DO Psychiatry and Behavioral Medicine 3

Question 1

A patient on an SSRI develops agitation, tremor, diaphoresis, hyperreflexia, and clonus within hours of adding tramadol. How does serotonin syndrome differ from Neuroleptic Malignant Syndrome?

Accepted Answer

Serotonin syndrome has rapid onset with clonus; NMS has slower onset with lead-pipe rigidity

Answer

NMS has clonus while serotonin syndrome has lead-pipe rigidity

Answer

NMS is caused by serotonergic agents; serotonin syndrome by antipsychotics

Answer

They are clinically indistinguishable without laboratory testing

Question 2

Electroconvulsive therapy (ECT) is most appropriately indicated in which clinical scenario?

Accepted Answer

Severe treatment-resistant depression with acute suicidality or when medications are contraindicated

Answer

Mild depression not responding to lifestyle modifications

Answer

Schizophrenia with predominant negative symptoms

Answer

Generalized Anxiety Disorder unresponsive to two SSRI trials

Question 3

A physician uses motivational interviewing to help a patient with alcohol use disorder consider behavior change. Which principle best describes this therapeutic approach?

Accepted Answer

Eliciting and strengthening the patient's intrinsic motivation through a collaborative, patient-centered approach

Answer

Confronting the patient directly about the negative consequences of their drinking

Answer

Providing structured education about the medical dangers of alcohol consumption

Answer

Setting behavioral contracts with defined consequences for relapse

Question 4

A 30-year-old woman develops sudden paralysis of her left arm following a traumatic car accident. Neurological examination and brain MRI are normal. She appears surprisingly unconcerned about the deficit. What is the most likely diagnosis?

Accepted Answer

Conversion Disorder (Functional Neurological Symptom Disorder)

Answer

Malingering

Answer

Somatic Symptom Disorder

Answer

Factitious Disorder

Question 5

A 17-year-old girl with anorexia nervosa (BMI 14) is hospitalized for nutritional rehabilitation. Which electrolyte abnormality is the most dangerous complication of refeeding and must be closely monitored?

Accepted Answer

Hypophosphatemia

Answer

Hyponatremia

Answer

Hyperkalemia

Answer

Hypercalcemia

Question 6

A 28-year-old man with no psychiatric history experiences sudden onset psychosis with delusions and hallucinations following an acute stressor. Symptoms fully resolve after 3 weeks with complete return to baseline. What is the most likely diagnosis?

Accepted Answer

Brief Psychotic Disorder

Answer

Schizophrenia

Answer

Schizophreniform Disorder

Answer

Substance-Induced Psychotic Disorder

Question 7

An 80-year-old man develops acute onset confusion, disorientation, fluctuating consciousness, and visual hallucinations 2 days after hip surgery. His family confirms he was cognitively intact prior to hospitalization. What is the most appropriate initial management?

Accepted Answer

Identify and treat the underlying medical cause

Answer

Administer haloperidol immediately to control agitation

Answer

Order an emergent EEG to rule out seizure activity

Answer

Transfer to inpatient psychiatry for behavioral stabilization