MED730 Psychiatry Clerkship Practice Questions and Answers Updated
2026 | Complete Psychiatry Clinical Rotation Study Guide with Verified
Questions, Detailed Rationales, Mental Status Examination (MSE),
Psychiatric Diagnosis, DSM-5 Disorders, Psychopharmacology, Patient
Interviewing, Risk Assessment, Suicide Evaluation, Treatment Planning &
Clinical Clerkship Exam Prep
Question 1: Which of the following is a first-rank symptom of schizophrenia as
described by Schneider?
A. Auditory hallucinations commenting on the patient’s behavior
B. Visual hallucinations of threatening figures
C. Delusions of reference involving media broadcasts
D. Disorganized speech with frequent derailment
CORRECT ANSWER: A. Auditory hallucinations commenting on the patient’s
behavior
Rationale: First-rank symptoms, as defined by Kurt Schneider, include specific types of
auditory hallucinations such as voices commenting on the patient's actions or two or
more voices arguing. These are considered highly suggestive of schizophrenia, although
not pathognomonic. Visual hallucinations and delusions of reference, while common in
psychotic disorders, are not classified as first-rank symptoms.
Question 2: A 25-year-old man presents with a 3-week history of elevated mood,
decreased need for sleep, pressured speech, and impulsive spending. He has no
prior psychiatric history. Which diagnosis best fits this clinical picture?
A. Major depressive disorder with mixed features
B. Bipolar II disorder
C. Cyclothymic disorder
D. Bipolar I disorder, current episode manic
CORRECT ANSWER: D. Bipolar I disorder, current episode manic
Rationale: Bipolar I disorder is diagnosed when a patient has experienced at least one
manic episode, which is defined as a distinct period of abnormally and persistently
elevated, expansive, or irritable mood lasting at least one week (or less if hospitalization
is required), accompanied by three or more additional symptoms such as decreased
need for sleep, pressured speech, and impulsivity. The duration and symptom profile
here meet criteria for mania, not hypomania, ruling out bipolar II and cyclothymia.
Question 3: Which neurotransmitter system is most implicated in the
pathophysiology of obsessive-compulsive disorder (OCD)?
A. Dopaminergic
B. Noradrenergic
,C. Serotonergic
D. GABAergic
CORRECT ANSWER: C. Serotonergic
Rationale: OCD is strongly associated with dysregulation in the serotonergic system.
Selective serotonin reuptake inhibitors (SSRIs) are first-line pharmacologic treatments,
and their efficacy supports the role of serotonin in modulating obsessions and
compulsions. While other systems may play secondary roles, serotonin is the most
consistently implicated.
Question 4: A patient reports recurrent episodes of intense fear, palpitations, chest
pain, and a sense of impending doom that peak within 10 minutes. There is no
identifiable trigger. What is the most likely diagnosis?
A. Generalized anxiety disorder
B. Panic disorder
C. Social anxiety disorder
D. Post-traumatic stress disorder
CORRECT ANSWER: B. Panic disorder
Rationale: Panic disorder is characterized by recurrent, unexpected panic attacks—
discrete periods of intense fear or discomfort that peak within minutes and include
physical and cognitive symptoms such as palpitations, chest pain, and fear of dying.
The absence of a situational trigger distinguishes it from phobia-related disorders.
Question 5: Which of the following is a negative symptom of schizophrenia?
A. Hallucinations
B. Delusions
C. Avolition
D. Agitation
CORRECT ANSWER: C. Avolition
Rationale: Negative symptoms refer to the diminution or loss of normal functions, such
as avolition (lack of motivation), alogia (poverty of speech), anhedonia, asociality, and
blunted affect. In contrast, hallucinations and delusions are positive symptoms,
representing additions to normal experience.
Question 6: A 70-year-old woman is brought in by her daughter due to increasing
forgetfulness, getting lost in familiar places, and difficulty managing finances. MRI
shows hippocampal atrophy. What is the most likely diagnosis?
A. Vascular dementia
B. Lewy body dementia
C. Alzheimer’s disease
D. Frontotemporal dementia
, CORRECT ANSWER: C. Alzheimer’s disease
Rationale: Alzheimer’s disease typically presents with progressive episodic memory
impairment as an early symptom, along with disorientation and executive dysfunction.
Hippocampal atrophy on neuroimaging is a hallmark finding. Other dementias have
different clinical and imaging profiles (e.g., parkinsonism in Lewy body, behavioral
changes in frontotemporal).
Question 7: Which medication is contraindicated in a patient with bipolar disorder
who is currently experiencing a manic episode?
A. Lithium
B. Valproate
C. Sertraline
D. Quetiapine
CORRECT ANSWER: C. Sertraline
Rationale: Antidepressants like sertraline can precipitate or worsen mania in patients
with bipolar disorder, especially when used without a mood stabilizer. Mood stabilizers
(lithium, valproate) and atypical antipsychotics (quetiapine) are appropriate for acute
mania.
Question 8: A patient believes that the FBI has implanted a tracking device in his
teeth. This belief persists despite clear evidence to the contrary. This is best
described as which type of delusion?
A. Somatic
B. Persecutory
C. Grandiose
D. Referential
CORRECT ANSWER: B. Persecutory
Rationale: Persecutory delusions involve beliefs of being targeted, harassed, or
conspired against by others. The belief that a government agency has implanted a
device for surveillance fits this category. Somatic delusions involve bodily functions,
grandiose involve inflated self-worth, and referential involve unrelated events having
personal significance.
Question 9: Which of the following is a key diagnostic criterion for post-traumatic
stress disorder (PTSD)?
A. Recurrent intrusive memories of the traumatic event
B. Persistent elevated mood for more than one week
C. Compulsions performed to reduce anxiety
D. Disorganized thinking without hallucinations
CORRECT ANSWER: A. Recurrent intrusive memories of the traumatic event
2026 | Complete Psychiatry Clinical Rotation Study Guide with Verified
Questions, Detailed Rationales, Mental Status Examination (MSE),
Psychiatric Diagnosis, DSM-5 Disorders, Psychopharmacology, Patient
Interviewing, Risk Assessment, Suicide Evaluation, Treatment Planning &
Clinical Clerkship Exam Prep
Question 1: Which of the following is a first-rank symptom of schizophrenia as
described by Schneider?
A. Auditory hallucinations commenting on the patient’s behavior
B. Visual hallucinations of threatening figures
C. Delusions of reference involving media broadcasts
D. Disorganized speech with frequent derailment
CORRECT ANSWER: A. Auditory hallucinations commenting on the patient’s
behavior
Rationale: First-rank symptoms, as defined by Kurt Schneider, include specific types of
auditory hallucinations such as voices commenting on the patient's actions or two or
more voices arguing. These are considered highly suggestive of schizophrenia, although
not pathognomonic. Visual hallucinations and delusions of reference, while common in
psychotic disorders, are not classified as first-rank symptoms.
Question 2: A 25-year-old man presents with a 3-week history of elevated mood,
decreased need for sleep, pressured speech, and impulsive spending. He has no
prior psychiatric history. Which diagnosis best fits this clinical picture?
A. Major depressive disorder with mixed features
B. Bipolar II disorder
C. Cyclothymic disorder
D. Bipolar I disorder, current episode manic
CORRECT ANSWER: D. Bipolar I disorder, current episode manic
Rationale: Bipolar I disorder is diagnosed when a patient has experienced at least one
manic episode, which is defined as a distinct period of abnormally and persistently
elevated, expansive, or irritable mood lasting at least one week (or less if hospitalization
is required), accompanied by three or more additional symptoms such as decreased
need for sleep, pressured speech, and impulsivity. The duration and symptom profile
here meet criteria for mania, not hypomania, ruling out bipolar II and cyclothymia.
Question 3: Which neurotransmitter system is most implicated in the
pathophysiology of obsessive-compulsive disorder (OCD)?
A. Dopaminergic
B. Noradrenergic
,C. Serotonergic
D. GABAergic
CORRECT ANSWER: C. Serotonergic
Rationale: OCD is strongly associated with dysregulation in the serotonergic system.
Selective serotonin reuptake inhibitors (SSRIs) are first-line pharmacologic treatments,
and their efficacy supports the role of serotonin in modulating obsessions and
compulsions. While other systems may play secondary roles, serotonin is the most
consistently implicated.
Question 4: A patient reports recurrent episodes of intense fear, palpitations, chest
pain, and a sense of impending doom that peak within 10 minutes. There is no
identifiable trigger. What is the most likely diagnosis?
A. Generalized anxiety disorder
B. Panic disorder
C. Social anxiety disorder
D. Post-traumatic stress disorder
CORRECT ANSWER: B. Panic disorder
Rationale: Panic disorder is characterized by recurrent, unexpected panic attacks—
discrete periods of intense fear or discomfort that peak within minutes and include
physical and cognitive symptoms such as palpitations, chest pain, and fear of dying.
The absence of a situational trigger distinguishes it from phobia-related disorders.
Question 5: Which of the following is a negative symptom of schizophrenia?
A. Hallucinations
B. Delusions
C. Avolition
D. Agitation
CORRECT ANSWER: C. Avolition
Rationale: Negative symptoms refer to the diminution or loss of normal functions, such
as avolition (lack of motivation), alogia (poverty of speech), anhedonia, asociality, and
blunted affect. In contrast, hallucinations and delusions are positive symptoms,
representing additions to normal experience.
Question 6: A 70-year-old woman is brought in by her daughter due to increasing
forgetfulness, getting lost in familiar places, and difficulty managing finances. MRI
shows hippocampal atrophy. What is the most likely diagnosis?
A. Vascular dementia
B. Lewy body dementia
C. Alzheimer’s disease
D. Frontotemporal dementia
, CORRECT ANSWER: C. Alzheimer’s disease
Rationale: Alzheimer’s disease typically presents with progressive episodic memory
impairment as an early symptom, along with disorientation and executive dysfunction.
Hippocampal atrophy on neuroimaging is a hallmark finding. Other dementias have
different clinical and imaging profiles (e.g., parkinsonism in Lewy body, behavioral
changes in frontotemporal).
Question 7: Which medication is contraindicated in a patient with bipolar disorder
who is currently experiencing a manic episode?
A. Lithium
B. Valproate
C. Sertraline
D. Quetiapine
CORRECT ANSWER: C. Sertraline
Rationale: Antidepressants like sertraline can precipitate or worsen mania in patients
with bipolar disorder, especially when used without a mood stabilizer. Mood stabilizers
(lithium, valproate) and atypical antipsychotics (quetiapine) are appropriate for acute
mania.
Question 8: A patient believes that the FBI has implanted a tracking device in his
teeth. This belief persists despite clear evidence to the contrary. This is best
described as which type of delusion?
A. Somatic
B. Persecutory
C. Grandiose
D. Referential
CORRECT ANSWER: B. Persecutory
Rationale: Persecutory delusions involve beliefs of being targeted, harassed, or
conspired against by others. The belief that a government agency has implanted a
device for surveillance fits this category. Somatic delusions involve bodily functions,
grandiose involve inflated self-worth, and referential involve unrelated events having
personal significance.
Question 9: Which of the following is a key diagnostic criterion for post-traumatic
stress disorder (PTSD)?
A. Recurrent intrusive memories of the traumatic event
B. Persistent elevated mood for more than one week
C. Compulsions performed to reduce anxiety
D. Disorganized thinking without hallucinations
CORRECT ANSWER: A. Recurrent intrusive memories of the traumatic event
