Family Medicine PAEA - Psychiatry
Which of the following is effective in the long-term treatment of panic attacks?
o A. Triazolam
o B. Propranolol (Inderal)
o C. Lorazepam (Ativan)
o D. Fluoxetine (Prozac) - ✔️✔️D
(SSRI's, such as fluoxetine, are the initial drugs of choice for the long-term treatment of
panic disorders)
Phenothiazines exert their antipsychotic effects by blocking
o A. alpha-adrenergic receptors
o B. dopamine receptors
o C. histamine receptors
o D. serotonin receptors - ✔️✔️B
(Blockage of the dopamine receptors in the mesolimbic areas of the brain is responsible
for the antipsychotic effects of the phenothiazines; blockage of the dopamine receptors
in the nigrostriatal areas lead to the motor side effects, such as dystonia and akathisia)
Which of the following historical factors differentiates post-traumatic stress disorder from
acute stress disorder?
o A. The inability of the person to recall an important aspect of the event
o B. Avoidance of stimuli that invokes recollections of the event
o C. A belief that their future has been foreshortened because of the event
o D. The presence of sleep disorder - ✔️✔️C
(Post-traumatic stress disorder and acute stress disorder have many of the same
characteristics. A sense of a foreshortened future, such as not expecting a normal life
span or a career due to the trauma, distinguishes post-traumatic stress disorder from an
acute stress disorder. The other answers are common to both disorders)
A patient with obsessive-compulsive disorder would most likely have which of the
following findings?
o A. Raw, red hands
o B. Priapism
o C. Memory impairment
o D. Abdominal pain - ✔️✔️A
(Common manifestations of obsessive-compulsive disorder include phobias of germ
and contaminants, which results in frequent hand washing leading to chafe and
,reddened hands. The other answers are inconsistent with obsessive-compulsive
disorder)
A patient presents within one hour of ingesting 30 tablets of diazepam (Valium). Which
of the following is the most appropriate intervention?
o A. IV naloxone
o B. alkalinization of the urine
o C. cardiac pacing
o D. gastric lavage - ✔️✔️D
(Gastric lavage, along with the administration of activated charcoal and monitoring of
vital signs and CNS status is the mainstay of therapy in the person who has overdosed
on benzodiazepines. Vomiting should be induced in the person who is not comatose.
Flumazenil (Romazicon), a specific benzodiazepine antagonist, might be used with
caution in certain patients)
The most important initial component of evaluating a patient with depressive illness is
o A. assessment of suicidal risk
o B. assessment of memory function
o C. determination of the presence of hallucinations
o D. determination of the degree of intellectual impairment - ✔️✔️A
(Two-thirds of all depressed patients contemplate suicide, and 10 to 15% commit
suicide)
A child has been under treatment for attention-deficit hyperactivity disorder (ADHD). No
response has occurred with behavioral adaptations. Which of the following categories of
medication should this patient be given?
o A. stimulants
o B. anxiolytics
o C. antipsychotics
o D. antidepressants - ✔️✔️A
( Stimulants, such as Ritalin, Dexedrine, and Cylert, are effective in 50 to 80% of
children with ADHD)
Which of the following antipsychotic medications is associated with significant
agranulocytosis but not with extrapyramidal side effects?
o A. Clozapine (Clozaril)
o B. Haloperidol (Haldol)
o C. Chlorpromazine (Thorazine)
o D. Fluphenazine (Prolixin) - ✔️✔️( Clozapine is referred as an "atypical" antipsychotic
agent. It can cause agranulocytosis and should be monitored with weekly CBC. This is
not a first line treatment drug)
, A 53 year-old man with a history of hypertension is being treated with atenolol
(Tenormin). He currently presents complaining of chronic fatigue, insomnia, decreased
appetite, and difficulty concentrating for the past 3 weeks. His wife also notes that he no
longer goes bowling with his friends and has lost interest in any sexual intimacy.
Physical examination is unremarkable. Which of the following is the most likely
diagnosis?
o A. major depression
o B. dysthymic disorder
o C. atypical depression
o D. drug-induced depression - ✔️✔️A
(Diagnostic criteria for a major depressive disorder include a loss of pleasure in usual
activities, vegetative or physical changes (poor appetite, loss of energy), and cognitive
changes such as difficulty in concentrating)
• A 56 year-old man is admitted to a hospital unit for evaluation of rectal bleeding and
weight loss. He has a strong family history of cancer. Soon after admission, a barium
enema is scheduled. The patient refuses the "prep" because he fears x-ray radiation.
He states he has had previous x-rays, but becomes frightened at the thought of an x-ray
and "can't face it." The most likely diagnosis is
o A. hysterical personality
o B. dissociative state
o C. conversion reaction
o D. phobic neurosis - ✔️✔️D
(Phobic neurosis is a phobic ideation of displacement where the patient transfers
feelings of anxiety from the object to one that can be avoided)
Rates of alcohol use in the adolescent are reportedly higher in:
o A. families with rigorous parental monitoring
o B. Japanese families
o C. adoptive children whose biological parent is an alcoholic
o D. mood disorders in a grandparent - ✔️✔️C
(There is a three-to fourfold increase in risk for alcohol dependence in adopted children
whose biological parents are alcohol dependents)
A divorced female patient presents for an employment physical. She states she has had
a "run of bad luck" with jobs and has not been able to hold any job for longer than 2-3
months. She also states she has been arrested several times for getting into fights
when she is out with the girls. She states she drinks an occasional beer, but denies any
significant problems with alcohol. Which of the following laboratory findings would
support your suspected diagnosis?
o A. decreased triglycerides
o B. decreased serum uric acid
o C. increased LDL cholesterol
Which of the following is effective in the long-term treatment of panic attacks?
o A. Triazolam
o B. Propranolol (Inderal)
o C. Lorazepam (Ativan)
o D. Fluoxetine (Prozac) - ✔️✔️D
(SSRI's, such as fluoxetine, are the initial drugs of choice for the long-term treatment of
panic disorders)
Phenothiazines exert their antipsychotic effects by blocking
o A. alpha-adrenergic receptors
o B. dopamine receptors
o C. histamine receptors
o D. serotonin receptors - ✔️✔️B
(Blockage of the dopamine receptors in the mesolimbic areas of the brain is responsible
for the antipsychotic effects of the phenothiazines; blockage of the dopamine receptors
in the nigrostriatal areas lead to the motor side effects, such as dystonia and akathisia)
Which of the following historical factors differentiates post-traumatic stress disorder from
acute stress disorder?
o A. The inability of the person to recall an important aspect of the event
o B. Avoidance of stimuli that invokes recollections of the event
o C. A belief that their future has been foreshortened because of the event
o D. The presence of sleep disorder - ✔️✔️C
(Post-traumatic stress disorder and acute stress disorder have many of the same
characteristics. A sense of a foreshortened future, such as not expecting a normal life
span or a career due to the trauma, distinguishes post-traumatic stress disorder from an
acute stress disorder. The other answers are common to both disorders)
A patient with obsessive-compulsive disorder would most likely have which of the
following findings?
o A. Raw, red hands
o B. Priapism
o C. Memory impairment
o D. Abdominal pain - ✔️✔️A
(Common manifestations of obsessive-compulsive disorder include phobias of germ
and contaminants, which results in frequent hand washing leading to chafe and
,reddened hands. The other answers are inconsistent with obsessive-compulsive
disorder)
A patient presents within one hour of ingesting 30 tablets of diazepam (Valium). Which
of the following is the most appropriate intervention?
o A. IV naloxone
o B. alkalinization of the urine
o C. cardiac pacing
o D. gastric lavage - ✔️✔️D
(Gastric lavage, along with the administration of activated charcoal and monitoring of
vital signs and CNS status is the mainstay of therapy in the person who has overdosed
on benzodiazepines. Vomiting should be induced in the person who is not comatose.
Flumazenil (Romazicon), a specific benzodiazepine antagonist, might be used with
caution in certain patients)
The most important initial component of evaluating a patient with depressive illness is
o A. assessment of suicidal risk
o B. assessment of memory function
o C. determination of the presence of hallucinations
o D. determination of the degree of intellectual impairment - ✔️✔️A
(Two-thirds of all depressed patients contemplate suicide, and 10 to 15% commit
suicide)
A child has been under treatment for attention-deficit hyperactivity disorder (ADHD). No
response has occurred with behavioral adaptations. Which of the following categories of
medication should this patient be given?
o A. stimulants
o B. anxiolytics
o C. antipsychotics
o D. antidepressants - ✔️✔️A
( Stimulants, such as Ritalin, Dexedrine, and Cylert, are effective in 50 to 80% of
children with ADHD)
Which of the following antipsychotic medications is associated with significant
agranulocytosis but not with extrapyramidal side effects?
o A. Clozapine (Clozaril)
o B. Haloperidol (Haldol)
o C. Chlorpromazine (Thorazine)
o D. Fluphenazine (Prolixin) - ✔️✔️( Clozapine is referred as an "atypical" antipsychotic
agent. It can cause agranulocytosis and should be monitored with weekly CBC. This is
not a first line treatment drug)
, A 53 year-old man with a history of hypertension is being treated with atenolol
(Tenormin). He currently presents complaining of chronic fatigue, insomnia, decreased
appetite, and difficulty concentrating for the past 3 weeks. His wife also notes that he no
longer goes bowling with his friends and has lost interest in any sexual intimacy.
Physical examination is unremarkable. Which of the following is the most likely
diagnosis?
o A. major depression
o B. dysthymic disorder
o C. atypical depression
o D. drug-induced depression - ✔️✔️A
(Diagnostic criteria for a major depressive disorder include a loss of pleasure in usual
activities, vegetative or physical changes (poor appetite, loss of energy), and cognitive
changes such as difficulty in concentrating)
• A 56 year-old man is admitted to a hospital unit for evaluation of rectal bleeding and
weight loss. He has a strong family history of cancer. Soon after admission, a barium
enema is scheduled. The patient refuses the "prep" because he fears x-ray radiation.
He states he has had previous x-rays, but becomes frightened at the thought of an x-ray
and "can't face it." The most likely diagnosis is
o A. hysterical personality
o B. dissociative state
o C. conversion reaction
o D. phobic neurosis - ✔️✔️D
(Phobic neurosis is a phobic ideation of displacement where the patient transfers
feelings of anxiety from the object to one that can be avoided)
Rates of alcohol use in the adolescent are reportedly higher in:
o A. families with rigorous parental monitoring
o B. Japanese families
o C. adoptive children whose biological parent is an alcoholic
o D. mood disorders in a grandparent - ✔️✔️C
(There is a three-to fourfold increase in risk for alcohol dependence in adopted children
whose biological parents are alcohol dependents)
A divorced female patient presents for an employment physical. She states she has had
a "run of bad luck" with jobs and has not been able to hold any job for longer than 2-3
months. She also states she has been arrested several times for getting into fights
when she is out with the girls. She states she drinks an occasional beer, but denies any
significant problems with alcohol. Which of the following laboratory findings would
support your suspected diagnosis?
o A. decreased triglycerides
o B. decreased serum uric acid
o C. increased LDL cholesterol
