Knowledge Questionnaire
Instructions: Choose only one answer for each of the following questions.
1. ___ The biopsychosocial model includes all information that the biomedical
model addresses
a. True
b. False
2. ___ It is inappropriate to interrupt the patient when being patient centered
a. True
b. False
3. ___ A histrionic patient might have the most difficulty
a. Developing an attractive appearance
b. Expressing emotion
c. Keeping track of their bank account
d. Relating to other people
4. ___ What percentage of primary care mental health patients present entirely
with medically unexplained symptoms
a. 70%
b. 50%
c. 30%
d. 10%
5. ___ Which of the following is most accurate when diagnosing chronic pain
patients as having unexplained symptoms
a. You have to be honest with the patient that you can never really be
sure there is no underlying disease
b. When many psychological symptoms are present, this is a good clue
there is no disease basis for the chronic pain
c. You often need to repeat previous diagnostic studies because a
disease explanation often has developed in the interim
d. A high false positive rate using just physical and psychological
symptoms as diagnostic criteria means that most require a full
diagnostic work-up
6. ___ Closed-ended questions should not be used in patient-centered interview
a. True
b. False
7. ___ Which of the following patient statements or behaviors from the same
patient is the MOST important clue to the patient’s story (and thus should
preferentially be pursued)
a. “you’re younger than I expected”
b. “in 1984 my wife died”
c. Describing a very sad situation
d. Angrily striking the physicians desk while talking about an upsetting
topic
8. ___ Dependent personality features are suggested by a reclusive, isolated
lifestyle.
a. True
b. False
9. ___ Self-defeating personality features are often heralded by undue suspicion
of the doctor and others
a. True
b. False
10. __ Obsessive personality features are sometimes associated with patients
taking charge of the doctor-patient conversation
a. True
b. False
11. __ All but one of the following is a clue that a counterproductive (harmful)
reaction to the patient is present
a. An intense emotional response towards the patient
b. Similar reactions, such as anger or fear, to many different patients
c. The failure of a physician to use skills s/he is known to possess
d. A positive reaction a patient reminding one of a much loved parent or
grandparent
e. An emotional reaction to the patient similar to that of other doctors
12. __ Which of the following statements would be the LEAST effective when
interacting with a severe, chronic somatizing patient
a. We may be able to help you live a more normal life
b. Things seem especially bad for you right now; how are you able to
cope?
c. I think we’re on top of this and you’re going to get better and better
d. I’d like to see you on a regular basis. How about every two weeks? Be
sure to take the acetaminophen with each meal and at bedtime, not
just when you think you need it
13. __ The depression often seen in somatizing patients typically is unresponsive
to antidepressants
a. True
b. False
14. __ When attempting to convince a patient to change an undesirable health
behavior (e.g., smoking) a physician should begin by
a. Asking a patient’s understanding of the problem
b. Encouraging the patient to verbally commit to quitting smoking
c. Explaining to the patient why quitting smoking is necessary
d. Employing emotional handing skills repeatedly
15. __ With regards to deliberate self-harm (DSH) the following statement is not
true:
a. DSH is common in patients with borderline personality disorder
b. Hitting oneself and skin burning are more commonly observed than skin
cutting
c. DSH is often not associated with suicidal intent
d. DSH is typically a surreptitious behavior and is often not reported
16. __ In the US suicide is the 4th leading cause of death for adults between the
ages of 18 and 65 years. The following statement is true regarding the
epidemiology of suicide.
a. Men complete suicide less often than women.
b. The suicide rate decreases in men over the age of 60 years
c. HIV, cancer, and asthma are associated with the highest risk of suicide
attempts among those with medical diseases
d. The presence of young children living in a household increases the risk
of suicide
17. __ In bereavement, which of the following statements is inaccurate
a. Auditory and visual hallucinations may occur in normal bereavement
b. Antidepressant medications are contraindicated, since they prolong
the grieving process
c. Sedative hypnotic medications can be useful for sleep difficulties
d. Depressive symptoms are common and intense
18. __ In the sleep disruption of depression, the following statement is accurate
a. Sedative hypnotics are counterproductive and are likely to perpetuate
sleep difficulties
b. Caffeine may be helpful in countering daytime tiredness and improving
alertness
c. Sleep hygiene methods including daily exercise, avoiding naps, and a
relaxing sleep time routine are not beneficial
d. Sedative antidepressants such as mirtazapine and trazodone have no
role
19. __ The therapeutic benefits of electroconvulsive therapy derive from which
one of the following factors
a. The bilateral generalized seizure
b. The brief-pulse electrical stimulus
c. The inevitable but transient anterograde amnesia
d. The enduring effects of the electrical stimulus upon parasympathetic
(vagal) tone
20. __ In the longitudinal course of bipolar disorder, depressive episodes often
precede manic episodes. This can lead to misdiagnosis. Which one of the
following clinical features is more common in bipolar depression as
opposed to major depressive disorder
a. Insomnia more than hypersomnia
b. Postpartum episodes
c. Psychomotor agitation more than retardation
d. Later onset (30s vs. teens)
e. Insidious vs. abrupt episode onset
21. __ Which of the following interventions would not be acceptable as first line
in the initial treatment of an acute episode of bipolar (Type 1) depression?
a. Antidepressant monotherapy
b. A combination of lithium and lamotrigine
c. Olanzapine and fluoxetine
d. Quetiapine
22. __ In panic disorder, which of the following statements is not true?
a. 90% of patients present with physical symptoms
b. 30-50% of patients develop agoraphobia
c. 25% of patients who present to ERs with chest pain have panic disorder
d. 10% of patients with panic disorder have major depressive disorder
23. __ The pharmacotherapy of panic disorder includes all but one of the
following options
a. SSRIs/SNRI antidepressants
b. Atypical antipsychotics
c. Beta-blockers
d. Buspirone
24. __ In prescribing benzodiazepines in patients with panic disorder the
following is true
a. Since benzodiazepines produce rapid symptoms relief they are
commonly prescribed in conjunction with antidepressants
b. Short-acting agents such as alprazolam are more effective and are
preferred to long-acting agents such as clonazepam
c. Patients eventually develop tolerance to anti-anxiety effect of
benzodiazepines but not the sedative effect, hence the dose
escalation is compromised by unwanted sedation
d. The majority of patients ultimately develop physiological dependence
to benzodiazepine compounds and invariably use more than the
prescribed dose
25. __ Patients with major depression who experience a partial response to the
initial antidepressant drug may benefit from augmentation with one of
several different agents. Which of the following compounds is not
commonly used as an adjunctive drug in managing depressed patients
a. Lithium carbonate
b. Triiodothyronine
c. Buspirone
d. Metoprolol
26. __ Risk factors for the development of Post-Traumatic Stress Disorder include
all but one of the following
a. Inadequate social support
b. Severity of stressor
c. History of childhood abuse
d. Male gender
27. __ Which of the following is a diagnostic characteristic for Post-Traumatic
Stress Disorder
a. Tinnitus
b. Paresthesiae
c. Hyperarousal
d. Headache
28. __ The pharmacotherapy of Social Anxiety Disorder includes which one of
the following options
a. Sedative serotonin-dopamine antagonist antipsychotics
b. Lithium carbonate
c. SSRI antidepressants
d. Stimulants
29. __ With regards to premenstrual mood disorders, which one of the following
statements is not true
a. 75% of women experience some mood, behavioral or somatic
symptoms during the late luteal phase of menstruation
b. Most women with Premenstrual Dysphoric Disorder seek
complementary or alternative medicines
c. SSRIs are helpful for managing mood symptoms; whereas hormonal
interventions are superior for managing physical symptoms
d. Psychotic symptoms occur in about 5% of cases
30. __ Choose the incorrect statement concerning the occurrence of
hallucinations in clinical settings
a. Hypnogogic hallucinations are pathognomonic of narcolepsy
b. Visual and tactile hallucinations suggest an organic etiology
c. Olfactory hallucinations suggest temporal lobe disorder
d. Auditory hallucinations such as hearing voices are the most common
form of hallucinations
31. __ Delirium is commonly observed in hospitalized patients. Which of the
following clinical features is not characteristic of delirium
a. Disruption of the sleep wake cycle
b. Auditory hallucinations are more common than visual hallucinations
c. Can be missed in children, wherein the hallucinations can be
misattributed to “fantasizing”
d. Symptoms fluctuate from hour to hour
32. __ Which of the following statements is acceptable regarding use of
antidepressants in non-depressed patients taking interferon for hepatitis C
a. All patients should receive antidepressant therapy
b. Only patients with a past history of depression should receive
antidepressants
c. Antidepressants should be reserved for patients with suicidal ideation
d. Patients with a past history of any psychiatric disorder
33. __ Corticosteroids are commonly associated with neuropsychiatric sequelae.
Which of the following statements is true
a. Serious psychiatric sequelae are observed in 50% of patients receiving
steroids
b. Manic and hypomanic states are more commonly observed with
prolonged exposure
c. Depressive symptoms are more commonly observed with short courses
d. A dose dependent relationship is observed
34. __ Which of the following statements is incorrect
a. Varenicline is the antidepressant of choice in the depressed smoker
b. Depressed patients have a higher prevalence of cigarette smoking
than others
c. Smoking cessation is more likely to trigger a depressive relapse in
patients with depression than others
d. Depressed patients have more difficulty quitting and often require a
combination of bupropion, varenicline and nicotine replacement
methods along with supportive psychotherapy
35. __ The prevalence of dementia increases with age. Which of the following is
a correct statement concerning the epidemiology of dementia
a.
b.
c.
d.
The rate is 10-20% in general medical inpatients
In nursing homes the rate varies from 20-30%
In patients over the age of 90 the rate increases to 90%
Dementia is not observed in young adults
36. __ Delirium can be distinguished from dementia by the following clinical
features. Choose the single correct answer
a. The presence of hallucinations, delusions and ideas of reference
b. Agitated behavior that requires antipsychotic medication and physical
restraint
c. An acute onset, fluctuating course and a change of consciousness
d. Disorientation to time and place is generally more severe than
disorientation to person and situation
37. __ With regards to the pharmacotherapy of Alzheimer’s disease, choose the
single correct statement
a. Cholinesterase inhibitors have a moderate effect in improving
cognitive function when administered early in the course of the
disease
b. Glutamate NMDA receptor antagonists have a dramatic effect on
psychotic symptoms
c. Antipsychotics, which carry a black box warning in patients with
dementia, should be avoided
d. Divalproex is FDA approved for management of disruptive behavior
38. __ In managing hospitalized patients with delirium the following is an
appropriate first choice
a.
b.
c.
d.
Cognitive restructuring
Antipsychotics such as olanzapine
Disulfiram for alcohol withdrawal states
Sedative antidepressants
39. __ In managing late-onset depression, which of the following is correct
a. Antidepressant medications should be used at lower doses and should
be discontinued after the remission of depressive symptoms to minimize
adverse effects
b. Psychosocial approaches such as interpersonal and cognitive
behavior therapy are preferred to pharmacotherapy, because of the
risk of antidepressant-induced seizures
c. Electroconvulsive is a reasonable therapeutic option when patients fail
to respond to antidepressant medications
d. Adequate management of hypertension, diabetes and dyslipidemia
have a profound effect upon mood
40. __ Major depression is associated with comorbid psychiatric disorders less
than one half the time
a. True
b. False
41. __ When dysthymia coexists with major depression, treatment responses
typically are better for the depression
a. True
b. False
42. __ Which of the following is incorrect
a. Subsyndromal (minor) depression is not treated with antidepressants
b. Subsyndromal depression is a risk factor for major depression
c. The focus of treatment for subsyndromal depression is the current
symptom
d. Subsyndromal depression occurs commonly during grief and
bereavement
43. __ Satisfactory antidepressant medication treatment for the first episode of
major depression is 3-4 months
a. True
b. False
44. __ Which of the following is incorrect about the antidepressant
discontinuation syndrome
a.
b.
c.
d.
An increased death rate has been reported
Fluoxetine is least likely to do this
It is unrelated to the serotonin syndrome
The best treatment is to reinstitute the antidepressant
45. __ Which of the following antidepressants is most likely to have all these sideeffects: sedation, weight gain, sexual dysfunction
a.
b.
c.
d.
e.
Citalopram
Paroxetine
Venlafaxine
Buproprion
Fluoxetine
46. __ Which of the following side effects are more likely with SNRIs
a.
b.
c.
d.
Elevated blood pressure
Sexual side effects
Weight gain
Cardiac arrhythmias
47. __ Stimulants such as Ritalin have no place in managing depression
a. True
b. False
48. __ Compared to bipolar depression, one of the following is not true about
unipolar depression
a. More abrupt onset
b. More often in men
c. More insidious onset
d. Fewer episodes
49. __ While benzodiazepines have sometimes been effective with other anxiety
disorders, they should be used sparingly in PTSD because they often are
ineffective and make the symptoms worse.
a. True
b. False