0.92.39.9 ‫שחזור מבחן לקראת סטאז' ורישוי רופאים‬
Pretest Psychiatry 12edition
1. A 42-year-old man comes to the emergency room with the chief complaint
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
anchorman gives him special messages about the state of the world every
night through the TV. Which of the following psychiatric findings best
describes this last belief of the patient?
a. Grandiose delusion
b. Illusion
c. Loose association
d. Idea of reference
e. Clouding of consciousness
26. A 65 year old man who had been hospitalized for an acute pneumonia 3 day’s previously .
begins screamlining for his nurse , stating that there are people in the room out to get me, he then
gets our of the bed and begins pulling out his IV line, on examination he alternates between
agitation and somnolence, he is not oriented to time and place, his vital sings are as following
:Pulse 126 beats per minute, respiration 32 breaths per minute, blood pleasure 80/58 ,
temperature 39 C which of the folloing diagnoses best fits this patients clinical picture?
A. Dementia
B. schizophrenform disorder
C. fugue state
D. Delirium
E. Brief psychotic episode
32. A 28-year-old business executive sees her physician because she is
having difficulty in her new position, as it requires her to do frequent public
speaking. She states that she is terrified she will do or say something that
will cause her extreme embarrassment. The patient says that when she
must speak in public, she becomes extremely anxious and her heart beats
uncontrollably. Based on this clinical picture, which of the following is the
most likely diagnosis?
a. Panic disorder
b. Avoidant personality disorder
c. Specific phobia
d. Agoraphobia
e. Social phobia
96. Benzodiazepines, barbiturates, and many anticonvulsants exert their
influence through which of the following types of receptors?
a. Muscarinic
b. Dopaminergic
c. Glutamic
d. Adrenergic
e. -Aminobutyric acid (GABA)–ergic
48. A 6 months old male infant is noted by his father to be difficult to care for, he is very
difficult to feed or soothe, and often responds to cuddling by crying and becoming rigid in his
mothers arms , physical examination and laboratory works are all entirely normal, which of the
following psychiatric disorders is this infant at a higher risk to display in his early school years?
A. Conduct disorder
B. childhood schizophrenia
C. separation anxiety disorders
D. antisocial personality disorder
E. Pica
100. After being struck on the head by a four-by-four piece of wood, a
previously serious and dependable construction worker starts making
inappropriate sexual remarks to his coworkers, is easily distracted, and
loses his temper over minor provocations. What part of his brain has most
likely been damaged?
a. Occipital lobe
b. Temporal lobe
c. Limbic system
d. Basal ganglion
e. Frontal lobe
105. A 17-year-old boy is brought to the emergency room by his friends
after he “took a few pills” at a party and developed physical symptoms,
including his neck twisting to one side, his eyes rolling upward, and his
tongue hanging out of his mouth. The patient responds immediately to
50 mg of diphenhydramine intramuscularly with the resolution of all physical
symptoms. Which of the following substances is most likely to have
caused the symptoms?
a. Methamphetamine
b. Meperidine
c. Alprazolam
d. Methylphenidate
e. Haloperidol
152. A 70-year-old man with a dementing disorder dies in a car accident.
During the previous 5 years, his personality had dramatically changed and
he had caused much embarrassment to his family because of his intrusive
and inappropriate behavior. Pathological examination of his brain shows
frontotemporal atrophy, gliosis of the frontal lobes’ white matter, characteristic
intracellular inclusions, and swollen neurons. Amyloid plaques and
neurofibrillary tangles are absent. Which of the following is the most likely
diagnosis?
a. Alzheimer disease
b. Pick disease
c. Creutzfeldt-Jakob disease
d. B12 deficiency dementia
e. HIV dementia
153. A 24-year-old previously healthy man is brought to the emergency
room after he began yelling that people on the bus were out to hurt him. In
the emergency room, he is agitated, hypervigilant, and anxious. He is
unable to give much history other than to say that he is a graduate student
and nothing like this has ever happened before. Which of the following is
the most likely cause of this behavior?
a. Delirium
b. Pick disease
c. Dissociative disorder
d. Vitamin B12 deficiency
e. Cocaine intoxication
154. An emaciated and lethargic 16-year-old girl arrives at the emergency
room. Her blood pressure is 75/50, her heart rate is 52 beats per minute,
her potassium is 2.8 meq/L, and her bicarbonate is 40 meq/L. The girl’s
parents report that she has lost 35 lb in 3 months but is still convinced that
she is overweight. She eats only very small amounts of low-calorie food,
and she runs 2 to 3 hours every day. What other activities is this patient
most likely to have engaged in?
a. Sexual promiscuity
b. Ethanol abuse
c. Purging
d. Wearing tight clothes
e. Shoplifting
156. A 43-year-old man is admitted to the neurology service after he went
blind suddenly on the morning of admission. The patient does not seem
overly concerned with his sudden lack of vision. The only time he gets
upset during the interview is when he is discussing his mother’s recent
death in Israel––he was supposed to bring his mother to the United
States, but did not because he had been using drugs and did not save the
necessary money. Physical examination is completely negative. Which of
the following is the most likely diagnosis?
a. Conversion disorder
b. Hypochondriasis
c. Factitious disorder
d. Malingering
e. Delusional disorder
163. A 69-year-old man with a diagnosis of delirium has symptoms of
psychosis which include: frightening auditory and visual hallucinations
and paranoid delusions. Which of the following medications should be
chosen first for this man’s symptoms?
a. Haloperidol
b. Quetiapine
c. Valium
d. Olanzepine
e. Ziprasidone
164. A 34-year-old man recurrently perceives the smell of rotten eggs.
This kind of hallucination is most commonly seen in patients with which
of the following diagnoses?
a. Parietal tumors
b. Narcolepsy
c. Grand mal epilepsy
d. Partial complex seizures
e. Wilson disease
173. A 23-year-old man comes to the physician with the complaint that
his memory has worsened over the past 2 months and that he has difficulty
concentrating. He has lost interest in his friends and his work. He has difficulty
with abstract thoughts and problem solving. He has also felt
depressed. MRI scan shows parenchymal abnormalities. Which of the following
is the most likely diagnosis?
a. Alzheimer disease
b. Vascular dementia
c. HIV-related dementia
d. Lewy body disease
e. Binswanger disease
189. Which of the following is the most common cause of delirium in the
elderly?
a. Substance abuse
b. Accidental poisoning
c. Hypoxia
d. Use of multiple medications
e. Alcohol withdrawal
207. A 58-year-old woman with a chronic mental disorder comes to the
physician with irregular choreoathetoid movements of her hands and trunk.
She states that the movements get worse under stressful conditions. Which
of the following medications is most likely to have caused this disorder?
a. Fluoxetine
b. Clozapine
c. Perphenazine
d. Diazepam
e. Phenobarbitol
230. A 25-year-old woman is diagnosed with schizophrenia when, after
the sudden death of her mother, she begins complaining about hearing the
voice of the devil and is suddenly afraid that other people are out to hurt
her. Her history indicates that she has also experienced a 3-year period of
slowly worsening social withdrawal, apathy, and bizarre behavior. Her family
history includes major depression in her father. Which of the following details
of her history leads the physician to suspect that her outcome may be poor?
a. She is female.
b. She was age 25 at diagnosis.
c. She had an acute precipitating factor before she began hearing voices.
d. She had an insidious onset of her illness.
e. There is a history of affective disorder in her family
234. A 62-year-old man with chronic schizophrenia is brought to the
emergency room after he is found wandering around his halfway house,
confused and disoriented. His serum sodium concentration is 123 meq/L
and urine sodium concentration is 5 meq/L. The patient has been treated
with risperidone 4 mg/day for the past 3 years with good symptom control.
His roommate reports that the patient often complains of feeling thirsty.
Which of the following is the most likely cause of this patient’s symptoms?
a. Renal failure
b. Inappropriate antidiuretic hormone (ADH) secretion
c. Addison disease
d. Psychogenic polydipsia
e. Nephrotic syndrome
241. A 45-year-old man is diagnosed as having diabetes and will require
insulin. His physician explains the use of the medication and tells the
patient that he will need to be seen at frequent intervals until his glucose
levels come under good control. The patient has always been somewhat
hostile with the physician, but upon hearing this news, he says angrily,
“You doctors are always the same! You always want control––of my time, of
my money, and now of my every action!” As far as the physician knows,
this patient has never had an unpleasant encounter with a physician before.
Which of the following is the most likely explanation for the patient’s reaction
to his doctor?
a. The patient is becoming delusional.
b. The patient is experiencing transference to this authority figure.
c. The patient is splitting.
d. The patient is becoming manic.
e. The patient is anticipating being rejected by his physician
291. A 25-year-old man comes to the psychiatrist with a chief complaint
of depressed mood for 1 month. His mother, to whom he was very close,
died 1 month ago, and since that time he has felt sad and been very tearful.
He has difficulty concentrating, has lost 3 lb, and is not sleeping soundly
through the night. Which of the following is the most likely diagnosis?
a. Major depression
b. Dysthymia
c. Posttraumatic stress disorder
d. Adjustment disorder
e. Uncomplicated bereavement
298. How long after a stroke is a patient at a higher risk for developing a
depressive disorder?
a. 2 weeks
b. 2 months
c. 6 months
d. 1 year
e. 2 years
303. A 27-year-old woman has been feeling blue for the past 2 weeks. She
has little energy and has trouble concentrating. She states that 6 weeks ago
she had been feeling very good, with lots of energy and no need for sleep.
She says that this pattern has been occurring for at least the past 3 years,
though the episodes have never been so severe that she couldn’t work.
Which of the following is the most likely diagnosis?
a. Borderline personality disorder
b. Seasonal affective disorder
c. Cyclothymic disorder
d. Major depression, recurrent
e. Bipolar disorder, depressed
313. Which of the following is a relative contraindication for ECT?
a. Space-occupying lesion in the brain
b. Pregnancy
c. Hypertension
d. Seizure disorder
e. Status post–myocardial infarction 6 months earlier
316. A 32-year-old man is being treated for a severe major depression.
Which of the following symptoms, if present, is one of the most accurate
indicators of long-term suicidal risk?
a. Revenge fantasies
b. Presence of rage in the patient
c. Hopelessness
d. Presence of guilt
e. The patient has a need for punishment
328. 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 behavior best exemplifies which of the following?
a. A compulsion secondary to an obsession
b. An obsession triggered by a compulsion
c. A delusional ideation
d. A typical manifestation of obsessive-compulsive personality disorder
e. A phobia
334. A 33-year-old man comes to his physician for an HIV test. The test is
positive. The patient has no signs or symptoms of AIDS. Which of the following
psychiatric diagnoses may develop in as many as 25% of patients
informed of a positive HIV test?
a. Adjustment disorder with anxiety
b. PTSD
c. Bipolar disorder, manic
d. Panic disorder
e. Hypochondriasis
347. A 24-year-old woman comes to the psychiatrist with a 2-month history
of short episodes of “feeling like I am going to die.” During these
episodes, she also notes feelings of dizziness and nausea, along with a feeling
of choking. She describes these episodes as very frightening and she is
terrified of having another. She denies substance use of any medical problems.
Which of the following treatment regimens should be started?
a. Imipramine
b. Fluoxetine
c. Phenelzine
d. Paroxetine and alprazolam
e. Buspirone and citalopram
355. Every 4 or 5 weeks, a usually well-functioning and mild-mannered
35-year-old woman experiences a few days of irritability, tearfulness, and
unexplained sadness. During these days, she also feels fatigued and bloated
and eats large quantities of sweets. Which of the following is the most likely
diagnosis?
a. Cyclothymia
b. Borderline personality disorder
c. Dissociative identity disorder
d. Premenstrual dysphoric disorder
e. Minor depressive disorder
358. A demanding 25-year-old woman begins psychotherapy stating that
she is both desperate and bored. She reports that for the past 5 or 6 years
she has experienced periodic anxiety and depression and has made several
suicidal gestures. She also reports a variety of impulsive and self-defeating
behaviors and sexual promiscuity. She wonders if she might be a lesbian,
though most of her sexual experiences have been with men. She has
abruptly terminated two previous attempts at psychotherapy. In both cases
she was enraged at the therapist because he was unwilling to prescribe anxiolytic
medications. Which of the following is the most likely diagnosis?
a. Dysthymia
b. Histrionic personality disorder
c. Antisocial personality disorder
d. Borderline personality disorder
e. Impulse control disorder not otherwise specified
375. A young woman presents to the emergency room vomiting bright red
blood. Once she is medically stable, the intern who performs her physical
examination notices that the enamel of her front teeth is badly eroded and
her parotid glands are swollen. Which of the following best describes the
source of these medical complications?
a. Inadequate caloric intake
b. Purging
c. Laxative abuse
d. Diuretic abuse
e. Ipecac toxicity
378. A 52-year-old woman is diagnosed with breast cancer that is metastatic
to her bones. She comes to the psychiatrist for help in managing her
depressed mood and anxiety secondary to this diagnosis. Which of the following
would most likely indicate an increased vulnerability to suicide if
found in this patient, in addition to her anxiety and depressed mood?
a. The extent of the cancer’s spread to her bones
b. The location of the bone metastases to her bones
c. A feeling of a loss of control
d. How much pain she has with the metastases (even though it is currently wellcontrolled)
e. A history of social phobia
401. A 36-year-old woman comes to the emergency room after she is
found unresponsive at a party. Urine toxicology is positive for cocaine.
Upon awakening, the patient is interviewed and is found to have a history
consistent with cocaine abuse. Which of the following is this patient at an
increased risk for having?
a. Death by suicide
b. Avoidant personality disorder
c. ADHD
d. Bipolar disorder––mania
e. Mild mental retardation
413. A 16-year-old male with a long record of arrests for breaking and
entering, assault and battery, and drug possession is found dead in his
room with a plastic bag on his head. For several months he had been experiencing
headaches, tremors, muscle weakness, unsteady gait, and tingling
sensations in his hands and feet. These symptoms (and the manner in
which the boy died) suggest that he was addicted to which of the following
substances?
a. PCP
b. Cocaine
c. Methamphetamine
d. An inhalant
e. Heroin
438. A 30-year-old woman is diagnosed as bipolar. At the same time that
this illness is diagnosed, it is discovered that she is pregnant. Which of the
following drugs has the highest risk to the fetus if used?
a. Valproic acid
b. Lithium
c. Chlorpromazine
d. Haloperidol
e. Fluoxetine