SMLE Psychiatry 1 — Questions and Answers
Question 1: A 25-year-old male presents with auditory hallucinations, paranoid delusions, and social withdrawal for 8 months. His speech is disorganised and he has flat affect. What is the most likely diagnosis?
- Brief psychotic disorder
- Schizophrenia (Correct answer)
- Schizoaffective disorder
- Delusional disorder
Correct answer: Schizophrenia
Schizophrenia requires ≥6 months of symptoms with at least one month of active-phase symptoms (≥2 of: delusions, hallucinations, disorganised speech, disorganised/catatonic behaviour, negative symptoms). This patient meets criteria with 8 months of symptoms.
Question 2: A patient on haloperidol develops high fever (41°C), severe muscle rigidity, autonomic instability, and elevated creatine kinase. What is the diagnosis?
- Serotonin syndrome
- Neuroleptic malignant syndrome (NMS) (Correct answer)
- Malignant hyperthermia
- Acute dystonia
Correct answer: Neuroleptic malignant syndrome (NMS)
Neuroleptic malignant syndrome is a life-threatening reaction to antipsychotic medications characterised by the tetrad of fever, rigidity (lead-pipe), autonomic instability, and altered consciousness with elevated CK. Treatment includes stopping the offending agent, dantrolene, and bromocriptine.
Question 3: A 30-year-old woman presents with depressed mood, loss of interest, insomnia, poor concentration, feelings of worthlessness, and suicidal ideation for 3 weeks. What is the minimum duration of symptoms required for a diagnosis of major depressive disorder?
- 1 week
- 2 weeks (Correct answer)
- 4 weeks
- 6 weeks
Correct answer: 2 weeks
According to DSM-5, major depressive disorder requires ≥5 symptoms (including depressed mood or loss of interest) present for at least 2 weeks, causing significant functional impairment. This patient meets the diagnostic criteria.
Question 4: A 22-year-old male presents with grandiosity, decreased need for sleep (2 hours/night), pressured speech, flight of ideas, and excessive spending for 10 days. He has had previous depressive episodes. What is the most likely diagnosis?
- Major depressive disorder
- Bipolar I disorder, manic episode (Correct answer)
- Cyclothymic disorder
- Bipolar II disorder
Correct answer: Bipolar I disorder, manic episode
Bipolar I disorder is diagnosed when a patient has at least one manic episode lasting ≥7 days (or requiring hospitalisation). This patient shows classic manic symptoms (grandiosity, decreased sleep, pressured speech, flight of ideas, excessive spending) lasting 10 days with a history of depression.
Question 5: Which class of medications is first-line for generalised anxiety disorder (GAD)?
- Benzodiazepines
- Selective serotonin reuptake inhibitors (SSRIs) (Correct answer)
- Typical antipsychotics
- Mood stabilisers
Correct answer: Selective serotonin reuptake inhibitors (SSRIs)
SSRIs (e.g., escitalopram, sertraline) are first-line pharmacotherapy for generalised anxiety disorder due to their efficacy, safety profile, and low potential for dependence. SNRIs (e.g., venlafaxine) are also first-line alternatives.
Question 6: A 45-year-old man is brought by his family after being found talking to himself, dishevelled, and wandering in the street. He is oriented to person but not to time or place. He has a history of heavy alcohol use and stopped drinking 3 days ago. He has visual hallucinations of insects. What is the most likely diagnosis?
- Schizophrenia
- Delirium tremens (Correct answer)
- Korsakoff syndrome
- Alcoholic hallucinosis
Correct answer: Delirium tremens
Delirium tremens is a severe form of alcohol withdrawal occurring 48-96 hours after last drink. It presents with confusion, agitation, visual hallucinations, autonomic hyperactivity (tachycardia, hypertension, fever), and seizures. It has a mortality of 5-15% if untreated.
SMLE Psychiatry 1
A 25-year-old male presents with auditory hallucinations, paranoid delusions, and social withdrawal for 8 months.
His speech is disorganised and he has flat affect.
What is the most likely diagnosis?