Family Medicine EOR Psychiatry Exam
(2026/2027) | QUESTIONS AND VERIFIED
ANSWERS
Physician Assistant (PA) Family Medicine End of Rotation (EOR) Psychiatry Examination |
Core Domains: Mood Disorders (Depression, Bipolar), Anxiety Disorders (GAD, Panic, PTSD,
OCD), Psychotic Disorders (Schizophrenia, Schizoaffective), Substance Use Disorders &
Withdrawal, Somatic Symptom & Related Disorders, Eating Disorders, Child & Adolescent
Behavioral Health (ADHD, Autism Spectrum), Suicide Risk Assessment & Crisis Intervention,
and Psychopharmacology in Primary Care | Physician Assistant Education Focus |
Specialty-Specific EOR Exam Format
Exam Structure
The Family Medicine EOR Psychiatry exam for the 2026/2027 academic cycle is an 80-question,
multiple-choice question (MCQ) examination.
Introduction
This Family Medicine EOR Psychiatry exam guide for the 2026/2027 cycle prepares Physician
Assistant students for the psychiatry-focused End of Rotation examination. The content assesses
the diagnosis, management, and appropriate referral of common mental health conditions
within the scope of family medicine, emphasizing the biopsychosocial model, safe prescribing,
therapeutic communication, and the integration of behavioral health into primary care.
Answer Format
All correct answers and clinical management strategies must be presented in bold and green,
followed by detailed rationales that apply DSM-6 diagnostic criteria, justify initial
pharmacotherapy (SSRIs, mood stabilizers), outline non-pharmacologic interventions (CBT,
MI), describe safety monitoring for medications, and specify criteria for urgent psychiatric
referral or hospitalization.
Question 1: A 34-year-old woman presents with persistent low mood, anhedonia, fatigue, poor
concentration, insomnia, and feelings of worthlessness for the past 3 months. She denies
suicidal ideation. Physical exam and labs are normal. Which of the following is the most
appropriate first-line pharmacologic treatment?
(A) Amitriptyline
(B) Bupropion
(C) Sertraline
,(D) Lithium
(E) Lorazepam
Correct Answer: (C) Sertraline
Rationale: This patient meets DSM-6 criteria for major depressive disorder (MDD). First-line
pharmacotherapy in primary care includes SSRIs (e.g., sertraline, escitalopram) due to favorable
side effect profile, safety in overdose, and efficacy. Sertraline is often preferred for its broad
spectrum (also effective in anxiety disorders). Amitriptyline (TCA) is second-line due to
anticholinergic effects and cardiac toxicity. Bupropion may be used if sexual side effects are a
concern but is less effective for anxiety. Lithium is for bipolar disorder. Benzodiazepines like
lorazepam are not antidepressants and carry dependence risk.
Question 2: A 28-year-old man presents with recurrent episodes of intense fear, palpitations,
chest pain, and shortness of breath lasting 10–15 minutes, occurring unexpectedly. He now
avoids leaving his home due to fear of having another episode. Which of the following is the
most likely diagnosis?
(A) Generalized anxiety disorder
(B) Panic disorder with agoraphobia
(C) Social anxiety disorder
(D) Post-traumatic stress disorder
(E) Obsessive-compulsive disorder
Correct Answer: (B) Panic disorder with agoraphobia
Rationale: Panic disorder is characterized by recurrent unexpected panic attacks followed by
≥1 month of persistent worry about future attacks or maladaptive behavior change (e.g.,
avoidance). Agoraphobia develops when patients avoid situations (e.g., crowds, public
transport) where escape might be difficult during an attack. GAD involves chronic excessive
worry about multiple domains. PTSD requires trauma exposure. OCD features obsessions and
,compulsions. First-line treatment includes SSRIs and cognitive-behavioral therapy (CBT) with
exposure.
Question 3: A 45-year-old man is brought in by his wife due to 2 weeks of elevated mood,
decreased need for sleep, pressured speech, grandiosity, and reckless spending. He has no prior
psychiatric history. Which of the following is the most appropriate next step?
(A) Start sertraline
(B) Start lithium
(C) Order TSH and basic metabolic panel
(D) Refer urgently to psychiatry
(E) Prescribe lorazepam as needed
Correct Answer: (D) Refer urgently to psychiatry
Rationale: This patient exhibits signs of acute mania (DSM-6 criteria: ≥1 week of abnormally
elevated/expansive mood with ≥3 symptoms such as decreased sleep, grandiosity, distractibility,
etc.). Mania is a medical emergency due to risk of harm, financial ruin, or psychosis. While labs
(TSH, BMP, drug screen) should be obtained to rule out medical causes (e.g., hyperthyroidism),
the priority is urgent psychiatric evaluation for possible hospitalization and initiation of mood
stabilizers (e.g., lithium, valproate) or atypical antipsychotics. Starting antidepressants
(sertraline) can worsen mania.
Question 4: A 22-year-old college student presents with intrusive thoughts about
contamination and spends 2–3 hours daily washing her hands, causing skin breakdown. She
recognizes the thoughts are excessive but cannot stop. Which of the following is the most
effective first-line treatment?
(A) Fluoxetine
(B) Exposure and response prevention (ERP) therapy
, (C) Clomipramine
(D) Risperidone
(E) Supportive counseling
Correct Answer: (B) Exposure and response prevention (ERP) therapy
Rationale: This describes obsessive-compulsive disorder (OCD). ERP, a form of CBT, is the
gold standard psychotherapy and first-line treatment for mild to moderate OCD. SSRIs (e.g.,
fluoxetine, sertraline) are also first-line and often combined with ERP for moderate-severe
cases. Clomipramine (a TCA) is effective but reserved due to side effects. Antipsychotics like
risperidone are adjuncts for treatment-resistant OCD. Supportive counseling alone is
insufficient.
Question 5: A 50-year-old man with alcohol use disorder presents with tremors, anxiety,
nausea, and diaphoresis 24 hours after his last drink. He is alert and oriented. CIWA-Ar score is
12. Which of the following is the most appropriate management?
(A) Discharge with outpatient follow-up
(B) Administer chlordiazepoxide and monitor
(C) Give haloperidol for agitation
(D) Start naltrexone
(E) Administer IV thiamine and glucose only
Correct Answer: (B) Administer chlordiazepoxide and monitor
Rationale: This patient is experiencing alcohol withdrawal. CIWA-Ar (Clinical Institute
Withdrawal Assessment for Alcohol) score ≥10 indicates need for pharmacologic treatment.
Benzodiazepines (e.g., chlordiazepoxide, lorazepam) are first-line to prevent progression to
seizures or delirium tremens. Thiamine and glucose should be given before any carbohydrate to
(2026/2027) | QUESTIONS AND VERIFIED
ANSWERS
Physician Assistant (PA) Family Medicine End of Rotation (EOR) Psychiatry Examination |
Core Domains: Mood Disorders (Depression, Bipolar), Anxiety Disorders (GAD, Panic, PTSD,
OCD), Psychotic Disorders (Schizophrenia, Schizoaffective), Substance Use Disorders &
Withdrawal, Somatic Symptom & Related Disorders, Eating Disorders, Child & Adolescent
Behavioral Health (ADHD, Autism Spectrum), Suicide Risk Assessment & Crisis Intervention,
and Psychopharmacology in Primary Care | Physician Assistant Education Focus |
Specialty-Specific EOR Exam Format
Exam Structure
The Family Medicine EOR Psychiatry exam for the 2026/2027 academic cycle is an 80-question,
multiple-choice question (MCQ) examination.
Introduction
This Family Medicine EOR Psychiatry exam guide for the 2026/2027 cycle prepares Physician
Assistant students for the psychiatry-focused End of Rotation examination. The content assesses
the diagnosis, management, and appropriate referral of common mental health conditions
within the scope of family medicine, emphasizing the biopsychosocial model, safe prescribing,
therapeutic communication, and the integration of behavioral health into primary care.
Answer Format
All correct answers and clinical management strategies must be presented in bold and green,
followed by detailed rationales that apply DSM-6 diagnostic criteria, justify initial
pharmacotherapy (SSRIs, mood stabilizers), outline non-pharmacologic interventions (CBT,
MI), describe safety monitoring for medications, and specify criteria for urgent psychiatric
referral or hospitalization.
Question 1: A 34-year-old woman presents with persistent low mood, anhedonia, fatigue, poor
concentration, insomnia, and feelings of worthlessness for the past 3 months. She denies
suicidal ideation. Physical exam and labs are normal. Which of the following is the most
appropriate first-line pharmacologic treatment?
(A) Amitriptyline
(B) Bupropion
(C) Sertraline
,(D) Lithium
(E) Lorazepam
Correct Answer: (C) Sertraline
Rationale: This patient meets DSM-6 criteria for major depressive disorder (MDD). First-line
pharmacotherapy in primary care includes SSRIs (e.g., sertraline, escitalopram) due to favorable
side effect profile, safety in overdose, and efficacy. Sertraline is often preferred for its broad
spectrum (also effective in anxiety disorders). Amitriptyline (TCA) is second-line due to
anticholinergic effects and cardiac toxicity. Bupropion may be used if sexual side effects are a
concern but is less effective for anxiety. Lithium is for bipolar disorder. Benzodiazepines like
lorazepam are not antidepressants and carry dependence risk.
Question 2: A 28-year-old man presents with recurrent episodes of intense fear, palpitations,
chest pain, and shortness of breath lasting 10–15 minutes, occurring unexpectedly. He now
avoids leaving his home due to fear of having another episode. Which of the following is the
most likely diagnosis?
(A) Generalized anxiety disorder
(B) Panic disorder with agoraphobia
(C) Social anxiety disorder
(D) Post-traumatic stress disorder
(E) Obsessive-compulsive disorder
Correct Answer: (B) Panic disorder with agoraphobia
Rationale: Panic disorder is characterized by recurrent unexpected panic attacks followed by
≥1 month of persistent worry about future attacks or maladaptive behavior change (e.g.,
avoidance). Agoraphobia develops when patients avoid situations (e.g., crowds, public
transport) where escape might be difficult during an attack. GAD involves chronic excessive
worry about multiple domains. PTSD requires trauma exposure. OCD features obsessions and
,compulsions. First-line treatment includes SSRIs and cognitive-behavioral therapy (CBT) with
exposure.
Question 3: A 45-year-old man is brought in by his wife due to 2 weeks of elevated mood,
decreased need for sleep, pressured speech, grandiosity, and reckless spending. He has no prior
psychiatric history. Which of the following is the most appropriate next step?
(A) Start sertraline
(B) Start lithium
(C) Order TSH and basic metabolic panel
(D) Refer urgently to psychiatry
(E) Prescribe lorazepam as needed
Correct Answer: (D) Refer urgently to psychiatry
Rationale: This patient exhibits signs of acute mania (DSM-6 criteria: ≥1 week of abnormally
elevated/expansive mood with ≥3 symptoms such as decreased sleep, grandiosity, distractibility,
etc.). Mania is a medical emergency due to risk of harm, financial ruin, or psychosis. While labs
(TSH, BMP, drug screen) should be obtained to rule out medical causes (e.g., hyperthyroidism),
the priority is urgent psychiatric evaluation for possible hospitalization and initiation of mood
stabilizers (e.g., lithium, valproate) or atypical antipsychotics. Starting antidepressants
(sertraline) can worsen mania.
Question 4: A 22-year-old college student presents with intrusive thoughts about
contamination and spends 2–3 hours daily washing her hands, causing skin breakdown. She
recognizes the thoughts are excessive but cannot stop. Which of the following is the most
effective first-line treatment?
(A) Fluoxetine
(B) Exposure and response prevention (ERP) therapy
, (C) Clomipramine
(D) Risperidone
(E) Supportive counseling
Correct Answer: (B) Exposure and response prevention (ERP) therapy
Rationale: This describes obsessive-compulsive disorder (OCD). ERP, a form of CBT, is the
gold standard psychotherapy and first-line treatment for mild to moderate OCD. SSRIs (e.g.,
fluoxetine, sertraline) are also first-line and often combined with ERP for moderate-severe
cases. Clomipramine (a TCA) is effective but reserved due to side effects. Antipsychotics like
risperidone are adjuncts for treatment-resistant OCD. Supportive counseling alone is
insufficient.
Question 5: A 50-year-old man with alcohol use disorder presents with tremors, anxiety,
nausea, and diaphoresis 24 hours after his last drink. He is alert and oriented. CIWA-Ar score is
12. Which of the following is the most appropriate management?
(A) Discharge with outpatient follow-up
(B) Administer chlordiazepoxide and monitor
(C) Give haloperidol for agitation
(D) Start naltrexone
(E) Administer IV thiamine and glucose only
Correct Answer: (B) Administer chlordiazepoxide and monitor
Rationale: This patient is experiencing alcohol withdrawal. CIWA-Ar (Clinical Institute
Withdrawal Assessment for Alcohol) score ≥10 indicates need for pharmacologic treatment.
Benzodiazepines (e.g., chlordiazepoxide, lorazepam) are first-line to prevent progression to
seizures or delirium tremens. Thiamine and glucose should be given before any carbohydrate to
