PA PSYCHIATRY EOR LATEST ACTUAL
EXAM 2 TEST BANK WITH REAL EXAM
QUESTIONS WITH 100% CORRECT
VERIFIED ANSWERS GRADED A+/ PSYCH
EOR PAEA LATEST EXAM NEW!!
1. A 28-year-old woman reports 6 weeks of depressed mood, anhedonia, fatigue,
poor concentration, and early morning awakening. She denies mania, psychosis, or
suicidal ideation. What is the most appropriate initial treatment?
A) Bupropion 150 mg BID
B) Escitalopram 10 mg daily
C) Venlafaxine 75 mg BID
D) Fluoxetine 20 mg BID
Rationale: SSRIs (escitalopram, sertraline, fluoxetine) are first-line for MDD.
Start low and go slow. Bupropion is second-line or for atypical depression.
Venlafaxine (SNRI) is effective but not first-line due to side effect profile.
Fluoxetine 20 mg BID is too high (usual starting dose is 20 mg daily).
2. A 45-year-old male presents with 5 days of elevated mood, decreased need for
sleep (sleeps 3 hours but feels rested), grandiosity, and increased goal-directed
activity. He has no psychotic features. This episode meets criteria for:
A) Hypomanic episode
B) Manic episode
C) Mixed episode
D) Cyclothymic disorder
Rationale: DSM-5 criteria for a manic episode require ≥1 week (or any duration if
hospitalization is required). Hypomania requires ≥4 days. Despite being 5 days, the
severity (grandiosity, decreased sleep, functional impairment) and lack of
hospitalization still favor mania if symptoms are severe. In practice, this duration
with impairing symptoms is often treated as mania.
,3. A patient with bipolar I disorder is currently depressed. Which medication is
most clearly associated with increased risk of switching to mania?
A) Lamotrigine
B) Quetiapine
C) Fluoxetine (monotherapy)
D) Lithium
Rationale: Antidepressant monotherapy (especially SSRIs) in bipolar depression
can precipitate mania/hypomania or rapid cycling. Mood stabilizers (lithium,
lamotrigine) or atypical antipsychotics (quetiapine, lurasidone) are preferred. If an
antidepressant is used, it must be co-administered with a mood stabilizer.
4. A 22-year-old college student reports feeling sad, worthless, and having
difficulty studying for 2 months. She denies suicidal ideation. Her TSH and CBC
are normal. She has never had a manic episode. What is the first-line
pharmacotherapy?
A) Sertraline 25 mg daily
B) Amitriptyline 25 mg at bedtime
C) Phenelzine 15 mg TID
D) Lithium 300 mg BID
Rationale: Sertraline (SSRI) is first-line for MDD. Amitriptyline (tricyclic) has
more side effects (anticholinergic, cardiac) and is second-line. Phenelzine (MAOI)
is third-line due to dietary restrictions and drug interactions. Lithium is for bipolar
disorder.
5. A 35-year-old woman has had persistent depressive symptoms for over 2 years,
but never meeting full MDD criteria. She reports poor appetite, low energy, and
low self-esteem. What is the diagnosis?
A) Major depressive disorder, moderate
B) Persistent depressive disorder (dysthymia)
C) Adjustment disorder with depressed mood
D) Bipolar II disorder
,Rationale: Persistent depressive disorder (PDD) requires depressed mood for most
of the day, more days than not, for ≥2 years (1 year in children/adolescents), with
at least two additional symptoms. MDD episodes are discrete (≥2 weeks).
Adjustment disorder is triggered by a stressor within 3 months.
6. Which of the following is a specifier for major depressive disorder?
A) With atypical features
B) With catatonia
C) With peripartum onset
D) All of the above
Rationale: All are specifiers: atypical (mood reactivity, hypersomnia,
hyperphagia), catatonia, peripartum onset (during pregnancy or within 4 weeks
postpartum), seasonal pattern, melancholic, anxious distress, mixed features, etc.
7. A 52-year-old male with bipolar I disorder is stable on lithium. He develops
polyuria and polydipsia. What is the most likely cause?
A) Lithium-induced diabetes mellitus
B) Lithium-induced nephrogenic diabetes insipidus
C) Syndrome of inappropriate antidiuretic hormone (SIADH)
D) Primary polydipsia
Rationale: Lithium causes nephrogenic diabetes insipidus (renal resistance to
ADH) in up to 20-40% of long-term users. Monitor urine specific gravity, serum
sodium, and lithium levels. Treatment includes amiloride or thiazide diuretics
(with caution).
8. A patient with MDD fails to improve after 6 weeks of sertraline 50 mg daily.
What is the next step?
A) Augment with lithium
B) Switch to venlafaxine 37.5 mg daily
C) Increase sertraline to 100-150 mg daily (max 200 mg)
D) Add aripiprazole 2 mg daily
Rationale: First step for inadequate response to an SSRI is to optimize the dose
(increase to maximum tolerated/therapeutic dose) for another 4-6 weeks.
, Augmentation (atypical antipsychotic, lithium) or switching is considered after
adequate dose and duration failure.
9. A 30-year-old woman with MDD reports that her depression consistently
worsens in the fall and winter and improves in spring. She has increased sleep,
increased appetite, and carbohydrate craving. What is the best initial treatment?
A) Bupropion XL 150 mg daily
B) Light therapy (10,000 lux, 30 minutes each morning)
C) Fluoxetine 40 mg daily
D) Melatonin 5 mg at bedtime
Rationale: This is seasonal affective disorder (MDD with seasonal pattern). First-
line is bright light therapy (10,000 lux for 30 minutes upon awakening). Bupropion
XL is FDA-approved for prevention but not initial acute treatment. Melatonin is
not first-line.
10. A 68-year-old man with a history of coronary artery disease presents with
depressed mood, anhedonia, and insomnia. He is worried about side effects. Which
antidepressant is most cardiotoxic in overdose?
A) Sertraline
B) Amitriptyline
C) Mirtazapine
D) Bupropion
Rationale: Tricyclic antidepressants (TCAs) like amitriptyline are the most
cardiotoxic in overdose (widened QRS, arrhythmias, hypotension). SSRIs,
mirtazapine, and bupropion are safer in overdose. For elderly with cardiac disease,
avoid TCAs.
11. A 25-year-old woman with bipolar I disorder is in the maintenance phase.
Which medication has the strongest evidence for preventing manic and depressive
relapse?
A) Valproate
B) Lithium
EXAM 2 TEST BANK WITH REAL EXAM
QUESTIONS WITH 100% CORRECT
VERIFIED ANSWERS GRADED A+/ PSYCH
EOR PAEA LATEST EXAM NEW!!
1. A 28-year-old woman reports 6 weeks of depressed mood, anhedonia, fatigue,
poor concentration, and early morning awakening. She denies mania, psychosis, or
suicidal ideation. What is the most appropriate initial treatment?
A) Bupropion 150 mg BID
B) Escitalopram 10 mg daily
C) Venlafaxine 75 mg BID
D) Fluoxetine 20 mg BID
Rationale: SSRIs (escitalopram, sertraline, fluoxetine) are first-line for MDD.
Start low and go slow. Bupropion is second-line or for atypical depression.
Venlafaxine (SNRI) is effective but not first-line due to side effect profile.
Fluoxetine 20 mg BID is too high (usual starting dose is 20 mg daily).
2. A 45-year-old male presents with 5 days of elevated mood, decreased need for
sleep (sleeps 3 hours but feels rested), grandiosity, and increased goal-directed
activity. He has no psychotic features. This episode meets criteria for:
A) Hypomanic episode
B) Manic episode
C) Mixed episode
D) Cyclothymic disorder
Rationale: DSM-5 criteria for a manic episode require ≥1 week (or any duration if
hospitalization is required). Hypomania requires ≥4 days. Despite being 5 days, the
severity (grandiosity, decreased sleep, functional impairment) and lack of
hospitalization still favor mania if symptoms are severe. In practice, this duration
with impairing symptoms is often treated as mania.
,3. A patient with bipolar I disorder is currently depressed. Which medication is
most clearly associated with increased risk of switching to mania?
A) Lamotrigine
B) Quetiapine
C) Fluoxetine (monotherapy)
D) Lithium
Rationale: Antidepressant monotherapy (especially SSRIs) in bipolar depression
can precipitate mania/hypomania or rapid cycling. Mood stabilizers (lithium,
lamotrigine) or atypical antipsychotics (quetiapine, lurasidone) are preferred. If an
antidepressant is used, it must be co-administered with a mood stabilizer.
4. A 22-year-old college student reports feeling sad, worthless, and having
difficulty studying for 2 months. She denies suicidal ideation. Her TSH and CBC
are normal. She has never had a manic episode. What is the first-line
pharmacotherapy?
A) Sertraline 25 mg daily
B) Amitriptyline 25 mg at bedtime
C) Phenelzine 15 mg TID
D) Lithium 300 mg BID
Rationale: Sertraline (SSRI) is first-line for MDD. Amitriptyline (tricyclic) has
more side effects (anticholinergic, cardiac) and is second-line. Phenelzine (MAOI)
is third-line due to dietary restrictions and drug interactions. Lithium is for bipolar
disorder.
5. A 35-year-old woman has had persistent depressive symptoms for over 2 years,
but never meeting full MDD criteria. She reports poor appetite, low energy, and
low self-esteem. What is the diagnosis?
A) Major depressive disorder, moderate
B) Persistent depressive disorder (dysthymia)
C) Adjustment disorder with depressed mood
D) Bipolar II disorder
,Rationale: Persistent depressive disorder (PDD) requires depressed mood for most
of the day, more days than not, for ≥2 years (1 year in children/adolescents), with
at least two additional symptoms. MDD episodes are discrete (≥2 weeks).
Adjustment disorder is triggered by a stressor within 3 months.
6. Which of the following is a specifier for major depressive disorder?
A) With atypical features
B) With catatonia
C) With peripartum onset
D) All of the above
Rationale: All are specifiers: atypical (mood reactivity, hypersomnia,
hyperphagia), catatonia, peripartum onset (during pregnancy or within 4 weeks
postpartum), seasonal pattern, melancholic, anxious distress, mixed features, etc.
7. A 52-year-old male with bipolar I disorder is stable on lithium. He develops
polyuria and polydipsia. What is the most likely cause?
A) Lithium-induced diabetes mellitus
B) Lithium-induced nephrogenic diabetes insipidus
C) Syndrome of inappropriate antidiuretic hormone (SIADH)
D) Primary polydipsia
Rationale: Lithium causes nephrogenic diabetes insipidus (renal resistance to
ADH) in up to 20-40% of long-term users. Monitor urine specific gravity, serum
sodium, and lithium levels. Treatment includes amiloride or thiazide diuretics
(with caution).
8. A patient with MDD fails to improve after 6 weeks of sertraline 50 mg daily.
What is the next step?
A) Augment with lithium
B) Switch to venlafaxine 37.5 mg daily
C) Increase sertraline to 100-150 mg daily (max 200 mg)
D) Add aripiprazole 2 mg daily
Rationale: First step for inadequate response to an SSRI is to optimize the dose
(increase to maximum tolerated/therapeutic dose) for another 4-6 weeks.
, Augmentation (atypical antipsychotic, lithium) or switching is considered after
adequate dose and duration failure.
9. A 30-year-old woman with MDD reports that her depression consistently
worsens in the fall and winter and improves in spring. She has increased sleep,
increased appetite, and carbohydrate craving. What is the best initial treatment?
A) Bupropion XL 150 mg daily
B) Light therapy (10,000 lux, 30 minutes each morning)
C) Fluoxetine 40 mg daily
D) Melatonin 5 mg at bedtime
Rationale: This is seasonal affective disorder (MDD with seasonal pattern). First-
line is bright light therapy (10,000 lux for 30 minutes upon awakening). Bupropion
XL is FDA-approved for prevention but not initial acute treatment. Melatonin is
not first-line.
10. A 68-year-old man with a history of coronary artery disease presents with
depressed mood, anhedonia, and insomnia. He is worried about side effects. Which
antidepressant is most cardiotoxic in overdose?
A) Sertraline
B) Amitriptyline
C) Mirtazapine
D) Bupropion
Rationale: Tricyclic antidepressants (TCAs) like amitriptyline are the most
cardiotoxic in overdose (widened QRS, arrhythmias, hypotension). SSRIs,
mirtazapine, and bupropion are safer in overdose. For elderly with cardiac disease,
avoid TCAs.
11. A 25-year-old woman with bipolar I disorder is in the maintenance phase.
Which medication has the strongest evidence for preventing manic and depressive
relapse?
A) Valproate
B) Lithium
