4. 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 - ANSWERA. Aggressiveness
27. The parents of a toddler are concerned about a recent...
4. 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 - ANSWERA. Aggressiveness
27. 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 - ANSWERB. 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 -
ANSWERA. 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 - ANSWERE. Obtain a teacher report
41. 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 - ANSWERA. 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
improved because the child has:
A. had negative reinforcement of the tantrums removed.
B. developed insight into the reasons for the oppositional behaviors.
C. realized how inappropriate and maladaptive the behavior had been.
D. learned to identify the maladaptive ideas that motivate the behavior.
E. acquired mindfulness and the ability to use the senses to self soothe - ANSWERA. had negative
reinforcement of the tantrums removed.
, 98. Parents report that their child who is almost 3 years old has not yet begun to talk. Since birth the
child has been distractible with an aversion to novelty and transitions. The
parents report that their child seems to have problems empathizing with siblings and
playmates at daycare. Which of the following questions should the psychiatrist ask first to
decide what type of advice to give the parents?
A. "Did you have a normal pregnancy?"
B. "Has your child's hearing been tested?"
C. "Has your child had a severe, traumatic loss?"
D. "Does your child experience separation anxiety?"
E. "Has your child had the measles-mumps-rubella immunization?" - ANSWERB. "Has your child's
hearing been tested?"
137. Parents bring their 10-year-old child for an evaluation due to concerns about the child's
reported difficulty paying attention in class and completing assignments in the expected time.
Parents report that the child has trouble staying on task while doing homework
assignments and they are concerned that the child has an attention disorder. At the
completion of the evaluation, the psychiatrist requests that both a parent and teacher fill out
a rating scale. The parent ratings fall into the clinical range, but the teacher's ratings do not
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 - ANSWERE. 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
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