Family Practice Exam Mental Health 5 — Questions and Answers
Question 1: A 70-year-old develops visual hallucinations and Parkinsonism 3 months after mild cognitive decline. Neuroleptic sensitivity is noted. The most likely diagnosis is:
- Parkinson's disease dementia
- Alzheimer's disease
- Lewy body dementia (Correct answer)
- Vascular dementia
Correct answer: Lewy body dementia
Lewy body dementia presents with cognitive fluctuations, recurrent visual hallucinations, Parkinsonism, and severe neuroleptic sensitivity.
Question 2: Which of the following is the most appropriate initial treatment for a patient with generalized anxiety disorder (GAD)?
- Lorazepam long-term
- Buspirone or an SSRI plus CBT (Correct answer)
- Propranolol alone
- Clonazepam plus quetiapine
Correct answer: Buspirone or an SSRI plus CBT
First-line treatment for GAD is an SSRI or buspirone combined with CBT; benzodiazepines are not recommended for long-term use.
Question 3: A patient with schizophrenia shows flat affect, alogia, and avolition with intact thought organization. These symptoms are best described as:
- Positive symptoms
- Negative symptoms (Correct answer)
- Disorganized symptoms
- Cognitive symptoms
Correct answer: Negative symptoms
Flat affect, alogia, and avolition are negative symptoms reflecting diminution of normal functions.
Question 4: A 55-year-old on lithium for bipolar disorder presents with coarse tremor, confusion, and diarrhea. His lithium level is 2.4 mEq/L. The next step is:
- Reduce lithium dose by 50%
- Hold lithium and initiate hemodialysis (Correct answer)
- Add propranolol for tremor
- Switch to valproate outpatient
Correct answer: Hold lithium and initiate hemodialysis
Lithium toxicity above 2.0 mEq/L with neurological symptoms requires immediate lithium discontinuation and hemodialysis.
Question 5: Which of the following best differentiates delirium from dementia?
- Presence of hallucinations
- Acute onset with fluctuating consciousness (Correct answer)
- Memory impairment
- Language difficulties
Correct answer: Acute onset with fluctuating consciousness
Delirium is distinguished from dementia by its acute onset, fluctuating course, and disturbance in attention and consciousness.
Question 6: A family physician screens a 16-year-old using the PHQ-A and scores 15. The most appropriate next action is:
- Rescreen in 4 weeks
- Start fluoxetine and follow up in 2 weeks
- Combine fluoxetine with CBT referral and monitor closely for suicidality (Correct answer)
- Refer to psychiatry only after a failed SSRI trial
Correct answer: Combine fluoxetine with CBT referral and monitor closely for suicidality
Moderate-to-severe adolescent depression warrants combined SSRI (fluoxetine is FDA-approved for adolescents) plus CBT with close suicidality monitoring.
Question 7: A patient taking valproate for bipolar disorder becomes pregnant. Which fetal risk must be specifically discussed?
- Cleft palate
- Neural tube defects (Correct answer)
- Cardiac septal defects
- Limb reduction defects
Correct answer: Neural tube defects
Valproate is associated with a significantly elevated risk of neural tube defects, including spina bifida, in the fetus.
Family Practice Exam Mental Health 5
A 70-year-old develops visual hallucinations and Parkinsonism 3 months after mild cognitive decline.
Neuroleptic sensitivity is noted.
The most likely diagnosis is: