Topics
"14 yo Native American Indian girl brought to mental health center b/c she has visions of
spirits. Tells psychiatrist spirits are elders who appear, give her advice. No hx of substance
abuse/mental disorder. Interview w/ parents reveals they are traditional Θ feel daughter's
visions are a gift. But they are worried about schoolwork, which has deteriorated b/c she has
been preoccupied with spirits. Tx should focus on: (3x)" - ANS-DEALING WITH HER
SCHOOL PROBLEMS
"16 yo says she thinks she may be pregnant but does not want to involve her parents. What
should guide the psychiatrist's actions?" - ANS-"THE PATIENT'S ABILITY TO GIVE
CONSENT WILL VARY FROM STATE TO STATE TO STATE"
"20 yo western trained psychiatrist of northern European descent has been asked to treat a
40 yo Hindu patient who emigrated to the US 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 loss over the last month, dysphoric mood with
intermittent anxiety, and suicidal ideation. In addition to assessing the patient's level of
suicidality, it would be appropriate for the psychiatrist to do which of the following when
beginning treatment? (3x)" - ANS-ASK THE PATIENT WHAT HE BELIEVES EXPLAINS THE
SYMPTOMS
"29 yo severely depressed with SI. Threatens to kill his wife and daughter to ͞take them with
me.͟ Legal responsibility is what" - ANS-NOTIFY THE WIFE
"3 yo girl hurts self with a tricycle. Then she hit the tricycle and asks, ͞Why did you hurt me?͟
Which thought process does this behavior exemplify?" - ANS-ANIMISM
"4 yo child upset when ice cream melts. 10 yo puts it in the freezer and tells him it will be ok.
ϰ yo insists it is ruined. Piaget's concept of this is:" - ANS-CONSERVATION (ALSO
REVERSIBILITY)
"7 yo states he knows dad died, but why didn't he come to the birthday party? Defense
mechanism?" - ANS-DENIAL
"A benefit to unrestricted access to mental health information in the EHR for all specialties" -
ANS-READMISSION RATES TEND TO BE LOWER IN HOSPITALS WITH
UNRESTRICTED ACCESS TO THE EHR
"A clinical trial will assess the impact of two atypical antipsychotic meds on glucose
intolerance. Half of the participants will start on drug 1 and then be treated with drug 2, while
the other half will start on Drug 2 then drug 1. What type of experimental design?" -
ANS-CROSSOVER DESIGN
"A cross sectional study shows less depressive disorders in people who use a natural pill.
They then observe people from the same population for a year and find that prevalence of
depression is lower in those who regularly used the pill. They then recruit a sample from the
same population and randomly assign people to pill or placebo for one year. This didn't show
any difference. Assuming no major flaws in design or analysis, what is the most likely
explanation for the discrepancies in results?" - ANS-SOME UNKNOWN VARIABLE
CONFOUNDED THE NON-RANDOM RESULTS
,"A group of researchers studied the temperament of a group of children at age 3 months, 2
years, 5 years, and 20 years to determine relationships between initial temperamental
characteristics of children who eventually had psychiatric problems. This is an example of
what type of study? (2x)" - ANS-COHORT
"A patient requests an alternative tx for depression. His psychiatrist does not practice this tx
himself but refers the pt to one who does. In 6 months the pt has complications from the tx
and sues the 1st psychiatrist for malpractice. Which element of malpractice is missing in this
case? - ANS-DUTY
"A preventative program for patients who exhibit attenuated psychotic symptoms and recent
decline in functioning is what type of prevention program?" - ANS-INDICATED PRIMARY
"A preventative program for patients who exhibit attenuated psychotic symptoms and recent
decline in functioning is what type of prevention program?" - ANS-INDICATED PRIMARY
"A resident performs a research study utilizing all of the outpatients with any psychiatric
disorder, who were treated during the first 2 months of the resident's outpatient experience.
The resident discovers that of the 47 patients diagnosed with any psychiatric disorder, six
meet the criteria for OCD. Which of the following statistic best defines this info?" - ANS-THE
POINT PREVALENCE OF OCD IS 6/47
"According to Thomas Θ Chess' categories of temperament, the difficult child shows what
characteristics?" - ANS-INTENSE EXPRESSIONS OF MOOD
"According to Winnicott, if mother can't provide ͞holding͟ environment for infant, infant will
develop what defensive process?" - ANS-FALSE SELF
"APA addressed ethics of sexual relationships between psychiatrists & pts by stating" -
ANS-NOT PERMISSIBLE TO HAVE A SEXUAL RELATIONSHIP WITH A CURRENT OR
FORMER PATIENT
"Assessment instrument used in epidemiology study that relies solely on subjects' report" -
ANS-GENERAL HEALTH QUESTIONNAIRE
"Calculate number needed to treat with lithium to prevent 1 suicide: 1000 subjects recruited
in study, 500 receive placebo, 500 randomized to lithium. After 1 year, 50 from placebo
commit suicide, 25 from lithium group suicide." - ANS-20
"Compulsions & obsessions are related to development disturbance during which of
Erikson's psychosocial stages?" - ANS-AUTONOMY VS SHAME AND DOUBT
"Consultant evaluates patient for capacity. Patient is refusing meds, procedures, yells at
nurses, orders take out into hospital, threatens lawsuits if demands are not met. Patient
accuses doctor of being abusive, screams at doctor, when asked for explanation of behavior
͞you're just another person here to abuse me!͟ Best response and advice for the medical team
is?" - ANS-͞THE PATIENT IS A DIFFICULT PATIENT TO WORK WITH. LET'S TALK ABOUT
WAYS TO MANAGE THE PATIENT'S BEHAVIOR.͟
"Erickson's psychosocial stage in which a person invests energy into establishing, caring for,
and guiding in the next generation? (2x)" - ANS-GENERATIVITY VS STAGNATION
"Famous entertainer comments publicly about having problems cutting down on ETOH use
despite knowing negative effects on family members. Well-known psychiatrist, never met the
entertainer, goes on a news program and says that the entertainer is most likely
experiencing ETOH abuse. What explains the ethics of the MD? (2x)" - ANS-UNETHICAL
BECAUSE THE PSYCHIATRIST HAS NOT EXAMINED THE ENTERTAINER
"First do no harm" refers to what ethics principle ;ϰx - ANS-NONMALEFICENCE
"Guardian of a pt with intellectual disability with medication-refractory epilepsy insists that the
pt should have epilepsy surgery. Neurosurgeon believes the seizure focus can be resected,
but there's a >50% chance of RUE paralysis which outweighs potential benefit from freedom
,from seizures. Guardian insists on surgery. Which describes physician responsibility in this
case?" - ANS-SHOULD PERFORM THE SURGERY ONLY UNDER COURT ORDER
"HIPAA limits disclosure of patient health information without patient's consent except for
what" - ANS-PAYMENT
"In forensic psychiatry, the term "standard of care" refers to the use of treatments that are
(2x)" - ANS-USED BY AVERAGE REASONABLE PRACTITIONERS
"In terms of the normal functioning of the personality, Anna Freud's contributions were in the
realm of" - ANS-DEFENSE MECHANISMS
"In Vaillant's model of lifespan development, what is classified as a mature defense
mechanism" - ANS-HUMOR
"In which stage of Piaget's theory of cognitive development do children first understand
conservation of volume?" - ANS-CONCRETE OPERATIONAL
"Legal responsibility to reach out to potential victim of pt's homicidal urges is called" -
ANS-DUTY TO PROTECT
"Medication can be administered without a patient's consent under which of the following
circumstances? (2x)" - ANS-AN EMERGENCY SITUATION EXISTS AND CAN BE
DOCUMENTED
"Most common allegation in malpractice suits against psychiatrist (3x)" - ANS-INCORRECT
TREATMENT
"Most common complaint in Southeast Asians who are diagnosed w/ mental disorder" -
ANS-MULTIPLE SOMATIC SYMPTOMS
"Naturalistic investigations of a treatment's effects look at which factor?" -
ANS-EFFECTIVENESS
"Piaget's contribution to development was a theory explaining what phenomenon (2x)" -
ANS-HOW INDIVIDUALS LEARN AND UNDERSTAND THE WORLD
"Psych eval requested on management of 32 yo pt admitted by internal medicine for tx of
severe gastrointestinal viral infectionͶ dehydration, nausea, vomiting, fever. Pt has hx of
schizoaffective disorder, controlled w stable doses of clozapine over the past year. Staff
concerned that pt might be delusional/hallucinating, as pt has appeared somewhat
confused/inattentive. On exam, pt is oriented to person, place but not time. Pt somewhat
slow, appears visibly ill/tired. Pt complains of stiffness, there is some rigidity to movements.
Psych recommendation?" - ANS-DISCONTINUE CLOZAPINE
"Psych MD sees 62 yo pt who has been hospitalized after an acute MI because staff report
that ͞the pt is driving us crazy.͟ Nurses complain that pt is constantly requesting info about his
condition and treatment, and will refuse tests and medications if he feels the explanations
are not sufficient. On interview pt admits, ͞I am a perfectionist͟ but is proud of this fact, saying
that it is ͞the secret of my success.͟ Pt is aware of the staff's frustration, but feels his requests
for information are reasonable. The best advice to the team?" - ANS-"ANSWER THE PT'S
QUESTIONS AND ACTIVELY INVOLVE THE PT IN ALL PORTIONS OF HIS TREATMENT"
"Pt called ED complaining of hallucinations that command the pt to kill others. Psychiatrist's
first action?" - ANS-OBTAIN PHONE NUMBER, ADDRESS OF PATIENT
"Pt qualifies for ECT, but does not want his doc to tell him the risks. He is a ͞chronic worrier͟
and fears hearing the risks will make him anxious, perhaps to the point of refusing treatment,
which he believes he needs. What is the best response?" - ANS-"DOCUMENT THE PT'S
KNOWING AND VOLUNTARY WAIVER AND PROCEED WITH TREATMENT"
"Pt's dementia progressed to the point that the pt's driving is affected. In addition to talking to
pt, the MD should do what (2x)" - ANS-"CONSULT STATE LAW ABOUT OBLIGATIONS
FOR REPORTING THE PT'S CONDITION"
, "Research suggests that the frequency of alcoholism in lesbians as compared to
heterosexual women was greater only in lesbians over 55 yo. Which of the following is
considered to be the best explanation for this finding?" - ANS-COHORT PHENOMENON
RELATED TO SOCIOCULTURAL ISSUES
"Researcher wants to compare a new atypical antipsychotic to the already existing atypical
antipsychotics. Researcher wants to conduct the study in routine clinical situations rather
than using highly selected subjects. Which of the following study designs would be the most
appropriate? (2x)" - ANS-EFFECTIVENESS
"Researchers wish to study a group of students 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
of the following requirements must be met?" - ANS-BASELINE DATA MUST HAVE BEEN
COLLECTED BEFORE THE EVENT
"The case of ͞Little Hans͟ led Freud to develop a psychological theory of the formation of
which of the following symptoms?" - ANS-PHOBIA
"Way to consider ͞learning styles͟ in which developing curriculum is best supported by
literature" - ANS-USE SUPPLEMENTAL MATERIAL DESIGNED TO ADDRESS THE
NEEDS OF ALL TYPES OF LEARNERS
"What can be used when a person wishes to assign a surrogate to make healthcare
decisions during future periods of mental incapacity?" - ANS-ADVANCE DIRECTIVE
"What characterizes the defendant's competency to stand trial in criminal proceedings?" -
ANS-IS PRESUMED UNLESS THE ISSUE IS RAISED
"What finding in the CATIE-AD trial was demonstrated in subjects using antipsychotic
medications for their behavioral disturbances by week 12?" - ANS-DECREASED LEVEL OF
SUSPICION
"What is the main concept of the Mental Health Parity and Addiction Equity Act of 2008?
(2x)" - ANS-MENTAL HEALTH INSURANCE BENEFITS CANNOT BE LESS FAVORABLE
THAN MEDICAL OR SURGICAL INSURANCE BENEFITS
"What is the proper response to an offered low monetary gift (cookie) from a schizotypal
patient?" - ANS-ACCEPT COOKIE AND THANK THE PATIENT
"What is the strategy of the ͞Health Homes͟ established by the Affordable Care Act of 2010?" -
ANS-EMPLOYING A WHOLE-PERSON APPROACH WITH CONNECTIONS TO
COMMUNITY CARE, AND SOCIAL AND FAMILY SERVICES
"What likely caused increased incarceration rates in the US between 1980 and 2010? (2x)" -
ANS-MANDATORY MINIMUM SENTENCES FOR DRUG RELATED OFFENSES
"What psychiatric illness is the leading cause of disability in persons 15- 44 yo?" - ANS-MDD
"When asked about a coworker after a recent conflict, a patient states ͞Ihey harbor no ill
feelings toward him, but he truly hates me.͟ This is an example of which defense
mechanism?" - ANS-PROJECTION
"When compared to younger age groups, the prevalence estimates of MDD in persons older
than 65 years are" - ANS-LOWER IN BOTH MEN AND WOMAN
"Which is listed on the President's New Freedom Commission on Mental Health (2003)?
(2x)" - ANS-ADDRESSING MENTAL HEALTH AS VIGOROUSLY AS PHYSICAL HEALTH
"Which legal mechanism best conveys a dying patient's instructions regarding medical
intervention when unable to make decisions?" - ANS-ADVANCE DIRECTIVES
"Which of the following describes core narcissistic character pathology according to
Kernberg's model?" - ANS-A FUSION OF THE IDEAL SELF, THE IDEAL OBJECT, AND
THE REAL SELF RESULTING IN THE DEVALUATION OF OTHERS