MSN 671 : Psychopathopharmacology I -Module 4 quiz 4

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Free MSN 671 : Psychopathopharmacology I -Module 4 quiz 4 Questions

1.

Which test measures selective attention by requiring naming the ink color of a word instead of reading the word?

  • ADHD Rating Scale

  • Stroop Task

  • Vanderbilt Assessment Scale

  • Wender Utah Rating Scale

Explanation

Correct Answer:

B. Stroop Task

Explanation:

The Stroop Task is a neuropsychological test that measures selective attention, inhibitory control, and cognitive flexibility. In this task, a person must state the ink color of a word (e.g., the word “blue” written in red ink) instead of reading the word itself. This creates a conflict between automatic reading and controlled processing, making it especially useful for detecting executive dysfunction, as seen in ADHD.

Why Other Options Are Wrong:

A. ADHD Rating Scale

This is incorrect because it is a symptom checklist based on DSM criteria, not a performance-based test of attention.

C. Vanderbilt Assessment Scale

This is incorrect because it is a behavioral rating scale filled out by parents or teachers, not a neurocognitive attention test.

D. Wender Utah Rating Scale

This is incorrect because it is a retrospective self-report questionnaire for adults recalling ADHD symptoms from childhood, not a selective attention task.


2.

What electrolyte imbalance increases the risk of lithium toxicity?

  • Hypercalcemia

  • Hyponatremia

  • Hypokalemia

  • Hypermagnesemia

Explanation

Correct Answer:

B. Hyponatremia

Explanation:

Lithium is handled by the kidneys in a manner similar to sodium. When sodium levels are low (hyponatremia), the kidneys reabsorb more lithium in place of sodium, which leads to elevated lithium concentrations and an increased risk of toxicity. Symptoms include tremor, ataxia, confusion, and in severe cases, seizures or coma.

Why Other Options Are Wrong:

A. Hypercalcemia

This is incorrect because lithium can actually cause hypercalcemia by increasing parathyroid hormone levels, but hypercalcemia itself does not increase lithium toxicity risk.

C. Hypokalemia

This is incorrect because potassium levels do not directly affect lithium clearance or toxicity.

D. Hypermagnesemia

This is incorrect because magnesium levels are not a major factor in lithium metabolism or toxicity risk.


3.

Which neurotransmitters regulate prefrontal cortical circuits impaired in ADHD?

  • Dopamine and norepinephrine

  • Dopamine and serotonin

  • Norepinephrine and serotonin

  • Dopamine and glutamate

Explanation

Correct Answer:

A. Dopamine and norepinephrine

Explanation:

The prefrontal cortex is responsible for executive functions such as attention, working memory, and impulse control. In ADHD, impaired regulation of dopamine and norepinephrine in prefrontal circuits leads to inefficient tuning of information processing. Stimulant medications like methylphenidate and amphetamines improve ADHD symptoms by enhancing both dopamine and norepinephrine signaling in these pathways.

Why Other Options Are Wrong:

B. Dopamine and serotonin

This is incorrect because serotonin primarily modulates mood, sleep, and anxiety, not the executive dysfunction central to ADHD.

C. Norepinephrine and serotonin

This is incorrect because serotonin is not a primary regulator of prefrontal attention circuits. Norepinephrine contributes, but dopamine is equally essential.

D. Dopamine and glutamate

This is incorrect because while glutamate is the brain’s main excitatory neurotransmitter, it is dopamine and norepinephrine specifically that fine-tune prefrontal cortical function in ADHD.


4.

Which antidepressant carries the strongest risk of discontinuation syndrome if abruptly stopped due to its short half-life?

  • Paroxetine

  • Fluoxetine

  • Sertraline

  • Escitalopram

Explanation

Correct Answer:

A. Paroxetine

Explanation:

Paroxetine has one of the shortest half-lives among SSRIs, leading to a high risk of discontinuation syndrome if stopped suddenly. Symptoms include dizziness, nausea, fatigue, irritability, insomnia, and “electric shock” sensations. To avoid this, paroxetine should be tapered gradually.

Why Other Options Are Wrong:

B. Fluoxetine

This is incorrect because fluoxetine has the longest half-life among SSRIs (and an active metabolite, norfluoxetine), making discontinuation symptoms much less likely.

C. Sertraline

This is incorrect because sertraline has an intermediate half-life and can cause discontinuation symptoms, but the risk is lower compared to paroxetine.

D. Escitalopram

This is incorrect because escitalopram also has an intermediate half-life and carries some risk, but not as high as paroxetine.


5.

Which receptor mechanism explains the ability of aripiprazole to act as both a dopamine stabilizer and antipsychotic?

  • Full agonist at D2 receptors

  • Partial agonist at D2 receptors

  • Antagonist at 5HT1A receptors

  • Inverse agonist at NMDA receptors

Explanation

Correct Answer:

B. Partial agonist at D2 receptors

Explanation:

Aripiprazole is a partial agonist at dopamine D2 receptors, which allows it to act as a dopamine system stabilizer. In states of excess dopamine (such as the mesolimbic pathway), it reduces signaling by competing with dopamine but producing only partial activation. In states of low dopamine (such as the mesocortical pathway), it provides some receptor activation, preventing underactivity. This dual action explains its effectiveness as an antipsychotic while causing fewer EPS and prolactin-related side effects.

Why Other Options Are Wrong:

A. Full agonist at D2 receptors

This is incorrect because a full agonist would overstimulate dopamine receptors and worsen psychosis rather than stabilize it.

C. Antagonist at 5HT1A receptors


This is incorrect because aripiprazole is actually a partial agonist at 5HT1A receptors, which contributes to its anxiolytic and antidepressant effects, not its dopamine-stabilizing properties.

D. Inverse agonist at NMDA receptors


This is incorrect because NMDA receptors are glutamate receptors, not dopamine receptors, and inverse agonism here would not explain aripiprazole’s mechanism.


6.

Which antipsychotic is most associated with significant metabolic side effects, including weight gain, diabetes, and hyperlipidemia?

  • Haloperidol

  • Risperidone

  • Olanzapine

  • Ziprasidone

Explanation

Correct Answer:

C. Olanzapine

Explanation:

Olanzapine is strongly associated with metabolic side effects, including significant weight gain, insulin resistance, diabetes mellitus, and hyperlipidemia. It has one of the highest risks for metabolic syndrome among atypical antipsychotics. This is why patients on olanzapine require careful monitoring of weight, blood glucose, and lipid panels during treatment.

Why Other Options Are Wrong:

A. Haloperidol

This is incorrect because haloperidol is a typical antipsychotic more associated with extrapyramidal symptoms (EPS) and tardive dyskinesia, not metabolic issues.

B. Risperidone

This is incorrect because risperidone carries a moderate risk of weight gain and prolactin elevation, but its metabolic side effects are less severe than those of olanzapine.

D. Ziprasidone

This is incorrect because ziprasidone is considered weight-neutral and has a low risk of metabolic complications, though it can prolong the QT interval.


7.

Which class of drugs is being studied as an adjunctive treatment for schizophrenia by enhancing NMDA receptor function?

  • GABA-A modulators

  • Glycine-site agonists

  • D2 receptor antagonists

  • 5HT1A receptor antagonists

Explanation

Correct Answer:

B. Glycine-site agonists

Explanation:

The glutamate hypothesis of schizophrenia suggests that NMDA receptor hypofunction contributes to negative and cognitive symptoms. Drugs that act as glycine-site agonists (or co-agonists such as D-serine and glycine transporter inhibitors) enhance NMDA receptor function, thereby improving synaptic signaling and potentially alleviating symptoms that dopamine-based antipsychotics do not fully address. This adjunctive approach is under active investigation.

Why Other Options Are Wrong:

A. GABA-A modulators

This is incorrect because while GABA-A dysfunction may influence psychosis, these modulators are not the primary focus for enhancing NMDA receptor function in schizophrenia.

C. D2 receptor antagonists

This is incorrect because D2 antagonists form the core of current antipsychotic treatment, but they do not address NMDA hypofunction.

D. 5HT1A receptor antagonists

This is incorrect because 5HT1A modulation affects anxiety and mood, but it does not directly enhance NMDA receptor function.


8.

There are several known dopamine pathways in the brain. Which of the following pathways contributes to an increase in prolactin levels, resulting in galactorrhea or amenorrhea, when a patient is treated with an antipsychotic drug that blocks D2 receptors?

  • Thalamic Dopamine Pathway

  • Nigrostriatal Dopamine Pathway

  • Tuberoinfundibular Dopamine Pathway

  • Mesolimbic Dopamine Pathway

  • Mesocortical Dopamine Pathway

Explanation

Correct Answer:

C. Tuberoinfundibular Dopamine Pathway

Explanation:

The tuberoinfundibular pathway projects from the hypothalamus to the pituitary gland and regulates the secretion of prolactin. Normally, dopamine inhibits prolactin release via D2 receptor stimulation. When antipsychotic drugs block D2 receptors in this pathway, dopamine’s inhibitory control is lost, leading to elevated prolactin levels (hyperprolactinemia). Clinically, this can result in galactorrhea, amenorrhea, gynecomastia, and sexual dysfunction in patients receiving antipsychotic therapy.

Why Other Options Are Wrong:

A. Thalamic Dopamine Pathway

This is incorrect because there is no well-defined thalamic dopamine pathway associated with prolactin regulation.

B. Nigrostriatal Dopamine Pathway


This is incorrect because the nigrostriatal pathway is involved in motor control, and its D2 blockade causes extrapyramidal side effects, not hyperprolactinemia.

D. Mesolimbic Dopamine Pathway


This is incorrect because the mesolimbic pathway regulates reward and emotion. D2 blockade here reduces positive symptoms of schizophrenia but does not affect prolactin.

E. Mesocortical Dopamine Pathway


This is incorrect because the mesocortical pathway influences cognition and negative symptoms. Its dysfunction is linked to apathy and impaired executive function, not prolactin regulation.


9.

Which opioid receptor subtype is primarily responsible for euphoria and reinforcement?

  • Kappa

  • Mu

  • Delta

  • Sigma

Explanation

Correct Answer:

B. Mu

Explanation:

The mu-opioid receptor is the primary receptor responsible for the euphoric and reinforcing effects of opioids. Activation of mu receptors in the mesolimbic dopamine pathway (particularly in the nucleus accumbens) increases dopamine release, producing the rewarding effects that contribute to opioid abuse and dependence. Mu receptors are also responsible for analgesia, respiratory depression, and constipation.

Why Other Options Are Wrong:

A. Kappa

This is incorrect because kappa receptor activation produces dysphoria and hallucinations, not euphoria.

C. Delta

This is incorrect because delta receptors are involved in mood regulation and analgesia but do not primarily mediate euphoria or reinforcement.

D. Sigma

This is incorrect because sigma receptors are not true opioid receptors; they are associated with psychotomimetic effects, not the rewarding effects of opioids.


10.

Symptoms of schizophrenia are hypothetically attributable to malfunctioning in the:

  • Mesolimbic and nigrostriatal pathways

  • Nigrostriatal and tuberoinfundibular pathways

  • Tuberoinfundibular and mesocortical pathways

  • Mesocortical and mesolimbic pathways

Explanation

Correct Answer:

D. Mesocortical and mesolimbic pathways

Explanation:

Schizophrenia symptoms are best explained by dysfunction in two major dopamine pathways. Hyperactivity in the mesolimbic pathway produces positive symptoms (hallucinations and delusions), while hypoactivity in the mesocortical pathway contributes to negative symptoms (apathy, social withdrawal) and cognitive impairment. This dual dysfunction is central to the modern dopamine hypothesis of schizophrenia.

Why Other Options Are Wrong:

A. Mesolimbic and nigrostriatal pathways

This is incorrect because the nigrostriatal pathway is associated with movement regulation and extrapyramidal side effects from antipsychotics, not the core symptoms of schizophrenia.

B. Nigrostriatal and tuberoinfundibular pathways

This is incorrect because neither of these pathways explains psychotic symptoms. The nigrostriatal pathway controls movement, and the tuberoinfundibular pathway regulates prolactin secretion.

C. Tuberoinfundibular and mesocortical pathways

This is incorrect because while the mesocortical pathway is involved in schizophrenia, the tuberoinfundibular pathway is not linked to psychotic symptoms but rather to prolactin regulation.


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