COMAT Psychiatry Exam V1 COMAT Psychiatry
Exam V1
1. A 24-year-old male is brought to the clinic by his parents because he has been hearing
voices for the past 7 months. He believes the government is tracking his movements through
his dental fillings. His speech is disorganized, and he has stopped showering or socializing.
What is the most likely diagnosis?
A. Schizophreniform disorder
B. Schizophrenia
C. Brief psychotic disorder
D. Schizotypal personality disorder
Correct Answer: B
Explanation: The patient meets the criteria for schizophrenia because his symptoms,
including hallucinations, delusions, and negative symptoms, have persisted for more than 6
months. Schizophreniform disorder is the correct diagnosis if symptoms last between 1
and 6 months, whereas brief psychotic disorder lasts less than 1 month. Accurate diagnosis
requires longitudinal assessment of the duration and impact on functioning.
2. A 32-year-old female with a history of Bipolar I disorder presents for a follow-up. She was
recently started on a new medication and now complains of a fine hand tremor, increased
thirst, and frequent urination. Which of the following medications is most likely responsible?
A. Valproate
,B. Quetiapine
C. Lithium
D. Lamotrigine
Correct Answer: C
Explanation: Lithium is a classic mood stabilizer known for causing side effects such as
polyuria, polydipsia, and a fine tremor. It has a narrow therapeutic index and requires
regular monitoring of serum levels, renal function, and thyroid function. Practitioners must
distinguish the fine tremor of lithium from the coarse tremor seen in toxicity, which
requires immediate medical intervention.
3. A 19-year-old college student presents with a BMI of 16.2 kg/m². She reports an intense
fear of gaining weight despite being underweight and admits to exercising 4 hours daily. She
has not had a menstrual period in 4 months. What is the most appropriate initial step in
management if she is hemodynamically unstable?
A. Outpatient Cognitive Behavioral Therapy
B. Prescribe Fluoxetine
C. Inpatient hospitalization
D. Family-based therapy
Correct Answer: C
,Explanation: Anorexia nervosa patients with significant physiological instability, such as
bradycardia, hypotension, or a very low BMI, require inpatient medical stabilization.
Fluoxetine is not effective in the acute phase when the patient is severely malnourished
and is more useful for preventing relapse once weight is restored. Clinicians must prioritize
physical stabilization and monitor for refeeding syndrome during the initial recovery
phase.
4. A 45-year-old male is brought to the emergency department after a seizure. He is sweating,
tachycardic, and has a coarse tremor. His last drink of alcohol was approximately 48 hours
ago. Which of the following is the first-line treatment for his condition?
A. Lorazepam
B. Haloperidol
C. Phenytoin
D. Disulfiram
Correct Answer: A
Explanation: Benzodiazepines like Lorazepam are the first-line treatment for alcohol
withdrawal to prevent progression to delirium tremens and further seizures. Phenytoin is
ineffective for alcohol-related seizures, and antipsychotics like Haloperidol should be
avoided as they lower the seizure threshold. The Symptom-Triggered Benzodiazepine
protocol (CIWA-Ar) is commonly used to guide dosing based on symptom severity.
, 5. A 28-year-old female complains of sudden episodes of intense fear accompanied by
palpitations, sweating, shortness of breath, and a fear that she is dying. These episodes last
about 10 minutes and occur unexpectedly. She now avoids going to the grocery store for fear
of having an episode. Diagnosis?
A. Panic disorder
B. Social anxiety disorder
C. Specific phobia
D. Generalized anxiety disorder
Correct Answer: A
Explanation: Panic disorder is characterized by recurrent, unexpected panic attacks
followed by at least one month of persistent concern about future attacks or a change in
behavior (agoraphobic avoidance). While Social Anxiety Disorder involves fear of scrutiny,
Panic Disorder involves fear of the physical sensations themselves. Selective Serotonin
Reuptake Inhibitors (SSRIs) and Cognitive Behavioral Therapy (CBT) are the mainstays of
long-term treatment.
6. A 72-year-old male is brought in by his daughter for confusion that started 2 days ago. He is
oriented only to person and his attention fluctuates throughout the interview. He has a
history of mild cognitive impairment but was previously able to care for himself. What is the
most likely diagnosis?
A. Alzheimer’s dementia
Exam V1
1. A 24-year-old male is brought to the clinic by his parents because he has been hearing
voices for the past 7 months. He believes the government is tracking his movements through
his dental fillings. His speech is disorganized, and he has stopped showering or socializing.
What is the most likely diagnosis?
A. Schizophreniform disorder
B. Schizophrenia
C. Brief psychotic disorder
D. Schizotypal personality disorder
Correct Answer: B
Explanation: The patient meets the criteria for schizophrenia because his symptoms,
including hallucinations, delusions, and negative symptoms, have persisted for more than 6
months. Schizophreniform disorder is the correct diagnosis if symptoms last between 1
and 6 months, whereas brief psychotic disorder lasts less than 1 month. Accurate diagnosis
requires longitudinal assessment of the duration and impact on functioning.
2. A 32-year-old female with a history of Bipolar I disorder presents for a follow-up. She was
recently started on a new medication and now complains of a fine hand tremor, increased
thirst, and frequent urination. Which of the following medications is most likely responsible?
A. Valproate
,B. Quetiapine
C. Lithium
D. Lamotrigine
Correct Answer: C
Explanation: Lithium is a classic mood stabilizer known for causing side effects such as
polyuria, polydipsia, and a fine tremor. It has a narrow therapeutic index and requires
regular monitoring of serum levels, renal function, and thyroid function. Practitioners must
distinguish the fine tremor of lithium from the coarse tremor seen in toxicity, which
requires immediate medical intervention.
3. A 19-year-old college student presents with a BMI of 16.2 kg/m². She reports an intense
fear of gaining weight despite being underweight and admits to exercising 4 hours daily. She
has not had a menstrual period in 4 months. What is the most appropriate initial step in
management if she is hemodynamically unstable?
A. Outpatient Cognitive Behavioral Therapy
B. Prescribe Fluoxetine
C. Inpatient hospitalization
D. Family-based therapy
Correct Answer: C
,Explanation: Anorexia nervosa patients with significant physiological instability, such as
bradycardia, hypotension, or a very low BMI, require inpatient medical stabilization.
Fluoxetine is not effective in the acute phase when the patient is severely malnourished
and is more useful for preventing relapse once weight is restored. Clinicians must prioritize
physical stabilization and monitor for refeeding syndrome during the initial recovery
phase.
4. A 45-year-old male is brought to the emergency department after a seizure. He is sweating,
tachycardic, and has a coarse tremor. His last drink of alcohol was approximately 48 hours
ago. Which of the following is the first-line treatment for his condition?
A. Lorazepam
B. Haloperidol
C. Phenytoin
D. Disulfiram
Correct Answer: A
Explanation: Benzodiazepines like Lorazepam are the first-line treatment for alcohol
withdrawal to prevent progression to delirium tremens and further seizures. Phenytoin is
ineffective for alcohol-related seizures, and antipsychotics like Haloperidol should be
avoided as they lower the seizure threshold. The Symptom-Triggered Benzodiazepine
protocol (CIWA-Ar) is commonly used to guide dosing based on symptom severity.
, 5. A 28-year-old female complains of sudden episodes of intense fear accompanied by
palpitations, sweating, shortness of breath, and a fear that she is dying. These episodes last
about 10 minutes and occur unexpectedly. She now avoids going to the grocery store for fear
of having an episode. Diagnosis?
A. Panic disorder
B. Social anxiety disorder
C. Specific phobia
D. Generalized anxiety disorder
Correct Answer: A
Explanation: Panic disorder is characterized by recurrent, unexpected panic attacks
followed by at least one month of persistent concern about future attacks or a change in
behavior (agoraphobic avoidance). While Social Anxiety Disorder involves fear of scrutiny,
Panic Disorder involves fear of the physical sensations themselves. Selective Serotonin
Reuptake Inhibitors (SSRIs) and Cognitive Behavioral Therapy (CBT) are the mainstays of
long-term treatment.
6. A 72-year-old male is brought in by his daughter for confusion that started 2 days ago. He is
oriented only to person and his attention fluctuates throughout the interview. He has a
history of mild cognitive impairment but was previously able to care for himself. What is the
most likely diagnosis?
A. Alzheimer’s dementia
