13. A 56 year old anxious executive calls at 5:00 because he woke up with chest tightness and shortness of breath. He was scared that he was having a heart attack and he also reported feeling dizzy, trembling, and his heart was pounding, he thought he wasg oing to die. The symptoms subsided in 20 minute and by the time the emergency medical services arrived he was sitting in his living room and in no distress. The patient's electrocardiogram reading was normal and his cardiac enzymes were also found to be normal. What is the most likely diagnosis?

    1. Nocturnal panic attack

    2. PTSD

    3. Psychophysiological insomnia

    4. Somatization disorder

    5. Myocardial infraction

14. Anorexia nervosa has mortality rate of up to approximately:

    1. 1%

    2. 18%

    3. 30%

    4. 42%

    5. 50%

15. What doesn’t cause manic episode???

    1. carbamezopine

    2. disulfiram

    3. isoniazid

    4. propranolol

    5. bromocriptine

16. A 36-year-old pregnant woman is admitted to the medical center for possible infection associated with

intravenous heroin injection. She admit to heroin dependency. She is 5 month into her pregnancy and

would like to "quit the heroin for good" What is the best course of action in this patient?

A. Allow her to continue

B. Methadone maintenance

C. Naltrexone

D. Advise her to stop heroin and start supportive therapy

E. Buprenophine

17. What is the “gold standard” to diagnose munchausen by proxy?

A.the child will confess

B. By witness the caregiver causing harm to the child - from kaplan

C. the child improve when removed from caregiver

D.you find disease producing subjects in the care giver belonging

18. Postpartum psychosis

A. Occurs more commonly in multigravida women

B. Rarely correlates with perinatal complications

C. delivery almost always begins within 8 weeks of

D. Usually occurs abruptly, with no prodromal psychotic symptoms

E. Is essentially an episode of a psychotic disorder

19. 14years old girl present to pediatrician ,she has “freaking out” describe shaking ,grasping for hair, feeling like going die for few min and resolve spontaneous in various time and various situations . Most likely diagnosis

a)dysthymia

b)social phobia

c) Separation anxiety

d) Panic

20. A 35-year-old woman has just been diagnosed with major depressive disorder. For the past 8months, she has had a depressed mood, decreased energy and concentration, and loss of interest inpreviously enjoyed activities. Although she never attempted suicide, she acknowledges that she thought she would probably jump off a local bridge if she ever had the chance. She denies any history of excessively elevated moods. You decide to start her on antidepressant therapy. Two weeks later, this patient is at greatest risk for

1. extrapyramidal symptoms

2. hypomanic episode

3. manic episode

4. medication noncompliance

5. suicide completion

21. Antidepressants should be used cautiously in cardiac patients because of increased risk of which

of the following?

1. Conduction side effects

2. Hypertension

3. Noncompliance

4. Suicide

5. All of the above

22. A patient with somatization disorder

1. has had physical symptoms for only 3 months

2. usually experiences minimal impairment in social or occupational functioning

3. may have a false belief of being pregnant with objective signs of pregnancy, such as decreased menstrual flow or amenorrhea

4. presents the initial physical complaints after age 30 years

5. has complained of symptoms not explained by a known medical condition

23. Which of the following is not a recommended treatment strategy for a patient with somatization

disorder?

1. Increasing the patient’s awareness that psychological factors may be involved

2. Having several different clinicians involved in caring for the patient

3. Avoiding additional laboratory and diagnostic procedures

4. Seeing patients during regularly scheduled visits at regular intervals

5. Listening to somatic complaints as emotional expressions rather than medical complaints

24. Suicide among schizophrenic patients

1. is most frequently secondary to command hallucinations

2. occurs most often in the later years of the illness

3. occurs most often in older female patients

4. is approximately 10 percent

5. is low

25. pervasive pattern of grandiosity, lack of empathy, and need for admiration suggests the diagnosis

of which of the following personality disorders?

1. Borderline

2. Narcissistic

3. Paranoid

4. Passive-aggressive

5. Schizotypal

26. An 18 y.o arrived to ED after assaulting a police officer in the street…generalized muscle weakness ataxia, nystagmus, slurred speech ...…. what did he take?

A. Inhalant

B. Benzodiazepines

C. Opioids

D. Hallucinogens

E. Amphetamines

27. Highest mortality rate from natural and unnatural causes :

A. schizophrenia

B. eating disorders

C. major depressive disorder

D.

E.

28. A hypomanic episode differs from a manic episode in that a hypomanic episode

A. lasts at least 1 week

B. lacks psychotic features

C. is severe

D. causes greater social impairment

E. all of the above

29. Serotonin syndrome

30. Least appropriate in NMS: antibiotics

31. The most dangerous at this point: acute manic episode

32. Tardive dyskinesia

33. Thyroid and depression (not sure about this)