Name____________________________ ID__________________

Choose the best answer

Time-60 minutes

1. A 19-year-old Japanese male presents with a new onset psychosis characterized by auditory
hallucinations, paranoid and referential delusions, and a formal thought disorder. Medical work-up is
negative. Which one of the following would be the most appropriate initial antipsychotic regimen?

A. Risperidone 2mg po qhs

B. Haloperidol 5mg po qhs

C. Quetiapine 200mg po bid

D. Olanzapine 5mg po qhs

2. Which one of the following would suggest that a thought represents a delusion rather than an
obsession?

A. The person attempts to ignore or suppress the thought

B. The thought is imposed from outside the person

C. The thought is recognized as unreasonable

D. The thought is ego dystonic in nature

3. Severe mental disorders such as schizophrenia can impair a person’s ability to enjoy and sustain
interpersonal relationships. Which of the following methods is the best choice for managing this issue?

A. Milieu therapy

B. Vocational training

C. Social skills training

D. Psychosocial clubhouses

4. Regarding Schizophrenia, which is TRUE:

A. Correlates with urban density in small cities

B. Incidence is increased in industrialized cities

C. Higher prevalence in low SES

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D. None of the above

5. Which is NOT a Schneiderian first-rank symptom?

A. Forced feelings

B. Thought blocking

C. Two that clearly were Schneiderian

D. Audible thoughts

E. Voices arguing

6. The most useful feature in distinguishing depression from negative symptoms in Schizophrenia:

A. Hopelessness

B. Poor energy

C. Poor concentration

D. Apathy

E. Blunting of affect

F. Social withdrawal

7. NMS criteria include all except:

A. Fever (hyperthermia)

B. Autonomic changes (autonomic instability)

C. Change in level of consciousness

D. Increased serum creatinine

8. Psychosocial interventions that prevent relapse in Schizophrenia:

A. Social skills training

B. CBT

C. Family therapy

D. A and C

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9. A man with schizophrenia for the past 8 years is at highest risk of suicide in the upcoming few weeks if
he experiences which of the following?

A. Suicidal ideation

B. Feelings of hopelessness and depression

C. Family history of suicide

D. Good insight

10. Which physiological factor explains postpartum psychosis in previously healthy person?

A. Sudden increase in anti-thyroid antibodies

B. Sudden decline in progesterone and estrogen

C. Sudden drop in cortisol

D. Blood loss or anemia during pregnancy

11. A man believes that others can read his thoughts, this is an example of?

A. Thought broadcast

B. Thought withdrawal

C. Ideas (delusion) of reference

D. None of the above

12. Which one is a correct definition of kinesthetic hallucination?

A. Feeling a light touch on the skin

B. Abnormal sensations in the viscera

C. Arm being moved by external force (leg being bent)

D. Sense of smell experienced with colors

13. Which is true regarding late onset schizophrenia?

A. Higher prevalence of persecutory delusions

B. Less likely to respond to antipsychotics

C. Onset after age 45

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D. B and C

14. All of the following are risk factors for delusional disorder, EXCEPT:

A. Immigration

B. Sensory impairment

C. Increasing age

D. Depression

15. Familial transmission of schizophrenia. Which is true of child’s risk if both parents are affected?

A. 40% risk

B. 50% risk

C. 12% risk

D. 1% risk

16. A positive prognosis for schizophrenia is associated with all of the following EXCEPT:

A. Older onset

B. Being female

C. Affective symptoms

D. Being single

17. In schizophrenia, the most useful predictor of drug response is:

A. Hallucinations

B. Detailed history of prior drug response

C. Previous non-compliance

D. Negative symptoms

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18. All of the following are negative symptoms of schizophrenia EXCEPT:

A. Inability to persist at work

B. Restricted facial expression

C. Apathy

D. Alogia

E. None

19. Which of the following is most characteristic of “flight of ideas”?

A. Loosened associations

B. Increased thought production

C. Being unable to distract the patient

D. Incoherent thought processes

20. Which one of the following symptoms would be most suggestive of a co-morbid depressive disorder
rather than negative symptoms in a patient diagnosed with schizophrenia?

A. Poor self-care

B. Anhedonia

C. Increased response latency

D. Tearfulness

21. Which one of the following symptoms helps to differentiate a Major Depressive Episode from normal
bereavement?

A. Hearing the voice of the deceased person

B. Terminal insomnia

C. Somatic preoccupation

D. Marked psychomotor retardation

22. Most common cause of death in a depressed patient / mood disorder:

A. Suicide

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B. Homicide

C. Cardiovascular disease

D. Cancer

23. Uncomplicated bereavement is NOT characterized by:

A. Transient guilt

B. A full depressive syndrome

C. Thoughts that they should have died with the loved one

D. Feelings of worthlessness

E. Sensations of seeing or hearing the deceased

24. Which drug is the treatment of choice for rapid cycling bipolar disorder?

A. Lithium

B. Valproate

C. Carbamazepine

D. None of the above

25. In adult clinical settings, what is the most frequent subtype of specific phobia?

A. Animal

B. Blood-injection-injury

C. Situational

D. Natural environment

26. Which of the following is a panicogen?

A. Sodium lactate

B. Carbon monoxide

C. D-cycloserine

D. None of the above

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27. Avoidance in agoraphobia is maintained by?

A. Classical conditioning

B. Positive reinforcement

C. Negative reinforcement

D. Punishing

28. OCD most commonly comorbid with:

A. Depression

B. Anxiety

C. OCPD

D. SUD (Alcohol abuse)

E. ADHD

29. A woman who experiences panic attack symptoms usually only when in board meetings with
authority figures has what likely diagnosis?

A. Social phobia

B. Generalized anxiety disorder

C. Panic disorder

D. None of the above

30. A woman from Somalia has symptoms of PTSD. What would be your first line therapy choice?

A. Olanzapine

B. Fluoxetine

C. Risperidone

D. Amitriptyline

31. Case of trichotillomania. Most appropriate behavioral management?

A. Relaxation training

B. Exposure Response Prevention

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C. Substitute behavior with something incompatible with pulling

D. Systematic desensitization

32. A young man was involved in an MVA three weeks ago in which his girlfriend died. He is irritable,
having nightmares and refuses to discuss the incident. The most likely diagnosis is:

A. Post-traumatic stress disorder

B. Acute stress disorder

C. Adjustment disorder with anxiety

D. Generalized anxiety disorder

33. Agoraphobia without panic disorder can be described as:

A. A fear of enclosed spaces

B. A fear of speaking in public

C. Worrying excessively about physical health

D. Avoidance of authority figures

34. The most common obsessions include all of the following EXCEPT:

A. Repeated thoughts about contamination

B. Aggressive themes

C. Sexual imagery

D. Praying

E. Forbidden thoughts

35. Gender identity is formed by:

A. 12-18 months

B. 3 years

C. 6-7 years

D. 12-13 years

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36. Pedophilia:

A. 50% are homosexual

B. 50% were sexually abused as children

C. 50% who seek treatment have only have 1 or 2 offenses

D. 50% abuse alcohol at time of offence

37. Which of the following is most in keeping with a diagnosis of gender identity disorder?

A. A five year old girl who plays with Lego

B. A five year old boy who asks God to make him into a girl

C. A 12 year old boy who cross dresses and masturbates

D. A 12 year old girl who has short hair and likes tough play

38. Although some individuals with Anorexia Nervosa exhibit no laboratory abnormalities, the
semistarvation characteristic of this disease can affect most major organ systems and produce a variety
of disturbances. Which of the following laboratory value is associated with Anorexia Nervosa

A. Hyperphosphatemia

B. Hypercholesterolemia

C. Elevated tri-iodothyronine

D. Elevated serum estrogen

39. In the pharmacologic treatment of Bulimia Nervosa, which one of the following is a currently
recommended initial treatment?

A. Fluoxetine 60mg daily

B. Lithium carbonate 600mg bid

C. Paroxetine 60mg daily

D. Venlafaxine 150mg daily

40. What’s most associated with factitious disorder?

A. Over protective mother

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B. Death of a parent at an early age

C. Career as health professional

D. Above average IQ

41. Pseudo seizures are an example of:

A. Conversion disorder

B. Hypochondriasis

C. Somatization disorder

D. La belle indifference

42. Regarding body dysmorphic disorder, which of the following is true?

A. The focus is most often on the abdomen

B. The focus is most often on the face

C. The focus is most often on the penis

D. The focus is most often on the legs

43. A 22 year-old recently emigrated Somalian man presents with acute onset of singing and hitting his
head against the wall. Which culture bound syndrome is most appropriate:

A. Zar

B. Sange Dormido

C. Koro

D. Latah

44. Which of the following is universally true across all cultures?

A. Men and women are equally aggressive

B. Fear of strangers in the second half of the second year of life

C. Taboos against incest

D. Gender roles differ only with respect to reproduction

E. Elders always have a leadership role

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45. Which of the following abilities are required for sound decision-making capacity?

A. The ability to state the meaning of information

B. The ability to document information

C. The ability to give information to a power of attorney

D. The ability to highlight important information

46. Competency involves all except?

A. Ability to manipulate information in a rational fashion

B. Ability to communicate in a consistent fashion

C. Ability to make a decision

D. Agreement with medical advice

47. Making decisions within the realm of one’s own rights fits with what ethical principle?

A. Beneficence

B. Non-maleficence

C. Autonomy

D. Justice

48. The best way to handle media enquiries is:

A. All reports should be directed through one hospital spokesperson

B. All physicians should answer all questions

C. Physicians should refuse to speak to the media

D. All of the above

49. Changes in the elderly:

A. Decreased absorption of oral meds

B. Increased albumin

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C. Decreased hepatic oxidation

D. Decreased hepatic acetylation

50. Elderly and suicide except:

A. Elderly have highest rate

B. Use more lethal/violent means

C. Do not communicate their intent

D. loneliness is a principal reason for 1/3 of suicide

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