Synopsis of Psychiatry 12th Edition Exam
Questions and Answers Complete Study Guide,
Kaplan & Sadock Synopsis of Psychiatry 12th
Edition Test Bank, Comprehensive Psychiatry
Exam Prep, Mental Health Nursing and
Psychiatry Practice Questions with Verified
Answers and Detailed Rationales for Medical,
Nursing, and Psychology Students
Question 1: Which of the following is the MOST appropriate initial step when conducting a psychiatric
evaluation of a new patient?
A. Ordering laboratory tests to rule out medical causes
B. Establishing rapport and obtaining informed consent for the evaluation
C. Immediately administering a standardized diagnostic interview
D. Contacting family members for collateral information
CORRECT ANSWER: B. Establishing rapport and obtaining informed consent for the evaluation
RATIONALE: The foundation of any psychiatric evaluation is establishing a therapeutic alliance and
obtaining informed consent, which promotes patient cooperation, trust, and ethical practice
psychiatry.lwwhealthlibrary.com
. While laboratory tests, structured interviews, and collateral information are valuable components, they
should follow the establishment of rapport and consent to ensure the patient feels safe and respected
during the assessment process.
Question 2: A 7-year-old child presents with persistent difficulty sustaining attention, frequent
fidgeting, and interrupting others in class. Symptoms are present in both home and school settings.
Which DSM-5 diagnosis is MOST consistent with this presentation?
A. Oppositional Defiant Disorder
B. Autism Spectrum Disorder
C. Attention-Deficit/Hyperactivity Disorder, Combined Presentation
D. Generalized Anxiety Disorder
CORRECT ANSWER: C. Attention-Deficit/Hyperactivity Disorder, Combined Presentation
RATIONALE: ADHD, Combined Presentation requires six or more symptoms of inattention and six or
more symptoms of hyperactivity-impulsivity persisting for at least 6 months, present in two or more
settings, and interfering with functioning
psychiatry.lwwhealthlibrary.com
. The child's symptoms of inattention, fidgeting (hyperactivity), and interrupting (impulsivity) across
home and school settings align with this diagnosis. ODD involves angry/irritable mood and
,Synopsis of Psychiatry 12th Edition Exam
Questions and Answers Complete Study Guide,
Kaplan & Sadock Synopsis of Psychiatry 12th
Edition Test Bank, Comprehensive Psychiatry
Exam Prep, Mental Health Nursing and
Psychiatry Practice Questions with Verified
Answers and Detailed Rationales for Medical,
Nursing, and Psychology Students
argumentative behavior; ASD requires social communication deficits and restricted/repetitive behaviors;
GAD involves excessive worry rather than core attentional/hyperactive symptoms.
Question 3: Which neurotransmitter system is PRIMARILY targeted by first-generation antipsychotic
medications?
A. Serotonin (5-HT2A) receptors
B. Dopamine D2 receptors
C. Norepinephrine reuptake transporters
D. GABA-A receptor complexes
CORRECT ANSWER: B. Dopamine D2 receptors
RATIONALE: First-generation (typical) antipsychotics exert their therapeutic effects primarily through
antagonism of dopamine D2 receptors in the mesolimbic pathway, which helps reduce positive
symptoms of psychosis
www.mchip.net
. While they may affect other receptors (contributing to side effects), D2 antagonism is their defining
mechanism. Second-generation antipsychotics have broader receptor profiles including significant 5-
HT2A antagonism.
Question 4: A patient with major depressive disorder has failed to respond to two adequate trials of
SSRIs. According to current treatment guidelines, which intervention is MOST appropriate as the next
step?
A. Switching to a different SSRI
B. Augmentation with lithium or an atypical antipsychotic
C. Initiating electroconvulsive therapy immediately
D. Discontinuing all pharmacotherapy and starting psychotherapy alone
CORRECT ANSWER: B. Augmentation with lithium or an atypical antipsychotic
RATIONALE: For treatment-resistant depression (failure of two adequate antidepressant trials),
evidence-based guidelines recommend augmentation strategies such as adding lithium, thyroid
hormone, or an atypical antipsychotic (e.g., aripiprazole, quetiapine) to the current antidepressant
,Synopsis of Psychiatry 12th Edition Exam
Questions and Answers Complete Study Guide,
Kaplan & Sadock Synopsis of Psychiatry 12th
Edition Test Bank, Comprehensive Psychiatry
Exam Prep, Mental Health Nursing and
Psychiatry Practice Questions with Verified
Answers and Detailed Rationales for Medical,
Nursing, and Psychology Students
www.wolterskluwer.com
. Switching to another SSRI may be considered but has lower efficacy after two failures. ECT is reserved
for severe, life-threatening, or highly treatment-resistant cases. Psychotherapy alone is insufficient after
multiple medication failures in moderate-severe MDD.
Question 5: Which feature is MOST characteristic of delirium rather than dementia?
A. Gradual onset over months to years
B. Fluctuating level of consciousness and attention
C. Preserved attention in early stages
D. Progressive memory impairment as the initial symptom
CORRECT ANSWER: B. Fluctuating level of consciousness and attention
RATIONALE: Delirium is characterized by acute onset, fluctuating course, inattention, and either
disorganized thinking or altered level of consciousness
psychiatry.lwwhealthlibrary.com
. Fluctuating attention and consciousness are hallmark features distinguishing delirium from dementia,
which typically has insidious onset, stable consciousness, and prominent early memory deficits.
Dementia involves progressive cognitive decline with relatively preserved attention early on.
Question 6: A patient reports recurrent, unexpected panic attacks followed by at least one month of
persistent concern about additional attacks, worry about the consequences of attacks, or significant
behavioral changes related to the attacks. Which diagnosis is MOST appropriate?
A. Generalized Anxiety Disorder
B. Panic Disorder
C. Agoraphobia
D. Social Anxiety Disorder
CORRECT ANSWER: B. Panic Disorder
RATIONALE: Panic Disorder requires recurrent unexpected panic attacks plus at least one month of one
or more of: persistent concern about additional attacks, worry about consequences of attacks, or
significant maladaptive behavioral changes related to the attacks
, Synopsis of Psychiatry 12th Edition Exam
Questions and Answers Complete Study Guide,
Kaplan & Sadock Synopsis of Psychiatry 12th
Edition Test Bank, Comprehensive Psychiatry
Exam Prep, Mental Health Nursing and
Psychiatry Practice Questions with Verified
Answers and Detailed Rationales for Medical,
Nursing, and Psychology Students
psychiatry.lwwhealthlibrary.com
. GAD involves excessive anxiety and worry about multiple events; Agoraphobia requires fear/avoidance
of situations where escape might be difficult; Social Anxiety Disorder centers on fear of social scrutiny.
Question 7: Which medication is considered FIRST-LINE pharmacotherapy for obsessive-compulsive
disorder?
A. Benzodiazepines
B. First-generation antipsychotics
C. Selective serotonin reuptake inhibitors (SSRIs)
D. Mood stabilizers
CORRECT ANSWER: C. Selective serotonin reuptake inhibitors (SSRIs)
RATIONALE: SSRIs (e.g., fluoxetine, sertraline, fluvoxamine) are first-line pharmacotherapy for OCD due
to robust evidence of efficacy in reducing obsessions and compulsions
www.wolterskluwer.com
. Higher doses and longer trials (10-12 weeks) are often needed compared to depression treatment.
Benzodiazepines lack efficacy for core OCD symptoms; antipsychotics are reserved for augmentation in
treatment-resistant cases; mood stabilizers are not indicated for OCD monotherapy.
Question 8: A veteran experiences intrusive memories of combat, hypervigilance, avoidance of
trauma reminders, and negative alterations in mood and cognition lasting 8 months following
deployment. Which diagnosis is MOST consistent?
A. Acute Stress Disorder
B. Posttraumatic Stress Disorder
C. Adjustment Disorder
D. Generalized Anxiety Disorder
CORRECT ANSWER: B. Posttraumatic Stress Disorder
RATIONALE: PTSD requires exposure to actual or threatened death, serious injury, or sexual violence,
followed by intrusion symptoms, avoidance, negative alterations in cognition/mood, and alterations in
arousal/reactivity lasting more than one month and causing functional impairment
Questions and Answers Complete Study Guide,
Kaplan & Sadock Synopsis of Psychiatry 12th
Edition Test Bank, Comprehensive Psychiatry
Exam Prep, Mental Health Nursing and
Psychiatry Practice Questions with Verified
Answers and Detailed Rationales for Medical,
Nursing, and Psychology Students
Question 1: Which of the following is the MOST appropriate initial step when conducting a psychiatric
evaluation of a new patient?
A. Ordering laboratory tests to rule out medical causes
B. Establishing rapport and obtaining informed consent for the evaluation
C. Immediately administering a standardized diagnostic interview
D. Contacting family members for collateral information
CORRECT ANSWER: B. Establishing rapport and obtaining informed consent for the evaluation
RATIONALE: The foundation of any psychiatric evaluation is establishing a therapeutic alliance and
obtaining informed consent, which promotes patient cooperation, trust, and ethical practice
psychiatry.lwwhealthlibrary.com
. While laboratory tests, structured interviews, and collateral information are valuable components, they
should follow the establishment of rapport and consent to ensure the patient feels safe and respected
during the assessment process.
Question 2: A 7-year-old child presents with persistent difficulty sustaining attention, frequent
fidgeting, and interrupting others in class. Symptoms are present in both home and school settings.
Which DSM-5 diagnosis is MOST consistent with this presentation?
A. Oppositional Defiant Disorder
B. Autism Spectrum Disorder
C. Attention-Deficit/Hyperactivity Disorder, Combined Presentation
D. Generalized Anxiety Disorder
CORRECT ANSWER: C. Attention-Deficit/Hyperactivity Disorder, Combined Presentation
RATIONALE: ADHD, Combined Presentation requires six or more symptoms of inattention and six or
more symptoms of hyperactivity-impulsivity persisting for at least 6 months, present in two or more
settings, and interfering with functioning
psychiatry.lwwhealthlibrary.com
. The child's symptoms of inattention, fidgeting (hyperactivity), and interrupting (impulsivity) across
home and school settings align with this diagnosis. ODD involves angry/irritable mood and
,Synopsis of Psychiatry 12th Edition Exam
Questions and Answers Complete Study Guide,
Kaplan & Sadock Synopsis of Psychiatry 12th
Edition Test Bank, Comprehensive Psychiatry
Exam Prep, Mental Health Nursing and
Psychiatry Practice Questions with Verified
Answers and Detailed Rationales for Medical,
Nursing, and Psychology Students
argumentative behavior; ASD requires social communication deficits and restricted/repetitive behaviors;
GAD involves excessive worry rather than core attentional/hyperactive symptoms.
Question 3: Which neurotransmitter system is PRIMARILY targeted by first-generation antipsychotic
medications?
A. Serotonin (5-HT2A) receptors
B. Dopamine D2 receptors
C. Norepinephrine reuptake transporters
D. GABA-A receptor complexes
CORRECT ANSWER: B. Dopamine D2 receptors
RATIONALE: First-generation (typical) antipsychotics exert their therapeutic effects primarily through
antagonism of dopamine D2 receptors in the mesolimbic pathway, which helps reduce positive
symptoms of psychosis
www.mchip.net
. While they may affect other receptors (contributing to side effects), D2 antagonism is their defining
mechanism. Second-generation antipsychotics have broader receptor profiles including significant 5-
HT2A antagonism.
Question 4: A patient with major depressive disorder has failed to respond to two adequate trials of
SSRIs. According to current treatment guidelines, which intervention is MOST appropriate as the next
step?
A. Switching to a different SSRI
B. Augmentation with lithium or an atypical antipsychotic
C. Initiating electroconvulsive therapy immediately
D. Discontinuing all pharmacotherapy and starting psychotherapy alone
CORRECT ANSWER: B. Augmentation with lithium or an atypical antipsychotic
RATIONALE: For treatment-resistant depression (failure of two adequate antidepressant trials),
evidence-based guidelines recommend augmentation strategies such as adding lithium, thyroid
hormone, or an atypical antipsychotic (e.g., aripiprazole, quetiapine) to the current antidepressant
,Synopsis of Psychiatry 12th Edition Exam
Questions and Answers Complete Study Guide,
Kaplan & Sadock Synopsis of Psychiatry 12th
Edition Test Bank, Comprehensive Psychiatry
Exam Prep, Mental Health Nursing and
Psychiatry Practice Questions with Verified
Answers and Detailed Rationales for Medical,
Nursing, and Psychology Students
www.wolterskluwer.com
. Switching to another SSRI may be considered but has lower efficacy after two failures. ECT is reserved
for severe, life-threatening, or highly treatment-resistant cases. Psychotherapy alone is insufficient after
multiple medication failures in moderate-severe MDD.
Question 5: Which feature is MOST characteristic of delirium rather than dementia?
A. Gradual onset over months to years
B. Fluctuating level of consciousness and attention
C. Preserved attention in early stages
D. Progressive memory impairment as the initial symptom
CORRECT ANSWER: B. Fluctuating level of consciousness and attention
RATIONALE: Delirium is characterized by acute onset, fluctuating course, inattention, and either
disorganized thinking or altered level of consciousness
psychiatry.lwwhealthlibrary.com
. Fluctuating attention and consciousness are hallmark features distinguishing delirium from dementia,
which typically has insidious onset, stable consciousness, and prominent early memory deficits.
Dementia involves progressive cognitive decline with relatively preserved attention early on.
Question 6: A patient reports recurrent, unexpected panic attacks followed by at least one month of
persistent concern about additional attacks, worry about the consequences of attacks, or significant
behavioral changes related to the attacks. Which diagnosis is MOST appropriate?
A. Generalized Anxiety Disorder
B. Panic Disorder
C. Agoraphobia
D. Social Anxiety Disorder
CORRECT ANSWER: B. Panic Disorder
RATIONALE: Panic Disorder requires recurrent unexpected panic attacks plus at least one month of one
or more of: persistent concern about additional attacks, worry about consequences of attacks, or
significant maladaptive behavioral changes related to the attacks
, Synopsis of Psychiatry 12th Edition Exam
Questions and Answers Complete Study Guide,
Kaplan & Sadock Synopsis of Psychiatry 12th
Edition Test Bank, Comprehensive Psychiatry
Exam Prep, Mental Health Nursing and
Psychiatry Practice Questions with Verified
Answers and Detailed Rationales for Medical,
Nursing, and Psychology Students
psychiatry.lwwhealthlibrary.com
. GAD involves excessive anxiety and worry about multiple events; Agoraphobia requires fear/avoidance
of situations where escape might be difficult; Social Anxiety Disorder centers on fear of social scrutiny.
Question 7: Which medication is considered FIRST-LINE pharmacotherapy for obsessive-compulsive
disorder?
A. Benzodiazepines
B. First-generation antipsychotics
C. Selective serotonin reuptake inhibitors (SSRIs)
D. Mood stabilizers
CORRECT ANSWER: C. Selective serotonin reuptake inhibitors (SSRIs)
RATIONALE: SSRIs (e.g., fluoxetine, sertraline, fluvoxamine) are first-line pharmacotherapy for OCD due
to robust evidence of efficacy in reducing obsessions and compulsions
www.wolterskluwer.com
. Higher doses and longer trials (10-12 weeks) are often needed compared to depression treatment.
Benzodiazepines lack efficacy for core OCD symptoms; antipsychotics are reserved for augmentation in
treatment-resistant cases; mood stabilizers are not indicated for OCD monotherapy.
Question 8: A veteran experiences intrusive memories of combat, hypervigilance, avoidance of
trauma reminders, and negative alterations in mood and cognition lasting 8 months following
deployment. Which diagnosis is MOST consistent?
A. Acute Stress Disorder
B. Posttraumatic Stress Disorder
C. Adjustment Disorder
D. Generalized Anxiety Disorder
CORRECT ANSWER: B. Posttraumatic Stress Disorder
RATIONALE: PTSD requires exposure to actual or threatened death, serious injury, or sexual violence,
followed by intrusion symptoms, avoidance, negative alterations in cognition/mood, and alterations in
arousal/reactivity lasting more than one month and causing functional impairment
