Select the single best response for each of the questions on this page.

1. A cognitive therapy approachto suicidal behavior would focus primarily on:

A. understandingthe patient's developmentaldeficits and rectifying early problematic
attachments.
B. addressingall-or-nothing beliefs and helping the patient learn problem-solving
techniques
C. exploring interpersonalskills and using exposuretechniquesfor anxiety-provoking
situations.
D. identifying underlying role transitions or disputesand helping the patient resolve
these.

2. A 4O-year-oldman has developedgradually progressivedementia and abnormal

involuntary movements. His older brother and his father have a similar illness. The
best diagnostictest for the detectionof this condition is:
A. excessCAG triplets in DNA analysis.
B. Fragile X chromosome.
C. Kayser-Fleischerring.
D. excessiveIgG synthesisin cerebrospinalfluid (CSF).

3. A psychiatristis treatingan older patient with depressionwho is a successful

executive. The patient is grateful for how much the depressionhas improved. The
patient offers the psychiatristsometips on investing sincethis is the patient's areaof
expertise. The psychiatrist'smost appropriateaction at this point is to:
A. report the patient for insider trading.
B. acceptthe information graciously,but do not act on it.
C. explore the patient's meaningsand feelingsaboutthe offer.
D. acceptthe offer as a way of validating the patient's successand gratitude.

4. The most common time for a patientwith schizophreniato attemptsuicideis

during the:
A. acutehospitalizationphase.
B. active hallucinatoryphase.
C. recoveryphaseof the illness.
D. later stagesof the disease.

5. Which of the following eventscommonly precipitatesa "midlife crisis"?

A. Bith of the first child
B. Questioningof sexualidentity
C. Death of a spouse
D. Recognitionof unattainablegoals

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 Select the single best response for each of the questions on this page.

6. The out-of-state children of a 90-year-old widower fly into town and bring their
father to see a psychiatrist. The children tell the psychiatrist they need to know
"has gone bonkers." They becameconcerned3 months ago
whether their father
when they realized that a woman in her 50s (whom they had never heard their father
mention before) had begun living with their father. The father, who had been living
alone for the past 10 years,has no history of psychiatric illness, but has multiple
chronic medical illnesses. The children statethat the woman is doing nothing to care
for their father, but appearsto have control of their father's finances. The woman
"signed over power of attorney" voluntarily
has told the children that their father has
to her. The children want to report the woman for elder abuse,as they feel that their
father is acting contrary to his own interests. The most relevant issuesfor a geriatric
or forensic psychiatrist in this caseare:
A. the father's relationship with his children and whether he wants them involved in his
decisions.
B. whether the father has voluntarily signed the power of attomey and whether the
children agreewith this decision.
C. whether the father has a mental disorder and whether it is adequatelytreated.
D. whether the children are perpetrating a scam to have their father entrust his assetsto
them.

7. The common experienceof becoming so caught up in a movie that one ignores the
surrounding environment is an example of which of the following componentsof the
hypnotic process?
A. Dissociation
B. Suggestibility
C. Trancelogic
D. Absorption

8. What is the earliest age that infants prefer to look at strongly patterned shapes,such
as faces?
A. l week
B. 4 weeks
C. 8 weeks
D. 12 weeks

9. The incidence of delirium in hospitalized, acutely ill geriatric patients is

approximately:
A. IVo.
B. l0Vo.
C. 407o.
D. 80Vo.

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 Select the single best response for each of the questions on this page.

10. Alcohol intoxication characteristicallycauseswhich of the following sleep

abnormalities?
A. Increasedsleeplatency
B. Increasedrapid eye movement (REM) sleep
C. Early morning awakening
D. Fragmentation of stage4 sleep

11. A primary carephysicianrefers a 36-year-oldman to a psychiatristfor a consultation

becauseof concern that the patient's symptoms of depressionhave not improved in
the year since he was fired from his job, even though he has started another one. The
female psychiatrist listens to the patient's somewhathesitant portrayal of this event
as being proof of his inadequacyand his fears that the new employer may also fire
him "sooner or later." The psychiatrist says,"Men often feel that they are not
allowed any failures, but I can tell already that you have moved on from this
successfullyand have no reasonto dwell on it." The intervention, intended as
reassurance,is followed by the patient withdrawing further and saying little for the
rest of the interview. The most likely causefor the patient's responseis that he felt:
A. judged by the psychiatrist and feared incurring further disapproval.
B. cut off by the prematureoffering of reassurance.
C. understoodby the psychiatrist and is moving on from his preoccupation.
D. gratified by the psychiatrist's assessmentof his successand wanted to leave it at that.

12. 432-year-old patient presentswith a 1-month history of worsening headaches,

episodicmood swings,and occasionalhallucinationswith visual, tactile, and
auditory content. A computerizedtomography (CT) scan of the head is most likely
to reveal a tumor in which of the followins areas?
A. Frontal lobe
B. Temporal lobe
C. Parietal lobe
D. Occipital lobe
E. Hypothalamus

13. A 3-year-old girl who hurt herself after falling off her tricycle hits the tricycle,
saying "You mean tricycle. Why did you hurt me?" Which of the following thought
processesdoes this behavior best exemplify?
A. Animism
B. Regression
C. Literalness
D. Egocentricity
E. Assimilation

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 Select the single best response for each of the questions on this page.

14. Flumazenil may be used to treat which of the following states?

A. Anticholinergic intoxication
B. Hypertensivecrisis
C. Serotonin syndrome
D. Benzodiazepineintoxication
E. Amphetamineintoxication

15. A clinically significantincreasein the concentrationof lamotrigine may occur if it is

coadministeredwith
A. lithium.
B. carbamazepine.
C. valproic acid.
D. risperidone.
E. clozapine.

16. A2l-year-old patient notices pain in the left periorbital region, followed by blurring
of vision and then loss of vision in the left eye. Examination shows normal eye
movements.The pupils react when light is shoneon the right eye, but there is no
reaction when light is shoneon the left eye. No funduscopic abnormalities are seen.
These developmentsare most consistentwith:
A. ischemic optic neuropathy.
B. a demyelinating lesion of the left optic nerve.
C. acuteglaucoma.
D. diabetic third nerve palsy.
E. an infarct of the right occipital cortex.

L7. A42-year-old woman presentsto her primary care physician complaining of "not
feeling like myself' for the past 3 weeks since she lost her job. The patient denies
"depressed,"
feeling but says she is having difficulty sleeping, has not been eating
well, and is constantly worried about the future. The most appropriatebrief
screeninginstrument that the patient could fill out herself in the physician's office
that would help clarify the patient's current symptoms is the:
A. Global AssessmentScale.
B. HamiltonRating Scalefor Depression.
C. Mini-Mental StatusExamination.
D. Symptom Checklist - 90 - Revised.
E. Beck DepressionInventory.

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1 8 . 434-year-old woman presentsfor the first time for psychiatric treatment, stating she
has been "unable to reach her potential." She statesthat her mood switches
frequently (day-to-day, sometimeswithin one day) from mildly to moderately
depressedto happy and energetic. She states,"I have no idea what kind of mood I'll
be in when I wake up in the morning." She has not had episodesclearly meeting
criteria for mania. The history suggeststhat the most appropriatediagnosis for this
patient's primary disorderis:
A. major depressivedisorder, recurrent.
B. cyclothymic disorder.
C. borderline personality disorder.
D. histrionic personality disorder.
E. bipolar I disorderwith rapid cycling.

19, which of the following is a muscarinicside effect of antidepressants?

A. Sedation
B. Urinary retention
C. Weight gain
D. Anxiety
E. Posturalhypotension

20. Adolescentswho are taking lithium give which of the following as the most common
reasonfor stopping treatment with the drug?
A. Priapism
B. Total body rash
C. Polyuria
D. Worseningacne
E. Weight loss

21. A 55-year-old patient with chronic atrial fibrillation develops aphasiaand right
hemiparesisacutely while having lunch with family members at 12 noon. Although
the examination in the emergencydepartment(ED) shows moderate weaknessof the
right extremities and a moderately severedysfluent aphasia,the computeized,
tomography (CT) scandone at 1:30 ptvtshows no acute lesion. The most appropriate
therapyis:
A. low-molecular-weight heparinoid.
B. aspirin.
C. intravenousheparin.
D. tissueplasminogenactivator(TPA).
E. clopidogrel.

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 Select the single best response for each of the questions on this pase.

22. Which of the following depressivesymptoms is consideredto be a melancholic

featuresspecifierin DSM-IV?
A. Difficulty falling asleep
B. Overwhelming sadness
C. Recurrent thoughts of death
D. Depressionregularly worse in the evening
E. Lack of pleasure

23. The statisticalconceptof power is defined as the:

A. ability of a test to predict a condition.
B. relationship between two setsof paired measurements.
C. probability of rejecting the null hypothesiswhen it should have been rejected.
D. probability of acceptingthe null hypothesiswhen it should have been accepted.
E. interval that is likely to capturethe population mean with a specified level of
confidence.

24. Which of the following adversereactionsis most typically associatedwith

fluoxetine?
A. Tachycardia, flattened T waves, and prolonged QT intervals
B. Delusionsand hallucinations
C. Myoclonic twitches and tongue tremors
D. Nervousness,restlessness, and anxiety
E. Dry mouth and constipation

25. According to Erikson, a child who strives to be competent by learning new skills and
taking pride in results is in which of the following stagesof development?
A. Industry versusinferiority
B. Identity versus identity confusion
C. Autonomy versus shameand doubt
D. Trust versusmistrust
E. Initiative versusguilt

26. The Brown-Sequard syndrome that follows complete hemisection of the spinal cord
includes:
A. contralateralloss of pain and temperaturesensationbeginning somewherebelow the
lesion.
B. contralateralloss of tactile sensationbeginning somewherebelow the lesion.
C. contralateral lower motor neuron paralysis beginning at the level of the lesion.
D. ipsilateral sensorychangessimilar to those seenin patients with amyotrophic lateral
sclerosisbeginningsomewherebelow the lesion.
E. the sametype of ataxic gait seenin patients with tabetic syndromes.

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 Select the single best response for each of the questions on this page.

27. Which of the following is the maximum length of time that a urine drug screencould
be positive for heavy daily use of cannabis?
A. 2 to 4 days.
B. 1 w e e k.
C. 2 weeks.
D. l month.
E. 2 months.

28. A therapeutictrial of methylphenidateis ineffective for a child who has attention-

deficit hyperactivity disorder, with no comorbid diagnosis. The next step in
managementshould consist of administration of:
A. clonidine.
B. fluoxetine.
C. bupropion.
D. imipramine.
E. dextroamphetamine.

29. A highly motivated patient in psychodynamicpsychotherapyfinds that he has

nothing to say, which is an example of:
A. denial.
B. agnosia.
C. resistance.
D. repression.
E. alexithymia.

30. A 58-year-old woman was found disoriented and wandering at the airport terminal.
Although she knew who she was, she could not remember how she got to the airport
nor why she was there. She was met at the airport by her niece who tried to re-orient
her many times, but the woman kept asking repetitive questions,even concerning
information she had just been given about her location. Her neurologic examination
was normal otherwise. The magnetic resonanceimaging (NRD scan of the brain and
electroencephalogram(EEG) were also normal. Within 12 hours, her symptoms
subsidedentirely. The most likely diagnosis of her problem was:
A. alcohol intoxication.
B. an acutedissociativestate.
C. an epileptic fugue state.
D. transientglobal amnesia.
E. attention-seekinebehavior.

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 Select the sinsle best response for each of the questions on this nage.

31. Which of the following is a characteristicof Cloninger's Type 1 alcoholism?

A. Late onset
B. Slow development of tolerance
C. Little guilt
D. Low reward dependence
E. High novelty seeking

32. The treatment of choice for severelithium intoxication is:

A. hemodialysis.
B. thiazide therapy.
C. managementof dehydration.
D. forced diuresis with mannitol therapy.
E. forced diuresis with furosemide therapy.

33. Which of the following is a risk factor for neuroleptic-inducedtardive dyskinesia?

A. Male gender
B. Anxiety disorder
C. Migraine headaches
D. Lower socioeconomicclass
E. Advanced age

34. Which of the following antidepressantagentshas the shortestelimination half-life?

A. Fluoxetine
B. Desipramine
C. Clomipramine
D. Trazodone
E. Doxepin

35. A 13-year-oldboy comes for assessmentof developmentaldelay, stereotypical

behaviors, impaired social interactions, and hyperactive behaviors. On examination,
he is noted to have large antevertedears,hyperextensiblejoints, and
macroorchidism. Which of the following syndromesis the most likely causeof his
clinical impairments?
A. Prader-Willi
B. Down's
C. Angelman's
D. Fragile X
E. DiGeorge

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 Select the single best response for each of the questions on this pase.

36. The primary role of a psychiatric expert witness is to:

A. argue as an adversary.
B. advancethe causeof psychiatry.
C. advise the court about the proper verdict.
D. statethe diagnosis and recommendedtreatment.
E. render an opinion basedon scientific knowledge.

37. Acute caffeine withdrawal has been reported to induce a distinct syndrome that
includes:
A. headache.
B. psychomotoragitation.
C. facial flushing.
D. diarhea.
E. slurred speech.

38. Patients with which of the following medical illnessesare most at risk for attempting
suicide?
A. Chronic fatigue and immunodeficiency syndrome
B. Terminal heart failure
C. Pancreaticcancer
D. Symptomatic HIV infection
E. Hepatitis C infection and liver failure

39. Which of the following FDA Use-in-Pregnancyratings describesthe risk of using

haloperidol during pregnancy?
A. Category A - Controlled studiesin humans show no risk.
B. Category B - Either animal studiesshow risk that is not substantiatedin human
studies,or animal studiesare negative and human studies are lacking.
C. Category C - Human studiesare lacking, and animal studies are positive for risk or
lacking. Use recommendedonly if the benefit outweighs potential risk.
D. Category D - There is positive evidence of human risk, but the benefit may outweigh
the risk.
E. Category X - It is contraindicated,becausethe fetal risk outweighs the benefit.

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 Select the single best response for each of the questions on this page.

40. Studies have shown that the two most powerful predictors of outcome in any form of
psychotherapyare:
A. length of treatment and frequency of sessions.
B. transferenceinterpretation and countertransferencemonitoring.
C. empathy and the therapeuticalliance.
D. correct diagnosis and therapist matching.
E. selection of focus and therapist activity.

41. Specificity of a test is defined as:

A. a false claim of true difference becausethe observeddifference is due entirelv to
chance.
B. the number of true positivesdivided by the sum of true positivesand false negatives.
C. the number of true positives divided by the sum of true positives and true negatives.
D. identifying the number of patients with the condition, who have a positive test result.
E. identifying the number of patients without the condition, who have a negative test
result.

42. A 47-year-old man drives himself to the emergencydepartment(ED) a few days

after being dischargedfrom the hospital for an extensive work-up to evaluate
recurrent chest pains that found no discernible pathology. In the ED, the physical
examination and medical testing are normal, but the patient refuses to leave, stating
that he needssurgery to "fix" his pain. A psychiatric consultation finds a well-
educated,lucid professional who is angry and expressesfear and despair that no one
can figure out what is wrong with him. The mental statusand neurological
examinations are normal and he denies suicidal or homicidal ideation. Past history
reveals that the patient's father died of lung cancer. The next intervention for the
psychiatristis to:
A. prescribepain medicationand p.r.n. benzodiazepines for anxiety.
B. explain to the patientthat his distressis stress-related.
C. explore the patient's feelingsabouthis father's death.
D. admit the patient to the medical unit for further tests.
E. admit the patient to the psychiatric unit for observation and treatment.

43. Which of the following is a primary characteristicof Wernicke's encephalopathy?

A. Acute onset
B. Associationwith alcoholic seizures
C. Association with retrogradeamnesia
D. Successfultreatment with folic acid
E. Associationwith visual hallucinations

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 Select the single best response for each of the questions on this page.

44. Brief episodesof suddenloss of muscle tone, often associatedwith intense emotion,
are characteristicof:
A. migraines.
B. narcolepsy.
C. panic attacks.
D. cocainewithdrawal.
E. dissociativeamnesia.

45. A 65-year-old patient with hypertensioncollapsedat home. In the emergency

department(ED), the patient is noted to be stuporous,with a right hemiparesisand
hemisensorydeficit, and the eyes are deviated to the left. The computerized
tomography (CT) scanwould most likely demonstratean intraparenchymal
hemorrhagein the:
A. right pons.
B. right thalamus.
C. left cerebellum.
D. left basalganglia.
E. right insular cortex.

46. Melancholia is characterizedby:

A. anhedonia.
B. oversleeping.
C. reactivemood.
D. hypersensitivityto rejection.
E. worsening of mood at the end of the day.

47. Which of the following is a predictor of a positive responseto lithium prophylaxis?

A. Rapid cycling
B. Mixed states
C. Substanceabuse
D. A history of good inter-episodefunction
E. Three or more prior episodes

48. Which of the following medications is most useful for treating autonomic symptoms
associatedwith withdrawal from heroin?
A. Alprazolam
B. Flumazenil
C. Clonidine
D. Methylphenidate
E. Diphenhydramine

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I
 Selectthe singlebestresponsefor eachof the auestionson this pase.

49. Testamentary
capacityrefersto a person'sability to:
A. participateasa witnessin court.
B. participateon a jury.
C. signchecks.
D. makea will.
E. standtrial.

50. 425-year-oldwomanwith no previoussignificantpsychiatricor medicalproblems

hasan acuteonsetof emotionallability, restlessness,
paranoidideation,andauditory
hallucinations.Shealsoexperiences abdominalpain,nausea,severeconstipation,
pain in her limbs, andheadache.Which of the following conditionsis mostlikely
indicatedby thesesymptoms?
A. Systemiclupuserythematosus
B. Acuteintermittentporphyria
C. Cushing'ssyndrome
D. Addison'sdisease
E. Pellagra

5 1 . Aphasia,which is characterizedby effortful, fragmented,dysfluent,telegraphic

speech,is seenwith lesionsaffectingthe:
A. cingulategyrus.
B. anteriortemporallobe.
C. posteriorfrontal lobe.
D. corpuscallosum.
E. parietallobe.

52. A patienttells the physician,"I feel thatI'm a womantrappedin a man's body." The
mostlikely diagnosisis:
A. androgeninsensitivitysyndrome.
B. genderidentity disorder.
C. transvesticfetishism.
D. hermaphroditism.
E. Klinefelter'ssyndrome.

53. The onsetof pubertyin boysbeginswith:

A. deepening of voice.
B. growthspurt.
C. testicularenlargement.
D. spermarche.
E. developmentof facial hair.

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 Select the single best resnonse for each of the questions on this page.

54. Physostigmineis useful in treating toxic syndromesresulting from overdosageof:

A. disulfiram.
B. alprazolam.
C. acetaminophen.
D. dexamethasone.
E. scopolamine.

5 5 . Head injury with resulting loss of consciousnessfollowed by a lucid interval of a few

hours, then a rapidly progressingcoma, is characteristicof which of the following
types of hemorrhage?
A. Intracranial
B. Subdural
C. Subarachnoid
D. Epidural
E. Petechial

56. A patient undergoing chemotherapycommonly becomesnauseatedand vomits in the

waiting room prior to treatment. This reaction is an example of:
A. classicalconditioning.
B. operantconditioning.
C. learnedhelplessness.
D. reciprocalinhibition.
E. flooding.

57. Which of the following drugs is effective in the prophylactic treatment of migraines?
A. Baclofen
B. Valproic acid
C. Rizatriptan
D. Ergotamine
E. Metoclopramide

5 8 . Which of the following personality disorders should be consideredin the differential

diagnosis of cyclothymic disorder?
A. Schizoid
B. Schizotypal
C. Dependent
D. Avoidant
E. Histrionic

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 Select the sinsle best response for each of the questions on this page.

59. Which of the following is used to evaluatethe relative frequenciesor proportions of

events in two populations that fall into well-defined categories?
A. t-test
B. Chi-square
C. Wilcoxon test
D. Analysis of variance(ANOVA)
E. Pearsoncorrelation coefficient

60. Which of the following antibiotics may significantly raise carbamazepinelevels and
precipitate heart block?
A. Amoxicillin
B. Cephalexin
C. Erythromycin
D. Penicillin
E. Tetracycline

6I. A 68-year-oldman experiencesstiffnessof the legs while walking and spasmsof the
lower extremities while trying to sleep. Examination reveals that the patient has a
very stiffJegged gait with a tendencyto adduct the legs while walking. The tone is
increasedin the lower extremities with a spasticcatch, knee jerks are hyperactive,
and clonus occurs during ankle jerks. The Romberg test reveals increasedsway
when the patient's eyesare closed. The diagnosismost likely is:
A. senile gait disorder.
B. cervical spondylosis.
C. restlesslegs syndrome.
D. alcoholic cerebellar degeneration.
E. Parkinson'sdisease.

62. Which of the following is a core feature of generalizedanxiety disorder?

A. Excessiveworrying
B. Lack of comorbid depressionor bipolar disorder
C. Presenceof anxiety for longer than one month
D. Hypervigilance
E. Lack of responseto cognitive-behavioral therapy

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63. Results of adoption studieson the relationship of heredity to the risk of alcoholism
reveal which of the following?
A. A strong associationexists in the biological sons of fathers with alcoholism who are
raised apart.
B. A strong associationexists in both sexesof the biological offspring of parentswith
alcoholism who are raised apart.
C. A strong associationexists in men raised by adoptive parentswith alcoholism.
D. A strong associationexists betweenheredity and alcoholism in women only.
E. A weak associationexists betweenheredity and alcoholism.

64. Which of the following in a patient with acute onset of vertigo would suggesta right
lateral medullary infarct?
A. Right facial loss of touch and temperaturesensation
B. Irft extremities intention tremor and dysmetria
C. I€ft trunk and extremities loss of position and vibratory sensation
D. Right trunk and extremities loss of position and temperaturesensation
E. Left facial loss of touch and temperaturesensation

65. Apoptosis of conical neurons differs from necrosisin that it:

A. is produced by extracellular agents.
B. producesan inflammatory response.
C. involves expressionof specific genes.
D. involves the death of neurons.
E. occurs only in cortical layer VI.

66. Which of the following personality disorders should be the main consideration in the
differential diagnosis of schizotypal personality disorder?
A. Dependent
B. Histrionic
C. Avoidant
D. Narcissistic
E. Antisocial

67. According to research,the most effective approachesin the behavioral treatment of

phobiasinvolve:
A. in-vivo exposure.
B. avoidancelearning.
C. sensate-focustraining.
D. assertivenesstraining.
E. contingencycontracting.

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 Select the single best response for each of the questions on this page.

68. Therapeutic focus on the patient's current social functioning is most characteristicof:
A. psychoanalyticpsychotherapy.
B. psychoanalysis.
C. supportivepsychotherapy.
D. . behavior therapy.
E. interpersonalpsychotherapy.

69. The most common organic causeof paranoid symptoms is:

A. hyperthyroidism.
B. a space-occupyingbrain lesion.
C. HIV disease.
D. stimulant abuse.
E. alcohol withdrawal.

70. Which of the following mechanismsbest describeswhy the neurolepticagent

risperidone causesvery little extrapyramidal side effects despite binding with high
affinity to a dopaminergic D2 receptor?
A. Dopaminergic Da antagonism
B. Serotoninergic 5-HT2 antagonism
C. Serotoninergic 5-HT3 antagonism
D. Serotoninergic5-HT1Aagonism
E. Serotoninergic 5-HT2 agonism

7L. The psychiatric symptom seenmost commonly in a patient with hepatitis C treated
with interferonis:
A. anxiety.
B. depression.
C. nightmares.
D. paranoia.
E. mania.

72. A 15-year-oldpatient who is depressedand suicidal and whose father abusesalcohol

is about to be dischargedfrom the hospital. Prior to discharge,the most important
initial step would be to:
A. assurea linkage to an outpatient treatment for the patient.
B. notify the patient's schoolof the patient'simpending discharge.
C. ensurethat any lethal meansare unavailable to the patient in the home.
D. refer the father to substanceabusetreatment.
E. notify Child Protection Servicesof the father's drinking problem.

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73. A physician's substanceabusehasjust beenreported. Which of the following

componentsis LEAST likely to be effective in the ensuing intervention?
A. Enlisting the assistanceof the most significantpeoplein the physician's life
B. Training the intervenersto presentrelevant information to the physician
C. Observing the physician until the physician becomesmotivated to seektreatment
D. Presentingfactual and documenteddata to the physician
E. Making pre-alrangementsof referral options for the physician

74. A23-yearold man is admitted to an inpatient unit with a diagnosis of acute

psychotic disorder after threateningto beat up his mother, with whom he lives. His
cousins brought him to the psychiatric emergencydepartment@D) and he agreedto
be admitted voluntarily. After two days, he demandsto sign out of the hospital
againstmedical advice. Which of the following facts should lead the resident to
j ustify involuntary commitment?
A. The patient sayshe will not take his medication at home.
B. The patient continuesto threatenhis mother.
C. The patient's mother cannot handle him at home.
D. The patient's psychotic symptoms have not resolved.
E. The patient refusesa follow-up appointment.

75. In patients taking lithium, the most frequent causeof severepolyuria is:
A. hyperglycemia.
B. increasedcholinergicfunction.
C. alteration of posterior pituitary function.
D. nephrogenicdiabetesinsipidus.
E. proximal renal tubular acidosis.

76. Lithium exposureduring the firsf trimester of pregnancy increasesthe risk of

congenital abnormalities in which of the following organs?
A. Heart
B. Brain
C. Lungs
D. Kidneys
E. Liver

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77. A2l-year-old man'sscoreson the MinnesotaMultiphasicPersonalityInventory

wereall within normallimits, exceptfor markedlyelevatedscoreson the depression
andpsychasthenia scales.Thesefindingssuggestthat this patient:
A. hasbipolar disorder,currentlyin the depressivephase.
B. hasdepressionwith psychoticfeaturessuchasdelusions.
C. hasdepressionwith anxietyandotherneuroticsymptoms.
D. throughactionsthat may bring him into conflict
is likely to dealwith his depression
with authority.
E. is trying to concealhis depressionby answeringin a mannerthat denieshe has
emotional problems.

78. A lO-year-oldgirl with a historyof hepatitisB is broughtfor evaluationof persistent

difficulties with schoolwork sincethe first grade. Shehastroublecompleting
assignments, becomingeasilydistractedanddisorganized.Sheoften losesher
homeworkandseemsnot to listento her parentsandteachers.If medicationsare
indicated,which of the following would be thebestfirst choiceof treatment?
A. Imipramine
B. Clonidine
C. Bupropion
D. Pemoline
E. Methylphenidate

79. Which of the following serumlevel testsis NOT usefulfor detectingexcessive

drinking?
A. Triglycerides
B. Bloodureanitrogen(BUN)
C. Meancorpuscularvolume(MCV)
D. (SGGT)
Serumgamma-glutamyltransferase
E. Serumglutamic-oxaloacetic (SGOT)
transferase

80. The ethicalprincipleof beneficence,

whenappliedto medicalethics,canbe
definedas:
A. avoidingharmto a patient.
B. respectinga patient'sindependence.
C. beingtruthfulwith oneselfandone'spatients.
D. applyingone'sabilitiessolelyfor thepatient'swell-being.
E. avoidingprejudicialbiasbasedon characteristicsof the patient.

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 Select the single best response for each of the questions on this page.

8 1 . One of the risk factors for tardive dyskinesia is:

A. male gender.
B. presenceof a mood disorder.
C. youngage.
D. normal cognitive function.
E. brief exposureto antipsychotic medication.

82. A shy 25-year-old woman had never been on a date. After six months of
psychodynamic psychotherapy,shebegan to struggle with positive feelings about her
male therapist that she found hard to accept. It was at that sametime she began to
date. Her therapist believed this was a transferenceacting out. The therapist said
nothing, becausehe believed an interpretation might interfere with her positive
learning experience. This is an example of:
A. a practicallsupportive
approach.
B. neutrality.
C. countertransference.
D. an analyticstance.
E. intersubjectivity.

8 3 . Which of the following is most likely to be a risk factor that can adversely influence
the psychological outcome of a child following the death of a parent?
A. Prior knowledge of the impending death for an extendedperiod of time
B. Loss of the opposite sex parent during latency
C. Above-averageintelligence in the child
D. Excessively dependentrelationship betweenthe deceasedand the surviving parent
E. Conflictual relationship betweenthe child and the deceasedparent

84. 434-year-old patient presentswith fever, headache,seizures,confusion, stupor, and

coma, evolving over a period of severaldays. The electroencephalogram(EEG)
shows periodic lateralizedhigh-voltage sharp waves arising in the left temporal
region, with slow-wave complexesrepeating at2- to 3-secondintervals. The
computerized tomography (CT) scan shows a low-density lesion in the left temporal
lobe. The most likely diagnosisis:
A. HfV encephalitis.
B. cryptococcal meningitis.
C. listeriameningitis.
D. herpessimplex encephalitis.
E. St. Louiq encephalitis.

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 Selectthe sinsle best responsefor eachof the questionson this pase.

85. The mostpowerfulstatisticalrisk factorfor both completedandattemptedsuicideis:

A. beingover65 yearsof age.
B. havinga psychiatricillness.
C. havinga chronicmedicalillness.
D. a family historyof suicide.
E. a historyof pastsuicideattempts.

86. Schizophreniform
disorderdiffers from schizophrenia
primarily in:
A. duration.
B. the severityof symptoms.
C. the presenceof a thoughtdisorder.
D. the presenceof a mooddisorder.
E. the presenceof subtypes.

87. Resilientindividualswho do well in their developmental

coursethroughlife despite
beingat high risk for negativeoutcomesarethoughtto be protectedin adulthood
mostimportantlyby:
A. havinggoodsleeping,exercise,andeatinghabits.
B. the absenceof negativeattributesin the family environment.
C. working at a well-paid,satisfyingjob.
D. havingthe ability to find, use,andinternalizesocialsupports.
E. belongingto a religiousorganization.

88. During a psychotherapy session,a patienttalks abouthow criticism from his father
still makeshim feel very devalued.The therapistcomments,"It must hurt whenyou
aretreatedthat way." This typeof interventionis called:
A. interpretation.
B. affirmation.
C. confrontation.
D. adviceandpraise.
E. empathicvalidation.

89. 422-year-oldcollegestudentcomplainsof suddenonsetof anxietyattacks

chancteizedby shortness of breath,palpitations,dizziness,lightheadedness,and
sweatypalmsfor the lasttwo days. Shehasalsobeenfeelingparanoidandfearsthat
the collegepolicehavebeenafterher becausesheparticipatedin the "hash-bash
festival" overthe weekend.Which of the following is thehost likely diagnosis?
A. Mixed anxietydepressivedisorder
B. Panicdisorderwithout agoraphobia
C. Generalizedanxietydisorder
D. Schizophreniformdisorder
E. Cannabis-inducedanxietvdisorder

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 nursing her 4-week-old
90. A woman with postpartum depressionwishes to continue yield significant
likely to
infant. Which of the following antidepressantsis LEAST
plasma levels in the infant?
A. Nefazodone
B. BuproPion
C. Fluoxetine
D. Sertraline
E. Venlafaxine

9 1 . The Thematic Apperception Test is used for:

A. evaluatinga broad rangeof cognitive abilities'
B. quantifying the results of a mental statusexamination'
C. screeningfor learningdisabilities'
D. inferringmotivational aspectsof behavior'
E. making a diagnosis of a personality disorder'

present as a pain disorder?

92. which of the following diseasesis most likely to
A. Depression
B. Obsessive-comPulsive disorder
C. Panic disorder
D. Schizophrenia
E. Schizophreniform disorder

than 100 feet she gets a

93. A77-year-old woman reports that when she walks more radiates down the legs'
which
numb and aching sensati-onin the buttocks and thighs
likely to render a diagnosis in
The pain subsidesonly if she sits down. The test most
this situationis:
A. a lumbar Puncture.
B. legplethYsmograPhY'
C. a Iopptei ultrasound of the lower extremity arteries'
D. *ugniti. resonanceimaging (lvtRl) of the lumbar splle'
of the lower extremities'
E. an electromyoJ.u* en6l and nerve conduction studies
with a history of alcohol
94. which of the following laboratory test results is consistent
abuse?
A. Increased'magnesium
B. Increasedmean corpuscularvolume
C. Increasederythrocyte sedimentationrate
D. DecreasedglutamYl transaminase
E. Decreasedcalcium

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 Select the single best response for each of the questions on this page.

9 5 . An 83-year-oldwoman experiencesabruptloss of vision in her right eye and has had

an intense, generalized,intermittently throbbing headachefor the past severalweeks.
Since the onset of the headache,she has been bedfast, with diminished appetite,
severeinsomnia,and achingjoints and limbs. She has lost 15 lbs and looks tearful,
frail, and disheveled. Evaluation revealswhite, fluffy exudateson both retinas,
atrophied right optic disk, low-grade fever, mild leukocytosis, and markedly elevated
erythrocyte sedimentationrate. The best treatment for this condition is:
A. amitriptyline.
B. carbamazepine.
C. prednisone.
D. coumadin.
E. clonidine.

96. A 6-year-old girl presentswith a 6-week history of fears about going to sleep,
frequent nightmares, and reports of stomachaches,nausea, and dizzinesswhen she is
to leavefor school in the morning. Prior to this, her social and cognitive
development was unremarkable. Her parentsreport that this episode began after her
mother was hospitalizedfor two weeks for abdominal surgery. Which of the
following diagnosesis most likely?
A. Social phobia
B. Major depressiondisorder
C. Generalizedanxiety disorder
D. Asperger'sdisorder
E. Separationanxiety disorder

97. Which of the following personalitydisordersshouldbe consideredin the differential

diagnosisof agoraphobia?
A. Antisocial
B. Dependent
C. Narcissistic
D. Schizotypal
E. Histrionic

"therapeuticwindow" is most relevantto:

9 8 . The conceptof a
A. doxepin.
B. nortriptyline.
C. desipramine.
D. amoxapine.
E. imipramine.

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 Select the single best response for each of the questions on this page.

99. A46-year-old man experiencesdouble vision and pain in the right eye. Examination
shows ptosis of the right eyelid, inability to elevate or adduct the right eye, and right
pupillary dilatation. This condition is most commonly causedby:
A. Grave's disease.
B. Horner's syndrome.
C. posterior communicating artery aneurysm.
D. myastheniagravis.
E. multiple sclerosis.

100. The mature ego defensewhich involves a semiconsciousdecision to postponepaying

attentionto an inner impulse is:
A. sublimation.
B. regression.
C. reaction formation.
D. suppression.
E. altruism.

101. A 2O-year-oldman is brought by his parentsfor an evaluationbecausethey are

worried about his poor performancein college. He has always been a very good
student,extremely bright, and totally devoted to studying. He has always done his
homework, sometimesfor hours, until his standardsfor good work were met.
However, he has not been able to finish assignedprojects at the college. His
classmateshave describedsome bizane behavior, such as counting loudly or
repeating words silently. They also complain that he has not been able to work with
anybody,as he doesnot want to follow anybody'srules but his own. He always
clasheswith others about the order of the tasks and how things should be done. He
denies any problems. He statesthat nobody understandshim and that his classmates
are againsthim. Which of the following is the most likely diagnosis?
A. Passive-aggressivepersonalitydisorder
B. Obsessive-compulsive disorder
C. Obsessive-compulsive personalitydisorder
D. Paranoidpersonality disorder
E. Delusional disorder

I02. In the treatment of acutemania with lithium, which of the following is the best
adjunctive agent?
A. Clonazepam
B. Haloperidol
C. Valproate
D. Carbamazepine
E. Electroconvulsivetherapy(ECT)

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 Select the single best response for each of the questions on this page.

103. A 35-year-oldpatientreportsseveralrecentepisodesof awakeningin the early

morning hours due to a severeunilateral headache,associatedwith rhinorrhea,
conjunctival irritation, lacrimation, and miosis of the pupil on the side of the
headache. The headachestypically last for about t hour and then subside. The most
likely diagnosisis:
A. temporal arteritis.
B. postherpeticrteuralgia.
C. migraine.
D. clusterheadache.
E. dental abscess.

104. Experimental subjectswho were askedto make simple judgments regarding the
length of lines often gave the wrong answerwhen they were quite sure of the correct
answerbecausethey did not like to disagreewith the responsesof the other
participants (who were actually part of the researchteam). This phenomenon
illustrates the group processinfluence that has been termed:
A. social facilitation.
B. social inhibition.
C. social loafing.
D. conformity.
E. minority influence.

105. The selectiveserotoninreuptakeinhibitor (SSRI) most likely to causea

di scontinuation syndrome is
A. citalopram.
B. fluvoxamine.
C. paroxetine.
D. sertraline.
E. fluoxetine.

106. A 73-year-old man presentsto the psychiatry clinic with depressedmood, thoughts
of death,fatigue, weight gain, constipation, and cold intolerance. As part of his
initial work-up, the psychiatrist would want to rule out a probable organic causefor
his symptomsby ordering:
A. an albumin level.
B. a carotid ultrasound.
C. coagulationstudies.
D. a.dexamethasone suppressiontest.
E. thyroid function tests.

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 Selectthe sinsle best responsefor eachof the questionson this pase.

107. Autism mostcommonlyoccursasa comorbidwith which of the following?

A. Mentalretardation
B. Bipolar affectivedisorder
C. Substance usedisorder
D. Obsessive-compulsive disorder
E. Attention-deficithyperactivitydisorder(ADHD)

108. Multifocal myoclonusin a comatosepatientmostlikely indicatesa:

A. posteriorfossatumor.
B. brainsteminfarct.
C. subarachnoidhemorrhage.
D. non-convulsive statusepilepticus.
E. metabolicencephalopathy.

109. A persistentlyintrusiveandinappropriateidea,thought,impulse,or imagethat

causesmarkeddistressis called:
A. a phobia.
B. a delusion.
C. a compulsion.
D. anobsession.
E. an ideaof reference.

110. A 32-year-oldwomanwith mixed anxietyanddepressionhasbeenworking well in

supportive-expressivepsychotherapy onceweeklyfor the past3 months. The focus
hasbeenon issuesrelatedto the childhoodneglectandabusethat sheexperienced
andhow theseimpacton her currentrelationships.In oneof her regularsessions,
sheis silentandtearful. With encouragement from her therapist,shereportsthat her
18-month-olddaughterhasbeenhospitalizedwith meningitisandsheis very upset
andworried. The therapistlistenssilently. The patientleavesthe sessionearly,
statingthat shehasnothingreally to talk aboutandmissesthe next session.When
shecomesthe following time, sheis angryat the therapistandaccusesthe therapist
of beinguncaringandinsensitivefor not evenexpressingconcernabouther child or
empathizingwith her distress.The therapist'simmediateresponsewould be to:
A. continueto listento the patientcompassionately.
B. explainthat reality issuesarenot the focusof the patient'stherapy.
C. inquireas.to whetherthe patientwould considertaking an antidepressant medication.
D. apologizeandacknowledgethat the silencefelt hurtfui anduncaringto the patient.
E. interpretthe patient'sangerasprojectedguilt over feelingsthat shehasbeenan
inadequatemother.

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 Select the single best response for each of the questions on this page.

111. A 23-year-oldwoman has gainednearly 50 lbs since she startedtaking birth

control pills. During the last 3 weeks, she has had frequent headachesand transient
blindness. Examinationrevealsthat shehaspapilledema. The diagnosismost
likely is:
A. classicmigraine.
B. benign intracranial hypertension.
C. diabetic optic neuropathy.
D. retrobulbar optic neuritis.
E. temporal arteritis.

112. During a certainperiod of development,a young animal is highly sensitiveto a

certain stimulus that provokes a specific behavior pattern at that time but not at other
times. This phenomenonis called:
A. drive.
B. imprinting.
C. programmed leaming.
D. statedependentlearning.
E. innatereleasingmechanism.

113. Which of the following is the optimal strategyin controlledtrials in maintenance

treatment with tricyclic antidepressantsfor patients with recurrent major depression?
A. Full-dose antidepressanttherapy
B. Three-quarters-doseantidepressanttherapy
C. One-half-doseantidepressanttherapy
D. One-quarter-doseantidepressanttherapy
E. Careful clinical observation

114. Five days after undergoing coronary artery bypassgraft surgery, a 47 -year-old man
is disoriented to time and place. He correctly identifies his right and left but not that
of the examiners. He can draw a squareand a circle, but cannot draw a clock. This
finding is most consistentwith:
A. dysprosody.
B. dyspraxia.
C. dysnomia.
D. dyscalculia.
E. dysphasia.

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 Selectthe sinsle best responsefor eachof the questionson this oase.

115. A personwho hasmentalretardationandultimatelyachievesat aboutthe first-grade

educationallevel mostlikely fits which of the following diagnosticclassifications?
A. Mild mentalretardation
B. Moderatementalretardation
C. Severementalretardation
D. Profoundmentalretardation
E. Mentalretardation,severityunspecified

116. An involuntarysetof flowing or jerky movementsinvolving multiplejoints best

describes:
A. a tremor.
B. a myoclonus.
C. tics.
D. myokymia.
E. chorea.

117. Along with depression,

themostcommoncomorbiddisorderin physiciansuicideis:
A. bipolarII disorder.
B. hypomania.
C. dysthymia.
D. substancedependence.
E. narcissisticpersonalitydisorder.

118. Which of the following drugsis mostlikely to be effectivein the treatmentof

trigeminalneuralgia?
A. Pramipexole
B. Valproic acid
C. Carbamazepine
D. Tizanidine
E. Baclofen

119. Which of thefollowingfindingsis seenin 90 - 100Vo

of patientswith narcolepsy?
A. BloodtypeAB
B. HumanleukocyteantigenHLA-DR2
C. Positivedexamethasone
testaftersleepdeprivation
D. Onsetof REM sleepwithin 20 minutesof sleep
E. Low voltagewavesoverthe occipitalregionnotedon sleep
(EEG)
electroencephalogram

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 Select the single best response for each of the questions on this Da€e.

120. Freud theorized that boys resolved the Oedipal complex by:
A. falling out of love with their mothers.
B. a loss of castrationanxietY.
C. identifying with their fathers
D. entering the latencYstage.
E. entering the Electra comPlex.

121. Which of the following antiepilepticdrugs can causerenal stones?

A. Vigabatrin
B. Gabapentin
C. Phenytoin
D. Lamotrigine
E. Topiramate

IZ2. A 62-year-oldman with diabetesmellitus is referred to a psychiatrist by his family

becausehe is not making any sense.When he is askedwhat is wrong, he answers,
"thar szing is phrumper zu stalking." This expressionhas normal intonation, but no
one in his family can understandit. The man verbally respondsto other questions
with similar utterances,but fails to successfullyexecuteany instructions. The
diagnosismost likely is:
A. schizophrenicword salad.
B. conductionaphasia.
C. Wernicke's aphasia.
D. Balint's syndrome.
E. drug intoxication.

123. Findings from the NIMH Epidemiological CatchmentArea studies indicate that the
lifetime prevalencerate for alcohol abuseand dependenceis approximately:
A. I7o.
B. 57o.
C. I57o
D. 25Vo.
E. 40Vo.

124. Themost common presentingcomplaint in Southeast-Asianpatients who are

diagnosedwith mental disordersis:
A. flashbacksand hYPervigilance.
B. multiple somatic sYmPtoms.
C. spirit possession.
D. neurasthenia.
E. sadness.

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 Selectthe singlebest responsefor eachof the questionson this page.

125. Raisedintracranialpressureis a possiblesideeffect of taking "megadoses"of which

of the following vitamins?
A . A
B. 86
C. Bn
D . C
E . D

126. A patientwith unipolardepressionhashadthreerecurencesof depression, each

separatedby 1 year,aftersuccessfultreatmentwith imipramine,200 mg daily.
Which of the following prophylactictreatmentsshouldbe recommended for this
patient?
A. Reducingthe dosageof imipramineto 100mg for 1 year
B. Reducingthe dosageof imipramineto 100mg for 5 years
C. Continuingadministrationof imipramine,200mg,for 1 year
D. Continuingadministrationof imipramine,200 mg, for 5 years
E. Discontinuingdrugtherapy

I27. fuaal dosesof alcoholcorrectedfor body weightleadto higherblood alcohollevels

in womenthanmen. Which of the following featuresaccountfor this differencein
women?
A. A lower proportionof body fat
B. Lower levelsof alcoholdehydrogenase in the gastricmucosa
C. Lower absorptioninto thebloodstream
D. Slowereliminationof alcoholfrom the blood
E. Lower proportionof alcoholmetabolizingin the liver

128. A l0-year-oldchild is seenin an outpatientclinic with a currenthistoryof an

extremefear of usingthe bathroomat school. Whenaskedaboutthis fear,the child
reportsbeingafraidthat the otherchildrenwill laughif they hearor smellthe child
in the bathroom.Which of the following is the mostappropriatediagnosis?
A. Socialphobia
B. Specificphobia
C. Delusionaldisorder
D. Separationanxietydisorder
E. Obsessive-compulsivedisorder

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 Select the single best response for each of the questions on this pase.

129. A psychiatrist consults with a medical resident who informs the psychiatrist that a
"becauseof
38-year-old female patient with acuterenal failure is refusing dialysis
her antisocial personality." The resident would like the psychiatrist to convince the
patient to stay in the hospital and begin her treatment. The psychiatrist informs the
resident that the psychiatrist:
A. is very persuasiveand hopesto convince the patient to stay.
B. will start brief dynamic psychotherapywith the patient.
C. will assessthe patient'scompetencyto make one's own medical decisions.
D. will need to establishemergencymedical guardianshipby the patient's next of kin.
E. could recofilmend dischargeagainstmedical advice given the patient's legal right to
self-determination.

130. A 43-year-oldman, a successfulexecutive,reluctantlyconsultsa psychiatrist

becausehis wife has threatenedto leave him if he does not change. The man reports
that he does not understandhis wife's complaints that he is driven, perfectionistic,
demanding,controlling, and unavailable. He believes himself to be simply a
conscientiousand moral person who is providing well for his wife and their children.
However, he sayshe is willing to try anything that may save his marriage. Other
than his anxiety about the marital situation, he denies any symptoms of anxiety,
mood disorder, true obsessionsor compulsions, health disturbances,or other
problems that disturb him. In recoilrmending an optimal initial treatment plan, key
considerationsfor choice of therapy should include:
A. the high probability that the patient is concealing major depressionand suicidality.
B . the dangerthat the patient will becomeexcessively demanding and dependenton the
therapist.
C. the need to provide structure and support when the patient disorganizesand regresses.
D . the difficulty of demonstratingto the patient that his ego-syntonic traits are
maladaptive.
E. the risk that successfultreatment will impair his ability to maintain his successat
work.

131. Which of the following changesin a patientis NOT associatedwith toxic serum
lithium concentrations?
A. S-T segmentdepressionandQ-T prolongationon ECG
B. Ataxia,coarsetremor,anddysarthria
C. Nephrotoxicsymptoms
D. Statusepilepticus
E. Thyrotoxicosis

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 Select the single best response for each of the questions on this page.

I32. The therapeutictechnique in which the therapist instructs the patient to hold on to a
symptom is:
A. reframing.
B. redirection.
C. paradoxical intervention.
D. communicationanalvsis.
E. feedback.

133. A 5-year-oldboy is energetic,but when his outletsfor exercisingmusclesare

insufficient, he becomesrestless,impulsive, and difficult to managein the home and
at school. His teacherrecognizesthe child's need for adequatemotor activity and
gives him classroomresponsibilities, such as cleaning the blackboard and running
brief errands. There is a positive responsefrom the child. This pattern of interaction
between the teacherand the child is an example of:
A. operantconditioning.
B. secureattachment.
C. classicalconditioning.
D. motor-sensoryattunement.
E. goodnessof fit.

I34. A 6-year-oldboy seestwo sodabottlesthat containthe sameamountof fluid. The

content of one is poured into a short, wide glass; and the content of the other is
pouredinto a tall, narrow glass. When askedwhich glasscontainsmore liquid, he
sayshe does not know. His S-year-oldbrother says, "They are the sarne,dummy. If
you pour them back into the bottle, they are the same." According to JeanPiaget, the
8-year-oldboy is exhibiting:
A. decentering.
B. peffnanence.
C. conservation.
D. intentionality.
E. transformation.

"deficit
135. The model" of psychologicalillness in psychodynamicpsychotherapy
definessomepatients'psychopathologyas due to:
A. genetic defects.
B. weakenedor absentpsychic structures.
C. deprived socioeconomicbackground.
D. in'adequateeducation.
E. inferioritycomplex.

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 Select the single best response for each of the questions on this page.

136. A 77-year-oldwoman whose husbanddied six weeks ago presentsfor evaluation at

an outpatient clinic. Six weeks prior, her husbandof 23 years died while at hospice.
The patient angrily complains about the length of time it took for her husband's
doctors to diagnosehim accurately. During the initial meeting, she soundsirritable
"My husbandwas everything to me. I can't accept
and looks fatigued. She says,
that he's gone...Ithink I shouldhave been able to savehim." She has one friend with
whom she speaksfrequently and has grown children with whom she is on good
"when the real darknessdescendson me, especially
terms. She says,however, that
in the middle of the night, I don't want to call anyone...I don't want to burden them."
Which of the following symptoms in this patient would be most indicative of a major
depressiveepisoderather than uncomplicatedbereavement?
A. Worrying constantly about financial matters
B. Hearing the voice of her husband
C. Having insomnia and loss of appetite
D. Experiencing feelings of guilt
E. Having thoughts of suicide

I37. Haurloss and weight gain are undesirableeffects of which of the following
anticonvulsants?
A. Felbamate
B. Phenytoin
C. Gabapentin
D. Phenobarbital
E. Divalproex sodium

138. One of the major psychological defensemechanismsthat determinesthe form and

quality of obsessive-compulsive symptomsis:
A. repression.
B. sublimation.
C. projection.
D. intellectualization.
E. reaction formation.

139. Which of the following approachesis LEAST likely to be utilized in the cognitive
therapy of a patient with substancedependence?
A. A strong therapeuticalliance
B. Goal orientation and problem focus
C. Relapseprevention
D. Interpretation of interactional process
E. Evaluation of dysfunctional beliefs

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140. Which of the following testswould be most useful in identifying a specific learning
disability in a child with a full scaleIQ of 93 on the WechslerIntelligenceScalefor
Children-Ill (WISC-III)?
A. Child Behavior Checklist
B. Children's ApperceptionTest
C. Stanford-BinetlntelligenceScale
D. Vineland Adaptive Behavior Scale
E. woodcock-Johnson Psycho-EducationalBattery-Revised

l4l. A 55-year-old man with alcohol dependencewho works at a brewery is prescribed

disulfiram. Upon returning to work, he complains of troubling headachesdespite
abstinencefrom alcohol. Which of the following most likely accountsfor the
headaches?
A. Onset of migraines
B. Alcohol fumes
C. Alcohol cravings
D. Hepatic dysfunction
E. Peripheralneuropathy

r42. which of the following representsa disorder of perception?

A. Delusion
B. Obsession
C. Phobia
D. Illusion
E. Paranoia

143. Which of the following imaging findings is often encounteredin hepatic

encephalopathy?
A. Cerebral edema
B. Periventricular white matter hyperintensities
C. Demyelinationof the corpuscallosum
D. Midline cerebellar atrophy
E. Enlarged ventricles

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 Select the single best response for each of the questions on this DaEe.

144. Eightdays after undergoing a total hip replacement, a7S-yeat-old woman is lucid,
bui has periodic episodesof disorientation, confusion, sleeplessness,and crying,
especially at night. She also has reportedly seenlittle frogs on a shelf in her room.
During a midmorning psychiatric evaluation, the woman is found to be pleasant,
cooperative,and in good contact with reality. The patient was diagnosedwith
depiession severalmonths ago and was prescribeddoxepin,25 mgtid, and
diazepam,5 mg tid, which were discontinuedprior to surgery. She is currently
taking meperidine for pain, diphenhydraminefor sleep, and a renewed prescription
for doxepin. The patient's recent confusion is NOT likely to be causedby:
A. medicationtoxicitY.
B. diazepamwithdrawal.
C. an electrolyte imbalance.
D. an atypical depressivedisorder.
E. a urinary tract infection.
"washout" period is neededfor starting a patient on fluoxetine after the
I45. A2-week
patient hasbeenon which of the following medications?
A. DextromethorPhan
B. Lithium
C. Paroxetine
D. Risperidone
E. Phenelzine

146. Severeweight gain and secondarydiabetesare a significant side effect of:

A. haloperidol.
B. risperidone.
C. loxapine.
D. olanzapine.
E. ziprasidone.

147. When conducting marital therapy with a couple who begin talking about divorce, the
psychiatrist's stancetoward the decision of divorce should be primarily:
A. focused on the couple's responsibility to decide the future of their relationship.
B. directed toward healing and preserving the marriage if at all possible.
C. oriented toward the needsand quality of life of the most fragile of the partners.
D. determinedby what can be ascertainedto be in the best interestsof the children.
E. influenced by the religious affiliations and values of the couple.

38 GO ON TO THE NEXT PAGE.

 Select the single best response for each of the questions on this page.

148. Which of the following scientific developmentsmadethe NIMH Epidemiological

CatchmentArea studiespossible?
A. The development of a multiaxial classification system
B. Advances in analyzing data from controlled clinical trials
C. New psychometric methodsfor calculating test-retestreliability
D. The developmentof operationalizeddiagnostic criteria and standardizedinstruments
E. The availability of computer-scoringprotocols for the Minnesota Multiphasic
Personality Inventory (MMPD

I49. A 20-year-oldfemale presentswith a one-yearhistory of bitemporal headaches,

polydipsia,polyuria, and bulimia. In the last two months,shehas begun to have
emotional outbursts with occasionalovert aggressivenessand transient confusion.
Her neurologic examination is unrevealing. A brain magnetic resonanceimaging
scanis likely to show a:
A. right parietal tumor.
B. right temporal tumor.
C. frontal midline tumor.
D. bilateral mesial temporal sclerosis.
E. hypothalamic tumor.

150. A 42-year-old man from Newfoundland presentscomplaining of frequent episodes

of paralysis. He describestheseepisodesas "being hagged,"or "visited by the old
woman." The paralysis occurs only upon waking and can last severalminutes. He
describesthe episode as being able to look around the room and to hear well, but
completely unable to move anything else. The paralysis may disappear
spontaneously,or upon his being called by his wife. He denieshallucinations,
nightmares,daytime sleepiness,or history of falls. Neurologicalexaminationis
normal. The most likely diagnosisis:
A. narcolepsy.
B. sleepparalysis.
C. familial periodic paralysis.
D. conversion disorder.
E. delusional disorder, somatic type.

END OF PART 2 OF TIIE

PSYCHIATRYRESIDENT
39 IN-TRAINING EXAMINATION.