COMPLETE 2020 CHILD PRITE FOR GRADLE QUESTIONS WITH CORRECT ANSWERS

COMPLETE 2020 CHILD PRITE FOR GRADLE QUESTIONS WITH CORRECT ANSWERS "1. A 16-year-old presents to a psychiatrist with concerning episodes of feeling detached from their body. During these times, the adolescent feels unreal, emotionally numb, and reports watching their body from outside in a dream-like state. There is no loss of consciousness with these episodes. The adolescent has no medical or psychiatric complaints and denies substance use. What is the most likely diagnosis? A. seizure disorder B. Dissociative identity disorder C. PTSD D. Borderline PD E. Depersonalization/derealization disorder - CORRECT ANSWER E" "2. Sexual minority youth may have additional struggles with respect to stigmatization when dealing with cultural, ethnic, or religious factors. These factors may result in delays in the development of sexual: A. behavior. B. orientation. C. milestones. D. identity integration. E. group identification. - CORRECT ANSWER D" "3. An FDA meta-analysis of antidepressant studies in children found suicide-related adverse events in 4% of those given medication, compared to 2% of those given placebo. The number-needed to harm by administering antidepressants found by this study is: A. 2 B. 4 C. 20 D. 25 E. 50 - CORRECT ANSWER E" "4. An adolescent presents to an ambulatory clinic with new onset of abrupt vocalizations and bilateral complex movements, occurring several times a week, often during sleep, lasting 30- 60 seconds. The patient, who is otherwise healthy, reports highly aggressive and impulsive behaviors during these events, but is asymptomatic between events. Previous head computed tomography electroencephalography show no evidence of pathology. Which area of the brain is most likely impacted? A. Frontal Lobe B. Parietal Lobe C. Occipital Lobe D. Temporal Lobe E. Generalized Brain Process - CORRECT ANSWER A" "5. According to cognitive psychology, negative emotional reactions to events that occur in individuals with depression are most likely caused by: A. automatic perceptions. B. level of cognitive ability. C. adverse childhood events. D. reinforced behavioral patterns. E. genetic determinants of illness. - CORRECT ANSWER A" "6. An eight-year-old is brought to the emergency department by his legal guardian after yelling during an argument, "Nobody loves me, so I'm just going to walk across the street and get hit by a car." The child was removed from his parents' care six months ago due to physical abuse and neglect. The child is passing all his subjects at school and is popular with peers. The child reports feeling sad and has auditory hallucinations telling him he is "no good." Which of the following is high on the differential diagnosis for this patient? A. Autism spectrum disorder B. Separation anxiety disorder C. Oppositional defiant disorder D. Post-traumatic stress disorder E. Obsessive compulsive disorder - CORRECT ANSWER D" "7. A 15-year-old has a family history of mood disorder and is struggling to develop a positive sense of self in the context of conflict with parents and academic difficulties. After a blow-up with parents, the teenager is referred for psychotherapy. The therapist focuses on resolving difficulties with the parents and extending the patient's social support network. Which of the following psychotherapeutic models is the therapist most likely using? A. Cognitive B. Behavioral C. Supportive D. Interpersonal E. Psychoanalytic - CORRECT ANSWER D" "8. A 15-year-old previously healthy female presents with altered mental status and severe agitation. She slowly developed progressive confusion and memory deficits three weeks ago, with no clear trigger. Over the past two weeks, she has experienced hallucinations, poor sleep and inattention. Prior to the visit she had a witnessed brief seizure episode. On assessment, she exhibits significant tachycardia and hypertension with an otherwise normal physical exam. Her preliminary ultrasound shows an ovarian lesion. Which of the following diagnoses is most likely consistent with this presentation? A. Creutzfeldt-Jakob disease B. Herpes simplex virus encephalitis C. Lambert-Eaton myasthenia syndrome D. Anti-N-methyl-d-aspartate receptor encephalitis E. Voltage-gated potassium channel antibody encephalitis - CORRECT ANSWER D" "9. Which of the following has been observed regarding white matter tract and network development during the first two years of life? A. Almost all are present at birth and are already organized into adult-like networks. B. Almost all are present at birth, and networks organize gradually over the first two years of life. C. About half are present at birth, the rest develop rapidly in infancy, and are fully organized by age two. D. About half are present at birth, and the rest both develop and organize rapidly during early infancy. E. Only a limited number are present at birth and most network development occurs later during childhood. - CORRECT ANSWER A" "10. Adolescents have more risk-taking behaviors, sensation seeking and increased emotional reactivity, because the last brain structure to develop is the: A. thalamus. B. amygdala. C. cerebellum. D. hippocampus. E. prefrontal cortex - CORRECT ANSWER E" "11. An adolescent who has been recently diagnosed with non-epileptic seizures has been sent from school to the emergency department on multiple occasions due to having episodes during class. The adolescent and parents state that they do not want the school to be informed of the patient's diagnosis. If the physician wanted to advocate that the diagnosis should be shared with the school, which of the following statements made by the physician would be best? A. "There are several potential legal ramifications of not informing the school." B. "There is real potential risk of inappropriate and invasive medical treatment." C. "If the school is not informed, the hospital will no longer be able to admit your child." D. "We will have to make a report to child protective services if you do not disclose the diagnosis." E. "Due to the potential dangerousness of not informing the school, we are obligated to share the diagno - CORRECT ANSWER B" "12. Which of the following symptoms is more common in adolescents with depression compared to younger children with the disorder? A. Irritability B. Melancholia C. Hallucinations D. Temper outbursts E. Somatic complaints - CORRECT ANSWER B" "13. An adolescent with insulin-dependent diabetes who is in treatment for medical non-adherence is pregnant. She wants to keep her pregnancy a secret and not inform her parents, citing the right to health care confidentiality. The physician feels obligated to inform the parents of the pregnancy. Which of the following concepts may justify the physician informing the parents of the pregnancy? A. Rights of the fetus B. Family-centered care C. Imminent danger to patient D. Parents must consent to care E. Inability to document patient is a mature minor - CORRECT ANSWER C" "14. In the mental status assessment, a unique component to evaluating infants may include observation for: A. speech. B. hyperactivity. C. affect regulation. D. feeding behaviors. E. dysmorphic features. - CORRECT ANSWER D" "15. During a routine visit to the pediatrician, the mother of a 24-month-old girl states that she has witnessed her daughter touching her vulva during baths. The mother asks if this behavior is cause for concern. How should the pediatrician respond? A. "This behavior is only atypical if done in a public setting." B. "Genital self-stimulation should raise concern for sexual abuse." C. "This behavior is only atypical if she displayed interests in other people's genitalia." D. "Exploration of the body is a typical behavior at this age and there is no reason to be concerned." E. "Typically developing children do not begin to engage in genital self-stimulation until they are older. - CORRECT ANSWER D" "16. Which of the following rating scales provides a general screening of behavioral health symptoms that identifies risk for childhood psychiatric disorders in a primary care setting? A. Pediatric Symptom Checklist B. Patient Health Questionnaire-9 C. Mood and Feelings Questionnaire D. McMaster Family Assessment Device E. Screen for Child Anxiety Related Disorders - CORRECT ANSWER A" "17. The therapeutic effects of second-generation antipsychotic medications are partly mediated through action on which of the following receptor sites? A. 5-HT 1A B. 5-HT 1B/D C. 5-HT 2A D. 5-HT 2C E. 5-HT 3 - CORRECT ANSWER C" "18. In psychiatric billing, current procedural terminology codes refer to the: A. time required to perform the service. B. insurance to be billed for the service. C. diagnosis for which services are being billed. D. specific service delivered in a treatment session. E. level of training of the clinician performing the service. - CORRECT ANSWER D" "19. A 17-year-old patient with a diagnosis of bipolar disorder reports experiencing "fast" thoughts and high energy over the past week despite sleeping four hours nightly. The patient says her mood has been "really good" most of the time but admits to becoming irritable with her friends and boyfriend. She has been spending extra time on her schoolwork and is doing well academically. She was recently sent to the principal for being uncharacteristically rude towards her teacher. Parents note stability with lithium treatment; however, the patient has decided that her diagnosis is incorrect and that she doesn't need to take medications. Which of the following depicts the best first step in the management of this patient? A. Discontinue lithium and initiate an alternative mood stabilizer B. Provide education on coping skills to use in stressful situations C. Increase the current lithium dose to target breakthrough sym - CORRECT ANSWER E" "20. Which of the following physiologic factors is associated with persistent aggression? A. Elevated heart rate B. Reduced serum cortisol C. Elevated skin conductance D. Increased serum 5HT function E. Increased cerebrospinal fluid 5HIAA - CORRECT ANSWER B" "21. An eight-year-old child is reportedly "spacey" and does not follow teachers' directions in the third-grade classroom. The child seems to respond to requests but not always in an appropriate manner. However, written homework is usually completed properly, and the child is not disorganized, forgetful, impulsive or hyperactive. Sensory evaluations are normal. The best diagnosis is: A selective mutism. B. auditory processing disorder. C. phonological speech disorder. D. intellectual disability. E attention-deficit/hyperactivity disorder. - CORRECT ANSWER B" "22. Lithium has a lower plasma concentration in the pediatric population compared to adults because of which of the following? A. Lower bioavailability B. Lower body fat stores C. Lower protein binding D. Higher clearance rate E. Higher volume of distribution - CORRECT ANSWER E" "23. When held to the standard of typical inclusion and exclusion criteria for clinical trials for adolescents with major depressive disorder, more than 60% of depressed adolescents who participated in the National Comorbidity Survey: Adolescent Supplement would have been excluded from at least one study. Which study criterion would have led to the largest number of exclusions? A. Lifetime bipolar disorder B. Significant risk of suicide C. Lifetime psychotic features D. Past year alcohol/drug use E. Past year use of psychotropic medication - CORRECT ANSWER B" "24. A 14-year-old with a history of sexual abuse and depression is brought to the emergency department with passive suicidal ideations. During the interview, the patient shares that she superficially cuts her wrist and consumes alcohol with friends "to ease the pain" of her low mood. She has begun seeing a psychiatrist, however, has not been prescribed medication. She denies having, or ever having had, suicidal intent or plan. The psychiatrist elicits reasons for living from her and they create a safety plan. The psychiatrist also counsels the caregiver to restrict access to dangerous self-harm methods. Which of the following best describes an action that should be included as part of the therapeutic assessment and intervention in the emergency department? A. Create a "no suicide contract" with the patient B. Recommend that the patient obtain a new psychiatrist C. Initiate lithium to address symptoms of depressio - CORRECT ANSWER D" "25. A 15 years old individual raised by parents who are both physicians states from an early age his intention to attend medical school. Which identity status is this individual most likely demonstrating? A. Identity diffusion B. Identity foreclosure C. Identity moratorium D. Identity achievement E. identity determination - CORRECT ANSWER B" "26. A child is observed walking with small paces, a stooped posture, and reduced arm swing. When the examiner asks him to start and stop walking, the child appears to have difficulty with both actions. A lesion in which of the following brain regions is likely to contribute to this presentation? A. Spinal cord B. Basal ganglia C. Insular cortex D. Cerebral cortex E. Cerebellar cortex - CORRECT ANSWER B" "27. Which of the following is the primary role of orexin signaling in the regulation of sleep-wake cycles? A. Initiation of sleep B. Generation of a wakeful state C. Maintenance of a wakeful state D. Maintenance of a sleeping state E. Coordination of sleep-wake states - CORRECT ANSWER E" "28. Which of the following domains, not generally evaluated through routine psychological testing, would be assessed by a neuropsychological evaluation? A. Intellect B. Personality C. Sensory perception D. Emotional functioning E. Academic achievement - CORRECT ANSWER C" "29. The primary mechanism by which very young children learn therapeutic concepts through cognitive-behavioral play therapy is: A. modeling. B. avoidance. C. safety-seeking. D. positive reward. E. negative reinforcement. - CORRECT ANSWER A" "30. The goal of stimulus control in the psychosocial treatment of adolescents with substance abuse refers to which of the following? A. Building positive reinforcers for abstinence B. Withholding reinforcers when drug use occurs C. Assisting the teen to manage urges to use drugs D. Assisting the teen to avoid environmental stress E. Assisting the teen in avoiding situations associated with drug use - CORRECT ANSWER E" "31. At what age can a typically developing child first be expected to ride a tricycle? A. Two years of age B. Three years of age C. Four years of age D. Five years of age E. Six years of age - CORRECT ANSWER B" "32. In research using the Adult Attachment Interview, parents who have secure relationships with their children are most likely to be able to describe their own childhood experiences and relationships in which of the following ways? A. Demonstrating strong affect B. Presenting in a coherent narrative C. Avoiding the negative experiences D. Focusing primarily on attachment issues E. Describing content with incongruent affect - CORRECT ANSWER B" "33. Which of the following hormones is derived from the serotonin molecule? A. Leptin B. Cortisol C. Prolactin D. Melatonin E. Growth hormone - CORRECT ANSWER D" "34. A child with a normal neurological examination is seen for several episodes of dizziness vertigo, occipital headache, and hemiparesis, all of which resolve within 24 hours Which et the following disorders could best explain the symptoms? A. Conversion disorder B. Basilar artery migraine C. Tension type headache D. Cyclical vomiting syndrome E. Confusional migraine disorder - CORRECT ANSWER B" "35. A school-age child with autism spectrum disorder, mild intellectual disability and attention- deficit/hyperactivity disorder is being assessed in the emergency room for otitis media. The patient is currently on risperidone and long-acting methylphenidate, both with reported benefit, and is otherwise medically stable. During the examination, the patient becomes agitated. Non-pharmacologic strategies have been unsuccessful in de-escalating the child. Which of the following is the next best pharmacologic strategy to address the patient's acute behavioral escalation? A. Clonidine B. Lorazepam C. Olanzapine D. Risperidone E. Diphenhydramine - CORRECT ANSWER D" "36. A three-year-old child is told the following scenario: "A child plays with a doll and places it on the bed before leaving the room. The child's sibling, who was not in the room before, comes in and moves the doll to the shelf. Where would the child look for the doll upon returning to the room?" The three-year-old indicates that the child will look on the shelf. This is because most three-year-olds have not acquired which cognitive process? A. Theory of mind B. Social referencing C. Object permanence D. Object conservation E. Transitional phenomena - CORRECT ANSWER A" "37. A clinician is consulted to see a school-age child for emotional outbursts. The child has a labile affect that is incongruent with speech content, and the clinician notes that the child's speech exhibits variable rhythm and intensity with periods of "explosive" speech. The child is otherwise attentive on interview. On neurologic assessment, the clinician notes that the child has a brisk gag reflex with subsequent intense crying and coughing. The child is also endorsing recent onset dysphagia although evaluation of the oropharynx is negative for pathology. Based on this assessment, the psychiatric symptoms are most likely A. bulbar palsy. B. multiple sclerosis. C. myasthenia gravis. D. pseudobulbar palsy. E. conversion disorder. - CORRECT ANSWER D" "38. Which of the following medications is known to worsen delirium in children? A. Propofol B. Clonidine C. Diazepam D. Melatonin E. Olanzapine - CORRECT ANSWER C" "39. If a child is determined by the special education committee to need services and requires an individualized education plan, which of the following must be adhered to? A. The plan has to be developed within 30 calendar days B. An evaluation is required every five years to determine continued eligibility C. A comprehensive review must be conducted and revised every two years D. The child can be mandated to change settings against the parent's will E. The most restrictive setting should be tried first in order to maximize success - CORRECT ANSWER A" "40. An 11-year-old child with a history of attention-deficit/hyperactivity disorder, parent-child relational problem and depressive symptoms has been seen by a child and adolescent psychiatrist for the past two years. The psychiatrist learns that the parents have decided to divorce after receiving a subpoena to appear in family court to provide testimony regarding custody of the child. The psychiatrist can provide testimony: A. only with a subpoena. B. after performing a separate forensic evaluation. C. after ensuring parents were notified to provide consent. D. in the form of a deposition in lieu of appearing in person. E. as an expert and offer an opinion regarding custody of the child. - CORRECT ANSWER C" “41. An abused child runs to hide in the bedroom closet at the sound of the garage door opening even though the abusive parent no longer lives in the home, and even though hiding never prevented the abuse when that parent was present. This fear response can best be explained with which of the following learning models? A. Incentive learning B. Operant conditioning C. Learned helplessness D. Classical conditioning E. Contingency management - CORRECT ANSWER D" "42. A child suddenly screams in the early part of the night with associated diaphoresis and tachypnea, lasting for 1-2 minutes. The child has no recall of the events the next day. These events are most associated with which of the following parasomnias? A. Nightmares B. Sleep terrors C. Sleep talking D. Confusional arousals E. REM sleep behavior disorder - CORRECT ANSWER B" "43. An emergency room physician evaluates a child with new-onset symptoms of obsessions and compulsions. The physician cannot determine a cause for the child's symptoms. Which of the following steps taken by the emergency room physician is considered lifelong learning? A. Obtain a psychiatry consult B. Pursue further medical evaluation C. Refer the patient to an outpatient psychiatrist D. Review evidence-based literature regarding the symptoms E. Develop a committee to create a standard evaluation for mental illness - CORRECT ANSWER D" "44. The medical director of an outpatient clinic for youth with disruptive behavior disorders was concerned that patients treated with antipsychotic medications were developing metabolic syndrome. The clinic implemented a system in the electronic medical record in which charts were flagged for providers and the clinic manager if the patient's body mass index had increased by more than 2 points since baseline. This system is an example of: A. root cause analysis. B. continuous quality improvement. C. consumer satisfaction monitoring. D. health-plan sponsored practice protocol. E. disease-specific outcome measurement. - CORRECT ANSWER B" "45. An adolescent is found unconscious in the school bathroom. The student has a perioral rash and perinasal dermatitis. A plastic bag is found on the floor next to the adolescent's backpack. A search of the backpack is most likely to reveal: A. alcohol. B. cannabis. C. cough syrup. D. an e-cigarette. E. an aerosol can. - CORRECT ANSWER E" "46. Which of the following personality disorders is most frequently comorbid in patients with bulimia nervosa? A. Avoidant B. Histrionic C. Borderline D. Narcissistic E. Obsessive-compulsive - CORRECT ANSWER C" "47. According to psychodynamic theory, which of the following is the main role of the therapist in play therapy? A Serve as a surrogate for the absent parent figure B. Enable the child to discuss feelings towards the aggressor C. Reduce violence by modelling appropriate gender roles and behavior D. Provide a setting for the child to develop the capacity for self-observation E Devise a strategy for the patient to ask for time-out when feeling frustrated - CORRECT ANSWER D" "48. Which of the following is typical of the language development of six-month-old infants? A. Babbling with consonant and vowel sounds B. Production of grunting, crying, and gurgling noises C. Inconsistent and unclear use of the first few words D. Starting to string words together in a very basic way E. Using first words with reliable consistency and purpose - CORRECT ANSWER A" "49. What is the primary goal of family therapy for oppositional defiant disorder? A Allowing the therapist to set limits with the child B. Monitoring for signs of abuse to ensure child safety C. Establishing a warm and mutually respectful relationship between parents and child D. Providing psychoeducation to the parents about features of oppositional defiant disorder E. Determining whether the family system has diffused or rigid boundaries with external systems - CORRECT ANSWER C" "50. Which scale for attention-deficit/hyperactivity disorder (ADHD) in children has a validated version for the child to complete? A. ADHD Rating Scale-5 B. Conners 3rd Edition Rating Scale C. Vineland Adaptive Behavior Scales D. Swanson, Nolan, and Pelham-IV Rating Scale E. Strengths and Weaknesses of ADHD Symptoms and Normal Behavior - CORRECT ANSWER B" "51. In equivocal sleep studies, CSF orexin levels of less than 110 pg/ml is most suggestive of which of the following sleep disorders? A. Narcolepsy B. Restless legs syndrome C. REM sleep behavior disorder D. Delayed sleep phase disorder E. Advanced sleep phase disorder - CORRECT ANSWER A" "52. Which of the following features would preclude a clinician from making a diagnosis of selective mutism? A. Diagnosis of social phobia B Symptoms occur in only one setting C. Symptoms have only occurred for six weeks D. Patient maintains non-verbal communication E. Symptoms occur during the first month of school - CORRECT ANSWER E" "53. Several times in the space of a month, a seven-year-old child references a nanny that she last saw at the age of three. With respect to the child's emotional development, this is most consistent with which of the following? A. Anxious temperament in the child B. Pathological grieving over loss of the nanny C. Attachment difficulties with primary caregivers D. Attempt to rework the separation from the nanny E. Reactivation of a prior loss after a more recent loss - CORRECT ANSWER D" "54. Velocardiofacial syndrome, which has been repeatedly implicated in early-onset psychosis, is most often the result of what kind of genetic abnormality? A. Methylation B. Gene deletion C. Polymorphisms D. Trinucleotide expansion E. Chromosomal translocation - CORRECT ANSWER B" "55. Which of the following is the most commonly identified challenge when implementing a patient portal in a child and adolescent psychiatric practice? A. Maintenance of patient confidentiality B. Unwillingness of providers to participate C. Lack of adolescent interest in online resources D. Refusal by parents to allow adolescents access E. Implementation difficulties within the electronic medical record - CORRECT ANSWER A" "56. Which of the following is the most accurate statement regarding the diagnosis of male hypoactive sexual desire disorder? A. It often manifests during puberty B. Symptoms can be caused by distress in a relationship C. Symptoms must occur with the onset of sexual activity D. The diagnosis is most prevalent between the ages of 26 and 44 E. Symptoms must be present for at least 12 months to make the diagnosis - CORRECT ANSWER A" "57. A psychiatrist reviews existing research on the prevalence of a specific side effect that occurs within a class of medications. Which of the following types of research articles will be most useful to the psychiatrist? A. Case series B. Meta-analysis C. Open label study D. Case control study E. Randomized controlled study - CORRECT ANSWER B" "58. Which of the following polysomnogram findings is consistent with narcolepsy? A. Long n2 phase B. Sleep onset REM C. Low total sleep time D. Increased sleep efficiency E. Increased slow wave sleep - CORRECT ANSWER B" "59. A 17-year-old is receiving cognitive behavioral therapy for depression. The patient says, "My coach hates me," after not playing in the last game, although the teen had played the previous five games. This thought process best exemplifies which of the following cognitive errors? A. Personalization B. Ignoring evidence C. Arbitrary inference D. Overgeneralization E. Selective abstraction - CORRECT ANSWER E" "60. An adolescent female is experiencing severe obsessions and compulsions. Despite having partial improvement on an adequate dose of sertraline for twelve weeks, the symptoms remain debilitating. After weighing the risks and benefits of combined pharmacotherapy, the psychiatrist recommends augmenting the sertraline. Of the following, which has been shown to be most effective, in conjunction with SSRIS, as augmentation in refractory obsessive- compulsive disorder? A. Lithium B. Bupropion C. Lorazepam D. Risperidone E. Clomipramine - CORRECT ANSWER D" "61. "Juuling" has become a popular method of using nicotine in youth, and uses which of the following forms of delivery? A. Gum B. Cigar C. Patch D. E-cigarette E. Chewing tobacco - CORRECT ANSWER D" "62. An adolescent was admitted medically overnight for chronic abdominal pain that has persisted for nine months despite three previous hospitalizations. Physical examination, laboratory studies and imaging are all inconsistent with physical disease. The patient has stopped attending school for the past four months, and spends considerable time distressed about the seriousness of the pain and focusing on this impairment. What is the initial best step in supporting the care of this patient given the likely diagnosis? A. Explain that symptoms are due to anxiety and stress B. Inform the patient that psychiatric hospitalization is indicated C. Counsel patient on the need to return to school as soon as possible D. Convene a multidisciplinary informing meeting to review assessment and diagnosis E. Provide reassurance that medical studies were normal and no further testing is needed - CORRECT ANSWER D" "63. A therapist using psychodynamic psychotherapy to treat a child is more likely to make use of which of the following interventions compared to when treating an adult? A. Passivity B. Neutrality C. Education D. Clarification E. Interpretation - CORRECT ANSWER C" "64. What defense mechanism also describes a sociobiological behavior aimed at proliferation of a species at the expense of an individual organism within that species? A. Altruism B. Introjection C. Idealization D. Identification E. Reaction Formation - CORRECT ANSWER A" "65. Which of the following would be considered an essential tool for population-based disease management? A. Stepped care B. Telemedicine C. Patient registries D. Direct care handoffs E. Individual treatment plans - CORRECT ANSWER C" "66. An adolescent female calls your office complaining of milky discharge from her breast after initiation of risperidone two weeks ago. Which of the following neuronal tracts is most likely implicated in the development of this side effect? A. Mesolimbic B. Nigrostriatal C. Mesocortical D. Tubero-infundibular E. Retinohypothalamic - CORRECT ANSWER D" "67. A school-age child with autism and attention-deficit/hyperactivity disorder is admitted to the medical floor for dehydration. For the past few weeks, the child has refused to eat except for oatmeal and macaroni and cheese. The child reports being worried about vomiting with other foods, as these foods "smell bad." The child denies body image disturbance or fear of gaining weight. Outpatient medications include guanfacine and methylphenidate. Which of the following is the most likely diagnosis? A. Specific phobia B. Anorexia nervosa C. Obsessive-compulsive disorder D. Stimulant-induced eating disorder E. Avoidant-restrictive food intake disorder - CORRECT ANSWER E" "68. According to Kohlberg's theory, a boy who regularly exhibits conventional, Stage 3 moral judgment would determine morality based on which of the following principles of thinking? A. "I should follow the rules to avoid punishment." B. "I should follow the rules but there may be exceptions." C. "I should follow the rules because a peaceful society requires it." D. "I should follow the rules because it is fair and the other boys did." E. "I should follow the rules because that's what good boys do in my family." - CORRECT ANSWER DE" "69. Observing which of the following in a young toddler would be most helpful in assessing gross motor ability? A. Chewing or swallowing B. Sitting on caretaker's lap C. Maintaining upward eye gaze D. Getting up from the prone position E. Reaching across midline to grab a toy - CORRECT ANSWER D" "70. An adolescent with symptoms of psychosis, SIB and choreiform movements is found to have elevated liver transaminases. Which genetically inherited disease is the most likely diagnosis? A. Wilson disease B. Tuberous sclerosis C. Huntington disease D. Sturge-Weber syndrome E. Neurofibromatosis type I - CORRECT ANSWER A" "71 What can a surviving parent do to help decrease a child's psychological risk following parental loss? A. Promote physical activity B. Support the mourning process C. Avoid talking about the deceased parent D. Promote cognitive understanding of death E. Limit child's exposure to daily life stressors - CORRECT ANSWER B" "72. A psychiatrist is being sued for malpractice, and the case has proceeded to civil court. By what standard of proof will the jury most likely be required to decide the outcome? A. Beyond a reasonable doubt B. Clear and convincing evidence C. Reasonable degree of certainty D. A preponderance of the evidence - CORRECT ANSWER D" "73. A clinician wants to study if certain medical conditions predict suicidal thoughts when adolescents are seen in an emergency room. Suicidal thoughts would be considered what type of variable? A. Mixed B. Dependent C. Extraneous D. Independent - CORRECT ANSWER B" "74. Which of the following best summarizes the core aim of the Health Information Technology for Economic and Clinical Health Act of 2009? A. Penalize systems of care for failing to adopt technologically based interventions for patients B. Increase privacy protections for the use of technology in health care by increasing penalties for breaches C. Incentivize the adoption and meaningful use of health information technology, particularly electronic health records D. Improve diagnostic accuracy through big data synthesis of patient information and dissemination to practitioners - CORRECT ANSWER C" "75 Which of the following genetic factors was first identified as possibly protective in children who have experienced early maltreatment? A. Low numbers of D2 receptors B. High levels of the monoamine oxidase A enzyme C. A genotype with a duplication of the MECP2 gene D. Deficiency in the aldehyde dehydrogenase enzyme - CORRECT ANSWER B" "76. From a systems of care perspective, which of the following components are integral to developing an empirically based "wraparound" process for individuals with serious emotional disturbances? (Select three) A. Skill mentorships B. Process driven care C Community-based care D. Problem-focused solutions E. Generalized service delivery F. Strength-focused opportunities G. Categorical mental health funding H. Provision of care based on established conditions - CORRECT ANSWER ACF" "77. Which of the following factors are most important in developing a strong therapeutic alliance for a telepsychiatry visit? (Select three) A. Dark room B. Hand signals C. Erect posture D. Large gestures E. Monotone voice F. Nodding frequently G. Using the phrase "tell me more" H. Visually interesting background - CORRECT ANSWER BCF" "78. The mother of an adolescent with severe generalized anxiety disorder asks the psychiatrist if it would it be a good idea for the adolescent to be started on benzodiazepines for anxiety since they had been very helpful to treat her own anxiety. She asks the psychiatrist for the current scientific opinion on the use of benzodiazepines in childhood anxiety. Which of the following would be appropriate responses? (Select three). A "There is risk of dependency in teenagers treated with benzodiazepines." B. "The most common adverse effect in adolescents is paradoxical hyperactivity." C "Benzodiazepines are sometimes used in youth to acutely reduce severe anxiety." D. "Benzodiazepines are FDA-approved for the treatment of childhood sleep disorders." E. "There is a relative paucity of studies examining the use of benzodiazepines in youth." F. "Benzodiazepines have been approved by the FDA for treatment of childhoo - CORRECT ANSWER ACE" "79. A seven-year-old child with attention-deficit/hyperactivity disorder struggles to read and perform academically at grade level. The parents would like the child to have an Individual Education Plan (IEP) at school. The psychiatrist recommends that they write a letter requesting an IEP. Which of the following components are important to get the school to initiate an IEP evaluation for a learning disability? (Select 3) A. The child has impaired motor skills B. The child is culturally disadvantaged C. The child has below average intelligence D. The child is attending a disadvantaged school E. The child's primary language is other than English F. Vision problems have been ruled out by a professional G. The child has failed high quality interventions to learn to read H. Emotional factors for inhibiting learning are ruled out by psychiatrist - CORRECT ANSWER FGH" "80. In order to maintain an ABPN certification, child psychiatrists must complete or have which of the following? (Select three) A. Follow practice guidelines B. Unrestricted license to practice C. Complete self-assessment modules D. Provide outcome data on select patients E. Complete performance in practice modules F. Obtain Drug Enforcement Administration license G. Maintain membership in American Medical Association H. Attend American Academy of Child and Adolescent Psychiatry annual meeting - CORRECT ANSWER BCE" "81. The Child Guidance Clinic movement initially began to address which of the following problems? A. Family poverty B. Juvenile delinquency C. Child abuse and neglect D. Education of children with disability E. Deinstitutionalization of the mentally ill - CORRECT ANSWER B" "82. Construct validity is best defined as the degree to which a measure: A. has a clinical impact. B. is influenced by other variables. C. tests what it purports to measure. D. accurately predicts a future criterion. E. is comparable to a measure of a related criterion. - CORRECT ANSWER C" "83. Which of the following differentiates efficacy from effectiveness studies? A. Subjects are randomized only in effectiveness studies. B. Only effectiveness studies are conducted with blinding. C. Effectiveness studies are conducted under real world conditions. D. Only efficacy studies can demonstrate the efficacy of a medication. E. Results of efficacy studies are more generalizable than those of effectiveness studies. - CORRECT ANSWER C" "84. Which of the following pieces of legislation addresses differential management and reimbursement of mental illness by insurance companies? A. Affordable Care Act of 2010 B. Children's Health Act of 2000 C. Americans with Disabilities Act D. Garrett Lee Smith Memorial Act E. Mental Health Parity and Addiction Equity Act - CORRECT ANSWER E" "85. An adolescent receiving interpersonal psychotherapy for depression is in the initial phase of treatment. Which of the following tasks is the adolescent most likely participating in during these early sessions? A. Completing a communication analysis B. Creating an inventory of their relationships C. Exploring ways to increase problem-solving D. Assisting with activity on the mood thermometer E. Engaging in role plays to enhance perspective-taking - CORRECT ANSWER B" "86. Concomitant use of which medication is likely to increase risperidone levels due to inhibition of CYP2D6? A. Sertraline B. Fluoxetine C. Alprazolam D. Atomoxetine E. Lisdexamfetamine - CORRECT ANSWER B" "87. A seven-year-old child is evaluated for worsening vision of the left eye, severe headaches, and skin changes on the body. The child's father has similar skin findings. On physical examination, the child has decreased visual acuity of the left eye and fundoscopic examination demonstrates edema of the optic disc. The right eye findings are normal. Which cutaneous finding is commonly associated with this disorder? A. Ash Leaf spots B. Port Wine Stain C. Shagreen Patch D. Café Au Lait spots E. Axial Telangiectasias - CORRECT ANSWER D" "88. Increased white matter maturation in the frontostriatal and frontotemporal cortex is most closely associated with which of the following changes over the course of development? A. Greater coordination of gait and balance systems B. Sharper visual discrimination and pattern detection C. Increased autonomic nervous system responsiveness D. Improved language and executive function performance E. Clearer sensory perception and cross-modality integration - CORRECT ANSWER D" "89. A child and adolescent psychiatrist is treating a 15-year-old with depression and anxiety with medication management and psychotherapy. The adolescent reveals in therapy that she has been skipping school with her friends and "vaping." She does not want her parents to know about these new behaviors. Which ethical principle would most apply when the psychiatrist is deciding what to do next? A. Fidelity B. Beneficence C. Confidentiality D. Assent/consent E. Non-maleficence - CORRECT ANSWER C" "90. A diagnosis of substance-induced psychosis has been most strongly associated with later diagnosis of schizophrenia for which of the following substances? A. Alcohol B. Cocaine C. Cannabis D. Hallucinogens E. Amphetamines - CORRECT ANSWER C" "91. Gene imprinting refers to a process when which of the following occurs? A. Genes are repressed after a period of activity. B. Introns are selectively spliced into the genome. C. Genes of either paternal or maternal origin are silenced. D. Adenine nucleotides are added to mRNA prior to its translation into DNA. E. There is an increase in expression of a gene over several family generations. - CORRECT ANSWER C" "92. An adolescent presents to the emergency room following a motor vehicle collision. On initial evaluation, the adolescent is found to have an elevated ethanol level in the serum. Which of the following assessment tools is most reliable in assessing this adolescent for a substance use disorder? A. Clinical history B. CRAFT screen C. Urine drug screen D. Adolescent Alcohol and Drug Involvement Scale E. Global Appraisal of Individual Needs-Short Screener - CORRECT ANSWER A" "93. A clinician is evaluating a child who speaks to peers without issue, but does not respond when spoken to by teachers, nodding instead or whispering to a friend who will speak on the child's behalf. The child is described as shy and withdrawn, but appears to play well with same age peers. The child is meeting developmental milestones, is physically healthy, and academically bright. Hearing evaluation is normal. There are no sensory aversions and no evident restricted interests. The use of which of the following medications may improve symptoms of this psychiatric condition when paired with behavioral therapy? A. Clonidine B. Fluoxetine C. Aripiprazole D. Risperidone E. Clomipramine - CORRECT ANSWER B" "94. Which of the following aspects of a young child's mental status exam are most likely to reflect traits of the parent rather than the child? A. Speech and language B. Judgment and insight C. Grooming and hygiene D. Motor behavior and activity E. Attention and concentration - CORRECT ANSWER C" "95. A child researcher is studying the impact of employing a social and emotional skills-building intervention in public schools. The researcher assigns five schools to receive the intervention and five other schools to be the control by lottery. Which of the following designs is the research team employing in this study? A. Factorial B. Crossover C. Time series D. Cluster randomization E. Comparative effectiveness - CORRECT ANSWER D" "96. The capacity for shame typically develops by what age? A. Six months B. One year C. Three years D. Five years E. Seven years - CORRECT ANSWER C" "97 As part of the evaluation process in residency, which of the following would be considered an example of both formative and summative assessment? A. Weekly supervision B. Mid-rotation feedback C. Annual clinical skills assessment D. Clinical Skills Verification assessments E. Child Psychiatry Resident-In-Training Examination - CORRECT ANSWER D" "98. Which of the following is an evidence-based outpatient treatment for an adolescent with non- suicidal self-harm? A. Exposure therapy B. Multisystemic therapy C. Mentalization-based therapy D. Insight-oriented psychotherapy E. Attachment-based family therapy - CORRECT ANSWER C" "99. A young woman presents to her doctor for pre-pregnancy counselling, reporting that her brother is severely affected by fragile X syndrome. She has had no problems, but worries about having a child with fragile X. Which of the following accurately describes her options for pre-pregnancy planning? A. She is a carrier, and all her sons will be affected B. Her carrier status can be determined via karyotyping C. She cannot be a carrier, so she need not be concerned D. Her carrier status can be determined using southern blotting E. Her carrier status can be determined using high-throughput sequencing - CORRECT ANSWER D" "100. An adolescent presents to the psychiatrist as a follow-up after starting an antipsychotic mediation. During the evaluation the adolescent is noted to have difficulty staying seated and endorses a new onset sense of restlessness. Which of the following is a first-line treatment of these symptoms? A. Buspirone B. Propranolol C. Benztropine D. Carbamazepine E. Methylphenidate - CORRECT ANSWER B" "101. The tasks of classification and conservation are typically mastered during which developmental period? A. Infancy B. Toddlerhood C. Preschool D. School Age E. Adolescence - CORRECT ANSWER D" "102. An adopted three-year-old child with epilepsy is seen for evaluation of intellectual disability. On observation, the child has microcephaly, fair skin, blonde hair and blue eyes. The child never had routine newborn screening. This child most likely has what inborn error of metabolism? A. Phenylketonuria B. Gilbert's disease C. Tay-Sachs disease D. Niemann-Pick disease E. Maple syrup urine disease - CORRECT ANSWER A" "103. Which of the following factors best distinguishes bipolar disorder from attention deficit hyperactivity disorder in youth? A. Irritability B. Impulsivity C. Grandiosity D. Distractibility E. Restlessness - CORRECT ANSWER C" "104. By what age can typically developing children first draw human figures that have realistic proportions? A. Three years B. Five years C. Seven years D. Nine years E. Eleven years - CORRECT ANSWER B" "105. Which of the following factors is the strongest predictor of suicidal behavior in a teenager? A. Access to a firearm B. Intimate partner violence C. History of a mood disorder D. History of substance abuse E. Previous intentional ingestion - CORRECT ANSWER E" "106. Which of the following patient characteristics best fits with criteria for psychoanalytic treatment? A. Low frustration tolerance B. Need for immediate symptom relief C. Disorganized behavior and thoughts D. Ability to form and maintain relationships E. Recent diagnosis of a severe medical illness - CORRECT ANSWER D" "107. Anticholinergic agents prescribed to prevent extrapyramidal side effects of antipsychotic medications should be gradually tapered after stabilization of the patient primarily in order to: A. avoid chronic suppression of acetylcholine. B. avoid the risk for anticholinergic psychosis. C. reduce potentiation of long-term GI side effects. D. decrease the cognitive burden from anticholinergics. E. lower the potential for increased weight gain in the long term. the psychotic-like phenomena experienced secondary to trauma? - CORRECT ANSWER D" "108. Which of the following signs or symptoms discriminates a primary psychotic disorder from the psychotic-like phenomena experienced secondary to trauma? A. Repetitive play B. Distorted beliefs C. Auditory hallucinations D. Disorganized thought and behavior E. Exacerbations during times of stress - CORRECT ANSWER D" "109. A four-year-old child, whose parents recently divorced and have joint legal and physical custody, has started becoming aggressive each time he is picked up from one parent's house. Verbal altercations ensue as soon as the parents see each other, after which they start yelling at the child for misbehaving. At the urging of the divorce mediator, the parents reluctantly agree to parent guidance meetings. Which of the following should be the first step in the treatment process? A. Devising acceptable forms of discipline for the child B. Identifying the parents' shared concerns about the child C. Educating the parents about normal preschool-age behavior following divorce D. Pointing out that the parents' animosity is having a deleterious effect on the child E. Strategizing ways the parents can minimize contact with each other during visitation - CORRECT ANSWER B" "110. A nine-year-old child and their family that frequently arrive late to clinic are transferred from a graduating fellow to a new fellow. At their first appointment with the new fellow, the family are late again and are eating food in the waiting room. The fellow is annoyed by this behavior. What action should the fellow take? A. Disregard the annoyance as the family probably couldn't help it. B. Disregard the annoyance as this is the first meeting with the family. C. Reveal the annoyance to the family and implore them not to be late again. D. Notice the annoyance and plan to address the lateness with the family after establishing rapport. E. Notice the annoyance and recognize that the family does not respect the importance of the fellow's time. - CORRECT ANSWER D" "111. The grandparent of a five-year-old child complains that early morning sleep is disturbed by the child's loud play. Although the grandparent scolds the child, the behavior is getting worse. A psychiatrist advises the grandparent to praise the child frequently during quiet play, and to consistently ignore any loud play. The psychiatrist hypothesizes that the grandparent's scolding is serving which of the following functions for the child? A. Punishment B. Reinforcement C. Omission of reward D. Conditioned stimulus E. Unconditioned stimulus - CORRECT ANSWER B" "112. A school hires a psychiatrist to be a consultant following a student suicide. Which of the following responsibilities would most likely be handled by the psychiatrist as a consultant rather than as a psychiatrist working at the school clinically? A. Prescribe medication as appropriate B. Direct group therapy among students C. Evaluate staff for grief and depression D. Advise administrators on how to respond E. Evaluate students for grief and depression - CORRECT ANSWER D" "113. The National Institute of Mental Health Recovery After an Initial Schizophrenia Episode (RAISE) Initiative demonstrated which of the following outcomes in individuals with a shorter duration of untreated psychosis? A. Fewer hospitalizations B. Greater improvement in quality of life C. Less improvement in symptoms of anxiety D. Same improvement in psychotic symptoms E. Greater improvement in symptoms of depression - CORRECT ANSWER B" "114. Which receptor's expression has most conclusively been shown to be altered by epigenetic modification in a patient who experienced a history of sexual abuse as child? A. NMDA receptor B. Serotonin receptor 1A C. D2 dopamine receptor D. Glucocorticoid receptor E. Adrenocorticotropin receptor - CORRECT ANSWER D" "115. A 13-year-old patient is evaluated for escalating oppositional behaviors, including school truancy, running away from home and substance use. The patient is given a provisional diagnosis of conduct disorder. The patient's parents ask if their child is likely to become a "lifetime criminal." Which of the following would be the most appropriate response regarding the course of conduct disorder? A. "We do not currently have enough data to say." B. "Most children are likely to become incarcerated as adults." C. "Most children end up improving significantly by young adulthood." D. "Most children become symptom-free with medication management." E. "Most children progressively decline in functioning before they get better." - CORRECT ANSWER C" "116. A psychiatrist is investigating the effectiveness of transcranial magnetic stimulation (TMS) for adolescent depression. A study is performed that compares two groups of adolescents on improvement in mean Hamilton Depression (HAM-D) Rating Scale scores at two weeks nost-treatment; one of the groups receives TMS and the other group receives sham TMS. Which of the following statistical tests is most appropriate for detecting group differences? A. T-test B. Chi-square C. Logistic regression D. Correlation coefficient E. Mixed factorials ANOVA - CORRECT ANSWER A" "117. An adolescent is having difficulty making friends, struggles with initiating conversations, exhibits poor eye contact, and has difficulty understanding social cues. The adolescent becomes easily upset with unexpected transitions and is very "rules focused." The patient prefers to be alone and spends considerable time reading about and discussing the solar system. The most likely diagnosis is: A. social anxiety disorder. B. autism spectrum disorder. C. obsessive-compulsive disorder. D. attention-deficit/hyperactivity disorder. E. social (pragmatic) communication disorder. - CORRECT ANSWER B" "118. An adolescent presents to a dermatologist seeking treatment for acne, and reports wanting the most intensive treatment available. The adolescent reports feeling "deformed," and has avoided school and social outings due to this belief. The patient describes a three-hour skin care routine. On exam, the patient has two small papules with mild erythema from self-inflicted trauma. Which of the following is the most likely diagnosis given this presentation? A. Trichotillomania B. Excoriation disorder C. Ilness anxiety disorder D. Body dysmorphic disorder E. Obsessive-compulsive disorder - CORRECT ANSWER D" "119. Which of the following neuropeptides promotes synaptogenesis and reduces apoptosis during toddlerhood? A. Leptin В. Нуросгetin C. Anandamide D. Agouti-related peptide E. Brain-derived neurotrophic factor - CORRECT ANSWER E" "120. A 13-year-old is being evaluated for severe weight loss. The patient has a pattern of restrictive eating and, when forced to eat a meal, usually leaves the table quickly after finishing and spends long periods of time in the bathroom. The patient denies any problematic eating behaviors. Testing which of the following would be most helpful in determining if the patient is accurately reporting about eating behaviors? A. Amylase B. Calcium C. Phosphate D. Lipid profile E. Aspartate aminotransferase - CORRECT ANSWER A" "121. Several studies were eliminated from consideration in a meta-analysis because of the need to reduce heterogeneity of the studies. What kind of problem does this create in interpreting these results? A. Possibility of a Type 1 error B. Treatment efficacy may be underestimated C. External validity of the results may be limited D. Type Il errors may still explain the positive finding E. Negative trials may have been eliminated from the study - CORRECT ANSWER CE" "122. Social aggression in primates and children has been correlated with low central transmission of which of the following neurotransmitters? A. Dopamine B. GABA C. Norepinephrine D. Glutamate E. Serotonin - CORRECT ANSWER E" "123. A young child playing soccer tells the coach, after missing a goal as the game ended, "I don't want to play anymore 'cause I'm not good like the other kids!" Which aspect of psycho-social development does this statement illustrate? A. Initiative vs. guilt B. Trust vs. mistrust C. Autonomy vs. shame D. Industry vs. inferiority E Identity vs. role confusion - CORRECT ANSWER D" "124. A child has been falling asleep during class. The child reports feeling a burning sensation in the lower extremities at night with urges to move the limbs. Diagnostic evaluation is only remarkable for a low serum ferritin level. What is the most likely diagnosis? A. Narcolepsy B. Tic disorder C. Rolandic epilepsy D. Restless legs syndrome E. Obstructive sleep apnea - CORRECT ANSWER D" "125. A seven-year-old child presents with a history of multiple staring spells. The child's electroencephalogram demonstrates a symmetrical 3-Hz spike and wave activity. Which of the following is the best initial choice for management of these seizures? A. Phenytoin B. Diazepam C. Ethosuximide D. Phenobarbital E. Carbamazepine - CORRECT ANSWER C" "126. In Margaret Mahler's description of the process of separation and individuation, the stage in which infants first begin to differentiate from their mothers after symbiosis is referred to as: A. hatching. B. practicing. C. consolidation. D. rapprochement. E. object constancy. - CORRECT ANSWER A" "127. Which of the following treatments, when combined with cognitive behavioral therapy, has shown efficacy in adolescents with delayed sleep phase disorder? A. Biofeedback B. Diphenhydramine C. Morning bright light therapy D. Night-time background white noise E. Early afternoon bright light therapy - CORRECT ANSWER C" "128. A 16-vear-old has a diagnosis of migraine headache and major depressive disorder. Which of the following medications for migraine prophylaxis can worsen depression and should be used with caution? A. Valproate B. Verapamil C. Topiramate D. Propranolol E. Amitriptyline - CORRECT ANSWER D" "129. An eight-year-old male patient presents with seizures, intellectual disability and he was noted to have a port wine colored stained skin on one half of the face. What is the likely diagnosis? A. Schwannomatosis B. Tuberous sclerosis C. Neurofibramatosis-1 D. Neurofibramatosis-2 E. Sturge-weber syndrome - CORRECT ANSWER E" "130. A child hospitalized for abdominal pain has an extensive medical workup that is normal. The mother insists that her child is sick and that further medical interventions be pursued. When consulted, the mother refuses to allow the child psychiatrist to interview her child alone. Which of the following is the best next course of action? A. Limit communication with the family to the father only B. Mandate that the child and mother begin family therapy C. Call child protective services to place the child with a foster family D. Obtain records from the child's past and present medical providers E. Refer the child to a gastrointestinal specialist for further medical workup - CORRECT ANSWER D" "131. Which of the following imaging modalities is best suited to rule out a pituitary tumor in a patient with anorexia nervosa? A. Computed tomography B. Magnetic resonance imaging C. Positron emission tomography D. Magnetic resonance spectroscopy E. Single-photon emission computed tomography - CORRECT ANSWER B" "132. Which of the following guarantees access to acute psychiatric care regardless of an individual's insurance status or ability to pay? A. The Stark Law B. Healthcare Quality Improvement Act C. Children's Health Insurance Program D. Hospital Readmissions Reduction Program E. Emergency Medical Treatment and Labor Act - CORRECT ANSWER E" "133. According to ego psychology, which of the following is the most common psychodynamic explanation for when young children blame others when they get in trouble? A. Excessive libidinal drive B. Conflicting drive derivatives C. Lack of fully formed superego D. Attempt to fulfill the ego-ideal E. Defense against painful affects - CORRECT ANSWER E" "134. The care of a child with autism spectrum disorder and significant co-morbid anxiety, irritability and functional decline at school has been managed by an outpatient pediatrician due to a lack of access to mental health services locally. The child would benefit from additional expertise and services. Which of the following is an appropriate next step? A. Refer the child to a local emergency room for stabilization B. Enroll in a telepsychiatry program with a child psychiatrist C. Work with the closest psychiatric hospital for admission and stabilization D. Contact Child Protective Services to obtain improved community support E. Transfer the child's care to a different primary care provider, closer to outpatient mental health - CORRECT ANSWER B" "135. An teenager with no prior med or psych disorders, with a typically normal circadian rhythm, was brought for an eval after noted irritability, poor school grades, and constant fatigue. On history, the only pertinent positive is the earlier school start time for this year, which has been a difficult adjustment. A deficiency in which of the following is most likely associated with the identified disorder? A. Iron B. Folate C. Melatonin D. Hypocretin-1 E. Anti-diuretic hormone - CORRECT ANSWER C" "136. An teenager with no prior med or psych disorders, with a typically normal circadian rhythm, was brought for an eval after noted irritability, poor school grades, and constant fatigue. On history, the only pertinent positive is the earlier school start time for this year, which has been a difficult adjustment. What is the most likely etiology for the noted changes? A. Obstructive sleep apnea B. Benign Rolandic epilepsy C. Limit setting sleep disorder D. Delayed sleep phase syndrome E. Sleep-onset association disorder - CORRECT ANSWER D" "137. When a 15-year-old is asked about school during an interview, the patient says, "My friends keep me company by describing all the things I do when I'm in class. I really hope they serve pizza for lunch in the cafeteria today. I'm going to the movies with my family this weekend." Which of the following would best describe the patient's thought process? A. Word salad B. Perseveration C. Circumstantiality D. Loose associations E. Linear and goal-directed - CORRECT ANSWER D"