Psychiatry Shelf Exam Questions And
Correct Answers (Verified Answers)
Plus Rationales 2025/2026 Q&A
1.
A 25-year-old man presents with persistent feelings of sadness,
anhedonia, and fatigue for the past 3 weeks. He reports difficulty
sleeping, decreased appetite, and poor concentration. What is the
most likely diagnosis?
A) Bipolar I Disorder
B) Schizophrenia
C) Major Depressive Disorder
D) Dysthymia
This patient meets criteria for Major Depressive Disorder (≥2 weeks of
depressive symptoms including low mood and anhedonia). Dysthymia
requires ≥2 years of chronic mild depression.
2.
A patient presents with recurrent episodes of intense fear,
palpitations, and shortness of breath lasting about 10 minutes, often
without a trigger. Which is the first-line treatment?
A) SSRIs
B) Benzodiazepines as monotherapy
C) Antipsychotics
D) CBT only
SSRIs are first-line for panic disorder. Benzodiazepines may be
adjuncts but are not recommended as first-line due to dependency
risk.
,3.
Which of the following is characteristic of borderline personality
disorder?
A) Detachment from social relationships
B) Grandiosity
C) Fear of abandonment and unstable relationships
D) Obsessive perfectionism
Borderline personality disorder features include unstable
relationships, fear of abandonment, impulsivity, and emotional
dysregulation.
4.
A 30-year-old woman presents with a history of unpredictable mood
swings, impulsive behavior, and recurrent self-harm. Which therapy
has the most evidence for long-term improvement?
A) Psychoanalysis
B) Dialectical Behavior Therapy (DBT)
C) Cognitive Behavioral Therapy for depression
D) Group therapy only
DBT is evidence-based therapy specifically designed for borderline
personality disorder to reduce self-harm and improve emotional
regulation.
5.
A patient presents with hallucinations, delusions, and disorganized
speech for the past 2 weeks. Which is the most likely diagnosis?
A) Schizoaffective disorder
B) Schizophrenia
,C) Brief psychotic disorder
D) Major depressive disorder with psychotic features
Brief psychotic disorder is diagnosed when psychotic symptoms last
at least 1 day but less than 1 month with full return to baseline.
6.
Which of the following is most associated with neuroleptic malignant
syndrome (NMS)?
A) Clozapine
B) High-potency antipsychotics
C) SSRIs
D) Lithium
NMS is a rare but life-threatening reaction to antipsychotics,
especially high-potency typical antipsychotics, characterized by
rigidity, fever, and autonomic instability.
7.
A 40-year-old man presents with tremor, diarrhea, and weight loss.
He also reports anxiety and irritability. Lab tests show elevated T3
and T4. Which psychiatric condition is commonly comorbid?
A) Bipolar disorder
B) Schizophrenia
C) Anxiety disorder
D) Major depressive disorder
Hyperthyroidism can mimic or exacerbate anxiety symptoms, leading
to irritability, tremor, and hyperarousal.
8.
, Which of the following is the hallmark symptom of post-traumatic
stress disorder (PTSD)?
A) Obsessions and compulsions
B) Re-experiencing the traumatic event
C) Depressive episodes
D) Personality change
PTSD is characterized by intrusive re-experiencing of trauma,
avoidance, negative mood, and hyperarousal.
9.
A 28-year-old man reports excessive worry about multiple domains
for at least 6 months. He has restlessness, fatigue, and difficulty
concentrating. First-line pharmacologic therapy is:
A) Benzodiazepines
B) SSRIs
C) Tricyclic antidepressants
D) Antipsychotics
Generalized Anxiety Disorder (GAD) is treated first-line with SSRIs or
SNRIs. Benzodiazepines may be adjunctive short-term.
10.
A patient presents with a depressed mood that occurs only during
the winter months for the past 3 years. The most likely diagnosis is:
A) Major depressive disorder, recurrent
B) Bipolar disorder
C) Seasonal affective disorder (SAD)
D) Dysthymia
SAD is a subtype of major depression with seasonal pattern, typically
winter-onset with hypersomnia and hyperphagia.
Correct Answers (Verified Answers)
Plus Rationales 2025/2026 Q&A
1.
A 25-year-old man presents with persistent feelings of sadness,
anhedonia, and fatigue for the past 3 weeks. He reports difficulty
sleeping, decreased appetite, and poor concentration. What is the
most likely diagnosis?
A) Bipolar I Disorder
B) Schizophrenia
C) Major Depressive Disorder
D) Dysthymia
This patient meets criteria for Major Depressive Disorder (≥2 weeks of
depressive symptoms including low mood and anhedonia). Dysthymia
requires ≥2 years of chronic mild depression.
2.
A patient presents with recurrent episodes of intense fear,
palpitations, and shortness of breath lasting about 10 minutes, often
without a trigger. Which is the first-line treatment?
A) SSRIs
B) Benzodiazepines as monotherapy
C) Antipsychotics
D) CBT only
SSRIs are first-line for panic disorder. Benzodiazepines may be
adjuncts but are not recommended as first-line due to dependency
risk.
,3.
Which of the following is characteristic of borderline personality
disorder?
A) Detachment from social relationships
B) Grandiosity
C) Fear of abandonment and unstable relationships
D) Obsessive perfectionism
Borderline personality disorder features include unstable
relationships, fear of abandonment, impulsivity, and emotional
dysregulation.
4.
A 30-year-old woman presents with a history of unpredictable mood
swings, impulsive behavior, and recurrent self-harm. Which therapy
has the most evidence for long-term improvement?
A) Psychoanalysis
B) Dialectical Behavior Therapy (DBT)
C) Cognitive Behavioral Therapy for depression
D) Group therapy only
DBT is evidence-based therapy specifically designed for borderline
personality disorder to reduce self-harm and improve emotional
regulation.
5.
A patient presents with hallucinations, delusions, and disorganized
speech for the past 2 weeks. Which is the most likely diagnosis?
A) Schizoaffective disorder
B) Schizophrenia
,C) Brief psychotic disorder
D) Major depressive disorder with psychotic features
Brief psychotic disorder is diagnosed when psychotic symptoms last
at least 1 day but less than 1 month with full return to baseline.
6.
Which of the following is most associated with neuroleptic malignant
syndrome (NMS)?
A) Clozapine
B) High-potency antipsychotics
C) SSRIs
D) Lithium
NMS is a rare but life-threatening reaction to antipsychotics,
especially high-potency typical antipsychotics, characterized by
rigidity, fever, and autonomic instability.
7.
A 40-year-old man presents with tremor, diarrhea, and weight loss.
He also reports anxiety and irritability. Lab tests show elevated T3
and T4. Which psychiatric condition is commonly comorbid?
A) Bipolar disorder
B) Schizophrenia
C) Anxiety disorder
D) Major depressive disorder
Hyperthyroidism can mimic or exacerbate anxiety symptoms, leading
to irritability, tremor, and hyperarousal.
8.
, Which of the following is the hallmark symptom of post-traumatic
stress disorder (PTSD)?
A) Obsessions and compulsions
B) Re-experiencing the traumatic event
C) Depressive episodes
D) Personality change
PTSD is characterized by intrusive re-experiencing of trauma,
avoidance, negative mood, and hyperarousal.
9.
A 28-year-old man reports excessive worry about multiple domains
for at least 6 months. He has restlessness, fatigue, and difficulty
concentrating. First-line pharmacologic therapy is:
A) Benzodiazepines
B) SSRIs
C) Tricyclic antidepressants
D) Antipsychotics
Generalized Anxiety Disorder (GAD) is treated first-line with SSRIs or
SNRIs. Benzodiazepines may be adjunctive short-term.
10.
A patient presents with a depressed mood that occurs only during
the winter months for the past 3 years. The most likely diagnosis is:
A) Major depressive disorder, recurrent
B) Bipolar disorder
C) Seasonal affective disorder (SAD)
D) Dysthymia
SAD is a subtype of major depression with seasonal pattern, typically
winter-onset with hypersomnia and hyperphagia.
