NBME Psychiatry 2

Question 1

A 34-year-old woman presents with a 2-week history of depressed mood, insomnia, anhedonia, and passive suicidal ideation. She has had two similar episodes in the past. Which medication is first-line for acute treatment?

Accepted Answer

Sertraline

Answer

SSRIs such as sertraline are first-line pharmacotherapy for major depressive disorder.

Question 2

A 28-year-old man is brought to the ED after being found agitated and confused. He has dilated pupils, tachycardia, diaphoresis, and clonus. Which substance is most likely responsible?

Accepted Answer

MDMA combined with an SSRI

Answer

The combination of MDMA with an SSRI can precipitate serotonin syndrome, characterized by the triad of altered mental status, autonomic instability, and neuromuscular abnormalities including clonus.

Question 3

A 45-year-old woman with schizophrenia on haloperidol develops involuntary chewing movements and tongue protrusion that persist even after dose reduction. What is the most likely diagnosis?

Accepted Answer

Tardive dyskinesia

Answer

Tardive dyskinesia is a late-onset movement disorder caused by long-term dopamine antagonist use, classically presenting with orofacial dyskinesias.

Question 4

A 22-year-old college student reports months of persistent worry about academic performance, restlessness, muscle tension, and difficulty concentrating. Symptoms cause significant impairment. What is the most likely diagnosis?

Accepted Answer

Generalized anxiety disorder

Answer

Generalized anxiety disorder is characterized by excessive, difficult-to-control worry about multiple domains lasting at least 6 months with associated somatic symptoms.

Question 5

A 55-year-old man with bipolar I disorder on lithium develops coarse tremor, polyuria, and confusion. His lithium level is 2.8 mEq/L. What is the most appropriate next step?

Accepted Answer

Discontinue lithium and provide supportive care

Answer

Lithium toxicity at levels above 2.0 mEq/L requires immediate discontinuation; severe toxicity may require hemodialysis.

NBME Practice Test

NBME Practice Test

NBME Psychiatry 2