, Question 1
An older adult with no prior psychiatric history presents with 8 months of
progressive apathy, executive dysfunction, and visual hallucinations. Which
feature most strongly differentiates dementia with Lewy bodies from
Alzheimer's disease in this differential?
A. Presence of visual hallucinations and spontaneous parkinsonism
B. Stepwise decline in cognition
C. Early prominent memory loss
D. Preserved insight into deficits
Correct Answer: A - Presence of visual hallucinations and
spontaneous parkinsonism
RATIONALE
DLB is characterized by core features including recurrent visual
hallucinations and spontaneous parkinsonism, which help differentiate
it from Alzheimer's disease. Alzheimer's typically presents with early
memory loss and gradual decline, not stepwise deterioration, which is
more vascular. Preserved insight is not a discriminating feature.
Question 2
Which screening instrument is most appropriate for detecting bipolar spectrum
disorder in a patient presenting with recurrent depressive episodes and a family
history of bipolar I disorder?
A. PHQ-9
B. MDQ
C. GAD-7
D. AUDIT-C
Correct Answer: B - MDQ
Page 2
, RATIONALE
The Mood Disorder Questionnaire (MDQ) is a validated screening
tool specifically designed to detect bipolar spectrum disorders,
including hypomanic symptoms. PHQ-9 and GAD-7 screen for
depression and anxiety, respectively, and AUDIT-C screens for
alcohol use. Family history of bipolar disorder increases risk, making
MDQ the most appropriate choice.
Question 3
A patient presents with acute onset of fear of dying, palpitations, and
derealization lasting 20 minutes, resolving spontaneously. Which DSM-5-TR
diagnosis is most appropriate?
A. Generalized anxiety disorder
B. Panic disorder
C. Social anxiety disorder
D. Illness anxiety disorder
Correct Answer: B - Panic disorder
RATIONALE
Panic disorder is characterized by recurrent unexpected panic attacks,
which are abrupt surges of intense fear or discomfort peaking within
minutes, with symptoms such as palpitations, derealization, and fear
of dying. GAD involves persistent worry, not discrete attacks. Social
anxiety is triggered by social situations, and illness anxiety involves
preoccupation with having a serious illness.
Question 4
Which factor most increases the risk of tardive dyskinesia in a patient receiving
long-term antipsychotic therapy?
A. High-potency typical antipsychotic use
B. Concurrent use of benzodiazepines
C. Female sex
Page 3
An older adult with no prior psychiatric history presents with 8 months of
progressive apathy, executive dysfunction, and visual hallucinations. Which
feature most strongly differentiates dementia with Lewy bodies from
Alzheimer's disease in this differential?
A. Presence of visual hallucinations and spontaneous parkinsonism
B. Stepwise decline in cognition
C. Early prominent memory loss
D. Preserved insight into deficits
Correct Answer: A - Presence of visual hallucinations and
spontaneous parkinsonism
RATIONALE
DLB is characterized by core features including recurrent visual
hallucinations and spontaneous parkinsonism, which help differentiate
it from Alzheimer's disease. Alzheimer's typically presents with early
memory loss and gradual decline, not stepwise deterioration, which is
more vascular. Preserved insight is not a discriminating feature.
Question 2
Which screening instrument is most appropriate for detecting bipolar spectrum
disorder in a patient presenting with recurrent depressive episodes and a family
history of bipolar I disorder?
A. PHQ-9
B. MDQ
C. GAD-7
D. AUDIT-C
Correct Answer: B - MDQ
Page 2
, RATIONALE
The Mood Disorder Questionnaire (MDQ) is a validated screening
tool specifically designed to detect bipolar spectrum disorders,
including hypomanic symptoms. PHQ-9 and GAD-7 screen for
depression and anxiety, respectively, and AUDIT-C screens for
alcohol use. Family history of bipolar disorder increases risk, making
MDQ the most appropriate choice.
Question 3
A patient presents with acute onset of fear of dying, palpitations, and
derealization lasting 20 minutes, resolving spontaneously. Which DSM-5-TR
diagnosis is most appropriate?
A. Generalized anxiety disorder
B. Panic disorder
C. Social anxiety disorder
D. Illness anxiety disorder
Correct Answer: B - Panic disorder
RATIONALE
Panic disorder is characterized by recurrent unexpected panic attacks,
which are abrupt surges of intense fear or discomfort peaking within
minutes, with symptoms such as palpitations, derealization, and fear
of dying. GAD involves persistent worry, not discrete attacks. Social
anxiety is triggered by social situations, and illness anxiety involves
preoccupation with having a serious illness.
Question 4
Which factor most increases the risk of tardive dyskinesia in a patient receiving
long-term antipsychotic therapy?
A. High-potency typical antipsychotic use
B. Concurrent use of benzodiazepines
C. Female sex
Page 3
