This is Part 1 of the comat Psychiatry Board
Review Question Bank.
PART 1 of 5
TABLE OF CONTENTS - PART 1 of 5
Chapter 1: Mood Disorders (Questions 1-10)
Chapter 2: Anxiety Disorders (Questions 11-20)
Chapter 3: Psychotic Disorders (Questions 21-30)
Chapter 4: Substance Use Disorders (Questions 31-40)
Chapter 5: Psychiatric Emergencies and Psychopharmacology (Questions 41-50)
CHAPTER 1: MOOD DISORDERS
Q1. A 34-year-old woman presents with two weeks of depressed mood, anhedonia, insomnia, poor
concentration, and feelings of worthlessness. Which diagnosis is most likely?
A. Persistent depressive disorder
B. Major depressive disorder
C. Bipolar II disorder
D. Adjustment disorder with depressed mood
Correct Answer: Major depressive disorder ✅
Rationale: Major depressive disorder requires at least five symptoms of depression present
for two weeks or longer, with depressed mood or anhedonia being one of them. The five symptoms
described here meet that threshold, and the two-week duration fits the diagnostic window.
Persistent depressive disorder requires a chronic course of at least two years rather than two weeks.
Bipolar II disorder would require a history of at least one hypomanic episode, which is absent here.
Adjustment disorder is a reaction to an identifiable stressor and is generally milder and time-limited.
,The key discriminator in this case is the duration and severity of the symptoms, which together point
to major depressive disorder.
Q2. A 28-year-old man with a prior episode of major depression now presents with four days of
elevated mood, decreased need for sleep, racing thoughts, and impulsive spending. Which diagnosis
is most likely?
A. Major depressive disorder with mixed features
B. Bipolar I disorder
C. Bipolar II disorder
D. Cyclothymic disorder
Correct Answer: Bipolar I disorder ✅
Rationale: Bipolar I disorder requires at least one manic episode lasting one week or longer,
or any duration if hospitalization is required. This patient has four days of elevated mood with three
classic manic symptoms, which is consistent with a hypomanic episode by duration, but the presence
of impulsive spending that suggests marked impairment pushes the presentation toward mania. The
diagnosis hinges on whether the episode caused marked impairment or required hospitalization,
both of which qualify as mania even at four days. Cyclothymic disorder involves chronic fluctuating
mood that does not meet full criteria for mania or hypomania. The clinical rule is that any manic
episode, regardless of prior depressive episodes, establishes Bipolar I.
Q3. A 45-year-old woman has had depressed mood for three years, with brief periods of normal
mood lasting no more than a few weeks. Which diagnosis is most likely?
A. Major depressive disorder, recurrent
B. Persistent depressive disorder
C. Bipolar II disorder
D. Cyclothymic disorder
Correct Answer: Persistent depressive disorder ✅
,Rationale: Persistent depressive disorder, previously called dysthymia, requires a depressed
mood for most of the day, more days than not, for at least two years. Brief periods of normal mood
lasting less than two months do not interrupt the diagnosis. Major depressive disorder would require
distinct episodes separated by recovery, which is not the pattern here. Bipolar II disorder requires
hypomanic episodes. Cyclothymic disorder involves mood swings between hypomanic and
depressive symptoms that do not meet full criteria for either. The key point in this case is the
chronicity and the absence of full major depressive episodes.
Q4. A 30-year-old man with bipolar I disorder presents with seven days of elevated mood,
grandiosity, decreased need for sleep, and hospitalization for dangerous behavior. Which phase of
treatment is most appropriate?
A. Acute phase
B. Maintenance phase
C. Continuation phase
D. Prophylactic phase
Correct Answer: Acute phase ✅
Rationale: The acute phase of bipolar treatment focuses on stabilizing the current manic
episode, often with mood stabilizers and antipsychotics, sometimes with hospitalization for safety.
The continuation phase follows the acute phase and aims to consolidate response over the next
several months. The maintenance phase is long-term prophylaxis to prevent relapse. There is no
separate prophylactic phase distinct from maintenance. This patient is actively manic with dangerous
behavior, so the priority is acute stabilization rather than long-term planning, which will follow after
the episode resolves.
Q5. A 25-year-old woman with bipolar I disorder is started on lithium. Which monitoring parameter
is most important to check regularly?
A. Serum lithium level
B. Complete blood count
C. Liver function tests
D. Urinalysis
, Correct Answer: Serum lithium level ✅
Rationale: Lithium has a narrow therapeutic index, with therapeutic levels typically between
0.6 and 1.2 milliequivalents per liter, and toxicity can occur just above that range. Regular serum
lithium levels, along with renal and thyroid function, are essential for safe prescribing. Complete
blood count is not routinely affected by lithium. Liver function tests are not the primary concern with
lithium. Urinalysis alone does not capture lithium levels. The reason lithium monitoring is so critical is
that toxicity can present with tremor, ataxia, confusion, and seizures, and can be precipitated by
dehydration or drug interactions.
Q6. A 40-year-old woman with major depressive disorder is started on sertraline. Which adverse
effect is most important to monitor in the first few weeks?
A. Hyponatremia
B. Hypertension
C. Hyperkalemia
D. Bradycardia
Correct Answer: Hyponatremia ✅
Rationale: Selective serotonin reuptake inhibitors can cause syndrome of inappropriate
antidiuretic hormone, leading to hyponatremia, particularly in older adults and within the first few
weeks of treatment. Hypertension is not a typical adverse effect of SSRIs. Hyperkalemia is not
associated with SSRIs. Bradycardia is not a typical adverse effect. The clinical rule is to check sodium
levels if a patient develops confusion, weakness, or seizures after starting an SSRI, and to consider
this diagnosis in any older adult who deteriorates after a dose change.
Q7. A 50-year-old man with major depressive disorder has not responded to two adequate trials of
SSRIs. Which diagnosis is most appropriate?
A. Treatment-resistant depression
B. Bipolar depression
C. Persistent depressive disorder
D. Adjustment disorder
Review Question Bank.
PART 1 of 5
TABLE OF CONTENTS - PART 1 of 5
Chapter 1: Mood Disorders (Questions 1-10)
Chapter 2: Anxiety Disorders (Questions 11-20)
Chapter 3: Psychotic Disorders (Questions 21-30)
Chapter 4: Substance Use Disorders (Questions 31-40)
Chapter 5: Psychiatric Emergencies and Psychopharmacology (Questions 41-50)
CHAPTER 1: MOOD DISORDERS
Q1. A 34-year-old woman presents with two weeks of depressed mood, anhedonia, insomnia, poor
concentration, and feelings of worthlessness. Which diagnosis is most likely?
A. Persistent depressive disorder
B. Major depressive disorder
C. Bipolar II disorder
D. Adjustment disorder with depressed mood
Correct Answer: Major depressive disorder ✅
Rationale: Major depressive disorder requires at least five symptoms of depression present
for two weeks or longer, with depressed mood or anhedonia being one of them. The five symptoms
described here meet that threshold, and the two-week duration fits the diagnostic window.
Persistent depressive disorder requires a chronic course of at least two years rather than two weeks.
Bipolar II disorder would require a history of at least one hypomanic episode, which is absent here.
Adjustment disorder is a reaction to an identifiable stressor and is generally milder and time-limited.
,The key discriminator in this case is the duration and severity of the symptoms, which together point
to major depressive disorder.
Q2. A 28-year-old man with a prior episode of major depression now presents with four days of
elevated mood, decreased need for sleep, racing thoughts, and impulsive spending. Which diagnosis
is most likely?
A. Major depressive disorder with mixed features
B. Bipolar I disorder
C. Bipolar II disorder
D. Cyclothymic disorder
Correct Answer: Bipolar I disorder ✅
Rationale: Bipolar I disorder requires at least one manic episode lasting one week or longer,
or any duration if hospitalization is required. This patient has four days of elevated mood with three
classic manic symptoms, which is consistent with a hypomanic episode by duration, but the presence
of impulsive spending that suggests marked impairment pushes the presentation toward mania. The
diagnosis hinges on whether the episode caused marked impairment or required hospitalization,
both of which qualify as mania even at four days. Cyclothymic disorder involves chronic fluctuating
mood that does not meet full criteria for mania or hypomania. The clinical rule is that any manic
episode, regardless of prior depressive episodes, establishes Bipolar I.
Q3. A 45-year-old woman has had depressed mood for three years, with brief periods of normal
mood lasting no more than a few weeks. Which diagnosis is most likely?
A. Major depressive disorder, recurrent
B. Persistent depressive disorder
C. Bipolar II disorder
D. Cyclothymic disorder
Correct Answer: Persistent depressive disorder ✅
,Rationale: Persistent depressive disorder, previously called dysthymia, requires a depressed
mood for most of the day, more days than not, for at least two years. Brief periods of normal mood
lasting less than two months do not interrupt the diagnosis. Major depressive disorder would require
distinct episodes separated by recovery, which is not the pattern here. Bipolar II disorder requires
hypomanic episodes. Cyclothymic disorder involves mood swings between hypomanic and
depressive symptoms that do not meet full criteria for either. The key point in this case is the
chronicity and the absence of full major depressive episodes.
Q4. A 30-year-old man with bipolar I disorder presents with seven days of elevated mood,
grandiosity, decreased need for sleep, and hospitalization for dangerous behavior. Which phase of
treatment is most appropriate?
A. Acute phase
B. Maintenance phase
C. Continuation phase
D. Prophylactic phase
Correct Answer: Acute phase ✅
Rationale: The acute phase of bipolar treatment focuses on stabilizing the current manic
episode, often with mood stabilizers and antipsychotics, sometimes with hospitalization for safety.
The continuation phase follows the acute phase and aims to consolidate response over the next
several months. The maintenance phase is long-term prophylaxis to prevent relapse. There is no
separate prophylactic phase distinct from maintenance. This patient is actively manic with dangerous
behavior, so the priority is acute stabilization rather than long-term planning, which will follow after
the episode resolves.
Q5. A 25-year-old woman with bipolar I disorder is started on lithium. Which monitoring parameter
is most important to check regularly?
A. Serum lithium level
B. Complete blood count
C. Liver function tests
D. Urinalysis
, Correct Answer: Serum lithium level ✅
Rationale: Lithium has a narrow therapeutic index, with therapeutic levels typically between
0.6 and 1.2 milliequivalents per liter, and toxicity can occur just above that range. Regular serum
lithium levels, along with renal and thyroid function, are essential for safe prescribing. Complete
blood count is not routinely affected by lithium. Liver function tests are not the primary concern with
lithium. Urinalysis alone does not capture lithium levels. The reason lithium monitoring is so critical is
that toxicity can present with tremor, ataxia, confusion, and seizures, and can be precipitated by
dehydration or drug interactions.
Q6. A 40-year-old woman with major depressive disorder is started on sertraline. Which adverse
effect is most important to monitor in the first few weeks?
A. Hyponatremia
B. Hypertension
C. Hyperkalemia
D. Bradycardia
Correct Answer: Hyponatremia ✅
Rationale: Selective serotonin reuptake inhibitors can cause syndrome of inappropriate
antidiuretic hormone, leading to hyponatremia, particularly in older adults and within the first few
weeks of treatment. Hypertension is not a typical adverse effect of SSRIs. Hyperkalemia is not
associated with SSRIs. Bradycardia is not a typical adverse effect. The clinical rule is to check sodium
levels if a patient develops confusion, weakness, or seizures after starting an SSRI, and to consider
this diagnosis in any older adult who deteriorates after a dose change.
Q7. A 50-year-old man with major depressive disorder has not responded to two adequate trials of
SSRIs. Which diagnosis is most appropriate?
A. Treatment-resistant depression
B. Bipolar depression
C. Persistent depressive disorder
D. Adjustment disorder
