Question 1 (10 points)

How many axes are used in the DSM classification?

Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. 1
0.0% b. 2
0.0% c. 3
0.0% d. 4
100.0% e. 5

Score: 10 / 10

Question 2 (10 points)

Axis IV codes which of the following?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. Clinical syndromes
0.0% b. Developmental disorders
100.0% c. Psychosocial stressors

0.0% d. General medical conditions

0.0% e. Personality disorders

Score: 10 / 10

Question 3 (10 points)

A patient presents with serious suicidal ideation and can't keep a job. What is the most likely GAF score for
this patient?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. 90
0.0% b. 70
100.0% c. 50

0.0% d. 30
0.0% e. 10

Score: 10 / 10
Question 4 (10 points)
A patient presents with a history of recurrent depression of moderate intensity, with the most recent
episode precipitated by a divorce. What would you code on Axis IV?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. Major depression, recurrent,
moderate
0.0% b. 70
0.0% c. Dependent personality
disorder
100.0% d. Problems with primary
support group
0.0% e. Learning disorder

Score: 10 / 10

Question 5 (10 points)

A patient with panic disorder presents with a history of hypertension and treatment for hypothyroidism.
What would you code on Axis III?
Student response: Percent Correct Student Answer Choices
Value Response Response
100.0% a. Hypertension,
hypothyroidism
0.0% b. Panic disorder with
agoraphobia
0.0% c. Panic disorder without
agoraphobia
0.0% d. 80
0.0% e. Medical disorder

Score: 10 / 10

Total score: 50 / 50 = 100.0%

Question 1 (10 points)

The general criteria for a personality disorder include which of the following?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. Periods of both elevated mood
and depression
 0.0% b. Pervasive and irrational fear of
social situations
100.0% c. An enduring pattern of
experience and behavior that
deviates from cultural
expectations
0.0% d. Chronic suspiciousness of
others
0.0% e. Self-mutilating behavior

Score: 0 / 10

Question 2 (10 points)

John is a 35-year-old man who works at an accounting firm. He is seen as shy and dependable by his
supervisors, but has made no friends among his co-workers. Although others have invited him to go to
parties, he has been unwilling to attend because he fears that he would do something that would
embarrass himself. He turned down a promotion that would have meant that he had to interact with the
firm's customers. The most likely diagnosis for John is:
Student response: Percent Correct Student Answer Choices
Value Response Response
100.0% a. Avoidant personality disorder

0.0% b. Social anxiety disorder

0.0% c. Dysthymic disorder
0.0% d. Paranoid personality disorder
0.0% e. Specific phobia

Score: 10 / 10

Question 3 (10 points)

A patient's behavior is described by a colleague as odd and eccentric. If the patient fulfills criteria for a
personality disorder, in which cluster would it be found?
Student response: Percent Correct Student Answer Choices
Value Response Response
100.0% a. Cluster A

0.0% b. Cluster B
0.0% c. Cluster C

Score: 10 / 10

Question 4 (10 points)

A colleague asks you for advice about a patient she sees for treatment of uterine fibroids. The patient
seems very attached to her doctor, and often schedules appointments for problems that are very minor.
She often asks your colleague about whether she will stay working in the clinic, and became very worried
when she took a two-week vacation. She became frantic during the vacation and called the covering
physician several times. What is the most likely diagnosis?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. Dysthymic disorder

0.0% b. Malingering
0.0% c. Narcissistic personality
disorder
0.0% d. Schizotypal personality
disorder
100.0% e. Borderline personality disorder

Score: 0 / 10

Question 5 (10 points)

A 45-year-old man is admitted to a medical unit following a heart attack. Psychiatric consultation was
requested because nursing staff reports that his offensive behavior is disruptive. When interviewed, the
patient is dismissive and only wants to talk about his beautiful girlfriend, expensive sports car, and famous
people whom he knows. He denies having had a heart attack and insists it was only "heartburn." He
belittles the staff and claims that only the famous doctor whom he knows is competent to treat him. What
is the most likely diagnosis?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. Schizoid personality disorder

100.0% b. Narcissistic personality

disorder
0.0% c. Delusional disorder
0.0% d. Schizophreniform disorder
0.0% e. Major depression with
psychosis

Score: 0 / 10

Total score: 20 / 50 = 40.0%

Question 1 (10 points)

You are discussing a patient with your attending, and she says, "The real problem for this patient is his
negative symptoms." This means that:
Student response: Percent Correct Student Answer Choices
Value Response Response
 100.0% a. The patient has significant
problems with lack of
motivation and lack of interest
in social interactions.
0.0% b. The patient has significant
problems with memory and
concentration.
0.0% c. The patient has significant
problems with hearing voices
and believing that others are
trying to harm him.
0.0% d. The patient has significant
problems with depression.
0.0% e. The patient has significant
problems with authority
figures.

Score: 10 / 10

Question 2 (10 points)

Your patient tells you that people put thoughts into her mind. Which theorist emphasized this kind of
symptom as a hallmark of schizophrenia?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. Freud
0.0% b. Jung
0.0% c. Kraepelin
0.0% d. Bleuler
100.0% e. Schneider

Score: 10 / 10

Question 3 (10 points)

You are asked to evaluate a patient who has been hearing voices for the last month and who has also been
telling others that the CIA is monitoring his phone calls. When you interview him, you find it difficult to
understand him because he changes the topic quickly in conversation and has trouble staying on a topic
even when he wants to discuss it with you. You talk to a family member who tells you that the patient was
fine three months ago and was doing well in college. He now has had to leave college because he can't
cope with his class schedule. The most appropriate diagnosis for this patient is:
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. Schizophrenia, paranoid type

0.0% b. Paranoid personality disorder

100.0% c. Schizophreniform disorder
 0.0% d. Brief psychotic disorder
0.0% e. Bipolar disorder

Score: 0 / 10

Question 4 (10 points)

You are asked to evaluate a patient who presents with the belief that she is part of a plot to assassinate
several leaders in the Middle East. She tells you that she hears a voice telling her to "get ready for action"
almost every day. She presents with normal affect and is able to tell you about her thoughts in a very clear
and logical way. Her family tells you that she has been having these thoughts for most of the last year. The
most likely diagnosis for this patient is:
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. Delusional disorder, grandiose
type
100.0% b. Schizophrenia, paranoid type

0.0% c. Bipolar disorder, manic

0.0% d. Schizophrenia,
undifferentiated type
0.0% e. Schizophreniform disorder

Score: 10 / 10

Question 5 (10 points)

A patient is brought by ambulance to the emergency department after a suicide attempt. The patient
attempted to kill herself by taking an overdose of acetaminophen but is now medically stable but under
observation. She tells you that she became despondent after her boyfriend told her that he was leaving her.
On physical examination, you discover multiple scars on her arms. She tells you that in the past she has
cut herself to relieve her emotional pain and that the sight of blood makes her feel much better. You
contact a family member who tells you that the patient has been hospitalized on several occasions for
suicide attempts. The most likely diagnosis is:
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. Schizophrenia, paranoid type
0.0% b. Histrionic personality disorder
0.0% c. Bipolar disorder, mixed
episode
100.0% d. Borderline personality disorder

0.0% e. Ketamine abuse

Score: 10 / 10
Question 6 (10 points)
You are working at a community clinic and evaluate a 50-year-old patient with a long history of
schizophrenia. You notice that her lips are moving in a smacking movement and you see writhing
movements in her hands. She tells you that at times she even bites her tongue because of the movements.
The most likely cause of these movements is:
Student response: Percent Correct Student Answer Choices
Value Response Response
100.0% a. Treatment with fluphenazine
(Prolixin)
0.0% b. Treatment with olanzapine
(Zyprexa)
0.0% c. Treatment with chlorpromazine
(Thorazine)
0.0% d. Parkinson's disease
0.0% e. Wilson's disease

Score: 0 / 10

Question 7 (10 points)

A patient with a long history of schizophrenia has made several suicide attempts in recent months. He has
been previously treated with haloperiodol (Haldol), olanzapine (Zyprexa), and thioridazine (Mellaril) with
little positive treatment effects. What might be the best choice of medication for this patient?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. fluphenazine (Prolixin)
0.0% b. risperidone (Risperdal)

0.0% c. aripiprazole (Abilify)

0.0% d. perphenazine (Trilafon)
100.0% e. clozapine (Clozaril)

Score: 0 / 10

Question 8 (10 points)

Which of the following is most characteristic of assertive community treatment?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. services are delivered in
community clinics
0.0% b. treatment focuses on control
of hallucinations
0.0% c. services are delivered in
 community hospitals
0.0% d. the treatment team is led by a
psychiatrist
100.0% e. services are available 24 hours
a day

Score: 10 / 10

Question 9 (10 points)

Symptoms of psychosis do not occur in which of the following?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. Manic episodes
0.0% b. Major depressive episodes
100.0% c. Hypomanic episodes

0.0% d. Mixed mood episodes

0.0% e. Schizophreniform disorder

Score: 10 / 10

Question 10 (10 points)

A previously well functioning 26 year old woman is brought to the emergency department by her friends.
They report that over the past four weeks the woman has been increasingly irritable. Sometimes she talks
very rapidly and has been sleeping less that usual. Her friends say that sometimes it's hard to talk to her
because she talks so quickly and won't let them respond to what she says. They became very worried when
she recently told them that she was hearing the voice of God telling her that she was a special messenger.
The most likely diagnosis is:
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. Brief psychotic disorder
0.0% b. Schizophreniform disorder
100.0% c. Bipolar disorder with psychotic
features
0.0% d. Schizophrenia, disorganized
type
0.0% e. Bipolar disorder, type II

Question 1 (9 points)
Genetic studies of mood disorders suggest that
Student response: Percent Correct Student Answer Choices
Value Response Response
 0.0% a. mood disorders are completely
caused by environmental
stressors
0.0% b. a single gene causes major
depression
100.0% c. multiple genes each contribute
a small effect in risk for mood
disorders
0.0% d. a single gene causes
melancholic depression but not
other types
0.0% e. multiple genes only cause
severe bipolar disorder but not
mild forms of it

Score: 9/9

Question 2 (9 points)
Mainly in the mesolimbic region, serotonin has an important modulatory effect on:
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. corticotropin release hormone
100.0% b. dopamine

0.0% c. norepinephrine
0.0% d. thyroxine
0.0% e. acetylcholine

Score: 9/9

Question 3 (9 points)
A common feature of patients' cognitions in depression is an information processing bias toward:
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. egocentric thoughts
0.0% b. fewer logical connections in
discourse
100.0% c. negative appraisals of others
and the world
0.0% d. appraisals of the world as
excessively dangerous
0.0% e. positive appraisals of others
Score: 0/9

Question 4 (9 points)
Which of the following mood disorders is characterized by milder depressive symptoms than in major
depression that persist for at least 2 years, with a symptom free period of no more than 2 months in each
year?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. Depressive personality
disorder
0.0% b. Adjustment disorder with
depressed mood
0.0% c. Bipolar II disorder
100.0% d. Dysthymic disorder

0.0% e. Subsyndromal depression

Score: 9/9

Question 5 (9 points)
A 35-year-old man presents for evaluation with the complaint of feeling very depressed. He states that he
has been sleeping excessively ("almost all the time I'm not a work") for the past several months and is
bothered by feeling worthless and inadequate around others. He has gained 15 pounds in the past several
months. He notes, however, that when his brother's children visit him, his mood improves substantially, but
after the children leave he once again feels depressed. He thinks about death a great deal but denies
suicidal intent or plan. His symptoms have significantly interfered with his daily functioning. The most likely
diagnosis is:
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. major depression, melancholic

100.0% b. major depression, atypical

0.0% c. major depression, seasonal

0.0% d. dysthymic disorder
0.0% e. adjustment disorder with
depressed mood

Score: 0/9

Question 6 (9 points)
An endocrine factor associated with depression is an elevated level of
Student response: Percent Correct Student Answer Choices
Value Response Response
100.0% a. cortisol
 0.0% b. growth hormone
0.0% c. colony stimulating factor
0.0% d. insulin-like growth factor
0.0% e. interleukin 2

Score: 9/9

Question 7 (9 points)
You are treating a diabetic patient who has is depressed and has persistent neuropathic pain. A logical
initial choice of antidepressant for this patient might be:
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. selegilene transdermal
(Emsam)
0.0% b. bupropion XL (Wellbutrin XL)

0.0% c. nortriptyline (generic)

0.0% d. fluvoxamine (Luvox)
100.0% e. duloxetine (Cymbalta)

Score: 0/9

Question 8 (9 points)
You evaluated a 35-year-old woman for depression four weeks ago and determined that she had major
depression. You initiated treatment for this patient with citalopram, 20 mg a day. Today the patient returns
for follow-up and reports that she feels somewhat better but still feels sad and has lack of appetite. The
most logical next step in this patient's treatment is:
Student response: Percent Correct Student Answer Choices
Value Response Response
100.0% a. increase dose of citalopram

0.0% b. discontinue citalopram

0.0% c. change medication to
sertraline (Zoloft, generic)
0.0% d. change medication to lithium
0.0% e. add T3 (Cytomel)

Score: 0/9

Question 9 (9 points)
You are treating a patient with major depression who has had a partial response to treatment with
sertraline (Zoloft, generic) at a dose of 150 mg/day. A logical next step in the treatment of this depression
might be:
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. decrease dose of sertraline
(Zoloft, generic)
0.0% b. add fluoxetine (Prozac,
generic)
100.0% c. add bupropion XL (Wellbutriin
XL)
0.0% d. add propranolol (generic)
0.0% e. change to mirtazapine
(Remeron) monotherapy

Score: 0/9

Question 10 (9 points)
You are evaluating a 21-year-old college student for depression and have determined that he has major
depression. He states that he often feels as though he would like to be dead, and has thought about killing
himself. Which of the following would MOST increase your concern about this man's suicide risk?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. He is in a close relation with a
significant other
0.0% b. He comes from a religious
family
100.0% c. He binge drinks alcohol on
weekends
0.0% d. He denies sleep difficulties
0.0% e. He exercises regularly

Score: 9/9

Question 11 (10 points)

You are called to the medical unit to evaluate a 72-year-old woman with depression so severe that she now
requires tube feeding as she refuses to eat. She now weighs approximately 82 pounds while in the past she
weighed 105 pounds. She shows almost no spontaneous movement and has not responded to several trials
of antidepressant medications. The most appropriate treatment for this patient would be:
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. cognitive-behavioral
psychotherapy
0.0% b. olanzapine (Zyprexa), 5 mg at
bedtime
 0.0% c. selegiline transdermal

0.0% d. fluoxetine, 20 mg a day

100.0% e. electroconvulsive therapy

Score: 0 / 10

Total score: 45 / 100 = 45.0%

Question 1 (13 points)

A 26-year-old woman was admitted to the psychiatric unit after having been brought to the emergency
department by police because she was involved in a traffic accident. On evaluation, she is physically well
but tells you that she wrecked her car while driving 90 mph because "I just felt so good." She also tells you
that she has been feeling this way for at least three weeks, after she returned from a vacation. She tells
you that before the accident she had been hearing voices telling her to give all her money away. On mental
status examination, you notice that although she makes sense and can answer your questions, she speaks
very rapidly and appears to feel as though she has to tell you as much as she can very quickly. She is now
taking lithium, 2,100 mg a day and has a blood level of 1.0 mEq/L. She appears to be improving on this
treatment. The most likely diagnosis for this patient is:
Student response: Percent Correct Student Answer Choices
Value Response Response
100.0% a. bipolar I disorder, manic

0.0% b. bipolar II disorder,

hypomanic
0.0% c. substance-induced mood
disorder
0.0% d. post-concussion syndrome
0.0% e. brief psychotic disorder

Score: 13 / 13

Question 2 (13 points)

A 25-year-old car salesman is referred to you because he has been drinking too much over the past two
weeks. The patient reports that he has been feeling very sad for the past six weeks, cries "for no reason,"
and has no interest in sex or work. A family members tells you that he has had these episodes for years.
The patient also tells you, "It's the oddest thing. Sometimes I feel great." During these episodes he is
outgoing, energetic, and gets lots of work done. During those times he doesn't drink. The most likely
diagnosis is:
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. major depression

0.0% b. substance-induced mood

disorder
 100.0% c. bipolar II disorder

0.0% d. cyclothymic disorder

0.0% e. bipolar I disorder

Score: 0 / 13

Question 3 (12 points)

Which of the following medications is the most appropriate treatment for a patient who presents with
elevated mood, pressured speech, and mood-congruent psychotic symptoms?
Student response: Percent Correct Student Answer Choices
Value Response Response
100.0% a. litium carbonate

0.0% b. lamotrigine (Lamictal)

0.0% c. alprazolam (Xanax)
0.0% d. citalopram (Celexa)
0.0% e. amitriptyline

Score: 12 / 12

Question 4 (13 points)

The appropriate laboratory work up to be completed before initiating treatment with lithium includes white
blood cell count, kidney function, and which of the following?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. interleukin 6 level

100.0% b. thyroid stimulating hormone

0.0% c. fasting blood glucose

0.0% d. dexamethasone suppression
test
0.0% e. alkaline phosphatase

Score: 0 / 13

Question 5 (12 points)

The most serious side effect associated with carbamazepine treatment for bipolar disorder is:
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. gastrointestinal upset
 0.0% b. fine tremor
0.0% c. alopecia
100.0% d. agranulocytosis

0.0% e. dizziness

Score: 0 / 12

Question 6 (13 points)

An appropriate choice of medication for the initial treatment of a moderately severe manic episode would
be:
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. lamotrigine (Lamictal)

0.0% b. clonazepam (Klonopin)

0.0% c. lorazepam (Ativan)
0.0% d. pregabalin (Lyrica)
100.0% e. olanzapine (Zyprexa)

Score: 0 / 13

Question 7 (12 points)

A patient with a history of several episodes of major depression and at least one hypomanic episode
presents with the current complaint of depression. The most appropriate treatment for this patient would
be:
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. pregabalin (Lyrica)

0.0% b. alprazolam (Xanax)

0.0% c. phenytoin (Dilantin)
0.0% d. levitiracetam (Keppra)
100.0% e. lamotrigine (Lamictal)

Score: 0 / 12

Question 8 (12 points)

A 47-year-old woman with a history of lupus presents with elevated mood, decreased need for sleep,
increased activity, and recent excessive spending. She has no previous history of mood disorder. What is
the most likely cause of her change in mood?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. treatment with interferon-
alpha
0.0% b. increased social stress
0.0% c. treatment with nonsteroidal
anti-inflammatory medication
100.0% d. oral steroids

0.0% e. cisplatin

Score: 0 / 12

Total score: 25 / 100 = 25.0%

Question 1 (10 points)

An early and frank discussion of the importance of confidentiality and for sharing information between
parent and child, as well as its limitations:
Student response: Percen Correct Student Answer Choices
t Respons Respons
Value e e
100.0 a fosters trust in the therapeutic
% . relationship
0.0% b is a more sensitive issue for
. younger children compared with
adolescents
0.0% c. should include a representative
from the patients insurance
company
0.0% d is only useful with adolescents
. and isn't important with young
children
0.0% e should always include a neutral
. third party

Score: 10 / 10

Question 2 (10 points)

Factors that most greatly affect the developmental differences of distribution of drugs in children are:
Student response: Percen Correct Student Answer Choices
t Respons Respons
Value e e
0.0% a lower plasma levels and hepatic
. metabolic activity differences
 100.0 b differences in proportion of
% . extracellular water volume and
body fat
0.0% c. cytochrome P450 2C9 and 2D6
0.0% d genetic variations sertonin and
. dopamine receptors
0.0% e how much water the patient
. drinks

Score: 10 / 10

Question 3 (10 points)

A nine-year-old boy presents with a four-month history of odd movements of his neck and face. They occur
sporadically but are most noticeable when he sits quietly and works on school work. The facial movements
are described by the boy's teacher as "grimaces" and the neck movements appear as though he is
stretching his neck. In the past month, he has been clearing his throat repetitively. The most appropriate
medication for this condition is:
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. diphenhydramine (Benadryl)
0.0% b. alprazolam (Xanax)
0.0% c. fluoxetine (Prozac)

0.0% d. propranolol (generic)

100.0% e. risperidone (Risperdal)

Score: 0 / 10

Question 4 (10 points)

A 10-year-old boy is brought to the pediatric clinic by his mother for evaluation. She states that for the past
six months he has been having difficulties in school and that she has received several calls from his teacher.
She states that the boy constantly argues with adults both at home and school when asked to do things,
and appears to go out of his way to make other people angry with him. He is also described as easily
angered by trivial things and often loses his temper. The boy's mother says he appears able to concentrate
when he want to work on his school work, but she often finds him playing his Xbox when she has told him to
do his homework. The most likely diagnosis for this patient is:
Student response: Percen Correct Student Answer Choices
t Respons Respons
Value e e
0.0% a attention deficit hyperactivity
. disorder, hyperactive
0.0% b major depressive disorder
.
0.0% c. anxiety disorder NOS
100.0 d oppositional defiant disorder
% .
0.0% e developmental reading disorder
 .

Score: 10 / 10

Question 5 (10 points)

A 12-year-old girl is brought to the pediatrics clinic because of her mother's concern about her school
achievement. The child had been doing generally well in school until sixth grade, but now is having
difficulties in several subjects. Most worrisome, although always weak in the subject, she is now failing
math. The mother brings a psychological evaluation from the school which shows the following: Average
intellectual ability; average performance in reading; and well below average performance in math. The most
appropriate diagnosis for this child is:
Student response: Percen Correct Student Answer Choices
t Respons Respons
Value e e
0.0% a oppositional defiant disorder
.
0.0% b attention deficit/hyperactivity
. disorder, inattentive
100.0 c. developmental mathematics
% disorder
0.0% d major depression
.
0.0% e specific mathematics phobia
.

Question 1 (10 points)

What stage of sleep is illustrated in this polysomnogram?

Student response: Percent Correct Student Answer Choices

Value Response Response
0.0% a. 1
100.0% b. 2

0.0% c. 3-4
0.0% d. REM
0.0% e. Slow-wave

Score: 10 / 10

Question 2 (10 points)

What stage of sleep is illustrated in this polysomnogram?

Student response: Percent Correct Student Answer Choices

Value Response Response
0.0% a. 1
0.0% b. 2
0.0% c. 3-4
100.0% d. REM

0.0% e. Slow-wave

Score: 10 / 10

Question 3 (10 points)

You are consulted by an 71-year-old woman who is treated for hypertension with fosinopril and occasionally
takes ibuprofen for arthritis, but is otherwise healthy. She complains that she doesn't sleep well at night.
She says that she goes to sleep, but wakes up frequently during the night. She often does not feel refreshed
in the morning. Her hypnogram is illustrated in the figure below. What is the most likely explanation for her
sleep complaints?

Student response: Correct Student Answer Choices

Percent
Respons Respons
Value
e e
0.0% a. Fosinopril-induced insomnia
0.0% b. Poor sleep hygiene
100.0% c. Normal developmental
changes
0.0% d. Psychophysiological insomnia
0.0% e. Pain from her arthritis

Score: 10 / 10

Question 4 (10 points)

Common causes of sleep problems related to disruption in circadian rhythms include travel across multiple
time zones (jet lag) and
Student response: Percent Correct Student Answer Choices
Value Response Response
100.0% a. shift work
 0.0% b. poor sleep hygiene

0.0% c. excessive caffeine use

0.0% d. alcohol use
0.0% e. seasonal changes

Score: 0 / 10

Question 5 (10 points)

An understanding of the two process theory of sleep would lead to which of the following recommendations?
Student response: Percen Correct Student Answer Choices
t Respons Respons
Value e e
0.0% a Avoid bright light during the day
.
100.0 b Avoid napping during the day
% .
0.0% c. Vary the time of day when you
get up
0.0% d Drink a glass of warm milk at
. bedtime
0.0% e Exercise in the middle of the
. afternoon

Score: 10 / 10

Question 1 (10 points)

According to the DSM-IV-TR, which of the following classes of substances is associated with the diagnosis of withdrawal delirium:
Student response: Percent Correct Student Answer Choices
Value Response Response
100.0% a. alcohol

0.0% b. cocaine
0.0% c. hallucinogens
0.0% d. nicotine
0.0% e. opioids

Score: 10 / 10

Question 2 (10 points)

Your patient is a 53-year-old woman with a 30-year history of smoking cigarettes at the rate of one pack per day. She has heard that
some medications are useful in helping smokers quit and asks your advice. Which of the following might be helpful to this patient?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. alprazolam (Xanax)
0.0% b. citalopram (Celexa)
0.0% c. propranolol (generic)
0.0% d. T3 (Cytomel)
100.0% e. varenicline (Chantix)

Score: 10 / 10

Question 3 (10 points)

You are a pediatrician who has been following a 15-year-old boy for a number of years. He has recently begun to play football, and
when he comes for a routine physical exam you notice that although he had experienced a normal puberty several years ago, he now has
gained substantial weight and appears much more muscular. When you ask him about it, he tells you that he has been working out
frequently at the local gym with other friends from the football team. As his physician, you should consider:
Student response: Correct Student Answer Choices
Percent
Respons Respons
Value
e e
0.0% a. growth hormone deficiency
0.0% b. thyroid disturbance
0.0% c. marijuana abuse
100.0% d. anabolic steroid abuse

0.0% e. normal developmental changes and the effects of

exercise

Score: 10 / 10

Question 4 (10 points)

Treatment outcomes for substance abuse in older adults are improved if:
Student response: Correct Student Answer Choices
Percent
Respons Respons
Value
e e
0.0% a. treatment programs emphasize breaking down
denial
100.0% b. treatment programs are age-appropriate

0.0% c. treatment focuses only on the medical

consequences of substance abuse
0.0% d. treatment groups include younger and older
persons
0.0% e. treatment emphasizes resolving age-related losses

Score: 0 / 10
Question 5 (10 points)
A 45-year-old man with a long history of alcohol abuse is admitted for detoxification. Which of the following medicines is most likely
to be used in this process?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. phenytoin (Dilantin)
100.0% b. chlordiazepoxide (Librium)

0.0% c. divalproex (Depakote)

0.0% d. alprazolam (Xanax)

0.0% e. quetiapine (Seroquel)

Score: 0 / 10

Question 6 (10 points)

You are treating a 46-year-old man who has a long history of abusing his prescriptions for lorazepam (Ativan), often taking higher
doses than prescribed and combining his medication with alcohol. He asks you, "Can't I just go cold turkey off the Ativan? I want to get
off this stuff!" The most serious potential effect of this strategy for detoxification would be:
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. insomnia
0.0% b. anxiety

0.0% c. lethargy
0.0% d. uncontrollable shivering
100.0% e. death

Score: 0 / 10

Question 7 (10 points)

You interview a child in the pediatrics clinic who appears similar to the child pictured below. What is the likely cause of these
developmental abnormalities?

Student response: Percent Correct Student Answer Choices

Value Response Response
100.0% a. maternal drinking of alcohol

0.0% b. trisomy-21
0.0% c. maternal intake of lithium
 0.0% d. maternal intake of valproic acid
0.0% e. maternal smoking

Score: 10 / 10

Question 8 (10 points)

A 27-year-old man comes to you for treatment of a skin rash. While taking his medical history, he tells you that he often uses ecstasy
(methylenedioxy-methamphetamine;MDMA), on the weekends when he goes to clubs with his friends and dances for several hours at a
time. He asks you, "How dangerous is ecstasy?" You tell him:
Student response: Correct Student Answer Choices
Percent
Respons Respons
Value
e e
0.0% a. ecstasy is safe if he only uses it on weekends
0.0% b. use of ecstasy has been associated with improved
cognitive functioning
100.0% c. ecstasy selectively kills off serotonergic neurons

0.0% d. he should be concerned about having low blood

pressure when taking it
0.0% e. ecstasy is addictive when taken even once

Score: 0 / 10

Question 9 (10 points)

Women reach criteria for alcohol dependence from onset of drinking more quickly than males and progress to liver disease with lower
levels of drinking over a shorter period of time compared with men. This is termed:
Student response: Percent Correct Student Answer Choices
Value Response Response
100.0% a. the telescoping effect

0.0% b. reverse abstinence

0.0% c. accelerated addiction
0.0% d. gender alcoholism differentiation

0.0% e. gender alcoholism acceleration

Score: 0 / 10

Question 10 (10 points)

Methamphetamine has been a growing problem in many parts of the US. Which of the following is associated with "meth" use?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. decreased sex drive
 0.0% b. loss of interest in others
0.0% c. lack of motivation

100.0% d. increased risk of HIV infection

0.0% e. interest in having only one sex partner

Question 1 (10 points)

Neurotransmitter abnormalities implicated in the etiology of delirium include:
Student response: Correct Student Answer Choices
Percent
Respons Respons
Value
e e
100.0% a. increased dopamine and decreased acetylcholine

0.0% b. increased GABA and decreased glutamate

0.0% c. decreased dopamine and increased serotonin
0.0% d. decreased GABA and decreased corticotropin
releasing factor
0.0% e. decreased GABA and increased melatonin

Score: 10 / 10

Question 2 (10 points)

You are called to evaluate a 72-year-old patient in the intensive care unit (ICU) because of his altered mental status. He underwent hip
replacement surgery two days ago and is currently treated with opiate pain medications and his previous regimen for hypertension. The
patient is otherwise healthy. He now presents with disorientation and cannot state the day, date, or place. He recognizes his wife of 36
years but believes he is at home with her in their bedroom. The most appropriate treatment for this condition is:
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. lorazepam (Ativan), 2 mg IM four times a day

100.0% b. haloperidol (Haldol), 2 mg IV

0.0% c. increase opiate pain medication (oxycodone)

0.0% d. discontinue antihypertensives
0.0% e. donepezil (Aricept), 5 mg

Score: 0 / 10

Question 3 (10 points)

An 83-year-old woman is brought to your office by her daughter because of her daughter's concerns about her functioning. The
daughter, who lives in New York, recently visited and was upset to find that her mother's condominium was poorly taken care of. When
she visited, the daughter found many unpaid bills and it appeared to her that her mother had not been taking her medication for
hypertension. Appropriate interventions for this condition would include additional diagnostic evaluation, referral to a geriatric care
manager, and:
Student response: Percent Correct Student Answer Choices
Value Response Response
 0.0% a. alprazolam (Xanax), 0.5 mg twice a day

0.0% b. olanzapine (Zyprexa), 5 mg a bedtime

100.0% c. donepezil (Aricept), 5 mg a day

0.0% d. fosinopril (generic), 10 mg twice a day

0.0% e. citalopram (Celexa), 20 mg a day

Score: 0 / 10

Question 4 (10 points)

John is a 17-year-old high school football player brought for evaluation by his parents because of their concern about changes in his
mood and school achievement. The problems started not long after John was briefly knocked unconscious during a football game about
six weeks ago. He was briefly disoriented at the time, but seemed to be much better the next day. Since then, however, John's school
achievement has been much worse and he recently failed a test in advanced algebra, a subject in which he previously had been very
good. John's parents also say that he seems to have become moody and apathetic about his personal care. The most likely diagnosis is:
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. major depression

0.0% b. marijuana dependence

0.0% c. prodromal schizophrenia
100.0% d. post concussion syndrome

0.0% e. normal adolescent development

Score: 0 / 10

Question 5 (10 points)

The mechanism of action of medications such as galantamine, rivastigmine, and donepezil is inhibition of:
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. monoamine oxidase

0.0% b. dopa decarboxylase

100.0% c. acetylcholinesterase

0.0% d. catechol-o-methyltransferase
0.0% e. monoamine transporter

Score: 0 / 10

Question 6 (10 points)

You see a 36-year-old woman at a community clinic who tells you that in the past she used injecting drugs and shared needles with
other persons. She complains of heavy bleeding with her periods and has been treated in the past for anemia. She now complains of
forgetfulness, difficulties in concentration, and problems in doing her job assembling small parts for electric motors. The most likely
cause of her cognitive difficulties is:
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. hypothyroidism

100.0% b. HIV infection

0.0% c. premenstrual dysphoric disorder

0.0% d. depression
0.0% e. mild cognitive impairment

Score: 0 / 10

Question 7 (10 points)

You are asked to evaluate a 78-year-old man with complaints of memory loss and occasional episodes of confusion. He was brought by
his wife because he recently became lost when driving home from the grocery store, only 5 blocks from his home. Diagnostic
evaluation reveals an otherwise healthy man currently treated for hypertension with a blood pressure of 138/80. Laboratories, including
vitamin B12, folate, and thyroid are normal. You obtain an MRI of the brain (below). The MRI shows:

Student response: Correct Student Answer Choices

Percent
Respons Respons
Value
e e
0.0% a. multiple lacunae consistent with vascular
dementia
0.0% b. significant brain atrophy from repeated trauma
0.0% c. normal brain atrophy consistent with the patient's
age
0.0% d. evidence of right temporal stroke
100.0% e. bilateral hippocampal atrophy

Score: 0 / 10

Question 8 (10 points)

The most likely diagnosis of the patient in question 7 is:
Student response: Percent Correct Student Answer Choices
Value Response Response
100.0% a. Alzheimer's disease

0.0% b. vascular dementia

0.0% c. HIV-related cognitive impairment
0.0% d. Parkinson's disease
 0.0% e. frontotemporal dementia

Score: 10 / 10

Question 9 (10 points)

A 68-year-old man comes for evaluation because of his concerns about having memory problems. He achieves a score of 29 on the
MMSE (missing one of the three words on three-word recall). His laboratory and neuroimaging studies are unremarkable. Psychometric
testing reveals above average general ability and intact reasoning and problem solving. Scores on verbal memory and new verbal
learning are significantly below average. The most appropriate diagnosis for this patient is:
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0% a. major depression

0.0% b. the patient is one of the "worried well"

100.0% c. mild cognitive impairment

0.0% d. Alzheimer's disease

0.0% e. frontotemporal dementia

Score: 0 / 10

Question 10 (10 points)

A 72-year-old man is brought by his family for evaluation. They report that he has progressively become less interested in his work
over the past year and has lost important clients because of his neglect of them. The family also report that he seems much less able to
organize complex tasks. On two occasions blurted out sexually inappropriate comments to family friends. You obtain an MRI of the
brain (see below). The most likely diagnosis is:

Student response: Percent Correct Student Answer Choices

Value Response Response
0.0% a. Alzheimer's disease
0.0% b. late onset schizophrenia

0.0% c. adult antisocial behavior

100.0% d. frontotemporal dementia

0.0% e. tertiary syphilis

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