Neurosciences/ Neurology
Posttraumatic stress disorder has been most commonly associated with reduced volume on MRI in which brain region?
A. Thalamus
B. Hippocampus
C. Hypothalamus
D. Cerebral cortex
E. Corpus callosum
Answer: B. Hippocampus
Why it's correct
PTSD is associated with reduced hippocampal volume, thought to reflect glucocorticoid-mediated toxicity and/or a pre-existing vulnerability trait. The hippocampus contextualizes fear memories, so its dysfunction contributes to impaired fear extinction.
Best choice for ADHD treatment in a patient with epilepsy stable on anticonvulsants?
A. Bupropion
B. Guanfacine
C. Atomoxetine
D. Amphetamine
E. Methylphenidate
Answer: E. Methylphenidate
Why it's correct
Despite historical caution, controlled data show stimulants—methylphenidate in particular—do not meaningfully lower seizure threshold in well-controlled epilepsy and effectively treat ADHD. Bupropion clearly lowers seizure threshold and is contraindicated.
Resolution of separation/individuation in toddlers, achieving an internal sense of a comforting parent, occurs with development of which of the following?
A. Joint attention
B. Object constancy
C. Social referencing
D. Transitional objects
E. Superego precursors
Answer: B. Object constancy
Why it's correct
In Mahler's separation-individuation theory, the culmination is 'object constancy'—the child internalizes a stable, comforting mental representation of the caregiver that persists in their absence, allowing secure separation. (Distinct from Piaget's object permanence.)
According to the WHO, which is the most common global barrier to accessing mental health treatment?
A. Language
B. Financial cost
C. Low perceived need
D. Lack of transportation
E. Availability of providers
Answer: C. Low perceived need
Why it's correct
WHO World Mental Health surveys find that low perceived need—not recognizing a problem or believing treatment is necessary—is the most common reason people with disorders do not seek care, ahead of structural barriers like cost or access.
A 17-year-old sets increasingly elaborate fires with excitement before and relief after, breaks curfew, and steals fire-setting materials from a store. Best diagnosis?
A. Pyromania
B. Kleptomania
C. Conduct disorder
D. Bipolar disorder unspecified
E. Intermittent explosive disorder
Answer: A. Pyromania
Why it's correct
Pyromania = deliberate, purposeful, recurrent fire-setting with tension/arousal before and gratification/relief after, plus fascination with fire—not for monetary gain, ideology, or as part of another disorder. The stealing here is instrumental (to obtain materials), not a separate kleptomania.
*Contrast with- Kleptomania is stealing for the act's own sake (objects not needed/valued). If fire-setting is part of a broad antisocial pattern, consider conduct disorder instead.
Most drugs of abuse activate which dopaminergic pathway, leading to addictive behavior?
A. Nigrostriatal
B. Mesocortical
C. Mesoaccumbens
D. Tuberohypophyseal
Answer: C. Mesoaccumbens
Why it's correct
Nearly all drugs of abuse converge on the mesolimbic/mesoaccumbens dopamine pathway (VTA → nucleus accumbens), increasing dopamine in the accumbens to produce reward and reinforce drug-seeking—the final common pathway of addiction.
Tidbit: The mesolimbic (mesoaccumbens) VTA→nucleus accumbens dopamine pathway = the brain's reward/reinforcement circuit and the common target of addictive drugs. Nigrostriatal = motor; mesocortical = cognition; tuberoinfundibular = prolactin.
Haloperidol metabolism is most likely to be affected by co-prescription of which medication?
A. Lithium
B. Valproate
C. Olanzapine
D. Gabapentin
E. Carbamazepine
Answer: E. Carbamazepine
Why it's correct
Carbamazepine is a potent inducer of hepatic CYP enzymes (especially CYP3A4), accelerating haloperidol metabolism and lowering haloperidol plasma levels—potentially causing loss of efficacy.
Fact: Carbamazepine is a broad CYP inducer (3A4, others; also auto induces) → lowers levels of many drugs (haloperidol, OCPs, warfarin, lamotrigine). Contrast with valproate, an inhibitor that raises lamotrigine levels.
A child spends several minutes recounting how a peer 'got in trouble today' and details how the peer is always breaking rules. This child is most likely in which age group?
A. Preschool
B. Toddlerhood
C. School-age
D. Early adolescence
E. Late adolescence
Answer: C. School-age
Why it's correct
School-age children (roughly 6-11, Piaget's concrete operational stage) develop a strong, rigid sense of rules and fairness and are highly attuned to whether peers follow or break them—hence the detailed, rule-focused 'tattling' narrative.
Which of the following is the most compelling argument for allowing all clinicians to have unrestricted access to mental health information in an electronic health record (EHR)?
A. Privacy rights do not apply to patients admitted involuntarily
B. Confidentiality of EHR information is less relevant in the era of big data
C. Unrestricted access to psychiatric records lowers the stigma of mental illness
D. Social media acceptance has diminished the concern for privacy and confidentiality
E. Readmission rates tend to be lower in hospitals with unrestricted access to the EHR
Answer: E. Readmission rates tend to be lower in hospitals with unrestricted access to the EHR
Why it's correct
The only evidence-based, clinically valid argument offered is the outcome claim: integrated, unrestricted access supports care coordination and is associated with lower readmissions. The other options assert that privacy no longer matters, which is ethically and legally false.
Which type of traumatic exposure is associated with increased risk of dissociative amnesia?
A. Trauma of brief duration
B. Trauma occurring at later age
C. Trauma caused by a caretaker
D. Trauma caused by a natural disaster
E. Trauma caused by a motor vehicle accident
Answer: C. Trauma caused by a caretaker
Why it's correct
Interpersonal, betrayal-based trauma perpetrated by a trusted caretaker—especially chronic, early-life abuse—carries the highest risk of dissociative amnesia (consistent with betrayal-trauma theory: the mind sequesters the memory to preserve a needed attachment).
Neurogenesis in adults occurs in a limited number of brain regions, including which of the following?
A. Globus pallidus
B. Lateral ventricle
C. Substantia nigra
D. Locus coeruleus
E. Subthalamic nucleus
Answer: B. Lateral ventricle
Why it's correct
Adult neurogenesis is largely confined to two niches: the subventricular zone lining the lateral ventricles (feeding the olfactory bulb via the rostral migratory stream) and the subgranular zone of the hippocampal dentate gyrus.
Buprenorphine is combined with naloxone in oral formulations to reduce which of the following?
A. Cravings
B. Side effects
C. Abuse potential
D. Drug interactions
E. Lethality in overdose
Answer: C. Abuse potential
Why it's correct
Naloxone has poor sublingual/oral bioavailability, so the combination works normally when taken as prescribed; if crushed and injected to misuse, naloxone precipitates withdrawal—reducing abuse/diversion potential.
Childhood trauma, which increases risk for depression and PTSD, has been correlated with increased expression of which gene?
A. AKT1
B. SERT
C. FRM1
D. ApoE2
E. FKBP5
Answer: E. FKBP5
Why it's correct
FKBP5 regulates glucocorticoid receptor sensitivity in the HPA axis. Early-life trauma produces enduring epigenetic (demethylation) changes that increase FKBP5 expression, impairing stress-hormone feedback and raising risk for depression and PTSD.
Which parent-child interaction best illustrates a 'contingent response' contributing to self-regulatory skill development?
A. Parent plays the child's favorite song during a temper tantrum
B. Baby starts crying, and the parent makes an exaggerated frown and speaks quietly
C. Preschooler expresses excitement and parent tells her to 'calm down'
D. Teacher tells a grieving child to 'be grateful'
E. Toddler becomes distressed with a block puzzle and caretaker responds with enthusiastic encouragement
Answer: B. Baby starts crying, and the parent makes an exaggerated frown and speaks quietly
Why it's correct
A contingent response is attuned mirroring—the caregiver reflects the infant's emotional state (marked affect matching) so the child feels understood and gradually internalizes emotion-labeling and regulation. Frowning and speaking softly in response to crying mirrors and 'contains' the distress.
What is the leading cause of death in patients with schizophrenia?
A. Cancer
B. Suicide
C. Infectious disease
D. Pulmonary disease
E. Cardiovascular disease
Answer: E. Cardiovascular disease
Why it's correct
Cardiovascular disease is the leading cause of death and the main driver of the ~15-20-year reduced life expectancy in schizophrenia, from metabolic syndrome, antipsychotic effects, smoking, sedentary lifestyle, and reduced healthcare access.
Which brain wave is most associated with alertness in an adult waking EEG?
A. Beta
B. Delta
C. Theta
D. Alpha
E. Gamma
Answer. A. Beta
Why it's correct
Beta waves (>13 Hz) dominate during active, alert wakefulness with eyes open and mental engagement. Alpha appears with relaxed eyes-closed wakefulness; theta/delta appear in drowsiness and deeper sleep.
Which agent is most likely to cause prolonged seizure activity (>3 minutes) following ECT?
A. Lithium
B. Propranolol
C. Fluoxetine
D. Fluvoxamine
E. Hydroxyzine
Answer: A. Lithium
Why it's correct
Lithium can prolong and intensify ECT-induced seizures and increases risk of post-ECT delirium and prolonged neuromuscular blockade. It is often held or reduced around ECT.
In cognitive development theory, which is a key element of concrete operational thinking?
A. Conservation
B. Symbolic play
C. Deferred imitation
D. Object permanence
E. Hypothetical-deductive thinking
Answer: A. Conservation
Why it's correct
Conservation—understanding that quantity remains constant despite changes in appearance (e.g., pouring water into a taller glass)—is the hallmark achievement of Piaget's concrete operational stage (~ages 7-11).
A student gets ill from apple-flavored liquor, then feels nauseated weeks later when someone orders apple juice. The apple flavoring represents what aspect of learned behavior?
A. Conditioned stimulus
B. Conditional response
C. Negative punishment
D. Unconditioned stimulus
E. Negative reinforcement
Answer: A. Conditioned stimulus
Why it's correct
The alcohol (unconditioned stimulus) caused nausea (unconditioned response). Through pairing, the apple flavor becomes a conditioned stimulus that now elicits nausea (conditioned response)—an example of taste-aversion (Garcia) conditioning.
A second-trimester pregnant patient has ~4 weeks of low mood and suicidal ideation after her partner died in an MVA; she feels worthless/guilty, avoids friends, lost 10 lbs, has insomnia, and occasionally hears her partner's voice. Most likely diagnosis?
A. Acute stress disorder
B. Major depressive disorder
C. Persistent complex bereavement
D. Adjustment disorder with depressed mood
E. Depressive disorder due to another medical condition
Answer: B. Major depressive disorder
Why it's correct
Despite the recent loss, the full syndrome—pervasive worthlessness/guilt, suicidal ideation, weight loss, insomnia, psychomotor/withdrawal, and mood-congruent perceptual disturbance over weeks—meets criteria for a major depressive episode. DSM-5 removed the bereavement exclusion, so grief does not preclude MDD.
Threat perception provokes defensive behavior, which is partly mediated by which of the following brainstem areas?
A. Septal area
B. Raphe projections
C. Nucleus accumbens
D. Centromedial amygdala
E. Dorsal periaqueductal gray
Answer: E. Dorsal periaqueductal gray
Why it's correct
The dorsal periaqueductal gray (PAG) is the brainstem output hub for innate defensive responses—freezing, flight, and fight—receiving descending signals from the amygdala and hypothalamus. Its dorsal columns mediate active escape/panic-like reactions.
To limit QT prolongation, citalopram should not be co-administered with medications that inhibit which cytochrome P450 enzyme?
A. 1A2
B. 2C19
C. 2C9
D. 2E1
E. 2B6
Answer: B. 2C19
Why it's correct
Citalopram is primarily metabolized by CYP2C19; inhibitors (e.g., omeprazole) raise citalopram levels and thus dose-dependent QT-prolongation risk. FDA limits citalopram to 20 mg/day with strong 2C19 inhibitors or in poor metabolizers.
How does imprinting lead to expression of a disease phenotype?
A. Acetylation of histones leads to altered chromosome packaging.
B. Maternally inherited transcription factors prevent expression of paternal alleles.
C. Methylation of a chromosome leads to overexpression of all genes on the same chromosome.
D. Methylation of the paternal or maternal allele leads to unopposed expression of the other allele.
Answer: D. Methylation of the paternal or maternal allele leads to unopposed expression of the other allele.
Why it's correct
Genomic imprinting silences one parental allele via methylation, so only the other parent's allele is expressed. If that active allele is deleted or mutated, there is no functional copy—producing disease (e.g., Prader-Willi/Angelman at 15q11-13)
What is the most clinically relevant reason to use the Edinburgh Postnatal Depression Scale (EPDS) as a screen in postpartum women?
A. It includes social factors
B. It is usually self-administered
C. It omits questions assessing suicidality
D. It de-emphasizes somatic symptoms of depression
E. It is more comprehensive than other depression screens
Answer: D. It de-emphasizes somatic symptoms of depression
Why it's correct
Somatic symptoms (fatigue, sleep/appetite change) overlap with the normal postpartum state and inflate false positives on generic depression scales. The EPDS deliberately minimizes somatic items and focuses on mood/cognitive symptoms, improving specificity postpartum.
A 45-year-old requests a fourth breast augmentation, worries everyone sees and mocks her 'asymmetry,' spends two hours each morning trying to mask the perceived defect. Most likely diagnosis?
A. Factitious disorder
B. Illness anxiety disorder
C. Body dysmorphic disorder
D. Somatic symptom disorder
E. Obsessive-compulsive disorder
Answer: C. Body dysmorphic disorder
Why it's correct
BDD = preoccupation with a perceived defect in physical appearance that is minimal or unobservable to others, with repetitive behaviors (mirror-checking, camouflaging, seeking cosmetic procedures) and significant distress/impairment.