SPEX Psychiatry 3

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?

Accepted Answer

Delirium

Answer

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?

Accepted Answer

Inhibition of inositol monophosphatase disrupting PI signaling

Answer

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?

Accepted Answer

Central nervous system stimulants

Answer

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?

Accepted Answer

Prolonged Exposure or Cognitive Processing Therapy

Answer

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?

Accepted Answer

Liver function tests

Answer

Valproate carries a black-box warning for hepatotoxicity; LFTs must be monitored regularly, especially in the first 6 months of treatment.

SPEX Exam Practice Test

SPEX Exam Practice Test

SPEX Psychiatry 3