1
,Q1. A 32-year-old patient presents with depressed mood,
anhedonia, hypersomnia, increased appetite, and leaden
paralysis. Which specifier best fits this presentation?
A) Melancholic features
B) Atypical features
C) Psychotic features
D) Catatonic features
Correct Answer: B
Rationale: Atypical features include mood reactivity,
hypersomnia, increased appetite/weight gain, leaden paralysis,
and long-standing rejection sensitivity. Melancholic features
include early morning awakening and anorexia.
2
,Q2. A patient with bipolar I disorder presents with rapid
speech, grandiosity, and decreased need for sleep lasting 7
days. He also has paranoid delusions. What is the most
appropriate initial pharmacotherapy?
A) Lithium monotherapy
B) Valproate plus an antipsychotic
C) SSRI monotherapy
D) Benzodiazepine monotherapy
Correct Answer: B
Rationale: Acute mania with psychotic features requires a mood
stabilizer (lithium or valproate) PLUS an antipsychotic (e.g.,
olanzapine, risperidone). Antidepressants can worsen mania.
Q3. Which serotonin-dopamine antagonist (SDA) antipsychotic
has the highest risk of metabolic syndrome?
A) Aripiprazole
B) Ziprasidone
C) Olanzapine
D) Lurasidone
Correct Answer: C
Rationale: Olanzapine and clozapine have the highest risk of
3
, weight gain, dyslipidemia, and hyperglycemia. Aripiprazole,
ziprasidone, and lurasidone have lower metabolic risk.
Q4. A 45-year-old with panic disorder is started on sertraline.
He reports increased anxiety and jitteriness after the first dose.
What is the most appropriate next step?
A) Discontinue sertraline immediately
B) Add a benzodiazepine temporarily and start at a lower dose
C) Increase the sertraline dose
D) Switch to fluoxetine
Correct Answer: B
Rationale: Initial activation or jitteriness from SSRIs is common in
anxiety disorders. Start at a very low dose and add a short-term
benzodiazepine (e.g., clonazepam) until tolerance develops.
Q5. A patient on clozapine develops fever, tachycardia, and
sore throat. WBC is 2,500/mm³. What is the priority action?
A) Continue clozapine and monitor weekly
B) Stop clozapine immediately and check absolute neutrophil
count (ANC)
4
,Q1. A 32-year-old patient presents with depressed mood,
anhedonia, hypersomnia, increased appetite, and leaden
paralysis. Which specifier best fits this presentation?
A) Melancholic features
B) Atypical features
C) Psychotic features
D) Catatonic features
Correct Answer: B
Rationale: Atypical features include mood reactivity,
hypersomnia, increased appetite/weight gain, leaden paralysis,
and long-standing rejection sensitivity. Melancholic features
include early morning awakening and anorexia.
2
,Q2. A patient with bipolar I disorder presents with rapid
speech, grandiosity, and decreased need for sleep lasting 7
days. He also has paranoid delusions. What is the most
appropriate initial pharmacotherapy?
A) Lithium monotherapy
B) Valproate plus an antipsychotic
C) SSRI monotherapy
D) Benzodiazepine monotherapy
Correct Answer: B
Rationale: Acute mania with psychotic features requires a mood
stabilizer (lithium or valproate) PLUS an antipsychotic (e.g.,
olanzapine, risperidone). Antidepressants can worsen mania.
Q3. Which serotonin-dopamine antagonist (SDA) antipsychotic
has the highest risk of metabolic syndrome?
A) Aripiprazole
B) Ziprasidone
C) Olanzapine
D) Lurasidone
Correct Answer: C
Rationale: Olanzapine and clozapine have the highest risk of
3
, weight gain, dyslipidemia, and hyperglycemia. Aripiprazole,
ziprasidone, and lurasidone have lower metabolic risk.
Q4. A 45-year-old with panic disorder is started on sertraline.
He reports increased anxiety and jitteriness after the first dose.
What is the most appropriate next step?
A) Discontinue sertraline immediately
B) Add a benzodiazepine temporarily and start at a lower dose
C) Increase the sertraline dose
D) Switch to fluoxetine
Correct Answer: B
Rationale: Initial activation or jitteriness from SSRIs is common in
anxiety disorders. Start at a very low dose and add a short-term
benzodiazepine (e.g., clonazepam) until tolerance develops.
Q5. A patient on clozapine develops fever, tachycardia, and
sore throat. WBC is 2,500/mm³. What is the priority action?
A) Continue clozapine and monitor weekly
B) Stop clozapine immediately and check absolute neutrophil
count (ANC)
4
