Psychiatry and Neurology Board Review Practice Questions
Book 1 - 2004
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QUESTION

25. Which of the following is TRUE?

A) Quantitative Electroencephalogram (Q EEG) can be useful in the diagnosis of demyelinating illness
B) Evoked Electroencephalogram (EEG evoked potentials) is useful in differentiating dementia and delirium
C) Nuclear magnetic resonance imaging (MRI) localizes areas of the brain that are physiologically active during specific tasks
D) Computed tomography (CT) helps to identify demyelinating disease
E) Computed tomography (CT) can identify brain changes in schizophrenia

ANSWER

25.      E      Computed tomography can identify brain changes in schizophrenia

Computed tomography (CT) identifies anatomic brain changes in cognitive disorders and possibly schizophrenia. Nuclear Magnetic resonance imaging (MRI) helps to identify demyelinating disease (e.g. multiple sclerosis); shows the biochemical condition of neural tissues as well as the anatomy without exposing the patient to ionizing radiation. Positron emission tomography (PET), functional MRI (fMRI), and single photon emission computed tomography (SPECT) localize areas of the brain that are physiologically active during specific tasks; characterizes and measures the metabolism of glucose in neural tissue. EEG and Q-EEG (quantitative) measures and quantifies electrical activity in the cortex; useful in diagnosing epilepsy and differentiating delirium (abnormal EEG) from dementia (normal EEG). Evoked EEG (evoked potentials) measures electrical activity in the cortex in response to touch, sound, or visual stimulation; used to evaluate vision and hearing loss in infants and brain responses in comatose patient and patients with demyelinating illness.

1. Fadem, B. Simring, S. High yield psychiatry. Lippincott Williams & Wilkins. Philadelphia. 2003:12.

QUESTION

53. Characteristics of Sleep Stages include:

A) REM sleep is characterized by “sawtooth”, beta, alpha & theta on EEG
B) Stages 3 & 4 are characterized by sleep spindles and K-complexes
C) Stage 2 is characterized by Delta (slow-wave sleep)
D) Awake & relaxed is characterized by theta waves
E) Stage 1 is characterized by Beta and Alpha waves

ANSWER

53.     A     REM sleep is characterized by “sawtooth”, beta, alpha & theta waves on
EEG

The awake stage is characterized by beta waves during active mental concentration and alpha waves during relaxed stage with eyes closed. Stage 1 is characterized by theta waves, 5% of sleep time in young adults, lightest stage of sleep characterized by peacefulness, slowed pulse and respiration, decreased blood pressure, and episodic body movements. Stage 2 is characterized by sleep spindles and K-complexes, is 45% of sleep time in young adults and is the largest percentage of sleep time. Stages 3 & 4 are characterized by Delta (slow-wave sleep), is 25% of sleep time in young adults which decreases with age. Stages 3 & 4 are the deepest, most relaxed stage of sleep; sleep disorders, such as night terrors, sleep walking (somnambulism), and bed wetting (enuresis) may occur. Rapid eye movement (REM) sleep is characterized by a “sawtooth” pattern with beta, alpha, and theta waves. REM is 25% of sleep time in young adults and decreases with age. REM sleep is associated with dreaming, penile and clitoral erections; increased cardiovascular activity; absence of skeletal muscle movement.

1. Fadem, B., Simring, S. High Yield Psychiatry. 2nd Edition. Lippincott, Williams & Wilkins, Philadelphia PA. 2003:37.

2. Kaplan, HI., Sadock BJ. A Comprehensive Textbook of Psychiatry. Williams & Wilkins, Baltimore MD. 1999:1967-1700.

QUESTION

92. You have just evaluated an 8-year-old girl who you believe suffers from ADHD. You suggest a trial of a psychostimulant.

Regarding your recommended treatment, all of the following statements are true EXCEPT?

A) Tolerance rarely develops to the euphoric effects of psychostimulants in children with ADHD
B) Long-term use of psychostimulants has been associated with the development of paranoid ideation in a subset of patients with ADHD
C) Psychostimulants may worsen tics in children with comorbid Tourette’s syndrome
D) Studies show a decreased emergence of adolescent substance abuse in children with ADHD who have been treated with psychostimulants
E) Psychostimulants help to improve the attention deficits, hyperactivity and learning disabilities often associated with ADHD

ANSWER

92.     A     Tolerance rarely develops to the euphoric effects of psychostimulants in
children with ADHD

Stimulant drugs have proven effective in the treatment of ADHD in approximately 70-80% of children with the disorder. Tolerance is known to develop to the euphoric and sympathomimetic effects of psychostimulants. The development of tolerance to the therapeutic effects of the drug, including increased attention and decreased hyperactivity, however, is not common. Though these medications are often very helpful in treating inattention and impulsivity, they have not proven beneficial in treating specific learning disorders commonly associated with ADHD, such as dyslexia. In children who suffer from both ADHD and Tourette’s syndrome, psychostimulants have been associated with increased stereotypy and tic behaviors. Toxic psychosis has been reported as a side effect in patients with chronic high dose stimulant use and in cases of overdose. Despite multiple concerns that children treated with stimulants would be at increased risk of later abusing substances, studies have found otherwise. Longitudinal studies instead show that psychostimulant treatment of childhood ADHD is protective against the later development of substance abuse and dependence .

1. Arana, George W., Rosenbaum F. Jerrold. Handbook of Psychiatric Drug Therapy, 4th Edition. Philadelphia: Lipincott, Williams and Wiliams 2000: 212-216

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