Knowledge Questionnaire

Instructions: Choose only one answer for each of the following questions.

  1. The biopsychosocial model includes all information that the biomedical model addresses
  2. True
  3. False
  4. It is inappropriate to interrupt the patient when being patient centered

a. True

b. False

  1. A histrionic patient might have the most difficulty

a. Developing an attractive appearance

____b. Expressing emotion

____c. Keeping track of their bank account

____d. Relating to other people

  1. What percentage of primary care mental health patients present entirely with medically unexplained symptoms

a. 70%

b. 50%

c. 30%

d. 10%

  1. Which of the following is most accurate when diagnosing chronic pain patients as having unexplained symptoms

a. You have to be honest with the patient that you can never really be sure there is no underlying disease

b. When many psychological symptoms are present, this is a good clue there is no disease basis for the chronic pain

c. You often need to repeat previous diagnostic studies because a disease explanation often has developed in the interim

d. A high false positive rate using just physical and psychological symptoms as diagnostic criteria means that most require a full diagnostic work-up

  1. Closed-ended questions should not be used in patient-centered interview

a. True

b. False

  1. Which of the following patient statements or behaviors from the same patient is the MOST important clue to the patient’s story (and thus should preferentially be pursued)

a. “you’re younger than I expected”

b. “in 1984 my wife died”

c. Describing a very sad situation

d. Angrily striking the physicians desk while talking about an upsetting topic

  1. Dependent personality features are suggested by a reclusive, isolated lifestyle.

a. True

b. False

  1. Self-defeating personality features are often heralded by undue suspicion of the doctor and others

a. True

b. False

  1. Obsessive personality features are sometimes associated with patients taking charge of the doctor-patient conversation

a. True

b. False

  1. All but one of the following is a clue that a counterproductive (harmful) reaction to the patient is present

a. An intense emotional response towards the patient

b. Similar reactions, such as anger or fear, to many different patients

c. The failure of a physician to use skills s/he is known to possess

d. A positive reaction a patient reminding one of a much loved parent or grandparent

e. An emotional reaction to the patient similar to that of other doctors

  1. Which of the following statements would be the LEAST effective when interacting with a severe, chronic somatizing patient

a. We may be able to help you live a more normal life

b. Things seem especially bad for you right now; how are you able to cope?

c. I think we’re on top of this and you’re going to get better and better

d. I’d like to see you on a regular basis. How about every two weeks? Be sure to take the acetaminophen with each meal and at bedtime, not just when you think you need it

  1. The depression often seen in somatizing patients typically is unresponsive to antidepressants

a. True

b. False

  1. When attempting to convince a patient to change an undesirable health behavior (e.g., smoking) a physician should begin by

a. Asking a patient’s understanding of the problem

b. Encouraging the patient to verbally commit to quitting smoking

c. Explaining to the patient why quitting smoking is necessary

d. Employing emotional handing skills repeatedly

  1. With regards to deliberate self-harm (DSH) the following statement is not true:

a. DSH is common in patients with borderline personality disorder

b. Hitting oneself and skin burning are more commonly observed than skin cutting

c. DSH is often not associated with suicidal intent

d. DSH is typically a surreptitious behavior and is often not reported

  1. In the US suicide is the 4th leading cause of death for adults between the ages of 18 and 65 years. The following statement is true regarding the epidemiology of suicide.

a. Men complete suicide less often than women.

b. The suicide rate decreases in men over the age of 60 years

c. HIV, cancer, and asthma are associated with the highest risk of suicide attempts among those with medical diseases

d. The presence of young children living in a household increases the risk of suicide

  1. In bereavement, which of the following statements is inaccurate

a. Auditory and visual hallucinations may occur in normal bereavement

b. Antidepressant medications are contraindicated, since they prolong the grieving process

c. Sedative hypnotic medications can be useful for sleep difficulties

d. Depressive symptoms are common and intense

  1. In the sleep disruption of depression, the following statement is accurate

a.Sedative hypnotics are counterproductive and are likely to perpetuate sleep difficulties

b. Caffeine may be helpful in countering daytime tiredness and improving alertness

c. Sleep hygiene methods including daily exercise, avoiding naps, and a relaxing sleep time routine are not beneficial

d. Sedative antidepressants such as mirtazapine and trazodone have no role

  1. The therapeutic benefits of electroconvulsive therapy derive from which one of the following factors

a. The bilateral generalized seizure

b. The brief-pulse electrical stimulus

c. The inevitable but transient anterograde amnesia

d. The enduring effects of the electrical stimulus upon parasympathetic (vagal) tone

  1. In the longitudinal course of bipolar disorder, depressive episodes often precede manic episodes. This can lead to misdiagnosis. Which one of the following clinical features is more common in bipolar depression as opposed to major depressive disorder

a. Insomnia more than hypersomnia

b. Postpartum episodes

c. Psychomotor agitation more than retardation

d. Later onset (30s vs. teens)

e. Insidious vs. abrupt episode onset

  1. Which of the following interventions would not be acceptable as first line in the initial treatment of an acute episode of bipolar (Type 1) depression?

a. Antidepressant monotherapy

b. A combination of lithium and lamotrigine

c. Olanzapine and fluoxetine

d. Quetiapine

  1. In panic disorder, which of the following statements is not true?

a. 90% of patients present with physical symptoms

b. 30-50% of patients develop agoraphobia

c. 25% of patients who present to ERs with chest pain have panic disorder

d. 10% of patients with panic disorder have major depressive disorder

  1. The pharmacotherapy of panic disorder includes all but one of the following options

a. SSRIs/SNRI antidepressants

b. Atypical antipsychotics

____c. Beta-blockers

____d. Buspirone

  1. In prescribing benzodiazepines in patients with panic disorder the following is true
  2. Since benzodiazepines produce rapid symptoms relief they are commonly prescribed in conjunction with antidepressants
  3. Short-acting agents such as alprazolam are more effective and are preferred to long-acting agents such as clonazepam
  4. Patients eventually develop tolerance to anti-anxiety effect of benzodiazepines but not the sedative effect, hence the dose escalation is compromised by unwanted sedation
  5. The majority of patients ultimately develop physiological dependence to benzodiazepine compounds and invariably use more than the prescribed dose
  1. Patients with major depression who experience a partial response to the initial antidepressant drug may benefit from augmentation with one of several different agents. Which of the following compounds is not commonly used as an adjunctive drug in managing depressed patients

a. Lithium carbonate

b. Triiodothyronine

c. Buspirone

d. Metoprolol

  1. Risk factors for the development of Post-Traumatic Stress Disorder include all but one of the following

a. Inadequate social support

b. Severity of stressor

c. History of childhood abuse

d. Male gender

  1. Which of the following is a diagnostic characteristic for Post-Traumatic Stress Disorder

a. Tinnitus

b. Paresthesiae

c. Hyperarousal

d. Headache

  1. The pharmacotherapy of Social Anxiety Disorder includes which one of the following options

a. Sedative serotonin-dopamine antagonist antipsychotics

b. Lithium carbonate

c. SSRI antidepressants

d. Stimulants

  1. With regards to premenstrual mood disorders, which one of the following statements is not true

a. 75% of women experience some mood, behavioral or somatic symptoms during the late luteal phase of menstruation

b. Most women with Premenstrual Dysphoric Disorder seek complementary or alternative medicines

c. SSRIs are helpful for managing mood symptoms; whereas hormonal interventions are superior for managing physical symptoms

d. Psychotic symptoms occur in about 5% of cases

  1. Choose the incorrect statement concerning the occurrence of hallucinations in clinical settings

a. Hypnogogic hallucinations are pathognomonic of narcolepsy

b. Visual and tactile hallucinations suggest an organic etiology

c. Olfactory hallucinations suggest temporal lobe disorder

d. Auditory hallucinations such as hearing voices are the most common form of hallucinations

  1. Delirium is commonly observed in hospitalized patients. Which of the following clinical features is not characteristic of delirium
  1. Disruption of the sleep wake cycle
  2. Auditory hallucinations are more common than visual hallucinations
  3. Can be missed in children, wherein the hallucinations can be misattributed to “fantasizing”
  4. Symptoms fluctuate from hour to hour
  1. Which of the following statements is acceptable regarding use of antidepressants in non-depressed patients taking interferon for hepatitis C
  1. All patients should receive antidepressant therapy
  2. Only patients with a past history of depression should receive antidepressants
  3. Antidepressants should be reserved for patients with suicidal ideation
  4. Patients with a past history of any psychiatric disorder
  1. Corticosteroids are commonly associated with neuropsychiatric sequelae. Which of the following statements is true
  1. Serious psychiatric sequelae are observed in 50% of patients receiving steroids
  2. Manic and hypomanic states are more commonly observed with prolonged exposure
  3. Depressive symptoms are more commonly observed with short courses
  4. A dose dependent relationship is observed
  1. Which of the following statements is incorrect
  1. Varenicline is the antidepressant of choice in the depressed smoker
  2. Depressed patients have a higher prevalence of cigarette smoking than others
  3. Smoking cessation is more likely to trigger a depressive relapse in patients with depression than others
  4. Depressed patients have more difficulty quitting and often require a combination of bupropion, varenicline and nicotine replacement methods along with supportive psychotherapy
  1. The prevalence of dementia increases with age. Which of the following is a correct statement concerning the epidemiology of dementia
  1. The rate is 10-20% in general medical inpatients
  2. In nursing homes the rate varies from 20-30%
  3. In patients over the age of 90 the rate increases to 90%
  4. Dementia is not observed in young adults
  1. Delirium can be distinguished from dementia by the following clinical features. Choose the single correct answer
  1. The presence of hallucinations, delusions and ideas of reference
  2. Agitated behavior that requires antipsychotic medication and physical restraint
  3. An acute onset, fluctuating course and a change of consciousness
  4. Disorientation to time and place is generally more severe than disorientation to person and situation
  1. With regards to the pharmacotherapy of Alzheimer’s disease, choose the single correct statement
  1. Cholinesterase inhibitors have a moderate effect in improving cognitive function when administered early in the course of the disease
  2. Glutamate NMDA receptor antagonists have a dramatic effect on psychotic symptoms
  3. Antipsychotics, which carry a black box warning in patients with dementia, should be avoided
  4. Divalproex is FDA approved for management of disruptive behavior
  1. In managing hospitalized patients with delirium the following is an appropriate first choice
  1. Cognitive restructuring
  2. Antipsychotics such as olanzapine
  3. Disulfiram for alcohol withdrawal states
  4. Sedative antidepressants
  1. In managing late-onset depression, which of the following is correct
  1. Antidepressant medications should be used at lower doses and should be discontinued after the remission of depressive symptoms to minimize adverse effects
  2. Psychosocial approaches such as interpersonal and cognitive behavior therapy are preferred to pharmacotherapy, because of the risk of antidepressant-induced seizures
  3. Electroconvulsive is a reasonable therapeutic option when patients fail to respond to antidepressant medications
  4. Adequate management of hypertension, diabetes and dyslipidemia have a profound effect upon mood
  1. Major depression is associated with comorbid psychiatric disorders less than one half the time
  1. True
  2. False
  1. When dysthymia coexists with major depression, treatment responses typically are better for the depression
  1. True
  2. False
  1. Which of the following is incorrect
  1. Subsyndromal (minor) depression is not treated with antidepressants
  2. Subsyndromal depression is a risk factor for major depression
  3. The focus of treatment for subsyndromal depression is the current symptom
  4. Subsyndromal depression occurs commonly during grief and bereavement
  1. Satisfactory antidepressant medication treatment for the first episode of major depression is 3-4 months
  1. True
  2. False
  1. Which of the following is incorrect about the antidepressant discontinuation syndrome
  1. An increased death rate has been reported
  2. Fluoxetine is least likely to do this
  3. It is unrelated to the serotonin syndrome
  4. The best treatment is to reinstitute the antidepressant
  1. Which of the following antidepressants is most likely to have all these side-effects: sedation, weight gain, sexual dysfunction
  1. Citalopram
  2. Paroxetine
  3. Venlafaxine
  4. Buproprion
  5. Fluoxetine
  1. Which of the following side effects are more likely with SNRIs
  1. Elevated blood pressure
  2. Sexual side effects
  3. Weight gain
  4. Cardiac arrhythmias
  1. Stimulants such as Ritalin have no place in managing depression
  1. True
  2. False
  1. Compared to bipolar depression, one of the following is not true about unipolar depression
  1. More abrupt onset
  2. More often in men
  3. More insidious onset
  4. Fewer episodes
  1. While benzodiazepines have sometimes been effective with other anxiety disorders, they should be used sparingly in PTSD because they often are ineffective and make the symptoms worse.
  1. True
  2. False