1.

A 12 year old girl with attention deficit hyperactivity disorder (ADHD) has describe a lack of the ability for spontaneous make-believe play and a

been optimized on appropriate dosing with methylphenidate. Although she delay in language development. Although there are various toys in the

notes some improvement in her symptoms of impulsivity, she still has office, the child is fixated on playing with a shiny candy bar wrapper that

significant symptoms of inattention, poor concentration, and some was in the trash bin. His mother reports that some of these symptoms have

hyperactivity. What would be the next best recommended medication to been present from around the age of 3, but she thought “he’d grow out of

target her symptoms of ADHD? it.” What is the most likely diagnosis?

a. Dextroamphetamine
a. Normal child development
b. Guanfacine
b. DiGeorge syndrome
c. Clonidine
c. Autism spectrum disorder
d. Bupropion
d. Avoidant personality disorder
e. Atomoxetine
e. ADHD
2. A woman brings in her 14-month-old daughter for concerns regarding a
5. A school psychiatrist is consulted on a 9-year-old girl whose mother
change in the child’s function-ing. The mother reports that the child had
reports she does not want to go to school and has been refusing to do her
normal development until about 6 months of age. Around that time, the
homework. The girl’s teacher states that her behaviors have been relatively
child began to lose social engagement with her parents. On exam, she has
good, but she refuses to read out loud in class. Her par-ents do not note any
repetitive wring-ing of her hands and appears to be psychomotorically
other changes in behavior at home. They state that their daughter continues
slowed. Her head growth circumference shows a decel-erated pattern.
to be active socially outside of school and enjoys visiting friends’ homes
Which of the following is the most likely diagnosis?
and spending the night at her grandparents’ house without her parents.
a. Childhood disintegrative disorder
Testing records indicate that her IQ is average for her age. What is the
b. Rett syndrome
most likely diagnosis?
c. Fragile X syndrome
a. Reading disorder
d. Autism spectrum disorder b. ADHD
c. Autism
e. Asperger disorder
d. Separate anxiety disorder
3. When during normal development does the highest rate of synapse e. Conduct disorder
6. Which of the following would be more likely to be seen in a patient with
formation in the brain occur?
conduct disorder as opposed to ADHD or a mood disorder?
a. Within the second trimester
a. Pattern of irritable mood
b. Within the third trimester
b. Excessive activity
c. Between 0 and 6 months of age
c. Impulsive behaviors
d. Around 2 years of age
d. Recurrent fights
e. During adolescence
e. Sleep disturbance
4. A 5-year-old child is brought to the clinic by his mother for “not being like
7. A 10-year-old boy presents for evaluation of behav-ioral problems. His
other children” at home and school. You find that the child does not make
parents state that he often fights with both his mother and father, mostly
appropri-ate eye contact with others, including his mother, and also fails to
surrounding doing chores and setting limits at home. His teacher tells you
respond to the social cues put forth by his mother. Reports from school
 that he has relatively good grades in school but that he becomes very rude b. Lorazepam

and dismissive toward her when she asks him to do a particular task, and c. Methylphenidate

he often refuses to cooperate with her after his tantrums. Which of the d. Trazodone

following is the most likely diagnosis? e. Imipramine

a. Normal child development 12. Which of the following medications would be the drug of choice for an
b. ADHD adolescent with ADHD, depression, and a seizure disorder?

c. Oppositional defiant disorder a. Atomoxetine

d. Conduct disorder b. Bupropion

e. Bipolar disorder c. Escitalopram

8. What is the most important step in treating a child with school refusal? d. Guanfacine

a. Establishing an appropriate home school program e. Venlafaxine

b. Sending the child back to school as soon as possible 13. How are stereotypies differentiated from tics?
c. Prescribing an anxiolytic medication to address the a. Stereotypies tend to be unilateral; tics tend to be

underlying anxiety bilateral.

d. Prescribing a stimulant medication to address the b. Stereotypies have an earlier onset than tics.

underlying ADHD c. Stereotypy intensity tends to fluctuate; tics tend to be

e. Starting family therapy consistent over time.

9. A mother brings in her 30-month-old child because he has not spoken any d. Stereotypies have a later onset than tics.

words yet. What is the best next step? e. Stereotypies and tics are indistinguishable.

a. Reassurance 14. Which of the following symptoms is NOT among criteria for brief

b. Audiometry psychotic disorder?

c. Chromosomal analysis a. Hallucinations

d. Brain MRI b. Disorganized speech

e. Speech therapy c. Catatonic behavior

10. Tourette’s syndrome is often comorbid with which of the following d. Negative symptoms

psychiatric illnesses? e. Delusions

a. Separation anxiety disorder 15. Which of the following is NOT a risk factor for schizophrenia?
b. Generalized anxiety disorder a. Infections

c. OCD b. Fetal hypoxia

d. Major depressive disorder c. Cannabis use

e. Childhood-onset schizophrenia d. Immigrant population

11. Which of the following is MOST appropriate for a child with aggressive e. All of the above

behaviors and a diagnosis of intel-lectual disability? 16. Which of the following increases the risk of tardive dyskinesia from

a. Lithium antipsychotic use?

 a. Male sex a. Good premorbid functioning, affective symptoms, no

b. Old age precipitating factors, soft neurological signs

c. Hypothyroidism b. Later age of onset, good premorbid functioning, family

d. Negative symptoms history of mood disorder, positive symptoms

e. Postsecondary education c. Younger age at onset, being single/divorced/ widowed,

17. Which of the following neurochemical abnormalities is associated with family history of schizophrenia, longer duration of

catatonia? untreated illness

a. High dopamine activity in basal ganglia d. History of perinatal trauma, multiple relapses, poor

b. Low GABA activity in frontal cortex premorbid functioning, acute onset

c. Low glutamate activity in parietal cortex 21. A patient with schizophrenia is brought to the emer-gency room in an
d. Low cholinergic activity in the medial temporal lobe acutely agitated state. He is adminis-tered haloperidol 5 mg

18. Which of the following statements is TRUE about schizophrenia with intramuscularly. A few minutes later, the nurse reports that the patient’s

onset in childhood or adolescence? neck is twisted to one side and his eyes are rolled back. What is the MOST

a. Prognosis is better than in adult-onset likely diagnosis?

schizophrenia. a. Acute dystonia

b. Onset is typically sudden. b. Akathisia

c. It is seen exclusively among patients with autism c. Tardive dyskinesia

spectrum disorder. d. Neuroleptic-induced parkinsonism

d. Patients with onset before adolescence have poorer 22. Which of the following is considered a positive symptom in

medication response. schizophrenia?

e. Affect is usually appropriate. a. Bizarre behavior

19. A patient believes aliens are communicating with him through a microchip b. Poverty of speech

they inserted in his teeth after abducting him 2 months prior. Despite being c. Asociality

reassured there is no microchip, the patient insists that he can “feel it” with d. Poor eye contact

his tongue. He denies ever hearing aliens through his ears or seeing them. 23. Which of the following is NOT a clinical feature of catatonia?
His thought process is coherent. He denies any such thoughts until 2 a. Stupor

months prior. What is the MOST likely diagnosis? b. Waxy flexibility

a. Schizophrenia c. Mutism

b. Delusional disorder d. Echolalia

c. Schizophreniform disorder e. Auditory hallucinations

d. Brief psychotic disorder

20. Which of the following are considered good prog-nostic factors for
24. Which of the following symptoms is not a criterion of
schizophrenia?
the “mixed features” specifier for a manic or hypomanic
episode?
 symptoms are decreased energy, increased sleep, and increased appetite
A. Anhedonia
with weight gain. She reports having a “good day” about once per week if
B. Fatigue
C. Indecisiveness something positive happens to her or her friends. Which treatment is
D. Suicidal thinking
particularly useful in this type of presentation?
E. Feelings of worthlessness
25. Which of the following is an alteration of the hypothalamic–pituitary– a. Amitriptyline

adrenal (HPA) axis that occurs in bipolar disorder? b. Buspirone

a. Decreased cortisol concentration in c. Mirtazapine

cerebrospinal fluid d. Ltihium

b. Decreased cortisol concentration in plasma e. Phenelzine

c. Decreased diurnal variation of cortisol levels 29. A mother describes her 8-year-old son as chronically irritable and reports
d. Suppression of glucocorticoids following that in the last few years he has begun to have frequent behavioral

dexamethasone administration outbursts as well. He yells uncontrollably at his mother several times per

e. All of the above week. He is aggressive with classmates and teachers, and school admin-

26. Persistent depressive disorder (dysthymia) requires that symptoms include istration is considering a suspension. He was not invited to several friends’

depressed mood for most of the day, for more days than not, for at least birthday parties because he hit a friend’s sis-ter during a community

what period of time? barbecue. What primary psychiat-ric disorder is this patient most likely to

a. 2 weeks develop as anadult?

b. 4 weeks a. Attention deficit hyperactivity disorder (ADHD)

c. 6 months b. Bipolar disorder

d. 1 year c. Intermittent explosive disorder

e. 2 years d. Major depressive disorder

27. A patient presents with atypical depression, includ-ing increased sleep, e. Schizophrenia

increased appetite with weight gain, mood reactivity, and rejection 30. Which of the following is observed in the personal-ity trait that best

sensitivity. Which of the following attributes of her presentation is most predicts the development of major depressive disorder?

likely to persist throughout life? A. Difficulty with self-discipline

a. Hypersomnia
B. Low stress tolerance
C. Low concern for other people’s well-being
b. Increased appetite D. Low social engagement and energy level

c. Mood reactivity
E. Preference of familiarity over novelty
31. A 25-year-old woman reports that for the last several years her mood
d. Rejection sensitivity
“never seems to be stable,” and this has been impacting her work and
e. Weight gain
relationships negatively. On further interview she endorses periods of
28. A 35-year-old patient is treated for major depressive disorder with an SSRI
feeling elevated and irritable and other times of feeling abnormally sad,
that is titrated to an adequate dosage. She takes the SSRI as prescribed for
but never so much in either direction to feel “out of control.” When she is
10 weeks without improvement in symptoms. She also does not respond to
irritable, she often has racing thoughts, and her friends sometimes tell her
an adequate therapeutic trial of an SNRI. The patient’s prominent
 she is speaking too quickly. When she feels low, she cries more often and b. Vivid dreaming

feels a sense of worthlessness, but she denies any neurovegetative symp- c. Decreased movement

toms or suicidal thoughts. She cannot remember the last time she “felt d. Increased cerebral perfusion

normal” for more than 2 or 3 weeks in a row. Which of the following is the e. Increased sympathetic activity

MOST likely diagnosis? 36. Which of the following medications is associated with parasomnias?
a. Chronic major depressive disorder with atypical a. Zolpidem

features b. Doxepin

b. Cyclothymic disorder c. Quetiapine

c. Bipolar II disorder with rapid cycling d. Fluoxetine

d. Schizoaffective disorder e. Dextroamphetamine

e. Unspecified bipolar disorder 37. What is the most common cause of excessive daytime sleepiness (EDS)?
32. Which symptom distinguishes childhood bipolar disorder from ADHD? a. Sleep restriction from social and vocational pressure

b. Narcolepsy
a. Irritability
c. Obstructive sleep apnea
b. Decreased need for sleep
d. Caffeine withdrawal
c. Accelerated speech
e. Idiopathic hypersomnolence
d. Hyperactivity
38. Which of the following stages of sleep demonstrates abnormality on EEG
e. All of the above are seen in both ADHD and
confirming the diagnosis of somnambulism?
bipolar disorder.
a. N1 (old NREM 1)
33. The essential feature of insomnia disorder is characterized by:
b. N2 (old NREM 2)

a. Daytime fatigue c. N3 (old NREM 3 and NREM 4)

b. Sleep inertia d. REM stage

c. Dissatisfaction with sleep quantity or quality 39. What is the first-line pharmacological treatment recommendation for late-
d. Cognitive impairment life schizophrenia?

e. Anxiety a. Quetiapine

34. Which of the following class of medications is most commonly associated b. Olanzapine

with rebound insomnia? c. Risperidone

a. Sedative, hypnotic, or anxiolytic substances d. Haloperidol

b. Second-generation antipsychotics e. Chlorpromazine

c. Stimulants 40. Psychosis with peripartum onset is MOST closely related to which class of
d. Selective serotonin reuptake inhibitors psychiatric disorders?

e. Tricyclic antidepressants a. Mood

35. Which of the following is suggestive of non-REMsleep? b. Psychotic

a. Decreased recall of thought content c. Anxiety

 d. Substance use e. Weight loss

e. Personality
45. Which of the following brain structures involved in
41. Family history of which personality disorder has the highest correlation response inhibition is hypoactive in mania, suggesting

with schizophrenia? a link to symptoms of impulsivity (e.g., risk taking and

pressured speech)?
a. Paranoid

b. Schizoid

c. Schizotypal
A. Amygdala
B. Anterior cingulate cortex
d. Obsessive–compulsive C. Insular cortex

e. Dependent
D. Orbitofrontal cortex

E. Thalamus
42. A patient with schizophrenia is in the emergency room. He does not 46. Which of the following is more common in males with bipolar disorder
answer any questions and refuses to sit down. He later walks backward to than in females with bipolar disorder?

a corner in the corridor and does not move. The family reports that for the a. Co-morbid anxiety

past few days he has been isolating himself, has not been eating, and has b. Mixed features

been sitting on his bed for hours. What is the most probable diagnosis? c. Rapid cycling

a. Schizophrenia, disorganized type d. Substance use disorder

b. Major depressive disorder e. Suicide attempts

c. Schizophrenia with catatonia 47. The presence of which of the following symptoms is more consistent with
d. Schizoaffective disorder melancholic features of major depressive disorder than atypical features?

e. Neuroleptic malignant syndrome a. Hypersomnia

43. Which of the following is TRUE regarding late- onset schizophrenia? b. Leaden paralysis

a. Schizophrenia is considered late onset after age c. Lack of mood reactivity

65. d. Weight gain

b. It is more common in women than in men. e. Interpersonal rejection sensitivity

c. It accounts for 10% of schizophrenia cases. 48. Which of the following sleep changes is commonly observed in patients
d. Genetic risk is higher than in patients with with major depressive disorder?

early- onset schizophrenia. a. Decreased REM density

e. Positive family history is less common than b. Decreased REM latency

in patients with early-onset schizophrenia. c. Increased REM density

44. In the context of a major loss, which of the following is a symptom d. Increased REM latency

that distinguishes major depressive disor-der from grief? e. No changes in either REM latency or density

a. Insomnia 49. Which of the following statements is TRUE regard-ing cognitive

b. Intense sadness symptoms in late-life depression?

c. Persistent dysphoria

d. Decreased appetite
 a. The neuropsychological profile of depression-

associated neurocognitive disorder is

indistinguishable from Alzheimer type.

b. There is no increased risk of neurocognitive disorder when

depressive symptoms are adequately treated.

c. Late-life depression may be a risk factor for later

cognitive decline, even when symptoms remit.

d. Risk of later cognitive decline is significant only in the

presence of comorbid neurological illness, such as history

of stroke.

e. Cognitive symptoms typically precede depressive

symptoms.

50. Which of the following statements is FALSE regard-ing bipolar disorder

with rapid cycling?

a. Patients must experience at least four mood episodes in 1 year.

b. Rapid cycling is a risk factor for

antidepressant-inducedmania.

c. Lithium is the treatment of choice.

d. Episodes must meet criteria for major depressive, manic, or

hypomanic episode, including episode duration.

e. Rapid cycling is a poor prognostic factor in bipolar disorder.