NR 605 EXAM PREP: DIAGNOSIS AND
MANAGEMENT IN PSYCHIATRIC CARE
QUESTIONS AND ANSWERS
1. Which dopamine pathway is primarily responsible for the development of extrapyramidal
symptoms (EPS) when blocked by first-generation antipsychotics?
A. Nigrostriatal pathway
B. Mesocortical pathway
C. Mesolimbic pathway
D. Tuberoinfundibular pathway
Answer: A
Conceptual Explanation: The nigrostriatal pathway controls motor function. Blockade of
D2 receptors in this pathway leads to EPS and tardive dyskinesia.
2. A patient taking Clozapine must have their Absolute Neutrophil Count (ANC) monitored. At
what ANC level should the medication be permanently discontinued?
A. Below 1500/mm³
B. Below 1000/mm³
,C. Below 2000/mm³
D. Below 500/mm³
Answer: D
Conceptual Explanation: An ANC below 500/mm³ indicates severe
neutropenia/agranulocytosis, requiring immediate and permanent cessation of Clozapine.
3. In the treatment of Bipolar I Disorder, which medication is most associated with a risk of
Stevens-Johnson Syndrome (SJS)?
A. Lithium
B. Valproate
C. Lamotrigine
D. Quetiapine
Answer: C
Conceptual Explanation: Lamotrigine carries a black box warning for serious rashes,
including SJS, especially if titrated too quickly.
4. A 24-year-old female presents with hyperthermia, muscle rigidity, and autonomic
instability after starting Haloperidol. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Acute Dystonia
C. Anticholinergic Toxicity
, D. Neuroleptic Malignant Syndrome (NMS)
Answer: D
Conceptual Explanation: NMS is characterized by ‘lead-pipe’ rigidity, high fever, and
autonomic dysfunction following the use of antipsychotics.
5. What is the primary mechanism of action of the antidepressant Bupropion?
A. Selective Serotonin Reuptake Inhibition
B. Norepinephrine and Dopamine Reuptake Inhibition
C. Monoamine Oxidase Inhibition
D. Serotonin and Norepinephrine Reuptake Inhibition
Answer: B
Conceptual Explanation: Bupropion acts as a Norepinephrine-Dopamine Reuptake
Inhibitor (NDRI) and does not affect serotonin.
6. Which brain region is primarily associated with the ‘fear response’ and is often overactive
in patients with PTSD?
A. Amygdala
B. Hippocampus
C. Prefrontal Cortex
D. Thalamus
MANAGEMENT IN PSYCHIATRIC CARE
QUESTIONS AND ANSWERS
1. Which dopamine pathway is primarily responsible for the development of extrapyramidal
symptoms (EPS) when blocked by first-generation antipsychotics?
A. Nigrostriatal pathway
B. Mesocortical pathway
C. Mesolimbic pathway
D. Tuberoinfundibular pathway
Answer: A
Conceptual Explanation: The nigrostriatal pathway controls motor function. Blockade of
D2 receptors in this pathway leads to EPS and tardive dyskinesia.
2. A patient taking Clozapine must have their Absolute Neutrophil Count (ANC) monitored. At
what ANC level should the medication be permanently discontinued?
A. Below 1500/mm³
B. Below 1000/mm³
,C. Below 2000/mm³
D. Below 500/mm³
Answer: D
Conceptual Explanation: An ANC below 500/mm³ indicates severe
neutropenia/agranulocytosis, requiring immediate and permanent cessation of Clozapine.
3. In the treatment of Bipolar I Disorder, which medication is most associated with a risk of
Stevens-Johnson Syndrome (SJS)?
A. Lithium
B. Valproate
C. Lamotrigine
D. Quetiapine
Answer: C
Conceptual Explanation: Lamotrigine carries a black box warning for serious rashes,
including SJS, especially if titrated too quickly.
4. A 24-year-old female presents with hyperthermia, muscle rigidity, and autonomic
instability after starting Haloperidol. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Acute Dystonia
C. Anticholinergic Toxicity
, D. Neuroleptic Malignant Syndrome (NMS)
Answer: D
Conceptual Explanation: NMS is characterized by ‘lead-pipe’ rigidity, high fever, and
autonomic dysfunction following the use of antipsychotics.
5. What is the primary mechanism of action of the antidepressant Bupropion?
A. Selective Serotonin Reuptake Inhibition
B. Norepinephrine and Dopamine Reuptake Inhibition
C. Monoamine Oxidase Inhibition
D. Serotonin and Norepinephrine Reuptake Inhibition
Answer: B
Conceptual Explanation: Bupropion acts as a Norepinephrine-Dopamine Reuptake
Inhibitor (NDRI) and does not affect serotonin.
6. Which brain region is primarily associated with the ‘fear response’ and is often overactive
in patients with PTSD?
A. Amygdala
B. Hippocampus
C. Prefrontal Cortex
D. Thalamus
