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Neurology
Addiction Psychiatry
Child Psychiatry
Psychopharmacology
Wild Card
100
The diagnosis of myasthenia gravis can be established in 80-90 percent of cases by identification of serum antibodies against a) acetylcholinesterase b) acetylcholine receptors c) motor end-plate sarcolemma d) L-type voltage gated calcium channels e) Myofibrils
What is acetylcholine receptors?
100
Which of the following personality disorders is most commonly associated with alcoholism? a) Histrionic b) Antisocial c) Borderline d) Dependent e) Passive-aggressive
What is Antisocial?
100
The concept of regression in normal child development is best described as? a) the loss of key cognitive milestones b) the intermittent loss of motor functioning c) a typical milestone of the child starting formal schooling d) acting-out behaviors that typically occur around toileting e) the transient return to earlier behaviors despite overall maturation
What is the transient return to earlier behaviors despite overall maturation?
100
A patient taking a typical antipsychotic medication develops akathisia. The psychiatrist may switch the patient to either an atypical antipsychotic medication or add which medication? a) alprazolam b) guanfacine c) propranolol d) phenobarbital e) trihexyphenidyl
What is propranolol?
100
Which of the following factors carries the highest standardized mortality ratio for suicide? a) family history of suicide b) history of self-mutilation c) history of prior suicide attempt d) presence of a substance use disorder e) current diagnosis of major depression
What is history of prior suicide attempt?
200
A 28-year-old female is referred to a psychiatrist by her PCP after her husband observes episodes of odd behavior lasting 1-2 minutes at most. During the last episode, the patient was cleaning the kitchen and began putting all the clean silverware back in the dishwasher. During these episodes he has observed her making chewing movements and is unable to interrupt her behavior. After the episode she has no recollection of the events. An MRI is normal. The most likely diagnosis is? a) Fugue states b) Dissociative states c) Transient global amnesia d) Complex partial seizures
What is Complex partial seizures?
200
A pregnant woman dependent on heroin presents for treatment stating ‘I want to do what’s best for my baby.” Which of the following is the safest treatment for both mother and baby? a) detoxification with clonidine b) detoxification with clonidine while initiating naltrexone c) detoxification without any medications (“cold turkey”) d) methadone maintenance for the duration of the pregnancy e) initiate methadone and then begin slow detoxification with the goal of no opioid use before the baby is born
What is methadone maintenance for the duration of the pregnancy?
200
Diagnosis of which of the following disorders requires symptoms to be present in two or more settings? a) Tourette Syndrome b) Conduct Disorder c) Separation anxiety disorder d) Oppositional defiant disorder (ODD) e) Attention-deficit hyperactivity disorder (ADHD)
What is ADHD?
200
If prescription of a benzodiazepine is necessary for a patient with severe hepatic dysfunction, which of the following is the most appropriate choice to avoid elevated serum levels? a) Diazepam b) Lorazepam c) Clonazepam d) Alprazolam e) Clorazepate
What is lorazepam?
200
Postpartum psychosis is most often associated with which of the following disorders? a) Bipolar disorder b) Delusional disorder c) Schizophrenia d) Major Depressive Disorder e) Posttraumatic stress disorder
What is Bipolar Disorder?
300
Which of the following changes that often occurs in the brains of people over 65 years of age is most likely responsible for an increased susceptibility to chronic subdural hematomas? a) cortical atrophy b) lacunae in the basal ganglia c) thickening and ossification of the dura mater d) occlusion of small penetrating cerebral arteries e) increased permeability of the blood brain barrier
What is cortical atrophy?
300
Which of the following is a side effect common to both naltrexone and disulfiram? a) orthostatic hypotension b) electrocardiogram abnormalities c) elevated liver enzymes d) flushing e) peripheral neuropathy
What is elevated liver enzymes?
300
Core gender identity is established by what age? a) 1 and ½ years b) 3 years c) 4 and ½ years d) 6 years e) 2 years
What is 3 years?
300
A patient with schizophrenia is admitted to a hospital because of a seizure secondary to supratherapeutic levels of Clozaril. Which of the following changes in the patient’s life could account for the elevated clozapine level? a) Moving to a group home that prohibits smoking b) Initiation of St. John’s Wort for depression c) Initiation of oxycodone for back pain d) Removal of black tea from the diet e) Removal of grapefruit juice from the diet
What is moving to a group home that prohibits smoking?
300
Bob and Joan are in couple’s therapy. Bob complains that Joan keeps long hours while working as a physician. Joan states that she has always been conscientious and always wants to make sure everything she does for her patients is “right.” She admits to spending hours checking and rechecking her orders. She spontaneously associates to a time in high school when after wishing her “straight A” college bound brother dead, her brother contracted tularemia after a hunting trip and died. Her checking behavior is an example of which defense mechanism? a) reversal b) projection c) denial d) undoing e) splitting
What is undoing?
400
A 60-year-old male is brought in for a dementia evaluation. He is no longer able to feed himself without assistance. On exam he demonstrates bradykinesia, left sided rigidity, postural instability and apraxia. The patient frequently raises his left arm into the air but appears unaware of this action. A brain MRI is notable for cortical atrophy, R > L. Which is the most likely diagnosis? a) frontotemporal dementia b) dementia with lewy bodies c) progressive supranuclear palsy d) Parkinson’s disease with dementia e) corticobasal ganglionic degeneration
What is corticobasal ganglionic degeneration?
400
The effects of caffeine on which of the following results in increased dopaminergic activity? a) GABA receptor b) Calcium channels c) Adenosine receptor d) Glutamate receptor e) Norepinephrine transporter
What is adenosine receptor?
400
Which of the following medications is not approved for the treatment of pediatric obsessive-compulsive disorder a) Escitalopram b) Venlafaxine c) Fluvoxamine d) Paroxetine e) Sertraline
What is Venlafaxine?
400
Which of the following SSRIs has the shortest half-life? a) Sertraline b) Fluoxetine c) Paroxetine d) Fluvoxamine e) Citalopram
What is Fluvoxamine?
400
According to the standard DBT approach, which of the following skills should be taught to patients first and regularly practiced in order to facilitate learning of other skills? a) mindfulness b) self-management c) distress tolerance d) emotional regulation e) interpersonal effectiveness
What is mindfulness?
500
REM sleep behavior disorder is commonly associated with abnormal inclusions containing which of the following proteins? a) amyloid b) synuclein c) ubiquitin d) Huntington e) Tau
What is synuclein?
500
A patient recently emigrated from East Africa and presents to establish primary care. The patient denies use of alcohol, tobacco or common street drugs, however, he notes that prior to immigrating, he routinely chewed on leaves of a local plan to improve concentration and help him stay awake while working long hours. Which of the following plants did the patient most likely use? a) Coca b) Khat c) Ibogaine d) Sinsemilla e) Jimson Weed
What is Khat?
500
A 9-year-old girl presents with a 3 month history of unprovoked bouts of laughter. The girl reports inconsistent awareness of these episodes, which occur more often when she is not sleeping well. She never feels happy or humorous during these spells. Her parents report that she began menstruating 6 months ago at the age of 8 and ½. On exam, she is at a Tanner’s stage 4. Which is the most likely explanation? a) turner syndrome b) tuberous sclerosis c) hypothalamic hamartoma d) multiple endocrine neoplasia
What is hypothalamic hamartoma?
500
What did the CATIE trial demonstrate about the effectiveness of second-generation antipsychotics for the treatment of schizophrenia? a) all antipsychotics lead to significant weight gain b) cataracts were a significant risk of second generation antipsychotics c) second generation antipsychotics were no more effective than first generation d) combinations of first and second generation antipsychotics were very effective e) most patients discontinued first generation but not second generation medications
What is second-generation antipsychotics were no more effective than first generation?
500
Explicit diagnostic criteria and the multiaxial system were introduced in which of the following DSM editions? a) DSM-I b) DSM-II c) DSM-III d) DSM-III-R e) DSM-IV
What is DSM-III?