CAP BOARDS 3 Flashcards
(387 cards)
1
Q
What is the most characteristic defense mechanism of BPD?
A
Projective identification. When the patient projects unwanted or intolerable aspects of themselves onto another person and when they induce the other person to take on those characteristics and play the role the patient has assigned to them.
2
Q
Ketamine’s MOA is most similar to what substance?
A
PCP.
3
Q
Ketamine and PCP - MOA?
A
Block the NMDA receptor.
4
Q
Tx for edema 2/2 lithium?
A
Spironolactone 25 mg/day
5
Q
Tx for tremor 2/2 lithium? (2)
A
1) propranolol 10-30 mg TID
2) primidone (25-100 mg/day)
6
Q
Tx for polydipsia and polyuria 2/2 lithium? (2)
A
1) amiloride (5-20 mg/day)
2) hydrochlorothiazide (50 mg/day and use 1/2 the lithium dose)
7
Q
The IEP is reviewed and revised how often?
A
Once a year
8
Q
At what age should a child be able to walk up stairs with one hand held and run stiffly?
A
18 months
9
Q
At what age should a child be walking independently and crawl up stairs?
A
15 months
10
Q
Child should be able to walk up and down stairs, one step at a time. Age?
A
24 months
11
Q
Child should be able to go upstairs with alternating feet. Age?
A
30 months
12
Q
Child should be able to go up stairs with alternating feet and stand on one foot. Age?
A
36 months
13
Q
What does RADS stand for?
A
Reynolds Adolescent Depression Scale
14
Q
Adolescents from divorced families are how much more likely to abuse drugs?
A
2x
15
Q
Children of divorce have lower rates of what?
A
Higher education
16
Q
What is the standard of proof in a civil commitment case?
A
Clear and convincing
17
Q
What is the standard of proof in a malpractice case?
A
Preponderance of evidence
18
Q
Standard of proof in a criminal case?
A
Guilty beyond a reasonable doubt
19
Q
Separation anxiety is a normal developmental process commonly seen between what ages?
A
10-18 months
20
Q
Stranger anxiety is typically seen around what age?
A
8 months
21
Q
A drug takes how many half-lives to reach steady state?
A
4-5 half-lives
22
Q
The parent has requested a special education evaluation. In which time period must the evaluation be completed?
A
60 working days
23
Q
Does chlorpromazine lower the seizure threshold?
A
YES
24
Q
Chlorpromazine is FDA approved from children 12 months + for what?
A
for the treatment of severe behavioral problems in Children (1 to 12 years of age) marked by combativeness and/or explosive hyperexcitable behavior (out of proportion to immediate provocations), and in the short-term treatment of hyperactive children who show excessive motor activity with accompanying conduct disorders consisting of some or all of the following symptoms: impulsivity, difficulty sustaining attention, aggressivity, mood lability, and poor frustration tolerance.
25
Chlorpromazine causes what? especially when given IM?
Hypotension, BP should be monitored
26
100 mg chlorpromazine is = to how many mg of Haldol?
2 mg
27
What is the usual dose range for chlorpromazine?
50-600 mg
28
Chlorpromazine should be started at what dose in kids?
10-25 mg
29
An individual's personal sense of self as male or female
Gender identity
30
Defined as activities, interests, or other social attributes recognized as masculine or feminine.
Gender role bx
31
Sex of the person to whom an individual is erotically attracted.
Sexual orientation
32
A child is able to copy a circle, but not able to follow a 3 step command. Age?
Because she can draw a circle, she must be at least 3. Children who are 4+ can usually follow a 3 step command. She must be between 3-4 y/o.
33
The correlation of DV and child abuse is between what percents?
30-60%
34
2 family members join together and draw in or scapegoat a third family member to deflect tension. What is this?
Triangulation
35
Perpetrators of Munchausen syndrome bt proxy are most likely to have a history of what? (6)
Factitious disorder, somatoform disorders, child abuse or neglect, self-harm bxs, substance use, and/or criminal activity.
36
What age or range is covered by the Individuals with Disabilities Education Act (IDEA)?
Birth to 21
37
Tx for topiramate overdose?
Dialysis
38
Sxs of topiramate overdose?
Severe lethargy, confusion, impaired vision, significant metabolic acidosis.
39
Initial GI side effects of topiramate?
Nausea, anorexia, dyspepsia, diarrhea
40
What cell type is responsible for cleaning debris in the CNS?
Microglia (clean up cells - macrophages - in the brain)
As the resident macrophage cells, they act as the first and main form of active immune defense in the central nervous system (CNS).
41
A child is displaying mastery of Piaget's concept of conservation. At what stage is this child?
Concrete operational stage
42
16M w ASD - irritability, agitation, aggression, and self-injurious bxs. Ist line therapy?
Applied behavioral anaylsis (ABA)
43
How is NNT calculated?
1/(Absolute Risk Reduction) = 1/(control event rate-experimental event rate)
44
How is Absolute Risk Reduction calculated?
Subtracting the experimental event rate (the rate of illness in active tx) - control rate (rate of illness in placebo)
45
Neuroimaging changes found in patients with PTSD? (3)
1) increased activation of the amygdala
2) deactivation in medial prefrontal cortex (mPFC) region - higher order memory and decision making
3) decreased hippocampal activation
46
14M is discharged on carbamazepine after admission for acute mania - about 4 weeks later, he is manic again despite no change in dose. Cause?
1) Autoinduction (CYP 3A4 and 2B6)
| It is usually complete 3-5 wks after the initiation of a fixed dose
47
Carbamazepine + grape fruit juice or food?
Serum levels may INCREASE
48
Carbamazepine + Cimetidine?
Serum concentration INCREASES
49
Carbamazepine + erythromycin?
Serum concentration increases
50
```
Serum electrolytes 2/2 diuretics
Sodium:
K+
Cl-
bicarbonate
pH
```
```
Sodium: decreased or normal
K+: decreased
Cl-: decreased
bicarbonate: increased
pH: increased
```
51
40 item screen to identify patients who require more in-depth screening for substance use disorders
Personal Experience Screening Questionnaire (PESQ)
52
139-item survey looking at 10 functional areas including substance use and abuse
Problem-Oriented Screening Instrument for Teenagers (POSIT)
53
159 item survey that covers various drugs and the consequences of their use
Drug Use screening Inventory-Adolescents (DUSI-A)
54
6-item brief screen designed for use in primary care settings. It is a behavioral health screening tool used w adolescents who may have simultaneous risky alcohol and other drug use disorders.
CRAFFT:
| Car, relax, alone, forget, friends, trouble
55
CRAFFT: 6-item brief screen designed for use in primary care settings. It is a behavioral health screening tool used w adolescents who may have simultaneous risky alcohol and other drug use disorders. What do the letters stand for?
Car, relax, alone, forget, friends, trouble
56
Who developed the concepts assimilation and accommodation?
Piaget
57
Refers to how individuals take in new information and incorporate it into existing ideas.
Assimilation
58
A less complex way to adapt to new information and essentially involves reinterpreting a new experience and making it fit with previously acquired information
Accommodation
59
Who postulated that the inner life of the infant was rich with aggressive and sexual fantasies.
Melanie Klein
60
Concept developed by Melanie Klein - used to make mental repairs to a damaged inner world and is a key part of moving from the paranoid-schizoid position into the depressive position.
Reparation
61
Child can walk alone (even crawl up stairs), make a tower with 3 cubes, follow simple 1 step commands, and indicate needs and desires by pointing. Age?
12 months
62
Child is able to sit up alone, indefinitely, without support. He is able to pull himself up to a standing position and move from chair to chair in this fashion but cannot walk without the physician holding his hand. He cries when his mother leaves the room. He makes sounds "mama"and "dada" but it is not clear whether he means anything by them. He can play pat-a-cake and wave goodbye. He does not have maxillary and mandibular central and lateral incisors. Age?
9 months
63
16M presents to ED w elevated temperature, sweats, and myoclonus. He is taking citalopram. What substance did this youth likely abuse?
Ecstasy/MDMA (Serotonin syndrome)
64
Conflict between wanting to stay with the mother and being emotionally close and yet wanting to be more independent and exploring. This phase is characterized by dissatisfaction, insatiability, tantrums, and ambivalence.
Rapprochement crisis
65
Rapprochement crisis: Conflict between wanting to stay with the mother and being emotionally close and yet wanting to be more independent and exploring. This phase is characterized by dissatisfaction, insatiability, tantrums, and ambivalence. Age? (Margaret Mahler)
18-22 months
66
According to Mahler, the nl autistic phase is seen when?
The first few weeks of life
67
According to Mahler, The nl symbiotic phase lasts until about when?
5 months
68
According to Mahler, at this point, the child is now aware of his/her mother but has no sense of individuality
Symbiotic phase
69
Leiter test - age range?
2-20 years
70
CBCL can be given to who?
teacher, parent,and child if old enough
71
WISC - age range?
6-16
72
Which test is tailored to work in line with the Individuals w Disabilities Education Act? It is often used in school-based assessments.
BASC-2
73
WIAT - indicated for ages ?
4-85
74
Dose range for clonidine?
0.1-0.4 mg per day
75
this medication binds alpha-2 autoreceptors and suppresses activity of the locus coeruleus
Clonidine
76
Clonidine binds what?
alpha-2 autoreceptors
77
Clonidine: binds alpha-2 autoreceptors and suppresses activity of the?
Locus coeruleus
78
Although this medication does not have FDA approval, it has become a widely accepted alternative to methadone taper.
Clonidine
79
A mother brings her 29-month old boy for initial evaluation of aggression. The child has been striking other children at his daycare. What rating scale is best suited to survey social and emotional disturbance broadly in this child?
ASQ-SE: The ages and stages questionnaire-social emotional.
19-33 item parent report form targeted at ages 6-30 months.
80
19-33 item parent report form targeted at ages 6-30 months. It is a broad-based screen for social and emotional disturbances in young children.
ASQ-SE: The ages and stages questionnaire-social emotional.
81
Scale normed down to the age of 2.5 (parent report's from age 2.5-6) and consists of 35-45 items assessing broadly for anxiety - panic, social anxiety, separation anxiety, generalized anxiety, obsessions and compulsions, and fear of physical injury.
Ages?
Spence Children's Anxiety Scale
2.5-6
8-15
82
17 question scale with items rated 1 to 7 indicating more severe symptoms.
Children's Depression Rating Scale - Revised (CDRS-R)
83
41 item scale assessing overall anxiety - generalized, social phobia, panic disorder, and separation anxiety.
Self-Report for Childhood Anxiety Related Emotional Disorders (SCARED)
84
Does the SCARED screen for PTSD or OCD?
No
85
20-item scale normed for children aged 7+. It assesses exposure to traumatic experiences and the impact of traumatic events.
UCLA-PTSRI
86
The UCLA-PTSRI for PTSD - age range?
7+
87
Imipramine has FDA approval for what in children?
Enuresis in children 6 years +
88
Why is imipramine generally not rx'd to kids?
Cardiac toxicity.
Needs screening EKG and you need to review family history closely.
89
which medication used to tx enuresis has a well known discontinuation syndrome and should be slowly tapered off?
Imipramine
90
According to Ainsworth, what percent of infants had a secure attachment pattern?
70%
91
How much time (%) is spent in sleep stage 2?
Makes up 50% of the sleep episode
92
A comorbid psychiatric disorder is present in what percent of people with internet addiction?
80% (most commonly ADHD, anxiety, depression)
93
What therapy has the most evidence to support its use in the tx of children with PTSD?
TF-CBT
94
14F w elated mood, racing thoughts, restlessness, and agitation after attending a party. She reports seeing halos around objects and flashes of colors, as well as hearing the voices of her dead grandparents. PE notable for tachycardia, HTN, dilated pupils, and tremor. Drug?
LSD (usually ingested as a solution or dissolved on paper or sugar cubes).
95
What substance is usually ingested as a solution or dissolved on paper or sugar cubes.
LSD
96
What substance has no physical dependence or w/d? But does have psychological dependence...
LSD
97
Side effects of this substance include elevated HR and BP, tense or chattering jaw, and body warmth and/or chills.
Ecstasy
98
This substance causes increased HR and BP, sweating, flushing, numbness, delirum, and a blank stare
PCP
99
A boy is able to leave the room that his mother is in and play with toys by himself for half an hour. He then returns to see his mother, appearing calm. Which developmental sub-stage is this child most likely in, according to Mahler?
Object constancy
100
Object constancy: 4th and final stage, according to Mahler. A boy is able to leave the room that his mother is in and play with toys by himself for half an hour. He then returns to see his mother, appearing calm. Age?
Starts around 24 months
101
At what age does rapprochement start?
15 months
102
According to Mahler, when does the practicing stage start?
9-16 months
103
According to Mahler, when does the hatching stage occur?
5-9 months
104
What is the lifetime suicide attempt rate in patients with body dysmorphic disorder?
22-24%
105
What percent of infants have an "easy temperament"?
40%
106
What percent of infants have an "difficult temperament"?
10%
107
What percent of infants have an "slow-to-warm up temperament"?
15%
108
Lithium during pregnancy - risk of Ebstein's anomaly?
1 per 2000
109
Lithium during pregnancy - risks?
Ebstein's anomaly, cleft palate, and fetal loss
110
Minuchin's structural family therapy emphasizes the role of ?
Structural family imbalances
111
What factors predict future development of mania in depressed youth? (4)
1) H/o hypomania after tx w antidepressants
2) fhx of bipolar
3) depressive episode characterized by rapid-onset PMR
4) depression w psychotic features
112
What genetic syndrome is caused by paternal deletion or maternal uniparental disomy of chr. 15q11.13?
Prader-Willi syndrome
113
Gross motor development progresses in a ? sequence?
Cephalocaudal
114
Fine motor development progresses from ? to ?
Midline to lateral.
115
What is the worst pre-divorce outcome prognostic factor?
Parental disharmony prior to the divorce
116
The child is able to understand the conservation of mass. Stage?
Concrete operations
117
The child is able to understand the conservation of mass. Age?
7-12 y/o. Concrete operations
118
According to Mahler, an infant a few months old is aware of his/her mother but believes that he/she is part of the mother, with no real distinction between them. What is this developmental phase termed?
Normal symbiotic phase
Few weeks - 5 months in age
119
After the normal symbiotic phase, the child begins the process of ?
separation-individuation = hatching, practicing, and rapprochement
120
What type of study is good at determining cause and effect?
Longitudinal studies
The benefit of a longitudinal study is that researchers are able to detect developments or changes in the characteristics of the target population at both the group and the individual level. The key here is that longitudinal studies extend beyond a single moment in time. As a result, they can establish sequences of events.
121
Autism is dx'd in what percent of individuals w fragile X?
20-30%
122
Autism in patients dx'd with fragile X is due to what two things?
1) excessive mGluR5
| 2) GABA-A neurotransmission
123
Facts of females that carry the fragile X gene abnormality? (2)
1) they may have cognitive disabilities
| 2) they carry the gene abnormality more frequently than males
124
What percent of females who carry the fragile X gene abnormality have decreased intelligence?
33%. IQ is typically 35-70
Affected patients can have learning disabilities, aggressive tendencies, and decreasing IQ with increasing age
125
Where is the abnormality in fragile X located?
The long arm of the X chromosome at the q27 site (FMR1 gene).
126
Common physical features include an elongated face and ears and large testes. Dx?
Fragile X
127
Wilson's disease - inheritance pattern?
Autosomal recessive
128
Sturge-Weber syndrome - inheritance pattern?
sporadic
129
? syndrome is caused by a mutation on chr. 3 and is inherited in anautosomal dominant pattern. It causes blood vessel tumors (hemangioblastomas) throughout the body, including the brain.
Von Hippel-Lindau
130
Von Hippel-Lindau syndrome is caused by a mutation on chr. ? and is inherited in anautosomal dominant pattern. It causes blood vessel tumors (hemangioblastomas) throughout the body, including the brain.
3
131
Syndrome among individuals of Latino descent, characterized by symptoms of intense emotional upset, including acute anxiety, anger, or grief; screaming and shouting uncontrollably; attacks of crying; trembling; heat in the chest rising into the head; and becoming verbally and physically aggressive. Dissociative experiences (e.g., depersonalization, derealization, amnesia), seizure-like or fainting episodes, and suicidal gestures are sometimes prominent. A general feature is a sense of being out of control.
Ataque de nervios
132
Second-generation children of immigrants are typically at higher risk for what? (3)
PTSD, anxiety,and substance use
133
Who displays more emotional reactivity in depression - whites or asians?
Asians
134
A physician religiously checks her email throughout the day to monitor for important messages. Under what kind of operant conditioning schedule is she behaving?
Variable interval (provides reinforcement for responses that occur after varying amts of time.
The reinforcement (having a new message in the inbox) does not occur with each check but varies with time
135
This type of schedule provides reinforcement after varying amts of time, regardless of whether a bx is performed.
Variable time
136
Interval scheduling tends to produce slower response rates that ratio schedules - why?
Because of the more indirect relationship between the bx and response.
137
MTA study is for what dx?
adhd
138
Duration of the MTA study looking at ADHD tx?
14 months
139
MTA study looking at ADHD - what benefits were seen in the combined tx group? (2)
1) lower doses of meds
| 2) increased functioning (anxiety, academic performance, parent-child relationships, and social skills)
140
MTA study looking at ADHD - the combined group they saw an increase in functioning - what 2 things improved the most?
Academic performance and family relations
141
MTA study looking at ADHD - Children who received medication tx grew on average how much less?
2 cm (over 14 months)
142
MTA study looking at ADHD - children who received med tx gained how much less?
3 kg (over 14 months)
143
SSRI vs placebo. Placebo response rate?
50%
144
SSRI vs placebo. SSRI response rate?
61%
145
SSRI vs placebo. Placebo response rate? = 50% and the SSRI response rate was 61%. What is the NNT?
10
146
What is the meaning of a p-value of 0.05?
95% probability that the observed result is due to the tested variable (5% will incorrectly reject the null hypothesis = hypothesis that there is no significant difference between specified populations, any observed difference being due to sampling or experimental error)
147
The probability that the observed result has nothing to do with what is being tested.
P-value
148
A small p-value indicates what?
Strong evidence against the null hypothesis = hypothesis that there is no significant difference between specified populations, any observed difference being due to sampling or experimental error
149
What is the null hypothesis?
Hypothesis of no effect, correlation, or association
150
In Wilson's disease, what builds up in the body?
Copper
151
15F is struggling academically, particularly in reading. She has been failing her reading tests despite trying to read on a daily basis with her parents at home. First step test?
WISC =to measure cognitive functioning to determine whether the individual is functioning in the average range or higher of intelligence
152
What is the Children's Apperception Test (CAT)?
Projective test
153
Why must drugs be given at shorter intervals in children?
They have a higher metabolic capacity
154
More efficient renal elimination - children or adults?
Children
155
Greater volume of extracellular water - children or adults?
Children.
156
Why do children have a lower plasma concentration of lithium compared to adults?
Children have a greater volume of extracellular water. Lithium distributes to total body water.
157
The lower content of adipose tissue in children results in what?
A larger concentration of lipophilic drugs when given the same weight-adjusted dose as adults.
158
Onset of PCP intoxication?
1-2 hours
159
peak of PCP intoxication?
2-4 hours
160
Duration of effect for PCP?
8-12 hours.
161
Intoxication of this substance can manifest by bx changes (impulsiveness, unpredictability, PMA, impaired judgement, assaultiveness). PE = HTN, tachycardia, diminished pain sensation, ataxia, dysarthria, muscle rigidity, seizures, vertical nystagmus.
PCP
162
7 y/o presents w frequent seizures, persistent rash on her face. On imaging, she has numerous growths in several organs, including her brain. She was previously dx'd with autism. Dx?
Tuberous sclerosis
163
when does an infant develop object permanence?
9 months.
164
Which testing instrument is designed to test attentional capacity?
Wisconsin Card-Sorting Test
165
Scale used to assess a child's motor development and ability to perform ADLs.
Vineland Adaptive Bx Scales
166
Used to assess a child's language and communication milestones.
Mullen Scales of Early Learning
167
What group had a higher risk of psychiatric illness after the death of their parent?
Adolescent boys
168
During which of Piaget's stages is a child able to arrange things alphabetically?
Concrete operational stage
169
Characteristics of this stage include conservation, decentration, reversibility, hierarchical classification, and spatial operations.
Concrete operational stage
170
A child is referred who was tested as having "low IQ" by a school psychologist using the WISC. What assessment would help to dx ID? (3 options)
1) Vineland
2) Woodcock-Johnson Scales of Independent Bx
3) Diagnostic Adaptive Bx Scale
To make a dx of ID, a low IQ test is needed as well as a test demonstrating poor adaptive functioning.
171
This scale was designed to assess handicapped and non-handicapped persons from birth to adulthood (age 19) in their personal and social functioning. The test is not administered directly to the child. Instead, questions are directed to primary caregivers and other people familiar with the child
Vineland Adaptive Bx Scale
172
What does "Russell's sign" involve?
Scars and abrasions that are often present on the hands of anorexic and bulimic patients who vomit frequently
173
Some physicians follow serum levels of what in order to assess binging?
Amylase levels
174
Metabolic issues in bulimia? (3)
1) hypokalemic alkalosis
2) elevated bicarb
3) hypochloremia
175
For a psychiatrist to be found liable for negligence, there must be a ? established
preponderance of evidence (greater than 50% chance that the claim is true)
176
What is responsible for the pathogenesis of refeeding syndrome?
Low levels of phosphate
177
AN = depletion of ? stores due to starvation
phosphate
178
when refeeding starts, insulin triggers the uptake of what?
Phosphate, from a depleted system
179
when refeeding starts, insulin triggers the uptake of phosphate, what is dependent of phosphate?
ATP.
180
when refeeding starts, insulin triggers the uptake of phosphate, which is depleted. Depleted sources of ATP (dependent on phosphate) in the myocardium results in what?
Tissue hypoxia and cardiorespiratory dysfunction or failure.
181
In a patient with AN, a change from bradycardia to a nl HR is considered what?
relative tachycardia
182
In a patient with AN, a change from bradycardia to a nl HR is considered relative tachycardia. Tx in the s/o refeeding?
requires emergent medical evaluation as this may be the early signs of heart failure d/t refeeding syndrome.
183
refeeding syndrome is caused by electrolyte and fluid shifts and is marked by? (5)
1) hypophosphatemia
2) hypokalemia
3) hypomagnesemia
4) volume overload
5) edema
184
Children with ADHD qualify for an IEP under what category?
Other health impairment
185
The lower limit of bl for intellectual function tests is considered how many SDs below the mean?
2
186
In children w ID, what is among the earliest presenting sxs?
Language delay
187
What is typically preserved in patients with ID?
Gross motor skills
188
this involves a change to existing thought patterns
Accommodation
189
This involves fitting new information into existing thought patterns
Assimilation
190
Means taking in new information and altering preconceived ideas to fit around it
Accommodation
191
Describes how humans take in new information and process it in light of what they have already learned before
Assimilation
192
Cognitive impairment in DiGeorge syndrome?
can vary from learning disabilities and mild ID to severe MR.
193
the prevalence of psychosis in patients with DiGeorge syndrome ?
30%
194
Deletion in DiGeorge syndrome?
22q11
195
Child understands reversibility - capacity to understand the relation between things, to realize that one thing can turn into another and back again - stage?
Concrete operations (7-11)
196
A child can see things from someone else's perspective. Stage?
Concrete operations (7-11)
197
Child believes that punishment for bad deeds is inevitable. Stage?
Preoperational thought (2-7)
198
Phenomenalistic Causality - events that occur together are thought to cause one another - is seen in what stage?
Preoperational thought (2-7)
199
What percent of patients with pervasive developmental disorder also have ID?
70-80%
200
Descriptive term for below-average intelligence and impaired adaptive functioning that is initially noticed during the developmental period (<18 yrs)
ID
201
What is one of the earliest signs of ID?
Language delays, expressive (speech) and receptive (understanding)
202
A 13 student identified as having a disability causes severe disruption at school. The child cannot be expelled until what is completed?
Manifestation determination: assessment of whether a child's disruptive bx was caused by a disability. If so, then the bx is considered a "manifestation" of the disability, and the child has increased protection and usually cannot be suspended or expelled because of it.
203
This type of therapy focuses on the patient's home/family, school/teachers, neighbors/friends. It has evidence for the use in conduct disorder.
Multisystemic therapy (MST)
204
Clonidine reduces what to a greater extent - hyperactivity or inattentive sxs?
Hyperactivity
205
What is the most widely accepted instrument for evaluating development in infants and toddlers?
Bayley-III: It evaluates cognitive, langauge, motor, adaptive bx, and social-emotional domains.
206
When does Piaget's final stage begin?
Age 11 (Formal operations)
207
The MTA study indicated that in the combo tx group what improved compared to meds or bx tx alone? (4)
1) anxiety sxs
2) academic performance
3) parent-child relations
4) social skills
208
Polysomnography is required prior to the multiple sleep latency test, which is performed to evaluate the presence of pathologic sleepiness. Describe the multiple sleep latency test.
The multiple sleep latency test (MSLT) tests for excessive daytime sleepiness by measuring how quickly you fall asleep in a quiet environment during the day. Also known as a daytime nap study, the MSLT is the standard tool used to diagnose narcolepsy and idiopathic hypersomnia.
The MSLT is a full-day test that consists of five scheduled naps separated by two-hour breaks. During each nap trial, you will lie quietly in bed and try to go to sleep. Once the lights go off, the test will measure how long it takes for you to fall asleep. You will be awakened after sleeping 15 minutes. If you do not fall asleep within 20 minutes, the nap trial will end.
209
Unidimensional rating scale used to evaluate overall functioning in children?
Children's Global Assessment Scale. It summarizes the individual's level of functioning based on hx, symptomatology, and behaviors across settings.
210
MCHAT is used to evaluate what?
Autism (Modified Checklist for Autism in Toddlers)
211
5 y/o boy is attempting to sit quietly next to his father at church. He is struggling to refrain from the impulse to shout to his older sister, who is in the church choir, as he is concerned about getting into trouble with his father. According to Kohlberg, what stage is this boy in?
Premoral stage: the child is responsive to cultural rules but complies for the sake of self-interest to avoid negative consequences from authority figures.
212
Of substantiated child maltreatment - % 2/2 neglect?
60%
213
Of substantiated child maltreatment - % 2/2 physical abuse?
20%
214
Of substantiated child maltreatment - % 2/2 sexual abuse?
10%
215
2 month old baby is on the changing table when his older sister suddenly starts playing with her toy drums to show her mother what she learned. The baby reacts by flexing his thights and knees and moving his arms outward and then bringing them together. What is this neonatal reflex?
Moro.
216
At what age does the Moro reflex disappear?
3-4 months
217
Absence of the Moro reflex before age 4 bilaterally suggests what?
damage to the brain or spinal cord
218
Absence of the Moro reflex before age 4 on one side suggests what?
Broken shoulder bone or brachial plexus injury
219
Defined as "perseverance and passion for long-term goals"
Grit
220
Which mood stabilizer may be better than lithium when treating rapid-cyclers and mixed episodes? It is also the preferred medication when treating interictal psychosis and mood sxs 2/2 temporal lobe epilepsy. It can be used in the management of bx outbursts and w/d of benzos or alcohol.
Carbamazepine
221
Is weight gain a common side effect of carbamazepine?
YES
222
Is SIADH a possible side effect of carbamazepine?
YES
223
What percent of patients taking carbamazepine have elevated LFTs?
5-15%
224
In patients taking carbamazepine - what can you do if they get elevated LFTs, leukopenia, or thrombocytopenia?
Decreasing the dose can often resolve these things
225
After the first psychotic episode, what percent of patients will experience a benign course?
33%
The other 66% relapse, fail to recover, or are rehospitalized in the first 2 years
226
What type of imaging can more precisely visualize a seizure focus?
PET scan
227
41-item scale assessing overall anxiety and can be subcategorized for specific anxieties such as generalized anxiety, social phobia, panic disorder, and separation anxiety.
Self-Report for Childhood Anxiety-Related Emotional Disorders (SCARED)
228
1-item clinician rating scale that assesses the overall severity of disturbance and impact on global functioning.
Children's Global Assessment Scale (C-GAS)
229
Clinician-administered instrument that assesses the frequency, severity, and impairment of childhood anxiety disorders. It is composed of 50 items rated on a 6-point scale to denote severity.
Pediatric Anxiety Rating Scale (PARS)
230
36-item scale used to assess the intensity and frequency of aggression and externalizing bxs as well as sxs of ADHD in children age 2-16. This scale was utilized to measure outcomes in PCIT.
Eyberg Child Bx Inventory (ECBI)
231
Eyberg Child Bx Inventory (ECBI): 36-item scale used to assess the intensity and frequency of aggression and externalizing bxs as well as sxs of ADHD in children age ? This scale was utilized to measure outcomes in PCIT.
2-16
232
Preferred tx for internet gaming disorder?
Behavioral tx
233
Behavioral tx is first line tx for internet gaming disorder. What medications have the most evidence? (3)
1) Bupropion
2) Methyphenidate
3) Escitalopram (Lexapro)
234
What percentage of youth who have had a homosexual experience identified themselves as gay?
27.1%
235
The CRAFFT is a behavioral health screening tool for children under age 21. C stands for?
CAR: have you ever ridden in a CAR driven by someone (including yourself) who was "high" or had been using alcohol or drugs?
236
The CRAFFT is a behavioral health screening tool for children under age 21. R stands for?
Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?
237
The CRAFFT is a behavioral health screening tool for children under age 21. A stands for?
Do you ever use alcohol/drugs while you are by yourself ALONE?
238
The CRAFFT is a behavioral health screening tool for children under age 21. FF stands for?
Do your FAMILY or FRIENDS ever tell you that you should cut down on your drinking or drug use?
Do you ever FORGET things you did while using alcohol or drugs?
239
The CRAFFT is a behavioral health screening tool for children under age 21. T stands for?
Have you gotten into TROUBLE while you were using alcohol or drugs?
240
Quantifier of non-specific psychological distress. It is a 6-item inventory rated on a 5 point Likert-type scale. Its a truncated version of the K-10 and its purpose is also to function as a global measure of distress drawing from depressive and anxiety related symptomology. It measures distress over a period of four weeks prior to administration of the test.
Kessler 6 (K6)
241
10-item screening tool developed by the WHO for adults. A score of 8 or more positive items indicates hazardous or risky drinking.
Alcohol Use Disorders Identification test (AUDIT)
242
10-item brief screening tool adapted from the 28-item tool. It can be self-administered or administered by a clinician and typically used for screening adults and older youth.
Drug Abuse Screening Test (DAST-10)
243
3 y/o boy successfully goes to the bathroom on his potty. He stands up and exclaims "Look! I did it mommy!" Which basic conflict describes this child?
Autnomy vs. shame and doubt (18 months to 3 years)
244
Which stage of sleep occupies the longest portion of the total sleep episode in children ages 3-12 years?
Stage 2.
245
How many stages of sleep are there?
REM + 1-4 non-REM sleep stages.
246
How much time (%) is spent in sleep stage 1?
5% of total sleep in a transition phase
247
What sleep stage gives sleep spindles and K complexes on EEG?
Stage 2
248
How much time (%) is spent in sleep stage 3/4?
"slow-wave" sleep that composes 10-20% of sleep time
249
How much time (%) is spent in REM sleep?
20-25% of sleep and includes dreams
250
What sleep stage gives "slow-wave" sleep
stage 3/4
251
The MTA study (ADHD) looked at about 600 kids aged?
7-9
252
What percentage of children reach adulthood with an intact family?
45%
253
By the time children have reached 15-17, what percent of teens have parents who have rejected each other, either through non-marriage or separation/divorce?
55%
254
Autonomic phenomenon, a condition in which the pupils alternately dilate and contract with a rhythmic pattern and can be a sign of seizure.
Hippus
255
This phenomenon, while possibly normal, can also indicate subclinical or continuing seizure or possible recurrence.
Hippus
256
Rapid saccadic movement of the eyes in horizontal or vertical planes. It has been associated with neuroblastoma in children.
Opsoclonus
257
The most common DSM-IV diagnosis among the Fragile X boys is ?
ADHD (73%), followed by anxiety disorder
258
Autism is diagnosed in what percent of individuals with fragile X syndrome?
20-30%
259
Starting an antipsychotic - fasting lipid panel?
Baseline and at 12 weeks
260
Starting an antipsychotic - glucose?
baseline and at 12 weeks
261
Starting an antipsychotic - BMI?
Baseline, 4, 8, 12 weeks
262
Conduct disorder = persistent and repetitive bx in which the patient violates the basic rights of others. How many criterion need to be diagnosed in 6 months?
1
263
Conduct disorder = persistent and repetitive bx in which the patient violates the basic rights of others. How many criterion need to be diagnosed in 12 months?
3 out of 15 (minimum)
264
What percent of teens have experimented with inhalants? (using at least once)
11 % (12th graders) - 17% (8th graders)
265
Inhalant use accounts for ?% of all substance-related deaths.
1%
266
Inhalants are CNS depressants and enhance ? system?
GABA system
267
Projective test that presents open-ended, ambiguous prompts (usually a drawing) and lets the user project personal thoughts and feelings when interpreting the prompt.
Thematic Apperception Test (TAT)
268
This assessment is often used in school-based assessments since its tailored to work with the Individuals w Disabilities Education Act. It asks for parent, teacher, and self-ratings, which may be a distinguishing feature, and is used for ages 2-21.
Bx Assessment System for Children (BASC)
269
Bx Assessment System for Children (BASC) - age range?
2-21
270
PTSD is more common in boys or girls?
Girls
271
Panic attacks in the immediate aftermath of a disaster constitute a risk factor for what?
PTSD
272
Delayed evacuation is a risk factor for what?
PTSD
273
The presence of a pre-disaster anxiety disorder is a risk factor for what?
PTSD
274
After chronic use, antihistamines should be tapered slowly d/t the risk of what?
Cholingeric rebound.
275
Contraindications of antihistamines include: (4)
Narrow-angle glaucoma, urinary outlet obstruction, GI obstruction, and known hypersensitivities
276
Sleep agents for insomnia? (3)
Clonidine, trazodone, or mirtazapine.
Antihistamines should only be used short term < 4 months.
277
What is discrete trial training (DTT)?
A method of teaching in simplified and structured steps.
278
Systemic approach to developing a program for each child. Steps include evaluating a child's strengths and weaknessness, identifying educational and treatment goals, and applying techniques for skill development.
Applied behavioral analysis (ABA)
279
Discrete trial training (DTT) is used with what?
Applied behavioral analysis (ABA)
A method of teaching in simplified and structured steps.
280
What is one of the earliest and most specific sxs of conduct disorder?
Animal cruelty
281
Prevalence of conduct disorder?
2-10% (median 4%)
282
What percentage of children have had at least one episode of sleepwalking?
10-30%
283
Suicide attempt risk triples in adolescents and young adults who sleep < ? hrs per night?
8
284
Parental-set bedtimes of 10 PM oe earlier result in lower incidence of what?
depression and SI
285
What percent of teens had sleepiness that resulted in a MVA?
10%
286
Several hundred children will be followed for 10 years to assess the occurrence of ADHD compared to the geographic latutude of the city in which they lived. What kind of study design is this?
Cohort study: follows individuals exposed to varying levels of an environmental factor such as a pollutant, varying levels of tx or drugs, or different geographic latitudes.
287
This type of study can be both prospective and retrospective
Cohort study: follows individuals exposed to varying levels of an environmental factor such as a pollutant, varying levels of tx or drugs, or different geographic latitudes.
288
There are three major types of longitudinal studies:
Panel Study: Involves sampling a cross-section of individuals, and collect repeated measures from the same sample at different points in time.
Cohort Study: Involves selecting a group based on a specific event such as birth, geographic location or historical experience.
Retrospective Study: Involves looking to the past by looking at historical information such as medical records.
289
Where are ECT electrodes typically placed to minimize cognitive effects?
Unilateral, non-dominant hemisphere
290
What is the most common reason for child psych consultation in the hospital?
SI
291
% of HS girls who experience SI?
25%
292
% of HS boys who experience SI?
17%
293
An examiner takes a stack of 10 cards and shows them t a child, telling him how many are in the deck. he then spreads them out over the floor. The examiner asks the child how many cards are on the floor. The child is quickly able to state that there are still 10 cards. Cognitive stage?
Concrete operational (7-11 years)
294
During this stage, objects and materials must be described in concrete terms in order to be understood/
Preoperational stage (2-7 years of age)
295
Vomiting - sodium?
Increased, decreased, or nl
296
vomiting - K+?
Decreased
297
Vomiting - Cl-?
Decreased
298
Vomiting - bicarbonate?
Increased
299
Vomiting - pH?
Increased
300
Cl- is only increased in what?
Laxative use. It can be increased or decreased
301
Greatest risk of suicide re-attempt occurs when?
3 months after initial attempt
302
Following SA, the reattempt rate ranges from ?per year
6-15%
303
patients who have first degree relatives who have completed suicide have a ?x greater risk of SA
4-5
304
The formal operational stage of Piaget's developmental stages begins when?
Age 12 and lasts into adulthood
305
This therapy can be effective in addressing self-injurious bxs in patients with autism by evaluating the functional role of the bx and implementing reinforcement strategies to extinguish the bx.
ABA
306
Parents request a special education evaluation. The school refuses the request. What should the parents do?
Appeal the decision
307
A child presents with ADHD and OCD. What dx is likely also present in this patient?
Tics.
308
In children with tic disorders, what percent have comorbid ADHD?
60-70%
309
Newborns spend about what percent of their sleep in a stage of sleep resembling REM?
50%
310
? waves are most prominent in the sleep of newborns.
delta
311
The proportion of people with the disease who test positive. How often the test correctly identifies a disease.
Sensitivity.
312
Sensitivity =
[+test/disease present]/Disease present
313
Specificity =
[-test/disease absent]/Disease absent
314
PPV =
[+test/disease present]/[Total test positive]
315
NPV =
[-test/disease absent]/[total test negative]
316
14M is noted by his teachers to struggle with reading, he is below the 10th percentile for his age. IQ = 100. What is the most likely dx?
Specific learning disorder
317
Specific learning disorder - problem must be present for at least how long?
6 months
318
Specific learning disorder combines what DSM 4 dxs? (4)
Reading d/o, mathematics d/o, d/o of written expression, and learning d/o NOS
319
Stage birth - birth to 1 year
Freud =
Erikson =
Piaget =
```
Freud = oral (birth - 18 months)
Erikson = trust vs mistrust (birth to 1 year)
Piaget = Sensorimotor (birth to 2 years)
```
320
Stage - 1 to 3 year
Freud =
Erikson =
Piaget =
```
Freud = oral (birth - 18 months), anal (18 months to 3 yrs)
Erikson = autonomy vs shame and doubt (1-3 yrs)
Piaget = Sensorimotor (birth to 2 years), preoperational (2-7 yrs)
```
321
Stage - 3 to 5 year
Freud =
Erikson =
Piaget =
```
Freud = phallic (3-5 yrs)
Erickson = initiative vs guilty (3-6 yrs)
Piaget = Preoperational (2-7 yrs)
```
322
Stage - 5 to 7 year
Freud =
Erikson =
Piaget =
```
Freud = latency (5-12 yrs)
Erickson = initiative vs guilty (3-6 yrs), industry vs inferiority (6-12 yrs)
Piaget = Preoperational (2-7 yrs)
```
323
Stage - 7 to 12 year
Freud =
Erikson =
Piaget =
```
Freud = latency (5-12 yrs)
Erickson = industry vs inferiority (6-12 yrs)
Piaget = Concrete operations (7-12 yrs), Formal operations (11 to adulthood)
```
324
Stage - 12 year +
Freud =
Erikson =
Piaget =
```
Freud = Genital (12-15 yrs)
Erickson = Identity vs role confusion (12-20 yrs)
Piaget = Formal operations (11 to adulthood)
```
325
What is the most common illicit substance of abuse in adolescents?
Cannabis
326
What is the most common substance of abuse in adolescents?
Alcohol
327
What percent of 12th graders reported drinking alcohol in the past 30 days?
47%
328
What percent of 12th graders reported binge drinking alcohol in the past 2 wks?
29.2%
329
Increased use of what substances is a concern about younger students?
Sedative-hypnotics, hydrocodone, oxycodone, and inhalants
330
Molindone is associated with what?
High rates of EPS
331
What antipsychotic is associated with greatest weight gain and increases in triglycerides?
Olanzapine
332
What antipsychotic was associated with the highest rate of EPS and elevated prolactin levels?
Risperidone
333
This stage consists of symbolic play, mental trial and error, and egocentrisim.
Preoperational (2-7)
334
What is the difference between grief in children and adults?
Adults tend to experience more constant grief while undergoing bereavement.
335
What syndrome is caused by a trinucleotide repeat?
Fragile X
336
Fragile X is a trinucleotide repeat disease caused by a mutation of the FMRi gene where?
X237.3/
337
What percent of persons with autism have Fragile X syndrome?
3-5%
338
Physical traits include large ears, long face, macroorchidism, high arched palate, double-jointed fingers, and hyperflexible joints.
Fragile X
339
Behavioral characteristics include ADHD, social anxiety, hand-biting, hand flapping, poor eye contact, sensory disorders, and aggression.
Fragile X.
340
Fetal alcohol syndrome occurs at a rate of ?% of live births.
1%
341
Down Syndrome occurs in about 1/? births
800
342
Patients with Prader-Willi syndrome have a higher risk of developing what disorders? (3)
OCD, impulse-control disorders, and affective disorders
343
IPT treats BN and BED how?
Addresses relationship-related stressors contributing to eating disturbance
344
A child is noted to have delayed motor development, jerking limb movements, and seizures. In spite of being delayed, the child appears quite happy, laughs frequently during the interview, but is not able to communicate verbally with the examiner. Which chr is affected?
15 (Angelman)
345
As many as what percent of boys between ages 8-12 may have transient tics?
15%
346
Transient tics are more common in boys or girls?
Boys
347
Jehovah's Witness - emergency blood transfusion in minor is needed to save her life. What do you do?
Give the transfusion
348
Jehovah's Witness - danger is not immediate but still critical - what do you do?
Court intervention or referral to an ethics committee may be indicated
349
What finding is more common among children with a parent with schizophrenia?
Neurological soft signs - poor motor coordination, motor sequencing impairment, sensory integrative dysfunction, and eye movement abnormalities
350
The combination of 2 smaller studies may yield a result in the opposite direction - what is this called?
Simpson's paradox - it is a weakness of meta-analysis
351
A therapy patient says he hates pizza and becomes nauseated whenever he smells it in the breakroom at work. he explains that the last time he tried to eat pizza he had been binge drinking with friends and became violently ill. What type of learning has this patient undergone?
Classical/Pavlovian conditioning, a conditioned stimulus (pizza) elicits a conditioned response (nausea) due to its proximity to an unconditioned stimulus (binge drinking) and unconditioned response (nausea)
352
This type of conditioning takes place when a reinforcement or punishment is used to modulate the frequency of a particular bx
Operant conditioning
353
Increased risk for sporadic schizophrenia is associated with what?
Advanced paternal age
354
Increased risk for sporadic schizophrenia is associated with advanced paternal age 2/2 what?
De novo mutations
355
The increase of SSRI rxs in depressed youth correlated with what?
A significant decrease in completed suicides
356
In the TORDIA study, patients who switched to another medication had a response rate of? if they switched to another med and added CBT?
41% // 55%
357
Formal operations is the most advanced stage - age?
11-15 years
358
A large study among gay adult men, what percent of monozygotic co-twins were gay?
52%
359
What is the most helpful first step in implementing CBT for OCD?
Completion of CYBOCS rating scale - which will assist in the creation of a sx hierarchy and implementation of exposure/response prevention strategies.
The CYBOCS can also be used during and after tx to evaluate response
360
In the TORDIA study, patients with h/o what risk factors were less likely to respond to tx? (4)
1) Chronic depression
2) Severe hopelessness
3) Self-harming bx
4) Family conflict
361
CAST stands for the Concise Associated Sx Tracking scale, which looks at what sx domains? (5)
1) irritability
2) insomnia
3) mania
4) anxiety
5) panic
362
A child is able to stand independently without holding onto furniture. This milestone is achieved by 50-90% of children by what age?
12 months
363
What is the most common comorbid conditions in patients with psychogenic nonepileptic seizures?
Depression, PTSD, dissociative disorder, and personality disorders. Only 5% of PNES patients do not have associated comorbidities
364
A h/o sexual or physical abuse is present in up to what percent of PNES patients?
33%
365
Melatonin given in the evening produces?
Phase advance
366
Melatonin given in the morning produces?
Phase delay
367
Mechanism by which the hippocampus stores memories?
Long-term potentiation: brief high-frequency stimulation of hippocampal pathways leads to long-term potentiation of the synaptic connections and is seen as the crucial process underlying memory formation
LTP can stimulate growth of new synapses.
368
Serves the function of eliminating irrelevant memories while lasting memories are fine-tuned
Long-term depression
369
Describes the co-occurence of Ca2+ influx in the neuron terminal together with the activation of second messenger systems that provide the so-called coincidence detection that is an integral part of associative learning.
Activity-dependent enhancement of presynaptic facilitation
370
Activity-dependent enhancement of presynaptic facilitation describes the co-occurence of Ca2+ influx in the neuron terminal together with the activation of second messenger systems that provide the so-called coincidence detection that is an integral part of ?
associative learning.
371
Short-term forms of learning generally involve what?
The modification of existing proteins in response to sensitizing stimuli
372
Long-term memory requires what?
Changes in gene transcription and the synthesis of new proteins to support the structural changes necessary to strengthen the synapse.
373
What are circumstances that allow you to object to a subpoena and potentially avoid having to produce documents? (4)
1) Information sought is "privileged"
2) Information sought is "lost"
3) Information sought violates your Fifth Amendment right against self-incrimination
4) Request is overly broad or unduly burdensome
374
A child can drink from a cup but is not quite able to use a spoon/fork. She cannot yet stack 2 blocks on top of each other but can put a block into a cup. She is able to say 3 words and can just barely stand unsupported. Age?
12 months
375
Unchanging abnl motor bxs or action sequences without obvious reinforcement/
Sterotypies
376
Stereotypies occur at what type of intervals?
Regular
377
First line tx for stereotypies is therapy. If medications are warranted what would you rx?
SSRI - due to compulsive nature of the bxs
378
Individuals demonstrate ? when switched from high rewards to low rewards. The frustration at a worsening reward can paradoxically weaken bx more than simply receiving the smaller reward all along
Negative constrast
379
This effect is an example of a paradoxical reward effect (the idea that rewards can sometimes weaken bx while non-rewards strengthen it). This effect is named for the idea that intermittently reinforced actions persist longer after the w/d of reinforcement than actions that have been continuously reinforced
Partial reinforcement extinction effect
380
This occurs when a subject decides that a previously positive reinforcer is no longer valued (and thus cannot be used to strengthen bx further.
Reinforced devaluation
381
Loss of a previously learned operant response after it is no longer reinforced by a stimulus.
Extinction
382
When reinforcement is delivered for any action other than the target undesirable bx (ex: twirling hair instead of nail biting).
Differential reinforcement of other bx = omission training
383
For patients with medulloblastomas - radiation of the entire neuro-axis is normally recommended. True or False?
TRUE
384
Medulloblastomas originate where?
Cerebellar vermis
385
Medulloblastomas are pathologically indistinguishable from what type of tumors?
Primitive neuroectodermal tumors
386
Medulloblastomas - better survival rates are seen with partial or total resection?
Total
387
CDRS - age range?
6-12
