Mood Disorders & Depression
dd dd dd
Question
dd1:
A dd28-year-old ddfemale ddpresents ddwith dddepressed ddmood, ddanhedonia, ddand dda dd15-
pound ddweight ddgain ddover ddthe ddpast dd3 ddmonths. ddShe ddreports ddsleeping dd12 ddhours
dda ddday ddand
feeling dd"heavy ddas ddlead." ddWhich ddmedication ddis ddmost ddlikely ddto ddexacerbate ddher
ddspecific ddsymptom ddcluster?
A) Sertraline
B) Bupropion
C) Fluoxetine
D) Venlafaxine
Answer: ddA) ddSertraline
Rationale: ddThe ddpatient ddis dddescribing dd"atypical dddepression" ddcharacterized ddby
ddhypersomnia, ddhyperphagia, ddand ddleaden ddparalysis. ddSSRIs ddlike ddSertraline, ddwhile
ddeffective, ddcan ddsometimes ddcause ddweight ddgain ddand ddsedation. ddBupropion ddis
ddoften
preferred ddfor ddatypical dddepression dddue ddto ddits ddactivating ddprofile ddand ddweight-
neutral ddeffects.
Question dd2:
A dd65-year-old ddmale ddwith dda ddhistory ddof ddhypertension ddand ddBPH ddpresents ddwith
dddepressive ddsymptoms. ddWhich ddantidepressant ddwould ddbe ddthe ddLEAST
ddappropriate dddue ddto ddits ddanticholinergic ddside ddeffect ddprofile?
A) Paroxetine
B) Citalopram
C) Escitalopram
D) Sertraline
Answer: ddA) ddParoxetine
Rationale: ddParoxetine ddis ddthe ddmost ddanticholinergic ddSSRI ddand ddhas ddstrong
ddCYP2D6 ddinhibition. ddIn ddan ddelderly ddmale ddwith ddBPH, ddanticholinergic ddeffects
ddcan ddworsen ddurinary ddretention, ddconstipation, ddand ddcognitive ddimpairment.
Question dd3:
A ddpatient ddwith ddtreatment-resistant dddepression ddhas ddbeen ddon ddVenlafaxine dd225 ddmg
dddaily
,for dd8 ddweeks ddwith ddpartial ddresponse. ddYou ddconsider ddaugmentation. ddWhich
ddagent ddis ddFDA-approved ddfor ddthis ddindication?
A) Buspirone
B) Aripiprazole
C) Methylphenidate
D) Lamotrigine
Answer: ddB) ddAripiprazole
Rationale: ddAripiprazole, ddquetiapine, ddand ddbrexpiprazole ddare ddFDA-approved
ddfor ddadjunctive ddtreatment ddof ddMajor ddDepressive ddDisorder dd(MDD). ddBuspirone
ddis ddused ddoff-label, ddand ddLamotrigine ddis ddtypically ddused ddfor ddbipolar dddepression.
Question dd4:
A dd32-year-old ddfemale ddwho ddjust dddelivered dda ddhealthy ddbaby dd2 ddweeks ddago ddreports
ddsevere ddmood ddswings, ddintrusive ddthoughts ddof ddharming ddthe ddbaby, ddand ddinsomnia
dddespite ddexhaustion. ddShe ddhas ddno ddprior ddpsychiatric ddhistory. ddWhat ddis ddthe ddmost
ddappropriate ddintervention?
A) Reassurance ddand ddwatchful ddwaiting
B) Initiate ddSertraline dd50 ddmg dddaily ddand ddrefer ddto dda ddpsychiatrist
C) Immediate ddhospitalization
D) Increase ddsleep ddhygiene ddand ddstart ddcognitive ddbehavioral ddtherapy
Answer: ddC) ddImmediate ddhospitalization
Rationale: ddThe ddpresence ddof ddintrusive ddthoughts ddof ddharming ddthe ddinfant ddcoupled
ddwith ddsevere ddmood ddswings ddand ddinsomnia ddin ddthe ddpostpartum ddperiod ddis dda
ddhallmark ddof ddpostpartum ddpsychosis dd(or ddsevere ddmania ddwith ddpsychotic
ddfeatures). ddThis ddis dda
psychiatric ddemergency ddrequiring ddimmediate ddhospitalization ddfor ddmaternal ddand
ddinfant ddsafety.
Question dd5:
A ddpatient ddis ddstarted ddon ddFluoxetine. ddAfter dd3 dddays, ddhe ddcalls ddthe ddclinic ddstating
ddhe ddfeels dd"wired" ddand ddmore ddanxious. ddWhat ddis ddthe ddbest ddresponse?
A) Discontinue ddthe ddmedication ddimmediately.
B) Reassure ddhim ddthat ddthis ddis dda ddcommon ddinitial ddside ddeffect ddand ddoften
ddresolves ddin dd1-2 ddweeks.
C) Increase ddthe dddose ddto ddcombat ddthe ddanxiety.
D) Add dda ddbeta-blocker ddfor ddsymptom ddmanagement.
,Answer: ddB) ddReassure ddhim ddthat ddthis ddis dda ddcommon ddinitial ddside ddeffect ddand
ddoften ddresolves ddin dd1-2 ddweeks.
Rationale: ddInitial ddactivation ddor ddjitteriness ddis dda ddcommon ddside ddeffect ddof
ddSSRIs. ddWhile ddtemporary ddadjunctive ddbenzodiazepines ddor ddbeta-blockers ddcan
ddbe ddused, ddthe ddfirst ddstep ddis ddpsychoeducation ddand ddreassurance ddthat ddthis
ddusually ddsubsides.
Question dd6:
Which ddlab ddvalue ddmust ddbe ddmonitored ddclosely ddin dda ddpatient ddtaking ddlong-term
ddLithium ddfor ddbipolar dddepression?
A) Liver ddfunction ddtests
B) Serum ddcreatinine ddand ddBUN
C) Complete ddblood ddcount
D) Serum ddcalcium
Answer: ddB) ddSerum ddcreatinine ddand ddBUN
Rationale: ddLithium ddis ddexcreted ddrenally ddand ddcan ddcause ddnephrogenic dddiabetes
ddinsipidus ddand ddchronic ddkidney dddisease. ddMonitoring ddrenal ddfunction dd(Creatinine,
ddBUN, ddGFR) ddis ddcritical. ddThyroid ddfunction ddshould ddalso ddbe ddmonitored.
Question dd7:
A ddpatient ddwith ddBipolar ddII dddisorder ddis ddcurrently ddin dda dddepressive ddepisode.
ddWhich ddmedication ddis ddcontraindicated ddas ddmonotherapy dddue ddto ddthe ddrisk ddof
ddinducing ddmania?
A) Lamotrigine
B) Quetiapine
C) Lurasidone
D) Fluoxetine
Answer: ddD) ddFluoxetine
Rationale: ddAntidepressants dd(SSRIs, ddSNRIs) ddare ddgenerally ddavoided ddas
ddmonotherapy ddin ddbipolar dddepression dddue ddto ddthe ddhigh ddrisk ddof ddprecipitating dda
ddmanic ddor ddhypomanic ddswitch. ddThey ddshould ddonly ddbe ddused ddin ddcombination
ddwith dda ddmood ddstabilizer.
Question dd8:
A dd45-year-old ddpatient ddwith ddMDD ddand ddchronic ddpain ddis ddstarted ddon ddDuloxetine.
ddWhat ddis ddthe ddmost ddimportant ddadverse ddeffect ddto ddeducate ddthe ddpatient ddabout?
A) Weight ddgain
B) Sexual dddysfunction
, C) Hypertensive ddcrisis
D) Withdrawal ddsyndrome ddif ddmissed dddoses
Answer: ddD) ddWithdrawal ddsyndrome ddif ddmissed dddoses
Rationale: ddWhile ddall ddSNRIs ddhave ddwithdrawal, ddDuloxetine ddhas dda ddshort ddhalf-
life dd(12 ddhours). ddMissing ddeven ddone dddose ddcan ddcause dd"brain ddzaps," ddnausea, ddand
dddizziness.
Hypertensive ddcrisis ddis dda ddconcern ddwith ddMAOIs.
Question dd9:
A ddpatient ddon ddPhenelzine dd(MAOI) ddpresents ddwith dda ddsevere ddheadache ddand
ddtachycardia. ddWhat ddis ddthe ddmost ddlikely ddprecipitating dddietary ddfactor?
A) Chocolate
B) Aged ddcheese
C) Coffee
D) Bananas
Answer: ddB) ddAged ddcheese
Rationale: ddMAOIs ddinhibit ddthe ddbreakdown ddof ddtyramine. ddAged ddcheeses, ddcured
ddmeats, ddand ddfermented ddfoods ddcontain ddhigh ddtyramine ddlevels, ddleading ddto
ddhypertensive ddcrisis dd(headache, ddtachycardia, ddelevated ddBP).
Question dd10:
A ddpatient ddhas ddbeen ddon ddSertraline ddfor dd6 ddmonths ddand ddreports ddsignificant
ddimprovement ddbut ddcomplains ddof ddanorgasmia. ddWhat ddis dda ddstandard ddstrategy ddto
ddmanage ddthis ddside
effect?
A) Add ddBupropion
B) Add ddBuspirone
C) Switch ddto ddFluoxetine
D) Add ddSildenafil
Answer: ddA) ddAdd ddBupropion
Rationale: ddBupropion ddis ddoften ddadded ddto ddSSRIs ddto ddcounteract ddSSRI-induced
ddsexual dddysfunction dd(especially ddanorgasmia ddand dddecreased ddlibido).
ddAlternatively, ddswitching ddto ddBupropion, ddMirtazapine, ddor ddVilazodone ddare
ddoptions.
Section dd2: ddAnxiety dd& ddTrauma-Related ddDisorders
Question dd11:
A dd19-year-old ddcollege ddstudent ddpresents ddwith ddexcessive ddworry ddabout ddgrades, ddfamily
dd dd dd
Question
dd1:
A dd28-year-old ddfemale ddpresents ddwith dddepressed ddmood, ddanhedonia, ddand dda dd15-
pound ddweight ddgain ddover ddthe ddpast dd3 ddmonths. ddShe ddreports ddsleeping dd12 ddhours
dda ddday ddand
feeling dd"heavy ddas ddlead." ddWhich ddmedication ddis ddmost ddlikely ddto ddexacerbate ddher
ddspecific ddsymptom ddcluster?
A) Sertraline
B) Bupropion
C) Fluoxetine
D) Venlafaxine
Answer: ddA) ddSertraline
Rationale: ddThe ddpatient ddis dddescribing dd"atypical dddepression" ddcharacterized ddby
ddhypersomnia, ddhyperphagia, ddand ddleaden ddparalysis. ddSSRIs ddlike ddSertraline, ddwhile
ddeffective, ddcan ddsometimes ddcause ddweight ddgain ddand ddsedation. ddBupropion ddis
ddoften
preferred ddfor ddatypical dddepression dddue ddto ddits ddactivating ddprofile ddand ddweight-
neutral ddeffects.
Question dd2:
A dd65-year-old ddmale ddwith dda ddhistory ddof ddhypertension ddand ddBPH ddpresents ddwith
dddepressive ddsymptoms. ddWhich ddantidepressant ddwould ddbe ddthe ddLEAST
ddappropriate dddue ddto ddits ddanticholinergic ddside ddeffect ddprofile?
A) Paroxetine
B) Citalopram
C) Escitalopram
D) Sertraline
Answer: ddA) ddParoxetine
Rationale: ddParoxetine ddis ddthe ddmost ddanticholinergic ddSSRI ddand ddhas ddstrong
ddCYP2D6 ddinhibition. ddIn ddan ddelderly ddmale ddwith ddBPH, ddanticholinergic ddeffects
ddcan ddworsen ddurinary ddretention, ddconstipation, ddand ddcognitive ddimpairment.
Question dd3:
A ddpatient ddwith ddtreatment-resistant dddepression ddhas ddbeen ddon ddVenlafaxine dd225 ddmg
dddaily
,for dd8 ddweeks ddwith ddpartial ddresponse. ddYou ddconsider ddaugmentation. ddWhich
ddagent ddis ddFDA-approved ddfor ddthis ddindication?
A) Buspirone
B) Aripiprazole
C) Methylphenidate
D) Lamotrigine
Answer: ddB) ddAripiprazole
Rationale: ddAripiprazole, ddquetiapine, ddand ddbrexpiprazole ddare ddFDA-approved
ddfor ddadjunctive ddtreatment ddof ddMajor ddDepressive ddDisorder dd(MDD). ddBuspirone
ddis ddused ddoff-label, ddand ddLamotrigine ddis ddtypically ddused ddfor ddbipolar dddepression.
Question dd4:
A dd32-year-old ddfemale ddwho ddjust dddelivered dda ddhealthy ddbaby dd2 ddweeks ddago ddreports
ddsevere ddmood ddswings, ddintrusive ddthoughts ddof ddharming ddthe ddbaby, ddand ddinsomnia
dddespite ddexhaustion. ddShe ddhas ddno ddprior ddpsychiatric ddhistory. ddWhat ddis ddthe ddmost
ddappropriate ddintervention?
A) Reassurance ddand ddwatchful ddwaiting
B) Initiate ddSertraline dd50 ddmg dddaily ddand ddrefer ddto dda ddpsychiatrist
C) Immediate ddhospitalization
D) Increase ddsleep ddhygiene ddand ddstart ddcognitive ddbehavioral ddtherapy
Answer: ddC) ddImmediate ddhospitalization
Rationale: ddThe ddpresence ddof ddintrusive ddthoughts ddof ddharming ddthe ddinfant ddcoupled
ddwith ddsevere ddmood ddswings ddand ddinsomnia ddin ddthe ddpostpartum ddperiod ddis dda
ddhallmark ddof ddpostpartum ddpsychosis dd(or ddsevere ddmania ddwith ddpsychotic
ddfeatures). ddThis ddis dda
psychiatric ddemergency ddrequiring ddimmediate ddhospitalization ddfor ddmaternal ddand
ddinfant ddsafety.
Question dd5:
A ddpatient ddis ddstarted ddon ddFluoxetine. ddAfter dd3 dddays, ddhe ddcalls ddthe ddclinic ddstating
ddhe ddfeels dd"wired" ddand ddmore ddanxious. ddWhat ddis ddthe ddbest ddresponse?
A) Discontinue ddthe ddmedication ddimmediately.
B) Reassure ddhim ddthat ddthis ddis dda ddcommon ddinitial ddside ddeffect ddand ddoften
ddresolves ddin dd1-2 ddweeks.
C) Increase ddthe dddose ddto ddcombat ddthe ddanxiety.
D) Add dda ddbeta-blocker ddfor ddsymptom ddmanagement.
,Answer: ddB) ddReassure ddhim ddthat ddthis ddis dda ddcommon ddinitial ddside ddeffect ddand
ddoften ddresolves ddin dd1-2 ddweeks.
Rationale: ddInitial ddactivation ddor ddjitteriness ddis dda ddcommon ddside ddeffect ddof
ddSSRIs. ddWhile ddtemporary ddadjunctive ddbenzodiazepines ddor ddbeta-blockers ddcan
ddbe ddused, ddthe ddfirst ddstep ddis ddpsychoeducation ddand ddreassurance ddthat ddthis
ddusually ddsubsides.
Question dd6:
Which ddlab ddvalue ddmust ddbe ddmonitored ddclosely ddin dda ddpatient ddtaking ddlong-term
ddLithium ddfor ddbipolar dddepression?
A) Liver ddfunction ddtests
B) Serum ddcreatinine ddand ddBUN
C) Complete ddblood ddcount
D) Serum ddcalcium
Answer: ddB) ddSerum ddcreatinine ddand ddBUN
Rationale: ddLithium ddis ddexcreted ddrenally ddand ddcan ddcause ddnephrogenic dddiabetes
ddinsipidus ddand ddchronic ddkidney dddisease. ddMonitoring ddrenal ddfunction dd(Creatinine,
ddBUN, ddGFR) ddis ddcritical. ddThyroid ddfunction ddshould ddalso ddbe ddmonitored.
Question dd7:
A ddpatient ddwith ddBipolar ddII dddisorder ddis ddcurrently ddin dda dddepressive ddepisode.
ddWhich ddmedication ddis ddcontraindicated ddas ddmonotherapy dddue ddto ddthe ddrisk ddof
ddinducing ddmania?
A) Lamotrigine
B) Quetiapine
C) Lurasidone
D) Fluoxetine
Answer: ddD) ddFluoxetine
Rationale: ddAntidepressants dd(SSRIs, ddSNRIs) ddare ddgenerally ddavoided ddas
ddmonotherapy ddin ddbipolar dddepression dddue ddto ddthe ddhigh ddrisk ddof ddprecipitating dda
ddmanic ddor ddhypomanic ddswitch. ddThey ddshould ddonly ddbe ddused ddin ddcombination
ddwith dda ddmood ddstabilizer.
Question dd8:
A dd45-year-old ddpatient ddwith ddMDD ddand ddchronic ddpain ddis ddstarted ddon ddDuloxetine.
ddWhat ddis ddthe ddmost ddimportant ddadverse ddeffect ddto ddeducate ddthe ddpatient ddabout?
A) Weight ddgain
B) Sexual dddysfunction
, C) Hypertensive ddcrisis
D) Withdrawal ddsyndrome ddif ddmissed dddoses
Answer: ddD) ddWithdrawal ddsyndrome ddif ddmissed dddoses
Rationale: ddWhile ddall ddSNRIs ddhave ddwithdrawal, ddDuloxetine ddhas dda ddshort ddhalf-
life dd(12 ddhours). ddMissing ddeven ddone dddose ddcan ddcause dd"brain ddzaps," ddnausea, ddand
dddizziness.
Hypertensive ddcrisis ddis dda ddconcern ddwith ddMAOIs.
Question dd9:
A ddpatient ddon ddPhenelzine dd(MAOI) ddpresents ddwith dda ddsevere ddheadache ddand
ddtachycardia. ddWhat ddis ddthe ddmost ddlikely ddprecipitating dddietary ddfactor?
A) Chocolate
B) Aged ddcheese
C) Coffee
D) Bananas
Answer: ddB) ddAged ddcheese
Rationale: ddMAOIs ddinhibit ddthe ddbreakdown ddof ddtyramine. ddAged ddcheeses, ddcured
ddmeats, ddand ddfermented ddfoods ddcontain ddhigh ddtyramine ddlevels, ddleading ddto
ddhypertensive ddcrisis dd(headache, ddtachycardia, ddelevated ddBP).
Question dd10:
A ddpatient ddhas ddbeen ddon ddSertraline ddfor dd6 ddmonths ddand ddreports ddsignificant
ddimprovement ddbut ddcomplains ddof ddanorgasmia. ddWhat ddis dda ddstandard ddstrategy ddto
ddmanage ddthis ddside
effect?
A) Add ddBupropion
B) Add ddBuspirone
C) Switch ddto ddFluoxetine
D) Add ddSildenafil
Answer: ddA) ddAdd ddBupropion
Rationale: ddBupropion ddis ddoften ddadded ddto ddSSRIs ddto ddcounteract ddSSRI-induced
ddsexual dddysfunction dd(especially ddanorgasmia ddand dddecreased ddlibido).
ddAlternatively, ddswitching ddto ddBupropion, ddMirtazapine, ddor ddVilazodone ddare
ddoptions.
Section dd2: ddAnxiety dd& ddTrauma-Related ddDisorders
Question dd11:
A dd19-year-old ddcollege ddstudent ddpresents ddwith ddexcessive ddworry ddabout ddgrades, ddfamily
