Lange q&a psychiatry 11th edition pdf free download

Lange q&a psychiatry 11th edition pdf free download

Lange Q&A Psychiatry 11E,Lange Q&A Psychiatry 11th Edition PDF Free Download

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A Bu p rop ion Wellbu trin A Dry m ou th B Du loxetine Cym balta B H yp otension C Methylp henid ate Ritalin C N au sea D Mixed am p hetam ine salts Ad d erall D Sed ation E Valp roic acid Dep akote E Trem or. Questions 59 and 60 The p arents bring in the boys 7-year-old An 8-year-old boy is brou ght to you r office by his brother for evalu ation. After fu rther history m other for evaluation of an u pp er resp iratory infec- is obtained , he is d iagnosed w ith attention- tion. Which w etting the bed again.

In ad d ition, she m entions of the follow ing classes of med ications w ould that the boys grand m other d ied recently and w on- be the most appropriate choice for the brother? d ers if this is affecting him. A Antip sychotic B Monoam ine oxid ase inhibitor MAOI At w hich of the follow ing ages w ou ld a child C Serotonin-sp ecific reu p take inhibitor norm ally be able to ap preciate that d eath is SSRI irreversible? D Stim ulant A 2 years E Tricyclic antid epressant TCA B 3 years C 5 years A 6-year-old boy is brou ght to the em ergency D 7 years d ep artm ent by his m other, w ho reports that E 12 years he w as p laying on som e step s in front of the hou se w hen he slip p ed and fell.

She tells Which of the follow ing d efense m echanism s you that she is concerned that he m ight have is the boy m ost likely em p loying w hen he is broken his arm. An x-ray of the boys arm w etting the bed? show s a fracture of the u lna, as w ell as signs of several old fractures of varying ages. Which of A Acting ou t the follow ing is the m ost app rop riate cou rse B Denial of action? C Regression A Recom m end calcium su pp lem ents and a D Repression m ultivitam in d aily. E Som atization B Refer the boy to an orthoped ist for fu rther evalu ation.

C Set the cu rrent broken bone in a cast and have the boy see his p ed iatrician for follow -u p care. D Tell the boy that you notice that he has C N eu rology consu lt had m u ltip le broken bones and ask him D Pu lm onary function tests how each of these fractures happened. E Routine laboratory stu d ies E Tell the m other that you notice that the boy has had m ultiple broken bones A 5-year-old girl d iagnosed w ith lu pu s is seen and recom m end that she lim it the boys by her fem ale p ed iatrician for a rou tine visit. sports activities. After retu rning hom e from the clinic, the girl asks her friend to p lay d octor. Which of the Th e m oth er of a 6-year-old boy calls an d follow ing d efense m echanism s best d escribes asks you for ad vice. She says th at h er son this behavior? still su cks his th u m b, an d sh e is concerned abou t th is beh avior.

Wh ich of th e follow - A Displacem ent in g su ggestion s for h er to d o is th e m ost B Dissociation ap p rop riate? C Id entification A Ask the d entist to construct a m outh D Rationalization ap p liance that w ill d eter su cking. E Reaction form ation B Coat her sons thum b in hot pepper sauce. Questions 68 and 69 C Give him gu m frequ ently. A year-old girl w ith a history of asthm a is D Ignore the behavior. brou ght to the clinic after a recent increase in her E Im p lem ent a behavioral system to asthm a sym p tom s. Du ring the visit, you learn that rew ard stop p ing.

she is being physically beaten by her m others boy- friend on a regu lar basis. Questions 65 and 66 Und er w hich of the follow ing circu m stances A year-old girl presents to her pediatrician com- d oes the law requ ire m and atory rep orting by plaining that she has been freaking out. The girl a p hysician of su sp ected child abu se? describes episodes of shaking, gasping for air, and feeling like she is going to die. The feelings intensify A In all cases for a few minutes and resolve spontaneously. These B Only in cases in w hich the child show s episodes have occurred at various times, in various sit- behavioral m anifestations of abu se.

uations, and the girl is worried that she is going crazy. C Only w hen consent of a p arent or A complete history and physical examination does not gu ard ian is obtained. reveal any further relevant symptoms or signs. D Only w hen the p hysician believes it is in a child s best interest. Which of the follow ing is the m ost app rop riate E Only w hen the p hysician has exam ined p harm acologic treatm ent? all child ren in the fam ily. A Arip ip razole B Carbam azep ine Which of the follow ing m anifestations w ou ld be the m ost likely ou tcom e of the abu se?

C Du loxetine D Sertraline A Aggression E Valp roic acid B Dissociative d isord er C Generalized anxiety d isord er Prior to prescribing m ed ications, w hich of the D Major d ep ressive d isord er follow ing shou ld the p ed iatrician ord er next? A 4-year-old boy is referred to you becau se he An 8-year-old boy is brou ght in by his m other w ill not sp eak in p reschool. Over the cou rse of w ho com p lains that she cannot get her son to abou t 2 m onths, he grad u ally stop ped talking. listen to her. She is fru strated becau se he fre- H is m other rep orts that he initially objected quently ignores her requ ests and instru ctions. to going to preschool, but now no longer Consid eration is given tow ard the d iagnosis of com plains. She states that at tim es her son is oppositional d efiant d isord er ODD. Which qu iet and stays in his room , bu t that she has of the follow ing featu res w ou ld best sup port not otherw ise noticed a significant change in the d iagnosis in this child?

his sp eech or behavior. Which of the follow ing A Aggression to p eop le is the m ost likely d iagnosis? B Dep ressive sym p tom s A Major d ep ressive d isord er MDD C Disobed ience tow ard teachers B Persistent d ep ressive d isord er D Lack of p articip ation in tasks requ iring d ysthym ia attention C Selective m u tism E Violation of ru les D Sep aration anxiety d isord er E Social anxiety d isord er social p hobia A year-old girl is seen by her p sychiatrist 1 year after an au tom obile accid ent. A 2-year-old boy is referred to you for evalu - onstrates intact langu age ability and com plex ation d u e to the su sp icion that the child is m otor skills.

She has no id entifiable abnor- the victim of abu se second ary to factitiou s m alities in the perception of stim uli, bu t she d isord er im posed by another. Which of the has lost the ability to read since the accid ent. follow ing fam ily m em bers is the m ost likely Which of the follow ing d eficits is she m ost p erp etrator fabricating the illness? likely d em onstrating? A Father A Agnosia B Brother B Alexia C Mother C Anom ia D Sister D Ap hasia E Uncle E Ap raxia. A fru strated m other brings her year-old son A year-old girl w ithou t significant m ed ical to a child p sychiatrist after he is expelled from history is brou ght by her father to the p ed ia- three high schools in 1 year.

She reports the trician for evaluation. Over the past school boy has tried tw ice to set his school on fire, has year, she has been having increasing d ifficu l- slashed school bus tires, and has broken into ties going to sleep. Althou gh she has alw ays the principals office to steal athletic trophies. had bed tim e ritu als, they have extend ed in In ad d ition, he has been su sp end ed nu m er- com plexity and length. Most of her tim e in ou s tim es for getting into fights w ith other the evening is now spent going arou nd the stu d ents. She shu d d ers and tearfully relates hou se nu m erou s tim es, locking and u nlock- that she recently caught him singeing one of ing the d oors and w ind ow s.

While she know s the fam ily cats w ith a cigarette butt. Which the chances of a bu rglary are slim , she is of the follow ing p ersonality d isord ers is this extrem ely anxiou s abou t her safety, and she boy m ost at risk of d evelop ing in the fu tu re? cant stop the u rges to perform these behav- iors. As a resu lt, she only obtains 5 hou rs of A Antisocial sleep, and she has been falling asleep in class B Bord erline w ith d im inishing grad es. Which of the follow - C H istrionic ing therap eu tic interventions is consid ered the D Obsessive-com p u lsive first-line treatm ent for this d isord er? A Cognitive-behavioral therapy CBT interp reting social cu es and u tilizes less com - B Fam ily therapy p lex sp oken langu age, is able to retain basic C Grou p therap y langu age for social com m u nication.

H e can care for his basic personal need s after exten- D Short-term psychod ynam ic therapy sive teaching, bu t w ou ld eventu ally requ ire E Supp ortive therapy consid erable su pport from co-w orkers and sup ervisors to m anage responsibilities in the D IRECTION S Questions 76 through 93 : The fol- fu tu re. low ing group of numbered items are preceded by a list of lettered options. For each question, select the one lettered option that is most closely asso- Questions 80 through 83 ciated w ith it. Each lettered option may be used Match the m ost likely d isord er w ith the appropriate once, multiple times, or not at all. p atient. Questions 76 through 79 A Anorexia nervosa B Au tism sp ectru m d isord er Match the severity level of intellectual d isability w ith C Bu lim ia nervosa the patients ad aptive functioning.

D Binge eating d isord er A N o intellectu al d isability E Illness anxiety d isord er B Mild intellectu al d isability F Interm ittent exp losive d isord er C Mod erate intellectu al d isability G Obsessive-com p u lsive d isord er D Severe intellectu al d isability H Panic d isord er E Profou nd intellectu al d isability I Pica J Pyrom ania A year-old boy w ho has lim ited attainm ent of conceptual skills, has sp oken language lim - K Tou rette d isord er ited to single w ord s or p hrases, requ ires su p - L Trichotillom ania p ort for all activities of d aily living, requ ires sup ervision at all tim es, and w ho cannot m ake A year-old girl w ith ep isod es of palpita- resp onsible d ecisions regard ing the w ell-being tions, chest p ain, shortness of breath, and of others. d iaphoresis w ho has a norm al physical and laboratory exam inations. An 8-year-old girl w ho has no obviou s d eficits in learning, is equ ally m atu re as her p eers, is A year-old overw eight girl feels a loss of able to perform d aily living tasks w ithout su p - control w hen she qu ickly consum es large p ort, and has sou nd ju d gm ent.

am ou nts of food , d enies heavy exercise, vom - iting or laxative u se afterw ard s, and feels significant guilt and sham e regard ing her An year-old boy w ho has d ifficu lties in behavior. acad em ic skills of w riting, read ing, and m ath, is im m atu re in social situ ations, and w ho has d ifficulties w ith regu lating em otions and An 8-year-old boy w ith erythem atou s, behavior in age-ap p rop riate fashion. While he chapped hand s, and an otherw ise norm al is able to p rovid e his ow n p ersonal care, he p hysical and laboratory exam ination. requ ires su p p ort in m ore com p lex d aily living tasks, ju d gm ent, and organization. A year-old girl w ith a bald p atch on the back of her head and an otherw ise norm al A year-old boy w hose concep tu al skills p hysical and laboratory exam ination.

Questions 84 through 87 Establishing tru st in the w orld throu gh resp onsiveness and em p athy of a caregiver. Match the m ost likely d isord er w ith the appropriate patient. B Au tism sp ectru m d isord er C Generalized anxiety d isord er The d evelop m ent of the ability to think abou t D Langu age d isord er and m anipu late id eas abstractly. E Selective m u tism F Social anxiety d isord er The d evelop m ent of the ability to ap p ly rea- G Social p ragm atic com m u nication soning so that the child is not lim ited only by d isord er p ercep tions. the multiple-choice questions in this section, select the lettered answer that is the one best response in A 9-year-old boy w ho frequ ently blu rts ou t each case. com m ents in class w ithou t w aiting his turn to be called on.

A year-old girl is brou ght to you by her m other because of d ropping grad es, apathy, and p oor m otivation. You learn that she has A 7-year-old boy w ho p erform s w ell in school recently started sm oking m ariju ana on a althou gh seem s to talk as if reciting a m ono- regu lar basis. Which of the follow ing p atterns logu e rather than interacting in conversation w ou ld m ost su p p ort the d iagnosis of cannabis and generally avoid s other child ren, bu t d oes u se d isord er, severe? not d isplay rep etitive or restricted interests. A Over 12 m onths, u sing m ore than An 8-year-old boy w ho is having d ifficu lty in intend ed and being u nsu ccessfu l at school and avoid s interactions w ith his class- stopp ing, w ith a loss of her sum m er job m ates and others for fear of em barrassm ent.

and legal consequ ences from her u se. B Over 12 m onths, having cravings to u se, spend ing significant tim e obtaining Questions 88 through 93 m arijuana, and m issing school in ord er Match the age range w ith the corresp ond ing d evel- to sm oke. opm ental m ilestone. C Over 12 m onths, continu ing to use d esp ite recu rrent argu m ents, being A Infant m onths high w hile d riving, u sing d espite B Tod d ler m onths know ing it is affecting her m otivation, C Preschool age 36 years need ing increased am ounts to get the D School age years sam e high, and having ongoing E Ad olescence years cravings w hen not u sing. D Over 18 m onths, sm oking by herself bu t Focu s on follow ing the ru les. need ing to sm oke m ore to achieve the sam e effect. Establishing self as au tonom ou s, sep arate E Over 18 m onths, sm oking m ost d ays from caregiver, by p racticing leaving and p er w eek, m ultip le tim es p er d ay, and retu rning to the caregiver.

d eveloping w ithd raw al sym ptom s once the m ariju ana is stopped. As the school p sychologist, you are asked to C N orm al variant in acad em ic attainm ent see a fou rth grad er w ho has been consistently D Post-trau m atic stress d isord er PTSD acting out in class. H e often lies abou t things E Vision d eficit he has d one in class, such as trying to cheat on tests, and he physically bu llies you nger A 7-year-old girl is brou ght to the p ed iatri- child ren. You learn that at hom e he practices cian d u e to w eight loss. She has been grad u - shooting his BB gu n at squirrels as w ell as ally refu sing food s over the p ast several w eeks at the fam ily d og. H e exp resses no concern to the point she is now barely even d rinking for these creatu res nor rem orse at his behav- su pplem ental shakes.

This has resu lted in sig- ior. Which of the follow ing is the m ost likely nificant w eight loss and fatigu e. The girls tells d iagnosis? you she is aw are she is losing w eight, that she A Au tism sp ectru m d isord er w ou ld like to fit into the ou tfits she has, bu t B Bip olar d isord er that she is afraid of vom iting if she eats the w rong thing. Physical exam ination reveals a C Child hood onset schizop hrenia child in the 5th p ercentile of w eight, w hile her D Cond u ct d isord er baseline had p reviou sly been in the 30th per- E Op p ositional d efiant d isord er centile, and basic laboratory stu d ies reveal a m ild m icrocytic anem ia.

Which of the follow - An 8-year-old boy is brou ght to the p ed iatri- ing is the m ost likely d iagnosis in this case? cian for concerns that he has significant tan- tru m s. C Binge eating d isord er H is parents note that the fam ily w alks on egg- D Bu lim ia nervosa shells to p revent setting him off, and they are E Sp ecific p hobia starting to feel held hostage by his chroni- cally irate m ood. They believe this change in A 7-year-old boy is brou ght to the p ed iatri- behavior started a year ago, bu t has m arked ly cian becau se, for the p ast 6 m onths, he has w orsened in the p ast several w eeks.

Which of been telling his m other that he is a girl. Ini- the follow ing is the m ost likely d iagnosis? tially his parents felt this w as a p hase, bu t A Bip olar d isord er the patient has becom e increasingly d istressed B Disru p tive m ood d ysregu lation d isord er and m ore insistent that he hop es his breasts DMDD w ill grow d u ring p u berty. H e has been p u t- ting on his old er sister s clothing, and prefers C Generalized anxiety d isord er p laying w ith her d olls rather than engaging in D Major d ep ressive d isord er MDD rou ghhou sing w ith his p eers. H e has rep eat- E Op p ositional d efiant d isord er ODD ed ly stated he d islikes his p enis and w ishes he never had one.

Physical exam ination reveals A healthy year-old stu d ent, w ho started norm al m ale genitalia of the app rop riate Tan- school in the United States after fleeing a ner stage. Based on this inform ation, w hich of w ar-engulfed region 1 year ago, is struggling the follow ing is the m ost likely d iagnosis? to keep up in her classes, m ore so w ith Eng- lish than m ath. Which of the follow ing best A Bod y d ysm orp hic d isord er explains w hy her d ifficu lty is not d u e to a B Delu sional d isord er learning d isability?

C Su icid e is a consid erable risk in d ep ressed be ad m itted to a hosp ital, since she d oes not ad olescents, and shou ld be sp ecifically ap p ear at im m inent risk of self-harm. Cer- ad d ressed d u ring an interview w ith a p atient tainly, w aiting m ore than that w ithou t any w ho ap p ears d ep ressed or agitated , or has a intervention w ou ld be inad equ ate and inap - history of a su icid e attem pt. The ad olescent p ropriate. She w ou ld likely benefit from m ed - su icid e rate has increased substantially d u r- ication m anagem ent, so a p sychiatrist w ou ld ing the p ast few d ecad es. Male gend er, a p rior be p referable to a social w orker in this situ a- su icid e attem pt, history of psychiatric illness, tion, bu t therapy w ou ld also be appropriate fam ily history, and su bstance u se are all risk concurrent treatm ent. factors for a com p leted su icid e. A history of a p rior su icid e attem p t is the largest risk fac- 3. D The Diagnostic and Statistical M anual of tor for suicid e for both m ales and fem ales in M ental Disorders, Fifth Edition DSM -5 recog- all age grou ps, and the m ajority of those w ho nizes N REM sleep arou sal d isord ers of tw o com plete su icid e have attem pted su icid e in types: sleep w alking typ e and sleep terror the p ast.

Both are characterized by recu rrent epi- m it suicid e have com orbid psychiatric illness, sod es of incom plete aw akenings from sleep, frequ ently m ajor d ep ression. Althou gh cu t- u su ally in the first third of the m ajor sleep ting behavior is concerning in ad olescents, it ep isod e, w ith am nesia for the ep isod es, no or is not necessarily associated w ith the intent little recollection of d ream im agery, and resu l- to kill oneself. More girls than boys d em on- tant im pairm ent or d istress. Sleep terror type strate su icid al behavior and attem pts, bu t at involves rep eated ep isod es of su d d en aw ak- least three tim es m ore teenage boys com p lete ening from sleep accom p anied by p anic sym p - su icid e than d o teenage girls. This is becau se tom s that begin w ith a scream ; it is associated boys m ore frequ ently u se gu ns and other w ith u nresp onsiveness to com fort or attem p ts violent m ethod s to attem p t suicid e.

to aw aken the child. Attacks typically last just a few m inu tes and are often m ore d istressing 2. C Given the ad olescents history of d ep res- to the caregiver, as the patient d oes not recall sion and risk factors of su bstance use and them in the m orning. N REM sleep arou sal fam ily history, it is im p ortant to initiate d isord er, sleep -w alking typ e, involves the ap prop riate treatm ent for her qu ickly. Given child sitting up or leaving the bed but is not the severity of her d epression in the p ast, and accom p anied by terror or au tonom ic arou sal. d ecline now , it is reasonable to initiate anti- N ightm are d isord ers occu r in the latter third d ep ressant treatm ent at this visit w ith close of the night and d u ring REM sleep , in con- follow -u p.

While it w ou ld be op tim al for a trast to sleep terrors. When aw akened , the p sychiatrist to evalu ate her as soon as possible ind ivid u al qu ickly becom es oriented , u nlike and a referral is ap propriate, the w ait in get- other parasom nias w here the ind ivid ual is ting to a specialist psychiatrist shou ld not d isoriented , confu sed , and d ifficu lt to arou se. d elay care. She d oes not necessarily need to Interm ittent exp losive d isord er d oes not occu r. d uring sleep and involves outbursts of anger acad em ic fu nctioning.

There is no ind ication and som etim es violent behavior. N arcolep sy that this child has d ifficulties w ith speech is characterized by the triad of sleep attacks, p rod u ction i. As there are sleep paralysis, as w ell as a hypocretin d efi- no d istu rbances in the flu ency and p attern of ciency. speech, a d iagnosis of child hood -onset flu - ency d isord er stu ttering is inap p rop riate. C Ep isod es of sleep terror, as w ell as of sleep - Social pragm atic com m u nication d isord er is w alking, occur d u ring d eep sleep stages characterized by persistent d ifficu lties in the N ightm are d isord er occurs d uring REM sleep. social use of verbal and nonverbal com m u- nication, for instance im p airm ents in greet- 5. E This patient is su ffering from a m ajor ings, inability to change com m u nication to d ep ressive d isord er MDD , single episod e. A a given context, d ifficu lties follow ing ru les selective serotonin reu ptake inhibitor SSRI for conversation or story-telling, or d ifficu l- such as sertraline is a first-line agent for MDD ties in u nd erstand ing w hat is inferred but not in child ren and ad olescents.

Tricyclic antid e- overtly stated. This child is able to appropri- p ressants TCAs su ch as im ip ram ine cau se ately m od u late verbal com m u nication, bu t his m ore ad verse effects than SSRIs typically d o, d ifficu lty is in the expression of verbal cues. and in overd ose are m u ch m ore likely to be There m ay be a com orbid learning d isord er, lethal. Mood stabilizers su ch as carbam aze- but at this time, there is insufficient information p ine and lithiu m are u sed for bipolar d isor- to m ake that d iagnosis. der and as adjuncts to the treatment of MDD refractory to antidepressant medications alone. C Sp eech d elay refers to exp ressive langu age Antipsychotics such as olanzapine are usually d evelop m ent and nu m ber of w ord s spoken. reserved for use as adjuncts when psychosis The average nu m ber of w ord s a 2-year-old develops or in bipolar disorder. sp eaks is w ord s.

Therefore, the inability to sp eak w ord s by age 3 w ould constitu te 6. D In the DSM -5, m ajor d epressive d isord er a speech d elay. requ ires a d epressed m ood for at least 2 w eeks for ad ults to receive the d iagnosis, but in the 9. E It is m ost likely that the boy u sed illicit case of child ren and ad olescents, an irritable substances d u ring his trip that caused him mood may substitute for having a d epressed to experience the acute psychotic sym ptom s. The required symptoms that involve While it is im p ortant to ru le ou t other m ed i- sleep, appetite, anhed onia, concentration, and cal cau ses, su bstance use w ould be the m ost psychomotor functioning are the same for likely. Seizu re d isord ers, head inju ries, d ia- ad ults and ad olescents w hen diagnosing major betes, and thyroid d isease often w ou ld be d epressive d isord er. accom p anied by other sym p tom s in ad d ition to the new onset psychosis.

B This boy m ost likely su ffers from langu age d isord er. Langu age d isord er is characterized B While a su bstance-ind u ced state rem ains by p ersistent d ifficu lties in the acqu isition and p ossible d u e to the large nu m ber of su bstances u se of langu age d u e to d eficits in com prehen- that cannot be confirm ed by u rine toxicology sion receptive or prod u ction expressive. screens, it is im portant to consid er that this Typ ical sym p tom s inclu d e having a m ark- instance of p sychosis is a m anifestation of an ed ly lim ited vocabu lary, m aking errors in u nd erlying m ood d isord er, m ost likely bipolar tense, and having d ifficulty recalling w ord s d isord er.

In ad d ition to an elevated or irritable or prod u cing sentences w ith d evelopm entally m ood , the d iagnosis of bip olar d isord er neces- ap propriate length or com p lexity. d ecreased need for sleep, increase in talkative- situ ations, w ith exp osu re causing intense ness, objective or su bjective flight of id eas, anxiety. Finally, a d iagnosis of specific phobia d istractibility, increase in goal-d irected behav- w ould require the display of marked and per- iors, and engagem ent in p otentially high-risk sistent fear cued by the presence of anticipation behaviors. Mania in bip olar d isord er can often of a specific object or situation. p resent concu rrently w ith psychotic sym p - tom s includ ing hallu cinations, d elu sions, and B Child ren w ith p arents w ho have a history d isorganized thinking. Anorexia nervosa an of an anxiety d isord er are at increased risk for eating d isord er and generalized anxiety d is- d evelop ing an anxiety d isord er them selves.

ord ers d o not p resent w ith psychotic sym p- Other risk factors for d eveloping a child - tom s. Ind ivid u als w ith bord erline personality hood anxiety d isord er inclu d e p arents w ho d isord er m ay have p sychotic-like sym ptom s, have an anxiou s, overly controlling, or reject- esp ecially w hen they are regressed , bu t they ing style, an insecu re attachm ent w ith ones are m u ch m ore likely to p resent w ith d ep res- p rim ary caregiver, and an inhibited and shy sion, suicid al thinking, and su bstance u se. tem peram ent. While p sychotic featu res can accom p any m ajor d ep ressive d isord er, the d ep ressive B These sym p tom s are consistent w ith a sym ptom s occu r first, and psychotic sym p- m anic ep isod e of bip olar d isord er. Major C This boys behavior and sym p tom s are d ep ression m ay have psychotic sym ptom s m ost consistent w ith sep aration anxiety d isor- if severe, bu t it w ou ld not p resent w ith an d er, characterized by d evelop m entally inap- inflated m ood or increased energy.

Panic p rop riate and excessive anxiety concerning d isord er w ou ld present w ith recu rrent panic separation from the hom e or from those to attacks and significant anxiety. Although w hom the ind ivid u al is attached. at school. The boy is not suffering from PTSD becau se there is no evid ence of a trau m atic C Cocaine is a stimu lant and can prod u ce event that is p ersistently re-exp erienced or both manic and psychotic sym ptoms. Alco- has cau sed sym ptom s of increased arou sal hol, cannabis, heroin, and PCP ingestion can and avoid ance of associated stim u li. For a ind uce a psychotic state includ ing hallucina- d iagnosis of reactive attachment d isord er, tions and paranoia, bu t it w ou ld not classically the boy w ould need to have su ffered m ark- be accompanied by manic symptom s.

ed ly d istu rbed social related ness, in m ost contexts, beginning before the age of 5 years, E This boy likely has ODD. ODD is an exter- and display a pattern of inhibited , w ithd raw n nalizing behavior d isord er that involves a p at- behavior toward caregivers. A related disorder, tern of hostile and d efiant behavior. Child ren d isinhibited social engagem ent d isord er, also w ith ODD are often angry, argu m entative, stem s from significant neglect or d eprivation and easily annoyed by others. In ord er to con- and results in child ren d isp laying a m ark- firm the d iagnosis, you w ou ld need to gather ed ly overfam iliar ap p roach and com fort w ith ad d itional inform ation regard ing the length strangers. The boys sym p tom s are not con- of tim e the behavior has been present at least sistent w ith social anxiety d isord er social 6 m onths is requ ired , as w ell as rule ou t a p hobia becau se he d oes not have a m arked m ood , p sychotic, or su bstance u se d isord er.

tension, irritability, and even noncom pliance behaviors su ch as ind u ced vom iting, laxative, w hen a child is p laced in a new situ ation su ch or d iu retic use. A hypokalem ic-hypochlore- as a d octors office , this child d oes not ap p ear m ic alkalosis d u e to vom iting is a p ossible to have anxiety in places w here escape m ay seriou s find ing that can contribute to a card iac be d ifficu lt in the event of a p anic attack su ch arrhythm ia. Anem ia as op p osed to increased as in agorap hobia , nor excessive w orry abou t iron can be seen, as w ell as d ecreased p rotein. a nu m ber of events su ch as in generalized The red u ced chlorid e can lead to elevated anxiety d isord er. While the p atients p resent- sod ium d u e to sod ium resorption. Becau se ing sym p tom s are not p rim arily involving of these changes, it is im portant to m onitor inattention, d istractibility, or hyp eractivity bu lim ic p atients for electrolyte and acid base consistent w ith ADH D, there is consid erable im balances.

com orbid ity betw een ADH D and ODD. H is lack of violence or seriou s violation of ru les A Bulimia nervosa is most effectively treated is not consistent w ith cond u ct d isord er; how - w ith cognitive-behavioral therapy. Family ther- ever, ODD esp ecially if u ntreated m ay lead apy, group therapy, and longer-term, insight- to cond uct d isord er over tim e. oriented therapies such as psychoanalysis and psychod ynamic psychotherapy may be used A This patient appears to be suffering from as adjuncts to cognitive-behavioral therapy, bulim ia nervous, an eating d isord er character- but they have not been demonstrated to be as ized by episod es of bingeing and compensa- effective in changing the behaviors associated tory behaviors e. Signs of bulim ia w ith bulimia nervosa. nervosa includ e erosion of tooth enamel caused by acid ic vomitu s as w ell as abrasions D When engaging a child in a clinical set- on the d orsu m of the hand d u e to scraping by ting, it is im portant to choose w ord s carefu lly the u pper teeth as the ind ivid ual pushes the in ord er to establish an op en, tru sting connec- hand to the back of the throat to ind u ce vom it- tion, especially w ith a troubled and resistant ing.

As it is not a secret that the abrasions are child. It is p referable to initiate the interview there, but the patient has not mentioned them, w ith m ore op en-end ed rather than closed - a d irect bu t open-end ed statement, such as, end ed qu estions. The qu estions shou ld op ti- Tell me about the scratches on your hand , m ally reflect em p athy for the child and their is most likely to be helpful in this situation. situ ation w ithout ap pearing too sentim ental Usually, a patient appreciates a d irect ques- or jud gm ental. Also, it is im portant to avoid tion rather than w ond ering if you ignored or assu m ptions abou t the p atients feelings w ith- d id not notice something obvious. Questions ou t checking w ith the patient first. The state- su ch as, Do you scratch you rself? or, Do m ent, You su re w ere lu cky the car sw erved you have a cat?

are not open-end ed ; they at the last m inute assu m es the boy w anted require yes or no answ ers and are unlikely to avoid being hit by the car, and also is a to yield new information. Are you trying to com m ent that d oes not lead to any elabora- hurt you rself? or H ow d id the scratches tion from the p atient. Statem ents B and C happen? m ay sound accu satory; patients are are both ju d gm ental and m ore likely to shut more likely to offer information if you seem d ow n conversation than facilitate it. Also, ask- nonjud gmental. If this girl d oes not volu nteer ing a child if they are confu sed is a close-end ed inform ation that confirm s to you that she is qu estion that com es across as cond escend ing.

not ind ucing vom iting, you may need to u se a more d irect bu t reassuring statement su ch as, D Psychom otor agitation is m ore com m only Som etimes I see girls w ho make them selves seen in child ren w ith MDD com pared to ad o- throw up. H ave you ever d one that? lescents w ith MDD. Child ren w ith MDD m ay ap p ear m ore anxiou s and irritable than sad D Med ical com p lications can arise for and d ep ressed. com m only seen in ad olescents w ith MDD a separate criterion. While ASD is more com- com pared to child ren w ith MDD. mon in males, it d oes exist in fem ales. ID m ay be comorbid w ith ASD, but m ust be separately B Suffocation e. ID is characterized by intellectu al and mon m ethod for attem pting suicid e in ind ivid - functioning d eficits in conceptual, social, and uals u nd er 15 years of age.

Su bstance ingestion practical d omains. Rett synd rome is seen only is another comm on m ethod. While firearms in fem ales and is characterized by normal pre- are used less frequently, they are more often natal and perinatal d evelop ment, normal head lethal. Other m ethod s of suicid e frequently circum ference at birth, and normal p sychom o- attempted by child ren inclu d e stabbing, cut- tor d evelopment throu gh the first 5 m onths ting, jum ping from build ings, ru nning in front of life. Betw een the ages of 5 and 48 months, of vehicles, and gas inhalation. Some su icid e there is d eceleration of head grow th, loss of attempts m ay be m istaken for accid ents, so hand skills w ith d evelop ment of stereotyped it is im portant to d irectly ask child ren if they hand m ovem ents su ch as hand w ringing, intend ed to hurt or kill themselves.

loss of social interaction w hich m ay improve later , appearance of poorly coord inated gait A H ead aches and nau sea are com m on or tru nk m ovem ents, and severely im paired ad verse effects associated w ith the synthetic exp ressive and recep tive language d evelop- antid iuretic horm one, Dd avp. H yp otension, ment w ith severe psychomotor retard ation. liver toxicity, sed ation, and trem or are not Consequ ently, child ren w ith Rett synd rom e, typically associated w ith d esm opressin. d uring the period of regression, m ay appear to meet criteria for ASD. In this case, there is tion abnormalities. Of note, Rett synd rome no longer has its ow n d iagnostic criteria in the C The m ost com m on ad verse effects of flu ox- DSM -5 bu t rem ains d escribed in the d ifferen- etine inclu d e gastrointestinal sym p tom s e.

Selective nausea, loose stools , insom nia, agitation, and m u tism is characterized by a failu re to sp eak, head aches. In general, hyp otension, liver tox- d esp ite norm al ability to d o so, in social situ - icity, sed ation, and w eight gain are not sid e ations w here speaking is exp ected , su ch as at effects associated w ith flu oxetine. school; ou tsid e of this social situation, they d isplay norm al speech and interactions. Chil- A This girls history and presentation are d ren w ith social pragm atic com m u nication consistent w ith ASD. ible rigid ity to routines, fixated or restricted interests, sensory input abnorm alities. C ASD is d iagnosed four times more in boys d ren w ith ASD have d ifficulties w ith social- than girls, and w hen it is present in girls, intel- emotional reciprocity and have d ifficulty lectual d isability is often comorbid.

The pres- engaging in prosocial behavior. Fu rther, they ence of functional language by age 5 is a positive often have imp aired eye contact and have d if- prognostic sign, and it also allow s child ren to ficulty und erstand ing nonverbal com munica- engage more effectively in social skills training. tion or cues. They also have abnormal social The remaining listed factors negatively affect attachments, su ch as app earing to have no the prognosis of patients w ith ASD. interest in peers as in this case. The DSM -5 sig- nificantly revised the category of ASD, so that A This patients presentation is consistent verbal language abilities no longer represent w ith conduct disord er CD.

w ith an increased risk of a child d evelop ing restless an d ju m p y beh avior is consistent CD inclu d e a low IQ, low school achievem ent, w ith m isinterp retation of m otor tics. Tou rette p oor parental su p ervision, p u nitive or erratic d isord er m ost com m only d evelop s in grad e p arental d iscip line, child hood physical abu se, school-aged boys, an d the involu ntary tics p arental conflict, the child s biological father m ay be m isinterp reted as p u rp osefu lly d is- being absent, antisocial p arents, and having a ru p tive behavior. It is not u n u su al for these large fam ily. child ren to have d ifficu lty w ith social and p eer interactions. Of note, there is frequ ent A Child ren and ad olescents w ho are d iag- com orbid ity w ith ADH D. Th is boy d oes nosed w ith cond u ct d isord er are at increased not su ffer from con d u ct d isord er or op p osi- risk for an tisocial p ersonality d isord er as tion al d efian t d isord er becau se he is p olite ad u lts.

Antisocial p erson ality d isord er is and d oes not d isp lay hostile, d estru ctive, or not d iagnosed u ntil after th e age of 18, and angry behaviors. Th e ou tbu rsts are n ot typ i- on e of the criteria is evid ence of con d u ct cal of p an ic d isord er, in w hich there are d is- d isord er p rior to the age of Earlier onset crete p an ic attacks, p eriod s of in tense fear, of con d u ct d isord er is associated w ith an or d iscom fort, w ith p hysical m anifestations increased risk of d evelop ing antisocial p er- su ch as p alp itation s and su bjective d ifficu lty sonality d isord er. Cond u ct d isord er is not as breathing. There is no evid ence that this boy closely associated w ith avoid ant p erson al- exp eriences d istress an d w orry w h en sep a- ity d isord er, p aranoid p ersonality d isord er, rated from an im p ortant attach m en t figu re schizoid p erson ality d isord er, or schizotyp al as in sep aration an xiety d isord er.

p ersonality d isord er. B Clonidine has become the first-line treat- D By d efinition, sym ptom s of ad ju stm ent ment for Tourette disorder. It has a limited d isord er d o not last longer than 6 m onths side-effect profile and helps control symptoms after a stressor or the term ination of its con- of a frequently associated comorbid disor- sequences. In both ad justm ent ADHD. Tricyclic antidepressants TCAs have d isord er and MDD, sym ptom s m ust cau se been shown to be effective in the treatment of m arked d istress or significant im pairm ent in Tourette disorder, but other antidepressants fu nctioning, m ay d evelop follow ing a stressor, such as bupropion, paroxetine, and venlafax- m ay d evelop w ithin 3 m onths of the onset of ine are not known to be effective.

High-potency a stressor, and m u st not represent norm al antipsychotics such as haloperidol and pimo- bereavem ent. Ad ju stm ent d isord er m ay also zid e were trad itionally the first-line agents for be given sp ecifiers d ep end ing on the p res- Tourettes, but are more likely to cause signifi- ence of anxiety, d ep ressed m ood , and cond u ct cant side effects. Recently, the newer atypical d istu rbances. Ad ju stm ent d isord er follow ing or second-generation antipsychotics such as bereavem ent m ay be given p rovid ed that risperid one and olanzapine have also been the ind ivid ual d oes not m eet criteria for fu ll used to treat the disorder.

MDD, and the intensity of qu ality of the grief reaction exceed s w hat is exp ected for cu ltu ral, A It is not u nu su al for p arents of a seriou sly religiou s, or age-m atched norm s. ill child to w ant to try to p rotect them from any fu rther su ffering or d istress. H aving an ill Parents m ay end u p treating su ch chil- sym ptom s of ad justm ent d isord er. d ren as if they w ere you nger than their actual age and m ay be m ore reluctant to set ap pro- E Tou rette d isord er is the m ost likely p riate lim its.

When calling a p arents attention d iagnosis becau se the boys ou tbu rsts are to the potential harm of su ch interaction, a cli- consistent w ith vocal tics, an d th e rep ort of nician m u st be tactfu l and em p athic. acknow led ging this m others d istress, she w ill Mood lability can be an associated sym p tom , be m ore recep tive to hearing feed back abou t althou gh the incid ence of bip olar d isord er is her interactions w ith her child , inclu d ing that not p articularly increased. Langu age or sepa- her relu ctance to set lim its and stru ctu re m ay ration anxiety d isord ers are also not increased inad vertently be d etrim ental. While it is essen- in ind ivid u als w ith Tou rette d isord er. tial, em p athizing alone w ill be insu fficient to set the stage for a d iscussion of p arentchild E A su bset of child ren w ith prior grou p A interactions.

Referring her to a p arent su p p ort beta-hem olytic strep tococcal infections have grou p m ight be u sefu l follow ing you r initial d evelop ed Tou rette d isord er after the infec- d iscu ssion w ith her. Telling her she is treat- tion. Other d isord ers associated w ith su ch an ing her son like a baby is overly harsh and infection inclu d e OCD and Syd enham chorea. m ore likely to m ake her d efensive rather that This grou p of d isord ers are referred to as p ed i- recep tive. atric au toim m u ne neu rop sychiatric d isord ers associated w ith strep tococcal infections, or C A psychiatric illness in a child or ad oles- PAN DAS. The other infectiou s agents listed cent w ith a m ed ical illness shou ld be treated are not associated w ith Tou rette d isord er. aggressively u sing the type of treatm ent m ost effective for the sp ecific p sychiatric illness, A This boys history is typical of ADH D, w hile keep ing in m ind p otential interactions com bined presentation.

H e d oes not comp lete of treatm ents. Med ical illnesses can exacerbate tasks, is careless, loses necessary item s, is d is- p sychiatric illness and vice versa. As su ch, tracted and forgetful, is energetic, impu lsive, effective treatm ent of a m ental illness m ay and cannot tolerate playing quietly. Symptom s p ositively affect a m ed ical illness if im p rove- are p resent before age 12 and are occu rring in at m ent of psychiatric sym p tom s enables the least tw o settings, and are causing im pairment child to m ore fully participate in treatm ent of and d istress. Increased energy and im pulsivity the m ed ical cond ition. In ad d ition, em otional can be a symptom of both ADH D and bipolar state is related to im m u ne response.

This boy d oes not d isplay excessive w hen the leu kem ia w ou ld rem it, not treat- aggression, d estru ction of prop erty, d eceitfu l- ing the d ep ression w ou ld be inap p rop riate. ness, theft, or serious violations of rules, as Ap p rop riate p harm acologic treatm ent shou ld seen in cond u ct d isord er. H is behaviors are be avoid ed only if there are sp ecific contrain- not negativistic, hostile, or d efiant, so he d oes d ications based on the m ed ical treatm ent the not suffer from oppositional d efiant d isord er. child is receiving. In ad d ition, the effective- Therefore, he d oes not have characteristics of a ness of psychotherapy is related to the specific d isruptive behavior d isord er. m ental illness, not to the p resence or absence of a m ed ical illness. E Stim u lant m ed ications are the first-line treatm ent for ADH D bu t have been associ- D It is not u nu su al for child ren w ith Tou rette ated w ith an increased risk of d eveloping d isord er to have com orbid p sychiatric d isor- tics.

In general, if a child suffers from tics or d ers. Obsessive-com pu lsive d isord er is a very has a fam ily history of tics, stim u lant m ed i- com m only associated d isord er, often present- cations shou ld be avoid ed , and an alternate ing in ad olescence. Other anxiety d isord ers, m ed ication shou ld be u sed to treat ADH D if attentional d isord ers, and learning d isord ers necessary. Benzod iazep ines, D 2 antagonists, can be seen as w ell. Autism spectru m d isord ers MAOIs, and SSRIs d o not com m only exacer- are not com m only associated w ith Tou rettes.

bate tics and are not u sed to treat ADH D. C To be d iagnosed w ith a learning d isor- Ad d erall are u sed to treat ADH D, bu t they d er w ith im p airm ent in read ing, there m u st are also stim u lants and w ill have sim ilar sid e be evid ence of an ind ivid u als p erform ance effects to the m ethylp henid ate-based m ed i- in a given acad em ic area in this case, read - cations. Aripip razole is a second -generation ing falling below w hat is exp ected for age. atyp ical antip sychotic, citalop ram is an anti- Psychom etric testing, su ch as IQ testing, is d ep ressant, and valp roic acid is a m ood stabi- one m easu re to assess the d isparity betw een lizer u sed in bip olar d isord er; none are u sed to exp ected achievem ent and actu al achieve- treat ADH D.

m ent. A learning d isord er can also be d iag- nosed if the ind ivid ual is u sing significant B The clinician can be help fu l to p arents and excessive com p ensatory levels of effort or by exp laining and norm alizing the child s su pp ort to sustain average achievem ent. H ow ever, it is still im p ortant for the p arent to resp ond to or correct this In the case of this you ng girl, jeal- d isord ers have a com orbid p sychiatric d is- ou sy of her you nger sibling is entirely nor- ord er. The m ost com m on com orbid cond i- m al and is m ore d ifficu lt for her, since as a tions inclu d e ADH D, anxiety, and d epressive p reschooler her langu age skills m ay not be d isord ers. d evelop ed su fficiently to articu late her d is- tress. Once the m other accep ts this child s w ay w hile still setting lim its on her aggres- sive behavior. Ignoring the behavior w ill not B Of the choices p rovid ed , Dd avp is the treat- ad d ress the aggression and is not em p athic.

m ent of choice for enu resis; it is a variation Und er no circu m stances is biting the child of the antid iu retic horm one vasop ressin and back help fu l. Threatening to w ithd raw is given intranasally. Benztrop ine is u sed to love is m anip u lative and anxiety-p rovoking p revent extrap yram id al sym p tom s cau sed to the child. By telling the child that she m u st by antip sychotic neu rolep tic u se. Meth- love the baby, the m other is not tru ly em p a- ylp henid ate is a stim u lant com m only u sed thizing w ith her and m ay elicit sham e and in the treatm ent of ADH D. Paroxetine is a fu rther resentm ent tow ard the baby.

serotonin-sp ecific reu p take inhibitor u sed to treat d ep ression and anxiety. Trazod one is an B A m onth-old girl is a you ng preschool antid ep ressant m ost often u sed for insom nia. age child. At this stage, she shou ld be able to state her age and gend er and be involved B The m ost com m on ad verse effects of m eth- in or have recently com p leted p otty train- ylp henid ate and other stim u lant m ed ications ing. Althou gh she has significant langu age, inclu d e insom nia, d ecreased ap p etite, w eight it w ou ld be very u nu su al for her to u se her loss, d ysp horia, and irritability.

Trem or, hyp o- langu age sp ontaneou sly to id entify and artic- tension, w eight gain, and liver toxicity are not u late her feelings abou t her you nger sibling. com m on sid e effects. Althou gh a p recociou s 3-year-old m ay be able to cou nt to 50, it w ou ld not necessarily be E Stim u lant m ed ications, su ch as m ethylp he- exp ected of her u ntil she is 5 years. stage of cognitive d evelopm ent and cannot yet ap p ly concep ts of conservation of m atter B Atom oxetine is a nonstim u lant norepi- concrete op erations. H er gross m otor skills nephrine reu ptake inhibitor, w hich has been and balance are likely not d evelop ed enou gh fou nd to be help fu l in treating both child hood to rid e a bicycle. She shou ld be able to rid e a and ad ult ADH D. Mixed am p hetam ine salts tricycle, how ever. Answe rs : D This p atients p resentation is su sp iciou s E Stranger anxiety occurs as part of nor- for au tism sp ectru m d isord er ASD.

ASD is m al child d evelopm ent and is evid ence of characterized by d eficits in social com m unica- the d evelopm ent of a secure attachm ent; it tion and social interaction as w ell as restricted , d oes not su ggest that a p arent is inatten- rep etitive p atterns of behaviors, interests, or tive. Stranger anxiety u su ally ap p ears by 7 to activities. Of the choices listed , the d ifficu lty 8 m onths and generally resolves w ith tim e. w ith im aginary p lay rep resents a d eficit in Typ ically, stranger anxiety is stronger tow ard u nd erstand ing relationships, w hich m ore com pletely u nknow n persons than tow ard broad ly falls u nd er the d iagnostic criterion those w ho are m ore fam iliar. Becau se stranger of d eficits in social interaction. The langu age anxiety at this age is d evelop m entally app ro- im p airm ent criterion of the DSM -IV -TR w as priate, this boy cannot be d iagnosed w ith sep - elim inated in the DSM Attentional d ifficu l- aration anxiety d isord er, and he is not overly ties, im pairm ent in m otor skill d evelopm ent, attached to his m other.

Child ren w ith au tism or d elay in potty training are not necessarily spectrum d isord er, in fact, often lack this featu res of ASD. d evelop m ental m arker. D Child ren w ith au tism spectrum d isor- D This boy w ou ld be d iagnosed w ith sep a- d er ASD have m ore favorable p rognoses if ration anxiety d isord er. While an 8-m onth-old they are able to converse m eaningfu lly w ith child w ou ld typically d isplay stranger anxi- others; though no longer p art of the DSM -5 ety, an 8-year-old w ou ld not.

This behavior d iagnostic criteria, the acqu isition of fu nc- w ou ld have norm ally gone aw ay for m ost tional language by the age of 5 years rem ains a child ren by age 3 or 4 years. School age chil- p ositive prognostic factor. Ind ivid u als w ith agora- their play, and be capable of m em orizing or phobia often refu se to leave their hom e d ue to reciting p oem s, d ialogu e from a TV show or the fear of d eveloping a panic attack. Obses- m ovie. These latter characteristics are not nec- sive-com pu lsive d isord er is characterized by essarily associated w ith a good prognosis.

obsessions and com pu lsions; the focu s is not related to sep aration. Social anxiety d isord er A This girl likely has anorexia nervosa. social p hobia involves anxiety in a social or H yp ercholesterolem ia is com m on in anorexia perform ance situ ation. Other find ings associated w ith the starvation state are m ild norm ocytic norm o- B Ind ivid uals w ho d evelop schizophrenia chrom ic anem ia and leu kop enia. If vom iting are m ore likely to have a p arent w ith a p sy- is ind u ced , hyp okalem ia, hyp ochlorem ia, and chotic or schizotyp al d isord er.

Ind ivid uals m etabolic alkalosis m ay be seen. H ypercaro- w ho d evelop schizop hrenia are m u ch m ore tenem ia, cau sing yellow ing of the skin, m ay likely to have a history of social w ithd raw al be seen if m any carrots are eaten in an attem p t and introversion rather than extroversion. to satisfy the appetite w ith a low -calorie food. Recent stressors su ch as p arental d ivorce or TSH is not typ ically altered. m oving m ay contribu te to the onset or exac- erbation of som e p sychiatric d isord ers bu t B While all of the choices are complications not sp ecifically schizophrenia.

Finally, recent resulting from anorexia nervosa, a card iac d ru g u se w ou ld be m ore likely to su p p ort a arrhythmia is consid ered a major com plica- d iagnosis of su bstance-ind u ced p sychosis. tion and therefore alone justifies an inpatient ad mission. If the patient has mu ltip le minor D Early-onset schizop hrenia occu rs before com plications e. ad mission to the hospital shou ld also be given. associated w ith a poorer ou tcom e. A better d eveloped the ability to have concrete think- p rognosis is associated w ith an acu te onset, ing. Usually, this level of cognitive m aturity is m ore affective sym ptom s, old er age at onset, achieved betw een the ages of 6 and good p rem orbid fu nctioning, w ell-d ifferenti- ated sym ptom s, and lack of a fam ily history of C This boy is displaying regression, a defense schizophrenia. mechanism in w hich there is an attempt to return to an earlier d evelopmental phase to C Child ren w ith ADH D often suffer from avoid the tension and conflict at the present low self-esteem , w hile child ren w ith m ania level of development e.

Distractibility, grandmothers death. Methods: A 1. Students were required to attend unless excused due to scheduling conflicts. Scores on the NBME psychiatry subject exam were compared with those of students taking the examination in the corresponding time period in each of the previous two academic years. Results: 83 students took the exam during the experimental period, while took the exam during the control period. Conclusions: An end-of-clerkship review session led to increased mean scores on the NBME psychiatry subject examination, particularly for students at the lower end of the score range. Future research should investigate the impact of such an intervention in other specialties and other institutions.

Carlos Baptista. Angellar Manguvo. Background and Purpose: There is a paucity of empirical-based knowledge upon which medical students and clerkship directors in the US and Canada direct National Board of Medical Examiners NBME subject exam preparation. This study investigated NBME subject exam preparation habits and their predictive effects on actual scores. Methods: Sixty medical students from the University of Missouri-Kansas City were surveyed in six clerkships on preparation time, resources utilization, study strategies, and help-seeking trends when relating to NBME subject exam preparation. Multiple regression analyses were conducted to determine predictive effects of the constructs on actual scores. Results: Participants relied on rote-memorization and mock exam rehearsal more than cooperative learning and conceptualization.

Despite observed positive correlations, none of the study variables significantly predicted actual scores. The full regression model, however, accounted for Conclusions: Exam preparation trends unveiled in this study may provide helpful insights to clerkship directors and medical students in making informed decisions on selection of preparatory resources and study strategies to best utilize time and funding. Annie J Daniel. Charles Gullo. As medical disciplines have become increasingly interdisciplinary and evidenced-based medicine is widely practiced, there is a need for curricula that reflect these changes. The newly revised Liaison Committee on Medical Education LCME standards 1. The approach allows for a more horizontally integrated curriculum in the preclinical years, while the use of distinct diseases and 8 themes creates a quality assurance mechanism that allows for tracking of vertical integration across the entire curriculum.

The first step in the development of this quality assurance model was to establish and empower a newly formed integration subcommittee. This subcommittee was tasked with developing a model to review, track, and improve the horizontal and vertical integration of the curriculum. Our integrated curriculum is now in its second year having completed the initial identification of gaps and redundancies through a process that relies on the mapping of diseases and themes throughout the courses. This ongoing review and evaluation mechanism has created a dynamic quality assurance process that allows our faculty to address issues of both horizontal and vertical integration of our curriculum at the course level. Charles Gullo , Bobby Miller. Many schools seek to predict performance on national exams required for medical school graduation using pre-matriculation and medical school performance data. The need for targeted intervention strategies for at-risk students has led much of this interest.

Assumptions that preadmission data and high stakes in-house medical exams correlate strongly with national standardized exam performance needs to be examined. The addition of scores from the first medical school exam improved our predictive capabilities with a linear model to As we added data to the model we increased our predictive values as expected. Step-wise addition of more exams in year two resulted in much higher predictive values, but also led to the exclusion of many early variables. Therefore, our best Step 1 predictive value of around These data suggest that the pre-admission information is a relatively poor predictor of licensure exam performance and that including class exam scores allows for much more accurate determination of students who ultimately proved to be at risk for performance on their licensure exams.

The continuous use of this data, as it becomes available, for assisting at-risk students is discussed. Maria Nelson. Amy Blue. Bedilu Jebena. Hasan Çelik. International Journal of Health Policy and Management IJHPM , Tristan Price , Nick Lynn , Martin Roberts , Tom Gale. Lukkana Promwattanaphan. miguel rodriguez. Ana Maria Marineci.

In order to ensure that user-safety is not compromised and you enjoy faster downloads, we have used trusted 3rd-party repository links that are not hosted on our website. At Medicalstudyzone. com , we take user experience very seriously and thus always strive to improve. We hope that you people find our blog beneficial! The most thorough psychiatry review available for the USMLE Step 2 CK and psychiatry clerkship exam — completely updated to reflect the DSM The Eleventh Edition of this this trusted review simulates the USMLE Step 2 CK test-taking experience by delivering multiple-step clinical vignette questions and updates on the latest therapies for psychiatric diseases and disorders. Questions are carefully selected to match the style and difficulty level of what students will face on the test.

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