PRITE Double Jeopardy

Psychopathology

Epidemiology

Issues in Practice

Research/Scholarly Literacy

Diagnostic Procedures

100

A 35-year-old female patient has discoid lupus, which has long been controlled with a stable dose of oral prednisone. She abruptly develops increased fatigue, inflamed joints, and diffuse myalgias. The patient also exhibits depressed mood and cognitive impairment. She has no prior psychiatric history and no focal neurological signs. Which of the following is the most likely etiology?

a) Seizure

b) Psychological stress

c) Metabolic dysfunction

d) Corticosteroid toxicity

e) Disease-induced cerebritis

100

According to the World Health Organization, which of the following mental disorders ranks in the top ten worldwide for greatest burden of disease, as measured by years of life lost due to poor health, disability or premature death?

a) Schizophrenia

b) Alcohol use disorder

c) Major depressive disorder

d) Posttraumatic stress disorder

e) Alzheimer disease and other dementias

c) Major depressive disorder

100

The staff of a psychiatric unit contemplates an initiative aimed at reducing the risk for completed suicides in an inpatient setting. Which of the following interventions is likely to have the greatest effect on decreasing suicide risk while maintaining a therapeutic environment and minimizing staff burden?

a) Establishing "no-suicide" contracts which each patient at the time of admission

b) Redesigning the physical space to eliminate potential anchor points for hanging

c) Implementing the use of constant observation more frequently and for longer durations

d) Increasing the number of locked doors on a unit to decrease the risk of elopement

e) Adopting a "universal precautions" approach in which all patients are treated as being at risk for suicide

b) Redesigning the physical space to eliminate potential anchor points for hanging

100

Parents bring a 16-year-old for evaluation for reporting that, despite having a curfew, the teen stayed out all night for the third time in a month. Over the last year, the teen has persistently violated parental rules, reacts with rage when attempts are made to address this, and is often edgy and confrontational with the slightest annoyance. The teen is impatient and unkind to a younger sister, and threatens to hit the father when limits are set. The school reports no concerns about behavior in that setting. There is no history of substance use. In the interview, the teen is pleasant, easy to engage and cooperative, but admits to little regard for the parents' rules, seeing them as "old school" and unnecessarily limiting. Which of the following is the most likely diagnosis?

a) Conduct disorder

b) Adjustment disorder

c) Oppositional defiant disorder

d) Antisocial personality disorder

e) Disruptive mood dysregulation disorder

c) Oppositional defiant disorder

100

In the assessment of a patient who complains of involuntary myoclonic movements, which of the following findings on electromyogram would support the diagnosis of conversion disorder?

a) Significant interference pattern

b) Diminished recruitment pattern

c) Rising pre-movement pattern

d) Electrical activity with muscle at rest

e) Irregular lines with muscle contraction

c) Rising pre-movement pattern

200

In which of the following ways are physicians who die by suicide different from the general population of suicide completers?

a) More likely to be older

b) More likely to be married

c) Less likely to abuse illicit drugs

d) More likely to have a chronic health problem

e) Less likely to be taking antidepressant medications

200

According to data from the National Comorbidity Survey Replication, what is the average number of years from the start of a mood disorder until diagnosis?

a) 0.5 to 1 year

b) 2 to 3 years

c) 6 to 8 years

d)11 to 13 years

e) 18 to 20 years

c) 6 to 8 years

200

A PGY-4 resident plans to incorporate telepsychiatry in outpatient practice following graduation. Licensing requirements related to telepsychiatry stipulate that the psychiatrist hold a medical license:

a) in any state.

b) only in the state where the patient is located.

c) only in the state where the psychiatrist is located.

d) in both the state where the psychiatrist and the patient are physically located.

b) only in the state where the patient is located.

200

Which of the following statistical methods attempts to address the effects of participants dropping out of a study prior to completion?

a) Odds ratio

b) Meta-analysis

c) Power analysis

d) Positive predictive value

e) Last observation carried forward

200

Which of the following neuroimaging/electropsychological tests is particularly helpful in differentiating neurocognitive disorder due to Alzheimer disease from frontotemporal neurocognitive disorder?

a) Evoked potentials

b) Magnetoencephalography

c) Computed tomography scan

d) Magnetic resonance imaging scan

e) Single-photon emission computed tomography scan

300

Longer duration of untreated, non-affective psychosis is associated with which of the following patient characteristics?

a) Female gender

b) Later age of onset

c) Higher educational level

d) First generation immigrant

e) Better premorbid psychosocial adjustment

d) First generation immigrant

300

In the United States, what is the number one preventable cause of death?

a) Suicide

b) Depression

c) Head trauma

d) Alcohol use disorder

e) Tobacco use disorder

300

Which of the following best reflects Kraepelin's views of psychiatric disorders?

a) Considered disorders of personality as clear-cut disease processes

b) Viewed psychiatric disorders as categorically distinct "natural disease entities"

c) Promoted a philosophical rather than a biological view of psychiatric disorders

d) Conceptualized "dementia praecox" and manic depressive illness as being on a continuum and sharing etiology

b) Viewed psychiatric disorders as categorically distinct "natural disease entities"

300

Which of the following types of studies is most likely to offer relevant information about whether an available genetic test for diagnosing neurodegenerative disorder is accurate enough to warrant use?

a) Cohort

b) Crossover

c) Cross-sectional

d) Quasi-experimental

e) Randomized controlled

c) Cross-sectional

300

Which of the following signifies the ability to shift back and forth between general concepts and specific examples?

a) Intellect

b) Insight

c) Judgement

d) Thought process

e) Abstract reasoning

400

An 18-year-old patient is evaluated for excessive skin-picking, resulting in multiple facial sores. The parents report that the patient spends up to one hour every day in the bathroom examining and washing the facial skin. On interview, the patient reports frustration with severe acne and discoloration of the facial skin. On examination, there are a few small pimples and no visible discoloration. The facial skin is most notable for excoriations. Which of the following is the most likely diagnosis?

a) Excoriation disorder

b) Illness anxiety disorder

c) Body dysmorphic disorder

d) Generalized anxiety disorder

e) Obsessive-compulsive disorder

c) Body dysmorphic disorder

400

Which of the following is the risk of individuals developing schizophrenia when a sibling has the disorder but the parents do not?

a) 1%

b) 10%

c) 50%

d) 90%

b) 10%

400

Children demonstrate a preference for the human voice and speech over other sounds at which age?

a) Birth

b) Two months

c) Four months

d) Six months

e) Eight months

a) Birth

400

Untreated depression in pregnancy is associated with poor maternal and infant outcomes, including pregnancy complications, preterm birth, and behavioral problems in the child. What does current evidence show about selective serotonin reuptake inhibitor use in pregnancy?

a) Causes oral cleft defects

b) Is associated with fetal demise

c) Is associated with neonatal adaptation syndrome

d) Should be used at lower doses later in pregnancy

e) Is associated with poor cognitive outcomes for the child

c) Is associated with neonatal adaptation syndrome

400

A patient is asked to draw a clock. After drawing a circle outlining the clock face, the patient does not add numbers or hands, but instead continues to trace the circle over and over again. This is an example of which of the following?

a) Inattention

b) Derailment

c) Perservation

d) Thought blocking

e) Psychomotor retardation

c) Perservation

500

A five-year old child presents for evaluation related to difficulties adjusting to the first transition from home into a school setting. Teachers are concerned about persistent social withdrawal and the consistent experience that the child does not seek or accept consoling when upset. The child was adopted three years ago after a series of problematic foster placements where care was physically and emotionally inadequate. Later in the interview, while playing with blocks, the child becomes frustrated. The mother attempts to gently intervene, leading to an overly fearful and aggressive response by the child. Which of the following is the most likely diagnosis?

a) Autism spectrum disorder

b) Reactive attachment disorder

c) Posttraumatic stress disorder

d) Obsessive-compulsive disorder

e) Attention-deficit/hyperactivity disorder

b) Reactive attachment disorder

500

Increased risk factors for the development of postpartum psychosis include:

a) being over 30 years of age.

b) complicated delivery.

c) multi-parity.

d) maternal history of puerperal psychiatric illness.

500

Treatment with clozapine resulted in a Finnish "epidemic" reported in the Lancet in 1975. What was the nature of this epidemic?

a) Nephrotoxicity

b) Rhabdomyolysis

c) Agranulocytosis

d) Sudden cardiac death

e) Hepatocellular degeneration

c) Agranulocytosis

500

A case-control study would be appropriate in answering an epidemiological question when the:

a) incidence of the disease is low.

b) etiology of the disease is well known.

c) treatment of the disease is to be evaluated.

d) prevalence of the disease is to be determined.

e) inheritance pattern of the disease is to be determined.

a) incidence of the disease is low.

500

Which of the following is a self-report questionnaire?

a) Beck Depression Inventory

b) Positive and Negative Symptom Scale

c) Clinical Global Impression Scale

d) Brief Psychiatric Rating Scale

e) Hamilton Rating Scale for Depression

a) Beck Depression Inventory