PANRE Psychiatry 5 — Questions and Answers
Question 1: A patient with schizophrenia on olanzapine gains 20 lbs over 6 months and develops fasting glucose of 126 mg/dL. What is the most appropriate next step?
- Continue olanzapine and start metformin
- Switch to aripiprazole or ziprasidone (Correct answer)
- Add orlistat
- Discontinue antipsychotic therapy
Correct answer: Switch to aripiprazole or ziprasidone
Switching to a metabolically neutral antipsychotic (aripiprazole or ziprasidone) is preferred over adding medications for metabolic side effects.
Question 2: Which condition is characterized by at least 2 years of fluctuating hypomanic and depressive symptoms that do not meet criteria for full bipolar episodes?
- Bipolar II disorder
- Cyclothymic disorder (Correct answer)
- Persistent depressive disorder
- Borderline personality disorder
Correct answer: Cyclothymic disorder
Cyclothymic disorder requires ≥2 years (1 year in children) of subsyndromal hypomanic and depressive periods.
Question 3: A patient reports that her neighbor has been poisoning her food for the past year. She is otherwise functional, with no hallucinations or disorganized speech. What is the most likely diagnosis?
- Paranoid schizophrenia
- Delusional disorder, persecutory type (Correct answer)
- Brief psychotic disorder
- Schizophreniform disorder
Correct answer: Delusional disorder, persecutory type
Delusional disorder features a fixed non-bizarre or bizarre delusion for ≥1 month without prominent hallucinations or disorganization.
Question 4: Which medication requires a REMS program due to the risk of QTc prolongation and cardiac arrhythmia?
- Quetiapine
- Haloperidol
- Clozapine (Correct answer)
- Ziprasidone
Correct answer: Clozapine
Clozapine has a REMS program primarily for agranulocytosis, but also requires monitoring for QTc effects.
Question 5: A 45-year-old man has persistent worry about multiple life domains, muscle tension, and restlessness for more than 6 months, causing work impairment. First-line treatment is:
- Alprazolam
- Buspirone or SSRI/SNRI (Correct answer)
- Propranolol
- Gabapentin
Correct answer: Buspirone or SSRI/SNRI
SSRIs, SNRIs, and buspirone are first-line pharmacotherapy for GAD; benzodiazepines are avoided as monotherapy.
Question 6: Which of the following symptoms is NOT part of the DSM-5 criteria for major neurocognitive disorder (dementia)?
- Decline from prior level of functioning
- Cognitive deficits that interfere with daily independence
- Acute onset over hours (Correct answer)
- Impairment in one or more cognitive domains
Correct answer: Acute onset over hours
Acute onset suggests delirium, not dementia; major NCD requires gradual onset and progressive decline.
Question 7: A 16-year-old is brought in by parents for refusing to speak at school for 3 months, though he speaks normally at home. His school performance is declining. What is the diagnosis?
- Social anxiety disorder
- Selective mutism (Correct answer)
- Autism spectrum disorder
- Avoidant personality disorder
Correct answer: Selective mutism
Selective mutism is defined by consistent failure to speak in specific social situations despite speaking normally elsewhere.
PANRE Psychiatry 5
A patient with schizophrenia on olanzapine gains 20 lbs over 6 months and develops fasting glucose of 126 mg/dL.
What is the most appropriate next step?