American Board of Psychiatry and Neurology ABPN Neuropharmacology and Psychopharmacology 3

Question 1

A patient on phenelzine (MAOI) eats aged cheese and develops a hypertensive crisis. Which mechanism explains this reaction?

Accepted Answer

Tyramine displaces norepinephrine causing massive sympathetic discharge

Answer

Serotonin syndrome from tyramine's serotonergic activity

Answer

Cheese triggers an IgE-mediated allergic response

Answer

Tyramine directly activates CNS dopamine receptors

Question 2

Which mood stabilizer is MOST teratogenic and requires mandatory REMS enrollment due to risk of major congenital malformations?

Accepted Answer

Valproate

Answer

Lithium

Answer

Lamotrigine

Answer

Carbamazepine

Question 3

Which receptor does memantine target for the treatment of moderate-to-severe Alzheimer's disease?

Accepted Answer

NMDA glutamate receptor

Answer

Acetylcholine muscarinic M1

Answer

GABA-A chloride channel

Answer

Sigma-1 receptor

Question 4

A patient experiences neuroleptic malignant syndrome (NMS). Which combination of features is MOST characteristic?

Accepted Answer

Fever, muscle rigidity, altered consciousness, autonomic instability

Answer

Tremor, bradykinesia, cogwheel rigidity, shuffling gait

Answer

Hyperthermia, diarrhea, agitation, myoclonus

Answer

Sedation, respiratory depression, miosis, bradycardia

Question 5

Which antiepileptic drug requires monitoring of serum levels and is known to cause Steven-Johnson syndrome, particularly in patients with HLA-B*1502 allele?

Accepted Answer

Carbamazepine

Answer

Levetiracetam

Answer

Gabapentin

Answer

Lacosamide

Question 6

A 35-year-old patient with bipolar I disorder is started on lithium. Which baseline laboratory test is MOST important before initiating therapy?

Accepted Answer

Renal function (BMP/creatinine) and thyroid function

Answer

Liver function tests and CBC

Answer

Fasting lipids and HbA1c

Answer

Urine drug screen and prolactin level