Neurosciences
Central nervous system responses to fear-provoking stimuli are mediated chiefly through which of the following structures?
a) Substantia nigra
b) Lateral hypothalamus
c) Posterior gray matter
d) Periaqueductal gray matter
e) Central nucleus of the amygdala
e) Central nucleus of the amygdala
A 28-year-old patient is referred by her primary care physician due to a recent onset of episodes of altered behavior which last about one to two minutes. The patient's spouse notes she will place all the clean silverware back in the dishwasher. During the episodes the spouse has observed the patient making chewing movements, and he is unable to interrupt the patient's behavior. After the episode, the patient has no recollection of the events. A magnetic resonance imaging scan is normal. Which of the following is the most likely diagnosis?
a) Fugue states
b) Dissociative states
c) Peduncular hallucinosis
d) Transient global amnesia
e) Complex partial seizures
e) Complex partial seizures
A 23-year-old patient with borderline personality disorder and 20 past suicide attempts presents for dialectical behavior therapy (DBT). The therapist asks the patient for a commitment to refrain from self-harm behaviors for one year. The patient replies, "Oh, sure, that won't be a problem at all" Which of the following responses by the therapist would be most consistent with principles of DBT?
a) Insist that the patient endorse the agreement in writing
b) Suggest that the patient increase the duration of the commitment to two years
c) Draw the patient's attention to the fact that this commitment would be extremely difficult to abide by
d) Inform the patient that treatment will be terminated if any acts of self-harm occur within the next year
e) Praise the patient for the decision and emphasize that the therapist does indeed believe that the patient will refrain from self-harm.
c) Draw the patient's attention to the fact that this commitment would be extremely difficult to abide by
In females, which of the following is typically the first marker of impending puberty?
a) Menarche
b) Increase in total body fat
c) Acceleration of linear growth
d) Increase in muscle mass and strength
e) Appearance of secondary sexual characteristics
c) Acceleration of linear growth
Which of the following tests primarily measures flexibility in shifting cognitive sets?
a) Trails B
b) Boston naming
c) Digits backwards
d) Rey complex figure
e) Pantomime use of objects
a) Trails B
After a head injury, a patient is observed to have personality changes, including increased impulsivity and euphoria. Which of the following is the most likely site of the injury?
a) Amygdala
b) Cerebellum
c) Ventral striatum
d) Orbitofrontal cortex
e) Anterior cingulate cortex
d) Orbitofrontal cortex
A 40-year-old patient reports episodes of flailing of the arms and tonic postures described as "fencing". Video/electroencephalogram monitoring confirms electrographic seizure. Which of the following seizure types is most likely associated with this phenomenon?
a) Alcohol withdrawal
b) Temporal lobe
c) Occipital lobe
d) Frontal lobe
e) Febrile
d) Frontal lobe
Which of the following is a first-line medication with demonstrated efficacy in multiple, randomized clinical trials for treatment of bipolar depression?
a) Paroxetine
b) Quetiapine
c) Ziprasidone
d) Aripiprazole
e) Divalproex sodium
b) Quetiapine
A recently retired woman begins psychotherapy to help cope with transitions in her life. She mentions regret that she did not pursue a graduate degree and instead "settled" for her ten-year job as an administrative assistant. She worries about her grown children, a son who lives with her and is not financially independent, and a daughter whom "I could have set on a better path." She would like to do something meaningful, but is unsure of her next step. Which of the following stages of psychosocial development is characterized by this patient?
a) Initiative vs. guilt
b) Industry vs. inferiority
c) Ego integrity vs. despair
d) Identity vs. role confusion
e) Generativity vs. stagnation
c) Ego integrity vs. despair
REM sleep is first evident at which stage of development?
a) In utero
b) Immediately post-partum
c) At one month of age
d) At three months of age
e) At one year of age
a) In utero
Animal literature has established that maternal licking and grooming behavior has a profound effect on the stress reactivity of offspring. Which of the following evidence exists regarding the mechanism of this effect?
a) Is due to heritable changes in oxytocin gene
b) Is not reversible by environmental interventions
c) Is heritable because the genetic code has been altered
d) Is due to DNA methylation affecting glucocorticoid receptor expression
e) Is due to female offspring being more susceptible to these changes than male offspring
d) Is due to DNA methylation affecting glucocoricoid receptor expression
A 47-year-old patient has seizures that are well-controlled on antiepileptic drug monotherapy, but the patient develops nausea, ataxia, and diplopia when treated with erythromycin for a sinus infection. This patient is most likely taking which of the following antiepileptic medications?
a) Valproate
b) Gabapentin
c) Topiramate
d) Levetiracetam
e) Carbamazepine
e) Carbamazepine
Which of the following psychotropic medications is relatively contraindicated for those with moderate-to-severe renal impairment?
a) Clozapine
b) Quetiapine
c) Olanzapine
d) Aripriprazole
e) Paliperidone
e) Paliperidone
Which of the following factors is associated with increased risk of developing conduct disorders?
a) Small family size
b) Parental criminality
c) Authoritative parenting
d) Slow-to-warm-up temperment
e) Increased autonomic fear conditioning
b) Parental criminality
A man with schizophrenia believes his family is trying to commit him to a psychiatric ward. As a result, he refuses to leave his bedroom or take any pills they give him and inscribes symbols on his arm to protect him from evil. Which of the following defense mechanisms is consistent with these behaviors?
a) Hypochondriasis
b) Isolation
c) Reaction formation
d) Projective identification
e) Repression
d) Projective identification
Excessive activation of which of the following receptors is thought to contribute to cell death in Alzheimer's disease?
a) GABA
b) NMDA
c) 5-HT2A
d) Nicotinic
e) Muscarinic
b) NMDA
During a neurological exam, a patient is unable to see objects presented in the upper left quadrant of each eye, giving a “pie in the sky” appearance. This indicates a lesion in which of the following regions of the brain?
a) Left optic nerve
b) Left visual cortex
c) Right parietal lobe
d) Right temporal lobe
e) Right parietal lobe
d) Right temporal lobe
Which of the following selective serotonin reuptake inhibitors has the strongest association with birth defects?
a) Sertraline
b) Citalopram
c) Paroxetine
d) Fluoxetine
e) Fluvoxamine
c) Paroxetine
Piaget's major contribution to development was a theory that explains which of the following phenomena?
a) Environmental influences on learning and behavior
b) Unconscious influences on behavior and actions
c) Individual's emotional separation from caretakers
d) How individuals learn about and understand the world
e) The ways in which individuals acquire physical and motor skills
d) How individuals learn about and understand the world
A 36-year-old female patient complains of easy fatigability, hair thining, weight loss, craving salt, nausea, and hyperpigmentation. The patient is noted to have a depressed mood and appears apathetic. Which of the following is the most likely diagnosis?
a) Hyperthyroidism
b) Hypothyroidism
c) Hypercortisolism
d) Adrenocortical insufficiency
e) Polycystic ovary syndrome
d) Adrenocortical insufficiency
Kluver-Bucy syndrome, characterized by placidity, hyperorality, hypersexuality, and increased food intake, can be induced in animals with bilateral resection of which of the following structures?
a) Thalami
b) Parietal lobes
c) Cingulate gyri
d) Temporal lobes
e) Occipital lobes
d) Temporal lobes
A 35-year-old patient with a history of migraine headaches presents complaining of daily headaches for 3 months. Previously, she had infrequent migraines, which responded to sumatriptan. She is taking sumatriptan daily with little benefit. Twice weekly, the patient also takes ibuprofen. She has a history of major depression but feels her mood has been "okay". Physical examination is normal. Which of the following would be the preferred initial approach for this patient's headaches?
a) Add duloxetine
b) Add amitriptyline
c) Discontinue ibuprofen
d) Discontinue sumatriptan
e) Recommend avoiding stressful activities
d) Discontinue sumatriptan
Which of the following side effects was common in clinical trials investigating ketamine for depression?
a) Diarrhea
b) Headache
c) Cardiomyopathy
d) Increased blood pressure
e) Increased suicidal ideation
d) Increased blood pressure
Which of the following neurocognitive disorders is associated with a fluctuating rate of progression, marked visuospatial impairment, and early unilateral resting tremor and increased muscle tone in the arm?
a) Alzheimer disease
b) Cerebrovascular disease
c) Frontotemporal dementia
d) Dementia with Lewy bodies
e) Spongiform encephalopathy
e) Spongiform encephalopathy
Which of the following personality traits is an independent risk factor for the development of a high number of somatic symptoms?
a) Neuroticism
b) Extraversion
c) Agreeableness
d) Conscientiousness
e) Openness to experience
a) Neuroticism