II.1. Transference is defined as which of the following descriptions?
a. An unconscious redirection of feelings from 1 person to another
by a patient
b. Redirection of a therapist’s feelings toward a patient
c. A defense mechanism to describe the attribution of exaggerated
positive qualities to others
d. Transferring the power in the therapeutic relationship to the
therapist
e. A therapist’s attempt to help patients tolerate unpleasant emo-
tions without resorting to maladaptive defense mechanisms
II.1. Answer a.
Transference is a patient’s unconscious redirection of feel-
ings from 1 person to another. Countertransference is the
feelings of a therapist toward the patient.
II.2. Redirection of unacceptable impulses into a socially approved
activity is the definition of which of the following defense
mechanisms?
a. Altruism
b. Rationalization
c. Sublimation
d. Suppression
e. Undoing
II.2. Answer c.
Defense mechanisms are unconscious techniques of the ego
that help a person cope with anxiety by blocking or divert-
ing conflicts from conscious awareness. Sublimation refers
to the redirection of unacceptable impulses into a socially
acceptable activity. (See Table 37.1.)
II.3. Word lists and oral stories are commonly used to evaluate which
of the following?
a. Visual memory
b. Orientation
c. Verbal memory
d. Calculation
e. Abstraction
II.3. Answer c.
Word lists and stories are commonly used to evaluate verbal
memory. Geometric designs or shapes are commonly used to
evaluate visual memory.
II.4. Which of the following statements is true about the Mini-Mental
Status Examination (MMSE)?
a. The maximum score is 50 points
b. It has a high sensitivity for diagnosing mild cognitive impairment
c. Its sections are Orientation, Memory (registration and recall),
Attention and Concentration, Language, and Visuospatial Function
d. A score of 27 or less has a high specificity for predicting dementia
e. It is lengthy to administer
II.4. Answer c.
The MMSE provides a general summary of cognitive func-
tion and is easy to administer. The sections are Orientation,
Memory, Attention and Concentration, Language, and
Visuospatial Function. The maximum score is 30 points. A
cutoff of 23 or less has a sensitivity of 81% and a specificity
of 89% for predicting dementia. There is less certainty about
its use in mild cognitive impairment.
II.5. Oppositional defiant disorder is most common in which of the
following age groups?
a. Infancy
b. Preschool age
c. School age
d. Early adolescence
e. Adulthood
II.5. Answer b.
Psychiatric disorders that could emerge in preschool-aged
children include separation anxiety, oppositional defiant
disorder, and attention-deficit/hyperactivity disorder.
II.6. Cyberbullying may have the highest risk at what stage?
a. Preschool
b. School age
c. Preadolescence
d. Late adolescence
II.6. Answer c.
Preadolescents tend to stress the value of shared rules in sus-
taining good social relationships and maintaining social
order. Preadolescence is also a time when social media can
exert profound influence.
II.7. An elderly woman’s husband is dying of Alzheimer disease. She
thinks if she devotes the rest of her life to God, perhaps her hus-
band will get better. This is an example of what stage of grief?
a. Denial
b. Anger
c. Bargaining
d. Depression
e. Acceptance
II.7. Answer c.
People in the bargaining stage of grief try to negotiate away
the pain. They commonly make “what if” and “if only” state-
ments, wondering if things could be different.
II.8. Which of the following statements is true about major depres-
sive disorder (MDD) in the United States?
a. Average age of onset is approximately 30 years, and twice as
many women as men are affected
b. The lifetime prevalence of MDD is 30%
c. MDD is the third leading cause of disability in the Western world
d. Although an equal number of men and women have MDD, the
age of onset for women is younger than for men
e. MDD is less common than generalized anxiety disorder
II.8. Answer a.
The lifetime prevalence of MDD in US adults is approxi-
mately 17%, and the 12-month prevalence is approximately
7%. The average age at onset of MDD is 32 years, with MDD
affecting nearly twice as many women as men. It was the
leading cause of disability in the Western world in 2010.
II.9. The first-line therapy for major depressive disorder is which of
the following treatments?
a. Tricyclic antidepressant
b. Lithium
c. Selective serotonin reuptake inhibitor
d. Exposure therapy
e. Electroconvulsive therapy
II.9. Answer c.
First-line pharmacologic therapy for major depressive disor-
der is selective serotonin reuptake inhibitor. Cognitive behav-
ioral therapy is also common and effective.
II.10. Distractibility, inflated self-esteem, impulsivity, and flight of
ideas are characteristics of which of the following situations?
a. Psychosis
b. Mania
c. Grandiose delusional disorder
d. Posttraumatic stress disorder
e. Long-term cannabis use
II.10. Answer b.
Characteristics of mania can be remembered with the mne-
monic DIGFAST, for distractibility, insomnia, grandiosity,
flight of ideas, activities or agitation, speech, and thought-
lessness. (See Box 39.2 for further details.)
II.11. The difference between bipolar I disorder and bipolar II disorder
is described for which of the following patient groups?
a. Patients with bipolar II do not have racing thoughts
b. Patients with bipolar II have hypomania that does not impair
function substantially and does not contain psychosis
c. Patients with bipolar II do not have major depressive episodes
d. Patients with bipolar II cycle more rapidly between mania and
depression
e. Patients with bipolar II respond well to tricyclic antidepressants
II.11. Answer b.
Bipolar I patients have episodic mania and depression. The
episodes of mania last at least 7 days and may include psy-
chosis. The hypomanic episodes of bipolar II may last 4 days
to less than 7 days, do not seriously affect functioning, and
cannot contain psychotic symptoms.
II.12. Four general criteria are used to identify pathologic or clinically
important anxiety. These criteria are intensity, disproportional-
ity to life circumstances, duration, and which other?
a. Presence of cognitive symptoms
b. Tachycardia
c. Impairment of activities of daily living
d. Triggering event
e. History of abuse or neglect, or both
II.12. Answer c.
The 4 general criteria for pathologic anxiety are intensity,
disproportionality to life circumstances, duration, and
impairment of activities of daily living.
II.13. Childhood-onset obsessive-compulsive disorder (OCD) can be
associated with which of the following conditions?
a. Hyperthyroidism
b. Attention-deficit/hyperactivity disorder
c. Substance abuse
d. Borderline personality disorder
e. Primitive neuroectodermal tumor
II.13. Answer b.
Childhood-onset OCD is more commonly associated with
attention-deficit/hyperactivity disorder, anxiety disorders,
and tic disorders than adult-onset OCD.
II.14. What is the first-line medication therapy for generalized anxiety
disorder?
c. Monoamine oxidase inhibitors
d. Selective serotonin reuptake inhibitor
e. Benzodiazepine
II.14. Answer d.
All selective serotonin reuptake inhibitors and serotonin
and norepinephrine reuptake inhibitors are considered first-
line agents for treatment of generalized anxiety disorder
because of their lack of abuse and dependence potential
(unlike benzodiazepines) and their favorable adverse effect
profiles (relative to tricyclic antidepressants).
II.15. Which of the following is not 1 of the 4 main symptom clusters
of posttraumatic stress disorder (PTSD)?
a. Intrusive symptoms
b. Avoidance
c. Alterations in mood and cognition
d. Hyperarousal
e. Hallucinations
II.15. Answer e.
The 4 main symptom clusters that constitute the syndrome
of PTSD are intrusive symptoms, avoidance, alterations in
mood and cognition, and hyperarousal. In addition to these
clusters, the diagnosis of PTSD is distinctive since it requires
a presumptive cause (a traumatic event).
II.16. The average age at onset of schizophrenia for women is which of
the following age ranges?
a. Younger than 15 years
b. 15-20 years
c. 25-30 years
d. 40-50 years
e. >60 years
II.16. Answer c.
The mean age at onset of schizophrenia for men is typically
the early 20s, but for women, it is the late 20s.
II.17. Active-phase symptoms of schizophrenia do not include which of
the following symptoms?
a. Delusions
b. Disordered thought processes
c. Depression
d. Disorganized behavior
e. Social withdrawal
II.17. Answer c.
Active-phase symptoms of schizophrenia include delusions
or hallucinations, disorganized speech (reflecting disor-
dered thought processes, such as loose associations or frank
derailment), disorganized behavior (ie, markedly odd, dys-
functional behavioral patterns), catatonic signs, and nega-
tive symptoms (eg, blunted affect, poverty of speech, social
withdrawal, avolition). Although patients may have blunted
affect, depression is not a core active-phase symptom.
II.18. A patient has an elevated sense of their power, talent, skills, or
accomplishments. This describes what type of delusional disorder?
a. Grandiose
b. Persecutory
c. Somatic
d. Jealous
e. Erotomanic
II.18. Answer a.
Grandiose delusional disorder is characterized by a grandi-
ose sense of power, talent, skills, or accomplishments. Mania
must be ruled out.
II.19. Substance abuse would be more common in which one of the
following personality disorders?
a. Narcissistic
b. Avoidant
c. Schizoid
d. Obsessive-compulsive
e. Dependent
II.19. Answer a.
Substance abuse disorders are more commonly associated
with Cluster B personality disorders. Cluster B includes
antisocial, borderline, histrionic, and narcissistic personal-
ity disorders.
II.20. Which of the following characteristics is not part of narcissistic
personality disorder?
a. Grandiose sense of importance
b. Preoccupation with fantasies of unlimited power and brilliance
c. Lack of empathy
d. More prevalent in women
e. Anger resulting from any criticism
II.20. Answer d.
Narcissistic personality disorder is more common in men
and affects less than 1% of the population. Patients have a
grandiose sense of self and are hurt and angered by criticism.
II.21. Which is the most treatable disorder of the following personality
disorders?
a. Avoidant
b. Schizoid
c. Dependent
d. Borderline
e. Paranoid
II.21. Answer d.
Borderline personality disorder is one of the most treatable
personality disorders. Approximately 50% of patients with
borderline personality disorder no longer meet full criteria
within 2 years, a finding that increases to 80% within 10
years, although functional impairments typically persist.
II.22. Which of the following statements is not true about functional
neurologic symptom disorder?
a. Patient shows motor or sensory deficits that do not fit the known
physiologic mechanism
b. Patient has motivation to avoid prosecution or gain financially
from the neurologic symptoms
c. The symptoms and signs are unconscious
d. Patients often seek multiple opinions
e. Functional neurologic symptom disorder replaces conversion dis-
order in the Diagnostic and Statistical Manual of Mental Disorders
(Fifth Edition)
II.22. Answer b.
Functional neurologic symptom disorder is an unconscious
motor or sensory function that does not fit a known physio-
logic mechanism.
II.23. A person with anorexia nervosa may also commonly have which
of the following conditions?
a. Amenorrhea
b. Episodes of acute psychosis
c. Elevations in liver function test levels
d. Lupus erythematosus and other autoimmune diseases
e. Migraine
II.23. Answer a.
Associated characteristics of anorexia include amenorrhea,
electrolyte imbalances, and a predisposition to cardiac
arrhythmias.
II.24. Which of the following does not interfere with sexual function?
a. Selective serotonin reuptake inhibitor use
b. Alcohol use
c. Opioid cessation
d. Nicotine use
e. Lithium use
II.24. Answer e.
Although studies on lithium use are mixed, reported sexual
dysfunction may relate to a premorbid condition or concom-
itant medications. Antidepressants, alcohol, and nicotine
can alter sexual function. Premature ejaculation can occur
after opioid cessation.
II.25. Before the diagnosis of attention-deficit/hyperactivity disorder
(ADHD) is made, which of the following should be ruled out?
a. Diabetes mellitus
b. Thyroid disorder
c. Lupus erythematosus
d. Hyponatremia
e. Parathyroid disorder
II.25. Answer b.
Hearing problems, absence seizures, thyroid disorder, and
medications or drug reactions should be considered before
making the diagnosis of ADHD.
II.26. Approximately what percentage of patients with attention-deficit/hyperactivity disorder (ADHD) will respond to stimulant ther-
apy?
a. 30%
b. 50%
c. 70%
d. 90%
e. 100%
II.26. Answer c.
Stimulant medication is effective in approximately 70% of
patients with ADHD. Combined treatment (stimulant therapy in addition to cognitive behavior therapy or social
skills training) is especially useful for patients with ADHD
complicated by behavior disorders.
II.27. Intellectual developmental disorder (IDD) is characterized by
which of the following statements?
a. IDDs are acquired disorders
b. The diagnosis of IDD is made on a clinical basis alone
c. Down syndrome and Fragile X syndrome are examples of IDDs
d. The diagnosis of an IDD must include regression of language
e. The prevalence of an IDD is approximately 5% of the US population
II.27. Answer c.
IDD affects about 1% of the US population and is character-
ized by intellectual and adaptive functioning impairment
that may be genetic or acquired. Down syndrome, Fragile X
syndrome, phenylketonuria, and fetal alcohol syndrome are
examples of IDDs.
II.28. A score of at least what number on the CAGE questionnaire to
assess alcohol abuse is considered a positive screen?
a. 1
b. 2
c. 3
d. 4
e. 5
II.28. Answer b.
A CAGE questionnaire score of 2 or more is considered clin-
ically important, suggesting clearly the presence of problem-
atic alcohol use. (In general, CAGE refers to cut down,
annoyance, guilt, and eye-opener regarding alcohol use [see
Box 45.2 for further details].)
II.29. A patient presents with euphoria, auditory hallucinations, and
bloodshot eyes. He becomes paranoid in the emergency depart-
ment and threatens violence. What substance did the patient
most likely take?
a. Alcohol
b. Opioid
c. Phencyclidine (PCP)
d. Cannabis
e. Cocaine
II.29. Answer c.
PCP use may result in euphoria, inhibition, and distortion of
time and sensation, as well as psychosis and violent behav-
ior at times.
II.30. How long can cocaine be detected in a patient’s urine after intermittent use?
a. 2 to 4 days
b. 1 to 24 hours
c. Up to 30 days
d. Up to 1 week
e. 2 to 4 weeks
II.30. Answer a.
Cocaine metabolites can be detected in urine up to 2 to 4
days after intermittent use. It may be detected up to 10 days
after chronic use.
II.31. A 16-year-old patient arrives in the emergency department and
is comatose. Her pupils are miotic, and doll’s eyes reflexes are
intact. No hemiplegia is obvious. After airway, breathing, and
circulation assessment, what is the best next step for this
patient?
a. Intravenous (IV) thiamine, followed by dextrose 5% in water
b. IV naloxone
c. Computed tomography of the head
d. Urine and plasma drug screen
e. Electrolyte panel
II.31. Answer b.
For any patient with coma and after stabilization of the
patient’s vital functions, IV naloxone should be considered
if appropriate for the patient. A glucose point of care and IV
dextrose 5% in water should be considered concomitantly.
II.32. In interviewing a patient, you notice that they are confused
about how they had arrived at your office and are unsure of the
date. The patient appears diaphoretic and was hypertensive
when checked in. On examination, you observe clonus at bilat-
eral knees. The patient is taking fluoxetine for depression and
recently had nortriptyline added to treat migraines. Addition of
what medication is likely to make these adverse effects worse?
a. Lithium
b. Fluphenazine
c. Lorazepam
d. Selegiline
e. Naltrexone
II.32. Answer d.
This patient has serotonin syndrome (characterized by the
triad of mental status change, autonomic instability, and
neuromuscular activation). Selegiline is a monoamine oxi-
dase inhibitor with additional serotonergic activity that
would worsen these symptoms.
II.33. Several days after starting aripiprazole therapy, a patient reports
that they are having trouble sitting still. The patient has an urge
to get up and walk around and actually finds that this movement
is helpful. What is the first-line medication to treat this adverse
effect?
a. Benztropine
b. Gabapentin
c. Propranolol
d. Lorazepam
e. Diphenhydramine
II.33. Answer c.
This patient has akathisia, a potential adverse effect of anti-
psychotics, especially aripiprazole. It is treated by a reduc-
tion in the dose of the antipsychotic or a change to an
alternative agent if possible. If these steps are not possible,
propranolol is the choice therapy.
II.34. A patient who has well-controlled bipolar disorder has had nau-
sea, diarrhea, and vomiting over the past 3 days. The patient
struggles to walk back to your office, and you note a coarse tremor
on examination. The patient appears confused on interview.
Which laboratory test is most likely to be abnormal in this case?
a. Lithium level
b. Urine drug and alcohol screen
c. Clozapine level
d. Thyrotropin level
e. Complete blood cell count
II.34. Answer a.
This patient with bipolar disorder likely has lithium toxic-
ity. The best way to assess for this condition is a lith-
ium level.
II.35. Which of the following should be monitored for patients taking
lithium?
a. Thyroid and renal function in addition to lithium plasma level
b. Lithium plasma level
c. Thyroid and liver function in addition to lithium plasma level
d. Osteopenia and lithium level
e. CYPC219 gene and lithium level
II.35. Answer a.
In addition to lithium plasma level, renal and thyroid func-
tion should be monitored during lithium treatment every 3
to 6 months initially and then annually for psychiatrically
stable patients.
II.36. Which of the following medications may result in serious adverse
effects, such as hepatotoxicity, pancreatitis, and nonhepatic
hyperammonemia?
a. Selective serotonin receptor inhibitor
c. Naltrexone
d. Valproate
e. Haldol
II.36. Answer d.
Valproate may rarely result in serious adverse effects, including
hepatotoxicity, pancreatitis, and nonhepatic hyperammonemia.
II.37. Which of the following indications is not accepted for electro-
convulsive therapy?
a. Major depressive episode
b. Acute mania
c. Catatonia
d. Acute psychosis
e. Mixed affective state
II.37. Answer d.
The principal indications for electroconvulsive therapy are
major depressive episode (unipolar or bipolar), acute mania,
mixed affective state, and catatonia. Acute psychosis is not
an indication.
II.38. Roberts has identified 7 critical stages through which patients
typically pass on the road to crisis stabilization, resolution, and
mastery. In Roberts’ 7-stage crisis intervention model, in which
stage would a provider focus on events that led up to the crisis
or occurred before the crisis and prioritize the concerns to
address first?
a. Develop a collaborative relationship
b. Identify the problems
c. Explore emotions
d. Identify coping strategies
e. Implement an action plan
II.38. Answer b.
Identify the problems stage.
II.39. What is the difference between the ego and the superego?
a. The ego represents sexual urges and demands, and the superego
represents organized functions that guide the relationship
between internal demands and the external world
b. The ego is the internal gauge of moral standards that provides
rules and guidelines for decisions and behaviors, and the super-
ego represents organized functions that guide the relationship
c. The ego represents organized functions that guide the relation-
ship between internal demands and the external world, and the
superego governs healthy decision-making
d. The ego represents organized functions that guide the relation-
superego is the internal gauge of moral standards that provides
rules and guidelines for decisions and behaviors
e. The ego is developed before the superego, and the superego
emerges around age 8 years with a focus on basic needs and wants
II.39. Answer d.
The ego represents organized functions that guide the rela-
tionship between internal demands and the external world,
and the superego is the internal gauge of moral standards that
provides rules and guidelines for decisions and behaviors.
II.40. Which of the following is not true regarding cognitive distortions?
a. Overgeneralization
b. Mind reading
c. Dichotomous thinking
d. Inaccuracies in reasoning that may be specific or general
e. Cognitions that develop from early beliefs and assumptions
II.40. Answer e.
Cognitive distortions are inaccuracies in reasoning that can
be specific or general and include overgeneralization, mind
reading, and dichotomous thinking. Schemas, which are
core beliefs, are cognitions that develop from early experi-
ences and include the person’s beliefs and assumptions.
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