Psychiatry Review questions with complete
solutions
•A |25 |year |old |male |with |history |of |bipolar |disorder |presents |to |the |Emergency |Department |
by |police |for |evaluation |of |assaultive |behaviors. |He |is |agitated, |yelling |at |staff. |The |medical |
professional |enters |the |room |to |interview |the |patient, |and |he |makes |threats |to |harm |the |
professional |and |punches |the |wall. |Which |of |the |following |is |the |next |most |appropriate |
intervention |at |this |time?
•A. |Ask |the |patient |if |he |is |having |suicidal |thoughts |
•B. |Exit |the |room |and |ask |for |security |support |
•C. |Introduce |self |and |role |and |offer |to |shake |the
patient's |hand |- |CORRECT |ANSWER✔✔-•B. |The |key |phrase |here |is |"next |most |appropriate |
action." |Ensuring |safety |of |oneself |is |the |most |important |first |step |in |any |interview. |All |of |
these |things |might |be |appropriate |at |some |point |during |the |interview. |However, |this |patient |is
|agitated |and |threatening, |and |the |medical |professional |should |not |remain |in |the |room |at |this |
time |without |support. |Introducing |oneself |is |appropriate, |but |shaking |the |patient's |hand |
would |be |a |potentially |unsafe |move |while |the |patient |is |so |acutely |agitated.
•A |14 |year-old |male |presents |to |the |pediatrician |with |his |parents |for |evaluation |of |"behavior |
concerns." |During |the |interview, |the |patient |appears |sarcastic |and |irritable, |frequently |rolling |
his |eyes. |He |states |he |is |feeling, |"fine." |Which |of |the |following |best |describes |this |patient's |
mood |and |affect?
•A. |Affect |"fine," |mood |is |congruent |with |affect. |
•B. |Affect |"fine," |mood |is |incongruent |with |affect. |
•C. |Mood |is |"fine," |affect |is |congruent |with |mood. |
•D. |Mood |is |"fine," |affect |is |incongruent |with |mood. |- |CORRECT |ANSWER✔✔-•D. |Mood |is |the |
patient's |self-report |of |their |feelings, |while |affect |is |the |interviewer's |observation |of |the |
patient's |feelings. |This |patient's |mood |is |"fine." |Affect |is |irritable, |which |does |not |match |the |
patient's |self-report |of |mood. |Therefore, |affect |is |mood-incongruent.
,•A |45 |year-old |male |presents |for |evaluation |of |depression. |He |reports |increasing |feelings |of |
sadness |over |the |past |3 |weeks, |is |sleeping |poorly, |and |his |appetite |and |energy |are |decreased. |
He |denies |suicidal |thoughts. |There |have |been |no |recent |stressors |and |the |patient |doesn't |
understand |why |he |feels |this |way. |He |feels |cold |more |often |and |notices |dry |skin |on |his |legs. |
He |has |been |increasingly |constipated. |His |physical |exam |is |consistent |with |his |concerns |on |
review |of |systems |and |shows |no |other |abnormalities. |Which |of |the |following |is |the |most |
appropriate |step?
•A. |Admit |the |patient |for |inpatient |psychiatric |hospitalization |
•B. |Obtain |TSH |
•C. |Refer |for |psychotherapy |
•D. |Start |antidepressant |medication |- |CORRECT |ANSWER✔✔-•B. |This |patient |has |symptoms |
concerning |for |depression, |but |he |also |has |signs |and |symptoms |concerning |for |
hypothyroidism. |Therefore, |TSH |should |be |obtained |at |this |time. |He |does |not |appear |at |
imminent |risk |of |harm |to |himself |so |inpatient |psychiatric |hospitalization |may |not |be |
warranted |at |this |time. |He |should |not |be |referred |for |therapy |or |medication |management |
until |medical |issues |are |ruled |out.
•A |45 |year-old |male |has |been |taking |diazepam |for |10 |years |for |Generalized |Anxiety |Disorder. |
Over |the |years, |he |notices |that |at |times |the |anxiolytic |effect |has |worn |off |and |he |has |needed |
a |dose |increase. |He |has |never |used |more |of |his |medication |than |prescribed. |Which |of |the |
following |terms |best |describes |his |need |for |increasing |medication |doses?
•A. |Abuse |
•B. |Addiction |
•C. |Dependence |
•D. |Tolerance |- |CORRECT |ANSWER✔✔-•D. |This |patient |is |using |a |diazepam, |a |benzodiazepine. |
Over |time |with |repeated |exposure, |he |notices |less |responsiveness |to |the |drug |effects |and |
needs |higher |doses |to |maintain |the |desired |effect. |This |is |known |as |tolerance. |He |is |not |
misusing |his |medications, |as |would |be |seen |in |addiction |or |abuse.
•Which |of |the |following |medications, |used |in |smoking |cessation, |is |most |associated |with |
behavioral |disinhibition |and |danger |to |self |and |others |as |a |possible |side |effect?
,•A. |Alprazolam |
•B. |Bupropion |
•C. |Nicotine |replacement |therapy |
•D. |Varenicline |- |CORRECT |ANSWER✔✔-•D. |Varenicline |should |be |used |with |caution |as |in |
prone |individuals, |it |can |increase |suicidal |or |violent |thoughts. |Alprazolam |is |not |used |
commonly |in |smoking |cessation, |but |can |be |disinhibiting. |Bupropion |is |an |antidepressant |
medication |that |can |have |some |jitteriness |as |a |side |effect |but |isn't |associated |with |suicidal |or |
violent |thoughts. |Nicotine |replacement |therapy |generally |isn't |associated |with |these |side |
effects.
•A |30 |year-old |male |with |a |5-year |history |of |substance |use |stops |using |abruptly. |2 |days |later, |
he |complains |to |the |primary |care |physician |of |feeling |jittery, |sweaty, |and |his |pulse |is |elevated. |
He |has |a |generalized |seizure |in |the |office. |Which |of |the |following |substances |was |this |patient |
most |likely |taking?
•A. |Amphetamine |
•B. |Benzodiazepine |
•C. |Nicotine |
•D. |Opiate |- |CORRECT |ANSWER✔✔-•B. |These |are |signs |and |symptoms |of |alcohol |and |
sedative-hypnotic |withdrawal. |Alcohol |and |benzodiazepines |work |at |the |same |GABA |receptor |
in |the |CNS |and |show |similar |withdrawal |symptoms |as |illustrated |in |the |vignette.
•A |37 |year-old |male |with |a |2-year |history |of |drinking |a |12-pack |of |beer |daily |is |having |
relationship |problems |as |a |result |of |his |drinking. |He |experiences |strong |cravings. |He |admits |
that |he |lies |to |his |wife |about |how |much |he |is |using. |He |has |gone |to |work |intoxicated |several |
times |because |he |is |unable |to |cut |down. |He |is |worried |that |his |wife |will |divorce |him, |but |
cannot |control |his |use. |Which |of |the |following |best |describes |this |behavior?
•A. |Addiction |
•B. |Tolerance |
•C. |Withdrawal |- |CORRECT |ANSWER✔✔-•A. |This |man |is |experiencing |adverse |life |experiences |
as |a |result |of |his |substance |use, |likely |meeting |criteria |for |alcohol |use |disorder. |Psychological |
dependence |consistent |with |addiction |is |described |in |the |vignette. |Tolerance |is |needing |
increasing |amounts |of |a |substance |to |get |the |same |effect, |which |is |not |described |in |the |
, vignette. |Withdrawal |is |characterized |by |a |syndrome |that |arises |after |cessation |of |a |substance.
|These |terms |are |important |to |understand.
•Which |neurotransmitter |is |involved |in |the |final |common |pathway |of |substance |use |and |other
|impulse-control |disorders, |such |as |sexual |and |gambling |addictions?
•A. |Dopamine |
•B. |GABA |
•C. |Norepinephrine |
•D. |Serotonin |- |CORRECT |ANSWER✔✔-•A. |Dopamine |is |in |high |concentrations |in |the |nucleus |
accumbens |and |is |implicated |in |addictive |disorders |and |behaviors. |GABA |is |the |receptor |
affected |by |alcohol, |benzodiazepines, |and |barbiturates.
•Which |of |the |following |treatments |is |the |most |important |to |prevent |Wernicke's |
Encephalopathy |from |chronic |alcohol |use?
•A. |Cobalamin |
•B. |Niacin |
•C. |Retinol |
•D. |Thiamine |- |CORRECT |ANSWER✔✔-•D. |Thiamine |is |deficient |and |leads |to |Wernicke's |
encephalopathy.
**Week |2** |- |CORRECT |ANSWER✔✔-
•A |28 |year-old |female |describes |sadness |and |fatigue |for |3 |months. |During |private |interview, |
she |denies |history |of |or |current |suicidal |thoughts |or |self |injurious |behaviors. |She |has |been |
going |to |work |and |has |managed |to |function |for |the |most |part. |Her |grandfather |has |a |history |
of |depression. |Which |of |the |following |is |the |most |appropriate |initial |recommendation |at |this |
time?
A. |Follow |up |in |2 |months |
B. |Initiate |trial |of |fluvoxamine |
solutions
•A |25 |year |old |male |with |history |of |bipolar |disorder |presents |to |the |Emergency |Department |
by |police |for |evaluation |of |assaultive |behaviors. |He |is |agitated, |yelling |at |staff. |The |medical |
professional |enters |the |room |to |interview |the |patient, |and |he |makes |threats |to |harm |the |
professional |and |punches |the |wall. |Which |of |the |following |is |the |next |most |appropriate |
intervention |at |this |time?
•A. |Ask |the |patient |if |he |is |having |suicidal |thoughts |
•B. |Exit |the |room |and |ask |for |security |support |
•C. |Introduce |self |and |role |and |offer |to |shake |the
patient's |hand |- |CORRECT |ANSWER✔✔-•B. |The |key |phrase |here |is |"next |most |appropriate |
action." |Ensuring |safety |of |oneself |is |the |most |important |first |step |in |any |interview. |All |of |
these |things |might |be |appropriate |at |some |point |during |the |interview. |However, |this |patient |is
|agitated |and |threatening, |and |the |medical |professional |should |not |remain |in |the |room |at |this |
time |without |support. |Introducing |oneself |is |appropriate, |but |shaking |the |patient's |hand |
would |be |a |potentially |unsafe |move |while |the |patient |is |so |acutely |agitated.
•A |14 |year-old |male |presents |to |the |pediatrician |with |his |parents |for |evaluation |of |"behavior |
concerns." |During |the |interview, |the |patient |appears |sarcastic |and |irritable, |frequently |rolling |
his |eyes. |He |states |he |is |feeling, |"fine." |Which |of |the |following |best |describes |this |patient's |
mood |and |affect?
•A. |Affect |"fine," |mood |is |congruent |with |affect. |
•B. |Affect |"fine," |mood |is |incongruent |with |affect. |
•C. |Mood |is |"fine," |affect |is |congruent |with |mood. |
•D. |Mood |is |"fine," |affect |is |incongruent |with |mood. |- |CORRECT |ANSWER✔✔-•D. |Mood |is |the |
patient's |self-report |of |their |feelings, |while |affect |is |the |interviewer's |observation |of |the |
patient's |feelings. |This |patient's |mood |is |"fine." |Affect |is |irritable, |which |does |not |match |the |
patient's |self-report |of |mood. |Therefore, |affect |is |mood-incongruent.
,•A |45 |year-old |male |presents |for |evaluation |of |depression. |He |reports |increasing |feelings |of |
sadness |over |the |past |3 |weeks, |is |sleeping |poorly, |and |his |appetite |and |energy |are |decreased. |
He |denies |suicidal |thoughts. |There |have |been |no |recent |stressors |and |the |patient |doesn't |
understand |why |he |feels |this |way. |He |feels |cold |more |often |and |notices |dry |skin |on |his |legs. |
He |has |been |increasingly |constipated. |His |physical |exam |is |consistent |with |his |concerns |on |
review |of |systems |and |shows |no |other |abnormalities. |Which |of |the |following |is |the |most |
appropriate |step?
•A. |Admit |the |patient |for |inpatient |psychiatric |hospitalization |
•B. |Obtain |TSH |
•C. |Refer |for |psychotherapy |
•D. |Start |antidepressant |medication |- |CORRECT |ANSWER✔✔-•B. |This |patient |has |symptoms |
concerning |for |depression, |but |he |also |has |signs |and |symptoms |concerning |for |
hypothyroidism. |Therefore, |TSH |should |be |obtained |at |this |time. |He |does |not |appear |at |
imminent |risk |of |harm |to |himself |so |inpatient |psychiatric |hospitalization |may |not |be |
warranted |at |this |time. |He |should |not |be |referred |for |therapy |or |medication |management |
until |medical |issues |are |ruled |out.
•A |45 |year-old |male |has |been |taking |diazepam |for |10 |years |for |Generalized |Anxiety |Disorder. |
Over |the |years, |he |notices |that |at |times |the |anxiolytic |effect |has |worn |off |and |he |has |needed |
a |dose |increase. |He |has |never |used |more |of |his |medication |than |prescribed. |Which |of |the |
following |terms |best |describes |his |need |for |increasing |medication |doses?
•A. |Abuse |
•B. |Addiction |
•C. |Dependence |
•D. |Tolerance |- |CORRECT |ANSWER✔✔-•D. |This |patient |is |using |a |diazepam, |a |benzodiazepine. |
Over |time |with |repeated |exposure, |he |notices |less |responsiveness |to |the |drug |effects |and |
needs |higher |doses |to |maintain |the |desired |effect. |This |is |known |as |tolerance. |He |is |not |
misusing |his |medications, |as |would |be |seen |in |addiction |or |abuse.
•Which |of |the |following |medications, |used |in |smoking |cessation, |is |most |associated |with |
behavioral |disinhibition |and |danger |to |self |and |others |as |a |possible |side |effect?
,•A. |Alprazolam |
•B. |Bupropion |
•C. |Nicotine |replacement |therapy |
•D. |Varenicline |- |CORRECT |ANSWER✔✔-•D. |Varenicline |should |be |used |with |caution |as |in |
prone |individuals, |it |can |increase |suicidal |or |violent |thoughts. |Alprazolam |is |not |used |
commonly |in |smoking |cessation, |but |can |be |disinhibiting. |Bupropion |is |an |antidepressant |
medication |that |can |have |some |jitteriness |as |a |side |effect |but |isn't |associated |with |suicidal |or |
violent |thoughts. |Nicotine |replacement |therapy |generally |isn't |associated |with |these |side |
effects.
•A |30 |year-old |male |with |a |5-year |history |of |substance |use |stops |using |abruptly. |2 |days |later, |
he |complains |to |the |primary |care |physician |of |feeling |jittery, |sweaty, |and |his |pulse |is |elevated. |
He |has |a |generalized |seizure |in |the |office. |Which |of |the |following |substances |was |this |patient |
most |likely |taking?
•A. |Amphetamine |
•B. |Benzodiazepine |
•C. |Nicotine |
•D. |Opiate |- |CORRECT |ANSWER✔✔-•B. |These |are |signs |and |symptoms |of |alcohol |and |
sedative-hypnotic |withdrawal. |Alcohol |and |benzodiazepines |work |at |the |same |GABA |receptor |
in |the |CNS |and |show |similar |withdrawal |symptoms |as |illustrated |in |the |vignette.
•A |37 |year-old |male |with |a |2-year |history |of |drinking |a |12-pack |of |beer |daily |is |having |
relationship |problems |as |a |result |of |his |drinking. |He |experiences |strong |cravings. |He |admits |
that |he |lies |to |his |wife |about |how |much |he |is |using. |He |has |gone |to |work |intoxicated |several |
times |because |he |is |unable |to |cut |down. |He |is |worried |that |his |wife |will |divorce |him, |but |
cannot |control |his |use. |Which |of |the |following |best |describes |this |behavior?
•A. |Addiction |
•B. |Tolerance |
•C. |Withdrawal |- |CORRECT |ANSWER✔✔-•A. |This |man |is |experiencing |adverse |life |experiences |
as |a |result |of |his |substance |use, |likely |meeting |criteria |for |alcohol |use |disorder. |Psychological |
dependence |consistent |with |addiction |is |described |in |the |vignette. |Tolerance |is |needing |
increasing |amounts |of |a |substance |to |get |the |same |effect, |which |is |not |described |in |the |
, vignette. |Withdrawal |is |characterized |by |a |syndrome |that |arises |after |cessation |of |a |substance.
|These |terms |are |important |to |understand.
•Which |neurotransmitter |is |involved |in |the |final |common |pathway |of |substance |use |and |other
|impulse-control |disorders, |such |as |sexual |and |gambling |addictions?
•A. |Dopamine |
•B. |GABA |
•C. |Norepinephrine |
•D. |Serotonin |- |CORRECT |ANSWER✔✔-•A. |Dopamine |is |in |high |concentrations |in |the |nucleus |
accumbens |and |is |implicated |in |addictive |disorders |and |behaviors. |GABA |is |the |receptor |
affected |by |alcohol, |benzodiazepines, |and |barbiturates.
•Which |of |the |following |treatments |is |the |most |important |to |prevent |Wernicke's |
Encephalopathy |from |chronic |alcohol |use?
•A. |Cobalamin |
•B. |Niacin |
•C. |Retinol |
•D. |Thiamine |- |CORRECT |ANSWER✔✔-•D. |Thiamine |is |deficient |and |leads |to |Wernicke's |
encephalopathy.
**Week |2** |- |CORRECT |ANSWER✔✔-
•A |28 |year-old |female |describes |sadness |and |fatigue |for |3 |months. |During |private |interview, |
she |denies |history |of |or |current |suicidal |thoughts |or |self |injurious |behaviors. |She |has |been |
going |to |work |and |has |managed |to |function |for |the |most |part. |Her |grandfather |has |a |history |
of |depression. |Which |of |the |following |is |the |most |appropriate |initial |recommendation |at |this |
time?
A. |Follow |up |in |2 |months |
B. |Initiate |trial |of |fluvoxamine |
