DIRECTIONS: (Items 1-28) Each of the questions or incomplete statements below is followed by four or five suggested
responses or completions. Select the one that is best in each case
1.
A 29-year-old mother of two children requested
medical clearance for impending surgery for cysts in
her breasts. She described the cysts as rapidly
enlarging and unbearably painful. While drawing
attention to her breasts, she said: "They're so large and
so tender to the touch. And I just can't have relations.
Forget that."
The Patient is probably suffering from:
She also had disabling back pain that spread up and
down her spine and made her legs give out on her
suddenly, causing her to fall When discussing that
symptom, she winced visibly and said: "Oh, there it
goes; my back keeps clicking. The pain is so severe it
affects me with my kids. Pain like that will make
anyone into a beast." (She had previously been
suspected of child abuse.) She also complained of,
dyspnea and a dry cough that prevented her walking
uphill.
2.
A.
B.
C.
D.
E.
Which of the following statements about
conversion disorder is most accurate?
A.
B.
C.
Her medical history began at menarche with
dysmenorrhea and menorrhagia. At 18 she had
exploratory surgery for a possible ovarian cyst and
later underwent another operation for suspected
abdominal adhesions. She also had a history of
recurrent urinary tract symptoms, although no
organisms were ever clearly documented, and she had
normal findings after a workup for "an enlarged
thyroid." At various times she had received the
diagnoses of spastic colon, migraine, and
endometriosis.
D.
E.
3.
C.
D.
E.
4.
The physical examination at the time of her medical
visit revealed inconsistencies in the breast tissue but no
frank masses, and the mammography findings were
normal.
stocking-and-glove anesthesia
hemianesthesia of the body beginning
precisely at the midline
astasia-abasia
normal reflexes
all of the above
A third-year medical student returned to the
student health services for the third time with a
complaint of ulcerative colitis. After a thorough
medical workup, he was told that no organic
disease was present. Despite that reassurance, the
student continued to test his stool for blood and
continued to believe that his doctor had missed
the correct diagnosis. The student is exhibiting
A.
B.
C.
D.
E.
1
The inability to speak is intentionally
produced in a conversion disorder
Conversion disorder is most common
among patients in a high socioeconomic
group
Psychoanalytic theory holds that the major
defense mechanism in conversion disorder
is suppression
Mutism is one of the most common
symptoms of conversion disorder
La belle indifference is a necessary
component in making the diagnosis of
conversion disorder
Characteristic signs of conversion disorder
include
A.
B.
Two marriages, both to alcoholic and abusive men who
refused to pay child support, had ended in divorce. She
had lost several clerical jobs because of excessive
absences. During the periods when she felt worst, she
spent most of the day at home in a bathrobe while her
relatives cared for her children. She had a history of
opiate dependence and claimed that she began using
analgesics for her back pain and then, “I overdid it.”
hypochondriasis
conversion disorder
pain disorder
somatization disorder
body dysmorphic disorder
depersonalization
phobia
conversion disorder
bulimia nervosa
hypochondriasis
5.
A patient with somatization disorder
A.
B.
C.
D.
E.
6.
found in 1 to 2 per 1,000 deliveries
usually experienced within days of delivery
a psychiatric emergency
not to be confused with postpartum blues
all of the above
10. Examples of atypical psychoses include
A.
B.
C.
D.
E.
Capgras's syndrome
Cotard's syndrome
postpartum psychosis
koro
all of the above
11. According to the fourth edition of Diagnostic and
Statistical Manual of Mental Disorders (DSMIV), postpartum psychosis is best classified as
conversion disorder
hypochondriasis
somatization disorder
Ganser's syndrome
body dysmorphic disorder
A.
B.
C.
D.
E.
an anxiety disorder
psychotic disorder not otherwise specified
a mood disorder
schizophrenia
a personality disorder
12. A 17-year-old high school junior was brought to
the emergency room by her distraught mother,
who was at a loss to understand her daughter's
behavior. Two days earlier, the patient's father
had been buried; he had died of a sudden
myocardial infarction earlier in the week. The
patient had become wildly agitated at the
cemetery, screaming uncontrollably and needing
to be restrained by relatives. She was
inconsolable at home, sat rocking in a corner, and
talked about a devil that had come to claim her
soul. Before her father's death, her mother
reported, she was a "typical teenager, popular, a
very good student, but sometimes prone to
overreacting." The girl had no previous
psychiatric history.
Vaginismus
Hypoactive sexual desire disorder
Sexual Aversion Disorder
Anorgasmia
None of the above
Most studies of normal pregnant women indicate that
the percentage who report the blues in the early
postpartum period is about
A.
B.
C.
D.
E.
Postpartum psychosis is
A.
B.
C.
D.
E.
A recurrent or persistent genital pain occurring before,
during or after sexual intercourse in men or women is
called
A.
B.
C.
D.
E.
8.
presents the initial physical complaints after age
30
has had physical symptoms for three months
has complained of pain, gastrointestinal, sexual,
and pseudoneurological symptoms, which are not
explained by a known medical condition
usually experiences minimal impairment in social
or occupational functioning
may have a false belief of being pregnant and
objective signs of pregnancy, such as decreased
menstrual flow or amenorrhea
All the following are classified as somatoform
disorders except
A.
B.
C.
D.
E.
7.
9.
10 percent
25 percent
50 percent
75 percent
100 percent
The most likely diagnosis is
A.
B.
C.
D.
E.
2
grief
brief psychotic disorder
schizophrenia
substance intoxication
delusional disorder
13. People going through the dying process:
A.
B.
C.
D.
17. Regarding the reporting of patients who have
HIV+ status:
are often left out of communications
regarding their health and prognosis
often experience a sense of loss of control
Usually want to be left alone
both A and B
A.
B.
14. According to Elizabeth Kubler-Ross:
A.
B.
C.
D.
denial, which is the first stage of dying, is a
brief stage which is experienced only when
diagnosed with a terminal illness
acceptance is a happy stage when the dying
person has come to terms with impending
death and has said his/her goodbyes
bargaining is a stage during which
individuals "shop around" for a different
prognosis
the stage of denial may occur more than
once during the terminal illness
C.
D.
E.
18. Individuals who have experienced, for a period of
two weeks or more, sad mood, weight los s or
gain, insomnia or hypersomnia, psychomotor
agitation or retardation, loss of energy, poor
concentration, feelings of worthlessness, passive
suicidal ideation:
15. Children who are dying
A.
B.
C.
D.
should be provided with all the details of
their illness and prognosis
should be provided with age-appropriate
information regarding their illness and
prognosis
should be shielded as much as possible
from the realities of their prognosis
should only be informed about their illness
if they are age 10 or older
A.
B.
C.
D.
16. Physicians working with dying patients:
A.
B.
C.
D.
physicians must keep information regarding
HIV status confidential
physicians are required to report HIV
status to the Department of Health and
must make every effort to inform
individuals who are at risk to contract the
virus from the patient
physicians are required to report HIV
status to the Department of Health and
they may inform the patient's spouse
only the Department of Health should be
informed about a patient's H1V status
physicians are required to report HIV
status, but never have to provide the
patient's name
E.
need to protect themselves by distancing
from the patient
need to become more empathic and
improve communication skills
often become depressed
must appear competent at all times
3
are probably in shock and should be
watched carefully
should be hospitalized immediately to
prevent a suicide attempt
should be referred to a psychologist for
counseling
should be given antidepressant medication
and watched carefully by the physician
are likely to be clinically depressed and
should be referred to a psychiatrist for
psychotropic medication evaluation and for
therapy
19. The difference between "normal" anxiety
associated with a diagnosis of HIV+ and a
diagnosable anxiety disorder is:
A.
B.
C.
D.
E.
23. Pain conduction pathways include:
A.
B.
C.
D.
E.
the patient experiences significant distress
or impairment in social, occupational, or
other important areas of functioning if they
meet criteria for an anxiety disorder
the patient always experiences panic attacks
if they have an anxiety disorder
patients with "normal" anxiety use their
anxiety to help them cope with their
disorder
there is no difference - it is just a matter of
degree
patients with a diagnosable disorder are
usually preoccupied with bodily concerns
and fears of contamination
ceberal cortex
hypothalamus
lateral spinothalamic tract
both A and B
both A and C
24. Research has demonstrated that in the United
States approximately of adults are dieting
and evidence body image dissatisfaction, while
anorexia nervosa and bulimia nervosa are
diagnosed in approximately of the
population.
A.
B.
C.
D.
50% to 70%; 1% to 4%
1% to 4%; 50% to 70%
10%; 10%
1%; 1%
20. Dementia:
A.
B.
C.
D.
E.
25. Research suggests that experiences are
associated with simple dieting and eating
disorders between ages 11 to 13, while
experiences are associated with increased dieting
and eating disorders between the ages of 14 to 15.
is characterized by cognitive, personality,
psychotic, and motor symptoms and is only
seen in the advanced stages of AIDS
is characterized by cognitive impairments
2 and behavior changes and often progresses
during the course of the infection
is usually only found in older individuals
who are HIV+
is usually only found in the very old and
very young who are HIV+
is not yet recognized as an AIDS-related
problem
A.
B.
C.
D.
26. Comorbidity rates for substance abuse and eating
disorders between 6% to 50% depending on the
eating disorder and the substance. Katzman
(1991) found that patients were more secretive
about their ______ abuse that their______ abuse.
21. The treatment plan for chronic pain usually does
not include:
A.
B.
C.
D.
E.
management of secondary factors
rest
treatment with antidepressant medications
withdrawal from narcotic analgesics
biofeedback
A.
B.
C.
D.
Food; Substance
Substance; Food
ETOH; Marijuana
Marijuana; ETOH
27. A study by Stewart found that around _______
percent of infertile women and _____percent of
women with amenorrhea were found to also have
anorexia nervosa, bulimia nervosa, or subclinical
eating disorders.
22. Which forms of analgesia are naloxone-reversible?
A.
B.
C.
D.
E.
Negative; New
No; New
New; Negative Body
Menarche; Dating
acupuncture
narcotic administration
placebo
all of the above
none of the above
A.
B.
C.
D.
4
17; 58
0; 10
1; 1
70; 35
28. According to DSM-IV, if an individual was
expected to weight 120 pounds but currently
weights 100 pounds, refuses to eat, fears gaining
weight, and binges and purges daily would meet
diagnostic criteria for?
A.
B.
C.
D.
E.
bulimia nervosa
anorexia nervosa
eating disorder not otherwise specified
Axis III coding
all of the above
DIRECTIONS:(Items 29-45)The questions below consist
of lettered headings followed by a list of numbered words
or phases. For each numbered word or phrase, select one
lettered heading that is most closely associated with it.
Each heading may be used once, more than once, or not
at all.
QUESTIONS 29 - 32
A.
B.
C.
Conversion disorder
Pain disorder
Somatization disorder
29. La belle indifference
30.
Briquet's syndrome
31. Alexithymia
32. Astasia-abasia
QUESTIONS 33 - 36
A.
B.
C.
D.
Desire phase
Excitement phase
Orgasm phase
Resolution phase
33. Male erectile disorder
34. Premature ejaculation
35. Sexual Aversion Disorder
36. Detumescence
5
QUESTIONS 37 - 42
A.
B.
C.
D.
E.
Frotteurism
Voyeurism
Vaginismus
Partialism
Dyspareunia
37. Persistent genital pain occurring before, during or
after intercourse
38. Rubbing up against a fully clothed woman to
achieve orgasm
39. Cunnilingus
40. Fellatio
41. Observing people who are naked or engaging in
sexual activity
42. Involuntary muscle contraction
QUESTIONS 43 - 45
A.
B.
C.
Amok
Koro
Wihtigo
43. Delusion that the person's penis is shrinking and
may disappear
44.
Affected persons believe that they may be
transformed into a giant monster that eats human
flesh
45. Sudden, unprovoked outburst of wild rage in
which affected persons attack anything in their
path
6