`NR668 CEA FINAL PREP BUNDLE
2026: COMPREHENSIVE TOPIC
TEST :QUESTIONS AND ANSWERS
WITH RATIONALES/GRADED
A+/2026 UPDATE/100%
CORRECT/INSTANT DOWNLOAD
SECTION A: Psychopharmacology & Neurobiology
(Questions 1–20)
1. A patient with treatment-resistant depression is started on intranasal
esketamine. Which mechanism of action is primarily responsible for its rapid
antidepressant effects?
A. Serotonin reuptake inhibition
B. Norepinephrine-dopamine reuptake blockade
C. Non-competitive NMDA receptor antagonism
D. Monoamine oxidase inhibition
Rationale: Esketamine is an NMDA receptor antagonist that increases glutamate,
leading to synaptic plasticity and rapid mood improvement within hours, unlike
traditional SSRIs.
2. Which cytochrome P450 enzyme is most responsible for the metabolism of
fluoxetine and its active metabolite norfluoxetine?
A. CYP1A2
B. CYP2D6
C. CYP3A4
D. CYP2C9
Rationale: Fluoxetine and norfluoxetine are potent CYP2D6 inhibitors and substrates,
leading to significant drug interactions (e.g., with risperidone, metoprolol).
,3. A patient on lithium therapy presents with coarse tremor, nausea, and
confusion. Serum lithium level is 2.1 mEq/L. What is the priority action?
A. Increase fluids and add a beta-blocker
B. Administer sodium polystyrene sulfonate
C. Hold lithium and assess for hemodialysis
D. Add clonazepam for tremor
Rationale: Lithium toxicity >2.0 mEq/L with CNS symptoms is severe; hemodialysis
may be needed. Holding lithium and urgent re-evaluation are critical.
4. Clozapine-induced agranulocytosis requires monitoring of which lab value?
A. Platelet count
B. Absolute neutrophil count (ANC)
C. Hemoglobin A1c
D. Liver function tests
Rationale: ANC monitoring is mandatory (weekly initially) due to 0.5–2% risk of
agranulocytosis. ANC <500 requires clozapine discontinuation.
5. Which antidepressant is most likely to cause syndrome of inappropriate
antidiuretic hormone (SIADH) in older adults?
A. Bupropion
B. Sertraline
C. Trazodone
D. Mirtazapine
Rationale: SSRIs, especially sertraline and citalopram, are common causes of SIADH
in elderly, presenting with hyponatremia and confusion.
6. A patient on valproate for bipolar disorder develops alopecia, weight gain,
and tremor. Which lab test is essential every 6 months?
A. Thyroid panel
B. Liver function tests and ammonia
C. Vitamin B12 level
D. BNP
Rationale: Valproate can cause hepatotoxicity and hyperammonemia; LFTs and
ammonia are required, especially with encephalopathy symptoms.
7. Long-term use of benzodiazepines is associated with all EXCEPT:
A. Cognitive decline
B. Falls in elderly
C. Tolerance and dependence
D. Increase in seizure threshold
Rationale: Benzodiazepines lower seizure threshold (risk of breakthrough seizures
on withdrawal), not increase it. They are anticonvulsants but cause tolerance.
, 8. Which antipsychotic has the highest risk of metabolic syndrome?
A. Aripiprazole
B. Lurasidone
C. Ziprasidone
D. Olanzapine
Rationale: Olanzapine and clozapine have highest weight gain, dyslipidemia, and
diabetes risk. Aripiprazole has lowest metabolic burden.
9. The therapeutic serum level for lithium maintenance therapy is generally:
A. 0.1–0.4 mEq/L
B. 0.6–1.2 mEq/L
C. 1.5–2.0 mEq/L
D. 2.5–3.0 mEq/L
Rationale: Acute mania: 0.8–1.2; maintenance: 0.6–0.8; toxicity >1.5.
10. A patient on lamotrigine develops a rash with desquamation and oral
lesions. What is the most appropriate action?
A. Add oral antihistamines and monitor
B. Discontinue lamotrigine immediately
C. Apply topical steroids
D. Increase dose slowly
Rationale: Suspect Stevens-Johnson syndrome/toxic epidermal necrolysis;
immediate discontinuation is life-saving.
11. Which medication is FDA-approved to treat tardive dyskinesia?
A. Trihexyphenidyl
B. Valbenazine
C. Amantadine
D. Clonazepam
Rationale: Valbenazine (INGREZZA) and deutetrabenazine are VMAT2 inhibitors
approved for TD.
12. Stimulants like methylphenidate primarily increase which
neurotransmitters?
A. GABA and serotonin
B. Acetylcholine and histamine
C. Dopamine and norepinephrine
D. Glutamate and glycine
Rationale: Methylphenidate blocks dopamine and norepinephrine reuptake,
improving ADHD symptoms.
13. A patient on MAOI (phenelzine) consumes aged cheese and develops
hypertension, headache, and palpitations. What is the first-line treatment?
A. Beta-blocker
2026: COMPREHENSIVE TOPIC
TEST :QUESTIONS AND ANSWERS
WITH RATIONALES/GRADED
A+/2026 UPDATE/100%
CORRECT/INSTANT DOWNLOAD
SECTION A: Psychopharmacology & Neurobiology
(Questions 1–20)
1. A patient with treatment-resistant depression is started on intranasal
esketamine. Which mechanism of action is primarily responsible for its rapid
antidepressant effects?
A. Serotonin reuptake inhibition
B. Norepinephrine-dopamine reuptake blockade
C. Non-competitive NMDA receptor antagonism
D. Monoamine oxidase inhibition
Rationale: Esketamine is an NMDA receptor antagonist that increases glutamate,
leading to synaptic plasticity and rapid mood improvement within hours, unlike
traditional SSRIs.
2. Which cytochrome P450 enzyme is most responsible for the metabolism of
fluoxetine and its active metabolite norfluoxetine?
A. CYP1A2
B. CYP2D6
C. CYP3A4
D. CYP2C9
Rationale: Fluoxetine and norfluoxetine are potent CYP2D6 inhibitors and substrates,
leading to significant drug interactions (e.g., with risperidone, metoprolol).
,3. A patient on lithium therapy presents with coarse tremor, nausea, and
confusion. Serum lithium level is 2.1 mEq/L. What is the priority action?
A. Increase fluids and add a beta-blocker
B. Administer sodium polystyrene sulfonate
C. Hold lithium and assess for hemodialysis
D. Add clonazepam for tremor
Rationale: Lithium toxicity >2.0 mEq/L with CNS symptoms is severe; hemodialysis
may be needed. Holding lithium and urgent re-evaluation are critical.
4. Clozapine-induced agranulocytosis requires monitoring of which lab value?
A. Platelet count
B. Absolute neutrophil count (ANC)
C. Hemoglobin A1c
D. Liver function tests
Rationale: ANC monitoring is mandatory (weekly initially) due to 0.5–2% risk of
agranulocytosis. ANC <500 requires clozapine discontinuation.
5. Which antidepressant is most likely to cause syndrome of inappropriate
antidiuretic hormone (SIADH) in older adults?
A. Bupropion
B. Sertraline
C. Trazodone
D. Mirtazapine
Rationale: SSRIs, especially sertraline and citalopram, are common causes of SIADH
in elderly, presenting with hyponatremia and confusion.
6. A patient on valproate for bipolar disorder develops alopecia, weight gain,
and tremor. Which lab test is essential every 6 months?
A. Thyroid panel
B. Liver function tests and ammonia
C. Vitamin B12 level
D. BNP
Rationale: Valproate can cause hepatotoxicity and hyperammonemia; LFTs and
ammonia are required, especially with encephalopathy symptoms.
7. Long-term use of benzodiazepines is associated with all EXCEPT:
A. Cognitive decline
B. Falls in elderly
C. Tolerance and dependence
D. Increase in seizure threshold
Rationale: Benzodiazepines lower seizure threshold (risk of breakthrough seizures
on withdrawal), not increase it. They are anticonvulsants but cause tolerance.
, 8. Which antipsychotic has the highest risk of metabolic syndrome?
A. Aripiprazole
B. Lurasidone
C. Ziprasidone
D. Olanzapine
Rationale: Olanzapine and clozapine have highest weight gain, dyslipidemia, and
diabetes risk. Aripiprazole has lowest metabolic burden.
9. The therapeutic serum level for lithium maintenance therapy is generally:
A. 0.1–0.4 mEq/L
B. 0.6–1.2 mEq/L
C. 1.5–2.0 mEq/L
D. 2.5–3.0 mEq/L
Rationale: Acute mania: 0.8–1.2; maintenance: 0.6–0.8; toxicity >1.5.
10. A patient on lamotrigine develops a rash with desquamation and oral
lesions. What is the most appropriate action?
A. Add oral antihistamines and monitor
B. Discontinue lamotrigine immediately
C. Apply topical steroids
D. Increase dose slowly
Rationale: Suspect Stevens-Johnson syndrome/toxic epidermal necrolysis;
immediate discontinuation is life-saving.
11. Which medication is FDA-approved to treat tardive dyskinesia?
A. Trihexyphenidyl
B. Valbenazine
C. Amantadine
D. Clonazepam
Rationale: Valbenazine (INGREZZA) and deutetrabenazine are VMAT2 inhibitors
approved for TD.
12. Stimulants like methylphenidate primarily increase which
neurotransmitters?
A. GABA and serotonin
B. Acetylcholine and histamine
C. Dopamine and norepinephrine
D. Glutamate and glycine
Rationale: Methylphenidate blocks dopamine and norepinephrine reuptake,
improving ADHD symptoms.
13. A patient on MAOI (phenelzine) consumes aged cheese and develops
hypertension, headache, and palpitations. What is the first-line treatment?
A. Beta-blocker
