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

Test Number Six

1. Which of the following enzymes is responsible for the metabolism of trazodone?

  A CYP 2D6

  B CYP 1A2

  C CYP 2C19

  D CYP 3A4

  E CYP 2C9

2. A young man presents to the emergency room with a complaint of several days of progressive lower extremity weakness and numbness bilaterally. History reveals he had a flu-like illness for about ten days prior to coming to the hospital. Examination confirms the lower extremity weakness, as well as loss of sensation to all sensory modalities below the middle of the thorax. Deep tendon reflexes are brisker below the waist than above and plantar reflexes are extensor bilaterally. The patient complains of recent episodes of urinary incontinence. The rest of the neurological and physical examinations are unremarkable. A lumbar puncture reveals 23 mononuclear cells, a protein level of 37 mg/dL and normal glucose. The most likely diagnosis is:

  A Spinal epidural abscess

  B Anterior spinal artery infarction

  C Acute transverse myelitis

  D Acute inflammatory demyelinating polyneuropathy

  E Spinal metastasis

3. Which of the following medications has FDA approval for treatment of bipolar maintenance, thereby treating both mania and depression?

  A Topiramate

  B Carbamazepine

  C Lamotrigine

  D Valproic acid

  E Gabapentin

4. Which one of the follow sleep stages correlates with childhood somnambulism as measured by an electroencephalogram (EEG)?

  A Rapid eye movement sleep (REM)

  B Stage II

  C Stage III

  D Stage IV

  E Stage I

5. Which of the following pregnancy categories should be given to a drug where animal studies show adverse fetal effect and no human studies are available?

  A Category A

  B Category B

  C Category C

  D Category D

  E Category E

6. A 60-year-old man with diabetes mellitus is seen by an outpatient psychiatrist because the family states he is not making any sense. When asked what is wrong, the man states: “Thot blegging at bremull fee gelking.” This expression has normal intonation, but no one can understand it. The man is able to respond to other questions with similar expressions, but he cannot execute any instructions. The most likely diagnosis is:

  A Wernicke’s aphasia

  B Balint’s syndrome

  C Gerstmann’s syndrome

  D Schizophrenic word salad

  E Conduction aphasia

7. Which of the following would the American Psychiatric Association consider unethical?

  A Accepting a cup of coffee from a patient

  B Charging a patient for missed visits

  C Selling your used car to a patient

  D Releasing information about a patient to their insurance company

  E Maintaining a separate set of psychotherapy notes in addition to the medical record

8. A 75-year-old woman develops a sudden onset of right-foot and leg paralysis. Her right arm, hand and face are only very slightly affected. There is no visual field deficit or aphasia. Over the ensuing weeks she is found to have lack of spontaneity, abulia and loss of bladder control. Which of the following vascular territories would be implicated in this stroke?

  A Right anterior choroidal artery

  B Left anterior cerebral artery

  C Small subcortical vessels

  D Deep penetrating vessels supplying the frontal lobes

  E Superior frontal branch of the right middle cerebral artery

9. Which of the following medications is excreted unchanged in the urine?

  A Sertraline

  B Olanzapine

  C Risperidone

  D Lamotrigine

  E Gabapentin

10. A 55-year-old woman was found wandering the local bus terminal in a confused and disoriented state. She could recall her name, but not how she got to the bus terminal or why she was there. Her daughter went to pick her up at the local hospital thereafter and tried to reorient her mother many times. Nevertheless, her mother kept asking repetitive questions, even about information she had just been given about her location. Neurologic examination was normal, as were brain MRI and EEG. Within 12 hours the woman’s symptoms subsided entirely. The most likely diagnosis of her problem was:

  A Attention-seeking behavior

  B An acute dissociative state

  C An epileptic fugue state

  D Alcohol intoxication

  E Transient global amnesia

11. Giving a patient nefazodone and trazodone at the same time will lead to which of the following?

  A Decreased trazodone levels

  B Decreased nefazodone levels

  C Increased trazodone levels

  D Increased nefazodone levels

  E Induction of CYP 3A4

12. Which of the following procedures would confirm the diagnosis of non-epileptic seizure?

  A Hypnotic suggestion

  B Videotelemetry

  C Magnetic resonance imaging brain scan (MRI)

  D Observation for a 24-hour period

  E Electroencephalogram (EEG) between episodes

13. One of your patients on neuroleptic medication complains of symptoms of akathisia. Which of the following is the most appropriate treatment?

  A Benztropine

  B Bromocriptine

  C Nimodipine

  D Propranolol

  E Clonidine

14. Lancinating facial pain that is sometimes triggered by minor sensory stimuli, is best treated initially with which of the following drugs?

  A Lioresal

  B Transdermal lidocaine patch

  C Eletriptan

  D Carbamazepine

  E Capsaicin

15. In the management of patients with acute ischemic stroke, administration of which of the following agents within 48 hours of the onset of stroke has been shown to have a beneficial effect in reducing the risk of recurrent stroke, disability, and death?

  A Aspirin

  B Heparin

  C Recombinant tissue plasminogen activator (rTPA)

  D Enoxaparin

  E Clopidogrel

16. A 35-year-old woman experiences numbness in both hands during her second trimester of pregnancy. The numbness involves the thumb, forefinger and middle finger of both hands. She reports that the dorsal part of the hand is not affected. She often awakens in the morning with aching of her arms, from the shoulder area to the hands. The most likely diagnosis is:

  A Ulnar entrapment neuropathies

  B Brachial plexopathy

  C Median neuropathies at the wrist

  D Thoracic outlet syndrome

  E C6 radiculopathies due to cervical spondylosis

image

Thenar atrophy in chronic bilateral carpal tunnel syndrome

17. Which of the following anxiety disorders is most common?

  A Panic disorder

  B Obsessive–compulsive disorder

  C Post-traumatic stress disorder

  D Specific phobia

  E Generalized anxiety disorder

18. The association of skin tumors, Lisch nodules of the iris, and abundant café au lait spots is diagnostic of a mutation in which of the following genes?

  A NACP (alpha-synuclein gene)

  B NF-1 (neurofibromatosis 1 gene)

  C ATM (ataxia telangiectasia gene)

  D TSC-1 (tuberous sclerosis gene 1)

  E NF-2 (neurofibromatosis 2 gene)

19. Culture correlates most with which of the following factors?

  A Race

  B Age

  C Gender

  D Nationality

  E Ethnicity

20. A 30-year-old patient presents to the emergency room 2 weeks after starting a crash fad diet to lose weight. The chief complaint is abdominal and extremity pain. The patient is anxious, tachycardic, disoriented and pale on examination, and seems to be responding to hallucinations. The family history from collaterals reveals that the patient’s father suffers similar episodes at times. The most likely diagnosis is:

  A Acute intermittent porphyria

  B Huntington’s disease

  C Hemophilia B

  D Bipolar I disorder

  E Anorexia nervosa with hallucinogen intoxication

21. Which one of the following interactions might one expect when a thiazide diuretic is added on to a patient taking psychiatric medication?

  A Decreased clozapine level

  B Decreased valproic acid level

  C Increased lithium level

  D Increased clozapine level

  E Decreased lithium level

22. Which of the following agents has been shown to reduce the accumulation of plaques and disability in patients with relapsing remitting multiple sclerosis?

  A Prednisone

  B Interferon beta-1a

  C Tizanidine

  D Lioresal

  E Intravenous gammaglobulin (IV IgG)

23. A bulimic patient admits to you that she has been using large quantities of ipecac on a daily basis. Which of the following medical issues should you be most concerned with?

  A Cardiomyopathy

  B Shortening of QTc interval

  C Leukocytosis

  D Increased serum amylase

  E Infection

24. The major clinical features of Binswanger’s disease include a gait disorder, a pseudobulbar state and:

  A Urinary incontinence

  B Aphasia

  C Constructional apraxia

  D Dementia

  E Diplopia

25. At which one of the following ages can children respond to simple directions and understand pronouns?

  A 16 months

  B 23 months

  C 30 months

  D 40 months

  E 60 months

26. A 32-year-old patient was referred for neurologic evaluation due to hand shaking. The history reveals that the shaking is present only when using the hands and is particularly bad when writing or bringing a cup to the mouth while drinking. Stress worsens the shaking. The shaking improves when the patient drinks a glass of wine. The patient’s older sibling also suffers from a similar disorder. From this history, the most likely diagnosis is:

  A Alcohol-withdrawal tremor

  B Wilson’s disease

  C Spinocerebellar ataxia

  D Early onset Parkinson’s disease

  E Essential tremor

27. At what age can children use language to tell a story, share ideas, and discuss alternatives?

  A 10 months

  B 20 months

  C 30 months

  D 50 months

  E 60 months

28. A palsy of the sixth cranial nerve is associated with which one of the following alcohol-related disorders?

  A Cerebellar degeneration

  B Wernicke’s encephalopathy

  C Marchiafava–Bignami syndrome

  D Alcohol-related delirium

  E Korsakoff’s syndrome

29. Which of the following tests would be most helpful in trying to understand deficits in a patient with right hemisphere disease?

  A Boston diagnostic aphasia examination

  B Sentence completion test

  C Word association technique

  D Judgment of line orientation test

  E Thematic apperception test

30. A 68-year-old patient presents to an outpatient neurologist with marked gait abnormality, slow movements and asymmetric rigidity of the upper extremities. Eye examination reveals mild impairment in both upward and downward voluntary vertical gaze. Further history reveals that levodopa therapy only improved the slowness and rigidity modestly. Several years later, the patient is found to have impairment in voluntary horizontal as well as vertical gaze. Oculocephalic reflexes were normal. The patient’s most likely diagnosis is:

  A Pseudobulbar palsy

  B Olivopontocerebellar atrophy

  C Striatonigral degeneration

  D Progressive supranuclear palsy

  E Dentatorubral degeneration

image

Typical facial expression of a patient with progressive supranuclear palsy, illustrating worried or surprised appearance, with furrowed brow and fixed expression of lower face.

31. All of the following are mature defenses except:

  A Humor

  B Introjection

  C Altruism

  D Anticipation

  E Suppression

32. A 50-year-old patient consults a neurologist for a gradually progressive and intermittent involuntary turning of the neck to the left. At times the patient complains of pain in the sternocleidomastoid muscle and head tremor. These symptoms are exacerbated by anxiety and stress. The most appropriate treatment for this condition is:

  A Divalproex sodium

  B Olanzapine

  C Botulinum toxin

  D Levodopa/carbidopa

  E Benztropine

image

A patient with cervical dystonia (torticollis) with head rotation to the right demonstrating marked hypertrophy of the left sternocleidomastoid muscle.

33. All of the following are possible causes for anorgasmia except:

  A Alcohol

  B TCAs

  C Diabetes

  D Spinal chord damage

  E Methylphenidate

34. A 16-year-old patient is reported to have episodes of muscle jerks that involve the whole body and absence episodes during which the patient seems dazed for a few seconds. The EEG shows bursts of 4 to 6 Hz polyspike and wave activity. The most likely diagnosis in this case is:

  A Juvenile myoclonic epilepsy

  B Nonepileptic seizures

  C Cataplexy

  D Petit-mal epilepsy

  E Rolandic epilepsy

35. Upon graduation from residency you start a new practice in your home town. You go to a local internist and a local psychologist and tell them that for every patient they refer you, you will pay them $100. This arrangement is…

  A Ethical because people need doctors and you need patients

  B Unethical because it puts the doctor’s interests ahead of the patient’s

  C Ethical because all parties involved benefit in some way

  D Ethical because the referring clinician is fairly compensated for his referral

  E Unethical because the primary care physician should know how to treat depression and should not need to refer to you

36. Multifocal myoclonus in a comatose patient is most likely indicative of a:

  A Brainstem infarct

  B Metabolic encephalopathy

  C Non-convulsive status epilepticus

  D Subarachnoid hemorrhage

  E Posterior fossa tumor

37. Which of the following famous therapists developed the “epigenetic principle”?

  A Erik Erikson

  B Melanie Klein

  C B.F. Skinner

  D Harry Stack Sullivan

  E Heinz Kohut

38. A 60-year-old patient with hypertension and diabetes consults a neurologist for left periorbital pain and diplopia. Examination reveals paralysis of abduction of the left eye. Which of the following is the most probable diagnosis?

  A Left pontine stroke

  B Pseudotumor cerebri

  C Diabetic sixth nerve palsy

  D Myasthenia gravis

  E Optic neuritis

39. Which one of the following is not an appropriate DSM specifier used for substance-induced anxiety disorder?

  A With generalized anxiety

  B With panic attacks

  C With obsessive–compulsive symptoms

  D With phobic symptoms

  E With delayed onset

40. A 35-year-old patient presents with headache, fever, seizures, confusion, stupor and coma that evolve over a period of a week. The EEG demonstrates periodic lateralized high-voltage sharp waves emanating from the left temporal region, as well as slow-wave complexes repeating at 2- to 3-second intervals. The brain CT scan shows a low-density lesion in the left temporal lobe. The most likely diagnosis in this case is:

  A Listeria meningitis

  B HIV encephalitis

  C St. Louis encephalitis

  D Herpes simplex encephalitis

  E Cryptococcal meningitis

41. Which of the following is the most important factor in distinguishing pain disorder from chronic pain syndromes?

  A The pain is severe enough to warrant clinical attention

  B The patient suffers disability from the pain

  C No physical lesion is found on imaging studies

  D Substance abuse and character pathology may complicate the picture

  E The pain is attributed to psychological factors

42. A 65-year-old man presents with 3 months of progressive limb weakness, worse on the right than the left. He has trouble swallowing liquids. Neurologic examination reveals normal cranial nerve function, but extensor neck muscle weakness. He has motor weakness in both distal and proximal muscles, which include the quadriceps, dorsal foot flexors, and especially the extensor pollicis longus. The upper extremity motor examination is significant for wrist and finger flexor weakness. Deep tendon reflexes are preserved and normal throughout. Muscle tone, coordination and gait are normal. The rest of the physical examination is normal. Laboratory values reveal mildly elevated serum creatine kinase. Which one of the following is the most likely diagnosis?

  A Myasthenia gravis

  B Inclusion body myositis

  C Polymyalgia rheumatica

  D Dermatomyositis

  E Polymyositis

43. Which of the following brain pathways starts in the ventral tegmental area and projects to the frontal cortex?

  A Tuberoinfundibular pathway

  B Nigrostriatal pathway

  C Mesolimbic pathway

  D Mesocortical pathway

  E Ventral amygdalofugal pathway

44. Which one of the following mitochondrial disorders is the most common?

  A Leber’s hereditary optic neuropathy

  B Myoclonus epilepsy with ragged-red fibers (MERRF)

  C Mitochondrial encephalopathy, myopathy, lactic acidosis, and stroke-like episodes (MELAS)

  D Kearns–Sayre syndrome (KSS)

  E Maternally-inherited myopathy with cardiomyopathy

45. Yves has a preoccupation with sexual fantasies involving being beaten, bound and humiliated. Which of the following terms best describes him?

  A Voyeurism

  B Transvestic fetishism

  C Fetishism

  D Frotteurism

  E Sexual masochism

46. Botulinum toxin is FDA-approved for a number of movement disorders including cervical dystonia and blepharospasm. Its mechanism of action at the neuromuscular junction involves:

  A Inhibition of acetylcholine release from presynaptic terminals

  B Blockade of voltage-dependent calcium channels

  C Inhibition of acetylcholine synthesis at the neuromuscular junction

  D Inhibition of acetylcholinesterase

  E Blockade of the nicotinic acetylcholine receptors in muscle

47. All of the following are symptoms of nicotine withdrawal except:

  A Depressed mood

  B Bradycardia

  C Somnolence

  D Increased appetite

  E Irritability

48. A 58 year old patient with chronic atrial fibrillation develops aphasia and right hemiparesis acutely while watching television at home one evening at 8:00 pm. In the emergency room, the neurologic examination reveals moderate right hemiparesis and an expressive aphasia. A head CT scan done at 9:30 pm reveals no acute lesion. The most appropriate therapy in the emergency room is:

  A Aspirin

  B Clopidogrel

  C Intravenous heparin

  D Low-molecular weight heparin

  E Intravenous tissue plasminogen activator (rTPA)

49. A man in his 30s is convinced that he has Lou Gehrig’s disease. Despite negative evaluations by several physicians he is still convinced that he has it. He comes to you convinced that the proper diagnosis has been missed. Your workup is negative but he remains convinced that he has the disease despite your efforts at reassurance. What is the most appropriate diagnosis?

  A Somatization disorder

  B Factitious disorder

  C Malingering

  D Hypochondriasis

  E Lou Gehrig’s disease

50. A 70-year-old woman complains of leg stiffness while ambulating and lower extremity spasms while trying to sleep. Neurologic examination reveals a markedly stiff-legged gait, with leg adduction while walking. Lower extremity tone is increased with a spastic catch. Knee jerk reflexes are hyperactive and ankle jerk reflexes elicit clonus. Romberg testing reveals sway when the patient closes her eyes. The most likely diagnosis in this case is:

  A Parkinson’s disease

  B Restless legs syndrome

  C Cervical spondylosis

  D Alcoholic cerebellar degeneration

  E Senile gait disorder

51. A patient comes to you reporting sexual difficulties. She wants to have sex but is unable to get sexually excited. She fails to develop appropriate genital swelling and lubrication for intercourse. She denies any pain during intercourse. What is the most appropriate diagnosis?

  A Sexual aversion disorder

  B Female sexual arousal disorder

  C Female orgasmic disorder

  D Vaginismus

  E Dyspareunia

52. A 60-year-old patient with hypertension complains of subacute painless visual loss of the right eye. Neurologic examination is normal apart from the blindness and a right afferent pupillary defect. A brain MRI scan reveals several periventricular white matter hyperintensities on T2 image sequencing. There are no lesions of the corpus callosum noted. The most likely diagnosis in this case is:

  A Optic neuritis

  B Temporal arteritis

  C Closed-angle glaucoma

  D Retinal vein occlusion

  E Ischemic optic neuropathy

53. Intoxication with which one of the following can cause nystagmus?

  A Heroin

  B LSD

  C Methadone

  D Nicotine

  E Phencyclidine

54. According to the American Academy of Neurology, an essential diagnostic criterion for the declaration of brain death prior to organ donation for transplantation requires:

  A A magnetic resonance imaging (MRI) scan with diffuse cortical damage

  B A positive apnea test

  C Neurologic consultation

  D Two flat or isoelectric electroencephalographs (EEGs) in 24 hours

  E Absence of deep tendon reflexes

55. When considering the cytochrome P450 system which one of the following statements is false?

  A CYP2D6 and CYP3A4 are two important enzymes psychiatrists must understand

  B Fluoxetine is a potent inhibitor of CYP2D6

  C A CYP450 inhibitor will decrease the plasma levels of a drug over time

  D Genetic polymorphisms in the CYP2D6 gene can make some patients rapid metabolizers

  E Paroxetine is a potent inhibitor of CYP2D6

56. A 47-year-old patient complains of gradual progressive weakness over the past 3–4 months, particularly in the right upper extremity. Neurologic examination demonstrates muscular atrophy of the right forearm and intrinsic muscles of the right hand. Deep tendon reflexes are brisk and plantar responses are extensor. Electrodiagnostic studies reveal widespread fasciculations, fibrillations, and positive sharp waves. This clinical picture most likely represents a diagnosis of:

  A Multiple sclerosis

  B Cervical spondylosis

  C Chronic inflammatory demyelinating polyneuropathy

  D Amyotrophic lateral sclerosis

  E Myasthenia gravis

57. Which of the following is the most likely age for a patient on neuroleptics to develop tardive dyskinesia?

  A 18 years

  B 25 years

  C 35 years

  D 45 years

  E 65 years

58. A 62-year-old patient presents with a first seizure with focal onset and secondary generalization. The most likely cause of this seizure is:

  A Subarachnoid hemorrhage

  B Glioblastoma multiforme

  C Temporal lobe epilepsy

  D Alcohol withdrawal

  E Temporal arteritis

59. Interactions with which one of the following medications will increase lamotrigine levels?

  A Oral contraceptives

  B Valproic acid

  C Carbamazepine

  D Phenytoin

  E Phenobarbital

60. Which of the following brain imaging techniques measures neuronal glucose metabolism?

  A Electroencephalography (EEG)

  B Magnetic resonance spectroscopy (MRS)

  C Single photon emission computerized tomography (SPECT)

  D Positron emission tomography (PET)

  E Functional magnetic resonance imaging (fMRI)

61. Which one of the following inhibits the abnormal involuntary movements associated with Huntington’s disease?

  A Haloperidol

  B Stereotactic thalamotomy

  C Pramipexole

  D Lioresal

  E Benztropine

62. Which one of the following disorders presents with a gait disturbance characterized by involuntary acceleration?

  A Huntington’s disease

  B Alcohol intoxication

  C Parkinson’s disease

  D Astasia–abasia

  E Guillain–Barré syndrome

63. The classic triad of symptoms present in meningitis includes fever, neck stiffness, and which of the following?

  A Tachycardia

  B Alteration of sensorium

  C Vomiting

  D Syncope

  E Headaches

64. Which one of the following is not usually seen in Guillain–Barré syndrome?

  A CSF pleocytosis

  B Elevated CSF protein

  C Areflexia

  D Motor loss with paresthesia

  E Ascending paralysis

65. Which type of intracranial hemorrhage frequently requires surgical intervention in order to improve the outcome?

  A Pontine hemorrhage

  B Thalamic hemorrhage

  C Putaminal hemorrhage

  D Temporal lobe hemorrhage

  E Cerebellar hemorrhage

66. Stiff-person syndrome, causing persistent limb rigidity and spasms, is often correlated with the presence of:

  A High titers of JC virus antigen

  B Circulating lupus anticoagulant

  C Autoantibodies against glutamic acid decarboxylase

  D Elevated methyl-malonic acid levels

  E Elevated syphilis (Treponema pallidum) titers

67. Gustatory special sensory auras localize to which area of the brain?

  A Cingulate gyrus

  B Dorsolateral prefrontal cortex

  C Occipital neocortex

  D Insular cortex

  E Parietal cortex

68. A man presents with sudden onset left neck pain, left eyelid droop, left pupillary miosis, left facial anhydrosis, right hemiparesis and expressive aphasia.The most likely cause is:

  A Left internal carotid artery dissection

  B Left vertebral artery dissection

  C Middle cerebral artery CVA

  D Posterior inferior cerebellar artery lesion.

  E Demyelination

69. A 40-year-old man presents to the ER complaining of subacute onset of daily headaches, blurred and double vision, fever, vertigo, joint pains and a feeling that his “eyeballs are popping out” of his head. On examination he has left-sided ptosis and inability to adduct and abduct the left eye fully. On primary gaze, his right eye looks straight and his left eye is slightly deviated to the left. Brain MRI reveals inflammatory changes in the cavernous sinus. The most likely diagnosis is:

  A Complicated migraine

  B Tolosa–Hunt syndrome

  C Cavernous sinus thrombosis

  D CNS lyme disease (borreliosis)

  E CNS sarcoidosis

70. Which of the following benzodiazepines is metabolized by glucuronidation?

  A Lorazepam

  B Diazepam

  C Triazolam

  D Clonazepam

  E Alprazolam

71. Which of the following is the most common side effect of selective serotonin reuptake inhibitors (SSRIs) early in treatment, leading to discontinuation by patients?

  A Sleeplessness

  B Sexual dysfunction

  C Gastrointestinal distress

  D Headache

  E Agitation/anxiety

72. Anterior capsulotomy and/or cingulotomy have been demonstrated to be effective in cases of treatment failure with which of the following severe disorders?

  A Tourette’s syndrome

  B Schizophrenia

  C Bipolar disorder

  D Antisocial personality disorder

  E Obsessive–compulsive disorder

73. A patient on lithium for bipolar disorder reports feeling slow, dull and unable to concentrate, despite an excellent response in terms of mood stability. The most likely reason for this is that the patient is:

  A Somatisizing

  B Accurately reporting side effects

  C Abusing other substances

  D Rationalizing noncompliance

  E Undervaluing normal mood

74. Which of the following choices accounts for about half of all completed suicides?

  A Schizophrenia

  B Personality disorders

  C Alcohol abuse

  D Major depression and bipolar disorder

  E Organic brain syndromes

75. Which of the following is not one of the therapist’s tasks in a group therapy setting?

  A Formulate goals

  B Decide on an open vs. closed group

  C Maintenance of a therapeutic environment

  D Choose frequency and length of group

  E Suppression of catharsis

76. Which of the following blood tests is the most important to monitor in a patient taking carbamazepine?

  A Creatinine

  B Fasting glucose

  C Complete blood count (CBC)

  D Lipid profile

  E Thyroid function tests (TSH and free T4)

77. At which of the following ages can children use a wide range of grammatical forms such as plurals, past tense, negatives and questions?

  A 5 months

  B 10 months

  C 17 months

  D 30 months

  E 40 months

78. Which of the following agents is contraindicated in patients taking clozapine?

  A Carbamazepine

  B Fluoxetine

  C Clonazepam

  D Lithium

  E Nortriptyline

79. Which one of the following cognitive enhancing agents is an NMDA receptor antagonist?

  A Galantamine

  B Donepezil

  C Rivastigmine

  D Memantine

  E Tacrine

80. Which one of the following is not a symptom of organophosphate exposure or poisoning?

  A Lacrimation

  B Salivation

  C Diarrhea

  D Vomiting

  E Mydriasis

81. Clostridium tetani causes trismus and dysphagia in those patients that acquire it by:

  A Activating glutamate receptors

  B Inhibiting GABA and glycine release in the brain and spinal cord

  C Blocking acetylcholine release at the neuromuscular junction

  D Blocking acetylcholinesterase in cholinergic synapses

  E Blocking calcium-mediated muscular contraction

82. Low-voltage, mixed frequency background with sleep spindles and K complexes are typically seen on electroencephalograms (EEGs) during which phase of sleep?

  A Stage I

  B Stage II

  C Stage III

  D Stage IV

  E REM sleep

83. In normal young adults, what percentage of total sleep time is spent in REM sleep?

  A 5%

  B 0%

  C 20%

  D 25%

  E 35%

84. Emergency room treatment of patients with MAOI-related hypertensive crisis, may involve administration of which of the following agents?

  A Diazepam

  B Hydrochlorothiazide

  C Phentolamine

  D Bromocriptine

  E Dantrolene

85. The emergency room treatment of an acute serotonin syndrome involves stopping the offending agent(s) and then:

  A Administering dantrolene

  B Hemodialysis

  C Administering bromocriptine

  D Supporting vital signs and functions

  E Administering oral or intramuscular lorazepam

86. Which of the following factors is most closely associated with child abuse and neglect?

  A Low socioeconomic status

  B Child with behavioral problems

  C Single-parent household

  D Large family size

  E Female child under 12 years of age

87. A patient is doing individual therapy in an interpersonal psychotherapy (IPT) framework for depression. In the first five sessions, the patient and therapist come to identify the patient’s unresolved grief due to the recent death of the patient’s spouse as the area of greatest concern, and this is related to the patient’s current feelings of depression. Which of the following will be the focus of the next phase in the patient’s treatment?

  A Identifying and testing the validity of the patient’s maladaptive assumptions

  B Finding new activities and relationships to offset the patient’s loss

  C Providing the patient with a corrective emotional experience in the treatment

  D Resolving guilt about conflicted feelings towards the patient’s spouse

  E Reframe the patient’s catastrophizing and fortune-telling over the spouse’s death

88. When dialectical behavioral therapy is used to treat patients with borderline personality disorder, the word “dialectical” refers to therapeutic strategies focused on:

  A Alleviating psychic tension between the id and its fantasies and the superego and its responsibilities

  B Going over traumatic events and analyzing their impact on the patient

  C Reframing cognitive distortions and finding underlying mechanisms to negative thoughts

  D Role-play that seeks to improve patient’s interpersonal relationships

  E Seeking for synthesis between seemingly contradictory ideas and emotions

89. A 35-year-old patient presents with longstanding history of orderliness and alphabetizing and color-coding of all his belongings. This behavior can take him up to 2 hours every day to accomplish and he is often late for work in the mornings due to his inability to stop this behavior. The patient denies obsessive thoughts and cannot explain the ongoing need to alphabetize, color-code and order everything. The most probable diagnosis in this case is:

  A Impulse control disorder NOS

  B Obsessive–compulsive personality disorder

  C Body dysmorphic disorder

  D Anxiety disorder NOS

  E Obsessive–compulsive disorder

90. Which one of the following would not be considered a case of pedophilia?

  A A 60-year-old elementary school teacher has clandestine sex with a 12-year-old neighbor

  B A 20-year-old female camp counselor has clandestine sex with a 17-year-old male camper

  C A 25-year old man has clandestine sex with his 13-year-old female cousin

  D A grandfather has clandestine sex with his 9-year-old granddaughter

  E A married couple, in their 30s, who are middle-school teachers at the same school, have a ménage-à-trois with an 11-year-old male student at their home

91. An 11-year-old elementary school student is given a trial of methylphenidate for ADHD, inattentive type. The dose is titrated appropriately by the psychiatrist, but the student continues to complain of the core symptoms of ADHD. The next medication to be tried should be:

  A Guanfacine

  B Clonidine

  C Bupropion

  D Dextroamphetamine

  E Venlafaxine

92. A 45-year-old woman is raped on an inner-city street late one night. She tells no one about the incident. The next day, her co-workers note that she is absent from work and a week later she is found 50 miles away in a nearby town mumbling incoherently to herself and wandering the streets. When taken to the local hospital emergency room she is initially unable to recall her name, her address, her birth date or her telephone number. This presentation is most compatible with a diagnosis of:

  A Dissociative amnesia

  B Dissociative fugue

  C Dissociative identity disorder

  D Post-traumatic stress disorder

  E Acute stress disorder

93. Which of the following categories of disorders classically has a female to male ratio of about 10 to 1?

  A Substance-abuse disorders

  B Sexual disorders

  C Eating disorders

  D Dissociative disorders

  E Personality disorders

94. The diagnosis of encopresis is seen to occur most frequently in children with which of the following in their history?

  A Sexual abuse

  B Attention deficit–hyperactivity disorder

  C Conduct disorder

  D Oppositional defiant disorder

  E Learning disorders

95. Which subtype of schizophrenia tends to present at an older age at onset and is associated with less regression in mental faculties, emotional responses and behavior than the other subtypes?

  A Undifferentiated

  B Residual

  C Catatonic

  D Disorganized

  E Paranoid

96. The impulse control disorder of chronic pathological gambling is believed to be associated with which of the following biological markers?

  A Decreased uptake in the brain on fluorodopa PET scans

  B Decreased dopamine levels in the nucleus accumbens

  C Increased serotonin and norepinephrine activity in the raphe and locus ceruleus

  D Decreased plasma MHPG levels and decreased platelet MAO activity

  E Decreased glutamate activity at NMDA receptors in the brain

97. Which one of the following is not typically associated with juvenile conduct disorder?

  A Children with history of abuse or domestic violence victimization

  B Children of underemployed parents

  C Children with onset of serious violations of rules prior to 15 years of age

  D Children with low plasma dopamine β-hydroxylase levels

  E Children with greater right frontal EEG activity at rest

98. A patient brings her daughter in for evaluation because she thinks the child may have autism. The child had normal development until 7 months of age. Since then she has decreased socializing, begun repetitive wringing hand movements, and appears psychomotor retarded. Her head circumference has not been keeping up with the growth curve according to her pediatrician. Which of the following is the most likely diagnosis?

  A Autism

  B Asperger’s disorder

  C Pervasive developmental disorder NOS

  D Childhood disintegrative disorder

  E Rett’s disorder

99. Which of the following famous psychoanalysts is responsible for the concepts of the “collective unconscious” and “archetypes”?

  A Erich Fromm

  B Kurt Goldstein

  C Edith Jacobson

  D Carl Jung

  E Otto Kernberg

100. A 5-year-old child presents with confusion, increased salivation, lacrimation, fasciculations, miosis, tachycardia and hypertension. Which of the following poisons can cause these manifestations?

  A Opium

  B Strychnine

  C Botulism

  D Hexane

  E Organophosphate insecticide

101. Which of the following benzodiazepines is phase II metabolized but not phase I metabolized?

  A Diazepam

  B Clonazepam

  C Lorazepam

  D Alprazolam

  E Triazolam

102. Which pregnancy category are benzodiazepines?

  A Category A

  B Category B

  C Category C

  D Category D

  E Category E

103. Which of the following is the most common cause of malpractice claims against psychiatrists?

  A Sexual assault

  B Improper termination

  C Suicide or attempted suicide

  D Boundary violations

  E Medication error

104. Which of the following is the most appropriate treatment for premature ejaculation?

  A SSRIs

  B Yohimbine

  C Testosterone

  D Alprostadil

  E Sildenafil

105. Which of the following disorders is not more common in males?

  A Autism

  B Obsessive–compulsive disorder

  C Attention deficit–hyperactivity disorder

  D Exhibitionism

  E Pathological gambling

106. For a socially harmful act to be considered a crime it must contain which of the following?

  A Parens patriae

  B Mens rea

  C Respondeat superior

  D Substituted judgment

  E Justice

107. A patient with severe panic disorder comes to you for help. Which of the following is the most effective treatment you can offer her?

  A Psychodynamic psychotherapy

  B An SSRI

  C Cognitive behavioral therapy

  D A tricyclic antidepressant

  E Cognitive behavioral therapy plus an SSRI

108. Which of the following is not a common comorbidity associated with social phobia?

  A Drug abuse

  B Conversion disorder

  C Alcohol abuse

  D Other anxiety disorders

  E Major depressive disorder

109. You start a patient in your practice on an SSRI for treatment of panic disorder. Which of the following medications can you add that will be effective, FDA-approved for panic disorder, and lead to a more rapid response?

  A Buspirone

  B Gabapentin

  C Propranolol

  D Topiramate

  E Clonazepam

110. An elderly bipolar patient is brought into the emergency room. He was found comatose at home by his son. His serum sodium is 115 mmol/L. Which of the following medications is the most likely cause of his sodium imbalance?

  A Lithium

  B Olanzapine

  C Carbamazepine

  D Quetiapine

  E Topiramate

111. Which of the following is not part of the recommended monitoring for patients taking risperidone?

  A Weight

  B Blood pressure

  C Glucose

  D Thyroid function tests

  E Lipid profile

112. A psychotherapist you work with recently lost his teenage daughter in a car accident. He proceeded to tell all of his patients about this recent loss. This revelation to his patients is problematic because;

  A He should not reveal personal information to a patient

  B The only personal information he can reveal is his educational history

  C Openly sharing his grief will help his patients to understand him

  D It is driven by his personal needs rather than the needs of the patient

  E He should only reveal this information to patients who have also lost children

113. Which of the following statistical measures would be used to quantify the degree of agreement between two raters in a study?

  A Point prevalence

  B Period prevalence

  C Lifetime prevalence

  D Kappa

  E Correlation coefficient

114. A female therapist is doing psychodynamic psychotherapy with a 29-year-old woman. She has been discussing issues surrounding her marriage and her relationship with her mother, who was distant emotionally when the patient was growing up. The patient becomes angry with the therapist when she requests therapy sessions three times per week and the therapist states that she cannot accommodate that with her schedule. She accuses the therapist of disliking her. This is an example of which of the following?

  A Rejection by the therapist

  B Delusion of an erotomanic nature

  C Transference on the part of the patient

  D A precursor to stalking by the patient

  E Displacement of anger onto the therapist

115. Which of the following is not an indication for neurological imaging in a psychiatric patient?

  A New onset psychosis

  B Acute mental status change with neurological abnormalities

  C Delirium of unknown etiology

  D Acute mental status change in a 65 year old patient

  E Mania

116. Which of the following types of therapy is considered the “gold standard” for treatment of obsessive–compulsive disorder?

  A Exposure with response prevention

  B Motivational enhancement therapy

  C Dialectical behavior therapy

  D Dynamic psychotherapy

  E Psychoanalysis

117. A 35-year-old woman with bipolar disorder gives birth to a child with an abnormally formed tricuspid valve. Which of the following medications was she most likely taking?

  A Haloperidol

  B Lithium

  C Valproic acid

  D Lamotrigine

  E Carbamazepine

118. Which of the following is not one of the psychological issues of pregnancy?

  A Pregnancy as a means of self-realization

  B Fear of inadequate mothering

  C Projection of hope onto the child to be

  D Absence of desire for sexual activity

  E Unconscious ambivalence about the effect on the dyadic relationship

119. The son of a 95-year-old woman with severe dementia asks that his mother be deemed incompetent. This decision must be made by:

  A The son

  B The psychiatrist

  C The internist

  D The hospital administrator

  E The court

120. In which of the following tests is a patient presented with geometric figures for about 10 seconds then asked to draw them from memory?

  A Benton Visual retention test

  B Weschler memory scale

  C Bender visual motor gestalt test

  D Wisconsin card sorting test

  E Mini mental status exam

121. Which of the following defense mechanisms is considered immature?

  A Anticipation

  B Schizoid fantasy

  C Altruism

  D Humor

  E Suppression

122. Lithium has been associated with which one of the following?

  A Neutropenia

  B Hyperparathyroidism

  C Pancreatitis

  D Hepatic failure

  E Eosinophilic colitis

123. You are screening Thomas for brief psychodynamic psychotherapy. Which of the following is a sign that he is an appropriate candidate?

  A He sticks his hand down his pants and smears feces on your office chair

  B He is fighting with both of his parents

  C He takes sertraline every day

  D He has one friend who he talks to twice per year

  E He is able to identify and discuss his feelings

124. Which of the following is most associated with object relations theory?

  A Melanie Klein

  B Carl Jung

  C Jean Baker Miller

  D Anna Freud

  E Sigmund Freud

125. Joe Lehobo is a cachectic crack addict. Dr. Medpusher wants to convince Joe to stop using crack, but Joe is ambivalent and denies that crack use is a problem for him. How should Dr. Medpusher proceed?

  A Prescribe fluoxetine

  B Dialectical behavior therapy

  C Motivational enhancement therapy

  D Electroconvulsive therapy

  E Involuntary hospitalization

126. Jim is a pediatrician in a local hospital. He is trying to raise money to build a new treatment center for children with developmental disabilities. He asks you to solicit your patients for contributions. You should agree to solicit funds from:

  A Only former patients

  B No patients

  C Only wealthy patients because this is a good cause and they have money to give

  D Only patients with intact reality testing

  E Elderly patients who can leave a donation to the hospital in their will

127. An explanatory statement that links a feeling to its unconscious meaning is known as:

  A Confrontation

  B Clarification

  C Interpretation

  D Empathic validation

  E Affirmation

128. A psychiatrist routinely receives free dinners, play tickets, and short trips from a pharmaceutical representative. Which of the following statements concerning this situation is correct?

  A There is no evidence that gifts influence physicians behavior

  B This situation represents a conflict of interest for the psychiatrist

  C This situation is ethical if no single gift is worth more than $500

  D Self-regulation by physicians is the most effective way to deal with this issue

  E Whereas doctors are not influenced by this behavior, support staff such as nurses, physicians assistants and secretaries are

129. You have to interview a patient using an interpreter. Which of the following is the best way to proceed?

  A Speak in English but very loudly

  B Look at the patient while speaking

  C Look at the interpreter while speaking

  D Address all questions to the interpreter and let her ask the patient.

  E Make sure you not only have an interpreter but also the patient’s family in the room so that they can all translate

130. In which of the following theories does human development move through predetermined steps and stages wherein each stage has its own characteristics and needs that must be negotiated before moving forward?

  A Levinson’s developmental theory

  B The epigenetic view of development

  C Vaillant theory of happy childhood

  D Neurodevelopmental theory

  E Normality as process

131. Which of the following tests is not considered routine monitoring for patients taking lithium?

  A Complete blood count

  B Serum electrolytes

  C 24-hour urine for creatinine and protein

  D Blood urea nitrogen and creatinine

  E Thyroid function tests

132. A patient has a panic attack and then worries significantly about having more attacks. How long must he worry to meet DSM criteria for panic disorder?

  A 1 week

  B 2 weeks

  C 1 month

  D 3 months

  E 6 months

133. Your patient’s mother dies. Shortly thereafter she begins to show signs of depression. How much time must pass following her mother’s death before she can be diagnosed with major depressive disorder?

  A 6 months

  B 3 months

  C 2 months

  D 1 month

  E 2 weeks

134. Which of the following drugs is known for a severe hyperthermic syndrome that can progress to disseminated intravascular coagulation, rhabdomyolysis, liver and kidney failure, as well as death?

  A Heroin

  B Gamma-hydroxybutyrate

  C Flunitrazepam

  D Methylenedioxymethamphetamine

  E Ketamine

135. Giving a patient CBT plus an SSRI for social anxiety disorder will most likely result in which of the following?

  A Better results than an SSRI alone

  B Better results than CBT alone

  C Poor results for refractory cases

  D No initial benefit over monotherapy with either an SSRI or CBT in most cases

  E Poorer response than psychodynamic psychotherapy alone

136. Which of the following is least likely to cause weight gain?

  A Clozapine

  B Olanzapine

  C Valproic acid

  D Lamotrigine

  E Lithium

137. Which of the following is not a component of skills training for patients with addictions?

  A Changing beliefs

  B Stress management techniques

  C Increasing assertiveness

  D Examining unconscious symbolism behind fears

  E Improving interpersonal communication

138. Which of the following is considered incorrect concerning seclusion and restraint?

  A Seclusion and restraint are considered ethical when no less restrictive alternative is available

  B A nurse observing a seclusion may extend the seclusion time if she feels the patient is still agitated

  C A written order from an M.D. is needed to seclude a patient

  D Seclusion orders are time limited

  E The patient’s condition while in seclusion should be regularly reviewed and documented

139. Which of the following daily methadone doses is the best to block cravings and result in reduction of subsequent drug use for the average patient?

  A 10 mg

  B 20 mg

  C 40 mg

  D 80 mg

  E 100 mg

140. A homeless man comes to your emergency room with a long history of alcohol use. He has been living in a local park and prostituting himself to other men for money to buy alcohol. Because the weather has been warm he has been bathing in local ponds and streams. He has been drinking excessively lately and requests detoxification. You must decide whether to send him to inpatient or outpatient detoxification. Which of the following factors will affect your decision most?

  A Length of time living in the park

  B Condom use

  C Social supports

  D Source of alcohol

  E History of delirium tremens

141. A 23-year-old male with severe obsessions, compulsions and tics comes to you for evaluation. Which of the following would be the best medication combination for this patient?

  A Citalopram plus lorazepam

  B Paroxetine plus buspirone

  C Sertraline plus naltrexone

  D Fluoxetine plus alprazolam

  E Fluvoxamine plus haloperidol

142. Which of the following choices does not present with psychotic symptoms?

  A Major depressive disorder

  B Hypomanic episodes

  C Delirium

  D Bipolar mixed episodes

  E Manic episodes

143. A patient comes to you and reports recurrent hypomanic episodes but denies any depressive symptoms. What is her diagnosis?

  A Bipolar I disorder

  B Bipolar II disorder

  C Cyclothymic disorder

  D Substance induced mood disorder

  E Bipolar disorder NOS

144. Which of the following medical conditions can present with panic attacks, elevated blood pressure, flushing and tremulousness?

  A Crohn’s disease

  B Raynaud’s phenomenon

  C Hypothyroidism

  D Hyperparathyroidism

  E Pheochromocytoma

145. Which of the following could be expected for a patient with social phobia as compared to the general population?

  A Increased number of friendships

  B Higher level of education

  C Lower rates of suicide

  D Poorer marital function

  E Increased success in career advancement

146. Regularly scheduled primary care appointments are a crucial and standard part of treating which one of the following diagnoses?

  A Panic disorder

  B Major depressive disorder

  C Hypochondriasis

  D Post-traumatic stress disorder

  E Delusional disorder somatic type

147. Which of the following factors does not increase the chances that an elderly patient will commit suicide?

  A Alcohol dependence

  B Widowed

  C Good physical health

  D Unemployed

  E Socially isolated

148. You have a patient on clozapine who develops a WBC count between 2000 and 3000. What is your next step in management?

  A Continue clozapine and repeat WBC/ANC

  B Stop clozapine. You may re-challenge if WBC count increases in future

  C Continue clozapine. Draw twice-weekly WBC/ANC

  D Continue clozapine. Draw weekly WBC/ANC for the next 4 weeks

  E Stop clozapine. You may not re-challenge this patient in future

149. Prolongation of the QTc interval above which of the following is an indication to stop a QTc-prolonging neuroleptic?

  A 100 milliseconds

  B 200 milliseconds

  C 300 milliseconds

  D 400 milliseconds

  E 500 milliseconds

150. You are doing a shift in the emergency room and a patient comes in complaining of depressed mood. On further questioning you discover that he is also suffering from fatigue and cognitive inefficiency. He provides you with a list of medications prescribed by his primary care physician. Of the following medications, which one could be responsible for exacerbating the patient’s symptoms?

  A Interferon

  B Ranitidine

  C Verapamil

  D Modafinil

  E Amoxicillin