DO Psychiatry and Behavioral Medicine 2

Question 1

A 40-year-old woman with depression is started on fluoxetine. What is the primary mechanism of action of SSRIs?

Accepted Answer

Inhibition of serotonin reuptake at the presynaptic terminal

Answer

SSRIs block the serotonin transporter (SERT), preventing reuptake of serotonin into the presynaptic neuron and increasing serotonin availability in the synaptic cleft.

Question 2

A patient on lithium for bipolar disorder presents with coarse tremor, confusion, ataxia, and nausea. His serum lithium level is 2.1 mEq/L. What is the most appropriate immediate management?

Accepted Answer

Discontinue lithium and provide supportive care with hydration

Answer

Lithium toxicity (levels >1.5 mEq/L with symptoms) requires immediate discontinuation and supportive care; the therapeutic range is 0.6–1.2 mEq/L.

Question 3

A 25-year-old woman presents with intense fear of abandonment, markedly unstable relationships alternating between idealization and devaluation, identity disturbance, recurrent self-harm, and severe emotional lability. What is the most likely diagnosis?

Accepted Answer

Borderline Personality Disorder

Answer

Borderline Personality Disorder is characterized by fear of abandonment, unstable relationships, identity disturbance, impulsivity, and recurrent self-harm or suicidal behavior.

Question 4

A patient with alcohol use disorder is admitted for detoxification. During which timeframe after the last drink is the risk for alcohol withdrawal seizures highest?

Accepted Answer

24–48 hours after last drink

Answer

Alcohol withdrawal seizures most commonly occur 24–48 hours after the last drink; delirium tremens typically peaks at 48–72 hours.

Question 5

A patient taking haloperidol develops hyperthermia (40.5°C), severe lead-pipe muscle rigidity, altered consciousness, and autonomic instability. CPK is markedly elevated. What is this condition?

Accepted Answer

Neuroleptic Malignant Syndrome

Answer

Neuroleptic Malignant Syndrome is a life-threatening antipsychotic reaction presenting with hyperthermia, lead-pipe rigidity, altered consciousness, and autonomic instability with elevated CPK.

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DO Psychiatry and Behavioral Medicine 2