Name *

First Name

Last Name

Question 001 *

A patient with a history of depression and chronic pain comes in with thoughts of death, low mood, feelings of worthlessness, and more confused, lethargy during the last month. He was recently started on fluoxetine 20mg PO q am and is also on furosemide 20mg per day and amitriptyline 25mg PO qhs for pain. CBC and CMP are within normal limits. He has no fever and physical exam shows no acute pain. He draws a clock poorly. What is the diagnosis and treatment?

A) Hypoactive delirium; stop amitriptyline

B) Depression; increase fluoxetine to 40mg PO q am

C) Hypoactive delirium; stop furosemide

D) Hypoactive delirium; order stat CT

E) Depression increase amitriptyline to 50mg PO qhs

Question 002 *

A 55 year old patient with prostate cancer presents with a severe subjective sense of restlessness and anxiety. He has been on fluoxetine 10mg PO q am for one year but says he recently also has been treated inpatient for significant nausea related to radiation. The nausea has improved with prochlorperazine 10mg IV every 6 hours, which was continued with PO medication since discharge. He is also on metoprolol and finasteride. What is the diagnosis and treatment?

Anxiety disorder due to a medical condition; increase fluoxetine to 20mg PO q am

Anxiety disorder due to a medical condition; add clonazepam 1mg PO bid

Akathisia; stop prochlorperazine

Akathisia; stop finasteride

Low Testosterone from finasteride; reassurance

Question 003 *

A 30 year old male patient presents with chest palpitations and pain. He was started on venlafaxine 4 day ago. The chest pain started soon after and got worse. He has 5/10 depression. When asking about past meds, he says he could not tolerate amitriptyline, nortriptyline or paroxetine in the past. He remembers becoming very lethargic with blurred vision and confused on those meds. You consider he must have a issue breaking down his medication, and attribute it to an issue with which P450:

2D6

2C9

1A2

3A4

Question 004 *

Patient comes in with Major Depressive Disorder and you decide to put the patient on a SSRI/SNRI. She is taking tamoxifen for her breast cancer. Which is the best option:

Paroxetine

Fluoxetine

Venlafaxine

Fluvoxamine

Question 005 *

A patient comes in saying he read a paper in which a particular type of therapy for his depression in 12 sessions had an effect size of 0.6 compared to a wait list control. He also found that a medication he is looking at also has an effect size of 0.6 compared to a placebo for a similar population. He asks if you had to choose one, which one would be the biggest win for him. You tell him:

Psychotherapy and the medication have a similar efficacy because the effect size is the same

Psychotherapy and medication move 0.6 standard deviation units from no treatment

Medication is likely superior in this case

None of the above

Question 006 *

Patient comes in with Major Depressive Disorder and you decide to put the patient on a SSRI/SNRI. She is taking tamoxifen for her breast cancer. Which medication is the most likely to increase risk of death from breast cancer:

Paroxetine

Desvenlafaxine

Venlafaxine

Fluoxetine

Question 007 *

When comparing effect sizes for therapeutic factors, which aspects of therapy contributes the LEAST to the overall effectiveness of therapy?

Goal Consensus/Collaboration

Empathy

Therapeutic Alliance

Positive Regard

Specific Treatment Differences

Question 008 *

A patient with first break psychosis is discharged on risperidone 2mg PO bid to your outpatient clinic. You follow him for 2 weeks and he talks about wanting to get off his medication. Which statement(s) are true:

The patients who continued antipsychotics after the first year had a 50% recurrence rate.

The first year recurrence of psychosis following discontinuation is 77% at one year and 90% at 2 years.

The patients who continued antipsychotics after the first year had only a 3% recurrence rate.

The first year recurrence of psychosis following discontinuation is 12% at one year and 22% at 2 years.

B and C

Question 009 *

A patient comes in with treatment-resistant schizophrenia and fails several second-generation antipsychotics, despite 3 months trials at high plasma levels of the medications. You decide to switch to clozapine. You inform the patient:

Clozapine has better short and long term results for positive symptoms

Clozapine has better short term benefits on negative symptoms

Clozapine is more effective for more severe baseline symptoms

All of the above

Question 010 *

A 35 year old male patient with long-standing schizophrenia presents to the ER with decreased speech, often silent or unresponsive, persistently unresponsive, weight loss of 20 lbs over the last 2 months, an affect of high internal fear, and negative medical workup. He is currently taking olanzapine and 6mg per day of lorazepam. Per chart review, he had lateral nystagmus 2 weeks prior when on 8mg per day of ativan. Your next step in treatment:

ECT

Increase lorazepam

Increase his olanzapine

Switch him to clozapine

Question 011 *

The National Institute of Mental Health Treatment of Depression Collaborative Research Program showed that imipramine was superior to placebo. In a later analysis of the data, they looked at how much proportion of variance in the improvement of depression scores was due to the medication vs. the psychiatrist who was giving the medication. They found:

Variance on Beck Depression Inventory scores relating to depression treatment was more affected by medication compared to the particular psychiatrist giving treatment

Variance on Beck Depression Inventory scores relating to depression treatment was equally affected by medication compared to the particular psychiatrist giving treatment

Variance on Beck Depression Inventory scores relating to depression treatment was more affected by the particular psychiatrist giving treatment compared to medication

Variance on Beck Depression Inventory scores relating to depression treatment was neither affected by psychiatrist or medication

Question 012 *

A patient with new onset schizophrenia of 9 months is brought in by his 45 year old mother. Both enjoy smoking pot together. He has been smoking high-potency strands for the past 2 years. Sometimes he uses high potency cannabis dabs, which vary from 50% to 75% THC. They are seeking treatment. You express your concern about the link between THC and psychosis. The mother says, “No! It is the pesticides and we make our own, so we are good”. You say back:

“Ok great! That is fantastic to hear. I think you will be ok!”

“Have you seen any difference in his behavior and symptoms when he smokes high-potency THC?”

“I am glad you don’t use pesticides, and since being legalized, studies have shown less people use them.”

“I am glad you don’t use pesticides because of how they are linked to psychosis.”

“Studies show that potency of THC has nothing to do with rates of psychosis.”

Question 013 *

A patient with Hep C, HTN and Bipolar disorder comes into your psych ward with an episode of trying to meet president Trump to show him how the Mayan Calendar and Quantum Physics predict that when global warming happens, an old virus that caused the mass extinction of the dinosaurs will come back and lead to the end of the world. He has started a TikTok account and now has 500k followers showing that he is on the right track (he posts 50 times per day). You start valproic acid. What are the facts about how his Alanine Aminotransferase (ALT) will change?

Starting valproate will increase the ALT about the same amount as starting a SSRI or lithium.

Starting valproate will increase the ALT much more than starting a SSRI or lithium.

Starting valproate will increase the ALT much less than starting a SSRI or lithium.

Starting valproate will decrease the ALT the same amount as starting a SSRI or lithium.

Question 014 *

You have a wealthy patient in a high socioeconomic status who worries that his son will not be able to become wealthy because his IQ is 100. You tell them true statement(s):

IQ is highly correlated (0.7) to income and so he might have a hard time in the future.

IQ is weakly correlated (0.21) to income so this is not a huge concern.

Parental income and SES index he grew up in are stronger predictors of his future income than IQ.

His son’s education level will have the strongest correlation with his future salary.

B, C, D

B and D

Question 015 *

A 17 year old female patient comes into your clinic with moderate depression for the last month. She has no family history of depression. No prior therapy or psychiatric treatment. She has no sexual partners. No recent stressors. Her only medication is a progestin-only pill, started 6 months ago. You decide to give her the following information so she can make an informed decision about her contraceptive use:

Hormonal contraception is not associated with any mood issues

Progesterone pills have been associated with increased risk of using an antidepressant and also being diagnosed with depression in a psychiatric hospital

Because the depression did not start within the first month of starting the hormonal contraception it is unlikely that the contraception is related to the depression

In a large study risk of mood issues did not increase till 2 months after initiation of hormonal contraceptive use, peaked at 6 months and after one year decreased significantly

B and D

Question 016 *

A therapist who has been practicing for 5 years asks you for advice on how to improve their therapy outcomes. Which of the following factor(s) have been shown to improve therapy outcomes the most?

Supervision

Continued education (CE)

More clinical experience

Deliberate practice

Question 017 *

In 2020 a 30 year old male patient of yours runs out of xanax early and finds himself injecting street xanax. His wife finds him 5 minutes after taking it with a needle in his arm with shallow breathing, confusion, lessened alertness, pinpoint pupils. She calls 911. By the time the EMS arrives 7 minutes later, he is not breathing at all and they start CPR. They continue chest compressions, give narcan and flumazenil, shock him, take him to the ER, but he does not make it. Review of the chart shows a previous UDS one week ago, negative for opioids but positive for THC and benzodiazepines. What would be the mostly likely cause of death?

Heroin cut into the street alprazolam (Xanax) pills

THC cut into the street alprazolam (Xanax) pills

Clonazepam (Klonopin) cut into the street alprazolam (Xanax) pills

Fentanyl cut into the street alprazolam (Xanax) pills

Alprazolam (Xanax) overdose due to IV administration

Question 018 *

A pivotal study on the effects of social media by Twenge and Campbell in 2019 showed the influence of social media on mental health in 221k adolescents. The data in general did not support a linear correlation as the best way to model the data because:

The data showed progressively worse mental health as the hours of social media increased

The data showed a slight increase in mental health markers as social medial neared 1-2 hours per day and then a decrease after more then 2 hours per day

The data showed no change in mental health till after 4 hours of social media per day

The data showed a slight decrease in mental health markers as social medial neared 1-2 hours per day and then an increase after more then 2 hours per day

Question 019 *

A 45 year old war vet with 1 leg comes to your clinic on no medication and no illicit drug use whose wife complains his personality has changed since his last deployment. He has had apathy, at times new compulsive, shallow, childish humor, and he seems to repeat movements, even when they don’t make sense, and also can’t tell when she is angry or sad anymore. Your top concern from this presentation is:

Post Traumatic Stress Disorder

Depression

Generalized Anxiety Disorder

Frontal Lobe Damage

Question 020 *

One of your patients has been assaulting staff and requiring IM medications on a daily basis during his inpatient stay. Which of the following factors has been shown to be the strongest predictor of violence inpatient?

History of physical aggressive behavior

Male sex

History of Substance use

Diagnosis of Schizophrenia or Bipolar

Diagnosis of Major Depressive Disorder

Question 021 *

A patient with hx of bipolar I that has not been compliant with their medications presents to your inpatient unit with an acute episode of depression. Patient is on a 5150 for DTS with active SI. Which of the following is NOT an acute or long-term consideration for lithium usage in this patient?

Has neuroprotective effects

Effective in treating bipolar depression

Reduces risk of suicide

Augments antidepressant monotherapy

Question 022 *

Which of the following SAD PERSONS risk factors for completed suicide is the MOST significant?

Substance use

Organized plan

Previous attempt

Depression

Lack of support system

Question 023 *

Which of the following is NOT a risk factor for Perinatal mood and anxiety disorders (PMAD)?

Hx of mood and anxiety disorders

Subjectively difficult birthing experience

Sleep disturbances

Adverse childhood experiences (e.g. sexual trauma)

Breastfeeding

Question 024 *

One of your long-standing patients who lost her spouse 6 months ago in a motor vehicle accident tells you that she is still unable to accept the reality of the death of her husband and encounters excessive and recurrent guilt concerning the events of his passing. Which of the following is NOT commonly associated with complicated grief?

Mutism and stupor

Decreased immune function

Increased risk for cardiovascular disease

Substance use disorders

Sleep disturbances

Question 025 *

In studies where they try to convince one group that they don’t have a choice (by having them read that they are just doing things predetermined by their biology, genetics or environment), it leads to them:

Being more likely to cheat

More likely to conform to social norms

Reduced helping behavior and increased aggression

Not slow down after making an error to re-evaluate.

All of the above