Family Practice Exam Mental Health 2 — Questions and Answers
Question 1: A 28-year-old woman presents with recurrent, intrusive thoughts about contamination and spends 3+ hours daily washing her hands. Which first-line pharmacotherapy is indicated?
- Alprazolam
- Sertraline (Correct answer)
- Quetiapine
- Lithium
Correct answer: Sertraline
SSRIs such as sertraline are first-line pharmacotherapy for obsessive-compulsive disorder (OCD).
Question 2: Which of the following best characterizes the sleep disturbance pattern in major depressive disorder?
- Hypersomnia only
- Early morning awakening with inability to return to sleep (Correct answer)
- Sleep-onset insomnia exclusively
- Narcoleptic episodes
Correct answer: Early morning awakening with inability to return to sleep
Early morning awakening (terminal insomnia) is a classic neurovegetative symptom of major depressive disorder.
Question 3: A 45-year-old veteran avoids driving, has nightmares about a combat explosion, and has emotional numbing for 7 months. The most likely diagnosis is:
- Acute stress disorder
- Adjustment disorder
- PTSD (Correct answer)
- Generalized anxiety disorder
Correct answer: PTSD
PTSD requires symptoms persisting beyond 1 month following a traumatic event, including re-experiencing, avoidance, and hyperarousal.
Question 4: Which medication is FDA-approved specifically for the treatment of PTSD?
- Paroxetine (Correct answer)
- Clonazepam
- Aripiprazole
- Buspirone
Correct answer: Paroxetine
Paroxetine (and sertraline) are the only FDA-approved medications for PTSD treatment.
Question 5: A physician notices a patient is making a fist and gritting teeth during the interview. This nonverbal observation is best described as a sign of:
- Psychomotor retardation
- Agitation or anger (Correct answer)
- Tardive dyskinesia
- Catatonia
Correct answer: Agitation or anger
Clenching fists and gritting teeth are nonverbal cues indicating agitation or suppressed anger.
Question 6: A 17-year-old is brought in after being found with a suicide note but denies current intent. What is the most appropriate next step?
- Prescribe an antidepressant and follow up in 2 weeks
- Reassure the parents and discharge
- Refer for inpatient psychiatric evaluation (Correct answer)
- Initiate outpatient CBT only
Correct answer: Refer for inpatient psychiatric evaluation
A suicide note represents a serious attempt indicator requiring inpatient psychiatric evaluation regardless of current denial of intent.
Question 7: Which of the following antidepressants is most associated with causing sexual dysfunction?
- Bupropion
- Mirtazapine
- Paroxetine (Correct answer)
- Venlafaxine
Correct answer: Paroxetine
Paroxetine has the highest rates of sexual dysfunction among antidepressants, likely due to potent serotonin reuptake inhibition and anticholinergic effects.
Family Practice Exam Mental Health 2
A 28-year-old woman presents with recurrent, intrusive thoughts about contamination and spends 3+ hours daily washing her hands.
Which first-line pharmacotherapy is indicated?