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Psychiatry Final Questions 2010-2012
1) A patient with hallucinations & extreme agitation, his urine screen was
positive for phenylcyclidine (PCP). Which is best for his severe agitation?
1
2
3
4
+ Haloperidol
Citalopram
Fluoxetine
Triptyline
-- PCP is stimulant. only haloperidol is antipsychotic here
4
5
Undifferentiated
+Catatonic
Paranoid
Disorganized
Residual
-- has been dropped from DSV 5
2 5%
3 20%
4 30%
-- risk for FDR to have schizophrenia is 10% same with
monozygotic twin
5) 25 years old male was in good health. Now he complains of anhedonia; his
mother died since 1 month, so now he is extremely sad & tearful. He lost 3 lb
and he can't sleep at night. Most likely the patient developed:
1
2
3
4
5
Adjustment disorder
PTSD
+Uncomplicated bereavement
Major depression
Dysthymic disorder
-- duration of one month is important to diagnose
6) Parents of a 4-year-old girl presented her because they think she has
abnormal development. She developed normally until 2-3 years, she spoke
words & sentences, & used to play with her mother. Now since 3 months, she
lost what she developed, doesnt speak at all, doesnt play, & lost bowel
continence after which she was free of diaper almost 1 year. She is most
likely to have:
1
2
3
4
5
7) An 8 years old child becomes very distressed & tearful every morning
before school. She complains of abdominal pain, and if she goes to school,
she continues complaining so that her mother goes many times and takes her
home early. She takes many days off school with same complaints. Her signs
disappear on weekends unless her parents went out and left her with a
babysitter. The child mostly has:
1+Separation anxiety disorder
2Attachment disorder
3Generalized anxiety
-- attachment disorder definition: child has impaired social
interactions that are due to pathologic parenting and not due to
an autism spectrum disorder.
8) A middle aged man, preoccupied with his health, is always concerned that
his abnormal bowel movement indicates cancer. Recently he is worried about
having MI although his doctor gives him reassurance & his tests are normal
all the time. The patient mostly has:
1 +Hypochondriasis
2 Conversion
3 Somatization
-- hypochondriasis is excessive worrying of a specific
disease/diagnosis
9) 19 years old, college student, had urinary incontinence which improved
slowly over few weeks. Now she presented with blurred vision in her right
eye after breakup with her boyfriend. She mostly has:
1 +Somatoform disorder
2 Multiple sclerosis
-- recurring, multiple, clinically significant physical complaints
which result in patient seeking treatment or having impaired
functioning
10) A female was referred to a psychiatric clinic after she called the police
to take her because she was responsible for her neighbor abortion. She said
that she had thoughts about her neighbor having abortion, and she feels
threatened from her neighbor because she thinks that her thoughts are
heard across the walls. The patient believes that her thoughts of her
neighbor abortion could make it happen. This is called:
1
2
3
4
5
Magical thinking
Displacement
Projection
Ideas of reference
+Thought broadcasting
-- She believes others can read her thought
11) A 12-year-old female complains of abnormality in her face that her eyes
are too far from each other and her nose is misshapen. She avoids people
because she doesnt want them to notice the abnormality. Doctors say that
she had nothing wrong. The patient has:
1 +Body dysmorphic disorder
2 Obsessive compulsive disorder
-- preoccupation with imagined defect in appearance or excess
concern around a slight anomaly
12) Difference between malingering & conversion is:
1 +Malingering refuses treatment & evaluation while conversion is
eager for treatment
2 Malingering is subconscious & conversion deliberately feigning sign
3 Malingering looks for primary gain, conversion looks for secondary
gain
4 Malingering are cooperative & friendly, conversion are non
cooperative
-- malingering is consciously done and not cooperative. Conversion
looks for both.
13) A 72-year-old female was brought in because she didnt eat anything since 2
days. She resists to be moved, she is motionless, and doesnt respond to stimulus
(verbal or non-verbal) and she previously said things that dont make sense. The
patient most likely has:
1.
2.
3.
4.
5.
Schizoaffective
+Catatonia
Cataplexy
Delusion disorder
Schizophreniform
14) A 52-year-old male had depressed mood, lost weight, and recently hears his
dead father voice blaming him for his faults and telling him that he is useless. The
patient believes that the inside of his body is rotting. This patient should be:
1. +Started on SSRI & antipsychotic
2. Started on SSRI alone
3. Patient had acute attack of schizophrenia
The patient had depression with psychosis (auditory hallucination + delusions). So,
we treat both.
15) To note vocal tics when observed:
1. Echolalia
2. +Coprolalia
3. Palilalia
Coprolalia : repetitive speaking of obscene words.
In the book, vocal tics include Coprolalia and Echolalia.??
16) A female complains that she sees little people walking around her house, she
also saw one of these little people in the doctor's clinic while waiting. This is
called:
1. +Hallucination
2. Hallucinogen
3. Illusion
Hallucination : Perception in absence of an external stimulus.
Illusion : misinterpretation of an external stimulus.
17) A female doesnt remember much about her childhood except that she was
taken away from her native parents because of abuse & neglect. Now she doesnt
account for a lot of hours & even days of her life. She finds cloths in her closet
she haven't bought, and her friends feel strange about her because she sometimes
acts childish and other times she is very aggressive. The patient has:
1. +Identity dissociative disorder
2. Disassociated Amnesia
3. Korsakoff dementia
Identity Dissociative Dis. : (1)has 2 or more distinct identities (2)inability to recall
personal information of one personality
Dissociated Amnesia : amnesia only, inability to recall important personal info, and
impaired daily function.
Korsakoff dementia : neurological disorder due tu lack of thiamine (vit B1) or viral
encephalitis
18) An 11-year-old adopted boy, his biological mother was alcoholic, was in a special
school because he had learning difficulties. On measuring his IQ, it was 60. We
classify him in which type of mental retardation?
1. +Mild Mental Retardation
2. Moderate Mental Retardation
3. Severe Mental Retardation
*from wiki, severity of intellectual disability. (different from the book)
Type
IQ
Mild
69-50
Moderate
49-35
Severe
34-20
Profound
<20
19) While examining a patient for MSE, speech was articulated & well formed but
not understood because words were from patient's own invention. This is called:
1. +Neologism
2. Word salad
Neologism : made-up word
Word salad : incoherent collection of words (real word)
27) A young male with chronic schizophrenia, presented with fever, rigidity, and
leukocytosis. The first drug to start is:
1. Benztropine
2. Lorazepam
*This is neuroleptic malignant syndrome; the treatment is most importantly to
discontinue his medications and supportive care (hydration & cooling). Drugs that
can be used are sodium dantrolene, bromocriptine and amantadine, but are used
infrequently because of their own side effects and unclear efficacy. First Aid
"Benzodiazepines may be used to control agitation, but not the first drug!" -Wiki
28) One is a "thought content" disorder:
1. Tangentiality
2. Loss of association
3. +Obsession
Thought content : (1)Poverty of thought vs Overabundance (2)Delusions
(3)Suicidal/Homicidal thought (4)Phobias (5)Obsession (6)Compulsion.
29) A 72-year-old female developed 2nd to 3rd degree burns in 35% of her body
after her house was fired. Few days later she removed the IV line and started to
have psychotic symptoms. This is mostly due to:
1. +Delirium
2. Drug-induced
3. Acute stress disorder
Delirium : (1) disturbances of consciousness (2)change in cognition/development of
perceptual disturbances (3)disturbances develop over short period of time & tends
to fluctuate during the course of the day.
30) A drug that is used in OCD:
1. Mirtazapine
2. +Clomipramine
3. Buspirone
First line TT : SSRIs, but TCA(clomipramine also effective)
35)A female delivered a baby, after few days she felt guilty as she cant
take over good maternal care to her child. This is called:
1 Postpartum depression - within 4w postpartum, last 2-6 month.
suicidal and infanticidal ideation. Tx: psychotherapy, maternal
SSRI.
2 +Postpartum blues - begins 2-4 d postpartum, usually last 48h.
mo medication needed, but increased risk of having PPD
3 Postpartum psychosis
36) Positive psychotic symptoms for 2 months:
+Schizophreniform disorder
brief psychotic - <1mo
schizophreniform - 1-6 mo
schizophrenia - >6mo
39)A man who changed many jobs because he hadstolen money from his
workplace. In interview,he said that he feels guilty but cant change his
habit. The most likely diagnosis is:
1 Dissociative fugue - sudden, unexpected travel away from home
with inability to recall past identity, may assume new one
2 Antisocial personality - lack of remorse for action, manipulative,
deceitful, charming at first
3 +Pathological gambling
40)Every four or five weeks, a usually well-functioning and mild mannered
35-year-old woman experiences a few days of irritability, tearfulness, and
unexplained sadness. During these days, she also feels fatigued and bloated
and she eats large quantities of sweets. What is the most appropriate
diagnosis?
1 Cyclothymia - characterized by numerous mood swings, with periods of
hypomanic symptoms that do not meet criteria for a hypomanic episode,
[1]
alternating with periods of mild or moderate symptoms of depression that do
not meet criteria for a major depressive episode.
3 Enuresis
42)A 9 months old girl was developing normally, but in the last period her
parents noticed that she stopped developing and had decreased head
circumference. This is most likely:
+Rett's disease
Rett syndrome is a rare genetic disorder that affects the way the brain develops.
It occurs almost exclusively in girls. (Slowed growth, Loss of normal movement and
coordination, Loss of communication and thinking abilities, Abnormal hand
movements, Unusual eye movements, Breathing problems, Irritability )
45)A 70 years old hypertensive patient after hip surgery started speaking
abnormal words out of the blue and had weakness in his right hand:
+Multi-infarct dementia
46) When you are asking the patient "Are you doing things in a particular
way?", you mean for?
+Preoccupation - ideas which come againand again preventing
normal activity
48)A female takes steroid high dose for asthma and now has impaired
glucose test, abdominal obesity and striae (Cushing features). Most likely
her compliant is due to:
1 +Mood disorder due to substance abuse (medications)
2 MDD
3 GAD
49) Repeating words or phrases:
+Echolalia
53) A 70 years old male with a dementing disorder dies in a car accident.
During the previous five years, his personality had dramatically changed and
he caused much embarrassment to his family due to his intrusive and
inappropriate behavior. Pathological examination of his brain shows frontotemporal atrophy, gliosis of the frontal lobes white matter, characteristic
intracellular inclusions, and swollen neurons. Amyloid plaques and
neurofibrillary tangles are absent. Choose the correct diagnosis:
1
2
3
4
5
Alzheimers disease
+Picks disease
Creutzfeldt-Jakob disease
B12 deficiency dementia
HIV dementia
Tourettes syndrome
Akathisia
+Tardive dyskinesia
Parkinsons disease
Wilsons disease
57) As soon as she returns home from the hospital, three days after
delivering a healthy baby girl, a 23 year old woman becomes increasingly
irritable and tearful. She constantly worries about the baby, fearing she
wont be an adequate mother. What is the most likely diagnosis?
1 +Postpartum depression
2 Postpartum psychosis
3 Adjustment disorder
4 Postpartum blues
5 Major depressive episode
Social phobia
Performance anxiety
Generalized anxiety disorder
+Specific phobia
Agoraphobia
60) After witnessing a violent argument between her parents, a young woman
develops sudden blindness, but she does not appear as distraught as would
be expected. Her pupils react normally to light and she does get hurt when
she trips over obstacles. Her parents, who are in the middle of a bitter
divorce, put aside their differences to focus on their daughters illness.
What is the most appropriate diagnosis?
1
2
3
4
5
Factitious disorder
Malingering
Somatization disorder
+Conversion disorder
Histrionic personality disorder
5 Phobia
Concentration
Memory
Thought associations
+Orientation
Level of consciousness
-Memory: Immediate : Say something (eg your name) and ask him 5
minutes later, Recent: What did you have for breakfast today? For
your dinner last night?, Remote : Do you remember your childhood?
War? Known past events?
- Thought association: Thought insertion / withdrawal / broadcasting
64) Fluoxetine is a:
1 MOA inhibitors
2 TCA antidepressant
3 +SSRI antidepressant
What Causes Schizophrenia? The exact cause is not known, but scientists suspect genes and
environment both play a role. Inside the brain, levels of the chemical messengers dopamine and
glutamate may be out of balance. And brain structures may be abnormal, too. For example, brain
scans of identical twins show that the
schizophrenia, compared with a twin who does not have the illness. Activity levels can also be higher
or lower than normal in some areas of the schizophrenic brain.
66) Delusion is a:
+Thought content disorder
2 Perception disorder
1
Definition : Delusions are false or erroneous beliefs that usually involve a misinterpretation of perceptions
or experiences. Their content may include a variety of themes (e.g., persecutory, referential, somatic,
religious, or grandiose).
67) A speech with lacking goal directed with lacking details is known as:
1 Circumstantiality
-Citing excessively minute details which distract from the central theme of a conversation. Example:
When asked about a bruise on her arm, the patient recounts everything else that happened that same
day before explaining how she was injured.
2 +Tangentiality
-Replying to questions with digressive or otherwise irrelevant speech. Example: The patient begins to
explain how she was injured, but loses her train of thought and goes on to other subjects.
Nihilistic
Poverty
Guilt
+Thought insertion
3. Delusional atmosphere - where the world seems subtly altered, uncanny, portentous or sinister.
This resolves into a delusion, usually in a revelatory fashion, which seems to explain the unusual feeling of
anticipation.
4. Delusional memory - where a delusional belief is based upon the recall of memory or false memory
for a past experience. For example, a man recalls seeing a woman laughing at the bus stop several weeks
ago and now realises that this person was laughing because the man has animals living inside him.
Secondary delusions (sometimes called delusion-like ideas) are considered to be, at least in principle,
understandable in the context of a person's life history, personality, mood state or presence of other
psychopathology. For example, a person becomes depressed, suffers very low mood and self-esteem,
and subsequently believes they are responsible for some terrible crime which they did not commit.
70) Agoraphobia can be associated with major depression and anxiety, and
can be associated with all of the following, except:
*Question actually cannot be answered except when having all the other options.
71) A female patient came to the clinic was taking a medication (she couldnt
remember). She complained of increasing urination and thirst. What is the
most likely diagnosis?
1 Major depression
2 +Bipolar disorder (side effects of Lithium)
3 Panic attack
Common side effects of lithium can include:
Hand tremor (If tremors are particularly bothersome, an additional medication can help.)
Increased thirst Increased urination
Diarrhea
Vomiting
Weight gain
Impaired memory
Poor concentration
Drowsiness
Muscle weakness
Hair loss
Acne
Decreased thyroid function (which can be treated with thyroid hormone
Minor alcohol withdrawal symptoms often appear 6 to 12 hours after a person stops drinking. Sometimes a
person will still have a measurable blood alcohol level when symptoms start. These symptoms include: Shaky hands
Sweating Mild anxiety Nausea Vomiting Headache Insomnia
Between 12 and 24 hours after they stop drinking, some patients may experience visual, auditory, or tactile
hallucinations. These usually end within 48 hours. Although this condition is called alcoholic hallucinosis, it's not the
same as the hallucinations associated with DTs. Most patients are aware that the unusual sensations aren't real.
Withdrawal seizures usually first strike between 24 and 48 hours after someone stops drinking, although they can
appear as early as 2 hours after drinking stops.. The risk of seizures is especially high in patients who previously have
undergone multiple detoxifications. DTs usually begin between 48 and 72 hours after drinking has stopped, Risk
factors for DTs include a history of withdrawal seizures or DTs, acute medical illness, abnormal liver function, and
older age.
Symptoms of DTs, which usually peak at 5 days, include: Disorientation, confusion, and severe anxiety Hallucinations
(primarily visual) which cannot be distinguished from reality Profuse sweating Seizures High blood pressure Racing
and irregular heartbeat Severe tremors Low-grade fever
73) A patient was having bulimia nervosa and depression. Shes complaining
of insomnia and apathy. Which drug should be avoided for this patient?
1
2
3
4
Amitriptyline
Imipramine
Trazodone
+Bupropion (because of higher reported incidence of seizures
+Affective symptoms
Male
Many relapses
Gradual onset
GOOD PROGNOSIS : A diagnosis of paranoid schizophrenia versus one of the other subtypes; this subtype
tends to respond better to treatment and paranoid schizophrenics usually have an overall higher level of functioning
than other subtypes; Being a female women typically have a later onset and also tend to respond better to
neuroleptics; Having fewer negative symptoms; No family history of schizophrenia; High level of functioning prior to
onset; Acute onset; Older age of onset; A good support system; Shorter period of active symptoms;
POOR PROGNOSIS : Earlier age of onset; Being a male; A higher number of negative symptoms; A family
history of schizophrenia; A low level of functioning prior to onset; Poor or no support system; A history of substance
abuse
+Hypothyroidism
Pheochromocytoma
Hyperthyroidism
Hypoparathyroidism
Supportive
Psychodynamic
Psychoanalysis
+Cognitive behavior (strongest evidence based!)
*Wiki says:
Several meta-analyses have shown CBT to be effective in schizophrenia, and
the American Psychiatric Association includes CBT in its schizophrenia guideline as
an evidence-based treatment.
According to data from the first randomized trial of cognitive therapy as a stand
alone therapy for schizophrenia, structured treatment with a therapist
significantly reduced the severity of psychiatric symptoms and improved personal
and social functioning and some dimensions of delusional beliefs and voice hearing.
78) A female patient complained of dizziness when waking in the morning and
standing. She is on amitriptyline for depression. The cause of her symptom is
due to:
1 Dehydration
2 Hypoglycemia
3 +Alpha adrenergic blockade (?)
Note : dizziness is usually caused by a drop in blood pressure when
suddenly changing position. Patients should slowly rise from a sitting or
lying position if dizziness is noticed.
anxiety that goes on for months or longer, even though there's no clear medical evidence that you
have a serious health problem
3 Conversion disorders
4 Somatization disorders
5 Undifferentiated somatoform disorders
Somatization Disorder Patients with somatization disorder (formally called hysteria or Briquet's syndrome)
typically have a long history of going to the doctor for many different unexplainable symptoms.
This pattern of symptoms has occurred for many years and began before they were 30 years old. Their symptom
history must include various pain issues, gastrointestinal problems (e.g. diarrhea or vomiting), sexual symptoms (e.g.
low libido), and symptoms that would suggest a neurological problem (e.g. paralysis or seizures).
1. Undifferentiated Somatoform Disorder This is similar to somatization disorder, except that the patient must
complain of at least one unexplainable symptom for at least 6 months. Common complaints include digestive
problems and chronic fatigue.
2. Conversion Disorder Individuals with this disorder have symptoms or difficulties with their senses (e.g.
blindness, deafness) or their motor functioning (e.g. difficulties swallowing, weakness in a specific area). Their
symptoms are pseudoneurological, which means they suggest a neurological cause but no such cause can be
found. Prior to the onset or worsening of their symptoms they experienced conflict or other types of stress that is
believed to be associated with the development of the disorder.
3. Pain Disorder As the name suggests, pain is the primary complaint with this disorder. There is no physical
explanation for the pain. Underlying psychological issues are believed to play a role in triggering, maintaining, or
exacerbating the pain or making it more intense.
4. Hypochondriasis Individuals with this disorder (often called hypochondriacs by those who know them) are
preoccupied with the belief or fear that they have a serious medical condition. Their belief or fear is triggered by their
own misinterpretation of their physical symptoms or bodily functions (e.g. they have occasional headaches and fear
they have a brain tumor).
5. Body Dysmorphic Disorder Individuals with this disorder become extremely preoccupied with and distressed
about one or more imagined or actual (but minor) physical flaws (e.g. someone with a small scar on her hand always
wears gloves or keeps her hand hidden from others).
6. Somatoform Disorder not Otherwise Specified (NOS ) This is essentially a catch-all diagnosis for anyone
who meets the basic criteria for a somatoform disorder but doesnt meet the criteria for one of the other somatoform
disorders
81) A patient has factitious disorder have association with all except:
+Malingering *Question actually cannot be answered except when
Factitious disorder is a serious mental disorder in which someone deceives others by appearing sick, by
purposely getting sick, or by self-injury. Factitious disorder symptoms can range from mild (slight exaggeration of
symptoms) to severe (previously called Munchausen syndrome). The person may make up symptoms or even
tamper with medical tests to convince others that treatment, such as high-risk surgery, is needed
83) A patient with low self confidence, preoccupied by being alone, can't
take decisions: which cluster?
1 A
2 B
3 +C (criteria for dependent personality disorder)
84) After delivering a full healthy child the mother started to be agitated
and hearing voices telling her to kill her baby. Which of the following is
right?
Start her on antipsychotics and antidepressants
2 +Take the baby immediately away from her (to ensure the
safety and healthy development of both the baby and its
mother)
3 It's a picture of schizophrenia
1
85) A patient afraid of having heart attack, he had sweating, palpitations, all
his investigations where normal, what's the diagnosis?
+Panic attack without agoraphobia
91) A pregnant lady is taking valproic acid. What is the deformity you expect
to see by ultrasound?
1 +Spina bifida
2 Renal hypoplasia
3 Tetralogy of Fallot
4 Microcephaly
*6 birth defects linked to valproic acid (spina bifida, Atrial septal defect,
cleft palate, Hypospadias, Polydactyly and Craniosynostosis)
92) Difference between panic disorder and GAD:
+GAD is more chronic and less fluctuation
More suicide
+Later onset Not Sure
More gradual
More substance abuse
*Question actually cannot be answered except when having all the other options.
101) Lonely, shy female, wishes she had more friends & a more active social
life but she fears that others will reject her. Her personality disorder is
described in:
1 Cluster A
2 Cluster B
3 +Cluster C (avoidant personality disorder)
4 Cluster D
5 Cluster E
102) Which one is a prognostic factor for a good outcome in schizophrenia?
1.
2.
3.
4.
103) EBM (evidence-based medicine) shows that the best psychotherapy for
schizophrenia is:
1. Psychoanalysis
2. Supportive
3. Cognitive-behavioral (improve patients ability to function in
society)
4. Family therapy or group therapy or something like that
104) A patient with GAD (or was it panic disorder?) commonly experiences all
of the following, except:
1.
2.
3.
4.
+Demoralization
Addiction to stimulants
Addiction to alcohol
Depression
Depression
Schizophrenia
+Malingering
Substance abuse
Factitious disorder
-intentionally produce medical and psychological symptoms in order to
assume the role of sick patient.
Malingering
-feigning of physical or psychological symptoms in order to achieve personal
gain
106) All might be signs of conversion, except:
1.
2.
3.
4.
111) Typical case of mild agitated patient in ER, which drug to give?
+Benzodiazepine
*The last two questions, the answers depend on the other choices which are missed
here!
Anyway, UpToDate says:
For severely violent patients requiring immediate sedation, give a rapidly acting
first generation (typical) antipsychotic (eg, droperidol) or benzodiazepine alone
(eg, midazolam) or a combination of a first generation antipsychotic and a
benzodiazepine (eg, droperidol and midazolam, or haloperidol andlorazepam)
For patients with agitation from drug intoxication or withdrawal, give a
benzodiazepine.
For patients with undifferentiated agitation, we prefer benzodiazepines, but
first generation antipsychotics are a reasonable choice.
For agitated patients with a known psychotic or psychiatric disorder, we prefer
first generation antipsychotic agents, but second generation antipsychotics are a
reasonable choice.
1. NE and Ach
2. NE and serotonin
3. +Ach and Dopamine (ach, dopamine, serotonin, GABA)
115) A case about a patient presented with acute alcohol intoxication, what
is the first line of management:
1 +Glucose
2 Thiamine
3 Diazepam
*UpToDate:)
As a general rule, all intoxicated patients should receive a rapid bedside glucose
determination, followed by dextrose infusion if hypoglycemia is present.
In addition, all patients presenting with acute ethanol intoxication should be
carefully assessed for occult traumatic injuries and should be asked whether they
have ingested or otherwise taken other drugs or potentially harmful substances.
Patients presenting with coma secondary to ethanol intoxication should receive at
least 100 mg of parenteral thiamine to prevent or treat Wernicke's
encephalopathy, along with dextrose.)
event,
15. Case about a female, mentions that she likes to look at things as all
good or all bad:
+A. Borderline personality
(Borderline personality disorder:
1-Patients have unstable moods, behaviors and interpersonal relationships.
2-They fear abandonment and have poor identity.
3-They are impulsive and have a history of suicide attempts.
4-They have a higher rate of physical, emotional, sexual abuse.)
16. A patient known to have dysthymia developed a major depressive
episode, what do we call this condition?
A. Bipolar I
+B. Double depression
C. Major depression
17. What drug is used to relieve symptoms of opioid withdrawal?
+A. Clonidine
(The signs and symptoms of opioid withdrawal include: lacrimation,
rhinorrhea, pupillary dilation, piloerection, diaphoresis, diarrhea,, mild
hypertension, tachycardia, fever, and insomnia ,A flulike syndrome
subsequently develops, with complaints, demands, and drug seeking.)
(Treatment of opioid withdrawal include: Naloxone,Clonidine)
18. Which of the following is NOT a manifestation of Wernickes encephalopathy?
A. Nystagmus
B. Gaze palsy
C. Confusion
D. Ataxia
+E. Confabulation
19. A patient with refractory major depression was scheduled for ECT. Which of the
following is a relative contraindication to ECT?
A. Hypertension
+B. Recent MI
C. Pregnancy
D. Degenerative joint disease
20. Which of the following is a common side effect of methylphenidate?
A. Tremor
+B. Insomnia
C. Weight gain s/e: decrease appetite, insomnia, weight loss
21. A 50 year old male who has problems with his sleep. Doesnt feel refreshed after
sleep, sleeps in inappropriate places. His wife reports he snores while sleeping. He also
complains of a dry mouth. Whats the most likely diagnosis?
+A. Obstructive sleep apnea
22. Which of the following is not a paraphilia?
A. Exhibitionism
B. Sadomasochism
+C. Gender identity disorder
23. A 5-year-old boy shows no interest in other children and ignoresadults
other than his parents. He spends hours lining up his toy cars orspinning their
wheels. He rarely uses speech to communicate. Physical examination indicates
that his head is of normal circumference and his gait is normal. Which of the
following is the most likely diagnosis for this boy?
A. Obsessive-compulsive disorder
B. Asperger syndrome
C. Childhood disintegrative disorder
+D. Autism
E. Rett disorder
+C. Bromocriptine
D. Benztropine
E. Lithium
*dx: neuroleptic malignant syndrome, rx : dantrolene, bromocriptine
reports not being able tosleep, and has lost 10 lb within 1 week. Which
of the following is themost likely diagnosis?
+A. Postpartum depression
B. Postpartum psychosis
C. Uncomplicated bereavement
D. Postpartum blues
E. Generalized anxiety disorder
B. Schizoaffective disorder
+C. Schizophreniform disorder
D. Schizophrenia
E. Phencyclidine (PCP) intoxication
29. A 27-year-old woman has been feeling blue for the past 2 weeks.
She has little energy and has trouble concentrating. She states that 6
weeks agoshe had been feeling very good, with lots of energy and no
need for sleep. She says that this pattern has been occurring for at
least the past 3 years,though the episodes have never been so severe
that she couldnt work.Which of the following is the most likely
diagnosis?
A. Borderline personality disorder
B. Seasonal affective disorder
+C. Cyclothymic disorder
D. Major depression, recurrent
E. Bipolar disorder, depressed
30. A patient who is convinced that people in the bus are talking about
him. He also believes that the TV news presenter is communicating with
him, this is called:
+A. Delusions of reference
B. Grandiosity
34. A young healthy adult is asked to give a urine sample for the annual
check-up. He cuts his finger and drops blood into the sample. Whats
the diagnosis?
A. Somatization disorder
+B. Factitious disorder
C. Malingering
D. Conversion disorder
E. Hypochondriasis
36. A 72-year-old retired English professor with a long history of
hypertension has been having difficulties with tasks he used to find easy
and enjoyable, such as crossword puzzles and letter writing, because he
cannot remember the correct words and his handwriting has
deteriorated. He has also been having difficulties remembering the
events of previous days and he moves and thinks at a slower pace.
Subsequently, he develops a mild right facial hemiparesis and slurred
speech. Your diagnosis is:
A. Wernicke-Korsakoff syndrome
B. Huntingtons disease
C. Alzheimers disease
+D. Vascular dementia
E. Creutzfeldt-Jakob disease
37. Which of the following is a mood stabilizer?
+A. Lamotrigine (Anticonvulsants)
B. Haloperidol
"
."
Sama (2014) Psychiatry Final Questions
The exam was 45 questions, one form.
Borderline personality disorder : person who suffers from this disorder has
labile interpersonal relationships characterized by instability. This pattern
of interacting with others has persisted for years and is usually closely
related to the person's self-image and early social interactions. The
pattern is present in a variety of settings (e.g., not just at work or home)
and often is accompanied by a similar lability (fluctuating back and forth,
sometimes in a quick manner) in a person's affect, or feelings. Relationships
and the person's affect may often be characterized as being shallow. A
person with this disorder may also exhibit impulsive behaviors and exhibit
at least 5 of the following symptoms:
Q2. Which of the following features is not true for anorexia nervosa?
a
b
c
d
e
Body weight at least 15% below normal (less than 85% of the expected)
Amenorrhea.
Q3. Which drug of the following antidepressant medications has the lowest
overall rate of sexual dysfunction?
a) Escitalopram SSRI: levo enantiomer of citalopram, similar efficacy
Inattention: Six or more symptoms of inattention for children up to age 16, or five or
more for adolescents 17 and older and adults; symptoms of inattention have been present
for at least 6 months, and they are inappropriate for developmental level:
Often fails to give close attention to details or makes careless mistakes in schoolwork, at
work, or with other activities.
Often has trouble holding attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow through on instructions and fails to finish schoolwork, chores, or
duties in the workplace (e.g., loses focus, side-tracked).
Often has trouble organizing tasks and activities.
Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long
period of time (such as schoolwork or homework).
Often loses things necessary for tasks and activities (e.g. school materials, pencils, books,
tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
Is often easily distracted
Is often forgetful in daily activities.
Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children
up to age 16, or five or more for adolescents 17 and older and adults; symptoms of
hyperactivity-impulsivity have been present for at least 6 months to an extent that is
disruptive and inappropriate for the persons developmental level:
Often fidgets with or taps hands or feet, or squirms in seat.
Often leaves seat in situations when remaining seated is expected.
Often runs about or climbs in situations where it is not appropriate (adolescents or adults
may be limited to feeling restless).
Often unable to play or take part in leisure activities quietly.
Is often "on the go" acting as if "driven by a motor".
Often talks excessively.
Often blurts out an answer before a question has been completed.
Often has trouble waiting his/her turn.
Often interrupts or intrudes on others (e.g., butts into conversations or games).
Buspirone
Diazepam
Chlordiazepoxide
Clonazepam
(+)Lorazepam
1st choice : chlordiazepoxide (less euphoric, less addiction)
compared to diazepam
2nd choice : diazepam
Lorazepam, Oxazepam and Temazepam (LOT) if liver damage is
expected.
Schizophrenia
Schizoaffective disorder
(+)Schizophreniform disorder
Bipolar II disorder
Delusional disorder
Schizophreniform Disorder
Diagnosis: Same criteria as Schizophrenia.
One difference, in schizophreniform disorder the symptoms have lasted between 1 and 6
months, whereas in schizophrenia the symptoms must be present for more than 6 months.
Delusions
2. Hallucinations
3. Disorganized speech (e.g., frequent derailment or incoherence)
4. Grossly disorganized behavior or catatonic behavior
5. Negative symptoms (such as flattened affect)
B. Social/occupational dysfunction: 1 major areas of functioning (work, interpersonal
relations, self-care) markedly below the level achieved prior to the onset of symptoms
C. Continuous signs of disturbance for 6 mo, including 1 mo of active phase symptoms; may
include prodromal or residual phases
D. Symptoms not due to medical, neurological, or substance-induced disorder
Lithium
(+)Donepezil
Carbamazepine
Lamotrigine
Valproic acid
During these days, she also feels fatigued and bloated and eats large
quantities of sweets. Which of the following is the most likely diagnosis?
a)
b)
c)
d)
e)
Criterion A is that in most menstrual cycles during the past year, at least 5 of the following 11
symptoms (including at least 1 of the first 4 listed) were present:
1.Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
2.Marked anxiety, tension, feelings of being keyed up or on edge
3.Marked affective lability (eg, feeling suddenly sad or tearful or experiencing increased
sensitivity to rejection)
4.Persistent and marked anger or irritability or increased interpersonal conflicts
5.Decreased interest in usual activities (eg, work, school, friends, and hobbies)
6.Subjective sense of difficulty in concentrating
7.Lethargy, easy fatigability, or marked lack of energy
8.Marked change in appetite, overeating, or specific food cravings
9.Hypersomnia or insomnia
10.A subjective sense of being overwhelmed or out of control
11.Other physical symptoms, such as breast tenderness or swelling, headaches, joint or muscle
pain, a sensation of bloating, or weight gain
(+)Insomnia
Hypotension
Weight gain
Liver toxicity
Tremor
Pain disorder
(+)Hypochondriasis
Delusional disorder
Conversion disorder
Somatization disorder
Q13. Which one of the following psychotherapies is used mainly for the
treatment of post-traumatic disorder?
a)
b)
c)
d)
e)
Reference:
http://en.wikipedia.org/wiki/Eye_movement_desensitization_and_repr
ocessing
Paedophilia
Voyeurism
Fetishism
(+)Dyspareunia
Exhibitionism
Common Paraphilia
o Pedophilia- Sexual gratification from fantasies or behaviors involving
sexual acts with children
o Frotterurism
Wilson disease
Hypothalamic tumor
(+)Alzheimer disease
Thiamine deficiency
Pseudodementia
Psychosocial/Life Events
Loss of a parent before age 11 is associated with the later development of major
depression. Stable family and social functioning have been shown to be
good prognostic indicators in the course of major depression.
Reference :first aid
(+)Depressive disorder
Medication toxicity
Urinary tract infection
Electrolyte imbalance
Alcohol withdrawal
ETIOLOGY
Common causes of delirium include:
_ CNS injury or disease
_ Systemic illness
_ Drug abuse/withdrawal
_ Hypoxia
Additional causes of delirium include:
_ Fever
_ Sensory deprivation
_ Medications (anticholinergics, steroids, antipsychotics, antihypertensives,
insulin, etc.)
_ Postop
_ Electrolyte imbalances
Reference :first aid
Schizoaffective disorder
(+)Schizophrenia
Delusional disorder
Bipolar I disorder
Schizoid personality disorder
DSM-IV Criteria
_ Two or more of the following must be present for at least 1 month:
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms (such as flattened affect)
_ Must cause significant social or occupational functional deterioration
Obsessions of doubts
(+)Delusions of control
Compulsive hoarding
Obsession of contamination
Obsession of symmetry
Panic Disorder
Panic disorder is characterized by the experience of panic attacks accompanied
by persistent fear of having additional attacks.
HIGH-YIELD FACTS
a)
b)
c)
d)
e)
She is female
She has no family history of Schizophrenia
She had a sudden onset of her illness
She had a known precipitating factor before she began hearing voices
(+)She had an insidious onset of her illness
Encephalitis
(+)Thiamine deficiency
Hypoxia
Carbon monoxide poisoning
Traumatic brain injury
Long-Term Complications of Alcohol Intake
b) Hydroxyzine
c) (+)Flumazenil
d) Naloxone
e) Fluoxetine
http://www.ncbi.nlm.nih.gov/pubmed/8438687
Flumazenil, a specific benzodiazepine antagonist, is useful in reversing the sedation
and respiratory depression that often occur when benzodiazepines are administered
to patients undergoing anesthesia or when patients have taken an intentional
benzodiazepine overdose. Judicious use of flumazenil may provide useful diagnostic
information and may obviate the need for mechanical ventilation and other invasive
supportive measures. Although some controversy exists regarding the possible
precipitation of seizure activity in the setting of mixed tricyclic antidepressantbenzodiazepine overdose, worldwide experience with flumazenil has validated its
safety and efficacy.
Q28. The only tricyclic antidepressant thought to be effective in the treatment of
obsessive-compulsive disorder is:
a) Imipramine
b) (+)Clomipramine
c) Amitriptyline
d) Desipramine
e) Nortriptyline
http://www.patient.co.uk/health/obsessive-compulsive-disorder-leaflet
If SSRIs do not help much, or cannot be taken, then another type of antidepressant
called clomipramine is sometimes used. This is classed as a tricyclic
antidepressant and used to be the main medication treatment for OCD before SSRIs
became available. Occasionally, other medicines that are used to treat mental
health disorders are used.
Clomipramine, a tricyclic antidepressant, has been used for years to treat OCD, but
it may have more side effects than SSRIs.
Antidepressants are used to relieve the obsessive thoughts and subsequent
compulsive behaviors in those who have OCD. By increasing the level of serotonin in
the brain, antidepressants help to regulate the communication between different
parts of the brain.
Q29. A 37-year-old woman comes to the physician with a chief complaint of feeling
sad. The patient states she has anhedonia, anergia, a 4-Kg weight loss in the last 3
weeks and states she "just doesn't care about anything anymore". She also admits
to suicidal ideation without intent or plan. Which of the following is the most likely
diagnosis?
a) (+)Major depression
b) Dysthymic disorder
c) Cyclothymia
d) Mood disorder secondary to a medical condition
e) Normal grief
http://www.webmd.com/depression/guide/major-depression
*symptoms might include:
-Fatigue or loss of energy almost every day
-Feelings of worthlessness or guilt almost every day
-Impaired concentration, indecisiveness
-Insomnia or hypersomnia (excessive sleeping) almost every day
-Markedly diminished interest or pleasure in almost all activities nearly every day
(called anhedonia, this symptom can be indicated by reports from significant others)
-Restlessness or feeling slowed down
-Recurring thoughts of death or suicide
-Significant weight loss or gain (a change of more than 5% of body weight in a
month)
Q30. A 27-year-old man complains of excess sleepiness during the day and having
intense dreams at times when he thinks he is still awake. He notes that he
sometimes has an irresistible urge to sleep and has fallen asleep on multiple
occasions even while driving. He feels refreshed after a daytime nap. Upon
questioning, he reports that he sometimes has "drop" attacks characterized by
sudden weakness in his whole body. He remains alert during the drop attacks but
does fall to the floor. An appropriate treatment intervention is:
a) Antihistamine to help him sleep
b) Administration of Zolpidem at bed time to improve night-time sleep
http://www.mayoclinic.org/diseases-conditions/central-sleepapnea/basics/symptoms/con-20030485
http://www.mayoclinic.org/diseases-conditions/obstructive-sleepapnea/basics/symptoms/con-20027941
obstructive sleep apnea
Morning headache
Difficulty concentrating
Mood changes
Morning headaches
Snoring
b) Performance anxiety
c) Social phobia
d) Generalized anxiety disorder
e) (+)Specific phobia
http://www.mdguidelines.com/phobias-specific
Individuals with specific phobias have unwarranted and intense fears of specific
objects or situations. The most common phobias are of animals (zoophobia), blood
(hemophobia), heights (acrophobia), travel by airplane (aerophobia), being closed in
(claustrophobia), and thunderstorms (keraunophobia). Others include spiders
(arachnophobia), strangers (xenophobia), and crowds (agoraphobia). Phobias may
develop after a firsthand experience of being injured, or after witnessing another
person become injured.
The anxiety produced by exposure to one of these objects or situations may be
a panic attack or more generalized anxiety, but it is always directed at something
specific.
Source:slide seminar
Q36. Which one of the following is not recognized as a symptom of posttraumatic stress disorder (PTSD)?
a)
b)
c)
d)
e)
Hyperarousal
Recurrent nightmares
Flashbacks
(+)Formal thought disorder
Avoiding reminders of the event
a)
b)
c)
d)
e)
-this is social phobia. The first line treatment for social anxiety
disorder is cognitive behavioral therapy with medications such as
selective serotonin reuptake inhibitors (SSRIs) used only in those who
are not interested in therapy
Source: http://en.wikipedia.org/wiki/Social_anxiety_disorder
b)
c)
d)
e)
Q40. A 27-year-old woman has been feeling blue for the past 2 weeks. She
has little energy and has trouble concentrating. She states that 6 weeks ago
she had been feeling very good, with lots of energy and no need for sleep.
She says that this pattern has been occurring for at least the past 3 years
and have no more than 2 symptom-free months in a row though the episodes
have never been so severe that she couldnt work. Which of the following is
the most likely diagnosis?
a)
b)
c)
d)
Bipolar depression
Seasonal affective disorder
Borderline personality disorder
(+)Cyclothymic disorder
Q41. The use of one of the following mood stabilizers is associated with
increased prevalence of polycystic ovary syndrome:
a)
b)
c)
d)
e)
(+)Valproate
Lamotrigine
Lithium
Carbamazepine
Topiramate
b)
c)
d)
e)
Agoraphobia
Panic disorder
Acute stress reaction
(+)Social phobia
Schizoaffective disorder
(+)Delusional disorder
Cyclothymia
Schizophreniform disorder
Bipolar I disorder
been yawning incessantly and has had a runny nose. Which of the following
drugs is this person most likely to be withdrawing from?
a)
b)
c)
d)
e)
Alcohol
(+)Heroin
Benzodiazepine
Cocaine
Phencyclidine
The End
..