PSYCHIATRY COMPLETE EXAM QUESTIONS
AND VERIFIED ANSWERS | 2026–2027 LATEST
UPDATE | GUARANTEED PASS | DETAILED
RATIONALES
Psychiatry Board Exam Practice Questions (ABPN / PRITE Format)
Section 1: Mood Disorders (Questions 1–15)
Question 1
A 45-year-old woman reports depressed mood, anhedonia, hypersomnia,
increased appetite with weight gain, and leaden paralysis. She has never had a
manic or hypomanic episode. Which specifier best applies to her major depressive
episode?
A) Atypical features
B) Melancholic features
C) Catatonic features
D) Seasonal pattern
Correct Answer: A
Rationale: Atypical features include mood reactivity (not required but common),
hypersomnia, increased appetite/weight gain, leaden paralysis (heavy feeling in
limbs), and long-standing interpersonal rejection sensitivity.
Question 2
A 30-year-old man with bipolar I disorder is stabilized on lithium. He presents with
acne, weight gain, and tremor. His lithium level is 1.0 mEq/L. What is the most
appropriate next step?
,A) Switch to valproate
B) Add propranolol for tremor
C) Reduce lithium dose to 0.6 mEq/L
D) Add topiramate for weight gain
Correct Answer: B
*Rationale: Tremor is a common side effect of lithium. Propranolol (a beta-
blocker) is effective for essential-like tremor. Dose reduction may compromise
mood stabilization; 1.0 is therapeutic.*
Question 3
A 55-year-old man with treatment-resistant depression has failed trials of SSRIs,
SNRIs, bupropion, and mirtazapine. He has no history of mania. What is the most
appropriate next pharmacological intervention?
A) Tranylcypromine (MAOI)
B) Lithium augmentation
C) Quetiapine monotherapy
D) Electroconvulsive therapy (ECT)
Correct Answer: B
Rationale: Lithium augmentation is a first-line strategy for treatment-resistant
depression with strong evidence. MAOIs are later-line. ECT is highly effective but
often reserved for more refractory cases or catatonia.
Question 4
A 25-year-old woman with bipolar II disorder is on lamotrigine. She presents with
a painful ulcer on her lip and a diffuse maculopapular rash involving her trunk.
What is the most appropriate next step?
A) Add topical steroid
B) Discontinue lamotrigine immediately
C) Add oral antihistamine
D) Continue lamotrigine with close observation
Correct Answer: B
,Rationale: Lamotrigine can cause Stevens-Johnson syndrome/toxic epidermal
necrolysis. Any rash with mucosal involvement (lip ulcer) requires immediate
discontinuation.
Question 5
A 70-year-old man with major depressive disorder and a history of hyponatremia
is started on an antidepressant. Which medication is most likely to cause
hyponatremia?
A) Bupropion
B) Sertraline
C) Mirtazapine
D) Vortioxetine
Correct Answer: B
Rationale: SSRIs (especially in elderly) are strongly associated with SIADH and
hyponatremia. Bupropion and mirtazapine have lower risk.
Question 6
A 35-year-old woman with a history of postpartum depression is now 8 weeks
pregnant and depressed. She wants to avoid medication but is symptomatic. What
is the most appropriate first-line treatment?
A) Fluoxetine
B) Interpersonal psychotherapy (IPT)
C) Bright light therapy
D) Transcranial magnetic stimulation (TMS)
Correct Answer: B
Rationale: IPT has strong evidence for treating depression during pregnancy and is
preferred for patients who want to avoid medication.
Question 7
A 50-year-old man with bipolar I disorder presents with rapid speech, grandiosity,
decreased need for sleep, and agitation. He has been off medications for 2
months. What is the most appropriate initial treatment?
, A) Lithium monotherapy
B) Valproate monotherapy
C) Atypical antipsychotic (e.g., risperidone)
D) Carbamazepine
Correct Answer: C
Rationale: For acute mania with agitation, atypical antipsychotics (risperidone,
olanzapine, quetiapine) are fastest-acting. Lithium and valproate take days to
weeks.
Question 8
A 28-year-old woman with major depressive disorder has failed adequate trials of
two SSRIs. She has no medical comorbidities. What is the next recommended
step?
A) Add a second antidepressant
B) Switch to an SNRI (venlafaxine)
C) Switch to bupropion
D) Add aripiprazole
Correct Answer: B
Rationale: STARD trial showed that switching to venlafaxine (SNRI) or bupropion is
effective after SSRI failure. Augmentation is also reasonable, but switching is often
first.*
Question 9
A 60-year-old man with bipolar I disorder and stable mood on lithium develops
lithium-induced nephrogenic diabetes insipidus. What is the best management
strategy?
A) Add hydrochlorothiazide
B) Switch to valproate
C) Add amiloride
D) Reduce lithium dose
Correct Answer: B
AND VERIFIED ANSWERS | 2026–2027 LATEST
UPDATE | GUARANTEED PASS | DETAILED
RATIONALES
Psychiatry Board Exam Practice Questions (ABPN / PRITE Format)
Section 1: Mood Disorders (Questions 1–15)
Question 1
A 45-year-old woman reports depressed mood, anhedonia, hypersomnia,
increased appetite with weight gain, and leaden paralysis. She has never had a
manic or hypomanic episode. Which specifier best applies to her major depressive
episode?
A) Atypical features
B) Melancholic features
C) Catatonic features
D) Seasonal pattern
Correct Answer: A
Rationale: Atypical features include mood reactivity (not required but common),
hypersomnia, increased appetite/weight gain, leaden paralysis (heavy feeling in
limbs), and long-standing interpersonal rejection sensitivity.
Question 2
A 30-year-old man with bipolar I disorder is stabilized on lithium. He presents with
acne, weight gain, and tremor. His lithium level is 1.0 mEq/L. What is the most
appropriate next step?
,A) Switch to valproate
B) Add propranolol for tremor
C) Reduce lithium dose to 0.6 mEq/L
D) Add topiramate for weight gain
Correct Answer: B
*Rationale: Tremor is a common side effect of lithium. Propranolol (a beta-
blocker) is effective for essential-like tremor. Dose reduction may compromise
mood stabilization; 1.0 is therapeutic.*
Question 3
A 55-year-old man with treatment-resistant depression has failed trials of SSRIs,
SNRIs, bupropion, and mirtazapine. He has no history of mania. What is the most
appropriate next pharmacological intervention?
A) Tranylcypromine (MAOI)
B) Lithium augmentation
C) Quetiapine monotherapy
D) Electroconvulsive therapy (ECT)
Correct Answer: B
Rationale: Lithium augmentation is a first-line strategy for treatment-resistant
depression with strong evidence. MAOIs are later-line. ECT is highly effective but
often reserved for more refractory cases or catatonia.
Question 4
A 25-year-old woman with bipolar II disorder is on lamotrigine. She presents with
a painful ulcer on her lip and a diffuse maculopapular rash involving her trunk.
What is the most appropriate next step?
A) Add topical steroid
B) Discontinue lamotrigine immediately
C) Add oral antihistamine
D) Continue lamotrigine with close observation
Correct Answer: B
,Rationale: Lamotrigine can cause Stevens-Johnson syndrome/toxic epidermal
necrolysis. Any rash with mucosal involvement (lip ulcer) requires immediate
discontinuation.
Question 5
A 70-year-old man with major depressive disorder and a history of hyponatremia
is started on an antidepressant. Which medication is most likely to cause
hyponatremia?
A) Bupropion
B) Sertraline
C) Mirtazapine
D) Vortioxetine
Correct Answer: B
Rationale: SSRIs (especially in elderly) are strongly associated with SIADH and
hyponatremia. Bupropion and mirtazapine have lower risk.
Question 6
A 35-year-old woman with a history of postpartum depression is now 8 weeks
pregnant and depressed. She wants to avoid medication but is symptomatic. What
is the most appropriate first-line treatment?
A) Fluoxetine
B) Interpersonal psychotherapy (IPT)
C) Bright light therapy
D) Transcranial magnetic stimulation (TMS)
Correct Answer: B
Rationale: IPT has strong evidence for treating depression during pregnancy and is
preferred for patients who want to avoid medication.
Question 7
A 50-year-old man with bipolar I disorder presents with rapid speech, grandiosity,
decreased need for sleep, and agitation. He has been off medications for 2
months. What is the most appropriate initial treatment?
, A) Lithium monotherapy
B) Valproate monotherapy
C) Atypical antipsychotic (e.g., risperidone)
D) Carbamazepine
Correct Answer: C
Rationale: For acute mania with agitation, atypical antipsychotics (risperidone,
olanzapine, quetiapine) are fastest-acting. Lithium and valproate take days to
weeks.
Question 8
A 28-year-old woman with major depressive disorder has failed adequate trials of
two SSRIs. She has no medical comorbidities. What is the next recommended
step?
A) Add a second antidepressant
B) Switch to an SNRI (venlafaxine)
C) Switch to bupropion
D) Add aripiprazole
Correct Answer: B
Rationale: STARD trial showed that switching to venlafaxine (SNRI) or bupropion is
effective after SSRI failure. Augmentation is also reasonable, but switching is often
first.*
Question 9
A 60-year-old man with bipolar I disorder and stable mood on lithium develops
lithium-induced nephrogenic diabetes insipidus. What is the best management
strategy?
A) Add hydrochlorothiazide
B) Switch to valproate
C) Add amiloride
D) Reduce lithium dose
Correct Answer: B
