Children classified as Anxious-Ambivalent/Resistant (C) showed distress even before separation, and were clingy and difficult to comfort on the caregiver’s return. They showed either signs of resentment in response to the absence (C1 subtype), or signs of helpless passivity (C2 subtype).

Question 514

Lady with ovarian cancer and depression, anxiety, low appetite, insomnia, pain, nausea. Which would you treat with?

1. Bupropion
2. Fluoxetine
3. Fluvoxamine
4. Mirtazapine

Answer 514

MIrtazapine

Question 515

What is the pharmacological mechanism of clozapine responsible for hypersalivaiton?

1. Partial agonism at D1
2. Antagonism at D3
3. Nicotinic antagonism
4. Agonism at M4

Answer 515

Agonism at M4

Question 516

What is the mechanism by which TCA overdose produce seizures?

1. Blocking Na Channels
2. Blocking Ca channels
3. Blocking glutamate
4. Anticholinergic

Answer 516

Blocking Na Channels

(If GABA receptors are an option, that may be a preferred answer)

Question 517

Which is true about TCAs?

1. Therapeutic plasma levels are established for all TCAs
2. Toxicity is closely related to high plasma levels
3. Nortriptyline has a linear dose response curve *** nortrip has curvilinear dose response curve
4. TCAs have a wide therapeutic window

Answer 517

1. Toxicity is closely related to high plasma level

(Note that Nortriptyline has a curvilinear dose response curve)

Question 518

Lady with chronic BPD, somatic symptom disorder with chronic pain, mydriasis, presents with anticholinergic toxicity. What is most likely to be found in elevated level in her tox screen? (What did she overdose on?)

1. TCA
2. Lithium
3. Opioid

Answer 518

TCA

Question 519

Lady with recent bereavement some anxio-depressive symptoms. She has poor social coping, limited psychological mindedness and ego deficits. Which therapy is most indicative to improve her coping skills?

1. Mindfulness
2. Supportive
3. Psychodynamic

Answer 519

Supportive

Question 520

Which is true about developmental coordination disorder

1. Asymmetrical movement
2. Causes clinically significant distress in school performance
3. F>M

Answer 520

Causes clinically significant distress in school performance

Question 521

PANDAS, all except

1. Girls more than boys
2. Episodic onset
3. Tics and abnormal movements

Answer 521

Girls>boys

Question 522

IPT for a 59 year old man with depression. He recently divorced, he has poor relationship with daughters, upcoming retirement in one year. What would be the focus?

1. Role transition
2. Deficits
3. Interpersonal conflict
4. Intrapsychic conflicts

Answer 522

Role transition

Question 523

Tourette’s disorder which is true?

1. Academic difficulties improves after tics have improved
2. Tics improve by early adulthood
3. Most do not pursue secondary education

Answer 523

Tics improve by early adulthood

Question 524

Bill C-14 added the designation “high risk accused” to which population does this apply?

1. NCR
2. Dangerous offenders
3. Unfit to stand trial
4. Civilly committed

Answer 524

NCR

Question 525

Woman with SCZ stabbed someone in the eye. She was found NCR. In reviewing her disposition what would the Review Board primarily take into consideration?

1. Diagnosis of SCZ
2. Risk of future violence
3. Minimal sentence duration
4. Extent of injuries

Answer 525

Risk of future violence

Question 526

Guy with hypothyroidism, He presents with 4 month history of negative sx, 2 months of +ve symptoms. He has had 4 years of daily cannabis use and weekend alcohol use. Not depressed. What is the most likely diagnosis?

1. Cannabis induced psychosis
2. Depression w psychotic feat.
3. Schizophreniform

Answer 526

Schizophreniform

Question 527

Lady with anorexia, previously stable. She is now starting to binge and purge in context of new stressors (change in job) impacting her mood. When meeting her for the first time, what is the most important to assess?

1. Hopelessness
2. Binge-purging cycle

Answer 527

Hopelessness

Question 528

1. Cognitive symptoms with SCZ. What is the main theory?
2. Hyperactivity of DA in mesocortical cortex
3. Hypoactivity of DA in mesocortical cortex
4. Hypoactivity of DA in mesolimbic cortex
5. Hyperactivity of DA in mesolimbic cortex

Answer 528

Hypoactivity of DA in mesocortical cortex

Question 529

Psychosocial therapies in SCZ. A patient reports exacerbation of hallucinations because her family critical of her sleeping all day, and being awake at night.

1. Family therapy
2. Family psychoeducation
3. CBT
4. Vocational training

Answer 529

Family psychoeducation

Question 530

What psychosocial interventions to relapse

1. CBT
2. Family psycho-ed involving problem solving
3. Social skills
4. Individual psychoeducation

Answer 530

Family psycho-ed involving problem solving

Question 531

Adult woman presents describing life-long difficulties tolerating public spaces. She feels very anxious in public places – often avoids it or tolerates it with ++ anxiety. “On occasion” will have a panic attack (described s’xs) when in such places. She avoids public places due to the anxiety, and due to fear of embarrassment / being judged by others. What is the most appropriate d’x?

1. GAD with panic attackes
2. Social anxiety with panic attacks
3. Agoraphobia with panic attacks
4. Panic Disorder

Answer 531

Social Anxiety with panic attacks

Question 532

Patient with developmental disability and self-harm. What is the most likely diagnosis?

* REPEAT

1. Fragile X
2. Lesch Nyhan
3. Down Syndrome
4. Rett Syndrome

Answer 532

Lesch Nyhan

Question 533

What is the phenotype of a child with FASD?

Answer 533

• smooth philtrum
• thin upper lip
• upturned nose
• flat nasal bridge and midface
• epicanthal folds
• small palpebral fissures
• small head circumference.

Question 534

Panic disorder with agoraphobia. Learning is maintained by:

1. Positive reinforcement
2. Negative reinforcement
3. Punishment
4. Classical conditioning

Answer 534

Negative reinforcement

Question 535

Catatonic excitement is most associated with:

1. Mania
2. Catalepsy
3. Automatisms
4. Stereotypies

Answer 535

Mania

Question 536

PSP. Which is true?

1. Myoclonus
2. Vertical eye movement palsy

Answer 536

Vertical eye movement palsy

Question 537

Anxiety disorder that is LEAST likely to develop in the elderly:

1. Specific phobia
2. Panic disorder
3. GAD
4. Social anxiety

Answer 537

Panic disorder

Question 538

Which is true about personality disorders in the elderly?

1. Comorbid with substance abuse
2. Unspecified PD is one of the most common in the elderly
3. Personality disorders worsen with age
4. Prevalence is higher in older than in younger patients

Answer 538

Unspecified PD is one of the most common in the elderly

Question 539

1. Patient reports seeing worms in his apartment for one day, second day reports spider crawling on his body. What is most important to get? *REPEAT
2. Medical history
3. Psychiatric History
4. Personal history
5. Developmental history

Answer 539

Medical history

Question 540

28 year old man breaks up with 18 year old female, feels unworthy. Friends are all married. Envious and sometimes has fantasies of wanting to hurt them. Which PD is most likely?

1. ASPD
2. NPD
3. HPD
4. BPD

Answer 540

Narcissistic PD

Question 541

At what clues do you think about autism

1. 12 month old solitary play
2. Not responding to name
3. Explores objects with their mouth
4. Uses gestures to communicate instead of language

Answer 541

Not responding to name

Question 542

80 yr old woman on Citalopram 40 mg. You meet her for the first time, which lab would be important to obtain?

1. Electrolytes
2. EKG
3. TSH

Answer 542

EKG

Question 543

Which do you include in the basic tests for dementia?

1. Folate and Syphilis
2. CT and EEG
3. MRI
4. Ca and Glucose

Answer 543

Ca and Glucose

Question 544

Patient presents with one sided paralysis and loss of sensation as well as aphasia. Which blood vessel is involved in the stroke?

1. Middle Cerebral artery, non-dominant
2. Middle Cerebral artery, dominant
3. Anterior Cerebral artery, non-dominant
4. Anterior Cerebral artery, dominant

Answer 544

Middle Cerebral artery, dominant

Question 545

Which is true about Broca’s aphasia?

1. Naming
2. Comprehension
3. Left frontal

Answer 545

Naming

Question 546

Sleep changes in the elderly, which is true?

1. Decreased sleep latency
2. Decreased total sleep time
3. REM increase
4. Increased stage 3 and 4

Answer 546

Decreased total sleep time

Question 547

Which neurotransmitter is responsible for Benzo and alcohol withdrawal?

1. GABA
2. Glutamate
3. Dopamine
4. NE

Answer 547

Glutamate

Question 548

LSD – Which neurotransmitter is responsible for symptoms of intoxication?

1. Dopamine
2. Serotonin
3. Acetylcholine
4. Norepinephrine

Answer 548

Serotonin

Question 549

Lawyer contacts you saying he has a consult from you on his client and that you should release your records. What do you do?

1. Can disclose you’ve seen the patient but nothing more
2. Can only disclose if patient gives you consent
3. Can disclose the report and answer questions since he already has it

Answer 549

Can only disclose if patient gives you consent

Question 550

Which is true about Schizophrenia?*REPEAT

1. CT findings that do not influence treatment may occur in 50% of patients
2. More severe atrophy is related to poorer outcome

Answer 550

More severe atrophy is related to poorer outcome

Question 551

Psychotherapy for Social anxiety disorder, which is most important

1. Cognitive restructuring
2. Relaxation
3. Graded exposure

Answer 551

Graded Exposure

Question 552

• Which of the following interferes the least with OCP?
  
  1. Epival
  2. Lamotrigine
  3. Carbamazepine
  4. Topiramate

Answer 552

Epival

Question 553

1. Most characteristic of amphetamine use disorder ?
   
   1. Paranoid delusions
   2. Visual hallucinations
   3. Loosening of associations
   4. Thought Disorder

Answer 553

Paranoid delusions

(somatic delusions also very common)

Question 554

1. BPD on venlafaxine and buprenorphine (suboxone), D/c from detox for EtOH.
   
   1. Disulfiram
   2. Acamprosate
   3. Naltrexone
   4. Topiramate

Answer 554

Acamprosate

(Because Naltrexone + suboxone not inidicated first line)

Question 555

1. Safest benzo in liver failure
   
   1. Temazepam
   2. Alprazolam
   3. Diazepam
   4. Clonazepam

Answer 555

Temazepam

Question 556

1. Doing forensic assessment for courts. What must you do:
   
   1. Provide full explanation of your credentials to the patient
   2. Be available for follow-up if needed
   3. Indicate who will be receiving the report

Answer 556

Indicate who will be receiving the report

Question 557

1. Lithium toxicity. Normal RF and electrolytes. Which medications was most likely recently added ?
   
   1. Captopril
   2. Septra
   3. Amlodipine
   4. Celexa

Answer 557

Captopril

(Thiazide or NSAID would also be correct)

Question 558

1. Adolescent and antipsychotics :
   
   1. Second generation gives metabolic side effects
   2. First generation are contra-indications
   3. No evidence that second generation give EPS

Answer 558

Second generation gives metabolic side effects

Question 559

1. During a seizure, a patient is not responsive, with their eyes open. Mouth movements only. They have no memory of the event. Aura (metallic taste) and post ictal confusion
   
   1. Complex partial
   2. Simple partial
   3. Generalized
   4. Absence

Answer 559

Complex Partial

(Recall, in simple partial, no alteration in awareness)

Question 560

1. Elderly person with sad mood, anhedonia, terminal insomnia, guilt and significant weight loss. Which is most specific to this presentation?
   
   1. psychomotor retardation
   2. decreased energy
   3. suicidal thought
   4. Concentration problems

Answer 560

psychomotor retardation

Question 561

1. 55 years old man with apathy and binge eating. Mother had ALS, what is in the differential?
   
   1. Lewy Body Dementia
   2. Alzheimer’s
   3. Frontal Temporal Dementia

Answer 561

Frontal Temporal Dementia

Question 562

1. MCI. Hypercholesterol and diabetes well controlled. Risk factors to develop AD (strongest risk)?
   
   1. Low education
   2. Low vitamin E and D
   3. Cholesterol
   4. Current depression

Answer 562

Current depression

Question 563

What is the annual conversion from MCI to Alzheimer’s Disease?

Answer 563

5-10%

(25% revert to normal)

Question 564

What are markers determinng risk progression from MCI to dementia?

Answer 564

• b-amyloid and tau protein levels
• CSFP
• APOE
• homocysteine levels
• high LDL
• serum IL-6
• olfactory dysfunction
• changes hippocampal volume on PET
• amyloid plaque on PET
• delayed verbal recall and executive function in neuropsych

Question 565

What are non-genetic risk factors for Alzheimer’s Disease?

Answer 565

systolic HTN >160mm/Hx (evidence to treat)

• serum cholesterol >6.5mmol/L
• Smoking, current
• hyperlipidemia ( no evidence for statins dec risk though)
• head injury with loss of consciousness
• low education <12 yrs
• Diabetes (vascular dem RF)
• estrogen alone or in combo with progesterone
• occup exposure environmental toxins- pesticides, fertilizers, fumigants and defoliants

Question 566

1. Child with long face, mid face hypoplasia. Big ears. Hyperlaxicity of the joint. Shy. No family of developmental disorder. Mild intellectual disorder.
   
   1. Fragile X
   2. Prader Willi
   3. FAS

Answer 566

Fragile X

Question 567

1. All are associated with autism spectrum except: *REPEAT
   
   1. Wilson’s disease
   2. PKU
   3. Fragile X
   4. Tuberous sclerosis

Answer 567

Wilson’s disease

Question 568

1. Narcolepsy. Which one is common :
   
   1. Hypnopompic hallucinations
   2. Insomnia
   3. Decreased REM total
   4. Increased REM latency

Answer 568

Hypnopompic hallucinations (or hypnogogic)

Note:

Decreased REM latency

Overall increased REM sleep

Question 569

1. Female with history of one prior depressive episode that responded well to meds. Now looks manic, thought she could fly and talk to God. Up for five nights. What is a good prognostic factor:**REPEAT
   
   1. Previous good response to antidepressants
   2. Female gender
   3. Psychotic features
   4. Insomnia less than 7 days

Answer 569

Female gender

Poor Prognostic Factors in BAD

• older age
• male
• psychosis
• mixed episodes
• substance use
• younger onset
• rapid cycling

Question 570

1. All seen in Post-concussion except
   
   1. Delusions
   2. H/a (headaches)
   3. Insomnia
   4. Depression

Answer 570

Delusions

Question 571

1. What is an example of de-escalating a psychotic person?
   
   1. If you don’t stop you will be put in restraints
   2. Anyone who is in your situation would be angry
   3. Your delusions are not true.

Answer 571

Anyone who is in your situation would be angry

Question 572

1. Teenage girl with anorexia. Best tx :
   
   1. Family
   2. IPT
   3. CBT

Answer 572

Family

Question 573

1. Adult woman being evaluated for ADHD, which element of her history is most likely to confirm the ADHD diagnosis?
   
   1. Childhood history of hyperactivity and some other ADHD-like symptom
   2. Current Distractibility
   3. Current jitteriness/restlessness, especially at work

Answer 573

Childhood history of hyperactivity and some other ADHD-like symptom

Question 574

1. Elderly man with BAD II, stabilized on Lithium 1200mg, Effexor 75mg and one other medication. Presenting with symptoms of fatigue, poor concentration, and weight gain. Which should you measure?
   
   1. TSH
   2. Sodium
   3. Calcium
   4. Renal function

Answer 574

TSH

Question 575

1. All of the following are true of Major Depressive Disorder EXCEPT:
   
   1. psychosocial stressors are equally important at all stages of the illness
   2. 5-10% of those with a single episode of MDE will go on to have a manic episode
   3. 50% will have another episode within 2 years

Answer 575

psychosocial stressors are equally important at all stages of the illness

Question 576

1. Which of the following is NOT true?
   
   1. Identical twin siblings have a 47% risk of schizophrenia if the other twin is affected
   2. The biological relative of an adopted proband are not at increased risk of schizophrenia
   3. Non-twin siblings have an 8% risk of schizophrenia if sibling is affected
   4. Risk of schizophrenia in the family increases significantly if two family members are affected

Answer 576

The biological relative of an adopted proband are not at increased risk of schizophrenia

Question 577

1. Mood crash after using MDMA is caused by:
   
   1. Serotonin depletion
   2. Noradrenaline depletion
   3. Glutamate depletion
   4. Gaba activation

Answer 577

Serotonin depletion

Question 578

1. Question on a single man with alcohol abuse history on live transplant list. He had refused residential treatment. He has been sober for three months. What is the main risk factor for his relapse after the transplant?
   
   1. Abstinent for less than 6 months prior to transplant
   2. Unemployed prior to transplant
   3. Didn’t go to rehab before becoming abstinent
   4. Single

Answer 578

Abstinent for less than 6 months prior to transplant

Predictors of Relapse:

dx SUD vs. abuse

fam hx add

failed rehab

multiple substances

poor soc support

short pretransplant length abstinence.

Question 579

1. Surgeon refers patient with history of GI bleeds and depression. Best choice:
   
   1. Paroxetine
   2. Fluoxetine
   3. Bupropion
   4. Fluvoxamine

Answer 579

Buporopion

SSRIs and SNRIs both show increased risk of bleeding in some studies

Question 580

1. What is an indication for clozapine
   
   1. One failed atypical antipsychotic
   2. One failed depot antipsychotic
   3. MDD
   4. Suicidal behaviour

Answer 580

Suicidal behaviour

Question 581

1. The most dopamine in the brain is found in the * repeat
   
   1. Reticular formation
   2. Caudate
   3. Amygdala
   4. Somewhere else

Answer 581

Caudate

Question 582

Which is NOT true about how structural family therapy would define a healthy family?

1. Absence of alliances crossing intergenerational boundaries
2. Subsystems
3. Boundaries
4. Derouting conflict through a child

Answer 582

Derouting conflict through a child

Question 583

Which is a prodromal sign for Schizophrenia?

1. Attenuated positive symptoms
2. Substance abuse
3. Negative symptoms
4. Brief Psychotic symptoms more than one week

Answer 583

Attenuated positive symptoms

these are MOST related

Question 584

Cognitive difference in MDD vs. neurocognitive disorder

1. Alexia
2. Visual anosia
3. Paraphasia
4. Executive dysfunction

Answer 584

Executive Dysfunction

Question 585

Why are elderly more sensitive to orthostatic hypotension?

1. Decreased hepatic fct
2. Decreased renal fct
3. Increased body fat
4. Change in Sensitivity of adrenergic receptors

Answer 585

Change in Sensitivity of adrenergic receptors

Question 586

ECT and elderly. Which is true?

1. ECT has equal risk in the elderly compared to the younger population
2. It is as effective as in the younger population
3. Risk of death is lower than other antidepressant treatment – risk of death is lower than with TCAs – geri CT section

Answer 586

Risk of death is lower than other antidepressant treatment

(risk of death is lower than with TCAs)

Question 587

Do the elderly have a higher or lower seizure threshold?

Answer 587

higher

(Seizure threshold goes up as you age)

Question 588

What would you do prior to initiating a cholinesterase inhibitor?

1. EKG
2. Liver function
3. Renal function
4. Electrolytes

Answer 588

EKG

Question 589

MD radiologist, also flies local airplanes, now has mild neurocognitive disorder. Who should you report to?

1. RCMP
2. Transport Canada
3. Ministry of Transportation at every province
4. College of Physicians at every province

Answer 589

Transport Canada

Question 590

1. When do you choose CT over MRI?
2. Calcified tumour
3. Stroke

Answer 590

Calcified Tumour

Question 591

1. MSE – which is more likely psychiatric than medical presentation?
2. Concrete
3. Normal clock drawing test

Answer 591

Normal clock drawing test

Question 592

14 year old boy with ~12 month history of bad behavior (school problems, fighting with siblings, cruelty to animals), and shoplifting nearly daily for the past 6 months. Dx?

a) ODD
b) Conduct D/O
c) ADHD
d) Antisocial PD

Answer 592

Conduct Disorder

Question 593

37 year old male inmate brought for assessment due to aggression/behavioral problems. On exam is found to be obese, small stature/hands, hypotonic. States he was acting out because he was mad that they don’t give him enough food. Dx?

a) Kluver Bucy Syndrome
b) Fragile X
c) Prader Willi
d) Cri Du Chat syndrome

Answer 593

Prader Willi

Question 594

Woman in her 70’s, no past psychiatric history, husband died suddenly 2 months ago. Presents with 5 month history of numerous depressive symptoms, including worthlessness. No SI, not consolable despite presence of family. Tx?

a) Reassurance
b) Refer to grief counseling
c) Start an SSRI
d) ?supportive intervention

Answer 594

Start SSRI

Question 595

8 year old boy with primary nocturnal enuresis. What is the main treatment for this disorder?

a) Desmopressin
b) Imipramine/TCA
c) Reassurance
d) Behavior therapy

Answer 595

Reassurance

Question 596

17 year old female, history described suggestive of anorexia. BMI is 14.2, HR is 42. Most appropriate next step?

a) Arrange for an ECG
b) Arrange for an inpatient admission
c) Arrange for outpatient treatment
d) ?Refer to cardiology

Answer 596

Arrange for an inpatient admission

Question 597

Which lab abnormality is seen in anorexia? ** repeat

a) low thyroid hormones
b) low cholesterol
c) low amylase
d) low (beta)carotene

Answer 597

low thyroid hormones

Question 598

What are symptoms and signs of anorexia?

Answer 598

• food restriction
• excessive exercises
• preoccupied with food, eating, calories
• social isolation
• mood irritability, depression, obsessive compulsive behaviour
• cold intolerance
• lanugo hair
• hair loss
• poor sleep (early am waking)
• dizziness, fainting
• GI symtpoms

Question 599

What Investigations are necessary in anorexia nervosa?

Answer 599

• CBC (possible reductions in all cell lines)
• Lytes
• BUN, Cr
• Hypercholesterolemia common
• LFTs may be elevated
• Decreased Mg, Zn, Phosphorous
• Metabolic alkalosis if vomiting (hypochloremic, hypokalemic)
• Metabolic acidosis with laxatives
• Thyroid - T4 low-normal, T3 decreased, reverse T3 elevated
• Low E for females, Low T for males
• ECG - bradycardia, prolonged QTC
• BMD, if 6 months amenorrhea

Question 600

Which of the following is NOT a defense mechanism?

a) Sublimation
b) Conversion
c) Fixation
d) Projection

Answer 600

Fixation

Question 601

Which of the following is NOT associated with Turner’s syndrome? * repeat

a) intellectual disabilities
b) short stature
c) cubitus valgus
d) gonadal streak/underdeveloped ovaries
e) coarctation of aorta
f) so secondary sex characteristics
g) Infertility

Answer 601

intellectual disabilities

Question 602

Which is an indication for ECT?

a) Borderline PD
b) Social Anxiety Disorder
c) Delirium
d) Somatization disorder

Answer 602

Delirium

Question 603

Middle aged man with bipolar disorder on lithium maintenance, admitted to medicine with CHF exacerbation. Develops ataxia, dysarthia, tremor. Li level is 0.6. Next step?

a) Repeat Li level
b) Hold Li.
c) Decrease Li dose
d) Increase Li dose

Answer 603

Hold Li

(TREAT SYMPTOMS, NOT LEVEL)

Question 604

What are symptoms of lithium toxicity?

Answer 604

• Nausea
• vomiting
• diarrhea
• sluggishness
• ataxia
• confusion
• agitation
• neuromuscular exictability (coarse tremor, fasciculation, myoclonic jerks)
• Severe - seizures, encephalopathy

Question 605

Adolescent female with “Type A” personality, mother is complaining that she is tired and cranky/irritable all the time and falling behind in homework. Very active in extracurricular activities and lots of contact with her friends through social media. Stays up late at night to complete homework after she returns from extracurricular activities. Sleeps in late, doesn’t wake up in time to eat breakfast before school etc. Next step?

a) Address sleep hygiene
b) CBC and urine drug screen
c) Start melatonin
d) Start SSRI

Answer 605

Address sleep hygiene

Question 606

Woman in early 20’s brought in Tuesday AM with dysphoria, depressive symptoms, passive SI (“I feel like life isn’t worth living”). Friend that was with her over the weekend stated that she was fine over the weekend and didn’t notice anything worrisome. Most likely substance consumed that weekend?

a) Alcohol
b) LSD
c) MDMA
d) Cannabis

Answer 606

MDMA

Question 607

What is the most important principle in the CMA Code of Ethics?

a) Consider first the well being of the patient
b) Non-maleficence
c) Consider first the best interests of the community/society
d) Focus on the patient’s wishes/goals

Answer 607

Consider first the well being of the patient

Question 608

Which is a sign of amphetamine intoxication?

a) dyskinesia
b) nystagmus

Answer 608

dyskinesia

Question 609

What is the DSM 5 Criteria for Stimulant Intoxication?

Answer 609

DSM 5 criteria for Stimulant Intoxication:

Two (or more) of the following signs or symptoms, developing during, or shortly after, stimulant use:

1. Tachycardia or bradycardia.
2. Pupillary dilation.
3. Elevated or lowered blood pressure.
4. Perspiration or chills.
5. Nausea or vomiting.
6. Evidence of weight loss.
7. Psychomotor agitation or retardation.
8. Muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias.
9. Confusion, seizures, dyskinesias, dystonias, or coma.

Question 610

26 year old male presents with first episode of Major Depression. Which would be most important in choosing treatment?

a) Father responded to sertraline
b) Past history of hypomanic episode
c) Comorbid personality disorder
d) Comorbid substance use

Answer 610

Past history of hypomanic episode

Question 611

Buprenorphine mechanism of action?

a) Opioid antagonist
b) Opioid full agonist
c) Opioid partial agonist
d) Opioid partial antagonist

Answer 611

Opioid partial agonist

at MU receptor

Question 612

Neurotransmitter responsible for REM sleep?

a) Serotonin
b) Acetylcholine
c) Dopamine
d) Norepinephrine

Answer 612

Acetylcholine

Question 613

First choice of antidepressant for adolescent with depression?

a) Fluoxetine
b) Desipramine
c) Bupropion
d) Venlafaxine

Answer 613

Fluoxetine

Question 614

Patient presenting for evaluation of suspected schizophrenia. Has cleft palate, cardiac abnormalities, learning disorder. Which chromosome would expect to find an abnormality on? **REPEAT

a) 6
b) 18
c) 21
d) 22

Answer 614

22

DiGeorge/22z11.2

congenital heart problems, specific facial features, frequent infections, developmental delay, learning problems and cleft palate. 20-30x higher risk of schizophrenia

Question 615

Male stabilized on Citalopram 40mg daily, Risperidone 3 mg daily, and Benztropine 1mg daily for treatment of psychotic depression. Received rx for codeine one week ago. Now presenting with fever, rigidity, disorientation, and inducible clonus. Next step?

a) Stop citalopram
b) Stop risperidone
c) Stop benztropine
d) Start cyproheptadine

Answer 615

Stop citalopram

(Clonus almost always = Serotonin Syndrome)

Question 616

How is remission of depression defined re: HAM-D score?

a) 50% score reduction
b) 25% score reduction
c) Score of 12 or less
d) Score of 7 or less

Answer 616

Score of 7 or less

Question 617

True of narcolepsy?

a) Polysomnography required for diagnosis
b) Modafinil is indicated for daytime sleepiness
c) Nortryptiline or imipramine is fist line for sleep paralysis
d) Only have auditory hallucinations with hypnogogic/hypnopompic hallucinations

Answer 617

Modafinil is indicated for daytime sleepiness

Question 618

Most common perceptual disturbance in Parkinson’s?

a) Visual hallucinations and illusions
b) Olfactory hallucinations and altered sense of smell
c) Something auditory
d) Something somatic

Answer 618

Visual hallucinations and illusions

Question 619

Middle aged woman presenting for treatment of depression with IPT. Had a chaotic upbringing, father was alcoholic and absent while had an enmeshed relationship with her mom. Her father died 5 years ago. Good marriage, warm relationship with her husband and her daughter. Saddened by daughter’s decision to move away with the grandchildren 2 years ago. Functions well at work, but has long-standing conflict with her boss. What should be the focus in IPT?

a) Grief over loss of father
b) Interpersonal deficits due to upbringing
c) Role transition due to changing relationship with daughter
d) Role dispute due to conflict with boss

Answer 619

Role transition due to changing relationship with daughter

Question 620

Young woman with symptoms of Borderline PD presenting with multiple suicide attempts and self-harm behavior. Has had failed attempts at psychotherapy. Which would be a component of the recommended treatment for her?

a) Transference interpretation
b) Mindfulness
c) Communication analysis
d) Challenging distorted thoughts

Answer 620

Mindfulness

Question 621

Young woman with symptoms of Borderline PD presenting with multiple suicide attempts and self-harm behavior. Which would be a component of the recommended treatment for her?

a) DBT to reduce self-harm
b) CBT to challenge her responses to stressors
c) Psychodynamic Tx for underlying conflicts causing her symptoms
d) Another distracter

Answer 621

DBT to reduce self-harm

Question 622

Which of the following would make someone unfit to stand trial?

a) Has a mental disorder
b) Is unaware that there would be consequences to being found guilty
c) Wants to represent themselves in court
d) Doesn’t want to do what’s in best interest

Question 623

Which is true of GAD?

a) Same prevalence as depression
b) Onset is typically in late adolescence
c) 44% rate of depression comorbidity

Answer 623

Onset is typically in late adolescence

Question 624

Which is NOT a symptom of NMS?

a) rigidity
b) hyperthermia
c) elevated serum creatinine
d) tachycardia

Answer 624

Elevated Serum Creatinine

Question 625

In evaluating erectile dysfunction in a patient, absence of an erection in which of the following scenarios would be most consistent with an organic dysfunction?

a) amyl nitrate ingestion
b) Erection during REM sleep
c) Erection while watching erotic pornographic material
d) Erection during NREM sleep

Answer 625

Erection during REM sleep

Question 626

21 year old male with schizophrenia, diabetes, and cannabis use disorder. On Risperidone. Which of the following is most significant risk factor for developing tardive dyskinesia?

a) Age
b) Male
c) Cannabis use
d) Diabetes

Answer 626

Diabetes

Risk Factors for TD

• Older
• female
• First > SGA
• Duration
• dose
• early occurrence of drug induced movement disorders
• Shchiz
• ID
• ETOH or SUD
• Dementia
• Diabetes
• Prior ECT

Question 627

Which of the following is NOT a risk factor for rapid cycling?

a) hypothyroid
b) antidepressant use
c) substance use
d) male gender

Answer 627

male gender

Rapid Cycling RF

• Younger, onset <17
• Women > men (70%)
• Hypothyroidism *** NOT hyperthyroid
• SSRIs

Question 628

EEG changes seen in delirium?

a) reduced alpha waves with generalized theta and delta waves
b) 3 other choices I cannot remember

Answer 628

reduced alpha waves with generalized theta and delta waves

OR diffuse slowing of the background rhythm

Question 629

Which is part of basic workup in someone suspected of dementia? (basic was bolded and underlined)

a) serum glucose and calcium
b) serum folate and VDRL for syphilis
c) CT head and APOE gene analysis
d) MRI

Answer 629

serum glucose and calcium

Question 630

Woman presents after her 86 year old father was diagnosed with Alzheimer’s dementia, worried about her risk. What do you advise?

a) Reassurance
b) ApoE gene analysis
c) Referral to genetics
d) CT scan

Answer 630

Reassurance

Question 631

Which of the following is NOT a risk factor for delusional disorder?

a) Immigration (recent?)
b) Sensory deficit
c) Older age
d) MDD

Answer 631

MDD

Question 632

13 year old boy with symptoms of OCD and functional/social impairment as a result. Recommendation?

a) Pharmacotherapy is required because of how severe his symptoms are
b) CBT is effective if the patient is willing to engage
c) It is essential for treatment to have CBT and meds

Answer 632

CBT is effective if the patient is willing to engage

Question 633

Patient stabilized on clozapine 600 mg. Which dose-dependent side effect is important to monitor for?

a) Agranulocytosis
b) Seizures
c) Hypotension
d) Prolonged QTc

Answer 633

Seizures

Question 634

Patient started on clozapine for treatment refractory schizophrenia. Develops tachypnea, tachycardia, chest pain, pulmonary edema. Afebrile, auscultation reveals basilar crackles bilaterally. Inverted T-waves on ECG. Most likely Dx?

a) Clozapine-induced tachycardia
b) MI
c) Clozapine-induced myocarditis
d) Pneumonia due to agranulocytosis

Answer 634

Clozapine-induced tachycardia

Question 635

Patient stable on clozapine 600mg for 6 weeks. Level is 350. Now presenting with rigidity, staring off into space, unresponsive. Afebrile, vital signs normal. Not cooperative or responding on exam. Next step?

a) Benztropine 1 mg
b) Lorazepam 1 mg
c) Stop clozapine
d) Reduce clozapine dose

Answer 635

Lorazepam 1 mg

Question 636

Which will increase Clozapine levels?

a) St. John’s Wort
b) Smoking
c) Alcohol
d) Caffeine

Answer 636

Caffeine

Cloz & caffeine metabolixed by CYP1A2, caffeine inhibits cloz metabolism and increases cloz levels

SJW and Smoking are P450 inducers therefore decrease levels of clozapine

Caffeine decreases Li levels

Question 637

All of the following include paranoia in their diagnostic criteria EXCEPT:

a) Schizotypal PD
b) Schizophreniform D/O
c) Paranoid PD
d) Schizoid PD

Answer 637

Schizoid

Question 638

Which is true about Guanfacine?

a) It can be added to stimulants
b) It can be stopped abruptly if ineffective
c) It is not useful in ADHD with comorbid tic disorder
d) Guanfacine can be used for a rapid response in ADHD

Answer 638

It can be added to stimulants

Question 639

Deficit seen in a lesion to the dominant anterior inferior frontal cortex?

1. language problems
2. other problems unrelated to language

Answer 639

language problems/impaired namind

Question 640

What is seen in early stages of Primary Progressive Aphasia?

a) Impairments in naming objects and sentence comprehension
b) Spelling and writing are preserved
c) does not share neuropathology with other dementia

Answer 640

Impairments in naming objects and sentence comprehension

Question 641

Which is NOT a feature of catatonia?

a) Abulia
b) Negativism
c) Posturing
d) Mutism

Answer 641

Abulia

Recall:

WiN MaC -SP GAME₂S

1. Waxy flexibility – slight, even, resistance to positioning by examiner
2. Negativism – do the opposite of what is asked/ no response to instructions or external stimuli
3. Mutism – no/very little verbal response
4. Catalepsy –passive induction of a posture held against gravity
5. Stupor – no psychomotor activity; not actively relating to environment
6. Posturing – spontaneous & active maintenance of a posture against gravity /adoption of unusual bodily postures continuously for a long time
7. Grimacing
8. Agitation – not influenced by external stimuli
9. Mannerism – repeated movements that appear to have some functional significance e.g. saluting
10. Echolalia – mimicking another’s speech
11. Echopraxia – mimicking another’s movements
12. Stereotypy – repetitive, abnormally frequent non-goal directed movements e.g. rocking to and fro

Question 642

Which region of the brain is responsible for interpreting the emotional tone of language/speech?

a) Amygdala
b) Tempoparietal
c) Hippocampus
d) Frontal lobe (I think it referenced either dominant or non-dominant side)

Answer 642

Tempoparietal

Question 643

Which is true about Developmental Coordination Disorder?

a) Females more than males
b) Can cause school difficulties
c) Asymmetric symptoms common

Answer 643

Can cause school difficulties

Question 644

Patient admitted for treatment of schizophrenia. Also has comorbid crack/cocaine use, but stem makes it clear that this is schizophrenia and not substance-induce psychosis. This is his second admission, now on depot IM due to noncompliance in community, still some residual positive symptoms, how long do you recommend he stay on antipsychotic before discontinuing?

1. Continue treatment for 6-12 months and then gradually taper
2. Continue treatment for 1-2 years and then gradually taper
3. Continue treatment for 5 years and then gradually taper over 6-24 months
4. Continue treatment indefinitely

Answer 644

Continue treatment indefinitely

Question 645

Evidence based psychosocial treatment for schizophrenia?

a) Family Tx focused on how the family dysfunction perpetuates schizophrenia
b) Family Tx focused on high expressed emotion
c) Intensive Community Treatment focused on patients at high risk of rehospitalization

Answer 645

Family Tx focused on high expressed emotion

Question 646

What is true of schizophrenia prodrome?

a) 80%-90% of patients with schizophrenia had prodromal symptoms
b) Convert to schizophrenia ~50% of the time
c) Antipsychotics have been shown to be effective in this stage
d) CBT (and ?stress management) have not been demonstrated to be effective in reducing these symptoms

Answer 646

80%-90% of patients with schizophrenia had prodromal symptoms

“Antipsychotics have been shown to be effective in this stage” could also be true

Question 647

Most common cause of death in schizophrenia?

a) Suicide
b) Diabetes
c) Homicide
d) ?

Answer 647

Diabetes

Question 648

54. A cognitive screening test has a 95% sensitivity and a 60% specificity. They give you the scoring parameters (ie. what a normal/abnormal score is). What is true of the test?
55. The high sensitivity means that if someone has a positive result, it is unlikely that they have the disease
56. High sensitivity means if negative test, unlikely they have disease

Answer 648

High sensitivity means if negative test, unlikely they have disease

Question 649

Study of fish oil for relapse prevention vs. placebo. Placebo response is 40%, and absolute risk reduction is 3.1% (95% CI 0.6% to 22%). What can you say about fish oil?

a) It has demonstrated a significant clinical effect
b) It has demonstrated it does harm
c) It has demonstrated that it is not clinically effective
d) Not enough information to comment on it’s clinical effect

Answer 649

Not enough information to comment on it’s clinical effect

Question 650

Primary vs. Secondary studies/research. Which is NOT an example of secondary study?

a) Systematic Review
b) Survey
c) Non-systematic review
d) Meta-analysis

Answer 650

Survey

Question 651

Woman with Bipolar disorder, stable on Lithium long-term. In hospital with abdominal pain, nausea, vomiting, disorientation. What is likely underlying cause?

a) hypercalcemia
b) hypothyroid
c) renal
d) ?

Answer 651

hypercalcemia

*Remember that lithium can cause hyperparathyroidism and hypercalcemia

Question 652

. Egas Moniz and Hess won Prize in Medicine in 1949. What did they win it for?

a) insulin coma
b) ECT
c) Preforontal leucotomy/lobotomy

Answer 652

Preforontal leucotomy/lobotomy

Question 653

12 year old boy presenting with vague symptoms of school dysfunction, also mention he is 95^th percentile for weight and has recurrent tonsillitis. Which rating scale would be important to use?

a) A child depression scale
b) A child anxiety scale
c) A pediatric sleep scale
d) Another scale

Answer 653

A pediatric sleep scale

• Getting at ruling out childhood OSA, which can mimic ADHD, and causes obesity, nocturnal enuresis, and recurrent tonsillitis

Question 654

Question about panic disorder treatment guidelines, which is true?

a) Buspirone monotherapy is not recommended
b) Propranolol is third-line adjunctive therapy
c) Citalopram not recommended

Answer 654

Buspirone monotherapy is not recommended

Question 655

Patient with Bipolar I depression, has been stable on Lithium, current level 0.6. Which of the following is NOT a first-line treatment recommendation?

a) Add bupropion to lithium
b) Optimize lithium
c) Lithium + lamotrigine
d) Add divalproex (switch to divalproex?)

Answer 655

Add bupropion to lithium = 2^nd line

Question 656

Which of the following is in keeping with the role of a group therapist?

a) Resolve conflict amongst group members
b) Be able to tolerate and contain group affect etc
c) Take a passive stance once the group dynamic is formed
d) Ensure everyone has chance to participate

Answer 656

Be able to tolerate and contain group affect etc

Question 657

What is TRUE of family therapy goals?

a) Resolution of symptoms of identified patient
b) When individuals can see how others see them therapy is complete
c) splits and alliances addressed by the Bowen model
d) Free association is desired

Answer 657

When individuals can see how others see them therapy is complete

Question 658

Which mood stabilizer can cause acute pancreatitis?

a) Carbamazepine
b) Lithium
c) Valproic Acid
d) Topiramate

Answer 658

Valproic Acid

Question 659

Patient with hepatic failure, which antipsychotic would be best?

a) Paliperidone
b) Haloperidol
c) Olanzapine
d) Perphenazine

Answer 659

Paliperidone

Paliperidone is the only option that is exclusively renally excreted and doesn’t interact with the liver.

Question 660

Patient on an antipsychotic (risperidone), clinical and laboratory evidence of hyperprolactinemia, which antipsychotic is best to switch to?

a) Aripiprazole
b) Haloperidol
c) Asenapine
d) Olanzapine

Answer 660

Aripiprazole

Question 661

Which is NOT an evidence-based pharmacologic treatment for aggression/impulsivity in Borderline PD?

a) Antipsychotic
b) mood stabilizer
c) SSRI
d) Clonazepam

Answer 661

Clonazepam

Recall in BPD

a) Antipsychotic (Aripiprazole)
b) mood stabilizer (Topiramate?)
c) SSRI (Fluoxetine?)

Question 662

Treating a patient with depression with IPT. Which of the following techniques will be part of therapy?

a) Examining evidence of underlying thoughts/assumptions
b) Communication analysis
c) Interpreting transference
d) Strengthening ego defenses

Answer 662

Communication analysis

Question 663

Treatment of cannabis use disorder

a) Motivational interviewing and relapse prevention strategies
b) Naltrexone
c) Varenicline
d) Self-referral to Narcotics Anonymous

Answer 663

Motivational interviewing and relapse prevention strategies

Question 664

Cannabis and schizophrenia?

a) Cannabis shows improvement in cognitive set-test, supporting idea of cannabis as self-medication
b) Better outcomes with clozapine in schizophrenia with comorbid cannabis use disorder
c) Dopamine Transporter (DAT1) polymorphism increases risk of psychosis with cannabis abuse
d) People who use cannabis will develop psychosis 7 yrs earlier

Answer 664

Dopamine Transporter (DAT1) polymorphism increases risk of psychosis with cannabis abuse

Question 665

Patient with schizophrenia, stable symptoms on Risperidone 3mg but developed TD. Best option?

a) Increase risperidone dose
b) Switch to clozapine
c) Botulinim toxin injection
d) Benztropine

Answer 665

Switch to clozapine

Question 666

Who was responsible for describing operant conditioning?

a) Pavlov
b) Bandura
c) Skinner
d) Ainsworth

Answer 666

Skinner

Question 667

Middle aged male patient presenting in distress (depressive symptoms but not enough for a diagnosis of MDD). Recent break up with girlfriend, problems at work, disappointed that he never fulfilled his goal of becoming a famous author, felt boss envied him because of how smart he was. Most appropriate diagnosis?

a) Antisocial PD
b) Borderline PD
c) Narcissistic PD
d) Paranoid PD

Answer 667

Narcissistic PD

Question 668

Middle aged patient, divorced, job loss, ?alcohol use, estranged from children and family. What Erikson stage best represents his situation?

a) Identity vs. Role Confusion
b) Generativity vs. stagnation
c) Intimacy vs. isolation
d) Integrity vs. ego despair

Answer 668

Generativity vs. stagnation

Question 669

Woman presenting with manic symptoms. Psychotic, 3-4 days without sleep. What is the best/most positive prognostic factor in her presentation?

a) Female
b) Has had insomnia for less than one week
c) Psychotic symptoms
d) Previous good response to antidepressant

Answer 669

Female

Question 670

Which condition doesn’t have an associated sleep disorder?

a) hypertension
b) Huntington’s disease
c) Alzheimer’s
d) Uremia

Answer 670

Hypertension

Question 671

Need to select best antidepressant for an older woman with a number of medical comorbidities: numerous falls due to orthostatic hypotension, untreated seizure disorder, hyponatremia (sodium = 132).

a) Mirtazapine
b) Desipramine
c) Bupropion
d) Sertraline

Answer 671

Desipramine

Question 672

Most suitable for inpatient addictions treatment? (repeat)

a) Guy who does a lot of coke, lots of relapses, lives with other people who do lots of coke
b) Married man with stable marriage and alcohol use disorder
c) guy who has frequent relapse and lives alone
d) Psychotic woman using cannabis

Answer 672

Guy who does a lot of coke, lots of relapses, lives with other people who do lots of coke

Question 673

79. Best candidate for methadone maintenance treatment?
    a) 29 year old woman, 6 months pregnant, 8 month history of IV heroin use
    b) 27 year old male, 9 month history of IV heroin use
    c) 32 year old male with cocaine dependence
    d) 35M with long QT syndrome

Answer 673

29 year old woman, 6 months pregnant, 8 month history of IV heroin use

– about equivalent for buprenorphine not combined with naloxone (as per ASAM)

Question 674

What best describes the neurobiological basis of relapse?

a) exposure to/use of low doses of substance results in lower than expected dopamine response
b) substance cues to use lead to glutamate mediated activation
c) GABA increases in withdrawal

Answer 674

substance cues to use lead to glutamate mediated activation

Question 675

Neurotransmitter responsible for alcohol withdrawal?

a) GABA
b) Glutamate
c) Norepinephrine
d) Dopamine

Answer 675

Glutamate

Question 676

Most common comorbidity with OCD (children/adolescents)

a) MDD
b) ODD
c) GAD
d) Tourette’s

Answer 676

MDD

Question 677

Which is true about alcohol?

a) Females have less gastric metabolism than men, resulting in increased physiologic effect for same amount of consumption compared to males
b) Alcohol increases fluidity of cell membrane
c) More alcohol dehydrogenase is made the more you drink

Answer 677

Females have less gastric metabolism than men, resulting in increased physiologic effect for same amount of consumption compared to males

(the other 2 answers describe short term effects)

Question 678

What is responsible for rising of action potential?

a) Efflux of Na
b) Influx of Na
c) Influx of K
d) Influx of Cl

Answer 678

Influx of Na

Question 679

Patient is stable on paroxetine. Upcoming scheduled GI/abdominal surgery. What do you recommend/which is true?

a) Needs to stop paroxetine prior to surgery due to bleeding risk
b) Increased bleeding risk of SSRI’s is only associated with GI bleeds
c) Risk of bleed is not clinically significant and paroxetine can be maintained

Answer 679

Risk of bleed is not clinically significant and paroxetine can be maintained

Question 680

Young woman stable on SNRI for treatment of previous severe depression, now presents to you 10 weeks pregnant. What do you recommend re: antidepressant?

a) lower dose to lowest possible with therapeutic effect
b) maintain current effective dose
c) stop antidepressant

Answer 680

maintain current effective dose

(recall that SSRI& SNRI are preg categegory C, except for Paxil, which is D)

Question 681

Question about pregnancy, paroxetine. Female worried about increased relative risk of persistent pulmonary hypertension of newborn. What do you tell her?

a) No risk if paroxetine avoided in first trimester
b) Absolute risk of PPH is low
c) Her paroxetine must be discontinued

Answer 681

Absolute risk of PPH is low

Question 682

Which of the following is NOT consistent with Freud’s description of the unconscious?

a) it is unaware of its contradictions/conflicts
b) it is unchanged/unaware of time
c) it is represented in language

Answer 682

it is represented in language

Question 683

All of the following are features of chronic fatigue syndrome associated with Major Depressive Disorder EXCEPT:

A. No family history of depression

B. Low rate of suicide

C. Uncommon to have weight change

D. Not triggered by a stressor

Answer 683

Not triggered by a stressor

Question 684

When major depression is superimposed on to chronic fatigue syndrome, which of the following is FALSE? (2 possible answers from below)

• a.* there is little weight change
  b. there is little sleep change (correct answer; many patients with CFS report non-refreshing sleep)
  c. pathological guilt tends not to occur
  d. there tends to be a family history of depression (correct answer?)
  e. there is a low risk of suicide

Answer 684

• there is little sleep change (correct answer; many patients with CFS report non-refreshing sleep)
• there tends to be a family history of depression

Question 685

Chronic fatigue syndrome is associated with all of the following EXCEPT

a. factitious disorder
b. somatization disorder
c. psycho-physiological reactions to stress
d. dysthymia
e. depression

Answer 685

factitious disorder

Question 686

60 year old male patient, 1 day post-op, keeps having agitation/aggression every time they try to lower dose of midazolam/propofol. You are called to assess. Most important part of history?

a) Family Hx
b) Medical Hx
c) Alcohol use Hx

Answer 686

Alcohol use Hx

Question 687

Which is NOT one of the defense mechanisms in dreams described by Freud?

a) Regression
b) Repression
c) Condensation
d) Displacement

Answer 687

Regression

Question 688

Which psychosocial intervention has evidence in PTSD?

a) Critical incident debriefing
b) CBT
c) ?
d) ?

Answer 688

CBT

Question 689

Woman on PTSD, good relief of symptoms and stable on Sertraline 150mg daily, but still having distressing nightmares and sleeping poorly. Which medication do you recommend?

a) Prazosin
b) clonidine
c) Trazodone
d) SNRI

Answer 689

Prazosin

Question 690

Which of the following is NOT a risk factor for cognitive side effects of ECT?

a) Treatment course duration
b) Stimulus size
c) Hyperventilation/oxygenation
d) Bilateral electrode placement

Answer 690

Hyperventilation/oxygenation

Question 691

Patient is having ECT, has a seizure that lasts longer than 3 minutes. Most important next step/medication to give?

a) Diazepam
b) Ketamine
c) Succinylcholine
d) Naloxone

Answer 691

Diazepam

Question 692

What does the MMPI test?

a) Defenses
b) Social introversion
c) IQ
d) Projective Personality Test

Answer 692

Social introversion

Component of MMPI:

1) Hypochondriasis
2) Depression
3) Hysteria
4) Psychopathic Deviate
5) Masculinity/Femininity
6) Paranoia
7) Psychasthenia
8) Schizophrenia
9) Hypomania
10) Social Introversion

Question 693

4 year old patient, which of the following would be suggestive of developmental delay?

a) Can ride a tricycle
b) Can draw a circle and a square
c) Speaks in 3 word sentences
d) Can follow 3 stage command

Answer 693

Speaks in 3 word sentences

Question 694

Guy with a traumatic brain injury and aggressive symptoms. Best evidence for treatment?

a) Quetiapine
b) Propranolol
c) Risperidone
d) Haldol

Answer 694

Propranolol

(or Risperidone)

Question 695

Patient with bradycardia and delirium. What is most likely cause of her bradycardia?

a) CHF
b) Raised intracranial pressure
c) Pulmonary edema
d) Metabolic acidosis

Answer 695

Raised ICP

Question 696

Panic disorder, what is true?

a) Combination of CBT and meds are more effective
b) medication is more effective than CBT
c) CBT is more effective than medication
d) Using Lorazepam is detrimental during exposure therapy

Answer 696

Combination of CBT and meds are more effective

Question 697

Depression, which is not true?

a) 50% with first episode will have relapse in next 2 years
b) Higher severity episode predicts worse future outcomes/more severe future depression/more frequent relapses

Answer 697

50% with first episode will have relapse in next 2 years

– this is TRUE only for inpts d/c’ed

Question 698

True of suicide in adolescents?

a) Homosexual orientation have a higher completed suicide rate
b) Overdose is most common method of suicide
c) most common cause of death in 13-19 year olds
d) Cognitive Immaturity predicts lethality

Answer 698

Homosexual orientation have a higher completed suicide rate

Question 699

Sleep changes in depression

a. decreased sleep latency
b. increased slow wave sleep
c. decreased REM latency
d. decreased REM density

Answer 699

decreased REM latency

(also increased REM density)

Question 700

Which history is consistent with seasonal pattern mood disorder?

a) Man with 2 seasonal depression and 7 non-seasonal depressions
b) Man has had one previous hypomanic episodes and past 3 years has had depressions starting in winter and resolving in spring, related to seasonal employment
c) Man has had depressive episode for past 3 years with onset in winter and resolution in spring, and one previous manic episode 5 years ago

Answer 700

Man has had depressive episode for past 3 years with onset in winter and resolution in spring, and one previous manic episode 5 years ago

Question 701

54 year old women with sudden onset of dementia symptoms and hallucinations. Rapidly progressive dementia with ataxia and stimulus-sensitive myoclonus. EEG shows generalized background slowing with periodic sharp discharges. Diagnosis?

a. Creutzfeld Jakob Disease
b. Lewy Body Dementia
c. Vascular Dementia
d. Pick’s Disease

Answer 701

Creutzfeld Jakob Disease

Question 702

Which is part of the limbic system?

a. nucleus accumbens
b. locus ceruleus
c. globus pallidus
d. subthalamic nucleus

Answer 702

nucleus accumbens

(also hypothalamus if that is an option)

Question 703

Mother calls her daughter a brat in family therapy and therapist reframes as “strong-willed.”

What is this an example of?

a. Paradoxical injunction
b. positive connotation
c. interpretation
d. confrontation

Answer 703

positive connotation

Question 704

Treatment of Lithium induced tremor:

a. propanolol
b. lorazepam
c. cogentin

Answer 704

propanolol

Question 705

With regards to violence assessment

a) Area under curve predicts violence
b) Clinical judgment has good positive predictive value
c) Structured clinical judgment assessment tools provide individualized measure of risk

Answer 705

Structured clinical judgment assessment tools provide individualized measure of risk

Question 706

Augmentation strategy for MDD?

a. Thyroxine
b. Abilify
c. Lamotrigine

Answer 706

Abilify

Question 707

Restless Leg Syndrome. Not in?

a. Pregnancy
b. Menopause
c. Renal failure
d. diabetic neuropathy
e. Iron deficiency

Question 708

Which of the following assesses frontal lobe functioning:

A. Olfactory testing

B. Luria’s three-step test

C. Evoked potentials

D. Nystagmus

Answer 708

Luria

(Fist edge palm)

Question 709

Nicotine dependence:

a. Nicotine is an indirect agonist of the dopamine receptor
b. Nicotine is a selective agonist of the nicotinic cholinergic receptor
c. Nicotine is a selective antagonist of the nicotinic cholinergic receptor
d. Nicotine is a partial agonist and antagonist of the acetylcholine receptor

Answer 709

Nicotine is a selective agonist of the nicotinic cholinergic receptor

Question 710

What is true of personality disorders in the elderly?

a. Traits remain stable over the years
b. Personality symptoms worsen with age
c. Personality Disorder NOS is one of the most common diagnoses in the elderly
d. Personality Disorders are less common in the elderly

Answer 710

Personality Disorders are less common in the elderly

Question 711

OCD in kids. Which is NOT present?

1. Abrupt onset
2. M>F
3. May not be aware of obsessions

Answer 711

Abrupt Onset

Question 712

Young male in MVA 3 weeks ago, in which fiancé died. He describes feeling numb, detached from his surroundings, decreased sleep because of nightmares, irritability, becomes apprehensive when conversation seems to be moving towards discussing crash

Most likely diagnosis?

a) PTSD
b) Acute Stress Disorder
c) Adjustment disorder with anxious mood
d) Bereavement

Answer 712

Acute Stress Disorder

Question 713

Universality in group therapy?

a. Often doesn’t become obvious to various members
b. Is important in the process of group cohesiveness
c. Members often see themselves as being more different than similar

Answer 713

Is important in the process of group cohesiveness

Question 714

Patient has been prescribed 1mg ativan for insomnia. When you discontinue the ativan, the patient complains within 2 weeks that his insomnia has returned. What do you infer from this presentation?

a. The patient has a dependence on (?is addicted to) benzodiazepines, and they should not be prescribed.
b. The patient’s insomnia has returned, as the benzodiazepine was only providing symptomatic relief

Answer 714

The patient’s insomnia has returned, as the benzodiazepine was only providing symptomatic relief

Question 715

Which is true regarding specific phobia?

a. virtual reality exposure is an effective treatment
b. medications are important part of treatment
c. a long treatment period is necessary

Answer 715

virtual reality exposure is an effective treatment

Question 716

Stem regarding man with alcohol history with relapse and brief periods of sobriety. Which medication has evidence in assisting with abstinence?

a. Topiramate
b. Acamprosate
c. Varenicline
d. Burpropion

Answer 716

Acamprosate

Question 717

Which of the following is true of schizophrenia?

a. Correlates with urban density in small cities
b. Incidence is increased in industrialized countries
c. Higher prevalence in low SES

Answer 717

Higher prevalence in low SES

Question 718

Post-partum psychosis question. What would be the biggest risk factor?

a. Personal history of bipolar disorder
b. Difficult pregnancy
c. Obstetrical complications
d. marital discord

Answer 718

Personal history of bipolar disorder

Question 719

Which is NOT considered a possible treatment option of ADHD

a. play therapy
b. CBT

Answer 719

Play Therapy

Question 720

All of the following increase PTSD risks in children, except:

a. Male sex
b. Coverage on news
c. Previous trauma
d. Parental substance use

Answer 720

Male Sex

Question 721

17ish kid, 4 months more disorganized at school, amotivated, says is sad, sees shadowy figure in room that talks to him. Dx?

a. Brief psychotic ep
b. MDD with psychotic features
c. Schizophrenia

Answer 721

MDD with psychotic features

Question 722

All of the following disorders has visual hallucinations EXCEPT:

a. Myasthenia Gravis
b. Atropine Poisoning
c. Narcolepsy

Answer 722

Myasthenia Gravis

Question 723

What is the behavioral activation theory behind major depressive disorder?

Answer 723

Avoidance causing lack of positive reinforcement

Question 724

What is most associated with childhood bipolar disorder

a) conduct disorder
b) 44% have an anxiety disorder
c) ADHD onset with later onset

Answer 724

conduct disorder

Child BD is most comborbid with ADHD (62%), ODD (53%), anxiety disorders (27%), conduct (19%) and SUD (12%)

Early onset BD predicts earlier onset ADHD (KS)

Question 725

Regarding vocational training in persons with schizophrenia:

A. Best evidence exists for integration of mental health and vocational services in the same program.

B. Emphasis should focus on long term job retention

C. Ensure patient retains employment in a sheltered environment.

Answer 725

Best evidence exists for integration of mental health and vocational services in the same program.

Question 726

Cognitive deficits in schizophrenia:

a. Better related to prognosis than positive sx
b. Cognitive remediation is very effective
c. Just recall is affected

Answer 726

Better related to prognosis than positive sx

Question 727

What is the best indication for long term IM antipsychotic?

a. Suicide attempts
b. Repeated hospitalization
c. Recurrent mood symptoms

Answer 727

Repeated hospitalization

Question 728

Higher risk of this medical illness in schizophrenia?

a. Rheumatoid arthritis
b. HIV

Answer 728

HIV

(susceptibility to RA or Schizophrenia could place individuals at lower risk for the other)

Question 729

Somebody with first episode of depression, what would most predict bipolar disorder?

a. Psychomotor retardation
b. Onset in early adulthood
c. Good response to antidepressant
d. Insidious onset of depression

Answer 729

Onset in Early Adulthood

Question 730

Which is true of informed consent?

a. must be done without coercion
b. can’t be done with anyone under 16
c. can’t be done with someone of below normal intelligence

Answer 730

must be done without coercion

Question 731

All of the following are component of evidence-based stress management EXCEPT:

A. cognitive reconstruction

B. relaxation

C. problem solving

D. peer support group

Answer 731

peer support group

Question 732

Which would be the appropriate test to use when comparing a proportion of patients who respond to a treatment or don’t?

a. chi-squared
b. t-test
c. ANOVA
d. regression analysis

Answer 732

chi-squared (binary predicter and binary outcome) – becayse YES or NO

Recall:

t-test (binary predicter and multi outcome)

ANOVA (multi predicter and multi outcome)

Question 733

What is the most common cause of death in mood disorders?

a. suicide
b. cardiovascular disease
c. cancer
d. homicide

Answer 733

cardiovascular disease

Question 734

1. Woman with cancer . Wants CAM treatment and hopeful for this to work. Oncologist does not think that the CAM treatment will work. You have been consulted to see her. What should you do?
   
   1. Assess for depression
   2. Tell her CAM treatments won’t work
   3. Listen to her illness experience

Answer 734

Listen to her illness experience

Question 735

1. All of the following are characteristics of paranoid personality disorder EXCEPT?
   
   1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her
   2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates
   3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her
   4. Neither desires nor enjoys close relationships, including being part of a family

Answer 735

Neither desires nor enjoys close relationships, including being part of a family

Question 736

1. 16 yr old girl. Lots of friends but shy with those she doesn’t know. Doesn’t want to read in front of class.
   
   1. GAD
   2. Avoidant personality
   3. Social Anxiety disorder/social phobia

Answer 736

Social Anxiety disorder/social phobia

Question 737

1. 75 yr old lady. Hypothyroidism. Taking sertraline for 10 yrs. Comes in with progressive confusion, myalgia, malaise. Just started Carbamazine. 1 week history of sx. What would you check.
   
   1. Na
   2. T4
   3. EEG
   4. MRI

Answer 737

Na

Question 738

1. Female, stable, on Lithium, has amenorrhea. Likely due to?
   
   1. Lithium toxicity
   2. Hypothyroid

Answer 738

Hypothyroid

Question 739

1. Which is true:
   
   1. glutamate induces transmission
   2. GABA induces transmission
   3. neuropeptides induce transmission

Answer 739

glutamate induces transmission

Question 740

1. Which of the following is the LEAST associated with Tourettes:

A. ADHD

B. OCD

C. Conduct disorder

D. Learning disorder

Answer 740

Conduct Disorder

Question 741

Order of anxieties from most primitive:

Disintgegratio, loss of love object, castrartion superego

Answer 741

• Disintegration
• loss of love object
• castrartion
• superego

Question 742

Which is true about the HCR-20 scale?

a) Can be used to assess risk of aggression to self or others
b) Can be used in psychiatric and forensic populations
c) Is used to assess current risk

Answer 742

Can be used in psychiatric and forensic populations

(not used to assess current risk, and not used to assess risk to self)

Question 743

Which dissociates fastest from D2 receptors?

1. Clozapine
2. Abilify
3. 1st gen option
4. Risperidone

Answer 743

Clozapine

Question 744

Elderly man, with dementia in a nursing home. Wanders into others rooms and attempts to abscond, has succeeded at times in past.

How to address this?

1. Disguise exits and put barriers in place to others rooms
2. Snoezelen room
3. Exercise class

Answer 744

Disguise exits and put barriers in place to others rooms

Question 745

Repeat 28 yo guy who sets fires when mad. Set a fire when he was 10 revenge against mom. Set fire against bakery after fired. Enjoyed watching it burn, also one fire while drunk with friends (likely accidental fire). Hx of school difficulties and treated with stimulant as kid. Diagnosis?

1. Pyromania
2. Antisocial PD
3. MDD
4. Etoh use d/o

Answer 745

Antisocial PD

Question 746

Borderline patient seeing a therapist. Patient is angry, states “you’ve given up on me”, dysregulated in appointment. Therapist starts to feel frustrated and has fleeting thoughts such as “what is the point” of treating this patient. What phenomenon is occurring here?

1. Projective identification
2. Pathological devaluing
3. Splitting
4. Denial

Answer 746

Projective identification

Question 747

Kid on clonidine for tics. Tics are well controlled. Needs ADHD treatment for ongoing ADHD symptoms that are impairing at school and home.

1. Atomoxetine
2. Methylphenidate

Answer 747

Methylphenidate

Question 748

Kid on guanfacine. What is a possible side effect?
a. Nausea/vomiting

B. bradycardia

C. hypertension

D. sedation

Answer 748

Sedation

(Recall, it is an a-2 agonist)

Question 749

Patient in CBT describes being overworked at work and at home, feels underappreciated, what element of CBT should be pursued?

1. Socratic questioning looking at why she feels the need to be perfect
2. Mindfulness
3. Addressing cognitive distortions
4. Exposure to anxiety

Answer 749

Socratic questioning looking at why she feels the need to be perfect

Question 750

Patient with schizophrenia, 2 trials on atypicals, for 6 weeks each, ongoing symptoms. Family report no substance use. What is the next step?

1. Confirm compliance
2. Clozapine
3. Start an injectable
4. Start a typical

Answer 750

Confirm compliance

Question 751

Man in ER with etoh intoxication and leg cellulitis. Homeless. What is the next best step?

1. Convince him to return for IV Abx the next day
2. Psych consult
3. Detox/etoh treatment
4. Refer to community outreach team

Answer 751

Refer to community outreach team

Question 752

Man with Persistent Depressive Disorder, couple episodes per year of elevated mood, cleaning/painting apartment lasting 2-3 days

1. Cyclothymia
2. Unspecified Bipolar Disorder with MDD, hypomania
3. MDD with short term manic symptoms
4. Bipolar II

Answer 752

Cyclothymia

Question 753

Lady with Etoh use disorder, admitted to the ward. Started on benzos, 2 mg po TID and oral thiamine. Develops nystagmus and ataxia. What is your next step?

1. Urine drug screen
2. Give IV thiamine
3. More benzo

Answer 753

IV thiamine

Question 754

Borderline patient, conflict at work with manager. Requesting a medical leave for depression with no depressive symptoms

1. Give her a note for 2 mos off work
2. Prescribe an antipsychotic so she can handle her irritability at work
3. Explore goodness of fit in her job and her contribution to conflict
4. Benzo rx

Answer 754

Explore goodness of fit in her job and her contribution to conflict

Question 755

Family therapy, parents in conflict. Therapist suggests kid’s acting out behaviour could be an attempt to distract from parents fighting at home. What is the therapist doing here?

1. Reframing
2. Re-triangulation
3. Distracting

Answer 755

Reframing

Question 756

Patient in ER, substance use history. Treated for agitation. Remains extremely agitated 12 hours later, with elevated BP. What is the most likely substance?

1. PCP
2. Psilocybin
3. Stimulant
4. Cocaine

Answer 756

Stimulant

• Cocaine too short
• PCP wouldn’t last that long
• PCP – vertical nystagmus in stem

Question 757

Patient in an abusive relationship. What should you do?

1. Patient education about effects of victimization
2. Strongly encourage to leave relationship
3. Abreaction and catharsis

Answer 757

Patient education about effects of victimization

Question 758

30 yo man with 3 year history of delusions, social withdrawal and suicidal ideation, what best reduces his suicide risk?

1. Clozapine
2. Lithium

Answer 758

Clozapine

Question 759

Man with schizophrenia, develops depression. Has failed citalopram. What best treats his suicidality?

1. Effexor
2. Lamotrigine
3. Valproate

Answer 759

Effexor

• Treat suicide risk/MDD by relevant guidelines

Question 760

OCD patient, on citalopram, worsening symptoms despite compliance in the context of exams at school. What is the best treatment so she won’t fail the semester?

1. CBT
2. Adjunctive risperidone
3. Switch to effexor
4. Switch to clomipramine

Answer 760

Adjunctive risperidone

(Recall, RIsperidone and Abilify are first line adjunctive agents for treating OCD)

Question 761

Bipolar I, recent manic episode in hospital, now stable for 1 month. What psychosocial treatment can be recommended?

1. Psychoeducation
2. IPSRT
3. MBCT
4. Peer support

Answer 761

Psychoed

(Superior to IPSRT)

Question 762

Woman pregnant, develops depression, best option for medication:

1. Sertraline
2. Paroxetine
3. Fluoxetine
4. Imipramine

Answer 762

Sertaline

Question 763

You are seeing a patient with QTC prolongation, depressed, insomnia in ICU. What antidepressant is safest?

1. Wellbutrin
2. Escitalopram
3. Desipramine
4. Mirtazapine

Answer 763

Mirtazapine

Recall, regarding QTC prolongation:

• TCAs highest (clomipramine best of them)
• Then Citalopram, escitalopram, venlafaxine
• Wellbutrin does not prolong QTC at all, Mirtazapine very low risk

Question 764

Man with Etoh use disorder, after detox, wants a medication to help with abstinence. CrCl is 20, ALT is 70. GGT 102. What is the best choice?

1. Naltrexone
2. Acamprosate
3. Pregabalin
4. Gabapentin

Answer 764

Naltrexone

Question 765

Woman stopped paxil suddenly, what symptoms would she get?

1. Nausea, vomiting, insomnia
2. Runny nose, diarrhea, piloerection
3. Sedation
4. Rigidity, hyporeflexia

Answer 765

Nausea, vomiting, insomnia

Question 766

3 years old, comes to you with parents who are concerned about developmental delay. What would you be concerned about?

1. Inability to name common objects
2. Speech not understandable to strangers
3. Not able to hop on one foot for 5-8 seconds
4. Unable to role play with other kids

Answer 766

Inability to name common objects

Question 767

Perimenopausal female with new depression. Also hot flashes, insomnia. What is the best treatment?

1. HRT
2. Sertraline
3. Venlafaxine
4. IPT

Answer 767

HRT ??

Recall, when treating Depression in Menopause

• First line: Proven therapeutic option for depression (ie, antidepressants, CBT and other psychotherapies) during perimenopause
• Likely good efficacy for all SSRI/SNRI, in treating depression and VMS
• Desvenlafaxine is most studied
• Some evidence that ET has antidepressant effects of similar magnitude to that observed with classic antidepressant agents when administered to depressed perimenopausal women with or without concomitant VMS.
• ET ineffective in POSTmenopausal women
• ET may augment clinical response to antidepressants in midlife and older women but their use should be considered with caution – ie, preferably when also indicated for other concurrent conditions such as VMS.
• ET not FDA approved to treat mood disturbance

Question 768

Patient with sense she is watching herself from the corner of the room when boss confronts her at work. History of family conflict at home growing up. Most likely diagnosis?

1. PTSD
2. Acute Stress Disorder
3. Derealization/Depersonalization disorder
4. MDD

Answer 768

Derealization/Depersonalization disorder

Question 769

Woman with short term memory loss, 6 hours in length, improves fully. Hx of migraines. Retained memory of her personal identity

1. Complex partial epilepsy
2. TGA
3. Conversion disorder

Answer 769

TGA

Question 770

Patient on inpatient psychiatry, required IM haldol 10 mg. Now completely rigid, appears to be having difficulty speaking and breathing. What is your next step?

1. Give him benztropine when he is able to consent
2. Get a substitute decision maker because he probably isn’t’ competent
3. Treat him because it is your duty as a doctor to treat in an emergency
4. Don’t treat involuntarily because this could be considered battery

Answer 770

Treat him because it is your duty as a doctor to treat in an emergency

Question 771

Recreation of feelings with interaction with therapist in psychoanalysis is what:

1. Transference
2. Repetition compulsion
3. Transference neurosis

Answer 771

Transference

Question 772

Man uses polysubstances - heroin, benzos, PCP and cannabis. Now in ER has elevated HR and BP, tremor, sweating. What is he withdrawing from?

1. Alprazolam
2. Heroin
3. Cannabis
4. PCP

Answer 772

Alprazolam

Question 773

Patient in ER, required IM haldol 10 mg yesterday for acute agitation. Now presents pacing, can’t sit still. What do you give him?

1. Abilify
2. Propranolol
3. More haldol
4. Benztropine

Answer 773

Propranolol

• In treating akathisia, propranolol now first line
• Benztropine second line
• Benzos for non-responders

Question 774

Child with separation anxiety. Parents going through divorce. Wants to stay with mom because afraid she will die. Doesn’t want to go to dad’s.

What is the most likely diagnosis to develop as an adult?

1. Generalized anxiety
2. Substance use
3. Depression
4. Specific phobia

Answer 774

Generalized anxiety

Question 775

Man with PTSD. Wants cannabis for treatment. What do you tell him?

1. You will refer him to a cannabis physician
2. You suggest nabilone because its better
3. You do not recommend cannabis because there is no evidence in PTSD
4. You inform him he should use a low THC content, high CBD content product

Answer 775

You do not recommend cannabis because there is no evidence in PTSD

Question 776

34 yo woman bioplar I, 5 previous admission. Now stable 2 years on Lithium 1200mg and Quetiapine 300mg. Wants to discuss decreasing meds. What do you tell her?

1. Decrease both lithium and quetiapine
2. Leave the same for relapse prevention
3. Discontinue quetiapine for metabolic risk
4. Discontinue lithium for long term renal risk

Answer 776

Leave the same for relapse prevention

Recall

• Maintenance is whatever worked to get them out of acute symptoms
• Quetiapine maxes out on sedation and weight gain at 150

Question 777

Patient in your outpatient office, parroting what you say and do, sitting strangely. What is the most likely diagnosis?

1. MDD
2. Schizophrenia
3. ASD

Answer 777

MDD

• catatonia, more common in mood disorders
• Majority of catatonia = depressive or bipolar

Question 778

Patient with panic attack. Therapist suggests to spin in office chair to induce dizziness experienced by panic attacks. What type of exposure?

1. Interoceptive
2. Flooding
3. In vivo
4. Imagined

Answer 778

Interoceptive

Question 779

Elderly patient who is depressed, visual hallucinations, parkinsonism. What to use for treatment?

1. Antipsychotic
2. SSRI
3. Ach inhibitor

Answer 779

Ach inhibitor

• Recall, in LBD
• If a patient experiences severe, disabling psychosis, a trial of a cholinesterase inhibitor and/or lowering the dose of antiparkinson medication should be considered first.
• When antipsychotic therapy is required, drugs are associated with an increased risk of death when used in older adult patients with dementia.
• If antipsychotic therapy is required in patients with DLB, only atypical antipsychotic drugs, such as olanzapine, quetiapine, pimavanserin, ziprasidone, aripiprazole, paliperidone, or clozapine, should be used in very small doses in order to reduce the risk of severe reaction
• The older, conventional antipsychotics should be avoided entirely

Question 780

Which medication can be used in augmentation of panic disorder treatment?

Clonazepam

Risperidone

Abilify

Buspirone

Answer 780

Clonazepam

Question 781

You accept the patient where they are AND want them to change. What therapy?

1. DBT
2. IPT
3. CBT
4. Psychodynamic

Answer 781

DBT

Question 782

12 yo kid with behavioural problems, meets criteria for ODD. Parents don’t want meds. What best therapy?

1. Play therapy
2. Psychodynamic
3. CBT
4. IPT

Answer 782

CBT

• Recall
• KS - primary treatment of ODD is family intervention using both direct training of the parents in child management skills and careful assessment of family interactions.
• The goals of this intervention are to reinforce more prosocial behaviors and to diminish undesired behaviors at the same time
• CBT - teach parents how to alter their behavior to discourage the child’s oppositional behavior by diminishing attention to it, and encourage appropriate therapy focuses on selectively reinforcing and praising appropriate behavior and ignoring or not reinforcing undesired behavior

Question 783

A child has DMDD. What is not true about DMDD?

• Key is that irritability is non-episodic
• Predictive of BAD in later life
• More predictive of unipolar depression
• Episodic irritability more associated with BAD in later life

Answer 783

Predictive of BAD in later life

Question 784

What is the normal target for clozapine treatment?

Answer 784

• 250-300ng/L normal target OR 1000-2500nmol/L
• 50 – 150 =low
• 200 – 300 good initial target
• 350 – 400 could be tried if response insufficient

Question 785

Elderly man, had developed a psychotic depression over the last several months, comes in to hospital dehydrated and deconditioned, catatonic with waxy flexibility, mutism and stupor. Best treatment?

1. ECT
2. Antipsychotic
3. Lorazepam
4. SSRI

Answer 785

ECT

Question 786

Which of the following is more suggestive of MDD vs primary NCD?

1. Executive dysfunction
2. Paraphasia
3. Alexia
4. Visual agnosia

Answer 786

Executive dysfunction

Question 787

4 yo kid with night terrors, twice in last 6 weeks. He has no recollection of the episodes. Mom comes for urgent appointment, concerned. What do you tell her?

1. Reassure they will improve with time
2. Sleep study
3. Medical work up
4. Some medication?

Question 788

Sleep changes in the elderly?

1. Increased fragmentation
2. Increased REM
3. Increased SWS
4. Increased TST

Answer 788

Increased fragmentation

Question 789

Patient is on multiple medications. Wakes up at night, eats and is unaware/doesn’t recall the episodes. Most likely attributed to what med?

1. Zolpidem
2. Sertraline
3. Lorazepam

Answer 789

Zolpidem

Question 790

Man, odd jobs for a number of years, divorced, now wondering what he’s done with his life. What is the most appropriate Eriksonian stage?

1. Generativity vs. Stagnation
2. Autonomy vs Shame
3. Initiative vs. guilt
4. Industry vs inferiority

Answer 790

Generativity vs. Stagnation

Question 791

Person with Parkinson’s Disease, episodes of anxiety, insomnia. Also times when awake but can’t move.

1. Pramipexole
2. Clonazepam
3. Modafinil

Answer 791

Pramipexole

(because freezing symptoms at night)

Question 792

You see a patient at a music festival. You do not treat them anymore. They come up to you and say you’re attractive and ask to meet up after the festival. Most appropriate response:

1. You cannot because of the physician-patient relationship
2. You tell her that you have to wait a year and it’s OK
3. You suggest meeting at a neutral location, like a coffee shop
4. You say, sure.

Answer 792

You cannot because of the physician-patient relationship

Question 793

Patient with end stage prostate cancer. Requests MAID. His nurse informs him there is a process required by law. He becomes angry and states he will kill himself if he is denied MAID. What do you do next?

1. Suicide assessment
2. Depression assessment
3. Assess his capacity

Answer 793

Suicide assessment

Question 794

Adult man presents with depression and suicidality after losing his job, again. Long standing symptoms of ADHD, wife has to look after finances because he can’t keep track of anything. Best medication?

1. Vyvanse
2. Wellbutrin
3. Sertraline

Answer 794

Wellbutrin

Question 795

Woman in ECT treatment. 3rd treatment, can’t get a seizure despite 2 tries. What do you do for next time?

1. Give wellbutrin
2. Sleep deprivation
3. Assess and reduce or discontinue and anticonvulsant medications

Answer 795

Assess and reduce or discontinue and anticonvulsant medications

• Next steps
• Caffeine
• Hyperventilation
• Consider adding ketamine to propofol

Question 796

63 yo M with a history of decline in MOCA from 25 to 19 over the past year. Remote history of head trauma 10 years ago. What is the indication for CT head in this patient?

1. Age
2. Rate of cognitive decline
3. History of head trauma

Answer 796

Rate of cognitive decline

Recall

• CT recommended if one or more of the following are present
• 
– Age < 60 years
• 
– Rapid (e.g., over 1–2 months) unexplained decline in cognition or function
• 
– Short duration of dementia (< 2 years)
• 
– Recent and significant head trauma
• 
– Unexplained neurologic symptoms (e.g., new onset of severe headache or seizures)
• 
– History of cancer (especially types that metastasize to the brain)
• 
– Use of anticoagulants or history of bleeding disorder
• 
– History of urinary incontinence and gait disorder early in the course of dementia (as may be found in normal pressure hydrocephalus)
• 
– Any new localizing sign (e.g., hemiparesis or a Babinski reflex)
• 
– Unusual or atypical cognitive symptoms or presentation (e.g., progressive aphasia)


Question 797

35 yo female patient with MS. Was on prednisone last year for exacerbation of MS. Now Started Interferon for MS and retinoic acid for acne. What is the most contributory to current symptoms of suicidality?

1. Interferon beta
2. Retinoic Acid
3. Prednisone
4. Sertraline

Answer 797

Prednisone

(7x SI HR)

Question 798

Woman with fibromyalgia, sees her family MD who prescribes oxycodone. She sees you for depression. Mentions that she has run out of oxys and asks for a Rx. What do you do?

1. Suggest switch to duloxetine from her current antidepressant
2. Consult with family MD to start on buprenorphine
3. Give her a short Rx for oxycodone
4. Tell her no.

Answer 798

Consult with family MD to start on buprenorphine

Question 799

What findings on neuroimaging in schizophrenia?

1. Reduction in cortical grey matter
2. Increased thalamus
3. Increased amygdala
4. Decreased ventricle size

Answer 799

Reduction in cortical grey matter

Question 800

What is the most likely to cause elevated prolactin?

1. Paliperidone
2. Quetiapine
3. Abilify
4. Lurasidone

Answer 800

Paliperidone

Question 801

Young man with schizophrenia. Still has some auditory haln but still able to do school. Feels “empty”, and apathetic. What is this?

a. MDD
b. Negative symptoms
c. relapse of psychosis
d. medication side effect

Answer 801

Negative symptoms

Question 802

What is the nature of the most common type of college complaint against psychiatrists?

Answer 802

1. Inappropriate behaviour/relations

Question 803

Which medications are first line for PTSD?

Answer 803

Fluoxetine

Paroxetine

Sertraline

Venlafaxine

Question 804

What are the main modalities of psychotherapy in PTSD?

Answer 804

CBT is an effective first line option (TF-CBT, EMDR, PE, and stress management therapy)

Question 805

Which is true about adolescent suicide

1. Hanging is most common method of completed suicide
2. Increased completion rate among homosexual adolescents
3. OD is most common method of completed suicide

Answer 805

Hanging is most common method of completed suicide

Question 806

What is true about postpartum psychosis?

a) 50% have family history of affective disorders
b) Occurs in about 1-2% of pregnancies
c) Usually happens 6 weeks after delivery

Answer 806

50% have family history of affective disorders

b) Occurs in about 1-2% of pregnancies – wrong, 1 to 2 per 1000 births,
c) Usually happens 6 weeks after delivery – wrong, within 2 weeks

Question 807

Mood stabilizers in pregnancy, what is true?

a) Mood stabilizers are absolutely contraindicated in pregnancy due to risk of birth defects
b) Lithium needs to be tapered before delivery because the drop in volume can lead to toxicity
c) Mood stabilizers should never be stopped in pregnancy due to the high risk of relapse

Answer 807

Lithium needs to be tapered before delivery because the drop in volume can lead to toxicity

Question 808

Deep brain stimulation – what is the most common target in depression?

a) Sub-callosal cingulum
b) Left OFC
c) Dorsolateral PFC
d) Amygdala

Answer 808

Sub-callosal cingulum

Recall, Dorsolateral PFC = for TMS

Question 809

Child is described as “very busy”. Hyperactive at home, disrupting class. Aggressive with classmates. First line medication:

a) Stimulant
b) Risperidone
c) Clonidine

Answer 809

Stimulant

Question 810

A child who has inattentive ADHD presents with motor tics for past I month. He does not sleep well, has reduced appetite and is in the 3’d percentile for weight. What do you treat with?

1. Clonidine
2. Risperidone
3. Atomoxetine

Answer 810

Atomoxetine

Question 811

Child is spiteful, vindictive, blames others, easily annoyed, annoying others, fighting. What is the most likely diagnosis?

a) ODD
b) ADHD
c) Conduct disorder

Answer 811

ODD

Question 812

ETOH + schizophrenia in liver failure. Would need to reduce dose, if on any of the following, except:

a) Paliperidone
b) Risperidone
c) Haloperidol
d) Olanzapine

Answer 812

Paliperidone

Recall, Paliperidone doesn’t undergo CYP 450 metabolism

(also LOT and desvenlafaxine)

Question 813

Alcohol withdrawal and liver failure, which benzo to use?

a) Oxazepam
b) Chlordiazepoxide
c) FLumazenil
d) Diazepam

Answer 813

Oxazepam

Question 814

Alcohol dependence. Renal stones. On morphine for pain control. Has a binge pattern of drinking (10-12 drinks on the weekends). Which medication to use?

a) Acamprosate
b) Naltrexone
c) Disulfiram
d) Topiramate

Answer 814

Acamprosate

* recall, topiramate has risk of renal stones

Question 815

26-year-old Caucasian man on 15 mg of Olanzapine daily. What is not a risk factor for his undiagnosed diabetes?

a) Ethnicity
b) Hypertension
c) Family history of DM
d) Obesity

Answer 815

Ethnicity

Question 816

What is true about Aripiprazole?

a) Needs to be taken with food
b) Significant Weight gain is an uncommon side effect
c) It is metabolized by CYP1A2
d) Hyperprolactinemia is common

Answer 816

Significant Weight gain is an uncommon side effect

(recall that Abilify is a 2D6 substrate)

Question 817

Which medication can increase clozapine levels?

a) Fluvoxamine
b) Paxil
c) Sertraline
d) Citalopram

Answer 817

Fluvoxamine

Recall Clozapine metabolized by 1A2

Fluvoxamine is strong 1A2 inhibitor

Question 818

Question about smoking, which medication would increase with smoking cessation?

a) Olanzapine
b) Ziprasidone
c) Risperidone
d) Aripiprazole

Answer 818

Olanzapine

Smoking is a 1A2 inducer

OLZ is a 1A2 substrate

Question 819

Which one is a partial D2 agonist?

a) Aripiprazole
b) Ziprasidone
c) Haldol
d) Risperidone

Answer 819

Aripiprazole

Question 820

What is true about atypical antipsychotics?

1. 5HT agonists > DA antagonists
2. 5HT2a antagonists> DA antagonists
3. DA antagonists> 5HT agonists
4. DA antagonists> 5HT antagonists

Answer 820

5HT2a antagonists> DA antagonists

Question 821

Which is a first line monotherapy for Bipolar I maintenance?

1. Risperidone LAI
2. Flupenthixol
3. Ziprasidone
4. Lamotrigine

Answer 821

Lamotrigine

Question 822

Schizophrenia and infertility

a) Deinstitutionalization decreases the rate of infertility
b) Schizophrenia fertility rates are similar to the general population
c) Antipsychotics do not decrease the fertility rate

Answer 822

Schizophrenia fertility rates are similar to the general population

Question 823

IPT does not have evidence for treatment of which condition?

a) Delusional disorder – neither does schz
b) Social Anxiety Disorder
c) Anorexia Nervosa
d) Depression

Answer 823

Delusional disorder

(Also no evidence for IPT in schizophrenia)

Question 824

Due to concerns about anticholinergic adverse effects on cognition, which one should not be used in the elderly?

a) Paroxetine
b) Citalopram
c) Sertraline

Answer 824

Paroxetine

Question 825

CATIE recommendations for TD. Already tried IM and quetiapine not successful for decreasing TD:

a) Clozapine
b) Risperidone
c) Olanzapine
d) Fluphenazine

Answer 825

Clozapine

Question 826

Boy with predominantly ADHD inattentive symptoms developed blinking tics but no verbal tics. Height is at 15 percentile but weight at 3^rd percentile. Also has insomnia. What would be the best treatment?

a) Clonidine
b) Risperidone
c) Atomoxetine

Answer 826

Atomoxetine

Question 827

What would you tell a parent of a child with ADHD and Tourette’s regarding use of stimulants?

a) Stimulants may be used in patients with tic
b) Stimulants should be used along with treatment for tics
c) Stimulants are contraindicated in Tourette’s syndrome

Answer 827

Stimulants may be used in patients with tic

Question 828

Narcolepsy –

a) According to guidelines, Modafinil is first-line for narcolepsy
b) TCAs and SSRIs have been shown to be helpful for sleep paralysis and hypnogogic hallucinations
c) Hypnopompic and hypnogogic hallucinations are more auditory in nature.
d) Polysomnography is essential for the diagnosis

Answer 828

According to guidelines, Modafinil is first-line for narcolepsy

Why other options are wrong:

b) TCAs and SSRIs have been shown to be helpful for sleep paralysis and hypnogogic hallucinations – cataplexy
c) Hypnopompic and hypnogogic hallucinations are more auditory in nature. – not true, can be auditory, visual or tactile
d) Polysomnography is essential for the diagnosis – not entirely true. Fro Narcolepsy Type 1 either PSG or orexin, and in NT2 then you need PSG

Question 829

Tacrolimus and fluvoxamine for renal transplantation patient – what would happen?

a) Toxicity with tacrolimus
b) Serotonin syndrome
c) Organ rejections
d) Long QTC

Answer 829

Toxicity with tacrolimus

Fluvoxamine is a 3A4 inhibitor, Tacrolimus is a 3A4 substrate

Question 830

Police bring in-patient who was driving under the influence. When can police ask physician to do an alcohol level?

a) Patient is deceased
b) Police have a search warrant
c) Police have a subpoena
d) Patient is arrested

Answer 830

Police have a search warrant

Question 831

Specificity – test is given to 100 people with disease and 100 people without. There are 20 false positives and 90 true positives. What is the specificity?

a) 80%
b) 90%
c) 10%

Answer 831

80%

(Sp = TN / TN + FP)

TN + FP = all people without disease

Question 832

What is the term for the proportion of variance that is accounted for by genetics

a) Heritability
b) LOD score
c) Gene linkage
d) Something starting with a “C”

Answer 832

Heritability

Recall:

LOD score - how close they are on the chromosome

c)Gene linkage – genes likely to be expressed together

Question 833

What is the best definition for incidence?

a) New cases per 1000 in a given time
b) New cases per 10000 in a given time
c) New cases in a defined population in a given period of time
d) Number of cases in a population per 100 000

Answer 833

New cases in a defined population in a given period of time

Question 834

MDMA (ecstasy) acts on which receptor for hallucinogenic effect

a) Serotonin
b) GABA
c) Norepinephrine
d) Glutamate

Answer 834

Serotonin

Question 835

What is the mechanism of action of Varenicicline?

a) Partial agonist of A4B2 nicotinic receptor
b) Partial agonist of A3B4 nicotinic receptor
c) Full antagonist at A4B3 nicotinic receptor

Answer 835

Partial agonist of A4B2 nicotinic receptor

Question 836

Minimal optimal treatment duration of substance use disorder

a) 1 month
b) 3 months
c) 6 months
d) 12 months

Answer 836

3 months

Question 837

Woman with symptoms of PMDD – 1rst line treatment according to CANMAT guidelines. Not sexually active:

a) Sertraline 50 mg po daily
b) Multiphasic OCP
c) Calcium 1500 mg po daily

Answer 837

Sertraline 50 mg po daily

Question 838

29-year-old man (graduate student) gets dumped by his girlfriend of 18 months. Presented with feeling like a failure, envious of his friends and imagines harm coming to them. States he feels useless and that he “can’t cut it”.

a) ASPD
b) BPD
c) Narcissistic
d) Histrionic

Answer 838

Narcissistic

Question 839

Man who is striking out in his sleep, he and his wife now sleep in separate beds, and he hurts his hand by hitting it against soothing while sleeping. He and his wife would like to start sleeping in the bed again. What would you use for treatment?

a) Zopiclone
b) Clonazepam
c) CPAP

Answer 839

Clonazepam

(Because this is REM sleep disorder)

Question 840

First line treatment for delirium. Post CABG.

a) Haloperidol
b) Ziprasidone
c) Risperidone
d) Chlorpromazine

Answer 840

Risperidone

Question 841

Woman on dialysis. Wants to stop dialysis. You assess her – no evidence of depression, 2 other psychiatrists have assessed her and agree that there is no mental illness. Observed for over a week. She knows that her dialysis is expected to be transient and she will die without it. What do you do?

a) Stop the dialysis
b) Treat against her will
c) Get substitute consent
d) Get court ordered treatment

Answer 841

Stop the dialysis

Question 842

What is the 4th stage of Kubler-Ross grief?

a) Depression
b) Acceptance
c) Anger
d) Bargaining

Answer 842

Depression

Recall five stages in order are denial, anger, bargaining, depression, and acceptance.

Question 843

What decreases likelihood of physician burnout and improves communication with patients?

a) Mindful communication training
b) Physician assistance program
c) 2 obvious incorrects

Answer 843

Mindful communication training

Question 844

Stress management therapy includes all of the following except:

a) Problem solving
b) Peer group support
c) Relaxation techniques
d) Cognitive restructuring

Answer 844

Peer group support

Question 845

Patient presenting with panic disorder and benzodiazepine dependence. She has escalated her use of alprazolam but not getting relief for her panic attacks. She is now using 10-12 mg of alprazolam daily and has panic attacks despite paroxetine 40 mg PO daily. What is the next step as an outpatient?

a) Increase paroxetine to 60 mg daily
b) Switch to diazepam 100-120 mg po daily in divided doses and then gradually taper
c) Switch to phenobarbital 300 mg PO daily and taper
d) Cross taper to sertraline 100-200 mg daily

Answer 845

Switch to diazepam 100-120 mg po daily in divided doses and then gradually taper

Though increase paroxetine is also correct, but not the *next step*

Question 846

What are the three basic approaches to a benzo taper?

Answer 846

1. use the same medication for tapering
2. switch to a longer-acting equivalent
3. use adjunctive medications to help mitigate potential withdrawal symptoms.

Question 847

You are on CL seeing a post-op patient after cardiac procedure who is presenting with confusion every time the anesthetist tries to decrease the propofol and midazolam. What information must you obtain?

a) History of alcohol use
b) Past psychiatric history
c) Hx of psychosis
d) Hx of anxiety

Answer 847

History of alcohol use

Question 848

56-year-old man who acutely started seeing worms in his apartment and feeling bugs crawling on his skin. What should you focus on?

a) Medical history
b) Family history
c) Personal history
d) Past psych hx

Answer 848

Medical history

Question 849

Most common anxiety disorder in the elderly

a) GAD
b) Social phobia
c) Specific phobia
d) Panic disorder

Answer 849

Specific Phobia

or GAD

Question 850

Man in car chase with police. He believes FBI is pursuing him. Acute onset of symptoms. He is hearing voices of FBI oh his radio.

a) Alcoholic hallucinosis
b) Paranoid schizophrenia
c) Delirium tremens
d) Schizoaffective disorder

Answer 850

Alcoholic hallucinosis

Question 851

Which of the following is X-linked recessive?

a) Lesch Nyhan
b) Wilson’s
c) PKU
d) Gaucher syndrome

Answer 851

Lesch Nyhan

(all others are autosomal recessive)

Question 852

49 kg boy; what is the correct initial dose of atomoxetine?

a) 10 mg
b) 18 mg
c) 25 mg
d) 40 mg

Answer 852

25 mg

(Starting dose = 0.5mg/kg)

Question 853

Pseudoseizures vs. epileptic seizures. What is true?

a) Pseudoseizures frequently happen during sleep
b) Hard to differentiate pseudoseizures from complex partial seizures by EEG alone

Answer 853

Hard to differentiate pseudoseizures from complex partial seizures by EEG alone

Question 854

Patient with MR. Functioning at Grade 2, IQ was 55. Recommendation for him to live in a group home and he could work in a sheltered workshop. What is the best diagnosis?

a) MR – moderate range
b) MR – mild range
c) Borderline intellectual functioning

Answer 854

MR – moderate range

Question 855

ADHD patient on Dexedrine. What is true?

a) will develop psychological dependence
b) If causes nightmares and insomnia, switch to long-acting
c) If poor appetite, give with food
d) Clinically significant height suppression

Answer 855

If poor appetite, give with food

Question 856

Anorexia nervosa – which of the following lab changes do you see?

a) Low cholesterol
b) High gonadotropins
c) Cardiac arrthymias in a small proportion of patients
d) 2:1 female to male ratio

Answer 856

Cardiac arrthymias in a small proportion of patients

In terms of F:M: estimated lifetime prevalence 3:1 F:M.

In clinical settings, the ratio of females to males ranges from 10:1 to 20:1

Question 857

Patient has binges once per month and purging several times per week. She exercises excessively. Weight was about 60 kg. What is the best diagnosis?

a) Eating disorder NOS
b) Bulimia nervosa
c) Anorexia nervosa – purging type
d) Binge eating disorder

Answer 857

Eating disorder NOS (OSFED + unspecified)

• we don’t know if she is pairing binging and purging
• we don’t know if she is restricting
• we suspect that she is not severely underweight based on her mass (unless she is very very tall)

Question 858

Difference between Illness Anxiety Disorderand delusional disorder

a) Illness Anxiety Disorder– will admit that their fears may be groundless or excessive
b) Somatic delusional disorder presents with depression clinically
c) Somatic delusion disorder responds well to atypical antipsychotic
d) Illness Anxiety Disorder reassured by negative investigations/medical work-up

Answer 858

Illness Anxiety Disorder – will admit that their fears may be groundless or excessive

Question 859

What does functional MRI measure?

a) Blood flow in the brain
b) Glucose consumption in the brain – PET Scan
c) radioactive ligands of drugs

Answer 859

Blood flow in the brain

Question 860

Teenager with panic disorder and CBT – she is against medication. What would you tell them about psychotherapy?

a) Medication is first-line for her disorder
b) CBT is equally effective as medication and CBT combination
c) CBT alone has more dropouts than medications alone
d) No psychotherapy has shown benefits in panic disorder

Answer 860

CBT is equally effective as medication and CBT combination

Question 861

What is true about driving in the elderly?

a) MMSE is a good indicator of driving ability
b) Most elderly gave up driving on their own
c) Most MVAs are caused by people over 65
d) Diagnosis of dementia should automatically mean revocation of license

Answer 861

Most elderly gave up driving on their own

Question 862

Poor response to treatment in MDD with which of the following comorbid disorders?

a) OCD
b) CD
c) ADHD
d) ODD

Answer 862

OCD

Question 863

Which one of the following is TRUE regarding Group therapy?

a. Consensual Validation is defined as confirmation of reality by comparison of one’s own perceptions to other group members
b. Consensual validation between group members decreases interpersonal distortions
c. Venting is the most effective element in group therapy
d. Therapist role is interpretive

Answer 863

Consensual validation between group members decreases interpersonal distortions

OR

Consensual validation between group members decreases interpersonal distortions

(they both are true)

Question 864

What is an early symptom of Primary progressive aphasia?

a) Poor executive function
b) Impaired naming and sentence comprehension
c) Writing and spelling are preserved
d) Neuropathology is distinct from other dementias

Answer 864

Impaired naming and sentence comprehension

Question 865

Testamentary capacity, does not require

a. Knowledge of who you are bequeathing to
b. Knowledge of debts
c. Gross ideas of assets and liabilities
d. Knowledge of how they want to distribute the money

Answer 865

Knowledge of debts

“Testamentary capacity” is a term with a particular legal meaning: whether an individual has the necessary cognitive abilities to be capable of making a valid will.

Question 866

When is the time to indicate termination in family therapy?

a) Considered complete When they can see how others see them
b) Bowen addressed alliances and splits
c) Addresses primary symptom resolution

Answer 866

Considered complete When they can see how others see them

Question 867

Which of the following is not a Prochaska’s stages of change?

a) Acceptance
b) Pre-contemplation
c) Action
d) Maintenance

Answer 867

Acceptance

Question 868

Which is true about narcotic withdrawal?

a. Seizures occur within 48 hrs after abrupt discontinuation of narcotic
b. It can be prevented by benzodiazepines
c. It typically requires inpatient treatment
d. It typically doesn’t cause delirium

Answer 868

It typically doesn’t cause delirium

Question 869

Which is true regarding children of divorced parents:

a. Most children of divorced parents are well adjusted
b. Children of divorced parents are as likely to drop out of school as children from intact families
c. Frequency of contact between fathers and children is a reliable predictor of favourable outcome
d. Sole custody, as opposed to joint custody, is a protective factor

Answer 869

Most children of divorced parents are well adjusted

Question 870

An 8 y.o. boy is described as inattentive and isolative. He is on an appropriate dose of methylphenidate but treatment is ineffective and discontinued. He then becomes more inattentive and isolative, develops many somatic complaints and has fears that other children think he is stupid. He has tantrums when comes time to socialize with peers. What is the most likely Dx?

a. MDD
b. ODD
c. GAD
d. Social phobia

Answer 870

Social Phobia

Question 871

You assess an elderly patient with moderate to severe dementia in a nursing home. He is combative at bath time but otherwise not aggressive. Which recommendation would you NOT make?

a. Initiate a staff education program
b. make bath time less threatening
c. give lorazepam 0.5 mg 1 hr before bath time
d. start risperidone 0.5 mg QD

Answer 871

start risperidone 0.5 mg QD

Question 872

Which of the following conditions most often resemble an anxiety disorder?

a. Hyperglycemia
b. Hyperthyroidism
c. Hyperparathyroidism
d. Porphyria

Answer 872

Hyperthyroidism

Question 873

What is the conceptualization for behavioural activation in depression?

a. Avoidance of positive reinforcing activities takes away from experiencing joyful activities
b. Negative patterns of thought leads to behavioural inhibition
c. Confrontation of anxiety provoking situations
d) One that was obviously wrong

Answer 873

Avoidance of positive reinforcing activities takes away from experiencing joyful activities

Question 874

What do you recommend to a family whose 13 y.o. son has OCD?

a. CBT if he can engage in therapy
b. Essential to do both CBT and meds
c. Medications is the only thing that works
d. ERP is more efficacious than meds alone

Answer 874

CBT if he can engage in therapy

Question 875

In the elderly with dementia and suicidality:

a. those who respond to Acetylcholinesterase inhibitors are at higher risk
b. There is no change in risk of suicide in dementia
c. the risk is higher in those with advanced symptoms and low insight
d. hopelessness and depression are not positively correlated with suicide in dementia

Answer 875

There is no change in risk of suicide in dementia

Question 876

In depression, which of the following is true?

a. amygdala hyperactivity
b. frontal hyperactivity
c. cerebellar hyperactivity
d. thalamic hyperactivity

Answer 876

amygdala hyperactivity

Question 877

Changes seen in Alzheimer’s disease, all except:

a) Focal left frontal atrophy
b) Decreased brain volume and Ventricular enlargement
c) White matter hyperdensities
d) Hippocampal atrophy

Answer 877

Focal left frontal atrophy – you would find this in FTP

Question 878

Which of the following is not seen in schizophrenia?

a. large hippocampus
b. small thalamus
c. large ventricles
d. cortical atrophy

Answer 878

large hippocampus

Question 879

9 yr old boy is able to negotiate with peers and understands rules. What Piagetian stage:

a. Pre-operational
b. Concrete operation
c. Phallic
d. Latency

Answer 879

Concrete operational

Question 880

Not a risk factor for suicide in elderly

a. rigid personality
b. recent housing change
c. comorbid physical illness
d. on an antidepressant

Answer 880

on an antidepressant

Question 881

All are true about mirtazapine except:

a. alpha 2 antagonist
b. anxiolytic via noradrenergic inhibition
c. sedation via antihistaminergic action
d. 5HT2 and 3 antagonism

Answer 881

anxiolytic via noradrenergic inhibition

Question 882

Old man with dementia. On SSRI, trazodone, and Risperidone 1.5 mg po qhs. Upper resp tract infection. Tx with dextromethorpan and something else and then develops: Confused, Myoclonus, diaphoresis, tremors, and temp 37.8. What is wrong?

a. Serotonin syndrome
b. NMS

Answer 882

Serotonin syndrome

Question 883

All demographic factors important in assessing violence except:

a. age
b. male gender
c. ethnicity
d. IQ

Answer 883

ethnicity

Question 884

Regarding schizoaffective disorder:

a) more prevalent in older, married females
b) mood symptoms without psychotic symptoms for at least two weeks is a diagnostic criteria
c) given evidence, there is no longer controversy re: specifics about diagnostic criteria
d) different outcomes re: psychotic predominant versus affective predominant

Answer 884

different outcomes re: psychotic predominant versus affective predominant

• Recall, women with schizoaffective disorder are more likely to be married than women with schizophrenia
• Schizoaffective bipolar type is more common in older women
• Prognosis is worse for psychotic vs affective symtpoms

Question 885

What is true of ECT in elderly?

a) no difference in complication rate between adults and elderly – higher comolications
b) response rate is lower in elderly – false – response rate is actually higher
c) elderly have lower seizure threshold – they have a higher
d) elderly have lower mortality with ECT versus other therapeutic options

Answer 885

elderly have lower mortality with ECT versus other therapeutic options

Why other options are wrong:

a) no difference in complication rate between adults and elderly – higher complications in elderly
b) response rate is lower in elderly – false – response rate is actually higher
c) elderly have lower seizure threshold – they have a higher sz threshold

Question 886

Woman in her 30’s with her 3^rd episode of depression, how long should she stay on treatment for?

1) 6 months
2) 12 months
3) 60 months
4) 24 months or longer

Answer 886

24 months or longer

Question 887

Which is most evidence based psychosocial treatment for schizophrenia?

1) Close monitoring in the community those at high risk for hospitalization
2) Family interventions, focusing on reducing levels of expressed emotion
3) Family therapy, focusing on family conflict as an etiology of schizophrenia

Answer 887

Family interventions, focusing on reducing levels of expressed emotion

Question 888

Person with OCD, 2 antidepressants have failed (clomipramine and paxil), now on sertraline and has been working, but starting to relapse. Best evidence for augmentation in OCD?

1) Risperidone
2) Buspirone
3) Lithium
4) T3

Answer 888

Risperidone

Question 889

What will contribute to cognitive changes in ECT?

1. barely suprathreshold stimulus
2. non response to ECT
3. stopping benzos
4. continuing SSRIs

Answer 889

non response to ECT – because non responding would cause them to increase stimulus

Question 890

Adolescent vs. Adult depression, which is least likely sx in adolescents?

1. melancholic features
2. worthlessness
3. agitation
4. weight loss

Answer 890

melancholic features

Question 891

What is most predictive of bipolar in depression?

• psychotic features
• good response to AD
• agitation

Answer 891

psychotic features

Question 892

What is true about Stuttering?

• rarely before the age of 4 – false, onset age 2-7
• circumlocutions and substitutions common
• symptom of anxiety – not true, associated with anxiety
• usually diagnosed when kid starts to read

Answer 892

circumlocutions and substitutions common

Why others are wrong:

“rarely before the age of 4” – false, onset age 2-7

“symptom of anxiety” – not true, associated with anxiety

Question 893

Which is true re: dysthymic disorder:

a) most have an insidious onset before the age 25
b) early onset is considered before the age of 21
c) presence of hypomanic episode is permissible in the diagnosis of dysthymia
d) early onset is considered before the age of 25

Answer 893

early onset is considered before the age of 21

Question 894

Risk factors for TD, except

a. Lack of Affective disorder
b. Brain lesion
c. Elderly
d. Female

Answer 894

Lack of Affective disorder

Recall, Risk Factors for TD:

• older
• female
• white and african descent
• longer illness duration
• ID and bran damaga
• Neg symptoms in schz
• Mood DIsorders
• Cog sx in mood disorders
• DM
• Smoking
• ETOH and substance abuse
• FGA vs SGA tx
• higher cumulative and current AP dose or plasma levels
• early PD side efects
• anticholinergic co tx
• akathisa
• emergent dyskinesia

Question 895

In ECT if you are unable to produce an adequate seizure, all of the following are possible options except:

a. Decrease muscle relaxant
b. Hyperventilate patient
c. Improve hydration
d. Decrease anesthetic agent

Answer 895

Decrease muscle relaxant

Question 896

Who is not suitable for heterogeneous group therapy?

a. ASPD
b. Dependent PD
c. OCPD
d. Histrionic

Answer 896

ASPD

Question 897

What most differentiates Major Depression from normal bereavement?

1) Appetite
2) Worthlessness
3) Concentration
4) Irritability

Answer 897

Worthlessness

Question 898

Woman depressed now, had hypomanic episode in past – treat with:

a. Quetiapine
b. Epival
c. Topamax

Answer 898

Quetiapine

Question 899

Woman with bipolar 1, on Remeron and lithium X many years. PPDs in past 20 years ago and 10 years ago had a manic episode. Increasing frequency of episodes of depression, now depressed and suicidal (rapid cycling). Best course of action:

a. Stop Remeron and add Epival
b. Stop Remeron, add lamotrigine
c. Continue Remeron and add Epival
d. Continue Remeron and switch to something?

Answer 899

Stop Remeron and add Epival

Question 900

Question about flight of ideas…

a. acceleration of thought formation
b. weakening of associations
c. it’s a thought content issue
d. Hard to distract from topic

Answer 900

acceleration of thought formation

Question 901

Which is a “very mature” defense mechanism

a. Rationalization
b. Undoing
c. Sublimation
d. Intellectualization

Answer 901

Sublimation

Question 902

Geriatric with LBD, tx of choice for behavioural sx:

a. Rivastigmine
b. Memantine
c. Cipralex
d. Clonazepam

Answer 902

Rivastigmine

Question 903

Child with GI symptoms, nightmares, respiratory symptoms, unexplained. Afraid to sleep alone and thinks he will die in sleep. Then starts staying home from school d/t symptoms. Dx?

a. Social anxiety
b. Undifferentiated somatoform d/o
c. Separation anxiety disorder
d. Generalized anxiety

Answer 903

Separation anxiety disorder

Question 904

Paranoid PD, which is true?

a. Prevalence 10%
b. More common in females
c. Usually only mild impairment
d. Are indifferent to the opinion of others

Answer 904

Usually only mild impairment

Prevalence 10% - false 2-4%

More common in females - false

Question 905

Which behavioural symptom in dementia is most likely to respond to pharmacotherapy

a. Wandering
b. Aggression
c. Increased movement
d. Restlessness

Answer 905

Aggression

Question 906

Where does COMT act

a. Presynaptic
b. Postsynaptic
c. In vesicle
d. Interneuron space (synaptic cleft)

Answer 906

Interneuron space (synaptic cleft)

Question 907

Which is not associated with porphyria

a. Precipitated by phenobarbital
b. Increased cholesterol
c. Anxiety
d. Psychosis

Answer 907

Increased cholesterol

Question 908

Huntington, which is false?

a. Caudate atrophy could be seen on CT
b. Start in mid 50’s
c. Personality change can be seen early in course

Answer 908

Start in Mid 50s

Symptoms of Huntington’s disease usually develop between ages 30 and 50, but they can appear as early as age 2 or as late as 80

Question 909

Memantine, all except?

a. Is indicated in mod-severe dementia (Health Canada)
b. Should be used in combination with AChEI for mod-severe dementia
c. Common side effects dizziness, headache, and somnolence
d. Significant improvements seen in 16 weeks

Answer 909

Significant improvements seen in 16 weeks

Question 910

HTN is not a risk factor for

a. Bingswanger’s
b. Vascular dementia
c. Lewy body
d. Alzheimer’s

Answer 910

LBD

Binswanger’s disease, also known as subcortical leukoencephalopathy and subcortical arteriosclerotic encephalopathy (SAE),^[1] is a form of small vessel vascular dementia caused by damage to the white brain matter.

Question 911

Delusional disorder all true except:

• most often starts in midlife
• delusions are usually chronic well systematized
• Schneidarian symptoms are uncommonly seen
• Premorbid personality disorders are usually absent

Answer 911

Premorbid personality disorders are usually absent

Question 912

Which one is not included as part of Amphetamine/Stimulant intoxication

a. Resp depression
b. Visual hallucinations
c. dyskinesias
d. another that were in the criteria

Answer 912

Visual hallucinations

* BUT there is a specifier for “with perceptual disturbances which is hallucinatiosn with intact relaity testing or aud, vis, tactile illusions in the absence of a delirium”

Recall, in Amphetamine Intoxication, 2 or more of

1. Tachycardia or bradycardia.
2. Pupillary dilation.
3. Elevated or lowered blood pressure.
4. Perspiration or chills.
5. Nausea or vomiting.
6. Evidence of weight loss.
7. Psychomotor agitation or retardation.
8. Muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias.
9. Confusion, seizures, dyskinesias, dystonias, or coma.

Question 913

Most common dx with chronic fatigue syndrome

a. GAD
b. MDD
c. Alcohol abuse
d. Panic disorder

Answer 913

MDD

Question 914

Elderly and schizophrenia, which is true:

• more visual than auditory hallucinations
• 20% have no active symptoms after 65
• more negative symptoms
• respond poorly to antipsychotics

Answer 914

20% have no active symptoms after 65

Question 915

Elderly woman with Hyponatremia (117) and urine osmolality was increased. Which medication is she taking?

• Topiramate
• Lithium
• Sertraline
• Carbamazepine

Answer 915

Carbamazepine or Sertaline - both are true

Question 916

Avoidant PD (know criteria), all except

• Gets others to make decisions for them
• decreased intimacy in romantic relationships
• avoids meeting new people/trying new things
• decreased openness in interpersonal relationships

Answer 916

Gets others to make decisions for them

Question 917

Man with ETOH dependence. Quits x 2 weeks then relapses with significant drinking (26oz/day x 1week). Motivated for abstinence. How do you treat?

• Naltrexone 50 mg + relapse prevention techniques
• Dilsulfram and motivational interviewing
• Acamprosate + group addictions therapy

Answer 917

Naltrexone 50 mg + relapse prevention techniques

Question 918

Which is true

a. Larger studies might find statistical significance not necessarily clinical significance
b. Parametric data are not valuable statistically and they are not used in meta-analysis
c. Randomization decreases systemic and selection bias
d. Efficacy are better than effectiveness studies for real-life practice

Answer 918

Larger studies might find statistical significance not necessarily clinical significance

Question 919

Adopted away kids from schizophrenic parents compared to controls, have:

a) marginally decreased rates of schizophrenia
b) marginally increased rates of schizophrenia
c) significantly increased rates of schizophrenia
d) No difference

Answer 919

significantly increased rates of schizophrenia

Question 920

a. is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost
b. shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met)
c. is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity)
d. Is involved in repetitive obsessions/rituals

Answer 920

Is involved in repetitive obsessions/rituals

Question 921

Panic Disorder and Agoraphobia in a female adult:

a. CBT is considered as effective as combo of CBT and meds
b. CBT is superior to meds

Answer 921

CBT is superior to meds – in Katzman, CBT favoured over meds

Question 922

Intermittent Explosive Disorder, which is NOT true?

a. Rapid onset and offset of rage/anger
b. Most likely to be associated with ASPD
c. Often feel remorse and regret after the episode

Answer 922

Most likely to be associated with ASPD

Depressive disorders, anxiety disorders, and substance use disorders are most commonly comorbid with intermittent explosive disorder

Individuals with ASPD, BPD, disriptive behaviours, they have an elevated risk of have IED

Question 923

1. What is the biggest factor in the development of physician burnout?
2. Having a history of depression
3. Having lots of administrative responsibilities
4. Increased risk of litigation
5. Age

Answer 923

Having lots of administrative responsibilities

Others:

• Female
• Earlier in Career
• Dissatisfaction with Work

Question 924

Females who are raised in families with members who have antisocial PD are at highest risk of developing what disorder?

1. MDD
2. Social anxiety disorder
3. Somatic symptom disorder –
4. PTSD

Answer 924

Somatic symptom disorder

– inherited from ASPD – both males and females are at risk of developing SSD when ASPD runs in family

Question 925

You are asked to see a 16 yo girl with borderline PD and a history of juvenile myoclonic epilepsy following a possible seizure. Which of the following is most suggestive of a conversion disorder?

1. Synchronous movements during seizure
2. Urinary incontinence
3. Post-ictal confusion
4. Eyes closed during the seizure

Answer 925

Eyes closed during the seizure

Question 926

1. During interview, after anxiety questions, you tell the patient that you are going to now ask them about trauma history, what is this called?
   
   1. Signposting
   2. Empathic engagement

Answer 926

Signposting

Question 927

1. STEM describes an 80-ish year old man with Parkinson’s disease and some cognitive impairment, who lives alone at home. He has no history of falls. His daughter is concerned about the possibility of him falling. What do you do?
2. Reassure the daughter as he has not fallen yet
3. Refer for assessment to get a walker
4. Limit the use of sedating medications

Answer 927

Limit the use of sedating medications

Question 928

1. 30yo ish person presenting w/ first episode, clinical history is definitely schizophrenia. Never on treatment. Admitted. What do you do?
2. Offer Oral because this is their first treatment
3. Start an LAI because decreases re-hospitalization
4. Offer Oral and LAI and decide based on patient preference

Answer 928

Offer Oral and LAI and decide based on patient preference

Question 929

You assess a patient in ER, do a suicide assessment, discharge him, he commits suicide. The family is suing you. What will be the most important factor in the court’s assessment?

1. Past history of suicide attempts
2. Thoroughness of suicide risk assessment
3. Physician’s level of experience
4. Length of time since seen

Answer 929

Thoroughness of suicide risk assessment

Question 930

What is the most common comorbidity with ASD?

Answer 930

Intellectual Disability

Question 931

COPD on theophylline which drug not to use?

a. Fluvoxamine
b. Paroxetine
c. Sertraline
d. Duloxetine

Answer 931

Fluvoxamine

• Fluovoxamine is metabolized by CYP3A4
• Increases levels of alprazolam, diazepam, theophylline, warfarin, clozapine, carbamazepine, mathadone, propranolol, diltiazem
• It is the SSRI MOST at risk of drug drug interactions

Question 932

Which drug won’t raise Abilify levels

a. Duloxetine
b. Venlafaxine
c. Buproprion
d. Desvenlafaxine

Answer 932

Desvenlafaxine

• Abilify is 2D6 substrate
• Bupropion, Duloxetine and venlafaxine are 2D6 inhibitors
• Desvenlafaxine

Question 933

On VPA, topirimate, quetiapine Delirious, normal VPA, ataxia, normal LFTS, high ammonia

a. Stop VPA
b. Stop quetiapine
c. Treat with an antipsychotic

Answer 933

Stop VPA

(high ammonia, ALWAYS STOP)

Question 934

Child is isolated doesn’t respond to stimulant, temper tantrums, afraid other kids “think I’m stupid” social activity refusal. Diagnosis? (REPEAT)

a. MDD
b. SAD
c. GAD
d. ODD

Answer 934

SAD

Question 935

When you treat ADHD with stimulant how does comorbid anxiety and irritability (vs depression?) respond?

a. Both improve
b. Both get worse
c. Irritability improves only, anxiety worsens
d. Anxiety improves only, irritability worsens

Answer 935

Both improve

Question 936

Mild-mod ID, functioning well with support, good social functioning

a. Cri du chat
b. Prader Willi
c. Smith- Magenis
d. Angelman

Answer 936

Prader Willi

Question 937

ECT cognitive SEs what doesn’t make it worse?

a. Hyperventilation
b. High stimulus
c. Freq of treatment

Answer 937

Hyperventilation

Question 938

Lady in 40s. Has chronic pain for 4 years on opioid. Due to reported difficulty controlling pain now snorting/taking larger amounts that prescribed of her opioids. Has been depressed for 4 months, what is the best treatment?

1. Buprenorphine
2. Duloxetine

Answer 938

Duloxetine

Question 939

Kid with night terrors, what on the EEG?

1. Slow waves
2. Sleep spindles
3. Sawtooth waves
4. Alpha waves

Answer 939

Slow Waves

Question 940

Domestic dispute with 2 kids in the home, which therapy in NOT indicated?

1. Play therapy
2. Family therapy
3. Supportive therapy
4. Crisis intervention

Answer 940

Family therapy

Question 941

9yo boy has tic DO, what is the course of the disorder?

1. Wax and wanes through life, each episode is longer
2. Peaks in late childhood, improves through adolescence
3. No predictable course
4. Progressively worsening and debilitating

Answer 941

Peaks in late childhood, improves through adolescence

Question 942

9yo boy with tics and ADHD on clonidine. Tics improved, still has ADHD symptoms, best medication to add?

1. Atomoxetine
2. Risperidone
3. Dextroamphetamine
4. Methylphenidate

Answer 942

Methylphenidate

Question 943

Adolescent boy who is suicidal, what is most important RF for suicide?

1. History of suicide attempts
2. Family history of attempts
3. Diagnosis of bipolar
4. Substance use

Answer 943

History of suicide attempts

Question 944

Psychotic 17yo boy, labile, irritable. Sounded sort of manic-like. What is best initial treatment?

1. Lithium
2. Risperidone
3. Fluoxetine
4. Clonazepam

Answer 944

Risperidone

Question 945

7mo old child, adopted by loving family at 2mos of age from neglectful environment. Not comforted by caregivers, does not seek comfort. Why can you not diagnose RAD?

1. It takes more than 4mos to attach to new parents
2. 2mos of trauma is not enough to cause RAD
3. You need to be 9mo old to get Dx of RAD
4. If adopted into stable family first year prognosis better

Answer 945

You need to be 9mo old to get Dx of RAD

Question 946

Child with tantrums at least every second day for 2 years. Consistently irritable. Has inattention. What is best Dx?

1. DMDD
2. ADHD
3. Bipolar

Answer 946

DMDD

Question 947

What is best trait to differentiate ADHD from bipolar in a child?

1. Impulsivity
2. Disruptive behavior
3. Hyperactivity
4. Grandiosity

Answer 947

Grandiosity

Question 948

13yo boy has not hit puberty, complaining of gynecomastia. Learning disability and ADHD comorbid. What is most likely diagnosis after genetic testing?

1. Fragile X
2. Klinefelter’s
3. Congenital adrenal hyperplagia
4. Androgen insensivity

Answer 948

Klinefelter’s

Question 949

8yo boy with enuresis. What is the treatment of choice?

1. Behavioral therapy
2. Imipramine
3. DDAVP
4. Observation

Answer 949

Observation

• Observe and reassure, children for whom not disruptive
• CPS guideline

Question 950

17yo girl brought in by friend on Tuesday, sees no point in living? What did she most likely use over the weekend?

1. MDMA
2. Cannabis
3. LSD
4. Alcohol (cocaine?)

Answer 950

MDMA

Question 951

Somebody with hypertension, tachycardia, vertical nystamus. What did he use?

1. PCP
2. Amphetamine
3. Cannabis
4. Psilocybin

Answer 951

PCP

Question 952

15yo boy brought in by police after a fight. Has nystagmus, dilated pupils, slurred speech, tremor, ataxia. What was he using?

1. Amphetamine
2. Psilocybin
3. Volatile solvents
4. Cannabis

Answer 952

Volatile Solvents

Question 953

In which stimulation treatments is epilepsy a relative contraindication?

1. rTMS
2. ECT
3. VGN
4. DBS

Answer 953

rTMS

Question 954

Which of the following is true in the treatment of catatonia

1. May require high dose benzo (up to 16mg/d ativan)
2. Benzos treat retarted cataonia better than excited catatonia
3. ECT contraindicated in neurological d/os
4. In a patient with SCZ you treat catatonia with atypical psychotics

Answer 954

May require high dose benzo (up to 16mg/d ativan)

Question 955

“Mirror transference” who did it?

1. Kohut
2. Anna Freud
3. Melanie Klein

Answer 955

Kohut

• Narcissistic Transferences
• The therapist comes to represent, in Kohut’s terms, either the grandiose self in mirror transferences or the idealized parental imago in idealizing transferences. In idealizing transferences, all power and strength are attributed to the idealized object, leaving the subject feeling empty and powerless when separated from that object.

Question 956

Which Eriksonian stage occurs at the same time as Freud’s phallic and Paiget’s preoperational?

1. Trust vs. mistrust
2. Autonomy vs. shame
3. Initiative vs. guilt
4. Industry vs. inferiority

Answer 956

Initiative vs. guilt

• Preoperational 2 – 7
• Phallic 3 – 5
• Erikson Initiative versus Guilt (about 3 Years to about 5 Years).

Question 957

What changes do you make in CBT for mild-neurocog?

1. Modify instructions and homework
2. Caregiver must attend with patient
3. Patient must be able to complete IADL

Answer 957

Modify instructions and homework

Question 958

Which is true about establishing interpersonal inventory in IPT?

1. Part can be done as homework
2. Challenges the sick role
3. Includes past and present relationships
4. Helps to establish goals of therapy

Answer 958

Helps to establish goals of therapy

Question 959

) Lady in CBT. Exploring with therapist that she is upset when friends cancel plans. She says “my friends hate me”, when therapist asks her to explore thoughts/ feelings. This is an example of:

1. Core belief
2. Cognitive distortion
3. Underlying assumption
4. Automatic thought

Answer 959

Automatic thought

Question 960

Guy in ER after panic attack, after fight with boss. Now fine. Says “I understand, I’m not mad at her, she has a lot on her plate”. Which PD is this?

1. Schizoid
2. Narcissistic
3. OCPD
4. Histrionic

Answer 960

OCPD

Question 961

Paranoid PD Core belief

1. Other are to be exploited
2. I’m incompetent
3. Others are interfering with my life
4. I’m am special

Answer 961

Others are interfering with my life

Question 962

65 year old man. Just retired as accountant. Was lead at the firm. Wife 5 years younger and still works as a lawyer. Kids live outside the home, but in town. Has a lot of time on his hands. What is the most appropriate therapy?

1. CBT
2. IPT
3. Davanloo – v. confrontational
4. Supportive psychotherapy

Answer 962

IPT

Recall Davanloo – v. confrontational

Question 963

Adult woman. 24 years old. Borderline history. Lives with mom whole life. Mom admitted for medical illness. Patient now in ER nightly demanding admission. What defenses is this?

1. Identification
2. Undoing
3. Reaction formation
4. Acting out
5. Denial

Answer 963

Identification

Question 964

25 year old Asian lady. Present with 3-week history of seizures, oral-fasical dyskinesia, cognitive impairment, psychosis. Which test would be HIGHEST yield?

1. MRI
2. EEG
3. PET
4. CSF analysis

Answer 964

CSF analysis

(NMDA)

Question 965

Elderly lady, anxious about family’s safety and everything. Needs reassurance often. Worried her anxiety is hurting family relationships, wants therapy. Which is key component to therapy?

1. Systematic desensitization
2. Exposure therapy
3. Behavioural analysis
4. Interpersonal inventory

Answer 965

Exposure therapy

Question 966

Woman in therapy. Feels criticized by parents. Routinely a few minutes late for sessions, therapist gently reminds patient to be on time. Patient feels strong shame/ anger. What describes her response?

1. Resistance
2. Transference
3. Acting out

Answer 966

Transference

Question 967

Patient with OCD, fear of germs and ++hand washing. Grew-up in home with sanitation issues. What is key component of therapy?

1. Exposure and response prevention
2. Explore past issues leading to her fears of contamination
3. Have her chart thoughts about contamination on paper and cognitive restructuring
4. Use downward arrow technique to uncover underlying fear

Answer 967

Exposure and response prevention

(If “DIRT” specifically was an option, would go with that)

Question 968

Elderly man brought to hospital because he had not been caring for himself. Had not left house for groceries in weeks/months, hoarding, no help. He is given IV fluids, meals. Develops weakness, fatigue, confusion, shortness of breath and pedal edema. What is most likely cause?

Answer 968

Refeeding Syndrome

Question 969

Adult male with tics. Not on meds. Which therapy is most useful?

1. Habit reversal
2. Exposure response prevention

Answer 969

Habit reversal

Question 970

Woman in group therapy reveals she regrets having children. Another person in group says the same thing. What is this?

1. Universalization
2. Cohesion
3. Catharsis

Answer 970

Universalization

Question 971

What is therapists role in group therapy?

1. Make sure all participants have a chance to speak
2. Contain and tolerate intense affect
3. Take a passive stance once group norm is formed
4. Resolve disputes for the group

Answer 971

Contain and tolerate intense affect

Question 972

Study of SSRI and hip fracture. Placebo group 5/100 fractures and SSRI group had 10/100. What is the risk ratio? CI (0.15-1.5).

1. 2
2. 0.5
3. 1
4. 0.05

Answer 972

2

Risk Ratio or Relative Risk = Incidence in Exposed Group /Incidence in Non-exposed Group

Question 973

You are doing a QI project looking at risk to staff in applying restraints. What is the first thing you do?

1. Create a well defined aim statement
2. Make a flow-chart for application of restraints
3. Implement and observe PDSA cycles
4. Identify an outcome measure

Answer 973

Create a well defined aim statement

Question 974

Lady who is pregnant. Had post-partum psychosis with first baby. Adamantly refusing medication. Which has the MOST evidence to prevent psychosis with this pregnancy?

1. Limit sleep disruption
2. Control her affect (emotional regulation)
3. Psychotherapy during pregnancy and after

Answer 974

Limit sleep disruption

Question 975

Body dysmorphic d/o - best initial treatment treat?

1. Fluoxetine
2. Clomipramine
3. Risperidone
4. Fluoxetine + Olanzapine

Answer 975

Fluoxetine

Question 976

Which of the following interferes with OCP the least?

1. Carbamazepine
2. VPA
3. Lamotrigie
4. Isoniazid

Answer 976

VPA

Question 977

Schizophrenia on clozapine and pregnant. Adamant that she wants to breastfeed. What do you advise patient?

1. Continue clozapine in pregnancy and post-partum
2. Continue clozapine in pregnancy stop postpartum
3. Stop now and start after delivery
4. Stop now and do not restart until after breastfeeding complete

Answer 977

Continue clozapine in pregnancy stop postpartum

(Typically you would continue an agent in breastfeeding if they were exposed in utero, but exceptions are when there are severe side effects with conitnued exposre such as clozapine,infant appears to be having side effects)

CLozapine has been associated iwth floppy baby syndrome, infants exposed in utero should be monitored for agranulocytosis first weeks of life

Question 978

A 15 year high achieving student who thinks she is depressed. She is competitive, has friends and keeps in contact with them on social media. Her grades are falling despite her staying up late into the after her hockey practice. She has difficulty waking up in the morning, doesn’t have time to eat breakfast before she goes to school or take a shower. Feels exhausted and irritable after school. What is your initial management?.

1. Blood work with urine tox
2. Melatonin
3. Start antidepressant
4. Sleep Hygiene

Answer 978

Sleep Hygiene

Question 979

Man admitted to neuro. Believes he has GBS. Knows a lot about it. Which is the most important clinical factor in making diagnosis of factitious disorder?

1. Wants the sick role
2. Clinically not compatible with medical illness
3. Need to ensure that all relevant medication investigations are negative
4. Physical exam not consistent with any known neurological disorder

Answer 979

Wants the sick role

Question 980

Consult from GP. Guy complains of ++ somatic symptoms. Comes to GP all the time in crisis. Demands ++ tests despite negative results. What do you recommend for initial management?

1. Schedule regular appointments not contingent on symptoms complains
2. Limit appoints and send for CBT
3. Tell patient their problem is entirely psychiatric

Answer 980

Schedule regular appointments not contingent on symptoms complains

Question 981

Man recently started on clozapine 100mg qHS. WBC and ANC are fine. Tachycardia 120-130 bpm. What is the next step?

1. Decrease clozapine
2. Ask about for signs of heart failure
3. Consult cardiology
4. Start beta-blocker

Question 982

Patient says this to you, “there is something in the air that “meochartising” that seems to be changing our lives. (Something like this). What is this an example of?

1. Neologism
2. World salad
3. Perseveration
4. Circumstantial thought

Answer 982

Neologism

Question 983

Which of the following is an example of a cenesthetic hallucination?

1. Feeling bugs crawling on skin
2. Aliens in bladder
3. Brain is on fire
4. Heart is missing

Answer 983

Brain is on fire

Question 984

Which is a component of mindfulness body scan?

1. Non-judgement
2. Progressive muscle relaxation - LOL
3. Forceful redirection when mind wanders
4. Analysing bodily sensations

Answer 984

Non-judgement

Question 985

Person who is 72 years old, 3 years of formal education. MoCA is 21/30. Which of the following would support diagnosis of major neuro-cog?

1. MMSE 23/30
2. Not able to do serial 7s
3. Not being able to operate his lawnmower

Answer 985

Not being able to operate his lawnmower

Question 986

A specific type of therapy includes free association, transference interpretation. What is contraindicated in this therapy?

1. ASPD
2. Chronic medical condition
3. Substance disorder

Answer 986

ASPD

(as this is individual dynamic therapy)

Question 987

Person on long standing antipsychotic had mouth puckering. Tried reducing the dose. Which was not helpful. Which of the following is MOST likely to improve symptoms?

1. Add benztropine
2. Add propanolol
3. Switch to clozapine

Answer 987

Switch to clozapine

Question 988

Patient with parkinson’s and cognitive dysfunction. Which is most likely to help with cognitive and IADL?

1. Rivastigmine
2. Memantine
3. Pramipexole
4. Pimavanserin

Answer 988

Rivastigmine

Recall in PD dementia, tx is symptomatic.

Usually start with ACHei or memantine in stepwise fashion

Question 989

Man on invega sustenna. Forensic patient, non-compliant. History of cannabis use. Has signs of hyperprolactinemia. What the FIRST step to treating?

1. Check prolactin in 3 months
2. Add abilify
3. Change to quetiapine

Answer 989

1. Add abilify

Question 990

Patient is on lithium. Which of the following does not cause an elevation?

1. Caffeine
2. Thiazide
3. NSAID
4. Low sodium diet

Answer 990

Caffeine

Question 991

Woman admitted to ward. Recently started on new antipsychotic. Becomes hypersexual, masturbating ++. Med stopped and symptoms resolve. Which was the med?

1. Aripiprazole
2. Risperidone
3. Lurasidone
4. Paliperidone

Answer 991

Aripiprazole

Question 992

Which drug is best for QTc prolongation?

1. Thorazine
2. Ziprasidone
3. Abilify
4. Risperidone

Answer 992

Abilify

Question 993

Mailman who saw 2 year-old killed by a truck 3 weeks ago. Now feels he’s delivering mail in a dream, flashbacks, nightmares, avoidance, hyperarousal. What is he most likely to develop?

1. PTSD
2. Acute stress disorder
3. depersonalization/ derealization
4. Adjustment disorder

Answer 993

PTSD

Recall

• 1/2 of people who present with PTSD had initially presented with acute stress disorder
• ASD vs Adjustment Do
  
  • Dx Adj DO when resposne to criterion A event doesnt meet criteria for ASD or when symptom pattern doesnt meet criterion A for exposure to actual or threatened death, serious injury, sexual violence

Question 994

Child who doesn’t speak and doesn’t understand verbal commands. Social doing well, has friends. What is this?

1. Language disorder
2. Hearing impairment
3. ASD
4. Speech sound disorder

Answer 994

Language disorder

Question 995

Child with difficulty in written comprehension and reading. Which is the best test?

1. Wechsler Individual Achievement Test (WIAT)
2. Wechsler Intelligence Scale for Children (WISC)
3. Two other options, version two of something and version 5 of something

Answer 995

Wechsler Individual Achievement Test (WIAT)

Question 996

Elderly man. You start him on donepezil. What side effects do you warn him about?

1. Constipation
2. Tachycardia
3. Nausea
4. Blurry vision

Answer 996

Nausea

• As per Stahl, nausea, diarrhea, appetite loss, weight loss
• Insomnia, dizziness
• Muscle cramps, fatigue, depression, strange dreams

Question 997

Perform poorly Trails B. Which are of the brain causes this dysfunction?

1. DLPFC
2. OFC
3. Temporal lobe
4. Peri-hippocampal

Answer 997

DLPFC

Question 998

You ask patient to comb hair and he runs fingers through it. You ask him to use a straw and he puffs his cheeks and blows out air. What is is?

1. Ideomotor dyspraxia
2. Visuospatial dysgnosia
3. Dysmetria

Answer 998

Ideomotor dyspraxia

• Ideomotor Apraxia, often IMA, is a neurological disorder characterized by the inability to correctly imitate hand gestures and voluntarily mime tool use, e.g. pretend to brush one’s hair.
• Visuospatial dysgnosia is a loss of the sense of “whereness” in the relation of oneself to one’s environment and in the relation of objects to each other.
• Dysmetria is a lack of coordination of movement typified by the undershoot or overshoot of intended position with the hand, arm, leg, or eye. It is a type of ataxia. It can also include an inability to judge distance or scale

Question 999

55 year old woman. One year of irritability, mood lability, depressed mood. Failed mirtazapine, and other SSRI. TSH and CBC are normal. What lab test would you order?

1. Calcium
2. FSH
3. CRP

Answer 999

Calcium

Question 1000

Who is medically assisted dying indicated for?

a) Terminal Heart failure and is moderately depressed
b) Patient comes from France to Canada to get MAID
c) Asymptomatic patient diagnosed with existential dread after ALS diagnosis
d) Patient clearly expressed his desire for MAID clearly 10 days ago but is now delirious

Answer 1000

Terminal Heart failure and is moderately depressed

• In order to be eligible for MAID, individuals must meet all of the following criteria:
• be eligible for publicly-funded health services in Canada;
• be at least 18 years of age and capable of making his or her own health care decisions;
• have a grievous and irremediable medical condition;
• make a voluntary request for MAID, i.e. a request that is not the result of outside pressure or influence; and
• give consent to receive MAID after being provided with all of the information necessary to make the decision, including information about his or her medical diagnosis, available forms of treatment and options to relieve suffering.
• have a serious and incurable illness, disease or disability;
• be in an advanced state of decline in capability that cannot be reversed;
• be enduring physical or psychological suffering from the illness, disease or disability that is intolerable to him or her and that cannot be relieved under conditions that he or she considers acceptable; and
• be at a point where his or her natural death has become reasonably foreseeable, taking into account all of his or her medical circumstances.

Question 1001

Woman who is 62, cognitive impairment with executive dysfunction, memory issues, incontinence, gait apraxia. Which is MOST likely in her medical history?

1. Hemorrhagic stroke
2. Sexually promiscuity
3. REM sleep behavior d/o
4. Family hx early dementia

Answer 1001

Hemorrhagic stroke

Note in Syphiliis – gait apraxia, incontinence – tabies dorsalis

Question 1002

Which of the following neurocognitive disorders is likely to be the underlying etioloigy in an alphasynucleonopathy?

1. Parkinson’s
2. HIV
3. FTLD
4. MS

Answer 1002

Parkinson’s

• There are three main types of synucleinopathy: Parkinson’s disease (PD), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA).

Question 1003

Woman in 60s with features of FTD (disinhibited, only eats white foods, some other stuff). MMSE 29/30. Husband ashamed to take her out in public because of her behaviour. What is the best treatment for impulsivity?

1. Donepezil
2. VPA
3. Risperidone
4. Citalopram

Answer 1003

Citalopram

• Serotonergic medications have been the most studied in bvFTD. The selective serotonin reuptake inhibitors (SSRIs) fluoxetine, sertraline, paroxetine, fluvoxamine, and citalopram have all been tested to treat the behavioral symptoms of FTD. There is evidence that these drugs can have some efficacy in reducing disinhibition, repetitive behaviors, sexually inappropriate behaviors, and hyperorality.

Question 1004

Adjunct for panic disorder who has partial response to sertraline and CBT?

1. Clonazepam
2. Risperidone
3. Buspirone
4. Trazodone

Answer 1004

Clonazepam

Question 1005

BPSD NCD (AD) family refuse antipsychotic what to use to treat?

1. Trazodone
2. Citalopram
3. VPA
4. Benzo

Answer 1005

Citalopram

Question 1006

Young adult male with 3 years of subsyndromal depressive symptoms. Has episodes of 2-3 hypomanic symptoms (stem described the symptoms). What is the diagnosis?

1. Bipolar II
2. Cyclothymic disorder
3. Unspecified bipolar
4. Other specified bipolar, inadequate duration of hypomania

Answer 1006

Cyclothymic disorder

Question 1007

75 year old lady. Fell a few months ago. Now afraid to go out to the mall because she might fall again. Denies depressive symptoms. What medication do you give her?

1. SSRI
2. Benzodiazepine
3. Antipsychotic
4. Cholinesterase inhibitor

Answer 1007

SSRI

Question 1008

Neuroimaging finding in SCZ?

1. Small hippocampus
2. Hyperactive in frontal lobe in cognitive task on PET
3. Hypoactive in occipital parietal region
4. Amygdala enlarged

Answer 1008

Small hippocampus

Question 1009

Geriatric man in the community. Has major neurocognitive disorder (?moderate severity). Lives at home with wife. Has agitation in the evenings when walking by window or mirror. Complains to wife that intruders are in the house. What is the recommended treatment?

1. Adult day program
2. Shut the blinds and put towels over mirrors
3. Get wife to utilize reminiscence therapy (i.e. teach her to teach patient)
4. Relieve him of chores and get more homecare

Answer 1009

Shut the blinds and put towels over mirrors

Question 1010

Older woman. Husband died 2 months ago unexpectedly. 5 week history of worthlessness and other depressive symptoms including poor sleep. Wants to join husband. Sister notes her to be inconsolable. What do you do?

1. Start SSRI
2. Refer to grief counselling
3. Start sedative/ hypnotic
4. Supportive intervention

Answer 1010

Start SSRI

Question 1011

Which of the following is most supportive of a diagnosis of progressive supranuclear palsy?

1. Difference in blood pressure from seated to standing
2. Lack of vertical eye movement

Answer 1011

Lack of vertical eye movement

Question 1012

Longterm clomipramine use. What is caused be the longterm antagonism of muscarinic receptors?

1. Increased abdominal girth
2. Anaorgasmia
3. Dental carries and gingivitis
4. Syncope

Answer 1012

Dental carries and gingivitis

(Long term TCA use, dry mouth, gingivitis)

Question 1013

Woman on domperidone and methadone. QTC 520. Shes depressed. CL consult. What antidepresant do you use?

1. Bupropion
2. Fluvoxamine
3. Citalopram
4. Amitriptyline

Answer 1013

Bupropion

• Based on current literature, fluoxetine, fluvoxamine, and sertraline appear to have similar, low risk for QT prolongation, and paroxetine appears to have the lowest risk.

Available data indicate that TCAs and citalopram pose the greatest risk for QT prolongation in older adults whereas the other SSRIs and SNRIs do not appear to pose any significant risk on their own. Data are lacking in other antidepressants, including bupropion, vilazodone, and levomilnacipran; however, it does not appear that bupropion prolongs the QT interval

Question 1014

Psychotic man. Charged with theft >$5000. All of the following EXCEPT one are required for fitness to stand trial?

1. Able to communicate with counsel/ advise his attorney
2. Needs to know what his charges are
3. Needs to understand nature of the proceedings in court
4. Needs to treat his psychosis

Answer 1014

Needs to treat his psychosis

Question 1015

Patient stable on lithium and asenapine. Palpitations, Tired, abdo pain.

1. Check calcium
2. Holter
3. Chest/abdo CT

Answer 1015

Check calcium

Question 1016

Older lady with hypothermic and bradycardic, depressive Sx and Hx of bipolar. On lithium, level was 0.4. Has TSH of 10, T4 was in normal range.

1. Stop lithium
2. Increase lithium
3. Check TPO antibodies
4. Start Synthroid

Answer 1016

Start Synthroid

When hypothyroidism develops in Li use, treat per appropriate guidelines.

Li-induced hypothyroidism is reversible with discontinuation of lithium, there is no need to discontinue it, and it should not be discontinued without consultation with the patient’s psychiatrist. If lithium is subsequently discontinued, it is reasonable to reassess the need for continued thyroid hormone replacement. There are no standard protocols for reassessment. We measure TSH approximately two months after discontinuation of lithium.

Question 1017

What medication causes a differential (directly?) in activation of 5-HT1 and 5HT2?

1. Moclobemide
2. Mirtazapine
3. Citalopram
4. Amitryptiline

Answer 1017

Mirtazapine

• The mechanism of action of mirtazapine is antagonism of central presynaptic α₂-adrenergic receptors and blockade of postsynaptic serotonin 5-HT₂ and 5-HT₃ receptors. The α₂-adrenergic receptor antagonism causes increased firing of norepinephrine and serotonin neurons. The potent antagonist of serotonin 5-HT₂ and 5-HT₃ receptors serves to decrease anxiety, relieve insomnia, and stimulate appetite. Mirtazapine is a potent antagonist of histamine H₁ receptors and is a moderately potent antagonist at α₁-adrenergic and muscarinic-cholinergic receptors.

Question 1018

Depressed teenager, isolating and other depressive Sx, how would you treat?

1. CBT
2. IPT
3. Venlafaxine
4. TCA

Answer 1018

CBT *** consensus with full group

Question 1019

Young adult with schizophrenia on clozapine, psychosis is in remission, but has depressive Sx. Which will best reduce suicide risk?

1. Venlafaxine
2. Lamotrigine
3. Lithium?

Answer 1019

Venlafaxine

Question 1020

Why might you choose to use lithium in bipolar?

1. Hx rapid cycling
2. Family history of bipolar
3. Mixed features
4. Seasonal pattern

Answer 1020

Family history of bipolar

Question 1021

Best prognostic feature for someone with mania?

1. Female gender
2. Insomnia less than 7 days
3. Good response to antidepressant in the past

Answer 1021

Female gender

Question 1022

Which of the following is caused by SSRI in pregnancy?

1. PPH of newborn
2. Ebstein anomaly
3. Cleft lip
4. Neural tube defect

Answer 1022

Persistent pulmonary hypertension of the newborn (PPHN)

Question 1023

Assessing driving in a patient. What doesn’t matter?

1. If they live in a rural or urban area
2. Whether they aware of their medical condition and consequences
3. If they compliant with treatment
4. If they modify their driving based on their medical condition

Answer 1023

If they live in a rural or urban area

Question 1024

What is the best choice of treatment in patient post cardiac event who has low appetite, poor sleep, early morning waking and depressed mood?

1. Mirtazepine
2. Venlafaxine

Answer 1024

Mirtazapine

• CANMAT review comorbidities
• SSRIs and NASSA preferred agent cardiac
• Avoid venlafaxine and TCAs for high blood pressure

Question 1025

What is most important to have important to put in place in the context of telepsychiatry?

1. Mechanism to refill prescriptions
2. Energized manner
3. Local resources to support if necessary

Answer 1025

Local resources to support if necessary

Question 1026

Signs that an illness is psychiatric as opposed to organic?

1. Concrete thinking
2. Disorientation
3. Normal clock drawing
4. Non auditory hallucinations

Answer 1026

Normal clock drawing

Question 1027

Man with history of bipolar, lithium stopped prior to surgery. Hospitalized, post surgery looks agitated. How do you differentiate bipolar from organic?

1. EEG
2. Lithium level on admission
3. GGT

Answer 1027

EEG

Question 1028

Patient under the provincial review board. He stabbed his son, found NCR . What is most important re: your recommendation to the review board.

1. Public safety
2. Severity of index offense
3. Current mental state
4. Progress over the last year

Answer 1028

Public safety

Question 1029

AN severe restricting prior to hospitalization. Few days after hospitalization looks lethargic confused. What do you do first?

1. IV glucose
2. Fluid restrict
3. IV Thiamine
4. Haloperidol

Answer 1029

IV Thiamine

Question 1030

Best prognosis for psychosis

1. Starts in adulthood
2. Severity of symptoms at presentation
3. Long duration of untreated psychosis

Answer 1030

Starts in adulthood

Question 1031

55 yo woman driving with husband , asking lots of questions, repetitive. 55 year old female, medically healthy, history of migraines. Presents to the ED with abrupt 2-hour anterograde and retrograde memory loss (do not mention if she has intact personal identity or a psychiatric history). Stressors at work. Completely resolves within 3 hours. Most likely diagnosis.

1. Dissociative Amnesia
2. Transient Global Amnesia

Answer 1031

Transient Global Amnesia

Question 1032

What would you say about Childhood Sexual Abuse and Borderline PD.

A. childhood sexual abuse is a risk factor in woman and not men

B. not relevant

C. it’s a risk factor amongst many risk factors

D. Borderline is actually complex PTSD

Answer 1032

it’s a risk factor amongst many risk factors

Question 1033

Young male with a 2 month history of positive symptoms and a 4 month total history of functional decline. Smokes cannabis once per month. What is his diagnosis?

1. Schizophrenia
2. Schizophreniform
3. Cannabis intoxication
4. Cannabis induced psychotic disorder

Answer 1033

Schizophreniform

Question 1034

Kid with temper tantrums. Parents cannot handle him. What is your FIRST step in management?

1. Psychoeducational assessment
2. Behavioural analysis
3. Family therapy
4. Parental training

Answer 1034

Behavioural analysis

Question 1035

Woman in mid 20s. She thinks her boss doesn’t think she is working hard enough. Feels like she isn’t doing a good job even though she works super long hours. Does not want to delegate as she doesn’t think people will complete the work up to her standards. What best describes her?

1. Self-doubt
2. The world is a dangerous place.
3. Lack of empathy

Answer 1035

Self-doubt

Question 1036

What is a dialectical statement? - repeat

1. Accept patient for where they are at, believe they can change

Answer 1036

Accept patient for where they are at, believe they can change

Question 1037

What medication do you have to dose adjust for moderate renal failure (<45 cc)

1. Venlafaxine
2. Vaprioc acid
3. Clozapine
4. Stimulant

Answer 1037

Venlafaxine

Renal impairment: reduce the total daily dose by 25% to 50% in patients with renal impairment. Reduce the total daily dose by 50% or more in patients undergoing dialysis or with severe renal impairment

Question 1038

What wouldn’t increase the levels of Benzo? (I think a 3A4 interaction?)

1. Estrogen
2. Carbamazepine
3. Erythromycin

Answer 1038

Carbamazepine

Benzos AND estrogens are 3A4 substrates

CBZ is inducer of 3A4

Erythromycin is 3A4 inhibitor

Question 1039

Monozygotic twin of child with ADHD. What percent chance that they also have it?

a. 70-80%
b. 50-60%
c. 20-40

Answer 1039

70-80%

Question 1040

Young adult man with schizophrenia working on a graduate degree what is the biggest risk for suicide?

a. prior education expectation
b. poor insight
c. positive syptoms with catatonia
d. negative symptoms

Answer 1040

prior education expectation

• High premorbid expectations
• Paranoia
• high risk patient as a young male, with a history of good adolescent functioning and high aspirations, late age of first hospitalization, higher IQ, with a paranoid or non-deficit form of schizophrenia, who retains the capacity for abstract thinking and who may be painfully aware of the impact of a deteriorating illness on his aspirations and life trajectory.

Question 1041

Young man with schizophrenia. Still has some auditory haln but still able to do school. Feels “empty”, and other negative symptoms. What is this?

a. MDD
b. Negative symptoms
c. relapse of psychosis
d. medication side effect

Answer 1041

Negative symptoms

Question 1042

What is true about PTSD

a. 2/3 will have 2 comorbidities

Answer 1042

2/3 will have 2 comorbidities

Question 1043

Psychotherapy. What is true re: therapeutic relationship?

a. Injury and repair is detrimental
b. It is main factor in outcome

Answer 1043

It is main factor in outcome

Question 1044

Most common cause of death in schizophrenia?

a. cardiovascular
b. accidents
c. suicide
d. cancer?

Answer 1044

cardiovascular

(JAMA 2020 paper: Most likely cause of premature death = suicide)

Question 1045

Pt in ER. Psychotic. Agitated. Can’t get a good history. Utox negative. What to treat with?

1. risperidone
2. ativan IM

Answer 1045

Risperidone

Question 1046

Child with Down’s Syndrome (facial dymophism, sigle palmar crease). What do you order?

A. Echo

B. ECG

Answer 1046

Echo

• Cardiac affection is a common issue in the Down syndrome (DS) population, in the form of both congenital and acquired heart disorders. Echocardiography plays an important role in the detection of such disorders. Fetal echocardiography can detect cardiac disorders as early as 10-12 wk of gestation.

Question 1047

Eating disorder patient. What tests would you order as an initial workup?

Answer 1047

• CBC, lytes, CAMP, albumin, LFTS, Cr, Urea
• ECG

Question 1048

According to CANMAT Bipolar 2018, for pregnant people, what is the best approach to treatment of BAD in first trimester?

Answer 1048

Psychological strategies preferred over medications in first trimester

When meds are necessary, preference should be given to monotherapy and lowest effective dose

Question 1049

According to CANMAT Bipolar 2018, what are risks associated with divalproex in pregnancy?

Answer 1049

• Should be avoided due to risks of NTD (5%)
• higher incidences of congenital abnormalities
• striking degrees of neurodevelopmental delay in children at 3y, loss of 9 IQ pts

Question 1050

According to CANMAT Bipolar 2018, in later pregnancy, what are considerations in dosing?

Answer 1050

Pts may require higher doses of meds towards end of pregnancy because:

Changes in physiology in 2nd and early 3rd trim

Increased plasma volume

Increased hepatice activity

Increased renal clearance

Question 1051

What are psychological therapies for bulimia, in adults and adolescents?

Answer 1051

Adults

1. CBT Modified for BN (most evidence)
2. IPT (as effective as CBT, but slower)
3. DBT (case reports)

Adolescents

1. Family Based Therapy (superior to supportive and CBT)
2. CBT for BN (not as effective as FBT)

Question 1052

Person who presents with symptoms of guillain barre, knows a lot about the diagnosis. Factitious disorder, how do you confirm?

1. Wants the sick role
2. Prove feigning symptoms
3. Rule out all medical possibilities

Answer 1052

Prove feigning symptoms

Question 1053

In bipolar disorder, which two Loci are most implicated?

Answer 1053

ANK3 - Voltage gated sodium channels

CACNA1C on 12p13 - L type Ca Channels

Question 1054

What is the overall appraoch to opioid use disorder clinical management?

Answer 1054

1. Start opioid agonist treatment (OAT) with buprenorphine/naloxone whenver feasible
2. For poor responders to above, consdier transition to methadone
3. If good response to methadone, consider transitioning to buprenorphine naloxone

Question 1055

What is important to consider when starting suboxone?

Answer 1055

• Pt needs to be in at least moderate withdrawal to start (COWS >12)
• 12-24 hours of abstinence since last opiod dose
• Begin at 2-4mg, increase by up to 8mg/day
• Max 24mg/day

Question 1056

What are adverse effects associated with suboxone?

Answer 1056

Precipitated withdrawal

Resp depression/sedation

Headache, fatiguw, occasional sexual SE

Question 1057

What is the main pharmacological difference between methadone and suboxone?

Answer 1057

• Suboxone
  
  • Buprenorphone is a partial opiod antagonist at mu receptor
  • Has a higher affinity for opioid receptor so displaces otehr opioids
  • But its maximal opioid agonist effect is lower than FULL op-ags (methadone, morphine, heroin)
  • “Ceiling effect” lowers risk of resp depression, side effects, non-med use
  • Naloxone os mu opioid receptor antagonist, can block the effect of buprenorphine
• Methadone
  
  • FULL opiod agonist at mu receptor
  • increased risk for AEs and OD and death
  • When used as directed, safe and effective for OUD tx

Question 1058

What are adverse effects/precautions with prescribing methadone?

Answer 1058

• QTC Prolongation
• Black Box Warning
  
  • Addiction, abuse, misuse
  • Resp depression
  • 3A4, 2C19,2C9,2D6 inhibitors could icnrease methadone levels –> resp depression
  • Serotonin syndrome if with other S-agents

Question 1059

What is imporant to consider about withdrawal management programs in OpioidUD?

Answer 1059

WIthdrawal management alone should be avoided, and detox should always be followed by immediate transition to long term addiction tx

Question 1060

What are main stimulants of abuse?

Answer 1060

• Cocaine
  
  • DOPAMINE
• Ecstacy
  
  • Serotonin
• Methamphetamine
  
  • Dopamine

Question 1061

What are sensitization effects of long term cocaine use?

Answer 1061

• Longer use- decreased seizure threshold
• Psychosis - paranoia, visual, auditory and tactile hallucinations
• Stereotypical behaviours

Question 1062

What are symptoms of cocaine intoxication?

Answer 1062

• Euphoria
• ↓ appetite
• ↑vigilance
• ↑ autonomic activity (or possibly ↓)
• ↑seizures
• ↑psychosis - paranoid delusions
• ↑ nausea vomiting
• ↑ arrhythmias
• ↑ psychomotor behaviour - agitation, stereotyped behaviour eg dyskinesias

Question 1063

What are symptoms of cocaine withdrawal?

Answer 1063

• DYSphoria
• ↑ appetite
• ↓ energy
• ↓ psychomotor activity (retardation)
• ↓ or ↑ sleep
• vivid unpleasant dreams

Question 1064

What pharmacotherapies have been found to be useful in treating cocaine use disorder?

Answer 1064

None

Question 1065

What is the neurobiology of ecstacy addiction?

Answer 1065

• Acute - ↑ serotonin (blocks reuptake, directly releases S)
• Chronic - ↓ serotonin levels by depleting stores and inhibiting synthesis of new S

Question 1066

What is the neurobiology of stimulant abuse?

Answer 1066

• Acute
  
  • serotonin levels by blocking reuptake, directly releasing S
• Chronic
  
  • ↓ serotonin levels by depleting stores, inhibiting synthesis of new S

Question 1067

What are symptoms of ecstacy intoxication?

Answer 1067

• Bruxism/trismus (lock jaw)
• Stimulant effects
  
  • ↑ wakefulness
  • ↑energy
  • ↑endurance
  • ↑ sweating
  • ↑ hot flashes
  • ↓ appetite
• Risk of SS

Question 1068

What are symptoms of ecstacy withdrawal?

Answer 1068

• ↓ mood
• ↓ energy
• suicidality in absence of MDD

Question 1069

What are long term effects of ecstacy use?

Answer 1069

• panic disorder (highest assoc)
• depression
• anxiety
• impulsiivty
• sleep problems
• cognitive dysfunction

Question 1070

What are key differences in metabolism of methamphetamine and cocaine with respect to duration of effects and withdrawal

Answer 1070

• Cocaine
  
  • Metabolizes rapidly
  • Effects last 1-2 hours
  • Withdrawal 1-2 days
• Methamphetamine
  
  • Metabolizes Slowly
  • Effects can last 10-20 hours
  • Withdrawal can last several days
• Recall meth –> 1000% ↑ of DA in NA (vs food 150%, sex 200%)

Question 1071

What are acute effects of inhalant intoxication?

Answer 1071

• Euphoria
• ↓inhibition
• dizzines
• slurred speech
• ataxia
• ↓ alterness/ drowsy
• accidents and injuries

Question 1072

What are signs and symptoms of an inhalant overdose?

Answer 1072

• ↓ resp depression
• nystagmus
• dizzy
• incoordination
• slurred speech
• unsteady gait
• ↓ reflexes
• tremor
• blurred vision
• arrhythmias
• chest pain
• muscle and joint pains
• asphyxia
• cardiac arrest
• Sudden Sniffing Death
  
  • if myocardium sensitive to NE, sudden surge of NE can have sudden death

with chronic use - permanent white matter changes, prolonged effects bc stored in fatty tissue

Question 1073

What are the main pharmacologic treatments of nicotine addiction?

Answer 1073

1. NRT
2. Varenicline
3. Bupropion

Question 1074

What are the symptoms of hallucinogen intoxication?

Answer 1074

• LSD onset within 1 hr, peaks 2-4, lasts 8-12
• Sympathomimetic effects
  
  • ↑HR
  • ↑ temp
  • ↑sweating
  • ↑tremor
  • ↑ pupil size (mydriasis)
  • ↑BP

Treat with reassurance, diazepam PO possibly

Question 1075

What is the timeline of alcohol withdrawal?

Answer 1075

• Discontinuation + 2 of
  
  • ↑ANS, ↑tremor, insomnia, NV, ↑anxiety, vis/aud/tactile, GTC sz, agitation
• 6-8 - hr shakes
• 8-12 - psychotic/perceptual probs
• 12-24 - h seizures
• 72h - DTs (1-3%)
  
  • monitor with CIWA <15 mild, >20 severe
  • Tx with Diazepam 1mg/drink QID, or Chlordiazepoxide 2.5mg/drink QID

Question 1076

What are amphetamine preparations?

Answer 1076

methamphetamine

methylphenidate

dextroamphetamine

dextroamphetamine/amphetamine salt /adderall

MDMA/MMDA/MDEA

Question 1077

What are signs and symptoms of amphetamine intoxication?

Answer 1077

• Recent use + 2 of
  
  • tachy or brady, ↑mydriasis, ↑↓bp, sweats, chills, NV, ↓wt/appetite, ↑agitation, resp depression, arrhythmias
  • confusion/seizures, dyskinesia coma
• Symptoms gone at 24h, reolved after 48h
• Tx Low dose Haldol 5mg for amphetamine induced psychocis

Question 1078

What are the 4 principles of motivational interviewing?

Answer 1078

Express Empathy

Develop Discrepancy

Roll with Resistance

Support Self-efficacy

Question 1079

What are the two main states of sleep and how much time does the average adult spend in each?

Answer 1079

NREM - 75%

REM - 25%

Question 1080

What level of arousal is associated with REM vs non-REM sleep?

Answer 1080

REM - hyperarousal state - increased blood pressure, resp rate, brain temp, glucose metabolism, cerebral blood flow

NREM - Hypoarousal state - lower blood pressure, low resting muscle tone

Question 1081

What are the 3 main components of NREM sleep and which waveform is associated with each?

Answer 1081

• N1 = theta, 5%
• N2 = sleep spindles and k-complexes, 45%
• N3 = delta waves, “Slow wave” or “deep sleep”, 25% - furthest from wakefulness

Note - when awake, eyes opened - beta waves

• when drowsy, eyes are clsoed, alpha waves

Question 1082

What phenomena occur during REM sleep?

Answer 1082

Detailed dreams and nightamres

Near total skeletal muscle paralysis (“atonia”)

Cyclical, every 90-100mins

Question 1083

Which brain regions are responsible for setting the circadian rhythm?

Answer 1083

Suprachiasmatic nucleus

Anterior hypothalamus

Question 1084

Which brain regiosn are responsible for NREM and REM sleep?

Answer 1084

NREM - hypothalamus (also thalamus, forebrain, medulla)

REM - Pons (pontine reticualr formation)

Question 1085

During what part of the sleep period does most N3 sleep occur?

Answer 1085

First part of sleep cycle

Question 1086

During what part of the sleep period does most REM sleep occur?

Answer 1086

Towards the end of sleep cycle

Question 1087

How long is REM latency typically and in which conditions is it shortened?

Answer 1087

90mins

Decreased in depression and narcolepsy

Question 1088

What is the main clinical feature of insomnia?

Answer 1088

Association of bed with state of arousal

Question 1089

What is first line treatment of insomnia?

Answer 1089

CBT for Insomnia

3 stages

1. Sleep hygiene and education, stimulus control, sleep restructuring
2. Cognitive therapy, relaxation training
3. Medication taper

Question 1090

What is the principle in using medication to treat insomnia?

Answer 1090

Use for short-term, trasnient insonia eg when in hospital

Use lwoest effective dose, intermittent dosing, gradually taper off

Not indicated for chronic insomnia

EG. Temazepam, zopiclone, zolpidem, doxepin, orexin and melatonin antagonists

Question 1091

Hypersomnolence Disorder

• what is it characterized by?
• How is it diagnosies?
• What are typical treatments?

Answer 1091

• Sleep 8-12h, very difficult to wake in am
  
  • naps and sleeps in day
  • sleep not restful
  • fall asleep fast, good sleep efficacy
• Polysomnography, Multiple sleep latency test (multipel naps in a day)
• 1. Modafinil, 2. Dexedrine, methlyphenidate

Question 1092

What are the three main criteria in narcolepsy, one of which must be present in order to make a diagnosis?

Answer 1092

1. Cataplexy a few x/ month (sudden bilat loss of muscle tone precip by laughing or in children or early disease, tongue thrusting, global hypotonia)
2. Hypocretin deficiency (<1/3 normal, <110pg/ml)
   
   1. PSG - REM sleep latency < 15 min ; MSLT _<_8min + REM seen on 2 naps

Question 1093

What are 4 main symptoms seen in narcolepsy?

Answer 1093

1. Sleep attacks
2. Cataplexy
3. Hypnopompic/hypnogogic hallucinations
4. Sleep paralysis

Question 1094

What are main treatments for narcolepsy?

Answer 1094

1. Scheduled napping, sleep hygiene, lifestyle adjusments
2. Daytime sleepiness - 1) modafinil, 2) dexedrine and methylphenidate
3. Sleep paralysis and H/HH - REM suppressants TCAs, SSRIs, SNRIs (off label) - theory is that these suppress REM, because REM is intruding on to wakefulness

Question 1095

What are the main management strategies in OSA?

Answer 1095

CPAP

Nasal surgery

Oral devices

Don’t sleep supine

DO NOT use narcotics, benzos, opioids

Question 1096

What is the main treatment of circadian rhythm sleep wake disorder?

Answer 1096

Chronotherapy (phase delay)

Melatonin early PM

Bright light early AM

Question 1097

In NREM sleep arousal disorder, what are main symptoms?

Answer 1097

• recurrent episodes of incomplete waking from sleep (first 1/3 of sleep)
• sleepwalking
• night terrors
• none or littel of draems recalled
• amnesia of episode

Question 1098

In NREM sleep arousal disorder, what are the principles of management?

Answer 1098

• SAFETY
• Reassurance, education
• Avoid precipitants (fll bladder, ETOH, noise, meds)
• V little data on meds - ?SSRIs, TCAs, Benzos were used historically but coudl worsen because they suppress N3 sleep

Question 1099

What are main symtpoms of REM sleep behaviour disorder?

Answer 1099

• repeated episodes of arousal during sleep associated with vocalizations/complex motor behaviour
• During REM, >90min after sleep onset
• 1 of the following
  
  • ​REM sleep without atonia on PSG/EMG (loss of skeletal muscle paralysis)
  • Hx suggestive of a-synucleinopathy

Question 1100

What are principles of management of REM sleep behaviour disorder?

Answer 1100

Ensure safety of patient and bed partner

Clonazepam 0.5-2mg

Melatonin 3-12 mg (always first line if OSA)

?Dopa agonists

Question 1101

What is prolonged QTC defined as for men and women?

Answer 1101

>450 men

>470 women

Question 1102

Alcohol dependence. Renal failure. On morphine for pain control. Has a binge pattern of drinking (10-12 drinks on the weekends). Which medication to use?

a) Acamprosate
b) Naltrexone
c) Disulfiram
d) Topiramate

Answer 1102

Topiramate

Question 1103

Woman presents to your office. She is 10 weeks pregnant. Has what seems to be a mixed episode (likely bipolar II). Passive SI, lost weight, expresses a lot of guilt concerning her other child. Considering risks and benefits, what is the best treatment for her and the fetus?

Woman 10 weeks pregnant. Presents with depressive symptoms including SI and is consumed by thoughts she is neglecting her first-born. She previously had two episodes of a few weeks with reduced sleep, demanding sex from her husband (symptoms suggestive of hypomania?). What is the best treatment considering risks and benefits.

ECT, Sertraline, lamotrigine, Abilify

Answer 1103

ECT

Question 1104

Which psychiatric medications are primarily renally excreted?

Answer 1104

Lithium

Topiramate

Gabapentin

Pregabalin

*Paliperidone

*Acamprosate

Question 1105

What are key features of cyclothymia?

Answer 1105

>2 years (>1yr in children) -

• numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode AND
• numerous periods with depressive symptoms that do not meet criteria for a major depressive episode.
• Symptomatic at least half the time
• Criteria for a major depressive, manic, or hypomanic episode have never been met

Question 1106

What are symptoms associated with antidepressant discontinuation syndrome?

Answer 1106

• Flu-like symptoms (lethargy, fatigue, headache, achiness, sweating)
• Insomnia (with vivid dreams or nightmares)
• Nausea (sometimes vomiting)
• Imbalance (dizziness, vertigo, light-headedness)
• Sensory disturbances (“burning,” “tingling,” “electric-like” or “shock-like” sensations)
• Hyperarousal (anxiety, irritability, agitation, aggression, mania, jerkiness)

Question 1107

What is the timeline of alcohol withdrawal?

Answer 1107

After cessation of drinking:

6-8 hours - tremulousness

8-12 hours - psychotic an perceptual disturbances

12-14 hours - seizure

up to 72h to a week - DTs

The syndrome of withdrawal sometimes skips the usual progression and, for example, goes directly to DTs.

Question 1108

What are symptoms of delirium tremens?

Answer 1108

Delirium occurring within 1 week after a person stops drinking

Autonomic hyperacticity (tachycardia, Diaphoresis, fever, HTN)

Anxiety

Insomnia

Perceptual distortions, most frequently visual or tactile hallucinations; Fluctuating levels of psychomotor activity, ranging from hyperexcitability to lethargy

Question 1109

What differentiates a manic episode from a hypomanic episode?

Answer 1109

Hypomanic episode only needs to be 4 days, manic at least a week (or hosp)

Hypomanic = marked change in functioning, but NOT functioanl impairment

Both need 3/7 DIGFAST criteria

Question 1110

What are the types of Other Specified Bipolar and Related Disorder?

Answer 1110

Other specified bipolar disorder

• Short-duration hypomanic episodes (2–3 days) and major depressive episodes
• Hypomanic episodes with insufficient symptoms and major depressive episodes
• Hypomanic episode without prior major depressive episode
• Short-duration cyclothymia (less than 24 months)

Question 1111

What are characteristics of Broca’s Aphasia vs Wernicke’s aphasia?

Answer 1111

Question 1112

What are “atypical features” in a depression?

Who is most likely to experience atypical features?

Answer 1112

• Symptoms
  
  • Mood reactivity brightening in response to circumstances
  • Overeating
  • Oversleeping
  • Leaden Paralysis
  • A long-standing pattern of interpersonal rejection sensitivity
• Assoc with
  
  • Younger age of onset
  • more severe psychomotor slowing
  • COMO panic disorder, SUD, and somatization

Question 1113

What are melancholic features of depression?

Which feature is most specific to melancholic depression

Answer 1113

In the DSM:

One of the following:

1. Loss of pleasure in all, or almost all, activities.
2. Lack of reactivity to usually pleasurable stimuli (does not feel much better, even temporarily, when something good happens).

Three (or more) of the following:

1. A distinct quality of depressed mood characterized by profound despondency, despair, and/or moroseness or by so-called empty mood.
2. Depression that is regularly worse in the morning.
3. Early-morning awakening (i.e., at least 2 hours before usual awakening).
4. Marked psychomotor agitation or retardation. most specific to melancholic depression
5. Significant anorexia or weight loss.
6. Excessive or inappropriate guilt.

Question 1114

What are the main features associated with hyponatremia?

Answer 1114

Confusion

Agitation

Lethargy

Headaches

Nausea

Imbalance

Question 1115

What is the pharmacology of Mirtazapine?

Answer 1115

Mirtazapine is a Noradrenergic/Specific Serotonergic Antidepressant (NaSSA)

• Presynaptic a2-adrenergic antagonist effects–> increased release of norepinephrine and serotonin
• Potent antagonist of 5-HT2A, 5-HT2C, 5-HT3, and H1 receptors
• Moderate peripheral a1-adrenergic and muscarinic antagonist;

Question 1116

What medication is helpful in treating opioid withdrawal symptoms?

Answer 1116

clonidine

Question 1117

What is the treatment apprach to neuropsychiatric symptoms of dementia in Lewy Body Dementia?

Answer 1117

1. Non-pharmacology appraoch
2. AcheI
3. Memantine
4. Antipsychotic

Question 1118

What is the treatment apprach to neuropsychiatric symptoms of dementia in FTD?

Answer 1118

1. Behavioural/non-pharm
2. SSRI (Citalopram >Trazodone, others)
3. Antipsychotic ONLY after 1 and 2 have failed
4. Memantine

Question 1119

What are the principles of management of Periodic Limb Movement Disorder/Restless Leg?

Answer 1119

1. Treat underlying cause (eg. iron deficiency anemia) or DC causative agent
2. Non pharm - decrease ETOH, nicotine and caffeine; hot baths, hot or cold compresses, massage, sleep hygiene
3. Dopamine-agonists (Pramipexole, Ropinarole, then Levodopa)
4. Anticonvuslants (Gabapentin and pregabalin)
5. Benzodiazepenes
6. Low dose oxycodone

Question 1120

What are the 4 Distorting operations in Freud’s Dream Interpretation?

Answer 1120

Condensation

Displacement

Visualization

Symbolism