Behavioural Science question discussion group - z0

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Prolonged QT interval (less common than with most other atypical antipsychotic drugs) is Rare (

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idk why cant i post

[ArchivalUser]

5. BIOLOGICAL ASSESSMENT OF PATIENTS WITH PSYCHIATRIC SYMPTOMS

1. A 57-year-old male patient who has had a
stroke cannot copy a design drawn by the
examiner. The test that the examiner is most
likely to be using to evaluate this patient is
the
(A) Bender Visual Motor Gestalt Test
(B) Luria–Nebraska neuropsychological
battery
© Halstead–Reitan battery
(D) dexamethasone suppression test (DST)
(E) electroencephalogram (EEG)


2. A 36-year-old female patient comes to the
physician complaining of extreme fatigue
and depression. Physical examination
reveals a darkening of her skin, particularly
in the creases of her hands as well as darkening
of the buccal mucosa. The most likely
cause of this picture is
(A) hypocortisolism
(B) hypercortisolism
© pheochromocytoma
(D) hypothyroidism
(E) hyperthyroidism


3. A physician administers sodium lactate
intravenously to a 28-year-old woman.
Using this technique, the physician is trying
to provoke, and thus confirm, the patient’s
diagnosis of
(A) conversion disorder
(B) amnestic disorder
© malingering
(D) panic disorder
(E) major depression


4. To determine which brain area is physiologically
active when a 44-year-old male
patient is translating a paragraph from
Spanish to English, the most appropriate
diagnostic technique is
(A) positron emission tomography (PET)
(B) computed tomography (CT)
© amobarbital sodium (Amytal) interview
(D) electroencephalogram (EEG)
(E) evoked EEG
(F) Glasgow Coma Scale
(G) Folstein Mini-Mental State Examination


5. To determine whether a 3-month-old
infant is able to hear sounds, the most
appropriate diagnostic technique is
(A) PET
(B) CT
© amobarbital sodium (Amytal) interview
(D) EEG
(E) evoked EEG
(F) Glasgow Coma Scale
(G) Folstein Mini-Mental State Examination


6. A 27-year-old female patient shows a sudden
loss of motor function below the waist
that cannot be medically explained. To
determine whether psychological factors are
responsible for this symptom, the most
appropriate diagnostic technique is
(A) PET
(B) CT
© amobarbital sodium (Amytal) interview
(D) EEG
(E) evoked EEG
(F) Glasgow Coma Scale
(G) Folstein Mini-Mental State Examination


7. To identify anatomical changes in the
brain of an 80-year-old female patient with
Alzheimer disease, the most appropriate
diagnostic technique is
(A) PET
(B) CT
© amobarbital sodium (Amytal) interview
(D) electroencephalogram (EEG)
(E) evoked EEG
(F) Glasgow Coma Scale
(G) Folstein Mini-Mental State Examination


8. To differentiate delirium from dementia
in a 75-year-old male patient, the most
appropriate diagnostic technique is
(A) PET
(B) CT
© amobarbital sodium (Amytal) interview
(D) EEG
(E) evoked EEG
(F) Glasgow Coma Scale
(G) Folstein Mini-Mental State Examination


9. A 40-year-old woman reports that over
the past 6 months she has had little appetite,
sleeps poorly, and has lost interest in her
normal activities. Physical exam is unremarkable.
Which of the following is the most
likely laboratory finding in this woman?
(A) Positive dexamethasone suppression
test (DST)
(B) Normal growth hormone regulation
© Increased 5-hydroxyindoleacetic acid
(5-HIAA) levels
(D) Normal melatonin levels
(E) Hyperthyroidism


10. A 50-year-old woman without a previous
psychiatric history reports that over the past
few months she has begun to experience
intense anxiety and has lost 15 pounds. The
patient also complains of “flushing and palpitations.”
Which of the following is the most
likely laboratory finding in this woman?
(A) Positive DST
(B) Normal growth hormone regulation
© Increased 5-HIAA levels
(D) Normal melatonin levels
(E) Hyperthyroidism


11. A college-educated 72-year-old female
patient has scored 15 on the Folstein Mini-
Mental State Examination. From this score,
the physician can conclude that this patient
probably
(A) is normal
(B) cannot calculate simple sums
© is cognitively impaired
(D) should be placed in an assisted living
facility
(E) has a lower-than-normal IQ


12. Four weeks after he begins to take a new
medication, a 28-year-old male psychiatric
patient develops fever and sore throat. He
reports feeling tired, and blood studies
reveal a white blood cell (WBC) count of less
than 2,000. This patient is most likely to be
taking which of the following agents?
(A) Amobarbital sodium
(B) Clozapine
© Lithium
(D) Dexamethasone
(E) Sodium lactate


Typical Board Question
A 55-year-old male patient with no history of psychiatric illness is admitted to the hospital
complaining of intense abdominal pain. He states that over the past few days his wife has
been giving him food that is poisoned so that she can kill him and be with another man.
The wife states that she loves her husband and would never harm him or leave him. When
the patient’s urine is collected, it appears purplish red in color. Urine testing is most likely to
reveal an elevated level of
(A) glucose
(B) 5-hydroxyindoleacetic acid (5-HIAA)
© porphobilinogen
(D) cortisol
(E) vanillylmandelic acid (VMA)

[ArchivalUser]

4. GENETICS, ANATOMY, AND BIOCHEMISTRY OF BEHAVIOR

1. A 30-year-old man who has had many
negative life experiences becomes upset
when he sees photographs of himself taken
during these times. The brain area most
likely to be activated by these photographs
is the
(A) dorsolateral convexity of the frontal lobe
(B) hypothalamus
© orbitofrontal cortex
(D) reticular system
(E) amygdala
(F) nucleus basalis of Meynert


2. A 43-year-old man comes to the emergency
department of a large hospital. He is
very anxious and complains of abdominal
cramps and diarrhea. The physician
observes intense flushing of the man’s skin.
In this patient, a 24-hour urine study is most
likely to reveal elevated levels of
(A) acetylcholine
(B) 5-hydroxyindoleacetic acid (5-HIAA)
© porphobilinogen
(D) vanillylmandelic acid (VMA)
(E) homovanillic acid (HVA)


3. In a clinical experiment, a 48-year-old
female patient with chronic pain who, in the
past, has responded to placebos is given
naloxone. Shortly thereafter the patient is
given an inert substance that she believes is
a painkiller. After the patient receives the
inert substance, her pain is most likely to
(A) increase
(B) decrease
© be unchanged
(D) respond to lower doses of opioids than
previously
(E) fail to respond to opioids in the future


4. A 65-year-old female patient has had a
stroke affecting the left hemisphere of her
brain. Which of the following functions is
most likely to be affected by the stroke?
(A) Perception
(B) Musical ability
© Spatial relations
(D) Language
(E) Artistic ability


5. Which of the following two structural
entities connect the cerebral hemispheres?
(A) Basal ganglia and anterior commissure
(B) Anterior commissure and reticular system
© Reticular system and corpus callosum
(D) Hippocampal commissure and corpus
callosum
(E) Amygdala and habenular commissure


6. A 23-year-old patient shows side effects such
as sedation, increased appetite, and weight
gain while being treated with antipsychotic
medication. Of the following, the mechanism
most closely associated with these effects is
(A) blockade of serotonin receptors
(B) blockade of dopamine receptors
© blockade of norepinephrine receptors
(D) blockade of histamine receptors
(E) decreased availability of serotonin


7. A 3-year-old girl who had been developing
typically since birth begins to withdraw
socially and then stops speaking altogether.
Also, instead of purposeful hand movements,
the child has begun to show repetitive
hand wringing behavior. The chromosome
most likely to be involved in this
disorder is chromosome
(A) 1
(B) 16
© 18
(D) 21
(E) X


8. The major neurotransmitter implicated in
both Alzheimer disease and schizophrenia is
(A) serotonin
(B) norepinephrine
© dopamine
(D) g-aminobutyric acid (GABA)
(E) acetylcholine (Ach)
(F) glutamate


9. The major neurotransmitter involved in
the antidepressant action of fluoxetine (Prozac)
is
(A) serotonin
(B) norepinephrine
© dopamine
(D) g-aminobutyric acid (GABA)
(E) acetylcholine (Ach)
(F) glutamate


10. The neurotransmitter metabolized to
5-HIAA (5-hydroxyindoleacetic acid) is
(A) serotonin
(B) norepinephrine
© dopamine
(D) g-aminobutyric acid (GABA)
(E) acetylcholine (Ach)
(F) glutamate


11. A 25-year-old male patient sustains a serious
head injury in an automobile accident.
He had been aggressive and assaultive, but
after the accident he is placid and cooperative.
He also makes inappropriate suggestive
comments to the nurses and masturbates a
great deal. The area(s) of the brain most likely
to be affected in this patient is (are) the
(A) right parietal lobe
(B) basal ganglia
© hippocampus
(D) reticular system
(E) amygdala
(F) left frontal lobe


12. A 35-year-old female patient reports that
she has difficulty sleeping ever since she
sustained a concussion in a subway accident.
The area(s) of the brain most likely to
be affected in this patient is (are) the
(A) right parietal lobe
(B) basal ganglia
© hippocampus
(D) reticular system
(E) amygdala
(F) left frontal lobe


13. A 55-year-old woman was diagnosed
with schizophrenia at the age of 22. If this
diagnosis was appropriate, the volume of the
hippocampus, the size of the cerebral ventricles,
and glucose utilization in the frontal
cortex of this patient are now most likely to
be, respectively
(A) increased, increased, increased
(B) decreased, decreased, decreased
© decreased, decreased, increased
(D) decreased, increased, decreased
(E) increased, decreased, increased


14. An 80-year-old female patient has a resting
tremor of her left hand, little expression
in her face, and problems taking a first step
when she has been standing still. The area(s)
of the brain most likely to be affected in this
patient is (are) the
(A) right parietal lobe
(B) basal ganglia
© hippocampus
(D) reticular system
(E) amygdala
(F) left frontal lobe


15. A 69-year-old former bank president
cannot tell you the name of the current president
and has difficulty identifying the
woman sitting next to him (his wife). He
began having memory problems 3 years ago.
The area(s) of the brain most likely to be
affected in this patient is (are) the
(A) right parietal lobe
(B) basal ganglia
© hippocampus
(D) reticular system
(E) amygdala
(F) left frontal lobe


16. A 45-year-old male patient becomes
depressed following a head injury. The
area(s) of the brain most likely to be affected
in this patient is (are) the
(A) right parietal lobe
(B) basal ganglia
© hippocampus
(D) reticular system
(E) amygdala
(F) left frontal lobe


17. A 28-year-old male patient is brought to
the emergency room after a fight in which
he attacked a man who cut into his line at
the supermarket checkout. In the emergency
room he remains assaultive and combative.
The body fluids of this patient are most
likely to show
(A) increased 3-methoxy-4-hydroxyphenylglycol
(MHPG)
(B) decreased MHPG
© increased 5-hydroxyindoleacetic acid
(5-HIAA)
(D) decreased 5-HIAA
(E) decreased homovanillic acid (HVA)


18. A 30-year-old woman who is withdrawing
from heroin shows intense anxiety,
increased pulse, elevated blood pressure,
and a hand tremor. Her symptoms improve
when she is given clonidine, an alpha-2-
adrenergic receptor agonist. The area(s) of
the brain most likely to be involved in the
improvement in this patient’s symptoms is
(are) the
(A) right parietal lobe
(B) basal ganglia
© locus ceruleus
(D) raphe nuclei
(E) amygdala
(F) substantia nigra


19. A very anxious 25-year-old patient is
examined in the emergency room. There is
no evidence of physical illness. If it could be
measured, the g-aminobutyric acid (GABA)
activity in the brain of this patient would
most likely be
(A) increased
(B) decreased
© unchanged
(D) higher than the activity of serotonin
(E) higher than the activity of norepinephrine


20. A 24-year-old man sustains a head injury
in an automobile accident. His father relates
that prior to the accident, the patient was
respectful, modest, controlled, and hard
working. In the hospital, the patient is rude
to the nurses and aides, loses his temper
with the slightest provocation, and refuses to
wear a hospital gown or anything else. These
behavioral changes after the accident indicate
that the area of the brain most likely to
have been injured in this patient is the
(A) dorsolateral convexity of the frontal lobe
(B) hypothalamus
© orbitofrontal cortex
(D) reticular system
(E) amygdala
(F) nucleus basalis of Meynert


21. Analysis of the blood plasma of a
45-year-old male patient shows increased
concentration of homovanillic acid (HVA).
This elevation is most likely to be associated
with which of the following conditions?
(A) Parkinson disease
(B) Depression
© Bulimia
(D) Pheochromocytoma
(E) Schizophrenia


22. Remembering that school closes early
before Thanksgiving Day every year is an
example of which of the following types
of memory?
(A) Semantic
(B) Episodic
© Procedural
(D) Working


23. A 55-year-old patient who is taking tiotropium
bromide (Spiriva) for chronic
obstructive pulmonary disease has memory
problems due to the agent’s action on which
of the following receptors?
(A) Adrenergic
(B) Cholinergic
© Dopaminergic
(D) Histaminergic
(E) Serotonergic


24. A 6-year-old child shows seizures, cognitive
defects, and autistic behavior. The child
also shows raised discolored areas on her
forehead (forehead plaques). Which of the
following chromosomes is most likely to be
involved in the etiology of this child’s symptoms?
(A) 1
(B) 16
© 18
(D) 21
(E) X


25. A 72-year-old man with Alzheimer disease
is being treated with memantine. What
is believed to be the basis of the therapeutic
action of memantine on neurons in the
brain?
(A) To inhibit the action of acetylcholinesterase
(B) To block the influx of calcium
© To inhibit the action of acetylcholine
(D) To increase the influx of glutamate
(E) To facilitate the influx of calcium


Typical Board Question
When a 70-year-old man who has had a stroke attempts to (a) divide a line in half, (b) turn
single lines into “Xs,” or © reproduce a clock face, he does the tasks like this (see Figure)
effectively neglecting the left of the drawings. The area(s) of the brain most likely to be
affected in this patient is (are) the
(A) right parietal lobe
(B) basal ganglia
© hippocampus
(D) reticular system
(E) amygdala
(F) left frontal lobe

sorry idk i couldn't post the pic...

[ArchivalUser]

BIOLOGICAL ASSESSMENT OF PATIENTS WITH PSYCHIATRIC SYMPTOMS(very tough!!!!)
CACAC
GBGEC
ABC


GENETICS, ANATOMY, AND BIOCHEMISTRY OF BEHAVIOR
BBDDDDEBAAEDDBCFCBCCEEDBEA

thankyou for the Q's.

[ArchivalUser]

ch 5 :Biological Assessment of Patients with Psychiatric Symptoms

1. The answer is A. The Bender Visual Motor Gestalt Test is used to evaluate visual and
motor ability by reproduction of designs. The Luria–Nebraska neuropsychological
battery is used to determine cerebral dominance and to identify specific types of brain
dysfunction, while the Halstead–Reitan battery is used to detect and localize brain
lesions and determine their effects. The dexamethasone suppression test is used to
predict which depressed patients will respond well to treatment with antidepressant
agents or electroconvulsive therapy. The electroencephalogram (EEG), which measures
electrical activity in the cortex, is useful in diagnosing epilepsy and in differentiating
delirium from dementia.


2. The answer is A. This female patient is showing evidence of hypocortisolism or Addison
disease. This condition is characterized by darkening of the skin, particularly in
places not exposed to the sun such as skin creases and inside the mouth. This darkening
is not seen in hypercortisolism, pheochromocytoma, or hyper- or hypothyroidism.
Hypercortisolism, which also may lead to depression and anxiety, is characterized by
weight gain, “moon” shaped face, and skin striae. Depression, dry hair, and weight gain
characterize hypothyroidism, while anxiety, fever, weight loss, and elevated heart rate
characterize hyperthyroidism. Patients with pheochromocytoma show intense anxiety
and elevated VMA in body fluids (see Chapter 4).


3. The answer is D. Intravenous administration of sodium lactate can help identify individuals
with panic disorder since it can provoke a panic attack in such patients.


4. The answer is A. Positron emission tomography (PET) localizes physiologically active
brain areas by measuring glucose metabolism. Thus, this test can be used to determine
which brain area is being used during a specific task (e.g., translating a passage written in
Spanish).


5. The answer is E. The auditory evoked EEG can be used to assess whether this child
can hear. Evoked EEGs measure electrical activity in the cortex in response to sensory
stimulation.


6. The answer is C. The amobarbital sodium (Amytal) interview is used to determine
whether psychological factors are responsible for symptoms in this patient who
shows a non-medically explained loss of sensory function (conversion disorder—see
Chapter 14).


7. The answer is B. Computed tomography (CT) identifies anatomical brain changes,
such as enlarged ventricles. Thus, although not diagnostic, this test can be used to
identify anatomical changes in the brain, such as enlarged ventricles in a patient with
suspected dementia of the Alzheimer type.


8. The answer is D. Electroencephalogram (EEG) measures electrical activity in the cortex
and can be useful in differentiating delirium (abnormal EEG) from dementia (usually
normal EEG).


9. The answer is A. Poor appetite, poor sleep, and lack of interest in usual activities
characterize patients who have major depression (see Chapter 12). In this depressed
woman, the dexamethasone suppression test is likely to be positive. A positive result is
seen when the synthetic glucocorticoid dexamethasone fails to suppress the secretion
of cortisol as it would in a patient with a normal mood. Also, in depression there may
be abnormal growth hormone regulation and melatonin levels, and decreased 5-HIAA.
Hypothyroidism may be associated with depression; hyperthyroidism is more commonly
associated with the symptoms of anxiety.


10. The answer is E. This woman’s symptoms (e.g., anxiety, fever, weight loss, and flushing)
indicate that she has hyperthyroidism (also see the answer to Question 9). People commonly
describe their perception of a rapid heartbeat as “palpitations.”


11. The answer is C. Scores below 18 on the Folstein Mini-Mental State Examination indicate
significant cognitive impairment. This test does not evaluate calculating ability or
IQ. Although the patient is impaired, it is not clear what caused the problem or whether
she needs to be placed in an assisted living facility.


12. The answer is B. Agranulocytosis is seen particularly in patients taking clozapine,
an antipsychotic, or carbamazepine, an anticonvulsant that is used to treat bipolar
disorder (see Chapter 12). Lithium, amobarbital sodium, dexamethasone, and sodium
lactate are not specifically associated with agranulocytosis.

Typical Board Question
The answer is C. This patient with abdominal pain, the false belief that his wife is trying to
poison him (a delusion, see Table 11.1), and urine with a purple-red color is most likely to
have porphyria, a disorder that is associated with psychiatric symptoms such as delusions.
Porphyria is a metabolic disorder in which toxic porphyrins accumulate in tissue leading to
high levels of porphobilinogen in urine which colors it purple-red. Purple-red urine is not
seen in the serotonin syndrome (high 5-HIAA), Cushing’s syndrome (high cortisol), pheochromocytoma
(high VMA), or diabetes (high glucose).


---------------------------------------------------------------------------------------------------------------
ch 4: Genetics, Anatomy, and Biochemistry of Behavior

1. The answer is E. The amygdala is an important brain area for the evaluation of sensory
stimuli with emotional significance. Thus, the brain area most likely to be activated by
these photos is the amygdala.


2. The answer is D. A 24-hour urine study is most likely to reveal elevated levels of VMA, a
metabolite of norepinephrine. Anxiety, abdominal cramps and diarrhea, and skin flushing
are symptoms of pheochromocytoma, a norepinephrine-secreting adrenal tumor.
This picture is not seen with elevated levels of other neurotransmitter metabolites.


3. The answer is C. Since the placebo response is based in part on activation of the
endogenous opioid system, it will be blocked by naloxone, and this patient’s pain will
be unchanged. This experiment will not necessarily affect her response to opioids in
the future.


4. The answer is D. Dominance for language in both right-handed and left-handed people
is usually in the left hemisphere of the brain. Perception, musical ability, artistic ability,
and spatial relations primarily are functions of the right side of the brain.


5. The answer is D. The corpus callosum and the hippocampal, habenular, and anterior
commissures connect the two hemispheres of the brain. The basal ganglia, reticular
system, and amygdala do not have this function.


6. The answer is D. Sedation, increased appetite, and weight gain are side effects of treatment
with certain antipsychotic agents. The mechanism most closely associated with
these side effects is blockade of histamine receptors since these antipsychotics are not
specific for dopamine blockade. Blockade of dopamine receptors by these antipsychotic
medications is associated with side effects such as Parkinsonism-like symptoms
and elevated prolactin levels.


7. The answer is E. This 3-year-old girl is showing signs of Rett’s disorder which is linked
to the X chromosome. Rett’s disorder is characterized by loss of social skills after a
period of typical functioning as well as hand wringing and breathing abnormalities (see
also Chapter 15).


8. The answer is F. While acetylcholine (Ach) is the major neurotransmitter implicated in
Alzheimer disease, abnormalities in glutamate are seen in both Alzheimer disease and
schizophrenia.


9. The answer is A. Blockade of serotonin reuptake by presynaptic neurons is the primary
action of the antidepressant fluoxetine.


10. The answer is A. Serotonin is metabolized to 5-HIAA.


11. The answer is E. The patient is showing evidence of the Klüver–Bucy syndrome, which
includes hypersexuality and docility and is associated with damage to the amygdala.


12. The answer is D. Sleep-arousal mechanisms are affected by damage to the reticular system.


13. The answer is D. Although neuroimaging cannot be used to diagnose psychiatric disorders,
brains of patients with schizophrenia such as this woman are likely to show
decreased volume of limbic structures such as the hippocampus; increased size of cerebral
ventricles due, in part, to brain shrinkage; and decreased glucose utilization in
the frontal cortex.


14. The answer is B. This 80-year-old female patient is showing signs of Parkinson disease
(e.g., a resting tremor, little facial expression, and problems initiating movement). This
disorder is associated with abnormalities of the basal ganglia.


15. The answer is C. This patient is showing evidence of Alzheimer disease. Of the listed
brain areas, the major one implicated in Alzheimer disease is the hippocampus.


16. The answer is F. Of the listed brain areas, depression is most likely to be associated with
damage to the left frontal lobe.


17. The answer is D. Assaultive, impulsive, aggressive behavior like that seen in this
28-year-old male patient is associated with decreased levels of serotonin in the brain.
Levels of 5-HIAA (5-hydroxyindoleacetic acid), the major metabolite of serotonin, have
been shown to be decreased in the body fluids of violent, aggressive, impulsive individuals
as well as depressed individuals. MHPG (3-methoxy-4-hydroxyphenylglycol), a
metabolite of norepinephrine, is decreased in severe depression, while homovanillic
acid (HVA), a metabolite of dopamine, is decreased in Parkinson disease and
depression.


18. The answer is C. The effectiveness of clonidine in treating withdrawal symptoms associated
with the use of opiates and sedatives is believed to be due to its action on alpha-
2-adrenergic receptors, for example, reducing the firing rate of noradrenergic neurons,
most of which are located in the locus ceruleus.


19. The answer is B. g-Aminobutyric acid (GABA) is an inhibitory amino acid neurotransmitter
in the CNS. Thus, the activity of GABA in the brain of this anxious patient is
likely to be decreased. Decreased serotonin and increased norepinephrine are also
involved in anxiety (Table 4.4).


20. The answer is C. Behavioral changes such as decreased impulse control, poor social
behavior, and lack of characteristic modesty indicate that the area of the brain most
likely to have been injured in this patient is the orbitofrontal cortex. Lesions of this
brain area result in disinhibition, inappropriate behavior, and poor judgment. In contrast,
lesions of the dorsolateral convexity of the frontal lobe result in decreased executive
functioning (e.g., motivation, concentration, and attention). The hypothalamus is
associated with homeostatic mechanisms and the reticular system with consciousness
and sleep. Damage to the amygdala results in decreased, not increased, aggression. The
nucleus basalis of Meynert is a site of Ach production; its damage could result in deficits
in intellectual functioning.


21. The answer is E. Increased body fluid level of homovanillic acid (HVA), a major metabolite
of dopamine, is seen in schizophrenia. Decreased HVA is seen in Parkinson disease,
depression, and in medicated schizophrenic patients. Increased vanillylmandelic
acid (VMA), a metabolite of norepinephrine, is seen in pheochromocytoma. Decreased
body fluid level of 5-HIAA, a metabolite of serotonin, is seen in depression and in
bulimia (Table 4.5).


22. The answer is A. Remembering that school closes early before Thanksgiving Day every
year is an example of semantic memory. Semantic memory is a type of declarative
memory which involves remembering general knowledge about the world. Episodic
memory involves remembering personally experienced events, procedural memory
involves remembering things one does automatically, and working memory involves
remembering recent information.


23. The answer is B. Decreased availability of acetylcholine by blockade of muscarinic acetylcholine
receptors (i.e., anticholinergic activity) in the CNS is associated with memory
problems. Blockade of adrenergic, dopaminergic, histaminergic, and serotonergic
receptors are not specifically associated with memory problems.


24. The answer is B. Chromosome 16 and chromosome 9 are both associated with tuberous
sclerosis. Seizures, cognitive defects, autistic behavior, and forehead plaques in this
6-year-old child are signs of this disorder.


25. The answer is B. The therapeutic action of memantine is believed to be to decrease the
influx of glutamate which ultimately blocks the influx of calcium which can lead to
nerve cell degeneration and death. In contrast to a group of drugs also used to treat
Alzheimer’s, that is, the acetylcholinesterase inhibitors, memantine does not directly
affect acetylcholine.

Typical Board Question
The answer is A. Damage to the right parietal lobe can result in impaired visual–spatial processing.
This can lead to problems copying simple drawings and neglect of the left side as
seen in this patient

@ rose : ur always welcome
yes ch 5 questions were tough since they were talking about some tests

( I liked the typical board question in ch 5 . FA mentions aboout 5 Ps as symptom of AIP one of which is psychological disturbances but from this q we come to know that its delusion, a more specific info.

q 9 which talks about dexamethasone suppresion test and how it can help in evaluating depression was good.

q 11 Maximum total score = 30; total score of 23 or higher suggests competence; total score of 18 or lower suggests incompetence

q 3 : I was wondering how sodium lacatate provok that attack so I found this link
books.google.co.in/books?id=qlXxu9D39xcC&pg=RA1-PA83&redir_esc=y#v=onepage&q&f=false

ref from http://en.wikipedia.org/wiki/Anxiogenic
--------------------------------------------------------------------------------------------------------------------
now ch 4 :

q 3 : opioid system and placebo relationship
basically talking about placebo analgesia
I got hold of the abstract which stated this first time http://www.ncbi.nlm.nih.gov/pubmed/80579?dopt=Abstract

q 13 : i didn't understand how the size of cerebral ventricles will increase if there is brain shrinkage ?

q 25 : this tells how glutamate is toxic which FA didn't bother to mention while discussing memantine )

[ArchivalUser]

ch 8 : Clinical Assessment of Patients with Behavioral Symptoms

1. A 12-year-old child who is having difficulty
in school is given an intelligence test.
The test determines that the child is functioning
mentally at the level of an 8-year-old
child. What category of intellectual function
best describes this child?
(A) Severely retarded
(B) Moderately retarded
© Mildly retarded
(D) Borderline
(E) Normal

2. A child is tested and found to have a mental
age of 12 years. The child’s chronological
age is 10 years. What is the IQ of this child?
(A) 40
(B) 60
© 80
(D) 100
(E) 120

3. A 29-year-old woman tells the doctor that
she often hears the voice of Abraham Lincoln
speaking directly to her. This woman is
showing a disorder of
(A) perception
(B) insight
© judgment
(D) mood
(E) affect

4. A child is tested and is found to have an
IQ of 90. What category of intellectual function
best describes this child?
(A) Severely retarded
(B) Moderately retarded
© Mildly retarded
(D) Borderline
(E) Normal or average

5. A doctor is evaluating a 20-year-old
female patient. Which of the following characteristics
of the patient is best evaluated
using the Minnesota Multiphasic Personality
Inventory-2 (MMPI-2)?
(A) Skills for daily living
(B) Depression
© Knowledge of general information
(D) Reading comprehension
(E) Intelligence

6. A physician examines a severely
depressed 75-year-old woman. The woman
relates that she feels so low that she cannot
enjoy anything in her life, and that even winning
the state lottery would not make her
feel any better. The best description of this
patient’s mood is
(A) anhedonic
(B) dysphoric
© euthymic
(D) labile
(E) euphoric

7. For evaluating the self-care skills of a
22-year-old woman with an IQ of 60 for
placement in a group home, what is the
most appropriate test?
(A) Thematic Apperception Test (TAT)
(B) Minnesota Multiphasic Personality
Inventory-2 (MMPI-2)
© Wechsler Intelligence Scale for Children-
Revised (WISC-R)
(D) Rorschach Test
(E) Vineland Social Maturity Scale
(F) Wide Range Achievement Test (WRAT)
(G) Beck Depression Inventory-II (BDI-II)
(H) Raskin Depression Scale
(I) Wisconsin Card Sorting Test

8. For determining, using bilaterally symmetrical
inkblots, which defense mechanisms
are used by a 25-year-old woman,
what is the most appropriate test?
(A) TAT
(B) MMPI-2
© WISC-R
(D) Rorschach Test
(E) Vineland Social Maturity Scale
(F) WRAT
(G) BDI-II
(H) Raskin Depression Scale
(I) Wisconsin Card Sorting Test

9. For evaluating depression in a 54-year-old
male patient using a self-rating scale, what is
the most appropriate test?
(A) TAT
(B) MMPI-2
© WISC-R
(D) Rorschach Test
(E) Vineland Social Maturity Scale
(F) WRAT
(G) BDI-II
(H) Raskin Depression Scale
(I) Wisconsin Card Sorting Test

10. For evaluating, by a primary care physician,
hypochondriasis in a 54-year-old male
patient using true/false questions, what is
the most appropriate test?
(A) TAT
(B) MMPI-2
© WISC-R
(D) Rorschach Test
(E) Vineland Social Maturity Scale
(F) WRAT
(G) BDI-II
(H) Raskin Depression Scale
(I) Wisconsin Card Sorting Test

11. The most appropriate test for evaluating
abstract reasoning and problem solving in a
54-year-old female patient is the
(A) TAT
(B) MMPI-2
© WISC-R
(D) Rorschach Test
(E) Vineland Social Maturity Scale
(F) WRAT
(G) BDI-II
(H) Raskin Depression Scale
(I) Wisconsin Card Sorting Test

12. A 24-year-old patient with schizophrenia
tells the physician that the CIA is listening to
his telephone conversations through his television
set. This patient is describing
(A) a hallucination
(B) an illusion
© clouding of consciousness
(D) blunted affect
(E) a delusion

Typical Board Question
A 6-year-old child is tested and is found to have an IQ of 50. There are no significant medical
findings. At this time, it can be expected that the child is able to
(A) identify some colors
(B) ride a two-wheeled bicycle
© understand that death is permanent
(D) copy a triangle
(E) utilize an internalized moral sense of right and wrong

-------------------------------------------------------------------------------------------------------------
ch 10: Normal Sleep and Sleep Disorders


1. The parents of a 5-year-old boy report
that the child often screams during the
night. They are particularly concerned
because during these disturbances the child
sits up, opens his eyes, and “looks right
through them,” and they are unable to
awaken him. The child has no memory of
these experiences in the morning. Physical
examination is unremarkable and the child
is doing well in kindergarten. During these
disturbances the child’s electroencephalogram
is most likely to be primarily characterized
by
(A) sawtooth waves
(B) theta waves
© K complexes
(D) delta waves
(E) alpha waves

2. During a sleep study a physician discovers
that a patient shows too little REM sleep
during the night. Theoretically, to increase
REM sleep the physician should give the
patient a medication aimed at increasing
circulating levels of
(A) serotonin
(B) norepinephrine
© acetylcholine
(D) dopamine
(E) histamine

3. During a sleep study a male patient’s electroencephalogram
(EEG) shows primarily
sawtooth waves. Which of the following is
most likely to characterize this patient at
this time?
(A) Penile erection
(B) Movement of skeletal muscles
© Decreased blood pressure
(D) Decreased brain oxygen use
(E) Decreased pulse

4. During a sleep study a female patient’s
EEG shows primarily delta waves. Which of
the following is most likely to characterize
this patient at this time?
(A) Clitoral erection
(B) Paralysis of skeletal muscles
© Sleepwalking (somnambulism)
(D) Nightmares
(E) Increased brain oxygen use

5. An 85-year-old patient reports that he
sleeps poorly. Sleep in this patient is most
likely to be characterized by increased
(A) sleep efficiency
(B) REM sleep
© nighttime awakenings
(D) stage 3 sleep
(E) stage 4 sleep

6. A woman reports that most nights during
the last year she has lain awake in bed for
more than 2 hours before she falls asleep.
After these nights, she is tired and forgetful
and makes mistakes at work. Of the following,
the most effective long-term treatment
for this woman is
(A) continuous positive airway pressure
(CPAP)
(B) an antipsychotic agent
© a sedative agent
(D) a stimulant agent
(E) development of a “sleep ritual”


Questions 7 and 8
A 22-year-old medical student who goes to
sleep at 11 PM and wakes at 7 AM falls asleep in
laboratory every day. He tells the doctor that
he sees strange images as he is falling asleep
and sometimes just as he wakes up. He has
had a few minor car accidents that occurred
because he fell asleep while driving.

7. Of the following the best first step in management
of this student is
(A) continuous positive airway pressure
(CPAP)
(B) an antipsychotic agent
© a sedative agent
(D) a stimulant agent
(E) development of a “sleep ritual”

8. Which of the following is this student
most likely to experience?
(A) Long REM latency
(B) Auditory hallucinations
© Tactile hallucinations
(D) Delusions
(E) Cataplexy


Questions 9 and 10
A patient reports that he is sleepy all day despite
having 8 hours of sleep each night. His wife
reports that his loud snoring keeps her awake.

9. Of the following, the best first step in the
management of this patient is
(A) continuous positive airway pressure (CPAP)
(B) an antipsychotic agent
© a sedative agent
(D) a stimulant agent
(E) development of a “sleep ritual”

10. Of the following, this patient is most
likely to be
(A) depressed
(B) aged 25 years
© overweight
(D) using a stimulant agent
(E) withdrawing from a sedative agent

11. Sawtooth waves are most characteristic
of what sleep stage?
(A) Stage 1
(B) Stage 2
© Stages 3 and 4
(D) REM sleep

12. Sleep spindles, K complexes, and bruxism
are most characteristic of what sleep stage?
(A) Stage 1
(B) Stage 2
© Stages 3 and 4
(D) REM sleep

13. Theta waves are most characteristic of
what sleep stage?
(A) Stage 1
(B) Stage 2
© Stages 3 and 4
(D) REM sleep

14. What sleep stage takes up the largest
percentage of sleep time in young adults?
(A) Stage 1
(B) Stage 2
© Stages 3 and 4
(D) REM sleep

15. Bed-wetting is characteristic of what
sleep stage?
(A) Stage 1
(B) Stage 2
© Stages 3 and 4
(D) REM sleep

16. A 22-year-old student in the middle of
finals week tells her doctor that for the last
2 weeks she has been studying late into the
night and has started to have trouble falling
asleep. What is the doctor’s most appropriate
recommendation?
(A) Exercise before bedtime
(B) A large meal before bedtime
© A glass of milk before bedtime
(D) A fixed wake-up and bedtime
schedule
(E) A short-acting benzodiazepine at
bedtime

17. A 45-year-old female patient reports that
over the last 3 months she has lost her appetite
and interest in her usual activities, and
often feels that life is not worth living. Compared
with typical sleep, in this patient the
percentage of REM sleep, percentage of delta
sleep, and sleep latency, respectively, are
most likely to
(A) increase, decrease, decrease
(B) increase, decrease, increase
© decrease, stay the same, increase
(D) decrease, decrease, increase
(E) increase, increase, increase

18. In a sleep laboratory, a woman shows
10% of sleep time in stage 1 sleep, 75% of
sleep time in stage 2 sleep, 15% of sleep time
in REM sleep, no delta sleep, and six nighttime
awakenings. This sleep pattern indicates
that this woman
(A) has narcolepsy
(B) has depressive illness
© is elderly
(D) has an anxiety disorder
(E) has nocturnal myoclonus

19. A 5-year-old child often wakes during
the night, crying and fearful. When his parents
come to him, he relates details of
dreams involving frightening creatures and
situations. Which of the following sleep disorders
best matches this picture?
(A) Kleine–Levin syndrome
(B) Nightmare disorder
© Sleep terror disorder
(D) Sleep drunkenness
(E) Circadian rhythm sleep disorder
(F) Nocturnal myoclonus
(G) Restless legs syndrome
(H) Bruxism

20. The mother of a 13-year-old boy reports
that he has “bouts” of overeating and of oversleeping,
each lasting a few days to a few
weeks. Which of the following sleep disorders
best matches this picture?
(A) Kleine–Levin syndrome
(B) Nightmare disorder
© Sleep terror disorder
(D) Sleep drunkenness
(E) Circadian rhythm sleep disorder
(F) Nocturnal myoclonus
(G) Restless legs syndrome
(H) Bruxism

21. A 32-year-old man has a 9 to 5 job in a
law office. Sunday night through Thursday
night the man goes to bed at 10 PM, but is
unable to fall asleep until about 2 AM. His
alarm wakens him at 6 AM and he feels tired
all day. On Friday and Saturday nights, the
man goes to bed at 2 AM, falls asleep quickly,
sleeps until 10 AM, and wakes feeling
refreshed. Which of the following sleep disorders
best matches this picture?
(A) Kleine–Levin syndrome
(B) Nightmare disorder
© Sleep terror disorder
(D) Sleep drunkenness
(E) Circadian rhythm sleep disorder
(F) Nocturnal myoclonus
(G) Restless legs syndrome
(H) Bruxism

22. A 70-year-old man cannot fall asleep
because of crawling feelings and aching in
his calves and thighs. He can suppress the
urge to move his legs for a short period but
then must move them. Which of the following
best fits this clinical picture?
(A) Kleine–Levin syndrome
(B) Nightmare disorder
© Sleep terror disorder
(D) Sleep drunkenness
(E) Circadian rhythm sleep disorder
(F) Nocturnal myoclonus
(G) Restless legs syndrome
(H) Bruxism

23. The sleep of a patient who begins taking
a moderate dose of diazepam (Valium) daily
is most likely to be characterized by which of
the following changes?
(A) Increased stage 1 and increased stage 2
(B) Increased stage 1 and decreased delta
© Decreased REM and decreased delta
(D) Decreased REM and increased delta
(E) Increased REM and decreased delta

24. A 21-year-old student who is part of a
study of circadian rhythms, sleeps in a cave
for 1 month with no access to clocks or
watches. At the end of the month, the length
of her circadian cycle is likely to be closest to
(A) 21 hours
(B) 22 hours
© 23 hours
(D) 24 hours
(E) 25 hours

25. A 52-year-old overweight man reports
that he often wakes up with a headache. He
also notes that he is tired all the time and
repeatedly falls asleep during the day. Evaluation
of the arterial blood of this patient is
most likely to reveal
(A) respiratory acidosis
(B) respiratory alkalosis
© metabolic alkalosis
(D) increased PaO2
(E) decreased PaCO2

26. A 33-year-old man with myasthenia
gravis is taking physostigmine for symptom
relief. The effect of this agent on sleep architecture
in this patient is most likely to be
increased
(A) stage 1 sleep
(B) stage 2 sleep
© stage 3 sleep
(D) stage 4 sleep
(E) REM sleep

Typical Board Question
The wife of a 62-year-old man tells the doctor that for the past year, her husband has punched
and kicked her repeatedly during the night. When she wakes him during these episodes, her
husband relates that he has been having a dream in which he is trying to escape from or
fighting with a frightening attacker. Over the next few years, this man is at increased risk to
develop
(A) Kleine–Levin syndrome
(B) sleep terror disorder
© nocturnal myoclonus
(D) Alzheimer disease
(E) Lewy body dementia

[ArchivalUser]

thankyou for the Q.

DDADEAIDHAGAA
DCAEDEDEACDBIDCDCCCADGEAAEC

[ArchivalUser]

Hi thank u for the questions they r awesome I think they r from NBME too.Iam waiting for more to come.

[ArchivalUser]

@ rose : your welcome !
@ sabriaz : yup !

ch 8 : Clinical Assessment of Patients with Behavioral Symptoms

1. The answer is C. Using the IQ formula, IQ = MA/CA × 100, the IQ of this child is 8 years
(mental age)/12 years (chronological age) × 100, that is, about 66 (IQ). An individual with
an IQ of 66 is classified with mild mental retardation (IQ 50–70).

2. The answer is E. Using the IQ formula, the IQ of the child is 12/10 × 100 = 120.

3. The answer is A. This 29-year-old woman who believes that she hears the voice of Abraham
Lincoln is showing an auditory hallucination, which is a disorder of perception.
Disorders of judgment, insight, mood, and affect are other variables assessed on the MSE.

4. The answer is E. An individual with an IQ of 90 is classified as having normal or average
intellectual function (IQ 90–109).

5. The answer is B. Clinical scales of the Minnesota Multiphasic Personality Inventory-2
(MMPI-2) evaluate depression as well as hypochondriasis, paranoia, schizophrenia,
and other characteristics. Intelligence, including general information and reading
comprehension, can be tested using the Wechsler Adult Intelligence Scale-Revised
(WAIS-R). (See also answer to Question 7).

6. The answer is A. This severely depressed 75-year-old woman is showing anhedonia, the
inability to feel pleasure, a characteristic of severe depression. Euphoric mood is an elated
mood, while euthymic mood is a normal mood, with no significant depression or elevation.
Dysphoric mood is a subjectively unpleasant feeling. Labile moods (mood swings)
are alterations between elevated and dysphoric moods.

7. The answer is E. The Vineland Social Maturity Scale is the most appropriate test for evaluating
the self-care skills of this woman with mental retardation for placement in a group
home.

8. The answer is D. The Rorschach Test, which utilizes bilaterally symmetrical ink blots, is
the most appropriate test to determine which defense mechanisms are used by this
woman.

9. The answer is G. For evaluating depression in this patient using a self-rating scale, the
most appropriate test is the Beck Depression Inventory-II (BDI-II). In the Raskin
Depression Scale, the patient is rated by an examiner.

10. The answer is B. The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is the
most appropriate test for use by a primary care physician to evaluate depression in a
patient since it is an objective test and no special training is required for administration
and scoring. The MMPI-2 uses true/false questions to evaluate personality characteristics
and psychopathology. In contrast, interpretation of projective personality tests
requires specific training.

11. The answer is I. The Wisconsin Card Sorting Test is the most appropriate test for evaluating
abstract reasoning and problem solving in a patient. In this test a patient is asked to
sort 128 response cards that vary in color, form, and number.

12. The answer is E. A false belief, in this case that the CIA is listening to one’s telephone conversations
through the television set, is an example of a delusion. A hallucination is a false
perception, and an illusion is a misperception of reality (see also Table 11.1). Clouding of
consciousness is the inability to respond to external events, while blunted affect is a
decreased display of emotional responses.

Typical Board Question
The answer is A. With an IQ of 50, the mental age of this 6-year-old child is 3 years. This is
calculated using the IQ formula: IQ = MA/CA × 100, that is, 50 = x/6 × 100, x = 3. Children who
are 3 years of age can identify some colors. However, the ability to ride a two-wheeled bicycle,
understand the meaning of death, copy a triangle, or utilize an internalized moral sense of
right and wrong do not develop until about the mental age of 6 years (see Chapter 1).

----------------------------------------------------------------------------------------------------------------------
ch 10: Normal Sleep and Sleep Disorders

1. The answer is D. This child demonstrates sleep terror disorder, which is characterized
by repetitive occurrences of screaming during the night and the inability to be awakened
or to remember those experiences in the morning. Sleep terrors typically occur
during delta sleep. If the child were having nightmares, which occur in REM sleep, the
child would awaken and relate the nature of his frightening dreams (see also answer to
Question 19).

2. The answer is C. Acetylcholine (Ach) is involved in both increasing REM sleep and increasing
sleep efficiency. Increased levels of dopamine decrease sleep efficiency. Increased levels
of norepinephrine decrease both sleep efficiency and REM sleep while increased levels
of serotonin increase both sleep efficiency and delta (slow-wave) sleep.

3. The answer is A. Sawtooth waves characterize REM sleep, which is also associated with
penile erection; dreaming; increased pulse, respiration, and blood pressure; and paralysis
of skeletal muscles.

4. The answer is C. Delta waves characterize sleep stages 3 and 4 (slow-wave sleep), which
is also associated with somnambulism, night terrors, episodic body movements, and
enuresis. Delta sleep is the deepest, most relaxed stage of sleep. Clitoral erection, paralysis
of skeletal muscles, nightmares, and increased brain oxygen use occur during REM
sleep.

5. The answer is C. Sleep in the elderly is characterized by increased nighttime awakenings,
decreased REM sleep, decreased delta sleep, and decreased sleep efficiency.

6. The answer is E. The most effective long-term management for this woman with
insomnia is the development of a series of behaviors associated with bedtime (i.e., a
“sleep ritual”). By the process of classical conditioning (see Chapter 7) the sleep ritual
then becomes associated with going to sleep. Sleep rituals can include things like taking
a warm bath, pulling down the blinds, and listening to soothing music. Continuous
positive airway pressure is used to treat sleep apnea; stimulant agents are used to treat
narcolepsy; and antipsychotics are used to treat psychotic symptoms. Sedative agents
have a high abuse potential and, because they tend to reduce REM and delta sleep,
their use may result in sleep of poorer quality.

7. The answer is D. 8. The answer is E. This medical student who falls asleep in laboratory
every day despite a normal amount of sleep at night probably has narcolepsy. Of the
listed choices, the most effective management for narcolepsy is the administration of
stimulant agents such as modafinil. Sedative agents are not useful for narcolepsy. In
narcolepsy, short REM latency, sleep paralysis, and cataplexy occur. The student’s
strange perceptual experiences as he is falling asleep and waking up are hypnagogic
and hypnopompic hallucinations, respectively.

9. The answer is A. 10. The answer is C. This man who snores and reports that he is sleepy
all day despite having 8 hours of sleep each night probably has obstructive sleep apnea.
Of the listed choices, the best first step in management of this patient is continuous
positive airway pressure (CPAP). Since obesity is associated with obstructive sleep
apnea, other suggestions for this patient would include weight loss. Use of stimulants
and withdrawal from sedatives are associated with wakefulness rather than the daytime
sleepiness seen here. Also, most sleep apnea patients are middle aged (age 40–60
years). Although depression and anxiety are associated with sleep problems, this man’s
snoring indicates that his sleep problem is more likely to have a physical basis.

11. The answer is D. Sawtooth waves are primarily seen in REM sleep.

12. The answer is B. Sleep spindles, K complexes, and bruxism are primarily seen in stage 2
sleep.

13. The answer is A. Theta waves are primarily seen in stage 1 sleep.

14. The answer is B. In young adults, 45% of total sleep time is spent in stage 2 sleep. Five
percent is spent in stage 1, 25% in REM, and 25% in delta sleep.

15. The answer is C. Bed-wetting occurs primarily in stages 3–4 (delta) sleep.

16. The answer is D. The most appropriate first step in management of this 22-year-old
student who is having temporary problems with sleep during finals week is to recommend
a fixed wake-up and bedtime schedule. Benzodiazepines are not appropriate
because of their high abuse potential and possibility of causing daytime sedation in
this student during examinations. These agents also decrease sleep quality by reducing
REM and delta sleep. Exercise should be done early in the day; if done before bedtime it
can be stimulating and cause wakefulness. A large meal before bedtime is more likely
to interfere with sleep than to help sleep. While many people believe that milk helps
induce sleep, this effect has never been shown empirically.

17. The answer is B. This woman’s symptoms indicate that she is likely to be experiencing
a major depressive episode (see Chapter 12). Sleep in major depression is associated
with increased REM sleep, reduced delta sleep, and increased sleep latency.

18. The answer is C. This sleep pattern indicates that this woman is elderly. Sleep in elderly
patients is characterized by increased stage 1 and stage 2 sleep, increased nighttime
awakenings, decreased REM sleep, and much reduced or absent delta sleep.

19. The answer is B. This child is experiencing nightmare disorder, which occurs during
REM sleep. In contrast to the child with sleep terror disorder (see also answer to Question
1), this child wakes up and can relate the nature of his frightening dreams. Kleine–
Levin syndrome is usually seen in adolescents and involves recurrent periods of hypersomnia
and hyperphagia, each lasting days to weeks. In sleep drunkenness a patient
cannot come fully awake after sleep, and in circadian rhythm sleep disorder the individual
sleeps and wakes at inappropriate times. Nocturnal myoclonus (muscular contractions
involving the legs) and restless legs syndrome (uncomfortable sensation in
the legs) occur more commonly in middle-aged and elderly people. Bruxism is tooth
grinding during sleep.

20. The answer is A. The fact that this patient is an adolescent, as well as the recurrent
periods of hypersomnia and hyperphagia each lasting for weeks to months, indicate
that this patient has Kleine–Levin syndrome (and see also answer to Question 19).

21. The answer is E. Circadian rhythm sleep disorder involves the inability to sleep at
appropriate times. This man shows the delayed sleep phase type of this disorder, which
is characterized by falling asleep and waking later than wanted. When the man is able
to follow his preferred sleep schedule (e.g., on weekends), he sleeps well and wakes
refreshed (see also answer to Question 19).

22. The answer is G. In restless legs syndrome, there are crawling, aching feelings in the
legs making it necessary for the patient to move them and causing difficulty in falling
asleep (see also answer to Question 19).

23. The answer is C. Decreased REM sleep and decreased delta sleep characterize the sleep
of patients such as this one, who are taking sedatives such as diazepam (a benzodiazepine),
barbiturates, or alcohol.

24. The answer is E. At the end of the month, the length of this student’s circadian cycle in
the absence of cues from the outside world is likely to be close to 25 hours.
[oh boy ! ]


25. The answer is A. This overweight middle-aged male patient is likely to have sleep
apnea. Like other patients with pulmonary disorders leading to depressed breathing,
patients with sleep apnea typically show chronic respiratory acidosis (increased partial
pressure of carbon dioxide [PaCO2]). Respiratory alkalosis (decreased PaCO2) results
from hyperventilation as a result of anxiety, high fever, or stimulant abuse. Metabolic
alkalosis typically results from excessive vomiting and resulting hypokalemia (see also
answers to Questions 9 and 10).

26. The answer is E. Physostigmine is a cholinomimetic agent used to treat myasthenia
gravis. The increase in acetylcholine resulting from treatment with this agent is most
likely to result in increased REM sleep in this patient.

Typical Board Question
The answer is E. Dreaming typically occurs during REM sleep. Because typically there is
muscle atonia during REM sleep, this man who is moving while dreaming is showing signs of
REM sleep behavior disorder. This disorder is associated with an increased risk for Parkinson
disease and Lewy body dementia. Kleine–Levin syndrome, sleep terror disorder, nocturnal
myoclonus, and Alzheimer disease are not specifically associated with REM sleep behavior
disorder (see also answer to Question 19).