Psychiatry MS3

Board Review
2012-2013

1. Dementia in Contrast to Delirium has which of

the following clinical features?

A. Acute onset
B. Disrupted Attention
C. Acutely worse cognitive dysfunction
D. Fluctuation of symptoms
E. Impoverished speech

2. A 6 year old boy comes to the doctor with a history of

complaint of constantly getting in trouble at school for
talking out of turn, running and he just doesnt listen.
Mother has placed the child in a smaller individualized
class but he continues to have difficulty focusing and is
falling behind in school. The psychiatrist prescribes
methylphenidate. Which is a possible side effect of this
A.medication?
Seizure
B. Motor Tics
C. Weight loss/anorexia
D. insomnia
E. All of the above

3. Which of the following is an approved medication

for Treatment of Alzheimers Dementia?

A.
B.
C.
D.
E.

Paroxetine
Sertraline
Haloperidol
Rivastigmine
methylphenidate

4. 55 year old patient with history of bipolar is admitted

after intentional overdose with altered mental status, ataxia
and then has a seizure. Thorough workup reveals Lithium
level of 4.1 meq/L. Which of the following treatments would
be recommended?

A. IV normal saline
B. Emergent dialysis
C. Administration of IV benztropine
D. Cardiac Monitoring
E. Flumazenil

5. A 57 y/o homeless male is brought into the Emergency Dept after he

was found acting confused in a local park. Police noted the man to be
stumbling and unable to maintain his gait. He seemed altered and
could not give answers to simple questions. On arrival, patient
remained confused, he was disoriented to person, time, and place. He
was unable to walk on his own and had noted ophthalmoplegia on
physical exam. Which of the following most likely explains his
presentation?
A. Alcoholic hallucinosis
B. Wernickes encephalopathy
C. Korsakoff syndrome
D. Dementia
E. Schizophrenia

6. A 1 y/o girl is brought in to the physician by her mother. The child

had been developing normally until about 6-9 months of age. At 9
months, her mother noticed that the girls head growth had begun to
decelerate, she seemed floppy, and she had lost interest in playing.
She had recently been noted to have episodes of crying, screaming,
and intense hyperactivity. Which of the following is the most likely
diagnosis?
A. Aspergers disorder
B. Down syndrome
C. Congenital rubella
D. Retts disorder
E. Childhood disintegrative disorder

7. A patient is admitted with overdose of desipramine, he is

tachycardic and has dry mucous membranes, his VBG
shows metabolic acidosis. what would be expected on the
EKG?

A. Inverted T waves
B. Frequent PVCs
C. QRS prolongation
D. Right axis deviation

8. An 18 y/o girl is brought into the office by her family because of

concern about continued weight loss and amenorrhea. Her mother
states that patient is a ballet dancer and has intense fear of gaining
weight. She refuses to have dinner with the family, and when forced
she cuts food into small pieces and rearranges them on the plate, but
will not eat. She is engaging in excessive exercise routines and has
repeatedly stated to others that she is fat and will never make it as a
dancer with these thunder thighs. In the office, patient is noted to be
cachectic with a BMI of 17. Which of the following medical
complications is seen with this condition?
A. Leukopenia
B. Hypokalemic alkalosis
C. Lanugo
D. Fatty degeneration of the liver
E. All of the above

9. Which of the following is true of Capgras Syndrome?

A. It is also called erotomania.

B. It is also called delusion of doubles.
C. It is usually associated with brain disease.
D. It is the same as hysteria.
E. It is seen in husbands of pregnant women.

10. A 2 y/o girl is being toilet trained by her parents. Each time she
soils her diaper, she is told that she is a very bad girl and she is
punished by having a toy taken away. When she uses the toilet
appropriately, she is not praised by her parents. Which of the following
sequelae is the child likely to experience as a result of this kind of
parental behavior?
A. A basic sense of mistrust
B. Shame and self-doubt
C. Guilt
D. Stagnation of her development
E. An absence of intimacy as an adult

Erickson
1. Basic trust v mistrust (birth to 1 year)
2. Autonomy v shame and doubt (1-3 years
3. Initiative v guilt (3-6 years)
4. Industry v inferiority (6-12 years)
5. Identity v role confusion (12-20 years
6. Intimacy v isolation (20-40 years):
7. Generativity v stagnation (40-65 years)

8. Ego integrity v despair (65 and older)

11. Which of the following is most important when trying to differentiate

between autistic disorder and Aspergers disorder?
A. Normal cognitive abilities
B. Restricted patterns of interest
C. Language development
D. Inflexible adherence to routines
E. Impairment in peer relationships

12. A gait disorder characterized by broad base, flexed trunk, and

small shuffling steps, is more likely to be associated with which of the
following conditions?
A. Cerebrellar ataxia
B. Huntingtons chorea
C. Cervical spondylosis
D. Parkinsons disease
E. Normal pressure hydrocephalus

13. A 25 y/o patient is evaluated for hoarding, intrusive thoughts, and

frequent handwashing, which started 2 years ago and now interferes
with daily life. In addition to psychotherapy, which of the following
medications would be most appropriate to begin?

A. Bupropion
B. Olanzapine
C. Clomiprimine
D. Mirtazepine
E. Alprazolam

14. A 15 y/o teenager is found unresponsive by parents after returning

home from a party. The parents suspect a drug overdose and friends
admit that the teenager had heroin at the party. Which of the following
signs are most likely present in this teen?

A. Diarrhea
B. Piloerection
C. Pupillary constriction
D. Rhinorrhea
E. Hypertension

15. A mother brings her 8 y/o son for an evaluation because he needs
some medicine for his behavior. The child reportedly argues with his
mother and is described as being angry and rude with her. The boy
has a temper tantrum when the examiner refuses to allow him to get a
drink of water. A discussion with the boys teacher reveals no trouble
attending to school work, but occasional refusal to do certain projects
and frequent bothering of other children. The most likely diagnosis is :
A. Depression
B. Conduct disorder
C. Reactive attachment disorder
D. Oppositional Defiant Disorder
E. ADHD

16. A 25 y/o man experienced a closed head injury in a motor vehicle collision.
Initially he had no loss of consciousness, behaved normally, and looked alert,
oriented, and coherent. Twenty minutes later, the patient turned pale and fell to
the ground unconscious. He recovered in 5 minutes. The most likely cause of
this episode was:

A. Subdural hematoma
B. Subarachnoid hematoma
C. Intracranial hemorrhage
D. Vasovagal syncopal attack
E. Dissecting aneurysm of the internal carotid artery

17. A 35 y/o patient is brought into the ED by a friend. The patient is

hypoventilating and has blue lips, pinpoint pupils, crackles on lung
auscultation, and a mild arrhythmia on EKG. Which of the following
drugs is most likely to be responsible for the symptoms?

A. Codeine
B. Alcohol
C. LSD
D. Cocaine
E. Diazepam

18. The parents of a 2 y/o child come to see the childs pediatrician
because their once happy-go-lucky infant has become oppositional and
obstinate. According to Freudian theory, which of the following
developmental stages is this child in?

A. Oral
B. Anal
C. Phallic
D. Oedipal
E. Latency

19. A 46 y/o M is being monitored in a sleep study lab. After he has

been asleep for 90 minutes, his EEG shows low voltage, random fast
activity with sawtooth waves. When awakened during this period, the
patient reports that he was dreaming. Which of the following sleep
stages was this patient in when awakened?
A. Alpha waves
B. Theta waves
C. Sleep spindles
D. Delta waves
E. Rapid eye movement (REM)

20. A young woman presents to the emergency room with a history of

intractable seizures and mental retardation. You discover she has
sever acne, skin depigmentation on her back and blotchy patches on
her retinal surface on fundoscopic examination. The most likely
diagnosis is:

A. Downs syndrome
B. Retts disorder
C. Neurofibromatosis
D. Tuberous sclerosis
E. Prader-Willi syndrome

21. A young girl who was underweight and hypotonic in infancy is

obsessed with food, eats compulsively, and at age 4, is already grossly
overweight. She is argumentative, oppositional, and rigid. She has a
narrow face, almond-shaped eyes, and a small mouth. Which of the
following is the most likely diagnosis?

A. Down syndrome
B. Fragile X syndrome
C. Fetal alcohol syndrome
D. Lesch-Nyhan syndrome
E. Prader-Willi syndrome

22. A child is brought into 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 Piagets developmental stages?

A. Sensorimotor
B. Preoperational thought
C. Concrete operations
D. Formal operations
E. Symbiosis

23. A 45 y/o woman with bipolar disorder complains of amenorrhea,

galactorrhea, decreased libido and anorgasmia. She presents to the
emergency room with an elevated serum prolactin level and is on
risperidone 4mg daily for bipolar disorder. On neurologic examination
you discover decreased vision in both lateral fields. The most likely
diagnosis is:

A. Acute right parietal stroke

B. Thalamic hemorrhage
C. Pituitary macroadenoma
D. Acute left parietal stroke
E. Midbrain infarct

24. A 48 y/o woman presents to your office with complaints of

lancinating, brief, sharp pain to the left side of her face. The pain is
short-lived and recurrent. It is triggered frequently by cold air touching
her face. The pharmacologic treatment of choice for this condition is

A. Divalproex sodium
B. Clonazepam
C. Carbamazepine
D. Tiagabine
E. Risperidone

25. 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 mans 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

26. A young woman comes to the emergency room with a one 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

27. Which 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
E. Electroconvulsive therapy

28. A 26 y/o woman comes into the ER. 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. Major depressive disorder, with psychotic features
C. Schizoid personality disorder
D. Borderline personality disorder
E. Schizotypal personality disorder

29. 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 husbands 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 wifes 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

30. A 45 y/o woman comes to the emergency room by ambulance

unconscious and barely breathing. Paramedics found an empty bottle
of 90 tablets of 2mg 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

31. A 60 y/o woman is 63 pounds overweight. She comes to her

psychiatrists 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 patients symptoms?

A. Night terrors
B. Major depressive disorder
C. Bipolar disorder
D. Narcolepsy
E. Sleep apnea

32. A patient is brought into the ER unconscious with signs of

respiratory depression. The patient was found unconscious on the
bathroom floor and has written a suicide not saying the he wanted to
die. An empty pill bottle which had contained his mothers 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

33. A 55 y/o woman lives on her own. She wears odd clothes and
pokes around in her neighbors garbage cans. She claims to have
psychic powers but does not report hearing voices. What is the most
likely diagnosis for her condition?

A. Schizoid personality disorder

B. Schizotypal personality disorder
C. Asperger syndrome
D. Avoidant Personality disorder
E. Schizophrenia

34. A 26 y/o woman presents who appears to have generalized anxiety

disorder with panic attacks. Terrified by the panic attacks, she requests
medication, saying I need something to control them immediately.
She is otherwise fit and healthy and has no history of any substance
abuse or dependence. A reasonable approach would be to

A. Start the patient on intensive psychotherapy

B. Start the patient on a combination of Bupropion and clonazepam
C. Start the patient on an SSRI
D. Start the patient on an SSRI and refer the patient to cognitivebehavioral therapy
E. Start the patient on a combination of an SSRI for the long term and
low-dose clonazepam for a short duration

35. The DSM IV diagnostic criteria for Acute Stress disorder include
most of the criteria for PTSD, but they add and emphasize one of the
following:

A. Dissociative symptoms
B. Psychotic symptoms
C. Neurotic symptoms
D. Depressive symptoms
E. Cognitive symptoms

36. A 28 y/o woman is admitted to a general medical unit for

hypoglycemia. A psychiatry consultation is requested because the
patients story doesnt fit. The patient tells the psychiatrist how bad
the problem is and uses medical jargon. She appears to be an
intelligent person with strong dependency needs. The nurse interrupts
the psychiatrist and tells him that she found insulin-filled syringes
beneath the patients pillow. This upsets the patient and she bolts. The
most likely diagnosis is

A. Somatization disorder
B. Hypochondriasis
C. Factitious disorder
D. Malingering
E. Munchausen syndrome by proxy

37. A 34 y/o male is seen in the psychiatric ER of a city hospital for

bizarre presentation. Social worker tells the psychiatrist that after
obtaining extensive collateral information, she learned that the patient
lives in a nearby town and was normal until a severe earthquake hit
the town recently. He is not able to recall his personal information, and
neither is he able to explain how he traveled the 65 miles from his town
or when he arrived in this city. There is no history of any substance
abuse and family members are concerned. What is the most likely
diagnosis?
A. Dissociative amnesia
B. Dissociative fugue
C. Transient global amnesia
D. Malingering
E. Dissociative identity disorder

38. A 25 y/o woman begins to see a therapist because of loneliness

and feelings of being unloved and unwanted with some mild depressive
symptoms. She flirts constantly with the therapist and is hurt when the
therapist does not reciprocate. Which of the following disorders is she
most likely to have?

A.
B.
C.
D.
E.

Antisocial personality disorder

Borderline personality disorder
Schizotypal personality disorder
Obsessive-compulsive disorder
Histrionic personality disorder

39. Which of the following is true regarding factitious disorder?

A.

B.
C.
D.

The goal of the person exhibiting the

symptoms is to avoid unpleasant
consequences at work.
It is easily diagnosed.
It is the same as malingering.
The goal of the person exhibiting the
symptoms is to assume the sick role.

40. A 38 y/o man presents with unilateral periorbital pain with ipsilateral
tearing and nasal discharge. He also has ptosis and miosis. The pain
is sharp and lasts for about 1 hour. What is the most likely diagnosis?

A.
B.
C.
D.
E.

Brain tumor
Migraines
Tension headache
Cluster headache
Retinal detachment

41. You are asked to see a 42 y/o male patient on a surgical ward who
had a major operation 2 days ago and is now exhibiting bizarre
behavior. He expresses fears that aliens are coming to take him away
and appears to be responding to hallucinations. On examination he is
tremulous and sweating. His laboratory workup is subnormal with
increased MCV and GGT. What is the most likely cause of his
symptoms?

A.
B.
C.
D.
E.

Alcohol withdrawal
Schizophrenia
Severe depression
Delirium tremens
Alcoholic hallucinosis

42. An 18 y/o girl presents to the student guidance clinic at her school.
She reports that she has a problem with eating. She describes eating
too much and faster than usual in episodes that she is unable to
control. She usually does this when not in the presence of others. She
does not report any purging behavior. What is the name of the disorder
she describes?

A.
B.
C.
D.

Bulimia nervosa, non purging

type
Impulse control disorder
Binge eating disorder
Anorexia, bingeeating/purging type

43. A 32 y/o man is seen in the psychiatry outpatient clinic after going
crazy. He states that 4 months ago he was involved in an automobile
accident and was trapped in his car for several hours. Since then he
has not been able to drive and has nightmares about the accident. He
also complains of difficulty sleeping and inability to concentrate at work;
he says that he feels nervous and on edge all the time. The diagnosis
is:

A.
B.
C.
D.
E.

Acute PTSD
Acute stress disorder
Chronic PTSD
Major depressive disorder
Panic disorder

44. A 45 y/o policeman who has demonstrated great courage on more

than one occasion while on duty is terrified of needles.
A.
B.
C.
D.
E.
F.
G.

Agoraphobia
Panic disorder
Obsessive-compulsive
disorder
Social phobia
Adjustment disorder
Specific phobia
Acute stress disorder

45. For several months, a 32 y/o housewife has been unable to leave
her house unaccompanied. When she tries to go out alone, she is
overwhelmed by anxiety and fear that something terrible will happen to
her and nobody will be there to help.

A.
B.
C.
D.
E.
F.
G.

Agoraphobia
Panic disorder
Obsessive-compulsive
disorder
Social phobia
Adjustment disorder
Specific phobia
Acute stress disorder

46. A 17 y/o girl blushes, stammers, and feels completely foolish when
one of her classmates or a teacher asks her a question. She sits at the
back of the class hoping not to be noticed because she is convinced
that the other students think she is unattractive and stupid.

A.
B.
C.
D.
E.
F.
G.

Agoraphobia
Panic disorder
Obsessive-compulsive
disorder
Social phobia
Adjustment disorder
Specific disorder
Acute stress disorder

47. Two years after she was saved from her burning house, a 32 y/o
woman continues to be distressed by recurrent dreams and intrusive
thoughts about the event.
A.
B.
C.
D.
E.
F.
G.
H.

Somatization disorder
Specific phobia
Dissociative identity d/o
OCD
Dissociative fugue
PTSD
Body dysmorphic d/o
Dysthymia

48. A 20 y/o student is very distressed by a small deviation of his nasal

septum. He is convinced that this minor imperection is disfiguring,
although others barely notice it.
A.
B.
C.
D.
E.
F.
G.
H.

Somatization disorder
Specific phobia
Dissociative identity d/o
OCD
Dissociative fugue
PTSD
Body dysmorphic d/o
Dysthymia

49. A nun is found in a distant city working in a cabaret. She is unable

to remember anything about her previous life.
A.
B.
C.
D.
E.
F.
G.
H.

Somatization disorder
Specific phobia
Dissociative identity d/o
OCD
Dissociative fugue
PTSD
Body dysmorphic d/o
Dysthymia

50. A 35 y/o woman is often late to work because she must shower
and dress in a very particular order or else she becomes increasingly
anxious.

A.
B.
C.
D.
E.
F.
G.
H.

Somatization disorder
Specific phobia
Dissociative identify d/o
OCD
Dissociative fugue
PTSD
Body dysmorphic d/o
Dysthymia

51. For the past three years, a 24 y/o college student has suffered from chronic
headache, back, neck, hand and shoulder pain, fatigue, shortness of breath,
dizziness, ringing ears, impotence, nausea, and constipation. He is incensed
when his primary physician recommends a psychiatric evaluation because no
organic cause for his symptoms can be found.

A.
B.
C.
D.
E.
F.
G.
H.

Somatization disorder
Specific phobia
Dissociative identity d/o
OCD
Dissociative fugue
PTSD
Body dysmorphic d/o
Dysthymia

52. A 26 y/o female reports daily depressed mood for 6 months with
increased sleep and appetite, and decreased interest and
concentration. Upon questioning, she denies nay periods of euphoric
mood but her spouse admits a few days of up mood every now and
then, with increased energy, decreased need for sleep, increased
house cleaning, and increased talkativeness. She denies that those
up periods interfere with her function; in fact, she functions better
during those periods. What is the most likely diagnosis?

A. Bipolar disorder, type I

B. Cyclothymia
C. Dysthymia
D. Unipolar depression
E. Bipolar disorder, type II

53. Ideally, what is the BEST first treatment in a patient with bipolar
disorder, type II?

A. An antidepressant
B. Cognitive behavioral therapy
C. Lithium
D. An anti-anxiety medication
E. ECT

54. By what age should a child have a six-word vocabulary, be able to

self-feed, and be able to walk up steps with his hand being held?
A. 6 months
B. 9 months
C. 12 months
D. 18 months
E. 24 months

55. A 20 y/o M 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 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. Trisomy21
D. Deletion on the paternal chromosome 15
E. Trisomy 18

56. A 50 y/o man is brought to the ER by ambulance. His respirations

are shallow and infrequent, his pupils are constricted, and he is
stuporous. He was noted to have suffered a grand mal seizure in the
ambulance. Which of the following drugs is this man likely to have
overdosed on?

A. Cocaine
B. LSD
C. Meperidine
D. PCP
E. MDMA (Ecstasy)

57. After ensuring adequate ventilation for this patient,

which of the following interventions should be next?

A. IV naloxone
B. IV phenobarbitol
C. IV diazepam
D. Forced diuresis
E. IM haloperidol

58. A 35 y/o man stumbles into the emergency room. His pulse is 100
bpm, blood pressure is 170/95, and he is diaphoretic. He is tremulous
and has difficulty relating a history. He does admit to insomnia the past
two nights and sees spiders walking on the walls. He has been a
drinker since age 19, but has not had a drink in three days. Which of
the following is the most likely diagnosis?

A. Alcohol-induced psychotic disorder

B. Wernickes psychosis
C. Alcohol withdrawal delirium
D. Alcohol intoxication
E. Alcohol idiosyncratic intoxication

59. Three policemen, with difficulty, drag an agitated and very

combative young man into an emergency room. Once there, he is
restrained because he reacts with rage and tries to hit anyone who
approaches him. When it is finally safe to approach him, the resident
on call notices that the patient has a generalized seizure. Which of the
following substances of abuse is the most likely to produce this
presentation?
A. Amphetamine
B. PCP
C. Cocaine
D. Meperidine
E. LSD

60. A 27 y/o professional football player sees flashes of light brightly

colored triangles and circles on the white walls of his home. He also
sees trailing images following moving objects and what seems to be a
pattern in the air. He has had similar experiences in the past, mostly
when he was ill or very tired. Which of the following past experiences
is most likely to be the cause of such perceptions?

A. He sniffed paint thinner twice at age 14

B. He used LSD four or five times at age 22
C. He smoked three to four joints every day
from age 17 to 21
D. He drinks five to six cups of coffee a day
E. He used to binge on alcohol once a week
during college years

61. A 19 y/o man is diagnosed with paranoid schizophrenia. He has

command auditory hallucinations and persecutory delusions, but is also
apathetic and withdrawn, with a flat affect. Which of the following
medications is most likely to treat both the positive and the negative
symptoms of this patient?

A. Chlorpromazine
B. Fluphenazine
C. Olanzapine
D. Quetiapine
E. Trifluoperazine

62. A 25 y/o man with MDD discusses the potential benefits and side

effects of various antidepressants with his psychiatrist. He clearly

indicates that he does not want a medication that could decrease his
libido or interfere with his ability to obtain and maintain an erection.
Which of the following antidepressants would be most appropriate for
this patient?
A. Bupropion
B. Clomipramine
C. Amitriptyline
D. Sertraline
E. Paroxetine

63. An 85 y/o M is brought to the psychiatrist by his wife. She states

that for the last four months since the death of his son, the patient has
been unable to sleep, has lost 20lb, has crying spells, and in the last
week has been starting to talk about suicide. She notes that he has
numerous other medical problems, including prostatic hypertrophy,
hypertension, insulin-dependent diabetes, and a history of myocardial
infarction. Which of the following medications is most appropriate for
the treatment of this patient?
A. Doxepin
B. Clonazepam
C. Sertraline
D. Tranylcypromine
E. Amitriptyline

64. A couple comes into the ER. The wife says that her husband had
become convinced that she is cheating on him, and that it is not true.
He has been following her, smelling her clothing, going through her
purse, and making regular accusations. He does not meet criteria for a
mood disorder. He denies other psychotic symptoms. Medical and
substance abuse history are negative. What is his diagnosis?
A. Schizophrenia
B. Major depressive disorder with
psychotic features
C. Delusional disorder
D. Delirium
E. Shared psychotic disorder

65. A 70 y/o male with a dementing disorder dies in a car accident.

During the previous five years, his personality had dramatically
changed and he had caused much embarrassment to his family dur to
his intrusive and inappropriate behavior. Pathological examination of
his brain shows frontotemporal atrophy, gliosis of the frontal lobe white
matter, characteristic intracellular inclusions, and swollen neurons.
Amyloid plaques and neurofibrillary tangles are absent. Which of the
following is the most likely diagnosis?
A. Alzheimers disease
B. Picks disease
C. Creutzfeld-Jakob disease
D. B12 deficiency dementia
E. HIV dementia

66. For the past 10 years, the memory of a 74 y/o woman has
progressively declined. Lately, she has caused several small kitchen
fires by forgetting to turn off the stove, she cannot remember how to
cook her favorite recipes, and she becomes disoriented and confused
at night. She identifies an increasing number of objects as that thing
because she cannot recall the correct name. Her muscle strength and
balance are intact. Which of the following is the most likely diagnosis?

A. Picks disease
B. Multi-infarct dementia
C. Huntingtons disease
D. Alzheimers disease

67. A woman feels jealous and hurt when, at a family gathering, her
husband flirts with her younger cousin. She makes a conscious
decision to put her feelings aside and to wait for a more appropriate
moment to confront her husband and convey her emotions. Which of
the following defense mechanisms this woman exhibiting?

A. Distortion
B. Repression
C. Isolation of affect
D. Suppression
E. Displacement

68. A 34 y/o M is deeply envious of his younger but much more

successful brother. Although it is difficult for him to admit, he believes
the younger brother was their parents favorite as well. He tells his
friends that his younger brother is envious of his good looks and
successes with women, even though there is some evidence that this is
not so. Which defense is this man exhibiting?

A. Denial
B. Projection
C. Reaction formation
D. Intellectualization
E. Splitting

69. A young woman with Bipolar Disorder is started on Aripriprazole 10

mg per day. Two days later she reports feeling unable to sit still, trouble
sleeping, restlessness, cant get comfortable, and needs to pace to
relieve these feelings. What is the most likely explanation?

A.
B.
C.
D.
E.

Early manifestation of NMS

Worsened Mania
Akathisia
Torticollis
Allergic to Aripriprazole (Abilify)

70. Which medication will be most helpful for treating Akathisia?

A. Propranolol
B. Phenytoin
C. Amantadine
D. Benztropine
E. Haloperidol

71. A 25 Y/O male with MDD is interested in anti-depressant treatment

but is worried about reported sexual side effects of some medications.
Which of the following anti-depressants has the lowest incidence of
sexual side effects (decreased libido, difficulty achieving or maintaining
an erection, delayed orgasm or anorgasmia)?

A. Clomipramine
B. Amitriptyline
C. Sertraline
D. Paroxetine
E. Bupropion

72. A 25 Y/O man is admitted to the MICU following a suicide attempt

by toxic ingestion. In the ER noted to be obtunded and urine output
was half of expected for his age. Lithium level was 4.5 meq/L. What is
the best next step in treatment of this patient?

A.
B.
C.
D.
E.

IV Normal Saline at 1L/Hour

Emergency Dialysis
Administration of Benztropine IM
Admit to MICU for close monitoring and telemetry
Administration of Flumazenil

73. A 41 year old woman visits her local psychiatrist out of sheer
boredom. She is started on a new medication and 10 days later her
nipples start leaking. What class of medication was started?

A. Benzodiazepines
B. SSRI
C. Anti-epileptic medication with mood stabilizing properties
D. Anti-Psychotic (Neuroleptic)
E. TCA

74. A 35 Year Old woman with Bipolar Disorder was recently started on
carbamazepine. She develops a high fever, chills, bleeding gums,
pallor and fatigue. What is she experiencing?

A.
B.
C.
D.
E.

Stevens Johnson Syndrome

Acute Aplastic Anemia
Serotonin Syndrome
Neuroleptic Malignant Syndrome
Malignant Hypertension