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1. Seretonin Specific Reuptake Inhibitors (SSRI's) have all of the following advantages over tricyclic antidepressant agents EXCEPT [1]:

   A. Little or no increase in heart rate
   B. No prolongation of the QT interval
   C. Little or no postural hypotension
   D. Rapid improvement in sleep quality and duration
   E. Little or no anti-cholinergic effects

2. A 78 year old man is bought to the emergency room for evaluation of mental status changes. The patient was found wandering around a park on mile from his home, and could not remember how he got there. He has a history of chronic obstructive pulmonary disease and type II diabetes mellitus. He takes an oral hypoglycemic agent and long acting theophylline because he cannot use an inhaler properly. The patient has no known relatives, and lives alone in an elderly persons housing complex. There was one similar episode in the past when the patient could not recall how to get home from a movie he had seen. The patient quit smoking 10 years previously, does not drink alcohol, and uses no recreational drugs. A physical examination is unrevealing including a neurologic examination. The mini-mental status examination score is 24 out of 30 (normal >26), with the patient unable to recall three objects (forgot all of them), spell "world" backwards, name watch (he did name the pen correctly), and he could not recall the year. The diagnosis of dementia was entertained. Which of the following is NOT an appropriate screening test to rule out other causes of mental status change in this patient [2]:

   A. Antinuclear Antibody (ANA)
   B. Thyroid Stimulating Hormone (TSH)
   C. Vitamin B12 level
   D. Serologic Test for Syphilis (RPR or VDRL)
   E. Computed Tomographic (CT) Scan of the Head

3. All screening tests are within normal limits. The diagnosis of dementia of the Alzheimer type is entertained. Which of the following is TRUE concerning this diagnosis [3] ?

   A. Alzheimer's Disease is ruled in when all other causes of dementia have been ruled out
   B. The diagnosis can be made by measuring cerebrospinal fluid acetylcholine levels
   C. The diagnosis is a pathological diagnosis only and is made clinically by exclusion
   D. The majority of cases of Alzheimer's Disease are found in certain families
   E. The disease will eventually plateau at a particular stage in the majority of cases

4. Tacrine, a drug which acts primarily on the central nervous system, appears to be effective in slowing the progression in early Alzheimer's Disease. The main property of this drug is [4]:

   A. Inhibition of dopamine degradation
   B. Inhibition of acetylcholinesterase
   C. Blockade of serotonin and norepinephrine reuptake
   D. alpha-2 adrenergic agonist activity
   E. Inhibition of GABA-nergic neuron activity

5. Which of the following is NOT a side effect of phenothiazine neuroleptic agents [5] ?

   A. Prolongation of the QT interval
   B. Dystonic Reactions
   C. Reduction in the seizure thresshold
   D. Postural Hypotension
   E. Bradycardia

6. Which of the following agents has been approved by the US Food and Drug Administration (FDA) for treatment of obsessive-compulsive disorder (OCD) [6] ?

   A. Nortriptyline
   B. Sertraline
   C. Trazadone
   D. Fluvoxamine
   E. Lorazepam

7. Which of the following is NOT a characteristic of panic attacks [7] ?

   A. Palpitations and Chest Pain
   B. Feeling smothered existing in unreality
   C. Fear of dying, or losing control
   D. Electrocardiographic changes consistent with ischemia during attacks
   E. Association with agorophobia

8. Which one of the following is not associated with delirium [8] ?

   A. Hypercalcemia
   B. Hypothyroidism
   C. Hyperkalemia
   D. Alcohol Withdrawal
   E. Sepsis

9. Which of the following is NOT characteristic of Anorexia [9] ?

   A. Intense fear of obesity, even when weight loss has occurred
   B. Underlying metabolic disturbance which inhibits weight gain
   C. Disturbances of body image - "feel fat"
   D. Weight loss >25% of normal weight
   E. Refusal to maintain normal body weight

10. Which of the following has NOT been shown to be effective for mania treatment [10] ?

    A. Carbamazepine (Tegretol®)
    B. Valproic Acid
    C. Lithium
    D. Electroconvulsive Therapy (ECT)
    E. Fluoxetine (Prozac®)

Answers

1. D (SSRI's may make sleep more difficult and should generally be taken in the morning.)
2. A (There are no symptoms or signs of a rheumatologic cause of cerebral dysfunction.)
3. C
4. B
5. E
6. D
7. D
8. C
9. B
10. E