Question 1
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Test 1 Question 4. A patient with lesions in the orbitofrontal region of the brain will present as:
Question 2
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Test 1 Question 69. Homozygosity for which one of the following is believed to predispose patients to Alzheimer-type dementia?
Question 3
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Test 1 Question 112. Which one of the following is associated with the amyloid precursor protein?
Answer
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Wilson’s disease
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Schizophrenia
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Alzheimer’s disease
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Bipolar disorder
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Huntington’s disease
Question 4
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Test 1 Question 147. The sign that best differentiates between delirium and dementia is:
Question 5
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Test 2 Question 92. Which one of the following is not more typical of a cortical dementia than of a subcortical dementia such as dementia of the Alzheimer type?
Question 6
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Test 2 Question 130. An 82-year-old patient in a skilled nursing facility displays confusion, restlessness, agitation, and disorganized speech only during the evening hours. Which one of the following is not an appropriate treatment approach?
Answer
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Increased lighting in the room
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Low-dose haloperidol at bedtime
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Having a calendar on the wall
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Flurazepam at bedtime for sleep
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Companionship and family support during the day
Question 7
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Test 2 Question 144. Which one of the following characteristics pertaining to vascular dementia is false?
Answer
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There is a stepwise decline in functioning
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Hypertension is a known risk factor
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There is abrupt onset of symptoms
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There is a good response to cholinergic therapies
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Smoking is a known risk factor
Question 8
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Test 3 Question 9. You are called to evaluate a 60-year-old man with a history of depression. His family reports that he has not been himself
for the past 5 days. On examination he makes poor eye contact, is inattentive, mutters incoherently, keeps rearranging pieces of paper on his bed tray with no apparent logic, and drifts off to sleep while you are talking to him. What is his most likely diagnosis?
Question 9
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Test 3 Question 49. Which one of the following psychiatric symptoms is not found with AIDS?
Answer
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Progressive dementia
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Personality changes
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Heat intolerance
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Depression
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Loss of libido
Question 10
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Test 3 Question 55. Which one of the following dopaminergic tracts or areas is responsible for the parkinsonian side effects of antipsychotic medications?
Question 11
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Test 3 Question 106. An elderly hospitalized patient with vascular risk factors has a stroke. The patient’s behavior following the stroke is noted to be unusually calm and markedly hypersexual. This presentation probably resulted from a stroke to the:
Answer
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Hippocampi
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Nucleus accumbens
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Hypothalamus
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Occipital lobes
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Amygdaloid bodies
Question 12
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Test 4 Question 126. On which chromosome is the gene for amyloid precursor protein found?
Answer
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Chromosome 19
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Chromosome 20
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Chromosome 21
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Chromosome 4
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Chromosome 13
Question 13
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Test 4 Question 147. Which one of the following is most consistent with delirium?
Question 14
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Test 5 Question 142. The prevalence of Alzheimer’s disease in those patients over age 85 years is:
Answer
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Less than 5%
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5% to 10%
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11% to 20%
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21% to 40%
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41% to 50%
Question 15
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Vignette 16 Question 1. Given his history, the most likely diagnosis is: (Pick two of six)
Answer
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Major depressive disorder
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Generalized anxiety disorder
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Vascular dementia
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Diffuse Lewy body disease
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Alzheimer’s dementia
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Pick’s disease
Question 16
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Vignette 16 Question 2. What would be your next maneuver with respect to this patient in the outpatient setting? (Pick three of seven)
Answer
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Start sertraline 25mg daily
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Start trazodone 50 mg at bedtime
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Start donepezil 5mg daily
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Obtain an electroencephalogram
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Start risperidone 0.25mg at bedtime
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Obtain an outpatient brain MRI
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Obtain neuropsychological consultation
Question 17
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Vignette 16 Question 3. His daughter is concerned that she cannot manage her father properly in the home. What suggestions can you make to help her with this situation? (Pick three of six)
Answer
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Refer him to an ACT team for ongoing management
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Obtain a visiting-nurse consultation
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Refer her to caregiver support programming and groups
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Convince her to get family members to provide coverage in the home to monitor the patient more closely
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Consult a physiatrist to have the patient placed in a subacute rehabilitation facility
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Seek skilled nursing facility or assisted-living facility placement for the patient
Question 18
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Vignette 16 Question 4. If the patient has a dementia of the Alzheimer type, what would be his expected prognosis if he were to remain untreated?
Answer
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1 to 3 years
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4 to 6 years
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7 to 10 years
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11 to 15 years
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15 to 20 years
Question 19
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Vignette 16 Question 5. The treatment of choice for a case of dementia believed to have features of both Alzheimer and vascular type would be: (Pick three of seven)
Answer
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An antiplatelet aggregant agent
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An atypical antipsychotic agent
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A sedative–hypnotic anxiolytic agent
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A cholinesterase-inhibiting agent
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Vitamin B complex supplementation
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An antidepressant agent
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An antihypertensive agent
Question 20
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Vignette 16 Question 6. Which of the following is not typically a complication of this man’s illness?
Question 21
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Vignette 16 Question 7. Which of the following drugs should be avoided in this patient? (Pick two of seven)
Answer
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Rivastigmine
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Aspirin
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Memantine
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Benztropine
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Diphenhydramine
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Fluoxetine
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Galantamine
Question 22
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Vignette 17 Question 1. Which of the following symptoms are not generally characteristic of Wanda’s present syndrome? (Pick two of six)
Question 23
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Vignette 17 Question 2. Which of the following risk factors predispose this patient to the current condition you now find her in? (Pick three of six)
Answer
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Smoking history
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Female gender
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Her age
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Her current medications
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Her MS
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Hypertension
Question 24
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Vignette 17 Question 3. The central nervous system (CNS) area(s) believed to be most closely implicated in this patient’s present condition is (are) the:
Answer
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Cerebellum
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Frontal and parietal lobes
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Midbrain and nigrostriatal pathway
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Reticular formation and dorsal tegmental pathway
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Hippocampus and amygdala
Question 25
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Vignette 17 Question 4. Which of the following neurotransmitters is probably the least likely to be implicated in the pathophysiology of delirium?
Answer
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Norepinephrine
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Dopamine
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Serotonin
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Acetylcholine
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Glutamate
Question 26
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Vignette 17 Question 5. Which of the following electroencephalography findings would you expect to find in this patient?
Question 27
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Vignette 17 Question 6. Which of the following agents would not be appropriate treatment for Wanda’s current condition? (Pick two of six)
Answer
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Haloperidol
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Risperidone
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Diphenhydramine
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Quetiapine
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Benztropine
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Olanzapine
Question 28
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Vignette 17 Question 7. Which of the following are true about the course and prognosis of delirium? (Pick three of six)
Answer
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Prodromal symptoms can occur months prior to onset of florid symptoms
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Symptoms usually persist as long as causally relevant factors are present
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Delirium usually progresses to dementia according to longitudinal studies
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Delirium does not adversely affect mortality in patients who develop it
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Prognosis of delirium worsens with increased patient age and longer duration of the episode
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Periods of delirium are sometimes followed by depression or PTSD