NR 605 FINAL EXAM PREP: DIAGNOSIS
AND MANAGEMENT IN PSYCHIATRY
QUESTIONS AND CORRECT ANSWERS
A+ GRADE
1. Which neurotransmitter system is primarily targeted by second-generation antipsychotics
to reduce extrapyramidal symptoms compared to first-generation antipsychotics?
A. D2 receptor antagonism only
B. Selective norepinephrine reuptake inhibition
C. GABA-A receptor modulation
D. D2 receptor antagonism and 5-HT2A receptor antagonism
Answer: D
Conceptual Explanation: Second-generation antipsychotics (SGAs) are characterized by
their dual antagonism of dopamine D2 and serotonin 5-HT2A receptors, which helps
mitigate extrapyramidal side effects.
2. A patient on Lithium therapy presents with coarse tremors, ataxia, and confusion. What is
the most likely serum Lithium level range for this presentation?
A. 0.6 - 1.2 mEq/L
B. 2.0 - 2.5 mEq/L
,C. 1.5 - 2.0 mEq/L
D. Below 0.5 mEq/L
Answer: C
Conceptual Explanation: Serum lithium levels between 1.5 and 2.0 mEq/L often present
with gastrointestinal distress, coarse tremors, and CNS symptoms like ataxia and confusion.
3. What is the primary diagnostic differentiator between Bipolar I Disorder and Bipolar II
Disorder?
A. The duration of hypomanic symptoms for at least two weeks
B. The presence of a major depressive episode
C. The presence of at least one full manic episode
D. The absence of any psychotic features
Answer: C
Conceptual Explanation: Bipolar I requires at least one full manic episode, whereas
Bipolar II requires a hypomanic episode and a major depressive episode, but never a full
manic episode.
4. A patient treated with an SSRI and an MAOI presents with hyperreflexia, clonus, and
autonomic instability. Which condition should be suspected?
A. Neuroleptic Malignant Syndrome
B. Anticholinergic Toxicity
, C. Serotonin Syndrome
D. Tardive Dyskinesia
Answer: C
Conceptual Explanation: Serotonin Syndrome is characterized by the triad of mental
status changes, autonomic hyperactivity, and neuromuscular abnormalities like
hyperreflexia and clonus, often caused by combining serotonergic agents.
5. Before initiating Clozapine, what is the mandatory baseline absolute neutrophil count
(ANC) required?
A. At least 1000/mm3
B. At least 1500/mm3
C. At least 2000/mm3
D. At least 500/mm3
Answer: B
Conceptual Explanation: To reduce the risk of agranulocytosis, a baseline ANC of at least
1500/mm3 (or 1000/mm3 for those with benign ethnic neutropenia) is required to start
Clozapine.
6. Which of the following is a core symptom requirement for a diagnosis of Major Depressive
Disorder (MDD) according to DSM-5?
A. Excessive guilt or worthlessness
AND MANAGEMENT IN PSYCHIATRY
QUESTIONS AND CORRECT ANSWERS
A+ GRADE
1. Which neurotransmitter system is primarily targeted by second-generation antipsychotics
to reduce extrapyramidal symptoms compared to first-generation antipsychotics?
A. D2 receptor antagonism only
B. Selective norepinephrine reuptake inhibition
C. GABA-A receptor modulation
D. D2 receptor antagonism and 5-HT2A receptor antagonism
Answer: D
Conceptual Explanation: Second-generation antipsychotics (SGAs) are characterized by
their dual antagonism of dopamine D2 and serotonin 5-HT2A receptors, which helps
mitigate extrapyramidal side effects.
2. A patient on Lithium therapy presents with coarse tremors, ataxia, and confusion. What is
the most likely serum Lithium level range for this presentation?
A. 0.6 - 1.2 mEq/L
B. 2.0 - 2.5 mEq/L
,C. 1.5 - 2.0 mEq/L
D. Below 0.5 mEq/L
Answer: C
Conceptual Explanation: Serum lithium levels between 1.5 and 2.0 mEq/L often present
with gastrointestinal distress, coarse tremors, and CNS symptoms like ataxia and confusion.
3. What is the primary diagnostic differentiator between Bipolar I Disorder and Bipolar II
Disorder?
A. The duration of hypomanic symptoms for at least two weeks
B. The presence of a major depressive episode
C. The presence of at least one full manic episode
D. The absence of any psychotic features
Answer: C
Conceptual Explanation: Bipolar I requires at least one full manic episode, whereas
Bipolar II requires a hypomanic episode and a major depressive episode, but never a full
manic episode.
4. A patient treated with an SSRI and an MAOI presents with hyperreflexia, clonus, and
autonomic instability. Which condition should be suspected?
A. Neuroleptic Malignant Syndrome
B. Anticholinergic Toxicity
, C. Serotonin Syndrome
D. Tardive Dyskinesia
Answer: C
Conceptual Explanation: Serotonin Syndrome is characterized by the triad of mental
status changes, autonomic hyperactivity, and neuromuscular abnormalities like
hyperreflexia and clonus, often caused by combining serotonergic agents.
5. Before initiating Clozapine, what is the mandatory baseline absolute neutrophil count
(ANC) required?
A. At least 1000/mm3
B. At least 1500/mm3
C. At least 2000/mm3
D. At least 500/mm3
Answer: B
Conceptual Explanation: To reduce the risk of agranulocytosis, a baseline ANC of at least
1500/mm3 (or 1000/mm3 for those with benign ethnic neutropenia) is required to start
Clozapine.
6. Which of the following is a core symptom requirement for a diagnosis of Major Depressive
Disorder (MDD) according to DSM-5?
A. Excessive guilt or worthlessness
