Psychiatry Final Exam

1. You are asked to consult on an elderly Hispanic patient with small cell carcinoma who is admitted to metro general from the ER with bilateral pneumonia. The Attending wants to do a radical FDA approved chemotherapeutic trial with significant side effects. What is the most ethical thing to do? A. Tell the patient that he has no choice but to agree with the treatment plan B. Make the patients family convince him to participate C. Have the patient read and understand a peer reviewed article D. Tell the patient about lung chemotherapy and not radiation option E. None of the above Question 2 - 3 A very affluent and attractive patient presents for continued treatment for Generalized Anxiety Disorder managed without psychotherapy. In the beginning of the session the patient wants to give you a Rolex. 2. The best immediate course of action A. Accept with no questions ask B. Refuse to accept the watch C. Neither accept nor refuse but ask why gift is being given 3. Patient wants to have a romantic relationship with you. What do you do? A. Relationships are only permissible with family members of patients but not the patients themselves B. Never permissible with patient or family members of patients i. once a patient always a patient Question 4 8 Mother of a 33 year old schizophrenic patient presents with the patient and a case worker. Patient is well known to you. In the past year his condition has improved. 4. If you want to diagnose the patient which of the following is ruled out first? A. Schizoaffective disorder 5. Which one of the following would indicate the worst long term prognosis A. First psychotic symptom after college graduation B. Enjoys company of others C. Regardless of topic the patient displays no facial expression i. negative symptoms are bad D. Very specific paranoid delusion E. Dresses appropriately 6. When patient speaks. He expresses himself with words common in English speech but the order and syntax is uncommon. What is this called? A. Tangential speech B. Clang association C. Word salad (syntax messed up) 7. If this patient were to have good long term prognosis. What is his subtype? A. Paranoid i. paranoid schizophrenic patients have good prognosis. This is the most common type and most research is done on this type. These patients often respond to treatment.) B. Disorganized C. Manic D. Undifferentiated E. Catatonic 8. What is the best treatment for this patient? A. Weekly pharmacotherapy and no social therapy B. Short term psychoanalysis. Monthly pharmacotherapy C. Monthly pharmacotherapy with weekly occupational therapy D. Monthly family therapy with annual family education. E. Biannual pharmacotherapy

9. A 61 year old African American female was started on Thorazine 100 mg twice a day. On 4 th day she is confused and disoriented. (Oriented to name only.) Patient experiences visual non-commanding hallucination and is labile. She is incoherent on interview. The most appropriate diagnosis is? A. Delirium i. can be reversed, must be recognized 10. 28 year old African American male admitted to the psychiatric ward due to paranoia and command hallucination. 1 week ago the patient was started on haloperidol (10 mg twice a day). The patient has a fever, agranulocytosis, myoglobinuria, and CPK is 16,000. What is the diagnosis? A. Malingering B. Dystonia C. Worsening of psychosis D. Neuroleptic Malignant Syndrome 11. Most common side effect of SSRI? A. Suicide B. Sexual dysfunction C. GI disturbance 12. 26 year old Caucasian female overdosed on unknown pills. When brought to ER she was having nausea, sweating, diarrhea, temperature 103 F. She was reluctant to provide information on the nature of the pills. What did she most likely overdose on? A. Tylenol B. Antipsychotic C. SSRI i. symptoms describe serotonin syndrome D. NSAIDS 13. A 72 year old Armenian male brought to ER confused, irritable, and agitated. Vitals were normal. The patient was being treated for paranoid delusions. It was found that the patient has a smooth mass in his lower abdomen extending to his umbilicus. Ultrasound shows distended urinary bladder. What is the most likely cause? A. Enlarged prostate B. Urethral malignancy C. UTI D. Anticholinergic side effects 14. All of the following regarding research on adult development are true except? A. Just as is the case for children and adolescents, there are predominant and universal developmental stages in adulthood. (FALSE) 15. All of the following statements about the DSM are true except? A. The multiaxial scale came into use in 1980 with DSM III (true) B. Came into use with DSM IV in 2000 (False) (alternate false answer choicescale came into use in 1968 with DSM III) 16. The most commonly employed brief psychiatric rating scale is? A. Vicks B. Nasdaq C. MMPI2 D. Global assessment functioning scale (GAF) 17. Commonly employed biotherapies include? A. ECT B. Psychosurgery (lobotomies are no longer performed) 18. In terms of psychopharmacology schedules. Which of the following is not contained in schedule I? A. Hydrocodone B. LSD C. Heroin 19. Which of the following is true? A. Schedule 1 drugs are not prescribed to treat patients. Only used for research purposes

20. Which of the following statements is false A. Phone refills are allowed for schedule II drugs 21. Which schedule of drugs has the highest abuse potential? A. Schedule I 22. All of the following are anticholinergic side effects except? A. Blurred vision B. Decrease in bronchial secretion C. Narrow angle glaucoma D. All of the above are side effects 23. All of the following are typical antipsychotics except? A. Thioridazine B. Haloperidol C. Fluphenazine D. Clozapine i. -azines + haloperidol are typicals) 24. What is a targeted brain area for antipsychotic medication? A. Basal ganglia B. Amygdale nucleus C. Hypothalamus D. Substantia nigra E. All of the above 25. Antidepressants include all of the following except? A. MAOI B. SSRI C. PKU 26. Which of the following is imipramine (a type of TCA) used for? A. Enuresis 27. SSRI side effects include? A. Nausea B. GI disturbance C. Sexual dysfunction D. All of the above 28. Benzodiazepine side effects include all of the following except? A. Teratogenicity B. Sedation C. Abuse potential D. Dependence, tolerance, withdrawal E. Attention problem F. Tardive Dyskinesia i. common for typical antipsychotics 29. Benzodiazepine is indicated in the treatment of all of the following except? A. Panic disorder B. Agitation C. Sleep problems D. Alcohol withdrawals. E. Benzodiazepine withdrawal F. Paranoid Schizophrenia 30. Which of the following is false regarding alprazolam (Xanax)? A. Street drug B. Long acting C. Worst in terms of dependence

31. Which of the following regarding dose equivalence for Benzodiazepines is false? A. 8 mg alprazolam/Xanax = 80mg diazepam/valium B. 25 mg of Xanax = 2.5 mg of Valium i. remember Diazepam is Valium, Alprazolam is Xanax. 1mg alprazolam=10 mg diazepam) 32. Which of the following drugs requires regular blood level monitoring? A. Lithium B. Alprazolam 33. Which of the following is false regarding the use of short acting benzodiazepine vs the use of long acting benzodiazepine? A. Tolerance and dependence B. Seizures during abstinence C. Antisocial activity D. Used for panic disorder E. Used for general anxiety 34. According to Piaget which of the following regarding adult learning is true? A. Adult learning continues through middle adulthood before it declines i. Age 35 is when most peoples genius will show. Middle adulthood is when you see peak in intelligence. 35. How is intimate partner abuse governed? A. It is governed by community laws 36. Intimate partner abuse is A. 7th leading cause of death for women 37. Karen Horneys work encompassed all of the following except? A. Feminism B. Anorexia C. Schizophrenia 38. Damage to dopamine neurons in midbrain is a central feature of Parkinsonism. This loss is accompanied by? A. Increase in dopamine 2 receptor density B. Decrease in dopamine 2 receptor density 39. All of the following psychotic disorders are more commonly diagnosed in Women than men. Which of the following is the most commonly diagnosed mental disorder in women? A. Depression 40. Which of the following is true regarding the DSM? A. 6 editions have been published since WW2. i. DSM V is scheduled to be released in May 2013. Aspergers will be excluded) 41. Individuals with antisocial personality disorder? A. Steer clear of sororities and fraternities B. Dislike social interactions C. Feel hurt if rejected by others D. None of the above 42. How many questions in the MMPI? A. 567 true and false questions B. 510 questions 43. How are factitious disorder and malingering similar? A. Both are conscious acts/ Fictional disorders 44. What is Erik Eriksons period of middle childhood A. Industry vs inferiority (6-12) 45. A 46 year old Haitian American man was brought to Hospital following automobile accident in which the passenger was killed. What is the most likely substance he was using? A. Alcohol 46. When stimulants are used to treat ADHD what are you targeting? A. Distractibility and impulsivity

47. A 25 year old Armenian American male presents complaining of sleeping problems after midterms. He complains of problems getting to sleep and staying asleep. He also admits to feeling depressed and restless. What is the problem? A. Amphetamine intoxication B. Cocaine withdrawal i. the answer could have also been amphetamine withdrawal if it was a choice 48. A 20 year old Egyptian American female presents at the Metro general ER with a roommate. The young patient is groggy, trips when walking and slurs her words. What is the best information provided that would support alcohol abuse? A. 3 months of drinking a bottle of wine twice a week. B. Patient has had multiple police citation for having open container 49. Ethical principles of AMA must be upheld by all of the following types of clinicians except? A. Forensic psychiatrists i. They dont have to uphold all the guidelines because they serve as expert witnesses and are involved in sentencing patients. 50. All of the following types of clinicians can diagnose a psychiatric disorder except? A. Psychiatrist B. Internists C. Licensed counselor D. psychologist E. Licensed social worker F. Licensed family therapist G. All of the above 51. Which of the following is false regarding negative reinforcement? A. Negative reinforcement is when an unpleasant consequence is removed following a response. This makes the response more likely. B. Negative reinforcement is the same as punishment C. Is a behavior modification technique 52. Regarding depression in elderly all of the following are true except? A. Treatable cause is always found B. Alcoholism is not a common find. i. alcoholism is a common finding in depression and in the elderly 53. Elder abuse by the caregiver is more likely to occur if: A. Patient is dependent B. Patient has multiple problems C. Patient is bedridden D. All of the above. 54. Reasons for slow absorption of medication in an elderly patient include all of the following except? A. Decreased gastric pH B. Decreased gastric motility C. Decreased gastric perfusion D. Increased gastric emptying 55. Which of the following is true regarding latent learning? (Learning that is not necessarily displayed on performance assessment although learning has occurred) A. Often occurs in med school B. All of the above 56. In the geriatric population all of the following are true except? A. Females live 7-8 years longer than males B. 85 and above is fastest growing portion C. Majority of elderly live at home (only 5% in nursing homes) D. Depression and alcohol dependency/abuse is rarely diagnosed 57. A 70 year old male patient has urinary retention, dry eyes, and feels dizzy. What is the most likely cause? A. Recently began tricyclic antidepressant regimen (anticholinergic)

58. Which is not part of the Mental status exam? A. Speech B. Judgment C. Appearance D. Sexual orientation 59. 34 year old Asian American women presents with depression, poor sleep, and appetite suppression. Which of the following would not be expected? A. She is well groomed. Wears bright colors and has a lot of make-up on 60. Each of the following is an example of thought content except? A. Flight of ideas B. Obsessions C. All of the above are examples of thought content 61. Risk factors for adolescent suicide include? A. Being bullied B. Anxiety C. Family history of suicide D. All of the above associated 62. Which mental disorder is associated with adolescent suicide A. Anxiety B. Depression C. Conduct disorder D. Bipolar disorder E. All of the above 63. What is the most common means of completed suicide? A. Hanging B. Firearms C. Drowning D. Falling E. Slashing wrist 64. All of the following are true regarding childhood disorders except? A. Boys more commonly diagnosed with mental retardation, ADHD, and conduct disorder B. Boys may have Retts disorders (only possible if boy has KlinefeltersXXY) C. Boys are more likely to have development learning disorder D. All of the above are true 65. The following statements are true about adolescent suicide except? A. Bullying can lead to it B. Young bipolar at higher risk than ADHD C. Early childhood suicide attempts D. All of the above 66. The following statements are true regarding forensic psychiatry except? A. Board certification is mandatory to practice 67. Regarding Forensic psychiatry A. Clinical expertise is applied to legal issues regarding B. Clinical legal, affects C. Needs to be licensed in a state to practice. i. dont need to be licensed to serve as expert testimony ii. also a forensic expert licensed in California can provide testimony elsewhere) 68. Forensic psychiatrists strive to uphold the following ethical standards A. Serve patients needs B. Value rights to confidentiality C. Do no harm D. All are false

69. Who would you associate Tabula Rosa (blank slate) ideology with? A. BF Skinner B. John Watson i. although he was also a behaviorist, he was a radical behaviorist. He said that if you give him 12 infants he could train one to be a doctor, one a lawyer, one a beggar, etc 70. A 27 year old male medical student receiving CBT for chronic depression and anxiety for 8 months. He attends a minority medical school but does not belong to that minority. He tells his therapist that he is an IV league college graduate and lists his many academic achievements. The patient also discusses his disdain about his medical school professors, classmates, and curriculum. He mentions that he lied about valuing the schools mission statement during his interview in order to be accepted. Which of the following is true? A. Low self esteem B. Has feelings of inferiority C. Person is narcisstic (cluster B personality disorder Dramatic, emotional// Cluster Aodd or eccentric// Cluster C Anxious or fearful) D. Person is ashamed and full of self-doubt E. Antisocial tendencies F. Might be embarrassed that he is accepted to a minority school. G. All of the above 71. People with personality disorder are A. Ego syntonic i. dont think anything is wrong with them B. Ego dystonic 72. Throughout her childhood a womans father played recordings of Bach, Beethoven, and Mozart while she did her daily work related activities. As she matured educationally she learned her performance was enhanced when she listened to music while doing work. What did her father really do? A. Operant B. Classical condition i. music is Conditioned Stimulus, enhanced performance is conditioned response C. Behavioral conditioning 73. Diagnosis of Mental retardation requires which of the following? A. Subnormal social adaptive skill B. Subnormal intellectual functioning. (person must have IQ less than 70 which is two standard deviations below the mean) C. Age 21 and younger at time of diagnosis. (would be true if it was 18) D. A and B are true 74. The following are true regarding mental retardation except? A. Must have psychometric testing done to confirm diagnosis. Use Waschler and/or Stanford Ninet B. Mean intelligence is 100, standard deviation 10 i. false because standard deviation must be 15 75. Operant conditioning is used to treat which of the following? A. Mental retardation B. ADHD C. Autism D. Conduct disorder E. Children F. All of the above 76. Which of the following operant reinforcement schedules is best to avoid extinction? A. Variable ratio (slot machine) Disclaimer: The professor claims that the best ratio for learning is continuous and that the best ratio to sustain behavior is variable interval (i.e. pop quiz). According to my reading variable ratio is most resistant to extinction

77. A father is proud of her daughter who plays the violin and piano. Whenever a guest comes the father gives the daughter a dollar to play for the guest. Eventually the daughter refuses to get paid and plays just to satisfy her father. Which of the following are involved A. Positive operant conditioning (initially daughter was reinforced to play) B. Social learning (daughter learned to play just to make dad happy) C. Both of the above are true 78. Which of the following are true regarding self-injurious behaviors? A. Include slashing and tattooing B. Occur in mentally retarded C. Social learning is involved (epidemic in psychiatric ward or school) D. All of the above i. remember people who self-mutilate are not necessary suicidal, they do it to relieve their anxiety and depression. Its done to avoid suicide. Should be taken as seriously as suicide 79. Which of the terms below describe the following: when a new stimulus that resembles a conditioned stimulus causes a conditioned response? A. Stimulus generalization 80. All of the following regarding physical punishment are false except? A. Never used on children i. false: can be used on children before they can think and reason-kindergarten/toddlers 81. Which of the following terms describes the following: When a therapist attempts to teach a complex behavior by rewarding approximations of the desired behavior until the correct behavior is achieved A. Shaping 82. Which of the of the following are true regarding social learning? A. It is more successful if the observed behavior results in positive consequences B. Others are observed and their behaviors are imitated C. All of the above 83. In regards to social learning theory which of the following are true: A. No tabula rosa B. Plans expectations, and beliefs feed into equation C. All of the above