Prite-Older Cards

Front 1

A patient with murderous impulses towards a neighbor gives the neighbor a boquet of flowers. This is an example of:

Back 1

reaction formation

Front 2

"Which of the following would be seen in electrophysiologic testing of patients with myasthenia gravis? -conduction block -Delayed F-responses -Increased motor latencies -Slow nerve conduction velocities -Decremental response to repetitive stimulation

Back 2

Decremental response to repetitive stimulation

Front 3

Which of the following laboratory parameters is often elevated in patients with alcohol dependence? -Creatinine -mean corpuscular volume -Erythrocyte sdimentation rate -Mean corpuscular hemoglobin -Acid phosphatase"

Back 3

mean corpuscular volume

Front 4

"Which of the following ethical principles is best described as applying one's abilities solely for the patient well being? -Nonmaleficence -Justice -Veracity -Respect for autonomy -Beneficence

Back 4

-Beneficence

Front 5

"A profound breakdown in both the logcial connection between ideas and the overall sense of goal directedness of speech is referred to as: -derailment -neologism -tangentiality -circumsantiality -flight of ideas

Back 5

-derailment

Front 6

Which of the following tricyclic antidepressants has the most potenet antihistaminic effect? -Doxepin -Imipramine -Clomipramine -Cortriptyline -Amitriptyline

Back 6

-Doxepin

Front 7

A 28 year old woman in otherwise good health has trigeminal neuralgia, for which she has been treated with oxcarbanzepine. The patient tells her physician that she wishes to begin an oral contraceptive. The physician should advise the patient that: -oxcarbazepine may decrease the effectiveness of the contraceptive. -oxcarbazepine may increase the concentration of the contraceptive -the contraceptive may decrease the effectivness of the oxcarbazepine -the contraceptive may increase the concentration of oxcarbazepine -no significan interaction has been demonstrated for these two drugs

Back 7

-oxcarbazepine may decrease the effectiveness of the contraceptive.

Front 8

Which of the following is a risk factor for the development of alcohol withdrawl delirium? -Agitation -Hypertension -Alcoholic hallucinosis -Current infectious disease -decreased serum Thiamine

Back 8

-Current infectious disease

Front 9

A patient with schizophrenia has recently been discharged from the hospital after a first psychotic episode. Family oriented therapy goals should include which of the following? -Facilitating rapid return to the patients regular activites -Confronting the patients problems while avoiding a direct discussion of the episode -Encouraging the family to express their intense emotional reactions with the patient -Educating the family about the patients ilness and providing support for the immediate problems -Exploring connections between the patient psychotic reaction and the familys maladaptive interpersonal patterns

Back 9

Educating the family about the patients ilness and providing support for the immediate problems

Front 10

Alexithymia is best defined as:

Back 10

difficulty being aware of emotions

Front 11

Which of the following is a positive prognostic predictor of overall outcome for children with autism? -communicative speech by age 5 -absence of self stimulatory behaviors -Appropriate eye contact by the child -Early initication of physical and occupational therapy -paticipation in applied behavioral analysis therapy

Back 11

-communicative speech by age 5

Front 12

Qhich of the following findings on a MRI scan would most specifically indicate a diagnosis of Huntingtons disease? -Cerebellar atrophy -Frontal lobe atrophy -Temporal lobe atrophy -Caudate head atrophy -Dilation of the 4th ventricle

Back 12

-Caudate head atrophy

Front 13

A physician meets with a patient and family to discuss treatment of the patient's symptoms that are consistent with mild alzheimers disease. There are no other neurological or psychiatric symptoms or findings. The most appropriate course of action would be to: -begin Selegiline treatment -begin ergoloid mesylates -begin vitamin E supplements -begine cholinesterase inhibitor treatment -Hold medication treatment until the patients symptoms have progressed to moderate severity

Back 13

-begine cholinesterase inhibitor treatment

Front 14

first-pass effect refers to which of the following aspects of a medications metabolism? -redistribution -lipid solubility -eliminations half-life -presystemic elimination -rate of intestinal absorption

Back 14

-presystemic elimination

Front 15

For which treatment of patients with compulsive sexual behavior, the best results have been seen with which of the following approaches? -twelve step groups -Couples therapy -period of celibacy -impatient hospitalization -psychodynamic psychotherapy

Back 15

-twelve step groups

Front 16

A patient presents with chapped and reddened hands. Upon questioning, the patient admits to washing the hands many times a day because ""I work in a hospital cafeteria and am intensely afraid of contracting a flesh eating bacterial infection."" The most likely diagnosis is: -hypochondriasis -specific phobia -somatoform disorder -avoidant personality disorder -paranoid personality disorder

Back 16

-specific phobia

Front 17

Which of the following types of studies is best suited to determine prevalence? -cohort -crossover -cross-sectional -double blinde -psychiatric case register

Back 17

-cross-sectional

Front 18

A person who is setimating the usefulness of a treatment study will use the number needed to treat [NNT] statistic to represent the number of patients who need to be treated to produce one additional good outcome beyond that obtainable with the control or comparison condition. NNT is cacluated by which of the following methods: -Calculating the inverse of the absolute risk reduction -Calculating the inverse of the relative risk reduction -Subtractin g the relative risk reduction from the absolutie risk reduction -subracting the usual control event rate from the experimental event rate -dividing the difference between the controil event rate and the experimental event rate by the experimental event rate

Back 18

-Calculating the inverse of the relative risk reduction

Front 19

A psychiatrist and patient move from the day room to an interview room where they have met on several occasions. The patient states, ""The room looks weird and different today; it doesnt feel right."". This statement is an example of: -illusion -oscillopsia -derealization -depersonalization -inappropriate affect

Back 19

-derealization

Front 20

Which of the following sleep stages is the most important in resoring the altered functions that result from the prolonged sleep deprivation? -rapid eye movement -Stage 1, non-rapid eye movement -Stage 2, non-rapid eye movement -Stage 3, non-rapid eye movement -Stage 4, non-rapid eye movement

Back 20

-"Stage 4, non-rapid eye movement"

Front 21

One controversy about pediatric bipolar disorder is whether severe irritability and emotional dysregulation are: -associated with functional impaiment -associated with later development of substance abuse -predictive of classic bipolar disorder in adulthood. -common problems in all children receiving mental health treatment. -often seen in first degree relatives of the child.

Back 21

-predictive of classic bipolar disorder in adulthood.

Front 22

Whcih of the following is the most signficant problem with the use of global assessment of functioning [GAF] scale? -Training in its use is required -it is lengthy and complicated to use -it confounds symptoms and functioning -it does not provide clear descriptions of each interval -Insurance companies will not accept it

Back 22

-it confounds symptoms and functioning

Front 23

a 78 year old patient has an ischemic stroke that left him with a residual mild hmiplegia. The patient appeared to be unaware that there was a problem of weakness on one side of his body. When asked to raise the weak arm that patient rased his normal arm. When the failure to raise the paralyzed are was pointed out to the patient, he admitted that the arm was slightly weak. He also found to negelct that side of the body when dressing and grooming. The patient did not shave one side of his face and found it difficult to put a shirt on when it was turned inside out. which of the following is likely to have been affected by the stroke? -Right frontal lobe -right parietal lobe -Right temprola lobe -right somatosensory cortex -deep thalamic nuclei

Back 23

-right parietal lobe

Front 24

Secure attachment in an infant is associated with which ofthe following outcomes? Easy temperament in childhood B. Emotional and social competence C. Higher intellectual ability in adolescence D. Educational success through childhood and adolescence E. Physical coordination and later athletic ability

Back 24

Emotional and social competence

Front 25

G,t;: Which of the following is the tnitial treatment of choice for children with obsessive-compulsive disorder (OCD)? A. Sertraline alone . R Clomipramine alone C.' Cognitive-behavioral therapy (CBT) alone D. Cognitive-behavioral therapy (CBT) and sertraline E. Cognitive-behavioral therapy (CBT) and clomipramine

Back 25

Cognitive-behavioral therapy (CBT) alone

Front 26

27. As part of a comprehensive pain management team for a patient with a history of narcotic ,a,buse, a consulting psychiatrist may appropriately be asked to do which ofthe following? Document manipUlative and drug-seeking behavior Administer and interpret comprehensive neurocognitive testing c~" Recommend and manage pharmacologic alternatives to narcotic analgesia Reassure the patient that the patient's pain is not being undertreated Resolve conflicts between the patient and the treatment team

Back 26

Resolve conflicts between the patient and the treatment team

Front 27

·28. Company X develops a new medication for depression. Although the initial trials reveal only modest, statistically insignificant mood benefits, the research team decides to analyze the drug's effects in subgroups. By subgrouping the subject pool into 20 subgroups, the researchers find statistically significant (p < .05) mood benefits for men and women with birthdays in the early fall. The conclusion that can be drawn from this finding is that it is~:---···-·~··-··· .. A.----an~artifact.of selection bias. "":'\ B an artifact of multiple analyses. an artifact of measurement error D. likely the result of scientific misconduct. valid, and the medication should be used in the subgroup that responded.

Back 27

B an artifact of multiple analyses.

Front 28

29. The risk of teratogenic neural tube defects is greatest for the offspring of mothers taking which of the following anticonvulsants? ~ Phenytoin Lamotrigine Valproate Levetiracetam " Carbamazepine

Back 28

Valproate

Front 29

· 30. Which of the following is an exampl~ of declarative memory? A. Skills and habits B. Simple classical conditioning C. Non"associative learning D: ··Priming E. Retention and recall of facts

Back 29

E. Retention and recall of facts

Front 30

31. Persistent visual hallucinations and paranoid delusions develop in a patient with Parkinson's disease. The most appropriate initial intervention would be to: .A.. initiate selegiline therapy. initiate risperidone therapy. initiate low-dose clozapine therapy. reduce the dose of levodopa/carbidopa therapy. administer electroconvulsive therapy (ECT).

Back 30

reduce the dose of levodopa/carbidopa therapy.

Front 31

32. An adult is admitted to the emergency department following an overdose oflithium carbonate. The serum lithium level is 2.6 mEq/L and has not decreased by 20% in 6 hours. Which of the following treatments is the most appropriate to administer? A. Sodium bicarbonate IV B. Hemodialysis 0.9% sodium chloride IV Mannitol IV E. Gastric lavage

Back 31

Hemodialysis

Front 32

33. A 42-year-old patient in individual psychodynamic psychotherapy describes an angry confrontation with a friend. The therapist comments that although the patient describes anger, the patient actually seems very sad. This intervention is best characterized as: i A. confrontation. B. clarification. C. interpretation. 9; affirmation reframing.

Back 32

A. confrontation.

Front 33

34. A 44-year-old man, found wandering aimlessly, is brought to the emergency department by police. Blood pressure is 200/132 and heart rate is 112 and regular. The patient is belligerent, picking at his skin, and reporting feeling crawling insects on his skin. The patient is oriented only to name, is tremulous and is unable to cooperate with a thorough neurological examination. The patient is diaphoretic and his pupils are dilated. The patient has palmar erythema and spider angiomata on the chest. Which of the following is the most likely explanation for the patient's symptoms? A. Opioid withdrawal B. Psilocybin intoxication C. Phencyclidine intoxication '" D. Schizophrenia, paranoid type Delirium tremens

Back 33

Delirium tremens

Front 34

35. A 75-year-old university professor reports that it has been more difficult to get prepared for class lectures over the past 6 months. The patient also complains of being slower periodically in solving complex problems as well as in remembering names and appointments, compared to the past. Mental status examination shows a cognitive examination within normal limits and no decrements in activities of daily living. There is no clear evidence for a general medical condition related to the symptoms. The most likely diagnosis is: 'A. Alzheimer's disease. 'R vascular dementia . .(2. dementia due to multiple etiologies. t D. mild neurocognitive disorder. E. age-related cognitive decline.

Back 34

E. age-related cognitive decline.

Front 35

36. Buprenorphine's advantages over clonidine, in the management of patients with opiate withdrawal,.inc1ude better control of which of the following symptoms? A. Nausea B. Cramping ,C. Craving D. Diarrhea E. Sweating

Back 35

,C. Craving

Front 36

37. A 71-year-old nursing home resident experiences symptoms including Parkinsonian gait disturbance, prominent delusions, fluctuation in level of attention, visual hallucinations, and sensitivity to the extrapyramidal effects ofantipsychotic medications. This clinical presentation is most consistent with which of the following diagnoses? A. Frontal dementia B. Vascular dementia -C:Dementia with Lewy bodies D. Normal pressure hydrocephalus E. Alzheimer's disease

Back 36

C:Dementia with Lewy bodies

Front 37

38. For which of the following patients would ordering a serum ceruloplasmin be indicated? A. A person with delirium who works in a dye factory B. A patient with abdominal pain . C. A young adult male with new onset emotional lability and movement disorder D. A pregnant woman with depression and hypertension An adolescent with mild cognitive changes who is suspected of abusing inhalants

Back 37

C. A young adult male with new onset emotional lability and movement disorder -wilsons disease- copper accumulation

Front 38

39. Patients with intermittent sustained muscle contraction that is most evident with sustained posture are most likely to have which ofthe following disorders? A. Rubral tremor i3-:~ Essential tremor ,C,. Cerebellar dysfunetion D Metabolic encephalopathy . E. Upper motor neuron weakness

Back 38

Metabolic encephalopathy

Front 39

40. (P;egnant woman who are victims of domestic violence tend to be injured on what part of -theIr body? ~~~~~::.:.'Abdomen B. Arm C. Back --face ---head

Back 39

Abdomen

Front 40

41. A 65-year-old patient has a stroke which causes him to faIL On examination, the patient is found to have weakness of the right leg, with only minor weakness ofthe right hand, and no weakness ofthe face. There is no sensory deficit. Speech is not affected, but the patient seems unusually quiet and passive. The stroke most likely involves the: A." right vertebral artery. B left anterior cerebral artery. C. mainstem left middle cerebral artery. posterior division left middle cerebral artery. left transverse sinus.

Back 40

B left anterior cerebral artery.

Front 41

A researcher develops a new questionnaire on the subject of traumatic stress. Which of the following actions would be most appropriate to test the measure's contenet validity?! Ask trauma experts to evaluate its relevance and completeness. - Compare the scores of hurricane survivors to those with no recent trauma. Yr. Compare the scores of subjects with anxiety disorder to those with no diagnosis. D: Compare the scores with those obtained using the Hamilton Anxiety Rating Scale (HARS). Compare the scores of subjects with posttraumatic stress disorder (PTSD) to those with major dcpression.

Back 41

Ask trauma experts to evaluate its relevance and completeness.

Front 42

A 4-year-old child is administered the "false beliefs task" in which two dolls act out a scene, whereby one doll switches the location of a marble from one site to another, while the other doll leaves the scene of the action. When the other doll returns to look for the marble, the child correctly points out that it will look in the original location. This response demonstrates the child is showing evidence of: A. joint attention. B theory of mind. C. egocentric thinking. object constancy. interobjectivity.

Back 42

B theory of mind

Front 43

Whata is interobjectivity?

Back 43

interobjectivity, the understandings that are shared within and between cultures about social reality

Front 44

What is Theory of mind?

Back 44

theory of mind Theory of mind is the ability to attribute mental states—beliefs, intents, desires, pretending, knowledge, etc.—to oneself and others and to understand that others have beliefs, desires and intentions that are different from one's own

Front 45

What is joint attention?

Back 45

Joint attention is the process by which one alerts another to a stimulus via nonverbal means, such as gazing or pointing.

Front 46

Which ofthe following is the best test for general assessment of a patient's psychiatric symptom patterns?' A Category Test . B. Reasons for Living Inventory State-Trait Anxiety Inventory ~ Wide Range Achievement Test (WRA T) Symptom Checklist-90-Revised (SCL-90)

Back 46

Symptom Checklist-90-Revised (SCL-90)

Front 47

A psychiatrist is asked to see a general medical inpatient for reported hypochondriasis. Which of the following is the most important differential diagnostic consideration? A.Malingering B. Conversion disorder C. Somatization disorder D. Body dysmorphic disorder liD Medical condition

Back 47

Medical condition

Front 48

46. A 42-year-old patient described frequent episodes of feeling "sad and down," accompanied by decreased energy and interest in activities. The patient estimates that these episodes have occurred at least four times in his life, usually lasting 2 or 3 weeks at a time. During these episodes, he spends most of the time in bed. The most recent episode of symptoms ended 1 week ago. Since that time, the patient reports feeling energetic and "on top of the world". He now sleeps only I to 2 hours a night and wakes feeling refreshed. Outside of occasional remarks from friends that he seems "flighty," the patient notes no deleterious effect of the mood change and finds that his productivity at work is the best it has ever been. The patient's most likely diagnosis is: A. bipolar I disorder, mixed type. B. bipolar I disorder, manic type. _.h bipolar I disorder with rapid cycling. bipolar II disorder. cyclothymic disorder.

Back 48

bipolar II disorder.

Front 49

47. A 68-year-old patient with hypertension develops rapidly progressing right arm and leg weakness, with deviation of the eyes to the left. Within 30 minutes of the onset of this deficit, the patient became increasingly sleepy. Two hours after the onset, the patient became unresponsive. On examination, the patient has dense right hemiplegia, eyes deviated to the left. The pupils are equal and reactive. There is right facial weakness to grimace elicited by noxious stimuli. Cough and gag reflexes are present. Which of the following computed tomography (CT) findings is most likely? Basilar artery thrombosis Left thalamic hemorrhage Left putaminal hemorrhage Acute infarct in left pons Acute infarct in right cerebellum

Back 49

Left putaminal hemorrhage

Front 50

Patients who complain of having lost not only possessions, status, and strength, but also heart, blood, and intestines suffer from which of the following syndromes? A. Cotard B. Capgras C. Fregoli's D. Charles Bonnet E. de Clerambault's

Back 50

Cotard

Front 51

What is de Clérambault's syndrome?

Back 51

Erotomania [or de Clérambault's syndrome] is a type of delusion in which the affected person believes that another person is in love with him or her. The illness often occurs during psychosis, especially in patients with schizophrenia or bipolar mania.[1] In one case, erotomania was reported in a patient who had undergone surgery for a ruptured cerebral aneurysm.[2] During an erotomanic psychosis, the patient believes that a "secret admirer" is declaring his or her affection to the patient, often by special glances, signals, telepathy, or messages through the media. Usually the patient then returns the perceived affection by means of letters, phone calls, gifts, and visits to the confused recipient.[3] The term erotomania is often confused with "obsessive love", obsession with unrequited love, or hypersexuality (see nymphomania). Erotomania is also called de Clérambault's syndrome, after the French psychiatrist Gaëtan Gatian de Clérambault (1872–1934), who published a comprehensive review paper on the subject

Front 52

What is Charles Bonnet syndrome?

Back 52

Charles Bonnet syndrome (CBS) is a condition that causes patients with visual loss to have complex visual hallucinations, first described by

Front 53

What is Fregoli delusion?

Back 53

The Fregoli delusion or Fregoli syndrome is a rare disorder in which a person holds a delusional belief that different people are in fact a single person who changes appearance or is in disguise. The syndrome may be related to a brain lesion, and is often of a paranoid nature with the delusional person believing themselves persecuted by the person they believe is in disguise.

Front 54

What is Capgras syndrome?

Back 54

The Capgras delusion (or Capgras syndrome) is a disorder in which a person holds a delusional belief that a friend, spouse or other close family member, has been replaced by an identical-looking impostor. The Capgras delusion is classed as a delusional misidentification syndrome, a class of delusional beliefs that involves the misidentification of people, places or objects. It can occur in acute, transient, or chronic forms.

Front 55

What is Cotard syndrome?

Back 55

The Cotard delusion or Cotard's syndrome, also known as nihilistic or negation delusion, is a rare neuropsychiatric disorder in which a person holds a delusional belief that they are dead, do not exist, are putrefying, or have lost their blood or internal organs. Rarely, it can include delusions of immortality.

Front 56

49. A 33-year-old patient is brought to the emergency department with a history of memory loss. During cognitive assessment, the patient answers questions by saying "I don't remember" or by giving approximate answers to simple questions like "how many legs does a dog have?" (with "five" given as the answer) and "what date is Christmas?" (with "December 26" given as the answer). This presentation is most characteristic of which of the following diagnoses? Ganser syndrome Korsakoff syndrome Dissociative disorder ~-Dementia syndrome of depression General medical condition

Back 56

Ganser syndrome

Front 57

What is Ganser syndrome?

Back 57

Ganser syndrome is a rare dissociative disorder previously classified as a factitious disorder. It is characterized by nonsensical or wrong answers to questions or doing things incorrectly, other dissociative symptoms such as fugue, amnesia or conversion disorder, often with visual hallucinations and a decreased state of consciousness. It is also sometimes called nonsense syndrome, balderdash syndrome, syndrome of approximate answers, pseudodementia or prison psychosis. This last name, prison psychosis, is sometimes used because the syndrome occurs most frequently in prison inmates, where it may represent an attempt to gain leniency from prison or court officials. Ganser is an extremely rare variation of dissociative disorder. It is a reaction to extreme stress and the patient thereby suffers from approximation or giving absurd answers to simple questions. The syndrome can sometimes be diagnosed as merely malingering, however, it is more often defined as dissociative disorder. Symptoms include a clouding of consciousness, somatic conversion symptoms, confusion, stress, loss of personal identity, echolalia, and echopraxia. The psychological symptoms generally resemble the patient's sense of mental illness rather than any recognized category. Individuals also give approximate answers to simple questions. For example, "How many legs are on a cat?", to which the subject may respond '3'. The syndrome may occur in persons with other mental disorders such as schizophrenia, depressive disorders, toxic states, paresis, alcohol use disorders and factitious disorders. EEG data does not suggest any specific organic cause.[1]

Front 58

50. A female patient engaged in twice-weekly psychodynamic psychotherapy with a male therapist for the last year begins to discuss sexual fantasies about the therapist. The therapist feels flattered by the sexual interest of this patient and notes his own feelings of attraction to her. The most appropriate next step for the therapist is to: -- seek consultation with a colleague. --end the treatment and refer the patient to another therapist. --explain to the patient that her feelings toward the therapist are not real. -- pull back from close engagement with the patient to maintain more rigid boundaries. E. encourage the patient's discussion ofher fantasies to deepen the erotic transference.

Back 58

-- seek consultation with a colleague.

Front 59

Which ofthe following cancers is the most common source of brain metastasis? A. Melanoma B. Renal carcinoma C. Colon carcinoma Breast carcinoma Lung carcinoma

Back 59

Lung carcinoma

Front 60

52. A 17-year-old patient is brought to the emergency department (ED) after reporting recent cocaine use to a teacher. In the ED the patient is agitated, hyperaroused, and unable to concentrate on the interview. The patient denies frank hallucinations, but appears very distractible and frightened. Physical examination reveals a heart rate of 100 with a normal rhythm. The most appropriate intervention would be to administer which of the following medications? A-, Haloperidol 10 mg <k) Lorazepam 2 mg -C. Naloxone 0.4 mg D. Phenelzine 15 mg £.----Propranolol 80 mg

Back 60

Lorazepam 2 mg

Front 61

According to the DSM-N-TR, the major feature that distinguishes Asperger's disorder from autism is: A. IQ. motor development. language development. degree of social reciprocity. E. difficulty tolerating change.

Back 61

language development.

Front 62

54. Which of the following anticonvulsant medications may be associated with kidney stones? A} Topiramate Ethosuximide C. Carbamazepine D. Phenytoin Gabapentin

Back 62

Topiramate

Front 63

A derivative ofwhich of the following vitamins is a necessary cofactor for the function of the enzyme glutamic acid decarboxylase? A. Thiamine Riboflavin Pyridoxine ~ Niacinamide /~ E. Pantothenic acid

Back 63

Pyridoxine

Front 64

I,56. Researchers wish to study a group ofstudents who were exposed to a terrorist attack in which some of their classmates were killed, and compare the students to other students who had not undergone such a trauma. For the study to be considered quasi-experimental, which ofthe following requirements must be met? The groups of students must not know one another. Baseline data must have been collected before the event. The study instruments must not include student self reports. None of the investigators may have been exposed to the event. Members of each group of subjects must be randomly selected.

Back 64

Baseline data must have been collected before the event.

Front 65

57. Which ofthe following principles is most commonly endorsed in parent management training programs for treatment ofoppositional defiant disorder? Use of fear as a motivator B. Use ofcorporal punishment ~.c. A "tough love" approach ~) Parental attention for prosocial behavior Spontaneity in generating rewards

Back 65

Parental attention for prosocial behavior

Front 66

58. Children should play together with social interaetion and role playing by what age? A. 2 years old B. 4 years old C. 6 years old D. 8 years old E. 10 years old

Back 66

B. 4 years old

Front 67

59) Which ofthe following caregiver characteristics is the strongest predictive factor for elder abuse? A. Alcohol abuse -~ B) Psychosocial stressors ~C. Poor physical health D. Financial dependency Inexperience in caregiving

Back 67

A. Alcohol abuse

Front 68

60. The side effects of sedation and weight gain are associated with mirtazapine's antagonism of which ofthe following receptors? H1 B. 5-HT3 C. 5-HT2A D. alpha2 E. 5-HT1A

Back 68

H1

Front 69

61. Which of the following substances is most likely to cause a patient to develop persistent dementia with long-term use? _~ Inhalants B. Opioids C. Phencyclidine D. Hallucinogens E. Amphetamines

Back 69

Inhalants

Front 70

62. A young adult patient who has been involved in a serious motor vehicle collision is brought to the emergency department for treatment. Although there was no head trauma, the patient did suffer several fractures. Behavioral symptoms include anxiety, a subjective sense of numbing, detachment, and difficulty remembering the accident. Which ofthe following is the most likely diagnosis? Panic disorder Acute stress disorder Depressive disorder D. Briefpsychotic disorder E. Dissociative arrmesia

Back 70

Acute stress disorder

Front 71

63. A 25-year-old patient reports double vision and some difficulty with balance. On right lateral gaze, there is weakness of the left medial rectus, with nystagmus ofthe right eye. On left lateral gaze, there is weakness of the right medial rectus, with nystagmus of the left There is also mild finger to nose ataxia on the right. The most likely diagnosis is: A. multiple sclerosis. B. myasthenia gravis. C. diabetic third nerve palsies. 'D. posterior communicating artery aneurysm. E. conversion disorder.

Back 71

A. multiple sclerosis.

Front 72

64. Which of the following laboratory tests is the most sensitive test for heavy alcohol use? A. Lactate dehydrogenase B.. . Serum alkaline phosphatase d!) Serum gamma-glutamyl transpeptidase D. Glutamic-oxaloacetic transaminase E. Glutamic-pyruvic transaminase

Back 72

Serum gamma-glutamyl transpeptidase

Front 73

65. Poverty of speech and poverty of content are aspects of which of the following conditiqns? A. Alogia B.. Aphonia C.: Aphasia D: Apraxia E-Anhedonia

Back 73

Alogia In psychology, alogia (Greek a-, “without”, and ?????, “speech”[1]), or poverty of speech, is a general lack of additional, unprompted content seen in normal speech. As a symptom, it is commonly seen in patients suffering from schizophrenia, and is considered as a negative symptom. It can complicate psychotherapy severely because of the considerable difficulty in holding a fluent conversation.

Front 74

What is apraxia?

Back 74

Apraxia is a neurological disorder characterized by loss of the ability to execute or carry out learned purposeful movements, despite having the desire and the physical ability to perform the movements. It is a disorder of motor planning which may be acquired or developmental, but may not be caused by incoordination, sensory loss, or failure to comprehend simple commands (which can be tested by asking the person to recognize the correct movement from a series). Apraxia should not be confused with aphasia, an inability to produce and/or comprehend language, or abulia, the lack of desire to carry out an action.

Front 75

What is aphasia?

Back 75

Aphasia (pronounced /?fe??? or ?fe?zi?/) is an acquired language disorder in which there is an impairment of any language modality. This may include difficulty in producing or comprehending spoken or written language. Traditionally, "Aphasia" suggests the total impairment of language ability, and "Dysphasia" a degree of impairment less than total. However, the term "Dysphasia" is easily confused with dysphagia, a swallowing disorder, and thus "Aphasia" has come to mean both partial and total language impairment in common use. Depending on the area and extent of brain damage, someone suffering from aphasia may be able to speak but not write, or vice versa, or display any of a wide variety of other deficiencies in language comprehension and production, such as being able to sing but not speak. Aphasia may co-occur with speech disorders such as dysarthria or apraxia of speech, which also result from brain damage. Aphasia can be assessed in a variety of ways, from quick clinical screening at the bedside to several-hour-long batteries of tasks that examine the key components of language and communication. The prognosis of those with aphasia varies widely, and is dependent upon age of the patient, site and size of lesion, and type of aphasia.

Front 76

What is Aphonia?

Back 76

Aphonia is the medical term for the inability to speak. It is considered more severe than dysphonia. A primary cause of aphonia is bilateral disruption of the recurrent laryngeal nerve, which supplies nearly all the muscles in the larynx. Damage to the nerve may be the result of surgery (e.g., thyroidectomy) or a tumor. Aphonia means "no voice." In other words, a person with this disorder has "lost" his/her voice.

Front 77

Which ofthe following disorders is characterized primarily by cogitive rather than perceptual preoccupation? A. Undifferentiated somatoform disorder B. Somatization disorder C. Conversion disorder D. Hypochondriasis E. Pain disorder

Back 77

Hypochondriasis

Front 78

67. A prison psychiatrist is asked to help evaluate the risk of violence in an individual with a felony conviction who is applying for parole. Which of the following is the best predictive factor for future violence that the psychiatrist should consider? A. Psychopathy rating an objective scale .' B. Presence of commentary auditory hallucinations C. Educational achievement while incarcerated D. Nature ofthe crime that led to the current conviction E. Family ties outside of prison

Back 78

E. Family ties outside of prison or A. Psychopathy rating an objective scale

Front 79

Which of the following medications has some evidence of effectiveness in both the psychotic and nonpsychotic subtypes of body dysmorphic disorder? A. Fluoxetine B. Aripiprazole C. Diazepam D. Thioridazine E. Desipramine

Back 79

A. Fluoxetine

Front 80

69. Elements common to both cognitive behavioral therapy (CBT) and eye movement desensitization reprocessing (EMDR) in the treatment ofpatients with posttraumatic stress disorder include: -establishment of the patient in the "sick role". -controlled exposure to trauma-related triggers. -raising awareness of stress responses through measurement and real-time communication of physiologic processes. -a repeated sequence of dual attention and personal association utilizing external stimuli to reprocess traumatic memories. -- a focus on the meaning of the trauma for the individual in terms of prior psychological conflicts and developmental experiences .

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-controlled exposure to trauma-related triggers.

Front 81

What is Eye movement desensitization and reprocessing (EMDR)?

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Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that was developed to resolve symptoms resulting from disturbing and unresolved life experiences. It uses a structured approach to address past, present, and future aspects of disturbing memories.

Front 82

A 44-year-old patient with alcohol dependence and cirrhosis is inquiring about medication to help stop drinking: The patient is disappointed in the drinking behavior but otherwise shows little evidence of a mood disorder. Which of the following medications has the most favorable risk/benefit profile for alcohol cessation? A. Fluoxetine B. Disulfiram C. Acamprosate D. Ondansetron E. Amitriptyline

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D. Ondansetron

Front 83

71. A 35-year-old patient is started on a trial of clozapine for treatment-refractory schizoaffective disorder. During the initial medication titration, the patient complains of sedation and orthostatic hypotension as well as flu-like symptoms, but seems symptomatically improved. However, after a dose increase from 150 to 200 mg, the patient develops a fever to 102 degrees, tachycardia to 130 bpm, and an acute mental status change. Chest x-ray,urine studies, and blood culture are unremarkable. A c'o'mplete blood count reveals a WBC of 11.4x 10 3/liter, with an elevated eosinophil percentage of 7%. Which of the following known toxic risks of clozapine is the most likely diagnosis? Seizure Myocarditis Pulmonary embolism D. Anticholinergic delirium E. Neuroleptic malignant syndrome

Back 83

Myocarditis

Front 84

signs of NMS?

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* Increased body temperature >100.4 degrees °F, or >38 °C * Confused or altered consciousness * Diaphoresis "sweat shock" * Rigid muscles * Autonomic imbalance [edit] Mnemonic A mnemonic used to remember the features of NMS is FEVER.[2] * F - Fever * E - Encephalopathy * V - Vitals unstable * E - Elevated enzymes (elevated CPK) * R - Rigidity of muscles

Front 85

The images display axial images of a patient's computed tomography (CT) scan without (left) and with (right) intravenous contrast. Which of the following is the correct diagnosis of the patient's condition? A. Glioma B. -Meningioma Cerebral abscess Epidural hemorrhage ~Subdural hemorrhage

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Subdural hemorrhage

Front 86

73. A patient with cocaine addiction experiences cravings for cocaine whenever passing by a "crack-house." This reaction exemplifies: operant conditioning. B. classical conditioning. ~. drug-seeking behavior. b: contingency management. desire to socialize.

Back 86

B. classical conditioning.

Front 87

What is operant conditioning?

Back 87

Operant conditioning is the use of consequences to modify the occurrence and form of behavior. Operant conditioning is distinguished from classical conditioning (also called respondent conditioning, or Pavlovian conditioning) in that operant conditioning deals with the modification of "voluntary behavior" or operant behavior. Operant behavior "operates" on the environment and is maintained by its consequences, while classical conditioning deals with the conditioning of respondent behaviors which are elicited by antecedent conditions. Behaviors conditioned via a classical conditioning procedure are not maintained by consequences.[1]

Front 88

What is classical conditioning?

Back 88

Classical conditioning (also Pavlovian or respondent conditioning) is a form of associative learning that was first demonstrated by Ivan Pavlov.[1] The typical procedure for inducing classical conditioning involves presentations of a neutral stimulus along with a stimulus of some significance. The neutral stimulus could be any event that does not result in an overt behavioral response from the organism under investigation. Pavlov referred to this as a conditioned stimulus (CS). Conversely, presentation of the significant stimulus necessarily evokes an innate, often reflexive, response. Pavlov called these the unconditioned stimulus (US) and unconditioned response (UR), respectively. If the CS and the US are repeatedly paired, eventually the two stimuli become associated and the organism begins to produce a behavioral response to the CS. Pavlov called this the conditioned response (CR).

Front 89

74. Which ofthe following is the most powerful predictor of falling in older adults? Postural instability Peripheral neuropathy Muscular deconditioning Environmental hazards Use of sedative medications

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Use of sedative medications

Front 90

75. The motivational enhancement therapy (MET) model for addiction treatment emphasizes which of the following factors? The need for individuals to hit rock bottom before recovery can be taken seriously J3:' The need for individuals to be medically stable before entering treatment C. The need for individuals to separate themselves from unhealthy environmental influences D. The role of family support in the development of healthy healing The role of ambivalence in the process of change

Back 90

The role of ambivalence in the process of change Motivational interviewing (MI) refers to a counseling approach in part developed by clinical psychologists Professor William R Miller, Ph.D. and Professor Stephen Rollnick, Ph.D. It is a client-centered, semi-directive method of engaging intrinsic motivation to change behavior by developing discrepancy and exploring and resolving ambivalence within the client. Motivational interviewing recognizes and accepts the fact that clients who need to make changes in their lives approach counseling at different levels of readiness to change their behavior. If the counseling is mandated, they may never have thought of changing the behavior in question. Some may have thought about it but not taken steps to change it. Others, especially those voluntarily seeking counseling, may be actively trying to change their behavior and may have been doing so unsuccessfully for years. Motivational interviewing is non-judgmental, non-confrontational and non-adversarial. The approach attempts to increase the client's awareness of the potential problems caused, consequences experienced, and risks faced as a result of the behavior in question. Alternately, therapists help clients envisage a better future, and become increasingly motivated to achieve it. Either way, the strategy seeks to help clients think differently about their behavior and ultimately to consider what might be gained through change. Motivational interviewing is considered to be both client-centered and semi-directive. It departs from traditional Rogerian client-centered therapy through this use of direction, in which therapists attempt to influence clients to consider making changes, rather than non-directively explore themselves. Motivational interviewing is based upon four general principles: 1. Express empathy, guides therapists to share with clients their understanding of the clients' perspective. 2. Develop discrepancy, guides therapists to help clients appreciate the value of change by exploring the discrepancy between how clients want their lives to be vs. how they currently are (or between their deeply-held values and their day-to-day behavior). 3. Roll with resistance, guides therapists to accept client reluctance to change as natural rather than pathological. 4. Support self-efficacy, guides therapists to explicitly embrace client autonomy (even when clients choose to not change) and help clients move toward change successfully and with confidence.

Front 91

76. A 28-year-old patient presents with a I-year history of agoraphobia. The patient is able to drive to the local drug store, but only with considerable pre-travel apprehension. The patient will venture alone no further than within approximately 5 miles of home. Personal history of panic attacks or depression is denied, although family history is positive for depression and alcoholism. The patient has had no previous treatment. The best initial treatment, and one that offers the best long-term prognosis for this patient is: ~ a benzodiazepine only. B. a serotonin selective reuptake inhibitor (SSRI) only . --a benzodiazepine and a serotonin selective reuptake inhibitor (SSRI). --cognitive behavioral therapy (CBT), including exposure. cognitive-behavioral therapy (CBT), including progressive muscle relaxation.

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--cognitive behavioral therapy (CBT), including exposure.

Front 92

77. Which of the following is the most specific factor for distinguishing delirium from dementia of the Alzheimer type? A. Apraxia -Sleep disturbance Fluctuating arousal Visual hallucinations E. short-term memory deficits

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Fluctuating arousal

Front 93

78. A patient in individual psychotherapy frequently describes hatred for a "mean, unfair" boss. This time, however, the patient adds, "But actually, I have heard my boss talking to others in the office, and he seems pretty much ok -even his voice sounds so different from the way I hear him in my head!" According to Fonagy, the patient is demonstrating which of the following mental activities'? A. Displacement Sublimation Imagination Mentalization Altruism

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Mentalization Mentalization is a psychological concept used by the psychoanalytic psychologist Peter Fonagy; he employs it to describe the ability to understand the mental state of oneself and others based on overt behaviour.[1] Fonagy sees mentalization as a form of imaginative mental activity, which allow us to perceive and interpret human behaviour in terms of intentional mental states (e.g. needs, desires, feelings, beliefs, goals, purposes, and reasons).[2]

Front 94

What is sublimation?

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In Freud's classic theory, erotic energy is only allowed limited expression due to constraints of human society. Freud considered this defense mechanism the most productive compared to the others that he identified (ie., repression, displacement, denial, reaction formation, intellectualization and projection). Sublimation is the process of transforming libido into "socially useful" achievements, mainly art. Psychoanalysts often refer to sublimation as the only truly successful defense mechanism.

Front 95

79. The Treatment for Adolescents with Depression Study recommended which of the following treatments for patients with moderate to severe depression? A. Fluoxetine alone B. Interpersonal therapy alone C. Cognitive-behavioral therapy (CBT) alone Fluoxetine and interpersonal therapy Fluoxetine and cognitive-behavioral therapy (CBT)

Back 95

Fluoxetine and interpersonal therapy

Front 96

80. When triiodothyronine augmentation of a tricyclic antidepressant is being considered, caution would be warranted ifthe patient: A. has a history of hypertension. B-; has subclinical hypothyroidism. C. has pronounced psychomotor retardation. ~~_~ relapsed with a previously effective TCA . .~ft:,j is a woman over age 50. "

Back 96

A. has a history of hypertension. also known as TSH

Front 97

81. Which of the following familial effects falsely inflates estimates of heritability? A. Extra-pair copulations ",»:..--Adoption out in early life C. Codominant transmission D. Sex-linked dominant transmission EShared developmental environment

Back 97

E Shared developmental environment

Front 98

82. A female psychiatrist has been treating a 32-year-old married female patient with weekly individual psychothcrapy for depressive symptoms and ambivalence about her marriage. Therapy has been progressing well for several months. The patient has just learned that she is pregnant and explores conflicted feelings about terminating the pregnancy and her fears that the unplanned pregnancy would trap her in the marriage. Uncharacteristically, the psychiatrist speaks strongly to the patient about the reasons not to make such a choice. The patient responds by saying "You are not going to make me feel guilty about this!" Which of the following statements would be the most appropriate for the therapist . to make in response? "I think that you are projecting your own guilt onto me." "I think that you have misunderstood what I was trying to say." "You seem to be resistant to exploring the reasons not to make such a choice." "You felt I was imposing a moral judgment onto you, and, appropriately, you obJected." E. "Don't you think that there are some situations in which guilt is really appropriate?"

Back 98

"You felt I was imposing a moral judgment onto you, and, appropriately, you obJected."

Front 99

83. Which of the following aspects of attention-deficit hyperactivity disorder (ADHD) is most likely to improve as children age? A. Impulsivity (!p Hyperactivity C. Inattention D. Peer relationships Academic difficulties

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Hyperactivity

Front 100

84/ A 56-year-old male patient presents to the emergency department restless and confused. Mild elevations of both lymphocytes and protein are found in cerebrospinal fluid (CSF). Electroencephalography (EEG) demonstrates diffuse slowing on left greater than on the right. A computed tomography (CT) scan is negative; however a brain magnetic resonance imaging (MRI) scan reveals left temporal signal changes. Spinal fluid analysis demonstrates antineuronal antibodies. Except for modest elevation of acute phase reactants, all other tests including chest x-ray are normal. The most likely diagnosis is: - Lupus cerebrititis - cryptococcal meningitis herpes simplex encephalitis. '1 -paraneoplastic limbic encephalitis. E. progressive multifocal leukoencephalopathy

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Any of the above???!!

Front 101

85. A male patient enters psychotherapy because of problems in his relationship with his wife. During the sessions the patient talks about his family of origin, his boss, and his problems at work, but never discusses details about his wife. This is an example of which of the following? A.Sublimation B. Repression Denial transference Resistance

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Resistance

Front 102

86. A young patient has new onset of severe headaches associated at times with periods of visual obscuration. The neurologic examination is normal except for the presence of papilledema. However, the magnetic resonance imagery (MRI) scan is normal and shows no mass effect. Which ofthe following would be the most appropriate test? A. Ocular tonometry B. Serum cortisol level C. Temporal artery biopsy D. Magnetic resonance angiography (MRA) E.Lumbar puncture to measure pressure

Back 102

E.Lumbar puncture to measure pressure

Front 103

87. Which of the following best describes Freud's psychological theory of development? Deficit theory Drive theory Learning theory Conflict theory Experiential theory Define it.

Back 103

Drive theory The terms drive theory and drive reduction theory refer to a diverse set of motivational theories in psychology. Drive theory is based on the principle that organisms are born with certain physiological needs and that a negative state of tension is created when these needs are not satisfied. When a need is satisfied, drive is reduced and the organism returns to a state of homeostasis and relaxation. According to the theory, drive tends to increase over time and operates on a feedback control system, much like a thermostat.

Front 104

A 29-year-old patient is admitted to the hospital with a 1 week history of euphoria, insomnia, pressured speech, and grandiosity. The patient has delusions of being monitored by the FBI, and the staff observes the patient responding to unseen others. In addition to these symptoms, which of the following is required for a diagnosis of schizoaffective disorder? Presence of mood symptoms for at least 1 week in the absence of psychotic symptoms Presence of psychotic symptoms for at least 1 week in the absence of mood symptoms ~ Presence of mood symptoms for at least 2 weeks in the absence of psychotic symptoms -Presence of psychotic symptoms for at least 2 weeks in the absence of mood symptoms - Presence of at least one prior episode of depression

Back 104

-Presence of psychotic symptoms for at least 2 weeks in the absence of mood symptoms

Front 105

89. A 40-year-old dentist is referred for evaluation by staff members who are concerned about his erratic behavior, staying excessively late at the office and problems with dexterity in treating patients. He complains of numbness and weakness of limbs, loss of dexterity, and loss of balance. Which of the following drugs is the dentist most likely abusing? A. Opioids B. Alcohol © Nitrous oxide D. Phencyclidine (PCP) E. Gamma hydroxybutyrate (GHB)

Back 105

Nitrous oxide

Front 106

90. Which ofthe following medications would be preferable for use in an anxious patient with pulmonary disease? Alprazolam Bupropion Buspirone ~9. Clonazepam Propranolol

Back 106

Clonazepam

Front 107

At what age do childr~n begin to. guide. their actions in ambiguous situations using cues , from the mother's facIal expressIOn or in her tone ofvOlce? 12 months 18 months C. 24 months D. 30 months E. 36 months

Back 107

12 months

Front 108

A Japanese family who recently moved from Japan brings their 6-year-old child for ." evaluation. They express concerns that the child appears depressed, is reluctant to go to school, and is fearful that harm will befall the parents. During the evaluation it is noted that the child sleeps in the same room as the parents. Which of the following is the most likely explanation ofthis sleeping arrangement? A. Insomnia B. .~Depression Cultural norm . /~ Separation anxiety \ -~ Stress-from moving to this country

Back 108

Cultural norm .

Front 109

93. A psychiatrist warns a 24-year-old patient that if the patient does not sign in to a hospital voluntarily, the patient will be involuntarily committed. This approach violates the spirit of A~ ... _competency~ beneficence nonmaleficence parens patriae. E. informed consent.

Back 109

informed consent

Front 110

94. According to psychoanalytic theory, feelings of persecution are most reflective of which of the following defense mechanisms? Projection Regression C. Isolation D. Repression Reaction formation

Back 110

Projection

Front 111

95. A 25-year-old single African-American man, who is a first-year law student at an Ivy League school, seeks psychotherapy for what he calls "academic paralysis." He is falling behind as he spends more time brooding about the racial and socioeconomic differences between himself and his classmates. He feels comfortable with his African-American psychiatrist and speaks openly about the racial slights that he experiences every day. The most important goal of dynamic psychotherapy with this patient is to: -- support the patient in a hostile environment. -- determine whether the patient's perceptions are correct or incorrect. -- validate the patient's experience of racism by having a therapist ofthe same race. -- use the shared ethnic background to offer insight to explain how the patient's alienation may be rooted in something more than his current situation. -- help the patient understand that the pain of racism is derived from narcissistic injury inflicted on one's self-concept.

Back 111

-- use the shared ethnic background to offer insight to explain how the patient's alienation may be rooted in something more than his current situation.

Front 112

96. While intoxicated with a psychotomimetic deug, a young man reports "seeing sounds" and "patterns of colors like fireworks or colored flames" associated with real auditory stimuli. Which of the following terms best describes this type of sensory experience? (~.'} Synesthesia ~ Oneiric state C. Bouffee delirante D. lsakower phenomenon Lilliputian hallucination

Back 112

Synesthesia

Front 113

97. A lawsuit charges that a psychiatric facility prematurely discharged a patient who was not approved for further stay by the managed care company. The final legal responsibility generally falls to the: A. psychiatrist. B. managed care company. C. managed care reviewer. D. psychiatric hospital. E. hospital medical director.

Back 113

A. psychiatrist.

Front 114

98. Patients with dissociative identity disorder are also most likely to meet the diagnostic criteria for which of the following disorders? A. Bipolar B. Delusional ~ Somatoform pain ~. Posttraumatic stress E. Obsessive-compulsive

Back 114

~. Posttraumatic stress

Front 115

99. Which of the following agents used to treat patients with Alzheimer's disease has a mechanism of action related to an antiglutaminergic mechanism? A. Donepezil ('!) Memantine C. Galantamine D. Rivastigmine E. Tacrine

Back 115

Memantine

Front 116

100. In the United Slates, most needs of dependent elderly patients are fulfilled by which of the following individuals or agencies? A. Spouses B. Adult children Nursing homes Volunteer services E. Paid in-home caregivers

Back 116

B. Adult children

Front 117

101. A 30-year-old Western-trained psychiatrist ofNorthern European descent has been asked to treat a 40-year-old Hindu patient who emigrated to the United States 2 years ago. The patient presents with complaints of weakness, fatigue, headaches, insomnia, palpitations, and decreased appetite. The patient also reports a 5-lb weight foss over the last month, dysphoric mood with intelmittent anxiety, and suicidal ideation. In~ddition to assessing the patient's level of suicidality, it would b~(lppropriate for the psychiatrist to do which ofthe following when beginning treatment? k. Assess the circumstances of the patient's immigration. B Assess self-identification with culture of origin vs. culture of immigration. --- Inquire what the patient believes explains the symptoms. D. Make a diagnosis of major depression and prescribe antidepressant medication. E. Offer the patient psychiatric hospitalization.

Back 117

--- Inquire what the patient believes explains the symptoms.

Front 118

According to Erikson, the predominant emotional issue in normal, school-aged children is: A. ordinal position B. physical appearance C. identity consolidation D. parental attachment love. E. personal worth and competence.

Back 118

E. personal worth and competence.

Front 119

103. Which of the following medications may worsen the course of serotonin syndrome? A. Bromocriptine B. Lorazepam C. Cyproheptadine D. Chlorpromazine E. Propranolol

Back 119

A. Bromocriptine

Front 120

A famous entertainer comments publicly about having problems cutting down on alcohol use, despite knowing that the use has negative effects on family members. A well-known psychiatrist, who has never met the entertainer, goes on a news program and says that the entertainer is most likely experiencing alcohol abuse. Which of the following statements is most accurate regarding the ethics ofthe psychiatrist's statement? A. It is ethical as long as there is no conflict of interest involved. B. It is ethical unless the entertainer's comments wcre coerced. e It is ethical because the entertainer is a figure in the public eye. D. It is unethical because the psychiatrist has not examined the entertainer. E. It is unethical because the psychiatrist was paid to make the statement.

Back 120

D. It is unethical because the psychiatrist has not examined the entertainer.

Front 121

Recurrent, intense sexually arousing fantasies, urges, or behaviors, including the use of nonliving objects, are the main diagnostic feature of which of the following disorders? Exhibitionism Fetishism C Frotteurism D. Masochism E. Voyeurism

Back 121

Fetishism

Front 122

A previously healthy 65-year-old patient presents to a psychiatrist with new-onset auditory hallucinations. The psychiatric evaluation of this patient should initially focus on uncovering; a recent history of abuse. an underlying medical condition. a genetic predisposition to psychosis. D. a likely histOlY of alcohol or substance abuse. E. the presence of concomitant mood symptoms.

Back 122

an underlying medical condition.

Front 123

A 32-year-old patient reveals a long-standing preoccupation with the shape of her mouth and teeth, though she says that her friends and spouse have assured her that her feelings are inappropriate. The patient reports that she often spends an hour cleaning her teeth, so that the abnormality will be less noticeable. At times she avoids social contact, fearing that people will silently criticize the appearance ofher mouth. She has no other obsessions or cleaning rituals. Which of the following is the best diagnosis for this patient's long-standing preoccupation? A. Social phobia !k'-". Hypochondriasis (C Body dysmorphic disorder \D. Bipolar disorder with psychotic features E. Obsessive-compulsive disorder (OCD)

Back 123

(C Body dysmorphic disorder

Front 124

108. Superior homonymous quadrantic defects in the visual fields result from lesions to which ofthe following structures? W Optic chiasm '-S. Occipital cortex C. Lateral geniculate body D. Parietal optic radiations E. Temporal optic radiations

Back 124

E. Temporal optic radiations

Front 125

109. The abnormal involuntary movements associated with Huntington's disease are generally most effectively suppressed by: ·levetiracetam. B. quetiapine. tizanidine. haloperidoL ropinirole.

Back 125

haloperidoL

Front 126

110. A 34-year-old man is referred for psychiatric evaluation 5 years after sustaining a head injury at work. Prior to the accident, he was a stable, happily married man. Since the accident, he has been described as overly talkative and restless. His wife divorced him because he was acting irresponsibly, which also resulted in termination from his job. Psychometric testing reveals that the man has average intelligence and no detectable memory deficits. The patient's clinical presentation is most consistent with damage to which ofthe following brain areas? Thalamus Frontal lobe C. Corpus striatum D. Amygdaloid body E. Nucleus accumbens

Back 126

Frontal lobe

Front 127

Ill. Which of the following subjective effects is the basis of the appeal of methylenedioxymethamphetamine (MDMA)? A. Invulnerability B. Profound calm Cool, detached insight Connectedness to others E. Entertaining visual illusions

Back 127

Connectedness to others

Front 128

112. An 18-year-old patient with a history ofmigraines is brought to the emergency department complaining ofheadache, nausea, and vomiting. The patient is given intravenous metoclopramide, and 1 hour later complains of difficulty speaking and shortness ofbreath. Examination reveals a severe contraction of the patient's tongue and repetitive spasms of the larynx. The most appropriate medication for initial management ofthe patient's condition would be: A. amantadine. diazepam. diphenhydramine. D. propranolol. E. dantrolene.

Back 128

diphenhydramine

Front 129

113. A healthy 37-year-old female business executive learns that her brother is killed in a major motor vehicle collision and is decapitated. Three days after the funeral, she spots a man driving a car just like her brother's and now is convinced he is not dead. She believes she is the victim of a conspiracy in which others are manipulating her into losing her mind in order to take over her business. She hears a buzzing noise on her phone at work and believes her line is tapped. At home, she thinks the light in her neighbor's window is a sign that she is under surveillance. She calls the police and begs that action be taken. A month after treatment, her symptoms are gone, and within 3 months, she has returned to normal function. The most likely diagnosis is: A. posttraumatic stress disorder. ~) brief psychotic disorder. C. adjustment disorder with mixed disturbance of emotions and conduct. .~D:~" bipolar affective disorder. ---~=-.,.. .E:--schizophrenia, paranoid type.

Back 129

brief psychotic disorder.

Front 130

114. Which of the following patients would automatically be considered as lacking the capacity to give infonned consent for medical procedures? A patient with depressive symptoms who refuses a life-saving intervention ~. A patient with schizophrenia who is institutionalized under involuntary legal status . ~ A patient previously found to lack decisional capacity to refuse treatment while delirious . D. A patient with Alzheimer's dementia who has a state-designated guardian .. A patient with borderline personality disorder who refuses an intervention after a conflict with medical staff

Back 130

D. A patient with Alzheimer's dementia who has a state-designated guardian

Front 131

A psychiatrist wishes to assess a patient's premorbid intellectual functioning. Which of the following tests would be best for this purpose? Reading subtest ofthe Wide Range AChiev.ement Test (WRAT) --Halstead-Reitan Neuropsychological Test Battery C. Luria-Nebraska Neuropsychological Test Battery --Min't-Mental State Examination (MMSE) -- Benton Test of Visual Retention

Back 131

Reading subtest ofthe Wide Range AChiev.ement Test (WRAT)

Front 132

116. A 52-year-old patient with alcohol dependence presents with several days of severe headache, nausea, and low grade fever: Physlcal examination reveals mild disorientation, nuchal rigidity, and mild spasticity in the lower extremities. A head computed . tomography (CT) scan is unrevealing, and a spinal tap reveals 54/mm leukocytes (mostly lymphocytes), a glucose of 45 mg/dL,protein of 43 mg/dL, and presence of occasional gram-positive spherical cells.· The most likely causative organism is: ~pneumococcus. -herpes simplex virus , C. Haemophilus influenzae D. Cryptococcus neoformans E. Mycobactereium tuberculosis

Back 132

Cryptococcus neoformans

Front 133

Which ofthe following sleep changes is produced by all benzodiazepines? A. Increase in stage 3 sleep B. Increase in stage 4 sleep C. Increase in REM sleep density D. Decrease in REM sleep E. REM rebound

Back 133

Decrease in REM sleep

Front 134

Informed consent is NOT required in which ofthe following forensic evaluations? ..' N Competency to stand trial ~Workers' compensation claims Mental state at the time of an offense ,f}: Dangerousness at criminal sentencing Dangerousness for purposes of conditional release

Back 134

Competency to stand trial

Front 135

The first symptom reported by patients with emerging amphetamine psychosis is: loss of insight. paranoid ideation. auditory hallucinations. D. visual hallucinations . . E. overreaction to stimuli in the peripheral visual field. /

Back 135

paranoid ideation.

Front 136

120. A patient with depression recounts to the psychiatrist events ofthe last week and describes many unpleasant experiences, concerns about the sadness of some friends, and a reluctance to read the newspaper because "all the news is bad." In cognitive psychology, which ofthe following formulations best accounts for this patient's presentation? A. Catastrophizing :0 B. Information overload Learned helplessness Selective attention bias 'E. Automatic negative thoughts

Back 136

Selective attention bias

Front 137

121. ~/Nephrologists most commonly request psychiatric consultation on patients with end-stage renal disease' for which of the following conditions? ~" Anxiety Delirium C. Depression D. Noncompliance E. Substance dependence

Back 137

D. Noncompliance

Front 138

122. Cognitive therapy was developed by: ~Alfred Adler. ~Aaron Beck. e. Heinz Kohut. ~Anton Pavlov. E. B. F. Skinner.

Back 138

~Aaron Beck.

Front 139

123. A 7-year-old boy has significant impairment in social interaction, lectures rather than converses, and is obsessed with dinosaurs. His cognitive and language development are age appropriate. The most likely diagnosis ~autism -Asperger's disorder. ·,C. Social anxiety disorder. d. oppositional defiant disorder. . E: Rett's disorder.

Back 139

-Asperger's disorder.

Front 140

124. The most prominent lobbying and support organization for families of people with severe psychiatric disorders is the: A National Alliance for the Mentally Ill. American Psychiatric Association. National Institute for Mental Health. D. Joint Commission on Mental Illness and Mental Health. Pharmaceutical Research and Manufacturers of America.

Back 140

National Alliance for the Mentally Ill.

Front 141

The therapist's initial tasks in starting supportive group therapy are deciding the logistics of organizing planned meetings and selecting patients who can participate in group work. Which of the following would be the appropriate action for the therapist to take next? ~ Analyze the dreams of select group members. Interpret the unconscious conflicts ofmembers in the group setting. Create and maintain a therapeutic environment keeping in mind the culture ofthe group. D. Select patients with a broad range of diagnoses and trauma experiences to "round out" the group.

Back 141

Create and maintain a therapeutic environment keeping in mind the culture ofthe group.

Front 142

126. Which ofthe following is the most common psychiatric diagnosis associated with violent acts? A. Bipolar disorder a~-, Schizophrenia Substance-use disorder D. Borderline personality disorder

Back 142

Substance-use disorder

Front 143

127. A 72-year-old patient complains ofleg weakness and frequent falls .. The patient has a several-month history of forgetfulness, urinarv urgency and frequency, ,but no incontinence. The patient walks withshufflin"g steps and a stooped posture, but themotor examination is otherwise normal. A bedside cognitive assessment reveals short-term membryproblems, but no other difficulties. The most likely diagnosis is: -~--/ k. Alzheimer's disease, B. Parkinson disease, chronic subdural hematoma. normal pressure hydrocephalus.

Back 143

normal pressure hydrocephalus.

Front 144

128/ A 5-year-old child attends the funeral of her grandmother. Later that evening, the child says, ''I'm worried that grandma may get cold and wet in the casket because of the rain." Which of the following concepts of death is the child having trouble understanding? A. Finality :§.~ Inevitability Irrevesibility D. Causality

Back 144

Finality

Front 145

129. Which of the following reflects the opinion of the American Psychiatric Association (APA) on the practice of charging a patient for a missed appointment? Strong discouragement Unconditional encouragement Previously advocated it, but now opposes it Supports it if it is contracted with the patient

Back 145

Supports it if it is contracted with the patient

Front 146

130. A 65-year-old patient wakes up with right-sided hemiparesis and motor aphasia. The patient is immediately brought to the emergency department, and an evaluation is completed within 1 hour. Neurological examination shows no additional abnormalities. Head computed tomography (CT) scan without contrast shows no abnonnality. Which of the following is the most appropriate next management step? A. Aspirin B. Warfarin C. Heparin e)Tissue plasminogen activator

Back 146

A. Aspirin

Front 147

A55-year-old male patient presents with a history of weakness and clumsiness. Symptoms began several months earlier with difficulty buttoning his clothes, getting the car keys in the ignition, and performing other fine motor tasks. He noticed that the muscles in his arm and forearm twitched under the surface, and cramped easily. Over the past few months his arms have continued to weaken and lose muscle mass. On examination he has diffuse wasting and weakness on both upper extremities, fasciculations, !:>light spasticity on arms and legs, and hyperreflexia with extensor plantar responses. The sensory, coordination, and cranial nerve examinations are normal. The underlying pathological process affects neuronal bodies in which of the following structures? -- Anterior horn of the spinal cord, medial brainstem, and prerolandic cortex --Posterior horn ofthe spinal cord, lateral brain stem, and postrolandic cortex --Intermediolateral column of the spinal cord, dorsal brain stem and intralaminar thalamus D. Clarke's column ofthe spinal cord, dorsal pons, and cerebellar cortex

Back 147

-- Anterior horn of the spinal cord, medial brainstem, and prerolandic cortex

Front 148

QYIn the Institute ofMedicine classification system developed to clarify different aspects of prevention, the category of "indicated interventions" refers to which of the following? A;~Preventative measures intended for the general public, such as immunizations -nterventions intended to identify and treat individuals with early acute or subclinical disorders C. Interventions that focus on high-risk individuals to enhance resilience and prevent onset ofthe illness D. Interventions targeting individuals already impaired as early as possible in the course of the illness

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D. Interventions targeting individuals already impaired as early as possible in the course of the illness

Front 149

133. Empirical studies of the diagnostic psychiatric interview process have suggested that the most comprehensive and accurate information is elicited by which of the following approaches? A. Nondirective interviewing that allows the patient to fully express his or her concerns and feelings B. Structured interviewing that systematically covers all relevant domains of history and psychopathology C. Focused interviewing, eliciting details ofthe chief complaint and then an inventory of symptoms D. Open-ended questions with empathic listening combined with inquiry about specific events and symptoms

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D. Open-ended questions with empathic listening combined with inquiry about specific events and symptoms

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134. A 13-year-old boy has trouble keeping up with physical education classes. On examination, he has symmetric weakness in legs and arms, which is worse in the proximal muscles, and most prominent in quadriceps or hamstrings. Both calves are enlarged, and are painful with exercise. A serum creatine kinase level is 13,000 mg/dL, and a muscle biopsy reveals abnonnalities in dystrophin protein staining. The pattern of inheritance of this disease is which ofthe following? A. Autosomal dominant B. Autosomal recessive X-linked Mitochondrial

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X-linked

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135. The Freudian stage oflatency is correlated with Erikson's stage of: trust vs mistrus industry vs. inferiority. C. initiative vs. guilt. -autonomy vs shame.

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industry vs. inferiority.

Front 152

136. Medication can be administered without a patient'~ consent llnder which ofthe following circumstances? The patient is judged to be psychotic. An emergency situation exists and can be documented. The patient is clearly delusional and has been on an inpatient unit for greater than 1 month without receiving any type of pharmacologic treatment. ~ The patient is in an emergency setting, such as a fully accredited hospital emergency department.

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An emergency situation exists and can be documented.

Front 153

137. Which ofthe following medical conditions is most likely to include psychosis in the symptom complex? Hypoparathyroidism Pheochromocytoma Multiple sclerosis Systemic lupus erythematosus

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Systemic lupus erythematosus

Front 154

138. A 54-year-old patient complains of intennittent double vision that has worsened over the last 3 weeks. The patient's coworker also noted that at times the patient had a "droopiness" of the eyelids as if sleepy. Examination reveals bilateral ptosis, mild esotropia, and double vision only after the patient is asked to maintain an upward gaze for 2 minutes. There is no dysarthria, but a mild 4/5 weakness is found in the proximal arm muscles bilaterally. Which ofthe following is the most appropriate test to perform next to establish the diagnosis? Edrophonium test B. Nuclear bone scan C. Spinal fluid electrophoresis D. Computed tomography (CT) scan of the thorax

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Edrophonium test

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The electroencephalography (EEG) finding of4-6 Hz irregular polyspike activity in a patient with generalized seizures is characteristic ofwhich of the following forms of epilepsy? CA:) Absence B. Benign rolandic C. .. Partial comptex D. Juvenile myoclonic

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. Partial comptex

Front 156

A 30-year-old patient has been treated for unreasonable fear of eating in public places, --feeling of embarrassment in public places, and anger over the possibility of being scrutinized. The patient has not responded to high doses of paroxetine, citalopram, buspirone, andalprazolam, each of them administered for 4 to 6 weeks.~Whichofthe following medications would be appropriate for the psychiatrist to consider prescribing next? A. Bupronpion B. Fluoxetine C. Mirtazapine D. Phenelzine

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D. Phenelzine

Front 157

141. Which of the following substances usually decreases serum benzodiazepine levels? Lithium Carbamazepine Cimetidine D. Erythromycin

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Carbamazepine

Front 158

142. A 45-year-old female patient who is divorced presents to thepsyci1iatrist, at the urging of the patient's adult children, with vague complaints of "not feeling good", and not sleeping well for the past month. The patient is pleasant but obvIously tense ..After two sessions, the patient reluctantly discloses being fearful and anxious over "weird things happening to me," including believing that some personal possessions are mysteriously missing or altered. The patient is convinced that a large painting has been replaced by a similar but significantly different one. The patient is aware that "this all sounds crazy," but cannot help feeling frightened that "someone is messing with my mind, maybe my ex-husband." The patient has called the police several times, but they have never found anything suspicious. The patient had been a successful insurance agent, and expresses worry that this distress is distracting and may negatively affect work performance, which could result in job loss. The patient reports no previous psychiatric history, except for feeling depressed for several months after the divorce a few years ago, feelings that resolved~~ without treatment.°WI1ich of the following courses of action would best clarify the diagnosis? A. Refer for psychological testing. Hospitalize for psychiatric observation. ~(;, Obtain a general medical/neurological workup. D. Obtain permission to interview the ex-husband.

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Obtain a general medical/neurological workup.

Front 159

Irregular, unequal, and small pupils that fail to react to light, do not dilate properly in response to mydriatic drugs, butdo constrict on accommodation, are seen in patients with which of the following illnesses? A:syphilis I ~:-Horner's syndrome Retrobulbar neuropathy Ciliary degeneration

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:syphilis

Front 160

144. In the structural model of family therapy, the family is viewed as a: -series of multiple, independent systems ofalliances and power hierarchies. 'B:.series ofrelationships based on rules and regulations. c- single, interrelated system with an emphasis on boundaries between the generations. --system in which family members react to each other according to past, unconscious patterns.

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single, interrelated system with an emphasis on boundaries between the generations.

Front 161

Which of the following is an age-related sleep pattern change? A ) Slow wave sleep increases. REM sleep percentage increases. c. Greater wakefulness is intermixed with sleep. y. There is less incidence of sleep-related movement disorders.

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Greater wakefulness is intermixed with sleep.

Front 162

146. ! The presence of antibodies against which ofthe following is considered etiologic in patients with myasthenia gravis? Myofibrils Acetylcholine receptors Motor end-plate sarcolemma D. Voltage-dependent calcium channels

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Acetylcholine receptors

Front 163

147. Which of the following statements reflects the American Psychiatric Association position statement on reparative conversion therapy for gay and lesbian individuals? A It is ethical because there is credible data that a sexual orientation can be altered with psychotherapy. B. It is ethical because there is credible data that sexual orientation can be altered by religious approaches. C. It is unethical because homosexuality is not considered a mental disorder and harm often comes from such treatment. D. It is unethical because sexuality is protected by law.

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C. It is unethical because homosexuality is not considered a mental disorder and harm often comes from such treatment.

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148. A 28-year-old homeless patient came to the emergency department with a 6-week history of heavy drinking (approximately 2 cases ofbeer a day). The patient has a past history of alcohol withdrawal delirium and seizures. The patient's blood alcohol level is 109 mg%, heart rate of 97, and blood pressure of 153/98. The patient is also diaphoretic and tremulous. Which of the following is the best intervention for this patient? ,-Transfer the patient to a community alcohol detoxification treatment program. "-B-:.-Transfer the patient to a homeless shelter and prescribe 6 tablets of lorazepam 0.5 mg prn. e. Advise the patient to go to another hospital that has an intensive outpatient alcohol treatment program. Recommend the patient for admission to the hospital's medical service.

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Recommend the patient for admission to the hospital's medical service.

Front 165

149. A test that detects 98% of the people who have a disease, but also provides a false positive result for many people without the disease, would have a: CY high sensitivity and low specificity. B. low sensitivity and high specificity. C. low sensitivity and low specificity. D. high sensitivity and high specificity.

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high sensitivity and low specificity.

Front 166

150. A 62-year-old patient presents to the psychiatrist requesting medication for depression. A detailed history reveals that the patient's spouse of 35 years died suddenly 6 weeks ago. Since then, the patient complains of frequent crying spells, decreased appetite -without weight loss, and poor sleep due to middle ofthe night awakenings. The patient continues to attend social engagements with friends and denies suicidal ideation. The patient has a family history of depression, but has never had a depressive episode in the past. The most likely diagnosis is: dysthymia. bereavement. C. acute stress disorder. D. major depressive disorder.

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bereavement

Front 167

(137" Research suggests that the frequency of alcoholism in lesbians as compared to '.~' heterosexual women was greater only in lesbians over 55 years of age. Which of the following is considered to be the best explanation for this finding? A. Underreporting of alcohol use among younger lesbians JC;:'~/' Tendency for lesbians to drink more alcohol as they age \\y Cohort phenomenon related to sociocultural issues D. Statistical artifact ofthe study design

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Cohort phenomenon related to sociocultural issues

Front 168

C~/ Which of the following is achieved during Piaget's stage of concrete operations? A. Egocentricity B. Deductive reasoning ~Animistic thinking ~/ Conservation

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Conservation

Front 169

Male sexuality in the seventh decade is characterized by which of the following? . No change in sex drive no change in penile turgidity Decreased time to erection rp) Decreased time to ejaculation

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No change in sex drive

Front 170

140. A young adult patient presents after recovering from a flu-like illness with a few days of progressive weakness and numbness of both legs and feet. Examination confirms the weakness and reveals loss of sensation to all sensory modalities below the middle of the thorax. Deep tendon reflexes are brisker on the lower extremities than on the upper extremities, and plantar reflexes are extensor. The patient has had several episodes of urinary incontinence. The remainder of the neurologic examination, as well as the vital signs, are nOlmal. A lumbar puncture reveals~~_mononucle~r cells, a protein level of 37 mg/dL, and nonnal glucose content. \\il1i~h of the foifo~lng is'the most likely . diagnosis? ~Acute demyelinating polyneuropathy B. Acute transverse myelitis .coo Anterior spinal artery infarction D~ Spinal epidural abscess

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Acute transverse myelitis

Front 171

141. A child with cancer achieves remission after undergoing extensive and multiple treatments. Two years later, the child develops a recurrence of the cancer that is unresponsive to treatment. The child says, "I'm dying. I just want to be at home with my mom, my dad, and my sister." At what age would the child most likely be to have this response to this situation? A. 3 years old B. 5 years old i2-j 8 years old ~. 14 years old

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14 years old

Front 172

. .'132:--)Which of the following describes core narcissistic character pathology according to Kernberg's model? -A,p An intact capacity to empathize with others without rage and envy -A nondefensive identity with an inferior self that maximizes dependency on others -A fusion ofthe ideal self the ideal object, and the real self resulting in the devaluation of others -Alternating self-representations that result in widely varying responses to perceived or real emotional abandonment

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A fusion ofthe ideal self the ideal object, and the real self resulting in the devaluation of others

Front 173

133. The difference between an idea ofreference and a delusion ofreference is that the former is: --not evidence ofpsychopathology. -- held with less conviction. -- not a form of paranoia --usually due to a genera] medical condition.

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held with less conviction.

Front 174

134. The presence of which ofthe following would suggest that a patient has somatization disorder rather than a general medical condition? A Late onset .. B. Acute course 9", Vague and diffuse pain D) Complaints involving multiple organ systems

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Complaints involving multiple organ systems

Front 175

135. The term "endophenotype" refers to which of the following phenomena in behavioral genetics? A. Residually normal expressed genes B Overlapping traits in two or more expressed diseases C Nonexpressed traits on variant alleles D~') Alternate expressed forms related to a disease

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Alternate expressed forms related to a disease

Front 176

136. Implantation of deep brain stimulation electrodes has been shown to lead to remission in about half of patients with treatment-refractory depression. To obtain this effect, the electrode is placed in the: orbitofrontal cortex. -B~' lateral parietal cortex. (I:J subgenual cingulate cortex. »-. dorsolateral prefrontal cortex.

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subgenual cingulate cortex

Front 177

129. The lesion depicted in the figure is most likely the result of an occlusion of which of the following arteries? /C',; (?/ Anterior cerebral B. Middle cerebral ~ Posterior cerebral ~. Internal carotid

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Middle cerebral

Front 178

130. Which of the following characteristics is common to all brief dynamic psychotherapies? Psychoanalytic formulation of the patient's psychological problems Practical working through of conflict by transference interpretation .'A , Passive patient role in the therapeutic alliance A3C;, Symptom relief as the only goal

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Practical working through of conflict by transference interpretation

Front 179

131 18-year-old patient is brought to the emergency department by family members after the patient reported ingesting a bottle of extra-strength acetaminophen caplets. The patient complains of a stomach ache but otherwise appears well. The patient is fully alert and oriented, with stable vital signs. Initial physical examination is otherwise unremarkable. At what point atter ingestion is it most useful to obtain a serum acetaminophen level? --30 minutes --2 hours --4 hours --24 hours

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4 hours

Front 180

125, In educating parents about the course of Tourette's syndrome, the psychiatrist should inform them that: the course is usually relentlessly progressive. the symptoms usually decrease in the face of other stressors . .C. the symptoms usually improve during adulthood. D, the tic behaviors are usually intentionally provocative,

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the symptoms usually improve during adulthood

Front 181

126. An important countertransference issue in an interethnic psychotherapeutic relationship is: avoidance of transference, denial of differences, C. competitiveness. D, grandiosity,

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denial of differences

Front 182

127. \Vhich of the following instruments would be most apprQpriate to measure the intensity of pain in young children? !«A> Faces scale B:Numerical rating scale c. McGill pain questionnaire D, West Haven-Yale multidimensional pain inventory

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Faces scale

Front 183

128, A 32-year-old woman with bipolar disorder has been treated with lithium, The patient reveals to her psychiatrist that she is now pregnant. Attempts to discontinue lithium in the past have led to relapses of the patient's disorder, with severe associated morbidity. A trial of an antipsychotic in the past resulted in neuroleptic malignant syndrome, and the patient has since refused to use them, Which of the following would be the best option (for treatment during the pregnancy? \ ' \A\ Continue lithium. B. Switch to valproate. C. Switch to carbamazepine, D. Switch to lamotrigine,

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Continue lithium

Front 184

122 A 35-year-old patient reports episodes of flashing lights traveling slowly from left to right in the left visual field. These visual symptoms persist for about 30 minutes and are followed by difficulty expressing self and concentrating. After about 30 minutes, these neurologic symptoms seem to subside, and the patient develops a pounding headache associated with nausea. Both physical examination and a magnetic resonance imaging (MRI) scan are normal. The most likely diagnosis is: A. posterior communicating anemysm with sentinel leak. B. carotid stenosis with carotidynia. C. vertebrobasilar insufficiency. D.. occipital lobe tumor. rE.." migraine with aura.

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migraine with aura

Front 185

123. A psychiatrist asks a patient, "Are there things you must do in a particular way or order?" With this question, the psychiatrist is trying to elicit: A. obsessions. B. preoccupations. C, . phobias. rp. compulsions. E. delusions.

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compulsions

Front 186

124. Which of the following is the most reliable finding from cerebrospinal fluid (CSF) analysis for a patient with multiple sclerosis in the chronic progressive ofthe disease? Myelin basic protein concentration B. Gamma globulin production C. Presence of oligoclonal bands D. Total protein concentration E Immunoglobulin G concentration

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Presence of oligoclonal bands

Front 187

119. Erotomania refers to which of the following conditions? ~. Sensate focus exercise ~ Compulsive masturbation C Delusions of a secret lover D~/ Hypochondriacal psychosis E. Hypersexuality during a manic episode

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Delusions of a secret lover

Front 188

120 A 42-year-old patient with a history of hypertension treated with hydrochlorothiazide and lisinopril presents for follow-up of severe melancholic and vegetative depression. The patient, while adherent to all medication regimens, has failed multiple combinations of antidepressants and is currently on a regimen that includes fluoxetine. The psychiatrist plans to discontinue fluoxetine and start selegiline. \:Vhich of the following is the most impOliant consideration to be made prior to starting selegiline? A. It is a reversible MAO-B inhibitor only, and therefore may be stalied today. but only after counseling the patient to avoid tyramine-rich foods. B. It is a reversible inhibitor of MAO-A and NIAO-B, and does not require the patient to avoid tyramine-rich foods. C It is an irreversible MAO-A and MAO-B inhibitor, and can only be started 5 weeks after discontinuing fluoxetine to decrease the risk of serotonin syndrome. D. It is an irreversible MAO-B inhibitor, but does not inhibit MAO-A, and therefore may be started in 2 weeks, as it carries only minimal risk of serotonin syndrome. E. It is contraindicated in a patient with baseline hypertension because of the risk of acute hypertensive crisis.

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It is an irreversible MAO-A and MAO-B inhibitor, and can only be started 5 weeks after discontinuing fluoxetine to decrease the risk of serotonin syndrome.

Front 189

121. Which ofthe following factors is most closely associated with child abuse and neglect? Household poverty Large family size Single-parent household D. Child with behavioral problems Child between 3 and 12 years old

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Household poverty

Front 190

115. A 42-year-old male patient with a gradually progressive cognitive deficit also develops jerking movements of the extremities, head, and trunk. Imaging studies show atrophy of the caudate nuclei bilaterally. The patient's father had a similar illness that started at age 50. vVhich of the following tests is most likely to confirm the diagnosis? A. Cerebrospinal fluid (CSF) analysis for 14-3-3 protein B. Electroencephalogram (EEG) for periodic discharges DNA analysis for Apo E4 alleles --DNA analysis for CAG repeats -- CSF analysis for oligoclonal bands

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DNA analysis for CAG repeats

Front 191

116. A 29-year-old female patient complains of mood swings, reporting that her mood changes very rapidly, sometimes without prompting, from elation to depression or intense anger. These moods last minutes to hours. Her history is significant for promiscuity, spending sprees, tumultuous relationships, unstable self-image, and occasional use of cocaine. She also gives a history of a brief period ofparanoia and auditory hallucinations during an emotional break-up with her last boyfriend, which remitted after a 2-day admission to the psychiatric unit. When asked about suicidal ideation, she reports that it is always in her mind and that, whenever she is under stress, she cuts her arms with a sharp blade to relieve a strong feeling of emptiness. Which of the following is the most likely diagnosis? --Bipolar affective disorder, rapid cycling --Bipolar affective disorder, type II --Schizoaffective disorder --Borderline personality disorder --Schizotypal personality disorder

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Borderline personality disorder

Front 192

117. Learned helplessness is a model for: anxiety. depression. thought disorder. organic dysfunction. personality disturbance.

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depression

Front 193

18 Which of the following is the major negative aspect of crossover designs for research studies? A.---Prohibitive"cost B.) Residual effects C subject dropout D Incomplete randomization E. Large sample size required

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Residual effects

Front 194

111. A patient with borderline personality disorder who has been making progress in long-tenn psychodynamic psychotherapy enters a session obviously distraught. After listening to scattered and seemingly unimportant details of recent daily life, the therapist asks if the patient is avoiding something that might seem too uncomfortable to talk about. The patient responds with intense anger and distress, saying "I just heard that you are getting a divorce, and 1 am sick about it. Here I am counting on you to help me sort out my chaotic life and messed-up relationships, and you can't even keep your own marriage together! What are you, some kind of hypocrite? I think I should leave and find someone who knows what they're doing!" Which of the following is the best response for the therapist to make next? --"Yes, I am getting a divorce, and I will tell you some of the facts about it if you really need to know them." ---"Although this is upsetting and frightening to you, it really has nothing to do with our work together." C:: "Where did you hear that? And why does it upset you so much? You know that . doctors are human, too." D:\ "I am going to need a moment to think about what you've said and are feeling before I can respond." E. "You know that your life is the focus here, not the details of my personal life. "

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I am going to need a moment to think about what you've said and are feeling before I can respond

Front 195

112\ A leading hypothesis as to why atypical antipsychotic medications are less likely than typical neuroleptic agents to cause extrapyramidal side effects is based on which of the following properties of atypical antipsychotics? ~ Higher affinity for D 1 receptors ~ Affinity for muscarinic cholinergic receptors Binding to multiple other dopamine receptors Decreased binding to D2 receptors Rapid dissociation from D2 receptors

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Rapid dissociation from D2 receptors

Front 196

113. A psychiatrist accepts a gift from a phannaceutical company that makes an antidepressant medication. This is considered ethical under which of the following circumstances? ,A, The gift does not exceed $500. -B.. The psychiatrist already uses the drug in practice. ~ The psychiatrist agrees to use the medication, but not exclusively. ~. The gift contributes to the psychiatrist's education or care ofpatients. The gift directly defrays costs of attending a continuing medical education event.

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The gift contributes to the psychiatrist's education or care ofpatients.

Front 197

114. Which of the following instruments is most helpful in the assessment of children suspected of having attention-deficit hyperactivity disorder (ADHD)? A-) Conners Teacher Rating Scale B~'-Wechsler Intelligence Scale for Children-III C. Woodcock-Johnson Psycho-educational Battery-Revised D. Vineland Adaptive Behavior Scales Rorschach Inkblot Test

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Conners Teacher Rating Scale

Front 198

107. Which of the following probabilities most accurately describes the likelihood of patients with schizophrenia committing homicide compared with the "general population? A Equal likelihood B Twice as likely C. Three times as likely D. Five times as likely E. Ten times as likely

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Equal likelihood

Front 199

108. A diagnosis of anorexia nervosa requires that the patient has maintained a weight below what percentage of a minimally normal weight for age and height? A. 55% B. 65% C. 75% D. 85% E. 95%

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D. 85%

Front 200

109. Which of the following medications has the lowest likelihood of discontinuation symptoms if the medication is abruptly stopped? r:i.) Fluoxetine '\13 Citalopram C. Fluvoxamine D. Paroxetine E. Sertraline

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Fluoxetine

Front 201

110 Which of the following antibiotics is most likely to cause or precipitate acute myasthenia? A. Ceftriaxone B. Minocycline Sulfamethoxazole Ciprofloxacin E. Amoxicillin

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Ciprofloxacin

Front 202

105>" An individual with a full scale IQ of65 could be expected to plateau at what level of . /? academic functioning? lA") 1 st grade 3rd grade C. 6th grade D. 9th grade e. 12th grade

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6th grade

Front 203

106. A 24-year-old female patient has paranoia and suspiciousness. The patient does not pay attention to dressing and hygiene and no longer cooks or cleans the house. The patient does not have memory loss, difficulty recognizing people or objects, driving a car, using household appliances or the telephone. A computerized tomography (CT) scan of the head obtained upon consultation is shown in the figure. The most likely diagnosis ~ late onset schizophrenia. B. Alzheimer's disease. C. Pick's disease. D paraphrenia. E. transient paranoid reaction.

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Pick's disease. Paraphrenia is a group of psychotic illnesses distinct from paranoia and from schizophrenia. In patients suffering from this type of psychosis, personality decay is minimal, and emotional rapport is well retained. The onset occurs around age 40. Furthermore, paraphrenia is characterized by the preoccupation with one or more semisystematized delusions. These delusions are not encapsulated from the rest of the personality as in delusional disorder. The affect is notably well-preserved and appropriate, as is the ability to maintain rapport with others. There is no intellectual deterioration, no flat nor grossly inappropriate affect. Disturbance of behavior is understandable in relation to the content of the delusions. The illness is associated with distress and agitation. Irrational behaviour may appear as delusions become more vivid and judgment lessens. Patients may accuse others of persecution and complain to the authorities.

Front 204

. 101 A patient reports headaches and peripheral visual loss. Visual field defects involving the temporal fields of both eyes are detected. A magnetic resonance imaging (MRI) scan of the brain is likely to reveal which of the following? A. Temporal arteritis B. Retrobulbar neuritis C. Bilateral mesial temporal sclerosis Tumor of splenium of corpus callosum Mass in sella turcica

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Mass in sella turcica

Front 205

102 Which of the following medications has FDA approval for the treatment of mania in children 12 years of age or older? --~---------~.-.-,~ A. Lithium , B-" V alproate C. Olanzapine D. Risperidone Carbamazepine

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Lithium

Front 206

103 A 54-year-old man with major depression is successfully treated with fluoxetine; however, after 3 months of treatment the patient develops significant sexual dysfunction. Dose reduction with fluoxetine does not alleviate the problem. The patient refuses to continue fluoxetine if the sexual side effects cannot be alleviated. Which of the following should the psychiatrist do next? Augment fluoxetine with bupropion. --Discontinue fluoxetine and begin paroxetine. , --Disontinue fluoxetine and begin sertraline. ~-Continue fluoxetine, but use brief (1-2-day) drug holidays . -- Urge the patient to wait, since the side effects will improve with time.

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Augment fluoxetine with bupropion and/or Disontinue fluoxetine and begin sertraline.

Front 207

104. Which of the following defense mechanisms involves internalizing the qualities of an object? Inhibition Introjection Displacement D. Rationalization Reaction formation

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Introjection

Front 208

97. Which of the following is the most common complication of idiopathic intracranial hypertension? ~. Herniation B. Exophthalmos CD Gait disorder D. Visual impairment ~: Cerebrospinal fluid rhinorrhea

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Visual impairment

Front 209

98. A 48-year-old patient with a significant history of alcohol withdrawal symptoms during previous hospitalizations presents in the emergency department to request "detox" and is admitted. Which of the following is appropriate monotherapy for alcohol withdrawal in this patient? ·A Clonidine Lorazepam C. Haloperidol ,D. . Cabamazepine E;· A beta blocker

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Lorazepam

Front 210

99. Which of the following pain medications is contraindicated in patients taking monoamine oxidase inhibitors (MAOIs)? .A. Meperidine B. Codeine C. Methadone D. Fentanyl Hydromorphone

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Meperidine

Front 211

lO0) In terms of the normal functioning of the personality, Anna Freud's contributions were in / the realm of: A> cognitive constructs. B~.defense mechanisms. C/ object relations. D. learning theory. instincts.

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defense mechanisms

Front 212

92 Which of the following medications is an effective first-line treatment for patients with restless legs syndrome? A. Carbamazepine Pramipexole _,,_ Clonazepam / D. Imipramine E. Gabapentin

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Pramipexole

Front 213

93. A form of learned fear in which a person or an experimental animal learns to respond strongly not only to a harmful stimulus, but also to a subthreshold stimulus, refers to: -A-avoidance B) sensItization. C. habituation. D irrational fear E. Learned helplessness

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sensItization

Front 214

94. A 28-year-old female patient reports episodes of severe headaches associated with nausea and vomiting. These headaches can be incapacitating and are often preceded by flashes oflight in the right visual field. During the headache, the patient sometimes has difficulty expressing herself. Which of the following would be the appropriate therapy to prevent these episodes? A. Warfarin B. Ticlopidine C. Topiramate D. Rizatriptan Aspirin

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Topiramate

Front 215

95. Which ofthe following is the most common method of completed suicide in female children and adolescents? Oral ingestion of toxic substances Carbon monoxid ·poisoning Hanging Drowning Firearms

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Firearms

Front 216

Which ofthe following reverses the effects of benzodiazepines? c:!;) Flurnazenil B. Nalmefene C. Naloxone D. Naltrexone Acetylcysteine

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Flurnazenil

Front 217

A 55-year-old patient with a history of alcohol dependence reports hearing voices for . the past 6 weeks. The patient reports that the last episode of alcohol intoxication was 1 month prior, with moderate drinking since that time. There is no prior history of psychosis:" On examination, the patient is alert and oriented. On laboratory evaluation, the patient has a GGT of 54 U/I, an MCV of 110, and an AST/AL T ratio of2.1. The most likely cause ofthis patient's hallucinations is: delirium tremens. delusional disorder. alcohol withdrawal, complicated. alcohol-induced psychotic disorder. psychotic disorder not otherwise specified.

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alcohol-induced psychotic disorder

Front 218

A child's parents are very concemed that their 4-year-old son still wets himself §~veral times a week. The child's brothers were potty trained when they were 3 and 3 1/2 years ·old. TtiereIs no evidence of developmental delay and the child's pediatrician has found nothing unusual. Which of the following would be the most appropriate intervention? A. A bell and pad device ,"~br. Desmopressin or imipramine Sending the child to the bathroom after every meal Referral for a medical workup for the child Reassurance and monitoring

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Reassurance and monitoring

Front 219

90. As classified by DSM-IV, which ofthe following subtypes of schizophrenia is characterized by older age of onset and less regression of mental faculties, emotional responses, and behavior? A Catatonic 6; Residual· . .C) Paranoid O. Undifferentiated E. Disorganized

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Paranoid

Front 220

91. A 19-year-old patient expresses the belief that she failed a recent midterm examination despite studying a great deal for the test. The patient is convinced that this means she will lose scholarship money and will need to drop out of college. The patient is an excellent student who is prone to excessive worrying. Her belief that she is going to have to drop out of college because she did poorly on the midterm exam is an example of which of the following types of distortion? A. Maximizing B. Personalizing ?s:;.,\ Overgeneralization ; IJ./ Catastrophic thinking E. Fortune telling

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Catastrophic thinking

Front 221

83. The psychiatrist who is assessing a patient's suitability for psychotherapy notes that the patient prominently uses the defenses of isolation of affect and intellectualization. The patient's description of many life events appears to involve reaction formation. Which of the following personality traits is most likely to characterize this patient? A. Schizoid B. Paranoid C. Histrionic Narcissistic Obsessive-compulsive

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Obsessive-compulsive

Front 222

84. A female child performs a dance for her mother and basks in the gleam in her mother's eyes. According to self-psychology, the child is having an experience of: A. mastery. B. idealization. C. pnmary narCISSIsm. D. good-enough mothering. E. Mirroring

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Mirroring

Front 223

Within the area of self-psychology, being mirrored refers to?

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Within the area of self-psychology, being mirrored refers "to all the transactions characterizing the mother-child relationship, including not only the reflections of grandiosity, but also constancy, nurturance, a general empathy and respect" (Kohut, 1977, pp. 146-147).[1] The parents' mirroring responses influence the development and maintenance of self-esteem and self-assertive ambitions. Their response will mirror back to the child a sense of worth, which in turn creates an internal self-respect.[

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In terms of Self psychology what is Self?

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Self Kohut's concept of self, and "defects" in it, is the core variable of self-psychology, where for instance superego/ego/id and oedipal conflicts could be considered to be the core of Freudian theory. The self is thought to be an adaptable structure, with a static core, defined in early life. Psychopathology is observed with regard to how the self adapts and reacts to other objects. For the therapist, the patient's self is also examined with regard to how to approach the patient.

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In terms of Self psychology what is Empathy?

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Empathy Kohut maintained that parents' failures to empathize with their children and the responses of their children to these failures were 'at the root of almost all psychopathology' [1]. Correspondingly, he emphasized the use of empathy as a tool in therapy. Kohut describes human empathy as a therapeutic skill. When a patient acts in a certain way, "put yourself in his/her shoes" - and find out how it feels for the patient to act in this manner. Using the skill of empathy, the therapist is able to reach conclusions sooner (with less dialogue and interpretation), and there is also a stronger bond between patient and therapist, making the patient feel more fundamentally understood. The implicit bond of empathy itself has a curing effect, according to Kohut. The conceptual introduction of empathy was not intended to be a "discovery." Empathic moments in psychology existed long before Kohut. Instead, Kohut posited that empathy in psychology should be acknowledged as a powerful therapeutic tool, extending beyond "hunches" and vague "assumptions," and enabling empathy to be described, taught, and used more actively.

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In terms of Self psychology what is Selfobject?

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Selfobject Selfobjects are external objects that function as part of the "self machinery." In other words, they are persons, objects or activities that "complete" the self, and which are necessary for normal functioning. Observing the patient's selfobject connections is a fundamental part of self-psychology. For instance, a person's particular habits, choice of education and work, taste in life partners, may fill a selfobject-function for that particular individual. Selfobjects are addressed throughout Kohut's theory, and include everything from the transference phenomenon in therapy, relatives, and items (for instance Linus van Pelt's security blanket). If psychopathology is explained as an "incomplete" or "defect" self, then the self-objects can be described as a self-prescribed "cure". As described by Kohut, the selfobject-function (ie. what the selfobject does for the self) is taken for granted and seems to take place in a "blindzone." The function thus usually does not become "visible" until the relation with the selfobject is somehow broken. When a relationship is established with a new selfobject, the relationship connection can "lock in place" quite powerfully, and the pull of the connection may affect both self and selfobject. Powerful transference, for instance, is an example of this phenomenon.

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In terms of Self psychology what is Optimal Frustraion?

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Optimal Frustration When a selfobject is needed, but not accessible, this will create a potential problem for the self, referred to as a "frustration." This is solved, optimally, by imagining the object's presence, thus creating a "surrogate" selfobject until the selfobject is available. If the frustration is solved too eagerly, this means that the imagined presence may not develop it's "surrogate" function. On the other hand, if the frustration response is suboptimal, the "surrogate" image may become too important. Suboptimal frustrations and maladaptations following them, may be compared to, for instance, Freud's trauma concept, the concept could also be considered reminiscent of problem solution in the oedipal phase. However, the scope of optimal frustration describes shaping of every "nook and cranny" of the self, rather than a few dramatic conflicts.

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In terms of Self psychology what is Idealizing?

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dealizing The need to establish a mutual selfobject connection with an object of idealization.

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In terms of Self psychology what is Alter ego/Twinship needs?

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Alter ego/Twinship needs Alter ego/Twinship needs concern the need to feel alikeness to other human beings [1]. This need relaxes as development continues allowing a greater degree of difference from others to be accepted [1].

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In terms of Self psychology what is the tripolar self?

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Insert your new answer text hereThe Tripolar Self The tripolar self is not associated with bipolar disorder, but is the sum of the three "poles" of the body: * "grandiose-exhibitionistic needs" * "the need for an omnipotent idealized figure" * "alter-ego needs" The tripolar self forms as a result of the needs of an individual binding with the interactions of other significant persons within the life of that individual.

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85. A father wants to know if he should allow his 5-year-old child to attend the funeral of her mother. The child expresses a desire to go. To help the child through the funeral, it will be important to do which of the following? A. Shield the child from viewing the body. B. Make the child an active participant in the service. iC') Have someone familiar accompany the child. ~:6. Allow the child to attend the ceremony, but not the burial. Seat the child in the back of the room in case the child starts to cry.

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Have someone familiar accompany the child

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Research into the complexity of healthcare systems and djstribJ!tiQ[l of resources is best carried out in which fashionT . Case series Cohort study Naturalistic study Case-control study Randomized controlled trial

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Naturalistic study

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What is a Naturalistic study?

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Naturalistic study: A type of study in which the researcher very carefully observes and records some behavior or phenomenon, sometimes over a prolonged period, in its natural setting while interfering as little as possible with the subjects or phenomena. In medical research, a naturalistic study usually involves observing people as they go about their normal activities. The presence of an observer obviously has an effect as one goes about one's daily activities.

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87. Which of the following medications is likely to be effective monotherapy for patients with social phobia. have not been responsive to selective serotonin reuptake inhibitors (SSRls)? ,~, (A.. ' Phenelzine . B. Bupropion C. Buspirone D. Nefazodone E. Chlorpromazine

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Phenelzine

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A 52-year-old male patient presents with a chief complaint of gait difficulties. On examination, the patient has mild dysarthria. There is very mild finger to nose ataxia and minimal heel to shin ataxia. The Romberg test is negative, but the patient is unsteady while walking and walks with a broad-based, lurching gait. The plantar reflexes are flexor. Imaging studies are most likely to demonstrate: A. hydrocephalus. B. caudate atrophy. frontal lobe atrophy. cerebellar vermis atrophy. periventricular white matter hyperintensities.

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cerebellar vermis atrophy--- caused by alcoholism

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As conceptualized by self psychology, which ofthe following is the most problematic reactionn a patient can have when attempting to fulfill a .self object need? Anger Shame Withdrawal D. Depression Masochism

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Shame

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A psychiatric consultation is requested for a patient whom the medical team believes is manufacturing symptoms of illness. Which of the following factors would be most consistent with a diagnosis of malingering? Low socioeconomic status Financial incentive for illness History of early childhood trauma Psychological need to feel cared for Consistent symptom presentation irrespective of the audience

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Financial incentive for illness

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Neurotoxicity associated with methylenedioxymethamphetamine (MDMA) is associated with deficits in neurons that produce which of the following neurotransmitters? A. Histamine B.. Dopamine Serotonin Acetylcholine Orexin/hypocretin

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Serotonin

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A 74-year-old, right-handed patient presents with significant memory loss, expressive aphasia, and left plantar extensor response. The most likely diagnosis is: ('A. vascular dementia. , Lewy body dementia. Alzheimer's dementia. D. frontal-temporal dementia. dementia due to normal pressure hydrocephalus.

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vascular dementia

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Which of the following neurohormones is known to modulate immune function, has analgesic properties, is derived from the serotonic molecule, and is a potent aittioxidant and free-radical scavenger?. Prolactin Oxytocin Melatonin Substance P Growth hormone

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Melatonin

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75. A 22-year-old woman is brought to the emergency department after fainting on a hot summer day. The patient is noted to be significantly underweight, and on questioning admits to restricting calorie intake and self-induced vomiting. Initial medical evaluation in the emergency department should include measurement ofthe serum levels of: copper. cortisoL potassium. carotene. platelets.

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potassium

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76. A patient who has been sexually assaulted is in the emergency department immediately after the traunla. Initiation of which of the following is most likely to be helpful in preventing long-term psychiatric sequelae? Treatment with benzodiazepines B. Initiation bf a selective serotonin reuptake inhibitor (SSRI) Single-session eye movement desensitization and reprocessing Group psychological debriefing with other victims of trauma E. Psychosocial interventions to establish safety from further trauma

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Psychosocial interventions to establish safety from further trauma

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A 47-year-old patient with acute mania is unresponsive to pharmacotherapy. The patient's current medication regimen includes lithium, divalproex, clonazepam, olanzapine, and bupropion. Electroconvulsive therapy (ECT) is begun, and the patient is continued on the previous medication regimen. After two ECT treatments, the patient becomes delirious. Which of the patient's medications is most likely to be responsible for this reaction? Lithium Divalproex Clonazepam Olanzapine Bupropion

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Lithium

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70. A resident performs a research study utilizing all of the outpatients with any psychiatric disorder, who were treated during the first 2 months ofthe resident's outpatient experience. The resident discovers that of 47 patients diagnosed with any psychiatric disorder, six meet the criteria for obsessive-compulsive disorder (OCD). Which of the following statistics best defines this information? The incidence of OCD is 6/47. -B:' The relative risk ofOCD is 6/47, '€:' The point prevalence of OCD is 6/47. B:' The lifetime expectancy ofOCD is 6/47. The treated period prevalence ofOCD is 6/47.

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The point prevalence of OCD is 6/47.

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in statistics what is formula for Relative risk and what does in mean?

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In statistics and mathematical epidemiology, relative risk (RR) is the risk of an event (or of developing a disease) relative to exposure. Relative risk is a ratio of the probability of the event occurring in the exposed group versus a non-exposed group.[1] Consider an example where the probability of developing lung cancer among smokers was 20% and among non-smokers 1%. This situation is expressed in the 2 × 2 table to the right. Here, a = 20(%), b = 80, c = 1, and d = 99. Then the relative risk of cancer associated with smoking would be RR=[a/(a+b)]/[c/(c+d)] = [20/100]/[1/100] = 20.

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71. Subacute combined degeneration of the posterior column of the spinal cord is associated with a deficiency of: A. vitamin A. B. vitamin B6. C. vitamin B12 D. vitamin D. E. vitamin e

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vitamin B12

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72. A muscular male patient presents to an outpatient psychiatric clinic complaining of discomfort in public places and excessive initability Though warm outside, the patient is dressed in heavy, baggy clothes, making hlm appear bigger than he is. The patient's belief that he is shrinking greatly distresses him. Which of the following is the most likely diagnosis for thIs-patient? ~:tk:' Atypical anorexia nervosa , B. Anabolic-androgenic steroid abuse :C.; Anxiety disorder, not otherwise specified D. Bipolar disorder with psychotic features E. Obsessive-compulsive disorder (OCD)

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Anabolic-androgenic steroid abuse

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73. A 75-year-old patient presents with a 3-day history ofintense, painful itching on the left side of the rib cage following a belt distribution. The patient also has had fever and malaise. On examination there is an erythematous rash with tense, clear vesicles in the distribution ofthe T4 dermatome. Which of the following is most likely to be the causative agent? -Cytomegalovirus -Herpes simplex virus Varicella zoster virus Human inununodeficiency virus Arthropod-borne virus

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Varicella zoster virus