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A. Subdural hematoma
B. Subarachnoid hemorrhage
C. Intracerebral hemorrhage
D. Vasovagal syncopal attack
E. Dissecting aneurysm of the internal carotid artery
3. Rare occurrences of priapism are most frequently associated with the use of which
of the following medications?
A. Bupropion
B. Trazodone
C. Amitriptyline
D. Benztropine
E. Diazepam
5. Most patients who are now diagnosed with a dysthymic disorder would have been
classified in DSM-II as having which of the following disorders?
A. Major depression
B. Depressive neurosis
C. Borderline depression
D. Secondary depression
E. Depressive melancholia
A. Serotonin syndrome
B. Noradrenergic crisis
C. Hypertensive crisis
D. Dopaminergic syndrome
E. Anticholinergic syndrome.
A. Donepezil
B. Selegiline
C. Pentoxyphilline
D. Galantamine
E. Memantine
9. A 35-year-old patient is brought into the emergency department (ED) by a friend.
The patient is hypoventilating and has blue lips, pinpoint pupils, crackles on lung
auscultation, and a mild arrhythmia on electrocardiogram (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
10. Which of the following questions is useful for evaluating immediate recall?
A. Phrenology
B. Psychosurgery
C. Electroconvulsive therapy
D. Insulin coma treatment
E. Moral treatment.
12. All of the following conditions seen in the emergency department (ED) generally
require pharmacologic intervention EXCEPT:
A. Suicidality
B. Psychosis
C. Delirium
D. Alcohol withdrawal
E. Serotonin syndrome
13. A 50-year-old man is examined in the emergency department for acute onset of
neck pain radiating down the left arm, progressive gait difficulty, and urinary
incontinence. Which of the following tests should be administered immediately?
A. Pregnancy
B. Intractable seizures
C. Parkinson’s disease
D. Neuroleptic malignant syndrome
E. Chronic obstructive pulmonary disease (COPD)
15. A53-year-old patient presents with a history of insidious onset of blurred vision
and diplopia over the past day. On examination the patient has mild ptosis,
bilateral sixth nerve palsies, unreactive pupils, and a hoarse, nasal voice with mild
dysarthria. Motor examination reveals mild weakness of the neck muscles, but is
otherwise unremarkable, as is the sensory examination. An electromyography
(EMG) reveals decreased amplitude of evoked muscle potentials and an increase
in amplitude with repetitive nerve stimulation. Which of the following is the most
likely diagnosis?
A. Botulism
B. Myasthenia
C. Diphtheria
D. Lathyrism
E. Ergotism
16. Which of the following is a central characteristic of factitious disorder ?
A. Brain
B. Spinal cord
C. Urinary tract
D. Peripheral nerves
E. Gastrointestinal tract
18. Electrophysiologic signs of denervation of muscle include:
A. Myotonic discharge
B. Delayed motor latencies
C. Poor recruitment pattern
D. Fibrillations and positive sharp waves.
E. Decremental response to repetitive stimulation.
19. Which of the following is the principal problem with disulfiram treatment of
patients with alcohol dependence?
A. Neologism
B. Clang term
C. Confabulation
D. Idiomatic expression
21. A patient complains of memory lapses and has been observed to sound like an
adult on some occasions and on others to talk like a scared child. Which of the
following is the most likely diagnosis?
A. Malingering
B. Conversion disorder
C. Separation anxiety disorder
D. Dissociative identity disorder
E. Factitious disorder with psychological symptoms.
22. Emil Kraepelin is an important figure in the history of psychiatry because of his
insight that:
24. A previously reliable and conscientious man has become increasingly profane,
irascible, and irresponsible over the past 6 months. These symptoms suggest that a
tumor is most likely to be found in which of the following regions of the brain?
A. Frontal lobe.
B. Parietal lobe.
C. Temporal lobe
D. Basal ganglion
E. Diencephalon
A. Rett’s disorder
B. Down syndrome
C. Fragile X syndrome
D. Asperger’s disorder
E. Williams syndrome.
A. Dissociation
B. Suppression
C. Sublimation
D. Denial
E. Fantasy
A. Inability to abstract
B. Delusions of being persecuted
C. Catatonic or grossly disorganized behavior
D. Disorganized speech with frequent derailment
E. Hallucinations of two or more voices conversing.
29. The etiology of benign intracranial hypertension has been linked to:
A. Iron deficiency
B. Hypervitaminosis A
C. Hypervitaminosis C.
D. Vitamin E deficiency
E. Vitamin B12 deficiency.
30. Which of the following is the mu opioid partial agonist approved by the FDA for
the treatment of patients with opioid dependence?
A. Levo-alpha-acetylmethadol (LAAM)
B. Buprenorphine
C. Methadone
D. Naltrexone
E. Naloxone
31. Abrupt withdrawal of nicotine is followed by which of the following symptoms?
A. Improved concentration
B. Decreased appetite
C. Increased heart rate
D. Elevated mood
E. Insomnia
32. Which of the following sleep disturbances would be most likely to occur after
initiating a trial of a selective serotonin reuptake inhibitor (SSRI)?
A. Apnea
B. Bruxism
C. Somniloquy
D. Sleepwalking
E. Head banging
33. A patient with treatment-resistant mania and a history of rapid cycling is being
treated with carbamazepine and thyroxine. After adding clozapine the patient is
clinically stabilized. The patient’s most recent white blood cell count is below
3,000/cu mm. The most appropriate immediate intervention is:
A. Nortriptyline
B. Methylphenidate
C. Venlafaxine
D. Sertraline
E. Phenelzine.
37. Which of the following laboratory tests should be conducted prior to intiating
lithium treatment?
A. Calcium
B. Platelet count
C. Alkaline phosphatase
D. Thyroid-stimulating hormone (TSH)
E. Erythrocyte sedimentation rate
38. Melanie Klein differed from Freud in her emphasis on which of the following
factors?
A. Importance of heredity
B. Early object relations
C. Sociocultural factors
D. Post-Oedipal development
E. Centrality of actual trauma.
39. Electroconvulsive therapy (ECT) is LEAST likely to be effective for patients
who have:
A. Chronic schizophrenia
B. Catatonic schizophrenia
C. A manic episode of bipolar disorder
D. Nonpsychotic depression
E. Schizoaffective disorder.
40. Which of the following drugs is contraindicated for a patient receiving a
monoamine oxidase (MAO) inhibitor?
A. Meperidine
B. Furazolidone
C. Beclomethasone
D. Trifluoperazine
E. Succinylcholine
41. Which of the following symptoms would be most commonly associated with
Tourette’s syndrome?
A. Somatization
B. Panic attacks
C. Violent behavior
D. Psychotic thinking
E. Obsessions and compulsions.
42. Which of the following tasks is most useful in evaluating the patient’s ability to
concentrate?
A. Circumstantiality
B. Flight of ideas
C. Perseveration
D. Obsession
E. Blocking
45. The studies in which monkeys are raised in varying degrees of isolation have
been important in contributing to which of the following theories of human
development?
A. Sociobiology
B. The significance of attachment
C. The effects of stressful environments
D. Dominance and submission paradigms.
E. The importance of respondent conditioning.
46. Which of the following medications has the LEAST protein-binding?
A. Fluoxetine
B. Sertraline
C. Paroxetine
D. Venlafaxine
E. Clomipramine.
47. A patient with Parkinson’s disease experiences visual hallucinations on levodopa/
carbidopa therapy. The most appropriate intervention would be to initiate
treatment with which of the following medications?
A. Olanzapine
B. Risperidone
C. Ziprasidone
D. Quetiapine.
A. Egocentrism
B. Diversity of interest
C. Uncritical acceptance of ideas
D. Cautious approach to new situations.
50. Supportive therapy differs from psychoanalytic therapy in that the therapist who
is conducting supportive therapy does which of the following?
A. Diazepam
B. Lorazepam
C. Oxazepam
D. Temazepam
54. Which of the following substances is a common cause of flashbacks?
A. Stimulants
B. Marijuana
C. Opiates
D. Alcohol
55. Which of the following is a major therapeutic goal of self-help groups?
A. Rituals
B. Obsessions
C. Compulsions
D. Preoccupations.
57. In managing the hypertensive crisis associated with monoamine oxidase (MAO)
inhibitors and the ingestion of food with tyramine, the agent of choice is:
A. Reserpine
B. Propranolol
C. Phentolamine
D. Chlorpromazine
58. Patients with which of the following have a greater risk of mortality following
electroconvulsive therapy (ECT)?
A. Status epilepticus
B. Cerebral bleeding
C. Brain edema
D. Recent myocardial infarction
E. Pregnancy-related difficulties.
59. Persistent visual hallucinations and paranoid delusions develop in a patient with
Parkinson’s disease. The most appropriate initial intervention would be to:
A. Initiate selegiline therapy
B. Initiate risperidone therapy
C. Initiate low-dose clozapine therapy
D. Reduce the dose of levodopa/carbidopa therapy.
E. Administer electroconvulsive therapy (ECT)
60. A patient with pathological gambling is most likely to have which of the
following comorbid conditions?
A. Major depression
B. Delusional disorder
C. Posttraumatic stress disorder
D. Panic Disorder
E. Kleptomania
61. The ability of catatonic patients to hold the same position for a prolonged period
is known as:
A. Cataplexy
B. Catalepsy
C. Stereotypy
D. Echopraxia
E. Avolition
62. Which of the following represents a basic concept of community psychiatry?
A. Social model
B. Fee-for-service
C. Psychodynamic construct
D. Medical model
E. Continuity of care
63. Which of the following memory loss patterns in characteristic of dissociative
amnesia?
A. It is accompanied by aphasias
B. It is accompanied by confabulation
C. It is accompanied by catastrophic reactions
D. Memory loss occurs for a discrete period of time.
E. Remote memory is worse than recent memory.
64. Which of the following antidepressants is unique in causing Parkinsonian
symptoms?
A. Amitriptyline
B. Amoxapine
C. Desipramine
D. Imipramine
E. Bupropion
65. Which of the following substance is recognized in DSM-IV as having an
intoxication syndrome but is not considered a substance of abuse?
A. Cannabis
B. Caffeine
C. Phencyclidine
D. Nicotine
E. Inhalants
66. Which of the following benzodiazepines does NOT have active metabolites?
A. Diazepam
B. Halazepam
C. Lorazepam
D. Chlorazepate
E. Chlordiazepoxide.
67. A 28-year-old woman is admitted to the emergency department in a mute, rigid,
and catatonic state. She has a history of outpatient psychiatric treatment, but
apparently is not taking any medications. Which of the following drugs would be
most appropriate to administer immediately?
A. Amytal
B. Lorazepam
C. Propranolol
D. Chlorpromazine
E. Methylphenidate.
68. Which of the following communication disorders is commonly associated with
both neurologic and psychiatric disorders?
A. Alexia
B. Mutism
C. Aphasia
D. Agraphia
E. Dysarthria
69. Which of the following suggests delirium rather than dementia?
A. Disorientation
B. Impaired memory
C. Impaired judgment
D. Impaired thinking
E. Clouding of consciousness
70. A 60-year-old man who is right-handed reports getting lost frequently in the
neighborhood where he has lived for the past 40 years. When asked to write a
sentence, he only writes on the right-hand part of the paper. In which of the
following cerebral lobes is a lesion mostly to be found?
A. Left frontal
B. Right frontal
C. Right parietal
D. Right temporal
E. Left occipital
71. The amyloid precursor protein, linked to a locus on chromosome 21, is associated
with:
A. Pick’s disease
B. Alzheimer’s disease
C. Huntington’s disease
D. Parkinson’s disease
E. Wilson’s disease.
72. According to the 1990 Global Burden of Disease Study, the leading cause of
neuropsychiatric disability worldwide is:
A. Panic disorder
B. Alcohol use
C. Schizophrenia
D. Bipolar disorder
E. Unipolar major depression.
73. Poverty of speech and poverty of content are aspects of which of the following
conditions?
A. Alogia
B. Aphonia
C. Aphosia
D. Apraxia
E. Anhedonia
74. Pathological gambling is classified in DSM-IV under which of the following
groups of disorders?
A. Impulse control
B. Substance abuse
C. Personality
D. Anxiety
E. Mood.
75. Which of the following antidepressants have also been effective in the treatment
of individuals with attention-deficit hyperactivity disorder (ADHD)?
A. Bupropion
B. Citalopram
C. Mirtazapine
D. Nefazodone
E. Fluoxetine.
76. Which of the following antidepressant agents in LEAST likely to cause sexual
dysfunction in men?
A. Bupropion
B. Fluoxetine
C. Sertraline
D. Trazodone
E. Fluvoxamine.
77. Wernicke’s disease is best described by which of the following triads of
symptoms?
A. Hallucinations, ataxia, and tremors
B. Hallucinations, ataxia, and peripheral neuropathy
C. Hallucinations, confabulation, and peripheral neuropathy
D. Ophthalmoplegia, ataxia, and global confusion
E. Ophtnalmoplegia, seizures, and confusion.
78. The detachment of the emotional component from perception, such that the
patient experiences the surroundings as if they were a stage set with a colorless
and artificial quality, is characteristic of which of the following?
A. Déjà vu
B. Jamais vu
C. Depersonalization
D. Derealization
E. Confusion
79. Which of the following substances is most likely to cause a patient to develop
persistent dementia with long-term use?
A. Inhalants
B. Opioids
C. Phencyclidine
D. Hallucinogens
E. Amphetamines
80. In contrast to psychodynamic psychotherapy, supportive psychotherapy is
fundamentally designed to be:
A. Inexpensive and delivered by nonmedical providers.
B. Focused on the patient’s mechanisms of coping with day-to-day stresses.
C. Time-limited with a preestablished duration of weeks to months rather
than years.
D. Less stigmatizing and more acceptable to patients, families, and
employers.
E. Centered on medical management and psychopharmacology.
81. A patient who had been taking venlafaxine for months and abruptly discontinued
it called the psychiatrist 3 days later complaining of nausea, insomnia, muscle
aches, anxiety, dizziness, and transient” electric shock” sensations. The most
likely cause of these symptoms is:
A. Viral illness.
B. Serotonin syndrome.
C. Malingering.
D. Neurological illness.
E. Antidepressant withdrawal.
82. A patient with murderous impulses towards a neighbor gives the neighbor a
bouquet of flowers. This is an example of:
A. Rationalization.
B. Sublimation.
C. Displacement.
D. Repression.
E. Reaction formation.
83. Which of the following laboratory parameters is often elevated in patients with
alcohol dependence?
A. Creatinine.
B. Mean corpuscular volume.
C. Erythrocyte sedimentation rate.
D. Mean corpuscular hemoglobin.
E. Acid phosphatase.
84. Which of the following ethical principles is best described as applying one’s
abilities solely for the patient’s well being?
A. Nonmaleficence.
B. Justice.
C. Veracity.
D. Respect for autonomy.
E. Beneficence.
85. A profound breakdown in both the logical connection between ideas and the
overall sense of goal-directedness of speech is referred to as:
A. Derailment.
B. Neologism.
C. Tangentiality.
D. Circumstantiality.
E. Flight of ideas.
86. Which of the following tricyclic antidepressants has the most potent
antihistaminic effect?
A. Doxepin.
B. Imipramine.
C. Clomipramine.
D. Nortriptyline.
E. Amitriptyline.
87. Which of the following is a risk factor for the development of alcohol withdrawal
delirium?
A. Agitation.
B. Hypertension.
C. Alcoholic hallucinosis.
D. Current infectious disease.
E. Decreased serum thiamine.
88. Alexithymia is best defined as:
A. An absence of emotions.
B. Difficulty being aware of emotions.
C. Repression of all unpleasant emotions.
D. The absence of fluctuations of mood.
E. A persistent state of dysphoria that the patient denies.
89. Which of the following findings on a magnetic resonance imaging (MRI) scan
would most specifically indicate a diagnosis of Huntington’s disease?
A. Cerebellar atrophy.
B. Frontal lobe atrophy.
C. Temporal lobe atrophy.
D. Caudate head atrophy.
E. Dilatation of the 4th ventricle.
90. First-pass effect refers to which of the following aspects of a medication’s
metabolism?
A. Redistribution.
B. Lipid solubility.
C. Elimination half-life.
D. Presystemic elimination.
E. Rate of intestinal absorption.
91. A psychiatrist and patient move from the day room to an interview room where
they have met on several occasions. The patient states. “ The room looks weird
and different today; it doesn’t feel right.” This statement is an example of :
A. Illusion.
B. Oscillopsia.
C. Derealization.
D. Depersonalization.
E. Inappropriate affect.
92. Which of the following is the most significant problem with the use of the Global
Assessment of Functioning (GAF) Scale?
A. Training in its use is required.
B. It is lengthy and complicated to use.
C. It confounds symptoms and functioning.
D. It does not provide clear descriptions of each interval.
E. Insurance companies will not accept it.
93. Secure attachment in an infant is associated with which of the following
outcomes?
A. Easy temperament in childhood.
B. Emotional and social competence.
C. Higher intellectual ability in adolescence.
D. Educational success through childhood and adolescence.
E. Physical coordination and later athletic ability.
94. The risk of teratogenic neural tube defects is greatest for the offspring of mothers
taking which of the following anticonvulsants?
A. Phenytoin.
B. Lamotrigine.
C. Valproate.
D. Levetiracetam.
E. Carbamazepine.
95. Which of the following is an example of declarative memory?
A. Skills and habits.
B. Simple classical conditioning.
C. Non-associative learning.
D. Priming.
E. Retention and recall of facts.
96. A 42-year-old patient in individual psychodynamic psychotherapy describes an
angry confrontation with a friend. The therapist comments that although the
patient describes anger, the patient actually seems very sad. This intervention is
best characterized as:
A. Confrontation.
B. Clarification.
C. Interpretation.
D. Affirmation.
E. Reframing.