PRITE PREPARATION PARTS 3 and 4 Flashcards
(219 cards)
1
Q
Which of the following findings on the mental status exam of a psychiatric patient is the strongest predictor of incapacity to make medical decisions?
A
Lack of insight
2
Q
Pedigree-based approaches are most powerful for identifying what type of gene variant?
A
Rare high penetrance
3
Q
Repetitive transcranial magnetic stimulation for the treatment of unipolar depression targets
which of the following brain regions?
A
Dorsolateral prefrontal cortex
4
Q
Which of the following cognitive responses to environmental stimuli has been found to be more characteristic of patients with anxiety disorders when compared to patients with depression?
A
Attentional bias toward potentially threatening stimuli
5
Q
In the labeled coronal section of human cortex below, what label indicates the insula?
A
B
6
Q
Which of the following instructions can enhance hypoactive deep tendon reflexes in a leg?
A
Clench a fist
7
Q
What is the leading cause of death in persons with severe mental illness?
A
Cardiovascular disease
8
Q
Which of the following medications is most effective for migraine prophylaxis?
A
Topiramate
9
Q
Which of the following epigenetic mechanisms inhibits the transcriptional machinery from accessing DNA and thus leads to decreased gene transcription?
A
Methylation
10
Q
Patients with which of the following neurocognitive disorders are more likely to develop severe extrapyramidal side effects from antipsychotic medications?
A
Lewy body disease
11
Q
Which of the following is the strongest risk factor for development of chronic daily headache in adults?
A
Medication overuse
12
Q
Which of the following neurotransmitters is predominantly inhibitory?
A
Glycine
13
Q
Maintenance of wakefulness is dependent on which of the following areas of the brain?
A
Ascending reticular activating system
14
Q
Which of the following signs or symptoms is necessary to make a diagnosis of anorexia
nervosa?
A
Intense fear of gaining weight
15
Q
When a child reaches the stage of formal operations, which of the following is a new cognitive capacity gained?
A
Abstraction
16
Q
A 25-year-old with a history of developmental delays presents for evaluation of anger outbursts. Prior karyotyping has demonstrated a microdeletion of genetic material. This finding is most likely to be seen in which of the following disorders?
A
Prader-Willi syndrome
17
Q
Which of the following areas are connected by the stria terminalis?
A
Amygdala to the septal area and the hypothalamus
18
Q
Which of the following is an evidence-based practice with the most available research that reduces relapses and symptoms, and improves medication adherence in schizophrenia?
A
Family psychoeducation
19
Q
Which of the following assessment strategies is most reliable in differentiating bipolar from unipolar depression in a patient presenting with an index depressive episode?
A
Longitudinal follow-up
20
Q
A typically developing child has recently begun to participate in social activities without parents, and has a best friend. The child can display empathy, but sometimes impulsively says things to friends that are not kind. How old is the child?
A
Elementary school-age
21
Q
According to the WHO Global Burden of Disease Study, which of the following conditions is in the top ten for disability as measured by loss of productive life years for ages 15 to 44 years in
both sexes?
A
Schizophrenia
22
Q
Which of the following legal mechanisms best conveys a dying patient’s instructions about wishes regarding medical interventions when the patient is no longer able to make decisions?
A
Advance directives
23
Q
Heavy smoking is most likely to affect the dosing of which of the following antipsychotic medications?
A
Olanzapine
24
Q
A 29-year-old woman presents to the emergency department (ED) accompanied by her partner reporting worsening mania after stopping the valproic acid prescribed by her outpatient psychiatrist. She wants to get pregnant, but her partner is not sure the patient is psychologically ready. The outpatient psychiatrist and patient have not discussed her desire to get pregnant, nor has she inquired about psychiatric treatment options that could maintain mood stability with minimal risk to a fetus. The ED psychiatrist documents in the electronic medical record the full set of concerns raised by the patient and her partner. What ethical principle is being applied by the psychiatrist documenting the concerns?
A
Veracity
25
In patients with epilepsy, which of the following is the most common comorbid psychiatric disorder?
Major depressive disorder
26
Histaminergic neurons that regulate sleep originate in which of the following brain nuclei?
Tuberomammillary
27
According to Winnicott's theory of the development of infants' assertiveness and sense of competence, which of the following best describes the critical function of the "holding environment"?
Encourages spontaneity while protecting the child from harm
28
Which of the following is a characteristic of assertive community treatment (ACT) for the treatment of the severely mentally ill?
24-hour-a-day mental healthcare coverage
29
A 22-year-old man with myotonic dystrophy undergoes evaluation for routine monitoring. Which of the following diagnostic tests would best detect the most common cardiac complications associated with this condition?
Electrocardiogram
30
Which of the following interventions, if employed by a hospital system, would most optimally protect against electronic medical record data breaches?
Train employees on how to recognize potential threats
31
A patient with multiple sclerosis is participating in a study to evaluate a novel MS treatment. During a study visit, the research coordinator requests that the patient's spouse participate in the study as a healthy control. If the spouse agrees to participate in the study, which of the following features of informed consent is potentially being violated?
Voluntarism
32
Which of the following terms describes the relevance of understanding temperament in working with parent-child relational problems?
Goodness of fit
33
The magnetic resonance imaging of the brain shown below is from a 65-year-old patient with progressive cognitive decline. Lumbar puncture showed normal opening pressure and was otherwise normal. Which of the following is likely to be found on examination?
Gait apraxia
34
The cortical synaptic remodeling characteristic of normal adolescence is also believed to be associated with which of the following neurobiological changes?
Preferential loss of excitatory synapses
35
A 70-year-old patient with depression presents with confusion two weeks following initiation of fluoxetine, and an adverse effect from the drug is suspected. Neurological examination is normal. Which of the following evaluations would be most useful to confirm this suspicion?
Urea & electrolytes
36
Shortly after a five-year-old child enters kindergarten, the child's parents report to the pediatrician that their child seems more emotionally reactive at home, displaying some regressive behavior and being more demanding of parental attention. The child's teacher describes no behavioral or academic concerns. Which of the following factors most likely accounts for the change noted by the parents?
Normative response to stress associated with the school transition
37
In an individual with persistent pain, which of the following neurotransmitter receptors is downregulated in the ventral striatum?
Dopamine
38
Which of the following peptides is released in the gastrointestinal tract to convey satiety information to the brain in response to food intake?
Cholecystokinin
39
Which of the following lab abnormalities is associated with refeeding syndrome?
Hypophosphatemia
40
L-methylfolate may be an effective augmentation agent for depression because it increases production of serotonin, norepinephrine, and dopamine via increased formation of which of
the following?
Tetrahydrobiopterin (BH4)
41
The AMPA receptor is stimulated by the presence of what neurotransmitter?
Glutamate
42
While waiting in line to ride a roller coaster, a man repeatedly hears a song over the loudspeakers. He rides the coaster, feels sick, and vomits soon after the ride ends. Now, whenever the man hears the song, he becomes severely nauseated. The feeling elicited by the song is an example of which of the following elements of learning?
Conditioned response
43
Which of the following ages is most closely associated with beginning to develop concern for others and learning to share?
Four years
44
Which of the following neurotransmitter systems facilitates sexual arousal?
Dopaminergic
45
In utero exposure to cannabis during neuronal development is associated with which of the following in the infant?
Cognitive deficits
46
In children with cancer, inadequate prophylaxis of pain and stress during difficult procedures,
such as bone marrow biopsies, is most likely to result in which of the following conditions?
Posttraumatic stress disorder
47
One in four individuals born with the 22q11.2 deletion develop which of the following psychiatric disorders?
Schizophrenia
48
Which of the following statistical measures could be used to determine how two independent variables in a study, such as depression and alcohol use disorder, affect the frequency of the occurrence event, such as suicide?
Regression analysis
49
A patient who first got drunk when a certain song played on the radio now experiences a strong urge to drink whenever hearing that song. According to classical conditioning, which of the following methods would best serve to unpair the conditioned stimulus from the unconditioned
stimulus?
Have the patient repeatedly listen to the song in the absence of alcohol
50
Which of the following physiologic changes that affect drug pharmacokinetics is commonly seen in older adults?
Decreased hepatic blood flow
51
Which of the following cell types is implicated in both neural circuit formation of the developing brain and scavenging for damaged neurons, plaques and infectious agents?
Microglia
52
The adult daughter and primary caregiver of a 70-year-old patient with Alzheimer dementia brings the patient to an outpatient psychiatry appointment. The psychiatrist meets privately with the daughter who expresses distress regarding her parent's increasing dependence on her.
The daughter describes feeling frustrated and often tearful, and is thinking of leaving a church group that is important to her in order to make more time for the increasing demands of being a caregiver. In meeting with the daughter to provide psychoeducation, which of the following would be the most appropriate initial response by the psychiatrist?
"It is important that you continue going to your church group."
53
Which of the following school accommodations may be included as part of an Individualized Education Program, but would not be included in a 504 plan as supported by the Section 504 of the Rehabiliation Act of 1973 of The American with Disabilities Rehabilitation Act?
Exemption from course requirements
54
Reduction in hippocampal volume is associated with what type of memory impairment?
Declarative
55
The multiple sleep latency test is used to diagnose which of the following?
Narcolepsy
56
What is the minimal degree of legal certainty that is constitutionally required for an involuntary mental health commitment?
Clear and convincing evidence
57
The psychiatrist is considering prescribing donepezil for an 87-year-old patient. Which of the following medications would most significantly interfere with its efficacy?
Oxybutynin
58
A 75-year-old man presents to the psychiatrist complaining of forgetfulness, lack of energy and difficulty concentrating. Which of the following tests would be most helpful initially, in making a diagnosis?
Neuropsychological testing
59
Research regarding the process of acculturation reports that which of the following is the best adaptational outcome for immigrant youth?
Formation of bicultural identity
60
What is the role of cis-regulatory elements in gene expression?
Mediators of transcriptional activity
61
A patient has failed several antidepressants and the psychiatrist is interested in starting the patient on a nortriptyline trial. The psychiatrist obtains a baseline electrocardiogram to obtain the patient's QTc interval. Which of the following QTc intervals is the shortest recommended to
withhold nortriptyline?
450 ms
62
Aggressive behavior in patients with Alzheimer disease is most often associated with which of the following?
Concurrent psychosis
63
During a medication management appointment, a patient with schizotypal personality disorder who is often guarded and paranoid offers a cookie to the psychiatrist. Which of the following is the psychiatrist's best response to this patient's boundary crossing?
Accept the cookie and thank the patient
64
A 72-year-old patient with two days of confusion and fever is evaluated in the emergency department for new-onset seizure. Magnetic resonance imaging of the brain demonstrates hemorrhage and swelling in the temporal lobes. Cerebrospinal fluid shows increased lymphocytes and protein. Which of the following medications is most likely to be effective in treating the patient's condition?
Acyclovir
65
A patient who takes buprenorphine is admitted following a motor vehicle accident and requires surgery to repair a femur fracture. Which of the following is the most appropriate step in treatment of the patient's pain?
Switch to methadone prior to the surgery
66
Which of the following neurotransmitter systems most directly regulates impulsive or affective aggression?
Serotonergic
67
Which of the following best describes a ten-year-old's understanding of the death of a pet?
Death is permanent and the pet will not be returning.
68
Which of the following best describes a ten-year-old's understanding of the death of a pet?
Death is permanent and the pet will not be returning.
69
A 40-year-old patient has been unable to speak at all after having a screaming argument with the spouse. The patient writes, "I have been trying to speak, but cannot make a single sound." Physical examination, including examination of the throat, is unremarkable except for occasional loud cough. Which of the following is the most likely diagnosis for this patient?
Conversion disorder
70
In psychoanalytic psychotherapy, which of the following is accepted as the primary mechanism by which therapeutic change occurs during treatment?
Integration of insight
71
During a medical admission for pneumonia, a patient is diagnosed with HIV. He is refusing to inform his partner of his HIV status despite plans to continue to be sexually active. Which of the following is the most appropriate action for the physician to take?
Consult state laws which address this issue
72
Which of the following is the best treatment recommendation for a pregnant woman who is dependent on heroin?
Methadone maintenance
73
Successful global cognitive performance with aging has most consistently been positively associated with the size of which of the following brain structures?
Hippocampal formation
74
Which of the following is a method of reducing the chance of false positive findings by calculating a more conservative p-value?
Bonferroni correction
75
A 37-year-old patient is evaluated for progressive spastic paraplegia. The patient also reports new-onset visual loss. Magnetic resonance imaging (MRI) of the spine is notable for longitudinal lesion in the cervical spinal cord, and MRI of the brain shows enhancement in the optic nerve. Antibodies to which of the following are associated with this syndrome?
Aquaporin-4
76
Inflammatory cytokines mediate depression through which of the following neurophysiological changes?
Increased expression of serotonin reuptake transporters
77
A 35-year-old patient is brought to the emergency department with altered mental status and respiratory distress after overdosing on "alcohol and pills." The patient is medically stabilized after receiving flumazenil. This patient most likely ingested a medication that works in the amygdala via which of the following mechanisms?
Enhancing inhibitory actions at post-synaptic GABA-A receptors
78
A 21-year-old patient is brought to the psychiatrist by family due to his poor academic performance. When asked about sleep, the patient responds, "sleep deep in the bed fed red, can't sleep well bell." Which of the following best describes the patient's thought process?
Clanging
79
Research using health care claims has shown a decreased rate of substance-related events in male patients with attention-deficit/hyperactivity disorder during treatment with which of the following type of medications?
Stimulants
80
Initial treatment for female orgasmic disorder usually includes which of the following?
Directed masturbatory training
81
Which of the following factors most likely predisposes to dissociative amnesia after a traumatic event?
Longer duration of trauma
82
When considering assessment instruments, validity is defined as whether:
the instrument actually measures what it purports to measure.
83
Tuberous sclerosis is transmitted by which of the following inheritance patterns?
Autosomal dominant
84
Which of the following is considered a risk factor for suicide attempt in transitional-aged youth with schizophrenia?
Higher level of education
85
A ten-year-old child is brought by a parent for psychiatric evaluation. The parent shares that the child has been pervasively irritable and has had approximately four severe temper outbursts weekly for the past two years. These outbursts are characterized by screaming, throwing toys,
and hitting others, and can occur with little provocation. The child's teacher reports that the child is alienating peers and has difficulty functioning in the classroom. Which of the following diagnoses best characterizes the child's presentation?
Disruptive mood dysregulation disorder
86
The clock drawing in the image below is consistent with a lesion in which of the following areas
of the brain?
Parietal lobe
87
A genetic researcher wishing to study polymorphisms including short tandem repeats could use
which of the following methods to produce many copies of the portion of the genome under
investigation?
Polymerase chain reaction
88
A 22-year-old female is hospitalized with severe paranoia and hallucinations. During the review
of systems she acknowledges a history of acute abdominal pain, particularly during
menstruation. Physical examination reveals reduced strength in the proximal upper and lower
extremities and reduced tendon reflexes. Which of the following laboratory values is likely to be
elevated and would explain her symptoms?
Porphobilinogen
89
A 35-year-old is seen by a chiropractor for treatment of mild neck discomfort. The patient
undergoes manipulation of the neck, and shortly after develops dysarthric speech, gait ataxia
and numbness over the right body. In addition, the patient complains of increased severity of
neck pain radiating to the occiput. The likely etiology of this patient's symptoms is:
vertebral artery dissection.
90
A psychiatrist who hosts a radio talk show routinely states at the beginning of the show that he
is not entering into a physician-patient relationship with the callers who seek his advice. With
this statement, the psychiatrist is addressing which of the following broad claims that must be
proven to sustain a claim of malpractice?
Duty
91
Which of the following methods is most likely to identify a gene responsible for autistic-like
traits displayed by multiple members of a family?
Linkage analysis
92
Medical anthropological research has shown that dissociative symptoms most commonly
represent which of the following worldwide?
Normal components of religious and ritual events
93
Which of the following psychotherapies for alcoholism focuses on patient ambivalence as a key
treatment target?
Motivational enhancement therapy
94
Which of the following historic figures in psychiatry coined the term "schizophrenogenic
mother" to capture aberrant qualities of mothering believed at one time to be a pathway to
development of schizophrenia?
Frieda Fromm-Reichman
95
Which of the following parent behaviors is most important to a toddler's language
development?
Engaging in frequent conversation and thinking aloud
96
Research suggests that which of the following is most closely associated with decreased
dropout rate in outpatient psychotherapy?
Greater therapist experience
97
The initial learning phase of a skilled motor sequence requires the recruitment of the
corticostriatal system and which other system?
Corticocerebellar
98
By age four years, most children have developed sufficient language skills to be able to engage
in:
story telling using words.
99
Which of the following neurochemical abnormalities has been described in patients with
depressive disorders?
Reduced circulating levels of GABA
100
Which of the following is an adverse effect of maintenance treatment with methadone for
opioid dependence?
Hypogonadism
101
Naturalistic investigations of a treatment's effects examine which of the following factors?
Effectiveness
102
The Food and Drug Administration specifically warns that antipsychotic medications prescribed
for dementia-related behavioral disturbances are associated with increased risk of death and
what other comorbidity?
Stroke
103
Tau staining of hippocampal tissue from a patient with progressive dementia is seen below.
Which of the following is the most likely diagnosis?
Alzheimer disease
104
Which of the following characteristics distinguishes Tourette syndrome from other tic
disorders?
Presence of multiple motor tics and one or more vocal tics
105
The Simpson-Angus Rating Scale assesses which of the following types of symptoms?
Motor
106
A seven-year-old child continues to have enuresis despite monitoring fluid intake, adequate
toileting and using a reward system. The pediatrician next suggests using an enuresis alarm.
This treatment, also referred to as the bell-and-pad technique, is a form of:
classical conditioning
107
The human lymphocyte antigen HLA-B*1502 is associated with significantly increased risk of
Stevens-Johnson syndrome in the context of carbamazepine use. This gene complex is most
common in which of the following American racial/ethnic groups?
Asian Americans
108
A female patient who drinks alcohol lightly (one standard drink per day) is concerned about
cancer risk after her father, who was a heavy drinker, developed an aggressive, upper digestive
tract tumor. She wants to know if she should stop drinking to decrease her risk of cancer.
Which of the following statements is the best evidence-based response?
Long-term abstinence would reduce risk significantly.
109
Which of the following represents the greatest vulnerability to development problems in
children?
Maternal mental illness diagnosed before child's birth
110
Which of the following has been identified as the largest contributor to waste in health care?
Excessive administration
111
Aspects of successful older age include independent living, positive adaptation, mastery, and
growth. Which of the following factors is most important in achieving that success?
Cognitive preservation
112
A 38-year-old patient is brought to the emergency department after experiencing euphoria and
reporting feeling like "flying above the dance floor" at a local club. The patient is now socially
withdrawn and exhibits nystagmus. Which of the following drugs would most likely produce this
constellation of symptoms?
Ketamine
113
A patient with a history of schizophrenia is brought to the emergency department with a twoday
history of unusual behaviors and refusal to eat or take medications. The patient resists
transfer from wheelchair to gurney, makes no eye contact and says nothing. While examining
arm movement the examiner notes the patient's arm remains extended rather than returning
to resting posture. Which of the following medications is most appropriate to administer?
Lorazepam
114
Which of the following neurochemicals has a major role in the acute reinforcing effects of drugs
of abuse?
Dopamine
115
Which of the following disorders has a significant treatment literature supporting the use of
structural family therapy?
Anorexia nervosa
116
For ten months a patient has been in psychodynamic psychotherapy with a resident who will
graduate and leave the area in two months. The patient suddenly decides to terminate
treatment. Which of the following is the best initial step for the resident to take?
Interpret that the patient may be trying to leave therapy before the resident leaves.
117
Which of the following examples of documentation of medication dosage is considered
confusing and dangerous, and is therefore unapproved by the Joint Commission on
Accreditation of Healthcare Organizations?
1.0 units
118
Which of the following is provided as part of low-intensity telemedicine mental health services?
In-person, telephone, or e-mail doctor-to-doctor "curbside" consultations
119
Histone acetylation leads to which of the following effects?
Activates transcription
120
A 35-year-old patient who was diagnosed with AIDS three years prior develops new-onset
headache associated with cognitive decline. Magnetic resonance imaging of the brain
demonstrates multiple ring-enhancing lesions. Which of the following is the most likely cause?
Toxoplasmosis gondii
121
An academic institution is developing a service to address physician burnout brought on by
personal, financial, and/or health related stress. They want to create a safe, stigma-free
environment that welcomes employees to discuss their personal and professional concerns.
Which of the following will help ensure success of this endeavor?
Offer personal counseling and financial counseling services at the same location to
reduce stigma.
122
The parents of a child with attention-deficit/hyperactivity disorder and oppositional defiant
disorder present for consultation. They are primarily interested in psychotherapeutic
approaches, and ask how to best proceed with the child. Which of the following would be the
most appropriate response?
"We should find out what your child enjoys and create a behavioral rewards program
for your child at home and at school."
123
From a neurodevelopmental perspective, the youngest age at which a child possesses sufficient
cognitive ability such that the child is likely to meet the Appelbaum criteria for general
healthcare decision-making capacity is approximately:
twelve years.
124
Which of the following is the predominant site of the endocannabinoid receptor CB1?
Presynaptic membrane
125
Adult inpatients on a locked, general psychiatry unit attend daily group therapy facilitated by a
staff psychologist. Which of the following factors most likely impedes the process of cohesion?
Turnover of patients
126
Which of the following disorders is associated with hypocretin-1 deficiency?
Narcolepsy
127
Which of the following genetic tests provides the most efficient method for sequencing all
protein-coding regions?
Whole exome sequencing
128
An observational study examines the effect of antidepressant medications on fetal adverse
event outcomes in a population of 900,000. Cases are defined as pregnant women taking
antidepressants, and controls as healthy pregnant women not on any medication. Peer
reviewers note that subjects were not randomized and information about fathers was not
collected. What other weakness are the reviewers most likely to point out?
Inappropriate control group
129
A patient reports sleeping only 3-4 hours at night for as long as two weeks at a time. Which of
the following questions would most likely identify the mood disturbance contributing to the
patient's sleep pattern?
"During these periods, how well rested do you feel during the day?"
130
A 25-year-old patient with seizure disorder since childhood is seen for evaluation of poorly
controlled seizures. The patient has adenomas on the face, mostly around the nasolabial folds
and cheeks. A fibrotic plaque is found in the lower back. The most likely diagnosis is:
tuberous sclerosis
131
Which of the following features of schizophrenia has become less common in Western
cultures?
Catatonia
132
After a stranger says "hello", a 12-month-old child turns and looks at his mother before
responding. When the mother smiles and nods her head, the infant laughs and smiles in
response to the stranger. This behavior is an example of:
social referencing
133
Which of the following is contained in sleep-promoting neurons of the ventrolateral preoptic
nucleus?
GABA
134
A patient with dementia is admitted after a fall and is found to have a fractured wrist. The team
recommends surgery, however the patient refuses. Which of the following is the most
appropriate next step?
Assess patient's capacity to refuse
135
Which of the following is most significantly affected when syringomyelia first presents?
Pain perception
136
Which of the following is an expected side effect for patients prescribed rivastigmine for
Alzheimer disease?
Bradycardia
137
For which of the following conditions is ECT indicated? (Select three)
Catatonia, Neuroleptic malignant syndrome, Major depressive disorder with psychotic features
138
The ability of preschool children to regulate their emotions is most strongly enhanced by the
development of:
language.
139
The three major epigenetic mechanisms include DNA methylation, histone modification, and:
expression regulation by micro-RNAs.
140
Which of the following genetic tests is preferred for the detection of Trisomy 21?
G-banded karyotyping
141
Which of the following has been reported regarding X-linked dominant inheritance of genetic
disorders?
Females are twice as likely as males to be affected in a multigenerational pedigree
142
A patient with social phobia avoids almost all social gatherings. The avoidance is regulated by a
reciprocal connection between the amygdala and the:
periaqueductal gray area of the brainstem.
143
When used in the treatment of insomnia, benzodiazepines have which of the following effects
on sleep?
Decrease REM sleep
144
A 26-year-old sexually active woman with bipolar II disorder agrees to a first-time trial of
lamotrigine. Before deciding on a target dose, her psychiatrist asks what kind of contraception
she uses. What is the reason for asking this question?
Oral contraceptives containing estrogens decrease serum levels of lamotrigine
145
Which of the following perinatal factors is specifically associated with the development of
attention-deficit/hyperactivity disorder?
Maternal tobacco use prenatally
146
Acute alcohol intoxication is likely mediated by which of the following molecular actions of
ethanol?
NMDA receptor antagonism and GABA receptor agonism
147
A 16-year-old is expelled from school for the third time since the beginning of the academic
year, this time for bringing a knife. The previous expulsions were for fighting and stealing from
the teacher. The adolescent has also been suspended several times for bullying classmates and
skipping school. Over the next decade, these types of behaviors will most likely:
decrease
148
Which of the following alternative treatments for depression carries a risk of inducing mania in
patients with bipolar disorder?
St. John's wort
149
In combination with growth hormone, which of the following is required to initiate the
adolescent growth spurt?
Gonadal hormones
150
The impaired physician who fails to obtain or benefit from treatment may require the services
of an administrative psychiatrist skilled in performing fitness-for-duty evaluations. In these
situations, the administrative psychiatrist:
is not bound by the usual parameters of confidentiality
151
Contralateral leg weakness with sparing of the face and arm associated with urinary incontinence and abulia are typical for stroke in the territory of which of the following arteries?
Anterior cerebral
152
Which of the following is the most common comorbidity in a patient with an anxiety disorder?
Another anxiety disorder
153
A 55-year-old woman undergoes gastric bypass surgery and, several weeks later, develops gait imbalance and numbness in the feet. Neurological examination is remarkable for hyperreflexia, spasticity in the legs and absent vibration sensation at the toes. Serum B12 level is normal. Deficiency of which of the following is most likely to cause these symptoms?
Copper
154
Which of the following statistics measures the magnitude of difference between two intervention groups?
Effect size
155
A 24-year-old is seen on the consult service for worsening disorientation and suspected delirium. The patient's initial presentation was notable for the development of severe headaches after starting on a high protein, low carbohydrate diet. There is no prior psychiatric history, but the patient reports slow growth as a child. Which of the following is the most definitive way to establish the diagnosis in this individual?
Ornithine transcarbamylase sequencing
156
A consulting psychiatrist suspects schizotypal personality disorder in a patient with odd speech patterns, eccentric appearance and constricted affect. Which of the following additional features would support this diagnosis?
Paranoid ideation
157
Which of the following distinguishes empathy from identification?
Retaining objectivity in the relationship
158
Which of the following neuropsychological tests examines both executive and visuospatial functioning?
Clock drawing
159
The number of new events in proportion to the population at risk for the event is referred to as:
cumulative incidence.
160
An insurance company pays a physician a single, standardized sum for a patient's care during a one-year period. This is known as what type of payment?
Capitation
161
Which of the following risk factors is most strongly associated with prolonged or complicated bereavement?
Male gender
162
Which of the following antiepileptic medications reduces the efficacy of oral contraceptives?
Carbamazepine
163
The genetic syndrome characterized by developmental delay, cardiac abnormalities, palate defects, immune deficiency, and an increased risk of schizophrenia is caused by which of the following types of chromosomal mutations?
Deletion
164
Which of the following findings on electromyography, when seen during REM sleep, would be most diagnostic of a REM sleep behavior disorder?
Excess muscle tone
165
A 13-year-old patient is evaluated by the psychiatrist. The patient's parents report that the patient is "sleepy" during the day, and often seems dazed and "out of it." Additionally, the patient is often not hungry and sometimes complains of nausea. On examination, the patient has red eyes, a runny nose and red sores around the mouth. Which of the following substances is most likely to be playing a role in this teenager's presentation?
Aerosols
166
Which of the following is a feature of the Medicare system?
Part B is an optional purchasable benefit for senior citizens.
167
Which of the following immunomodulators is associated with increased risk of significant depression in patients with cancer?
Interferon
168
Which of the following antipsychotic medications carries the lowest risk of QT prolongation on electrocardiogram?
Aripiprazole
169
The following recording obtained from a patient in an intensive care unit is most consistent with which of the following?
Metabolic encephalopathy
170
Parents meet with a psychiatrist to discuss concerns about their teenager, who has expressed confusion about gender and identity. The adolescent has refused to come to the appointment. Which of the following questions would be most appropriate for the clinician to ask the parents during this initial session?
“What pronoun do you want me to use when referring to your child?”
171
Personalized dosing according to CYP genotype is best established for which of the following classes of medications?
Tricyclic antidepressants
172
Which of the following physical health conditions has the highest risk of suicide?
Brain injury
173
A mother's capacity to understand her infant's internal states, which is communicated by mirroring is called:
holding
174
A 32-year-old patient with schizoaffective disorder has a long history of non-compliance with treatment and multiple hospitalizations. Because of the patient's impulsive and violent behavior, family members are extremely reluctant to take care of the patient. Which of the following is the most appropriate treatment modality at this time?
Assertive community treatment
175
Slow-wave sleep enhances the secretion of which of the following hormones?
Growth hormone
176
In a patient presenting with early-stage cognitive impairment, identification of which of the following suggests a subcortical rather than cortical dementia?
Preserved calculation skills
177
A randomized controlled trial is performed to compare the addition of metformin to usual treatment in the prevention of diabetes in patients currently prescribed an antipsychotic medication. Eighteen percent of patients in the metformin group develop diabetes while 20% of patients in the usual treatment group develop diabetes, with p<.01. In this study what is the number needed to treat in order to prevent diabetes in one individual taking antipsychotic medication?
50
178
A patient with pathological gambling is most likely to have which of the following comorbid conditions?
Major depression
179
Psychodynamic theory, which focuses on the here-and-now interactions between therapist and patient and identifies transference and countertransference as uniquely co-created by patient and therapist together, has its roots in which school of classical psychoanalytic theory?
Self-psychology
180
Which of the following disorders is most common among patients who complete suicide?
Mood
181
Individuals exposed in utero to the 1944-1945 Dutch "hunger winter" have elevated rates of disease, including heart disease, breast cancer, obesity, and cognitive function. Robust evidence has implicated which of the following mechanisms in this phenomenon?
Differences in DNA methylation
182
Which of the following approaches has demonstrated efficacy in the treatment of trichotillomania?
Habit reversal therapy
183
Which of the following attachment styles in infants is characterized by paying little overt attention to the parent's presence?
Avoidant
184
Which of the following neuroimaging tools represents the most sensitive, non-invasive clinical tool for monitoring inflammation in patients with multiple sclerosis?
Magnetic resonance imaging
185
A 25-year-old patient with diabetes presents with eyelid ptosis that worsens towards the end of the day. The patient reports developing double vision while reading. The symptoms seem improved upon awakening the following morning. The patient denies any pain, and eye examination is otherwise unremarkable. Which of the following is the most likely cause of this presentation?
Myasthenia gravis
186
A 28-year-old with intellectual disability and autism spectrum disorder presents with depression. On exam, the patient has a long face, large everted ears and a high arched palate. Which of the following genetic syndromes is the most likely diagnosis?
Fragile X syndrome
187
A 72-year-old woman reports sadness, tearfulness, and intermittent insomnia since the sudden death of her husband seven months ago due to a heart attack. She states that she still cannot believe that he is gone, and thinks about him much of the day. While she says that she wishes she were dead so she could be with him, she does not have thoughts of harming herself. Which of the following is the most likely diagnosis?
Normal grief
188
Which of the following is most strongly associated with higher frequency of medically certified sick leave from work?
Perceived poor relationship with supervisor
189
The consultation-liaison psychiatrist evaluates a 54-year-old patient with end-stage breast cancer. The patient was previously very optimistic and energetic, but has recently been told that the treatment protocol had failed and only palliative care was recommended. Since that time the patient has appeared depressed, and the team is concerned that she is suicidal. On interview, the patient is initially pleasant and able to amiably discuss neutral topics. When the subject shifts to her illness, the patient becomes tearful and expresses a crushing feeling of hopelessness about the future. She denies any plan to hurt herself, saying, "What's the point? I'm going to die soon anyway, but I would rather God just took me and didn't draw this out." Which of the following would be the best initial approach to this patient?
Validate the patient as having a normal reaction to an overwhelming situation.
190
A patient is referred for specialized therapy that focuses on providing psychoeducation, validating the patient's emotional vulnerability and encouraging change. This type of therapy is referred to as:
dialectical behavioral.
191
Widening concern for the larger social system and differentiation of one's own social, political, and historical system from others primarily occurs during which of the following developmental transitions?
Young adulthood to middle adulthood
192
Where do the dopaminergic neurons originate in the mesocorticolimbic system?
Ventral tegmental area
193
Which of the following is most often cited by the literature as a significant barrier to adopting an electronic health record (EHR)?
Initial cost of introducing a system
194
Three days after giving birth, a 25-year-old woman with no past psychiatric history experiences rapid mood shifts, including tearfulness, irritability, anxiety, insomnia, lack of energy, loss of appetite, and the general experience of feeling overwhelmed. The woman's mother was previously treated for depression. Which of the following treatments is indicated at this time?
Psychoeducation
195
A resident is considering using an Internet search to gather information about a patient. In which of the following situations is this most appropriate?
Distinguishing between the patient's grandiose delusions and reality
196
Which of the following antipsychotic medications is absorbed primarily through the oral mucosa?
Asenapine
197
What is the rate-limiting enzyme in the synthesis of norepinephrine?
Tyrosine hydroxylase
198
Which of the following cortical regions is a key component of the salience network?
Anterior cingulate cortex
199
A patient treated for major depression is in remission. Presence of which of the following risk factors would suggest the need for maintenance pharmacotherapy?
Lifetime history of 3 episodes of depression
200
The Continuous Performance Test measures what cognitive function?
Sustained attention
201
What is the main advantage of family-based genetic association studies over case-control association studies?
Less affected by systematic population differences
202
Which of the following is the most common cause of premature death in individuals with schizophrenia?
Cardiovascular disease
203
Which of the following is characteristic of epigenetic codes as compared to genetic codes?
Dynamic three-dimensional structure
204
Which of the following parental factors is most important for healthy child development?
Emotional attunement
205
In the image below, what label indicates the putamen?
A
206
FDA-approved use of deep brain stimulation for treatment-resistant obsessive-compulsive disorder (under the humanitarian device exemption mechanism) involves stimulation of what brain regions?
Anterior limb of the internal capsule
207
What region of the frontal lobes is most closely associated with working memory?
Dorsolateral prefrontal
208
An 82-year-old patient presents with severe memory loss, impaired social judgment, restricted interests, and inability to perform activities of daily living independently. The best combination therapy to reduce decline in attention and global functioning would be donepezil plus a medication with what mechanism of action?
Modulation of glutamate transmission
209
Which of the following symptoms is most suggestive of benign paroxysmal positional vertigo?
Severe dizziness with rolling over in bed and tilting head back
210
Which of the following augmentation agents has the best evidence for efficacy in patients with obsessive-compulsive disorder who have an inadequate response to a selective serotonin reuptake inhibitor?
Aripiprazole
211
What is the term for clusters of alleles that are in linkage disequilibrium and inherited as a single unit?
Haplotypes
212
The neural tube is formed from which of the following?
Ectoderm
213
Which of the following is the definition of type 1 error?
True null hypothesis is erroneously rejected
214
A 53-year-old patient with no prior psychiatric history develops personality changes and impulsive, disinhibited behavior. Structural brain imaging shows no evidence of a lesion. Which of the following findings is likely to be evident on positron emission tomography imaging for this patient?
Reduced perfusion in bilateral lateral temporal lobes
215
A 24-year-old patient presents to the emergency department reporting ringing in the ears, and nausea and vomiting. Respirations are noted to be deep and rapid. During questioning the patient admits taking an overdose of numerous, unidentified pills. Which of the following did the patient most likely ingest?
Aspirin
216
A patient reports feeling detached from her surroundings, which seem fastasy-like and bizarre. In the mental status exam the psychiatrist records the patient as having:
derealization.
217
Which of the following neuropsychological tests relies on inhibition of overlearned behaviors to assess executive functioning?
Stroop Color Word Test
218
Restless leg syndrome has been associated with deficiency in which of the following substances?
Iron
219
