AP Prep 1/

Question 1

Lack of insight is a strong predictor of ___ to make medical decisions.

Answer 1

incapacity

Question 2

___-based approaches are powerful for identifying rare high penetrance gene variants.

Answer 2

Pedigree

Question 3

*Repetitive ___ for the treatment of unipolar depression targets the left prefrontal cortex/dorsolateral prefrontal cortex.

Answer 3

transcranial magnetic stimulation (At NR Tina target’s the left prefrontal cortex/Dorsolateral PFC)

Question 4

Patients with ___ disorders have attentional bias toward potentially threatening stimuli.

Answer 4

anxiety

Question 5

Clenching a fist can ___ hypoactive deep tendon reflexes in a leg.

Answer 5

enhance

Question 6

*___ is the main cause of death in people with SMI.

Answer 6

Heart disease

Question 7

Topiramate may help migraine ___.

Answer 7

prophylaxis.

Question 8

Methylation is an epigenetic mechanism that ___ transcriptional machinery from accessing DNA and thus leads to decreased gene transcription.

Answer 8

inhibits

Question 9

Patients with Lewy body disease may be more likely to develop ___ extrapyramidal side effects from neuroleptics.

Answer 9

severe

Question 10

Medication overuse is a strong risk factor for development of ___ daily headache in adults.

Answer 10

chronic

Question 11

Glycine is a predominantly ___ neurotransmitter

Answer 11

inhibitory

Question 12

___ is the main excitatory neurotransmitter in the central nervous system.

Answer 12

Glutamate

Question 13

GABA is the main inhibitory ___ in the adult vertebrate brain.

Answer 13

neurotransmitter

Question 14

Maintenance of ___ is dependent on the ascending reticular activating system.

Answer 14

wakefulness

Question 15

Intense fear of gaining weight is a necessary feature to ___ anorexia nervosa.

Answer 15

diagnose

Question 16

Abstraction is a new cognitive capacity gained when children reach the stage of ___ operations.

Answer 16

formal (13-> adulthood)

Question 17

Prader-Willi syndrome (obesity, ID, short) involves a ___ of genetic material.

Answer 17

microdeletion

Question 18

The ___ connects the amygdala to the septal area and the hypothalamus.

Answer 18

stria terminalis

Question 19

Family psychoeducation is a strongly evidence-based practice that reduces ___ and symptoms, and improves medication adherence in schizophrenia.

Answer 19

relapses

Question 20

Longitudinal follow-up reliably ___ bipolar from unipolar depression in a patient who presents with an initial episode of depression.

Answer 20

differentiates

Question 21

Elementary school-age children typically start to engage in social activities without their parents, have a best friend, can show ___ though may sometimes impulsively say things to friends that are unkind.

Answer 21

empathy

Question 22

Schizophrenia is one of the WHO Global Burden of Disease Study top ten conditions for disability in terms of loss of ___ life years for ages 15-44 in men and women.

Answer 22

productive

Question 23

Advance directives convey a dying patient’s instructions about wishes regarding ___ interventions when the patient is no longer able to make decisions.

Answer 23

medical

Question 24

Heavy smoking (and polycyclic aromatic hydrocarbons) may lower levels of olanzapine because cigarettes induce CYP___.

Answer 24

1A2

(Olanzapine is metabolized by CYP 450 1A2, 2D6 (minor), and direct glucuronidation; t1/2 1-2 days). CYP 1A2 inhibitors (eg, fluvoxamine) may increase olanzapine bioavailability by 50-100%. Adjust olanzapine dosing in presence of 1A2 inducers or inhibitors).

Question 25

Veracity is an ethical principle that means ___ or "speaking truly" from "verax."

Answer 25

accuracy

Question 26

___ is the most common comorbid psychiatric disorder in patients with epilepsy.

Answer 26

Major depressive disorder

Question 27

___ neurons regulate sleep and originate in the tuberomammillary brain nuclei.

Answer 27

Histaminergic

Question 28

A holding environment, per Winnicott's thoughts on infant development of assertiveness and sense of competence, encourages ___ while protecting the infant from harm.

Answer 28

spontaneity

Question 29

24/7 mental healthcare coverage is one characteristic of ___ community treatment (ACT) for the treatment of the severely mentally ill.

Answer 29

assertive

Question 30

Norepinephrine is mostly synthesized in the ___

Answer 30

locus coeruleus

Question 31

The ___ has the highest concentration of serotonin-producing cells in the brain.

Answer 31

raphe nuclei

Question 32

Electrocardiogram is appropriate to detect the most common ___ complications associated with myotonic dystrophy.

Answer 32

cardiac

Question 33

Training ___ how to recognize potential threats is important to protect hospital systems against EMR data breach.

Answer 33

employees

Question 34

Participating voluntarily is one of the features of ___ consent.

Answer 34

informed

Question 35

Goodness of fit describes the relevance of understanding ___ in working with parent-child relational problems.

Answer 35

temperament

Question 36

Gait ___ may be seen in normal pressure hydrocephalus.

Answer 36

apraxia (deficit and, thus, has a cerebral localization. Patients with gait apraxia have a hard time getting started with walking and may have a “magnetic” or shuffling gait. Gait apraxia is commonly seen in dementia (especially vascular dementia) and in NPH.)

Question 37

Adolescent cortical synapse remodeling is also believed to be associated with preferential loss of ___ synapses.

Answer 37

excitatory

Question 38

Urea and electrolytes may be helpful studies for a geriatric patient suspected of ___, which can cause confusion and is a potential antidepressant side effect.

Answer 38

hyponatremia

Question 39

Remember that responses to ___ may at times be normative.

Answer 39

stress

Question 40

In those with persistent pain the ___ receptor is down-regulated in the ventral striatum.

Answer 40

dopamine

Question 41

Cholecystokinin is a peptide released in the gastrointestinal tract to convey ___ information to the brain in response to food intake.

Answer 41

satiety

Question 42

Hypophosphatemia is one of the lab abnormalities that may be seen in ___ syndrome.

Answer 42

refeeding

Question 43

___ increases formation of tetrahydrobiopterin (BH4) , which increases production of serotonin, norepinephrine, and dopamine which may be how it is an effective augmentation agent for depression.

Answer 43

L-methylfolate

Question 44

The AMPA receptor is ___ by the presence of glutamate.

Answer 44

stimulated

Question 45

When Pavlov's dog drooled on hearing a bell, the drool is the ___ response.

Answer 45

Conditioned

Question 46

Beginning to develop concern for others and learning to share typically happens at ___ years.

Answer 46

four

Question 47

___ neurotransmitter system facilitates sexual arousal.

Answer 47

Dopaminergic

Question 48

In utero exposure to cannabis during neuronal development is associated with cognitive ___ in the infant.

Answer 48

deficits

Question 49

In children with cancer, ___ prophylaxis of pain and stress during difficult procedures may result in Post traumatic stress disorder.

Answer 49

Inadequate

Question 50

One in four people born with the ___ deletion develop schizophrenia.

Answer 50

22q11.2 DiGeorge syndrome/22q11.2 deletion syndrome/ velocardiofacial syndrome is a syndrome caused by the deletion of a small segment of chromosome 22. It is characterized by developmental delay, cardiac abnormalities, palate defects, immune deficiency, and an increased risk of schizophrenia.

Question 51

___ ___ can be used to determine how two independent variables in a study, such as depression and alcohol use disorder, affect the frequency of the occurrence event, such as suicide.

Answer 51

Regression analysis

Question 52

Per Classical conditioning, to ___ the conditioned stimulus from the unconditioned stimulus, have the dog listen to the bell in the absence of food.

Answer 52

unpair

Question 53

PharmacoKINETICs is the branch of pharmacology concerned with the ___ of drugs within the body.

Answer 53

movement

Question 54

PharmacoDynamics is the branch of pharmacology concerned with the ___ of drugs and the mechanism of their action.

Answer 54

effects

Question 55

Decreased hepatic ___ flow in older adults is a common physiologic change that affects drug pharmacokinetics.

Answer 55

blood

Question 56

Microglia are implicated in both neural circuit ___ of the developing brain and scavenging for damaged neurons, plaques and infectious agents.

Answer 56

formation [Microglia secrete innate proinflammatory cytokines TNF-a and IL-1B in patients with inflammatory conditions that affect the brain.]

Question 57

It is essential that caregivers, for example of Alzheimer patients, take ___ of themselves, for example by continuing to go to their church group that is important to them.

Answer 57

care

Question 58

Exemption from course requirements is something that may be included as part of an Individualized Education Program, but would not be included in a ___ plan.

Answer 58

504

Question 59

Reduction in hippocampal volume is associated with ___ memory impairment.

Answer 59

declarative

Question 60

The multiple sleep ___ test is used to diagnose narcolepsy.

Answer 60

latency

Question 61

Clear and ___ evidence is the minimal degree of legal certainty that is constitutionally required for an involuntary mental health comitment.

Answer 61

convincing

Question 62

Donepezil binds and reversibly ___ the cholinesterases, thus inhibiting hydrolysis of acetylcholine. This increases acetylcholine concentrations at cholinergic synapses.

Answer 62

inactivates

Question 63

oxybutynin (treats overactive bladder) has anticholinergic effects that would ___ with efficacy of cholinesterase inhibitors like donepezil, galantamine, rivastigmine.

Answer 63

inhibit

Question 64

An 80yo woman presents to the psychiatrist complaining of lack of energy, forgetfulness, difficulty concentrating. Which of the tests below would be of most help initially in formulating diagnosis? - CT scan - Sleep study - Neuropsychological testing - Electroencephalogram - Cerebrospinal fluid studies

Answer 64

Neuropsychological testing

Question 65

Research regarding the process of acculturation reports that formation of a ___ identity is the best adaptational outcome for immigrant youth.

Answer 65

bicultural

Question 66

___-regulatory elements are mediators of transcriptional activity in gene expression.

Answer 66

Cis

Question 67

What is the first step to manage behavioral agitation?

Answer 67

Attempt verbal de-escalation

Question 68

Initial treatment for female ___ disorder usually includes directed masturbatory training.

Answer 68

orgasmic

Question 69

___ duration of trauma likely predisposes to dissociative amnesia after a traumatic event.

Answer 69

Longer

Question 70

When considering assessment instruments, ___ is defined as whether the instrument actually measures what it purports to measure.

Answer 70

validity

Question 71

Tuberous sclerosis is transmitted in an ___ ___ inheritance pattern.

Answer 71

Autosomal dominant

Question 72

Higher level of education is considered a ___ factor for suicide attempt in transitional-aged youth with schizophrenia.

Answer 72

risk

Question 73

A ten-year-old child is pervasively irritable and has had four severe temper outbursts weekly for the past two years. The outbursts involve hitting others, throwing tows, screaming and can occur with minimal provocation. The child's teacher reports that the child is alienating peers and has difficulty functioning in the classroom. Which diagnosis best characterizes this presentation?

Answer 73

Disruptive mood dysregulation disorder

Question 74

Associated functions of the ___ lobe include: * Perception and integration of somatosensory information (e.g., touch, pressure, temperature, and pain) * Visuospatial processing * Spatial attention * Spatial mapping * Number representation

Answer 74

parietal

Question 75

A genetic researcher wishing to study polymorphisms including short tandem repeats could use ___ to produce many copies of the portion of the genome under study.

Answer 75

polymerase chain reaction

Question 76

A patient has psychosis, acute abdominal pain, reduced strength and tendon reflexes. Elevation in ___ would explain her symptoms.

Answer 76

Porphobilinogen (Pt has Acute Intermittent Porphyria)

Question 77

A patient has chiropractic neck manipulation and soon after has dysarthric speech, ataxic gait, numbness over R body. The patient also complains of increased severity of neck pain radiating to the occiput. The symptoms likely caused by:

Answer 77

vertebral artery dissection

Question 78

A talk show psychiatrist saying at start of show that they aren't entering a physician-patient relationship with callers who seek his advice is addressing this broad claim that needs to be proven in malpractice cases:

Answer 78

Duty

Question 79

___ analysis may identify a gene responsible for autistic-like traits displayed by multiple members of a family.

Answer 79

Linkage

Question 80

Linkage analysis: Study aimed at establishing linkage between genes. Today linkage analysis serves as a way of gene-hunting and genetic testing. Linkage is the tendency for genes and other genetic markers to be inherited together because of their location ___ one another on the same chromosome.

Answer 80

near

Question 81

Medical anthropological research has shown that, worldwide, dissociative symptoms most commonly represent ___ components of religious and ritual events.

Answer 81

normal

Question 82

Motivational enhancement therapy for alcoholism focuses on patient ___ as a key treatment target.

Answer 82

ambivalence

Question 83

Frieda Fromm-Reichman coined the term "___ ___" to capture aberrant qualities of mothering believed at one time to be a pathway to development of schizophrenia.

Answer 83

schizophrenogenic mother

Question 84

Parental engagement in frequent conversation and thinking aloud is key to a toddler's ___ development.

Answer 84

language

Question 85

Greater therapist experience is closely associated with ___ dropout rate in outpatient psychotherapy.

Answer 85

decreased

Question 86

The initial learning phase of a skilled motor sequence requires recruitment of the ___ and corticocerebellar systems.

Answer 86

corticostriatal

Question 87

By age four years, most children have developed sufficient language skills to be able to engage in: - parallel play - puns and wordplay - organized arguments - moral decision-making - story telling using words

Answer 87

story telling using words

Question 88

___ circulating levels of GABA have been described in patients with depressive disorders.

Answer 88

Reduced

Question 89

___gonadism is an adverse effect of maintenance treatment with methadone for opioid dependence.

Answer 89

Hypo

Question 90

Naturalistic investigations of a treatment's effects examine which of the following factors? - Efficacy - Accuracy - Precision - Efficiency - Effectiveness

Answer 90

Effectiveness

Question 91

The FDA specifically warns that antipsychotic medications prescribed for dementia-related behavioral disturbances are associated with stroke and increased risk of ___.

Answer 91

death

Question 92

Confounding efforts to develop effective diagnostic tools and disease-modifying therapies is the realization that Alzheimer's disease is mixed proteinopathy (amyloid and ___) frequently associated with other age-related processes such as cerebrovascular disease and Lewy body disease.

Answer 92

tau

Question 93

Tourette syndrome is distinguished from other tic disorders by the presence of multiple motor tics and one or more ___ tics.

Answer 93

vocal

Question 94

The Simpson-Angus Rating Scale assesses ___ symptoms.

Answer 94

motor

Question 95

A seven-year-old continues to have enuresis despite monitoring fluid intake, adequate toileting and using a reward system. The pediatrician next suggests using an enuresis alarm. This treatment, also referred to as the bell-and-pad technique, is a form of ___ ___.

Answer 95

Classical conditioning

Question 96

The human lymphocyte antigen HLA-B*1502 is associated with significantly increased risk of Stevens-Johnson syndrome in the context of carbamazepine or lamotrigine use. The HLA-B*1502 gene complex is most common among ___ Americans.

Answer 96

Asian

Question 97

A female patient whose father got an aggressive upper GI tumor, drinks one standard alcoholic drink/day and wants to know if she should stop drinking to decrease her risk of cancer. Long-term abstinence would reduce her risk ___.

Answer 97

significantly

Question 98

Which of the following represents the greatest vulnerability to development problems in children? - Maternal non-infectious illness - Maternal use of antidepressants - Maternal mental illness diagnosed before child's birth - Early childhood infectious illness prior to age five - Early childhood non-infectious illness prior to age five years

Answer 98

Maternal mental illness diagnosed before child's birth

Question 99

*Excessive ___ is the largest contributor to waste in health care.

Answer 99

ADMINISTRATION

Question 100

Aspects of successful older age include independent living, positive adaptation, mastery, and growth. Which of the following factors is most important in achieving this success? - Economic security - Emotional well-being - Cognitive preservation - Lack of physical disability - Active social engagement

Answer 100

Cognitive preservation

Question 101

A 40yo comes to the ED following euphoria and feeling like they were "flying above the dance floor" at the club. The patient is now showing nystagmus and is socially withdrawn. Which of the drugs below would be most likely to produce this constellation of symptoms? - Methcathinone - Cocaine - Amphetamine - Ketamine - Alcohol

Answer 101

Ketamine

Question 102

What is primary pharmacotherapy indicated for catatonia?

Answer 102

Benzodiazepines (Lorazepam)

Question 103

___ has a major role in the acute reinforcing effects of drugs of abuse.

Answer 103

Dopamine

Question 104

Anorexia nervosa has a significant treatment literature supporting the use of structural ___ therapy.

Answer 104

family

Question 105

In psychodynamic therapy, when a patient takes an action, prior to encouraging, asking or the therapist taking some other action, first ___ the patient's action.

Answer 105

interpret

Question 106

``` Which of the following examples of documentation of medication dosage is considered confusing and dangerous, and is therefore unapproved by the Joint Commission on Accreditation of Healthcare Organizations? 0.1 mg 40 mg 1.0 units 5,000 units 2,000 units ```

Answer 106

1.0 units is confusing and dangerous

Question 107

In-person, telephone, or e-mail doctor-to-doctor "curbside" consultations are provided as part of low-intensity ___ mental health services.

Answer 107

telemedicine

Question 108

___ acetylation activates transcription.

Answer 108

Histone

Question 109

A 40yo was diagnosed with AIDS four years ago and has new-onset headache and cognitive decline. Brain MRI shows multiple ring-enhancing lesions suggesting ___ ___.

Answer 109

Toxoplasmosis gondii

Question 110

Offering personal counseling and financial counseling services at the same location for healthcare provider burnout is a good idea to help ensure success by reducing ___.

Answer 110

stigma

Question 111

For a child with ADHD and oppositional defiant disorder it may be helpful to find out what the child enjoys and create a behavior ___ program at home and at school.

Answer 111

rewards

Question 112

From a neurodevelopmental perspective, the youngest age at which a child possesses sufficient cognitive ability such that the child is likely to meet the Appelbaum criteria for general healthcare decisision-making capacity is approximately ___ years.

Answer 112

twelve

Question 113

The predominant site of the endocannabinoid receptor CB1 is the ___ membrane.

Answer 113

presynaptic

Question 114

___ of patients impedes the process of cohesion with inpatient group therapy.

Answer 114

Turnover

Question 115

Narcolepsy is associated with a ___-1 deficiency.

Answer 115

hypocretin

Question 116

Whole ___ sequencing provides a highly efficient method for sequencing all protein-coding regions.

Answer 116

exome

Question 117

If a patient sleeps 3-4 hours/night for up to two weeks in a row, to identify the mood disturbance contributing to the patient's sleep pattern it would be helpful to ask "During these periods, how well rested do you ___ during the day?"

Answer 117

feel

Question 118

A 25-year-old with seizure disorder since childhood is seen for evaluation of poorly controlled seizures. She has adenomas on the face, mostly around the nasolabial folds and cheeks. A fibrotic plaque is found in the lower back. The most likely diagnosis is which of the following: - neurofibromatosis - tuberous sclerosis - Von Hippel Lindau - Tay Sachs disease - Sturge Weber syndrome

Answer 118

tuberous sclerosis

Question 119

Which of the following features of schizophrenia has become less common in Western cultures? - Alogia ("Without speech") - Catatonia - Stilted speech - Religious delusions - Disorganized thought

Answer 119

Catatonia

Question 120

After a stranger says "hello," a 12-month-old child turns and looks at his mother before responding. When the mother smiles and nods her head, the infant laughs and smiles in response to the stranger. This behavior is an example of social ___.

Answer 120

referencing

Question 121

___ is contained in sleep-promoting neurons of the ventrolateral preoptic nucleus.

Answer 121

GABA

Question 122

A patient with dementia is admitted after a fall and is found to have a fractured wrist. The team recommends surgery, however the patient refuses. Which of the following is the most appropriate next step? - Watchful waiting - Seek a surrogate decision maker - Assess patient's capacity to refuse - Perform the necessary procedures - Contact the court for an emergency guardian

Answer 122

Assess patient's capacity to refuse

Question 123

Which of the following is most significantly affected when syringomyelia (cyst or cavity develops in the spinal cord) first presents? - Proprioception - Pain perception - Auditory perception - Vibratory perception - Light touch perception

Answer 123

Pain perception

Question 124

___cardia is an expected side effect for patients prescribed rivastigmine for Alzheimer disease.

Answer 124

Brady (rivastigmine is an anticholinesterase so boosts acetylcholine and is cholinergic, slowing heart rate)

Question 125

___ is indicated for catatonia, neuroleptic malignant syndrome and major depressive disorder with psychotic features.

Answer 125

ECT

Question 126

The ability of preschool children to regulate their ___ is strongly enhanced by the development of language.

Answer 126

emotions

Question 127

The three major ___ mechanisms include DNA methylation (decreases transcription), histone modification (histone acetylation activates transcription) and expression regulation by micro-RNAs.

Answer 127

epigenetic

Question 128

Which of the following genetic tests is preferred for the detection of Trisomy 21? - G-banded karyotyping - Single-nucleotide polymorphism - Fluorescence in situ hybridization - Comparative genomic hybridization

Answer 128

G-banded karyotyping

Question 129

For X-linked dominant inheritance of genetic disorders, females are ___ as likely as males to be affected in a multigenerational pedigree.

Answer 129

twice

Question 130

A patient with social phobia avoids almost all social gatherings. The avoidance is regulated by a reciprocal connection between the amygdala and the ___ ___ ___ ___ ___ ___.

Answer 130

periaqueductal gray area of the brainstem

Question 131

Which two of the following compulsions are the most common in adults with obsessive-compulsive disorder? - Cleaning - Ordering - Counting - Checking

Answer 131

Cleaning and checking are the most common compulsions.

Question 132

When used in treatment of insomnia, benzodiazepines ___ REM sleep.

Answer 132

decrease

Question 133

Oral contraceptives containing estrogens ___ serum levels of lamotrigine.

Answer 133

decrease

Question 134

Maternal ___ use prenatally is a perinatal factor specifically associated with the development of attention-deficit/hyperactivity disorder.

Answer 134

tobacco

Question 135

Acute alcohol intoxication is likely mediated by ___ receptor antagonism and GABA-A receptor agonism.

Answer 135

NMDA

Question 136

A 16-year-old is expelled from school for the third time since the beginning of the academic year, this time for bringing a knife. The previous expulsions were for fighting and stealing from the teacher. The adolescent has also been suspended several times for bullying classmates and skipping school. Over the next decade, these types of behaviors will most likely: - increase - decrease - wax and wane - remain the same

Answer 136

decrease

Question 137

St. John's wort is an alternative treatment for depression that carries a risk of ___ mania in patients with bipolar disorder.

Answer 137

inducing

Question 138

In combination with growth hormone, ___ hormones are required to initiate the adolescent growth spurt.

Answer 138

gonadal (estrogen, progesterone, and testosterone)

Question 139

The impaired physician who fails to obtain or benefit from treatment may require the services of an administrative psychiatrist skilled in performing fitness-for-duty evaluations. In these situations, the administrative psychiatrist is ___ bound by the usual parameters of confidentiality.

Answer 139

not

Question 140

Contralateral leg weakness with sparing of the face and arm associated with urinary incontinence and abulia (inability to act decisively) are typical for a stroke in the territory of the ___ cerebral artery.

Answer 140

anterior

Question 141

Which of the following is the most common comorbidity in a patient with an anxiety disorder? - A mood disorder - A personality disorder - Another anxiety disorder - A substance use disorder - An impulse control disorder

Answer 141

Another anxiety disorder

Question 142

A 60yo man has gastric bypass and a few weeks later develops gait imbalance and numbness in his feet. On exam he has hyperreflexia, spasticity in the legs and absent vibration sensation in the toes. Serum B12 is normal. Deficiency of which of the following is most likely to cause these symptoms? - Iron - Folate - Copper - Thiamine - Pyridoxine

Answer 142

Copper

Question 143

The ___ ___ measures the magnitude of difference between two intervention groups.

Answer 143

effect size

Question 144

A 30yo has worsening disorientation and suspected delirium after initially having severe headache after starting a high protein, low carbohydrate diet. The patient had slow growth as a child. To definitively diagnose the individual, ___ transcarbamylase sequencing may be helpful.

Answer 144

Ornithine

Question 145

Schizotypal personality disorder is suspected in patient with odd speech patterns, constricted affect and eccentric appearance. Which of the following additional features would support schizotypal personality disorder? - Anhedonia - Paranoid ideation - Lack of social anxiety - Auditory hallucinations - Delusions of reference

Answer 145

Paranoid ideation

Question 146

Retaining ___ in the relationship distinguishes empathy from identification.

Answer 146

objectivity

Question 147

The clock drawing neuropsychological test examines both ___ and visuospatial functioning.

Answer 147

executive

Question 148

*The number of new events in proportion to the population at risk for the event is referred to as ___ ___.

Answer 148

cumulative incidence

Question 149

An insurance company pays a physician a single, standardized sum for a patient's care during a one-year period. This is known as what type of payment?

Answer 149

Capitation

Question 150

___ gender is associated with prolonged or complicated bereavement.

Answer 150

Male

Question 151

Which of the following antiepileptic drugs reduces the efficacy of oral contraceptives? - Valproate - Gabapentin - Zonisamide - Levetiracetam - Carbamazepine

Answer 151

Carbamazepine

Question 152

DiGeorge syndrome/22q11.2 deletion syndrome/ velocardiofacial syndrome is a syndrome caused by the ___ of a small segment of chromosome 22. It is characterized by developmental delay, cardiac abnormalities, palate defects, immune deficiency, and an increased risk of schizophrenia.

Answer 152

deletion

Question 153

___ muscle tone on electromyography when seen during REM sleep is suggestive of REM sleep behavior disorder.

Answer 153

Excess

Question 154

A 12yo's parents say he is "sleepy" during the day, often dazed and out of it. He is often not hungry and sometimes says he has nausea. On exam he has red eyes, runny nose and red sores around the mouth. He is likely using ___.

Answer 154

aerosols

Question 155

Medicare Part B is an ___ purchasable benefit for senior citizens.

Answer 155

optional

Question 156

Which of the following immunomodulators is associated with increased risk of significant depression in patients with cancer? - Mitoxantrone - Natalizumab - Glatiramer - Interferon - Fingolimod

Answer 156

Interferon

Question 157

Which of the following antipsychotics has the lowest risk of QT prolongation? - Quetiapine - Haloperidol - Ziprasidone - Aripiprazole - Thioridazine

Answer 157

Aripiprazole

Question 158

Parents meet with psychiatrist about their teen who has confusion about gender and identity, and the teen refused to come to the appointment. It would be worthwhile to first ask the parents (in this visit where teen is not present and its just the parents), "what ___ do you want me to use when referring to your child."

Answer 158

pronoun

Question 159

Personalized dosing according to CYP genotype is best established for which of the following classes of medications? - Opioids - Mood stabilizers - Typical antipsychotics - Atypical antipsychotics - Tricyclic antidepressants

Answer 159

Tricyclic antidepressants

Question 160

Which of the following physical health conditions has the highest risk of suicide? - Epilepsy - Back pain - Brain injury - COPD - HIV

Answer 160

Brain injury

Question 161

A mother's capacity to understand her infant's internal states, which is communicated by ___ is called holding.

Answer 161

mirroring

Question 162

___ community treatment is an appropriate treatment modality option to take care of a patient who has a long history of non-adherence with treatment, multiple hospitalizations, impulsive / violent behaviors and family family members have become reluctant to take care of the patient.

Answer 162

Assertive

Question 163

Slow-wave sleep enhances the secretion of ___ ___.

Answer 163

growth hormone

Question 164

In a patient with early-stage cognitive impairment, preserved calculation skills suggest a ___ rather than cortical dementia.

Answer 164

subcortical

Question 165

___ ___ ___ ___ = 1 / (Absolute risk reduction)

Answer 165

Number needed to treat

Question 166

Psychodynamic theory, which focuses on the here-and-now interactions between therapist and patient and identifies transference and countertransference as uniquely co-created by patient and therapist together, has its roots in ___-psychology.

Answer 166

self

Question 167

Which of the following disorders is the most common among patients who complete suicide? - Mood - Somatoform - Anxiety - Psychotic - Personality

Answer 167

Mood

Question 168

Individuals exposed in utero to the 1944-45 Dutch "hunger winter" have elevated rates of disease, including heart disease, breast cancer, obesity, and cognitive function. Robust evidence has implicated differences in DNA ___.

Answer 168

methylation (which decreases transcription)

Question 169

Which of the following approaches has demonstrated efficacy in the treatment of trichotillomania? - Group therapy - Habit reversal therapy - Relapse prevention therapy - Interpersonal psychotherapy - Psychodynamic psychotherapy

Answer 169

Habit reversal therapy

Question 170

Which of the following infant attachment styles is characterized by paying little overt attention to the parent's presence? - Secure - Avoidant - Resistant - Ambivalent - Disorganized

Answer 170

Avoidant

Question 171

Magnetic resonance imaging is the most sensitive, non-invasive clinical tool for monitoring ___ in patients with multiple sclerosis.

Answer 171

inflammation

Question 172

A 30yo patient with diabetes comes in with eyelid ptosis that worsens towards the end of the day. They have double vision while reading. The symptoms improve upon awakening the following morning. The patient denies pain and eye exam is otherwise unremarkable. Likely cause is ___ ___.

Answer 172

Myasthenia gravis | antibodies against postsynaptic acetylcholine receptors

Question 173

A 30yo with intellectual disability and autism spectrum disorder presents with depression. On exam, the patient has a long face, large everted ears, prominent jaw, macroorchidism and a ___ arched palate as well as frequent hand flapping. The patient likely has Fragile X syndrome (caused by trinucleotide expansion of the FMR1 gene, the most common INHERITED form of intellectual disability).

Answer 173

high

Question 174

Fragile X syndrome is caused by a (CGG) trinucleotide expansion of the FMR1 gene and is the most common ___ form of intellectual disability.

Answer 174

inherited

Question 175

Down syndrome is the most common ___ cause of intellectual disability.

Answer 175

genetic

Question 176

What is the most common genetic cause of intellectual disability?

Answer 176

Down syndrome

Question 177

What is the most common inherited cause of intellectual disability?

Answer 177

Fragile X syndrome

Question 178

A 67yo woman notes tearfulness, sadness and intermittent insomnia since the sudden death of her husband seven months ago due to a stroke. She says she still can't believe he is gone, thinks about him much of the day and while she wishes she were dead so she could be with him, does not have thoughts of harming herself. Which of the following is the most likely diagnosis? - Normal grief - Major depressive disorder - Separation anxiety disorder - Posttraumatic stress disorder - Persistent complex bereavement disorder

Answer 178

Normal grief

Question 179

Between 2001 and 2013 which two of the following groups experienced the greatest increase in high-risk drinking and alcohol use disorder diagnoses? - Males - Adolescents - Older adults - Majority race/ethnicity - Higher socioeconomic groups

Answer 179

Adolescents and older adults

Question 180

Which of the following is most strongly associated with higher frequency of medically certified sick leave from work? - High workload - Limited use of skill set - Limited decision authority - Unclear workplace policy and procedures - Perceived poor relationship with supervisor

Answer 180

Perceived poor relationship with supervisor

Question 181

When initially speaking with a patient who feels sad about recently learning they have end stage disease, feels hopeless, no plan to hurt themself, a fair approach would be to initially ___ the patient as having a normal reaction to an overwhelming situation.

Answer 181

validate

Question 182

Dialectical behavioral therapy focuses on providing psychoeducation, validating patient's emotional vulnerability and encouraging ___.

Answer 182

change

Question 183

Widening concern for the larger social system and differentiation of one's own social, political and historical system from others primarily occurs primarily during the developmental transition from ___ ___ to ___ ___.

Answer 183

Young adulthood to middle adulthood

Question 184

In the mesocorticolimbic system dopaminergic neurons originate in the ___ ___ ___.

Answer 184

ventral tegmental area

Question 185

Which of the following is most often cited by the literature as a significant barrier to adopting an electronic health record (EHR)? - Age of many practitioners - Initial cost of introducing a system - Effects of system on physician autonomy - Lack of interoperability with other systems - Ambiguity of Federal and State policies on EHR use

Answer 185

Initial cost of introducing a system

Question 186

___ is often an appropriate initial step prior to psychotherapy or pharmacotherapy.

Answer 186

Psychoeducation

Question 187

Using an internet search to gather information about a patient may be appropriate to ___ between the patient's grandiose delusions and reality.

Answer 187

distinguish

Question 188

Which of the following antipsychotics is absorbed primarily through the oral mucosa? - Clozapine - Asenapine - Iloperidone - Aripiprazole - Ziprasidone

Answer 188

Asenapine/Saphris

Question 189

What is the rate-limiting enzyme in the synthesis of norepinephrine?

Answer 189

Tyrosine hydroxylase (converts L-Tyrosine to L-Dihydroxyphenylalanine aka L-DOPA)

Question 190

The ___ cingulate cortex is a key component of the salience network.

Answer 190

anterior

Question 191

If a patient in remission has a lifetime history of 3 episodes of depression ___ pharmacotherapy is likely appropriate.

Answer 191

maintenance

Question 192

The Continuous Performance Test measures ___ attention.

Answer 192

sustained

Question 193

Family-based genetic association studies have the advantage over case-control association studies in that family-based genetic association studies are less affected by ___ population differences.

Answer 193

systematic

Question 194

*___ ___ is the most common cause of premature death in individuals with schizophrenia.

Answer 194

Cardiovascular disease

Question 195

___ codes as compared to genetic codes are three-dimensional structures.

Answer 195

Epigenetic

Question 196

Emotional ___ is an essential parental factor for healthy child development.

Answer 196

attunement

Question 197

In the first two years of life the motor cortex (front lobe) develops ___ of the sensory cortex (parietal lobe).

Answer 197

ahead

Question 198

FDA-approved use of deep brain stimulation for treatment-resistant obsessive-compulsive disorder involves stimulation of the ___ ___ ___ ___ ___ ___.

Answer 198

anterior limb of the internal capsule

Question 199

The ___ ___ cortex is most closely associated with working memory (temporarily storing and manipulating information).

Answer 199

dorsolateral prefrontal

Question 200

An 80yo presents with severe memory loss, impaired social judgment, restricted interests, and inability to perform activities of daily living independently. The best combination of therapy to reduce decline in attention and global functioning would be donepezil plus ___, which is an uncompetitive antagonist at glutamatergic NMDA receptors.

Answer 200

memantine

Question 201

Severe dizziness with rolling over in bed and tilting head back is suggestive of ___ ___ ___ ___.

Answer 201

benign paroxysmal positional vertigo

Question 202

Which of the following augmentation agents has the best evidence for efficacy in patients with obsessive-compulsive disorder who have an inadequate response to a selective serotonin reuptake inhibitor? - Lithium - Bupropion - Quetiapine - Olanzapine - Aripiprazole

Answer 202

Aripiprazole

Question 203

What is the term for clusters of alleles that are in linkage disequilibrium and inherited as a single unit?

Answer 203

Haplotypes

Question 204

___ ___ refers to the non-random association of alleles at two or more loci in a general population. When alleles are in ### ###, haplotypes (clusters of alleles that are in ### ### and inherited as a single unit) do not occur at the expected frequencies.

Answer 204

Linkage disequilibrium

Question 205

The neural tube is formed from ___.

Answer 205

Ectoderm

Question 206

A type ___ error is when the true null hypothesis is erroneously rejected.

Answer 206

1

Question 207

A 55yo with no PSH develops changes in personality and impulsive, disinhibited behavior. Brain imaging does not suggest any lesion. On positron emission tomography (tracks glucose analog uptake indicating metabolic activity) will likely see ___ perfusion in bilateral lateral temporal lobes.

Answer 207

reduced

Question 208

A 30yo comes to ED reporting ringing in the ears, nausea, vomiting. Respirations are deep and rapid. Pt overdoses on numerous, unidentified pills, most likely which of the following? - Aspirin - Trazodone - Propranolol - Lorazepam - Acetaminophen

Answer 208

Aspirin

Question 209

A patient reports feeling detached from his surroundings, which seem fantasy-like and bizarre. In the mental status examination the psychiatrist notes the patient has having: - illusion - deja vu - jamais vu - derealization - depersonalization

Answer 209

derealization

Question 210

The Stroop Color Word Test relies on ___ of overlearned behaviors to assess executive function.

Answer 210

inhibition

Question 211

Restless leg syndrome has been associated with deficiency of which substance?

Answer 211

Iron Pramipexole, a first-line treatment for restless leg syndrome, is a nonergot dopamine agonist with specificity for the D2 subfamily dopamine receptor and has also been shown to bind to D3 and D4 receptors. By binding to these receptors it is thought that pramipexole can stimulate dopamine activity on the nerves fo the striatum and substantia nigra.

Question 212

The neurogenic hypothesis of depression postulates that antidepressant efficacy depends on ___ in the hippocampus.

Answer 212

neurogenesis

Question 213

In cognitive psychology, the process by which a person's reaction to stimuli decreases with repeated presentation is referred to as ___.

Answer 213

habituation

Question 214

Which of the following is a risk factor for rapid cycling bipolar disorder? - Female sex - Opiate abuse - Hyperthyroidism - Age under 25 years - Narcissistic personality disorder

Answer 214

Female sex

Question 215

What is the optimal time to conduct amniocentesis for chromosomal analysis of genetic disorders? - 8 weeks gestation - 12 weeks gestation - 20 weeks gestation - 28 weeks gestation - 34 weeks gestation

Answer 215

20 weeks gestation

Question 216

Which of the following psychiatric disorders is the most prevalent in patients with cancer? - Delirium - Major depression - Adjustment disorder - Brief psychotic disorder - Generalized anxiety disorder

Answer 216

Adjustment disorder

Question 217

Antagonism at which of the following neuropeptide receptors promotes analgesic effects? - Oxytocin - Endorphin - Dynorphin - Nociceptin - Enkephalin

Answer 217

Nociceptin

Question 218

Which of the following conditions is held to a stricter confidentiality standard by federal law? - Suicidality - Homicidality - Substance use disorders - Psychotic disorders - Treatment with electroconvulsive therapy

Answer 218

Substance use disorders

Question 219

Which of the following forms of competency requires the highest legal threshold? - Creating a will - Driving privileges - Advanced directives - Durable power of attorney - Making financial decisions

Answer 219

Making financial decisions

Question 220

A patient responds to questions with brief, concrete replies. The patient has poverty of speech and at times repeats the questions asked. ___ is a process of poor thinking inferred from speech and language usage. There may be a general lack of additional, unprompted content seen in normal speech: the replies to questions may be brief and concrete, with a reduction in spontaneous speech.

Answer 220

Alogia ("without" "speech")

Question 221

If a child expresses desire to attend a funeral, have someone familiar ___ the child.

Answer 221

accompany

Question 222

Which of the following is the foundational factor that leads to successful abstinence for individuals participating in Alcoholics Anonymous? - Believing in God - Having a sponsor - Attending weekly meetings - Receiving chips as a motivation - Recognizing that they are an alcoholic

Answer 222

Recognizing that they are an alcoholic

Question 223

A patient who vomits, for example in context of eating disorder, may have elevated serum ___.

Answer 223

amylase

Question 224

* A 12-year-old child is brought by an exasperated parent for evaluation due to child's belligerent refusal to do chores or homework. The child constantly talks back, is described as irritable much of the time, and is easily annoyed by others. The child purposely annoys other children and, as a result, does not have any friends. Which of the following diagnoses best characterizes the child's presentation? - Conduct disorder - Bipolar disorder, type 1 - Oppositional defiant disorder - Attention-deficit/hyperactivity disorder - Disruptive mood dysregulation disorder

Answer 224

Oppositional defiant disorder

Question 225

The Clinical Antipsychotic Trials of Intervention Effectiveness - Alzheimer's Disease (CATIE-AD) demonstrated that, relative to placebo, antipsychotic medication use for the treatment of behavioral disturbance in participants had which of the following effects in the majority of subjects by week 12? - Improved amotivation - Improved quality of life - Reduced suspiciousness - Improved functional status - Reduced caregiver burden

Answer 225

Reduced suspiciousness

Question 226

The four processes that reflect the flow and focus of a motivational interviewing conversation are: engaging, focusing, planning and ___.

Answer 226

evoking

Question 227

The pleasurable effects of drugs of abuse begin with increased neurotransmitter release in the ___ ___.

Answer 227

nucleus accumbens

Question 228

Which of the following types of memory is most dependent on medial temporal lobe integrity? - Implicit - Working - Procedural - Declarative - Retrospective

Answer 228

Declarative

Question 229

A questionnaire to screen for major depressive disorder has no inquiries pertaining to depressed mood, but has a few inquiries pertaining to spending sprees. Which of the following forms of validity is most affected? - Content - Criterion - Construct - Concurrent - Convergent

Answer 229

Content | For a psychological test to demonstrate content validity it must sample the area of interest adequately.

Question 230

When a child is having difficulty at school, parents aren't sure of any stressors, child is reluctant to go in the morning, it is especially important to get child, parent and ___ collateral and so for the latter a release to speak should be obtained.

Answer 230

teacher

Question 231

Which type of therapy focuses on building self-esteem and a cohesive sense of self, as well as improving interpersonal relationships in individuals with more severe psychopathology? - Cognitive - Dialectical - Behavioral - Supportive - Psychodynamic

Answer 231

Supportive

Question 232

Although physical health and cognitive function may decline in older age, sense of well-being often ___ in older age.

Answer 232

increases

Question 233

Corticosteroids lead to ___ AMPA glutamate receptor signalling in the hippocampus.

Answer 233

decreased

Question 234

The neuropsychological finding that best distinguishes Alzheimer dementia from depression is that patients with Alzheimer dementia have memory deficits that do ___ improve with hints or cues.

Answer 234

not

Question 235

In a geriatric patient with known dementia and at risk of delirium in the hospital, ___ may be a test helpful to delineate between worsening dementia and delirium.

Answer 235

electroencephalogram (EEG)

Question 236

Which of the following is most associated with an increase in the risk of developing Alzheimer disease in a person with mild cognitive impairment? - Anxiety - Tobacco smoking - Previous head trauma - College level education - Elevated blood pressure

Answer 236

Elevated blood pressure

Question 237

Meperidine is a serotonergic opioid that when added to other serotonergic agents could lead diaphoresis, delirium, psychomotor agitation, hyperactive reflexes, inducible clonus at the ankles, fever, hypertension or in other words, ___ ___.

Answer 237

serotonin syndrome

Question 238

A parent of a child with a recent suicide attempt is advised to remove firearms and parent declines saying they need them for protection and will secure them. The psychiatrist files a report with child protective services. The ethical conflict that conflicts with this decision is ___.

Answer 238

Autonomy

Question 239

The Center for Medicare and Medicaid's Care of Mental, Physical, and Substance-use Syndromes (COMPASS) program tested the effectiveness of the collaborative care model for patients with depression and comorbid cardiovascular disease and/or diabetes. Which of the following factors did nurse case managers report as the biggest challenge they faced during implementation of the program? - Documentation burdens - Difficulties enrolling the target sample - Patient non-adherence or lack of motivation - Lack of time to accomplish all necessary tasks - Lack of engagement of the primary care doctor or psychiatrist

Answer 239

Patient non-adherence or lack of motivation

Question 240

If a psychiatrist is aware of physical abuse and does not report it, this opens liability to legal ___.

Answer 240

sanctions

Question 241

A geriatric patient is prescribed an SSRI for depression and two week's later the patient's family notes they are more lethargic, confused, have headaches and an unsteady gait. Which of the following lab values is most likely to be abnormal in this patient? - Creatinine - Serum sodium - Cardiac enzymes - Serum glucose - Liver function studies

Answer 241

Serum sodium

Question 242

A lawsuit charges that a psychiatric facility prematurely discharged a patient who was not approved for further stay by the managed care company. The final legal responsibility generally falls to the: - psychiatrist - managed care company - managed care reviewer - psychiatric hospital - hospital medical director

Answer 242

psychiatrist

Question 243

The sleep of a healthy 70-year-old is most likely to show a decrease or absence of which of the following? - REM sleep - Slow waves - K complexes - Alpha waves - Sleep spindles

Answer 243

Slow waves

Question 244

Lower birth weight corrected for gestational age most strongly predicts the risk for later development of which of the following? - Schizophrenia - Autism spectrum disorder - Major depressive disorder - Intellectual developmental disorder - Attention-deficit/hyperactivity disorder

Answer 244

Attention-deficit/hyperactivity disorder

Question 245

*An 18yo with BPAD 1 has been euthymic for the past 12 months on lithium therapy, but has had trouble focusing on readings and maintaining attention in school. His parents describe history that aligns with ADHD, inattentive subtype. Addition of methylphenidate may improve the patient's cognitive symptoms ___ increasing his risk of subsequent mania.

Answer 245

*without

Question 246

On exam, a patient pursuing slow movement of a finger with the eyes in different directions shows "jerky" eye movements. This finding is suggestive of which of the following? - Multiple sclerosis - Parkinson disease - Wernicke encephalopathy - Phencyclidine intoxication - Benzodiazepine intoxication

Answer 246

Parkinson disease

Question 247

An 11yo is jealous of parents attention to academic success of gifted older sibling. At summer camp, the 11yo gets strongly attached to an older camper who is accomplished martial artist that shows the child some basic skills. When the child returns home he becomes a dedicated martial artist. The parents note he seems less jealous of the older sibling. Which psychodynamic defense mechanism best accounts for the child's behavior? - Suppression (conscious, often healthier than repression) - Repression (unconscious) - Sublimation - Displacement - Isolation of affect

Answer 247

Sublimation

Question 248

Which of the following cations blocks the NMDA receptor at resting membrane potential? - Sodium - Calcium - Potassium - Magnesium - Phosphorus

Answer 248

Magnesium

Question 249

A patient with recurrent upper GI bleeding develops a moderately severe major depressive episode for which antidepressant treatment is appropriate. Which of the antidepressants below is least likely to increase the risk of bleeding? - Citalopram - Mirtazapine - Venlafaxine - Nortriptyline - Escitalopram

Answer 249

Mirtazapine

Question 250

Which of the following is the most common biological causes of prenatal neurotoxicity linked to the development of intellectual disability? - Alcohol exposure - Lead exposure - Maternal diabetes - Mercury exposure - Radiation exposure

Answer 250

Alcohol exposure

Question 251

Which of the following is the best predictor of later functional and adaptive outcomes in autism spectrum disorder? - Age of onset - Verbal ability at age five years - Hyporeactivity to sensory input - Presence of highly restricted, fixated interests - Frequency of stereotyped or repetitive motor movements

Answer 251

Verbal ability at age five years

Question 252

A pt goes to therapist noting "disturbing thoughts." They spend 2+ hours each morning to confirm the oven is off, an hour checking CO levels in the children's rooms each night. They say if they don't do these things, they constantly worry the family will die of CO poisoning, despite recognition that this is highly unlikely. Which of the following techniques is most commonly used in the treatment of this condition. - Behavioral activation - Mindfulness techniques - Motivational interviewing - Encouragement to elaborate - Exposure and response prevention

Answer 252

Exposure and response prevention

Question 253

A 70yo has a stroke on the left side of the brain resulting in right-sided hemiparesis. Which of the following gait abnormalities is most commonly associated with this type of lesion? - Ataxic - Shuffling - Scissoring - Paraparetic - Circumduction

Answer 253

Circumduction (gait in which the leg is stiff, without flexion at knee and ankle, and with each step is rotated away from the body, then towards it, forming a semicircle.)

Question 254

Disorganization of behavioral and physiological circadian rhythms is caused by ablation of which of the following areas of the brain in primates? - Red nucleus - Caudate nucleus - Lentiform nucleus - Nucleus accumbens - Suprachiasmatic nucleus

Answer 254

Suprachiasmatic nucleus

Question 255

Which of the following magnetic resonance imaging studies would demonstrate an abnormality in mild traumatic brain injury? - FLAIR - T1 weighted - T2 weighted - Diffusion tensor imaging - Positron emission tomography

Answer 255

Diffusion tensor imaging

Question 256

At approximately 18 months, the typically developing child demonstrates which of the following language development milestones? - Uses verbs in phrases - Uses word combinations - Produces meaningful words - Speaks in complete sentences - Makes repetitive vowel sounds

Answer 256

Uses word combinations

Question 257

By what age does core gender identity typically form?

Answer 257

Three years old (3)

Question 258

Severity of cognitive deficits associated with severe head trauma most closely correlates with: - mechanism of injury - premorbid educational status - anatomic location of brain injury - duration of posttraumatic amnesia - severity of Glasgow Coma score at time of injury

Answer 258

duration of posttraumatic amnesia

Question 259

In the United States, studies examining demographic differences reported the lowest one-year prevalence rate of alcohol use disorders among which group? - Asian Americans - Native Americans - African Americans - Hispanic Americans - Non-Hispanic White Americans

Answer 259

Asian Americans

Question 260

The gag reflex and palatal elevation assess function of which cranial nerve?

Answer 260

The vagus nerve (X)

Question 261

A typically developing 3yo should be capable of which of the following motor skills? - Skipping - Tandem walking - Copying a triangle - Pedaling a tricycle - Following a three-step command

Answer 261

Pedaling a tricycle

Question 262

Which of the following areas of the hypothalamus have been reported to play a central role in maternal behavior of mothers towards infants? - Arcuate - Preoptic - Paraventricular - Tuberomamillary - Suprachiasmatic

Answer 262

Preoptic

Question 263

"Therapeutic misconception" refers to which of the following with regard to obtaining informed consent in research trials? - Misconception that patients with dementia cannot give consent - Assumption by the researcher that the trial's primary purpose is to help the patient - Lack of understanding by subjects that they can drop out of the research trial at any time - Misunderstanding by the researcher that the research participants will benefit from participation - Assumption by research participants that decisions about their care are being made solely with their benefit in mind

Answer 263

Assumption by research participants that decisions about their care are being made solely with their benefit in mind

Question 264

The evidence suggests that after completing a course of treatment for insomnia disorder, long-term outcomes are better among patients who were treated with which of the following? - Zolpidem - Trazodone - Biofeedback - Diphenhydramine - Cognitive behavioral therapy

Answer 264

Cognitive behavioral therapy

Question 265

Which of the following most accurately characterizes the neuropsychiatric changes associated with aging? - It takes longer to learn new material, and complete learning occurs - New material is learned more quickly, and complete learning occurs - It takes longer to learn new material, and complete learning does not occur - There is no difference in the time taken to learn new material, and complete learning occurs - There is no difference in the time taken to learn new material, but complete learning does not occur

Answer 265

It takes longer to learn new material, and complete learning occurs

Question 266

A 49yo complains to the neurologist of an urge to move both legs after lying in bed each night. The patient's spouse reports that during the day and throughout night the patient has limb jerks. The spouse also notes that the patient is becoming depressed. First-line treatment for this condition would be prescribing which of the following medications? - Tramadol - Ropinirole - Gabapentin - Mirtazapine - Clonazepam

Answer 266

Ropinirole (dopamine agonist)

Question 267

Which of the following is the most commonly validated risk factor for autism? - Birth order - Vaccination - Advanced parental age - Low maternal education - Low parental socioeconomic status

Answer 267

Advanced parental age

Question 268

An overweight patient with type 1 diabetes mellitus manipulates insulin dosing in an attempt to lose weight. This behavior is most consistent with a diagnosis of: - factitious disorder - conversion disorder - somatic symptom disorder - avoidant/restrictive food intake disorder - psychological factors affecting other medical conditions

Answer 268

psychological factors affecting other medical conditions

Question 269

Oxytocin suppresses the ___ during emotionally charged situations.

Answer 269

amygdala

Question 270

Energy homeostasis is thought to be regulated by leptin (inhibits hunger) receptors in which of the following brain regions? - Midbrain - Hippocampus - Hypothalamus - Periaqueductal grey - Parabrachial nucleus

Answer 270

Hypothalamus

Question 271

Which of the following enzymes is the rate-limiting step in the synthesis of dopamine? - Monoamine oxidase - Tyrosine hydroxylase - Phenylalanine hydroxylase - Catechol-O-methyltransferase - Dihydroxyphenylalanine decarboxylase

Answer 271

Tyrosine hydroxylase

Question 272

In biofeedback, the relaxation state coincides with decrease in: - PaCO2 level - skin conductance - finger temperature - parasympathetic tone - respiratory heart rate variability

Answer 272

skin conductance

Question 273

Damage to which of the following structures may account for flapping movements of the limbs seen in carbon monoxide poisoning? - Caudate - Amygdala - Cerebellum - Globus pallidus - Substantia nigra

Answer 273

Globus pallidus

Question 274

Which of the following medications have the best evidence for monotherapy treatment of bipolar depression? - Bupropion - Citalopram - Quetiapine - Lurasidone - Ziprasidone - Lamotrigine - Aripiprazole - Olanzapine-Fluoxetine combination

Answer 274

- >Quetiapine - >Lurasidone - >Olanzapine-Fluoxetine combination

Question 275

Which of the following repeat expansion disorders is more commonly associated with greater repeat instability with paternal transmission than with maternal transmission? - Friedreich ataxia - Huntington disease - Fragile X syndrome - Myotonic dysphrophy type 1

Answer 275

Huntington disease

Question 276

Which of the following DNA-based discovery techniques can empirically interrogate a genome without any a priori genetic hypothesis? - Twin studies - Linkage analysis - Candidate gene approach - Genome-wide association studies

Answer 276

Genome-wide association studies

Question 277

A metabolite of which of the following hormones is a potent allosteric modulator of the GABA-A receptor and has been implicated in depression? - Cortisol - Oxytocin - Estrogen - Progesterone

Answer 277

Progesterone

Question 278

In CJD or prion diseases, see dementia, myoclonus and on autopsy cortical stain, cytosolic ___ of neurons and glia with prion inclusions.

Answer 278

vacuolation

Question 279

Lithium was first approved by the US FDA for treatment of acute mania in 1970. The most important reason why lithium had difficulty entering the US market is that pharmaceutical companies were reluctant to produce a drug that they could not ___.

Answer 279

patent

Question 280

An 8yo boy is reported by teachers to be sexually seductive to other children, to openly display sexual behavior and to sexualize play activities. This is most likely a manifestation of: - precocious puberty - previous sexual abuse - normal sexual behavior - borderline intellectual disability

Answer 280

previous sexual abuse

Question 281

Which of the following factors is the primary contributor to the increased rates of incarceration in the United States since 1990? - Higher crime rates - More arrests per crime - Fewer juveniles arrested and convicted - Higher use of mandatory minimum sentences

Answer 281

Higher use of mandatory minimum sentences

Question 282

A recently adopted three-year-old is brought for evaluation of inhibited, emotionally withdrawn behavior. The child rarely seeks or responds to comfort when distressed, and has limited positive affect and emotional responsiveness to others. What additional history is required for the most likely diagnosis? - Serious neglect - Restricted interests - Ritualized behaviors - Developmental delay

Answer 282

Serious neglect

Question 283

By the age of about 15 months, typically developing children being to achieve which of the following milesetones? - Infer others' emotions and content - Engage in reciprocal conversation - Display social smile and gesture in peer interactions - Understand that others have minds different from their own

Answer 283

Understand that others have minds different from their own

Question 284

In ___ conditioning, praising the spouse for having picked up dirty dishes would be an example of a positive reinforcer.

Answer 284

operant

Question 285

In a symptom-free person who has a relative with Alzheimer disease, genetic testing for Alzheimer disease has ___ predictive value.

Answer 285

limited

Question 286

Which of the following statements best describes current thinking about the relationship between attention-deficity/hyperactivity disorder (ADHD) in children and adults? - They appear to be separate disorders, although there is some overlap. - Most adults with ADHD did not have significant symptoms as children. - A significant number of children with ADHD will go on to become adults with ADHD. - Adults can receive the diagnosis of ADHD even if they did not have symptoms as children.

Answer 286

A significant number of children with ADHD will go on to become adults with ADHD.

Question 287

A patient is hospitalized for shortness of breath and chest pain. Further workup reveals lung cancer. The patient asks the physician not to tell the patient's spouse about the cancer diagnosis but, instead, to indicate the patient has pneumonia so that the spouse will not worry. Which of the following is the most appropriate response by the physician? - As requested, tell the spouse that the patient has pneumonia. - Answer the spouse, but only if the spouse directly asks about a cancer diagnosis. - Let the patient know that it is unethical to lie, and inform the spouse of the diagnosis. - Tell the spouse that the patient has not given permission to discuss the patient's care.

Answer 287

Tell the spouse that the patient has not given permission to discuss the patient's care.

Question 288

Needle exchange is an example of which of the following types of reduction strategies? - Harm - Supply - Access - Demand

Answer 288

Harm

Question 289

___ (inverse agonist and antagonist of 5-HT2A receptors with no dopaminergic receptor affinity) is used to treat hallucinations and delusions associated with Parkinson's disease psychosis.

Answer 289

Pimavanserin

Question 290

When prescribed for long-term use, most patients will require a ___ benzodiazepine dose over time.

Answer 290

stable

Question 291

The ___-___ ___, striatum and thalamus form a circuit that when overactive produces worry/obsessive symptoms. This is why neurosurgical approaches for the treatment of refractory obsessive-compulsive disorder target the cortico-striatal-thalamo-cortical circuitry.

Answer 291

dorsolateral-prefrontal cortex

Question 292

Decreased dopamine in the ___ projection of the dorsolateral prefrontal cortex is postulated to be responsible for the negative and depressive symptoms of schizophrenia.

Answer 292

mesocortical

Question 293

Hyperactivity of dopamine in the ___ pathway mediates positive psychotic symptoms.

Answer 293

mesolimbic

Question 294

What is the most frequently studied deep brain stimulation depression target?

Answer 294

Subcallosal cingulate cortex (The neurosurgeons doing deep brain stimulation aim for the SCC)

Question 295

___ plays a key role in fine-tuning working memory (temporarily storing and manipulating information such as when doing mental arithmetic) function in the dorsolateral prefrontal cortex.

Answer 295

Dopamine

Question 296

In response to stress, corticotrophin-releasing hormone (CRH) is released from the ___ ___ of the hypothalamus.

Answer 296

Paraventricular nucleus

Question 297

Pramipexole is an effective first-line treatment for patients with restless leg syndrome. Pramipexole is a dopamine agonist with specificity for the D2 subfamily dopamine receptor, and has also been shown to bind to D3 and D4 receptors. By binding to these receptors, it is thought that pramipexole can stimulate dopamine activity on the nerves of the striatum and ___ ___.

Answer 297

substantia nigra

Question 298

Modafinil/Provigil significantly increases dopamine in the brain by ___ dopamine transporters; however, it has a lower affinity for dopamine receptors compared to amphetamines. Labeled indications of modafinil/provigil include narcolepsy, OSA, shift work sleep disorder. Off-label uses of modafinil/provigil include ADHD, cancer-related fatigue, MDD (antidepressant augmentation), multiple sclerosis-related fatigue.

Answer 298

blocking

Question 299

___ ___ posited that development occurs in sequential, clearly defined stages, and that each stage must be resolved for development to proceed smoothly.

Answer 299

Erik Erikson

Question 300

Erik Erikson posited that development occurs in sequential, clearly defined stages, and that each stage must be resolved for development to proceed smoothly. Erikson's stages of development: * Trust vs mistrust (birth to 18 months) * Autonomy vs shame and doubt (18 months to 3 years) * Initiative vs guilt (3 to 6 years) * Industry vs inferiority (6 to 12 years, school age) * ____ vs ___ ___ (12 to 18 years; Dr. A-D's 15yo twins) * Intimacy vs isolation (19 to 40 years) * Generativity vs stagnation (40 to 65 years) * Ego integrity vs despair (65 to death)

Answer 300

Identity vs role confusion

Question 301

___ effects, when dysfunctional, have been shown to most comprehensively replicate the core symptoms of schizophrenia.

Answer 301

Glutamate (Part of PCP's MOA is NMDA antagonism which produces acute psychosis that mimics schizophrenia and leads to excess neurotransmitter release that can cause agitation and seizures)

Question 302

Erik Erikson defined ___ ___ as lack of continuity in how the self if experienced in relationships over time.

Answer 302

identity diffusion

Question 303

The ___ dopaminergic pathway includes the nucleus accumbens (part of ventral striatum and mediates addiction and associated behaviors).

Answer 303

Mesolimbic (Dopamine blocking antipsychotics decrease pleasure by blocking the mesolimbic pathway)

Question 304

Following a full-term normal birth, circadian sleep rhythms (suprachiasmatic nucleus) are similar to those of an adult by ___ months.

Answer 304

six (6) months

Question 305

___ is the stage of development when the maximal number of axons and synapses exist.

Answer 305

Infancy

Question 306

___ accounts for the brain's rapid increase in size from birth through the second year of life.

Answer 306

Synaptogenesis

Question 307

In typically developing children the corticospinal tracts have completed myelination by ___ years of age

Answer 307

three (3) yo

Question 308

The development of brain grey matter volume peaks during ___ childhood. Adolescence is the stage of development in which maximal pruning of cortical synapses occurs.

Answer 308

late

Question 309

The development of brain grey matter volume peaks during late childhood. ___ is the stage of development in which maximal pruning of cortical synapses occurs.

Answer 309

Adolescence

Question 310

Synaptic ___ predominantly occurs during adolescence and young adulthood.

Answer 310

pruning

Question 311

Freud's theory of psychosocial development emphasizes that as humans develop they become ___ on different and specific objects through their stages of development. Oral: birth-1yo (Receiving pleasure through nursing and sucking (stuck? histrionic) Anal: 1-3yo (The toddler focuses on receiving pleasure in evacuating his bowels (stuck? OCD) Phallic: 3-6yo (the gratitification is now focused on the phallis) [Eliza Grey attack at 5yo!] Latency: 6-puberty [Here the drives are seen as dormant and hidden, and pleasure is mostly related to secondary process thinking] [Freud's latency: 6-puberty, lines up somewhat with Erikson's Industry vs Inferiority: 6-12yo, school age] Genital: puberty on -> (There is genital interest, but expressed in love relationships, families, responsibilities of adulthood)

Answer 311

fixated

Question 312

*DNA ___ recruits proteins involved in gene repression or by inhibiting the binding of transcription factors to DNA.

Answer 312

*methylation

Question 313

*DNA ___ (generally rapid and reversible) increases expression of genes through transcription activation (acetyl groups cause histone groups to wrap DNA less tightly, so it is more readily accessible/able to be transcribed).

Answer 313

*acetylation (Acetylation of lysine residues in histone proteins relaxes chromatin structure)

Question 314

The ___ has the highest concentration of serotonin-producing cells in the brain.

Answer 314

Raphe nuclei

Question 315

The raphe nuclei has the highest concentration of ___-producing cells in the brain.

Answer 315

serotonin

Question 316

Norepinephrine is mostly synthesized in the ___.

Answer 316

locus coeruleus

Question 317

___ is mostly synthesized in the locus coeruleus.

Answer 317

Norepinephrine

Question 318

___ prevention involves methods to detect and address an existing disease prior to the appearance of symptoms.

Answer 318

Secondary prevention

Question 319

Secondary prevention involves methods to detect and address an existing disease ___ to the appearance of ___.

Answer 319

prior; symptoms

Question 320

___ prevention involves methods to reduce the harm of symptomatic disease such as disability or death through rehabilitation and treatment (Pt on seroquel gets diabetes mellitus, treat with metformin).

Answer 320

Tertiary prevention

Question 321

Tertiary prevention involves methods to reduce the harm of ___ disease such as disability or death through rehabilitation and treatment (Pt on seroquel gets diabetes mellitus, treat with metformin).

Answer 321

symptomatic

Question 322

Tertiary prevention involves methods to ___ the harm of symptomatic disease such as disability or death through rehabilitation and treatment (Pt on seroquel gets diabetes mellitus, treat with metformin).

Answer 322

reduce

Question 323

Varenicline/Chantix is a partial agonist at ___ nicotinic acetylcholine receptors. Varenicline activates these receptors to a lesser extent than the full agonist nicotine and also prevents nicotine from binding to these receptors. Reward properties of nicotine are most closely associated with nicotinic acetylcholine receptor ___.

Answer 323

alpha4beta2; alpha4beta2

Question 324

___/___ is a partial agonist at alpha4beta2 (Alpha4Beta2) nicotinic acetylcholine receptors. Varenicline activates these receptors to a lesser extent than the full agonist nicotine and also prevents nicotine from binding to these receptors. Reward properties of nicotine are most closely associated with nicotinic acetylcholine receptor alpha4beta2.

Answer 324

Varenicline/Chantix

Question 325

Varenicline/Chantix is a ___ agonist at alpha 4 beta 2 (Alpha4Beta2) nicotinic acetylcholine receptors. Varenicline activates these receptors to a lesser extent than the full agonist nicotine and also prevents nicotine from binding to these receptors. Reward properties of nicotine are most closely associated with nicotinic acetylcholine receptor alpha4beta2.

Answer 325

partial

Question 326

An epigenetic cause of fragile X syndrome involves methylation of the ___ sites of the promoter region of the fragile X mental retardation 1 gene. Fragile X syndrome is the most common cause of inherited intellectual disability (Trinucleotide repeat in FMR1 gene. Long face, large everted ears, prominent jaw, macroorchidism and a high arched palate, frequent hand flapping).

Answer 326

CpG

Question 327

An epigenetic cause of fragile X syndrome involves methylation of the CpG sites of the ___ region of the fragile X mental retardation 1 gene. Fragile X syndrome is the most common cause of inherited intellectual disability (Trinucleotide repeat in FMR1 gene. Long face, large everted ears, prominent jaw, macroorchidism and a high arched palate, frequent hand flapping).

Answer 327

promoter

Question 328

An epigenetic cause of fragile X syndrome involves methylation of the CpG sites of the promoter region of the fragile X mental retardation 1 gene. ___ ___ ___ is the most common cause of inherited intellectual disability (Trinucleotide repeat of CGG in FMR1 gene. Long face, large everted ears, prominent jaw, macroorchidism and a high arched palate, frequent hand flapping).

Answer 328

Fragile X syndrome

Question 329

___'s theory of cognitive development: +Sensorimotor period: birth->2 years +Preoperational period: 2->7 years ("they draw on everything") +Concrete operational stage: 7->12 years ("they love dinos, collecting things like cards"; they first understand conservation of volume in the concrete operational stage) +Formal operational stage: 13->adulthood (able to think abstractly, logically, apply these processes to hypothetical situations)

Answer 329

Piaget

Question 330

Piaget's theory of cognitive development: +___ period: birth->2 years +Preoperational period: 2->7 years ("they draw on everything") +Concrete operational stage: 7->12 years ("they love dinos, collecting things like cards"; they first understand conservation of volume in the concrete operational stage) +Formal operational stage: 13->adulthood (able to think abstractly, logically, apply these processes to hypothetical situations)

Answer 330

Sensorimotor (birth->2 years)

Question 331

Piaget's theory of cognitive development: +Sensorimotor period: birth->2 years +Preoperational period: 2->7 years ("they draw on everything") +___ operational stage: 7->12 years ("they love dinos, collecting things like cards"; they first understand conservation of volume in the concrete operational stage) +Formal operational stage: 13->adulthood (able to think abstractly, logically, apply these processes to hypothetical situations)

Answer 331

Concrete (7-12yo)

Question 332

In the United States, what is the number one preventable cause of death?

Answer 332

Tobacco use disorder

Question 333

Ocular jerk movements with optokinetic ___ suggests psychogenic blindness.

Answer 333

drum

Question 334

In bipolar affective disorder, neuroimaging shows ___ functional connectivity between amygdala and the prefrontal cortex.

Answer 334

decreased

Question 335

Pathogenic copy number variants affecting DNA base pairs are associated with ___-___ (hyperphagia, failure to thrive, early obesity, hypogonadism, OCD, short, small hands and small feet).

Answer 335

Prader-Willi

Question 336

___ ___ are different proteins encoded by the same gene.

Answer 336

Splice variants

Question 337

Amygdala-___-periaqueductal gray (endorphins) is the neural pathway most consistently found to mediate reactive aggression.

Answer 337

hypothalamus

Question 338

Amygdala-hypothalamus-periaqueductal gray (endorphins) is the neural pathway most consistently found to mediate reactive ___.

Answer 338

aggression

Question 339

Amygdala-hypothalamus-___ gray (endorphins) is the neural pathway most consistently found to mediate reactive aggression.

Answer 339

periaqueductal

Question 340

___ properties of nicotine are most closely associated with nicotinic acetylcholine receptor alpha4beta2.

Answer 340

Reward

Question 341

Reward properties of nicotine are most closely associated with nicotinic acetylcholine receptor ___.

Answer 341

alpha4beta2

Question 342

Reward properties of nicotine are most closely associated with ___ acetylcholine receptor alpha4beta2. Varenicline/Chantix is a partial agonist at alpha4beta2 nicotinic acetylcholine receptors. Varenicline activates these receptors to a lesser extent than the full agonist nicotine and also prevents nicotine from binding to these receptors.

Answer 342

nicotinic

Question 343

___ is a common neuropsychiatric symptom seen in neurocognitive disorder and traumatic brain injury.

Answer 343

Depression

Question 344

The hypothalamic ___ nucleus is key to integration of neural and nutrient signals with hormonal signals from the small intestine, pancreas, liver, adipose tissue and brainstem.

Answer 344

arcuate

Question 345

Gender ___ is typically established by 3yo.

Answer 345

identity

Question 346

___ adenylate cyclase-activating polypeptide is a potent neuroprotective factor preventing neuronal cell death (apoptosis).

Answer 346

Pituitary

Question 347

Pituitary ___ cyclase-activating polypeptide is a potent neuroprotective factor preventing neuronal cell death (apoptosis).

Answer 347

adenylate

Question 348

Pituitary adenylate cyclase-activating polypeptide is a potent ___ factor preventing neuronal cell death (apoptosis).

Answer 348

neuroprotective

Question 349

With regards to neuroinflammation, estrogen leads to ___ inflammatory cytokine production.

Answer 349

decreased

Question 350

*L-Tyrosine (non-essential amino acid, can get in diet and also synthesized from phenylalanine) is converted by Tyrosine hydroxylase to L-Dihydroxyphenylalanine (L-DOPA) -> Dopamine is converted by dopamine hydroxylase to Norepinephrine -> Epinephrine What is the rate limiting step in the synthesis of norepinephrine?

Answer 350

Tyrosine hydroxylase

Question 351

The Wisconsin Card Sorting Task measures the ability to generate ___ strategies in response to feedback.

Answer 351

alternative

Question 352

The ___ is used to measure concept formation and concept flexibility.

Answer 352

Wisconsin Card Sorting Test

Question 353

The ___ area of the frontal cortex is most consistently activated during shifting of cognitive sets in the Wisconsin Card Sorting Test.

Answer 353

dorsolateral

Question 354

The ___ ___ is the area of the brain primarily responsible for face recognition (Its BETO!!!)

Answer 354

fusiform gyrus (think about the name, "fusiform"... ITS BETO!)

Question 355

Activation of the ___-___ receptor is thought to be responsible for the anti-anxiety, motor-impairing and sedative hypnotic effects of alcohol.

Answer 355

GABA-A

Question 356

A patient reports insomnia, frequent nighttime awakenings and excessive daytime sleepiness. A sleep study reveals brief lower extremity jerks with brief repeated arousals. The patient is unaware of these movements. Which of the following diagnoses is most consistent with the presentation? - Narcolepsy - Primary insomnia - Sleep terror disorder - Periodic limb movement disorder - Circadian rhythm sleep disorder

Answer 356

Periodic limb movement disorder

Question 357

Which of the following symptoms is considered an irreversible effect of chronic anabolic steroid use? - Infertility - Hirsutism - Impotence - Gynecomastia - Testicular atrophy

Answer 357

Hirsutism

Question 358

An infant who engages in an interactive game of peek-a-boo most closely demonstrates the concept of which of the following cognitive abilities? - Centering - Egocentrism - Conservation - Object permanence - Tertiary circular reactions

Answer 358

Object permanence

Question 359

A 30yo presents with headache and clumsiness of the right hand for several weeks. PE is notable for difficulty with rapid alternating movements of the right hand, an overt intention tremor on finger-to-nose testing, and mildly dysmetric finger-tapping. Cranial nerves are intact and there is no papilledema. Damage is likely to the ___.

Answer 359

Cerebellum

Question 360

Which of the changes below is supported by the literature for teachers considering "learning styles" when planning curricula? - Transition all lectures to small group problem-based formats - Offer several different modalities and allow students to choose - Make no changes, lecture-based curricula result in higher test scores - Allow students to self-declare learning styles and opt out of certain requirements - Use supplemental material designed to address the needs of all types of learners

Answer 360

Use supplemental material designed to address the needs of all types of learners

Question 361

A high-achieving patient becomes increasingly anxious about the perception of her work. This has led her to work longer hours to produce results that she believes will be viewed positively by her team. The therapist asks the patient whether the long hours are truly needed to be successful. She responds, "I always have to work harder than everyone else to succeed." In cognitive theory, this statement is an example of: - a schema - globalization - internalization - an automatic thought - a compensatory strategy

Answer 361

a schema

Question 362

Which of the following is the most significant barrier to accessing mental health services in school-based health centers? - Lower quality of care - Stricter referral process - Health insurance restrictions - Concerns about confidentiality - Limited access to appointments

Answer 362

Concerns about confidentiality

Question 363

Which of the following therapies is the most likely to describe a therapeutic goal as "improving ego functioning and self-esteem"? - Family therapy - Exposure therapy - Supportive psychotherapy - Dialectical behavior therapy - Interpersonal psychotherapy

Answer 363

Supportive psychotherapy

Question 364

A 30yo has intermittent muscle twitching. Exam show full strength with normal muscle bulk. Electromyography shows spontaneous discharges which are relatively constant and represent firing of the motor unit. These findings are typical of: - cramps - spasms - myokymia - fibrillations - fasciculations

Answer 364

fasciculations ("muscle twitches")

Question 365

A pro dancer's performance and the show won wide acclaim, but she can't stop replaying a minor misstep she made that was not noticed by the audience or other performers. Despite being congratulated on her performance, she feels that, due to the error, she has let herself down. Which of the following cognitive errors is the patient displaying? - Minimization - Personalization - Overgeneralization - Selective abstraction - Dichotomous thinking

Answer 365

Selective abstraction

Question 366

Which of the following is the primary purpose of mental health courts? - Adjudicate insanity defense - Determine fitness to stand trial - Divert offenders with mental illness away from incarceration - Provide preliminary rulings on psychiatric malpractice cases - Civilly commit dangerous mentally ill patients to outpatient treatment

Answer 366

Divert offenders with mental illness away from incarceration

Question 367

A patient prominently uses the defenses of isolation of affect and intellectualization. The patient's description of many life events appears to involve reaction formation. Which personality trait is most likely to characterize this patient?

Answer 367

Obsessive-compulsive [associated with disruption in cortico (dorsolateral prefrontal cortex)-striato-thalamo-cortical circuit function]

Question 368

A researcher follows two groups of people to assess for the development of dementia. One group has a history of lorazepam use and the other does not. What type of study design is being used?

Answer 368

Prospective cohort

Question 369

Disruption in cortico (dorsolateral prefrontal cortex)-striato-thalamo-cortical circuit function is most closely associated with what group of disorders? - Mood - Somatoform - Schizophrenic - Posttraumatic stress - Obsessive-compulsive

Answer 369

Obsessive-compulsive

Question 370

A patient comes to the ED after a syncopal episode with hyperthermia, headache, flushing, and tachycardia. He has significant hypotension requiring fluid resuscitation. According to the family, the patient has a history of schizophrenia, generalized anxiety disorder and alcohol use disorder. An interaction with which of the following medications is most likely to have caused the patient's symptoms? - Amitriptyline - Disulfiram - Fluoxetine - Haloperidol - Lorazepam

Answer 370

Disulfiram

Question 371

___ introduced the strange situation experiment to evaluate attachment between a parent and child.

Answer 371

Mary Ainsworth

Question 372

A 75yo has subacute onset of progressive ataxia of gait and limbs. Lab studies shown anti-Yo antibody in the serum. Which of the following tests should be ordered next? - PET scan of brain - CT chest, abdomen, pelvis - MRI brain - Serial titers of anti-Yo antibody - MRI spine

Answer 372

CT chest, abdomen, pelvis (anti-Yo is a paraneoplastic antibody)

Question 373

A 9yo with attention-deficit/hyperactivity disorder does not respond to methylphenidate. Which of the following medications should be tried next? - Clonidine - Fluoxetine - Bupropion - Guanfacine - Dextroamphetamine

Answer 373

Dextroamphetamine

Question 374

In which of the following ways does sexual health change in older individuals? - Libido is reduced - Sperm count decreases - Refractory period for men increases - Anxiety surrounding sexuality is increased - Testosterone production in men is greatly decreased

Answer 374

Refractory period for men increases

Question 375

Which of the following developmental stages in psychodynamic group therapy is characterized by intimacy? - Engagement - Subgrouping - Termination - Working group - Differentiation and individuation

Answer 375

Working group

Question 376

Over several months, a 45yo with no PSH becomes labile and irritable. They undergo personality changes and are observed to laugh inappropriately when neighborhood kids taunt a stray cat. Within two years, the patient develops a fear of contamination and greatly decreases food intake due to being convinced that all food has germs. Memory is preserved. The patient can no longer work or live independently. Neuropsychiatric testing demonstrates impaired language and attention. Which of the following is the most likely diagnosis? - Schizophrenia - Alzheimer disease - Frontotemporal dementia - Dementia with Lewy bodies - Obsessive-compulsive disorder

Answer 376

Frontotemporal dementia

Question 377

Which of the following is used in biofeedback as a marker of autonomic activity? - Heart rate variability - Systolic blood pressure - Diastolic blood pressure - Respiratory rate variability - Circadian core body temperature

Answer 377

Heart rate variability

Question 378

A 22mo places a wooden block on a toy train track and says, "choo-choo!" while moving the block back and forth along the track. This behavior is most likely an example of which of the following types of play? - Fantasy - Parallel - Symbolic - Cooperative - Sensorimotor

Answer 378

Symbolic

Question 379

Which of the following is associated with increased risk of depression in people with multiple sclerosis? - Older age - Female sex - Type of deficit - Lesion volume - Family history of depression

Answer 379

Lesion volume

Question 380

According to psychoanalytic theory, the term ___ ___ ___ refers to mental activity exemplified by unconscious thoughts that do not maintain logical connections.

Answer 380

primary process thinking

Question 381

Which of the following infant and toddler temperamental styles has been shown to have the greatest association with the eventual onset of anxiety symptoms in childhood? - Inhibited - Irritable - Hyperactive - Dysregulated - Aggressive

Answer 381

Inhibited

Question 382

The central principle of "The Goldwater Rule" for psychiatrists is that it is unethical for psychiatrists to offer professional opinions on public figures without a ___-___-___ evaluation.

Answer 382

face-to-face

Question 383

Which of the following is the strongest risk factor for postpartum depression? - Marital difficulties - Low socioeconomic status - Family history of depression - Level of reproductive hormones - Untreated depression during pregnancy

Answer 383

Untreated depression during pregnancy

Question 384

Which of the following hormones is released during sleep, but likely does not have a circadian pattern? - Melatonin - Cortisol - Prolactin - Oxytocin - Growth hormone

Answer 384

Growth hormone

Question 385

Extracorporeal treatment is typically indicated in cases of severe lithium toxicity. Lithium is readily dialyzable due to its: - high tissue binding - high protein binding - low molecular weight - high volume of distribution - low proximal tubule resorption

Answer 385

low molecular weight

Question 386

Which of the following is among the first medications ever approved to treat depression? - Lithium - Iproniazid - Desipramine - Methylphenidate - Chlorpromazine

Answer 386

Iproniazid [early ANTIDEPRESSANT, now for tuberculosis!]

Question 387

A grad student says in exam week the R leg is paralyzed. On PE reflexes are normal, pt is asked to lie down flat and lift the unaffected leg. When he does this, the doctor feels increased pressure under the affected leg. What is the most likely diagnosis?

Answer 387

Conversion disorder

Question 388

When testing for Babinski reflex, downward scraping of the shin can help the examiner overcome the ___ response by a patient.

Answer 388

withdrawal

Question 389

A 22yo began psychotherapy due to feeling inadequate and depressed in the setting of working as a barista since graduating from college and deferring medical school acceptance. The patient has been having conflicts with his mom and dad about his ambivalence to become a doctor. What is the most likely developmental task that the patient is struggling with?

Answer 389

Identity (Erik Erikson's theory of development, Identity vs role confusion: age 12-18. Adolescents experience some role confusion and mixed emotions about the specific ways in which they fit into society. They may experiment with a variety of behaviors and activities before they achieve a sense of identity.)

Question 390

In malpractice lawsuits, for patient's to win, doctor-patient ___ must be established.

Answer 390

relationship

Question 391

The ability to temporarily store and manipulate information, such as when doing mental arithmetic, is referred to as ___ ___.

Answer 391

working memory (dorsolateral prefrontal)

Question 392

When observed in a young adult, bilateral paresis of the medial rectus muscle of the eye on attempted lateral gaze, with course nystagmus in the abducting eye, is characteristic of which condition?

Answer 392

Multiple sclerosis

Question 393

Clinical studies of adolescents and young adults have found that physicians can decrease the risk of suicidal events when prescribing antidepressant medication by ___ titrating the antidepressant.

Answer 393

slowly

Question 394

Ethical standards issued by the American Medical Association prohibit physician involvement in which of the following aspects of a death penalty case unless a commutation (substitution for a lesser sentence) order is in place? - Assessment of competence to stand trial - Restoration of competence to be executed - Rendering an opinion about criminal responsibility - Serving as a fact witness at the guilt-innocence trial phase - Treatment of condemned prisoner to reduce mental health symptoms

Answer 394

Restoration of competence to be executed

Question 395

Hearing one's name each time the wind rustles the leaves outside the room each morning is an example of an ___.

Answer 395

illusion

Question 396

A form of learned fear in which a person or an experimental animal learns to respond strongly not only to a harmful stimulus, but also to a subthreshold stimulus refers to: - avoidance - sensitization - habituation - irrational fear - learned helplessness

Answer 396

sensitization

Question 397

Naltrexone is helpful for patients with alcohol ___.

Answer 397

cravings

Question 398

Which of the following is seen most frequently as a comorbid condition in children with autism spectrum disorder? - Selective mutism - Intellectual disability - Early-onset schizophrenia - Obsessive-compulsive disorder - Attention-deficit/hyperactivity disorder

Answer 398

Intellectual disability

Question 399

The term ___ refers to small insertions and deletions in DNA sequence.

Answer 399

indels (INsertions and DELetionS in DNA sequence)

Question 400

Pt comes to ED with significant paranoia, is hypervigilant, pacing and responding to unseen others. Which of the following techniques would be most appropriate to build rapport with the patient? - Make sustained eye contact - Acknowledge the patient's fear - Directly confront the patient's paranoia - Agree that the patient's suspiciousness is justified - Approach the interview as if the patient is a close friend

Answer 400

Acknowledge the patient's fear

Question 401

18yo has been avoiding food for the past four months. Her BMI is less than normal, and she menstruates regularly. Family members say she obsesses about being "fat," even though she continues to lose weight. On several occasions, they have overheard her vomiting in the bathroom after consuming a large meal. She meets criteria for which of the following diagnoses? - Bulimia nervosa - Anorexia nervosa - Rumination disorder - Unspecified eating disorder - Avoidant/restrictive food intake disorder

Answer 401

Anorexia nervosa

Question 402

The ___ is a small region of the cerebral cortex located deep within the lateral sulcus, which is a large fissure that separates the frontal and parietal lobes from the temporal lobe. Along with the medial pre-frontal cortex, the insula is involved in both fear conditioning and fear extinction.

Answer 402

insula

Question 403

A patient with schizophrenia is started on clozapine after failing two other antipsychotic trials. His initial absolute neutrophil count is 2200/mm3. How frequently should the psychiatrist order a CBC with differential for this patient? - Daily - Three times weekly - Weekly - Every two weeks - Monthly

Answer 403

Weekly

Question 404

Text messaging and online media to communicate with peers is ___ for modern adolescents socializing with their peer group.

Answer 404

normal

Question 405

40yo goes to hospital due to concussion after MVC. No abnormalities on PE other than lacerations and ecchymoses. One week later, the patient has generalized pain, dizziness, difficulty sleeping, and recurrent nightmares when able to sleep. The patient now fears driving. Which of the following is the most likely explanation for the development of these symptoms? - Malingering - Adjustment disorder - Acute stress disorder - Somatic symptom disorder - Posttraumatic stress disorder

Answer 405

Acute stress disorder

Question 406

D3 has been found to be effective as an adjunct to antidepressant medications for the treatment of ___.

Answer 406

depression

Question 407

Which of the following scales is the easiest to use for an initial assessment of delirium in the geriatric population? - Confusion Assessment Method - Montreal Cognitive Assessment - Mini-Mental Status Examination - Geriatric Mental State Schedule - Brief Psychiatric Rating Scale

Answer 407

Confusion Assessment Method (ICU "CAM")

Question 408

In a properly conducted randomized clinical trial, it is inappropriate to include p values in a table showing baseline characteristics of subjects by treatment group because any differences at baseline must have arisen by chance given ___.

Answer 408

randomization

Question 409

Which of the following is the best predictor of healthy aging in elderly individuals? - Adopting a spiritual attitude - Resisting old age stereotypes - Avoiding dependency on others - Remaining in contact with friends - Taking a passive stance toward obstacles

Answer 409

Remaining in contact with friends

Question 410

A stroke in which of the following arterial territories would result in an inability to read, but with preserved ability to write? - Carotid - Basilar - Vertebral - Middle cerebral - Posterior cerebral

Answer 410

Posterior cerebral

Question 411

Which of the following genes has been most associated with late-onset neurocognitive disorder due to Alzheimer disease? - APP - CR1 - PSEN1 - PSEN2 - APOE*E4

Answer 411

APOE*E4 (eat blueberries, exercise, learn, get connected and stimulated!)

Question 412

Which psychodynamic theory emphasizes individuals' ability to understand their own and others' internal states as explanations for behavior?

Answer 412

Mentalization theory

Question 413

When the central nervous system responds to an acute cortical insult microglia processes retract, and the cell body ___.

Answer 413

enlarges [Microglia secrete innate proinflammatory cytokines TNF-a and IL-1B in patients with inflammatory conditions that affect the brain.]

Question 414

Which of the following is most likely to reduce psychotic symptoms in patients with Parkinson disease without worsening motor symptoms? - Quetiapine - Mirtazapine - Aripiprazole - Rivastigmine - Pimavanserin

Answer 414

Pimavanserin (inverse agonist and antagonist with high affinity for 5-HT2A receptors, no affinity for dopaminergic (including D2) receptors)

Question 415

Which of the following diagnoses is associated with high hypnotizability potential? - Schizophrenia - Panic disorder - Dissociative disorder - Substance dependence - Attention-deficit/hyperactivity disorder

Answer 415

Dissociative disorder

Question 416

Synaptic ___ predominantly occurs during adolescence and young adulthood.

Answer 416

pruning

Question 417

Grey matter volume development peaks in late ___, before the synaptic pruning time in adolescence/young adulthood.

Answer 417

childhood

Question 418

Which of the following has been reported regarding the likelihood of escalation of benzodiazepine dose when prescribed for long-term use? - Most patients will require a higher dose over time - Most patient will maintain a stable dose over time - Older patients tend to require a higher dose over time - Patients with bipolar disorder tend to require a higher dose over time - Patients with schizophrenia tend to require a higher dose over time

Answer 418

Most patient will maintain a stable dose over time

Question 419

A 73yo patient developed sudden onset memory loss, and was unaware of how the patient and spouse arrived at the supermarket. The spouse noted that the patient was able to drive without problem, but appeared anxious during much of the trip. The patient was able to appropriately answer questions, but then didn't remember the conversation. The entire episode lasted three hours, after which time the patient returned to baseline. The most likely diagnosis is: - presyncope - complicated migraine - complex partial seizure - transient global amnesia - posterior circulation stroke

Answer 419

transient global amnesia

Question 420

Which of the following is the best example of a second stage or "self-conscious" emotion, which is believed to develop around the end of the second year of life? - Envy - Fear (earlier: within first year) - Anger - Altruism - Empathy

Answer 420

Envy

Question 421

HIPAA limits disclosure of patient health information information without patient authorization except as necessary for which of the following? - Research - Payment - Education - Medical licensure - Medical malpractice

Answer 421

Payment

Question 422

The validity scales of the Minnesota Multiphasic Personality Inventory-II measure the test-taking ___ of the patient.

Answer 422

attitude

Question 423

Pt has history of depression and well-controlled epilepsy and has undergone multiple unsuccessful antidepressant trials before responding to bupropion. Pt has yet to try several antidepressants including imipramine, nortriptyline, duloxetine, selegiline. The patient's insurance company recommends switching to another antidepressant because of bupropion's well-known tendency to reduce seizure threshold. The psychiatrist should ___ bupropion.

Answer 423

continue

Question 424

A 20yo comes to the ED following nausea, sweating and hematemesis. They have had recent severe headaches and numbness in the extremities. CT shows generalized brain atrophy. Labs show renal tubular acidosis and a CPK of 3120 mcg/L. The presentation is consistent with chronic use of which of the following substances? - Phencyclidine - Amphetamines - Steroids - Cocaine - Inhalants

Answer 424

Inhalants (chronic use->renal tubular acidosis, CPK increase, generalized brain atrophy)

Question 425

Which of the following is transmitted through the spinothalamic tract? - Pain and Temperature - Balance - Vibration - Joint position - Tactile sense

Answer 425

Pain and Temperature

Question 426

A patient's managed care insurance company refuses to authorize continued hospitalization for a depressed patient who remains acutely suicidal. The treating inpatient psychiatrist remains concerned about the potential for suicide and does not discharge the patient. The psychiatrist's actions best illustrate the ethical principle in managed care of responsibility to ___.

Answer 426

treat

Question 427

___ REM latency on a multiple sleep latency test (MSLT) confirms the diagnosis of narcolepsy. Also see this in depressed patients.

Answer 427

Decreased

Question 428

___ of neurons accounts for the brain's rapid increase in size from birth through the second year of life.

Answer 428

Synaptogenesis

Question 429

Which of the following is the most common reason for patients to discontinue selective serotonin reuptake inhibitors early? - GI distress - Sedation - Agitation - Insomnia - Jitteriness

Answer 429

GI distress

Question 430

Patients with which of the following neurologic disorders have been reported to have the highest prevalence of pathological laughing and crying? - Multiple sclerosis - Parkinson disease - Traumatic brain injury - Multiple system atrophy - Amyotrophic lateral sclerosis

Answer 430

Amyotrophic lateral sclerosis (ALS) (pathologic laughing and crying)

Question 431

Parents are concerned because their 2yo girl is playing with trucks instead of dolls, likes to wear boy's clothes, and prefers to play with boys instead of girls. The parents have tried to change these behaviors, but the child has been resistant. When interviewed by the physician, the child insists that she is a girl. Which of the following is the most likely diagnosis? - Gender dysphoria - Normal development - Transvestic disorder - Body dysmorphic disorder - Oppositional defiant disorder

Answer 431

Normal development

Question 432

An 80yo in the ICU is awake throughout the night, pulls IV lines, misidentifies nurses as bank employees. In addition to questions of orientation, which of the following components of the Mini-Mental State Examination would be most helpful in confirming the patient's diagnosis? - Recall - Serial 7s - Metaphors - Registration - Sentence completion

Answer 432

Serial 7s (tests attention)

Question 433

Which of the following neurotransmitters, present in the periaqueductal grey matter, is involved in the mediation of pain? - Aspartate - Serotonin - Endorphins - Dopamine - Histamine

Answer 433

Endorphins

Question 434

Glycogen synthase kinase-3 ___ is a pharmacological effect of lithium.

Answer 434

inhibition

Question 435

Which of the following stages of development occurs first in female physical development? - Rise in growth hormone secretion - Onset of gonadal estrogen production - Increase in adrenal androgen production - Surge in luteinizing and follicle-stimulating hormones - Organization of pulsatile release of gonadotropin-releasing hormone

Answer 435

Increase in adrenal androgen production

Question 436

Which type of genetic variation is most commonly investigated in genome-wide association studies? - mRNA abundance - Translation efficiency - Insertions or deletions - Copy number variants - Single nucleotide polymophisms

Answer 436

Single nucleotide polymorphisms (SNPs) (SNPs are locations within the human genome where the type of nucleotide present (A,T,G, or C) can differ between individuals. SNPs are the most common type of genetic variation found among people.)

Question 437

What Freudian psychosexual stage of development is characterized by an intensification of libidinal drives, separation from a dependence on one's parents, and achievement of a mature sense of self?

Answer 437

Genital

Question 438

Deep brain stimulation targeting what brain region has been most frequently studied for the experimental treatment of depression?

Answer 438

Subcallosal cingulate cortex (SCC targeted by the neurosurgeons)

Question 439

A 30yo has episodes of irresistible sleepiness, and falls asleep while driving. She reports experiencing episodes of paralysis and hallucinations upon awakening. These symptoms are best explained by a deficiency of ___.

Answer 439

Orexin/Hypocretin [Orexin, from orexis, meaning "appetite" in Greek, is involved in the stimulation of food intake. In addition, it stimulates wakefulness, regulates energy expenditure and moderates visceral function. The most common form of narcolepsy, in which the sufferer experiences brief losses of muscle tone (cataplexy) is caused by a lack of orexin in the brain due to destruction of the cells that produce it.]

Question 440

A 29yo with new-onset headache characterized by unilateral, stabbing eye pain has runny nose and conjunctival injection on the same side as the headache during episodes. The episodes occur every night after falling asleep and last up to two hours. The patient most likely has ___ headache.

Answer 440

cluster

Question 441

Pt that says they often feel they have "no self" and her thoughts are not hers, feels like a robot and as if can't control her body. She says she knows she has feelings, but can't feel them instead feels emotionally numb and often feels her head is full of cotton. Recently she started having "out of body" experiences. Which of the following is the most likely diagnosis? - Illness anxiety disorder - Dissociative identity disorder - Posttraumatic stress disorder - Borderline personality disorder - Depersonalization/derealization disorder

Answer 441

Depersonalization/derealization disorder

Question 442

The three main components of "Meaningful use" of electronic medical records (EMR) include the use of certified EMR in a meaningful manner, the use of certified EMR to submit clinical quality measures and electronic exchange of health information to improve ___ of care.

Answer 442

quality

Question 443

Which of the following neurotransmitters is thought to play a key role in fine-tuning working memory function in the dorsolateral prefrontal cortex? - Serotonin - Dopamine - Nitrous oxide - Acetylcholine - Norepinephrine

Answer 443

Dopamine

Question 444

Current evidence of psychiatrists using pharmacogenomics testing in clinical practice shows promise for clinical utility, but replicated evidence about outcomes is ___.

Answer 444

lacking

Question 445

To minimize liability for the psychiatrist providing an informal "curbside" consultation for PCP, care of the patient remains under the direction of the PCP who also remains in charge of ___ medications or additional services.

Answer 445

ordering

Question 446

Which of the following sleep disorders is associated with mild neurocognitive disorder with Lewy bodies (core features: fluctuating cognition, visual hallucinations, "spontaneous" Parkinsonism that started AFTER onset of cognitive decline; suggestive features: Marked sensitivity to side effects of antipsychotic medications + answer to this question)? - Nocturnal seizures - Nightmare disorder - Restless leg syndrome - Obstructive sleep apnea - REM sleep behavior disorder

Answer 446

REM sleep behavior disorder

Question 447

A pt is unable to demonstrate how to blow out a match. Motor and sensory function are normal, and the rest of the neurological exam is unremarkable. The patient's inability to perform this action is termed ___.

Answer 447

apraxia (The brain is unable to make and deliver correct movement instructions to the body.)

Question 448

Splice variants are best defined as ___ ___ encoded by the same gene.

Answer 448

different proteins

Question 449

Which of the following antidepressant medications is safest to use in patients with seizure disorders and depression? - Amoxapine - Bupropion (NO!) - Clomipramine - Fluoxetine - Maprotiline

Answer 449

Fluoxetine/prozac

Question 450

According to Erikson, the predominant emotional issue in typically developing, ___-age children is personal worth and competence.

Answer 450

school [Industry vs inferiority: age 6 to 12 years. The child compares self-worth to others (such as in a classroom environment or with other siblings). A child can recognize major disparities in personal abilities relative to other children. The role of the teacher is very important, the teacher should ensure that children do not feel inferior but proud of their individual achievements.]

Question 451

Which of the following would be considered a boundary violation? - Investing in a patient's business - Treating the town pharmacist in a small rural town - Accepting a patient's holiday gift of a hand-knit scarf - Seeing one patient at a reduced fee while charging others the full rate - Discussing the patient's sexual feelings toward the psychiatrist in session

Answer 451

Investing in a patient's business (boundary violations involve exploitation)

Question 452

Under the Health Insurance Portability and Accountability Act (HIPAA), a provider must obtain specific consent or authorization from a patient before sharing individually identifiable health information to: - a third party payer for the purpose of payment - an investigator for the purpose of conducting epidemiological research - a health care provider who is taking over the ongoing care of the patient - a non-clinical hospital administrator for the purpose of quality improvement - another clinician unfamiliar with the patient for the purpose of medical consultation

Answer 452

An investigator for the purpose of conducting epidemiological research

Question 453

___ is maximized to ensure that a screening test misses only a small number of individuals with an illness.

Answer 453

Sensitivity

Question 454

If tyrosine hydroxylase is dramatically decreased due to a specific neurotoxin, which of the following types of neurons are most likely to be impaired by this neurotoxin. - Dopaminergic - GABAminergic - Glutaminergic - Histaminergic - Serotonergic

Answer 454

Dopaminergic *L-Tyrosine (non-essential amino acid, can get in diet and also synthesized from phenylalanine) is converted by Tyrosine hydroxylase to L-Dihydroxyphenylalanine (L-DOPA) -> Dopamine is converted by dopamine hydroxylase to Norepinephrine -> Epinephrine What is the rate limiting step in the synthesis of norepinephrine? Tyrosine hydroxylase

Question 455

Which ethical principle, as elucidated in the Belmont Report, underlies the practice of informed consent?

Answer 455

Respect for persons

Question 456

The frequency of typical sexual behaviors (i.e. self-stimulation, exhibitionism, sexual intrusiveness) exhibited by children of both genders peaks at what age?

Answer 456

five years (Eliza Gray attack!; latter part of Freud's 3-6yo Phallic phase)

Question 457

Sleep spindle density most markedly decreases from middle age into old age in which of the following regions of the brain? - Motor and sensory cortex - Frontal and occipital lobes - Parietal lobes and association cortex - Extended amygdala and insula cortex - Medial temporal lobes and hippocampus

Answer 457

Frontal and occipital lobes

Question 458

In epigenetic histone protein amino acid residue modification, acetylation is generally rapid and ___.

Answer 458

reversible

Question 459

A breastfeeding patient taking sertraline wants to test her breast milk and the baby's blood for levels of the drug. The physician explains to the patient that testing is not indicated. The rationale is that evidence shows that infants are harmed more by having a ___ mother than being exposed to sertraline.

Answer 459

depressed

Question 460

A right-handed patient with a history of intractable seizures underwent neurosurgical treatment. In follow-up testing, the blindfolded patient was unable to name objects placed in the left hand, but had no difficulty naming the objects when they were displayed on a screen. What was the site of the surgical intervention? - Thalamus - Corpus callosum - Right parietal lobe - Left superior temporal lobe - Bilateral medial temporal lobes

Answer 460

Corpus callosum [The corpus callosum consists of a large bundle of fibers connecting the right and left hemispheres of the brain. Each hemisphere controls movement in the opposite (contralateral) side of the body and can also specialize in performing specific cognitive and perceptual functions. The corpus callosum allows information to move between hemispheres and is therefore a very important integrative structure.]

Question 461

Pramipexole is an effective first-line treatment for patients with ___ leg syndrome.

Answer 461

restless Pramipexole is a nonergot dopamine agonist with specificity for the D2 subfamily dopamine receptor and has also been shown to bind to D3 and D4 receptors. By binding to these receptors it is thought that pramipexole can stimulate dopamine activity on the nerves fo the striatum and substantia nigra.

Question 462

Degeneration of the dorsal nucleus of the thalamus and the mammillary bodies is found in which of the following disorders? - Wilson disease - Alzheimer disease - Parkinson disease - Huntington disease - Wernicke-Korsakoff syndrome

Answer 462

Wernicke-Korsakoff syndrome

Question 463

Which of the following psychosocial treatment modalities is most relevant and effective for the positive symptoms of schizophrenia? - Social skills training - Compliance therapy - Cognitive remediation - Supportive employment - Cognitive behavior therapy

Answer 463

Cognitive behavior therapy

Question 464

The ___ ___ ___ Test is used to measure concept formation and concept flexibility.

Answer 464

Wisconsin Card Sorting (Dorsolateral frontal cortex activated during shifting of cognitive sets) The Wisconsin Card Sorting Task measures the ability to generate alternative strategies in response to feedback.

Question 465

An example of a positive (health promoting) effect of the neuroinflammatory response is ___ propagation of cytokines with associated decreased physical activity in response to a peripheral infection.

Answer 465

microglial [Microglia secrete innate proinflammatory cytokines TNF-a and IL-1B in patients with inflammatory conditions that affect the brain.]

Question 466

What is the most prominent lobbying and support organization for families of people with severe psychiatric disorders?

Answer 466

National Alliance for the Mentally Ill (NAMI)

Question 467

Which of the following sleep changes is often seen in depressive disorders? - Decreased REM latency - Increase in total sleep time - Increase in slow-wave sleep - Decrease in nocturnal arousal - Decreased core body temperature

Answer 467

Decreased REM latency (this is seen in depressive disorders and in narcolepsy)

Question 468

Genetic deletion is involved in the development of ___ syndrome/DiGeorge syndrome/22q11.2 deletion syndrome.

Answer 468

velocardiofacial DiGeorge syndrome/22q11.2 deletion syndrome/ velocardiofacial syndrome is a syndrome caused by the deletion of a small segment of chromosome 22. It is characterized by developmental delay, cardiac abnormalities, palate defects, immune deficiency, and an increased risk of schizophrenia.

Question 469

Positron emission tomography scanning measures what?

Answer 469

Glucose metabolism | Glucose "PET"

Question 470

What proportion of the human genome comprises the "exome"?

Answer 470

2% [Exon: a segment of a DNA or RNA molecule containing information coding for a protein or peptide sequence]

Question 471

Pervasive and excessive emotionality and attention-seeking behaviors are the essential features of which personality disorder?

Answer 471

Histrionic (stuck in Freud's birth-1yo oral stage)

Question 472

A court has ordered the psychiatrist to complete a "competency to stand trial" evaluation for a person with a history of psychosis who was arrested for shoplifting. Which of the following questions is relevant to competency to stand trial in this scenario? - Can the person work effectively with counsel? - What was the person's intent at the time of the crime? - If actively psychotic, can the person make treatment decisions? - Was the person able to waive Miranda rights at the time of arrest? - At the time of the offense, did the person understand the illegality of the behavior?

Answer 472

Can the person work effectively with counsel?

Question 473

Guanfacine and clonidine are alpha-2 adrenergic ___.

Answer 473

agonists

Question 474

___ selectively inhibits the reuptake of norepinephrine with little to no activity at other neuronal reuptake pumps or receptor sites. Of note, it also increases SI and has a black box warning for this.

Answer 474

Atomoxetine

Question 475

Modafinil has been shown to significantly increase dopamine in the brain by blocking dopamine ___.

Answer 475

transporters

Question 476

Memantine is an uncompetitive antagonist of the N-methyl-D-aspartate (NMDA) type of ___ receptors, located ubiquitously throughout the brain.

Answer 476

glutamate

Question 477

A 70yo has fallen multiple times over the past five months. The pt's mental status is normal. Smooth pursuit and saccadic movements are impaired, more prominently for vertical gaze, but full range of motion is easily elicited by doll's head maneuvers. The patient has mild symmetric rigidity and bradykinesia. There is no tremor. A brain magnetic resonance imaging scan is unremarkable, as are the results of cerebrospinal fluid and routine laboratories including toxic drug screen. Which of the following is the most likely patient diagnosis? - Corticobasal degeneration - Olivopontocerebellar degeneration - Idiopathic Parkinson disease - Primary progressive aphasia - Progressive supranuclear palsy

Answer 477

Progressive supranuclear palsy

Question 478

The validity of an assessment instrument refers to the extent to which it measures what it ___ to measure.

Answer 478

intends

Question 479

The recognition of affective behavior by the mirror neuron system involves connections between the anterior mesial frontal cortex and the ___.

Answer 479

insula The insula is a small region of the cerebral cortex located deep within the lateral sulcus, which is a large fissure that separates the frontal and parietal lobes from the temporal lobe. Along with the medial pre-frontal cortex, the insula is involved in both fear conditioning and fear extinction.

Question 480

Obsessive-compulsive disorder is most commonly comorbid with: - schizophrenia - mood disorders - anxiety disorders - substance use disorders - trauma and stressor-related disorders

Answer 480

anxiety disorders

Question 481

During the stress response in humans, corticotropin-releasing hormone (CRH) is released from the ___ ___ of the hypothalamus.

Answer 481

Paraventricular nucleus

Question 482

The ___ regulates a wide range of behavioral and physiological activities. It controls many autonomic functions such as hunger, thirst, body temperature, and sexual activity. To do this, it integrates information from many different parts of the brain and is responsive to a variety of stimuli including light (it regulates circadian rhythms), odors (eg, pheremones), stress, and arousal (hypothalamic neurons release oxytocin directly into the bloodstream). Other functions it controls include parenting behavior, perspiration, blood pressure, and heart rate.

Answer 482

hypothalamus

Question 483

A patient's psychotic symptoms fail to respond to risperidone 8mg/day and lab testing shows drug levels below expected. Assuming medication adherence, genotyping for CYP450 polymorphism should reveal which of the following results? - Two copies of variant alleles - Two copies of wild-type alleles - Multiple copies of wild-type alleles - One wild-type and one variant allele

Answer 483

Multiple copies of wild-type alleles

Question 484

The physician should recommend that a child get a hearing test if the child is not able to make two-word sentences by what age?

Answer 484

2 years

Question 485

A researcher is contemplating a cross-over study in which study subjects serve as their own controls and participate in both arms of the treatment. This design is most likely to cause what aspect of the study to be increased? - Precision - Relative cost - Between-subject variation - Number of subjects recruited

Answer 485

Precision (the quality, condition, or fact of being exact and accurate.)

Question 486

What type of nicotininc acetylcholine receptor is most closely associated with the reward properties of nicotine?

Answer 486

a4B2 Varenicline activates a4B2 (alpha4beta2) receptors to a lesser extent than the full agonist nicotine and also prevents nicotine from binding to these receptors.

Question 487

After a child survives a natural disaster, which of the following social factors is most likely to be protective against developing post-traumatic symptoms? - The availability of peer support - Timely relocation to a safer location - Access to counseling and mental health services - Validation of the importance of the event through media coverage

Answer 487

The availability of peer support

Question 488

___ is the emotional reaction of the analyst to the subject's contribution.

Answer 488

Countertransference

Question 489

Detection of single nucleotide variants in rare genetic diseases is most likely to occur with which of the following types of genetic study? - Exome sequencing - DNA-protein analysis - Family-based linkage - RNA sequencing analysis

Answer 489

Exome sequencing | Exon: a segment of DNA or RNA molecule containing information coding for a protein or peptide sequence

Question 490

When a patient at the end of life requires a transition to a different care setting, presence of an ___ care person is associated with a better transition.

Answer 490

identified

Question 491

Which of the following individuals is most likely to have legal responsibility for a crime? - A 23yo who has "consensual sex" with a 15yo after the teen produced fake ID showing age of 20 - A 40yo with severe alcohol use disorder who robs a liquor store to obtain more vodka - A 45yo man with severe intellectual disability who steals a loaf of bread because his father demanded it - A 42yo actively psychotic woman who sets fire to the grass outside a church after being instructed to do so by voices in order to save the church from "el diablo"

Answer 491

A 40yo with severe alcohol use disorder who robs a liquor store to obtain more vodka

Question 492

A patient who takes olanzapine develops diabetes. Treating the patient with metformin is an example of what kind of prevention?

Answer 492

Tertiary (Methods to reduce the harm of symptomatic disease, such as disability or death, through rehabilitation and treatment)

Question 493

Secondary prevention involves methods to detect and address an existing disease ___ to the appearance of symptoms.

Answer 493

prior

Question 494

Which of the following methods examines the consistency with which genetic variants are passed from parent to offspring within different families? - Recombination - Linkage analysis - DNA sequencing - Genome-wide association studies

Answer 494

Linkage analysis Genetic linkage is the tendency of DNA sequences that are close together on a chromosome to be inherited together during the meiosis phase of sexual reproduction.

Question 495

A primary rationale for implementing collaborative care is that existing mental health care programs do not have the ___ to provide effective treatment to all patients in need.

Answer 495

capacity

Question 496

According to ___ ___, a child who perceives the mother as an integrated person who is responsible for both good and bad experiences at the same time is said to be in the depressive position.

Answer 496

Melanie Klein

Question 497

High voltage delta activity associated with slow eye-rolling movements on polysomnogram is characteristic of the ___ stage of sleep.

Answer 497

N3

Question 498

Intensive case management is defined as a program with elements of the assertive community treatment model, assertive outreach model, and case management model with a caseload of up to 20 patients. When compared to care as usual, the literature has shown which of the following effects of intensive case management? - Decreased death by suicide - Increased patient employment - Reduced length of hospitalization - Reduced incidence of metabolic syndrome

Answer 498

Reduced length of hospitalization