child development
Diagnosis for a 6-year-old child who frequently loses temper, argues with adults, and deliberately annoys others.
What is Oppositional defiant disorder.. characterized by defiant, hostile behavior without severe violations of others’ rights.
Which antidepressant is least likely to cause sexual side effects?
What is buproprion?
Most likely diagnosis when A 50-year-old woman is tearful, has insomnia, and decreased appetite for 2 weeks after her divorce. She is functioning well at work.
A. Major depressive disorder
B. Adjustment disorder with depressed mood
C. Persistent depressive disorder
D. Normal bereavement
E. Cyclothymic disorder
What is Adjustment disorder... involves emotional symptoms in response to a stressor occurring within 3 months, with less severity than MDD.
Diagnosis for patient on lithium who develops excessive thirst and frequent urination. Lab results reveal hypernatremia and dilute urine.
What is nephrogenic diabetes insipidus... Lithium can impair the kidney's ability to concentrate urine
132. A patient develops persistent oral-facial movements after long-term antipsychotic use. What is the diagnosis?
A. Acute dystonia
B. Akathisia
C. Parkinsonism
D. Tardive dyskinesia
E. Neuroleptic malignant syndrome
Explanation: Tardive dyskinesia is a late-onset extrapyramidal side effect characterized by repetitive involuntary movements.
Diagnosis of a 19-year-old patient who has a 2-week history of auditory hallucinations and disorganized behavior without mood symptoms.
What is Schizophreniform disorder... diagnosed when schizophrenia symptoms are present for more than 1 week but less than 6 months.
Oof the following ____ best differentiates between delirium and dementia?
A. Memory loss
B. Disorganized thinking
C. Gradual onset
D. Impaired attention
E. Visual hallucinations
What is Impaired attention... more prominent and acute in delirium, helping differentiate it from chronic dementias.
134. A child with frequent aggression, rule-breaking, and stealing is likely to be diagnosed with:
A. Intermittent explosive disorder
B. Oppositional defiant disorder
C. Conduct disorder
D. ADHD
E. Autism spectrum disorder
What is conduct disorder?
Explanation: Conduct disorder involves repetitive, persistent violation of societal norms and others' rights.
A 19-year-old woman is brought in for evaluation of binge eating and subsequent vomiting. Her BMI is 21.
A. Anorexia nervosa, binge/purge type
B. Bulimia nervosa
C. Binge eating disorder
D. Avoidant/restrictive food intake disorder
E. Normal behavior
What is Bulimia?
A patient taking fluoxetine experiences restlessness, tremors, and clonus after taking St. John's Wort. What is the most likely diagnosis?
What is Serotonin syndrome
Best diagnosis for a 16-year-old who reports hearing voices for 3 days after a breakup. No other symptoms are present.
A. Schizophrenia
B. Schizophreniform disorder
C. Brief psychotic disorder
D. Delusional disorder
E. Bipolar disorder with psychotic features
What is Brief psychotic disorder... involves sudden onset of psychotic symptoms lasting less than 1 month, often triggered by stress.
114. A 50-year-old man with schizophrenia has had 2 failed antipsychotic trials. He now reports drooling and sedation on his new medication. Which drug is he likely taking?
A. Risperidone
B. Aripiprazole
C. Clozapine
D. Haloperidol
E. Ziprasidone
Clozapine is associated with sedation, hypersalivation, and is used in treatment-resistant schizophrenia.
A man is convinced his wife is unfaithful without any evidence, and is otherwise functional has diagosis of
Delusional disorder, _____ type
What is Jealous type delusional disorder... involves persistent belief in infidelity without basis, with otherwise preserved functioning.
The primary concern in using benzodiazepines long-term in elderly patients
A. Hypertension
B. Tardive dyskinesia
C. Hepatotoxicity
D. Cognitive impairment and falls
E. QT prolongation
What are Benzodiazepines... increase the risk of sedation, cognitive impairment, and falls in the elderly population.
Tthe most evidence-based therapy for a child diagnosed with autism spectrum disorder who exhibits poor eye contact, repetitive behaviors, and limited speech.
A. CBT
B. Family therapy
C. Applied behavior analysis (ABA)
D. Group therapy
E. Occupational therapy
What is ABA... a structured behavioral intervention with strong evidence for improving core symptoms in autism.
The most appropriate next step for a woman with major depressive disorder who fails two SSRI trials.
A. Add benzodiazepine
B. Switch to MAOI
C. Start ECT
D. Add second antidepressant (e.g., bupropion)
E. Start psychotherapy (not this answer)
What is Augmenting with another antidepressant... such as bupropion, or switching classes completely
91. Risky class of medications for patient with depression who loves to eat aged cheese
What is MAOIs like phenelzine... can cause hypertensive crisis when combined with tyramine-rich foods such as aged cheese.
115. A 25-year-old patient with bipolar disorder is started on lithium. What organ system requires the most frequent monitoring?
Lithium is nephrotoxic and requires regular monitoring of renal function and serum levels.
The mechanism of action of clozapine’s superior efficacy in treatment-resistant schizophrenia?
A. Dopamine D2 antagonism
B. Dopamine D4 antagonism
C. Serotonin 5-HT1A partial agonism
D. NMDA receptor antagonism
E. GABA-A receptor modulation
What is dopamine D4 antagonism and 5-HT2A antagonism... contributing to its efficacy in treatment-resistant cases.
Diagnosis for a 22-year-old who has mood episodes and psychosis. The psychotic symptoms persist in the absence of mood symptoms.
What is schizoaffective disorder?
Most consistent with a 70-year-old man with vascular dementia who becomes agitated in the evenings.
What is sundowning?
Most likely diagnosis of A 12-year-old with intellectual disability and macroorchidism exhibits hand-flapping.
A. Rett syndrome
B. Down syndrome
C. Fragile X syndrome
D. Prader-Willi syndrome
E. Autism spectrum disorder
What is Fragile X syndrome... intellectual disability, macroorchidism, and stereotypic movements like hand-flapping.
Personality disorder characterized by unstable interpersonal relationships, identity disturbance, and impulsivity?
What is Borderline personality disorder?
The best next step for a 24-year-old man who uses heroin daily. He presents with yawning, lacrimation, muscle aches, and diarrhea.
A. Naloxone
B. Methadone
C. Buprenorphine
D. Naltrexone
E. Diazepam
What is Buprenorphine... used for opioid withdrawal management and can be started when moderate withdrawal is present.
137. A patient on lithium develops tremor, nausea, and ataxia. Serum lithium level is 2.0 mEq/L. What is the appropriate treatment?
A. Stop lithium and observe
B. Hemodialysis
C. Reduce dose
D. Administer activated charcoal
E. Add valproic acid
What is hemodialysis?
Lithium levels above 2.0 with symptoms suggest moderate toxicity; hemodialysis may be indicated depending on severity.
111. A 45-year-old man believes that songs on the radio contain special messages meant just for him. What type of delusion is this?
A. Grandiose
B. Persecutory
C. Erotomanic
D. Somatic
E. Referential
What are Referential delusions... involve the belief that ordinary events have special meaning specifically for the individual.
Antipsychotic that has the lowest risk of extrapyramidal side effects (EPS)?
A. Haloperidol
B. Risperidone
C. Olanzapine
D. Clozapine
E. Fluphenazine
What is Clozapine?
Most likely diagnosis for A 70-year-old man with cognitive decline who exhibiting visual hallucinations, fluctuating alertness, and Parkinsonian features.
A. Alzheimer's disease
B. Vascular dementia
C. Frontotemporal dementia
D. Parkinson’s disease dementia
E. Lewy body dementia
What is Lewy body dementia... presents with visual hallucinations, fluctuating cognition, and Parkinsonism.
A child with ADHD has poor response to stimulants and has tics. Best next treatment includes two of the following.
A. Atomoxetine
B. Guanfacine
C. Clonidine
D. Bupropion
E. Fluoxetine
What are Alpha-2 agonists like guanfacine or clonidine... good alternatives in children with ADHD and comorbid tics.
A man with PTSD is experiencing recurrent nightmares and sleep disturbances. The medication most effective for reducing nightmares and its MOA
A. Quetiapine
B. Trazodone
C. Prazosin
D. Propranolol
E. Lorazepam
What is Prazosin... an alpha-1 adrenergic antagonist
Most effective for reducing alcohol cravings
A. Haloperidol
B. Disulfiram
C. Acamprosate
D. Bupropion
E. Diazepam
What is Acamprosate... helps maintain abstinence
Which medication is FDA-approved for maintenance treatment of bipolar disorder and carries a risk of SJS?
What is lamotragine?
The cause of A 50-year-old woman experiencing tremors, rigidity, and bradykinesia after years on haloperidol.
What is Drug-induced parkinsonism, a common extrapyramidal side effect from long-term use of typical antipsychotics.
Treatment for a 40-year-old man with schizophrenia is started on risperidone, who develops sustained upward deviation of the eyes.
A. Increase risperidone dose
B. Start propranolol
C. Administer benztropine
D. Add haloperidol
E. Start diazepam
What is benztropine? The patient is experiencing oculogyric crisis, an acute dystonic reaction treated with anticholinergics
A 24-year-old has involuntary flailing of one arm and is found to have a lesion in the contralateral subthalamic nucleus. Diagnosis?
A. Tourette syndrome
B. Huntington disease
C. Hemiballismus
D. Essential tremor
E. Wilson disease
What is Hemiballismus?
Hemiballismus is characterized by unilateral involuntary flinging movements due to subthalamic nucleus damage.
A child with selective mutism is unable to speak in social settings but speaks at home. The best initial treatment is:
A. Risperidone
B. Cognitive behavioral therapy
C. Family therapy
D. Methylphenidate
E. Electroconvulsive therapy
What is CBT... focuses on gradual exposure and communication is first-line for selective mutism.
A characteristic symptom of catatonia, maintaining limbs in fixed positions
What is Waxy flexibility
113. A 30-year-old woman has a fear of contamination and washes her hands for hours daily. Which brain structure is most involved?
A. Amygdala
B. Prefrontal cortex
C. Hippocampus
D. Basal ganglia
E. Thalamus
What is basal ganglia?
Explanation: The basal ganglia, especially the caudate nucleus, are implicated in the pathophysiology of OCD.
Likely cause for patient with bipolar disorder, receiving treatment, who reports fatigue and has elevated liver enzymes and low platelets.
What is Valproic acid treatment... can cause hepatotoxicity and thrombocytopenia; labs should be monitored routinely.
Lab abnormality most likely when a 34-year-old woman with schizophrenia is started on a new antipsychotic. She develops fever, muscle rigidity, and confusion.
A. Hypokalemia
B. Elevated creatine kinase
C. Leukopenia
D. Hypernatremia
E. Elevated prolactin
What is Neuroleptic malignant syndrome causes muscle breakdown, leading to elevated creatine kinase.
Which neuroimaging finding is most associated with schizophrenia?
A. Decreased hippocampal volume
B. Enlarged ventricles
C. Increased white matter
D. Cerebellar atrophy
E. Caudate hypertrophy
What is Enlarged lateral ventricles... a consistent finding in patients with schizophrenia on neuroimaging studies.
A reversible cause of dementia, that presents with gait disturbance and incontinence as well.
What is Normal pressure hydrocephalus