PRITE Flashcards
Maternal licking & grooming behavior has profound effect on stress reactivity of offspring. Why?
DNA methylation affecting glucocorticoid receptor expression
Patient with epilepsy well-controlled on AED. Develops nausea, ataxia, diplopia when treated with erythromycin for a sinus infection. What AED in patient most likely on?
Carbamazepine
- can cause diplopia and ataxia
- Erythromycin increases concentration of Carbamazepine (decreases metabolism)
- think of sketchy car photo
- can cause aplastic anemia
- increased risk of SIADH and hyponatremia
A recently retired woman begins outpatient psychotherapy to help cope with several recent transitions in her life. She mentions regret that she did not pursue a graduate degree and instead "settled" for her ten-year job as an administrative assistant. She worries about her grown children, a son who lives with her and is not financially independent, and a daughter whom "I could have set on a better path." She would like to do something meaningful in the last few decades of her life, but is unsure of her next step. Which of the following stages of psychosocial development is characterized by this patient? A Initiative vs. guilt B Industry vs. inferiority C Ego integrity vs. despair D Identity vs. role confusion E Generativity vs. stagnation
C Ego integrity vs despair
https://i.pinimg.com/originals/33/5c/a1/335ca173e263341c5705c07c6e05a009.jpg
Neurocog disorder associated with fluctuating rate of progression, marked Visio spatial impairment, early unilateral resting tremor and increased muscle tone in the arm?
Dementia with Lewy bodies
Core features:
- fluctuating cognition
- visual hallucinations
- Parkinsonism - bradykinesia, rest tremor, rigidity (at least 1)
- REM sleep behavior disorder
DLB starts with cognitive impairment and motor within 1 year.
-VERSUS-
Parkinson’s needs all 3 motor symptoms for at least 1 year BEFORE onset of cognitive impairment or dementia
Which is suggestive of L5 radiculopathy in a patient with back pain & foot drop? A. Tenderness at ankle B. Hyperreflexia at knee C. Weakness of ankle inversion D. Loss of groin sensation E. Increased pain with bending over
C. Weakness of ankle inversion
L4 - patellar reflex, quad weakness, anterior thigh numbness
L5 - tibialis anterior weakness (foot drop), great toe numbness
S1 - Achilles reflex, gastroc weakness, lateral foot numbness
Polysomnogram associated with MDD:
- REM latency
- slow wave sleep
- REM intensity
- sleep efficiency
- Short REM latency (shorter time between sleep onset & first REM period)
- decreased slow wave sleep (stage 3/4)
- increased REM intensity
- decreased sleep efficiency
Pt with bipolar disorder taking advil develops n/v/d, coarse tremor, ataxia, confusion & slurred speech
Lithium toxicity
- NSAIDs decrease renal blood flow —> increase lithium reabsorption
> 1.5 - GI symptoms (nausea, diarrhea)
- CNS (drowsy, ataxia, tremor, twitching)
> 2.0 - blurred vision, confusion, slurred speech
- unsteady gait
- disorientation, seizures
* * avoid thiazide or loop diuretics
> 3.0 - coma, cardiovascular collapse, death
** often need dialysis
Pt with bipolar disorder. Confused, tremulous, anxious, difficulty walking straight, vomiting. Started on lisinopril & hydrochlorothiazide recently. 93% O2 sat. Disoriented, ataxic. Generalized seizure. Cause?
Lithium toxicity
- Thiazides reduce renal clearance of lithium (larger effect than loop diuretics)
- ACEI reduce thirst —> mild dehydration —> increased sodium reabsorption and lithium levels (ARBs have same effects) **-pril & -artan **
> 1.5 - GI symptoms (nausea, diarrhea)
- CNS (drowsy, ataxia, tremor, twitching)
> 2.0 - blurred vision, confusion, slurred speech
- unsteady gait
- disorientation, seizures
* * avoid thiazide or loop diuretics
> 3.0 - coma, cardiovascular collapse, death
** often need dialysis
Excessive activation of what receptor is thought to contribute to cell death in Alzheimer’s?
NMDA
Placidity, hyperorality, hypersexuality and increased food intake
Kluver-Bucy Syndrome
- bilateral resection of temporal lobes (specifically hippocampus & amygdala)
**placidity = calmness, feeling of quiet, blunted affect, apathy
**hypermetamorphosis = excessive attentiveness to visual stimuli, and tendency to touch every visual stimulus, regardless of the history or reward value of that object
Anorexia vs ARFID (avoidant restrictive food intake disorder)
ARFID - significant weight loss or nutritional deficiency but WITHOUT fear of weight gain or body image disturbance
Anorexia mnemonic
get RID of weight
R = Restricted intake I = Intense fear of weight gain D = Disturbed perception of body image
According to the World Health Organization, which of the following mental disorders ranks in the top ten worldwide for greatest burden of disease, as measured by years of life lost due to poor health, disability or premature death?
MDD
Cells that secrete proinflammatory cytokines TNF-alpha & IL1B in patients with inflammatory conditions that affect the brain?
Microglia = specialized macrophages in the CNS
A 72-year-old patient’s examination is remarkable for profound sensory ataxia with loss of vibratory sensation and cognitive issues described as irritability fluctuating with somnolence. Nutritional deficiency?
B12 (Cobalamin)
In an integrated setting with primary care and mental health, which of the following would be a population-based technique used to provide collaborative care?
A. Tracking clinic patients in a registry
B. Having a care plan for each patient in the clinic
C. Using evidence-based mental health treatments
D. Ensuring good communication between primary care and mental health
E. Having the mental health providers see patients when they are symptomatic
A. Tracking clinic patients in a registry
POPULATION-BASED TECHNIQUE
Leptin vs. Ghrelin
Leptin lessens appetite (from fat/adipose)
Ghrelin greatens appetite (from GI tract)
MDMA electrolyte abnormality
Hyponatremia
Factors that increase risk of individuals in US developing MDD
- male
- married
- living in rural area
- being of non-European descent
- having low socioeconomic status
Living in rural area & low SES
EMG finding to support diagnosis of conversion disorder:
A. Significant interference pattern
B. Diminished recruitment pattern
C. Rising pre-movement potentials
D. Electrical activity with muscle at rest
E. Irregular lines with muscle contraction
C. Rising pre-movement potentials
Primary purpose of mental health courts:
A. Adjudicate insanity defense
B. Determine fitness to stand trial
C. Divert offenders with mental illness away from incarceration
D. Provide preliminary rulings on psychiatric malpractice cases
E. Civilly commit dangerous mentally ill patients to outpatient treatment
C. Divert offenders with mental illness away from incarceration
Central principle of “The Goldwater Rule” for psychiatrists:
A. May not give unsolicited info regarding public figures to the media
B. May not receive financial compensation for opinions on public figures
C. Unethical for psychiatrists to offer professional opinions on public figures without a face to face eval
D. May offer professional opinion if, in their professional opinion, it is not misrepresenting the public figure
C. Unethical for psychiatrists to offer professional opinions on public figures without a face to face eval
mandate by Affordable Care Act designed, in part, to increase access to mental health services:
A. Inclusion of rehabilitation services as an essential benefit
B. Prohibition on preexisting condition denials due to a history of a mental disorder
C. Requirement that each state ensure federally specified essential mental health benefits
D. Requirement that psychiatrists be included as part of the patient-centered medical home
E. Incorporation of depression and several other mental health conditions among Accountable Care Organization’s quality indicators
B. Prohibition on preexisting condition denials due to a history of a mental disorder
According to cognitive theory, which of the following types of maladaptive schemas are generally most prominent in depressive disorders? A. Catastrophic thinking B. Thought-action fusion C. Overestimation of threats D. Negative evaluations of self E. Inflated sense of responsibility
D. Negative evaluations of self
Treatment for Clozapine-induced increased salivation (sialorrhea):
- Decrease Clozapine dose (not a long-term solution)
- Glycopyrrolate 2-4 mg nightly (anticholinergic)
- Less common: Trihexphenidyl or Clonidine (alpha 2 agonist)
Dopamine
- What is it produced from?
- What is it converted to by dopamine hydroxylase?
Tyrosine (tyrosine hydrolase) --> L-DOPA (dopa-decarboxylase) --> Dopamine (dopamine hydroxylase) --> Norepinephrine (PNMT) --> Epinephrine
Serotonin
- What is it produced from? (amino acid, not location)
Tryptophan (tryptophan hydroxylase) –>
5-HTP (5-HTP hydroxylase) –>
Serotonin (MAO) –>
5-HIAA
In the learned helplessness model - the behavioral deficits found in animals exposed to uncontrollable stress are reversed by what substance?
A. Lithium B. Stimulants C. Anxiolytics D. Antipsychotics E. Antidepressants
Antidepressants
Asymmetrical tonic posturing or a fencing posture - seizure origin?
Contralateral frontal lobe
Most common cause of inherited intellectual disability?
A. Rett B. Down C. Fragile X D. Prader-Willi E. Velocardiofacial
Fragile X
INHERITED!!!
Hypothalamic-pituitary-adrenal axis-related cortisol production is less active during which of the following sleep-related activities? A. REM sleep B. Sleep onset C. Sleep deprivation D. Morning awakening E. Nocturnal awakening
B. Sleep onset
Gender identity is believed to be most strongly influenced by which of the following factors? A. Innate feelings B. Parental influence C. Cultural expectations D. Chromosome complement E. Mirroring of the same-sex parent
A. innate feelings
Which of the following tests primarily measures flexibility in shifting cognitive sets? A. Trails B B. Boston naming C. Digits backwards D. Rey complex figure E. Pantomime use of objects
Trails B test - connecting circles with letters and numbers 1-A-2-B-3-C-4-D
- executive abilities including set shifting and mental flexibility
OTHERS:
- Trails A test: connect circles with just numbers as quickly as possible. Visual attention & processing speed
- Boston naming test: naming black & white drawn objects, tests language
- Digits backwards: working memory
- Rey complex figure test: redrawing a complex geometrical figure. tests perceptual organization, visuospatial constructional ability, and visual memory
- Pantomime use of objects: demonstrate motor action of using a tool without the tool in hand, used to test for apraxia (difficulty carrying out action/movement)
22q11.2 deletion associated with what mental illness:
Schizophrenia
- 22q11.2 deletion syndrome (DiGeorge Syndrome) has numerous phenotypic presentations which commonly includes schizophrenia (=distinguishable facial features, low IQ)
- 1% of patients with schizophrenia have 22q11.2 deletion
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3129332/
Which of the following psychotropic medications is relatively contraindicated for those with moderate-to-severe renal impairment? A. Clozapine B. Quetiapine C. Olanzapine D. Aripiprazole E. Paliperidone
Paliperidone (Invega)
- Risperidone’s active metabolite so doesn’t undergo hepatic metabolism
- Renal clearance & elimination
***Other are metabolized by the liver (clozaril, seroquel, zyprexa, abilify)
A defendant with bipolar disorder has pleaded guilty to a breaking and entering charge and is being considered for diversion to mental health court. Which of the following patient factors would be crucial to determine whether the patient has capacity to be referred to mental health court?
A. Has thoughts of self-harm or harming others
B. Is willing to enter a plea of not guilty by reason of insanity
C. Agrees to waive the right to be represented by an attorney
D. Has insight into the fact that the crime was the result of a mental disorder
E. Understands that the choice of this option involves waiving certain constitutional rights
E. Understands that the choice of this option involves waiving certain constitutional rights
As Bryan pointed out, they are going to lose their right to a firearm, right to due process, etc
Neuropeptide decreased in hypothalamus in nacrolepsy
Orexin A
According to data from the National Comorbidity Survey Replication, what is the average number of years from the start of a mood disorder until diagnosis? A. 0.5 to 1 year B. 2 to 3 years C. 6 to 8 years D. 11 to 13 years E. 18 to 20 years
C. 6-8 years
A 25-year-old patient without psychiatric history is brought to the emergency department by police. The patient is nonsensically yelling, assaulting security guards, and has vomited once. Heart rate is 135 beats per minute, blood pressure is 155/80 mmHg and temperature is 101°F (38.3°C.) Urine toxicology is negative for opioids, cannabinoids, amphetamines and benzodiazepines, and a blood alcohol level is zero. Agitation med rec?
Bath salt intoxication –> Benzo - Ativan
- agitation, combative behavior, psychosis, tachycardia, and hyperthermia
- Treatment is primarily supportive, with benzodiazepines such as lorazepam for agitation and excessive sympathetic stimulation, and aggressive cooling for severe hyperthermia
A school-aged boy does well academically but most of his energy is channeled into basketball, and he states that he hopes to become a professional basketball player. He teases girls at school, but plays mostly with boys. With which of the following of Freud's psychosexual stages of development do these characteristics correspond? A. Oral B. Anal C. Phallic D. Genital E. Latency
E. Latency
Oral (birth - 1 year): mouth sucking, swallowing, etc
Anal (age 1-3): withholding or expelling feces potty training
Phallic (age 3-6): penis or clitoris, masturbation, recognizing sexual parts and identifying w/parent
Latent (6-puberty): little or no sexual motivation present
Genital (puberty to adult): penis or vagina, sexual intercourse
Neuroimaging best for differentiating Alzheimers from FTD?
SPECT = Single-photon emission computed tomography scan
A 65-year-old patient with visual hallucinations and cognitive decline develops bradykinesia, rigidity and mUltiple falls. There are episodes of confusion and delirium. Treatment with which of the following can result in worsening of this condition and support the suspected diagnosis? A. Levodopa B. Clozapine C. Haloperidol D. Clonazepam E. Diphenhydramine
C. Haloperidol
Dementia w/Lewy Bodies
- AVOID TYPICAL ANTIPSYCHOTICS (especially Haldol) - cause a severe sensitivity reaction that worsens symptoms
- first line treatment to treat hallucinations & agitation are acetylcholinesterase inhibitors (rivastigmine, donepezil)
- motor symptoms can be treated w/carbidopa-levodopa
Common side effect of Ketamine in clinical trials for depression:
High BP
- feelings of dissociation
- vomiting
Once an ongoing doctor-patient relationship has been established, a physician may not ethically abandon a patient. In which of the following scenarios has the psychiatrist abandoned the patient?
A. A patient has seen the psychiatrist once in consultation and the patient wants to transfer care, but the psychiatrist declines.
B. A psychiatrist goes on vacation and sets up a new voice mail message that contains contact information for a covering psychiatrist.
C. Several months before a planned retirement, a psychiatrist offers all patients the contact information for a colleague who has agreed to take new patients.
D. An attending psychiatrist treats a patient on the inpatient unit and then goes off service; when discharge approaches, the patient asks the team to arrange outpatient coverage with the original attending, who declines.
E. A patient has seen a psychiatrist once in a consultation at which the psychiatrist provided a prescription; the psychiatrist subsequently spoke to the patient on the phone about symptoms and side effects but declines to take on the patient’s care.
E
A 35-year-old man develops blurry vision, drooping eyelids, double vision and difficulty swallowing. Over the next few days the symptoms worsen and he has severe constipation and progressive weakness of bulbar muscles. Sensation is normal and he is found to have pupils that do not react to light. Which of the following is the most likely toxin to result in this syndrome?
Botulinum
- symmetric descending weakness (starts with face then goes down)
- bilateral cranial neuropathies (vision, facial weakness, dysphagia, dysarthria)
38 yo homeless man brought to ED due to severe muscle pain and stiffness. Alcohol & injection drug use. Temp 100 F, BP 150/90, HR 102. Pupils normal, equal, reactive to light. Marks on patient’s arms and several abrasions/lacerations on lower extremities. Unable to open mouth. Painful spasms of neck muscles triggered by physical stimuli.
Tetanus
Which ethical principle must a psychiatrist apply when a patient comes in for suicide attempt via intentional overdose and does not desire inpatient admission?
Beneficence - efforts focused on providing treatment that helps the patient by mitigating the symptoms that placed the patient in danger
weighing against autonomy!
Neurogenesis in the adult brain is largely restricted to what region of the brain?
Dentate gyrus (hippocampus)
What can liothyronine be used for?
T3 - can be used to augment SSRIs and TCAs for treatment-resistant depression
The highest concentration of serotonin-producing cells in the brain is where?
Raphe nuclei
A 29 yo F is admitted w/recurrent episodes of weakness in the arms and legs
accompanied by severe abdominal pain requiring opioid medications. During the current episode delirium and agitation are noted. Testing for which of the following should be conducted to confirm the suspected diagnosis?
A. Opiates
B. Cortisol
C. Myoglobin
D. Heavy metal
E. Porphobilinogen
Acute intermittent Porphyria = pain in abdomen, back, arms or legs = digestive symptoms = mental changes (anxiety, confusion, hallucinations, etc) = muscle weakness
5 Ps = Painful abdomen, Port wine colored urine, Polyneuropathy, Psychological disturbance, Precipitated by drugs
A key distinction between boundary violations and boundary crossings is that:
A. some boundary violations are permissible.
B. boundary crossings always benefit the patient.
C. boundary violations are characteristically exploitative.
D. boundary violations occur only in the context of treatment.
E. boundary crossings are minor boundary violations that generally lead to major boundary violations.
C. boundary violations are characteristically exploitative
Boundary violation = major rupture of a boundary that leads to exploitation of the patient or serious harm to the efficacy of treatment
Boundary crossing = a minor break in the frame of treatment that is done with the intention to be therapeutic (ex: extending the time of an appt to accommodate for patient’s crying)
The theory that brain serotonergic systems are dysregulated in posttraumatic stress disorder (PTSD) led to the investigation of genes known to affect that system. Some subsequent studies have found that patients with PTSD have a higher frequency of the homozygous S-SERT genotype. This approach to gene identification is most accurately referred to as which of the following?
A. Genetic screening test
B. Candidate-gene approach
C. Whole genome association
D Parametric linkage analysis E. Identify by descent mapping
B. Candidate gene approach
- the study of the genetic influences on a complex trait by:
1. generating hypotheses
2. identifying candidate genes that may have a role
Which of the following statistical methods attempts to address the effects of participants dropping out of a study prior to completion? A. Odds ratio B. Meta-analysis C. Power analysis D. Positive predictive value E. Last observation carried forward
E. Last observation carried forward
= method of imputting missing data in longitudinal studies, if a person drops out of the study before it ends then the last observed score is used for all subsequent observation points
36-year-old female patient complains of easy fatiguability, weight loss, craving salt, nausea, hyperpigmentation, and muscle cramps. The patient is noted to have a moderately depressed mood and appears apathetic. Which of the following is the most likely diagnosis? A. Hyperthyroidism B. Hypothyroidism C. Hypercortisolism D. Adrenocortical insufficiency E. Polycystic ovary syndrome
D. Adrenocortical insufficiency (Addison’s disease)
- weakness, hyperpigmentation, weight loss in 99% of patients
- may have electrolyte abnormalities
- may be depressed
Psychotropic when administered with hydrocodone known to decrease its analgesic effect:
SSRIs:
- Prozac (Fluoxetine)
- Zoloft (Sertraline)
- Paxil (Paroxetine)
- Celexa (Citalopram)
- SSRIs inhibit a liver enzyme that coverts prodrug opioids (hydrocodone and codeine) into their active pain-relieving forms.
https: //med.stanford.edu/news/all-news/2019/02/common-opioids-less-effective-for-patients-on-ssri-antidepressants.html
Which of the following is the first step when determining whether or not a criminal defendant is not guilty by reason of insanity?
A. Evaluate the defendant.
B. Ascertain the facts of the case.
C. Review the medical and psychiatric records.
D. Review observations of the defendant made by others.
E. Determine the legal insanity standard to be used.
E. Determine the legal insanity standard to be used
Functional magnetic resonance imaging studies have shown the highest level of response to anticipated rewards in the nucleus accumbens during which of the following developmental periods? A. Infancy B. Toddlerhood C. Mid-latency D. Adolescence E. Adulthood
D. Adolescence
A 36-year-old patient presents to the neurology clinic with a history of double vision, vertigo and vomiting. Examination of the eye movements reveals paresis of the medial rectus on attempted lateral gaze, with a coarse nystagmus in the abducting eye with lateral movements of the eyes in either direction. These findings are characteristic of which of the following?
A. Pontine infarct
B. Multiple sclerosis
C. Progressive supranuclear palsy
D. Olivo pontocerebellar degeneration
E. Subacute combined degeneration of the spinal cord
B. Multiple Sclerosis
Internuclear ophthalmoplegia (INO) = Ipsilateral adduction failure, Nystagmus Opposite
Primary medication that increases Clozaril levels
Fluvoxamine
**Clozapine can cause seizures at high doses (dose-dependent). When plasma levels of Clozapine are above 600 –> adjunctive tx with Valproic acid is recommended for prophylaxis
How the following affect Clozapine levels:
- smoking
- Asian population
- age
- male gender
- Smoking, younger age, male gender lower plasma levels (smoking induces CYP enzyme)
- Asians have higher plasma levels
Risk of patients on Clozapine who want to stop smoking
Risk of seizure due to sudden increase in plasma Clozapine concentration –> must decrease dose of Clozapine
***same applies if a patient is being admitted to a smoke-free facility bc nicotine replacement do not have same effect on CYP enzyme (smoking induces the enzyme)
Which of the following sources of pain is thought to have a primarily central (non-nociceptive) mechanism? A. Cancer pain B. Fibromyalgia C. Osteoarthritis D. Diabetic neuropathy E. Postherpetic neuralgia
B. Fibromyalgia
Highest rates of posttraumatic stress disorder are found in which of the following?
A. Witnessing an assault
B. Experiencing sexual violence
C. Witnessing an unnatural death
D. Experiencing a natural disaster
E. Becoming injured in a motor vehicle accident
B. Sexual violence
During which stage of development does the maximal number of axons and synapses exist? A. Infancy B. Toddlerhood C. Preschool-age D. School-age E. Adolescence
A. Infancy
Piaget’s major contribution to development was a theory that explains which of the following phenomena?
A. Environmental influences on learning and behavior B. Unconscious influences on behavior and actions
C. Individuals’ emotional separation from caretakers
D. How individuals learn about and understand the world
E. The ways in which individuals acquire physical and motor skills
D. How individuals learn about and understand the world
Piaget’s theory of cognitive development - 4 stages of mental development of how children acquire knowledge and to understand the nature of intelligence
- Sensorimotor stage
- Preoperational stage
- Concrete operational stage
- Formal operational stage
Nuremberg code
research ethical principles for human experimentation
- created as a result of the Nuremberg trials at end of WWII against members of Nazi leadership
- not officially accepted as law by any nation
- first articulated the principle of human subject consent for ethically conducted research
- Human must consent
- Yield fruitful results for good of society
- Designed and based on animal experiments
- Avoid unnecessary physical and mental suffering/injury
- Should not be conducted if reason to believe death or disabling injury will occur
- Risk should not exceed humanitarian importance of the problem
- Protection for the subject
- Conducted only be scientifically qualified persons
- Subject can bring it to end if causing physical or mental harm
- Scientist should terminate if likely to result in death or injury
Which of the following regions of the central nervous system contain dopaminergic neurons which project to the caudate and putamen? A. Thalamus B. Brainstem C. Hypothalamus D. Substantia nigra E. Ventral tegmental area
D. Substantia nigra
Location of synthesis of neurotransmitters:
- Raphe nucleus
- Basal nucleus of meynert
- Nucleus accumbens
- Locus ceruleus, adrenal medulla
- Substantia nigra
- Raphe nucleus = Serotonin
- Basal nucleus of meynert = ACh
- Nucleus accumbens = GABA
- Locus ceruleus, adrenal medulla = NE
- Substantia nigra = Dopamine
area of the brain responsible for face recognition
fusiform gyrus
Synaptic plasticity is often dependent on a calcium mediated long-lasting increase in AMPA receptor signal transmission, a process which is referred to as: A. synaptic tagging. B. synaptic depression. C. long-term depression. D. long-term potentiation. E. synaptic enhancement.
D. long-term potentiation
SHORT-TERM PLASTICITY:
synaptic enhancement = increased probability of synaptic terminals releasing transmitters in response to presynaptic action potentials
synaptic depression (fatigue) = depletion of readily releasable vesicles
LONG-TERM PLASTICITY:
long-term depression = efficacy of synaptic transmission is reduced
long-term potentiation = persistent enhancement of synaptic transmission (patterns of synaptic activity that produce a long-lasting increase in signal transmission between two neurons)
OTHER:
synaptic tagging = how neural signaling at a particular synapse creates a target for subsequent plasticity-related products essential for LTP/LTD
Identity diffusion, as defined by Erik Erikson, describes which of the following?
A. Mental activity that is both interactional and intersubjective
B. lack of continuity in how the self is experienced in relationships over time
C. State of primitive fusion that exists between early object representations and self- representation
D. Behavior originating at one point in development that may serve an entirely different function later on
B. lack of continuity in how the self is experienced in relationships over time
Identity diffusion = no commitment to a specific identity yet, not actively searching for identity
Anatomical studies of neuronal cell density in schizophrenia consistently show which of the following? A. Decreased pyramidal neuron density B. Decreased interneuron cell density C. Decreased total neuronal density D. No change in neuronal density
D. No change in neuronal density
Obsessive-compulsive disorder (OCD) with childhood onset differs from adulthood onset in which of the following ways?
A. Symptom burden is less.
B. Psychiatric comorbidity burden is greater.
C. Persistence of OCD later in life is less likely.
D. Compulsions without obsessions are less common.
B. Psychiatric comorbidity is greater
Epidural vs. Subdural hematoma
SuBdural = Banana = shaped like a banana (concave)
Epidural = PIE (EPI) = Lemon shaped (convex)
Which of the following best characterizes the role of the therapist in motivational interviewing?
A. Argues directly for behavioral change
B. Provides solutions to behavioral problems
C. Is directive and helps persuade the patient of the advantages of behavioral change
D. Points out the discrepancy between behavioral and personal goals in order to motivate change
D. Points out the discrepancy between behavioral and personal goals in order to motivate change
Adoptive parents of a child whose birth mother died by suicide ask the psychiatrist about the child’s relative risk for future suicidal behavior. Which of the following is the most accurate response?
A. There is no information on genetic risk of suicide.
B. The child’s risk is no higher than other adoptees.
C. The child’s risk of suicide attempt, but not completed suicide, is elevated as compared to other adoptees.
D. The child’s risk of completed suicide is elevated relative to other adoptees.
D. The child’s risk of completed suicide is elevated relative to other adoptees.
Which of the following is the observed effect on provider behaviors for documentation of tobacco use and referral for cessation counseling when prompts for tobacco use and treatment are implemented in electronic health records?
A. Both behaviors increase
B. Both behaviors decrease
C. Only documentation of use increases
D. Only referral for cessation counseling increases
A. Both behaviors increase
Clinical exome sequencing is most useful for detection of which of the following genetic abnormalities? A. Long insertion variants B. Repetitive DNA sequence C. Single nucleotide substitutions D. Structural chromosomal abnormalities
C. Single nucleotide substitutions
exome sequencing is used for identifying disease-causing DNA variants in the 1% of the genome which codes for proteins (exons)
Patients in correctional institutions can generally be forcibly administered antipsychotic medications in three circumstances: emergency situations; treatment of symptoms that threaten the safety of self or others, and:
A. to help obtain a confession to a capital crime.
B. when ordered by a licensed forensic psychiatrist.
C. to restore a criminal defendant to competency in order to stand trial.
D. when a physician determines that the benefits outweigh the risks of medications.
C. to restore a criminal defendant to competency in order to stand trial
Where must you hold a license to do telepsychiatry:
- the state in which the PATIENT is located
Which of the following gene mapping strategies is most effective in detecting rare genetic variants of large effect? A. Pedigree linkage analysis B. Affected sib pair linkage analysis C. Family tree genome-wide association D. Case-control genome-wide association
A. Pedigree linkage analysis
influential psychiatrist known for treating psychiatric disorders as categorically distinct “natural disease entities”
Kraepelin
A set of feelings that a patient reenacts in the therapeutic relationship =
Transference = a situation where the feelings, desires, and expectations of one person are redirected and applied to another person.
A 35-year-old female patient has discoid lupus, which has long been controlled with a stable dose of oral prednisone. She abruptly develops increased fatigue, inflamed joints, and diffuse myalgias. The patient also exhibits depressed mood and cognitive impairment. She has no prior psychiatric history and no focal neurological signs. Which of the following is the most likely etiology? A. Seizure B. Psychological stress C. Metabolic dysfunction D. Corticosteroid toxicity E. Disease-induced cerebritis
Lupus cerebritis - neuropsych manifestations of SLE.
- acute confusional state
- cognitive dysfunction
- mood changes
- lethargy
- seizures, coma
A nine-year-old child has been successfully treated with methylphenidate for attention-deficit/hyperactivitydisorderforseveralyears. Duringthelasttwomonths,the medication has not been as effective despite several dose adjustments. It is decided that the child needs a different medication. Which of the following would be the best choice? A. Buspirone B. Atomoxetine C. Desipramine D. Risperidone E. Mixed amphetamine salts
E. Mixed amphetamine salts (Adderall - Dextroamphetamine and Lisdexamfetamine)
Most highly heritable mental disorder
Autism spectrum disorder
Major drug interaction for Lamictal
Valproic acid / Depakote
- Depakote blocks lamictal’s metabolism via phase 2 glucoridnation –> reduces plasma clearance –> prolongs Lamictal’s half-life
- *NEVER ADD DEPAKOTE TO LAMICTAL!!!**
- *Can add Lamictal to Depakote in very low doses**
In which of the following ways are physicians who die by suicide different from the general population of suicide compieters?
A. More likely to be older
B. More likely to be married
C. Less likely to abuse illicit drugs
D. More likely to have a chronic health problem
E. Less likely to be taking antidepressant medications
E. Less likely to be taking antidepressants
Which of the following acts as an obligate co-agonist with glutamate at the NMDA receptor? A. Glycine B. Tyramine C. Enkephalin D. Substance P E. Glycoprotein lib
A. Glycine
Dorsolateral prefrontal cortex primary function
Working memory (remembering a phone number long enough to make a phone call) & selective attention
Why decrease or stop Lithium before ECT?
Increased risk of delirium
The majority of research suggests that opioid-dependent offenders are more likely to remain drug abstinent following release from prison if they receive which of the following interventions?
A. Methadone maintenance while in prison
B. Prison-based Narcotics Anonymous groups
C. Injectable sustained release naltrexone while in prison
D. Weekly motivational interviewing sessions while in prison
E. Transfer to a methadone program following incarceration
A. Methadone maintenance while in prison
At what stage of development does the peak of dopamine receptor density occur in the striatum, possibly accounting for increased response to rewards for behavior during this stage? A. Infancy B. Childhood C. Adolescence D. Early adulthood E. Late adulthood
C. Adolescence
An 18-year-old patient is evaluated for excessive skin-picking, resulting in multiple facial sores. The parents report that the patient spends up to one hour every day in the bathroom examining and washing the facial skin. On interview, the patient reports frustration with severe acne and discoloration of the facial skin. On examination, there are a few small pimples and no visible discoloration. The facial skin is most notable for excoriations. Which of the following is the most likely diagnosis?
A. Excoriation disorder
B. Illness anxiety disorder
C. Body dysmorphic disorder D. Generalized anxiety disorder
E. Obsessive-compulsive disorder
C. Body dysmorphic disorder
By which of the following mechanisms of action does phencyclidine induce psychosis? A. Inhibition of D2 receptors B. Inhibition of SHT receptors C. Inhibition of NMDA receptors D. Stimulation of GABA-A receptors E. Stimulation of GABA-B receptors
C. Inhibition of NMDA receptors
In the United States, what is the number one preventable cause of death? A. Suicide B. Depression C. Head trauma D. Alcohol use disorder E. Tobacco use disorder
E. Tobacco use disorder
Which of the following is the most likely mechanism for QTc interval prolongation related to antipsychotic medications? A. Sodium influx B. Calcium influx C. Sodium channel blockade D. Stimulation o f ATPase pump E. Potassium channel blockade
E. Potassium channel blockade
Delirium EEG findings: A. Beta activity B. Normal EEG C. Focal delta slowing D. 3-Hz spike wave complexes E. Generalized theta and delta activity
E. Generalized theta and delta activity
Which of the following neurotransmitters, in addition to dopamine, is most often implicated in the regulation of mammalian brain-reward circuitry? A. GABA B. Glycine C. Serotonin D. Glutamine E. Endocannabinoid
A. GABA
Which of the following is currently the most significant barrier to widespread use of videoconferenee-based telepsychiatry? A. Inconvenience B. Time constraints C. Cost effectiveness D. Patient dissatisfaction E. Physician dissatisfaction
E. Physician dissatisfaction
Which of the following agents is likely to decrease lithium levels? A. Caffeine B. Lisinopril C. Ibuprofen D. Quetiapine E. Hydrochlorothiazide
A. Caffeine
ACEI dehydrate –> increased sodium reabsorption and lithium levels
NSAIDs increases lithium reabsorption
Thiazides reduce renal clearance of lithium
A patient with narcolepsy is experiencing episodes described as, "weakness in the arms and legs" brought on with laughter. This symptom is most likely to respond to treatment with which of the following? A. Modafinil B. Melatonin C. Venlafaxine D. Clonazepam E. Methylphenidate
C. Venlafaxine
Cataplexy can be treated w/
- TCAs (Imipramine, Desipramine)
- SSRIs
- SNRIs (Venlafaxine)
The development of brain gray matter volume peaks during which of the following stages of development? A. Early childhood B. Late childhood C. Early adolescence D. Late adolescence E. Early adulthood
B. Late childhood
Which of the following is required for NMDA receptor ion channel opening, in addition to ligand binding? A. Potassium B. Depolarization C. Phosphorylation D. Enzymatic activation E. G-protein-Iinked activation
B. Depolarization
Which of the following is most suggestive of psychogenic blindness?
A. Abnormal color vision only
B. Loss of vision in only the hemifield
C. Ocular jerk movements with optokinetic drum
D. Normal direct and consensual response to light
E. Normal brain magnetic resonance imaging scan
C. Ocular jerk movements (nystagmus) with optokinetic drum
- -> indicates intact visual pathway
- normal in infants through adulthood
Which of the following is a developmental task of the school-age stage?
A. Manage the new emotion of guilt around moral transgressions
B. Begin to establish peer relationships and pursue group activities
C. Use language, stories, and pretend play for purposes of emotional self-regulation
D. Begin to grasp triadic relationships in which complex emotions flourish in the family context
E. Achieve the following crucial symbolic capacities: narrative-making, fantasy, and imaginative play
B. Begin to establish peer relationships and pursue group activities
A patient describes feeling detached from his body as if he were floating above and looking down on himself. Which of the following describes this experience? A. Illusion B. Derealization C. DepersonaIization D. Hypnagogic hallucination E. Hypnopompic hallucination
C. Depersonalization
Which of the following second generation antipsychotic medications has the lowest affinity for the D2 receptor? A. Quetiapine B. Olanzapine C. Ziprasidon D. Paliperidone E. Risperidone
A. Seroquel
Contralateral leg weakness associated with personality changes can be seen in a stroke in which of the following large artery territories? A. Vertebral B. Middle cerebral C. Anterior cerebral D. Posterior cerebral E. Anterior choroidal
C. Anterior cerebral (ACA) stroke
= lower extremity deficits with cognitive and personality changes
**ACA is in the middle of the brain
Who first described cognitive distortions in the context of CBT?
Aaron Beck
As John walked down the street he thought to himself “Everyone can tell that I’m a loser." Type of cognitive distortion: A. Selective abstraction B. Overgeneralization C. Arbitrary interference/interpretation D. Magnification E. Personalization F. Absolutistic, dichotomous thinking G. Inexact labeling H. Minimization
C. Arbitrary interference/interpretation
= the process of forming an interpretation of a situation, event, or experience when there is no factual evidence to support the conclusion or where the conclusion is contrary to the evidence
This thought is distorted for a number of reasons: John has no way of knowing what ‘everyone’ thinks, and it is extremely unlikely that anybody is even thinking about him since most people are likely to be wrapped up in their own concerns just as he is.
When reviewing a set of extremely positive student evaluations a professor notes that one of them contains the comment, "could leave more time for questions during class." At a subsequent psychotherapy session the professor tells the psychiatrist, "I am a terrible professor. I just talk the whole time.II This is an example of which of the following types of cognitive errors? A. Selective abstraction B. Overgeneralization C. Arbitrary interference/interpretation D. Magnification E. Personalization F. Absolutistic, dichotomous thinking G. Inexact labeling H. Minimization
A. Selective abstraction
= the process of focusing on a detail taken out of context, ignoring other more salient features of the situation, and conceptualizing the whole experience on the basis of this element
His thinking is distorted because he has automatically focused on the one negative piece of feedback to the exclusion of all the positive feedback – his judgement of his teaching was not a fair reflection of the evidence.
Carl gets a C- on a piece of homework, thinks to himself “I’m going to fail everything”, and feels hopeless. This is an example of which of the following types of cognitive errors? A. Selective abstraction B. Overgeneralization C. Arbitrary interference/interpretation D. Magnification E. Personalization F. Absolutistic, dichotomous thinking G. Inexact labeling H. Minimization
B. Overgeneralization
= drawing a general conclusion about their ability, performance, or worth on the basis of a single incident
Carl’s thinking is distorted in this case because the conclusion he is reaching is too broad given the evidence. It is equally plausible that his c-minus is a ‘blip’ and that he will do well on tests in the future, or that there were good reasons why he got a poor grade this time that could be remedied in the future.
Paul’s baby is sick on his only clean shirt before he has to go to work to give a presentation. He has an image of his boss noticing, giving him a disgusted look, and firing him on the spot. This is an example of which of the following types of cognitive errors? A. Selective abstraction B. Overgeneralization C. Arbitrary interference/interpretation D. Magnification E. Personalization F. Absolutistic, dichotomous thinking G. Inexact labeling H. Minimization
D. Magnification
= errors in evaluation which are so gross as to constitute distortions
Paul’s thinking (an image in this case) is an example of magnification because he is imagining and paying attention to a worst-case scenario.
Emma’s friend was the third person to try to tell her that she thought Emma was drinking too much and putting herself in danger. Emma dismissed her concerns by saying “You’re like everyone else, you worry too much” and thought to herself “I don’t know what they’re all so worried about” This is an example of which of the following types of cognitive errors? A. Selective abstraction B. Overgeneralization C. Arbitrary interference/interpretation D. Magnification E. Personalization F. Absolutistic, dichotomous thinking G. Inexact labeling H. Minimization
H. Minimization
= errors in evaluation which are so gross as to constitute distortions
Someone bumps into Sally as she gets off the train. Sally calls the person a “complete f****** idiot” and feels furious. This is an example of which of the following types of cognitive errors? A. Selective abstraction B. Overgeneralization C. Arbitrary interference/interpretation D. Magnification E. Personalization F. Absolutistic, dichotomous thinking G. Inexact labeling H. Minimization
G. Inexact labeling
= the affective reaction is proportional to the descriptive labelling of the event rather than to the actual intensity of a traumatic situation
Her conclusion that the person who bumped her is a ‘complete idiot’ is a distortion because it is such an extreme interpretation of what happened. A more benign (and realistic) interpretation is that the other person was simply clumsy or made a mistake.
On Sam’s journey to work he steps in a puddle, realizes he has forgotten his watch, and has to rush after his train is late. He thinks “the world has got it in for me” and feels deflated. This is an example of which of the following types of cognitive errors? A. Selective abstraction B. Overgeneralization C. Arbitrary interference/interpretation D. Magnification E. Personalization F. Absolutistic, dichotomous thinking G. Inexact labeling H. Minimization
E. Personalization
= the patient’s proclivity to relate external events to himself when there is no basis for making such a connection
Naturally Sam has placed himself at the centre of the story (we all tend to be somewhat egocentric), but his thinking is biased because he has assigned agency to the world around him and he is implicitly making the prediction that the world will continue to ‘have it in for him’.
Tanya either did things perfectly or not at all. If she saw the slightest speck of dust at home she saw it as ‘filthy’. She was similarly strict with descriptions of herself – she was either doing ok, or was failing in every way. This is an example of which of the following types of cognitive errors? A. Selective abstraction B. Overgeneralization C. Arbitrary interference/interpretation D. Magnification E. Personalization F. Absolutistic, dichotomous thinking G. Inexact labeling H. Minimization
F. Absolutistic, dichotomous thinking
= the tendency to place all experiences in one of two opposite categories; for example, flawless or defective, immaculate or filthy, saint or sinner
Her thinking is biased because she fails to see life in the ‘shades of grey’ that it actually operates.
SSRI use in pregnancy followed by jitteriness, restlessness, feeding difficulty, irritability, increased muscle tone, and rapid breathing after birth in baby
Neonatal adaptation syndrome (NAS)
- 25-30% of infants exposed to SSRIs have this
- similar to colic, self-limiting
- unclear if withdrawal related or overstimulation of serotronergic system
lesion of the posterior third of the left superior temporal gyrus?
Wernicke’s aphasia (receptive aphasia)
neurogenesis occurs in which region of the adult human brain?
hippocampus
Which of the following was an outcome of deinstitutionalization?
A. Reduced the total cost of mental illness
B. Improved medication compliance through case management
C. Had little effect on emergency department visits by mentally ill patients
D. Diverted all funds for hospital beds to community mental health services
E. Resulted in a higher ratio of mentally ill patients in prisons as compared to hospital
E. Resulted in a higher ratio of mentally ill patients in prisons as compared to hospital
A 55 yo develops new onset diplopia. Initial exam demonstrates double vision when looking to the right with decreased abduction of the right eye. Upon examination later in the day the clinician now finds that the patient has drooping of the left eyelid and difficulty elevating the left eye. The following morning the patient reports awakening without any double vision. This pattern of double vision is typical for which of the following conditions? A. Multiple sclerosis B. Brainstem glioma C. Myasthenia gravis D. Retinal detachment E. Stroke in the occipital lobe
C. Myasthenia gravis
- bulbar muscle weakness w/fatigue
- improves with edrophonium, rest, ice
Antidepressant least likely to cause sexual dysfunction:
Escitalopram (Lexapro)
3 parts of loop circuit in brain that produce worry/obsessive symptoms when overactive:
- Striatum
- Dorsolateral prefrontal cortex
- Thalamus
Best medication for palliative care end of life patients with fatigue, depression, poor appetite
Stimulants (dextroamphetamine, methylphenidate, pemoline)
A person works in an office near a railroad. Eventually, the person no longer notices the sounds from passing trains. This is an example of:
A. extinction.
B. habituation.
C. sensitization.
B. habituation (Pavlov terms)
habituation = ability to discontinue response to highly repetitive stimuli (train!)
sensitization = increase in responsiveness as a result of repeated application of stimulus or an aversive stimulus
extinction = diminishment of response when reinforcement discontinued (give a treat with the bell every time then take away the treat and the bell no longer elicits response)
Best neuroimaging technique for studying connectivity pathways in the brain: A. EEG B. Diffusion tensor imaging C. Magnetoencephalography D. PET E. SPECT
B. Diffusion tensor imaging
A person w/sustained damage to hippocampus is still able to learn new skills such as playing tennis because this type of learning involves which of the following structures? A. Amygdala B. Limbic cortex C. Basal ganglia D. Mammillary bodies E. Posterior thalamic nuclei
C. Basal ganglia
One model of integrated care is the “Improving Mood-Promoting Access to Collaborative Treatment” (IMPACT), which recommends screening for depression of at least 75% of primary care patients and following through with diagnostic evaluations and treatment management. Which of the following is characteristic of this model when compared to treatment as usual?
A. There is no difference, both are equally effective.
B. The model costs twice as much as usual treatment.
C. The model doubles the effectiveness of depression treatment.
D. The model is more effective, but the benefits fade within three months.
E. The model works well for the elderly, but is not effective for young adults.
C. The model doubles the effectiveness of depression treatment.
long-term memory that involves the recollection of ideas, concepts and facts commonly regarded as general knowledge (factual info such as grammar and algebra)
semantic memory
Treatment of lithium-induced tremor
Common side effect of lithium!
Propanolol
One of the most consistent and specific findings among anatomical volumetric studies has been the association between increased trait aggression and reduced volume of the: A. striatum. B. amygdala. C. frontal lobe. D. orbitofrontal cortex. E. anterior cingulate cortex.
B. amygdala
What medication, when added to lithium for treatment-resistant bipolar depression, is the least likely to induce rapid cycling or a mixed state?
Wellbutrin
Which of the following does the Wisconsin Card Sorting Task most accurately measure?
A. Simple motor speed
B. Matching and discrimination of visual cues
C. Recognition, immediate and intermediate recall
D. The ability to reproduce sequence from memory
E. The ability to generate alternative strategies in response to feedback
E. The ability to generate alternative strategies in response to feedback
- set-shifting
- the ability to display flexibility in the face of changing schedules of reinforcement
A 54-year-old patient who takes 60 mg of fluoxetine daily for MDDvis evaluated for worsening migraines. The patient calls the psychiatrist several days later and reports fever, diarrhea and feeling that her muscles are tightening up. What migraine medication is most likely to cause these symptoms when taken with fluoxetine?
Triptans! - effects on serotonin
Any SSRI or SNRI can interact w/triptans to cause Serotonin syndrome!
Females of which of the following ethnic groups report experiencing the highest rates of lifetime intimate partner violence? A. Asian American B. Native American C. African American D. Hispanic American E. Caucasian American
B. Native American
Where is orexin produced in the brain?
Hypothalamus
When compared to patients with somatic symptom disorder, patients with illness anxiety disorder are less likely to: A. be female. B. display fa belle indifference. C. have multiple physical complaints. D. develop a major depressive disorder.
C. have multiple physical complaints
Illness anxiety disorder = anxiety about having a serious medical illness
Somatic symptom disorder = somatic expression of anxiety (back pain)
FMR1 mutation
Fragile X syndrome
In Heinz Kohut’s theories of self-psychology, what is meant by the term “self-objects”?
A. Personal belongings of significance used to help define the self
B. Different aspects of the self that emerge in different types of situations
C. Various components of the self that appear during different stages of life
D. Other people in the environment who perform particular functions for the self
D. Other people in the environment who perform particular functions for the self
Pathogenic copy number variants affecting DNA base pairs are associated with which of the following syndromes? A. Down B. Turner C. Prader-Willi D. Lesch-Nyhan
C. Prader-Willi
Repetitive transcranial magnetic stimulation for the treatment of unipolar depression targets which of the following brain regions? A. Ventral striatum B. Locus coeruleus C. Periamygdaloid cortex D. Medial temporal cortex E. Dorsolateral prefrontal cortex
E. Dorsolateral prefrontal cortex
- Which of the following instructions can enhance hypoactive deep tendon reflexes in a leg?
A. Clench a fist
B. Elevate an arm
C. Stare at a distant object
D. Think of moving the limb
E. Sensory stimulation of the opposite limb
A. Clench a fist
8. Which of the following medications is most effective for migraine prophylaxis? A. Sumatriptan B. Topiramate C. Fluoxetine D. Duloxetine E. Naproxen
B. Topiramate
Which of the following epigenetic mechanisms inhibits the transcriptional machinery from accessing DNA and thus leads to decreased gene transcription? A. Acetylation B. Methylation C. Demethylation D. Histone modification E. Chromatin remodeling
B. Methylation
Which of the following neurotransmitters is predominantly inhibitory? A. Norepinephrine B. Glutamate C. Dopamine D. Tyrosine E. Glycine
E. Glycine
When a child reaches the stage of formal operations, which of the following is a new cognitive capacity gained? A. Centration B. Abstraction C. Reversibility D. Egocentrism E. Object permanence
B. Abstraction
Piaget’s theory of cognitive development - 4 stages of mental development of how children acquire knowledge and to understand the nature of intelligence
- Sensorimotor stage (birth - 2 yrs) - understanding that objects exist and events occur in the world independently of one’s actions, object permanence
- Preoperational stage (2-7) - thinking at a symbolic level, symbolic play, centration, egocentrism (focused on themselves)
- Concrete operational stage (7-11) - beginning of logical or operational thought but can only apply logic to physical objects (hence concrete, can’t yet think hypothetically); conservation, reversibility, seriation, transivity, class inclusion
- Formal operational stage (12+) - gain ability to think in abstract manner, math, creativity; abstraction
A 25-year-old with a history of developmental delays presents for evaluation of anger outbursts. Prior karyotyping has demonstrated a microdeletion of genetic material. This finding is most likely to be seen in which of the following disorders? A. Phenylketonuria B. Down syndrome C. Tuberous sclerosis D. Fragile X syndrome E. Prader-Willi syndrome
E. Prader-Willi
Which of the following is an evidence-based practice with the most available research that reduces relapses and symptoms, and improves medication adherence in schizophrenia? A. Case management B. Occupational therapy C. Group psychotherapy D. Family psychoeducation E. Cognitive behavioral therapy
D. Family psychoeducation
Which of the following assessment strategies is most reliable in differentiating bipolar from unipolar depression in a patient presenting with an index depressive episode? A. Family history B. Longitudinal follow-up C. Young Mania Rating Scale D. Mood Di~order Questionnaire E. Hamilton Depression Rating Scale
B. Longitudinal follow-up
According to the WHO Global Burden of Disease Study, which of the following conditions is in the top ten for disability as measured by loss of productive life years for ages 15 to 44 years in both sexes? A. Anxiety B. Dementia C. Schizophrenia D. Substance use disorder E. Posttraumatic stress disorder
C. Schizophrenia
Antipsychotics to be aware of in smokers:
Clozapine, Zyprexa
Smoking induces CYP1A2 –> increases metabolism
Smoking stops –> less CYP activity –> higher level of med (risk of seizures w/clozapine)
Smoking restarts after d/c –> higher CYP activity –> decreased level of med –> relapse of psychosis
**NRT does not induce CYP
A 29-year-old woman presents to the emergency department (ED) accompanied by her partner reporting worsening mania after stopping the valproic acid prescribed by her outpatient psychiatrist. She wants to get pregnant, but her partner is not sure the patient is psychologically ready. The outpatient psychiatrist and patient have not discussed her desire to get pregnant, nor has she inquired about psychiatric treatment options that could maintain mood stability with minimal risk to a fetus. The ED psychiatrist documents in the electronic medical record the full set of concerns raised by the patient and her partner. What ethical principle is being applied by the psychiatrist documenting the concerns? A. Fidelity B. Veracity C. Compassion D. Confidentiality E. Nonmaleficence
B. Veracity - conformity to facts, accuracy
Histaminergic neurons that regulate sleep originate in which of the following brain nuclei? A. Raphe nucleus B. Locus coeruleus C. Tuberomammillary D. Ventrolateral preoptic E. Laterodorsal tegmental
C. Tuberomammillary
Which of the following is a characteristic of assertive community treatment (ACT) for the treatment of the severely mentally ill?
A. Primarily office-based care
B. 24-hour-a-day mental healthcare coverage
C. Use of day hospital at least three days a week
D. Indirect involvement in admissions and discharges by the ACT team
E. Integration of primary care through a federally qualified health centers
B. 24-hour-a-day mental healthcare coverage
Which of the following interventions, if employed by a hospital system, would most optimally protect against electronic medical record data breaches?
A. Use a virtual local area network
B. Switch from local to cloud-based computing
C. Create a policy for periodic software upgrades
D. Train employees on how to recognize potential threats
E. Hire information technology experts who specialize in cybersecurity
D. Train employees on how to recognize potential threats
Which of the following terms describes the relevance of understanding temperament in working with parent-child relational problems? A. Goodness of fit B. Slow to warmup C. Social referencing D. Intensity of reaction E. Affective attunement
A. Goodness of fit
= the compatibility of a person’s temperament with his surrounding environment
- some temperaments and environments seem to naturally fit together, while others do not
Normal pressure hydrocephalus mnemonic, symptoms
Wet, wobbly, wacky
Urinary incontinence, Gait apraxia, altered cognition
Concern of Prozac in elderly causing confusion
Hyponatremia, SIADH, BUN
In an individual with persistent pain, which of the following neurotransmitter receptors is downregulated in the ventral striatum? A. Cortisol B. Serotonin C. Dopamine D. Substance P E. Norepinephrine
C. Dopamine
Which of the following peptides is released in the gastrointestinal tract to convey satiety information to the brain in response to food intake? A. Leptin B. Insulin C. Orexin D. Ghrelin E. Cholecystokinin
E. Cholecystokinin
Which of the following neurotransmitter systems facilitates sexual arousal? A. GABAergic 8. Glycinergic C. Serotonergic D. Dopaminergic E. Glutamatergic
D. Dopaminergic
In utero exposure to cannabis during neuronal development is associated with which of the following in the infant? A. Cognitive deficits B. Language delays C. Abstinence syndrome D. Slowed physical growth E. Congenital abnormalities
A. Cognitive deficits
In children with cancer, inadequate prophylaxis of pain and stress during difficult procedures, such as bone marrow biopsies, is most likely to result in which of the following conditions? A. Panic disorder B. Nightmare disorder C. Somatization disorder D. Generalized anxiety disorder E. Posttraumatic stress disorder
E. Posttraumatic stress disorder
Which of the following physiologic changes that affect drug pharmacokinetics is commonly seen in older adults? A. Increased protein binding B. Increased total body water C. Decreased hepatic blood flow D. Decreased gastric transit time E. Decreased hepatic glucoronidation
C. Decreased hepatic blood flow
Reduction in hippocampal volume is associated with what type of memory impairment? A. Iconic B. Implicit C. Working D. Procedural E. Declarative
E. Declarative
- remembering facts and events of everyday life
- what we refer to when we say “memory” in everyday language
Aggressive behavior in patients with Alzheimer disease is most often associated with which of the following? A. Word-finding difficulty B. Concurrent psychosis C. Premorbid anxiety disorder D. Late stage of Alzheimer disease E. Earlier onset of Alzheimer disease
B. Concurrent psychosis
During a medication management appointment, a patient with schizotypal personality disorder who is often guarded and paranoid offers a cookie to the psychiatrist. Which of the following is the psychiatrist’s best response to this patient’s boundary crossing?
A. Accept the cookie and thank the patient
B. Ignore the gift and proceed with the visit
C. Accept the gift but pay the patient for the cost of the cookie
D. Refuse the cookie and explore the meaning of the gift with the patient
E. Refuse the cookie and tell the patient that the psychiatrist does not accept gifts from patients
A. Accept the cookie and thank the patient
A patient who takes buprenorphine is admitted following a motor vehicle accident and requires surgery to repair a femur fracture. Which of the following is the most appropriate step in treatment of the patient’s pain?
A. Continue buprenorphine at a lower dose
B. Switch to methadone prior to the surgery
C. Switch to a nonsteroidal anti-inflammatory drug
D. Continue buprenorphine at the maintenance dose
E. Discontinue pain medications and treat withdrawal symptoms symptomatically
B. Switch to methadone prior to the surgery
Which of the following neurotransmitter systems most directly regulates impulsive or affective aggression? A. GABAergic B. Serotonergic C. Oxytocinergic D. Dopaminergic E. Noradrenergic
B. Serotonergic
*low levels of Serotonin are associated with impulsive aggression
During a medical admission for pneumonia, a patient is diagnosed with HIV. He is refusing to inform his partner of his HIV status despite plans to continue to be sexually active. Which of the following is the most appropriate action for the physician to take?
A. Request a psychiatry evaluation
B. Consult state laws which address this issue
c. Warn the partner without the patient’s permission
D. Request that the social worker inform the partner
E. Adhere to confidentiality and do not disclose the status
B. Consult state laws which address this issue
Which of the following is the best treatment recommendation for a pregnant woman who is dependent on heroin? A. Methadone taper B. Methadone maintenance C. Detoxification with clonidine D. Buprenorphine maintenance E. Rapid detoxification with naltrexone
B. Methadone maintenance
Successful global cognitive performance with aging has most consistently been positively associated with the size of which of the following brain structures? A. Cerebellum B. Parietal lobe C. White matter D. Frontal lobes E. Hippocampal formation
E. Hippocampal formation
Progressive spastic paraplegia , longitudinal lesion of spinal cord, enhancement of optic nerve, aquaporin-4 antibodies
NMO (Neuromyelitis optica)
Inflammatory cytokines mediate depression through which of the following neurophysiological changes?
A. Decreased levels of glutamate in the basal ganglia
B. Increased release of dopamine into the basal ganglia
C. Increased expression of serotonin reuptake transporters
D. Increased expression of brain derived neurotrophic factor
E. Decreased conversion of the amino acid tyrosine to serotonin
C. Increased expression of serotonin reuptake transporters
Which of the following is considered a risk factor for suicide attempt in transitional-aged youth with schizophrenia?
A. Manic symptoms
B. Loose associations
C. Higher level of education
D. Adherence with medications
E. Reduced expectations of performance from others
C. Higher level of education
- Which of the following cognitive responses to environmental stimuli has been found to be more characteristic of patients with anxiety disorders when compared to patients with depression?
A. Misattributions regarding stimuli
B. Hopelessness regarding meaning of stimuli
C. Automatic negative thoughts toward the stimuli
D. Attentional bias toward potentially threatening stimuli
E. Lack of awareness of physiological responses to stimuli
D. Attentional bias toward potentially threatening stimuli
Which of the following factors most likely predisposes to dissociative amnesia after a traumatic event? A. Unknown perpetrator B. Single traumatic event C. Longer duration of trauma D. Later age at onset of trauma E. Trauma caused by a natural disaster
C. Longer duration of trauma
When considering assessment instruments, validity is defined as whether:
A. the instrument gives the same results each time it is used.
B. the instrument actually measures what it purports to measure.
C. different raters obtain the same outcomes when using the instrument.
D. different questions addressing the same content yield the same answers.
E. the instrument yields the same results on different dates of administration.
B. the instrument actually measures what it purports to measure.
A psychiatrist who hosts a radio talk show routinely states at the beginning of the show that he is not entering into a physician-patient relationship with the callers who seek his advice. With this statement, the psychiatrist is addressing which of the following broad claims that must be proven to sustain a claim of malpractice? A. Direct cause B. Negligence C. Duty D. Harm E. Competence
C. Duty
Medical anthropological research has shown that dissociative symptoms most commonly represent which of the following worldwide?
A. Symptoms of depersonalization disorder
B. Normal components of religious and ritual events
C. Symptoms of posttraumatic stress disorder
D. Associated symptoms of schizophreniform psychoses
E. Drug-induced symptoms from use of psychoactive substances
B. Normal components of religious and ritual events
Which of the following psychotherapies for alcoholism focuses on patient ambivalence as a key treatment target? A. 12-step facilitation B. Contingency management C. Relapse prevention therapy D. Motivational enhancement therapy E. Cognitive behavioral therapy
D. Motivational enhancement therapy
Motivational Enhancement Therapy (MET) is a counseling approach that helps individuals resolve their ambivalence about engaging in treatment and stopping their drug use
By age four years, most children have developed sufficient language skills to be able to engage in: A. parallel play. B. puns and wordplay. C. organized arguments. D. moral decision-making . E. story telling using words.
E. story telling using words.
Which of the following neurochemical abnormalities has been described in patients with depressive disorders?
A. Reduced circulating levels of GABA
B. Increased cerebrospinal fluid levels of somatostatin
C. Upregulation of pre-synaptic beta-adrenergic receptors
D. Decreased activity of the hypothalamic-pituitary-adrenal axis
E. Exaggerated thyroid-stimulating hormone in response to thyroid-releasing hormone stimulation
A. Reduced circulating levels of GABA
Which of the following is an adverse effect of maintenance treatment with methadone for opioid dependence? A. Tremor B. Hypertension C. Hypogonadism D. Hyperglycemia E. Hypothyroidism
C. Hypogonadism
The Simpson-Angus Rating Scale assesses which of the following types of symptoms? A. Motor B. Anxiety C. Cognitive D. Psychotic E. Depression
A. Motor
an established instrument for neuroleptic-induced parkinsonism (NIP)
gait, arm dropping, rigidity, tremors, salivation, etc
A seven-year-old child continues to have enuresis despite monitoring fluid intake, adequate toileting and using a reward system. The pediatrician next suggests using an enuresis alarm. This treatment, also referred to as the bell-and-pad technique, is a form of: A. operant conditioning. B. behavioral activation. C. classical conditioning. D. systematic desensitization. E. exposure and response prevention.
C. classical conditioning.
A female patient who drinks alcohol lightly (one standard drink per day) is concerned about cancer risk after her father, who was a heavy drinker, developed an aggressive, upper digestive tract tumor. She wants to know if she should stop drinking to decrease her risk of cancer. Which of the following statements is the best evidence-based response?
A. Only male drinkers are at risk.
B. Only heavier drinking elevates risk in women.
C. Long-term abstinence would reduce risk significantly.
D. There is no association between alcohol use and risk.
E. Light use is not associated with elevated risk in either gender.
C. Long-term abstinence would reduce risk significantly.
Which of the following represents the greatest vulnerability to development problems in children?
A. Maternal non-infectious illness
B. Maternal use of antidepressants
C. Maternal mental illness diagnosed before child’s birth
D. Early childhood infectious illness prior to age five years
E. Early childhood non-infectious illness prior to age five years
C. Maternal mental illness diagnosed before child’s birth
Which of the following has been identified as the largest contributor to waste in health care? A. Fraud B. Excessive testing C. Poor delivery of care D. Excessive administration E. Poor coordination of care
D. Excessive administration
Aspects of successful older age include independent living, positive adaptation, mastery, and growth. Which of the following factors is most important in achieving that success? A. Economic security B. Emotional well-being C. Cognitive preservation D. Lack of physical disability E. Active social engagement
C. Cognitive preservation
Which of the following is provided as part of low-intensity telemedicine mental health services?
A. Continuing medical education and staff training
B. Collaborative care with primary care physicians
C. An integrated program of mental health screening with therapy on site
D. In-person, telephone, or e-mail doctor-to-doctor “curbside” consultations
E. Collaborative mental health care for children using synchronous telepsychiatry
D. In-person, telephone, or e-mail doctor-to-doctor “curbside” consultations
A 35-year-old patient who was diagnosed with AIDS three years prior develops new-onset headache associated with cognitive decline. Magnetic resonance imaging of the brain demonstrates multiple ring-enhancing lesions. Which of the following is the most likely cause?
A. Lymphoma
B. Cytomegalovirus
C. Pneumocystis carinii
D. Toxoplasmosis gondii
E. Progressive multifocal leukoencephalopathy
D. Toxoplasmosis gondii
From a neurodevelopmental perspective, the youngest age at which a child possesses sufficient cognitive ability such that the child is likely to meet the Appelbaum criteria for general healthcare decision-making capacity is approximately: A. four years. 8. six years. C. twelve years. D. sixteen years. E. eighteen years.
C. twelve years.
Which of the following is the predominant site of the endocannabinoid receptor CB1? A. Vesicle B. Nucleus C. Cell body D. Mitochondria E. Presynaptic membrane
E. Presynaptic membrane
Which of the following features of schizophrenia has become less common in Western cultures? A. Alogia B. Catatonia C. Stilted speech D. Religious delusions E. Disorganized thought
B. Catatonia
After a stranger says" hello", a 12-month-old child turns and looks at his mother before responding. When the mother smiles and nods her head, the infant laughs and smiles in response to the stranger. This behavior is an example of: A. secure attachment. B. object constancy. C. object permanence. D. theory of mind. E. social referencing.
E. social referencing.
Which of the following is an expected side effect for patients prescribed rivastigmine for Alzheimer disease? A. Nocturia B. Bradycardia C. Weight gain D. Constipation E. Decreased REM sleep
B. Bradycardia
A patient with social phobia avoids almost all social gatherings. The avoidance is regulated by a reciprocal connection between the amygdala and the:
A. hippocampus.
B. locus coeruleus.
c. parabrachial nucleus.
D. periaqueductal gray area of the brainstem.
D. periaqueductal gray area of the brainstem.
Which of the following compulsions is most common in adults with obsessive-compulsive disorder? A. Cleaning B. Ordering C. Counting D. Checking
Cleaning & Checking
When used in the treatment of insomnia, benzodiazepines have which of the following effects on sleep? A. Decrease REM sleep B. Increase sleep latency C. Decrease sleep quality D. Decrease length of sleep
A. Decrease REM sleep
A 26-year-old sexually active woman with bipolar II disorder agrees to a first-time trial of lamotrigine. Before deciding on a target dose, her psychiatrist asks what kind of contraception she uses. What is the reason for asking this question?
A. Lamotrigine decreases the efficacy of hormonal contraception.
B. Lamotrigine is a teratogen so good contraception is necessary.
C. Oral contraceptives containing progestin increase serum levels of lamotrigine.
D. Oral contraceptives containing estrogens decrease serum levels of lamotrigine.
D. Oral contraceptives containing estrogens decrease serum levels of lamotrigine.
A 16-year-old is expelled from school for the third time since the beginning of the academic year, this time for bringing a knife. The previous expulsions were for fighting and stealing from the teacher. The adolescent has also been suspended several times for bullying classmates and skipping school. Over the next decade, these types of behaviors will most likely: A. increase. B. decrease. C. wax and wane. D. remain the same.
B. decrease.
Which of the following alternative treatments for depression carries a risk of inducing mania in patients with bipolar disorder? A. Choline B. Methylfolate C. St. John's wort D. N-acetylcysteine
C. St. John’s wort
In combination with growth hormone, which of the following is required to initiate the adolescent growth spurt? A. Gonadal hormones B. Cortisol C. Adrenocorticotropic hormone D. Thyroid-stimulating hormone
A. Gonadal hormones
The impaired physician who fails to obtain or benefit from treatment may require the services of an administrative psychiatrist skilled in performing fitness-for-duty evaluations. In these situations, the administrative psychiatrist:
A. serves as a patient advocate.
B. has the authority to administer necessary treatment.
C. may assist the physician with professional obligations.
D. is not bound by the usual parameters of confidentiality.
E. may not respond to the physician’s questions concerning diagnosis or treatment.
D. is not bound by the usual parameters of confidentiality.
Which of the following is the most common comorbidity in a patient with an anxiety disorder? A. A mood disorder B. A personality disorder C. Another anxiety disorder D. A substance use disorder E. An impulse control disorder
C. Another anxiety disorder
Which of the following distinguishes empathy from identification?
A. Establishing rapport
B. Retaining objectivity in the relationship
C. Experiencing what the patient is feeling
D. Understanding what the patient is feeling
E. Being able to put oneself in the patient’s place
B. Retaining objectivity in the relationship
Someone with empathy strongly feels what the other person is feeling but maintains a sense of being separate. Contrasted to actually identifying with the other person and not being able to maintain the separate self.
An insurance company pays a physician a single, standardized sum for a patient's care during a one-year period. This is known as what type of payment? A. Per diem B. Capitation C. Global budget D. Fee-for-service E. Episode of illness
B. Capitation
Which of the following antiepileptic medications reduces the efficacy of oral contraceptives? A. Valproate B. Gabapentin C. Zonisamide D. Levetiracetam E. Carbamazepine
E. Carbamazepine
Which of the following findings on electromyography, when seen during REM sleep, would be most diagnostic of a REM sleep behavior disorder?
A. Excess muscle tone
B. Increased fasciculations
C. Reduced recruitment of muscle fibers
D. Shortened firing duration of muscle units
E. Increased spontaneous muscle fiber discharges
A. Excess muscle tone
Which of the following immunomodulators is associated with increased risk of significant depression in patients with cancer? A. Mitoxantrone B. Natalizumab C. Glatiramer D. Interferon E. Fingolimod
D. Interferon
Which of the following antipsychotic medications carries the lowest risk of QT prolongation on electrocardiogram? A. Quetiapine B. Haloperidol C. Ziprasidone D. Aripiprazole E. Thioridazine
D. Aripiprazole
Higher risk = Thioridazine, Haldol, Chlorpromazine, Ziprazidone, Seroquel
Lower risk = Olanzapine, Risperdal, Paliperidone, Aripiprazole, Clozaril, Latuda
A mother's capacity to understand her infant's internal states, which is communicated by mirroring is called: A. holding. 8. internalization. C. rapprochement. D. identity diffusion. E. projective identification.
A. holding.
A 32-year-old patient with schizoaffective disorder has a long history of non-compliance with treatment and multiple hospitalizations. Because of the patient's impulsive and violent behavior, family members are extremely reluctant to take care of the patient. Which of the following is the most appropriate treatment modality at this time? A. Intensive family therapy B. Long-term supportive therapy C. Assertive community treatment D. Motivational enhancement therapy E. Psychopharmacologic consultation
C. Assertive community treatment
Slow-wave sleep enhances the secretion of which of the following hormones? A. Cortisol B. Melatonin C. Growth hormone D. Thyroid stimulating hormone E. Adrenocorticotropic hormone
C. Growth hormone
A patient with pathological gambling is most likely to have which of the following comorbid conditions? A. Major depression B. Delusional disorder C. Posttraumatic stress disorder D. Panic disorder E. Kleptomania
A. Major depression
Which of the following attachment styles in infants is characterized by paying little overt attention to the .parent's presence? A. Secure B. Avoidant C. Resistant D. Ambivalent E. Disorganized
B. Avoidant
Which of the following antipsychotic medications is absorbed primarily through the oral mucosa? A. Clozapine B. Asenapine C. lloperidone D. Aripiprazole E. Ziprasidone
B. Asenapine
FDA-approved use of deep brain stimulation for treatment-resistant obsessive-compulsive disorder (under the humanitarian device exemption mechanism) involves stimulation of what brain regions? A. Caudate nucleus B. Orbital frontal cortex C. Subthalamic nucleus D. Subgenual cingulate gyrus E. Anterior limb of the internal capsule
E. Anterior limb of the internal capsule
What region of the frontal lobes is most closely associated with working memory? A. Orbitofrontal B. Frontal operculum C. Inferior mesial frontal D. Dorsolaterai prefrontal E. Ventromedial prefrontal
D. Dorsolaterai prefrontal
Which of the following augmentation agents has the best evidence for efficacy in patients with obsessive-compulsive disorder who have an inadequate response to a selective serotonin reuptake inhibitor? A. Lithium B. Bupropion C . Quetiapine D. Olanzapine E. Aripiprazole
E. Aripiprazole
The neural tube is formed from which of the following? A. Somites B. Ectoderm C. Notochord D. Endoderm E. Mesoderm
B. Ectoderm
A 24-year-old patient presents to the emergency department reporting ringing in the ears, and nausea and vomiting. Respirations are noted to be deep and rapid. During questioning the patient admits taking an overdose of numerous, unidentified pills. Which of the following did the patient most likely ingest? A. Aspirin B. Trazodone C. Propranolol D. Lorazepam E. Acetaminophen
A. Aspirin
Aspirin overdose = ringing in ears, n/v, drowsiness, confusion, rapid breathing
A patient reports feeling detached from her surroundings, which seem fantasy-like and bizarre. In the mental status exam the psychiatrist records the patient as having: A. illusion . B. dejavu. C. jamais vu. D. derealization. E. depersonalization.
D. derealization.
Depersonalization is specifically a sense of detachment from oneself and one’s identity. Derealization is when things or people around seem unreal.
Restless leg syndrome has been associated with deficiency in which of the following substances? A. Iron B. Copper C. Glucose D. Thiamine E. Cyanocobalamin
A. Iron
The neurogenic hypothesis of depression postulates that antidepressant efficacy depends on neurogenesis in which of the following areas of the brain? A. Thalamus B. Basal ganglia C. Hippocampus D. Fusiform gyrus E. Medial prefrontal cortex
C. Hippocampus
Antagonism of which of the following neuropeptide receptors promotes analgesic effects? A. Oxytocin B. Endorphin C. Dynorphin D. Nociceptin E. Enkephalin
D. Nociceptin
Which of the following conditions is held to a stricter confidentiality standard by federal law?
A. Suicidality
B. Homicidality
C. Substance use disorders
D. Psychotic disorders
E. Treatment with electroconvulsive therapy
C. Substance use disorders
A19-year-old college student who has "always been overweight," complains she is unable to lose weight despite exercising for an hour four times a week over the last year. She describes college as "very stressful, " admitting she sometimes eat a whole pizza or a gallon of ice cream when feeling overwhelmed ; this eating pattern is occurring four or five times a week recently. Afterward, she feels remorseful and vomits. She is concerned that she will always be overweight, and plans to increase her exercise to two hours a day, six times a week. Which of the following laboratory findings is most likely? A. Anemia B. Hypercarotinemia C. Hypercholesterolemia D. Reduced bone density E. Elevated serum amylase
E. Elevated serum amylase
The Clinical Antipsychotic Trials of Intervention Effectiveness - Alzheimer's Disease (CATIE-AD) demonstrated that, relative to placebo, antipsychotic medication use for the treatment of behavioral disturbance in participants had which of the following effects in the majority of subjects by week 12? A. Improved amotivation B. Improved quality of life C. Reduced suspiciousness D. Improved functional status E. Reduced caregiver burden
C. Reduced suspiciousness
The four processes that reflect the flow and focus of a motivational interviewing conversation are: engaging, focusing, planning, and: A. evoking. B. reflecting. C. validating. D. assessing. E. empowering.
A. evoking.
Mammillary body damage produces:
A. Ataxia, clumsy hand
B. Rigidity, bradykinesia, tremor
C. Apathy, hypersexuality, hyperphagia
D. Amnesia, confabulation, lack of insight
E. Progressive aphasia, personality changes
D. Amnesia, confabulation, lack of insight
**Think of Wernicke-Korsakoff
The neuropsychological finding that best distinguishes Alzheimer dementia from depression is that patients with Alzheimer dementia have:
A. worse attentional performance.
B. better visuospatial performance.
C. worse performance on measures of effort.
D. memory deficits that do not improve with hints or cues.
E. disproportionately worse executive function deficits relative to memory loss.
D. memory deficits that do not improve with hints or cues.
A 75-year-old nursing home resident with a several-year history of declining memory and deteriorating self-care, and a previous history of heavy alcohol use becomes increasingly agitated, combative and disoriented following admission to the hospital. Collateral information is unavailable. The patient is afebrile with normal vital signs and a physical examination normal for age. Which of the following tests would be most helpful in delineating between worsening dementia and delirium as the precipitant of the current presentation?
A. Chest plain film
B. Abdominal ultrasound
C. Electrocardiogram
D. Electroencephalogram
E. Magnetic resonance imaging scan of the brain
D. Electroencephalogram
Which of the following is most associated with an increase in the risk of developing Alzheimer disease in a person with mild cognitive impairment? A. Anxiety B. Tobacco smoking C. Previous head trauma D. College level education E. Elevated blood pressure
E. Elevated blood pressure
A patient is brought to the emergency department for altered mental status. She is currently prescribed sertraline, aripiprazole, and buspirone by a psychiatrist. She was discharged two days prior after a cholecystectomy, and has reportedly been taking a "pain killer" and ondansetron every eight hours since discharge. On mental status exam, the patient appears diaphoretic, is oriented only to person, and exhibits psychomotor agitation. Physical exam reveals hyperactive reflexes and inducible clonus at the ankles. She is febrile and hypertensive. Prescription of which of the following pain medications would most likely account for the patient's presentation? A. Ibuprofen B. Meperidine C. Oxycodone D. Codeine with acetaminophen E. Hydrocodone with acetaminophen
B. Meperidine (Demerol)
An adolescent with a recent suicide attempt is about to be discharged from the hospital. The psychiatrist requests that the adolescent's parent remove firearms from the house as a safety precaution. The parent insists, "I need firearms to protect my family and I will make sure that they are secured." The psychiatrist files a report with child protective services. Which of the following is the ethical concept that conflicts with this decision? A. Autonomy B. Beneficence C. Equipoise D. Justice E. Nonmaleficence
A. Autonomy
A two-year-old child accompanies her mother to a psychotherapy visit. The psychiatrist observes obvious bruises on the child. The mother expresses guilt and promises not to repeat the conduct. The psychiatrist provides education about the hazards of physical punishment and decides not to report the behavior to child protective services. The mother later injures the child more seriously. Which of the following best describes the psychiatrist’s legal position?
A. The physician had no duty to the child in this scenario.
B. A “good faith decision standard” immunizes the physician from liability.
C. Legal sanctions could ensue because the earlier abuse was not reported.
D. The mother’s privilege to confidentiality in psychotherapy overrides reporting mandates.
E. A “reasonable professional standard” overrides the mandate to report the earlier abuse.
C. Legal sanctions could ensue because the earlier abuse was not reported.
The sleep of a healthy 70-year-old is most likely to show a decrease or absence of which of the following? A. REM sleep B. Slow waves C. K complexes D. Alpha waves E. Sleep spindles
B. Slow waves
A ten-year-old child is jealous of long-standing parental attention to a gifted older sibling’s academic success. At summer camp, the younger child becomes strongly attached to an older camper who is highly accomplished in martial arts and teaches the child some introductory skills. Upon returning home, the child becomes a dedicated martial arts student. The child’s parents note that the child
seems less jealous of the older sibling. Which of the following psychodynamic defense mechanisms would best account for the child’s behavior?
A. Suppression
B. Repression
C. Sublimation
D. Displacement
E. Isolation of affect
C. Sublimation
A patient with recurrent upper gastrointestinal bleeding develops a moderately severe major depressive episode for which antidepressant treatment is indicated. Which of the following antidepressants is least likely to increase the risk of bleeding? A. Citalopram B. Mirtazapine C. Venlafaxine D. Nortriptyline E. Escitalopram
B. Mirtazapine
Which of the following is the best predictor of later functional and adaptive outcomes in autism spectrum disorder?
A. Age of onset
B. Verbal ability at age five years
C. Hyporeactivity to sensory input
D. Presence of highly restricted, fixated interests
E. Frequency of stereotyped or repetitive motor movements
B. Verbal ability at age five years
A 67-year-old patient has a stroke on the left side of the brain resulting in right-sided hemiparesis. Which of the following gait abnormalities is most commonly associated with this type of lesion? A. Ataxic B. Shuffling C. Scissoring D. Paraparetic E. Circumduction
E. Circumduction
Disorganization of behavioral and physiological circadian rhythms is caused by ablation of which of the following areas of the brain in primates? A. Red nucleus B. Caudate nucleus C. Lentiform nucleus D. Nucleus accumbens E. Suprachiasmatic nucleus
E. Suprachiasmatic nucleus
By what age does core gender identity typically form? A. Birth B. Eighteen months C. Three years D. Five years E. Ten years
C. Three years
Which of the following areas of the hypothalamus have been reported to play a central role in maternal behavior of mothers towards infants? A. Arcuate B. Preoptic C. Paraventricular D. Tuberomamillary E. Suprachiasmatic
B. Preoptic
In biofeedback, the relaxation state coincides with a measured decrease in: A. PaC02 level. B. skin conductance. C. finger temperature. D. parasympathetic tone. E. respiratory heart rate variability.
B. skin conductance.
Damage to which of the following structures may account for flapping movements of the limbs seen in carbon monoxide poisoning? A. Caudate B. Amygdala C. Cerebellum D. Globus pallidus E. Substantia nigra
D. Globus pallidus
A metabolite of which of the following hormones is a potent allosteric modulator of the GABA-A receptor and has been implicated in depression? A. Cortisol 8. Oxytocin C. Estrogen D. Progesterone
D. Progesterone
An eight-year-old boy is reported by his teachers to be sexually seductive to other children, to openly display sexual behavior, and to sexualize play activities. This is most likely a manifestation of: A. precocious puberty. B. previous sexual abuse. C. normal sexual behavior. D. borderline intellectual disability.
B. previous sexual abuse.
Which of the following factors is the primary contributor to the increased rates of incarceration in the United States since 1990?
A. Higher crime rates
B. More arrests per crime
C. Fewer juveniles arrested and convicted
D. Higher use of mandatory minimum sentences for drug related offenses
E. Deinstitutionalization of chronically mentally ill
D. Higher use of mandatory minimum sentences for drug related offenses
By the age of about 15 months, typically developing children begin to achieve which of the following milestones?
A. Infer others’ emotions and intent
B. Engage in reciprocal conversation
C. Display social smile and gesture in peer interactions
D. Understand that others have minds different from their own
D. Understand that others have minds different from their own
Engage in reciprocal conversation - 6 months (babbling)
Display social smile and gesture - 2 months
Needle exchange is an example of which of the following types of reduction strategies? A. Harm B. Supply C. Access D. Demand
A. Harm
Harm reduction strategies recognize the inherent worth of all individuals and are based on ethical principles of pragmatism, utilitarianism, and liberal individualism. Instead of trying to eliminate risky health behaviors like drug use, a likely unattainable outcome, harm reduction identifies the negative consequences of risky health behavior and attempts to reduce those consequences. These programs also promote individual autonomy by empowering users with the information and resources needed to make decisions about their health.
Primary taste cortex in humans: A. Dorsolateral B. Orbitofrontal C. Anterior insular D. Somatosensory E. Posterior temporal
C. Anterior insular
According to Heinz Kohut, which of the following traits is normal in children and a significant aspect of healthy personality development? A. Altruism B. Likeability C. Narcissism D. Persistence E. Assertiveness
C. Narcissism
Family of an 8 yo child drives to a hospital for the child to receive chemo for leukemia. Child begins to develop n/v every time they visit the hospital for repeat chemo.
A. Operant conditioning
B. Classical conditioning
B. Classical conditioning
Classical = type of learning in which a response (n/v) naturally elicited by one stimulus (chemo) becomes to be elicited by a different formally neutral stimulus (the hospital)
Ex. Bell and dog food
Operant = type of learning in which behaviors (press the lever) are emitted to earn rewards (treat) or avoid punishments.
Ex. Mouse pressing lever to get treat
Abnormal elevated metabolic finding associated w/increased risk of stroke in patients under 50
Homocysteinemia (similar to risk associated w/tobacco use and hyperlipidemia)
A patient in his 30s is undergoing cognitive testing. Asked to produce as many words in one minute starting with P, names 9 words. He is able to do 12 words when prompted to name as many animals as possible. What does this suggest?
Frontal lobe injury (vascular dementia)
- If a patient is less able to generate letter words than generate names within a specified group –> more likely to have vascular dementia
A surge in what hormone initiates puberty in adolescents? A. Prolactin B. Testosterone C. Somatostatin D. FSH E. GnRH
E. GnRH
At about age 6 months in boys and 3–4 years in girls, there is an active inhibition of GnRH secretion, which persists throughout childhood. Puberty is initiated with a sustained increase in pulsatile release of GnRH from the hypothalamus after this quiescent period.
Ambiguous results on sleep study…what would confirm narcolepsy?
CSF Orexin (low)
**not an EEG
Changes that occurs in brains > 65 years of age most likely responsible for higher risk of chronic subdural hematoma?
A. Cortical atrophy
B. Lacunae in basal ganglia
C. Thickening & ossification of dura mater
D. Occlusion of small penetrating cerebral arteries
E. Increased permeability of blood-brain barrier
A. Cortical atrophy
QI tool used to identify many possible causes for an effect or problem and sort into useful categories?
Fishbone diagram
= a visualization tool for categorizing the potential causes of a problem.
Which circuit mediates the ability to resist responding to aggravating situations with hostility? A. Papez B. Dorsolateral C. Orbitofrontal D. Frontoparietal E. Anterior cingulate
C. Orbitofrontal
Stages of change for tobacco cessation:
- Current smokers NOT planning to quit
- Current smokers considering quitting within next 6 months or made a recent attempt
- Current smokers who have made attempts and planning to quit in next 30 days
- Not currently smoking, recently quit
- Not currently smoking, former smoker (> 6 months ago)
- PRECONTEMPLATION = Current smokers NOT planning to quit
- CONTEMPLATION = Current smokers considering quitting within next 6 months or made a recent attempt
- PREPARATION = Current smokers who have made attempts and planning to quit in next 30 days
- ACTION = Not currently smoking, recently quit
- MAINTENANCE = Not currently smoking, former smoker (> 6 months ago)
25 yo with visual hallucinations (similar to the wavy distortions produced by heat rising from asphalt and affecting the whole of both visual fields), accompanied by vertigo, dysarthria, tingling in hands & feet and sometime around both sides of mouth followed by occipital headache
Basilar migraine (Bickerstaff)
- brainstem aura
- Vertigo, dysarthria, tinnitus, diplopia, visual symptoms followed by severe throbbing occipital headache with n/v
Acute onset pain and decreased vision in right eye, colors look faded. Right afferent pupillary defect and swollen optic disc. Spontaneous recovery over 6 weeks. What disorder are they likely to develop? A. Multiple sclerosis B. Myasthenia gravis C. Pseudotumor cerebri D. Neurosyphilis E. Migraine
A. Multiple sclerosis
Optic neuritis = unilateral decreased visual acuity, dimness, decreased color perception (desaturation), afferent pupillary defect, eye pain
Patient becomes increasingly annoyed at therapist and blurts out "you must really hate me!" Which defense mechanism? A. Projection B. Resistance C. Displacement D. Reaction formation E. Projective identification
A. Projection
Projecting your own negative thoughts/feelings/motives onto another person
2 yo boy who isn’t talking, not social with other children and avoids eye contact. Frequently irritable and hyperactive at home, hand-flapping and biting. Maternal uncle w/ID and learning problems in mother. 20th percentile for height, 30th percentile for weight, 90th percentile for head size.
Fragile X
- Macrocephaly
- Macro-orchidism
- Large ears
Dopaminergic pathways involved in:
- positive symptoms
- negative symptoms
- coordinated movement
- prolactin
- positive symptoms = Mesolimbic
- negative symptoms = Mesocortical
- coordinated movement = Nigrostriatal (extra-pyramidal parkinsonism)
- prolactin = Tuberoinfundibular (decreases dopamine control of prolactin secretion –> galactorrhea, amenorrhea)
Which neuromod modality has received regulatory approval in the US as an adjunctive tx for recurrent MDD in adults?
A. Vagus nerve stimulation
B. Magnetic seizure therapy
C. Trigeminal nerve stimulation
D. Implanted cortical stimulation
E. Transcranial direct current stimulation
A. Vagus nerve stimulation (currently approved to treat epilepsy & depression)
Transcranial direct current stimulation is NOT the same as TMS! It is not yet FDA approved
What distinguishes a general psych eval from a forensic psych eval? A. Use of diagnostic criteria B. Use of collateral informants C. Maintenance of confidentiality D. Consultation w/other providers E. Review of previous medical records
C. Maintenance of confidentiality
Older woman w/acute headache & inability to read. She can't write fluently but verbal fluency intact. A. Left vertebral B. Left MCA C. Right MCA D. Left PCA E. Right ACA
D. Left PCA
Disequilibrium while standing w/feet together & eyes closed indicates disorder of: A. Vestibular nuclei B. Superior colliculi C. Cerebellar vermis D. Posterior spinal columns E. Lateral spinothalamic pathway
D. Posterior spinal columns (Romberg - propioception)
Most studies report that resident duty hour reforms have had which consequence:
A. Decrease in hospital costs
B. Increased patient mortality
C. Decreased resident wellbeing
D. Negative effect on resident education
E. Improved resident cognitive performance
E. Improved resident cognitive performance
Most common psychiatric comorbidity in patients with OCD?
MDD
Dopaminergic neurons project to nucleus accumbens in reward pathway implicated in addiction. Cell bodies reside in which area of the brain? A. Amygdala B. Raphe nuclei C. Locus ceruleus D. Ventral tegmental area E. Medial dorsal thalamus
D. Ventral tegmental area
- drug & natural reward circuitry of brain
- Mesocorticolimbic system
IV Ketamine antagonizes which neurotransmitter system?
NMDA
First domain to test in neuropsych testing for suspected early onset dementia: A. Praxis B. Memory C. Language D. Visuospatial E. Executive functioning
C. Language
Diencephalon is the precursor to what brain structure?
Thalamus
Higher rate of ADHD & OCD in 6-12 yo boys most closely related to:
A. Larger total brain volume of boys
B. Loss of grey matter in basal ganglia
C. Increase in volume of amygdala and hippocampus
D. Rostrocaudal pattern of growth of corpus collosum
E. Increase in white matter in dorsolateral prefrontal cortex
B. Loss of grey matter in basal ganglia
Secondary mania is most common from what:
Multiple sclerosis
Patient on Clozapine presents with dyspnea, orthostatic hypotension & HR 130. CBC reveals elevated eosinophils. EKG non-specific T wave changes. What test would guide acute management? A. Clozapine level B. Troponin level C. Aldolase level D. EEG E. CT brain
B. Troponin level
Clozapine-associated myocarditis
- present w/fever, dyspnea, flu-like symptoms, tachycardia, chest pain
- clinical findings: EKG abnormalities, elevated CK, troponin and eosinophilia
**Clozapine toxicity presents with hyperthermia, AMS, seizures, arrhythmias, hypersalivation (drooling)
Which has been shown to reduce symptoms and improve biomarkers of inflammation and oxidative stress in people with schizophrenia? A. Kava B. Glycine C. Valerian D. St. Johns wort E. N-acetylcysteine
E. N-acetylcysteine
Loss of nicotinic receptor sites and potentiation of remaining receptor sites are processes involved in: A. Bipolar disorder B. Alzheimer disease C. Non-epileptic seizures D. MDD E. OCD
B. Alzheimer disease
Risk of prescribing Gabapentin in patient taking an Opioid?
CNS depression
Intubation delirium neurotransmitter implicated? A. Serotonin B. Glutamate C. ACh D. Norepi E. GABA
C. ACh
Acetylcholine (Ach) is a neurotransmitter implicated in attention, memory, disorganized thinking, and perceptual disturbances.
The deficiency of this neurotransmitter leads to symptoms of delirium
72 yo with no past psych hx aggressive toward home health care nurse but not toward daughter or other family members. Medical workup unremarkable, MoCA score 26. A. Delirium B. Elder abuse C. AUD D. Major neurocog disorder
B. Elder abuse
*Not delirium bc it’s not consistent w/other family members, initial medical workup unremarkable
As a person nears midlife, which is the most developmentally typical scenario?
A. Focus solely on one’s career
B. Depression in parents whose last child is leaving home
C. Reappraisal of one’s marriage and committed relationships
D. Abrupt, significant changes that appear to be impulsive in nature
E. Increased difficulty adjusting to a change from a youthful appearance
C. Reappraisal of one’s marriage and committed relationships
Bc it acts as both an inducer and substrate of CYP3A4, which of the following meds might require a dose increase after several weeks to maintain steady-state blood levels? A. Lithium B. Phenytoin C. Phenobarb D. Carbamazepine E. Valproic acid
D. Carbamazepine
In patients w/Down Syndrome, there are three copies of the gene coding for which of the following proteins? A. Presenilin 1 protein B. Presenilin 2 protein C. Apo-e2 D. Apo-e4 E. Amyloid precursor protein
E. Amyloid precursor protein (hence why they develop alzheimers earlier)
Medication to avoid to prevent further bone loss: A. Valproic acid B. Topiramate C. Lamotrigine D. Zonisamide E. Levetiracetam
A. Valproic acid (decreases bone mineral density)
Best medication for MDD & Bulimia
Prozac
Most abundant circulating steroid in women: A. Cortisol B. Estrogen C. Progesterone D. Dehydroepiandrosterone (DHEA) E. Adrenocorticotrophic hormone (ACTH)
D. Dehydroepiandrosterone (DHEA)
Which of the following concomitant medications would warrant a lower starting and target dose of Lamictal? A. Carbamazepine B. Valproate C. Topiramate D. Risperdal E. Zyprexa
B. Valproate
Valproic acid / Depakote
- Depakote blocks lamictal’s metabolism via phase 2 glucoridnation –> reduces plasma clearance –> prolongs Lamictal’s half-life
- *NEVER ADD DEPAKOTE TO LAMICTAL!!!**
- *Can add Lamictal to Depakote in very low doses**
Highest rate of suicide in the US: A. Native Americans B. Asian Americans C. African Americans D. Caucasian Americans E. Hispanic and Latino Americans
A. Native Americans
Neuron type that ceases fire during REM sleep: A. Histamine B. Muscarinic C. Cholinergic D. Serotonergic E. Noradrenergic
A. Histamine
Courts have ruled that physicians can ask and counsel patients about guns, based on which of the following physicians’ rights?
A. Freedom of speech
B. Protection from malpractice
C. To set standards for clinical care
D. To protect oneself from patient violence
E. To practice within the scope of their license
A. Freedom of speech
A patient getting an EEG takes Valium beforehand, which EEG pattern will be increased? A. Beta rhythms B. Alpha rhythms C. Occipital spikes D. Diffuse slow waves E. Frontal delta activity
A. Beta rhythms
A patient with with depression talks to therapist about feeling incompetent and when asked about the meaning of these thoughts, states, "I am worthless." In CBT, this statement is an example of: A. mode B. schema C. core belief D. automatic thought E. intermediate belief
C. core belief
core belief = strongly held and highly stable beliefs that exert a powerful influence over thoughts and feelings. They influence the way in which incoming information is perceived, attended to and interpreted and are difficult to change. (I am unlovable, I am incompetent). Beliefs about ourselves, other people, the world we live in, beginning in early childhood. Basic assumptions about your value in the world, determine to what degree you see yourself as worthy, safe, competent, powerful, independent, loved. May not be consciously aware of them but they shape our perception of situations.
automatic thought = brief stream of thought that we may be unaware of but we are aware of the emotions they cause
intermediate belief = attitudes/rules a person follows in life that apply across situations. Attitudes, assumptions and rules. “It would be terrible if…” “if…then…” “should…”
schemas = patterns of core beliefs, beliefs about yourself, the future, other people and the world, along w/associated intermediate beliefs, which produce emotions, body sensations and behaviors. Examples - emotional deprivation, abandonment, instability, mistrust/abuse, defectiveness/shame, social isolation/alienation, dependence/incompetence
Microarray analysis can detect which of the following genetic errors? A. Exact deletion breakpoints B. Unbalanced translocations C. Minor duplication locations D. Single nucleotide point mutations
B. Unbalanced translocations
First rank symptoms of schizophrenia
- delusions
- auditory hallucinations
- thought insertion/broadcasting/withdrawal
- passivity experiences (outside agency forms the actions/sensations/emotions/etc, taking over the will of the patient)
Kurt Schneider
described first-rank symptoms of schizophrenia
At what age is a woman most likely at risk for completed suicide? A. 15 B. 35 C. 55 D. 75 E. 95
C. 55
During psychotherapy, a patient describes a situation when her roommate abruptly left the room to take a phone call. She remembers thinking "I'm being left out again." Example of: A. Core belief B. Immediate belief C. Idea of reference D. Self-serving bias E. Automatic thought
E. Automatic thought
core belief = strongly held and highly stable beliefs that exert a powerful influence over thoughts and feelings. They influence the way in which incoming information is perceived, attended to and interpreted and are difficult to change. (I am unlovable, I am incompetent). Beliefs about ourselves, other people, the world we live in, beginning in early childhood. Basic assumptions about your value in the world, determine to what degree you see yourself as worthy, safe, competent, powerful, independent, loved. May not be consciously aware of them but they shape our perception of situations.
automatic thought = brief stream of thought that we may be unaware of but we are aware of the emotions they cause
intermediate belief = attitudes/rules a person follows in life that apply across situations. Attitudes, assumptions and rules. “It would be terrible if…” “if…then…” “should…”
schemas = patterns of core beliefs, beliefs about yourself, the future, other people and the world, along w/associated intermediate beliefs, which produce emotions, body sensations and behaviors. Examples - emotional deprivation, abandonment, instability, mistrust/abuse, defectiveness/shame, social isolation/alienation, dependence/incompetence
MS patient with inappropriate uncontrollable laughter - diagnosis + treatment?
Pseudobulbar affect
- MS lesion in area of brain that controls emotion (limbic)
- also caused by Parkinsons & Alzheimers
- -> SSRIs, TCAs (Amitryptiline)
- -> Dextromethorphan hydrobromide & quinidine sulfate
Under HIPAA, patients may be excluded from accessing which of the following:
A. Biopsychosocial formulation
B. Complete, unedited copy of patient’s medical record
C. Psychotherapy notes kept out of general medical record
D. Disclosures of the patient’s health info made by a physician
E. Amount paid to a physician by a third-party payer for provided services
C. Psychotherapy notes kept out of general medical record
Which of the following is more common among widowers than widows?
A. Greater mortality
B. Lower life satisfaction
C. Greater personal growth
D. Lower depression scores
E. Greater flexibility in coping strategies
A. Greater mortality
“Testamentary capacity” refers to ability of a person to do what:
A. Make a will
B. Make a monetary gift
C. Refuse a medical procedure
D. Designate a POA
E. Serve as a witness in a criminal trial
A. Make a will
Medication FDA-approved for anti-somnolence in patients w/OSA?
Modafinil
Which side effect of Carbamazepine is more common in Asians? A. Agranulocytosis B. Liver dysfunction C. SJS D. Neurological effects E. SIADH
C. SJS
risk factor for developing NMS while taking antipsychotic? A. Female gender B. Low serum iron C. Adjunctive valproate D. Concurrent treatment w/SSRI E. Elevated AST
B. Low serum iron
more common in men!
Which of the following improves in patients prescribed cholinesterase inhibitors for Lewy body dementia? A. Insomnia B. Incontinence C. Motor functioning D. Behavioral disturbance E. GI symptoms
D. Behavioral disturbance
Onset of action for lithium's antimanic effect occurs in what period of time: A. 0-2 days B. 3-6 days C. 1-3 weeks D. 4-6 weeks E. 8-12 weeks
C. 1-3 weeks
Which of the following interventions has the most evidence supporting its use in patients during recovery or chronic phase of schizophrenia? A. Cognitive remediation B. Metacognitive training C. Mindfulness meditation D. Psychodynamic therapy E. Acceptance and commitment therapy
A. Cognitive remediation
Medication that can lead to prolonged seizures when combined w/ECT?
Lithium (also causes delirium)
Risk factor for suicide among outpatients w/schizophrenia: A. Female gender B. Low personal expectations C. Unawareness of symptoms D. Multiple psychiatric admissions E. Younger age at symptom onset
D. Multiple psychiatric admissions
Hippocampus & parahippocampal gyrus main function
Declarative memory (facts)
Which interview technique is most likely to help establish rapport with paranoid patients?
A. Maintain direct eye contact
B. Ask brief, close-ended questions
C. Remain as relaxed and friendly as possible
D. Avoid detailed explanation of delusional material
E. Preface symptom questions with normalizing statements
E. Preface symptom questions with normalizing statements
In pre-adolescence, which is as common in females as males? A. Schizophrenia B. Autism C. MDD D. ODD E. ADHD
C. MDD
CATIE study demonstrated what:
A. All antipsychotics led to significant weight gain
B. Cataracts were a significant risk of second generation antipsychotics
C. SGAs were no more effective than FGAs
D. Combinations of FGAs & SGAs were very effective
E. Most patients discontinued FGAs but not SGAs
C. SGAs were no more effective than FGAs
Paternalism can be justified by which of the following: A. Justice B. Autonomy C. Beneficence D. Responsibility E. Nonmaleficence
C. Beneficence
The term paternalism has its roots in the notion of paternal administration—government as by a father to administer in the way a beneficent father raises his children. The analogy with the father presupposes two features of the paternal role: that the father acts beneficently (that is, in accordance with the interests of his children) and that he makes all or at least some of the decisions relating to his children’s welfare, rather than leaving them free to make those decisions. On this model, “paternalism” may be defined as the intentional overriding of one person’s known preferences or choices by another person, where the person who overrides justifies the action by the goal of substantially benefiting or avoiding harm to the person whose preferences or choices are overridden. (Both “benefiting” and “avoiding harm” can generally, though not always, be understood as forms of beneficence.) An act of paternalism, then, overrides moral obligations to respect autonomous choice on grounds of beneficence.
Which of the following abnormalities of speech is a patient with autism most likely to demonstrate? A. Dyslexia B. Aphasia C. Impaired prosidy D. Pressured speech E. Problematic enunciation
C. Impaired prosidy
Cluster headache preventive treatment: A. Ibuprofen B. Verapamil C. Prednisone D. Gabapentin E. Amitryptiline
B. Verapamil
Primary pacemaker for generating circadian rhythms of sleep & wakefulness: A. Pineal gland B. Dentate nucleus C. Arcuate nucleus D. Ventromedial nucleus E. Suprachiasmatic nucleus
E. Suprachiasmatic nucleus
the fear of the genitals shrinking and retracting into the body
A. Koro B. Latah C. Hwa-byung D. Shenjing Shuairuo E. Ataque de Nervios
A. Koro (Africa, Asia, Europe)
Southeast Asia condition in which abnormal behaviors result from a person experiencing a sudden shock
A. Koro B. Latah C. Hwa-byung D. Shenjing Shuairuo E. Ataque de Nervios
B. Latah
When surprised, the affected person typically engages in such behaviors as screaming, cursing, dance movements, and uncontrollable laughter, and will typically mimic the words or actions of those around them.[1] Physical symptoms include an increased heart rate and profuse sweating, but no clear physiological source has been identified.
Korean culture-bound illness that includes symptoms of insomnia, depression, and somatization in the lower abdomen. This illness is unique in that it is found mostly, but certainly not only, in middle-aged Korean females.
A. Koro B. Latah C. Hwa-byung D. Shenjing Shuairuo E. Ataque de Nervios
C. Hwa-byung
- culture-related anger syndrome in Korea
characterized by physical and mental fatigue, dizziness, headaches, other pains, concentration difficulties, sleep disturbance, and memory loss
A. Koro B. Latah C. Hwa-byung D. Shenjing Shuairuo E. Ataque de Nervios
D. Shenjing Shuairuo (neurasthenia)
Syndrome among individuals of Latino descent characterized by symptoms of intense emotional upset, including acute anxiety, anger, or grief; screaming and shouting uncontrollably; attacks of crying; trembling; heat in the chest rising into the head; and becoming verbally and physically aggressive; a sense of being out of control.
A. Koro B. Latah C. Hwa-byung D. Shenjing Shuairuo E. Ataque de Nervios
E. Ataque de Nervios
Patient being transitioned from Zyprexa to Ziprasidone due to side effects. To avoid lowering the oral absorption of Ziprasidone by 50%, patient counseled on taking the medication: A. while fasting B. with low-fat content meal C. with 8 ounces of water D. with high carbohydrate content meal E. with caloric intake of > 500 calories
E. with caloric intake of > 500 calories
Magnetic gait
- feet seem attached to floor as if a magnet
- each step initiated in a “wresting” motion carrying feet upward and forward
Normal pressure hydrocephalus
CT of which area is typically limited due to imaging artifacts? A. Orbits B. Inner ear C. Frontal sinuses D. Posterior fossa E. Lumbar spinal cord
D. Posterior fossa
Side effect of vagal nerve stimulator: A. Dyspnea B. Hand tremor C. Arm weakness D. Dysconjugate gaze E. Loss of consciousness
A. Dyspnea
A student attributes his poor grade on surgery rotation to the attending not liking him and the surgical techs always being in his way. Defense mechanism? A. denial B. sublimation C. rationalization D. isolation of affect E. reaction formation
C. rationalization - trying to rationalize/justify his poor performance by others’ actions
Hyperactivity in brain circuit for OCD:
- Orbitofrontal cortex
- Basal ganglia
- Thalamus
FDA approved which antipsychotic for augmentation of antidepressants in MDD? A. Clozaril B. Seroquel C. Latuda D. Geodon E. Risperdal
B. Seroquel
A therapeutic factor in group therapy in which individuals develop awareness that they are not alone in their struggles and that others share similar problems: A. Cohesion B. Contagion C. Inspiration D. Acceptance E. Universalization
E. Universalization
Which is associated w/persistence of symptoms in adults with somatic symptom disorder? A. Male gender B. Younger age C. Current employment D. Lower educational level E. Higher SES
D. Lower educational level
Referring a patient with schizophrenia to vocational rehab is an example of: A. Health promotion B. Tertiary prevention C. Primary prevention D. Secondary prevention E. Population-based intervention
B. Tertiary prevention
Tertiary prevention focuses on people who are already affected by a disease. The goal is to improve quality of life by reducing disability, limiting or delaying complications, and restoring function. This is done by treating the disease and providing rehabilitation.
“Expressed emotion” in family therapy =
A. A successful outcome of therapy
B. Behavioral substitutes for expressed anger
C. Level of criticism and hostility in family
D. Body language family members direct at one another
E. Percentage of crying or laughter in a family encounter
C. Level of criticism and hostility in family
According to Winnicott, a caregiver who is sufficiently attuned and responsive to a child's needs to allow the child to become aware of the child's own drives is referred to as: A. true self B. self object C. auxiliary ego D. transitional object E. good-enough parent
E. good-enough parent
A gene can be differently expressed after reversible gene inactivation depending on whether it was inherited from the mother or father. What is this called? A. Anticipation B. Genetic imprinting C. Incomplete penetrance D. Triple repeat expansion E. X-linked recessive inheritance
B. Genetic imprinting
Genetic/Genomic imprinting = ability of a gene to be expressed depends upon the sex of the parent who passed on the gene
Anticipation = phenomenon in which the signs and symptoms of some genetic conditions tend to become more severe and/or appear at an earlier age as the disorder is passed from one generation to the next.
Incomplete penetrance = some individuals who carry the pathogenic variant express the associated trait while others do not.
The STAR-D trial is a pragmatic trial designed to be more generalizable to clinical practice than standard RCTs. What aspect enhanced its generalizability?
A. Designed to test efficacy rather than effectiveness
B. Primary outcome was response rather than remission
C. Incorporated patient choice into randomization strategy
D. Patients recruited through advertising for treatment-resistant depression
C. Incorporated patient choice into randomization strategy
A former street thug becomes a social worker to help reform kids in gangs - defense mechanism? A. Projection B. Denial C. Splitting D. Blocking E. Regression F. Somatization G. Introjection H. Displacement I. Repression J. Isolation of affect K. Intellectualization L. Acting out M. Rationalization N. Reaction formation O. Undoing P. Humor Q. Sublimation R. Suppression
Sublimation - channeling destructive impulses into something constructive
A man buys an expensive new watch and tells his friends he needed it because his old one was not reliable enough and he needs to make sure to get to his appointments on time - defense mechanism?
A. Projection B. Denial C. Splitting D. Blocking E. Regression F. Somatization G. Introjection H. Displacement I. Repression J. Isolation of affect K. Intellectualization L. Acting out M. Rationalization N. Reaction formation O. Undoing P. Humor Q. Sublimation R. Suppression
M. Rationalization
Man who has had a brief fantasy of killing his wife by sabotaging her car takes the car in for a complete checkup - defense mechanism?
A. Projection B. Denial C. Splitting D. Blocking E. Regression F. Somatization G. Introjection H. Displacement I. Repression J. Isolation of affect K. Intellectualization L. Acting out M. Rationalization N. Reaction formation O. Undoing P. Humor Q. Sublimation R. Suppression
O. Undoing
Patient hates her father but takes care of him and treats him overly nice - defense mechanism?
A. Projection B. Denial C. Splitting D. Blocking E. Regression F. Somatization G. Introjection H. Displacement I. Repression J. Isolation of affect K. Intellectualization L. Acting out M. Rationalization N. Reaction formation O. Undoing P. Humor Q. Sublimation R. Suppression
Reaction formation - immature defense mechanism bc it doesn’t solve the problem and provide satisfaction, it is the opposite of her feelings.
VERSUS
Sublimation would be the mature mechanism of channeling her negative thoughts about her dad into a karate class or something along those lines, which would provide her satisfaction and escape from those feelings
Displacement vs. Reaction formation vs. Projection
Displacement = displacing bad feelings onto a neutral person (mad at wife, yell at daughter)
Reaction formation = forming a reaction to your feelings rather than acting on impulse (lustful thoughts enter monastery)
Projection = projecting your feelings onto another person (husband who is cheating accuses wife of cheating)
I don’t like a boy named Mike, so I say “I know that dude hates me, I know it.”
A. Projection B. Denial C. Splitting D. Blocking E. Regression F. Somatization G. Introjection H. Displacement I. Repression J. Isolation of affect K. Intellectualization L. Acting out M. Rationalization N. Reaction formation O. Undoing P. Humor Q. Sublimation R. Suppression
A. Projection (projecting your feelings onto another person)
“I don’t remember his name! It’s on the tip of my tongue!”
A. Projection B. Denial C. Splitting D. Blocking E. Regression F. Somatization G. Introjection H. Displacement I. Repression J. Isolation of affect K. Intellectualization L. Acting out M. Rationalization N. Reaction formation O. Undoing P. Humor Q. Sublimation R. Suppression
D. Blocking - temporary inability to remember
The resident acts and dresses like the attending he admires the most
A. Projection B. Denial C. Splitting D. Blocking E. Regression F. Somatization G. Introjection H. Displacement I. Repression J. Isolation of affect K. Intellectualization L. Acting out M. Rationalization N. Reaction formation O. Undoing P. Humor Q. Sublimation R. Suppression
G. Introjection - unconscious imitation
My dad was angry with my mother, so he started yelling at my baby sister
A. Projection B. Denial C. Splitting D. Blocking E. Regression F. Somatization G. Introjection H. Displacement I. Repression J. Isolation of affect K. Intellectualization L. Acting out M. Rationalization N. Reaction formation O. Undoing P. Humor Q. Sublimation R. Suppression
H. Displacement
The father of the victim identified his body. He didn’t show any kind of emotion.
A. Projection B. Denial C. Splitting D. Blocking E. Regression F. Somatization G. Introjection H. Displacement I. Repression J. Isolation of affect K. Intellectualization L. Acting out M. Rationalization N. Reaction formation O. Undoing P. Humor Q. Sublimation R. Suppression
J. Isolation of affect
Pyromaniac becomes a firefighter
A. Projection B. Denial C. Splitting D. Blocking E. Regression F. Somatization G. Introjection H. Displacement I. Repression J. Isolation of affect K. Intellectualization L. Acting out M. Rationalization N. Reaction formation O. Undoing P. Humor Q. Sublimation R. Suppression
N. Reaction formation - unacceptable impulse transformed into its opposite
Pyromaniac putting out fires
A. Projection B. Denial C. Splitting D. Blocking E. Regression F. Somatization G. Introjection H. Displacement I. Repression J. Isolation of affect K. Intellectualization L. Acting out M. Rationalization N. Reaction formation O. Undoing P. Humor Q. Sublimation R. Suppression
O. Undoing - the action itself of reaction formation - acting out the reverse of unacceptable behavior
Pyromaniac starts working in a special effect company in Hollywood, where he can blow things up
A. Projection B. Denial C. Splitting D. Blocking E. Regression F. Somatization G. Introjection H. Displacement I. Repression J. Isolation of affect K. Intellectualization L. Acting out M. Rationalization N. Reaction formation O. Undoing P. Humor Q. Sublimation R. Suppression
Q. Sublimation - using an acceptable channel/outlet to carry out unacceptable impulses
**healthiest mechanism
“I’d rather forget that my dog was run over by a car.”
A. Projection B. Denial C. Splitting D. Blocking E. Regression F. Somatization G. Introjection H. Displacement I. Repression J. Isolation of affect K. Intellectualization L. Acting out M. Rationalization N. Reaction formation O. Undoing P. Humor Q. Sublimation R. Suppression
R. Suppression - conscious forgetting
**the only conscious defense mechanism
“Poor thief, he
probably really needs a car. Look how benevolent I am”
A. Projection B. Denial C. Splitting D. Blocking E. Regression F. Somatization G. Introjection H. Displacement I. Repression J. Isolation of affect K. Intellectualization L. Acting out M. Rationalization N. Reaction formation O. Undoing P. Humor Q. Sublimation R. Suppression
G. Introjection - internalizing an object’s quality
ex: identification w/an aggressor leading to belief that the aggression is under one’s control
“I’m allowed to take stacks of napkins home from McDonald’s because they’ll just throw them away
anyway”
A. Projection B. Denial C. Splitting D. Blocking E. Regression F. Somatization G. Introjection H. Displacement I. Repression J. Isolation of affect K. Intellectualization L. Acting out M. Rationalization N. Reaction formation O. Undoing P. Humor Q. Sublimation R. Suppression
M. Rationalization - using rational explanations to justify an unacceptable behavioral or belief
Baby learning to eat
Which Erikson stage applies? A. Generativity vs. Stagnation B. Trust vs. Mistrust C. Ego integrity vs. Despair D. Initiative vs. Guilt E. Autonomy vs. Shame & doubt F. Identity vs. Role confusion G. Intimacy vs. Isolation H. Industry vs. Inferiority
B. Trust vs. Mistrust
Children develop a sense of trust when caregivers provide reliability, cafe, affection. FEEDING, COMFORT.
- Trust vs. Mistrust (age 0-18 mos)
- Autonomy vs. Shame & doubt (age 2-3)
- Initiative vs. Guilt (age 3-5)
- Industry vs. Inferiority (age 6-11)
- Identity vs. Role confusion (age 12-18)
- Intimacy vs. Isolation (age 19-40)
- Generativity vs. Stagnation (age 40-65)
- Ego integrity vs. Despair (65-death)
A toddler replies no when told to eat his food at the dinner table
Which Erikson stage applies? A. Generativity vs. Stagnation B. Trust vs. Mistrust C. Ego integrity vs. Despair D. Initiative vs. Guilt E. Autonomy vs. Shame & doubt F. Identity vs. Role confusion G. Intimacy vs. Isolation H. Industry vs. Inferiority
E. Autonomy vs. Shame & doubt
- Trust vs. Mistrust (age 0-18 mos)
- Autonomy vs. Shame & doubt (age 2-3)
- Initiative vs. Guilt (age 3-5)
- Industry vs. Inferiority (age 6-11)
- Identity vs. Role confusion (age 12-18)
- Intimacy vs. Isolation (age 19-40)
- Generativity vs. Stagnation (age 40-65)
- Ego integrity vs. Despair (65-death)
Potty training
Which Erikson stage applies? A. Generativity vs. Stagnation B. Trust vs. Mistrust C. Ego integrity vs. Despair D. Initiative vs. Guilt E. Autonomy vs. Shame & doubt F. Identity vs. Role confusion G. Intimacy vs. Isolation H. Industry vs. Inferiority
E. Autonomy vs. Shame & doubt
- Trust vs. Mistrust (age 0-18 mos)
- Autonomy vs. Shame & doubt (age 2-3)
- Initiative vs. Guilt (age 3-5)
- Industry vs. Inferiority (age 6-11)
- Identity vs. Role confusion (age 12-18)
- Intimacy vs. Isolation (age 19-40)
- Generativity vs. Stagnation (age 40-65)
- Ego integrity vs. Despair (65-death)
Children learning to explore and play in their environment and with others
Which Erikson stage applies? A. Generativity vs. Stagnation B. Trust vs. Mistrust C. Ego integrity vs. Despair D. Initiative vs. Guilt E. Autonomy vs. Shame & doubt F. Identity vs. Role confusion G. Intimacy vs. Isolation H. Industry vs. Inferiority
D. Initiative vs. Guilt
- Trust vs. Mistrust (age 0-18 mos)
- Autonomy vs. Shame & doubt (age 2-3)
- Initiative vs. Guilt (age 3-5)
- Industry vs. Inferiority (age 6-11)
- Identity vs. Role confusion (age 12-18)
- Intimacy vs. Isolation (age 19-40)
- Generativity vs. Stagnation (age 40-65)
- Ego integrity vs. Despair (65-death)
Children getting involved in school, hobbies, sports
Which Erikson stage applies? A. Generativity vs. Stagnation B. Trust vs. Mistrust C. Ego integrity vs. Despair D. Initiative vs. Guilt E. Autonomy vs. Shame & doubt F. Identity vs. Role confusion G. Intimacy vs. Isolation H. Industry vs. Inferiority
H. Industry vs. Inferiority - coping w/new social and academic demands. Success leads to feeling of competence, failure results in feeling of inferiority
- Trust vs. Mistrust (age 0-18 mos)
- Autonomy vs. Shame & doubt (age 2-3)
- Initiative vs. Guilt (age 3-5)
- Industry vs. Inferiority (age 6-11)
- Identity vs. Role confusion (age 12-18)
- Intimacy vs. Isolation (age 19-40)
- Generativity vs. Stagnation (age 40-65)
- Ego integrity vs. Despair (65-death)
Peers, dating, competition
Which Erikson stage applies? A. Generativity vs. Stagnation B. Trust vs. Mistrust C. Ego integrity vs. Despair D. Initiative vs. Guilt E. Autonomy vs. Shame & doubt F. Identity vs. Role confusion G. Intimacy vs. Isolation H. Industry vs. Inferiority
F. Identity vs. Role confusion
- Trust vs. Mistrust (age 0-18 mos)
- Autonomy vs. Shame & doubt (age 2-3)
- Initiative vs. Guilt (age 3-5)
- Industry vs. Inferiority (age 6-11)
- Identity vs. Role confusion (age 12-18)
- Intimacy vs. Isolation (age 19-40)
- Generativity vs. Stagnation (age 40-65)
- Ego integrity vs. Despair (65-death)
According to Erikson, a child who strives to be
competent by learning new skills, taking pride in
results is which stage? (Also correlated with the
Freudian stage of latency)
A. Generativity vs. Stagnation B. Trust vs. Mistrust C. Ego integrity vs. Despair D. Initiative vs. Guilt E. Autonomy vs. Shame & doubt F. Identity vs. Role confusion G. Intimacy vs. Isolation H. Industry vs. Inferiority
H. Industry vs. Inferiority
- Trust vs. Mistrust (age 0-18 mos)
- Autonomy vs. Shame & doubt (age 2-3)
- Initiative vs. Guilt (age 3-5)
- Industry vs. Inferiority (age 6-11)
- Identity vs. Role confusion (age 12-18)
- Intimacy vs. Isolation (age 19-40)
- Generativity vs. Stagnation (age 40-65)
- Ego integrity vs. Despair (65-death)
Erikson’s psychosocial stage in which a person invest energy into establishing, caring for, and guiding in the next generation?
A. Generativity vs. Stagnation B. Trust vs. Mistrust C. Ego integrity vs. Despair D. Initiative vs. Guilt E. Autonomy vs. Shame & doubt F. Identity vs. Role confusion G. Intimacy vs. Isolation H. Industry vs. Inferiority
A. Generativity vs. Stagnation
- middle adulthood
- adults need to create or nurture things that will outlive them, often by having children or creating a positive change that benefits other people.
- through work and parenthood
- Trust vs. Mistrust (age 0-18 mos)
- Autonomy vs. Shame & doubt (age 2-3)
- Initiative vs. Guilt (age 3-5)
- Industry vs. Inferiority (age 6-11)
- Identity vs. Role confusion (age 12-18)
- Intimacy vs. Isolation (age 19-40)
- Generativity vs. Stagnation (age 40-65)
- Ego integrity vs. Despair (65-death)
10 y/o pt reports he collects baseball cards. Child is
excited b/c he is only one in his peer group who owns
several cards. According to Erickson, what
developmental task are most relevant for this child?
A. Generativity vs. Stagnation B. Trust vs. Mistrust C. Ego integrity vs. Despair D. Initiative vs. Guilt E. Autonomy vs. Shame & doubt F. Identity vs. Role confusion G. Intimacy vs. Isolation H. Industry vs. Inferiority
H. Industry vs. Inferiority
- Trust vs. Mistrust (age 0-18 mos)
- Autonomy vs. Shame & doubt (age 2-3)
- Initiative vs. Guilt (age 3-5)
- Industry vs. Inferiority (age 6-11)
- Identity vs. Role confusion (age 12-18)
- Intimacy vs. Isolation (age 19-40)
- Generativity vs. Stagnation (age 40-65)
- Ego integrity vs. Despair (65-death)
According to Freud, which psychosexual stage is
associated with a primary erotic focus on the genital
area and unconscious fantasies of sexual involvement
with the opposite-sex parent?
Phallic stage
Compulsions & obsessions are related to development
disturbance during which of Erikson’s psychosocial
stages?
A. Generativity vs. Stagnation B. Trust vs. Mistrust C. Ego integrity vs. Despair D. Initiative vs. Guilt E. Autonomy vs. Shame & doubt F. Identity vs. Role confusion G. Intimacy vs. Isolation H. Industry vs. Inferiority
E. Autonomy vs. Shame & doubt
- Trust vs. Mistrust (age 0-18 mos)
- Autonomy vs. Shame & doubt (age 2-3)
- Initiative vs. Guilt (age 3-5)
- Industry vs. Inferiority (age 6-11)
- Identity vs. Role confusion (age 12-18)
- Intimacy vs. Isolation (age 19-40)
- Generativity vs. Stagnation (age 40-65)
- Ego integrity vs. Despair (65-death)
During what stage of development according to Piaget does a child develop understanding of object permanence?
A. Sensorimotor stage
B. Preoperational stage
C. Concrete operational stage
D. Formal operational stage
A. Sensorimotor stage (age 0-2)
Piaget’s theory of cognitive development - 4 stages of mental development of how children acquire knowledge and to understand the nature of intelligence
- Sensorimotor stage (birth - 2 yrs) - understanding that objects exist and events occur in the world independently of one’s actions, object permanence
- Preoperational stage (2-7) - thinking at a symbolic level, symbolic play, centration, egocentrism (focused on themselves)
- Concrete operational stage (7-11) - beginning of logical or operational thought but can only apply logic to physical objects (hence concrete, can’t yet think hypothetically); conservation, reversibility, seriation, transivity, class inclusion
- Formal operational stage (12+) - gain ability to think in abstract manner, math, creativity; abstraction
During what stage of development according to Piaget does symbolic play occur?
A. Sensorimotor stage
B. Preoperational stage
C. Concrete operational stage
D. Formal operational stage
B. Preoperational stage (age 2-7)
Piaget’s theory of cognitive development - 4 stages of mental development of how children acquire knowledge and to understand the nature of intelligence
- Sensorimotor stage (birth - 2 yrs) - understanding that objects exist and events occur in the world independently of one’s actions, object permanence
- Preoperational stage (2-7) - thinking at a symbolic level, symbolic play, centration, egocentrism (focused on themselves)
- Concrete operational stage (7-11) - beginning of logical or operational thought but can only apply logic to physical objects (hence concrete, can’t yet think hypothetically); conservation, reversibility, seriation, transivity, class inclusion
- Formal operational stage (12+) - gain ability to think in abstract manner, math, creativity; abstraction
At what stage of development according to Piaget does a child begin to understand the concept of conservation?
A. Sensorimotor stage
B. Preoperational stage
C. Concrete operational stage
D. Formal operational stage
C. Concrete operational stage
Piaget’s theory of cognitive development - 4 stages of mental development of how children acquire knowledge and to understand the nature of intelligence
- Sensorimotor stage (birth - 2 yrs) - understanding that objects exist and events occur in the world independently of one’s actions, object permanence
- Preoperational stage (2-7) - thinking at a symbolic level, symbolic play, centration, egocentrism (focused on themselves)
- Concrete operational stage (7-11) - beginning of logical or operational thought but can only apply logic to physical objects (hence concrete, can’t yet think hypothetically); conservation, reversibility, seriation, transivity, class inclusion
- Formal operational stage (12+) - gain ability to think in abstract manner, math, creativity; abstraction
At what stage of development according to Piaget does a child gain the ability to do math and think creatively?
A. Sensorimotor stage
B. Preoperational stage
C. Concrete operational stage
D. Formal operational stage
Piaget’s theory of cognitive development - 4 stages of mental development of how children acquire knowledge and to understand the nature of intelligence
- Sensorimotor stage (birth - 2 yrs) - understanding that objects exist and events occur in the world independently of one’s actions, object permanence
- Preoperational stage (2-7) - thinking at a symbolic level, symbolic play, centration, egocentrism (focused on themselves)
- Concrete operational stage (7-11) - beginning of logical or operational thought but can only apply logic to physical objects (hence concrete, can’t yet think hypothetically); conservation, reversibility, seriation, transivity, class inclusion, decentration
- Formal operational stage (12+) - gain ability to think in abstract manner, math, creativity; abstraction
A 10 yo child remains sad and angry about his parent’s
divorce but no longer believes that he caused the
separation. This cognitive change is example of what
mechanism?
Decentration - starts in the preoperational stage and solidifies in the concrete operational stage
- Preoperational stage (2-7) - thinking at a symbolic level, symbolic play, centration, egocentrism (focused on themselves)
- Concrete operational stage (7-11) - beginning of logical or operational thought but can only apply logic to physical objects (hence concrete, can’t yet think hypothetically); conservation, reversibility, seriation, transivity, class inclusion, decentration
information from environment is fit into existing schemas; toddler calls horse “big doggie”
A. Accommodation
B. Assimilation
C. Equilibration
B. Assimilation
an existing schema is changed in light of new information; toddler differentiates dog, cat, cow, horse
A. Accommodation
B. Assimilation
C. Equilibration
A. Accommodation
Gross motor milestones in babies/toddlers/kids:
- Holding head upright
- Sitting supported
- Sitting unsupported
- Crawling
- Walking
- Running
- Jumping
- Riding tricycle
- Hopping on one foot
Just remember to travel from head to toe the 1st year of life in increments of 3 months.
3 Months = Head - Holds head in upright position, rolls over
6 Months = Trunk - Sits unsupported (sits with hands/arms at 4 months)
9 Months = Knees - Crawling
12 Months = Feet - Walking
Then the 2nd year of life, remember to double it and go by increments of 6 months.
18 Months = Run - “Run” away from home at 18 years old
24 Months = Jump - Both (2) feet leave ground
Lastly, remember to double the increments again and go by 12 months for the next 2 years of life.
3 Years = Tricycle - “Tri” = 3
4 Years = Hop on 1 Foot - Tree yoga pose shaped like 4
https://www.ezmedlearning.com/blog/milestones
Language milestones in babies/toddlers/kids:
- cooing
- smile at people
- make eye contact with others
- vocalizes differently for different needs/feelings
- babble
- repeat sounds (mama, dada, papa)
- respond to change in tone of voice
- imitate speech
- point at objects
- 1-2 word vocabulary
- understand phrases, words
- follow simple instructions
- answer simple questions with head nod
- recognize words for common items (dog, cup, ball)
- vocab of 10-20 words
- point to pictures in book when named
- point to body parts
- 2 word phrases
- 2 step directions (pick up your toy and give it to mommy)
- animal sounds
- 3 word phrases
- 200+ words
- colors, time
3 months = “COO”
- coos, recognizes familiar voices, and cries/vocalizes differently for different needs/feelings, eye contact, social smile
6 months = “Babble”
- babbles, repeat sounds (ma, da, ba, ga, pa
- say mama and dada without meaning
- respond to changes in tone of your voice
9 months = “Imitation”
- imitate speech & non-speech, actions, gestures
- pointing at objects
recognize name
12 months = “1-2”
- vocab of 1-2 words (mama, dada meaningful now)
- begin to understand words, phrases, instructions, answer simple questions
- recognize words for common items (call, shoe, cup, dog)
18 months = “18”
- vocab of 10-20 words
- word spurt, increases to 50 words
- point to pictures in a book when you name them
- point to body parts
2 years = “2”
- 2 word phrases
- 2 step directions
- animal sounds
3 years = “3”
- 3 word phrases
- vocab of 200+ words
- grammar & pronunciation better
4 years = “4”
- 4 or more word sentences
- 4 sentences at a time when telling stories
- identify colors
Developmental milestones:
- tower of > 6 cubes
- stands on one foot
- turns handles
- draw circle
- throw ball
- use scissors
- draws square
- skips
- draws triangle
- distinguishes fantasy from reality
Age 3:
- tower of > 6 cubes
- stands on one foot
- turns handles
- draw circle
Age 4:
- throw ball
- use scissors
- draws square
Age 5:
- skips
- draws triangle
- distinguishes fantasy from reality
16 y/o pt brought to psychiatrist’s attn after having
single grand mal sz. Been staying up late studying for exams. Pt’s parents have noted on occasion pt has sudden jerks of entire body or brief arm jerking movements in the morning, resulting in dropping objects. Has anxiety. EEG: rare 4-6 HZ irregular polyspike/wave bursts/slow wave discharges. Diagnosis?
Juvenile myoclonic epilepsy
- “bilateral polyspike & slow waves”
- early: absence seizures –> myoclonic jerks in the morning aggravated by sleep deprivation
- -> GTC later
- 50% have concomitant psych dx
–> TREAT W/VALPROATE
62 y/o M w/ DM is not making sense, saying “thar
szing is phrumper zu stalking”. Normal intonation but
no one in the family can understand it. He verbally
responds to Qs w similar utterances but fails to
successfully execute any instruction.
Wernicke’s (expressive) aphasia
66 y/o with HTN develops vertigo, diplopia, nausea,
vomiting, hiccups, L face numbness, nystagmus,
hoarseness, ataxia of limbs, staggering gait, and
tendency to fall to the left. Dx?
Lateral medullary stroke = Wallenburg Syndrome (PCA - Posterior circulation)
- Contralateral hemiparesis
- Ipsilateral facial sensory loss
- Diplopia, Dysarthria, Ataxia, Vertigo, Vomiting
Fever, HA, seizures, confusion, stupor, and coma,
evolving over several days. EEG with lateralized highvoltage sharp waves arising in the L temporal region
w slow wave repeating at 2-3 sec intervals. CT low density lesion in L temporal lobe
Herpes simplex encephalitis
23 y/o in ER after a party. Dehydration, dilated pupils, HTN,
elevated CPK. Which drug did he take?
MDMA
Strong correlation between Asperger’s and?
Nonverbal learning disability
Substance associated most with aggression and violence
Alcohol
