PRITE PREPARATION PARTS 1 and 2 Flashcards
(299 cards)
1
Q
Activation of which of the following receptors is thought to be responsible for the anti-anxiety, motor-impairing and sedative-hypnotic effects of alcohol?
A
GABA-A
2
Q
A patient reports insomnia, frequent nighttime awakenings and excessive daytime sleepiness. A sleep
study reveals brief lower extremity jerks with brief repeated arousals. The patient is unaware of these movements. Which of the following diagnoses is most consistent with the patient’s presentation?
A
Periodic limb movement disorders
3
Q
An infant who engages in an interactive game of peek-a-boo most closely demonstrates the concept of which of the following cognitive abilities?
A
Object permanence
4
Q
A 26-year-old patient presents with headache and clumsiness of the right hand for several weeks. Physical examination is noteworthy for difficulty with rapid alternating movements of the right hand, an overt intention tremor on finger-to-nose testing, and mildly dysmetric finger-tapping. Cranial nerves are intact and there is no papilledema. Damage to which of the following structures will most likely be seen on magnetic resonance imaging scan?
A
Cerebellum
5
Q
A resident who runs a lecture course for medical students is told that the medical school now requires all teachers to consider “learning styles” when planning curricula. Which of the following changes to the curriculum would be best supported by existing literature?
A
Use supplemental material designed to address the needs of all types of learners
6
Q
The therapist is treating a high-achieving patient who has become increasingly anxious about the perception of her work. This has led the patient 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 necessary to be successful. The patient responds, “I always have to work harder than everyone else to succeed.” In cognitive theory, this statement is an example of
A
a schema.
7
Q
Which of the following is the most significant barrier to accessing mental health services in school-based health centers?
A
Concerns about confidentiality
8
Q
Which of the following forms of psychotherapy is most likely to describe a therapeutic goal as
“improving ego functioning and self-esteem”?
A
Supportive psychotherapy
9
Q
In the sagittal section shown, what letter corresponds to the brain structure commonly termed the habenular nucleus?
A
D
10
Q
A 27-year-old patient is seen for intermittent muscle twitching. Examination demonstrates full strength with normal muscle bulk. An electromyography study demonstrates spontaneous discharges which are relatively constant and represent firing of the motor unit. These findings are typical of
A
fasciculations.
11
Q
A professional dancer who sees a psychiatrist for psychotherapy made her Broadway debut last week. Although her performance and the show won wide acclaim, she cannot stop replaying a minor misstep she made. It does not appear that the misstep was noticed by the audience or other performers. Despite being congratulated on her performance she feels that, because of the error, she has let herself down.
Which of the following cognitive errors is the patient displaying?
A
Selective abstraction
12
Q
Which of the following is the primary purpose of mental health courts?
A
Divert offenders with mental illness away from incarceration
13
Q
The psychiatrist who is assessing a patient’s suitability for psychotherapy notes that the 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 of the following personality traits is most likely to characterize this patient?
A
Obsessive-compulsive
14
Q
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?
A
Prospective cohort
15
Q
Disruption in cortico-striato-thalamo-cortical circuit function is most closely associated with what group of disorders?
A
Obsessive-compulsive
16
Q
A patient is brought to the emergency department after a syncopal episode with hyperthermia, headache, flushing, and tachycardia. The patient has significant hypotension requiring fluid resuscitation. According to family, the patient has a history of schizophrenia, generalized anxiety disorder, and alcohol use disorder. An interaction with which of the following medications is most likely to have caused the patient’s symptoms?
A
Disulfiram
17
Q
Ainsworth introduced the strange situation experiment to evaluate which of the following?
A
Attachment between a parent and child
18
Q
A 72-year-old patient presents with subacute onset of progressive ataxia of gait and limbs. Laboratory testing reveals the presence of an anti-Yo antibody in the serum. Which of the following tests should be ordered next?
A
Computed tomography scan of the chest, abdomen and pelvis
19
Q
A nine-year-old child with attention-deficit/hyperactivity disorder does not respond to methylphenidate. Which of the following medications should be tried next?
A
Dextroamphetamine
20
Q
In which of the following ways does sexual health change in older individuals?
A
Refractory period for men increases
21
Q
Which of the following developmental stages in psychodynamic group therapy is characterized by intimacy?
A
Working group
22
Q
Over the course of several months, a 46-year-old patient with no past psychiatric history becomes emotionally labile and irritable. The patient undergoes personality changes, and is observed to inappropriately laugh when neighborhood children taunt a stray cat. Within two years, the patient develops a fear of contamination and greatly decreases food intake due to being convinced that all food has germs. Memory is preserved. The patient is no longer able to work or live independently. Neuropsychiatric tests show impaired language and attention. Which of the following is the most likely diagnosis?
A
Frontotemporal dementia
23
Q
Which of the following measures is used in biofeedback as a marker of autonomic activity?
A
Heart rate variability
24
Q
A 22-month-old is observed to place a wooden block on a toy train track and say, “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?
A
Symbolic
25
Which of the following is associated with an increased risk of depression in patients with multiple sclerosis?
Lesion volume
26
According to psychoanalytic theory, the term primary process thinking refers to mental activity exemplified by which of the following?
Unconscious thoughts that do not maintain logical connections
27
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
28
Which of the following is the central principle of "The Goldwater Rule" for psychiatrists?
It is unethical for psychiatrists to offer professional opinions on public figures without a face-to-face evaluation.
29
Which of the following is the strongest risk factor for postpartum depression?
Untreated depression during pregnancy
30
Which of the following hormones is released during sleep, but likely does not have a circadian pattern?
Growth hormone
31
In cases of severe lithium toxicity, extracorporeal treatment is typically indicated. Lithium is readily dialyzable due to its:
low molecular weight.
32
Which of the following is among the first medications ever approved to treat depression?
Iproniazid
33
A graduate student is brought to the emergency department during exam week because of the sudden onset of paralysis in the right leg. On physical exam, reflexes are normal. The doctor asks the patient to lie down flat and lift the unaffected leg. When the patient does this, the doctor feels increased pressure under the affected leg. Which of the following is the most likely diagnosis?
Conversion disorder
34
When testing for the Babinski reflex, what alternative stimuli can be used by the examiner to overcome the withdrawal response by a patient?
Downward scraping of the shin
35
A 23-year-old patient began psychotherapy due to feelings of inadequacy and depression in the context of working in a coffee shop since graduating from college and deferring medical school acceptance. The patient has been having conflicts with parents over his ambivalence about becoming a physician. Which of the following is the most likely developmental task with which the patient is struggling?
Identity
36
A celebrity radio psychiatrist tells the listening audience that medications like alprazolam are often prescribed for insomnia. A radio listener obtains alprazolam 1 mg tablets from a friend. The listener takes four tablets, falls, and sustains a sprained wrist and a concussion. The listener is now suing the psychiatrist for malpractice. Which of the following is the most likely outcome of this case?
Psychiatrist will win because a doctor-patient relationship was not established.
37
The ability to temporarily store and manipulate information, such as when doing mental arithmetic, is referred to as
working memory.
38
When observed in a young adult, bilateral paresis of the medial rectus muscle of the eye on attempted lateral gaze, with a coarse nystagmus in the abducting eye, is characteristic of which of the following conditions?
Multiple sclerosis
39
Clinical studies of adolescents and young adults have found that physicians can decrease the risk for suicidal events when prescribing antidepressant medication by
slowly titrating the antidepressant.
40
Ethical standards issued by the American Medical Association prohibit physician involvement in which of the following aspects of a death penalty case unless a commutation order is in place?
Restoration of competence to be executed
41
A patient describes hearing his name each time the wind rustles the leaves outside his room each morning. Which of the following describes this phenomenon?
Illusion
42
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
sensitization.
43
A patient in early remission from alcohol dependence presents to the psychiatrist reporting intense craving for alcohol. The patient is having difficulty managing the cravings and is concerned about relapsing. In addition to providing psychosocial interventions, which of the following medications would be most appropriate to recommend for this patient?
Naltrexone
44
Which of the following is seen most frequently as a comorbid condition in children with autism spectrum disorder?
Intellectual disability
45
The term indels refers to
small insertions and deletions in DNA sequence.
46
A patient presents to the emergency department with significant paranoia. The patient is hypervigilant, pacing, and responding to unseen others. Which of the following techniques would be most appropriate to establish rapport with the patient?
Acknowledge the patient's fear
47
The psychiatrist evaluates an 18-year-old patient who has been avoiding food for the last four months. Her BMI is less than normal, and she menstruates regularly. Family members report that the patient 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. The patient meets criteria for which of the following diagnoses?
Anorexia nervosa
48
What brain region is indicated in this figure?
Insula
49
A patient with schizophrenia is newly initiated on clozapine therapy after failing two other antipsychotic trials. The patient's initial absolute neutrophil count is 2200/mm3. How frequently should the psychiatrist order a CBC with differential for this patient?
Weekly
50
Parents of a 16-year-old are concerned that their child prefers using text messaging and online social media to communicate with peers. They have discovered text messages to and from romantic partners, and visits to sexual health-related websites. The family is from a higher socioeconomic stratum, and the adolescent has thus far met normal developmental milestones. Which of the following is the most likely consequence of this adolescent's reliance on electronic forms of communication?
Continued socialization within the current peer group
51
A 35-year-old patient is hospitalized because of a concussion after a motor vehicle collision. Physical examination shows no abnormalities other than minor 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?
Acute stress disorder
52
Which of the following vitamins has been found to be effective as an adjunct to antidepressant medications for the treatment of depression?
D3
53
Which of the following scales is the easiest to use for an initial assessment of delirium in the geriatric population?
Confusion Assessment Method
54
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 randomization.
55
Which of the following practices is the best predictor of healthy aging in elderly individuals?
Remaining in contact with friends
56
A stroke in which of the following arterial territories would result in an inability to read, but with preserved ability to write?
Posterior cerebral
57
Which of the following genes has been most associated with late-onset neurocognitive disorder due to Alzheimer disease?
APOE*E4
58
A cross-sectional study reveals that depressive disorders are less common in individuals who take a particular natural remedy pill daily. The same investigators then prospectively observe individuals from the same population for one year and find that the prevalence of depression is much lower in those who regularly use the natural pill compared to those who do not. They then recruit a sample from the same population and randomly assign subjects to pill or placebo for one year. In this last study, they do not find any difference in the prevalence of depression between the two groups. Independent reviewers do not find any major flaws in the design or analytic methods of the three studies. They do note that a few of the study subjects in the intervention group correctly guessed their assignment, and that the study was partly funded (though not designed or analyzed) by the company that produces the natural remedy. What is the most likely explanation for the discrepancy in results?
Some unknown variable confounded the non-random results.
59
A 26-year-old medical student is struggling with time management and peer-peer interactions on hospital rotations. The student has received feedback that she spends too much time organizing and highlighting her patient care cards and writing and re-writing notes to the exclusion of spending time with patients. She constantly violates duty hours because of a seeming inability to complete her work during the normal day. When given a group presentation assignment, she completed it on her own telling her peers, "It was just easier to do it myself." Which of the following personality disorders is most consistent with these symptoms?
Obsessive-compulsive personality disorder
60
Which of the following psychodynamic theories emphasizes individuals' ability to understand their own and others' internal states as explanations for behavior?
Mentalization theory
61
When the central nervous system responds to an acute cortical insult, which of the following occurs?
Microglia processes retract, and the cell body enlarges.
62
Which of the following is most likely to reduce psychotic symptoms in patients with Parkinson disease without worsening motor symptoms?
Pimavanserin
63
Which of the following diagnoses is associated with high hypnotizability potential?
Dissociative disorder
64
Which of the following neurodevelopmental processes predominantly occurs during adolescence and young adulthood?
Synaptic pruning
65
Which of the following has been reported regarding the likelihood of escalation of benzodiazepine dose when prescribed for long-term use?
Most patients will maintain a stable dose over time.
66
A 72-year-old patient developed sudden onset of memory loss, and was unaware of how the patient and spouse arrived at the supermarket. The spouse noted that the patient was able to drive without problem, but appeared anxious during much of the trip. The patient was able to appropriately answer questions, but then didn't remember the conversation. The entire episode lasted three hours, after which time the patient returned to baseline. The most likely diagnosis is
transient global amnesia.
67
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
68
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) limits disclosure of patient health information without patient authorization except as necessary for which of the following?
Payment
69
The validity scales of the Minnesota Multiphasic Personality Inventory-II measure which of the following?
Test-taking attitude of the patient
70
A patient with a history of depression and well-controlled epilepsy underwent numerous antidepressant trials before finally responding to bupropion. Antidepressants not tried included imipramine, nortriptyline, duloxetine, and selegiline. No seizures have occurred during treatment with bupropion SR 100 mg BID. The patient's health insurance provider, however, recommends switching to another antidepressant because of bupropion's well-known tendency to reduce seizure threshold. Which of the following is the most appropriate response by the treating psychiatrist?
Continue bupropion SR
71
A 21-year-old patient is brought to the emergency department after having an episode of nausea, sweating and hematemesis. The patient reports recently having severe headaches and numbness in the extremities. Computed tomography scan reveals generalized brain atrophy. Laboratory studies reveal evidence of renal tubular acidosis and a CPK of 3120 mcg/L. This presentation is consistent with chronic use of which of the following substances?
Inhalants
72
Which of the following is transmitted through the spinothalamic tract?
Pain
73
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
treat.
74
A patient undergoes a multiple sleep latency test (MSLT) and is diagnosed with narcolepsy. What finding on the MSLT would confirm the diagnosis?
Decreased REM latency
75
Which of the following accounts for the brain's rapid increase in size from birth through the second year of life?
Synaptogenesis of neurons
76
Which of the following is the most common reason for patients to discontinue selective serotonin reuptake inhibitors early?
GI distress
77
Patients with which of the following neurological disorders have been reported to have the highest prevalence of pathological laughing and crying?
Amyotrophic lateral sclerosis
78
Parents are concerned because their two-year-old 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?
Normal development
79
A medical student on the psychiatric consult service is called to evaluate an 80-year-old patient in the ICU who is awake throughout the night, pulling out IV lines, and misidentifying the nurses as bank employees. The student wants to conduct a brief cognitive screen. In addition to questions of orientation, which of the following components of the Mini-Mental State Examination would be most helpful in confirming the patient's diagnosis?
Serial 7s
80
Which of the following neurotransmitters, present in the periaqueductal grey matter, is involved in the mediation of pain?
Endorphins
81
Which of the following is a pharmacological effect of lithium?
Glycogen synthase kinase-3 inhibition
82
Which of the following stages of development occurs first in female physical development?
Increase in adrenal androgen production
83
What type of genetic variation is most commonly investigated in genome-wide association studies?
Single nucleotide polymorphisms
84
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?
Genital
85
Deep brain stimulation targeting what brain region has been most frequently studied for the experimental treatment of depression?
Subcallosal cingulate cortex
86
A 32-year-old patient has episodes of irresistible sleepiness, and falls asleep while driving. The patient reports experiencing episodes of paralysis and hallucinations upon awakening. These symptoms are best explained by a deficiency in which of the following?
Orexin
87
A 32-year-old presents with new-onset headache characterized by unilateral, stabbing eye pain. During these episodes the patient develops runny nose and conjunctival injection on the same side as the headache. These episodes occur every evening after falling asleep and last up to two hours. Based on this history the patient most likely has
cluster headache.
88
A patient presents to the psychiatrist with the complaint of, "I think I'm going crazy." The patient reports that she often feels as if she has "no self" and her thoughts are not her own. In fact, she often feels like a robot and as if she is unable to control her body. She states that she knows she has feelings but is not able to feel them, instead feeling emotionally numb, and she frequently feels that her head is "full of cotton." Recently, she has begun having "out of body" experiences. Which of the following is the most likely diagnosis?
Depersonalization/derealization disorder
89
There are three primary components of "Meaningful Use" of electronic medical records (EMR). These include the use of a certified EMR in a meaningful manner, the use of certified EMR technology to submit clinical quality measures, and which of the following?
Electronic exchange of health information to improve quality of care
90
Which of the following neurotransmitters is thought to play a key role in fine-tuning working memory function in the dorsolateral prefrontal cortex?
Dopamine
91
What does current evidence show regarding psychiatrists using pharmacogenomics testing in clinical practice?
Research shows promise for clinical utility, but replicated evidence about outcomes is lacking.
92
A 65-year-old patient is evaluated for right-hand numbness. Computed tomography (CT) scan of the brain is shown below. Which of the following is the most likely explanation for the finding on CT scan?
Remote stroke
93
A psychiatrist working in a primary care clinic employing the collaborative care model is contacted by a family practice provider (PCP) for an informal "curbside" consultation regarding a patient. After a five-minute telephone consultation, the psychiatrist provides recommendations without evaluating the patient. Which of the following practices is recommended to minimize liability for the psychiatrist?
Care of the patient remains under the direction of the PCP who also remains in charge of ordering medications or additional services.
94
Which of the following sleep disorders is associated with mild neurocognitive disorder with Lewy bodies?
REM sleep behavior disorder
95
During a neurological examination an 80-year-old patient is unable to demonstrate how to blow out a match. Motor and sensory function are normal, and the rest of the neurological examination is unremarkable. The patient's inability to perform this action is termed
apraxia.
96
Splice variants are best defined as
different proteins encoded by the same gene.
97
Which of the following antidepressant medications is safest to use in patients with seizure disorders and depression?
Fluoxetine
98
According to Erikson, the predominant emotional issue in typically developing, school-age children is
personal worth and competence.
99
Which of the following would be considered a boundary violation?
Investing in a patient's business
100
An epigenetic cause of fragile X syndrome involves which of the following changes regarding the fragile X mental retardation 1 gene?
Methylation of the CpG sites of the promoter region
101
Which of the following disorders is associated with the loss of fast-conducting peripheral sensory nerves and decreased sex steroid secretion that accompanies aging?
Delayed ejaculation
102
The Epidemiological Catchment Area Project examined rates of somatic and psychiatric symptoms in the general population. Subjects with which of the following conditions had significantly higher rates of mood and anxiety symptoms when compared to those with low back pain?
Irritable bowel syndrome
103
What neural pathway has been most consistently found to mediate reactive aggression?
Amygdala-hypothalamus-periaqueductal gray
104
An overweight patient with bipolar II disorder has chronic kidney disease, hypertension, and diabetes mellitus type II. The patient's hypomanic episodes have been relatively mild, but frequent depressive episodes have caused severe disability. The patient is currently euthymic on a mood stabilizer, but has intolerable adverse effects. Which of the following would be the most appropriate next medication choice?
Lamotrigine
105
Which of the following has been found regarding infants' attachments to their parents?
Infants can form multiple attachments, but the strength of those attachments may differ.
106
Which of the following areas of the frontal cortex is most consistently activated during shifting of cognitive sets in the Wisconsin Card Sorting Test?
Dorsolateral
107
Under the Health Insurance Portability and Accountability Act (HIPAA), a practitioner must obtain specific consent or authorization from a patient before sharing individually identifiable health information to
an investigator for the purpose of conducting epidemiological research.
108
To ensure that a screening test misses only a small number of individuals with an illness, which of the following should be maximized?
Sensitivity
109
A researcher is involved in testing a new environmental pollutant found to be a neurotoxin. After injecting the agent into the experimental animal brain, the levels of tyrosine hydroxylase dramatically decrease. Which of the following types of neurons are most likely to be impaired by this neurotoxin?
Dopaminergic
110
Which of the following ethical principles, as elucidated in the Belmont Report, underlies the practice of informed consent?
Respect for persons
111
The frequency of typical sexual behaviors (i.e. self-stimulation, exhibitionism, sexual intrusiveness) exhibited by children of both genders peaks at age
five years.
112
Sleep spindle density most markedly decreases from middle age into old age in which of the following regions of the brain?
Frontal and occipital lobes
113
Which of the following occurs in epigenetic histone protein amino acid residue modification?
Acetylation is generally rapid and reversible.
114
A breastfeeding patient taking sertraline wants to test her breast milk and the baby's blood for levels of the drug. The physician explains to the patient that testing is not indicated. Which of the following is the rationale for the physician's advice?
Evidence shows that infants are harmed more by having a depressed mother than being exposed to sertraline.
115
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?
Corpus callosum
116
Which of the following medications is an effective first-line treatment for patients with restless leg syndrome?
Pramipexole
117
Degeneration of the dorsal nucleus of thalamus and the mammillary bodies is found in which of the following disorders?
Wernicke-Korsakoff syndrome
118
Which of the following psychosocial treatment modalities is most relevant and effective for the positive symptoms of schizophrenia?
Cognitive behavior therapy
119
Which of the following psychological tests is used to measure concept formation and concept flexibility?
Wisconsin Card Sorting Test
120
Which of the following is the best example of a positive (i.e., health promoting) effect of the neuroinflammatory response?
Microglial propagation of cytokines with associated decreased physical activity in response to a peripheral infection.
121
The most prominent lobbying and support organization for families of people with severe psychiatric disorders is the
National Alliance for the Mentally Ill.
122
Which of the following sleep changes is often seen in depressive disorders?
Decreased REM latency
123
Which of the following genetic mechanisms is involved in the development of velocardiofacial syndrome?
Genetic deletion
124
A randomized controlled trial of antipsychotic medication efficacy in recent-onset cases of schizophrenia is reported. In this study, control group subjects received their usual antipsychotic medication and could use rescue benzodiazepines for agitation. The intervention group received a new antipsychotic agent and no rescue medications. Both groups responded equally well. Which of the following is a threat to validity in this study?
Confounding variable
125
Positron emission tomography scanning measures which of the following?
Glucose metabolism
126
What proportion of the human genome comprises the "exome"?
0.02
127
Pervasive and excessive emotionality and attention-seeking behaviors are the essential features of which of the following personality disorders?
Histrionic
128
A court has ordered the psychiatrist to complete a "competency to stand trial" evaluation for a person with a history of psychosis who was arrested for shoplifting. Which of the following questions is relevant to competency to stand trial in this scenario?
Can the person work effectively with counsel?
129
Which of the following medications is an alpha-2 adrenergic agonist?
Guanfacine
130
A 65-year-old patient has fallen several times over the past six months. The patient's mental status exam is normal. Smooth pursuit and saccadic movements are impaired, more prominently for vertical gaze, but full range of motion is easily elicited by doll's head maneuvers. The patient has mild symmetric rigidity and bradykinesia. There is no tremor. A brain magnetic resonance imaging scan is unremarkable, as are the results of cerebrospinal fluid and routine laboratories including toxic drugs screen. Which of the following is the most likely patient diagnosis?
Progressive supranuclear palsy
131
The validity of an assessment instrument refers to the extent to which it:
measures what it intends to measure.
132
The recognition of affective behavior by the mirror neuron system involves connections between the anterior mesial frontal cortex and the:
insula.
133
Obsessive-compulsive disorder is most commonly comorbid with
anxiety disorders
134
During the stress response in humans, corticotrophin-releasing hormone is released from which of the following?
Paraventricular nucleus
135
A patient's psychotic symptoms fail to respond to risperidone 8 mg daily, and laboratory testing reveals a risperidone blood level below expected. Assuming adherence to the treatment, genotyping for CYP450 polymorphism should reveal which of the following results?
Multiple copies of wild-type alleles
136
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?
2 years
137
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
138
What type of nicotinic acetylcholine receptor is most closely associated with the reward properties of nicotine?
α4β2
139
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
140
The psychiatrist is working with a patient who acknowledges that alcohol is causing a problem in life, but reports not being ready to quit drinking. The psychiatrist works diligently to convince the patient to quit drinking. Each week, the patient returns without having made any behavioral change. The patient asks, "Why should I come in for an appointment every week, especially when I am not ready to quit drinking?" The psychiatrist insists that they are making progress. Of note, one of the psychiatrist's parents was an alcoholic and, despite efforts to do so, the psychiatrist was not able to convince the parent to quit drinking before the parent's death. Which of the following factors is influencing the psychiatrist to insist they are making progress?
Countertransference
141
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
142
When a patient at the end of life requires a transition to a different care setting, which of the following factors is associated with a better transition?
Presence of an identified care person
143
Which of the following individuals is most likely to have legal responsibility for a crime?
A 35-year-old with severe alcohol use disorder who robs a liquor store to obtain more vodka
144
A patient who takes quetiapine develops diabetes. Treating the patient with metformin is an example of what kind of prevention?
Tertiary
145
Which of the following methods examines the consistency with which genetic variants are passed from parent to offspring within different families?
Linkage analysis
146
Which of the following is a primary rationale for implementing collaborative care?
Existing mental health care programs do not have the capacity to provide effective treatment to all patients in need.
147
According to Melanie Klein, 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.
148
High voltage delta activity associated with slow eye-rolling movements on polysomnogram is characteristic of what stage of sleep?
N3
149
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, research findings have demonstrated which of the following effects of intensive case management?
Reduced length of hospitalization
150
Which of the following is the most effective treatment of spasmodic torticollis?
Botulinum toxin
151
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 of the following would be the most likely preliminary diagnosis?
Oppositional defiant disorder
152
A college student who is in good academic standing and has test anxiety begins psychotherapy with a cognitive-behavioral psychotherapist. The therapist asks, "If you were to fail the upcoming physics exam, what would that mean?" The student replies, "I would then fail the whole course, and I would have to leave school, and no one in my family would want to have anything to do with me." The student's response would be best characterized as:
catastrophic thinking.
153
Which of the following neurotransmitters plays a key role in regulating the transition between sleep and wakefulness?
Histamine
154
A 26-year-old obese patient presents to the emergency department complaining of a severe headache. The patient is otherwise healthy and does not take any medications. Head computed tomography and brain magnetic resonance imaging scans are unrevealing. The only finding on physical examination is shown in the fundoscopic images below. Which of the following is the most likely diagnosis?
Idiopathic intracranial hypertension
155
An 18-year-old patient presents to the emergency department with a clouded sensorium, agitation and hyperactivity, mild paranoia, pressured speech, and euphoric though labile mood. Physical examination is notable for hypertension, tachycardia, and vertical nystagmus. Which of the following substances was most likely used?
Phencyclidine
156
During a routine medical examination, a 65-year-old man states, "My wife thinks I should ask you…she thinks I should do something about…it's our sex life…never mind." The physician asks, "Your sex life?" The patient responds, "Yes, you see…we get started okay, but then…" The patient then stops talking. Which of the following responses by the physician is most appropriate?
"You're doing fine. Go on."
157
A group of residents who are working on a quality improvement (QI) project decide that they would like to improve the handoff procedures taking place during shift changes on an inpatient psychiatry unit. Several of the residents have experienced poor handoffs in which crucial information (active medical issues, new medical changes) was not reported. They predict that handoffs are frequently missed, and that this is a systemic problem on the unit that could be improved. In developing an appropriate QI project, what should they do next?
Design a protocol to determine the prevalence of missed handoffs on the unit
158
Which of the following fine motor tasks involved in dressing does a child typically master last?
Tying laces on shoes
159
Which of the following disorders carries the greatest global burden of disease according to the World Health Organization's estimates of years lived with disability?
Major depressive
160
Transcranial magnetic stimulation typically targets which of the following areas of the brain in the treatment of depression?
Left prefrontal cortex
161
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?
Coaching, supporting, and providing positive behavioral reinforcement
162
A male patient with major depression presents to the emergency department with suicidal ideation. The nurse notes that the patient is wearing women's undergarments. The psychiatrist ascertains that the patient used to become sexually aroused while cross-dressing, and thinks often about dressing as a woman. These thoughts cause him significant distress. Which of the following diagnoses best fits this case presentation?
Transvestic disorder
163
A seven-year-old child is evaluated 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 conditioning model as an explanation for the child's anxiety?
"How do your parents respond when you are afraid of the bus?"
164
Current evidence regarding the efficacy of family therapy as a treatment for eating disorders reports that it
is superior to individual therapy for adolescents 6-12 months after treatment.
165
A 43-year-old patient seeks psychotherapy after his wife threatens to divorce him due to his constant accusations that she is having affairs. The patient acknowledges monitoring his wife's emails and text messages, and tracing phone calls from numbers he does not recognize on their home phone. The patient asserts that all of the couple's friends are "on my wife's side" and refuses to confide in them due
to doubts about their loyalty, and belief that shared information will be used against him in divorce proceedings. The patient also refuses communication with his brother who suggested marital therapy several years ago. The patient has no changes in sleep, appetite or energy level. Which of the following is the most likely diagnosis?
Paranoid personality disorder
166
The primary purpose of computed tomography scan in the evaluation of a patient suspected of having an acute ischemic stroke is to
exclude the presence of hemorrhage.
167
A patient with depression complains of low energy, poor concentration, and weight gain. Which of the following medications would be the best choice to prescribe for this patient?
Bupropion
168
The cortical response to inflammation is primarily mediated by which of the following?
Microglia
169
A 28-year-old female with a history of heroin dependence has been stabilized on methadone maintenance for the past year. The patient is now three months pregnant, and presents to the psychiatrist to find out what is the best treatment approach for her and her unborn child. Which of the following is the best recommendation for the psychiatrist to make?
Continue methadone maintenance
170
A patient in weekly supportive psychotherapy and psychopharmacologic treatment with a psychiatrist inquires about using a smartphone app to manage his bipolar disorder. Which of the following responses regarding the use of apps for mental health care is most supported by the literature?
"I would like to review the app myself. Then we can further discuss the idea."
171
Which of the following symptoms would best support a diagnosis of dissociative identity disorder rather than posttraumatic stress disorder?
Amnesia for everyday events
172
Blockade of which of the following receptors is primarily responsible for the sedative and weight-gaining side effects of many antipsychotic and antidepressant medications?
Histamine
173
Which of the following is a core feature of practicing mindfulness?
Experiencing internal and external stimuli non-judgmentally
174
Which of the following is a psychosocial treatment for schizophrenia that focuses on social awareness and basic mental processes, with the aim of helping patients understand their own intellectual capacities, strengths, and limitations?
Metacognitive therapy
175
Which of the following medications was first used as a treatment for gout, and later promoted by John Cade for treatment of unstable mood?
Lithium
175
The parents of a six-year-old report that 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?
Social (pragmatic) communication disorder
176
Which of the following genetic methods best allows for the analysis of rare variation in the population?
Next generation sequencing
177
Which of the following chemotherapy agents is most commonly associated with a distal sensory
polyneuropathy?
Cisplatin
178
The physician directs a patient with a tremor to tap one hand at a different rate to see if the tremor can be entrained to be at the same rate as the tapping hand. This is a method to test for which of the following types of tremor?
Psychogenic
179
A patient presenting with findings of agraphia, acalculia, right-left disorientation, and finger agnosia is most likely to have a lesion in the region of which part of the dominant hemisphere?
Angular gyrus
180
A 15-year-old patient is brought to the emergency department for agitation and paranoia. The patient seems to be hallucinating, and comments that, "I'm walking on air." Physical examination reveals tachycardia. This clinical picture is most characteristic of:
dextromethorphan intoxication.
181
A psychiatrist is consulted by a local police department to evaluate an officer's fitness to return to work. The psychiatrist is concerned about being in a double agentry conflict. Which of the following is the most ethical means of addressing this potential conflict?
Provide informed consent about the limits of confidentiality
182
A patient with cocaine addiction experiences cravings for cocaine whenever passing by a "crack-house." This reaction exemplifies
classical conditioning.
183
In the schematic of the hippocampal formation shown below, what letter denotes the region known as the subiculum?
C.
184
A patient presents with complaints of excessive daytime sleepiness, morning headaches, and excessive nighttime sweating. These symptoms are consistent with which of the following sleep disorders?
Obstructive sleep apnea
185
A patient in the third month of psychodynamic psychotherapy continues to dismiss any attempt by the
psychiatric resident to offer alternative viewpoints to the patient's assumptions about the cause of
interpersonal conflict and the negative effects of it. This type of behavior is most characteristic of which
of the following conditions?
Narcissistic personality disorder
186
The psychiatrist interviews an otherwise healthy 85-year-old retired surgeon. The patient is most likely to have problems with which of the following tasks?
Remembering whether he learned about a recent event on TV or in the newspaper
187
Event-related potentials on electroencephalograph are currently most useful for confirming which of the
following diagnoses?
Conversion disorder
188
Epigenetic drift refers to a collection of epigenetic changes at certain sites in the genome that diverge as a function of age. Epigenetic drift has been postulated to contribute to which of the following disorders?
Late-onset Alzheimer disease
189
A patient with a long history of splitting, self-mutilation, and outward aggression presents at least weekly to the emergency department in crisis. During one visit, the patient is very angry and begins kicking the chairs, gurney, and walls. Staff are concerned that the patient will get hurt. Which of the following is the most appropriate initial response?
Offer the patient the option of going to a quiet room or taking a medication to calm down
190
A patient remains depressed despite psychotherapy and several adequate medication trials. The psychiatrist is unsure what to try next, and consults with a supervisor. Which of the following ethical principles is illustrated by this consultation?
Non-maleficence
191
Which of the following medications may lead to serotonin syndrome if combined with fluoxetine?
Linezolid
192
Which of the following aspects of attention-deficit/hyperactivity disorder is most likely to improve as
children age?
Hyperactivity
193
In which of the following areas are circadian rhythms related to sleep behavior set and maintained?
Suprachiasmatic nucleus
194
A 25-year-old woman presents with concerns about difficulty engaging in sexual intercourse. She appears embarrassed and has difficulty providing any additional information about her symptoms, stating, "I am extremely uncomfortable talking about this." She experienced "vaginal spasms" during her last sexual encounter and she, consequently, feels anxious when considering having sex. She has become avoidant and dismissive of sexual encounters. She has had a normal gynecologic examination without discomfort, and her gynecologist referred her to the psychiatrist. Which of the following is the most likely diagnosis?
Genito-pelvic pain/penetration disorder
195
An 80-year-old presents with depressed mood and cognitive decline. The patient answers the interviewer's questions with brief, one-word responses and rare spontaneous elaboration. This is an example of which of the following?
Poverty of speech
196
A 21-year-old is hospitalized for a first episode of psychosis, and the patient's parents have called the psychiatrist twice asking for advice about how to assist in their son's care. The patient does not want the
team to speak to his parents because he believes that his parents are identical imposters planted by government agents. According to federal Health Insurance Portability and Accountability Act (HIPAA)
guidance, which of the following best describes the extent to which information can be shared?
Provide information given the lack of capacity and likely benefit
197
The psychiatrist is reviewing the literature to find out which antidepressant has the best evidence to treat depression in "real world" settings. The psychiatrist should seek evidence from which of the
following types of research studies?
Effectiveness
198
In the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study, which of the following
medications was considered most effective due to its low rate of discontinuation, high reduction in psychopathology, and longest time to discontinuation of treatment?
Olanzapine
199
By which of the following ages should the corticospinal tracts have completed myelination in typically developing children?
3 years
200
Parents describe their ten-year-old 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?
Nonconformity to gender role
201
A 71-year-old patient who was diagnosed with Parkinson disease three years ago is brought to the clinic
for changes in mood and thinking. The patient's motor symptoms are well controlled on carbidopa/levodopa. The patient's spouse states that the patient has trouble getting up and motivated to do anything, and the patient does not express interest in attending social events. There has also been a recent "slowness" in the patient's thinking, with the symptoms remaining stable throughout the day. There is no report of sadness, worthlessness, or suicidal ideation. Cognitive evaluation is unremarkable except for slow processing. Which of the following is the most likely explanation for the patient's
symptoms?
Apathy
202
A 55-year-old psychiatrically hospitalized patient with chronic schizophrenia is stabilized on clozapine.
Two weeks following hospital discharge the patient presents with impending signs of psychotic relapse. Assuming patient adherence to medication and negative serum and urine toxicology studies for illicit substances, which of the following is the most likely explanation for the patient's relapse?
Resumption of heavy smoking
203
The Study of Women's Health Across the Nation compared women ages 42 to 52 years with persistent or recurrent depressive symptoms to those with a single depressive episode. Which of the following risk factors distinguished those with persistent disease?
Sleep problems
204
The decreased late-life prevalence of which of the following disorders is explained by typical psychosocial maturation?
Personality disorders
205
Plasticity in the mammalian brain necessary for learning and memory is best accounted for by which of the following structural changes?
Synaptic connectivity
206
DNA methylation regulatory enzymes and proteins have recently been described inside what intracellular feature?
Mitochondria
207
A patient presents with multiple episodes of limb-shaking lasting over three minutes. During these episodes the patient is conscious, talking, and reports the ability to briefly suppress the movements. Which of the following factors is associated with poor prognosis for this patient?
Insidious onset of symptoms
208
A patient borrowed a friend's light box to attempt bright light therapy for seasonal mood change, and is now complaining of undesirably later sleep onset and later wakening times. Which of the following is the most likely reason for this sleep outcome?
Light exposure was too late in the day
209
Which of the following is most likely to be free of any significant interaction with other antiepileptic
medications?
Levetiracetam
210
Which of the following actions by a psychiatrist is an example of a boundary violation?
Conducting a session after hours in a local coffee bar
211
The Patient Health Questionnaire-9 is a validated tool to assess the severity of which of the following
disorders?
Major depressive
212
Following a normal full-term birth, by what age are circadian sleep rhythms similar to those of an adult generally established in the child?
6 months
213
Which of the following medications used in the treatment of attention-deficit/hyperactivity disorder
carries an FDA black box warning for suicidal ideation in children and adolescents?
Atomoxetine
214
Psychiatry is consulted about a 37-year-old patient who has just undergone bone marrow
transplantation (BMT) to treat leukemia. The BMT was uneventful. Staff report concerns that the patient
is now much more anxious and fearful than he was during the pre-transplant planning. The patient acknowledges having trouble sleeping, and states he is fearful about leaving the hospital. The mental status examination is otherwise unremarkable. Which of the following is the most appropriate diagnosis for the psychiatrist to make?
Adjustment disorder with anxiety
215
Boys with which of the following variables are more likely to delay first sexual intercourse until after age
18?
Anxiety symptoms
216
The diffusion weighted magnetic resonance imaging scan below reveals an acute stroke in the distribution of which of the following arteries?
Posterior cerebral
217
A 25-year-old patient with no previous psychiatric history has a new preoccupation with imagined defects in appearance which is a cause of excessive concern. The patient has a normal medical workup and, other than the distress over appearance, does not have other psychiatric symptoms. Which of the following medications is most appropriate for the patient?
Fluoxetine
218
A college student reports feeling embarrassed at school, particularly when speaking publicly or choosing a seat in the cafeteria, at which time the patient experiences blushing, muscle twitching and a feeling of shame. The patient expresses sadness about not having friends. Which of the following is the most likely
diagnosis?
Social anxiety disorder
219
A 75-year-old presents with new onset of "confusion." Upon further evaluation, the patient seems to have trouble speaking, and is able to communicate with single words or short sentences but often
cannot think of the word he wants to say. Some sentences do not make sense, and the patient utters phrases such as, "the snoodle linkered in the yard" when referring to his dog. He is unable to repeat the
phrase "no ifs, ands, or buts." He is able to follow commands, and seems to understand the questions. This type of language disorder is consistent with which of the following types of aphasia?
Broca's
220
A female patient who has been engaged in twice-weekly psychodynamic psychotherapy with a male therapist for the last year begins to discuss sexual fantasies about the therapist. The therapist feels
flattered by the sexual interest of this patient and notes his own feelings of attraction to her. The most appropriate next step for the therapist is to
seek consultation with a colleague.
221
Which of the following is the major negative aspect of crossover designs for research studies?
Residual effects
222
The neural circuit that connects the anterolateral orbitofrontal cortex, anterior part of the putamen and thalamus is involved in which of the following cognitive functions?
Response inhibition
223
There is an increased risk of schizophrenia diagnosis in the relatives of patients with which of the following personality disorders?
Schizotypal
224
Which of the following diagnostic assessments is administered with a clinical interview rather than self
report?
Brief Psychiatric Rating Scale
225
Terminally ill cancer patients who experience concerns about a "bad death" are most typically worried
about dying
in pain.
226
Which of the following neuropsychiatric symptoms is most commonly seen in mild neurocognitive disorder?
Depression
227
Maximum sleepiness in humans occurs when melatonin level reaches its highest point, and which of the following reaches its lowest point?
Body temperature
228
An agitated patient with bipolar disorder, manic, was evaluated in the emergency department and resisted voluntary psychiatric hospitalization. The frustrated psychiatrist said to the patient "You can come in voluntarily and choose when you will be discharged, or I will involuntarily hospitalize you so that you have no say in how long you stay in the hospital." The patient had made no threat of suicide or violence towards others. Which of the following best explains why the psychiatrist's decision does not meet the standard of care?
The psychiatrist's use of coercion invalidated informed consent
229
An eight-year-old child recently had testing with the Wechsler Intelligence Scale for Children and received a full-scale IQ score of 60. Which of the following additional tests would determine if the child meets criteria for intellectual disability?
Vineland Adaptive Behavior Scales
230
Which of the following is the most serious limitation of the candidate gene approach in identifying genetic disorders?
High probability of false positive findings
231
A woman is psychiatrically hospitalized with prominent paranoid delusions, auditory hallucinations, and progressive mood lability. She subsequently develops waxing and waning confusion, word-finding difficulty, and periods of mutism. An electroencephalogram detects extreme delta brushing. Anti-NMDA receptor antibody testing is positive. Which of the following neoplasms is most likely to be detected on further testing?
Ovarian teratoma
232
A psychiatrist's neighbor revealed that he was feeling increasingly depressed after his wife's death. Dissatisfied with the current provider, he asked for other referral options. The psychiatrist offered the names of several local colleagues. A few weeks later the neighbor mentioned to the psychiatrist that he was diagnosed with depression and now treated with fluoxetine 20 mg. He then asked several questions about the diagnosis, treatment options, and medication information. Subsequently, the neighbor asked for advice about increasing the dose when his provider was out of town. The psychiatrist advised that this was an acceptable option. Which of the following actions most clearly established a doctor-patient relationship between the psychiatrist and the neighbor?
Advising the increase in medication dose
233
The method for estimating the sample size required to detect statistical effects of defined size for variables with well-known variances is referred to as which of the following types of analysis?
Power
234
Which of the following hypothalamic nuclei is key to the integration of neural and nutrient signals with hormonal signals from the small intestine, pancreas, liver, adipose tissue, and brainstem?
Arcuate
235
A 25-year-old patient attends the fourth session of supportive psychotherapy. It is clear to the clinician that the clinician is viewed by the patient as a "good parent." The patient tells the clinician, "I feel so lucky to have found such a wise and loving doctor." The clinician should proceed by
utilizing the transference to strengthen the therapeutic alliance
236
A 65-year-old patient is prescribed sertraline for depression and within weeks develops waxing and waning impairment of alertness, attention and memory. Vital signs and physical examination are within normal limits. Which of the following tests would be most helpful in clarifying the etiology of the change in patient's mental status?
Serum electrolytes
237
Which of the following is characteristic of sleep in individuals over the age of 65, as compared to that of young adults?
Increased fragmentation
238
A 54-year-old patient awakens with weakness of the right hand. The patient reports having spent most of the previous night drinking at a bar, and then falling asleep at home with the right arm draped over the armrest of a chair. Examination demonstrates weakness of wrist and finger extension, with preserved grip strength. The most likely cause of this weakness is injury to which of the following peripheral nerves?
Radial
239
Which of the following processes involves genetic control by factors other than the DNA sequence?
Epigenetics
240
Which of the following is a necessary characteristic for symptoms that qualify for a DSM diagnosis of premenstrual dysphoric disorder?
Must be present during the final week of the luteal phase
241
Which of the following psychodynamic theorists posited that development occurs in sequential, clearly defined stages, and that each stage must be resolved for development to proceed smoothly?
Eric Erikson
242
Which of the following measures of disease frequency is most appropriate for determining the rate of new cases of a disorder in a given time period?
Incidence
243
In which of the following stages of Piaget's theory of cognitive development do children first understand conservation of volume?
Concrete operational
244
A glucocorticoid receptor is which of the following types?
Nuclear
245
Which of the following medications would be preferable for use in an anxious patient with pulmonary disease?
Buspirone
246
What is the main concept of the Mental Health Parity and Addiction Equity Act of 2008?
Mental health insurance benefits cannot be less favorable than medical or surgical insurance benefits.
247
Typically developing children acquire an understanding of the difference between inner life and outer reality (theory of mind) by what age?
Four years
248
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?
MECP2 coding for methyl CpG-binding protein 2
249
When used at a therapeutic dose/level during pregnancy, the dose of which of the following medications should be reduced in the immediate post-partum period to minimize the risk of adverse drug effects?
Lithium
250
A military veteran returning from a war zone complains of memory problems. Which of the following findings would support a diagnosis of dissociative amnesia?
Dense memory deficits limited to a few traumatic episodes
251
Which of the following types of glial cells assist in forming myelin sheaths in the peripheral nervous system?
Schwann
252
Which of the following medication classes is most likely to exacerbate physiological tremor?
Corticosteroids
253
Gender identity is typically established by what age?
Three years
254
In this image of the ventral surface of the brain, what region is most closely associated with the cortical processing of faces?
E
255
A researcher examines the relationship between two dichotomous variables, parental depression (yes or no) and child anxiety (yes or no). Which of the following inferential statistics is best employed in the interpretation of these data?
Chi square test
256
A 71-year-old patient with no prior medical history presents to an emergency department with a recent and severe "thunderclap" headache. The patient also notes unilateral eye pain and blurred vision. Examination reveals mildly dilated pupils and conjunctival injection. Which of the following diagnostic tests is most likely to reveal the most likely cause of this patient's headache?
Intraocular pressure measurement
257
Which of the following is the most important protective factor in building resilience in children?
Quality of parenting
258
Which of the following is a potent neuroprotective factor preventing neuronal cell death (apoptosis)?
Pituitary adenylate cyclase-activating polypeptide
259
Which of the following is a neuropsychological test of sustained attention?
Conners' Continuous Performance Test
260
A school consults a psychiatrist after some parents refuse to vaccinate their children, citing concerns that such vaccines may cause autism. In advising the school on how to persuade this group to allow vaccination, which of the following strategies is best grounded in social psychological principles and most likely to be successful?
Show how vaccination can be congruent with the group's core values
261
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 which of the following principles?
Decentration
262
Which of the following areas is most consistently associated with the rewarding effects of alcohol?
Nucleus accumbens
263
Which of the following is the greatest risk factor for developing akathisia?
Rapid dose escalation
264
Estrogen has which of the following modulatory effects on neuroinflammation?
Decreased inflammatory cytokine production
265
Which of the following is a reported outcome of mental health courts (MHCs)?
Participants access community treatment more quickly.
266
An 82-year-old man presents with progressive dementia and myoclonus over three months. An electroencephalograph demonstrates periodic sharp waves with a frequency of 1Hz over both hemispheres. Which of the following is the most likely diagnosis?
Creutzfeldt-Jakob disease
267
Which of the following is the reason for IV atropine administration to a patient prior to triggering the electrical stimulus during ECT?
Prevent bradycardia and asystole
268
A non-Hindu, Western-trained psychiatrist has been asked to treat a 40-year-old Hindu patient who emigrated to the United States two years ago. The patient presents with complaints of weakness, fatigue, headaches, insomnia, palpitations, and decreased appetite. The patient also reports a five-pound weight loss over the last month, dysphoric mood with intermittent anxiety, and suicidal ideation. In addition to assessing the patient's level of suicidality, it would be appropriate for the psychiatrist to do which of the following when beginning treatment?
Inquire what the patient believes explains the symptoms
269
Genetic copy number variations (CNVs) in individuals with severe neurodevelopmental disorders display what difference when compared to controls?
Increase in the burden of CNVs
270
For a psychological test to demonstrate content validity it must do which of the following?
Sample the area of interest adequately
271
Multiple neurologists have evaluated a patient for self-reported concerns of a brain tumor. The patient reports no symptoms suggestive of a brain tumor and states, "but I have a cousin who died from a brain tumor." Physical examinations have been non-focal and unremarkable. Although one neuroimaging study was negative, the patient repeatedly requests a new MRI, still concerned there is an undetected tumor. Which of the following is the most likely diagnosis?
Illness anxiety disorder
272
Due to the slowed growth of neural language synapses, children older than six years of age have more difficulty than younger children with
learning a new language.
273
Which of the following, secreted by adipose tissue, regulates the fat stores in the body?
Leptin
274
According to reports conducted by the US Preventive Services Task Force, which of the following demographic groups has the highest prevalence of depression?
Previously married
275
An individual who is afraid of loud noises has a panic attack in a grocery store when a shelving unit crashes to the floor. The individual needs to take a lorazepam immediately, and goes home. Subsequently, the individual avoids the grocery store due to feeling fearful. According to classical conditioning, what is the conditioned stimulus in this scenario?
Grocery store
276
What genetic mechanism can best account for the high prevalence of diseases such as schizophrenia, autism and intellectual disability, despite the fact that these illnesses are associated with a marked reduction in fertility?
De novo mutations
277
At any given time, approximately what proportion of medical students, worldwide, report having suicidal ideation?
0.1
278
Memantine exerts its cognitive preservation effects through which of the following mechanisms?
Glutamate NMDA receptor antagonism
279
According to Winnicott, if a mother is unable to provide a "holding environment" for her infant, what defensive process is likely to arise in the infant?
False self
280
Which of the following is the most common triggering factor for malpractice claims arising from psychiatric care?
Suicide
281
Which of the following neurotransmitter effects, when dysfunctional, has been shown to most comprehensively replicate the core symptoms of schizophrenia?
Glutamate
282
Which of the following magnetic resonance imaging (MRI) techniques is most likely to reveal the abnormalities of ischemic stroke earliest?
Diffusion-weighted MRI
283
A patient in long-term psychodynamic psychotherapy verbally attacks the therapist for being controlling and uncaring. This patient's behavior is most likely an example of which of the following?
Transference
284
Which of the following ethnic groups in the United States has the lowest 12-month prevalence of alcohol use disorder?
Asian Americans and Pacific Islanders
285
The Freudian stage of latency is correlated with Erikson's stage of
industry vs. inferiority.
286
Modulators that enhance receptor function when an agonist is present but do not directly activate the receptor without an agonist present are called
positive allosteric modulators.
287
Which of the following types of amnesia is most likely to be reversible?
Dissociative amnesia in a patient with major depressive disorder
288
Which of the following disorders is caused by an autosomal microdeletion?
Williams syndrome
289
What is the most common fear among preschool-age children who are faced with a terminal illness?
Separation from caretakers
290
What is the earliest age by which 90% of girls in the United States will have reached menarche?
14 years
291
Which of the following must be established in a medical malpractice case for a plaintiff to prevail?
Breach of duty causing harm
292
The psychiatrist suspects that a patient is a poor metabolizer based on excessive side effects when on low doses of several antidepressants. Which of the following methods is used to identify CYP enzyme DNA sequence variants that may explain this patient's intolerance?
Microarray assays
293
By what age can typically developing children answer open-ended questions such as why, when and
how?
Five years
294
The psychiatrist is asked to evaluate a patient with bipolar disorder who is exhibiting threatening
behavior while hospitalized on the cardiology unit for cardiac ischemia. The psychiatrist learns that the
patient was recently incarcerated for assaulting a police officer, and has a record of other arrests for
disturbing the peace and firearms violations. During the psychiatric interview the patient curses about
an ex-girlfriend who left the patient for another man, and states his intention to track this person down
and "teach her a lesson she'll never forget." In most states, the psychiatrist has the legal responsibility to
inform the police that the patient poses a potential danger.
295
Which of the following is an example of the "change talk" elicited in motivational interviewing?
"If I didn't smoke, I could use the money for music."
296
Valproate has epigenetic modifying properties due to its effect on
histone deacetylase.
297
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 at what age?
Early childhood
298
Absent gross negligence, dereliction of duty in a malpractice trial is typically established by which of the
following?
Testimony of expert witnesses
