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Flashcards in Psych Bootcamp Deck (81):

58 yo old woman with symptoms of depression, including hopelessness and anxious feeling since she lost her husband 12 months ago. physical exam and labs are normal. Which one of the following is a reasonable choice for her?
-olanzapine (Zyprexa)
-risperidone (Risperdol)
-quetiapine (Seroquel)
-clonazepam (Rivotril)
- venlafaxine (Effexor)


SSRI First Line

SNRI and NDRI also good

Olanzapine atypical antipsychotic
Risperidone antipsyhotic


Patients with gender identity disorders often have a history of
-cross-dressing in childhood
-child abuse
-chromosomal anomalies
-previous homosexual behavior.
- late onset of puberty.

Cross dressing in childhood


The basic mechanism of defense in phobic reactions is



38 yo old man washes his hands 60 times a day. He checks the doors, windows, and stove at least a dozen times before retiring for the night.He is requesting help with medication to stop the urge. Which one of the following is the most likely diagnosis?
-obsessive-compulsive personality disorder
-obsessive-compulsive disorder
-schizotypal personality disorder
-social anxiety disorder
paranoid disorder

with personality disorder, no insight. Also impairment in function


26 yo-old female with depression presents with restlessness, agitation and nausea. She was recently switched from escitalopram (SSRI) to phenelzine (MAOI). Her bp is 140/90 mmHg and she is tachycardic and febrile(t-38). Her neurological examination is normal except hyperreflexia and myoclonous. What is the most likely diagnosis?
- akathisia
- Serotonin withdrawal
- hypertensive crisis
- neuroleptic malignant syndrome
- serotonin syndrome

Serotonin syndrome (myoclonus)

Serotonin also loves the GI tract


What class of drug is phenelzine



In which one of the following situations would it be unethical for the psychiatrist to break confidentiality and notify the authorities?

-The psychiatrist believes that the patient is actively suicidal.
-The patient has aggressive fantasies.
-The patient has severely impaired judgement and is in a responsible position, e.g. an airline pilot.
-The patient has taken a significant overdose.
-The psychiatrist believes that the patient will probably commit murder.

Aggressive fantasies


37-yo old man has been preoccupied with back pain for the past year.  He mentioned it as severe and incapacitating. There is a history of minor injury 18 months ago. The patient has visited many doctors, constantly requesting medication; no abnormal physical findings have emerged. The most likely diagnosis is
-posttraumatic stress disorder.
-somatoform pain disorder.
-delusional disorder.

somatoform pain disorder

no dysthmymia is now persistent depressive disorder.


A major distinguishing factor between schizophrenia and acute organic brain syndrome (delirium) is
-difficulty in maintaining attention.
-inappropriate affect.
-fluctuation of consciousness.
-concrete interpretation of proverbs.

Fluctuation of consciousness`


A man is indignant when his graduate school thesis committee refuses to approve his project.  "They're just jealous of me because they know I'll be the most brilliant anthropologist in history," he remarks.  He has had this attitude all of his life.  Which one of the following is the most likely diagnosis?
-antisocial personality disorder
-borderline personality disorder
-bipolar disorder
-narcissistic personality disorder



Korsakoff psychosis is characterized by which one of the following?
visual hallucinations and memory impairment
confabulation and altered levels of consciousness
auditory hallucinations and altered levels of consciousness
confabulation and memory impairment
visual hallucinations and altered levels of consciousness

Confabulation and memory impairment


Medical complications of bulimia nervosa include all of the following, EXCEPT
dental abnormalities.
parotid gland enlargement.
metabolic acidosis.

Metabolic acidosis


Which one of the following is the most effective method of treatment for patients with pathological gambling disorders?
-self-help group therapy
-family therapy
-individual therapy
-activity group therapy

Individual therapy


28 year-old man presents with bizarre delusions, a blunted affect, and tangential thought processes. Which one of the following characteristics indicates a poor prognosis?
- a family history of schizophrenia
- magnetic resonance imaging (MRI) that shows no significant changes in brain morphology
- a sudden onset of symptomatology
- catatonic symptomatology
- an extensive premorbid history of social withdrawal

premorbid history of social withdrawal


25 year-old unconcious man is brought into the emergency room with pinpoint pupils, depressed respiration, and no sign of physical trauma.  Laboratory results are pending.  He receives intravenous glucose without response.  Which of the following is the most appropriate drug to administer next?



Pinpoint pupils; OPiods (reverse with naloxone), cholinergic toxidrome (organophosphates)

Antidote for cholinergic = atropine or 2PAM


60 year-old man 3 days following cardiac bypass surgery.  He appears confused, seems to think he is on a cruise ship and describes seeing a burglar is trying to get in through the window of his room.  He describes the appearance of this person in vivid details.  Which one of the following is this patient experiencing?
-flight of ideas
-obsessional thoughts


Day three very common to get delirium tremens.
DT doesn't occur until after 48h of last drink.

Hallucinations can be delirium tremendous.

Use benzo's (they inhibit GABA


55 year-old man with history of alcohol abuse comes to the emergency room of a general hospital.  He is confused and on examination is noted to have palsies of conjugate gaze, horizontal nystagmus, and ataxia.  Which one of the following is the most likely diagnosis?
alcohol intoxication
delirium tremens
alcohol hallucinosis
Wernicke's encephalopathy
conversion reaction

Wernickes Encephalopathy

Prevented with thiamine (B1)- usually needs 2 weeks of thiamine dosing.

for prevention of werknickes 3d of thiamine.


Which one of the following populations is at greatest risk of completed suicide?
females over 45 years of age
females age 14 to 18
females under 14 years of age
males age 14 to 18
males over 45 years of age

Males over 45


A 22-yo-old university student is brought to the emergency room after trying to smash a computer at university lab. He says the computer is being used to control his thoughts and Canadian Security Intelligence Service
is behind this.  This patient is exhibiting which one of the following?
- delusions
-visual hallucinations
-auditory hallucinations



23 year-old man is brought to the emergency room after being found unresponsive in park.  Physical examination reveals pinpoint pupils unresponsive to light and a respiratory rate of 7 breaths per minute.  Which one of the following is the most likely cause?
hydromorphine overdose
lead intoxication
arsenic poisoning
alcohol intoxication
tricyclic antidepressant overdose

hydromorphone overdose


30 year-old woman reports episodic feelings of sadness since adolescence. Occasionally she feels good, but these periods seldom last more than 2 weeks.  She is able to work but thinks she is not doing as well as she should. she seems to focus more on repeated disappointments in her life and her low opinion of herself than on discrete depressive symptoms.  In your differential diagnosis at this point, which one of the following is the most likely diagnosis?
-adjustment disorder with depressed mood
-childhood depression
-major depression with melancholia


for major depressive episode have to have at least 5 sx of SIGECAPS

Therapy; SSRI and psychotherapy


27-year-old woman with depression repeatedly talks about irrelevant topics when being interviewed by a psychiatrist.  Which one of the following symptoms is the patient demonstrating?



38 year-old man mentions he is feeling somewhat down and in conflict with his wife. And he has always been rigid; he is a conscientious hard worker at his employment. he is dressed very neatly , he rambles and provides details personal history. The most likely personality type is
self-defeating (masochistic).



38 year-old man mentions he is feeling somewhat down and in conflict with his wife. And he has always been rigid; he is a conscientious hard worker at his employment. he is dressed very neatly , he rambles and provides details personal history. The most likely personality type is
self-defeating (masochistic).



19 year old man has withdrawn to the basement of his house because he believes he is the subject of a conspiracy to kill him and that the home is under surveillance by mafia. Which of the following is the most likely diagnosis?

Antisocial personally disorder
Obsessive- compulsive disorder
Bipolar disorder- manic phase



36 year old woman she has been experiencing palpitations, dizziness, shortness of breath, a feeling of impending doom and a fear of dying for 3 to 4 months. Which of the following would be the most appropriate initial step in managing this patient?

Prescribe benzodiazepines
Refer the patient to a psychiatrist
Perform a physical examination
Teach relaxation techniques
Offer psychotherapy



A depressed patient is mostly likely to commit suicide when

The patient is staring to recover from the depression
The patient becomes physically ill
The patient receives bad news or disappointment
The patient has completed a course of electroconvulsive treatments
The depression is most profound

starting to recover


47 year old man complains of the several months history of worrying about his health, increased desire to sleep, demoralization, and difficulty focussing attention on tasks. Which one of the following is the most likely diagnosis?

Somatization disorder
Generalized anxiety disorder
Chronic fatigue syndrome
Schizoid personality disorder

depression/? GAD


28 yo old man is very angry with his co-workers and describe fantasies of driving to work and punching them up. Which one of the following is the most warning sign that he may take action?

The presence of temporal lobe epilepsy
The presence of the persecutory delusions
A history of alcohol abuse
A history of violence
A lack of anxiety

A history of violence


25 yo old woman comes 10 days after the death of her father describes many memories of her father and says that she is tearful occasionally and having some trouble falling asleep. She returned to work 4 days after her father’s death. Proper treatment for this patient should consist of which of the following?

-Long term psychotherapy
-A longer period of time away from work
-Referral for further psychiatric evaluation
-Conservative, supportive treatment
-Administration of antidepressant agents

Conservative, supportive tx


27 yo old man is hospitalized after weeks of the worsening psychosis. He is given thiothixene, an antipsychotic medication. Five days later, he develops a fever of 39.8 C, become delirious and lies stiffy in his bed. His family reports that he had been physically well before his admission. Which one of the following diagnosis is most immediate concern?

-Viral meningitis
-Ruptured cerebral aneurysm
-Neuroleptic malignant syndrome
-Unsuspected opioid dependence
-Tardive dyskinesia

neuroleptic malignant syndrome; complete dopamine blockade


20 year old college student broke up with her boyfriend 3 days ago. She now complains of depressed mood, anxiety , difficulty concentrating on studies, and preoccupation with “mistakes” she made in the relationship. Which one of the following is the most appropriate treatment at this time



adjustment disorder is the cause.
does not require medication.


28 year old man requests help. He says he feels like he is really a woman “trapped in a man’s body”. Which of the following is the most likely diagnosis?

-Sexual desire disorder
-Gender identity disorder
-Depersonalization disorder
-Body dysmorphic disorder

gender identity


48 year old man is being treated for depression. His roommate said that he was up all night, talking rapidly and that in the last 24 hrs, he has run up 5,000.00 on his credit card. You would now revise your diagnosis to which of the following?

Narcissistic personality disorder
Generalized anxiety disorder
Frontal lobe tumor
Bipolar affective disorder
Paranoid schizophrenia

Bipolar affective disorder


25 year old man comes with a history of intermittent chest pain for about 7 months. He mentions that the pain can occur at any time, but often occurs late in the day. The pain can be sharp, dull, or aching and may last for hours. He is physically active and is carrying a full academic load. The pain is unrelated to exercise and does not restrict his activities. His father and uncle have both had MI within the past year. Physical examination is normal, although the patient appears restless and has a heart rate of 100/min. which one of the following is the most likely diagnosis?

Generalized anxiety disorder
Transient myocardial ischemia
Reflux esophagitis



35 year old woman presents to the emergency room with shortness of breath, dizziness and tingling in her figures for which no organic cause can be found. Which one of the following is the most appropriate diagnosis?

Endogenous anxiety
Hyperventilation syndrome
Situational reaction


** blood gas
N P02 80 - 100
sats N
PCo2 low

In PE/ ASthma Po2 is low

dizziness because CO2 vasodilates


19 year old male with history of substance abuse is brought to the emergency room by police. He demonstrates violent behavior, slurred speech and muscular rigidity. Which one of the following drugs is mostly likely to be associated with the clinical presentation?


Phencyclidine (PCP)
- stimulants have dilated pupils
-violent behaviour


36 year old married woman presents to her family physician’s office with headaches. She is weepy , anxious and she has some facial bruising. She admits that her husband has been physically abusing her on and off over the past 12 months. Which one of the following actions should be taken?

Refer to a counseling service for marital counselling
Provide information about safety and shelters
Admit the patient to psychiatric unit
Prescribe anti-depressant medication
Arrange for the husband to come with his wife to a therapeutic session

Provide information about safety and shelters

with kids involved notify CAS


35 year old homeless man is brought into the ER by police after he was found haranguing passersby. Which one of the following is most suggestive of psychosis?

-Rumination about the meaninglessness of material things
-Disorientation to time and place
-A belief that his thoughts are controlled via secret television messages
-An unfounded suspicion that others are plotting against the government
-hyper-religiosity and ascetic living habits

-A belief that his thoughts are controlled via secret television messages


25 year old woman has insomnia, irritability, increased psychomotor activity, and impulsivity. Which one of the most likely diagnosis?

-Antisocial personality disorder
-Major depressive disorder


R/o hyperthyroid


What is the most common comorbid psychiatric diagnosis in patients with chronic pain?

Depressive disorder
Somatization disorder
Substance abuse disorder
Conversion disorder
Anxiety disorder



A 55-year-old male presents to his primary care physician complaining of inability to sleep. He has lost interest in sex and has decreased energy and decreased ability to concentrate. He is diagnosed with depression. His chief problem is not being able to sleep. Which medication would you prescribe him for both his depression and insomnia?




A 23-year-old female presents with two days of severe, constant epigastric abdominal pain. Her medical record indicates that she has previously had similar episodes that were attributed to conversion disorder because following admission for abdominal pain, she had developed severe depression. The patient indicates she had drank several shots of whiskey to celebrate her birthday the day before her abdominal pain started. Which of the following, if elevated, can account for this patient’s presentation?

Uroporphyrinogen III
Hemoglobin F
Hemoglobin A
Coproporphyrin III

Uroporphyrinogen III

- acute intermittent porphyry


A 34-year-old business executive is in danger of losing his job because he has been unable to give the monthly progress reports to the investors of his company. He tells his bosses that he isn't feeling well around the time that he is required to make these presentations. He complains that he is worried that he will make a mistake and they will think he is stupid. During these events his hands tremble and his voice becomes shaky and he becomes diaphoretic. What is the most appropriate diagnosis?

Obsessive Compulsive Disorder
Social anxiety disorder
Panic Attack
Specific Phobia
Avoidant Personality Disorder

social anxiety disorder


A 19-year-old female is brought in by her parents after they became concerned that their daughter stayed up all night for the last 6 nights. She says she has not been tired and has been feverishly cleaning her apartment. The patient, who is a college student, says she has recently decided to drop out of school and start her own business which she feels can rival the top companies in the world. On physical exam, the patient appears agitated and is cannot be interrupted when speaking. She denies auditory and visual hallucinations. What is the most likely diagnosis?

Schizoid Personality Disorder
Alcohol intoxication
Manic Episode
Major Depressive Episode
Brief Psychotic Disorder



A 17-year-old girl is brought to the physician by her mother who says she is concerned that her daughter has not been eating enough. The girl, who appears to be about 20% below normal body weight denies having had a menstrual period in the last 4 months and is worried about her body image. She says that she is worried she will get fat if she eats too much. She has a depressed mood and has had difficulty sleeping for the past month. The best treatment for this girl's medical problems is:


mirtazapine (improves sleep and appetite)


A 26-year-old store clerk is brought into the emergency room because she was found running through the store naked. She begins talking very rapidly, and states she has not slept for 8 days. She also claims to have had multiple sexual partners in the past 2 weeks. Her mother is called and she tells the emergency room physician that she has been missing for several months, and that she had been treated for major depression by her psychiatrist. Which of the following is the BEST diagnosis given the patient's history?

Manic episode
Bipolar Disorder I
Bipolar Disorder II
Cyclothymic Disorder
Hypomanic episode

Bipolar I


A 42-year-old divorced female presents to her primary care physician for lack of energy. Upon further questioning she is found to have increased fatigue, difficulty concentrating, and weight gain. She spends most of her day sleeping and no longer goes to her book club, which she used to love going to. Which of the following neurotransmitters is likely decreased in this patient?




A 55-year-old with a history of alcohol abuse is admitted to the hospital after having a myocardial infarction. On hospital day three, you notice that the patient is agitated, tachycardic and hypertensive. He states that he feels bugs crawling on his skin and claims that elephants are crawling on the walls. Which of the following medications should have been given to this patient during admission?

Valproic acid


DTs always on Day 3


A 25-year-old medical student is referred to a psychiatrist because he has been exhibiting excessive, uncontrollable, often irrational worry about everyday things that is disproportionate to the actual source of worry. He has been experiencing fatigue, headaches, nausea and muscle aches. He is started on buspirone and begins to experience improvement of his symptoms after a few months. What is the mechanism of action?

-Inhibit serotonin reuptake
-Alter concentration of inositol triphosphate (IP3)
-Serotonin receptor partial agonist
-Inhibit reuptake of norepinephrine and dopamine, and is a nicotinic antagonist.
-Blocks beta adrenergic receptors

Serotonin partial agonist


A 72-year-old male presents to the emergency room complaining of inability to urinate, constipation and hallucinations. On examination, he is noted to be confused, tachycardic and have xerostomia. An EKG shows slowing of his atrioventricular conduction. An astute medical student looks up his medical records and notes his psychiatrist placed the patient on a tricyclic antidepressant. Which of the following tricyclic antidepressants can also be used to treat enuresis?




A 55-year-old alcoholic male is brought to the emergency department by the police. The man was found stumbling and can not identify himself or his local address. The intern orders an MRI of his brain, which shows destruction of his mammillary bodies. Which of the following deficiencies does he have?

Vitamin B1
Vitamin B2
Vitamin B12
Vitamin B6
Vitamin B3

Vitamin B1


A 35-year-old white female is brought into the emergency department by police after she is found wandering in the streets past midnight yelling "I won't listen to you anymore" at the asphalt. On exam, she is a disheveled woman who appears older than her stated age and is extremely malodorous. She complains of auditory hallucinations and demonstrates loose associations of her thoughts. The emergency doctor administers haloperidol, which acutely helps relieve some of her symptoms. In the acute setting, which of the following would be the most common potential side effect of this medication?

Tardive Dyskinesia
Painful paralysis of the ocular muscles
Fetal neural tube defects

Painful paralysis of ocular muscles


A 34-year-old truck driver is referred to a physician after he falls asleep at the wheel 2 times in one week while driving his usual route. The man says he has been sleeping well, but says that sometimes when he laughs, he falls asleep immediately. He also complains that sometimes when he wakes up in the morning, he has experiences a brief period of paralysis where he can't move his body. The medication prescribed to treat his illness is also useful in what other illness?

Bipolar disorder
Major Depression


This is narcolepsy


A 21-year-old female presents to her doctor for a wellness exam. She complains that over the last 3 weeks she has had decreased interest in her usual athletic activities, and is now considering quitting the swimming team she has been competitively racing for during the last 9 years. She also says that she has only been able to get about 6 hours of sleep per night and has had difficulty staying asleep once she falls asleep. This is much less than her usual 8-9 hours per night. She admits to feeling guilty regarding her parent's recent divorce. She denies thinking about death and wants to feel better again. What is the most appropriate pharmacological management of this patient?




A 12-year-old boy is brought to his pediatrician because his parents state that he has been complaining of masked criminals walking around in his room just before he goes to sleep. The boy, who has no other health or developmental problems usually responds by screaming. He says he remembers everything that happened. He is not ever found out of his bed. What type of hallucination is he experiencing?

Night terrors


Hypnagogic; happen at night

Hypnopompic; in the morning PUMPED up in the am


A 27-year-old intern is three months into her internship in surgery. She moved from winnipeg where she spent most of her life, to Toronto. She has been feeling anxious and depressed, which has begun interfering in her work. What is her most likely diagnosis?

Post-traumatic stress disorder
Generalized anxiety disorder
Panic disorder
Adjustment disorder

adjustment disorder


A 32-year-old bipolar male is brought into the emergency room by police as he was naked and robbing a bank. He suffered several lacerations to his forearms. He was sutured in the emergency room and admitted to the psychiatry ward. He is started on a neuroleptic for his acute mania. Several hours later, he becomes rigid, develops a high fever, and an unstable blood pressure. His urine is noted to have myoglobin present. Which of the following medications should he be started on?


High fever think of neuroleptic malignant syndrome
CK will be high because of muscle breakdown


A 24-year-old woman is referred to a psychiatrist for an evaluation. She states that she has been cutting newspaper clippings because she feels as though newspaper articles have recently been published linking her to a recent earthquake. On physical exam, the patient is calmly seated on the exam table, in no acute distress. Her BP is 123/72, pulse 65, respirations 18. Her physical exam is normal and she is cognitively intact. Which of the following best describes her behavior?

Loose association
Ideas of Reference
Dissociative Fugue



Which one of the following is NOT a risk factor for Alzheimer disease?

Female sex
Tobacco use
Family history of dementia
Trisomy 21

Tobacco Use


A 14-year-old male with a past medical history of depression is brought to the Emergency Department after taking some pills from a bottle that was in his medicine cabinet at home. On physical exam, his temperature is 38.1°C (100.58°F), heart rate is 150/minute, blood pressure is 138/88 mmHg, and respiratory rate is 25/minute. He is confused, his pupils are dilated, he has decreased bowel sounds, and his skin is flushed and dry.

What is the antidote



A 23-year-old man who lives at home with his mother is brought to the emergency room by police after calling 911 to complain about television programs that are harassing him. Upon presentation to the hospital, the patient refuses to speak to any medical personnel, but is observed to be muttering under his breath. His mother, who follows him to the emergency department, provides collateral history. She reports that her son has been acting "stranger and stranger" for the past four months. She explains that her son is convinced the FBI is "after him", and has been sending him messages through the television and through websites. Recently, he smashed his computer screen to try to avoid these messages. In addition, she reports that her son has been increasingly "lazy," failing to go to work, and, more recently, to complete basic hygiene tasks such as showering and brushing his teeth. Her son has not made any suicidal or homicidal statements, and his mother reports that his mood seems unchanged despite his unusual actions. When asked about substance use, the patient's mother reports that she is sure he is not using any substances, as he spends all of his time in his room and she checks up on him frequently.

Whwat is the dx



Clozapine is the neuroleptic of choice for schizophrenia when:

the patient shows no evidence of tardive dyskinesia
the patient has not improved with adequate dosages for 6 weeks of 3 other antipsychotics
the patient is under fifteen years of age
the patient has a WBC count of >10,000
the patient is very sensitive to anticholinergic side effects

with adequate dosages for 6 weeks of 3 other antipsychotics


Which of the following symptoms of schizophrenia responds best to antipsychotic medication?

A social behavior
Flat affect
Paranoid delusions
Lack of motivation
All of the above

- positive sx respond and negative sx do not


Aspects of the management approach for the violent patient include each of the following EXCEPT:

Interview the patient in a room or space with exits available to both you and the patient
Ensure that extra staff are quickly accessible
Use verbal de-escalation techniques when the patient is verbally abusive and agitated
Use low potency antipsychotics either p.o. or I.M. for chemical restraint
Use physical restraint to protect the patient from hurting themselves and others

Use low potency antipsychotics either p.o. or I.M. for chemical restraint


Each of the following symptom presentations is
characteristic of delirium EXCEPT:

-Incoherent speech, agitation and disorientation
-Drowsiness, impaired attention and visual hallucinations
-Disturbed sleep wake cycle, memory impairment and auditory hallucinations
-Alert, hypervigilant and paranoid delusions
-Apathetic, disoriented and dysphoric

-Alert, hypervigilant and paranoid delusions


Which of the following is characteristic of thought form or process?

-Receiving secret messages from the TV
-Fear of going on the subway
-Illogical shifting between topics
-The belief that one is pregnant despite evidence to the contrary
-Thoughts of suicide

Illogical Shifting between topics


Which of the following is least favorable symptom of schizophrenia?

-Flat affect
Deterioration of social and occupational function
-Brief recurrent attacks of psychosis
Bizarre delusions

-Brief recurrent attacks of psychosis

needs to be 6 months


Risk factors for violence include each of the following EXCEPT:

Psychomotor retardation and ideas of reference
Past history of violent or impulsive acts
Substance abuse
Childhood abuse
Head injury

psychomotor retardation


Which one of the following predicts a poor outcome for schizophrenia?

-Presence of a precipitating factor
-Being married
-Good premorbid social functioning
-Family history of mood disorders
-Insidious onset

Insidious onset


A 40 year old man presents to the ER stating that his psychiatrist has recently increased his medication. He cannot sit or stand for long and has to keep pacing. Which one of the following diagnoses is most likely?

-Acute akathisia
-Tardive dyskinesia
-Panic reaction
-Acute dystonia

Acute Akathisia


A 57 year old man has been admitted to the coronary care unit for a myocardial infarction. You are called to evaluate him because he has become agitated, disoriented and seems to be hallucinating. Which one of the following medications is the most appropriate at this time?

-Morphine sulfate
-Lithium carbonate


Benzo if available first but then give antipsychotic


Each of the following statements about delusional disorders is correct EXCEPT:

-They are less common in schizophrenia
-The patient often functions well at work
-It is unlikely the patient will go on to develop schizophrenia
-The delusion responds well to neuroleptics
-Delusions are never bizarre

-The delusion responds well to neuroleptics


A 72 year old man with schizophrenia was switched to haloperidol 6 months ago. On a review visit, his wife complains that he has had episodes of drooling and difficulty feeding himself. Neurologic examination reveals marked stiffness of his arms and new bilateral tremors. Which one of the following is the most likely cause of these symptoms?

Acute akathisia
Neuroleptic malignant syndrome
Tardive dyskinesia
Dystonic reaction

Tardive dyskinesia
(over 3 months think of TD)


Which of the following is the least effective in the treatment of schizophrenia?


Phenelzine (MAOI)


Which of the following is essential in making the diagnosis of schizophrenia?

Deterioration in function
Disorganized thinking
Onset before age 54

deterioration of function


Which of the following exemplifies a type of thought that is symptomatic of schizophrenia?

The television sending subliminal messages
The foul odor emanating from the ventilation system (in order to poison the individual)
Thoughts that jump from topic to topic
The fear of heights
God is talking to the individual

The television sending subliminal messages


A 32-year-old man comes to the physician because he thinks he might be losing his mind. For the past year, he has been having intrusive thoughts of killing his 4-year-old son. He does not want to do this and considers the thoughts ridiculous. He is becoming increasingly depressed and is worried that something is happening to him. He is a pastor at a local church and say: that the thoughts are especially prevalent when he is reading scriptures and preparing for a sermon. He has not told anyone, including his wife, about “these repulsive ideas.” He says that he is a good father and takes good care of his son. During his first year of college. he was treated briefly with counseling for an adjustment problem. He says that he does not think he has family history of psychiatric illness, but his mother is considered to be overly anxious. Vital signs are within normal limits. Physical examination shows no abnormalities. Mental status examination shows an embarrassed, mildly anxious affect. Results of laboratory studies are within the reference range.

Which of the following is the most likely diagnosis?

Bipolar disorder
Dysthymic disorder
Generalized anxiety disorder
Major depressive disorder
Obsessive-compulsive disorder
Schizoaffective disorder

Schizoaffective Disorder


She reports that she hears the voice of Mother Earth asking for her protection. The most appropriate initial step in pharmacotherapy for this patient’s acute symptoms is administration of which of the following?

Lithium carbonate



A 21-year-old female presents to her college’s student health clinic with a chief complaint of incessant worry. She states that for the past several years she’s been troubled by constant worries about various aspects of her life. She states, “If I’m not worried about one thing, then I’m worrying about something else." She feels as if these intrusive thoughts occur most days and are making it difficult for her to study, stay productive at work, and even enjoy being with friends. When asked to further explain her symptoms she endorses muscle tension, irritability, and difficulty sleeping. The patient adds that she’s tried to control her thoughts but nothing seems to work. A basic medical work-up including toxicology screen is negative. The patient denies having any medical conditions or taking any medications or drugs.

A. Imipramine
B. Clonazepam
C. Clonidine
D. Propranolol
E. Paroxetine



A 37-year-old woman is admitted to the hospital after a suicide attempt by an overdose of pills and alcohol. She has a 6-year history of major depressive disorder treated with various antidepressants. During this period, she has attempted suicide by hanging herself twice, jumping from a bridge, and taking several overdoses of pills. She is 163 cm (5 ft 4 in) tall and weighs 50 kg (110 lb): SMI is 19 kg/m2. Her pulse is 64/min, and blood pressure is 110/70 mm Hg. Mental status examination shows a depressed moot She says that she has had difficulty sleeping and that she feels hopeless and helpless There is still evidence of suicidal ideation Laboratory findings are within the reference range Urine toxicology screening is negative. This patient is most likely to have which of the following abnormalities?

Decreased concentration of 5-hydroxyindoleacetic acid in cerebrospinal fluid analysis
Delayed REM sleep on nighttime polysomnography
Enlarged lateral ventricles on CT scan of the head
Increased sensitivity to lactate infusion
Serology positive for human leukocyte antigen-DR2

Decreased concentration of 5-hydroxyindoleacetic acid in cerebrospinal fluid analysis