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

Test Number Two

1. Which one of the following is false?

  A Carl Jung focused on the growth of the personality and individuation

  B Harry Stack Sullivan saw human development as a function of social interaction

  C Erik Erikson developed a model of the life cycle that spanned from childhood to old age

  D Jean Piaget developed a theory of cognitive development

  E The work of Freud, Jung and Erikson was a function of carefully crafted psychological and neurodevelopmental studies

2. A 75-year-old woman presents to the emergency room with an acute onset of right hemisensory loss, mild right hemiparesis and a right-sided Babinski sign. On mental status examination, you note that she cannot repeat simple phrases, she can follow simple task instructions both verbal and on paper, she cannot write well, and she is having word-finding difficulties with multiple paraphasic errors. This clinical picture is consistent with a:

  A Broca’s aphasia

  B Wernicke’s aphasia

  C Transcortical sensory aphasia

  D Conduction aphasia

  E Transcortical motor aphasia

3. Which one of the following statements is not true regarding receptors?

  A Seven-transmembrane domain receptors require G proteins to open ion channels

  B In the ligand-gated ion channel receptor, the channel is built into the complex that binds the ligand

  C Seven-transmembrane domain receptors have an external NH2 terminal end and an intracellular COOH terminal end

  D Nerve growth factor (NGF) and brain-derived neurotropic factor (BDNF) bind to seven-transmembrane domain receptors

  E Hormones may diffuse into the cell and bind cytoplasmic receptors, which leads to influence over gene expression

4. Correcting hyponatremia too rapidly with hypertonic saline replacement can result in:

  A Guillain–Barré syndrome

  B Acute thalamic hemorrhage

  C Acute demyelinating encephalomyelitis (ADEM)

  D Acute cerebellar syndrome

  E Acute locked-in syndrome

5. A patient comes into your office and explains away why he beat his brother with a baseball bat. He gives several examples of how his brother had mistreated him in the past and says that if he had not gotten this beating the mistreatment would have continued. Which of the following defenses does this represent?

  A Projection

  B Blocking

  C Externalization

  D Rationalization

  E Denial

6. A 34-year-old obese African-American woman presents to the emergency room with a complaint of 6 weeks of intermittent bifrontal headache and vague visual obscurations. She is on oral contraceptive medication and has a history of being on tetracycline therapy for a recent sexually transmitted disease. The immediate diagnostic test of choice in the emergency room is:

  A Noncontrast head CT scan

  B Lumbar puncture with cerebrospinal fluid opening pressure

  C Brain MRI without gadolinium

  D Serum sedimentation rate (ESR)

  E Serum prolactin level

7. Which of the following organizations is made up of family members of the mentally ill?

  A American Association for Mental Health

  B National Mental Health Assembly

  C National Alliance for the Mentally Ill

  D Council for Mental Health Reform

  E Association for the Advancement of Psychotherapy

8. Which one of the following is not a diagnostic criterion of migraine without aura?

  A Headache must last 4 to 72 hours

  B Pulsatile quality

  C Photophobia

  D Nausea and vomiting

  E Mild to moderate intensity

9. What is the lifetime prevalence of schizophrenia?

  A 10%

  B 5%

  C 1%

  D 0.5%

  E 0.1%

10. Which one of the following is not a contraindication to the use of recombinant tissue plasminogen activator (r-TPA) in acute ischemic stroke?

  A Stroke occurrence 2 hours prior to r-TPA administration

  B Major surgery within 2 weeks of r-TPA administration

  C Uncontrolled hypertension

  D Prothrombin time > 15

  E Thrombocytopenia

11. Which of the following is based on active outreach to patients in the community?

  A Traditional social work

  B Assertive community treatment

  C Day hospitals

  D Psychiatric rehabilitation

  E Electroconvulsive therapy

12. A 45-year-old woman presents to your office complaining of longstanding lower extremity discomfort, particularly at night prior to sleep onset. She reports shooting pains in the lower extremities that are relieved upon standing or walking. The discomfort is described as a “crawling” sensation. The treatment of choice for her condition is:

  A Sertraline

  B Cyproheptadine

  C Ropinirole

  D Levetiracetam

  E Ziprasidone

13. Which of the following is the best diagnostic procedure to determine if a 12-year-old boy is depressed?

  A MMPI

  B Scholastic achievement test

  C Dexamethasone suppression test

  D Face to face interview with the child

  E Interview the child’s teacher by phone

14. A 65-year-old man presents to the emergency room with acute onset of vertigo, nausea, vomiting, dysarthria and nystagmus. On further examination, he is noted to have loss of pain and temperature sensation to the left-hand side of his face. He has right-sided loss of pain and temperature sensation to his trunk and leg. He has a left Horner’s syndrome and falls to his left-hand side when you ask him to walk, and has left finger-to-nose dysmetria. You diagnose an acute stroke which is most likely localized to the:

  A Left hemisphere

  B Left lateral medulla

  C Left pons

  D Right pons

  E Right lateral medulla

15. Which of the following is associated with violence and aggression?

  A Blunted response to CRH stimulation test

  B Blunted growth hormone response to hypoglycemia

  C Decreased 5-HIAA in the CSF

  D Decreased dopamine in the CSF

  E Increased levels of norepinephrine in the CSF

16. Metachromatic leukodystrophy is inherited by _____ pattern of inheritance and results in a deficiency in _____:

  A Autosomal recessive; hexosaminidase A

  B Autosomal dominant; hexosaminidase A

  C Autosomal dominant; arylsulfatase A

  D Autosomal recessive; arylsulfatase A

  E Autosomal recessive; galactocerebroside β-galactosidase

17. Which one of the following is not true with respect to seasonal affective disorders (SAD)?

  A Patients are likely to respond well to light therapy

  B The “with seasonal pattern” specifier can be applied to bipolar I, bipolar II, and major depressive disorders according to the DSM-IV

  C It is not necessary to have full remissions of symptoms at other times of the year to make this diagnosis

  D SAD involves a regular temporal relationship between the onset of symptoms and the time of year

  E You must demonstrate at least two depressive episodes at the same time of year to make the diagnosis

18. Which one of the following primitive reflexes is not generally expected to disappear by about 6 months of age?

  A Rooting

  B Moro

  C Palmar grasp

  D Parachute response

  E Tonic neck reflex

19. Which of the following would fall under the heading of somatoform disorder NOS?

  A A patient with pain in one or more areas that is thought to be significantly mediated by psychological factors

  B A patient with a persistent belief that she has cancer despite reassurance by her physician that nothing is wrong

  C A patient who develops a motor deficit following significant psychological stressors

  D A patient who feels that she is pregnant and presents with amenorrhea, enlarged abdomen, and breast engorgement, but a negative pregnancy test

  E A patient with medical complaints involving pain, GI complaints, neurological complaints, and sexual complaints. No medical explanation can be found for these symptoms

20. An AIDS patient presents with decreased visual acuity. The most likely offending infectious agent responsible for this presentation is:

  A Cytomegalovirus

  B Toxoplasmosis

  C Tuberculosis (Mycobacterium)

  D Cryptococcus neoformans

  E JC virus

21. Which one of the following is not true regarding schizophrenia?

  A The disorder is chronic and usually has a prodromal phase

  B Eugen Bleuler coined the term schizophrenia

  C The patient’s overall functioning declines or fails to reach the expected level

  D The most frequent hallucinations are olfactory

  E Social withdrawal and emotional disengagement are common

22. Which one of the following is not seen in narcolepsy?

  A Cataplexy

  B Nighttime awakening

  C Excessive daytime sleepiness

  D Sleep paralysis

  E Hypnagogic hallucinations

23. Uncontrollable excessive talking, as seen in mania is also known as:

  A Alexithymia

  B Logorrhea

  C Echolalia

  D Flight of ideas

  E Stilted speech

24. Which one of the following is not an appropriate therapy for status epilepticus?

  A Rectal diazepam

  B Intravenous lorazepam

  C Intramuscular phenytoin

  D Intravenous valproic acid

  E Oxygen by nasal cannula with airway protection

25. Which one of the following statements is true regarding atypical antipsychotics?

  A Ziprasidone is an agonist at the 5-HT-1A receptor, and an inhibitor of reuptake of both serotonin and norepinephrine

  B Risperidone is a significantly weaker antagonist of D2 than haloperidol

  C Quetiapine is known for its high incidence of extrapyramidal symptoms

  D Olanzapine has been associated with weight loss in the majority of patients

  E Clozapine has been shown to increase suicidality in chronically ill patients

26. Which of the following anticonvulsant agents is most appropriate for primary generalized seizures including tonic–clonic, absence, atonic and myoclonic seizure types?

  A Divalproex sodium

  B Phenytoin

  C Oxcarbazepine

  D Carbamazepine

  E Ethosuximide

27. Which of the following is not a side effect of the tricyclic antidepressants?

  A Tachycardia

  B Prolonged PR interval

  C Prolonged QRS interval

  D Orthostatic hypotension

  E Diarrhea

28. The L5 motor nerve root innervates the nerves responsible for:

  A Foot extension

  B Foot flexion

  C Leg extension

  D Hip flexion

  E The ankle jerk reflex

29. Which one of the following antidepressants can be used as an antipruritic agent and for the treatment of gastric ulcer because of its potent histamine blockade?

  A Trazodone

  B Fluoxetine

  C Citalopram

  D Amitriptyline

  E Amoxapine

30. A patient involved in a car accident is found on MRI to have a spinal fracture and a partial crush lesion to the cervical spinal cord that effectively causes a functional hemisection of the cord. His deficits would be expected to include:

  A Contralateral loss of motor control and pain and temperature sensation with ipsilateral loss of proprioception and vibration sensation

  B Ipsilateral loss of motor control and pain and temperature sensation with contralateral loss of proprioception and vibration sensation

  C Ipsilateral loss of motor control and proprioception and vibration sensation with contralateral loss of pain and temperature sensation

  D Contralateral loss of motor control and proprioception and vibration sensation with ipsilateral loss of pain and temperature sensation

  E Ipsilateral loss of motor control and contralateral loss of proprioception, vibration, pain and temperature sensations

31. A child is able to use some symbols and language. Her reasoning is intuitive. She is unable to think logically or deductively. Which of Piaget’s stages does this child fit into?

  A Sensorimotor

  B Preoperational thought

  C Concrete operations

  D Formal operations

  E Trust vs mistrust

32. A 72-year-old man suffers a stroke with loss of motor functioning in the left leg and, to a lesser extent, the left arm. He has abulia and his eyes and head seem preferentially deviated to the right. His left arm is apraxic. His head CT is shown below. The arterial territory involved is that of the:

  A Right middle cerebral artery

  B Right posterior cerebral artery

  C Right vertebral artery

  D Right anterior cerebral artery

  E Right posterior communicating artery

image

33. Which of the following is true regarding norepinephrine (NE) and/or the locus ceruleus?

  A Norepinephrine is synthesized in the locus ceruleus

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

  C Acetylcholine is synthesized with NE in the substantia nigra

  D 5-HT is synthesized in the locus ceruleus

  E The locus ceruleus is the site of the formation of serotonin

34. Pure motor hemiparesis is most likely to result from a stroke localized to the:

  A Midbrain

  B Cerebellum

  C Medulla

  D Thalamus

  E Internal capsule

35. Which one of the following receptor types is associated with weight gain and sedation?

  A 5-HT-2A

  B Alpha 1

  C 5-HT-1A

  D H1

  E M1

36. The lesion causing a left-arm hemiballismus would most likely localize to the:

  A Right subthalamic nucleus

  B Left subthalamic nucleus

  C Right putamen

  D Left putamen

  E Right globus pallidus interna

37. Which of the following is not a biogenic amine neurotransmitter?

  A Dopamine

  B GABA

  C Epinephrine

  D Acetylcholine

  E Serotonin

38. The mechanism of action by which reserpine both improves the symptoms of adult-onset primary focal dystonia and can cause depression is:

  A Direct postsynaptic dopamine antagonism

  B Direct postsynaptic serotonin agonism

  C Direct postsynaptic serotonin antagonism

  D Presynaptic dopaminergic depletion

  E Direct postsynaptic cholinergic antagonism

39. In the psychotic patient, the defense mechanism of projection takes the form of:

  A Feelings of persecution

  B Feelings of abandonment

  C Feelings of sadness

  D Feelings of gratification

  E Feelings of isolation

40. The drainage of cerebrospinal fluid into the blood is a function of the:

  A Choroid plexus

  B Virchow–Robin spaces

  C Dural mitochondria

  D Ventricular ependymal cells

  E Arachnoid granulations

41. Which one of the following is a method of making a prediction in order to compare the value of one variable to another?

  A Probability

  B Point prevalence

  C Incidence

  D Regression analysis

  E Kappa

42. A 72-year-old woman with a history of smoking, diabetes, hypertension, hyperlipidemia and myocardial infarction presents to your emergency room by ambulance with an acute onset of obtundation with dense right hemiplegia, right hemisensory loss to light touch, pain and temperature, and mutism. You suspect a left lobar hemorrhage because of the acuity of onset of her symptoms and a blood pressure reading of 210/100 mmHg in the emergency room. Once stabilized, the best immediate diagnostic test of choice from the emergency room would be:

  A Lumbar puncture with opening pressure and CSF assay for xanthochromia

  B Brain MRI scan without gadolinium

  C Blood work for coagulation panel (PT, PTT, INR)

  D Noncontrast head CT scan

  E Routine bedside electroencephalogram (EEG)

43. Which one of the following is most closely associated with prognostic outcome in psychodynamic therapy?

  A Length of training

  B Neutrality of the therapist

  C Age of the therapist

  D Gender of the therapist

  E Empathy and warmth

44. Melatonin is a neuronal hormone that promotes sleep and is produced in the brain by the:

  A Pineal gland

  B Anterior pituitary gland

  C Posterior pituitary gland

  D Hypothalamus

  E Thalamus

45. Which one of the following is an objective psychological test?

  A Rorschach

  B Sentence completion test

  C Thematic apperception test

  D MMPI

  E Draw a person test

46. Subacute sclerosing panencephalitis is a rare late complication of which one of the following organisms:

  A Measles virus

  B Herpes simplex virus

  C Epstein–Barr virus

  D Mumps virus

  E JC virus

47. Which one of the following does not describe a patient with ADHD?

  A The patient fails to follow through on instructions and fails to finish schoolwork

  B The patient often fidgets with hands or feet or squirms in his seat

  C The patient often has difficulty awaiting his turn

  D The patient often seems not to listen when spoken to directly

  E The patient shows impairment from symptoms at school but not at home

48. A 13-year-old boy is brought to the emergency room from a group home because of acute agitation. On examination you note choreoathetotic movements, hyperreflexia, acute agitation, self-scratching and mutilating behavior, and a marked cognitive impairment. You peruse the group home chart and note that this young boy has an enzymatic deficiency in hypoxanthine-guanine phosphoribosyltransferase. Your keen memory brings you back to your pediatrics rotation in medical school and you realize the diagnosis is:

  A Tay–Sachs disease

  B Metachromatic leukodystrophy

  C Krabbe disease

  D Gaucher’s disease

  E Lesch–Nyhan syndrome

49. Which one of the following is not a DSM IV-TR criterion for schizophrenia?

  A Delusions

  B Presence of active phase symptoms for 6 months

  C Hallucinations

  D Disorganized speech

  E Grossly disorganized or catatonic behavior

50. Botulinum toxin type A is not the treatment of choice for which one of the following disorders?

  A Hemifacial spasm

  B Blepharospasm

  C Cervical dystonia

  D Restless legs syndrome

  E Limb spasticity related to multiple sclerosis

51. A patient presents with a delusion about being poisoned that has been present for 5 months. The patient has no hallucinations or other psychotic symptoms. There has been no major impact on the patient’s daily functioning. The patient has no mood symptoms. The most likely diagnosis is:

  A Dementia

  B Schizophrenia

  C Schizoaffective disorder, bipolar type

  D Delusional disorder

  E Brief psychotic disorder

52. A young woman presents to the emergency room with a complaint of a band-like, bifrontal, squeezing headache that began six hours earlier. She denies nausea, vomiting, or any other associated symptoms. She describes the pain as waxing-and-waning in intensity throughout the six-hour period. Physical examination is unremarkable. She reports suffering from similar attacks in the past. The most likely diagnosis is:

  A Tension-type headache

  B Migraine without aura

  C Migraine with aura

  D Paroxysmal hemicrania

  E Basilar migraine

53. Which one of the following is not consistent with a major depressive episode?

  A Anhedonia

  B Withdrawal from social situations

  C Low frustration tolerance

  D Weight loss

  E Increased libido

54. The generator of migraine headache is thought to be the:

  A Reticular activating system

  B Trigeminal nucleus caudalis

  C Dural and intracerebral blood vessels

  D Suprachiasmatic nucleus

  E Contraction of scalp and cranial muscles

55. A patient comes to your clinic with complaint of hypersomnia, hyperphagia, psychomotor slowing, and depressed mood. He states that this happens yearly usually around October or November. The treatment plan for this man should include:

  A Risperidone

  B Naloxone

  C Exposure to bright artificial light for 2–6 hours per day.

  D Flooding

  E Alprazolam

56. What is the mechanism of action of carbidopa in the combination agent carbidopa–levodopa that is used for the treatment of Parkinson’s disease?

  A Postsynaptic dopamine receptor agonism

  B Monoamine oxidase type B inhibition

  C Dopa decarboxylase inhibition

  D Catechol-O-methyltransferase inhibition

  E Acetylcholine receptor antagonism

57. A young woman presents to the emergency room with complaints of palpitations, sweating, shortness of breath, chest pain and nausea. She thinks that she is having a heart attack. EKG reveals normal sinus rhythm with no ischemic changes. Cardiac enzymes are not elevated. Given her symptoms, an alternative diagnosis would be:

  A Manic episode

  B Myxedema madness

  C Mad Hatter’s syndrome

  D Psychotic disorder NOS

  E Panic attack

58. The phenomenon of apoptosis refers to:

  A Neuronal migration

  B Neuronal maturation

  C Neurogenesis

  D Neuronal myelination

  E Neuronal programmed cell death

59. Which of the following is not a tricyclic antidepressant?

  A Amitriptyline

  B Amoxapine

  C Doxepin

  D Desipramine

  E Nortriptyline

60. A 2-year-old toddler is brought to the emergency room because of seizures, hemiparesis and apparent blindness. You immediately notice a marked reddish discoloration of the left side of the forehead and face. The parents tell you that their child has not met appropriate developmental milestones. Your most likely diagnosis is:

  A Tuberous sclerosis

  B Sturge–Weber syndrome

  C Von Hippel–Lindau disease

  D Ataxia–telangiectasia

  E Fabry’s disease

61. How is a doctor who agrees to take Medicare paid?

  A He agrees to take only what Medicare pays for the service

  B He is allowed to bill the patient for the difference between what Medicare pays and what he charges

  C He is paid by a third party to make up the difference between his fee for service rate and the fee allowed by Medicare

  D He can sue the government if his full fee is not paid

  E He is not allowed to charge copays

62. The pain syndrome known as reflex sympathetic dystrophy does not involve which one of the following characteristics?

  A Hypersensitivity to painful stimuli

  B Myofascial trigger points

  C Cyanosis of the extremities

  D Sweating and shiny skin

  E Warm or hot skin on the extremities

63. The police bring an acutely paranoid patient into the Emergency Room who was found wandering the streets. In your initial approach to this patient you should first:

  A Sedate the patient with haloperidol and lorazepam

  B Assess the dangerousness of the patient to self or others

  C Obtain an EKG

  D Contact the patient’s family if possible

  E Obtain any old charts from medical records

64. Carbamazepine will not lower the levels or the efficacy of which one of the following agents?

  A Warfarin

  B Clozapine

  C Alprazolam

  D Propranolol

  E Citalopram

65. Which one of the following is false concerning the right to die and surrogate decision making?

  A Patients that believe that continuing treatment would lessen their quality of life have the right to demand that treatment be withheld or withdrawn

  B Advanced directives or a living will are a way for patients to express their preferences before anything happens that would cause them to lose capacity

  C If a patient leaves no clear instructions, the state will carry out a course of action to protect and preserve human life

  D Surrogate decision makers can be appointed by the patient, or the courts

  E The standard of substituted judgment means that the surrogate will do whatever is in the patient’s best interests

66. Patients who smoke tobacco heavily can markedly reduce levels of psychotropic medications they are taking. Which one of the following medications is not affected by tobacco smoking in this way?

  A Clozapine

  B Olanzapine

  C Haloperidol

  D Risperidone

  E Amitriptyline

67. A consultation-liaison psychiatrist is called to evaluate a patient who is in denial of a major illness. The most important obligation of the psychiatrist at the first evaluation is to:

  A Confront the denial forcefully

  B Tell the staff to “play along” with the patient’s denial

  C Obtain neuropsychological testing

  D Meet with the patient’s family

  E Make sure the patient has been informed about the illness and treatment

68. A 38-year-old delivers twins by uncomplicated cesarean section at 37 weeks. The pregnancy, her first, was unremarkable. On day three following her delivery, she experiences an acute onset of what she describes as the worst headache of her life. The neurologist is called and discovers that she has a notable bitemporal hemianopsia, neck stiffness, a positive Kernig’s sign, persistent hypotension and a right third nerve palsy. The most likely diagnosis is:

  A Sheehan’s syndrome

  B Cushing’s disease

  C Subarachnoid hemorrhage

  D Acute bacterial meningitis

  E Familial hemiplegic migraine

69. A patient describes feeling anxious about being in places or situations from which escape may be difficult or in which help may not be available should the patient begin to panic. The patient avoids various situations because of these fears. The term that best describes this patient’s symptoms is:

  A Agonothete

  B Agoniada

  C Agoraphobia

  D Agora

  E Agouara

70. Normal-pressure hydrocephalus presents as the triad of:

  A Dementia, parkinsonism, and visual hallucinations

  B Dementia, ophthalmoplegia, and ataxia

  C Dementia, incontinence, and gait disturbance

  D Chorea, irritability, and obsessive–compulsive traits

  E Dementia, axial rigidity, and vertical ophthalmoplegia

71. Which one of the following is not true concerning cyclothymic disorder?

  A It is similar to bipolar disorder, but less severe

  B Symptoms must be present for at least 2 years

  C It is equally common in men and women

  D Substance abuse is common in patients with cyclothymia

  E There are often psychotic symptoms found in patients with cyclothymia

72. Which one of the following is not a potential risk factor for ischemic stroke?

  A Prior cardiac disease

  B Depression

  C Gender

  D Family history

  E Obesity

73. A patient enters your office. She is agitated, acts seductively, wears colorful clothes that are bizarre in appearance, has an excessive amount of makeup on, and vacillates between being entertaining, hyperexcited, and threatening. Based on this information, her most likely diagnosis is:

  A Major depressive disorder

  B Brief psychotic disorder

  C Body dysmorphic disorder

  D Bipolar disorder

  E Delusional disorder

74. Which one of the following symptoms is not suggestive of a carotid territory transient ischemic attack or stroke?

  A Ataxia with vertigo

  B Aphasia

  C Ipsilateral monocular blindness

  D Contralateral body weakness

  E Contralateral homonymous visual field defects

75. Which of the following is not commonly part of the thought process of the manic bipolar patient?

  A Flight of ideas

  B Clang associations

  C Racing thoughts

  D Tangentiality

  E Suicidal ideation

76. Which one of the following agents is not potentially useful for the treatment of essential tremor?

  A Lorazepam

  B Primidone

  C Propranolol

  D Desipramine

  E Botulinum toxin type A

77. To meet criteria for a major depressive disorder, a patient must have symptoms for:

  A 1 week

  B 2 weeks

  C 1 month

  D 2 months

  E 6 weeks

78. Which one of the following tumors is associated with myasthenia gravis?

  A Thyroid carcinoma

  B Thymoma

  C Glioblastoma multiforme

  D Breast papilloma

  E Non-Hodgkin’s lymphoma

79. Which one of the following is not true regarding schizophrenia?

  A Lifetime prevalence is about 1%

  B Prevalence is greater in rural than in urban areas

  C The male-to-female ratio is 1:1

  D Onset is rare before age 10 years or after age 40 years

  E There is a higher incidence of the disease in babies born in winter and early spring

80. Which one of the following genetically inherited neurological disorders is not acquired by autosomal dominant heredity?

  A Friedrich’s ataxia

  B Myotonic dystrophy

  C Tuberous sclerosis

  D Huntington’s disease

  E Neurofibromatosis

81. Which one of the following is not a characteristic of a major depressive episode?

  A Constipation

  B Dry mouth

  C Headache

  D Disinhibited behavior

  E Early morning awakening

82. Migraine is most likely a hereditary disorder that maps to which chromosome:

  A Chromosome 14

  B Chromosome 15

  C Chromosome 17

  D Chromosome 18

  E Chromosome 19

83. Which one of the following would be listed under thought content in the mental status exam?

  A Obsessions

  B Word salad

  C Flight of ideas

  D Circumstantiality

  E Tangentiality

84. CNS cysticercosis is caused by brain parenchymal invasion by which one of the following organisms:

  A Leishmania major

  B Taenia solium

  C Toxoplasma gondii

  D Echinococcus granulosus

  E Trichinella spiralis

85. Which of the following lab tests can be used to detect chronic alcohol abuse?

  A RBC count

  B WBC count

  C GGT

  D CPK

  E Alkaline phosphatase

86. The most frequent neurological complication of chronic alcohol abuse is:

  A Wernicke’s encephalopathy

  B Alcoholic cerebellar degeneration

  C Alcoholic neuropathy

  D Marchiafava–Bignami disease

  E Alcoholic dementia

87. A study in which a group comes from a well-defined population and is followed over a long period of time is a:

  A Case history study

  B Cohort study

  C Cross-sectional study

  D Case–control study

  E Retrospective study

88. The Miller–Fisher syndrome involves the classic symptom complex of:

  A Dementia, parkinsonism, psychosis

  B Gait ataxia, urinary incontinence and dementia

  C Ataxia, areflexia, ophthalmoplegia

  D Alexia without agraphia

  E Right–left confusion, finger agnosia, acaculia

89. Konrad Lorenz, during his work with animals demonstrated which one of the following concepts which may be used to understand early human psychological development?

  A Sensory deprivation

  B Altruism

  C Imprinting

  D Stress syndromes

  E Episodic dyscontrol

90. A 29-year-old woman presents to the ER by ambulance in a wheelchair. She was brought from home with a complaint of rapidly progressive bilateral leg weakness over the past 2 weeks. Her legs were also painful and she complained of numbness and tingling in the lower part of both legs. Just prior to the onset of symptoms she had a 3-day bout of bad diarrhea with fever and chills that resolved spontaneously. Which one of the following would not be a likely finding on diagnostic testing and examination of this patient?

  A Diminished deep tendon reflexes

  B High cell count with absent protein in CSF

  C Conduction block and prolonged F-wave latencies on nerve conduction studies

  D Positive Campylobacter jejuni antibody serology

  E Complement fixing antibodies to peripheral nerve myelin on nerve biopsy

91. Which one of the following is not a second messenger?

  A Adenylyl cyclase

  B cGMP

  C Ca2+

  D cAMP

  E IP3

92. Which one of the following is not more typical of a cortical dementia than of a subcortical dementia such as dementia of the Alzheimer type?

  A Apathy and depression

  B Aphasia

  C Dyspraxia

  D Absence of motor abnormalities

  E Insidious progression of cognitive decline

93. A child is playing in his home, and at the same time that his dog barks the doorbell also rings. The child believes that the doorbell rang because the dog barked. This child would fit best into which of Piaget’s stages?

  A Sensorimotor

  B Preoperational thought

  C Concrete operations

  D Formal operations

  E Latency

94. The sensory dermatomes of the nipples and the umbilicus are respectively located at the level of:

  A T2 and T8

  B T3 and T9

  C T4 and T10

  D T5 and T11

  E T6 and T12

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

  A Nicotinic

  B Muscarinic

  C Alpha 1

  D AMPA

  E GABA

96. Buspirone’s mechanism of action is predominantly linked to which one of the following receptors:

  A Serotonin 2A

  B Serotonin 1A

  C NMDA

  D Dopamine 2

  E Norepinephrine

97. Which one of the following statements is true regarding excitatory neurotransmitters?

  A They open anion channels that depolarize the cell membrane and increase the likelihood of generating an action potential

  B They open cation channels that hyperpolarize the cell membrane and increase the likelihood of generating an action potential

  C They open cation channels that hyperpolarize the cell membrane and decrease the likelihood of generating an action potential

  D They open anion channels that hyperpolarize the cell membrane and decrease the likelihood of generating an action potential

  E They open cation channels that depolarize the cell membrane and increase the likelihood of generating an action potential

98. Phencyclidine (PCP) exerts its hallucinogenic effects primarily by mediation of which of the following receptors:

  A Serotonin 2A

  B Serotonin 1A

  C NMDA

  D Dopamine 2

  E Norepinephrine

99. Which one of the following is not an immature defense?

  A Hypochondriasis

  B Introjection

  C Sublimation

  D Regression

  E Passive aggression

100. Which one of the following agents is least likely to exacerbate the extra-pyramidal symptoms of Parkinson’s disease?

  A Amoxapine

  B Perphenazine

  C Thorazine

  D Fluphenazine

  E Phenelzine

101. Who was the author of The Ego and Mechanisms of Defense, and gave us the first comprehensive study of defense mechanisms?

  A Sigmund Freud

  B Kohut

  C Erich Fromm

  D Ana Freud

  E Carl Jung

102. Which one of the following is not necessary for a patient to be declared competent to stand trial?

  A Understanding of the nature of the charges against him

  B Not having a mental illness

  C Having the ability to consult a lawyer

  D Helping the lawyer in his defense

  E Understanding of court procedure

103. Which one of the following is present in paranoid schizophrenia?

  A Flat affect

  B Catatonic behavior

  C Incoherence

  D Preoccupation with systematized delusions

  E Grossly disorganized behavior

104. How long should a patient remain on antidepressant medication after having experienced four major depressive episodes in the last five years?

  A 3 months

  B 6 months

  C 12 months

  D 2 years

  E Indefinitely

105. Which one of the following symptoms is not part of dysthymic disorder?

  A Poor appetite

  B Low self-esteem

  C Feelings of hopelessness

  D Hallucinations

  E Fatigue

106. Which ruling determined that the physician–patient relationship imposes an obligation on the psychiatrist for care and safety of the patient and others?

  A Wyatt vs Stickney

  B Durham vs the United States

  C O’Connor vs Donaldson

  D Tarasoff vs regents of the University of California

  E Clites vs State

107. Which one of the following tricyclic antidepressants is not considered a tertiary amine?

  A Imipramine

  B Amitriptyline

  C Desipramine

  D Clomipramine

  E Trimipramine

108. Which one of the following surgical interventions can not be used for the invasive treatment of idiopathic Parkinson’s disease?

  A Thalamotomy

  B Subthalamic nucleus deep brain stimulation

  C Superior colliculus deep brain stimulation

  D Pallidotomy

  E Pallidal deep brain stimulation

109. The metabolite of which one of the following tricyclic antidepressants has potent dopamine blocking ability that can lead to antipsychotic-like side effects?

  A Amoxapine

  B Clomipramine

  C Desipramine

  D Trimipramine

  E Imipramine

110. A patient presents with a non-dominant hemispheric stroke in the middle cerebral artery territory. Which one of the following symptoms and signs would you not find on neurologic examination?

  A Hemi-inattention

  B Anosognosia

  C Right–left disorientation

  D Impaired prosody of speech

  E Visual and tactile extinction

111. Interaction with the enzyme CYP 2D6 has what bearing on the use of tricyclic antidepressants?

  A None. Tricyclics do not interact with CYP 2D6

  B Those with decreased CYP 2D6 activity will have lower than expected plasma drug concentrations

  C Giving a patient on a tricyclic a CYP 2D6 inhibitor could cause a drop in the plasma concentration of the drug

  D Cimetidine can cause an increase in tricyclic levels as a result of its interaction with CYP 2D6

  E Concomitant use of drugs that inhibit CYP 2D6 with tricyclics may necessitate higher than usual prescribed doses of either drug to obtain the same levels

112. A 50-year-old man presents to the emergency room with a complaint of acute onset of right eye pain, ptosis, and diplopia. The symptoms began that morning immediately upon his awakening from sleep. Your examination reveals a normal-sized pupil that is fully reactive to light and a right eye that cannot adduct nasally with a ptotic right eyelid. The most likely cause of this condition is:

  A Diabetes

  B Stroke

  C Posterior communicating artery aneurysm

  D Multiple sclerosis

  E Myasthenia gravis

113. Residual schizophrenia is characterized by:

  A Absence of prominent hallucinations

  B Delusions

  C Incoherence

  D Disorganized behavior

  E Posturing

114. Which one of the following agents would not be useful for the treatment of tics in Tourette’s syndrome?

  A Fluphenazine

  B Molindone

  C Botulinum toxin type A

  D Haloperidol

  E Protriptyline

115. Which one of the following is not characteristic of catatonic schizophrenia?

  A Mutism

  B Negativism

  C Rigidity

  D Echolalia

  E Grossly inappropriate affect

116. A right middle cerebral artery territory ischemic stroke posterior to the optic chiasm would be expected to cause:

  A Bitemporal hemianopsia

  B Left monocular blindness

  C Left homonymous hemianopsia

  D Right homonymous hemianopsia

  E Right upper quadrantanopsia

117. Which one of the following statements is not true regarding chemical signaling between neurons?

  A Neurotransmitter synthesis may be stimulated by influx of Ca2+

  B Norepinephrine-releasing neurons have presynaptic alpha receptors which are involved in a negative feedback system to stop NE release

  C Once dopamine is released into the synaptic cleft it works until it diffuses away, or is removed by reuptake mechanisms

  D Exocytosis is the process by which neurotransmitter storage vesicles release their contents into the synaptic cleft

  E MAO type B metabolizes NE and serotonin

118. A 4-year-old boy presents to the ER in an acute state of agitation. Careful history-taking and examination reveal hypotonia, delayed developmental milestones, athetotic movements of the upper extremities and mental retardation. The parents explain that their son constantly bites his hands and lips to the point of bleeding. Lesch–Nyhan syndrome is the clinical diagnosis. This syndrome is caused by a deficiency of which of the following enzymes:

  A Ornithine transcarbamylase

  B Hypoxanthine-guanine phosphoribosyltransferase

  C Adenylosuccinate deficiency

  D Arginase

  E Carbamoylphosphate synthase

119. A child is brought to your office for depression. During the course of your interview you see that the patient can think abstractly, reason deductively, and define abstract concepts. This child would fit into which of Piaget’s developmental stages?

  A Sensorimotor

  B Preoperational thought

  C Concrete operations

  D Formal operations

  E Symbiosis

120. Predisposition for dementia pugilistica is increased in carriers with defects on which one of the following chromosomes:

  A Chromosome 16

  B Chromosome 17

  C Chromosome 18

  D Chromosome 19

  E Chromosome 20

121. Which one of the tricyclic antidepressants has the most antihistaminic activity?

  A Amoxapine

  B Clomipramine

  C Desipramine

  D Nortriptyline

  E Doxepin

122. Which one of the following is not helpful in the treatment of obsessive–compulsive disorder?

  A Bupropion

  B Fluvoxamine

  C Clomipramine

  D Sertraline

  E Fluoxetine

123. Which one of the following is true regarding the tricyclic antidepressants?

  A The downregulation of β-adrenergic receptors correlates most closely with time needed for clinical improvement in patients

  B Giving tricyclics leads to an increase in β-adrenergic receptors

  C Giving tricyclics leads to an increase in 5-HT receptors

  D Giving tricyclics leads to an increase in β-adrenergic receptors and a decrease in 5-HT receptors

  E Giving tricyclics leads to a decrease in β-adrenergic receptors and an increase in 5-HT receptors

124. Which one of the following is not effective in treating enuresis in childhood?

  A Desmopressin

  B Bell-and-pad conditioning

  C Amitriptyline

  D Imipramine

  E Olanzapine

125. Which one of the following ions uses the second ion channel to open during an action potential, acts as a second messenger once in the neuron, activates the release of neurotransmitter, and activates ion channels that allow for influx of other ions that halt the action potential?

  A Na+

  B K+

  C Cl

  D Ca2+

  E IP3

126. Patients with which one of the following disorders may have clinically significant side effects from tricyclic antidepressant drugs?

  A Insomnia

  B Benign prostatic hypertrophy

  C Migraine

  D Parkinson’s disease

  E Pituitary adenoma

127. Which one of the following statements is true regarding inhibitory neurotransmitters?

  A They open chloride channels that depolarize the cell membrane and increase the likelihood of an action potential

  B They open cation channels that depolarize the cell membrane and increase the likelihood of an action potential

  C They open chloride channels that hyperpolarize the cell membrane and increase the likelihood of an action potential

  D They open chloride channels that hyperpolarize the cell membrane and decrease the likelihood of an action potential

  E They open potassium channels that depolarize the cell membrane and decrease the likelihood of an action potential

128. A patient with a fear of spiders is put in a room with many spiders, and immediately a live tarantula is placed on his hand for as long as necessary until the dissipation of his anxiety. This behavioral technique is called:

  A Graded exposure

  B Aversion therapy

  C Flooding

  D Assertiveness training

  E Modeling

129. Which one of the following is true regarding psychoanalytic psychotherapy?

  A All of the patient’s remarks should be taken at face value

  B Most of what the patient says is unimportant

  C Disclaimers often precede emotionally charged material, and are important to note

  D It’s important to point out to the patient every instance in which they exhibit low self-esteem

  E One should interpret the patient’s resistance at each and every opportunity

130. An 82-year-old patient in a skilled nursing facility displays confusion, restlessness, agitation, and disorganized speech only during the evening hours. Which one of the following is not an appropriate treatment approach?

  A Increased lighting in the room

  B Low dose haloperidol at bedtime

  C Having a calendar on the wall

  D Flurazepam at bedtime for sleep

  E Companionship and family support during the day

131. Which one of the following is not a technique used in cognitive therapy?

  A Reattribution

  B Role playing

  C Thought recording

  D Abreaction

  E Developing alternatives

132. Heroin withdrawal does not involve which one of the following symptoms?

  A Pinpoint pupils

  B Abdominal pain

  C Piloerection

  D Muscle twitching

  E Dysphoria

133. Which one of the following is among the least sedating of the tricyclic anti-depressants?

  A Desipramine

  B Amitriptyline

  C Trimipramine

  D Doxepin

  E Imipramine

134. Which one of the following is not an example of secondary gain?

  A Getting money

  B Getting medical help

  C Getting out of having to work

  D Getting out of family responsibilities

  E Getting drugs of abuse

135. In hypothyroidism one would expect to find:

  A Serum free T4 is increased

  B Serum total T4 concentration is increased

  C Serum thyroid stimulating hormone is increased

  D Serum T3 uptake is increased

  E Serum T3–T4 ratio is decreased

136. Which one of the following conditions involves increased risk in electroconvulsive shock therapy (ECT)?

  A Pregnancy

  B Hypopituitarism

  C Uncontrolled epilepsy

  D Neuroleptic malignant syndrome

  E Cerebral aneurysm

137. Caution should be taken when prescribing which one of the following to a woman on oral contraception?

  A Risperidone

  B Valproic acid

  C Gabapentin

  D Lithium

  E Carbamazepine

138. An 8-year-old child has a mental age of 6 years. For school placement purposes, the IQ should be reported as:

  A 50

  B 75

  C 100

  D 120

  E 135

139. Psychiatrist: What’s on your mind?

  Patient: I’ve been feeling depressed.

  Psychiatrist: Can you tell me more about what’s been happening?

  Patient: I haven’t been eating as much as I used to.

  Psychiatrist: Could you explain to me what you’ve been going through.

  The psychiatrist’s approach is an example of:

  A Closed-ended questions

  B Open-ended questions

  C Countertransference

  D Detailed mini-mental status exam

  E Negative reinforcement

140. Violent or aggressive behavior is associated with:

  A Decreased levels of 5-hydroxyindoleacetic acid in spinal fluid

  B Decreased growth hormone response to insulin-induced hypoglycemia

  C Abnormal dexamethasone suppression test

  D Decreased response to corticotrophin releasing hormone stimulation test

  E Decreased response to thyrotropin releasing hormone suppression test

141. Which one of the following is not a potential repercussion of lithium intoxication?

  A Seizure

  B Renal toxicity

  C Ataxia and coarse tremor

  D Non-specific T-wave changes.

  E Jaundice

142. Obsessive–compulsive disorder is associated with abnormality of which one of the following neurotransmitters?

  A Norepinephrine

  B Serotonin

  C Melatonin

  D Acetylcholine

  E Dopamine

143. Which one of the following is not true regarding use of the tricyclic antidepressants?

  A Due to their ability to prolong cardiac conduction time their use in patients with conduction defects is contraindicated

  B These agents should be discontinued before elective surgery because they may cause hypertensive episodes during surgery

  C Some patients who experience orthostatic hypotension may respond to the use of fludrocortisone

  D Myoclonic twitches and tremors of the tongue and upper extremities are common in some patients on tricyclics

  E Amoxapine is the least likely to cause parkinsonian symptoms of all the tricyclics

144. Which one of the following characteristics pertaining to vascular dementia is false?

  A There is a stepwise decline in functioning

  B Hypertension is a known risk factor

  C There is abrupt onset of symptoms

  D There is a good response to cholinergic therapies

  E Smoking is a known risk factor

145. Which one of the following antidepressants is the most serotonin-selective of the tricyclics?

  A Amoxapine

  B Clomipramine

  C Desipramine

  D Nortriptyline

  E Doxepin

146. A team comprised of a psychiatrist, psychologist, social worker, nurse, and medical student discharge a patient because the insurance will no longer pay for her stay. She kills herself. Who will be held legally responsible for the team’s actions?

  A The medical student

  B The psychologist

  C The social worker

  D The nurse

  E The psychiatrist

147. Which one of the following is not a side effect of treatment with tricyclic antidepressants?

  A Termination of ventricular fibrillation

  B Increase collateral blood supply to ischemic heart muscle

  C Decreased contractility

  D Tachycardia

  E Hypertension

148. The best indicator for future suicidal behavior is:

  A Age

  B Psychosis

  C Past suicidal behavior

  D Substance use

  E Personality disorder

149. A patient presents to your office with obsessive–compulsive disorder (OCD). She has been tried on several SSRIs with little improvement. You decide to try a tricyclic. Which tricyclic has been shown to have significantly better efficacy in treating OCD than the others?

  A Desipramine

  B Doxepin

  C Amitriptyline

  D Clomipramine

  E Nortriptyline

150. Which one of the tricyclic antidepressants is used to treat childhood enuresis?

  A Desipramine

  B Clomipramine

  C Maprotiline

  D Amoxapine

  E Imipramine