Psychiatry Test Preparation and Review Manual: Expert Consult, 2nd Ed.

Test Number Four

1. Which one of the following is false regarding Freud’s theories of human development?

  A During development, sexual energy shifts to different areas of the body that are usually associated with eroticism

  B The anal phase is from age 1 year to 3 years

  C Latency is marked by a sharp increase in sexual interest

  D Freud thought that resolution of his stages was essential to normal adult functioning

  E The phallic stage is from age 3 to 5 years

2. Ischemia to which one of the following arterial territories is responsible for the phenomenon known as amaurosis fugax?

  A Carotid

  B Vertebrobasilar

  C Lenticulostriate

  D Anterior cerebral

  E Middle cerebral

3. Which one of the following is true regarding norepinephrine (NE) and/or the locus caeruleus?

  A NE is synthesized in the locus caeruleus

  B Dopamine is synthesized in the locus caeruleus, NE in the dorsal raphe nuclei

  C Acetylcholine is synthesized with NE in the substantia nigra

  D GABA is synthesized in the locus caeruleus

  E The locus caeruleus is the site of formation of serotonin

4. A 75-year-old man with a recent history of influenza vaccination presents to the emergency room with an acute onset of paraparesis and urinary incontinence. He reported that his symptoms began a week earlier with dull, progressive low back pain that soon resulted in bilateral leg weakness. The most likely diagnosis in this case is:

  A Spinal cord metastases

  B Acute spinal cord compression

  C Vacuolar myelopathy

  D Transverse myelitis

  E Acute disseminated encephalomyelitis

5. A doctor in a certain hospital makes a diagnosis for a particular patient. That diagnosis is considered reliable if:

  A It is accurate

  B Many different doctors in different locations would agree upon the same diagnosis

  C The disorder has features characteristic enough to distinguish it from other disorders

  D The disorder allows doctors to predict the clinical course and treatment response

  E The diagnosis is based on an understanding of the underlying pathophysiology and has biological markers

6. Which one of the following set of symptoms and signs correctly identifies Horner’s syndrome?

  A Ptosis, miosis, sweating

  B Ptosis, mydriasis, sweating

  C Ptosis, miosis, anhydrosis

  D Ptosis, mydriasis, anhydrosis

  E Lid-lag, miosis, anhydrosis

7. A patient presents with the following symptoms: tremor, halitosis, dry mouth, tachycardia, hypertension, fever, euphoria, alertness, agitation, paranoia, hallucinations, and irritability. Which one of the following substances is the most likely cause?

  A Amphetamines

  B Opioids

  C Alcohol

  D Barbiturates

  E Benzodiazepines

8. The inability to recognize familiar faces is known as:

  A Anosognosia

  B Simultanagnosia

  C Aprosodia

  D Prosopagnosia

  E Astereognosis

9. Which one of the following is not a potential effect of PCP use?

  A Paranoia

  B Nystagmus

  C Catatonia

  D Convulsions

  E Hypotension

10. A characteristic of a facial nerve (Bell’s) palsy that clearly distinguishes it from a stroke-related facial paresis is:

  A The presence of miosis

  B The involvement of the whole face

  C Anhydrosis

  D Rapid recovery of motor functioning

  E A post-infectious onset

11. Object permanence develops during which one of Piaget’s developmental stages?

  A Sensorimotor

  B Preoperational thought

  C Concrete operations

  D Formal thought

  E Rapprochement

12. Which one of the following is not a classic feature of syringomyelia?

  A Spasticity

  B Muscular atrophy

  C Fasciculations

  D Loss of temperature and pain sensation

  E Preservation of proprioception

13. A patient comes into the emergency room and admits to sniffing glue daily for the past eight months. Which one of the following is not your concern as this patient’s physician?

  A Liver damage

  B Permanent brain damage

  C Kidney damage

  D Myocardial damage

  E Urinary retention

14. One of the most common causes of the movement disorder of opsoclonus–myoclonus in the infant is:

  A Neonatal seizures

  B Craniopharyngioma

  C Prematurity

  D Neuroblastoma

  E Meningioma

15. A physician examines a patient in the emergency room who has recently been diagnosed with a social phobia. Which one of the following answer choices would most likely be the greatest fear for this patient?

  A Having to take responsibility for planning a dinner with her husband

  B Being in a relationship with a new boyfriend

  C Going to a state fair and being around thousands of people

  D Being scrutinized by others

  E Competing for a new position that just opened up in her company

16. The Ramsay Hunt syndrome classically affects which one of the following pairs of cranial nerves?

  A III and VI

  B IV and VI

  C V and VII

  D V and VIII

  E VII and VIII

17. Which one of the following statements is not true regarding body dysmorphic disorder?

  A It is a preoccupation with an imagined defect in appearance

  B It is most commonly associated with a comorbid mood disorder

  C The most common concerns involve facial flaws

  D Treatment with surgical, medical, dental or dermatological care is usually successful

  E If a slight physical anomaly is present the concern is markedly excessive

18. Which one of the following primary brain tumors is the most common in patients over 60 years of age?

  A Anaplastic astrocytoma

  B Glioblastoma multiforme

  C Meningioma

  D Ependymoma

  E Acoustic neuroma

19. Patients with obsessive–compulsive disorder are noted to have anomalies of which one of the following brain regions?

  A Corpus callosum

  B Striatum

  C Hippocampus

  D Caudate nucleus

  E Cerebellum

20. Anton’s syndrome results from a stroke that localizes to the:

  A Frontal lobes

  B Temporal lobes

  C Parietal lobes

  D Occipital lobes

  E Cerebellar hemispheres

21. Which one of the following should not be considered a predictive factor for violence?

  A Alcohol intoxication

  B Recent acts of violence

  C Command auditory hallucinations

  D High socioeconomic status

  E Menacing other people

22. Riluzole, the only agent FDA-approved in the treatment of amyotrophic lateral sclerosis, affects which one of the following neurotransmitters?

  A Glutamate

  B GABA

  C Acetylcholine

  D Dopamine

  E Norepinephrine

23. A 29-year-old patient is admitted to the neurology unit for evaluation of seizures. Workup is negative and there has not been any seizure activity captured on electroencephalogram during his seizure episodes. Neurological examination is negative. The patient is noted to be very sad, and a psychiatric consult is called. Nurses have noted conflict between the patient and his wife during her visits. As the consultant, which one of the following would be the highest on your list of differential diagnoses?

  A Obsessive–compulsive disorder

  B Conversion disorder

  C Somatization disorder

  D Social phobia

  E Panic disorder

24. What is the most common CNS cancer noted in patients with advanced AIDS?

  A Glioblastoma multiforme

  B Lymphoma

  C Meningioma

  D High-grade brainstem glioma

  E Epidermoid tumor

25. The highest rate of synapse formation in the brain takes place during which one of the following time periods?

  A Adolescence

  B Weeks 32 to 35 of gestation

  C Weeks 13 to 26 of gestation

  D Within the first 6 weeks of gestation

  E As a toddler

26. Which one of the following is not a presenting feature of AIDS dementia complex?

  A Poor attention and concentration

  B Slowness of thinking

  C Personality changes

  D Apathy

  E Hemiparesis

27. Which one of the following is not a medical complication of weight loss in eating disorders?

  A Cachexia

  B Loss of cardiac muscle

  C Delayed gastric emptying

  D Lanugo

  E Increased bone density

28. The most frequent opportunistic CNS infection in the AIDS patient is:

  A CNS toxoplasmosis

  B Cryptococcal meningitis

  C Herpes meningitis

  D Cytomegalovirus encephalitis

  E Neurosyphilis

29. Which one of the following is not a medical complication of purging seen in eating disorders?

  A Electrolyte abnormalities

  B Salivary gland inflammation

  C Erosion of dental enamel

  D Hyperkalemia

  E Seizures

30. A 45-year-old man with end-stage AIDS and CD4 count of 50/μL presents to the ER with a complaint of rapidly progressive onset of gait difficulty, spasticity, leg weakness, sphincter dysfunction and loss of proprioception to both feet and legs. The most likely diagnosis in this case is:

  A Progressive multifocal leukoencephalopathy

  B Distal sensory polyneuropathy

  C Vacuolar myelopathy

  D Neurosyphilis

  E HTLV-1 myelopathy

31. Which one of the following medical conditions should not be considered when evaluating patients with anxiety disorders?

  A Carcinoid syndrome

  B Hyperventilation syndrome

  C Hypoglycemia

  D Hyperthyroidism

  E Central serous chorioretinopathy

32. A 45-year-old man with end-stage AIDS and CD4 count of 0/μL presents to the ER with a complaint of progressive onset over the past few weeks of ataxia, visual field deficits, altered mental status, aphasia and fluctuating sensory deficits. T2-weighted brain MRI reveals the image to the right. The most likely diagnosis in this case is:

  A CNS toxoplasmosis

  B Lymphoma

  C Neurosyphilis

  D AIDS dementia complex

  E Progressive multifocal leukoencephalopathy

image

33. When diagnosing a patient with social phobia, which axis II diagnosis is it most important for the treating psychiatrist to keep in mind?

  A Paranoid personality disorder

  B Schizoid personality disorder

  C Obsessive–compulsive personality disorder

  D Avoidant personality disorder

  E Borderline personality disorder

34. Which one of the following is not a prion disease?

  A Kuru

  B Gerstmann–Sträussler–Scheinker syndrome

  C Fatal familial insomnia

  D Devic’s syndrome

  E Creutzfeldt–Jakob disease

35. A psychiatrist is covering the emergency room and a patient comes in who has a previous diagnosis of bipolar II disorder. Based on this diagnosis which one of the following symptoms would the knowledgeable psychiatrist expect to see in this patient over time?

  A Psychotic features

  B Manic episodes that do not respond to treatment with mood stabilizers

  C Rapid cycling between severe depression and mania

  D Recurrent manic episodes in the absence of depression

  E Recurrence of both depressive and hypomanic episodes

36. The classic triad of headache, ipsilateral Horner’s syndrome and contralateral hemiparesis is generally due to:

  A Carotid artery occlusion

  B Giant cell arteritis

  C Wallenberg’s syndrome

  D Pontine hemorrhage

  E Cerebral aneurysmal rupture

37. A set of statistical procedures designed to compare two or more groups of observations and determine whether the differences are due to chance or experimental difference is called:

  A Correlation coefficient

  B Control group

  C Analysis of variance (ANOVA)

  D Regression analysis

  E Null hypothesis

38. A 55-year-old woman presents to the emergency room with a sudden and acute onset of right-sided painless complete facial paralysis, involving both the upper and lower parts of the face. The symptoms began earlier that day and were initially accompanied by a mild ache behind the ear which resolved. The organism most likely responsible for this condition is:

  A Borrelia burgdorferi

  B Herpes simplex virus

  C Epstein–Barr virus

  D West Nile virus

  E Varicella zoster virus

39. A psychiatrist is asked to evaluate a child who does not make appropriate eye contact, fails to respond to the social cues of others, lacks the ability for spontaneous make-believe play, and on close examination has a delay in language development. What is this child’s most likely diagnosis?

  A Schizophrenia

  B Avoidant personality disorder

  C Asperger’s disorder

  D Conduct disorder

  E Autism

40. A veterinary radiologist presents to the emergency room with a 4-week history of headache, vague fever, and paresthesias in the fingers and toes. His temperature is 103.5°F (39.7 °C). He complains of difficulty swallowing with pharyngeal spasms for the past 3 days. The most likely diagnosis is:

  A West Nile virus infection

  B Tetanus infection

  C Acute botulism

  D Rabies

  E Epstein–Barr virus infection

41. Which one of the following receptor subtypes is associated with the neurotransmitter glutamate?

  A Nicotinic

  B Muscarinic

  C Alpha 1

  D AMPA

  E GABA

42. A 60-year-old woman presents to the emergency room with a progressive downward course over the past 6 months characterized by behavioral disinhibition, emotional lability, severe naming and word-finding difficulties, hyperorality, stubbornness, inability to plan, and poor judgment. Autopsy of this patient’s brain would most likely reveal:

  A Hirano bodies

  B Pick’s inclusion bodies and gliosis

  C Lewy bodies

  D Neurofibrillary plaques and tangles

  E Severe white-matter demyelination

43. Your friend just had a baby that is 8 months old. You and she talk about the child and note its temperament. At this point in the child’s development you tell your friend that the child’s temperament is most likely a function of:

  A Biological factors

  B The parent’s culture

  C The grandmother’s influence on weekends

  D The baby’s birth month

  E The influence of the child’s siblings

44. The neuropathological hallmark of idiopathic Parkinson’s disease is:

  A Brainstem Lewy bodies

  B Hirano bodies

  C Amyloid plaques

  D Mesial temporal sclerosis

  E Caudate nucleus atrophy

45. A young woman comes to a psychiatrist’s office seeking help because of problems on her job. She describes nervousness talking in front of other coworkers at conferences, and difficulty at social events. She thinks that her boss knows her inner feelings and that there was wording put in everyone’s contracts with her specifically in mind. Her dress is eccentric and out of date. She complains that she does not have any friends at the office. Given this picture, she most likely has which one of the following diagnoses?

  A Borderline personality disorder

  B Dependent personality disorder

  C Schizotypal personality disorder

  D Histrionic personality disorder

  E Schizoid personality disorder

46. Which one of the following is not a possible symptom of fibromyalgia?

  A Headache

  B Psychosis

  C Depression

  D Sleep disturbance

  E Paresthesias

47. Pancreatic cancer is most often associated with which one of the following psychiatric disorders?

  A Psychosis

  B Anxiety

  C Depression

  D Impulse control disorders

  E Bulimia

48. A 75-year-old man with known history of prostate cancer presents to the emergency room with an acute onset of bilateral leg weakness, leg spasticity, sensory loss to pain and temperature below the waist, and acute bladder and bowel incontinence. The first test of choice to perform in the emergency room setting is:

  A Noncontrast head CT

  B Brain MRI

  C Screening spine MRI

  D Spinal X-rays

  E HTLV-1 antibody titer

49. Which one of the following symptoms would a psychiatrist look for in a child to make the diagnosis of conduct disorder rather than depression, ADHD, or bipolar disorder?

  A Irritable mood

  B Difficulty organizing tasks

  C Excessive activity

  D Starting fights with other children

  E Sleep disturbance

50. Subacute combined degeneration of the spinal cord is a result of deficiency in which one of the following:

  A Vitamin B12

  B Vitamin B1

  C Vitamin B6

  D Niacin

  E Folic acid

51. When patients who have been victim to childhood incest become adults, which one of the following disorders are they most prone to develop?

  A Anorexia

  B Bipolar disorder

  C Social phobia

  D Major depression

  E Conversion disorder

52. A patient presents to the emergency room with an acute onset of pure right hemiparesis that on examination is noted to affect the face, arm and leg equally. There is no sensory deficit, and no cortical signs are noted. This stroke most likely localizes to the:

  A Left thalamus and internal capsule

  B Left internal capsule

  C Right basis pontis

  D Right medulla

  E Left midbrain

53. Which one of the following statements is true regarding the amino acid neurotransmitters?

  A Histamine is an amino acid neurotransmitter

  B GABA is an excitatory amino acid neurotransmitter

  C Glutamate is an inhibitory amino acid neurotransmitter

  D Glutamate receptors have been found to be important in the mechanism of action for cocaine

  E Benzodiazepines, barbiturates and several anticonvulsants work through mechanisms involving GABA-B

54. Which one of the following is not a symptom or sign of Parkinson’s disease?

  A Bradykinesia

  B Loss of postural reflexes

  C Tremor

  D Choreoathetosis

  E Rigidity

55. A psychiatrist is asked to evaluate an 8-year-old girl. She does not want to go to school, and refuses to do her homework. Her teacher reports that she will not read out loud in class. She likes to go and spend the weekends at friends’ houses or go on over-night trips with her grandparents. Her IQ is average. What diagnosis should the informed psychiatrist most strongly consider?

  A ADHD

  B Conduct disorder

  C Separation-anxiety disorder

  D Pervasive developmental disorder

  E Reading disorder

56. Which one of the following is not a feature of botulism toxin poisoning?

  A Myoclonus

  B Dysphagia

  C Diplopia

  D Nausea

  E Urinary retention

57. A couple brings their son in to see a psychiatrist. The child fights with his mother and father and is rude and dismissive toward them. He states that he wants to leave, and when the doctor tells him he has to stay he yells, curses, cries, and rolls around on the floor. His teacher tells the psychiatrist that his work at school is good, but that he gets very nasty with her when she tells him to do a particular task, and he often refuses to cooperate with her. The child’s most likely diagnosis is:

  A ADHD

  B Bipolar disorder

  C Conduct disorder

  D Oppositional defiant disorder

  E Separation-anxiety disorder

58. Balint’s syndrome is the result of a lesion to which one of the following areas?

  A Frontal lobe

  B Temporal lobe

  C Parietal lobe

  D Occipital lobe

  E Bilateral parietal–occipital lobes

59. A psychiatrist evaluates a 7-year-old patient who is brought in by his parents because of complaints they have been receiving from school. The child has been sexually provocative with other children, sexualizes play activities, and openly displays sexual behavior. The most likely cause of this behavior is:

  A Normal development

  B Early onset puberty

  C Traumatic brain injury

  D Sexual abuse

  E Psychosis with sexual delusions

60. Which one of the following symptoms is a feature of Anton’s syndrome?

  A Aphasia

  B Prosopagnosia

  C Apraxia

  D Confabulation

  E Hiccups

61. Which one of the following personality disorders is least associated with violent behavior?

  A Borderline personality disorder

  B Histrionic personality disorder

  C Narcissistic personality disorder

  D Dependent personality disorder

  E Antisocial personality disorder

62. Inhalant intoxication (sniffing glue) causes which one of the following neurologic conditions?

  A Myopathy

  B Neuropathy

  C Myelopathy

  D Denervation of muscle

  E Seizures

63. A 30-year-old man presents to the emergency room with a complaint that there is a cockroach living in his rectum. He says he knows that there is a hole in the side of his rectum which was created by the roach. He has no prior psychiatric history, but states that he has felt the roach crawling around in his rectum for the past 18 months. He is a lawyer with a busy successful practice, and says he has no problems at work. During previous trips to the doctor for this complaint, he was examined and told that there was no cockroach in his rectum. He feels that they just did not examine him properly, otherwise the roach would have been found. Examination and blood work are all normal. His most likely diagnosis is:

  A Conversion disorder

  B Schizophrenia

  C Depression with psychotic features

  D Delusional disorder with somatic features

  E Hypochondriasis

64. Which one of the following substances of abuse is the most likely to lower the seizure threshold during intoxication?

  A Morphine

  B PCP

  C Cocaine

  D Cannabis

  E Alcohol

65. Five patients are brought into the emergency room on a Friday evening. Of the five, which one is most likely to kill themselves successfully?

  A Bob, who has schizophrenia

  B Carol, who has alcoholism

  C Dave, who is mentally retarded

  D Sally, who has borderline personality disorder

  E Mark, who has major depressive disorder

66. Meige’s syndrome comprises which one of the following sets of symptoms?

  A Hemifacial spasm and seizures

  B Hemifacial spasm and cervical dystonia

  C Blepharospasm and ptosis

  D Blepharospasm and oromandibular dystonia

  E Lid apraxia and myokymia

67. A physician that has reason to believe a patient may kill or injure another person must notify the potential victim, authorities, or the victim’s family or friends. This is the result of which one of the following answer choices?

  A Durham rule

  B M’Naghten rule

  C Ford vs Wainwright

  D Tarasoff rule

  E Respondeat superior

68. The phenomenon of scanning speech results from a lesion to the:

  A Cerebellum

  B Thalamus

  C Frontal lobes

  D Midbrain

  E Dominant temporal lobe

69. A friend just gave birth to a healthy baby boy 5 days ago. Now your friend is crying and irritable, and has been dysphoric over the past 2 days. Which one of the following is the most likely diagnosis based on the information given?

  A Postpartum depression

  B Postpartum blues

  C Postpartum psychosis

  D Postpartum bipolar disorder

  E Specific phobia of being a parent

70. Which one of the following is a syndrome of near muteness with normal reading, writing and comprehension?

  A Aphasia

  B Apraxia

  C Agnosia

  D Aphemia

  E Abulia

71. Which one of the following is not true regarding the N-methyl-D-aspartate (NMDA) receptor?

  A The NMDA receptor has been linked with learning and memory

  B The NMDA receptor allows for the passage of potassium only

  C The NMDA receptor only opens when it has bound two molecules of glutamate and one molecule of glycine

  D The NMDA receptor can be blocked by physiological concentrations of magnesium

  E The NMDA receptor can be blocked by PCP

72. Which one of the following refers to a state of unresponsiveness from which arousal only occurs with vigorous and repeated stimulation?

  A Alertness

  B Lethargy

  C Stupor

  D Coma

  E Persistent vegetative state

73. Of the following disorders, which one has the best prognosis?

  A Somatization disorder

  B Body dysmorphic disorder

  C Pain disorder

  D Hypochondriasis

  E Conversion disorder

74. Which one of the following statements is true?

  A All patients with acute Guillain–Barré syndrome should be hospitalized in an intensive care unit in case of respiratory compromise

  B All comatose patients require a head CT scan before a lumbar puncture is performed

  C A positive grasp reflex is always a sign of frontal lobe damage

  D Cerebellar hemispheric lesions produce deficits that are contralateral to the lesion

  E Bell’s palsy is most often caused by Borrelia burgdorferi infection

75. Which one of the following choices is considered unethical by the American Psychiatric Association Ethics Committee?

  A Closing a practice and finding follow-up care for your patients

  B Refusing to discuss a patient’s case with her family unless she gives you permission

  C Charging a colleague rent to sublet office space from you

  D A patient wills you their estate after death. You accept and use the money for a new car

  E You charge a fee to supervise another psychiatrist

76. Emotional memory localizes to the:

  A Amygdala

  B Hippocampus

  C Primary auditory cortex

  D Nucleus basalis of Meynert

  E Pons

77. Of the following medications, which one is the least anticholinergic?

  A Amitriptyline

  B Imipramine

  C Desipramine

  D Nortriptyline

  E Maprotiline

78. By what age should a child have a six-word vocabulary, be able to self-feed, and be able to walk up steps with his hand being held?

  A 6 months

  B 9 months

  C 12 months

  D 18 months

  E 24 months

79. A 30-year-old male is brought to the emergency room after being arrested for exposing his genitals to women on the train. He states that he has impulses to expose himself that he can’t control, and that he finds the whole experience very sexually exciting. Which one of the following medications would be an appropriate treatment for this patient?

  A Medroxyprogesterone acetate

  B Lorazepam

  C Ziprasidone

  D Duloxetine

  E Chlorpromazine

80. A 45-year-old woman presents to the emergency room with an acute left hemiparesis of the arm and leg. You ask her to lift her normal right leg while you put your hand under her paretic leg. You note that while lifting her good leg, she pushes her affected leg downwards on the bed with normal strength. You suspect a hysterical or psychogenic disorder. This phenomenon is termed:

  A Hoffman’s sign

  B Hoover’s sign

  C Lasègue’s sign

  D Romberg sign

  E Gegenhalten

81. Clomipramine is not used for which one of the following?

  A Depression

  B Obsessive–compulsive disorder

  C Panic disorder

  D Premature ejaculation

  E Command auditory hallucinations

82. The only true emergency in neurology that requires immediate MRI imaging and evaluation in the emergency room is:

  A Acute suspected early hemispheric stroke

  B Acute suspected myasthenia gravis.

  C Acute suspected spinal cord compression

  D Acute suspected Guillain–Barré syndrome

  E Acute suspected subarachnoid hemorrhage

83. Which one of the following terms refers to the state’s right to intervene and act as a surrogate parent for those who cannot care for themselves?

  A Actus reus

  B Mens rea

  C Parens patriae

  D Durable power

  E Respondeat superior

84. Which one of the following medications has the unique mechanism of action of being a selective GABA reuptake inhibitor?

  A Gabapentin

  B Tiagabine

  C Pregabalin

  D Vigabatrin

  E Lioresal

85. Which one of the following answer choices is measured by the trail making test?

  A Memory

  B Language

  C Social learning

  D Psychosis

  E Executive function

86. The principal mechanism of action of the Alzheimer’s disease agent memantine involves which one of the following receptors?

  A Acetylcholine

  B Dopamine

  C NMDA

  D Glycine

  E GABA

87. Which one of the GABA receptors is thought to be the site of action of the benzodiazepines?

  A GABA-A

  B GABA-B

  C GABA-C

  D GABA-D

  E GABA-E

88. Vagal nerve stimulation is FDA-approved for which one of the following indications?

  A Refractory epilepsy

  B Bipolar mania

  C Schizophrenia

  D Intermittent explosive disorder

  E Obsessive–compulsive disorder

89. Which one of the following statements is true regarding carbamazepine?

  A Carbamazepine is approved in the US for treatment of temporal lobe epilepsy and general epilepsy, but not trigeminal neuralgia

  B Carbamazepine is metabolized by the kidneys

  C Carbamazepine can be associated with a transient increase in the white blood cell count

  D Carbamazepine has been shown to be as effective as the benzodiazepines in some studies for management of alcohol withdrawal

  E A benign pruritic rash occurs in 60–70% of patients treated with carbamazepine

90. Auscultation of the head that reveals a bruit would likely be indicative of which one of the following?

  A Brain tumor

  B Venous sinus thrombosis

  C Temporal arteritis

  D Intracranial aneurysm

  E Arteriovenous malformation

91. Which one of the following tests is considered to be projective?

  A Halstead–Reitan battery

  B Stanford–Binet test

  C Wechsler–Bellevue test

  D Draw-a-Person test

  E MMPI

92. A 47 year-old man presents to the emergency with intermittent headaches, and periodic drop attacks. His brain MRI on T1 weighted imaging reveals the scan to the right. The most likely diagnosis is:

  A Choroid plexus papilloma

  B Colloid cyst of the third ventricle

  C Ependymoma

  D Pineal region germinoma

  E Pituitary macroadenoma

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93. Which one of the following drugs is both an opioid agonist and antagonist?

  A Aripiprazole

  B Naltrexone

  C Buprenorphine

  D Methadone

  E Gabapentin

94. Hallervorden–Spatz syndrome is a neurodegenerative disorder that results from lesions localizing to the:

  A Frontal lobes

  B Parietal lobes

  C Occipital lobes

  D Basal ganglia

  E Hippocampus

95. A patient presents to the emergency room because of alcohol withdrawal. He and his family describe a history of alcohol-induced blackouts. Which one of the following memory problems is most consistent with alcohol induced blackouts?

  A Making up details of how he got to work 3 days ago

  B Retrograde amnesia

  C Anterograde amnesia

  D Loss of memories from his daughter’s birthday 5 years ago

  E Inability to tell you who the current President is

96. Strict vegetarians who ingest no meat products can suffer from deficits in proprioception and vibration sensation due to lesions that localize to the:

  A Posterior spinal cord

  B Central spinal cord

  C Anterior spinal cord

  D Thalamus

  E Peripheral sensory nerves

97. A psychiatrist is treating a bipolar patient with carbamazepine. After being started on the drug he has therapeutic serum levels. Three months later the patient starts to become hypomanic and the psychiatrist decides to check a level. The level comes out below therapeutic range. Both the patient and his family reassure the psychiatrist that he has been taking the medication regularly. What should the psychiatrist do with this patient?

  A Confront him, because he and his family are lying

  B Stop the carbamazepine and put him on divalproex sodium

  C Increase the dose of carbamazepine and take follow-up serum levels

  D Add a high dose of a selective serotonin reuptake inhibitor

  E Hospitalize the patient

98. Patients exposed to isoniazid (INH) for tuberculosis treatment can develop a sensory polyneuropathy as a result of a deficiency in which one of the following?

  A Vitamin B6

  B Vitamin B12

  C Niacin

  D Thiamine

  E Vitamin A

99. What is the best way to handle suicidal patients with borderline personality disorder?

  A Take the threats seriously and take whatever steps are necessary to protect these patients

  B Do not discuss suicide with them

  C Isolate these patients from friends and family

  D Make these patients promise not to hurt themselves (contract for safety)

  E Give these patients benzodiazepine prescriptions to calm them down

100. The West Nile virus is considered to belong to which one of the following viral families?

  A Arenaviruses

  B Arboviruses

  C Filoviruses

  D Papovaviruses

  E Retroviruses

101. A patient is on lithium, risperidone, and a daily aspirin. He comes to his session confused and unsteady on his feet. He states that he has the flu, because of recent GI upset. Which one of the following should the psychiatrist do with this patient first?

  A Refer him to an internist

  B Get a lithium level

  C Review the patient’s recent diet

  D Send stool for ova and parasites

  E Obtain a complete blood count

102. Which one of the following neurotransmitters localizes predominantly to the basal forebrain and is responsible for memory, attention, and executive functioning?

  A Serotonin

  B Norepinephrine

  C GABA

  D Glycine

  E Acetylcholine

103. Which one of the following drugs does not act by blocking the reuptake of norepinephrine into the presynaptic neuron?

  A Imipramine

  B Venlafaxine

  C Bupropion

  D Nefazodone

  E Mirtazapine

104. What is the mechanism of action of the hallucinogen PCP (phencyclidine)?

  A Dopamine antagonism

  B Serotonin antagonism

  C Norepinephrine antagonism

  D NMDA antagonism

  E Acetylcholinesterase inhibition

105. A physician needs to give a benzodiazepine to someone with impaired liver function. Which one of the following would be the best choice of medication in this situation?

  A Diazepam

  B Oxazepam

  C Clonazepam

  D Prazepam

  E Estazolam

106. Which one of the following fungal organisms can cause vertebrobasilar strokes by invasion of vessel walls and tends to colonize in the paranasal sinuses and cause a hypersensitivity pneumonitis?

  A Histoplasma

  B Candida albicans

  C Aspergillus

  D Cryptococcus neoformans

  E Pseudallescheria boydii

107. Which one of the following side effects is most likely to develop in a patient started on fluoxetine?

  A Loss of consciousness

  B Shuffling gait

  C Headache

  D High blood pressure

  E Blurred vision

108. The GABA-A receptor (the most predominant GABA receptor) is which one of the following:

  A A sodium channel

  B A chloride channel

  C A calcium channel

  D A potassium channel

  E A magnesium channel

109. A psychiatrist made a minor error in her last session with a patient. The patient comes to her for psychodynamic psychotherapy. The best approach is to:

  A Interpret the patient’s reaction

  B Ignore the mistake

  C Give a long but clear explanation of her reasoning

  D Briefly acknowledge that she made a mistake

  E Profusely apologize

110. A failure to develop a cohesive self-awareness is known as:

  A Entrapment

  B Climactereium

  C Identity diffusion

  D Activity dependent modulation

  E All-or-none phenomenon

111. What is the most important step in treating separation-anxiety disorder in an 11-year-old?

  A Give methylphenidate

  B Give risperidone

  C Rapidly send the child back to school

  D Thorough psychoanalysis of the mother

  E High dose benzodiazepine treatment

112. Why do doctors use naltrexone for alcohol abuse?

  A It is almost 100% effective

  B It blocks the effects of alcohol at the GABA receptor

  C It alters dopamine levels to decrease pleasure from drinking

  D It has been shown to decrease craving and decrease alcohol consumption

  E It is better than behavioral modification in treating alcohol abuse

113. A 30-year-old man on imipramine complains of difficulty urinating and impotence. What should his doctor do for him?

  A Increase the dose of imipramine

  B Tell the patient to decrease fluid intake

  C Tell the patient to stop all sexual activity

  D Prescribe bethanechol

  E Prescribe melatonin

114. Which one of the following statements about mood disorders is true?

  A Major depression is more common in men than in women

  B Bipolar disorder has equal prevalence for men and women

  C Higher socioeconomic status leads to increased depression

  D There is a correlation between the hyposecretion of cortisol and depression

  E About 90% of those with major depressive disorder receive specific treatment

115. A mother brings a 26-month-old child into the doctor’s office. The child has not spoken any words yet. How should the doctor proceed?

  A Speech therapy

  B Audiometry

  C Sensory evoked potentials

  D Tell the mother to give it more time

  E Chromosomal analysis

116. The assisted recall of information by a person in the same external environment that the information was originally acquired in is known as:

  A Classical conditioning

  B Social learning

  C Partial recovery

  D Respondent conditioning

  E State-dependent learning

117. A 29-year-old man comes into the hospital with complaint of confusion, ataxia, disorientation and dysarthria. He has the smell of alcohol on his breath. Which one of the following is the best first step for the physician to take?

  A Phone the patient’s primary care physician

  B Speak with the patient’s family

  C Give intravenous thiamine

  D Sedate the patient with haloperidol

  E Give the patient an anticonvulsant

118. Niacin deficiency (pellagra) results in which one of the following classic triads of symptoms?

  A Gastritis, neuropathy, stroke

  B Dementia, dermatitis, diarrhea

  C Neuropathy, ataxia, dementia

  D Neuropathy, retinopathy, areflexia

  E Neuropathy, spasticity, encephalopathy

119. A psychiatrist is doing psychodynamic psychotherapy with a patient. The patient is usually on time, but missed a session last Tuesday. When he comes back, how should the psychiatrist approach this issue?

  A Do not mention the missed appointment

  B Refuse to treat the patient anymore

  C “You missed your appointment Tuesday. I was wondering what happened.”

  D “I’m glad you didn’t show on Tuesday. I spent the time with a patient I like better than you.”

  E “I’m going to charge you twice the normal fee because you missed your appointment last Tuesday.”

120. Which one of the following is not a sign of cannabis intoxication?

  A Conjunctival injection

  B Increased appetite

  C Dry mouth

  D Bradycardia

  E Orthostatic hypotension

121. A patient comes to his psychiatrist’s office with complaints consistent with akathisia. Which one of the following would be the best treatment?

  A Bupropion

  B Amoxapine

  C Vitamin B6

  D Captopril

  E Propranolol

122. What is the mechanism by which clonidine is effective in reducing symptoms of opiate withdrawal?

  A Indirect dopamine blockade

  B Serotonin increase in the locus ceruleus

  C Agonist activity at alpha-2 adrenergic receptors

  D Generation of the metabolite trichloroethanol

  E Decreased free T4

123. Blockade of muscarinic cholinergic receptors will not lead to which one of the following?

  A Difficulty urinating

  B Improvement in Alzheimer’s symptoms

  C Dry mouth

  D Blurred vision

  E Delirium

124. Which one of the following lab tests is most likely to pick up alcohol abuse?

  A Gamma glutamyl transferase (GGT)

  B Mean corpuscular volume (MCV)

  C Uric acid

  D Serum glutamic-oxaloacetic transaminase (SGOT)

  E Serum glutamic-pyruvic transaminase (SGPT)

125. A psychiatrist is asked by a primary care physician to treat a patient with Tourette’s disorder. He is suffering from several motor tics. Which one of the following would be the best medication to give him?

  A Propranolol

  B Pimozide

  C Paroxetine

  D Pindolol

  E Piroxicam

126. On which chromosome is the gene for amyloid precursor protein found?

  A Chromosome 19

  B Chromosome 20

  C Chromosome 21

  D Chromosome 4

  E Chromosome 13

127. Which one of the following answer choices is central to Kohut’s theories of self psychology?

  A The theory of oedipal conflict

  B The concept of the good enough mother

  C The paranoid–schizoid position

  D The necessity for parental mirroring and empathic responsiveness to the child

  E The importance of the depressive position

128. A patient with bipolar disorder is on carbamazepine. He goes to his primary care physician and is placed on erythromycin. What should be expected to happen?

  A Carbamazepine levels will go down

  B Erythromycin levels will go down

  C No interaction of any kind

  D Carbamazepine levels will go up

  E Erythromycin levels will go up

129. A patient with bipolar disorder gives birth to a child with spina bifida and hypospadias. What is the most likely cause for the child’s defects?

  A Genetics

  B Intrauterine infection

  C Haloperidol use during pregnancy

  D Valproic acid use during pregnancy

  E Lithium use during pregnancy

130. A patient presents with decreased energy, increased appetite, weight gain, increased sleep, decreased mood, lack of interest in usual activities, and social withdrawal. Which one of the following medications would be the best choice to treat him?

  A Citalopram

  B Lithium

  C Desipramine

  D Phenelzine

  E Venlafaxine

131. A patient states that he was given an antidepressant in the past but does not remember the name. He does remember having his blood pressure checked regularly by the psychiatrist because of the antidepressant. Which one of the following was the patient most likely taking?

  A Mirtazapine

  B Paroxetine

  C Venlafaxine

  D Citalopram

  E Fluoxetine

132. Which one of the following is the focus of interpersonal therapy?

  A Anxiety management

  B Belief systems

  C Faulty cognitions

  D Social interactions

  E Transference

133. Which one of the following is not an aspect of experiments carried out by Nikolas Tinbergen?

  A Quantifying the power of certain stimuli in eliciting specific behavior

  B Displacement activities

  C Innate releasing mechanisms

  D Autism

  E Imprinting

134. Which one of the following structures is most critical to the formation of memory?

  A Right frontal lobe

  B Right parietal lobe

  C Thalamus

  D Cerebellum

  E Hippocampus

135. Which one of the following is not a rating scale used for mood disorders?

  A Beck depression inventory

  B Zung self-rating scale

  C Carroll rating scale

  D Montgomery–Åsberg scale

  E Brief psychiatric rating scale (BPRS)

136. Which one of the following is not a characteristic of sleep terror disorder?

  A Awakening from sleep and screaming

  B Autonomic arousal

  C Recall of a detailed dream

  D Sweating

  E Unresponsiveness to attempts to comfort the person during the episode

137. Thioridazine is most often associated with which one of the following side effects?

  A Hematuria

  B Delayed orgasm

  C Retrograde ejaculation

  D Priapism

  E Hypospadias

138. What is the mechanism of action of donepezil?

  A Dopamine blockade

  B Serotonin reuptake inhibition

  C Acetylcholinesterase inhibition

  D Increasing GABA activity

  E Prevention of beta amyloid deposition

139. Depression may present differently in different cultures. How would the knowledgeable psychiatrist predict depression would present in a 37-year-old Chinese immigrant?

  A Concern with mood symptoms

  B Somatic complaints

  C Hysteria

  D Self mutilation

  E Paranoia

140. Which one of the following neurotransmitters is most involved in the effects of methylenedioxyamphetamine (ecstasy)?

  A Serotonin

  B Norepinephrine

  C GABA

  D Glycine

  E Acetylcholine

141. The growth of child guidance clinics in the US in the early 1900s lead to:

  A The development of the first medications for ADHD

  B The development of sewage systems in major US cities

  C The development of child psychiatry as a profession

  D Freud’s three essays on the theories of sexuality

  E The Ryan White Care Act

142. The most common neurologic manifestation of neurosarcoidosis is:

  A Cranial neuropathy

  B Cauda equina syndrome

  C Peripheral neuropathy

  D Meningoencephalitis

  E Uveitis

143. Trazodone is most often associated with which one of the following side effects?

  A Hematuria

  B Delayed orgasm

  C Retrograde ejaculation

  D Priapism

  E Hypospadias

144. Which one of the following answer choices is true regarding aggression?

  A High levels of cerebrospinal fluid (CSF) serotonin are associated with increased aggression

  B Serotonin is unrelated to aggression

  C Low levels of CSF serotonin are associated with increased aggression

  D Low levels of CSF serotonin are associated with decreased aggression

  E Low levels of dopamine are associated with increased aggression

145. How does mirtazapine work?

  A Serotonin reuptake inhibition

  B Norepinephrine reuptake inhibition

  C Alpha-2 adrenergic receptor antagonism

  D Partial dopamine antagonism

  E Decreasing breakdown of serotonin in the synaptic cleft

146. Which one of the following answer choices is most consistent with sleep changes in the elderly?

  A Increased REM sleep only

  B Increased slow wave sleep only

  C Increased REM and slow wave sleep

  D Decreased REM and slow wave sleep

  E Decreased slow wave sleep only

147. A score of 70 on the Global Assessment of Functioning corresponds with:

  A Persistent failure to maintain personal hygiene

  B Major impairment in several areas

  C Superior functioning in all areas

  D Some difficulty functioning, but generally functioning well

  E No friends, unable to keep a job

148. Which one of the following is not an aspect of Kleine–Levin syndrome?

  A Irritability

  B Voracious eating

  C Loss of libido

  D Incoherent speech

  E Hypersomnia

149. David works 17 hours per day. He does not have many friends because he feels that they interfere with his work schedule. He believes that he is a moral person and harshly criticizes those whom he finds to be unethical. He often starts projects but fails to complete them because he can not do them perfectly. His family describes him as stubborn and cheap, because he will never throw anything out. David’s most likely diagnosis is:

  A Generalized anxiety disorder

  B Obsessive–compulsive disorder

  C Obsessive–compulsive personality disorder

  D Schizoid personality disorder

  E Avoidant personality disorder

150. Which one of the following is an important technique of cognitive behavioral therapy?

  A Maintaining therapeutic neutrality

  B Offering interpretations of patients’ unconscious wishes

  C Abreaction

  D Working through unresolved conflict

  E Finding and testing automatic thoughts