2019 Ninja PRITE Question Book (Part 1)

Assessing whether a schizophrenic criminal defendant may meet standard for insanity defense, what do you ask?

"WHAT WERE THE VOICES SAYING TO YOU AT THE TIME OF THE CRIME?"

80yo p/w insidious forgetfulness f/b progressive language impairment 2yr later with difficulty using common tools/appliances. Dx?

ALZHEIMER'S DISEASE

Amyloid precursor protein in what cognitive disorder?

ALZHEIMER'S DZ

Clock drawing test is quickly administered and sensitive screen for which d/o?

ALZHEIMER'S DZ

Individuals over 40yo with Down's syndrome frequently develop:

ALZHEIMER'S DZ

Most common cause of dementia in pts > 65 yrs of age:

ALZHEIMER'S DZ

PET scan shows bitemporoparietal hypoperfusion in early stages of which dementia?

ALZHEIMERS

Motivational interviewing of patients with addictive disorders addresses what? (2x)

AMBIVALENCE ABOUT BECOMING DRUG FREE

Do NOT use in pt w/ narrow-angle glaucoma

AMITRIPTYLINE

Dry mouth, blurred vision, constipation, urinary retention. S/E of what psychotropic?

AMITRIPTYLINE

Nortriptyline is the active metabolite of which of the following TCAs?

AMITRIPTYLINE

Which antidepressant is successfully used to treat pain syndromes?

AMITRIPTYLINE

Injury of bilateral parahippocampal cortex and hippocampal formation results in what

AMNESIA

Distinguishing dissociative identity disorder from PTSD?

AMNESIA FOR EVERYDAY EVENTS

Lesions in mammillary bodies will produce what symptoms?

AMNESIA, CONFABULATION, LACK OF INSIGHT

Pt with hx of herpes simplex and seizure d/o undergoing EEG monitoring that recorded no epileptic activity during, after and before a confused state wherein pt suddenly awoke frightened. The next day pt with baseline demeanor has no memory about that episode. (2x)

AMNESTIC DISORDER

65yo pt lives alone, increasingly forgetful over the past year, lifelong difficulty recalling names of acquaintances, now has difficulty with phone calls and remembering appts. lives independently, drives, prepares meals, MSE with delayed recall of 4 words, otherwise normal. Pt upset by difficulty and is not depressed. symptoms most consistent with...?

AMNESTIC MILD COGNITIVE IMPAIRMENT

Antidepressant that causes Parkinson's sx:

AMOXAPINE

Which TCA should be avoided in pts w/ Parkinson's?

AMOXAPINE

Urine toxicology in a pt on bupropion may produce a false-positive screening test for which substances?

AMPHETAMINE

21-year-old male at ED is agitated, believes computers are flashing messages at him, and says "I need my knife to protect myself." Which substance on UDS? (2x)

AMPHETAMINES

Tachycardia, dilated pupils, hypervigilance, anger, HTN, psychotic sxs, and chills. UDS shows? (2x)

AMPHETAMINES

Polymerase chain reaction (PCR) used in genetic linkage studies involves:

AMPLIFICATION OF MICROSATELLITE MARKERS

Brain area activated by subliminal presentations of emotional faces

AMYGDALA

Threatening objects produce startle response prior to person becoming consciously aware. Connection of thalamus to what?

AMYGDALA

bipolar has decreased connectivity here

AMYGDALA AND PFC

Neural pathway mediating reactive aggression?

AMYGDALA-HYPOTHALAMUS- PERIAQUEDUCTAL GRAY

Which enzymes can be increased in serum of pt's with bulimia?

AMYLASE

Fall from a ladder with persistent back pain and inability to void. B/l leg weakness, decreased pinprick in sacral and perianal area. Dx?

CAUDA EQUINA COMPRESSION

Pts complain of having lost not only possessions, status, and strength, but also heart, blood, and intestine suffer from which of the following syndromes?

COTARD

Etiology of meningitis assoc with fever, HA, CSF pleocytosis with lymphocyte predominance, slightly elevated CSF protein, and normal CSF glucose

COXSACKIE VIRUS

A patient who is prescribed a high-dose of fluphenazine develops a fever of 103 F, tachycardia and AMS. Which test is most likely to be helpful?

CREATINE KINASE

Which metabolic changes is characteristic of normal aging?

CREATININE CLEARANCE DECLINES

82 year old with progressive dementia, myoclonus over 3 months. EEG shows periodic sharp waves with 1hz over both hemispheres. Dx?

CREUTZFELDT--JAKOB DISEASE

What does the pentobarbital challenge test do? (2x)

ESTIMATES THE STARTING DOSE OF PENTOBARBITAL USED FOR BARBITURATE DETOXIFICATION

What substance is only detected in urine for 7-12 hours after ingestion?

ETOH

Comorbid disorder in men with PTSD

ETOH ABUSE/DEPENDENCE

60 y/o alcoholic with 4 day h/o unstructured, maligning AH and clear sensorium. Dx?

ETOH-INDUCED PSYCHOTIC D/O

Why would you not test breast milk or baby's blood for sertraline levels in a breast feeding patient?

EVIDENCE SHOWS THAT INFANTS ARE HARMED MORE BY HAVING A DEPRESSED MOTHER THAN BEING EXPOSED TO SERTRALINE

40y/o has episodes of flailing of the arms and tonic postures described as "fencing." EEG confirms seizure. Which seizure type? (4x)

FRONTAL LOBE

62yo progressive personality changes, has dull emotions, lack of initiative, and apathy. An autopsy is likely to show atrophy of ...?

FRONTAL LOBE

Location of characteristic lesions seen in CT scans of pt with carbon monoxide poisoning associated comas?

GLOBUS PALLIDUS

Pt w/ episodes of severe, intermittent, lancinating pain involving the posterior tongue and pharynx, w/ radiation to deep ear structures. Triggered by swallowing of cold liquids and talking. Workup: normal. Dx? (2x)

GLOSSOPHARYNGEAL NEURALGIA

What is decreased with heavy ETOH intake

GLUCOSE

Acamprosate works through which neurotransmitter system?

GLUTAMATE

Stimulant-induced craving for drugs of abuse is most frequently mediated by which neurochemicals?

GLUTAMATE

Which neurotransmitter, IF dysfunctional, most replicates core symptoms of schizophrenia?

GLUTAMATE

Memantine's cognitive preservation effect has which mechanism?

GLUTAMATE NMDA RECEPTOR ANTAGONIST

The cognitive enhancement associated with experimental D-cycloserine treatment in pt's with schizophrenia has been attributed to enhancement of NMDA receptor activity by which of the following neurotransmitters?

GLYCINE

Which neurotransmitter is predominantly inhibitory?

GLYCINE

Which neurotransmitters are reduced in quantity, uptake and turnover is spasticity?

GLYCINE & GABA

Med most helpful in tx of antipsychotic induced drooling?

GLYCOPYRROLATE

Pts with blood phobia have 2 stage response when exposed to stimulus. First is increased anxiety and elevated BP. 2nd response?

HYPOTENSION

What causes of decreased vision in older adults is characterized by an inability to focus on an object as a result of retinal damage

MACULAR DEGENERATION

Which of the following produces best outcome in terms of drug consumption and criminal behavior for heroin-dependents?

MAINTAINING OF METHADONE

Most common psych d/o that occurs in pts s/p organ transplant

MAJOR DEPRESSION

79y/o asks for eval for STD. Upset and guilty about an affair. Spouse says affair happened many years ago. Pt is sad but not confused. Dx? (2x)

MAJOR DEPRESSION WITH PSYCHOSIS

The Patient Health Questionnaire-9 is a validated tool to assess the severity of what disorder?

MAJOR DEPRESSIVE

Discontinuation syndrome associated with SSRI consists of:

MALAISE, NAUSEA, PARESTHESIAS, DIZZINESS, MOOD SYMPTOMS, AND HEADACHE

25 y/o prisoner who claims to be depressed is hospitalized after he swallowed some razor blades. The razor blades are found to have been carefully wrapped in surgical tape before the pt swallowed them. Later, the pt confesses he swallowed the blades because he wanted some time out of prison:

MALINGERING

At 10 mg selegiline does not require dietary restriction because

MAO-B IS NOT INVOLVED WITH INTESTINAL TYRAMINE REACTION

Which perinatal factor is specifically associated with development of ADHD?

MATERNAL TOBACCO USE PRENATALLY

27 y/o F, 1 week postpartum, has sudden emotional outbursts; not sad, wants the baby. What's going on?

MATERNITY BLUES

10yo w ADHD and aggressive outburst is started on a moderate dose of a stimulant. ADHD symptoms have improved, but aggression has not. In addition to behavioral intervention, what is the next best step to manage both the ADHD and aggression?

MAXIMIZE DOSAGE OF LONG ACTING STIMULANT

Which of the following is more common in patients experiencing a first episode psychotic depression at old age compared to younger age?

NIHILISTIC DELUSIONS

An 80 year old has depressed mood and cognitive decline. They respond with brief one word responses and rare spontaneous elaboration. This is an example of?

POVERTY OF SPEECH

What is the diagnosis of pt with FTT in infancy, hyperphagia, obesity, hypogonadism, OCD? Pt has short stature and small hands/feet.

PRADER-WILLI

What syndrome has pathogenic copy number variants affecting DNA base pairs?

PRADER-WILLI

4 y/o child that was hypotonic as an infant is now demonstrating developmental delays, foraging for food and having many temper tantrums. Dx? (4x)

PRADER-WILLI SYNDROME

First-line treatment for restless leg syndrome (2x)

PRAMIPEXOLE

The new onset of pathological gambling, increased libido, and hypersexuality in a patient with Parkinson disease is likely to be secondary to: (3x)

PRAMIPEXOLE

Pt with flashbacks, nightmares, and insomnia r/t sexual trauma is improving slightly with Zoloft but still having nightmares, next step in mgmt.?

PRAZOSIN

What medication is best for decreasing nightmares in PTSD pts? (2x)

PRAZOSIN

68yo with dull R-sided non-throbbing HA's worse at night and with prolonged chewing. Best initial tx?

PREDNISONE

The cortical synaptic remodeling characteristic of normal adolescence is also believed to be associated with what neurobiological change?

PREFERENTIAL LOSS OF EXCITATORY SYNAPSES

Transcranial magnetic stimulation for Tx of depression targets which brain regions? (X2)

PREFRONTAL CORTEX

Where does the neuron morphology in the brain change the most?

PREFRONTAL CORTEX

Characteristic of women with increased risk of battery

PREGNANCY

Clinical circumstance that best warrants consideration of psychotherapy as the sole treatment for mild to moderate depression:

PREGNANCY, LACTATION, OR WISH TO BECOME PREGNANT

Common symptoms of paranoid personality disorder

PREOCCUPATION W/ UNJUSTIFIED DOUBTS OF LOYALTY/TRUSTWORTHINESS OF FRIENDS/ASSOCIATES

Which of the following is a risk factor for child abuse?

PRESENCE OF A STEP-PARENT

Risk factor for TD

PRESENCE OF MOOD DISORDER

Which is the most reliable finding from CSF analysis for a pt with multiple sclerosis in the chronic progressive phase of the dz? (2x)

PRESENCE OF OLIGOCLONAL BANDS

29 y/o pt is admitted to the hospital with a 1 week history of euphoria, insomnia, pressured speech, and grandiosity. Pt has delusions of being monitored by the FBI, and the staff observes pt responding to unseen others. In addition to these symptoms, what is required for diagnosis of Schizoaffective disorder? (2x)

PRESENCE OF PSYCHOTIC SYMPTOMS FOR AT LEAST 2 WEEKS IN THE ABSENCE OF MOOD SYMPTOMS

First pass effect refers to which of the following aspects of a med's metabolism? (2x)

PRESYSTEMIC ELIMINATION

Occurrence of sexual abuse or inappropriate sexual exposure is indicated by? (2x)

PRETENDING TO HAVE INTERCOURSE WITH A STUFFED ANIMAL

Young adult gained 70 lbs in last year c/o daily severe headaches sometimes associated with graying out of vision. Papilledema present. CT and MRI brain no abnormalities but ventricles smaller than usual. Goal of treatment in this case: (2x)

PREVENT BLINDNESS

The most important risk factor for developing postpartum psychosis: (x2)

PREVIOUS POSTPARTUM PSYCHOSIS

What factors is most highly correlated with completed suicide in adolescent males?

PREVIOUS SUICIDE ATTEMPT

Pt complaining of an inability to move his arm. Pt is becoming enraged at his wife and, on several occasions, feared he might strike her. Shortly after one argument, his arm became limp. Dx:

PRIMARY GAIN

65y/o w/ h/o asthma presents for treatment of essential tremor. Which for first-line? (4x)

PRIMIDONE

What is the transmissible element that causes progressive decline and myoclonic jerks. Brain biopsy shows spongiform changes?

PRION

Consistent predictor of future suicidal behavior (2x)

PRIOR ATTEMPTS

Risk factor for PTSD

PRIOR CHILDHOOD ADVERSITY

Finding from studies of neuroimmune mechanisms of depression

PRO-INFLAMMATORY CYTOKINES ARE OFTEN ELEVATED

In a patient with right hemiparesis, lifting the patient's right hand above the face and letting it drop "face-hand test" assesses for what?

PSYCHOGENIC PATHOLOGY

28 y/o F w/ HA, hyperventilates, asynchronous tonic-clonic sz, no LOC during Sz:

PSYCHOGENIC SEIZURE

70 y/o presents with fearfulness, anger and agitation after moving in with adult child. On first visit pt is resigned and timid during exam. Which is most consistent with pt's behaviors?

PSYCHOLOGICAL ABUSE

Pt has partial resection of bowel. Has not resumed ambulation despite encouragement. Pt has low mood, poor sleep, and anhedonia. Dx?

PSYCHOLOGICAL FACTORS AFFECTING GENERAL MEDICAL CONDITION

Pt has been sexually assaulted is in the ER immediately after the trauma. Initiation of which of the following is most likely to be helpful in preventing long-term psychiatric sequelae? (3x)

PSYCHOSOCIAL INTERVENTIONS TO ESTABLISH SAFETY FROM FURTHER TRAUMA

Which is NOT common in patients >65: depression, cog d/o, phobias, ETOH d/o, psychotic d/o

PSYCHOTIC D/O

Pts w late-life depression compared w early onset depression more likely to report:

PSYCHOTIC SXS

What predicts bipolarity in adolescent with depression? (2x)

PSYCHOTIC SYMPTOMS

What is the principle problem with disulfiram in the treatment of alcoholics?

PT CAN STOP TAKING IT AND RESUME DRINKING

85 y/o pt w/ hx of HTN and COPD reports feeling depressed. The pt has an episode of depression 20 yrs ago, which was successfully treated with nortriptyline. The pt's HTN is currently well managed with hydrocholorothiazide. The physician prescribes nortriptyline 25mg qday. After 1 wk, the pt calls and reports feeling no better. What would be an appropriate reason to obtain a nortriptyline level?

PT'S ADVANCED AGE

12 y/o disclosed to counselor hx of sexual abuse by relative. Report made to authorities. During eval, pt reports anxiety/inability to concentrate due to thinking about event/irritability/sleep problems/crying frequently. Grades fell significantly after abuse began & relationships suffered. Dx? (5x)

PTSD

Pts with dissociative identity disorder are also most likely to meet the diagnostic criteria for which of the following disorders?

PTSD

Differential diagnosis of pt presents at ED with panic d/o: (x2)

PULMONARY EMBOLISM

15 y/o pt is found unresponsive by parents after pt returns from a party, friend confirms pt used heroin. What are signs?

PUPILLARY CONSTRICTION

What is associated with flattening of T waves and development of U waves on EKG?

PURGING BEHAVIOR

A derivative of which of the following vitamins is a necessary cofactor for the function of the enzyme glutamic acid decarboxylase?

PYRIDOXINE

What drug can reduce psychotic symptoms in parkinson's disease w/out worsening motor symptoms

Pimavanserin

Which tests can be used for projective personality testing?

RORSCHACH, DRAW A PERSON, THEMATIC APPERCEPTION (NOT MMPI)

Withdrawal from which sub can constitute a life-threatening medical emergency?

SEDATIVE-HYPNOTICS

An increase in beta frequency during an awake EEG is caused by what type of medication?

SEDATIVES

Convulsive episode with leftward eye deviation, tonic contracture of left side. Postictally, eyes deviate to right w/ hemiparesis of left side

SEIZURE FOCUS RIGHT FRONTAL REGION

Most serious side effect of rTMS

SEIZURES

What is a major side effect of clozapine?

SEIZURES

What inhibitor of monoamine oxidase is also useful in the treatment of Parkinson's disease?

SELEGILINE

Which med is irreversible MAO-B inhibitor?

SELEGILINE

Enlarged parotid glands in a pt being treated for anorexia nervosa would suggest which of the following? (2x)

SELF-INDUCED VOMITING

A surgeon unable to describe anatomical parts involved in one of his common surgeries is experiencing what type of memory impairment?

SEMANTIC

What symptom commonly develops relatively late in children with PTSD?

SENSE OF FORESHORTENED FUTURE

Most common fear expressed by adults leaving home to go to hospice?

SEPARATION FROM LOVED ONES

In a likely delirious patient, in addition to orientation questions, which part of the MMSE is most helpful to confirm the diagnosis?

SERIAL 7S

Mechanism by which risperidone cause very little EPS despite binding w/ high affinity to a dopaminergic D2 receptor

SEROTONERGIC 5HT2 ANTAGONISM

Trazodone requires larger doses to be used as an antidepressant due to lower potency affinity to which receptor?

SEROTONIC TRANSPORTER

Decreased level of what NT is most associated with depressed mood, poor sleep, and poor impulse control

SEROTONIN

Neurotoxicity associated with MDMA is associated with deficits in neurons that produce which of the following neurotransmitters? (2x)

SEROTONIN

Neurotransmitter maintains consistent levels with age:

SEROTONIN

Which of the following measures of rapid eye movement (REM) is typically reduced in MDD?

SLEEP ONSET TO REM ONSET

A pt presents with a hx of irresistible episodic sleepiness that is accompanied by a vivid, dreamlike state at the onset of an episode. Which of the following additional sleep symptoms are likely to be present? (x2)

SLEEP PARALYSIS

Paralysis when awakening, lasts several minutes. Can see/hear but cannot move during episodes. Disappears spontaneously or when called by his wife. No hallucinations, nightmares, daytime sleepiness or h/o falls. Neuro exam normal (4x)

SLEEP PARALYSIS

What risk factor distinguished 42-52yo women w/ persistent or recurrent depressive sx from those w/ a single depressive episode?

SLEEP PROBLEMS

5 y/o with screaming/crying for no reason about 1 hour after falling asleep. Sits up in bed with eyes open, trembling, sweating, mother cannot gain his attention for 5 minutes. No new stressors. Boy has no memory of the event. PE normal. Dx? (4x)

SLEEP TERROR

One of the most common psych d/o found in individuals who commit violence against others (even more than IED, BMD, MDD, CPS):

SUBSTANCE RELATED D/O

Psych d/o in violent people

SUBSTANCE RELATED D/O

Atomoxetine is most likely to be considered as initial treatment in ADHD in adolescents with: (2x)

SUBSTANCE USE D/O

Which of the following is the most common psychiatric diagnosis associated with violent acts?

SUBSTANCE USE DISORDERS

Maximum duration of PCP in the urine: (2x)

8 DAYS

Risk factor for developing bulimia?

CHILDHOOD SEXUAL ABUSE

Best neuropsych test of sustained attention

CONNER'S CONTINUOUS PERFORMANCE TEST

Dehydrated bulimic w/ BP 100/60 and orthostasis HR 60. Stat lab test: (3x)

POTASSIUM

What is the first priority in ER management of a rape victim?

ESTABLISHING PSYCHOLOGICAL SAFETY

Source of pain that is primarily central (non-nocioceptive)?

FIBROMYALGIA

A risk factor for child abuse:

FINANCIAL STRESS

Which of the following is predictive of better adaptation in bereavement?

FINDING MEANING IN LOSS

What factor differentiates malingering from factitious disorder? (2x)

HAVING EXTERNAL INCENTIVE

How many symptom-free weeks must be between two episodes of depression for them to be considered separate and therefore recurrent according to DSM-IV?

8 SYMPTOM-FREE WEEKS

Once it becomes effective, pharmacological tx of pts with panic d/o should generally continue for what length of time?

8-12 MONTHS

What is the lowest dose of methadone that suppresses opioid drug hunger and induces a cross tolerance of illicit opiates?

80-120mg

A diagnosis of anorexia nervosa requires that the patient has maintained a weight below what percentage of a minimally normal weight for age and height? (2x)

85%

Alcoholic hallucinosis versus DT: alcoholic hallucinosis includes what? (3x)

A CLEAR SENSORIUM

A pt reports, "undercover agents are all there, and they're gonna kill me." Pt's comment is best described as:

A DELUSION

Highest rate of suicide associated with

HAVING READY ACCESS TO FIREARMS

Most serious complication for a pt who ingests EtOH while on disulfiram

HYPOTENSION

Most effective approach in behavioral treatment of phobias:

IN-VIVO EXPOSURE

Underlying dynamic of much of the behavior of pts with paranoid personality d/o:

A DEVELOPMENTAL FAILURE TO ACHIEVE OBJECT CONSTANCY

Panic attack reaches peak in

A FEW MINUTES

When evaluating a patient in the ED for risk of dangerousness to others, the best predictor of future violent behavior is (3x):

A HISTORY OF VIOLENT BEHAVIOR

IQ scores generally considered to be stable beginning at:

7 YEARS OLD

Pt with addiction and social anxiety d/o discusses their painful experience of anxiety during their first AA meeting. What reply is consistent with 12-step facilitation therapy? (7x)

"YOU DID THE MOST IMPORTANT THING, YOU WENT TO THE MEETING. IT WILL GET EASIER."

Eval of which lab test is most specific for chronic heavy alcohol consumption? (7x)

% CDT (PERCENT CARBOHYDRATE DEFICIENT TRANSFERRIN)

Word that pt makes up is a

. NEOLOGISM

When is there highest risk of suicide in MDD patients recently dc'd from hospital?

0-3 MONTHS AFTER DC

At 30 years after presentation for treatment, mortality rates for anorexia nervosa are:

0.20%

Federal eligibility requirements for maintenance treatment with methadone specify that an individual must have been dependent on opioids for at least what length of time?

1 YEAR

Risks of complicated bereavement:

1) AMBIVALENT RELATIONSHIP TO DECEASED; 2) SIMULTANEOUS GRIEVING FOR MULTIPLE DEATHS; 3) PRE-EXISTING LOW SELF-ESTEEM & INSECURITY; 4) RECURRENT MAJOR DEPRESSION

41 y/o pt w/o family h/o corticocerebellar degeneration presents with 3-month h/o ataxia of gait/limbs, dysarthria, and progressive nystagmus. MRI and CSF normal. 1) Antibody panel with presence of? 2) What type of tumor is likely present?

1) ANTI-YO 2) OVARIAN CARCINOMA

29 y/o recent immigrant from China believes his penis is shrinking; concerned he might die once his penis retracts into his abdomen. 1) What type of d/o is this? 2) What is best treatment?

1) CULTURE-BOUND SYNDROME 2) SUPPORTIVE THERAPY

4 y/o does not run/climb, falls, has iliopsoas/quadriceps/gluteal weakness, enlargement of calves with firm, "rubbery" consistency, decreased DTRs and normal sensation. Wide based stance and walks waddling. When rising from the ground, uses a four-point position through full extension of all four extremities. Has family h/o similar sx in males. 1) EMG reveals? 2) Genetic mutation in what protein?

1) SMALL, SHORT-LASTING MOTOR UNIT POTENTIALS WITH INCREASED RECRUITMENT 2) DYSTROPHIN

How long after ingestion is amphetamine detectable in urine?

1-2 DAYS

CT is preferable over MRI in which situation?

70 Y/O FEMALE WHO FELL AT HOME AND NOW HAS DEPRESSED LEVEL OF CONSCIOUSNESS

Ninety-five percent of right-handed people develop left hemispheric dominance for language. What percentage of left handed people develop left hemispheric dominance for language?

75%

Prevalence rate of suicide in general adolescent population?

10%

What is the risk of developing schizophrenia when sibling has it but parents don't?

10%

what proportion of med students world wide have SI?

10%

Neuropsychological test most useful in the early diagnosis of Alzheimer disease:

10-ITEM WORD LIST LEARNING TASK.

DSM 5 prior age of presentation ADHD symptoms

12 YEARS OLD

Psychotherapy for addiction utilizes a disease-model approach and emphasizes acceptance of the disease and surrender to help beyond oneself: (2x)

12-STEP FACILITATION

How many hours after ingestion do amphetamines reach peak levels?

2 HOURS

65 y/o pt initially diagnosed w bereavement. Duration of sx to dx MDD?

2 MONTHS

The immediate phase of amphetamine withdrawal is characterized by dysphoria and anhedonia as well as euphoric recall of drug use and craving for the drug. The anhedonia and dysphoria are usually much improved in which of the following time frames?

2-4 MONTHS

8y/o has episodes of staring into space and then blinking for a few seconds. EEG will show? (7x)

3 CYCLES PER SECOND SPIKE AND WAVE ACTIVITY

According to DSM 5, Length of time of sleep difficulty for diagnosis of insomnia

3 MONTHS

The natural course of an untreated manic episode lasts approximately what length of time?

3 MONTHS

Patient with depression on admission. Which risk factor suggests need for maintenance psychotherapy? (2X)

3 OR MORE EPISODES OF DEPRESSION IN A LIFETIME

Typical duration for alcohol detox using benzodiazepine withdrawal?

3 TO 5 DAYS

Age that corticospinal tract complete myelination

3 YEARS

Withdrawal symptoms in chronic heroin users peak after what period of time (x2)

36 HOURS

Maximum time cocaine metabolites detectable in urine? (2x)

4 DAYS

Student presents for psych eval with continued anxiety, hyperalertness, flashbacks, and social avoidance after barely escaping an attacker 1 month ago. These symptoms are expected to last no longer than ?

4 WEEKS

Dose for 2ppd smoker?

42mg/day.

Alcohol withdrawal symptoms peak in how long? (x2)

48 HOURS

Minimum recommended washout period for fluoxetine prior to starting MAOI (2x)

5 WEEKS

Low CSF levels of this neurotransmitter metabolites is associated with suicidality?

5-HYDROXYINDOLE ACETIC ACID (5-HIAA)

LSD and mescaline show agonist at which of the receptors?

5HT2A

Medicare pays for hospice care when a physician declares that a patient has a maximum life expectancy of how long?

6 MONTHS

Average # of yrs from start of mood d/o to dx?

6-8YRS

What avg dose range of methadone yields best results in decreasing illicit use? (3x)

60-100MG

Pt repeatedly becomes distressed after what seems, even to the pt, to be minor disappointments. Pt also seems to suffer from extreme narcissistic vulnerability. A therapist utilizing self-psychology would be most likely to interpret this as due to?

A LACK OF DEVELOPMENTALLY APPROPRIATE EMPATHIC CAREGIVERS.

Pt reports headaches and peripheral visual loss. Visual field defects involving the temporal fields of both eyes are detected. An MRI scan is likely to reveal?

A MASS IN THE SELLA TURCICA

Essential criterion for declaration of brain death prior to organ donation requires?

A POSITIVE APNEA TEST

EEG that reveals posterior alpha and anterior beta activity is most likely to have been obtained from whom? (4x)

A RELAXED ADULT WITH EYES CLOSED

For which patient would ordering a serum ceruloplasmin be indicated?

A YOUNG ADULT MALE WITH NEW ONSET EMOTIONAL LABILITY AND MOVEMENT DISORDER

The single most consistently documented and significant risk factor in the epidemiology of tardive dyskinesia is?

ADVANCED AGE

Picture of tau staining for pt with progressive dementia. Dx?

ALZHEIMER'S

Evidence that alcoholism is hereditary? (2x)

ADOPTED SIBLINGS

What symptoms are most commonly associated with Tourette's syndrome?

OBSESSIONS AND COMPULSIONS

36 yo F w/ fatigue, weight loss, salt craving, nausea, hyperpigmentation, and muscle cramps, depressed mood, and apathy? Dx?

ADRENOCORTICAL INSUFFICIENCY

CT scan with occipital and intraventricular hyper-intensities:

PARENCHYMAL HEMORRHAGE

Pregnant women involved in a DV relationship get struck where most commonly? (5x)

ABDOMEN

10 y/o child freq episodes brief lapses of consciousness without premonitory sxs. Lasts 2-10 seconds, followed by immediate and full resumption of consciousness without awareness of what has happened. These ictal episodes most likely caused by what kind szs? (4x)

ABSENCE

Which differentiates deteriorative d/o from schizophrenia?

ABSENCE OF PROMINENT POSITIVE SYMPTOMS

Ability to alternate b/w general concepts and specific examples

ABSTRACT REASONING

Asking a pt, "which one does not belong in the following group: 13 pennies, a piggy bank, and a cow?" is a test of which domain:

ABSTRACT REASONING

Asking the patient "how are an apple and an orange alike?" assesses which of the following cognitive functions?

ABSTRACT REASONING

Wisconsin card sorting test (WCST) assesses (2x)

ABSTRACT REASONING AND FLEXIBILITY IN PROBLEM SOLVING

Asking a patient to interpret the phrase "Don't cry over spilled milk" tests what?

ABSTRACT THINKING

44 y/o pt w ETOH dependence/cirrhosis inquiring about med to stop drinking. Pt is disappointed in drinking behavior but otherwise shows little evidence of a mood D/O. Which meds has his most favorable risk/benefit profile for ETOH cessation? (2x)

ACAMPROSATE

Myasthenia gravis can be diagnosed in 80-90% of cases by identification of serum antibodies against what? (3x)

ACETYLCHOLINE RECEPTORS

Neuronal enzyme that is the target of drugs to treat Alzheimer's i.e. galantamine and rivastigmine

ACETYLCHOLINESTERASE

Best describes the intervention goal associated with contemplation stage of substance abuse treatment using motivational enhancement therapy: (2x)

ACKNOWLEDGE AMBIVALENCE AND EVOKE REASONS TO CHANGE

Appropriate response when pt describes paranoid delusions

ACKNOWLEDGE THE PATIENT'S EMOTIONAL REACTION TO DELUSION

5 y/o presents w/ sudden onset of slurred speech and gait difficulty. Exam shows truncal ataxia and nystagmus, mild dysarthria and extensor plantar responses. Recent h/o measles. MRI, UA, blood work unremarkable. Dx?

ACUTE CEREBELLITIS

A life threatening complication of cerebellar hemorrhage is: (2x)

ACUTE HYDROCEPHALUS

Pt recovering from surgery of an intracranial hemorrhage 2/2 arterial aneurysm, develops a sudden onset of headache, vomiting and progressive decline of consciousness. Pupils are miotic, and abducens muscles are weak bilaterally. Etiology:

ACUTE HYDROCEPHALUS

Progressive weakness over several days - absent reflexes worse in lower extremities - slow conduction velocity, conduction block A 54-year-old patient had a viral upper respiratory infection 2 weeks ago and now presents with a 3-day episode of progressive, symmetric weakness in the legs, and tingling in the toes and fingers. On exam, Achilles and patellar deep tendon reflexes are diminished. Nerve conduction studies demonstrate decreased conduction velocity and decreased amplitude of action potentials. The most likely Dx: (4x)

ACUTE INFLAMMATORY DEMYELINATING POLYNEUROPATHY

Weakness in limbs 2 weeks after a viral gastroenteritis. Weakness in UE/LE, absent DTRs. Spinal fluid shows no cells and elevated protein. EMG shows slow conduction velocity, prolonged distal motor latency, and conduction block. (2x)

ACUTE INFLAMMATORY POLYNEUROPATHY

Good prognostic feature in schizophrenia

ACUTE ONSET

Primary characteristic of Wernicke encephalopathy

ACUTE ONSET

Psych MD was consulted for anxiety and depression. Pt reports severe pain and indicates that doctors refuse to prescribe enough medication to control pain. A factor important for psychiatrist to consider:

ACUTE PAIN IS OFTEN UNDERTREATED, AND POOR PAIN MANAGEMENT CAN CONTRIBUTE TO ANXIETY AND DEPRESSION.

Pt c/o progressive weakness of several days. Exam + for generalized weakness and absent reflexes. Nerve conduction studies show slowing of velocities. Dx? (2x)

ACUTE POLYNEUROPATHY

28 y/o graduate student BIB wife and reports a change in his behavior since he witnessed a fatal motor vehicle collision 3 wks ago. Pt felt feeling of helpless, horrified at time of accident. Now pt feels like "his spirit leaves his body." And feels numb and detached, and dreams about events. Dx:

ACUTE STRESS

29 y/o pt reports having been robbed at knifepoint almost a month ago. Pt escaped unharmed, but has been experiencing a sense of unreality, detachment, and dampened emotions that is interspersed with periods of intense physiological arousal. These symptoms are causing difficulties at work. The most likely Dx?

ACUTE STRESS DISORDER

What conditions associated w MR have an autosomal recessive inheritance pattern?

ADRENOGENITAL SYNDROME, HURLER'S, TAY- SACHS, PHENYLKETONURIA

32 y/o w/ no psychiatric history brought to ER with 2 days of memory loss, insomnia, poor appetite, and difficulty performing daily routines. Subjective sense of numbing, detachment, and anxiety. One week earlier pt witnessed her child being fatally injured in a motor vehicle accident. All labs and scans normal. Dx? (4x)

ACUTE STRESS DISORDER

35 hospitalized w/ concussion following MVC with only minor lacerations and bruises. One week later has generalized pain, dizziness, difficulty sleeping and recurrent nightmares. Now fears driving. What is most likely explanation?

ACUTE STRESS DISORDER

A 28 yo patient presents to the ED after experiencing a sexual assault 1 week earlier. Although the patient cannot recall all aspects of the event, she remembers feeling helpless, detached, and as if her surroundings were not real during the assault. For the past week the pt has has difficulty sleeping due to nightmares about the assault and has not been able to talk about the event with any of her friends. She is also experiencing intermittent episodes of palpitations, SOB, dizziness, and nausea throughout the day. Dx?

ACUTE STRESS DISORDER

28 y/o with acute urinary incontinence and unsteady gait. Also reports 1 week h/o numbness progressing from both feet up to abdomen. Light touch, temperature, and pinprick are reduced below the mid-thoracic region. Vibration and position sensation in both feet are absent. Muscle bulk and tone are normal. Strength in BLE are reduced, R>L. Brisk DTRs in BLE with + Babinski's. What's the Dx?

ACUTE TRANSVERSE MYELITIS

A young pt w/ a few days of progressive weakness and numbness of both legs and feet after recovering from a flu-like illness. Exam: weakness and loss of sensation to all sensory modalities below the middle of the thorax. DTR: brisker on the lower extremities, plantar reflexes are extensor. Pt has had several episodes of urinary incontinence. Other neuro exam and vital: normal. LP: 23 mononuclear cells, protein level: 37mg/dl, and normal glucose. Dx:

ACUTE TRANSVERSE MYELITIS

Young pt recovering from flu-like illness w/ progressive weakness and numbness of legs and feet. Weakness and numbness below middle of thorax. Increased LE DTR's, extensor plantar reflexes. Urinary incontinence. LP 23 mononuclear cells, protein level 37, nml glucose

ACUTE TRANSVERSE MYELITIS

Pt with multiple past med trials reporting extensive SEs with those meds has been started on fluoxetine and now reports severe sweating. Pt's depression and anxiety have significantly improved on 10mg daily but pt reports "my bedding is drenched every day when I wake up". Most appropriate next course of action?

ADD TERAZOSIN TO PT'S MED REGIMEN

What is a characteristic of hallucinogens?

ADDICTIVE CRAVING IS MINIMAL

35 y/o pt presents with severe depression with episodes of anxiety for 9 months that have become so bad he can no longer leave the house, has severe weight loss, hyperpigmentation of exposed skin, and cold tolerance. Dx? (2x)

ADDISON'S DISEASE

Prostaglandin D2 increases extracellular levels of...

ADENOSINE

Caffeine results in dopaminergic activity, where?

ADENOSINE RECEPTOR

10yr old child, 3 yr hx of involuntary movements and vocalizations, symptoms wax and wane but never disappeared, child is aware of symptoms and only mildly distressed, academic performance is below average, what is the co-occurring disorder most likely causing this functional impairment at school?

ADHD

11 y/o with reading disability. Most likely comorbid dx:

ADHD

Comorbid condition w/ Tourette's in kids:

ADHD

Failing grades, poor organization, spending sprees, spontaneous trips ditching class, fidgety, euthymic. No change in sleep, appetite, no anhedonia. Dx?

ADHD

What DSM-IV-TR disorder requires symptoms to be present in two or more settings?

ADHD

Pt with low mood, middle insomnia, impaired concentration and memory x 3 months, onset shortly after adult child was convicted with felony and imprisoned x 10 years. Most likely Dx?

ADJUSTMENT D/O WITH DEPRESSED MOOD

Pt with leukemia underwent marrow transplant. Psych consulted. Pt more anxious and fearful about leaving hospital. Having trouble sleeping. MSE unremarkable. Dx? (x2)

ADJUSTMENT DISORDER WITH ANXIETY

20 y/o pt w/ acute onset belligerence, distortion of body image, depersonalization, and cloudy sensorium following ingestion of a street drug. Horizontal nystagmus, ataxia, and slurred speech, pupils not dilated. Management:

ADMINISTER AMMONIUM CHLORIDE

A 24 yo pt who is intoxicated with PCP presents to the ED. The pt is verbally aggressive, threatening to staff, and actively hallucinating. Pt's behavior has escalated despite redirection and placement in a quiet seclusion room. Which of the following is the best treatment for managing this patient's acute presentation?

ADMINISTER HALDOL 5MG IM

In long-term opioid therapy for management of chronic pain, the sign most indicative of addiction is?

ADMINISTRATION BY NON-PRESCRIBED ROUTES

19yo college student at ED ate postage stamp sized LSD, now distressed, begging for help, says things aren't right. What is the treatment?

ADMINISTRATION OF 20 MG DIAZEPAM

50 y/o pt w ETOH dependence admitted to ED for confusion, oculomotor deficits, ataxia, and dysarthria. The first step in acute management of this pt's condition:

ADMINISTRATION OF THIAMINE

20 y/o pt brings 2 y/o child to ER with multiple bruises. Mother says he fell down stairs. Mother has healing black eye and cut lip. Says she slipped on ice and hit head. X-ray of child's arm show hairline fx and healing callus. What action should psychiatrist take first?

ADMIT CHILD FOR CARE AND PROTECTION DESPITE MOTHER'S OBJECTIONS

50 y/o pt presents to the ER voicing suicidal thoughts. The pt states the intent to kill himself with a gun in the woods behind his house. Best course of action is to:

ADMIT THE PT TO THE HOSPITAL FOR FURTHER ASSESSMENT AND CARE.

Tic severity begins to decrease during which age period?

ADOLESCENCE

13yo pt is reported by parents to be sleepy during the day, out of it, dazed, decreased appetite, nauseated, red eyes, runny nose, red sores around mouth.Which substance is playing a role?

AEROSOL INHALANTS

Neural circuit that connects anterolateral orbitofrontal cortex, anterior part of the putamen, and the thalamus is involved in what cognitive function?

AFFECTIVE PROCESSING

A Caucasian pt with what risk factors has the highest risk for completed suicide in the US?

AGE GREATER THAN 85 YEARS

Which is a consistently identified risk factor for suicide that is unique to adults with schizophrenia compared to the general population?

AGE LESS THAN 35 YEARS

Known risk factors for dementia:

AGE, FAM HX, FEMALE, DOWN'S SYNDROME

8yo w/ no hx of emotional disturbance p/w separation anxiety & over-concern for health of surviving parent.

AGE-TYPICAL PRESENTATION OF NORMAL BEREAVEMENT

42 y/o surgeon experienced intense stomach cramps and palpitations when unable to immediately find the right instrument when performing an appendectomy. The surgeon was extremely alarmed by this and began to worry about the symptoms recurring. The surgeon then traded all ED calls so as to avoid these situations, began to avoid other crowded and noisy environments, and avoided a variety of social and professional settings. Likely diagnosis:

AGORAPHOBIA WITHOUT PANIC

Finish "epidemic" with clozapine in 1975

AGRANULOCYTOSIS

End stage AIDS with worsening fine motor movement, fluency, and visual spatial coordination, Dx? (2x)

AIDS DEMENTIA COMPLEX

Periodically assess neuroleptic side effects using? (it also shows pt's awareness of side effects) (2x)

AIMS

t c/o inability to sit still and describes feeling an inner tension. Exam notes pt is constantly shifting body and legs. Paced hall continuously. Received a course of neuroleptics until recently. Dx?

AKATHISIA

After gastric bypass surgery, continued abuse of what substance can be more life threatening than before surgery?

ALCOHOL

Chronic peripheral neuropathy of insidious onset, symmetric, more prominent distally in limbs, legs more than arms affected, slowly progressive, with greater sensory than motor involvement, with involvement of peripheral sympathetic nerves, and variable loss of DTR, is most likely caused by agent:

ALCOHOL

Drug of abuse that does not depend on specific neuronal membrane binding sites:

ALCOHOL

Most common substance of abuse in adolescents:

ALCOHOL

What psychoactive drug produces amnesia?

ALCOHOL

Pts over 65 y/o who experience chronic insomnia are most likely to have what comorbid psych conditions

ALCOHOL ABUSE

Which of the following caregiver characteristics is the strongest predictive factor for elder abuse? (2x)

ALCOHOL ABUSE

What is the most common biological cause of prenatal neurotoxicity linked to the development of intellectual disability (mental retardation)?

ALCOHOL EXPOSURE

55 y/o pt w/ hx of ETOH dependence reports hearing voices for the past 6 weeks. Pt reports that the last episode of ETOH intoxication was 1 month prior, with moderate drinking since that time. There is no prior hx of psychosis. On exam, pt is alert and oriented. On laboratory evaluation, pt has a GGT of 54, an MCV of 110, and an AST/ALT ratio of 2.1. the most likely cause of this pt's hallucinations is:

ALCOHOL INDUCED PSYCHOTIC DISORDER

Which diagnosis is associated with the highest risk of person to person violence?

ALCOHOL USE DISORDER

40 yo female presents with new onset paranoid delusion as well as AH and VH, no SI. Denies hx of mania or MDD. Pt has previous hospital admission for MDD and anxiety symptoms and had taken citalopram, sertraline and quetiapine but was non- compliant. Hx reveals chronic alcohol use with heavy drinking one week ago. What is the most likely cause of her paranoia?

ALCOHOL-INDUCED MOOD DISORDER

Priority of treatment: Marital problems, Depression, vs. Alcoholism.

ALCOHOLISM DETOX AND ABSTINENCE

A person's inability or difficulty to describe or be aware of emotions or mood is called: (4x)

ALEXITHYMIA

19 y/o pt reported hearing a voice that talked about what pt was thinking. The pt's speech has a normal rate and rhythm, but says things such as, "It is white, very white. I know. Things are that way. They are. I am." (Poverty of speech and content) This speech is an example of: (2x)

ALOGIA

Poverty of speech and poverty of content are aspects of which of the following conditions?

ALOGIA

First line treatment of vocal tics in Tourette syndrome: (2x)

ALPHA 2 ADRENERGIC AGONIST

Orthostatic hypotension associated with TCA's is caused by blockade of what receptor?

ALPHA-1-ADRENERGIC

Mirtazapine mediates increased release of NE and and serotonin through what mechanism?

ALPHA-2 ADRENERGIC BLOCKADE

Mirtazapine is an antagonist at which receptor?

ALPHA-2-ADRENERGIC

45yo pw gradual progressive weakness for 3-4mo in LUE, atrophy in RUE intrinsic mm, and brisk reflexes and extensor plantar responses. EMG with widespread fasciculations, fibrillations, and +sharp waves. Dx?

ALS

80 y/o pt w/ no prior psych hx, more forgetful, having difficulty with ADLs. However, pt is able to conduct routine social activities so that casual acquaintances don't notice abnormalities. What is the dx?

ALZHEIMER DEMENTIA

Bilat loss of neurons in the CA1 segment of the hippocampus is the most common histologic finding in patients with:

ALZHEIMER DEMENTIA

83 yo pt with mild HTN comes in with new onset headache and left hemiparesis. MRI shows right parietal lobe hemorrhage, small occipital hemorrhage and evidence of previous hemorrhage in right temporal and left parietal regions. What is likely etiology for these findings?

AMYLOID ANGIOPATHY

Protein mutation associated with Alzheimer disease in people younger than 60 yo

AMYLOID PRECURSOR

Atrophy of the intrinsic muscles of the right arm and forearm. Reflexes are generally brisk, plantar reflexes are extensor. Electrophysiology shows widespread fasciculations, fibrillation and sharp waves, normal sensation, muscle spasticity. Positive sharp waves on EMG. (5x)

AMYOTROPHIC LATERAL SCLEROSIS

Pt present with progressive weakness of left upper extremity, followed by the right upper extremity. + Muscle wasting of bilateral arms. Upper and lower ext reflexes increased, and plantar response are extensor. Normal nerve conduction studies. EMG: fibrillations in arm and leg muscles. Dx?

AMYOTROPHIC LATERAL SCLEROSIS

Which neurological disorder has the highest prevalence of pathological laughing and crying

AMYOTROPHIC LATERAL SCLEROSIS

Unilateral distal weakness in one limb, often associated w/ muscle wasting in the same distribution, the most common Dx:

AMYOTROPHIC LATERAL SCLEROSIS (ALS)

The role of the sponsor in AA characterized by:

AN AA MEMBER WHO PROVIDES 1:1 GUIDANCE IN WORKING THE AA PROGRAM.

Mental status changes after CABG, fluent speech and excellent comprehension, inability to name fingers and body parts, right and left orientation errors inability to write down thoughts and calculation, but with good reading comprehension:

AN EMBOLIC STROKE AFFECTING LEFT ANGULAR GYRUS

A person who smokes a pack of cigarettes per day stops smoking and experiences the need for a cigarette after every meal. Example of:

AN ENVIRONMENTAL TRIGGER

A plastic surgeon asks the psychiatrist to evaluate a 15 yo pt who is requesting rhinoplasty. The surgeon is willing to perform the operation but is concerned by the pt's young age. The pt is with her parents. The pt explains "I broke my nose playing hockey 2 years ago and it has bothered me ever since" On exam, her nose is noticeable asymmetrical. Patient shows no obvious psychological distress other than concern for her appearance. Pt states "I just want to look normal again". Parents report child has had poor self esteem since the injury and they are hoping the operation will help her self confidence. Which of the following is the most likely psychological outcome for this pt following cosmetic surgery? (x2)

AN IMPROVEMENT IN QUALITY OF LIFE

20 y/o male college student who is a weight lifter and star player on the football team, is brought to the ED by roommates because of their concern regarding the pt's increased irritability and aggressiveness over the last several weeks, including threats to harm particular classmates. The roommates report that the patient has been exercising in the gym more frequently than usual. They do not think he has been drinking alcohol excessively, using cannabis or other illicit substances and he has never done so in the past.

ANABOLIC STEROID USE

A muscular male patient presents to an outpatient psychiatric clinic complaining of discomfort in public places and excessive irritability. Though warm outside, the patient is dressed in heavy, baggy clothes, making him appear bigger than he is. The patient's belief that he is shrinking greatly distresses him. Which of the following is the most likely diagnosis for the patient? (2x)

ANABOLIC-ANDROGENIC STEROID ABUSE

Karyotyping is a method of genetic analysis characterized by which techniques? (2x)

ANALYZING CHROMOSOMAL STRUCTURES

Melancholia is characterized as (2x):

ANHEDONIA

13 yo seen for therapy has lost weight and is now 20th %ile for weight and 60th %ile for hight. Decided to eat healthy, wants to lose 5-10 lbs, spending time researching food. Diagnosis?

ANOREXIA NERVOSA

18 yo f avoiding food for 4 months with low BMI, regular menstruation, obsessing about being fat, trying to lose weight, sometimes vomits after large meals. Diagnosis?

ANOREXIA NERVOSA

Molecular mechanism of ketamine?

ANTAGONIST AT NMDA RECEPTORS

Bilateral lower extremity weakness, abulia, mutism, urinary incontinence are most likely to result from occlusion of which of the following arteries?

ANTERIOR CEREBRAL

Contralateral leg weakness with personality changes is an injury where

ANTERIOR CEREBRAL

70 y/o F sudden onset paralysis R foot and leg. R arm and hand slightly affected. No aphasia or visual field deficit. Over weeks found with loss of bladder control, abulia and lack of spontaneity. Which vascular area:

ANTERIOR CEREBRAL ARTERY (LEFT)

Akinetic mutism can result from bilateral infarctions of which of the following structures:

ANTERIOR CINGULATE GYRUS

Effortful, nonfluent speech with decreased speech output; where is the lesion?

ANTERIOR FRONTAL GYRUS

55 y/o pt w/ hx of weakness and clumsiness x several months. Difficulty w/ fine motor tasks. Arm muscles twitch and cramp easily, weakening, atrophy. Sensory, coordination, cranial nerve exams wnl. Underlying illness affects neuronal bodies where?

ANTERIOR HORN OF SPINAL CORD, MEDIAL BRAINSTEM AND CORTEX

55 y/o M presents w/ hx of weakness and clumsiness. Symptoms began several months earlier with difficulty buttoning his clothes, getting the car keys in the ignition, and performing other fine motor tasks. He noticed that the muscles in his arm and forearm twitched under the surface, and cramped easily. Over the past few months his arms have continued to weaken and lose muscle mass. On exam, he has diffuse wasting and weakness of BUE, fasciculations, slight spasticity on arms and legs, and hyperreflexia with extensor plantar responses. Sensory, coordination, and CN exams are normal. The underlying pathological process affects neuronal bodies in which of the following structures?

ANTERIOR HORN OF THE SPINAL CORD, MEDIAL BRAINSTEM, AND PREROLANDIC CORTEX

Which of the following instruments is most helpful in the assessment of children suspected of having ADHD?

CONNERS TEACHER RATING SCALE

28 y/o cocaine user complains of LBP, numbness in both legs and feet, thighs, buttocks, abdomen, and says R leg is weak and clumsy, L leg is tired. Has urinary incontinence and difficulty walking. Decreased light touch, pinprick, and temperature. Normal vibration and proprioception. DTR is hard to elicit. Muscle tone is normal. Decreased strength in B/L LE but worse on right. Diagnosis?

ANTERIOR SPINAL ARTERY INFARCTION

The uncinated fasciculus connects which of the following brain areas?

ANTERIOR TEMPORAL AND VENTRAL PRE- FRONTAL REGIONS

Amnesia characterized by loss of memory of events, occurs after onset of etiologic condition or agent

ANTEROGRADE

Characteristic of alcohol-induced blackouts (2x)

ANTEROGRADE AMNESIA FOR A TIME WHILE HEAVILY INTOXICATED BUT AWAKE

Pt w/ hx of Central Pain Syndrome presented to ED with high temp, tachycardia, dilated and poorly reactive pupils, VH, agitation, constipation, and dry skin. Dx:

ANTICHOLINERGIC DELIRIUM

Schizophrenic with VH, restlessness, marked thirst, agitation, elevated temperature, dilated pupils, dry skin. Dx?

ANTICHOLINERGIC INTOXICATION

Another psychiatrist refers to a pt by saying this pt is "special" and need really good treatment. You need to be careful with the pt to: (2x)

ANTICIPATE THE POTENTIAL FOR SPLITTING BETWEEN THE REFERRING MD AND YOURSELF.

Which clinical feature distinguishes panic disorder from pheochromocytoma?

ANTICIPATORY ANXIETY (in panic d/o)

A 72 yo patient had an embolic infarct in the middle cerebral artery territory. ECG shows no structural abnormalities. Doppler studies of the neck arteries reveal less than 50% occlusion on both carotid arteries. An EKG reveals AFib. Which of the following strategies has the best likelihood of reducing recurrent strokes in this patient? (2x)

ANTICOAGULATION WITH WARFARIN

45 y/o still grieving for mother 3 years after her death. States she feels her mother hovering over her and sees mother at night. Friends are concerned. Patient has normal job function, cleans house, endorses anhedonia. Tx?

ANTIDEPRESSANT MEDICATION AND PSYCHOTHERAPY

Pt taking venlafaxine for months stops abruptly and calls psychiatrist 3 days later with nausea, insomnia, muscle aches, anxiety, dizziness, and transient "electric shock" sensations. The most likely cause:

ANTIDEPRESSANT WITHDRAWAL

In learned helplessness model, the behavioral deficits in animals exposed to uncontrollable stress is reversed by? (5x)

ANTIDEPRESSANTS

Restless Legs syndrome 2/2 medication

ANTIDEPRESSANTS

Severe spasms and rigidity of limbs intermittently and later more persistent/continuous: (2x)

ANTIGLUTAMIC AND ANTIDECARBOXYLASE ANTIBODIES (anti- GAD) ANTIBODIES

72 y/o pt had a lacunar infarct in the middle cerebral artery territory. Echo is normal. Doppler studies of neck arteries reveal less than 50% occlusion on both carotid arteries. EKG is normal. The best strategies to reduce recurrent stroke:

ANTIPLATELET THERAPY WITH ASPIRIN AND DIPYRIDAMOLE

What medication strategies is most effective and rapid in the treatment of severe bipolar illness, manic phase? (X2)

ANTIPSYCHOTIC MEDICATION + LITHIUM OR VALPROATE

Which meds have best results for treating agitation in dementia?

ANTIPSYCHOTICS

According to DSM-IV-TR, what personality disorder in adults requires evidence of another specific psychiatric diagnosis prior to age 15?

ANTISOCIAL

Alcohol abuse in men commonly assoc w what comorbid mental D/O

ANTISOCIAL PERSONALITY

Which disorder has greatest co-incidence of alcohol abuse and dependence? (3x)

ANTISOCIAL PERSONALITY DISORDER

55yr old Hispanic American brought to psychiatrist by family, spells of uncontrollable shouting, crying, trembling, insomnia, pt feels chest heat going up to head, pt and family believe pt is suffering ataque de nervios, pt meets criteria for?

ANXIETY DISORDER

OCD is commonly comorbid with

ANXIETY DISORDERS

Increased rate of comorbidity with ADHD?

ANXIETY OR OPPOSITIONAL DEFIANT DISORDER

Boys with are most likely to delay first sexual intercourse until after 18 yo.

ANXIETY SYMPTOMS

Contraindication to the use of clonidine in managing opiate withdrawal:

AORTIC INSUFFICIENCY

71yo pt w/ Parkinson's x3yrs p/w difficulties getting up, is not motivated to do anything, has no interest in social events, and has "slowness" in thinking; although motor sx well controlled on Sinemet, sx stable throughout day and no sadness, worthlessness, or SI. Cognitive eval shows slow processing. What is most likely explanation?

APATHY

Which of the following tests is recommended by the American Academy of Neurology to establish the diagnosis of brain death?

APNEA TEST

80yo pt is unable to blow out match although motor and sensory function are normal. What is this called?

APRAXIA

Inability to carry out motor activites on verbal command despite intact comprehension & motor function indicates?

APRAXIA

Conduction aphasia often occurs as a result of damage to which structure?

ARCUATE FASCICULUS

This hypothalamic nuclei is key to integration of neural and nutrient signals with hormonal signals from the small intestine, pancreas, liver, adipose tissue and brainstem

ARCUATE NUCLEUS

What is the similarity between copy number variation and single nucleotide polymorphisms?

ARE COMMONLY FOUND IN HEALTHY INDIVIDUALS

6 year old with autism spectrum is referred to psychiatrist for irritability, aggression, and hitting self. Child has not responded to Risperdal. Which has the most evidence for managing irritability and aggression?

ARIPIPRAZOLE

78 y/o pt with Alzheimer's dementia living with spouse and daughter, starting to accuse the spouse of infidelity. On evaluation, he asserts that the spouse is unfaithful. He is alert and acts congenially with the spouse, he is on donepezil. Labs and medical workup is unrevealing of any disorder outside of dementia. Next?

ARRANGE FOR REGULAR EVALUATIONS OF THE PT AND REASSURE THE FAMILY.

Most frequent cause of death following TCA overdose: (2x)

ARRHYTHMIA

Metachromatic leukodystrophy associated w/ mutation in gene for which enzyme? (2x)

ARYL SULFATASE

10 y/o M s/p MVA sustained burn and crush injuries to R foot 4 days ago, does not remember the accident but never lost consciousness, keeps asking for his mother who was killed in the accident and having nightmares crying out "Daddy help Mommy." When should the child be told about his mother's death?

ASAP

An idiosyncratic, physiologic rxn to EtOH including rash, nausea, tachycardia, and hypotension occurs in what ethnic group?

ASIANS

Initial psychiatric intervention for 50-year-old married man with ED during sex but normal masturbatory ability, otherwise good marriage, and normal evaluation by PCP?

ASK PT TO BRING WIFE TO DISCUSS BEHAVIORAL EXERCISES

Immediate intervention in case of a pt with paranoid delusion and idea of reference:

ASKING FOR DETAILS OF PERCEPTION THAT LED TO THIS DISTRESSING DISCOVERY.

65 y/o pt wakes up with right-sided hemiparesis and motor aphasia. Pt is immediately brought to the emergency department and an evaluation is completed within 1 hour. Neurological exam: no additional abnormalities. Head CT w/o contrast: no additional abnormalities. Which is the appropriate next step in management?

ASPIRIN

A med that is most likely to slow the progression of vascular dementia:

ASPIRIN

In managing acute ischemic stroke, administer this within 48 hrs of onset of stroke for beneficial effect in reducing risk of recurrent stroke, disability and death:

ASPIRIN

Pt with CPS hospitalized 6x in the past year, hx of non-adherence to treatment, difficulty maintaining housing, and multiple med probs - which treatment most appropriate for this patient? (3x)

ASSERTIVE COMMUNITY TREATMENT

Successful psychosocial interventions in schizophrenics: (2x)

ASSERTIVE COMMUNITY TREATMENT

80 y/o pt with Alzheimer's is brought in for increasingly combative behavior. Daughter would like to keep the pt at home if possible. What interventions would be most helpful in this situation? (3x)

ASSESSING FOR CAREGIVER BURNOUT

effects of SSRI in pregnancy

ASSOCIATED WITH NEONATAL ADAPTATION SYNDROME

As opposed to strokes caused by arterial embolism or thrombosis, those caused by cerebral vein or venous sinus thrombosis are:

ASSOCIATED WITH SEIZURES AT ONSET

Inability to recognize objects by touch:

ASTEREOGNOSIS

Typical of Idiopathic Parkinson's disease, rather than another Parkinsonian syndrome: (2x)

ASYMMETRICAL ONSET AND PROGRESSION OF MOTOR SYMPTOMS.

A diagnosis of panic d/o requires which of the following?

AT LEAST SOME ANXIETY ATTACKS THAT ARE UNPROVOKED

What statement reflects current thinking about neurological procedures for intractable OCD?

AT PRESENT, THERE IS LITTLE EVIDENCE TO SUGGEST THAT ANY ONE PROCEDURE IS SUPERIOR TO ANOTHER.

This medication is commonly used in social phobia associated with performance situations, shortly before exposure to a phobic stimulus?

ATENOLOL

What med used for ADHD has been associated with liver damage?

ATOMOXETINE (STRATTERA)

Computer assisted continuous performance testing is used to assess what?

ATTENTION

What does the clock drawing task test?

ATTENTION, VISUOSPATIAL, PLANNING, EXECUTIVE FUNCTION (NOT orientation)

Which DSM-V diagnosis requires symptoms to be present in 2 or more settings?

ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD)

Adding which class of medication to an SSRI is an effective augmentation for treatment of PTSD?

ATYPICAL ANTIPSYCHOTICS

8 days after hip surgery a 75 y/o pt has episodes of disorientation, sleeplessness, and crying especially at night. Also little frogs in her room. In mid morning she is ok. Was Dx w/ MDD several months ago and taking doxepin 25 mg tid and diazepam 5 mg tid were d/c before surgery. Currently on meperidine, diphenhydramine. The recent confusion is NOT caused by:

ATYPICAL DEPRESSIVE DISORDER

Most useful instrument to assess a non-verbal 3-year-old child who plays alone in the corner, stacking/unstacking blocks?

AUTISM DIAGNOSTIC OBSERVATION SCHEDULE (ADOS)

A child with intellectual disability is free of seizures but develops epilepsy in adolescence. Pattern of onset is often seen with?

AUTISM SPECTRUM DISORDER

Manic episode while on carbamazepine. Good response in 2 wks. 4 wks recurrence.

AUTOINDUCTION OF EPOXIDE PATHWAY

Pattern of inheritance in Huntington's disease

AUTOSOMAL DOMINANT

Pattern of inheritance in Wilson's disease

AUTOSOMAL RECESSIVE

After child survives natural disaster, what is a protective factor to protect against developing PTSD

AVAILITY OF PEER SUPPORT

Pts with which personality d/o sees themselves socially inept, personally unappealing, or inferior to others? (2x)

AVOIDANT

What personality disorders should be the main consideration in differential dx of schizotypal personality disorder?

AVOIDANT

Difference between childhood onset OCD differs and adult onset

PSYCHIATRIC COMORBIDITY BURDEN IS GREATER

30 yo is pushed by family to get help for isolation she is uncomfortable around others and have problems making friends unless convinced they will accept her. She thinks others are highly critical of her and only has 2 close friends from childhood and has never dated. Fears of embarrassment interfere with job seeking as well. What is this dx?

AVOIDANT PERSONALITY DISORDER

A dislocation of shoulder joint resulting in weakness of abduction of arm, wasting of deltoid muscle and slight impairment of sensation on the lateral aspect of shoulder, involves which nerves:

AXILLARY

In comparison to men, women who abuse ETOH are more likely to also have...

AXIS I DIAGNOSIS

77 y/o pt w/ hx of BMD, stable w/ bupropion 300mg and valproic acid 1000 mg Qday. Pt reports feeling less motivated than usual at work, able to concentrate, but taking longer to finish tasks. Denied sadness. HTN is well controlled. MMSE score 26/30. Pt has master degree. The most appropriate workup:

B12 AND HOMOCYSTEINE LEVEL

Adult LP with opening pressure 190, protein 110, glucose 27, leukocytes 5,000. Dx?

BACTERIAL MENINGITIS

In a pt with hippocampus damage, what allows them to still learn new skills like playing tennis?

BASAL GANGLIA

Pt with vascular dementia typically has neuropathological changes assoc with:

BASAL GANGLIA

25 y/o w/ VH - similar to the wavy distortions produced by heat rising from asphalt - affecting the whole of both visual fields, + vertigo, dysarthria, tingling in both hands and feet and around both sides of mouth followed by occipital headache. Most likely dx:

BASILAR MIGRAINE

Which of the following is a pt self-reported questionnaire? (x2)

BECK ANXIETY INVENTORY

Most appropriate brief screening instrument that a pt can fill by him/herself at physician's office to screen for depression is (3x)

BECK DEPRESSION INVENTORY

The best time to obtain ECG in the treatment of children with TCA:

BEFORE TREATMENT, FOR ALL CHILDREN, TO ESTABLISH BASELINE

A doc meets with a pt and family to discuss treatment of pt's mild Alzheimer's disease. There are no other neurological or psychiatric symptoms or findings. The most appropriate course of action would be to:

BEGIN CHOLINESTERASE INHIBITOR TREATMENT

45 y/o pt who is in good physical health reports increased fatigue, decreased appetite, and an inability to take pleasure in usual activities. Pt is begun on fluoxetine 20mg/day, and pt's mood improves over the course of 2 weeks. However, pt now notes a new onset of anxiety symptoms, including restlessness in the arms and legs. Pt is observed to fidget and seems unable to sit still for the exam. Neurological exam: unremarkable. Which courses of Tx would be most appropriate?

BEGIN PROPRANOLOL 10MG TID

42yr old female with depression, Spanish speaking, usually seen by psychiatrist with interpreter, but this time bilingual husband will serve as interpreter, psychiatrist sees unexplained injuries and suspects abuse by husband, at next appointment pt comes with close bilingual friend and requests friend to join session, pt says husband is parking car and will be in shortly, what would be the best approach to clarify to clarify suspicions of abuse?

BEGIN SESSION WIT PT, INTERPRETER, AND PTS FRIEND WHILE HAVING THE HUSBAND REMAIN OUTSIDE

A patient reports feeling "irritable" with inability to sleep more than an hour at night one week after receiving 80 mg prednisone daily for a poison ivy rash.

BEGIN TO GRADUALLY TAPER THE PATIENT OFF OF THE PREDNISONE

Pt w/ MDD has been unresponsive to prior trials with a TCA and SSRIs. Pt has 1st degree right bundle branch block and poorly controlled HTN. Pt w/ no SI. Next step?

BEGIN TX WITH PHENELZINE

Studies show effective intervention for children with ADHD is to involve their parents in what part of Tx? (4x)

BEHAVIORAL MANAGEMENT

Generalized anxiety disorder is characterized by excessive worrying along with what combination of symptoms?

BEING EASILY FATIGUED AND FEELING KEYED UP

Characteristics of Parkinson's tremor

BEING INHIBITED WITH VOLITIONAL MOVEMENT

Shaking hands, increased when using hands/writing/volitional activities. Stress worsens, wine improves. Is familial. DX:

ESSENTIAL TREMOR

Acute onset of left facial weakness involving the forehead & perioral musculature. Onset of facial weakness was preceded by pain in left ear and mastoid, and by sensation of discomfort in the left ear w/ loud noises or low pitch sounds. Dx?

BELL'S PALSY

Phenobarbital tolerance test is helpful in detox from what?

BENZODIAZEPINES

25 y/o pt receives haldol and develops laryngospasm: Tx? (2x)

BENZTROPINE

What is the treatment of acute dystonia?

BENZTROPINE

6 y/o girl hosp for surgery to repair fracture sustained in MVA in which mother was injured & brother died. She reports seeing her brother in her room since accident, MSE is nml. Receiving Vicodin & Benadryl. What explains pt seeing brother?

BEREAVEMENT

62 y/o pt presents to psychiatrist requesting med for depression. Detailed hx reveals pt's spouse of 35 years died suddenly 6 wks ago. Since then, pt complains of frequent crying spells, decreased appetite without weight loss, and poor sleep due to middle of the night awakening. Pt continues to attend social engagements with friends and denies SI. Pt has family hx of depression, no hx of depressive episode in past. Dx:

BEREAVEMENT

62 y/o requests antidepressant. Spouse died 6 wks ago. Crying spells, decreased appetite, poor sleep. Continues to see friends, no SI. Fam Hx of depression, no prior depressive episodes (3x)

BEREAVEMENT; ASSURE PATIENT OF NO PATHOLOGY

Which med reduces the acute sx of neuroleptic induced akathisia? (2x)

BETA BLOCKERS (PROPRANOLOL, ATENOLOL)

What drug is useful in the Rx of urinary retention secondary to TCA therapy (5x)

BETHANECHOL

38 y/o taking imipramine 300mg qday for recurrent MDD. After 3 weeks, mood is improved, but has difficulty passing urine and mild erectile dysfunction. Appropriate action? (2x)

BETHANECHOL 25MG TID

Which is associated w/ worsened retrograde amnesia during ECT? (5x)

BILATERAL ELECTRODE PLACEMENT

49 y/o with gradual hearing loss. A tuning fork used during the Weber test reveals a failure to lateralize, and the woman's perception of air conduction is better than that of bone conduction. She has trouble discriminating words "fat" "cat" "mat". Dx?

BILATERAL SENSORINEURAL HEARING LOSS

Episodes of unrestrained eating w/o compensatory behaviors of bulimia. Dx? (5x)

BINGE-EATING DISORDER

The first-line treatment for retentive encopresis:

BIOFEEDBACK

76 y/o pt complains of bilateral, severe, persistent headache w/ loss of vision and scalp tenderness, and stiffness of proximal musculature. Sedimentation rate: 96mm/hr. Which diagnostic procedure:

BIOPSY

Postpartum psychosis is often associated with which of the following disorders? (2x)

BIPOLAR

Hx of MDD, irritable, restless, distractible, insomnia, poor appetite, guilt, impulsive spending

BIPOLAR D/O, MIXED

Male and female prevalence rates are comparable for which of the following disorders?

BIPOLAR DISORDER

What diagnosis, considered in the absence of other comorbidities, is estimated to put one at highest lifetime risk for suicide?

BIPOLAR DISORDER

DSM-IV defines h/o major depression plus hx of mixed manic and depressive episode as:

BIPOLAR DISORDER, TYPE I

42 y/o pt with episodes of feeling "sad and down" accompanied by decreased energy/interest in activities. Pt estimates these episodes occurred at least four times in his life, lasting 2-3 weeks at a time. During episodes, spends most of the time in bed. Most recent episode of sx ended 1 week ago. Since then, pt reports feeling energetic and "on top of the world." He now sleeps only 1-2 hours a night, wakes feeling refreshed. Friends remark pt seems flighty, but pt notes no deleterious effect of the mood change and finds that his productivity at work is the best it has ever been. Most likely Dx:

BIPOLAR II DISORDER

Episodic OCD with variable severity of Sxs, independent of Tx, is more common in:

BIPOLAR MOOD DISORDER

40 y/o w/ 6 kids: insomnia, poor appetite, dizziness/nausea, thinks husband is poisoning her. Despite all classes of meds marked fluctuations from sadness to euphoria 5x during the year. Dx? (2x)

BIPOLAR W/ RAPID CYCLING

Which group children are at greatest risk for death resulting from child abuse?

BIRTH TO 3 Y/O OLD

A pituitary tumor that protrudes through the diaphragmatic sella is most likely to cause?

BITEMPORAL HEMIANOPSIA

Visual problem in pituitary tumor compressing optic chiasm (10x)

BITEMPORAL HEMIANOPSIA

Only one criterion is necessary for Dx of schizophrenia if the reported delusion is:

BIZARRE

5 y/o cannot maintain eyes open, attempts to look at person/object results in tonic eyelid closure. Can watch television w/o difficulty. Extraocular movements NML. Dx?

BLEPHAROSPASM

What causes the cardiac toxicity of imipramine in overdose?

BLOCKADE OF VOLTAGE-GATED SODIUM CHANNELS

What is the mechanism of action of varenicline in the treatment of tobacco use disorders?

BLOCKS REINFORCING EFFECT OF NICOTINE

Gadolinium contrast in MRI scans is most specifically useful for diagnosing patients with diseases affecting which of the following structures?

BLOOD BRAIN BARRIER

A negative Sx of schizophrenia:

BLUNTED AFFECT

18 y.o. With skin picking, one hour washing face every day

BODY DYSMORPHIC DISORDER

25 y/o referred by plastic surgeon, claims that part of her face is swollen. (2x)

BODY DYSMORPHIC DISORDER

32 y/o pt reveals a long-standing preoccupation with the shape of her mouth and teeth, though she says that her friends and spouse have assured her that her feelings are inappropriate. Pt reports that she often spends an hour cleaning her teeth, so that the abnormality will be less noticeable. At times she avoids social contact, fearing that people will silently criticize the appearance of her mouth. She has no other obsessions on cleaning rituals. Best dx for pt's long-standing preoccupation?

BODY DYSMORPHIC DISORDER

Maximium sleepiness in humans occurs when melatonin reaches its highest point and when what reaches lowest point

BODY TEMPERATURE

Bulimia nervosa presents in which personality d/o?

BORDERLINE

DBT has been shown to be effective in the treatment of what personality disorder?

BORDERLINE

Personality d/o w chronic feelings of emptiness, transient psychotic sx, mood swings, tumultuous relationships, self-mutilation, poor self-image, impulsivity? (7x)

BORDERLINE

Pts w/ this personality d/o most likely to have 1st degree relatives with depression

BORDERLINE

What personality d/o is associated with transient psychotic symptoms (2x)

BORDERLINE

Pt with which dx are most likely to engage in parasuicidal behaviors?

BORDERLINE D/O

Which personality d/o is most commonly found in pts w/ severe factitious d/o?

BORDERLINE PERSONALITY

29 y/o F w/ mood swings- mood changes very rapidly, sometimes without prompting, from elation to depression or intense anger. These moods last minutes to hours. Her history is significant for promiscuity, spending sprees, tumultuous relationships, unstable self-image, and occasional use of cocaine. Hx of a brief period of paranoia and AH? During and emotional break-up with her last boyfriend, which remitted after a 2-day admission to the psych unit. When asked about SI, she reports that it is always in her mind and that, whenever she is under stress, she cuts her arms with a sharp blade to relieve a strong feeling of emptiness. Most likely Dx?

BORDERLINE PERSONALITY D/O

The most frequent cause of simultaneous, bilateral facial nerve palsies

BORRELIA BURGDORFERI

Test to discriminate cognitive difficulties in Alzheimer's from those in depression:

BOSTON NAMING TEST

Which of the following tests is used for assessment of expressive language?

BOSTON NAMING TEST

Characteristics of Ach receptors in cerebral cortex

BOTH INHIBITORY AND EXCITATORY

R neck pain, usually rotating neck to left. Corrected by touching chin. Spasm of R SCM on PE. Treatment?

BOTOX

35yo gets blurry vision, drooping eyelids, and difficulty swallowing. Weakness of bulbar muscles. What caused this?

BOTULINUM

50 y/o otherwise healthy pt who is a secretary notices cramping and stiffening of hands only while writing, stiffness ceases when pt stops writing. Occasionally hands will tremor. Which of the following Is most effective therapy

BOTULINUM TOXIN

Most effective tx for "writer's cramp" (focal dystonia assoc w/ writing) (2x)

BOTULINUM TOXIN

Right neck pain, tends to rotate neck to left - touching the chin prevents deviation - prominent right SCM spasm. Tx? (4x)

BOTULINUM TOXIN

Which of the following is the most effective treatment of blepharospasm? (2x)

BOTULINUM TOXIN

Which of the following is the most effective treatment of spasmodic torticollis? (x2)

BOTULINUM TOXIN

53 y/o w/ insidious onset of blurred vision, diplopia x1 day, ptosis, CN6 palsy, unreactive pupils, hoarse voice, dysarthria, weak neck muscles. EMG - inc amp with repetitive nerve stimulation. Dx?

BOTULISM

What test findings are associated with anorexia and bulimia?

BRADYCARDIA, AMENORRHEA, HYPOKALEMIA, AND ELEVATED SERUM AMYLASE

The term for abnormally slow speech seen in depression

BRADYLALIA

65 y/o has first generalized tonic-clonic Sz seen by spouse and they have been confused and lethargic since. Episode began w/ repetitive shaking of right arm. Blood tests unremarkable and no hx of other recent symptoms, trauma, or metabolic disorders. What study will likely reveal cause?

BRAIN MRI

Rapid onset of right facial weakness, left limb weakness, diplopia: (2x)

BRAIN STEM INFARCTION

Which lesion causes bilateral coarse nystagmus worsening with visual fixation and present with horizontal and vertical gaze?

BRAINSTEM

Adult onset opsoclonus-myoclonus-ataxia is associated with which form of cancer?

BREAST CARCINOMA

42 y/o anesthesiologist with repeated episodes of falling asleep in the OR, mild depression, irritability and mild cognitive troubles. UDS is negative. He gained substantial weight in 18 months, which he attributes to poor eating habits. Most likely Dx:

BREATHING-RELATED SLEEP D/O

67 y/o with MDD doing well on SSRI but continues to have insomnia and sleepiness during day. Snores loudly, morning headaches, and night sweats. Dx?

BREATHING-RELATED SLEEP DISORDER

23 y/o M w/ Borderline. Had fight w/ g/f now psychotic, cutting, AH w/ command to harm self. What level of care:

BRIEF INPATIENT HOSPITALIZATION

Tx for med student w/ chronic anxiety and sense of inadequacy?

BRIEF PSYCHODYNAMIC THERAPY

45 y/o M, with recurrent episodes of LOC while wearing a shirt with a tight collar, has feeling of faintness accompanied by pallor, followed by collapse and LOC, and several seconds later by a few bilateral jerks of the arms and legs. Entire episode lasted less than one minute. Most likely explanation? (2x)

CAROTID SINUS SYNCOPE

Healthy 37 y/o F business exec learns that her brother is killed in a MVA. 3 days after the funeral, she spots a man driving a car just like her brothers and is now convinced he is not dead. She believes she is the victim of a conspiracy in which others are manipulating her into losing her mind on order to take over her business. She hears a buzzing noise on her phone at work, believes her line is tapped. At home, light in her neighbor's window is a sign that she is under surveillance. She calls the police. 1 month after treatment, her symptoms are gone and within 3 months she is nml. Dx?

BRIEF PSYCHOTIC DISORDER

57 y/o has new onset speech difficulty cannot name objects and sometimes cannot say "yes or no" and cannot repeat "no ifs, ands or buts" but can follow verbal and written commands. No problems with chewing/swallowing. What is the condition? (x2)

BROCA'S APHASIA

Medication for restless leg syndrome:

BROMOCRIPTINE

Contralateral loss of pain and temp sensation with motor paralysis and proprioception loss on the other. Dx? (2x)

BROWN-SEQUARD SYNDROME (HEMISECTION)

What is a sleep disturbance likely to occur after initiating a trial of an SSRI?

BRUXISM

23 y/o pt w/ excessive preoccupation with body shape. Pt is in no apparent distress, but admits to binge eating episodes followed by purging twice weekly for past 6 months, Body weight: normal. Dx: (x2)

BULIMIA NERVOSA

Pt with significant medical hx admitted to inpatient psych unit. Labs show: low K and Cl, elevated HCO3 and amylase, and normal lipase. Dx: (2x)

BULIMIA NERVOSA, PURGING TYPE

What is the mu opioid partial agonist approved by the FDA for the treatment of patients with opioid dependence? Administered sublingually: (3x)

BUPRENORPHINE

29 y/o M h/o recurrent depression & 1.5 PPD smoking. Medication?

BUPROPION

Antidepressant for ADHD

BUPROPION

Antidepressant less likely to cause sexual dysfunction: (3x)

BUPROPION

Antidepressant with low risk of weight gain:

BUPROPION

Bulimia and depression. Contraindicated:

BUPROPION

Patient depressed, low energy, poor concentration, weight gain. Best med?

BUPROPION

What antidepressant has an FDA pregnancy use B rating?

BUPROPION

What antidepressant increases REM sleep?

BUPROPION

What med can you add to lithium for tx resistant bipolar depression and is least likely to induce rapid cycling/mixed state?

BUPROPION

What meds could be helpful in the treatment of depression in persons over the age of 65 because it does not produce orthostatic hypotension: (2x)

BUPROPION

Which medication should be discontinued prior to ECT?

BUPROPION

What med is not used in tx of opioid maintenance and relapse prevention?

BUPROPION (NALTREXONE, METHADONE, BUPRENORPHINE AND CLONIDINE ARE USED)

Smoking cessation strategy with highest success rate

BUPROPION PLUS GROUP THERAPY

Sx most likely related to excessive use of vitamin B12

BURNING SENSATIONS

3 days s/p cardiac arrest and CPR, 73 y/o man is comatose. His eyes are open but he does not fix and follow with his eyes. Doll's eyes elicits full horizontal eye movements. His spontaneous limb movements are symmetrical. Reflexes: mildly hyperactive. The EEG shows? (2x)

BURST SUPPRESSION PATTERN

35 y/o truck driver diagnosed w/ GAD. Does not want med that causes sleepiness:

BUSPAR

Dx for 45yo woman w/ pins & needles feeling in hand at night and upon awakening

CARPAL TUNNEL SYNDROME

Which term describes state of immobility that is constantly maintained? (Ability of a catatonic pt to hold the same position) (2x)

CATALEPSY

21 y/o recently diagnosed with schizophrenia becomes largely mute and occasionally repeats words in a parrot-like manner. This is a subtype of schizophrenia called:

CATATONIC

Based on epidemiological studies from 1994-2004, which groups has highest suicide completion rate?

CAUCASIAN AMERICAN MEN IN THEIR 60S

1993 - highest rate of suicide in 75-84 y/o age group:

CAUCASIAN-AMERICAN MALES

One month after a MVA, a 21y/o co persistent pain in the left shoulder and arm, with sharp pain radiating into the left thumb. Exam shows weakness of the biceps. The biceps reflex on the left is absent. The most likely diagnosis is? (2x)

C-6 RADICULOPATHY

A hyperextension lesion of the shoulder resulting in weakness of abduction, internal rotation, flexion, and adduction of the extended arm most likely includes which nerve roots?

C5, C6

Triptan drugs should not be given in abortive treatment of migraine in pts with:

CAD

Due to the increased risk of stroke and sudden death, the U.S. FDA has determined that what substance is unsafe when used in combination with ephedra?

CAFFEINE

Has intoxication syndrome but not a substance of abuse

CAFFEINE

The most common mood altering substance worldwide:

CAFFEINE

35 y/o ED physician is referred for psychiatric evaluation by ED medical director who has noted recent changes in the physician including rambling speech, psychomotor agitation, a flushed and excited appearance, and restless demeanor. On eval, physician complains of having to work excessive and different shifts due to several members of the group being out on vacation or sick. Physician also complains of palpitations. The physician admits to using alcohol to initiate sleep and more caffeine to stay alert. Dx?

CAFFEINE INTOXICATION

Acute anxiety, restless, flushed, irritable, nauseous, wo insomnia -attributes everything to stress at work

CAFFEINE INTOXICATION

Motor speech paradigm activation task on fMRI - hyperactivity in right temporal lobe. Damage is where?

CALCARINE FISSURE

27 y/o pt w/ BMD I, has been stabilized as an outpt one month following a hospitalization, and is now receiving weekly med management and supportive psychotherapy. Pt has been euthymic for the past 2 wks, but today does not show up for a scheduled appointment. The most appropriate response by the psychiatrist is?

CALL THE PT TO EXPRESS CONCERN AND FIND OUT WHY THE PT DID NOT MAKE THE APPOINTMENT

Methodological advantage of a genome wide association study in comparing individuals with schizophrenia to demographically matched controls.

CAN DETECT COMMON GENE VARIANTS THAT HAVE SMALL EFFECT ON DISEASE RISK

In considering safe sex practices for avoiding HIV infection, oral sex is best characterized by:

CAN RARELY TRANSMIT VIRUS

Question to ask when evaluating for immediate recall (3x)

CAN YOU REPEAT THESE SIX NUMBERS?

Question to evaluate immediate recall?

CAN YOU REPEAT THESE SIX NUMBERS?

Pts w/ PTSD have higher frequency of a specific genotype, this refers to what gene identification approach

CANDIDATE-GENE APPROACH

Use of which substance in adolescence is associated with development of schizophrenia?

CANNABIS

What substance is a common cause of flashbacks?

CANNABIS

Conjunctival injection in a patient with a substance use disorder is most suggestive of:

CANNABIS INTOXICATION

Patient reports that an identical-appearing impostor has replaced his father. What is the name of this delusion? (2x)

CAPGRAS SYNDROME

Which of the following is most likely to reduce pain in postherpetic neuralgia

CAPSAICIN

35 yo pt stabilized on methadone maintenance tx 5 yrs is BIB family to ED bc pt is lethargic/confused. During assessment pt becomes obtunded/resp depression. Family reports pt recently began new med. Which med is likely responsible?

CARBAMAZEPINE

Med that has potential to decrease methadone blood level: (2x)

CARBAMAZEPINE

Schizophrenic stabilized on haldol 10. Return of psychotic Sx's after starting med for another condition. Cause?

CARBAMAZEPINE

Bipolar w/ 4+ manic episodes / yr for 3 yrs. Treatment of choice?

CARBAMAZEPINE, 1200 MG DAILY

Most appropriate initial tx for idiopathic Parkinson dz in an 81 y/o pt

CARBIDOPA/LEVODOPA

What condition is a relative contraindication to ECT?

CARDIAC ARRYTHMIA

45 y/o pt has recurrent episodes of LOC. A detailed description by family: pt reporting a feeling of faintness accompanied by pallor, followed by collapse and LOC, and several seconds later by a few bilateral jerks of the arms and legs. Prior to recovery, the pt's face and chest are flushed. No precipitating factors are identified. Which of the following is the most likely explanation:

CARDIAC SYNCOPE

A 20 year old male pt presents to his physician for a physical examination because he is worried that he may have contracted an infectious disease. He states that his worry is interfering with his ability to complete work assignments. He states that he counts to 100 repetitively in order to distract himself from this worry. He has no prior medical or psychiatric history. He does not abuse substances and is not involved in any relationships. Which of the following regions of the pt's brain is most likely to show increased activity on PET scan? (2x)

CAUDATE

What MRI finding would most specifically indicate a diagnosis of Huntington's Disease? (5x)

CAUDATE HEAD ATROPHY

Best therapy for patient with illness anxiety disorder

CBT

Psychotherapy that has been shown to be effective in bulimia nervosa:

CBT

The evidence suggests that after completing treatment for insomnia, long term outcomes are better among patients with which medication/therapy?

CBT

28 y/o pt presentes with one year history of agoraphobia. Pt is able to drive to the local drug store, but only with considerable pre-travel apprehension. Pt will venture alone no further than within approximately 5 miles of home. Personal hx of panic attacks or depression is denied, although family hx is positive for depression and alcoholism. Pt has had no previous treatment. The best initial treatment and one that offers the best long term prognosis is? (x2)

CBT INCLUDING EXPOSURE & SSRI AND BENZO

CNS response to fear mediated by what structure.

CENTRAL NUCLEUS OF THE AMYGDALA

70 y/o develops flaccid paralysis following severe water intoxication. He develops dysphagia and dysarthria without other cranial nerve involvement. Sensory exam is limited but grossly normal, DTR's are symmetric, and cognition is intact. Likely dx: (2x)

CENTRAL PONTINE MYELINOLYSIS

70 y/o pt develops confusion, lethargy, and generalized tonic-clonic seizure. Lab reveals serum sodium of 95mEq/L. This is most likely a complication of excessively rapid correction of which metabolic problem?

CENTRAL PONTINE MYELINOLYSIS

Unsteady gait, appendicular ataxia in LE only and normal eye movement. Walks with lurching broad-based gait. (8x)

CEREBELLAR DEGENERATION (ALCOHOLIC)

66 y/o M in ED w/ sudden occipital HA, dizziness, vertigo, N/V, unable to stand, mild lethargy, slurred speech. Exam: small reactive pupils, gaze deviated to the R, nystagmus, w/ occasional ocular bobbing, R facial weakness, decreased R corneal reflex, truncal ataxia, b/l hyperreflexia, b/l Babinski. Dx?

CEREBELLAR HEMORRHAGE

Tremor with a frequency of around 3 Hz, irregular amplitude, most evident towards the end of reaching movements: (2x)

CEREBELLAR TUMOR

Normal Romberg w/ eyes open but loses balance with eyes closed. Where is the abnormality?

CEREBELLAR VERMIS

52 y/o M presents with a chief complaint of gait difficulties. On exam: mild dysarthria, very mild finger to nose ataxia and minimal heel to shin ataxia. Romberg test: negative, but very unsteady while walking and walks with a broad-based, lurching gait. The plantar reflexes are flexor. Imaging studies are most likely to demonstrate:

CEREBELLAR VERMIS ATROPHY

Unilateral hearing loss, vertigo, unsteadiness, falls, headaches, mild facial weakness and ipsilateral limb ataxia is most commonly associated with tumors in what locations?

CEREBELLOPONTINE ANGLE

26 y.o. w/HA and R-hand clumsiness for weeks. Exam shows difficulty w/rapid alternating movements of hand, overt intention tremor on finger-to-nose, and mildly dysmetric finger tamping. CNS intact and no papilledema. Where will damage show on MRI? (5x)

CEREBELLUM

Abnormal emotional expressions such as pathological laughter or crying caused by lesions affecting cortical subcortical circuits linking frontal cortex, pons and what?

CEREBELLUM

Presence/severity of depressive Sx in MS is correlated with:

CEREBRAL INVOLVEMENT

43 y/o pt w/ memory loss x 8 months associated with abd pain, wt loss, joint distention/pain, fever, lymphadenopathy, hyperpigmentation of skin, decrease hemoglobin, and fat in stool. Which test result is likely to be found in this patient?

CEREBROSPINAL FLUID WITH PAS+ CELLS INFECTED WITH TROPHERYMA

25 yo pt w several year cognitive decline, dysarthria, dysphagia, and slow movements. Has hand tremor which increases in amplitude on arm extension. Also has hepatic disease of unknown etiology. Ocular exam reveals golden brown ring around cornea. Can confirm diagnosis w blood test for?

CERULOPLASMIN

28y/o with emotional lability and impulsivity. LFT's elevated. Close relative had similar sx and died at 30y/o from hepatic failure. Which blood level would be diagnostic? (3x)

CERULOPLASMIN

A 63 y/o pt with insidious onset of neck pain, progressive limb weakness, falls, and urinary incontinence. On exam, pt has decreased neck ROM, mild distal and proximal limb weakness, brisk DTRs with ankle clonus, and upgoing plantar reflexes. Increase muscle tone in legs. Rest of exam is normal. What is most likely dx?

CERVICAL MYELOPATHY

Pt displays spastic gait in which legs are stiff, feet scrape against floor, and legs circumduct which each step. Reflexes are increased and plantar responses are extensor bilaterally. Dx?

CERVICAL SPONDYLOSIS

Stiffness of legs while walking and spasms of LE while sleeping. Stiff legged gait, adducts legs while walking. Increased LE tone/spastic catch, hyperactive knee jerks, ankle jerk clonus. Increased Romberg sway. (5x)

CERVICAL SPONDYLOSIS

Schizophrenic on haldol 10 develops acute EPS. Cause?

CESSATION OF SMOKING

What is the first step to manage restless leg syndrome?

CHECK FOR IRON DEFICIENCY

A broad-based rating scale for psychiatric symptoms in children? (2x)

CHILD BEHAVIOR CHECKLIST (CBCL)

Night terrors typically appear when in life?

CHILDHOOD

5 y/o is evaluated for ADHD. Parents complain that the child has multiple symptoms of hyperactivity, impulsivity, inattention, and distractibility. Parents also bring teacher feedback reports that confirm these symptoms and state child is failing academically and having social problems. In psych MD office child is quiet, calm and cooperative, and very engaging . The difference in clinical presentation from parent and school reports is most likely because:

CHILDREN WITH ADHD CAN PRESENT WITH BRIEF PERIODS OF HEIGHTENED FOCUS AND CALM, ESPECIALLY IN A STRUCTURED SETTING.

55 y/o pt presents for detox after alcohol binge. Pt reports "mild liver disease." Labs reveal ALT is 80 and AST 70. What would be the preferred agent for detox?

CHLORDIAZEPOXIDE

Which neurotransmitter system is the last to mature in the CNS of children and adolescents? (2x)

CHOLINERGIC

Involuntary set of flowing jerky movements in multiple joints describe:

CHOREA

Children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) often manifest:

CHOREIFORM MOVEMENTS AND OCD SYMPTOMS

What is part of routine workup of child with mental retardation but without dysmorphic features or neurological findings?

CHROMOSOMAL ANALYSIS

AIDS pt, progressive weakness of extremities over weeks. Distal sensory deficit for pinprick and vibration. Slow nerve conduction, but EMG shows no denervation

CHRONIC INFLAMMATORY DEMYELINATING POLYRADICULONEUROPATHY

Risk factors for somatic symptoms disorder

CHRONIC PHYSICAL ILLNESS

ECT is least likely to be effective for patients who have?

CHRONIC SCHIZOPHRENIA

Increases paxil concentration:

CIMETIDINE

Pt on methadone maintenance started taking a reflux drug and now is sedated. What med was recently added?

CIMETIDINE

35 M w/ severe OCD, failed multiple meds, CBT and ECT, what next?

CINGULOTOMY

Which of the following antibiotics is most likely to cause or precipitate acute myasthenia?

CIPROFLOXACIN

On MSE, thought process with lack of goal directedness, excessive details, and difficulty with closure describes a thought pattern of: (2x)

CIRCUMSTANTIALITY

What chemo agent is most commonly assoc with distal sensory polyneuropathy? (3x)

CISPLATIN

SSRI w/ no or mild inhibition of major P450 isoenzymes of 1A2, 2C9, 2C19, 2D6, 3A4

CITALOPRAM

Which of the following has the longest mean half-life: citalopram, paroxetine, venlafaxine, fluvoxamine, trazodone (x2)?

CITALOPRAM

Pts that "cut" as a form of self-mutilation typically:

CLAIM TO FEEL NO PAIN

Pt is nonsensical but is rhyming. What is this called? (4x)

CLANG ASSOCIATION

What procedure is necessary to diagnose childhood ADHD?

CLINICAL INTERVIEW OF PARENTS AND CHILD

Initial approach for child with new-onset tic disorder

CLINICAL MONITORING

Elderly pt with profound apathy, how do you distinguish depression from executive dysfunction?

CLOCK DRAWING

25 y/o with OCD diagnosed 2 years ago is likely to benefit from what medicine (in addition to psychotherapy)? (2x)

CLOMIPRAMINE

Which TCA has consistently been found to be useful in long term treatment and relapse prevention of OCD?

CLOMIPRAMINE

causes seizure in overdose?

CLOMIPRAMINE

Which medication is most effective in the treatment of cataplexy?

CLOMIPRAMINE (TCAs 2/2 TO INC NE)

Most effective treatment for REM sleep behavior disorders.

CLONAZEPAM

What drug is used to treat autonomic sxs associated with heroin withdrawal? (3x)

CLONIDINE

These empirical non-stimulant meds have empirical support to treat ADHD:

CLONIDINE, BUPROPION, IMIPRAMINE, ATOMOXETINE

In ER, which symptoms most strongly suggest a general medical condition? (2x)

CLOUDED SENSORIUM

Suggests delirium rather than dementia:

CLOUDING OF CONSCIOUSNESS

HIV seropositive pt w/ psychotic symptoms has an absolute neutrophil count of 950 cells/mm3. Pt is on zidovudine, lamivudine, and ritonavir. What antipsychotic would be contraindicated? (2x)

CLOZAPINE

Reduces the suicide rate in adults with schizophrenia:

CLOZAPINE

Superior efficacy for atypical antipsychotics over typical antipsychotics in the treatment of psychosis has been consistently demonstrated in what medications? (x2)

CLOZAPINE

Which antipsychotic med is assoc with decreased psychotic sxs, decreased substance use, and increased abstinence in pts with schizophrenia and addictive d/o?

CLOZAPINE

Which of the following antipsychotic meds is most likely to be effective in pts with refractory schizophrenia who have failed to improve with other antipsychotics? (2x)

CLOZAPINE

24 yo m with nocturnal HA resulting in early am waking. ROS +rhinorrhea, nostril blocking and ipsilateral eye tearing and facial swelling. HA persists 45-60 min. Likely dx: (2x)

CLUSTER HA

32 yo has a new onset headache with unilateral stabbing eye pain, also experiences runny nose and conjunctival injection on same side as headache occurring every evening after falling asleep and last 2 hours. Diagnosis?

CLUSTER HA

35 y/o M awakens frequently middle of night with severe HAs, which sometimes occurs nightly and lasts approx 1-2 hrs, so severe that pt is afraid to go to sleep, located around L eye and assoc with lacrimation, ptosis, & miosis. Likely dx is: (12x)

CLUSTER HEADACHES

Genetic linkage studies investigates what in medico-psychiatric research:

CO-SEGREGATION OF GENES DURING MEIOSIS

During the acute initial refeeding phase of tx for pt w/ severe anorexia nervosa, which is most helpful focus of psychotherapeutic interventions with the pt? (4x)

COACHING, SUPPORT, AND POSITIVE BEHAVIORAL REINFORCEMENT

72 yo with profound sensory ataxia with loss of vibratory sensation and cognitive issues with irritability and somnolence. Nutritional deficiency?

COBALAMIN

Progressive LE stiffness & hyperreflexia (ankle clonus) with extensor plantar responses and decreased light-touch & vibration/proprioception in b/l stocking pattern?

COBALAMIN DEFICIENCY

2 days s/p hospitalization dysphoric, fatigued, hypersomnic, vivid dreams, requesting double portions:

COCAINE

A state of general fatigue, hypersomnolence, and depression may be seen during a patient's withdrawal from: (4x)

COCAINE

A substance of abuse with powerful reinforcing effect:

COCAINE

Tachycardia, HTN, excessive perspiration, pupils dilated in college student after attending a party. Drug? (2x)

COCAINE

Not pregnant premenopausal pt in ED has galactorrhea, elevated prolactin level, pt denies seizures or antipsychotic meds. What condition could explain this?

COCAINE WITHDRAWAL

35 y/o pt in ED presents w hypoventilation, blue lips, pinpoint pupils, crackles on lung auscultation, mild arrhythmia on EKG. Most likely drug of abuse: (4x)

CODEINE

Psychiatrist asks "How many quarters are in $15?", examining what ability

COGNITION

Most important potential side effect of ECT to discuss with 78 yo patient (2x)

COGNITIVE DYSFUNCTION

Most commonly limits the use of ECT:

COGNITIVE IMPAIRMENT

Prophylactic Treatment for a pt with severe delusional depression following a course of ECT includes what?

COMBINATION OF ANTIPSYCHOTICS AND ANTIDEPRESSANTS

Why is there a relatively high rate of suicide in epileptics?

COMORBID PSYCHIATRIC DISORDERS

The presence of which of the following would suggest that a patient has somatization disorder rather than a general medical condition?

COMPLAINTS INVOLVING MULTIPLE ORGAN SYSTEMS

32 Pt reports AH of someone not present, then stops moving, stares blankly, repetitively picks clothing, and does not respond for several minutes. Symptoms resolve after 15min but pt has no recollection of events. This represents what type of seizure?

COMPLEX PARTIAL

Seizures get controlled, then has paranoid delusions, what type of seizure

COMPLEX PARTIAL

28 y/o female referred to psych d/t recent onset episodes of altered behavior lasting 1 to 2 minutes. Husband notes if occurs when cooking pt will place the clean silverware back in dishwasher. Also notes she does drawing movements he is unable to interrupt. Pt has no recollection of the events. MRI scan is normal. Diagnosis? (x2)

COMPLEX PARTIAL SEIZURES

Pt w/ episodes of altered behavior lasting 1-2 minutes. During episodes pt makes chewing movements. Pt has no recollection. MRI is normal. Dx?

COMPLEX PARTIAL SEIZURES

Psych MD asks a patient, "are there things you must do in a particular way or order?"which this question, psych MD is trying to elicit?

COMPULSIONS

Repetitive behaviors that the pt feels compelled to perform ritualistically, while recognizing the irrationality and absurdity of the behaviors, describes:

COMPULSIONS

65 y/o pt w MDD has died by suicide. Pt had received tx from same psychiatrist x 5 yrs. Psychiatrist contacts the pt's spouse. Best way to communicate this?

CONCENTRATE ON ADDRESSING THE FEELINGS OF THE SPOUSE

Asking a patient to recite a series of numbers in reverse order is a standard test of:

CONCENTRATION

The purpose of asking a pt to start at 100 and count backwards by 7's is to measure which of the following?

CONCENTRATION

Which comorbid diagnosis of childhood ADHD worsens the prognosis into adolescence and adulthood to the greatest degree?

CONDUCT DISORDER

Fluent speech w preserved comprehension, inability to repeat statements is consistent with what type of aphasia?

CONDUCTION

Electrodiagnostic test finding most indicative of a demyelinating neuropathic process?

CONDUCTION BLOCK

Pt c/o hearing loss on right side. When tuning fork held at vertex of skull, pt hears sound better on the right. When fork is held in front of the pt's ears, pt reports hearing it better on the left. Dx?

CONDUCTIVE HEARING LOSS ON THE RIGHT

Risk factor that can adversely influence psych outcome of child after death of parent

CONFLICTUAL RELATIONSHIP W/ DECEASED PARENT

What is the easiest scale to use for initial assessment of delirium in geriatric patients?

CONFUSION ASSESSMENT METHOD

What medical condition has highest relative risk for adverse event with ECT?

CONGESTIVE HEART FAILURE

Which of the following subjective effects is the basis of the appeal of MDMA?

CONNECTEDNESS TO OTHERS

New-onset back pain after shoveling - left paraspinal muscle spasm, negative straight leg raise, reflexes symmetric, no weakness, no sensory deficit. Management?

CONSERVATIVE (BED REST) WITH NSAIDS

Suicidal thoughts, constant worrying, feels depressed, guilt, lacks energy, hypersomnia, feels ineffective at work. Tx?

CONSIDER TX W/ ANTIDEPRESSANT

SI, tearful, sad, does not smile, normal prosody, affect?

CONSTRICTED

In pts w/ recurrent depression, successful Tx with antidepressants should be followed by which Tx strategies?

CONT ANTIDEPRESSANT AT SAME DOSE

What is the most common pattern of obsessions in pts with OCD? (x2)

CONTAMINATION

Pt who is dependent on cannabis had a period of cancelling appts frequently but is now showing up consistently and acknowledges that the negative costs of marijuana outweigh the anxiolytic effect and is committing to altering his use. Pt is at which stage of change?

CONTEMPLATION

Test for anxiety that does not include Qs about physical sx such as tachycardia and diaphoresis would be considered lacking in what?

CONTENT VALIDITY

Pt in methadone tx earns number of take-home doses based on compliance with attendance and participation in groups. What kind of intervention is this? (2x)

CONTINGENCY MANAGEMENT

Pt w/ h/o Depression and well--controlled epilepsy responded to bupropion after failing on several antidepressants. Pt had not tried imipramine, nortriptyline, duloxetine, and selegiline. No Sz have occurred on bupropion 100mg BID. Insurance recommends changing med due to reduced sz threshold with bupropion. What is appropriate response from psychiatrist?

CONTINUE BUPROPION

A patient with depression and epilepsy responded well to Bupropion SR. No seizures have occured while on bupropion SR.. Insurance wants to switch antidepressant because of buproprion's side effect of reducing seizure threshold. What should the psychiatrist do?

CONTINUE BUPROPION SR

58 y/o pt is started on citalopram 20mg for MDD. After 3 wks pt reports some improvement in vegetative sxs but remains dysphoric. What is the next step?

CONTINUE CITALOPRAM AT THE PRESENT DOSE WITH NO ADDITIONAL MED

Previous dual antipsychotic failure. Tolerating Clozapine 200mg for a month. What should be next step in medication management?

CONTINUE CLOZAPINE BY ITSELF

Pt has not responded to adequate trials of SSRI, SNRI, TCA, MAOI, but feels improved with 8 treatments of ECT. What next?

CONTINUE MAINTENANCE ECT FOR AT LEAST 10 WEEKS

Patient in sustained opioid remission is now 10wk pregnant, how to manage?

CONTINUE METHADONE CURRENT DOSE

Can 65 yo patient with family history of dementia continue to drink the same amount of alcohol in their old age

CONTINUE THE ALCOHOL AS LONG AS PATTERN ON USE DOES NOT CHANGE

65y/o had MDD but was treated w/ CBT to remission. Usually has 1 glass of wine w/ dinner. Same level of drinking for many years. Family h/o dementia in both parents. Advice? (3x)

CONTINUE THE ALCOHOL AS LONG AS THE PATTERN OF USE DOES NOT CHANGE

Pt w/ hx of MDD has been taking Fluoxetine 40 mg PO QDay for one year since achieving remission of third depressive episode. Pt wants to stop medication because of sexual side effects responsive to Sildenafil 100 mg PRN. What should psychiatrist recommend to pt?

CONTINUE THE FLUOXETINE AS LONG AS IT IS EFFECTIVE

1-month post death of loved one. What would suggest a pathological grief rxn?

CONTINUED FEELINGS OF WORTHLESSNESS

In pts with recurrent depression, successful treatment with antidepressants should be followed by which treatment strategy?

CONTINUING ANTIDEPRESSANTS AT THE SAME DOSAGE

24 y/o pt w/ sudden onset stumbling and pain in legs, negative neuro workup - saw a counselor previously for protracted grief after father's death - increased conflict with husband. Dx?

CONVERSION D/O

40-year-old cannot speak after a screaming argument with spouse. Patient writes, "I have been trying to speak, but cannot make a single sound." Throat exam is normal. There is an occasional loud cough. Diagnosis?

CONVERSION DISORDER

Adolescent on neurology service for loss of vision with all negative testing. Walks around garbage can. Dx?

CONVERSION DISORDER

Pt presents with sudden right leg paralysis with normal reflexes, doctor feels increased pressure under affected leg when patient lifts unaffected leg. Diagnosis is:

CONVERSION DISORDER

What is associated with a markedly increased risk of complications from ECT? (x2)

COPD

Name for tics comprised of obscene gestures (2x)

COPROPRAXIA

Right handed pt recently underwent neurosurgery is now unable to name objects in left hand when blind folded. He was able to name them when displayed on a screen. Where was the surgery?

CORPUS CALLOSUM

12 yo comes in for worsening attention, impulsive, and hyperactive. He is snoring and hard to wake in the AM. Central adiposity, broad based neck and enlarged tonsils. exam is unremarkable. In child with ADHD and sleep problems, what is the most accurate about ADHD and sleep in this patient?

CORRECTING THE UNDERLYING SLEEP DISORDER CAN IMPROVE ADHD SYMPTOMS

Poststroke depression in 80 yo pt (R handed) is assoc w cognitive impairments that:

CORRELATE WITH LEFT HEMISPHERIC INVOLVEMENT

Why would brains >65 years old or a history of alcoholism more susceptible to chronic subdural hematoma?

CORTICAL ATROPHY (LONGER DISTANCE FOR BRIDGING VEINS TO BE DAMAGED)

Neurosurgical approach that treats refractor OCD targets what structure?

CORTICO-STRIATAL-THALAMO-CORTICO- CIRCUITRY

What does the hypothalamus secrete when you are stressed?

CORTICOTROPIN RELEASING HORMONE CRH

Psych MD in the ER evaluates a 27 y/o pt with no past psychiatric history who presents with SI following an altercation w/ her boyfriend. The psych MD makes a diagnosis of adjustment disorder with mixed emotional features. What is initially most appropriate for the psych MD to recommend for this pt?

CRISIS INTERVENTION

What factor is necessary to consider when deciding if a patient's grief is defined as normal or abnormal?

CROSS-CULTURAL GRIEF PRACTICES

Schizophrenic with poor response to 3 trials of antipsychotic meds, next step? (2x)

CROSSOVER TO CLOZAPINE

Immunocompromised patient with confusion and mild headache, b/l papilledema and cerebellar ataxia. CSF stain shows pleocytosis, inc. protein, low glucose? India ink stain shown below. What is diagnosis?

CRYPTOCOCCUS

52 y/o pt with EtOH dependence present with several days of severe headache, nausea, and low grade fever. Physical exam reveals mild disorientation, nuchal rigidity, and mild spasticity in the lower extremities. A head CT is unrevealing. LP: 55/mm3 leukocytes (mostly lymphocytes), 45 mg/dl glucose, protein: 43 mg/dl, and presence of occasional gram positive spherical cells. The most likely causative organism is:

CRYPTOCOCCUS NEOFORMANS

After an injection with haldol, a patient appears tremulous, dystonic, confused, and has a fever of 38.8 degrees C. Which of the following would be an essential part of the diagnostic workup for this patient? (2x)

CSF EVALUATION

75 y/o with hx of extensive tobacco smoking presents with subacute progressive ataxic d/o over several months. MRI brain is unremarkable. CSF shows mild pleocytosis. Found positive for anti-Yo antibody. What test should be ordered next?

CT CHEST

Pt in ED with sudden HA and collapsing, some lethargy. Exam shows rigid neck, no papilledema, no focal CN or motor signs. The initial test should be?

CT HEAD

72-year-old pt presents with subacute onset of progressive ataxia of gait and limbs. Lab testing reveals the presence of an anti-Yo antibody in serum. Which of the following tests should be ordered next?

CT SCAN OF THE CHEST, ABDOMEN, AND PELVIS

Next test to order after anti-Yo antibody found in serum in 72 year old patient with subacute onset of progressive ataxia of gait and limbs

CT of chest (also CT of abdomen and pelvis)

Reducing the intensity of an addict's reaction to environmental reminders of drug use is a goal of what intervention?

CUE EXPOSURE TREATMENT

Guy drinks 12-15 cups of coffee a day, Has insomnia and headaches relieved by drinking coffee. Irritable and poor concentration if he doesn't drink coffee. How to treat?

CUT CAFFEINE BY 25% WEEKLY

What does CAGE stand for? (7x)

CUT DOWN, ANNOYED, GUILTY, EYE OPENER

34 y/o F presents "unable to reach her potential" w mood switches frequently (day to day, sometimes within one day) from mildly to moderately. Depressed to happy in the morning. No episodes meeting criteria for mania. Hx suggests most likely Dx? (2x)

CYCLOTHYMIC DISORDER

Strongest genetic contribution

CYCLOTHYMIC DISORDER

Histology consistent with Jakob-Creutzfeldt disease

CYTOSOLIC VACUOLATION OF NEURONS AND GLIA WITH PRION INCLUSIONS

Which medication class exacerbates physiology tremor? Barbiturates, corticosteroids, benzos, CCB's, Beta blockers

Corticosteroids

Which of the following agents has been shown to augment the effects of CBT on anxiety disorders?

D-CYCLOSERINE

A consult is requested for a patient on a medical ward who is agitated and hallucinating. Pt appears to be flushed and hot with dry skin, mydriasis, a rapid pulse and diminished bowel sounds. What is your first recommendation?

D/C ANTICHOLINERGIC DRUGS

A 75 yo with baseline dementia admitted for new onset confusion, disoriented to time and place, work up negative, started on Haldol. After 3 days pt is much improved and minimally somnolence but still disoriented, what is the next pharmacological treatment approach

D/C HALDOL

Which vitamin is effective as an adjunct to antidepressants for treating depression?

D3

44 yo M found wandering aimlessly, brought into ED, BP is 200/132, HR 112 and regular. Pt is belligerent, picking his skin, feels like insects crawling on his skin. Oriented only to name, tremulous, is diaphoretic, dilated pupils, palmar erythema, and spider angiomata on chest. What explains his symptoms?

DELIRIUM TREMENS

Indication for treating a manic w/ ECT:

DANGEROUS LEVELS OF EXHAUSTION

MAOIs affect catecholamines by directly retarding:

DEACTIVATION

Across all cultures, what stressful life changes is correlated with greatest increase in death and illness in the subsequent 2 years?

DEATH OF A SPOUSE

Role of the hippocampus and parahippocampal gyrus? (4x)

DECLARATIVE MEMORY (FACTS)

60y/o on 6mg risperidone, 50mg sertraline. Slowed thinking, drooling, cog-wheeling, masked facies. Mood/paranoia improved on meds. What to do? (5x)

DECREASE DOSE OF THE ANTIPSYCHOTIC

One year after achieving methamphetamine abstinence, these craving will most likely:

DECREASE IN INTENSITY

36 y/o pt c/o dysphoria, insomnia, fatigue, poor concentration. Pt is started on sertraline 50mg, increased to 100mg in 2 weeks. 2 months after dose increase, pt reports mood greatly improved. However, pt notes new onset of sx of delayed ejaculation, frequently to point of anorgasmia. He believes this began almost immediately after dose increase. First step in management of problem would be?

DECREASE THE SERTRALINE DOSAGE TO 50MG/DAY

Myasthenia gravis associated w/ which EMG finding? (10x)

DECREASED AMPLITUDE WITH REPETITIVE MOTOR NERVE STIMULATION

How estrogen modulates effects on neuroinflammation

DECREASED INFLAMMATORY CYTOKINES

Early stage HIV type I associated dementia as compared to early onset dementia has which of the following deficits?

DECREASED PROCESSING SPEED

A characteristic of non-REM sleep?

DECREASED RECALL OF DREAM ACTIVITY

What finding on a multiple sleep latency test (MSLT) confirms the diagnosis of narcolepsy?

DECREASED REM LATENCY

Alcohol use is associated with what changes in sleep?

DECREASED REM SLEEP

Metabolic abnormality commonly found w anorexia nervosa/purging subtype? (4x)

DECREASED SERUM POTASSIUM

Individuals who consume ETOH at night usually develop:

DECREASED SLEEP LATENCY

Sinusoidal waves at 9-11 Hz on EEG is:

DEEP SLEEP

T2 MRI figure in pt with cervical myelopathy. Most consistent with what dx?

DEGENERATIVE CERVICAL SPONDYLOSIS

Disorder associated with decreased sex steroid secretion and loss of fast-conducting peripheral sensory nerves with aging?

DELAYED EJACULATION

58 y/o have week's h/o intense feelings of sorrow and bitterness only 6 mos after wife's death. "We would have been married 30 yrs this month." His daughter confirmed his level of functioning only took a dip a week ago. Moderate diff sleeping and poor appetite only assoc Sxs. No SI. Physical exam normal. Dx:

DELAYED GRIEF

52 y/o pt w/ hx of depression & HTN hospitalized, being evaluated by psych resident. His family reports he had severe HA & "has not been himself" for 10 days. On exam, pt has poor eye contact and is inattentive, muttering, picking at his clothes, occasionally dozing off although it is midday. Dx: (4x)

DELIRIUM

72 w/ recent behavior/memory problems. Disrobing, not sleeping, irritable. Waxing and waning consciousness. Dx? (8x)

DELIRIUM

Pt with ICU psychosis most likely has what condition? (2x)

DELIRIUM

Alcoholic p/w 2 days confusion, AH/VH, disorientation, distractibility, with fever, tachycardia, and tremor. EEG shows low-voltage fast waves superimposed on slow waves. Long-term olanzapine treatment for schizoaffective d/o. Dx?

DELIRIUM A/W ETOH WITHDRAWAL

21 y/o pt is hospitalized w/ 4 wk hx of progressive paranoia, irritability, confusion and sleep disturbance. Psych MD elicits pt hx of viral illness preceding the onset of psychiatric Sx and mental status changes. No family psych hx. Benadryl markedly make Sx worsened. Dx:

DELIRIUM SECONDARY TO VIRAL ENCEPHALITIS

54 y/o pt with gastric ulcer undergoes emergent surgery and 30 hrs post-op becomes confused, agitated and responds to internal stimuli and suffers a generalized tonic-clonic seizure: Dx:

DELIRIUM TREMENS

Changes w/ sleep associated with aging:

DELTA WAVE AMPLITUDE DECREASES AND PROPORTIONALLY LESS TIME IS SPENT IN STAGE 3 AND 4

Pt believes he is the Son of God. This Sx is called:

DELUSION

Belief that television is sending you special messages

DELUSION OF REFERENCE

Isolated erotomania is a form of what?

DELUSIONAL D/O

Normal male, except that he is paranoid about wife cheating on him:

DELUSIONAL D/O

Complaints of skin infection with insects, negative medical w/u:

DELUSIONAL D/O, SOMATIC TYPE

80 yo male tells PCP he thinks his wife of 55 years is having an affair, wife and two middle aged children disagree. Pt acknowledges no clear evidence of his belief. Pt is healthy, no psych history, no hallucinations, cognitive testing is normal for age. What is his most likely diagnosis?

DELUSIONAL DISORDER

Erotomania refers to which of the following conditions?

DELUSIONS OF A SECRET LOVER

Binswanger disease has pseudobulbar state, gait disorder, AND:

DEMENTIA

What is a poor prognostic sign for HIV?

DEMENTIA

65 y/o is brought to the ED with disorientation and mild agitation, and is experiencing vivid VH of several children playing inside the house. Two similar episodes in the past, normal in between episodes. Normal language and memory, normal CN, mild symmetric rigidity and bradykinesia, no deficits. MRI, drug screen, CSF normal:

DEMENTIA WITH LEWY BODIES

80 y/o with VH and worsening gait, episodic confusion, disturbed sleep, fighting in sleep, bilateral rigidity, masked facies. Levodopa/carbidopa improved movement temporarily. Diagnosis? (4x)

DEMENTIA WITH LEWY BODIES

Neurocog d/o with fluctuating rate of progression, visual spatial impairment and early unilateral resting tremor and increased muscle tone.

DEMENTIA WITH LEWY BODIES

65 y/o high school grad has a MMSE score of 23, this score would suggest which of the following:

DEMENTIA, MILD COGNITIVE IMPAIRMENT

25 y/o pt with pain in L periorbital region, followed by blurring then loss of vision in left eye. Exam normal but no reaction when light shone on L eye. This is consistent with:

DEMYELINATING LESION OF LEFT OPTIC NERVE

Neural plasticity is largely mediated through the capacity to rapidly change in number and morphology of what?

DENDRITIC SPINES

Neurogenesis in adult brain is restricted to what region of the brain?

DENTATE GYRUS

Pt becomes panicky and distressed every time psychiatrist goes on vacation, this pattern is most likely a characteristic of:

DEPENDENT PERSONALITY

DDx of histrionic personality disorder includes what other personality d/o?

DEPENDENT PERSONALITY DISORDER

Which personality d/o should be in the dif dx of agoraphobia:

DEPENDENT PERSONALITY DISORDER

20 y/o in MVA, no injuries - speaks softly, feels calm, dim vision, mechanical movements, feels detached:

DEPERSONALIZATION

A feeling of being outside oneself or detached (x2)

DEPERSONALIZATION

Patient presents with complain "I think I'm going crazy." Reports that she has no self and thoughts are not her own. Feels like a robot and is unable to control her body. States she has feelings and is not able to feel them. Feels emotionally numb. Feels head is "full of cotton." Recently started having "out of body experiences." Diagnosis?

DEPERSONALIZATION / DEREALIZATION DISORDER

ADHD comorbid disorder

DEPRESSION

Blunted response to TRH stimulation test correlates with ...

DEPRESSION

Clinical syndrome that is most commonly comorbid with Parkinson's disease:

DEPRESSION

Most common psych complication from TBI

DEPRESSION

Most common psychiatric presentation following a stroke? (2x)

DEPRESSION

Strongest predictor in pt following MI (ever stronger than EF):

DEPRESSION

This neuropsych symptoms is most commonly seen in mild neurocognititve disorder

DEPRESSION

Which disease is most likely to present as pain disorder?

DEPRESSION

Which Sx is most common in pts with SLE?

DEPRESSION AND/OR COGNITIVE DYSFUNCTION

The presence of adverse life events has been associated with precipitation of which of the following aspects of bipolar disorder?

DEPRESSIVE EPISODE

A profound breakdown in both the logical connection between ideas and the overall sense of goal-directedness of speech is called:

DERAILMENT

A diagnostic feature of panic attack is: (2x)

DEREALIZATION

Detachment of emotional component from perception

DEREALIZATION

Psychiatrist and patient move from the day room to an interview room where they have met on several occasion. The patient states, "the room looks weird and different today; it doesn't feel right." This statement is an example of:

DEREALIZATION

80yr old pt with MDD has tried SSRIs and SNRIs with no improvement, wants to start TCA, no cardiac hx and EKG is normal, which medication is most appropriate due to the side effect profile?

DESIPRAMINE

A psychiatrist wished to start an inpatient on a TCA but the pt is reluctant due to hearing these drugs may cause dry mouth, constipation, blurred vision and urinary retention. What TCA would have the least side effects?

DESIPRAMINE

Antidepressant preferred for >65 y/o for which blood levels are clinically useful (3x)

DESIPRAMINE

Avoidant PD differs from Schizoid PD by: (2x)

DESIRE FOR SOCIAL RELATIONS

An appropriate purpose for projective testing is: (3x)

DETECTING THE PRESENCE OF SUBTLE PSYCHOTIC THOUGHT PROCESSES

What does functional MRI measure?

DETECTS BLOOD FLOW

Pt confides to the psych MD that the pt's spouse has been physically abusing the pt. In all cases, the psych MD should do what before the pt leaves office?

DETERMINE WHETHER THE PATIENT IS IN PRESENT DANGER

Core principle of motivational interviewing when used to treat addictive disorder:

DEVELOP DISCREPANCY

Child w ADHD ineffective Tx with methylphenidate. Next step in management: (4x)

DEXTROAMPHETAMINE

Substance found in several over-the-counter symptom cold remedies and is abused to produce a dissociative feeling: (2x)

DEXTROMETHORPHAN

Which OTC drug causes a dissociative feeling

DEXTROMETHORPHAN

Psych stress increases cortisol and prolonged cortisol is associated with bad outcomes. Stress also affects other hormones. Increase in which hormone is correlated with decreased PTSD severity most likely due to hormone's anti-glucocorticoid properties:

DHEA

Orbital pain with L eye paralysis of adduction and elevation of the eye but normal pupil function. Dx?

DIABETIC 3RD NERVE PALSY

55 y/o w/ DM and HTN develops R periorbital pain and diplopia. Exam: paralysis of abduction of R eye.

DIABETIC 6TH NERVE PALSY

Irregular asymmetric small (1-2mm) pupils which reacts to accommodation but not to light.

DIABETIC AUTONOMIC NEUROPATHY

Which is an advantage for CT head vs MRI?

DIAGNOSING ACUTE EPIDURAL HEMORRHAGE

A pt who has been receiving dialysis tx for years has become more disoriented, has memory loss. Physical exam normal, nursing staff report that pt has begun to have seizures. Blood lab testing shows no obvious etiology, neurodiagnostics show no suggestive findings. What most likely accounts for this presentation?

DIALYSIS DEMENTIA

Which side effect occurs less frequently in pts treated with mirtazapine vs SSRIs?

DIARRHEA

Drug least effective as adjunctive tx of chronic violent behavior

DIAZEPAM

Due to its rate of oral absorption, what most enhances the euphoria produced by benzodiazepines with methadone?

DIAZEPAM

What are splice variants?

DIFFERENT PROTEINS ENCODED BY THE SAME GENE

CT scan is better than MRI for what?

DIFFERENTIATING HEMORRHAGING FROM EDEMA

25 y/o M w 7 months depression, forgetfulness, weight loss, insomnia, painful tingling in both feet+incoordination. Involuntary choreic movements of B/L UE, apathetic, monosyllabic. Labs normal. EEG: mild diffuse slowing. CT/MRI nml. During admission develops severe akinetic mutism, seizures, dies. Brain autopsy shows:

DIFFUSE AMYLOID PLAQUES, SPONGIFORM NEURONAL DEGENERATION, AND SEVERE ASTROGLIOSIS

Principal mechanism of termination of synaptic activity of dopamine in prefrontal cortex?

DIFFUSION

Which MRI technique most likely reveals early signs of ischemic stroke?

DIFFUSION WEIGHTED MRI

MRI finding for woman with memory decline, urinary incontinence, and trouble walking

DILATION OF VENTRICLES

Best treatment for genito-pelvic pain/penetration disorder

DILATION WITH GRADUATED SIZED VAGINAL DILATORS

25 y/o pt hospitalized for an acute psychotic break, begins to complain of thickened speech. Physical exam reveals eyes deviated to the upper right, grimacing, and posturing of the arms. The only meds taken were haldol and clonazepam. The most helpful treatment at this point would be: (3x)

DIPHENHYDRAMINE

35 yo with hx of migraines has daily migraines for past 3 months no longer responding to sumatriptan which she now takes daily. Hx of MDD but reports okay mood. Normal physical exam. Preferred initial approach.

DISCONTINUE SUMATRIPTAN

Primary focus of pt with hypochondriasis:

DISEASE

A 35 yo F 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. Pt 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? (x2)

DISEASE INDUCED CEREBRITIS

Which psychiatric disorder is comorbid with ADHD?

DISRUPTIVE BEHAVIOR DISORDERS

A patient presents to the ED after witnessing a tragic MVA in which they witnessed a death. What symptom present immediately following the event increases the individual's risk of developing PTSD?

DISSOCIATION

Psychiatrist asks, "Do you find things in your possession that you cannot explain?" Trying to elicit:

DISSOCIATION

The most common acute effect of recreational ketamine use:

DISSOCIATION

55 year old brought to ED disheveled and behaving strange, stares blankly and is mute. Doesn't know who they are and all studies are negative. Has vague memory of "walking away from something horrible". Dx?

DISSOCIATIVE AMNESIA

What is an effective treatment for obsessive compulsive disorder?

ESCITALOPRAM

Pt brought to ed by family because of concern for pts ability to recognize them since TBI one month ago. Pt had LOC after trauma. Tenderness and swelling over L temporal area. Neuro exam normal. Pt knows own name, but unable to identify family members or events related to family. What is diagnosis?

DISSOCIATIVE AMNESIA

Most reversible type of amnesia

DISSOCIATIVE AMNESIA WITH MDD

What diagnosis is associated high hypnotizability potential

DISSOCIATIVE DISORDER

Which of the following diagnoses involves a sense of loss of identity, often following a traumatic experience and associated with inability to recall one's past?

DISSOCIATIVE FUGUE

44 y/o pt reports hx of repeated episodes of self-mutilation and sudden changes in relationships. After several months of psychotherapy, the pt speaks in unusual accent, is irritable, and has little awareness of in-session discussions. Psych MD has past records that state pt has been Dx with borderline personality disorder and has a sexual trauma history. Dx?

DISSOCIATIVE IDENTITY D/O

Newly married 22-year-old pt is strongly encouraged by husband to seek eval due to abrupt changes in pt's attitudes and behaviors. Pt denies awareness of this, but does acknowledge "missing time" that made her feel like her life is "scattered on the floor of a film editor's studio after pieces were cut and the ends spliced back together." Old gf of husband has threatened to file charges 2/2 hostile telephone messages that have been traced to pt's phone. Pt denies memory of making calls. What is the d/o?

DISSOCIATIVE IDENTITY D/O

Depression, according to Beck's model is a manifestation of: (2x)

DISTORTED NEGATIVE THOUGHTS (COGNITIVE DISTORTIONS)

Pt on methadone screen positive for alcohol, achieve abstinence of alcohol by co- administering what with methadone?

DISULFIRAM

Which med reduces acetaldehyde dehydrogenase function? (2x)

DISULFIRAM

What does the cerebellum do in the human adult brain?

DIVERSE ROLES IN MOVEMENT, BEHAVIOR, AND LEARNING

42 y/o M with a gradually progressive cognitive deficit also develops jerking movements of the extremities, head, and trunk. Imaging shows atrophy of the caudate nuclei bilaterally. Pt's father had a similar illness that started at age 50. Which of the following tests is most likely to confirm the diagnosis? (6x)

DNA ANALYSIS FOR CAG REPEATS

Molecular mechanism explaining how early life development contributes to psychiatric disorders

DNA METHYLATION

Process of gene expression

DNA TRANSCRIBED TO MRNA AND PRODUCES PROTEINS

Females have comparable rates to males for:

DOMESTIC VIOLENCE

In nicotine dependence, neurotransmitter most associated w/ reward and reinforcement is:

DOPAMINE

Neurotransmitter assoc w/ reward & reinforcement in nicotine dependence

DOPAMINE

Neurotransmitter from responsible for rewarding nature of drug abuse

DOPAMINE

The risk of increased psychosis for pts with psychotic disorders who take bupropion is attributable to enhancement of:

DOPAMINE

What neurotransmitter is thought to play a key role in fine-tuning working memory function in the dorsolateral prefrontal cortex?

DOPAMINE

Drug abuse activates these neuro circuits, generating signals in the ventral tegmental area to where?

DOPAMINE INTO THE NUCLEUS ACCUMBENS

Mechanism responsible for the euphoric effects of methamphetamine:

DOPAMINE RELEASE IN THE NUCLEUS ACCUMBENS

Which of the following levels would be affected what changes in tyrosine hydroxylase levels: Dopaminergic, Gutaminergic, GABAminergic, Serotonergic, Histaminergic,

DOPAMINERGIC

Area of frontal cortex activated in Wisconsin Card Sorting Test during shifting of cognitive sets?

DORSOLATERAL

Area of brain to remember a number to make a phone call

DORSOLATERAL PFC

40 y/o M reports long hx of continuous dysphoria and insomnia (dysthymia). Recently he feels worse and reports poor energy, hopelessness and SI. Dx:

DOUBLE DEPRESSION

Dx for 40yo male w/ mild chronic dysphoria, insomnia, fatigue, and lessened job performance, now with despondency, tearfulness, lack of energy, skipping work, hopelessness, psychomotor agitation, and SI

DOUBLE DEPRESSION

Compared to "treatment as usual", how does the IMPACT model of integrated care (which recommends screening for depression of at least 75% of primary care patients and following through with psych eval/mgmt) differ?

DOUBLES THE EFFECTIVENESS OF DEPRESSION TREATMENT

Adrenogenital syndrome, Down syndrome, Hurler's syndrome, Tay-Sachs disease and phenylketonuria all cause mental retardation. Which one does NOT have autosomal recessive inheritance pattern?

DOWN SYNDROME

What neurological syndromes is the result of trisomy 21?

DOWN SYNDROME

Alternative stimuli that can be used to overcome withdrawal response to Babinski reflex:

DOWNWARD SCRAPING OF THE SHIN

Which tricyclic antidepressant has the most potent antihistaminic effect?

DOXEPIN

Pt arrested for possession of cocaine, spends 2 days in jail, after missing apps with subs abuse counselor. Intervention is referred to as...?

DRUG COURT

70 y/o +HIV heroin abuser is treated with Lopinavir and Ritonavir and fluoxetine for MDD. Hep C was dx and treated 2 months ago. Since then pt is more irritable, insomnia, and diarrhea. Why?

DRUG-DRUG INTERACTION

Which antidepressant is least likely to cause sexual side effects?

ESCITALOPRAM

Most prevalent movement d/o in those over 70 y/o?

ESSENTIAL TREMOR

Tx for neuropathic pain in diabetes

DULOXETINE

The Sural nerve biopsy of a pt w charcot-marie-tooth type 1 is shown (image), exam shows diminished LE DTRs and deformities of feet BL. These deformities are typical of which molecular abnormality?

DUPLICATION OF THE PERIPHERAL MYELIN PROTEIN GENE

Schizophreniform disorder differs from schizophrenia primarily in

DURATION

What aspect of sleep is increased in older adults? (2x)

DURATION OF AWAKENINGS

Acute stress d/o differentiated from PTSD by

DURATION OF SYMPTOMS

5 days after CABG a 47 y/o M is disoriented to time and place. He identifies his right and left but not that of the examiners. Can draw square and circle but not a clock. This is:

DYSPRAXIA

Medical student asks for something to help w/o attention and alertness. Taking a 2-week board review course and struggles to keep up w/ the pace. Sleeping 4hrs/night. Usually sleeps 8hr/night. Dx? (2x)

DYSSOMNIA NOS

When combined with functional neuroimaging, which of the following biomarkers is most likely to identify those geriatric pts with mild cognitive impairment most at risk for developing Alzheimer's disease? (7x)

E-4 APOLIPOPROTEIN E ALLELE

Genetic anticipation refers to: (2x)

EARLIER ONSET OR WORSENING OF ILLNESS WITH EACH SUCCEEDING GENERATION IN A PEDIGREE (WITH EACH TRANSMISSION OF UNSTABLE DNA)

What is associated with poor prognosis in schizophrenics?

EARLY AGE OF ONSET, NEGATIVE SYMPTOMS, LACK OF PRECIPITATING FACTORS

For adult, death of loved one by violent means affects grieving process in what way?

EARLY BEREAVEMENT IS SIMILAR, HOWEVER, DYSPHORIA PERSISTS FOR PROLONGED PERIOD

25 y/o pt has been Dx w/ ETOH dependence. Pt has neither had ETOH to drink nor met any of the criteria for alcohol dependence in the past 6 months. What remission specifiers would apply to the Dx of ETOH dependence?

EARLY FULL REMISSION

Mutations in the gene that codes for the parkinson protein are most commonly associated with which parkinsonism?

EARLY-ONSET PARKINSON'S DISEASE

What is the term for senseless repetition in schizophrenics?

ECHOLALIA

A 70 y/o patient presents with severe psychotic depression. Patient stopped eating and speaks very little. Failed multiple med trials. What's next?

ECT

Pt with MDD 4-wks into sertraline 200mg trial without improvement. Duloxetine 90mg added for an additional 6 weeks followed by 4-weeks on phenelzine 90mg. Pt cont to be depressed. What would be the most definitive treatment:

ECT

A 54yo pt complains of intermittent double vision that has worsened over the last 3wks. The pt's coworker also noted that at times the patient had a "droopiness" of the eyelids as if sleepy. Examination reveals bilateral ptosis, mild esotropia, and double vision only after the pt is asked to maintain an upward gaze for 2 minutes. There is no dysarthria, but a mild 4/5 weakness is found in the proximal arm muscles bilaterally. What is most appropriate test to perform next to establish the diagnosis?

EDROPHONIUM TEST

45 y/o pt w/ first episode MDD, on Paxil and insight-oriented therapy, but depression worsens over months. Takes Paxil only occasionally, as he is worried about becoming dependent on it (a friend was addicted to Valium). Best intervention?

EDUCATE PATIENT ON THE DIFFERENCES BETWEEN ANTIDEPRESSANTS, LIKE PAXIL, AND BENZODIAZEPINES, LIKE VALIUM.

22 y/o borderline splitting inpatient staff. You should:

EDUCATE STAFF ABOUT SPLITTING

What test is most helpful to distinguish dementia vs delirium

EEG

Which procedure confirms the diagnosis of non-epileptic seizures? Video telemetry or EEG between episodes?

EEG VIDEO TELEMETRY

After an OD on Amitriptyline, what test is needed? (4x)

EKG

Monitor TCA overdose using (2x)

EKG

Psych MD in the ED evaluates a 67 y/o pt w/ h/o depression who c/o panic attacks since the death of her spouse 1 month ago. Pt has frequent episodes of acute-onset palpitations, chest tightness, nausea, shortness of breath, and intense anxiety lasting several minutes, with no specific triggers. This morning it woke her up from her sleep. Exam: overweight, pale, anxious appearing, and mildly diaphoretic. Her BP is 140/90, pulse 106. Most appropriate next step in management?

EKG

Which of the following surgical procedures can be used in the treatment of epilepsy refractory to meds? (2x)

ELECTRICAL STIMULATION OF THE VAGUS NERVE

Pt w/ hx of melancholic depression is severely dehydrated, emaciated, and catatonic. He began withdrawing, talking about death, stopped eating and drinking and lost 20lbs. Tx of choice? (x2)

ELECTROCONVULSIVE THERAPY (ECT)

Tx for worsening depression, severe weight loss, dehydration, catatonia.

ELECTROCONVULSIVE THERAPY (ECT)

What augmentation strategies for treatment-refractory depression has shown the highest efficacy and replicability?

ELECTROCONVULSIVE THERAPY (ECT)

70 y/o with mild Alzheimer's lives with family and prescribed SSRI for depression. Also has HTN, adult onset DM, and RA, which are stable. The pt develops acute confusion but no other med or psych symptoms which test should be ordered first? (2x)

ELECTROLYTES

What is a SE common to both naltrexone and disulfiram? (3x)

ELEVATED LIVER ENZYMES

Suicide risk for adopted child whose bio mother died by suicide

ELEVATED RELATIVE TO OTHER ADOPTEES

Use of levomethadyl acetate hydrochloride (LAAM) for management of pt w/ opioid dependence allows for:

ELIMINATION OF NEED TO TAKE HOME DOSES

Medical specialty with highest rate of substance use d/o:

EMERGENCY MEDICINE

Homicide and homicidal behaviors are most often related to what factors?

EMOTIONS NOT ASSOCIATED WITH MENTAL ILLNESS

Homicide and homicidal behaviors are most often related to which of the following factors?

EMOTIONS NOT ASSOCIATED WITH MENTAL ILLNESS.

In overcoming the resistance to treatment often encountered with patients who have anorexia nervosa, what is it most useful for the psychiatrist to emphasize?

EMPHASIZE HOW TREATMENT WILL ALLOW THE PATIENT TO FOCUS ENERGY ON OTHER MATTERS.

14 y/o brought to ED after telling mom that she had been raped by stepdad. On psych eval, pt reports feeling "okay" and denies acute distress. Pt is calm during interview and appears generally unaffected by recent trauma. On further questioning, pt appears confused and believes she is at a friend's house. Which is the preferable intervention?

EMPLOY GROUNDING STRATEGIES TO ORIENT PT

Educate fam of schizophrenia pt to?

ENCOURAGE ADHERENCE TO MEDS

Pt with histrionic personality d/o storms in his psychodynamic session and a few minutes late, clearly in rage. He expresses hopelessness and declares vehemently that he must divorce his wife. Next best intervention:

ENCOURAGE THE PT TO REFLECT MORE ON WHAT HAS HAPPENED TO TRIGGER SUCH PAINFUL FEELINGS.

Which is a retrograde neurotransmitter?

ENDOCANNABINOIDS

What neurotransmitter present in the periaqueductal gray matter is involved in the mediation of pain?

ENDORPHINS

The blood brain barrier is made up of what kind of cells?

ENDOTHELIAL

Which of the following is usually the first step in treating adolescents with substance abuse disorders?

ENGAGING THE PT AND FAMILY IN STEPS TO DIMINISH DRUG-SEEKING BEHAVIOR

75 yo patient evaluated for progressive gait, urine incontinence, and cognitive decline. After removal of csf, there is improvement in gait and balance. What would CT show?

ENLARGEMENT OF THE FRONTAL HORNS

15 y/o pt depressed + suicidal has an alcoholic father. Prior d/c from hospital the next step should be:

ENSURE THAT ANY LETHAL MEANS ARE UNAVAILABLE AT HOME

84 y/o pt w hx of chronic alcoholism & amnesia will need, in addition to abstinence, the following intervention to prevent a progression to alcohol-related dementia:

ENSURING A GOOD NUTRITIOUS DIET

Mother of 2 school aged kids dies unexpectedly. What with improve psychological outcome for the children?

ENSURING AVAILABILITY OF PSYCHOSOCIAL SUPPORTS

Most common cause of aseptic meningitis:

ENTERIC VIRUS

Earliest evidence of cell loss in pts with Alzheimer's Dz typically occurs in which of the following areas of the brain?

ENTORHINAL CORTEX

Predominantly non-REM sleep problem:

ENURESIS

Person who smokes a pack of cig/day stops smoking and has need for cig after every meal. This is... (2x)

ENVIRONMENTAL TRIGGER

25 y/o pt with severe headache, visual loss, vomiting, bilateral babinski, and then becomes drowsy:

EPENDYMOMA OF THE FOURTH VENTRICLE

Head injury, LOC -> lucid interval x hours -> rapid progressing coma. Hemorrhage?

EPIDURAL

Head CT w/ lens-shaped hyperdensity (x2)

EPIDURAL HEMATOMA

What characterizes the memory loss in patients with dissociative amnesia? (2x)

EPISODIC

15 y/o pt w/ physical complaints, decreased appetite, irritability, thoughts of death, anhedonia. Which med is FDA-approved for first line tx? (2x)

ESCITALOPRAM

40 y/o M developed gradually progressive dementia and abnormal involuntary movements. Older brother and father have similar illness. Best Dx. test (2x)

EXCESS CAG TRIPLETS IN DNA ANALYSIS

Symptoms that may dominate picture of mood disorders w catatonia?

EXCESSIVE PURPOSELESS MOTOR ACTIVITY NOT INFLUENCED BY EXTERNAL STIMULI

Core feature of GAD

EXCESSIVE WORRYING

Purpose of CT scan when patient suspected of having stroke?

EXCLUDE HEMORRHAGE

Psych MD tests a medical pt with go/no-go test in which psych MD asks pt to tap the table once if Psych MD taps it once, but not to tap the table if psych MD taps it twice. Psych MD is screening for deficits in?

EXECUTIVE FUNCTIONING

Cognitive triad of depression: negative self-perception, experience the world as self- defeating, AND?

EXPECTATION OF CONTINUED FAILURE

What event assoc. w/ highest rates of PTSD

EXPERIENCING SEXUAL VIOLENCE

6 y/o w/ 4 wk intense eye-blinking and lip pursing. Wax and wane, increase with stress. Family Hx of tic d/o. First step:

EXPLAIN TO FAMILY MAY BE TRANSIENT

Pt recurrently goes to ED because of severe chest pain. Has been w/u for everything and all test are normal. He states that something needs to be done to "fix" his pain. Psych consult is placed. MSE and neuro is normal. Past hx reveals his father died of lung CA. Next intervention as psychiatrist is:

EXPLORE PT'S FEELINGS ABOUT FATHER'S DEATH

Principal behavioral technique for OCD (4x)

EXPOSURE & RESPONSE PREVENTION

Pt with contamination fears and hand washing rituals is treated with response prevention combined with:

EXPOSURE THERAPY

Which psychotherapeutic technique is most clearly indicated for treatment of simple phobia?

EXPOSURE THERAPY

This symptom is essential to support a diagnosis of dissociative identity disorder (2x)

EXTENSIVE INABILITY TO RECALL PERSONAL INFORMATION

57 y/o diabetic pt =w/ HTN c/o several episodes of visual loss, "curtain falling" over his L eye, transient speech and language disturbance, and mild R hemiparesis that lasted 2 hrs. Suggests presence of what?

EXTRACRANIAL LEFT INTERNAL CAROTID STENOSIS

One of the earliest sx of Tourette's:

EYE-BLINKING AND HEAD JERKING

Pts in a locked in state following basilar artery occlusion typically retain what movement?

EYELIDS AND VERTICAL GAZE

Judgment by experts that items on a test "makes sense" is an example of:

FACE VALIDITY

24 y/o M seen in ED with chest pain claims to have a rare connective tissue d/o and said he required a recent heart transplant due to aorta dissection. He provides the MD with a list of immunosuppressive meds and requests that a transesophageal echo be done. He has no sternotomy scar and outside records indicate his story is false. Is this likely factitious d/o or malingering?

FACTITIOUS D/O (MALINGERERS USUALLY AVOID INVASIVE TESTS)

25 y/o prisoner claiming to be depressed is hospitalized after he swallowed some razor blades. Razor blades were carefully wrapped with surgical tape before swallowing. Confesses he wanted some time out of prison. Dx? (x2)

FACTITIOUS DISORDER

What condition shows motivation to assume the sick role? (3x)

FACTITIOUS DISORDER

Associated with improved outcome in late-life depression?

FAMILY HISTORY OF DEPRESSION

Suggest underlying bipolar in 27 y/o F who presents w/ first major depressive episode:

FAMILY HX OF BIPOLAR

27 year old normal patient with intermittent muscle twitching. EMG findings showing spontaneous discharges, fairly constant, representing motor unit firing are typical of?

FASCICULATIONS

Pts taking MAOIs should use caution when consuming what?

FAVA BEANS

Main clinical factor of hypochondriasis vs. somatization d/o?

FEAR OF HAVING A DISEASE

Which gender has a higher risk for tardive dyskinesia (TD)?

FEMALE

What factor is a good prognostic indicator in schizophrenia? (2x)

FEMALE GENDER

This is a risk factor for the rapid cycling form of bipolar disorder

FEMALE SEX

Opioid NOT detected in standard UDS:

FENTANYL

Which med is comparative safety during Tx w/ MAOI?

FENTANYL

These symptoms make a diagnosis of NMS more likely than other neurological and general medical conditions: (x2)

FEVER AND SEVERE MUSCLE RIGIDITY

The ability of magnetic seizure therapy to target specific brain regions implicated in depression gives it what potential advantage, compared with traditional ECT:

FEWER COGNITIVE SIDE EFFECTS

In pts over 65 w MDD, Bupropion has what advantage over SSRIs?

FEWER DRUG INTERACTIONS

Electrophysiologic signs of denervation:

FIBRILLATION AND POSITIVE SHARP WAVES

Pt is engaged in interpersonal psychotherapy for depression. In the first several sessions, the patient and therapist identify unresolved grief after the death of the patient's mother as the problem area, and relate these feelings to the patient's current depression. Which of the following will be the focus of the middle phase of treatment?

FINDING NEW ACTIVITIES AND RELATIONSHIPS TO OFFSET THE PATIENT'S LOSS

Most common method for completed suicides in adolescents (2x)

FIREARMS

Most common method of committing suicide for women in the US is:

FIREARMS

When does synaptogenesis peak?

FIRST 4 YEARS OF LIFE

Longer duration of psychosis is associated w/

FIRST GENERATION IMMIGRANT

What symptoms are seen in a manic episode but not in MDE?

FLIGHT OF IDEAS

Take agoraphobic to crowded place and stay there until anxiety dissipates

FLOODING

Which of the following is the most specific factor for distinguishing delirium from dementia of the Alzheimer type? (2x)

FLUCTUATING AROUSAL

Medication useful in management of orthostatic hypotension in Parkinson's (4x)

FLUDROCORTISONE

25 yo m with no psych history has new preoccupation and excessive concern with imagined defects in appearance, no other symptoms. Which is best med (Quetiapine, Mirtazapinne, Olanzapine, Bupropion, Fluoxetine)?

FLUOXETINE

25-year-old pt with no previous psych history has a new preoccupation with imagined defects in appearance, which is a cause of excessive concern. The pt has a normal medical workup and, other than the distress over appearance, the pt does not have other psych sx. Which of the following meds is most appropriate?

FLUOXETINE

First-line treatment of panic disorder?

FLUOXETINE

Medication reduces analgesic effect when administered w/ hydrocodone

FLUOXETINE

Pt who responded in the past to SSRIs requests a drug from this class when subsequently seen for another episode of depression. However, pt reports concerns that when the previous medication was tapered, pt experienced fatigue, insomnia, abdominal distress, flu-like symptoms, and dizziness. What meds would be appropriate for this pt?

FLUOXETINE

What med has shown some efficacy in reducing binging and purging in bulimia nervosa? (x3)

FLUOXETINE

What med has some evidence of effectiveness in both psychotic/nonpsychotic subtypes of body dysmorphic disorder?

FLUOXETINE

Which SSRI used to treat discontinuation syndrome caused by SSRI termination (x2)?

FLUOXETINE

Which SSRIs has longest half-life?

FLUOXETINE

Which antidepressant is safest in seizure disorders and depression?

FLUOXETINE

Which of the following meds has the lowest likelihood of discontinuation symptoms if the medication is abruptly stopped?

FLUOXETINE

Cytochrome P450 (CYP450) subenzyme, inhibited by ________, increases TCA levels

FLUOXETINE, 2D6

Dermatologist asks for psych consult on 38 y/o pt. 5 years ago pt began having concerns of perceived skin irregularity she calls "bumps." Over time increasingly more difficult for her to ignore "bumps" and picks at them. Several dermatologists have been unable to convince pt it is not a dermatological issue. Aside from this no evidence of other mood or thought d/o. First- line treatment for pt?

FLUVOXAMINE

Man obsesses about killing his g/f. Instead of killing, picks his face w/ a pin. Medication:

FLUVOXAMINE

Pt on clozapine and VPA. Psychiatrist increases VPA and adds Fluvoxamine, PCP gives aspirin, atorvastatin, and zolpidem, pt has seizure. Which med increased clozapine levels?

FLUVOXAMINE

SSRI with shortest half life

FLUVOXAMINE

46 y/o F pt presents w increasing dysphoria, progressively increased frequency with which she washes her hands to the point of excoriation, dose range for effective Tx: (x2)

FLUVOXAMINE 200-300MG DAILY

Conduction block in NCS indicates what?

FOCAL DEMYELINATION

40 yo new-onset sz b/l thrashing movement. What suggests non-epileptic cause?

FOLLOWING COMMANDS

Transcutaneous electrical nerve stimulation (TENS)

FOR PERIPHERAL NEURALGIA

Most common inherited mental retardation: (2x)

FRAGILE X

13 y/o w developmental delay, stereotyped behaviors, impaired social interactions, hyperactive behavior, large anteverted ears, hyperextensible joints, macroorchidism. Dx? (3x)

FRAGILE X SYNDROME

Developmental disability assoc w triple repeat genetic abnormality (4x)

FRAGILE X SYNDROME

Alcohol intoxication causes what sleep abnormalities?

FRAGMENTATION OF STAGE 4 SLEEP

91 y/o hospice pt w/ cachexia, end stage dementia, and renal impairment has stopped eating and drinking. What comfort measure would be most appropriate? (3x)

FREQUENT SMALL SIPS OF WATER

After middle age, what region of the brain has decreasing sleep spindle density?

FRONTAL AND OCCIPITAL LOBES

34 y/o M is referred for psychiatric evaluation 5 years after sustaining a head injury at work. Prior to the accident, he was a stable, happily married man. Since the accident, he has been described as overly talkative and restless. His wife divorced him because he was acting irresponsibly, which also resulted in termination from his job. Psychometric testing reveals that the man has average intelligence and no detectable memory deficits. Pt's clinical presentation is most consistent with damage to which to the following brain areas?

FRONTAL LOBE

Dementia characterized by personality change, attention deficit, impulsivity, affect lability, indifference, perseveration, and loss of executive function. Assoc. with dysfunction in what area of the brain?

FRONTAL LOBE

Previously pleasant mom becomes profane and irresponsible over 6 months. Most likely a pathology in: (2x)

FRONTAL LOBE

Pt with seizure has flailing arms and tonic postures of "fencing." What seizure type?

FRONTAL LOBE

Executive dysfxn comes from damage to?

FRONTO-SUBCORTICAL

Over the course of several months, a 46 yo pt w no past psych hx becomes emotionally labile/irritable. Pt undergoes personality changes, is observed to laugh inappropriately when neighbor kids taunt stray cat. Within 2 yrs pt is convinced all food has germs. Memory is preserved. Pt is no longer able to work/live independently. Neuropsych testing shows impaired language/attn. (2x)

FRONTOTEMPORAL DEMENTIA

65 y/o pt brought in by family for gradual onset and very slow progression of mental confusion with respect to place and time, anomia, slowness of comprehension, neglect of personal hygiene and grooming, apathy, and alterations of personality and behavior, impairment of gait and upright stance, and prominent grasp and suck reflexes. Dx? The clock drawing test is a quickly administered and sensitive screen for:

FRONTOTEMPORAL DEMENTIA OR ALZHEIMER DEMENTIA

Optimal strategy in maintenance tx with TCA for patient with recurrent MDD (2x)

FULL DOSE ANTIDEPRESSANT THERAPY

What are the cortical columns?

FUNCTIONAL UNITS FOR INFORMATION PROCESSING

Area of brain responsible for face recognition

FUSIFORM GYRUS

DA and what else regulates reward circuitry

GABA

Huntington's disease characterized by loss of neurons producing which NT

GABA

Activation of this receptor is likely responsible for anti-anxiety, motor-impairment, and sedative hypnotic effects of alcohol

GABA-A

Pharmacologic mechanisms of topiramate include: inhibition of firing of voltage- dependent sodium channels, antagonism of kainite binding to the alpha-amino-3- hydroxy-5-methyl-4- isoxazole propionic acid (AMPA) receptor & potentiation at which receptor?

GABA-A

Treatment of Trigeminal Neuralgia: (7x)

GABAPENTIN (BUT MOST EFFECTIVE IS CARBAMAZEPINE)

18 y/o restless, feels mind going blank, poor concentration, irritability, insomnia, fatigue > 1 yr, used to be good student up until 2-3 yrs ago, no substance use

GAD

A 19-yo college student complains of "difficulty concentrating and my mind going blank when I try to study." She feels restless, keyed up and worries excessively. Does not use substances.

GAD

EEG-biofeedback training is efficacious for what d/o?

GAD

Prevalence of separation anxiety d/o and GAD in children follows what pattern with regard to age?

GAD INCREASES WITH AGE WHILE SEPARATION ANXIETY DECREASES WITH AGE

Young adult w/ headache behind left ear. 2 days later twisting of face. Impaired taste sensation. Paralysis of forehead, lower face on left, incomplete closure of left eye w/ blinking. No sensory deficit or other cranial nerve deficit. MRI shows:

GADOLINIUM ENHANCEMENT OF LEFT FACIAL NERVE

A compound that increases muscle mass by increasing episodic secretion of GH (2x):

GAMMA HYDROXYLBUTYRATE

17 y/o pt is brought to the ER by friends who report that he ingested a drug 2 hours earlier. Pt's behavior after the drug ingestion as relaxed and tranquil but talkative. Soon after, the pt c/o drowsiness, dizziness, and nausea. On exam, pt has labile level of consciousness. The drug screen is negative for benzodiazepines, barbiturates, and opioids. Psych MD alerts ED to the possibility of imminent respiratory difficulty. What drug most likely caused this condition? (2x)

GAMMA-HYDROXYBUTYRATE (GHB)

Most common EEG finding in metabolic encephalopathy? (question requires assigning diagnosis to EEG)

GENERALIZED SLOWING

52 y.o. With delirium - eeg

GENERALIZED THETA AND DELTA ACTIVITY (SLOWING)

A young adult woman has difficulty with sexual intercourse. She is very embarrassed about giving information about it. She experiences "vaginal spasms" at her last encounter and thus she feels anxious thinking about having sex. She has a normal gynecological exam without discomfort. What is the most likely diagnosis?

GENITO-PELVIC PAIN/PENETRATION DISORDER

Analyzing genetic markers in a diseased population and comparing it to the norm

GENOME WIDE ASSOCIATION STUDIES

Pt working overtime develops frightening nocturnal episodes characterized by semi- wakefulness and inability to move, accompanied by the sense that an intruder is present. The pt denies daytime sleep attacks or sudden loss of motor control. Best initial tx?

GETTING SUFFICIENT SLEEP

A 25 year old body-builder comes to ed with euphoria, peripheral vision loss and hallucinations. Pt states these occurred after ingesting a liquid nutritional supplement an hour ago. UDS and BAL are negative. What did he ingest?

GHB

Which is a common side effect leading to discontinuation of SSRI's early in treatment?

GI DISTRESS

The most common reason that people discontinue the use of SSRI: (3x)

GI SIDE EFFECTS

What area of the body has the most serotonin?

GI TRACT

1st seizure with focal onset and secondary generalization in a 58 y/o pt is likely the consequence of what? (2x)

GLIOBLASTOMA MULTIFORME

Awareness of own symptoms rated by:

GLOBAL ASSESSMENT SCALE

Deep brain stimulation in which brain structure is a useful treatment for primary generalized dystonia?

GLOBUS PALLIDUS

68 y/o pt w/ hx of schizophrenia since early adulthood and maintained for yrs on thioridazine. On exam: pt's tongue frequently retracts on its longitudinal axis and moves in lateral directions. No other findings. When tongue movements are pointed out, pt reports being unaware of making them. What recommendation for best Tx:

GRADUALLY D/C THIORIDAZINE AND START LOW DOSE RISPERIDONE

Age-related sleep pattern change (2x)

GREATER WAKEFULNESS INTERMIXED WITH SLEEP

50 y/o Cambodian woman with 2 kids suffered catastrophic trauma from the Pol Pot regime in Cambodia (rape, abuse, watched family starve, escaped refugee camp with 2 kids). Has PTSD/MDD sx that are increased when her now grown daughter dates man patient doesn't like. Needs supportive therapy, antidepressant, AND?

GROUP THERAPY OF PEOPLE OF THE PATIENT'S OWN BACKGROUND WHO SHARE THE SAME EXPERIENCE

Hormone release during sleep which doesn't have a circadian rhythm pattern:

GROWTH HORMONE

Repeat ED visits for CP, negative, most important

H/O OF PAIN ON EXERTION RELIEVED BY REST

The side effects of sedation and weight gain are associated with mirtazepine's antagonism of which of the following receptors?

H1

Which of the following is characteristic of post lumbar puncture HA? (4x)

HA WORSE W/ SITTING UPRIGHT

2 y/o child w/ hx of upper respiratory infections, most likely:

HAEMOPHILUS INFLUENZA

80 y/o Alzheimer's with increasingly combative behavior. Family wants to keep at home. Give what medication?

HALDOL

Alcoholic, AH on & off alcohol, extreme agitation. During withdrawal give benzo and

HALDOL

Cancer patient on chemo is disoriented and agitated. Afebrile VSS. Neg neuro exam. Poor attention, cog impairment. Held for observation. CT neg, EEG diffuse slowing. Treat with:

HALDOL

Emergency management of pt w phencyclidine (PCP) toxicity should include?

HALDOL, BENZODIAZEPINES, CLOSE SUPERVISION AND RELATIVELY DARK, QUIET SURROUNDINGS.

Which of the following side effects can result from stimulant medication treatment and warrants immediate discontinuation of the medication and a reassessment of the treatment plan?

HALLUCINATIONS

No additional criterion A symptoms are required for the dx of schizophrenia if the pt has which of the following symptoms: (2x)

HALLUCINATIONS OF 2 OR MORE PEOPLE CONVERSING

Apathetic and nervous, sees halos, flashes of color, recent ETOH and LSD, unemployed, never hospitalized. Dx?

HALLUCINOGEN PERSISTING PERCEPTION D/O

28 y/o woman who is at 33 weeks gestation and has a history of bipolar disorder is brought to the emergency department by family members because she was running around the neighborhood loudly proclaiming, "I am the mother of Christ." The pt is in restraints, yelling, spitting, disorganized, and tangential, with rapid speech. Family members report that the pt was stable on valproate, but discontinued the medication when she learned she was pregnant. Which medication to give acutely for this pt?

HALOPERIDOL

Elderly w/ VH and cognitive decline -> bradykinesia, rigidity, and multiple falls. What to avoid?

HALOPERIDOL

Treatment of Huntington's chorea (3x)

HALOPERIDOL

What drug is most appropriate in emergency treatment of anticholinergic toxicity?

HALOPERIDOL

What psychological test determines neuropsychologic impairment? (2x)

HALSTEAD-REITAN BATTERY

Needle exchange is an example of what type of reduction strategies?

HARM

Methadone prescription in heroin dependence is called what kind of strategy?

HARM REDUCTION

A 62 yo pt is referred for complaints of memory problems. The patient reports feeling more forgetful and gives examples of "losing my keys, handbag, or forgetting the names of aquaintances." The pt denies any other neurocognitive symptoms. Family members confirm the patient's report, and feel that this has been a gradual change over the last year. Family members report that the pt is a former hx professor who continues to enjoy intellectual activities and they need to prepare if the patient is going to lose these capabilities as a result of dementia. The standard MMSE would be a relatively insensitive instrument for this patient because it:

HAS A CEILING EFFECT FOR WELL-EDUCATED PERSONS

25 y/o M scores in MMPI are all normal except for elevated scores on the depression and psychasthenia scales. This suggests:

HAS DEPRESSION WITH ANXIETY AND OTHER NEUROTIC SYMPTOMS

Women differ from men in drinking behavior and in development and effects of alcohol use d/o, compared w/men, women: (X2)

HAVE A FASTER PROGRESSION FROM FIRST DRINK TO ALCOHOL DEP

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

HAVE MULTIPLE PHYSICAL COMPLAINTS

A father wants to know if he should allow his 5 y/o child to attend the funeral of her mother. The child expresses a desire to go. To help the child through the funeral, it will be important to do which of the following?

HAVE SOMEONE FAMILIAR ACCOMPANY THE CHILD

The best way to ask adolescent about alcohol abuse? (2x)

HAVE YOU EVER RIDDEN IN A CAR DRIVEN BY SOMEONE INCLUDING YOURSELF, WHO WAS HIGH OR HAD BEEN USING ALCOHOL OR DRUGS?

Hallucinations in patients with conversion disorder are characterized by?

HAVING A CHILDISH, FANTASTIC QUALITY

Most powerful statistical risk factor for completed and attempted suicide

HAVING A PSYCH ILLNESS

Increase risk for psychopathology in offspring?

HAVING BIO-RELATIVES WITH PSYCHIATRIC ILLNESS

Hallucinations in pt with conversion d/o are characterized as:

HAVING CHILDISH, FANTASTIC QUALITY

77 y/o F whose husband died 6 wks ago, complains about the length of time it took for her to dress. She sounds irritable, looks fatigued. "I can't accept he is gone.... I should have been able to save him". She says "When the real darkness descends on me specially in the middle of the night I don't want to call anyone." What is more indicative of MDD rather than uncomplicated bereavement:

HAVING THOUGHTS OF SUICIDE.

Condition most likely to account for the presence of cognitive impairment in a pt with untreated Hep C (HCV) infection and normal ammonia level who is HIV sero- negative:

HCV INFECTION OF BRAIN

Which of the following is the leading cause of child maltreatment fatalities? (x2)

HEAD INJURIES

Acute caffeine withdrawal symptoms include: (2x)

HEADACHE

Schneiderian first-rank symptom of schizophrenia: (3x)

HEARING VOICES AND ARGUING ABOUT ONESELF

The difference between an idea of reference and a delusion of reference is that the former is:

HELD WITH LESS CONVICTION

25 y/o F is brought to ER after being severely beaten by her BF. Following medical stabilization, first step in an acute psychological intervention is:

HELP HER RECOGNIZE THAT IMMEDIATE DANGER HAS PASSED AND SHE IS IN A SAFE PLACE

Developing a plan for managing a future lapse or relapse of addictive illness is most likely to:

HELP LIMIT THE EXTENT AND LENGTH OF DRUG USE

What is the function of Al-anon? (2x)

HELPS RELATIVES COPE WITH ALCOHOLICS DRINKING

A condition with increased frequency in pts with HIV on long term HAART:

HEPATOTOXICITY

Miosis due to OD on:

HEROIN

Pt in the ED is in withdrawal from a substance. Symptoms include muscle aches, lacrimation, yawning, and diarrhea. What substance withdrawn?

HEROIN

What drugs make up the street drug named Speedball?

HEROIN AND COCAINE

Pt with several days of fever and severe headaches presents to ED b/o generalized seizure. Pt is confused and somnolent. Also reported to have been irritable and has c/o foul smells. T2 MRI displayed (hyperintensity of left temporal): (2x)

HERPES ENCEPHALITIS

Viral agents frequently associated with idiopathic unilateral facial nerve palsy:

HERPES SIMPLEX

49 y/o pt develops seizure disorder that is difficult to control. CSF shows lymphocytic pleocytosis and many RBC's. MRI: T2 hyperintensity in the Left temporal lobe, with gadolinium enhancement in this area in T1 weighted image. EEG: periodic discharges. Dx?

HERPES SIMPLEX ENCEPHALITIS

Fever, HA, seizures, confusion, stupor, and coma, evolving over several days. EEG with lateralized high-voltage 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. (8x)

HERPES SIMPLEX ENCEPHALITIS

Pt presents with personality changes, cognitive difficulties, affective lability, and olfactory and gustatory hallucinations. The most likely medical cause of this presentation is: (2x)

HERPES SIMPLEX VIRUS (HSV) INFECTION

Most frequent route for HIV transmission in teenage girls

HETEROSEXUAL CONTACT

Pt c/o severe dull and constant headache not associated with N&V. +vision loss in left eye. +pain and stiffness of limbs. MRI shows periventricular white matter hyperintensities on T2. Elevated sed rate. Next step?

HIGH DOSE PREDNISONE

Psych MD is counseling a pt about risks and benefits of ECT. What statement correctly describes the risk of cognitive impairment?

HIGH DOSE UNILATERAL ELECTRODE REPLACEMENT IS ASSOCIATED WITH LESS COGNITIVE IMPAIRMENT.

Treatment for Huntington's disease:

HIGH POTENCY ANTIPSYCHOTICS

Spinal fluid of patient w/ acute inflammatory polyneuropathy shows:

HIGH PROTEIN, NORMAL CELL COUNT

Adult neurogenesis in which area of the brain? (x2)

HIPPOCAMPUS

Working memory requires prefrontal cortex, dorsal thalamus and what other area of the brain to function?

HIPPOCAMPUS

Blockade of which receptor causes sedation and weight gain side effects for antipsychotics and antidepressants?

HISTAMINE

Mirtazapine's side effects of sedation and weight gain are caused by binding to which receptors?

HISTAMINE

Neurotransmitter regulating sleep and wakefulness?

HISTAMINE

Which of the following should lead a psychiatrist to be concerned about benzodiazepine abuse or dependence?

HISTORY OF ABUSE OF OTHER DRUGS OR ALCOHOL.

What differentiates bulimia from binge eating disorder?

HISTORY OF LAXATIVE ABUSE

What should lead a provider to increase concern for patient having a substance use disorder?

HISTORY OF MISUSING OTHER DRUGS OR ALCOHOL

Based upon longitudinal studies, which risk factors correlated w/ suicide more than one year after initial assessment?

HISTORY OF PRIOR ATTEMPTS AND HOPELESSNESS

Which of the following factors carries the highest standardized mortality ration for suicide

HISTORY OF PRIOR SUICIDE ATTEMPTS

Personality d/o should be considered in ddx of cyclothymic d/o? (2x)

HISTRIONIC

Personality disorder with pervasive and excessive emotionality and attention seeking behaviour

HISTRIONIC

What personality disorder results in displays of rapidly shifting and shallow expression of emotions in patients? (3x)

HISTRIONIC

Which personality disorder is characterized by a style of speech that is excessively impressionistic and lacking in detail?

HISTRIONIC

A 40-year-old pt is hospitalized for eval of fever, weight loss and ataxia. Psychiatric consultation is requested as the patient seems depressed, and a family member reports that the pt has been exhibiting progressive memory loss over the last several months. Which of the following lab tests may help explain the patient's presentation?

HIV

HIV+ pt w/ memory loss, inattention, lack of motivation, & poor coordination. Normal LP. CT scan shows atrophy. MRI shows diffuse & confluent white matter changes in T2, w/o any mass effect or gadolinium enhancement. Dx?

HIV- ASSOCIATED DEMENTIA

34 y/o pt w/ hx of memory impairment dies of unknown cause for autopsy. Pathological exam: diffuse and multifocal rarefaction of cerebral white matter accompanied by scanty perivascular infiltrates of lymphocytes and clusters of a few foamy macrophages, microglial nodules, and multinucleated giant cells. Most likely Dx:

HIV-ASSOCIATED DEMENTIA

Which is seen in 90 - 100% of pt w/ narcolepsy (genetics)

HLA-DR2

Pt is hoarding, home filled with filth, acknowledges is she is keep a lot of things (hoarding)

HOARDING DISORDER

The clinical syndrome associated with occlusion of the cortical branch of the posterior cerebral artery would result in which of the following?

HOMONYMOUS HEMIANOPIA WITH ALEXIA WITHOUT AGRAPHIA

In the cognitive therapy model, which of the following is most associated with suicide risk?

HOPELESSNESS

A 57 yo pt develops drooping of the R eyelid following mild neck trauma. The patient's neurological exam is remarkable for asymmetric pupils, smaller on the R, mild eyelid ptosis and decreased sweating over the R face. These findings are consistent with which of the following?

HORNER'S SYNDROME

Component of type A behavior most reliable risk factor for CAD

HOSTILITY

Dz w/ trinucleotide repeat expansion

HUNTINGTON'S

35 y/o pt w/ 2 yr hx of cognitive deterioration, difficulty at work, and irritability. Exam: restless w/ slow, writhing movements in most muscle groups and frequent blinking. Pt's father and paternal grandpa had similar sx and died in their 50s. Dx: (2x)

HUNTINGTON'S DISEASE

98 y/o M in ER, unconscious after choking, had progressive neuro condition presented in his early 30's w involuntary irregular movements of all extremities & face but after 15 yr course evolved into rigid, akinetic condition w diff swallowing, speaking. Also progressive dementia & full time care. After obstruction was relieved pt remained unconscious, had cardiac arrest & died. PM exam showed generalized brain atrophy. (Pathology picture showing brain atrophy). Dx: (3x)

HUNTINGTON'S DISEASE

Pt w/ depression, 3 yr hx of change in personality, irritability, impulsive outbursts, & eccentric or inappropriate social interactions. He subsequently lost his job & is now withdrawn & fidgety. Pt has increased eye blinking, marked tongue impersistence, mild bradykinesia, akinesia & mild hyperreflexia w/o clonus. The pt's dad died of severe dementia at 55. Dx? (2x)

HUNTINGTON'S DISEASE

21 y/o F hospitalized for excessive bleeding following elective first trimester abortion. Pt reports having anxiety about bleeding, but is relieved about abortion. Pt reports that baby's father is abusive but does not want to leave him. What is the strongest predictor of depression? (3x)

HX OF PRE-PREGNANCY DEPRESSION

What aspect of ADHD is most likely to improve as children age? (3x)

HYPERACTIVITY

What aspects of ADHD is likely to improve as children age?

HYPERACTIVITY

What distinguishes ADHD in children vs adults?

HYPERACTIVITY

Which of the following would represent a concern if administered concomitantly with a SSRI?

HYPERICUM PERFORATUM

Neurofibrillary tangles in Alzheimer's are composed of:

HYPERPHOSPHORYLATED TAU PROTEINS

32 y/o pt w cocaine dependence prescribed desipramine by another MD for withdrawal- assoc depression. Psychiatrist should warn pt of what adverse effects that might result from an interaction between desipramine and cocaine?

HYPERTENSION

Weight loss, 3-month hx of anxiety, mild depression, & insomnia, thin, elevated HR, low BP, mild tremor

HYPERTHYROIDISM

How would a social biologist describe adaptive benefit of PTSD?

HYPERVIGILANCE ALLOWS FOR QUICK SENSING OF REAL THREATS

Benign intracranial HTN etiology: (2x)

HYPERVITAMINOSIS A

What has demonstrated efficacy for Irritable bowel syndrome? (4x)

HYPNOSIS

What electrolyte abnormality is most seen in bulimics?

HYPOCHLOREMIC ALKALOSIS WITH HYPOKALEMIA

Characterized mainly by cognitive rather than perceptual preoccupation

HYPOCHONDRIASIS

Preoccupation and fear of having contracted serious disease based on misinterpretation of bodily sxs despite medical eval and reassurance. (3x)

HYPOCHONDRIASIS

42 y/o pt has had chronic abdominal pain, constipation and nausea for the past 14 months. Extensive medical work-up has revealed no organic cause, but the pt insists that these are symptoms of a serious disease. Most likely diagnosis:

HYPOCHONDRIASIS WITH POOR INSIGHT

Electrolyte imbalance common in chronic heavy EtOH use?

HYPOMAGNESEMIA AND HYPOPHOSPHATEMIA

Mild confusion, lethargy, thirst, polydipsia: (3x)

HYPONATREMIA

Which electrolyte abnormality is associated with MDMA use?

HYPONATREMIA

32 y/o s/p thyroidectomy presents c/o frequent panic attack, progressive cognitive inefficiency, perceptual disturbances, severe muscle cramps, and carpopedal spasm. PE: alopecia and absent DTR. Dx?

HYPOPARATHYROIDISM

Most frequent side effect of MAOI's

HYPOTENSION

9 y/o F has 3 month h/o seemingly unprovoked bouts of laughter. Worse when not sleeping well. Pt does not feel happy during these episodes. Started menstruating 6 months ago, and at Tanner stage 4. Dx? (2x)

HYPOTHALAMIC HAMARTOMA

20 y/o with 1-year h/o bitemporal headaches, polydipsia, polyuria, and bulimia plus 2-month h/o emotional outbursts, aggression, and transient confusion. Neuro exam normal. What will MRI of brain show?

HYPOTHALAMIC TUMOR

Gelastic seizures are a/w which brain foci?

HYPOTHALAMUS

Orexin is made in what part of the brain?

HYPOTHALAMUS

BMD II with rapid cycling have higher prevalence of what endocrinologic dysfunction?

HYPOTHYROIDISM

What symptom is more likely to occur in acute stress d/o than in PTSD?

REDUCTION IN AWARENESS OF SURROUNDINGS

"When I hear the news, the newscaster is talking about me." This represents?

IDEAS OF REFERENCE

MMPI does what? (2x)

IDENTIFIES MAJOR AREAS OF PSYCHOPATHOLOGIC FUNCTIONING

In treatment of recovering addict, rehearsal strategies help with what?

IDENTIFYING INTERNAL HIGH-RISK RELAPSE FACTORS

30 y/o develops pain behind left ear. The following day pt complains of numbness on the L side of the face, tearing from L eye, and discomfort with low frequency sounds. Exam shows L facial weakness, but no sensory deficit. Likely diagnosis: (2x)

IDIOPATHIC BELL'S PALSY

36 y/o pt w pain behind L ear progressing to numbness of L side of face, tearing of L eye, discomfort w low frequency sounds, left facial weakness on exam. Dx? (9x)

IDIOPATHIC BELL'S PALSY

26-year-old obese pt presents to ER with severe headache. Pt is otherwise healthy and does not take any meds. Head CT and brain MRI are unrevealing. The only finding on exam is shown in the fundoscopic images below (blurred optic disk). What is diagnosis? (x2)

IDIOPATHIC INTRACRANIAL HYPERTENSION

23 y/o admitted in inpatient unit w/ Dx acute psychotic d/o after threatening to beat up his mother (with whom he lives). Agreed to voluntary admit, but 2 days later demands to sign out AMA. What justifies involuntary hospitalization in this pt? (2x)

IF THE PATIENT CONTINUES TO THREATEN HIS MOTHER

Patient with self reported concerns of brain tumor; no symptoms suggestive of brain tumor, but states he has a cousin who died of brain tumor. PE unremarkable. Neuroimaging negative, patient repeatedly requests MRI, still concerned about tumor. Dx?

ILLNESS ANXIETY D/O

A 45yr old pt, terminated treatment with previous PCP "because he didn't take my concerns seriously." Pt believes he has dreaded illness and stomach cancer, denies all symptoms and labs are normal, diagnosis?

ILLNESS ANXIETY DISORDER

The parent of a 43 y/o pt died 5 years ago from pancreatic cancer. 4 years ago patient began feeling full after eating large fatty meals, fearing it was pancreatic cancer. Constantly weighs himself so that he is not losing weight. Now avoids going to doctor to avoid being diagnosed with cancer. No other psychiatric symptoms. What is diagnosis?

ILLNESS ANXIETY DISORDER

Patient describes hearing his name when the wind rustles leaves outside in the morning. Phenomenon?

ILLUSION

Phenomena is most typical of hallucinogen use?

ILLUSIONS

Pt w panic disorder failed 2 SSRI trials. Which med should be used next?

IMIPRAMINE

Pathological gambling is included in what grouping:

IMPULSE CONTROL D/O

According to DSM-IV-TR, compulsive skin picking would be:

IMPULSE CONTROL D/O NOS

REM sleep is first evident at which stage of development? (x3)

IN UTERO

Family of 75 y/o pt is concerned about his safety b/c he has been forgetting to turn off stove. Psych MD suspects an evolving cognitive d/o. What is most likely to be the earliest impairment to occur in the pt?

INABILITY TO RECALL 3 WORDS AFTER A 3 MIN DELAY

Prosopagnosia is:

INABILITY TO RECOGNIZE FACES

Most common eye tracking movement abnormality in pts with schizophrenia?

INAPPROPRIATE SACCADES (SACCADIC INTRUSIONS)

The component of ADHD that is most likely to remain in adulthood:(x2)

INATTENTION

3 month progressive limb weakness L>R, problems swallowing. Normal CN, weakness in neck extensor muscles, in distal and proximal muscles (quadriceps, feet dorsal flexors, extensor pollicis longus) and in wrist/finger flexors. DTRs normal. Motor tone/coordination/gait normal. Elevated CK.

INCLUSION BODY MYOSITIS

SE with ketamine?

INCREASE BP

What stage of development occurs first in female physical development?

INCREASE IN ADRENAL ANDROGEN PRODUCTION

The rapid learning demonstrated by children during the school-age years is paralleled neurodevelopmentally by which of the following brain processes?

INCREASE IN WHITE MATTER

Positive allosteric modulators of neurotransmitter-gated, multimeric ion channels do what?

INCREASE PROBABILITY OF OPENING IN PRESENCE OF A LIGAND

Pt w OCD started on 100mg sertraline, at 4 week f/u increased to 150mg b/o no response. Week 10, pt reported no improvement. Next step?

INCREASE SERTRALINE TO 200MG

32yo h/o panic disorder, phobias, numerous failed trials of antidepressants. On clonazepam 0.5mg bid with good response. 1mo later response still good but not as good. Dose increased to 1mg bid, on 3rd visit pt reports some loss of benefit again. What is the appropriate course of action?

INCREASE TO 1.5MG PER DAY

Why is l-methylfolate preferable to folate in adjunctive tx of depression?

INCREASE TRANSFER ACROSS BBB

Motor dysfunction in Parkinson's associated with:

INCREASED ACTIVITY IN SUBTHALAMIC NUCLEUS AND PARS INTERNA OF GLOBUS PALLIDUS

What symptoms of nicotine withdrawal may persist in a patient for up to 6 mos?

INCREASED APPETITE

Sx for a pt 2 months after traumatic experience:

INCREASED AROUSAL AND INTRUSIVE THOUGHTS

What eeg read Correlates to a positive response to ECT?

INCREASED ECT-INDUCED FRONTAL DELTA ACTIVITY

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

INCREASED FRAGMENTATION

Physiologic changes during REM sleep

INCREASED HEART RATE, INCREASED EYE MOVEMENTS, DECREASED MUSCLE TONE

Disadvantage of using shorter half-life benzodiazepines in the tx of EtOH withdrawal: (X2)

INCREASED LIKELIHOOD OF GRAND MAL SEIZURES

This is characteristic of sleep in individuals over the age of 65 compared to young adults

INCREASED SLEEP FRAGMENTATION

58 y/o with MDD is getting ECT, develops dense retrograde amnesia after 3rd treatment. How can this be ameliorated?

INCREASING THE INTERVAL BETWEEN ECT TREATMENTS

Concurrent use of phenelzine and meperidine can cause hypermetabolic reaction secondary to what?

INDIRECT PHARMACODYNAMIC EFFECTS AT A COMMON BIOACTIVE SITE

bipolar disorder pt with multiple arrests for violences exhibits threatening behaviour and threatens to harm ex-gf. what is your legal responsibility

INFORM POLICE THAT PATIENT IS POTENTIAL DANGER

Neurocognitive functions most likely to show decline in people over 65 years of age? (x2)

INFORMATION PROCESSING SPEED

Which of the following functions is most likely to normalize in an 80 y/o pt successfully treated for depression?

INFORMATION PROCESSING SPEED

16 y/o adolescent with burns to the face 2/2 playing with a spray paint can that ignited. Grades dropped from A's to F's. The mother is concerned about hearing problems. No other health problems. Dx?

INHALANT ABUSE

15 year-old pt is brought to ER by friends due to aggression and impaired judgment while intoxicated. On exam the pt has a mild tremor, nystagmus, slurred speech, unsteady gait and hypoactive deep tendon reflexes. The pt complains of dizziness and appears uncoordinated. Which of the following substances did the pt use?

INHALANTS

21 year old has episode of nausea, sweating and hematemesis. Pt reports having recent severe headaches and numbness in extremities. CT shows generalized brain atrophy and labs show renal tubular acidosis and CPK of 3120 mcg/L. This is likely due to chronic use of what?

INHALANTS

What substance can cause dementia w/ long-term use?

INHALANTS

Serotonergic antidepressants are appropriate treatment for depression in 54 y/o pt with recent coronary artery bypass graft surgery because they: (2x)

INHIBIT PLATELET FUNCTIONING

Phencyclidine induces psychosis by

INHIBITING NMDA-R

Mechanism of action of botulinum toxin at neuromuscular junction: (3x)

INHIBITION OF ACETYLCHOLINE FROM PRESYNAPTIC TERMINALS

What condition in patients with schizophrenic or schizophreniform psychosis is associated with poor prognosis?

INITIAL ONSET DURING ADOLESCENCE

Pt with HTN develops painless vision loss in the left eye. Exam: blindness in L eye and afferent pupillary defect on the left. MRI: several T2 hyperintensities in the white matter periventricularly. No corpus callosum lesions. No enhancement with gadolinium. Dx?

ISCHEMIC OPTIC NEUROPATHY

The mood disturbance of PMDD is characterized by ...

IT CAN BE AS SEVERE AS IN MDD

Psych MD is asked to evaluate a 37 y/o F who complains of chronic vulvar pain. This pain is accompanied by a burning sensation which is localized to the vestibular region. Pt's husband reports a 12-month lack of any sexual intercourse with pt. on psychiatric eval, the pt expresses ambivalence about the lack of intimacy with her husband, and appears somewhat annoyed at him for not understanding how painful sex has become. Pt denies depression or anxiety, but admits to frustration about the pain. The gynecologist reports that a full physical and laboratory workup is remarkable except for pain in the vestibule which can be elicited with touch. Which would be the most reasonable intervention?

INITIATE NORTRIPTYLINE AND SLOWLY TITRATE.

Pt p/w limb-shaking episodes lasting >3min. Pt is conscious, talking, and is briefly able to suppress movements during these episodes. Which is a risk factor for poor prognosis?

INSIDIOUS ONSET OF SYMPTOMS

32 y/o pt w/ hx of treatment resistant depression was brought to ER after overdose on imipramine. Pt reported wanting to die, but then changed her mind and then called for help. Pt's regular psych MD had recently added imipramine to the pt's partially effective regimen of fluoxetine 80mg qday. Pt is afebrile, BP is 100/58 and HR is 96 and regular. Pt is vague about the detail of the attempt, but reports no longer feeling suicidal. Medical resident recommends admission to a psych unit. Request for a TCA blood level and EKG are deferred. Medical resident asserts that the pt's combined imipramine and desipramine level of 750ng/ml is not in the cardiotoxic range. What is the best course of action for the psych MD to take?

INSIST ON FURTHER CARDIAC MONITORING IN EITHER THE ED OR ICU

Abrupt withdrawal of nicotine is followed by what symptom?

INSOMNIA

EEG biofeedback more effective than progressive muscle relaxation in treating?

INSOMNIA

This major symptom of delirium may require that the pt receive pharmacological treatment:

INSOMNIA

Region of brain connected with the anterior medial frontal cortex during recognition of affective behavior by mirror neuron system.

INSULA

Gustatory special sensory seizures (auras) localize where?

INSULAR CORTEX

Body dysmorphic d/o vs. Delusional d/o somatic type:

INTENSITY W WHICH PT INSISTS ON PERCEIVED BODY DEFICITS

Thematic apperception test is used for

INTERFERING MOTIVATIONAL ASPECTS OF BEHAVIOR

Which medication reduces accumulation of plaques and disability in pt's with relapsing remitting MS?

INTERFERON BETA-1 A

24 y/o pt w/ hx of epilepsy since childhood has several seizures in rapid succession. Following Szs, pt developed paranoia and hallucination, but resolved over a matter of days. Dx:

INTERICTAL PSYCHOSIS

Which of the following best describes the characteristics of the normal adult alpha rhythm seen on an EEG recording?

INTERMITTENT AND POSTERIOR DOMINANT

Pt with double vision when looking to the left shows her eyes on primary gaze. On left gaze the right eye fails to adduct and there is nystagmus in the left eye. On right gaze and vertical gaze the eyes move normally. Dx?

INTERNUCLEAR OPHTHALMOPLEGIA

Which of the following characteristics is considered particularly likely to be found in patients with MDD with atypical features? (2x)

INTERPERSONAL REJECTION SENSITIVITY

Common cause of acute cerebellar ataxia in adults:

INTOXICATION WITH ANTIEPILEPTICS

In the US, which of the following is the most common precipitant of PTSD in children and adolescents?

INTRAFAMILIAL VIOLENCE

71 year old patient with thunderclap headache, unilateral eye pain, blurred vision, dilated pupils, conjunctival injection. Which dx test is best to reveal cause of patient's headache

INTRAOCULAR PRESSURE MEASUREMENT

63 y/o with new onset aphasia and R hemiparesis, 2 days ago had milder/similar symptoms that resolved in 30 minutes, yesterday had similar episode x 45 minutes. Current Sx started 1.5 hrs ago. CT shows no stroke or hemorrhage. Tx?

INTRAVENOUS THROMBOLYTIC AGENTS

A pt has multiple stroke like symptoms of short duration over several days. And has new onset symptoms for the last 90 minutes. CT scan shows no evidence of stroke or hemorrhage. What is the appropriate treatment? (2x)

INTRAVENOUS THROMBOLYTIC AGENTS

Substantially increase rate of sustained abstinence a/w Disulfiram use?

INVOLVE PATIENTS PARTNER IN MEDICATION ADMINISTRATION

Apoptosis of cortical neurons differs from necrosis in that it: (2x)

INVOLVES EXPRESSION OF SPECIFIC GENES

Of the following, first medication approved to treat depression: lithium, iproniazid, desipramine, methylphenidate, chlorpromazine:

IPRONIAZID

Atomoxetine's principal mechanism of action exerts a therapeutic action because it: (2x)

IS A SELECTIVE NOREPINEPHRINE REUPTAKE INHIBITOR.

Animal licking/ grooming affects offspring stress. Mechanism?

IS DUE TO DNA METHYLATION AFFECTING GLUCOCORTICOID RECEPTOR EXPRESSION

What is an accurate statement about the brain's default mode network?

IS INVOLVED IN REPROCESSING PREVIOUSLY EXPERIENCED STIMULI

Evidence for efficacy of family therapy as treatment for eating disorders?

IS SUPERIOR TO INDIVIDUAL THERAPY FOR ADLESCENTS 6-12 MONTHS AFTER TREATMENT

Depression increases risk of mortality from what disease? (2x)

ISCHEMIC HEART DISEASE

Which of the following is the most significant problem with the use of the global assessment of functioning scale?

IT CONFOUNDS SYMPTOMS AND FUNCTIONING

42 y/o pt with hx of HTN treated with HCTZ and lisinopril presents for f/u of severe melancholic and vegetative depression. The patient, while adherent to all med regimens, has failed multiple combos of antidepressants and is currently on a regimen that includes fluoxetine. The psychiatrist plans to discontinue fluoxetine and start selegiline. The most important consideration to be made before starting?

IT IS AN IRREVERSIBLE MAO-A & MAO-B INHIBITOR AND CAN ONLY BE STARTED 5 WEEKS AFTER DISCONTINUING FLUOXETINE TO DECREASE RISK OF SEROTONIN SYNDROME

Which of the following is the most accurate information on the use of biofeedback for hypertension?

IT IS EFFECTIVE FOR HYPERTENSION, HOWEVER, IT IS LESS EFFECTIVE THAN MEDICATION

The most valid criticism of relying on a no-harm contract to determine a pt's suicide potential:

IT LACKS ANY SIGNIFICANT EMPIRICAL EVIDENCE TO SUPPORT ITS US

Causative agent of progressive multifocal leukoencephalopathy (PML):

JC VIRUS

Asking pt what they would do in a hypothetical situation is testing what?

JUDGMENT

Psych MD asked pt "what would you do if you lost your prescription?" This question primarily assesses:

JUDGMENT

The EEG finding of 4-6 hz irregular polyspike activity in a patient with generalized seizures is characteristic of which of the following forms of epilepsy? (2x)

JUVENILE MYOCLONIC

16 y/o pt brought to psychiatrist's attn after having single grand mal sz. Pt's parents have noted on occasion pt has sudden jerks of entire body, resulting in dropping objects. EEG: rare 4-6 HZ irregular polyspike/wave bursts. Diagnosis? (9x)

JUVENILE MYOCLONIC EPILEPSY

mech for Qtc prolongation with neuroleptics

K CHANNEL BLOCKED

EEG findings in Stage II (N2) sleep

K-COMPLEXES AND SLEEP SPINDLES

Dissociative compound, sense of fragmentation and detachment during intoxication

KETAMINE

Which drug causes euphoria, a feeling like "flying above the dance floor," social withdrawal, nystagmus? (2x)

KETAMINE

Pt recently emigrated from East Africa presents to establish care at a health center. Pt denies use of alcohol, tobacco, or common street drugs, however notes that, prior to immigrating, he routinely chewed leaves of a local plant to improve concentration and help him stay awake while working long hours. Which plant did pt most likely use?

KHAT

17 yo with increased sleep duration to 18 hours, lethargy and cognitive slowing. Sleep EEG is normal.

KLINE-LEVIN SYNDROME

45 y/o reports lower back pain along w/ pain and numbness in R leg and foot w/ difficulty walking x 4 wks. Exam: limited due to back pain, foot drop on right side. Nerve conduction studies: normal motor and sensory in leg. EMG: decreased recruitment and spontaneous activity in right tibialis anterior and tibialis posterior muscles. Otherwise normal. Dx:

L-5 RADICULOPATHY

TMS advantages over ECT

LACK OF ANESTHESIA

Which depressive symptom is a melancholic feature specifier in DSM-IV? (2x)

LACK OF PLEASURE

Distinguishing absence seizures from partial complex seizures:

LACK OF POSTICTAL MANIFESTATIONS

Development of brain grey-matter volume peaks at what stage

LATE CHILDHOOD

Characteristic of Cloninger's type 1 alcoholism:

LATE ONSET

Epigenetic drift has been postulated to contribute to what disorder?

LATE ONSET ALZHEIMER'S DISEASE

What is the diagnostic value of transient paresis or aphasia after a seizure? (3x)

LOCALIZES THE FOCUS OF SEIZURE

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? (8x)

LATERAL MEDULLARY STROKE

Which part of cortical-striatal-pallidal-thalamic cortical circuit evaluates painful stimuli

LATERAL ORBITOFRONTAL

Pure sensory deficit extending to midline and involving face, arm, trunk, and leg, caused by a lacunar infarct where?

LATERAL THALAMUS

Free RBCs protoporphyrin test in the screening for intoxication with:

LEAD

What is a characteristic of atypical depression?

LEADEN PARALYSIS

When compared to the other subtypes of ADHD, children with the inattentive subtype have higher rates of anxiety and somatic complaints and

LEARNING DISORDERS

65 y/o pt has a stroke which causes him to fall. On exam, weakness of the right leg, with only minor weakness of the right hand, no weakness of the face, no sensory deficit. Speech is not affected, but pt seems unusually quiet and passive. The stroke most likely involves the:

LEFT ANTERIOR CEREBRAL ARTERY

Head & eyes deviate to right and right arm extends immediately before a generalized tonic- clonic seizure. Seizure focus:

LEFT CEREBRAL HEMISPHERE

Blocking R PCA (posterior cerebral artery) causes which visual disturbance?

LEFT HOMONYMOUS HEMIANOPSIA

Region of the brain most closely associated with cortical processing of faces

LEFT PARIETAL

Loss of ability to execute previously learned motor activities (which is not the result of demonstrable weakness, ataxia or sensory loss) is associated with lesions of?

LEFT PARIETAL CORTEX

68 y/o pt w/ hypertension develops rapidly progressing right arm and leg weakness, with deviation of the eyes to the left. Within 30 minutes of the onset of this deficit, pt became increasingly sleepy. Two hours after the onset, the patient became unresponsive. On exam: dense right hemiplegia, eyes deviated to the left, pupils: equal and reactive, a right facial weakness to grimace elicited by noxious stimuli. Cough and gag reflexes: present. Which CT finding is most likely? (2x)

LEFT PUTAMINAL HEMORRHAGE

Hormone released from adipose tissues, enters the brain and provides negative feedback / reduces food intake, regulates fat stores?

LEPTIN

A 50 yo BIB ED for SA by being in a closed garage with the cars running for several hours. CT brain 2 weeks later would show

LESION IN GLOBUS PALLIDUS

Pt scores on revised Wechsler adult intelligence scale (WAIS-R) subtests for picture arrangement and block design are very low compared to scores on other subtests. Most suggestive of:

LESION IN NONDOMINANT HEMISPHERE

Risk factor for depression in MS patients

LESION VOLUME

When compared to younger adults, anxiety disorders in adults over age 65 have:

LESS COMORBIDITY WITH ALCOHOL ABUSE

physician suicide is different than the rest of the pop

LESS LIKELY TO BE TAKING ANTIDEPRESSANT

What is the best reason for preferring the use of SSRI antidepressants over TCAs in tx of pts w/depression who are > 65yo?

LESS LIKELY TO CAUSE ORTHOSTATIC HYPOTENSION

What is the advantage of buprenorphine compared to methadone taper in detoxification from opiate dependence?

LESS RISK OF RESPIRATORY SUPPRESSION

65 y/o M with 6 mo h/o confusion episodes, disorientation, VHs of children playing in his room. Hallucinated images are fully formed, colorful, vivid and pt has little insight into their nature. No AH. Wife says he is normal between episodes. Exam: Normal language, memory, mod diff with trails test, mild diff with serial subtractions, mild symmetric rigidity and bradykinesia. Brain MRI unremarkable. CSF, routine labs and UDS normal. Diagnosis: (7x)

LEWY BODY DEMENTIA

Lab to get prior to starting naltrexone

LFT's

What is the 5HT3 receptor classification?

LIGAND GATED

Began bright light therapy for seasonal mood change, now experiencing undesirable later sleep onset and awakening time. What is the most likely reason.

LIGHT EXPOSURE WAS TOO LATE IN THE DAY

35 year old woman reports history of recurrent depression always beginning in fall/early winter and remit by spring. She is trying to become pregnant, what's best tx?

LIGHT THERAPY

Genetic technique to analyze chromosomes for a disorder

LINKAGE ANALYSIS

Which method examines the consistency that genetic variants are passed from parent to offspring within different families? (recombination, linkage analysis, DNA sequencing, Genome-wide association studies)

LINKAGE ANALYSIS

58 yo depression and psychomotor retardation on SSRI. Tx augmented by?

LIOTHYRONINE

Complex partial epilepsy aura has what symptom?

LIP SMACKING

32 y/o w/ diarrhea x 2 wks, is anxious, and not oriented to date/time of day. Taking "some drug" for BMD and patient doubled her dose a month ago when she felt she wasn't getting better fast enough. What med caused these Sx?

LITHIUM

47y/o pt w acute mania is unresponsive to pharmacotx. Pt's current med regimen includes lithium, divalproex, clonazepam, olanzapine, bupropion. ECT is begun, pt is continued on previous med regimen. After 2 ECT tx, pt becomes delirious. Cause? (x3)

LITHIUM

Med that is assoc w prolonged seizures/confusional state during ECT:

LITHIUM

What drug is good for acute mania?

LITHIUM

Which med should be held before ECT? (x3)

LITHIUM

Opiates inhibit Camp dependent protein phosphorylation in:

LOCUS CERULEUS

Doctor examines 81-year-old pt twice daily, mid morning and late afternoon. Comparing the two assessments, what findings suggest that the patient is delirious?

LOGICAL AND COHERENT SPEECH ON THE FIRST EXAM, DISORGANIZED SPEECH ON THE SECOND

Process of calcium mediated long-lasting increase in AMPA receptor signal transmission

LONG-TERM POTENTIATION

Somatic sx/complaint, negative medical workup, negative psych eval

LOOK AGAIN FOR ORGANIC ETIOLOGY

21 y/o pt presents to the ED after using marijuana for the first time. The pt reports pounding heart, sweating, fear of dying and shaking. The most appropriate next step to administer:

LORAZEPAM

28 F pt mute, rigid, catatonic. Not on meds. What Tx?

LORAZEPAM

45 y/o pt w/ hx of MDD recently had Citalopram twofold, with addition of Trazodone 100 mg/night for sleep. Ten days later, pt presents to ED with severe restlessness, nausea, vomiting, and diarrhea. Serum tox negative. On exam, pt confused, mildly agitated, febrile to 100.8, and tachy to 108. Neuro exam = nystagmus, B/L hyperreflexia, and ankle clonus. Tone without rigidity. In addition to stopping all meds & starting supportive care, what med should be given?

LORAZEPAM

A benzodiazepine reliably absorbed when administered PO or IM:

LORAZEPAM

Aggressive pt, yelling and assaulting, vomit, HR 135, BP 155/80, T 101F. Utox neg. Suspect bath salts intoxication. tx?

LORAZEPAM

Avoid which drug in a pt intoxicated with alcohol or a sedative drug?

LORAZEPAM

Pt w/ h/o bipolar presents w immobility, posturing, echopraxia. First line tx? (5x)

LORAZEPAM

Pt with hx of bipolar disorder p/w immobility, posturing, and echopraxia. First line tx? (3x)

LORAZEPAM

Schizophrenic patient becoming catatonic with waxy flexibility. Which is the most appropriate medication?

LORAZEPAM

17 yo pt brought to ED after reporting recent cocaine use to teacher. In ED pt is agitated, hyperaroused, unable to concentrate on interview. Pt denies hallucinations, however appears very distractible, frightened. Physical exam shows HR 100, normal rhythm. What is most appropriate intervention to give? (x2)

LORAZEPAM 2 MG

An intoxicated pt in ER throws a food tray at security guard, no respond to verbal redirection and refused to take meds by po. Pt is now pacing, cursing and threatening to "hurt someone". The most appropriate meds:

LORAZEPAM 2MG IM, REPEATED IN 45 MIN IF NO RESPONSE

A nurse w/ 24 hr hx of anxiety and insomnia has a generalized tonic-clonic seizure. Dx?

LORAZEPAM WITHDRAWAL

Which commonly precipitates suicide in the elderly?

LOSS

Which finding would you expect if someone is diagnosed with ulnar neuropathy at the elbow?

LOSS OF SENSATION IN THE FOURTH AND FIFTH DIGIT AND WEAKNESS OF INTRINSIC HAND MUSCLES

Delirium in HIV patients treated with what parenteral agent?

LOW DOSE OF A HIGH-POTENCY ANTIPSYCHOTIC

What is commonly associated with conversion d/o?

LOW INTELLIGENCE

Pt s/p surgery develops weakness and wasting of small muscles of the hand and sensory loss of the ulnar border of the hand and inner forearm. Dx?

LOWER BRACHIAL PLEXUS PARALYSIS

60 y/o w/ depression & paranoia treated with 50mg Zoloft and 6mg risperidone. On follow up pt c/o slow thinking & excessive salivation. On PE masked faces and cogwheel rigidity present. Mood and paranoia have greatly improved. What is the next step?

LOWER DOSE OF ANTIPSYCHOTIC MEDS

In studies that compare SSRI antidepressants with TCAs, which of the following is the best documented advantage of SSRIs over TCAs?

LOWER DROP OUT RATES DUE TO SIDE EFFECT

Equal dose of alcohol corrected for body weight lead to higher BAL in woman than me. Why?

LOWER LEVELS OF ALCOHOL DEHYDROGENASE IN GASTRIC MUCOSA

Compared to pharmacotherapy, advantage of CBT in tx of panic disorder is

LOWER RATE OF RELAPSE FOLLOWING D/C OF TREATMENT

Young pt with new onset severe HAs associated with periods of visual obscuration. Neuro exam is normal except for papilledema. MRI: normal and shows no mass effect. Next test? (7x)

LUMBAR PUNCTURE TO MEASURE PRESSURE

68 y/o w/ pain in buttocks while walking, shooting down legs, w/ weakness and numbness. Relieved by sitting, pain persists with standing. Dx?

LUMBAR SPINAL STENOSIS

Which cancer has the highest likelihood of going to brain?

LUNG

A C&L psychiatrist sees a sick patient with AMS. Has persecutory delusions and AH/VH. Malar rash and proteinuria, fever, pancytopenia present. What is cause of AMS?

LUPUS CEREBRITIS

SSRIs with the greatest potential for slowing or blocking metabolism of other medications?

LUVOX

Best recommendation for pt with delirium? Minimize contact with family members or limit sleep meds to diphenhydramine, or maximize staff continuity assigned to pt?

MAXIMIZE STAFF CONTINUITY ASSIGNED TO PT

Which is a limitation of the MMSE? (7x)

MAY FAIL TO DETECT VERY MILD COGNITIVE IMPAIRMENT

CT Head Large hypodensity on R frontal and parietal lobes

MCA STROKE W/ RESIDUAL L SIDED WEAKNESS

Non-specific hematological marker for heavy drinking

MCV

61 y/o with left frontal lobe damage secondary to cerebrovascular accident may be predisposed to which psychiatric syndrome?

MDD

Bulimia is comorbid with:

MDD

First-degree relatives of patient with BMD II have a higher incidence of what disorder?

MDD

25 y/o pt reports experiencing intense periods of profound tiredness over the past 2-3 weeks. During these periods she has increased need for sleep and spend much of day in bed. Pt also reports increased appetite. These episodes often occur in setting of interpersonal discord. Dx?

MDD WITH ATYPICAL FEATURES

50 y/o pt is being treated for sadness, anorexia, poor energy, and difficulty concentrating. Fluoxetine 20mg is prescribed and the pt achieves full remission. Later pt admits that she had visual and auditory hallucinations. This improved with treatment and pt currently denies any hallucinations. Dx?

MDD WITH PSYCHOTIC FEATURES

Hippocampal atrophy has been identified in all of the following disorders:

MDD, ALZHEIMER'S DISEASE, PTSD. (NOT DISSOCIATIVE AMNESIA)

23 y/o in ER after a party. Dehydration, dilated pupils, HTN, elevated CPK. Which drug did he take? (7x)

MDMA

Drug of abuse associated with sxs of bruxism, anorexia, diaphoresis, decreased ability to orgasm, and hot flashes: (2x)

MDMA/ECSTASY

Lab parameter often elevated in patients with alcohol dependence? (2x)

MEAN CORPUSCULAR VOLUME

50 y/o pt with myasthenia gravis and a 3-day hx of cough, low-grade fever and chills, presents with great difficulty breathing. The pt appears tired and anxious, and the pt's skin is clammy and sweaty. Initial management?

MECHANICAL VENTILATION

First step in the management of acute myasthenic crisis:

MECHANICAL VENTILATION

Myasthenia gravis pt with mild respiratory infection develops severe respiratory fatigue, restlessness, and diaphoresis. Pt appears anxious and tremulous. Tx?

MECHANICAL VENTILATION

"My father was very involved in my life. I remember going to football games in the snow with him" is an example of memory associated with what part of the brain?

MEDIAL TEMPORAL LOBE

Gay couple seeks therapy. One has HIV, one is negative. HIV negative feels betrayed and believes HIV positive partner was unfaithful. What should therapist say?

MEDIAN DURATION OF ASYMPTOMATIC STAGES OF HIV INFECTION IN THE US IS 10 YEARS

22 y/o with pain in the right hand that radiates into the forearm and bicep muscle. Paresthesias in the palm of the hand, thumb, index, middle ring finger. Sensory systems in the ring finger split the ringer finger longitudinally. Dx? (6x)

MEDIAN NERVE ENTRAPMENT AT THE WRIST

During 2nd trimester, a pregnant 38 y/o F has numbness in both hands, particularly thumb, forefinger, middle finger bilaterally. Dorsal part of hand unaffected. Arms ache in the morning from shoulders to hands. Diagnosis: (3x)

MEDIAN NEUROPATHY AT THE WRIST

The multimodal Tx study of children w/ ADHD examined the comparative responses over 14 months of children to medication and intense psychosocial interventions. What did the findings of the study reveal w/ respect to ADHD symptom changes? (2x)

MEDICATION MANAGEMENT IS SUPERIOR TO COMMUNITY CARE TREATMENT

75 y/o F pt is 8 days s/p total hip replacement and has delirium. Her diazepam and doxepin were discontinued just prior to surgery. She is getting meperidine for pain, diphenhydramine for sleep and a renewed prescription for doxepin. Her confusion is likely due to which of the following: medication toxicity, diazepam WDRL, electrolyte imbalance, atypical depression, UTI.

MEDICATION TOXICITY, DIAZEPAM WITHDRAWAL, ELECTROLYTE IMBALANCE, ATYPICAL DEPRESSION, OR UTI. (ALL OF THE ABOVE)

5 y/o with 4 month history of morning HA, vomiting, and recent problems with gait, falls, and diplopia: (2x)

MEDULLOBLASTOMA

8 y/o with persistent delayed sleep onset despite good sleep hygiene, given no indication of broader psychopathology, which med has best evidence to treat this problem and restore normal circadian rhythm? (2x)

MELATONIN

Which of the following neurohormones is known to modulate immune function, has analgesic properties, is derived from the serotonin molecule, and is a potent antioxidant and free-radical scavenger?

MELATONIN

Neuronal damage from excitotoxicity secondary to glutamate sensitivity. Treat with:

MEMANTINE

What cognitive enhancer is an NMDA receptor antagonist?

MEMANTINE

Which is an NMDA receptor antagonist? (2x)

MEMANTINE

Military veteran from war zone with memory problems. Which finding would support dissociative amnesia? Closed head injury, decreased procedural memory, anterograde & retrograde amnesia, memory deficits limited to few traumatic episodes, vague recall of all memories since childhood

MEMORY DEFICITS LIMITED TO FEW TRAUMATIC EVENTS

Recurrent deafness, tinnitus then vertigo:

MENIERE'S DISEASE

Which of following is invariably the first manifestation of neurosyphilis?

MENINGITIS

50 y/o pt is in the ED for acute onset of neck pain radiating down the left arm, progressive gait difficulty, and urinary incontinence. This test should be administered immediately:

MRI SCAN OF THE CERVICAL SPINE TO EXCLUDE A DIAGNOSIS OF SPINAL CORD COMPRESSION.

14 y/o @ summer camp develops severe headache and fever, drowsiness, stiffness of neck on passive forward flexion, petechial rash and skin pallor. Spinal tap reveals opening pressure 200mm H20, 84%neutrophils (7,000 nucleated cells), glucose level of 128mg/dl, and protein level of 33mg/dl. Most likely causative agent?

MENINGOCOCCUS

What is the relationship of violence to mental d/o?

MENTAL D/O HEIGHTENS RISK IN SOME, DECREASES RISK IN OTHERS

Drug-addicted healthcare professional experiences seizure that is not a withdrawal phenomenon. Cause?

MEPERIDINE

Healthcare professional has seizure as a result of drug addiction, seizure is not from withdrawal. What substance are they using?

MEPERIDINE

Which opioid has a potentially lethal interaction with monoamine oxidase inhibitors (MAOIs)? (4x)

MEPERIDINE

Pt taking phenelzine is treated in ED for chest pain. While treated, pt develops hyperreflexia, HTN, goes into coma. Which med is most likely cause?

MEPERIDINE (DEMEROL)

DM pt with creeping paresthesias and burning pain in L anterolateral thigh. DTRs normal, no weakness. Dx?

MERALGIA PARESTHETICA

So dopamine neurons in what system is primarily implicated in tasks related to cognitive processing?

MESOCORTICAL

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

MESOLIMBIC

52 y/o with h/o unipolar depression is brought to ED with a first episode of catatonia. Pt is on no meds, UDS is neg. Further w/u should initially focus on what factor?

METABOLIC DISORDERS

Multifocal myoclonus in a comatose patient indicates: (2x)

METABOLIC ENCEPHALOPATHY

72 y/o w chronic hepatitis in ED for treatment of ongoing alcohol withdrawal. Hospital protocol is to use chlordiazepoxide, but psych suggest lorazepam because

METABOLIZED THROUGH GLUCURONIDE CONJUGATION

35 y/o pt with hx of opioid and alcohol dependence presents to the emergency department complaining of tremulousness, anxiety, nausea and vomiting. Used large amounts of heroin and alcohol the day prior. Initial preferred medication for opioid withdrawal?

METHADONE

Pregnant pt dependent on heroin presents for treatment, wants to do what's best for baby. What is safest treatment for both mother and unborn baby? (2x)

METHADONE MAINTENANCE FOR THE DURATION OF THE PREGNANCY

22 y/o heroin dependent female discovers she is pregnant and wants to detox. What way would you recommend? (4x)

METHADONE MAINTENANCE UNTIL DELIVERY THEN DETOXIFICATION

opioid dependent offenders remain drug free with this intervention

METHADONE MAINTENANCE WHILE IN PRISON

What barbiturate is used in ECT to produce a light coma?

METHOHEXITAL

Epigenetic change with fragile X mental retardation 1 gene in fragile x syndrome?

METHYLATION OF THE CPG SITES OF THE PROMOTER REGION

Causes long-term inhibition of new serotonin synthesis and decrease in serotonin terminal density:

METHYLENEDIOXYMETHAMPHETAMINE (MDMA)

Drug of abuse that exerts it ffects primarily though serotonin release and reuptake inhibition:

METHYLENEDIOXYMETHAMPHETAMINE (MDMA)

32 y/o w/ ADHD mixed type as child. As adult still has Sx. Tx:

METHYLPHENIDATE

Medication helpful in early HIV dementia but is potentially toxic later in the disease?

METHYLPHENIDATE

Pt with a long history of substance abuse is admitted to the hospital for shortness of breath. The pt is found to have multiple granulomas in both lungs; a biopsy reveals the presence of talc within the granulomas. Pt most likely abusing what substance?

METHYLPHENIDATE

Which med would you prescribe for 20 y/o college student being worried over his grades? He complains that he has not been able to focus on studying and that his mind wanders frequently during classes. His energy level is low. He sleeps well and his appetite is good. History indicates he was treated with stimulants since second grade.

METHYLPHENIDATE

Reduces Sxs during acute exacerbation of MS:

METHYLPREDNISONE

Psychiatrist is called to eval a pt on a medical floor who has developed acute dysarthria w/ protruding tongue and torticollis. Which med is suspect? (2x)

METOCLOPRAMIDE

TD in 63 y/o w/ end stage renal failure. Culprit:

METOCLOPRAMIDE

Child presents w/ moderate intellectual disability, deficits in visual-spatial processing, high levels of anxiety, a phobia, and is highly sociable. Which genetic d/o? (2x)

MICRODELETION ON CHROMOSOME 7q11.23 (WILLIAMS SYNDROME)

Which cell types secretes innate pro-infammatory cytokines TNF - alpha and Il -1 B in pts with inflammatory conditions that affect the brain? (X2)

MICROGLIA

What occurs when the central nervous system responds to an acute cortical insult?

MICROGLIA PROCESSES RETRACT, AND THE CELL BODY ENLARGES

Positive effect of neuroinflammatory response: activation of microglia in response to repeated social defect, microglial priming and hyper-reactivity following a CNS injury, chronic microglial activation following TBI, microglial propagation of cytokines with associated decreased physical activity in response to a peripheral infection, increased cytokine inflammatory genes and decreased anti-inflammatory genes associated with increasing age.

MICROGLIAL PROPAGATION OF CYTOKINES WITH ASSOCIATED DECREASED PHYSICAL ACTIVITY IN RESPONSE TO A PERIPHERAL INFECTION

54yr old pt dies from rapidly progressing dementia associated with myoclonus, what is most likely finding at autopsy?

MICROVACUOLATION OF GLIA AND NEURONAL DENDRITES

Typical feature of epileptic activity in alcoholic pt with seizure 12h after EtOH cessation

MULTIPLE EPISODES

35 y/o reports episodes of flashing lights traveling slowly from L to R in the left visual field, symptoms persisting for about 30 minutes, followed by difficulty expressing self and concentrating. After about 30 minutes, these neurologic symptoms seem to subside, and pt develops a pounding headache associated with nausea. Both physical exam and MRI are normal. (3x)

MIGRAINE WITH AURA

Which test is an objective measure of personality in adults and is helpful in confirming diagnosis of personality disorder? (3x)

MILLON CLINICAL MULTIAXIAL INVENTORY (MCMI)

Which test to confirm personality disorder?

MILLON CLINICAL MULTIAXIAL INVENTORY (MCMI-III)

2 months after severe brain injury, pt opens the eyes for prolonged periods but remains inattentive, does not speak, and shows no signs of awareness of the environment or inner need. Pt is capable of some rudimentary behaviors such as following a simple command, gesturing, or producing single words or brief phrases, always in an inconsistent way from one exam to another. Which of the following is the most accurate description of the pt's condition?

MINIMALLY CONSCIOUS STATE

Which psychological test has been validated for adolescents, elderly and ethnic minority groups, and is recommended for the assessment of psychological functioning in patients from diverse cultures?

MINNESOTA MULTIPHASIC PERSONALITY INVENTORY (MMPI-2)

Horner's syndrome is characterized by?

MIOSIS, PTOSIS, AND ANHIDROSIS OF FOREHEAD

Which antidepressant has strongest histamine-R affinity?

MIRTAZAPINE

15 y/o has hx of seizures beginning at the age of 9years, followed by prolonged motor or sensory deficits lasting days to weeks. The pattern of the seizures and the focal deficits has changed over time. The pt also has hemicranial headaches. No family hx of similar symptoms. Most likely diagnosis?

MITOCHONDRIAL ENCEPHALOMYOPATHY, LACTIC ACIDOSIS AND STROKE.

Which is the most common mitochondrial disorder?

MITOCHONDRIAL ENCEPHALOPATHY, MYOPATHY, LACTIC ACIDOSIS, AND STROKE-LIKE EPISODES (MELAS)

Child w ADHD not respond to methylphenidate IR. What med to try next (4x)

MIXED AMPHETAMINE SALTS

What psychological tests measure test-taking attitudes at time of exam (4x)

MMPI (MINNESOTA MULTIPHASIC PERSONALITY INVENTORY) VALIDITY SCALE

The most important tool for evaluation of early and moderate dementia:

MMSE

MAOI least likely to cause drug-food interaction in therapeutic antidepressant doses:

MOCLOBEMIDE

A patient with day time sleepiness, frequent naps. Sleep studies shows that pt enters REM within 5 minutes and wakes frequently at night. Which treatment is appropriate?

MODAFINIL GIVEN DOSE IN THE MORNING

8 y/o boy w/ ADHD, oppositional defiant disorder, and chronic motor tic disorder has worsening of his tics on a good dose of a stimulant that seems to control his ADHD. How do you manage this further in trying to improve the tics?

MONITOR THE TICS ONLY

70 Y/O pt with confusion, lethargy, fever. Dx of encephalitis is made after CSF analysis. What clinical feature suggests West Nile virus?

MONOPARESIS

Which area of MSE relies primarily on patient report?

MOOD

Which d/o is the most common among pts who complete suicide: (4x)

MOOD

What disorder is most likely to be comorbid in pts w trichotillomania?

MOOD DISORDER

50 y/o PT w/ depression believes that he is responsible for the destruction of the world. This is an example of: (2x)

MOOD-CONGRUENT DELUSION

Pts > 65 years w bipolar disorder differ from younger pts w same dx—how?

MORE MIXED EPISODES

Prevalence of AIDS increased after discovery of AZT, best explanation?

MORE PATIENTS WERE LIVING LONGER

The best describes data on suicide risk from meta-analysis of clinical studies of depressed children and adol treated w. SSRI:

MORE YOUTH APPEAR TO FAVORABLY RESPOND TO MEDS THAN SPONTANEOUSLY REPORT SUICIDALITY

Pt is initiating light therapy for seasonal depression. What statement accurately represents what is known about the type, dose, and timing of effective treatment?

MORNING LIGHT TREATMENT APPEARS TO BE MORE EFFECTIVE THAN MID-AFTERNOON EXPOSURE.

In contrast to pts with factitious disorder, pts with malingering are characterized by having:

MOTIVATION FOR SECONDARY GAIN.

What key factor distinguishes factitious disorder from malingering

MOTIVATION TO BE IDENTIFIED AS ILL

The psychiatrist asks pt w EtOH dependence to rate readiness to quit drinking on scale of 1-10. When pt responds "3," psychiatrist asks, "Why a 3 instead of a 1?" The psychiatrist is using which of the following modalities?

MOTIVATIONAL ENHANCEMENT THERAPY

Pt with OCD resistant to entering treatment is a candidate for:

MOTIVATIONAL INTERVIEWING

Psychotherapy for alcoholism that targets pt ambivalence

MOTIVATIONAL-ENHANCEMENT THERAPY

50 y/o M w/ acute neck pain radiating down L arm, gait problems, urinary incontinence. What test should be ordered?

MRI OF C SPINE TO R/O CORD COMPRESSION

50 y/o man w a cut onset of neck pain radiating down left arm, progressing gait difficulty, urinary incontinence. Which test should be administered immediately?

MRI OF HEAD TO EXCLUDE DX OF ACUTE HYDROCEPHALUS

35-year old pt with new onset of numbness and tingling in the legs. The pt complains of a band-like sensation around the mid chest and reports episodes of urinary incontinence. Which of the following tests should be ordered next?

MRI OF THE SPINE

Check for residual physical dependence of opiates by administering:

NALOXONE

25 y/o pt reports double vision and some difficulty with balance. On right lateral gaze, there is weakness of the left medial rectus, with nystagmus of the right eye. On left lateral gaze, there is weakness of the right medial rectus, with nystagmus of the left eye. There is also mild finger to nose ataxia on the right. Dx:

MULTIPLE SCLEROSIS

36 yo pt w/ double vision, vertigo, vomiting, paresis of medial rectus on lateral gaze w/ coarse nystagmus in abducting eye w/ lateral eye movement

MULTIPLE SCLEROSIS

41 y/o chronic fatigue, cognitive impairment, reduced perceptual motor speed, poor effort maintenance, and irritability (MRI: hyperintensity in frontal lobe and what looks like a finger protrusion)

MULTIPLE SCLEROSIS

Acute onset of fever, sore throat, diplopia, & dysarthria. Exam reveals an inflamed throat, left adductor nerve palsy w/ impairment of vertical pursuit, diffuse hyperreflexia w/ bilateral clonus, lower ext spasticity, & mild right hemiparesis. CT is uninformative. Spinal fluid has protein of 24, 10 mononuclear cells, and glucose of 70. Dx? (2x)

MULTIPLE SCLEROSIS

Bilateral paresis of medial rectus muscle during lateral gaze with course nystagmus in abducting eye characteristic of:

MULTIPLE SCLEROSIS

Diagnosis of 32yo woman w/ vertigo and INO

MULTIPLE SCLEROSIS

Female with vertigo and diplopia, when looks left has isolated L eye nystagmus, and cannot adduct R eye. Dx?

MULTIPLE SCLEROSIS

Pt w/ acute onset of pain and decreased vision in the R eye. Colors look faded when viewed through the R eye. On exam, has a R afferent pupillary defect and a swollen right optic disc. Pt spontaneously recovers over the next 6 wks. Likely to develop later: (3x)

MULTIPLE SCLEROSIS

Receptor blocked by antidepressants -> blurred vision

MUSCARINIC

Gait pattern in which one side of pelvis is dropped is associated with which neurological condition?

MUSCULAR DYSTROPHY

This is a necessary characteristic for symptoms that qualify for DSM diagnosis of premenstrual dysphoric disorder

MUST BE PRESENT DURING THE FINAL WEEK OF LUTEAL PHASE

Communication d/o assoc w/ neurological and psych d/o

MUTISM

20 y/o occasional double vision when looking to R and normal acuity in each eye alone. L ptosis and difficulty keeping L eye adducted. Pupils round and reactive. Speech nasal and neck flexors weak. No paresis or reflex abnormalities in extremities. Dx?

MYASTHENIA GRAVIS

55 yo diplopia when looking right, drooping of left eyelid, and drooping L eye, symptoms better in the morning

MYASTHENIA GRAVIS

Neoplasms of the thymus are associated with:

MYASTHENIA GRAVIS

Term for sudden, irrepressible shock-like contraction of a muscle triggered by an event in CNS?

MYOCLONUS

65 yo pt with progressive weakness, worse when squatting and standing from a chair. C/o decreased strength in right hand. On exam, prominent weakness of the quadriceps bilaterally and on opposition of the thumb in the right hand. Atrophy of foreman muscles with normal DTRs. No other weakness noted on exam. Sensory exam normal. ROS negative. Labs show normal CK and neg for anti-transfer RNA synthase antibodies (Jo1). What is the most likely dx? (2x)

MYOTONIC DYSTROPHY

What occurs when the central nervous system responds to an acute cortical insult?

Microglia processes retract, and the cell body enlarges

At what receptors does phencyclidine's major action occur?

N-METHYL-D-ASPARTATE ACID (NMDA)

High voltage delta activity with slow eye-rolling on polysomnogram characterizes which stage of sleep?

N3

Pt who became addicted to codeine has a long h/o multiple relapses. Pt has completed a 2 wks detox and 2 wks following that, is about to start a court mandated maintenance on naltrexone. Prior to starting the maintenance therapy, psychiatrist should check for residual physical dependence by administering what? (2x)

NALOXONE

Alcoholic on disulfiram reports EtOH cravings. What drug will likely decrease these? (4x)

NALTREXONE

LFT after 8 weeks is required in pts with alcohol dependence treated:

NALTREXONE AND DISULFIRAM

Dementia rather than depression in regards to memory has...

NAMING DEFICITS (RATHER THAN IMPAIRED NONVERBAL INTELLIGENCE)

Pt with body dysmorphic d/o may have what personality d/o?

NARCISSISTIC

Interpersonal exploitativeness is a diagnostic feature of (2x):

NARCISSISTIC PERSONALITY DISORDER

Brief episodes of sudden loss of muscle tone, with intense emotion are characteristic of:

NARCOLEPSY

A medication to treat MS is an integrin antagonist that primarily acts by blocking lymphocytes and monocytes adhesion to the endothelial cells:

NATALIZUMAB

The key distinction in the differential diagnosis of social phobia versus agoraphobia is: (2x)

NATURE OF THE FEARED OBJECT

Drinking ETOH while taking disulfiram most likely to produce what sx

NAUSEA AND VOMITING

Biogenic amine made in Locus Coeruleus

NE

Example of a harm reduction technique used in people with opioid dependence:

NEEDLE EXCHANGE

Bipolar pt w/ 2 hospitalizations for mania taking lithium

NEEDS LIFETIME LITHIUM TREATMENT

Most closely correlates w/ social fx in schizophrenics:

NEGATIVE SYMPTOMS

Which type of child maltreatment is most prevalent? (3x)

NEGLECT

55 yo pt complains of numbness in 4th/5th digit R hand. Sxs worse when pt speaks on phone, awakens w paresthesias in same fingers. Test to confirm the dx?

NERVE CONDUCTION STUDIES

Most typical SE of fluoxetine:

NERVOUSNESS, RESTLESSNESS, AND ANXIETY

Having a pt's friend or spouse monitor disulfiram administration and report to the treating psych MD is an example of:

NETWORK THERAPY

Biological consequences of psychological stress affect which mechanism?

NEURO-IMMUNO-ENDOCRINE FUNCTION

Most common solid tumor of the CNS in kids

NEUROBLASTOMA

A 25 yr old pt develops progressive hearing loss, has acoustic neuromas and café au lait spots, diagnosis?

NEUROFIBROMATOSIS TYPE 2

Recent schizophrenic med adjustment, now with fever, diaphoresis, stiffness, tachycardia, confusion. Dx?

NEUROLEPTIC MALIGNANT SYNDROME

Term for burning dysesthesia with shock-like paroxysms:

NEUROPATHIC

Bender-Gestalt diagrams assesses:

NEUROPSYCHOLOGICAL IMPAIRMENT

75 y/o M, Korean war veteran, with gradual development of forgetfulness and cognitive deterioration, presents with very fast /slurred speech and impaired gait. A head CT shows some generalized atrophy, unusual for his age. The LP show 35 WBC, lymphocytosis and the protein level is 110mg/Dl and elevated gamma globulin. Dx:

NEUROSYPHILIS

75 y/o WWII veteran w/ gradual onset forgetfulness, intellectual deterioration, fast/slurred speech, gait impaired, CT with normal atrophy. LP: 35WBCs (most lymph), protein 110, increased gamma globulin. Dx?

NEUROSYPHILIS

Personality trait that is independent risk factor for somatic symptoms?

NEUROTICISM

Dx for pt w/ new-onset sz, multiple subQ nodules, freckling of axilla?

NF TYPE I

27 y/o F has multiple brown popular lesions on the face, neck, shoulders that have developed over years. Has b/l hearing loss, b/l limb and gait ataxia. MRI w/ gadolinium shown on test and has b/l enhancing masses. Pt is a carrier of a mutation in which gene? (3x)

NF-2 (NEUROFIBROMATOSIS 2 GENE)

33 y/o with insomnia, fatigue, nervousness, irritability, and depressed mood. Has scaly dermatitis in sun-exposed areas, apathy, and mild memory impairment. Which vitamin is pt deficient in?

NIACIN

Most commonly abused substance among patients with schizophrenia? (2x)

NICOTINE

Patient with long history of treatment resistant depression on phenelzine complaining of sweating, palpitations, and headache. BP = 210/118. Recently took OTC medicine to treat URI. What is the most appropriate intervention?

NIFEDIPINE

Pt taking tranylcypromine for atypical depression called Psych MD, reports HA, vomiting, chills, palpations over one day. Pt asks if he continue med during illness. In addition to directing pt to stop med, emergent Tx would 1st include what med?

NIFEDIPINE

40 y/o dentist is referred for evaluation by staff members who are concerned about his erratic behavior, staying excessively late at the office and problems with dexterity in treating pts. He complains of numbness and weakness of limbs, loss of dexterity, and loss of balance. Which drugs is the dentist most likely abusing? (2x)

NITROUS OXIDE

Excess activation of which receptor contributes to cell death in Alzheimer dx?

NMDA

Molecular mechanism of ethanol causes intoxication? (x2)

NMDA ANTAGONISM AND GABA AGONISM

28 y.o. hospitalized with paranoid delusions, AH, and agitation, tx w/Haldol 5, pt becomes rigid & mute, in days gets choreoform mvmt, has seizures, gets resp problems leading to ICU admit. Exam shows ovarian mass, CSF will show antibodies to:

NMDA RECEPTORS

Pathologic findings in brain of Tourette's?

NO ABNORMALITY

Neuronal cell density in schizophrenia characterized by

NO CHANGE

Male sexuality in the seventh decade is characterized by which of the following?

NO CHANGE IN SEX DRIVE

Most common explanation given by individuals >65 years for difficulty maintaining sleep?

NOCTURIA

Lack of prolactin elevation after szs suggests what kind of szs:

NON-EPILEPTIC

What does NOT predict violence?

NON-VIOLENT CRIMINAL ACTIVITY

What neurotransmitter has been associated with anxiety?

NOREPINEPHRINE

5 y/o child several month after that he lost his mother in a MVA reports that his mother is watching him from sky every day is and example of:

NORMAL GRIEF

60 y/o lost spouse 2 wks ago - sadness comes and goes

NORMAL GRIEF

Involuntary jerking of legs while falling asleep, not uncomfortable, stops with falling asleep

NORMAL PHENOMENON, NONPATHOLOGICAL

CT & MRI show ventriculomegaly are out of proportion to sulcal atrophy. This is suggestive of what diagnosis?

NORMAL PRESSURE HYDROCEPHALUS

Pt presents with a slowly progressive gait disorder, followed by impairment of mental function, and sphincteric incontinence. No papilledema or headaches are reported. Likely diagnosis? (4x)

NORMAL PRESSURE HYDROCEPHALUS

16 yr old has degrading and masochistic fantasies, accompanied by excitement and anxiety. Represent what?

NORMAL SEXUAL BEHAVIOR DEVELOPMENT

35 yo uninjured in an accident but witnessed deaths of co-workers. The following day reports emotional numbness, intrusive images, inability to sleep since the accident. Most appropriate intervention

NORMALIZING STRESS REACTION AND MOBILIZING RELATIONAL SUPPORTS

A known limitation of the Minnesota Multiphasic Personality Inventory?

NORMS DO NOT ACCOUNT FOR OUTCOMES BASED ON RELIGION AND RACE

Blood levels for therapeutic and potentially toxic effects can routinely be assessed for which med?

NORTRIPTYLINE

Safest heterocyclic antidepressant for 78 y/o w depression, agitation & dementia is:

NORTRIPTYLINE

What drug has a curvilinear therapeutic window? (6x)

NORTRIPTYLINE

Dexamethasone suppression test for diagnosing mood disorders:

NOT USEFUL IN ROUTINE CLINICAL PRACTICE

What type of receptor is a glucocorticoid receptor?

NUCLEAR

DA release in what structure represents common final event assoc w reinforcing effects of opiates, cocaine, amphetamines, nicotine, PCP, and alcohol? (4x)

NUCLEUS ACCUMBENS

Which of the following areas of the brain is most associated with the reward effects of cocaine? (2x)

NUCLEUS ACCUMBENS

The most important feature of post natal brain development is an increase in what?

NUMBER OF DENDRITIC AND AXONAL PROCESSES

Role of glycine at NMDA receptor (x2)

OBLIGATE COAGONIST

55 y/o pt BIB family after episode of amnesia/bewilderment lasting several hrs. CVA ruled out. Pt keeps asking what is happening. What med to administer at this point?

OBSERVATION WITH NO PHARMACOLOGICAL INTERVENTION

23 y/o pt presents to ED by ambulance for SI. Pt has alcohol odor and slurred speech. He endorses SI but his plan is incomprehensible. Next step:

OBSERVE AND EVALUATE WHEN HE IS SOBER.

What is NOT likely to be an effective intervention for a physician with a substance abuse problem? (2x)

OBSERVING THE PATIENT UNTIL HE/SHE BECOMES MOTIVATED TO SEEK TREATMENT

Persistently intrusive inappropriate idea, thought, impulse, or image that causes marked distress is

OBSESSION

Which of the following represents a disorder of the content of thought?

OBSESSIONS

20 y/o M with poor performance in college, before was very good student except for not being able to finish assigned projects at college. Classmates have described bizarre behavior, such as counting loudly or repeating words silently. He does not want to follow others rules but his owns, he believes nobody understands him and are against him.

OBSESSIVE COMPULSIVE PERSONALITY DISORDER

Group of disorders associated with disruption in cortico-striato-thalamo-cortical circuit function

OBSESSIVE-COMPULSIVE

Pt prominently uses the defenses of isolation of affect & intellectualization. Description of life events appears to involve reaction formation. What personality trait is most likely to characterize this pt? (3x)

OBSESSIVE-COMPULSIVE

Pt p/w complaints of excessive daytime sleepiness, morning headaches, and excessive nighttime sweating. Symptoms are consistent with which sleep disorder?

OBSTRUCTIVE SLEEP APNEA

45 y/o F pt with vague complaints of "not feeling good," not sleeping well X 1 month. Pt discloses fear/anxiety over "weird things happening to me," believes that some personal possessions are mysteriously missing or altered. Pt aware "this all sounds crazy," frightened that "someone is messing with my mind, maybe my ex-husband." Pt called police several times. Pt had been a successful insurance agent, and expresses worry that his distress is distracting and may negatively affect work performance, which could result in job loss. No past psychiatric hx, except for feeling depressed for several months after the divorce a few years ago = resolved without treatment. Which course of action would best clarify the diagnosis?

OBTAIN A GENERAL MEDICAL/ NEUROLOGICAL WORKUP

Most clearly predictive of alcohol abstinence for alcoholics who attend AA meeting:

OBTAINING A SPONSOR

35 y/o w daily headaches over last several weeks lasting an hour. Sharp, severe, boring pain into right eye. Another element of this headache?

OCCURS DURING REM

Memory loss pattern in dissociative amnesia

OCCURS FOR A DISCRETE PERIOD OF TIME

Which of the following statements characterizes late-onset schizophrenia?

OCCURS MORE FREQUENTLY IN WOMEN THAN MEN

40 y/o pt complains of repetitive, continuous hand-washing throughout day to the point of chafing skin. Pt denies fear of germs or any obsessive thoughts, cannot explain continuous washing. Dx?

OCD

Anterior capsulotomy and/or cingulotomy are indicated and demonstrated effective for pts with what severe incapacitating disorder?

OCD

Pediatric Autoimmune Disorder Associated with Streptococcus (PANDAS) is associated with what disorder?

OCD

Which condition is least likely to respond to hypnosis?

OCD

psychogenic blindness

OCULAR JERK MOVEMENTS WITH OPTOKINETIC DRUM

In some Japanese and Korean cultures, rather than an intense fear of embarrassing oneself socially, social phobia symptoms may instead manifest with intense fear of what?

OFFENDING OTHERS

During a visit, a borderline patient is very angry and begins kicking chairs, gurney, and walls. Staff are concerned pt will get hurt. What is the best initial response?

OFFER THE PATIENT THE OPTION OF GOING TO A QUIET ROOM OR TAKING A MEDICATION TO CALM DOWN

In pts with pronounced defects in recent memory, remote memory is:

OFTEN DEFICIENT ON CLOSE EXAMINATION EVEN WHEN IT SEEMS WELL PRESERVED

Heavy smoking will likely affect the dosing of which of the following medications?

OLANZAPINE

Which med has increased risk of hyperglycemia and DM?

OLANZAPINE

Rate of completed suicide highest for adult males when? (2x)

OLDER THAN 65

After Cannabis ingestion (in chronic use) it can be detected in urine how long? (3x)

ONE MONTH

Length of time criteria for delusional d/o

ONE MONTH

What factor is associated with a better long-term prognosis in pts w schizophrenia?

ONSET AFTER 35 YEARS OF AGE

The most common complication of temporal arteritis is caused by occlusion of the: (2x)

OPHTHALMIC ARTERY

Wernicke's disease triad:

OPHTHALMOPLEGIA, ATAXIA, GLOBAL CONFUSION

Naltrexone is classified as? (Mechanism of action)

OPIATE ANTAGONIST

UDS performed on pt who eats poppy seed bagels may yield false (+) for?

OPIATES

26yo presents to ED due to PMR, slurred speech, constricted pupils. Intoxicated with...?

OPIOIDS

25 y/o F with L eye pain which increases with moving the eye. Diminished acuity in L eye, pupils constrict well with light on R eye, but only constrict weakly with light on L eye. Dx?

OPTIC NEURITIS

The most common possible cause of a posterior cerebral artery infarct in 36 y/o F with hx of migraine: (2x)

ORAL CONTRACEPTIVES

Which med has secondary prevention against embolic stroke in pts with A-fib?

ORAL WARFARIN

Head injury with personality changes, impulsivity and euphoria. Site of injury?

ORBITOFRONTAL CORTEX

36 y/o F pt w/ schizophrenia has been treated w/ olanzapine is discovered prolactin level : 354ng/ml (normal:3-30).The first action is:

ORDER A PREGNANCY TEST

26 y/o pt w/ sudden onset back pain. Spasms in R paraspinal muscles in the lumbar region. Straight leg raising on the R is limited by sharp pain at 45 degrees. Ankle jerk on L is diminished. No muscle weakness, no sensory deficit. Next step? (3x)

ORDER MRI SCAN OF THE LUMBAR SPINE

What symptom best differentiate chronic traumatic grief from uncomplicated bereavement?

PERSISTENT AVOIDANCE OF DEATH REMINDERS

32 yo with episodes of severe sleepiness and falls asleep while driving, reporting episodes of paralysis and hallucinations while awakening. Symptoms are best explained by a deficiency of what?

OREXIN

Neuropeptides decreased in hypothalamus in narcolepsy

OREXIN A

Complication of anorexia nervosa LEAST likely to resolve after restoring weight is? (2x)

OSTEOPOROSIS

Patient presents with paranoia and auditory hallucinations, found to have waxing and waning confusion. Anti-NMDA receptor antibody was positive. Which neoplasam is associated for her symptoms

OVARIAN TERATOMA

26yo pt thinks his brow bridge is too prominent and looks like a neanderthal. Physician finds brow bridge prominent but WNL. Pt wants plastic surgery consult. What best describes the pt's belief?

OVERVALUED IDEA

Pt reports the continuing suspicion that the spouse is committing adultery, but acknowledges the possibility of being wrong since there is no evidence to support the pt's belief: (3x)

OVERVALUED IDEA

What medicine interferes with efficacy of Donepezil?

OXYBUTYNIN

30 y/o with intermittent HAs, each attack lasting approx 1 hour. Attacks w/ sharp, stabbing pain around eye, tearing, and nasal congestion. Most effective abortive treatment? (2x)

OXYGEN

Neurohormone for social bonding

OXYTOCIN

Med student is struggling with time management and peer to peer interactions on rotations. Has gotten feedback that she spends too much time organizing and highlighting her notes. She also violates duty hours due to inability to finish work during the day. If given a group assignment she completes it on her own saying it's easier to do it myself. Which of the following personality disorders does she likely have?

Obsessive-compulsive Personality Disorder

Terminally ill cancer patients who experience concerns about bad death are most typically worried about dying with what?

PAIN

What sensation is transmitted through the spinothalamic tract?

PAIN

The class of meds with greatest prevalence for prescription drug abuse (x2)

PAIN RELIEVERS

What condition has been shown to increase the risk of suicide to the greatest degree in persons with depression?

PAIN SYNDROMES

psychotropic with mod-severe renal impairment?

PALIPERIDONE

The most common psychiatric symptom associated with pheochromocytoma?

PANIC ATTACKS

Hyperthyroidism should be ruled out as part of the DDx of what psychiatric d/o

PANIC D/O

Childhood physical and sexual abuse increases the risk for which anxiety do?

PANIC DISORDER

Respiratory illness is most clearly a risk factor for developing which anxiety disorder? (2x)

PANIC DISORDER

35 yo pt w/ new onset headache, what suggests mass lesion w/ raised ICP?

PAPILLEDEMA ON EYE EXAM

A disorder of content of thought

PARANOIA

Positive Sxs of schizophrenia:

PARANOIA, AH, THOUGHT INSERTION, DELUSIONS

Subtype of schizophrenia less severe and starts older: (2x)

PARANOID

The first symptom reported by patients with emerging amphetamine psychosis is: (2x)

PARANOID IDEATION

40 y/o hand surgeon has come into conflict with the hospital admin. Though the hospital went out of its way to recruit this surgeon, he has felt consistently betrayed and has accused the administration of trying to exploit him by expecting that he should take more calls, though this has never been stated. The doctor-hospital relationship deteriorated further when peer review raised a question about one of the surgeon's cases. The surgeon believes that none of his complaints have been satisfactorily resolved. He has become more unforgiving and isolated: (2x)

PARANOID PERSONALITY DISORDER

Man convinced wife is cheating. Monitors emails, texts, phone calls. No changes in sleep, appetite, energy. Diagnosis?

PARANOID PERSONALITY DISORDER

Corticotropin-releasing hormone is release from which brain region during stress?

PARAVENTRICULAR NUCLEUS

66 y/o c/o frequent falls, mild axial and L UE rigidity, mild slowness of finger tapping, hand opening, and wrist opposition (all worse on left), normal posture, slow gait with short steps, does not swing left arm, slow rising from chair. What is the dx?

PARKINSON'S DISEASE

80 yo male evaluated for gait imbalance and falls. wife explains that he kicks and screams while sleeping, he reports dreams of being chased. Pt likely has/will develop?

PARKINSON'S DISEASE

Gait consisting of: postural instability, festination, & truncal rigidity. Lewy bodies visualized. Also with involuntary acceleration is seen in what condition? (3x)

PARKINSON'S DISEASE

Picture showing substantia nigra changes, what neurological disease would be expected?

PARKINSON'S DISEASE

REM sleep behavior disorder associated with which pathology:

PARKINSON'S DISEASE

Resting, non-intentional tremor

PARKINSON'S DISEASE

Delayed neurological deterioration following carbon monoxide-induced coma is most likely manifested by:

PARKINSONISM

SSRI that mostly to cause birth defect?

PAROXETINE

What antidepressant med is considered to be the most effective in the tx of premature ejaculation? (x2)

PAROXETINE

What med is most potent inhibitor of the norepinephrine transporter?

PAROXETINE

Which SSRI has mild anticholinergic activity due to some affinity at the muscarinic receptors? (3x)

PAROXETINE

Which SSRI has the greatest potential for discontinuation syndrome with missed doses (x2)?

PAROXETINE

36 y/o with several episodes of palpitations, sweating, trembling, SOB. Work suffering due to anxiety. Initial Tx regimen:

PAROXETINE AND CBT

What term best describes buprenorphine's action at the mu opioid receptor? (2x)

PARTIAL AGONIST

How does abilify reverse neuroleptic induced hyperprolactinemia?

PARTIAL D2 AGONIST

Person with covert obstructionism, procrastination, stubbornness, and inefficiency may be classified as suffering from which personality d/o outside of current DSM classification?

PASSIVE-AGGRESSIVE

What is a very common impulse control d/o NOS?

PATHOLOGIC GAMBLING

Verbally and physically aggressive after a small amount of ETOH. Dx?

PATHOLOGICAL INTOXICATION

45 y/o with R hemiparesis, CT shows L internal capsule ischemic changes extending to adjacent basal ganglia + old lacunar injury of R caudate head. LP - 65 wbcs (mostly lymphocytes), 78 protein, 63 glucose, + reagin antibodies. Tx?

PCN

An 18 y/o pt presents to the Emergency Dept with a clouded sensorium, agitation, hyperactivity, mild paranoia, pressured speech and euphoric though labile mood. Physical exam notable for HTN, tachycardia and vertical nystagmus. Cause?

PCP

Ataxia, nystagmus, muscular rigidity, normal or small pupils suggests intoxication with what?

PCP

Gene mapping strategy to detect rare genetic variants of large effect

PEDIGREE LINKAGE ANALYSIS

Abnormal LFTs would be most commonly associated w/ what medication used to treat ADHD in children/adol?

PEMOLINE

Decreases in men during andropause

PENILE RIGIDITY

Depersonalization is classified as disturbance of which of the following?

PERCEPTION

What task is useful in evaluating a pt's ability to concentrate? (2x)

PERFORMING SERIAL 7'S

Pt c/o unpleasant aching and drawing sensations in calves and thighs associated with a crawling feeling, forcing him to move legs, bringing transient relief. Sxs worsened by fatigue. Exam nl. Best med tx? (2x)

PERGOLIDE (FOR RESTLESS LEG SYNDROME)

Pt reports insomnia, frequent nighttime awakenings, and excessive daytime sleepiness. Sleep study reveals brief lower external jerks with brief repeated arousals. Pt is unaware of these movements. Which dx is most consistent with pt presentation? (2x)

PERIODIC LIMB MOVEMENT DISORDER

14 y/o pt after a demanding physical test becomes extremely weak and unable to stand. PE is positive for depressed DTR's. Labs: K=2.8. Hx of similar episodes after strenuous exercises. EKG: minimally prolonged PR, QRS, QT interval. Father and grandfather had similar episodes. Dx? (3x)

PERIODIC PARALYSIS

49 y/o w/ DM2 presents with severe burning of soles of feet and insomnia b/c the touch of the sheet against the feet is painful. Exam shows decreased sensation to pin and touch up to ankle, 50% reduction in vibratory sense at ankle and impaired proprioception at toes. Ankle jerks are absent, but knee jerks present. Dx?

PERIPHERAL NEUROPATHY

68 y/o pt is depressed following a hip surgery. Pt is withdrawn, looks blank, shows dysarthria, weakness, PMR, hyperreflexia, and has trouble swallowing. MRI of the head will show:

PERIVENTRICULAR WHITE MATTER DEMYELINATION

Unilateral foot drop with steppage gait indicates:

PERONEAL NERVE COMPRESSION

Pt c/o left foot slapping floor when he walks. He has to step high to avoid tripping. Weakness of dorsiflexion of left foot, w/ small area of numbness in the dorsum of the left foot. Normal ankle and knee jerks, and hamstring reflexes. Dx?

PERONEAL NERVE PALSY

Pt asked to draw clock, keeps tracing circle over and over again

PERSEVERATION

Two days after bowel surgery, 53 y/o is delirious. Correctly draws a square when asked, but then continues to draw squares when asked to draw other shapes. MSE would reveal:

PERSEVERATION

Neuroimaging that measures neuronal glucose metabolism (2x)

PET SCAN

18 y/o pt in ER w/ a clouded sensorium, agitation and hyperactivity, mild paranoia, pressured speech, and euphoric, though labile mood. On exam: HTN, tachycardia, and vertical nystagmus. The most likely used? (3x)

PHENCYCLIDINE (PCP)

2 wks washout of which med is needed before starting fluoxetine

PHENELZINE

30 y/o pt has been treated for unreasonable fear of eating in public places, feeling of embarrassment in public places, and anger over the possibility of being scrutinized. Pt has not responded to high doses of paroxetine, citalopram, buspirone, and alprazolam, each of them administered for 4-6 wks. Which meds would be appropriate for next? (2x)

PHENELZINE

An effective antidepressant for depression w/ atypical features is:

PHENELZINE

Fluoxetine should NOT be prescribed with what? (2x)

PHENELZINE

Abdominal pain, diarrhea, hypokalemia, weight loss, steatorrhea, skin pigmentation. Possible laxative abuse. Measure:

PHENOLPHTHALEIN

Treatment for patients with MAOI related hypertensive crisis in the ER may involve the administration of which of the following meds? (2x)

PHENTOLAMINE

A 73 yo M pt is seen for follow up treatment for a seizure disorder. On examination the pt is found to have gum hypertrophy, cerebellar ataxia and hirsutism. Which of the following medication is the pt taking (most likely)?

PHENYTOIN/DILANTIN

Patient with anorexia nervosa is admitted to inpatient unit and has begun treatment with high caloric oral feedings; 2 days after admission an EKG shows ventricular tachycardia. Which tests would best determines the likely cause of arrhythmia?

PHOSPHATE

40 y/o eats and sleeps too much, craves sweets, poor concentration, irritable, constant conflicts with husband. States "I always feel better in spring." What is the treatment?

PHOTOTHERAPY

Screen for depression in primary care setting?

PHQ

Childhood environmental factor in dissociative ID d//o?

PHYSICAL ABUSE

Naltrexone prevents relapse of opioid dependency most effectively in which group?

PHYSICIANS

74 y/o F suspicious, poor ADLs, personality changes, most likely dx:

PICK'S DISEASE

Potent neuroprotective factor preventing neuronal cell death (apoptosis)

PITUITARY ADENYLATE CYCLASE ACTIVATING POYPEPTIDE

Pancreatic cancer patient just diagnosed, tells nurses he wishes he was dead. Distant with psychiatrist. Several month hx of depressive Sx's, no support system. "The only family at home is my gun"

PLACE ON SUICIDE PRECAUTIONS

Abnormal elevated metabolic findings associated with increased risk of stroke in patients under 50

PLASMA HOMOCYSTEINE

39 y/o pt with hx of multiple miscarriages develops an acute left sided hemiparesis. Work up reveals elevated anticardiolipin titers and no other risk factors for stroke. Appropriate intervention at this point is?

PLASMAPHERESIS

45 y/o pt w/weakness of hips and thighs, and lesser extent the shoulder and neck. Also extremely difficult to rise from a squatting or kneeling position, No muscle pain. No tender. DTR: normal. Dx:

POLYMYOSITIS

65 y/o morbidly obese pt with new onset of depression endorses fatigue and hypersomnia. He is not on meds and has no PMH. What test?

POLYSOMNOGRAPHY

Schizophrenic stops taking antipsychotic. States that nothing is wrong. What is this behavior?

POOR INSIGHT

25 yo CF started on desipramine 50mg Qday. SE of constipation, dry mouth, visual difficulties, tremor and agitated feeling. Not on any other medications. Blood level is 400ng/ml. Most likely cause?

POOR METABOLISM OF CYTOCHROME P450 SUBSTRATES

What is reason that opioid antagonist naloxone can be co-administered with buprenorphine sublingually with no adverse effect?

POOR SUBLINGUAL ABSORPTION OF NALOXONE

Which of the following is a common medical cause of anxiety in a pt dying of cancer?

POORLY CONTROLLED PAIN

22 yo female is hospitalized with paranoia, hallucinations, abdominal pain worse with periods, physical exam shows reduced strength in upper and lower extremities and reduced tendon reflexes. Which of the following lab values is likely to be elevated and explain her symptoms?

PORPHOPBILINOGEN

What do you call a modulator that enhances receptor function when an agonist is present but does not directly activate the receptor?

POSITIVE ALLOSTERIC MODULATOR

Most effective treatment for OSA

POSITIVE PRESSURE THERAPY

Mucosal lesion that heals and then pt has pain in trigeminal nerve area

POST-HERPETIC NEURALGIA

Hemisensory loss followed by pain and hyperpathia involving all modalities and reaching the midline of the trunk and head is most consistent with ischemia in the distribution of which of the following arteries?

POSTERIOR CEREBRAL

In which arterial area would a stroke resolve in inability to read but preserved ability to write?

POSTERIOR CEREBRAL

Right-side palsy with equal involvement of the face, arm and leg combined with third nerve palsy is most likely due to occlusion of a branch of which artery?

POSTERIOR CEREBRAL

50 y/o pt recently began having VH of children playing. VH are fully formed, colorful and vivid, but with no sound. Pt is not scared or disturbed, but rather amused. On exam, normal language, memory, cranial nerves, no weakness or involuntary movement, no sensory deficits. DTR: symmetric. CSF/UDS nml.

POSTERIOR CEREBRAL ARTERY ISCHEMIA

Aphasia w/ effortful fragmented, non-fluent, telegraphic speech, is seen in a lesion where?

POSTERIOR FRONTAL LOBE

AIDS and progressive hemiparesis and R homonymous visual field deficit assoc w patchy white matter lesions on MRI with normal routine CSF.

PROGRESSIVE MULTIFOCAL LEUCOENCEPHALOPATHY

43 y/o newly AIDS pt has increasing social withdrawal and irritability over several weeks. Can't remember phone number, unable to do chores, appears distracted. Mild right hemiparesis, left limb ataxia, and bilateral visual field defects. LP: normal cell counts, protein, and glucose. T2 Scan is shown. What is the diagnosis:

PROGRESSIVE MULTIFOCAL LEUKOENCEPHALITIS

A 43 y/o patient with newly diagnosed AIDS has increased irritability, can't remember phone numbers. Mild right hemiparesis, left ataxia and visual field defects apparent. LP is normal. MRI above. What is diagnosis?

PROGRESSIVE MULTIFOCAL LEUKOENCEPHALITIS

AIDS patient with memory problems, R hemiparesis, L limb ataxia, BL visual field deficits, and normal CSF. MRI T2 scan showed.

PROGRESSIVE MULTIFOCAL LEUKOENCEPHALITIS

65 y/o pt fell several times past 6 mos. MSE nml. Smooth pursuit, saccadic movements impaired. Worse w vertical gaze. Full ROM w doll head maneuver. Mild symmetric rigidity/bradykinesia, no tremor. MRI/CSF/labs unremarkable. Dx? (4x)

PROGRESSIVE SUPRANUCLEAR PALSY

66 y/o c/o frequent falls, several-month hx of anxiety, unwillingness to leave home. On exam, mild impairment of vertical gaze on smooth pursuit/ saccades, mild axial rigidity & minimal rigidity of upper extremities, along w mild slowness of movement on finger tapping, hand opening & wrist opposition. Posture nml. Gait tentative/awkward, but w/o shuffling, ataxia, tremor. Pt is slow in arising from a chair. Most likely dx: (7x)

PROGRESSIVE SUPRANUCLEAR PALSY

A 66 yo complains of frequent falls. ON exam, the pt has difficulty with upward gaze, and has severe axial rigidity which is less apparent in upper or lower extremities. There is mild slowness of movement on finger tapping, hand opening and wrist opposition and the patient's fingers acquire cramped pastures with the effort of the task. The pt's neck posture is extended. Gait is somewhat slow, with short steps, and The pt is slow when arising from a chair. What is most likely diagnosis?

PROGRESSIVE SUPRANUCLEAR PALSY

Dx for 68yo c/o falls. PE shows upright rigid posture, stiff gait, extended knees, and pivoting while turning.

PROGRESSIVE SUPRANUCLEAR PALSY

Gait abnormality, slow movement, asymmetric UE rigidity. Difficulty in voluntary vertical upward/downward gaze. Slowness/rigidity improved slightly with levodopa. Later has problems with horizontal & vertical gaze. Oculocephalic reflexes normal. Involuntary saccades. (2x)

PROGRESSIVE SUPRANUCLEAR PALSY

Which hormone is secreted in functional pituitary adenoma:

PROLACTIN

How do antipsychotic meds elevate prolactin (PRL)? (5x)

PROLACTIN IS UNDER TONIC INHIBITORY CONTROL BY DOPAMINE

22 y/o pt suffers a traumatic brain injury following a skiing accident, and is admitted to an inpatient rehabilitation facility. There, pt has frequent episodes of sudden anger and aggression directed toward staff. On psychiatric evaluation, pt is aware of these episodes, saying, "I can't help it, I just see red." Pt denies symptoms of depression or anxiety, and there is no evidence of acute confusion on examination. The rehabilitation staff report that all behavioral strategies have failed, and that pt's outbursts are intimidating the staff. Which of the following medications has the best evidence for efficacy?

PROPRANOLOL

35 pt is evaluated for headache syndrome characterized by paroxysms of sharp pain around the eyes and side of the head lasting 5 min and happening 10x/day. Headaches are accompanied by rhinorrhea and conjunctival erythema. Which med is most likely to give relief?

PROPRANOLOL

Treatment for severe performance anxiety

PROPRANOLOL

Duty as outlined by Tarasoff

PROTECT THE POTENTIAL VICTIM OF A DANGEROUS PATIENT

23 y/o Caucasian F in office for f/u after an ER visit 2 days earlier for sudden diplopia, R leg weakness and shaking, difficulty w/ speech which resolved after a few hours. Pt had fever 103.1 F and was tx for UTI. Current exam: normal CN & sensory, minimal R leg weakness, brisk DTR and musculocutaneous reflexes throughout, and equivocal plantar reflex on L. R toe is downgoing. Hx of several episodes of transient neurological deficits that resolved spontaneously after a few days. Her spinal fluid is most likely to show what?

PROTEIN: 50MG, + OLIGOCLONAL BANDS, NUCLEATED CELLS: 10

18 y/o F in ED, just raped. Immediate intervention:

PROVIDE SUPPORT AND ALLOW TO VENT

Prognosis of acute inflammatory demyelinating polyneuropathy is poorest if the disease process involves which of the following?

PROXIMAL AXON

In young pt w/ epilepsy, Tx depression w/:

PROZAC

A 20 y/o female patient reports menses stopped 4 months ago and she's pregnant. Reports morning sickness and vomiting, bigger breasts. Pregnancy test negative, ultrasound negative, still thinks she's pregnant. What's the diagnosis

PSEUDOCYESIS

60 y/o w/ depressive syndrome has memory problems. Incorrect on date, messes up serial sevens, spells backwards, but slowly. After 4 wks of trazodone, both mood and cognition are improved. Dx? (2x)

PSEUDODEMENTIA

45 y/o F pt on phenelzine for MDD, takes OTC medication for cold sx and develops hypertensive crisis. Which OTC medication would most likely cause this? (3x)

PSEUDOEPHEDRINE

Psychiatrist is evaluating frequent liar. Pt's lies are grandiose and extreme. Pt appears to believe the stories. This is called:

PSEUDOLOGIA FANTASTICA

25 y/o pt c/o severe HA and vomiting. Pain is dull and mostly in occipital region. Exam: b/l severe papilledema, otherwise WNL. LP: opening pressure: 200mmH2O, no cells, 62mg/dl glucose, 31 mg/dl protein. CT: normal. Dx?

PSEUDOTUMOR CEREBRI

Severe occipital HA, BL papilledema and no other abnormalities. Chronic acne treated with isotretinoin. Lumbar puncture elevated opening pressure with no cells, 62 mg/dl glucose, and 22mg/dl protein. CT is normal. (7x)

PSEUDOTUMOR CEREBRI

EKG finding in pt with bingeing and purging bx:

QT AND T WAVE CHANGES

Which of the following factors has the most evidence to support its protective effect in bereavement following the loss of a spouse? (x2)

QUALITY OF SOCIAL SUPPORT OF THE BEREAVED

2nd generation with the lowest D2 affinity

QUETIAPINE

Antipsychotic associated with development of cataracts:

QUETIAPINE

First line to treat bipolar depression

QUETIAPINE

Pt w/ Parkinson's disease experiences visual hallucinations on levodopa/carbidopa therapy. Which med would be the most appropriate intervention:

QUETIAPINE

Which of the following agents is most likely to be helpful in the treatment of visual hallucinations and psychosis associated with advanced Parkinson's disease?

QUETIAPINE

54 y/o wakes up with weakness or R hand. he has been drinking at a bar and fell asleep on right arm over the armrest of chair. exam shows weakness of wrist and finger extension with normal grip strength. Which nerve is affected?

RADIAL NERVE

Highest concentration of 5HT producing cells in brain?

RAPHE NUCLEI

Where are the major clusters of cell bodies containing serotonin in brain?

RAPHE NUCLEUS IN THE BRAIN STEM

PTSD. what predicts best long-term outcome?

RAPID ONSET OF SYMPTOMS

Borderline patient pulling away from a relationship due to growing up in abusive household is stuck in which stage

RAPPROCHEMENT

Parents bring their 10 yo child for an eval due to concerns about child's reported difficulty paying attention in a class and completing assignments in the expected time. Parents report that the child has trouble staying on task while doing homework and they are concerned that the child has an attention disorder. At the completion of the eval, the psychiatrist requests that both a parent and a teacher fill out a rating scale. The parent ratings fall into the clinical range but the teacher's ratings do not meet criteria for a clinical problem. How should the psychiatrist account for the differences in observed ratings?

RATING DISCREPANCIES BY DIFFERENT OBSERVERS ARE COMMON IN CLINICAL PRACTICE.

Essential tremor improves with

REACHING FOR OBJECTS

Defining feature of mood in atypical depression

REACTIVE

Psychiatrist wishes to assess a pt's premorbid intellectual functioning. Which of the following tests would be best for this purpose?

READING SUBSET OF THE WIDE RANGE ACHIEVEMENT TEST

4 months ago the wife of a pt died and pt blames himself for her death. Next step:

REASSURANCE

In addition to orientation, attention, calculation, language and registration, what other cognitive domain does the mmse test?

RECALL

In pts with self- injurious bx and SI, the decision to admit to the inpatient unit would be strongly supported by hx of:

RECENT ALCOHOL ABUSE

Asking a pt what the pt ate for breakfast yesterday tests:

RECENT MEMORY

Greatest risk of death w/ ECT:

RECENT MI

Psychiatrist recommends AA to pt who abuses alcohol, but pt reluctant. Next step?

RECOMMEND PATIENT SPEAK TO A CURRENT AA MEMBER

59 y/o ER physician with alcohol problem and depressed mood, less tolerant to day and night shift. In addition to abstinence from ETOH, what is next step?

RECOMMEND RELIEF FROM THE NIGHT SHIFT

Most common time for pt w/ schizophrenia to attempt suicide is during

RECOVERY PHASE OF THE ILLNESS

57 y/o w AMS over several hours, followed by abrupt return to normal. No recollection, patient observed to be confused, oriented. Pt keeps asking same question, otherwise neuro exam normal, no weakness, loss of balance, speech impairment. What is typical of this condition?

RECURRENT EPISODES RARE

Which dx criteria helps to establish dx of substance dependence vs. abuse? (x2)

RECURRENT UNSUCCESSFUL EFFORTS TO CONTROL USE

Parkinson's Disease treated w/ levodopa. Visual hallucinations. Recommendations? (5x)

REDUCE DOSE OF LEVODOPA

Characteristic MRI scan finding in Alzheimer disease:

REDUCED HIPPOCAMPAL VOLUMES.

Insomnia secondary to depression will more consistently affect REM sleep in which of the following ways? (3x)

REDUCED LATENCY TO REM SLEEP

M pt BIB to ED by police after he threatening to kill his wife and admits that has thoughts of harming his spouse ever since learning of her infidelity, saying "I want her to hurt like I do now." The pt doesn't display delusions and mood problems. He admits to drinking occasionally, but in the last week and prior to violence. Next step:

REFER PT BACK TO LAW ENFORCEMENT

What is being assessed when patient is asked to repeat words "Apple, table, penny"?

REGISTRATION

What is a symptom of normal bereavement in a <5 y/o child after the death of a parent?

REGRESSION IN BOWEL AND BLADDER CONTROL

Psych MD is asked to recommend treatment interventions for a 16 y/o pt with a presumptive diagnosis of conversion disorder. Which of the treatments is most likely to be both accepted by the pt and result in functional improvement:

REHABILITATIVE TREATMENT

Which of the following strategies exemplifies use of reciprocal inhibition by a patient to attenuate anxiety associated with a party?

REHEARSING MENTAL IMAGES OF PLEASURABLE EXPERIENCES WHILE ATTENDING THE PARTY

Man w/ HTN and MI, has stressors and depression, Tx?

RELAXATION TRAINING

What does acetylation of lysine residues in histone proteins do?

RELAXES CHROMATIN STRUCTURE

Which of the following is the primary mechanism through which amphetamine secret their stimulant effect?

RELEASE OF CATECHOLAMINES

65yo p/w pillow-punching (x several months) in his sleep with sudden awakening from dreams involving pursuit by assailants. Dx?

REM BEHAVIOR DISORDER

Which sleep disorder is associated w/ mild neurocognitive disorder w/ Lewy bodies?

REM SLEEP BEHAVIOR DISORDER

Preventing adolescent suicide:

REMOVE FIREARMS

Frequently a medical sx/sign in pts with anorexia:

REPRODUCTIVE HORMONE DYSFUNCTION

Women at highest risk of MDD during:

REPRODUCTIVE YEARS

Characterizes schizophrenics that smoke

REQUIRE MORE NEUROLEPTIC MEDS

41 y/o pt in ED w/ blood alcohol level of 0.425.Pt is stuporous, the pulse is 75, BP is 110/70. UDS is negative. What is the immediate concern?

RESPIRATORY FAILURE

Characterizes depression in pt with MS:

RESPONDS TO ANTIDEPRESSANTS

Tremor decreasing with volitional movements and appears primarily in an attitude of repose:

RESTING TREMOR

65 y/o M trouble falling asleep 2/2 unpleasant aching and drawing sensations in calves and thighs. Also creeping and crawling sensations in legs. Urge to move legs can be suppressed voluntarily for short while but is ultimately irresistible. Most likely Dx is:

RESTLESS LEG SYNDROME

The primary focus of behavior therapy in the treatment of anorexia nervosa is to :

RESTORE WEIGHT

55 y/o psychiatrically hospitalized pt with chronic schizophrenia stabilized on Clozapine. Two weeks after d/c pt p/w impending signs of psychotic relapse. Assuming pt adherence to meds and negative serum/urine tox screens, what is most likely explanation for relapse (x2)?

RESUMPTION OF HEAVY SMOKING

Example of declarative memory (2x)

RETENTION AND RECALL OF FACTS

Unconsciousness can be induced by a small area of damage where?

RETICULAR FORMATION

60 y/o right-handed M, getting lost, only writes on right half of paper. Left-sided hemi- neglect. Where is the lesion? (8x)

RIGHT PARIETAL LOBE

78 y/o pt had an ischemic stroke that left him with a residual mild hemiplegia. Pt appeared to be unaware that there was a problem of weakness on one side of this body. When asked to raise the weak arm, the patient raised his normal arm. When the failure to raise the paralyzed arm was pointed out to pt, he admitted that the arm was slightly weak. He also neglects the side of the body when dressing and grooming. Pt did not shave one side of his face, had difficulty putting a shirt on when it was turned inside out. Area of brain likely affected by stroke? (4x)

RIGHT PARIETAL LOBE

Which EMG findings in pt complaining of involuntary myoclonic movements supports dx of conversion disorder?

RISING PRE-MOVEMENT POTENTIALS

62 y/o pt evaluated for frequent falls w/o loss of consciousness. Pt w rigidity, hallucinations. Three episodes of hallucinations resolved w/o sequelae. Cause?

RISPERIDONE

Which antipsychotic med has the largest number of studies supporting its use for Tx of explosiveness and reactive anger in youth?

RISPERIDONE

Abortive treatment of common migraines is best achieved w/ which medication? (8x)

RIZATRIPTAN

Which drug for the Tx of parkinsonism has been associated with sudden sleep attacks? (2x)

ROPINIROLE

This is considered as an unstructured psychological test (x2):

RORSCHACH INKBLOT

Pt was hit from behind while driving & awoke w/ pain radiating into his left ankle. Weakness of plantar flexion and decreased ankle jerk. Straight leg raising reveals pain beyond 45 degrees on left. Dx?

S-1 RADICULOPATHY

Which dietary supplement has demonstrated some efficacy in Tx of depression?

S-ADENOSYL-L-METHIONINE (SAME)

25 y/o has HA and vomiting. Pain is dull and in occipital region, worse when lying down. +severe papilledema b/l. LP shows opening pressure of 80 w/ normal CSF chemistry, and 120 RBC's in last tube. D-dimer, FDP in blood are elevated. CT normal. (3x)

SAGITTAL SINUS THROMBOSIS

26 y/o F w/ 3-day hx of severe continuous non-throbbing headache, has not improved on NSAID, has mild bilateral papilledema. A head CT w and w/o contrast is shown.

SAGITTAL SINUS THROMBOSIS

Severe occipital HA, BL papilledema and vomiting. Just started birth control pills. Lumbar puncture elevated opening pressure with no cells, 62 mg/dl glucose, and 31mg/dl protein, RBC 400. CT is normal.

SAGITTAL SINUS THROMBOSIS

Psych comorbidities in individuals w mental retardation vs general population:

SAME TYPES OF PSYCHOPATHOLOGY

Which of the following statements specifically tests concentration?

SAY THE LETTERS OF THE ALPHABET BACKWARDS STARTING WITH "Z"

Psych consulted re: 43 y/o who c/o "lump in throat," headaches, bloating, back pain, diarrhea, chest pain, painful urination, sexual indifference; complaints do NOT match objective findings from dx workup. What should be recommended to pt's PCP? (2X)

SCHEDULE REGULAR VISITS WITH A PHYSICAL EXAM

Psych eval of 82 y/o F with memory loss (mostly working memory): she frequently calls for help with bathroom but will urinate on herself (staff feel pt is doing this to get back at them). Pt frustrated with staff because she feels the sudden need to void without much warning and wishes the staff would arrive sooner because she's embarrassed about this. MSE significant only for mod memory loss, labs are normal. Which behavioral intervention should be attempted with pt?

SCHEDULE REGULAR VOIDING, INDEPENDENT OF PT REQUESTS, AND SUFFICIENTLY FREQUENT TO ELIMINATE THE ACCIDENTS

40 y/o M emotional detachment, little interest in sex, no close friends. Axis II Dx?

SCHIZOID PD

23 y/o pt w/ no previous psych hx BIB family. Parents reports that pt has stopped seeing friends for the last 6 months, is afraid when cars pass by on the street, seems to be talking to self and television. Pt also has unusual movements of arms at times, flap and wave on their own accord. What is the diagnosis?

SCHIZOPHRENIA

75 y/o male brought in by family for psych eval, family reports no past psych history, has gotten suspicious, withdrawn, hostile. Talks to self, talks about being controlled by aliens, believes aliens are putting thoughts in his head. 28/30 on MOCA, MRI shows age-related changes. Diagnosis?

SCHIZOPHRENIA

Adol pts with velcardiofacial syndrome (chromosome 22q11 deletion syndrome) are at substantially increased risk for developing which psychotic d/o? (2x)

SCHIZOPHRENIA

Chromosomal microdeletions in q11.2 of chromosome 22

SCHIZOPHRENIA

20 y/o avoids everyone but parents. Stopped going to school. Feels everyone watching him. Always quiet, sits at home doing nothing, mumbles to self, some bizarre movements, flat affect. Denies depression or substance use.

SCHIZOPHRENIFORM

A 22 y/o pt is brought to the ED by family members who report unusual behavior that has worsened over a few weeks. Disorganized and difficult to interview - stating "The world is ending! You must repent now!" Patient is actively responding to unseen others and accuses family of being "devils". No family history and no prior psych history for pt. Behavior began two months ago follow grad from college. What is dx

SCHIZOPHRENIFORM DISORDER

16-year-old adolescent is being evaluated for possible schizophrenia. A family history of which of the following personality d/o is most strongly associated with this dx?

SCHIZOTYPAL

25 y/o hospitalized for appy. Pt reports being "bothered by surgeon's aura". Lives alone, no close friends, gets on websites about auras and crystal work. Pt's mother affirms he's "always been this way." Which personality disorder?

SCHIZOTYPAL

There is increased risk of schizophrenia with this personality disorder

SCHIZOTYPAL

Useful info to confirm diagnosis of antisocial personality d/o (APD) in 20 y/o patient?

SCHOOL COUNSELING RECORDS

What type of glial cells form myelin sheaths in the PNS?

SCHWANN

A conscious memory that covers for another memory that is too painful to hold in the consciousness is:

SCREEN MEMORY

Which d/o is treated w/ light therapy? (3x)

SEASONAL AFFECTIVE DISORDER

What did the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) demonstrate about effectiveness of 2nd gen. antipsychotics for tx of schizophrenia? (2x)

SECOND GEN. ANTIPSYCHOTICS WERE NO MORE EFFECTIVE THAN FIRST GENERATIONS

Most common side effect with clozapine tx is:

SEDATION

MDD patient with good response to venlafaxine presents with dysphoria, agitation, nausea, poor balance after running out of medication. Cause of sx?

SEROTONIN DISCONTINUATION SYNDROME

27 y/o depressed patient treated with SSRI and tranylcypromine (and with 5- hydroxytryptophan) now presents with VH, mild confusion, myoclonic jerks, diaphoretic, flushing, restless: (6x)

SEROTONIN SYNDROME

40 y/o pt experienced delirium, tremor, diaphoresis, rigidity, hyperpyrexia, and myoclonus in making the transition from the use of clomipramine to phenelzine. Pt is most likely experiencing:

SEROTONIN SYNDROME

Patient comes to ED confused, lethargic, flushing, diaphoretic, and restless. Recently started fluoxetine but doesn't recall names of other psychotropics he's taking. Temp is 101.5, BP 110/62, has tremor and myoclonus. What's causing his symptoms?

SEROTONIN SYNDROME

40 y/o has hyperarousal after seeing bad MVA. Has nightmares, avoids freeways, isolating at home. Therapy only moderately helpful. Which medication? (3x)

SERTRALINE

50 y/o fireman became clinically depressed after sustaining a myocardial infarction. What is an appropriate medication to prescribe?

SERTRALINE

Adol attends a "pharm party", takes 2 methadone tabs, later found to have decreased respirations and is rushed to the ED. Which med could cause an interaction which could cause this response?

SERTRALINE

Which antidepressant has active metabolites that extend its effective half-life?

SERTRALINE

Orthostatic hypotension is least likely to occur as a S/E with what antidepressants?

SERTRALINE, NORTRIPTYLINE, IMIPRAMINE, AMITRIPTYLINE, TRAZODONE

Extremely demanding patient repeatedly calls psychiatrist's office and berates staff in offensive terms. Which step should the psychiatrist take first?

SET LIMITS WITH THE PATIENT

Which intervention is helpful in dealing with a borderline pt on a medical ward?

SETTING LIMITS WITH THE PT ON THE STRUCTURE OF THE MEDICAL CARE

In terminal cancer patients who ultimately die by suicide, which one of the following complaints is most frequently reported?

SEVERE UNCONTROLLED PAIN

Important determinant factor to whether an individual who was exposed to trauma will develop PTSD?

SEVERITY AND PROXIMITY OF TRAUMA

Mirtazepine (vs other antidepressants) has low incidence of what side effect?

SEXUAL SIDE EFFECTS

30 y/o pt recently Dx w/ Hodgkin's dz constantly states, "Why me?" According to Elizabeth Kubler-Ross, the patient's reaction is consistent with what phases?

SHOCK AND DENIAL

Which of the following is a characteristics change on polysomnogram associated with major depression? (x3)

SHORT REM LATENCY

The large number of CB1 cannabinoid receptors found in the hippocampus best explains cannabis' negative effects on: (2x)

SHORT TERM MEMORY

Asking pt to remember 3 things and repeat them in a few minutes is testing:

SHORT-TERM MEMORY

MDD has what sleep abnormality?

SHORTENED REM LATENCY, DECREASED STAGE 4 SLEEP, INCREASED AWAKENINGS IN THE SECOND HALF OF THE NIGHT

15 y/o pt fell to the ground after being hit in the head while playing soccer. Pt did not lose consciousness, but was confused for following 20min.The next day, pt reported a headache and irritable, neuro exam normal. Best recommendation to family about pt:

SHOULD BE EXAMINED IN 2 WKS BEFORE RESUMING PLAY

What characterizes executive abilities in healthy individuals >65?

SHOW NO SIGNIFICANT CHANGE

55 y/o M with changes in his voice, orthostatic hypotension and one immobile vocal cord on inspection suffers from:

SHY-DRAGER SYNDROME

Most likely to increase risk of impairment after bereavement in 80 y/o (X2)

SIGNIFICANT DEPRESSIVE SXS SHORTLY AFTER THE LOSS

Current thinking about relationship between ADHD in children and adults:

SIGNIFICANT NUMBER OF CHILDREN WILL GO ON TO BECOME ADULTS WITH ADHD

27 y/o M seen in ED c/o insomnia, hopelessness, anorexia, decreased concentration for 2 weeks and is now acutely suicidal. Pt has hx of ETOH use daily for the past 3 months. The most likely Dx?

SIMD

Which of the following is a non-DSM term for the category of schizophrenia when the dx is based solely on deficit or negative symptoms?

SIMPLE SCHIZOPHRENIA

Complex partial seizures are differentiated from simple partial seizures by:

SIMPLE SEIZURES HAVE NO LOSS OF CONSCIOUSNESS BUT HAVE ALTERED RESPONSIVENESS TO OUTSIDE STIMULI.

What type of genetic variation is most commonly investigated in genome wide association studies?

SINGLE NUCLEOTIDE POLYMORPHISMS

Clinical exome sequencing helps detect which genetic abnormalities

SINGLE NUCLEOTIDE SUBSTITUTIONS

Neuroimaging technology most useful in studying connectivity pathways:

SINGLE PHOTON EMISSION CT SCAN

Test that differentiates Alzheimer's from frontal-temporal dementia

SINGLE PHOTON EMISSION CT SCAN

51y/o pt w/ dysthymic disorder has responded well to citalopram. However, the pt continues to complain of morning headaches, anxiety and daytime fatigue. The psychiatrist prescribes clonazepam and the pt immediately reports profound daytime sedation. The differential dx, in addition to a direct sedative effect of the drug, should include:

SLEEP APNEA

Most common symptom in narcoleptics:

SLEEP ATTACKS

Complication of heavy EtOH likely to persist beyond first week of withdrawal?

SLEEP FRAGMENTATION

HPA axis cortisol production is less active in?

SLEEP ONSET

A 35 yo recurrent episodes of awakening during sleep waking up with a panicked scream and sweating, racing HR. can't remember, daytime drowsiness affecting functioning, EEG normal. What is the diagnosis?

SLEEP TERRORS

Physical finding associated with hypothyroidism:

SLOW RELAXATION OF DEEP TENDON REFLEXES

57 y/o office worker w numbness in 4th/5th digit of right hand, which wakes patient in middle of night. Nerve conduction study finding most likely to explain syndrome?

SLOWED CONDUCTION VELOCITY ACROSS THE ELBOW IN THE ULNAR NERVE

75 YOM getting into several car accidents. Good physical health, no disease, no meds, most likely cause of accidents?

SLOWER VISUAL PROCESSING

Way to decrease risk of suicidal events when prescribing antidepressants to adolescents and young adults:

SLOWLY TITRATING THE ANTIDEPRESSANT

Follow-up studies on the Drug Abuse Resistance Education (DARE) program for elementary students have reported what finding?

SMALL TO NON-MEASURABLE DECREASES IN SUBSTANCE USE BY PARTICIPANTS

60 y/o pt w/ progressive proximal arm and leg weakness, elevated creatine kinase level. MD suspects a myopathy and orders EMG. Which findings on EMG:

SMALL, SHORT DURING MOTOR UNIT ON NEEDLE EXAM

A patient has a seizure secondary to a supratherapeutic level of clozapine. What changes in a patient's life could account for this finding? (2x)

SMOKING CESSATION

College student feels embarrassed with public speaking or choosing seat in cafeteria and experiences blushing, muscle twitching, and shame. Endorses sadness about not having friends. What is dx?

SOCIAL ANXIETY DISORDER

Using cash only due to substantial discomfort while writing checks or signing credit card receipts in the presence of others (because of messy handwriting)?

SOCIAL ANXIETY DISORDER

What is a negative sx of schizophrenia?

SOCIAL INATTENTIVENESS

Though recent research has demonstrated that the blunted emotional expression in schizophrenia does not imply that a patient is anhedonic, individuals with schizophrenia do experience loss of interest or pleasure associated with?

SOCIAL INTERACTIONS

28 y/o M episodic anxiety, palpitations, flushing, shaking, chest tightness. Mostly at work or w/ group of friends. Embarrassed, afraid to go to work, avoiding people:

SOCIAL PHOBIA

Avoids interpersonal situations due to anxiety and panic attacks

SOCIAL PHOBIA

20 yo Japanese American patient present of complaining of personal body odor that is offensive to other people. This is most often compared to this DSM diagnosis?

SOCIAL PHOBIA, BODY DYSMORPHIC DISORDER, DELUSIONAL DISORDER (SOMATIC TYPE)

Focus for outpatient psychotherapeutic groups for schizophrenia?

SOCIAL SKILLS DEVELOPMENT

Hyperkalemic periodic paralysis is characterized by episodes of generalized weakness of fairly rapid onset. It is also associated with a rise in serum K, with weakness typically appearing after a period of rest following exercise. Which of the following molecular deficits underlies this disease?

SODIUM CHANNEL INACTIVATION

Pattern of drinking in women alcoholics (as opposed to males):

SOLITARY DRINKING

A patient has periodic pelvic pain for past two years. Had laparoscopy, diagnosed with endometriosis, started oral contraceptives and analgesics with some relief, still has symptoms. The patient reports worry that she will quit job due to pain. Calls doctor every few days to ask whether new tx should be considered or she may have cancer?. What is diagnosis:

SOMATIC SYMPTOMS DISORDER

Pt presents with chapped and reddened hands. Upon questioning, pt admits to washing the hands many times a day because "I work in a hospital cafeteria and am intensely afraid of contracting a flesh-eating bacterial infection." The most likely Dx:

SPECIFIC PHOBIA

Pt reports having a fear of driving and experiences feeling of panic, SOB, heart racing, sweating, and clamminess when anticipating a drive down street roads. Pt acknowledges going out of the way to avoid this situation. Pt denied similar Sx in other settings. Dx:

SPECIFIC PHOBIA

The parents of an 18 y/o adol who is overweight notice that their child is avoiding high caloric foods, such as meat and pasta. When the parents inquire about this, the teen says, "I am afraid of eating." The evaluating psychiatrist asks when the eating behavior changed, and the teen reports having had an episode of panic which occurred while eating and was accompanied by choking feelings. A fear of choking while eating and a wish to avoid foods that might cause choking developed. The teen denies other episodes of panic. Dx? (2x)

SPECIFIC PHOBIA

Dysprosody is an abnormality of (2x)

SPEECH

An IV meth user develops severe back pain, followed after several days by bilateral lower extremity weakness/sensory loss, bladder incontinence, low grade fever, tenderness to percussion over the 2nd and 3rd lumbar vertebrae, paraparesis and loss of sensation to light touch and pinprick in both legs, buttocks & sacral region. (3x)

SPINAL EPIDURAL ABSCESS

Fluctuating aching pain in lower back, buttocks, and sciatic distribution elicited by standing or walking, and relieved by sitting with numbness in a similar distribution, loss of ankle reflexes: what dx?

SPINAL STENOSIS

79 y/o pt with a deteriorating mental state over a 3-week period has an exaggerated startle response with violent myoclonus that is elicited by turning on the room lights, speaking loudly, or touching the pt. Myoclonic jerks are also seen. Diagnosis: (5x)

SPONGIFORM ENCEPHALOPATHY

Abulia refers to impairment in ability to:

SPONTANEOUSLY MOVE AND SPEAK (inability to act decisively, absence of willpower)

Factor most predictive of effective methadone Tx

TOTAL DAILY DOSE

What sleep stage is the most important in restoring the altered functions that result from prolonged sleep deprivation? (3x)

STAGE 4, NON-RAPID EYE MOVEMENT

Somnambulism during childhood is associated with which of the following stages of sleep measured by an EEG?

STAGE IV

Test to assess intelligence in 4 y/o?

STANFORD-BINET

In cancer patients, what should you use to treat sub-threshold depression sx?

START AN SSRI

50yo referred to psych following negative medical workup of abd pain. Pt appears depressed and in constant pain. What is the preferred psych intervention?

START LOW DOSE IMIPRAMINE

Psychiatrist plans to add nortriptyline as adjunct to fluoxetine. He should proceed how?

START NORTRIPTYLINE AT LOWER THAN NORMAL DOSE

55 y/o pt c/o of mild muscular aches and stiffness for which steroid treatment was previously given. Hx of hypercholesterolemia and hypertriglyceridemia, and was treated with atorvastatin and gemfibrozil with a positive response. Serum creatine kinase level is slightly elevated. Which of the following is the most likely diagnosis?

STATIN-INDUCED MYELOPATHY

38 y/o F with muscle spasm of the proximal limbs and trunk, lumbar lordosis while walking, w/o EMG abnormality and with serum antiglutamic acid antibodies is suffering from:

STIFF-PERSON SYNDROME

Most common cause of organic paranoid symptom

STIMULANT ABUSE

Formication, agitation, stereotypical oral movements, & paranoia?

STIMULANT INTOXICATION

Normal changes with motor fxn in aging?

STOOPED POSTURE AND SLOWED WALKING

What factor may be protective in assessing a pt's risk for suicide?

STRICT RELIGIOUS FAITH

What is the most common manifestation of acute neurosyphilis?

STROKE

Name of test where pt is told to name the colors in which the words are printed rather than reading the words themselves

STROOP COLOR WORD TEST

Which test assesses ability to attend to a task while inhibiting interfering stimuli?

STROOP COLOR WORD TEST

At a minimum, state physician health programs provide which services to impaired physician?

STRUCTURED MONITORING PROGRAM

79 y/o pt w/ decreasing mental state over 3 weeks has an exaggerated startle response with violent myoclonus that is elicited by turning on the room lights, speaking loudly, or touching the patient. Myoclonic jerks occur spontaneously, ataxia, EEG: sharp waves. Dx: (5x)

SUBACUTE SPONGIFORM ENCEPHALOPATHY

Head CT demonstrates which dx (grainy picture with diffuse speckling in posterior region, unilateral)

SUBARACHNOID HEMORRHAGE

Vascular lesion most characteristic of sudden severe headache, vomiting, collapse, relative preservation of consciousness, few or no lateralizing neurological signs, and neck stiffness:

SUBARACHNOID HEMORRHAGE

Deep brain stimulation targeting what area of the brain is most studied for treatment of depression

SUBCALLOSAL CINGULATE CORTEX

Implantation of DBS electrodes has been shown to lead to remission in about half of patients with treatment-refractory depression. To obtain this effect, the electrode is placed in the:

SUBGENUAL CINGULATE CORTEX

Which of the following aspects of sleep is increased in older adults?

SUBJECTIVE QUALITY

How should buprenorphine and the buprenorphine/naloxone combo be administered?

SUBLINGUALLY

25 y/o presents to ED c/o chest pain, SOB, and anxiety but appears NAD and calmly answers questions. Pt reports h/o panic attacks, requesting alprazolam by name, and reports "I usually need a prescription for at least 2mg 4x per day to get relief". When asked to describe 1st panic attack, pt states, "I can't remember when they started or the frequency". Which d/o is likely present?

SUBSTANCE ABUSE

Along w/ depression most common comorbid disorder in physician suicide is

SUBSTANCE DEPENDENCE

Pain by neurogenic inflammation mediated by?

SUBSTANCE P

What condition is frequently associated with OCD?

TOURETTE SYNDROME

24-year-old w/ 1 month increasing fatigue, difficulty falling asleep, poor motivation, and trouble paying attention in night school. No personal or family hx of depression. Rx Mirtazapine 15mg qhs. After two doses, pt becomes euphoric, hyperactive, talkative, and full of creative ideas. Pt stood on a chair at night school and offered hearty congratulations to teacher for contributing to pt's certain future success. Most likely dx?

SUBSTANCE-INDUCED BIPOLAR DISORDER

21 y/o pt experiences a brief manic episode after starting an SSRI. The pt meets Dx criteria for what disorder? (2x)

SUBSTANCE-INDUCED MOOD DISORDER

For polysubstance dependence need criteria for:

SUBSTANCES AS A GROUP, BUT NOT FOR ANY PARTICULAR SUBSTANCE

CNS region containing dopaminergic neurons projecting to caudate and putamen

SUBSTANTIA NIGRA

Acute onset of hemiballismus of LUE & LLE. MRI is most likely to show lesion located where?

SUBTHALAMIC NUCLEUS

Implantation of deep brain stimulation electrodes is an effective tx for Parkinson's. Optimal location for electrodes?

SUBTHALAMIC NUCLEUS

Why is there limited value of serial sevens as a test of concentration?

SUCCESSFUL PERFORMANCE REQUIRES ARITHMETIC SKILL

A patient with somatic delusional disorder refusing to see a psychiatrist but sees a dermatologist regularly. What should the psychiatrist recommend the dermatologist do?

SUGGEST THAT THE DERMATOLOGIST ASK ABOUT DRUG USE

Black box warning on SSRIs with regard to children and adolescents:

SUICIDAL IDEATION

The leading cause of death among gun buyers in the first year after the weapon was purchased is:

SUICIDE

The effective treatment for acute migraine: (2x)

SUMATRIPTAN

A lesion in what structure is associated with ptosis, lack of sweating on same side of the face, and conjunctival injection?

SUPERIOR CERVICAL GANGLION

Where is the lesion when a picture of a female patient with ptosis is shown?

SUPERIOR CERVICAL GANGLION

Acute onset of dense sensorimotor deficit in the contralateral face and arm, with milder involvement of the lower extremity, associated with gaze deviation toward the opposite side of the deficit, likely indicates occlusion of:

SUPERIOR DIVISION OF THE MCA

Exposure to light effects which brain structure?

SUPRACHIASMATIC NUCLEUS

Wear in the brain are circadian rhythms related to sleep behavior set and maintained?

SUPRACHIASMATIC NUCLEUS

Syndrome characterized by fluent speech, preserved comprehension, inability to repeat, w/o associated signs. Location of lesion in the brain?

SUPRAMARGINAL GYRUS OR INSULA

Right shoulder weakness on initial abduction and external rotation of the arm at the shoulder joint, after carrying sand bags. Affect nerve:

SUPRASCAPULAR

A finding that should raise a concern for child abuse?

SYMMETRICAL BRUISING IN A 24-MONTH-OLD

Which of the following is the best test for general assessment of a patient's psychiatric symptom patterns?

SYMPTOM CHECKLIST-90-REVISED (scl-90)

35 y/o F pt presents to the physician complaining of decreased interest in sexual activity and difficulty becoming aroused by her spouse over the last 3 months. Upon further questioning, the patient also reports anhedonia, difficulty sleeping, fatigue, and decreased appetite over the same time period. Medical history and workup are otherwise unremarkable, and pt is not currently taking any medications. According to the DSM-IV-TR, pt's decreased interest in sex is most likely assoc w which?

SYMPTOM OF A MAJOR DEPRESSIVE EPISODE

Pt with which medical condition most likely to commit suicide?

SYMPTOMATIC HIV INFECTION

17 y/o with depressed mood, low self esteem and poor concentration possibly has dysthymia. Which feature would support the Dx?

SYMPTOMS >1 YEAR

32y/o cannot move the right leg. Exam does not find a cause. Dx is likely to be conversion d/o if which of the following is found? (6x)

SYMPTOMS NOT INTENTIONALLY PRODUCED

18 y/o pt presents with an acute onset of blindness after witnessing the murder of a close friend. Neurological examination is inconsistent with loss of vision but otherwise unremarkable. What is most probable outcome for this pt?

SYMPTOMS WILL FULLY RESOLVE IN A MATTER OF DAYS OR WEEKS.

Neuronal plasticity for learning and memory is best accounted for by:

SYNAPTIC CONNECTIVITY

The most likely reason that adults are superior to adolescents in abstract thinking. The brain undergoes:

SYNAPTIC PRUNING

What neurodevelopmental process predominately occurs during adolescence and young adulthood?

SYNAPTIC PRUNING

Why does the brain rapidly increase in size from birth to two years old?

SYNAPTOGENESIS OF NEURONS

While intoxicated with a psychomimetic drug, a young man reports "seeing sounds" and "patterns of colors like fireworks or colored flames" associated with real auditory stimuli. What best describes this type of sensory experience? (3x)

SYNESTHESIA

REM sleep behavior disorder is commonly associated with abnormal inclusions containing which of the following proteins? (2x)

SYNUCLEIN

Irregular, unequal, small pupils nonreactive, do not dilate, but do constrict to accommodation:

SYPHILIS

2 years after MVA with rear-end collision, pt develops BUE weakness with some muscle wasting, loss of DTRs in arms, loss of sensation to pain and temp in neck/arms/shoulders, intact sensation to touch. Most likely cause? (X2)

SYRINGOMYELIA

Pt with chronic muscle wasting in both UE, loss of light touch, pain, and temperature sensation in shoulders, upper arms, and back, and painful paresthesias over the same distribution, diagnosis?

SYRINGOMYELIA

Which medical condition is likely to include psychosis in the symptom complex?

SYSTEMIC LUPUS ERYTHEMATOSUS

With the use of 2nd gen antipsychotics, alpha receptor antagonism is associated with what side effects?

TACHYCARDIA

What technique may be dangerous in managing patient with PCP intoxication?

TALKING THE PATIENT DOWN

45 y/o pt w lung cancer and depression. Physical and emotional symptoms are stable, pt worries that "family always seems on edge w me." Family meeting shows children fear losing father, frustrated that lives seem "on hold". Daughter feels she can't invite friends over out of fear of "stressing her father." Father feels guilty about this but does prefer quiet environment. Best strategic systemic approach to problem?

TASK FAMILY WITH COMING UP WITH PRACTICAL SCHEDULE

FTD with mutation in chromosome 17 is assoc with abnormal intraneuronal deposition of which protein?

TAU

An 82-yo pt has falls, ophthalmoplegia, parkinsonism and progressive dementia. Autopsy shows:

TAU POSITIVE NEUROFIBRILLARY TANGLES

Brain of football player who died by suicide has findings typical of chronic traumatic encephalopathy, what is most typical pathology for this behavior?

TAUPATHY

22 y/o brought to ED by roommate who found him unconscious with a suicide note. Temp 100.9, BP 100/60, P 124, RR 8, warm and dry skin, dilated pupils and reactive to light, bowel sounds decreased, EKG with sinus tachy and QTC of 589, no obvious trauma. On which did pt OD?

TCA

7 y/o child is brought in by parents who report he's been hyperactive since age 4, talks constantly, interrupts, has trouble sitting still to do homework, will not play quietly outdoors. What else do you need to make the diagnosis of ADHD? (4x)

TEACHER REPORT

Patient is Alzheimer's dementia in clinic. Patient's daughter is frustrated with having to care for her mother more and is considering removing her from her church group because of it. What is the most initial response by the psychiatrist?

TELL HER TO CONTINUE GOING TO HER CHURCH GROUP

Adult male presents to clinic with broken hand due to first time DV toward his same-age spouse. Best response by psychiatrist?

TELL THE PATIENT THAT VIOLENCE IS HIS RESPONSIBILITY AND HE NEEDS TO STOP IT

Which medication for insomnia is most likely to cause amnestic cognitive impairment?

TEMAZEPAM

32 y/o pt 1-month hx of worsening headaches, episodic mood swings and occasional hallucinations with visual, tactile and auditory content. CT head reveals tumor where:

TEMPORAL LOBE

Kluver-Bucy syndrome: placisity, hyperorality, hypersexuality and hyperphagia, can be induced in animals with bilateral resection of which structure?

TEMPORAL LOBES

Superior homonymous quadrantic defects in the visual fields result from lesions to which of the following structures? (2x)

TEMPORAL OPTIC RADIATIONS

Chronic rx opioid use affects which hormone?

TESTOSTERONE

The dorsolateral-prefrontal cortex, striatum and ____ are part of a loop circuit that produces worry and obsessive symptoms

THALAMUS

What does the Wisconsin card sorting task most accurately measure?

THE ABILITY TO GENERATE ALTERNATIVE STRATEGIES IN RESPONSE TO FEEDBACK

5 y/o has been enuretic after mother died in an MVA 4 days ago and keeps saying, "Mommy will come home soon." The father wonders if the children should attend the funeral. What is your recommendation?

THE CHILD AND SIBLING SHOULD BOTH BE ALLOWED TO ATTEND IF THEY WANT TO GO.

With respect to ADHD symptoms, the 1999 multimodal treatment study of children with ADHD was most notable for demonstrating which of the following?

THE EQUIVALENCE OF COMBINED METHYLPHENIDATE AND PSYCHOSOCIAL TREATMENT COMPARED TO MEDICATION ALONE

Which of the following is the best predictor of whether or not a patient who sustained a significant trauma will develop early PTSD morbidity?

THE NATURE AND SEVERITY OF THE TRAUMA

In problem solving training, what is the next step after using specific behavioral terms and feeling expressions

THE OTHER PARTNER PARAPHRASES THE STATEMENT OF THE PROBLEM

C&L psychiatrist sees a 20 y/o pt with cancer pain on methadone maintenance program. The staff feels that the pt's request for additional narcotics represent drug-seeking behavior. Most appropriate recommendation: (2x)

THE PT SHOULD BE GIVEN MORE OPIOID MEDICATION TO ACHIEVE ADEQUATE PAIN CONTROL BECAUSE OF THE PT'S TOLERANCE.

70 y/o pt was hospitalized because of a middle cerebral artery stroke. The psychiatrist was asked to evaluate the pt. The pt has non-fluent aphasia. Which most likely characterized the pt's interaction with the psychiatrist? (2x)

THE PT WAS ABLE TO FOLLOW THE VERBAL REQUEST, "CLOSE YOUR EYES."

Huntington's disease etiology is classified as a polymorphism due to what property?

THE REGION HAS MANY ALLELES DIFFERING IN THE NUMBER OF GAC REPEATS

Patient is shown a picture of a person standing next to window and is asked to describe what happened. What test?

THEMATIC APPERCEPTION TEST (TAT)

The personality test in which a pt is shown pictures of situations and asked to describe what is happening in each picture is:

THEMATIC APPERCEPTION TEST (TAT)

Which is a Projective Assessment test:

THEMATIC APPERCEPTION TEST (TAT)

To obtain additional about unconscious drives and psychodynamic processes, which test would be most helpful?

THEMATIC APPRERCEPTION TEST (TAT)

4 y/o child is administered the "false beliefs task" in which two dolls act out a scene, whereby one doll switches the location of a marble from one site to another, while the other doll leaves the scene of the action. When the other doll returns to look for the marble, the child correctly points out that it will look in the original location. This response demonstrates the child is showing evidence of (x2):

THEORY OF MIND

Pt is evaluated for unilateral lower extremity weakness with no apparent physiologic explanation.

THERE IS A RISK THAT RELEVANT NEUROLOGIC ILLNESS WILL BE IDENTIFIED IN THE FUTURE.

This statement best characterizes current information on the recommended initial treatment of psychotherapy or pharmacotherapy for a pt with panic disorder:

THERE IS INSUFFICIENT DATA TO CHOOSE ONE TREATMENT OVER ANOTHER, OR COMBINATION OVER MONOTHERAPY

Best characterizes the role of spirituality in abstinence in alcoholics who attend AA?

THERE IS LIMITED EVIDENCE SUPPORTING THE ROLE OF SPIRITUALITY IN ABSTINENCE

Which of the following is an effective treatment for mild-to-moderately severe idiopathic Raynaud's disease?

THERMAL BIOFEEDBACK

45 y/o with nystagmus and ataxia, short term memory loss and believes wife is possessed by demons. Most appropriate treatment?

THIAMINE

50 y/o with alcohol dep at ED for confusion, oculomotor disturbances, ataxia, and dysarthria. Give which med first? (5x)

THIAMINE

Disorder of what element of MSE is evidenced by patient repeatedly referring back to the answer to a previous question?

THOUGHT PROCESS

Which symptom would indicate MDD rather than just bereavement: Poor appetite and sleep, hearing the voice of the loved one, feelings of guilt or thoughts of suicide?

THOUGHTS OF SUICIDE

Absence seizure EEG?

THREE CYCLE PER SECOND SPIKE-AND- WAVE

73 y/o M w/ onset of fatigue, weight gain, constipation, cold intolerance, depressed mood. Which organic caused needs to be ruled out?

THYROID

A genetic susceptibility for OCD is suggested by evidence that there is a familial link with (4x)

TIC DISORDERS

Severe jabbing pain, lasts few seconds, triggered by light touch on face

TIC DOULOUREUX

Test for psychogenic tremor by:

TLL PATIENT TO TAP HAND AND SEE IF TREMOR CHANGES

Best rationale for using cholinesterase inhibitors in pts with Alzheimer:

TO REDUCE NEUROPSYCH SYMPTOMS

Individuals carrying inactive alleles of the CYP2A gene have increased coniine levels per unit of drug ingested and are relatively protected from addiction to:

TOBACCO

Most often abused hallucinogens associated with:

TOLERANCE TO EUPHORIC EFFECTS

23 y/o pt is admitted to the hospital with rhabdomyolysis and renal failure. On examination, pt is noted to have ataxia and peripheral neuropathy. Following treatment of the pt's acute medical problems, it becomes apparent that the pt has dementia. MRI: cerebellar atrophy and diffuse white matter changes. Which long standing substance of abuse:

TOLUENE

Pt presents highly anxious with seizures, has emotional lability, irritability, dizziness, and confusion. MRI reveals multiple subcortical demyelinating lesions. The most likely sx is exposure to which of the following substances?

TOLUENE

28 y/o F reports episodes of severe HAs w nausea/vomiting. HAs can be incapacitating, often preceded by flashes of light in the right visual field. During headache, pt sometimes has difficulty expressing herself. Which med would be the appropriate to prevent these episodes? (2x)

TOPIRAMATE

Chronic A-fib develops aphasia and R hemiparesis at noon. ER exam notes weakness of R extremities and severe dysfluent aphasia, but CT at 1:30 PM has no acute lesion. Most appropriate treatment: (4x)

TPA

Which test requires rapid and efficient integration of attention, visual scanning and cognitive sequencing?

TRAIL MAKING TEST

What test requires rapid and efficient integration of attention, visual scanning, and cognitive sequencing?

TRAIL-MAKING TEST (TMT)

What is perceptual abnormality in which hallucinogenic drugs cause moving objects to appear as a series of discrete and discontinuous images?

TRAILING

Test that measure flexibility in shifting cognitive sets

TRAILS B

Pt presents to ED with 5-day hx of N/V, diarrhea, HR of 90, BP 150/92, and temp 100, sweating, tremor, hyperreflexia and distractibility, normal labs an and CT head, and years of Fluoxetine use. One week ago a new med was started, what med was it?:

TRAMADOL

Focused attention, altered consciousness usually seen in pts w dissociative D/O (2x)

TRANCE

Pt who is 2 months sober on disulfiram, what lab studies should be done at baseline and after 2 months of treatment?

TRANSAMINASES

61y/o pt presents to ED with family who report that the pt unable to remember recent events. Memory problems started 2 hours prior; cognitively intact before episode. Pt is alert, anxious, frustrated: "Why am I in the hospital?" Dx: (2x)

TRANSIENT GLOBAL AMNESIA

A 72 year old develops sudden onset memory loss. She didn't know how she and spouse arrived at supermarket. The spouse noted that she could drive without issues but appeared anxious. The patient was able to appropriately answer questions but forgot the conversation and then returned to baseline. What is the most likely diagnosis?

TRANSIENT GLOBAL AMNESIA

On the way to airport for vacation, 58 yo F begins to behave in very strange way. Husband notices when he talks to her she answers appropriately w fluent speech but seems to have no ability to retain any new information. She repeatedly asks where they are going, even after he has told her many times. The episode lasts for about 6 hours. The following day she is back to normal but has no recollection of the prior day events. This episode is most consist with a diagnosis of: (3x)

TRANSIENT GLOBAL AMNESIA

breakage and removal of seg of chromosome and moved to another

TRANSLOCATION

23 y/o develops tingling paresthesias in the lower extremities, followed several days later by progressive weakness, R>L. PE shows sensory level at T10 to pinprick, +3/5 weakness of LE, slightly weaker on R. Knee and ankle jerks are hyperactive, b/l congenit. Pt has difficulty walking with broad-based, stiff-legged gait. Dx?

TRANSVERSE MYELITIS

What condition is a forerunner of MS? (2x)

TRANSVERSE MYELITIS

Man sexually aroused by crossdressing. Diagnosis?

TRANSVESTIC DISORDER

19 y/o pt presents for evaluation of depression. Pt reports a generally very low mood, although it brightens up briefly when something good happens. Pt reports feeling best in the morning. Pt has been sleeping and eating more than usual, and complains of feelings of heaviness in the extremities. Pt reports always being very sensitive to perceived rejection by others. Trials with two selective serotonin reuptake inhibitors (SSRIs) have failed. Which of the following treatments may be particularly effective for this pt?

TRANYLCYPROMINE

Antidepressant w/ shortest elimination half-life:

TRAZODONE

What pharmacological treatment should be used for long-term insomnia in pts with dementia over 65 years of age?

TRAZODONE

Describes the relationship of stimulant treatment of children with ADHD and the emergence and/or presence of tic d/o:

TREATMENT WITH STIMULANTS HAS BEEN SHOWN TO REDUCE TICS IN CHILDREN WITH COMORBID ADHD AND TIC D/O.

Increased PR, QRS, or QT on EKG:

TRICYCLICS

52 y/o w recurrent stabbing pain over right cheek and jaw forcing him to frown. Stopped shaving or brushing teeth d/t fear of pain. Episodes last less than 1 minute. Only exam abnormality is pain upon repeated touching of pt's face. Most likely explanation of symptoms?

TRIGEMINAL NEURALGIA

Severely sensitive, lancinating pain on the cheek

TRIGEMINAL NEURALGIA

Tests for detecting excessive drinking

TRIGLYCERIDES, MCV, SGGT, SGOT

Which genetic abnormality presents with macroorchidism, intellectual disability, and frequent hand flapping in teenager?

TRINUCLEOTIDE REPEAT IN FMR1 GENE

What EEG findings are expected in a comatose pt with hepatic encephalopathy? (2x)

TRIPHASIC WAVES

Hx of OCD, Zoloft only partially effective. Next:

TRY ANOTHER SSRI

15 y/o pt w/ hx of atypical seizures that include psychomotor attacks and generalized motor episodes. Pt does poorly in school. Exam reveals skin lesion, no other abnormalities. A mutation of which gene?

TSC-1 (TUBEROUS SCLEROSIS GENE 1)

55yo p/w depression, fatigue, wt gain, & somnolence x1 mo. Hx MI 3mo ago (VTach), on amiodarone, HCTZ, & metformin. Management?

TSH & T4 level

49 y/o pt with ETOH dependence is brought to the ED with a one-week history of malaise, headache, diplopia, lethargy and confusion. On examination, the pt has a temp of 38.2 C, stiff neck, medical deviation of the right eye with impaired abduction and hoarseness. CSF: 114 leukocytes, predominantly monocytes, a protein of 132mg/dl, and glucose of 29mg/dl. Likely type of meningitis:

TUBERCULOUS

15 y/o pt w/ partial complex seizures w/ secondary generalization, mental retardation, and adenoma sebaceum. Dx?

TUBEROUS SCLEROSIS

14 y/o girl presents with delayed onset of puberty, short status, and a history of cardiac abnormalities and hypertension. She has poor social skills. Psychological assessment reveals a normal verbal IQ and a below-normal performance IQ. Which of the following is the most likely dx?

TURNER SYNDROME

Two antidepressants are tested alone and as a combo treatment against a waitlist control group in pts with treatment resistant MDD. Both meds are found to have a significant therapeutic effect individually, and the combo treatment is more efficacious than the summed effects of each med given alone. What has been demonstrated? (2x)

TWO TREATMENTS MAIN EFFECTS AND AN INTERACTION EFFECT

85 yo patient with hx of dementia admitted for agitation becomes more confused and angry. What lab should you get?

UA

Persistent numbness in the L hand, decreased sensation in 4th/5th digits (palmar/dorsal), weak finger abduction/adduction especially 5th digit: (4x)

ULNAR NERVE ENTRAPMENT AT THE ELBOW

37 y/o truck driver w numbness of L hand, inc severity in past 2 yrs. Reduced pinprick sensation on L little/ring fingers, atrophy of hypothenar muscle. (6x)

ULNAR NERVE LESION

Weakness of opponens of thumb and adduction of 4th, 5th digit, decreased sensation in 4th, 5th digits extending into palm and ending at crease of wrist, caused by:

ULNAR NERVE LESION

A 34 yo patient is being treated for malaria after returning from a trip to Kenya. The patient has a history of schizoaffective disorder which has been well controlled for more than a decade with a combo of Risperdal and Lithium. The pt is given a single dose of mefloquine, however after 1 week the patient reports feeling anxious. This escalates over the next week to PMA and persecutory delusions. The most likely cause of the pt's psychotic symptoms is:

UNCOMMON SE OF THE ANTIMALARIAL TREATMENT

Confabulation is:

UNCONSCIOUS FILLING IN OF MEMORY GAPS

Neurasthenia, an accepted condition in Europe and Asia, corresponds to which of the following in DSM-IV-TR?

UNDIFFERENTIATED SOMATOFORM DISORDER

No harm contract between patients and clinicians are? (2x)

UNHELPFUL IN MAKING DECISIONS

WHO study in 1990, what is the 2nd worldwide leading source of years of healthy life lost to premature death/disability (#1 is ischemic heart disease): (x2)

UNIPOLAR MAJOR DEPRESSION

Strongest risk factor for postpartum depression:

UNTREATED DEPRESSION DURING PREGNANCY

70yo w depression plus confusion x 2wk following the start of fluoxetine . An adverse effect is suspected but neuro exam normal. What evaluation would be most useful to confirm suspicion of an adverse effect? (x2)

UREA AND ELECTROLYTES

85 y/o nursing home pt w/ hx of dementia being more confused and screaming "fire" whenever the light next to the bed is turned on. Next step?

URINALYSIS

17 y/o pt has an insidious onset of unusual behavior and argumentativeness. Exam, the mouth is held slightly open. Pt has mild dysarthria and hoarseness, generalized slowness, rigidity, and a mild resting tremor of the left arm and head. rule out drug and/or alcohol abuse. Liver function tests show elevated transaminases. An increase in which laboratory test is most likely to confirm Dx? (4x)

URINARY COPPER EXCRETION

Which is a muscarinic SE of antidepressants? (2x)

URINARY RETENTION

Easiest biologic sampling to falsify when testing for drugs?

URINE

Most effective initial treatment for pts with PCP intoxication:

URINE ACIDIFICATION

62 y/o pt with hx chest pain has and depression, one month ago started on paroxetine, presents with new onset of lethargy and headache, low Na and BUN, normal K , and Cr of 0.4. Next test: (2x)

URINE OSMOLALITY

A 32 yo pt presents to ED with acute onset paranoia, AH and hypervigilance. On exam pt is tachycardic, HTN and has PMA and anxiety. No past psych hx or PMH. ROS is + intermittent substernal CP. Which test is most helpful in developing a DDX?

URINE TOXICOLOGY

67 y/o recently retired pt with Parkinsons, no other psych hx, has taken Pramipexole for several years without cognitive decline. Pt has since started gambling excessively. Pt does not drink or use illicit substances. What is the most likely cause?

USE OF DOPAMINERGIC AGENTS

Which of the following is the most powerful predictor of falling in older adults?

USE OF SEDATIVE MEDICATIONS

What is the principle goal of the cognitive-behavioral therapy of panic d/o?

USING RESTRUCTURED INTERPRETATION OF DISTURBING SENSATIONS

Important distinction between depressive symptoms in pts with cancer as compared to those patients with depression but no cancer is that the patients w cancer?

USUALLY MAINTAIN INTACT SELF-ESTEEM

Psychiatrist is treating pt with bipolar disorder whose condition is relatively stable, recently reports feeling depressed. The psychiatrist is considering adding lamotrigine, however is concerned it may interact with pts current meds. Which medication interaction is psychiatrist concerned about?

VALPROATE

Which med is treatment of choice for bipolar with rapid cycling?

VALPROATE

16 y/o pt w/ new onset tonic clonic seizures. Pt reports having jerky movements which cause him to drop objects. EEG shows polyspike pattern. Which antiepileptic medication?

VALPROIC ACID

Antiepileptic for juvenile myoclonic epilepsy:

VALPROIC ACID

What is the medication for adequate initial treatment of absence seizures in children?

VALPROIC ACID

Other than nicotine replacement therapies, evidence most strongly supports the use of which of the following agents for smoking cessation?

VARENICLINE (CHANTIX)

What is the most efficacious treatment of tobacco-use disorder?

VARENICLINE (CHANTIX)

54 y/o pt has several days of low grade fever, malaise and severe pain in the right side of the ribcage. Examination reveals an erythematous rash with clusters of tense vesicles, with clear content, on a belt distribution from the front of the chest to the back under the nipple, limited to the right side. Likely causal viral agent? (4x)

VARICELLA ZOSTER VIRUS

74 y/o, right-handed patient presents with significant memory loss, expressive aphasia, and left plantar extensor response. The most likely diagnosis is:

VASCULAR DEMENTIA

Pt c/o pain when walking that radiates from lower back and is severe in the calves. Pain relieved by stopping for a couple of minutes, then resuming. No sensory or motor deficits. Test most likely to yield Dx?

VASCULAR EVALUATION OF LOWER EXTREMITIES

Pt who 5 days ago experienced a ruptured aneurysm located in the left middle cerebral artery develops a fluctuating aphasia and hemiparesis with no significant headaches. Underlying event:

VASOSPASM

Closed TBI, initially no LOC, then 20 minutes later LOC. Patient recovers in 5 minutes.

VASOVAGAL SYNCOPAL ATTACK

In Narcolepsy weakness in the arms and legs with laughter would respond to which med

VENLAFAXINE

Phenylethylamine antidepressant that targets serotonin and norepinephrine reuptake inhibition:

VENLAFAXINE

The usual target for Deep Brain Stimulation in Essential Tremor:

VENTRAL INTERMEDIATE THALAMUS

Mesolimbic DA pathway includes which structure?

VENTRAL STRIATUM

Formication, agitation, stereotypical oral movements and paranoia are sx of intoxication with which of the following substances?In the reward pathways implicated in the neurobiology of addiction, dopaminergic neurons project to the nucleus accumbens. The cell bodies of these neurons reside in what area of brain?

VENTRAL TEGMENTAL AREA

In addiction, dopaminergic neurons project to nucleus accumbens. Cell bodies of these neurons reside in which area of brain?

VENTRAL TEGMENTAL AREA

In addiction, dopaminergic neurons project to nucleus accumbens. Cell bodies of these neurons reside in which area of the brain?

VENTRAL TEGMENTAL AREA

17y/o is evaluated for binge eating associated with a 60 lb weight gain over the past four months. CT shows a craniopharyngioma that likely disrupts what structure?

VENTROMEDIAL HYPOTHALAMUS

When interpreting IQ test results, what indicates need for further assessment?

VERBAL SCORE SIGNIFICANTLY HIGHER THAN NONVERBAL SCORE

Chiropractic adjustments are a known precipitant for which of the following acute conditions? (2x)

VERTEBRAL ARTERY DISSECTION

70 y/o pt w/ attacks of "whirling sensations" w/n/v, diplopia, dysarthria, tingling of lips. Occurs several times daily for 1 minute, severe that pt collapses and is immobilized when symptoms start. No residual s/s, no tinnitus, hearing impairment, ALOC or association with any particular activity. Dx?

VERTEBROBASILAR INSUFFICIENCY

This tool best measures the degree of self-care in children with MR:

VINELAND ADAPTIVE BEHAVIOR SCALE

8 yo child recently had Wechsler Intelligence Scale for Children (WISC-IV) and received full scale IQ of 60. Which additional tests would determine if child meets criteria for intellectual disability (mental retardation)? (2X)

VINELAND ADAPTIVE BEHAVIOR SCALES, 2ND EDITION (VABS-II)

A pt with EtOH-dependence present to ED with confusion, ataxia, nystagmus and ophthalmologist. High doses of which of the following vitamins could have prevented this syndrome?

VITAMIN B1

Subacute combined degeneration of the posterior column of the spinal cord is associated with a deficiency of: (2x)

VITAMIN B12 DEFICIENCY

60 y/o F with 10 month hx of apathy and depression has hyperchromic macrocytic anemia. Best test to order next:

VITAMIN B12 LEVEL

Polyneuropathy can be caused by either deficiency or extreme excess of which of the following B vitamins?

VITAMIN B6

19 y/o F has bouts of motor agitation, often followed by intense, seemingly meaningless writing; also mood lability, tactile & olfactory hallucinations. During the interview, patient abruptly stops paying attention and begins rapidly pacing around the room. What should be the next step?

WAIT 15 MINS, THEN OBTAIN PROLACTIN LEVEL

In relapse prevention therapy, teaching a recovering pt w/ an addiction that relapse is a process rather than an event conveys what?

WARNING SIGNS PRECEDE SUBSTANCE USE

44 y/o pt with schizophrenia is admitted to an inpatient psychiatric unit. After several days pt has muscle tremor, ataxia, twitching, diarrhea, restlessness, vomiting, polyuria, and stupor. Dx?

WATER INTOXICATION

What hematological finding necessitates immediate dc of clozaril?

WBC 2000-3000, GRANULOCYTES 1000-1500

Exam findings suggests L5 radiculopathy in pt with back pain and foot drop?

WEAKNESS OF ANKLE INVERSION

MRI scan of head reveals an infarct in distribution of left anterior cerebral artery. Pt most likely exhibits: (2x)

WEAKNESS OF CONTRALATERAL FOOT AND LEG

Inhibitors of enzyme catechol-O-methyl transferase are used in Parkinson disease to address which disease-associate problem?

WEARING OFF OF LEVODOPA EFFECT

A psychological test that demonstrates high reliability:

WECHSLER ADULT INTELLIGENCE SCALE (WAIS)

Measures attention, concentration, and freedom from distractibility:

WECHSLER ADULT INTELLIGENCE SCALE (WAIS)

Test correlates most strongly w premorbid fcn in pt w early dementia

WECHSLER ADULT INTELLIGENCE SCALE II VOCABULARY TEST

Which test correlates most strongly with pre-morbid functioning in pt w/ early dementia:

WECHSLER ADULT INTELLIGENCE SCALE IV VOCABULARY TEST (WAIS-IV)

Stanford-Binet most similar to:

WECHSLER INTELLIGENCE SCALE FOR CHILDREN - III

Which assessment instrument best measures cognitive functioning in a 4 year old child?

WECHSLER PRESCHOOL AND PRIMARY SCALE OF INTELLIGENCE-REVISED WPPSI-R

Aphasia secondary to lesion in posterior third of left superior temporal gyrus

WERNICKE

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. (8x)

WERNICKE'S APHASIA

In ER following MVA, receives IV dextrose 5%. Experiences confusion, oculomotor paralysis, and dysarthria:

WERNICKE'S ENCEPHALOPATHY

Pt who was admitted to the ER after a MVA receives IV dextrose 5% to provide access for administration of parenteral meds. Later, pt experiences confusion, oculomotor paralysis, and dysarthria. Symptoms were likely caused by:

WERNICKE'S ENCEPHALOPATHY

Sixth cranial nerve palsy is associated with which alcohol-related syndrome?

WERNICKE'S ENCEPHALOPATHY

Disorder with degeneration of mammillary bodies and dorsal nucleus of thalamus

WERNICKE-KORSAKOFF SYNDROME

When is a psychiatrist permitted to notify a 3rd party identified to be at risk for contracting HIV from a patient

WHEN PATIENT W AIDS UNWILLING/UNABLE TO TAKE AUTONOMY-PRESERVING PRECAUTIONS LIKE ABSTINENCE

Which cancer treatment may be followed by a subcortical dementia due to a leukoencephalopathy with onset after 6 months post-treatment?

WHOLE BRAIN RADIATION

42yr old pt eval for depression, drinks 3 drinks/night, >3 on weekends, pt reports readiness to quit as "3/10", what is the most helpful response for motivational interviewing?

WHY A 3 AND NOT A 0

In documenting suicide risk-assessment, key risk management strategy is to discuss what factors in the record?

WHY THE PSYCHIATRIST REJECTED ALTERNATIVE WAYS OF RESPONDING

What would be a useful screening test to evaluate an 8 y/o child's academic performance?

WIDE RANGE ACHIEVEMENT TEST (WRAT)

Pt has severe postural tremor of upper extremities and dystonic posturing of the hands. Pt voice is mildly dysarthric. Eyes have a golden brown limbic ring. Deep tendon reflexes are markedly increased. Elevated LFT's. Dx?

WILSON'S DISEASE

Neuropsychological test that specifically evaluates impairments in frontal lobe function in adults?

WISCONSIN CARD SORTING TASK (WCST)

75 y/o pt presents with symptoms of dementia. Especially poor performance on which of the following neuropsychological tests might suggest a Dx of vascular dementia rather than Alzheimer's dementia?

WISCONSIN CARD SORTING TEST (WCST)

Most specific test for assessing executive functioning? (x2)

WISCONSIN CARD SORTING TEST (WCST)

On what test would perseverative error be considered a specific outcome of clinical relevance?

WISCONSIN CARD SORTING TEST (WCST)

What test would be considered most useful to specifically evaluate concept formation, reasoning, and executive functioning? (5x)

WISCONSIN CARD SORTING TEST (WCST)

Which of the following tests would be considered most useful to specifically evaluate concept formation with set shifting? (2x)

WISCONSIN CARD SORTING TEST (WCST)

Normal bereavement in prepubertal children

WISH TO UNITE W/ DEAD LOVED ONE

Late-onset schizophrenia is more common in men or women? (2x)

WOMEN

Test more specific to identify specific learning disability in child w/ full scale IQ of 93 on WISC- III

WOODCOCK-JOHNSON PSYCHO- EDUCATIONAL BATTERY - REVISED

In normal aging, last cognitive abilities to decline

WORD KNOWLEDGE

Which is important when working w/ family members who are caregivers to pts w/dementia? • There needs only be one caregiver at a time • Grief work w/fam not necessary before pt. dies • All fam to equally share caregiving responsibility • Work w/fam should enhance effectiveness of care to pt. • Fam should explore SNF options as soon as pt is diagnosed

WORK W/ FAMILY SHOULD ENHANCE EFFECTIVENESS OF CARE TO PT

Ability to temporarily store and manipulate information such as in mental arithmetic:

WORKING MEMORY

Dorsal-lateral-pre-frontal cortex plays an important role in what activity?

WORKING MEMORY

13 y/o M w trouble keeping up w P.E. class. On exam: symmetric weakness in legs/ arms, worse in proximal muscles, most prominent in quadriceps/hamstrings. Both calves enlarged, painful w exercise. Serum creatine kinase level is 13,000. Muscle bx reveals abnormalities in dystrophin protein staining. Pattern of inheritance is?

X-LINKED

Can alcohol fumes at work (brewery) cause a pt on disulfiram headaches?

YES

Which atypical antipsychotic causes least weight gain?

ZIPRASIDONE

Nicotinic acetylcholine receptor associate with reward properties of nicotine

ɑ4β2

Antipsychotic drug adrenergic effect causing orthostatic hypotension

Α1-BLOCKADE