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CME: posttest and certificate

Overall peer comparison

For Stahl’s Self-Assessments in Psychiatry: Multiple Choice Questions for Clinicians, second edition, the correct answer was selected 65% of the time.

Release/expiration dates

Released: May 1, 2015
CME Credit Expires: April 1, 2018

CME Posttest Study Guide

Optional posttests with CME credits are available for a fee (waived for NEI Members). For participant ease, each chapter has its own posttest and certificate. NOTE: the book as a whole is considered a single activity and credits earned must be totaled and submitted as such to other organizations. To receive a certificate of CME credit or participation, complete the chapter posttest and evaluation, available only online at neiglobal.com/CME (under “Book”). If a score of 70% or more is attained, you will be able to immediately print your certificate. If you have questions, call 888–535–5600, or email .
PLEASE NOTE: Posttests can only be submitted online. The posttest questions have been provided below solely as a study tool to prepare for your online submissions. Faxed/mailed copies of posttests cannot be processed and will be returned to the sender. If you do not have access to a computer, contact customer service at 888–535–5600.

Basic neuroscience

1. Agonists cause ligand-gated ion channels to:
A. Open wider
B. Open for a longer duration
C. Open more frequently
2. Communication between human CNS neurons at synapses is?
A. Chemical
B. Electrical
C. Both A and B
D. Neither A nor B

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3. The direct role of transcription factors is to:
A. Cause neurotransmitter release
B. Influence gene expression
C. Synthesize enzymes
D. Trigger signal transduction cascades
4. N-methyl-D-aspartate (NMDA) receptors are activated by:
A. Glutamate
B. Glycine
C. Depolarization
D. Glutamate and glycine
E. Glutamate and depolarization
F. Glycine and depolarization
G. Glutamate, glycine, and depolarization

Psychosis and schizophrenia

1. Based on thorough evaluation of a patient and his history, his care provider intends to begin treatment with a conventional antipsychotic but has not selected a particular agent yet. Which of the following is most true about conventional antipsychotics?
A. They are very similar in therapeutic profile but differ in side-effect profile
B. They are very similar in both therapeutic and side-effect profile
C. They differ in therapeutic profile but are similar in side-effect profile
D. They differ in both therapeutic and side-effect profile
2. A 37-year-old woman with schizophrenia has failed to respond to two sequential adequate trials of antipsychotic monotherapy (first olanzapine, then aripiprazole). Which of the following are evidence-based treatment strategies for a patient in this situation?
A. High dose of her current monotherapy (aripiprazole)
B. Augmentation of her current monotherapy with another atypical antipsychotic
C. Switch to clozapine
3. A 27-year-old male who has been treated with quetiapine for the last 8 weeks is now having his medication changed to aripiprazole. What is the recommended starting dose for aripiprazole?
A. Low dose
B. Middle dose
C. Full dose

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4. A 34-year-old man who has been taking a conventional antipsychotic for 6 years has begun demonstrating extrapyramidal side effects (EPS), and his clinician elects to switch him to an atypical antipsychotic with serotonin 2A antagonism. The majority of atypical antipsychotics:
A. Have higher affinity for dopamine 2 receptors than for serotonin 2A receptors
B. Have higher affinity for serotonin 2A receptors than for dopamine 2 receptors

Unipolar depression

1. A 36-year-old man with major depressive disorder has lab work done to assess his levels of inflammatory markers. The results come back indicating elevated levels of tumor necrosis factor-alpha (TNF-alpha) and interleukin 6 (IL-6). Elevated cytokine levels may indirectly lead to:
A. Excessive glutamate and reduced serotonin
B. Excessive glutamate and excessive serotonin
C. Reduced glutamate and reduced serotonin
D. Reduced glutamate and excessive serotonin
2. A 36-year-old patient has only partially responded to his second monotherapy with a first-line antidepressant. Which of the following has the best evidence of efficacy for augmenting antidepressants in patients with inadequate response?
A. Adding an atypical antipsychotic
B. Adding buspirone
C. Adding a stimulant
3. Margaret is a 42-year-old patient with untreated depression. She is reluctant to begin antidepressant treatment due to concerns about treatment-induced weight gain. Which of the following antidepressant treatments is associated with the greatest risk of weight gain?
A. Escitalopram
B. Fluoxetine
C. Mirtazapine
D. Vilazodone
4. A 38-year-old patient with depression presents with depressed mood, anhedonia, and loss of energy. These symptoms can be conceptualized as reflecting reduced positive affect and are hypothetically more likely to respond to agents that enhance:
A. Serotonin and possibly dopamine function
B. Dopamine and possibly norepinephrine function
C. Norepinephrine and possibly serotonin function

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Bipolar disorder

1. A 28-year-old woman presents with a depressive episode. She has previously been hospitalized and treated for a manic episode but is not currently taking any medication. The agents with the strongest evidence of efficacy in bipolar depression are:
A. Lamotrigine, lithium, quetiapine
B. Quetiapine, olanzapine-fluoxetine, lurasidone
C. Olanzapine-fluoxetine, lurasidone, lamotrigine
D. Lurasidone, lamotrigine, lithium
2. A 24-year-old woman with no history of psychiatric symptoms presents with a major depressive episode and is prescribed an antidepressant. She quickly experiences improved mood and exhibits symptoms suggestive of hypomania. Recommendations from the International Society for Bipolar Disorders (ISBD) state that the patient’s antidepressant should be:
A. Discontinued
B. Maintained, but ONLY IF a mood stabilizer is added
3. A 24-year-old man with bipolar disorder is being initiated on lithium, with monitoring of his levels until a therapeutic serum concentration is achieved. Once the patient is stabilized, how often should his serum lithium levels be monitored (excluding one-off situations such as dose or illness change)?
A. Every 2 to 3 months
B. Every 6 to 12 months
C. Every 1 to 2 years
D. Routine monitoring is not necessary
4. Which drugs would theoretically reduce glutamate release by blocking voltage-sensitive sodium channels?
A. Gabapentin
B. Levetiracetam
C. Pregabalin
D. Valproate

Anxiety disorders

1. A 51-year-old male veteran with chronic PTSD has agreed to begin pharmacotherapy for his debilitating symptoms of arousal and anxiety associated with his experiences in Iraq 2 years ago. Which of the following would be appropriate as first-line treatment?
A. Paroxetine
B. Paroxetine or diazepam
C. Paroxetine, diazepam, or D-cycloserine
D. Paroxetine, diazepam, D-cycloserine, or quetiapine

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2. A 57-year-old man presents with OCD who has not responded to numerous previous trials of serotonergic medications at typical depression doses. Which of the following is true regarding the appropriate dosing of SSRIs in OCD?
A. Doses are typically lower than those in depression
B. Doses are typically the same as those in depression
C. Doses are typically higher than those in depression
3. Which of the following is a strategy currently being investigated for PTSD?
A. Modulating glutamate neurotransmission during fear conditioning
B. Modulating glutamate neurotransmission during fear extinction
4. A 31-year-old female assault victim who is brought to the ER appears traumatized from the incident. Which of the following pharmacotherapy options has been theorized as a potential preemptive treatment to the development of PTSD?
A. N-methyl-D-aspartate (NMDA) agonist such as D-cycloserine
B. Alpha 2 delta ligand such as pregabalin
C. Beta adrenergic blocker such as propranolol
D. Benzodiazepine such as diazepam

Chronic pain

1. A 29-year-old woman has just been diagnosed with major depressive disorder and is being prescribed a selective serotonin reuptake inhibitor (SSRI). In addition to depressed mood, she has been experiencing widespread aches and pains. She asks if the SSRI is likely to alleviate her painful physical symptoms as well as her emotional ones. Which of the following statements is true?
A. SSRIs may have inconsistent effects on pain because serotonin can both inhibit and facilitate ascending nociceptive signals
B. SSRIs may worsen pain because serotonin can facilitate but not inhibit ascending nociceptive signals
C. SSRIs generally alleviate pain because serotonin can inhibit but not facilitate ascending nociceptive signals
D. SSRIs generally have no effect on pain because serotonin neither facilitates nor inhibits nociceptive signals
2. A 22-year-old woman with pain throughout her body, extreme fatigue, and poor sleep is diagnosed with fibromyalgia. Her care
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provider considers prescribing pregabalin, which may alleviate pain by:
A. Binding to the closed conformation of voltage-sensitive sodium channels
B. Binding to the open conformation of voltage-sensitive sodium channels
C. Binding to the closed conformation of voltage-sensitive calcium channels
D. Binding to the open conformation of voltage-sensitive calcium channels
3. A 36-year-old woman has just been diagnosed with fibromyalgia. In addition to her painful physical symptoms, she is experiencing problems with memory and significant difficulty concentrating at work. Which of the following may be most likely to alleviate both her physical pain and her cognitive symptoms?
A. Bupropion
B. Cyclobenzaprine
C. Milnacipran
D. Pregabalin

Sleep/wake disorders

1. Denise is a 32-year-old patient with shift work disorder who reports that she is having difficulty in her job as a pastry chef due to excessive sleepiness during her shift. Which of the following is a potential therapeutic mechanism to promote wakefulness?
A. Inhibit GABA activity
B. Inhibit histamine activity
C. Inhibit orexin activity
2. A 72-year-old woman has been having difficulty sleeping for several weeks, including both difficulty falling asleep and frequent nighttime awakenings. Medical examination rules out an underlying condition contributing to insomnia, and she is not taking any medications that are associated with disrupted sleep. The patient is retired and spends the day caring for her grandchildren, including driving the older ones to school in the morning. Which of the following would be the most appropriate treatment option for this patient?
A. Flurazepam
B. Temazepam
C. Zaleplon
D. Zolpidem CR

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3. A clinician is planning to prescribe eszopiclone for a 34-year-old male patient with insomnia. What is the correct starting dose for this patient?
A. 0.5 mg/night
B. 1 mg/night
C. 2 mg/night
D. 3 mg/night
4. What type of orexin antagonists may be effective for treating patients with sleep–wake disorders?
A. Single orexin receptor antagonists selective for orexin 1 receptors
B. Single orexin receptor antagonists selective for orexin 2 receptors
C. Dual orexin receptor antagonists that block both orexin 1 and 2 receptors
D. A and B
E. B and C
F. A and C
G. A, B, and C

Attention deficit hyperactivity disorder

1. Which of the following is true regarding cortical brain development in children with ADHD compared to healthy controls?
A. The pattern (i.e., order) of cortical maturation is different
B. The timing of cortical maturation is different
C. The pattern and timing of cortical maturation are different
D. Neither the pattern nor the timing of cortical maturation are different
2. A 44-year-old man is diagnosed with ADHD-inattentive subtype following an assessment that confirms problems with focus, sustained attention, and executive function. After 2 months treatment on a therapeutic dose of a long-acting stimulant, his focus and sustained attention are much better, but he still has trouble with executive function. At this point, would it be appropriate to raise the dose of the stimulant to try to address his residual symptoms?
A. Yes
B. No
3. A 25-year-old woman with a history of drug use is diagnosed with ADHD and prescribed atomoxetine. Why does atomoxetine lack abuse potential?
A. It decreases norepinephrine levels in the nucleus accumbens, but not in the prefrontal cortex

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B. It increases dopamine levels in the prefrontal cortex but not in the nucleus accumbens
C. It modulates serotonin levels in the raphe nucleus
D. It increases dopamine in the striatum and anterior cingulate cortex

Dementia and cognitive function

1. Which of the following properties of memantine may be primarily responsible for its therapeutic actions in Alzheimer’s disease?
A. Serotonin 3 (5HT3) antagonism
B. Sigma antagonism
C. N-methyl-D-aspartate (NMDA) antagonism at the magnesium site
2. Ruth, a 71-year-old patient with dementia who is taking a cholinesterase inhibitor, has been exhibiting psychiatric symptoms, including extreme agitation and aggression toward her two daughters who help care for her. Which of the following medications might be tried first to alleviate these presenting symptoms?
A. Citalopram, 20 mg/day
B. Galantamine, 8 mg/twice daily
C. Risperidone, 0.5 mg/day
D. Selegiline, 8 mg/day
3. A 65-year-old woman is concerned that her husband is exhibiting some symptoms suggestive of Alzheimer’s disease. She is extremely anxious and wants a definitive diagnosis. Which of the following is true regarding the current application of biomarkers for the early detection and differential diagnosis of Alzheimer’s disease?
A. There are currently no identified biomarkers that can predict progression to dementia
B. Use of biomarkers in Alzheimer’s disease is currently recommended solely for research purposes
C. Use of biomarkers in Alzheimer’s disease is just now being recommended for clinical practice

Substance use and impulsive-compulsive disorders

1. Impulsivity is hypothesized to be related to the _____, while compulsivity is hypothesized to be related to the _____.
A. Amygdala, ventral striatum
B. Ventral striatum, amygdala
C. Dorsal striatum, ventral striatum
D. Ventral striatum, dorsal striatum

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2. Peter is a 17-year-old student who has been using spice (synthetic cannabinoid) over the past year. Synthetic cannabinoids such as spice may be associated with an increased risk of psychosis compared to natural marijuana because they:
A. Do not contain cannabidiol
B. Are full rather than partial agonists
C. A and B
D. Neither A nor B
3. A 26-year-old woman develops a dependence on opioids after taking them during her recovery from knee surgery. She attempts to stop using them on her own, but when she does stop or decreases her dose she experiences nausea, muscle aches, sweating, diarrhea, insomnia, and depression. She and her practitioner decide that buprenorphine would be an appropriate treatment strategy. Which of the following is true?
A. The patient should initiate buprenorphine while down-titrating her current opioid
B. The patient should be in a mild withdrawal state prior to initiating buprenorphine
C. The patient should complete withdrawal before beginning buprenorphine treatment
4. A 28-year-old painter presents with a severe drinking problem and you prescribe naltrexone. What is the mechanism of naltrexone?
A. Naltrexone blocks mu-opioid receptors to reduce the euphoria you might normally experience with heavy drinking
B. Naltrexone blocks metabotropic glutamate receptors (mGluR) to reduce the euphoria you might normally experience with heavy drinking
C. Naltrexone stimulates mu-opioid receptors to reduce the euphoria you might normally experience with heavy drinking
D. Naltrexone stimulates mGluR receptors to reduce the euphoria you might normally experience with heavy drinking

CME online posttests and certificates

Optional posttests with CME credits are available for a fee (waived for NEI Members). For participant ease, each chapter has its own posttest and certificate. NOTE: the book as a whole is considered a single activity and credits earned must be totaled and submitted as such to other organizations. To receive a certificate of CME credit or participation, complete the chapter posttest and evaluation, available only online at neiglobal.com/CME (under “Book”). If a score of 70% or more is attained, you will be able to immediately print your certificate. If you have questions, call 888–535–5600, or email .
 

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