PANRE Psychiatry 2 — Questions and Answers
Question 1: A 35-year-old with bipolar I disorder is stable on lithium but develops polyuria and polydipsia. What is the most appropriate next step?
- Switch to valproate immediately
- Check serum lithium level and renal function (Correct answer)
- Add desmopressin without further workup
- Discontinue lithium and start lamotrigine
Correct answer: Check serum lithium level and renal function
Nephrogenic diabetes insipidus is a common lithium side effect; checking levels and renal function guides management.
Question 2: Which medication augmentation strategy is FDA-approved for treatment-resistant major depressive disorder in adults?
- Buspirone
- Aripiprazole (Correct answer)
- Clonazepam
- Gabapentin
Correct answer: Aripiprazole
Aripiprazole is FDA-approved as an adjunct to antidepressants for treatment-resistant MDD.
Question 3: A patient on clozapine develops a WBC of 2,800/mm³. What is the correct action?
- Continue clozapine with increased monitoring
- Reduce dose by 50%
- Discontinue clozapine immediately (Correct answer)
- Add G-CSF and continue clozapine
Correct answer: Discontinue clozapine immediately
A WBC below 3,000/mm³ requires immediate discontinuation of clozapine due to agranulocytosis risk.
Question 4: Which of the following is the first-line pharmacotherapy for panic disorder?
- Benzodiazepines
- SSRIs (Correct answer)
- Tricyclic antidepressants
- Buspirone
Correct answer: SSRIs
SSRIs are first-line for panic disorder due to efficacy and favorable side-effect profile.
Question 5: A 28-year-old presents with 2 weeks of depressed mood, insomnia, poor concentration, and passive suicidal ideation after a romantic breakup. She denies psychosis. What is the diagnosis?
- Adjustment disorder with depressed mood
- Major depressive episode (Correct answer)
- Dysthymia
- Bereavement
Correct answer: Major depressive episode
Five or more DSM-5 depressive symptoms for ≥2 weeks including depressed mood qualifies as a major depressive episode.
Question 6: Which side effect is most associated with SNRI antidepressants compared to SSRIs?
- QTc prolongation
- Hypertension (Correct answer)
- Weight gain
- Agranulocytosis
Correct answer: Hypertension
SNRIs inhibit norepinephrine reuptake, which can raise blood pressure, especially at higher doses.
Question 7: A patient with schizophrenia on haloperidol develops sustained muscle contractions of the neck. Which medication should be given immediately?
- Propranolol
- Benztropine
- Lorazepam
- Diphenhydramine IV (Correct answer)
Correct answer: Diphenhydramine IV
Acute dystonic reactions respond rapidly to IV diphenhydramine or IM benztropine; IV diphenhydramine acts fastest.
PANRE Psychiatry 2
A 35-year-old with bipolar I disorder is stable on lithium but develops polyuria and polydipsia.
What is the most appropriate next step?