Applied behavior analysis US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Applied behavior analysis. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Applied behavior analysis US Medical PG Question 1: A mother brings her 3-year-old son to the doctor because she is worried that he might be harming himself by constantly banging his head on the wall. He has been exhibiting this behavior for a few months. She is also worried because he has started to speak less than he used to and does not respond when his name is called. He seems aloof during playtime with other children and seems to have lost interest in most of his toys. What is the most likely diagnosis?
- A. Autism spectrum disorder (Correct Answer)
- B. Attention deficit hyperactivity disorder
- C. Generalized anxiety disorder
- D. Bipolar disorder
- E. Obsessive-compulsive disorder
Applied behavior analysis Explanation: ***Autism spectrum disorder***
- The child's symptoms of **head banging** (a repetitive, self-stimulatory behavior), **decreased speech**, **lack of response to his name**, **social aloofness**, and **loss of interest in toys** are classic indicators of **Autism Spectrum Disorder (ASD)**.
- ASD involves persistent deficits in **social communication and interaction** across multiple contexts, as well as **restricted, repetitive patterns of behavior, interests, or activities**.
*Attention deficit hyperactivity disorder*
- **ADHD** is characterized primarily by **inattention, hyperactivity, and impulsivity**, which are not the prominent or primary concerns described in this case.
- While children with ADHD may have social difficulties, their core symptoms do not typically include severe **social aloofness, communication regression**, or **self-injurious repetitive behaviors** like head banging.
*Generalized anxiety disorder*
- **Generalized anxiety disorder (GAD)** in children typically presents with excessive worry about multiple events or activities, often accompanied by **physical symptoms of anxiety** such as restlessness, fatigue, and difficulty concentrating.
- It does not explain the **communication regression, social deficits**, or **stereotypical behaviors** like head banging observed in this child.
*Bipolar disorder*
- **Bipolar disorder** in children often manifests with severe mood dysregulation, including distinct periods of **elevated or irritable mood (mania/hypomania)** and depression.
- The symptoms described, such as social withdrawal and communication difficulties, are not characteristic of the primary presentations of bipolar disorder.
*Obsessive-compulsive disorder*
- **OCD** is characterized by the presence of **obsessions (recurrent, persistent thoughts, urges, or images)** and/or **compulsions (repetitive behaviors or mental acts)**.
- While head banging can be a repetitive behavior, the broader constellation of symptoms, including social and communication deficits, is not typical of primary OCD in young children.
Applied behavior analysis US Medical PG Question 2: A 52-year-old man is on a week-long cruise vacation with his family to celebrate his mother's 80th birthday. He has a very important presentation at work to give in one month, which will in part determine whether he receives a promotion. He decides to focus on enjoying the vacation and not to worry about the presentation until the cruise is over. Which of the following psychological defense mechanisms is he demonstrating?
- A. Introjection
- B. Regression
- C. Suppression (Correct Answer)
- D. Inhibition
- E. Isolation of affect
Applied behavior analysis Explanation: ***Suppression***
- **Suppression** is a **conscious** defense mechanism where an individual intentionally puts disturbing thoughts or feelings out of mind to deal with them later.
- The man is aware of the upcoming presentation but *consciously chooses* to defer worrying about it until his vacation is over, fitting the definition of suppression.
*Introjection*
- **Introjection** involves unconsciously internalizing the ideas or voices of others, often resulting in adopting their beliefs or behaviors as one's own.
- This mechanism is not about consciously delaying a stressful thought but rather about incorporating external influences into one's internal world.
*Regression*
- **Regression** is an ego defense mechanism where an individual reverts to an earlier, more immature, or childish stage of development in response to stress or anxiety.
- This mechanism typically involves a return to coping strategies or behaviors from childhood and does not describe the conscious decision to postpone dealing with an adult responsibility.
*Inhibition*
- **Inhibition** typically refers to a **restraint** or **blockage** of an impulse, behavior, or thought, often due to anxiety or conflict.
- It often manifests as an inability to perform certain actions or express specific feelings, which is not the case here; the individual is actively and consciously choosing to defer thoughts rather than being unable to access them.
*Isolation of affect*
- **Isolation of affect** is an unconscious defense mechanism where the emotional component of an idea or experience is separated from the intellectual component.
- The individual can discuss the event or thought without feeling its associated emotions, which is distinct from consciously choosing to postpone thinking about a known stressor.
Applied behavior analysis US Medical PG Question 3: A 38-year-old project manager is told by her boss that her team will need to work on an additional project in the coming week for a very important client. This frustrates the woman, who already feels that she works too many hours. Instead of discussing her feelings directly with her boss, the woman leaves a voice message for her boss the next day and deceitfully says she cannot come to work for the next week because of a family emergency. Which of the following psychological defense mechanisms is this individual demonstrating?
- A. Displacement
- B. Acting out
- C. Malingering
- D. Passive aggression (Correct Answer)
- E. Blocking
Applied behavior analysis Explanation: ***Passive aggression***
- This defense mechanism involves expressing negative feelings indirectly instead of openly addressing the conflict or frustrating situation. The woman's **deceitful excuse** avoids confrontation while still 'punishing' the boss by not being available.
- It often stems from a fear of direct confrontation and a need to control the situation without appearing openly hostile, manifesting as **procrastination, stubbornness, or intentional inefficiency**.
*Displacement*
- **Displacement** occurs when a person redirects uncomfortable feelings from the source of frustration to a safer, less threatening target.
- In this scenario, the woman did not redirect her frustration onto another person or object; instead, she acted on the source of the frustration indirectly.
*Acting out*
- **Acting out** involves expressing unconscious emotional conflicts or stressors through immediate physical actions, often impulsive or destructive.
- The woman's behavior, while deceitful, is a calculated avoidance rather than an uncontrolled emotional outburst.
*Malingering*
- **Malingering** is the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives like avoiding work or obtaining financial compensation.
- While there is an element of deceit, the primary motivation described is her frustration and desire to avoid the extra work, not necessarily an external material gain typically associated with malingering.
*Blocking*
- **Blocking** is a defense mechanism characterized by a temporary but sudden and complete loss of thought, often due to an emotional conflict. The individual's mind goes blank.
- The woman is not experiencing a loss of thought but is actively fabricating an excuse to avoid a difficult situation.
Applied behavior analysis US Medical PG Question 4: A 14-year-old girl presents to the pediatrician for behavior issues. The girl has been having difficulty in school as a result. Every time the girl enters her classroom, she feels the urge to touch every wall before heading to her seat. When asked why she does this, she responds, "I'm not really sure. I just can't stop thinking about it until I have touched each wall." The parents have noticed this behavior occasionally at home but were not concerned. The girl is otherwise healthy, has many friends, eats a balanced diet, does not smoke, and is not sexually active. Her temperature is 98.2°F (36.8°C), blood pressure is 117/74 mmHg, pulse is 80/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam is notable for a healthy young girl. Neurologic exam is unremarkable. There is no observed abnormalities in behavior while the girl is in the office. Which of the following is the most appropriate initial step in management for this patient?
- A. Cognitive behavioral therapy (Correct Answer)
- B. Lorazepam
- C. Risperidone
- D. Clomipramine
- E. Fluoxetine
Applied behavior analysis Explanation: ***Cognitive behavioral therapy***
- This patient exhibits classic symptoms of **obsessive-compulsive disorder (OCD)**, characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions) performed to alleviate anxiety.
- **Exposure and response prevention (ERP)**, a component of cognitive behavioral therapy, is the first-line psychosocial treatment for OCD and has strong evidence for its efficacy in both children and adults.
*Lorazepam*
- **Lorazepam** is a benzodiazepine used for acute anxiety or panic attacks, providing short-term relief.
- It is not a primary treatment for OCD and does not address the underlying obsessive-compulsive cycle; long-term use can lead to dependence.
*Risperidone*
- **Risperidone** is an atypical antipsychotic, primarily used for conditions like schizophrenia, bipolar disorder, or severe behavioral disturbances.
- While sometimes used as an augmentation strategy in refractory OCD, it is not a first-line treatment, especially without prior trials of CBT or SSRIs.
*Clomipramine*
- **Clomipramine** is a tricyclic antidepressant (TCA) with potent serotonin reuptake inhibition, making it effective for OCD.
- However, due to its less favorable side effect profile compared to selective serotonin reuptake inhibitors (SSRIs), it is typically reserved for cases where SSRIs are ineffective.
*Fluoxetine*
- **Fluoxetine** is an SSRI, a first-line pharmacologic treatment for OCD.
- While effective, current guidelines recommend starting with **CBT (specifically ERP)** as the initial treatment for mild to moderate OCD, or combining it with medication for more severe cases.
Applied behavior analysis US Medical PG Question 5: A 10-year-old child is sent to the school psychologist in May because he refuses to comply with the class rules. His teacher says this has been going on since school started back in August. He gets upset at the teacher regularly when he is told to complete a homework assignment in class. Sometimes he refuses to complete them altogether. Several of his teachers have reported that he intentionally creates noises in class to interrupt the class. He tells the psychologist that the teacher and his classmates are at fault. What is the most appropriate treatment?
- A. Cognitive-behavioral therapy (Correct Answer)
- B. Interpersonal therapy
- C. Administration of lithium
- D. Motivational interviewing
- E. Administration of clozapine
Applied behavior analysis Explanation: ***Cognitive-behavioral therapy***
- This child exhibits symptoms consistent with **Oppositional Defiant Disorder (ODD)**, including persistent refusal to comply with rules, anger outbursts, and blaming others. **CBT** is a highly effective treatment for ODD, teaching children coping skills, anger management, and problem-solving.
- CBT helps children identify and change **maladaptive thought patterns** and behaviors, which is crucial for managing the defiant and argumentative behaviors seen in ODD.
*Interpersonal therapy*
- **Interpersonal therapy (IPT)** primarily focuses on improving interpersonal relationships and communication patterns, often used for depression or eating disorders.
- While improved relationships might be a secondary benefit, IPT does not directly target the core **defiant behaviors** and **anger management** issues central to ODD.
*Administration of lithium*
- **Lithium** is a mood stabilizer primarily used in the treatment of **bipolar disorder** and severe mood dysregulation.
- There is no indication from the provided symptoms (defiance, anger, blaming others) that the child is experiencing a mood disorder that would warrant lithium.
*Motivational interviewing*
- **Motivational interviewing** is a counseling approach that helps individuals resolve ambivalence to change, often used in substance abuse or health behavior change.
- While it can be useful in encouraging willingness to engage in therapy, it is not a direct therapeutic modality for addressing the specific **behavioral challenges** and **underlying cognitive distortions** of ODD.
*Administration of clozapine*
- **Clozapine** is an antipsychotic medication reserved for severe mental illnesses like **treatment-resistant schizophrenia** due to its significant side effects.
- The child's symptoms of defiance and rule-breaking are not indicative of a psychotic disorder requiring antipsychotic medication.
Applied behavior analysis US Medical PG Question 6: A 3-year-old boy is brought to your pediatrics office by his parents for a well-child checkup. The parents are Amish and this is the first time their child has seen a doctor. His medical history is unknown, and he was born at 39 weeks gestation. His temperature is 98.3°F (36.8°C), blood pressure is 97/58 mmHg, pulse is 90/min, respirations are 23/min, and oxygen saturation is 99% on room air. The child is in the corner stacking blocks. He does not look the physician in the eye nor answer your questions. He continually tries to return to the blocks and becomes very upset when you move the blocks back to their storage space. The parents state that the child has not begun to speak and often exhibits similar behaviors with toy blocks he has at home. On occasion, they have observed him biting his elbows. Which of the following is the best next step in management?
- A. Risperidone
- B. Restructuring of the home environment
- C. Fluoxetine
- D. Hearing exam
- E. Educating the parents about autism spectrum disorder (Correct Answer)
Applied behavior analysis Explanation: ***Educating the parents about autism spectrum disorder***
- The child exhibits several **red flags for autism spectrum disorder (ASD)**, including **lack of eye contact, delayed speech, repetitive behaviors** (stacking blocks, becoming upset when routine is disrupted), and **self-injurious behavior** (biting elbows).
- Since this is the child's **first medical visit**, the parents are unaware of these concerns. The physician's first step should be to **educate the parents** about ASD to initiate further evaluation and early intervention.
- While a **formal diagnosis** requires more extensive evaluation (including developmental screening tools like M-CHAT-R and comprehensive assessment), educating the parents is crucial for obtaining their consent and cooperation for subsequent steps, which would include referral to a developmental specialist and early intervention services.
*Risperidone*
- **Risperidone** is an atypical antipsychotic medication sometimes used to manage severe **irritability** or **aggressiveness** in children with ASD, but it is not a first-line treatment for initial diagnosis or typical symptoms.
- Administering medication without a formal diagnosis, comprehensive behavioral management plan, and parental understanding is premature and inappropriate.
*Restructuring of the home environment*
- While **environmental modifications** can be beneficial for children with ASD, suggesting this as the first step without a clear diagnosis or parental understanding of specific needs is insufficient.
- The priority is to establish a diagnosis through proper evaluation and then tailor interventions, which may include home modifications in conjunction with other therapies like applied behavior analysis (ABA).
*Fluoxetine*
- **Fluoxetine** is a selective serotonin reuptake inhibitor (SSRI) used for anxiety, depression, and obsessive-compulsive disorder. It may be used in ASD to address **comorbid anxiety** or **repetitive behaviors**, but it is not a primary diagnostic tool or initial treatment.
- Like risperidone, prescribing medication without a proper diagnosis and understanding of the child's specific psychiatric needs is not the appropriate first step.
*Hearing exam*
- Although **hearing impairment** can cause **delayed speech** and affect social interaction, the child's other symptoms, such as **lack of eye contact, repetitive behaviors, and self-injurious actions**, are not typical of isolated hearing loss.
- While a hearing exam might be part of a comprehensive developmental workup later (as hearing and vision screening are standard in evaluating developmental delays), addressing the more pervasive signs suggestive of ASD takes precedence in the initial discussion with parents.
Applied behavior analysis US Medical PG Question 7: A 47-year-old woman is upset with her neighbor for playing music too loudly late at night. Rather than confront her neighbor directly, the woman makes a habit of parking her car in a manner that makes it difficult for her neighbor to park in his spot. Which of the following defense mechanisms is this woman demonstrating?
- A. Displacement
- B. Passive aggression (Correct Answer)
- C. Regression
- D. Sublimation
- E. Acting out
Applied behavior analysis Explanation: ***Passive aggression***
- This involves expressing **negative feelings indirectly** rather than openly addressing the conflict, which is exactly what the woman is doing by inconveniencing her neighbor with parking.
- She is avoiding direct confrontation but still demonstrating her anger and resentment through her actions.
*Displacement*
- This defense mechanism involves transferring an **emotional reaction from the original source** to a safer, less threatening one.
- While she is upset with her neighbor, she is not displacing her anger onto a different, unrelated target.
*Regression*
- This involves reverting to **earlier, more childish patterns of behavior** in response to stress or conflict.
- The woman's actions, while indirect, are not indicative of a return to immature behaviors.
*Sublimation*
- This defense mechanism involves channeling unacceptable impulses or emotions into **socially acceptable or productive activities**.
- Her actions are not productive or socially acceptable; instead, they are disruptive and aimed at annoying her neighbor.
*Acting out*
- This refers to expressing **unconscious emotional conflicts or impulses through behavior**, often in a destructive or self-destructive manner.
- While her actions are a form of behavior, "acting out" typically implies a more impulsive or self-harming nature than the deliberate, indirect aggression shown here.
Applied behavior analysis US Medical PG Question 8: A 15-year-old boy is referred to a child psychologist because of worsening behavior and constant disruption in class. He has received multiple reprimands in the past 6 months for not doing the homework his teacher assigned, and he refuses to listen to the classroom instructions. Additionally, his teachers say he is very argumentative and blames other children for not letting him do his work. He was previously well behaved and one of the top students in his class. He denies any recent major life events or changes at home. His past medical history is noncontributory. His vital signs are all within normal limits. Which of the following is the most likely diagnosis?
- A. Attention deficit hyperactivity disorder
- B. Antisocial personality disorder
- C. Conduct disorder
- D. Oppositional defiant disorder (Correct Answer)
- E. Major depressive disorder
Applied behavior analysis Explanation: ***Oppositional defiant disorder***
- This patient's symptoms of **argumentativeness**, **defiance**, and **blaming others**, combined with his previous good behavior and denial of major life events, are classic signs of **oppositional defiant disorder (ODD)**.
- ODD involves a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months, clearly distinguishing it from a temporary behavioral issue.
*Attention deficit hyperactivity disorder*
- While **ADHD** can cause inattention and difficulty following instructions, it typically presents earlier in childhood and is characterized by **hyperactivity**, **impulsivity**, and **inattention** that would have likely been prominent before recently.
- The patient's primary symptoms here are an argumentative and defiant attitude rather than core symptoms of inattention or hyperactivity that began recently.
*Antisocial personality disorder*
- This disorder is typically diagnosed in **adulthood (18 years or older)**, although symptoms of **conduct disorder** must be present before age 15. The patient is currently 15.
- **Antisocial personality disorder** involves a pervasive pattern of disregard for and violation of the rights of others, which is more severe than the defiance seen in this case.
*Conduct disorder*
- **Conduct disorder** involves a more severe pattern of behavior, including aggression towards people or animals, destruction of property, deceitfulness or theft, and serious violations of rules, which is not described in this patient.
- The behaviors in this patient (argumentativeness, defiance) are less severe than the behaviors associated with conduct disorder.
*Major depressive disorder*
- Although behavioral changes can occur in **depression**, this patient does not exhibit other common symptoms such as **anhedonia**, changes in sleep or appetite, or persistent sadness, which would be expected with **major depressive disorder**.
- His behaviors are primarily externalizing and defiant rather than indicating an internal state of sadness or loss of interest.
Applied behavior analysis US Medical PG Question 9: A 20-year-old man comes to the physician because of decreasing academic performance at his college for the past 6 months. He reports a persistent fear of “catching germs” from his fellow students and of contracting a deadly disease. He finds it increasingly difficult to attend classes. He avoids handshakes and close contact with other people. He states that when he tries to think of something else, the fears “keep returning” and that he has to wash himself for at least an hour when he returns home after going outside. Afterwards he cleans the shower and has to apply disinfectant to his body and to the bathroom. He does not drink alcohol. He used to smoke cannabis but stopped one year ago. His vital signs are within normal limits. He appears anxious. On mental status examination, he is oriented to person, place, and time. In addition to starting an SSRI, which of the following is the most appropriate next step in management?
- A. Cognitive-behavioral therapy (Correct Answer)
- B. Psychodynamic psychotherapy
- C. Motivational interviewing
- D. Interpersonal therapy
- E. Group therapy
Applied behavior analysis Explanation: **Cognitive-behavioral therapy**
- **Cognitive-behavioral therapy (CBT)**, specifically **Exposure and Response Prevention (ERP)**, is the most effective psychotherapy for **obsessive-compulsive disorder (OCD)**, which this patient's symptoms strongly suggest.
- CBT helps patients challenge distorted thoughts and gradually expose themselves to feared situations while preventing compulsive rituals, thus breaking the cycle of obsessions and compulsions.
*Psychodynamic psychotherapy*
- This therapy focuses on **unconscious conflicts** and **past experiences** to understand current symptoms.
- While it can be helpful for some mental health conditions, it is generally **less effective** than CBT for the specific, highly ritualized symptoms of OCD.
*Motivational interviewing*
- **Motivational interviewing** is a patient-centered counseling style designed to address **ambivalence about change** and enhance intrinsic motivation.
- It is often used in substance abuse or lifestyle changes, but it does not directly teach coping skills for OCD symptoms or address the underlying thought patterns.
*Interpersonal therapy*
- **Interpersonal therapy (IPT)** focuses on the patient's **current interpersonal relationships** and social functioning.
- While social difficulties can arise from OCD, IPT does not directly target the obsessions and compulsions that are central to the disorder.
*Group therapy*
- **Group therapy** can provide support and a sense of community, but for a severe condition like OCD, **individual therapy** (especially CBT/ERP) is typically recommended first due to the highly individualized nature of obsessions and compulsions.
- It may be a complementary approach, but usually not the most appropriate initial next step given the intensity of the patient's symptoms.
Applied behavior analysis US Medical PG Question 10: A resident doctor was reprimanded by the attending physician for making medication errors during morning rounds. Later that day, when a medical student asked a simple question about drug dosages during the evening rounds, the resident responded with excessive criticism and harsh comments, making the student visibly uncomfortable and embarrassed. Which of the following ego defense mechanisms is the resident demonstrating?
- A. Displacement (Correct Answer)
- B. Reaction formation
- C. Projection
- D. Passive aggression
- E. Acting out
Applied behavior analysis Explanation: ***Displacement***
- **Displacement** involves redirecting unacceptable feelings and impulses from their original source to a safer, less threatening recipient.
- The resident, unable to express anger towards the attending physician (a threatening figure), directs it at the medical student (a safer target).
*Reaction formation*
- **Reaction formation** is transforming an unacceptable impulse or feeling into its opposite.
- This would involve the resident being overly kind or solicitous towards the medical student, rather than critical, to mask their underlying anger or insecurity.
*Projection*
- **Projection** involves attributing one's own unacceptable thoughts or feelings to someone else.
- In this scenario, projection would mean the resident accusing the medical student of being incompetent or prone to errors, rather than simply criticizing them in response to prior reprimand.
*Passive aggression*
- **Passive aggression** is an indirect expression of hostility, often characterized by procrastination, stubbornness, intentional inefficiency, or forgotten commitments.
- While the criticism was harsh, it was a direct expression of anger, not an indirect, subversive act.
*Acting out*
- **Acting out** involves expressing unconscious emotional conflicts or stressors through actions rather than words.
- This mechanism typically involves impulsive behavior that could be harmful to oneself or others, which is not primarily what occurred with the verbal criticism.
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