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• 3
• 4 A 35-year-old woman comes to the physician for a periodic health maintenance examination. She has no physical complaints, but she
• 5 is concerned that she hardly ever feels happy. She says that she has basically been "down" for at least 3 years. She rarely goes out
• 6 with friends, and basically keeps to herself at work. She states that her work performance has been stable, but she usually feels tired
• 7 and "blah." Which of the following is the most likely diagnosis?
• 8
• 9
10
0 A. Antisocial personality disorder
•
• 1i 0 B. Cyclothymic disorder
• 12
0 C. Depression
• 13
0 D. Dysthymic disorder
0 E. Schizoaffective disorder
0 F. Seasonal affective disorder

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• 4 An 8-year-old boy is brought to the office by his mother and father. The mother describes several episodes of sleep troubles over the
• 5 past few weeks. Her son has awakened screaming within a few hours of going to sleep, sits upright in bed, and looks frightened. She
• 6 has tried to comfort him at these times, but he does not respond to her questions and instead cries. The episodes last approximately
• 7 20 minutes. In the morning, he wakes up very tired and says that he doesn't remember the episode. Both parents do not believe him,
• 8 which is one of the reasons they have brought him in today. A physical examination and baseline blood work are within normal limits.

• 9 Which of the following is the most likely diagnosis?

• 10
• 11
0 A. Narcolepsy
• 12
• 13 0 B. Nightmare disorder
0 C. Seizure disorder

0 D. Sleep terror disorder

0 E. Sleepwalking disorder

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• 4 A woman with severe depression attends weekly psychotherapy sessions and takes fluoxetine. She is doing well and is beginning to
• 5 feel better, but she becomes furious at her psychiatrist, who is about to leave for vacation and is not willing to reveal where he is
• 6 going. She angrily says that he is just like her father, who always had his own "own life" outside the family. Wh ich of the following best
• 7 describes this patient's reaction?
• 8
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• 9
10
0 A. Acting out
•
• 11 0 B. Countertransference
• 12
0 C. Identification
• 13
0 0 . Projection
0 E. Transference

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•
•
An 8-year-old girl is admitted to the neurologic unit for the evaluation of fainting spells that have been occurring for the past few
• 5 weeks. The neurologist wants to have the patient monitored in the hospital for the possibility of a seizure disorder. The physical
• 6 examination is unremarkable. The blood work is significant for mildly low serum glucose. After 2 days of video-EEG monitoring, no
• 7 seizures are found, no fainting spells have occurred, and the neurologist comes by to order the discharge. The girl's mother is very
• 8 upset and insists on a more extensive workup in the hospital to make sure that nothing is wrong with her child. She threatens to call the
• 9 hospital legal department if she does not get her way. What is the most likely diagnosis?
• 10
• 11
0 A. Factitious disorder
• 12
• 13 0 B. Hypoglycemia

0 C. Malingering

0 D. MOnchhausen by proxy
0 E. MOnchhausen syndrome

0 F. Undiagnosed seizure disorder

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• 4 A 74-year-old, right-handed man comes to see you in your office because of progressive gait dysfunction. He and his family report a
• 5 6- to 7-month history of gradually deteriorating, wide-based gait and increasing unsteadiness. He has gotten to the point of requiring
• 6 assistance while walking. His family also reports that he has had urinary "accidents" over the same time period. His past medical
• 7 history is significant for several episodes of genital herpes and one episode of meningitis as a child. He has had muHiple sexual
• 8 partners. On examination he is awake and alert, but oriented only to person. Otherwise his examination is nonfocal, but when asked to

• 9 walk across the room he seems to be frozen to the spot on gait initiation, as if his feet were stuck to the floor. Which of the following

• 10 diagnostic tests would provide the most useful information regarding the patienrs diagnosis?

• 11
• 12
0 A. Brain MRI
• 13
0 B.RPR

0 C. Electroencephalogram

0 D. CT and lumbar puncture

0 E. Vitamin B 12 level

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• 4 A 29-year-old woman comes to her new primary care physician requesting medication to help with her recent spells of anxiety and
• 5 depression. She wishes to be started on a medication that will not cause too much sedation. Examination of the patient's old records
reveal two previous hospitalizations for minor laceration repair on her left arm and treatment for accidental Tylenol overdose, for wh ich
• 7 both times she was under close observation. She is otherwise healthy and does not smoke cigarettes or drink alcohol. She is not
• 8 currenUy taking any medication. Given this history, wh ich of the following antidepressant medications would most likely be

• 9 contraindicated for this patient?

• 10
• 11
0 A. Buspirone
• 12
• 13 0 B. Fluoxetine
0 C. Nortriptyline

0 D. Paroxetine
0 E. Sertraline

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• 4 A 50-year-old woman with a past history of 2-month episodes of depressed mood, feelings of guilt and hopelessness, difficulty
• 5 sleeping, and a decreased appetite is currently on medication. She has been well for the past 2 years. She is complaining to her
• 6 psychiatrist about her decreased ability to reach orgasm. The patient should be asked for a history of which of the following?
• 7
• 8
0 A. Benz.odiazepine use
• 9
• 10 0 B. History of alcohol
• 11
0 C. Sexual abuse in childhood
• 12
• 13 0 0 . Smoking history
0 E. SSRI use

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• 4 A 68-year-old man is admitted to the hospital for delirium associated with a urinary tract infection. Upon adequate treatment of the
• 5 infection, the patient's mental status improves significantly, though he is noted to remain partly disoriented. He also has an impairment
• 6 in short-term memory, difficulties in naming simple objects, and impaired concentration. His family members confirm an 8-month
• 7 history of gradual progressive decline in cognitive abilities, wh ich they attribute to old age. However, the man is no longer able to
manage his finances and has gotten lost wh ile driving to the grocery store on two occasions. Prior to his discharge from the hospital,

• 9 the nursing staff reports that he continues to drip urine, although his infection has resolved. The nurses also notice that he cannot walk

10 straight and requires assistance when walking. No other obvious signs or symptoms are present. Which of the following will confirm
•
the diagnosis of this patienrs condition?
• 11
• 12
• 13
0 A. Brain biopsy
0 B. CT followed by LP
0 c. No test is required , as the diagnosis is clinical
0 D. Urine examination and culture

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• 4 A 72-yea r-old African American woman is being readied for discharge from the hospital 2 weeks after a stroke affecting her right
• 5 occipital cortex. A psychiatric consultation is called to evaluate the patient for depression, as she has had decreased appetite, some
• 6 crying spells, and severe insomnia. After determining that the patient is not suffering from delirium, wh ich of the following medications
• 7 would be most appropriate to treat her depressive symptoms?
• 8
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• 9
10
0 A. Methylphenidate
•
• 11 0 B. Nortriptyline
• 12
0 C. Phenelzine
• 13
0 0 . Sertraline
0 E. Trazodone

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• 4 A 32-year-old single mother of two is brought to the hospital after overdosing on over-the-counter sleeping medication. In talking to a
• 5 psychiatrist she denies any prior psychiatric problems. She admits that she was laid off from work the day before and that
• 6 approximately 2 weeks ago she discovered that her ex-husband, who was providing child support, had committed fraud and had lost all
• 7 of his money. She has no other family and was in foster care and shellers until she was 18 years old. She fell desperate when she
• 8 realized that she didn't have any money to pay the rent and buy food for the children. That is when she went to the pharmacy and

• 9 bought the medication. She tearfully admits that she has been selfish and really hasn't thought of her children. She feels guilty now
about the attempt. She has no prior medical or psychiatric history. Which of the following is the most likely diagnosis?

• 11
• 12
0 A. Acute stress disorder
• 13
0 B. Adjustment disorder

0 C. Antisocial personality disorder

0 D. Brief psychotic disorder

0 E. Major depressive disorder

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• 4 A 45-year-old white woman comes to her primary care physician for her routine yearly examination. Her physician notices that she
• 5 has lost approximately 25 lbs over the past year. When asked about her weight loss, she states that she has not had much of an
• 6 appetite since her daughter left to go to college about 8 months ago. In describing this, she is somewhat tearful and complains of
• 7 loneliness, poor memory, decreased concentration, and feeling tired. AHhough she appears very sad, she denies feeling depressed
• 8 and states that she simply needs to become more socially active to distract herself from her worries, which keep her up at night. Her

• 9 physical examination is normal except for the noticeable weight loss. Her current weight is 105 lb. Which of the following is the most

• 10 likely diagnosis?

• 11.
• 12
0 A. Adjustment disorder with depressive symptoms
• 13
0 B. Bereavement
0 C. Dependent personality disorder

0 D. Dysthymic disorder
0 E. Major depressive disorder

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• 4 A 32-year-old man is in twice-weekly insight-oriented psychotherapy with a psychiatrist Recently, the patient has been exploring his
• 5 thoughts and feelings around his wife's complaint that he is too restricted and inhibited in their sexual activity. The patient admits that
• 6 he wishes to be more sexually available for his wife, but finds himself maintaining a restricted stance. Which of the following defense
• 7 mechanisms would best describe this patient's tendency in his sexual relationship with his wife?
• 8
• 9
10
0 A. Projection
•
• 11 0 B. Reaction formation
0 C. Sexualization
• 13
0 0 . Somatization
0 E. Sublimation

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• 3
• 4 An 18-year-old girl with no known past medical history comes to the university health center complaining of fatigue. She says that she
• 5 feels as if she has barely enough energy to finish her classwork, has been having tension headaches, and has been feeling somewhat
• 6 anxious about how these problems may affect her academic progress at her new school, to which she transferred last month. Physical
• 7 examination and laboratory studies, including complete blood count, thyroid studies, serum chemistries, and testing for
• 8 mononucleosis, are all within normal limits. When discussing the results of these studies she admits to feeling homesick, and states,

• 9 "I'm worried that I'm not good enough to make it here." Sleep and appetite are normal. Despite these problems, she has made many

10 friends and goes out most weekends. She does not drink or use any illicit drugs. Which of the following is the most likely diagnosis?
•
• 11
• 12
0 A. Adjustment disorder
• :13
0 B. Bipolar disorder

0 C. Generalized anxiety disorder

0 D. Major depressive disorder

0 E. Panic disorder

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