1 which of the following correlatesmost closely with social functioning in

schizophrenia?
(A) Positive symptoms
(B) Negative symptoms
(C) Verbal working memory
@) Spatialworking memory

2. Detection of two Apolien e4 allelesin the diagnosticevaluationof dementiais useful

becauseit:
(A) increasesthe probability of the diagnosisof Alzheimer's disease.
(B) excludesthe diagnosisof Alzheimer's disease.
(C) confirms the diagnosisof Alzheimer's disease.
(D) decreasesthe probability of the diagnosisof Alzheimer's disease.

a
J. A therapist finds herself sexually preoccupiedwith a patient, frequently fantasizing
about the patient, and looking forward to the patient's next visit. Despite
acknowledging thesefeelings to herself and wondering about their meaning, she is
unableto shakethem. The most important next stepwould be to:
(A) talk to the patient aboutthesefeelings.
(B) talk to her spouseaboutthesefeelings.
(C) talk to a supervisoraboutthesefeelings.
(D) ignore thesefeelingsin the hope they will go away.

4. At which of the following agesdo adult maleshave the highestratesfor completed

suicide?
(A) 30
(B) 4s
(c) 60
(D) 7s

5. Which of the following medicationsdecreasesbenzodiazepineplasmalevels?

(A) Carbamazepine
(B) Fluoxetine
(C) Cimetidine
(D) Disulfiram

6. The rate of illicit drug usagein high schoolis highestamong which of the following
groupsin the United States?
(A) African Americans
(B) Asian Americans
(C) Hispanic Americans
(D) CaucasianAmericans

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

7. In combination with growth hormone, which of the following is required to initiate

the adolescentgrowth spurt?
(A) Gonadal hormones
(B) Cortisol
(C) Adrenocorticotropic hormone (ACTH)
(D) Thyroid-stimulating hormone (TSH)

8. Interest in secrets,collecting, and participating in organizedgamesis characteristic

of which of the following age groups of children?
(A) Preschool
(B) Elementary
(C) Middle school
(D) High school

9. A 50-year-old married man presentswith the recent onset of erectile dysfunction

despite a previously satisfactory sex life with his wife. He has been increasingly
preoccupiedwith his job and the politics at work to the chagrin of his wife who
enjoys his company and is frustrated by, and somewhatworried about, the
impotence. They have begun to argue more and more. His physical examination
and evaluation were unremarkable,and he was referred by his primary care
physicianfor a psychiatricevaluation. The best interventionat this point would be:
(A) prescribing sildenafil.
(B) penile implants.
(C) couple psychotherapy.
@) intracavernosalinjections.

10. The symptomsof a panic attackusually reachtheir peak within:

(A) a few seconds.
(B) a few minutes.
(C) about t hour.
@) about 3 hours.

11. A hospitalizedpatient is told of his diagnosisof pancreaticcancer. Later that

"wishes he was dead." The psychiatristis called to
eveninghe tells his nursethat he
assessthe patient who is somewhatdistant with the psychiatrist. Examination
revealsthat the patient has a severalmonth history of severedepressivesymptoms
"The only family I have
and has no support system. During the interview, he states,
at home is my gun." The psychiatristshouldfirst:
(A) explain to the patient'sresidentphysicianthat he is having an adjustmentdisorder.
(B) start the patient on an antidepressant.
(C) place the patient on suicide precautions.
(D) start the patient on brief dynamic psychotherapy.

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 12. IncreasedPR, QRS, or er intervals on electrocardiographyare most
commonly
associatedwith:
(A) anxiolyrics.
(B) lithium.
(C) sedatives.
@) tricyclic antidepressants.

1 3 . The "strangesituation" in child developmentis usedto assessthe

infant,s:
(A) level of curiosity.
@) security of attachment.
(C) ability to relate to strangers.
@) responseto new types of stimulation.
@) developmentalstatuswith object constancy.

14. The psychiatrist is called to the emergencydepartment(ED)

to evaluate a
29-year-old woman.who_hashad frequent pr"uious ED visits
and psychiatric
hospitalizations for her chronic schizophrenia. The patient is
actively hallucinating,
somewhat agitated,not violent or suicidal, and is cooperating with
the interview.
She says she stoppedtaking her medication severalaays ago
Uecausethe prescription
ran out and her caseworker was unavailable to help get u n"*
one. The patient had
been stable on olanzapinefor severalmonths previiristy and
was doing firly well in
a structuredliving environment. She deniescommand-hallucinations.
The next
intervention for the psychiatrist would be to:
(A) contact the patient's casemanagerto be sure that
she has environmental support.
Sive the patient a new prescripti,onand dischargeher from the ED.
Q)
(C) switch the patient to haloperidol decanoate.
(D) admit the patient to a partial hospital program.
@) admit the patient to the psychiatric unit for further observation and stabilization.

1 5 . 425--yearold patient presentswith bulimia nervosaand major

depression. Which of
the following antidepressantsis contraindicatedfor this patient?
(A) Nortriptyline.
(B) Bupropion.
(C) Venlafaxine.
(D) Fluoxetine.
(E) Nefazodone.

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

16. A 59-year-oldwoman who is experiencinga graduallyprogressivehearingloss

reports that she must always ask her friends to repeat what they say. A tuning fork
used during the Weber test reveals a failure to lateralize, and the woman's perception
of air conduction is better than that of bone conduction. She can hear fingers
rubbing and a watch ticking at 4 inches bilaterally, but she has difficulty
"fat," "cat," "mat," "sat," and "that" when whispered in her
discriminating the words
ears. The diagnosismost likely is:
(A) cortical deafness.
(B) hystericaldeafness.
(C) pure word deafness.
(D) bilateral sensorineuralhearingloss.
(E) receptive aphasia.

I7. Medicare pays for hospice care when a physician declaresthat a patient has a
maximum life expectancyof
(A) l month.
(B) 3 months.
(C) 6 months.
Q) 12 months.
(E) 2years.

1 8 . A 40-year-old married woman with six children was admitted with symptoms of
insomnia, decreasedappetite,marked somatic complaints such as dizziness and
nausea,and a paranoid delusion that her husbandis trying to poison her. Her
subsequentcourse of treatment included mood stabilizers, antidepressants,and
antipsychotics. Despite the treatment,she has displayed marked fluctuations of
mood from sadnessto euphoria five times over the course of a year. Her most likely
diagnosisis:
(A) schizoaffective disorder.
(B) bipolar II disorder.
(C) paranoid personality disorder.
@) bipolar disorderwith rapid cycling.
(E) major depressionwith psychotic features.

19. The most common adverseeffect of benzodiazepinesis:

(A) drowsiness.
(B) dizziness.
(C) ataxia.
p) cognitive deficit.
(E) dyspnea.

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

20. Comorbid depressionhas been demonstratedto be associatedwith an increasedrisk

of monality from:
(A) thyroid cancer.
(B) tuberculosis.
(C) ischemicheart disease.
(D) pancreatitis.
@) musculardystrophy.

21, After injuring his right upper extremity in a work-related accident, a 29-year-old man
has difficulty holding a pencil with his right hand. He has decided to sue his
employer for violation of safety rules in the workplace. Neurologic examination
revealsthat reflexes are intact, but he has weaknessof the opponensof the right
thumb and of adduction of the fourth and fifth digits. He also has decreased
sensationin the right fourth and fifth digits, extending into the palm of the hand
and ending at the creaseof the wrist. These symptoms and signs are most likely
causedby:
(A) malingering.
(B) C8 radiculopathy.
(C) ulnar nerve lesion.
@) radial nerye lesion.
(E) conversion disorder.

)) A 30-year-old woman experiencesimpulsive wishes to slash her wrists, generalized

anxiety, social phobia, and dissociation. Although examinationrevealsno psychotic
symptoms, she reports having recurring flashbacksof childhood sexual and physical
abuse. The diagnosismost likely is:
(A) depression.
(B) schizophrenia.
(C) generalizedanxiety disorder.
@) post-traumatic stressdisorder.
@) obsessive-compulsivedisorder.

23. A study reports a difference betweentwo groups, which later tums out to have
occurred by chance. This type of error is called a:
(A) variance.
(B) type I error.
(C) type II error.
(D) standarderror.
(E) standarddeviation.

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 Selectthe singlebestresponsefor eachof the questionson this page.

24. Blockadeof the dopaminereceptorsin the tuberoinfundibulartractsresultsin breast

enlargement, galactorrhea,
impotence,andamenorrhea.The mechanismof actionis
an increaseof:
(A) norepinephrine.
(B) dopamine.
(C) prolactin.
@) serotonin.
@) cholecystokinin.

25. A 38-year-oldpatientis broughtto the emergencydepartment(ED) after

experiencingeuphoriaandreportingfeelinglike "flying abovethe dancefloor" at a
local club. The patientis now sociallywithdrawnandexhibitsnystagmus.Which of
the following drugswould mostlikely producethis constellationof symptoms?
(A) Methcathinone
(B) Cocaine
(C) Amphetamine
@) Ketamine
(E) Alcohol

26. Which of the following benzodrazepines

is mostlikely to accumulatewith repeated
administration?
(A) Diazepam
(B) Lorazepam
(C) Oxazepam
@) Temazepam
@) Alprazolam

27. The mostcommonlyabusedhallucinogensareassociated

with:
(A) physiologicaldependence.
@) hallucinogenwithdrawalsyndrome.
(C) toleranceto euphoriceffects.
@) toleranceto autonomiceffects.
@) lackof cross-tolerance.

28. Abnormalresultson liver functiontestswould be mostcommonlyassociated

with
which of the following medicationsusedin the treatmentof attention-deficit
hyperactivitydisorderin childrenandadolescents?
(A) Clonidine
(B) Desipramine
(C) Dextroamphetamine
@) Methylphenidate
@) Pemoline

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29. An early intervention for a patient with agoraphobiais to bring the patient to a
crowded marketplace and have the patient remain there until the anxiety dissipates.
This is an example of:
(A) gradedexposure.
(B) participant modeling.
(C) aversion therapy.
@) flooding.
@) systematicdesensitization.

30. Pathologic examination of the brain in patients with Tourette's disorder shows:
(A) no abnormality.
(B) degenerationof the medial temporal lobes.
(C) demyelination of the corticothalamii pathways.
@) thinning of the arcuatefasciculus.
(E) loss of neurons in the amygdala.

3 1 . The developmentof full postural control in children by 4 years of age correlates

neuroanatomicallywith the developmentalmaturity of:
(A)pyramidal neuronsin the motor cortex.
(B)lateralization of neuronal population.
(C)synapseformation in the thalamus.
(D)axonal connectionsthrough the corpus callosum.
@) myelination of cerebellarfibers.

32. An l8-year-old woman presentsat the emergencydepartment (ED) after being

referred by a rape crisis center counselorwho she had just called to report being
raped. The psychiatrist is told that the police and family members will be arriving to
meet with the patient. The patient will fare best if the psychiatrist's immediate
intervention is to do which of the following?
(A) Provide support and allow ventilation of the patient's fear and rage to the psychiatrist,
police, and her family.
(B) Have a female gynecologist meet the patient and reassureher that all appropriate
medical tests will be done.
(c) Reassurethe patient that the rapist will be caught and convicted.
(D) Ask if the patient knows who the assailantis and where the assailantcan be found.
(E) Reassurethe patient that she will be safe and does not have to go home alone.

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

33. A woman who is on long-term valproate therapy becomespregnant. Which of the

following vitamins reducesthe risk of neural tube malformation to the fetus?
(A) Thiamine
(B) Folic acid
(C) Brz
(D) E
(E) C

34. Which of the following pharmacokineticfactors declines with normal aging?

(A) Liver conjugation
(B) Gastric absorption
(C) Fat-to-lean body ratio
@) Glomerular filtration rate
(E) Free fraction of protein-bound drugs

35. The beginning phaseof therapy with a child who was a victim of incest should first
focus on:
(A) reducing sexually inappropriatebehaviors of the child.
(B) reducing the shameand guilt associatedwith the abuse.
(C) developing coping skills to addressanxiety-relatedsymptoms.
@) dealing with prior betrayal and establishingtrust with the therapist.
@) identifying the unconsciouslink betweenrepetitive play reenactmentand the original
trauma.

36. A psychiatrist who hosts a radio talk show routinely statesat the beginning of the
show that he is not entering into a physician-patientrelationship with the callers who
seekhis advice. With this statement,the psychiatrist is addressingwhich of the
following broad claims that must be proven to sustain a claim of malpractice?
(A) Direct cause
@) Negligence
(C) Duty
(D) Harm
(E) Competgnce

37. Patients at highest risk for sensitivity to small dose reductions during low-dose
benzodrazepinewithdrawal are those who have:
(A)used marijuana in the past.
(B)an underlying depressivedisorder.
(C)a heightenedsomatic suggestibility.
(D)an accompanyingpersonality disorder.
@) a personalor family history of alcoholism.

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 3 8 . What component of type A behavior is the most reliable risk factor for development
of coronary artery disease?
(A) Hostility
(B) Rapid speech
(C) Time urgency
(D) Competitiveness
@) Visible mannerisms

39. A 45-year-old woman with bipolar disorder has been on lithium carbonate, I,2O0
mg, and sertraline, 50 mg, for over 3 years. Her serum lithium level is 0.8 mEq/L.
She has become more depressedand fatigued, with a low energy level over the last 6
months. An increasein the sertraline dosagewas not effective. The next step should
be to:
(A) discontinue sertraline and administer bupropion.
(B) obtain a TSH level.
(C) add desipramine.
@) discontinue lithium.
(E) admit the patient to an inpatient unit.

40. Successfulpsychosocialinterventions in the managementof patients with

schizophrenia,when combined with pharmacotherapy,include:
(A) multimodal behavioral therapy.
(B) systematicdesensitization.
(C) insight-oriented therapy.
@) reality therapy.
(E) assertivecommunity treatment.

41. In which of the following types of researchstudiesis a group studied over a

prolonged time period?
(A)Case-control
(B)Cross-sectional
(C)Crossover
(D)Cohort
@) Retrospective

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

42. A37-year-old man who was placed on an increasing regimen of imipramine 10 days
previously to treat depressionis currently taking L25 mg of the drug daily. The
patient statesthat his urine streamis weak and that his bladder feels swollen.
Physical evaluation confirms the man has mild lower abdominal distention. The
most effective treatment is:
(A) bethanechol.
(B) benztropine.
(C) physostigmine.
@) amantadine.
(E) diazepam.

43. A27-year-old patient tendsto avoid interpersonalsituationsdue to excessiveanxiety

and has occasionalpanic attackswhen coercedinto certain feared situations. The
most likely diagnosisis:
(A) social phobia.
@) generalizedanxiety disorder.
(C) avoidant personality disorder.
@) dependentpersonality disorder.
@) panic disorder with agoraphobia.

44. Women are at highest risk for major depressionduring:

(A) latency.
(B) menopause.
(C) their reproductive years.
@) their early teenageyearsbefore puberty.
(E) their early childhood.

45. The most cofirmon eye-tracking movement abnormality in patients with

schizophreniais
(A) inaccuratesaccades(hypermetric or hypometric).
(B) impaired initiation of saccades(ocular apraxia).
(C) inappropriatesaccades(saccadicintrusions).
@) impersistenceof gaze (large amplitude saccadicintrusions).
@) abnormalsaccadicvelocity (slow saccades).

46. Which of the following affects is defined as disharmony between the patient's
emotional feeling tone and the thought or speechaccompanyingit?
(A) Labile
(B) Flat
(C) Blunted
(D) Inappropriate
(E) Restricted

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

47. Which of the following interventionsis NOT consistentwith the theoretical

assumptionsof crisis intervention?
(A) Reassurance
(B) Brief hospitalization
(C) Psychodynamicinsighr
@) Treatment with psychotropic medication
(E) Focuson pastrelationships

48. The key treatmentin managingWernicke's encephalopathyis:

(A) thiamine.
(B) hydration.
(C) clonidine.
@) benzodiazepines.
(E) electrolyte replacement.

49. The requirement that all handicappedchildren have accessto a free appropriate
public education is containedin the:
(A) Americanswith Disabilities Act.
(B) U.S. Departmentof EducationBudget.
(C) Brown v. Board of Educationdecision.
@) Individuals with DisabilitiesEducationAct.
(E) 14th Amendmentto the U.S. Constitution.

50. A highly successfulbusinessexecutive hospitalized for a bleeding ulcer has repeated

argumentswith a usually well-liked, conscientioushead nurse and threatensto leave
the hospital againstmedical advice. The best approachfor the consulting
psychiatristin managingthis situationwould be to:
(A) actively support the authority of the nurse, providing an analogy to the hierarchical
structure of the businessworld.
(B) interpret the patient's threats as an effort to escapefrom a dependentposition, but
explain to the patient that even greaterdependencymight result from his actions.
(C) listen seriously to the patient's complaints and acknowledge his discomfort with the
passiveposition to which he is unaccustomed.
(D) attempt to arrangefor the patient to be transferredto a psychiatry ward.
@) stressto the patient the need for a compromise.

5 1 . which of the following terms is defined as sudden,irrepressible, shocklike

contraction of a muscle triggered by an event within the central neryous system?
(A) Tremor
(B) Chorea
(C) Myoclonus
(D) Tic
(E) Ballism

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

52. Which of the following somatoform disordersis characterizedby the multiplicity of

the complaints and the multiple organ systemsthat are affected?
(A) Somatrzationdisorder
(B) Conversiondisorder
(C) Hypochondriasis
(D) Body dysmorphic disorder
(E) Pain disorder

53. A 66-year-old man presentsto the emergencydepartment@,D) with suddenonset of I

occipital headache,dizziness,vertigo, nausea,vomiting, and inability to stand. On
arrival, he is mildly lethargic and has slurred speech. His cranial nerve examination
reveals small reactive pupils, skew deviation, gaze deviated to the right, nystagmus
with occasionalocular bobbing, right facial weakness,and decreasedcorneal reflex
on the right eye. Motor examination reveals truncal ataxia, bilateral hyperreflexia,
and bilateral Babinski's signs.The most likely diagnosisis:
(A) pontine infarction
(B) centralpontine myelinolysis.
(C) cerebellarhemorrhage.
(D) putaminal hemorrhage.
@) fontine hemorrhage.

54. Miosis or pupillary constrictionis most often associatedwith an overdoseof which

of the following substances?
(A) LSD
(B) Heroin
(C) Phencyclidine
@) Cocaine
(E) Cannabis

55. Horner's syndromeis characterizedby which of the following?

(A) Mydriasis, ptosis, and hyperhidrosis of the forehead
(B) Mydriasis, diplopia, and anhidrosisof the forehead
(C) Miosis, ptosis, and anhidrosisof the forehead
(D) Miosis, diplopia, and anhidrosisof the forehead
(E) Mydriasis, ptosis,and conjunctivalinjection

56. According to the principles of operantconditioning, a behavior will tend to decrease

in frequencyif it:
(A) fails to satisfy a biological need.
(B) is incompatible with a positively reinforced behavior.
(C) is paired with an unconditioned stimulus.
@) receivesintermittent positive reinforcement only.
@) reducesthe intensity of a biological drive.

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57. A patient presentsto the emergencydepartment(ED) after having had a sudden
onset of headacheand collapsing. The patient has some lethargy, but with relative
preservationof consciousness.Physicalexaminationshowsthat the neck is rigid,
there is no papilledema, and there are no focal cranial nerve or motor signs. The
initial investigative procedurefor this presentationshould be:
(A) a carotid ultrasound.
(B) a magnetic resonanceimaging (N{R.Dscan of the brain.
(C) a lumbar puncture.
(D) an electroencephalography.
(E) a computerized tomography (CT) scanof the head.

5 8 . A 38-year-oldman who lost a leg in a boating accidentone month ago has sleep
disturbances,recurrent nightmares,and intrusive thoughts about the accident that he
cannotsuppress.The diagnosismost likely is:
(A)major depression.
(B)uncomplicatedbereavement.
(C)generalizedanxiety disorder.
(D)post-traumatic stressdisorder.
@) adjustmentdisorder with depressedmood.

59. The assumptionthat there is no significant difference between two random samples
of a populationis called:
(A)sensitivity.
(B)null hypothesis.
(C)specificity.
(D)probability.
@) point prevalence.

60. The psychiatristconsultson an evaluationof a62-year-oldwoman with bipolar

disorder' She is admitted to the hospital for medical reasons,but develops altered
mental status,dysarthria, and ataxia. Since the patient is taking lithium, which of the
following, if startedrecently,shouldcausethe psychiatristto suspecta drug
interaction?
(A) Acetazolamide
(B) Psyllium
(C) Indomethacin
(D) Sodium bicarbonate
(E) Theophylline

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 Selectthe sinsle best responsefor eachof the questionson this page.

6I. A23-year-oldpatientdevelopstingling paresthesias in the lower extremities,which

is followed 1 or 2 dayslaterby progressiveweaknessof the lower extremitiesthat is
greateron the right thanon the left. Physicalexaminationshowsa sensorylevel at
T10 to pinprick,with 3 out of 5 weaknessof the lower extremities,slightly weaker
on the right. Both the kneeandthe anklejerks arehyperactive,andthereare
bilateralBabinski'ssigns. The patienthasdifficulty walking, with a broad-based,
stiffJeggedgait. This presentation is mostconsistentwith:
(A) transversemyelitis.
(B) Friedreich'sataxia.
(C) acutepost-infectiouspolyneuritis.
@) subacutecombineddegeneration.
@) caudaequinacompression by metastaticdeposit.

62. Bulimia nervosais mostlikely to be comorbidwith which of the following

disorders?
(A) Schizophrenia
(B) Major depression
(C) Panicdisorder
@) Sleepwalking
(E) Attention-deficithyperactivitydisorder(ADHD)

63. A 45-year-oldmandrinks 1 qt of vodkadaily, experiencesauditoryhallucinations

whendrinking or not drinking alcoholover a 6-monthperiod,andexhibitsextreme
agitation.Which of the following medicationswould be most appropriateto usein
additionto benzodiazepine therapyduringthe man'swithdrawalfrom alcohol?
(A) Lithium
(B) Buspirone
(C) Fluoxetine
@) Haloperidol
@) Carbamazepine

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

restlesslegs?
(A) Gabapentin
(B) Trihexyphenidyl
(C) Lamotrigine
@) Topiramate
@) Pergolide

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 65' The ageat whichchildrentypically
first usesentences
of two or morewordsis:
(A) 16monrhs.
(B) Z+monrhs.
(C) ZZmonths.
(D) 40 months.
(E) 48 months.

66' A patientwho previouslyexperienced

an episodeof major depressionhasbeen
irritabre,restress,andeasilybistractibre
rire puri*, arso
decreased ability to sleep,ioo, upprtite,reetin'g;Jfguitt, hasexperienceda
anddestructive impulsivespendinghabits,
behavioi.rn. diagnosis mostlikely rs:
(A) schizoaffective disorder.
(B) bipolardisorder,mixed.
(C) bipolardisorder,typeIL
@) major depression, ricurrent.
@) borderlinepersonalitydisorder.

67' Flooding'gradedexposure'andparticipant
modelingarealr techniquesthat:
(A) areusedin gestalttherapy
to promoteabreaction.
(B) areusedin teachings"f-Lare
srun, to p"rron, *irt, mentarretardation.
(c) involve confrontationof actual
o, i-u!in.J un^i"ry-producingexperiences.
3l;ffirut:::1'#,T*""-"niun?-".*".jl",orop",ini.'o-naitioning.
68' A2}-year-old woman with borderline
personality disorder was admitted
inpatient psychiatric unit because to an
of escalati"g uii.iJd id"ution. The
treating her found himself repeatedly resident
in conR[i*i,r, irr" unit staff ;";;
arguing frequently with the hlad her care,
nurse. The resident insisted that
judgmental and hostile to the staff were too
the patient, while the head nurse
speciartreatment for this patient accusedhim of seeking
-0.:1.::r*l"g rrr" plrent to ignore unit poricies.
The patientexpressed out*g" atthe
stating,"only Dr. .rigid""1fi"liiJ",,attitudeirtrre irsing staff,
X "u"n t i-",to understand
realized that the staff
me.,,ihe attending psychiatrist
were dividing into factionr, ,o-"
others declaring the patient to be siding with the resident,
dlvious and ,,getting away with
attending psychiatrist should: murder.,, The
(A) dischargethe patient from
the unit as soon as possible.
(B) transfer the paiient to a
different resident.
(c) take the head nurse aside
and counsel about the need to be
@) confront the patient about her manipulative, less hostile.
divisive behavior.
@) educatethe resident and the staff uuout
th";;o;;cious nature of splitting.

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: I
il

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

69. Which of the following side effects has a higher incidence in patients taking
carbamazepinethan those taking lithium?
(A) Dizziness
@) Tremor
(C) Increasedthirst
@) Weight gain
(E) Diarrhea I
70. Galactorrheain a female patient who is taking the antipsychotic medication
risperidone is most likely to be secondaryto:
(A)microscopic undetectedprolactinoma.
(B)inhibition of the tuberoinfundibular dopaminergic pathway.
(C)mesolimbic dopaminergic pathway overstimulation.
(D)weight gain.
@) pregnancy.

7I. The most common chronic diseasethat often causesgradually progressiveerectile

failure in men is:
(A) diabetesmellitus.
(B) multiple sclerosis.
(C) Addison's disease.
@) Peyronie'sdisease.
(E) Shy-Drager syndrome.

72. A S-year-oldboy is brought to a psychiatrist by his parentswho give a history

consistentwith attention-deficit hyperactivity disorder (ADHD). The next most
important sourceof information in establishingthe diagnosis of ADI{D would be:
(A) neuroimaging studies.
(B) child behaviorchecklist.
(C) teacherreports.
@) continuous performancetests.
@) complete blood count, lead level, and thyroid studies.

73. Patients who are startedon bupropion (Zyban) for nicotine dependenceshould be
instructed to set a date to stop smoking:
(A) right away.
(B) after achieving the therapeuticdose of 300 mg.
I
(C) on the third day after starting bupropion.
@) during the secondweek on bupropion.
(E) after 4 weeks of treatment with bupropion.

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 Selectthe sinsle best responsefor eachof the questionson this page.

74. An attorney refers a 65-year-old man to a psychiatrist to determine whether the man
is capableof making a valid will. over the past 2 years,the man has become
increasingly forgetful and moody, but his speechand behavior have not been bizarre.
It would NOT be appropriatefor the psychiatrist to attempt to determine whether
the man:
t (A) knows he is making a will.
t] (B) knows how the will distributes his property.
(C) knows the nature and extent of his property subject to distribution by the will.
@) knows which personswould normally be expectedto benefit from his will.
@) has idiosyncratic desiresabout who should benefit from his will.

75. Priapism is a rare but potentially seriousand painful side effect of which of the
following drug therapies?
(A)Lithium
(B)Trazodone
(C)Methadone
(D)Imipramine
@) Chlordiazepoxide

76. Which of the following neuroleptic medicationshas the weakest affinitv for the
dopamine D2-like receptor?
(A) Chlorpromazine
(B) Clozapine
(C) Thiothixene
(D) Pimozide
(E) Haloperidol

77. The Stanford-Binet test is most similar to the:

(A) Bender-Gestalttest.
(B) Shipley-Hartford test.
(C) Thematic Apperception Test.
@) Minnesota Multiphasic Personality Inventory.
(E) Wechsler Intelligence Scalefor Children - III.

7 8 . A I2-year-old girl refusesto attend school becauseshe fears that her mother may die
in an accident..Initial managementshould include:
I (A)returning the girl to her current classroom.
(B)transferring the girl to another school.
(C)admitting the girl to partial hospitalization.
(D)enrolling the girl in a therapeuticclassroom.
@) beginning home schooling for the girl.

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

79. Which of the following featuresis characteristicof women as compared to men with
alcohol-related disorders?
(A) Earlier onset of disorder
(B) Fasterprogressof disorder
(C) Lower mortality rate
(D) Less likely to attempt suicide
(E) Irss likely to have an alcohol-dependentsignificant other

80. A29-year-old man comes to a clinic for a psychiatric evaluation. He is married and
has an infant. He complains of severedepressionand has been planning to take his
own life. He also threatensto kil his wife and daughterbecausehe believes life will
"I
be too hard for them, stating, want to take them with me." He seemsoddly at ease
with thesemurderousthoughts, but saysthat he has come to the doctor in a last
"pain
attempt to get relief from this of life." Which of the following actions best
describesthe mandatory legal responsibility of the psychiatrist?
(A)Notify the wife about the patient's intentions.
(B)Hospitalize the patient as a dangerto self and others.
(C)Notify the police of the patient'sbehavior.
(D)Tell the patient that this information will need to be divulged to others.
@) There is no legal mandate,only the psychiatric standardof practice.

81. A 45-year-old woman with bipolar disorder has experiencedfour or more manic
episodesper year for the last 3 years. Which of the following drug regimens would
most likely benefit this patient?
(A)Carbamazepine,40Omg qd
(B)Carbamazepine,1200mg qd
(C)Lithium carbonate,300 mg qd
(D)Lithium carbonate,1200mg qd
@) Haloperidol, 20 mg qd

82. The stageof group developmentwhere group members are testing the norms of the
group, competing with each other, and striving for autonomy is:
(A) maturation.
(B) orientation.
(C) solidification.
(D) termination.
(E) differentiation.

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 8 3. Which of the following testsis helpful in discriminating between cognitive
difficulties presentin patients with dementia of the Alzheimer's typJand cognitive
abnormalities associatedwith depression?
(A) The Token Test
(B) The WechslerMemory Scale
(C) The Wisconsin Card Sorting Test
@) The Benton Visual Retention Test
@) The Boston Naming Test

84. A young adult who has garned70 pounds in the last year complains of daily severe
headachesthat are sometimesassociatedwith graying out of ,ririon. physical
examination is normal except for the presenceof papilledema. computerized
tomography (CT) and magnetic resonanceimaging (NRI) scansshow no specific
abnormalities, although the ventricles appearsomewhat smaller than usual. The goal
of treatment in this caseis to prevent:
(A) blindness.
(B) secondaryseizures.
(C) transtentorialherniation.
(D) dementia.
(E) hydrocephalus.

8 5 . 462-year-old woman has experiencedmild insomnia, decreasedappetite,

intermittent crying, and moderate sadnessfor the past month since the death
of her
husbandfrom cancer. She had cared for her husbind during his final months with
strong support from family, friends, and her church. she has maintained her
personalcontacts since her husband'sdeath and has continued to appropriately
handlehouseholdresponsibilities.She is looking forward to a long ptanneAreunion
with college friends 4 months in the future. Her minister suggestedihe see u
psychiatrist when she becametearful discussingher husband s devotion
to her
church. The psychiarristshould:
(A) suggestshort-term psychotherapyfor the patient to deal with the loss of her
husband.
(B) consider starting the patient on a trial of a selective serotonin reuptake inhibitor
(ssRr).
(c) assurethe patient that her current symptoms are unlikely to suggestpathology.
(D) refer the patient to a grief counselor.
(E) suggestthat the patient contact her internist regarding medication to assisther
sleep.
86. Which of the following is most suggestiveof an underlying bipolar illness in
a27-
year-old female patient who presentswith her first major dlpressive episode?
(A) A family history of bipolar disorder
(B) Age of onset
(C) Prominent anxiety
(D) Female gender
(E) A family history of alcoholism

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

87. An exampleof "learnedhelplessness"is a child who stopsall attemptsto improve

after:
(A) failing no matter how hard the child tries.
(B) being punished for failing.
(C) never being rewarded for doing well.
@) being ignored.
@) being ostracizedby the child's peersfor good academicperformance.

88. In contrast to long-term psychotherapy,time-limited psychotherapyis more likely to

have which of the following characteristics?
(A) Behavior techniquesare used to reduce the duration of therapy.
(B) It is appropriatefor patients unable to undergo long-term psychotherapy.
(C) It is appropriatefor patients unable to establisha therapeutic alliance.
@) Transferenceand countertransferenceare not issues.
(E) A central issue is selectedas the focus of therapy.

89. Low-potency antipsychotic agentscan produce orthostatic hypotension through

blockade of which of the following receptors?
(A) 5HrAA
(B) Dz
(C) Beta adrenergic
@) Alpha-l adrenergic
(E) GABA

90. Patients with chronic use of benzodiazepineare most likely to develop which of the
following?
(A) Disinhibition
(B) Tremor
(C) Sedation
@) Amnesia
(E) Sialorrhea

9L Which of the following psychological testsmeasurestest-taking attitudes at the time

of examinatioir?
(A) RorschachInkblot
(B) Symptom Checklist-90
(C) Thematic Apperception
@) Katz Adjustment Scale
@) Minnesota Multiphasic PersonalityInventory

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 92' All of the following medications should be consideredfor the
treatment of
aggressionin an individual with mental retardation EXCEpT:
(A) lithium carbonate.
(B) clonazepam.
(C) thioridazine.
(D) haloperidol.
(E) propranolol.

93' A 49-year-old patient with diabetesmellitus presentswith severe

burning of the soles
of the feet and difficulty sleepingbecausethe mere touch of
the sheetagainst the feet
is painful. Examination shows that the patient has decreased
sensationio pin and
touch up to the ankle, 50 percentreduction in vibratory sense
at the ankle, and
impaired proprioception at the toes. The ankle jerks are absent,
but the knee jerks
are present. The most likely diagnosisis:
(A) central pain syndrome.
(B) cervical myelopathy.
(C) lumbar stenosis.
@) peripheral neuropathy.
@) shingles.

94' A 60-year-oldpatient who is an alcoholicexperiencesunsteadiness

of gait without
any other neurologic symptoms. Examination reveals minimal
appendicular ataxia
in the patient's lower extremities only and normal eye movements.
The patient
walks with a lurching, broad-basedgait. The diagnosismost
likely is:
(A) hysterical gait disorder.
(B) alcoholic cerebellar degeneration.
(C) alcoholic frontal lobe degeneration.
@) spinocerebellardegeneration.
@) multiple sclerosis.

95' A 7o-year-oldman has recentlybegunexperiencingattacksof "whirling

sensations,,
accompaniedby nausea,diplopia, dysarthria, and tingling of the
lips. Tiese episodes
occur severaltimes daily for no more than a minute, Uut ihey
- rL severethat he
collapsesand is immobilized when symptoms start. The paiient
experiencesno
residual symptoms betweenepisodesand has no tinnitus, hearing
impairment,
clouding of consciousness, or evidentassociationwith any particular activity. The
man's symptcimsmost likely indicatea diagnosisof:
(A) panic attacks.
(B) vertebrobasilarinsufficiencv.
(C) benign positional vertigo.
(D) cataplectic attacks.
(E) Mdnidre's disease.

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

96. The differential diagnosis in a 6-year-old child with daily fecal soiling includes all of
the following EXCEPT:
(A)anal stenosis.
(B)hypothyroidism.
(C)Hirschsprung'sdisease.
(D)smoothmuscledisease.
@) hepatitis.

97. A patient with alcohol dependencewho takes disulfiram reports recurrent cravings
for alcohol. Which of the following medications is most likely to reduce the
patient's symptoms?
(A) Propanolol
(B) Paroxetine
(C) Carbamazepine
@) Olanzapine
@) Naltrexone

98. An l8-year-old man is brought to a psychiatrist a few weeks after dischargefrom a

psychiatric hospital to which he was admitted for a first psychotic episode and
diagnosedwith schizophrenia. He is doing well on olanzapine,but his parents are
concernedbecausehe is withdrawn and will not talk to them about any plans to
return to college or resumeany of his normal activities. He is not actively psychotic
in the first meeting with the psychiatrist, but is depressed.The most important goal
for the psychiatrist at this meeting is to:
(A) provide a clear structurefor the treatment and the therapeutic relationship.
(B) answerthe patient's and the family's questionsabout what schizophreniais.
(C) addressthe patient's feelings of devastationand assessthe risk for suicide.
(D) assessthe patient'scompliancewith medication.
(E) persuadethe patient to resumehis college studies and social life.

99. In the later stagesof HIV infection, the most common neurologic complication is:
(A) cytomegalovirus encephalitis.
(B) cryptococcal meningitis.
(C) HIV polyneuritis.
(D) AIDS vacuolar myelopathy.
(E) AIDS dementia complex.

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100. Handwashingrituals are most closely relatedto which of the following
defense
mechanisms?
(A) Projection
(B) Reversal
(C) Undoing
@) Repression
(E) Regression

101' An 1S-year-oldstudentcomplainsof restlessness, an inability to sit still, feelingsthat

his mind is going blank, an inability to concentrate,tension,ioitubility,
an inability
to fall asleep,and tirednessfor "as long as I can remember, at least for
ttre last year.,,
He has not been able to perform well at school and has been worried about
his
performanceconstantly. His teachershave also been complaining
about his
declining performance and grades. He had been a good student, irithout
any
difficulties up to about2 or 3 years ago and he denies substanceabuse.
His physical
examination and initial laboratory test results are within normal limits.
Which of the
following is the most likely diagnosis?
(A)Dysthymic disorder
(B)Generalizedanxiety disorder
(C)Attention-deficit hyperactivity disorder (ADHD), predominantly inattentive
type
(D)Obsessive-compulsive disorder
@) Adjustment disorder with anxiety

102. The loss of ability to executepreviously leamed motor activities,

which is not the
result of demonstrableweakness,ataxia,or sensoryloss, is associated
with lesions
of the:
(A)
left thalamus.
(B)
cerebellar vermis.
(C)
left frontal lobe.
(D)
left parietal cortex.
@) amygdala.

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103. A 2S-year-oldmale complainsof episodicanxiety marked by heart pounding,
flushing, shaking,chesttightness,and sweatypalms for the last 2 years. These
episodesoccur mostly at work or during encounterswith a group of his friends. He
feels embarrassedand stressedout by theseepisodesand feels that people are
constantly watching him and scrutinizing him. He has been afraid to go to work as
he worries that he will be humiliated by his flushing and shaking in public. He feels
inadequate,socially inept, and hasbeenavoiding new relationships. Which of the
following is the most likely diagnosis?
(A) Social phobia
(B) Agoraphobia
(C) Avoidant personality disorder
@) Panic disorder with agoraphobia
@) Paranoid personality disorder

104. A major task of a psychotherapygroup during the initial engagementphaseis:

(A) learning to tolerate conflict.
(B) learning to tolerate differences.
(C) acceptingthe therapist'sexpertise.
@) resolving strugglesbetween members.
@) determining the limits of emotional safety.

105. A 20-year-oldwoman experienceslethargy,restlessness with confusion,diaphoresis,

flushing, tremors, and myoclonic jerks. She is receiving treatment for depression,
but she cannot remember the name of the medication. The diagnosis most likely is:
(A) tyramine reaction.
(B) tricyclic overdose.
(C) serotonin syndrome.
(D) anticholinergic delirium.
(E) neuroleptic malignant syndrome.

106. The laboratory test value most likely to be elevatedin a patient with autonomic
instability, nonfocal neurological signs, and elevatedtemperatureis:
(A) cortisol.
(B) creatinephosphokinase.
(C) ceruloplasmin.
@) cholecystokinin.
(E) chloride.

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 107. Fetal alcohol syndromeis NOT associated
with:
(A) macrocephaly.
(B) facial dysmorphisms.
(C) postnatalgrowth retardation.
@) intrauterine growth retardation.
(E) learning difficulties.

108' which of the following drugs for the treatment

of parkinsonism has been associated
with the occurrenceof suddln sleep attacks?
(A)Selegiline
(B)Benztropinemesylate
(C)Amantadine
(D)Entacapone
@) Ropinirote

109. while intoxicatedwith a psychotomimetic

drug, a young man reports..seeing
sounds" and "pattems of colors like fireworks
6r colored flames,, associatedwith
real auditory stimuli. which of the following
t".mr-uert describesthis type of
sensoryexperience?
(A) Synesthesia
(B) Oneiric state
(C) Bouffde d6lirante
@) Isakower phenomenon
(E) Lilliputian hallucinations

110' A patient in group therapycalls anotherpatient

at home and objectsto something
the patient had said in the previousgroup session.
This patient,saction is an
example ot
(A) acting in.
(B) acting out.
(C) dependency.
@) group resistance.
@) group transference.

111. which of the following factorsis a good

prognosticindicator in schizophrenia?
(A) No mood disturbance
(B) Insidiousmode of onset
(C) Female gender
@) Early age of onset
@) Structural brain abnormalities

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 Selectthe singlebest responsefor eachof the questionson this pase.

II2. Ita responseinhibitory to anxietyoccursin thepresenceof anxiety-evokingstimuli,

it weakensthe connectionbetweenthe stimuli andthe anxiety. This is called:
(A) anxietyhierarchy.
(B) aversivecontrol.
(C) shapingbehavior.
@) adventitiousreinforcement.
@) reciprocalinhibition.

113. Which of the following medicationsis LEAST likely to causeweight gain asa side
effect?
(A) Bupropion
(B) Minazapine
(C) Isocarboxazid
(D) Olanzapine
@) Valproic acid

114. A patientbelievesthat his televisionis speakingdirectlyto him. This belief is most

appropriatelytermed:
(A) persecutorydelusion.
(B) auditoryhallucination.
(C) ideaof influence.
(D) ideaof reference.
(E) overvaluedidea.

115. Which of the following predictsbipolarityin an adolescentpresentingwith major

depressivedisorder?
(A) Lower IQ
(B) Suicidalideation
(C) Psychoticsymptoms
(D) Goodpremorbidadjustment
@) Insidiousonsetof depression

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116' A 5-year-old boy is brought to the emergencydepartmentby his mother who reports
that her son began screamingand crying for no apparentreason about I hour after he
had fallen asleepthat night. She found him sitting up in bed with his eyes open, and
he was trembling and sweating. It took her nearly 5 minutes to gain his attention.
Her son apparentlyhas had similar but less severeepisodestwo or three times
before. Although the mother recently learnedthat she is pregnant, she has not
informed her son yet. According to the mother, her son tras not had any recent
stressfulexperiences. The boy is sleepy,irritable, and rememb"tr nothing about
what happened. Results of physical examination are normal. The diagnosis most
likely is:
(A) dream-anxiety episode.
(B) psychomotor seizure.
(C) sleep-terrorepisode.
@) separationanxiety.
@) sleep-relatedcolic.

117. Which of the following conditionsis a symptom of carotid insufficiency?

(A) Vertigo
(B) Syncope
(C) Transient diplopia
@) Transient memory loss
@) Transient monocular blindness

118. A 23-yeat-old Caucasianwoman comes to the office for follow-up after an

emergency department@D) visit 2 daysearlier. She reports a suddenonset of
diplopia, right leg weaknessand shaking, and difficulty with speechthe night of the
ED visit, which completelyresolveda few hours later. She naA a fever (T=103.1. F)
and was treated for a urinary tract infection. Current examination reveals normal
cranial neryes, normal sensoryexam, minimal weaknessin her right leg, brisk deep
^
tendon reflexes and musculocutaneousreflexes throughout, and equivocal plantar
reflex on the left. The right toe is downgoing. Review of her history reveals several
episodesof transient neurological deficits that resolved spontaneouriy after a few
days. Her spinal fluid is most likely to show:
(A) protein: 50 mg; oligoclonal bands:+; nucleatedcells: 10.
(B) protein: 15 mg; oligoclonalbands:+; nucleatedcells: 10.
(C) protein: 150 mg; oligoclonalbands:-; nucleatedcells: 10.
@) protein: 150 mg; oligoclonalbands:-; nucleatedcells: 0.
(E) protein: 15 mg; oligoclonalbands:-; nucleatedcells: 0.

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 Select the single best response for each of the questions on this pa9e.

119. The fundamental developmentalneed of all personsfor mirroring, validation, and

affirmation is central to which psychoanalytic theory?
(A)Jungianpsychoanalysis
(B)Self psychology
(C)Object relations
(D)Ego psychology
@) Social psychology

lZ0. AZ-year-oldboy who has been preoccupiedwith a small blanket for severalmonths
carries it with him everywhere and becomesupset if anyone tries to take it away.
Recently, he refused to stay with a baby-sitter until the blanket was retrieved, and
then he seemedoblivious to everything but the blanket. The psychiatrist should
recommendthat the:
(A) blanket be taken away gradually by cutting it in half every few days until gone.
(B) child's behavior is part of normal developmentand that eventually he will give up the
blanket by himself.
(C) child is showing signsof the Oedipalconflict and that he will be less interestedin the
blanket when he feels more comfortable with his father.
(D) child be evaluatedby a child psychiatrist for signs of autism.
@) mother should be more attentive to the child.

121. Which of the following best describesthe psychiatric assertivecommunity treatment

casemanagementmodel?
(A) Interdisciplinary team, servicesin situ, higti staff/patient ratio, and intensive outreach
(B) Functional assessment,goal-setting,and skill training
(C) Linking service,brokering service, and office-based
(D Provid-s support and psychotherapywith clinically educatedand supervisedstaff
@) uses cognitive therapy, day hospital, psychotherapy,and psycho-education

I22. A4l-year-old man presentsfor consultation regarding an increasing senseof conflict

about changing from his work-related faith to a grace-orientedbelief system. His
past history revealsno psychiatric treatment and a stable vocational history. Mental
ituto, findings include an euthymic mood, appropriateaffect, clear sensorium,no
perceptualdisturbance,and a superior intellect. A likely DSM-IV diagnosis is:
(A) acculturation problem.
(B) age-relatedproblem.
(C) phaseof life problem.
(D) religious and spiritual problem.
@) adjustmentdisorder.

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 Selectthe singlebestresponsefor eachof the questionson this page.

123. Accordingto Erik Erikson,anindividualover65 yearsof agewho hasdevelopeda

senseof satisfactionthat life hasbeenproductiveandworthwhilehassuccessfullv
managedthepsychosocial taskof developing:
(A) basictrust.
(B) integrity.
(C) generativity.
(D) intimacy.
@) industry.

124. A 65-year-oldpatientwith diabetesmellituscomesto the emergencydepartment

@D) complainingof acuteonsetleft-sidedweakness.On examination,ihe physician
finds that the patientis alertandoriented,but hasdeviationof gazeto ttrerigtrt, teft
hemiplegiaandhemisensory deficit, andleft homonymoushemianopsia.About
12 hourslater,the nursereportsthat the patientis unconscious.The left pupil is
enlargedandunreactive.An emergencycomputerizedtomography(CT) scanis
likely to showa:
(A) left subduralhematomawith 5 mm midline shift.
(B) right frontal malignantgliomawith subfalcialherniation.
(C) right middlecerebralarteryinfarct with edemaanduncalherniation.
@) left cerebellarinfarct with acutehydrocephalus.
(E) left putaminalhemorrhage with intraventricularextension.

I25. A 45-year-oldwomanis takingphenelzinefor depression.Shetakesan over-the-

countermedicationfor cold symptomsanddevelopsa hypertensivecrisis. Which of
the following medicationsis mostlikely to be associated
with the hypertensivecrisis
in this patient?
(A) Chlorpheniramine
(B) Diphenhydramine
(C) Acetaminophen
@) Pseudoephedrine
(E) Ibuprofen

126. A 50-year-oldindividual with depression believesthat he is responsiblefor the

destructionof the world. This is an exampleof a:
(A) delusionof control.
(B) delusionof persecution.
(C) mood-congruent delusion.
(D) delusionof reference.
@) pseudo-hallucinatoryexperience.

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

L27. Which of the following features characteizes patients with schizophreniawho

smoke cigarettes?
(A) Lower incidence of positive symptoms
(B) Less vulnerable to tardive dyskinesia
(C) Require more antidepressantmedication
@) Require more neuroleptic medication
@) Require more depot neuroleptic medication

128. Which of the following conditions associatedwith mental retardation does NOT
have an autosomal-recessiveinheritancepattern?
(A)Adrenogenital syndrome
(B)Down's syndrome
(C)Hurler's syndrome
(D)Tay-Sachsdisease
@) Phenylketonuria

I29. An obstetrician requestsan urgent psychiatric consultation in her office becausea

24-year-old patient who is in the secondtrimester of her first pregnancy is acting
"very
bizarre." The patient is found to be manic without psychotic features. She has
a history of one previous episodeof mania and was diagnosedas having bipolar I
disorder. She had been on lithium, but discontinuedthe medication when she and
her husbanddecided to have a family. She is not currently under a psychiatrist's
care, but is willing to begin treatment. The consultant should recommend the
obstetrician prescribe:
(A) electroconvulsivetherapy (ECT).
(B) high-potencyneuroleptics.
(C) lithium.
(D) valproic acid.
(E) carbamazepine.

130. A 36-year-oldpatientpresentswith severalepisodesof palpitations,sweating,

trembling, sensationsof shortnessof breath, and choking. Additionally, the patient
reports that his work performanceis suffering becauseof his anxiety. Medical
evaluation is normal. An initial preferred treatmentregimen includes:
(A) alprazolam and psychoanalytictherapy.
(B) paroxetine and cognitive behavioral therapy.
(C) clonazepamand interpersonaltherapy.
@) chlordiazepoxide and brief psychodynamictherapy.
(E) buspirone and dialectical behavior therapy.

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 1 3 1 .weight losshasbeenassociated
with which of the folrowing medications?
(A) Amitriptyline
(B) Olanzapine
(C) Divalproex
@) Mirtazapine
@) Bupropion

L32' A youngfemalepatientbeginningcognitivetherapywith
a femaleresidenttells the
residentthat sheis so sadtodaythat sheneedsa nu! from the
trrerapist.rrre resident
shouldfirst:

!1) hug the patientbecausethey arethe samegender.

(B) determinewhetherthe patienthasany suicldalideation.
(c) explainto the patientwhy physicalcontactis to be avoided.
@) offer to seethe patientfor a longersessiontoday.
(E) pat the patient,shandinstead.

133. A well-definedrisk factorfor tardivedyskinesiais:

(A) youngadulthood.
@) femalegender.
(C) Caucasianrace.
@) prominentpositivesymptoms.
@) high expressed emotion.

134. The mostconsistentpredictorof futuresuicidalbehavioris:

(A) a family historyof suicide.
(B) a clinical diagnosisof depression.
(C) alcoholabuse.
(D) a prior historyof suicidalbehavior.
@) agitation.

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

135. A 2Q-year-oldmale college studentreportsfeeling uneasyaroundpeople and avoids

contactwith everyonebut his parents. He stoppedgoing to school 2 months ago
explaining that his fellow studentswere scrutinizing him all the time. He states,
"They watched my every move. They made me nervous." I{is parents say he has
always been quiet, was doing well until a couple of months ago, and now sits at
home most of the time doing nothing. He frequently mumbles to himself and
sometimesdisplays bizane movements. He deniesdepressionor substanceabuse
and his affect is flat. His physical examination and routine laboratory tests are
within normal limits. Which of the following is the most likely diagnosis?
(A) Social phobia
(B) Schizophreniform disorder
(C) Schizophrenia,paranoid type
(D) Avoidant personality disorder
(E) Schizophrenia,disorganizedtype

136. A 57-year-oldpatient with diabetesmellitus and hypertensionhas had several

episodesof visual loss describedas a curtain falling over his left eye. While at the
physician'soffice, the patienthad a transientepisodeof speechand language
disturbance,associatedwith mild right hemiparesisthat lasted about 2 hours. This
combination of symptoms very strongly suggeststhe presenceof:
(A) intracranial left middle cerebral artery stenosis.
(B) supraclinoid left internal carotid stenosis.
(C) extracranial left intemal carotid stenosis.
(D) cardiac source of embolization.
(E) aotic atheromata.

137. The mechanismof action of botulinustoxin at the neuromuscularjunction involves:

(A) inhibition of acetylcholine synthesisat the neuromuscularjunction.
(B) blockadeof the nicotinic acetylcholinereceptorsin muscle.
(C) inhibition of acetylcholinesterase.
(D) inhibition of the releaseof acetylcholine from presynaptic terminals.
(E) blockade of the voltage-dependentcalcium channels.

138. The Schneiderianfirst-rank syrnptomsof schizophreniainclude:

(A)voices commenting.
(B)perplexity.
(C)feelings of emotional impoverishment.
(D)euphoricmood changes.
@) restricted affect.

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

139. Which of the following findings is LEAST likely to be presentin fetal alcohol
syndrome?
(A) Growth retardation
(B) Facial dysmorphism
(C) Mental retardation
(D) Macrocephaly
(E) Irritability

140. Which of the following symptomscommonly developsrelatively late in children

with post-traumatic stressdisorders?
(A) New trauma-relatedfears not seeninitiallv
(B) Sleepdifficulties
(C) Senseof foreshortenedfuture
(D) Attentional difficulties
(E) Nightmares

141. The major featuredistinguishingmalingeringfrom factitious disorderis:

(A) the consciousfeigning of symptoms.
(B) an externalincentivethat is promoting the symptoms.
(C) an associationwith antisocialpersonality.
@) patients who are predominately female.
(E) the presenceof symptomsusually in a medical or hospital setting.

I42. It is appropriateto periodically assessside effectsfrom neurolepticmedicationby

administeringwhich of the following tests?
(A) Positive and NegativeSyndromeScale
(B) Scalefor the Assessmentof NegativeSymptoms
(C) Global DeteriorationScale
@) Functional Assessmentand StagingTool
@) Abnormal Involuntary Movement Scale

143. An electroencephalogram (EEG) that revealsposterioralpha and anteriorbeta

activity is most likely to havebeenobtainedfrom:
(A) a sleepingadult.
(B) a l-year-old infant.
(C) a relaxedadult with eyesopen.
(D) a relaxedadult with eyesclosed.
(E) an adult performing intensemental activity with eyesclosed.

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

144. Individuals with which of the following personality disorders are most likely to have
first-degree relatives with major depression?
(A)Histrionic
(B)Paranoid
(C)Avoidant
(D)Borderline
@) Dependent

145. A 32-year-old male was diagnosedwith attention-deficit hyperactivity disorder

(ADHD), mixed type, as a child. As an adult, although his hyperactivity has
diminished, he still struggleswith decreasedattention span,impulse control
problems, and distractibility. Pharmacologicaltreatment might include:
(A) phenobarbital.
(B) methylphenidate.
(C) buspirone.
(D) diazepam.
@) chlorpromazine.

146. Concurrent intake of which of the following substancesincreaseslithium levels?

(A) Fluoxetine
(B) Caffeine
(C) Laxatives
@) Theophylline
(E) Osmotic diuretics

147. After a mild heart attack, a7o-year-old man is seenby a psychiatrist for depression.
The patient comes twice a month for psychotherapyand takes a selective serotonin
reuptake inhibitor (SSRI). In a session,the patient describeshis fear of imminent
death. The psychiatrist tells him that his cardiologist is an excellent doctor, and that
he is receiving the best treatment. The characteristicin this vignette that most clearly
illustrates supportive therapy is:
(A)giving of advice.
(B)frequencyof the session.
(C)provision of reassurance.
(D)prescription of an antidepressant.
@) encouragingcompliance with the patient's medical regimen.

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 Selectthe singlebest responsefor eachof the questionson this nase.

148. For the pastseveralyears,the annualprevalencerateof a diseaseis substantially

higherthanits annualincidencerate. Which of the following statementscanbe
concluded?
(A) The diseasetendsto be chronic.
(B) The morbidityrateis decreasing.
(C) Preventionof the diseaseis improving.
(D) Case-findingmethodsarenot very effective.
@) Personswho havethe diseasetendto be stigmatized.

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I
I
I
DIRECTIONS: For eachof the following questions,selectthe most appropriateresponsefrom the
commonsetof lettered answerchoicesaboveit. Answerchoicesmay be selectedonce'morethan
once,or not at all.

Questions149and 150referto the following text:

movementdisorder(A-E).
For eachpatternof inheritance,selectthe associated

A. Huntington'sdisease
B . Parkinson'sdisease
c. Tourette'sdisorder
D . Essentialtremor
E. Wilson'sdisease

I49. Autosomalrecessive

150. Autosomaldominant

END OFPART 1 OFTHE

PSYCHIATRY RESIDENT
40 IN-TRAINING EXAMINATION.