NRNP 6675 COMPREHENSIVE
PSYCHIATRIC MENTAL HEALTH
EXAMINATION QUESTIONS WITH
VERIFIED ANSWERS
1. A 45-year-old male with Schizophrenia is started on Clozapine after failing two other
antipsychotic trials. Which Absolute Neutrophil Count (ANC) value requires immediate
interruption of treatment according to the Clozapine REMS program for a general population
patient?
A. ANC < 2,000/µL
B. ANC < 1,500/µL
C. ANC < 500/µL
D. ANC < 1,000/µL
Answer: D
Conceptual Explanation: For the general population, treatment must be interrupted if the
ANC falls below 1,000/µL. If the ANC is 1,000-1,499/µL, treatment can continue but
monitoring frequency increases to three times weekly.
,2. Which neurobiological pathway is primarily associated with the ‘negative symptoms’ of
Schizophrenia, such as avolition and alogia?
A. Mesocortical pathway
B. Mesolimbic pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
Answer: A
Conceptual Explanation: The Mesocortical pathway is associated with cognitive and
negative symptoms of schizophrenia due to hypofunctioning dopamine. The mesolimbic
pathway is associated with positive symptoms (hallucinations/delusions).
3. A patient taking Phenelzine (an MAOI) consumes a meal high in tyramine and experiences
a hypertensive crisis. What is the physiological mechanism behind this reaction?
A. Increased reuptake of serotonin
B. Antagonism of dopamine D2 receptors
C. Blockade of alpha-1 adrenergic receptors
D. Release of stored norepinephrine from nerve terminals
Answer: D
, Conceptual Explanation: Tyramine causes the release of stored norepinephrine. Since
MAOIs prevent the breakdown of norepinephrine, the massive release leads to severe
vasoconstriction and hypertensive crisis.
4. A 28-year-old female presents with a 2-week history of persistently elevated mood,
decreased need for sleep (2 hours per night), pressured speech, and a $15,000 shopping
spree. She has no prior psychiatric history. What is the most likely diagnosis?
A. Bipolar II Disorder
B. Bipolar I Disorder
C. Cyclothymic Disorder
D. Major Depressive Disorder with Hypomania
Answer: B
Conceptual Explanation: The presence of a manic episode (at least 7 days, significant
impairment, or hospitalization) is sufficient for a Bipolar I diagnosis. Bipolar II requires a
hypomanic episode AND a major depressive episode.
5. Which medication is considered the ‘gold standard’ for reducing the risk of suicide in
patients with Bipolar Disorder?
A. Quetiapine
B. Valproic Acid
C. Lamotrigine
PSYCHIATRIC MENTAL HEALTH
EXAMINATION QUESTIONS WITH
VERIFIED ANSWERS
1. A 45-year-old male with Schizophrenia is started on Clozapine after failing two other
antipsychotic trials. Which Absolute Neutrophil Count (ANC) value requires immediate
interruption of treatment according to the Clozapine REMS program for a general population
patient?
A. ANC < 2,000/µL
B. ANC < 1,500/µL
C. ANC < 500/µL
D. ANC < 1,000/µL
Answer: D
Conceptual Explanation: For the general population, treatment must be interrupted if the
ANC falls below 1,000/µL. If the ANC is 1,000-1,499/µL, treatment can continue but
monitoring frequency increases to three times weekly.
,2. Which neurobiological pathway is primarily associated with the ‘negative symptoms’ of
Schizophrenia, such as avolition and alogia?
A. Mesocortical pathway
B. Mesolimbic pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
Answer: A
Conceptual Explanation: The Mesocortical pathway is associated with cognitive and
negative symptoms of schizophrenia due to hypofunctioning dopamine. The mesolimbic
pathway is associated with positive symptoms (hallucinations/delusions).
3. A patient taking Phenelzine (an MAOI) consumes a meal high in tyramine and experiences
a hypertensive crisis. What is the physiological mechanism behind this reaction?
A. Increased reuptake of serotonin
B. Antagonism of dopamine D2 receptors
C. Blockade of alpha-1 adrenergic receptors
D. Release of stored norepinephrine from nerve terminals
Answer: D
, Conceptual Explanation: Tyramine causes the release of stored norepinephrine. Since
MAOIs prevent the breakdown of norepinephrine, the massive release leads to severe
vasoconstriction and hypertensive crisis.
4. A 28-year-old female presents with a 2-week history of persistently elevated mood,
decreased need for sleep (2 hours per night), pressured speech, and a $15,000 shopping
spree. She has no prior psychiatric history. What is the most likely diagnosis?
A. Bipolar II Disorder
B. Bipolar I Disorder
C. Cyclothymic Disorder
D. Major Depressive Disorder with Hypomania
Answer: B
Conceptual Explanation: The presence of a manic episode (at least 7 days, significant
impairment, or hospitalization) is sufficient for a Bipolar I diagnosis. Bipolar II requires a
hypomanic episode AND a major depressive episode.
5. Which medication is considered the ‘gold standard’ for reducing the risk of suicide in
patients with Bipolar Disorder?
A. Quetiapine
B. Valproic Acid
C. Lamotrigine
