Neurons Gone Wild
The primary purpose of computed tomography scan in the evaluation of a patient suspected of having an acute ischemic stroke is to:
A. Identify the site of ischemia.
B. quantify cerebral blood flow.
C. exclude the presence of hemorrhage.
D. identify patients with microvascular occlusions.
E. estimate the extent of potentially salvageable tissue.
C. exclude the presence of hemorrhage.
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?
A. Bipolar disorder
B. Conduct disorder
C. Major depressive disorder
D. Oppositional defiant disorder
E. Attention-deficit/hyperactivity disorder.
D. Oppositional defiant disorder
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:
A. personalization.
B. negative focus.
C. arbitrary inference.
D. catastrophic thinking.
E. all-or-nothing thinking.
D. catastrophic thinking.
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?
A. Give the patient intramuscular haloperidol
B. Immediately hospitalize the patient involuntarily
C. Threaten to call the police if the patient does not stop the aggressive behavior
D. Give the patient the choice of stopping the behavior or being placed in restraints
E. Offer the patient the option of going to a quiet room or taking a medication to calm down
E. Offer the patient the option of going to a quiet room or taking a medication to calm down
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?
A. Gender dysphoria
B. Fetishistic disorder
C. Voyeuristic disorder
D. Transvestic disorder
E. Exhibitionistic disorder
D. Transvestic disorder
In which of the following areas are circadian rhythms related to sleep behavior set and maintained?
A. Raphe nuclei
B. Optic chiasm
C. Locus coeruleus
D. Nucleus accumbens
E. Suprachiasmatic nucleus
E. Suprachiasmatic nucleus
Which of the following fine motor tasks involved in dressing does a child typically master last?
A. Zipping a jacket
B. Buttoning a sweater
C. Tying laces on shoes
D. Strapping Velcro on boots
E. Snapping buttons on a coat
C. Tying laces on shoes
Current evidence regarding the efficacy of family therapy as a treatment for eating disorders reports that it:
A. is superior to individual therapy for patients of all ages.
B. is efficacious for adults, but adolescents are less likely to respond.
C. is superior to individual therapy for adolescents 6-12 months after treatment.
D. improves remission rates for adults in anorexia nervosa but not in bulimia nervosa.
E. is superior to individual therapy at the end of treatment, but effects are not sustained.
C. is superior to individual therapy for adolescents 6-12 months after treatment.
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?
A. Provide information only with written consent
B. Accept a parent's surrogate consent to release information
C. Provide information given the lack of capacity and likely benefit
D. Provide information only when the patient retracts the objection
E. Receive information from the parents but do not offer information
C. Provide information given the lack of capacity and likely benefit
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?
A. Delusional disorder
B. Paranoid personality disorder
C. Schizotypal personality disorder
D. Chronic paranoid schizophrenia
E. Major depressive disorder with psychotic features
B. Paranoid personality disorder
The cortical response to inflammation is primarily mediated by which of the following?
A. Microglia
B. Astrocytes
C. Satellite cells
D. Ependymal cells
E. Oligodendrocytes
A. Microglia
By which of the following ages should the corticospinal tracts have completed myelination in typically developing children?
A. 3 months
B. 12 months
C. 3 years
D. 6 years
E. 18 years
C. 3 years
Which of the following symptoms would best support a diagnosis of dissociative identity disorder rather than posttraumatic stress disorder?
A. Dissociative flashbacks
B. Amnesia for everyday events
C. Amnesia for some aspects of a trauma
D. Reduced awareness of one's surroundings
E. Hyperarousal focused around a traumatic event
B. Amnesia for everyday events
What is the main concept of the Mental Health Parity and Addiction Equity Act of 2008?
A. Mental health care may be provided at a discount, even in the absence of insurance.
B. People with mental health conditions cannot be discriminated against in the workplace.
C. Mental health medications should cost no more than physical health medications.
D. Mental health treatment and substance abuse treatment may be provided simultaneously.
E. Mental health insurance benefits cannot be less favorable than medical or surgical insurance
E. Mental health insurance benefits cannot be less favorable than medical or surgical insurance
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:
A. cocaine withdrawal.
B. caffeine intoxication.
C. marijuana withdrawal.
D. prescription opioid withdrawal.
E. dextromethorphan intoxication.
E. dextromethorphan intoxication.
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?
A. Global
B. Broca's
C. Wernicke
D. Conduction
E. Transcortical
B. Broca's
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?
A. Anxiety disorder
B. Gender dysphoria
C. Body dysmorphic disorder
D. Separation anxiety disorder
E. Nonconformity to gender role
E. Nonconformity to gender role
Which of the following is a core feature of practicing mindfulness?
A. Experiencing internal and external stimuli non-judgmentally
B. Learning to systematically relax muscles through the body
C. Noticing thoughts and discovering which ones are maladaptive
D. Practicing regulating the breath to induce a parasympathetic state
E. Increasing focus by continually bringing attention back to a chosen point
Experiencing internal and external stimuli non-judgmentally
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:
A. inform the police that the patient poses a potential danger.
B. inform the patient's parole officer that the patient has violated conditions of his parole.
C. recommend hospital discharge because the patient could pose a threat to other patients.
D. warn the patient that the threatening statements have been recorded in the medical record and can be utilized as incriminating evidence in court.
A. inform the police that the patient poses a potential danger.
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?
A. Serum electrolytes
B. Sertraline plasma level
C. Electrocardiogram
D. Complete blood count
E. Dexamethasone suppression test
A. Serum electrolytes
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?
A. INPP5E coding for pharbin
B. Elastin gene on chromosome 7
C. ASXL1 coding for a chromatin-binding protein
D. MECP2 coding for methyl CpG-binding protein 2
E. Partial deletion of the short arm of chromosome number 5
D. MECP2 coding for methyl CpG-binding protein 2
In which of the following stages of Piaget's theory of cognitive development do children first understand conservation of volume?
A. Preoperational
B. Sensorimotor
C. Formal operational
D. Concrete operational
E. Assimilation and accommodation
D. Concrete operational
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?
A. Major role therapy
B. Social skills training
C. Metacognitive therapy
D. Psychodynamic therapy
E. Assertive community treatment
C. Metacognitive therapy
Which of the following is the most common triggering factor for malpractice claims arising from psychiatric care?
A. Suicide
B. Sexual misconduct
C. Harm to a third party
D. Involuntary hospitalization
E. Use of seclusions/restraints
A. Suicide
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?
A. Melanoma
B. Thymoma
C. Ovarian teratoma
D. Hodgkin lymphoma
E. Small cell lung cancer
C. Ovarian teratoma