,1. A pa ent with treatment-resistant schizophrenia has failed op mized trials of Risperidone
and Olanzapine. Which medica on is the gold standard next step?
A. Haloperidol
B. Clozapine
C. Ziprasidone
D. Aripiprazole
Answer: B. Clozapine
Ra onale: Clozapine is the gold standard and only FDA-approved medica on for treatment-
resistant schizophrenia a er failure of two alterna ve an psycho cs .
2. A pa ent experiences a sudden onset of hyperreflexia, neuromuscular clonus, severe
diaphoresis, and diarrhea a er adding Tramadol to their stable regimen of Sertraline. What is
the likely diagnosis?
A. Neurolep c Malignant Syndrome
B. Serotonin Syndrome
C. Acute Pancrea s
D. Hypertensive Crisis
Answer: B. Serotonin Syndrome
Ra onale: The combina on of mul ple pro-serotonergic medica ons can trigger Serotonin
Syndrome, characterized by hyperreflexia, clonus, autonomic instability, and gastrointes nal
distress .
3. Which of the following an psycho cs carries the GREATEST metabolic risk?
A. Aripiprazole
B. Ziprasidone
C. Clozapine
D. Risperidone
,Answer: C. Clozapine
Ra onale: Clozapine and Olanzapine carry the greatest risk for weight gain, dyslipidemia, and
insulin resistance. Aripiprazole and Ziprasidone have lower metabolic risk profiles .
4. A pa ent taking an an psycho c develops prolonged involuntary contrac on of facial and
neck muscles within hours of medica on administra on. This presenta on is most consistent
with:
A. Tardive Dyskinesia
B. Akathisia
C. Acute Dystonia
D. Neurolep c Malignant Syndrome
Answer: C. Acute Dystonia
Ra onale: Acute dystonia presents as prolonged involuntary muscle contrac ons, more likely in
the first few hours a er an psycho c administra on. Risk factors include younger age, male sex,
and high-potency first-genera on an psycho cs. Treatment includes IM an cholinergics such as
Benadryl or Benztropine .
5. A pa ent with ADHD and a history of severe s mulant use disorder requests medica on
management. Which non-s mulant op on is most appropriate?
A. Methylphenidate
B. Atomoxe ne
C. Dextroamphetamine
D. Lisdexamfetamine
Answer: B. Atomoxe ne
Ra onale: Atomoxe ne is a selec ve norepinephrine reuptake inhibitor that treats ADHD
without abuse poten al, making it preferred for pa ents with substance use histories .
6. Which class of an depressants is contraindicated in pa ents with a history of narrow-angle
glaucoma due to its strong an cholinergic proper es?
A. SSRIs
B. Tricyclic An depressants (TCAs)
, C. SNRIs
D. MAOIs
Answer: B. Tricyclic An depressants (TCAs)
Ra onale: TCAs cause prominent blockade of muscarinic-1 receptors, leading to an cholinergic
side effects that can worsen narrow-angle glaucoma .
7. A pa ent taking Phenelzine requires surgery. How many days must the MAOI be
discon nued before the procedure to ensure safety with anesthe c agents?
A. 1 day
B. 14 days
C. 3 days
D. 5 days
Answer: B. 14 days
Ra onale: MAOIs require a strict 14-day washout period before surgery to minimize the risk of
severe drug interac ons with anesthe c agents and sympathomime cs .
8. Which diagnos c screening tool is preferred for monitoring involuntary movements in
pa ents receiving long-term treatment with first-genera on an psycho cs?
A. PHQ-9
B. Abnormal Involuntary Movement Scale (AIMS)
C. GAD-7
D. MoCA
Answer: B. Abnormal Involuntary Movement Scale (AIMS)
Ra onale: The AIMS test is the gold-standard screening tool used to detect and track the
development of tardive dyskinesia in pa ents on long-term an psycho cs .
9. A 35-year-old male with bipolar I disorder is stabilized on Valproic Acid. Which laboratory
values require rou ne monitoring?
A. Serum crea nine and TSH
B. Liver func on tests (LFTs) and complete blood count (CBC) for platelets
and Olanzapine. Which medica on is the gold standard next step?
A. Haloperidol
B. Clozapine
C. Ziprasidone
D. Aripiprazole
Answer: B. Clozapine
Ra onale: Clozapine is the gold standard and only FDA-approved medica on for treatment-
resistant schizophrenia a er failure of two alterna ve an psycho cs .
2. A pa ent experiences a sudden onset of hyperreflexia, neuromuscular clonus, severe
diaphoresis, and diarrhea a er adding Tramadol to their stable regimen of Sertraline. What is
the likely diagnosis?
A. Neurolep c Malignant Syndrome
B. Serotonin Syndrome
C. Acute Pancrea s
D. Hypertensive Crisis
Answer: B. Serotonin Syndrome
Ra onale: The combina on of mul ple pro-serotonergic medica ons can trigger Serotonin
Syndrome, characterized by hyperreflexia, clonus, autonomic instability, and gastrointes nal
distress .
3. Which of the following an psycho cs carries the GREATEST metabolic risk?
A. Aripiprazole
B. Ziprasidone
C. Clozapine
D. Risperidone
,Answer: C. Clozapine
Ra onale: Clozapine and Olanzapine carry the greatest risk for weight gain, dyslipidemia, and
insulin resistance. Aripiprazole and Ziprasidone have lower metabolic risk profiles .
4. A pa ent taking an an psycho c develops prolonged involuntary contrac on of facial and
neck muscles within hours of medica on administra on. This presenta on is most consistent
with:
A. Tardive Dyskinesia
B. Akathisia
C. Acute Dystonia
D. Neurolep c Malignant Syndrome
Answer: C. Acute Dystonia
Ra onale: Acute dystonia presents as prolonged involuntary muscle contrac ons, more likely in
the first few hours a er an psycho c administra on. Risk factors include younger age, male sex,
and high-potency first-genera on an psycho cs. Treatment includes IM an cholinergics such as
Benadryl or Benztropine .
5. A pa ent with ADHD and a history of severe s mulant use disorder requests medica on
management. Which non-s mulant op on is most appropriate?
A. Methylphenidate
B. Atomoxe ne
C. Dextroamphetamine
D. Lisdexamfetamine
Answer: B. Atomoxe ne
Ra onale: Atomoxe ne is a selec ve norepinephrine reuptake inhibitor that treats ADHD
without abuse poten al, making it preferred for pa ents with substance use histories .
6. Which class of an depressants is contraindicated in pa ents with a history of narrow-angle
glaucoma due to its strong an cholinergic proper es?
A. SSRIs
B. Tricyclic An depressants (TCAs)
, C. SNRIs
D. MAOIs
Answer: B. Tricyclic An depressants (TCAs)
Ra onale: TCAs cause prominent blockade of muscarinic-1 receptors, leading to an cholinergic
side effects that can worsen narrow-angle glaucoma .
7. A pa ent taking Phenelzine requires surgery. How many days must the MAOI be
discon nued before the procedure to ensure safety with anesthe c agents?
A. 1 day
B. 14 days
C. 3 days
D. 5 days
Answer: B. 14 days
Ra onale: MAOIs require a strict 14-day washout period before surgery to minimize the risk of
severe drug interac ons with anesthe c agents and sympathomime cs .
8. Which diagnos c screening tool is preferred for monitoring involuntary movements in
pa ents receiving long-term treatment with first-genera on an psycho cs?
A. PHQ-9
B. Abnormal Involuntary Movement Scale (AIMS)
C. GAD-7
D. MoCA
Answer: B. Abnormal Involuntary Movement Scale (AIMS)
Ra onale: The AIMS test is the gold-standard screening tool used to detect and track the
development of tardive dyskinesia in pa ents on long-term an psycho cs .
9. A 35-year-old male with bipolar I disorder is stabilized on Valproic Acid. Which laboratory
values require rou ne monitoring?
A. Serum crea nine and TSH
B. Liver func on tests (LFTs) and complete blood count (CBC) for platelets
