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Examination for Professional Practice of Psychology Practice Test

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The Examination for Professional Practice in Psychology
(EPPP) is developed and owned by the Association of
State and Provincial Psychology Boards (ASPPB). The EPPP
is provided to state and provincial boards of psychology to
assist them in their evaluation of the qualifications of
applicants for licensure and certification. This
standardized knowledge-based examination is
constructed by ASPPB with the assistance of its test
vendor- Pearson VUE. The EPPP is continuously
administered in a computerized delivery format through
the Pearson VUE network of computer testing centers.
State and provincial psychology boards acting collectively
through ASPPB provide support for the testing format.
Pearson VUE maintains a network of more than 275
Pearson Professional Centers (PPCs) in the United States
and Canada in order to provide access to computer-based
testing (CBT) for candidates.
The resources of individual psychologists- ASPPB and its
test vendor are used in the ongoing development of and
improvements to the EPPP. These combined resources are
greater than those available to any individual psychology
licensing. The EPPP is only one part of the evaluation
procedures used by state and provincial boards to
determine candidates readiness to practice the
profession of psychology. Most boards supplement the
EPPP with other requirements and/or assessment
procedures. The EPPP is intended to evaluate the
knowledge that the most recent practice analysis has
determined as foundational to the competent practice of
psychology. Most candidates taking the EPPP have
obtained a doctoral degree in psychology- a year of predoctoral supervised experience and appropriate
postdoctoral experience. Candidates are expected to have
acquired a broad basic knowledge of psychology-
regardless of individual areas of concentration. This
knowledge- and the candidates ability to apply it- are
assessed through the candidates responses to objective-
multiple-choice questions that are representative of the
field at large. The average pass-rate for doctoral level
candidates who are taking the test for the first time
exceeds 80% in the most recent trial years.

Regardless of the jurisdiction- in order to sit for the
EPPP- individuals seeking licensure must first apply for
licensure to the licensing authority in the state-
province or territory in which they wish to be licensed.
The licensing authority reviews applicants credentials
and determines if they meet the requirements
established in the laws of the state- province or
territory.

Domain and Topics covered by killexams Q&As are as under;
-----------------

- Functional correlates and determinants of the neurobiological and genetic bases of behavior pertaining to perception- cognition- personality- and mood and affect in normal- acute and chronic neurobehavioral disease processes and disease comorbidities
- Drug classification- mechanisms of action- and desired/adverse effects of therapeutic agents- drugs of abuse- and complementary or alternative agents
- Results from major trials and general guidelines for pharmacological- psychotherapeutic- and combined treatment of psychological disorders
- Behavioral genetics- transmission and expression of genetic information and its modification- and the role and limitations of this information in understanding disorders
- Applications of structural and functional brain imaging methods- electrophysiological methods- therapeutic drug monitoring methods- and genetic screening methodologies- and the evidence for their effectiveness

- Major research‐based theories and models of intelligence and their application
- Major research-based theories- models- and principles of learning and their application
- Major research‐based theories and models of memory and their application
- Major research‐based theories and models of motivation and their application
- Major research-based theories and models of emotion and their application
- Elements of cognition- including sensation and perception- attention- language- information processing- visual-spatial processing- executive functioning
- Relations among cognitions/beliefs- behavior- affect- temperament- and mood
- Influence of psychosocial factors on cognitions/beliefs and behaviors

- Major research‐based theories and models of social cognition (e.g.- person perception- development of stereotypes- prejudice)
- Social interaction and relationships (e.g.- attraction- aggression- altruism- organizational justice- verbal and non‐verbal communication- internet communication- mate selection- empathy)
- Group and systems processes (e.g.- school- work- and family systems- job satisfaction- team functioning- conformity- persuasion) and social influences on functioning
- Major research‐based personality theories and models
- Cultural and sociopolitical psychology (e.g.- privilege- cross‐cultural comparisons- political differences- international and global awareness- religiosity and spirituality- acculturation)
- Identity diversity and intersectionality (e.g.- psychological impact of diversity on individuals- families- and systems)
- Causes- manifestations- and effects of oppression

- Normal growth and development across the lifespan
- Influence of individual‐environment interaction on development over time (e.g.- the relationship between the individual and the social- academic- work- community environment)
- Major research‐based theories and models of development
- Influence of diverse identities on development
- Family development- configuration- and functioning and their impact on the individual across the lifespan
- Life events that can influence the course of development across the lifespan
- Risk and protective factors that may impact a developmental course (e.g.- nutrition- prenatal care- health care- social support- socioeconomic status- abuse- victimization- and resiliency)
- Disorders and diseases that impact the expected course of development over the lifespan

- Psychometric theories- item and test characteristics- test construction and standardization procedures- reliability and validity- sensitivity and specificity- and test fairness and bias
- Assessment theories and models (e.g.- developmental- behavioral- ecological- neuropsychological)
- Assessment methods and their strengths and limitations (e.g.- self‐report- multiinformant reports- psychophysiological measures- work samples- assessment centers- direct observation- structured and semi‐structured interviews)
- Commonly used instruments for the measurement of characteristics and behaviors of individuals and their appropriate use with various populations

- Issues of differential diagnosis and integration of non‐psychological information into psychological assessment
- Instruments and methods appropriate for the assessment of groups and organizations (e.g.- program evaluation- needs assessment- organizational and personnel assessment)
- Criteria for selection and adaptation of assessment methods (e.g.- evidenced-based knowledge of assessment limitations- cultural appropriateness- trans‐cultural adaptation- and language accommodations)
- Classification systems and their underlying rationales and limitations for evaluating client functioning; dimensional vs. categorical approaches to diagnosis
- Factors influencing evidence-based interpretation of data and decision‐making (e.g.- base rates- group differences- cultural biases and differences- heuristics)
- Constructs of epidemiology and base rates of psychological and behavioral disorders
- Major research-based theories and models of psychopathology
- Measurement of outcomes and changes due to prevention or intervention efforts with individuals- couples- families- groups- and organizations
- Use of technology in implementing tests- surveys- and other forms of assessment and diagnostic evaluation (e.g.- validity- cost-effectiveness- consumer acceptability)

- Factors related to treatment or intervention decision-making (e.g.- relevant research- matching treatment to assessment/diagnosis- matching client or patient with psychologist characteristics- knowledge and use of allied services- cost and benefit- readiness to change)
- Contemporary research-based theories and models of treatment- intervention- and prevention
- Treatment techniques and interventions and the evidence for their comparative efficacy and effectiveness
- Methods and their evidence base for prevention- intervention- and rehabilitation with diverse and special populations
- Interventions to enhance growth and performance of individuals- couples- families- groups- systems- and organizations
- Research-based consultation models and processes
- Research-based models of vocational and career development
- Telepsychology and technology‐assisted psychological services
- Healthcare systems- structures- and economics- and how these impact intervention choice
- Approaches to health promotion- risk reduction- resilience- and wellness
- Contemporary theories and models of supervision and their evidence base

- Sampling and data collection methods
- Design of case- correlational- quasi‐experimental- and experimental studies
- Analytic methods- including qualitative (e.g.- thematic- phenomenological) and quantitative (e.g.- probability theory; descriptive- inferential- and parametric statistics; meta-analysis; factor analysis; causal modeling)
- Statistical interpretation (e.g.- power- effect size- causation vs. association- clinical vs. statistical significance)
- Critical appraisal and application of research findings (e.g.- adequacy of design and statistics- limitations to generalizability- threats to internal and external validity- design flaws- level of evidence)
- Evaluation strategies and techniques (e.g.- needs assessment- process and implementation evaluation- formative and summative program evaluation- outcome evaluation- cost‐benefit analysis)
- Considerations regarding community involvement and participation in research
- Dissemination and presentation of research findings

- Current ethical principles and codes for psychologists (APA- CPA)
- Professional standards and relevant guidelines for the practice of psychology (e.g.- standards for educational and psychological testing)
- Laws- statutes- and judicial decisions that affect psychological practice
- Identification and management of potential ethical issues
- Models of ethical decision‐making
- Approaches for continuing professional development
- Emerging social- legal- ethical- and policy issues and their impact on psychological practice
- Client and patient rights
- Ethical issues in the conduct of research
- Ethical issues in supervision
- Ethical issues in technology-assisted psychological services

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EPPP
Examination for Professional Practice of Psychology - 2026
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Question: 549
A 33-year-old female client presents with symptoms of anorexia nervosa (DSM-5: F50.0), with a BMI of
16.5 (reference: 18.5�24.9). Her family history includes a mother with perfectionistic tendencies, and she
grew up in a family with high expectations for academic and physical achievement. A recent life event, a
job loss, triggered a relapse of her symptoms. Lab results show hypokalemia (K+: 2.8 mEq/L, reference:
3.5�5.0 mEq/L), indicating electrolyte imbalance. Which family functioning factor most significantly
contributed to her eating disorder?
A. Hypokalemia
B. High family expectations
C. Job loss
D. Maternal perfectionism
Answer: B
Explanation: High family expectations, particularly around achievement, can foster perfectionism and
body image concerns, significantly contributing to the development of anorexia nervosa. This family
dynamic likely shaped the client�s maladaptive behaviors. Maternal perfectionism may have modeled
these tendencies, but the broader family expectation is more directly implicated. Job loss is a trigger, and
hypokalemia is a consequence, not a cause.
Question: 550
The STAR*D trial (2006), a landmark study on major depressive disorder, evaluated treatment strategies
in patients who failed initial SSRI therapy. Level 2 of the trial compared switching to sertraline,
bupropion, or venlafaxine versus augmenting citalopram with bupropion or buspirone. The remission rate
(defined as HDRS =7) for bupropion augmentation was 29.7%, compared to 20.4% for buspirone
augmentation (p=0.04). What does this finding suggest about the pharmacological augmentation strategy
for SSRI non-responders?
A. Bupropion�s dopaminergic and noradrenergic effects provide a superior augmentation strategy
B. Buspirone�s partial 5-HT1A agonism is more effective for anxiety than depression
C. Sertraline and venlafaxine are less effective than bupropion in combination therapy
D. The difference in remission rates is not clinically significant due to small effect size
Answer: A
Explanation: The STAR*D trial demonstrated that augmenting citalopram with bupropion, which
enhances dopamine and norepinephrine activity, resulted in a significantly higher remission rate (29.7%)
compared to buspirone (20.4%), a partial 5-HT1A agonist. This suggests that bupropion�s
catecholaminergic effects are more effective for SSRI non-responders, likely by addressing residual
symptoms like fatigue and anhedonia. Buspirone�s serotonergic action may be less effective for
depression in this context, though it can help with anxiety. The statistical significance (p=0.04) supports
clinical relevance, and the trial did not directly compare sertraline or venlafaxine augmentation.
Question: 551
A 45-year-old male client presents with concerns about declining cognitive function, reporting difficulty
recalling names and occasional lapses in attention during work meetings. Neuropsychological testing
reveals a Mini-Mental State Examination (MMSE) score of 26/30, with deficits in delayed recall. His
medical history includes hypertension managed with medication, and he reports a sedentary lifestyle.
According to normative data on cognitive aging, which of the following best explains the client�s
cognitive changes in the context of normal lifespan development?
A. Normal age-related decline in fluid intelligence and processing speed
B. Early onset of Alzheimer�s disease due to memory deficits
C. Secondary effects of untreated hypertension on cerebral blood flow
D. Subclinical depression masking as cognitive impairment
Answer: A
Explanation: The client�s MMSE score of 26/30 is within the normal range for his age, and deficits in
delayed recall are consistent with normative age-related declines in fluid intelligence and processing
speed, which typically begin in the 40s and affectButler, K. M., & Williamson, J. (2017). Cognitive
aging: A primer. Springer). Alzheimer�s disease is less likely given the absence of significant functional
impairment or rapid progression. Hypertension is managed, reducing the likelihood of vascular
contributions, and there�s no evidence of depressive symptoms.
Question: 552
In a study examining the impact of a parenting intervention on child behavior problems, a researcher uses
a cluster-randomized trial. Ten schools are randomly assigned to either the intervention or control
condition, with 50 students per school (total n = 500). Child behavior is measured using the Child
Behavior Checklist (CBCL) at baseline and post-intervention (6 months). The researcher plans to use a
mixed-effects model to account for clustering. What is the primary reason for using a mixed-effects
model, and what assumption must be checked?
A. Increases power; homogeneity of variances
B. Accounts for clustering; normality of residuals
C. Accounts for clustering; independence of observations
D. Increases power; sphericity
Answer: B
Explanation: A mixed-effects model is used to account for clustering (e.g., students within schools), as it
models both fixed effects (intervention) and random effects (school-level variation). The assumption of
normality of residuals must be checked to ensure the model�s estimates are valid.
Question: 553
A 37-year-old female with social anxiety disorder undergoes genetic testing, revealing a 5-HTTLPR short
allele, associated with serotonin transporter function. Her EEG shows increased theta power (4�8 Hz) in
the frontal regions, indicative of hyperarousal. Therapeutic drug monitoring of venlafaxine indicates a
plasma level of 150 ng/mL (therapeutic range: 100�400 ng/mL). A post-treatment fMRI scan shows
reduced amygdala hyperactivation. Which of the following best explains the role of these findings?
A. The 5-HTTLPR allele directly increases theta power, causing anxiety symptoms
B. The therapeutic venlafaxine level negates the relevance of genetic and imaging findings
C. The increased theta power is caused by venlafaxine�s side effects
D. The 5-HTTLPR allele modulates serotonin signaling, influencing anxiety severity and treatment
response
Answer: D
Explanation: The 5-HTTLPR short allele affects serotonin transporter function, influencing anxiety
regulation and treatment response in social anxiety disorder. Increased theta power reflects hyperarousal,
not a direct effect of the allele or venlafaxine�s side effects. Reduced amygdala hyperactivation post-
treatment indicates venlafaxine�s efficacy, supported by therapeutic levels, highlighting the relevance of
genetic and imaging findings.
Question: 554
A hospital evaluates a staff training program on patient-centered care using a pre-post survey (scored 0-
100). A paired t-test shows a significant score increase (t(50)=3.2, p<0.01). To ensure cultural
appropriateness for diverse staff, what adaptation is critical?
A. Translate the survey into multiple languages.
B. Modify items to reflect cultural care values.
C. Administer the survey in English with interpreters.
D. Use a single-language survey with visual aids.
Answer: B
Explanation: Modifying survey items to reflect cultural values around patient care ensures cultural
appropriateness, as care constructs vary across cultures. Translation alone may miss cultural nuances.
English-only administration or visual aids risk misinterpretation in diverse settings.
Question: 555
A researcher studies personality stability using Cattell�s 16 Personality Factors (16PF) in a trial of 200
adults over 5 years. She finds that Factor B (reasoning) remains stable (ICC = 0.85), but Factor Q3 (self-
control) declines (ICC = 0.60). A client, Aisha, scores low on Q3 (sten = 3) and reports impulsivity
influenced by cultural expectations of emotional expressiveness. How should the researcher interpret
Aisha�s Q3 score in light of Cattell�s theory and cultural factors?
A. Q3 decline is due to measurement error in the 16PF.
B. Low Q3 reflects a stable trait unaffected by culture.
C. Cultural norms reduce self-control, lowering Q3 scores.
D. Reasoning (Factor
B. drives impulsivity, not Q3.
Answer: C
Explanation: Cattell�s 16PF includes Q3 (self-control), which reflects discipline vs. impulsivity. The
study�s finding that Q3 declines suggests environmental influences, such as Aisha�s cultural norms
valuing emotional expressiveness, may reduce self-control, lowering her Q3 score. This aligns with
research on cultural impacts on personality expression. Q3�s decline is not attributed to measurement
error, and Factor B (reasoning) is unrelated to impulsivity.
Question: 556
A 60-year-old man undergoes cognitive testing, scoring in the 85th percentile for verbal fluency despite a
family history of dementia. His lifestyle includes regular exercise and social engagement. According to
the cognitive reserve hypothesis, how does his lifestyle contribute to his performance?
A. It builds neural pathways to offset genetic risk
B. It eliminates dementia risk entirely
C. It has no impact due to genetic predisposition
D. It reduces cognitive demand through simplification
Answer: A
Explanation: The cognitive reserve hypothesis posits that lifestyle factors like exercise and social
engagement build neural pathways, enhancing resilience against genetic risks like dementia. The man�s
high verbal fluency reflects this reserve. Eliminating risk, no impact, or reducing demand do not align
with the hypothesis.
Question: 557
A 52-year-old male with chronic pain and depression is prescribed duloxetine (60 mg daily). Laboratory
results show normal renal function (eGFR: 90 mL/min/1.73 m�) but elevated liver enzymes (AST: 80
U/L, reference: 10-40 U/L). Based on duloxetine�s mechanism and adverse effect profile, what is the
most appropriate action?
A. Switch duloxetine to amitriptyline and monitor AST
B. Discontinue duloxetine and switch to venlafaxine
C. Reduce duloxetine to 30 mg daily and recheck AST in 1 week
D. Continue duloxetine and monitor liver enzymes monthly
Answer: D
Explanation: Duloxetine, an SNRI, can cause mild liver enzyme elevations (AST: 80 U/L), but elevations
<3x the upper limit of normal (120 U/L for AST) do not typically warrant discontinuation. Guidelines
recommend monitoring liver enzymes periodically (e.g., monthly) in such cases, especially with normal
renal function and no other hepatotoxicity signs. Discontinuing or reducing duloxetine is premature
without further elevation or symptoms. Switching to venlafaxine or amitriptyline is not justified, as both
carry similar or greater hepatotoxicity risks. Monitoring is the most appropriate step.
Question: 558
A researcher is designing a correlational study to investigate the relationship between workplace diversity
training and employee attitudes toward inclusion. The study involves 400 employees, with training
exposure measured as hours completed and attitudes measured with the Inclusive Climate Scale (ICS).
The researcher finds a Pearson correlation of r = .28, p = .001. What does the correlation coefficient
indicate, and what is a potential issue with interpreting this result?
A. Weak positive correlation; causation cannot be inferred
B. Moderate negative correlation; response bias
C. Weak positive correlation; selection bias
D. Moderate negative correlation; history effects
Answer: A
Explanation: A Pearson correlation of r = .28 indicates a weak positive correlation, suggesting that more
diversity training is associated with more positive attitudes toward inclusion. A potential issue is that
causation cannot be inferred, as the correlation does not establish whether training causes attitude changes
or if other factors (e.g., pre-existing attitudes) influence both variables.
Question: 559
A 41-year-old female with attention-deficit/hyperactivity disorder (ADHD) undergoes genetic screening,
identifying a DRD2 gene polymorphism, associated with dopamine receptor function. Her EEG shows
increased delta power (1�4 Hz) in the frontal regions, indicative of cortical underarousal. Therapeutic
drug monitoring of atomoxetine indicates a plasma level of 400 ng/mL (therapeutic range: 200�600
ng/mL). A post-treatment fMRI scan shows normalized frontoparietal connectivity. Which of the
following best explains the role of these findings?
A. The DRD2 polymorphism directly increases delta power, causing inattention
B. The increased delta power is caused by atomoxetine�s side effects
C. The DRD2 polymorphism modulates dopamine signaling, influencing ADHD severity and treatment
response
D. The therapeutic atomoxetine level negates the relevance of genetic and imaging findings
Answer: C
Explanation: The DRD2 polymorphism affects dopamine receptor function, influencing ADHD
pathophysiology and treatment response. Increased delta power reflects cortical underarousal, not a direct
effect of the polymorphism or atomoxetine�s side effects. Normalized frontoparietal connectivity post-
treatment indicates atomoxetine�s efficacy, supported by therapeutic levels, highlighting the relevance of
genetic and imaging findings.
Question: 560
A 65-year-old retiree participates in a study on successful aging, reporting high life satisfaction despite
mild arthritis. Neuroimaging shows reduced prefrontal cortex volume, consistent with normative aging,
yet cognitive testing reveals above-average executive functioning. According to Baltes� selective
optimization with compensation (SOC) model, which strategy best explains her cognitive resilience?
A. Selection of less demanding social activities
B. Optimization via disengagement from cognitive tasks
C. Compensation through reliance on external aids like calendars
D. Compensation by avoiding cognitive challenges
Answer: C
Explanation: The SOC model suggests that successful aging involves selection (focusing on key goals),
optimization (enhancing abilities), and compensation (using external aids to offset declines). The retiree�s
above-average executive functioning despite prefrontal volume loss is best explained by compensation,
such as using calendars to support memory. Disengagement or avoiding challenges would not enhance
cognition, and social activities are less relevant.
Question: 561
A psychologist is diagnosing a 22-year-old male client with symptoms of social withdrawal and flat
affect. The psychologist uses a structured clinical interview but is concerned about the representativeness
heuristic, which may lead to an overdiagnosis of schizophrenia. Which cognitive bias is the psychologist
addressing?
A. Availability heuristic
B. Representativeness heuristic
C. Confirmation bias
D. Anchoring bias
Answer: B
Explanation: The representativeness heuristic involves judging the likelihood of a condition based on how
closely symptoms resemble a prototype, potentially leading to overdiagnosis of schizophrenia due to
stereotypical symptoms like social withdrawal and flat affect. The psychologist�s concern about this bias
prompts a careful diagnostic approach. Availability, confirmation, and anchoring biases involve different
cognitive processes not described in the scenario.
Question: 562
A 50-year-old male client with major depressive disorder reports persistent feelings of hopelessness and
anhedonia, despite adherence to an SSRI regimen. A recent blood test shows elevated inflammatory
markers (C-reactive protein: 5 mg/L vs. normative mean of 1 mg/L). Based on the polyvagal theory and
its application to emotion regulation, which intervention would most effectively address his emotional
dysregulation and enhance vagal tone to Excellerate mood?
A. Biofeedback training to increase heart rate variability
B. Cognitive-behavioral therapy to challenge hopeless thoughts
C. Vagus nerve stimulation to enhance parasympathetic activity
D. Interpersonal therapy to Excellerate social support
Answer: A
Explanation: The polyvagal theory links vagal tone to emotional regulation, with higher vagal activity
promoting calm and social engagement. Elevated inflammatory markers suggest a neuroinflammatory
component to depression, which can impair vagal tone. Biofeedback training targeting heart rate
variability (HRV) enhances vagal tone, improving parasympathetic control and emotional regulation,
directly addressing the client�s hopelessness and anhedonia. Vagus nerve stimulation is invasive and less
accessible. Cognitive-behavioral therapy targets thoughts but not vagal tone. Interpersonal therapy
improves support but does not directly enhance vagal activity.
Question: 563
A 25-year-old female client presents with symptoms of bulimia nervosa (DSM-5: F50.2), including
binge-purge cycles. Her developmental history includes growing up in a family with high conflict and
emotional volatility, where she felt pressured to mediate disputes. She experienced peer bullying in
adolescence, and a recent life event, a breakup, triggered a relapse. Lab results show hypomagnesemia
(Mg: 1.4 mEq/L, reference: 1.7�2.2 mEq/L), linked to purging. Which family functioning factor most
significantly contributed to her eating disorder?
A. Peer bullying
B. Hypomagnesemia
C. Emotional volatility in family
D. recent breakup
Answer: C
Explanation: High conflict and emotional volatility in the family can contribute to bulimia nervosa by
creating a stressful environment that disrupts emotional regulation and fosters maladaptive coping
mechanisms like binge-purge cycles. This family dynamic likely played a central role in the client�s
disorder. Peer bullying and the breakup are secondary stressors, and hypomagnesemia is a consequence
of purging, not a cause.
Question: 564
A 33-year-old female with anorexia nervosa undergoes genetic testing, revealing a HTR2A gene
polymorphism, associated with serotonin receptor function. Her EEG shows increased beta power (13�30
Hz) in the occipital regions, indicative of hypervigilance. Therapeutic drug monitoring of fluoxetine
indicates a plasma level of 200 ng/mL (therapeutic range: 100�300 ng/mL). A post-treatment fMRI scan
shows reduced anterior cingulate cortex (ACC) hyperactivation. Which of the following best explains the
role of these findings?
A. The HTR2A polymorphism directly increases beta power, causing restrictive eating
B. The therapeutic fluoxetine level negates the relevance of genetic and imaging findings
C. The increased beta power is caused by fluoxetine�s side effects
D. The HTR2A polymorphism modulates serotonin signaling, influencing anorexia severity and treatment
response
Answer: D
Explanation: The HTR2A polymorphism affects serotonin receptor function, influencing emotional
regulation and treatment response in anorexia nervosa. Increased beta power reflects hypervigilance, not
a direct effect of the polymorphism or fluoxetine�s side effects. Reduced ACC hyperactivation post-
treatment indicates fluoxetine�s efficacy, supported by therapeutic levels, highlighting the relevance of
genetic and imaging findings.
Question: 565
A 27-year-old female client with a recent diagnosis of autism spectrum disorder (ASD, DSM-5: F84.0)
presents for therapy to address social difficulties. Her developmental history includes delayed language
acquisition and sensory sensitivities, noted by her parents but not addressed due to limited access to
healthcare in their rural community. She experienced social rejection in school, and her family structure
was patriarchal, with rigid gender roles. recent genetic testing revealed a SHANK3 gene mutation,
associated with ASD. Which factor most significantly impacted her developmental course?
A. Limited access to healthcare
B. Patriarchal family structure
C. SHANK3 gene mutation
D. Social rejection in school
Answer: C
Explanation: The SHANK3 gene mutation is a primary genetic factor associated with autism spectrum
disorder, directly contributing to the client�s neurodevelopmental symptoms, such as delayed language
and sensory sensitivities. This genetic alteration fundamentally shaped her developmental course. Limited
healthcare access delayed diagnosis, patriarchal family structure may have compounded social challenges,
and social rejection is a secondary consequence, but the genetic mutation is the most significant driver.
Question: 566
Dr. Chen provides telepsychology to a client with social anxiety using a platform with a 99.9% uptime
guarantee. The client�s Liebowitz Social Anxiety Scale score is 80/120. During sessions, Dr. Chen
notices minor video lag (100 ms). What is the most ethical action per telepsychology guidelines?
A. Continue with current settings
B. Optimize platform settings to reduce lag
C. Switch to telephone-based therapy
D. Transition to in-person sessions
Answer: B
Explanation: Optimizing platform settings to reduce lag ensures high-quality service delivery, aligning
with telepsychology guidelines for technological competence. Continuing without adjustments risks
session efficacy, telephone-based therapy limits visual cues, and in-person sessions may not be feasible
for social anxiety.
Question: 567
A neuropsychologist is evaluating a 55-year-old male patient with suspected early-onset Alzheimer�s
disease. The patient struggles with tasks requiring visual-spatial processing, such as copying a complex
geometric figure, and exhibits deficits in executive functioning, including poor planning and impulsivity.
A positron emission tomography (PET) scan reveals hypometabolism in the parietal and temporal lobes.
Based on models of visual-spatial processing, such as the dual-stream hypothesis, which cognitive deficit
is most likely contributing to his difficulty with the figure-copying task, and what intervention would
best compensate for this deficit?
A. Impaired ventral stream processing, addressed with visual aids to enhance object recognition
B. Impaired dorsal stream processing, addressed with verbal scaffolding to guide task performance
C. Impaired attentional control, addressed with cognitive training to Excellerate focus
D. Impaired motor coordination, addressed with occupational therapy to Excellerate fine motor skills
Answer: B
Explanation: The dual-stream hypothesis posits two visual processing pathways: the dorsal stream
(�where� pathway) handles spatial location and motion, while the ventral stream (�what� pathway)
processes object identity. Difficulty copying a complex figure suggests impaired dorsal stream
processing, as this task requires spatial organization and visuomotor integration, functions associated
with the parietal lobe, which shows hypometabolism in the PET scan. Verbal scaffolding, such as
providing step-by-step verbal instructions, can compensate by engaging intact language areas to guide
spatial tasks. Ventral stream deficits would impair object recognition, not figure copying. Attentional
control deficits are less specific to the task, and motor coordination is not primarily implicated given the
cognitive nature of the deficit.
Question: 568
You are treating a 30-year-old male veteran with PTSD and comorbid alcohol use disorder (AUD). His
PCL-5 score is 60 (severe), and his Alcohol Use Disorders Identification Test (AUDIT) score is 22 (high
risk). A 2024 meta-analysis found that a specific integrated intervention reduced both PTSD and AUD
symptoms by 40%, compared to 25% for sequential treatment. Which intervention is most supported by
this evidence?
A. Implement sequential treatment with prolonged exposure (PE) followed by CBT for AUD
B. Recommend integrated prolonged exposure and relapse prevention (PE-RP)
C. Suggest eye movement desensitization and reprocessing (EMDR) for PTSD
D. Propose motivational interviewing (MI) for AUD with concurrent CBT
Answer: B
Explanation: The 2024 meta-analysis supports integrated prolonged exposure and relapse prevention (PE-
RP), which reduces both PTSD and AUD symptoms by 40% by addressing trauma and substance use
concurrently. This aligns with the client�s severe symptoms and high-risk AUD. Sequential treatment (PE
then CBT) achieved a 25% reduction, while EMDR and MI with CBT lack evidence for integrated
PTSD-AUD treatment.
Question: 569
A 48-year-old male with chronic pain undergoes genetic screening, identifying a COMT Val158Met
polymorphism, associated with pain sensitivity. His fMRI scan shows increased somatosensory cortex
activation during pain stimuli, with a BOLD signal change of 2.2% (normal: <1.5%). Therapeutic drug
monitoring of duloxetine indicates a plasma level of 60 ng/mL (therapeutic range: 30�120 ng/mL). Which
of the following best explains the interplay of these findings?
A. The COMT polymorphism modulates catecholamine signaling, influencing pain perception and
treatment response
B. The COMT polymorphism directly increases somatosensory cortex activation, causing chronic pain
C. The increased somatosensory cortex activation is caused by duloxetine�s side effects
D. The therapeutic duloxetine level indicates no role for genetic or imaging findings
Answer: A
Explanation: The COMT Val158Met polymorphism affects catecholamine metabolism, influencing pain
sensitivity and treatment response in chronic pain. Increased somatosensory cortex activation reflects
heightened pain processing, not a direct effect of the polymorphism or duloxetine�s side effects. The
therapeutic duloxetine level supports its efficacy in modulating pain, highlighting the relevance of
genetic and imaging findings.
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