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

Test Number Three

1. During which one of Piaget’s stages of development will a child be able to understand that a tall glass and a short wide glass can contain the same volume of water despite their different shapes?

  A Sensorimotor stage

  B Preoperational thought stage

  C Concrete operations stage

  D Formal thought stage

  E Anal stage

2. Which one of the following is not a characteristic of Transient global amnesia?

  A Loss of personal information and identity

  B Reversible anterograde and retrograde memory loss

  C Inability to learn newly acquired information

  D Preservation of alertness without motor or sensory deficits

  E Men are affected more commonly than women

3. Which one of the following answer choices is not true regarding GABA?

  A GABA is thought to suppress seizure activity

  B GABA is thought to exacerbate mania

  C GABA is thought to decrease anxiety

  D GABA-A activity is potentiated by topiramate

  E Gabapentin has no activity at the GABA receptors or transporter

4. An 8-year-old boy has been at sleep-away summer camp for 2 weeks and presents with a sudden onset of facial diplegia. The most likely infectious organism that might have caused this symptom is:

  A Treponema pallidum

  B Borrelia burgdorferi

  C Leptospira interrogans

  D Rickettsia rickettsii

  E Yersinia pestis

5. A middle-aged man has been referred to your office by a plastic surgeon. The man is seeking a face lift for his “excessively large cheeks”. The surgeon has not been able to find anything abnormal about the man’s face or skin, and when he comes to see you, you fail to see anything wrong either. The patient insists that his cheeks are grotesque and ruining his whole appearance. When pressed, he admits that others may not consider his cheeks to be as bad as he does. His most likely diagnosis is:

  A Malingering

  B Schizophrenia

  C Somatization disorder

  D Conversion disorder

  E Body dysmorphic disorder

6. Tourette’s syndrome often involves which one of the following psychiatric manifestations?

  A Generalized anxiety disorder

  B Social anxiety disorder

  C Panic disorder

  D Obsessive–compulsive disorder

  E Psychotic disorder

7. A young woman comes to the emergency room with a 1 week history of pressured speech, decreased sleep, grandiosity, and loosening of associations. The patient feels that she is being monitored by a satellite and she is seen talking to herself when no one else is in the room. Which one of the following criteria must be met to diagnose this patient with schizoaffective disorder instead of bipolar disorder?

  A Presence of mania

  B Psychotic symptoms in the absence of mood symptoms for a 1 week period

  C At least one prior episode of depression

  D Presence of psychotic symptoms during a manic episode

  E Psychotic symptoms in the absence of mood symptoms for a 2 week period

8. Which one of the following therapies would be best-suited to a bipolar patient in a manic episode during pregnancy?

  A Haloperidol

  B Lithium

  C Aripiprazole

  D Divalproex sodium

  E Electroconvulsive shock therapy

9. You are called to evaluate a 60-year-old man with a history of depression. His family reports that he has not been himself for the past 5 days. On examination he makes poor eye contact, is inattentive, mutters incoherently, keeps rearranging pieces of paper on his bed tray with no apparent logic, and drifts off to sleep while you are talking to him. What is his most likely diagnosis?

  A Depression

  B Dementia

  C Delusional disorder

  D Delirium

  E Obsessive–compulsive disorder

10. Which one of the following pharmacologic agents would be most likely to cause extrapyramidal side effects and possible tardive dyskinesia?

  A Hydroxyzine

  B Diphenhydramine

  C Metoclopramide

  D Ondansetron

  E Tizanidine

11. The most common symptom seen in patients with narcolepsy is:

  A Hypnopompic hallucinations

  B Sleep paralysis

  C Hypnagogic hallucinations

  D Sleep attacks

  E Cataplexy

12. The primary auditory cortex localizes to which one of the following brain regions?

  A Temporal lobe

  B Parietal lobe

  C Frontal lobe

  D Occipital lobe

  E Thalamus

13. Which one of the following neurotransmitters works as an adjunctive neurotransmitter for glutamate as well as an independent neurotransmitter with its own receptors?

  A GABA

  B Norepinephrine

  C Serotonin

  D Dopamine

  E Glycine

14. Which one of the following agents is not acceptable and useful for the treatment of postherpetic neuralgia?

  A Gabapentin

  B Lidoderm

  C Pregabalin

  D Carbamazepine

  E Phenytoin

15. A construction worker is brought to the emergency room immediately after an accident on a job site. He was standing very near a three story scaffold that fell and missed crushing him by inches. He reports feeling anxiety, a sense of numbing, detachment, difficulty remembering the accident, and states that he feels like he is in a daze. The most likely diagnosis is:

  A Generalized anxiety disorder

  B Major depression

  C Delirium

  D Dissociative amnesia

  E Acute stress disorder

16. Trauma to which one of the following vessels or groups of vessels commonly causes epidural hematoma?

  A Middle meningeal artery

  B Meningeal bridging veins

  C Cavernous sinus

  D Basilar artery

  E Transverse sinus

17. A 26-year-old woman comes into the emergency room. She reports that she has been having mood swings that go from depressed to elated to rageful in minutes to hours. She has been having paranoid feelings and vague auditory hallucinations over the past week since breaking up with her boyfriend. On this past Monday she cut her arms with a razor, but only superficially. Her history reveals promiscuity, unstable relationships, and cocaine use. She now reports suicidal ideation. Her most likely diagnosis is:

  A Bipolar disorder

  B Depression with psychotic features

  C Schizoid personality disorder

  D Borderline personality disorder

  E Schizotypal personality disorder

18. What is the characteristic electroencephalographic pattern noted in Creutzfeldt–Jakob disease?

  A Three-per-second spike and wave

  B Periodic high-amplitude sharp wave complexes

  C Temporal spikes

  D Generalized background slowing

  E Periodic lateralizing epileptiform discharges (PLEDS)

19. To be diagnosed with polysubstance dependence, how many substances must a patient be found dependent on?

  A Six substances, including caffeine

  B Two groups of substances, where dependence criteria were met for one of the groups

  C Four substances, including nicotine, but excluding caffeine

  D Five specific substances

  E Three or more groups of substances where dependence criteria were met for the groups, but not necessarily for any one particular substance

20. Which one of the following cerebrospinal fluid findings is indicative of aseptic meningitis?

  A Variably increased lymphocytes, slightly decreased glucose, very high protein

  B Moderately increased lymphocytes, decreased glucose, mildly elevated protein

  C Highly increased neutrophils, decreased glucose, very high protein

  D Slightly increased lymphocytes, normal glucose, mildly elevated protein

  E Absent or few lymphocytes, normal glucose, very high protein

21. A small child is in the park with her mother. As the two interact, the child goes off to play for a brief time, then returns to her mother, then goes off to play, then returns to her mother. The child continues this pattern, regularly checking to see that the mother is still there. She would best fit into which one of Mahler’s stages of separation–individuation?

  A Normal autism

  B Symbiosis

  C Rapprochement

  D Practicing

  E Object constancy

22. What type of systemic poisoning results in the development of characteristic Mees’ lines of the fingernails as in the photograph?

  A Mercury

  B Arsenic

  C Lead

  D Organophosphates

  E Ionizing radiation

image

23. The assumption that there is no significant difference between two random samples of a population is called:

  A Correlation coefficient

  B Control group

  C Analysis of variance (ANOVA)

  D Regression analysis

  E Null hypothesis

24. Organophosphate poisoning by pesticide exposure causes neurologic deficits by which one of the following mechanisms?

  A Anticholinergic toxicity

  B Cholinergic toxicity

  C Gamma-aminobutyric acid blockade

  D Serotonergic toxicity

  E Dopaminergic toxicity

25. Emil Kraepelin used which one of the following terms in reference to schizophrenia?

  A Language delay

  B Dementia praecox

  C Split-personality

  D Rebound hyperactivity

  E Downward drift

26. Which one of the following agents causes poisoning in humans that can result in a blue line at the gingival margin?

  A Manganese

  B Thallium

  C Arsenic

  D Mercury

  E Lead

27. The police bring a man into the hospital who has been stealing satellite dishes off of houses and setting them up in his own yard because he feels that he has a chip in his head that allows him to talk directly to God. He states that God has instructed him to do this as preparation for the second coming. When his wife is questioned about her husband’s behavior she responds that indeed God has been directly communicating with her husband, and that she has helped him steal some of the larger satellite dishes. The wife’s condition can best be described as:

  A Schizoid personality disorder

  B Delusional disorder

  C Shared psychotic disorder

  D Bipolar disorder

  E Substance-induced psychotic disorder

28. Truncal ataxia or instability can result most specifically from a lesion to the:

  A Cerebellar hemispheres

  B Cerebellar vermis

  C Cerebellopontine angle

  D Thalamus

  E Midbrain

29. Which one of the following neurotransmitters has large numbers of receptors in the spinal cord, is synthesized primarily from serine, and has been the subject of research involving negative symptom reduction in schizophrenia?

  A GABA

  B Glycine

  C Serotonin

  D Dopamine

  E Glutamate

30. Which one of the following is not a contraindication to lumbar puncture?

  A Thrombocytopenia

  B Cerebral mass lesion

  C Suspected meningitis with obtundation

  D Recent head trauma

  E Papilledema

31. What is the difference between post-traumatic stress disorder and acute stress disorder?

  A The nature of the trauma

  B The symptoms that follow the trauma

  C The impairment resulting from the symptoms

  D The duration of the symptoms

  E The age of the patient

32. Which chromosomal abnormality is the most common cause of mental retardation?

  A Trisomy 21

  B Trisomy 18

  C Cri-du-chat syndrome

  D Fragile X syndrome

  E Prader–Willi syndrome

33. Ending up in strange places with no recollection of how one got there, or finding objects in one’s possession that one doesn’t recall acquiring is most characteristic of:

  A Anxiety

  B Psychosis

  C Histrionic personality

  D Dissociation

  E Depression

34. Which one of the following child abuse injuries is the most likely to result in death or long-term sequelae?

  A Embolic stroke from multiple bone fractures

  B Subdural hematoma from head trauma

  C Skull fracture from head trauma

  D Cerebral hypoxia from choking

  E Seizures from head and brain trauma

35. A 59-year-old man comes into your office complaining of depression. His wife of 25 years died unexpectedly 5 weeks ago. Since then he has been crying, has had little appetite but has lost no weight, and reports difficulty sleeping. He has been going out to dinner once each week with friends and says that it helps get his mind off of his wife’s death. He is not suicidal. This is the first time in his life that he has had symptoms such as these. His most likely diagnosis is:

  A Bipolar disorder

  B Major depressive disorder

  C Acute stress disorder

  D Bereavement

  E Dysthymic disorder

36. Which one of the following is not considered a lower motor neuron sign?

  A Hypotonia

  B Muscle atrophy

  C Fasciculations

  D Babinski’s sign

  E Hyporeflexia

37. Mahler’s stage that is characterized by a baby considering himself a fused entity with his mother, but developing increased ability to differentiate between the inner and outer world is called:

  A Normal autism

  B Symbiosis

  C Differentiation

  D Rapprochement

  E Object constancy

38. Which one of the following therapeutics can eliminate benign paroxysmal positional vertigo?

  A Diazepam

  B Brandt–Daroff exercises

  C Meclizine

  D Metoclopramide

  E Gabapentin

39. Which one of the following is not a diagnostic criterion for kleptomania?

  A Recurrent failure to resist stealing objects

  B Decreased sense of tension immediately preceding the theft

  C Pleasure at the time of committing the theft

  D The theft is not done to express anger

  E The act is not in the context of an antisocial personality disorder

40. The persistent vegetative state is not characterized by which one of the following?

  A Preserved eye opening

  B Preserved response to noxious stimuli

  C Preserved eye tracking

  D Preserved swallowing

  E Preserved sleep–wake cycles

41. An Hispanic man comes into the emergency room complaining of headache, insomnia, fear, anger, and despair. Your differential diagnosis is most likely to include which one of the following?

  A Schizophrenia

  B Schizoaffective disorder

  C Panic disorder

  D Ataque de nervios

  E Myoclonic sleep disorder

42. What is the most typical effect of depression on nocturnal sleep?

  A Decreased total sleep time

  B Initial insomnia

  C Middle insomnia

  D Early morning awakening

  E Sleep–wake cycle reversal

43. Which one of the following symptoms would not be expected in a patient with pyromania?

  A Deliberate and purposeful fire setting

  B Tension before the act

  C Fascination with fire

  D Pleasure when setting fires

  E Setting fires for monetary gain or as an expression of political ideology

44. Apoptosis mediated by the N-methyl-D-aspartate (NMDA) receptor complex is most likely caused by elevated intracellular levels of which one of the following ions?

  A Calcium

  B Magnesium

  C Sodium

  D Potassium

  E Chloride

45. A patient is brought into the emergency room following a fight with police. Upon examination the psychiatrist finds that the patient has a history of several discrete assaultive acts. His aggression in these situations was out of proportion to what one would consider normal. The patient has no other psychiatric disorder and no history of substance abuse. He has no significant medical history. What is his most likely diagnosis?

  A Impulse control disorder NOS

  B Pyromania

  C Mania

  D Temporal lobe epilepsy

  E Intermittent explosive disorder

46. A 45-year-old woman comes to the emergency room by ambulance unconscious and barely breathing. Paramedics found an empty bottle of 90 tablets of 2 mg clonazepam on her dresser that was filled at the pharmacy the day before. One of the first agents to administer to this patient in the acute setting is:

  A Naloxone

  B Flumazenil

  C Dimercaprol

  D Atropine

  E Epinephrine

47. Which one of the following should not be considered in the differential diagnosis for intermittent explosive disorder?

  A Delirium

  B Dementia

  C Temporal lobe epilepsy

  D Obsessive–compulsive disorder

  E Substance intoxication

48. The electroencephalographic pattern that most often characterizes infantile spasms is:

  A Three-per-second spike and wave

  B Hypsarrhythmia

  C Periodic lateralizing epileptiform discharges (PLEDS)

  D Triphasic sharp waves

  E Burst-suppression pattern

49. Which one of the following psychiatric symptoms is not found with AIDS?

  A Progressive dementia

  B Personality changes

  C Heat intolerance

  D Depression

  E Loss of libido

50. Which one of the following structures is not part of Papez’ circuit?

  A Amygdala

  B Mamillary body

  C Fornix

  D Cingulate gyrus

  E Hippocampus

51. A child is in the doctor’s office for an evaluation. His mother is waiting outside in the waiting area. The child is aware that his mother still exists even though she is not present in the room. For this to be true, the child must have reached which one of Mahler’s stages of separation–individuation?

  A Normal autism

  B Practicing

  C Differentiation

  D Symbiosis

  E Object constancy

52. Which one of the following neurologic disorders is not believed to be caused by defects in the calcium channel system?

  A Lambert–Eaton myasthenic syndrome

  B Malignant hyperthermia

  C Hypokalemic periodic paralysis

  D Familial hemiplegic migraine

  E Benign familial neonatal convulsions

53. A young woman comes to her psychiatrist’s office for help. She feels that others are exploiting her, but has no hard evidence. She is preoccupied with the lack of loyalty that she feels all of her friends have. She reads hidden demeaning connotations into the psychiatrist’s comments. She bears grudges and is unforgiving of slights. Her most likely diagnosis is:

  A Schizophrenia

  B Schizotypal personality disorder

  C Paranoid personality disorder

  D Schizoid personality disorder

  E Dementia

54. Which one of the following is not a clinical feature of phenylketonuria?

  A Sensorineural deafness

  B Infantile spasms

  C Microcephaly

  D A characteristic “mousy” odor

  E Light hair and skin pigmentation

55. Which one of the following dopaminergic tracts or areas is responsible for the parkinsonian side effects of antipsychotic medications?

  A Mesolimbic–mesocortical tract

  B Tuberoinfundibular tract

  C Nigrostriatal tract

  D Caudate neurons

  E Ventral striatum

56. Which one of the following disorders is correctly depicted in the photomicrograph below?

  A Lissencephaly

  B Schizencephaly

  C Dandy–Walker syndrome

  D Arnold–Chiari type I malformation

  E Arnold–Chiari type II malformation

image

57. A schizophrenic man on an inpatient psychiatric unit develops a fever of 102.3°F (39.1°C), a high WBC count, unstable pulse and blood pressure, and rigidity in the arms and legs. The most likely diagnosis is:

  A Meningitis

  B Serotonin-specific reuptake inhibitor withdrawal

  C Lithium toxicity

  D Neuroleptic malignant syndrome

  E PCP use

58. Internal carotid artery stenosis should be treated surgically by endarterectomy if the stenosis is symptomatic and above:

  A 50%

  B 60%

  C 70%

  D 80%

  E 90%

59. A patient comes into the clinic because his family (whom he only sees one or two times per year) keeps telling him to “go see a shrink”. He has no close relationships. He participates mainly in solitary activities. He has no desire for sexual activity with others. He is indifferent to the praise or criticism of others. On examination his affect is flat. His most likely diagnosis is:

  A Schizoid personality disorder

  B Schizotypal personality disorder

  C Narcissistic personality disorder

  D Major depressive disorder

  E Dysthymic disorder

60. Poor outcome in Guillain-Barré syndrome is often associated with a preceding infection by which one of the following pathogens?

  A Haemophilus influenzae

  B Streptococcus pneumoniae

  C Eescherichia coli

  D Campylobacter jejuni

  E Clostridium difficile

61. Which one of the following is false regarding the Pearson correlation coefficient?

  A It spans from −1 to +1

  B A positive value means that one variable moves the other variable in the same direction

  C It can give information about cause and effect

  D It indicates the degree of relationship

  E A negative value means that one variable moves the other variable in the opposite direction

62. Which one of the following solid tumors metastasizes most frequently to the brain?

  A Breast

  B Colon

  C Prostate

  D Lung

  E Thyroid

63. A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation is most characteristic of:

  A Obsessive–compulsive personality disorder

  B Avoidant personality disorder

  C Schizoid personality disorder

  D Dependent personality disorder

  E Passive–aggressive personality disorder

64. The most useful treatment for intractable post-lumbar puncture headache is:

  A Repeat lumbar puncture with blood patch

  B Bed-rest for 2 weeks

  C Acetaminophen

  D Hydrocodone

  E Sumatriptan

65. Which one of the following baseline lab values would be the least important to obtain on a patient starting lithium therapy:

  A Thyroid function tests

  B Electrocardiogram

  C White blood cell count

  D Renal function tests

  E VDRL

66. Compression of which one of the following peripheral nerves results in meralgia paresthetica?

  A Sciatic

  B Lateral femoral cutaneous

  C Obturator

  D Superior gluteal

  E Common peroneal

67. Following a long day in the hospital, you visit your best friend from college who has recently had a baby. The child has been spending more of her time asleep than awake and is not particularly aware of the environment. If your friend were to ask you which of Mahler’s stages of separation–individuation the child fits into, you would confidently answer:

  A Normal autism

  B Symbiosis

  C Object constancy

  D Practicing

  E Differentiation

68. The classic finding on needle electromyography (EMG) that denotes the presence of a radiculopathy is:

  A High-frequency, short-duration potentials

  B Positive sharp waves and fibrillations

  C Fasciculations

  D Small, short motor unit potentials

  E Myotonia

69. Which one of the following brain structure’s dopaminergic neurons have been linked with Tourette’s syndrome and the development of tics?

  A Caudate

  B Substantia nigra

  C Amygdaloid body

  D Frontal cortex

  E Hippocampus

70. A 35-year-old woman delivers her baby at 40 weeks gestation without complication. Seven days later she experiences an acute onset of pancephalic headache, behavioral and personality changes, irritability, intermittent seizures and diplopia. The most likely diagnosis of her problem is:

  A Aseptic meningitis

  B Cerebral venous thrombosis

  C Complicated migraine

  D Bacterial meningoencephalitis

  E Pseudotumor cerebri

71. When should advanced directives be discussed with a patient?

  A At a time when the patient is competent

  B When admitted to the hospital

  C When a question of capacity arises

  D When the patient is in pre-op

  E When in the outpatient office

72. The most common congenital viral infection in newborns is caused by which one of the followed pathogens?

  A Cytomegalovirus (CMV)

  B Herpes simplex (HSV)

  C Human immunodeficiency virus (HIV)

  D Rubella

  E Measles

73. A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior as well as fears of separation, is characteristic of which one of the following?

  A Obsessive–compulsive personality disorder

  B Avoidant personality disorder

  C Schizoid personality disorder

  D Dependent personality disorder

  E Passive–aggressive personality disorder

74. The most frequent myopathy in patients over 50 years of age is:

  A Dermatomyositis

  B Polymyositis

  C Facioscapulohumeral dystrophy

  D Inclusion body myositis

  E Oculopharyngeal muscular dystrophy

75. Which one of the following is a behavioral effect of opioids?

  A Miosis

  B Increased arousal

  C Euphoria

  D Diarrhea

  E Tachycardia

76. Duchenne’s and Becker’s muscular dystrophies are both disorders linked to an absence or deficiency of which one of the following muscle membrane proteins?

  A Dystrophin

  B Laminin

  C Dystroglycan

  D Spectrin

  E Merosin

77. A 60-year-old woman is 63 pounds (28 kg) overweight. She comes to her psychiatrist’s office with a complaint of increased irritability, noting a fight with her husband over how much sugar he put in her coffee one morning. She is fatigued and naps several times each day. She has no history of psychiatric problems, but adds that her husband now sleeps in the living room because of her snoring. Which one of the following is the most likely cause of the patient’s symptoms?

  A Night terrors

  B Major depressive disorder

  C Bipolar disorder

  D Narcolepsy

  E Sleep apnea

78. The rate-limiting enzyme in the dopamine synthetic pathway is:

  A Dopa decarboxylase

  B Tyrosine hydroxylase

  C Dopamine β-hydroxylase

  D Phenylethanolamine N-methyltransferase (PNMT)

  E Catechol-O-methyltransferase

79. Which one of the following is the therapeutic range for lithium?

  A 6–12 mEq/L

  B 0.5–1.9 mEq/L

  C 0.6–1.2 mEq/L

  D 2–4 mEq/L

  E >4 mEq/L

80. Alcohol, benzodiazepine sedative-hypnotic agents, and barbiturates all predominantly exert their clinical effects on the brain at which one of the following receptor sites?

  A Cholinergic nicotinic

  B N-methyl-D-aspartate (NMDA)

  C Glycine

  D GABA-A

  E GABA-B

81. An elderly man comes into his doctor’s office with symptoms of dementia and notable loss of executive functioning. Dysfunction of which one of the following brain regions would be most closely associated with the patient’s loss of executive functioning?

  A Caudate nucleus

  B Putamen

  C Globus pallidus

  D Frontal lobes

  E Temporal lobes

82. A patient who is not malingering, but is believed to be producing the symptoms and signs of confusion or dementia involuntarily or unconsciously and believes that the symptoms are real is thought to have which one of the following conditions?

  A Conversion disorder

  B Ganser’s syndrome

  C Capgras syndrome

  D Hypochondriasis

  E Folie-à-deux

83. A child in school fails test after test. No matter how hard he studies, he fails. Over time he views himself as destined to fail and stops trying. Which one of the following theories best applies to this child’s situation?

  A The epigenetic principle

  B Industry theory

  C Cognition theory

  D Learned helplessness

  E Sensory deprivation

84. Entacapone and tolcapone exert their antiparkinsonian effects on which one of the following enzymes?

  A Catechol-O-methyltransferase

  B Monamine oxidase type A

  C Monoamine oxidase type B

  D Dopa decarboxylase

  E Dopamine β-hydroxylase

85. Which one of the following could drastically increase lithium levels?

  A Citalopram

  B Carbamazepine

  C Sertraline

  D Ibuprofen

  E Acetaminophen

86. The neurologic examination finding of Argyll Robertson pupils occurs in a majority of patients with which one of the following conditions:

  A Lyme disease

  B Multiple sclerosis

  C Tabes dorsalis

  D Bubonic plague

  E Intracerebral aneurysm

87. A patient on paroxetine complains of nausea, insomnia, muscle aches, anxiety, and dizziness. Which one of the following is the most likely explanation?

  A He has the flu

  B He has irritable bowel syndrome

  C He stopped taking his antidepressant abruptly

  D He is faking the symptoms

  E He has multiple sclerosis

88. A 33-year-old man with known epilepsy has a 45-second generalized tonic–clonic seizure at a bus stop outdoors. He is brought to the nearest ER and once he is arousable and awake is found to have a marked right-sided hemiparesis. What is the best explanation of this occurrence?

  A Postictal stroke

  B Todd’s paralysis

  C Complicated postictal migraine

  D Conversion disorder

  E Transient ischemic attack (TIA)

89. Which one of the following does not have active metabolites?

  A Oxazepam

  B Chlordiazepoxide

  C Triazolam

  D Clonazepam

  E Quazepam

90. The disease known as tropical spastic paraparesis is considered to be a _____ caused by the _____ virus.

  A Myelopathy; HTLV-1

  B Neuropathy; HTLV-1

  C Myelopathy; herpes simplex

  D Neuropathy; herpes simplex

  E Neuropathy; HIV type 1

91. To control aggression in a mentally retarded child, which one of the following would be most effective?

  A Clonazepam

  B Mirtazapine

  C Doxepin

  D Lithium

  E Naltrexone

92. Which one of the following diseases is not associated with expansion of trinucleotide repeat sequences?

  A Friedrich’s ataxia

  B Myotonic dystrophy

  C Multiple system atrophy

  D Fragile X syndrome

  E Huntington’s disease

93. Which one of the following dopaminergic pathways or areas is associated with the antipsychotic effects of the antipsychotic medications?

  A Nigrostriatal pathway

  B Mesolimbic–mesocortical pathway

  C Tuberoinfundibular pathway

  D Caudate nucleus

  E Amygdaloid body

94. The characteristic bedside neurologic diagnostic sign known as the “battle sign” is indicative of which one of the following pathologies:

  A Basilar skull fracture

  B Frontal lobe damage

  C Increased intracranial pressure

  D Hypocalcemia

  E Impending transtentorial cerebral herniation

95. Of the following combinations of medications, which one would the knowledgeable psychiatrist most want to avoid?

  A Fluoxetine–lithium

  B Fluoxetine–phenelzine

  C Citalopram–valproic acid

  D Citalopram–aripiprazole

  E Mirtazapine–lamotrigine

96. Which one of the following agents is the best choice for treating attention deficit–hyperactivity disorder in a patient with Tourette’s syndrome?

  A Bupropion

  B Methylphenidate

  C Dextroamphetamine

  D Atomoxetine

  E Clonidine

97. A method of obtaining a prediction for the value of one variable in relation to another variable is called:

  A Correlation coefficient

  B Control group

  C Analysis of variance (ANOVA)

  D Regression analysis

  E Null hypothesis

98. Which one of the following oral agents would be most beneficial in the treatment of limb spasticity related to multiple sclerosis?

  A Clonazepam

  B Phenytoin

  C Lioresal

  D Phenobarbital

  E Cyproheptadine

99. A measurement of the direction and strength of the relationship between two variables is called:

  A Correlation coefficient

  B Control group

  C Analysis of variance (ANOVA)

  D Regression analysis

  E Null hypothesis

100. A patient in the intensive care unit is delirious and agitated. The electroencephalogram demonstrates a characteristic pattern of triphasic waves and some generalized background slowing. What other clinical bedside sign would you be most likely to see in this patient on physical examination?

  A Herpetic skin vesicles

  B Penile chancre

  C Asterixis

  D Dupuytren’s contractures

  E Pulmonary rales

101. A researcher at a university hospital takes rats and randomly crowds them, shocks them, feeds them at different times, and uses bright lights and loud noise to interrupt their sleep. The rats eventually decrease their movement and exploratory behavior. What can be learned from this?

  A This researcher has serious psychological problems and really needs a girlfriend

  B This is evidence for Freud’s theory of coercive electrocution

  C Unpredictability and lack of environmental control play a large role in the generation of stress

  D Rats enjoy loud noise and bright lights, especially when accompanied by electric shocks

  E Aggression among members of the same species is common

102. Which one of the following is not a potential side effect of valproic acid?

  A Weight gain

  B Alopecia

  C Hemorrhagic pancreatitis

  D Thrombocytosis

  E Liver failure

103. A patient is admitted to the hospital for suicidal behavior. The insurance company refuses to pay for the stay after the third day, and the patient is still suicidal. Which one of the following answer choices is the most ethical way to proceed?

  A Send the patient home because the insurance company refuses to pay

  B Secretly tell the patient to sign out against medical advice

  C Make the patient pay out of pocket, and if they can’t afford it, discharge them

  D Sue the insurance company

  E Continue to treat the patient as long as necessary, and file an appeal with the insurance company after discharge

104. The mechanism by which clonidine can help alleviate the symptoms of opioid withdrawal is through mediation of:

  A Norepinephrine reuptake inhibition

  B Alpha-2 adrenergic agonism

  C Alpha-1 adrenergic antagonism

  D Dopamine antagonism

  E Serotonin antagonism

105. On a urine toxicology screen, how long can heroin be detected?

  A 12 hours

  B 48 hours

  C 4 weeks

  D 72 hours

  E 8 days

106. An elderly hospitalized patient with vascular risk factors has a stroke. The patient’s behavior following the stroke is noted to be unusually calm and markedly hypersexual. This presentation likely resulted from a stroke to the:

  A Hippocampi

  B Nucleus accumbens

  C Hypothalamus

  D Occipital lobes

  E Amygdaloid bodies

107. A psychiatrist is working on an inpatient unit and one of her patients has a very resistant case of depression. She considers the option of giving the patient electroconvulsive therapy (ECT). Which one of the following should make her most concerned about giving this patient ECT?

  A Pregnancy

  B Past seizures

  C Family history of severe depression

  D Psychotic symptoms

  E Recent myocardial infarction

108. A 20-year-old man comes to your office with his mother because of behavioral problems. On examination you note that he is verbally inappropriate, mildly mentally retarded, very tall and somewhat obese and has a small penis and scrotum. His condition is most likely due to which one of the following?

  A Absence of an X chromosome (XO)

  B Presence of an extra X chromosome (XXY)

  C Trisomy 21

  D Deletion on the paternal chromosome 15

  E Trisomy 18

109. A psychiatrist is consulted on a medical unit because there is a patient with a substance abuse history who is in need of pain control. Which one of the following answer choices would be the best way to treat this patient’s pain?

  A Large doses of opiates

  B A mixture of opiates and benzodiazepines

  C Patient-controlled analgesia

  D No opiates of any kind

  E PRN (as needed) buprenorphine

110. A 35-year-old woman presents to your office with her husband. He tells you that she has experienced discrete episodes of physical and verbal aggression directed toward other people and property for the past year. Her husband states that the aggressiveness is not precipitated by any particular trigger and is completely unpredictable and intermittent. In between these bouts of aggression, the patient is otherwise fine and leads a normal life as a wife and mother. The most plausible diagnosis is:

  A Borderline personality disorder

  B Intermittent explosive disorder

  C Antisocial personality disorder

  D Psychotic disorder due to temporal lobe seizures

  E Bipolar I disorder, with manic and psychotic episodes

111. While working on the ward of a state hospital, a psychiatrist comes across a patient with catatonic schizophrenia. The patient sits in one spot for extended periods of time, without changing position. This phenomenon is best described as:

  A Psychomotor retardation

  B Catalepsy

  C Cataplexy

  D Catatonia

  E Stereotypy

112. Which one of the following agents has the unique mechanism of action of being a dopamine and norepinephrine reuptake inhibitor?

  A Tiagabine

  B Venlafaxine

  C Duloxetine

  D Bupropion

  E Atomoxetine

113. Harry Harlow conducted a series of experiments with Rhesus monkeys. Some of his monkeys would stare vacantly into space, engage in self mutilation, and follow stereotyped behavior patterns. To which one of the following groups did these monkeys belong?

  A Total isolation (no caretaker or peer bond)

  B Mother-only reared

  C Peer-only reared

  D Partial isolation (can see, hear and smell other monkeys)

  E Separation (taken from caretaker after developing bond)

114. Sildenafil, vardenafil and tadalafil all improve erectile dysfunction by which one of the following mechanisms?

  A Phosphodiesterase 5 inhibition

  B Calcium channel antagonism

  C Nitric oxide antagonism

  D Alpha 1 adrenergic antagonism

  E Carbonic anhydrase inhibition

115. Which one of the following medications is the most likely to cause parkinsonian symptoms?

  A Maprotiline

  B Amoxapine

  C Venlafaxine

  D Doxepin

  E Clomipramine

116. If you divide the incidence of a disease in those with risk factors by the incidence of the same disease in those without risk factors, the result is called the:

  A Relative incidence

  B Attributable risk

  C Relative risk

  D Period incidence

  E Incidence risk

117. Cingulotomy is a treatment used for which one of the following choices?

  A Psychosis

  B Depression

  C Obsessive–compulsive disorder

  D Generalized anxiety disorder

  E Pedophilia

118. Which one of the following causative etiologic factors is not believed to contribute to the genesis of dissociative identity disorder?

  A A traumatic life event

  B A vulnerability for the disorder

  C Environmental factors

  D Absence of external support

  E Prior viral infection or exposure

119. Which one of the following is considered first-line treatment for a mute catatonic patient who is brought into the emergency room?

  A Haloperidol

  B Methylphenidate

  C Risperidone

  D Lorazepam

  E Paroxetine

120. Which one of the following is not a feature of malingering?

  A Findings are compatible with self-inflicted injuries

  B Medical records may have been tampered with or altered

  C Family members are able to verify the consistency of symptoms

  D Symptoms are vague or ill defined

  E History and examination do not yield complaints or problems

121. Which one of the following answer choices is most true concerning mutism?

  A It is a psychiatric disorder only

  B It is a neurological disorder only

  C It is a function of a high-energy environment

  D It is associated with both psychiatric and neurological conditions

  E It is most frequently the result of head trauma

122. Therapy that is focused on the measurement of autonomic processes and teaching patients to gain voluntary control over these physiological parameters through operant conditioning is called:

  A Stimulus-response therapy

  B Biofeedback

  C Relaxation training

  D Behavior therapy

  E Desensitization

123. A patient has overdosed on lithium following a fight with her boyfriend. Her lithium level is 2.8 mEq/L. She is exhibiting severe signs of lithium toxicity. Which one of the following answer choices is the best treatment at this time?

  A IV fluids

  B Celecoxib

  C Wait and watch

  D Hemodialysis

  E Gastric lavage

124. The most useful long-term treatment parameter for a noncompliant patient with schizophrenia and history of violence would be:

  A Long-term state psychiatric hospitalization

  B Partial hospitalization

  C Day treatment program

  D Outpatient commitment program

  E Social skills training

125. Which one of the following is a dangerous combination?

  A MAOI–lorazepam

  B MAOI–acetaminophen

  C MAOI–meperidine

  D MAOI–ziprasidone

  E MAOI–loxapine

126. The psychiatrist’s right to maintain a patient’s secrecy in the face of a subpoena is known as:

  A Privilege

  B Confidentiality

  C Communication rights

  D Private rights

  E Clinical responsibility

127. Which one of the following is not a requirement for treatment with clozapine?

  A Baseline white blood cell (WBC) count before starting treatment

  B Two WBC counts during the first 7 days of treatment

  C Weekly WBC count during the first 6 months of treatment

  D WBC counts every 2 weeks after the first 6 months of treatment

  E WBC count every week for 4 weeks following discontinuation of clozapine

128. Which one of the following is not a change in sleep architecture noted in patients over age 65 years of age?

  A Lower percentage of stages 3 and 4 sleep

  B Less total REM sleep

  C Fewer REM episodes

  D Increased awakening after sleep onset

  E Shorter REM episodes

129. Which one of the following will increase clozapine levels?

  A Red wine

  B Cimetidine

  C Cheese

  D Acetaminophen

  E Aripiprazole

130. The most widely abused recreational substance among US high school students is:

  A Alcohol

  B Cocaine

  C Lysergic acid diethylamide (LSD)

  D Inhalants

  E Cannabis

131. Beck, in the theory supporting his cognitive triad, felt that “distorted negative thoughts” lead to:

  A Failure of good enough mothering

  B Transitional object development

  C Mania

  D Depression

  E Aggression toward the primary caregiver

132. The mechanism of action of the sleeping aid ramelteon involves which one of the following receptor systems?

  A Acetylcholine

  B GABA-A

  C Histamine

  D Melatonin

  E Norepinephrine

133. What is alogia?

  A Poverty of movement

  B Poverty of emotion

  C Poverty of speech only

  D Poverty of thought content only

  E Poverty of speech and thought content

134. The rapid-cycling specifier in bipolar I disorder applies to patients who have had _____ mood disturbance episodes over the previous _____.

  A 4; 6 months

  B 4; 12 months

  C 6; 24 months

  D 6; 12 months

  E 3; 12 months

135. Which one of the following best explains pathological gambling?

  A Primary reinforcement

  B Random reinforcement

  C Poor response to dexamethasone suppression testing

  D Continuous reinforcement

  E Cerebellar dysfunction

136. Late-onset schizophrenia is characterized by a more favorable prognosis and the onset of symptoms after age:

  A 40 years

  B 45 years

  C 50 years

  D 55 years

  E 60 years

137. A group that does not receive treatment and is the standard for comparison is called the:

  A Correlation coefficient

  B Control group

  C Analysis of variance (ANOVA)

  D Regression analysis

  E Null hypothesis

138. Bowlby’s stages of childhood attachment disorder, after a lengthy departure of the child’s mother, do not include which one of the following?

  A Protest

  B Despair

  C Detachment

  D Denial of affection

  E Acceptance

139. You have a patient whom you think has both depression and attention-deficit/hyperactivity disorder. Which one of the following medications would be the best choice for this patient?

  A Fluoxetine

  B Paroxetine

  C Bupropion

  D Venlafaxine

  E Imipramine

140. Which one of the following agents is FDA approved for use in the pediatric population under 18 years of age?

  A Paroxetine

  B Citalopram

  C Sertraline

  D Mirtazapine

  E Venlafaxine

141. During a session a therapist tells the patient “I know you feel terrible right now, but things are going to get better with the passage of time”. This type of statement is characteristic of which type of therapy?

  A Supportive psychotherapy

  B Psychodynamic psychotherapy

  C Psychoanalysis

  D Play therapy

  E Cognitive behavioral therapy

142. Which one of the following statements regarding risperidone intramuscular injection (Risperdal Consta) is false?

  A The formulation comes in three doses: 25, 37.5 and 50 mg

  B The drug must be refrigerated before reconstitution

  C The drug must be reconstituted with sterile water

  D The drug must be administered only to the deltoid or the gluteus muscles

  E The drug is dosed to be administered every 2 weeks

143. A patient is brought into the emergency room unconscious with signs of respiratory depression. The patient was found unconscious on the bathroom floor and has written a suicide note saying that he wanted to die. An empty pill bottle that had contained his mother’s prescription for morphine was found on the bathroom floor. Which one of the following would the knowledgeable physician use to treat this patient?

  A Buprenorphine

  B Benztropine

  C Naloxone

  D Naltrexone

  E Bromocriptine

144. Which one of KüblerRoss’ stages of reaction to impending death corresponds to a period when a patient goes through self-blame for his illness and asks “Why me?”

  A Shock and denial

  B Anger

  C Bargaining

  D Depression

  E Acceptance

145. Asking patients if they are suicidal will:

  A Increase the chance that they will kill themselves

  B Help them plan out their suicide

  C Scare the patients

  D Have no influence on whether patients will attempt suicide

  E Make patients refuse to speak to their therapist any further

146. The usual and accepted length of a period of grief following the death of a loved one can last up to:

  A 3 months

  B 6 months

  C 9 months

  D 12 months

  E 24 months

147. In which one of the following groups has suicide increased dramatically over the past 40+ years?

  A Geriatrics

  B Married men

  C Married women

  D Adolescents

  E Chronic alcoholics

148. Which one of the following sleep-promoting agents has the longest half-life?

  A Ramelteon

  B Zolpidem

  C Zaleplon

  D Eszopiclone

  E Triazolam

149. What is the therapeutic range for valproic acid?

  A 50–150 ng/mL

  B 25–50 ng/mL

  C 200–250 ng/mL

  D 1000–1500 ng/mL

  E 0.5–0.15 ng/mL

150. A psychiatrist interviews a Japanese immigrant who was brought to the hospital by her family for depression. In the meeting with her she does not endorse any significant symptoms. When speaking to the family, they state that she has been having many of the symptoms that she previously denied. Which one of the following is the most likely explanation for this situation?

  A She is lying

  B She is psychotic and paranoid

  C Culture

  D Mental retardation

  E The family is lying