Name *

First Name

Last Name

Question 001 *

A 55-year-old male comes in who recently lost his wife, lives alone, and has been highly isolated since Covid. He questions life’s significance and believes factors outside his control have determined outcomes and circumstances. What is an empathic statement you could make after he says, “I just found so much joy in my wife and in our life we had together. Now I feel life is bleak and dire, with no purpose, like it is just happening to me.”

A) You must be so angry at her not being around, it makes you feel some sense of power that you can do something.

B) As we are together, your joy you shared together is evident, you loved her so much. I, myself, went through a similar thing and found it very helpful to go on long walks.

C) As we are together, I can tell you found so much meaning and joy in your connection and the loss has left you feeling dreary and with this feeling that life is happening to you and it is hard to take any action of your own.

D) You have such sadness and sorrow for the loss of your wife. This has led you to feel isolated, and even more so with Covid fears. I feel awful hearing how hard it has been.

Question 002 *

A 29-year-old male with a history of PTSD and cannabis use disorder is admitted to inpatient psychiatry due to concerning behavior in the community. Seven months ago, he was sharpening his knife in his backyard, and later that evening saw a news story on national TV stating that a bus driver was stabbed in another state. Since then, the patient believes that he stabbed the bus driver despite evidence which disproves this. His wife reports that he was previously a loving and caring husband and father, but his behavior has drastically changed over the past seven months. He has been trying to turn himself into the police to confess to his “crime,” but they reiterate that he is not guilty and there is no case. His wife states that he has been doing unusual behaviors in order to get “picked up” by the police and held responsible for the stabbing. For example, he has committed petty crimes (such as stealing candy from the local pharmacy), walking along the side of the highway, and not fully putting out his cigarettes before discarding them in an ashtray (he states this is his attempt to commit arson). He has been in the inpatient unit for three days and has refused all medications. He is seen pacing the halls of the unit for 12 hours each day, has been unwilling to communicate with staff, and unwilling to speak on the phone to his wife and family. Nursing staff reports he has not eaten or had anything to drink for the past 24 hours. After much persuasion, he eventually agrees to sit down for an interview with his psychiatrist. His mental status exam is significant for a flat affect, and he describes his mood as “normal.” He sits still during the interview, with no tremors, tics, or other stereotypes, and he maintains appropriate eye contact. He denies restlessness. He denies auditory and visual hallucinations and he does not appear internally preoccupied. When asked about his food refusal, he reveals “I saw a man repairing the ceiling in the cafeteria, and it meant my esophagus will close off if I continue to eat.” Nursing confirms that engineering was in fact present the previous day fixing a leak in the ceiling. When asked about his pacing and refusal to speak with staff and family, he explains “I heard motorcycles outside in the parking lot which is a message that I need to keep moving and that I shouldn’t talk to anyone.” He firmly believes these thoughts to be true, stating, “In fact, I am going to face repercussions for speaking with you and for not pacing right now.” He then immediately ends the interview, stands up, and resumes pacing. He has no prior inpatient psychiatric hospitalizations. What is the most appropriate initial pharmacotherapy?

A) Olanzapine

B) Propranolol

C) Fluoxetine

D) High-dose lorazepam

Question 003 *

A 42-year-old female is admitted to inpatient psychiatry due to an acute major depressive episode with anhedonia, loss of appetite, low energy, psychomotor slowing, and acute suicidal ideation (SI) with intent and plan to hang herself. Her past medication history includes fluoxetine, sertraline, duloxetine, and amitriptyline. She experienced no relief from her depression despite adequate trial duration and strict medication adherence. You consider ketamine for this patient’s treatment-resistant depression. Which of the following is true regarding the use of ketamine and esketamine in treatment-resistant depression?

A) There have been no reports of suicidal ideation as a side effect from esketamine.

B) Both ketamine and esketamine are FDA approved for treatment-resistant depression.

C) In clinical trials, esketamine improved depressive symptoms in patients with MDD with SI, but it did not demonstrate a statistically significant impact on specifically SI.

D) Esketamine should only be administered to patients who are admitted to an inpatient psychiatry unit.

Question 004 *

A 42-year-old man with past psychiatric history significant for schizophrenia features is brought to an urgent care clinic by his wife due to a sudden change in behavior over the past 3 days. His wife reports he is unable to sit still. The patient reports he suddenly feels an intense compulsion to move all the time and is significantly distressed. The patient states he saw his outpatient psychiatrist last week who added or changed one of his medications, but he does not remember details, although he states has been taking it as prescribed. What drug is the most likely culprit and what drug do we use to treat the current condition?

A) Clozapine, diphenhydramine

B) Lurasidone, propranolol

C) Haloperidol, benztropine

D) Quetiapine, diphenhydramine

Question 005 *

A 27-year-old female with PMH significant for migraines, premenstrual dysphoric disorder (PMDD), and remote history of unspecified eating disorder presents to her primary care physician for her yearly physical. She feels as though her migraines are getting worse, especially around her periods, which are now associated with more severe dysphoria and increased appetite, resulting in what she describes as “binges.” She has never been prescribed any medications, but she is interested in medication options that might help these symptoms. Which is the most appropriate medication for this patient?

A) Sumatriptan

B) Bupropion

C) Duloxetine

D) Mirtazapine

E) Lisdexamfetamine

Question 006 *

A 54-year-old woman with a remote history of mild adjustment disorder presents to an outpatient psychiatrist due to difficulty falling and staying asleep for the past seventeen years. There are no other signs or symptoms of depression/anxiety/PTSD. She is interested in exploring ways to improve her sleep. What is the best treatment option for insomnia?

A) Zolpidem

B) Cognitive Behavioral Therapy for Insomnia (CBT-I)

C) Diphenhydramine

D) Melatonin

Question 007 *

In which scenario might pramipexole be beneficial in bipolar disorder?

A) Monotherapy for acute mania

B) Adjunct treatment for patients with acute mania

C) Monotherapy for treatment-resistant bipolar depression

D) Adjunct treatment for patients with treatment resistant bipolar depression

Question 008 *

A previously healthy 10-year-old girl develops tics and OCD symptoms over the course of a week. Two weeks ago, she was seen by her pediatrician due to a sore throat and a throat culture revealed group A strep. She is diagnosed with pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS). What is the most appropriate treatment for PANDAS?

A) Risperidone

B) Strict elimination/restriction diets

C) Anti-inflammatory medications, antibiotics, and behavioral therapies

D) Bone marrow transplant

Question 009 *

Nature published a meta-analysis, “The Serotonin Theory of Depression: A Systematic Umbrella Review,” that concluded serotonin levels are not decreased in people with depression and therefore:

A) Antidepressants should no longer be prescribed.

B) Depression is no longer seen as a brain-based disease.

C) There are more complicated things going on in the brain in depression accounting for why things like ketamine, antidepressants, and exercise work.

D) None of the above

Question 010 *

According to the Columbia Mass Murder Database of 1,800 personal-cause mass shooting and other types of mass murder, the following has been found:

A) Mass shootings have gone up 4x from 1900-1970s to 1970s-2019.

B) People with psychotic illness are more than twice as likely to use non-fire arms means of committing mass murder.

C) As a percentage of those that commit mass murder using a firearm, the rate of those with psychotic illness over time has decreased.

D) All of the above

Question 011 *

Although clozapine is the treatment of choice for treatment-resistant schizophrenia, many patients experience suboptimal responses to clozapine alone. What can be added to clozapine to rapidly improve symptoms in treatment-resistant schizophrenia?

A) ECT

B) Lithium

C) Quetiapine

D) Vortioxetine

Question 012 *

Which medication can help with cognition in individuals living with bipolar disorder?

A) Omeprazole

B) Pramipexole

C) Lamotrigine

D) Lithium

Question 013 *

In a large retrospective correlational study in Italy, of 20,961 patients and 242 primary care physicians, the highest empathy physicians compared to the medium or low empathy physicians:

A) Had about 60% the rate of diabetes complications

B) Had about 130% the rate of diabetes complications

C) Had equal amount of diabetes complications

D) Physician empathy does not influence medical outcomes

Question 014 *

How might a patient with moral injury present in the clinic?

A) A patient describing their reaction to an event in which their individual sense of identity or justice was shattered

B) A patient says to the provider, “I have a lot of self-loathing, have been isolating from friends and family, and have a lot of guilt.”

C) A patient describing their reaction to an event in which they have a startle reflex and flashbacks

D) Both A and B

E) A and B and C

Question 015 *

A 35-year-old male patient with schizophrenia on an inpatient unit hits a staff member in the back. When observing his journal later in the day, the resident noted entries for several days with coherent writing about how that staff member was unkind to him and how he was planning on hurting the staff member. The particular staff member was a bit harsh with prior patients per the residents direct observations. The patient was asked about the attack and did not express remorse. What type of aggression would this be categorized as:

A) Psychotic aggression

B) Impulsive aggression

C) Predatory aggression

D) None of the above

Question 016 *

Police find a 25-year-old female who attacked her mother. The police find the 25-year-old sitting next to her mother who is now passed out and mumbling about demons, and pointing at her passed-out mother. She has a sour smell and matted hair. The 25-year-old is taken in and UDS is negative. What is the most likely cause of aggression:

A) Psychotic aggression

B) Impulsive aggression

C) Predatory aggression

D) None of the above

Question 017 *

What term could be used to describe “the analyst’s mind being colonized by the patient’s internal world”?

A) Projection

B) Projective identification

C) Sublimation

D) Denial

Question 018 *

Which patient population with psychosis is most likely to be given depot antipsychotics rather than oral antipsychotics?

A) White men

B) Black women

C) Black men

D) White women

Question 019 *

A 2018 study by Mandsager and colleagues looked at all-cause mortality in 122,007 patients with a mean age of 53 over 8.4 years and found that the hazard ratio for smoking was 1.41 and diabetes was 1.40. What did they find the hazard ratio was for reduced cardiorespiratory fitness (comparing low vs. elite on an exercise treadmill test)?

A) 1.05

B) 1.25

C) 1.41

D) 5.04

Question 020 *

San-Millán et al., 2018, compared blood lactate levels (in millimoles per liter) and workload (in watts) during bicycle exercise. The paper explored three groups. The first group was composed of individuals with diabetes mellitus or metabolic syndrome, the second group was made of individuals who are moderately active (three hours of exercise per week), and the third group was professional endurance athletes. At 2mmol/L of blood lactate, on a bicycle test, what did they find in terms of how many watts each group averaged?

A) Metabolic syndrome 125 watts, moderately active 125 watts, and professional athletes 125 watts

B) Metabolic syndrome 300 watts, moderately active 175 watts, and professional athletes 125 watts

C) Metabolic syndrome 125 watts, moderately active 175 watts, and professional athletes 300 watts

D) Metabolic syndrome 175 watts, moderately active 125 watts, and professional athletes 300 watts

Question 021 *

In the SMILES study in 2017, Jacka and colleagues did a 12 week trial of 67 participants, randomizing people to a dietary intervention or a befriending protocol. The findings were:

A) 32.3% remission from depression in the diet group compared to 8% in the control

B) Decrease in 21.76 servings of unhealthy foods per week in the diet group

C) MADRS decreased 7.1 more points in the diet group

D) All of the above

Question 022 *

When studying complex polypharmacy in patients with bipolar disorder, Dr. Goldberg’s 2009 article found the following conclusion(s):

A) Complex polypharmacy was least often associated with lithium, divalproex, or carbamazepine.

B) Complex polypharmacy was least often associated with atypical antipsychotics or antidepressants.

C) Complex polypharmacy was most often associated with a history of psychosis and age at onset.

D) Complex polypharmacy was most often associated with a history of rapid cycling, prior hospitalizations, current illness state, and history of alcohol or substance use disorders.

Question 023 *

According to Howes et al., 2016, 20-30% of those diagnosed with schizophrenia are treatment-resistant which, according to the consensus criteria in this article, is defined as:

A) Failure to achieve 20-30% reduction in psychotic symptoms after two different antipsychotics trials of at least 6 weeks (if long-acting injectable, at least 4 months) at therapeutic dosages (dose equivalent of at least 600mg chlorpromazine).

B) Patient must have taken at least 80% of prescribed doses, determined by checking at least two sources of adherence (example: pill counts, medication administration record, patient/caregiver report).

C) Minimum of at least one measured antipsychotic plasma level to ascertain for treatment adherence with, optimally, serum levels being obtained without notifying the patient prior to blood draws on at least two occasions, separated by at least two weeks.

D) All of the above

Question 024 *

A patient comes in with a blood level of olanzapine at 15 ng/mL despite you prescribing 30mg PO qhs (minimum response threshold is 23 ng/mL and point of futility is 150 ng/mL). You schedule a visit with the patient and ask:

A) “Most people who take medicines every day miss some doses. How many do you think you missed in the past 4 weeks?”

B) “Did you take your pills?”

C) “Why are you not taking the pills?”

D) “Why are you not being compliant with the pills?”

Question 025 *

Put the following in the correct order from greatest to smallest amount of genetic heritability:

A) Height > adult-onset OCD > child-onset OCD > ADHD

B) Height > ADHD > child-onset OCD > adult-onset OCD

C) Height > ADHD > adult-onset OCD > child-onset OCD

D) Height > child-onset OCD > adult-onset OCD > ADHD