1. Blocking the H1 receptor will lead to which of the following?
A Weight gain
B Dry mouth
C Orthostatic hypotension
D Elevated prolactin
E Urinary retention
2. Needle electromyographic studies of muscles of patients with myasthenia gravis would be expected to reveal:
A Delayed F-responses
B Slow nerve conduction velocities
C Decrementing response to repetitive stimulation
D Incrementing response to repetitive stimulation
E Increased motor latencies
3. While working in the ER you evaluate a patient with confusion, myoclonus, diarrhea, hypotension, tachycardia and a normal CPK. The patient is not speaking. His family tells you that he was recently started on a new medication by his psychiatrist for treatment of bipolar disorder. They don’t know the name of the medication or what kind of medication it was. Using your astute clinical skills and significant psychiatric knowledge you narrow the diagnosis down to either NMS or serotonin syndrome. But alas, you must pick one diagnosis for the medical record. Which one will it be and why?
A NMS because the patient is confused
B NMS because rigidity is more commonly part of serotonin syndrome
C Serotonin syndrome because it commonly presents with hypotension
D NMS because it usually presents with normal CPKs
E Serotonin syndrome because it more commonly presents with myoclonus and GI symptoms
4. Which of the following MRI imaging anomalies is most closely associated with patients diagnosed with Huntington’s disease?
A Caudate head atrophy
B Cerebellar atrophy
C Generalized cortical atrophy
D Putamen atrophy
E Communicating hydrocephalus
5. Which of the following must be present to meet DSM criteria for somatization disorder?
A Three pain symptoms
B Two sexual symptoms
C Three pseudoneurological symptoms
D Two GI symptoms
E The illness must begin after age 30
6. A 65-year-old woman is brought to the emergency room from a nursing home. She is noted to have cognitive impairment, delusions, masked facies, shuffling gait, cogwheel rigidity of the extremities, visual hallucinations, and agitation. She is medicated by the emergency room physician with 5 mg of intramuscular haloperidol with acute worsening of her muscular rigidity. The most likely diagnosis is:
A Frontotemporal dementia
B Dementia with Lewy bodies
C Alzheimer’s dementia
D Normal pressure hydrocephalus
E Vascular dementia
7. Which one of the following is not an inhibitor of CYP450 1A2?
E Grapefruit juice
8. Brain metastasis is most commonly due to which of the following:
A Lung carcinoma
B Breast carcinoma
D Prostate carcinoma
E Colorectal carcinoma
9. The obligation to act in the patients best interests is known as:
B Fiduciary duty
E Parens patriae
10. The CT of the brain shown to the right depicts which one of the following pathologies:
A Epidural hematoma
B Left middle cerebral artery infarction
C Subdural hematoma
D Sagittal sinus thrombosis
E Uncal herniation
11. When considering schizophreniform disorder and brief psychotic disorder which one of the following statements is false?
A A clear stressor is not needed for the diagnosis of brief psychotic disorder
B In schizophreniform disorder the patient returns to baseline functioning after the episode resolves
C Both conditions can present with hallucinations
D Schizophreniform disorder is ruled out when there is a medical condition present which could be causing psychotic symptoms
E The duration for brief psychotic disorder is at least 1 month but less than 6 months
12. Which one of the following does not pertain to Parkinson’s disease?
A Resting 4 to 6 Hz tremor
B Considered a synucleinopathy
C Loss of pigment in the pars compacta of the substantia nigra
D Absence of eosinophilic, intraneuronal inclusions in the substantia nigra
E Impaired dopamine synthesis in the nigrostriatal tract
13. You meet a new patient who describes episodes of distractibility, racing thoughts, increased goal directed activity, and elevated mood. These episodes last for 4 days and she is having one currently. She also describes past episodes lasting 3–4 weeks in which her mood is depressed and she experiences loss of appetite, fatigue, poor concentration and suicidal thoughts. Which of the following is the most accurate diagnosis?
A Bipolar I disorder
B Bipolar II disorder
C Major depressive disorder
D Schizoaffective disorder bipolar type
E Cyclothymic disorder
14. Which one of the following does not pertain to Wilson’s disease?
B Intention tremor, 4 to 6 Hz
C Kayser–Fleischer corneal rings
D Chronic hepatic dysfunction, cirrhosis
E Early onset, ages 15 to 45 years
15. Which one of the following statements is false concerning development during the school-age years (ages 5–12)?
A Children develop the ability to empathize with others during these years
B Children have a basic grasp of grammar and syntax and can understand word play
C Children learn social cues, rules and expectations
D Children become motivated by desire for approval and positive feedback
E Children have developed the capacity for abstract thinking
16. Which one of the following movement disorders is not associated with dementia?
A Parkinson’s disease
B Wilson’s disease
C Diffuse Lewy body disease
D Huntington’s disease
E Primary torsion dystonia (dystonia musculorum deformans)
17. What percentage of the general population has a diagnosable personality disorder?
18. Which one of the following CNS infections is most likely to produce ring-enhancing lesions on brain neuroimaging studies?
B CNS HIV-related lymphoma
C Cryptococcal meningitis
D Progressive multifocal leukoencephalopathy
E AIDS-related dementia complex (ARDC)
19. Which one of the following would not correlate with the brain imaging finding of thin gyri, wide sulci and enlarged ventricles, (especially the third ventricle)?
A Alzheimer’s disease
B Chronic alcoholism or drug abuse
C A lacunar infarct of subcortical white matter
E Trisomy 21 (Down’s syndrome)
20. A left-sided middle cerebral artery territory stroke is most likely to produce which of the following?
A Impaired naming and repetition
B Preserved language functioning
C Right hemiparesis with leg weakness worse than the face and arm
D Receptive, fluent aphasia
E Speech paraphasias
21. Dr. Smith, a psychiatrist, has been having sexual fantasies about one of his psychotherapy patients. He tells you this and gives you several reasons why the prohibition of sex with patients does not apply to this situation. Which of the following would be the most ethical advice you could give him?
A He should continue to discuss the situation with colleagues to better define his sexual boundaries
B He should see the patient more frequently to use the strong feelings between them as a motivational tool for positive change in therapy
C He should share his fantasies with the patient
D He should transfer the patient’s care to another psychiatrist
E He should stock his desk with condoms so that if they have sex in his office she does not become pregnant
22. Alexia without agraphia is attributable to a stroke in which of the following arterial territories?
A Middle cerebral
B Posterior cerebral
C Posterior communicating
23. You are studying two variables, a binary predictor variable and a continuous outcome variable. You want to know if the relationship between those two variables is due to chance alone. Which of the following tests would you use?
A Analysis of variance
B Chi-square test
D Negative predictive power
E Predictive validity
24. Which of the following childhood disorders is accompanied by pectus excavatum, ocular lens dislocation, Marfan’s habitus, mental retardation and scoliosis?
C Tay–Sachs disease
D Niemann–Pick disease
E Metachromatic leukodystrophy
25. At what age can a child run well without falling, build a tower of six cubes, and engage in parallel play?
A 18 months
B 2 years
C 3 years
D 4 years
E 5 years
26. Niemann–Pick disease is due to a deficiency in which one of the following?
D Hypoxanthine guanine phosphoribosyl transferase (HPRT)
E Phenylalanine hydroxylase
27. A patient in treatment for bipolar disorder reports severe mid-upper abdominal pain radiating to the back, nausea, anorexia, fever and evidence of an acute abdomen. Pain is worse after eating and upon lying down. She is taking citalopram and valproic acid. Which of the following tests would be most useful in making a diagnosis?
A Complete blood count
B Basic metabolic panel
C Liver function tests
E Prolactin level
28. The most common inherited cause of infantile mental retardation is due to:
A Arylsulfatase-A deficiency
B Hexosaminidase-A deficiency
C Trisomy 21
D Sphingomyelinase deficiency
E Trinucleotide repeat disorder causing long face, long ears and macro-orchidism
29. Which one of the following is not a feature of trisomy 21?
A Single palmar crease
B Short stature
C Brushfield spots on the iris
D Normal penis with small, firm testes and sterility
E Increased risk of dementia
30. A child is brought to clinic with the following characteristics: elfin facies, short stature, hypoplastic teeth, mild mental retardation, friendly personality and gifted musically. This disorder is due to:
A Trisomy 21
B Autosomal microdeletion in chromosome 7q
C Deletion in chromosome 15q
D Deletion 45X0
E 47 XXY
31. Where should electrodes be placed in ECT to minimize cognitive impairment?
A Anterior bilateral placement
B Right unilateral placement
C Left unilateral placement
D Posterior bilateral placement
E Midline placement
32. Which one of the following is not a neurologic cause of autistic symptoms?
A Rett syndrome
B Fragile X syndrome
C Marfan syndrome
D Angelman syndrome
E Tuberous sclerosis
33. A patient suffering from depression is referred for ECT. Prior to ECT which of the following medications should be discontinued?
34. Which one of the following is not a feature of tuberous sclerosis?
A Cutaneous and conjunctival telangiectasias
B Mental retardation
D Shagreen patches
E Ash leaf spots
35. Which one of the following is considered a mature defense mechanism?
36. Hemianesthesia following a stroke with gradual return of sensory function and pain is due to a lesion of:
A The corona radiata
B The spinothalamic tract
C The spinoreticular tract
D The thalamus
E The internal capsule
37. Robert is arrested for assault and held in prison. Because of disorganized behavior a psychiatric evaluation is conducted by a forensic psychiatrist to determine Robert’s fitness to stand trial for the charges. Robert reports that 1 month earlier he was evaluated for hearing voices in a local emergency room. What is the difference between the evaluation done by the forensic psychiatrist and the evaluation done by the emergency room psychiatrist?
A Only the ER evaluation requires a full medication history
B Only the forensic evaluation contains details on Robert’s memory
C The forensic psychiatrist does not have a doctor–patient relationship with Robert
D The ER evaluation will be the only one to contain recommendations
E Only the ER evaluation contains details on Robert’s memory
38. Burst-suppression wave pattern and periodic complexes seen on EEG are characteristic of which of the following?
A Alzheimer’s disease
B Parkinson’s disease
C AIDS-related dementia complex
D Creutzfeldt–Jakob disease
39. The symptoms of this disorder include dementia, incontinence and gait apraxia;
A Normal pressure hydrocephalus
B Diffuse Lewy body disease
C Alzheimer’s disease
D Progressive supranuclear palsy
E Wernicke–Korsakoff syndrome
40. An intracranial bleed that causes brief loss of consciousness, followed by an initial lucid period then further deterioration thereafter, is a result of damage to:
A Bridging veins
B Middle meningeal artery
C Aneurysm of the posterior communicating artery
D Reticular activating system
E Frontal lobes
41. At which age will the majority of children be able to play pat-a-cake?
A 10 months
B 2 months
C 17 months
D 2 years
E 10 weeks
42. An HIV-positive patient develops incoordination, lack of attention and motivation and memory loss that are gradual in onset. CSF is normal on lumbar puncture. MRI of the brain reveals confluent white matter changes on T2 sequencing, no mass effect and no gadolinium enhancement. The most likely diagnosis is:
A Progressive multifocal leukoencephalopathy
B CNS lymphoma
C CNS toxoplasmosis
D Cryptococcal meningitis
E HIV-related dementia
43. Which one of the following is not a substrate for CYP 2D6?
44. Which of the following disorders characteristically presents with festinating gait, postural instability and truncal rigidity?
A Alcoholic cerebellar atrophy
B Alzheimer-type dementia
C Normal pressure hydrocephalus
D Parkinson’s disease
E Tropical HTLV-1 paraparesis
45. Billy and Susan are out at a bar. They spend the evening drinking heavily. They each drink 10 beers. As the evening comes to an end they both vomit and pass out on the floor. An ambulance is called and they are brought into the ER. Susan is found to have a higher blood alcohol level than Billy. Why is this so?
A Susan drank more
B Susan has a higher body water content than Billy
C Billy metabolizes more alcohol in his gastric mucosa
D Susan urinates less frequently than Billy
E Susan is morbidly obese
46. A 70-year-old patient presents with severe left hemicranial headache of acute onset with left eye visual loss. He also presents with aches, pains and stiffness in the extremities for several weeks. MRI of the brain reveals T2 periventricular white matter hyperintensities. Serum sedimentation rate is 110 mm/h. Which of the following is the next most important step in management?
A Obtain a temporal artery biopsy.
B Begin treatment with high dose prednisone.
C Begin treatment with broad-spectrum intravenous antibiotics
D Obtain a magnetic resonance arteriogram
E Begin treatment with intravenous acyclovir
47. Which of the following conditions is not a potential effect of low folate levels?
B Panic attacks
48. Which of the following agents is most appropriate for acute abortive therapy of migraine headache?
B Divalproex sodium
49. A depressed patient comes to you with brittle hair, weight gain, muscle weakness, dry skin, constipation, and cold intolerance. Which is the most appropriate next step in management?
A Start sertraline
B Refer the patient for a head CT
C Check TSH level
D Check serum glucose
E Prescribe sertraline plus Colace
50. A patient reports a history of sudden onset of severe headache, vomiting, collapse, and preservation of consciousness. On examination there are no lateralizing neurologic signs but there is some neck stiffness noted. This clinical picture is most characteristic of:
A Epidural hemorrhage
B Subdural hemorrhage
C Acute venous sinus thrombosis
D Intracerebral hemorrhage
E Subarachnoid hemorrhage
51. Internuclear ophthalmoplegia is a characteristic finding in patients with which of the following:
A Amyotrophic lateral sclerosis
B Myasthenia gravis
C Multiple sclerosis
D Huntington’s chorea
E Progressive supranuclear palsy
52. Demyelinating neuropathy is most often accompanied by which of these findings on electrodiagnostic studies?
A Fibrillations and positive sharp waves
B Delayed sensory latency
C Decreased motor amplitude
D Conduction block
E Decremental response to repetitive stimulation
53. Which of the following is not one of the DSM signs of cannabis intoxication?
A Conjunctival injection
C Increased appetite
D Dry mouth
54. A 30-year-old patient presents with depression and personality changes over several years. His family reports ongoing irritability, impulsivity, and odd social behaviors. On exam you note mild hyper-reflexia, mild bradykinesia, increased eye blinking and tongue impersistence. You note he is very fidgety. His father died of dementia in his 50 s. The most likely diagnosis in this case is:
A Early-onset Alzheimer’s disease
B Wilson’s disease
C Huntington’s disease
D Corticobasal degeneration
E Frontotemporal dementia
55. Caution should be exercised when prescribing which one of the following to a patient on carbamazepine because the combination will increase carbamazepine levels?
56. Which of the following disorders is known to be precipitated by chiropractic adjustments?
A Lumbosacral subluxation
B Brachial plexitis
C Vertebral artery dissection
D Sacroiliac dislocation
E Anterior spinal artery occlusion
57. A patient presents with acute onset of right facial paresis involving the forehead and lower face equally. The paresis was preceded by right ear and mastoid pain and loud noises and low pitch sounds ipsilaterally. This presentation is most likely to be:
A Bell’s palsy
B Trigeminal neuralgia
C Facial dystonia
D Acute lateral medullary infarct
E Left-sided Horner syndrome
58. The pharmacologic treatment of choice for postherpetic neuralgia is:
59. In which brain area can characteristic lesions be seen that are associated with coma due to carbon monoxide poisoning?
A Cingulate gyrus
B Globus pallidus
C Corona radiata
D Corpus callosum
60. Persistent limb rigidity and spasms, also known as stiff-person syndrome is often related to:
A High titers of JC virus antigen
B High titers of HTLV-1 virus antigen
C Circulating lupus anticoagulant
D Autoantibodies against glutamic acid decarboxylase
E Autoantibodies against nicotinic receptors
61. Why does mirtazapine decrease nausea?
A 5-HT2 antagonism
B 5-HT3 antagonism
C 5-HT2 agonism
D Alpha-2 antagonism
E Alpha-2 agonism
62. A 6-year old girl presents with 6 months of headache, vomiting, diplopia, gait unsteadiness and falls. T1-weighted sagittal MRI brain imaging reveals the scan. The most likely diagnosis is:
C Arachnoid cyst
63. Which one of the following happens in 50% of families following the death of a child?
A One of the remaining children commits suicide
B One parent dies
C Neglect of the remaining children
D Parental divorce
E Physical abuse of surviving children
64. Which area of the brain, when damaged minimally, can induce unconsciousness?
A Limbic system
B Reticular formation
C Internal capsule
E Cerebral cortex
65. Which of the following is most likely to be found on neuroimaging of schizophrenics?
A Decreased metabolic activity in the frontal lobes
B Increased size of the lateral ventricles
C Increased cerebral asymmetry
D Increased size of the fourth ventricle
E Decreased size of the thalamus
66. A patient suffers an injurious fall down a flight of stairs. Neurologic examination reveals right biceps weakness, absent right biceps reflex, right shoulder and arm pain with pain radiating to the right thumb. The likely diagnosis is:
A C-6 radiculopathy
B Biceps tendon tear
C Radial neuropathy
D Ulnar neuropathy
E Cervical myelopathy
67. Which of the following is not a common symptom of narcolepsy?
A Sleep attacks
B Sleep-onset REM period
D Sleep paralysis
68. A deficiency of which vitamin is associated with subacute combined degeneration of the posterior columns of the spinal cord?
A Vitamin E
B Vitamin D
C Vitamin B12
D Vitamin B6
E Vitamin A
69. Which of the following neurologic signs would be more indicative of vascular dementia rather than a dementia of the Alzheimer type?
A Anomic aphasia
B Constructional apraxia
D Extensor plantar responses
E Short-term memory loss
70. A 75-year-old man displays paranoid ideation and suspiciousness. He is unable to dress himself or manage his activities of daily living, such as cooking or cleaning. He does not have memory loss, difficulty identifying people or objects, driving a car or using a telephone or a pen. Head CT scan reveals the image. The likely diagnosis is:
A Pick’s disease
B Late-onset schizophrenia
C Lewy-body dementia
D Alzheimer’s dementia
E Medication-induced psychosis with parkinsonism
71. Which of the following deficits is associated with the condition known as hyperkalemic periodic paralysis?
A Sodium channel inactivation
B Calcium channel inactivation
C Potassium channel inactivation
D Chloride channel inactivation
E Nicotinic cholinergic transmission blockade
72. Which is the most reliable cerebrospinal fluid (CSF) finding in patients in the chronic progressive phase of multiple sclerosis?
A Myelin basic protein concentration
B Total protein concentration
C Presence of oligoclonal bands
D Acellularity of the CSF
E Immunoglobulin G concentration
73. Mirtazapine works via action on which of the following receptors?
A Dopamine type 2
B Alpha 2
D Alpha 1
74. The most useful treatment for acute cluster headaches in men is:
B Oxygen therapy with a triptan medication
C Immediate-release oxycodone with acetaminophen (Percocet)
D Butalbital and acetaminophen (Fioricet)
75. The chronic headache syndrome known as hemicrania continua is most responsive to:
B Oxygen therapy with a triptan medication
C Immediate-release oxycodone with acetaminophen (Percocet)
D Butalbital and acetaminophen (Fioricet)
76. Which of the following combination of risk factors is most important to control when considering the prevention of lacunar strokes?
A Hypertension and hyperlipidemia
B Hypertension and obesity
C Hyperlipidemia and obesity
D Hypertension and tobacco smoking behavior
E Hyperlipidemia and diabetes
77. A 1-day-old neonate is found to have this MRI image of the brain. The most likely diagnosis is:
A Arnold–Chiari Type I malformation
B Arnold–Chiari Type II malformation
C Dandy–Walker malformation
D Arachnoid cyst
78. A 5-year-old boy is evaluated and found to have developmental delay, aggressivity, temper tantrums and overeating behavior. The boy had hypotonia as an infant. The most likely diagnosis is:
A Prader–Willi syndrome
B Fragile X syndrome
C Trisomy 21
D Williams syndrome
E Angelman syndrome
79. Which of the following syndromes is characterized by a rapidly progressing dementia with exaggerated startle response and violent unprovoked myoclonus?
A Progressive multifocal leukoencephalopathy
B Subacute sclerosing panencephalitis
C Spongiform encephalopathy
D Cytomegalovirus encephalitis
E Herpes encephalitis
80. Which one of the following complications of HIV disease is caused by a central nervous system (CNS) infection by JC virus?
A CNS lymphoma
B CNS toxoplasmosis
C Cryptococcal meningitis
D Progressive multifocal leukoencephalopathy
81. Which of the following is the most common complication of idiopathic intracranial hypertension (pseudotumor cerebri)?
B Visual impairment
C Gait disorder
D Uncal herniation
E Hypovitaminosis A
82. Which of the following is achieved during Piaget’s developmental stage of concrete operations?
B Animistic thinking
C Deductive reasoning
D Object permanence
83. Male sexual behavior in the seventh decade is characterized by which of the following?
A Decreased time to ejaculation
B Decreased time to erection
C No change in sex drive
D No change in penile turgidity
E Absence of ejaculation upon orgasm
84. Infantile secure attachment is associated with which of the following outcomes?
A Higher intellectual ability in adolescence and adulthood
B Educational success throughout childhood and adolescence
C Physical coordination and later athletic ability
D Emotional and social competence
E Easy temperament in childhood
85. A young girl performs in a school play and revels in the praise and pride displayed to her by her mother. In Kohut’s theory of self-psychology, this child is experiencing:
B Good-enough mothering
D Primary narcissism
86. According to Margaret Mahler’s stages of separation–individuation the period from 10 to 18 months of age during which the infants’ ability to move autonomously increases their exploration of the outer world is known as:
A Object constancy
87. Which of the following is an example of declarative memory?
B Retention and recall of facts
C Skills and habits
D Simple classical conditioning
E Non-associative learning
88. The “addictive” nature of gambling behavior and the disorder of pathological gambling can best be explained by theories of:
A Operant conditioning
B Classical conditioning
C Drive and neurotic impulses
D Self-psychology and pathological narcissism
E Habituation and sensitization
89. A patient with depression tells the therapist about a variety of unpleasant personal circumstances that have occurred in the past week, worries about friends being sad and withdrawn, and a reluctance to watch the news on television because “the only news on television is bad news.” In the theory of cognitive psychology, this type of behavior is best formulated as:
A Learned helplessness
B Selective attention bias
D Automatic negative thoughts
E Information overload
90. A clinical test that detects 96% of patients with a certain disease, but also produces many false positives in patients without the disease, is deemed to have:
A High sensitivity and high specificity
B Low sensitivity and high specificity
C Low sensitivity and low specificity
D High sensitivity and low specificity
E Low overall clinical utility
91. Which of the following classes of psychotropic medications has the best documented treatment effects for agitation in the demented patient?
B Mood stabilizers
D Selective serotonin reuptake inhibitor antidepressants
E Tricyclic antidepressants
92. A television news program reports that a famous actress has been seen in public exhibiting verbal outbursts and unexplained violent behavior directed at people and property. A well-known psychiatrist appears on the program and when asked about the actress, states she is likely suffering from bipolar disorder and possibly substance abuse. Which of the following best qualifies the ethics of the psychiatrist’s on-air affirmations?
A It is ethical because the actress is a public figure
B It is ethical unless there is conflict of interest involved
C It is unethical because the psychiatrist has never examined the actress
D It is unethical because the psychiatrist was paid to appear on-air and make such statements
E It is ethical because the psychiatrist is acting under the constitutional rights of freedom of speech and freedom of the press
93. Transcranial magnetic stimulation (Neurostar TMS®) was cleared by the FDA in 2008 for in-office treatment of major depressive disorder. The area of the brain that is treated with electromagnetic stimulus application is first mapped by finding the motor threshold at the area on the motor strip corresponding to the thumb and fingers. Following the discovery of the best area of motor threshold by this mapping, the ongoing treatment is applied to approximately which of the following brain areas?
A Left cingulate gyrus
B Left parietal lobe
C Left dorsolateral prefrontal cortex
D Right parietal lobe
E Right dorsolateral prefrontal cortex
94. Transcranial magnetic stimulation (Neurostar TMS®) was cleared by the FDA in 2008 for in-office treatment of major depressive disorder. Which one of the following correctly classifies the type of patient history for which this treatment is indicated?
A For patients who failed to achieve satisfactory benefit from one antidepressant medication at an adequate dose and duration in the current episode
B For patients who failed to achieve satisfactory benefit from two antidepressant medications at an adequate dose and duration in the current episode
C For patients who failed to achieve satisfactory benefit from three antidepressant medications at an adequate dose and duration in the current episode
D For patients who failed to achieve satisfactory benefit from at least one antidepressant medication with at least one augmenting agent (second antidepressant or antipsychotic agent) at adequate doses and duration in the current episode
E For patients who failed to achieve satisfactory benefit from at least one antidepressant agent at an adequate dose and duration in the current episode, or who could not tolerate the side effects of antidepressant agents or who did not wish to take antidepressant agents
95. A patient comes to you 3 weeks after witnessing a child hit by a car. Since then she has been having feelings of detachment and feels “in a daze.” She has recurrent thoughts and dreams about the event. She describes depersonalization. She has avoided discussing the event with friends and family and her sleep has been poor. What is the most appropriate diagnosis?
A Post-traumatic stress disorder
B Major depressive disorder
C Acute stress disorder
D Panic disorder
E Primary insomnia
96. Which one of the following properties of atypical antipsychotics is hypothesized to be responsible for these medications to be less likely to produce extrapyramidal side effects?
A Decreased binding to D2 receptors
B Rapid dissociation from D2 receptors
C Affinity for muscarinic cholinergic receptors
D Binding to multiple other dopamine receptors besides D2 receptors
E Higher affinity for D1 receptors
97. Which of the following choices is a risk factor for developing conversion disorder?
A High socioeconomic status
B Little education
C High intelligence
D Urban setting
E Lack of military service
98. Neurotoxicity due to methylenedioxymethamphetamine (MDMA) is associated with deficits in neurons that produce which of the following neurotransmitters?
99. A high score on the MMPI infrequency scale (scale F) is most consistent with which one of the following diagnoses?
A Major depressive disorder
B Histrionic personality disorder
D Obsessive–compulsive disorder
100. When triiodothyronine is added to a tricyclic antidepressant for augmentation, the clinician needs to be cautious if:
A The patient is an older woman over 50 years of age
B The patient has subclinical hypothyroidism
C The patient has a history of hypertension
D The patient has a history of cognitive deficits with depression
E The patient relapsed while on a previously effective tricyclic antidepressant
101. One of your patients has been taking zolpidem for sleep recently and started having sleep walking episodes on the medication. She finds these episodes to be disturbing. She asks you about taking eszopiclone instead. Which of the following possible responses to her question is most accurate?
A Eszopiclone is a bad choice because she will develop tolerance over time
B Eszopiclone can also cause sleep walking
C Eszopiclone works as a melatonin receptor agonist
D Eszopiclone is used to treat both sleep and depression
E Unlike with zolpidem, hallucinations do not occur with eszopiclone
102. As part of doing blood-work for an alcoholic patient you decide to order a GGT (gamma-glutamyl transpeptidase). How long after the patient stopped drinking would you expect the GGT to return to normal?
A 2 days
B 3 weeks
C 10 days
D 8 weeks
E 5 days
103. A schizophrenic patient asks his doctor to bill his insurance company as if he had an adjustment disorder instead of schizophrenia because he is concerned about the stigma that schizophrenics face. What should the doctor do?
A Agree to bill for an adjustment disorder because the stigma is real
B Kick the patient out of her practice and refuse to see him again
C Explore the reasons behind the request and explain why this is something she is not comfortable doing
D Suggest she bill the visit as psychotic disorder NOS because, though it is not accurate, it is closer to the truth than adjustment disorder
E Agree to bill as an adjustment disorder as long as the patient spends time exploring their feelings surrounding the request and their feelings about the diagnosis
104. Which of the following is not one of the psychiatric symptoms that can result from adrenal insufficiency?
105. Which of the following is true about administering different mood stabilizers together?
A Valproic acid will increase lamotrigine levels
B Lamotrigine will increase valproic acid levels
C Valproic acid will decrease lamotrigine levels
D Valproic acid will decrease carbamazepine levels
E Carbamazepine will increase lithium levels
106. Which of the following neurochemical changes would you expect to see in a patient with increased aggression?
A Increased serotonin
B Decreased dopamine
C Decreased testosterone
D Decreased GABA
E Decreased acetylcholine
107. Which one of the following statements is false concerning motor development during infancy?
A The cerebellum is not fully formed until 1 year of age
B Myelination of peripheral nerves is not complete until 2 years of age
C The grasp and tonic neck reflexes begin to develop between 2 and 6 months
D Fine pincer grasp develops around 9 to 12 months
E The ability to sit without support occurs at 6 months
108. Which of the following is a risk factor for neuroleptic-induced tardive dyskinesia?
A Anxiety disorder
B Migraine headaches
C Lower socioeconomic class
D Advanced age
E Male gender
109. Which of the following statements about benzodiazepines is correct?
A Clonazepam has a rapid rate of absorption
B Alprazolam has a half life of 2.5 hours
C Diazepam has a half life of 200 hours
D Lorazepam is considered a short acting benzodiazepine
E Clonazepam is considered a short acting benzodiazepine
110. Which of the following anxiety disorders has equal rates in both males and females?
A Panic disorder
B Generalized anxiety disorder
C Social phobia
D Obsessive–compulsive disorder
E Specific phobia
111. Which of the following is part of the correct schedule for monitoring WBC count when using clozapine?
A Weekly WBC for the first 6 weeks then every other week thereafter
B Daily WBC for the first week, then weekly for the next 6 months
C Weekly WBC for the first 6 months then monthly thereafter
D Daily WBC for the first week after discontinuation of clozapine
E Weekly for the first 6 months then biweekly for 6 months then monthly thereafter
112. The following choices are potential side effects of lithium except:
A Hair loss
D Neural tube defects
113. Which of the following is most correct regarding management of alcohol withdrawal symptoms?
A IV thiamine and dextrose should be given for the first 9 days
B If alprazolam is used it should be given BID
C Disulfiram should be given during withdrawal
D One should choose clonazepam over lorazepam in a hepatically impaired patient
E If lorazepam is used it should be given QID
114. Which of the following terms refers to spastic contractions of discrete muscle groups such as the neck, tongue, eyes or back?
B Tardive dyskinesia
C Acute dystonia
E Tardive dystonia
115. Which one of the following is not an inducer of CYP3A4?
116. Suzie goes to the emergency room with a pain in her right leg. Prior to initiating treatment the physician obtains informed consent. This is an example of which of the following ethical principles?
D Parens patriae
117. The average number of ECT treatments needed to treat depression is:
118. Which of the following is not included in the SCID (Structured Clinical Interview for DSM IV Axis I Diagnosis)?
A Mood episodes
B Anxiety disorders
C Functional Impairment
D Eating disorders
E Mood disorders differential
119. Which of the following is true regarding self-disclosure in psychotherapy?
A It is always prohibited
B It is acceptable if it helps the therapist feel more comfortable
C It is acceptable for the therapist to share their real feelings as long as they don’t lie
D It is acceptable if it is done solely for the benefit of the patient
E It is never prohibited
120. A 67-year-old male carries a diagnosis of bipolar disorder and is being treated with carbamazepine. His family brings him to the emergency room because he has become confused and disoriented over the past 2 days. He is afebrile and has no neurological deficits. Although you could reasonably order any of the following tests to evaluate his condition, which of the following is most important that you check given the patient’s history?
A Head CT
B Chest X-ray
D Basic metabolic panel
121. Which of the following medications would be the best choice for a patient with psychosis and impaired hepatic function?
122. A general consensus among experienced clinicians and researchers is known as:
A Face validity
B Descriptive validity
C Predictive validity
D Construct validity
E Positive predictive power
123. Which one of the following statements is false concerning desvenlafaxine extended release tablets (Pristiq)?
A Desvenlafaxine may cause orthostasis and hyponatremia in the elderly
B Dosage should be adjusted in patients with renal disease
C Monitoring must be conducted for increase in suicidality during treatment, especially in children and teens
D Taking desvenlafaxine in combination with an MAOI may precipitate a serotonin syndrome
E Desvenlafaxine has no impact on blood pressure, unlike venlafaxine
124. Which of the following GAF scores would be most appropriate for a patient who has impaired reality testing and has major impairment in work functioning and family interactions?
125. Which of the following changes can be seen in the sleep of elderly human subjects?
A Gradual phase retardation
B Increased REM sleep
C Decreased Stage I sleep
D Increased sleep efficiency
E Decreased Stage III and Stage IV sleep
126. Which one of the following statements is false concerning atomoxetine (Strattera)?
A Atomoxetine works as a norepinephrine reuptake inhibitor
B Full results are seen within 2 weeks of initiating treatment with atomoxetine
C Once daily dosing of atomoxetine works well for most patients
D Most common side effects include dizziness and reduced appetite
E Atomoxetine carries a black box warning for suicidality
127. Which of the following famous therapists suggested that empathic failures in the mother lead to developmental arrest in the child at a stage when the child needs others to help perform self-object functions?
A Melanie Klein
B Heinz Kohut
C Jacques Lacan
D Adolph Meyer
E B. F. Skinner
128. Naltrexone extended release injectable suspension (Vivitrol) is indicated for treatment of which of the following disorders?
A Major depressive disorder
B Generalized anxiety disorder
D Alcohol dependence
E Cocaine withdrawal
129. Which of the following rating scales is used to evaluate severity of depression?
130. Which of the following medications is a serotonin and norepinephrine reuptake inhibitor, lacks significant antihistaminic effects, can cause withdrawal symptoms if stopped abruptly, and has an indication for neuropathic pain?
131. Which one of the following foods can be consumed when taking an MAOI?
A Aged cheese
B Cured meats
C Smoked fish
132. A 19-year-old male is brought into the emergency room after his family noticed an acute change in his behavior. He is aggressive, assaultive, and belligerent. On exam it is noted that he has nystagmus, slurred speech, a perioral rash, and a tremor. His family reports that he became out of control while in the garage and kicked a hole through the garage door. He has no prior psychiatric history. What is his most likely diagnosis?
A Bipolar disorder
B Psychotic disorder NOS
C Panic disorder
D Inhalant intoxication
E Antisocial personality disorder
133. Which one of the following is not a clinical feature of narcolepsy?
B Increased REM latency
C Hypnagogic hallucinations
D Associated with human leukocyte antigen HLA-DR2 in most cases
E Sleep paralysis
134. Jimmy has IQ testing as part of an evaluation for behavioral disturbances. His IQ score is 45. Based on this information Jimmy is:
A Not mentally retarded
B Mildly mentally retarded
C Moderately mentally retarded
D Severely mentally retarded
E Profoundly mentally retarded
135. Which of the following statements is correct concerning clozapine?
A Smoking will not affect clozapine levels
B Risk of agranulocytosis is dose related
C Clozapine carries high risk of prolactin elevation
D Doses of clozapine greater than 600 mg/day carry a much higher risk of seizures than lower doses
E Adding lithium to clozapine lowers the chances of NMS
136. Which one of the following is false concerning delusional disorder?
A Non-bizarre delusions are present
B The patient meets criteria A for schizophrenia
C There is a preservation of functioning
D “Erotomanic” is a subtype
E “Somatic” is a subtype
137. Which of the following is the most significant risk factor for post-traumatic stress disorder and the best predictor of symptom development following exposure to trauma?
A A family history of anxiety or depression
B The availability of psychiatric care immediately following the trauma
C Low socioeconomic status
D Being single, divorced or widowed
E The nature, severity and duration of exposure to the trauma
138. Which of the following correctly describes the likelihood of patients with schizophrenia committing homicide as compared with the general population at large?
A Half as likely
B Equally likely
C Twice as likely
D Five times as likely
E Ten times as likely
139. A new patient comes to you asking for help with depression. She states that she has had a very low mood recently and has been feeling overwhelmed. She has a 2-month-old daughter at home and keeping up with a new baby has been hard for her. She reports constant fatigue, listlessness, and weight loss. She states that her libido is down and she is very upset because she could not breast feed her baby due to lack of milk production. Her concentration is normal. She bursts into tears and states that she doesn’t think she can be a good mother. Which of the following would be the most appropriate next step in the management of this case?
A Start psychotherapy only
B Start an antidepressant
C Start a benzodiazepine
D Send patient for endocrine bloodwork
E Report the case to child protective services
140. Which of the following choices about avoidant personality disorder is most accurate?
A It is often misdiagnosed as paranoid personality disorder
B These patients tend to be indifferent to praise or criticism
C Affective instability is a key component of the disorder
D These patients avoid social interaction out of fear of shame or ridicule
E These patients are unable to discard worthless objects
141. Which one of the following is not a possible psychiatric manifestation of Acute Intermittent Porphyria?
142. The prevalence of Alzheimer’s disease in those patients over age 85 years is:
A Less than 5%
B 5 to 10%
C 11 to 20%
D 21 to 40%
E 41 to 50%
143. Which of the following statements concerning psychiatrists and suicide is most accurate?
A The law imposes liability on the psychiatrist whenever a patient commits suicide
B A psychiatrist is expected to foresee all possible harm that may come to a patient
C The law views suicide as predictable in all cases
D No-Harm contracts are dependable legal protection for the psychiatrist
E Psychiatrists must document risk assessment and appropriate interventions to meet the standard of care when treating a suicidal patient
144. Which of the following is the correct criterion for a covered disability according to the Americans with Disabilities Act (ADA)?
A It is due to a substance-related disorder
B It is due to a general medical condition
C It seriously affects social functioning at work
D It substantially limits one or more major life activities
E It causes significant impairment in the workplace
145. Which one of the following is false concerning the homeless mentally ill?
A The numbers of homeless mentally ill continue to grow
B A significant number of homeless mentally ill are also dependent on alcohol or other substances of abuse
C Street dwellers usually have schizophrenia, substance abuse or both
D Episodically homeless have personality disorders, substance abuse or mood disorders
E Traditional mental health systems are often very effective at treating the homeless once they are enrolled in treatment
146. Which one of the following situations is considered ethical behavior for a psychiatrist?
A Having sex with a current patient
B Noting romantic feelings between therapist and patient then discontinuing therapy, then beginning a sexual relationship
C Transferring the case to another doctor, then waiting for one year, then beginning a sexual relationship with the former patient
D Taking on a new patient with whom you had been sexually involved several years ago, but are not currently
E Never having sex with a patient or ex-patient, ever, under any circumstances
147. Which of the following medications is a partial nicotine agonist which decreases craving and withdrawal in patients trying to stop smoking?
C Nicotine gum
D Nicotine nasal spray
148. The treatment of choice for organophosphate insecticide exposure and poisoning is:
A Pralidoxime and atropine
C Intravenous fluids and ventilation
E Dimercaprol or penicillamine
149. Which one of the following is false regarding HIPAA?
A Authorization must be obtained for release of health information except for routine uses such as provider payment or healthcare operations
B Patients must have access to written notice of their privacy rights
C Patients have a right to know how their protected information is kept and disclosed
D Patients have a right to copies of their medical record
E Patients may control who receives their information but not how the information is communicated
150. One of your patients asks you to give them information about Mirtazapine. If you made all of the following statements to the patient, which one would be considered factually inaccurate?
A Mirtazapine blocks serotonin reuptake
B Mirtazapine causes minimal sexual dysfunction
C Mirtazapine can be very sedating
D Mirtazapine is a potent H1 receptor antagonist
E Mirtazapine can cause weight gain