Psychiatry Board Exam Review
Boards Exam Possible Questions
1. Dementia
Definition: Insidious and irreversible cognitive decline over time.
2. Romberg Test
(+) result indicates a cerebellar deficit.
3. Mesolimbic Pathway
Associated with positive symptoms of schizophrenia.
4. Treatment for Borderline Personality Disorder (BPD)
Refer to Dialectical Behavior Therapy (DBT) for patients exhibiting self-harm behaviors such as cuts on the wrist.
5. Mini-Mental State Examination (MMSE)
Function: Tests attention and concentration.
Documentation of hallucinations: Record under content section.
6. Family Dynamics in Therapy
Family with more responsibility taken by the mom compared to the dad, leading to arguments affecting children: Recommended approach is Family System Therapy.
7. Questioning Techniques
Best type of questioning for patients experiencing mania: Closed-ended questions.
8. Fidelity in Healthcare
Definition: Being truthful, loyal, maintaining promises, and practicing honesty in patient-care relationships.
9. Parietal Lobe Function
Major function: Sensory processing.
10. Factitious Disorder Imposed on Another
Requirement: Report to Child Protective Services (CPS) when observed in a child.
11. Family Therapy Approaches
Structural Family Therapy:
Focus: Defined boundaries and hierarchies within family systems.
Technique: Enactment where family members talk to each other, allowing the therapist to observe interactions and help modify behavior.
Systemic Family Therapy:
Goal: Increase levels of self-differentiation.
Noted example: An adolescent discussing conflict with their mom about the dad suggests triangulation, requiring referral to family system therapy.
12. Patient Information Disclosure
Scenario: Insurance company requests additional patient information for payment processing.
Response: Provide requested information and ask for the patient’s consent.
13. Case Management Model
Function: Improves patient quality of life.
14. Conduct Disorder Treatment
Recommended treatment: Multisystemic Family Therapy (MST).
15. Responding to Transference
Steps to manage transference in therapy:
Maintain professional boundaries.
Address transference directly, e.g., "It seems you're responding to me as if I remind you of someone."
Monitor for countertransference.
Refer to another professional if necessary.
16. Health Assessments for Antipsychotic Patients
If a patient has been stable for a prolonged period on antipsychotic medication, check lipid levels.
17. Nigrostriatal Pathway
Associated condition: Parkinsonism due to low dopamine levels.
18. Mental Health Parity and Addiction Equity Act
Requirement: Health insurance must provide the same level of benefits for mental health and substance use treatment as for medical/surgical care.
19. Medication for BPD and Self-harm
Suggested medication: Lithium for patients with borderline personality disorder (BPD) who express desires to self-harm.
20. Child Development and Independence
Scenario: A 3-year-old child hits when someone attempts to help him, indicating a desire for independence; this behavior is normal as per Erikson’s stages of development.
21. Acute Stress Disorder
Diagnosis for a patient anxious due to a burglary experienced 3 weeks prior.
22. Empathy vs. Compassion in Patient Responses
Importance: Empathy is emphasized over compassion; it acknowledges the patient’s feelings more deeply.
23. Best Imaging for Cerebral Blood Flow
Recommended tests: MRI/PET scan.
24. Definition of Apoptosis
Explanation: Neuronal loss or cell death.
25. MRI Findings and Schizophrenia
Notable findings: Ventricular enlargement with cortical atrophy observed in schizophrenia patients.
26. CAGE Questionnaire Assessment
CAGE score greater than 2 indicates significant alcohol use; further assessment is necessary.
27. MMSE Concentration Test
Technique: Conduct serial 7s—counting backward from 100 by subtracting 7 each time.
28. Medication for Anxiety and Asthma Patients
Recommended: Vistaril.
Caution: Avoid beta-blockers like propranolol due to risk of bronchospasm in patients taking bronchodilators like Albuterol.
29. Enactment in Structural Family Therapy
Purpose: To map, track, and modify family structure through real-time interactions.
30. PSDA (Plan-Do-Study-Act)
Application: Used for quality improvement efforts in healthcare.
31. Therapeutic Interventions for Pain
Effectiveness of massage as a pain management strategy.
32. Logotherapy
Definition: A therapeutic approach that helps individuals discover meaning and purpose in their lives.
33. Nightmares in Children
Neurological Basis: Norepinephrine is implicated in causing nightmares.
34. Trendelenburg Sign in Patients
Action: Refer/assess further for underlying conditions associated with this sign.
35. Patient on Lithium with Comorbid Conditions
Considerations: Refer patients with hypothyroidism and a family history of Hashimoto’s disease to endocrinology.
36. Chronic Alcohol Consumption Effects
Mechanism: Upregulates NMDA receptors and downregulates GABA.
37. Evidence Levels in Clinical Research
Highest quality: Level 1 evidence, which includes systematic reviews or meta-analyses.
38. Signs of Opioid Withdrawal
Presenting symptoms include:
Yawning
Irritability/anxiety
Pupillary dilation (pinpoint pupils indicate intoxication)
Piloerection (chicken skin)
Muscle aches
Lacrimation
Rhinorrhea.
39. FDA Approved Antidepressant for Insomnia
Doxepin is the only approved antidepressant for treating insomnia.
40. Combination of Depression and Nerve Pain
Recommended treatment: Selective Norepinephrine Reuptake Inhibitors (SNRIs).
41. Cancer Patients on Tamoxifen
Recommended medication: Lexapro for patients with depression and cancer undergoing treatment with Tamoxifen.
42. SSRIs in Older Patients
Caution: SSRIs can occasionally exacerbate anxiety in older adults.
43. O’Connor Doctrine
Overview: Harmless mentally ill individuals cannot be held against their will; specifically, they cannot be confined under O’Connor principles.
44. Social Media Ethics in Healthcare
Violation: Posting patient images on social media breaches patient trust.
45. Cultural Syndromes in Therapy
Recommended approach: Use brief supportive therapy considering cultural context.
46. Genetic Dysfunction of 5-HT Receptors
Implication: Patients with genetic dysfunction of the serotonin transporter receptor (5-HT) may not be candidates for SSRIs.
47. HLAB-1502 Screening
Important: Screen Asian patients for HLAB-1502 prior to initiating treatment with carbamazepine to prevent Stevens-Johnson syndrome.
48. Autonomy in Patient Treatment
Definition: Ensure patients are placed in the least restrictive environment.
49. Rennie vs. Klein Case
Summary: Discusses the right to refuse psychotropic medications; patients can decline prescribed medications.
50. Justice in Healthcare
Principle violation: A patient being excluded from a research study due to indigence highlights a justice violation in healthcare access.
51. Educational Strategies for Preteens
Methodology: Use logical explanations to clarify nicotine use for an 11-year-old.
52. Recovery Model in Psychiatry
Emphasis: Focuses on resilience and supporting mental health recovery.
Most effective for: Schizophrenia.
53. Developing Resilience
Suggested Activities: Engage patients in self-esteem building exercises.
54. Goals of Recovery Model
Objective: Assist individuals in living a meaningful life post-treatment.
55. Yoga and Depression
Finding: Depression symptoms can be alleviated through yoga practices.
56. Solution Focused Therapy
Core principle: Solutions will often include the concept of a ‘miracle’ to facilitate patient motivation.
57. Diagnosing Alzheimer’s Disease
In case of an MMSE score of 27, recommendation: Reassess this diagnosis for accuracy.
58. Lack of Insight Documentation
Documentation: Expected in the discharge notes or patient assessment reports.
59. Triptans and Serotonin Syndrome
Important note: Triptans can increase the likelihood of serotonin syndrome when used in conjunction with other serotonergic agents.
60. Contraceptive Considerations with Buspar and Klonopin
Recommendation: Discontinue Klonopin for a patient planning to conceive while on Buspar.
61. Habeas Corpus in Mental Health Law
Function: Protects individuals from unlawful commitments and allows them to leave against medical advice (AMA).
62. Psychiatric Family History and Risk in Bipolar Disorder
Analysis: Family history of bipolar disorder is a significant risk factor; greatest risk found in first-degree relatives.
63. Neurotransmitters Related to Mood Disorders
Major neurotransmitters: Serotonin and Dopamine are crucial in mood regulation, with some sources noting norepinephrine involvement as well.
64. Administration of Ritalin
Instruction: Administer Ritalin 30-45 minutes before meals for optimal absorption and effectiveness.
65. Neuroleptic Malignant Syndrome (NMS)
Symptoms: Include mutism; monitoring for this condition is essential in patients on antipsychotic medications.
66. Kava Kava and Liver Health
Warning: Avoid use of kava kava in individuals with elevated liver enzymes or liver disease.
67. Normal Score on MOCA
Score interpretation: A MOCA score of 30 indicates normal cognitive function.
68. Interaction of St. John’s Wort
Mechanism: It is an inducer of hepatic enzymes, which may affect the metabolism of other drugs.
69. Risks of Depakote in Pregnancy
Warning: Depakote (Valproate) should not be used during pregnancy due to associated risks of birth defects.
70. Tarasoff Principle
Legal duty: Mental health providers have the responsibility to warn potential victims of imminent danger posed by a patient.
71. Humanistic Therapy Introduction
Characteristics: Emphasis on self-directed growth and self-actualization of the patient.
72. Clozapine and Myocarditis
Major risk: Clozapine treatment can lead to myocarditis requiring close monitoring.
73. MTHFR Gene Mutation and Treatment
Recommendation: Patients with this mutation should receive folate supplements.
74. Characteristics of Effective Group Therapy (Yalom)
Notable factors include: instillation of hope, altruism, and group cohesiveness.
75. Prazosin Use in PTSD
Medication indicated for reducing nightmares associated with PTSD.
76. PTSD Assessment Questions
Key question: Inquire whether the patient has experienced re-experiencing of distressing events.
77. Intellectual Disabilities and Genetics
Genetic conditions are significant risk factors in developing intellectual disabilities.
78. Neuroanatomy in PTSD
Findings: Associated with cortical thinning and decreased hippocampal volume in PTSD patients.
79. Adjustment Disorder Diagnosis
Example of case: An adjustment disorder can occur in a woman undergoing a significant career change.
80. Medication Interactions: Tegretol & Doxycycline
Caution: Monitor and potentially decrease Tegretol dose due to interactions with Doxycycline.
81. Handling Anorexic Patients
Case management strategy: Prepare to admit to the hospital if a patient with anorexia presents with severe dehydration and bradycardia.
82. PHQ Score Monitoring
Progression observation: If PHQ score decreases from 26 to 20 after 8 weeks on Lexapro, consider increasing the Lexapro to 20 mg.
83. Echolalia in Clinical Assessment
Definition: Patient repeating the speech of others is termed echolalia.
84. Educational Act Coverage
Expectation: Conditions like Tourette’s syndrome are covered under the disability education act.
85. Difference Between Anorexia and Bulimia
Key distinction: The presence of bingeing/purging behaviors differentiates bulimia from anorexia.
86. Suicide Risk and Zoloft
Action: Discontinue Zoloft in a patient who has attempted suicide while on this medication.
87. Ritalin and Timing of Doses
Advice: An afternoon dose of Ritalin should be avoided to prevent interference with sleep.
88. Atypical Antipsychotics and QT Prolongation
Consideration: Identify the atypical antipsychotic with the least likelihood of causing QT prolongation; Lurasidone noted for lower risk.
89. Accutane and Depression Links
Warning: Accutane (Isotretinoin) is associated with increased risk of depression.
90. Fetal Alcohol Syndrome Features
Physical characteristics: Include a smooth philtrum, small eyes, flat midface, low nasal bridge, and thin upper lip.
91. Erikson’s Developmental Stage: Industry vs. Inferiority
Key takeaway: Competence is the vital focus at this developmental stage.
92. Essential Tremors and Alcohol
Clinical note: A tremor that improves with alcohol suggests essential tremors rather than withdrawal effects.
93. Patient Management in the Emergency Department
Priority: Stability assessment is essential for a patient presented with seizures.
94. Macrocytic Anemia Etiology
Categorization: Typically associated with Vitamin B12 deficiencies.
95. Facial Nerve Assessment
Technique: Assess facial nerve (Cranial Nerve VII) by asking the patient to puff their cheeks.
96. Enlarged Ventricles and Schizophrenia
Neuroradiological finding: Enlarged ventricles observed in patients diagnosed with schizophrenia.
97. Addiction and Neurology
Brain region affected: The Nucleus Accumbens is pivotal in the addiction pathway, involved in dopamine and GABA signaling.
98. Neurotransmitter Roles in Mood Disorders
Key neurotransmitters involved: Norepinephrine and Serotonin play significant roles in the pathophysiology of mood disorders.
99. Stimulants vs. Non-Stimulants in ADHD
Consideration for management of ADHD is guided by type of symptoms using stimulant and non-stimulant medications, considering their wear-off periods.
100. Eating Disorders Definitions
Differences between Anorexia and Bulimia emphasized through descriptions of binging and purging behaviors to guide treatment and understanding.