ABPN General Psychiatry

Question 1

“good enough mothering” theorist

Answer 1

Winnicott

Question 2

“Man presents to ER in acute state of disorientation with tachycardia, ophthalmoparesis, diaphoresis, and ataxia. Dies 48 hours later”

Answer 2

Wernicke’s encephalopathy (mental confusion, ophthalmoplegia, gait ataxia)

***ophthalmoplegia = 6th CN palsy usually

Question 3

% of schizophrenics known to smoke tobacco

Answer 3

50-90%

Question 4

3 Hz stimulation on EMG

Answer 4

Lambert-Eaton

Question 5

3-per-second spike and wave pattern on EEG

Answer 5

absence seizures

Question 6

4 primary symptoms of Parkinson’s disease

Answer 6

Tremor, Rigidity, Bradykinesia, Postural instability

Question 7

4p16.3 abnormality

Answer 7

Huntington’s Disease

Question 8

60 yo woman with stiffness in right leg but not left. Takes her longer to complete tasks and complains she has the pace of a turtle. Sometimes forgets how to walk. Sometimes feels as if hands don’t belong to her. All symptoms over last year.

Answer 8

Corticobasal ganglionic degeneration (CBD)
- degeneration of cerebral cortex & basal ganglia
- asymmetric motor & cognitive impairments
- apraxia, alien limb phenomena, aphasia, parkinsonism

Question 9

65 yo M with worsening hypersomnia, poor memory and concentration, social withdrawal, lack of motivation (pseudobulbar state). History of HTN. BP 170/90. Flat affect, depressed mood. Reflexes slowed. Labs are normal. MRI shows subcortical degeneration.

Answer 9

Binswanger disease = subcortical leukoencephalopathy (a form of small-vessel vascular dementia)

Question 10

7 criteria of schizoid personality disorder

Answer 10

DSS-ACNE

1. D- Doesn’t desire or enjoy relationships/family
2. S- Chooses solitary activities
3. S- Little interest in sex
4. A- Takes pleasure in few, if any, activities
5. C- Lacks close friends or confidants
6. N- Appears indifferent to praise or criticism
7. E- Shows emotional coldness, detachment, or flattened affectivity

Question 11

A child has inhibited emotionally withdrawn behavior toward adults and minimal social or emotional responsiveness toward others due to social neglect or deprivation has:
A. Reactive attachment disorder
B. Disinhibited social engagement disorder

Answer 11

A. Reactive attachment disorder

Question 12

a child who actively approaches and interacts with unfamiliar adults after experiencing social neglect or deprivation has:
A. Reactive attachment disorder
B. Disinhibited social engagement disorder

Answer 12

B. Disinhibited social engagement disorder

Question 13

a man enjoys wearing female underwear

Answer 13

fetishistic disorder

Question 14

Aaron Beck

Answer 14

founder of CBT

Question 15

Aaron Beck’s cognitive triad is a model for what?
What is the cognitive triad?

Answer 15

Model for depression
Thoughts about:
- one’s self
- the world
- the future

Question 16

Abulia means what?

Answer 16

an absence of willpower, reduced impulse to act or think with indifference related to consequence

Literally means = “without will”

Question 17

acalculia, agraphia (without alexia), right and left confusion, finger agnosia (inability to name fingers)

Answer 17

Gerstmann’s syndrome = left angular gyrus / parietal lobe damage

Question 18

action-oriented psychotherapy that teaches individuals to identify, challenge, and replace self-defeating thoughts and beliefs with healthier thoughts that promote emotional wellbeing and goal-achievement

Answer 18

Rational Emotive Behavior Therapy (REBT)
- Albert Ellis
- later influenced CBT
- ABC techniques of irrational beliefs: Activating event leads to irrational Beliefs which causes upsetting emotional Consequences

Question 19

ADHD symptoms must be present prior to the age of:

Answer 19

12

Question 20

agonist / partial agonist at 5HT1A receptor & agonist/antagonist at D2 receptor

Answer 20

Buspar - mainly works at 5HT1A receptor, some activity at D2 (mechanism is complex and not fully understood)

Question 21

agoraphobia

Answer 21

fear of public spaces where escape is difficult, being outside, being in a crowd, etc

Examples:
- public transportation
- open places (parking lots, open markets, bridges)
- enclosed places (shops, theaters, cinemas)
- standing in line
- being in a crowd
- being outside the home alone

Question 22

akinetic mutism lesion

Answer 22

Bilateral anterior cingulate

Question 23

Alexithymia

Answer 23

Inability to describe one’s emotions

Question 24

Alice is a 20 yo college student who often feels stressed and tends to eat compulsively to relax. She has been binging on whatever she can get her hands on about 3x/week. She feels lack of control to stop and eats until she is uncomfortably full. Then feels ashamed and disgusted. Feels fat and ugly and is depressed. Tries to induce vomiting but can’t. Compensates by running 2-3 hours in a row and feeling faint. After binging, often goes whole next day without food or water.

Diagnosis:

Answer 24

Bulimia nervosa
= binge-eating + inability to control + compensatory behaviors

(normal weight compared to anorexia)

Question 25

Alopecia is a known side effect of which psychotropics? (2)

Answer 25

Depakote, Lithium

Question 26

Alpha synuclein in - striatum: - striatum & cortex: - striatum & cerebellum:

Answer 26

- striatum / basal ganglia: parkinson's disease - striatum / basal ganglia & cortex: DLB - striatum / basal ganglia & cerebellum: MSA Alpha synuclein = Lewy bodies striatum = basal ganglia

Question 27

anterior horn cell degeneration, upper and lower motor neuron degeneration

Answer 27

ALS

Question 28

anterograde and retrograde amnesia while preserving identity and knowledge, self-resolving and time-limited

Answer 28

transient global amnesia <24 hours

Question 29

antiepileptic that causes hirsutism, facial changes, and gingival hypertrophy

Answer 29

phenytoin

Question 30

Antiepileptic that induces its own metabolism

Answer 30

Carbamazepine

Question 31

Antipsychotic approved to treat schizophrenia, nausea and vomiting, acute intermittent porphyria, tetanus, and intractable hiccups

Answer 31

Chlorpromazine (Thorazine)

Question 32

Antipsychotic that causes dark circles around eyes (oculocutaneous hyperpigmentation in sun-exposed areas)

Answer 32

Chlorpromazine (Thorazine)

Question 33

Antipsychotic use in elderly with dementia

Answer 33

Black box warning! NEVER use! Due to increased risk of death

Question 34

Piblokto

Answer 34

anxiety, depression, confusion, depersonalization, and derealization ending in stuporous sleep and amnesia that occurs in female Eskimos of northern Greenland

Question 35

Are SSRIs effective for conversion disorder?

Answer 35

No - evidence has only supported CBT, TCAs, Haldol and ECT

Question 36

Asian delusion that the penis will disappear into the abdomen and cause death

Answer 36

Koro

Question 37

At what spine level does the spinal cord typically end in an average adult?

Answer 37

T12-L1

Question 38

ATP7B gene - Disease - What protein?

Answer 38

- Wilson's disease - copper-transporting ATPase2 (transports copper from liver to other parts of body)

Question 39

Benefits of Cariprazine

Answer 39

Vraylar! Better side effect profile - less metabolic effects, less QTc prolongation, doesn't affect prolactin --> may cause nausea & akathisia

Question 40

Benefits of Desipramine over other TCAs

Answer 40

Less histaminergic & muscarinic affinity (less sedating & less anticholinergic effects)

Question 41

bilateral acoustic schwannomas is classic for:

Answer 41

Neurofibromatosis 2 (NF2)

Question 42

bitemporal hemianopsia, decreased libido, diabetes insipidus

Answer 42

Craniopharyngioma (common in kids) - distinguishing feature from pituitary adenoma is the endocrine abnormalities *diabetes insipidus may present as urinary frequency

Question 43

brain pathways involved in schizophrenia/antipsychotics: - prefrontal cortex - mesolimbic - tuberoinfundibular - nigrostriatal

Answer 43

- prefrontal cortex: negative symptoms - mesolimbic: positive symptoms - tuberoinfundibular: hyperprolactinemia - nigrostriatal: extrapyramidal side effects

Question 44

Brief sensation of dryness and burning in the throat, a suffusing warmth & hunger for air. Hyperpnea, with a brief outcry, follows the first breath. In <1 minute, apnea, a few gasps, loss of consciousness and convulsions occur. Sometimes include a bitter almond-like breath and a rose-colored hue of the skin. Oxyhemoglobin in the blood.

Answer 44

Cyanide poisoning

Question 45

callosal thinning, corpus callosum atrophy

Answer 45

MS

Question 46

Carl Jung psychological types

Answer 46

8 psychological types - basis of the Myers-Briggs personality test - helps to explain how people interpret respond to the world so differently

Question 47

CATIE trial

Answer 47

Clinical Antipsychotic Trials of Intervention Effectiveness - showed equal efficacy for atypical and typical antipsychotics

Question 48

cerebellar brain tumor that presents with ataxia

Answer 48

Medulloblastoma

Question 49

child presents with chronic headaches & visual changes + nausea, intracranial calcified mass with cystic spaces and cholesterol-rich fluid

Answer 49

Craniopharyngioma

Question 50

childhood epilepsy with centrotemporal spikes

Answer 50

Rolandic epilepsy - benign, doesn't require treatment, outgrow after puberty

Question 51

Chronic schizophrenic taking medication every day for 20 years is an example of what kind of prevention? Primary, secondary, or tertiary?

Answer 51

Tertiary Primary = prevent onset of disease (reduce risk factors, etc) Secondary = identifies disease early and seeks prompt treatment Tertiary = reducing deficits caused by illness to improve functioning

Question 52

Chronic toluene inhalant exposure can lead to what symptoms?

Answer 52

Mimics MS! Due to DEMYELINATION - brisk deep tendon reflexes, ankle clonus, nystagmus, ataxia - personality & cognitive changes

Question 53

classic triad of spongiform vacuolation, loss of neurons, and astrocyte cell proliferation

Answer 53

Creutzfeldt-Jakob disease (CJD) - prion disease

Question 54

common migraine presentation in children (compared to adults) - laterality? - location? - associated symptoms? - duration?

Answer 54

bilateral (instead of unilateral) frontotemporal +photophobia common +n/v common shorter duration

Question 55

compensatory behavior in binge-eating disorder

Answer 55

there is none! if there is --> bulimia or anorexia!

Question 56

compulsive utterance of obscene words

Answer 56

coprolalia

Question 57

Condition where patient can't move or speak, but eyes can follow observer walking around room

Answer 57

akinetic mutism

Question 58

conjunctival injection, increased appetite, dry mouth, tachycardia intoxication

Answer 58

cannabis

Question 59

Criteria for bipolar I disorder: 1. At least _______ (time) of mania 2. _____ or more of the following symptoms: grandiosity, decreased sleep, talkative, racing thoughts, distractible, goal-directed activity, risky behavior 3. marked impairment in __________, requires ________________, or involves ________ features

Answer 59

1. At least one week of mania 2. 3 or more of the following symptoms: grandiosity, decreased sleep, talkative, racing thoughts, distractible, goal-directed activity, risky behavior 3. marked impairment in functioning, requires hospitalization, or involves psychotic features

Question 60

Criteria for Reactive Attachment Disorder: - symptoms evident before age ___ - child has a developmental age of at least _______ - symptoms have been present for at least _______

Answer 60

- symptoms evident before age 5 - child has a developmental age of at least 9 months - symptoms have been present for at least 12 months

Question 61

CSF assay for 14-3-3 and tau proteins

Answer 61

Creutzfeldt-Jakob Disease (CJD) prion disease

Question 62

cytokines consistently elevated in MDD

Answer 62

TNF-alpha & IL6

Question 63

decreased fluency of spontaneous speech & impaired repetition, but intact comprehension (can follow verbal commands) Name + Lesion?

Answer 63

Broca's aphasia, inferior frontal gyrus of the dominant hemisphere

Question 64

Wihtigo

Answer 64

delusional fear displayed by Native American Indians of being turned into a cannibal through possession by a supernatural monster

Question 65

Diagnostic criteria for anorexia (3)

Answer 65

1. Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health 2. Intense fear of gaining weight or becoming fat, even though underweight 3. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

Question 66

diarrhea, restlessness, extreme agitation, myoclonus

Answer 66

serotonin syndrome

Question 67

Diseases associated with chromosome 21 abnormalities

Answer 67

Down's syndrome & Alzheimer's disease

Question 68

distinguishing feature between schizoid & schizotypal personality disorders

Answer 68

schizoid - w/o the below schizotypal - perceptual disturbances + eccentric behavior

Question 69

does attachment last for life?

Answer 69

yes, according to the theorists (Bowlby) - predicts later life relationships

Question 70

Dorsal column volume loss

Answer 70

Vit B12 deficiency

Question 71

drive theory

Answer 71

Freud

Question 72

Edrophonium chloride vs. Pyridostigmine in MS

Answer 72

Edrophonium chloride used to diagnose Pyridostigmine used to treat

Question 73

Embryonic hindbrain develops into:

Answer 73

Cerebellum, Pons, Medulla

Question 74

Embryonic midbrain develops into:

Answer 74

Colliculi, Tegmentum, Cerebral peduncles

Question 75

Emil Kraeplin

Answer 75

mental disorders have different outcomes

Question 76

examples of cognition-oriented therapies

Answer 76

reality orientation (dementia) & cognitive retraining (helps with memory, attention, tasks, etc)

Question 77

examples of stimulation-oriented therapies

Answer 77

art, music, pet therapy

Question 78

exhibitionistic disorder

Answer 78

sexual arousal from exposing genitals to a stranger

Question 79

FDA approved medication for bulimia

Answer 79

Fluoxetine (Prozac)

Question 80

FDA approved medications to treat PTSD in adults

Answer 80

Sertraline, Paroxetine

Question 81

first vs. second generation antipsychotics

Answer 81

first = dopamine antagonist second = dopamine and serotonin antagonist

Question 82

first-line treatment for MS acute attack

Answer 82

IV steroids followed by oral steroids

Question 83

frontal lobe lesion that leads to apathy with limited spontaneous movement, gesture, and speech

Answer 83

medial frontal lobe

Question 84

frontal lobe lesion that leads to depression

Answer 84

left frontal lobe / prefrontal cortex

Question 85

frontal lobe lesion that leads to mania, euphoria, laughter

Answer 85

right frontal lobe / prefrontal cortex

Question 86

frontal lobe lesion that leads to profanity, irritability, irresponsibility

Answer 86

orbitofrontal

Question 87

Pick's disease

Answer 87

frontotemporal atrophy = Pick's (frontotemporal) dementia - may include hyperorality and hypersexuality

Question 88

frotteuristic disorder

Answer 88

sexual arousal by touching or rubbing against a nonconsenting person

Question 89

Ganser syndrome

Answer 89

When a patient gives an answer that doesn't quite answer the question For ex - When asked what 1+1 is, answer is 3.

Question 90

Generalized muscle weakness with improvement in strength after minimal exercise

Answer 90

Lambert-Eaton

Question 91

genetic factors account for ____% of risk for developing schizophrenia

Answer 91

60-80%

Question 92

Gower's maneuver

Answer 92

Duchenne's muscular dystrophy - patient gets up from floor or chair using hands

Question 93

Halstead-Reitan Battery

Answer 93

tests for brain damage

Question 94

HAM-D rating scale

Answer 94

Hamilton Depression Rating Scale

Question 95

Highest prevalence: A. Depressive disorders B. Anxiety disorders C. Schizophrenia D. Dementia E. Substance abuse

Answer 95

B. Anxiety disorders

Question 96

How do neurotransmitter levels change with age? - Serotonin - Dopamine - GABA - Glutamate

Answer 96

All decrease with age!

Question 97

How is Methadone affected in pregnancy?

Answer 97

Clearance is increased and half-life decreased during trimester 2/3 --> may need to increase dose or decrease dose interval

Question 98

How long can these drugs be found in urine? - PCP: - Cannabis: - Cocaine: - Heroin:

Answer 98

- PCP: 8 days - Cannabis: 4 weeks - Cocaine: 8 hours - Heroin: 72 hours

Question 99

How to diagnose Huntington's disease

Answer 99

PCR - examines trinucleotide repeats (>35 in adults, >50 in kids)

Question 100

HTN, blurry vision, diaphoresis, stiff neck, headache, n/v while eating fancy cured meats, wine, beer, cheese

Answer 100

"Tyramine hypertensive crisis" - Tyramine-containing foods can't be broken down in presence of MAOIs so Tyramine acts as a sympathomimetic

Question 101

Insomnia, unsteady gait, headache, nystagmus, upward gaze paralysis (can't look up), eyelid retraction

Answer 101

Pineal gland tumor (Parinaud syndrome) = Pineoblastoma **insomnia due to secretion of melatonin

Question 102

infantile spasms, hypsarrhythmic EEG, psychomotor delay with age of onset between 3-8 months

Answer 102

West syndrome (infantile spasms)

Question 103

IQ 20-40

Answer 103

Severe ID

Question 104

IQ 40-50

Answer 104

Moderate ID

Question 105

IQ 50-70

Answer 105

Mild ID

Question 106

IQ 71-84

Answer 106

Borderline IQ

Question 107

IQ < 20

Answer 107

Profound ID

Question 108

key difference between paranoid and schizotypal personality disorder

Answer 108

magical thinking Paranoid personality disorder - pervasive distrust & suspiciousness of others, perceive others as malevolent, doubt loyalty of others, reluctant to confide in others, bearing grudges Schizotypal personality disorder - ideas of reference, magical thinking, unusual perceptual experiences, odd thinking, suspiciousness, odd behavior, lack of friends, social anxiety

Question 109

known side effects of Gabapentin

Answer 109

SJS, DRESS, erythema multiforme, depression/SI, renal failure, thrombocytopenia

Question 110

Lamictal use in pregnancy

Answer 110

safe!

Question 111

lesion associated with abulia

Answer 111

lateral or bilateral frontal lobe injury

Question 112

lesion to what area of hypothalamus can lead to obesity?

Answer 112

ventromedial

Question 113

lethargy, disorientation, vomiting in someone after starting Depakote

Answer 113

hyperammonemia / hyperammonemic encephalopathy

Question 114

Levomilnacipram (Fetzima) MOA

Answer 114

SNRI

Question 115

LGBTQ teens revealing their sexuality to others at school leads to what with self-esteem and bullying?

Answer 115

increased self-esteem increased bullying

Question 116

lifetime prevalence of GAD

Answer 116

5-8%

Question 117

likelihood of a male child inheriting Huntington's disease from one parent who is an affected carrier

Answer 117

50% autosomal dominant inheritance

Question 118

low 5-HIAA & MHPG + hypoglycemia

Answer 118

firesetters

Question 119

major excitatory neurotransmitter of the brain

Answer 119

Glutamate (acts on NMDA receptor)

Question 120

major inhibitory neurotransmitters

Answer 120

GABA + Glycine

Question 121

MAOI inhibitors work on what neurotransmitters?

Answer 121

Serotonin, Norepi, Dopamine

Question 122

Mechanism of action of Zolpidem

Answer 122

GABA-A alpha-1 agonist (NOT a benzo) - important distinction from benzos is that it preserves deep sleep stages (whereas benzos disrupt deep sleep) **benzos non-selectively bind to all GABA subtypes

Question 123

Mechanism of Vilazodone (Viibryd)

Answer 123

SSRI + partial serotonin (5HT1A) agonist

Question 124

medication to help with decreasing alcohol intake when not ready to completely quit

Answer 124

Naltrexone (decreases cravings by decreasing reward pathway) compared to Acamprosate or Disulfiram which can be uncomfortable and dangerous with alcohol use

Question 125

microhemorrhages in the periventricular gray matter, around the aqueduct and 3/4 ventricles and superior vermis

Answer 125

Wernicke's encephalopathy

Question 126

Mnemonic for TCA side effects

Answer 126

Tachycardia Cardiac effects (increased QTc, arrhythmias) Anticholinergic effects (flushing, dilated pupils, urinary retention) Sedation

Question 127

MOA of Memantine

Answer 127

NMDA antagonist

Question 128

MOA of the drug that causes people to vomit if drinking alcohol

Answer 128

aldehyde dehydrogenase irreversible inhibitor (Disulfiram) --> causes flushing, n/v, hypotension, vertigo, chest pain if alcohol is consumed **can include mouthwash, cough syrup, vinegar, vanilla extract

Question 129

mood stabilizer that inhibits inositol monophosphatase

Answer 129

Lithium

Question 130

Mood stabilizer with side effect of acne and psoriasis flares

Answer 130

Lithium

Question 131

Most accurate confirmatory way to diagnose Creutzfeldt Jakob Disease (CJD)?

Answer 131

Pathological exam of the cortex (brain biopsy)

Question 132

most common genetic marker for: - Alzheimer's - early-onset familial Alzheimer's

Answer 132

- Alzheimer's: ApoE4 - early-onset familial Alzheimer's: Presenilin-1

Question 133

Most common viral cause of viral meningitis

Answer 133

Enteroviruses cause 85% of viral meningitis

Question 134

most reliable psychological test

Answer 134

Wechsler adult intelligence scale

Question 135

Muscle weakness that - improves with rest - improves with activity

Answer 135

- improves with rest = Myasthenia gravis - improves with activity = Lambert-Eaton (small cell lung cancer)

Question 136

Neonatal myasthenia gravis - origin? - course of illness?

Answer 136

- origin: from mother's autoantibodies - course of illness: resolves within months

Question 137

Nefazodone (mechanism + side effect concerns)

Answer 137

serotonin antagonist & reuptake inhibitor (SARI) known for liver monitoring & orthostatic hypotension

Question 138

nerve entrapment from lying wrong, arm over chair or crutches that leads to weakness in wrist/fingers, inability to extend arm or turn forearm over

Answer 138

Saturday night palsy = Radial nerve entrapment

Question 139

neural changes to the gray/white matter in brains of 3-6 year olds with MDD

Answer 139

decrease in gray matter volume and gray matter thinning no change in white matter volume

Question 140

neurotransmitter effects of MDMA (molly, ecstasy) - serotonin - norepinephrine - dopamine - vasopressin - oxytocin long-term damage comes from what?

Answer 140

- serotonin: increases - norepinephrine: increases - dopamine: increases - vasopressin: increases (indirectly) - oxytocin: increases (indirectly) ***the latter increase or enhance love, trust, sexual arousal, social experiences long-term damage comes from effects on serotonergic nerve terminals

Question 141

Neurotransmitters that decrease aggression

Answer 141

GABA - inhibits aggression Serotonin - decreases frequency of aggression Norepi - decreases aggression **Dopamine seems to increase aggression

Question 142

new-onset headache, fever, fatigue, muscle aches, joint pain, night sweats, weight loss, jaw claudication (tiredness with chewing), decreased vision

Answer 142

Giant cell temporal arteritis

Question 143

Nigrostriatal depigmentation

Answer 143

Parkinson's

Question 144

normal bereavement timeline

Answer 144

<2 months

Question 145

normal reflex grade

Answer 145

2+ (0 or 1+ = sluggish or no response) (3+ or 4+ = hyperactive or brisk response)

Question 146

Omega 3 benefits for Alzheimer's disease

Answer 146

MINIMAL improvement in depressive and agitation symptoms

Question 147

Origin of craniopharyngioma

Answer 147

Rathke's pouch

Question 148

parkinsonism, flapping tremor, ataxia, dystonia, bulbar signs (dysphagia, dysarthria)

Answer 148

Wilson's disease

Question 149

pathological gambling is most associated with what?

Answer 149

Mood disorders, particularly MDD

Question 150

Patient is asked to imagine a difficult situation they have encountered in the past and then works with the therapist to practice how to cope successfully with the problem

Answer 150

Cognitive rehearsal (a CBT technique)

Question 151

Patients between age 54 to 66 present with loss of memory, change in intellectual function, and changes in mood. Associated with HTN and old age. Subcortical degeneration of white matter.

Answer 151

Binswanger disease = subcortical leukoencephalopathy (a form of small-vessel vascular dementia)

Question 152

Paxil during pregnancy

Answer 152

First trimester risk of atrial & septal defects, recommended to switch but okay if benefit>risk (Category D)

Question 153

pergolide - drug type?

Answer 153

dopamine agonist for Parkinson's disease (like Bromocriptine, Pramipexole, Ropinirole)

Question 154

Person can speak fluently with normal prosody and rhythm but what they're saying doesn't make sense, sounds like gibberish words jumbled together. Comprehension and repetition impaired. They seem unaware of not making sense. Name + Lesion?

Answer 154

Wernicke's aphasia, superior temporal gyrus in the dominant hemisphere

Question 155

Person can't reach for an object or point to it with their arm - Lesion of?

Answer 155

Dorsal stream - "where" stream - relays info related to movement and spatial relationships between objects in the visual field

Question 156

person is unable to remember certain categories of information (places, activities, people)

Answer 156

systematized dissociative amnesia

Question 157

phonological disorder vs. fluency disorder of childhood

Answer 157

phonological disorder = pronunciation difficulty (articulation, speech impediment) fluency disorder = stuttering

Question 158

Pimavanserin MOA

Answer 158

selective serotonin 5HT2A inverse agonist

Question 159

Pramipexole side effects

Answer 159

- hallucinations - sleep attacks - congestive heart failure - n/v, dizziness, orthostatic hypotension

Question 160

Pregnancy Drug Categories:

Answer 160

Category A = safe Category B = No human studies, animal studies show no risk Category C = No human studies, animal studies show some risk Category D = Human studies show some risk, benefit > risk Category X = Evidence shows risk, risk > benefit

Question 161

preserved speech fluency and comprehension but difficulty with repetition Lesion?

Answer 161

arcuate fasciculus (conduction aphasia) - connects Broca’s & Wernicke’s areas • left (dominant) interior parietal or superior temporal

Question 162

Prosopagnosia

Answer 162

face blindness (inability to recognize faces) **fusiform gyrus in the brain

Question 163

Prozac washout period before starting an MAOI

Answer 163

5 weeks

Question 164

pseudocyesis

Answer 164

false pregnancy

Question 165

Psych drugs that are known to cause SJS (3)

Answer 165

Armodafinil, Lamictal, Carbamazepine

Question 166

RAISE study

Answer 166

Recovery After an Initial Schizophrenic Episode comprehensive care for first-episode psychosis improves functional & clinical outcomes

Question 167

Recreational substance that is known to cause early dementia

Answer 167

Inhalants

Question 168

Risk of SSRIs beyond week 20 of pregnancy

Answer 168

pulmonary HTN

Question 169

safe psychotropic to combine with MAOIs

Answer 169

Lithium

Question 170

Schizoid vs. Schizotypal personality disorder - how to remember and set them apart

Answer 170

Schizo = split (latin) Schizoid - split, like to be alone, don't desire relationships Schizotypal - more like schizophrenia with odd eccentric magical thinking & perceptual experiences

Question 171

Sedating TCAs

Answer 171

“Just a TAD sleepy” Trimipramine Amitriptyline Doxepin

Question 172

self-psychology theory theorist

Answer 172

Kohut

Question 173

Simple vs. complex phonic tic

Answer 173

Simple = grunt, sniffle, throat clearing Complex = words, phrases, vulgar language

Question 174

Someone can't perceive or identify the size, shape or orientation of an object - Lesion where?

Answer 174

Ventral stream

Question 175

spinal tract for conscious fine muscle control of skeletal muscle

Answer 175

Anterior + Lateral + Corticobulbar Corticospinal Tract

Question 176

spinal tract responsible for subconscious regulation of reflex activity

Answer 176

Medial Reticulospinal Tract

Question 177

Spinal tract responsible for subconscious upper limb muscle tone and movement

Answer 177

Lateral Rubrospinal Tract

Question 178

spinal tract that subconsciously controls eye, head, upper limb position in response to visual and auditory stimuli

Answer 178

Medial Tectospinal Tract

Question 179

Spinal tract that subconsciously regulates balance and muscle tone

Answer 179

Medial Vestibulospinal Tract

Question 180

SSRI effect on cytokines

Answer 180

Decrease in IL1B (may decrease TNF alpha & IL6 but not significant)

Question 181

Stage of sleep for night terrors

Answer 181

NREM Stage 3/4

Question 182

STARD trial

Answer 182

Sequenced Treatment Alternatives to Relieve Depression patients who fail multiple antidepressants show higher rates of relapse and lower remission

Question 183

STEP-BD trial

Answer 183

adjunctive antidepressants does not help bipolar depression or cause mania Systematic Treatment Enhancement Program for Bipolar Disorders

Question 184

Studies show that acupuncture has a __% success rate for treating insomnia

Answer 184

90% (increases GABA & sleep quality)

Question 185

Sudden awakening from sleep with piercing scream, panicky fear, and palpitations. Takes a few minutes to calm down, doesn't seem aware of surroundings or husband. Doesn't remember the episode.

Answer 185

Night terror

Question 186

Amok

Answer 186

Sudden rampage involving homicide and/or suicide in Malaysian culture

Question 187

TADS study

Answer 187

The Treatment of Adolescents with Depression Study combination of antidepressants + therapy better than either alone

Question 188

TCA known for less sedation effect

Answer 188

Protriptyline

Question 189

Technique to ameliorate GI side effects of Lithium

Answer 189

switch from Lithium carbonate to Lithium citrate (syrup)

Question 190

the emotional dependence of an infant on its mother -vs- the emotional attachment of a mother to her child

Answer 190

attachment -vs- bonding

Question 191

theorist of attachment theory

Answer 191

John Bowlby

Question 192

Therapist asks patient to defend the validity of his or her thoughts and beliefs. Therapist performs Socratic questioning to determine the accuracy of the patient's maladaptive thoughts. If the patient cannot produce objective evidence supporting his or her assumptions, the invalidity is exposed.

Answer 192

Validity testing (a CBT technique)

Question 193

Therapist focuses on developing patient's self-esteem, ego functioning, and adaptive skills

Answer 193

Supportive psychotherapy

Question 194

timeline for persistent depressive disorder

Answer 194

2 years

Question 195

timeline for sexual disorders (like fetishistic disorder)

Answer 195

>6 months

Question 196

TORDIA study

Answer 196

Treatment of Resistant Depression in Adolescents - adolescents with initially SSRI-resistant depression have improved outcomes with combined meds + psychotherapy

Question 197

Trail-making test tests for:

Answer 197

executive functioning

Question 198

Treatment for absence seizures

Answer 198

1) Ethosuximide 2) Depakote

Question 199

treatment for rumination disorder in: - adults: - infants & those with intellectual disabilities:

Answer 199

- adults: diaphragmatic breathing - infants & those with intellectual disabilities: behavioral habit reversal & aversive training

Question 200

treatment of acute mania

Answer 200

Lithium, Valproate, Atypical antipsychotic

Question 201

treatment of bipolar depression (5)

Answer 201

Quetiapine, Olanzapine/Fluoxetine, Lurasidone, Cariprazine (Vraylar), Lumateperone (Caplyta)

Question 202

tremor entrainment test

Answer 202

if positive --> functional neurologic tremor

Question 203

Types of dissociative amnesia: ________ – unable to remember an event or period of time (most common type) ________ – unable to remember a specific aspect of an event or some events within a period of time. ________ – complete loss of identity and life history (rare)

Answer 203

localized – unable to remember an event or period of time (most common type) selective – unable to remember a specific aspect of an event or some events within a period of time. generalized – complete loss of identity and life history (rare)

Question 204

ventral tegmental area (VTA)

Answer 204

dopamine, reward pathway

Question 205

Victims of bullying in adolescence have a *** times greater risk of developing GAD, panic disorder and agoraphobia as an adult

Answer 205

4 times higher!

Question 206

Vomiting, fever, restless sleep caused by the evil eye occurring in Mediterranean people

Answer 206

Mal de ojo

Question 207

voyeuristic disorder

Answer 207

sexual arousal from watching a person get naked without knowing

Question 208

What is Adderall XR?

Answer 208

Amphetamine/Dextroamphetamine combo (2 isomers, extended release)

Question 209

What is the most common disorder that adults with childhood-onset fluency disorder go on to develop?

Answer 209

Social anxiety disorder

Question 210

What is the nutritional deficiency in Wernicke's?

Answer 210

Thiamine (B1)

Question 211

What percentage of children with ADHD will go on to be adults meeting criteria?

Answer 211

60%

Question 212

What to know about sodium oxybate for narcolepsy

Answer 212

Improves quality of overnight sleep & thus improves daytime wakefulness Treats catalepsy Can cause daytime sedation --> treat with low-dose amphetamine

Question 213

When is DBS indicated for Parkinson's disease?

Answer 213

Late in the course when severe symptoms resistant to meds

Question 214

Why is the Geriatric Depression Scale unique?

Answer 214

Used to evaluate depression in elderly with complex history, can distinguish depression from parkinson's or dementia vs. mdd

Question 215

Wisconsin card-sorting test tests for:

Answer 215

executive functioning

Question 216

YMRS Scale

Answer 216

Young Mania Rating Scale

Question 217

ZODIAC study

Answer 217

Ziprasidone Observational Study of Cardiovascular Outcomes Those on Ziprasidone did not have higher cardiovascular outcomes than those on Olanzapine despite Ziprasidone's known risk of QTc prolongation

Question 218

what part of the brain is damaged by Thiamine deficiency (Wernicke's)?

Answer 218

mamillary bodies

Question 219

Correcting hyponatremia vs. hypernatremia too fast

Answer 219

Hyponatremia: - From low to high, your pons will die (osmotic demyelination syndrome / central pontine myelinolysis) = locked in syndrome Hypernatremia: - From high to low, your brains will blow (cerebral edema / herniation)

Question 220

lifetime prevalence of schizophrenia

Answer 220

1%

Question 221

69 yo presenting with acute onset vertigo, lack of coordination, left-sided facial numbness. Loss of pinprick over left face and right body, left-sided dysmetria, rotatory nystagmus, left-sided ptosis and miosis.

Answer 221

Left Lateral Medullary (Wallenberg) Syndrome - PICA (Vertebrobasilar)

Question 222

Contralateral hemiparesis or hemisensory loss, ipsilateral facial sensory loss, CN palsies, diplopia, dysarthria, ataxia, vertigo, vomiting

Answer 222

Posterior circulation stroke (PICA) - vertebrobasilar Lateral medullary = Wallenberg Syndrome

Question 223

Contralateral face, arm weakness and sensory loss, eyes deviated toward lesion

Answer 223

MCA (left MCA = aphasia) stroke

Question 224

Contralateral foot and leg weakness, behavioral change, confusion, impaired gait and stance (apraxia), akinetic mutism, urinary incontinence, grasp and suck reflex

Answer 224

ACA stroke

Question 225

Arylsulfatase A deficiency

Answer 225

Metachromatic leukodystrophy

Question 226

logorrhea

Answer 226

uncontrollable excessive talking log = words rrhea = flow/discharge

Question 227

Brown Sequard Syndrome - _____________ hemiparesis - _____________ pain & temp loss - _____________ propioception & vibration

Answer 227

lesion to hemisection (half) of spinal cord - ipsilateral hemiparesis - contralateral pain & temp loss - ipsilateral propioception & vibration

Question 228

term for rapid shifting from one topic to another

Answer 228

flight of ideas

Question 229

Dramatic flinging/flailing of left arm Name + Lesion

Answer 229

Hemiballismus - right subthalamic nucleus lesion **hemiballismus = contralateral subthalamic nucleus

Question 230

Postpartum hemorrhaging causing hypotension and requiring transfusion --> Mom is tired, losing weight, can't breastfeed

Answer 230

Sheehan syndrome - postpartum pituitary infarction leading to panhypopituitarism **can be associated with bitemporal hemianopsia (can compress the chiasm), neck stiffness & positive Kernig's (meningeal irritation)

Question 231

Vertebrobasilar ~vs~ Carotid artery stroke/TIA symptoms

Answer 231

Vertebrobasilar - cerebellar symptoms (ataxia, vertigo, diplopia, dysphagia, dysarthria) Carotid artery - blindness, sensory or motor loss, aphasia, visual field deficits

Question 232

Myasthenia gravis is associated with what type of tumor?

Answer 232

Thymoma (20% of adults with MS have a thymoma) **75% of adults with MS have some thymus abnormality, whether thymoma or thymus hyperplasia

Question 233

male to female ratio for schizophrenia

Answer 233

1:1

Question 234

What chromosome is associated with migraines?

Answer 234

Chromosome 19

Question 235

most common neurological complication of chronic alcoholism?

Answer 235

alcoholic neuropathy (Alcohol directly damages nerves)

Question 236

acute descending paralysis with ophthalmoplegia, ataxia, areflexia

Answer 236

Miller-Fisher variant of Guillain-Barre Syndrome (anti-GQ1b ganglioside)

Question 237

classic nerve conduction abnormalities of conduction block and prolonged F-wave latencies

Answer 237

pathognomonic of Guillain-Barre Syndrome (GBS)

Question 238

3 receptor types associated with glutamate

Answer 238

AMPA, kainate, and NMDA

Question 239

MOA of PCP (drug)

Answer 239

NMDA antagonist

Question 240

Author of "Ego and Mechanisms of Defense" and founder of the defense mechanisms

Answer 240

Anna Freud

Question 241

dementia pugilistica

Answer 241

Boxer's dementia "Punch drunk syndrome" "chronic traumatic encephalopathy"

Question 242

What chromosome puts people at higher risk for boxer's dementia?

Answer 242

chromosome 19 (ApoE4)

Question 243

TCA with most antihistaminergic activity

Answer 243

Doxepin

Question 244

TCA used to treat enuresis in kids

Answer 244

Imipramine

Question 245

Why does grapefruit juice interact with Methadone?

Answer 245

CYP3A4 inhibition (which increases Methadone levels)

Question 246

a non-motor symptom that often appears in Parkinson's patients before onset of motor symptoms

Answer 246

Decreased olfactory sense

Question 247

Benefit of Pimavanserin compared to other antipsychotics for Parkinson’s

Answer 247

Doesn’t worsen motor symptoms

Question 248

most common comorbidity in delusional disorder

Answer 248

depression

Question 249

Hydroxyzine contraindications

Answer 249

Cardiac - QT prolongation, MI, CHF, bradycardia Metabolic - electrolyte abnormalities Pulmonary - asthma Other - hot environmental temperature (risk of heat stroke)

Question 250

Chronic paroxysmal hemicrania vs. Cluster headaches - More common in men vs. women: - # of attacks per day: - Attack duration: - Triggered by: - Main treatment: - Relation to circadian rhythm:

Answer 250

- More common in men vs. women: CPH women; Cluster men - # of attacks per day: CPH up to 40 per day; Cluster up to 8 per day - Attack duration: CPH 2-30 min; Cluster 15 min to 3 hours - Triggered by: CPH turning head, alcohol; Cluster alcohol - Main treatment: CPH indomethacin; Cluster High flow oxygen, sumatriptan - Relation to circadian rhythm: CPH unrelated; Cluster mostly at night

Question 251

35 yo with severe pain behind left eye. Reports intense stabbing pain that woke him at midnight, improved in 30 minutes, then returning right before he fell back asleep. Several months ago had similar episodes of pain that resolved spontaneously after 2 weeks. Exam reveals left-sided ptosis, miosis and rhinorrhea.

Answer 251

Cluster headache - can have horner syndrome, occurs in clusters then no periods of headaches

Question 252

timeline for Tourette disorder

Answer 252

at least 1 year

Question 253

timeline for GAD

Answer 253

at least 6 months

Question 254

antipsychotic that is mainly metabolized/excreted via renal/urine

Answer 254

Paliperidone (80% excreted via urine) **compared to most other antipsychotics that are hepatically metabolized

Question 255

Timeline for erectile dysfunction disorder

Answer 255

6 months

Question 256

Timeline for rumination disorder

Answer 256

1 month

Question 257

Pioglitazone relevance to psychiatry

Answer 257

It is a an insulin sensitizing drug. Can be used as an adjunctive antidepressant in treatment-refractory cases and seems to help in non-diabetic adults with insulin resistance

Question 258

#1 cause of loss of years of healthy life in both high- and low- income countries

Answer 258

Depression!

Question 259

evidence is best for what treatments for depersonalization/derealization

Answer 259

CBT + SSRI or Benzo

Question 260

2 blackbox warnings for Latuda

Answer 260

- can increase suicidality in children and adolescents - can increase mortality in dementia-related psychosis

Question 261

brain tumor that causes cognitive slowing, fatigue, weight loss, headaches, new-onset seizures, speech impairment

Answer 261

oligodendroglioma

Question 262

most common location of ischemic stroke in migraine infarction

Answer 262

posterior circulation

Question 263

treatment of Hallucinogen Persisting Perception Disorder (HPPD) after use of LSD

Answer 263

Benzos (GABA agonist!) HPPD involves persisting perceptual disturbance after d/cing use of hallucinogen, primarily involves visual hallucinations

Question 264

timeline for aura in migraine to be considered "persistent aura" without evidence of infarction?

Answer 264

at least 1 week

Question 265

Why is Desipramine sometimes used for cocaine dependence and smoking cessation?

Answer 265

Inhibits noradrenergic reuptake

Question 266

Acamprosate MOA

Answer 266

GABA + Glutamate agonist - used for alcohol dependence

Question 267

Acamprosate contraindication

Answer 267

Severe renal impairment

Question 268

Myasthenia gravis vs. Lambert-Eaton with regards to pre- vs post-synaptic ACh receptor malfunction

Answer 268

Myasthenia gravis = post-synaptic Lambert-Eaton = pre-synaptic

Question 269

MTA study

Answer 269

Multimodal Treatment of ADHD Study - revealed both medication alone and combination of med + therapy were superior to therapy alone for patients with ADHD

Question 270

curative surgery for epilepsy

Answer 270

temporal lobectomy **corpus callosotomy or extra-temporal resections are palliative

Question 271

most common cause of sporadic fatal encephalitis worldwide

Answer 271

Herpes simplex virus type 1

Question 272

encephalitis affecting bilateral temporal lobe involvement

Answer 272

herpes simplex

Question 273

heritability of bipolar disorder based on twin studies

Answer 273

60-90%

Question 274

dystonia in Parkinson's disease more common in what population?

Answer 274

Young-onset Parkinson's (before age 40) - think of VA guy - can be the initial presenting symptom in this population (compared to late-onset)

Question 275

atypical antipsychotic least likely to result in weight gain

Answer 275

Abilify

Question 276

HAM-D vs. BDI

Answer 276

HAM-D: 17 questions asked by provider (ham-D for Doctor does it!) BDI: 21 questions completed by patient (bdI for I do it!)

Question 277

Antipsychotic MOA

Answer 277

dopamine antagonist

Question 278

Cyclothymic disorder criteria - timeline: - symptoms:

Answer 278

- timeline: 2 years - symptoms: hypomanic & depressive symptoms that don't meet criteria for hypomania, mania, or MDD

Question 279

Cluster A personality disorders: - described as: - what are they?

Answer 279

- described as: odd, eccentric Paranoid, Schizoid, Schizotypal

Question 280

Cluster B personality disorders: - described as: - what are they?

Answer 280

- described as: dramatic, emotional Histrionic, Borderline, Narcissistic, Antisocial

Question 281

Cluster C personality disorders: - described as: - what are they?

Answer 281

- described as: anxious, fearful Avoidant, Dependent, Obsessive-Compulsive

Question 282

most common side effect of Vortioxetine (Trintellix)

Answer 282

persistent nausea (does not resolve like typical SSRIs)

Question 283

MOA of Vortioxetine (Trintellix)

Answer 283

SRI (serotonin reuptake inhibitor, not selective)

Question 284

FDA approved meds for PMDD

Answer 284

Zoloft, Prozac, Paxil

Question 285

first drug of choice for generalized seizures

Answer 285

Depakote

Question 286

Timing for premature ejaculation

Answer 286

Less than 1 minute

Question 287

Most common side effect of DBS from the direct electrical stimulation?

Answer 287

Hypomania - can be reversed by decreasing stimulation settings

Question 288

unique benefit of Vortioxetine (Trintellix)

Answer 288

shows improvement in COGNITION independent of mood improvement. Cognitive improvements can occur even prior to mood changes.

Question 289

New neuromod technique that uses electrical signals to stimulate the trigeminal nerve CN V through a battery-powered patch placed on the patient's forehead

Answer 289

Trigeminal Nerve Stimulation (TNS)

Question 290

Trigeminal Nerve Stimulation (TNS) is FDA approved to treat what condition

Answer 290

ADHD

Question 291

most common population for rumination disorder

Answer 291

infants between 3 months to 1 year of age

Question 292

When do myelination & synaptogenesis start, occur, peak, and end in the brain?

Answer 292

Myelination: starts in utero, peaks right before birth, continues through life Synaptogenesis: starts in second trimester, peaks in toddlerhood (age 2), ends around age 10 (synaptic overproduction occurs before that, then synaptic pruning begins)

Question 293

Hz of Parkinson's disease tremor

Answer 293

4-6 Hz

Question 294

acute stress disorder timeline

Answer 294

3 days to 1 month

Question 295

Circumlocutions

Answer 295

word substitutions to avoid problematic words in childhood-onset fluency disorder

Question 296

Brexpiprazole is FDA approved to treat:

Answer 296

MDD as adjunctive agent, schizophrenia

Question 297

It is the goal of the ______ to satisfy the needs of the id in a socially acceptable way

Answer 297

ego The ego balances the id's unconscious urges and desires with the superego's restriction of moral standards

Question 298

30 yo resident complaining of excessive daytime sleepiness for the past 3 months. Works in the hospital during the day and moonlights at night. Increases caffeine intake for moonlighting. Has difficulty falling asleep at night bc afraid of pager going off. Daytime sleepiness so bad that she falls asleep driving to work and ran a red light.

Answer 298

Circadian rhythm sleep disorder - persistent or recurrent sleep disturbance due to either intrinsic (altered circadian rhythm, blindness) or extrinsic (travel, daytime sleep schedule) factors with consequences, which include- insomnia, excessive daytime sleepiness, wake time dysfunction Types: - Delayed or advanced sleep-phase type - Irregular sleep-wake type - Shift work type - Jet lag type - Free-running type

Question 299

person-centered psychotherapy

Answer 299

Carl Rogers

Question 300

Criteria for migraine without aura: - at least ___ attacks - lasting for __ to __ hours - at least __ of the following characteristics: ___lateral location, _________ quality, __________ or __________ pain intensity, aggravation/causing avoidance of routine activity - at least __ of the following: photophobia, phonophobia, nausea, vomiting

Answer 300

- at least 5 attacks - lasting for 4 to 72 hours - at least 2 of the following characteristics: unilateral location, pulsating quality, moderate or severe pain intensity, aggravation/causing avoidance of routine activity - at least 1 of the following: photophobia, phonophobia, nausea, vomiting

Question 301

Criteria for migraine with aura: - at least __ attacks - __ or more of the following aura symptoms: visual, sensory, speech, language, motor, brainstem, retinal - at least __ of the following: one spreads gradually over >5 minutes, 2 or more aura in succession, each aura lasts 5-60 min, at least one aura is unilateral, at least one aura is positive, aura is accompanied by or followed within 60 min headache

Answer 301

- at least 2 attacks - 1 or more of the following aura symptoms: visual, sensory, speech, language, motor, brainstem, retinal - at least 3 of the following: one spreads gradually over >5 minutes, 2 or more aura in succession, each aura lasts 5-60 min, at least one aura is unilateral, at least one aura is positive, aura is accompanied by or followed within 60 min headache

Question 302

MMSE scoring:

Answer 302

21-24: Mild impairment 10-20: Moderate impairment 0-9: Severe impairment

Question 303

31 yo woman 5 mos postpartum ingests chalk and clay since delivery. Has been craving and eating chalk and clay for over 4 mos and is hoping it will help her lose weight. She thinks she is overweight. She has been binging at least twice a week on food mixed with clay and chalk. Eats slowly over 3 hours until she feels uncomfortably full. Adds chalk to regular meals, as it satisfies her cravings. Sometimes she just chews on it then regurgitates it.

Answer 303

Pica = persistent intake of nonnutritive substances for at least 1 month she meets features of a few other eating disorders but does not meet criteria for them!

Question 304

Hypnagogic vs. Hypnopompic hallucinations

Answer 304

Hypnagogic = with sleep onset (feeling GROGGY) Hypnopompic = with waking (POPPING awake!)

Question 305

Levomilnacipran FDA approved for?

Answer 305

MDD

Question 306

Cannabinoid 1 vs 2 receptors

Answer 306

CB1 = psychiatric effects CB2 = immune system, inflammatory response, pain

Question 307

Piaget stage where conservation is achieved

Answer 307

Concrete operations = CONservation

Question 308

Genetic inheritance of Tourette's

Answer 308

Autosomal dominant

Question 309

Concordance of Tourette's disorder in monozygotic twins

Answer 309

85%

Question 310

Heschl's gyrus

Answer 310

Primary auditory cortex - bilateral superior temporal lobe

Question 311

periodic high-amplitude sharp triphasic wave complexes on EEG

Answer 311

Creutzfeldt-Jakob disease

Question 312

Periodic lateralizing epileptiform discharges (PLED) on EEG

Answer 312

Herpes encephalitis

Question 313

CSF: - opening pressure: elevated - WBC: elevated lymphocytes - protein: elevated - glucose: low

Answer 313

Fungal/TB Meningitis

Question 314

CSF: - opening pressure: elevated - WBC: elevated neutrophils - protein: elevated - glucose: low

Answer 314

Bacterial Meningitis

Question 315

CSF: - opening pressure: normal or elevated - WBC: elevated lymphocytes - protein: normal to elevated - glucose: normal low

Answer 315

Viral (Aseptic) Meningitis

Question 316

Mahler's stage in which baby spends more time asleep than awake

Answer 316

Normal autism (birth to 2 mos)

Question 317

Mahler's stage when baby is developing the ability to distinguish the inner from the outer world. The child perceives itself as being part of a single entity with its mother.

Answer 317

Symbiosis (2-5 mos)

Question 318

Mahler's stage when child is drawn further into the outside world and begins to distinguish itself from its mother.

Answer 318

Differentiation (5-10 mos)

Question 319

Mahler's stage when baby has the ability to move independently and explore the outside world (crawling, walking, exploring)

Answer 319

Practicing (10-18 mos)

Question 320

Mahler's stage in which the child's independence vacillates with its need for its mother. The child moves away from the mother, then quickly returns for reassurance. Now they're more tentative and want to make sure mom is still there.

Answer 320

Rapprochement (18-24 mos)

Question 321

Mahler's stage in which the child understands the permanence of other people, even when they are not present, allowing separation.

Answer 321

Object constancy (2-5 yrs)

Question 322

statistical test that checks differences between means of 2 versus 3 or more groups

Answer 322

2 = t-test > 3 = ANOVA

Question 323

statistical test that checks difference between 2 or more categorical outcomes

Answer 323

chi-square

Question 324

Head bleed resulting from tear of middle meningeal artery

Answer 324

Epidural hematoma Epidural = middle meningeal ARTERY Subdural = bridging VEINS

Question 325

Head bleed resulting from tear of meningeal bridging veins

Answer 325

Subdural hematoma Epidural = middle meningeal ARTERY Subdural = bridging VEINS

Question 326

toxicity of acetylcholinesterase inhibitors (physostigmine) (organophosphates) (pesticides)

Answer 326

DUMBBELS Diarrhea Urination Miosis Bronchospasm Bradycardia Emesis Lacrimation Salivation **cholinergic toxicity

Question 327

Pt presents with vomiting, shortness of breath, bradycardia, hypoxia, pinpoint pupils, lacrimation, widespread rhonchi, muscle fasciculations, increased bowel sounds and diarrhea. diagnosis + management

Answer 327

Insecticide poisoning (organophosphates, anticholinesterase inhibitor, increases cholinergics) --> immediate atropine (anticholinergic/antimuscarinic) **remove clothes bc can be absorbed via skin

Question 328

most common sleep disruption in depression

Answer 328

early morning awakening

Question 329

hypsarrhythmia

Answer 329

EEG pattern for infantile spasms West syndrome = infantile spasms, hypsarrhythmia, and psychomotor developmental arrest

Question 330

microcephaly, a characteristic "mousy" odor, infantile spasms, and light hair and skin pigmentation

Answer 330

PKU (Phenylketonuria)

Question 331

Brain structure suspected to be involved in Tourette's with dopaminergic activity

Answer 331

Caudate nucleus - causes the movements related to Tourette's, Parkinson's, tics

Question 332

rate-limiting enzyme in the dopamine synthetic pathway

Answer 332

Tyrosine hydroxylase

Question 333

Drugs that work on GABA-A vs GABA-B

Answer 333

GABA-A: Benzos, Barbiturates, Alcohol GABA-B: Sodium oxybate, Lioresal (antispasticity agent)

Question 334

Entacapone & Tolcapone MOA

Answer 334

COMT inhibitors

Question 335

Benzos metabolized by conjugation

Answer 335

LOT = Lorazepam Oxazepam Temazepam long-acting benzos that bypass oxidation so safer in hepatic disease, also have no active metabolites

Question 336

method of obtaining a prediction for the value of one variable in relation to another variable is called

Answer 336

regression analysis

Question 337

triphasic waves on EEG

Answer 337

hepatic encephalopathy

Question 338

compulsive eating, hypersexuality, hyperorality, visual agnosia, docility (calm, subserviant)

Answer 338

Kluver-Bucy Syndrome = bilateral lesions of the temporal lobe disconnecting amygdaloid bodies

Question 339

While working on the ward of a state hospital, a psychiatrist comes across a patient with schizophrenia. The patient sits in one spot for extended periods of time, without changing position. This phenomenon is best described as:

Answer 339

catalepsy = immobile position that is constantly maintained.

Question 340

How is sleep affected in elderly? - # REM episodes: - Length of REM: - % of N1: - % of N2: - % of N3:

Answer 340

- # REM episodes: increased - Length of REM: decreased - % of N1: increased - % of N2: increased - % of N3: decreased

Question 341

alogia

Answer 341

lack of speech that results from a mental deficiency or dementia (lack of thought content)

Question 342

To meet criteria for rapid cycling specifier in bipolar disorder, the patient must present with at least _____ mood episodes over the past ___ months

Answer 342

4 mood episodes over 12 months

Question 343

age to be considered late-onset in schizophrenia

Answer 343

45

Question 344

# of neurons in the developed human brain

Answer 344

86-100 billion

Question 345

Premonitory phase of migraines symptoms (6)

Answer 345

Hypo/peractivity Fatigue Depression Food cravings Yawning Neck stiffness Occurs hours to days before migraine

Question 346

Mirtazapine MOA

Answer 346

alpha-2 antagonist (+histamine H1 blockade --> sedation; +5HT3 antagonism --> antinausea)

Question 347

FDA-approved meds for pediatric bipolar disorder (6)

Answer 347

Lithium Four atypicals: - Abilify - Risperdal - Quetiapine - Olanzapine - Asenapine

Question 348

Timeline for seizures in alcohol withdrawal

Answer 348

first 48 hours

Question 349

Prazosin MOA

Answer 349

alpha-1 antagonist

Question 350

Ketamine MOA

Answer 350

glutamate NMDA antagonist

Question 351

hypnagogic hallucinations are a known side effect of what antipsychotic

Answer 351

Asenapine

Question 352

bipolar disorder rapid cycling definition

Answer 352

at least 4 mood episodes in the last 12 mos

Question 353

most appropriate effective treatment for hypoactive sexual desire disorder

Answer 353

Stimulants

Question 354

narcolepsy criteria: - symptoms at least ___ times per week over the past ___ months - recurrent episodes of uncontrollable sleepiness, lapsing into sleep, or napping during the same day At least one of the following: - Episodes of cataplexy occurring at least ___ times a month - ____ Hypocretin - REM sleep latency of ___ minutes and a mean sleep latency of ___ minutes

Answer 354

- symptoms at least 3 times per week over the past 3 months - recurrent episodes of uncontrollable sleepiness, lapsing into sleep, or napping during the same day At least one of the following: - Episodes of cataplexy occurring at least several times a month - Low Hypocretin - REM sleep latency of 15 minutes and a mean sleep latency of 8 minutes

Question 355

oligoclonal bands in CSF

Answer 355

Multiple Sclerosis

Question 356

Saffron use in Alzheimer's

Answer 356

similar cognitive improvements and efficacy compared to Donepezil with fewer side effects (less nausea)

Question 357

body integrity identity disorder

Answer 357

feeling that a limb or other body part is foreign and doesn't belong to them, needs to be removed

Question 358

most common psychiatric illness/comorbidity in Lupus

Answer 358

depression

Question 359

best OCD meds target what receptor profile

Answer 359

serotonin

Question 360

What does SCOFF stand for?

Answer 360

Sick (vomit) Control One Fat Food

Question 361

SCOFF sensitivity and specificity

Answer 361

High sensitivity (identifies all eating disorder patients, low false negatives) Low specificity (low false positives, may falsely diagnose some but at least all of the real ones are captured)

Question 362

least common type of seizure in Lennox-Gastaut

Answer 362

myoclonic

Question 363

falls & vertical gaze palsy, writing smaller (micrographia) --> progresses to symmetric rigidity & dementia

Answer 363

progressive supranuclear palsy (PSP) **rapidly progressive and fatal

Question 364

management of autonomic dysreflexia (high BP) in spinal cord injury patients

Answer 364

1. Look for urinary retention of bowel distention (triggered by insults below the level of injury) 2. Treat with IV short-acting antihypertensive agent - sodium nitroprusside or labetalol

Question 365

nondominant hemisphere in most people

Answer 365

right hemisphere

Question 366

Stroke- With eyes closed, touch left arm and can feel it. Then touch both arms and can only feel right. Name for syndrome? Lesion to what? What side of brain?

Answer 366

Hemineglect syndrome = lesion to parietal or frontal lobe of nondominant hemisphere (right) Dominant Left = pays attention to right only Non-Dominant Right = pays attention to both right & left (preferentially to left) Thus: if non-dominant right is damaged --> the left brain will outweigh --> thus the right side of body will be preferenced

Question 367

Most common comorbidity in hoarding disorder

Answer 367

Depression (NOT OCD!)

Question 368

FDA approved drug for Lennox-Gastaut Syndrome

Answer 368

Felbamate

Question 369

BARS scale

Answer 369

Barnes akathisia rating scales

Question 370

Vagus nerve stimulator known to reduce what seizure type

Answer 370

Complex partial

Question 371

Gabapentin anacarbil

Answer 371

= Gabapentin XR take with FOOD!!!!

Question 372

major active metabolite of Risperidone

Answer 372

Paliperidone

Question 373

Painless transient loss of vision in one eye described as "curtain falling over eye" that only lasts a few seconds Name + Etiology + Next step in diagnosis:

Answer 373

Amaurosis fugax - retinal ischemia secondary to small embolism in ophthalmic artery originating from carotid artery **technically a TIA*** **question hint may be carotid bruit on exam --> Carotid duplex ultrasound

Question 374

Location of synthesis of neurotransmitters: - Serotonin: - ACh: - GABA: - NE: - Dopamine:

Answer 374

- Serotonin: raphe nucleus - ACh: basal nucleus of Meynert - GABA: nucleus accumbens - NE: locus ceruleus, adrenal medulla - Dopamine: substantia nigra

Question 375

Man with recent flu vaccine presents with acute onset paraparesis and urinary incontinence. Symptoms began a week ago with progressive low back pain that led to bilateral leg weakness.

Answer 375

Transverse myelitis **question stem may make you think of Guillain-Barre but think of this when there's sensory level loss and bowel/bladder dysfunction after a URI or vaccine - course = back pain --> leg weakness --> urinary incontinence

Question 376

Reliability vs. Accuracy in diagnosis

Answer 376

Reliability = Precision = consistence = can apply across he board (doctors at diff locations would agree on the diagnosis) Accuracy = Validity = how accurate = how true values are (the disorder has features that are characteristic enough to separate it from other disorders)

Question 377

Term for when a diagnosis allows doctor to predict clinical course and treatment response (a test is able to predict a future outcome) - Face validity - Content validity - Construct validity - Convergent validity - Predictive validity

Answer 377

Predictive validity

Question 378

Term for when a diagnosis is based on underlying pathophys and the use of biologic markers to confirm the disease - Face validity - Content validity - Construct validity - Convergent validity - Predictive validity

Answer 378

Construct validity

Question 379

the extent to which a test assesses all the aspects of the condition it purports to assess ex: a rating scale that doesn't measure neurovegitative signs would have low ***** validity for assessing depression - Face validity - Content validity - Construct validity - Convergent validity - Predictive validity

Answer 379

Content validity

Question 380

The extent to which a test correlates with other tests for the same condition Ex: New depression rating scale correlates highly with HAM-D scores, therefore has high ******* validity - Face validity - Content validity - Construct validity - Convergent validity - Predictive validity

Answer 380

Convergent validity

Question 381

Child with horner syndrome in setting of cervical paravertebral mass

Answer 381

Neuroblastoma

Question 382

Horner's syndrome etiology

Answer 382

Lesion of thalamus or medulla, or common carotid

Question 383

Prosopagnosia

Answer 383

inability to recognize familiar faces

Question 384

Astereognosis

Answer 384

inability to recognize and identify items by weight, texture, and form alone when items are held in hand (a form of tactile agnosia) a=without stereo=solid, 3D, texture gnosis=recognition/knowledge

Question 385

Aprosodia

Answer 385

deficit in emotional aspect of expressive or receptive speech

Question 386

Bells palsy vs stroke

Answer 386

Bells palsy = full face Stroke = spares upper third of face (brow, eyelid, forehead)

Question 387

35 yo presents with complaints of muscle weakness and sensory loss in upper extremities. MVC 7 yrs ago, sustained whiplash C spine injury. Moderate wasting of small hand muscles and impaired pain/temp in bilat UE. Light touch vibration position sense intact.

Answer 387

Central cord syndrome due to Syrinomyelia - CSF drainage from central canal of spinal cord is disrupted --> fluid filled cavity compresses surrounding neural tissue - most caused by Arnold-Chiari malformation - classic is cape or shawl pattern sensory deficit of upper arms and trunk - sensory deficits (pain and temp) + LMN signs (flaccidity, muscular atrophy, fasciculations)

Question 388

Opsoclonus-myoclonus in an infant vs. an adult

Answer 388

Paraneoplastic movement disorder seen most often in infants 6-18 mos, 50% or more associated with neuroblastoma "dancing eyes and dancing feet syndrome" (multifocal myoclonus and rapid dancing movements of the eyes) In adults = lung cancer

Question 389

Bells palsy vs. Ramsay-Hunt

Answer 389

Both facial droop involving forehead, ear pain, hearing abnormalities, but Ramsay-Hunt includes a rash in the ear Ramsay-Hunt = VZV reactivation in sensory ganglion affecting facial (7) and acoustic (8) cranial nerves

Question 390

Anton's syndrome

Answer 390

Visual anosognosia = blindness without insight, patients often confabulate and refuse to believe they are blind. Results from stroke or brain damage to occipital lobe

Question 391

Riluzole MOA + indication

Answer 391

Glutamate antagonist ALS

Question 392

AIDS patient with CD4 of 50 presenting with gait instability, spasticity, leg weakness, sphincter dysfunction, loss of proprioception

Answer 392

Vacuolar myelopathy - most common cause of spinal cord pathology in AIDS patients - occurs in late-stage AIDS with low CD4 count

Question 393

HIV, low CD4 count, visual symptoms, gait ataxia, asymmetric patchy non-enhancing white matter lesions

Answer 393

Progressive Multifocal Leukoencephalopathy (PML) - JC virus

Question 394

HIV patient presenting with fevers, headaches, vomiting, papilledema, encapsulated yeasts on LP

Answer 394

Cryptococcal meningitis - cryptococcus replicates in CNS --> clogs arachnoid villi --> CSF outflow obstruction --> increased ICP --> headaches, n/v, confusion, lateral gaze palsy, etc

Question 395

HIV patient with floaters and blurry vision

Answer 395

CMV Retinitis

Question 396

HIV patient with cognitive and personality changes

Answer 396

HSV encephalitis (affects temporal lobes)

Question 397

HIV patient with gradual onset of incoordination, lack of attention and motivation, memory loss. MRI with white matter changes.

Answer 397

HIV dementia - early symptoms of attention and concentration problems - slowed thought (bradyphrenia) - social withdrawal, apathy, depression, fatigue --> can lead to gait incoordination, rigidity, slowed gait ***white matter changes! (diffuse increase in intensity of white matter)

Question 398

Cervical myelopathy + Bilateral optic neuropathy

Answer 398

Neuromyelitis optica = Devic's disease (variant of MS)

Question 399

Kuru

Answer 399

prion disease affecting cannibalistic Fore people - manifests as progressive cerebellar ataxia

Question 400

Triad of headache, ipsilateral Horner's syndrome and contralateral hemiparesis

Answer 400

Carotid artery occlusion -- horner's itself can cause headache

Question 401

Vet presents with 4-week history of headache, vague fever, paresthesias in fingers and toes. Temp is 103.5 F. Complains of difficulty swallowing with pharyngeal spasms for the past 3 days.

Answer 401

Rabies!!! - hydrophobia - fear of drinking due to pharyngeal spasms

Question 402

Double vision, ptosis, difficulty swallowing, nausea, dry mouth. Had potato salad yesterday from home-canned potatoes

Answer 402

Botulism = Diplopia, Dysarthria, Dysphagia, Dyspnea, Urinary retention

Question 403

Pure motor hemiparesis on same side of face and body

Answer 403

Lacunar infarct - contralateral face, arm, leg affected with motor symptoms (no sensory deficits usually) = posterior limb of internal capsule!

Question 404

Balint's syndrome

Answer 404

Rare stroke from simultaneous lesions to bilateral parietal-occipital lobes Leads to Ocular apraxia (inability to scan extrapersonal space), Optic ataxia (jerks that can impede vision), Simultanagnosia (inability to perceive a scene with multiple parts to it)

Question 405

Ocular apraxia (inability to scan extrapersonal space), Optic ataxia (jerks that can impede vision), Simultanagnosia (inability to perceive a scene with multiple parts to it)

Answer 405

Balint's syndrome

Question 406

Is depression or schizophrenia a higher risk factor for completing suicide?

Answer 406

Depression

Question 407

blepharospasm and oromandibular dystonia

Answer 407

Meige's syndrome blepharospasm = eyelid blinking involuntary contraction of eyelids and lower facial muscles

Question 408

Scanning speech

Answer 408

Ataxic speech - cerebellar lesion (irregular, choppy speech)

Question 409

Aphemia

Answer 409

near muteness with normal reading, writing, and comprehension (a=without; phenia=phasia=voice=speech)

Question 410

least anticholinergic TCA

Answer 410

Desipramine

Question 411

Hoover's sign

Answer 411

patient suspected of a hysterical or psychogenic hemiparesis does not give effort in the contralateral (unaffected) lower extremity when asked to lift the paretic (affected) lower extremity off the table The examiner places a hand under the patient's heel on the unaffected side to feel if the patient is pushing down toward the bed in an attempt to give a full effort at raising the affected leg. In a real hemiparesis, the patient would be expected to make every effort to brace himself with the unaffected leg while trying to raise the paretic leg.

Question 412

Hoffman's sign

Answer 412

equivalent of Babinski's in the upper extremity

Question 413

Tiagabine

Answer 413

selective GABA reuptake inhibitor for partial complex seizures

Question 414

GABA type that benzos target

Answer 414

GABA-A

Question 415

Head bruit

Answer 415

Hallmark of AVM

Question 416

Mixed opioid agonist/antagonist

Answer 416

Buprenorphine

Question 417

Hallervorden-Spatz syndrome

Answer 417

autosomal recessive neurodegenerative disease of childhood that presents with dementia and parkinsonism, caused by lesions to basal ganglia

Question 418

dementia, dermatitis, diarrhea

Answer 418

triad for Pellagra (Vitamin B3 / Niacin deficiency)

Question 419

Pimozide

Answer 419

dopamine antagonist approved for tics / tourette's (in europe, antipsychotic approved for schizophrenia)

Question 420

treatment for atypical depression

Answer 420

NOT STANDARD TREATMENT! --> MAOIs! **Atypical depression shows excellent response to MAOIs compared to other meds

Question 421

BPRS

Answer 421

Brief psychiatric rating scale - used for schizophrenia and psychosis

Question 422

Antipsychotic that can cause retrograde ejaculation and impotence

Answer 422

Thioridazine

Question 423

Donepezil MOA

Answer 423

Acetylcholinesterate inhibition

Question 424

What neurotransmitters does ecstasy affect?

Answer 424

Dopamine and Serotonin

Question 425

Kleine-Levin syndrome

Answer 425

rare disorder with hypersomnia interrupted by irritability, hyperorality, hypersexuality other symptoms can include confusion, disorientation, incoherent speech, apathy, hallucinations, delusions, memory impairment avg onset age 10-20, resolves by age 40

Question 426

Relative contraindications to Amantadine

Answer 426

Renal disease, Seizure disorder

Question 427

Defense mechanism associated with specific phobia

Answer 427

Repression **spider bite as a kid leads to fear of spiders, despite repressing and not remembering the spider bite

Question 428

Meds that can be useful for binge-eating (5)

Answer 428

1) SSRIs (Fluoxetine is the best!) 2) Topamax, Atomoxetine, Sibutramine, Duloxetine

Question 429

Brodmann areas associated with language production and speech

Answer 429

Brodmann areas 44 & 45

Question 430

Brodmann area 17

Answer 430

primary visual cortex

Question 431

Brodmann area 4

Answer 431

primary motor cortex

Question 432

Brodmann areas associated with the primary auditory cortex

Answer 432

Brodmann areas 41 & 42

Question 433

Most common psychiatric comorbidity in narcissistic personality disorder

Answer 433

Anxiety disorders

Question 434

Only MAOI that is specific to MAO-B

Answer 434

Selegiline

Question 435

Recurrent brief attacks of vertigo that occur without warning and resolve spontaneously in otherwise healthy children Diagnosis + age of onset

Answer 435

Benign paroxysmal vertigo of childhood (BPVC) Age of onset is 3-4 years old

Question 436

Spinal cord level that leads to autonomic dysreflexia

Answer 436

T6 or above

Question 437

AUD remission timeline

Answer 437

Early remission = 3-12 months Sustained remission = >12 months **none of criteria met, SOBER and symptom FREE!

Question 438

Tonic seizures: - duration: - occur during wakefulness or sleep? - symmetry: - extremity movement:

Answer 438

- duration: 5-20 seconds - occur during wakefulness or sleep? sleep - symmetry: symmetrical - extremity movement: flexion OR extension

Question 439

Criteria for intermittent explosive disorder: - Verbal aggression (temper tantrums, arguments, fights) or physical aggression toward property, animals or other individuals occurring ___ x per week for at least ___ months. OR - __ episodes of aggression or outbursts that result in damage of property or others in a __-month period

Answer 439

- Verbal aggression (temper tantrums, arguments, fights) or physical aggression toward property, animals or other individuals occurring 2x per week for at least 3 months. OR - 3 episodes of aggression or outbursts that result in damage of property or others in a 12-month period

Question 440

Hydroxyzine MOA

Answer 440

Central & peripheral histamine H1 receptor antagonist

Question 441

Minamata disease

Answer 441

Methylmercury intoxication or mercury-induced encephalitis

Question 442

Atrophy of visual calcarine cortex and cerebellum

Answer 442

Mercury intoxication/encephalitis - causes cerebellar ataxia, dysarthria, intention tremor, gaze nystagmus, dysmetria, dysdiadochokinesia

Question 443

distinguishing factors between NMS and Serotonin Syndrome

Answer 443

Both present with: AMS, autonomic instability, diaphoresis, mutism, can have elevated CPK Distinct to SS are: myoclonus, hyperreflexia, GI symptoms (diarrhea) NMS presents with rigidity and slowed reflexes Also - SS is abrupt onset, NMS is gradual

Question 444

caudate head atrophy

Answer 444

Huntington's disease

Question 445

most common source of brain mets

Answer 445

Lung

Question 446

subdural vs epidural hematoma shape

Answer 446

epidural can't draw an S (lemon) subdural could draw an S (banana)

Question 447

ring-enhancing lesion on MRI (4 causes)

Answer 447

tuberculosis, lymphoma (HIV), toxoplasmosis (HIV), Nocardia

Question 448

alexia without agraphia stroke / territory

Answer 448

left PCA (posterior cerebral artery) - affects posterior occipital lobe / corpus collosum

Question 449

PTSD brain imaging finding

Answer 449

decreased hippocampal volume (unclear if that's what predisposes individuals to developing PTSD vs if PTSD causes it)

Question 450

Sphingomyelinase deficiency

Answer 450

Niemann-Pick disease may initially present in adulthood with psychosis, and when psychosis is associated with a vertical supranuclear gaze palsy, various dyskinesias, and seizures, NPC should be suspected

Question 451

most common cause of mental retardation

Answer 451

Fragile X > Down syndrome

Question 452

chromosome 7q11 deletion

Answer 452

Williams' syndrome

Question 453

Elfin facies, short stature, mild MR, hypoplastic teeth, friendly personality, gifted musically

Answer 453

Williams' syndrome (7q11 deletion)

Question 454

mature defense mechanisms (5)

Answer 454

Altruism, Humor, Sublimation, Suppression, Anticipation

Question 455

Do prodromal symptoms count toward the 6 months to meet criteria for schizophrenia?

Answer 455

Yes, to meet criteria, must have a 6-month period of active-phase symptoms (delusions, hallucinations, disorganized speech, disorganized behavior, negative symptoms), prodromal symptoms, or residual symptoms

Question 456

Triptan MOA

Answer 456

Serotonin 5HT1B/1D agonist

Question 457

Frovatriptan unique quality

Answer 457

not contraindicated in combo with MAOIs or SSRIs (like other triptans)

Question 458

Triptans work by _______ cranial vessels, ______________ neuropeptide release, and reducing pain transmission in the __________ pathways

Answer 458

Triptans work by constricting cranial vessels, decreasing/inhibiting neuropeptide release, and reducing pain transmission in the trigeminal pathways

Question 459

Priapism is a known side effects of what psych meds (5):

Answer 459

Trazodone, Antipsychotics, Prazosin, Stimulants, Strattera

Question 460

Latuda MOA

Answer 460

Dopamine D2 and Serotonin 5HT2 antagonist less histamine activity so less weight gain compared to other antipsychotics

Question 461

Conduct disorder precursor and later manifestation

Answer 461

Precursor = often ODD Later manifestation = Antisocial personality (after age 18)

Question 462

Which antipsychotics can lower WBC (through bone marrow suppression)?

Answer 462

SGAs / Atypical antipsychotics (Risperdal, Abilify, Zyprexa, Quetiapine, Clozapine) - dones and -pines

Question 463

elements of "evidence-based treatment practice" (3)

Answer 463

1) scientific/research evidence 2) Clinical expertise / expert opinion 3) Choices, values and goals of the patient

Question 464

Reactive attachment disorder vs. Disinhibited social engagement disorder

Answer 464

RAD = fearful, untrusting, doesn't seek comfort in others, minimal social/emotional response to others, irritable DSED = friendly with strangers (disinhibited), lack of fear or caution, over-familiar, seek attention in strangers

Question 465

antisocial personality disorder criteria: - must occur prior to age ___ - must be at least age ___

Answer 465

- must occur prior to age 15 (evidence of conduct disorder prior to that age) - must be at least age 18

Question 466

Criteria for encopresis: - Age must be ___ yo - repeated passage of feces into inappropriate places, e.g., clothing or floor - intentional or involuntary? At least ___ such event must occur every month for at least ___ months

Answer 466

- Age must be at least 4 yo - repeated passage of feces into inappropriate places, e.g., clothing or floor - intentional or involuntary? EITHER! At least 1 such event must occur every month for at least 3 months

Question 467

Partial vs. Full remission in binge-eating disorder

Answer 467

Partial = binging less than 1x/week for a sustained period Full = Not meeting criteria at all for a sustained period

Question 468

core conditions of Carl Rogers' client-centered therapy (3):

Answer 468

empathy, congruence/acceptance, unconditional positive regard

Question 469

timeline to meet criteria for pica

Answer 469

at least 1 month

Question 470

timeline for alcohol withdrawal:

Answer 470

8-12 hours: Tremulous, insomnia, anxiety, autonomic instability (diaphoresis, palpitations) 12-48 hours: Seizures (highest in 24-48 hours!!!), hallucinations 48-96 hours: Delirium tremens (fever, disorientation, SEVERE agitation, confusion, hallucinations) **emergency, treat with benzos!

Question 471

unilateral complete loss of sensation

Answer 471

Contralateral thalamic stroke **thalamus is the major relay for all sensory information

Question 472

the "talk and die" syndrome, where there is a brief loss of consciousness followed by a period of lucidity then sudden deterioration

Answer 472

epidural hematoma **vs subdural which is progressive, gradual increasing headache and confusion, often goes unrecognized in alcoholics with frequent falls

Question 473

Older person with headache and sudden onset blindness in one eye. Recent complaints of fever, pelvic and shoulder girdle pain, weight loss, elevated ESR.

Answer 473

Temporal (giant cell) arteritis + Polymyalgia rheumatica - usually elderly female - can cause jaw claudication - blindness due to ophthalmic artery occlusion - due to focal granulomatous inflammation - treated with steroids before temporal artery biopsy!

Question 474

Sudden onset headache ("worst headache of my life") with vomiting, collapse, photophobia, preserved consciousness. Some neck stiffness on exam.

Answer 474

subarachnoid hemorrhage **often caused by aneurysm or AVM rupture

Question 475

childhood brain tumor causing cerebellar symptoms

Answer 475

pilocytic astrocytoma (eosinophilic, corkscrew fibers) vs. medulloblastoma (rosettes, small blue cells) PA is most common brain tumor in childhood, benign, good prognosis MB is most common malignant brain tumor in kids, poor prognosis

Question 476

neuroimaging findings in schizophrenia

Answer 476

- enlarged lateral & 3rd ventricles - decreased metabolic activity / thinning of frontal lobes

Question 477

Cause of hyperkalemic periodic paralysis

Answer 477

sodium channel mutation

Question 478

most common risk factors for lacunar strokes (3)

Answer 478

HTN, diabetes, current tobacco smoking

Question 479

Dandy-Walker malformation

Answer 479

fourth ventricle balloons out and cerebellum doesn't develop

Question 480

startle myoclonus

Answer 480

creutzfeldt-jakob disease

Question 481

Kohut self-object terms: - Mirroring - Idealizing - Twinship

Answer 481

- Mirroring – This is where the parent (usually the mother) would reflect back at the child a sense that he or she is worthy, loved and special. Praise, pride! Experience where the caregiver recognizes the child’s capabilities and talents and affirms the child’s feelings of strength. - Idealiizing – Kohut believed that children need to idealize their caregiver and see them as powerful and knowledgeable. The child needs to feel as though they can turn to their caregiver to meet their needs and to help them make sense of their world. Their caregiver needed to be able to calm and reassure them. Children need someone whom they can admire and idealize and from whom to gain beliefs, values, aspirations, and strength. As the child feels connected to a powerful selfobject other, she develops a sense of self through the unconscious experience that says, “You’re powerful; you make me feel better. I’m connected to you; therefore, I’m powerful, too” Twinship – Kohut believed that children need to feel they fit in with others. They have a need to be similar to their parents – not too different that they felt “wrong”. Children mimic behaviours or characteristics from their caregiver and gradually as the child matures, would be able to feel more comfortable with any differences. Example is shaving next to dad in the mirror.

Question 482

Behavioral theory behind gambling

Answer 482

Operant conditioning

Question 483

Location of TMS

Answer 483

Left dorsolateral prefrontal cortex

Question 484

Indication for TMS

Answer 484

Failed benefit from one antidepressant at adequate dose/duration

Question 485

contraindications to T3 for depression augmentation (3)

Answer 485

cardiac disease, angina, HTN

Question 486

Only anxiety disorder with equal rates in men and women VS Mood disorder with equal rates in men and women

Answer 486

OCD Bipolar disorder

Question 487

term for - when a diagnosis is based on a general consensus among experienced clinicians and researchers: - when a diagnosis is based on an understanding of the underlying pathophysiology: - when a diagnosis is based on characteristic features that distinguish it from other disorders:

Answer 487

- when a diagnosis is based on a general consensus among experienced clinicians and researchers: face validity - when a diagnosis is based on an understanding of the underlying pathophysiology: construct validity - when a diagnosis is based on characteristic features that distinguish it from other disorders: descriptive validity

Question 488

conditioning type that exposure is based on

Answer 488

classical conditioning extinction = no longer get conditioned response with unconditioned stimulus extinction burst = sudden increase in response's frequency

Question 489

Psychotropics for intractable hiccups (3)

Answer 489

Thorazine, Perphenazie, Metoclopramide

Question 490

Beck Anxiety Inventory primarily screens for what?

Answer 490

Panic disorder

Question 491

Feeding centers of brain + functions + lesions + hormones

Answer 491

Lateral Hypothalamus = increases appetite via Ghrelin (makes you hunGGHREEE). Lesion of LH --> Less Hunger! VentroMedial Hypothalamus = satiety via Leptin (makes you fuLLLLL). Lesion of VMH --> Very Much Hunger!

Question 492

Sleep stages: - "slow-wave sleep" - K complexes - high frequency beta - slower alpha - Delta - Theta waves - Sleep spindles

Answer 492

Stage 1: Theta waves Stage 2: Sleep spindles, K complexes Stage 3/4: "slow-wave sleep," Delta REM: Rapid eye movement Awake: high frequency Beta, slower Alpha

Question 493

Kohlberg

Answer 493

theory of moral development

Question 494

Operant Conditioning principles: - Reinforcement: - Punishment: - Positive: - Negative:

Answer 494

- Reinforcement: response increases in frequency - Punishment: response decreases in frequency - Positive: introduce stimulus - Negative: remove stimulus

Question 495

Defense Mechanism: "I can't remember a time before the divorce" - Repression - Suppression - Reaction Formation - Projection - Rationalization - Displacement - Sublimation - Isolation of Affect - Undoing

Answer 495

Repression = unconsciously remove idea/feeling from consciousness

Question 496

Defense Mechanism: "I don't know what to think about it right now" An olympic athlete focuses on training activities to put aside anxiety about upcoming competition - Repression - Suppression - Reaction Formation - Projection - Rationalization - Displacement - Sublimation - Isolation of Affect - Undoing

Answer 496

Suppression = conscious repression

Question 497

Defense Mechanism: Using baby talk to give bad news Going home when stressed so parents will do laundry and cook for you - Repression - Suppression - Reaction Formation - Projection - Rationalization - Displacement - Sublimation - Isolation of Affect - Undoing

Answer 497

Regression = returning to earlier stage of development

Question 498

Defense mechanism: Fighting with someone you have a crush on - Repression - Suppression - Reaction Formation - Projection - Rationalization - Displacement - Sublimation - Isolation of Affect - Undoing

Answer 498

Reaction Formation = unacceptable impulse transformed into the opposite

Question 499

Defense Mechanism: Man who cheated convinced of his wife cheating - Repression - Suppression - Reaction Formation - Projection - Rationalization - Displacement - Sublimation - Isolation of Affect - Undoing

Answer 499

Projection = place wishes, thoughts, etc onto others

Question 500

Defense Mechanism: "I know cheating is wrong but my teacher didn't teach us this" - Repression - Suppression - Reaction Formation - Projection - Rationalization - Displacement - Sublimation - Isolation of Affect - Undoing

Answer 500

Rationalization = Justifying attitudes, beliefs, or behaviors

Question 501

Defense Mechanism: Taking anger out on dog or wife when mad at boss - Repression - Suppression - Reaction Formation - Projection - Rationalization - Displacement - Sublimation - Isolation of Affect - Undoing

Answer 501

Displacement = changing target of emotion

Question 502

Defense Mechanism: Boss attracted to employee becomes her mentor Putting anger into winning a tennis match Instead of self-harming by cutting one's wrist, using an ice cube instead to feel pain. - Repression - Suppression - Reaction Formation - Projection - Rationalization - Displacement - Sublimation - Isolation of Affect - Undoing

Answer 502

Sublimation = channeling unacceptable impulse in a socially acceptable direction

Question 503

Defense Mechanism: Despite being devastated by his divorce, John said with a straight face that he had no feelings about having just been left by his wife. - Repression - Suppression - Reaction Formation - Projection - Rationalization - Displacement - Sublimation - Isolation of Affect - Undoing

Answer 503

Isolation of Affect = Separating feelings from ideas and events. The ego represses the affect (emotion) but the thought remains conscious. The person seems devoid of feeling to others.

Question 504

Defense Mechanism: Jane stole merchandise at work and then gave a dollar to a homeless person on the street on her way home. - Repression - Suppression - Reaction Formation - Projection - Rationalization - Displacement - Sublimation - Isolation of Affect - Undoing

Answer 504

Undoing = The ego's chance at a “do-over.” The ego gets to reverse something it feels is unacceptable or uncomfortable.

Question 505

Erikson Stage: Age 0-18 mos "Can I trust the world?" Learning to trust, paying attention to environment

Answer 505

Trust vs. Mistrust

Question 506

Erikson Stage: Age 18 mos-3 years "Can I do things myself or must I rely on others?" Independence, learning to do things on own, encouragement builds you up and punishment breaks you down

Answer 506

Autonomy vs. Shame and Doubt

Question 507

Erikson Stage: Age 3-6 years "Is it okay for me to do, move, act?" Exploring and taking initiative to do things on your own, asserting one's self to gain a sense of purpose

Answer 507

Initiative vs. Guilt

Question 508

Erikson Stage: Age 6-12 years "How can I be good?" Developing self-confidence through learning things, trying to meet social and academic demands to feel competent

Answer 508

Industry vs. Inferiority

Question 509

Erikson Stage: Age 12-18 years "Who am I?" Trying to discover who you are, trusted with more responsibility, treated like an adult at times and a kid at other times, developing a sense of self and identity

Answer 509

Identity vs. Role Confusion

Question 510

Erikson Stage: Age 19-40 years "Can I love and be loved? What do others think of me?" Relying on others and intimate relationships for support

Answer 510

Intimacy vs. Isolation

Question 511

Erikson Stage: Age 40-65 years "What can I contribute to the world?" Provide value to society through productivity and mentorship to others, feeling accomplishment or usefulness to others

Answer 511

Generativity vs. Stagnation

Question 512

Erikson Stage: Age 65+ "Was my life a good one?" Reflection on life, providing wisdom and fulfillment vs bitterness and regret

Answer 512

Integrity vs. Despair

Question 513

Mahler: Continuation of intrauterine life, there is no difference between self and external world. No sight, sleeping all the time, always on mother. Stage + Age?

Answer 513

Normal Autism (birth to 2 mos)

Question 514

Mahler: Vaguely acknowledges the mother's existence, not as a unique entity but as the main source of need-satisfaction. "Mutual cueing" & social smile. Stage + Age?

Answer 514

Symbiosis (2-5 mos)

Question 515

Mahler: Infant starts to "hatch" and begins to see self as separate from mother. Can be held by others, separation anxiety, crawling away & back. Stage + Age?

Answer 515

Differentiation (5-10 mos)

Question 516

Mahler: Increased exploration of the outer world, intent to separate as a distinct self. Walking away. Stage + Age?

Answer 516

Practicing (10-18 mos)

Question 517

Mahler: A balance b/w a desire to assert autonomy and independence as a separate object with a fear of abandonment with complete separation. Begin to see that good and bad can overlap. Toddlers saying no, no, no. "terrible twos" and temper tantrums. Stage + Age?

Answer 517

Rapprochment (18-24 mos)

Question 518

Mahler: Marks the development of an internalized mental model of the mother, which unconsciously accompanies and supports the child even when they are physically separated. Playing and knowing Mom will return. Stage + Age?

Answer 518

Object Constancy (2-3 yrs)

Question 519

Piaget: Acquires knowledge through sensory experiences and manipulating objects - through reflexes, sense, motor responses. Achieve objective permanence (things continue to exist when not seen). Stage + Age?

Answer 519

Sensorimotor (0-2 yrs)

Question 520

Piaget: Emergence of language, using words and pictures to represent objects with symbolic thought. Egocentric, struggles to see perspective of others. Concrete. Learn through pretend play. Stage + Age?

Answer 520

Preoperational (2-7 yrs)

Question 521

Piaget: Begin thinking more logically about concrete events (logical thought), achieve concept of conservation (amount of liquid in short wide cup equals tall skinny cup), less egocentric, realize their thoughts are their own Stage + Age?

Answer 521

Concrete Operational (7-11 yrs)

Question 522

Piaget: Abstract thought, hypothetical reasoning. Begin to think about moral, philosophical, ethical, social, political issues. Use deductive logic and scientific reasoning. Stage + Age?

Answer 522

Formal Operational (12 yrs+)

Question 523

Ages for Freudian stages: Oral Anal Phallic Latency Genital

Answer 523

Oral = 0-1 yrs Anal = 1-3 yrs Phallic = 3-5 yrs Latency = 5 yrs until puberty Genital = puberty to adulthood

Question 524

Distinguish between simple partial and complex partial seizures

Answer 524

Both are "Focal" or "Partial" seizures Simple = focal aware Complex = focal unaware

Question 525

Types of Generalized Seizures (compared to focus/partial): (8)

Answer 525

~ Absence ~ Atonic ("drop attack") - involuntary loss of muscle control ~ Tonic - spontaneous rigidity of muscles ~ Clonic - repetitive contractions (convulsions) ~ Generalized tonic-clonic - tonic following by clonic **most common type!** ~ Myoclonic - Brief non-rhythmic muscle spasms/jerks ~ Infantile spasms ~ Febrile

Question 526

Developmental Milestone Age: - cooing, social smile, holding head up 45 degrees, recognizes parent

Answer 526

2 months

Question 527

Developmental Milestone Age: - cooing, laughing, grasping, weight bearing on legs, rolling

Answer 527

4 months

Question 528

Developmental Milestone Age: - Imitating sounds, single syllables, transferring objects from hand to hand, sits up with support

Answer 528

6 months

Question 529

Developmental Milestone Age: - Babbling, playing peek-a-boo, waves bye-bye, sits up without support, army crawling or crawling

Answer 529

8 months

Question 530

Developmental Milestone Age: - Dada/Mama, Playing simple ball games, standing alone, walks holding on, thumb-finger pincer grasp

Answer 530

12 months

Question 531

Developmental Milestone Age: - 1-2 word vocabulary, indicating desires by pointing, walking, stoops and recovers

Answer 531

14/15 months

Question 532

Developmental Milestone Age: - 16 word vocabulary, able to feed self, walking well without any support

Answer 532

18 months

Question 533

Developmental Milestone Age: - Combining words, helping undress, running well, walks up stairs, kicks a ball

Answer 533

24 months

Question 534

Developmental Milestone Age: - knows full name, pretend play, taking clothes off, jumps off ground with both feet

Answer 534

30 months

Question 535

Developmental Milestone Age: - Riding a tricycle, standing on one foot, drawing a circle

Answer 535

36 months (3 years)

Question 536

Developmental Milestone Age: - Hopping on one foot, using scissors

Answer 536

48 months (4 years)

Question 537

Developmental Milestone Age: - Skipping, copying a triangle, counts to 10

Answer 537

60 months (5 years)

Question 538

When do white matter tracks mature? Vs. white matter volume peaks?

Answer 538

Mature: age 30 Volume peaks: age 50

Question 539

Most common defense mechanisms used in histrionic personality disorder

Answer 539

Repression, Dissociation

Question 540

4 yo boy who has been jealous of siblings, increasingly competitive, ambitious about taking on the world. Has been searching for his purpose and role within the family. Erikson stage?

Answer 540

Initiative vs. Guilt

Question 541

sleepwalking is most common in what age group

Answer 541

middle-age children (peaks at age 10)

Question 542

Features that make retinal migraine unique:

Answer 542

- Unilateral vision disturbance - Gradual onset - +/- headache Can involve scintillations, scotomata or blindness

Question 543

psychiatric disorder with highest risk of violence

Answer 543

substance use disorders!!!!!! >>>>>> schizophrenia

Question 544

what is the risk of tyramine-foods with MAOIs?

Answer 544

hypertensive crisis (HTN, neck stiffness, diaphoresis, n/v)

Question 545

Seeing setbacks as a reflection of your core self. Rather than thinking, “I made a mistake,” you think, “I'm a loser.” This distortion also occurs when assessing others.

Answer 545

Essentializing (cognitive distortion term)

Question 546

4 skill modules of DBT:

Answer 546

Acceptance = Mindfulness + Distress tolerance Change = Emotion regulation + Interpersonal effectiveness

Question 547

Indications for schema therapy

Answer 547

Borderline & Narcissistic personality disorder

Question 548

Information from the environment is fit into existing schemas "Toddler calls a horse a big dog" Assimilation or Accommodation?

Answer 548

Assimilation Accommodation would be being able to differentiate a horse from a dog based on learning distinguishing features

Question 549

Prozac CYP enzyme

Answer 549

CYP2D6 inhibitor

Question 550

Stage of sleep for sleepwalking

Answer 550

Stage 3

Question 551

Psychotropics that are excreted unchanged in the urine (2)

Answer 551

Paliperidone, Gabapentin

Question 552

Grapefruit juice CYP

Answer 552

CYP3A4 inhibitor

Question 553

What should all patients be started on within 48 hours of stroke to reduce risk of stroke recurrence, disability & death?

Answer 553

Aspirin!

Question 554

Most common anxiety disorder

Answer 554

Specific phobia! (we don't think of it because regular people out in the world don't see psychiatrists for it!)

Question 555

Drug that reduces accumulation of plaques and disability in patients with MS?

Answer 555

Interferon B-1a

Question 556

Who coined the term "epigenetic principle"?

Answer 556

Erikson = human development occurs in sequential, clearly defined stages, and that each stage must be properly resolved for development to proceed normally.

Question 557

Sudden onset symmetrical muscle weakness + elevated CK = + rash = vs. Asymmetrical muscle weakness =

Answer 557

Sudden onset symmetrical muscle weakness + elevated CK = polymyositis + rash = dermatomyositis vs. Gradual onset asymmetrical muscle weakness = Inclusion body myositis

Question 558

Sadism vs Masochiasm

Answer 558

Sadism - hurting other is SAD Masochism - like to hurt Myself

Question 559

positive sharp waves and fibrillation potentials on EMG

Answer 559

ALS

Question 560

adult brain tumor where seizure is a common presenting symptom

Answer 560

Glioblastoma multiforme

Question 561

Treatment of abnormal involuntary movements in Huntington's

Answer 561

Haldol - treats chorea

Question 562

Involuntary gait acceleration

Answer 562

Festination (Parkinson's)

Question 563

Meningitis triad

Answer 563

Headache, fever, neck stiffness

Question 564

% of sleep in REM

Answer 564

25%

Question 565

Criteria for OCD

Answer 565

obsessions OR compulsions OR both

Question 566

age of onset required for conduct disorder

Answer 566

prior to age 13

Question 567

Latin terms to be found guilty of a crime (2)

Answer 567

Mens rea (evil intent) + Actus reus (voluntary conduct)

Question 568

statistical measure used to quantify the degree of agreement between two raters in a study (how much two people agree)

Answer 568

Kappa

Question 569

Tricuspid valve abnormality in fetus

Answer 569

Ebstein's anomaly - Lithium

Question 570

timeline required to meet criteria for panic disorder

Answer 570

1 month

Question 571

Psychotropics excreted as changed drugs in feces

Answer 571

Abilify, Geodon

Question 572

CYP1A2 inducers vs. inhibitors + what drugs it mainly affects

Answer 572

inducers = tobacco inhibitors = fluvoxamine Clozapine, Olanzapine

Question 573

CYP2C9 inducer + what drug it mainly affects

Answer 573

St. John's Wort Valproic acid

Question 574

CYP3A4 inducers vs. inhibitors + what drugs it mainly affects

Answer 574

inducers = carbamazepine, st. john's wort inhibitors = grapefruit juice, -onazoles lots of SSRIs & antipsychotics & other psychotropics

Question 575

Why to not combine Clozapine and Carbamazepine

Answer 575

risk of agranulocytosis

Question 576

55 yo with multiple falls and dizziness. Dry mouth, dry skin, erectile dysfunction. Recent onset resting tremors. Diagnosed with diabetes 6 mos ago, controlled with diet. + orthostatic hypotension. Rigidity and bradykinesia on exam.

Answer 576

MSA (Multiple System Atrophy) / Shy-Drager Syndrome = parkinsonism + cerebellar + corticospinal + autonomic dysfunction (postural hypotension, sweating, bowel/bladder incontinence, salivation/lacrimation, ED)

Question 577

Malan's Triangle of Conflict

Answer 577

Defenses, Anxiety, Feelings Short-term Brief Psychodynamic Therapy model

Question 578

Timeline for Agoraphobia

Answer 578

6 mos (like most other anxiety disorders)

Question 579

Timeline for Separation Anxiety Disorder in a child

Answer 579

at least 1 month

Question 580

Khyâl Attacks

Answer 580

"Wind attacks" = panic attacks in Cambodians

Question 581

Parder-Willi chromosome

Answer 581

absence of paternal chromosome 15

Question 582

Receptor that makes Clozapine unique

Answer 582

D4

Question 583

Object permanence —> separation anxiety age

Answer 583

8 months (sensorimotor)