Family Practice Exam Mental Health 3 — Questions and Answers
Question 1: A 35-year-old presents with pressured speech, decreased need for sleep, grandiosity, and increased goal-directed activity for 10 days. He has never had a depressive episode. What is the diagnosis?
- Bipolar I disorder (Correct answer)
- Bipolar II disorder
- Cyclothymia
- Hypomanic episode
Correct answer: Bipolar I disorder
A manic episode lasting ≥7 days without a required depressive history meets criteria for Bipolar I disorder.
Question 2: Which of the following is the safest antidepressant in pregnancy?
- Paroxetine
- Sertraline (Correct answer)
- Amitriptyline
- Phenelzine
Correct answer: Sertraline
Sertraline has the most safety data in pregnancy and is generally considered first-line when antidepressant treatment is needed.
Question 3: A patient on clozapine develops a fever and sore throat. The most urgent concern is:
- Serotonin syndrome
- Agranulocytosis (Correct answer)
- Neuroleptic malignant syndrome
- QT prolongation
Correct answer: Agranulocytosis
Clozapine can cause agranulocytosis; fever and sore throat are warning signs requiring immediate CBC with differential.
Question 4: Which cognitive domain is primarily impaired early in Alzheimer's disease?
- Procedural memory
- Episodic memory (Correct answer)
- Implicit memory
- Semantic memory for remote events
Correct answer: Episodic memory
Episodic memory (new learning and recent recall) is the earliest and most prominently affected domain in Alzheimer's disease.
Question 5: A patient taking an MAOI for depression wants to eat at a restaurant. Which food must be strictly avoided?
- Grilled chicken breast
- Aged cheddar cheese (Correct answer)
- White bread
- Steamed broccoli
Correct answer: Aged cheddar cheese
Aged cheeses contain high tyramine content; consumption with an MAOI can trigger a hypertensive crisis.
Question 6: Which of the following best describes the ego defense mechanism 'projection'?
- Attributing one's own unacceptable feelings to another person (Correct answer)
- Reverting to childhood behaviors under stress
- Channeling impulses into socially acceptable activities
- Refusing to acknowledge a painful reality
Correct answer: Attributing one's own unacceptable feelings to another person
Projection involves attributing one's own unwanted thoughts or feelings to someone else.
Question 7: A 60-year-old man presents with sudden-onset confusion, fever, muscle rigidity, and autonomic instability after starting haloperidol. The most likely diagnosis is:
- Serotonin syndrome
- Anticholinergic toxicity
- Neuroleptic malignant syndrome (Correct answer)
- Malignant hyperthermia
Correct answer: Neuroleptic malignant syndrome
Neuroleptic malignant syndrome (NMS) presents with the tetrad of fever, rigidity, altered consciousness, and autonomic instability after antipsychotic exposure.
Family Practice Exam Mental Health 3
A 35-year-old presents with pressured speech, decreased need for sleep, grandiosity, and increased goal-directed activity for 10 days.
He has never had a depressive episode.
What is the diagnosis?