Psychiatry By: Alhag Abu Anzeh Muhammad (baghdats@yahoo.com)

07.10.2013:

77. Mouth ulceration is associated with which of the following types of withdrawal ? a.alcohol b.Benzodiazepins c.Cocaine d.Nicotin e.Opoids 79. Postpartum psychosis: A. Occurs more commonly in multigravida women B. Rarely correlates with perinatal complications C. delivery almost always begins within 8 weeks of D. Usually occurs abruptly, with no prodromal psychotic symptoms E. Is essentially an episode of a psychotic disorder 80.Depression and mania share which of the following symptoms: A. Psychomotor acceleration B. low self esteem C. Grandiosity D. anger E. Pessimism 81. A hypomanic episode differs from a manic episode in that a hypomanic episode: A. Lasts at least 1 week B. lack psychotic features C. Is sever D. Causes greater social impairment E. All of the above 82. The highest suicide rates are in which of the following age group: A. Under age 15 B. 15 to 24 C . 25 to 44 D. 45 to64 E. Older than age 65

83. A 36 y o pregnant woman is admitted to the medical center for possible infection associated with i.v heroin injection. She admits to heroin dependency. She is 5 month into her pregnancy and would like to quit the heroin for good. What is the best course of action in this patient? A. Allow her to continue B. methadone maintenance C. Naltrexone D. Advice her to stop heroin and start supportive therapy E. Buprenophine 84.The following may precipitate mania except: A. Carbamezopine B.disulfirm C. Isoniazide D. Propranolol 85.A 35-year-old woman has just been diagnosed with major depressive disorder. For the past 8months, she has had a depressed mood, decreased energy and concentration, and loss of interest in previously enjoyed activities. Although she never attempted suicide, she acknowledges that she thought she would probably jump off a local bridge if she ever had the chance. She denies any history of excessively elevated moods. You decide to start her on antidepressant therapy. Two weeks later, this patient is at greatest risk for: a.extrapyramidal symptoms b.hypomanic episode c.manic episode d.medication noncompliance e.suicide completion 86. Tourett’s disorder has been shown to possibly have a familial and genetic relationship with: a.panic disorder b.OCD c.generalized anxiety disorder d.social phobia e.none of the above 87. early prognosis of anorexia nervosa? a.early onset 88. A patient with somatization disorder: A.has had physical symptoms for only 3 months B.usually experiences minimal impairment in social or occupational functioning C. may have a false belief of being pregnant with objective signs of pregnancy, such as decreased menstrual flow or amenorrhea D. presents the initial physical complaints after age 30 years E. has complained of symptoms not explained by a known medical condition 89. Most indicative of Violence in bipolar/mania patient? c.history of violence

90.What is the “gold standard” to diagnose munchausen by proxy? A.the child will confess B.you find disease producing subjects in the care giver belonging C. By witness the caregiver causing harm to the child D. the child improve when removed from caregiver 91.Anorexia nervosa has mortality rate of up to approximately: A. 1% B. 18% C. 30% D. 42% E. 50% 92.Most common case of delirium within 3 day of postoperative in a 40 year old man with history of alcohol dependence? a.Delirium tremens b.Infection c.Pain medication postoperative d.Pain stress of surgery 93. A 14 years old girls present to her pediatrician complaining that she had been “freaking out" the girl dexribes episodes of shaking gasping for air. And feeling like she in going to die. The feelings in tensiy for a few minutes and resolve spontaneously. These episodes have occurred various times in various Situation and the gil is worried she is going crazy . A complete history and physical does not reveal any farther relevant symptoms or signs . Which of the following is the most likely diagnosis of this patient: A. dysthymic disorder B. social phobia C. separation anxiety disorder D. panic disorder E. acute schizophrenia like psychotic disorder 94.A pervasive pattern of grandiosity lack of empathy and need for administration suggest the diagnosis of which of the following personality disorder: A. borderline B. narcissistic C. paranoid D. passive aggressive E. schizotypel 95. Antidepressants should be used cautiously in cardiac patients because of increased risk of which of the following? A. Conduction side effects B. Hypertension C. Noncompliance D. Suicide 96 .Suicide among schizophrenic patients: a. is most frequently secondary to command hallucinations b. occurs most often in the later years of the illness c. occurs most often in older female patients d. is approximately 10 percent e. is low

97.A36 year old female patient with schizophrenia present to the emergency department after experiencing auditory hallucinations commanding her to kill herself. she reports that the hallucinations have become more frequent over the course for the past week .the patient has previously attempted to take her life an tow occasions when she overdosed on sleeping pills .she is also an alcoholic and recently divorced .her husband of 4 years. of the followings factors , which poses the greatest risk factor for suicide in this patient? A .alcohols B .divorce C .age D .gender E .previous suicide attempts. 98.Which of the following disorders is most closely associated with thyroid disease??? A .schizophrenia B .alcoholism C .depression D . phobia E .borderline personality disorder 99. Which of the following factors is common in victims of elder abuse? A . alcohol abuse B . social isolation C . mental illness D . hostility E . prescription drug abuse 100.A45 year old women with history of dysthymic disorder recently started taking sertraline 75 mg/day she now complains of sudden onset of myclonus ,diaphoresis ,diarrhea, shivering and worsened anxiety, on physical examination she has a low grade fever and exhibitis heper reflexia ,further history reveals she has been taking st.johns wort valerian and multivitamins over the counter for the past 9 month. what is the most likely diagnosis ? A . Nms B . malignant heperthermia C . lehhal catatonia D . serotoin syndrome E . anticholinergic toxicity 101. Which of the following is not associated with an increased intensity of benzodiazepine withdrawal symptoms? A . abrupt dicontinuation of benzodiazepines B . use of short half life benzodiazepines C . prolonged treatment with benzodiapines D . higher doses of enzodiapines E . gradual taper of benzodiapines

102. An 18 y.o arrived to ED after assaulting a police officer in the street…generalized muscle weakness ataxia, nystagmus, slurred speech ...…. what did he take? A. Inhalant B. Benzodiazepines C. Opioids D. Hallucinogens E. Amphetamines 103.positive factor in anorexia nervosa: a.younger age b.chronicty c.self vomiting d.binge eat 104. 43 years old a man with bipolar, enter the ER with agitation which the grievous risk factors for violence: a. Diagnose of bipolar b. cocaine c. acute mania d. persecutory delusion 105. which disease has the highest rate of mortality from natural or unnatural causes: a. schizophrenia b. Anorexia nervosa c. major depressive disorder d. bipolar disorder e. panic disorder 106. after week of treatment with intramuscular of haloperidol a 26 old women with schizophrenia develop confusion , fever, high wbc levels ,muscle rigidity and dark urine . what is the less effective procedure ? a. Prescribe antibiotic for the presumed infection at the ingest site b.consider a trial of dantrolene c.medial admission fluid d. closely monitor vital sign and renal function 107.a 24 year salesperson is referred for an evaluation of difficulty dealing with costumers because she gets " so nervous and anxious that mind gets blank ". A careful evaluation revels that she has social phobia. she is motivated to obtain treatment and continue doing her job. All of the following are effective except: a.selective serotonin reuptake inhibition – SSRI b.flooding c.modeling d.systemic desensitization e.electrical convulsion therapy- ECT

108. the term double depression is used to describe: a.a major depressive disorder superimposed on grief reaction b. major depressive disorder superimposed on dysthymia c. major depressive patient not responding to treatment d.major depressive disorder psychosis e.major depressive disorder with anxiety 109. A 56 year old anxious executive calls at 5:00 because he woke up with chest tightness and shortness of breath , he was scared than e was having a heart attack and he also reported feeling dizzy , trembling and his heart was pounding , he thought he was going to die . The symptoms subsided in 20 minute and the time the emergency medical services arrived he was sitting in his living room and in no distress. The patient's ECG reading was normal and his cardiac enzymes were also found to be normal. What is the most likely diagnosis? a.nocturnal panic attack b.PTSD c. psychophyisological insomnia d.somatization disorder e. myocardial infraction 110. Which best predictor for suicide likelihood? A .alcohol B .gender c. previous suicidal behavior d. divorce e. unemployment

18.09.2013:

76. All of the following drugs can cause psychotic symptoms similar to schizophrenia EXCEPT: A. Ecstasy B. Opioids C. Phencyclidine D. Ketamine E. Lysergic acid diethylamide (LSD) 77. The prevalence of schizophrenia is: A. 10% B. 1% C. 5% D. 0.1% E. 2% 78. A 32-year-old male with chronic paranoid schizophrenia, in full remission is married and living a productive life. He and his wife decide to have children, but would like to know the probability of children developing schizophrenia. Which of the following statements is correct? A. The risk is similar to that of general population (1%). B. The risk is about 50% C. The risk is much lower than the general population because he will be able to recognize the early signs of schizophrenia and seek prompt treatment for the child D. The risk is about 10% E. The risk is about 100% 79. A 36-year-old pregnant women is admitted to the medical center for possible infection associated with intravenous heroin injection. She admit to heroin dependency. She is 5 month into her pregnancy and would like to "quit the heroin for good" What is the best course of action in this patient? A. Allow her to continue B. Methadone maintenance C. Naltrexone D. Advise her to stop heroin and start supportive therapy E. Buprenophinea 80. Which of the following has the most reinforcing effects, that is, the greatest potential to become addicted? A. Cocaine B. Alcohol C. Marijuana D. Heroin E. Nicotine

81. The relationship between mitral valve prolapse (MVP) and panic disorder can be described as? a. Important to recognize and treat mitral valve prolapse in panic disorder b. High clinical relevance. c. Patient with panic disorder are predisposed to develop MVP d. Higher incidence of MVP in patients with panic disorder e. Panic disorder is very well controlled if MVP is corrected. 82. A 56 year old anxious executive calls at 5:00 because he woke up with chest tightness and shortness of breath. He was scared that he was having a heart attack and he also reported feeling dizzy, trembling, and his heart was pounding, he thought he was going to die. The symptoms subsided in 20 minute and by the time the emergency medical services arrived he was sitting in his living room and in no distress. The patient's electrocardiogram reading was normal and his cardiac enzymes were also found to be normal. What is the most likely diagnosis? a. Nocturnal panic attack b. PTSD c. Psychophysiological insomnia d. Somatization disorder e. Myocardial infraction 83. A 22 year old female is self – referred for an evaluation to rule out bipolar disorder. She complains of rapid mood swings with a controllable anger and irritability. During the assessment it is noted that she has not had any sustained relationships for many years and feels empty she fear abandonment by her fries and blames other of making her feel angry . What is the most important differential diagnosis in this patient? a. Major depressive disorder b. Borderline personality disorder c. Histrionic personality disorder d. Depressive personality e. Generalized anxiety disorder 84. 56 years – old female is admitted to an acute psychiatric inpatient unit for severe depression the patient was ruminating about suicide and guilt feelings that were distressing her. She is "convinced" that she has committed sin and deserved to be punished. although there was nothing in her history to justify this the resident doctor thinks that the patient is obsessed with thoughts of guilt and feel that the patient has a primary obsessional disorder a trial of antidepressant medication was not helpful despite trying a high dose the attending physician explains that the patient is not obsessional but severely depressed because ? a. She has suicide ideation b. She has indeed committed sin and is now depressed c. She is distressed by the guilt feeling and is "convinced" of the sin d. The attending physician thinks so e. Antidepressants alone were not effective

85. The manifestation of depression symptoms are slightly different age groups and also in men and women. Agitated depression is a term more commonly used to describe depression in which group of patients? a. Young children b. Adolescents c. Adults d. Women e. Elderly 86. The term double depression is used to describe? a. Major depressive disorder superimposed on grief reaction b. Major depressive disorder superimposed on dysthymia c. Major depressive disorder, patient not responding to treatment d. Major depressive disorder with psychosis e. Major depressive disorder with anxiety 87. A 36 – year old Caucasian male is stable on lithium for bipolar disorder for the past 4 years .during his routine visit with his family physician. He complains of fatigue and lack of motivation. He is also feeling very cold during this winter and has gained weight. He wonders if he is getting depressed again. What is the next most appropriate step to take in this case? a. Diagnose depression and start the patient on antidepressants b. Obtain the patients lithium levels c. Check the patient's thyroid – stimulating hormone d. Discontinue lithium e. Consider ECT 88. A 46 old female who is 6 week postpartum complains of feeling low in her mood and having crying spells, lack of motivation and feeling of hopelessness for the past 4 week she is diagnosed with postpartum depression. Which of the following is true about postpartum depression? a. Risk of infanticide is minimal b. Selective serotonin reuptake inhibitors (SSRIs) are contraindicated c. Risk of depression during subsequent pregnancies is increased d. Suicide risk is low e. Hospital admission is rarely required 89. Which of the following SSRIs is least likely to cause serotonin discontinuation syndrome? a. Paroxetine b. Citalopram c. Escitalopram d. Fluoxetine e. Sertraline

90. Of all of the tricyclic antidepressants which of the following has the most potent serotonin reuptake inhibition activity? a. Clomipramine b. Imipramine c. Amitriptyline d. Nortriptyline e. Desipramine 91. A neurologist is consulted by psychiatrist to assess a 42 years old depressed woman with recent onset of “muscle twitches”. She was taking Citalopram 80mg. Duloxetine 40mg was recently added because of suboptimal response to Citalopram alone. She denies any alcohol or substance abuse. On examination, the neurologist notes that the patient is slightly disoriented and also has mild tremors and hyperreflexia. What is the most likely cause of the “muscle twitches” in this patient? a. Serotonin syndrome b. Alcohol withdrawal syndrome c. Neuroleptic malignant syndrome d. Malingering e. Encephalitis 92. Which of the following antidepressant blocks reuptake of dopamine? a. Venlafaxine b. Bupropion c. Buspirone d. Mirtazapine e. Fluoxetine 93. The advancement in Central Nervous System (CNS) pharmacology is attributed to the better understanding of neurotransmitters and neuroreceptors. Which of the following is true about neuroreceptors ? a. 5-HT2A antagonists enhance Rapid Eye Movement (REM) sleep b. 5-HT1A antagonists are anxiolytics c. Most typical antipsycotics are D2 agonists d. D2 receptors are found in the limbic system e. α2-adrenergic agonists cause increase of norepinephrine release 94. A 56 years old male with history of chronic benzodiazepine use for insomnia is brought to Emergency Department (ED) by his daughter with complaints of sedation, incoherence and problems with coordination. His daughter states that he had been using diazepam 10-20mg every night for many years. She also recalls that a few days ago her father saw his family physician and got a new medication for some other problem. The ED physician checks the current medication list and believes that the patient has benzodiazepine overdose. Which of the following can increase the levels of benzodiazepine? a. Topiramate b. Cimetidine c. Phenytoin d. Carbamazepine e. Rifampicin

95. Selective mutism is defined as: a. Refusal to speak in learning situations b. Inability to speak in specific social situations c. Occasional refusal to speak in school d. Consistent refusal to speak in specific social situations e. None of the above 96. First symptom of Attention Deficit Hyperactivity Disorder (ADHD) to remit is usually: a. Hyperactivity b. Distractibility c. Careless mistakes in school work d. Impulsivity e. Learning difficulties 97. In Tourette’s disorder, the initial tics are in the: a. Face and neck b. Arms and hands c. Body and lower extremities d. Respiratory system e. Alimentary system 98. Before issuing diagnosis of enuresis, a urinalysis must be done to rule out which common condition? a. Bladder infection b. Structural malformation c. The common cold d. A urinary tract infection e. Urethra stenosis 99. Major depression disorder in school aged children? a. May present as irritable mood rather than depressed mood b. Usually includes pervasive anhedonia c. Includes mood-congruent auditory hallucinations less commonly than in adults with the same disorder d. Is never diagnosed in the context of bereavement e. None of the above 100. Which of the following is not a negative psychotic symptom? a. Flat affect b. Apathy c. Disorganized thinking d. Avolition e. Poverty of thoughts

101. Which of the following psychotic symptoms commonly co-occure with adolescent substance use disorder? a. Suicidal ideation and suicide attempts b. Panic attacks c. Re experiencing numbing and avoidance d. Binging and puring e. All of the above 102. Risk factors for the development of adolescent substance abuse includes all of the following except: a. Early onset of cigarette smoking b. Diminished parental supervision c. Pervasive developmental disorder d. Parental substance abuse e. Conduct disorder 103. Dementia of the Alzheimer`s type account for what percentage of old age dementia? a. 10% b. 20% c. 40% d. 60% e. 80% 104. Elderly persons taking antipsychotic are especially susceptible to the following side effects except? a. Akathesia b. Paresthesias c. Dry mouth d. Tradive dyskinesia e. A toxic confusal state 105. Which of the following factor is common in victims of elder abuse? a. Alcohol abuse b. Social isolation c. Mental illness d. Hostility e. Prescription drug abuse 106. Which of the following is the greater risk factor for suicide? a. Unemployment b. Single status c. Low income status d. Resident of urban area e. History of admission to a psychiatry hospital

107. Which of the following electrolyte abnormalities is associated with bulimic patients? a. Metabolic acidosis b. Respiratory acisdosis c. Metabolic alkalosis d. Respiratory alkalosis e. Normal electrolytes 108. A 42-year old man is seen in your office. He has recently seen a psychiatrist and is being treated for severe depression. The patient cannot recall the medication that he is taking, but remembers that his psychiatrist told him not to eat cheeses or aged meats. Which of the following agent is this patient most likely taking? a. Tricyclic antidepressant b. Selective serotonin release inhibitor c. Monoamine oxidase (MAO) inhibitor d. Neuroleptic e. Anxiolytic 109. High fever, tachycardia, tachypnea, diaphoresis, hypertension and seizures develop in a psychiatric patient who is receiving haloperidol. The most likely diagnosis? a. Malignant hypertension b. Rhabdomyolysis c. Neuroleptic malignant syndrome d. Sepsis e. Serotonin syndrome 110. Children who exhibit symptoms of school avoidance with nausea, vomiting and abdominal pain may benefit from? a. Antidepressant medication b. Methylphenidate c. Psychotherapy d. Benzodiazepine

20.09.2012:

26. A 24 year old salesperson is referred for an evaluation of difficulty dealing with costumers because she gets "so nervous and anxious that my mind gets blank". A careful evaluation revels that she has social phobia. She is motivated to obtain treatment and continue doing her job. All of the following interventions, except: a. Selective serotonin reuptake inhibition - SSRI's b. Flooding c. Modeling d. Systematic desensitization e. Electrical convulsion therapy - ECT 27. Factitious disorder with predominant physical signs and symptoms is also known as: a. Hypochondriasis b. Munchhausen c. Munchhausen by proxy d. Somatoform disorder e. Factitious disorder not other specified 28. Which of the following is true about blood-injection-injury phobia? a. Twice as common in women than men b. Low familial inheritance c. Sever tachycardia and hypertensive response d. Easily treated e. Bradycardia and hypertension often follow initial tachycardia 29. The term double depression is used to describe: a. Major depressive disorder superimposed on grief reaction b. Major depressive disorder superimposed on dysthemia c. Major depressive patient not responding to treatment d. Major depressive disorder with psychosis e. Major depressive disorder with anxiety 30. A 26 year old Caucasian make is stable on lithium for bipolar disorder for the past 4 years. During his routine visit with his family physician, he complains of fatigue and lack of motivation. He is also feeling very cold during this winter and has gained weight. He wonders if he is getting depressed again. What is the next most appropriate step to take in this case? a. Diagnose depression and start the patient on antidepressants b. Obtain patient lithium levels c. Check patient Thyroid stimulating hormone (TSH) levels d. Discontinue lithium e. Consider electric convulsion therapy (ECT)

31- 46 female is 6 week postpartum complains of felling low in her mood and having crying spells, lack of motivation and feeling hopelessness for the past 4 weeks what diagnosed to have postpartum depression? a. True risk of infanticide is minimal b. SSRI are contraindicated c. Risk of depression during subsequent pregnancy is high d. Suicide risk is low e. Hospital admission is rarely required 32- Which SSRI is least likely to cause serotonin discontinuation syndrome ? A. Paroxetine B. Citalopram C. Escitalopram D. Fluoxetine (Prozac) E. Sertraline 33- Of all tricyclic antidepressants which of the following most potent serotonin reuptake inhibition activity? a. Clomipramine b. Imipramine c. Amitriptyline d. Desipraminn 34- Which symptom has to be present to diagnose major depression disorder? a. Depressed mood or loss of interest or pleasure b. Lack of energy or motivation c. Lack of appetite d. Hopelessness e. Gilt or worthlessness 35- 36 year old pregnant admitted due to possible infection associated with IV heroin, she is 5 month into her pregnancy and would like to quit heroin for good, what best course of action? a. Allow her to continue to use heroin as withdrawal is dangerous b. Methadone maintenance c. Naltrexone d. Advise her to stop heroin and start supportive therapy e. Buprenorphine 36- Good test of recent memory? a. Subtract 7 from 100 b. Ask Their date of birth c. Ask How many sibling they have d. Ask What they had eat for their last meal e. Ask Who is the president

37- Most common case of delirium within 3 day of postoperative in a 40 year old man with history of alcohol dependence? a. Delirium tremens b. Infection c. Pain medication postoperative d. Pain stress of surgery 38- Clinical feature which may be associated with delirium: a. Disorganized thought process b. Hallucination c. Illusion d. All of the above 39- Which of the following drug is best use to treat acute delirium? a. Amobarbital (amytal) b. Chlorpromazine c. Diazepam d. haloperidol e. physostigmine 40- Mouth ulceration is associated with which of the following types of withdrawal ? a. alcohol b. benzodiazepins c. cocain d. nicotin e. opoids 41. The postpartum blues: A. occur in up to 50 percent of women after childbirth B. are self-limited C. begin shortly after childbirth and lessens in severity over the course of a week D. are considered to be normal E. all of the above 42. Depression and mania share which of the following symptoms? A. Psychomotor acceleration B. Low-self esteem C.Grandiosity D. Anger E. Pessimism 43. The highest suicide rates are in which of the following age groups? A. Under age 15 B. 15 to 24 year olds C. 25 to 44 year olds D. 45 to 64 year olds E. Over age 65

44. The best indicator for increased risk of suicide? a. Alcohol dependence b. Marriage c. Previous suicidal behavior d. Schizophrenia e. Major depressive disorder 45. Which of the following antidepressants would not be the best choice for the above patient with a history of suicidal ideation? A. SSRI B. MAOI C. Bupropion (Wellbutrin) D. TCA E. Venlafaxine (Effexor) 46. Generalized Anxiety disorder: A. is least likely to coexist with another mental disorder B. has a female to male ration of 1:2 C. is a mild condition D. has about a 50 percent chance of a recurrence after recovery E. has a low prevalence in primary care settings 47. Tourett’s disorder has been shown to possibly have a familial and genetic relationship with: A. panic disorder B. OCD C. generalized anxiety disorder D. social phobia E. none of the above 48. Medical disorders to be considered in the differential diagnosis of somatization disorder include: A. multiple sclerosis B. systemic lupus erythematosus C. acute intermittent porphyria D. all of the above 49. The most accurate statement regarding pain disorder is: A. It is diagnosed equally among men and women B. Peak ages of onset are in the second and third decades C. It is least common in persons with blue collar occupations D. First degree relatives of patients have an increased likelihood of having the same disorder E. Depressive disorders are no more common in patients with pain disorder than in the general public 50. Factitious disorders are best treated by which of the following? A. Immediate discharge from the hospital B. Confrontation about the patient’s deceit C. Focusing on management rather than cure D. Performing only minimally invasive procedures to satisfy the patient E. Using low-dose neuroleptics to decrease the patient’s physical distress

01.03.2012:

87) a previous healthy 15 yrs. Old boy was at a party. he presented to the emergency room after a sudden onset of anger, agitation and paranoia. He clam that a government agent is spying on him. The first thing to do is: a- EEG b- glucose tolerance test c- PET for the head d- thyroid function test e. urine toxicology screen 88) flouxetine's most common adverse effect: a- hypotension b- liver toxicity c. nausea d- sedation e- weight gain 89) appropriate medication for Tourette disorder: a- bupropione b. clonidine c. haloperidol d- paroxetine e- venlafaxine 90. Which of the following is the most common adverse effect of methylphenidate ? A. Hypotension. B. Insomia. C. Liver toxicity. D. Tremor E. Weight gain. 91. Which of the following qualities would be most commonly associated with a more favorable prognosis of autistic disorder? A. Easy toilet training. B. Interested in mechanical toys. C. Organized play. D. Reciprocal conversion. E. Reciting songs and poems from memory. 92. Which of the following laboratory abnormalities are most likely to be found in a patient with anorexia nervosa? A. Hypercholesterolemia. B. Hyperkalemia. C. Hypocarotenemia. D. Increased thyroid stimulating hormone (TSH). E. Leukocytosis.

93. Which of the following disorders is rarely confused with anxiety that stems primarily from medical disorder? A. Panic disorder B. Specific phobia C. Obsessive compulsive disorder. D. Post traumatic stress disorder E. Generalized anxiety disorder 94.a 28 year old female was diagnosed to have (post stress disorder) PTSD after she was assaulted and raped 6 months ago. Over the next2 years, despite extensive therapy and pharmacological treatment, the response was suboptimal. She was later diagnosed to have major depressive disorder and substance abuse problems. Which of the following is the most common comorbid condition in women with PTSD? A. Substance abuse B. Depression C. Obsessive compulsive disorder D. Psychotic disorder E. Eating disorder

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95. Which of the following is the most common somatoform disorder? A. Conversion disorder B. Somatization disorder C. Pain disorder D. Hypochondriasis E. Body dismorphic disorder 96. Which of the following helps in distinguishing malingering and factitious disorder? A. Age B. Secondary gain C. Deliberate production of symptoms D. Course of illness E. Response to conformation 97. A 46 year old women is frustrated and angry with her neurologist because he recommended a psychiatric evaluation for what she describes as “medical problems”. She complains of dizziness, nausea, palpitations, abdominal pain and sweating , but no one is able to give her the right treatment. She was seen by an ear specialist, cardiologist , and a gastroenterologist , but nothing abnormal was detected. She was hoping that a neurologist would find a cause for her symptoms. She also states that these symptoms occur with symptoms without any precipitating factors, last for 20 to 30 minutes, and she feels as if she is “about to die”. The most probable diagnosis in this women is: A. GAD. B. Major depressive disorder. C. MVP. D. Panic disorder. E. Meniere’s disease.

98. A 76 year old male patient is admitted to an acute psychiatric unit for severe suicidal ideation. He admits to feeling hopeless and refuses to contract for safety. He has a history of noncompliance with treatment and is refusing to take any medications. He has severe psychomotor retardation and stops eating and drinking. A reasonable choice of treatment in this patient would be: A. Persuade the patient to take antidepressant. B. Wait and watch for the patient to change his mind. C. Consider feeding against his well. D. Electroconvulsive treatment (ECT). E. Intensive psychotherapy. 99. One of the criteria for the diagnosis of major depressive disorder is weight loss that is unintentional. The criteria for weight loss specify that: A. Loss of any amount of weight is significant. B. Loss of 5% or more of the body weight in the past one month. C. Loss of 10% or more of the body weight in the past one month. D. Loss of 10% of body weight in the past 2 weeks. E. Loss of 5% of body weight in the past 2 weeks. 100. Mania can be associated with all of the following features except: A. Sometimes associated with depression symptoms. B. Can be triggered by antidepressants. C. Irritability is a recognized symptom. D. Is always followed by depression. E. Can occur during bereavement. 101. Which of the following illicit drugs can lead to a full range of symptoms similar to that seen in patients with schizophrenia? A. Ecstasy. B. Alcohol. C. Marijuana. D. Phencyclidine. E. Opiates. 102. A 46 year old male is stable on low dose haloperidol for chronic schizophrenia. Recently he was diagnosed to have comorbid depression and was started on fluxetine 20mg. he calls the physician with complains of stiffness in his arms and legs. What is possible cause of these symptoms? A. Malingering, the patient would like to stop taking antidepressant medicine. B. Increase level of haloperidol because of fluxetine. C. Fluxetine is causing extrapyramidal side effect symptoms. D. Decrease levels of haloperidol are causeing extrapyramidal side effects. E. Increase level of fluxetine because of haloperidol. 103. What is the characteristic feature of chronic marijuana abuse? A. Motivational syndrome. B. Seizure. C. Wernick’s encephalopathy. D. HPPD. E. Stroke.

104. A 52 year old male is admitted to medical unit for an ulcer on his foot. 2 days after admission, he was found to tolerate the Intravenous antibiotics well and has no fever. However he becomes restless and appears slightly confused. He also complains of insomnia and the nurse noticed he is diaphoretic with an increase heart rate and blood pressure, physical examination reveals a course tremor of the upper extremities and his reflexes are described as brisk. what is the most likely diagnosis? A. Alcohol withdrawal. B. Opiate withdrawal. C. Methamphetamine withdrawal. D. Nicotine withdrawal. E. Marijuana withdrawal. 105. Which of the following is considered to be a poor prognostic factor with patient with anorexia nervosa? A. Late age of onset. B. Family members open to participate in patient care. C. Early age onset. D. No suicidal behavior. E. No previous hospitalization. 106. Which of the following is the most significant risk factor for suicide? A. Psychiatric disorder. B. Death of a loved one. C. Loss of job. D. Lack of home. E. Conflict at work 107. Which of the following medical disorder is associated with the highest risk of suicide? A. Epilepsy. B. Huntington’s disease. C. AIDS. D. Cancer. E. Brain injury. 108. cortisol has a significant impact on mood and Cushing’s syndrome is often associated with psychiatric disturbance. What is the most common psychiatric manifestation in patient with Cushing’s syndrome? A. Mania. B. Psychosis. C. Anxiety. D. Panic attack. E. Depression. 109. A majority of the psychotropic medications are metabolized in the liver. Which of the following statements is true regarding the treatment of depression in hepatic disease? A. Fluxetine is not cleared by hepatic enzymes. B. Lithium is the mood stabilizer of choice in the presence of hepatic failure. C. SSRI’s are contraindicated in liver disease. D. Paroxetine causes minimal inhibition of hepatic enzymes. E. Half lives of drugs are reduced in liver disease.

110. Which of the following statements is true about suicide in medically ill patients? A. Most terminally ill patients develop a psychiatric disorder. B. Most terminally ill patients are at risk of suicide. C. Anger is an important factor in suicide. D. Medical illness is not common in patients who commit suicide. E. suicide in medically ill patients is not preventable.

1) in distinguishing schizophrenia from amphetamine induced toxic psychosis the presence of which of the following in the most helpful? a- tectile or visual hallucination b- paranoid delusion c-intact orientation d- clear consciousnes e- auditory hallucination 2) which of the following electrolyte abnormality is associated with bulumic patient ? a- metabolic acidosis b- respiratory acidosis c-metabolic alkalosis d- respiratory alkalosis e-normal 3) PTSD differs from acute stress disorder(ASD): a- ASD occurs more commonly than PTSD b- PTSD is associated with at least 3 dissociative symptoms c- reexpercing the trauma is not found in ASD d- avoidance of stimuli is associated with the trauma is only found in PTSD e- PTSD lasts less than 1 month after trauma 4) double depression: a- 2 family members with depressive disorder concurrently b-recurrent major depressive disorder with current symptoms twice as disabling c- two episodes of major depressive disorder at month d-superimposed bipolar 2 disorder with atypical depression e- recurrent major depression disorder superimposed with dysthmic disorder 5) clozapine: a. Is associated with few, if any, extraperamidal side effects. b- is believed to exert its therapeutic effect mainly by blocking the dopamine receptors. c- causes significant increase in prolactin level d- is associated with 10-20% incidence of agranolocytosis e- requires monthly monitoring of blood chemistry 6) late onset schizophrenia: a- is more common in men b. is associated with a preponderance of paranoid symptoms c- is clinically distinguished from early onset schizophrenia d- results in poorer response to antipsychotic medication e- has an onset after 60 years of age.

7) minor signs and symptoms of discontinuation on benzodiazepine: a- hyperpyrexia b- grand mal seizure c- psychosis d. nightmares. e- death 8) which of the following complications would be the best indication for admitting patient with anorexia nervoasa to the hospital: a- anemia b. arrhythmia c- bradycardia d- hypotension e- lanugo 9) Which of the following would be the most appropriate treatment for panic disorder? a- aripiprazole b- carbamazepine c- resperidone d. sertraline e- valporic acid 10) in bipolar disorder, which tests should be done before treatment with lithium? a-thyroid function test, creatinine, pregnancy test b-thyroid function test, creatinine, liver c-thyroid function test, creatinine, complete blood count d- thyroid function test, liver function test pregnancy test 87. E

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76. The use of which of the following medications is limited by potentially life-threatening rashes? a.Phenytoin. b.Lamotrigine. c.Carbamazipine. d.Gabapentin. e.Tramadol. 77. Urges of impulses for repetitive intentional behavior performed in a serotyped manner in an attempt to relieve anxiety is termed: a.Adaptation. b.Congruence. c.Compulsion. d.Obsession. e.Transference. 78. Which of the following is the greatest risk factor of suicide? a.Unemployment. b.Single status. c.Low income status. d.Resident of urban area. e.History of admission to a psychiatric hospital. 79. In a dying patient, which of the following is used to detect depression? a.Pervasive hopelessness. b.Weight loss. c.Crying. d.Dependency. e.Concern over being a burden. 80. Which of the following electrolyte abnormalities is associated with bulimic patients? a.Metabolic acidosis. b.Respiratory acidosis. c.Metabolic alkalosis. d.Respiratory alkalosis. e.Normal electrolytes. 81. A 42 year old man is seen in your office. he has recently seen a psychiatrist and is being treated for severe depression. the patient cannot recall the medication that he is taking, but he remembers that the psychiatrist told him not to eat cheeses or aged meats. which of the following agents is this patient most likely taking? a. tricyclic antidepressant b. ssri c. mao inhibitor d. neuroleptic e. anxiolytic

82. High fever,tachycardia,tachypnea,diaphoresis,hypertension and seizuers develop in a psychiatric patient who receiving haloperidol. the most likely diagnosis is: a. malignant hyperthermia b. rhabdomyolysis c. neuroleptic malignant syndrome d. sepsis e. serotonin syndrome 83. Which of the following is most likely to cause withdrawal symptoms with abrupt discontinuation? a. fluoxetine (prozac) b. sertraline (zoloft) c. paroxetine(paxil) d. citalopram(celexa) e. none of the ssri’s cause withdrawal symptoms 84. Children who exhibit symptoms of school avoidance with nausea, vomiting and abdominal pain may benefit from: a. antidepressent medication b. Methylphenidate c. Psychotherapy d. bezodiazepines e. Mood stabilizers 85. Which of the following statements about somatization disorder is true? a. men are more affected than women. b. Patients exhibit multiple physical complaints that usually have an identifiable physiologic basis c. The condition usually develops after age 50. d. Symptoms rarely affect the patient’s interpersonal relationships. e. Treatment involves frequent office visits and reassurance to the patient. 86. Which of the following statements about suicide is true? a. Males make more suicide attempts b. Women are more successful c. Anxiety is the most common contributing factor d. Most suicides occur during December e. Married people have the lowest risk for suicide 87. Galactorrhea is associated with which of the following medications? a. benzodiazepines b. tricycle antidepressants c. Mao inhibitors d.antipsychotic medication e. Dopamine agonist

88. Which of the following is most commonly associated with tricyclic antidepressant toxicity? a. 3rd degree AV block b. PR interval prolongation c. QT interval prolongation d. Widened QT e. T elevation 89. A 25 year old male was hospitalized for his first episode of psychosis, started on haloperidol. After 3 days patient’s upper body was contracting, he is in pain and is frightened. What is the best medication to help relieve his suffering? a. Propranolol b. Olanzepin c. Quetiapine d. Benztropine e. Risperidone 90. Most common type of obsession in patients with OCD? a. Worries about contamination b. Intrusive sexual thoughts c. Religious obsessions d. Hoarding e. Preoccupation with body image 91. A 18 yrs single man recently diagnosed with schizophrenia referred for consultation was recently fired from his job at a fast food restaurant, clinical pictures has been dominated by positive symptomatology, his cousin recently diagnosed with schizophrenia, patient asking about his prognosis, good prognosis in his case? a. predominant to symptom b. young age at onset c. family history of schizophrenia d. bizarre delusion e. poor premorbid psychosoied functioning 92. A 74 yr women with history of Parkinson disease referred for psychiatric consultation due to worsening psychotic symptom, a complete medical workup failed to find any organic etiology for her auditory hallucination and paranoid delusion, which of the following anti psychotic appropriate in treating patient symptom? a. haloperidol b. respiridone c. quetiapine d. ziprasidone e. perphenazine 93. The most common location of imagined defect in body dysmorphic disorder? a. stomach and waist b. breast and genitals c. arms and legs d. face and hair e. neck and shoulder

94. Which of the following most appropriate step in initial management of patient with neuroleptic malignant disorder (NMS)? a. hydration,cooling blanket,cardiac and renal function monitoring b. cooling blanket,dialysis,hydration,cardiac monitoring c. hydration,administer baclofen IV,restraints,cardiac monitoring d. administer lorazepam IV,hydration,measure urine output. e. adminster diphenhydramine IV,cooling blancket,cardiac monitoring 95. According to data from (NIHM) clinical anti psychotic trials effectiveness study, which one where patient least to discontinue due to lack of efficacy? a. olazipine b. quetiapine c. ziprasidone d. risperidone e. pephenazine 96. Regarding use of SSRIs for the treatment of OCD? a. the starting dose for OCD IS LESS than the starting dose for depression b. target symptom worsen before they improve once treatment with SSRI is started c. the maintenance dose for OCD may be higher than maintenance dose for depression d. the onset of response is quicker in OCD than in depression e. if the patient fails to respond to one SSRI they will fail to respond to all SSRI 97. Belief in clairvoyance and telepathy fall in the list of diagnostic of which of the following? a. histrionic personality disorder b. schizoid personality disorder c. schizotypal personality disorder d. narcissistic personality disorder e. paranoid personality disorder 98. The best indicator for increased risk of suicide? a. alcohol dependence b. marriage c. schizophrenia d. previous suicidal behavior e. major depressive disorder 99. A 30 year old man with history of bipolar disorder on combination of drugs, present wit fever, headache, hacking cough, this progress to a spreading red rash, which of the following most likely to have caused this condition? a. lamotrigine and valporic acid b. fluxetine and valporic acid c. lamotrigine and fluxetine d. lithium and lamotrigine e. lithium and valporic acid

100. A 75 yr women widow leaves her home for annual vacation in florida, she forget to take her medication,2 days later develop( tremor, sweating, nausea ,increase anxiety),does not use alcohol or street drug, cessation of which most cause her symptom? a. lorazepamb b. lithium 3. buspirone d. trazodone e. valporate 102. Which one of the following disorders is most often comorbide with anorexia nervosa ? a. Depression b. OCD c. Social phobia d. schizophrenia e. Avoidant personality disorder 104. A 12 year old boy performs a 3 hour of daily compulsive hand washing and has extreme difficulty going to school due to contamination fear. most appropriate treatment: a. Interpersonal, cognitive or psychodynamic therapy plus fluoxetine. b. Response prevention plus sertraline. c. Social skill group plus methylphenidate. d. desmopressin (DDAVP) nasal spray plus behavioral conditioning. e. Family therapy. 105. Which of these substances is most likely abused by adolescents? a. Marijuana b. Alcohol c. Cocaine d. Ecstasy e. LCD 107. Which of the following is common in the childhood history of patients with borderline personality disorder? a. Shyness b. Psychosis c. Conduct disorder d. Sexual abuse e. Magical & odd beliefs 110. Hypothyroidism in the elderly may commonly present with all of the following except? a. lassitude b. fatigue c. cognitive impairment d. anorexia e. constipation

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28. person who experience other as either” all good ”or “all bad” and cannot experience an ambivalent relationship are exhibiting which of the following ? a.Denial b.Identification c.Projection d.Regression e.Splitting 30. which of the following brain regions appears abnormal in schizophrenia ? a. medulla oblongata b. optic chiasm c. prefrontal cortex d. reticular activity system (RAS) e. third ventricle 31. common side effects of the selective serotonin reuptake inhibition includes : a. constipation and orthostatic hypotension b. sedation and priapism c. restless ,tremors ,seizures . d. nausea ,insomnia and sexual dysfunction e. confusion and memory loss 32. posttraumatic stress disorder differ from adjustment disorder in that PTSD: a. accurse in veterans b. characterized by impairment of social functioning c. persists long after stress has abated d. is characterized by preoccupation with the stress e. can be accompanied with depression 33. A 30y old man complains of panic attacks and anticipatory anxiety . which of the following drugs would be an effective treatment a. carbamazepin b. fluoxeten c. haloperidol d. meprobamate e. pentobarbital 34) A 55 y wom. Is seen on a medical service for complains of abdominal pain , the physician notes a history of life long poor health and multiple past somatic complaints .what is the best treatment strategy ? d.

35. which of the following side effects associated with antipsychotic medication can be lethal and requires the most emergent treatment ? a. oculogyric crises b. torticollis c. trismus d. opisthotomus e. laryngeal dystonia 38. borderline personality disorder : b. prevalence in female d. best treatment choice is antidepressant 39. most distinctive of malingering from factitious disorder is: b. secondary gain e. response to confront 40. what is the peak onset of schizophrenia in men? a. 22 - 27 years b. 24 - 31 years c. 17-25 years d. 26-45 years 41. which of the following is a good prognostic indicator for schizophrenia? a. prominent affective symptoms b. insidious onset c. ventriculomegaly d. negative symptoms 42. which of the following drugs has been shown to decrease the suicide rate ? a. carbamazepine b. olanzupine c. sertraline d. lithium e. valproic acid 43. a 48 year -old male patient with difficult to treat depression has tried all the anti depressants except MAOIs. He is currently on an SSRI. Which of the following SSRI s needs the longest wash out period before switching a patient to an MAOI? a. paroxetine b. fluoxetine c. citalopram d. sertraline e. escitalopram

44. Which of the following tricyclic anti depressants closely resembles an SSRI in its action mechanism? a. amitriptyline b. nortriptyline c. imipramine d. clomipramine e. doxepine 45. a 70 year old man with a dementing disorder dies in a car accident during the previous 5 years his personality had changed and he had caused much embarrassment to his family because of his intrusive and inappropriate behavior .he had frontotemporal atrophy gliosis of the frontal lobe`s with matter , characteristic intracellular inclusions, and swollen neurons . amgloide placks………………. Which of the following is the most likely diagnosis? a. Alzheimer disease b. pick disease c. Creutzfeldt-Jakob disease d. B12 deficiency dementia e. HIV dementia 48. most common cause of delirium in elderly? c. hypoxia d. multiple medications 49. 58 year old female with chronic mental disorder , comes to the physician with irregular choreathetoid movement of her hands and the trunk she states the movement get worse under stress full condition , which medication to cause this disorder: a. fluxetin b. clozapen c. perphenazin d. diazepam e. phenobarbitol 50. 25 y / m has a chief complain of depression for 1 month , his mother who he was close to had died 1 month ago and since then he is very tearful has difficulty concentrating ,lost 1.5kg , and has insomnia .What is the diagnosis? a. major depression b. dysthemia c. PTSD d. Adjustment disorder e. Uncomplicated bereavement 51. A 27 years old male feeling blue for the past two weeks, he has little energy and troubles concentrating. Six weeks ago he had been feeling very good, this pattern has been occurring for the past three years, though it never was so severe, what is most likely the diagnosis? a. Border line disorder b. Seasonal affective disorder c. Cyclothymic disorder d. Major depression, recurrent e. Bipolar disorder, depressed

52. A 32 years old male treated for major depression which of the following symptoms if present is one of the most accurate indicators of a long term suicidal risk? a. Revenge fantasies b. Presence of range in the patient c. Hopelessness d. Presence of guilt e. Patient has a need for punishment 53. A 33 years old male comes to his physician for an HIV test, the test is positive, he has no symptoms of AIDS. Which of the following psychiatric diagnosis may develop in approximately 25 percent of patients informed of positive HIV test? a. Adjustment disorder with anxiety b. PTSD c. Bipolar disorder, manic d. Panic disorder e. Hypochondriasis 54. Dysthymic disorder: a. Usually begins in adulthood b. Does not respond to antidepressants c. Presents with symptoms of lack of say in life and preoccupation with inadequacy d. Usually limited to one or two episodes e. Characteristically marked by psychomotor agitation or retardation 55. Most common cause of delirium within three days post operatively in a 40 years old man with a history of alcohol dependence is: a. Stress of surgery b. Post operative pain c. Pain medication d. Infection e. Delirium tremens 56. True anorexia (A.N) : a. very common in older children and adolescent b. medical complication include irregular heart beat constipation and osteoporosis c. medical evaluation of pt with A.N doesn’t include ECG d. delusions about food in schizophrenia are also usually concerned with the caloric content of food . e. OC behaviour is very uncommon in ( A.N) patients 57. levodopa causes mania and psychosis supports which neurochemical hypothesis ?? a. norepinephrin b. dopamine c. glycine d. serotonin e. glutamine

58. After being struck on the head by a 4X4 piece of wood , a previously serious and dependable construction worker starts inappropriate sexual remarks to his co-workers, is easily distractible and losses his temper on minor provocation. What is the damaged part? a. Occipital lobe b. Temporal lobe c. Limbic lobe d. Basal gang. e. Frontal lobe 59. 8 y /boy is constantly clearing his throat and blinking his eyes for 3 weeks ,he has symptoms intermittently for several years never free of them for more than a day or two . What is the best Tx ? a. Alprazolam b. methylephedrine c. haloperidol d. amitriptyline e. lithium 60. 8y/boy complains of night bed wetting , behavioral interventions were not helpful , what is the best treatment of choice ? a. Ritalin b. Paroxetine c. Trazodone d. Bezotropine e. Imipramine

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56. A 72 years old man with acute urinary retention and blurred vision after taking antidepressions for 3 days, which of these medication has these side effects? A. venlafaxina B. paroxetine C. bupropion D. nefazodone E. amitriptyline 57. A8 year-old boy constantly cleaning throat and blinking eyes for 3 weeks, symptoms intermittently for several years. Never complete free from symptoms for more of one or two days. First medication in this case: A. Alprazolam B. methyphenidrate C. Haloperidol D. Amitriptyline E. lithium 58. Hormones is most commonly used in the adjuvant treatment of depression: A. progesterone B. cortisol C. ACTH D. levothyrotine E. Prolactin 59. A72 year-old with long story of recurrent psychotic depression, hospitalized during a relapse. He has prostatic hypertrophy, coronary heart disease, recurrent orthostatic hypotension. Which of the following is the most appropriate antipsychotic medication for this patient? A. chlorpromazine B. clozapine C. thioridazine D. haloperidol E. olanzapine 60. The BZD acting depends on her interaction with which of the following receptors: A. GABA B. Serotonin C. NMD D. Dopamine E. Acetylcholine 61. Which of the following statements is true about fire setter? A. girls and boys are equally at risk for pathological fire setting B. fire serrated by children rarely cause any serious damage C. children younger than 6 are not likely to experiment with fire D. the prognosis for treated children is excellent E. a commonly associated feature is lower than average IQ

62. Alexithymia is: A. an unpleasant mood B. a loss of interest in and withdrawal from pleasurable activities C. an inability to describe or to be aware of emotion or mood D. a normal range of mood implying absence of depressed or elevated emotional state E. a state in which a person is easy annoyed and provokated to anger 63. Which of the following drugs is best used to treat acute delirium? A. chlorpromazine(taroctyl) B. b)diazepam (valium) C. haloperidol (halodol) D. amobarbital (amytal) E. physostagmen salicylate (antilirium) 64. Which of the following is the most common symptom pattern associated with OCD? A. obsession of doubt. B. obsession of contamination. C. intensive thoughts. D. obsession of doubt. E. compulsive hoarding. 65. Medical complication of eating disorder related to weight loss include all of the following except: A. erosion of dental enamel with corresponding decay B. bradycardia C. constipation and delayed gastric emptying D. abnormal taste sensation E. osteoporosis 66. Anorexia nervosa has mortality rate of up to approximately: A. 1% B. 18% C. 30% D. 42% E. 50% 67. The first symptom of ADHD to remit as usually: A. hyperactivity B. distractibility C. careless mistakes in school work D. impulsivity E. learning difficulties 68. When an examiner asks a patient to count backwards by 7 starting at 100…: A. recent memory B. remote memory C. concentration

69. A 8 year old boy present for a routine visit, 1 month earlier you diagnosed tourette disease and prescribed him medications. He and his parents reported that the medication is being helpful. Which of the following is the most common initial symptom of tourette? A. eye tics, such as blinking B. facial tics, such as grimacing or licking C. vocal tics such as throat clearing or grunting D. whole body tics, such as body rocking or pelvic thrusting E. self abusive tics, such hitting 70. A 8 year old child referred to the clinic because of bed wetting, several behavioral interventions have been attempted, including eliminated fluid intake in the evening, scheduled awakenings at nights to use the bathroom and urine alarm (bell and pad). These techniques were unsuccessful and the child continued to urinate every night. Which medication is the most appropriate to prescribe to treat the enuresis: A. retalin B. paroxetin C. trazodone D. imepramin (primonil) E. benztropine (cogentin) 71. Which of the following is the most common side effect of mythylphenidate (Ritalin)? A. tremor B. Hypotension C. weight gain D. insomnia E. liver toxcity 72. A 15 years old is brought in to the pediatricians office by her mother, who is concerned about her lack of apparent appetite. The patient is wearing baggy clothes but her weight is in the 70-th percentile for her height. She admits that she "does not eat much", but she claims to have a voracious appetite. She is active in school musical productions, and she is very worried about "getting fat" and not getting the lead part. Her medical history is unremarkable and although she started menstruating at age 13, she has not had her period for at least 5 months. Which of the following laboratory abnormalities would be the most likely found in patient? A. Decreased CRH B. Hyperholesteroemia C. Hyperglycemia D. Hyperthyroidism E. Leukocytosis. 73. A patient reports to you that for the past week or two he has had the belief that his intestines and his heart have been removed. When asked about his lack of getting out in the world he responds "what world? There is no world". This aspect of patients illness would be best referred to as which of the following? A. Schizoaffective disorder B. Capgras syndrome C. Folie a' deux D. Cotard syndrome E. Major depression

74. A 52 yr old woman who has been treated with medication for 3 years for a chronic mood disorder reports that although she feels well, she wonders if her medication is causing side effects. She complains of dry mouth, trouble urinating and occasional dizziness when she gets out of the bed. Which of the following medications is the most likely being prescribed? A. Fluoxetine B. Imipramid (Premonil) C. Phenelzine D. Lithium E. Divalproex sodium 75. A 38 year old woman presents to your clinic telling that she has had disturbing, recurrent thoughts about harming her 7 mo old infant. She imagines using a knife and stab her child. Since having these distressing thoughts, she had removed all sharp objects from her kitchen. Because of this, she has not been able to prepare meals at home and has chosen to buy fast food or take-out food for family meals. She has not shared these thoughts with her husband. The most accurate diagnosis for this condition is which of the following? A. impulsive control disorder not otherwise specified B. OCD C. obsessive-compulsive personality disorder D. psychosis not otherwise specific E. schisotypal personality disorder 76. F 36 year old man is brought to the emergency department in respiratory arrest. On examination: he is unresponsible, and the medical student rotating thought the emergency department observers pinpoint pupils and antecubital track marks. There is suspicion that patient’s condition may be the result of a drugs overdose. The patient most likely has overdosed on which of the following drugs? A. cocaine B. PCP C. heroin D. alcohol E. inhales 77. A 60 year old man has a history of left middle cerebral stroke. Which of the following psychological disturbances is the most common following such a neurologic effect? A. anxiety B. OCD C. depression D. mania E. panic symptoms 78. Postmortem studies and CSF sampling from living patients have revealed a correlation between aggression, impulsiveness, and suicide, and a low level in the metabolism of which of the following neurotransmitters compared to control subjects? A. dopamine B. GABA C. glutamine D. norepinephrine E. serotonin

79. A 25 y.o. man is brought into the emergency department lethargic and stuporous. He responds only to painful stimuli, wakes up briefly and yells, then goes back to sleep. Ambulance personal report that they found him near a house known for drug trafficking. There is no evidence of physical injury. Which of the following medications should he receive first? A. dextrose and flumaztnil B. dextrose, flumazenil, and naloxone C. dextrose, flumazenil, naloxone, and thiamine D. dextrose and naloxone E. dextrose, naloxone and thiamine 80. A social worker makes a routine visit to a 3 y.o. boy who has just been returned to his biological mother after spending 3 month in foster care as a result of a severe neglect. the child initially appears very shy and cling fearfully to his mother. Later on, he starts playing in a very destructive and disorganized way. When a mother tries to stop him from throwing block at her, he starts kicking and biting. The mother becomes enraged and start shouting. Which of the following is the most likely diagnosis for this child? A. oppositional defiant disorder B. ADHD C. reactive attachment disorder D. posttraumatic stress disorder E. major depression

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86. A 4-year-old girl is brought to her pediatrician because her parents think she does not seem to be “developing normally.” The girl’s mother states that her daughter seemed normal for at least the first 2 to 3 years of her life. She was walking and beginning to speak in sentences. She was able to play with her mother and older sister. The mother has been noticing that over the past 2 months her daughter has lost these previously acquired abilities. She will no longer play with anyone else and has stopped speaking entirely. She has lost all bowel control, when previously she had not needed a diaper for at least a year. Which of the following is the most likely diagnosis? A. Rett disorder B. Childhood disintegrative disorder C. Autism D. Asperger disorder E. Pervasive developmental disorder 87. Which of the following has been considered common finding in the history of fire- letters stuttering? A. Stuttering B. Trichtillomania C. Auditory hallucinations D. Echolalia E. Enuresis 88. A 7-year-old boy avoids sleepovers because he wets his bed one to two times per week and is afraid his friends would tease him. He has never achieved a year-long period of dryness throughout the night. A physiologic work-up shows no evidence of an organic cause for this problem, and there is no evidence of a psychiatric disorder in any other category. Which of the following treatments is likely to be effective and should be tried first? A. Pharmacotherapy with imipramine B. Bladder training (reward for delaying micturition during daylight hours( C. Classic conditioning with a bell-and-pad apparatus D. Pharmacotherapy with desmopressin E. Psychotherapy 89. A social worker makes a routine visit to a 3-year-old boy who has just been returned to his biological mother after spending 3 months in foster care as a result of severe neglect. The child initially appears very shy and clings fearfully to his mother. Later on, he starts playing in a very destructive and disorganized way. When the mother tries to stop him from throwing blocks at her, he starts kicking and biting. The mother becomes enraged and starts shouting. Which of the following is the most likely diagnosis for this child? A. Oppositional defiant disorder B. ADHD C. Reactive attachment disorder D. Posttraumatic stress disorder (PTSD) E. Major depression 90. Concerning selective mutism which is correct: A. only 1-3% history of delay onset of speach B. is commonly associated with malformation of broca's area C. first characteristic of it is school phobia D. common in boy > girls E. children with selective mutism speak freely at home

91. A 4 year-old boy experiences episodes of waking up screaming in the middle of the night thrashing wildly with his eyes wild opening ,when his parents try to wake him up and secure him he pushes them away,2 min later he had suddenly fallen asleep, the next day he has no memory about the event. correct statement about his condition include: A. behavioral therapy and relaxation technique are the treatment of choice B. specific treatment is seldom required for this disorder 92. A 12-year-old boy is brought to the psychiatrist because his mother says the boy is driving her “nuts.” She reports that he constantly argues with her and his father, does not follow any of the house rules, and incessantly teases his sister. She says that he is spiteful and vindictive and loses his temper easily. Once he is mad, he stays that way for long periods of time. The mother notes that the boy started this behavior only about 1 year previously. While she states that this behavior started at home, it has now spread to school, where his grades are dropping because he refuses to participate. The patient maintains that none of this is his fault--his parents are simply being unreasonable. He denies feeling depressed and notes that he sleeps well through the night. Which of the following is the most likely diagnosis? A. oppositional defiant disorder (ODD) B. Antisocial personality disorder C. Conduct disorder D. Childhood-onset schizophrenia E. Mania 93. Which of the following statement concerning disorder is true associated with physical cruelty to animals? A. This disorder is more common in children of parents with avoiding personality with avoidant B. This disorder is defined as a part of developmental stage C. Conduct disorder is frequently associated with physical cruelty to animals D. ? E. Traditional individual psychotherapy is the most effective treatment for this disorder 94. Conduct disorder coexist often with: A. ADHD B. Dysthymic disorder C. Major depressive disorder; D. Early onset bipolar I; E. Anxiety disorder 96. Childhood schizophrenia: A. is not diagnosed using the same symptoms as are used for adult schizophrenia B. tends to have a better prognosis that adult schizophrenia; C. Boys became symptomatic at the same age as girls; D. tends to have an abrupt onset; E. all of the above 97. An 18-year-old girl comes to the psychiatrist because she pulls out her hair in patches when she is anxious or upset. She is taught to make a tight fist whenever she has this impulse rather than pull out her hair. Which of the following techniques is this? A. Habit reversal training B. Extinction C. Simple conditioning D. Flooding E. Desensitization

98. A 24-year-old woman, 5 days after delivery of a normal ,full-term infant, is brought to the obstetrician because she is so tearful. She states that her mood is quite labile, often changing within minutes. She has trouble sleeping, both falling asleep and awakening early. She notes anhedonia, stating she doesn’t enjoy “much of anything” right now. Which of this patient’s symptoms point preferentially to a postpartum depression? A. Time--that is, 5 days post delivery B. Tearfulness C. Labile mood D. Insomnia E. Anhedonia 99. A 35-year-old woman is seeing a psychiatrist for treatment of her major depression. After 4 weeks on fluoxetine at 40 mg/day, her psychiatrist decides to try augmentation. Which of the following is the most appropriate medication? A. Lithium B. Sertraline C. An MAO inhibitor D. Clonazepam E. Haloperidol 100. A 37-year-old woman is admitted to an inpatient treatment program for withdrawal from heroin. Eighteen hours after her last injection of heroin, she becomes hypertensive, irritable, and restless. She also has nausea, vomiting, and diarrhea. Which medication would be best to treat some of the symptoms of opioid withdrawal? A. Chlordiazepoxide B. Haloperidol C. Paroxetine D. Phenobarbital E. Clonidine 101. A 30-year-old woman is diagnosed as bipolar. At the same time that this illness is diagnosed, it is discovered that she is pregnant .Which of the following drugs has the highest risk to the fetus if used? A. Valproic acid B. Lithium C. Chlorpromazine D. Haloperidol E. Fluoxetine 103. A 36-year-old woman is diagnosed with a paranoid delusional disorder after she repeatedly called police to her home, convinced the neighbors were about to harm her by electrocuting her in her sleep. She is started on olanzapine. Which of the following side effects is this patient at greater risk for while on this medication? A. Increased sweating B. Neuroleptic malignant syndrome C. Insomnia D. Glucose abnormalities E. Hyponatremia

104. A 35 year old woman is referred to a psychiatric outpatient clinic by a plastic surgeon. According to the referral letter, this person has consulted 3 cosmetic surgeons in the last 6 months about what she perceives to be a deformity in the upper lip, all of the physicians told her that there is no deformity and there is no need for any surgery but the woman firmly believes that there is a deformity, and this believe has hampered her socially and occupationally. What is the diagnosis? A. Hypochondriasis B. Somatization C. Body dismorphic disorder D. Delusional disorder ,somatic type 105. It is NOT prescribed for the express train of psychoanalytic psychotherapy: C. Cognitive deficiencies; D. Ability to verbalization of deficiencies 106. Which of the following is common in the childhood history of patients with borderline personality disorder? A. Shyness B. Psychosis C. Conduct disorder D. Sexual abuse E. Magical and odd beliefs 107. A 35-year-old man tells his therapist that he has difficulty describing his emotions accurately. He says that he can't find the words to describe how he is feeling. What is the phenomenon that is causing this inability? A. Neurasthenia B. Alexithymia C. Mental fatigue D. Dysphoria 108. A 30 year-old woman begins to see a therapist because of loneliness and feelings of being unloved and unwanted with some mild depressive symptoms .she flirts constantly with the therapist and is hurt when the therapist douse not reciprocate. Which of the following disorders is she most likely to have? A. Antisocial personality disorder B. Borderline personality disorder C. Schizotypal personality disorder D. Obsessive - compulsive personality disorder E. Histrionic personality disorder 110. A 57 year-old man whom ….have treated for 20 years for bipolar disorder is admitted to the general hospital with chest pain, the hospital physician ask whether the lithium he is receiving can affect his electrocardiogram (ECG),your inform her that lithium has which at the following ? A. Ventricular dysrhythmia B. ST-segment depression C. T-wave flattening D. Prolong the QT interval E. Appearance of U waves

1. What's right according to Anorexia Nervosa: A. Very often occurs in adolescents and tanagers ; B. System's complications may include: heart rate arrhythmia ;constipation and osteoporosis 2. What's right according to Tourette’s syndrome : A. Has been shown to possibly have a familial and genetic relationship with OCD; B. Social phobia C. Generalized anxiety disorder D. The behavioral techniques is most effective therapy for this disorder; E. None of the above 3. Which of the following statements is true of suicide in adolescence? A. Completed suicide decreases in incidence with increasing age. B. Completed suicide is more common in girls than in boys. C. Suicide attempts are always associated with a mood disorder. D. Suicide attempts often precipitated by arguments with family members, girlfriends, or boyfriends. E. The most common method used in completed suicide among adolescents in the United States is toxic ingestion. 4. A 23 year-old patient with schicophrcuin Who was recently started on neuroleptic complains that he cannot still and feels constantly restless the nursing staff has noted that he often paces. which of the following is this known as ? A. Parkinsonism E. Akathisia 5. If a patient receiving clozapine shows a white blood count (WBC) of 2,000 per cc, the clinician should: A. Increase the dosage of clozapine at once B. Terminate any a...ntibiotic therapy C. Stop the administration of clozapine at once D. Monitor the patient’s WBC every 10 days E. Institute weekly complete blood count (CBC) tests with differential 6.The most common cause of delirium within 3 days postoperatively in a 40-year-old man with a history of alcohol dependence is : A. Stress of surgery B. Postoperative pain C. Pain medication D. Infection E. Delirium tremens 7. Mouth ulceration is associated with which of the following types of withdrawal? A. Cocaine B. Opioids C. Nicotine D. Alcohol E. Benzodiazepines

8. All of the following statements regarding cyclothymic disorder are true except? A. Symptoms must be present for at least 2 years B. Occurs at the same rate in men and women C. Symptoms may satisfy criteria for major depression D. Consists of hypomania alternating with depressed mood E. Lifetime prevalence rate is about 0.4 to 1 percent 9. Dysthymic Disorder: A. Usually begins in adulthood B. Does not respond to anti-depressants C. Presents with symptoms of lack of say in life and preoccupation with inadequacy D. Is usually limited to one or two episodes E. Is characteristically marked by psychomotor agitation or psychomotor retardation 10. Hypothyroidism in the elderly may commonly present with all of the following except? A. Lassitude B. Fatigue C. Cognitive impairment D. Anorexia E. Constipation

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86) A 70-year-old man with a dementing disorder dies in a car accident. During the previous 5 years, his personality had dramatically changed and he had caused much embarrassment to his family because of 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. Which of the following is the most likely diagnosis? a. Alzheimer disease b. Pick disease c. Creutzfeldt-Jakob disease d. B12 deficiency dementia e. HIV dementia 87) 24-year-old previously healthy man is brought to the emergency room after he began yelling that people on the bus were out to hurt him. In the emergency room, he is agitated, hypervigilant, and anxious. He is unable to give much history other than to say that he is a graduate student and nothing like this has ever happened before. Which of the following is the most likely cause of this behavior? a. Delirium b. Pick disease c. Dissociative disorder d. Vitamin B12 deficiency e. Cocaine intoxication 88) emaciated and lethargic 16-year-old girl arrives at the emergency room. Her blood pressure is 75/50, her heart rate is 52 beats per minute, her potassium is 2.8 meq/L, and her bicarbonate is 40 meq/L. The girl’s parents report that she has lost 35 lb in 3 months but is still convinced that she is overweight. She eats only very small amounts of low-calorie food, and she runs 2 to 3 hours every day. What other activities is this patient most likely to have engaged in? a. Sexual promiscuity b. Ethanol abuse c. Purging d. Wearing tight clothes e. Shoplifting 89) A 23-year-old man comes to the physician with the complaint that his memory has worsened over the past 2 months and that he has difficulty concentrating. He has lost interest in his friends and his work. He has difficulty with abstract thoughts and problem solving. He has also felt depressed. MRI scan shows parenchymal abnormalities. Which of the following is the most likely diagnosis? a. Alzheimer disease b. Vascular dementia c. HIV-related dementia d. Lewy body disease e. Binswanger disease 90) which of the following is the most common cause of delirium in elderly? a) substance abuse b) accidental poisining c) hypoxia d) use of multiple medication

91. a58 year old woman with chronic mental disorder ,comes to the physician with irregular choreoathetoid movements of her hands and trunk .she states that the movments get worse under stressful conditions. which of the following medications is most likely to have caused this disorder: a-fluoxetine b-perphenazine c-diazepam d-phenobarbitol e-clozapine 92. 62 year old man with chronic schizophrenia is brought to the ER after he is found wandering around his halfway house confused and disoriented. His serum Na is 123 meq/l and urine Na is 5 meq/l the patient has been treated with risperidone 4mg/day for the past 3 years with good symptoms control .his roommate reports that the patient often complain of feeling thirsty .which of the following is most likely cause of this symptoms: a-renal failure b-inappropriate ( ADH ) secretion c-addison disease d-phsychogenic polydipsia e-nephrotic syndrome 93. 75 years old man is being cared for in hospic setting. He has widely spread prostatic carcinoma and is considered terminal. Which of the following psychiatric symptoms are seen in 90% of all terminal patients: a-delusions b-hallucinations c-flight of ideas d-anxiety e-depression 94. a 25 year old man comes to the psychiatrist with chef complaint of depressed mood for I month . his mother ,to whom he was very close died 1 month ago and since that time he has felt sad and been very tearful . he has difficulty concentrating, has lost 1.5 kg and is not sleeping soundly through the night. which of the following is the most likely diagnosis: a-major depression b-disthymia c-post traumatic stress disorder d-adjustment disorder e-uncomplicated bereavement 95.how long after stroke is a patient at higher risk of developing a depressive disorder: a-2 weeks b-2months c-6months d-1year e-2years

96. a 27 years 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 three years though the episodes have never been so severe that she couldn’t work. which of the following is the diagnosis: a- border line personality disorder b-seasonal affecting disorder c-cyclothymic disorder d-major depression, recurrent e-bipolar disease, depressed 97. which of the following is a relative contraindication for ECT: a-space occupying lesion in the brain b-pregnancy c-hypertension d-seizure disorder e-post myocardial infarction 6 months earlier 98. 32 year old man is being treated for major depression. Which of the following symptoms. If present is one of the most accurate indicators of long term suicidal risk: a-revenge fantasies b-presence of rage in the patient c-hopelessness d-presence of guilt e-the patient has need for punishment 99. 28 years old taxi driver is chronically consumed by fears of having accidentally run over a pedestrian . although he tries to convince himself that his worries are silly, his anxiety continues to mount until he drives back to the scene of the accident and proves to himself that nobody lies hurt in the street . this behavior exemplifies which of the following: a-a compulsion secondary to obsession b-an obsession triggered by a compulsion c-a delusional ideation d-a typical manifestations of obsessive compulsive personality disorder e-a phobia 100. 33 years old man comes to his physician for an HIV test , the test is positive. The patient has no signs or symptoms of AIDS. which of the following psychiatric diagnosis may develop in as many as 25% of patient informed of positive HIV test: a-adjustment disorder with anxiety b-PTSD c-bipolar disorder, manic d-panic disorder e-hypochondriasis

101. every 4 to 5 weeks a usually well functioning few day irritation: d. pre menstrual 102. A young woman presents to the emergency room vomiting bright red blood. Once she is medically stable, the intern who performs her physical examination notices that the enamel of her front teeth is badly eroded and her parotid glands are swollen. Which of the following best describes the source of these medical complications? a. Inadequate caloric intake b. Purging c. Laxative abuse d. Diuretic abuse e. Ipecac toxicity 103. A 52-year-old woman is diagnosed with breast cancer that is metastatic to her bones. She comes to the psychiatrist for help in managing her depressed mood and anxiety secondary to this diagnosis. Which of the following would most likely indicate an increased vulnerability to suicide if found in this patient, in addition to her anxiety and depressed mood? a. The extent of the cancer’s spread to her bones b. The location of the bone metastases to her bones c. A feeling of a loss of control d. How much pain she has with the metastases (even though it is currently wellcontrolled) e. A history of social phobia 104. A 36-year-old woman comes to the emergency room after she is found unresponsive at a party. Urine toxicology is positive for cocaine. Upon awakening, the patient is interviewed and is found to have a history consistent with cocaine abuse. Which of the following is this patient at an increased risk for having? a. Death by suicide b. Avoidant personality disorder c. ADHD d. Bipolar disorder--mania e. Mild mental retardation 105. A 16-year-old male with a long record of arrests for breaking and entering, assault and battery, and drug possession is found dead in his room with a plastic bag on his head. For several months he had been experiencing headaches, tremors, muscle weakness, unsteady gait, and tingling sensations in his hands and feet. These symptoms (and the manner in which the boy died) suggest that he was addicted to which of the following substances? a. PCP b. Cocaine c. Methamphetamine d. An inhalant e. Heroin

107. A 28-year-old business executive sees her physician because she is having difficulty in her new position, as it requires her to do frequent public speaking. She states that she is terrified she will do or say something that will cause her extreme embarrassment. The patient says that when she must speak in public, she becomes extremely anxious and her heart beats uncontrollably. Based on this clinical picture. which of the following is the most likely diagnosis? a. Panic disorder b. Avoidant personality disorder c. Specific phobia d. Agoraphobia e. Social phobia 108. Benzodiazepines, barbiturates, and many anticonvulsants exert their influence through which of the following types of receptors? a. Muscarinic b. Dopaminergic c. Glutamic d. Adrenergic e. Aminobutyric acid (GABA)-allergic 109. After being struck on the head by a four-by-four piece of wood, a previously serious and dependable construction worker starts making inappropriate sexual remarks to his coworkers, is easily distracted, and loses his temper over minor provocations. What part of his brain has most likely been damaged? a. Occipital lobe b. Temporal lobe c. Limbic system d. Basal ganglion e. Frontal lobe 110. A 17-year-old boy is brought to the emergency room by his friends after he “took a few pills” at a party and developed physical symptoms, including his neck twisting to one side, his eyes rolling upward, and his tongue hanging out of his mouth. The patient responds immediately to 50 mg of diphenhydramine intramuscularly with the resolution of all physical symptoms. Which of the following substances is most likely to have caused the symptoms? a. Methamphetamine b. Meperidine c. Alprazolam d. Methylphenidate e. Haloperidol 1. A 43-year-old man is admitted to the neurology service after he went blind suddenly on the morning of admission. The patient does not seem overly concerned with his sudden lack of vision. The only time he gets upset during the interview is when he is discussing his mother’s recent death in Israel--he was supposed to bring his mother to the United States, but did not because he had been using drugs and did not save the necessary money. Physical examination is completely negative. Which of the following is the most likely diagnosis? a. Conversion disorder b. Hypochondriasis c. Factitious disorder d. Malingering e. Delusional disorder

2. A 69-year-old man with a diagnosis of delirium has symptoms of psychosis which include: frightening auditory and visual hallucinations and paranoid delusions. Which of the following medications should be chosen first for this man’s symptoms? a. Haloperidol b. Quetiapine c. Valium d. Olanzepine e. Ziprasidone 3. A 34-year-old man recurrently perceives the smell of rotten eggs. This kind of hallucination is most commonly seen in patients with which of the following diagnoses? a. Parietal tumors b. Narcolepsy c. Grand mal epilepsy d. Partial complex seizures e. Wilson disease 4. A 25-year-old woman is diagnosed with schizophrenia when, after the sudden death of her mother, she begins complaining about hearing the voice of the devil and is suddenly afraid that other people are out to hurt her. Her history indicates that she has also experienced a 3-year period of slowly worsening social withdrawal, apathy, and bizarre behavior. Her family history includes major depression in her father. Which of the following details of her history leads the physician to suspect that her outcome may be poor? a. She is female. b. She was age 25 at diagnosis. c. She had an acute precipitating factor before she began hearing voices. d. She had an insidious onset of her illness. e. There is a history of affective disorder in her family 5.The first symptoms of ADHD to remit is usually: a. hyperactivity b.Distractivity c. carless mistakes in schoolwork d. Impulsivity e. learning difficulties 6. A 45-year-old man is diagnosed as having diabetes and will require insulin. His physician explains the use of the medication and tells the patient that he will need to be seen at frequent intervals until his glucose levels come under good control. The patient has always been somewhat hostile with the physician, but upon hearing this news, he says angrily, “You doctors are always the same! You always want control--of my time, of my money, and now of my every action!” As far as the physician knows, this patient has never had an unpleasant encounter with a physician before. Which of the following is the most likely explanation for the patient’s reaction to his doctor? a. The patient is becoming delusional. b. The patient is experiencing transference to this authority figure. c. The patient is splitting. d. The patient is becoming manic. e. The patient is anticipating being rejected by his physician

7. A 24-year-old woman comes to the psychiatrist with a 2-month history of short episodes of “feeling like I am going to die.” During these episodes, she also notes feelings of dizziness and nausea, along with a feeling of choking. She describes these episodes as very frightening and she is terrified of having another. She denies substance use of any medical problems. Which of the following treatment regimens should be started? a. Imipramine b. Fluoxetine c. Phenelzine d. Paroxetine and alprazolam e. Buspirone and citalopram 8.Which of the following is not an appropriate pharmacologic treatment for tic disorder? a. methylphenitate b. guanfacine c. risperidone d. clonidine e. haloperidol 9. A demanding 25-year-old woman begins psychotherapy stating that she is both desperate and bored. She reports that for the past 5 or 6 years she has experienced periodic anxiety and depression and has made several suicidal gestures. She also reports a variety of impulsive and self-defeating behaviors and sexual promiscuity. She wonders if she might be a lesbian, though most of her sexual experiences have been with men. She has abruptly terminated two previous attempts at psychotherapy. In both cases she was enraged at the therapist because he was unwilling to prescribe anxiolytic medications. Which of the following is the most likely diagnosis? a. Dysthymia b. Histrionic personality disorder c. Antisocial personality disorder d. Borderline personality disorder e. Impulse control disorder not otherwise specified 10. A 30-year-old woman is diagnosed as bipolar. At the same time that this illness is diagnosed, it is discovered that she is pregnant. Which of the following drugs has the highest risk to the fetus if used? a. Valproic acid b. Lithium c. Chlorpromazine d. Haloperidol e. Fluoxetine