CP 1/ (Incorporated 1-64 Dr M, AP1&2

Question 1

Which of the following fine motor tasks involved in dressing does a child typically master last?

• Zipping a jacket
• Buttoning a sweater
• Tying laces on shoes
• Strapping Velcro on boots
• Snapping buttons on a coat

Answer 1

Tying laces on shoes (~5yo)

Question 2

The parents of a seven-year-old child report that their child has “mood swings” which consist of the child suddenly becoming irritable, angry, and throwing tantrums. When asked what precipitates these episodes, they reply, “When we tell him ‘no’ or he does not get his way.” Based on this information, which diagnosis is most appropriate preliminarily?

Answer 2

Oppositional defiant disorder

Question 3

During the acute initial refeeding phase of treatment for a patient with severe anorexia nervosa, which of the following is the most helpful focus of psychotherapeutic interventions with the patient?

• Framing the use of disordered eating behavior as a maladaptive coping mechanism
• Identifying triggers for relapse and developing plans to prevent relapse
• Exploring developmental, familial, and cultural antecedents to illness
• Challenging cognitive distortions and negative core beliefs
• Coaching, supporting, and providing behavioral reinforcement

Answer 3

Coaching, supporting, and providing behavioral reinforcement

Question 4

A 7yo is seen for anxiety after repeatedly refusing to get on the school bus, and voicing an irrational fear that the bus will crash. Which of the following questions would be most useful for exploring an operant conditional model as an explanation for the child’s anxiety?

• “How do you feel when you’re on the bus?”
• “How often do you suppose buses get into accidents?”
• “Have you ever been in a car accident, even a small one?”
• “Have you ever seen any bad bus accidents on television?”
• “How do your parents respond when you are afraid of the bus?”

Answer 4

“How do your parents respond when you are afraid of the bus?”

[Operant conditioning is a learning process through which the strength of a behavior is modified by reinforcement or punishment.]

Question 5

Current evidence regarding the efficacy of family therapy as treatment for eating disorders reports that it:

• is superior to individual therapy for patients of all ages.
• is efficacious for adults, but adolescents are less likely to respond.
• is superior to individual therapy for adolescents 6-12 months after treatment.
• improves remission rates for adults in anorexia nervosa but not in bulimia nervosa.
• is superior to individual therapy at the end of treatment, but effects are not sustained.

Answer 5

-is superior to individual therapy for adolescents 6-12 months after treatment.

Question 6

The parents of a 6yo report the child has been having difficulty in multiple settings. The child has difficulty taking turns in conversations, frequently monopolizes conversations with topics that are not of interest to peers, and does not follow social norms such as saying “good morning” in response to his teacher’s greeting. In addition, the child has a hard time understanding jokes, often interpreting what is being said quite literally. The parents report that otherwise the child is interested in making friends, has a variety of interests, and is able to adapt to variations in routine. On exam, the child makes good eye contact and speaks with the psychiatrist in a very formal tone. Which of the following is the most likely diagnosis?

• Language disorder
• Speech sound disorder
• Autism spectrum disorder
• Childhood-onset fluency disorder
• Social (pragmatic) communication disorder

Answer 6

Social (pragmatic) communication disorder

Question 7

A 16yo comes to the ED for agitation and paranoia. The patient seems to be hallucinating and says, “I’m walking on air.” Physical exam show tachycardia. The clinical picture is most characteristic of:

• cocaine withdrawal
• caffeine intoxication
• marijuana withdrawal
• prescription opioid withdrawal
• dextromethorphan intoxication

Answer 7

dextromethorphan intoxication (creates dissociative feelings, present in many over the count medications such as sleep aids)

Question 8

Which of the following aspects of attention-deficit/hyperactivity disorder is most likely to improve as children age?

• Impulsivity
• Hyperactivity
• Inattention
• Peer relationships
• Academic difficulties

Answer 8

Hyperactivity

Question 9

By which age should the corticospinal tracts have completed myelination in typically developing children?

Answer 9

3 years

Question 10

Parents describe their 10yo as a “girly boy.” They state that most of their son’s friends are girls, and he prefers to “play house” and play with dolls. They report no distress or impairment in the teen’s functioning. Which of the following is the most likely diagnosis?

• Anxiety disorder
• Gender dysphoria
• Body dysmorphic disorder
• Separation anxiety disorder
• Nonconformity to gender role

Answer 10

Nonconformity to gender role

Question 11

Following a normal full-term birth, by what age are circadian sleep rhythms similar to those of an adult generally established in the child?

Answer 11

6 months

Question 12

Boys with which of the following variables are more likely to delay first sexual intercourse until after age 18?

• Anxiety symptoms
• Physical aggression
• Depressive symptoms
• Increased alcohol use
• Higher maternal education level

Answer 12

Anxiety symptoms

Question 13

Which psychodynamic theorist posited that development occurs in sequential, clearly defined stages, and that each stage must be resolved for development to proceed smoothly?

Answer 13

Erik Erikson

• 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)
• Identity vs role confusion (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)

Question 14

*In which stage of Piaget’s theory of cognitive development do children first understand conservation of volume?

Answer 14

*Concrete operational

Piaget’s stages 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)

Question 15

Typically developing children acquire an understanding of the difference between inner life and outer reality (theory of mind) by what age?

Answer 15

Four years

Question 16

A young girl has marked developmental regression, progressive loss of acquired motor and language skills, stereotyped repetitive hand movements, muscle hypotonia, autonomic dysfunctions, and severe cognitive impairment. Which of the following genes is most likely to be involved in the etiology of these symptoms?

• INPP5E coding for pharbin
• Elastin gene on chromosome 7
• ASXL1 coding for a chromatin-binding protein
• MECP2 coding for methyl CpG-binding protein 2
• Partial deletion of the short arm of chromosome number 5

Answer 16

MECP2 coding for methyl CpG-binding protein 2

Question 17

Gender identity is typically established by what age?

Answer 17

Three years

Question 18

A ten-year-old child remains sad and angry about his parents’ divorce but no longer believes that he caused the separation. This cognitive change is an example of ___.

Answer 18

decentration

Question 19

Due to the slowed growth of neural language synapses, children older than six years of age have more difficulty that younger children with:

• learning a new language
• acquiring new vocabulary words
• decoding non-verbal social cues
• understanding rules for grammar
• inferring word meanings from context

Answer 19

learning a new language

Question 20

The Freudian stage of latency (6-puberty) is correlated with which of Erikson’s stages?

Answer 20

Erikson’s: industry vs inferiority (6-12yo, school age, the child compares self worth to others)

[Freud’s theory of psychosocial development emphasizes that as humans develop, they become fixated on different and specific objects through their stages of development.
Oral: birth-1yo
Anal: 1-3yo
Phallic: 3-6yo
Latency: 6-puberty (here the drives are seen as dormant and hidden and pleasure is mostly related to secondary process thinking)
Genital: puberty on]

Question 21

What is the most common fear among preschool-age children who are faced with a terminal illness?

• Losing their toys
• Disappointing caretakers
• What happens after death
• Separation from caretakers

Answer 21

Separation from caretakers

Question 22

What is the earliest age by which 90% of girls in the United States will have reached menarche?

Answer 22

14 years

Question 23

By what age can typically developing children answer open-ended questions such as why, when and how?

Answer 23

Five years

Question 24

Parental loss due to an external cause (suicide, homicide or accident) during childhood most elevates the risk for depression as a young adult when the loss occurs in ___ ___.

Answer 24

early childhood

Question 25

Which of the following is proposed to be a basic emotion, learned directly or inferred by infants during the first year of life? - Envy - Fear - Shame - Pride - Guilt

Answer 25

Fear

Question 26

A 12yo patient comes for therapy after summer break. The patient has lost a significant amount of weight and is now at the 20th percentile compared to age group for weight and 60th percentile for height. The patient decided to eat a healthier diet, identifies no concerns about the weight loss, and wants to lose another 5-10 pounds. Previously the patient had consistently been at the 75th percentile for weight, but felt self-conscious about appearance. The parents are concerned because the patient spends much time researching the nutritional content of food and has restricted intake to a limited range of food items. Which of the following is the best description of the patient's current behaviors? - Bulimia nervosa - Anorexia nervosa - Healthy eating approach - Body dysmorphic disorder - Avoidant/restrictive food intake disorder

Answer 26

Anorexia nervosa

Question 27

In females, which of the following is typically the first marker of impending puberty? - Menarche - Increase in total body fat - Acceleration of linear growth - Increase in muscle mass and strength - Appearance of secondary sexual characteristics

Answer 27

Acceleration of linear growth

Question 28

An adolescent patient is hospitalized on the neurology service for sudden onset loss of vision. Medical workup is negative and the primary team is unsure of the etiology. The resident walks the patient and when they approach a bin in the hall the patient walks around it. What is the most likely diagnosis?

Answer 28

Conversion disorder

Question 29

Difficulty with which of the following physical tasks would be most concerning if noted in an elementary school-age child? - Writing legibly - Playing team sports - Jumping and hopping - Playing a musical instrument - Sewing and using hand tools

Answer 29

Jumping and hopping

Question 30

The decline in a toddler's sharing behavior between ages two and three is most closely related to the normal developmental milestone of sense of being an ___ self.

Answer 30

autonomous | Terrible twos, less sharing!

Question 31

The parents of a 4yo are concerned that she is unable to tie her shoes. She is able to run, kick a ball, ride a tricycle and zip up her coat. What is the most likely explanation?

Answer 31

Normal development [Shoe tying is usually reached around 5yo; Always remember, what we are seeing may be consistent with normal development!]

Question 32

What genetic syndrome is the most common cause of inherited intellectual disability?

Answer 32

Fragile X [In contrast, what is the most common genetic cause of intellectual disability? Down Syndrome.]

Question 33

Which of the following childhood environmental factors is most prevalent in patients diagnosed with dissociative identity disorder in the United States, Canada and Europe? - Physical abuse - Loss of a parent - Medical procedures - Surgical procedures - Exposure to terrorism

Answer 33

Physical abuse

Question 34

Gender identity is believed to be most strongly influenced by which of the following factors? - Innate feelings - Parental influence - Cultural expectations - Chromosome complement - Mirroring of the same-sex parent

Answer 34

Innate feelings

Question 35

Which of the following tests primarily measures flexibility in shifting cognitive sets? - Trails B - Boston naming - Digits backwards - Rey complex figure - Pantomime use of objects

Answer 35

Trails B

Question 36

Panic disorder typically first manifests during which stage of life?

Answer 36

Late adolescence

Question 37

A school-aged boy does well academically but most of his energy is channeled into basketball, and he states that he hopes to become a professional basketball player. He teases girls at school, but plays mostly with boys. With which of the following of Freud's psychosexual stages of development do these characteristics correspond?

Answer 37

Latency [Freud's Latency (6-puberty) corresponds to Erikson's Industry vs inferiority (6 to 12 years, school age] Freud's theory of psychosocial development emphasizes that as humans develop they become fixated 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)

Question 38

Parental criminality is a factor associated with increased ___ of developing conduct disorder.

Answer 38

risk

Question 39

A 4yo has a slim torso, long legs and all 20 primary teeth. The child can walk and run, but does so quickly and intensely, often walking up on toes. The child is ambidextrous and can ride a small bicycle with training wheels although appears a little uncertain when doing so. Which of these physical findings should raise concern about the child's physical development? - Ambidexterity - Walking on toes - Presence of all baby teeth - Pace and intensity of walking - Uncertainty when riding a bicycle

Answer 39

Walking on toes

Question 40

An electroencephalogram for a child who seems to often stare into space and then blink for a few seconds is likely to show the ___ cycles per second spike-and-wave activity characteristic of absence seizures.

Answer 40

three | EEG shows 3 cycles per second, 3Hz spike-and-wave activity in absence seizures

Question 41

Parents bring a 15yo noting that, despite having a curfew, she stayed out all night for the fourth time in a month. Over the past year, she has persistently violated parental rules, reacts with rage when attempts are made to address this, and is often edgy and confrontational with the slightest annoyance. She is impatient and unkind to a younger sister, and threatens to hit the father when limits are set. The school reports no concerns about behavior in that setting. There is no history of substance use. In the interview, she is pleasant, easy to engage and cooperative, but admits to minimal regard for her parents' rules, seeing them as "old school" and unnecessarily limiting. Which is the most likely diagnosis? - Conduct disorder - Adjustment disorder - Oppositional defiant disorder - Antisocial personality disorder - Disruptive mood dysregulation disorder

Answer 41

Oppositional defiant disorder

Question 42

To be eligible for special education services a student must require specific interventions in order to make progress in school and have a ___ disability.

Answer 42

documented

Question 43

A 16yo girl has periodic fantasies involving degradation and masochism (the tendency to derive pleasure, especially sexual gratification, from one's own pain or humiliation). She describes these fantasies as disturbing and accompanied by both excitement and anxiety. These fantasies most likely represent which of the following? - A risk factor for future paraphilic sexual behavior - Evidence of prior exposure to sexual maltreatment - A normal precursor to homosexual orientation in adulthood - Turning against the self as defense against unresolved Oedipal wishes - Part of the normal process of determining personal sexual behavior patterns

Answer 43

Part of the normal process of determining personal sexual behavior patterns

Question 44

Which of the following most seriously threatens the external validity of a research study? - Placebo responses in the study population - A study population that is not representative of the population to be treated - Mortality or differential attrition during the course of treatment during the study - Maturation due to natural change during the period between baseline and post-test - Statistical regression or regression toward the mean

Answer 44

A study population that is not representative of the population to be treated [External validity is the validity of applying the conclusions of a scientific study outside the context of that study. In other words, it is the extent to which the results of a study can be generalized to and across other situations, people, stimuli, and times.]

Question 45

Pharmacological treatment in autism spectrum disorder is most likely to have a positive effect on which of the following? - Aggressiveness - Gaze aversion - Prosodic modulation - Gestural communication - Pragmatic communication

Answer 45

Aggressiveness

Question 46

Functional magnetic resonance imaging studies have shown the highest level of response to anticipated rewards in the nucleus accumbens (ventral striatum along with olfactory tubercle; what's in the dorsal striatum? caudate + putamen) during which of the following developmental periods? - Infancy - Toddlerhood - Mid-latency - Adolescence - Adulthood

Answer 46

Adolescence [Adolescence is also the stage of development at which dopamine receptor density in the striatum occurs, possibly accounting for increased response to rewards for behavior during this stage.]

Question 47

During which stage of development does the maximal number of axons and synapses exist?

Answer 47

Infancy

Question 48

Piaget's major contribution to development was a theory that explains how individuals learn about and ___ the world.

Answer 48

understand [Piaget's stages 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)]

Question 49

___ ___ signifies the ability to shift back and forth between general concepts and specific examples.

Answer 49

Abstract reasoning [In Piaget's stages of cognitive development, abstraction is a major part of the Formal operational stage (13->adulthood) and differentiates it from the Concrete operational stage (7->12 years)] [Piaget's stages 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)]

Question 50

A 5yo who mother was in a minor car accident thinks that he is responsible for causing the accident because he yelled "I hate you" in protest when his mother left him with a baby-sitter an hour earlier. This belief represents age-appropriate ___ thinking.

Answer 50

egocentric (Mr. Beard's final words to his dad)

Question 51

REM sleep is first evident at which stage of development?

Answer 51

In utero

Question 52

A 9yo achieved urinary continence at 4yo, but started wetting the bed again at 6yo. The family has tried various management strategies including waking the child at night, but the patient is difficult to arouse and has enuresis at different times in the night. The patient's father and paternal uncles wet the bed until they were approximately 10yo. Which of the following points to a possible psychiatric comorbidity? - Difficulty arousing from sleep - Positive family history of enuresis - Resistant to behavioral management - Enuresis during different sleep stages - Having a previous period of continence

Answer 52

Having a previous period of continence

Question 53

The psychiatric assessment of a child or adolescent should always include ___ interviews.

Answer 53

parental

Question 54

Identity diffusion, as defined by Erik Erikson, describes ___ of continuity in how the self is experienced in relationships over time.

Answer 54

lack

Question 55

Obsessive-compulsive disorder (OCD) with childhood onset has ___ psychiatric comorbidity than that of adult onset.

Answer 55

greater

Question 56

Children of birth mother's who die by suicide are at ___ risk of completed suicide.

Answer 56

higher

Question 57

Children demonstrate a preference for the human voice and speech over other sounds at what age?

Answer 57

Birth

Question 58

A 9yo has been successfully treated for attention-deficit/hyperactivity disorder for years with methylphenidate (ritalin, concerta, etc). During the past two months, the medication has not been as effective despite multiple dose adjustments. It is decided that the child needs a different medication. Which of the following would be the best choice? - Buspirone - Atomoxetine - Desipramine - Risperidone - Mixed amphetamine salts

Answer 58

Mixed amphetamine salts (Adderall, etc)

Question 59

Per the WHO, mental health prevention measures are universal, selective and indicated. Which of the following would be an indicated intervention? - Playing the "Good Behavior Game" in the school classroom - Giving emotional resilience courses for emergency personnel - Restricting access to tobacco and alcohol to those over a certain age - Initiating a promotional campaign to discourage unsafe dieting behavior - Providing parenting training for parents of children with conduct problems

Answer 59

Providing parenting training for parents of children with conduct problems

Question 60

What is the most highly heritable of all mental disorders?

Answer 60

Autism spectrum disorder (young woman at WFM register said her "ENTIRE family" has Autism spectrum disorder, the most highly heritable of all mental disorders)

Question 61

Limitations of Piaget's model of cognitive development include a failure to adequately include ___ factors relevant to learning.

Answer 61

emotional [Piaget's stages 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)]

Question 62

A 5yo watching his first July 4th parade asks as it begins, "Mommy, will there be clowns in the parade today like at the circus we went to?" This question is most likely the result of use of previous experiences to think ___.

Answer 62

categorically

Question 63

A typically developing two-year old child is able to demonstrate the language and speech milestone to use ___-word or longer phrases.

Answer 63

two

Question 64

A 14yo broke his nose playing hockey, it is noticeably asymmetric and it has bothered him since. He says he just wants to look normal again. Parents say self-esteem has been low since the break and they hope surgery will help. What is the most likely psychological outcome for this patient following cosmetic surgery? - An improvement in quality of life - Continued preoccupation with appearance - No change in esteem despite less focus on his nose - Chronic anxiety which will generalize to other stresses - Relational problems with parents for encouraging the surgery

Answer 64

An improvement in quality of life (Brother Jon)

Question 65

During which stage of development does the maximal pruning of cortical synapses occur?

Answer 65

Adolescence (don't smoke up in adolescence, will mess up synaptic pruning!)

Question 66

A 5yo has difficulties adjusting to the first transition from home into a school setting. Teachers are concerned about persistent social withdrawal and the consistent experience that the child does not seek or accept consoling when upset. The child was adopted three years ago after a series of problematic foster placements where care was physically and emotionally inadequate. On exam the child looks shy and initially clings to the mother. Later while playing with blocks the child becomes frustrated. The mother tries to gently intervene which leads to an overly fearful and aggressive response by the child. What is the most likely diagnosis?

Answer 66

Reactive attachment disorder [Reactive attachment disorder arises from a failure to form normal attachments to primary caregivers in early childhood.]

Question 67

A 10yo notes he started collecting basketball cards, an interest shared with his dad and friends. He is excited because he is the only one of his friends who has several cards. He says things at home and school are OK. His parents say he is doing well, though his grades in school could be higher. According to Erikson, what developmental task is most relevant for this child?

Answer 67

Industry vs inferiority Erikson's stages: * 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) * Identity vs role confusion (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)

Question 68

A 17yo comes to the ED with family after inflicting lacerations on the thigh with a plastic knife. On exam, the patient does not make eye contact, has limited facial expression, and postures periodically in a stereotypic manner. Speech is monotone, and the patient covers the ears at times during the interview reporting, "It is too loud." The patient says the cutting was not a suicide attempt but can't say more and reports, "My parents can provide additional information." The parents note the patient has always been intolerant of noise and has also always been "quirky and socially awkward" but has appeared more withdrawn over the past three days since the parents shared a plan to separate. The patient has few friends and prefers solitary activities. There is no previous history of self-injurious behavior. Which of the following is the most likely diagnosis? - Autism spectrum disorder - Major depressive disorder - Social communication disorder - Schizotypal personality disorder - Borderline intellectual functioning

Answer 68

Autism spectrum disorder

Question 69

In 2-3yo children the capacity to tolerate frustration is primarily influenced by which of the following: - Ability to internalize social norms - Quality of the parent-child attachment - Ability to use language to describe affect - Exposure to peer group social interactions - Resolution of ambivalent feelings towards parents

Answer 69

Quality of the parent-child attachment

Question 70

The development of brain gray matter volume peaks during which stage of development?

Answer 70

Late childhood [Makes sense because maximal pruning is in adolescence, immediately after the peak development of gray matter in late childhood!]

Question 71

A 5-month-old attempts to get his father's attention by making gurgling noises, waving his arms, and kicking his feet. The mother responds by gently tickling the baby, who laughs happily. This social interaction is best explained within which of the following developmental concepts? - Arousal - Imprinting - Attachment - Temperament - Theory of mind

Answer 71

Attachment

Question 72

A 6yo prefers opposite gender clothing and play scenarios. If this child were to develop symptoms of gender dysphoria, what would be the most common course of symptoms? - Worsens during adolescence - Remains stable into adulthood - Continues until reassignment surgery - Resolves spontaneously by adulthood - Waxes and wanes throughout adulthood

Answer 72

Resolves spontaneously by adulthood

Question 73

Beginning to ___ peer relationships and pursuing group activities is a developmental task of the school-age stage.

Answer 73

establish

Question 74

Prior childhood adversity is a ___ factor for the development of posttraumatic stress disorder.

Answer 74

risk

Question 75

A 14yo boy reports he has felt sexually aroused spending time with male friends. The says that consciously he is significantly more attracted to females than males, but wonders if his feelings of arousal mean he is homosexual. Which of the following statements is most accurate to communicate to the patient? - He is most likely homosexual, but will not fully feel that way for a few years. - These feelings are common and his sexual preference will continue to solidify. - If he feels more attracted to females than males then he is, by definition, heterosexual. - This statement was probably made due to erotic transference and should be carefully explored. - He is most likely bisexual, and his feelings for people of both genders may change over the next few years.

Answer 75

These feelings are common and his sexual preference will continue to solidify.

Question 76

Untreated depression in pregnancy is associated with poor maternal and infant outcomes, including pregnancy complications, preterm birth, and behavioral problems in the child. Current evidence shows that selective serotonin reuptake inhibitor use in pregnancy is associated with neonatal ___ syndrome.

Answer 76

adaptation [Neonatal adaptation syndrome generally presents within a few hours following birth and may include a combination of respiratory distress, feeding difficulty, jitteriness, irritability, temperature instability, sleep problems, tremors, shivering, restlessness, jaundice, rigidity, and hypoglycaemia.]

Question 77

The father of a 3.5yo boy who goes to preschool notes that recently the boy has come into the bathroom when the father is in the shower. He seems happy to see his dad emerge and is very interested in observing his father's genitals. On one occasion the boy asked, "Why is it so fat?" pointing to his father's penis. This behavior is most likely an indication of which of the following? - Normal preschool-age sexual interest - Inappropriate exposure to adult sexuality - Sexual molestation by a non-family member - Response to sex education in preschool curriculum - An early indication of homosexual or bisexual orientation

Answer 77

Normal preschool-age sexual interest

Question 78

Throughout the course of psychotherapy a patient with borderline personality disorder reports a history of growing up in an abusive household, wishing to escape abusive parents but also depending on them, and abruptly ending relationships due to "feeling too close to the other person and getting scared." According to Margaret Mahler's model this patient's problems can be formulated as not having worked through which stage?

Answer 78

Rapprochement (establishment or resumption of harmonious relations)

Question 79

Underlying heart defects are a ___ contraindication to treatment with psychostimulants.

Answer 79

relative

Question 80

Which of the following substances is in several OTC cold remedies and is abused to produce a dissociative feeling? - Ethanol - Ephedra - Acetaminophen - Pseudoephedrine - Dextromethorphan

Answer 80

Dextromethorphan ("Robo tripping")

Question 81

Which of the following molecular mechanisms is best supported as a possible explanation for how early life stress could lead to the development of psychiatric disorders in adulthood? - DNA methylation - Alternative splicing - Deletion mutations - Gene amplification - Reciprocal translocations

Answer 81

DNA methylation [DNA methylation decreases gene expression]

Question 82

The ___ process used to provide community care to children and youth is best described as an individualized, family-driven and youth-guided team planning process.

Answer 82

wraparound

Question 83

When a parent dies to facilitate a child's adaptive mourning process it is essential to give the child opportunities to ___ feelings of loss.

Answer 83

express

Question 84

Which of the following patient characteristics best differentiates bulimia nervosa from binge eating disorder? - Normal BMI - Duration of symptoms - History of laxative abuse - Degree of control over food intake - History of non-suicidal self-injurious behavior

Answer 84

History of laxative abuse

Question 85

A child with autism spectrum disorder is placed in a therapeutic foster home where a consistent response is made to a given action with the goal of improving the child's functioning. This technique derives from which learning theory?

Answer 85

Behaviorism

Question 86

The likely course for development of children after parents' divorce is that children do ___ in one-parent homes, provided stable parental functioning and financial security.

Answer 86

well

Question 87

When do cortisol levels peak in healthy children? - Morning - Afternoon - Evening - Night

Answer 87

Morning

Question 88

A 17yo boy comes in with macroorchidism, long face, large everted ears, prominent jaw, a high arched palate, intellectual disability, frequent hand-flapping. He most likely has which genetic abnormality?

Answer 88

Trinucleotide repeat/expansion in the FMR1 gene [Fragile X syndrome is the most common cause of INHERITED intellectual disability]

Question 89

In Heinz Kohut's theory of self-psychology, the term "self-objects" means other ___ in the environment who perform particular functions for the self.

Answer 89

people

Question 90

What is the risk of individuals developing schizophrenia when a sibling has the disorder but the parents do not?

Answer 90

10%

Question 91

Pathogenic copy number variants affecting DNA base pairs are associated with ___-___, which often presents with failure to thrive in infancy, hyperphagia, early obesity, hypogonadism, obsessive-compulsive disorder, short stature, small hands and small feet.

Answer 91

Prader-Willi [Copy number variations have been identified in the imprinted chromosome 15 region associated with Prader-Willi syndrome and Angelman syndrome. These diseases might be caused by copy number variants due to inversions and deletions in critical genes.]

Question 92

What is the lifetime prevalence in the US of conduct disorder?

Answer 92

~10% (males = 12.0%, females = 7.1%)

Question 93

Serum ferritin levels were inversely correlated with the severity of ADHD. The children with the most severe ___ deficiency were the most inattentive, impulsive, and hyperactive. This result suggests that low stores may explain as much as 30% of ADHD severity.

Answer 93

iron

Question 94

Psychoeducation and ___ are the first line treatment for children with retentive encopresis.

Answer 94

laxatives

Question 95

The average age of onset of trichotillomania is ___.

Answer 95

adolescence

Question 96

A teacher assigns each child in the class to solve as many math problems as they can on their own in a 20-minute period. The teacher makes a note of each student's progress, divides the class into groups to further work on the problems together, and provides help to each group when members are stuck. This strategy makes use of the educational concept ___.

Answer 96

zone of proximal development

Question 97

By age ___ years, toddlers can typically manipulate scissors.

Answer 97

three years

Question 98

An adolescent boy was engaged in therapy lasting ten weeks. During this therapy the boy was able to relate his test-taking anxiety, chronic feeling of interpersonal inadequacy, and inaccurate sense of physical unattractiveness to an earlier relationship with his father who was often critical and harsh, and unpredictably embarrassed the boy in social settings. Therapy used most likely was ___

Answer 98

short-term psychodynamic

Question 99

During a psychiatric evaluation, using a qualified interpreter who has proficiency in the family's language of origin would help develop the ___ alliance between a culturally competent psychiatrist and a new immigrant patient and family.

Answer 99

therapeutic

Question 100

A youth who has been on long-term risperidone treatment develops tardive dyskinesia which continues despite initially reducing the dose, and then sequential optimal trials of aripiprazole, olanzapine and quetiapine, each for sufficient duration and dose. The most appropriate next step is to switch to ___.

Answer 100

clozapine (multiple trials have shown clozapine does not worsen TD; valbenazine and deutetrabenazine are approved for TD, but not enough youth data)

Question 101

The ___ ___ represents the odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure.

Answer 101

odds ratio

Question 102

Base rates are a statistic used to describe the percentage of a population that demonstrates some characteristic. Base rates indicate probability based on the ___ of other information.

Answer 102

absence

Question 103

Prevalence is the proportion of persons who ___ a condition at or during a particular time period.

Answer 103

have

Question 104

Incidence refers to the proportion or rate of persons who ___ a condition during a particular time period.

Answer 104

develop

Question 105

Cumulative incidence is calculated as the number of ___ events or cases of disease divided by the total number of individuals in the population at risk for a specific time interval.

Answer 105

new (if there is a time period, they mean cumulative incidence rather than prevalence)

Question 106

Positive predictive value is the probability that subjects with a positive screening test truly ___ the disease.

Answer 106

have

Question 107

***___ is an important guide when arranging the infrastructure necessary to provide telepsychiatric consultation to a school.

Answer 107

***Family Educational Rights and Privacy Act (FERPA) [HIGH YIELD]

Question 108

After a recent substance abuse relapse, from an MI (Miller and Rollnick) perspective after a self-deprecating statement the following might be helpful: "This recent relapse is making you upset because you were trying hard to stay sober" REDS, in motivational interviewing stands for:

Answer 108

Roll with Resistance Express Empathy Develop Discrepancy Support Self-Efficacy

Question 109

In transition from in person to web-based psychotherapy for an eight year old, web-based therapy efficacy will be helped by implementation with the ___ of a parent, caregiver, or teacher.

Answer 109

support

Question 110

*___ is the non-pharmacologic treatment of choice for ADHD validated in treatment trials.

Answer 110

*Behavioral parent training/Parent management training | involves appropriate behaviors, positive reinforcement is part of this

Question 111

___ is one of the psychiatric disorders most likely comorbid in an adolescent with diabetes.

Answer 111

Major depressive disorder (Anytime looking at chronic medical disorders and co-morbidity, most often find MDD as main comorbidity)

Question 112

* Which traumatic event is most commonly experienced by adolescents in the United States? - Sexual abuse - Natural disaster - Physical abuse - War-related trauma - Death of a loved one

Answer 112

*Death of a loved one

Question 113

A ten-year-old's report card is all A's, but a C in math which has always been difficult. What is an assessment instrument that would be helpful to assess the child's academic deficit? - Wide Range Intelligence Test - Stanford-Binet Intelligence Scales (use around 5yo, some of the others can't use that early. It is not super-standardized like WISC) - Leiter International Performance Scale - Wechsler Intelligence Scale for Children (For kids over 6 and the most standardized tests) - Woodcock-Johnson Tests of Achievement

Answer 113

-Woodcock-Johnson Tests of Achievement (Child has all A's except for one in a specific learning area so this it good test to hone in on the different areas)

Question 114

In youth with substance use disorders, evidence suggests the chance for recovery in a peer support group is best optimized if the patient is peer-matched along which parameter? - Age - Gender - Ethnicity - Substance of choice - Socioeconomic status

Answer 114

Age (Developmental level)

Question 115

The MTA study at the 6-to-8 year follow up regarding ADHD treatment from childhood to adolescence suggested periodic drug holidays ___ be given to assess continued need and benefit.

Answer 115

should

Question 116

The classic triad of HIV-related encephalopathy in children is characterized by ___, acquired microcephaly and developmental delays.

Answer 116

pyramidal tract motor deficits

Question 117

Illness anxiety disorder is ___ excessively that you are or may become seriously ill.

Answer 117

worrying

Question 118

Metformin has been shown to reduce ___-___ associated with antipsychotic use.

Answer 118

weight-gain

Question 119

***Number needed to treat is calculated as 1 / ___

Answer 119

***Absolute risk reduction [VERY HIGH YIELD]

Question 120

In application of dialectical behavior therapy for adolescents, which of the following skills should be taught first? - Mindfulness - Distress tolerance - Emotion regulation - Self-management - Interpersonal effectiveness

Answer 120

Mindfulness

Question 121

____ denotes or relates to a person who sense of personal identity and gender corresponds with their birth sex.

Answer 121

cisgender

Question 122

transgender denotes or relates to a person whose sense of personal identity and gender does not correspond with their birth ___.

Answer 122

sex

Question 123

Which of the following changes in sleep architecture occurs as a result of sleep deprivation? - Increased sleep latency - Decreased sleep efficiency - Increased sleep fragmentation - Decreased NREM sleep duration - Increased REM sleep duration

Answer 123

Increased REM sleep duration (REM sleep is really critical for our health and wellbeing.)

Question 124

What is most likely psychological explanation for school-age children's fantasies about superheroes and heroic acts?

Answer 124

Strategy to manage fears related to knowledge of world events

Question 125

Chromosomal ___ analysis testing assesses for deletions or duplications of sections of DNA.

Answer 125

microarray (Chromosomal microarray analysis looks at smaller segments, assessing for deletions or duplications in sections of DNA. SNPs - single nucleotide polymorphisms are important here too in addition to deletions and duplications and can also be seen through chromosomal microarray analysis testing) [Microarray assays are used to identify CYP enzyme DNA sequence variants that may explain patient's intolerance of medications if we suspect they are a poor metabolizer for example]

Question 126

The Treatment of Severe Childhood Aggression (TOSCA) study enrolled children ages 6-12 with both diagnosed attention-deficit/hyperactivity disorder and disruptive behavior (Conduct disorder, Oppositional defiant disorder) with significant aggression. Participants whose symptoms did not resolve in the first stage of the study received augmented treatment which of the following? - Lithium - Fluoxetine - Risperidone - Parent training - Methylphenidate

Answer 126

Risperidone

Question 127

Family from other country punishes 8yo causing welts 1-2x/week which is cultural norm from country they were in previously. Psychiatrist should remain ___ yet firm while discussing US societal and legal norms.

Answer 127

empathetic

Question 128

An ___ for a child with autism spectrum disorder is appropriate in the setting of new onset of developmental regression.

Answer 128

electroencephalogram

Question 129

___ is an ethical principle referring to the importance of providing patients with truthful information about their medical conditions to allow them to make a truly informed decision about accepting or rejecting recommended medical interventions.

Answer 129

Veracity (conformity to facts; accuracy, providing truthful information)

Question 130

Which of the following is most helpful in working up the diagnosis of nonepileptic seizures in children? - Structural MRI - Routine electroencephalogram (EEG) - Serum creatine kinase levels - Serum prolactin levels - Prolonged video EEG

Answer 130

Prolonged video EEG (Odds are low of capturing spell with random/routine EEG which is why you recommend prolonged video EEG to w/u diagnosis of nonepileptic seizures in children)

Question 131

A five-year-old child is observed to serve toy food onto the parent's miniature plastic plate, then hands the serving dish to the parent and says, "Now you feed me!" This is an example of ___

Answer 131

Cooperative play

Question 132

For a medicine to be efficacious and having fewer side effects, we want a ___ number needed to treat and a higher number needed to harm.

Answer 132

lower

Question 133

A child has a history of angry outbursts. The child and parents develop a plan for grocery shopping that, if the child asks for candy at the checkout stand, has a meltdown and is unable to stay calm, the child will lose video game play time for the day. Which of the following terms best describes this strategy? - Time out - Token economy - Attending and ignoring - Praise and positive reinforcement - Antecedent-behavior-consequence

Answer 133

Antecedent-behavior-consequence

Question 134

A previously healthy child with a history of ADHD and depression is medically admitted for vomiting, headache, increased intracranial pressure, hepatosplenomegaly, skin desquamation (peeling), and musculoskeletal/abdominal pain. Caregivers report use of cod liver oil for the child's depression and ADHD over the last few years with steady increases in dosing due to lack of perceived effectiveness. The child has an otherwise normal diet and also is prescribed melatonin and clonidine. Toxicity due to what is the most likely etiology of the patient's symptoms?

Answer 134

Vitamin A (When you see cod liver oil think Vitamin A. Increased intracranial pressure and hepatosplenomegaly, think Vitamin A)

Question 135

The psychiatrist serving as an expert witness testifies in court that the adolescent defendent was psychotic at the time of the alleged crime. As evidence of this, the psychiatrist cites multiple witnesses who reported that the defendant ran out fo his antipsychotic medication and began complaining about hearing voices in the days before the crime. The prosecutor objects that the psychiatrist's testimony is predicated on hearsay evidence, but the judge rules that the objection is invalid for which of the following reasons? - The psychiatrist cited the witness accounts to justify an expert opinion - The jury will decide if the psychiatrist's argument is valid and persuasive - The judge considers the witness accounts cited by the psychiatrist to be highly credible - The psychiatrist cited the witness accounts to establish the fact of the patient's symptoms (is a bit overly definitive: "to establish the fact") - The prosecutor is attempting to discredit the psychiatrist prior to cross examination

Answer 135

The psychiatrist cited the witness accounts to justify an expert opinion (how else will you say the expert opinion if you can't say the diagnosis? Need collateral to establish diagnosis)

Question 136

___ was a large ADHD study with children 6yo+ with four arms, many large studies have four arms like MTA did. There was medication (stimulant) alone, combined (stimulant + behavioral therapy), behavioral therapy alone, treatment as usual (no difference from typical treatment/not as much follow-up). What is established is that medications are really important for ADHD. The combined treatment was similar to medication by itself. The behavioral treatment alone was not up to the mark. When kids have ODD or something, combined arm might get more leverage. If child just has ADHD, medication alone is an effective treatment.

Answer 136

MTA

Question 137

One of the findings of the MTA study was that as children grow and develop into adolescents, 50-60% will ___ have symptoms of ADHD compared to childhood, so needing to persist with treatment is not necessarily true.

Answer 137

not

Question 138

One of the findings of the MTA study was that often over time hyperactivity decreases first, impulsivity decreases some and ___ is the most recalcitrant, hardest to treat and most lingering feature of ADHD.

Answer 138

inattentiveness

Question 139

Long-term ADHD data hasn't supported stimulants lowering weight/height of children. That said, a study showed those children on stimulants lose 1.5cm. Children with ADHD were interestingly taller than peers so normalized perhaps because of this. Nonetheless, it's important to keep considering the continuous need for medication. Can ___ during summer with almost all psychiatric medication. Think through every year whether everything is needed.

Answer 139

reassess

Question 140

*Motivational interview where we (REDS): Roll with Resistance Express Empathy Develop Discrepancy Support Self-Efficacy was developed by which two people?

Answer 140

*Miller and Rollnick

Question 141

A 12yo girl admitted with features of paranoia, hallucinations, and mood lability is found to be resistant to antipsychotic management. She subsequently develops facial tics, autonomic instability and obtundation. Work-up reveals an adnexal mass. Removal of the mass is most likely to help normalize the activity of a receptor for which of the following neurotransmitters? - GABA - Serotonin - Dopamine - Glutamate - Acetylcholine

Answer 141

Glutamate (This is classic picture for anti-NMDA receptor encephalitis. It is thought to be resistant to antipsychotics which makes sense because anti-NMDA receptor encephalitis is glutamate based)

Question 142

What stage of infancy is most associated with cooing, imitating, and other efforts to facilitate reciprocal social interactions? - 1-2 months - 3-7 months - 8-18 months - 19-36 months

Answer 142

3 to 7 months (a long window allows for a bell shaped development, think about this with windows in terms of test options)

Question 143

A 13-year-old is brought for an initial assessment. The patient has an extensive psychiatric history with multiple diagnoses. The psychiatrist chooses to combine the unstructured interview with a more structured technique using a respondent-based interview. Which instrument would be most representative of a structured assessment using this technique?

Answer 143

Diagnostic Interview Schedule for Children (fully structured)

Question 144

Kiddie ___ ___ ___ ___ ___ (Semi-scructured, still allow for some open ended in additional to structured questions) (This is the one we are most likely to see in a clinical trial) (the initial pages are unstructured information gathering, then there are screening sets; may be helpful to take a look at how the questions are written b/c with children can be tough to know how to ask these questions such as about mania; 3 is true sx, 1 is absence of sx, 2 is not sure; anytime you hit 3, need to do supplemental module on that particular disorder)

Answer 144

Schedule for Affective Disorders and Schizophrenia

Question 145

Object Permanence is a concept from ___.

Answer 145

Piaget

Question 146

Object Konstancy is a concept from ___ ___.

Answer 146

melanie Klein

Question 147

In the ___-operational stage for Piaget (2-7yo) have egocentrism, magical thinking, animism.

Answer 147

pre

Question 148

The majority of graduate medical education funding is derived from what source?

Answer 148

Medicare

Question 149

The psychiatrist treating the ten-year-old child of divorcing parents receives a subpoena from the attorney for one of the parents requiring the psychiatrist to appear in court and provide a copy of the child's psychiatric medical record. The parents are in conflict about the child’s custody. The psychiatrist thinks that a court appearance would jeopardize the treatment alliance. After obtaining legal advice, the psychiatrist's response upon receiving such a subpoena should be to:

Answer 149

*seek informed consent from each parent to share information with the court. (the usual question is what’s your next best step, which would be reach out to your attorney. This question goes beyond this. You have to try and get informed consent from each parent. If the parents don’t give the consent, you still need to participate)

Question 150

Which of the following neurotransmitter systems is most prevalent and widely distributed in the human brain?

Answer 150

Glutamatergic (85% of the synapses in the brain are glutamatergic)

Question 151

When compared to an older child, adolescent, or adult, which of the following findings on mental status examination in a school-age child is most likely related to potential delays in cognitive development? - Thought blocking during interview - Command hallucinations to harm peers - Insistence that others are trying to hurt him - Difficulty differentiating fantasy from reality - Disorientation to self, day, place and situation

Answer 151

Difficulty differentiating fantasy from reality (Think of someone with mild/moderate ID. May have a lot of difficulty with distinguishing reality vs fantasty. The other answer choices in this question are signs of psychosis or delirium)

Question 152

A three-year-old in preschool is most likely to identify a classmate as a "friend" based upon the other child's: - gender - ethnicity - physical appearance - similarity of play interests - status within the larger peer group

Answer 152

similarity of play interests

Question 153

If an adolescent on an atypical antipsychotic medication presents with akathisia but without dystonia, which of the following medications would be most appropriate? - Lithium - Propranolol - Benztropine - Trihyxyphenidyl - Diphenhydramine

Answer 153

Propranolol (akathisia, think beta blockers first)

Question 154

An unmedicated 17-year-old patient presents with complaints of an uncomfortable and irresistible urge to move the legs, which usually occurs when laying down at bedtime, and is immediately relieved following movement, stretching, or walking around. Which of the following is the most appropriate first step intervention? - Low-dose clonidine - Low-dose propranolol - Low-dose diphenhydramine - High-dose omega-3-fatty acids - Iron supplementation if deficient

Answer 154

*Iron supplementation if deficient (Sounds like restless leg syndrome. 25% of ADHD children can have RLS. Important to ask on initial interview in clinic about both RLS and OSA in our patients, don’t just ask about hours of sleep, get a bit more detail)

Question 155

A student has been referred for a school-initiated psychiatric consultation. The parents refused consent. What is the most appropriate next step for the psychiatrist to take? - Meet with the student at least once to assess for risk of harm to self or others - Recommend that the school obtain a court order for the evaluation to proceed - Refer the student and parents for an assessment in the psychiatrist's private practice (Shouldn’t do this, drum up business for your practice. Need to be careful about anti-kickback laws. You are in a consult setting with school. Can’t be a double agent, this would be unethical) - Advise the school to initiate a special education evaluation despite parental objections - Observe the child in school unobtrusively and make recommendations to teachers

Answer 155

Observe the child in school unobtrusively and make recommendations to teachers [In questions like these where you don’t have consent. Think of least invasive thing you can do, most conservative thing you can do. You are hired by the school and your responsibility is to them. School mental health people sometimes sit in class and observe and provide information such as were they disrupting, did they get up, etc. If parent doesn’t consent to you meeting them you can’t meet the child. If you don’t have consent you can’t see them, this applies to consultation questions too, but this doesn’t mean you can’t observe class.]

Question 156

* **[MEMORIZE THIS] Sexual awareness and attraction in early adolescence is linked to which of the following biological factors? - Adrenal androgens - Gonadal development - Pheromone emissions - Epigenetic gene activation - Cerebral cortical maturation

Answer 156

Adrenal androgens [MEMORIZE THIS, IT IS NOT THE GONADS!]

Question 157

The psychiatrist evaluates a 17-year-old patient who reports sometimes feeling detached from himself and his surroundings. The patient also reports episodes during which he seems to "lose track of time." Friends have told the patient that he has behaved in ways that he does not remember. The patient denies hallucinations. There is no apparent delusional thinking. Reality testing and orientation are intact. The patient's diagnosis is most likely associated with which of the following? - Trauma - Intellectual disability - Alcohol and drug use - Medical comorbidity and etiology - Prodrome to a primary psychotic disorder

Answer 157

*Trauma [Its really important to think through a history of trauma. A lot of what may present as potential bipolar could be PTSD, which can lead to irritability and other symptoms)

Question 158

Which of the following scenarios may be considered a relative contraindication to a child being evaluated via telepsychiatry? - Depressed and suicidal child in their home - Hyperactive and oppositional child at their school - Anxious and somatic child at their primary care office - Acutely psychotic adolescent in an emergency department - Assaultive and aggressive adolescent in a detention facility

Answer 158

Depressed and suicidal child in their home [Would not be good to be suicidal at home...]

Question 159

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

Answer 159

Pedigree

Question 160

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

Answer 160

inhibits

Question 161

Glycine is a predominantly ___ neurotransmitter

Answer 161

inhibitory

Question 162

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

Answer 162

Glutamate

Question 163

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

Answer 163

neurotransmitter

Question 164

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

Answer 164

diagnose

Question 165

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

Answer 165

formal (13-> adulthood)

Question 166

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

Answer 166

microdeletion

Question 167

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

Answer 167

differentiates

Question 168

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 168

empathy

Question 169

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

Answer 169

accuracy

Question 170

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

Answer 170

Major depressive disorder

Question 171

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

Answer 171

Histaminergic

Question 172

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

Answer 172

spontaneity

Question 173

Norepinephrine is mostly synthesized in the ___

Answer 173

locus coeruleus

Question 174

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

Answer 174

raphe nuclei

Question 175

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

Answer 175

cardiac

Question 176

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

Answer 176

temperament

Question 177

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

Answer 177

excitatory

Question 178

Remember that responses to ___ may at times be normative.

Answer 178

stress

Question 179

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

Answer 179

dopamine

Question 180

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

Answer 180

refeeding

Question 181

___ 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 181

L-methylfolate

Question 182

The AMPA receptor is ___ by the presence of glutamate.

Answer 182

stimulated

Question 183

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

Answer 183

conditioned

Question 184

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

Answer 184

four

Question 185

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

Answer 185

deficits

Question 186

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

Answer 186

inadequate

Question 187

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

Answer 187

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 188

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

Answer 188

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

Question 189

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 189

504

Question 190

The multiple sleep ___ test is used to diagnose narcolepsy.

Answer 190

latency

Question 191

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

Answer 191

bicultural

Question 192

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

Answer 192

risk

Question 193

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 toys, 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 193

Disruptive mood dysregulation disorder

Question 194

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 194

polymerase chain reaction

Question 195

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

Answer 195

Linkage

Question 196

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 196

near

Question 197

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

Answer 197

ambivalence

Question 198

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 198

schizophrenogenic mother

Question 199

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

Answer 199

language

Question 200

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

Answer 200

corticostriatal

Question 201

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 201

story telling using words

Question 202

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

Answer 202

vocal

Question 203

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 203

Classical conditioning

Question 204

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 204

Maternal mental illness diagnosed before child's birth

Question 205

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

Answer 205

family

Question 206

___ acetylation activates transcription.

Answer 206

Histone

Question 207

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 207

rewards

Question 208

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 208

twelve

Question 209

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

Answer 209

presynaptic

Question 210

Narcolepsy is associated with a ___-1 deficiency.

Answer 210

hypocretin

Question 211

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

Answer 211

exome

Question 212

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 212

feel

Question 213

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 213

referencing

Question 214

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

Answer 214

GABA

Question 215

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

Answer 215

emotions

Question 216

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

Answer 216

epigenetic

Question 217

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 217

G-banded karyotyping

Question 218

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

Answer 218

twice

Question 219

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

Answer 219

periaqueductal gray area of the brainstem

Question 220

Oral contraceptives containing estrogens ___ serum levels of lamotrigine.

Answer 220

decrease

Question 221

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

Answer 221

tobacco

Question 222

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

Answer 222

NMDA

Question 223

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 223

decrease

Question 224

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

Answer 224

gonadal (estrogen, progesterone, and testosterone)

Question 225

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 225

Another anxiety disorder

Question 226

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

Answer 226

effect size

Question 227

Retaining ___ in the relationship distinguishes empathy from identification.

Answer 227

objectivity

Question 228

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

Answer 228

cumulative incidence

Question 229

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 229

Capitation

Question 230

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

Answer 230

Carbamazepine

Question 231

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 231

deletion

Question 232

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

Answer 232

Excess

Question 233

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 233

aerosols

Question 234

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 234

pronoun

Question 235

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

Answer 235

mirroring

Question 236

Slow-wave sleep enhances the secretion of ___ ___.

Answer 236

growth hormone

Question 237

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

Answer 237

Number needed to treat

Question 238

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 238

Habit reversal therapy

Question 239

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 239

Avoidant

Question 240

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 240

high

Question 241

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

Answer 241

inherited

Question 242

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

Answer 242

genetic

Question 243

What is the most common genetic cause of intellectual disability?

Answer 243

Down syndrome

Question 244

What is the most common inherited cause of intellectual disability?

Answer 244

Fragile X syndrome

Question 245

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 245

Adolescents and older adults

Question 246

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 246

validate

Question 247

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

Answer 247

ventral tegmental area

Question 248

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

Answer 248

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

Question 249

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

Answer 249

anterior

Question 250

The Continuous Performance Test measures ___ attention.

Answer 250

sustained

Question 251

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 251

systematic

Question 252

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

Answer 252

Epigenetic

Question 253

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

Answer 253

attunement

Question 254

In the first two years of life the motor cortex develops ___ of the sensory cortex.

Answer 254

ahead

Question 255

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

Answer 255

anterior limb of the internal capsule

Question 256

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

Answer 256

dorsolateral prefrontal

Question 257

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

Answer 257

Haplotypes

Question 258

___ ___ 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 258

Linkage disequilibrium

Question 259

The neural tube is formed from ___.

Answer 259

Ectoderm

Question 260

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

Answer 260

1

Question 261

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 261

Aspirin

Question 262

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 262

derealization

Question 263

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

Answer 263

inhibition

Question 264

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

Answer 264

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 265

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

Answer 265

neurogenesis

Question 266

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

Answer 266

habituation

Question 267

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 267

Female sex

Question 268

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 268

20 weeks gestation

Question 269

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

Answer 269

Nociceptin

Question 270

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 270

Substance use disorders

Question 271

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

Answer 271

accompany

Question 272

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

Answer 272

amylase

Question 273

* 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 273

Oppositional defiant disorder

Question 274

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

Answer 274

evoking

Question 275

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

Answer 275

nucleus accumbens

Question 276

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 276

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

Question 277

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 277

teacher

Question 278

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 278

Supportive

Question 279

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 279

Autonomy

Question 280

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

Answer 280

sanctions

Question 281

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 281

psychiatrist

Question 282

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 282

Attention-deficit/hyperactivity disorder

Question 283

*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 283

*without

Question 284

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 284

Sublimation

Question 285

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

Answer 285

Magnesium

Question 286

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 286

Alcohol exposure

Question 287

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 287

Verbal ability at age five years

Question 288

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 288

Exposure and response prevention

Question 289

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 289

Suprachiasmatic nucleus

Question 290

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 290

Diffusion tensor imaging

Question 291

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 291

Uses word combinations

Question 292

By what age does core gender identity typically form?

Answer 292

Three years old (3)

Question 293

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

Answer 293

The vagus nerve (X)

Question 294

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 294

Pedaling a tricycle

Question 295

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 295

Preoptic

Question 296

"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 296

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

Question 297

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 297

Cognitive behavioral therapy

Question 298

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 298

Advanced parental age

Question 299

Oxytocin suppresses the ___ during emotionally charged situations.

Answer 299

amygdala

Question 300

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 300

Hypothalamus

Question 301

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 301

Tyrosine hydroxylase

Question 302

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

Answer 302

skin conductance

Question 303

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 303

Globus pallidus

Question 304

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 304

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

Question 305

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 305

Genome-wide association studies

Question 306

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 306

Progesterone

Question 307

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 307

patent

Question 308

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 308

previous sexual abuse

Question 309

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 309

Serious neglect

Question 310

By the age of about 15 months, typically developing children begin 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 310

Understand that others have minds different from their own

Question 311

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

Answer 311

operant

Question 312

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 312

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

Question 313

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

Answer 313

Harm

Question 314

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 314

dorsolateral-prefrontal cortex

Question 315

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

Answer 315

mesocortical

Question 316

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

Answer 316

mesolimbic

Question 317

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

Answer 317

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

Question 318

___ 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 318

Dopamine

Question 319

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

Answer 319

Paraventricular nucleus

Question 320

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

Answer 320

Erik Erikson

Question 321

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 321

Identity vs role confusion (12 to 18 years; Dr. A-D's 15yo twins)

Question 322

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

Answer 322

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 323

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

Answer 323

identity diffusion

Question 324

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

Answer 324

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

Question 325

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

Answer 325

six (6) months

Question 326

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

Answer 326

Infancy

Question 327

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

Answer 327

Synaptogenesis

Question 328

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

Answer 328

three (3) yo

Question 329

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 329

late

Question 330

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 330

Adolescence

Question 331

Synaptic ___ predominantly occurs during adolescence and young adulthood.

Answer 331

pruning

Question 332

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 332

fixated

Question 333

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

Answer 333

*methylation

Question 334

*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 334

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

Question 335

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

Answer 335

Raphe nuclei

Question 336

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

Answer 336

serotonin

Question 337

Norepinephrine is mostly synthesized in the ___.

Answer 337

locus coeruleus

Question 338

___ is mostly synthesized in the locus coeruleus.

Answer 338

Norepinephrine

Question 339

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

Answer 339

Secondary prevention

Question 340

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

Answer 340

prior; symptoms

Question 341

___ 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 341

Tertiary prevention

Question 342

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 342

symptomatic

Question 343

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 343

reduce

Question 344

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 344

CpG

Question 345

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 345

promoter

Question 346

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 in FMR1 gene. Long face, large everted ears, prominent jaw, macroorchidism and a high arched palate, frequent hand flapping).

Answer 346

Fragile X syndrome

Question 347

___'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 347

Piaget

Question 348

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 348

Sensorimotor (birth->2 years)

Question 349

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 349

Concrete (7-12yo)

Question 350

Ocular jerk movements with optokinetic ___ suggests psychogenic blindness.

Answer 350

drum

Question 351

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

Answer 351

decreased

Question 352

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 352

Prader-Willi

Question 353

___ ___ are different proteins encoded by the same gene.

Answer 353

Splice variants

Question 354

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

Answer 354

hypothalamus

Question 355

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

Answer 355

aggression

Question 356

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

Answer 356

periaqueductal

Question 357

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

Answer 357

Reward

Question 358

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

Answer 358

alpha4beta2

Question 359

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 359

nicotinic

Question 360

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 360

arcuate

Question 361

Gender ___ is typically established by 3yo.

Answer 361

identity

Question 362

*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 362

Tyrosine hydroxylase

Question 363

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

Answer 363

alternative

Question 364

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

Answer 364

Wisconsin Card Sorting Test

Question 365

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

Answer 365

dorsolateral

Question 366

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

Answer 366

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

Question 367

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

Answer 367

Hirsutism

Question 368

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 368

Object permanence

Question 369

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 369

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

Question 370

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 370

a schema

Question 371

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 371

Concerns about confidentiality

Question 372

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 372

Supportive psychotherapy

Question 373

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 373

fasciculations ("muscle twitches")

Question 374

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 374

Selective abstraction

Question 375

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 375

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

Question 376

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 376

Prospective cohort

Question 377

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 377

Obsessive-compulsive

Question 378

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

Answer 378

Mary Ainsworth

Question 379

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 379

Dextroamphetamine

Question 380

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

Answer 380

Working group

Question 381

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 381

Heart rate variability

Question 382

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 382

Symbolic

Question 383

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

Answer 383

primary process thinking

Question 384

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 384

Inhibited

Question 385

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

Answer 385

Growth hormone (however, GH secretion is enhanced by slow-wave sleep)

Question 386

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 386

low molecular weight

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

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 392

slowly

Question 393

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

Answer 393

illusion

Question 394

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 394

sensitization

Question 395

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 395

Intellectual disability

Question 396

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

Answer 396

indels (INsertions and DELetionS in DNA sequence)

Question 397

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 397

Acknowledge the patient's fear

Question 398

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 398

Anorexia nervosa

Question 399

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 399

insula

Question 400

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

Answer 400

normal

Question 401

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 401

Acute stress disorder

Question 402

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

Answer 402

depression

Question 403

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 403

randomization

Question 404

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

Answer 404

Mentalization theory

Question 405

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

Answer 405

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

Question 406

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

Answer 406

Dissociative disorder

Question 407

Synaptic ___ predominantly occurs during adolescence and young adulthood.

Answer 407

pruning

Question 408

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

Answer 408

childhood

Question 409

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 409

Envy

Question 410

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 410

Payment

Question 411

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

Answer 411

attitude

Question 412

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 412

continue

Question 413

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 413

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

Question 414

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

Answer 414

Pain and Temperature

Question 415

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 415

treat

Question 416

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

Answer 416

Decreased

Question 417

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

Answer 417

Synaptogenesis

Question 418

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 418

GI distress

Question 419

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 419

Normal development

Question 420

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

Answer 420

Endorphins

Question 421

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

Answer 421

inhibition

Question 422

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 422

Increase in adrenal androgen production

Question 423

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 423

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 424

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 424

Genital

Question 425

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 425

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 426

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 426

cluster

Question 427

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 427

Depersonalization/derealization disorder

Question 428

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 428

quality

Question 429

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

Answer 429

lacking

Question 430

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 430

ordering

Question 431

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

Answer 431

different proteins

Question 432

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

Answer 432

Fluoxetine/prozac

Question 433

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

Answer 433

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 434

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 434

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

Question 435

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 435

An investigator for the purpose of conducting epidemiological research

Question 436

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

Answer 436

Sensitivity

Question 437

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 437

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 438

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

Answer 438

Respect for persons

Question 439

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

Answer 439

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

Question 440

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

Answer 440

reversible

Question 441

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 441

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 442

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

Answer 442

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 443

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 443

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

Question 444

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

Answer 444

National Alliance for the Mentally Ill (NAMI)

Question 445

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 445

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

Question 446

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

Answer 446

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 447

Positron emission tomography scanning measures what?

Answer 447

Glucose metabolism | Glucose "PET"

Question 448

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

Answer 448

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

Question 449

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

Answer 449

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

Question 450

Guanfacine and clonidine are alpha-2 adrenergic ___.

Answer 450

agonists

Question 451

___ 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 451

Atomoxetine

Question 452

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

Answer 452

intends

Question 453

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

Answer 453

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 454

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

Answer 454

anxiety disorders

Question 455

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

Answer 455

Paraventricular nucleus

Question 456

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 456

hypothalamus

Question 457

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 457

Multiple copies of wild-type alleles

Question 458

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 458

2 years

Question 459

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 459

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

Question 460

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 460

The availability of peer support

Question 461

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

Answer 461

Countertransference

Question 462

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 462

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

Question 463

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

Answer 463

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

Question 464

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

Answer 464

prior

Question 465

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 465

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 466

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 466

capacity

Question 467

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 467

Melanie Klein

Question 468

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

Answer 468

N3

Question 469

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 469

Reduced length of hospitalization