NBME Surgery Shelf Exam 2026 Questions and Answers

NBME Surgery Shelf Exam 2026 Questions and Answers Leading cause of overdose-related deaths in psychiatric population Nortriptyline (TCA. causes QT prolongation, cardiac arrhythmia, then death). TCA that causes QT prolongation nortriptyline Pseudoseizures vs. real seizures: If real, within ______ [prolactin] will double. PTSD tx = sertraline Prochlorperazine: S/e = ____ Tx = ____ 1 hour akathisia, anticholinergics (i.e. benztropine) (PREVENTION = concurrent admin of IV benzo) Hallucinations, insomnia, tremor, GI distress, seizures. benzo withdrawal Dysphoria, psychomotor agitation or retardation, fatigue. Cocaine withdrawal Abdominal pain, chills, myalgias, NVD, piloerection Worst antipsychotic S/Es: Ziprasidone = Heroin withdrawal QT prolongation Worst antipsychotic S/Es: Clozapine = neutropenia, myocarditis Antipsychotic LEAST associated with movement problems = Weight-neutral antipsychotic = Worst lamotrigine S/E = ziprasidone clozapine stevens-johnson syndrome (if titrated up too quickly. A rash is fairly normal, though... usually...) Tx to relieve the autonomic sx of heroine withdrawal = diphenhydramine, trihexyphenidyl) Tx for PCP intoxication = midazolam anticholinergic (benztropine, Nystagmus, HTN, coma, hyperacusis, agitation, psychosis PCP intoxication (tx = midazolam) Tx for ACUTE (acute!) mania = haloperidol ___ withdrawal includes elevated temperature benzo If an antipsychotic (anticholinergic) --- urinary S/Es, tx = bethanechol (cholinergic) Enuresis: 1st-line tx = DDAVP (S/E = water intoxication, so watch out. Technically behavior therapy should be tried first.) Enuresis: 2nd-line tx = Imipramine ____ = most common drug cause of depression Antisocial PD - Must be ___ years old 15 ___ side-effect (long-term tx): hypothyroidism propranolol lithium Acute stress disorder: ___ days - __ weeks after life is in jeopardy. 2, 4 Adjustment disorder: Within ___ months of life stressor, dissipating at ___ months. 3, 6 Akathisia is a s/e of neuroleptics or prochlorperazine. Prevented by concurrent administration of ___ IV benzo Rett syndrome: Age-appropriate development for 1st ___ months (at least). 3 long-lasting (depot) antipsychotics: haloperidol, fluphenazine, risperidone Narcolepsy: sleep attacks occuring DAILY for at least ___ months 3 Tx for Intermittent Explosive Disorder = carbamazepine Of the TCAs, _____ is the most serotinergic, so it is used in OCD. clomipramine Prochlorperazine = ____. S/e = _____. Brief psychotic disorder: time = anti-emetic, akathisia 1 month 5 Delusional disorder: time = at least 1 month (Function is not impaired. Delusion = non-bizarre. Hallucinations may be present.) Bulimia tx = SSRI Presence of an affective disorder (along with schizophrenia) ____ risk for tardive dyskinesia. increases Antipsychotics: ACUTE DYSTONIA is a side-effect. Tx = anticholinergics 3 anticholinergics by neuroleptics) diphenhydramine, benztropine, trihexyphenidyl (tx acute dystonia caused 2 lab results in Neuroleptic Malignant Syndrome: increased CPK, leukocytosis 3 S/Es of TCAs (e.g. imipramine): blurred vision / pupillary dilation (antimuscarinic effect), dry mouth (anticholinergic effect), orthostatic hypotension (a1-adrenergic effect) Nortriptyline: class = TCA Imipramine: class = TCA