MD Psychiatry and Behavioral Science 1 — Questions and Answers
Question 1: A 25-year-old man presents with auditory hallucinations, disorganized speech, and flat affect for 8 months. He has no history of substance abuse or medical illness. What is the most appropriate first-line pharmacological treatment?
- Haloperidol
- Risperidone (Correct answer)
- Clozapine
- Lithium
Correct answer: Risperidone
Atypical antipsychotics such as risperidone are the first-line treatment for schizophrenia due to their efficacy and lower risk of extrapyramidal side effects compared to typical antipsychotics.
Question 2: According to DSM-5, how many total symptoms (including depressed mood or anhedonia) are required for a diagnosis of Major Depressive Disorder over a minimum 2-week period?
- 3
- 4
- 5 (Correct answer)
- 7
Correct answer: 5
DSM-5 requires at least 5 of 9 symptoms (including depressed mood or anhedonia as one) present for at least 2 weeks, causing significant functional impairment.
Question 3: A patient taking lithium develops coarse tremor, confusion, and vomiting. His serum lithium level is 2.8 mEq/L. What is the most important immediate intervention?
- Add propranolol for tremor control
- Increase oral fluid intake
- Discontinue lithium and provide supportive care including possible hemodialysis (Correct answer)
- Switch to valproate immediately
Correct answer: Discontinue lithium and provide supportive care including possible hemodialysis
A lithium level above 2.0 mEq/L indicates severe toxicity requiring immediate discontinuation; hemodialysis is indicated for levels above 3.0 mEq/L or in severe clinical toxicity.
Question 4: A 32-year-old woman experiences recurrent unexpected panic attacks and has persistent worry about future attacks for 3 months. She avoids crowded places and public transportation. What is the most likely diagnosis?
- Generalized Anxiety Disorder
- Panic Disorder with Agoraphobia (Correct answer)
- Social Anxiety Disorder
- Specific Phobia
Correct answer: Panic Disorder with Agoraphobia
Panic disorder is characterized by recurrent unexpected panic attacks with persistent concern about future attacks; when accompanied by avoidance of situations where escape would be difficult, agoraphobia is also diagnosed.
Question 5: Which of the following is a required DSM-5 criterion for a diagnosis of Post-Traumatic Stress Disorder (PTSD)?
- Symptoms must be present for at least 1 month (Correct answer)
- Trauma exposure must be directly witnessed, not personally experienced
- Flashbacks must occur at least once daily
- Physical injury must have occurred during the traumatic event
Correct answer: Symptoms must be present for at least 1 month
DSM-5 requires that PTSD symptoms (intrusion, avoidance, negative cognitions/mood, and hyperarousal) persist for more than 1 month following traumatic exposure, distinguishing it from acute stress disorder.
Question 6: A 45-year-old man on haloperidol for 2 years develops involuntary, repetitive facial grimacing, lip-smacking, and tongue protrusion. What is the most likely diagnosis?
- Parkinson's disease
- Tardive dyskinesia (Correct answer)
- Acute dystonia
- Akathisia
Correct answer: Tardive dyskinesia
Tardive dyskinesia is a late-onset movement disorder associated with prolonged antipsychotic use, characterized by involuntary, repetitive orofacial and limb movements that persist beyond medication cessation.
Question 7: A 38-year-old man on haloperidol develops severe generalized muscle rigidity, hyperthermia (104°F), diaphoresis, and altered mental status. Labs show CK of 12,000 U/L and leukocytosis. What is the diagnosis?
- Serotonin syndrome
- Malignant hyperthermia
- Neuroleptic malignant syndrome (Correct answer)
- Heat stroke
Correct answer: Neuroleptic malignant syndrome
Neuroleptic malignant syndrome (NMS) is a life-threatening reaction to antipsychotics presenting with the tetrad of hyperthermia, lead-pipe rigidity, autonomic instability, and altered consciousness with markedly elevated CK.
MD Psychiatry and Behavioral Science 1
A 25-year-old man presents with auditory hallucinations, disorganized speech, and flat affect for 8 months.
He has no history of substance abuse or medical illness.
What is the most appropriate first-line pharmacological treatment?