INS Exam 4 Compilation Flashcards by Emmanuel Scott

A 31-year-old patient was hospitalized 3h after ingestion of an unknown quantity of phenobarbital. The drug concentration in the plasma was found to be 6 mg/L after admission. Assume that in this patient pharmacokinetic parameters for phenobarbital are as follows: oral bioavailability, 100%, V= 80L, CL = 38L/day; half-life = 2 days. Which of the following dose of phenobarbital patient ingested? (Mukherjee)

600 mg

228 mg

480 mg

160 mg

240 mg

480 mg

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A 26-year old electrician has a “Nervous Disposition.” He easily startled, worries about inconsequential matters. Diazepam is prescribed. Diazepam are thought to cause sedative and/or anxiolytic effects by (Mukherjee)

Enhancing the actions of dopamine

Acting as a partial agonist at 5-HT receptors

Increasing functional activity at GABA receptors

Facilitating GABA mediated increases in chloride ion conductance

Blocking the NMDA glutamate receptor subtype

Facilitating GABA mediated increases in chloride ion conductance

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In the management of toxicity caused by ingestion of methanol in wood spirits. Which one of the following statements is MOST accurate? (Mukherjee)

Hemodialysis will not remove methanol from blood

Naltrexone is a suitable antidote is poisoning due to methanol

Treatment should involve the administration of disulfiram in the ER

Ethanol will prevent formation of formaldehyde in methanol poisoning

Delirium treatments is characteristics of methanol poisoning

Ethanol will prevent formation of formaldehyde in methanol poisoning

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A 25-yaer old young woman suffer from a seizure disorder characterized by tonic rigidity of the extremities followed in 20-30s of tremor progressing of massive jerking of the whole body. This clonic phase last for 1 to 2 mins, leaving the patient in a stuporous state. Which of the following drugs is MOST suitable for her long-term management? (Mukherjee)

Clonazepam

Tiagabine

Ethosuximide

Lamotrigine

Felbamate

Lamotrigine

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A 30-year old male patient is on drug therapy for a psychiatric problems for 4 years. He has been recently diagnosed having “long QT syndrome.” Which one of the following drugs used in the management of CNS dysfunction is MOST likely to cause problems in this patient? (Mukherjee)

Alprazolam

Ethosuximide

Buspirone

Lithium

Ziprasidone

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A 41-year old school teacher is taking haloperidol for a psychotic disorder. Which of the following adverse effects is Likely to occur in this patient? (Mukherjee)

Weight loss

Increase seizure threshold

Orthostatic hypotension

Agranulocytosis

Prolong QT interval

Orthostatic hypotension

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A 25 year old woman is brought to the ER by her classmate. She shows following symptoms attributed to a drug over dose. Increase heart rate and blood pressure, Mydriasis, behavioral excitation, aggressiveness, paranoia, and hallucination. Which one of the following drugs is MOST likely to be responsible for these symptoms? (Mukherjee)

Ethanol

Marizuana

Amphetamine

Fentanyl

Codeine

Amphetamine

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A 21 year old man is suffering from generalized anxiety disorder (GAD). He has prior history of drug dependence that includes the illicit use of secobarbital and alcohol. The physician also prescribes a drug that can be helpful in GAD and that has the advantage of no abuse liability. The drug prescribed was MOST likely to have been (Mukherjee)

Phenobarbital

Diazepam

Lorazepam

Buspirone

Oxazepam

Buspirone

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A college student is brought to the emergency department by friends. The physician is informed that the student had taken a drug and then went “crazy.” The patient is continuously laughing, increased heart rate and reddening of conjunctiva. Which of the following drugs MOST likely to be involved is (Mukherjee)

Cocaine

MDMA, “ecstasy”

Marijuana

Heroin

Phencyclidine

Marijuana

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Which of the following drug in overdose is known to cause the potentially fatal “serotonin syndrome?” (Mukherjee)

LSD

Nicotine

MDMA “ecstasy”

Coacaine

Phencyclidine

MDMA “ecstasy”

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The intense craving experienced by those who are trying to recover from chronic alcohol abuse can be ameliorated by which of the following drugs? (Mukherjee)

Disulfiram

Fomepizole

Naltrexone

Thiamine

Haloperidol

Naltrexone

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A 6 year old child is having learning difficulties at school. Electroencephlogram studies reveal brief 3-HZ spike and wave discharges appearing synchronously in all leads every 5 to 10 min. Which drug would be MOST effective in this child without the disadvantages of excessive sedation or tolerance development? (Mukherjee)

Diazepam

Phenobarbital

Valproic Acid

Clonazepam

Ethosuximide

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A 32 year old pregnant woman with alcoholism presented to ER in early stages of labor. She consumes large amounts of alcohol beverage throughout her pregnancy. This patient’s infant is at risk of a syndrome that includes (Mukherjee)

Underdevelopment of the lungs

Limn malformation

Mental retardation and craniofacial abnormalities

Spina bifida

Fetal hydration syndrome

Mental retardation and craniofacial abnormalities

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Which of the statements concerning the adverse effects of antipsychotic drugs is accurate? (Mukherjee)

Clozapine causes a small but important incidence of agranulocytosis

Renal pigmentation is a dose-dependent toxic effects of clozapine

Blurring of vision and urinary retention are common adverse effects of haloperidol

Failure to ejaculate is not common adverse effects of pehnothiazines

Aripiprazole can cause hyperglycemia, hyperprolactimia or weight gain

Clozapine causes a small but important incidence of agranulocytosis

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An antipsychotic drug that is quite sedating and associated with significant weight gain, hyperlipidemia, and increased risk of Type II diabetes is (Mukherjee)

Haloperidol

Aripiprazole

Chlorpromazine

Risperidone

Clozapine

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MAO inhibitors

Blocks reuptake of serotonin

Blocks reuptake of norepinephrine and serotonin

Degrades transmitters

Allows transmitters to work for a long time

Increases depression

Allows transmitters to work for a long time

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Lithium salts are used prophylactically in treating (Nyanda)

Fear and anxiety

Aggression

Compulsive disorder

Excitement induced urination

Manic depression

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The following statements concerning antidepressants are true EXCEPT: (Nyanda)

Patients taking antidepressants exhibit mental and physical dependence

Antidepressants drugs are extremely dangerous especially with the tricyclics

Antidepressants cause weight gain

Antidepressants potentiate effects of alcohols and sedatives

Majority of antidepressants drugs are known to have a short half-life and can be given frequently to calm the patient

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Which of the following drugs will alleviate an 8 year old boy from bed wetting? (Nyanda)

A. Trazedone
B. Imipramine
C. Fluxetine
D. tranylcypromine
E. Diazepam

B. Imipramine

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Which of the following is a tricyclic antidepressant drug? (Nyanda)
A. Diazepam
B. Epinephrine
C. Clozapine
D. Nortriptyline
E. Dopamine

D. Nortriptyline

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A 2 year old girl has a history of near-drowning, having been submerged in a semi-frozen lake for 20 minutes. As a result of this experience, there are bilateral infarcts in the hippocampal complex. Which of the following behavioral disorders is this patient most likely to display?

Aphasia

Social crudeness

A loss of long-term memory

A loss of immediate and short-term memory

Hypersexuality

A loss of immediate and short-term memory

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The type of receptor that is critical for the induction of hippocampal LTP, by virtue of its admitting calcium into a dendritic spine, is called:

An AMPA receptor

An NMDA receptor

A glycine receptor

A cholinergic GPCR

A noradrenergic GPCR

An NMDA receptor

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Weak stimulation of a pathway in the hippocampus will not by itself trigger long-term potentiation. However, if one pathway is weakly activated at the same time that a neighboring pathway onto the same cell is strongly activated, both synaptic pathways undergo long-term potentiation. This phenomenon is termed

Input specificity

State dependent potentiation

Associativity

Retrograde signaling

Habituation

Associativity

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Epileptic seizures can be caused by a variety of acquired or congenital factors, including all of the following EXCEPT:

Cortical damage from trauma

Cutting the corpus callosum

Stroke

Tumors

Congenital cortical dysgenesis (failure of the cortex to grow properly)

Cutting the corpus callosum

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A 12 year old boy has a seizure in which he experiences loss of consciousness and contraction of all of his muscles. A minute later he fails and begins to jerk, during which his extremities are flexed. His classmates were worried and stood around him as he continued to twitch for about 2 minutes. Soon the twitching subsided and he became immobile, and did not respond to calling of his name or shaking to try to awaken him. As one of his classmates ran for help, the boy began to respond but seemed extremely confused and tired. The classification of this type of seizure is Absence seizure Complex partial Petit mal Simple partial Generalized tonic-clonic

Generalized tonic-clonic

Language and speech require the participation of both Wernicke’s area and Broca’s area. These two regions of the brain communicate with each other via a fiber bundle called: The thalamocortical tract The arcuate fasciculus The perforant path The fornix Middle forebrain bundle

The arcuate fasciculus

The MRI of a 57 year old, right-handed woman reveals a lesion in the lateral aspect of the left hemisphere involving the inferior frontal gyrus, lateral portions of the pre-and postcentral gyri, the inferior parietal lobule, and portions of the adjacent superior temporal gyrus. Which of the following is the MOST prominent deficit in this patient? Blindness in the left eye Aphonia Paralysis of all eye movement Language comprehension and use Right-sided paralysis of the lower extremity

Language comprehension and use

A 72 year old retired butcher suffered a stroke affecting his left posterior temporal lobe. A sample of his speech is as follows: “Boy, I’m sweating, I’m awful nervous, you know, once in awhile I get caught up, I can’t mention the tarripoi, a month ago, quite a litte, I’ve done a lot well, I impose a lot, while, on the other hand, you know what I mean, I have to run around, look it over, trebbin and all that sort of stuff.” Split-brain Broca’s aphasia Wernicke’s aphasia Aprosodia Conduction aphasia

Wernicke’s aphasia

A blindfolded Meharry medical student is asked to identify a common object presented to her left hand. She is not allowed to touch the object with her right hand. Which of the following structures must be intact for her to complete this task? The primary somatic sensory cortex on the left side of her brain The primary visual cortex on the right side of her brain The corpus callosum The fonix The hippocampus

The corpus callosum

Computerized Tomography (CT): Is a superior imaging modality than magnetic resonance imaging (MRI) in every way except visualizing calcification Does not utilize radiation to generate images Cannot distinctly visualize gray and white matter in the presence or absence of surrounding bony structures Is not a useful tool to visualize structural shift in brain tissue or CSF volume change Cannot acquire a whole 3-D volume of brain images

Cannot distinctly visualize gray and white matter in the presence or absence of surrounding bony structures

Magnetic Resonance Imaging (MRI): Relies upon radio-frequencies to derive anatomical images Was developed the same year as CT Does not acquire image volumes in three dimensions Utilizes the same dipole relaxation rates for fat, protein, CSF and water Is the safest imaging modality for women of child-bearing age

Relies upon radio-frequencies to derive anatomical images

Magnetic Resonance Spectroscopy (MRS): Requires CT scans to define anatomic areas of interest Is most useful in the diagnosis of dementia and mental status changes Can be utilized to quantify brain metabolite concentrations Alone can generate anatomic images of psychiatric brain abnormalities Cannot define metabolism changes that occur with clinical pathology

Can be utilized to quantify brain metabolite concentrations

Single Photon Emission Computed Tomography (SPECT): Cannot measure cerebral blood flow Needs magnetic resonance imaging to define brain anatomy Utilizes a single photon that is detected simultaneous in two directions Deploys the same radiation theory and procedure as Computerized Tomography to derive brain images Utilizes MRI to detect radiation

Needs magnetic resonance imaging to define brain anatomy

Positron Emission Tomography (PET): Cannot be utilized for brain receptor studies targeting specific neurotransmitters Is a non-invasive imaging procedure Is less expensive than Computerized Tomography imaging Has less image resolution than Single Photon Emission Computerized Tomography Utilizes a photon detecting device that does not generate anatomic images

Utilizes a photon detecting device that does not generate anatomic images

Significant bone density is a major disadvantage of: Computerized tomography Magnetic Resonance Imaging Magnetic Resonance Spectroscopy Single photon emission computed tomography Positron Emission Tomography

Computerized tomography

Magnetic Resonance Imaging (MRI): Uses T2 sequences to define tumor location Uses T1 sequence that are no better than CT to localize anatomy in the occipital area of the brain Uses T1 sequences for anatomical resolution that are much better than CT Uses T1 sequences that are better than T2 to localize white matter and gray matter difference Uses T2 sequences that are no better than Magnetic Resonance spectroscopy to localize anatomy in the occipital area of the brain

Uses T2 sequences to define tumor location

Functional Magnetic Resonance Imaging (fMRI): Generates its images from changes in hemoglobin concentrations Generates its images from changese in cerebral blood flow rates Generates its images from X-rays Generates its images from radioactive tracers Generates its images from changes in neurotransmitter receptor densities

Generates its images from changes in hemoglobin concentrations

A 26 year old female student reports hearing “a strange male voice” while alone in her room, telling her to move things around. The LEAST likely diagnosis is: Schizophrenia Rest of answer choices are missing

Schizophrenia

Which is true about Schizophrenia? It is sufficient to demonstrate catatonic behavior to be diagnosed with schizophrenia Males are disproportionally affected with schizophrenia Substance abuse is rare among female patients with schizophrenia A particular disturbance, which should last at least six months Both mono and dizygotic twins have about 10% of concordance rate for schizophrenia

A particular disturbance, which should last at least six months

A 68 year old man comes to the office with complaints of memory loss. He says he forgets where puts items, names of familiar people and what he is about to do. He continues with his duties as treasurer of his civic club. His wife says he seems normal to her. His examination is normal except for a MMSE score of 29 out of a possible 30; he missed one of three words to remember after 3 minutes. What is the most likely diagnosis? Age associated memory change Mild cognitive impairment Dementia of the Alzheimer type Lewy body disease

Age associated memory change

A 68 year old man is brought to the office by his family because of memory loss. Patient insists he is normal. Family relates instances of short term memory loss, disorientation, difficulty with house hold chores, and inability to correctly handle financial matters. His examination is normal except for a MMSE score of 21 out of a possible 30. What is the most likely diagnosis? Age associated memory change Mild cognitive impairment Dementia of the Alzheimer type Lewy body disease

Dementia of the Alzheimer type

A 68 year old man comes to the office with complaints of memory loss. He says he forgets where he puts items, names of familiar people and what he is about to do. He continues with his duties as treasurer of his civic club. However, he must make lists of tasks to do or else he will forget them. Wife says he has bad memory but normal otherwise. His examination is normal except for a MMSE score of 27 out of a possible 30; he could not remember any of the 3 words after three minutes. What is the most likely diagnosis? Age associated memory change Mild cognitive impairment Dementia of the Alzheimer type Lewy body disease

Mild cognitive impairment

A 67 year old man comes to your office with his wife. Both report that he has had mental changes. He has reported seeing little people in the house. They are not threatening but follow him around. He wanders in the neighborhood and has gotten lost on a few occasions. On several occasions he has fallen for no known reason. On exam he has an expressionless face. There is a resting tremor and the motor tone is increased in a cog wheel type rigidity. On the Mini Mental State Examination he missed 2 of the 3 words to remember after 3 minutes, and he had difficulty copying the drawing of intersecting pentagons. Which of the following diagnoses are more likely? Normal pressure hydrocephalus Lewy body disease Multi-infarct dementia Parkinson’s disease dementia A and B B and D

B and D

Cholinesterase inhibitors are indicated in various disorders of memory disturbance. Which of the following should not be expected from their use? Temporary stabilization of global function and cognition in a demented patient Inhibit the transition from mild cognitive impairment to dementia Reduce time burden on care giver for a Alzheimer’s disease patient Delay nursing home placement for a Alzheimer’s disease patient

Inhibit the transition from mild cognitive impairment to dementia

When evaluating a patient with probably Alzheimer’s disease you plan a series of tests to answer what question(s) Are there amyloid plaques in the brain How severe is the Alzheimer’s disease Is there another possible cause of patient’s symptoms Does the patient have Parkinson’s disease

Is there another possible cause of patient’s symptoms

Characteristics of normal pressure hydrocephalus that help in distinguishing it from Alzheimer’s disease are all of the one below except Difficulty initiating walking (apraxia of gait) Urinary and fecal incontinence Normal appearance and ability to carry on a superficial conversation Decrease spontaneous activity and reduced level of interest

Normal appearance and ability to carry on a superficial conversation

Causes of dementia are: Multiple strokes Normal pressure hydrocephalus Creutzfeld-Jakob (prion) disease Lewy body disease A, C, and D All of the above

All of the above

Basic science and clinical studies have led to an understanding of the basic defect underlying the Lambert-Eaton syndrome. Which of the following best characterizes this defect? (Chirwa) The production of excess quantities of acetylcholine The production of antibodies that act against nicotinic Ach receptors A reduction in brain catecholamines Reduction in presynaptic Ca++ channels Viral encephalitis

Reduction in presynaptic Ca++ channels

While reviewing the lecture note from Dr. Chirwa, a group of freshmen found that there are several agents that act pre-synaptically and inhibit cholinergic functions. Which of the following agents inhibits cholinergic activity by blocking the storage of Ach into its vesicles? (Maleque) Alpha-bungarotoxin Botulinum toxin Vesamicol Hexamethonium Tubocurarine

Vesamicol

Which of the following drugs is an antagonist at nicotinic (N1) receptors? (Maleque) Atropine Dopamine Succinylcholine Trimethaphan Acetylcholine

Trimethaphan

Visual field loss in the nasal visual field of each eye most likely reflects pathology where\> The optic chiasm The temporal lobes The occipital lobe Both eyes

Both eyes

Local anesthetic agents act primarily: At a cortical level to decrease the patient’s awareness of pain impulses At the neuromuscular junction to decrease frequency of pain impulses reaching the CNS On the axon membrane to prevent depolarizing potentials At ganglion sites to decrease central pain input On the muscle membrane to decreasing blood flow

On the axon membrane to prevent depolarizing potentials

A 35 year old woman has recently started a regiment of antipsychotic therapy with a typical neuroleptic drug. A side effect of her medication is that she begins to lactate. This side effect is due to the fact that neuroleptic drugs block receptors in the pituitary gland for which of the following substances? Epinephrine Dopamine Glycine Norepinephrine Serotonin

Dopamine

A 75 year old woman with dementia showed a loss of neurons from the septal nuclei in the basal forebrain region of the cerebrum. Some cognitive improvement occurred when she was treated with a drug to enhance the function of these neurons. This drug most likely enhanced signaling in the brain from which of the following types of neuron? Adrenergic Cholinergic Dopaminergic Glutaminergic Serotonergic Orexin/Hypocretin

Cholinergic

Histamine cells projecting to the cerebellar cortex originate in which of the following? Hypothalamus Pontine nuclei Olivary nucleus Reticular nucleus Raphe nuclei Locus coeruleus

Hypothalamus

Pyridoxine deficiency associated with isoniazid can result in seizures due to Glutamate neurotoxicity GABA deficiency Cholinergic deficiency Serotonin syndrome Dopamine deficiency

GABA deficiency

Areas where the blood-brain barrier is compromised include which of the following? Anterior thalamic nucleus Hypothalamic Paraventricular nucleus Pineal gland Frontal cortex Intermediolateral column of spinal cord

Pineal gland

Lesions of the cerebellum cause dysarthria. On the neurological examination, dysarthria is characterized by Errors in direction and force of movement, i.e. pastpointing Unsteady gait Intentional tremor Slow and slurred speech Inability to maintain an upright posture

Slow and slurred speech

Which of the following is TRUE regarding children with a diagnosis of Autism? The vast majority of them will have an Axis II diagnosis of mental retardation Their auditory processing skills may be abnormal Their receptive and functional communication skills will be subnormal They will need special education consistent with Public Law 94-992 All of the above A, B, and C, only A and B, only

A, B, and C, only

Children with developmental learning disabilities: Are often mentally retarded, also Have normal general/globial intelligence Often “grow out” of their disabilities Must receive psychological testing from a physician before a diagnosis is made All of the above

Have normal general/globial intelligence

Males are more likely to exhibit which of the following disorders: Prader-Willi syndrome, mental retardation and autism Learning disabilities, Klinefelter’s syndrome, conduct disorder Attention Deficit Hyperactivity Disorder, Gender Identity Disorder Fragile X syndrome, Rett’s Disorder, Maple Syrup Urine Disorder All of the above A, B, and C, only None of the above

A, B, and C, only

The case of the brain injury of U.S. congresswoman Gabrielle Giffords gives students of Integrated Neuroscience an up-close and ongoing opportunity for synthesizing their knowledge of the subject, since her medical progress has largely been reported in the public domain. Hence, we may make the following statements regarding Congresswoman Giffords: Her rehabilitation has been excellent relative to the 6 to 112 month general expectation for brain injury recovery Her microsystem, mesosystem, and exosystem and chronosystem factors have converged to forma prognostically positive context for her recovery She has received medical care that the vast majority of Americans would not receive following a brain injury All of the above

All of the above

With regard to Congresswoman Giffords, we may also say that: There are many parallels between her brain injury and that of Phineas Gage The Chronosystem of Phineas Gage was superior to that of the Congresswoman The frontal cortex was impacted in both the cases of Gage and Giffords The Exosystem of Phineas Gage was superior to that of the Congresswoman All of the above A and C, only B and D, only

A and C, only

Which of the following regarding Congresswoman Giffords is FALSE? Her corpus callosum was impacted by the bullet Her right side motor ability was more impacted than the left side Her language skills were more affected than her creative skills Plasticity may account for some of her recovery ALL of the above

Her corpus callosum was impacted by the bullet

Which of the item(s) is/are FALSE regarding the Wechsler intelligence scales and the Stanford-Binet Scale? Z-scores have a mean of 100 and a SD of 15 T-scores have a mean of 50 and a SD of 10 Mild mental retardation may be denoted by an IQ of 65 Medical students must score at the 150+ IQ level as part of admissions testing A and C, only B and D, only

B and D, only

Which of the following statement(s) is/are TRUE regarding the Minnesota Multiphasic Personality Scale II It is a projective personality test (it is objective) It is comprised of 550 true-false items Raw scores are converted to Z-scores with a mean of 50 and a SD of 10 (T scores, not Z) It consists of 10 clinical dimensions/scales and 3 validity scales A and B, only B and D, only

B and D, only

Which IQ classification(S) correspond(s) appropriately with the DSM classifications of Mental Retardation (MR)? Profound MR = 20 to 25 Severe MR = 20-25 to 35-40 Moderate MR = 35-40 to 50-55 Mild MR = 50-55 to about 70 ALL of the above A and C, only B and D, only

ALL of the above

The Wechsler Adult Intelligence Scale III consists of which of the following subtests? Arithmetic, digit span and letter-number sequencing Vocabulary, similarities and information Picture completion and block design Digit symbol-coding and symbol search ALL of the above A and B only B and D, only

ALL of the above

The “Frontal lobe” is associated with which of the following cognitive and emotional attributes? Thinking, planning and mood control Long-term memory and auditory perception Visual-spatial processing and attention Long term memory and emotions ALL of the above A and C, only B and D, only

Thinking, planning and mood control

Left hemispheric attributes include all of the following EXCEPT: Analytical and logical thinking Capacity for scientific and detailed thinking Ability for precise and organized thinking Capacity for creative and imaginative thinking A and C, only B and D, only

Capacity for creative and imaginative thinking

Neurotransmitter behavioral impacts may include all of the following EXCEPT: Dopamine = movement disorders; hallucinations and delusions Acetylcholine = dementias Gamma Amino-butyric acid = anxiety Norepinephrine = depression Serotonin = anxiety, mood regulation None of the above/they are all TRUE

None of the above/they are all TRUE

Peyton, a 21 year old University of Tennessee (UT) college student and star quarterback sustained closed-head brain injury secondary to a car accident. He has experienced gross impairments of attention, mood control, thinking, and auditory perception for a one-year period. While he continues to take college classes, he only enrolls in very simple courses such as (1) Artistic Painting and Design and (2) Creative Computer-Based Music Composition that his coaches have negotiated his success with the professors who are UT alumni, so as to allow him continued UT matriculation. Premorbidly, he excelled in his major of electrical engineering. Peyton’s football peers have voiced dismay over their perceptions that he may never return to his premorbid capacity for leadership on the field, Moreover, they tend to cringe when his language outbursts easily become profoundly profane during work-outs when he becomes mentally slowed in his attempts to best determine which wide receiver to whom to throw the football, although his running and tackling workouts continue to be excellent. Further, they suspect that his previously ESPN publicized candidacy for the NFL Draft Combine during Spring 2012 has been absolutely ruled out. Which of the following statements is FALSE regarding Peyton? His brain damage is likely restricted to the frontal and temporal lobes He has become mentally retarded and he may likely continue to experience lowered intelligence Many of his executive functions have sharply declined Many of his rudimentary psychological functions are impaired Neuropsychological testing for localization of his brain insults may enhance treatment planning NONE of the above

He has become mentally retarded and he may likely continue to experience lowered intelligence

Which of the following statements are TRUE regarding neurotransmitters: Glutamic Acid may play a role in the production of symptoms of schizophrenia GABA is associated with anxiety Serotonin is linked to anxiety Serotonin is linked to depression Dopamine is linked to depression and mania Norepinephrine is linked to depression All of the above None of the above

All of the above

Physicians may be at an increased risk for Unipolar Disorder and suicidal ideation secondary to: Constant family discord and emotional neglect emanating from extended work hours Discomfort with admitting errors Discomfort with asking for mental health treatment Stigmatization of mental difficulties to licensure boards Fear of disclosure of mental difficulties to licensure boards All of the above

All of the above

The standard of care for panic disorders and agoraphobia includes: SSRIs, BNZs, TCAs Cognitive Behavioral Therapy Respiratory Training Systematic Desensitization All of the above ALL of the above except “A” and “C”

All of the above

Executive functions include: Multi-tasking, task attack, time management Visual-spatial processing, concentration, control of emotions Organizational skill, delay of gratification, abstract thinking Receptive and functional language skills, symbol recognition A and C, only B and D, only

A and C, only

The tests that comprise the Halstead-Reitan Battery of Neuropsychological Tests include: Category Test and Rhythm Test Tactual Performance test Trail-making test and critical flicker frequency test Finger-Oscillation test Time sense test ALL of the above A, B, and C, only

ALL of the above

Both lesion and functional neuroimaging studies in humans have shown that right parietal regions are involved in the processing of information from: a. Right and left hemispace b. Left hemispace only c. Right hemispace only d. Right and left visual field information only e. None of the above

Right and left hemispace

In which part of the cerebral cortex to sensations, emotions and thoughts come together and make us who we are a. The multimodal associate areas b. The premotor cortex c. The motor cortex d. The primary sensory cortex e. The Brodmann areas 44 and 45

a. The multimodal associate areas

Which of the following statements about the cellular structure of the cerebral cortex is TRUE? a. Neocortical regions containing from three to six cellular layers are found in all cell lobes b. In terms of cytoarchitecture, the association cortices all have the same histological appearance c. Archicortex includes the hippocampus d. The primitive “paleocortex” is found only in non-human primates e. The computations performed by 6-layered are demonstrated to be more efficient than those in 3-laered cortex

c. Archicortex includes the hippocampus

A middle-aged male was having difficulty sleeping and was referred to a sleep clinic. The diagnostician specifically sought to determine whether the patient showed rapid eye movement (REM) sleep on the recorded electroencephalogram (EEG) activity. What kind of activity should the diagnostician look for in the EEG activity in order to determine the presence of REM? Alpha rhythms Beta rhythms Theta rhythms Delta rhythms Non-specific spike and wave activity

Beta rhythms

Deep sleep is associated with what stage of sleep? REM Stage I Stage II Stage II Stage IV

Stage IV

Which of the following hypothalamic nuclei received DIRECT input from the retina and mediate hormonal fluctuations that are related to cycles of light and darkness? Supraoptic Medial optic Dorsomedial Suprachiasmatic Paraventricular

Suprachiasmatic

Which of the following is CORRECT concerning contralateral neglect syndrome? A. In normal subjects, the left parietal cortex dominates the control of attention B. A left parietal lesion results in sever right neglect C. A right parietal lesion leads to only minimal left neglect due to preserved attention within the left hemisphere. D. Right neglect may be caused by bilateral parietal lesions due to diminished attentional processing in both fields E. Only the right parietal cortex is involved in the control of attention

D. Right neglect may be caused by bilateral parietal lesions due to diminished attentional processing in both fields

The cognitive function of association cortex do NOT include the ability to A. make a motor response elicited by a sensory reflex pathway B. attend to and act upon internal motivations C. identify relevant features of external stimuli D. plan appropriate responses to external stimuli E. attend to external stimuli

make a motor response elicited by a sensory reflex pathway

That which is characteristic of frontal lobectomy patients is A. Signs of complacency, self-satisfaction and boastfulness B. Extremely high moral values C. Improved memory recall D. Increased ability to deal with day to day as well as future decisions E. Decreased sociopathic behavior

A. Signs of complacency, self-satisfaction and boastfulness

A middle-aged male was having difficulty sleeping and was referred to a sleep clinic. The diagnostician specifically sought to determine whether the patient showed rapid eye movement(REM) sleep on the recorded electroencephalogram(EEG) activity. What kind of activity should the diagnostician look for in order to determine the presence of REM? A. Slow-wave EEGs B. Low-voltage EEGs C. Sleep spindles D. High-voltage biphasic waves E. An increase in most skeletal muscle tone

B. Low-voltage EEGs

Extraocular movements during REM are due to activity in which region of the brain? A. Paramedian Pontine Reticular Formation(PPRF) B. Lateral Geniculate Nucleus C. Supraoptic Nucleus D. Suprachiasmatic Nucleus E. Reticular Formation

A. Paramedian Pontine Reticular Formation(PPRF)

A man was being seen in the hospital and after taking an MRI you were able to notice that strangely he had calcification of the raphe nuclei, preventing it from producing neurotransmitter. What is the most likely reason why the man came to see you? A. He was falling asleep at work an abnormal amount B. He was unable to fall asleep at night after a long day of work C. He was having abnormal dreams D. He was having lack of REM sleep E. He had no patience with any of his co-workers

A. He was falling asleep at work an abnormal amount

1. An EEG technician can look at an electroencephalogram and tell that the subject was awake, but relaxed with eyes closed, during generation of the recording. She can tell this because the EEG recording exhibits predominantly A. Alpha rhythm B. Beta rhythm C. Theta rhythm D. Delta rhythm E. Variable rhythm

A. Alpha rhythm

2. During a typical 8-hour sleep period, REM sleep A. occurs once B. occurs several times, each of approximately equal duration C. occurs for unpredictably varying durations D. decreases from up to 50 minutes in the first cycle to 10 minutes in the final cycle E. increases from about 10 minutes in the first cycle to up to 50 minutes in the final cycle

E. increases from about 10 minutes in the first cycle to up to 50 minutes in the final cycle

3. A 55 y/o man sees his primary care physician to address his erectile dysfunction. It so happens that the doctor is conducting a sleep study and to rule out the cause of the erectile dysfunction as being psychological, the physician places EEG probes on the patient and instructs the patient's concerned wife to monitor for erection during which phase of sleep? A. Alpha Waves B. Beta Waves C. Theta Waves D. Delta Waves E. REM

E. REM

4. The local newspaper announces a car accident in which a 30-year old woman survived, but after recovery suffered of constant disorientation, impaired planning ability, and repetition of behaviors. After reading this article you infer the woman suffered a lesion in the: A. frontal association cortex B. parietal association cortex C. temporal association cortex D. somatosensory cortex

A. frontal association cortex

6. A 67-year-old woman suffered a cerebral infarction 3 weeks ago. She frequently forgets to put her left arm into the sleeve of her robe or blouse, always leaves food on the left side of her plate, and frequently bumps into things on her left side. She has no language disorders or paralysis of speech. Which of the following represents the most likely site of cerebral cortical damage in this patient? A. Motor cortex in the right hemisphere B. Parietal association cortex in the left hemisphere C. Parietal association cortex in the right hemisphere D. Inferior temporal cortex in the left hemisphere E. Inferior temporal cortex in the right hemisphere

C. Parietal association cortex in the right hemisphere

7. In normal sleep REM sleep cycle occur approximately every ____ minutes? A. 45 B. 60 C. 30 D. 90

D. 90

An intravenous bolus dose of thiopental usually leads to loss of consciousness within 10-15 seconds. If no further drugs are administered, the patient will regain consciousness in just a few minutes. The reason for this is that thiopental is A good substrate for renal tubular secretion Exhaled rapidly Rapidly metabolized by hepatic enzymes Redistributed from brain to other body tissues Secreted in the bile

Redistributed from brain to other body tissues\*\*\*

A 13 year old boy got hurt in his right leg while playing soccer after class. His leg was swollen and he was screaming for pain. He was taken to the ER by his friends. The X-ray showed a complete fracture and the surgeon told the boy that he will have a surgery right now. The boy got so scared of surgery that he started crying and wanted to run away. In order to calm him down, the nurse gave him a pre-anesthetic drug. The drug most likely is Atropine Metoclopramide Ketamine Thiopental Diazepam

Diazepam\*\*\*

An anesthetic that is used extensively in balanced anesthesia protocols, has no significant postoperative vomiting, and is especially suitable for day surgery anesthesia. The favorable properties of the drug include an antiemetic effect and a rate of recovery more rapid than that following use of other intravenous drugs. The drug does not cause cumulative effects, possibly because of its short half-life (2-8 minutes) in the body. The drug most likely is (Maleque) Enflurane Ketamine Morphine Propofol Remifentanil

Propofol\*\*\*

1. Use of which of the following anesthetic drugs is associated with a high incidence of disorientation, sensory and perceptual illusions, and vivid dreams during recovery from anesthesia? A. Diazepam B. Fentanyl C. Ketamine D. Midazolam E. Thiopental

C. Ketamine

A number of drugs from different drug groups are used in general anesthesia for different clinical stages. Benzodiazepines are used for which of the following clinical stages? A. Premedication B. Induction of anesthesia C. Maintenance of anesthesia D. Post-operative emesis E. Rapid emergence

A. Premedication

An anesthetic that is an antiemetic, has more rapid recovery than other general anesthetics, used extensively in balanced anesthesia protocols, and is especially suitable for day surgery anesthesia in children is A. Enflurane B. Ketamine C. Morphine D. Propofol E. Remifentanil

D. Propofol

The depth of anesthesia is primarily dependent upon A. Concentration of anesthetics in the lung B. Concentration of anesthetics in the gas mixer inhaled C. Concentration of anesthetics in the CNS D. The number of drugs in the combination E. The blood flow through the carotids

C. Concentration of anesthetics in the CNS

A 55-year old woman with liver dysfunction is scheduled for foot surgery. Which of the following drugs can be used for preanesthetic sedation in this patient without concern for excessive CNS depression? Diazepam Flurazepam Lorazepam Phenobarbital Clorazepam

Lorazepam\*\*\*

The most frequent type of drug interaction that occurs in patients treated with sedative-hypnotic drugs is (Mukherjee) Inhibition of liver drug-metabolizing enzymes Increased cerebral blood flow Additive CNS depression Decreased renal function Antagonism of sedative or hypnotic actions

Additive CNS depression\*\*\*

A 45 year old man, is having trouble sleeping. He recalls that his wife has been prescribed phenobarbital, to control her epileptic seizures, and that barbituates are sometimes also prescribed as sleeping pills. He decides to take pill for couple of days to help him sleep. He developed several adverse effects. Which of the following effect is most unlikely to be caused by phenobarbital? (Mukherjee) Nystagmus Psychotic reaction Anticholinergic action Inhibition of hepatic drug metabolizing enzymes Hypersensitivity reaction

Inhibition of hepatic drug metabolizing enzymes\*\*\*

A 53 year old man with a history of anxiety is brought to the emergency department in an ambulance. Paramedics report that the patient was found unresponsive at home by his wife. On arrival, the patient is bradycardic and hypotensive, with a decreased respiratory rate. The patient arouses to painful stimuli but is only oriented to self. On further exam, the patient is found to have decreased deep tendon reflexes. The physician suspects that the patient has over-dosed on benzodiazepines. Which of the following medication can be given to reverse the effects of benzodiazepines? Naloxone Flumazenil Morphine N-acetylcysteine Methyldopa

Flumazenil\*\*\*

The distinction between an ideal sedative and an ideal hypnotic drug is A. sedative agents cause greater depression of the CNS than hypnotic agents B. there is little difference between the two; it is just a matter of dose, especially with the benzodiazepines C. sedative agents produce a reduction of anxiety while hypnotic drugs produce restful sleep D. sedative agents produce a reduction in cognitive functions while hypnotic agents do not E. sedative agents produce a state from which the person is easily aroused while hypnotic agents produce a trancelike state

C. sedative agents produce a reduction of anxiety while hypnotic drugs produce restful sleep

A 45-year old man comes to your office complaining of daytime sleepiness. On questioning you find that he has been taking a benzodiazepine in order to go to sleep at night. He is in the process of discontinuing the use of this agent but needs some assistance for the next week. The MOST appropriate agent to prescribe is A. Triazolam B. Alprazolam C. Flurazepam D. Lorazepam E. Quazepam

A. Triazolam

An 18-year old male is having difficulty sleeping because of the death of grandmother. He is given triazolam that A. is an antagonist at dopamine D-2 receptors B. Is an antagonist at alpha-adrenoceptors C. Binds to GABA-A receptors D. Binds to serotonin 5-HT1 receptors E. Binds to NMDA receptor

C. Binds to GABA-A receptors

An 85-year-old healthy man has difficulty sleeping. Triazolam is prescribed for his at one half of the adult dose. Which of the statement about the use of triazolam is this elderly patient is accurate? A. Triazolam is distinctive in that it does not cause rebound insomnia on abrupt discontinuance. B. Ambulatory dysfunction does not occur in elderly patients taking one half of the conventional adult dose C. He may experience amnesia, especially if he also drinks alcohol D. Over-the-counter cold medication may antagonize the hypnotic effects of the drug E. Triazolam decreased renal function

C. He may experience amnesia, especially if he also drinks alcohol

Which of the following drugs is contraindicated in patients with a history of acute intermittent porphyria, variegate porphyria, hereditary coporphyria, or symptomatic porphyria? A. Zolpidem B. Eszopiclone C. Phenobarbital D. Diazepam E. Chloral hydrate

C. Phenobarbital

A 67 year old man presents for evaluation of tremor. For several months he has noted tremor of left upper extremity only. Wife says when patient walks the left arm does not swing as well as on right side. On examination patient appears dull with little facial expression. You notice tremor of left upper extremity when it is resting in patient’s lap but the tremor disappears when he reaches out to shake your hand. Tone in left upper extremity is increased. When he walks he takes small steps and there is decreased left arm swing. Which of the following oral agents will not improve the lack of CNS dopamine: A. Levodopa alone B. Dopamine agonists C. Dopamine D. Combination of carbidopa and levodopa

C. Dopamine

A 44-year-old woman was treated with warfarin, a high plasma protein binding agents. Which of the following drugs MOST likely increase the plasma level of warfarin? A. Buspirone B. Zaleplon C. Diazepam D. Naloxone E. Chloral hydrate

E. Chloral hydrate

A 2 year-old child has ingested an unknown substance and has evidence of respiratory depression. This symptom is usually found with poisoning due to: A. Indomethacin B. Atropine C. Opioids D. Mushrooms E. Aspirin

C. Opioids

Patients with normal platelet counts and normal bleeding time may still bleed severely as a result of aspirin ingestion prior to a dental or surgical procedure. The aspirin interference with normal platelet function may last as long as: A. 2 hours B. 6 hours C. 12 hours D. 1 day E. 7 days

E. 7 days

The appropriate antidote in the treatment of pentazocine overdosage is: A. nalorphine B. levallorphan C. naloxone D. morphine E. phenobarbital

C. naloxone

PREREQUSITES for brain death A. Exclude Severe Metabolic Disturbance B. Exclude Drug Intoxication C. Exclude Hypothermia (Core Body ---Temperature \> 90 degree F) D. Proximate cause of irreversible loss of brain function should be known=Clinical Evidence/ Neuro-Imaging E. All of the above

D. Proximate cause of irreversible loss of brain function should be known=Clinical Evidence/ Neuro-Imaging

Care should be taken to quickly rule out reversible causes of coma. Common reversible causes are all EXCEPT: (Singh) Hypoglycemia or hyperglycemia Hypoxia Severe electrolyte abnormalities Heat intoleracnce A, B, and C

A, B, and C

Research on narcolepsy has suggested that these patients may have…(Singh) A lack of hypocretin An auto-immune insult on hypothalamic neurons Abnormal regulation of brainstem sleep centers All of the above

A lack of hypocretin\*\*\*

A patient complains of being constantly tired in spite of sleeping 9 to 10 hours most nights. There are no abnormal neurological findings but he is obese, has a short neck. His polysomnogram showed about 250 awakenings per night. Each awakening was preceded by an 11-12 second cessation of breathing. Breathing interruptions were caused by a temporary lack of muscle tone in the tongue. The most likely diagnosis in this case is…(Singh) Obstructive apnea Polysomnogram was normal Narcolepsy REM behavior disorder

Obstructive apnea\*\*\*

All of the following statements regarding stages of sleep are true EXCEPT Stage 1: presence of well formed alpha rhythm Stage 2: appearance of spindle/K-complexes Slow wave sleep shows EEG with delta activity \> 20% REM sleep, except for rapid eye movements and loss of muscle tone, resembles the wakeful/drowsy state

Stage 1: presence of well formed alpha rhythm\*\*\*

Common features of disorders of arousal include all of the above EXCEPT: Occurring in the 1st third of the night Amnesia the following morning Variable levels of agitation Occurring at the transition out of slow-wave sleep Day time sleepiness

Day time sleepiness\*\*\*

Prerequisites for declaration of brain death by a physician after a clinical examination include all of the above EXCEPT (Singh) Approximate cause of irreversible loss of brain function should be known through patient’s history and or examination (clinical Evidence) or via investigations (neuro-imaging) There is no reversible severe metabolic disturbance Drug intoxication has been excluded Hypothermia (core body temperature \> 90 degree F) has been excluded Family’s consent is sought before conduction the exam for brain death

Family’s consent is sought before conduction the exam for brain death\*\*\*

Glasgow coma scale or GCS is a neurological scale that aims to give a reliable, objective way of recording the conscious state of a person for initial as well as subsequent assessment. A patient is assessed against the criteria of the scale, and the resulting points give a patient score. Which statement regarding GCS is CORRECT? Higher the score, deeper the coma Lower the score, deeper the coma The worst scores obtained is recorded for eyes, verbal response and motor movements This scale is only of relevance in drug-induced coma Lower the score, deeper the coma

Lower the score, deeper the coma\*\*\*

The most comorbid axis I psychiatric disorder found in patients with personality disorder is

Anxiety disorders

Which of the anxiety disorders is the most common cormorbid personality?

Social phobia

Which of the following is false?

Narcisistic personality disorder is more commonly diagnosed in women

Mr. X is stopped by the police for driving 70 miles per hour on a 40 mph road. If he were to have a specific personality disorder, his answer to the policeman is likely to be

Schizotypal PD- I knew it was going to happen when I left my house this morning- a black cat crossed my way

A 55 yo man is sitting on the examining table. He has been discouraged for 2 years and he has a poor appetite. His head and eyes are downcast, his eyes are red, and he says: I am sorry to bother you doctor, but I need somebody to talk to. I can’t take it any more:

Major depression disorder

Which statement is true about Major Depressive disorder?

It is more common in divorced, widowed, and single individuals w/ no children

Sleep problems and major depressive disorder:

Initial and terminal insomnia are very common

After age, race, and gender, what other factors would not place a person for suicide risk?

Problems with concentration and attention

A 35-yo patient who is involved in a fight at a bar is very horrified and felt very helpless at the time. He was in state of shock. Was unaware of his surroundings, had nightmare mood problems Within 2-3 weeks he was able to go to the bar again.

Acute stress disorder

Genetic susceptibility for OCD is suggested by evidence that there is a family link with

Tic disorders

OCD symptoms are characterized by which of the following psychological defense mechanism

Isolation and undoing

Which of the following psychotherapeutic techniques is most clearly treatment for social phobia

Exposure therapy

A 12 yo girl disclosed to her counselor a history of sexual abuse. The cousoler made a report to the authorities and the patient describes anxiety, stress……

Post traumatic stress disorder

A 32 yo patient with past psychiatric history is brought to the ED with a 2 day memory loss.. Patient has inability to sleep, no appetite, and difficulty performing daily routines. She was unable to remember any of the three objects, but was able to remember the name of the hospital. Screening lab survey, toxicology screen, and CT were all normal. The problem?

Acute stress disorder

Reoccurrance is the rule in the case of major depression disorder, hence the treatment is dependent on the number of episodes of depression. How much longer does the patient have to be treated if he or she has 3 or more episodes?

Lifelong

Which of the following neurotransmitters is not involved in depression disorder?

GABA

Which of the following would distinguish between the diagnosis and bereavement of major depressive disorder?

No functional impairment

A 43 yo white male comes for the evaluation of his ongoing depression for the last 6mos. He has hypersomnia, increased appetite, and a feels as his limbs become extremely heavy. He is very sensitive towards criticism. What is the diagnosis?

Catatonic

The susceptibility for OCD is increased if the patient had what type of infection?

Strep

Which of the following statements is true for a panic disorder?

Most common age of presentation is 25

Which of the following treatments is most commonly indicated for performance type social phobia?

Beta blockers

Which of the following comorbid conditions is most commonly seen in patients with panic disorder?

Major depression episode

Repetitive behaviors that the patient feels impailed to perform ritualistically while recognizing the irrationality and the absurdity of the behavior describes

Rituals

Reserpine causes depression by:

Depleting monoamine stores

26yo female students hears a strange noise in the room telling her to move things around. The least likely diagnosis is what?

Delusional disorder

Psychosis:

is a problem assessing reality

Which structure is a permanent paired fibers bundle carrying efferents from the hippocampus?

Fornix

Which layers of the precentral gyrus is significantly thicker b/c of the presence of pyramidal cells?

The posterior cerebral artery supplies all of the following accept?

Temporal pole

Which artery supplies the medial surface of the corpus callosum ?

Anterior Cerebral

Which other entity do the receptors of postganglionic parasympathetic target tissue synapses share similarities to?

The receptor of sympathetic postganglionic receptors

At the Hubbard General Hospital, a man was given a muscle relaxant b/f intertrachial intubation.

Tubocrine

Ganglionic blockage would be expected to give rise to all of the following except:

Hypertension

Which of the following is the most beneficial in reducing neural tube defects?

Folate

An orthoscleratic artery embolus from the carotid artery most commonly infarcts in the distribution of

Middle cerebral

Cells of the brain and the spinal cord whose origination is from the mesenchyme are:

Microglia

Which of the following neuronal agents depletes catecholamines at the presynaptic site?

Reserpine

A 66yo woman has headaches that began around the age of 50. At the beginning, the frequency was 4-8 times a month and she had 15 attacks in the past 60 days, which were 1.5 to 3 days long. Headaches on one side of the head for this patients calls for which treatment?

5-HT agonist

A heroin addict comes to the ED anxious and agitated. He complains of chills, muscle aches, and diarrhea. What will block the effects of the injected heroin for up to 48 hrs?

Naltrexone

A local lesion in which of the following structures which experience a prolonged coma?

Periaqueductal region at the top of the midbrain

25 yo sophomore medical student is hit by a car and she has a large mass in her sellica tucica. If untreated, it will cause:

Amenorrhea

A 38 yo woman has great difficulty keeping up b/c she keeps falling asleep during the day.

Hypocretin and Orexin

Which area receives integrated sensory information from multiple sensory modalities?

Hippocampus

INS Exam 4 Compilation Flashcards

(167 cards)