SPEX Psychiatry 3 — Questions and Answers
Question 1: A 72-year-old man develops acute confusion, visual hallucinations, and fluctuating level of consciousness 2 days after hip surgery. He has no prior psychiatric history. What is the most likely diagnosis?
- New-onset schizophrenia
- Dementia with Lewy bodies
- Delirium (Correct answer)
- Brief psychotic disorder
Correct answer: Delirium
Postoperative delirium is common in elderly patients and is characterized by acute onset, fluctuating course, and often visual hallucinations.
Question 2: Which of the following best describes the mechanism of action of lithium in bipolar disorder?
- Dopamine D2 receptor blockade
- Inhibition of inositol monophosphatase disrupting PI signaling (Correct answer)
- Serotonin 5-HT1A agonism
- GABA-B receptor agonism
Correct answer: Inhibition of inositol monophosphatase disrupting PI signaling
Lithium inhibits inositol monophosphatase and GSK-3β, disrupting phosphatidylinositol signaling cascades implicated in its mood-stabilizing effects.
Question 3: A 19-year-old college student reports persistent difficulty sustaining attention, losing items, and being easily distracted since childhood. He functions adequately but struggles academically. Stimulant medication is prescribed. What is the drug class?
- Selective norepinephrine reuptake inhibitors
- Central nervous system stimulants (Correct answer)
- Alpha-2 adrenergic agonists
- Tricyclic antidepressants
Correct answer: Central nervous system stimulants
CNS stimulants (amphetamine salts, methylphenidate) are first-line pharmacotherapy for ADHD, increasing dopamine and norepinephrine in prefrontal circuits.
Question 4: Which therapy is the first-line evidence-based treatment for PTSD according to VA/DoD and APA guidelines?
- Psychodynamic psychotherapy
- Supportive counseling
- Prolonged Exposure or Cognitive Processing Therapy (Correct answer)
- Eye movement desensitization (EMDR) alone
Correct answer: Prolonged Exposure or Cognitive Processing Therapy
Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) are the most strongly evidence-based, guideline-recommended treatments for PTSD.
Question 5: A patient with bipolar I disorder is started on valproate. Which laboratory value requires monitoring due to a potentially fatal adverse effect?
- Thyroid-stimulating hormone
- Serum creatinine
- Liver function tests (Correct answer)
- Serum potassium
Correct answer: Liver function tests
Valproate carries a black-box warning for hepatotoxicity; LFTs must be monitored regularly, especially in the first 6 months of treatment.
Question 6: A 45-year-old man presents with 6 months of persistent worry about multiple life domains that he cannot control, accompanied by muscle tension, fatigue, and poor sleep. The most appropriate diagnosis is:
- Panic disorder
- Generalized anxiety disorder (Correct answer)
- Adjustment disorder with anxious mood
- Social anxiety disorder
Correct answer: Generalized anxiety disorder
GAD requires at least 6 months of excessive, uncontrollable worry about multiple topics with associated physical symptoms such as muscle tension and fatigue.
Question 7: Which of the following is a contraindication to electroconvulsive therapy (ECT)?
- Age over 70 years
- Active suicidal ideation
- Recent intracranial mass with elevated ICP (Correct answer)
- Severe treatment-resistant depression
Correct answer: Recent intracranial mass with elevated ICP
Elevated intracranial pressure from an intracranial mass is the primary contraindication to ECT because seizure-induced ICP spikes can cause herniation.
SPEX Psychiatry 3
A 72-year-old man develops acute confusion, visual hallucinations, and fluctuating level of consciousness 2 days after hip surgery.
He has no prior psychiatric history.
What is the most likely diagnosis?