1 - University of Arizona



Multiple Choice.

1. A 19-year old man is brought to the emergency department by a friend. The patient is speaking rapidly in an excited fashion and says he is “on top of the world” because he is communicating mentally with the President. Physical examination reveals dilated pupils, erythema of the mucous membranes of the nose, and tachycardia. When seen by a physician 1 hour later, the patient seems depressed and shows little response to her presence. What is the major mechanism of action of the agent this patient has abused on neurotransmitter systems in his brain?

A. Blocks reuptake of dopamine

B. Blocks release of dopamine

C. Blocks reuptake of serotonin

D. Blocks release of serotonin

E. Blocks release of norepinephrine

2. A 24-year-old woman complains of intense hunger as well as tiredness and headache. She states that she has been studying for final exams over the last few weeks and took the last exam yesterday. This woman is most likely to be withdrawing from which of the following substances?

A. Alcohol

B. Amphetamines

C. Benzodiazepines

D. Phencyclidine (PCP)

E. Heroin

3. Six hours after birth, an infant begins to show excessive salivation and lacrimation. The child is also sweating, has a rapid heart rate, and appears restless and agitated. Of the following, what is the most likely cause of this picture?

A. Exposure to alcohol

B. Alcohol withdrawal

C. Exposure to heroin

D. Heroin withdrawal

E. Amphetamine withdrawal

4. A 50-year-old man who has been taking diazepam in moderate doses daily over the past 5 years finds that he has forgotten to take the pills with him when he goes on vacation. Two days later, he calls his physician to report which of the following symptoms?

A. Somnolence

B. Lethargy

C. Respiratory depression

D. Sedation

E. Tremor

5. When a 45-year-old man fills out a form to obtain a life insurance policy, he checks the box marked “never smoked.” He is denied the policy when the insurance company tests his urine sample and finds elevated levels of which of the following?

A. Benzoylecgonine

B. Gamma-glutamyltransferase

C. Serum glutamic-oxaloacetic transaminase

D. Cotinine

E. Creatinine phosphokinase

6. Physical effects of caffeine use include all of the following EXCEPT:

A. Blood pressure reduction

B. CNS stimulation

C. Cardiac stimulation

D. Increased gastric acid secretion

E. Diuresis

7. All of the following statements concerning PCP are true EXCEPT:

A. Its effects may last for several days

B. It may be detected in the blood for more than 1 week

C. Psychosis may occur with long-term use

D. Violent behavior occurs

E. It has few long-term effects

8. Which of the following effects commonly occurs following withdrawal from nicotine?

A. Weight gain

B. Euphoria

C. Excitability

D. Delirium tremens

E. Long-term abstinence

9. Which of the following drugs is most frequently abused in the United States?

A. Marijuana

B. Cocaine

C. Speed

D. LSD

E. Heroin

10. All of the following are common effects of marijuana use EXCEPT:

A. Impaired memory

B. Alteration in time perception

C. Decreased appetite

D. Conjunctival reddening

E. Increased sexual desire

11. Which of the following is an effect of amphetamines?

A. Increased fatigue

B. Reduced pain threshold

C. Reduced appetite

D. Slow onset of action

E. Reduced libido

12. Benzodiazepines are prescribed for all of the following uses EXCEPT:

A. Sedatives

B. Muscle relaxants

C. Anesthetics

D. Antihistamines

E. Tranquilizers

13. All of the following effects are commonly seen as a result of opiate use EXCEPT:

A. Sedation

B. Analgesia

C. Decreased respiratory drive

D. Euphoria

E. Hyperactivity

14. Korsakoff’s syndrome is associated with long-term use of

A. Amphetamines

B. Alcohol

C. Barbiturates

D. Cocaine

E. LSD

15. Which of the following statements about alcoholism is true?

A. Alcohol excites the CNS

B. Life expectancy is reduce by approximately 4 years

C. It is more common in Asian Americans than in white Americans

D. Women are more secretive about use of alcohol than men

E. It is associated with about 20% of traffic accidents

16. All of the following symptoms occur with heroin withdrawal EXCEPT:

A. Lacrimation

B. Nausea

C. Sedation

D. Sweating

E. Vomiting

17. Which of the following symptoms occurs with withdrawal from benzodiazepines?

A. Hypersomnia

B. Tremor

C. Lethargy

D. Respiratory depression

E. Sedation

18. Which of the following conditions is commonly associated with caffeine withdrawal?

A. Excitement

B. Euphoria

C. Headache

D. Decreased appetite

E. Mydriasis

Matching. For each patient, select the drug most likely responsible for the symptoms listed.

A. Alcohol B. Secobarbital C. Cocaine D. Methylphenidate E. Caffeine

E. Diazepam G. Heroin H. Marijuana I. Nicotine J. PCP

19. A 40-year-old man with a history of depression and insomnia is brought to the emergency department with signs of severe respiratory depression.

20. The police bring a 25-year-old man to the hospital in a coma. His girlfriend tells the physician that prior to having a convulsion and fainting, he said that he felt his body expanding and floating up to the ceiling.

21. A 22-year-old woman is brought to the hospital highly agitated and aggressive and demonstrating paranoid ideation. Physician examination reveals tachycardia, hypertension, and nasal inflammation.

22. A 32-year-old man is brought to a the hospital. He appears sedated, but euphoric. A blood test reveals the presence of HIV.

Multiple Choice.

23. The age group in which illegal drug use is most common is

A. 10-15 years

B. 15-18 years

C. 18-25 years

D. 25-35 years

E. 35-45 years

24. A 35-year-old firefighter who was seriously burned while fighting a house fire 9 months ago takes an opioid-based medication daily to help control his pain. Which of the following is most likely to be true about this patient?

A. He receiving too much pain medication

B. Psychological therapies will be of little benefit to him

C. His expression of pain is related exclusively to the extent of his pain

D. He is at high risk for depression

E. He is at high risk for addiction to opioids after the pain remits

25. All of the following are true about chronic pain EXCEPT:

A. It is associated with childhood sexual abuse

B. It may be used to justify an individual’s inability to establish social relationships

C. It may involve social gain

D. It is rarely influenced by cultural factors

E. Financial gain may be involved

26. All of the following statements about chronic pain are true EXCEPT:

A. It is a relatively rare complaint of patients

B. It is commonly associated with depression

C. It frequently results in depression

D. It can be treated with phenothiazines

E. It is associated with substance abuse

27. Which of the following statements about chronic pain and pain relief is true?

A. Patients are at high risk for drug addiction

B. Pain medications should be given only when the patient is experiencing severe distress

C. Deconditioning is the first line of treatment in pain caused by cancer or chronic disease

D. Behavior modification is useful for pain caused by cancer

E. Many patients being treated for pain are overmedicated

28. All of the following statements about patients with chronic pain who receive psychotherapy and behavioral therapy are true EXCEPT:

A. They need less pain medication

B. They become overly dependent on the therapist

C. They become more active

D. They show increased attempts to return to their normal lives

E. Behavioral therapy and psychotherapy are generally beneficial to chronic pain patients

29. Which of the following psychological problems is LEAST likely to be associated with chronic pain syndrome?

A. Hypochondriasis

B. Borderline personality disorder

C. Narcissistic personality disorder

D. Paranoid personality disorder

E. Depression

30. A 45-year-old man reports that over the past 9 months he has lost interest in activities he formerly enjoyed and has little appetite for food or sex. He then states that “my family would be better off it I weren’t around.” Physical examination is unremarkable. Which of the following is most likely to characterize the sleep of this patient?

A. Shift in REM from the last part to the first part of the sleep cycle

B. Short first REM period

C. Increased slow-wave sleep

D. Lengthened REM latency

E. Reduced percentage of REM sleep

31. A 35-year-old female patient is being monitored in a sleep laboratory. When her EEG shows primarily delta waves, which of the following is most likely to characterize this patient?

A. Clitoral erection

B. Paralysis of skeletal muscles

C. Episodic body movements

D. Nightmares

E. Increased brain oxygen use

32. An 85-year-old patient reports that he is often tired during the daytime. His mood is normal and his general health is good. Sleep in this patient is most likely to be characterized by increased

A. Stage 3 sleep

B. Stage 4 sleep

C. Total sleep time

D. REM sleep

E. Nighttime awakenings

33. A 28-year-old student asks his doctor for “sleeping pills” because he often has lain awake in bed for more than 2 hours before falling asleep. He cannot wake up in time for class, is often tired and forgetful, and makes mistakes on exams. When questioned, the student relates that although he goes to bed at 11PM on weeknights, he commonly stays up until 3AM on weekends. What is the doctor’s most appropriate recommendation?

A. A glass of milk before bedtime

B. A fixed wake-up and bedtime schedule

C. A short-acting benzodiazepine at bedtime

D. One hour of exercise before bedtime

E. A large meal before bedtime

34. A 5-year-old child often screams during the night. When this happens, his parents report that he sits up, opens his eyes, and “looks right through them,” but they cannot awaken him. He has no memory of these experiences in the morning. Which of the following sleep disorders best matches this clinical picture?

A. Kleine-Levin syndrome

B. Nightmare disorder

C. Sleep terror disorder

D. Sleep drunkenness

E. Circadian rhythm sleep disorder

35. Which of the following statements concerning narcolepsy is true?

A. The REM sleep of a narcoleptic person is abnormal

B. Narcolepsy occurs in approximately 50 out of every 10,000 persons

C. Narcolepsy occurs most frequently in the elderly

D. Sedatives are used to treat narcolepsy

E. Cataplexy rarely occurs

36. Which neurotransmitter is particularly involved in increasing of REM sleep?

A. Serotonin

B. Norepinephrine

C. Acetylcholine

D. Dopamine

E. Histamine

37. Which of the following is characteristic of a patient in REM sleep?

A. Hyperactivity of skeletal muscles

B. Decreased blood pressure

C. Penile and clitoral erection

D. Decreased brain oxygen use

E. Decreased pulse

38. Which of the following signs is characteristic of a patient in non-REM sleep?

A. Paralysis of skeletal muscles

B. Decreased blood pressure

C. Increased pulse

D. Increased respiration

E. Agitation

39. A patient who is suffering from major depression has sleep problems. Which of the following is likely to be found in this patient?

A. Increased slow-sleep

B. Lengthened REM latency

C. Reduced percentage of REM sleep

D. Shift in REM from last to first part of the night

E. Short first REM period

40. All of the following statements about hypersomnia are true EXCEPT:

A. It is associated with narcolepsy

B. It is associated with sleep apnea

C. It is associated with withdrawal of CNS stimulants

D. It is seen frequently in patients with mania

E. It includes complaints about somnolence

41. Slow-wave sleep is characterized by

A. Penile erection

B. Dreaming

C. Night terrors

D. Total recall of the arousal

E. Increased brain oxygen use

42. Which of the following statements about sleep is true?

A. Patients with Alzheimer’s disease have increased slow-wave sleep

B. Drugs that decrease brain dopamine produce wakefulness

C. Patients with Alzheimer’s disease have reduced REM sleep

D. Dopamine blockers decrease sleep time

E. Increased noradrenergic activity is associated with increased REM sleep

43. Which of the following statements about patients with insomnia is most likely to be true?

A. It occurs in less than 5% of the population

B. It has little effect on daytime functioning

C. It is rarely associated with anxiety

D. It may be an early sign of severe depression

E. It must occur daily for at least 6 months to be diagnosed as insomnia

44. Which of the following is characteristic of sleep in a person age 79?

A. Increase total sleep time

B. Decreased REM sleep

C. Decreased sleep latency

D. Increased stage 3 sleep

E. Increased stage 4 sleep

Matching. Match the sleep characteristic with its appropriate sleep stage. Each lettered option may be selected once, more than once, or not at all.

A. Stage 1 B. Stage 2 C. Stages 3 and 4 D. REM sleep

45. Sleep spindles

46. K-complexes

47. Theta waves

48. Sawtooth waves

49. Slow-wave sleep

50. Amounts to 45% of sleep time

Multiple Choice.

51. The EEG of a 28-year-old patient shows mainly alpha waves. This patient is most likely to be

A. Awake and concentrating

B. Awake and relaxing

C. In stage 1 sleep

D. In stage 4 sleep

E. In REM sleep

52. Visual hallucinations, tachycardia, and sweating are most likely seen following withdrawal from which of the following drugs?

A. Alcohol

B. Cocaine

C. Opioids

D. Amphetamines

E. Barbiturates

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