PANRE Psychiatry 4 — Questions and Answers
Question 1: A 68-year-old with new-onset psychosis, no psychiatric history, and recent urinary incontinence and gait disturbance is most likely experiencing which condition?
- Late-onset schizophrenia
- Normal pressure hydrocephalus with psychosis
- Lewy body dementia (Correct answer)
- Vascular dementia
Correct answer: Lewy body dementia
Lewy body dementia classically presents with parkinsonism, visual hallucinations, and fluctuating cognition in an older adult.
Question 2: Which psychotherapy has the strongest evidence base for borderline personality disorder?
- Cognitive processing therapy
- Dialectical behavior therapy (Correct answer)
- Interpersonal therapy
- Supportive therapy
Correct answer: Dialectical behavior therapy
Dialectical behavior therapy (DBT) is the gold-standard psychotherapy for borderline personality disorder.
Question 3: A patient on lithium for 10 years presents with coarse tremor, ataxia, and confusion. His lithium level is 2.4 mEq/L. What is the priority intervention?
- Add propranolol for tremor
- Hold next dose and recheck level in 12 hours
- Hemodialysis (Correct answer)
- IV sodium bicarbonate
Correct answer: Hemodialysis
Lithium levels above 2.0 mEq/L with neurological symptoms warrant hemodialysis for rapid elimination.
Question 4: Which of the following is a core feature used to diagnose ADHD in adults per DSM-5?
- Symptoms present before age 12 (Correct answer)
- At least 6 symptoms from one domain
- Symptoms in only one setting
- Onset after age 18 is sufficient
Correct answer: Symptoms present before age 12
DSM-5 requires that several inattentive or hyperactive-impulsive symptoms were present before age 12.
Question 5: A veteran with PTSD asks about the most evidence-based non-pharmacological treatment. What should you recommend?
- EMDR or prolonged exposure therapy (Correct answer)
- Supportive counseling
- Hypnotherapy
- Mindfulness-based stress reduction alone
Correct answer: EMDR or prolonged exposure therapy
Trauma-focused CBT (including prolonged exposure) and EMDR have the strongest evidence for PTSD.
Question 6: A 30-year-old presents with 6 months of grandiosity, decreased need for sleep, pressured speech, and impulsive spending, but continues to work. Which diagnosis best fits?
- Bipolar I disorder, manic episode
- Bipolar II disorder, hypomanic episode (Correct answer)
- Cyclothymic disorder
- Substance-induced mood disorder
Correct answer: Bipolar II disorder, hypomanic episode
Hypomania lasts ≥4 days, does not cause marked impairment, and does not require hospitalization, distinguishing it from mania.
Question 7: Which of the following is the safest antidepressant choice during pregnancy when treatment is necessary?
- Paroxetine
- Sertraline (Correct answer)
- Nortriptyline
- Phenelzine
Correct answer: Sertraline
Sertraline has the most pregnancy safety data among SSRIs; paroxetine carries cardiac malformation risk.
PANRE Psychiatry 4
A 68-year-old with new-onset psychosis, no psychiatric history, and recent urinary incontinence and gait disturbance is most likely experiencing which condition?