Neurociencias

Question 1

33.1.
Which of the following phenomenon seen in individuals with
schizophrenia is an endophenotype measure?

A. Auditory hallucinations
B. Ventricular enlargement
C. Anhedonia
D. Suicidal ideation
E. Thought blocking

Answer 1

33.1. B. Ventricular enlargement
An endophenotype is an internal phenotype based on neuropsychological,
neuroanatomical, cognitive, neurophysiologic, biochemical, and brain
imaging data. To qualify as an endophenotype, the biologic marker
associated with illness in the population must be heritable, seen in people
with and without the active illness (which rules out all answer choices but
ventricular enlargement), co-segregates with illness within families, and is
present at a higher rate in unaffected family members than in the general
population. Endophenotypes are not synonymous with symptoms (which
also eliminates all answer choices except for ventricular enlargement). The
use of endophenotypes in psychiatric studies assumes that a type of
biologic marker is simpler to detect and be determined by fewer genes than
that of a whole disease, such as schizophrenia

Question 2

33.2.
What type of glial cell is responsible for removing cellular debris
following neuronal death?

A. Astrocyte
B. Microglia
C. Oligodendrocyte
D. Schwann Cell

Answer 2

33.2. B. Microglia
Astrocytes, the most common type of glial cell, serve as nutrition for
neurons, deactivate certain neurotransmitters and integrate with the
blood–brain barrier. Dendrocytes and Schwann cells create myelin sheaths
in the central and peripheral nervous systems, respectively. Microglia are
involved in removing cellular debris after neuronal death.

Question 3

33.3.
A 5-year-old boy is fascinated when he sits in a heated electric chair
massager. He says in delight, “Mommy, it feels warm and it’s
shaking!” In what area of the brain do the neurons that carry the
information regarding the boy’s physical experience synapse?

A. Thalamus
B. Arcuate fasciculus
C. Hypothalamus
D. Pons
E. Spinal cord

Answer 3

33.3. A. Thalamus
The signals for pain, temperature, coarse touch, and deep pressure travel
along the spinothalamic tract while the signals for proprioception,
vibration, and light touch travel along the fasciculus gracilis and cuneatus.
All neurons for all somatosensory modalities synapse in the thalamus.
However, had this been a reflex arc, such as would occur with the child
placing his hand on a hot stove and jerking it away, the synapse would be
in the spinal cord.

Question 4

33.4.
A 30-month-old girl is playing with an electronic toy that asks her
to identify the “blue triangle” from among other differently colored
shapes. The part of the visual system that allows her to engage in
this activity is in what area of the brain?

A. Parietal
B. Frontal
C. Occipital
D. Temporal

Answer 4

33.4. D. Temporal
The primary visual cortex cells, located in the occipital lobe, respond
specifically to line orientation. Those cells project to the secondary visual
cortex, also in the occipital lobe, which responds to angles and movement
of lines. The temporal lobe detects shape, form, and color while the parietal
lobe detects motion, location, and distance

Question 5

33.5.
The first step in the processing of sound occurs in what structure of
the auditory system?

A. Endolymph
B. Hair cells
C. Ossicles
D. Cochlear nerve
E. Tympanic membrane

Answer 5

33.5. E. Tympanic membrane
The processing of sound begins with changes in ambient air pressure,
which are picked up by the tympanic membrane, which then vibrates. The
vibrations are transmitted to the ossicles, endolymph of the cochlear spiral,
and cilia on hair cells which generate neuronal impulses that travel to the
cochlear nerve

Question 6

33.6.
A 79-year-old man is brought to the emergency department by
emergency medical services (EMS). His wife reports that they were
eating dinner 30 minutes ago when he began to slur his speech “and
his arm drew up.” She adds that the patient has hypertension but
does not take his lisinopril. Vital signs are temperature 37.2 C (99 F),
BP 210/120, pulse 110, and respirations 22. Physical examination
reveals a clenched right fist. Right arm and wrist are flexed. Tendons
are hyperreflexive. Head CT is pending. Which of the spinal tracts
was most likely affected?

A. Spinothalamic
B. Corticospinal
C. Fasciculus cuneatus
D. Spinocerebellar
E. Fasciculus gracilis

Answer 6

33.6. B. Corticospinal
The patient has most likely suffered a stroke which affected the
corticospinal tract. The limb spasticity and hyperreflexia indicate an upper
motor neuron lesion in a descending tract. The corticospinal tract, which
controls fine motor movements, is the only descending one. The others are
ascending. Spasticity usually occurs more often in the upper limbs than the
lower ones, and more often following a hemorrhagic stroke than an
ischemic one.

Question 7

33.7.
A 42-year-old man presents to the neurology clinic for management
of his movement disorder. Five years ago, he noticed that his arms
were “drawing up and getting stiff,” and he was stumbling and
becoming clumsy. He also started having memory lapses and
feelings of depression. Over time, he developed trouble with balance.
Though he has some physical difficulty with speech, he can state that
he is distressed by his word-finding difficulties and trouble focusing
on tasks. His mother developed the same symptoms when she was in
her 50s and died 20 years later. He is on sertraline for depression.
Vitals signs are within normal limits. Physical examination is
significant for rigidity in both arms with occasional involuntary
writhing movements. A brain scan is most likely to show shrinkage
of what brain structure?

A. Putamen
B. Caudate
C. Globus pallidus
D. Substantia nigra
E. Subthalamic nucleus

Answer 7

33.7. B. Caudate
The caudate shrinks in Huntington disease, which is what this patient has.
The substantia nigra is affected in Parkinson disease. Lesions in the
subthalamic nucleus can lead to intense ballistic movements, which are
different than the rigidity and choreiform movements of Huntington.
Damage to the globus pallidus can lead to dystonic posturing and limb
flapping.

Question 8

33.8.
A 23-year-old man is walking home alone from work at night when
he hears someone walk up behind him. He speeds up and notices
that the footsteps speed up as well. He turns around and faces a man
holding a knife and demanding his wallet. He starts breathing
rapidly and notices his heart beating faster before he turns and
sprints away. What brain center was responsible for his physiologic
response to the situation?

A. Cerebellum
B. Primitive reflex circuit
C. Hypothalamus
D. Basal ganglia
E. Motor cortex

Answer 8

33.8. C. Hypothalamus
The hypothalamus is responsible for mediating the fight or flight response
to danger through the autonomic motor system. This involves an increased
heart rate, shunting of blood away from the viscera, and increased
respirations. The basal ganglia appear to mediate postural tone. The
primitive reflex circuit mediates motor movement without immediate
conscious awareness, such as quickly pulling a hand away from a hot stove.
The motor cortex cells cause contraction of individual muscles. The
cerebellum modulates muscle tone

Question 9

33.9.
A 31-year-old professional football player undergoes neurocognitive
testing following his second concussion in 3 months. He is given a
computerized continuous performance test in which he is instructed
to press the space bar on the keyboard every time the letter “X”
flashes on the screen over a period of six, 5-minute trials. His results
are in normal range during the first trial, but steadily diminish
throughout the remainder of the testing. Damage to what lobe of the
brain is the most likely cause for his performance?

A. Frontal
B. Occipital
C. Temporal
D. Parietal

Answer 9

33.9. A. Frontal
Continuous performance tests measure attention and are used at times to
aid in the diagnosis of attention-deficit hyperactivity disorder (ADHD). An
intact right frontal lobe is necessary to do well on this test. Of note, there
have not been consistent pathologic findings in individuals with ADHD
who have no known brain injury

Question 10

33.10.
A 54-year-old man is brought to the emergency department (ED)
by EMS following a motor vehicle accident in which he sustained
blunt-force head trauma. Prior to the accident, he had never been
to the hospital and had no history of physical or mental illness.
After an inpatient stay of several weeks due to cortical swelling and
multiple bilateral leg fractures, he is discharged to a rehab facility
to help with ambulation. Staff there describe him as “snappy,
foulmouthed, and hateful.” His family notes that he had always
been known to be a mild-mannered, kind man who “never cursed a
day in his life.” Since discharge from the rehab facility 3 months
ago, the behavior has continued. What is the most likely lobe of the
brain that was affected in the car accident?

A. Frontal
B. Temporal
C. Parietal
D. Occipital

Answer 10

33.10. A. Frontal
The frontal lobe is responsible for executive functions such as cognition,
personality, and social behavior. Damage to this lobe can therefore lead to
personality change, such as from a preinjury mild-mannered person to a
postinjury difficult
and abusive person. Temporal lobe damage can result
in, among other things, difficulty with words, attention, memory, and
identification of objects. Parietal lobe damage can result in difficulty
drawing objects, distinguishing left from right, difficulty reading, and
spatial disorientation. Occipital lobe damage can lead to vision defects and
inability to recognize written words.

Question 11

33.11.
The rate of synaptogenesis is highest during what decade of life?

A. First
B. Second
C. Third
D. Fourth

Answer 11

33.11. A. First
Synaptogenesis peaks within the first 2 years of life and continues at its
highest rate during the first 10 years. Though there have been recent
discoveries of neurogenesis in specific brain regions in adults, it is well
below the amount seen in young children.

Question 12

33.12.
A 20-base-pair gene strand of mRNA contains a substitution point
mutation at the fifth base pair. A strand of miRNA is introduced to
the mRNA and binds to it. What would be the expected effect of the
miRNA on the mRNA strand?

A. It will repair the substitution
B. It will excise the substitution
C. It will silence the gene
D. It will upregulate gene expression
E. It will have no effect

Answer 12

33.12. C. It will silence the gene
A purpose of miRNA is to regulate gene expression through RNA silencing
by cleaving the target mRNA. miRNA therefore downregulates, not
upregulates, gene expression. Repair proteins, not miRNA, excise bases.

Question 13

33.13.
Parents call EMS for their 36-year-old daughter, who they say has
not left her room for 3 days, refusing to come out because she
thinks the air in the rest of the house is poisoned. They are worried
because she has not eaten anything and because she is “screaming
half the night at people on TV.” She is on haloperidol and
quetiapine, “but she hasn’t taken them in weeks. She refuses to
take a long-acting injection. She’s been on just about every
medicine there is for hearing voices, but she never stays on
anything for long.” They report that she has been hospitalized 10
times for similar symptoms over the last 10 years. She has no
medical illnesses. They state that her weight goes up and down
depending on the medication she is on. The patient is most likely to
have decreased volume of what brain structure?

A. Lateral ventricles
B. Third ventricle
C. Hippocampus
D. Amygdala
E. Hypothalamus

Answer 13

33.13. C. Hippocampus
Neuroimaging studies have shown decreased volume of the prefrontal
cortex and hippocampus in the brains of people with schizophrenia. In
contrast, the ventricles are enlarged. Interestingly, neuroimaging does not
show signs of neurodegeneration

Question 14

33.14.
Compared to that of a child without autism spectrum disorder
(ASD), the brain growth of a child with ASD shows what
characteristic?

A. Negligible growth during the first year followed by normal growth
afterward
B. Growth during the first year, followed by a plateau for the next 2
years
C. Accelerated growth from the end of the first year to age 4 years
D. Linear, steady growth throughout childhood until adolescence
E. Growth during the first 5 years followed by slow cortical shrinking

Answer 14

33.14. C. Accelerated growth from the end of the first year to age
4 years
The brain doubles in size in the first year, reaches 80% of its adult size by
age 3, and 90% of its adult size by age 5. The brains of children with ASD
most likely start with average size at birth, then grow at an accelerated rate
between the end of the first year and ages 2 to 4 years. Most of the
differences are seen in the frontal and parietal cortex, cerebellar
hemispheres, and amygdala. The mechanism for this difference is not
currently known

Question 15

33.15.
The cell bodies of serotonergic nuclei reside in what brain
structure?

A. Ventral tegmental area
B. Raphe nuclei
C. Locus ceruleus
D. Basal forebrain complex
E. Tuberomammillary nucleus

Answer 15

33.15. B. Raphe nuclei
Serotonergic nuclei cell bodies are found in the midline raphe nuclei of the
brainstem. The rostral raphe nuclei send projections up throughout the
brain, while the caudal raphe nuclei send projections down to the medulla,
cerebellum, and spinal cord. The ventral tegmental area is where, along
with the substantia nigra, dopamine neurons reside. Norepinephrineproducing
neurons are in the locus ceruleus and lateral tegmental
noradrenergic nuclei. The basal forebrain and mesopontine complexes are
where acetylcholine projection neurons are found. Histaminergic cell
bodies are located in the tuberomammillary nucleus

Question 16

33.16.
A 45-year-old man who has been addicted to methamphetamine
for the past 7 months tells other members in a drug abuse support
group that decreasing his drug use is difficult. “Using just makes
me feel good, you know? The feeling of that high is what keeps me
coming back for more.” What dopamine brain pathway is most
responsible for the feelings he is describing?

A. Mesolimbic
B. Mesocortical
C. Mesoaccumbens
D. Tuberohypophyseal
E. Nigrostriatal

Answer 16

33.16. C. Mesoaccumbens
The mesoaccumbens dopamine pathway plays a central role in the feelings
of reward and pleasure and is activated by drugs of abuse. The mesolimbic
pathway is believed to mediate positive symptoms of schizophrenia. The
mesocortical pathway is believed to play a role in negative symptoms of
schizophrenia. The tuberohypophyseal system mediates prolactin release,
and the nigrostriatal pathway modulates motor control

Question 17

33.17.
Dopamine is synthesized from what amino acid?

A. Tryptophan
B. Tyrosine
C. Histidine
D. Glycine
E. Glutamic acid

Answer 17

33.17. B. Tyrosine
Dopamine, like norepinephrine and epinephrine, is a catecholamine, all of
which are synthesized from the amino acid tyrosine. Serotonin is
synthesized from tryptophan, while histamine is synthesized from
histidine. GABA is synthesized from glutamic acid. Glycine is both an
amino acid and inhibitory neurotransmitter.

Question 18

33.18.
A 62-year-old man with a 30-year history of drinking three to five
beers a day would be expected to have what profile of N-methyl-Daspartate
(NMDA) and gamma-aminobutyric acid (GABA) receptor
regulation?
GABA NMDA

A. Upregulation Upregulation
B. Upregulation Downregulation
C. Downregulation Downregulation
D. Downregulation Upregulation

Answer 18

33.18. D. GABA Downregulation, NMDA Upregulation
Long-term ethanol use results in the downregulation of GABA receptors
and upregulation of NMDA receptors. The latter leaves the patient in a
hyperexcitable state in the case of abrupt alcohol discontinuation, which
can contribute to delirium tremens.

Question 19

33.19.
A 23-year-old woman presents to the outpatient clinic with
complaints of “not wanting to do anything or eat anything” and
feeling “down” for the past 4 weeks. She has been waking up 2
hours before her alarm goes off and cannot return to sleep. She
used to go out with friends but has avoided talking with them for
the past 3 weeks because “I just don’t have the energy.” Some days
she does not go to work because she is too tired. She reports
trouble focusing. She denies suicidal ideation. She has no chronic
illnesses and is on no medications. Vital signs are within normal
limits. Physical examination is noncontributory. On mental status
examination, she gives her mood as “down, blah.” What brain
pathway structures are most likely to be affected?

A. Hypothalamus, anterior pituitary gland, adrenal gland
B. Hippocampus, amygdala, hypothalamus, and thalamus
C. Hippocampal formation, fornix, mammillary bodies, anterior
thalamus, posterior cingulate gyrus
D. Suprachiasmatic nucleus, pineal gland, retinohypothalamic tract,
superior cervical ganglia

Answer 19

33.19. A. Hypothalamus, anterior pituitary gland, adrenal gland
A consistent finding in major depressive disorder is hyperactivity of the
hypothalamic pituitary adrenal axis (HPA), which consists of the
hypothalamus, anterior pituitary gland, and adrenal gland. The
hyperactivity leads to hypercortisolemia and resistance to dexamethasone
suppression of cortisol secretion. The hippocampus, amygdala, thalamus,
and hypothalamus form the limbic system. The addition of the fornix,
mammillary bodies, and posterior cingulate gyrus form the Papez circuit,
which mediates fear and aggression, feeding, and other homeostatic
activities. The suprachiasmatic nucleus, superior cervical ganglia,
retinohypothalamic tract, and pineal gland mediate the release and
feedback loop of melatonin.

Question 20

33.20.
A 44-year-old woman and her husband present to the urgent care
clinic. She has a chief complaint of, “I can’t breathe!” She states
that she has had more than 10 episodes of shortness of breath over
the last 3 months during which “my heart feels like it’s beating out
of my chest,” and “I’m shaking and pouring with sweat.” The first
time it occurred, she thought she was having an allergic reaction to
a new food she had tried, but a rechallenge of that food did not
produce the same results. The symptoms start abruptly and peak in
about 15 minutes. The current episode began 2 minutes ago. She
wanted her husband to accompany her to “see that this is real and
that I’m not just going crazy, which is how I feel when this
happens.” She worries that she will have an episode one day at
work and “I’ll get fired,” so she has been working from home as
much as her boss will allow. After several minutes, her elevated BP
and pulse return to normal limits, and she is no longer acutely
distressed. What neuropeptide has been associated with her
condition?

A. Neurotensin
B. Cholecystokinin
C. Substance P
D. Neuropeptide Y
E. Thyrotropin-releasing hormone

Answer 20

33.20. B. Cholecystokinin
Cholecystokinin is associated with panic disorder, which is this patient’s
diagnosis. Neurotensin is associated with schizophrenia. Substance P and
neuropeptide Y may play a role in posttraumatic
stress disorder (PTSD)
and major depression. Thyrotropin-releasing hormone is associated with
depression.

Question 21

33.21.
A 33-year-old woman presents to the outpatient clinic with a
complaint of extreme fatigue, poor appetite, and weight loss of 20
pounds over the past 3 months. She notes that picking up her 4-
month-old infant has gotten progressively more difficult over the
past month. In addition to feeling weak, she reports muscle pain.
She has difficulty getting to sleep most nights. On the infrequent
occasions when she can sleep longer, fatigue is unchanged. “I don’t
want to do anything, and I don’t have the energy for it.” She has
also tried making her favorite foods, “but I’m just not hungry.”
When she eats, she tends to crave salty foods. She has not had
these symptoms before. Vital signs are normal. BMI is in the 30th
percentile. Physical examination reveals hyperpigmentation of her
elbows, face, and neck. What treatment will be most helpful for her
symptoms of apathy, decreased appetite, impaired sleep, and
fatigue?

A. Mirtazapine
B. Sleep hygiene
C. Cortisone
D. A high-salt diet
E. Cannabidiol

Answer 21

33.22. A. Major depression
Major depression has years of data showing an interaction with the
immune system through a decrease in immunocompetence, and most
recently, inflammatory activation. There are now several studies showing
that bipolar disorder, particularly mania, can lead to increased plasma
concentrations of inflammatory cytokines. Schizophrenia has also been
associated with immune system activation. The relationship between
autism and immune abnormalities has not been substantiated. There is
emerging evidence for a link between Alzheimer disease and an immune
response

Question 22

33.22.
What psychiatric disorder has the most evidence for the
interaction between the immune system and the nervous system?

A. Major depression
B. Bipolar disorder
C. Schizophrenia
D. Autism
E. Alzheimer disease

Answer 22

33.23. C. Internal locus of control
The ability to see stressors as somewhat under one’s control (internal vs.
external locus of control) has been shown to be protective against stressinduced
immune alterations. This can be accomplished through reframing
techniques in cognitive behavioral therapy. Group therapy can provide
social support, which has also been identified as a protective factor

Question 23

33.23.
Psychotherapy focused on what subject matter has been shown to
serve as a protective factor against stress-induced immune
responses?

A. Relaxation techniques
B. Medication adherence
C. Internal locus of control
D. Positive thinking
E. Connection between mind and body

Answer 23

33.23. C. Internal locus of control
The ability to see stressors as somewhat under one’s control (internal vs.
external locus of control) has been shown to be protective against stressinduced
immune alterations. This can be accomplished through reframing
techniques in cognitive behavioral therapy. Group therapy can provide
social support, which has also been identified as a protective factor

Question 24

33.24.
A researcher studies an uncommon disease found in several
blood-related members of a family and determines that the relative
risk is 1.2. How should this figure be interpreted?

A. A family member exposed to the conditions for the disease has a
20% chance of developing it
B. The disease is 20% more likely to have a genetic etiology
C. Any family member has a 20% chance of developing the disease
D. 20% of the family members exposed to the conditions for the
disease will develop it
E. The disease will affect 20% of any given set of family members

Answer 24

33.24. B. The disease is 20% more likely to have a genetic
etiology
Relative risk is the rate of occurrence of a disease among family members
of an affected individual divided by the rate of occurrence in the general
population. If the number is greater than one, the disease occurs more
often in the family than it does in the general population. Therefore, the
disease is more likely to be genetic. In this case, the disease is 20% more
likely to have a genetic contribution

Question 25

33.25.
Several residents in a small town have been diagnosed with
Disease X. A researcher suspects that the disease may be correlated
with certain genetic variations. What type of study would best test
the researcher’s hypothesis?

A. Pedigree analysis
B. Sib-pair analysis
C. Linkage
D. Association

Answer 25

33.25. D. Association
An association study examines whether or not a certain allele occurs more
frequently than expected in affected individuals in a population. The
researcher will collect DNA samples from those with Disease X and those
without, then look for certain single-nucleotide polymorphisms (SNPs) to
see if they occur significantly more frequently in those with the disease
phenotype. If they do, the SNPs are associated with the disease. Linkage
studies attempt to find the relationship between a genetic variation and a
disease, but within a family or families, not compared to a population. Sibpair
analysis compares the frequency of a trait between siblings to that
expected in a random segregation. A pedigree analysis determines if two or
more genetic loci are cosegregating within a pedigree

Question 26

33.26.
What is a major barrier to performing genetic mapping studies for
psychiatric illnesses as opposed to other medical illnesses?

A. Psychiatric illnesses are less heritable than other medical illnesses
B. Many antipsychotic medications interfere with DNA sample
viability
C. There are fewer individuals with psychiatric than nonpsychiatric
illnesses
D. Individuals with psychiatric illness often cannot give informed
consent
E. Defining and assessing phenotypes of psychiatric illnesses is
inconsistent

Answer 26

33.26. E. Defining and assessing phenotypes of psychiatric
illnesses is inconsistent
Genetic mapping studies depend on consistent phenotyping algorithms.
Psychiatric illnesses are diagnosed most often using the DSM-5-TR, which
depends on subjective clinical evaluation and leads to less interrater
reliability and variable assignment of participants to a certain disease
phenotype. In addition, because the DSM-5-TR is menu based, individuals
with the same disease phenotype can have different sets of symptoms,
which may have different genetic etiologies. Psychiatric illnesses are
among the most common conditions affecting individuals of all ages.
Antipsychotic medications do not change DNA sample viability. Psychiatric
illnesses do not alter most people’s ability to give informed consent to
participate in studies, range in heritability, and are often multifactorial,
just as most other medical illnesses are. Even if they were not, the purpose
of mapping studies is to look for genetic contributors to the disease

Question 27

33.27.
Association studies discovered an association between the e4
allele of the
apolipoprotein E
gene and the development of what
psychiatric illness?

A. Alzheimer disease
B. Autism
C. Bipolar disorder
D. Fragile X
E. Schizophrenia

Answer 27

33.27. A. Alzheimer disease
The
apoE-e4
allele has been established through genome-wide association
studies as being linked to the development of late-onset Alzheimer disease.
The GRB-associated binding protein 2 (
GAB2
) allele has also been shown
to increase the risk of developing the disease.

Question 28

33.28.
Linkage studies have shown consistent evidence for contribution
to autism by alleles of what chromosome?

A. X
B. 7
C. 15
D. 22

Answer 28

33.28. B. 7
Chromosome 7q has shown the most consistent evidence for linkage in
autism families. Genes include
RELN
on chromosome 7q and
WNT2
on
7q31. The
FMR1
gene on the X chromosome is linked to Fragile X
syndrome. Chromosome 15q11-13 plays a vital role in Angelman and
Prader–Willi syndromes, but has not shown strong support for
autism.
There has been a small amount of linkage between autism and the
SHANK3
gene on chromosome 22q13

Question 29

33.29.
A 7-year-old girl presents to the outpatient clinic for an EEG as
part of an evaluation for seizures. Her teachers report multiple
instances a day of “zoning out” for several seconds, even while she
is actively talking. Her parents have noticed the same behavior at
home for the last 4 weeks. After a few seconds, she resumes talking
or whatever behavior in which she had been engaged. She is on
fexofenadine for seasonal allergies which were diagnosed a year
ago. Birth and postnatal histories reveal no abnormalities. She is
on no medications. Vital signs are within normal limits. Forty-five
minutes of EEG recordings show no abnormal tracings. What is the
next step in the EEG evaluation?

A. Give a bolus of insulin to induce a seizure
B. Have her return for another EEG after being off fexofenadine for a
week
C. Have her hyperventilate for 3 minutes
D. Continue the EEG for another 45 minutes
E. End the study with a conclusion that there is no EEG evidence for
seizures

Answer 29

33.29. C. Have her hyperventilate for 3 minutes
In addition to photic stimulation, hyperventilation is used to increase the
probability that abnormal discharges will occur. This is done by having the
patient take exaggerated deep breaths for 1 to 4 minutes, and is considered
one of the safest methods for EEG activation. Barring a contraindication
for someone with cardiopulmonary disease or cerebrovascular
pathophysiology, this activation technique would be tried before ending
the evaluation. Insulin therapy was used prior to ECT to cause therapeutic
seizures and has no place in current psychiatric treatment. Fexofenadine is
not known to alter EEG findings

Question 30

33.30.
The presence of what waveform during a normal waking EEG is
indicative of a possible physiologic abnormality?

A. Alpha
B. Beta
C. Delta
D. Theta

Answer 30

33.30. C. Delta
Alpha waves
are the most common waveform seen during a normal awake
EEG with the eyes closed. Fast-frequency
beta waves
can also be seen in
awake EEGs.
Theta waves
are seen mostly in the drowsy state, though they
can appear sporadically in the wake state. Excessive appearances of theta
should raise suspicion for a pathophysiologic process.
Delta waves
should
only be seen during deep sleep and should not be present during a normal
awake EEG.

Question 31

33.31.
A 43-year-old man is being evaluated for obstructive sleep apnea.
He is diagnosed with schizophrenia, for which he is taking
aripiprazole long-acting injection, and panic disorder, for which he
takes escitalopram and alprazolam as needed. He presents for an
overnight polysomnogram and tells the technician that he had to
take alprazolam because he was nervous about the study. He has
been taking the escitalopram daily and his last injection of
aripiprazole was 2 weeks ago. He is on no other medications and
has no other illnesses. What changes can be expected on his EEG
based on his medication regimen?

A. No significant changes
B. Increased delta activity
C. Increased beta activity
D. Increased alpha activity
E. Increased theta activity

Answer 31

33.31. C. Increased beta activity
Some psychotropic medications produce EEG changes, but usually not at
nontoxic doses. Benzodiazepines are an exception, and always generate an
increase in beta activity