2016 P-RITE Q/As
Which of the following psychotherapy modalities is most commonly used in crisis management? A. Psychoanalysis B. Behavioral therapy C. Supportive therapy D. Interpersonal psychotherapy E. Psychodynamic psychotherapy
A. Psychoanalysis B. Behavioral therapy C. Supportive therapy D. Interpersonal psychotherapy E. Psychodynamic psychotherapy Clinical psychiatry Psychopathology & associated conditions
A three-year-old girl presents for routine physical examination. Which of the following is the child expected to be able to do? A. Tie shoelaces B. Copy a square C. Copy a triangle D. Have imaginary friends E. Have a sense of herself as female
A. Tie shoelaces B. Copy a square C. Copy a triangle D. Have imaginary friends E. Have a sense of herself as female 3 yo have sense of gender Neurosciences
7. In order to make a DSM 5 diagnosis of attention-deficit hyperactivity disorder (ADHD), symptoms must be present prior to what age? A. 5 years B. 7 years C. 12 years D. 17 years E. 21 years
C
A two-year-old child presents for routine physical exam. Which of the following skills is the child likely to be able to demonstrate? A. Kick a ball B. Catch a ball C. Copy a circle D. Ride a tricycle E. Hop on one foot
A 2 yo: kick ball 3 yo: trike, copy circle, sense of Gender 4 yo: hop 1 foot and catch bounced ball Neurosciences
The psychiatrist is asking a patient questions describing symptoms of mania. The patient responds, "that sounds exactly like my cousin," and proceeds to tell a long story about the cousin impulsively traveling to Mexico and exhausting all savings, never actually answering the psychiatrist's request. This is an example of: A. tangentiality. B. circumstantiality. C. flight of ideas. D. pressured speech. E. clang associations.
A Clinical psychiatry Diagnostic procedures
The clinical observation that depressed adolescents have difficulty with flexible problem-solving has led to studies demonstrating deficits in tests such as the Trails Making Test B. If these findings are sufficiently replicated it would suggest that, for adolescents, a major depressive disorder causes deficits in which of the following domains of cognitive functioning? A Verbal memory B. Working memory C. Processing speed D. Executive functioning E. Visual-spatial memory
A Verbal memory B. Working memory C. Processing speed D. Executive functioning E. Visual-spatial memory Clinical psychiatry Behavioral & social sciences
61. At what age is normal genital self-stimulation particularly pronounced in children? A. 6 months B. 18 months C. 3 yearsf D. 5 years E. 7 years
A. 6 months B. 18 months C. 3 yearsf D. 5 years E. 7 years
59. Which of the following is the most appropriate dose of nicotine patches to give a patient who smokes 40 cigarettes per day? A. 7 mg/d B. 14 mg/d C. 21 mg/d D. 28 mg/d E. 42mg/d
A. 7 mg/d B. 14 mg/d C. 21 mg/d (1ppd) D. 28 mg/d E. 42mg/d (2ppd)
32. A patient reports hearing the voice of some one who is not present, then stops moving, stares blankly, repetitively picks at clothing, and does not respond to questions or commands for several minutes. The confusion resolves after 15 minutes, but the patient has no recollections of these events. This likely represents which of the following types of seizure? A. Absence B. Myoclonic C. Simple partial D. Tonic-clonic E. Complex partial.
A. Absence B. Myoclonic C. Simple partial D. Tonic-clonic E. Complex partial.
There is robust evidence from epidemiological studies that the offspring of older fathers have an increased risk of which of the following disorders? A. Alcoholism B. Schizophrenia C. Major depression D. Antisocial personality disorder E. Attention-deficit/hyperactivity disorder
A. Alcoholism B. Schizophrenia C. Major depression D. Antisocial personality disorder E. Attention-deficit/hyperactivity disorder 'older Studs, opens risk 4 Schizophrenia' Neurosciences
A 12-year-old patient is referred for assessment of inattention and behavioral problems in the classroom and the home. Attention-deficit/hyperactivity disorder is diagnosed. The evaluation reveals a significant level of anxiety symptoms. Which of the following recommendations for initial treatment has the strongest evidence base? A. Alpha agonist monotherapy B. Serotonin specific antidepressant monotherapy C. Combined psychostimulant and alpha agonist D. Combined alpha agonist and behavior therapy E. Combined psychostimulant and behavior therapy
A. Alpha agonist monotherapy B. Serotonin specific antidepressant monotherapy C. Combined psychostimulant and alpha agonist D. Combined alpha agonist and behavior therapy E. Combined psychostimulant and behavior therapy Clinical psychiatry Treatment
38. 38. An 80 yr old patient with major depress1 n has tried previous selective serotonin reuptake inhibitors (SSRis) and one previous serotonin-norepinephrine reuptake inhibitor (SNRI) without significant improvement. The patient has not yet tried a tricyclic antidepressant (TCA). There is no known history of cardiac disease and an electrocardiogram (EKG) is within normal limits. In light of their side effect profiles, which of the following medications is most appropriate for this patient? A. Amitriptyline B. Clomipramine C. Desipramine D. Doxepin E. Imipramine
A. Amitriptyline B. Clomipramine C. Desipramine: best tolerated, low sedation D. Doxepin E. Imipramine
Potentially threatening objects produce a startle response before a person becomes consciously aware of them. This process is due to direct connections of the thalamus with which of the following? A. Amygdala B. Hippocampus C. Primary visual cortex D. Medial prefrontal cortex E. Autonomic nervous system
A. Amygdala B. Hippocampus C. Primary visual cortex D. Medial prefrontal cortex E. Autonomic nervous system Neurosciences
Research studies have found an association between Alzheimer disease and the accumulation of which of the following proteins inside conical neurons? A. Amyloid B. Tau C. Fibrillin D. Presenilin E. Neuropeptide Y
A. Amyloid B. Tau (Tau Tangles- Cone: conical neurons) C. Fibrillin D. Presenilin E. Neuropeptide Y Neurosciences
34. A 9 year old boy of normal intelligence is seen for evaluation of behavior problems occurring both at home and at school. Parents and teachers describe a 3 to 4 year pattern of persistent intense irritability and anger with almost daily outbursts of verbal and physical aggression triggered by even minor frustrations. The child previously enjoyed playing with friends and participating in team sports. Recently, however, he has become more socially isolated as peers are wary of his angry outbursts, and he has been asked to leave a team because of explosive behavior. Sleep onset is often delayed by the childs refusal to cooperate with bed time routine. Appetite and energy level are normal. The child's view is the the only problem is that "other kids are mean and aduts are unfair." This childs clinical presentation is most highly correlated with an eventual diagnosis of which of the following disorders by the time he reaches young adulthood? A. Anxiety B. Bipolar I C. Somatic symptom D. Narcissistic personality E. Attention-deficit hyperactivity .
A. Anxiety B. Bipolar I C. Somatic symptom D. Narcissistic personality E. Attention-deficit hyperactivity
A psychiatrist is conducting a study to assess how a diagnosis of a chronic pain syndrome affects an individual's work performance as measured by the rate of errors. Which of the following statistical measures would be used to describe the probability that an individual with chronic pain will make an error compared to an individual who is pain free? A. Attributable fraction B. Effect size C. Odds ratio D. Relative risk E. Hazard ratio
A. Attributable fraction B. Effect size C. Odds ratio D. Relative risk E. Hazard ratio Clinical psychiatry Research & scholarship literacy
A psychiatrist treats a patient in psychotherapy for depression and anxiety. The patient's partner has received a prestigious job offer in another city. Although the patient can easily find work in the other city, the patient feels angry about the possibility of having to move and is thinking of ending the relationship. The patient also reveals feeling a loss of control. According to Erik Erikson, this patient is struggling to navigate which stage of psychosocial development? A. Autonomy versus shame and doubt B. Identity versus role confusion C. Generativity versus stagnation D. Intimacy versus isolation E. Integrity versus despair
A. Autonomy versus shame and doubt B. Identity versus role confusion C. Generativity versus stagnation D. Intimacy versus isolation E. Integrity versus despair Clinical psychiatry Development & maturation
An interpersonal psychodynamic group comprised of people with heterogeneous diagnoses and levels of functioning has room to take a new member. When considering patients to refer to the group, which of the following diagnoses would be a relative contraindication? A. Bipolar disorder B. Major depression C. Antisocial personality disorder D. Dependent personality disorder E. Narcissistic personality disorder
A. Bipolar disorder B. Major depression C. Antisocial personality disorder D. Dependent personality disorder E. Narcissistic personality disorder Clinical psychiatry Treatment
Prostaglandin D2 helps regulate the sleep-wake cycle by increasing extracellular levels of which of the following chemicals? A. GABA B. Hypocretin C. Adenosine D. Melatonin E. Histamine
A. GABA B. Hypocretin C. Adenosine D. Melatonin E. Histamine Neurosciences
Children in which of the following age groups are at greatest risk for death resulting from child abuse? A. Birth - 3 years B. 4 - 6 years C. 7 - 10 years D. Il - 13 years E. 14 - 18 years
A. Birth - 3 years B. 4 - 6 years C. 7 - 10 years D. Il - 13 years E. 14 - 18 years Clinical psychiatry Epidemiology
Which of the following is the most effective treatment of focal hand dystonia associated with writing ("writer's cramp")? A. Carbamazepine B. Valproic acid C. Botulinum toxin D. Glatiramer acetate E. Levodopa/carbidopa
A. Carbamazepine B. Valproic acid C. Botulinum toxin D. Glatiramer acetate E. Levodopa/carbidopa Clinical neurology
85. Adults with a history of childhood abuse are more likely than normal controls to have reduced size of which of the following structures on magnetic resonance imaging (MRI) scan of the brain? A. Caudate B. Amygdala C. Hippocampus D. Prefrontal E. Cerebellar vermis
A. Caudate B. Amygdala C. Hippocampus D. Prefrontal E. Cerebellar vermis
A researcher Investigates whether heavy cannabis use in adolescence is associated with schizophrenia. Daily cannabis use during adolescence in 200 adult participants with schizophrenia is compared with use in 200 participants without a psychiatric diagnosis, Which of the following study designs is the researcher using? A. Cohort study B. Ecological study C. Case-control study D. Cross-sectional study E. Randomized control trial
A. Cohort study B. Ecological study C. Case-control study D. Cross-sectional study E. Randomized control trial Case-control Study Clinical psychiatry Research & scholarship literacy
Which of the following is an example of a retrograde neurotransmitter? A. GABA B. Glutamate C. Dopamine D. Norepinephrine E. Endocannabinoids
A. GABA B. Glutamate C. Dopamine D. Norepinephrine E. Endocannabinoids Cannabinoids are backwards/Retro on End. Neurosciences
A 70-year-old man presents with a 4-month history of worsening cognitive decline, urinary incontinence and difficulty walking. Which of the following are the most likely findings on this patient's structural magnetic resonance imaging (MRI) scan? A. Cortical atrophy B. Cerebellar atrophy C. Enlarged ventricles D. Striatal degeneration E. Diffuse small cortical infarcts
A. Cortical atrophy B. Cerebellar atrophy C. Enlarged ventricles D. Striatal degeneration E. Diffuse small cortical infarcts Clinical psychiatry Diagnostic procedures
15. A 35-year-old construction worker was uninjured when a crane collapsed at a construction site, but witnessed the deaths of two co-workers who were crushed. When evaluated in a hospital emergency department the following day, the patient reports emotional numbness, intrusive images, and an inabililty to sleep since the accident. Which of the following interventions IS most appropriate? A. Critical incident debriefing about the work accident B. Normalizing stress reaction and mobilizing relational supports C. Prescribing a benzodiazepine to restabilize the sleep/wake cycle D. Referral for trauma-focused cognitive-behavioral psychotherapy (CBT) E. Prescribing propranolol to decrease long-term risk for chronic posttraumatic stress disorder (PTSD)
A. Critical incident debriefing about the work accident B. Normalizing stress reaction and mobilizing relational supports C. Prescribing a benzodiazepine to restabilize the sleep/wake cycle D. Referral for trauma-focused cognitive-behavioral psychotherapy (CBT) E. Prescribing propranolol to decrease long-term risk for chronic posttraumatic stress disorder (PTSD)
58. Which of the following is the most common psychiatric complication of corticosteroid therapy? A. Dementia B. Delirium C. Psychosis D. Anxiety E. Mood disorder
A. Dementia B. Delirium C. Psychosis D. Anxiety E. Mood disorder
The case of "Little Hans" led Freud to develop a psychological theory of the formation of which of the following symptoms? A. Depression B. Regression C. Phobia D. Inattention E. Mania
A. Depression B. Regression C. Phobia D. Inattention E. Mania Clinical psychiatry Issues in practice
Which of the following is a typical phase-of-life problem in middle adulthood? A. Determining one's identity B. Achieving intimacy in relationships C. Choosing a sustainable career path D. Overcoming a sense of invulnerability E. Caring for both one's children and parents
A. Determining one's identity B. Achieving intimacy in relationships C. Choosing a sustainable career path D. Overcoming a sense of invulnerability E. Caring for both one's children and parents Clinical psychiatry Development & maturation
17. A 75 yr old patient is admitted for confusion. The patient is disoriented to time and place, easily distracted and unable to recall any of the 3 words after 5 minutes. The patient is somnolent much of the day and is often up at night, repeatedly asking, "Where am I ?". The current symptoms are new and different from baseline mild dementia. Workup for the patient's confusion is negative thus far, and haloperidol is started. After 3 days the patient is much improved, with minimal somnolence. The patient continues to be disoriented and is surprised when informed he is in a hospital. Which of the following is the best pharmacologic treatment approach to take next with this patient? A. Discontinue haloperidol B. Continue haloperidol until the disorientation resolves C. Increase the dose of haloperidol until the disorientation resolves D. Switch from haloperidol to risperidone E. Switch from haloperidol to lorazepam
A. Discontinue haloperidol B. Continue haloperidol until the disorientation resolves C. Increase the dose of haloperidol until the disorientation resolves D. Switch from haloperidol to risperidone E. Switch from haloperidol to lorazepam When patients' cognitive states stabilize, antipsychotics should be continued over the next few days, then tapered and discontinued.
Which of the following is characteristic of persons diagnosed with rapid eye movement(REM) sleep behavior disorder? A. Disorder overwhelmingly affects females B. Episodes are commonly associated with daytime naps C. Polysomnography is notable for REM sleep without atonia D. Episodes occur within the first 60 minutes after sleep onset E. Upon waking from an episode, these individuals are usually confused and disoriented
A. Disorder overwhelmingly affects females B. Episodes are commonly associated with daytime naps C. Polysomnography is notable for REM sleep without atonia D. Episodes occur within the first 60 minutes after sleep onset E. Upon waking from an episode, these individuals are usually confused and disoriented Clinical psychiatry Psychopathology & associated conditions
Which of the following is the most common type of dissociative amnesia? A. Failure to recall new events as they occur B. Total loss of memory for one's own personal history C. Failure to recall events during a particular period of time D. Inability to recall some, but not all, events during a particular time E. Inability to recall information in a particular category (e.g., related to one's family)
A. Failure to recall new events as they occur B. Total loss of memory for one's own personal history C. Failure to recall events during a particular period of time D. Inability to recall some, but not all, events during a particular time E. Inability to recall information in a particular category (e.g., related to one's family) Clinical psychiatry Psychopathology & associated conditions
A 7-year-old child has an estimated vocabulary of approximately 5000 words, This represents a delay in which of the following domains of language development? A. Grammar B. Semantics C. Pragmatics D. Social communication E. Phonological awareness
A. Grammar B. Semantics C. Pragmatics D. Social communication E. Phonological awareness Clinical psychiatry Development & maturation
Which of the following is observed in patients with lesions involving one of the cerebellar hemispheres? A. Gross movements are affected more than fine movements. B. Skilled movements of the extremities ipsilateral to the lesion are disturbed. C. Posture and gait are more severely impaired than for lesions of the vermis. D. Dysmetria and hypotonicity typically affect the leg and foot more than the arm and hand. E. Dysarthria and articulation disturbances are often present and difficult to discriminate from a stroke.
A. Gross movements are affected more than fine movements. B. Skilled movements of the extremities ipsilateral to the lesion are disturbed. C. Posture and gait are more severely impaired than for lesions of the vermis. D. Dysmetria and hypotonicity typically affect the leg and foot more than the arm and hand. E. Dysarthria and articulation disturbances are often present and difficult to discriminate from a stroke. Neurosciences
A patient presents to the primary care clinic with concern about having a brain tumor after an acquaintance died from brain cancer. The patient denies any headache or other neurologic symptoms. However, the patient reports reading on the internet that brain tumors can be easily missed and that there may not be any obvious symptoms initially. There are no neurologic or cognitive findings on exam and a computed tomography (CT) scan is normal. However, the patient returns a month later insisting that other tests such as a brain positron emission tomography (PET) scan be done. The patient has been worried about a missed diagnosis, and has continued to spend hours researching brain tumors. The patient displays no other psychiatric symptoms. Which of the following is the patient's most likely diagnosis? A. Illness anxiety disorder B. Somatic symptom disorder C. Adjustment disorder with anxiety D. Delusional disorder, somatic type E. Functional neurological symptom disorder
A. Illness anxiety disorder B. Somatic symptom disorder C. Adjustment disorder with anxiety D. Delusional disorder, somatic type E. Functional neurological symptom disorder Clinical psychiatry Psychopathology & associated conditions
86. The physiologic changes during REM sleep include increased eye movements, decreased muscle tone and which of the following? A. Increased heart rate B. Increased muscle activity C. Decreased blood pressure D. Decreased respiratio"ns E. Decreased cerebral blood flow
A. Increased heart rate (REM- Rate Eye Muscles up/up/down) B. Increased muscle activity C. Decreased blood pressure D. Decreased respiratio"ns E. Decreased cerebral blood flow
36. When a psychiatrist fails to obtain informed consent for treatment, the psychiatrist has failed to respect which of the following core principles of medical ethics? A. Justice B. Fidelity C. Autonomy D. Beneficence E. Nonmaleficence
A. Justice B. Fidelity C. Autonomy- makes choice x consent D. Beneficence E. Nonmaleficence
A diagnosis of Huntington disease would be best confirmed by which of the following methods? A. Karyotyping B. Genetic linkage analysis C. Fluorescent in situ hybridization D. Trinucleotide expansion analysis E. Mitochondrial DNA insertion analysis
A. Karyotyping B. Genetic linkage analysis C. Fluorescent in situ hybridization D. Trinucleotide expansion analysis E. Mitochondrial DNA insertion analysis Neurosciences
26. A 61 year old patient presents to the emergency department ( ED) accompanied by family who report that he patient is unable to remember recent events. The patients memory problems began 2 hours prior, and he patient was congnitively intact before this episode. The patient is alert, slightly anxious and frustrated, and repeatedly asks, "Why am I in the hospital, is some one sick?" This presentation is most consistent with a diagnosis of A. Korsakoff dementia. B. temporal lobe epilepsy. C. transient global amnesia. D. midline cerebellar tumor. E. middle cerebral artery occlusion.
A. Korsakoff dementia. B. temporal lobe epilepsy. C. transient global amnesia. D. midline cerebellar tumor. E. middle cerebral artery occlusion.
Which of the following characteristics would be most expected of infants who are hypersensitive and less able to tolerate environmental stimuli? A. Lethargic and often withdrawn B. Seldom distressed and often pensive C. Easily startled and more frequent crying D. Recognizing and giving less attention to the familiar E. Inability to discriminate mother's voice from a stranger's
A. Lethargic and often withdrawn B. Seldom distressed and often pensive C. Easily startled and more frequent crying D. Recognizing and giving less attention to the familiar E. Inability to discriminate mother's voice from a stranger's Clinical psychiatry Development & maturation
A patient with Parkinson disease develops a change in behavior characterized by frequent, compulsive gambling. Which of the following medications is most likely contributing to this change in the patient's behavior? A. Levodopa B. Selegiline C. Pramipexole D. Benztropine E. Entacapone
A. Levodopa B. Selegiline C. Pramipexole- D. Benztropine E. Entacapone Clinical neurology
A 55-year-old patient complains of "the worst headache of my life" and is evaluated for subarachnoid hemorrhage. Computed tomography (CT) scan of the brain is normal and does not show any blood. Which of the following is the most appropriate next step to determine the presence of subarachnoid blood? A. Lumbar puncture B. Conventional angiogram C. Outpatient follow up in one week D. Repeat CT scan of the brain in 24 hours E. Magnetic resonance imaging (MRI) scan of the brain
A. Lumbar puncture B. Conventional angiogram C. Outpatient follow up in one week D. Repeat CT scan of the brain in 24 hours E. Magnetic resonance imaging (MRI) scan of the brain Clinical neurology
A patient with autism is brought to the emergency department due to severe agitation, On examination, the patient has a fever of 38.20 C, heart rate 105, and blood pressure 160/95 mmHg. Leukocyte count is 18.1 103/gL, and creatine kinase is 15000 U/L The patient is noted to be mute, rigid, drooling, and hasn't eaten in 2 days. Chest x-ray and urinalysis are unremarkable. Current medications include fluoxetine, buspirone, methylphenidate, guanfacine, olanzapine, haloperidol, and valproic acid. Which of the following is the most likely diagnosis? A. Malignant catatonia B. Serotonin syndrome C. Anticholinergic toxicity D. Delirium secondary to infection E. Neuroleptic malignant syndrome
A. Malignant catatonia B. Serotonin syndrome C. Anticholinergic toxicity D. Delirium secondary to infection E. Neuroleptic malignant syndrome Clinical psychiatry Treatment
Which of the following conditions is most likely to be associated with the finding of upbeating nystagmus on primary gaze on neurologic exam? A. Medullary lesion B. Pontine hemorrhage or infarct C. Occult lung or breast carcinoma D. Craniopharyngioma in the optic chiasm region E. Congenital anomaly of the anterior third ventricle
A. Medullary lesion B. Pontine hemorrhage or infarct C. Occult lung or breast carcinoma D. Craniopharyngioma in the optic chiasm region E. Congenital anomaly of the anterior third ventricle Neurosciences
Narcolepsy is believed to be caused by deficiency of which of the following substances? A. Melatonin B. Hypocretin C. Acetylcholine D. Norepinephrine E. Melanin-concentrating hormone
A. Melatonin B. Hypocretin C. Acetylcholine D. Norepinephrine E. Melanin-concentrating hormone 'Hypo-cretin/orexin in Narcolepsy' Neurosciences
Pain caused by neurogenic inflammation is mediated by which of the following? A. Metalloproteinase B. Interleukin 6 C. Substance P D. Dopamine E. Complement
A. Metalloproteinase B. Interleukin 6 C. Substance P D. Dopamine E. Complement Neurosciences
49. The prevalence of AIDS in the US population increased after the discovery of zidovudine (AZT) and other effective treatments. Which of the following is the best explanation for this increase? A. More patients came forth with the diagnosis after treatment was discovered B. More patients contracted the illness, as there was less fear involved C. More patients with the illness were living longer D. More patients contracted the illness from birth
A. More patients came forth with the diagnosis after treatment was discovered B. More patients contracted the illness, as there was less fear involved C. More patients with the illness were living longer D. More patients contracted the illness from birth
50. A 16 yr old adolescent reports, "hearing music at night" and "sometimes even hearing my name." During which of the following stages of sleep should this phenomenon occur if they are hypnagogic hallucinations ? A. N1 B. N2 C. N3 D. REM E. Wakefulness
A. N1 B. N2 C. N3 D. REM E. Wakefulness
An 8-year-old child with mild intellectual disability is most likely to have difficulty with which of the following? A. Naming colors B. Following the bedtime routine C. Brushing teeth without supervision D. Understanding social cues of peers E. Accepting hugs from family members
A. Naming colors B. Following the bedtime routine C. Brushing teeth without supervision D. Understanding social cues of peers E. Accepting hugs from family members mild DDMR = Difficulty with Social Cues Clinical psychiatry Psychopathology & associated conditions
A patient presents for evaluation of "sleep problems." Though the patient is not aware of any physical discomfort, the bed partner notices that the patient experiences frequent "jerking" movements in both legs. The patient is referred for a sleep study, which reveals brief bursts of activity on electromyography lasting less than five seconds in duration and occurring every 20-40 seconds. Which of the following is the most likely diagnosis? A. Narcolepsy B. Sleep terror disorder C. Restless leg syndrome D. REM sleep behavior disorder E. Periodic limb movement syndrome
A. Narcolepsy B. Sleep terror disorder C. Restless leg syndrome D. REM sleep behavior disorder E. Periodic limb movement syndrome Clinical psychiatry Diagnostic procedures
42. A patient receives 20$ each time a random urine drug screen is negative for substance use. However, if the urine drug screen is positive, the patient is "locked out" of getting the reward until three consecutive negative urine drug screens are provided. This represents which of the following behavioral techniques? A. Network therapy B. Twelve step facilitation C. Contingency management D. Relapse prevention therapy E. Motivatioal enhancement therapy
A. Network therapy B. Twelve step facilitation C. Contingency management D. Relapse prevention therapy E. Motivatioal enhancement therapy Contingency management (CM) is the application of the three-term contingency (or operant conditioning), which uses stimulus control and consequences to change behavior, and originally derived from the science of applied behavior analysis (ABA), but it is sometimes implemented from a cognitive-behavior therapy (CBT)
Which of the following psychiatric medications should be discontinued prior to ECT? A. Olanzapine B. Fluoxetine C. Memantine D. Lorazepam E. Zolpidem
A. Olanzapine B. Fluoxetine C. Memantine D. Lorazepam E. Zolpidem Clinical psychiatry Treatment
A 32-year-old patient presents to the emergency department with three days of recurrent headaches. The pain is described as sudden in onset, predominantly periorbital and frequently awakening the patient from sleep. The episodes last for approximately 40 minutes and spontaneously resolve. On examination the patient appears restless, has mild ptosis of the left eye, mild left miosis, increased lacrimation, nasal congestion and rhinorrhea all ipsilateral to the pain. The examination is otherwise unremarkable. Which of the following treatments is most likely to abort the headache? A. Oxygen B. Ibuprofen C. Topiramate D. Indomethacin E. Dexamethasone
A. Oxygen B. Ibuprofen C. Topiramate D. Indomethacin E. Dexamethasone Clinical neurology
Which of the following interventions is an example of a wraparound, in-home, community-based treatment for youth with behavioral disturbances? A. Parent training B. Multisystemic therapy C. Functional family therapy D. Dialectical behavior therapy E. Parent-child interaction therapy
A. Parent training B. Multisystemic therapy C. Functional family therapy D. Dialectical behavior therapy E. Parent-child interaction therapy Clinical psychiatry Treatment
A woman presents to the physician for evaluation of inability to achieve orgasm. Presence of which of the following factors would argue against a diagnosis of female orgasmic disorder? A. Patient concerns about her body image B. Intimate partner violence in current relationship C. Religious beliefs with strong prohibitions against sexual activity D. Discrepancy between patient's and partner's desire for sexual activity E. Ability to achieve orgasm during masturbation but not during partnered sexual activity
A. Patient concerns about her body image B. Intimate partner violence in current relationship C. Religious beliefs with strong prohibitions against sexual activity D. Discrepancy between patient's and partner's desire for sexual activity E. Ability to achieve orgasm during masturbation but not during partnered sexual activity Clinical psychiatry Psychopathology & associated conditions
53. During a session the psychiatrist tells a long-time patient, "I am moving to another state and will not be able to see you anymore. This is our last session. I am giving you a one-month supply of medication. Here is the letter documenting the end of our treatment. This concludes our session." The patient independently finds another psych1atrast and stablishes care·without incident. Three months later, the patient sues the previous psychiatrist for damages, citing abandonment. Which of the following is the best·defense against medical malpractice? A. Patient did not suffer an appreciably bad outcome. B. Patient filed outside the time period of the statute of limitations. C. Psychiatrist now lives in another state and is not liable for prior activities. D. Psychiatrist fulfilled the duty to the patient by giving 30 days of medication. E. Psychiatrist provided written notification of termination that the patient signed.
A. Patient did not suffer an appreciably bad outcome. B. Patient filed outside the time period of the statute of limitations. C. Psychiatrist now lives in another state and is not liable for prior activities. D. Psychiatrist fulfilled the duty to the patient by giving 30 days of medication. E. Psychiatrist provided written notification of termination that the patient signed.
46. An 8 yr old child is evaluated for asthma. The pediatrician identifies signficant and ongoing symptoms of ADHD, in the patient as well. Aftter a standard stimulant trial, th parents report little improvement in the child and ongoing oppositional and impulsive behavior at home. While continuing to medically treat the child the pediatrican refers the child to a psychiatrist for medication management, and the parens to a psychologist for prent training. All three professionals monitor the symptoms and communciate regularly. This is an example of what level of collaborative care? A. Primarily primary care B. Shared (integrated) care C. Primarily mental health care D. Primarily primary care with consultation E. Shared (integrated) care and higher levels of care
A. Primarily primary care B. Shared (integrated) care C. Primarily mental health care D. Primarily primary care with consultation E. Shared (integrated) care and higher levels of care
In a community mental health center providing recovery-oriented care, which aspect of the psychiatrists' role is based on recovery-oriented principles? A. Providing trauma-informed care B. Leadership of the multidisciplinary team C. Collaborating in partnership with consumers to support their goals D. Consultation to and supervision of other mental health professions E. Providing diagnostic evaluation and medication management of mental disorders
A. Providing trauma-informed care B. Leadership of the multidisciplinary team C. Collaborating in partnership with consumers to support their goals D. Consultation to and supervision of other mental health professions E. Providing diagnostic evaluation and medication management of mental disorders Clinical psychiatry Consultation/collaborative integrated care
A psychiatrist is consulted regarding a 43-year-old patient who complains of "a lump in my throat," headaches, bloating, back pain, diarrhea, chest pain, painful urination, and sexual indifference. The patient's complaints do not match the objective findings obtained from a thorough diagnostic workup. Which of the following would be best to recommend to the patient's primary care provider? A. Refer to a gastroenterologist B. Refer for intensive psychotherapy C. Prescribe an antipsychotic medication D. Tell the patient there is no medical illness E. Schedule regular visits with a physical examination
A. Refer to a gastroenterologist B. Refer for intensive psychotherapy C. Prescribe an antipsychotic medication D. Tell the patient there is no medical illness E. Schedule regular visits with a physical examination Clinical psychiatry Consultation/collaborative innovative care
Which of the following interventions has the most robust evidence for preventing suicide? A. Restricting access to lethal methods B. Media reporting guidelines for suicide C. Public education campaigns about suicide D. Screening interventions within high schools E. Prescription of selective SSRIs for those at high risk
A. Restricting access to lethal methods B. Media reporting guidelines for suicide C. Public education campaigns about suicide D. Screening interventions within high schools E. Prescription of selective SSRIs for those at high risk Clinical psychiatry Psychopathology & associated conditions
The efficacy of case management in the treatment of substance use problems is best established for which of the following outcomes? A. Retention in treatment B. Enhanced quality of life C. Reduced substance use D. Lower rates of HIV infection E. Improved occupational function
A. Retention in treatment B. Enhanced quality of life C. Reduced substance use D. Lower rates of HIV infection E. Improved occupational function Clinical psychiatry Treatment
Hearing impairment is a feature of which of the following chromosomal disorders? A. Rett syndrome B. Phenylketonuria C. Wilson disease D. Huntington disease E. Neurofibromatosis-2
A. Rett syndrome B. Phenylketonuria C. Wilson disease D. Huntington disease E. Neurofibromatosis-2 (2 ears) Neurosciences
The presence of which of the following would help in determining if a tonic-clonic seizure-like episode was non-epileptic rather than an epileptic seizure? A. Self-injury B. Stereotyped episodes C. Lack of elevation of prolactin D. Rhythmic movements of arms E. Presence of postictal confusion
A. Self-injury B. Stereotyped episodes C. Lack of elevation of prolactin D. Rhythmic movements of arms E. Presence of postictal confusion Clinical Neurology
22. Ingestion of which of the following may give a false positive urine toxicology screen for benzodiazepines? A. Sertraline B. Ephedrine C. Quetiapine D. Poppy seeds E. Proton-pump inhibitors
A. Sertraline 'Zoloft may cauze + BenZO test' B. Ephedrine C. Quetiapine D. Poppy seeds E. Proton-pump inhibitors
18. Which of the following is the best treatment for genito-pelvic pain/penetration disorder? A. Sildenafil B. Prostaglandin E1 C. Prohibition of sexual play D. Dilation with graduated sized vaginal dilators E. Constant reinforcement by partner during intercourse
A. Sildenafil B. Prostaglandin E1 C. Prohibition of sexual play D. Dilation with graduated sized vaginal dilators E. Constant reinforcement by partner during intercourse
47. Patients taking lithium are more likely to show elevated levels of which of the following serum electrolytes independent of renal function? A. Sodium B. Potassium C. Calcium D. Magnesium E. Chloride
A. Sodium B. Potassium C. Calcium (Cal seems to Run on Lithium) D. Magnesium E. Chloride
An unmarried, nulliparous woman participates actively in the rearing of her siblings' children. According to Darwinian theory, such altruistic behavior would be explained by which of the following concepts? A. Sublimation B. Socialization C. Reciprocity D. Maladaptation E. Kin selection
A. Sublimation B. Socialization C. Reciprocity D. Maladaptation E. Kin selection Clinical psychiatry Behavioral & social sciences
Which of the following types of therapies is generally most appropriate for patients who have poor reality testing, primitive and immature defenses, Inadequate affect regulation and/or poor impulse control? A. Supportive B. Interpersonal C. Psychoanalytic D. Short-term psychodynamic E. Acceptance and commitment
A. Supportive B. Interpersonal C. Psychoanalytic D. Short-term psychodynamic E. Acceptance and commitment Clinical psychiatry Treatment
Global mental health most differs from other areas of global medicine in which of the following ways? A. The effects of mental health treatment are simpler to quantify. B. Psychiatry places a greater emphasis on cure rather than care. C. The treatments required can usually occur in a briefer period of time. D. Cultural beliefs have a greater influence on diagnostic understandings. E. There is less demand for psychiatric services than other types of medical care.
A. The effects of mental health treatment are simpler to quantify. B. Psychiatry places a greater emphasis on cure rather than care. C. The treatments required can usually occur in a briefer period of time. D. Cultural beliefs have a greater influence on diagnostic understandings. E. There is less demand for psychiatric services than other types of medical care. Clinical psychiatry Administration & systems
Which of the following is an aspect of legal standards for competence? A. The law presumes a person is competent. B. Competence must be assessed before each decision. C. The law presumes a person with dementia is incompetent. D. The law presumes a person with active psychosis is incompetent. E. The law presumes a person with developmental delay is incompetent.
A. The law presumes a person is competent. B. Competence must be assessed before each decision. C. The law presumes a person with dementia is incompetent. D. The law presumes a person with active psychosis is incompetent. E. The law presumes a person with developmental delay is incompetent. Clinical psychiatry Issues in practice
57. Initiatives by The World Health Organization to improve mental health services across the lifespan in low and middle-income countries have prioritized which of the following? A. Training non-specialist providers to identify and treat mental illnesses B. Sending physicians from these countries to the US for psychiatry training C. Developing psychiatric hospitals and treatment centers in these countries D. Developing training programs in these countries to produce more psychiatri ' E. Imbedding psychiatrists in schools and other government regulated organizations
A. Training non-specialist providers to identify and treat mental illnesses B. Sending physicians from these countries to the US for psychiatry training C. Developing psychiatric hospitals and treatment centers in these countries D. Developing training programs in these countries to produce more psychiatri ' E. Imbedding psychiatrists in schools and other government regulated organizations
33. Which of the following antidepressants' plasma levels correlates with therapeutic response? A. Trazodone B. Imipramine C. Amoxapine D. Trimipramine E. Clomipramine
A. Trazodone B. Imipramine -Im pra(y) mine levels are good C. Amoxapine D. Trimipramine E. Clomipramine
65. Alpha activity in a normal awake adult electroencephalogram (EEG) recording is enhanced by A. drowsiness. B. eye closure. C. hyperventilation. D. photic stimulation. E. use of benzodiazepines.
A. drowsiness. B. eye closure. C. hyperventilation. D. photic stimulation. E. use of benzodiazepines.
An individualized education program (IEP) offers a wider range of options than a 504 plan for schools to meet children's educational needs because an IEP: A. has a lower standard for eligibility. B. allows accommodations for psychiatric illness. C. allows modification to the academic requirements for the student. D. allows schools to discipline any disruptive behavior as they see fit. E. allows schools to evaluate family members of the student if necessary.
A. has a lower standard for eligibility. B. allows accommodations for psychiatric illness. C. allows modification to the academic requirements for the student. D. allows schools to discipline any disruptive behavior as they see fit. E. allows schools to evaluate family members of the student if necessary. Clinical psychiatry Consultation/collaborative integrated care
For a person to meet diagnostic criteria for enuresis, the behavior must be: A. involuntary in nature. B. during nighttime sleep. C. attributable to a medical condition. D. in a child of at least 5 years of age. E. associated with the effects of a substance.
A. involuntary in nature. B. during nighttime sleep. C. attributable to a medical condition. D. in a child of at least 5 years of age. E. associated with the effects of a substance. Clinical psychiatry Psychopathology & associated conditions
48. Erikson theorized that a successful developmental task in the 40-to 60-year-old age group is to: A. master intimate relationships despite the demands of work. B. learn to love people without a desire for them to be different. C. become comfortable with' one's identity as perceived by society. D. feel useful to society through behaviors that protect future E. develop a sense of integrity that is able to tolerate the knowledge of impending death.
A. master intimate relationships despite the demands of work. B. learn to love people without a desire for them to be different. C. become comfortable with' one's identity as perceived by society. D. feel useful to society through behaviors that protect future E. develop a sense of integrity that is able to tolerate the knowledge of impending death.
In order to meet criteria A for schizophrenia, a patient must have at least one of three core symptoms: delusions, hallucinations, or: A. negative symptoms. B. disorganized speech. C. marked decrease in functioning. D. abnormal psychomotor behavior. E. grossly disorganized or catatonic behavior.
A. negative symptoms. B. disorganized speech. C. marked decrease in functioning. D. abnormal psychomotor behavior. E. grossly disorganized or catatonic behavior. Clinical psychiatry Psychopathology & associated conditions
Small insertions, deletions, or duplications within the DNA molecule are referred to as: A. point mutations. B. nonsense mutations. C. chromatin remodeling. D. copy number variations. E. single nucleotide polymorphisms.
A. point mutations. B. nonsense mutations. C. chromatin remodeling. D. copy number variations. E. single nucleotide polymorphisms. Neurosciences
Children with a tic disorder are less likely than adolescents and adults with a tic disorder to experience co-occurrence of: A. specific learning disability. B. major depressive disorder. C. separation anxiety disorder. D. social anxiety disorder (social phobia). E. attention-deficit/hyperactivity disorder.
A. specific learning disability. B. major depressive disorder. C. separation anxiety disorder. D. social anxiety disorder (social phobia). E. attention-deficit/hyperactivity disorder. Clinical psychiatry Psychopathology & associated conditions
In behavioral psychology, extinction is defined as: A. strengthening behavior by removing an unpleasant event. B. weakening of the conditioned response due to withdrawal of the stimulus. C. diminishing the probability of a behavior by pairing it with an aversive event. D. repeated pairing of a neutral stimulus with one that evokes an emotional response. E. decreasing strength of the association between stimulus and response due to repetition of the stimulus.
A. strengthening behavior by removing an unpleasant event. B. weakening of the conditioned response due to withdrawal of the stimulus. C. diminishing the probability of a behavior by pairing it with an aversive event. D. repeated pairing of a neutral stimulus with one that evokes an emotional response. E. decreasing strength of the association between stimulus and response due to repetition of the stimulus. Clinical psychiatry Behavioral & social sciences
52. According to Winnicott, a caregiver who is sufficiently attuned and responsive to a child's needs to allow the child to become aware of the child's own drives is referred to as an: A. true self. B. self object. C. auxiliary ego. D. transitional object. E. good-enough parent.
A. true self. B. self object. C. auxiliary ego. D. transitional object. E. good-enough parent.
20. For children to be optimally stimulated for learning, parents need to provide toys suitable for the infant's level of development as well as novel situations that the infant can begin to grasp. According to Vygotsky, these objects and interactional experiences should be within the infant's: A. zone of proximal development. B. line of visual perception. C. transitional space. D. reflexive abilities. E. sphere of influence
A. zone of proximal development. B. line of visual perception. C. transitional space. D. reflexive abilities. E. sphere of influence
Which of the following most seriously threatens the external validity of a research study? A. Placebo responses in the study population B. A study population that is not representative of the population to be treated C. Mortality or differential attrition during the course of treatment during the study D. Maturation due to natural change during the period between baseline and post-test E. Statistical regression or regression toward the mean
B Clinical psychiatry Research & Scholarship Literacy
12. A 30-year-old patient with treatment-resistant schizophrenia is on clozapine. The patient presents to the emergency department with dyspnea, orthostatic hypotension and a heart rate of 130 bpm. Complete blood count is normal except for an elevated eosinophil count. Electrocardiogram (EKG) shows non-specific T-wave changes. Which of the following tests is most likely to be helpful in guiding the acute management of this patient? A. Clozapine level B. Troponin level C. Aldolase level D. Electroencephalogram (EEG) E. Computed tomography (CT) scan of brain
B Clozapine pt with inc HR, Twave changes-> Troponin
A patient is prescribed fluoxetine 20 mg daily to treat a first depressive episode. After three weeks the patient reports that the medication is "not working" and continues to endorse mild depressive symptoms. Which of the following interventions is most appropriate? A. Discontinue fluoxetine and start citalopram 20mg per day B. Continue fluoxetine 20mg per day and reassess in two weeks C. Continue fluoxetine 20mg per day and add buspirone 5mg twice daily D. Increase the dose of fluoxetine to 40mg per day E. Discontinue fluoxetine and start bupropion 150mg per day
B Wait 6wks to see Sx before increasing SSRI Clinical psychiatry Treatment
10. Which of the following medications has been found to be a secondary cause of restless legs syndrome? A. Opioids B. Antidepressants C. Benzodiazepines D. Dopamine agonists -1 E. Beta adrenergic agonists
B AntidepRESsants can cause REStless legs
A pt reports a fear of driving and experiences feelings of panic, SOB, palpitations, sweating, clamminess when anticipating a drive down a steep road. The pt acknowledges going out of the way to avoid this situation. They deny similar symptoms in other settings. Which is the most likely diagnosis? A Panic disorder B Specific phobia C GAD D PTSD E OCD
B Specific phobia Clinical psychiatry Psychopathology & associated conditions
14. According to DSM 5, for a patient to be diagnosed with insomnia disorder, the sleep difficulty should be present for at least what length of time? A. 1 week B. 1 month C. 3 months D. 6 months E. 1 year
C Poor sleep 3+ mo = insomnia
A patient is referred to psychiatry by the primary care provider (PCP). The PCP informs the psychiatrist that the patient repeatedly complains of abdominal pain and nausea, but an extensive medical work-up was within normal limits. The patient recently immigrated to the United States, and the PCP wonders whether the patient's presentation is a culture-bound syndrome. Asking the patient which of the following questions is most likely to yield information that helps with clinical formulation? A. "Are you homesick?" B. "Why don't you believe the test results?" C. "What do you think is causing your problem?" D, "Do you have trouble expressing your feelings?" E. "Is there something that you are not telling your doctor?"
C Clinical psychiatry Treatment
A 70-year-old patient develops confusion, lethargy, and a generalized tonic-clonic seizure. Laboratory testing reveals a serum sodium of 95 mEq/l. Which of the following is the most likely complication of excessively rapid correction of this metabolic problem? A. Basilar artery stroke B. Dialysis encephalopathy C. Central pontine myelinolysis D. Portal-systemic encephalopathy E. Non-convulsive status epilepticus
C Correcting Poor salt = CPM Clinical neurology
A child spends several minutes talking with parents recounting how a peer "got in trouble today." The child continues in great detail about how the peer is always breaking the rules. This child is most likely in which of the following age groups? A. Preschool B. Toddlerhood C. School-age D. Early adolescence E. Late adolescence
C MacArthur = School age Clinical psychiatry Development & maturation
Which of the following SSRIs has the greatest potential for discontinuation syndrome with missed doses? A. Fluoxetine B. Sertraline C. Citalopram D. Paroxetine E. Escitalopram
D "Pare" Paroxetine = Dyscontinuation syndrome" Clinical psychiatry Treatment
The parents of a four-and-a-half-year-old child report that the child insists there is a small monkey who shares the child's room. The child talks to the monkey, asks others to converse with the monkey and insists that the monkey have a seat at the dinner table. The parents ask if they should be concerned. The best response to the parents is that their child is exhibiting: A. early signs of psychosis. B. signs of visual abnormalities. C. signs of exposure to trauma. D. behavior typical for preschoolers. E. early signs of developmental delay.
D Clinical psychiatry Development & Maturation
11. The National Institute of Mental Health (NIMH) was founded during a period of therapeutic optimism following which historical event? A. Discovery of chlorpromazine B. Invention of the polio vaccine C. Passing of the Civil Rights Acts D. Treatment of soldiers during World War II E. Establishment of the food and drug administration (FDA)
D NIMH founded 1949 after WWII
The main goal of group cognitive behavior therapy for chronic pain treatment is to: A. decrease individual members' pain. B. convince family members that chronic pain is real. C. utilize the group process to avoid thinking about stress. D. improve patients' functioning despite the presence of pain. E. reinforce distorted automatic thoughts about the pain experience,
D: CBT-P: goal improve functioning despite pain Clinical psychiatry Treatment
Which of the following is a premise of the objects relations theory? A Everyone develops true and false selves B Aggression and envy are central to psychopathology C The "paranoid position" is representative of the first 6 months of life D The mind is inhabited by mental representations of the self and others E The pleasure principle is central to understanding unconscious conflicts
D: Objects Relations Theory- people desire relationships with others. Clinical psychiatry Behavioral & social sciences
Pretend play in preschool-age children depends upon children's increasing ability in which of the following skills? A. Emotion regulation B. Language acquisition C. Cooperation with peers D. Ability to follow parental rules E. Use of one object to represent another
E Preschool Pretending depends on ability for 1 object to represent another (symbolic play) Clinical psychiatry Development & maturation
Which of the following findings would support a diagnosis of ulnar neuropathy at the elbow? A. Decreased sensation in the thumb and second finger and weakness of thumb abduction B. Hypersensitivity to touch in the upper arm and weakness of raising the arm over the head C. Tenderness in the neck radiating to the back of the arm with decreased triceps reflex D. Impaired sensation on dorsum of hand and weakness of finger and wrist extension E. Loss of sensation in the fourth and fifth digit and weakness of intrinsic hand muscles
E Ulnar weakness and neuropathy (4th, 5th) Clinical neurology
6. In normal aging, which of the following cognitive abilities is the last to show decline? A. Perceptual speed B. Inductive reasoning C. Numerical ability D. Spatial orientation E. Word knowledge
E Word and Vocabulary are resilient to brain aging
9. A patient is brought to the emergency department in a state of psychosis caused by the use of inhalants. The patient is paranoid and anxious but cooperative. Which of the following is the best initial treatment of this acute condition? - A. Benzodiazepines B. Antipsychotics C. Inhaled oxygen D. Gastric lavage E. Watchful waiting
E. Watchful Waiting for substance induced psychosis