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COMPLETE 2020 CHILD PRITE FOR GRADLE
QUESTIONS WITH CORRECT ANSWERS
"1. A 16-year-old presents to a psychiatrist with concerning episodes of feeling detached from their body. During these times, the adolescent feels unreal, emotionally numb, and reports watching their body from outside in a dream-like state. There is no loss of consciousness with these episodes. The adolescent has no medical or psychiatric complaints and denies substance use. What is the most likely diagnosis? A. seizure disorder B. Dissociative identity disorder C. PTSD D. Borderline PD
E. Depersonalization/derealization disorder - CORRECT ANSWER E"
"2. Sexual minority youth may have additional struggles with respect to stigmatization when dealing with cultural, ethnic, or religious factors. These factors may result in delays in the development of sexual: A. behavior. B. orientation. C. milestones. D. identity integration.
E. group identification. - CORRECT ANSWER D"
"3. An FDA meta-analysis of antidepressant studies in children found suicide-related adverse events in 4% of those given medication, compared to 2% of those given placebo. The number- needed to harm by administering antidepressants found by this study is: A. 2 B. 4 C. 20 D. 25
E. 50 - CORRECT ANSWER E"
"4. An adolescent presents to an ambulatory clinic with new onset of abrupt vocalizations and bilateral complex movements, occurring several times a week, often during sleep, lasting 30- 60 seconds. The patient, who is otherwise healthy, reports highly aggressive and impulsive behaviors during these events, but is asymptomatic between events. Previous head computed tomography electroencephalography show no evidence of pathology. Which area of the brain is most likely impacted?
A. Frontal Lobe B. Parietal Lobe C. Occipital Lobe D. Temporal Lobe
E. Generalized Brain Process - CORRECT ANSWER A"
"5. According to cognitive psychology, negative emotional reactions to events that occur in individuals with depression are most likely caused by: A. automatic perceptions. B. level of cognitive ability. C. adverse childhood events. D. reinforced behavioral patterns.
E. genetic determinants of illness. - CORRECT ANSWER A"
"6. An eight-year-old is brought to the emergency department by his legal guardian after yelling during an argument, "Nobody loves me, so I'm just going to walk across the street and get hit by a car." The child was removed from his parents' care six months ago due to physical abuse and neglect. The child is passing all his subjects at school and is popular with peers. The child reports feeling sad and has auditory hallucinations telling him he is "no good." Which of the following is high on the differential diagnosis for this patient? A. Autism spectrum disorder B. Separation anxiety disorder C. Oppositional defiant disorder D. Post-traumatic stress disorder
E. Obsessive compulsive disorder - CORRECT ANSWER D"
"7. A 15-year-old has a family history of mood disorder and is struggling to develop a positive sense of self in the context of conflict with parents and academic difficulties. After a blow-up with parents, the teenager is referred for psychotherapy. The therapist focuses on resolving difficulties with the parents and extending the patient's social support network. Which of the following psychotherapeutic models is the therapist most likely using? A. Cognitive B. Behavioral C. Supportive D. Interpersonal
E. Psychoanalytic - CORRECT ANSWER D"
C. "If the school is not informed, the hospital will no longer be able to admit your child." D. "We will have to make a report to child protective services if you do not disclose the diagnosis." E. "Due to the potential dangerousness of not informing the school, we are obligated to share the
diagno - CORRECT ANSWER B"
"12. Which of the following symptoms is more common in adolescents with depression compared to younger children with the disorder? A. Irritability B. Melancholia C. Hallucinations D. Temper outbursts
E. Somatic complaints - CORRECT ANSWER B"
"13. An adolescent with insulin-dependent diabetes who is in treatment for medical non- adherence is pregnant. She wants to keep her pregnancy a secret and not inform her parents, citing the right to health care confidentiality. The physician feels obligated to inform the parents of the pregnancy. Which of the following concepts may justify the physician informing the parents of the pregnancy? A. Rights of the fetus B. Family-centered care C. Imminent danger to patient D. Parents must consent to care
E. Inability to document patient is a mature minor - CORRECT ANSWER C"
"14. In the mental status assessment, a unique component to evaluating infants may include observation for: A. speech. B. hyperactivity. C. affect regulation. D. feeding behaviors.
E. dysmorphic features. - CORRECT ANSWER D"
"15. During a routine visit to the pediatrician, the mother of a 24-month-old girl states that she has witnessed her daughter touching her vulva during baths. The mother asks if this behavior is cause for concern. How should the pediatrician respond? A. "This behavior is only atypical if done in a public setting." B. "Genital self-stimulation should raise concern for sexual abuse." C. "This behavior is only atypical if she displayed interests in other people's genitalia."
D. "Exploration of the body is a typical behavior at this age and there is no reason to be concerned." E. "Typically developing children do not begin to engage in genital self-stimulation until they are
older. - CORRECT ANSWER D"
"16. Which of the following rating scales provides a general screening of behavioral health symptoms that identifies risk for childhood psychiatric disorders in a primary care setting? A. Pediatric Symptom Checklist B. Patient Health Questionnaire- C. Mood and Feelings Questionnaire D. McMaster Family Assessment Device
E. Screen for Child Anxiety Related Disorders - CORRECT ANSWER A"
"17. The therapeutic effects of second-generation antipsychotic medications are partly mediated through action on which of the following receptor sites? A. 5-HT 1A B. 5-HT 1B/D C. 5-HT 2A D. 5-HT 2C
E. 5-HT 3 - CORRECT ANSWER C"
"18. In psychiatric billing, current procedural terminology codes refer to the: A. time required to perform the service. B. insurance to be billed for the service. C. diagnosis for which services are being billed. D. specific service delivered in a treatment session.
E. level of training of the clinician performing the service. - CORRECT ANSWER D"
"19. A 17-year-old patient with a diagnosis of bipolar disorder reports experiencing "fast" thoughts and high energy over the past week despite sleeping four hours nightly. The patient says her mood has been "really good" most of the time but admits to becoming irritable with her friends and boyfriend. She has been spending extra time on her schoolwork and is doing well academically. She was recently sent to the principal for being uncharacteristically rude towards her teacher. Parents note stability with lithium treatment; however, the patient has decided that her diagnosis is incorrect and that she doesn't need to take medications. Which of the following depicts the best first step in the management of this patient? A. Discontinue lithium and initiate an alternative mood stabilizer B. Provide education on coping skills to use in stressful situations
"24. A 14-year-old with a history of sexual abuse and depression is brought to the emergency department with passive suicidal ideations. During the interview, the patient shares that she superficially cuts her wrist and consumes alcohol with friends "to ease the pain" of her low mood. She has begun seeing a psychiatrist, however, has not been prescribed medication. She denies having, or ever having had, suicidal intent or plan. The psychiatrist elicits reasons for living from her and they create a safety plan. The psychiatrist also counsels the caregiver to restrict access to dangerous self-harm methods. Which of the following best describes an action that should be included as part of the therapeutic assessment and intervention in the emergency department? A. Create a "no suicide contract" with the patient B. Recommend that the patient obtain a new psychiatrist
C. Initiate lithium to address symptoms of depressio - CORRECT ANSWER D"
"25. A 15 years old individual raised by parents who are both physicians states from an early age his intention to attend medical school. Which identity status is this individual most likely demonstrating? A. Identity diffusion B. Identity foreclosure C. Identity moratorium D. Identity achievement
E. identity determination - CORRECT ANSWER B"
"26. A child is observed walking with small paces, a stooped posture, and reduced arm swing. When the examiner asks him to start and stop walking, the child appears to have difficulty with both actions. A lesion in which of the following brain regions is likely to contribute to this presentation? A. Spinal cord B. Basal ganglia C. Insular cortex D. Cerebral cortex
E. Cerebellar cortex - CORRECT ANSWER B"
"27. Which of the following is the primary role of orexin signaling in the regulation of sleep-wake cycles? A. Initiation of sleep B. Generation of a wakeful state C. Maintenance of a wakeful state D. Maintenance of a sleeping state
E. Coordination of sleep-wake states - CORRECT ANSWER E"
"28. Which of the following domains, not generally evaluated through routine psychological testing, would be assessed by a neuropsychological evaluation? A. Intellect B. Personality C. Sensory perception D. Emotional functioning
E. Academic achievement - CORRECT ANSWER C"
"29. The primary mechanism by which very young children learn therapeutic concepts through cognitive-behavioral play therapy is: A. modeling. B. avoidance. C. safety-seeking. D. positive reward.
E. negative reinforcement. - CORRECT ANSWER A"
"30. The goal of stimulus control in the psychosocial treatment of adolescents with substance abuse refers to which of the following? A. Building positive reinforcers for abstinence B. Withholding reinforcers when drug use occurs C. Assisting the teen to manage urges to use drugs D. Assisting the teen to avoid environmental stress
E. Assisting the teen in avoiding situations associated with drug use - CORRECT ANSWER E"
"31. At what age can a typically developing child first be expected to ride a tricycle? A. Two years of age B. Three years of age C. Four years of age D. Five years of age
E. Six years of age - CORRECT ANSWER B"
"32. In research using the Adult Attachment Interview, parents who have secure relationships with their children are most likely to be able to describe their own childhood experiences and relationships in which of the following ways? A. Demonstrating strong affect
A. Theory of mind B. Social referencing C. Object permanence D. Object conservation
E. Transitional phenomena - CORRECT ANSWER A"
"37. A clinician is consulted to see a school-age child for emotional outbursts. The child has a labile affect that is incongruent with speech content, and the clinician notes that the child's speech exhibits variable rhythm and intensity with periods of "explosive" speech. The child is otherwise attentive on interview. On neurologic assessment, the clinician notes that the child has a brisk gag reflex with subsequent intense crying and coughing. The child is also endorsing recent onset dysphagia although evaluation of the oropharynx is negative for pathology. Based on this assessment, the psychiatric symptoms are most likely A. bulbar palsy. B. multiple sclerosis. C. myasthenia gravis. D. pseudobulbar palsy.
E. conversion disorder. - CORRECT ANSWER D"
"38. Which of the following medications is known to worsen delirium in children? A. Propofol B. Clonidine C. Diazepam D. Melatonin
E. Olanzapine - CORRECT ANSWER C"
"39. If a child is determined by the special education committee to need services and requires an individualized education plan, which of the following must be adhered to? A. The plan has to be developed within 30 calendar days B. An evaluation is required every five years to determine continued eligibility C. A comprehensive review must be conducted and revised every two years D. The child can be mandated to change settings against the parent's will
E. The most restrictive setting should be tried first in order to maximize success - CORRECT
ANSWER A"
"40. An 11-year-old child with a history of attention-deficit/hyperactivity disorder, parent-child relational problem and depressive symptoms has been seen by a child and adolescent psychiatrist for the past two years. The psychiatrist learns that the parents have decided to
divorce after receiving a subpoena to appear in family court to provide testimony regarding custody of the child. The psychiatrist can provide testimony: A. only with a subpoena. B. after performing a separate forensic evaluation. C. after ensuring parents were notified to provide consent. D. in the form of a deposition in lieu of appearing in person.
E. as an expert and offer an opinion regarding custody of the child. - CORRECT ANSWER C"
“41. An abused child runs to hide in the bedroom closet at the sound of the garage door opening even though the abusive parent no longer lives in the home, and even though hiding never prevented the abuse when that parent was present. This fear response can best be explained with which of the following learning models? A. Incentive learning B. Operant conditioning C. Learned helplessness D. Classical conditioning
E. Contingency management - CORRECT ANSWER D"
"42. A child suddenly screams in the early part of the night with associated diaphoresis and tachypnea, lasting for 1-2 minutes. The child has no recall of the events the next day. These events are most associated with which of the following parasomnias? A. Nightmares B. Sleep terrors C. Sleep talking D. Confusional arousals
E. REM sleep behavior disorder - CORRECT ANSWER B"
"43. An emergency room physician evaluates a child with new-onset symptoms of obsessions and compulsions. The physician cannot determine a cause for the child's symptoms. Which of the following steps taken by the emergency room physician is considered lifelong learning? A. Obtain a psychiatry consult B. Pursue further medical evaluation C. Refer the patient to an outpatient psychiatrist D. Review evidence-based literature regarding the symptoms
E. Develop a committee to create a standard evaluation for mental illness - CORRECT
ANSWER D"
A. Babbling with consonant and vowel sounds B. Production of grunting, crying, and gurgling noises C. Inconsistent and unclear use of the first few words D. Starting to string words together in a very basic way
E. Using first words with reliable consistency and purpose - CORRECT ANSWER A"
"49. What is the primary goal of family therapy for oppositional defiant disorder? A Allowing the therapist to set limits with the child B. Monitoring for signs of abuse to ensure child safety C. Establishing a warm and mutually respectful relationship between parents and child D. Providing psychoeducation to the parents about features of oppositional defiant disorder E. Determining whether the family system has diffused or rigid boundaries with external systems
- CORRECT ANSWER C" "50. Which scale for attention-deficit/hyperactivity disorder (ADHD) in children has a validated version for the child to complete? A. ADHD Rating Scale- B. Conners 3rd Edition Rating Scale C. Vineland Adaptive Behavior Scales D. Swanson, Nolan, and Pelham-IV Rating Scale
E. Strengths and Weaknesses of ADHD Symptoms and Normal Behavior - CORRECT ANSWER
B"
"51. In equivocal sleep studies, CSF orexin levels of less than 110 pg/ml is most suggestive of which of the following sleep disorders? A. Narcolepsy B. Restless legs syndrome C. REM sleep behavior disorder D. Delayed sleep phase disorder
E. Advanced sleep phase disorder - CORRECT ANSWER A"
"52. Which of the following features would preclude a clinician from making a diagnosis of selective mutism? A. Diagnosis of social phobia B Symptoms occur in only one setting C. Symptoms have only occurred for six weeks
D. Patient maintains non-verbal communication
E. Symptoms occur during the first month of school - CORRECT ANSWER E"
"53. Several times in the space of a month, a seven-year-old child references a nanny that she last saw at the age of three. With respect to the child's emotional development, this is most consistent with which of the following? A. Anxious temperament in the child B. Pathological grieving over loss of the nanny C. Attachment difficulties with primary caregivers D. Attempt to rework the separation from the nanny
E. Reactivation of a prior loss after a more recent loss - CORRECT ANSWER D"
"54. Velocardiofacial syndrome, which has been repeatedly implicated in early-onset psychosis, is most often the result of what kind of genetic abnormality? A. Methylation B. Gene deletion C. Polymorphisms D. Trinucleotide expansion
E. Chromosomal translocation - CORRECT ANSWER B"
"55. Which of the following is the most commonly identified challenge when implementing a patient portal in a child and adolescent psychiatric practice? A. Maintenance of patient confidentiality B. Unwillingness of providers to participate C. Lack of adolescent interest in online resources D. Refusal by parents to allow adolescents access
E. Implementation difficulties within the electronic medical record - CORRECT ANSWER A"
"56. Which of the following is the most accurate statement regarding the diagnosis of male hypoactive sexual desire disorder? A. It often manifests during puberty B. Symptoms can be caused by distress in a relationship C. Symptoms must occur with the onset of sexual activity D. The diagnosis is most prevalent between the ages of 26 and 44
E. Symptoms must be present for at least 12 months to make the diagnosis - CORRECT
ANSWER A"
"61. "Juuling" has become a popular method of using nicotine in youth, and uses which of the following forms of delivery? A. Gum B. Cigar C. Patch D. E-cigarette
E. Chewing tobacco - CORRECT ANSWER D"
"62. An adolescent was admitted medically overnight for chronic abdominal pain that has persisted for nine months despite three previous hospitalizations. Physical examination, laboratory studies and imaging are all inconsistent with physical disease. The patient has stopped attending school for the past four months, and spends considerable time distressed about the seriousness of the pain and focusing on this impairment. What is the initial best step in supporting the care of this patient given the likely diagnosis? A. Explain that symptoms are due to anxiety and stress B. Inform the patient that psychiatric hospitalization is indicated C. Counsel patient on the need to return to school as soon as possible D. Convene a multidisciplinary informing meeting to review assessment and diagnosis
E. Provide reassurance that medical studies were normal and no further testing is needed -
CORRECT ANSWER D"
"63. A therapist using psychodynamic psychotherapy to treat a child is more likely to make use of which of the following interventions compared to when treating an adult? A. Passivity B. Neutrality C. Education D. Clarification
E. Interpretation - CORRECT ANSWER C"
"64. What defense mechanism also describes a sociobiological behavior aimed at proliferation of a species at the expense of an individual organism within that species? A. Altruism B. Introjection C. Idealization D. Identification
E. Reaction Formation - CORRECT ANSWER A"
"65. Which of the following would be considered an essential tool for population-based disease management? A. Stepped care B. Telemedicine C. Patient registries D. Direct care handoffs
E. Individual treatment plans - CORRECT ANSWER C"
"66. An adolescent female calls your office complaining of milky discharge from her breast after initiation of risperidone two weeks ago. Which of the following neuronal tracts is most likely implicated in the development of this side effect? A. Mesolimbic B. Nigrostriatal C. Mesocortical D. Tubero-infundibular
E. Retinohypothalamic - CORRECT ANSWER D"
"67. A school-age child with autism and attention-deficit/hyperactivity disorder is admitted to the medical floor for dehydration. For the past few weeks, the child has refused to eat except for oatmeal and macaroni and cheese. The child reports being worried about vomiting with other foods, as these foods "smell bad." The child denies body image disturbance or fear of gaining weight. Outpatient medications include guanfacine and methylphenidate. Which of the following is the most likely diagnosis? A. Specific phobia B. Anorexia nervosa C. Obsessive-compulsive disorder D. Stimulant-induced eating disorder
E. Avoidant-restrictive food intake disorder - CORRECT ANSWER E"
"68. According to Kohlberg's theory, a boy who regularly exhibits conventional, Stage 3 moral judgment would determine morality based on which of the following principles of thinking? A. "I should follow the rules to avoid punishment." B. "I should follow the rules but there may be exceptions." C. "I should follow the rules because a peaceful society requires it." D. "I should follow the rules because it is fair and the other boys did."
E. "I should follow the rules because that's what good boys do in my family." - CORRECT
ANSWER DE"
D. Independent - CORRECT ANSWER B"
"74. Which of the following best summarizes the core aim of the Health Information Technology for Economic and Clinical Health Act of 2009? A. Penalize systems of care for failing to adopt technologically based interventions for patients B. Increase privacy protections for the use of technology in health care by increasing penalties for breaches C. Incentivize the adoption and meaningful use of health information technology, particularly electronic health records D. Improve diagnostic accuracy through big data synthesis of patient information and
dissemination to practitioners - CORRECT ANSWER C"
"75 Which of the following genetic factors was first identified as possibly protective in children who have experienced early maltreatment? A. Low numbers of D2 receptors B. High levels of the monoamine oxidase A enzyme C. A genotype with a duplication of the MECP2 gene
D. Deficiency in the aldehyde dehydrogenase enzyme - CORRECT ANSWER B"
"76. From a systems of care perspective, which of the following components are integral to developing an empirically based "wraparound" process for individuals with serious emotional disturbances? (Select three) A. Skill mentorships B. Process driven care C Community-based care D. Problem-focused solutions E. Generalized service delivery F. Strength-focused opportunities G. Categorical mental health funding
H. Provision of care based on established conditions - CORRECT ANSWER ACF"
"77. Which of the following factors are most important in developing a strong therapeutic alliance for a telepsychiatry visit? (Select three) A. Dark room B. Hand signals C. Erect posture D. Large gestures E. Monotone voice
F. Nodding frequently G. Using the phrase "tell me more"
H. Visually interesting background - CORRECT ANSWER BCF"
"78. The mother of an adolescent with severe generalized anxiety disorder asks the psychiatrist if it would it be a good idea for the adolescent to be started on benzodiazepines for anxiety since they had been very helpful to treat her own anxiety. She asks the psychiatrist for the current scientific opinion on the use of benzodiazepines in childhood anxiety. Which of the following would be appropriate responses? (Select three). A "There is risk of dependency in teenagers treated with benzodiazepines." B. "The most common adverse effect in adolescents is paradoxical hyperactivity." C "Benzodiazepines are sometimes used in youth to acutely reduce severe anxiety." D. "Benzodiazepines are FDA-approved for the treatment of childhood sleep disorders." E. "There is a relative paucity of studies examining the use of benzodiazepines in youth."
F. "Benzodiazepines have been approved by the FDA for treatment of childhoo - CORRECT
ANSWER ACE"
"79. A seven-year-old child with attention-deficit/hyperactivity disorder struggles to read and perform academically at grade level. The parents would like the child to have an Individual Education Plan (IEP) at school. The psychiatrist recommends that they write a letter requesting an IEP. Which of the following components are important to get the school to initiate an IEP evaluation for a learning disability? (Select 3) A. The child has impaired motor skills B. The child is culturally disadvantaged C. The child has below average intelligence D. The child is attending a disadvantaged school E. The child's primary language is other than English F. Vision problems have been ruled out by a professional G. The child has failed high quality interventions to learn to read
H. Emotional factors for inhibiting learning are ruled out by psychiatrist - CORRECT
ANSWER FGH"
"80. In order to maintain an ABPN certification, child psychiatrists must complete or have which of the following? (Select three) A. Follow practice guidelines B. Unrestricted license to practice C. Complete self-assessment modules D. Provide outcome data on select patients E. Complete performance in practice modules
