COMAT Psychiatry Exam V2 COMAT Psychiatry
Exam V2
1. A 24-year-old male is brought to the emergency department by his roommate who states
the patient has been acting strangely for the past 7 months. The patient reports hearing
voices that comment on his daily activities and believes the government is monitoring his
thoughts through his dental fillings. He has withdrawn from social interactions and stopped
attending his university classes. Physical examination and toxicology screen are
unremarkable. What is the most likely diagnosis?
A. Schizophreniform disorder
B. Schizophrenia
C. Brief psychotic disorder
D. Schizoaffective disorder
Correct Answer: B
Explanation: Schizophrenia requires the presence of symptoms for at least six months,
including at least one month of active-phase symptoms like delusions or hallucinations.
This patient meets the criteria due to the 7-month duration and the presence of both
auditory hallucinations and paranoid delusions. A common pitfall is choosing
schizophreniform disorder, which is reserved for symptoms lasting between one and six
months.
,2. A 32-year-old female presents with a 2-week history of persistently low mood, loss of
interest in her usual hobbies, and significant difficulty sleeping. She reports feeling
‘worthless’ and has noticed a decrease in her concentration at work. She denies any history
of manic or hypomanic episodes. Which of the following is the most appropriate first-line
pharmacotherapy?
A. Amitriptyline
B. Sertraline
C. Phenelzine
D. Quetiapine
Correct Answer: B
Explanation: Selective serotonin reuptake inhibitors (SSRIs) like sertraline are considered
first-line treatment for major depressive disorder due to their favorable safety profile and
tolerability. Tricyclic antidepressants and MAOIs are generally reserved for treatment-
resistant cases due to their significant side effect profiles. Clinicians must monitor for
suicidal ideation during the initiation phase of SSRI therapy, especially in younger adults.
3. A 19-year-old college student is brought to the clinic by her mother. The patient has a BMI
of 16.2 kg/m2 and is noted to have fine, downy hair on her arms and back. She expresses an
intense fear of gaining weight despite being significantly underweight and restricts her caloric
intake to 500 calories per day. What is the most likely diagnosis?
A. Bulimia nervosa
,B. Anorexia nervosa, restricting type
C. Avoidant/restrictive food intake disorder
D. Body dysmorphic disorder
Correct Answer: B
Explanation: Anorexia nervosa is characterized by a restriction of energy intake leading to
significantly low body weight and an intense fear of gaining weight. The presence of lanugo
(fine hair) is a physical manifestation of starvation and physiologic compensation for heat
loss. Unlike bulimia nervosa, the primary indicator here is the significantly low body
weight, which is the defining clinical feature for anorexia.
4. A 72-year-old male with a history of hypertension and early-stage Alzheimer’s disease is
admitted to the hospital for a urinary tract infection. On his second hospital day, he becomes
acutely agitated, disoriented to time and place, and begins seeing ‘spiders’ on the wall that
are not there. His symptoms fluctuate throughout the day. What is the most likely diagnosis?
A. Delirium
B. Dementia with Lewy bodies
C. Schizophrenia, late-onset
D. Major depressive disorder with psychotic features
Correct Answer: A
, Explanation: Delirium is characterized by an acute change in consciousness and cognition
that fluctuates over hours or days, often triggered by an underlying medical condition like
an infection. The presence of visual hallucinations in an elderly patient with an acute
change in mental status is highly suggestive of delirium rather than a primary psychiatric
disorder. Management focuses on treating the underlying cause, which in this case is the
urinary tract infection.
5. A 28-year-old male is started on haloperidol for the treatment of acute psychosis. Two days
later, he presents to the emergency department with his neck twisted to one side and intense
muscle spasms in his neck. He is extremely distressed but remains conscious. What is the
most appropriate immediate treatment?
A. Dantrolene
B. Benztropine
C. Bromocriptine
D. Propranolol
Correct Answer: B
Explanation: The patient is experiencing an acute dystonic reaction, an extrapyramidal
side effect commonly associated with high-potency first-generation antipsychotics like
haloperidol. Acute dystonia is treated with anticholinergic medications such as benztropine
or diphenhydramine to restore the dopamine-acetylcholine balance in the basal ganglia.
Failure to recognize this can lead to patient distress and non-compliance with future
antipsychotic treatments.
Exam V2
1. A 24-year-old male is brought to the emergency department by his roommate who states
the patient has been acting strangely for the past 7 months. The patient reports hearing
voices that comment on his daily activities and believes the government is monitoring his
thoughts through his dental fillings. He has withdrawn from social interactions and stopped
attending his university classes. Physical examination and toxicology screen are
unremarkable. What is the most likely diagnosis?
A. Schizophreniform disorder
B. Schizophrenia
C. Brief psychotic disorder
D. Schizoaffective disorder
Correct Answer: B
Explanation: Schizophrenia requires the presence of symptoms for at least six months,
including at least one month of active-phase symptoms like delusions or hallucinations.
This patient meets the criteria due to the 7-month duration and the presence of both
auditory hallucinations and paranoid delusions. A common pitfall is choosing
schizophreniform disorder, which is reserved for symptoms lasting between one and six
months.
,2. A 32-year-old female presents with a 2-week history of persistently low mood, loss of
interest in her usual hobbies, and significant difficulty sleeping. She reports feeling
‘worthless’ and has noticed a decrease in her concentration at work. She denies any history
of manic or hypomanic episodes. Which of the following is the most appropriate first-line
pharmacotherapy?
A. Amitriptyline
B. Sertraline
C. Phenelzine
D. Quetiapine
Correct Answer: B
Explanation: Selective serotonin reuptake inhibitors (SSRIs) like sertraline are considered
first-line treatment for major depressive disorder due to their favorable safety profile and
tolerability. Tricyclic antidepressants and MAOIs are generally reserved for treatment-
resistant cases due to their significant side effect profiles. Clinicians must monitor for
suicidal ideation during the initiation phase of SSRI therapy, especially in younger adults.
3. A 19-year-old college student is brought to the clinic by her mother. The patient has a BMI
of 16.2 kg/m2 and is noted to have fine, downy hair on her arms and back. She expresses an
intense fear of gaining weight despite being significantly underweight and restricts her caloric
intake to 500 calories per day. What is the most likely diagnosis?
A. Bulimia nervosa
,B. Anorexia nervosa, restricting type
C. Avoidant/restrictive food intake disorder
D. Body dysmorphic disorder
Correct Answer: B
Explanation: Anorexia nervosa is characterized by a restriction of energy intake leading to
significantly low body weight and an intense fear of gaining weight. The presence of lanugo
(fine hair) is a physical manifestation of starvation and physiologic compensation for heat
loss. Unlike bulimia nervosa, the primary indicator here is the significantly low body
weight, which is the defining clinical feature for anorexia.
4. A 72-year-old male with a history of hypertension and early-stage Alzheimer’s disease is
admitted to the hospital for a urinary tract infection. On his second hospital day, he becomes
acutely agitated, disoriented to time and place, and begins seeing ‘spiders’ on the wall that
are not there. His symptoms fluctuate throughout the day. What is the most likely diagnosis?
A. Delirium
B. Dementia with Lewy bodies
C. Schizophrenia, late-onset
D. Major depressive disorder with psychotic features
Correct Answer: A
, Explanation: Delirium is characterized by an acute change in consciousness and cognition
that fluctuates over hours or days, often triggered by an underlying medical condition like
an infection. The presence of visual hallucinations in an elderly patient with an acute
change in mental status is highly suggestive of delirium rather than a primary psychiatric
disorder. Management focuses on treating the underlying cause, which in this case is the
urinary tract infection.
5. A 28-year-old male is started on haloperidol for the treatment of acute psychosis. Two days
later, he presents to the emergency department with his neck twisted to one side and intense
muscle spasms in his neck. He is extremely distressed but remains conscious. What is the
most appropriate immediate treatment?
A. Dantrolene
B. Benztropine
C. Bromocriptine
D. Propranolol
Correct Answer: B
Explanation: The patient is experiencing an acute dystonic reaction, an extrapyramidal
side effect commonly associated with high-potency first-generation antipsychotics like
haloperidol. Acute dystonia is treated with anticholinergic medications such as benztropine
or diphenhydramine to restore the dopamine-acetylcholine balance in the basal ganglia.
Failure to recognize this can lead to patient distress and non-compliance with future
antipsychotic treatments.
