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PRITE CHILD PSYCHIATRY EXAM WITH COMPLETE SOLUTIONS
100 % VERIFIED!!
Pharmacological treatment in autism spectrum disorder is most likely to have a positive effect on which of the following? A. Aggressiveness B. Gaze aversion C. Prosodic modulation D. Gestural communication - ANSWER A. Aggressiveness
The parents of a toddler are concerned about a recent increase in the frequency, intensity and duration of the child's temper tantrums. The parents report that the toddler gets on the floor, kicks and screams when they set limits. The child's health and developmental history is unremarkable. Family history is significant for mood and anxiety disorders on the mother's side, and attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) on the father's side. Which of the following would be the most appropriate step for the psychiatrist to take next? A. Administer a Denver developmental screening test to the child. B. Explore the parents' concerns about seemingly normal behavior. C. Inquire about early separations and traumatic events in the child's life. D. Administer an inventory to assess the parenting style of each parent. E. Begin parent psychoeducation about ADHD and oppositional d - ANSWER B. Explore the parents' concerns about seemingly normal behavior.
Questions 39 — 42 pertain to the following vignette. A 9-year-old girl is brought in by her parents for an outpatient psychiatric evaluation due to behavior difficulties at home. When frustrated, the girl screams, yells, curses and threatens to kill herself. This behavior has been occurring more frequently whenever the girl does not get her way. The parents usually give in and allow the girl to do what she wants. Similar episodes have occurred at school. The girl is often irritable, argumentative and
provocative. Her schoolwork is on grade level. The girl has friends and interacts well with them, though she is described as "bossy." Her appetite, energy and sleep patterns have been normal and stable. There are no other problems. When seen with her parents and individually, the child is calm, cooperative and interactive. She denies suicidal or homicidal ideation and says that she "just gets mad." Her mood is euthymic w - ANSWER A. Send the patient home with the parents.
40 Which of the following would be the most appropriate initial diagnostic step by the physician? A. Neuroimaging B. Genetic testing C. Psychological testing D. Neurological evaluation E. Obtain a teacher report - ANSWER E. Obtain a teacher report
- At a follow-up interview, the physician learns that the recent exacerbation of symptoms appears to be related to increasing parental disagreement about how the patient's outbursts should be handled. It would be most appropriate for the physician to next obtain additional information about parental discipline and: A. explore reasons for parental differences. B. reinforce the parent with the best approach. C. Explain the options for psychiatric interventions. D. explore the parents' slowness in obtaining care. E. Elicit the child's opinion about which parent's discipline style works best - ANSWER A. explore reasons for parental differences.
42 The psychiatrist educates the parents about possible reasons for the perpetuation of the child's temper tantrums. The psychiatrist teaches the parents how to develop and implement an age-appropriate behavioral management plan with clear expectations and consequences. Over the next month, the child's behavior improves. The parents state that whenever the child has a temper tantrum they ignore the behavior, wait for the child to calm down and then expect the child to obey the rules. The behavior has most likely
meet criteria for a clinical problem. How should the psychiatrist account for the differences in observed ratings? A. The child is exaggerating the problems due to dislike of school. B. The child's symptoms are mild and don't require further evaluation. C. Parents arc overly concerned about the child's school performance. D. The teacher is too busy and overworked to notice the chi - ANSWER E. Rating discrepancies by different observers are common in clinical practice
A 4th grader has a history of tics and attention-deficit hyperactivity disorder (ADHD), treated with a stimulant medication. Recently, the tics worsened significantly and the stimulant was discontinued; however, the tics persisted. When a psychiatrist is consulted, the diagnoses of ADHD and Tourette syndrome are confirmed. Which of the following is the best next medication trial for this child? A. Benzodiazepine B. Atypical antipsychotic C. Alpha-adrenergic agonist D. Tricyclic antidepressant (TCA) E. Selective serotonin reuptake inhibitor (SSRI) - ANSWER C. Alpha-adrenergic agonist (Clonidine)
21 A child with an IQ of 68 is most likely to exhibit adjustment issues and struggles during which of the following developmental stages? A. Infancy B. Toddlerhood C. Preschool D. School-age E. Adolescence - ANSWER E. Adolescence
41 A 9-year-old child has been successfully treated with methylphenidate for attention- deficit hyperactivity disorder (ADHD) for several years. During the last 2 months, the medication has not been as effective despite several dose adjustments. It is decided that the child needs a different medication. Which of the following would be the best choice? A. Buspirone B. Atomoxetine C. Desipramine D. Risperidone E. Mixed amphetamine salts - ANSWER E. Mixed amphetamine salts
- Which of the following is the most widely used comprehensive (broad-band) rating scale for the assessment of school-aged children due to the availability of age-based and gender-based norms? A. Vineland Adaptive Behavior Scales (VABS-II) B. Revised Conners' Parent Rating Scale (CPRS-R) C. Denver Developmental Screening Test (DDST-II) D. Revised Behavior Problem Checklist (RBPC) E. Child Behavior Checklist (CBCL) - ANSWER E. Child Behavior Checklist (CBCL)
- Diagnosis of which of the following DSM-IV-TR disorders requires symptoms to be present in two or more settings? A. Tourette syndrome B. Conduct disorder C. Separation anxiety disorder D. Oppositional defiant disorder (ODD) E. Attention-deficit hyperactivity disorder (ADHD) - ANSWER E. Attention-deficit hyperactivity disorder (ADHD)
- Which of the following side effects can result from stimulant medication treatment and warrants immediate discontinuation of the medication and a reassessment of the treatment plan? A. Hallucinations B. Initial insomnia C. Loss of appetite D. Evening behavior rebound E. Irritability and/or dysphoria - ANSWER A. Hallucinations
- A 14-year-old patient recently released from juvenile detention is brought to the emergency department by police for assessment of aggressive behavior. Parents called the police after the teen started yelling, cursing, throwing things and hitting one of the parents. The teen has had behavior problems since early elementary school, but no psychiatric or medical history. In addition to diagnosing the behavior problem,which of the following is the most appropriate initial step for the psychiatrist to take?
A. Evaluate the patient for additional psychopathology B. Neuroimaging and hormonal screening of the patient C. Neurological and physical examination of the patient D. Documentation of patient's criminal history E. Clarification of the patient's guardianship - ANSWER A. Evaluate the patient for additional psychopathology
- There appears to be a strong correlation of Asperger disorder with which of the following learning profiles? A. Dyslexia B. General intellectual disability C. Receptive language disorder D. Nonverbal learning disability E. Expressive language disorder - ANSWER D. Nonverbal learning disability
A child presents with moderate intellectual disability (mental retardation), deficits in visual-spatial processing, high levels of anxiety, a phobia, and is highly sociable. Which of the following genetic disorders is this child most likely to have? A. Trisomy of chromosome 21 (Down syndrome ) B. Deletion in chromosome 15 (Prader-Willi syndrome) C. Microdeletion on chromosome 7q11.23 (Williams syndrome) D. Microdeletion on chromosome 22q11.2 (Velocardiofacial syndrome) E. Partial or complete absence of one of the two X chromosomes (Turner syndrome) - ANSWER C. Microdeletion on chromosome 7q11.23 (Williams syndrome)
A 15-year-old patient is brought to the emergency department for agitation and paranoia. The patient seems to be hallucinating, and comments that, "I'm walking on air." Physical examination reveals tachycardia. This clinical picture is most characteristic on A. cocaine withdrawal. B. caffeine intoxication. C. marijuana withdrawal. D. prescription opioid withdrawal. E. dextromethorphan intoxication - ANSWER E. dextromethorphan intoxication
A 17-year-old adolescent is referred for a developmental evaluation. The teenager was identified in the second grade as showing significant academic delays. Academic testing shows achievement at about the 6th grade level. This adolescent most likely falls into which of the following categories of intellectual disability (mental retardation)? A. Borderline intellectual functioning B. Mild intellectual disability C. Moderate intellectual disability
C.Estrogen D.Thyroid E.Oxytocin - ANSWER D.Thyroid
- Which of the following is the most common comorbid diagnosis in children with separation anxiety disorder? A. Enuresis B. Major depressive disorder C. Generalized anxiety disorder D. Oppositional defiant disorder (ODD) E. Attention-deficit hyperactivity disorder (ADHD) - ANSWER C. Generalized anxiety disorder
- A 9-year-old child has been refusing to go to school for the past two months. The child's teacher reports that the child would continually cry after being dropped off at school, causing classmates to tease, leading to the child becoming further isolated. Previously the child had seen the pediatrician for repeated headaches. The parents decided to obtain psychiatric evaluation after the child began to have frequent nightmares. Which of the following is the most likely diagnosis?
A. Social phobia B. Specific phobia C. Somatoform disorder D. Separation anxiety disorder E. Posttraumatic stress disorder (PTSD) - ANSWER D. Separation anxiety disorder
- Which of the following aspects of attention-deficit hyperactivity disorder (ADHD) is most likely to improve as children age? A. Impulsivity B. Hyperactivity
C. Inattention D. Peer relationships E. Academic difficulties - ANSWER B. Hyperactivity
- The Treatment for Adolescents with Depression Study (TADS) recommended which of the following treatments for patients with moderate to severe depression? A. Fluoxetine alone B. Interpersonal psychotherapy (IPT) alone C. Cognitive-behavioral therapy (CBT) alone D. Fluoxetine and IPT E. Fluoxetine and CBT - ANSWER E. Fluoxetine and CBT
- A 10-year-old child presents with explosive outbursts at home when asked to complete tasks or when told "no." These behaviors are not present while playing with siblings. Which of the following treatments has the largest body of evidence supporting its use to treat this condition? A. Stimulants B. Alpha-2 agonists C. Atypical antipsychotics D. Parent management training E. Cognitive-behavioral therapy (CBT) - ANSWER D. Parent management training
- Which of the following is seen most frequently as a comorbid condition in children with autism? A. Selective mutism B. Intellectual disability (MR) C. Early-onset schizophrenia D. Obsessive-compulsive disorder (OCD)
- An 8-year-old child recently had testing with the Wechsler Intelligence Scale for Children (WISC-IV) and received a full scale IQ score of 60. Which of the following additional tests would determine if the child meets criteria for intellectual disability (mental retardation)?
A. Test of Nonverbal Intelligence (TONI-3) B. Wechsler Individual Achievement Test (WIAT-II) C. Vineland Adaptive Behavior Scales, 2" ed. (VABS-I1) D. Diagnostic Interview Schedule for Children (DISC-IV) E. Reitan Indiana Neuropsychological Test Battery (RINTB - ANSWER C. Vineland Adaptive Behavior Scales, 2" ed. (VABS-I1): helps in diagnosing and classifying intellectual and developmental disabilities and other disorders. The Vineland-II contributes to determining eligibility or qualification for special services; planning rehabilitation or intervention programs; and tracking and reporting progress. The Vineland-II measures the adaptive behaviors of individuals with intellectual and developmental disabilities; autism spectrum disorders; ADHD; post-traumatic brain injury; hearing impairment; and dementia/Alzheimer's disease.
- The parents of a 7-year-old child report that their child has "mood swings" which consist of the child suddenly becoming irritable, angry and throwing tantrums. When asked what precipitates these episodes, they reply, "When we tell him 'no' or he does not get his way." Based on this information, which of the following would be the most likely preliminary diagnosis? A. Bipolar disorder B. Conduct disorder C. Major depressive disorder D. Oppositional defiant disorder (ODD) E. Attention-deficit hyperactivity disorder (ADHD) - ANSWER D. Oppositional defiant disorder (ODD)
- Autism spectrum disorders in children and adolescents are most highly comorbid with which of the following types of disorder?
A. Anxiety B. Eating C. Elimination D. Personality E. Psychotic - ANSWER A. Anxiety
- Which of the following comorbid diagnoses of childhood attention-deficit hyperactivity disorder (ADHD) worsens the prognosis into adolescence and adulthood to the greatest degree? A. Conduct disorder B. Tourette syndrome C. Major depressive disorder D. Generalized anxiety disorder E. Expressive language disorder - ANSWER A. Conduct disorder
11 8. Which of the following is the initial treatment of choice for mild anxiety disorders in children?
A. Observation alone B. Psychotherapy alone C. A selective serotonin reuptake inhibitor (SSRI) alone D. An SSRI and psychotherapy E. A benzodiazepine and psychotherapy - ANSWER B. Psychotherapy alone
- Which of the following is considered to be the key component underlying the symptoms of selective mutism?
A. Avoidant behavior B. Phonological disorder
coding tool that allows you to accurately assess and diagnose autism spectrum disorders across age, developmental level, and language skills
- The Child-Adolescent Anxiety Multimodal Study (CAMS) compared sertraline, cognitive-behavioral therapy (CBT) and combination therapy in children and adolescents with moderate/severe generalized anxiety disorder, separation anxiety disorder and/or social phobia. Which of the following reflects the primary findings?
A. CBT alone was superior to sertraline alone B. Sertraline alone was superior to CBT alone C. CBT alone did not separate from placebo D. Combination treatment was superior to the monotherapies E. Combination treatment was superior to CBT but not sertraline alone - ANSWER D. Combination treatment was superior to the monotherapies
- The psychiatrist evaluates a 10-year-old boy with a history of primary nocturnal enuresis. He is dry during the day with no urgency, frequency or dysuria. The patient's father reports that he had the same problem until he was 12 years old. The patient is otherwise healthy but wants to stop bedwetting because he's planning to go to overnight camp. The next step to take is to:
A. order a urinalysis. B. order a bladder voiding study. C. recommend a trial of DDAVP D. Recommend a trial of imipramine E. Order projective psychological testing - ANSWER C. recommend a trial of DDAVP: bc he wants to stay the night without wetting the bed. Normally Bedwetting alarms are the best initial step, then Biofeedback (gold stars for dry nights), the medications like Imipramine or DDAVP.
- A 17-year-old adolescent is able to feed, bathe, and dress self but requires some supervision for these activities. The patient functions well living in a group home setting.The adolescent is currently employed as a grocery store greeter and typically
works under the supervision of another employee. Caregivers report that the adolescent has the academic skills of a second grader. Which diagnostic classification best represents the patient's severity of intellectual disability? A. Mild B. Moderate C. Severe D. Profound E. Borderline - ANSWER B. Moderate
- A 13-year-old patient is evaluated by the psychiatrist. The patient's parents report that the patient is "sleepy" during the day, and often seems dazed and "out of it."Additionally, the patient is often not hungry and sometimes complains of nausea. On examination, the patient has red eyes, a runny nose and red sores around the mouth. Which of the following substances is most likely to be playing a role in this teenager's presentation?
A.Cannabis B.Heroin C.Aerosols D.Opiates E.Stimulants - ANSWER C. Aerosols - children who abuse substances most likely will abuse inhalants as they are cheap and accessible (garage).
- The psychiatrist evaluates a 7-year-old boy who presents with aggression. The parents indicate that they are not particularly worried about the behavior but were referred by the child's school for evaluation after cognitive testing of the boy revealed an IQ of 68. The patient was temperamentally inhibited and avoidant as an infant. He was first noted to have difficulty interacting with peers and a preoccupation with trains at 2 years of age.He does not exhibit any stereotypes or tics. Which of the following aspects of this patient's clinical presentation is most indicative of autism spectrum disorder?
A. prevent maltreatment. B. help contain patients' anxiety symptoms. C. prevent hospitalizations or residential placements. D. manage appropriate behavior in children with autism. E. provide multimodal treatment for patients with learning disorders - ANSWER C. prevent hospitalizations or residential placements - young people with complex needs are more likely to be able to stay in their homes and communities, or, should a crisis occur, to be in out-of-home placements only for short periods of time. Young people in Wraparound tend to have better outcomes than similar young people who don't receive Wraparound, across different areas of their lives including mental health, and functioning in their homes, schools and communities. And all of this saves money by minimizing the time that young people spend in out-of-home facilities like residential treatment centers or psychiatric hospitals, which can cost $1000 - $3000 per day.
- Atomoxetine is most likely to be considered as an initial treatment for ADHD in adolescents with:
A. Eating disorders B. Seizure disorders C. Depressive disorders D. Developmental disorders E. Substance use disorders - ANSWER E. Substance Use disorders (SUD): A high prevalence of comorbidity of ADHD and substance-use disorders (SUDs) has been shown in the literature. Some clinicians suggest that adults with ADHD may abuse cocaine in order to self-medicate their ADHD symptoms. Atomoxetine is a drug that has been effective in treating ADHD in those who have a propensity to abuse stimulants.
- The parents of a child with attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) present for consultation. They are primarily interested in psychotherapeutic approaches, and ask how to best proceed with the child. Which of the following would be the most appropriate response?
A. "All of you should return with your child's siblings so we can observe your family dynamics live." B. "We should find out what your child enjoys and create a behavioral rewards program for your child at home and at school." C. "It is important for us to consider which maladaptive thought processes are hindering your child." D. "Your child would benefit from being enrolled in a group with children trying to gain insight into their behaviors." E. "An individual therapist should begin to work on guided imagery and relaxation with your child." - ANSWER B. "We should find out what your child enjoys and create a behavioral rewards program
- Which of the following is the most common biological cause of prenatal neurotoxicity linked to the development of intellectual disability (mental retardation)?
A. Alcohol exposure B. Lead exposure C. Maternal diabetes D. Mercury exposure E. Radiation exposure - ANSWER A. Alcohol exposure
- Which of the following actions is most important for prevention of suicide in adolescence? A. Prescribe only antidepressants that are not lethal in overdose. B. Establish school-based suicide education program. C. Hospitalize all adolescents with suicidal ideation. D. Reduce availability of firearms in the home. E. Establish a teen crisis hotline. - ANSWER D. Reduce availability of firearms in the home.
