Mood Disorders
A 50-year-old woman with major depressive disorder (MDD) has responded well to treatment with SSRIs. She asks about her risk of relapse if she discontinues the medication. Which of the following is the most accurate information to provide?
A) She has a low risk of relapse after the first episode
B) Relapse risk is high after multiple episodes of depression
C) Relapse risk decreases significantly after 6 months off medication
D) There is no risk of relapse if remission is achieved for 12 months
B) Relapse risk is high after multiple episodes of depression
A 25-year-old male diagnosed with schizophrenia is started on an antipsychotic. Two weeks later, he develops muscle stiffness, fever, confusion, and elevated creatine kinase. What is the most appropriate next step in management?
A) Increase in antipsychotic dose
B) Switch to another antipsychotic
C) Discontinue the antipsychotic and initiative supportive care
D) Add a benzodiazepine
C) Discontinue the antipsychotic and initiative supportive care
A 35-year-old male presents with tremors, sweating, and agitation after stopping alcohol use abruptly. He reports drinking heavily for the past 10 years. On examination, he is confused and disoriented. Which of the following is the most likely diagnosis?
A) Alcohol intoxication
B) Alcohol use disorder
C) Alcohol withdrawal delirium
D) Wernicke-Korsakoff syndrome
C) Alcohol withdrawal delirium
A 9-year-old boy diagnosed with ADHD is started on stimulant medication. After a month of treatment, his parents report that his attention has improved, but he is having difficulty falling asleep at night. What is the best approach to address this side effect?
A) Discontinue the stimulant and switch to an antidepressant
B) Reduce the dose of the stimulant or change the timing of administration
C) Add a sedative to help him sleep
D) Continue the current dose and monitor sleep
B) Reduce the dose of the stimulant or change the timing of administration
An 85-year-old woman is admitted to the hospital for a hip fracture. On the second day of hospitalization, she becomes disoriented, agitated, and has visual hallucinations. Which of the following is the most likely cause of her delirium?
A) Alzheimer's disease
B) Post-operative infection
C) Dehydration
D) Hypoxia
B) Post-operative infection
A 22-year-old woman with social anxiety disorder has been in therapy for 6 months. She is now able to attend social gatherings with minimal discomfort. What is the typical long-term prognosis for social anxiety disorder?
A) Symptoms resolve completely in most patients within one year
B) The disorder tends to be chronic but can improve significantly with treatment
C) It usually worsens with age, regardless of therapy
D) The progrnosis is poor without medication
B) The disorder tends to be chronic but can improve significantly with treatment
A 25-year-old male presents with auditory hallucinations and delusions of persecution for the past 6 months. He believes that his neighbors are spying on him. He has shown a significant decline in his personal hygiene and social interactions. Which of the following is the most likely diagnosis?
A) Schizoaffective Disorder
B) Brief Psychotic Disorder
C) Schizophrenia
D) Delusional Disorder
C) Schizophrenia
A 30-year-old woman has frequent panic attacks characterized by sudden onset of palpitations, shortness of breath, and fear of losing control. After acute treatment with a benzodiazepine, what is the best long-term pharmacological management for this condition?
A) CBT alone
B) Short-term benzodiazepine use as needed
C) SSRIs or SNRIs combined with CBT
D) Tricyclic antidepressants alone
C) SSRIs or SNRIs combined with CBT
A 3-year-old boy is brought to the clinic for concerns about his development. His parents report that he does not respond to his name, avoids eye contact, and prefers to play alone. What is the most appropriate next step in management?
A) Wait until school age to assess his social skills
B) Initiate early intensive behavioral interventions
C) Begin speech therapy after 6 months of observation
D) Refer for genetic testing immediately
B) Initiate early intensive behavioral interventions
A 22-year-old college student with social anxiety disorder finds it difficult to give presentations and interact in social settings. She has declined therapy in the past. What is the best pharmacological option for her?
A) Buspirone
B) Beta-blockers
C) SSRIs
D) Benzodiazepines
C) SSRIs
A 34-year-old man presents to the emergency department with acute mania. He is extremely agitated, has pressured speech, and is engaging in risky behaviors. What is the best immediate treatment option for him?
A) Fluoxetine
B) Lamotrigine
C) Lithium
D) Haloperidol
D) Haloperidol
A 29-year-old woman with schizoaffective disorder presents with depressive symptoms along with ongoing auditory hallucinations. She is already on an antipsychotic. What is the best next step in her treatment?
A) Increase the antipsychotic dose
B) Add an antidepressant
C) Switch to a different antipsychotic
D) Initiate CBT
B) Add an antidepressant
A 42-year-old man with a history of opioid use disorder is brought to the emergency department for severe withdrawal symptoms, including agitation, muscle aches, and gastrointestinal distress. What medication should be administered to relieve his symptoms?
A) Methadone
B) Naltrexone
C) Naloxone
D) Disulfiram
A) Methadone
A 16-year-old boy with a history of aggressive behavior, theft, and truancy is diagnosed with conduct disorder. Which of the following is a common risk factor for developing conduct disorder?
A) Maternal depressin
B) Low Socioeconomic Status
C) Poor academic performance
D) All of the above
D) All of the above
A 28-year-old man with OCD has not responded to cognitive-behavioral therapy (CBT) alone. Which pharmacological treatment is the next best step?
A) Benzodiazepines
B) Antipsychotics
C) SSRIs
D) Tricyclic Antidepressants
C) SSRIs
The following is false about panic disorder:
A) Symptoms begin unexpectedly or out of the blue
B) Physical symptoms like tremors, tachycardia and psychological symptoms like hyperarousal, fear of impending doom can be seen
C) Sudden onset of symptoms precipitated by some fearful event or stimuli
D) It is important to look for medical conditions like hyperthyroidism,hypoglycemia, phaeochromocytoma, cardic disorders before diagnosing panic disorder
C) Sudden onset of symptoms precipitated by some fearful event or stimuli
A 24-year-old female with schizoaffective disorder presents with auditory hallucinations and paranoia during a depressive episode. Which feature distinguishes schizoaffective disorder from schizophrenia?
A) Presence of mood symptoms during psychosis
B) Mood symptoms occurring independently of psychosis
C) Psychotic symptoms occurring only during mood episodes
D) Absence of negative symptoms
B) Mood symptoms occurring independently of psychosis
All are positive symptoms included in the diagnostic criteria for schizophrenia except:
A) Audible thoughts
B) Voices arguing or discussing or both
C) Thought broadcasting
D) Perplexity
D) Perplexity
A 33-year-old man with OCD since childhood has been undergoing cognitive-behavioral therapy (CBT) with exposure and response prevention. He reports a significant decrease in his compulsions. What is the next step in therapy to maintain progress?
A) Discontinue the therapy and observe for relapse
B) Continue CBT for long-term maintenance
C) Add an SSRI for further symptom control
D) Switch to psychodynamic psychotherapy
B) Continue CBT for long-term maintenance
A 31-year-old man with OCD reports that his compulsions include constant hand-washing because of an intense fear of contamination. Which of the following would be an appropriate symptom specifier for his OCD diagnosis?
A) with fair insight
B) with poor insight
C) with absent insight/delusional beliefs
D) with insight and avoidance
A) with fair insight
A 30-year-old woman with PTSD due to a traumatic car accident continues to experience flashbacks and nightmares despite psychotherapy. Which medication would be most appropriate to add for symptom relief?
A) Alprazolam
B) Prazosin
C) Haloperidol
D) Mirtazapine
B) Prazosin
A 25-year-old university student had a fight with a boy who lived in his neighborhood. The next day while he was going out, he started feeling two men in police uniform were observing his movements as a result he became frightened and could not be convinced otherwise by his parents. His symptoms represent:
A) Delusion of persecution
B) Delusion of reference
C) Delusion of guilt
D) Thought insertion
C) Delusion of guilt
A 50 year old woman reports depressed mood, poor appetite, weight loss for 1 month following her husband’s death. After he died she began to feel that she would be ‘better off dead’ at times. She believed that she can hear her husband’s voice calling her. She has no ideas of worthlessness but feels guilty that she did not do something before her husband died. Which of the following condition best describes these symptoms?
A) Schizophrenia
B) Pathological Grief
C) Acute Psychosis
D) None of the above
B) Pathological Grief
A 16-year-old male with conduct disorder has a history of aggressive behavior, truancy, and theft. What is the most appropriate next step in management?
A) Immediate placement in a juvenile detention center
B) Behavioral therapy focusing on anger management and social skills
C) Initiating an antipsychotic medication
D) Psychoanalysis to explore underlying trauma
B) Behavioral therapy focusing on anger management and social skills
A 50 year old woman reports depressed mood, poor appetite, weight loss for 1 month following her husband’s death. After he died she began to feel that she would be ‘better off dead’ at times. She believed that she can hear her husband’s voice calling her. She has no ideas of worthlessness but feels guilty that she did not do something before her husband died. Which of the following condition best describes these symptoms?
A) Schizophrenia
B) Pathological Grief
C) Acute Psychosis
D) None of the above
B) Pathological Grief