Physician Assistant Psychiatry and Behavioral Science 2

Question 1

A patient stable on lithium is started on a new medication and develops coarse tremor, ataxia, and confusion two weeks later. Which medication most likely caused this?

Accepted Answer

Hydrochlorothiazide

Answer

Thiazide diuretics reduce renal lithium clearance, raising serum levels into the toxic range.

Question 2

Before starting clozapine for treatment-resistant schizophrenia, which laboratory monitoring is mandatory?

Accepted Answer

Absolute neutrophil count

Answer

Clozapine can cause severe neutropenia/agranulocytosis, so baseline and serial ANC monitoring is required.

Question 3

A patient on sertraline who recently added tramadol presents with agitation, diaphoresis, hyperreflexia, and inducible clonus. What is the most likely diagnosis?

Accepted Answer

Serotonin syndrome

Answer

Hyperreflexia and clonus with rapid onset after combining serotonergic agents is characteristic of serotonin syndrome.

Question 4

A patient taking phenelzine eats aged cheese and cured meats and develops a severe occipital headache with BP 220/120. What is the mechanism?

Accepted Answer

Tyramine-induced norepinephrine release

Answer

MAO inhibition prevents dietary tyramine breakdown, causing massive norepinephrine release and hypertensive crisis.

Question 5

Bupropion is contraindicated in which patient?

Accepted Answer

A 22-year-old with bulimia nervosa

Answer

Bupropion lowers the seizure threshold and carries higher seizure risk in patients with eating disorders.

Physician Assistant Practice Test

Physician Assistant Practice Test

Physician Assistant Psychiatry and Behavioral Science 2