MCCQE Common Psychiatric Disorders 3 — Questions and Answers
Question 1: A 40-year-old man presents with persistent worry about multiple life domains, muscle tension, irritability, and sleep disturbance for more than 6 months. What is the first-line psychotherapy?
- Psychodynamic therapy
- Cognitive behavioural therapy (CBT) (Correct answer)
- Hypnotherapy
- Interpersonal therapy
Correct answer: Cognitive behavioural therapy (CBT)
CBT is the most evidence-based psychotherapy for generalized anxiety disorder, targeting maladaptive worry and avoidance behaviours.
Question 2: A 55-year-old woman on phenelzine for depression eats aged cheese and develops severe hypertensive crisis. What is the mechanism?
- Serotonin syndrome from cheese-induced 5-HT release
- Tyramine-induced norepinephrine surge due to MAO inhibition (Correct answer)
- Direct vasopressin release from casein
- Histamine toxicity from fermentation
Correct answer: Tyramine-induced norepinephrine surge due to MAO inhibition
MAO inhibitors block tyramine breakdown; dietary tyramine triggers massive norepinephrine release from sympathetic terminals, causing hypertensive crisis.
Question 3: A 27-year-old woman presents after an argument with her partner. She describes intense fear of abandonment, unstable relationships, impulsive self-harm, and chronic feelings of emptiness. What is the most likely diagnosis?
- Bipolar II disorder
- Borderline personality disorder (Correct answer)
- Histrionic personality disorder
- Cyclothymic disorder
Correct answer: Borderline personality disorder
Borderline personality disorder is characterized by fear of abandonment, unstable relationships, impulsivity, self-harm, and chronic emptiness.
Question 4: A 70-year-old man with no prior psychiatric history develops visual hallucinations, fluctuating cognition, and REM sleep behaviour disorder. Parkinsonism follows 6 months later. What is the most likely diagnosis?
- Alzheimer's dementia
- Delirium tremens
- Dementia with Lewy bodies (Correct answer)
- Vascular dementia
Correct answer: Dementia with Lewy bodies
Dementia with Lewy bodies classically presents with visual hallucinations, fluctuating cognition, REM sleep behaviour disorder, and parkinsonism.
Question 5: A 30-year-old man with alcohol use disorder has his last drink 48 hours ago. He now presents with agitation, tremor, diaphoresis, tachycardia, and a witnessed tonic-clonic seizure. What is the most appropriate immediate treatment?
- Haloperidol IM
- IV lorazepam (Correct answer)
- Oral naltrexone
- IV phenytoin
Correct answer: IV lorazepam
IV benzodiazepines (e.g., lorazepam, diazepam) are first-line treatment for alcohol withdrawal seizures and delirium tremens by enhancing GABA-A activity.
Question 6: A 16-year-old girl is brought in by her parents due to refusal to maintain a minimally normal body weight, intense fear of gaining weight, and distorted body image. Her BMI is 15.5. What medical complication is most life-threatening?
- Lanugo hair
- Cardiac arrhythmias from electrolyte imbalance (Correct answer)
- Amenorrhea
- Constipation
Correct answer: Cardiac arrhythmias from electrolyte imbalance
Cardiac arrhythmias due to electrolyte disturbances (especially hypokalemia and hypophosphatemia) are the leading cause of death in anorexia nervosa.
Question 7: A patient with schizophrenia on long-term haloperidol develops repetitive lip-smacking movements and tongue protrusion that persist after medication dose reduction. What is this condition?
- Acute dystonia
- Tardive dyskinesia (Correct answer)
- Akathisia
- Parkinsonism
Correct answer: Tardive dyskinesia
Tardive dyskinesia is a late-onset, potentially irreversible movement disorder caused by dopamine receptor supersensitivity from chronic antipsychotic use.
MCCQE Common Psychiatric Disorders 3
A 40-year-old man presents with persistent worry about multiple life domains, muscle tension, irritability, and sleep disturbance for more than 6 months.
What is the first-line psychotherapy?