Beat the boards review

Dronabinol

a synthetic derivative, which can be prescribed for the control of nausea and vomiting caused by chemotherapeutic agents (after other agents have failed) used in the treatment of cancer and to stimulate appetite in AIDS patients,

SOD-1 protein

abnormally deposited in amyotrophic lateral sclerosis.

action stage

actual execution of the new planned behavior/s

Naltrexone exerts its mechanism of action by acting primarily as? A. Full Opioid agonistB. Kappa AntagonistC. Partial Opioid AgonistD. Opioid AntagonistE. Glutamate Modulator

Opioid Antagonist

Gradient echo (GRE) MRI

detect iron deposition in organs, microbleeds, as well as early stages of degenerative disease

Early-onset familial Alzheimer's disease is associated with which of the following genetic mutations with autosomal dominant transmission? A. Apolipoprotein E epsilon 2 alleleB. Apolipoprotein E epsilon 4 alleleC. Presenilin 1 geneD. Microtubule-associated protein tau (MAPT) geneE. Progranulin (PRGN) gene

. Presenilin 1 gene

Post-traumatic stress disorders in women have _______% of lifetime prevalence as compared to _______% in men;

10-12/5-6

mirtazapine mechanism

Alpha-2-adrenergic receptor antagonist

Which one of the following disorders is associated with a mutation of the MECP2 gene? A. Autism spectrum disorderB. Rett syndromeC. Angelman syndromeD. Lennox-Gastaut syndromeE. Tuberous sclerosis complex

Rett syndrome

alogia

diminished speech output

Buprenorphine

partial agonist at the mu opioid receptor and an antagonist at the kappa opioid receptor.

A 33-year-old woman diagnosed with generalized anxiety disorder visits the clinic to discuss about starting cognitive behavioral therapy (CBT). Which of the following is usually the first step in the CBT? A. Cognitive restructuringB. Learning about relaxation techniquesC. Self-control desensitizationD. Learning to monitor one's own emotions and thoughtsE. Educating patients about their symptoms, the treatment process, and setting goals

Educating patients about their symptoms, the treatment process, and setting goals

amarousis fugax

Episodes of transient visual loss (TVL) lasting less than 60 seconds in an older patient

______ a popular drug of abuse at clubs and dance parties, which has pro-serotonergic effects

MDMA

Myelencephalon gives rise to the

medulla oblongata.

involuntary repeatitive body movements

tardive dyskinesia

___________ are involuntary jerky movements of the body or the limbs. These can be induced by the use of antipsychotic drugs or can be a manifestation of other organic conditions.

tremors

chroming

Inhaling spray paint

Which of the following is a considered a significant risk factor for schizotypal personality disorder? A. Oppositional behaviorB. Parents with schizophreniaC. Loss of a parentD. Parents with social anxietyE. Divorced parents

Parents with schizophrenia

Pons and cerebellum are derived from which of the following structure? A. DiencephalonB. MesencephalonC. MetencephalonD. MyelencephalonE. Telencephalon

Metencephalon

Which one of the following medications is FDA-approved to treat fibromyalgia? A. CitalopramB. EscitalopramC. FluoxetineD. GabapentinE. Milnacipran

Milnacipran

In use for the treatment of alcohol use disorder, naltrexone exerts its effect through which one of the following mechanisms? A. Reduces the positive reinforcing effects of alcoholB. Reduces the symptoms of severe alcohol intoxicationC. Results in unpleasant physical symptoms on exposure to alcoholD. Increases the unpleasantness of alcohol withdrawal symptomsE. Breaks down endorphins to reduce the rewarding effects of alcohol

Reduces the positive reinforcing effects of alcohol

A 19-year-old woman presents to the hospital. She reports an increase in crying, freezing, clinging, shrinking, and failing to speak in social situations for the past eight months. She becomes intensely anxious when interacting with unfamiliar people. She is lagging in studies as she is a psychiatry student herself and needs to communicate frequently with new people. She wants to get rid of this fear. The physical cause of her symptoms is ruled out. Which of the following is first-line pharmacologic therapy for this patient? A. Selective serotonin reuptake inhibitorsB. Low dose buspironeC. Low dose selegilineD. Beta-blockersE. Phenelzine

Selective serotonin reuptake inhibitors

_____________is the pathway involved in cognition and emotional processing.

Striatopallidothalamic

telencephalon gives rise to the

cerebral hemispheres

Beta amyloid plaques

characteristic of Alzheimer's disease

subcortical arteriosclerotic encephalopathy or Binswanger's disease

characterized by the 4 D's: dysmnesia (impaired recall that is improved with cuing), dysexecutive syndrome, delay (slowness), and depletion (apathy and amotivation). This patient also shows signs of a 'frontal' or 'magnetic' gait characterized by impaired limb placement and frequent falls. Further, he has signs of pseudobulbar or suprabulbar palsy that occur due to interruption of the corticobulbar tracts as they descend through the corona radiata and internal capsule, and present with deficits in cranial nerve function and, additionally, can present with "emotional incontinence."

Of the following risk factors, which one has the highest prevalence among patients with major depressive disorder (MDD)? A. Alcohol useB. Male genderC. Childhood traumaD. Poor self-esteemE. Acute illness

childhood trauma

The most common presentation of respiratory ill-effects of chronic cannabis use is ______________

chronic bronchitis

PML

demyelinating disease caused by the reactivation of a common virus in the central nervous system.

persistent depressive disorder

diagnosed by the presence of low mood and any 2 of the following symptoms: i) appetite changes, ii) sleep changes, iii) low energy or fatigue, iv) low self-esteem, v) poor concentration or difficulty making decisions, vi) hopelessness for a period of 2 or more years in adults and at least 1 year in children and adolescents in the absence of any manic episodes.

Methylphenidate

a psychostimulant which causes medication-induced obsessive-compulsive disorder. It inhibits the reuptake of adrenaline, norepinephrine, serotonin, and dopamine resulting in the increased sympathetic drive.

he most common chromosomal abnormality to cause intellectual disability; it occurs from an extra chromosome 21 in majority of the cases.

fluoxeine

Placebo effect

it is defined as the improvement or positive response in a patient's condition seen after use of a placebo drug or treatment which is attributed to the belief in the treatment by the patient.

__________is used in the acute management of bipolar disorder and is linked with Ebstein's anomaly.

lithium

Benzoylecgonine

major metabolite of cocaine

Multiple myeloma

malignancy of plasma cells.

Ms. H is a 76-year-old woman who is stable on her current dose of risperidone. How often should you complete an AIMS? A. MonthlyB. Every 3 monthsC. Every 6 monthsD. Every 9 monthsE. Annually

every 6 months for elderly patients at higher risk for TD

SSRI discontinuation syndrome

flu-like symptoms, tachycardia, headache; sensory abnormalities include electric shock-like sensations and parasthesias; changes in vision, sleep, affect, as well as sexual and psychotic symptoms also occur,

electrolyte abnormalities associated with anorexia nervosa

hypo:-hypochloremia, hyponatremia, hypomagnesemia, hypokalemia, hypophosphatemia, and sometimes hypocalcemia. Bicarbonate levels increase due to the alkalosis associated with vomiting of gastric fluid.

Thalamus

involved in relaying of sensory and motor signals to and from the cerebral cortex, regulation of consciousness, sleep, and alertness involving various neurotransmitters including dopamine, serotonin, and gamma-aminobutyric acid (GABA)

estate planner

manages an individual's assets in the event he loses capacity or dies;

cognitive reprocessing therapy

t is a form of cognitive behavioral therapy and major guidelines recommend it as a first-level psychological intervention for PTSD.

Provisional tic disorder

the presence of a single tic or multiple motor and/or vocal tics, present for less than 1 year since the first tic onset.

Suvorexant

an orexin receptor antagonist indicated treatment of insomnia characterized by difficulties with sleep onset and/or sleep maintenance.

Body dysmorphic disorder

an unhealthy preoccupation with one's body or body part which the person perceives as flawed or defected.

allele seems to be protective against AD, associated with delayed onset of the disease and fewer plaques

apoE2

brown-sequard syndrome

are, associated with hemiparaplegia ( on one side) and the loss of sensation on the opposite side.

Wechsler scales

assess intelligence in different age groups;

Bayley Scale for Infant & Toddler Development

assess the development of children between 1 and 42 months

Diffusion-tensor imaging (DTI)

complex form of diffusion-weighted imaging that can be used to assess the integrity of white matter fibers and document the extent of microstructural damage after traumatic brain injuries, and would be most likely to disclose any brain abnormality in this patient.

six subtypes of adjustment disorder

depressed mood, with anxiety, with mixed anxiety and depressed mood, with disturbance of conduct, with mixed disturbance of emotions and conduct, and unspecified.

Cushing syndrome

depression, cognitive defects, headaches, muscle weakness and hyperpigmentation (in ectopic ACTH syndrome), but have additional features that include weight gain, obesity, diabetes, and striae. Also, features of mineralocorticoid deficiency would not be seen in Cushing's syndrome.

Vortioxetine MOA

enhances of serotonergic activity in the CNS through inhibition of the reuptake of 5-HT, 5-HT3 receptor antagonism and 5-HT1A receptor agonism. It is FDA approved for Major Depressive Disorder.

gold standard treatment for winter depression

phototherapy or bright light therapy

sumatriptan

serotonin receptor agonist used as abortive therapy in the treatment of acute migraines

Persistent (chronic) motor or vocal tic disorder differs from tourette's disorder in requiring _______________

single or multiple motor or vocal tics,

mindfulness

process whereby all the attention is focused towards all that is happening at that moment, including the environment.

relative risk (or risk ratio)

the incidence among individuals exposed to a risk factor divided by the incidence in unexposed individuals.

Which situation represents a reasonable use of ECT for patients with schizophrenia? A. Catatonic patientsB. Patients who are responding to antipsychoticsC. Patients with elevated lipidsD. When the patient's WBC is elevatedE. If the family requests ECT

catatonic patients

About _____% of the people are affected by panic disorders throughout their lifetime.

2.5

According to Piaget's theory of cognitive development, the preoperational stage (ages 2 to 7 years) is marked by which one of the following developments? A. Sensorimotor stageB. Immanent justice, magical thinkingC. Cause and effect thinkingD. Logical thinkingE. Think about thoughts, make deductions

Immanent justice, magical thinking

A 59-year-old man is admitted through the emergency department and diagnosed with alcohol withdrawal delirium (or delirium tremens). His last drink is most likely to have occurred approximately how long prior to development of this condition? A. 12 hoursB. 24 hoursC. 1 to 2 daysD. 3 to 7 daysE. 7 to 14 days

3 to 7 days

An 18-year-old man returns home from first year of college for winter break. He appears withdrawn, sad, and not interested in family activities. He denies any sleep or appetite problems but reports trouble focusing on his school work. He reports that his girlfriend recently broke up with him. What is his most likely diagnosis? A. Cyclothymic disorderB. Adjustment disorder with depressed moodC. Major depressive disorderD. Persistent depressive disorderE. Unspecified depressive disorder

Adjustment disorder with depressed mood

at ________ months, an infant can hold his head balanced and lift his head 90 degrees from the prone position

4 months

Alcohol withdrawal tremulousness (the shakes or the jitters) usually begins ____ to _____ (Days or hours) after cessation of drinking.

6-8 hours

Which of the following enzymes is inhibited by disulfiram? A. Alcohol dehydrogenaseB. Aldehyde dehydrogenaseC. Sulfuryl dehydrogenaseD. Glucose-6-phosphataseE. Acetate dehydrogenase

Aldehyde dehydrogenase

_____________ and ______________ can increase the elimination of valproic acid and thus reduce blood concentrations.

Carbamazepine and phenytoin

Which of the following brain region is the principal source of norepinephrine involved in the panic attacks? A. ThalamusB. Medial prefrontal cortexC. TectumD. Ventral tegmental areaE. Locus ceruleus

E. Locus ceruleus

Anticholinergic effects

blurred vision, dry mouth, constipation and urinary retention.

antidepressants used to treat premenstrual difficulties that inhibit CYP 2D6

fluoxetine or paroxetine.

Patients with schizophrenia who commit suicide have an ___________ in the AMPA receptors specific for glutamate in the caudate nucleus.

increase

Bilateral lesions of the amygdala cause ---------------leading to hypersexuality, hyperorality (fixation on oral exploration), and disinhibited behavior, but primitive reflexes will be absent.

kluver-bucy syndrome

Pimavanserin

only FDA-approved medication for treatment of psychosis in Parkinson's disease.

catatonia

At least 3 of the following clinical signs are necessary for its diagnosis: stupor, catalepsy, waxy flexibility, negativism, posturing, mutism, mannerism, stereotypy, echolalia, grimacing, and echopraxia

A 28-year-old female pharmacist presents to your clinic, seeking help for an addiction to opiate pain pills that she developed 2 years ago. She has decided, "I'm done with using," but has not been able to successfully sustain remission from drug use in the past. You are debating between pharmacological options to recommend to her. You wish to minimize risks of overdose associated with whichever medication you prescribe and consider a medication that is a partial agonist at the opioid receptor. Given this profile, you will most likely choose which of the following medications? A. MethadoneB. BuprenorphineC. NaltrexoneD. ClonazepamE. Topiramate

. Buprenorphine

A 79-year-old male with atrial fibrillation is brought to the clinic by his daughter due to progressive weakness of the right leg and difficulty walking over the past 3 months. The patient complains of back pain in addition to difficulty walking. On exam, there is atrophy, decreased tone, and weakness of the right quadriceps muscle; weakness of right hip flexion; and decreased sensation of the anteromedial thigh. The right patellar reflex is absent. Laboratory testing reveals an INR of 4 (normal range is up to 1.4). Which one of the following is the most likely etiology of the patient's weakness? A. Femoral neuropathy due to psoas muscle hematomaB. Sciatic neuropathy due to piriformis hematomaC. L5 radiculopathy due to disc herniationD. Tibial nerve compression in the tarsal tunnelE. Left middle cerebral artery cardioembolic stroke

. Femoral neuropathy due to psoas muscle hematoma

What approximate percentage of Americans exposed to ethanol will develop alcohol use disorder at some point in their lives? A. 2% to 5%B. 10% to 15%C. 20% to 30%D. 50% to 70%E. 90% to 100%

10-15%

During a therapy session a 16-year-old girl, diagnosed with panic disorder, starts having a panic attack. How should this patient be managed? A. Administer fluoxetine 20 mgB. Administer alprazolam 0.5 mgC. Breathing exercises and mindfulnessD. PsychoeducationE. Ask the patient to pace around the room

Breathing exercises and mindfulness

The ___________ area is responsible for speech and damage to this area leads to motor aphasia.

Broca's

A 24-year-old G1P0 woman at 14 weeks gestation presents to your clinic for treatment of current opioid use. She reports using heroin for the last several months, but desires to quit for the health of her baby. Which of the following pharmacotherapies is most appropriate for her at this time? A. BuprenorphineB. Buprenorphine and NaloxoneC. NaltrexoneD. ClonidineE. Olanzapine

Buprenorphine

A 23-year-old man presents to the clinic because of a depressed mood for the past 6 months. He is a medical student, and he can no longer concentrate on his studies. He is facing difficulty falling asleep. He wakes up repeatedly at night and finds it difficult to go back to sleep. He feels sleepy throughout the day. He has increased appetite and reports gaining 10 lbs during the last 3 months. He has started thinking about ending his life and expressed his suicidal ideation to the physician. He has lost interest in activities that he used to enjoy, like participating in the drama club of his medical school. He drinks 2 to 3 beers daily and more on the weekends. He is sexually active with his girlfriend and uses condoms regularly. He is diagnosed with a major depressive disorder. He is reluctant to start medication for his depressed mood because he thinks that anti-depressants may adversely affect his sexual life. Which of the following is the appropriate treatment option for this patient?

Bupropion

A 40-year-old man presents to the clinic because of decreased sexual arousal. His history is notable for a recent diagnosis of major depressive disorder for which he was prescribed medication. In addition to treating his depression, he would also like to quit smoking. Which of the following is the most appropriate pharmacotherapy to replace his existing medication? A. DiazepamB. BupropionC. BuspironeD. Lithium

Bupropion

Which one of the following disease states is thought to be caused by infectious protein agents known as prions? A. Lewy body diseaseB. Pick's diseaseC. Creutzfeldt-Jakob disease (CJD)D. Parkinson's diseaseE. Progressive supranuclear palsy

CJD

Which of the following is the 12-month prevalence of generalized anxiety disorder (GAD) among adults in the general population of the United States? A. 0.009B. 0.012C. 0.018D. 0.029E. 0.033

D. 0.029

A 27-year-old woman presents to outpatient psychiatry clinic with complaints of depression and anxiety. She is currently on fluoxetine, oral contraceptive pills, and St. John's wort. She has never been pregnant and has no medical conditions. Which pharmacokinetic drug-drug interaction are you most likely to counsel patient about? A. St. John's wort can interact with fluoxetine to cause serotonin syndromeB. St. John's wort can decrease concentrations of fluoxetineC. Fluoxetine can increase concentrations of St. John's wortD. St. John's wort can decrease OCP concentrationsE. OCP can increase fluoxetine concentrations

D. St. John's wort can decrease OCP concentrations

Metoclopramide

D2 receptor antagonist at the chemoreceptor areas in the CNS. It also has 5-HT3 receptor antagonist activity and 5-HT4 receptor agonist activity. It can also precipitate delirium in vulnerable patients at high doses.

Which one of the following is a sign of opioid overdose? A. MydriasisB. Increased oxygen saturationC. HyperthermiaD. Decreased respiratory rate and depthE. Increased skeletal muscle tone

Decreased respiratory rate and depth

Which of the following is an early feature of neurocognitive disorder due to Alzheimer's disease? A. Fluctuating level of cognitionB. Magnetic gaitC. Memory impairmentD. Social disinhibitionE. Urinary incontinence

Memory impairment

A 56-year-old woman consults for the first time with a gambling problem. She says that her husband is demanding that she stop her gambling, or else he will divorce her. During her last gambling session, she lost about $250,000, which is her biggest loss so far. Unfortunately, she acquired this money from a shared retirement fund with her husband, which made her husband very angry. She shares that she has tried quitting at least five times in the past 2 years, but she feels very restless when she does not get to play in the casino at least once a week. Currently, she is jobless because she was terminated for embezzling funds a year ago. Her physical examination is unremarkable. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), what is the patient's diagnosis?

Moderate gambling disorder, persistent

___________________________ is a viral infection of the brain which occurs from reactivation of the JC virus in immunocompromised individuals.

Progressive multi-focal encephalopathy

Venlafaxine

SNRI

gold-standard pharmacologic treatment for PMDD

SSRIs

A 20-year-old man presents to the emergency department in a severely agitated state that developed shortly after acute exposure to intensive toluene inhalation. He is short of breath, has an unsteady gait, and has slurred speech. The patient has a history of inhaling toluene for the past 2 years and has had similar episodes of intoxication in the past. Which of the following metabolic derangements is most likely to be associated with the acute inhalation of this substance? A. HypochloremiaB. HyperkalemiaC. Metabolic alkalosisD. Type 1 renal tubular acidosisE. Type 2 renal tubular acidosis

Type 1 renal tubular acidosis

To be considered a migraine headache without aura, at least 2 of 5 clinical characteristics must be met. Which one of the following options accurately represents 2 of the diagnostic criteria? A. Presence of visual symptoms and phonophobiaB. Unilateral location and pulsating qualityC. Bilateral location and minor pain intensityD. Avoidance of routine activities and dull, constant qualityE. Moderate or severe pain intensity and headache location in the temples

Unilateral location and pulsating quality

A 78-year-old man, a diagnosed case of major neurocognitive disorder due to Alzheimer's disease, is brought for evaluation of anxiety, restlessness, and irritability that has been present for the past 6 months but has worsened for the past week. There is associated insomnia and poor fluency in the language. Currently, the patient appears acutely agitated, aggressive, and furious. He gets out of control during consult, starts shouting and attacking nursing staff in an agitated manner. For what condition is the use of benzodiazepine warranted in this patient? A. Alzheimer's diseaseB. AnxietyC. InsomniaD. DeliriumE. Acute agitation

acute agitation

A 35-year-old man is brought to the clinic by his brother for anger management. The man has been arrested several times since adolescence due to reckless and aggressive behavior. He often escaped getting serious charges through lying and deceit. However, his brother is sick of having to cover for him or bail him out and wants him to get help for his behavior. When asked about feeling any remorse for his action, the man claims that he feels no remorse. What is the most likely diagnosis? A. Paranoid personality disorderB. Schizoid personality disorderC. Narcissistic personality disorderD. Antisocial personality disorderE. Borderline personality disorder

antisocial personality disorder

Angelman Syndrome

characterized by developmental disability and intellectual disability, it is caused by genetic imprinting and lack of function of Chr 15 that is inherited from the mother.

Unlike adult-onset Huntington's disease which presents with chorea, juvenile Huntington's disease much more commonly presents with ________ and ____________

dystonia and seizures

In males, the peak age for the onset for the first psychotic episode is ---------------while for females it is ______________________.

early to mid twenties, late-twenties

Observer-expectancy

effect that occurs due to the cognitive bias of the researcher or their beliefs and expectations that unconsciously influence the behavior of the study participants.

CSF in viral meningitis

elevated protein levels, clear CSF, opening pressure that is normal or elevated, glucose levels that are often normal, and WBC counts elevated to between 10-10,000 with majority lymphocytes.

schema therapy

employed in those patients of generalized anxiety disorder that suffered from early traumatic events and hence developed schemas (or mental representations of themselves, others and the world) based on those events. Schema therapy helps to revise this mental representation to meet the interpersonal needs of the patient.

microtubule-associated protein tau (MAPT) gene

encodes the tau protein that is present in neurofibrillary tangles, a hallmark of AD.

Spinal cord neoplasms

frequently affect the pyramidal tract, leading to areflexia and extensor plantar responses,

bagging

inhaling vapors from a bag filled with the substance

women should drink no more than _____ per day

no greater than 4 per day

FLAIR (fluid-attenuated inversion recovery) MRI

particularly useful for visualizing lesions located near CSF compartments, like multiple sclerosis and subarachnoid hemorrhage

Serotonin Syndrome

potentially fatal syndrome characterized by hyperreflexia, hypertension, tachycardia, delirium, and myoclonus.

formication

sensation of having insects crawling on or under the skin.

maintenance stage

the sustained behavioral change.

hypoactive delirium

lethargy, sedation, poor attention

A 20-year-old man with bipolar II disorder is being treated with combination of fluoxetine 20 mg daily and olanzapine 20 mg daily. His family history is significant for hyperlipidemia in his father and diabetes mellitus in his mother. You educate the client about metabolic syndrome and advise regular monitoring of weight, waist circumference, blood pressure, fasting plasma glucose, and fasting lipid profile. What components of the lipid profile are included in definition for metabolic syndrome? A. Total cholesterolB. TriglyceridesC. Triglycerides and high-density lipoprotein (HDL)D. Triglycerides and low-density lipoprotein (LDL)E. Triglycerides and total cholesterol

. Triglycerides and high-density lipoprotein (HDL)

Normal pressure hydrocephalus is characterized by prominence of which medical symptom? A. Cardiac myopathyB. Clumsy handC. NystagmusD. OphthalmoplegiaE. Urinary incontinence

. Urinary incontinence

Heroin is a ______-acting opioid, so the withdrawal symptoms usually peak within _______days and gradually subside over a period of ________ days. Chronic withdrawal symptoms can last for ________________.

1-3 and 5-7, weeks to months

at __________ months, an infant is able to walk with one hand held or independently.

12

A 91-year-old patient needs to be free from consuming alcohol for approximately what duration of time prior to safely starting disulfiram? A. 2 hoursB. 12 hoursC. 2 daysD. 5 daysE. 4 weeks

12 hours

The prevalence of inhalant use is highest among which one of the following age groups? A. 12 to 25 yearsB. 26 to 40 yearsC. 41 to 65 yearsD. Over 65 yearsE. 0 to 11 years

12 to 25 years

What is the estimated age of onset of panic disorder or agoraphobia? A. 11B. 22C. 33D. 44E. 55

22

By ______ months, a child should run well without falling, go up and down stairs alone, and should have progressed from a bottle to a cup to using a straw to drink.

24

At which one of the following ages should a child be able to combine 2 words together into phrases? A. 6 monthsB. 12 monthsC. 24 monthsD. 3 yearsE. 4 years

24 months

ondansetron

5HT-3 selective serotonin receptor antagonist, and it acts as a centrally acting anti-emetic via inhibition of the vagal nerves to the CNS and gastrointestinal tract. It has been proven to decrease the incidence and duration of postoperative delirium and can be safely used as an adjunctive agent until the primary cause of delirium is appropriately addressed.

at ________ months , an infant can crawl on his hands and knees

8

Which one of the following medications can increase the blood concentration of valproic acid? A. AcetaminophenB. Acetylsalicylic acidC. CholestyramineD. CarbamazepineE. Phenytoin

ASA- reduces elimination of VPA

Cognitive impairment is frequently observed in patients with schizophrenia. Which of the following neurotransmitter have been implicated for this abnormality? A. DopamineB. SerotoninC. NorepinephrineD. AcetylcholineE. Glutamate

Acetylcholine

_____________________ is characterized by the Amyloid β protein deposition and phosphorylated tau protein.

Alzheimer's disease

frontal and parietal atrophy is more prominent in _______________

Alzheimer's disease

Stiff person syndrome is often associated with which one of the following types of antibodies? A. Anti- glutamic acid decarboxylase (GAD) antibodiesB. ANNA-1 (anti-Hu) antibodiesC. Antibodies directed against presynaptic voltage-gated P/Q-type calcium channelsD. Asialo-GM 1 antibodiesE. MAG (myelin-associated glycoprotein) antibodies

Anti- glutamic acid decarboxylase (GAD) antibodies

A 31-year-old woman with a diagnosis of multiple sclerosis for the past 2 years presents to your clinic to establish care. Her first symptoms were visual loss and pain in her left eye, which were treated with steroids. Two months later, she developed similar symptoms in her right eye. At that point, she was started on weekly intramuscular interferon beta-1a treatment. Despite being on treatment, she later developed complete quadriplegia secondary to a cervical spine transverse myelitis with a prolonged hospitalization. She states that despite the use of IV steroids, she has not recovered the use of her legs now 3 months after treatment. Her MRI from 2 months ago fails to show periventricular white matter abnormalities. Which one of the following antibodies is most likely to be positive in this patient? A. Antithyroglobulin antibodyB. Anti-Gad65 antibodyC. Anti-Hu antibodyD. Antithyroperoxidase antibodyE. Anti-aquaporin 4 antibody

Anti-aquaporin 4 antibody

When patients in recovery speak of 90 in 90, they are most likely referring to which one of the following actions? A. Attending 90 12-step groups in 90 daysB. Receiving 90 mg of naloxone combined with 90 mg of buprenorphineC. Exercising 90 minutes a day 90 times a yearD. Combining 90 mcg of fentanyl with 90 mg of heroinE. Writing 90 reasons to stay drug-free in 90 minutes

Attending 90 12-step groups in 90 days

Of the following antidepressants, which one will not contribute to the development of serotonin syndrome? A. FluoxetineB. MoclobemideC. VenlafaxineD. BupropionE. Paroxetine

Bupropion

___________ has a higher sensitivity and specificity than GGT, and is useful in recognizing persons who frequently consume at least eight drinks daily.

CDT

A 50-year-old man presents with the complaints of day-time sleepiness and disturbed sleep. He mentions that he often wakes up during the night due to being unable to breathe, and his partner complains of his snoring. He is often tired during the day. Polysomnography shows 20 obstructive apneic episodes per hour of sleep and an apnea/hypopnea index (AHI) of 29. How should his symptoms be managed? A. Weight loss and CPAPB. Diazepam and CPAPC. Fluoxetine and diazepamD. Sodium oxybate and CPAPE. Methylphenidate and fluoxetine

CPAP and weight loss

Fluvoxamine an inhibitor of ------ at high doses

CYP 3A3/4, 2C9, 2C19, 1A2 and of 2D6

A 22-year-old man is sent for substance use assessment after a minor road traffic accident that occurred thirty minutes prior. The patient admits that he was tricked into ingesting five to ten marijuana jelly beans by his friends during a party. On examination, the patient shows motor incoordination, restlessness, agitation, red eyes, and a fast heartbeat. The patient admits to prior use of marijuana two or three times a month during social occasions within a 5 month period. He explains how he was eating hamburgers while driving which resulted in his loss of control over the steering wheel. Further questioning reveals the presence of auditory hallucinations with intact reality testing which also began one hour back. There is no history of any other substance use, medical or psychiatric illness. What is the most likely diagnosis in this patient? A. Cannabis use disorderB. Cannabis withdrawalC. Cannabis intoxicationD. Cannabis-induced psychosisE. Cannabis-induced anxiety disorder

Cannabis intoxication

A 35-year-old man is brought to the clinic by his wife. His wife says that the patient no longer gives any verbal responses in spite of being very articulate before. He had been experiencing very low moods for the past 3 months and had started shutting himself off from everyone. Recently, he has not been eating routinely and only sleeps a few hours nightly. He remains in his room, barely moving, even to the point of not going to the bathroom to relieve himself. Upon examination, the patient spontaneously raises his arm and keeps it there throughout the examination. He also resists the attempts of the physician to move his arm. What is the most likely diagnosis? A. Psychosis associated with major depressive disorderB. Psychosis associated with dysthymiaC. Catatonia disorder associated with major depressive disorderD. Catatonia disorder associated with schizophreniaE. Catatonia disorder associated with schizophreniform disorder

Catatonia disorder associated with major depressive disorder

shortened palpebral fissures, macroglossia, iris white spots (Brushfield spots), and deep palmar transverse creases. Muscle hypotonia and incoordination are common features. Abnormalities of internal organs include congenital hypothyroidism, GI atresias, and cardiac atrial/ventricular septal defects.

Clinical features of Down's syndrome

Which one of the following pairs of atypical antipsychotics has a higher risk of metabolic syndrome? A. Risperidone and quetiapineB. Olanzapine and quetiapineC. Risperidone and ziprasidoneD. Clozapine and olanzapineE. Aripiprazole and ziprasidone

Clozapine and olanzapine

A 29-year-old man presents to the clinic because of difficulties at work. He works as a programmer at a software company and was recently offered a managerial role, but refused because it would require more interaction with unfamiliar employees Ever since he was in school, he always avoided taking part in speeches, debates and plays because he was afraid his peers would make fun of him. He attended a social work event recently, but started sweating profusely and felt nauseous and dizzy when he was asked to say a few words about the firm; he excused himself and left early. Which of the following is the treatment of choice for his condition? A. Supportive therapyB. Motivational interviewingC. Cognitive Behavioral Therapy (CBT)D. Dialectical Behavioral Therapy (DBT)E. Hypnotherapy

Cognitive Behavioral Therapy (CBT)

Which of the following subtype of dopamine receptor is most commonly targeted in patients with schizophrenia? A. D1B. D2C. D3D. D4E. D5

D2

brief psychotic disorder

DSM-5 criteria as symptoms of psychosis (delusions, hallucinations, disorganized speech or behavior) lasting between one day and one month

A 27-year-old woman presents with fever and cough. Throughout her check-up, she continually calls her mother to ask what questions she should ask her attending physician and whether she should buy the medicine prescribed to her. Upon inquiry, she mentions that she has always relied on her mother to make decisions for her as she herself is too incompetent and fears making a wrong detrimental choice unless her mother is there to help her. What is the most likely diagnosis? A. Avoidant personality disorderB. Borderline personality disorderC. Dependent personality disorderD. Social anxiety disorderE. Agoraphobia

Dependent personality disorder

A 55-year-old man is arrested after a bar fight. He has no ID but says he has been living for the last 3 weeks at an area motel and working at an oil change garage. The motel manager and his boss confirm this. He reports he has no recollection of who he is or where he comes from. On medical exam, the patient is found to be healthy with otherwise normal mental status findings. His most likely diagnosis is which of the following? A. Depersonalization/derealization disorderB. Dissociative identity disorderC. Dissociative amnesia, with dissociative fugueD. Dissociative amnesiaE. Other specified somatic symptom and related disorder

Dissociative amnesia, with dissociative fugue

Which one of the following tests represents the neurodiagnostic technique of choice to distinguish between a patient suspected to be suffering from frontotemporal neurocognitive disorder from one who may have Alzheimer's disease? A. ElectroencephalographyB. Magnetic resonance imaging (MRI)C. Amyloid protein imagingD. Computer tomography (CT)E. Positron emission tomography (PET)

E. Positron emission tomography (PET)

Which of the following is the etiologic agent of progressive multifocal leukoencephalopathy (PML)? A. TraumaB. Autoimmune responseC. BacteriaD. FungiE. Virus

E. Virus

An 80-year-old, recently widowed man complains of problems with sleep initiation and maintenance during this period of bereavement and requests a medication to help him sleep. Which one of the following medications is the best treatment choice? A. FlurazepamB. DiazepamC. TrazodoneD. EszopicloneE. Lorazepam

Eszopiclone

A 24-year-old woman presents with a history of multiple suicide attempts, fights with others, use of multiple drugs, risk-taking behaviors and promiscuity. Her clinician diagnoses her on her initial visit with Borderline PD. What should the clinician have done prior to giving this diagnosis? A. Evaluated patient multiple timesB. Received information from collateral sourcesC. Excluded possibility that these behaviors occurred in the context of another psychiatric disorderD. Evaluated patient after starting medicationsE. Evaluated pt after starting psychotherapy

Excluded possibility that these behaviors occurred in the context of another psychiatric disorder

Vilazodone

FDA indicated for major depressive disorder. It is a partial agonist at the 5HT1A receptor and a selective serotonin reuptake inhibitor.

Iloperidone

FDA indicated for schizophrenia. The mechanism of action is unknown, but it is thought to work through D2 and 5-HT2 antagonism.

An internist in town calls you for advice regarding a male patient. The patient and his wife entered the internist's office yesterday and the patient shook hands with the doctor, and good-naturedly said to him, "Nice to meet you Dr. Fuzzball", evidently referring to the doctor's frizzy hair. The patient's wife reported that her husband had been acting oddly at work, "like he's drunk or high or something." Also, last week when they went to a restaurant, the patient asked the man at the next table, a complete stranger, how much money he made. Later, he made an off-color sexual joke to the man's wife. While listening to his wife, the patient dismisses his wife's concerns completely, saying that "life is too short not to have a little fun." Based on the information provided, which one of the following diagnoses would you explore first? A. Alzheimer's diseaseB. Vascular dementiaC. Frontotemporal dementiaD. DeliriumE. Dementia with Lewy bodies

Frontotemporal dementia

most common side effect associated with acetylcholinesterase inhibitors.

GI disturbance

Which one of the following treatment options is the most effective treatment for dissociative disorders? A. PsychotherapyB. SSRIsC. ClonidineD. BenzodiazepinesE. Buspirone

Psychotherapy

A 45-year-old man comes to the clinic seeking help to quit drinking alcohol. He mentions drinking around 10 glasses of alcohol a day, and how most of his time is spent drinking, getting alcohol or recovering from its effects. His heavy drinking started two years ago when he felt like he was constantly on edge and worrying about the smallest things for several months. He would be restless and fatigued and was having trouble sleeping. He started drinking more to keep his nervousness at bay, but now his drinking problem has resulted in problems at work as well as creating problems with this family. What is the most likely diagnosis? A. Generalized anxiety disorderB. Alcohol use disorderC. Generalized anxiety disorder with comorbid alcohol use disorderD. Panic disorderE. Panic disorder with comorbid alcohol use disorder

Generalized anxiety disorder with comorbid alcohol use disorder

A 19-year-old male patient explains that 6 weeks ago he ingested some psychedelic mushrooms with his fraternity brothers. At first, he felt fine. As the evening wore on, he felt increasingly anxious. He wasn't hallucinating, but his sensations were so vivid that he felt they were burning themselves into his eyes and his ears. He couldn't stop this from happening. When he closed his eyes, the afterimages were just as vivid and would begin to swirl around. This made him even more afraid. He spent most of the night wandering around the streets too wired and anxious to be able to fall asleep. He finally crashed around 6 a.m. the next morning. When he awoke, he felt different. He says over this time, It's like there is a delay in my consciousness. Like when I move my head, the images are just a tiny amount delayed. And sometimes there is movement around the edges. And sometimes everything looks far away. Which one of the following diagnoses is the patient's most likely diagnosis? A. Depersonalization/derealization disorderB. Hallucinogen intoxicationC. Hallucinogen persisting perception disorderD. Hallucinogen withdrawalE. Hallucinogen-induced psychotic disorder

Hallucinogen persisting perception disorder

A new genetic test for risk of developing Alzheimer's disease identifies everyone at risk, but only a small proportion of those people with a positive test actually develop the disease. Which one of the following sets best describes the sensitivity and specificity of that test? A. High sensitivity, low specificityB. High sensitivity, high specificityC. Low sensitivity, high specificityD. Low sensitivity, low specificityE. The sensitivity and specificity of the test cannot be determined from the information given

High sensitivity, low specificity

Glutatmate

major excitatory neurotransmitter in the brain.

Bilateral lesions in the ---------------- result in Wernicke-Korsakoff syndrome

mammillary bodies

Which of the following will be seen in patients on neuroimaging during tic suppression? A. Increased activity in the frontal cortexB. Increase activity in globus pallidusC. Increase activity in the putamenD. Decrease activity in the caudate nucleusE. Increase activity in the thalamus

Increased activity in the frontal cortex

Which of the following structural changes are seen in the brain of a patient with bipolar disorder? A. Increased grey matter volume of the prefrontal cortexB. Increased white matter volume of anterior temporal cortexC. Increased cortical thickness of the insular cortexD. Increased white matter volume of the prefrontal cortexE. Increased volume of the ventral striatum

Increased volume of the ventral striatum

A 23-year-old woman with schizophrenia presents to the clinic with complaints of auditory hallucinations. The patient says that she started hearing the voice of the devil after the death of her mother. She also believes that her neighbors are trying to harm her. In the past, she had slowly worsening social withdrawal and apathy. There is a family history of major depressive disorder that affected her father. Which of the following suggests a poor outcome in this patient? A. GenderB. AgeC. Precipitating factor before the onset of symptomsD. Insidious onsetE. Family history

Insidious onset

A 33-year-old female presents to the clinic due to loss of interest and pleasure in life. The patient complains that she feels only a little joy in living and prefers to be lonely. The patient is doing well with her job and is keen to submit her work perfectly on time. A diagnosis of a depressive personality is made. Which of the following is the treatment of choice for this patient? A. Self-help measuresB. Group psychotherapyC. Insight-oriented psychotherapyD. Serotonergic agentsE. Amphetamine

Insight-oriented psychotherapy

Both morning glory seeds and catnip, taken in sufficient quantity, can mimic the intoxication produced by ________

LSD

ophthalmic side effect of lamotrigine

Lamotrigine associated photopigmentation/photosensitivity occurs due to an unknown mechanism. It is known to bind to melanin-containing tissues and toxic accumulation over time may lead to photosensitivity and other ocular issues.

Wave IV on the brainstem auditory evoked response (BAER) corresponds to activity at which one of the following anatomic locations? A. Cochlear fibers of CN VIIIB. Inferior colliculiC. Superior temporal gyrusD. Medial geniculate bodyE. Lateral lemnisci

Lateral lemnisci

validity

Measure what it intends to measure

Memantine needs dose modification in ______________ and __________impairment but not for _________ or ________ impairment.

Memantine needs dose modification in severe hepatic and renal impairment but not for mild or moderate impairment.

In children diagnosed with schizophrenia, which of the following features indicates a poor prognosis? A. Acute onsetB. Onset before the age of 10 yearsC. Presence of positive symptomsD. Female genderE. Good premorbid adjustment

Onset before the age of 10 years

Vertical nystagmus is most closely associated with intoxication with which of the following substances? A. N,N-dimethyltryptamine (DMT)B. Phencyclidine (PCP)C. 3,4-methylenedioxymethamphetamine (MDMA)D. Lysergic acid diethylamide (LSD)E. Mescaline

PCP

A 24-year-old man with schizophrenia presents for his appointment. He tries to explain recent events in his life. He talks for quite a few minutes coherently and with correct syntax. However, it is clear that he has elucidated next to nothing during his monologue. Which one of the following thought disturbances is this patient most likely exhibiting? A. DerailmentB. Loose associationsC. PerseverationD. Poverty of thought contentE. Thought blocking

Poverty of thought content

Which of the following neurotransmitter alteration is associated with sleep disturbance? A. Reduced synthesis of serotoninB. Elevated levels of dopamineC. Elevated levels of acetylcholineD. Reduced levels of norepinephrineE. Elevated levels of GABA

Reduced synthesis of serotonin

prevalence of anxiety disorders

They are estimated to be found in 33.7% of the adult population during a lifetime.

A 21-year-old woman presents to the hospital with depression. She delivered her baby 2 months ago. Her baby was born with microcephaly, flat nasal bridge, deep-set eyes, small palpebral fissures, low set ears, micrognathia, and small fingernails. She blames herself for his condition and says that she has never touched alcohol in her life. Her friends support her statement of not taking alcohol during pregnancy, but they do reveal her continuous use of an unknown drug. Genetic testing of the baby does not reveal any defect. Which of the following is the correct diagnosis? A. Fetal alcohol syndromeB. Toluene embryopathyC. Edwards syndromeD. Opitz G/BBB syndromeE. Noonan syndrome

Toluene embryopathy

Nocturnal panic attacks typically appear during which phase of sleep? A. Transition between stage 1 and 2B. Transition between stage 2 and 3C. Transition between REM and awake stateD. REM sleepE. Stage 1

Transition between stage 2 and 3

A 25-year-old woman is brought to the emergency department by her mother with the complaint of not being able to sleep for the last 2 days. She has slept for 2 to 3 hours every day for the past 2 weeks. She has not slept at all in the last 48 hours, but reports good energy. She is working on a project to save humanity from global climate change. She has spent her savings to work on the project. She thinks she has found the solution. She has started smoking and drinking during the last months. She smokes a pack of cigarettes every day. She has a history of major depressive disorder for which she used fluoxetine 2 years back. She stopped taking her medication when her symptoms resolved. The only medication she is taking right now are oral contraceptives. She also has a history of systemic lupus erythematosus for which she is using hydroxychloroquine. On physical examination, her pulse is 94 beats per minute, her respiratory rate is 18 breaths per minute, her temperature is 37°C (98.6°F), and her blood pressure is 128/85 mmHg. Her lab investigations reveal normal complete blood count and serum electrolyte levels. Her serum creatinine level is elevated. Which of the following is the appropriate treatment option for this patient? A. LithiumB. Valproic acidC. FluoxetineD. Stop hydroxychloroquineE. Venlafaxine

VPA

Increased levels of norepinephrine can be detected in patients with acute anxiety and panic attacks. Which of the following is the primary metabolite of norepinephrine? A. 5-hydroxyindoleacetic acid (5-HIAA)B. Homovanillic acid (HVA)C. Vanillylmandelic acid (VMA)D. 3,4-Dihydroxyphenylacetic acid (DOPAC)E. Succinic semialdehyde

Vanillylmandelic acid (VMA)

Locked-in syndrome

a complete paralysis of the patient, with eye movements being spared.

hypnotherapy

a controversial treatment for phobias. It aims to alter an individual's consciousness and increase the therapist's suggestibility so that patients can take steps they might otherwise not agree to.

wilson's disease

a disorder of copper transport that is characterized by inadequate biliary copper excretion. This inadequacy leads to accumulation of copper in liver, brain, kidneys, and corneas. Neurologic presentation includes movement disorders such as tremors and ataxia, and spastic dystonia such as masklike face, rigidity, gait disturbance, dysarthria, drooling, and dysphasia. Other problems associated with Wilson's disease include various presentations of hepatitis, cataracts, hemolytic anemia, cardiomyopathy, arthritis, depression, neuroses, and others.

Succinic semialdehyde

a metabolite of gamma-aminobutyric acid (GABA) which subsequently enters the citric acid cycle and it is used in the generation of energy.

Huntington's disease

a neurodegenerative disease characterized by progressive motor, psychiatric, and cognitive decline. Psychiatric, behavioral and cognitive changes may occur years before motor abnormalities manifest, and include depression, irritability, apathy, and impulsivity.

Structural therapy can be used for patients in either the ______or ________stage of change.

action or maintenance

____________ and ____________ can present w/ either no real motor change but with pain, or weakness/numbness but not typically with sudden involvement of bladder and bowel dysfunction.

acute disc herniation and degenerative disc disorders

Disulfiram

alcohol sensitizing agent. Disulfiram is used after the intensive first phase of rehabilitation. The use of disulfiram with alcohol produces an uncomfortable physical reaction, including nausea, vomiting, and a burning sensation in the face and stomach. There are severe adverse effects, including mood swings, psychosis, neuropathies, and fatal hepatitis. The history of coronary artery disease makes disulfiram unsuitable for this patient.

Gateway hypothesis

alcohol, nicotine, and cannabis act as preliminary drugs that make the user prone to using other serious substances.

Nefazodone (Serzone)

an antagonist of alpha 1 adrenergic receptors, in addition to inhibiting serotonin and weakly inhibiting norepinephrine reuptake

Devic's disease, or neuromyelitis optica (NMO),

autoimmune central nervous system demyelinating disorder which preferentially affects the optic nerves and spinal cord. Diagnostic criteria include optic neuritis and transverse myelitis and the presence of at least 2 out of the 3 of the following: 1) antibody to NMO (aquaporin-4) IgG; 2) brain MRI not consistent with multiple sclerosis; or 3) longitudinally extensive (greater than 3 vertebral segments) spinal cord lesion. patients typically do not respond to multiple sclerosis disease-modifying medications.

Stroke in the __________ such as the caudate and the putamen have been associated with obsessive compulsive disorder symptoms.

basal ganglia

estazolam

benzodiazepine indicated in the treatment of insomnia characterized by difficulty with sleep onset and sleep maintenance.

Rich is a 20-year-old man who is currently hospitalized for major depressive disorder with psychotic features. This is his first known psychotic episode. His presentation is most likely to predict future development of which one of the following psychiatric conditions? A. Bipolar disorderB. Dissociative disorderC. Panic disorderD. Posttraumatic stress disorderE. Somatic symptom disorder

bipolar disorder

Which one of the following phobic stimuli is most likely to be associated with vasovagal syncope? A. AnimalB. Natural environmentC. Blood-injection-injuryD. SituationalE. Darkness

blood injection injury

representative payee

can be appointed by an individual to manage their supplemental security income (SSI) benefits in the event they are incapable of doing so themselves. This covers benefits only, not healthcare related decisions.

A 45-year-old woman presents to the emergency department with complaints of dyspnea and palpitations. This was her fourth visit to the ER in the last three months with similar complaints. She was getting progressively more hesitant to leave her house due to the fear of palpitations which would make her feel like she was about to die. Her hormone profile was normal. Her ECG shows ventricular tachycardia and echocardiogram showed increased cardiac wall thickness. Gallium scintigraphy showed significant cardiac uptake of gallium. What is the most likely diagnosis? A. Panic disorder B. Generalized anxiety disorder C. Cardiac sarcoidosis D. Hyperthyroidism E. Agoraphobia

cardiac sarcoidosis

Polyomavirus JC (often called JC virus)

carried by a majority of people with PML and is harmless except among those with depressed immune defenses. PML is most common among individuals with AIDS;

A 55-year-old man is brought to the clinic by his wife. His wife states that the patient suddenly stopped responding to her. He does not eat or sleep properly and remains in his room, barely moving. His hygiene has suffered considerably. She mentions that he had been experiencing low moods for the past three months. He does not have any significant medical history. Upon examination, the patient spontaneously raises his arm and keeps it there throughout the examination. He is unresponsive to any of the examiner's questions and commands. He also resists the attempts of the physician to move his arm. His vitals and EEG are normal. What is the most likely diagnosis? A. CatatoniaB. Locked-in syndromeC. Stiff person syndromeD. Nonconvulsive status epilepticusE. Schizophrenia

catatonia

Separation anxiety disorder

characterized by the presence of inappropriate fear of separation from attachment figures with at least 3 of the following features: recurrent anxiety in anticipation of separation from home or major attachment figures, consistent and excessive fear of losing or possible harm to or an toward event causing separation from the attachment figure, reluctant on being alone, refusal to sleep alone, repeated nightmares of separation, or complaints of physical symptoms when separated. The duration of anxiety should be at least 4 weeks in children and 6 months or more in adults. The disturbance causes significant impairment in major areas of functioning.

There is a __________ in the density of μ-opioid receptors in frontal and temporal cortex in patients with suicidal behaviors.

decrease

avolition

decrease in motivation and self-initiated purposeful activities.

Gigantism

excess growth hormone production before adolescence and is characterized by overall excessive growth

A 21-year-old man sustains a traumatic brain injury while a passenger in a motor vehicle. As a consequence his ability to plan, sequence and monitor his activities for effectiveness is impaired. His cognitive dysfunction is best characterized as which of the following? A. AcalculiaB. AgnosiaC. Executive dysfunctionD. SimultagnosiaE. Personality change due to brain injury

executive dysfunction

Opitz G/BBB Syndrome

genetic disease described by hypertelorism, laryngotracheal-esophageal abnormalities (with a resultant hoarse cry, recurrent stridors, swallowing difficulties), oral clefts, genitor-urinary anomalies (such as hypospadias or splayed labia majora), imperforate anus, congenital heart defects, and developmental delay.

Tuberous sclerosis

genetic disorder with autosomal dominant transmission. About half of children with tuberous sclerosis develop autism spectrum disorder or features of autism spectrum disorder. Tuberous sclerosis accounts for about 1% to 4% of all autism spectrum disorder cases, but 8% to 14% of autism spectrum disorder cases with seizures.

The symptoms associated with acute alcohol withdrawal are related to overactivity of which neurotransmitter? A. DopamineB. GABAC. GlutamateD. Nitric oxideE. Serotonin

glutamate

Buprenorphine

good option to help with detoxification and it is a partial µ agonist so it can help with tapering and withdrawal. It is often paired with naloxone to prevent misuse.

Which infection is thought to be associated with obsessive compulsive symptoms? A. StaphylococcusB. Group A StreptococcusC. MycoplasmaD. SyphilisE. Herpes simplex

group A streptococcus

___________ is generally recommended as the antipsychotic that carries a lower risk for seizures.

haldol

Two primary endogenous receptor ligands that bind these two cannabinoid receptors have been identified.

he first one is anandamide, also known as N-arachidonoylethanolamine (AEA) and the second is 2-arachidonoylglycerol (2-AG). Anandamide (AEA) acts as a partial agonist at CBR1 receptor with high-affinity, but because 2-AG acts as a full agonist at both CBR1 and CBR2 with mild-to-moderate affinity, it is considered to be more efficient in executing effects like the reward, addiction, anxiety, coordination, appetite, learning, sleep, and cognition.

down syndrome

he most common chromosomal abnormality to cause intellectual disability; it occurs from an extra chromosome 21 in majority of the cases.

A 56-year-old man is brought by his family to the clinic due to his aggressive behavior. The patient exhibits temper outbursts, which results in violent behavior. His son reports that the patient is indifferent and has a lack of concern for whatever is happening around him. The patient had a stroke 3 months ago. During an interview with the psychiatrist, the patient is distractible, inattentive, and is emotionally labile. Which of the following is the most appropriate pharmacotherapy for the aggression symptoms in this patient? A. ImipramineB. LithiumC. HaloperidolD. MethylphenidateE. Benzodiazepines

imipramine

A 23-year-old woman presents to the clinic accompanied by her sister. According to the patient, she has been feeling sad most of the time for the past 2 months without any apparent reason. She has been feeling tired and feels like sleeping most of the day resulting in multiple days of missed work. She has not been able to concentrate on her work and feels worthless. According to the patient's sister, she has lost a significant amount of weight and has not been eating well. She has stopped socializing and spends the majority of her time in bed. Which of the following is most likely to be seen in this patient? A. Decreased core body temperatureB. Decreased phasic rapid eye movement (REM) sleepC. Increased REM latencyD. Increased REM densityE. No change in total sleep time

increased REM density

changes in sleep/wake cycle associated with neurocognitive disorder

increased fragmentation of sleep, increased latency for the onset of sleep, decreased sleep efficiency, decreased total sleep time, and decreased slow-wave

Antihistaminic effects

increased somnolence and weight gain.

pre-contemplation,

individuals process less information about their problems and spend less time re-examining themselves.

huffing

inhaling vapors from a rag soaked with a substance that is then placed over the nose or mouth

clinical triad of tuberous sclerosis

intellectual disability, seizures, and hamartomas.

MDD with psychotic features

involves the occurrence of delusions and hallucinations

phenelzine

irreversible monoamine oxidase inhibitor

Female sexual arousal disorder

is defined as the inability to attain sufficient vaginal lubrication in response to sexual activity. Women with sexual arousal disorder lack or have low sexual desire and struggles with achieving arousal.

A group of renowned psychiatrists discusses personality change due to another medical condition. Regarding course and prognosis, they agree that it depends on the cause. Few of these conditions cause permanent personality change, and others are associated with a reversible personality change. They discuss the treatment options for reversible personality change due to medical conditions. They are of the opinion that personality changes can revert in a few conditions if the underlying cause is treated. Which of the following is an example of such a reversible cause of personality change? A. Head injuryB. Huntington's diseaseC. Brain tumorD. Multiple sclerosisE. Levodopa

levodopa

NCD with ____________ presents with cognitive impairment within one year of motor symptoms of Parkinson's disease

lewy bodies

interpersonal therapy

manual-driven treatment for depressive disorders that focuses on interpersonal issues as the cause of depression and as a method of cure, choosing one of the four issues of grief, role dispute, role transition, and interpersonal deficit. The therapist offers advice, aids decision making, clarifies areas of conflict and does not focus on transference. Sessions are weekly for 50 minutes over 16 weeks.

A 58-year-old woman presents to the clinic with a history of chest pain, sweating, palpitations, and nausea 2 days ago in a crowded mall. According to the patient, she lost consciousness after these symptoms and regained consciousness to find people gathered around her calling an ambulance. She felt better and left the mall before the ambulance arrived. She has a history of generalized anxiety disorder but is not on any medications. Which of the following should be the next step in the management of this patient? A. Start clonazepamB. Start paroxetineC. Advise cognitive behavioral therapyD. Obtain an electrocardiogramE. No treatment required

obtain an EKG

odds ratio

odds that an individual with a disease has been exposed to a risk factor divided by the odds that a control has been exposed.

contemplation

patients are now more aware of themselves and their problems, thus are more able to evaluate themselves.

vitamin b6 deficiency

peripheral neuropathy, pellagra-like skin changes, anemia, depression, confusion, and seizures.

A 17-year-old girl who just started college presents to the clinic with complaints of inability to cope with academic requirements. She explains that she has always been this way but her new friends at college have pointed out to her that she always seems to be in a low mood and uninterested in her surroundings. She did mention feeling low on energy very frequently. Her counselor had asked her to maintain a record of her mood for the past 3 months, which showed that she experiences similar symptoms and that she has been feeling that way for over one and a half year. Her diet, sleeping habits, and self-esteem are unaffected. There is no history of substance use. Which of the following is the most likely diagnosis? A. Persistent depressive disorderB. Major depressive disorderC. Bipolar disorderD. Personality disorderE. Schizoaffective disorder

persistent depressive disorder

Female orgasmic disorder

persistent or recurrent delay in or absence of orgasm following a normal sexual excitement phase, causing distress.

____menopausal women are more affected by the female orgasmic disorder as compared to _______menopausal women

post/pre

A 38-year-old woman is brought to the clinic by her husband. She has a history of schizophrenia for which she is taking olanzapine 15 mg for the last 2 weeks. Her symptoms have improved and she is not experiencing the auditory hallucinations with which she had presented earlier. However, her husband is worried about her restlessness. She is not able to sit still and keeps pacing around the room at night. He is also concerned that her wife's face has become expressionless. On examination, flat affect can be observed and she is continuously tapping her toes. Which of the following is the appropriate next step in the management of this patient? A. Replace olanzapine with clozapineB. Reduce the dose of olanzapineC. Advise cognitive-behavior therapyD. Refer the patient for electroconvulsive therapyE. Prescribe benztropine

reduce the dose of olanzapine

A __________ in the levels of GABA leads to sleep disturbance and increased wakefulness.

reduction

delusional disorder

refers to the presence of one or more delusions for a period of one month or longer with the criteria for schizophrenia not being met. The delusions must be present in the absence of any mood or another psychotic disorder and is not brought about due to drugs or illness. These delusions can be erotomanic, grandiose, jealous type, persecutory type, somatic, mixed, and unspecified.

severe fear or anxiety about one or more social situations in which the individual is exposed to possible critical observation by others. For example, social interactions like having a conversation or meeting unfamiliar people, being observed while eating or drinking, and performing in front of others, e.g., giving a speech. The individual fears that showing anxiety symptoms to others will be humiliating, and people will reject him. The social situations almost always provoke fear or anxiety, and the patient avoids these situations. The fear or anxiety is out of proportion to the actual danger posed by the social situation and to the sociocultural context. Significant distress is caused in social, occupational, and other fields of life of the patient.

social anxiety disorder

A 30-year-old woman presents to the clinic with fear of getting trapped in the elevator. She works at an insurance company which is located on the 10th floor, and she climbs stairs every day to reach her office. She has never had any accidents in an elevator but says that she has had this fear since childhood. She denies this type of anxiety in any other situations. What is the most likely diagnosis? A. Social anxiety disorderB. Acute stress disorderC. Generalized anxiety disorderD. Specific phobiaE. Agoraphobia

specific phobia

craving

strong desire or urge to use the inhalant substance.

Lacunar infarct of -------------- leads to hemiballismus (violent involuntary limb movements, on one side of the body),

subthalamic nucleus

Deep-brain stimulation targets for Parkinson's disease

subthalamic nucleus and the globus pallidum.

Wave III on the brainstem auditory evoked response (BAER) corresponds to activity at

superior olivary complex

A 75-year-old woman is brought to the urgent care by her husband, a week after she had a urinary tract infection. She was treated with trimethoprim-sulfamethoxazole. The confusion she experienced at the onset of infection persists. She has been difficult to arouse in the mornings. Yesterday, she saw shadows on the kitchen wall and was frightened. He thinks she needs a course of "stronger antibiotics." Her medical history is significant for hypothyroidism, osteoarthritis, and generalized anxiety disorder. She has been on the same regimen of medications, including acetaminophen as needed for pain, lorazepam 1 mg twice a day, and levothyroxine 75 mcg a day, for the last twenty-five years. Recent labs indicate normal liver and kidney function, and a TSH level of 2.3 (within normal limits). Her husband emphatically denies that she is using alcohol or any illicit substances. On exam, her vitals are normal. She stares off into space, and appears startled when asked questions. She focuses long enough to say that she has no urinary frequency or pain with urination, but is unable to cooperate with the Mini-Cog assessment. She is oriented to being in the hospital, but disoriented to date. She holds on to supports when walking the length of the room. Given this information, what is the best first step in her acute management? A. Initiate nitrofurantoinB. Initiate donepezilC. Taper lorazepamD. Initiate clonidineE. Initiate sertraline

taper lorazepam

derailment

the gradual or sudden deviation from a train of thought without blocking, sometimes used synonymously with loosened associations

agnosia

the inability to recognize a sensory stimulus; this can be in the form of an object, person, sound or shape.

A 65-year-old man with a history of hypertension, diabetes, and coronary heart disease is admitted for coronary artery bypass grafting. Post-operatively he is depressed and psychiatry is called. The QTC interval is prolonged greater than 500 ms, and the psychiatric consultant defers starting an antidepressant at the present time. Several weeks later at outpatient follow-up, the patient remains significantly depressed and a diagnosis of major depressive disorder (MDD) is made. Which of the following medications is least likely to prolong the patient's QTC further? A. CitalopramB. EscitalopramC. AmitriptylineD. BupropionE. Olanzapine

Bupropion

A 39-year-old soldier has been referred for a psychiatric evaluation of the symptoms of posttraumatic stress disorder (PTSD) after he returned from a one-year tour of duty in Iraq. During this tour, he was frequently involved in combat situations and also witnessed several of his friends getting injured in a bomb blast. Which of the following statements describes the risk factors that may be associated with the development of this disorder? A. Prior mental disorders are not a risk factor for the development of PTSDB. A debilitating medical condition is always considered to be a traumatic event that can lead to the development of PTSDC. Anaphylactic shock may qualify as a traumatic event that can lead to the development of PTSDD. The severity of the trauma is not associated with the likelihood of developing PTSDE. Higher education increases the risk for the development of PTSD after experiencing a traumatic event

. Anaphylactic shock may qualify as a traumatic event that can lead to the development of PTSD

Medical complications of anorexia nervosa -purging type- include which one of the following concerns? A. HyperkalemiaB. Cardiac arrhythmiasC. HyperchloremiaD. LeukocytosisE. Decreased serum bicarbonate levels

. Cardiac arrhythmias

A 45-year-old woman presented to the clinic with complaints of lower back pain that started suddenly about 6 months back at the gym. The pain started in the lower back initially, but now her neck muscles feel tense and tight. She is a pathologist and has an increased workload for the past few months. The pain is affecting her work, and she attributes her pain to her misery. On further inquiry, she got divorced 6 months ago and has struggled with a low mood, disturbed sleep, and a decreased appetite. She uses hallucinogens about 2 times per week. Her lab reports show no abnormality and no abnormality in the radiological investigations. What is the best treatment option for this patient? A. DuloxetineB. Amphetamine-derivativesC. PsychotherapyD. AlprazolamE. Nerve blocks

. Duloxetine

A 20-year-old woman comes to the clinic after a fainting spell. She mentions that she had been stuck in a crowd at the mall for 15 minutes. She became dizzy and nauseated and eventually fainted. She reports experiencing similar symptoms whenever she goes into an elevator or is stuck in crowds. She feels like she cannot breathe whenever she is in a small space and tends to avoid using elevators or being around crowds. Upon inquiry, she mentions that she is not scared of open spaces or public transport. What is the best treatment for this patient?

. Exposure therapy and reducing safety behaviors

What is the underlying etiology that causes the development of narcissistic personality disorder? A. Impaired empathic functioningB. Impaired emotional attachmentC. Impaired self-worthD. Impaired understanding of dangerE. Impaired understanding of social norms

. Impaired empathic functioning

Which is the Erikson's stage in which the goal is the mastery of skills? A. Trust vs. MistrustB. Autonomy vs. Shame and DoubtC. Initiative vs. GuiltD. Industry vs. InferiorityE. Identity vs. Role Confusion

. Industry vs. Inferiority

A 55-year-old man is brought to the clinic by his wife who complains of his addiction to pain medication. She has caught him several times trying to illegally buy oxycodone. He claims that only oxycodone can relieve his chronic back pain. What can be done to detoxify the patient? A. Keep the patient under observation and cut off all pain medicationB. Keep patient under observation and give buprenorphineC. Keep patient under observation and give disulfiramD. Administer clonidine in out-patientE. Administer naltrexone in out-patient

. Keep patient under observation and give buprenorphine

A 22-year-old woman presents to the clinic with complaints which began 10 days ago of low mood, feeling of hopelessness, and reduced pleasure in things she loved doing. She has not slept well during this time and has been eating more than usual. She has been unable to focus on her studies and has an exam coming up. She has had no such episode in the past and she is unable to identify any major stress that might have triggered her symptoms. Physical examination was unremarkable and lab results were within normal limits. What is the most likely diagnosis? A. Major depressive disorderB. Other Specified Depressive Disorder- Recurrent brief depressionC. Other Specified Depressive Disorder- Depressive episode with insufficient symptomsD. Other Specified Depressive Disorder- Short duration depressive episodeE. Persistent depressive disorder

. Other Specified Depressive Disorder- Short duration depressive episode

A diffuse dorsal root ganglionopathy is commonly due to which one of the following causes? A. B12 deficiencyB. Diabetes mellitusC. Primary systemic amyloidosisD. Sjögren's syndromeE. Tangier's disease

. Sjögren's syndrome

Which of the following hypnotic medications is FDA-approved for sleep onset (or sleep initiation) insomnia only? A. DoxepinB. EstazolamC. EszopicloneD. SuvorexantE. Zaleplon

. Zaleplon

dose of bromocriptine and max dose

2.5mg twice daily, to a maximum dose of 45 mg per day

Which one of the following age ranges best represents the peak onset of schizophrenia in women? A. 15 to 25 years of ageB. 20 to 25 years of ageC. 25 to 35 years of ageD. 35 to 45 years of ageE. 45 to 60 years of age

25 to 35

primary metabolites of dopamine that may be useful in identifying the levels of dopaminergic activity

3,4-Dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA)

The 12-month prevalence of alcohol dependence is ________% and the lifetime prevalence of alcohol dependence is _________%

3.8 and 12.5

A 26-year-old woman is being evaluated for depression after a referral from her physician. She is a new mother with a 4-month-old boy. She complains of feeling down for the past few weeks. The diagnosis of major depressive disorder with postpartum onset will be correct if the start of her symptoms is within what time of delivery? A. 2 weeksB. 4 weeksC. 6 weeksD. 8 weeksE. 10 weeks

4 weeks

A 34-year-old woman presents to the clinic for a follow-up visit. She was diagnosed with schizophrenia 3 weeks ago when she was brought into the emergency department with acute psychosis. She was stabilized using haloperidol and lorazepam and was discharged with a prescription for haloperidol. The patient says that she feels slightly better but is still experiencing auditory hallucinations. How many weeks since starting the current regimen should the patient continue before alteration? A. 2 weeksB. 4 weeksC. 8 weeksD. 10 weeksE. 12 weeks

4 weeks

A severity of "mild" is used when the patient meets ________ (out of the nine criteria), while a "moderate" severity is used when the patient fulfills __________ criteria. A severity of "severe" is used when the patient fulfills ________ criteria.

4-5, 6-7, 8-9

Binge drinking is defined as consumption of alcohol within 2 hours of _____or more drinks for women and ____ or more drinks for men.

4/5

Hospitalization is also recommended for bradycardia < _____ beats per minute.

40

Diagnosis of migraine without aura requires:

5 attacks fulfilling criteria; headache attacks lasting 4 to 72 hours; headache has at least 2 characteristics from among: unilateral location, pulsating activity, moderate or severe pain intensity, aggravation, and causing avoidance of routine physical activity; and during the headache, at least 1 symptom of nausea and/or vomiting, photophobia, and phonophobia must be present.

Among adults in the United States, about how many times greater is the prevalence of bulimina nervosa among women compared to men? A. 2-foldB. 10-foldC. 5-foldD. 15-foldE. 20-fold

5-fold

For the diagnosis of generalized anxiety disorder (GAD), symptoms of the disorder must be present for what length of time? A. 1 monthB. 3 monthsC. 6 monthsD. 1 yearE. 2 years

6 months

Symptoms must be present for how long to diagnose a social anxiety disorder (social phobia) or a specific phobia? A. 1 monthB. 3 monthsC. 6 monthsD. 1 yearE. 2 years

6 months

The concerned parents of an infant bring their child in for an appointment. There is a family history of developmental delay, and they are concerned their child has not reached certain milestones. At what age should an infant be able to sit up on his/her own? A. 2 monthsB. 4 monthsC. 6 monthsD. 10 monthsE. 16 months

6 months

After remission from a single major depressive episode, antidepressant medication should be continued for a minimum of what length of time? A. 1 month at the same doseB. 3 months at the same doseC. 6 months at the same doseD. 1 year at 50% of the doseE. 2 years at the same dose

6 months at the same dose

The American Medical Association's Alcohol Consumption Guidelines state that women should limit their weekly alcohol consumption to fewer than how many drinks? A. 7 drinksB. 14 drinksC. 21 drinksD. 28 drinksE. 35 drinks

7 drinks

Insomnia that has an underlying psychiatric illness should not be treated with a benzodiazepine for more than ___________.

7-10 days

In patients with major depressive disorder, a decrease in the level of serotonin is implicated as the likely pathophysiology. Which of the following can be measured to estimate the levels of serotonin? A. 5-hydroxyindoleacetic acid (5-HIAA)B. Homovanillic acid (HVA)C. Vanillylmandelic acid (VMA)D. 3,4-Dihydroxyphenylacetic acid (DOPAC)E. Succinic semialdehyde

A. 5-hydroxyindoleacetic acid (5-HIAA)

A 35-year-old woman is brought to the emergency department in an altered mental state for the past one hour. She was found sleeping in her bed with an empty bottle of sleep medicine on her side table. She is not responsive to voice. She withdraws her extremities when a painful stimulus is applied. On physical examination, her pulse is 61/min, her temperature is 98.6°F (37°C), and her blood pressure is 119/76 mmHg. Her respiratory rate is 5/min, and her breathing is shallow. Her pupils are normal and reactive to light and accommodation. Her deep tendon reflexes are 1+ bilaterally. Her ECG shows no abnormalities. Which of the following is the appropriate next step in the management of this patient? A. Administer flumazenilB. Administer naloxoneC. Administer epinephrineD. Administer atropineE. Administer albuterol

A. Administer flumazenil

A 65-year-old man comes to the clinic complaining of having experienced a possible heart attack. He mentions that last night he had chest pain, palpitations, and couldn't breathe. Furthermore, he had been feeling agitated and nervous constantly for the past few days. Upon further inquiry, he mentioned that he has run out of his "sleep medication" a few days back and had forgotten to get more. He cannot remember the name, but it was prescribed to him by his family physician six months prior to help with his insomnia. His ECG is normal, and echocardiogram showed no abnormalities. What medication had he been prescribed? A. AlprazolamB. FluoxetineC. EscitalopramD. AmitriptylineE. Venlafaxine

A. Alprazolam

A 70 year old patient with HLD and CAD having painless transient monocular visual loss lasting seconds in one eye is most likely to have: A. An embolus from a cardiac sourceB. Optic neuritisC. Increased intracranial pressureD. MigraineE. Spontaneous anterior chamber hyphema

A. An embolus from a cardiac source

Psychotherapeutic approaches to generalized anxiety disorder would most likely include which of the following? A. Breathing retrainingB. Dialectical behavior therapyC. Schema therapyD. Mentalization trainingE. Applied behavior analysis

A. Breathing retraining

You are requested to evaluate a 23-year-old man who was brought to the emergency department by the police due to his bizarre behaviors in the parking lot. His urine drug screen is positive for amphetamine and negative for other substances. The patient vehemently denies use of any recreational drugs. The patient reports being prescribed one of the following medications which can result in false-positive results for amphetamine and methamphetamine. Which is the most likely medication? A. BupropionB. ClomipramineC. CitalopramD. SertralineE. Venlafaxine

A. Bupropion

Injuries to which one of the following areas of the spinal cord would be most likely implicated in abnormal sweating, trouble maintaining normal body temperature, and blood pressure problems? A. Cervical and high thoracicB. Middle to low thoracicC. Low thoracic and upper lumbarD. LumbarE. Sacral

A. Cervical and high thoracic

Ms. A is a 32-year-old Hispanic woman with her only symptom being a 2-year history of believing that a former employer from 10 years ago is tapping her cell phone. The most likely diagnosis is which of the following? A. Delusional disorderB. SchizophreniaC. Brief psychotic disorderD. Major depressive disorder with psychotic featuresE. Stimulant-induced psychotic disorder

A. Delusional disorder

A 20-year-old man presents to the emergency department with bleeding from the nose. After initial treatment, he tells the doctor he has had bleeding from the nose many times before as well. When the patient was asked about substance use, he said he has been sniffing paint thinners for the last 9 months. He works for a construction company, where he has unlimited access to the cans of paint thinners. He wants to stop sniffing as it has been affecting his work due to a constant headache and stomach pain. Which of the following drugs should be avoided in this patient to decrease the incidence of sudden sniffing death syndrome? A. EpinephrineB. GabapentinC. AspirinD. NaproxenE. Valproic acid

A. Epinephrine

In patients with obsessive compulsive disorder, there is a link between the development of OCD and which of the following infection causing microorganism? A. Group A beta-hemolytic streptococcusB. Corynebacterium diphtheriaC. Haemophilus influenzaD. Mycoplasma pneumoniaeE. Bordetella pertussis

A. Group A beta-hemolytic streptococcus

A 14-year-old boy is brought to the clinic by his mother who is concerned about his health. His mother says that the patient has been sniffing super-glue for the past four months. He has been caught stealing super-glue from the store one time, and frequently steals them from the school. He has been irritable and is locked up in his room most of the time. His school performance has decreased over the past few months. The patient says that he wants to stop sniffing but has been unable to stop the urge. He complains of headaches and runny nose. He denies using any other drugs. Which of the following substance will be positive in urinalysis of this patient? A. Hippuric acidB. OxazepamC. 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acidD. AmphetamineE. Benzoylecgonine

A. Hippuric acid he patient uses glue for inhalation, which contains toluene as the volatile substance. 95% of the inhaled toluene is metabolized in the liver to benzyl alcohol, and benzoic acid followed by conjugation with glycine to form hippuric acid, which is excreted in the urine

A 40-year-old man presents to the psychiatry clinic with symptoms of PTSD and a mood disorder. The patient is responding poorly to treatment so there is a desire to refine his diagnosis. He is referred for further psychological assessment. Which of the following instruments will be helpful in diagnosing the patient? A. Minnesota Multiphasic Personality InventoryB. General Health QuestionnaireC. Brief Psychiatric Rating ScaleD. Adaptive Behavior ScalesE. CAGE Questionnaire

A. Minnesota Multiphasic Personality Inventory

A 30-year-old man presents to the clinic with complains of low mood, feeling of hopelessness, and reduced pleasure in socializing for the past week. He has not slept well in this duration and has been eating more than usual. He has been unable to keep up with his job and has been skipping days frequently. He does not have the energy to get out of bed. He explains that he has been experiencing this every month for the past one and a half year with a little variability in symptoms. Systemic examination was unremarkable. What is most likely diagnosis? A. Other Specified Depressive Disorder-Recurrent brief depressionB. Major depressive episodeC. Other Specified Depressive Disorder-Depressive episode with insufficient symptomsD. Persistent depressive disorderE. Other Specified Depressive Disorder -Short duration depressive episode

A. Other Specified Depressive Disorder-Recurrent brief depression

A 15-year-old boy is brought to the hospital by his parents after finding a rag soaked in kerosene oil in his room. He spends most of the time locked in his room, and dropped out of school 2 years ago. He has attempted suicide twice. Which of the following is one of the diagnostic criteria of inhalant use disorder? A. There is a persistent desire to cut down the use of an inhalant substance.B. Inhalant substances are easily available, little time is spent obtaining an inhalant substance.C. Inhalant substances are only used in situations when it is physically safe.D. Use of inhalant substances is discontinued when knowledge of exacerbation of psychological symptoms due to inhalant use is obtained.E. The inhalant substance is taken in small amounts and over a longer period than intended.

A. There is a persistent desire to cut down the use of an inhalant substance.

The doctrine of informed consent with regard to medical care calls for which one of the following considerations? A. Whether the patient has demonstrated an understanding about a treatment's associated risksB. Whether the patient has an acute mental disorderC. Whether the patient will comply with treatment recommendationsD. Whether the patient has been advised to seek a second opinionE. Whether the patient makes a decision that agrees with the physician's recommendation

A. Whether the patient has demonstrated an understanding about a treatment's associated risks

A 42-year-old man presents with alcohol use disorder presents for a follow up. He reports he has been sober and has tested negative for alcohol use the past 10 months. On this visit, he still reports alcohol craving. According to the DSM-5, what is the patient's diagnosis? A. Alcohol use disorder, in early remissionB. Alcohol use disorder, in sustained remissionC. Mild alcohol use disorderD. Alcohol use disorder, unspecifiedE. Mild alcohol use disorder, in sustained remission

Alcohol use disorder, in early remission

A 35-year-old man presents to the emergency department with the complaint of rigidity and tremors. He has a known history of schizophrenia and has been taking typical antipsychotics for 6 months. Upon examination, he is responsive and cooperative. His movements are stiff and his muscles are rigid. The patient remains mostly immobile. Pill-rolling tremors can be noted in his hands. What is the most likely diagnosis? A. CatatoniaB. Antipsychotic-induced parkinsonismC. Neuroleptic malignant syndromeD. Locked-in syndromeE. Stiff person syndrome

Antipsychotic-induced parkinsonism

A 20-year-old woman is brought to the emergency department by her parents who found her in an unconscious state with an empty rat poison bottle and a suicide note by her side . They report that for the last 2 weeks, she had been extremely sad and experienced frequent crying spells. She also has markedly disturbed sleep and anorexia. She has stopped spending time with friends and family, preferring to be left alone. After initial resuscitation and involvement of the psychiatric department, what is the next best step in the management of this patient? A. Prescribe antidepressants and discharge herB. Admit her to the psychiatric facility for further treatment and monitoringC. Give intramuscular zuclopenthixol and discharge herD. Refer her for cognitive behavioral therapy (CBT)E. Observe for 24 hours and discharge with a follow-up plan after 2 weeks

B. Admit her to the psychiatric facility for further treatment and monitoring

Which of the following part of the limbic system is involved in anxiety? A. Cingulate gyrusB. AmygdalaC. HippocampusD. HypothalamusE. Basal ganglia

B. Amygdala

A 61-year-old man is brought to the emergency room. He is new to San Francisco, having traveled from his home to buy a large quantity of Buddha statues for unclear reasons. He stored the statues in his small hotel room. This caused such congestion that the room could not be cleaned; the hotel management requested he remove the statues or vacate the premises. The patient became extremely agitated and accused the hotel manager of conspiring to kill his family. On exam, the patient is distraught; he hasn't slept for several days. He is very concerned about his family in Denver, who he believes have become a target of a large terrorist organization. He heard the news anchors talk to him directly about this threat. He denies any drug use, and his urinary toxicology screen is negative. His physical exam is within normal limits. His wife and son are relieved to hear that the patient has been located. They suspected that he hasn't been taking his long-term medications as prescribed, and started to call the hospitals and the morgues in their area after his disappearance, fearing the worst. They mention that he's been "obsessively" purchasing Buddha statues, for protection. His house was "overflowing" with objects of religious significance. What would be the best treatment for the patient, once he is acutely stabilized? A. Habit Reversal TrainingB. Depot antipsychotic medicationC. SSRI antidepressantD. Support group for hoarding behaviorsE. Lamotrigine

B. Depot antipsychotic medication

A previously healthy 27-year-old woman presents to the clinic because of a 2-month history of depressed mood and fatigue. During this time, she has had a 5 kg (11 lbs.) weight gain. She reports trouble concentrating on her job as a preschool teacher and has missed work several times in recent weeks due to generalized fatigue. She has smoked a pack of cigarettes a day for the past 10 years and is actively trying to quit smoking. A drug is prescribed that will treat the patient's mood disturbance and support smoking cessation. The patient should be counseled about which of the following possible side-effects of this drug? A. QTc prolongationB. DizzinessC. Weight gainD. Decreased libidoE. Orthostatic Hypotension

B. Dizziness

Which one of the following statements best describes the role of gonadotropin-releasing hormone (GnRH) in the treatment of adolescents with gender dysphoria? A. GnRH has no role in the treatment of this disorderB. GnRH delays the onset of puberty, allowing an adolescent time to explore gender-related issuesC. GnRH stops brain maturation and allows gender reassignment psychotherapy to take placeD. GnRH prepares the body for hormone therapy to allow the adolescent to transition to the opposite gender more easilyE. GnRH disrupts the hormonal process that causes gender dysphoria

B. GnRH delays the onset of puberty, allowing an adolescent time to explore gender-related issues

A 23-year-old woman admits herself to an inpatient rehabilitation center. She says that she shared needles while injecting heroin with a couple of friends. Considering that the patient has been sharing needles, which important sexually transmitted infections (STIs) should you screen for this patient? A. HIV and gonorrheaB. HIV and hepatitis BC. Hepatitis B and gonorrheaD. Hepatitis B and chlamydiaE. Chlamydia and gonorrhea

B. HIV and hepatitis B

An 88-year-old man is admitted to the inpatient oncology unit for dehydration and pain management. He has a history of a non-localized tumor metastasized to liver and brain. Primary team offered a psychiatric evaluation and patient agreed. Patient is alert and coherent. As per neurology resident, patient has mild attention deficits and preserved short-term memory. He denies presence of hallucinations and has not had seizures. Neurology team started him on levetiracetam for seizure prophylaxis. Patient has told the chaplain that he understands "this is the end." Though he does not want to die, he accepts his condition and reports some regrets about things he could have done better in his life. Team tells you that he is planned to be discharged to hospice today or tomorrow. What would be the most appropriate care for this patient? A. Refuse to see this patient as it is not acceptable to initially evaluate a patient shortly before dischargeB. In your evaluation, review patient's regrets in an attempt to correct or reframe cognitive distortionsC. After your evaluation consider starting him on an SSRID. Call the neurology team to see if they can discontinue levetiracetamE. Compliment the patient for transitioning successfully from the depression to the acceptance stage of the death and dying process

B. In your evaluation, review patient's regrets in an attempt to correct or reframe cognitive distortions

Which of the following is a measure of the number of new cases of fetal alcohol syndrome (FAS) in infants during a specific period of time? A. Odds ratio of FAS in infantsB. Incidence of FAS in infantsC. Prevalence of FAS in infantsD. Relative risk of FAS in infantsE. Attributable risk of FAS in infants

B. Incidence of FAS in infants

A 20-year-old woman presents to the clinic with complaints of dyspnea, dizziness, chest pain, and palpitations along with intense anxiety. She reports a history of repeated episodes of severe anxiety and fear that reach a peak within minutes. This is affecting her professional life tremendously. She admits that she has been inhaling typewriter ink for the past three years. On examination, heart rate is 100 beats/min, and blood pressure of 140/90 mmHg is recorded. ECG and chest x-ray are normal. Which of the following is the correct diagnosis for this patient? A. Cocaine-induced depressive disorderB. Inhalant-induced anxiety disorderC. Mild neurocognitive disorderD. Brief Psychotic disorderE. Substance/Medication induced Psychotic Disorder

B. Inhalant-induced anxiety disorder

A 23-year-old man presents with diarrhea for 2 days. He brings with him a meticulously made hourly schedule, with detailed explanations of his daily activity to help the physician pinpoint the cause of his diarrhea. His bag seems to be filled with a lot of useless junk which the patient claims will most likely be useful in the future, so he never throws it away. When probed about his detail-oriented behavior, he mentions that he is meticulous about everything he does and has been a perfectionist since early adulthood. He admits that this can often get in the way of completing a certain task, but he still prefers to do things perfectly. What is the most likely diagnosis? A. Obsessive-compulsive disorderB. Obsessive-compulsive personality disorderC. Hoarding disorderD. Generalized anxiety disorderE. Illness anxiety disorder

B. Obsessive-compulsive personality disorder

A 17-year-old girl has been diagnosed with premenstrual dysphoric disorder. She has a two-year history of cyclical mood changes that start just before her menses, and persist during the menstrual period. A few days before her menses, she becomes extremely irritable and anxious. She has difficulty sleeping and has an increase in appetite. The symptoms disappear a couple of days after the menses begin. Which of the following statements best describes the features associated with this disorder? A. Most women with premenstrual dysphoric disorder show a significant increase in weight in the premenstrual period.B. Signs of peripheral edema are commonly seen in most women with premenstrual dysphoric disorder.C. Cravings for sweet and salty foods are commonly reported by women with premenstrual dysphoric disorder in the premenstrual period.D. Premenstrual breast pain in women in premenstrual dysphoric disorder is associated with methylxanthine intake.E. Delusions are commonly seen in the late luteal phase of the menstrual cycle in women with premenstrual dysphoric disorder.

C. Cravings for sweet and salty foods are commonly reported by women with premenstrual dysphoric disorder in the premenstrual period.

A 21-year-old woman presents to the clinic with complaints of intense fear and avoidance of social situations. She is diagnosed with social anxiety disorder. Which of the following is a risk factor of this disorder? A. Parent with schizophreniaB. Parent with bipolar disorderC. Parent with an anxiety disorderD. Childhood road traffic accidentE. Getting lost as a child

C. Parent with an anxiety disorder

The predominant endocannabinoid receptors in the brain

CBR1 (cannabinoid receptor 1), with the presence of CBR2 (cannabinoid receptor 2) in parts of cerebellum and brainstem, but their overall abundance is in the gastrointestinal tract and the immune system.

A 25-year-old man presents to the clinician complaining of palpitations, sweating, and flushing, ever since his promotion to a manager in a large software company about 6 months ago. He says he has had several episodes of these symptoms and they only occur whenever he has to give presentations in front of a large group of people. During these episodes his heart starts racing, he fears that his face will "turn red" and everyone will laugh at him. He thought of avoiding the presentations, but he fears that he may lose his job if he tries to do so. He denies anxiety or persistent worries during other times. The patient has history of mild-persistent asthma and recalls a doctor telling him that he has a slow heart rate. He does not consume alcohol. His only medication is an albuterol inhaler. He is concern about any potential sexual side effects of new medications. Vitals are pulse 55/min, respiratory rate 15/min, and blood pressure 120/80 mmHg. The physical examination is unremarkable. Mental status examination shows the patient to be worried. Which of the given is the next best step? A. Cognitive behavioral therapy (CBT)B. DuloxetineC. OlanzapineD. PropranololE. Escitalopram

CBT

A 27-year-old man diagnosed with panic disorder has been on benzodiazepine monotherapy for the past 2 years. He wants to discontinue medication as he feels much better now. Which of the following psychotherapies can be helpful in the discontinuation of medication in this patient? A. Cognitive behavioral therapy B. Eye movement desensitization and reprocessing C. Panic-focused psychodynamic psychotherapy D. Interpersonal psychotherapy E. Supportive psychotherapy

CBT

A 65-year-old man with a history of major depressive disorder currently treated with sertraline 100 mg daily and aripiprazole 10 mg daily was admitted to the hospital for an elective cholecystectomy. Three days after the surgery, he reports seeing aliens in his room and begins to pull out his intravenous lines. He is noted to be tachycardic, hypertensive, diaphoretic and tremulous. The next best step in the psychiatric management of this patient would be which of the following? A. Increase sertraline doseB. Decrease aripiprazole doseC. Start clorazepate q 1 hour until asleepD. Start hydroxyzine 3 times dailyE. Change nothing. A thorough medical workup needs to be obtained before psychiatric management can be initiated

Change nothing. A thorough medical workup needs to be obtained before psychiatric management can be initiated

_________________ can reduce the absorption of valproic acid from the intestine.

Cholestyramine

Sleep Phase Chronotherapy is form of behavioral treatment that is indicated for treatment of which of the following sleep-wake disorders? A. Insomnia disorderB. Hypersomnolence disorderC. NarcolepsyD. Circadian rhythm sleep wake disorder, delayed sleep phase typeE. Circadian rhythm sleep wake disorder, irregular phase type

Circadian rhythm sleep wake disorder, delayed sleep phase type

A 26-year-old woman who has had her recurrent major depressive disorder stably controlled with paroxetine for a number of years consults with the psychiatrist about the advisability of continuing it as she is planning to get pregnant. Based upon this information, which of the following statements about the use of paroxetine during pregnancy is most reasonable for the psychiatrist to offer as a reply? A. Stop the paroxetine before becoming pregnantB. Stay on paroxetine throughout pregnancy since the risk of relapse of major depressive disorder is heightened in pregnancyC. Consider alternative treatments and carefully weigh the risks and benefits of paroxetine in pregnancy before becoming pregnantD. Stay on paroxetine during the first trimester and then stop it as the risk of it causing a congenital malformation is highest in the second and third trimesters

Consider alternative treatments and carefully weigh the risks and benefits of paroxetine in pregnancy before becoming pregnant

A 16-year-old girl is brought to the clinic by her mother due to worsening symptoms of Crohn's disease. Upon inquiry, she mentions that she has not been adhering to the medication and lifestyle changes prescribed to her by the doctor. She further mentions that she feels agitated and constantly worried around the time that her symptoms from Crohn's disease worsen for the past two months. Her sleep is affected because of the worrying, and she's tired all the time. She constantly worries that she will always be in bad health and will always be in pain and will never be able to fully pursue her dreams because of her health. What is the best treatment for this patient? A. Counsel patient to be compliant with her medication and lifestyle changesB. Prescribe SSRIs for anxietyC. Prescribe benzodiazepines for sleepD. Continue medication and lifestyle changes for Crohn's disease along with CBTE. Prescribe stronger painkillers

Continue medication and lifestyle changes for Crohn's disease along with CBT

A 27-year-old man comes to the clinic for a follow-up exam. Paroxetine therapy was initiated 6 weeks ago for a major depressive episode. He now feels much better and says he is delighted with his newfound energy. He gets around 8 hours of sleep nightly. His appetite is increased. Last year, he had 3 episodes of depressed mood, insomnia, and low energy during which he had to stop his job training and also stopped going to the gym. Now, he has been able to resume his job at a local bank. He also goes to the gym 3 times a week to work out and enjoys reading books again. His temperature is 36.5°C (97.7°F), pulse is 70/min, blood pressure is 128/70 mmHg, physical and neurologic examination shows no abnormalities. On mental status examination, he describes his mood as "good." Which of the following is the most appropriate next step in management? A. Switch from paroxetine to cognitive behavioral therapyB. Continue paroxetine therapy for 2 yearsC. Continue paroxetine therapy for 6 monthsD. Taper paroxetine over 2 monthsE. Add lithium to the current regimen

Continue paroxetine therapy for 2 years

A 32-year-old man presents to the clinic because of a 2-month history of difficulty sleeping and worsening fatigue. During this time, he has also had difficulty concentrating and remembering tasks at work as well as diminished interest in his hobbies. He has no suicidal or homicidal ideation. He does not have auditory or visual hallucinations. Vital signs are normal. Physical examination shows no abnormalities. Mental status examination shows a depressed mood and flat affect with slowed thinking and speech. The clinician prescribes sertraline. Three weeks later, the patient comes to the clinic with only minor improvements in his symptoms. Which of the following is the most appropriate next step in management? A. Increase dose frequency of sertralineB. Continue sertraline for 3 more weeksC. Change medication to fluoxetineD. Change medication to duloxetineE. Change medication to bupropion

Continue sertraline for 3 more weeks

A 79-year-old man presents to the clinic for follow-up of his Alzheimer's disease. The patient was diagnosed with late-onset Alzheimer's disease with mild neurocognitive impairment two months back. He was started on oral rivastigmine and memantine combination, along with advice to make social and dietary adjustments. The patient seems to be doing better, with decreased irritability and proper sleep. His memory remains impaired, and he is still inattentive and confused most of the time. It is reported that ever since patient began treatment, he's been nauseous with one to two episodes of vomiting in a week and on and off diarrhea. The patient expresses resistance in compliance to medication. What is the most appropriate management for the patient's gastrointestinal symptoms? A. Stop rivastigmine and increase the dose of memantineB. Decrease dose of both rivastigmine and memantineC. Initiate daily metronidazoleD. Convert rivastigmine administration to transdermal patchE. Replace rivastigmine with donepezil

Convert rivastigmine administration to transdermal patch

A psychiatric consult is called for a 71-year-old man, with a known case of chronic kidney disease, who was operated on for total knee arthroplasty and under regional anesthesia. He was shifted to the intensive care unit post-operatively when the patient developed hemodynamic deterioration due to impairment of renal function. Now, 24-hours post-operatively, the patient is awake but drowsy and is unable to react to commands or speak. He is hypoactive delirious as detected by CAM-ICU (confusion assessment method for the ICU). The RASS score is -2. There is no evidence of a hallucinatory or anxious component. A similar episode in the past is denied by the patient's family. What is the first step treatment option for delirium in this patient? A. First generation antipsychotics (FGAs)B. Second generation antipsychotics (SGAs)C. BenzodiazepinesD. Adequate hydration and correction of electrolyte disturbanceE. Dialysis

D. Adequate hydration and correction of electrolyte disturbance

The parents of a 9-year-old girl in a special education program are in a meeting with school staff to discuss the different options available for their child's education. They recently found out about the Individualized Family Service Plan, and want to know more details about the plan. Which of the following differentiates Individualized Family Service Plan (IFSP) from an Individualized Education Plan (IEP)? A. The focus is on the child's needs to achieve academic success in an educational setting.B. The goal is to give the child the ability to adapt to and progress in an educational setting.C. The family contacts the special education department's designee for coordination.D. An IFSP only applies to children from birth to three years of age.E. The goals and outcomes are focused on the child only.

D. An IFSP only applies to children from birth to three years of age.

A 79-year-old woman with a major neurocognitive disorder due to Alzheimer's Disease presents for follow-up brought in by her daughter. Her daughter states that the patient has been waking up abruptly at night in between very loud snores. Medical history is remarkable for hypertension, osteoarthritis, nephrolithiasis, a myocardial infarction (MI) 5 years ago, and diabetes mellitus type 2 all of which have been under good control since her MI by serial routine laboratories and physical exam findings. The daughter denies that the patient exhibits symptoms of wincing or avoidance of movements. The patient's urinalysis (UA) is within normal limits and the patient is afebrile. Which among the patient's conditions would correlate most with the severity of her major neurocognitive disorder? A. HypertensionB. OsteoarthritisC. Diabetes mellitus type 2D. Breathing-related sleep disorderE. Nephrolithiasis

D. Breathing-related sleep disorder

A 71-year-old woman with life-long epilepsy is hospitalized with sadness, anhedonia, hypersomnia, feelings of worthlessness, loss of appetite, and ruminative suicidal ideation. She believes she has wronged her family and that she deserves to die. Her husband and children cannot understand why she feels this way, as she has always been a "wonderful mother and wife." She has been intermittently nonadherent with carbamazepine, her only medication, and as a result experienced a generalized tonic-clonic seizure two days ago. Her medical workup is within normal limits and she has received a loading dose of phenytoin. What is the best way to achieve rapid resolution of her psychiatric symptoms? A. Start MirtazapineB. Start BupropionC. Start LamotrigineD. Maintain on the lowest effective dose of phenytoin and initiate ECTE. Discontinue phenytoin and initiate ECT

D. Maintain on the lowest effective dose of phenytoin and initiate ECT

A 40-year-old man presents to the clinic with the complaint of an increased need for sleep and an increased appetite for the last 4 weeks. He reports that because he has been eating more, his weight has increased by 20 pounds. He also endorses feeling low, profound weakness, and a strong sensitivity to social rejection. He is otherwise a healthy person with no medical conditions in the past. He has a 15-pack-year smoking history, but he gave up smoking last year. He has a past history of a major depressive episode as a teenager but this resolved with pharmacologic treatment and he has been doing well since then. Which of the following is the most likely diagnosis? A. Major depressive disorder with melancholic featuresB. Major depressive disorder with seasonal patternC. Major depressive disorder with catatonic featuresD. Major depressive disorder with atypical featuresE. Major depressive disorder with psychotic features

D. Major depressive disorder with atypical features

A 16-year-old girl states that she has always had a hard time paying attention in school and frequently daydreams. She admits to occasional use of marijuana. She is started on atomoxetine, and the dose is titrated to 40 mg daily. She reports no side effects to it. Four weeks later, however, she presents with dizziness, sedation, dry mouth, and an increased heart rate. She explains that her OB/GYN started her on "some depression pill" to treat her premenstrual syndrome. Which one of the following is the likely cause of her symptoms? A. Patient is now using other drugs of abuseB. Patient is not taking her atomoxetineC. Patient is not accurately reporting her symptomsD. Patient is taking a medication that is increasing the levels of atomoxetineE. Patient is having thyroid problems

D. Patient is taking a medication that is increasing the levels of atomoxetine

A 43-year-old woman presents with abrupt, increasing weight loss for about a week. Her husband claims that she is spending 6-8 hours in the gym per day and is incurring absences in her workplace due to this preoccupation. Medical history is remarkable for bipolar I disorder and mitral regurgitation. She mentions the she has stopped taking her lithium almost three weeks ago, as advised by her cardiologist. Which of the following is the best next step? A. Call her cardiologist and verify his or her discontinuation of lithiumB. Restart her on regular-release formulation lithium 300 mg three times a dayC. Start her on oral carbamazepine aiming for a blood level of 4 μg/mLD. Start her on oral divalproex sodium 15 mg/kgE. Start her on oral clonazepam 0.25 mg twice daily

D. Start her on oral divalproex sodium 15 mg/kg

A 55-year-old man with bipolar I disorder, requiring long-term lithium therapy, is brought to the physician's office for a follow up by his wife. She reports that her husband has been using the bathroom constantly at night and drinking around 20 glasses of water per day. Review of systems is positive for occasional headaches. He denies psychotic or depressive symptoms, as well as alcohol and drug use. He has never had an episode similar to this. On physical examination, his blood pressure was 115/60 mmHg, his heart rate was 72 beats per minute, and his temperature was 36.8°C. Initial laboratory results are shown:Serum:Glucose 95 mg/dLCreatinine 1.1 mg/dLBlood urea nitrogen (BUN) 27 mg/dLNa+ 145 mEq/LK+ 3.5 mEq/LCl— 100 mEq/LOsmolality of 310 mOsm/kgUrine:Color- ClearGlucose- NegativeProteins- NegativeKetones- NegativeOsmolality- 101 mOsm/kgUrinary specific gravity- 1.004The urine osmolality did not increase during a water restriction challenge and desmopressin administration. Which of the following is the most likely underlying etiology for this patient's symptoms? A. Injury to the neurohypophysial systemB. Decrease V1 receptors on the distal convoluted tubule cell's surfaceC. GlomerulosclerosisD. Renal tubulointerstitial fibrosisE. Decrease channel aquaporin-2 on the collecting duct cell's surface

Decrease channel aquaporin-2 on the collecting duct cell's surface

A 30-year-old man presents to the clinician complaining of recurrent episodes of palpitations, chest pain, shortness of breath, sweating, and dizziness for the past 8 months. He says that he feels like he will lose control over himself during these episodes. Most of these episodes have occurred during a situation where it is unacceptable for him to leave, such as during team meetings. His last episode occurred at home when he noticed he was running late. He has been otherwise healthy. He occasionally drinks a beer or a glass of wine. Vital signs are normal. Cardiopulmonary exam shows no abnormalities. Thyroid function studies and an electrocardiogram show no abnormalities. Given his symptoms, which of the given is this patient at greatest risk of developing? A. Preoccupation with an observed flaw on physical appearanceB. Abnormally elevated mood and flight of ideasC. Inability to recall autobiographical informationD. Intrusive thoughts and irresistible impulsesE. Depressed mood and feeling of guilt

Depressed mood and feeling of guilt

Deutetrabenazine

Deutetrabenazine is a novel vesicular monoamine transporter 2 (VMAT2) inhibitor resulting in decreased uptake of monoamines (dopamine, serotonin, histamine, and norepinephrine) into synaptic vesicles and depletion of monoamine stores from nerve terminals. It is indicated for the treatment of Huntington's disease and tardive dyskinesia in adults. It differs from tetrabenazine in that the hydrogen atoms have been replaced by deuterium; whereas tetrabenazine is administered 2-3 times daily, deutetrabenazine can be administered once to twice daily.

A 30-year-old woman is referred to the psychiatry clinic for evaluation. The patient has been in a toxic relationship with a financially unstable, violent man for several years. During the interview, she tells the therapist that she wants to stay in the relationship because she has a fear of being alone to take care of herself. Before her relationship, she was dependent on her parents to take her every decision until late adulthood. Which of the following is an additional feature of this patient's most likely diagnosis? A. Difficulty in expressing disagreement with othersB. Excessive devotion to workC. Rigidity and stubbornnessD. Restraint within intimate relationshipsE. A need for excessive admiration

Difficulty in expressing disagreement with others

A 68-year-old man with a past medical history of macular degeneration, hypertension, and hypothyroidism is brought to clinic by his wife with concerns about her husband's mental status. She reports observing episodes of confusion over the last 6-9 months, with alternating days of disorientation/confusion and clarity. He reports often seeing a small girl in the red dress sitting next to him at home over the last 6 months, though his wife has never observed this. He also states that his walking has slowed down over the last year. He forgets to take his medications regularly and now needs reminders, and has been getting lost while driving. On examination, he demonstrates a shuffling gait, and slowness on movements in the upper extremities. There are no tremors. His Folstein Mini-Mental state examination score is 21/30. CT of the brain and EEG did not reveal any significant findings. Which one of the following diagnoses is the most probable? A. Charles Bonnet syndromeB. Early Alzheimer's diseaseC. Neurocognitive disorder due to Parkinson's diseaseD. Diffuse Lewy body diseaseE. Neurocognitive disorder due to frontotemporal lobar degeneration

Diffuse Lewy body disease

A 67-year-old man with stable schizophrenia, coronary artery disease, and hypertension presents to the emergency department with complaints of a racing heart, difficulty breathing, and mild chest pain. His vitals are significant for a heart rate of 112, a respiratory rate of 18, and a fever of 101.2°F. He is disoriented to time and place, and intermittently to his name. His labs--including a white blood cell count, absolute neutrophil count, urinalysis, and 2 troponin levels--are unremarkable. His chest X-ray is compromised by poor inspiratory effort and shows a possible effusion. His EKG shows only sinus tachycardia. His medication regimen includes clozapine, lisinopril, and metoprolol. Which one of the following management options is the most appropriate action? A. Discharge him home and ask him to contact his outpatient psychiatrist the next dayB. Administer acetaminophen and IV fluids, and then discharge him homeC. Administer oral levofloxacin and IV fluids, and then discharge home with a prescription for oral antibioticsD. Discontinue clozapine, repeat troponin level, consult cardiology, and admit for further cardiac monitoring to rule out a myocardial infarctionE. Discontinue clozapine, repeat troponin level, consult cardiology, and admit for further cardiac monitoring for myocarditis

Discontinue clozapine, repeat troponin level, consult cardiology, and admit for further cardiac monitoring for myocarditis

A 15-year-old boy presents to the clinic with his parents, who are anxious about his temper outbursts. He tends to be verbally and physically abusive towards inanimate objects, his parents, school friends, and even his football coach. He has many anger outbursts per week, his parents say at least 5 per week and is constantly irritable. He often apologizes for losing his temper. These symptoms have been present since age 8, but they thought he would grow out of it. He experiences difficulty at school, home, and football practice, rendering him incapable of performing his daily functions efficiently. On evaluation he was noted to be irritable, however he later apologized and was more cooperative. He has not been diagnosed with bipolar disorder and has no family history of bipolar disorder. What is the most likely diagnosis? A. Disruptive mood dysregulation disorderB. Bipolar disorderC. Oppositional defiant disorderD. Intermittent explosive disorderE. Schizophrenia

Disruptive mood dysregulation disorder

A 75-year-old patient, who has a history of postoperative delirium who will undergo coronary artery bypass surgery shortly. The most appropriate strategy to prevent postoperative delirium in this patient would be to start which of the following medications? A. LorazepamB. DonepezilC. memantineD. SertralineE. Start no new medication since pharmacologic strategies are not effective in preventing delirium

E. Start no new medication since pharmacologic strategies are not effective in preventing delirium

Following a first tonic-clonic seizure, presence of which one of the following findings would carry the highest risk for seizure recurrence? A. Transient metabolic and toxic statesB. Benign rolandic seizureC. Febrile seizure in a childD. Impact seizures in early nonsevere head traumaE. Structural brain lesions

E. Structural brain lesions

A 30-year-old man is admitted to the hospital after he overdosed on benzodiazepines last night. He has a 7-year history of major depressive disorder and has been prescribed multiple classes of different antidepressants. He has no history of mania. He has been adherent with his medications, but his symptoms have not improved. He feels depressed, finds it difficult to fall asleep, does not take an interest in any of his daily life activities, and feels guilty and fatigued. He is currently jobless. He is not motivated to support himself financially. He has not been in any romantic relationships for the past 5 years. He often inflicts cuts on his arms. He has attempted suicide twice in the past. Which of the following is the appropriate next step in the management of this patient? A. Start a trial of imipramineB. Consider electroconvulsive therapyC. Start a trial of methylphenidateD. Prescribe olanzapineE. Order serum thyroid hormone levels

ECT

A 50-year-old woman comes to you with major depression along with psychotic features. She has been declared as high risk for suicide by the crisis management team. Apart from this, she has not been eating or drinking well, to the point that she has lost weight and is severely dehydrated. She has a history of multiple failed treatments. What would be the next step in management? A. BupropionB. VenlafaxineC. Electroconvulsive therapy (ECT)D. Monoamine oxidase inhibitorsE. Mirtazapine

ECT

A 45-year-old man presents to the clinic for a follow-up visit. The patient was diagnosed with panic disorder 3 years ago and has tried cognitive behavioral therapy, paroxetine, and escitalopram but has not responded to treatment. Patient agree to try switching to imipramine. He denies being on any other medications or acute medical concerns. Further questioning reveals potentially his father died of a heart attack when he was around 30 years old. Which of the following investigation is required before switching this patient to imipramine? A. Electrocardiogram B. Echocardiography C. Complete blood count D. Lactate dehydrogenase levels E. Cardiac markers

EKG

A 20-year-old man comes to the clinic for a consult regarding his inability to quit cannabis after multiple attempts. The patient explains that he was diagnosed with bipolar disorder three years back, and since then has been stable on quetiapine. The patient began using marijuana with peers when he was eleven years old. Since then he has also been using tobacco on and off, but his use of cannabis has been consistent because of cravings and inability to cope with withdrawal. Currently, he smokes 2-3 marijuana cigarettes daily and complains feeling exhausted, inattentive, and anxious. His last manic episode was six months back when he experimented with cannabis and cocaine. He fears that his marijuana-use would provoke another manic or psychotic episode, so he wants to quit but is unable to do so. Which risk factor played a crucial role in predisposing this patient to cannabis use disorder? A. Early-onset of cannabis-useB. Daily marijuana cigarettesC. Bipolar disorderD. GeneticsE. Concurrent use of other substances

Early-onset of cannabis-use

Which of the following is most likely to interfere with the effects of zolpidem, zaleplon, and eszopiclone? A. Eating a fatty meal at time of ingestion of the medicationB. Ingesting medication on an empty stomachC. Taking a warm shower 30 minutes before bedtimeD. Ingesting the medication 30 minutes before bedtime

Eating a fatty meal at time of ingestion of the medication

An 80-year-old, recently widowed man complains of initial insomnia during this period of bereavement and requests something to help him with sleep. Which one of the following medications is the best treatment alternative? A. FlurazepamB. DiazepamC. TrazodoneD. EszopicloneE. Lorazepam

Eszopiclone

brexpiprazole

FDA approved for treatment of major depressive disorder and schizophrenia. It is thought to work via partial agonist activity at 5-HT1A and dopamine D2 receptors, and antagonist activity at 5-HT2A receptors.

When there is difficulty, tensing, tightening, pain or fear of pain of the vagina, vulva or pelvis during intercourse or penetration attempts, this is most likely a manifestation of which one of the following disorders? A. Female orgasmic disorderB. Conversion disorderC. Illness anxiety disorderD. Somatic symptom disorderE. Genito-pelvic pain/penetration disorder

Genito-pelvic pain/penetration disorder

A 19-year-old G2P1 woman with a history of recurrent major depressive disorder delivers a full-term baby girl. She had opted to continue fluoxetine 20mg daily along with weekly psychotherapy during pregnancy, and her depression remained in full remission during her pregnancy. Six weeks after delivery, she presents at her postpartum psychiatric visit reporting sad mood, increased tearfulness, low motivation, irritability, and inability to sleep when her infant is sleeping. These symptoms have been present since delivery and are worse over the last 3 weeks. She denies any thoughts of harming herself or the baby but is feeling overwhelmed with caring for the baby and her 2-year-old daughter. She continues to see her therapist weekly. She is breastfeeding and wants to continue. What is the best initial step in treatment? A. Augment fluoxetine with bupropionB. Augment fluoxetine with quetiapineC. Switch fluoxetine to sertralineD. Increase fluoxetine doseE. Discontinue fluoxetine and refer for Electroconvulsive therapy

Increase fluoxetine dose

A 29-year-old woman diagnosed with major depressive disorder is brought to the emergency department after an attempted suicide by ingestion of rat poison. Which of the following receptor alteration will be most likely seen in this patient? A. Increased 5-HT1A and 5-HT2A receptor expression in prefrontal cortexB. Decrease in the α2-adrenergic receptor densities in hypothalamusC. Decrease in the density of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors in the caudate nucleusD. Increased density of μ-opioid receptors in frontal and temporal cortexE. Decreased M1 and M4 receptor binding in anterior cingulate cortex

Increased 5-HT1A and 5-HT2A receptor expression in prefrontal cortex

A 23-year-old man visits the psychiatric clinic with his girlfriend for consultation due to alterations in his behavior. The patient had a traffic accident 2 years ago. As a result he had to undergo amputation of his left leg below the knee. He is currently using a prosthetic. According to the patient, he has flashbacks associated with accident that started 6 months ago. He has trouble sleeping at night and wakes up sometimes due to nightmares related to the accident. He has stopped traveling in the car as it gives him anxiety. The patient seems sad and depressed most of the time, which has affected his personal relationships. He has angry outbursts at times, especially when he is having difficulty with the prosthesis. There is no history of psychiatric illness or substance use. Which of the following will be the most likely alteration seen in this individual? A. Increased dopamine levelsB. Decreased norepinephrine levelsC. Increased serotonin levelsD. Increased GABA levelsE. Decreased glutamate levels

Increased dopamine levels

A 55-year old man presents to the clinic for feeling depressed and expressing that he has a total lack of interest in daily activities with difficulty falling asleep for the past year. He says that his condition has gradually worsened after his wife died 18 months ago. He says that he was able to control the emotions for the first few months but now finds everything to be hopeless. His vital signs are within normal limits. He is oriented to person, place, and time. He describes his mood as "not okay." During the exam, he is noted to sit in a crouched over posture with his head hanging low. He denies any suicidal ideation. Which of the following findings are consistent with an imaging study of this patient's brain? A. Increased frequency of hyperintensities in subcortical regionsB. Caudate nucleus atrophyC. Degenerated substantia nigraD. Degeneration of the frontal and temporal lobesE. Reduced hippocampal volume

Increased frequency of hyperintensities in subcortical regions. These hyperintensities are particularly seen in the periventricular area, basal ganglia and thalamus. These changes are known to occur due to the damage resulting from the neurodegenerative effects of recurrent mood episodes in these patients.

A 67-year-old man who has a history of major depressive disorder feels that his current medication is not able to control his symptoms. It is decided to change his medication to a tricyclic antidepressant (TCA). In the case of elderly patients, which of the following is found with the use of tricyclic antidepressants? A. Decreased plasma half-lifeB. Increased steady-state levelsC. Reduced volume of distributionD. Reduced risk of postural hypotensionE. Reduced sensitivity to antimuscarinic side effects

Increased steady-state levels

antisocial personality disorder

Individuals with this disorder have a pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years old, as indicated by 3 or more of the following: 1) failure to conform to lawful behavior, 2)deceitfulness for personal profit or pleasure, 3) impulsivity or failure to plan ahead, 4) irritability and aggressiveness leading to physical fights or assaults, 5) reckless disregard for the safety of self or others, 6)consistent irresponsibility and lack of remorse. 7) Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another. They lack empathy and tend to be callous and cynical although they might hide this through deceit and manipulation to get what they want. Individuals with borderline personality disorder show a pervasive pattern of instability in interpersonal relations, self-image, with marked impulsivity, beginning in early adulthood.

major depressive disorder (MDD) with a seasonal pattern

MDD is characterized by the presence of 5 or more of the following symptoms: 1) depressed mood 2) loss of interest 3) weight gain/loss or decrease/increase in appetite 4) insomnia or hypersomnia almost every day 5) psychomotor agitation or retardation nearly every day 6) feeling of tiredness 7) feelings of guilt or worthlessness 8) inability to think, concentrate, or make decisions 9) suicidal ideation, suicide attempt, or having a plan for suicide. These symptoms must be present for at least 2 weeks, nearly every day (except suicidal ideation and weight gain/loss), should not be attributable to an underlying medical condition or use of medication and should cause clinically significant distress and impairment. This patient's symptoms typically occur during winter with complete resolution in the intervening period.

A 19-year-old obese woman presents with complaints of throbbing headaches for the past several days. These generalized, constant headaches are associated with nausea. The headaches are not responsive to acetaminophen that she takes up to four 500 mg pills per day. Historically, preceding her menstrual period by several days, she typically has left temporal headache associated with photophobia and nausea. However, she feels that her current headache is different. Her past medical history is otherwise unremarkable. She takes an oral contraceptive and a multivitamin every day. She admits to occasional alcohol use and smokes a few cigarettes per day. The physical exam reveals blurred optic disks at the temporal margins and no other abnormalities. Which one of the following is the next most appropriate step? A. Send her home with a prescription for a triptan and reassuranceB. Head CTC. MRI and magnetic resonance arteriogram (MRA)D. MRI and magnetic resonance venogram (MRV)E. Lumbar puncture

MRI and magnetic resonance venogram (MRV)

A 15-year-old boy presents to the emergency with a cough, choking, vomiting with aspiration, and abdominal pain for half an hour. His parents reveal that the patient has been huffing kerosene for the last three years. He has previously presented to the emergency room twice with intoxication. A heart rate of 90 beats/min and blood pressure of 90/80 mmHg is recorded. Which of the following is the treatment of choice in this patient? A. Maintenance of airway, breathing, circulation, and charcoal administrationB. Maintenance of airway, breathing, circulation, and epinephrine administrationC. Maintenance of airway, breathing, circulation, and IV naloxoneD. Maintenance of airway, breathing, circulation, and norepinephrine administrationE. Maintenance of airway, breathing, circulation, and aggressive fluid resuscitation

Maintenance of airway, breathing, circulation, and aggressive fluid resuscitation

A 35-year-old man presents to the clinic with a 2-month history of difficulty concentrating at work. He is worried he may lose his job due to poor performance. He constantly feels tired but attributes his fatigue to waking up early most mornings and being unable to fall back asleep. His wife has noticed that he has been speaking more slowly, and his appetite has decreased. He used to enjoy dance classes with her but has not been as interested in this recently. He is a veteran who returned from a deployment to Afghanistan 2 years ago. Which of the following is the most likely diagnosis? A. Post-traumatic stress disorderB. Persistent depressive disorderC. Major depressive disorderD. Adjustment disorderE. Acute stress disorder

Major depressive disorder

A 72-year-old male patient with cognitive impairment develops frightening visual hallucinations. You prescribe low dose risperidone. The patient develops severe bradykinesia, tremor, rigidity, and gait disturbance. His adverse reaction suggests which NCD diagnosis? A. NCD due to Alzheimer's diseaseB. NCD with Lewy bodiesC. Normal pressure hydrocephalusD. NCD due to frontotemporal lobar degenerationE. Vascular NCD

NCD with Lewy bodies

35-year-old man comes to see his physician for a routine appointment an hour late. He tells the physician that he was in a very important meeting with a client and every second was essential because "millions of dollars were at stake". He says "for successful people like us, time is money". He feels that he is finally getting the recognition and attention he deserves at his law firm because he won a high-profile case without the help of his "stupid coworkers that are clearly jealous" of his talent and success. Which of the following personality disorders does he most likely have? A. Borderline personality disorder (BPD)B. Narcissistic personality disorderC. Histrionic personality disorderD. Paranoid personality disorder (PPD)E. Antisocial personality disorder (ASPD)

Narcissistic personality disorder

A 30-year-old woman presents to the psychiatry clinic with a chronic history of low mood and occasional anger outbursts. In an interview with the psychiatrist, she reports that she is unsatisfied with her achievements and wants more success in life. She reports that she was recently promoted at work after being there for 2 years, she then angrily states "how could they have taken so long?" Throughout the consultation, she shows a very arrogant behavior and thinks herself entitled to special treatment. She believes that she should be granted more than she already has. The front desk staff report that she became angry at not being taken right away, even though there were people ahead of her. Which of the following is the most likely diagnosis of this patient? A. Borderline personality disorderB. Obsessive-compulsive personality disorderC. Antisocial personality disorderD. Major depressive disorderE. Narcissistic personality disorder

Narcissistic personality disorder

A 36-year-old entrepreneur is consulting you because his spouse is concerned regarding his alcohol intake. He reports that he drinks wine a couple of days a week when he takes clients out to dinner. On weekends, he reports drinking 2-4 beers each weekend day, while watching games with his buddies. He inquires about the criteria for "low-risk" drinking. You first clarify that "low risk" is not defined as "no risk." Current understanding, based on a major nationwide survey of 43,000 U.S. adults conducted by the National Institutes of Health (NIH) shows that only about 2 in 100 people who drink within both the single-day and weekly low risk limits meet criteria for alcoholism or alcohol abuse. Even within the low risk limits drinkers can have problems if they drink too quickly, have health problems, or are over age 65.Which option defines the single-day, and weekly limits, for a healthy adult male younger than age 65? A. No more than 2 drinks on any day and no more than 5 drinks per weekB. No more than 3 drinks on any day and no more than 7 drinks per weekC. No more than 3 drinks on any day and no more than 10 drinks per weekD. No more than 4 drinks on any day and no more than 14 drinks per weekE. No more than 4 drinks on any day and no more than 17 drinks per week

No more than 4 drinks on any day and no more than 14 drinks per week

A 37-year-old woman consults for a second opinion regarding her bipolar disorder (BD).She has been taking valproate for her condition with her symptoms well controlled. Unfortunately, during the course of her treatment she delivered a dead neonate with multiple neural tube defects. She is asking if switching to carbamazepine would be better since she is planning to have another baby and her insurance entirely co-pays for this medicine. You would reply: A. No, carbamazepine is associated with craniofacial defectsB. No, carbamazepine is associated with autism spectrum disordersC. Yes, carbamazepine is associated with the least maternal side effectsD. Yes, carbamazepine is associated with better pregnancy outcomesE. Yes, carbamazepine has a beneficial effect in the depressed phase of BD

No, carbamazepine is associated with craniofacial defects- First trimester exposure to carbamazepine can cause an increase in malformations such as craniofacial defects, neural tube defects, developmental delays, and behavioral changes. Children of epileptic pregnant women treated with carbamazepine had a 10 mm decrease in fetal head circumference, which did not become normal by the age of 18 months.

When a subject comes to believe that the treatment they are receiving is ineffective, their negative expectation can result in a lack of beneficial response. This effect is known by which of the following terms? A. Selection biasB. Placebo effectC. Observer expectancyD. Nocebo effectE. Construct validity

Nocebo effect

Oral contraceptives are an effective method of birth control. Which one of the following methods is more effective than oral contraceptives in preventing pregnancy? A. DiaphragmB. SpermicideC. SpongeD. CondomE. Progestin implants

Progestin implants

The spouse of an extroverted 60-year-old man with amyotrophic lateral sclerosis throws him a surprise party. He bursts out crying and continues to sob for an inordinate amount of time. The audience of friends who had gathered grow concerned. Which of the following sequelae would you be concerned that this man is developing? A. Pseudobulbar affectB. Charles Bonnet syndromeC. Klüver-Bucy syndromeD. Major depressionE. Post-traumatic stress disorder

Pseudobulbar affect

A 66-year-old man, with chronic schizophrenia who has been treated successfully with quetiapine for 15 years, is found to have new onset hypercholesterolemia. Which one of the following recommendations should the physician implement in accordance with the American Diabetic Association-American Psychiatric Association (ADA-APA) guidelines? A. Closer monitoring of lipid levelsB. Referral to a primary care physicianC. Referral to a specialistD. Initiation of a statinE. Initiation of gemfibrozil

Referral to a specialist

You are evaluating a 30-year-old woman in the emergency department who attempted suicide by jumping in front of a car. She said she has been bothered by uncontrollable body movements that have been getting progressively worse and interfere with her ability to work and interact casually with her peers. During the 1 hour intake you notice the following symptoms: she pouts her lips and puffs out her cheeks, the raises her arm abruptly. She tells you both her father (who died at age 60 by shooting himself) and her older brother had similar uncontrollable movements of their body. Her brother was started on a newly FDA approved medication and she also wishes to be prescribed but she does not recall the name. The mechanism of action of the medication her brother is on is which of the following? A. Reversibly inhibits VMAT2B. Inhibits 5-HT reuptake, 5-HT3 receptor antagonism and 5-HT1A receptor agonismC. Likely works as an inverse agonist and antagonist activity at 5-HT2A receptors and 5-HT2C receptorsD. One component is a mu opioid receptor partial agonist and a kappa opioid receptor antagonist. The other is a mu opioid receptor antagonistE. An extended release selective inhibition of norepinephrine and serotonin reuptake

Reversibly inhibits VMAT2

An internist refers to the psychiatrist a woman with panic disorder whose symptoms have been fairly stable for a number of years on alprazolam 0.5 mg taken four times daily. Although she does not have panic attacks on this regimen, she experiences increased anxiety and dysphoria as the time for her next dose of alprazolam approaches. She requests a discussion of alternative pharmacotherapies. Which of the following responses is most likely to be the best for this patient? A. Discontinue alprazolam and start a selective serotonin reuptake inhibitorB. Review the relatively short half-life of alprazolam, which can lead to "clock watching" and inter-dose withdrawal symptoms, and suggest that substituting alprazolam with a longer acting benzodiazepine, such as clonazepam, might resolve the problemC. Discuss the negative effects of chronic benzodiazepine use and encourage her to discontinue benzodiazepine treatment after completing a 12-session course of cognitive behavioral therapyD. Increase the dose of alprazolam at each dosing interval by a small amountE. Stop alprazolam and start clonazepam 0.5 mg taken four times daily

Review the relatively short half-life of alprazolam, which can lead to "clock watching" and inter-dose withdrawal symptoms, and suggest that substituting alprazolam with a longer acting benzodiazepine, such as clonazepam, might resolve the problem

A 35-year-old man visits the clinic with a complaint of hearing voices for the past 6 months. The patient says the voice is of the devil telling him that he is a bad person and he is going to go to hell. The voices have become more frequent over the past 2 months. The patient also says that he has been unable to sleep properly at night. He has stopped going to work or going out with friends and stays in bed all day. He feels sad and depressed most of the time. The patient says that at times he feels fine, but the voices in his head do not go away. There is no history of drug use. Which of the following is the most likely diagnosis in this patient? A. Major depressive disorderB. SchizophreniaC. Schizoaffective disorderD. Bipolar disorderE. Schizophreniform Disorder

Schizoaffective disorder

A 19-year-old man, currently under active psychopharmacologic treatment for depression, is brought to the emergency department by his roommate. The roommate saw the patient ingest an unknown substance in the living room before going to a dance club. The patient's blood pressure is 168/98 mm Hg, pulse is 128 beats/minute, respirations are 22 breaths per minute, and temperature is 104.1 F. On examination, the patient is agitated, diaphoretic, and flushed. Pupils are dialated bilaterally, mucous membranes are dry, and hyperactive bowel sounds are present. He is hyperreflexive with intermittent myoclonus of the legs. Labs suggest a degree of metabolic acidosis. Urine toxicology screen is positive for amphetamines. Which of the following is the most likely diagnosis? A. Serotonin syndromeB. Amphetamine overdoseC. Diphenhydramine poisoningD. Neuroleptic malignant syndromeE. Cocaine overdose

Serotonin syndrome

A 17-year-old girl is brought to the emergency department in an agitated state by her mother. The patient is convinced that her mother has been possessed by aliens, and has been trying to poison her. The mother explains that she had caught her daughter smoking cannabis in the basement of their house multiple times after her father abandoned them 3 months back. The onset of psychotic symptoms has been gradual with the start of cannabis use, but ever since the girl smoked 1 g of THC-rich CBD-low strain of cannabis (more than her usual dose) five hours back, she has been shouting, panicking, and crying simultaneously. There is associated visual hallucination with the absence of intact reality testing since substance use. There is no history of psychiatric or medical illness, but family history is positive for substance use and mental illness. Considering genetics as a contributor, carriers of which genotype are the most vulnerable to cannabis-induced psychosis? A. Val158Met polymorphism of the catechol-O-methyltransferase (COMT) genotypeB. Serotonin transporter-linked polymorphic region (5HTTLPR) genotypeC. G allele genotype in the A118G SNP of OPRM1D. Opioid receptor mu 1 (OPRM1) genotypeE. Dopamine receptor D4 promoter hypermethylation

Val158Met polymorphism of the catechol-O-methyltransferase (COMT) genotype

The reliability of a new assessment instrument refers to its ability to do which of the following? A. Yield a low rate of false positivesB. Be administered by non-professionalsC. Measure what it intends to measureD. Yield similar results when administered by different raters at different timesE. Achieve consensus among expert

Yield similar results when administered by different raters at different times

DMDD

a disorder which presents as explosive outbursts and chronically irritable mood presenting for at least 12 months in at least 2 settings (e.g., home and school). DMDD cannot be diagnosed before the age of 6 or after 18 under current guidelines.

Laboratory CSF findings suggestive of bacterial meningitis

a high WBC count (especially neutrophils), a high protein level, and a low glucose level.

D-Cycloserine

a partial agonist at the N-methyl-D-aspartate receptor that can be used in conjunction with exposure therapy as it has shown to enhance its effects. However, the studies have shown the benefits decrease over time and with repeated administration.

Normal pressure hydrocephalus

a potentially reversible chronic disorder that affects elderly patients, characterized by dilation of the cerebral ventricles, as well as a triad of gait apraxia, impaired cognitive function and urinary incontinence. Patients typically present with an abnormal gait, although dementia and impaired urinary control may also be present,

behavioral inhibition

a temperamentally based style of responding characterized by the tendency to be particularly fearful and restrained when dealing with novel or stressful situations

A 42-year-old man presents with a diagnosis of schizophrenia. He has gained 40 pounds on his current antipsychotic. Which one of the following medications would be the best next choice of medication? A. AripiprazoleB. OlanzapineC. RisperidoneD. QuetiapineE. Haloperidol

abilify

Which one of the following antipsychotics is a partial D2 receptor agonist? A. HaloperidolB. OlanzapineC. ClozapineD. AripiprazoleE. Paliperidone

abilify

Huntingtin protein

abnormally deposited in Huntington's disease.

Tau protein

abnormally deposited in frontotemporal neurocognitive disorder due to frontotemporal lobar degeneration.

Patients with vascular neurocognitive disorder tend to report which one of the following conditions? A. Abrupt onsetB. Gradual declineC. Usually no history of atherosclerotic disease or prior strokesD. No other complaintsE. Normal neurological exams other than on mental status evaluation

abrupt onset

REM behavior disorder,

absence of muscle atonia normally present during _____REM___sleep.

When a therapist says to a patient in DBT, "Growing up, you did the best a child could do under very difficult circumstances," how can this intervention be best characterized? A. AcceptanceB. DialecticalC. Interpersonal skillsD. MindfulnessE. Transference

acceptance

A 13-year-old boy presents to the emergency department with unconsciousness. Physical examination shows depressed reflexes, and a heart rate of 120 beats per min is recorded. Parents reveal that the patient had ingestion of a high dose of gasoline and was involved in huffing and ingesting gasoline from one year. A diagnosis of hydrocarbon intoxication is made. History of any other psychiatric or medical illness is negative. Which of the following is the most common cause of death with inhalant intoxication? A. Hepatic failureB. CNS toxicityC. Acute cardiac toxicityD. Chemical pneumonitisE. Corrosive injury to the esophagus

acute cardiac toxicity

A 24-year-old woman presents to the clinic because she feels sad and has had frequent, brief episodes of crying for the last month. During this period, she sleeps in every morning and spends most of her time in bed playing video games or reading. She has not been spending time with friends but still attends a weekly book club and continues to plan her annual family reunion. She stopped going to the gym, eats more, and has gained 4 kg (8.8 lbs.) over the past 4 weeks. Three weeks ago, she also started to smoke marijuana a few times a week. She drinks one glass of wine daily and does not smoke cigarettes. She is currently unemployed; she lost her job as a physical therapist 3 months ago. Her vital signs are within normal limits. On mental status examination, she is calm, alert, and oriented to person, place, and time. Her mood is depressed; her speech is organized, logical, and coherent. She denies suicidal thoughts. Which of the following is the most likely diagnosis? A. Adjustment disorderB. Dysthymic disorderC. Substance use disorderD. Bipolar disorderE. Major depressive disorder

adjustment disorder

A 30-year-old woman visits the psychiatric clinic with her sister for consultation regarding her altered behavior for the past three months. The patient says that she has trouble sleeping at night and wakes up sometimes due to nightmares. She has developed anxiety. She feels sad and depressed most of the time, which has affected her relationships with her family. She has angry outbursts at certain times, she is not able to concentrate, and has become hypervigilant. Her sister says that the patient had gone through a divorce two months ago. She has not been going to work and avoids talking about her divorce. There is no past history of psychiatric illness. Which of the following is the most likely diagnosis in this patient? A. Acute stress disorderB. Post-traumatic stress disorderC. Major depressive disorderD. Adjustment disorderE. Brief Psychotic disorder

adjustment disorder

A 30-year-old man presents to the emergency department saying that he is being bothered by voices coming from the walls of his home that are telling him to kill himself. The patient has a history of schizophrenia and was recently discharged from the hospital after receiving treatment for an acute psychotic episode. He was advised to continue taking haloperidol at home, but he did not continue taking medicine. What would be an appropriate step in the acute management of this patient in the emergency department? A. Electroconvulsive therapy (ECT)B. Depot haloperidol injectionC. Administer olanzapineD. Continue observationE. Place in physical restraints

administer olanzapine

Which of the following factor is the most important when choosing an antipsychotic drug? A. Renal clearanceB. Presence of negative symptomsC. GenderD. Adverse effectsE. Onset of action

adverse effects

The presence of the G allele genotype (GG/AG) in the A118G SNP of OPRM1 has been associated with increased craving and excess mesocorticolimbic activation to ___________ use

alcohol

Which of the following substances is most frequently identified in fatally injured motor vehicle drivers in the United States? A. BenzodiazepinesB. StimulantsC. AlcoholD. OpioidsE. Cannabinoids

alcohol

the opioid receptor mu 1 (OPRM1) gene has been studied concerning the risk of __________ and ___________ because of the involvement of the endogenous opioid system in the reinforcing and addictive effects of alcohol and opiates.

alcoholism and opioid use

Which of the following is a negative symptom associated with schizophrenia? A. AlogiaB. AgitationC. MutismD. StuporE. Echopraxia

alogia

______--------- is the diagnostic feature of schizoid personality disorder.

aloofness

A 23-year-old woman presented to the emergency room with shortness of breath that is not related to exertion and not associated with chest pain. The symptoms started while she was sitting at her desk and suddenly started to think about death and was overcome by the fear of impending doom. She started feeling dizzy, nauseous, and she felt like she was getting choked to death. She got a similar attack last month and has avoided exercise in fear that exercise might have precipitated the attack. She did not consult the doctor and is currently not using any medication. She does not use any recreational drugs and does not smoke. There is no significant medical history. On physical exam, she is sweating, trembling, and shaking. Blood pressure is 125/80mmHg, pulse rate is 110/min, and the respiratory rate is 25/min. She is around 9 kg (20 lbs.) overweight. Her ECG shows no abnormalities, and all her blood tests are normal. What is the best initial treatment for this patient? A. AlprazolamB. ParoxetineC. ImipramineD. BuspironeE. Phenelzine

alprazolam

Deposition of amyloid plaques in the brain is the mechanism of disease in ____________________

alzheimer's disease

A 35-year-old woman presents to the clinic with stiffness, body aches, and fatigue for the past 4 months. She describes dull aching pain on the base of her skull, whole neck, shoulders, elbows, hips, and knees. Her muscle stiffness is worse in the morning, and it gets aggravated in winter. She feels that she has not been able to sleep well for the last few months and wakes up tired in the morning. She has used anti-depressants as a teenager, but she stopped taking them after getting married 10 years ago. She starts crying while telling about her husband's death in a motor vehicle accident 5 months ago. She remains worried about her 6-year-old daughter's future. On lab investigations, her blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anti-nuclear antibody (ANA), and uric acid level are unremarkable. What is the most appropriate treatment option for this patient? A. AmitriptylineB. CorticosteroidsC. MethotrexateD. SurgeryE. Allopurinol

amitriptyline

The patient is a 64-year-old man with congestive heart failure (CHF; ejection fraction is 31%), poorly controlled type 2 diabetes (HbA1C 9.5) and diabetic neuropathic pain. He has been feeling depressed for the past 4 weeks, with lack of motivation to participate in his usual interests, insomnia, decreased energy (fatigue), decreased appetite, and a sense of feeling "slowed down." He was started on an antidepressant 4 weeks ago to help with mood and peripheral neuropathic pain. Since starting the new medication, he notes that he has been much thirstier than usual. He presents to the emergency department with acute shortness of breath but no chest pain. Which of the following medications likely precipitated his emergency department presentation? A. DuloxetineB. VenlafaxineC. AmitriptylineD. SertralineE. Bupropion

amitriptyline

A 19-year-old man was bought to the emergency by the police. They picked him up wandering near the park. He was in an angry, agitated, and anxious state. He kept on pushing everyone away saying that no one will get him. His examination showed tachycardia, elevated blood pressure, dilated pupils and stereotyped behavior. The patient went on to develop seizures. Which of the following substance leads to such a presentation? A. Amphetamine B. Cannabis C. Alcohol D. Heroin E. Inhalant

amphetamine

Disinhibited social engagement disorder

an attachment disorder that is characterized by a pattern of behavior involving culturally inappropriate and excessively familiar behavior with relative strangers.

Vitamin B1 deficiency

an cause Wernicke encephalopathy, which involves truncal ataxia, confusion, and ophthalmoplegia, and Korsakoff syndrome (amnestic-confabulatory syndrome).

prosopagnosia,

an inability to recognize faces. due to damage from the fusiform gyri

Short-term effects include paranoia, delusional thinking, irritability, anxiety psychomotor agitation, impaired judgement, mood swings/anger/violence ("roid rage"). On the other hand, long-term effects include acne, kidney and liver failure, cardiomegaly, hypertension hypercholesterolemia, increased risk of stroke and MI.

anabolic steroid abuse

stroke in the ____________________is associated with Tourette's syndrome.

anterior cingulate cortex

atropine

anticholinergic agent which will exacerbate the symptoms of tachycardia and dry mouth

Symptoms of heroin withdrawal

anxiety, restlessness, back and legs aches, irritability and increased sensitivity to pain. For diagnosis of opiate withdrawal three or more of the following signs or symptoms must be present; pupillary dilation, lacrimation or rhinorrhoea, piloerection or increased sweating; diarrhea; yawning; fever; and insomnia.

lesion in the ________________results in conduction aphasia.

arcuate fasciculus

paranoid-type schizophrenia

associated with a preoccupation with delusions of persecution or grandeur or auditory hallucinations.

residual-type schizophrenia

associated with the continuous presence of schizophrenic symptoms in the absence of a full set of active symptoms that meet the diagnostic criteria of another type of schizophrenia

huntington's disease is ___________ _________ (inheritance)

autosomal dominant

Chronotherapy

behavioral technique where individuals delay their sleep times successively for 3 hours every day until they reach the sleep window they desire. In insomnia, patients experience poor sleep quality or quantity with difficulty falling asleep, staying asleep or waking up early in the morning.

A young woman presents reporting recurrent, episodic binge eating. During her binges, she eats an unusually large amount of food and feels a sense of lack of control over her eating. The frequency of her binges is at least 2 days per week for the past 7 months. She does not purge, use laxatives or diuretics, or engage in other compensatory behaviors to prevent weight gain. Her BMI is 23. Which one of the following diagnoses is the most likely diagnosis for this patient? A. Bulimia nervosaB. Binge-eating disorderC. Anorexia nervosaD. Premenstrual dysphoric disorderE. Major depressive disorder

binge eating disorder

A 29-year-old woman presents to the clinic with disturbed sleep for the past 2 weeks. She has a habit of working late, sometimes past 1 am. She wakes up every 2 hours during her sleep. The idea of not getting enough sleep terrifies her, and the thought consumes her. Her sleep problem has considerably affected her work. She has noticed that she is now aggressive and has problems managing her anger. She consumes 6 cups of coffee per day, and habitually consumes alcohol. She does not have any medical history. What is the most appropriate management for this patient? A. Sleep hygiene techniqueB. BiofeedbackC. GabapentinD. PhototherapyE. Flurazepam

biofeedback

A 20-year-old woman is brought to the clinic by her mother for bizarre behavior and mood changes for the last eight days. While her mother was initially happy to see her so elated, considering her history of low moods, she was shocked last night to find her on the rooftop claiming that she can fly and the 'voices' were telling her she had to save the neighborhood from evil. In addition, she has not slept for nearly a week and yet has been excessively energized and talkative. She reports having many amazing ideas and thoughts that she wants to share with the world. She has never exhibited abnormal behavior like this before, and has no significant psychiatric history except for low moods. Basic lab workup and brain imaging are normal. What is the most likely diagnosis? A. Schizoaffective disorderB. Bipolar I disorderC. Major depression with psychotic featuresD. Brief psychotic disorderE. Schizophrenia

bipolar I disorder

A 30-year-old woman comes to the clinic with a history of low mood and suicidal ideation for a month. She also has decreased energy, low appetite, and is unable to concentrate at work. She is tearful and feels guilty for not taking better care of her four-month-old baby. She has not had any similar episodes in the past, but reports being hospitalized some years back after a week of no sleep and behavioral changes along with hyperactivity. She was prescribed lithium and valproate on discharge, but cannot recall the exact diagnosis. What is the most likely diagnosis at present? A. Major depressive disorderB. Depression with psychosisC. Bipolar I disorderD. Bipolar II disorderE. Postpartum depression

bipolar I disorder

there is no definite pharmacologic treatment for neuroleptic malignant syndrome, ----------, __________, and _________ have been shown to be beneficial.

bromocriptine, dantrolene, and amantadine

A 20-year-old woman with a history of bulimia nervosa presents with depressed mood, anhedonia, poor sleep, and suicidal ideation. Which one of the following medications is contraindicated in this patient? A. FluoxetineB. MirtazapineC. SertralineD. BupropionE. Venlafaxine

bupropion

gambling disorder

can be made if the gambling behavior is not better explained by a manic episode, and the person involved exhibits a minimum of four of the criteria for problematic gambling behavior in a period of twelve months. This criteria may include the need to gamble with ever-increasing amounts of money to attain the needed enjoyment, restlessness or irritability when attempting to lessen or discontinue gambling, recurring failed attempts to regulate, lessen, or stop gambling, fixation with gambling or thinking of ways to get money for gambling, gambling when feeling upset, returning to gambling to recover money lost while gambling, lying to hide the extent of attachment to gambling, endangering or losing important relationships, occupation, or other opportunities due to gambling, and depending on others to provide money to alleviate critical financial circumstances caused by gambling.

Magnetic resonance spectroscopy (MRS)

can be used to detect cellular metabolites and evaluate CNS disorders, including brain tumors and neurodegenerative disorders.

A 40-year-old man is evaluated for chronic cough and sputum production for the past three years. He is a construction worker by profession. Examination shows red eyes, barrel-shaped chest, yellow-stained fingers, and a peculiar body odor that has been tried to mask with aromatic fragrance. On auscultation, generalized expiratory wheeze is heard all over the chest. Vital parameters are stable. He is diagnosed with chronic bronchitis and managed medically. What is the most probable underlying cause of chronic bronchitis in this patient? A. InhalantsB. Cannabis smokingC. Cocaine snortingD. Environmental pollutionE. Occupational lung disease

cannabis smoking

A 22-year-old man is brought to the clinic by his parents who are concerned about his bizarre behavior. According to the parents, the patient has been living with them after dropping out of college 2 years ago. He spends most of the time in his room by himself rather than going out and looking for work. He has not been sleeping well at night. Recently, he has started wearing his clothes inside out and makes strange gestures while having meals. He says that he is being told by the voices coming out of the wall to kill the president. Sometimes he is seen smiling to himself for long periods of time. He does not respond to questions or just repeats the question back to them. Which of the following best describes the presentation of this patient's disorder? A. Catatonic typeB. Disorganized typeC. Paranoid typeD. Residual typeE. Undifferentiated

catatonic type

drugs such as cocaine and amphetamines increase the levels of which one of the following neurotransmitters or class of neurotransmitters important in behavioral arousal and cortical activation? A. CatecholaminesB. HistamineC. AcetylcholineD. TryptophanE. Gamma aminobutyric acid

catecholamines

fragile X syndrome

caused by a loss of function mutation located in the Xq27.3 locus of the fragile X mental retardation 1 (FMR1) gene. As a result, levels of FMR1 protein are reduced or absent. The FMR1 protein is part of the processes responsible for stabilizing RNA, translating mRNA proteins that develop synapsis or dendritic spines, and the development of the brain. Absence of this protein results in dendritic spine dysmorphogenesis that manifests as intellectual disability and dysfunctional behavior.

Psychiatric disorders such as bipolar disorder, attention-deficit/hyperactivity disorder, and schizophrenia have genetic contributions which are best described in which one of the following ways? A. Inherited according to simple Mendelian lawsB. Caused by point mutationsC. Caused by multiple genesD. Caused by single genesE. Caused by environmental factors

caused by multiple mutations

somatic type delusion

central theme of the delusion involves bodily functions or sensations.

Flumazenil contraindications

certain cardiac arrhythmias and with anticholinergic signs. seizure disorder- lowers seizure threshold

Stupor

characterized a state of unresponsiveness except to intense pain.

sexual aversion disorder

characterized by a lack of desire, avoidance, and repulsion for sexual activities in a consensual relationship.

paranoid personality disorder

characterized by a lack of trust and suspicion of hidden ulterior motives in interpersonal communication or relations without any proof. They are preoccupied with doubts regarding loyalty and wrong intentions, are usually reluctant to confide in others, perceive wrong ideas from any conversation and may also have a suspicion regarding fidelity of spouse or partner.

Delayed sleep-wake phase disorder (DSWPD)

characterized by an inability to fall asleep before early morning, usually after 2am, which can be more than 3 hours later than the conventional sleep time of the general population. This results in a delay in waking up the subsequent morning and excessive daytime sleepiness when they are unable to sleep in due to work, education or social requirements. However, if they are able sleep in, their sleep is of normal duration and quality.

orbitofrontal syndrome

characterized by disinhibition and impairment in judgment, sexually disinhibition, social inappropriateness, and psychosis (hallucinations and delusions).

panic disorder

characterized by recurring episodes of intense fear which include sweating, palpitations, shortness of breath, shaking, a feeling of impending doom, and numbness. The cause of this disorder is currently unknown. Attempts have been made to explain its origin via a genetic cause. Risk factors for developing this condition include psychological stress, smoking, and a past history of maltreatment.

borderline personality disorder

characterized by unstable mood swings, desperate attempts to avoid abandonment, chronic feelings of emptiness and boredom, intense outbursts of anger and difficulty controlling them, impulsive behavior, and recurrent self-mutilation or manipulative suicidal behavior. Persons with BPD commonly employ primitive defense mechanisms, such as denial, projective identification, and splitting.

Ionotropic gamma-aminobutyric acid (GABA) receptors are associated with which of the following ion channels? A. Sodium channelsB. Potassium channelsC. Calcium channelsD. Chloride channelsE. Magnesium channels

chloride channels

Other drugs causing false positives in commercial urine drug-screen amphetamine immunoassays include

chlorpromazine, metformin, bupropion, dimethylamylamine, labetalol, promethazine, trazodone, and fenofibrate.

MS

chronic demyelinating disorder of the central nervous system (CNS) characterized by repeated episodes of demyelination affecting various areas of the CNS, including the optic nerves, brain, and spinal cord (dissemination in space) over time (dissemination in time). Both gray and white matter are affected in multiple sclerosis.

The presence of _______ is a hallmark clinical finding in serotonin syndrome.

clonus

For weight gain, diabetes, and dyslipidemias, the atypical antipsychotics in descending order from those most associated to those least associated with these hallmarks of the metabolic syndrome are: ___________________(6 medications)

clozapine, olanzapine, quetiapine and risperidone, ziprasidone and aripiprazole.

Wave II on the brainstem auditory evoked response (BAER) corresponds to activity at

cochlear nuclei

A 19-year-old man presents for a psychiatric evaluation, as he believes that he may be having a mental illness. He reports experiencing serious and rapid changes in his mood from cheerful to gloomy and vice versa with the slightest provocation for at least three years. There are some days when he feels better, but he mostly experiences these swings. He is able to perform his daily life activities, but has serious distress because of these mood changes. His college grades are good, and he has no apparent stressors. His vitals are normal. On MMSE there is no abnormality. Urine toxicology is negative for drugs. What is the most like diagnosis? A. DysthymiaB. CyclothymiaC. Major depressive disorder (MDD)D. SchizophreniaE. Substance use disorder

cyclothymia

A woman asks her psychiatrist about changes in sleep that may occur in the presence of a dementia / neurocognitive disorder. Which one of the following statements regarding that type of sleep disturbance most commonly seen in neurocognitive disorder is accurate? A. Decreased sleep fragmentationB. Decreased sleep-onset latencyC. Decreased slow-wave sleepD. Increased sleep efficiencyE. Increased total sleep time

decreased slow wave sleep

depressive disorder is associated with ______________ REM latency and _________ sleep maintenance.

decreased x2

Cyclothymia

defined by low-grade hypomanic and depressive symptoms over two years (at least one year for children and adolescents), not due to a specific due to substance use, and associated with significant distress or impairment. Patients with cyclothymia experience intense and rapid mood fluctuations of opposite polarity leading to interpersonal and behavioral consequences that usually prove to be the most prominent clinical expression of the disorder. Cyclothymia is the common factor underlying a wide range of comorbidity and complications including anxiety, suicidality, and drug abuse.

Other Specified Depressive Disorder-Recurrent brief depression

depressed mood and at least 4 other symptoms of depression are present for 2-13 days at least once per month for 12 consecutive months.

Which of the following psychiatric diagnoses is the most disabling globally in the year 2010, as measured in disability-adjusted life years (DALY)? A. Autism spectrum disorderB. Posttraumatic stress disorderC. Alcohol use disorderD. SchizophreniaE. Depressive disorder

depressive disorder

withdrawal

described as the development of abnormal physical or psychological symptoms that follow the sudden discontinuation of abuse drug, so it is incorrect as well.

tolerance

described by either a need for markedly increased amounts of an inhalant substance to get the desired effect or intoxication, or a markedly diminished effect with the continuous use of the same amount of inhalant consumption. The degree to which tolerance develops differs greatly across various individuals as well as across substances and may involve some central nervous system effects.

Toluene embryopathy

developed in babies born to women who abuse toluene or exposed as a result of incidental occupational exposure during the first trimester of pregnancy. Features of toluene embryopathy include and overlap symptoms seem in fetal alcohol syndrome - growth retardation, microcephaly, micrognathia, small palpebral fissures, deep set eyes, low set ears, flat nasal bridge, and small fingernails.

Weissman and Klerman

developed interpersonal therapy

fibromyalgia

diagnosed by the presence of widespread pain in the body for at least 3 months with pain in 11 out of 18 tender point sites. Her duration of pain is 4 months, and more than 11 tender point sites are involved. The diagnosis of other musculoskeletal disorders can be ruled out based on negative lab results. Fibromyalgia is usually triggered by physical or emotional trauma. It often co-exists with depression or anxiety, which may also respond to amitriptyline.

schizophrenia

diagnosed when at least 2 of the following are present for a significant period of time in one month and the symptoms should be persistent for at least 6 months.At least one of (1), (2), or (3) must be present:1. Delusions2. Hallucination3. Disorganized speech4. Disorganized or catatonic behavior5. Negative symptoms (flat affect, apathy, social withdrawal etc.)The patient described has odd behavior, flat affect, auditory hallucinations and disorganized behavior for 6 months which meet the DSM V criteria to be diagnosed

An 11-month-old girl presents to the emergency department lethargic. Mother reports that boyfriend shook patient because she wouldn't stop crying. Head CT without contrast appears normal. Which MRI imaging sequence would most likely disclose brain abnormality in this patient? A. Diffusion tensor MRIB. FLAIR MRIC. Gradient echo MRID. Magnetic resonance spectroscopyE. PET scan

diffusion tensor MRI

A 25-year-old man presents to his clinician complaining of recurrent episodes of chest pain, shortness of breath, sensation of choking, and palpitations. He says that his symptoms usually stop when he starts breathing deeply. He says that he avoids going to college as he is afraid that he might have another episode. Physical exam of the patient is unremarkable. He is prescribed lorazepam. The patient should avoid concurrent intake of which of the following drugs? A. Diphenhydramine B. Levocetirizine C. Venlafaxine D. Phenelzine E. Naloxone

diphenhydramine. Oral benzodiazepines such as lorazepam are CNS depressants that are used in the management of panic disorder. Other drugs that possess CNS depressant properties such as 1st generation antihistamines (diphenhydramine), opioids, and barbiturates should be avoided because of synergistic effect and risk of respiratory depression.

Which of the following features is necessary to establish a diagnosis of delirium? A. Presence of a medical conditionB. Caused by substance intoxicationC. Disturbance in attentionD. Caused by substance withdrawalE. Induced by a medication

disturbance in attention

Donepezil _________ (does or does not) need any dose adjustments in hepatic or renal impairment

does not

risk factors for derlirium

dopamine activation, GABA activation (i.e. benzodiazepine usage), Glutamate activation (i.e. alcohol withdrawal, hepatic failure), excess cortisol (i.e. from glucocorticoids)., acetylcholine deficiency

Anticholinergic delirium

dry mucous membranes, hot, dry flushed skin, anhydrosis, blurred vision from mydriasis, fever, absent bowel sounds, and urinary retention. Altered mental status manifests as confusion and delirium with pressured, incoherent speech, agitation and visual and/or auditory hallucinations;

dialectical

explains the idea of bringing the 2 opposite theories of acceptance and change together.

A 28-year-old man presents to the clinic for the treatment of his anxiety and fear of driving. According to the patient, his workplace was situated near his home, so he used to walk to work, but recently he has been promoted to another department which is located on a different site far away from his home and can be reached by driving only. The patient says that he is terrified of driving, and the thought alone triggers palpitations, nausea, and sweating. He has tried to drive to work a few times but ended up pulling over to the side of the road due to severe nausea. He worries that he will die due to an accident. Which of the following is the most appropriate treatment in this patient? A. Exposure therapyB. Cognitive restructuringC. HypnotherapyD. ClonazepamE. D-Cycloserine

exposure therapy

Psychosocial rehabilitation

extensive tretament modality designed to help patients with mental illness in various aspects of functioning incluuding social, emotional and cognitive.

The Z-drugs (zolpidem, zaleplon, and eszopiclone) are most likely to be associated with which of the following adverse effects? A. Atrial fibrillationB. CatalepsyC. Degenerative joint diseaseD. FallsE. Gastro-esophageal reflux

falls

____________forms of early onset AD are associated with abnormal presenilin.

familial

Glioblastoma multiforme

fast growing glioma that develops from astrocytes and oligodendrocytes.

social anxiety disorder

fear of being in a social setting in which the person is exposed to being observed by others. The person fears being judged and embarrassing themselves in front of others.

brisk tendon reflexes

feature of upper motor neuron lesion and are assessed using a tendon hammer.

A 22-year-old woman presents to clinic with the complaint that she is not able to have an orgasm. She's had three previous relationships end because of her inability to have an orgasm with her partner. She does, however, wish to have close companionship and is disappointed by her breakups. Her most likely diagnosis is which of the following? A. Female sexual interest/arousal disorderB. Genito-pelvic pain/penetration disorderC. Sexual aversion disorderD. Female orgasmic disorderE. Somatic symptom disorder

female orgasmic disorder

A 22-year-old woman presents to the clinic with the complaint of fatigue for the past 4 months. Her GPA has dropped remarkably due to poor performance in her last semester at university. She is not able to concentrate on her assignments. She feels tired and sleepy throughout the day. She also faces difficulty falling asleep at night. She has stopped attending practices for her basketball team's upcoming basketball tournament. She states she stopped going to practices and spending time with her friends because she no longer enjoys these things. When asked about her mood, she states it is "alright...I guess." She does not report any hallucinations or delusions. She has no history of any mood disorder. On physical examination, her pulse is 74 beats per minute, her respiratory rate is 13 breaths per minute, her temperature is 98.6°F (37°C), and her blood pressure is 118/78 mmHg. Her speech is slow in rate. Her thoughts are organized and her memory is intact. Which of the following is the appropriate next step in the management of this patient? A. LorazepamB. FluoxetineC. LithiumD. BuspironeE. Selegiline

fluoxetine

A 25-year-old woman presents to the clinic with the complaint of fatigue for the past 6 months. She feels dizzy and tired throughout the day. She reports multiple episodes of vomiting and diarrhea during the past few months. Her mother works as a nurse in a community hospital. She feels that she over-eats sometimes. She is trying to maintain her weight within the normal range. She is afraid of gaining weight like her elder sister, who has hypothyroidism. On physical examination, her pulse is 89/min, her respiratory rate is 16/min, her temperature is 98.6°F (37°C), and her blood pressure is 110/68 mmHg. Her BMI is 20kg/m2. Her oral cavity examination shows eroded enamel. She has non-tender bilateral swellings on her face anterior to her ears. Her knuckles are calloused. Which of the following is the appropriate treatment option for this patient? A. FluoxetineB. LamotrigineC. QuetiapineD. LevothyroxineE. Bupropion

fluoxetine

A 28-year-old woman presents to your healthcare facility with 6-weeks history of depressed mood, weight gain, anxiety, and fatigue. She reports that she gained 6 kg in the past 2 months. She is very stressed and worried about her job due to decreased ability to concentrate for the past 6 weeks. The physician asks her about any harmful thoughts; she explained she has some thoughts of being better off dead but she does not a definite plan or intent and wouldn't due to her religious beliefs. She reports she has never felt like this before. Her medication is alprazolam 0.5 mg 3 times daily and all routine labs including CBC and TSH were within normal limits. Which medication is the best for her presentation? A. MirtazipineB. ParoxetineC. DespiramineD. FluoxetineE. Clozapine

fluoxetine

A 51-year-old man presents to the clinic because of restlessness. His history is notable for hypertension, dyslipidemia, depression, and tobacco use. He appears agitated and anxious and can't stand still. When sitting, he continually moves his legs. His wife died 6 months ago, and he has since required the addition of amlodipine to the hydrochlorothiazide for control of his hypertension. He admits that he has increased his tobacco use. He takes fluoxetine for depression. His only other medications are simvastatin and baby aspirin. Which of the following is the most likely cause of this complaint? A. FluoxetineB. AmlodipineC. SimvastatinD. NicotineE. Aspirin

fluoxetine

A 9-year-old boy is brought to the clinic by his parents because of his declining school performance over the past 6 months. The patient's teacher informed them that he refuses to talk in class and only uses gestures. His grades are declining because he does not work with other students in group projects or take part in oral presentations. However, he usually does well on written assignments and tests. His father says he is quite talkative at home and speaks clearly and fluently. The child is enrolled in cognitive behavioral therapy. Which of the following medications would be a first choice if a medication is needed to better manage his condition? A. ClomipramineB. BuspironeC. FluoxetineD. GuanfacineE. Clonazepam

fluoxetine

____________is approved for the treatment of moderate to severe bulimia nervosa and has shown benefit in reducing binge-eating and purging behavior, reducing the chance of relapse, and improving eating attitudes. It is is also used to treat anorexia nervosa but does not have an FDA indication for this use

fluoxetine

stress inoculation training

form of cognitive behavioral therapy and can be used in the acute setting for the symptoms of anxiety.

Eye movement desensitization and reprocessing

form of cognitive behavioral therapy which is usually prescribed in the acute setting and has shown to be effective for PTSD

Logical thinking and think about thoughts, make deductions are elements of the _____________stage (11-16 years) where deductive reasoning can be used. (Piaget)

formal operations

Which of the following is the most common inherited cause of intellectual disability? A. Down's syndromeB. Edward's syndromeC. Fetal alcohol syndromeD. Fragile X syndromeE. Wilson disease

fragile x syndrome

CRSD irregular phase type

fragmented pattern of sleep, into at least 3 distinct times in a day. Behavioral therapy for this type of disorder requires a focus on sleep hygiene, bright light therapy and physical activity.

A 36-year-old woman presents with the complaint of being unable to recognize faces. Damage to which area of the brain could be responsible for these symptoms? A. Angular gyrusB. Fusiform GyrusC. Broca's areaD. Wernicke's areaE. Prefrontal association area

fusiform gyrus

Mesencephalon

gives rise to the midbrain.

Diencephalon

gives rise to the thalamus,hypothalamus, and epithalamus

A 30-year-old married man is referred to a psychiatrist. He comes to the clinic with his wife. The patient has been unemployed for the last 7 years. Three months ago, he was assaulted by 3 men who locked him in the trunk of a car and later threatened to shoot him. They ended up beating him and leaving him at the side of the road. He is diagnosed with post-traumatic stress disorder. Which factor improves his prognosis? A. Higher severity of traumaB. Long duration of traumaC. Previous psychiatric historyD. Poor premorbid functionE. Good social support

good social support

Which one of the following types of behavior therapy has been found to be most effective in treating trichotillomania (hair-pulling disorder)? A. Habit reversal trainingB. Response preventionC. Systematic desensitisationD. Observational learningE. Social skills training

habit reversal training

A 26-year-old man with a stimulant use disorder presents to the clinic after not following up with you for 2 months. To detect any drug use during that 2 month period, which of the following body samples should you obtain? A. UrineB. Oral fluidC. HairD. SweatE. Blood

hair

The severity and speed of withdrawal associated with opioids depend on the _______ of the opioid used.

half-life

Cannabis-induced psychosis

hallucinations with an absence of intact reality testing

schizotypal personality disorder

have a reduced capacity for close interpersonal relations and also show eccentricities and distortions in behavior from the beginning of early adulthood. They show 5 or more of the following characteristics: ideas of reference (excluding delusions of reference), odd beliefs that influence behavior and are inconsistent with cultural norms, unusual bodily perceptions, odd thinking and speech, paranoid ideation, inappropriate or constricted affect, eccentric behavior or appearance, no close relations or confidantes apart from family, and excessive social anxiety that does not improve with familiarity.

metabolic syndrome

here are 5 metabolic risk factors; at least 3 metabolic risk factors must be present for diagnosing metabolic syndrome. These include: 1. A large waistline, abdominal obesity. A waist measurement of 35 inches or more for women or 40 inches or more for men. 2. A high triglyceride level. Level of 150 mg/dL or higher or being on medicine to treat high triglycerides. 3. A low HDL cholesterol level. Level of less than 50 mg/dL for women and less than 40 mg/dL for men or being on medicine to treat low HDL cholesterol. 4. High blood pressure. Measurements of 130/85 mmHg or higher or being on medicine to treat high blood pressure. 5. High fasting blood sugar. A fasting blood sugar level of 100 mg/dL or higher or being on medicine to treat high blood sugar

________ risk of recurrence after a first tonic-clonic seizure involves abnormal neurologic findings; intellectual disability; abnormal electroencephalographic findings; myoclonic jerks, absences, or atonic seizures; structural brain lesions; family history of epilepsy; and elderly individuals.

high

The anxiety spectrum disorders are characterized by which of the following? A. Having low comorbidity with depressive disorders B. Having a low prevalence rate C. Having high suicide risk D. Being more common in males E. Having increasing prevalence into old age

high suicide risk

inflammatory polyradiculopathy

history of subacute to chronic, asymmetrical distal more than proximal sensory loss weakness with reduced deep tendon reflexes

poverty of content

hought that gives little information because of vagueness, empty repetitions, or obscure phrases.

Atrophy of the caudate nucleus, putamen and deep cerebral cortex are the hallmark features of __________

huntington disease

A 55-year-old man presents to the emergency department with complaints of chest pain, palpitations, and dyspnea. The patient complains of being unable to breathe in deeply enough and experiencing rapid breathing at rest several times for the past few months. Upon physical examination tetany of the hands is present, along with dry mouth and excessive sweating. The ECG shows sinus tachycardia and depression of ST segment. Hormone profile of the patient is normal. What is the most likely diagnosis? A. Acute coronary syndromeB. Hyperventilation syndromeC. HyperthyroidismD. Panic disorderE. Generalized anxiety disorder

hyperventilation syndrome (tetany)

amphetamine toxicity

hypervigilance, anxiety, tension, impaired judgment, etc. Physical symptoms include tachycardia, high blood pressure, pupillary dilation, etc. Other symptoms include muscle pain and seizures.

A 29-year-old woman is referred for psychiatric evaluation by her gynecologist. The referral note requests your expertise to rule out a somatoform disorder. The note mentions that the patient has been extensively worked-up, over the past 9-months, and does not have clinical, laboratory, and radiological findings suggestive of breast cancer. However, she remains anxious and distressed despite the reassurances and education. The patient's chief complaint on your interview with her is, "I fear I am going to die from breast cancer. My husband and my doctors think I am crazy and want me to see a psychiatrist - they don't understand me." You learn that one of her maternal aunts had breast cancer, a couple of years ago. What is her most likely psychiatric diagnosis? A. Adjustment DisorderB. Body Dysmorphic DisorderC. Generalized Anxiety DisorderD. Illness Anxiety DisorderE. Somatic Symptom Disorder

illness anxiety disorder

A 35-year-old-man presented in the outpatient department complaining about being concerned about having colon cancer since his best friend died of the disease 8 months ago. He has no history of weight loss, fatigue, or blood in the stool. He gets worried reading about colon cancer on the internet. He has recently visited 2 physicians and undergone various diagnostic investigations, including colonoscopy. The results were normal, and the physicians reassured him that he did not have cancer. He feels that he gets tired quickly and would like to have more tests. Which of the following is the most likely diagnosis? A. Somatic symptom disorderB. Illness anxiety disorderC. Functional neurological disorderD. Factitious disorderE. Malingering

illness anxiety disorder

Social skills training

important to control the inadequate expressive behavior and inappropriate stimulus control. The patients are taught to pick up social cues and respond effectively. They are provided with the necessary skills to become a productive member of society while also fighting their disablity by being distracted with the work.

There is significant __________ in the binding of M1 and M4 muscarinic receptors in the anterior cingulate cortex in patients with suicidal behaviors.

increase

A 45-year-old man is responding well to mirtazapine 30 mg qhs but complains of daytime sedation. He has no other side effects. Which one of the following strategies is the clinical strategy most likely to help decrease his sedation? A. Increase the doseB. Decrease the doseC. Add a stimulantD. Divide the dose in 2E. Wait 4 to 6 weeks

increase the dose

Wave V on the brainstem auditory evoked response (BAER) corresponds to activity at

inferior colliculi

A 29-year-old man presents to the hospital with excessive anxiety, restlessness, rhinorrhoea, vomiting, and profuse diarrhea from the past two days. He reports he had been "chasing the dragon." On physical examination, his muscles are twitching, dilated pupils, and blood pressure of 170/100 mm Hg is recorded. Which of the following is the correct diagnosis? A. Inhaled heroin withdrawalB. Alcohol withdrawalC. Hallucinogen withdrawalD. Sedative-hypnotic withdrawalE. Cannabis withdrawal

inhaled heroin withdrawal

Factitious disorder

intentional, without any motivational gain, feigning of symptoms for attaining a personal goal.

The Thematic Apperception Test (TAT) is most useful in assessing which of the following functions? A. Activities of daily livingB. IntelligenceC. Interpersonal functionD. Motor functionE. Verbal memory

interpersonal function

Which one of the following psychotherapies is a manual-based psychotherapy whose focus is limited to the following aspects of a patient's functioning: the conflicts, role transitions, grief, and deficits that contribute to a depressive disorder? A. Depressive disorders psychotherapyB. Dialectical behavioral therapyC. Interpersonal therapyD. Object relations therapyE. Psychosocial rehabilitation

interpersonal therapy

post partum psychosis

irritability, decreased need for sleep, low mood and energy, hallucination, disorganized thoughts, memory impairment and delusions. Patients with post-partum psychosis may also experience mood disorders (mania, depression, mixed type etc.) Delusions of altruistic homicide often occur. These symptoms usually occurs within 6 weeks postpartum and severely affect the functioning of life. It is associated with increased risk of suicide and infanticide and warrants immediate attention, therefore this condition is a psychiatric emergency.

Pellagra

is a disease caused by a lack of the vitamin niacin (vitamin B3). Symptoms include inflamed skin, diarrhea, dementia, and sores in the mouth. Areas of the skin exposed to either sunlight or friction are typically affected first.

Alpha‐synuclein (α‐syn)

is an intracellular neuronal protein which is thought to be the cause of synucleinopathies. These neurodegenerative diseases are characterized by the presence of misfolded aggregates of alpha‐synuclein, which is a major component of lewy bodies and lewy neurites present in Parkinson's disease, dementia with Lewy Bodies, diffuse Lewy body disease, and Lewy body variant of Alzheimer's disease. Other neurodegenerative diseases that share this protein include multiple system atrophy (MSA) and neurodegeneration with brain iron accumulation type I.

Tuberous sclerosis

is characterized by non-cancerous tumours to grow in the brain and on other vital organs such as the kidneys, heart, liver, eyes, lungs, and skin. Symptoms may include seizures, intellectual disability, developmental delay, behavioral problems, skin abnormalities, and lung and kidney disease. It is caused by a mutation of either of two genes, TSC1 and TSC2, which code for the proteins hamartin and tuberin, respectively.

Charles Bonnet syndrome

is the development of visual "hallucinations" in persons who have lost most or all of their vision.

undifferentiated type schizophrenia

it is associated with symptoms that do not meet the criteria for other types.

Medial prefrontal cortex

it is involved in long term explicit or declarative memory which is the ability to recollect facts and events consciously with primary output through glutamatergic pyramidal neurons.

tectum

it is located in the dorsal portion of the midbrain and consists of the superior colliculi and inferior colliculi, which are involved in visual and auditory reflexes respectively via neurotransmitters like glutamate.

hypothalamus

it is particularly important for maintaining homeostasis using the autonomic and endocrine systems

malignant hyperthermia

it occurs following administration of halogenated inhalational anesthetics like halothane or depolarizing muscle relaxants like succinylcholine in genetically susceptible individuals.

A 15-year-old girl is brought to the emergency room by her mother, concerned that her daughter has lost weight over the past 2 months to the point "her clothes don't fit anymore." The patient has a medical history significant for asthma. She was previously diagnosed with social anxiety disorder and recently joined a dance team at school. The mother reports the patient is quite busy and no longer eats meals with the family. The emergency department physician suspects an eating disorder and consults psychiatry with consultation question of whether to admit the patient to the medical unit versus sending her home with follow-up to the eating disorders clinic. For a patient with an eating disorder, which of the following indicators would lead you to strongly recommend inpatient medical admission? A. Significant decrease in daily dietary intakeB. Significant weight loss in a short timeC. Junctional bradycardia on EKGD. Continued exercise despite weight lossE. A blood pressure of 100/70 mm Hg

junctional bradycardia on EKG

Rivastigmine is metabolized by the ________

kidneys

A 23-year-old man, a recent immigrant from China, is brought by his brother to the psychiatry clinic because of his intense anxiety that his penis was receding into his body and that he was about to die. What is the patient's most likely diagnosis? A. Body dysmorphic disorderB. KoroC. AmokD. Ganser's syndromeE. Khyal Cap

koro

A 35-year-old man is brought to the emergency department with a severe headache for the past 2 hours. The headache is localized in the occipital region and is throbbing in character. He also complains of chest tightness. He was attending a party at his friend's house where he drank red wine and ate some cheese and nuts. He suddenly started developing symptoms, and soon an ambulance was called to take him to the hospital. His medical records show that he is being treated for major depressive disorder. On physical examination, his pulse is 94/min, his respiratory rate is 19/min, his temperature is 98.6°F (37°C), and his blood pressure is 197/128 mmHg. His face is flushed, and he is sweating profusely. He is oriented to time, place, and person. His muscle tone and deep tendon reflexes are normal. Which of the following is the appropriate treatment option for this patient? A. LabetalolB. CyproheptadineC. DantroleneD. PropranololE. Betamethasone

labetalol

Ophthalmologic checks may be useful in the long-term treatment of patients who are prescribed which one of the following psychotropics? A. LithiumB. LamotrigineC. Valproic acidD. SertralineE. Clonazepam

lamotrigine

observation learning

learning by watching others complete tasks.

For men, drinking should be _____per week or _________ day.

less than 14, no more than 5

In patients with ________________, there is a prodrome of agitation and excitement before the onset of muscle rigidity while __________ typically begins with muscle rigidity.

lethal catatonia/NMS

A 65-year-old woman is brought to the clinic by her son with the complaint of hearing voices at night for the past month. The voices tell her to leave the apartment that she has been living in for the last 20 years. She also sees a 4-year-old boy playing in the living room, but her son denies seeing him. She has a 5-year history of Parkinson's disease for which she takes levodopa and carbidopa. Her maternal aunt had schizophrenia. She also has a history of diabetes mellitus and hypertension for the past 15 years. Her current medications include losartan, amlodipine, and regular insulin regimen. She does not have a history of smoking or drinking. On physical examination, her pulse is 74 beats per minute, her respiratory rate is 13 breaths per minute, her temperature is 98.6°F (37°C), and her blood pressure is 129/88 mmHg. Her thoughts are organized, and her memory is intact. Which of the following is the most likely underlying cause of this patient's symptoms? A. DeliriumB. SchizophreniaC. High blood sugar levelD. LevodopaE. Brain tumor

levodopa

NMS

life-threatening neurological disorder that is most often caused by an adverse reaction to neuroleptic or antipsychotic drugs. Symptoms typically include high fever, sweating, unstable blood pressure, stupor, muscular rigidity, and autonomic dysfunction. Typically, NMS develops within the first 2 weeks of treatment with the drug; however, the disorder may develop any time during the therapy period. The syndrome may occur in patients taking dopaminergics if they are discontinued abruptly. Generally, intensive care is needed for proper treatment. The neuroleptic or antipsychotic drug is discontinued, and the fever is treated aggressively.

A 20-year-old woman presents with a one-month-history of depressed mood, insomnia, and tiredness. She finds it difficult to get out of bed in the morning, and even minor tasks require considerable effort. Her speech is slow and quiet; there is a noticeable latency in her responding to questions. She has had similar depressive episodes before; they typically occur during the winter and last about 4 months. She reports her mood is generally good between those episodes. What is the most suitable treatment for this patient? A. Light therapyB. Electroconvulsive therapy (ECT)C. Deep brain stimulationD. Repetitive transcranial magnetic stimulation (rTMS)E. Antidepressant drugs

light therapy

A 25-year-old woman presents to the hospital with a 5-day history of productive cough, chest pain, and dyspnea. She is found to have severe pneumonia and is hospitalized. Within 24 hours of initiation of antibiotic therapy, she becomes delirious and tachycardic. Neurological examination reveals hyperreflexia and myoclonus in both lower limbs. A review of her medical history shows that she was diagnosed with persistent depressive disorder 4 months ago and is currently on fluoxetine. Which of the following drugs could have resulted in the deterioration of her symptoms during her current hospital stay? A. LinezolidB. CeftriaxoneC. CiprofloxacinD. AzithromycinE. Gentamicin

linezolid

A 19-year-old man accompanied by his friend is brought into the emergency department for altered behavior. The patient has an unsteady gait and slurred speed. He appears lethargic with generalized muscle weakness. The friend explains that they had been sniffing glue when suddenly the patient had difficulty in talking and was unable to walk. They had recently started glue sniffing and the patient had no problems like this in the past. What is the property of the inhalant substance that can cause these effects on the brain? A. Lipid solubilityB. Water solubilityC. High molecular weightD. High protein bindingE. Highly charged molecules

lipid solubility

A 28-year-old woman visits the psychiatric clinic for a routine follow-up visit. She was diagnosed with bipolar disorder three years ago. She had presented with an acute manic episode for which she was hospitalized. She has had multiple psychotherapy sessions and has been prescribed various medications. The patient says her overall mood has been stable with the current regimen of drugs, but is having difficulty at work and home due to tremors, mostly affecting her hands, for the past two months. Which of the following drugs is the most likely cause of tremor in this patient? A. GabapentinB. CarbamazepineC. OlanzapineD. Topiramate

lithium

__________has become the most frequent cause of drug-induced nephrogenic diabetes insipidus (NDI)

lithium

first drug of choice to treat postpartum psychosis

lithium

A 65-year-old woman with a history of bipolar disorder is admitted to the general medical service with a sodium level of 165 mmol/L. The medication most likely the cause of this abnormality is which of the following? A. CarbamazepineB. OxcarbazepineC. LithiumD. Valproic acidE. Aripiprazole

lithium. Water loss due to impaired renal concentrating ability was implicated in the pathogenesis of hypernatraemia.

fusiform gyrus

located in the medial undersides of both occipital lobes and the medioventral sides of the temporal lobes.

MDD with melancholic features

loss of pleasure in activities or lack of happiness in response to happy stimuli and 3 of the following: profound despondency or moroseness, depression particularly worse in the morning, early morning awakening, marked psychomotor retardation, significant anorexia or weight loss and inappropriate guilt.

__________risk of recurrence after a first tonic-clonic seizure involves febrile seizure in a child; febrile status epilepticus (child); transient metabolic and toxic states; benign rolandic seizures; and impact seizures in early nonsevere head trauma.

low

A 32-year-old baseball coach is accused of sexually molesting a 9-year-old boy after a game. Which of the following characteristics are considered indicative of a good prognosis for the perpetrator? A. Lack of guiltB. Presence of substance abuseC. Low frequency of actsD. Antisocial personality traitsE. Early age of paraphilic behaviors

low frequency of acts

Lab abnormalities in diabetes insipidus

low urine osmolality, despite increased plasma osmolality, and a low urine specific gravity.

medications approved for fibromyalgia

lyrica, milnacipran, duloxetine

social skills training

mainstay of treatment for individuals with autism

Giving glucose before thiamine to a patient presenting with alcohol withdrawal most increases the probability of irreversible damage to which one of the following brain structures? A. Corpus callosumB. CerebellumC. Mammillary bodiesD. Frontal cortexE. Hippocampus

mammillary bodies

Catecholaminergic disruption is attributed to episodes of _______

mania

Catecholaminergic disruption is attributed to episodes of ___________whereas cholinergic dysfunction is attributed to episodes of ______________.

mania/depression

Which of the following drugs have the highest rates of use and of substance use disorders according to the Substance Abuse and Mental Health Services Administration (SAMHSA)? A. HeroinB. FentanylC. MarijuanaD. CocaineE. Phencylclidine

marijuana

________ training and ________ training have been found useful in patients with female orgasmic disorder.

masturbation/

Zinc deficiency

may cause cognitive dysfunction in children and may cause diarrhea, skin lesions, hair loss, and increased incidence of pneumonia.

Cariprazine

mechanism of action is unknown, but it is thought to work as a partial agonist at central D2 and 5-HT1A receptors, and 5-HT2A antagonism. It is FDA indicated for schizophrenia and bipolar disorder.

Wave VI on the brainstem auditory evoked response (BAER) corresponds to activity at

medial geniculate body

____________is the pathway involved in negative/cognitive sx of schizophrenia

mesocortical

Mr. Y is a 45-year-old Asian man with chronic psychotic symptoms. His positive psychotic symptoms are thought to be produced by dysfunction in which dopamine pathway? A. NigrostriatalB. MesolimbicC. MesocorticalD. TuberoinfundibularE. Striatopallidothalamic

mesolimbic

Succinic semialdehyde

metabolite of gamma-aminobutyric acid (GABA) which subsequently enters the citric acid cycle and it is used in the generation of energy.

Dopamine receptor D4 promoter hypermethylation has been recently studied to increase susceptibility to drug addiction to ________ and ______.

methamphetamines and heroin.

A college student is brought to the emergency room by his roommate. The student has been cleaning their apartment vivaciously for the past 18 hours. "Nothing I do seems to make it clean enough," he says, visibly agitated. Which of the following drugs is most likely to have precipitated this presentation? A. ClonazepamB. FluoxetineC. OlanzapineD. MethylphenidateE. Acetaminophen

methylphenidate

postpartum blues

mild depressive symptoms (e.g., tearfulness or sadness) that may last up to 2 weeks following delivery

A 75-year-old woman presents to the clinic with complaints of difficulty sleeping and weight loss during the past few months. She finds it very difficult to fall asleep and repeatedly wakes up at night, sleeping only 3 to 4 hours a night. She has also lost her appetite with a weight loss of 10 lbs during the past month. She has lost interest in different activities that she previously used to enjoy, like knitting sweaters for her grandchildren. She feels tired throughout the day and complains of poor focus. She does not have any suicidal ideation. Her current medications include amlodipine for hypertension and omeprazole for GERD. On physical examination, her pulse is 74/min, her respiratory rate is 13/min, her temperature is 98.6°F (37°C), and her blood pressure is 128/83 mmHg. She has a flattened affect. Which of the following is the appropriate treatment option for this patient? A. MirtazapineB. ClomipramineC. FluoxetineD. LithiumE. Sodium valproate

mirtazapine

Which of the following is an alpha 2 adrenergic receptor blocker indicated in major depressive disorder? A. FluoxetineB. NefazodoneC. VenlafaxineD. MirtazapineE. Bupropion

mirtazapine

____________ is a reversible inhibitor of monoamine oxidase a (RIMA), and it can be used for depressive disorders. This drug is not FDA-approved in the U.S., but it is used in the U.K. and Australia

moclobemide

A 25-year-old man presents to the clinic with complaints of sleepiness, although he has been sleeping for long hours. He says that he suddenly feels sleepy, and even a mere 15 minutes nap helps him feel refreshed. These 'sleep attacks' occur throughout the day, sometimes in the middle of a meal. He has started to hallucinate during the day and complains of his muscles freezing after he laughs a lot. He also experiences sleep paralysis. These episodes would occur 3 times per week but have become more frequent now. Polysomnography shows REM sleep latency of 15 minutes. What is the best management option for this patient? A. ModafinilB. AmitriptylineC. FluoxetineD. BupropionE. Imipramine

modafinil

MDD with atypical features

mood is reactive to positive stimuli along with significant weight gain, hypersomnia, leaden paralysis and long standing pattern of inter-personal conflicts causing significant social impairment.

Naloxone (Narcan)

mu opioid receptors antagonist.

Which one of the following effects is the most common adverse effect of naltrexone? A. DizzinessB. HeadacheC. FatigueD. NauseaE. Vomiting

nausea

carbamazepine side effects

nausea, vomiting, drowsiness, diplopia, blurred vision, and ataxia. Hematological side effects such as mild anemia, leucopenia, and thrombocytopenia are also common. It may also cause electrolyte disturbances such as hyponatremia and hepatotoxicity. The development of a rash is a common side effect within the first 6 months of treatment and may warrant discontinuation of the drug due to the risk of Stevens-Johnson syndrome (SJS) and other serious dermatological reactions.

flumazenil

negative allosteric modulator (or sometimes referred to as an antagonist) at the benzodiazepine binding site on the GABA-A receptor. Thus, it can only reverse the effects of drugs that bind to the benzodiazepine binding site, that is, the benzodiazepines and the non-benzodiazepine hypnotics called the Z-drugs, that is, zaleplon, zolpidem, and eszopiclone.

_______________ DI is caused by an injury to the neurohypophysial system (posterior pituitary or neurohypophysis) and responds to exogenous ADH administration.

neurogenic or central

Functional neurologic symptom disorder

neurologic symptoms that cannot be explained by neurologic investigations or any other known disease.

Variation in the serotonin transporter-linked polymorphic region (5HTTLPR) has been associated with an increased risk for ____________dependence.

nicotine

A 30-year-old man who was diagnosed with depressive disorder presents to the psychiatric clinic with complaints of difficulty sleeping. According to his wife, he shouts during his sleep at night and appears to be scared. He does not recall anything when he wakes up. What is the diagnosis? A. Sleep drunkennessB. SomnambulismC. NightmaresD. Night terrorsE. Narcolepsy

night terrors

Which of the following parasomnias occurs during REM sleep? A. Nightmare disorderB. Confusional arousalsC. Sleeptalking disorderD. Sleep terror disorderE. Sleepwalking disorder

nightmare disorder

Which one of the following symptoms is commonly included in the signs and symptoms of benzodiazepine discontinuation syndrome? A. Grand mal seizuresB. PsychosisC. NightmaresD. HyperpyrexiaE. Death

nightmares

_______________ is the pathway involved in EPS

nigrostriatal

mixed- subtype of delusional disorder

no one delusional theme predominates.

Buspirone

non-benzodiazepine anxiolytic medication that binds to serotonin 1a and 2 receptors. It is approved for treating generalized anxiety disorder.

Eszopiclone

non-benzodiazepine hypnotic is indicated for in the treatment of insomnia characterized by difficulty with sleep onset and sleep maintenance.

Bupropion

norepinephrine and dopamine reuptake inhibitor. It also acts as a nicotinic receptor antagonist and used in smoking cessation.

CRSDs

occur when there is an inability to maintain alignment between the internal clock and the external environment.

A 25-year-old woman comes to your clinic for a second opinion. She tested positive for amphetamines in a random urine drug test done by her company. During the entire course of her interview, you don't note any signs of a possible amphetamine use disorder. Which among the following substances can cause false positives in amphetamine immunoassays? A. AlcoholB. CitalopramC. OfloxacinD. AlprazolamE. Caffeine

ofloxacin

Transient ischemic attacks

often have a specific pattern of occurrence, reflecting the anatomic position of the affected vessel and its watershed, and will often be of recent onset and escalating frequency preceding a stroke event. TIAs from an embolic source can be varied in their symptoms, depending on where the embolus lodges in the cerebral vasculature, but generally TIA symptoms of either type are more persistent, lasting up to 24 hours by definition.

A 37-year-old woman is brought to the clinic by her husband with the complaint of hearing voices for the past 2 months. She describes the voices as a constant loud chattering of people. She has not been able to sleep for the last 2 months without the use of sleep aids. She only sleeps for 3 to 4 hours daily. She also repeatedly checks her blood pressure with a home blood pressure monitoring device. She insists that she has hypertension, and she may get a heart attack without using the appropriate medicines. She thinks that her husband will divorce her soon. She has no history of smoking or drinking. On physical examination, her pulse is 84 beats per minute, her respiratory rate is 16 breaths per minute, her temperature is 98.6°F (37°C), and her blood pressure is 118/78 mmHg. She is restless and has a flat affect. Her thoughts are disorganized. The psychiatrist prescribes her olanzapine for her psychotic symptoms. Which of the following should be monitored during her treatment? A. Lipid profileB. Thyroid hormone levelsC. Complete blood countD. Serum electrolyte levelsE. Serum creatinine level

olanzapine

A 56-year-old woman with schizophrenia presents with increasing withdrawal and apathy. She has had a history of developing tardive dyskinesia with increased doses of fluphenazine. She is a known cigarette smoker consuming 2 and a half packs-per-day of cigarettes. Which among the following medications is known to be decreased in blood concentrations of current cigarette smokers? A. OlanzapineB. ChlorpromazineC. QuetiapineD. ZiprasidoneE. Aripiprazole

olanzapine

A psychiatric consult is called for a 72-year-old man who underwent laparoscopic colon surgery under general anesthesia five days ago. Following extubation, the patient had been stable and oriented. For the past two days, however, the patient has been complaining of excruciating pain, so his tramadol dose was increased. Following this dose increase he developed two episodes of vomiting. His vital signs are stable. A CT scan of his abdomen shows 4-cm sized region of fluid collection at the colorectal anastomosis. The patient has been restless, irritable and agitated for the past three hours. He is unable to respond appropriately to commands and continues to make frequent nonpurposeful movements while lying on his bed. He is diagnosed as hyperactive delirium with a RASS score of +2. There was one further episode of vomiting during the delirious state. While the underlying etiology of delirium is addressed, which of the following anti-emetics can be most safely used in the context of postoperative delirium? A. AprepitantB. OndansetronC. MetoclopramideD. PromethazineE. Diphenhydramine

ondansetron

ventral tegmental area

one of the major dopaminergic areas in the brain located in the midbrain with projections via mesolimbic and mesocortical pathways to limbic and cortical regions respectively. These pathways are involved in various cognitive and emotional processes, especially motivation, reward, and addiction.

A 30-year-old woman presents to the clinic with the complaints of dyspnea, dizziness, chest pain and palpitations. For the past two years she experiences these symptoms whenever she is exposed to insects. She gives the history of similar phobia in her mother. On examination, heart rate is 100 beats/min, and blood pressure of 120/80mmHg is recorded. ECG and chest x-ray are normal. She is offered multiple sessions of exposure therapy, but she refuses to take them due to her busy schedule and the high cost of the treatment. Which of the following is an appropriate treatment option for her? A. Flooding B. One-session exposure therapy C. Quetiapine for 6 months D. Sertraline for 3 months E. Alprazolam for 3 months

one session exposure therapy

papillary constriction (miosis), decreased level of consciousness, drowsiness, and slurred speech. When severe, respiratory depression, hypotension, and hypothermia can also be observed

opioid intoxication i

naltrexone

opioid receptor agonist and helps decrease cravings. This may be a valid long-term option, but the will not address the patient's withdrawal symptoms. As alcohol withdrawal can be fatal, it is often necessary to taper a patient down on benzodiazepines in the initial stages of treatment.

A 68-year-old man with no past psychiatric history is admitted to an inpatient psychiatric unit after being seen in a clinic with an increased energy level, pressured speech, tangential thinking, insomnia, and grandiose delusions. He has no recent history of disease or other health problems. There is no known history of alcohol or drug use disorder, and the only remarkable aspect of his family psychiatric history was that his mother was diagnosed with generalized anxiety disorder. During the physical examination, the patient makes sexually inappropriate remarks to the clinician and tells her he had his eyebrow pierced 2 days ago to "catch the ladies' eyes". His vital signs are currently stable, and he scored 28 out of 30 on the Mini-Mental State Examination (MMSE). His neurologic examination is nearly normal, except that upon primitive reflexes testing, palmomental and grasp are present. Serum chemistries, a complete blood count, liver function tests, and thyroid function tests were all within normal limits. The results of a fluorescent treponemal antibody absorption (FTA-ABS) test and a urine drug screen were negative. A noncontrast CT scan of the head is ordered.The CT scan is most likely to show an injury at which of the following locations? A. Orbitofrontal cortexB. AmygdalaC. Mammillary bodiesD. Arcuate fasciculusE. Subthalamic nucleus

orbitofrontal cortex

A 38-year-old woman visits the clinic with a complaint of anxiety when leaving the house. According to the patient, for the past 3 years she has been having increasing difficulties in leaving the house because of the persistent fear of "getting stuck". She is afraid of not being able to get help if she experiences panic attacks when she is out of the house or in a closed space like a shopping mall. She has had multiple episodes of the intense worry associated with palpitations, shortness of breath, chest pain, sweating, and dizziness with a fear of dying that last for around 15 minutes. She constantly worries about when will the next attack occur and what will happen if these continue to occur for the rest of her life. This is affecting her everyday activities as she avoids going out until absolutely necessary. What is the most likely diagnosis? A. Panic disorderB. AgoraphobiaC. Panic disorder and agoraphobiaD. Generalized anxiety disorderE. Social anxiety disorder

panic disorder and agoraphobia

anti-Hu in ---------------- syndromes commonly associated with small-cell lung cancer.

paraneoplastic neuropathy syndromes

Which of the following is a risk factor for antisocial personality disorder? A. Parental neglectB. Peer pressureC. Early age for drivingD. Parents with social anxietyE. Frequently changing schools

parental neglect

A 30-year-old woman presents to her primary care physician with complaints of episodes where she can feel her heart thumping. She also states that these episodes are accompanied by trembling, increased sweating, and lightheadedness. She fears these attacks will happen to her anywhere anytime. She also constantly worries about having a heart attack. She first started having these episodes when she got into college and has been experiencing them ever since. The patient's physical examination is unremarkable. The patient denies use of alcohol or any other drugs. Thyroid hormone levels are normal. Urine analysis shows normal levels of VMA. Which of the following will be used in the management of the patient? A. Phenoxybenzamine B. Propylthiouracil C. Cyproheptadine D. Dantrolene E. Paroxetine

paroxetine

Which of the following medications given for depressive disorder is most likely to cause withdrawal symptoms if abruptly discontinued? A. ParoxetineB. SertralineC. FluoxetineD. CitalopramE. Escitalopram

paroxetine

A 5-year-old boy is brought to a local physician for excessive behavioral outbursts and irritable mood, both at home and at his daycare center. He is frequently disruptive during playtime and group activities, according to the daycare center teacher, requiring staff to isolate the boy from other children. The boy's mother notes that the patient has thrown tantrums at home in response to interactions with all family members for the past 15 months. The patient has no significant past medical history and no family psychiatric history. The patient was born preterm at approximately 30 weeks gestation. The mother of the patient has read about a new disorder in psychiatry, disruptive mood dysregulation disorder (DMDD). Which of the following factors is a reason that DMDD would be excluded in the differential diagnosis for this boy? A. Patient's ageB. Nature of patient's behavioral dysregulationC. Absence of past medical historyD. Absence of family psychiatric diseaseE. Patient's premature birth

patient's age

A 24-year-old man presents to the psychiatry clinic with complaints that he is preoccupied with making and following strict rules. He states that he is frequently called rigid and stubborn by family and at the workplace. The patient has trouble in work completion as he spends too much time in making it flawless. During the interview, the patient has a stiff and formal demeanor, and his answers to therapist questions are unusually detailed. Which of the following features is a characteristic of the most likely diagnosis of this patient? A. PerfectionismB. Blunted affectC. Instability in relationshipsD. AloofnessE. Suspiciousness

perfectionism

A 64-year-old man presents to clinic. His family members who accompany him report a history of depression, apathy, and cognitive decline over the last 10 to 15 years characterized by 'slow thinking and slow movements.' On exam, he is unshaven and disheveled and has urine stains on his pants. His blood pressure is 200/110 with a pulse of 84. The patient speaks slowly, softly, and is hard to understand due to a 'mumbling speech.' His gait is unsteady with a stiff walk and odd placement of his feet, which leads to swaying and near falls. He has clumsy and slow limb movements, left sided weakness and an extensor plantar sign on his left. He has incomplete gaze paresis. At one point in the interview when a clinic door closed loudly, the patient started crying although he could not describe why and denied feeling sad or distressed. Given this patient's presentation, in which region or brain structure is brain damage most likely present? A. AmygdalaB. CerebellumC. HippocampusD. Periventricular white matterE. Thalamus

periventricular white matter

depersonalization/derealization disorder

persistent or recurrent experiences of feeling detached from or an outside observer of one's mental processes or body, with intact reality testing, accompanied by clinically significant distress or impairment of functioning.

Depersonalization/derealization disorder

persistent or recurrent experiences of feeling detached or outside of one's body or mental processes without loss of reality testing, which he also does not describe.

histrionic personality disorder

pervasive pattern of excessive emotionality and attention-seeking beginning by early adulthood, interacting with others in provocative ways and using physical appearance to draw attention. Individuals with narcissistic personality disorder have a pervasive pattern of grandiosity, need for admiration, and lack of empathy, beginning by early adulthood. They often tend to overestimate their abilities and are convinced of their superiority, expecting others to recognize their superiority as well. Their self-esteem is very fragile, and they require constant admiration and attention.

A 29-year-old man presents to the emergency department complaining of visual hallucinations. The patient has a history of schizophrenia and one week ago he was advised to take medication to relieve extrapyramidal side effects associated with the use of antipsychotic drug chlorpromazine. On examination, the patient has dry mouth associated with dilated pupils and warm skin. His pulse rate is 128 bpm. After the offending agent is held, which of the following medications may be indicated? A. AtropineB. DantroleneC. HaloperidolD. LorazepamE. Physostigmine

physostigmine

A 79-year-old female nursing home resident is found unresponsive. Her nephew, who visited that day, is called and admits to giving the patient some 'generic Benadryl' for her allergies. Which medication is most likely to reverse the patient's delirium? A. AtropineB. NaloxoneC. FlumazenilD. Pralidoxime (2-PAM)E. Physostigmine

physostigmine

A 67-year-old man is brought in by his wife with complaints of slowness of movements, tremors, unstable gait, and recent onset of "visions," such as a snake in the house and bats in their bedroom. He was so scared that they had to leave the house for a few nights. While open to the consideration that these animals didn't exist, he describes these experiences as "terrifying" and "very real" when they were happening. He has a remote psychiatric history of depression, but denies recent changes in mood. His past medical history is significant for hyperlipidemia and hypertension. His medications include ibuprofen, atorvastatin, and amlodipine. He has no history of substance abuse. His tremor has been present for about a year, and his wife adds that the visions started within the last 2 months. On exam, he has a resting tremor, cogwheel rigidity, masked facies, and stooped posture, but he is alert and fully oriented. Provided that the workup for any acute medical illness is negative, what would be the best treatment for his visions? A. RisperidoneB. No treatment is necessaryC. QuetiapineD. PimavanserinE. Carbidopa-levodopa

pimavanserin

An 18-year-old woman presents to the hospital after aspiration with a large amount of paint thinner while painting her room. She is not showing any symptoms at the moment. The patient is kept under observation, six hours later she starts developing severe abdominal pain, nausea, and vomiting. She reveals that she is involved in sniffing and snorting paint thinner from past three years. History of any other psychiatric or medical illness is negative. What is the most common complication associated with hydrocarbon intoxication? A. PneumonitisB. Hepatic failureC. ComaD. Oesophageal tearE. Dysrhythmias

pneumonitis

POEMS,

polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes. The polyneuropathy is distal and symmetric, with sensory involvement before motor. Organomegaly can include hepatomegaly, splenomegaly, or lymphadenopathy. Endocrinopathies include diabetes mellitus, thyroid disorder, and imbalance of estrogen or testosterone. The M-protein is a monoclonal gammopathy detected by serum protein electrophoresis. Skin changes include hyperpigmentation, hypertrichosis, skin tightening, and Raynaud's phenomenon, among others. In this patient, the serum protein electrophoresis will clinch the diagnosis.

St.John wort

popular name for Hypericum perforatum and contains a combination of atleast 10 different components. The most important out of these are flavonoids, hypericins and xanthons. It is a potent inducer of intestinal and hepatic cytochrome P450 enzymes, thereby reducing the plasma concentration of the drugs given concurrently. It has shown to reduce the plasma concentration of combined oral contraceptive pills and has led to treatment failure. St.john wort does interact with serotonergic drugs like fluoxetine and nefazodone to cause serotonin syndrome but that is a pharmacodynamic drug interaction. Fluoxetine is an enzyme inhibitor, so the drugs cancels out the effect and augments the same neurotransmitter pathway.

A 38-year-old woman with a history of childhood trauma, borderline personality disorder, major depression, and morbid obesity is referred for a pre-operative psychiatric evaluation prior to bariatric surgery. The patient has attempted several weight loss programs without lasting benefit, and has recently been prescribed stimulant medications for treatment of binge-eating disorder, also without benefit. She is concerned about worsening of her mood following surgery. Which of the following factors most predicts worsening depression/mood disorder following bariatric surgery? A. Premorbid history of borderline personality disorderB. Premorbid history of major depressionC. Multiple failed attempts at weight loss prior to surgeryD. Post-operative weight gainE. Pre-operative body mass index

post operative weight gain

A single 56-year-old man notices memory impairment. His physician diagnoses him with mild early onset Alzheimer's disease. The man understands what awaits him. To prepare for his inevitable cognitive decline he appoints his brother to act as his agent (surrogate decision-maker) in regard to health care decisions when he can no longer make them himself. To what role did the patient appoint his brother? A. ConservatorB. Estate plannerC. GuardianD. PayeeE. Power of Attorney

power of attorney

A 50-year-old woman visits the psychiatric clinic for a follow-up visit and psychotherapy following diagnosis of acute stress disorder. She recently lost her husband and her house in a hurricane. She has moved to a different state to live with her daughter. She says that she still has nightmares that are affecting her sleep although there has been a decrease in the flashbacks. She has diabetes and takes metformin. Which of the following can be beneficial for this patient's symptoms? A. TriazolamB. GabapentinC. NefazodoneD. PrazosinE. Venlafaxine

prazosin

A 24-year-old woman with an opioid use disorder is brought for a follow up in your clinic. When she is asked about her condition, she replies, "I really don't know why they (the police) make a big deal out of this". Based on her reply, what stage of change is this patient in? A. Pre-contemplationB. ContemplationC. PreparationD. ActionE. Maintenance

precontemplation

Interpersonal therapy, rational-emotive behavior therapy, and gestalt therapy would be appropriate for patients who are in the ___________ stage of change.

preparation

cannabis-induced anxiety

presents with new-onset anxiety symptoms in the absence of hallucination after cannabis use.

5-HIAA

primary metabolite of serotonin and low levels of 5-HIAA can be used to indirectly measure the levels of serotonin which is associated with a significantly higher risk of attempting suicide in patients with depression.

in schizophrenia, -------------such as apathy, flattened affect, lack of energy, social absenteeism, and lack of expressiveness are constantly associated with a poorer outcome in terms of treatment response, hospitalization time, readmissions, and social functioning in this condition

primary negative symptoms

Mentalization

process of thinking about one's own self as well as others, which is an advanced and effective way of dealing with persons who have anxiety disorders.

Positron emission tomography (PET)

produce images that show concentrations of radioactive compounds injected into patients; this is useful in detecting brain tumors, degenerative diseases, and locating epileptic foci.

general inflammatory myopathies

produce symmetrical weakness and are not associated with a loss of muscle stretch reflexes.

Myasthenic syndrome

produces symmetrical weakness and is not associated with low back pain.

Mutations in the _____________gene result in frontotemporal lobar degeneration, a common cause of pre-senile dementia.

progranulin

Individualized Family Service Plan (IFSP)

provides special services for young children with developmental delays.

Ganser syndrome

psychiatric condition where an individual consciously feigns to be affected by medical or psychiatric condition in spite of being healthy.

A 30-year-old woman visits the psychiatric clinic with her husband for consultation regarding her altered behavior. The patient gives a history of motor vehicle accident two years ago following which she had to undergo amputation of her right leg below the knee. She has had multiple surgeries since the accident and is currently using a prosthetic. The patient says that she started to have flashbacks associated with distressing recollections of the accident six months ago. After that, she has had trouble sleeping at night and wakes up sometimes due to nightmares related to the accident. She has stopped traveling in the car as it gives her anxiety. She feels sad and depressed most of the times which has affected her relationship with her husband. She has angry outbursts at certain times especially when she is having difficulty with her prosthetic leg. There is no history of psychiatric illness. She takes ibuprofen for pain and denies using any recreational drugs. Which of the following psychotherapeutic treatment may be harmful in the acute setting for this patient? A. Psychodynamic therapyB. Eye movement desensitization and reprocessingC. Cognitive processing therapyD. Psychological debriefingE. Stress inoculation training

psychologyical debriefing

A 15-year-old boy presents to the emergency department with inhalant intoxication. He has a history of inhaling petrol for the last 2 years. He started inhaling petrol in the company of his friends and got addicted to the "high" he experienced from the inhaling. Which of the following organ systems may most commonly be affected by the inhalation of hydrocarbons? A. Cardiovascular systemB. Pulmonary systemC. Central nervous systemD. Gastrointestinal systemE. Renal system

pulmonary system

A 79-year-old woman comes to the psychiatry clinic for evaluation. The patient states that she has a need to check things all the time. For example, when she goes to bed she has to return several times to the main door of her house to check that the door was locked. On further interview she tells you that these symptoms started after a stroke a year ago. Prior to that she never had these symptoms. Where is the lesion most likely located? A. Left occipital lobeB. Right occipital lobeC. Anterior cingulate cortexD. Orbitofrontal cortex bilaterallyE. Putamen

putamen

amok

rare cultural bound syndrome defined as sudden attack and aggressive behavior by a single individual having suicidal and homicidal ideations resulting in fatalities and destruction of property.

acromegaly

rare endocrine disorder that is a result of excess growth hormone production. It typically presents with enlarged hands and feet. Enlargement of the forehead, jaw, and nose is also observed. The disorder is due to excess growth hormone production from the pituitary gland, most of the times it is due to the presence of a benign tumor, known as a pituitary adenoma.

Hallucinogen persisting perception disorder

re-experiencing, following hallucinogen use, of one or more perceptual symptoms experienced while intoxicated, which may include geometric hallucinations, false perceptions of movement in the peripheral vision, flashes of color, visual trails behind moving objects, positive afterimages, halos around objects, macropsia, and micropsia.

Angular gyrus connects the primary visual cortex to the Wernicke's area and is needed for _____________

reading

Dissociative amnesia

requires 1 or more episodes of inability to recall important personal information, usually traumatic or stressful, too extensive to be explained by ordinary forgetfulness, not occurring as a symptom of another disorder.

tourette's disorder

requires multiple motor and one or more vocal tics present at some time during the illness, not necessarily concurrently, persisting for more than one year, with onset younger than 18 years of age

cannabis use disorder

requires the presence of distressing symptoms of cannabis use and inability to quit cannabis despite knowledge of harmful effects or increase in the amount of cannabis use or strong craving to consume cannabis accompanied by tolerance or withdrawal symptoms for at least 12 month period.

A 38-year-old man presents to the clinic for a consult regarding the inability to quit smoking weed. The patient started using marijuana ten years back. Ever since then the patient has been a consistent cannabis-user with increasing dependence over time. His cannabis-use has progressively caused interpersonal conflicts in his marital life. The patient was diagnosed with subfertility after failure to conceive for the past six years. There is associated chronic cough with sputum production, shortness of breath on exertion, and gastrointestinal disturbances (mild ulcerative colitis). He is also hypertensive for which he uses amlodipine daily. Which body system is most significantly affected by chronic cannabis use? A. CardiovascularB. RespiratoryC. GastrointestinalD. ReproductiveE. Endocrine

respiratory

hyperactive delirium

restlessness, agitation, hypervigilance, hallucinations, delusions

You are being consulted for treatment of AIDS-related anorexia associated with weight loss with dronabinol (brand name Marinol). Dronabinol is a synthetic delta-9- tetrahydrocannabinol (delta-9-THC) which is also a naturally occurring component of Cannabis sativa L. (marijuana). Dronabinol is a Schedule drug under the Controlled Substances Act of 1970. Please identify the correct category: A. Schedule IB. Schedule IIC. Schedule IIID. Schedule IVE. Schedule V

schedule III

A 30-year-old man is brought to the emergency department by the police. His neighbors saw him dancing around a fire he set in the trash outside his house and called 911. On mental status examination, his speech is pressured and he appears distracted. He was up all night creating new dance moves for a party he plans to attend the following weekend. He also went to the mall and bought as many outfits as he could carry out of the store. This is the first time he has ever felt so good, full of energy, and confident in himself. He mentions hearing voices frequently over the past 2 years telling him his neighbors are evil people and that they need to be taught a lesson, which he is now starting to believe. Which of the following is the most likely diagnosis? A. Schizoaffective disorderB. SchizophreniaC. Schizophreniform disorderD. Delusional disorderE. Brief psychotic disorder

schizoaffective disorder

A 35-year-old man presents to the clinic for a checkup. He had cut himself by accident while making dinner last night and came to the clinic to get his wound checked. He has not seen a physician in years. When asked about his life, he tells the physician he likes his job working as a computer programmer. He can work from home and communicates directly with his boss when required, usually through e-mails. He doesn't care much about any positive or negative feedback from his boss. He doesn't choose to spend holiday with family members and never dated. Although his family tells him to get married, he says he is content with his life the way it is. Throughout the conversation, he maintains poor eye contact and has a flat affect. He recalls it's always been this way throughout his life. What is the most likely diagnosis? A. Paranoid personality disorder (PPD)B. Schizoid personality disorderC. Schizotypal personality disorderD. SchizophreniaE. Avoidant personality disorder

schizoid personality disorder

A 20-year-old man presents to the psychiatry clinic with his parents who report their son has been behaving oddly for the past 6 months. He was found talking to himself quite a lot of times and is unable to carry out his daily tasks. Upon further questioning, the patient says he has been hearing voices when nobody is in the room. He denies any suicidal ideations. Upon mental status examination, the patient's appearance looks disheveled with poor eye contact, speech is coherent, thoughts are tangential, and judgment is poor. Which of the following is the most likely diagnosis? A. Social anxiety disorderB. Bipolar disorderC. Schizotypal personality disorderD. SchizophreniaE. Major depressive disorder

schizophrenia

Which one of the following personality disorders is the premorbid personality of schizophrenia? A. AvoidantB. BorderlineC. ParanoidD. SchizoidE. Schizotypal

schizotypal

ECT

sed in patients of major depressive disorder (MDD) who do not show improvement in symptoms with the use of anti-depressant drugs. ECT involves electrical stimulation of the brain. This procedure is usually carried out under anesthesia. It is safe to use, even during pregnancy. The few side effects of ECT include retrograde amnesia and adverse effects of anesthesia.

Alcoholic ketoacidosis

seen in the setting of heavy alcohol use, decreased food intake, and dehydration, where liver glycogen is depleted, insulin production decreased, and lipolysis increases with release of free fatty acids that are converted to ketones, giving the fruity smell to the breath.achypnea is a result of acidosis with respiratory compensation. Abdominal pain is present is 60% of cases and may progress to pancreatitis.

You are called by a friend in distress, "My husband found out he is getting fired - he's been drinking all night, and now swallowed a handful of my valium. I don't know what to do." You help her to call emergency services. Upon arrival the emergency medical technicians (EMTs) suggest administration of commonly known benzodiazepine receptor antagonist. You urge caution to its use based on knowledge of patient's history. What in his history would most likely account for your caution? A. Cocaine useB. Seizure disorderC. Peanut allergyD. Bipolar disorderE. Psychotic disorder

seizure disorder

The most common causes of a ______________ or ______________ include paraneoplastic disease, Sjogren's syndrome, and idiopathic sensory neuronopathy. Other causes include toxicity of cis-platinum and other analogues, vitamin B6 toxicity, and HIV-related sensory neuronopathy.

sensory neuronopathy or dorsal root ganglionopathy

A 35-year-old woman presents to the clinic with excessive worry about her husband and 13-year-old daughter. According to the patient, whenever her husband and daughter leave the house, she becomes extremely worried about losing them or something bad happening to them. She calls them every hour to find out if they are fine and when will they be returning home. She often has nightmares of losing them. She experiences headaches and nausea whenever she is away from her family. She is not able to concentrate on work as she is constantly worried about her family and takes the majority of the time out for calling them. This has also affected her relationship with her family. These symptoms have been going on for 8 months. There is no significant past medical, surgical, or psychiatric history. The patient denies using any drugs. Which of the following is the most likely diagnosis?

separation anxiety disorder

A 28-year-old woman presents to the clinic with complaints of low mood, significant weight loss, and apathy for one month. She also mentioned that she has been experiencing day time somnolence even after sleeping well the night before. She has been feeling so tired that she had to resign from her job and cannot keep herself focused on anything. Moreover, she also doesn't feel like going out with friends anymore. No obvious trigger was identified from the history. Which neurotransmitter is the most important mediator in this condition? A. TryptophanB. SerotoninC. AcetylcholineD. NorepinephrineE. Dopamine

serotonin

A 20-year-old woman has symptoms of major depression. In addition, she admits to occasional binging, purging, and cutting. She has taken fluoxetine in the past, but it gave her side effects. Therefore, she is to be treated with sertraline 50 mg. She mentions that she has been taking some St. John's wort for depression as well, and wants to know if she could take both of them together. Which one of the following adverse reactions can result with this combination? A. Neuroleptic malignant syndromeB. Tardive dyskinesiaC. Serotonin syndromeD. Hepatic failureE. Renal failure

serotonin syndrome

A 30-year-old man being treated for depression presents with lethargy, confusion, diaphoresis, flushing, tremors, and myoclonic jerks. The most likely diagnosis is which of the following? A. Anticholinergic deliriumB. Serotonin syndromeC. SSRI discontinuation syndromeD. Neuroleptic malignant syndromeE. Hyperammonemia

serotonin syndrome

A 65-year-old woman was prescribed SSRIs to treat her depression. Two months after the beginning of treatment she presented to the emergency department with delirium, restlessness, tachycardia, diaphoresis, and hyperthermia. Upon examination, there is a presence of hyperreflexia and bilateral Babinski sign. The patient has an elevated WBC count and creatinine phosphokinase levels. It was found she had started taking antiemetics along with her antidepressants due to food poisoning. Head CT scan and MRI are normal. What is the most likely diagnosis? A. StrokeB. Malignant hyperthermiaC. Serotonin syndromeD. SSRI discontinuation syndromeE. Neuroleptic malignant syndrome

serotonin syndrome

A 28-year-old woman presents the clinic for a follow-up. She has recently completed cognitive behavioral therapy for generalized anxiety disorder but has not shown any improvements in her symptoms. She has a past history of substance use disorder. Which of the following is the most appropriate treatment in this patient? A. DiazepamB. SertralineC. ImipramineD. LorazepamE. Alprazolam

sertraline

Lennox- Gastaut

severe childhood-onset epilepsy. It is characterized by multiple and concurrent seizure types, cognitive dysfunction, and slow spike waves on electroencephalogram (EEG). Typically, it presents in children aged 3-5 years and can persist into adulthood.

Galantamine is contraindicated in ________ and __________ impairment.

severe renal and hepatic

SSRIs have been found to have a -------onset of therapeutic action in premenstrual dysphoric disorder, showing their effect within hours to days. This onset of action allows ------dosing to be used for the treatment of premenstrual dysphoric disorder.

short and intermittent

____________________ is an impairment in the perception of more than one object at a time.

simultanagnosia

A 20-year-old man presents to the hospital with extreme anxiety whenever he is to give a presentation in one of his college classes. He reports he was fine through high school, but now he always worries about an upcoming presentation for days ahead and, the night before, is unable to sleep. During the presentation, he starts sweating, blushing, and his mouth gets dry. He reports that it feels like torture and as if everyone in class is laughing at him. Other social situations, like going to parties, are difficult for him as well. Which of the following is his most likely diagnosis? A. Separation anxiety disorder B. Selective Mutism C. Social anxiety disorder D. Generalized anxiety disorder E. Specific Phobia

social anxiety disorder

Which of the following symptoms is not considered when diagnosing persistent depressive disorder? A. Depressed moodB. Feelings of hopelessnessC. InsomniaD. Poor appetiteE. Suicidal thoughts

suicidal thoughts

Wave VII on the brainstem auditory evoked response (BAER) corresponds to activity at

superior temporal gyrus/upper sylvian fissure.

cyclothymia

symptoms should persist for at least two years, with numerous periods of psychological ups and downs that do not meet criteria for mania, hypomania, or major depression, and do not significantly interfere with daily functioning.

Khyal cap or khyal attack

syndrome found amongst Cambodian population where individuals perceive wind like substance causes distress, anxiety, palpitations, and other autonomic symptoms.

Corticobasal degeneration and progressive supranuclear palsy are parkinsonian variants or Parkinson plus syndromes characterized by the accumulation of _______________

tau proteins

Sudden sniffing death syndrome

term that has been used to describe lethal ventricular dysrhythmias and sudden cardiac death associated with hydrocarbon use.

Conus Medullaris Syndrome

the Conus Medullaris, the most distal part of the spinal cord, can be associated with BOTH upper and lower motor lesions, hyperreflexia, and present as a Bilateral and Symmetrical Pattern of symptoms along with early onset of bladder and bowel dysfunction.

thought blocking

the abrupt interruption in train of thinking before a thought or idea is finished

selection bias

the bias introduced when the participants or data for analysis is selected in a way that the sample is not representative of the population being studied as proper randomization could not be achieved.

attributable risk

the difference in the rate of a disease between a population exposed to risk factor and an unexposed one

delusional disorder

the occurrence of one or more delusions with a duration of 1 month or longer; Criterion A for schizophrenia has never been fulfilled; functioning is not significantly compromised, and behavior is not observably peculiar; If major depressive or manic episodes have transpired, these are short as compared to the delusional periods; the condition cannot be attributed to another medical condition or the effects of a substance and is not better explained by another mental disorder. Types of delusional disorders include erotomanic, grandiose, jealous, persecutory, somatic, mixed, or unspecified.

MDD with anxious distress

the patient is apprehensive and has typically higher anxiety levels along with restlessness, difficulty concentrating, fear of something awful happening or the fear of losing control of themselves.

perseveration,

the persistence of a response to a previous stimulus after a new stimulus has been presented

agoraphobia

the presence of intense fear or anxiety which is triggered by real or anticipated exposure to at least 2 of the situations from using public transportation, being in open spaces, being in enclosed spaces, standing in line or being in a crowd or being outside of the home alone.

panic disorder

the presence of recurrent unexpected panic attacks with intense fear that reaches peak within minutes and is associated with 4 of the symptoms from palpitations, sweating, shaking, shortness of breath, choking, nausea, abdominal pain, feeling dizzy or light-headed, chills or heat sensation, paraesthesias, derealization, fear of losing control and fear of dying.

Vanillylmandelic acid (VMA)

the primary metabolite of norepinephrine along with a conjugated form of 3-Methoxy-4-hydroxyphenylglycol (MHPG, MOPEG), low levels of which are associated with anorexia nervosa and pathological gambling.

Locus Ceruleus (LC)

the principal source of norepinephrine-containing neurons located in the upper dorsolateral pontine tegmentum. Activation of panic attacks is characterized by increased activity of sympathetic activity which occurs due to activation of locus ceruleus. Norepinephrine leads to activation of amygdala, neocortex, hypothalamus, hippocampus, cerebellum, and thalamus. Neurons in the locus ceruleus project to the amygdala and directly activate it which is responsible for the initial fear response which is then further reinforced by the frontal cortex.

cauda equina

the syndrome typically presents with hyporeflexia or areflexia, mostly lower motor neuron involvement, and a more asymmetrical pattern with later involvement of bladder and bowel dysfunction. Cauda Equina syndrome is more typically gradual and unilateral.

cannabis intoxication

there should be a recent use of cannabis along with clinically significant behavioral or psychological changes (e.g., euphoria, impaired motor coordination, anxiety, and sensation of slowed time, impaired judgment, and social withdrawal) that developed during, or shortly after, cannabis use. This patient possesses motor incoordination, anxiety, and impaired judgment (as reflected by his decision to drive after being aware of cannabis use). There should also be the presence of two or more of the following signs and symptoms developing within two hours of cannabis use: increased appetite, conjunctival injection, dry mouth, and tachycardia.

3,4-Dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA)

they are primary metabolites of dopamine that may be useful in identifying the levels of dopaminergic activity.

A 19-year-old man presents to the clinic with use of inhalants for the past three years. He now wants to get rid of this addiction. He gives a history of attempting suicide twice. Previously, he used to sniff glue and spray paint once a day to achieve ecstasy, but now he has to sniff five times to achieve the same effect. Which of the following is the correct term describing his condition? A. CravingB. ToleranceC. WithdrawalD. PotentiationE. Dependence

tolerance

exposure therapy

treatment of choice in patients with specific phobias. It involves exposing the patient gradually to the feared object or situation in manageable steps with increasing levels of intensity.

serotonin syndrome

triad of altered mental status, autonomic dysfunction and movement dysfunction with the absence of muscle rigidity following the use of serotonergic agents.

____________ deficiency or diversion of __________ by a carcinoid syndrome may also cause pellagra.

tryptophan

__________is the pathway involved with hyperprolactinemia

tuberoinfundibular

utilization behavior

type of disinhibition, particularly of executive function, associated with brain damage, where the patient has difficulty resisting the impulse to operate or manipulate objects in the visual field and within reach.

DBT

type of psychotherapy for patients with severe problems in emotional regulation, such as individuals with borderline personality disorder. It is an integrative therapy with many different components, including individual therapy, skills training, telephone coaching, and a therapist consultation team; it attempts to help patients explore their own thoughts and behaviors without delving into their childhood and teaches them mindfulness, distress tolerance, as well as how to regulate their emotions and be effective in their interpersonal relations.

Injuries to the thoracic spine

typically affect the legs. njuries to the cervical or high thoracic spinal cord may also result in blood pressure problems, abnormal sweating, and trouble maintaining normal body temperature.

axonal polyneuropathy,

typically presents with painful burning sensations and paresthesias. in 30% of HIV patients

Mentalization therapy

used in patients with borderline personality disorder and antisocial personality disorder. It has a basis in attachment theory and integrates cognitive and rational components of psychodynamic therapy.

Dantrolene

used in the management of malignant hyperthermia, which presents with hyperthermia and severe muscle contractions as an adverse effect of anesthetic drugs.

Cyproheptadine

used in the management of serotonin syndrome. It also presents with hypertension, diaphoresis, and flushing of the face. However, it also causes hyperthermia, hyperreflexia, and altered mental status

Wechsler Individual Achievement Test

used to assess an individual's academic skills, such as reading, writing and mathematics.

Wechsler Intelligence Scale for Children

used to assess children and adolescents between 6 years-16 years 11 months.

Wechsler Preschool & Performance Scale of Intelligence

used to assess children between 2 years 6 months - 7 years 7 months;

lithium induced nephrogenic DI

usually a self-limiting condition in which there is a down-regulation of channel aquaporin-2 in the luminal wall of the cell's surface, leading to decreased urine osmolality and increased urine volume (polyuria).

The patient is a 19-year-old woman with bipolar disorder who was admitted to the psychiatric hospital with a manic episode with mixed features. On admission, she was irritable with pressured speech and had a depressed mood with dysphoric affect. She reported suicidal thoughts but denied any suicidal intent or plan, as she is future-oriented about her career as an actress. She was started on a mood stabilizer while in the hospital and enjoyed a robust response. Following discharge, she demanded an urgent appointment with her outpatient provider because she noticed that hair began developing on her chin. The patient was horrified by this and reported that it is very important to her career that she maintain her image. Which of the following medications likely caused the adverse effect that bothers the patient so much? A. LamotrigineB. Valproic acidC. OxcarbazepineD. LithiumE. Carbamazepine

valproic acid (PCOS- hirsutism)

A 27-year-old man with a seizure disorder is brought to the emergency department by his girlfriend after falling while climbing a building. The girlfriend reports that he was started on a new medication for the treatment of depressed mood, low energy, and difficulty sleeping 2 weeks ago by his physician. She says that he has had unstable emotions for several months. Over the past 3 days, he had not slept and has spent all his time "training to climb Everest." He has never climbed before this period. He also spent all of his savings buying mountain climbing gear. Physical examination shows ecchymosis over his right upper extremity, pressured speech, and easy distractibility. He is alert but not oriented to place. Which of the following drugs is the most likely cause of this patient's current behavior? A. VenlafaxineB. SelegilineC. BupropionD. QuetiapineE. Lithium

venlafaxine

A deficiency of which of the following vitamins and minerals leads to signs and symptoms summarized by the 4 Ds mnemonic: diarrhea, dermatitis, dementia and death? A. Vitamin B1B. Vitamin B6C. Vitamin B12D. Vitamin B3E. Zinc

vitmain B3

Recurrent brief depression

when the depressed mood is present for 2-13 days every month, not coinciding with the menstrual cycle, and occurring for at least 12 consecutive months.

Supportive therapy

widely used to help patients who are suffering from chronic, continuous illnesses with unrelenting intensity in difficult situations whose lives have been profoundly impaired by their disorder with encouragement and hope. It aims to reinforce a patients healthy psychological defense mechanisms and improve their coping strategies so that they can learn to tackle any stressful situation they face in the real world. It allows patients to cope with conditions like personality and psychotic disorders to deal with a crisis and maintain optimism and hope

Which one of the following side effects most commonly influences adolescents with bipolar disorder, suggesting that these patients avoid taking lithium? A. TeratogenicityB. PriapismC. Worsening of acneD. NeurotoxicityE. Polyuria

worsening of acne

A 22-year-old woman was recently diagnosed with schizophrenia but is reluctant to start any antipsychotic medications due to concern regarding weight gain. She has been participating in psychotherapy which has not been beneficial so far in decreasing her hallucinations. Which of the following will be the most appropriate drug option for this patient? A. QuetiapineB. OlanzapineC. RisperidoneD. ZiprasidoneE. Clozapine

ziprasidone

guanfacine

α2A-adrenergic receptor agonist approved for the treatment of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents

A 59-year-old man presents to the clinic because of unexplained weight loss over the past 8 months. During the examination, he tells the clinician that he has been having marital issues with his wife. He filed for bankruptcy 2 months ago for a business he had owned with his brother until his brother died of skin cancer a year ago. He has tried to hide his financial issues from his wife and explains that he is feeling increasingly desperate and no longer "sees the light at the end of the tunnel." He worries about finances and what would happen if he developed cancer like his brother, and then cannot fall asleep. In the morning, he feels tired and finds it hard to start the day. The patient says the symptoms began a few months after his brother's death and then, "Everything started to fall apart. I can't concentrate, my wife will probably leave me soon, and now I have lost the business." Which of the following is the most appropriate reaction by the clinician? A. "This is obviously a very difficult time for you, and it would be normal to turn to certain substances when you are feeling this way. Would you be willing to provide a urine sample for testing?"B. "Losing your brother must have been extremely hard for you. Would you be willing to speak with a grief counselor?"C. "After the death of your brother, it is even more important to stay close to your family. What do you think about starting to attend family therapy with your wife?"D. "I cannot imagine how hard this must be for you. You say you no longer see the light at the end of the tunnel. Are you having thoughts of suicide?"E. "Considering what you have been going through, it is absolutely normal to feel that way. You will see that things will become easier for you over time!"

"I cannot imagine how hard this must be for you. You say you no longer see the light at the end of the tunnel. Are you having thoughts of suicide?"

A 19-year-old man is brought to the clinic accompanied by his mother who is concerned about his increased use of cocaine. According to the patient, he has been using cocaine for the past 14 months which has started to affect his studies and relationship with his friends and family. He says that he uses cocaine as it gives him an instant feeling of euphoria and well-being. Which of the following statements about cocaine's effects on neurotransmitters is true? A. Blocks dopamine reuptake transporter (DAT)B. Increases reuptake of serotonin thus making extracellular serotonin decreasedC. Increases reuptake of norepinephrineD. Increases reuptake of dopamineE. Cocaine has no effect on acetylcholine

. Blocks dopamine reuptake transporter (DAT)

A 25-year-old woman is brought to the clinic after her partner confronted her about vomiting after every meal. The patient admits to taking laxatives or vomiting after binge eating and "feeling guilty about throwing up but can't stop". Upon further questioning, she reports daily mood fluctuations for the last three years, ranging from moderately depressed to happy and energetic, that are interfering with her performance at work. She has never had a manic episode. The patient is 165 cm (5 ft 5 in) tall and weighs 59 kg (130 lb); BMI is 22 kg/m2. Her temperature is 98.5°F (36.9°C), pulse is 72/min, blood pressure is 115/75 mmHg, respirations are 12/min. Physical exam is notable only for enlarged parotid glands and poor dentition. Which of the following is this patient's most likely diagnosis? A. Anorexia nervosa - purging type; cyclothymiaB. Bulimia nervosa; bipolar II disorder with rapid cyclingC. Anorexia nervosa - purging type; bipolar I disorder with rapid cyclingD. Bulimia nervosa; bipolar I disorder with mixed featuresE. Bulimia nervosa; cyclothymia

. Bulimia nervosa; cyclothymia

A 33-year-old man presented to the clinic with complaints of chronic alcohol use that is causing him distress in life as he is unable to focus on his work or his family. He admits to getting agitated whenever someone suggests he quit his drinking and feels guilty about his alcohol consumption. He drinks 10 glasses of alcohol per day, and often needs a drink upon waking up in the morning. He wants to stop drinking and has tried quitting before. He has joined Alcoholics Anonymous, but always resumes drinking after 1-2 days because he 'gets all jittery and anxious.' He has a history of coronary artery disease. Which of the following is the best initial treatment option for this patient? A. DisulfiramB. NaltrexoneC. NaloxoneD. Alcoholic AnonymousE. Chlordiazepoxide

. Chlordiazepoxide

Which one of the following substances has the highest percentage of users who develop a use disorder for that substance? A. AlcoholB. CocaineC. EcstasyD. HeroinE. Nicotine

. Nicotine

Which one of the following tricyclic antidepressants has lower anticholinergic activity than the others? A. AmitriptylineB. ClomipramineC. DoxepinD. ImipramineE. Nortriptyline

. Nortriptyline

Alzheimer's disease Lifetime risk at age 75 increases to ----and ---- respectively. Lifetime risk at age 85 for males is --- and for females is ----.

10.2% and 18.5%, 12.1% and 20.3%

Delirium tremens is most likely to develop at what point in the intoxication-withdrawal cycle? A. 12 hours after the last drinkB. 24 hours after the last drinkC. 3-10 days after the last drinkD. 10-14 days after the last drinkE. 14-28 days after the last drink

3-10 days after the last drink

Psychotic and perceptual symptoms begin _____ to ______ and seizures usually occur between_____ to ______ after the last drink.

8-12 hours and 12 to 24 hours

Traditional sex therapy has ____% success rates in the treatment of anorgasmia.

90

A recent outbreak of 11 cases of HIV in Indiana was further studied and linked to 181 people newly diagnosed with HIV with also 92.3% co-infected with HCV. This group was linked together by HIV type 1 pol gene sequences through phylogenetic analysis and with 87.8% caused by syringe sharing while injecting the prescription opioid oxymorphone. Which of the following interventions could occur as the result of these findings? A. A syringe-exchange programB. Medicaid expansion for substance abuseC. Medicaid expansion for HIV patientsD. Medicaid coverage for the new generation HCV medicationsE. Closing methadone clinics

A syringe-exchange program

A 50-year-old man experienced depressive symptoms during a period of psychosis. He said he felt down, hopeless, and has been unable to sleep. He was diagnosed with schizophrenia when he was 25 years old. These depressive symptoms only manifest during psychotic episodes and have been happening for the past 2 years. In that time he has had about 1.5 months of psychosis. His symptoms are controlled well when his psychosis is managed. Because he does not meet the full criteria for major depressive disorder, what is his likely diagnosis? A. SchizophreniaB. Schizoaffective disorderC. Persistent depressive disorder (dysthymia)D. Schizophrenia and persistent depressive disorder (dysthymia)E. Unspecified schizophrenia spectrum and other psychotic disorders

A. Schizophrenia

A 26-year-old woman complains of increasingly severe seasonal affective symptoms. Beginning this October, she endorses crying spells, low motivation and self-esteem, increased appetite and food cravings, and hypersomnia. Which of the following statements is accurate regarding bright light therapy? A. Sessions should occur in the morningB. Sessions should last 2-3 hoursC. Light intensity should be about 2,000 luxD. Light source should be about 5 feet awayE. Patients must stare directly into the light source

A. Sessions should occur in the morning

A 26-year-old man with no past medical history is brought to the office by his wife for irritability, distractibility, and talkativeness for the past seven days. The patient's wife reports that within the past week her husband has spent a great deal of money on various luxury items, had been sleeping three hours per night, and has not gone to work. Review of systems is positive for occasional headaches. He denies auditory and visual hallucinations, as well as alcohol or drug use. In the office, the patient's speech seems pressured and he is bragging about his most recent accomplishments. Which of the following risk factors is most closely associated with the development of this patient's condition? A. Chronic excessive alcohol consumptionB. Male sexC. Asian descentD. Attention-deficit/hyperactivity disorder (ADHD)E. Childhood maltreatment

ADHD

A 9-year-old girl is brought to the psychiatric clinic for frequent melt downs, outbursts and irritability at school. The patient has had similar symptoms for the past 3 years at home, causing much distress in the family. The patient's temper outbursts have caused her peers to avoid her at school and has resulted in her being isolated during class by her teacher. The patient, on questioning about her behavior, responds to the physician in an aggressive manner and begins to yell at the top of her voice. The patient's mother denies any significant past medical history for the patient but notes a history of paternal psychiatric illness. Which of the following disorders does the patient's father have that is most highly correlated with the patient's condition? A. Attention-deficit/ hyperactivity disorderB. SchizophreniaC. Familial Alzheimer's diseaseD. Autism spectrum disorderE. Borderline personality disorder

ADHD

An 8-year-old child with the diagnosis of oppositional defiant disorder is most likely to have which of the following comorbid conditions? A. Bipolar disorderB. ADHDC. Conduct disorderD. Separation anxiety disorderE. Substance use disorder

ADHD

Which of the following medications is most strongly contraindicated in patients with advanced renal disease? A. AcamprosateB. BuprenorphineC. DisulfiramD. SertralineE. Naltrexone

Acamprosate

A 69-year-old man is brought from home to the clinic accompanied by his wife, who says that the patient seems very confused and behaves like he is in a hotel. It seem to have started all of a sudden, and at times seems to know where he is and other times seems confused about his surroundings. The patient had his medications changed recently, and is currently taking propranolol, hydrochlorothiazide, ranitidine, and diphenhydramine. The wife denies that the patient had previous diagnosis of dementia or mental health disorder. Medical workup and urine drug screen are negative. Which of the following neurotransmitter is implicated in the etiology of this patient's condition? A. Acetylcholine deficiencyB. Dopamine blockageC. Gamma-aminobutyric acid (GABA) deficiencyD. Glutamate deficiencyE. Low cortisol

Acetylcholine deficiency

Which one of the following classes of drugs would be most effective for treating the cognitive symptoms of neurocognitive disorder with Lewy bodies? A. Acetylcholinesterase inhibitorsB. Atypical antipsychoticsC. Dopamine antagonistsD. Dopamine agonistsE. SNRIs

Acetylcholinesterase inhibitors

A 25-year-old man presents to the clinic for a follow-up visit. He was diagnosed with panic disorder 6 months ago for which he was prescribed clonazepam. He found out that clonazepam is an addictive drug and wants to stop its use as he is worried about the withdrawal symptoms. Which of the following is the most appropriate step in the management of this patient? A. Add paroxetine and taper clonazepamB. Stop clonazepam and start paroxetineC. Add imipramine and taper clonazepamD. Stop clonazepam and start imipramineE. Stop clonazepam and start cognitive behavioral therapy

Add paroxetine and taper clonazepam

agoraphobia

Agoraphobia is marked anxiety caused by two or more of the following situations: using public transport, being in an open space, being in an enclosed space, standing in a line or a crowd, or being outside the home alone. Being in such a situation must always provoke a sense of fear and the patient tries to avoid these situations as much as possible. A majority of individuals with agoraphobia have other comorbid disorders like social anxiety disorder and panic disorder.

A 17-year-old girl is brought to the psychiatric clinic by her mother complaining of changed behavior. The mother says that the patient had received her learner's permit one week ago. When the patient's brother took the patient out for practice, a dog ran out in front of the car while she was driving which caused her to lose control of the car and crash into a tree. The patient's brother sustained several injuries of severe nature while she only received few scratches. A few days after the accident, her behavior started to change. She stopped talking to her friends at school and her family at home. She stopped caring about her hygiene and avoided going out to the same street where the accident occurred. She is not aware of her surroundings and describes the feeling of numbness. She is irritable and angry whenever someone tries to talk to her. She says it is her fault due to which her brother sustained injuries. When considering cognitive behavioral therapy (CBT), which of the following describes the cognitive restructuring strategy? A. Aims to reduce anxietyB. Involves exposure to the traumatic event through imaginationC. Involves gradual exposure to feared stimuliD. Aims at helping the patient to evaluate their belief regarding traumaE. Aims at providing information about core symptoms following trauma

Aims at helping the patient to evaluate their belief regarding trauma

Which of the following statements about cholinesterase inhibitors is true? A. Galantamine is indicated for treatment of dementia associated with Parkinson's diseaseB. All of the cholinesterase inhibitors have been found to be equally effective in the treatment of NCD due to Alzheimer's diseaseC. Rivastigmine is hepatically metabolizedD. Due to drug-drug interactions, galantamine should not be prescribed concurrently with memantineE. Donepezil is the only cholinesterase inhibitor indicated for the treatment of NCD due to Alzheimer's disease

All of the cholinesterase inhibitors have been found to be equally effective in the treatment of NCD due to Alzheimer's disease

A 15-year-old girl is brought in to see the psychiatrist by her parents due to their concern about her diet and preoccupation with being thin. Despite being very underweight, the girl states that she is fat and that she often uses laxatives to compensate for episodes of over-eating. She stopped having her menstrual period about 6 months before. Which of the following is the most likely diagnosis for this patient? A. Binge-eating disorderB. Anorexia nervosa, binge-eating/purging typeC. Bulimia nervosaD. Avoidant/restrictive food intake disorderE. Anorexia nervosa, restricting type

Anorexia nervosa, binge-eating/purging type

A 45-year-old woman with bipolar I disorder presents to the psychiatric emergency department with two weeks of depressive symptoms including anhedonia, insomnia, diminished interest, psychomotor agitation, indecisiveness, and feelings of worthlessness. The patient was first hospitalized at age 25 with a severe psychotic mania and began treatment with lithium. She denies alcohol and drug use. She takes 1300 mg/day, and blood levels ranged from 0.6 to 1mEq/L. On further questioning, the patient admits suicidal ideation with a plan to shoot herself in the head. Vital signs are temperature 37.7°C (99.8°F), pulse 65/min, respirations 18/min, and blood pressure 110/60 mm Hg. Physical examination is normal. Which of the following is the most appropriate next step? A. Order TSH, blood urea nitrogen (BUN) and creatinineB. Add lamotrigine 200 mg qd and refer to a psychiatristC. Arrange admission to the hospital for this patientD. Increase lithium dosage to 1600mg/day and refer to a psychiatristE. Switch to olanzapine with fluoxetine and refer to a psychiatrist

Arrange admission to the hospital for this patient

While you are on an extended vacation, your partner psychologist calls you to update you on a patient with major depression. You saw the patient 10 days ago, at which time she seemed to be improving with psychotherapy alone. Your partner psychologist claims that the patient is not suicidal or having serious symptoms of depression, but tells you the patient is now interested in starting a medication. Your psychologist colleague agrees that based on his session with the patient, medication would be helpful. You won't return from vacation for several weeks. What would be the best next step in this situation? A. Ask the psychologist to have the patient sent to the nearest emergency roomB. Ask the psychologist to refer the patient to a psychiatrist who can further evaluate her before you returnC. Authorize the psychologist to prescribe the medication in your nameD. Let the patient follow up on the day you get back to workE. Call a psychiatrist friend to see the patient in your clinic and split the patient's fee thereafter

Ask the psychologist to refer the patient to a psychiatrist who can further evaluate her before you return

Which of the following is the most common genetic pattern of transmission of juvenile Huntington's disorder? A. Autosomal recessive from both parentsB. Autosomal dominant from motherC. Autosomal dominant from fatherD. X-linked dominant from fatherE. X-linked dominant from mother

Autosomal dominant from father

Which one of the following choices most accurately represents the lifetime risk for developing Alzheimer's disease (AD) at the age of 65? A. 3% to 8%B. 9% to 17%C. 20% to 26%D. 29% to 37%E. 40% to 45%

B. 9% to 17%

A 16-year-old girl with no history of psychosis broke up with her boyfriend 2 weeks ago. Since then, she stays out late and isolates herself in her room. She presents with her parents to the emergency department with strange aggressive behavior, crying, refusing to answer questions, and being combative. A 5 mg dose of haloperidol is given, and she starts to calm down. Which one of the following steps would be the best next step in treatment? A. Give benztropine 2mg IMB. Order urine toxicology screenC. Give lorazepam 2 mg IMD. Order brain CT scanE. Ask her parents about previous history of hallucinations and delusions

B. Order urine toxicology screen

A 22-year-old woman expresses fear about being in places from where escape is difficult and has been diagnosed with agoraphobia. What are the risk factors for this disorder? A. Social inhibition enforced by parentsB. SmokingC. AsthmaD. Behavioral inhibitionE. Being locked in a closet as a child

Behavioral inhibition

Which one of the following types of bias is exemplified by an intelligence test written in English, given to an individual who is not fluent in that language? A. Cultural biasB. Implicit biasC. Explicit biasD. Item selection biasE. Bias in construct validity

Bias in construct validity

A 31-year old woman presents to the clinic because of fatigue. She reports low energy, poor sleep and increased appetite over the last few months. She complains of inability to concentrate and poor performance at work. Her interest in interacting with coworkers has also decreased. She has a history of asthma, epilepsy and obesity. She denies suicidal ideation. Which of the following is the mechanism of action of the most appropriate pharmacotherapy for this patient? A. Alpha-2-adrenergic receptor antagonistB. Blocks presynaptic serotonin channelsC. Dopamine antagonistD. Monoamine oxidase inhibitorE. Norepinephrine/dopamine reuptake inhibitor

Blocks presynaptic serotonin channels

Following a particularly intense grief counseling session, the patient stands up and offers a hug to the psychiatrist. In what way does the American Psychiatric Association (APA) distinguish between "boundary crossings" and "boundary violations" in such situations? A. Although the courts and other regulatory bodies may differentiate between boundary violations and boundary crossings, the APA code of ethics does notB. Boundary crossings are considered the first steps on a slippery slope leading to boundary violations and thus are to be avoidedC. Boundary crossings are considered unethical based on the APA's official position to avoid all physical contact with patients other than hand shaking or necessary elements of the physical examinationD. Boundary crossings do not harm the patient, may facilitate the therapeutic process, and may be ethical when engaged in judiciously, whereas boundary violations are harmful or exploitative to the patient and are always unethicalE. Boundary crossings are similar to boundary violations except they do not involve sexual activity

Boundary crossings do not harm the patient, may facilitate the therapeutic process, and may be ethical when engaged in judiciously, whereas boundary violations are harmful or exploitative to the patient and are always unethical

A 40-year-old woman visits the psychiatric clinic for a consultation. She states that she owned a small business that recently closed down as she declared bankruptcy. She is currently living with her friend. She experienced auditory hallucinations with someone telling her to kill herself as she has lost everything and there is nothing left to live for. The voices stopped after a week. During that time the patient also says she didn't feel like doing anything and was not talking to anyone. She is worried about her symptoms and thinks that she might develop some serious psychiatric disorder similar to her older brother, diagnosed with schizophrenia, who committed suicide. There is no other significant psychiatric history. Physical examination is unremarkable. Laboratory investigations are all within normal limits. Which of the following is the most likely diagnosis based on this patient's past history? A. Major depressive disorder with psychotic featuresB. SchizophreniaC. Borderline personality disorderD. Schizophreniform disorderE. Brief psychotic disorder

Brief psychotic disorder

A 33-year-old man has presented to the clinic with muscular rigidity, mutism, and slow response to stimuli for the past 2 days. He is sweating profusely. He has a pulse rate of 102/minute and a blood pressure of 160/100 mmHg. His labs show increased white blood cells, increased creatinine phosphokinase, increased liver enzymes, and myoglobinuria. He has a history of psychosis managed with haloperidol for the past 5 months. What is the best management for this patient? A. LevodopaB. AmantadineC. BromocriptineD. Electroconvulsive therapyE. Change the antipsychotic medication

Bromocriptine

A 53-year-old man is getting ready to be discharged from the hospital after a myocardial infarction. The patient's history includes a previous myocardial infarction 2 years ago and previous treatment for depression. He reports that he has a 15-year history of smoking cigarettes; he smokes a pack and a half every day. He has tried, unsuccessfully, to quit several times. He states that he previously tried to quit using nicotine gum (2 mg/piece), but he limited himself to only chewing 6 pieces per day to save money. Which action is the best for this patient? A. Nicotine 4 mg gumB. Nicotine patches 21 mg/dayC. Varenicline 0.5 mg once dailyD. Nortriptyline 10 mg once dailyE. Bupropion SR 150 mg twice daily

Bupropion SR 150 mg twice daily

A 22-year-old woman presents to the ER due to insomnia, anxiety, restlessness, and muscle twitching. She denies substances (urine toxicology screen and HCG are negative). She denies any changes in diet, but her roommate tells you they are trying to lose weight to fit into bridesmaid's dresses and have been drinking 10 cups of green tea per day. Per chart review, her outpatient psychiatrist recently prescribed fluvoxamine. You suspect the patient is suffering from caffeine intoxication due to caffeine interaction with fluvoxamine via which mechanism? A. CYP3A4 inductionB. CYP2D6 inductionC. CYP1A2 inhibitionD. CYP1A2 inductionE. CYP3A4 inhibition

C. CYP1A2 inhibition

A child born to a 43-year-old mother is diagnosed with Down's syndrome. On the second day of life massive emesis begins. Which one of the following complications is the infant's most likely medical complication? A. Atrial septal defectB. Congenital hypothyroidismC. Duodenal atresiaD. Hypotonia of gastro-esophageal sphincterE. Macroglossia

C. Duodenal atresia

A 29-year-old woman is brought to the emergency department by her brother with sudden weakness in the lower limbs resulting in an inability to walk for the last 6 hours. She had a motor vehicle accident a week ago in which her mother died. On physical examination, her deep tendon reflexes are 2+, muscle tone and bulk is normal bilaterally in both upper and lower extremities. Sensations over both affected limbs are intact. There is no associated pain or tenderness. Her previous detailed neurologic evaluation in the hospital after the accident was normal. She is talking about her daily life with the hospital staff without any concern about her disability. Which of the following is the most appropriate next step in her management? A. Lipid-lowering drugsB. MRI of spineC. Cognitive behavioral therapyD. Muscle relaxantsE. Nerve conduction studies

CBT

___________________- is a rapidly fatal neurodegenerative disorder characterized by the accumulation of abnormally shaped infectious prion proteins in neurons.

CJD

Wave I on the brainstem auditory evoked response (BAER) corresponds to activity at

CN VIII

A 35-year-old man is caught using illegal substances in a motel room during a raid by the police. He is found in possession of THC-rich marijuana, cocaine cigars, LSD pills, heroin injections, nicotine cigarettes, and a stash of alcohol bottles. The patient is sent for assessment because of bleeding from his nose, chest pain, and disorientation to time, place, and person. His family is contacted and they provide information on the patient's problematic substance use since his adolescence. Which combination of substances used by this patient in early adolescence are most commonly identified as a gateway to other illicit substances? A. Alcohol, cocaine, and LSDB. Nicotine, cannabis, and opiatesC. Cannabis, alcohol, and nicotineD. Cocaine, nicotine, and alcoholE. Opiates, cannabis, and cocaine

Cannabis, alcohol, and nicotine

Alcoholic ketoacidosis in individuals with alcohol use disorder results most directly from recent alcohol binging and vomiting, with inadequate intake of which one of the following nutrients? A. CarbohydrateB. Coenzyme 10C. FatD. ProteinE. Vitamin B 12

Carbohydrate

When monitoring alcohol abstinence, aside from a gamma-glutamyltransferase (GGT), and comparable to a GGT, which laboratory test can be ordered? A. Mean corpuscular volume (MCV)B. Carbohydrate-deficient transferrin (CDT)C. Alanine aminotransferase (ALT)D. Alkaline phosphatase (ALP)E. Uric acid

Carbohydrate-deficient transferrin (CDT)

On evaluation, a 62-year-old woman is found to be experiencing a major depressive episode. On cognitive exam, she scores poorly. Which feature would most suggest that her depression is a manifestation of a neurodegenerative disorder? A. Depression onset occurred first, followed by cognitive impairmentB. Patient shows diminished effortC. Cognitive decline has been continuing for months to yearsD. Patient frequently answers "I don't know"E. Cognitive impairment clears with antidepressant treatment

Cognitive decline has been continuing for months to years

A 17-year-old boy presents to the clinic with complaints of experiencing severe anxiety whenever he has to give presentations in class. He usually tries to make excuses to get out of giving any presentations. He mentions that he also avoids going to parties, and avoids any form of socialization with unfamiliar people. He is diagnosed with social anxiety disorder. What is the best treatment for this patient? A. Cognitive restructuring and exposure therapyB. Mindfulness-based cognitive therapyC. Interpersonal psychotherapyD. Exposure therapyE. SSRIs

Cognitive restructuring and exposure therapy

Which of the following is true about the treatment of ADHD? A. Shorter acting psychostimulants worsen insomniaB. Combination treatment (behavioral + pharmacologic) most effective in treating children with ADHD and associated syndromes (e.g., oppositional behaviors)C. Atomoxetine is first line treatmentD. EKG is not necessary for individuals with possible cardiac family historyE. Children on stimulants achieve adult height on average 2-3 inches less than expected

Combination treatment (behavioral + pharmacologic) most effective in treating children with ADHD and associated syndromes (e.g., oppositional behaviors)

A 35-year-old woman presents to the clinic with complaints of low mood, significant weight loss, and feeling easily tired for the past 3 months. She has been unable to focus on her work. She has been experiencing insomnia at night. She has not been enjoying the time when she is out with her friends or family. She is now concerned because she's been wishing she were dead rather than alive, and she hasn't had thoughts like that before. There is no history of any tragic incident in the recent past. Which of the following is most likely about her condition? A. Common between 18-30 years of ageB. Common amongst malesC. Symptoms must be present for 4 weeks to diagnose itD. No genetic basis have been identifiedE. It is also known as dysthymia

Common between 18-30 years of age

A 66-year-old man is brought to the clinic by his wife. He is weepy, responds slowly to queries, has poor hygiene, and has urine stains on his pants. He is oriented x 3 but does not respond to other cognitive screening questions. His spouse reports he's never had a depressive episode earlier in his life. What is your next clinical step? A. Complete full medical workupB. Start fluoxetineC. Start citalopram with low dose risperidoneD. Schedule a follow-up visit without starting medicationE. Refer for ECT evaluation

Complete full medical workup

A 50-year-old man presents to the psychiatric outpatient department for the evaluation of posttraumatic stress disorder (PTSD). The patient has a history of being involved in a bomb blast, in which he suffered serious injuries and witnessed a number of other people lose their lives. Which of the following statements best describes the development and course of this disorder? A. PTSD cannot develop in children younger than 6 years of ageB. PTSD symptoms usually begin 6 months after exposure to the traumatic eventC. Complete recovery occurs within 3 months in about one-half of the adultsD. PTSD patients never remain symptomatic for more than 12 monthsE. Social isolation may reduce PTSD symptoms in older individuals

Complete recovery occurs within 3 months in about one-half of the adults

A 22-year-old man presents to the clinic complaining of extreme fatigue, disturbed sleep, loss of appetite, and decreased interest in daily life activities for the past 3 weeks. These issues started after his girlfriend broke up with him. He feels like crying most of the time with thoughts of dejection and hopelessness. He thinks he did not push himself enough to keep her happy and hates himself. He prefers solitude and has not gone to his workplace for the past one week. What is the most appropriate next step in the management of this case? A. Conduct a suicide risk assessmentB. Discharge home with a prescription for fluoxetineC. Refer the patient for psychotherapyD. Order thyroid function testsE. Admit him to the hospital

Conduct a suicide risk assessment

A patient diagnosed with generalized anxiety disorder is most likely to endorse which of the following symptoms? A. Reduced interaction with peers due to fear of critiqueB. Avoids crowded places due to fear of no escapeC. Avoids the elevator due to fear of being trappedD. Constantly washing hands due to fear of infectionE. Constant fear that "something bad" may happen at work

Constant fear that "something bad" may happen at work

A 22-year-old man presents to the clinic for treatment of his cannabis addiction. The patient was introduced to cannabis by peers in high school five years back and ever since then he has continued to smoke two to three weed cigars daily. One month back, he and his friends were in a major road traffic accident after vaping THC-rich cannabis, out of which only the patient managed to survive. This incident has motivated the patient to quit cannabis for good. He expresses how the withdrawal symptoms and intense cravings have made it difficult for him to quit. He smoked his last weed cigar two days back, and has been distressed since then because it did not provide him with physical or psychological relief. What treatment option is best suited for this patient? A. Contingency management programB. Cognitive behavioral therapyC. Oral tetrahydrocannabinolD. Extended-release zolpidemE. N-acetylcysteine

Contingency management program

While all of the syndromes listed below can be associated with some motor loss in the lower extremities and possible loss of some functioning of both bladder and bowel, which syndrome is associated with a more sudden onset of symptoms, bilateral loss of motor function, and early onset of bladder and bowel involvement with hyper reflexia? A. Conus medullaris syndromeB. Acute disk herniationC. Degenerative disk disorderD. Cauda equina syndromeE. Brown-Sequard syndrome

Conus medullaris syndrome

A 45-year-old, self-employed, married man presents to your office with complaints of mild to moderate depression for the past 3 years. On interview, he acknowledges a history of drinking 3 to 4 drinks of hard liquor 2 to 3 times a week for about 10 years. He denies any history of legal or financial trouble because of his drinking, though he does have occasional arguments about his drinking, and every few months or so he goes to work late or skips work altogether for a day to get over a hangover. He denies any history of suicidal thoughts, intent, plan, or of suicide attempts. His medical history is unremarkable. After ensuring that he is an appropriate candidate for antidepressant medications, he is started on citalopram 20 mg once daily and titrate over the course of the next 6 weeks to 40 mg daily. He seems to have a good response to this medication, with overall improvement in both depressive and anxiety symptoms. He does not have significant side effects from it. He has reduced his drinking to about 1 to 2 drinks once a week, and his wife corroborates this. He is not sure whether he thinks it is "worth it" to quit drinking completely. Which one of the following suggestions would be the most appropriate advice at this stage of treatment? A. Current state of knowledge about his illnesses and his medication indicates that he is likely to have the most sustained improvement with complete abstinence from alcoholB. 1 to 2 drinks every weekend are not harmful, as long as he is not missing workC. His wife needs to get more active in monitoring his use of alcohol and report any increase in amounts of frequency immediatelyD. He should not mix alcohol and medicationsE. He should get involved in Alcoholics Anonymous now

Current state of knowledge about his illnesses and his medication indicates that he is likely to have the most sustained improvement with complete abstinence from alcohol

A 15-year-old girl was brought in by her mother, who was concerned about her daughter's behaviour and mood over the last year. Her mother reports periods of excessive crying, difficulty waking (and increased school absenteeism as a result), and a lack of interest in spending time with friends. These symptoms occur for weeks at a time. At other times, according to her mother, her daughter is excitable, energetic (to the point of restless), and very talkative, with conversations jumping from topic to topic. During these times (which usually last a few days), her mother finds her daughter to be very irritable. The patient herself concurs and reports that she "just doesn't feel right most of the time", indicating that she either feels "down and scared about everything" or "like I can handle anything and everyone". She denies, however, changes in appetite, energy, or concentration and does not report feelings of guilt or worthlessness. What diagnosis is most appropriate? A. Bipolar IB. Bipolar IIC. Cyclothymic disorderD. Persistent depressive disorderE. Disruptive mood dysregulation disorder

Cyclothymic disorder

A 45-year-old, self-employed, married man presents with complaints of mild to moderate depression for the past 3 years. On interview, he acknowledges a history of drinking 3 to 4 drinks of hard liquor 2 to 3 times a week for about 10 years. He denies any history of legal or financial trouble because of his drinking, though he does have occasional arguments about his drinking, and every few months or so he goes to work late or skips work altogether for a day to get over a hangover. He denies any history of suicidal thoughts, intent, plan, or of suicide attempts. His medical history is unremarkable. At this time, which one of the following steps would be the best next step in his treatment? A. Admit him to an inpatient dual diagnosis unitB. Offer him naltrexone or disulfiramC. Start an SSRI antidepressantD. With his permission, obtain further collateral information, and assess the patient's interest in changing his alcohol useE. Ask him to return for follow-up in one month

D. With his permission, obtain further collateral information, and assess the patient's interest in changing his alcohol use

A 73-year-old woman with alcohol use disorder is brought to the hospital after her son finds her lying on the ground, tremulous and confused. Concerned that she may be exhibiting symptoms of delirium tremens, she is admitted to the ICU and the CIWA (Clinical Institutes Withdrawal Assessment for Alcohol) protocol is initiated. Chronic intoxication with alcohol leads to which of the following neurotransmitter change(s) in the brain? A. Decrease in GABA-receptor sensitivity and upregulation of NMDA-receptorsB. Increase in GABA-receptor sensitivity and downregulation of NMDA-receptorsC. Increase in GABA-receptor sensitivity and upregulation of NMDA-receptorsD. Decrease in GABA-receptor sensitivity and downregulation of NMDA-receptorsE. Global increase in dopamine transmission

Decrease in GABA-receptor sensitivity and upregulation of NMDA-receptors

A 65-year-old man with end-stage liver disease and portal hypertension undergoes surgery to have therapeutic shunts placed to alleviate his portal hypertension. He has a history of major depression and has been taking sertraline for many years. How should his depression be managed after the surgery? A. Increase the dose of sertralineB. Decrease the dose of sertralineC. Maintain the pre-surgery dose of sertralineD. Switch to bupropionE. Switch to venlafaxine

Decrease the dose of sertraline

Which of the following abnormalities can be observed in patients with anxiety disorders? A. Decreased platelet MAO activityB. Decreased activity of norepinephrine centrallyC. Decreased activity of gamma-aminobutyric acid (GABA) centrallyD. Decreased levels of circulating epinephrineE. Decreased levels of circulating norepinephrine

Decreased activity of gamma-aminobutyric acid (GABA) centrally

A 92-year-old female with congestive heart failure and chronic obstructive pulmonary disease (COPD) undergoes left hip replacement surgery. Two days after the operation, she becomes increasingly agitated, demanding to go home; she is also confused about why she is in the hospital. Psychiatric consultation is called, and when the consultant sees the patient, she is lying quietly. The patient is arousable but has difficulty paying attention during the interview, at times seeming to be distracted by "something in the corner." She becomes tearful and requests to go home. The staff notes her to be sleeping most of the day but agitated at night. Which one of the following diagnoses is most likely given her current symptoms? A. Depression with psychotic featuresB. Delirium, hyperactive subtypeC. Delirium, hypoactive subtypeD. Delirium, mixed subtypeE. Alzheimer's disease with behavioral disturbances

Delirium, mixed subtype

A 45-year-old woman is brought to the psychiatric clinic by her son. He witnessed his father slap his mother for spilling hot tea on the floor. She then apologized profusely and went to make him another cup. Since he was young, the son remembers his mother doing everything she could to make his father happy. She would ask his for approval on everything, including which clothes to buy their kids or how she should dress when going out. He recalls that his mother became very depressed when he left for college and she did not want to be alone at home while his father was away on business trips. She eventually joined a yoga class to make new friends. She now has several close friends (that his father approves of) and talks to them every day. Which of the following personality disorders does she most likely have? A. Avoidant personality disorderB. Dependent personality disorderC. Histrionic personality disorderD. Paranoid personality disorderE. Borderline personality disorder (BPD)

Dependent personality disorder

Opioid intoxication is generally characterized by which one of the following signs? A. Pupillary dilationB. PiloerectionC. Increased blood pressureD. Depressed respirationE. Increased body temperature

Depressed respiration

ou are attending a seminar on the prevention of drug abuse. One of the speakers talks about primary prevention and universal programs. Which of the following is a characteristic of a universal program? A. Designed for the general populationB. Designed for subsets of the general population at riskC. Designed for individuals already experimenting with drugsD. Designed for individuals who have recently started using drugsE. Designed for individuals who have never used drugs

Designed for the general population

A 46-year-old man presents with increasing daytime sleepiness. Medical history is remarkable for bipolar I disorder well controlled with lithium. On physical examination, he is afebrile with a blood pressure of 133/86 mmHg, heart rate at 87 bpm, respiratory rate at 18 cpm. His present BMI is 31.2. You eventually refer him to a sleep specialist who diagnoses him with obstructive sleep apnea (OSA) and starts him on a continuous positive airway pressure (CPAP) machine. Which among the following can possibly happen to this patient while he is being treated for his OSA? A. Development of a manic episodeB. Development of a depressive episodeC. Development of dysthymiaD. Development of schizophreniaE. Development of a schizoaffective disorder

Development of a manic episode

A 13-year-old girl presents to the hospital complaining of a headache. The patient reports a history of an increasing frequency of headaches over the past year. She often complaints of a headache and refuses to go to school. She also failed her last semester of school. Physical examination reveals cracked, dry perioral skin with sores on the lips, and stains of ink on her fingernail beds. Heart rate is 70 beats/min, and blood pressure is 120/80 mmHg. Which of the following statements is correct regarding the administration of inhalants? A. Breathing through a rag soaked in inhalant is known as baggingB. Directly inhaling the substance through nostrils or the mouth is known as chromingC. Inhaling spray paint is known as huffingD. Breathing through a rag soaked in inhalant is known as chromingE. Directly inhaling the substance through the nostrils is known as sniffing

Directly inhaling the substance through the nostrils is known as sniffing

A 17-year-old man presents to the emergency department after ingesting a mouthful of gasoline. The patient does not report any vomiting at the time and is currently asymptomatic. He gives a history of on and off ingesting and sniffing gasoline from past three years. The patient is vitally stable with the blood pressure of 120/80 mmHg; heart rate is 75 beats per minute, respiratory rate 16 breaths per minute, and temperature 98.8F. Chest x-ray, ECG and abdominal ultrasound are normal. Which of the following should be the next step in the management of this patient? A. Immediately discharge the patient no need for any treatmentB. Admit for 24 hours observation with continuous fluid support and pulse oximetryC. Discharge the patient after 6 hours of observation if the patient remains asymptomatic on cardiac monitoring and chest x-ray is normalD. Admit the patient for 3-4 days for observationE. Gastric lavage with activated charcoal

Discharge the patient after 6 hours of observation if the patient remains asymptomatic on cardiac monitoring and chest x-ray is normal

requires the presence of 2 or more distinct identities or personality states which recurrently take control of a person's behavior with inability to recall important personal information too extensive to be explained by ordinary forgetfulness.

Dissociative identity disorder

Which one of the following neuropathies is the most common neuropathy associated with HIV? A. Distal symmetric axonal polyneuropathyB. Distal symmetric demyelinating polyneuropathy secondary to direct viral infiltrationC. Guillain-Barre syndrome (GBS)D. Mononeuritis multiplexE. Chronic inflammatory demyelinating polyneuropathy (CIDP)

Distal symmetric axonal polyneuropathy

A 37-year-old woman presents to the clinic for a routine physical, which is unremarkable. In conversation, she expresses frustration about her mood. She isn't sure when the symptoms began, but she estimates that for about the last 3 years, she has often been depressed. She describes depression as intermittent, but she is often low. She also reports tiredness, not sleeping well at night, and experiencing a loss of self-esteem because she cannot shake the depression. She is diagnosed with dysthymia and prescribed psychotherapy and fluoxetine. Which of the following are important to consider for optimal safety and efficacy? A. Dosage based on patient body weight, drug plasma levels, and adherence to treatmentB. Dosage based on patient body weight, drug plasma levels, and duration of treatmentC. Dosage based on patient body weight, drug plasma levels, and white blood cell countD. Dosage, duration of treatment, and adherence to treatmentE. Thyroid function, drug plasma levels, and renal function tests

Dosage, duration of treatment, and adherence to treatment

A 58-year-old man is brought to the clinic by his wife in an agitated state. He seems restless, jittery, and unable to sit in his seat. He reports feeling 'vibrations' all over his body, a fast heartbeat, and muscles twitching under his skin. He speaks in a rambling flow, speaking of multiple things in a single sentence then changing thought mid-sentence. His wife explains that he works out in the morning and that particular day he had consumed three energy drinks, two pills of caffeinated-multivitamins, and two cups of coffee all at once to "help him workout better". On further inquiry, the wife admits to a past history of comorbid psychiatric illness. Which psychiatric illness is associated with a low incidence of caffeine intoxication? A. Depressive disorderB. Bipolar disorderC. Sleep disorderD. Substance-use related disorderE. Anxiety disorder

E. Anxiety disorder

Echopraxia

Echopraxia is characterized by mimicking of another person's movements.

A 34-year-old police officer visits the psychiatric clinic for a follow-up visit. The officer is a part of the team that works with victims of child abuse. He developed irritable behavior and had an angry outburst at work along with the inability to concentrate on work one year ago. He was referred to the psychiatric clinic for evaluation of his behavior where he was diagnosed with PTSD. He has been undergoing cognitive behavioral therapy for the past 3 months. Which of the following CBT interventions is considered gold-standard treatment for PTSD? A. Exposure therapyB. Eye movement desensitization and reprocessingC. Cognitive processing therapyD. Psychodynamic therapyE. Hypnotherapy

Exposure therapy

A 25-year-old man with schizophrenia mentions for the first time that his deceased mother told him in a dream to kill his older brother. When probed about this statement, he answers, "It was just a thought". He is currently taking clozapine 200 mg twice daily. You have just started your practice in a new state, and he is one of your first patients. Which among the following should be your next step? A. Familiarize yourself with your present state's law on your "duty to warn"B. Inform the patient's older brother about the patient's intentC. Inform the local police about the patient's intentD. Call 911E. Increase clozapine to 475 mg twice daily

Familiarize yourself with your present state's law on your "duty to warn"

Which one of the following statements regarding central nervous system maturation is true? A. Visual perception is well-developed at birthB. Fetus can hear sounds in uteroC. Synapses are completely developed by 6 months of ageD. Infants cannot recognize mother's voice until 1 year of ageE. Social smile develops by first week

Fetus can hear sounds in utero

A 17-year-old boy has been sent to the clinic for assessment on suspicion of recent substance abuse. The boy appears hyperactive and panicked. He's fidgeting in his seat and nipping on his fingers with a restless movement of his legs. Examination shows red eyes, fast pulse, impaired limb coordination, and slowed processing of commands. The patient seems confused and frightened, denying use of any substance in an agitated manner. His urine drug screen reveals a level of 90 ng/mL delta-9-THC. Which endogenous ligand binding with endocannabinoid receptors best explains these effects on the brain? A. Full agonist activity of AEA at CB receptor 1B. Full agonist activity of 2-AG at CB receptor 1C. Partial agonist activity of 2-AG at CB receptor 1D. Partial agonist activity of AEA at CB receptor 2E. Full agonist activity of AEA at CB receptor 2

Full agonist activity of 2-AG at CB receptor 1

Zaleplon

GABA-A agonist with a very short half-life of about 1 hour. It is generally safe and can be taken if the patient only wishes to sleep about 4 hours, making it ideal for someone who wakes up in the middle of the night. It can be habit-forming and should not be used every day.

A 25-year-old woman presents to the clinic with generalized aches and body pain in the past 7 months. According to the patient, she has not had any accidents or physical injuries that could have contributed to the pain. She has not been able to sleep at night and feels restless. She often wakes up in the morning, feeling more tired and irritable. The patient says that she worries a lot about everything, including her work, her family, and friends for no apparent reason. She is unable to concentrate at work and home stuff, which further increases her worry. Physical examination is unremarkable. There is no significant past medical, surgical, or psychiatric history. What is the most likely diagnosis? A. Generalized anxiety disorderB. Acute stress disorderC. AgoraphobiaD. Panic disorderE. Specific phobia

GAD

A 25-year-old man comes with the complaint of unpleasant sensations which are only relieved upon moving his legs. This urge to move his legs is worse during periods of rest or inactivity. The patient has been experiencing these sensations for 9 months now and is experiencing significant social and occupational impairment. How should this patient be managed? A. Gabapentin and levodopaB. Gabapentin enacarbil and sleep hygieneC. Oxycodone and levodopaD. Codeine and clonazepamE. Temazepam and gabapentin

Gabapentin enacarbil and sleep hygiene

An 85-year-old woman with a history of Alzheimer's disease on hemodialysis is referred for evaluation. Which of the following medications is contraindicated? A. RivastigmineB. GalantamineC. DonepezilD. TacrineE. Memantine

Galantamine

Temporal arteritis is a cause of secondary headaches. Which one of the following statements correctly applies to this condition? A. It usually occurs in patients 20 to 40 years of ageB. Eye pain occurs in most casesC. It is not commonly associated with signs or symptoms of systemic illnessD. Giant cells are present on histological exam of affected vesselsE. It is generally a benign, time-limited condition that resolves on its own

Giant cells are present on histological exam of affected vessels

A 72-year-old woman diagnosed with Alzheimer's disease is brought to the clinic by her son for recently aggravated sleeping troubles. He explains that his mother was diagnosed with early-stage Alzheimer's five years ago with memory and learning impairment, but intact social and intellectual cognition. She was put on memantine plus donepezil. Since then, her cognitive functions have continued to deteriorate, but the medications have slowed the progression. For the last year, the patient experiences difficulty falling asleep at night, frequent awakening, increasing daytime somnolence, and nighttime agitation. She has also had some episodes of vivid nightmares and associated depression. Her physician advised non-pharmacological interventions six months ago that did not help, and the patient continues to experience sleeping issues along with low mood. What is the best treatment option for her? A. A dose-adjusted sedative hypnotic benzodiazepine at nightB. Initiating zolpidem and increasing dose graduallyC. A low dose olanzapine with sertraline at nightD. Giving donepezil in the morning and adding trazodone at nightE. Replacing donepezil with galantamine at night

Giving donepezil in the morning and adding trazodone at night

A 25-year-old woman presents to the emergency department after she tripped and fell down the stairs. On examination, she has a small bruise on her knee and a few scrapes on her hands; all other findings are normal. When asked to elaborate on the event, she says her entire life flashed before her eyes and starts to get emotional but does not give any more details about the fall. She asks with tears in her eyes if she is going to die from a brain bleed and that she has not even met the love of her life yet. When the physician reassures her that since she did not hit her head, it is unlikely she will experience a brain bleed, she laughs and leans forward to sit closer towards him. Which of the following characteristics does this woman most likely have? A. Suspicious and mistrustingB. Submissive and clingyC. Gullible and shallowD. Perfectionist and inflexibleE. Reckless and impulsive

Gullible and shallow

A 23-year-old man with an athletic build and facial acne arrives to the emergency department s/p MVA sustaining multiple injuries. Upon questioning family members, they report a 6-month history of mood instability and sudden bursts of anger. Serum and urine drug tests are (-). Which of the following findings might support the probability of anabolic steroid abuse? A. Low blood pressureB. Enlarged testiclesC. Excessive facial and body hairD. GynecomastiaE. Deepening of the voice

Gynecomastia

A 17-year-old girl seeks consultation. She reports that she got high at a party last month. Now she has experiences of geometric hallucinations and false perception of movement at the periphery of her vision. She is highly distressed because these experiences are not diminishing. Which one of the following diagnoses is the most likely diagnosis for this patient? A. Amphetamine intoxicationB. Hallucinogen persisting perception disorderC. Illness anxiety disorderD. Opioid withdrawal with perceptual disturbanceE. Unspecified somatic symptom and related disorder

Hallucinogen persisting perception disorder

A 19-year-old man explains that he ingested some psychedelic mushrooms with his fraternity brothers 6 weeks ago. At first, he felt fine. As the evening wore on, he felt increasingly anxious. He wasn't hallucinating, but his sensations were so vivid that he felt they were burning themselves into his eyes and ears. When he closed his eyes, the equally vivid afterimages would begin to swirl around. He spent most of the night wandering around the streets too wired and anxious to fall asleep. He finally crashed around 6 a.m. the next morning. When he awoke, he felt different. He says that over this time, 'It's like there is a delay in my consciousness. Like when I move my head, the images are just a tiny amount delayed. Sometimes, there is movement around the edges. Sometimes, everything looks far away.' Which one of the following diagnoses is the most likely diagnosis for this patient? A. Depersonalization derealization disorderB. Hallucinogen intoxicationC. Hallucinogen persisting perception disorderD. Dissociative identity disorderE. Hallucinogen-induced psychotic disorder

Hallucinogen persisting perception disorder

A 66-year-old man explains during review of systems that he occasionally sees a visual trail behind moving objects in his field of vision. With additional questioning, he also describes transient visual distortions, occasional brief hallucinations of geometric figures or sounds or voices, and episodes of sudden, intense emotion. He denies any past history of seizure disorder, migraine headache, posttraumatic stress disorder, or other persisting visual problems. Which one of the following options is the most likely diagnosis for this patient? A. Transient ischemic attacks (TIAs)B. Hallucinogen persisting perception disorderC. A demyelinating disorder such as multiple sclerosisD. Auras of either a migraine syndrome or seizure disorder occurring in the absence of a headache or seizureE. Transient global amnesia

Hallucinogen persisting perception disorder

Which one of the following pairs of antipsychotic medications are the medications that are FDA approved for the treatment of Tourette syndrome? A. Haloperidol and pimozideB. Perphenazine and thiothixeneC. Risperidone and ziprasidoneD. Quetiapine and aripiprazoleE. Asenapine and iloperidone

Haloperidol and pimozide

Antithyroglobulin and antithyroperoxidase antibody may be seen in -------------

Hashimoto's encephalopathy,

A 6-year-old boy is brought to the emergency department by his father in an unconscious state. Cardiac monitoring showed pulseless ventricular tachycardia which was managed by defibrillation. The boy's heart came back into sinus rhythm but again crashed 10 minutes later. Father gives a history of the patient accidentally ingesting 20 caffeine pills (350 mg caffeine per pill) and then collapsing down the stairs thirty minutes before the presentation. He insists that the bruises over his ribs are from the fall. What definite management should be done for caffeine intoxication? A. Gastric lavageB. Hydration with two liters ringers lactate solutionC. Administration of calcium hexobarbitalD. Activated charcoalE. Hemofiltration and hemodialysis

Hemofiltration and hemodialysis

A 25-year-old woman presents with fatigue and severe pain in her right elbow for the past 6 months. She finds the pain to be debilitating and present on most days. She has gotten repeated tests done, none of which could find a medical cause. She expresses intense anxiety about her pain and is scared that there is a sinister underlying pathology. She also mentions that her pain worsens during times of personal stress and when she feels neglected. The patient also has a theatrical manner about her. Her clothes are provocative, and her attitude is overly familiar and flirtatious with everyone she meets. Her dramatic and flirtatious mannerism has been present since early adulthood. What is the most likely diagnosis? A. Somatic symptom disorder + delusional disorderB. Histrionic personality disorder + somatic symptom disorderC. Histrionic personality disorder + illness anxiety disorderD. Narcissistic personality disorder + illness anxiety disorderE. Narcissistic personality disorder + somatic symptom disorder

Histrionic personality disorder + somatic symptom disorder

A 49-year-old journalist survived a bomb blast in Afghanistan five years ago. He presented to the psychiatric clinic with symptoms of intrusive memories of the blast with bodies of dead people lying all around him. He had trouble sleeping at night due to nightmares of the blast. He felt irritable and angry at times. He has become hypervigilant and prefers staying in the house. He feels unhappy, anxious and tearful. His behavior has affected his relationship with his wife. Which of the following can be used as a pharmacotherapy based early intervention to prevent the development of PTSD? A. HydrocortisoneB. MorphineC. KetamineD. PropranololE. Alprazolam

Hydrocortisone

A 55-year-old woman presents with complaints of crying spells, fatigue, and sad and anxious mood. On history, she endorses fatigue, lightheadedness, muscle weakness, fever, weight loss, nausea and diarrhea, headache, sweating, joint pains. You note darkening of her palmar creases. What is her most likely diagnosis? A. Hypocortisolism (Addison's disease)B. Hyperadrenocorticism (Cushing's syndrome)C. Subcortical leukoencephalopathy (Binswanger's disease)D. Lymphocytic thyroiditis (Hashimoto's disease)E. Systemic lupus erythematosus (SLE)

Hypocortisolism (Addison's disease)

What is considered to contribute to the mechanism of disease in someone with schizophrenia? A. Decreased expression of brain-derived neurotrophic factor (BDNF)B. Long alleles of MAOA-uVNTR promoter polymorphismC. Deposition of amyloid plaquesD. Catecholaminergic and cholinergic dysfunctionE. Impairment in excitation-inhibitory balance due to altered NMDA receptor signaling

Impairment in excitation-inhibitory balance due to altered NMDA receptor signaling

A 48-year-old woman presents to the hospital with an overwhelming fear of spiders. She has had this fear as long as she can remember, but it has markedly increased now secondary to living in a wooded area where spiders are frequently encountered. She wants to get rid of this phobia. Which of the following is correct regarding specific phobia? A. Phobic stimulus does not always provoke fear or anxiety.B. The phobic stimulus is actively and persistently avoided for at least one month.C. The fear experienced is within reasonable limits to the actual danger.D. In the natural environment, patients with an animal-specific phobia are likely to show sympathetic nervous system arousalE. In blood-injection-injury specific phobia, patients are likely to show sympathetic nervous system arousal

In the natural environment, patients with an animal-specific phobia are likely to show sympathetic nervous system arousal

A 52-year-old woman has a 3- to 4-week history of progressive, asymmetrical, mainly distal more than proximal sensory loss and weakness of the legs, with pain in the back, buttocks, and thighs. The knee reflexes are absent and the ankle reflexes are reduced, with flexor toe signs. The most likely diagnosis is: A. Inflammatory polyradiculoneuropathyB. Spinal cord tumorC. Inflammatory myopathyD. Spinal stenosisE. Paraneoplastic myasthenic syndrome

Inflammatory polyradiculoneuropathy

A 17-year-old girl presents to the hospital with nausea, anorexia, and runny eyes/nose. Parents report that for the last year and a half she has avoided family interactions, has not been attending school regularly, and is in her room most of the time. They deny that she is abusing any drugs, as she does not ask for extra money, rarely leaves her room, and is not involved in any suspicious activities. Physical examination reveals rash around the nose and mouth, a heart rate 90 beats/min, and blood pressure of 130/80 mmHg. Chest x-ray, abdominal ultrasound, and ECG are normal. Which of the following is the correct diagnosis? A. Alcohol use disorderB. Opioid use disorderC. Inhalant use disorderD. Cocaine use disorderE. Alcohol withdrawal

Inhalant use disorder

An 18-year-old man presents to the clinic with fatigue, insomnia, overeating, irritability, trouble concentrating, making decisions, pessimism, feelings of guilt and passive suicidal thoughts. Parents reveal that the patient is involved in suspicious activities, as he is often caught stealing money from his mother's bag. The patient admits to recent and past recreational use of lacquer thinner. Which of the following is the correct diagnosis? A. Inhalant-induced depressive disorderB. Inhalant-induced anxiety disorderC. The inhalant-induced major neurocognitive disorderD. Inhalant-induced psychotic disorderE. The inhalant-induced mild neurocognitive disorder

Inhalant-induced depressive disorder

20-year-old man presents to the emergency, complaining about hearing and seeing strange people who tell him to kill everyone in sight from past one year. The patient is well oriented in time, place and person, and the mental status examination is normal except for his visual and auditory hallucinations. He avoids social interactions and left job and studies 2 years ago. Patient reports starting to huff kerosene oil approximately when he left his job two years ago. Which of the following is the correct diagnosis? A. Inhalant-induced depressive disorderB. Inhalant-induced anxiety disorderC. The inhalant-induced mild neurocognitive disorderD. Inhalant-induced psychotic disorderE. The inhalant-induced mild neurocognitive disorder

Inhalant-induced psychotic disorder

stimulant-induced psychotic disorder.

Initial effects of stimulants include increased energy, alertness, sociability, euphoria, decreased need for sleep and decreased appetite. With high dose or repeated use, individuals may experience anxiety, irritability, suspiciousness, impaired judgement, stereotyped behavior, and psychotic symptoms such as paranoia and hallucinations can appear. Stimulant users typically remain alert and oriented, but the delusional state may impair judgement, cognition, and attention.

OSA

It is characterized by multiple obstructive apneic/hypopneic episodes in an hour, nocturnal breathing disturbances, and daytime fatigue. An AHI of 15-30 is considered moderate. Treatment involves behavioral changes like quitting alcohol and smoking, and weight loss. Undergoing CPAP is the recommended therapeutic treatment as it improves day-time sleepiness, cognitive function and mood disturbances.

Which of the following statements is true in reference to starting Buprenorphine? A. It should be started when the patient is intoxicated with an opiateB. It should be started when objective evidence of opiate withdrawal is evidentC. It should be started at the time the patient consumes heroinD. It should only be administered at hsE. It should be administered orally/PO

It should be started when objective evidence of opiate withdrawal is evident

Natalizumab use is associated with an increased risk of symptomatic infection of the central nervous system from which of the following viruses? A. Herpes simplex virus 1B. Varicella zoster virusC. CytomegalovirusD. JC virusE. Epstein-Barr virus

JC virus

A 21-year-old woman wants to get rid of her addiction to codeine. She mentions that she is 2 months pregnant and has been trying to quit her addiction since she found out about her pregnancy but has failed again and again. How should she be managed? A. Administer lofexidine in out-patientB. Administer clonidine in out-patientC. Keep under observation and give naltrexoneD. Keep under observation and give buprenorphineE. Keep under observation and give naltrexone + buprenorphine

Keep under observation and give buprenorphine

A 63-year-old man with a long history of alcohol use disorder presents to the ED after a recent binge. He reports that he developed nausea and vomiting. In addition, he subsequently stopped eating. He now complains of severe abdominal pain, shortness of breath, and dizziness. His breath has a fruity smell. He is most likely to be suffering from which one of the following conditions? A. CholecystitisB. Impending delirium tremensC. KetoacidosisD. Korsakoff's syndromeE. Wernicke's encephalopathy

Ketoacidosis

The synucleins are a family of low molecular weight proteins found in brain. Alpha-synuclein is implicated in the development of which neurodegenerative disorder? A. Alzheimer diseaseB. Corticobasal degenerationC. Creutzfeldt-Jacob diseaseD. Lewy body diseaseE. Progressive supranuclear palsy

LBD

A 47-year-old man with history of alcoholic liver cirrhosis and alcohol use disorder presents to the emergency department with altered mental status. The patient consumed on average 12 to 18 beers a day and has had no alcohol use for the past 18 months, since undergoing alcohol detoxification and a 90 day alcohol residential rehabilitation program. At his psychosocial screening appointment one month prior to this presentation, he was found to be psychiatrically stable and an excellent candidate for liver transplantation. He is currently on the liver transplant waiting list. The patient, who was brought by his wife to the emergency department, presents with mild confusion, acute anxiety, panic symptoms, paranoid/persecutory ideation, and psychomotor agitation. Which of the following medications would you administer for managing the patient's current clinical presentation? A. Haloperidol 5 mg and benztropine 2 mg orallyB. Lorazepam 2 mg intravenouslyC. Diazepam 5 mg orallyD. Lactulose 30 mL orallyE. Spironolactone 100 mg orally

Lactulose 30 mL orally

A 4-year-old child begins preschool. The teacher reports that he appears to suffer from developmental delay. An evaluation finds that the child has congenital hearing impairment and delayed language development. Which IQ test would be most appropriate with which to assess this child? A. Bayley Scale for Infant & Toddler DevelopmentB. Leiter International Performance ScaleC. Wechsler Individual Achievement TestD. Wechsler Intelligence Scale for ChildrenE. Wechsler Preschool & Performance Scale of Intelligence

Leiter International Performance Scale

________________ is approved for the treatment of severe binge-eating disorder in adults and has shown benefit in reducing mean number of binge days per week compared with placebo.

Lisdexamfetamine

A 24-year-old woman presents to the clinic with complaints of chest pain, palpitations, and dizziness whenever she travels on the subway or goes to the mall or a concert. She has been diagnosed as having panic disorder with agoraphobia. What is the mechanism of this disorder? A. Decreased expression of brain-derived neurotrophic factor (BDNF)B. Long alleles of the MAOA-uVNTR promoter polymorphismC. Catecholaminergic disruption and cholinergic dysfunctionD. Decreased function in serotoninergic dorsal raphe and dopaminergic ventral tegmental areaE. Deposition of amyloid plaques

Long alleles of the MAOA-uVNTR promoter polymorphism

A 25-year-old woman presents to the clinic complaining of sadness that started 6 weeks after her daughter was born (her daughter is 9-months old now). Since then, she has not returned to work. Her daughter usually sleeps through the night, but the patient still has difficulty staying asleep. She is easily distracted from normal daily tasks. She used to enjoy cooking, but only orders delivery or take-out now. She says that she always feels too exhausted to do so and does not feel much hungry anyway. The pregnancy of the patient's child was complicated by gestational diabetes. The child was born at 36-weeks' gestation. The patient does not smoke, drink alcohol, or use illicit drugs. She is 157 cm (5ft 1in) tall and weighs 47 kg (105lb); BMI is 20 kg/m2. Vital signs are within normal limits. She is alert and cooperative but makes little eye contact. Physical examination shows no abnormalities. Which of the following is the most likely diagnosis? A. Depression with peripartum-onsetB. Major depressive disorderC. Adjustment disorderD. Persistent depressive disorderE. Postpartum blues

MDD

A 32-year-old woman presents to the clinic with "a feeling of emptiness that's eating her insides." She has lost interest in daily activities, lost a considerable amount of weight as she has decreased appetite, and she also can't sleep at night. She has a feeling of worthlessness, and this has been going on for the past 6 weeks, and she says she feels this way "every day, for every second of it." These changes in her mood have made it difficult for her to perform her daily tasks. On further inquiry, she reveals that her husband died last month. She does not use any illicit drugs and does not have any change in psychomotor activity. What is the most likely diagnosis? A. BereavementB. Major depressive disorderC. Attention deficit hyperactivity disorderD. Adjustment disorder with depressed moodE. Bipolar disorder

MDD

A 45-year-old male comes to the clinic for feeling depressed and expressing that he has a total lack of interest in daily activities and difficulty falling asleep following the death of his spouse, which happened a couple of months ago. He also expresses thoughts of worthlessness and hopelessness with frequent impulses to commit suicide. Even though he was able to control these emotions previously, he mentions that he feels unsafe now. What is the most likely diagnosis? A. Normal sadnessB. BereavementC. Major depressive disorderD. Unspecified depressionE. Adjustment disorder with depressed mood

MDD

A 35-year-old man is brought to the clinic by his wife with complains of mood instability for 4 weeks. She has noticed that he has been talking more than usual and has an inflated self-esteem. She has also observed a sudden increase in his energy levels. She explains that between his high levels, he feels depressed and hopeless. He explains that he does not feel sleepy anymore and is fresh even after sleeping for just 3-4 hours unlike the normal 7-8 hours. She has not experienced similar symptoms prior to this. Past medical history reveals that the patient has had a history of major depressive disorder. He has not been taking any drugs. Systemic examination is unremarkable. What is the most likely diagnosis? A. Major depressive disorder with atypical featuresB. Major depressive disorder with mixed featuresC. Major depressive disorder with psychotic featuresD. Major depressive disorder with melancholic featuresE. Major depressive disorder with anxious distress

MDD with mixed features

Which one of the following neurologic disorders is best described as having multiple effects on the nervous system separated in time and space? A. Glioblastoma multiformeB. Multiple system atrophyC. Multiple sclerosisD. Multiple myelomaE. Multiple xanthoma

MS

A 33-year-old woman presents to the emergency department with sudden onset of palpitations, sweating, trembling, shortness of breath, chest pain, dizziness, and feeling as if she is going to die. The patient says that she has experienced similar symptoms in the past 3 months that last for around 10 minutes. The episodes occur at random and unexpectedly, which has led the patient to worry almost constantly about when she is going to have another attack. The patient does not smoke but drinks alcohol occasionally. She was diagnosed with hypothyroidism 4 months ago and takes levothyroxine. Which of the following is the most likely diagnosis? A. Medication-induced anxiety disorderB. Anxiety disorder due to another medical conditionC. Panic disorderD. Generalized anxiety disorderE. Acute stress disorder

Medication-induced anxiety disorder

A 65-year-old man is brought to the clinic by his wife. His wife states that he has been accusing her of cheating on him for the past 6 weeks. She is distressed at how her loyalty is all of a sudden being questioned after many decades of marriage. The patient even tried to convince his children to try to spy on his wife to "catch her in the act." His medical history is significant for Parkinson's Disease and he has been receiving treatment with dopamine agonists for 3 months. What is the most likely diagnosis? A. Delusional disorderB. SchizophreniaC. Medication-induced delusional jealousyD. DementiaE. Schizophreniform disorder

Medication-induced delusional jealousy

VPA

Men undergoing _______ treatment show erectile dysfunctions, abnormalities in androgens blood levels and sperm motility. ___________affects the release of luteinizing hormone, prolactin, and follicle stimulating hormone. It also interferes with peripheral endocrine hormones and has a wide inhibitory action on glucuronidation and cytochrome systems leading to high serum concentration of androstenedione, testosterone, and dehydroepiandrosterone sulfate.

A 56-year-old woman consults for the first time with a gambling problem. She says that her husband is demanding that she stop her gambling, or else he will divorce her. During her last gambling session, she lost about $250,000, which is her biggest loss so far. Unfortunately, she acquired this money from a shared retirement fund with her husband, which made her husband very angry. She shares that she has tried quitting at least five times in the past 2 years, but she feels very restless when she does not get to play in the casino at least once a week. Currently, she is jobless because she was terminated for embezzling funds a year ago. Her physical examination is unremarkable.The patient eventually undergoes psychotherapy, and for the past eleven months she has been able to avoid gambling. She happily shares that she has been able to start a small business with a friend, and her husband has stopped threatening to divorce her. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), what is the patient's diagnosis currently? A. Mild gambling disorder, persistent, in remissionB. Mild gambling disorder, persistent, in early remissionC. Moderate gambling disorder, persistent, in sustained remissionD. Moderate gambling disorder, persistent, in remissionE. Moderate gambling disorder, persistent, in early remission

Moderate gambling disorder, persistent, in early remission

Ingestion of which one of the following available common foodstuffs or herbal preparations is capable of producing symptoms resembling LSD intoxication? A. RosemaryB. NutmegC. Morning glory seedsD. Betel nutsE. Ephedra

Morning glory seeds

A patient with a tobacco use disorder presents in the pre-contemplation stage of change. Based on the transtheoretical model of Prochaska, Norcross, and DiClemente, which psychotherapy system would be most appropriate for this patient? A. Interpersonal therapyB. Rational-emotive behavior therapyC. Structural therapyD. Gestalt therapyE. Motivational interviewing

Motivational interviewing

Multiple systems atrophy or Shy Drager Syndrome

Multiple systems atrophy or Shy Drager Syndrome is a neurodegenerative condition characterized by tremors, bradykinesia, postural instability and ataxia. Apart from multiple sclerosis, none of the other options cause multiple CNS lesions separated by time.

A 17-year-old girl has been under treatment for cannabis use disorder for the past 6 months. She has been enrolled in a contingency management program and receives add-on weekly cognitive behavioral therapy. She had been abstinent for 5 months when she relapsed and smoked weed during a meet-up with old friends. The patient admits that the therapy has been helping her, and she is still motivated to quit, but sometimes the cravings get too intense. She wants to try a pharmacological agent to reduce cravings. Which pharmacological agent has been most studied for adolescents to add-on with psychosocial interventions? A. Oral tetrahydrocannabinolB. Extended-release zolpidemC. BupropionD. N-acetylcysteineE. Oral tetrahydrocannabinol and lofexidine

N-acetylcysteine

Established treatment for neurocognitive disorder due to Alzheimer's disease includes which one of the following treatment options? A. Dopamine agonistsB. StatinsC. AnticholinergicsD. Estrogen replacement therapy (ERT)E. N-methyl-D-aspartate (NMDA) receptor antagonists

N-methyl-D-aspartate (NMDA) receptor antagonists

What is the mechanism of action of ketamine prescribed for major depressive disorder? A. Selective serotonin reuptake inhibitorB. Alpha-2 adrenergic receptor antagonistC. Monoamine oxidase inhibitorD. N-methyl-d-aspartate receptor antagonistE. Serotonin norepinephrine receptor blocker

N-methyl-d-aspartate receptor antagonist

A 60-year old woman has been forgetting her grandchildrens' names since last year. Her condition has rapidly worsened over the past four months, and now she cannot recall what she had for her most recent meal. She complains of low mood. She has also experienced sudden, involuntary movements of her limbs, which has caused her to spill her tea on three occasions. EEG is performed and shows periodic sharp wave complexes. She has no family history of neurocognitive disorder (NCD). What is the most likely diagnosis? A. Frontotemporal NCDB. HemochromatosisC. NCD due to prion diseaseD. Friedrich's ataxiaE. NCD due to Alzheimer's disease

NCD due to prion disease

Degeneration of selected ___________neurons results in the symptom of anhedonia, which is a prominent feature of schizophrenia

NE

A 27-year-old woman presents with excessive sweating, mutism and altered state of consciousness. She is a known patient of schizophrenia who has been taking antipsychotics for the past 3 months. Physical examination reveals tachycardia, fever and hypertension. She is rigid and unresponsive. She appears disoriented, being unaware of her surroundings and is unable to communicate. What is the most likely diagnosis? A. CatatoniaB. Antipsychotic-induced parkinsonismC. Neuroleptic malignant syndromeD. Locked-in syndromeE. Stiff person syndrome

NMS

A 35-year-old man is brought to the emergency department by his wife following the deterioration of his mental health. The patient has a history of schizophrenia and is currently taking haloperidol and clonazepam. According to the wife, the patient was doing well, but since the last few hours, he has been disoriented and does not remember where he lives. On examination, the patient is conscious but not oriented to person, place, or time. His blood pressure is 190/110 mm Hg, respiratory rate is 24 breaths per minute, pulse rate is 124 bpm, and the temperature is 39°C. There is increased resistance on the movement of the limbs. On laboratory evaluation, creatinine phosphokinase levels are elevated with a white blood cell count of 15000/mm3. Which of the following is the most likely diagnosis in this patient? A. Neuroleptic malignant syndromeB. Malignant hyperthermiaC. Tardive dyskinesiaD. Serotonin syndromeE. Lethal catatonia

NMS

Disorders of arousal include confusional arousals, sleepwalking, and sleep terrors, all of which are characterized by partial arousals from _______sleep

NREM

In the COMBINE (Combining Medications and Behavioral Interventions for Alcoholism) study, which of the following findings was found to be true regarding the pharmacological treatment of alcoholism with naltrexone and acamprosate? A. Naltrexone was superior to acamprosateB. Acamprosate was superior to naltrexoneC. Combined treatment with acamprosate and naltrexone was superior to monotherapy with either medicationD. Neither naltrexone nor acamprosate had any efficacy in the treatment of alcoholismE. Naltrexone and acamprosate were equally efficacious

Naltrexone was superior to acamprosate

A 33-year-old man presents with a complaint of cough. He demands to be seen by the best medical expert in the hospital as he deserves the attention of only the "best". He doesn't like waiting with the other patients, considering himself more important and deserving to be seen first. During his examination he is needlessly boastful, expecting to be admired and given special attention. What is the most likely diagnosis? A. Antisocial personality disorderB. Borderline personality disorderC. Narcissistic personality disorderD. Histrionic personality disorderE. Schizotypal personality disorder

Narcissistic personality disorder

A 28-year-old woman with a history of a psychiatric illness wants to conceive. She is currently using carbamazepine, and would like to know what the risk of the specific pharmacological agent can be on her pregnancy outcome. She is aware of the risks and wishes to continue her medication. Which of the following is a likely abnormality she can expect? A. Neural tube defectsB. Persistent pulmonary hypertension of the newbornC. Ebstein's anomalyD. Drug withdrawal symptomsE. Tetralogy of Fallot

Neural tube defects

A 60-year-old man is brought to the clinic by his ex-wife who has concerns regarding his progressively altered behavior for the past eight months. She explains that they have been divorced for three years, but recently he has started visiting her at odd times in disheveled attire, calling her his wife, is disoriented to time/place, and speaking of past incidences as present occurrences. He seems restless and confused one moment, then blank and frozen the next. She recalls that he has had tremors while writing, and mild walking difficulty, because of which he retired early from his job about four years ago, but there were no behavioral or intellectual problems at the time, nor during their separation. She also recalls that he was prescribed medication for his motor issues, but he was not compliant. He does not have any family history of cardiovascular or psychiatric disorders, nor has he had any such issues in the past. What is the most likely diagnosis of this patient? A. Neurocognitive disease (NCD) with Lewy bodiesB. Neurocognitive disease (NCD) due to Parkinson's diseaseC. Neurocognitive disease (NCD) due to Prion's diseaseD. Vascular neurocognitive disorderE. Lewy body variant of Alzheimer's disease

Neurocognitive disease (NCD) due to Parkinson's disease

A 63-year-old woman presents with a progressive memory problem, with intermittent visual hallucinations. There appears to be a fluctuation to her symptomatology. On examination, she is found to be slightly bradykinetic. There is no resting tremor noted. Which one of the following neurodegenerative conditions does this most likely represent? A. Parkinson's diseaseB. Alzheimer's diseaseC. Gerstmann-Straussler-Scheinker (GSS) syndromeD. Neurocognitive disorder with Lewy bodiesE. Progressive nuclear palsy

Neurocognitive disorder with Lewy bodies

A 35-year-old man is brought to the emergency department by his wife following the deterioration of his mental health. The patient has a history of schizophrenia and is currently taking haloperidol and clonazepam. According to the wife, the patient was doing well, but since the last few hours, he has been disoriented and does not remember where he lives. On examination, the patient is conscious but not oriented to person, place, or time. His blood pressure is 190/110 mm Hg, respiratory rate is 24 breaths per minute, pulse rate is 124 bpm, and the temperature is 39°C. There is increased resistance on the movement of the limbs. On laboratory evaluation, creatinine phosphokinase levels are elevated with a white blood cell count of 15000/mm3. Which of the following is the most likely diagnosis in this patient? A. Neuroleptic malignant syndromeB. Malignant hyperthermiaC. Tardive dyskinesiaD. Serotonin syndromeE. Lethal catatonia

Neuroleptic malignant syndrome

A 28-year-old man with schizophrenia presents to the clinic for a follow up 2 weeks after switching to fluphenazine from haloperidol. On examination, the patient is moving slowly with a shuffling gait and has a resting tremor. Which of the following receptor is most likely responsible for these symptoms? A. Nigrostriatal pathway D2 dopamine receptorsB. Mesolimbic pathway D2 dopamine receptorsC. Acetylcholine receptorsD. D4 dopamine receptorsE. 5-hydroxytryptamine-2 (5-HT2) receptors

Nigrostriatal pathway D2 dopamine receptors

A 14-year-old boy presents to the emergency department with tremors, slurred speech, gait disturbances, and palpitations. Parents reveal that the patient is addicted to turpentine oil and has left school two years ago. He is vitally stable with a blood pressure of 120/80 mmHg, and heart rate is 75 beats per minute, respiratory rate 16 breaths per minute, and temperature 98.8F. Chest x-ray, ECG and abdominal ultrasound are normal. Which of the following is correct regarding pharmacotherapy with inhalant intoxication? A. Steroids are proven to be most effectiveB. Antibiotics are first-line agentsC. Formoterol remains the mainstay of treatmentD. No specific antidotes available, treatment is supportive therapyE. Epinephrine and norepinephrine must be administered

No specific antidotes available, treatment is supportive therapy

Cocaine use most frequently leads to which one of the following cerebrovascular events? A. Binswanger's diseaseB. Intraventricular hemorrhagesC. Nonhemorrhagic cerebral infarctionsD. Subarachnoid hemorrhagesE. Subdural hematomas

Nonhemorrhagic cerebral infarctions

Corpus striatum, a part of the basal ganglia located lateral to the thalamus, is divided into the caudate nucleus and the lentiform nucleus by a band of nerve fibers known as the internal capsule and plays an important role in the integration of emotional and cognitive behaviors associated with _______________

OCD

A 26-year-old woman is brought to the clinic by her husband for a consult on her agitated, erratic behavior for the past three days, which has aggravated since that morning after consumption of two cups of coffee and three energy drinks midst her tennis-practice within one hour. He explains that she plays tennis with her colleagues as a hobby, but recently has been over-performing, fueling up on energy drinks because of an inter-state game coming up in the following week. The patient is described as being restless and agitated since that morning along with associated gastrointestinal disturbances, increased urination, and frequent palpitations. Upon further questioning, there does not appear to be any history of psychiatric or medical illness. Currently, the patient is on oral contraceptive pills and multivitamin supplements. Which risk factor most likely increased the likelihood of caffeine intoxication in this patient? A. Female genderB. Oral contraceptive useC. Multivitamin useD. Thyroid hormone imbalancesE. Diuretic use

OCP use. Oral contraceptive use has been long studied to cause a decrease in the elimination of caffeine, hence predisposing the individual to intoxication symptoms if caffeine use is not monitored.

Which of the following disorders is most evenly distributed between males and females? A. Generalized anxiety disorderB. Obsessive-compulsive disorderC. Panic disorderD. Post-traumatic stress disorderE. Social anxiety disorder

Obsessive-compulsive disorder

A 45-year-old, self-employed, married man presents to the clinic with complaints of mild to moderate depression for the past 3 years. On interview, he acknowledges a history of drinking 3 to 4 drinks of hard liquor, 2 to 3 times a week for about 10 years. He denies any history of legal or financial trouble because of his drinking, though he does have occasional arguments about his drinking, and every few months or so he goes to work late or skips work altogether for a day to get over a hangover. He denies any history of suicidal thoughts, intent, plan or of suicide attempts. His medical history is unremarkable. The patient's wife corroborates the history and adds that he is generally a very anxious person and prone to excessive worry. Sometimes he even has physical symptoms, such as diarrhea, when he is stressed out. Which one of the following steps would be the best next step in this patient's treatment? A. Admit him to an inpatient dual diagnosis unitB. Obtain further history from patient to evaluate the presence of an anxiety disorderC. Start an SSRID. Refer him to Alcoholics Anonymous (AA)E. Refer him to individual therapy

Obtain further history from patient to evaluate the presence of an anxiety disorder

A 60-year-old man with a long-standing history of heavy alcohol use is brought to the emergency department, agitated and confused. He reports that his last use of alcohol was more than a week ago, and Wernicke-Korsakoff syndrome is suspected. Which one of the following features is characteristic of this condition? A. It only occurs in alcoholicsB. Thiamine treatment reverses almost all cases of alcohol-induced neurocognitive disorderC. Ocular changes may include abducens nerve paralysis and nystagmusD. Anterograde amnesia is present, but not retrograde amnesiaE. EEG is essential for an accurate diagnosis

Ocular changes may include abducens nerve paralysis and nystagmus

A 22-year-old woman presents to the clinic with her mother. Her mother explains the patient "has been talking to someone who is not there" since the last week. She has also not been eating, sleeps all day long, cries most days, doesn't enjoy activities she used to, and appears sluggish. Three years ago, the woman was diagnosed with some "mental issues", the details of which the mother does not know. She currently takes no medication. She had similar symptoms three months ago, but they resolved on their own after several weeks. The mother breaks down into tears and says, "One month ago she was cheerful, and energetic. She stayed up late every night finishing months worth of college assignments in one week. She was talking more than usual and singing all the time. I don't know what has happened to her again". Which of the following is the next step in management? A. Reassure the mother that the patient's condition does not warrant treatment.B. Cognitive behavioral therapy (CBT)C. Lithium and amitriptylineD. Olanzapine and fluoxetineE. Propranolol

Olanzapine and fluoxetine

Which one of the following statements about frontotemporal lobe dementia (DSM-IV)/ neurocognitive disorder due to frontotemporal lobar degeneration (FTD) (DSM-5) is true? A. Onset rarely presents after age 75B. Brain imaging reveals predominantly frontal and parietal atrophyC. Behavioral and emotional changes begin to develop in later stagesD. Changes in cognition predominantly affect visual constructional and visuoperception abilitiesE. The onset and course is abrupt and rapidly progressive in nature

Onset rarely presents after age 75. The majority of cases will present with an onset before 60 years of age.

A 27-year-old woman is being evaluated for premenstrual dysphoric disorder. During the interview, she is tearful because she did not sleep well last night and also had an argument with her husband this morning. She complains of irritability with her children and states that she feels exhausted, depressed, and overwhelmed. She reports that she has been having these symptoms beginning before each menstrual period for the last two years, and this has disrupted her work and family life. Which of the following statements best describes the management of this disorder? A. Oophorectomy followed by hormone replacement therapy may be effective in the treatment of this disorder.B. Surgical therapy has been found to have no role in the treatment of premenstrual dysphoric disorder.C. Surgical therapy is the recommended first-line treatment intervention for premenstrual dysphoric disorder.D. SSRIs have been found to have a longer onset of action in this disorder as compared to other mood disorders.E. Intermittent dosing is not possible with SSRIs for the treatment of premenstrual dysphoric disorder.

Oophorectomy followed by hormone replacement therapy may be effective in the treatment of this disorder.

A 25-year-old woman comes to the clinic with complains of depressed mood and extremely low energy levels for the past 4 weeks, and she has not been able to go to work during this time. She denies having any other symptoms. Past medical history reveals that she had a similar episode 2 years back for which she had to undergo psychotherapy. On examination, pulse is 80/min, blood pressure is 120/70 mmHg, respiratory rate is 12/min, no signs of anemia seen and thyroid size appears normal. Investigations showed hemoglobin of 12.2 and a normal thyroid profile. What is the most likely diagnosis? A. Other Specified Depressive Disorder-Short duration depressive episodeB. Major depressive episodeC. Other Specified Depressive Disorder- Depressive episode with insufficient symptomsD. Others Specified Depressive Disorder -Recurrent brief depressionE. Persistent depressive disorder

Other Specified Depressive Disorder- Depressive episode with insufficient symptoms

A 28-year-old woman presents to the clinic with complaints of low mood, very little energy, and irritability for the past week. She has not slept well in this duration and has been eating more than usual. She has been unable to pay attention to her work or her children which is making her even more anxious. She mentions that she has had these episodes on and off for the past 8 to 9 months but they don't happen every month and they don't coincide with her menstrual cycle. Systemic examination was unremarkable. What is the most likely diagnosis? A. Other Specified Depressive Disorder-Depressive episode with insufficient symptomsB. Other Specified Depressive Disorder-Persistent depressive disorderC. Major depressive episodeD. Other Specified Depressive- Recurrent brief depressionE. Other Specified Depressive Disorder-Short duration depressive episode

Other Specified Depressive Disorder-Short duration depressive episode

A 17-year-old adolescent with chronic polysubstance abuse presents to the emergency department with seizure and hypertension. After a period of quiet, he becomes combative with staff. Which one of the following drugs would be the most likely cause of these symptoms? A. CannabisB. AlprazolamC. MDMA (Ecstasy)D. PhencyclidineE. Heroin

PCP

An 18-year-old man is brought by the police to the emergency department for evaluation. On physical exam, he is aggressive, dysarthric, and ataxic. He is drooling and has horizontal nystagmus. He is most likely showing signs of intoxication from which one of the following substances? A. AlcoholB. AmphetamineC. CocaineD. HeroinE. Phencyclidine

PCP

An 18-year-old man is brought to the emergency department with extreme agitation. He needs to be held down by 4 security officers. He has prominent drool which is getting on everyone. When he is subdued you note the presence of vertical nystagmus and tachycardia. Which substance is this patient most likely intoxicated with? A. AlcoholB. CocaineC. InhalantD. LSDE. Phencyclidine

PCP

___________ has a complex genetic component. Of the complex genetic component, variation in monoamine oxidase A (MAO-A) has been implicated in this disorder. In particular the long alleles of the MAOA-uVNTR promoter polymorphism

Panic disorder with agoraphobia

A 35-year-old man is brought by his colleague to the psychiatry clinic due to his suspiciousness and distrust towards other coworkers. He interprets their intentions as exploitative and harmful towards him. During the interview, he tells the therapist that all his coworkers are against him and don't want him to prosper. A further interview reveals that he has suspicions regarding the fidelity of his spouse. There are no complaints of hallucinations or delusions, and his past medical and psychiatric history is insignificant. Which of the following is the most likely diagnosis of this patient? A. Paranoid schizophreniaB. Schizoaffective disorderC. Schizotypal personality disorderD. Paranoid personality disorderE. Personality trait

Paranoid personality disorder

A 45-year-old man presents to emergency with the complaints of abdominal pain and fever. He is unwilling to give his biodata and insists that he has been poisoned by his brother who recently came to visit him. When the test results show no evidence of poisoning he throws a tantrum and insists that the entire hospital is plotting to harm him and steal his money. He refuses to receive any more treatment. A psychiatrist is able to calm him down and finds out that he has been suspicious of the motives of everyone around him since adolescence. He has no history of hallucinations but has been involved in several altercations. What is the most likely diagnosis? A. Paranoid personality disorderB. SchizophreniaC. Delusional disorderD. Brief psychotic disorderE. Schizophreniform disorder

Paranoid personality disorder

A 64-year-old man is seen by his physician for his annual checkup. During the exam, he questions the physician's every action and, when the prescriptions are written, he asks if the physician is getting any financial gain from "pharma." He appears hypervigilant throughout the visit. His behavior is consistent with a lifelong pattern. What is the most likely diagnosis? A. Antisocial personality disorderB. Borderline personality disorderC. Paranoid personality disorderD. Schizoid personality disorderE. Schizotypal personality disorder

Paranoid personality disorder

A 16-year-old girl is brought to the clinic by her mother who expresses concern regarding her daughter's growing caffeine dependence for the past four months. She explains that her daughter drinks four to five cups of coffee and invariable caffeinated sodas throughout the day. Her concern stems from her daughter's progressively aggravating moodiness, irritability, gastrointestinal disturbances, and sleeping difficulties that are disturbing her personal and social life. The patient seems restless and frustrated, acknowledging her mother's concerns and the harm posed by excess caffeine use, but refuses to cut back on her intake, expressing fear of withdrawal symptoms which are 'unacceptable' to the patient. Which active metabolite is responsible for the psychostimulant effect of caffeine? A. TheobromineB. TheophyllineC. Methyluric acidD. ParaxanthinesE. 1,3,7-Trimethyluric acid

Paraxanthines

A 65-year-old man has been advised to undergo pallidotomy. This procedure is indicated for which of the following disease? A. Alzheimer's diseaseB. Tardive dyskinesiaC. DementiaD. HydrocephalusE. Parkinson's disease

Parkinson's disease

The diagnosis of Unspecified Psychotic Disorder is best used for which of the following situations? A. Delusions with overlapping mood symptomsB. Delusional symptoms in a partner of patient with schizophreniaC. Patient in the ER with auditory hallucinations without collateralD. Persistent auditory hallucinations aloneE. Psychotic symptoms lasting less than one month but have not yet remitted

Patient in the ER with auditory hallucinations without collateral

An 8-year-old girl has been previously diagnosed with bipolar disorder for her symptoms of hyperactivity and inattention. A new evaluation is completed and a diagnosis of ADHD is confirmed. She is started on atomoxetine at a dose appropriate to her body weight. The family returns 3 weeks later, reporting that the child is more hyperactive, hyperverbal, and is sleeping less. What is the most likely explanation for this change in clinical presentation? A. Patient is not taking the medication as prescribedB. Patient's behavior is explained by the additional diagnosis of oppositional defiant disorderC. Patient likely has bipolar illness (whether with or without ADHD), and her hypomania was activated by the atomoxetineD. Patient is unresponsive to atomoxetineE. Patient does not really have ADHD

Patient likely has bipolar illness (whether with or without ADHD), and her hypomania was activated by the atomoxetine

A 62-year-old man with a history of panic disorder on alprazolam 0.25 mg as needed for panic attacks is admitted in the ICU after esophagectomy due to stage I esophageal cancer. The patient smokes one pack of cigarettes per day. Psychiatric evaluation has been recommended for the treatment of anxiety because the nursing staff has noted the patient is "very anxious." The patient's girlfriend at bedside tells you that she has "never seen him like this." She says he takes alprazolam on average 2 or 3 times per week for panic attacks. Patient is unable to swallow due to surgery, and he is fed with a percutaneous endoscopic gastrostomy tube (PEG). The patient drinks socially with friends, but never has more than a few drinks and never drinks when he takes alprazolam. Patient cannot talk presently due to the effect of his surgery. His girlfriend informs you that to her knowledge he does not have a psychiatric history other than panic disorder and no family history. The girlfriend also reports that she has an anxiety disorder and is struggling with her boyfriend's disease. What's the next best step of care for this patient? A. Perform a psychiatric evaluation on the patient's girlfriend and refer accordinglyB. Increase the dose of alprazolam to 0.5 mg as needed, as it can be crushed and given through the PEGC. As patient cannot swallow, switch to lorazepam 0.25 mg IV as needed for anxietyD. As patient cannot swallow, switch to lorazepam 0.5 mg IV as needed for anxietyE. Perform a Confusion Assessment Method for the ICU (CAM-ICU)

Perform a Confusion Assessment Method for the ICU (CAM-ICU)

The wife of a 67-year-old man brings him for evaluation. He is mildly disoriented, has facial tremors, an enlarged liver, and an enlarged beefy tongue. On neurologic exam, his gait is unsteady, especially when the lights are lowered. Tactile sensation is decreased, especially in the legs, and he has generalized weakness with spasticity and increased reflexes. Most likely diagnosis? A. NeurosyphilisB. Pernicious anemia - vitamin B12 deficiencyC. Multiple sclerosisD. Cerebellar degeneration from alcoholismE. Multi-infarct vascular disease

Pernicious anemia - vitamin B12 deficiency

A 13-year-old boy presents with his parents, who report that he has had the slow progression of multiple motor tics over the past 2 years, not present every day or week, but occurring on at least half the days of any given month. Which one of the following diagnoses is the most likely diagnosis for this patient? A. Tourette's disorderB. Persistent (chronic) motor or vocal tic disorderC. Provisional tic disorderD. Unspecified tic disorderE. Stereotypic movement disorder

Persistent (chronic) motor or vocal tic disorder

A 22-year-old female presents to your office for a second opinion. She had recently been started on Valproic acid for a bipolar disorder and migraine headache. She is worried since she was told by her neighbor that Valproic acid is associated with a lot of adverse effects. Which among the following conditions can occur secondary to Valproic acid use? A. Glioblastoma multiformeB. Retinitis pigmentosaC. Polycystic ovarian syndromeD. Generalized epilepsyE. Myelodysplastic syndrome

Polycystic ovarian syndrome

A 25-year-old woman is brought to the outpatient clinic by her husband who complains his wife is not being herself since the birth of their newborn, who is 3 weeks old. The husband complains his wife often hears voices from strangers who tell her to harm her baby. She has no previous psychiatric illness. She has become increasingly irritable and is having insomnia. Before the birth of her baby, she was a cheerful person who liked going out with friends, but now she stays home all day and talks to herself. Which of the following is the most likely diagnosis? A. Postpartum psychosisB. Postpartum depressionC. Bipolar I disorderD. SchizophreniaE. Schizophreniform

Postpartum psychosis

A 31-year-old homeless man presents to the outpatient clinic with complains of hearing voices of a person who is conspiring against him and planning to harm him. His past medical history is positive for paranoid schizophrenia, diagnosed 2 years ago. He was prescribed risperidone by the psychiatrist but has been noncompliant since. He has been hospitalized several times before for acute psychotic episodes. Urine toxicology screen is negative. On mental status examination, he appears disheveled with poor eye contact, affect is blunted, mood is anxious, and judgment is poor. Which of the following is the most appropriate management for this patient? A. Switch to aripiprazoleB. Increase the dose of risperidoneC. Prescribe long acting injectable risperidoneD. Refer for long term hospitalizationE. Electroconvulsive therapy.

Prescribe long acting injectable risperidone

A 17-year-old boy with mild ADHD presents to your clinic alone for a regular follow up. He confides that he is currently taking medication for tuberculosis. You remember that patients with tuberculosis may also have concomitant HIV infection. You are now thinking of offering HIV screening to this patient. Which among the following would be the most appropriate next step? A. Inform the patient's parents and let them sign the consent form for screeningB. Proceed with HIV screening after the patient has given his informed consentC. Advise the patient to follow-up in one month with his parents for screeningD. Let the patient finish anti-tuberculosis therapy and perform screening afterE. Refer the patient back to the clinician managing his tuberculosis

Proceed with HIV screening after the patient has given his informed consent

Which one of the following cerebrospinal fluid (CSF) lab values would most consistently be seen in acute viral meningitis? A. Opening pressure > 25 cm H 2 OB. % neutrophils greater than 10C. Protein level > 50mg/dLD. Glucose between 40 and 80E. Cloudy and purulent fluid

Protein level > 50mg/dL

A 4-year-old child who was adopted at the age of 2 years and has an early history of social neglect, is brought to the pediatric outpatient department by her adoptive mother with symptoms of culturally inappropriate, excessively familiar behavior with strangers. She actively approaches unfamiliar adults and has no hesitancy in hugging them, sitting in their laps, or leaving with them. Which of the following is the most important intervention for this child? A. A trial of psychopharmacological interventionB. Limiting contact with non-caregiving adultsC. Provision of an emotionally available attachment figure to the childD. Promotion of regression for "reattachment"E. "Rebirthing therapy"

Provision of an emotionally available attachment figure to the child

Multiple lines of research have shown associations between treatment with which of the following medication classes and decreased rates of substance use-related problems among patients with attention-deficit/hyperactivity disorder? A. Selective serotonin reuptake inhibitorsB. Dopamine receptor antagonistsC. PsychostimulantsD. Alpha-1 receptor antagonistsE. Monoamine oxidase inhibitors

Psychostimulants

A 26-year-old man presents for possible opioid intoxication. Which among the following signs or symptoms should you look for in patients with this condition? A. Piloerection with pupillary dilationB. Lacrimation and rhinorrheaC. Insomnia and muscle achesD. Pupillary constriction and drowsinessE. Fever, diarrhea, with nausea and vomiting

Pupillary constriction and drowsiness

______ sleep parasomnias include nightmares, which are characterized by frightening dreams and autonomic arousal, and REM behavior disorder

REM

A 38-year-old woman presents with an acute onset of emotional volatility and delusions. She is accompanied by her daughter who tells you that the patient started to behave strangely 5 days ago, a week after she witnessed a car accident. She became aggressive to her neighbors, stating that they hired a killer to eliminate her. She does not have any concurrent chronic medical conditions. The patient has a 10-pack-year history of smoking. She drinks alcohol occasionally. She does not have a history of illicit substances use. She is divorced and lives with her daughter. They have a good relationship. On presentation, the patient's vital signs are within normal limits and the physical examination is unremarkable. The patient is alert but disoriented. She shifts topics frequently. She expresses her beliefs regarding her neighbors' intentions throughout the whole interview. Which of the following features should be observed in the natural course of the patient's condition to support the diagnosis of a brief psychotic disorder? A. Remission within 1 monthB. Unresponsiveness to antipsychoticsC. Emergence of negative symptomsD. Temperature increaseE. Decrease in consciousness

Remission within 1 month

Which of the following will be seen more in children with aggression as a part of conduct disorder at rest on EEG? A. Resting frontal brain electrical activityB. Resting parietal brain electrical activityC. Resting temporal brain electrical activityD. Resting occipital brain electrical activityE. Resting cerebellar activity

Resting frontal brain electrical activity

A 36-year-old woman presents for treatment of premenstrual symptoms occurring for 10 days before her cycle for the past 3 years. She complains of mood swings and lashing out at her husband and kids, which has disrupted her family and role functioning. She also complains of premenstrual fatigue, interrupted sleep, cravings for sweets, abdominal bloating, headaches, and breast tenderness, which usually resolve after the first day of menses. She is diagnosed with premenstrual dysphoric disorder (PMDD). Which of the following is the most appropriate treatment? A. Primrose oilB. Vitamin AC. Vitamin ED. St John's WortE. Selective serotonin reuptake inhibitors

SSRIs

A 25-year-old man is brought to the psychiatry clinic for evaluation. He was caught by the police while setting the neighbor's garden on fire. Upon further questions, the patient believes his neighbors are trying to poison his food. According to his parents, their son has been found talking to imaginary people in the house. He has stopped going out with his friends and wants to stay alone at home, they are afraid to leave their son at home because he once tried to harm himself. These symptoms have been occurring for the past 3 months. He denies any other symptoms and his physical examination is within normal limits. During the examination, his appearance is disheveled, speech is coherent and has a restricted affect. Toxicology screen test is negative. Which of the following is the most likely diagnosis? A. Brief psychotic disorderB. SchizophreniaC. Schizophreniform disorderD. Substance use disorderE. Avoidant personality disorder

Schizophreniform disorder

A 28-year-old woman presents to the clinic with her husband, with complaints of low mood for the past 10 days. She has been eating and sleeping more than she used to and has lost interest in activities she liked to do before, such as knitting. She does not usually look forward to winters and Christmas, because she usually worries about getting tired and cold. This winter, she got the flu and became sick. Since then, she does not feel like going out of the house and cannot seem to focus on helping with her children's homework assignments. Her husband explains that this happens to her every year and they always end up spending the vacations at home. She does mention during the holidays she occasionally drinks 1 can of beer a week with her husband. What is the most likely diagnosis? A. Persistent depressive disorderB. Adjustment disorder with depressed moodC. Generalized anxiety disorderD. Substance-induced mood disorderE. Seasonal affective disorder

Seasonal affective disorder

______________ stage is a stage of cognitive development from 0-2 years of age. (Piaget)

Sensorimotor stage

A 9-year-old boy is brought to the clinic by his parents, who say that the child does not like to go to school and insists on coming back home immediately after school. The teacher at school says that the child complains about abdominal pain every morning when he gets to school. The parents say that the child sleeps in their bed at night and refuses to sleep in his own bed. Which of the following is the most likely diagnosis? A. Separation anxiety disorderB. Social anxiety disorderC. Specific phobiaD. Reactive attachment disorderE. Posttraumatic stress disorder

Separation anxiety disorder

Which of the following neurotransmitter system is most commonly targeted in the treatment of obsessive-compulsive disorder? A. Serotonergic pathwayB. Dopaminergic pathwayC. Glutamatergic pathwayD. Cholinergic pathwayE. GABAergic pathway

Serotonergic pathway

A 35-year-old woman has failed multiple antidepressant trials. She explains that her sister, also with depression, had a good response to phenelzine. After being started on phenelzine herself, she has an initial good response, but after several weeks admits herself to the hospital with suicidal urges. The resident on call does not renew the phenelzine and starts her on sertraline. The next day, she complains of having a headache and feeling dizzy. Her vital signs are a temperature of 102°F, her pulse is 110 bpm, and her blood pressure is 152/100 mmHg. She is most likely suffering from which one of the following conditions? A. Idiosyncratic withdrawal disorderB. Lithium intoxicationC. Meperidine syndromeD. Monoamine oxidase toxicityE. Serotonergic syndrome

Serotonergic syndrome

A 19-year-old woman is brought to the clinic by her parents with the complaint of recurrent palpitations during the last 3 months. During an episode, she feels chest tightness, shortness of breath, and palpitations. Her face becomes flushed, and she sweats profusely. She is not able to identify any trigger for these episodes. The symptoms appear suddenly and last for 10-15 minutes. She had one episode during a lecture in her school. She is worried that she might get the episode anywhere and anytime, and has started avoiding social gatherings and skipping school. She spends most of her time in her room. Her parents are worried about her. She thinks there is something wrong with her heart. On physical examination, her pulse is 77/min, her respiratory rate is 14/min, her temperature is 98.6°F, and her blood pressure is 115/73 mmHg. Her BMI is 19kg/m2. Her lab investigations, including ECG, do not show any abnormality. Which of the following is the appropriate treatment option for this patient? A. PropranololB. ClomipramineC. SertralineD. BuspironeE. Bupropion

Sertraline

A 25-year-old man presents to the clinic for a follow-up visit. He was diagnosed with social anxiety disorder and was advised cognitive behavioral therapy. According to the patient, he is still facing difficulties in social situations and wants to change the course of treatment. Which of the following is the most appropriate treatment for this patient? A. PhenelzineB. SertralineC. GabapentinD. BuspironeE. Olanzapine

Sertraline

A 39-year-old man presents with numbness and tingling of the feet, which has been occurring for the past 5 years. Recently, he states that he has been tripping on his own feet. His past medical history is significant for the development of diabetes mellitus. Physical exam reveals normal bulk and tone in all extremities, with slight dorsiflexion weakness symmetrically at the ankles. Pinprick and vibration are impaired in stocking-glove distribution in the lower extremities up to the shins. A gait exam reveals slight bilateral foot drop. He also explains that he has recently been seeing a dermatologist for patches of hyperpigmentation over his back and legs, which he says are getting worse. Which one of the following tests should be the next step in diagnosing the patient? A. Electromyography (EMG) with nerve conduction study (NCV)B. Hemoglobin A1CC. Cerebral spinal fluidD. Serum protein electrophoresisE. Antinuclear antibodies, erythrocyte sedimentation rate, and dsDNA

Serum protein electrophoresis

phototherapy or bright light therapy (BLT).

Sessions typically last 30-90 minutes with exposure to upto 10,000 lux of white fluorescent light. Typically light boxes that emit light similar to sunlight are used; they are placed on a table or desk and patients sit in front of the box, adjusting the distance according to instructions in the light box to get the appropriate intensity of light, which is usually about 2 feet for a 10000 lux light box. Patients are also instructed not to look at the light source directly.

An 18-year-old woman presents with the complaint of excessive daytime sleepiness. For about one year, she has been experiencing an irrepressible desire to fall asleep anywhere at any time despite getting adequate sleep at night. This has greatly affected her school performance and social life. She also mentions that whenever she displays any strong emotion, like laughing or being surprised, she tends to lose control of her legs and falls to the ground. Nocturnal sleep polysomnography shows that her mean sleep latency is 11 minutes and 2 sleep onset REM periods are found on multiple sleep latency test (MSLT). How should this patient be managed? A. Sodium oxybate during the day, sleep-CBTB. Sodium oxybate at night, scheduled napsC. Imipramine and scheduled napsD. Fluoxetine and imipramineE. Olanzapine and sleep-CBT

Sodium oxybate at night, scheduled naps

You are taking care of a 75-year-old man with multiple medical problems who requires dialysis. Ethical reasons for withholding dialysis would include which of the following? A. Stage IV pancreatic cancerB. DeliriumC. Moderate hepatic impairmentD. Pain requiring chronic narcotic useE. Schizophrenia

Stage IV pancreatic cancer

A 58-year-old man presents for a routine visit after being lost to follow up. He has refractory schizophrenia and reports good control of his symptoms with clozapine 50 mg twice daily. During the interview, you notice that he is repeatedly smacking his lips and clenching his hands. When asked the patient about it, the patient denies this occurrence and reports that nobody has mentioned this to him. Past psychiatric history notes tardive dyskinesia with chlorpromazine and a suicidal attempt 2 years prior. Which among the following would be your next step in managing this patient? A. Start him on tetrabenazine 12.5 mg once daily in the morningB. Start him on valbenazine 40 mg once dailyC. Decrease clozapine to 12.5 mg twice dailyD. Discontinue clozapine and start the patient on risperidone 2mg once dailyE. Admit the patient and discontinue clozapine

Start him on valbenazine 40 mg once daily

Stereotypic movement disorder

Stereotypic movement disorder is a motor disorder with onset in childhood involving repetitive, nonfunctional motor behavior that markedly interferes with normal activities or results in bodily injury. It is often misdiagnosed as tics or Tourette's disorder.Unlike the tics of Tourette's disorder, which tend to appear around age six or seven, repetitive movements typically start before age three, are more bilateral than tics, and consist of intense patterns of movement for longer runs than tics.

A 19-year-old man is brought by police to the emergency department. His girlfriend called because he was seeing things that were not there. He appears guarded, suspicious, and ignores most questions about personal and medical history. He is somewhat uncooperative, hyperactive, underweight, and complains about the strangers that he catches glimpses of as they dart behind doors and curtains around the ED. Affect appears anxious. Vital signs are normal. He is oriented to person, situation, place, and time. His girlfriend reports he has been increasingly "paranoid" over the last 4-5 weeks and she is afraid that he might act out in a violent way since he is "so sure people want to hurt him." Which one of the following substance-induced psychotic disorders is most likely given this constellation of symptoms? A. Alcohol withdrawal deliriumB. Sedative/hypnotic withdrawalC. Stimulant-induced psychotic disorderD. Thiamine-deficiency deliriumE. Inhalant intoxication

Stimulant-induced psychotic disorder

A 55-year-old man is brought with the complaint of confusion, somnolence, and muscle rigidity. He is found to have a temperature of 104°F (40°C), and his serum creatinine kinase levels are elevated. He has a history of schizophrenia and has been taking olanzapine for several years. Due to worsening of symptoms, he was recently switched to haloperidol. How should this patient be managed? A. Stop all medication, start bromocriptine and supportive treatmentB. Reduce dose of current medication, supportive treatmentC. Supportive treatment and give apomorphineD. Supportive treatment and ECTE. Stop all medication and give levetiracetam

Stop all medication, start bromocriptine and supportive treatment

A 45-year-old woman comes with the complaint of fever and tremors. She had been experiencing nausea for a few days and took metoclopramide to remedy the nausea. Her drug history also reveals that she has been taking sertraline to treat her major depression for 3 years. During her examination, she becomes increasingly drowsy and confused, and her neurological evaluation shows increased muscular rigidity. Her labs show leukocytosis and elevated serum CK levels. How should this patient be managed? A. Reduce dose of current medication, supportive treatmentB. Stop all medication, supportive treatment, dantroleneC. Supportive treatment and deep brain stimulationD. Supportive treatment and cyproheptadineE. Reduce dose of current medication and give amantadine

Stop all medication, supportive treatment, dantrolene

A 39-year-old woman presents for second opinion with chief complaints of continued mood symptoms and intolerance of current antidepressant. She reports sadness, loneliness, anxiety, and feeling "like a loser who's bad at relationships" after a recent breakup. She started doing poorly at work, not keeping up with chores at home, losing weight, and sleeping poorly. When she started thinking about killing herself, she went to her P.C.P. for help. She was started on sertraline 25 mg four weeks ago but has continued to feel nauseous and "headachy" with no change in depressive symptoms. On follow up two weeks ago, her provider asked her to "give it a couple more weeks to see if it works or not." She has become only partially adherent. Based on what you've learned so far, what is your most likely recommendation? A. Continue sertraline 25 mg qd and add PRN ibuprofen and antacidsB. Increase sertraline to 50 mg qd and add PRN ibuprofen and antacidsC. Decrease sertraline to 12.5 mg qd for two weeksD. Stop sertraline and start mirtazapine 15 mg qhsE. Stop sertraline and start trazodone 50 mg qhs

Stop sertraline and start mirtazapine 15 mg qhs

Acamprosate

Structural analogue of γ-aminobutyric acid (GABA); believed to decrease alcohol intake by affecting calcium channels and modifying transmission along GABA and glutamine pathways in the brain, resulting in decreased positive reinforcement of alcohol intake and decreased withdrawal cravings. The typical dosage is 2 tabs PO tid (666 mg PO tid)

An effective treatment for Parkinson's disease is the implantation deep in the brain of stimulating electrodes. Implantation into which one of the following brain regions results in greatest efficacy? A. Mammillary bodyB. Anterior caudate nucleusC. Spinothalamic tractD. Superior thalamic nucleusE. Subthalamic nucleus

Subthalamic nucleus

A 21-year-old man presents to the emergency in an unconscious state. Physical examination shows pale, cold skin, fixed dilated pupils, silent planters and absent corneal reflex. He is pulseless with unrecordable blood pressure and straight-line ECG.History of other medication, medical or psychiatric disorder is negative. His friends report that he has been sniffing chloroform from the last 13 months and presented to the emergency last month with inhalant intoxication. Which of the following is the cause of death in this patient? A. PotentiationB. Caffeine intoxicationC. Hallucinogen intoxicationD. Cannabis withdrawalE. Sudden sniffing syndrome

Sudden sniffing syndrome

A 20-year old woman has been diagnosed with major depressive disorder after presenting to the clinic with symptoms of depressed mood, decreased energy, poor concentration and loss of interest in previously enjoyed activities. Her symptoms have been present for the past 9 months. Additionally, she admits to the thought of jumping off a bridge if she had the chance, but states she has not acted on this thought. She has no other psychiatric history. She is started on sertraline. Which of the following adverse outcome is this patient at the great risk of during the first 2 weeks following initiation of therapy? A. Extrapyramidal symptomsB. Hypomanic episodesC. Medication noncomplianceD. Life-threatening arrhythmiasE. Suicide completion

Suicide completion

A 32-year-old woman presents to the emergency department because of a 3-hour history of severe nausea, vomiting, tremor, and anxiety. She recently started a new medication but did not remember its name. She has a history of major depressive disorder treated with fluoxetine. Her temperature is 38.9°C (102.1°F), pulse is 132/min, respiratory rate is 22/min, and blood pressure is 152/94 mmHg. She is confused. Physical examination shows diaphoresis and an ataxic gait. Patellar reflexes are 4+ bilaterally. This patient's condition is most likely due to which of the following medications? A. SuccinylcholineB. HaloperidolC. ScopolamineD. SumatriptanE. Amiodarone

Sumatriptan

A 35-year-old woman presents to the clinic with complaints of low mood for the past 3 months. She explains that she was feeling completely fine in the past. Unfortunately, her best friend who was living with her had died 3 months ago. She explains that she feels fine at work and is productive as before. However, as soon as she comes home, she sometimes gets tearful or starts thinking about her friend. She denies suicidal thoughts, auditory or visual hallucinations, difficulties sleeping, focusing, or appetite changes. She has not consulted any health care provider prior to the appointment. She denies personal or family history of psychiatric conditions. She denies any substance use. Which of the following would be the next step to recommend as treatment for this patient? A. Mood stabilizerB. Supportive psychotherapyC. Tricyclic antidepressantsD. BenzodiazepinesE. Both selective serotonin reuptake Inhibitor (SSRI) and selective norepinephrine reuptake inhibitor (SNRI)

Supportive psychotherapy

A 70-year-old woman presents with involuntary jerky movements of her limbs and face. She has been taking haloperidol and fluoxetine for her psychotic depression for 2 years. The dosage of both drugs was recently increased in order to manage an increase in her psychotic symptoms. She also has been taking insulin for her diabetes for 15 years. She is diagnosed with tardive dyskinesia. How should she be managed? A. Stop all medication, supportive treatmentB. Stop haloperidol, administer benztropineC. Stop fluoxetine, supportive treatmentD. Switch to clozapine, administer valbenazineE. Stop fluoxetine and haloperidol, administer baclofen

Switch to clozapine, administer valbenazine

Which one of the following proteins is often abnormally deposited in individuals who experience REM sleep behavior disorder? A. SynucleinB. TauC. Beta amyloidD. HuntingtinE. SOD-1 (copper-zinc superoxide dismutase)

Synuclein

A 34-year-old man presents to the clinic with complains of blurred vision, dry mouth, and constipation. He has gained 5 kilograms in 2 months and has started sleeping more than usual. He also feels dizzy right after he stands up and starts having palpitations. Past medical history revealed that he got diagnosed with major depressive disorder 6 to 8 months ago and was prescribed a medication for it. He was asked to monitor drug levels at a regular interval but he did not get them checked. No dietary restrictions were advised. Which of the following class of drugs may give rise to these symptoms? A. Monoamine oxidase (MAO) inhibitorsB. Tricyclic antidepressants (TCA)C. Selective serotonin reuptake inhibitors (SSRI)D. Norepinephrine dopamine reuptake inhibitors (NDRI)E. Serotonin norepinephrine reuptake inhibitors (SNRI)

TCAs

A 26-year-old woman presents to the clinic concerned about continuing her psychotropic medication after finding out that she is pregnant. She has been taking antidepressants for her severe depression for 6 years. After a great deal of trial and error, her mood stabilized last year by taking both escitalopram 25mg and imipramine 75mg. She is 6 weeks pregnant but found out about her pregnancy 2 days ago. How should this patient be managed? A. Switch to paroxetineB. Lower dosage of imipramineC. Completely stop all medicationD. Taper off imipramine and decrease dosage of escitalopramE. Switch to nortriptyline

Taper off imipramine and decrease dosage of escitalopram

A 56-year-old male has insidious onset of cognitive impairment, depression and rapid jerky movements in his limbs and trunk. His father died from an advanced form of this condition. Which treatment would most likely help to decrease his disabling movement disturbance? A. Carbidopa/levodopaB. FluoxetineC. RivastigmineD. RopiniroleE. Tetrabenazine

Tetrabenazine

Which one of the following options is a test of criminal sanity or responsibility? A. Maximum autonomyB. The M'Naghten ruleC. Parens patriaeD. The Tarasoff decisionE. The treatment contract

The M'Naghten rule

Valbenazine MOA

The exact mechanism of action of valbenazine in the treatment of tardive dyskinesia is not known, but is may be mediated through reversible inhibition of vesicular monoamine transporter 2 (VMAT2), a transporter regulating monoamine (most notably dopamine) uptake from the cytoplasm to the synaptic vesicle for storage and release. It thus reduces dopamine release which in turn improves tardive dyskinesia.

A 10-year-old boy, who is a second-grade student, has significant speech and language difficulties. According to his teachers, his writing and listening skills are significantly below grade level; he has difficulty in segmenting a simple word without assistance. Which of the following statements best describes the role of health care providers in interacting with school personnel for the children who have special education needs? A. The health care provider is not allowed to talk to the person responsible for the development of a child's individualized education programB. The health care providers should not suggest solutions to the school regarding the possible educational ramifications of a child's disabling conditionsC. The healthcare providers should avoid having in-person meetings with the school personnelD. The healthcare providers should write a prescription to the school to provide a specific education service for a child with a disabilityE. The health care providers should be involved in the official individualized education program (IEP) planning meetings

The health care providers should be involved in the official individualized education program (IEP) planning meetings

An 18-year-old man presents to the emergency with unconsciousness for the past 30 minutes. Parents reveal that he ingested a large quantity of nail polish remover after an argument with his sister. The patient has been huffing and bagging nail polish remover for the past two years, and has previously presented to the emergency twice with intoxication. Physical examination shows pale, cold skin, fixed, dilated pupils, silent plantars, and absent corneal reflex. He has no pulse, no measurable blood pressure, and a straight-line ECG. His death is declared, and dysrhythmia is suggested to be the most likely cause of death. Which of the following is correct regarding the pathophysiology of the development of dysrhythmias after hydrocarbon intoxication? A. The interaction of a high dose of catecholamines and abuse substancesB. The desensitization of myocardium due to extensive use of hydrocarbonsC. The depressed release of catecholamines due to long-term use of hydrocarbonsD. The decreased sensitization of myocardium which leads to a catecholamine surgeE. The increased sensitization of myocardium to catecholamines

The increased sensitization of myocardium to catecholamines

An 8-year-old boy has been referred to the clinic for a psychiatric evaluation. The boy has a two-year history of frequent anger outbursts at home and at his school. During these episodes, he becomes verbally aggressive, responding to directions from his parents or teachers with profanity and offensive statements. His mood remains persistently irritable between these episodes. Which of the following statements best describes the features associated with this disorder? A. The frequent temper outbursts seen in this disorder manifest only in the form of verbal aggression.B. Individuals diagnosed with this disorder also qualify simultaneously for the diagnosis of bipolar disorder.C. The rates of prevalence of this disorder are higher in females.D. The onset of this disorder must be before the age of 10 years.E. The diagnosis of this disorder is usually established for the first time before the developmental age of 5 years.

The onset of this disorder must be before the age of 10 years.

A patient who suffered damage to her frontal lobes following a motor vehicle accident displays utilization behavior. This is best exemplified by which of the following behaviors? A. The patient sits in the waiting room next to another woman knitting. When the woman leaves to go to the bathroom and leaves her knitting needles, the patient picks them up and begins knittingB. The patient is eating breakfast quietly. A delivery truck backfires, making a loud noise. The patient begins to cry with loud moans for no apparent reasonC. The patient sits at home in a comfortable chair in the living room. She stares ahead blankly not reading, watching television, or interacting with others. She does not appear dysphoric or in any distressD. The patient begins to walk around her neighborhood and collect different metal pieces from the trash, which she brings homeE. The patient spends hours a day making detailed notes of the day's events in little notebooks, which she makes herself

The patient sits in the waiting room next to another woman knitting. When the woman leaves to go to the bathroom and leaves her knitting needles, the patient picks them up and begins knitting

A 17-year-old homeless boy presents to the emergency with a cough, choking, vomiting with aspiration and abdominal pain for the last half hour. He admits huffing pine oil the past 2 years. Chest x-ray, abdominal ultrasound, and ECG came out to be normal. Which of the following is true regarding the mechanism of hydrocarbon intoxication? A. High viscosity, high surface tension, and higher volatility increase the risk of toxicityB. The renal system is most commonly affected by aspirationC. The primary CNS effect associated with hydrocarbon toxicity is decreased level of consciousnessD. Hydrocarbons never affect the peripheral nervous systemE. Hepatotoxicity is rare with chlorinated hydrocarbons

The primary CNS effect associated with hydrocarbon toxicity is decreased level of consciousness

An 8-year-old boy is a first-grade student who exhibits significant difficulty in auditory processing and early literacy skills. His teachers have reported that his writing and language skills, and his phonological awareness, are well below grade level. Which of the following statements best describes the role of a healthcare provider in the identification and referral of children who have special education needs? A. Developmental surveillance performed by the primary health care provider is generally not enough to identify children with disabilitiesB. The primary health care provider has no role in the referral of children with disabilities for special education servicesC. The primary health care provider should be familiar with local school agencies for referral of the children with disabilitiesD. The primary health care provider is the only person who can refer the child for special education servicesE. Follow-up of the referral of the child with a disability by the primary health care provider is not recommended

The primary health care provider should be familiar with local school agencies for referral of the children with disabilities

A 70-year-old man with a history of alcohol use disorder and alcohol withdrawal seizures was brought to the ED because he was found staggering on the sidewalk. He was disoriented to time but able to state that he had been on a drinking binge for several days and that he had taken several "epilepsy pills" that morning as he was afraid of having a seizure when he tried to stop drinking. On examination, he was ataxic and had nystagmus and double vision. His blood pressure was elevated and he was slightly tremulous. Which of the following is the next best step in assessing and treating this man? A. Brain imagingB. Toxicology screeningC. Thiamine administrationD. Benzodiazepine administrationE. Electrocardiogram

Thiamine administration

Leiter International Performance Scale

This nonverbal, language free test is used as a measure of intelligence in individuals who have difficulty in responding to traditional tests. The test is administered individually and assesses chief areas of cognitive skill: general intellectual ability (IQ), memory, and processing speed. It focuses on fluid intelligence, which is the best way to measure an individual's innate abilities, and visual processing. It can be used to assess individuals of a wide variety of ages, between 3-75 + years. As the test is nonverbal, neither the examiner nor the individual being assessed are required to speak, therefore the test is not meaningfully affected if the examinee has a poor educational, social or familial background or has poor language skills. The test is therefore ideal in patients who do not speak English, have hearing impairments, speech or language disorders, are cognitively delayed, or suffer from autism spectrum disorder, as can be seen in this case.

Erikson's Stage 4: Industry vs. Inferiority (5 Years to Puberty): T

This stage is characterized as one of lesser conflicts and emotional intensity. No body zone is at the fore in this stage. The child's task is to learn and to develop a sense of competence.

Edwards syndrome

Trisomy 18; it is the second most common autosomal trisomy observed in live births. The clinical features include hypertonia, horseshoe kidney, smallmouth, micrognathia, pointy ears, short sternum, prominent occiput and flexed fingers with the index finger overlapping the third finger and the fifth finger overlapping the fourth

Which of the following brain regions is the primary source of histamine-releasing neurons? A. Raphe NucleusB. Locus ceruleusC. Nucleus basalis of MeynertD. Tuberomammillary nucleusE. Ventral tegmentum

Tuberomammillary nucleus

Which one of the following causes of autism spectrum disorder is particularly associated with the development of seizures? A. Fragile X syndromeB. Tuberous sclerosisC. Down syndromeD. In utero thalidomide exposureE. In utero measles exposure

Tuberous sclerosis

You are seeing a 65-year-old man with a history of schizophrenia on the inpatient unit. Per chart review, he has been on a number of first- and second-generation antipsychotics but his symptoms remit while on haloperidol and he is able to work as cashier at a local grocery store. As part of your intake, you perform an AIMs exam and note that it appears as though he is chewing gum, however he neither has gum in his mouth nor wears dentures. Which of the following medications may assist with his symptoms? A. BrexpiprazoleB. ValbenazineC. VilazodoneD. IloperidoneE. Cariprazine

Valbenazine

Which one of the following pairs correctly relates the location of cell body to the major neurotransmitter it produces? A. Pons - serotoninB. Raphe nuclei - dopamineC. Ventral tegmental area (VTA) - dopamineD. Locus coeruleus - serotoninE. Prefrontal cortex - norepinephrine

Ventral tegmental area (VTA) - dopamine

An 83-year-old man presents with emotional turmoil and decreases in self-care following the death of his wife of 35 years. His internist cleared him medically. You recommend grief therapy. Which of the following interventions is contra-indicated when providing grief therapy? A. Educate patient about the grief processB. Normalize the grief experience, which often includes cycling between thoughts of the deceased person and a future life without the deceased personC. Facilitate the patient coming to terms with lossD. Warn patient against expressions of anger, which indicate deepening psychopathologyE. Monitor for development of axis I/other mental disorders

Warn patient against expressions of anger, which indicate deepening psychopathology

_____________ area is responsible for understanding the written or spoken word.

Wernicke's

When are patients with narcissistic personality disorder most likely to idealize another person? A. When patient and another person are both focused on a charitable causeB. When being associated with the other person increases the patient's statusC. When patient wants something from the other personD. When patient is severely depressedE. When patient and another person have the same level of education

When being associated with the other person increases the patient's status

A 45-year-old, self-employed, married man presents with complaints of mild to moderate depression for the past 3 years. On interview, he acknowledges a history of drinking 3 to 4 drinks of hard liquor 2 to 3 times a week for about 10 years. He denies any history of legal or financial trouble because of his drinking, though he does have occasional arguments about his drinking, and every few months or so he goes to work late or skips work altogether for a day to get over a hangover. He denies any history of suicidal thoughts, intent, plan, or of suicide attempts. His medical history is unremarkable. At this time, which one of the following steps would be the best next step in his treatment? A. Admit him to an inpatient dual diagnosis unitB. Offer him naltrexone or disulfiramC. Start an SSRI antidepressantD. With his permission, obtain further collateral information, and assess the patient's interest in changing his alcohol useE. Ask him to return for follow-up in one month

With his permission, obtain further collateral information, and assess the patient's interest in changing his alcohol use

The lifetime use of inhalants is highest in which of the following age groups? A. Young adults aged 18 to 25 yearsB. Adults aged 26 to 34 yearsC. Youth aged 8 to 17 yearsD. Adults 40 to 65 years oldE. Adults over the age of 65

Youth aged 8 to 17 years

A 24-year-old woman presented to the clinic with difficulty sleeping at night for the past 2 months, which in turn causes her to be sleepy throughout the day. She is able to fall asleep but often wakes up after a few hours and cannot fall back to sleep. She has more than 3 similar episodes per week, and this started after she moved to the new city for her job. She works as a carpenter, and she has not been able to work attentively because of her sleep problem. She denies any mood symptoms or psychotic symptoms. She asks if there is anything she could try taking in the middle of the night to fall back to sleep. What is the best treatment option for her? A. Zaleplon as neededB. Midazolam for 4 weeksC. Fluoxetine for 4 weeksD. Trazodone for 4 weeksE. L-Tryptophan for 4 weeks

Zaleplon as needed

Carbidopa/levodopa and ropinirole

_____________and ______________ (D2 agonist) are used to manage symptoms of motor deficits in Parkinson's disease.

Binswanger disease, also called subcortical arteriosclerotic encephalopathy

a type of vascular cognitive impairment which occurs due to atherosclerotic changes and eventual injury to small vessels in the brain, resulting in gradual subcortical ischemia and dementia. Symptoms are slow and progressive, and so is the cognitive decline.

Tetrabenazine

a vesicular monoamine transporter type-2 inhibitor which blocks dopamine release.

A 40-year-old man, presents to his primary care physician with complaints of mood disturbances he has been experiencing for the past year. On physical examination excessive frontal bossing was observed along with increased space between his teeth. When asked if the patient had recently changed hat sizes, the patient replied that he has had to buy larger hats as all his previous hats had become too tight. What is the most likely diagnosis? A. HypoparathyroidismB. HyperparathyroidismC. OsteoporosisD. AcromegalyE. Gigantism

acromegaly

____________ is the complete absence of voluntary movement,

akinesia

On autopsy, hyperphosphorylated tau protein found in the hippocampus is most common in which one of the following neurocognitive disorders? A. Creutzfeldt-Jakob diseaseB. Lewy body diseaseC. NeurosyphillisD. Alzheimer's diseaseE. Vascular disease

alzhemier's disease

M'Naghten rule,

amed after the defendant in a murder trial who had suffered from delusions for many years before killing one of his perceived persecutors, holds that a person is not guilty of a crime by reason of insanity if they had a mental illness that made them unaware of the nature, quality, and consequences of their acts or if they were incapable of realizing that their acts were wrong.

Linezolid

an antibiotic that also inhibits monoamine oxidase (MAO) and can cause serotonin syndrome with concurrent administration of other serotonergic drugs.

Acute angle glaucoma is most strongly associated with the primary mechanisms of action of which of the following medication classes? A. D2 antagonistB. Beta-blockersC. GABA-A receptor modulatorsD. Anticholergic agentsE. 5-HT3 agonists

anticholernic agents

physostigmine

anticholinesterase drug that inhibits the enzyme acetylcholinesterase in the synaptic cleft which is involved in the breakdown of acetylcholine leading to the reversal of the toxicity.

benztropine

antimuscarinic drug. It is used in the management of acute dystonia and Parkinsonism (rigidity, tremors, bradykinesia)

Neuroleptic malignant syndrome (NMS) would be most likely caused by a member of which one of the following classes of drugs? A. AntipsychoticB. AnticholinergicC. SSRID. Tricyclic antidepressantE. Antibiotic

antipsychotic

A 28-year-old man comes to the emergency room with multiple wounds incurred in a fist fight. One of the nurses recognizes him and says he comes in all of the time after repeated physical fights. He is charming towards the female nurses and tries to get extra bandages and medications from them. When inquired about the trigger for the fight, he said "it just happened, whatever..I didn't think about it." He shows no remorse towards the person he had beaten up. He admits to having been a part of multiple physical fights and was jailed for assault at the age of 16. He exhibit no signs of anxiety, depression or paranoia. His speech is excitable and sometimes loud, but the rate is not pressured. His urine toxicology result came back negative for any substance usage. What is the most likely diagnosis? A. Borderline personality disorderB. Bipolar disorderC. Antisocial personality disorderD. Narcissistic personality disorderE. Histrionic personality disorder

antisocial personality disorder

Friedreich's ataxia

autosomal recessive disorder which presents with a staggering gait, nystagmus, diabetes mellitus, and hypertrophic cardiomyopathy, but not memory loss.

A 27-year-old man presents to the clinic due to difficulty in interaction with others since middle school. The patient wants to build a good companionship but is reluctant to do so because of fear of criticism and rejection. Interview with the therapist reveals that he is preoccupied with the fear of criticism and thinks himself as unappealing to interact with others. Which of the following is the most likely diagnosis of this patient? A. Dependent personality disorderB. Schizoid personality disorderC. Avoidant personality disorderD. AgoraphobiaE. Social anxiety disorder

avoidant personality disorder

most common negative schizophrenia sx (2)

avolition and diminished emotional expression

Chlordiazepoxide

benzodiazepine that is used in mild to moderate withdrawal symptoms. Most clinicians use benzodiazepines because of their safety. It should be given in tapering doses to allow the patient to stop drinking safely.

As therapy for sleep disorders, which one of the following classes of medication should be discouraged in the long-term care setting due to risk of adverse effects (e.g., memory impairment, falls, daytime sleepiness), physiologic tolerance, and adverse effects of discontinuation? A. Tricyclic antidepressantsB. AntipsychoticsC. Serotonergic antidepressantsD. Non-benzodiazepine sedative hypnoticsE. Benzodiazepines

benzodiazepines

Flumazenil is commonly used for its ability to reverse the effects of which of the following classes of drugs in overdose situations? A. AlcoholB. BarbituratesC. BenzodiazepinesD. OpioidsE. Tricyclic antidepressants

benzos

Which one of the following features is a poor prognostic feature in schizophrenia? A. Blunted or flat affectB. Confusion at the height of the psychotic episodeC. Good premorbid functioningD. Perplexity at the height of the psychotic episodeE. Prominent psychotic symptoms within 4 weeks of the first noticeable change in usual behavior or functioning

blunted or flat affect

______________ refers to slowness of movement and progressive reduction in the speed and amplitude of the repeatitive movements. It can be checked using finger tapping, toe tapping, or foot tapping and also by assessing the hand movements like pronation and supination. These abnormalities are the hallmark of either Parkinson's disease or drug induced Parkinsonism.

bradykinesia

A 20-year-old man comes to the psychiatry clinic reporting symptoms of irritable mood, inability to feel joy for his job as a river cruise boat captain, loss of energy, increased appetite with weight gain, and difficulty falling asleep at night. Symptoms have lasted for four and a half weeks and this is the second time in his life he has felt like this. Patient also has a history of epileptic seizures characterized by auras in which he experiences hallucinations and panic, followed by a minute or two of impaired consciousness. What would be the least indicated antidepressant for the treatment of his symptoms? A. BuproprionB. MirtazapineC. FluoxetineD. ParoxetineE. Venlafaxine

bupropion

A 30-year-old man presented to the clinic with a low mood for the past 3 weeks. He has decreased sleep, decreased energy, decreased concentration, and a feeling of hopelessness. He has no interest in his daily tasks and has been falling behind at work. He starts crying spontaneously. He is overweight and has a 12-pack-years smoking history. He has tried to quit smoking multiple times but has been unable to do so. What is the most appropriate management in this patient? A. BupropionB. SertralineC. AmitriptylineD. BuspironeE. Carbamazepine

bupropion

A 55-year-old woman is diagnosed with generalized anxiety disorder. She also has a past history of drug dependence and withdrawal seizures. Which of the following drugs may be safely prescribed to her without risk of dependence? A. PhenobarbitalB. AlprazolamC. BupropionD. BuspironeE. Zolpidem

buspar

A 45-year-old woman presents to the psychiatric clinic with a history of increased thirst, hunger, and urination associated with weakness and headaches for the past 6 months. Physical examination is unremarkable. The patient has a history of schizophrenia and is currently taking the antipsychotic drug. On laboratory evaluation, fasting blood glucose levels are 149 mg/dL, and HbA1c is 8.9%. Which of the following is the most likely antipsychotic drug the patient is currently using? A. HaloperidolB. ZiprasidoneC. LithiumD. ClozapineE. Paroxetine

clozapine

Which one of the following illegal drugs is most often associated with visits to U.S. emergency departments? A. HeroinB. Methylenedioxymethamphetamine (MDMA)C. CocaineD. MarijuanaE. Amphetamines

cocaine

Wilson's disease, which presents with movement disturbance, spastic dystonia, hepatitis, cataracts, and other problems, is characterized by inadequate biliary excretion of which one of the following elements? A. IronB. SeleniumC. CalciumD. CopperE. Magnesium

copper

Which of the following region of the brain plays a critical role in the integration of emotional and cognitive behaviors associated with obsessive-compulsive disorder (OCD)? A. AmygdalaB. HypothalamusC. Corpus striatumD. Locus ceruleusE. Substantia nigra

corpus striatium

Motivational interviewing

counselling technique used to help change patients maladaptive behaviors, such as cigarette smoking, obesity treatment, and substance use.

a decrease in the levels of acetylcholine will lead to __________sleep duration.

decreased

an increase in the dopamine will lead to ___________ duration of sleep.

decreased

Nutmeg taken in a high enough dose can induce _________, __________, and a sensation of heaviness in the limbs.

depersonalization, derealization

Synuclein

deposited in synucleinopathies such as Lewy body disease, Parkinson 's disease, and REM sleep behavior disorder.

cholinergic dysfunction is attributed to episodes of __________

depression

preparation

display of readiness to change in the immediate future, and these people may even have an action plan prepared.

Increased _______ levels have been associated with greater severity of positive symptoms in patients with schizophrenia

dopamine

A 50-year-old woman presents with low mood, weight loss, sleep changes, fatigue, poor concentration, loss of interest in her daily tasks, and a feeling of worthlessness. She does not have a history of mental illness. She also complains of pain and reports recently being diagnosed with fibromyalgia. These symptoms started after her divorce about 4 weeks back. What is the most appropriate management in this patient? A. DuloxetineB. Hospital admissionC. Electroconvulsive therapyD. AlprazolamE. Light therapy

duloxetine

Anorexia nervosa is associated with which of the following structural changes in the brain? A. Enlarged ventriclesB. Widened gyriC. Narrow sulciD. Cortical atrophyE. Hippocampal atrophy

enlarged ventricles

A 64-year-old man presents for an evaluation. His daughter reports that since he lost his job 10 months ago, he has had diminished interest in his favorite past times like fishing. He spends about 10 hours sleeping and has gained 25 lbs. since his symptoms started. His wife of 41 years is threatening him with a divorce due to his present state. His medical history is remarkable for hyperlipidemia with mixed dyslipidemia on atorvastatin and gemfibrozil, while his past medical history is pertinent for a fatty liver incidentally diagnosed when he had a biliary colic. Social history is remarkable for a glass of red wine, every meal daily, which he started 4 months prior.You eventually decide to start him on an anti-depressant. Which among the following anti-depressants would you start him on? A. AmitriptylineB. DuloxetineC. BupropionD. TrazodoneE. Escitalopram

escitalopram

anti-depressants less likely to cause hepatotoxicity

escitalopram, citalopram, paroxetine, and fluvoxamine

Betel nuts are chewed in some parts of the world to produce a mild ________ and sensation of ___________

euphoria/floating in space

Contingency management strategies

have been used for a variety of substances, and it works on the principles of operant conditioning. It provides users with rewards for desirable and positive behavior, and to some extent, punishment for undesirable or harmful behaviors. It explores the underlying motivational drives and seeks to increase the preferable drive that would lead to steady abstinence. Contingency management is continued until the patient can stay sober after the rewards are removed or stopped.

Construct validity

he assessment of the degree to which the parameters set are being assessed.

Which one of the following statements regarding Alcoholics Anonymous (AA) is true? A. Each major city has a chapter of AA that directly reports to the global headquartersB. It is official AA policy to recommend that all members discontinue all psychotropic medicationsC. Even after a year of attending AA, if a member cannot believe in a higher being, he must leave AAD. The only requirement for AA membership is a desire to stop drinkingE. AA operations are partially funded by the federal government

he only requirement for AA membership is a desire to stop drinking

Psychodynamic psychotherapy

helpful for patients with depression, anxiety and post traumatic stress disorder.

habit reversal training

helps patients replace repetitive distressing behaviors with competing behaviors that are more socially acceptable, less disfiguring, and less distressing. An example is snapping a rubber band around the wrist rather than plucking hair.

specificity

helps rule in a disease or condition. A positive test result on a highly specific test means that you can be quite positive that you do have the disease.

Sensitivity

helps to rule out a disease or condition; if a highly sensitive test is negative, you can be sure that you don't have the disease.

Rivastigmine is contraindicated in _________ impairment and needs dose modification based on patient tolerability in _________ impairment.

hepatic/renal

A 23-year-old woman presents to the clinic with a complaint of difficulty falling asleep for the past 2 months. She is a medical student, and her final exams start next month. She goes to bed between 12 am to 3 am and is not able to fall asleep for 3-4 hours. When she is not able to sleep, she starts using social media applications on her mobile phone. She attends lectures in the morning that usually begin at 9 am. She is unable to focus during the lectures and falls asleep. She takes a 2 hour nap in the afternoon. She has tried over the counter sleep medications, but she is afraid of becoming dependent on them. Her performance in school has declined. She has no specific timetable for meals. She usually eats dinner at around 11 pm. On physical examination, her pulse is 74/min, her respiratory rate is 13/min, her temperature is 98.6°F (37°C), and her blood pressure is 118/78 mmHg. Which of the following is the appropriate next step in the management of this patient? A. Prescribe diphenhydramineB. Improve sleep hygieneC. Prescribe triazolamD. Prescribe trazodoneE. Prescribe quetiapine

improve sleep hygiene

Lower viscosity, lower surface tension, and higher volatility all ____ the risk of aspiration thus ________ the risk of toxicity. from hydrocarbon ingestion

increase

There is an ______________ body temperature noted commonly in patients with depression due to a reduction in the amplitude of the master circadian oscillator in the hypothalamus that controls body temperature.

increased

It is known that smoking is two to three times more common among patients with schizophrenia and cigarette smoke is associated with ___________________ activity. Thus, there can be diminished serum concentrations of many drugs, including olanzapine and clozapine which are both SGAs.

increased CYP1A2

NCD due to Prion's disease

initially presents as personality changes, visual disturbances, abnormal movements, (i.e. myoclonus/choreoathetosis/ballismus) and/or in coordination with rapidly progressive cognitive deterioration.. leads to death within 12-18 months

Malingering

intentional production of symptoms for an external gain like sickness benefits or sick leave from work.

CBT

involves a combination of behavioral and cognitive methods, including cognitive restructuring (correcting maladaptive thinking) and exposure tasks (confronting the feared social situations) which have been shown to be efficacious in the short-term and long-term.

Which of the following is linked with the pathophysiology of restless leg syndrome? A. Iron deficiencyB. Vitamin B12 deficiencyC. Zinc deficiencyD. Vitamin D deficiencyE. Vitamin C deficiency

iron deficiency

chorea

irregular jerky movements, mostly affects the limbs and trunk, followed by voluntary motor abnormalities and cognitive decline at a rate of upto 2 points/year on MMSE.

Adjustment disorder with depressed mood

is a psychiatric condition in which depressive symptoms (e.g., depressed mood, sleep disturbance, fatigue, feelings of guilt, appetite change, psychomotor change, and/or anhedonia) occur in the setting of a significant stressor and last for less than 6 months.

Triazolam

is a short-acting benzodiazepine. It can be used as a short-term treatment for insomnia.

desipramine

is a tricyclic antidepressant agent (TCA) which is effective for MDD, but it could lead to cardiotoxicity, could actually increase suicidal thoughts, and is more dangerous in overdose

Levomilnacipran (Fetzima)

is an extended release selective inhibition of norepinephrine and serotonin reuptake. It is FDA indicated for major depressive disorder.

disorganized schizophrenia

is associated with marked regression to primitive, unorganized and disinhibited behavior in the absence of symptoms that are part of the diagnostic criteria for the catatonic type.

Natalizumab

monoclonal antibody against the alpha-4 subunit of integrin molecules. It is indicated for the treatment of Crohn disease and multiple sclerosis. There is an increased risk of the development of progressive multifocal leukoencephalopathy (due to JC virus infection) with its use.

Noonan Syndrome

multisystem genetic disorder characterized by congenital heart defects, skeletal malformation, small stature facial dysmorphism, and mild intellectual disability.

dantrolene

muscle relaxant used in the treatment of malignant hyperthermia.

You are working in a psychiatric emergency room and emergency medical technicians (EMTs) drop off a patient who was "found on the side of the road, mumbling and slurring her speech, not able to complete a coherent sentence." the EMTs further report the patient said, "I want to die," The patient's vitals are remarkable for a blood pressure of 80/49 mmHg, heart rate 44 BPM, respiratory rate of 6. You complete a quick physical examination and see evidence of puncture sites on her hands, and pinpoint pupils.You have limited other medical or psychiatric history for her, but are concerned she may be experiencing an opiate overdose. Given your suspicion, which medication would you recommend immediately? A. NaloxoneB. FlumazenilC. EpinephrineD. HaloperidolE. Buprenorphine

naloxone

The two TCAs with the lowest anticholinergic activity are

nortriptyline and desipramine.

prevalence

number of individuals with a disease at a specific point in time or during a particular time, respectively, divided by the population at risk at that point or during that interval of time.

Unspecified Depressive Disorder

only diagnosed when the depressive symptoms do not meet the criteria for any defined depressive disorder or when there is insufficient information to make a more specific diagnosis.

Normal CSF values:

opening pressure of 10-20 cm H2O, WBC count 0-5 cells/microL, glucose >60% of serum glucose, and protein level < 45mg/dL.

antiadrenergic effects

orthostatic hypotension and tachycardia.

A 22-year-old man presents to the emergency department because he thinks he might be having a heart attack. He has had recurrent episodes of severe anxiety and chest pain for the past two weeks. These episodes occur randomly at least once a week and last about 5 minutes; they are associated with sweating and shortness of breath. Examination findings and extensive work-up, including thyroid function tests and toxicology screening are normal. Which of the following is the most likely diagnosis? A. Panic disorder B. Social anxiety disorder C. Agoraphobia D. Specific phobia E. Other specified anxiety disorder

other specified anxiety disorder

Impaired understanding of danger

paranoid personalities.

A 22-year-old woman presents with palpitations and dizziness. She mentions that these symptoms are triggered by being in a social situation where she could be scrutinized. What is a major risk factor for this disorder? A. Parent with schizophreniaB. Parent with bipolar disorderC. Parent with an anxiety disorderD. Friend with anxiety disorderE. Childhood motor vehicle accident

parent with anxiety disorder

A 48-year-old woman with schizophrenia presents to the clinic with involuntary and abnormal movements of her arms and trunk. During the consultation, facial grimacing and lip-smacking is noted. She is currently taking only one drug for the treatment of schizophrenia. Which of the following is the most likely drug being used by the patient? A. FluoxetineB. ClozapineC. PerphenazineD. DiazepamE. Phenobarbital

perphenazine

Which of the following medications is expected to be most effective in treating the nightmares associated with PTSD? A. DiazepamB. DuloxetineC. LoxapineD. PrazosinE. Ramelteon

prazosin

__________________ helps to plan complex motor movements and sequences of motor movements by working in conjunction with the motor cortex.

prefrontal association area

opioid withdrawal,

pupillary dilation (midriasis), piloerection, and hypertension

selective mutism

rare multidimensional childhood disorder in which an individual fails to speak in certain social situations while speaking comfortably in more familiar settings

koro

rare psychiatric condition in which the affected person thinks his genitals are regressing or retracting into his body, which will lead to subsequent death. Affected persons experience intense anxiety and experience distorted beliefs regarding the shrinking of their penis in case of men and retraction of vulva or nipples in females. The condition is more common in men as compared to women. Treatment options include identification of the underlying etiology, antipsychotics, and antidepressants

femoral neuropathy

results in weakness and atrophy of the quadriceps (comprised by the vastus lateralis, vastus medialis, vastus intermedius and rectus femoris) and sensory loss of the anteromedial thigh. Anti-thrombotic therapy is a risk factor for the development of hemorrhage into the iliopsoas muscle group, causing a compressive femoral neuropathy.

__________________ a cholinesterase inhibitor, is used to treat cognitive impairment in Alzheimers and parkinson's disease.

rivastigmine

Increased activity of _______ is associated with the production of positive and negative symptoms in patients with schizophrenia.

serotinin

Disturbance in which one of the following neurotransmitter systems is implicated in recurring major depression with a seasonal pattern? A. CholinergicB. DopaminergicC. GlutaminergicD. NoradrenergicE. Serotonergic

serotonergic

A 32-year-old woman is referred to a psychiatrist by her dermatologist. She has undergone extensive work for "skin allergies" for the past 11 months and has received negative results. She denies similar symptoms prior to 11 months ago. She has a successful financial career. Medical history is unremarkable and no history of drinking, smoking, or illicit drug use. On examination, you note that she has some areas of faint lichenification in both arms and forearms. She explains that sometimes she feels herself getting "ant-infested" and scratches herself. She denies other preoccupations and repetitive behaviors. Mental status examination is otherwise within normal limits. You diagnose her with a delusional disorder. Based on the DSM-5, what is your complete delusional disorder sub-type diagnosis for this patient? A. Somatic typeB. Somatic type, multiple episodes, currently in acute episodeC. Unspecified typeD. Unspecified type, multiple episodes, currently in acute episodeE. Unspecified type, continuous

somatic type

A 21-year-old woman is brought to the emergency department by her mother. She had a huge fight with her boyfriend so she slashed her wrists superficially. She says he was going on a trip for a few weeks and she did not want him to leave her all alone. Her mother says this is not the first time she tried to hurt herself; she has multiple scars of old cuts on her forearm. She has also been feeling very empty and lost the past few years; all the men she got into a relationship with turned out to be wicked and selfish and she does not want to lose her current boyfriend who is a perfect gentleman and the most amazing guy. Which of the following defense mechanisms is most likely employed by this patient in her view of men? A. IntellectualizationB. SplittingC. HumorD. AltruismE. Rationalization

splitting

Apolipoprotein E epsilon 4 (APOEε4) allele is the primary genetic risk factor for the development of ____________ cases of AD.

sporadic

anti-Gad65 in ---------------

stiff person syndrome,

A 25-year-old man is brought by police to the emergency department because his girlfriend called 911 to report that he is seeing things that are not there and is sure people want to hurt him. He is anxious, guarded, suspicious, and ignores most questions. He is hyperactive, underweight, and complains about the "strangers" darting behind the curtains of the ED and talking about him. His heart rate and blood pressure are moderately elevated. Intoxication with which of the following types of substances is most likely responsible for this patient's presentation? A. AlcoholB. Sedative/hypnoticC. StimulantD. OpioidE. Hallucinogen

stimulant

A 75-year-old man presents with left-sided weakness. He was brought to the clinic by a passer-by who noticed that his legs gave away beneath him. The patient has slurred speech and was unable to lift his left arm and leg up for more than a few seconds, and his left hand grip strength is weak. Moderate facial weakness on the left side can be seen. His pulse is 90 beats/min, and BP is 175/100 mmHg. He has a history of smoking 20-pack years. He is taking aspirin and lisinopril for hypertension. He doesn't mention experiencing headaches, atypical clumsiness or paraesthesias prior to this incident. The CT shows ischemic changes but no space-occupying lesions. What is the most likely diagnosis? A. HypoglycemiaB. StrokeC. Intracranial tumorD. Intracerebral abscessE. Subdural hemorrhage

stroke

A 69-year-old married African-American man has had a moderately heavy drinking habit for a number of years, averaging 6 to 12 beers daily. As you have followed him for maintenance treatment for his major depressive disorder, you have tactfully addressed his alcohol intake on numerous occasions, without success. He otherwise appears happily married, enjoying retirement and his hobbies (deer hunting and fishing). He is now despondent having recently been diagnosed with metastatic prostate cancer. He foresees a shortened life and progressive bone pain. You are concerned about his expressions of passive suicidal ideation, although he denies any active intent or plan. He had a great uncle who hanged himself many years before. Which one of the following risk factors most increases his risk for suicide, in addition to chronic and terminal illness? A. Marital statusB. RaceC. Substance abuseD. Family history

substance abuse

A 74-year-old man with an unremarkable medical history makes an appointment to get his insurance paperwork completed. His wife passed away 2 years before and he had lived alone since then. Since retirement, he had lost contact with his friends and spent most of his time watching television. He has the following vital signs: temperature is 98°F, his blood pressure is 145/91 mm Hg, his pulse is 100/min, and his respiratory rate is 16/min. He is quiet and cooperative throughout the physical examination, which was unremarkable. At the conclusion of the visit, the patient thanks the nurses, physician, and staff for taking time out of their busy schedule to assist him with his paperwork. He leaves the office prior to obtaining a return appointment. Which one of the following options would be most important to include in an initial screening of this patient? A. Prostate-specific antigen testB. Dementia screeningC. Stool guaiac testD. Suicide screeningE. Cholesterol screening

suicide screening

A 19-year-old man presents to the emergency department with complaints of cough, shortness of breath, dizziness, and incoordination. The patient appears intoxicated and confused. The symptoms started while he was inhaling paint thinner for recreational purposes. A diagnosis of acute inhalant intoxication is made. Which of the following is the mainstay of treatment in this patient? A. SteroidsB. AntibioticsC. Steroids plus antibioticsD. EpinephrineE. Supportive care

supportive care

GnRH

suppresses production of testosterone and estrogen and thereby delays puberty, allowing the child or adolescent with gender dysphoria time to determine whether he or she is indeed transgender and whether he or she would like to pursue hormonal therapy and/or surgery in order to transition. GnRH is typically offered only in the context of individual and family therapy.

ephedra

sympathomimetic, now banned in the US, that is anorexigenic and stimulating.

response prevention

used for obsessive-compulsive behaviors