Psychiatry Shelf
PSYCHIATRY SHELF EXAM | EXAM QUESTIONS AND
CORRECT ANSWERS | LATEST VERSION 2026/2027
PSYCHIATRY SHELF
1. A 34-year-old woman presents with 3 weeks of persistently low
mood, loss of interest in her usual hobbies, early-morning awakening,
excessive guilt, poor concentration, and a 4-kg weight loss. She has
never had a similar episode and denies any periods of elevated mood.
Thyroid studies are normal. Which of the following is the most likely
diagnosis?
A. Major depressive disorder, single episode
B. Persistent depressive disorder
C. Bipolar II disorder
D. Adjustment disorder with depressed mood
E. Cyclothymic disorder
A. Major depressive disorder, single episode
She has at least five depressive symptoms, including depressed mood and
anhedonia, lasting more than 2 weeks with no history of mania or
hypomania, which meets criteria for a single major depressive episode.
2. A 28-year-old man reports feeling down most days for the past 2.5
years. He describes low energy, poor appetite, and low self-esteem, but
he has never had enough symptoms at one time to meet criteria for a
major depressive episode. He has not been symptom-free for more than
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, Psychiatry Shelf
a few weeks during this time. Which of the following is the most likely
diagnosis?
A. Major depressive disorder, recurrent
B. Cyclothymic disorder
C. Bipolar II disorder
D. Adjustment disorder with depressed mood
E. Persistent depressive disorder
E. Persistent depressive disorder
Chronic depressed mood on most days for at least 2 years in adults,
without symptom-free intervals longer than 2 months, defines persistent
depressive disorder (dysthymia).
3. A 25-year-old woman is brought in by police after being found
directing traffic on a highway. For the past 8 days she has slept 2 to 3
hours a night without feeling tired, has spent her savings on luxury
items, and speaks so rapidly that she is difficult to interrupt. She states
she has been chosen to lead a global peace movement. Which of the
following is the most likely diagnosis?
A. Brief psychotic disorder
B. Schizoaffective disorder, bipolar type
C. Cyclothymic disorder
D. Bipolar II disorder, current episode hypomanic
E. Bipolar I disorder, current episode manic
E. Bipolar I disorder, current episode manic
A week or more of elevated mood with decreased need for sleep,
pressured speech, reckless spending, and grandiose delusions causing
marked impairment is a manic episode, which is sufficient for bipolar I
disorder.
4. A 31-year-old man with two prior episodes of major depression
describes a 5-day period last month when he felt unusually energetic,
needed only 4 hours of sleep, and completed several work projects
ahead of schedule. Coworkers noticed he was more talkative, but his
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, Psychiatry Shelf
job performance did not suffer and he was never hospitalized. Which of
the following is the most likely diagnosis?
A. Bipolar II disorder
B. Major depressive disorder with mixed features
C. Bipolar I disorder
D. Cyclothymic disorder
E. Persistent depressive disorder
A. Bipolar II disorder
Hypomania lasting at least 4 days without marked impairment or
psychosis, combined with a history of major depressive episodes, defines
bipolar II disorder.
5. A 23-year-old college student describes frequent mood swings over
the past 3 years. She has periods of several days in which she feels
unusually cheerful and productive, alternating with periods of feeling
down and unmotivated. None of these episodes has met full criteria for
hypomania or major depression. Which of the following is the most
likely diagnosis?
A. Cyclothymic disorder
B. Disruptive mood dysregulation disorder
C. Borderline personality disorder
D. Persistent depressive disorder
E. Bipolar II disorder
A. Cyclothymic disorder
Two or more years of numerous subthreshold hypomanic and depressive
periods, never meeting full episode criteria, is characteristic of
cyclothymic disorder.
6. A 40-year-old man with bipolar I disorder has had three manic
episodes and one serious suicide attempt in the past 5 years. He asks
which maintenance medication has the strongest evidence for reducing
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, Psychiatry Shelf
his risk of suicide. Which of the following is the most appropriate
medication?
A. Olanzapine
B. Lithium
C. Valproic acid
D. Carbamazepine
E. Lamotrigine
B. Lithium
Lithium is the mood stabilizer with the most consistent evidence for
reducing suicide attempts and completed suicide in bipolar disorder.
7. A 27-year-old woman with newly diagnosed bipolar I disorder is
about to begin lithium therapy. In addition to a pregnancy test, which
of the following baseline studies is most important to obtain before
starting treatment?
A. Serum creatinine and thyroid-stimulating hormone
B. Complete blood count and HLA-B*1502
C. Serum prolactin and electroencephalogram
D. Fasting lipid panel and hemoglobin A1c
E. Liver function tests and lipase
A. Serum creatinine and thyroid-stimulating hormone
Lithium can cause renal impairment, nephrogenic diabetes insipidus, and
hypothyroidism, so baseline renal and thyroid function are essential.
8. A 52-year-old man maintained on lithium for 10 years presents with
a coarse tremor, slurred speech, unsteady gait, and confusion. Two
weeks ago he began taking an over-the-counter medication daily for
knee pain. Which of the following medications most likely precipitated
his current condition?
A. Glucosamine
B. Ibuprofen
C. Cetirizine
D. Acetaminophen
E. Topical capsaicin
B. Ibuprofen
NSAIDs reduce renal lithium clearance and commonly raise lithium levels
into the toxic range, producing coarse tremor, ataxia, dysarthria, and
confusion.
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PSYCHIATRY SHELF EXAM | EXAM QUESTIONS AND
CORRECT ANSWERS | LATEST VERSION 2026/2027
PSYCHIATRY SHELF
1. A 34-year-old woman presents with 3 weeks of persistently low
mood, loss of interest in her usual hobbies, early-morning awakening,
excessive guilt, poor concentration, and a 4-kg weight loss. She has
never had a similar episode and denies any periods of elevated mood.
Thyroid studies are normal. Which of the following is the most likely
diagnosis?
A. Major depressive disorder, single episode
B. Persistent depressive disorder
C. Bipolar II disorder
D. Adjustment disorder with depressed mood
E. Cyclothymic disorder
A. Major depressive disorder, single episode
She has at least five depressive symptoms, including depressed mood and
anhedonia, lasting more than 2 weeks with no history of mania or
hypomania, which meets criteria for a single major depressive episode.
2. A 28-year-old man reports feeling down most days for the past 2.5
years. He describes low energy, poor appetite, and low self-esteem, but
he has never had enough symptoms at one time to meet criteria for a
major depressive episode. He has not been symptom-free for more than
Page 1 of 82
, Psychiatry Shelf
a few weeks during this time. Which of the following is the most likely
diagnosis?
A. Major depressive disorder, recurrent
B. Cyclothymic disorder
C. Bipolar II disorder
D. Adjustment disorder with depressed mood
E. Persistent depressive disorder
E. Persistent depressive disorder
Chronic depressed mood on most days for at least 2 years in adults,
without symptom-free intervals longer than 2 months, defines persistent
depressive disorder (dysthymia).
3. A 25-year-old woman is brought in by police after being found
directing traffic on a highway. For the past 8 days she has slept 2 to 3
hours a night without feeling tired, has spent her savings on luxury
items, and speaks so rapidly that she is difficult to interrupt. She states
she has been chosen to lead a global peace movement. Which of the
following is the most likely diagnosis?
A. Brief psychotic disorder
B. Schizoaffective disorder, bipolar type
C. Cyclothymic disorder
D. Bipolar II disorder, current episode hypomanic
E. Bipolar I disorder, current episode manic
E. Bipolar I disorder, current episode manic
A week or more of elevated mood with decreased need for sleep,
pressured speech, reckless spending, and grandiose delusions causing
marked impairment is a manic episode, which is sufficient for bipolar I
disorder.
4. A 31-year-old man with two prior episodes of major depression
describes a 5-day period last month when he felt unusually energetic,
needed only 4 hours of sleep, and completed several work projects
ahead of schedule. Coworkers noticed he was more talkative, but his
Page 2 of 82
, Psychiatry Shelf
job performance did not suffer and he was never hospitalized. Which of
the following is the most likely diagnosis?
A. Bipolar II disorder
B. Major depressive disorder with mixed features
C. Bipolar I disorder
D. Cyclothymic disorder
E. Persistent depressive disorder
A. Bipolar II disorder
Hypomania lasting at least 4 days without marked impairment or
psychosis, combined with a history of major depressive episodes, defines
bipolar II disorder.
5. A 23-year-old college student describes frequent mood swings over
the past 3 years. She has periods of several days in which she feels
unusually cheerful and productive, alternating with periods of feeling
down and unmotivated. None of these episodes has met full criteria for
hypomania or major depression. Which of the following is the most
likely diagnosis?
A. Cyclothymic disorder
B. Disruptive mood dysregulation disorder
C. Borderline personality disorder
D. Persistent depressive disorder
E. Bipolar II disorder
A. Cyclothymic disorder
Two or more years of numerous subthreshold hypomanic and depressive
periods, never meeting full episode criteria, is characteristic of
cyclothymic disorder.
6. A 40-year-old man with bipolar I disorder has had three manic
episodes and one serious suicide attempt in the past 5 years. He asks
which maintenance medication has the strongest evidence for reducing
Page 3 of 82
, Psychiatry Shelf
his risk of suicide. Which of the following is the most appropriate
medication?
A. Olanzapine
B. Lithium
C. Valproic acid
D. Carbamazepine
E. Lamotrigine
B. Lithium
Lithium is the mood stabilizer with the most consistent evidence for
reducing suicide attempts and completed suicide in bipolar disorder.
7. A 27-year-old woman with newly diagnosed bipolar I disorder is
about to begin lithium therapy. In addition to a pregnancy test, which
of the following baseline studies is most important to obtain before
starting treatment?
A. Serum creatinine and thyroid-stimulating hormone
B. Complete blood count and HLA-B*1502
C. Serum prolactin and electroencephalogram
D. Fasting lipid panel and hemoglobin A1c
E. Liver function tests and lipase
A. Serum creatinine and thyroid-stimulating hormone
Lithium can cause renal impairment, nephrogenic diabetes insipidus, and
hypothyroidism, so baseline renal and thyroid function are essential.
8. A 52-year-old man maintained on lithium for 10 years presents with
a coarse tremor, slurred speech, unsteady gait, and confusion. Two
weeks ago he began taking an over-the-counter medication daily for
knee pain. Which of the following medications most likely precipitated
his current condition?
A. Glucosamine
B. Ibuprofen
C. Cetirizine
D. Acetaminophen
E. Topical capsaicin
B. Ibuprofen
NSAIDs reduce renal lithium clearance and commonly raise lithium levels
into the toxic range, producing coarse tremor, ataxia, dysarthria, and
confusion.
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