Psychiatry & Neurology Board Exam Sample Questions
Book 2 - 2004
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QUESTION

7. A 48-year-old male auto mechanic complains of chronic, non-restorative sleep, frequent awakenings, daytime fatigue and poor concentration. He estimates that he sleeps about 5 out of the 9 hours he spends in bed. His only medication is ibuprofen for chronic lower back pain.

On exam, he is 40 pounds above his ideal body weight and he has mildly elevated blood pressure.

Which one of the following is LEAST useful in further evaluating the patient’s sleep/wake complaints?

     A) Polysomnography
     B) Tape recording of respiratory sounds during sleep
     C) Head CT without contrast
     D) Beck Depression Inventory
     E) Interview with bed partners

ANSWER

7.    C    Head CT without contrast

In order to properly evaluate sleep disorders it is important to obtain a detailed history of the sleep wake complaint and its associated symptoms. A full psychiatric history must be obtained, and screens such as the Beck Depression Inventory can help in evaluating Axis I disorders such as major depression that could be contributing to the sleep disturbance. Interview with bed partners or tape recordings of sleep to assess for abnormal breathing can help in ruling out sleep apnea as a cause of the sleep disturbance. Polysomnography is a detailed lab based evaluation of sleep used to help in the diagnosis of insomnia and may include an EEG, EKG, O2 sat, evaluation of eye movements and measurement of muscle tone during sleep.

1. Jerald, Kay, Tasman, Allan and Lieberman, Jeffrey A. Psychiatry, Behavioral Science and Clinical Essentials. W.B. Saunders Company, Philadelphia PA. 2000: 460-461.

QUESTION

67. A 44-year-old woman has a 20-year history of vague and chronic physical complaints. She says that she has always been sick but that her doctors never seem to identify the problem and cannot help her.

Diagnostic impression:

     A) Somatization disorder
     B) Conversion disorder
     C) Hypochondriasis
     D) Factitious disorder
     E) Body dysmorphic disorder

ANSWER

67.    A    Somatization disorder

Somatoform disorders (such as somatization disorder) are characterized by physical symptoms without a sufficient organic cause. A person who has somatoform disorder is not faking and not delusional, but truly believes he has a physical problem. The most important differential diagnosis of the somatoform disorders is unidentified organic disease. The characteristics of somatization disorder include a history of multiple somatic complaints over many years, including: 4 pain symptoms (e.g., headache), 2 gastrointestinal symptoms (e.g. nausea), 1 sexual symptom (e.g., menstrual irregularities), 1 pseudoneurological symptom (e.g., paralysis). These chronic and lifelong symptoms are increased by stressful life events.

1. Fadem,B., Simring, S. High Yield Psychiatry. 2nd Edition. Lippincott, Williams & Wilkins, Philadelphia PA. 2003:82-84.

2. Kaplan, HI., Sadock BJ. A Comprehensive Textbook of Psychiatry. Williams & Wilkins, Baltimore MD. 1999:1504-1544.

QUESTION

119. Adverse effects associated with carbamazepine:

     A) Aplastic anemia
     B) Neural tube defects
     C) Alopecia
     D) Hypothyroidism
     E) Renal dysfunction

ANSWER

119.    A    Aplastic anemia

Carbamazepine is a mood stabilizing agent. It is an anticonvulsant and may also be used to treat trigeminal neuralgia, impulse control disorders, and withdrawal from sedatives. Adverse effects associated with carbamazepine include aplastic anemia and agranulocytosis, which require monitoring. Additional adverse effects include sedation, dizziness, ataxia, and congenital anomalies. Neural tube defects, alopecia, hypothyroidism, and renal dysfunction are not associated with use of carbamazepine.

1. Fadem,B., Simring, S. High Yield Psychiatry. 2nd Edition. Lippincott, Williams & Wilkins, Philadelphia PA. 2003:128.

2. Kaplan, HI., Sadock BJ. A Comprehensive Textbook of Psychiatry. Williams & Wilkins, Baltimore MD. 1999:2282-2288.

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