MCCQE - Medical Council of Canada Qualifying Examination Common Psychiatric Disorders Questions and Answers 1 — Questions and Answers
Question 1: A 45-year-old man with no other medical history is diagnosed with a first episode of moderate Major Depressive Disorder. According to the Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines, which of the following is the most appropriate initial pharmacological treatment?
- Quetiapine
- Sertraline (Correct answer)
- Lithium
- Lorazepam
Correct answer: Sertraline
According to CANMAT guidelines, second-generation antidepressants, including Selective Serotonin Reuptake Inhibitors (SSRIs) like sertraline, are recommended as first-line pharmacotherapy for moderate to severe Major Depressive Disorder. Quetiapine, an atypical antipsychotic, is considered a second-line agent or for adjunctive use. Lithium is a mood stabilizer primarily used for bipolar disorder. Lorazepam is a benzodiazepine used for short-term management of anxiety and is not a primary treatment for depression.
Question 2: A 22-year-old is brought to the clinic by his family due to a 7-month history of progressive social withdrawal, disorganized speech, and a firm belief that his thoughts are being broadcasted by a local radio station. He also reports hearing a voice that provides a running commentary on his actions. His functioning at university has declined significantly. What is the most likely diagnosis?
- Schizophreniform disorder
- Brief psychotic disorder
- Schizophrenia (Correct answer)
- Delusional disorder
Correct answer: Schizophrenia
The diagnosis of schizophrenia requires the presence of characteristic symptoms for at least one month, with continuous signs of the disturbance persisting for at least six months. This patient's 7-month history of psychotic symptoms (delusions, hallucinations) and functional decline fits the criteria for schizophrenia. Schizophreniform disorder has a duration of 1 to 6 months. Brief psychotic disorder lasts less than one month. Delusional disorder is characterized by delusions without the other prominent symptoms of schizophrenia like disorganized speech and significant negative symptoms.
Question 3: A 30-year-old woman presents with recurrent, unexpected panic attacks and has developed a significant fear of having another attack, leading her to avoid crowded public spaces. Which of the following represents a first-line, evidence-based treatment for her condition?
- Propranolol as needed
- Buspirone monotherapy
- Psychoanalytic psychotherapy
- Cognitive-Behavioural Therapy (CBT) (Correct answer)
Correct answer: Cognitive-Behavioural Therapy (CBT)
Both Cognitive-Behavioural Therapy (CBT) and SSRI antidepressants are considered first-line, evidence-based treatments for panic disorder with agoraphobia. CBT is highly effective for helping patients understand and manage the cognitive and behavioural aspects of the disorder. Propranolol may manage some physical symptoms but is not a first-line treatment for the core disorder. Buspirone is generally not effective for panic disorder. Psychoanalytic psychotherapy is not considered a first-line, evidence-based treatment.
Question 4: A 28-year-old male with Bipolar I Disorder is being maintained on lithium. He complains of increased thirst and frequent urination. Due to the known side-effect profile of his medication, long-term monitoring must include regular assessment of:
- Liver function tests and platelet count
- Thyroid function and renal function (Correct answer)
- Serum glucose and lipid profile
- Complete blood count and vitamin B12
Correct answer: Thyroid function and renal function
Lithium is known to have significant long-term effects on the kidneys and thyroid gland. It can cause nephrogenic diabetes insipidus (leading to polyuria and polydipsia) and hypothyroidism. Therefore, regular monitoring of renal function (e.g., creatinine) and thyroid function (e.g., TSH) is mandatory for patients on chronic lithium therapy.
Question 5: According to DSM-5 criteria, for a diagnosis of Generalized Anxiety Disorder (GAD), excessive anxiety and worry must be present more days than not for a minimum duration of:
- 6 months (Correct answer)
- 1 month
- 3 months
- 2 weeks
Correct answer: 6 months
The core time criterion for a diagnosis of Generalized Anxiety Disorder in the DSM-5 is the presence of excessive anxiety and worry occurring more days than not for at least 6 months. This chronicity distinguishes GAD from more transient or situational anxiety.
Question 6: A 24-year-old female has a history of multiple tumultuous relationships that end abruptly, recurrent acts of self-harm during periods of stress, and chronic feelings of emptiness. She often makes frantic efforts to avoid perceived abandonment by her partners. This clinical picture is most characteristic of which core feature of Borderline Personality Disorder?
- Pervasive distrust and suspiciousness
- Grandiose sense of self-importance
- Instability in relationships, self-image, and affects (Correct answer)
- Social inhibition and feelings of inadequacy
Correct answer: Instability in relationships, self-image, and affects
A pervasive pattern of instability is the hallmark of Borderline Personality Disorder, as defined by the DSM-5. This includes instability in interpersonal relationships (e.g., alternating between idealization and devaluation), unstable self-image, and affective instability (intense mood swings). The patient's presentation directly reflects these core features. Distrust is characteristic of Paranoid PD, grandiosity of Narcissistic PD, and social inhibition of Avoidant PD.
MCCQE - Medical Council of Canada Qualifying Examination Common Psychiatric Disorders Questions and Answers 1
A 45-year-old man with no other medical history is diagnosed with a first episode of moderate Major Depressive Disorder.
According to the Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines, which of the following is the most appropriate initial pharmacological treatment?