EMO
A 28-year-old woman comes to the clinic because she has been feeling down. For the past 10 days, she has had low mood, decreased energy, and mild difficulty concentrating at work. She reports sleeping more than usual. She denies changes in appetite, psychomotor changes, feelings of worthlessness, or suicidal thoughts. Her medical history is unremarkable. She does not use alcohol or drugs. Physical exam and basic labs are normal.
She states that although she feels somewhat sluggish, she is still able to perform her daily responsibilities and has not missed work.
Which of the following is the most likely diagnosis?
A. Adjustment disorder with depressed mood
B. Cyclothymic disorder
C. Major depressive disorder
D. Persistent depressive disorder (dysthymia)
E. Premenstrual dysphoric disorder
What is A- adjustment disorder with depressed mood
***NEED 5 FOR 2 WEEKS OF SIGECAPS!! BE CAREFUL!!!
A 9-year-old girl is brought to the pediatrician because she refuses to go to school. For the past 3 months, she has complained of stomachaches and headaches every morning before school. Her symptoms improve quickly if she is allowed to stay home. When asked privately, she says she worries that something bad will happen to her mother while she is away. She calls home multiple times during the school day to check on her. Her academic performance is normal when she attends, and she has no history of trauma. Physical exam and basic labs are normal.
Which of the following is the most likely diagnosis?
A. Generalized anxiety disorder
B. Separation anxiety disorder
C. Social anxiety disorder
D. Illness anxiety disorder
E. Oppositional defiant disorder
What is B. Separation anxiety?
***Looks ALOT like GAD so look out
A 35-year-old man with bipolar disorder is started on lithium. Which of the following is a common long-term adverse effect of lithium therapy?
A. Pulmonary fibrosis
B. Nephrogenic diabetes insipidus
C. Acute cholestatic hepatitis
D. Agranulocytosis
E. Hyperprolactinemia
What is B. Nephrogenic DI
A 25-year-old man with schizophrenia is started on haloperidol. Two weeks later, he develops muscle rigidity, a shuffling gait, and tremor. Which of the following is the most likely mechanism for these side effects?
A. Serotonin 5-HT2A receptor antagonism
B. Dopamine D2 receptor antagonism in the nigrostriatal pathway
C. Alpha-1 adrenergic receptor blockade
D. Muscarinic acetylcholine antagonism
E. GABA-A receptor potentiation
What is B? ***make sure you know the dopamine pathways!!
A 40-year-old woman lost her spouse 2 weeks ago. She reports feeling sad, crying frequently, and having trouble sleeping. She denies feelings of worthlessness, guilt, or thoughts of death unrelated to her spouse. She continues to care for her children and attend work.
Which of the following is the most likely diagnosis?
A. Major depressive disorder
B. Persistent depressive disorder
C. Normal bereavement
D. Adjustment disorder with depressed mood
E. Bipolar II disorder
Answer: C. Normal bereavement
Explanation: Bereavement in the first 2 weeks after a loss can present with sadness and functional impairment, but it does not meet DSM-5 criteria for MDD (duration ≥2 weeks with ≥5 symptoms including depressed mood or anhedonia).
A 24-year-old man is brought in by his roommates because they are worried about his recent behavior. For the past five days, he has been unusually outgoing, sleeping only three hours per night, and starting multiple new projects. He talks rapidly and seems easily distracted, but he has continued to attend his classes and has not engaged in risky behavior. He describes feeling “better than normal,” but not out of control.
Which of the following is the most likely diagnosis?
A. Bipolar I disorder
B. Bipolar II disorder
C. Cyclothymic disorder
D. Major depressive disorder
E. Persistent depressive disorder (dysthymia)
What is bipolar II disorder?
A 10-year-old girl is brought to the clinic by her mother due to “constant worrying.” For the past 8 months, she worries about her school performance, whether her friends like her, and if her parents will get into car accidents. She often asks repeated questions for reassurance and has trouble sleeping due to worry. She complains of stomachaches and muscle tension. She does not have repetitive rituals to reduce her anxiety, and her worries are not limited to social situations. She performs all schoolwork but sometimes takes extra time due to checking her work.
Which of the following is the most likely diagnosis?
A. Obsessive-compulsive disorder
B. Generalized anxiety disorder
C. Social anxiety disorder
D. Separation anxiety disorder
E. Panic disorder
What is GAD?
A 28-year-old woman is started on sertraline for major depressive disorder. After 1 week, she reports headache, nausea, and trouble sleeping. She is otherwise stable. Which of the following is the most likely explanation?
A. Serotonin syndrome
B. Common SSRI side effects
C. Neuroleptic malignant syndrome
D. Hypertensive crisis
E. Akathisia
What is B. Common SSRI symp?
A 30-year-old woman with schizophrenia is started on risperidone. After one month, she complains of amenorrhea and galactorrhea. Which of the following is the most likely mechanism?
A. Serotonin reuptake inhibition
B. Dopamine D2 receptor blockade in the tuberoinfundibular pathway
C. Muscarinic receptor antagonism
D. Alpha-2 adrenergic agonism
E. NMDA receptor blockade
What is Dopamine D2?
A 25-year-old woman reports a 2-week period of low mood, fatigue, and anhedonia. She also reports a 5-day period 3 months ago when she felt “super energetic,” slept only 3 hours per night, and took on multiple projects. During that period, she was productive and her friends noticed she was unusually talkative, but she did not require hospitalization.
Which of the following is the most likely diagnosis?
A. Major depressive disorder
B. Bipolar I disorder
C. Bipolar II disorder
D. Cyclothymic disorder
E. Persistent depressive disorder
Answer: C. Bipolar II disorder
A 32-year-old woman comes to her 6-week postpartum visit. She reports persistent sadness, low energy, and difficulty bonding with her newborn. She has trouble sleeping even when the baby is asleep and says she often feels like she is “failing as a mother.” Her appetite is decreased and she has lost interest in activities she used to enjoy. She denies thoughts of harming herself or the baby. Symptoms began about 3 weeks after delivery and have been progressively worsening.
Which of the following is the most likely diagnosis?
A. Normal postpartum adjustment
B. Postpartum blues
C. Postpartum psychosis
D. Postpartum depression
E. Persistent depressive disorder
What is D. Postpartum depression
A 4-year-old boy is brought to the clinic because he rarely makes eye contact, does not respond to his name consistently, and prefers to play alone rather than with other children. He often lines up his toy cars in a specific order and becomes very upset if the order is disturbed. He has no language delay but tends to repeat phrases from television.
Which of the following is the most likely diagnosis?
A. Social anxiety disorder
B. Autism spectrum disorder
C. Intellectual disability
D. Obsessive-compulsive disorder
E. Reactive attachment disorder
What is B ASD?
A 42-year-old man with treatment-resistant depression is started on phenelzine. He enjoys aged cheese and cured meats. Which of the following complications is he at risk for if he consumes these foods?
A. Hypertensive crisis
B. Serotonin syndrome
C. Agranulocytosis
D. Tardive dyskinesia
E. SIADH
What is A. Hypertensive crisis?
A 32-year-old man with treatment-resistant schizophrenia is started on clozapine. Which of the following is the most serious potential adverse effect requiring routine laboratory monitoring?
A. Extrapyramidal symptoms
B. Agranulocytosis
C. Hyperprolactinemia
D. QT prolongation
E. Hepatotoxicity
What is B?
A 28-year-old man spends 4–5 hours per day checking doors and locks, feeling extreme anxiety if he does not. He is distressed by these behaviors and wishes he could stop. He is otherwise neat and organized but flexible with daily routines.
Which of the following is the most likely diagnosis?
A. Obsessive-compulsive disorder
B. Obsessive-compulsive personality disorder
C. Generalized anxiety disorder
D. Schizotypal personality disorder
E. Major depressive disorder
Answer: A. Obsessive-compulsive disorder
A 26-year-old woman, 5 days after giving birth, reports feeling emotional and overwhelmed. She cries easily, especially when she is tired or unsure what her baby needs. She says she still feels connected to her baby and is caring for him without difficulty. She denies changes in appetite, severe sadness, or thoughts of harming herself or her child. She says these feelings come and go and improve with reassurance from her partner.
Which of the following is the most likely diagnosis?
A. Postpartum depression
B. Postpartum psychosis
C. Generalized anxiety disorder
D. Postpartum blues
E. Acute stress disorder
What is D. Postpartum blues?
***know the difference between normal and not
A 9-year-old girl is brought to the clinic because she frequently argues with teachers, refuses to follow instructions, and deliberately annoys her classmates. At home, she often defies her parents’ rules, is easily annoyed by adults, and blames others for her mistakes. These behaviors have been occurring for the past 8 months and are causing difficulties at school.
Which of the following is the most likely diagnosis?
A. Conduct disorder
B. Attention-deficit/hyperactivity disorder
C. Oppositional defiant disorder
D. Intermittent explosive disorder
E. Disruptive mood dysregulation disorder
What is C. ODD?
A 30-year-old woman with bipolar disorder is started on valproate. Which of the following is a major concern with this medication in women of childbearing age?
A. Pulmonary fibrosis
B. Teratogenicity (neural tube defects)
C. Hyperprolactinemia
D. Agranulocytosis
E. Optic neuropathy
What is B. Teratogenicity?
A 45-year-old woman with schizophrenia is started on ziprasidone. ECG shows a prolonged QT interval. Which of the following is a clinical concern associated with this side effect?
A. Torsades de pointes
B. Agranulocytosis
C. Acute dystonia
D. Neuroleptic malignant syndrome
E. Hyperprolactinemia
What is A?
A 9-year-old girl refuses to go to school, complains of stomachaches every morning, and worries that something bad will happen to her mother. She is otherwise healthy and performs well academically when attending school.
Which of the following is the most likely diagnosis?
A. Generalized anxiety disorder
B. Separation anxiety disorder
C. Social anxiety disorder
D. Panic disorder
E. Adjustment disorder
Answer: B. Separation anxiety disorder
Explanation: Anxiety is focused on separation from attachment figures and causes physical symptoms like stomachaches. GAD involves worry across multiple domains.
A 30-year-old man comes to the clinic because he spends several hours each day checking his door locks and stove. He says he knows it is “irrational,” but he feels extreme anxiety if he tries to stop. He has been late to work multiple times because of his need to repeatedly check things until the anxiety subsides. He wishes he could stop these behaviors and feels embarrassed by them.
His girlfriend says he is generally neat and likes order, but he is not perfectionistic about schedules or rules. He enjoys hobbies and is flexible with plans. He has no rigid moral beliefs and does not insist that others follow his routines.
Which of the following is the most likely diagnosis?
A. Obsessive-compulsive personality disorder
B. Obsessive-compulsive disorder
C. Generalized anxiety disorder
D. Illness anxiety disorder
E. Autism spectrum disorder
What is B. OCD-- be careful not to confuse with OCPD
A 13-year-old boy is brought to the emergency department by his mother after she discovered a notebook in which he wrote about wanting to kill her “to see what it would feel like.” When interviewed, he calmly confirms he has thought about harming her multiple times and says he is curious about the experience. He shows no remorse or emotional distress about these thoughts. He has a history of harming animals, setting small fires, and stealing from neighbors. His teachers report he has been bullying classmates and threatening younger students. He has no history of hallucinations, mania, substance use, or neurological issues.
Which of the following is the most likely diagnosis?
A. Oppositional defiant disorder
B. Conduct disorder
C. Intermittent explosive disorder
D. Antisocial personality disorder
E. Schizophrenia
What is B conduct disorder?
Which of the following correctly matches the drug with its primary mechanism of action in mood disorders?
A. Fluoxetine – dopamine D2 receptor antagonist
B. Lithium – inhibits inositol monophosphatase and modulates second messenger systems
C. Phenelzine – selectively inhibits norepinephrine reuptake
D. Valproate – blocks NMDA receptors
E. Bupropion – MAO inhibitor
What is B?
A 28-year-old man with schizophrenia on haloperidol develops acute dystonia (neck stiffness and upward eye deviation) 24 hours after starting therapy. Which of the following is the best initial treatment?
A. Lorazepam
B. Benztropine
C. Haloperidol dose increase
D. Fluoxetine
E. Lithium
What is Benztropine?
A 22-year-old college student presents with 3 weeks of low mood, insomnia, and poor concentration. He reports heavy cannabis use daily for the past 2 months. He has no prior psychiatric history. Physical exam and labs are normal.
Which of the following is the most likely diagnosis?
A. Major depressive disorder
B. Cannabis-induced depressive disorder
C. Bipolar II disorder
D. Persistent depressive disorder
E. Adjustment disorder
Answer: B. Cannabis-induced depressive disorder