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homecert.001&mcs&0&N&<b>Post Traumatic Stress Disorder</b><p>ML is a 15 yo WF who was sexually and physically abused for the past 7 years.  She was recently diagnosed with posttraumatic stress disorder. She complains of mild symptoms including guilt and difficulty concentrating.<p>Based on ML’s presentation, which of the following treatment strategies would be considered best practice?	&nonpharmacologic therapy&pharmacologic therapy;nonpharmacologic and pharmacologic therapy;no therapy-ML requires further evaluation;&&&&a&PTSD.0&&&&&1&&&N.
homecert.002&mcs&0&N&RM is a 35 yo M who emigrated from Africa.  In his native country, he experienced extended periods of famine and war.  He has received an initial psychiatric assessment and was diagnosed with depression and posttraumatic stress disorder.  He has never received treatment.<p>Based on RM’s presentation, which of the following treatment strategies would be considered best practice?&nonpharmacologic and pharmacologic therapy&nonpharmacologic therapy;pharmacologic therapy;no therapy-ML requires further evaluation;&&&&a&PTSD.0&&&&&1&&&N.
homecert.003&mcs&0&N&For which of the following patients would depakote be considered a first line treatment option?&A 30 yo AAF diagnosed bipolar disorder-manic phase and ptsd&A 22 yo AAF who was diagnosed with PTSD after years of sexual abuse.  She complains of difficulty sleeping, hypervigilance, and irritability.;A 53 yo WM diagnosed with depression and PTSD.;A 53 yo WM who developed PTSD after experiencing combat in the military.;&&&&a&PTSD.0&&&&&1&&&N.
homecert.004&mcs&0&N&A tricyclic antidepressant would be considered one of the treatments of choice for a patient with PTSD and which comorbid medical illness?&chronic pain&liver disease;ulcer;hypertension;&&&&a&PTSD.0&&&&&1&&&N.
homecert.005&mcs&0&N&RI is a 42yo WM who was diagnosed with PTSD 5 years ago.  He has periods of extreme irritability and can get aggressive.  He recently was arrested for starting a fight with little provocation.  These symptoms have been attributed to his PTSD.  His prescriber started him on olanzapine 10mg qhs.  There has been some response.  However when the dose is increased, RI complains of side effects.  The prescriber has decided to augment the olanzapine.  According to the Consensus guidelines, which of the following would be a good adjunctive medication in this patient to treat his irritable, aggressive, or violent behavior?&Valproic Acid&Buspirone;Clonazepam;Risperidone;&&&&a&PTSD.0&&&&&1&&&N.
homecert.006&mcs&0&N&BL is a 30 yo WF who has severe PTSD and has been breastfeeding her child for 6 months.  She plans to continue to breastfeeding for at least another year.  Because of the severity of her symptoms, a medication is going to be started.<p>Which of the following would be recommended?&Sertraline 50 mg qd&Alprazolam 1mg qid;Valproic acid 250mg tid;Buspirone 10mg tid;&&&&a&PTSD.0&&&&&1&&&N.
homecert.007&mcs&0&N&<b>Substance Abuse</b><p>MB is a 29 yo F who is currently heroin dependent.  Dr. Jones plans to treat her with burpenorphine as a maintenance agent.<p>Which of the following routes of administration would be most appropriate for this patient?&sublingual&oral;subcutaneous;intravenous;&&&&a&SubAbuse.0&&&&&1&&&N.
homecert.008&mcs&0&N&Based on the manufacturer’s drug label, which of the following would be an appropriate induction schedule and maintenance dose?&Subutex® 8mg for 1 day, Subutex® 16mg for 1 day, then Suboxone® 16mg &Subutex® 1mg for 2 days, Subutex® 2mg for 3 days, then Subutex® 3mg ;Suboxone® 1mg for 1 day, Suboxone® 2mg for 1 day, then Suboxone® 3 mg ;Subutex® 5mg for 2 days, Subutex® 8 mg for 3 days, then Suboxone® 8 mg ;&&&&a&SubAbuse.0&&&&&1&&&N.
homecert.009&mcs&0&N&Dr. Jones works in an office based practice and is going to be prescribing buprenorphine to some of his substance abusing patients.  He plans to primarily prescribe Suboxone®. Which of the following would be a good rational for choosing this formulation:&Suboxone® contains buprenorphine and naloxone, which reduces the risk for diversion by inducing withdrawal symptoms if someone is heroin dependent and injects the agent.&Suboxone® contains disulfiram and buprenorphine, which makes it an excellent combination product for those patients with heroin and alcohol dependence.;Suboxone® contains buprenorphine and methadone, which has been shown to improve compliance in patients with a history of relapse on methadone maintenance as monotherapy.;Suboxone® contains buprenorphine and naltrexone, which increases it efficacy in heroin dependent patients by offering 2 mechanisms for preventing heroin abuse.;&&&&a&SubAbuse.0&&&&&1&&&N.
homecert.010&mcs&0&N&TS is a 41 yo AAM who is going to be maintained on buprenorphine to prevent a relapse of his heroin dependence.  He is taking the following medications: methylphenidate, penicillin VK, propranolol, and diazepam.  Which of the following of these medications may cause a significant interaction with the buprenorphine?&Diazepam&Methylphenidate;Penicillin VK;Propranolol;&&&&a&SubAbuse.0&&&&&1&&&N.
homecert.011&mcs&0&N&Dr. Smith has 4 new patients that he plans to start on buprenorphine.  Which of the following should he monitor more closely for a potential drug-drug interaction with buprenorphine?&TR is a 38 yo F diagnosed with HIV who is currently being treated with zidovudine and indinavir.&LM is a 49 yo M who is currently taking desipramine, trazodone, and diphenhydramine at bedtime for insomnia.;JS is a 29 yo F diagnosed with obsessive compulsive disorder who is currently being treated with sertraline. ;MT is a 21 yo M who is currently taking bupropion for smoking cessation.;&&&&a&SubAbuse.0&&&&&1&&&N.
homecert.012&mcs&0&N&Which one of the following would be considered a good candidate for office-based care?&34yo M who has successfully been maintained on methadone maintenance for 2 years.&46yo F who is being seen for the first time for treatment of her heroin, cocaine, and alcohol dependence.;23yo M who was recently diagnosed with heroin dependence and is being assessed for schizophrenia.;55 yo F who is currently heroin dependent, has a long history of noncompliance with methadone maintenance treatment, and has had a multiple heroin relapses.;&&&&a&SubAbuse.0&&&&&1&&&N.
homecert.013&mcs&0&N&<b>Psychiatric Issues in Pediatrics</b><p>RL is a 9 year-old boy, 80 lbs, diagnosed with ADHD since age 7.  He had an unsuccessful trial of bupropion 150mg x 2 weeks with no significant improvement in symptoms and he developed a rash.   His parents are resistant to stimulant medication due to concern about growth suppression and possible substance abuse risk.  They want to try behavioral interventions.  Currently, RL is barely passing 4th grade due to inability to complete his assignments and severe disruptive behavior in the classroom.  He is defiant and argumentative with bursts of anger and loud, intrusive behavior.<p>Which of the following non-pharmacological interventions has shown the best therapeutic outcome for ADHD:&parent training and structured limit setting&Integrated play therapy and cognitive restructuring;cognitive-behavioral therapy;interpersonal psychotherapy;&&&&a&PsyIssues.0&&&&&1&&&N.
homecert.014&mcs&0&N&Which of the following statements accurately describes the risk of growth suppression with stimulants?&studies of stimulant use have found little or no decrease in expected height-- any decrease in growth early in treatment is compensated for later on.&dextroamphetamine has been shown to cause growth delay longterm, however, methylphenidate studies show no evidence of growth suppression.;If growth suppression from stimulants is suspected then clonidine can be added at bedtime in order to increase release of growth hormone during sleep.;there are no reports of growth suppression with stimulant use in ADHD.;&&&&a&PsyIssues.0&&&&&1&&&N.
homecert.015&mcs&0&N&Select the most appropriate,  regimen to treat ADHD symptoms in RL:&Methylphenidate 5mg qam and q noon&Concerta 36mg qam;Adderall XR 20mg qam;Ritalin 10mg bid, clonidine 0.05mg qhs;&&&&a&PsyIssues.0&&&&&1&&&N.
homecert.016&mcs&0&N&RL has taken the generic Adderall 10mg qam and 10mg qnoon x 2 weeks with no significant response in symptoms.  In addition, he has developed embarassing facial tics and his family says he talks like a robot and doesn’t eat well. Your best recommendation is:&discontinue Adderall and try methylphenidate&increase Adderall to 15mg qam and qnoon;divide dose of Adderall tid in order to lower peaks and decrease tics;add clonidine 0.05mg bid and qhs as an adjunct to improve ADHD and tics;&&&&a&PsyIssues.0&&&&&1&&&N.
homecert.017&mcs&0&N&TP is an 11 year-old girl with symptoms of hopelessness, worthlessness, insomnia, decreased appetite, low energy and poor school performance x 1 month.  She recently ran away from home stating “noone would care anyway”.  She endorses low self-esteem and fear of  “not fitting in” at new school.  Fortunately, she was brought back safely by a neighborhood family.  She is diagnosed with major depressive disorder.  Recommend a treatment with the most evidence for therapeutic efficacy in patients like TP.&cognitive-behavioral therapy&interpersonal psychotherapy;venlafaxine;nortriptyline;&&&&a&PsyIssues.0&&&&&1&&&N.
homecert.018&mcs&0&N&If treated with an SSRI, which of the following adverse effects is TP more likely to experience compared to adults?&behavioral activation or hypomania&increased bleeding;confusion, memory impairment;decreased libido and anorgasmia;&&&&a&PsyIssues.0&&&&&1&&&N.
homecert.019&mcs&0&N&<b>Sleep Disorders</b><p>MM is a 52 year-old woman recovering from a myocardial infarction 1 month ago.  She has just started temazepam 15mg qhs for insomnia.  How will temazepam impact sleep stages in MM?&increase time spent in Stage 2 NREM sleep&increase time spent in REM sleep;decrease time spent in NREM sleep;increase time spent in Stage 3 NREM sleep;&&&&a&SleepDis.0&&&&&1&&&N.
homecert.020&mcs&0&N&MM was diagnosed with major depression.  Sertraline therapy was initiated and titrated up to 100mg qam with significant improvement in depressive symptoms after one month of treatment.  How does sertraline and most other effective antidepressants impact sleep architecture?&decreases time spent in REM&increases time spent in REM;redistributes REM to the first half of the night;redistributes NREM deep sleep to the last half of the night;&&&&a&SleepDis.0&&&&&1&&&N.
homecert.021&mcs&0&N&MM wants to stop temazepam therapy after 2 months of routine use as she has been sleeping well and feels better physically and emotionally.  Your recommendation:&tapering temazepam gradually via every other night therapy or 7.5mg dosage is optimal&discontinuing temazepam completely is appropriate given resolution of depressive symptoms;moving sertraline administration time to qhs can prevent temazepam withdrawal symptoms;replacing temazepam with trazodone will prevent insomnia and withdrawal symptoms;&&&&a&SleepDis.0&&&&&1&&&N.
homecert.022&mcs&0&N&Which of the following accurately describes physiologic changes during REM sleep?&increased variability in heart rate and blood pressure&body temperature increases;blood may become thinner;muscle tone and sympathetic tone significantly increase;&&&&a&SleepDis.0&&&&&1&&&N.
homecert.023&mcs&0&N&JP is a 22 year-old male diagnosed with narcolepsy at age 19.  His sleep attacks have significantly decreased with treatment-- however, episodes of cataplexy and hypnagogic hallucinations continue to cause functional impairment.  He denies illicit drug use-- however, he admits to drinking alcohol occasionally with college friends.  Current medications: <ul><li>Metadate CD 60mg qam<li>zolpidem 10mg qhs prn insomnia<li>fluoxetine 10mg qam</ul><p>Which of the following is the most appropriate drug therapy recommendation for optimizing treatment of narcolepsy in JP?&increase fluoxetine to 20mg qam&change fluoxetine to imipramine 50mg qhs and discontinue prn zolpidem;add sodium oxybate 600mg qhs;discontinue Metadate CD and start modafinil 200mg qam;&1/13/04, per instructions from Louise Maitland, changed correct answer to "increase fluoxetine to 20mg qam" from "change fluoxetine to imipramine 50mg qhs and discontinue prn zolpidem"&&&a&SleepDis.0&&&&&1&&&N.
homecert.024&mcs&0&N&Which of the following describes patient counseling information for sodium oxybate?&nausea, vomiting, dizziness and enuresis are all possible adverse effects to look for and report&significant improvement in cataplexy can be seen within the first week of treatment with a total daily dosage of nine grams.;medication should be administered twice daily with food for maximum efficacy.;sodium oxybate is not effective for reducing sleep attacks associated with narcolepsy;&&&&a&SleepDis.0&&&&&1&&&N.
homecert.025&mcs&0&N&<b>Bipolar Disorder</b><p>Episodes of bipolar depression differ from unipolar depression in that periods of bipolar depression are usually?&more rapid in onset&less frequent;longer in duration;switch more frequently;&&&&a&BipolDis.0&&&&&1&&&N.
homecert.026&mcs&0&N&Mr. G is a 44 year old male with bipolar disorder and is currently depressed.  He has a history of antidepressant-induced mood instability.  Which of the following antidepressants may be useful for him given his history?&paroxetine&tranylcypromine;mirtazapine;imipramine;&&&&a&BipolDis.0&&&&&1&&&N.
homecert.027&mcs&0&N&Which of the following anticonvulsants has been supported for use in bipolar depression with a placebo-controlled study?&lamotrigine&carbamazepine;oxcarbazepine;divalproex sodium;&&&&a&BipolDis.0&&&&&1&&&N.
homecert.028&mcs&0&N&Mrs. H is a 34 year old female who presents to your clinic with what you believe is bipolar disorder.  This is her initial presentation and she has not been treated previously.  Your assessment is that she is depressed.  Which mood stabilizer should be initiated first?&lithium&olanzapine;valproic acid;carbamazepine;&&&&a&BipolDis.0&&&&&1&&&N.
homecert.029&mcs&0&N&On her follow-up visit, Mrs. H complains that the medication you prescribed did not agree with her.  She tried her best to be compliant for the 4 weeks since she last saw you but just could not tolerate the medication.  Which medication should be tried next?&valproic acid&lithium;carbamazepine;oxcarbazepine;&&&&a&BipolDis.0&&&&&1&&&N.
homecert.030&mcs&0&N&Mr. B is a 55 year old male with bipolar disorder who has been maintained on lithium monotherapy for the past year.  He has been compliant and lithium levels have averaged around 0.8 mEq/L.  On presentation to your clinic today he reports sudden depressive symptoms.  Which of the following would be the best treatment choice to add to the lithium?&fluoxetine&carbamazepine;olanzapine;valproic acid;&&&&a&BipolDis.0&&&&&1&&&N.
homecert.031&mcs&0&N&<b>Psychiatric Issues in the Elderly</b><p>At what age do women appear to be at an increased risk of Alzheimer disease compared to men?&after age 80-85 years&after age 65 years;before age 65 years;age 75-80 years;&&&&a&PsyIssEld.0&&&&&1&&&N.
homecert.032&tf&0&N&According to the Cache County Study, Alzheimer disease was less common among women with a history of HRT compared to nonuser.&TRUE&FALSE&&&&a&PsyIssEld.0&&&&&1&&&N.
homecert.033&mcs&0&N&The estimated hazard for women in the Cache County Study who had used HRT for more than 10 years was&similar to that for men&more than that for men;less than that for men;much higher than would be predicted based on the statistical model utilized;&&&&a&PsyIssEld.0&&&&&1&&&N.
homecert.034&mcs&0&N&Which of the following best supports the relative hazard of women who took calcium supplements and multivitamins in the Cache County Study?&neither was significantly associated with risk of AD&too few women received them to evaluate adequately;the model did not control for these two factors;the relative hazard was lower for those women with 1 APOE e4 allele;&&&&a&PsyIssEld.0&&&&&1&&&N.
homecert.035&mcs&0&N&Compared to nonusers of HRT, which group showed a significantly reduced risk of AD?&former HRT users&those with 1 APOE e4 allele;those with 2 APOE e4 alleles;those currently receiving HRT;&&&&a&PsyIssEld.0&&&&&1&&&N.
homecert.036&mcs&0&N&Which of the following is correct regarding the interaction between HRT and the presence of 1 or 2 APOE e4 alleles?&neither reached statistical significance&both alleles reached statistical significance;only those with 1 APOE e4 allele statistical significance;only those with 2 APOE e4 alleles statistical significance;&&&&a&PsyIssEld.0&&&&&1&&&N.
homecert.037&mcs&0&N&<b>Eating Disorders/Personality Disorders</b><p>M.C. is 35 years old and was diagnosed with schizophrenia 10 years ago.  M.C.'s cousin has been diagnosed with schizotypal personality disorder.  In comparison with healthy controls, both M.C. and his cousin are likely to exhibit which of the following findings?&Abnormal event related N400 waves on EEG and elevated scores on the Thought Disorders Index&Color blindness and enlarged superior and inferior colliculi;Abnormal saccadic eye movements and decreased CSF MHPG concentrations;Greater frequency of motor tics and decreased performance on the California Verbal Learning Test;&&&&a&EatPersOrd.0&&&&&1&&&N.
homecert.038&mcs&0&N&Schizophrenic and schizotypal patients exhibit deficiencies on neuropsychological testing in which one of the following areas?&Immediate and delayed memory recall, e.g. Wechsler Memory Scale&Psychomotor speed, e.g. finger tapping;Elevated anger score, e.g. State-Trait Anger Expression Inventory;Low empathy scores, e.g. Antisocial Trait Test;&&&&a&EatPersOrd.0&&&&&1&&&N.
homecert.039&mcs&0&N&F.T. is a 52 year old woman suffering from arthritis.  Her doctor has prescribed prednisone and, since she has begun taking it, she has experienced an increase in appetite and gained 40 lbs.  Based on the information in this review, one possible reason for F.T.'s increase in appetite is which of the following?&Prednisone antagonizes leptin and insulin effects&Prednisone is blocking orexin secretion;Prednisone induces tryptophan hydroxylase, increasing serotonin synthesis;Prednisone potentiates the actions of cholecystokinin;&&&&a&EatPersOrd.0&&&&&1&&&N.
homecert.040&mcs&0&N&In young women with anorexia nervosa and amenorrhea, which of the following is probably necessary before resumption of normal menstrual cycles will occur.&Weight gain to at least 90% of adequate weight for height&Weight gain to at least 85% of adequate weight for height;Weight gain to approximately 100% of adequate weight for height;Increase in protein intake to 110% of adequate protein for height;&&&&a&EatPersOrd.0&&&&&1&&&N.
homecert.041&mcs&0&N&G.M. is an 18 year-old woman with anorexia nervosa.  She is 5'3" and weighs 87 lbs.  She currently demonstrates osteopenia on BMD testing.  Which of the following would exhibit the greatest likelihood of obtaining a normal BMD in this patient?&Gaining 20 lbs. and resuming normal menstrual periods&Taking oral contraceptives (estrogen + progesterone based pills) for 1 year;Gaining 10 lbs. and increasing her weight-bearing exercises;Gaining 10 lbs. and increasing her calcium intake;&&&&a&EatPersOrd.0&&&&&1&&&N.
homecert.042&mcs&0&N&Which of the following correlates with the degree of osteopenia found in patients suffering from anorexia nervosa?&Bone isozyme of alkaline phosphatase&Amino terminal pro-peptide of procollagen I;Elevated bone band of ALT;None of the above;&&&&a&EatPersOrd.0&&&&&1&&&N.
homecert.043&mcs&0&N&<b>Obsessive Compulsive Disorder/Generalized Anxiety Disorder</b><p>According to the findings of the International OCD Treatment Refractory Consortium, which of the following patients would be most likely to be refractory to treatment for OCD?&A 26 year old woman with sudden onset OCD within the last year and an eight year history of anorexia nervosa.&A 28 year old man with a stable course of OCD for 10 years, and depression;A 30 year old woman with a family history of motor tics and an eight year history of OCD;A 22 year old woman with borderline personality disorder, alcohol dependence and a seven year history of OCD;&&&&a&OCDGenAx.0&&&&&1&&&N.
homecert.044&mcs&0&N&E.E. is a 31 year old woman with asthma, hypertension, and OCD.  She has shown little response to a 	trial of 250 mg/day of clomipramine and a small response to a trial of 150 mg/day of sertraline.  The best choice for augmentation of sertraline in E.E. would be which of the following?&Risperidone 1.5 mg bid&Buspirone 5 mg tid;Pindolol 2.5 mg tid;Trazodone 200 mg/day;&&&&a&OCDGenAx.0&&&&&1&&&N.
homecert.045&mcs&0&N&S.G. is an 18 year old male with OCD and Tourette's.  He has shown partial response to 60 mg/day of citalopram.  Whhich of the following medications when added to citalpram would be associated with 	the highest chance of therapeutic response?&Pimozide&Clomipramine;Clonidine;Buspirone;&&&&a&OCDGenAx.0&&&&&1&&&N.
homecert.046&mcs&0&N&In a patient who has suffered from severe OCD (YBOCS >30) for 24 years and has not responded to trials of SSRIs, clomipramine (alone and in combination), as well as an SSRI with pindolol or risperidone, which of the following has shown a significant response in placebo-controlled, double-blind study?&Two weeks of oral morphine&Four weeks of oral lorazepam;Two weeks of oral cyproheptadine;Four weeks of intravenous cimetidine;&&&&a&OCDGenAx.0&&&&&1&&&N.
homecert.047&mcs&0&N&N.N. is a 42 year old woman who has taken part in a genetic research study.  It has been found that she is deficient in the <font size="1">y2</font> GABA<font size="1">A</font> receptor subunit she only has half the usual complement of <font size="1">y2</font> subunits on her GABA<font size="1">A</font> receptors.  Based on this finding one would expect that N.N. would exhibit which of the following behavioral features?&Hypervigilance, increased muscular tension, and difficulty sleeping&Hyperactivity, poor motor coordination, and insomnia;Narolepsy, poor memory, and difficulty concentrating;Hypervigilance, cataplexy, and decreased psychomotor speed;&&&&a&OCDGenAx.0&&&&&1&&&N.
homecert.048&mcs&0&N&L.E. is a 24 year old air traffic controller with a long history of GAD.  Although his anxiety responds to benzodiazepines he can't take them due to their sedating effects.  L.E. would benefit from a benzodiazepine with which of the following receptor binding profile?&A benzodiazepine selective for the á2 receptor subunit&An inverse agonist at the á6 receptor subunit;A benzodiazepine selective for the á6 receptor subunit;An inverse agonist at the á5 and â2 receptor subunits;&&&&a&OCDGenAx.0&&&&&1&&&N.
homecert.049&mcs&0&N&<b>Depression</b><p>Mrs. A., a 76 year old female comes to clinic with her daughter.  Her daughter complains to you that her mother has incontinence and has fallen several times.  After speaking with Mrs. A. you find that she is confused and dizzy. Her current medications are amitriptyline 250 mg twice daily for depression and thioridazine 100 mg daily for sleep.  What do you suspect is the cause of these symptoms?&Anticholinergic delirium&Akathisia ;Stroke;Thioridazine toxicity;&01/13/04 per instructions from Louise Maitland, changed correcct answer from Akathisia to<br>Anticholinergic delirium&&&a&Depress.0&&&&&1&&&N.
homecert.050&mcs&0&N&An 82 year-old man with a 35 year history of depression is severely emaciated, dehydrated and catatonic upon admission to the hospital.  Four weeks ago, the man began withdrawing from relatives, talking constantly about death, and stopped eating and drinking unless prompted by his daughter.  He has lost more than 20 lbs.  Prior to exhibiting these symptoms the man was healthy.  After the patient is medically stabilized, the treatment of choice would be:&Electroconvulsive therapy&Fluoxetine;Desipramine;Haloperidol;&&&&a&Depress.0&&&&&1&&&N.
homecert.051&mcs&0&N&JK comes into the emergency room complaining of chest pain, palpitations, sweating, and feeling like 	he is going to die.  This is the fourth episode this week and each episode lasts less than ten minutes.  These episodes have prevented JK from going to his job.  After a series of negative tests the diagnosis is panic disorder.  He does not have a history of substance abuse, but does describe having a history of depression.  What would you use to treat JK ?&Sertraline&Olanzapine;Alprazolam;Buspirone;&&&&a&Depress.0&&&&&1&&&N.
homecert.052&mcs&0&N&Mr. C., a 76 year old male, was brought into the hospital after having to be “talked down” from a local bridge.  When asked, he describes overwhelming feelings of sadness and guilt.  He also complains that he has not been sleeping or eating and that he has experienced a 15 lb. weight loss over the past six weeks.  This is his first episode of depression.  You decide at this point that the patient needs medication treatment.  His labs are within normal limits.  His EKG shows a prolonged QTc interval  of 475 and bradycardia.  Which of the following medications would you choose to treat his illness?&Paroxetine&Amitriptyline;Imipramine and olanzapine;Trazodone;&&&&a&Depress.0&&&&&1&&&N.
homecert.053&mcs&0&N&How long would you expect for it to take for Mr. C’s symptoms to remit?&four weeks&one week;two weeks;eight weeks;&&&&a&Depress.0&&&&&1&&&N.
homecert.054&mcs&0&N&Once Mr. C’s symptoms have remitted, how long should he stay on the antidepressant that you have chosen?&six months&one month;two months;forever;&&&&a&Depress.0&&&&&1&&&N.
homecert.055&mcs&0&N&Mr. C. will be seen for follow-up of his response to antidepressant therapy at monthly intervals.  Which of the following self-rated rating scales would you have min fill out at his clinic visit to determine his response to medication?&Beck Depression Inventory&Hamilton Rating Scale for Depression;Montgomery-Asberg Depression Rating Scale;Clinical Global Improvement Scale;&&&&a&Depress.0&&&&&1&&&N.
homecert.056&mcs&0&N&<b>Schizophrenia</b><p>LM, a patient in your clinic was recently diagnosed with schizophrenia and her physician wishes to begin therapy with risperidone.  She has no other medical conditions.  What initial dose would you recommend?&1 mg bid&2 mg bid;3 mg/bid;4 mg bid;&&&&a&Schizophr.0&&&&&1&&&N.
homecert.057&mcs&0&N&LM has been receiving risperidone for one week and has returned to your clinic for follow-up.  Which of the following rating scales would you use to monitor for response of her positive and negative symptoms to medication?&Brief Psychiatric Rating Scale&Montgomery Asberg Scale;Barnes Akathisia Scale;Clinical Global Impression Scale;&&&&a&Schizophr.0&&&&&1&&&N.
homecert.058&mcs&0&N&A 35 year old male is brought into the emergency department for an acute psychotic episode.  He received haloperidol 5 mg IM upon admission.  Although he appears calmer and more sedated, he is complaining of stiffness, in his back and neck, as well as tongue swelling.  What medication would 	you recommend for him?&diphenhydramine 25 mg IM&haloperidol 5 mg po;lorazepam 1 mg IM;flumazenil 0.2 mg IV;&&&&a&Schizophr.0&&&&&1&&&N.
homecert.059&mcs&0&N&A patient with a long history of schizophrenia has primary symptoms of flat affect, withdrawn behavior, poor grooming and auditory hallucinations. He has taken multiple medications in the past with only partial response.  Which of the following medications would be most likely to improve both his positive and negative symptoms?&clozapine&thioridazine;haloperidol;fluphenazine;&&&&a&Schizophr.0&&&&&1&&&N.
homecert.060&mcs&0&N&AS , a 55 year old male, is admitted to the inpatient psychiatric unit with auditory hallucinations and paranoia..  Initial monitoring tests show a previous myocardial infarction, coronary artery disease, and the EKG shows a QTc of 435.  Which of the following antipsychotics would you recommend for AS?&Risperidal&Chlorpromazine ;Thioridazine;Ziprasidone;&&&&a&Schizophr.0&&&&&1&&&N.
homecert.061&mcs&0&N&JD, a 49 year old female, with a long history of schizophrenia comes to your clinic for the first time.  She is currently stabilized on olanzepine. Her medical history is significant for hypertension and obesity.  Which of the following labs are most important to monitor in this patient?&Blood glucose and lipids&Thyroid function tests and lipids;Liver function test and thyroid function test;Lipids and liver function tests;&&&&a&Schizophr.0&&&&&1&&&N.
homecert.062&mcs&0&N&KJ is hospitalized secondary to noncompliance with his thiothixene.  He states that is makes him feel restless.  Which of the following medications would you recommend to treat the restlessness.&Propranolol&Diphenhydramine;Physostigmine;Bromocriptine;&&&&a&Schizophr.0&&&&&1&&&N.
homecert.063&mcs&0&N&<b>Developmental Disorders</b><p><FONT SIZE=2><i>Questions 1 through 6 are based on the paper by Symanski and King.</i></font><p>Which of the following would not satisfy a criterion for diagnosis of mental retardation?&Presence of Down syndrome&Impaired functioning in self-care activities relative to others in one’s age group;Intelligence quotient of 35 determined by Stanford-Binet test;Onset estimated at age 2 years;&&&&a&DevelopDis.0&&&&&1&&&N.
homecert.064&mcs&0&N&Which of the following is LEAST likely to explain recent-onset symptoms of anxiety and eractivity in a person with severe mental retardation?&Development of clinically significant hypothyroidism&Initiation of phenobarbital for seizure disorder;Change in residential setting;Manic episode;&&&&a&DevelopDis.0&&&&&1&&&N.
homecert.065&mcs&0&N&Which adverse effect of antipsychotics may be seen at a greater incidence in people with mental retardation?&Akathisia&Insomnia;Orthostasis;Neuroleptic malignant syndrome;&&&&a&DevelopDis.0&&&&&1&&&N.
homecert.066&mcs&0&N&Which of the following is specifically required by the federal guidelines on psychotropic drug use in people with developmental diabilities?&An interdisciplinary committee must review and approve all drug treatment plans&Patient must have a DSM-IV Axis I disorder;Drug dosing must fall within the range indicated on the product labeling;Assessment for medical for behaviors should be performed after patient is stabilized on drug;&&&&a&DevelopDis.0&&&&&1&&&N.
homecert.067&mcs&0&N&Which of the following is true regarding evidence-based use of psychotropic drugs in people with developmental disabilities?&Treatment guidelines for most disorders have been adapted from adult guidelines because of limitations in data for this population&The use of SSRI’s in depression is supported by randomized controlled trials;There is no evidence supporting the use of lithium for bipolar affective disorders in people with developmental disabilities;Studies of the use of neuroleptics for self-injury and aggression have produced more consistent results than for use in stereotyped behaviors;&&&&a&DevelopDis.0&&&&&1&&&N.
homecert.068&mcs&0&N&<b>Neurological Disorders</b><p><font size=2><i>Questions 1 through 4 are based on the paper by Holmes et al.</font></i><p>Which of the following has NOT been found to confer an increased risk of development of major malformations in a fetus?&Presence of an untreated seizure disorder in the mother&Multiple births during a single pregnancy;Maternal treatment of a mood disorder with an anticonvulsant;Maternal treatment of a seizure disorder with an anticonvulsant;&&&&a&NeuroDis.0&&&&&1&&&N.
homecert.069&mcs&0&N&Which malformation has been identified as being more common with maternal administration of valproic acid?&Lumbrosacral spina bifida&Hypoplasia of nails and stiff joints;Microcephaly;Cleft palate;&&&&a&NeuroDis.0&&&&&1&&&N.
homecert.070&mcs&0&N&Which of the following maternal exposures was found to have the greatest association with development of major malformations?&Multiple anticonvulsant exposures&Carbamazepine monotherapy;Phenobarbital monotherapy;Phenytoin monotherapy;&&&&a&NeuroDis.0&&&&&1&&&N.
homecert.071&mcs&0&N&<i><font size=2>The following three questions are based on the paper by Poewe and Luginer.</i></font><p>Which of the following has been found to confer a greater risk of comorbid depression in PD?&Young age at diagnosis of PD&Severe, disabling PD;Tremor predominant PD;Use of dopamine agonists;&&&&a&NeuroDis.0&&&&&1&&&N.
homecert.072&mcs&0&N&Which of the following is true regarding pharmacotherapy for depression in PD?&High dose selegiline has been beneficial for mood and motor symptoms&Literature support for the use of SSRI’s exceeds that for the use of TCA’s;Treatment of depressive symptoms rarely impact motor symptoms;Depression in Parkinson’s disease is often resistant to antidepressant therapy;&&&&a&NeuroDis.0&&&&&1&&&N.
homecert.073&mcs&0&N&What is the role of behavioral therapies and psychosocial counseling in the treatment depression associated with PD?&Behavioral therapies are very useful for when used at the time of diagnosis&Depression in PD is not responsive to psychosocial counseling;Behavioral therapies have an unclear role for depression in PD;Counseling is only helpful when combined with pharmacologic treatment;&&&&a&NeuroDis.0&&&&&1&&&N.
homecert.074&mcs&0&N&<b>Research Design and Biostatistics</b><p><font size=2>To answer the next two questions, use the data in Table 1 of the Zandi* article.  Use the data that relates to whether patients had Alzheimer disease and whether or not women used HRT therapy.<br><i>*Zandi PP, Carlson MC, Plassman BL et al.  Hormone replacement therapy and incidence of Alzheimer disease in older women: The Cache County Study. JAMA. 2002:288: 2123-2129. [Same article as used in section on Psychiatric Issues in the Elderly – Matthew Fuller]</i></font><p>Which of best approximates the relative risk?  (This study uses hazard ratios to present risk.  Hazard ratios are the same concept as relative risks and take into account data that is collected over time.  It would be a more precise estimate than the relative risk but is usually very similar to the relative risk.  	The relative risk you would calculate would represent an unadjusted relative risk.)&0.33&0.1;0.6;2;&&&&a&ReDesBios.0&&&&&1&&&N.
homecert.075&mcs&0&N&Which of the following represents the closest approximate to the number needed to treat (in this case also called the number needed to harm)?&20&10;14;42;&&&&a&ReDesBios.0&&&&&1&&&N.
homecert.076&mcs&0&N&In Table 2, several models are presented. The Relative Hazard Ratio is presented with 95%confidence intervals. Which of the following is NOT appropriate concerning confidence intervals?&Confidence intervals are similar to the standard deviation and also represent the variation in the sample size.&Confidence intervals provide a range of plausible results.;Confidence intervals provide inferences on the population at large.;If you repeated the study 100 times, 95% of the time the result would fall in this range.;&&&&a&ReDesBios.0&&&&&1&&&N.
homecert.077&mcs&0&N&In the discussion section is the following quote:  “ . . . the unusual sociocultural attributes of the Cache County sample may suggest a lack of generalizability of findings to other populations.”  This quote refers to:&External validity&Internal validity;Reliability;Variability;&&&&a&ReDesBios.0&&&&&1&&&N.
homecert.078&mcs&0&N&This same quote also addresses issues related to which bias?&Selection bias&Classification bias;Recall bias;Confounding bias;Observer bias;&&&&a&ReDesBios.0&&&&&1&&&N.
homecert.079&mcs&0&N&Nuovo et al advocate the use of number needed to treat because:&Relative risk reduction alone may lead the reader to believe the treatment effect is larger than it is.&Relative risk reduction inaccurately represents data.;Number needed to treat is a more precise estimate of risk;Number needed to treat best represents the proportional difference.;&&&&a&ReDesBios.0&&&&&1&&&N.
homecert.080&mcs&0&N&Not reporting which of the following affects the internal validity of the study?&Method of randomization&Number needed to treat;Absolute risk reduction;Relative risk reduction;&&&&a&ReDesBios.0&&&&&1&&&N.