Psychiatry Flashcards
7 cards from real NBME practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Psychiatry flashcards as text
A 38-year-old woman with MDD fails two adequate trials of SSRIs. She has no contraindications. Which augmentation strategy has the strongest evidence for treatment-resistant depression?
Answer: Adding lithium or atypical antipsychotic
Augmentation with lithium or atypical antipsychotics (e.g., aripiprazole, quetiapine) has the most robust evidence for treatment-resistant depression.
A 55-year-old man with bipolar disorder is started on valproate. Which laboratory values should be monitored at baseline and periodically?
Answer: LFTs, CBC, and ammonia level if encephalopathy occurs
Valproate can cause hepatotoxicity and thrombocytopenia; LFTs and CBC should be monitored, and ammonia checked if altered mental status develops.
A 6-year-old boy repeatedly wets the bed at night despite normal development. What is the first-line behavioral intervention for primary enuresis?
Answer: Urine alarm (bell-and-pad) therapy
The urine (enuresis) alarm has the highest long-term cure rate and is first-line behavioral treatment for primary nocturnal enuresis.
A 42-year-old woman is hospitalized for severe suicidal ideation with a plan. She refuses all medication. Which intervention can be administered without her consent if she is deemed incompetent?
Answer: Any treatment under an emergency exception or court-ordered treatment
When a patient is incompetent, treatment can be provided under an emergency exception for imminent harm or via surrogate/court authorization.
A 29-year-old man presents with recurrent, unexpected panic attacks with palpitations, shortness of breath, and fear of dying, followed by 1 month of worry about future attacks and behavioral avoidance. What is the diagnosis?
Answer: Panic disorder
Panic disorder requires recurrent unexpected panic attacks plus persistent concern about future attacks or maladaptive behavioral changes lasting at least 1 month.
A patient taking phenelzine (an MAOI) eats aged cheese and develops a hypertensive crisis. Which neurotransmitter excess causes this reaction?
Answer: Tyramine-induced norepinephrine surge
MAOIs block tyramine metabolism; dietary tyramine triggers massive norepinephrine release from sympathetic neurons, causing hypertensive crisis.
A 14-year-old girl refuses to attend school, claiming stomach pain every morning. Medical workup is negative. She stays home and plays video games when not in school. What is the most likely diagnosis?
Answer: School avoidance (separation anxiety or social anxiety)
School avoidance with somatic complaints and secondary gain (staying home) is most consistent with anxiety-driven school refusal, often linked to separation or social anxiety.