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Child Psychiatry
Forensic Psychiatry
Geriatric Psychiatry
Somatic Treatment Methods
Global Neurology
100
The symptoms of a child with ADHD are unresponsive to an adequate trial of immediate-release methylphenidate. Which of the following medications should be used next? A. Clonidine B. Bupropion C. Atomoxetine D. Desipramine E. Mixed amphetamine salts
What is E.?
100
A patient with schizophrenia who is admitted to the hospital for medical evaluation of chest pain should have a formal assessment of decision-making capacity: A. upon admission to the hospital. B. when the patient disagrees with the treating physician's recommendations regarding the diagnostic workup or treatment. C. when there is reason to believe that the patient lacks the ability to understand, appreciate, or reason logically with the information relevant to healthcare decisions. D. when requested by the medical team treating the paient. E. whenever a new treatment or a change in the patient's treatment is initiated by the medical team.
What is C.?
100
Which of the following characteristics present in a 2-year-old is most likely to persist into adult life? A. Irritability B. Inhibition C. Attentiveness D. High level activity
What is B.?
100
Antipsychotic drugs elevate prolactin due to which of the following? A. Prolactin is under tonic inhibitory control by dopamine. B. Dopamine is a competitive inhibitor of prolactin. C. Antipsychotics bind to prolactin receptors causing blockade. D. Antipsychotics stimulate hypophyseal production of prolactin. E. Antipsychotics stimulate production of precursors to prolactin.
What is B.?
100
Gait characterized by postural instability accompanied by festination and truncal rigidity is seen in: A. Alzheimer's disease B. alcoholic cerebellar degeneration C. hysterical gait D. cervical spondylosis E. Parkinson's disease
What is E.?
200
Compared to older adolescents with depression, children ages 8 to 12 with depression most often show which of the following? A. Delusions B. Anhedonia C. Hypersomnia D. Hopelessness E. Somatic complaints
What is E.?
200
Patients who are committed to psychiatric treatment institutions in most states are presumed to: A. be insane for legal purposes. B. be competent to make their own decisions. C. be dangerous enough to require 15-minute checks. D. have provided sufficient informed consent. E. have no right to refuse treatment.
What is B.?
200
Which of the following is the most common movement disorder in persons 70 years or older? A. Parkinson disease B. Tardive dyskinesia C. Essential tremor D. Dystonia E. Ataxia
What is C.?
200
Which of the following antipsychotic medications would be the best choice to avoid motor symptoms in Parkinson's disease? A. Perphenazine B. Haloperidol C. Clozapine D. Fluphenazine E. Chlorpromazine
What is C.?
200
The diagnosis of myasthenia gravis can be established in 80 to 90 percent of cases by identification of serum antibodies against: A. acetylcholinesterase B. acetylcholine receptors C. motor end-plate sarcolemma D. L-type voltage-dependent calcium channels E. myofibrils
What is B.?
300
An 8-year-old child has persistent delayed sleep onset despite good sleep hygiene. Given that there is no indication of broader psychopathology, which of the following medications presents the best evidence of treatment of this problem to restore a normal circadian rhythm? A. Clonidine B. Doxepin C. Diphenhydramine D. Melatonin E. Lorazepam
What is D.?
300
Constitutional and common law dictate that the mental health care provided to prisoners be at or above the level of services that should be available to them if they were in the community. This "necessaries" doctrine is justified by which of the following principles? A. Prisoners with mental health needs are less able to identify their problems than those in the community. B. Prison is such a toxic environment that any mental health condition requires more aggressive mental health treatment. C. Treatment must be provided to those who are prevented from seeking their own medical care. D. Given prison conditions, if prisoners are not adequately treated they endanger other inmates. E. Those who have committed crimes will be more dangerous to the public if they are not adequately treated.
What is C.?
300
Which of the following morphologic changes is associated with normal aging? A. Ten percent loss of hippocampal volume per year B. Diffuse cerebral atherosclerosis in fine arterioles C. Loose aggregates of amorphous material with amyloid D. Widespread neurofibrillary tangles in the frontal and temporal cortex
What is C.?
300
A 25-year-old Caucasian female is started on 50 mg per day of desipramine. Within a few days, the patient calls the psychiatrist complaining of severe side effects including constipation, dry mouth, visual difficulties, tremor, and agitated feeling. The patient is on no other medication. The blood level of desipramine is 400 ng/ml. Which of the following is the most likely cause of the patient's symptoms? A. First pass effect B. Inhibition of P-glycoprotein C. Active metabolites of desipramine D. Poor metabolism of cytochrome P450 substrates E. Noncompliance with recommended dosing instructions
What is D.?
300
Which of the following electrodiagnostic test findings is most indicative of a demyelinating neuropathic process? A. Conduction block B. Delayed sensory latency C. Decreased amplitude of motor responses D. Decremental response to repetitive stimulation E. Fibrillations and positive sharp waves
What is A.?
400
A cognitive behavioral explanation of trichotillomania would suggest that hair pulling reduces an uncomfortable tension that the child is experiencing. The act of hair pulling is, under this model, considered which of the following? A. Reward B. Extinction C. Punishment D. Positive reinforcement E. Negative reinforcement
What is E.?
400
The psychiatrist who released audiotapes and medical records of the treatment of poet Anne Sexton to the author who was writing a biography of Sexton after her death could have been criticized for violating which of the following principles? A. Privacy B. Confidentiality C. Informed consent D. Doctor-patient privilege E. Psychiatrist-patient privilege
What is B.?
400
A 91-year-old hospice patient with severe cachexia, end-stafe dementia, and renal impairment has stopped eating and drinking. Which of the following comfort measures would be most appropriate? A. Total parenteral nutrition B. Intravenous hydration C. Nasogastric tube feeding D. Frequent small sips of water E. Appetite-inducing medications
What is D.?
400
A patient develops feelings of restlessness, an inability to relax, jitteriness, pacing, and rapid alternation of sitting and standing shortly after being started on a low dose of haloperidol. Addition of which of the following medications would be most effective in managing these symptoms? A. Amantadine B. Hydroxyzine C. Atenolol D. Nifedipine E. Cyproheptadine
What is C.?
400
Characteristic lesions seen in the CT scans of patients who have had coma associated with carbon monoxide poisoning are located in which of the following areas of the brain? A. Hypothalamus B. Globus pallidus C. Dentate nucleus D. Corpus collosum E. Cingulate gyrus
What is B.?
500
Which of the following developmental disability syndromes is associated with a triple-repeat genetic abnormality? A. Rett disorder B. Down syndrome C. Fragile X syndrome D. Asperger disorder E. Williams syndrome
What is C.?
500
A prosecutor in a murder trial questions the defendant about the ability to reason at the time of the murder and about understanding relevant issues of right and wrong. The defendant states, "I feel now just as I always have; murder is wrong, but killing a spy from Mars who is trying to steal the secret of human life is right." This scenario most specifically relates to and likewise poses a problem for which of the following evaluations of criminal responsibility? A. Competency determination B. Burden of proof C. M'Naghten rule D. Tarasoff obligation E. Durham standard
What is C.?
500
The family of a 75-year-old patient is concerned about the patient's safety because the patient has been forgetting to turn off the stove or put perishable food in the refrigerator. The psychiatrist suspects an evolving cognitive disorder. Which of the following is the most likely to be the earliest impairment to occur in the patient? A. Inability to name the last three presidents B. Inability to express emotional aspects of sleep C. Inability to recall the birthdays of siblings D. Inability to demonstrate correct use of a car ignition key E. Inability to recall three words after a three-minute delay
What is E.?
500
A 40-year-old patient experienced delirium, tremor, diaphoresis, rigidity, hyperpyrexia, and monoclonal in making the transition from the use of clomipramine to phenelzine. The patient is likely experiencing: A. serotonin syndrome B. neuroleptic malignant syndrome C. TCA discontinuation syndrome D. SSRI discontinuation syndrome E. MAOI-tyramine reaction
What is A.?
500
The clinical sequence of sudden severe headache, vomiting, collapse, relative preservation of consciousness, few or no lateralizing neurological signs, and neck stiffness is most characteristic of which of the following vascular lesions? A. Subdural hemorrhage B. Epidural hemorrhage C. Intracerebral hemorrhage D. Subarachnoid hemorrhage
What is D.?