SMLE Psychiatry

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?

Accepted Answer

Schizophrenia

Answer

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?

Accepted Answer

Neuroleptic malignant syndrome (NMS)

Answer

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?

Accepted Answer

2 weeks

Answer

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?

Accepted Answer

Bipolar I disorder, manic episode

Answer

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)?

Accepted Answer

Selective serotonin reuptake inhibitors (SSRIs)

Answer

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.

SMLE Practice Test

SMLE Practice Test

SMLE Psychiatry