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

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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. conversion disorder

B. smile dementia

C. major depression

D. schizophrenia, residual type

E. obsessive-compulsive
2. In using the muscle relaxant succinykholine

during electroconvulsive therapy, the physician

must be alert to the rare complication in which

the
A. relaxant may potentiate the convulsive

effect

B. patient may constitutionally lack



succinylcholinesterase and so stay apneic

C. succinylcholine may precipitate a toxic

psychosis

D. muscle relaxant may cause acute hemolysis

E. patient is resistant to the succinylcholine
3. The following is a "absolute" contraindication to

ECT
A. A brain tumor

B. recent myocardial infarction

C. pregnancy

D. recent intracerebral hemorrhage

E. there are no absolute contraindication to

ECT
4. Medications used right before given ETC should

be administered in the following order.

A. an ticholinergic, anesthetic, muscle relaxant

B. anesthetic, muscle relaxant, anticholinergic

C. muscle relaxant, anesthetic, anticholinergic

D. anticholinergic, muscle relaxant, anesthetic

E. muscle relaxant, anticholinergic, anesthetic

5. 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.

The most likely diagnosis is
A. somatization disorder

B. conversion disorder

C. hypochondriasis

D. dysthymic disorder

E. pain disorder
6. In body dysmorphic disorder
A. plastic surgery is usually beneficial

B. a comorbid diagnosis is unusual

C. anorexia nervosa may also be diagnosed

D. 50% of patients may attempt suicide

E. serotonin-specific drugs are effective in reducing

the symptoms


7. A patient with somatbatization disorder


A. presents the initial physical complaints after

age 30


B. has had physical symptoms for three

months


C. has complained of pain, gastrointestinal,

sexual, and pseudoneurological symptoms,

which are not explained by a know medical

condition

D. usually experiences minimal impairment in

social or occupational functioning

E. may have a false belief of being pregnant

and objective signs of pregnancy, such as

decreased menstrual flow or amenorrhea
8. All the following are classified as somatoform

disorders except


A. conversion disorder

B. hypochondriasis

C. somatization disorder

D. Munchausen syndrome

E. body dysmorphic disorder
9. Medical disorders to be considered in a

differential diagnosis of somatization disorder

include
A. multiple sclerosis

B. systemic lupus erythematosus

C. acute intermittent porphyria

D. hyperparathyroidism

E. all the above
10. The differential diagnosis of a factitious disorder

includes
A. somatization disorder

B. hypochondriasis

C. antisocial personality disorder

D. malingering

E. all the above


11. Factitious disorder

A. usually begin in childhood

B. are best treated with psychoactive drug;

C. usually have a good prognosis

D. are synonymous with Ganser's syndrome

E. may occur by proxy

12. Patients with factitious disorder with

predominantly physical signs and symptoms

A. do not usually gain admission to a hospital

B. may take anticoagulants to simulate

bleeding disorders

C. are usually easy to manage in the hospital

D. do not display symptoms of pseudologia

phantastica

E. usually receive the co-diagnosis of

schizotypal personality disorder


13. Factitious disorder with predominantly physical

signs and symptoms is


A. under voluntary control, but the patient

often denies the voluntary production of the

illness

B. also known as Munchausen syndrome



C. frequency seen in patients with a family

history of serious illness or disability

D. frequently seen in persons employed in

health care jobs

E. characterized by all the above
14. Observing people who are naked or engaging in

sexual activity is called;


A Exhibitionism

B. Fetichism

C. Sexual Aversion Disorder

D. Sexual Sadism

E. None of the above
15. Rubbing up against a fully clothed woman to

achieve orgasm, is considered


A. an orgasm disorder

B. a paraphilia

C. a gender identity disorder

D. a male erectile disorder

E. none of the above

16. Sexual Aversion Disorder


A. Is characterized by absence of sexual

fantasies and of desire of sexual activity.

B. Is a farm of paraphilias

C. Is all the time associated with

homosexuality

D. Is all the time detected in females

E. Is characterized by an aversion to and

avoidance of genital sexual contact with a

sexual partner

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.

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.
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

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.

The diagnosis of this case should be
A. Factitious Disorder with Predominantly

psychological signs and symptoms

B. Munchausen Syndrome

C. Schizophrenia Paranoid Type

D. Somatization Disorder

E. Somatoform Disorder NOS


18. Male erectile disorder is also called
A. Impotence

B. Male orgasmic disorder

C. Frotteurism

D. Partialism

E. none of the above
19. Vaginismus is characterized by

A. Involuntary muscle constriction of the outer

third of the vagina

B. Fantasies involving harm to others

C. Persistent genital pain occurring before,

during, or after intercourse

D. Sexual masochism

E. All of the above


20. All of the following is characteristic of the

orgasmic phase EXCEPT


A. The male orgasm is associated with four or

five rhythmic spasms of the prostate,

seminal vesicles, vas and urethra

B. Involuntary contraction of the internal and

external sphincters

C. Hypotension

D. Facial grimacing

E. Carpopedal spasm

21. The following is correct about the resolution

phase in the female and male sexual response

cycle EXCEPT
A. After orgasm males do not have refractory

periods


B. Refractory period usually does not exist in

females


C. Resolution consist of the disgorgement of

blood from the genitalia

D. If orgasm occurs, resolution is rapid

E. resolution through orgasm is characterized

by a subjective feeling of well-being
22. The following conditions have classified among

the gender identity disorders EXCEPT

A. Turner's Syndrome

B. Klinefelter's Syndrome

C. Congenital virilizing adrenal hyperplasia

D. Androgen insensitive Syndrome

E. Klismaphilia

23. Which of the following conditions IS NOT A

PARAPHILIA
A. Partialism

B. Coprophilia

C. Urophilia

D. Hypoxyphilia

E. Nymphomania
24. In regard to gender identify disorder the DSM IV

include the following diagnostical categories



EXCEPT

A. Gender identity disorder in children

B. Gender identity disorder is adolescents and

adults


C. Transsexualism

D. Gender identity disorder NOS


25. Orgasm is characterized by all the following

EXCEPT
A. involuntary contractions of the anal

sphincter

B. carpopedal spasm

C. absence of contractions of the uterus

D. blood pressure rise

E. slight clouding of consciousness


26. A married man with a chief complaint of

premature ejaculation is best treated with


A. antianxiety agents

B. psychoanalysis

C. squeeze techniques

D. cognitive therapy

E. none of the above
27. Premature ejaculation is associated with
A. stress

B. negative cultural conditioning

C. more frequency among college-educated

men


D. some general medical factors

E. all the above


28. Persons with gender identity disorder

A. usually try to maintain the gender role

assigned by biological sex

B. are usually adults

C. usually assert that they will grow up to be

members of the opposite sex

D. usually desire sex-change operations

E. 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.

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.


The MOST likely diagnosis is
A. Somatization disorder NOS

B. Conversion disorder

C. Briquet syndrome

D. Hypochondriasis

E. 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.
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. Conversion disorder

B. Munchausen's syndrome

C. Ganser's syndrome

D. Briquets syndrome

E. Hypochondriasis




EXAM CONTINUES – NEXT PAGE PLEASE

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 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."
The psychiatrist asked, “What makes you think it

looks so awful? Everyone has those lines.”


“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.”

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. Somatization disorder

B. Body dysmorphic disorder

C. Pain disorder

D. Undifferentiated somatoform disorder

E. Somatoform disorder NOS

EXAM CONTINUES - NEXT PAGE PLEASE

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.

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.
The clinical diagnosis in this case should be


A. Adjustment disorder with depressed mood

B. Pain disorder

C. Conversion disorder

D. Somatization disorder

E. Malingering

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. bulimia nervosa

B. anorexia nervosa

C. eating disorder NOS

D. Axis III coding

B. all the above
34. A leading predisposing factor in the development

of factitious disorder with predominantly physical

signs and symptoms is employment as a
A. teacher

B. health care worker

C. police officer

D. banker

E. waitress
EXAM CONTINUES - NEXT PAGE PLEASE

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 35 - 38
A. Conversion disorder

B. Pain disorder

C. Somatization disorder
35. La belle indifference
36. Alexithymia
37. Briquet's syndrome
38. Astasia-abasia

QUESTIONS 39 - 42
A. Somataform disorder NOS

B. Undifferentiated somatoform disorder

C. Both

D. Neither


39. Fatigue, loss of appetite, gastrointestinal or

urinary complaints


40. Pseudocyesis
41. A disorder involving multiple somatic delusions
42. Symptoms can be fully explained by a known

general medical condition



QUESTIONS 43 - 47
A. Desire phase

B. Excitement phase

C. Orgasm phase

D. Resolution phase


43. Vaginal lubrication
44. Orgasmic platform
45. Testes increase in size by 50 percent
46. Slight clouding of consciousness
47. Detumescence

QUESTIONS 48-51
A. Klinefelter's syndrome

B. Turner's syndrome

C. Congenital virilizing adrenal hyperplasia

D. True hermaphroditism

E. 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


49. A baby was born with ambiguous external

genitalia. Further evaluation revealed that both

ovaries and testes were present.

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.

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

QUESTIONS 53 - 58
A. Hypochondriasis

B. Somatization disorder

C. Both

D. Neither


53. 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. If the statement is True

B. 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

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. C

  58. D

  59. T

  60. T

  61. F





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