ABNORMAL PSYCHOLOGY

REVIEW LECTURE
BOARD EXAMS
05.28.15
1. ___________ is a psychological experience characterized by concern about future events, and ___________ is
characterized by concern about current circumstances.
a. Panic; anxiety
b. Fear; anxiety
c. Anxiety; fear
d. Depression; anxiety
2. Which of the following is true about generalized anxiety disorder?
a. It is most common in individuals aged 1524 years.
b. Its course tends to be chronic.
c. It is the least common of the anxiety disorders.
d. It is more common in men.
3. Why are the majority of people who suffer from agoraphobia women?
a. Chromosomal features related to sensitivity of the hypothalamuspituitary axis are more common in
women.
b. Women are more likely to use cognitive distortions in which they appraise events as threatening.
c. The hormonal system in women sensitizes the female nervous system to stress.
d. Cultural factors make it more acceptable for women to avoid situations and to report their fears.
4. Marty has a fear of dogs. Which of the following suggests that his fear qualifies as a specific phobia rather than
just an everyday fear?
a. Martys fear of dogs comes and goes following an episodic pattern.
b. Marty owns a cat but no dog.
c. Marty believes that his fear of dogs is reasonable and appropriate.
d. Marty will only work night shifts, a time when he thinks all dogs will be safely inside.
5. Which technique appears to be the most effective treatment for phobias?
a. exposure to the feared stimulus under therapeutic supervision
b. rapid and repeated exposure to the feared stimulus followed by immediate escape
c. hypnosis during which fear-related conflicts are banished from the unconscious
d. challenging the client to see that the fears are irrational, unrealistic, and excessive
6. Every morning when he leaves for work Anthony has recurring doubts about whether he locked his front door.
He continues thinking about this throughout the day, to the distraction of his work. Anthony is experiencing:
a. obsession
b. derealization
c. panic
d. compulsion
7. The primary symptom of hypochondriasis / illness anxiety disorder is:
a. fear of developing a disease
b. fear of spreading a disease

c. fear of contact with diseased individuals

d. fear of currently having a disease
8. Someone who presents with the following symptoms might have hypochondriasis.
a. interpreting momentary flutters in the stomach as a sign of illness
b. reluctance to visit the doctor for fear of having a panic attack
c. enjoyment of the immediate attention received when visiting a doctor
d. realization that the presence of an illness could qualify the individual for full-time disability benefits
9. Choose the scenario that best demonstrates a complex somatic symptom disorder
a. Lisa reports that she has continuous nausea and is unable to work, but a medical exam fi nds no sign of illness.
Lisa claims she only feels better when her husband stays home to nurse her.
b. Eddie visits 11 different physicians in 6 months but is frustrated that no doctor seems able to make an adequate
diagnosis.
c. Sherry has physical complaints that have lasted at least 10 years. Her symptoms include pain in her feet,
hands, and neck; alternating diarrhea and constipation; and difficulty walking. Sherrys physician cannot find any
illness to account for these complaints.
d. Pedro stops working because he thinks that his ears are twice the size they should be and that he looks like a
freak. His therapist observes, however, that Pedros ears are a normal size.
10. Hypochondriasis, now called Illness Anxiety Disorder, is related to ______, whereas somatization disorder,
now called complex somatic symptom disorder, is linked to ______.
a. obsessive-compulsive disorder; schizotypal personality disorder
b. dissociative disorder; obsessive-compulsive disorder
c. psychotic disorders; anxiety disorders
d. anxiety disorder; antisocial personality disorder
11. In factitious disorder:
a. the individual is faking symptoms for personal gain
b. the individual is voluntarily producing the symptoms without any obvious financial or other external incentives
c. the individual is not in control of the symptoms but there is no physical explanation
d. the symptoms are caused by a yet-to-be-identified virus
12. Jorge, a 19-year-old male, was hospitalized after his legs collapsed under him while walking to class. He could
not regain his stance and has been unable to walk since, although he desperately wants to walk again. A
neurological exam revealed no medical problem. Jorges behavior is consistent with:
a. somatization disorder
b. functional neurological disorder
c. malingering
d. body dysmorphic disorder
13. Mrs. Thompson brought her 4-year-old daughter, Carmen, to the emergency room, stating that the child had
been vomiting nonstop throughout the morning. Carmens condition improved over the course of several days. On
the day of her discharge from the hospital, a nurse walked in as Mrs. Thompson was giving Carmen a drink of
floor cleaner. Mrs. Thompsons behavior is consistent with:
a. parental hypochondriasis
b. Munchausen syndrome by proxy
c. conversion syndrome by proxy
d. parental somatization

14. ______ describes the experience of losing a sense of your own reality, whereas ______ describes losing your
sense of reality of the external world.
a. Depersonalization; derealization
b. Derealization; somatization
c. Derealization; depersonalization
d. Somatization; derealization
15. The disorder in DSM IV-TR with a symptomatology closest to functional neurological disorder of DSM 5 is
a. malingering
b. body dysmorphic disorder
c. somatization disorder
d. conversion disorder
16. Michaels wife, Jennifer, reported him missing to the police in 1998. Two years later she saw Michael in an
airport. He lived two states away from Jennifer, was married to another woman, and had two children with her.
Michael told Jennifer that his name was Danny, not Michael, and that he had never met her before. Michaels
presentation is consistent with:
a. multiple personality disorder
b. dissociative trance disorder
c. dissociative identity disorder
d. dissociative fugue
17. The different identities or personalities in dissociative identity disorder are called ______, whereas the change
from one personality to another is called a ______.
a. masks; transition
b. faces; switch
c. faades; transition
d. alters; switch
18. An individual who is experiencing an elevated mood, a decreased need for sleep, and distractibility is most
likely experiencing:
a. panic disorder
b. mania
c. depersonalization
d. hallucinations
19. What is the general agreement among mental health professionals about the relationship between
bereavement and depression?
a. Bereavement is less severe than depression in all cases.
b. Depression can lead to bereavement in many cases.
c. Bereavement can lead to depression in many cases.
d. Symptoms of bereavement and depression rarely overlap.
20. Bipolar I disorder is characterized by ______, whereas bipolar II is characterized by ______.
a. full manic episodes; hypomanic episodes
b. hypomanic episodes; full manic episodes
c. both depressive and manic episodes; full manic episodes
d. full manic episodes; both depressive and manic episodes

21. Which statement best characterizes the relationship between anxiety and depression?
a. Anxiety usually precedes the development of depression.
b. Depression usually precedes the development of anxiety.
c. Almost all depressed patients are anxious, but not all anxious patients are depressed.
d. Almost all anxious patients are depressed, but not all depressed patients are anxious.
22. Which theory suggests that depression occurs when individuals believe that they have no control over the
circumstances in their lives?
a. attribution theory
b. learned helplessness
c. social learning theory
d. theory of equifi nality
23. In treating depressed clients, a psychologist helps them think more positively about themselves, about their
place in the world, and about the prospects for the future. This psychologist is basing her techniques on whose
model of depression?
a. Sigmund Freud
b. Carl Rogers
c. Rollo May
d. Aaron Beck
24. Maintenance treatment for depression can be important because it can prevent:
a. transmission
b. bereavement
c. incidence
d. relapse
25. Which of the following is a risk factor for suicide?
a. having a relative who committed suicide
b. playing aggressive, full-contact sports
c. a history of multiple marriages
d. an abstract, philosophical cognitive style
26. The general adaptation syndrome describes several stages people experience in response to sustained
stress. These stages occur in which order?
a. alarm, resistance, exhaustion
b. resistance, alarm, exhaustion
c. resistance, exhaustion, alarm
d. exhaustion, alarm, resistance
27. Next month Shanti has to take an important college entrance exam. Which factor is most likely to influence
whether her response to the exam is positive or negative?
a. the genetic vulnerability to stress that Shanti has inherited from her parents
b. whether Shanti will be taking the exam in a room by herself or with other students
c. Shantis beliefs about how much control she has over the situation
d. how much time Shanti has to study before the exam
28. The study of how psychosocial factors influence cancer is known as:

a. psychopathology
b. psychopharmacology
c. psycho-oncology
d. oncosociology
29. Which of the following is a risk factor for coronary heart disease?
a. anger that is part of the type A behavior pattern
b. belligerence that is part of the type B behavior pattern
c. competitive drive that is part of the type B behavior pattern
d. carefree disregard for deadlines that is part of the type A behavior pattern
30. Biofeedback can be used to teach people how to:
a. reduce their competitive drive and sense of urgency
b. consciously control physiological functions that are outside awareness
c. develop more supportive social support networks
d. control their facial expressions to control their mood
31. Which of the following accurately characterizes the effects of denial as a coping strategy?
a. Individuals who undergo coronary artery bypass surgery return to normal activities more rapidly if
they deny their pain.
b. Denial may have damaging short-term consequences in terms of the stress response, but it seems
to be helpful to rehabilitation in the long term.
c. People who deny their disease may not notice meaningful variations in their symptoms.
d. Denial appears to have exclusively negative consequences on health and adaptation.
32. Which three behaviors, all of which can be modified, put people at the most risk for physical problems?
a. unhealthy diet, lack of exercise, smoking
b. pollution, unhealthy diet, lack of exercise
c. lack of exercise, smoking, reckless driving
d. smoking, alcohol use, road rage
33. Dr. Thompson sees a patient with a chubby face, calluses on her fingers, and small scars on the back of her
hand. Tests indicate that the patient weighs slightly more than her expected weight and that she has an electrolyte
imbalance. The patient reports that she is having persistent constipation and that she feels as if her heart has
been skipping beats. These symptoms are consistent with:
a. depression
b. anxiety
c. anorexia nervosa
d. bulimia nervosa
34. Research on bulimia nervosa suggests that it most often co-occurs with:
a. anxiety disorders
b. mood disorders
c. psychotic disorders
d. substance use disorders
35. In a study by Fallon and Rozin, female undergraduates:
a. rated their current body size the same as the ideal body size
b. rated the ideal body size smaller than the attractive body size

c. rated the ideal body size heavier than the attractive body size
d. rated their current body size smaller than the ideal body size
36. While sleeping, Michael, a 55-year-old overweight male, experiences a cessation in his breathing for short
periods. Michaels wife reports that he snores continuously and never feels rested. Michaels symptoms are
consistent with:
a. narcolepsy
b. sleep apnea
c. sleepwake schedule disorder
d. cataplexy
37. The primary difference between sleep terrors and nightmares is:
a. sleep terrors usually begin with a scream and stiffening of arms and legs
b. children do not remember nightmares
c. sleep terrors occur during NREM sleep, thus, less likely to be remembered
d. sleep terrors are more prevalent in the population
38. Statistics about sexual activity have suggested that:
a. more people engage in oral intercourse than vaginal intercourse
b. the majority of people engage in heterosexual, vaginal intercourse in the context of a relationship with one
partner
c. 60% to 75% of the population has exclusively homosexual sex
d. in the 1990s, people were more likely to be having sex with multiple partners than they were to be in a
monogamous sexual relationship
39. The most common form of treatment for gender identity disorder is:
a. exposure therapy
b. antidepressant medication
c. cognitivebehavioral therapy
d. sexual reassignment surgery
40. In which phase of the sexual response cycle can men experience difficulty attaining or maintaining erections?
a. resolution
b. orgasm
c. arousal
d. plateau
41. Simone and her partner have sexual intercourse about once a month. Simone says she wants to have sex but
cant seem to achieve adequate lubrication to make sex enjoyable. Simones symptoms are most consistent with:
a. impotence
b. sexual aversion disorder
c. sexual arousal disorder
d. vaginismus
42. Which component is essential to the diagnosis of female orgasmic disorder?
a. orgasms occur less frequently than desired
b. a 20% to 30% reduction in the frequency of orgasms in the last 6 months
c. a 70% to 80% reduction in the frequency of orgasms in the last year
d. orgasm never or almost never occurs

43. The overarching goal of Masters and Johnsons psychosocial treatment for sexual dysfunction was:
a. reducing or eliminating psychologically based performance anxiety
b. helping couples to decrease the frequency of their sexual encounters to normalize sexual experiences
c. encouraging couples to be more willing to try medical treatments, despite their potential side effects
d. helping both individuals in a couple to understand past parental influences on contemporary sexual relations
within the couple
44. A disorder in which an inappropriate, inanimate object is the source of sexual arousal is known as a:
a. parapathology
b. paranormality
c. paraphilia
d. paraphasia
45. Which of the following statements is an accurate characterization of pedophilia?
a. It involves an attraction to male children more often than female children.
b. It is most commonly directed at girls who are beginning to mature physically.
c. It is often rationalized by the perpetrator as an acceptable way to teach children about sexuality.
d. It involves the use of physical force to get a child to perform sexual acts.
46. Shane is being treated for a paraphilia by imagining harmful consequences occurring in response to his
unwanted behavior and arousal. Shane is receiving what kind of treatment?
a. covert sensitization
b. marital therapy
c. relapse prevention
d. orgasmic reconditioning
47. The definition of substance abuse according to the DSM-IV-TR is based on:
a. how much of the substance is consumed per day
b. how much of the substance is consumed per week
c. how significantly the substance interferes with the users life
d. the type of substance used
48. ______ is the need for greater amounts of a drug to experience the same effect, whereas ______ is the
negative physical response that occurs when a drug is not taken.
a. Tolerance; withdrawal
b. Delirium; withdrawal
c. Dependence; tolerance
d. Accommodation; abuse
49. Which of the following statements most accurately describes the relationship between gender and alcohol
consumption?
a. Women are more likely to use alcohol, but men are more likely to be heavy drinkers.
b. Men are more likely to use alcohol, but women are more likely to be heavy drinkers.
c. Women are more likely to use alcohol and be heavy drinkers.
d. Men are more likely to use alcohol and be heavy drinkers.
50. For marijuana users, reverse tolerance occurs when:
a. chronic use renders the user unable to feel high

b. a first-time user does not feel high

c. more pleasure from the drug is reported after repeated use
d. a chronic user experiences withdrawal symptoms
51. Research shows that the way individuals think about a drug influences the way they act when using the drug.
This phenomenon is known as the:
a. tolerance paradigm
b. expectancy effect
c. dependency model
d. opponent-process theory
52. Carloss psychiatrist treats him for cocaine abuse by delivering a shock when Carlos attempts to use cocaine,
a treatment known as ______. In contrast, Lisas therapist has her imagine having painful seizures at the same
time that Lisa is thinking about using cocaine, a treatment known as ______.
a. aversion therapy; covert sensitization
b. contingency management; relapse prevention
c. narcotics anonymous; controlled use
d. agonist substitution; aversive treatment
53. Some personality disorders are diagnosed more frequently in men than in women. One explanation for this
difference is as follows:
a. Symptoms are interpreted by clinicians in different ways depending on the gender of the person with the
symptoms.
b. Men are more likely to seek help from mental health professionals than women.
c. Most clinicians are men, and they tend to see psychopathology more often in patients of the same
gender as themselves.
d. Because of hormonal differences, women are more likely to have acute disorders and men are more
likely to have chronic personality disorders.
54. Genetic research and an overlap in symptoms suggest a common relationship between schizophrenia and:
a. borderline personality disorder
b. schizotypal personality disorder
c. schizoid personality disorder
d. antisocial personality disorder
55. Which symptom is characteristic of persons with borderline personality disorder?
a. impulsivity
b. aloofness
c. mania
d. grandiosity
56. Greeting a new acquaintance with effusive familiarity, crying uncontrollably during a movie, and trying to be the
center of attention at a party are typical behaviors
of someone with:
a. borderline personality disorder
b. narcissistic personality disorder
c. histrionic personality disorder
d. paranoid personality disorder

57. Which of the following statements is most true about borderline personality disorder?
a. Childhood abuse is rare in people with borderline personality disorder.
b. Borderline personality disorder is more frequently diagnosed in men than in women.
c. Behaviors in borderline personality disorder overlap those seen in posttraumatic stress disorder.
d. Borderline personality disorder is seldom accompanied by self-mutilation.
58. People with which personality disorder often exhibit childlike, egocentric behaviors?
a. paranoid
b. antisocial
c. schizotypal
d. narcissistic
59. An individual who is preoccupied with details, rules, organization, and scheduling to the extent that it interferes
with daily functioning may have:
a. obsessive-compulsive personality disorder
b. narcissistic personality disorder
c. antisocial personality disorder
d. schizoid personality disorder
60. Symptoms of schizophrenia which divides them into three broad
categories?
a. paranoid catatonic and language
b. relapse, episodic and chronic
c. genetic, psychiatric and somatic
d. positive, negative and disorganized
61. Emotional and social withdrawal, apathy, and poverty of speech and thought are examples of what type of
symptoms in schizophrenia?
a. psychotic
b. negative
c. disorganized
d. positive
62. Rhonda fears that her employer is trying to poison her with gas emitted from the overhead lights in her office.
Given what you know about Rhondas thoughts, what subtype of schizophrenia is she most likely to have?
a. catatonic
b. disorganized
c. paranoid
d. undifferentiated
63. Which disorder is characterized by symptoms similar to those seen in schizophrenia but of shorter duration,
often with successful remission of symptoms?
a. schizophreniform disorder
b. delusional disorder
c. schizoaffective disorder
d. bipolar disorder
64. Which sibling of an individual with schizophrenia is most likely to develop schizophrenia?
a. monozygotic twin raised in the same home

b. monozygotic twin raised in a different home

c. dizygotic twin raised in the same home
d. dizygotic twin raised in a different home
65. Which two psychosocial interventions appear to be most helpful for people with schizophrenia?
a. hypnosis and psychosurgery
b. ECT and social skills training
c. psychoanalytic psychotherapy and expressed emotion management
d. family therapy and education and vocational rehabilitation (halfway houses)
66. According to the DSM-5, the two symptoms that are characteristic of ADHD are:
a. inattention and hyperactivity
b. echolalia and impulsivity
c. hallucinations and delusions
d. obsessions and compulsions
67. Echolalia is characterized by which of the following behaviors?
a. continuously reading the same sentence or words
b. repeating the speech of others
c. mimicking the movements of others
d. staring ahead without blinking for long periods
68. Behavioral techniques are often used to address communication problems that occur with autism. ______
involves rewarding the child for progressive approximations of speech, and ______ involves rewarding the child
for making sounds that the teacher requests.
a. Shaping; discrimination training
b. Modeling; syntax training
c. Imitating; expression training
d. Processing; academic training
69. Research has shown that ADHD in children is associated with:
a. chronic neglect
b. having an alcoholic father
c. maternal smoking during pregnancy
d. death of a parent in early childhood
70. ______ is a form of intellectual disability caused by the presence of an extra 21st chromosome.
a. Down syndrome
b. Fragile X syndrome
c. PKU syndrome
d. Fetal alcohol syndrome
71. ______ is characterized by acute confusion and disorientation; whereas ______ is marked by deterioration in
a broad range of cognitive abilities.
a. Delirium; amnesia
b. Amnesia; delirium
c. Dementia; delirium
d. Delirium; dementia

72. Which is an indicator of abnormal behavior?

I. dysfunction
II. distress
III. atypical response or not culturally accepted
a. I
b. I, II
c. I, III
d. I, II, III
73. People who study psychopathology are scientists because of following which order of the practice of science?
a. evaluate science create science consume science
b. consume science evaluate science create science
c. create science evaluate science consume science
d. consume science create science evaluate science
74. The prevalence of a psychological disorder refers to
a. number of people in the population that have this
b. number of cases in a given time period
c. types of disorder connect with assessment and treatment
d. pattern of occurrence of the disorder
75. The lifetime prevalence of phobias for females is 16%. This means
I. 16% of the female population will have this at some point in their life
II. A female has a 16% chance of having this at some point in her life
III. females are 16 times more likely to have a phobia than males
a. II
b. I
c. I, III
d. I, II
76. The primitive act of drilling a hole into the skull to release the demon in the brain is called
a. humoral surgery
b. ECT
c. trephining
d. maleficarum
77. This STD was believed to be capable of making the person have delusions of persecution because of the
bacterial organisms ability to enter the brain
a. Chlamydia
b. AIDS
c. Syphilis
d. Vaginal yeast
78. A cognitive explanation to phobia are explained in the following statements except:
I. Attend to negative stimuli
II. Interpret ambiguous stimuli as threatening
III. Believe that negative events are more likely to
a. III

b. II
c. I
d. II, III
79. Which statement is true for flooding, a behavioral treatment for phobia?
a. It is just as effective as systematic desensitization
b. This is used as a last resort, when gradual exposure has failed
c. It is similar to social skills training in a way that both requires role-play
d. In flooding, fearful patients are exposed to demonstrations of other persons interacting fearlessly with the
phobic object
80. Albert is experiencing a panic attack. Which is Albert least likely experiencing?
a. Labored breathing
b. Palpitations
c. Nausea
d. Abdominal pains
81. Bea was in the work place, in the same environment and doing the same task for thirty minutes when she had
a panic attack. When she calmed down, she was asked if there was any concern that came up to her head, she
couldnt recall any. Beas panic attach was
a. cued
b. uncued
c. situationally predisposed
d. exclusive
82. Panic attack is noted in other cultures with its own name. In Puerto Rice, for example, it is called
a. hysteria
b. kayak angst
c. ataque de nervios
d. ataque de panico
83. Carlo is diagnosed with panic disorder. He may also have (comorbid)
a. Illness Anxiety Disorder
b. Schizotypal Personality Disorder
c. Major depression
d. Narcotic addiction
84. He is know for legitimizing the practice of hypnosis
a. Jean-Martin Charcot
b. Anton Mesmer
c. Sigmund Freud
d. Josef Breuer
85. This model of explaining the etiology of disorder suggests that it is not about being predisposed to a disorder,
but to being predisposed to certain factors and behaviors that would lead to stressful events, and consequentially,
a disorder.
a. Diathesis-stress model
b. Reciprocal gene-environment model
c. Nongenomic theory

d. Epigeneric theory
86. This is the action by which a neurotransmitter is quickly drawn back into the discharging neuron after being
released into a synaptic cleft
a. agonization
b. vesicle suction
c. reuptake
d. activation
87. This therapy is known as re-writing the brain
a. Interpersonal therapy
b. Reality-testing
c. Psychoanalysis
d. Cognitive-behavioral therapy
88. The principle of ______ reminds us that we must consider the various paths to a particular
outcome, not just the result
a. social effects
b. unique determinism
c. personalization
d. equifinality
89. Elsa is careful in undergoing neuropsychological meeting without the use of CT Scan, PET Scan of MRI. She
is having second thoughts because there is a high risk of false positive, which means
a. she might be diagnosed with a disorder with a disorder comorbid with what she truly has
b. she might be concluded into not having a brain abnormality when really does have it
c. she might be concluded into having a brain abnormality when she really does not have it
d. she might only be diagnosed with a disorder based on a brain abnormality
90. This is the research method which examines the prevalence, distribution, and consequences of disorders in
population
a. nosology
b. epidemiology
c. etiology
d. survey
91. Clinical significance, as opposed to statistical significance, tries to stay away from the seeing patients more as
more similar than they are, a phenomenon called
a. patient uniformity myth
b. false positive
c. false negative
d. patient similarity myth
92. Freud viewed obsessions and compulsions as resulting from instinctual
forces, sexual or aggressive, which are difficult to control or moderate because of
a. early sexualization
b. overly harsh toilet training
c. corporal punishment
d. seduction of the parent towards the

93. Most common concerns of people with body dysmorphic disorder involve
a. abdominal fats
b. genitalia
c. facial flaws
d. legs
94. Hoarding disorder is common for ______ than ______, and for ______ than _______
a. lower SES; higher SES; female; male
b. lower SES; higher SES; male; female
c. female, male; younger; older age group
d. male; female; older; younger age group
95. Cognitive behavioral perspective on hoarding disorder sees the following as factors except
a. Poor organizational abilities
b. Unusual beliefs about possessions
c. Delusions of grandeur
d. Excessive discipline during childhood
96. The main difference of binge eating disorder with anorexia nervosa and bulimia nervosa is
a. the presence of self-loathe
b. the absence of compensatory behavior
c. binging
d. absence of distorted view of physical self
97. Which is the correct order of the sexual response cycle?
a. desireexcitementorgasmresolution
b. orgasmexcitementdesireresolution
c. excitementorgasmresolutiondesire
d. excitementdesireorgasmresolution
98. This involves the womens identification of pleasurable areas in the body, followed by partner involvement
a. directed masturbation
b. anxiety reduction
c. arousal reformation
d. erogenous therapy
99. Which statement is not true for gender dysphoria?
a. this was formerly called gender identity disorder
b. a person with this disorder believes he or she was born in the wrong sex
c. gender dysphorias symptomatology involves a distorted sexual orientation
d. a person with this disorder is preoccupied with getting rid of primary and secondary sex characteristics
100. Sex reassignment has prerequisites. Which of the following is not one of these prerequisites?
a. Above average score in an IQ test
b. Reasonable emotional stability
c. Successful adaptation in the new role for at least one year prior to surgery
d. Adequate understanding of the limitations and consequences of surgery