SPEX Psychiatry 2 — Questions and Answers
Question 1: A 35-year-old woman presents with recurrent, intrusive thoughts about harming her infant despite having no intent to act on them. She is distressed by these thoughts. What is the most likely diagnosis?
- Postpartum psychosis
- Postpartum depression
- Postpartum OCD (Correct answer)
- Infanticide ideation disorder
Correct answer: Postpartum OCD
Postpartum OCD is characterized by ego-dystonic intrusive thoughts (often about harming the baby) without intent, causing significant distress.
Question 2: Which antidepressant mechanism is most associated with serotonin syndrome when combined with linezolid?
- Norepinephrine reuptake inhibition
- Serotonin reuptake inhibition (Correct answer)
- Dopamine reuptake inhibition
- GABA-A potentiation
Correct answer: Serotonin reuptake inhibition
Serotonin reuptake inhibitors (SSRIs/SNRIs) combined with linezolid (an MAO inhibitor) can precipitate serotonin syndrome due to excess serotonergic activity.
Question 3: A patient on clozapine develops fever, sore throat, and a WBC of 1,800/µL. What is the immediate management?
- Reduce clozapine dose by 50%
- Discontinue clozapine immediately and hospitalize (Correct answer)
- Add prophylactic G-CSF and continue clozapine
- Switch to olanzapine and monitor CBC weekly
Correct answer: Discontinue clozapine immediately and hospitalize
Clozapine must be stopped immediately if agranulocytosis (ANC <500) or severe leukopenia occurs, as continuing risks fatal infections.
Question 4: According to DSM-5, persistent depressive disorder (dysthymia) requires a depressed mood for at least:
- 2 weeks
- 1 month
- 6 months
- 2 years (Correct answer)
Correct answer: 2 years
DSM-5 requires at least 2 years of depressed mood (1 year in children/adolescents) for a diagnosis of persistent depressive disorder.
Question 5: A 28-year-old man with schizophrenia develops muscle rigidity, hyperthermia (41°C), diaphoresis, and altered consciousness after starting haloperidol. Labs show elevated CPK. What is the diagnosis?
- Serotonin syndrome
- Malignant hyperthermia
- Neuroleptic malignant syndrome (Correct answer)
- Anticholinergic toxicity
Correct answer: Neuroleptic malignant syndrome
Neuroleptic malignant syndrome presents with the tetrad of hyperthermia, rigidity, autonomic instability, and altered consciousness, with elevated CPK, following antipsychotic exposure.
Question 6: Which personality disorder is characterized by a pervasive pattern of grandiosity, need for admiration, and lack of empathy, occurring in a variety of contexts?
- Antisocial personality disorder
- Borderline personality disorder
- Histrionic personality disorder
- Narcissistic personality disorder (Correct answer)
Correct answer: Narcissistic personality disorder
Narcissistic personality disorder is defined by grandiosity, entitlement, need for admiration, and empathy deficits per DSM-5.
Question 7: A physician is asked to evaluate a patient's capacity to consent to surgery. Which of the following is NOT one of the four legal standards for decision-making capacity?
- Understanding the information presented
- Appreciating how the information applies to their situation
- Reasoning about treatment options
- Absence of any psychiatric diagnosis (Correct answer)
Correct answer: Absence of any psychiatric diagnosis
Decision-making capacity requires understanding, appreciation, reasoning, and communication of a choice — a psychiatric diagnosis alone does not negate capacity.
SPEX Psychiatry 2
A 35-year-old woman presents with recurrent, intrusive thoughts about harming her infant despite having no intent to act on them.
She is distressed by these thoughts.
What is the most likely diagnosis?