SPEX Psychiatry 4

Question 1

A 16-year-old girl has not eaten adequate calories for 8 months, fears weight gain, and has a BMI of 15.5. She denies body image distortion. Which DSM-5 diagnosis applies?

Accepted Answer

Anorexia nervosa, restricting type

Answer

DSM-5 anorexia nervosa no longer requires insight into body image distortion; food restriction, low weight, and intense fear of gaining weight are sufficient.

Question 2

A psychiatrist evaluates a patient who tells her that a neighbor is 'controlling his mind through the walls.' The neighbor is real, but the belief is fixed and false. This is best described as:

Accepted Answer

A delusion of control (thought insertion/passivity)

Answer

A fixed false belief that an external agent is controlling one's thoughts or actions is a delusion of control, also called a passivity experience.

Question 3

Which of the following is the MOST important predictor of completed suicide in a clinical risk assessment?

Accepted Answer

History of a prior suicide attempt

Answer

A prior suicide attempt is the single strongest predictor of future completed suicide, conferring an approximately 40-fold increased risk.

Question 4

A 55-year-old woman with no prior psychiatric history presents with new onset auditory hallucinations and paranoid delusions. Physical exam shows cogwheel rigidity and a resting tremor. MRI shows cortical and subcortical atrophy. What is the most likely etiology?

Accepted Answer

Dementia with Lewy bodies

Answer

Dementia with Lewy bodies classically presents with fluctuating cognition, recurrent visual hallucinations, and spontaneous parkinsonism, and can present with prominent psychiatric symptoms.

Question 5

A patient taking phenelzine (an MAOI) eats aged cheese and develops a severe occipital headache, hypertension (BP 210/120), and diaphoresis. What is the mechanism?

Accepted Answer

Tyramine-induced hypertensive crisis

Answer

MAOIs block intestinal MAO-A, allowing dietary tyramine to enter systemic circulation and trigger massive norepinephrine release from sympathetic terminals.

SPEX Exam Practice Test

SPEX Exam Practice Test

SPEX Psychiatry 4