INTERNAL MEDICINE II – MD3012 PSYCHIATRY MCQs & ANSWERS

1) A 24-year-old patient is experiencing an intense hunger as well as weakness and

headache. This patient is most likely to be withdrawing from which of the following

substances?

2) A 29-year-old man comes to the emergency department complaining of stomach

cramps, agitation, severe muscle aches and diarrhoea. Physical examination reveals

that the patient is sweating, has dilated pupils, fever and runny nose and shows

goose bumps on his skin. Of the following, the most likely cause of this picture is?

3) A 56-year-old woman is seen in a psychiatry outpatient clinic because she reports

she is “not being able to function”. She reports feeling rejected all the time and

complains of depressed mood. She also complains of lack of appetite and feeling of

heaviness in the arms and legs. She reports sleeping up to 15 hours every day over

the past few weeks. Her affect is observed to be reactive when she states that her

mother is coming to see her in two weeks. The most appropriate diagnosis is:

5) A 39-year-old man being treated for major depressive disorder complains of

persistent sleep problems since the onset of depression. He is otherwise healthy

and does not have any physical health problems. He is referred for a sleep study. The

EEG is likely to show all of the following, EXCEPT:

6) The neuropsychiatric disorder that has been best characterized in terms of the

influence of the brain on the immune system and vice versa is which one of the

following?

8) A 35-year-old physician tells his internist that he has lost interest in playing in the

hospital string quartet, an activity he formerly enjoyed. He reports that over the

past 3 months he commonly wakes up a few hours before his alarm goes off and

cannot fall back to sleep, and has lost 12 pounds without dieting. He states “maybe

my family would be better off without me”. He says that although he has lots of

aches and pains and often feels tired, he feels somewhat better as the day

progresses. Physical examination and laboratory studies are unremarkable. The most

appropriate diagnosis for this patient is:

9) An 80-year-old man is brought to the emergency room by his wife. The man, who

has a history of depression and suicidal behaviour, refuses to eat and states that

life is not worth living anymore. Consultations with his primary care physician and a

consulting psychiatrist reveal that the patient has not responded to at least three

different antidepressant medications that he has taken in adequate doses and for

adequate time periods in the past 2 years. The most appropriate next step in the

management of this patient is to recommend:

10) A 45-year-old woman presents with the symptoms of a major depressive episode.

The patient has never previously taken an antidepressant. Her physician… fluoxetine

(Prozac). The most likely reason for this choice is that, when compared to a

heterocyclic antidepressant, fluoxetine

11) All of the following are true about the course of a major depressive disorder,

EXCEPT

12) A 34-year-old African American man is admitted to an inpatient psychiatry unit

following a suicide attempt. The patient reports many symptoms… disorder,

including lack of interest, feelings of guilt, insomnia and difficulty concentrating. He

states that recently he has been hearing voices… world because he has a special gift

from God. All of the following support a diagnosis of major depressive disorder,

severe, EXCEPT:

13) A 65-year-old woman, who was diagnosed with advanced lung cancer 3 months

ago, has lost 18 pounds, wakes frequently during the night, and has very little

energy. Over the past month, she has been preoccupied with feelings of guilt about

“people I have hurt in my life” and expresses concern that she will die in pain. The

sign or symptom most likely to indicate that this patient is experiencing a major

depressive episode rather than a normal reaction to life-limiting illness is:

14) Jane is a 27-year-old woman who comes to a pharmacy with a prescription for

triazolam (benzodiazepines) 0.5 mg by mouth as needed for asleep. Which of the

following… when filling her prescription?

15) Which of the following antipsychotics has been used in receptor-binding PET

studies of schizophrenia?

16) A 23-year-old woman is diagnosed with schizophrenia, paranoid type, following a

first episode of psychosis and is started on an atypical antipsychotic. She is worried

that antipsychotics will cause weight gain. Which of the following is the most

accurate statement regarding weight gain and antipsychotics?

17) A 22-year-old man with schizophrenia who has been taking an antipsychotic for the

past 3 months reports that recently he has experienced an uncomfortable sensation

in his arms and legs during the day and must constantly move them. Because of

this, he can sit still for only a few minutes at a time (à akathisia). The antipsychotic

agent that his patient is most likely to be taking is:

18) Structural MRI findings associated with schizophrenia include all of the following,

EXCEPT:

19) A patient with schizophrenia is being treated with clozapine (first atypical

antipsychotic). He is told he needs an initial CBC, then weekly CBCs for the first 6

months of treatment, which he agrees to do. Four months into the therapy, the

patient’s WBC count is noted to be 3250 (normal range 4,000-11,000) per mm3

. The

patient complains of a mild sore throat. Which of the following actions should the

physician take first?

20) Which of the following drugs has been found consistently in clinical trials to reduce

the negative symptoms of schizophrenia (demotivation, self-neglect and reduced

emotion?

21) Which of the following best reflects the evidence on olanzapine as a treatment for

schizophrenia?

22) A 37-year-old Caucasian male with a history of chronic paranoid schizophrenia is

hospitalized for a relapse of symptoms. He is given parenteral haloperidol because

he is very agitated and threatening. The patient continues to be belligerent and has

to be put in physical restraints. The next day the patient is less agitated and

belligerent, but he reports feeling nauseated and tired and toward evening is found

to be disoriented to time and place. His laboratory work-up shows an increase in

BUN and creatinine. He is diagnosed with acute renal failure and transferred to the

medical floor. What could be the cause of his acute presentation?

23) A reduced density of interneurons in layer 2 of the prefrontal cortex has been

observed among patients with:

24) Which of the following cognitive impairments is found in persons with

schizophrenia?

27) The frontline treatment for schizophrenia is:

28) A 27-year-old patient with schizophrenia shows extreme psychomotor agitation to

the point of physical exhaustion. At times, he holds unusual, uncomfortable-looking

body positions. This patient is most likely to have which of the following subtypes

of schizophrenia?

30) In a 50-year-old patient with schizophrenia, the size of the cerebral ventricles,

glucose utilization in the frontal lobes and size of limbic structures are most likely

to be, respectively:

32) Which of the following symptoms of schizophrenia is likely to respond best to

antipsychotic medication?

33) A 53-year-old hospitalized patient with schizophrenia tells the physician that a

newscaster was talking about her when he said on television “a woman was found

shoplifting today”. This patient’s statement is an example of:

4) A 42-year-old man comes to the emergency room with the chief complain that “the

men are following me”. He also complains of hearing a voice telling him to hurt

others. He tells the examiner that the news anchor man gives his special messages

about the state of the world every night through the TV. This last belief is an

example of which of the following psychiatric findings?

35) A 38-year-old patient with schizophrenia tells the physician that the government has

been listening in on all of his phone conversations for the past year. The patient’s

false belief about the government is an example of a disorder of:

36) The negative symptoms (anhedonia, alogia, asociality, avolition and affective

flattening) of schizophrenia include all of the following, EXCEPT:

37) A 35-year-old woman has lived in a state psychiatric hospital for the past 10 years.

She spends most of her day rocking, muttering softly to herself, or looking at her

reflection in a small mirror. She needs help with dressing and showering, and she

often giggles and laughs for no apparent reason. Which of the following is the most

likely diagnosis?

38) Mr. A is a 22-year-old law student living alone in the school’s dormitory. He had

hopes to become a federal judge. Over the last 8 months his academic performance

has declined, and he is being considered for academic probation. He has become

increasingly isolated and withdrawn, and the girl he was dating broke off their

relationship. He believes that she had been replaced by a look-alike from a distant

planet, and that his fellow law students are conspiring against him. He believes

that they snort and sneeze whenever he enters the classroom. He reports getting

distracting “signals” from the television set, and that he hears voices of “the devil”

calling to him. He called his father and asked for his help. Distressed, his father,

himself a lawyer, brought his to the psychiatric emergency room for an evaluation.

Physical examination was normal, and laboratory tests, including head computed

tomography (CT) scan and urine toxicology, were negative. Which of the following

psychiatric conditions is the most likely diagnosis?

39) A 47-year-old woman is brought to the emergency room after she jumped off an

overpass in a suicide attempt. In the emergency room she states that she wanted to

kill herself because the devil has been tormenting her for many years. After

stabilization of her fractures, she is admitted to the psychiatric unit, where she is

treated with risperidone and sertraline. After two weeks she is no longer suicidal

and her mood is euthymic. However, she still believes that the devil is recruiting

people to try to persecute her. In the past 10 years, the patient has had three

similar episodes prior to this one. Throughout this time, she has never stopped

believing that the devil is persecuting her. Which of the following is the most

appropriate diagnosis for this patient?

40) A 19-year-old man is brought to the physician by his parents after he called them

from college, terrified that the Mafia was after him. He reports that he has eaten

nothing for the past six weeks other than canned beans because "they are into

everything—I can't be too careful." He is convinced that the Mafia has put cameras

in his dormitory room and that they are watching his every move. He occasionally

hears the voices of two men talking about him when no one is around. His

roommate states that for the past two months the patient has been increasingly

withdrawn and suspicious. Which of the following is the most likely diagnosis?

41) Which of the following medications has been found to be particularly effective for

treating insomnia associated with depression?

42) A 38-year-old man comes to his physician with complaints of impaired ejaculation.

He is on the following medications: perphenazine (antipsychotic), digoxin (digitalis

glycosides) and propranolol. He is also receiving methadone treatment and admits

to periodic cannabis use. Which substance is the most likely culprit in his problems

with ejaculation?

43) David is a 55-year-old man with periodic leg movements. His diagnosis has been

confirmed with more than 40 limb movements noted on an EMG in an 8-hour

period. He has daytime sleepiness and poor performance at work. What is the

appropriate initial treatment for David?

45) A 46-year-old man is brought to the emergency department by ambulance because

he has been having visual hallucinations for the past four hours. The patient’s wife

says he has had diarrhoea, agitation and confusion for the past two days. Two

weeks ago, he was fired from his job because of excessive absences. He has been

unable to find a new job and has been asking his friends for money for several days.

The patient has a 25-year-history of drinking one pint of whiskey daily.

Temperature is 38.5 °C (101.3 °F), pulse rate is 126/min and blood pressure

162/102 mmHg. Which of the following is the most appropriate initial management

of this patient’s condition?

46) A 34-year-old woman is admitted to the obstetrics ward to deliver a normal full-term

infant. Ten hours after the delivery, she tries to steal the infant out of the nursery

because she believes that the government is after her and will steal her child.

When confronted by a nurse, she attempts to scratch the nurse and grab her child.

47) A 20-year-old female patient tells the doctor that she has little interest in going back

to school or in getting a job. She also reports that she often craves snack food and

has gained over 10 pounds in the past 4 months. What substance is this patient

most likely to be using?

49) George is a 30-year-old man who complains of not being able to fall asleep. He says

that periodically he can fall asleep but that he may wake up at 1 to 2 A.M. And be

unable to fall asleep again. Medical and psychiatric causes of insomnia have been

ruled out. What medication would be most appropriate for George?

50) A 32-year-old man is diagnosed with a major depression. He and his psychiatrist

discuss starting an antidepressant. The patient is concerned about the chance for

impairment of his ability to get an erection on these kinds of medication. Which of

the following medications should the patient be started on to treat his depression

but avoid these symptoms?

51) An 85-year-old man is brought to the psychiatrist by his wife. She states that for the

last 4 months, since the death of his son, the patient has been unable to sleep, has

lost 20 lb, has crying spells and in the last week has been starting to talk about

suicide. She notes that he has been numerous other medical problems, including

prostatic hypertrophy, hypertension, insulin-dependent diabetes and a history of

myocardial infarction. Which of the following medications is most appropriate for

the treatment of this patient?

52) A 34-year-old secretary climbs 12 flights of stairs every day to reach her office

because she is terrified by the thought of being trapped in the elevator. She has

never had any traumatic event occurred in an elevator; nonetheless she has been

terrified of them since childhood. Which of the following is the treatment of choice

for this patient?

53) A therapist is using systematic desensitization to treat a client with a snake phobia.

It is like that her first step in treatment will be to ask the client to…

54) A 20-year-old woman tells the physician that sometimes she becomes frightened

when her room is dark because her computer looks like a lion lurking in the corner.

This is an example of:

55) A 65-year-old woman lives alone in a dilapidated house, although her family

members have tried in vain to move her to a better dwelling. She wears odd and

out-of-fashion clothes and rummages in the garbage cans of her neighbours to look

for redeemable cans and bottles. She is very suspicious of her neighbours. She was

convinced that her neighbours were plotting against her life for a brief time after

she was mugged and thrown onto the pavement by a teenager, but now thinks that

this is not the case. She believes in the “power of crystals to protect me” and has

them strewn haphazardly throughout her house. Which of the following is the most

likely diagnosis?

56) An individual with a schizotypal personality disorder will usually exhibit which of the

following characteristics?

58) A 23-year-old patient shows side effects such as sedation, increased appetite and

weight gain while being treated with antipsychotic medication. Of the following,

the mechanism most closely associated with these effects is:

59) A very anxious 25-year-old patient is examined in the emergency room. There is no

evidence of physical illness. If it could be measured, the g-aminobutyric acid (GABA)

activity in the brain of this patient would most likely be?

60) A 25-year-old male patient who is slow moving and has a flat affect is put on

fluoxetine (Prozac). Within 2 weeks, the patient is showing greatly increased activity

level, flight of ideas, and pressured speech. In this patient, the medication has:

61) An individual with obsessive-compulsive personality disorder will exhibit which of

the following characteristics?

63) Which compulsive behaviour might stem from an obsession with order and

symmetry?

65) A 28-year-old taxi driver is chronically consumed by fears of having accidentally run

over a pedestrian. Although he tries to convince himself that his worries are silly, his

anxiety continues to mount until he drives back to the scene of the "accident" and

proves to himself that nobody lies hurt in the street. This behaviour is an example

of which of the following?

66) A 33-year-old man comes to the psychiatrist because he is anxious about his new

job. He notes that he previously held a job shelving books in the back of a library, but

because of budget cuts he has been forced to interact with customers. He states he

does not like being around people and prefers being by himself. He appears

emotionally cold and detached during the interview. Which is the most appropriate

personality disorder?

67) A 27-year-old woman drops out of college after 2 weeks. When asked why, she

states although she would desperately like to have friends, she is afraid to

approach anyone because “they would think I am just a nerd”. Furthermore, in the

middle of a class, one of the professors asked her a question and she became

extremely uncomfortable. She has never had a significant relationship with anyone

other than her parents and sister.

68) Primary reinforcement by drugs of abuse engages a widespread network of the

brain’s motivational pathways, which include all of the following, EXCEPT:

69) All of the following antidepressants increase serotonin neurotransmission by

reuptake inhibition, EXCEPT:

70) A 36-year-old man is treated for depression with an SSRI. He has a less than full

recovery despite taking the highest recommended dose of the SSRI. The attending

psychiatrist is considering using an augmenting agent. All of the following can be

used, EXCEPT:

71) Symptoms of narcolepsy (=chronic sleep disorder, characterized by daytime

drowsiness and sudden attacks of sleep) include all of the following, EXCEPT:

75) Generalized Anxiety Disorder (GAD) is a pervasive condition in which the sufferer

experiences:

76) A 32-year-old woman comes to the psychiatrist with a chief complaint of anxiety.

She notes that she worries about paying the mortgage on time, whether or not she

will get stuck in traffic and be late for appointments, her husband’s and daughter’s

health, and the war in Iraq. She notes that she has always been anxious, but since

the birth of her daughter two years ago, the anxiety has worsened to the point that

she feels she cannot function as well as she did previously.

80) Which of the following psychotropic medications is most effective in preventing

relapse in rapid cycling bipolar disorder?

83) Animal models in psychiatric research have proven to be useful in which one of the

following disorders?

86) A physician becomes very angry with a patient when the patient does not take his

medication. The patient reminds the doctor of her rebellious son. This reaction to

the patient’s behaviour is most likely to be a result of:

95) Children with ADHD are known to have deficits in which of the following brain

areas?

96) Which of the following symptoms is most likely to persist when a young person

suffers from attention deficit and hyperactivity disorder (ADHD) becoming an adult?

98) Atomoxetine is a relatively new drug used for the treatment of ADHD. Which of the

following represents the advantage of using Atomoxetine over Ritalin?

99) A 9-year-old boy is referred to a psychiatrist because of poor school performance.

He has been tested for learning disabilities, but none are present, with an IQ in the

high normal range. The teacher reports that it is hard to hold his attention, he

appears hyperactive and fidgety at school, which disrupts the class, however, he

does not purposefully go out of his way to disobey the teacher. His parents have

noticed no difficulties at home, but his soccer coach has noticed attention problems

during practice, his Sunday school teacher has trouble teaching him because of

distractibility. Which of the following is the most likely diagnosis for this patient?

100) A 6-year-old boy with an early history of distractibility, hyperactivity, and

impulsivity is diagnosed with ADHD. He is treated with methylphenidate. Three

weeks later he is brought in and his inattention is much better. The mother also

notes that he has a small bald spot from where he has begun repeatedly rubbing his

head. You periodically observe him to suddenly raise his head to the spot, rub back

and forth once, and put his hand down. There is no rash but the area is hairless.

The most likely diagnosis is which of the following?

101) Which of the following is NOT usually associated with avoidant personality

disorder?