Download 1 DIRECTIONS (Items 1-34): Each of the numbered items or

DIRECTIONS (Items 1-34): Each of the numbered items or incomplete statements in this section is followed by answers
or completions of the statement. Select the ONE lettered answer or completion that is BEST in each case and fill in the
circle containing the corresponding letter on the answer sheet.
1.
Electroconvulsive treatment is most specifically
therapeutic for
A.
B.
C.
D.
E.
2.
B.
C.
D.
E.
relaxant may potentiate the convulsive
effect
patient may constitutionally lack
succinylcholinesterase and so stay apneic
succinylcholine may precipitate a toxic
psychosis
muscle relaxant may cause acute hemolysis
patient is resistant to the succinylcholine
The following is a "absolute" contraindication to
ECT
A.
B.
C.
D.
E.
4.
conversion disorder
smile dementia
major depression
schizophrenia, residual type
obsessive-compulsive
In using the muscle relaxant succinykholine
during electroconvulsive therapy, the physician
must be alert to the rare complication in which
the
A.
3.
5.
A brain tumor
recent myocardial infarction
pregnancy
recent intracerebral hemorrhage
there are no absolute contraindication to
ECT
The most likely diagnosis is
A.
B.
C.
D.
E.
Medications used right before given ETC should
be administered in the following order.
A.
B.
C.
D.
E.
A 38-year old married woman had complained of
nervousness since childhood. She also said she was
sickly since her youth, with a succession of physical
problems doctors often indicated were caused by her
nerves or depression. She, however, believed that she
had a physical problem that had not yet been
discovered by the doctors. Besides nervousness, she
had chest pain and had been told by a variety of
medical consultants that she had a nervous heart. She
also consulted doctors for abdominal pain and had
been told she had a spastic colon. She had seen
chiropractors and osteopaths for backaches, for pains
in her extremities, and for anesthesia of her fingertips.
Three months previously, she was vomiting and had
chest pain and abdominal pain, and she was admitted
to a hospital for a hysterectomy. Since the
hysterectomy, she had had repeated anxiety attacks,
fainting spells that she claimed were associated with
unconsciousness that lasted more than 30 minutes,
vomiting, food intolerance, weakness, and fatigue. She
had been hospitalized several times for medical
workups for vomiting, colitis, vomiting of blood, and
chest pain. She had had a surgical procedure for an
abscess of the throat. She said she felt depressed, but
thought that it was all because her "hormones were not
straightened out." She was still looking for a medical
explanation for her physical and psychological
problems.
an ticholinergic, anesthetic, muscle relaxant
anesthetic, muscle relaxant, anticholinergic
muscle relaxant, anesthetic, anticholinergic
anticholinergic, muscle relaxant, anesthetic
muscle relaxant, anticholinergic, anesthetic
6.
In body dysmorphic disorder
A.
B.
C.
D.
E.
1
somatization disorder
conversion disorder
hypochondriasis
dysthymic disorder
pain disorder
plastic surgery is usually beneficial
a comorbid diagnosis is unusual
anorexia nervosa may also be diagnosed
50% of patients may attempt suicide
serotonin-specific drugs are effective in reducing
the symptoms
7.
A patient with somatbatization disorder
A.
B.
C.
D.
E.
12.
presents the initial physical complaints after
age 30
has had physical symptoms for three
months
has complained of pain, gastrointestinal,
sexual, and pseudoneurological symptoms,
which are not explained by a know medical
condition
usually experiences minimal impairment in
social or occupational functioning
may have a false belief of being pregnant
and objective signs of pregnancy, such as
decreased menstrual flow or amenorrhea
Patients with factitious disorder with
predominantly physical signs and symptoms
A.
B.
C.
D.
E.
13. Factitious disorder with predominantly physical
signs and symptoms is
A.
8.
All the following are classified as somatoform
disorders except
A.
B.
C.
D.
E.
9.
B.
C.
conversion disorder
hypochondriasis
somatization disorder
Munchausen syndrome
body dysmorphic disorder
D.
E.
Medical disorders to be considered in a
differential diagnosis of somatization disorder
include
A.
B.
C.
D.
E.
A
B.
C.
D.
E.
multiple sclerosis
systemic lupus erythematosus
acute intermittent porphyria
hyperparathyroidism
all the above
Exhibitionism
Fetichism
Sexual Aversion Disorder
Sexual Sadism
None of the above
15. Rubbing up against a fully clothed woman to
achieve orgasm, is considered
A.
B.
C.
D.
E.
somatization disorder
hypochondriasis
antisocial personality disorder
malingering
all the above
11. Factitious disorder
A.
B.
C.
D.
E.
under voluntary control, but the patient
often denies the voluntary production of the
illness
also known as Munchausen syndrome
frequency seen in patients with a family
history of serious illness or disability
frequently seen in persons employed in
health care jobs
characterized by all the above
14. Observing people who are naked or engaging in
sexual activity is called;
10. The differential diagnosis of a factitious disorder
includes
A.
B.
C.
D.
E.
do not usually gain admission to a hospital
may take anticoagulants to simulate
bleeding disorders
are usually easy to manage in the hospital
do not display symptoms of pseudologia
phantastica
usually receive the co-diagnosis of
schizotypal personality disorder
usually begin in childhood
are best treated with psychoactive drug;
usually have a good prognosis
are synonymous with Ganser's syndrome
may occur by proxy
2
an orgasm disorder
a paraphilia
a gender identity disorder
a male erectile disorder
none of the above
renewed his complaints about “suicidal thoughts"
and “hearing voices.” It was the opinion of the
ward staff members that the patient was not truly
psychotic but merely feigned his symptoms
whenever the subject of the disposition of his case
came up. They thought that he wanted to remain
in the hospital primarily so that he could bully the
other patients and be a big man' on the ward.
16. Sexual Aversion Disorder
A.
B.
C.
D.
E.
Is characterized by absence of sexual
fantasies and of desire of sexual activity.
Is a farm of paraphilias
Is all the time associated with
homosexuality
Is all the time detected in females
Is characterized by an aversion to and
avoidance of genital sexual contact with a
sexual partner
The diagnosis of this case should be
A.
17. A muscular 24-year-old man presented himself to
the admitting office of a state hospital. He told
the admitting physician that he had taken thirty
200 mg tablets of chlorpromazine (Thorazine) in
the bus on the way over to the hospital. After
receiving medical treatment for the "suicide
attempt," he was transferred to the inpatient ward.
B.
C.
D.
E.
Factitious Disorder with Predominantly
psychological signs and symptoms
Munchausen Syndrome
Schizophrenia Paranoid Type
Somatization Disorder
Somatoform Disorder NOS
18. Male erectile disorder is also called
On mental status examination the patient told a
fantastic story about his father, a famous surgeon,
who had a woman he was operating on die in
surgery and who was then killed by the husband
of the woman. The patient then stalked his
father's murderer several thousand miles across
the United States and, when he found him, was
prevented from killing him, at the last moment, by
the timely arrival of the man's 94-year-old
grandmother. He also related several other
intriguing stories involving his $64,000 sports car,
which had a 12-cylinder diesel engine, and about
his children, two sets of identical triplets. AIR
those stories had a grandiose tinge, and none of
them could be confirmed. The patient claimed
that he was hearing voices, as on television or in a
dream. He answered affirmatively, to questions
about thought control, thought broadcasting, and
other Schneiderian first-rank symptoms; he also
claimed depression. He was oriented and alert
and had a good range of information except that
he kept insisting that it was the Germans (not the
Russians) who had invaded Afghanistan. There
was not evidence of any associated features of
mania or depression, and the patient did not seem
elated, depressed, or irritable when he related the
stories.
A.
B.
C.
D.
E.
Impotence
Male orgasmic disorder
Frotteurism
Partialism
none of the above
19. Vaginismus is characterized by
A.
B.
C.
D.
E.
Involuntary muscle constriction of the outer
third of the vagina
Fantasies involving harm to others
Persistent genital pain occurring before,
during, or after intercourse
Sexual masochism
All of the above
20. All of the following is characteristic of the
orgasmic phase EXCEPT
A.
B.
C.
D.
E.
On the ward the patient bullied the other patients
and took food and cigarettes from them. He was
reluctant to be discharged, and, whenever the
subject of his discharge was brought up, he
3
The male orgasm is associated with four or
five rhythmic spasms of the prostate,
seminal vesicles, vas and urethra
Involuntary contraction of the internal and
external sphincters
Hypotension
Facial grimacing
Carpopedal spasm
21. The following is correct about the resolution
phase in the female and male sexual response
cycle EXCEPT
A.
B.
C.
D.
E.
26. A married man with a chief complaint of
premature ejaculation is best treated with
A.
B.
C.
D.
E.
After orgasm males do not have refractory
periods
Refractory period usually does not exist in
females
Resolution consist of the disgorgement of
blood from the genitalia
If orgasm occurs, resolution is rapid
resolution through orgasm is characterized
by a subjective feeling of well-being
27. Premature ejaculation is associated with
A.
B.
C.
22. The following conditions have classified among
the gender identity disorders EXCEPT
A.
B.
C.
D.
E.
D.
E.
Turner's Syndrome
Klinefelter's Syndrome
Congenital virilizing adrenal hyperplasia
Androgen insensitive Syndrome
Klismaphilia
A.
B.
C.
D.
E.
Partialism
Coprophilia
Urophilia
Hypoxyphilia
Nymphomania
C.
D.
Gender identity disorder in children
Gender identity disorder is adolescents and
adults
Transsexualism
Gender identity disorder NOS
She left the hospital against medical advice, but
was shortly admitted to another hospital with
opisthotonos and a history of having been bitten
by a sick squirrel.
25. Orgasm is characterized by all the following
EXCEPT
A.
B.
C.
D.
E.
usually try to maintain the gender role
assigned by biological sex
are usually adults
usually assert that they will grow up to be
members of the opposite sex
usually desire sex-change operations
usually achieve sexual excitement when
cross-dressing
29. A young nursing student was admitted to the
hospital for severe headache, nausea, vomiting,
stiff neck, and sudden development of a dilated,
light fired, right pupil. Eyelid ptosis and
extraocular muscle weakness were not present. It
was later discovered she had put an
anticholinergic drug in her eye and that she had a
history of multiple hospitalizations for obscure
disorders. At one time, she had caused skin
abscesses and bacteremia by injecting urine
subcutaneously.
24. In regard to gender identify disorder the DSM IV
include the following diagnostical categories
EXCEPT
A.
B.
stress
negative cultural conditioning
more frequency among college-educated
men
some general medical factors
all the above
28. Persons with gender identity disorder
23. Which of the following conditions IS NOT A
PARAPHILIA
A.
B.
C.
D.
E.
antianxiety agents
psychoanalysis
squeeze techniques
cognitive therapy
none of the above
involuntary contractions of the anal
sphincter
carpopedal spasm
absence of contractions of the uterus
blood pressure rise
slight clouding of consciousness
The MOST likely diagnosis is
A.
B.
C.
D.
E.
4
Somatization disorder NOS
Conversion disorder
Briquet syndrome
Hypochondriasis
Factitious disorder with physical symptoms
30. A 46-year-old woman was referred by her
husband's psychiatric for consultation. In the
course of discussing certain marital conflicts that
the husband was having with his wife, he had
described attacks of dizziness that his wife
experienced and that left her incapacitated, In
consultation the wife described being overcome
with feelings of extreme dizziness, accompanied by
slight nausea, four or five nights a week. During
the attacks the room around her would take on a
“shimmering” appearance, and she would have
the feeling that she was floating and unable to
keep her balance. Inexplicably, the attacks almost
always occurred at about 4:00 pm. She usually
had to lie down on a couch and often did not feel
better until 7:00 or 8:00 pm. After recovering, she
generally spent the rest of the evening watching
television, more often than not, she fell asleep in
the living room, not going to bed in the bedroom
until 2:00 or 3:00 am.
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The patient had been pronounced physically fit
her internist, a neurologist, and an ear, nose, and
throat specialist on more than one occasion.
Hypoglycemia had been ruled out by glucose
tolerance tests.
When asked about her marriage, the pmt
described her husband as a tyrant, frequently
demanding and verbally abusive of her and their
four children. She admitted that she dreaded his
arrival home from work each day, knowing that he
would comment that the house was a mess and
the dinner, if prepared, not to his liking. Since
the onset of her attacks, when she was unable to
make dinner, he and the four children would go
to McDonald's or the local pizza parlor. After
that he would settle in to watch a ball game on
television in the bedroom, and their conversation
was minimal. In spite of their troubles, the
patient claimed that she loved and needed her
husband very much.
The most probable diagnosis in this case should
be
A.
B.
C.
D.
E.
Conversion disorder
Munchausen's syndrome
Ganser's syndrome
Briquets syndrome
Hypochondriasis
5
31. The patient was a happily married 23-year-old
investment counselor who had reluctantly agreed
to see a psychiatrist, an old friend of her
husband's. She told the psychiatrist that she did
not think she needed to see a psychiatrist, because
her problem was "these ugly lines on my
forehead." The psychiatrist asked, "What lines?"
The patient pointed to the frown lines above her
nose, which to the psychiatrist seemed no more
pronounced than they are on the foreheads of
most people her age.
The psychiatrist asked about other problems in the
patient's life and learned that her concern with her
appearance was not affecting her ability to work but
that she had started to avoid social situations because
she did not want people looking at her blemish. The
patient acknowledged being upset and unhappy about
her problem but denied having a persistently depressed
mood or any associated symptoms of depression.
The most likely diagnosis in this case is
A.
B.
C.
D.
E.
The patient continued: "It's horrible, isn't it? I
mean, I don't have to be the most gorgeous girl
on earth, but I also don't want to be disfigured."
Somatization disorder
Body dysmorphic disorder
Pain disorder
Undifferentiated somatoform disorder
Somatoform disorder NOS
The psychiatrist asked, “What makes you think it
looks so awful? Everyone has those lines.”
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“C’mon. I appreciate your trying to make me feel
better, but I can see what I look like.”
“What do you look like?”
It's horrible. Everybody notices. They make me
look so old I'm we my husband is turned off. I
don't know what I would ever do if he left me. I
have started to wear all this heavy makeup to hide
them, but try to hide something like this."
Let me ask you this. Most of us are sensitive
about our appearance, and sometimes we
exaggerate some minor imperfection. Do you
think you may be doing that?"
The patient sighed. “My husband has been saying
the same thing. I think about that, and sometimes
I can convince myself that I am too concerned
about something that is really very minor. But
then I go to the mirror, and there it is. Can't you
help me convince my husband and I should see if
a plastic surgeon can do something about it?”
“Before we get into that, how long have you been
bothered by the lines?”
“I’m not sure, but I didn't pay any attention to it
until a few months ago. A friend at work
mentioned that she had seen a doctor for a bad
sunburn and told me I had better be mirror and
kept noticing the lines.”
6
32. A 39-year. woman was referred for
psychiatric evaluation after a brief hospitalization
for complaints of intermittent numbness in her
arms and the right side of her face. Extensive
neurological and neurosurgical evaluation revealed
stenosis of the outlets of several cervical
vertebrae; intermittently compromised nerve roots
were thought to account for the physical
symptoms. The patient, an artist who composed
large structures from various work materials, was
advised by her physicians to stop for the next
several months all lifting, reaching, raising her
arms, and other strenuous activities requisite to
her work. She had felt despondent for more than
two months, with episodes of tearfulness, anxiety,
and increased irritability. She continued to
supervise her assistants but was increasingly
uninterested in work She had no sleep or
appetite change, but her libido was diminished.
She was still able to enjoy music. The patient had
no prior personal or familial history of a mood
disorder.
33. According to DSM-IV if an individual was
expected to weigh 120 lbs. but currently weighs
100 lbs., refuses to eat, fears gaining weight, and
binges and purges daily, she would diagnostic
criteria for?
A.
B.
C.
D.
B.
34.
teacher
health care worker
police officer
banker
waitress
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The clinical diagnosis in this case should be
A.
B.
C.
D.
E.
A leading predisposing factor in the development
of factitious disorder with predominantly physical
signs and symptoms is employment as a
A.
B.
C.
D.
E.
The identified stressors in her case were the
physical illness and the directive to minimize for
an indefinite interval the use of her arms. The
net result was to preclude the patient's ability to
continue her artistic endeavors, which were crucial
to her sense of self. In response, she experienced
the emergence of a depressive constellation with
less than a fall vegetative set of symptoms. The
clinician diagnosed adjustment disorder with
depressed mood. Intervention was directed to (1)
clarification with the neurosurgeon of the likely
course and necessary treatment of the outlet
problem and (2) several sessions with the patient
to explore her responses to and perceptions of the
changes in her life imposed by the neurological
problem.
bulimia nervosa
anorexia nervosa
eating disorder NOS
Axis III coding
all the above
Adjustment disorder with depressed mood
Pain disorder
Conversion disorder
Somatization disorder
Malingering
7
DIRECTIONS (Items 35.58): The questions below
consist of lettered headings followed by a list of numbered
words or phrases. For each numbered word or phrase,
select the one lettered heading that is most closely
associated with it. Each heading may be used once, more
than once, or not at all.
QUESTIONS 43 - 47
A.
B.
C.
D.
Desire phase
Excitement phase
Orgasm phase
Resolution phase
43. Vaginal lubrication
QUESTIONS 35 - 38
44. Orgasmic platform
A.
B.
C.
Conversion disorder
Pain disorder
Somatization disorder
45. Testes increase in size by 50 percent
46. Slight clouding of consciousness
35. La belle indifference
47. Detumescence
36. Alexithymia
37. Briquet's syndrome
QUESTIONS 48-51
38. Astasia-abasia
A.
B.
C.
D.
E.
QUESTIONS 39 - 42
A.
B.
C.
D.
Somataform disorder NOS
Undifferentiated somatoform disorder
Both
Neither
Klinefelter's syndrome
Turner's syndrome
Congenital virilizing adrenal hyperplasia
True hermaphroditism
Androgen insensitivity syndrome
48. A 17-year-old girl presented to a clinic with
primary amenorrhea and no development of
secondary sex characteristics. She was short in
stature and had a webbed neck
39. Fatigue, loss of appetite, gastrointestinal or
urinary complaints
49. A baby was born with ambiguous external
genitalia. Further evaluation revealed that both
ovaries and testes were present.
40. Pseudocyesis
41. A disorder involving multiple somatic delusions
50. A baby was born with ambiguous external
genitalia. Further evaluation revealed that
ovaries, a vagina, and a uterus were normal and
intact . No tests were found.
42. Symptoms can be fully explained by a known
general medical condition
51. A buccal smear from a phenotypically female
patient revealed that the patient was XY. A
further workup revealed undescended tests.
52. A tall, thin man who presented for infertility
problems was found to be XXY.
EXAM CONTINUES - NEXT' PAGE PLEASE
8
QUESTIONS 53 - 58
A.
B.
C.
D.
53.
Hypochondriasis
Somatization disorder
Both
Neither
Is found approximately equal in men and women
54. Peak incidence during the 40's or 50's
55. Chronic debilitating condition
56. Includes disease conviction or disease fear
57. Associated with anhedonia
58. Hallucinations may be present
DIRECTIONS (ITEMS 59 - 61): Each of the following
statements is either true or false. On the answer sheet, fill
in the circle containing
A.
B.
If the statement is True
If the statement is False
59. Compared to adolescent onset, adult onset of
eating disorders is associated with a history of
more negative life events and poorer prognosis.
60. Mitchell (1990) found that a history of substance
abuse had no affect on treatment outcome of
eating disorder patients at a 2 to 5 year follow-up.
61. According to Beckman & Burns (1990) and Pope
& Hudson (1992) there is a strong link between
eating disorders and sexual abuse history.
END OF EXAM
9
ANSWERS
1. C
2. B
3. E
4. A
5. A
6. E
7. C
8. D
9. E
10. E
11. E
12. B
13. E
14. E
15. B
16. E
17. A
18. A
19. A
20. C
21. A
22. E
23. E
24. C
25. C
26. C
27. E
28. C
29. E
30. A
31. B
32. A
33. B
34. B
35. A
36. B
37. C
38. A
39. B
40. A
41. D
42. D
43. B
44. B
45. B
46. C
47. D
48. B
49. D
50. C
51. E
52. A
53. A
54. D
55. B
56. A
57.
58.
59.
60.
61.
10
C
D
T
T
F