Question 1
A 32-year-old primipara reports tearfulness, exhaustion, and mood lability starting 3 days after an
uncomplicated vaginal delivery. She states she is predominantly happy and is sleeping when the
baby sleeps. Her symptoms have been present for 4 days. What is the most likely diagnosis?
A) Major depressive disorder with peripartum onset
B) Baby blues
C) Postpartum psychosis
D) Perinatal panic disorder
.Rationale: Baby blues affects 60-80% of new mothers, starts 2-3 days postpartum, lasts 2 days to
2 weeks, and presents with tearfulness and lability but preserved self-esteem and predominant
happiness..
Question 2
A new mother you are seeing at a 6-week postpartum visit endorses feeling anxious, having
intrusive thoughts about her baby being contaminated by germs, and reports she washes her
hands 20 times per day. She is horrified by these thoughts. What is the most appropriate next
step?
A) Immediately hospitalize her for command hallucinations
B) Reassure her that all new mothers have these thoughts
C) Screen for perinatal OCD and provide psychoeducation that thoughts do not equal actions
D) Start an antipsychotic medication immediately for psychosis
Rationale: Perinatal OCD involves ego-dystonic intrusive thoughts (often contamination or harm)
and compulsions. The mother recognizes the thoughts as unhealthy, which differentiates OCD from
psychosis.
Question 3
A pregnant woman with a known history of bipolar disorder stopped her mood stabilizer when she
learned she was pregnant at 6 weeks gestation. Based on the landmark study of 10,000 US
mothers, what is her approximate risk of mood episode relapse during the perinatal period?
A) 10-15%
,B) 70% or higher
C) 30-40%
D) Less than 5%
Rationale: The notes state that 70% of bipolar symptoms relapse without medications.
Discontinuing mood stabilizers during pregnancy significantly increases the risk of relapse.
Question 4
A NICU mother reports that she cannot stop thinking about the image of her baby’s code blue
event. She avoids the hospital room where it happened and feels numb. These symptoms have
lasted 6 weeks. Which disorder best explains her presentation?
A) Generalized anxiety disorder
B) Posttraumatic stress disorder (PTSD)
C) Postpartum psychosis
D) Adjustment disorder
.Rationale: Perinatal PTSD involves intrusive thoughts (flashbacks), avoidance of trauma
reminders, and negative mood. NICU parents have PTSD rates up to 53%, and the size/sickness of
the baby is less predictive than the parent’s baseline coping..
Question 5
A father of a 4-month-old infant reports low mood, irritability, and that he feels excluded from the
mother-baby bond. He has trouble sleeping but does not want to seek help because he fears it will
hurt his military career. What prevalence rate is most consistent with paternal postpartum
depression?
A) 1-2%
B) 10%
C) 25%
D) 50%
Rationale: The notes state the prevalence of PPD in fathers is 10%. Military spouses often avoid
care because 66% believe seeking mental health support would hurt their spouse’s chance of
promotion.
Question 6
A clinician administers the Edinburgh Postnatal Depression Scale (EPDS) to a postpartum woman
who scores a 16. How should this score be interpreted?
A) No depression present
,B) Mild depression
C) Moderate depression
D) Severe depression
.Rationale: EPDS scoring: 0-6 minimal, 7-13 mild, 14-19 moderate, 19-30 severe. A score of 16
indicates moderate depressive symptoms requiring further assessment and intervention..
Question 7
A breastfeeding mother with untreated major depression asks about starting an antidepressant.
Which medication is most commonly prescribed during pregnancy and postpartum due to its
extensive safety data?
A) Paroxetine (Paxil)
B) Fluoxetine (Prozac)
C) Sertraline (Zoloft)
D) Bupropion (Wellbutrin)
.Rationale: Sertraline (Zoloft) is the most commonly prescribed SSRI during pregnancy and
postpartum. Starting dose is 25mg with a range of 50-200mg. It has the most favorable safety
profile for breastfeeding..
Question 8
A new mother reports that 10 days after giving birth, she started believing that her thoughts are
being broadcast on the television and that the nurses are plotting to take her baby. She appears
agitated and has not slept in 3 days. What is the priority intervention?
A) Prescribe sertraline and send her home
B) Immediate psychiatric hospitalization for suspected postpartum psychosis
C) Reassure her that these are normal intrusive thoughts
D) Screen her for OCD using the Y-BOCS
.Rationale: Postpartum psychosis affects 1-2 per 1,000 births, with onset typically within 2 weeks.
Symptoms include thought broadcasting, delusions, and disorganized behavior. This is a
psychiatric emergency..
Question 9
In a therapy session, a postpartum woman with panic disorder describes her three greatest fears.
Which set of fears is most characteristic of a panic attack?
A) Fear of heights, spiders, and public speaking
B) Fear of dying, going crazy, and losing control
, C) Fear of contamination, harming the baby, and germs
D) Fear of abandonment, rejection, and criticism
Rationale: The notes specify that the three greatest fears in panic disorder are dying, going crazy,
and losing control. These are distinct from the ego-dystonic fears of OCD.
Question 10
A Black pregnant woman reports she is afraid to go to the hospital because she has heard stories
of poor treatment. The data supports her concern: compared to white women, Black women in
the US have a maternal mortality rate of:
A) 5.2 per 100,000
B) 14.4 per 100,000
C) .43.5 per 100,000.
D) 100.1 per 100,000
Rationale: Black maternal mortality is 43.5 deaths per 100,000 live births, compared to 14.4 for
other ethnic groups and 12.7 for white women. Black mothers are 4x more likely to die from
maternity complications.
Question 11
A clinician is using the PHQ-9 to screen a prenatal patient. What is the critical next step if the
patient answers “Several days” or more to question 9 (“Thoughts that you would be better off
dead or hurting yourself”)?
A) Ignore it if she looks well
B) Immediately assess for suicidal ideation using the C-SSRS and create a safety plan
C) Schedule her for a follow-up appointment next month
D) Prescribe a low dose of benzodiazepine
.Rationale: Any response other than zero on EPDS #10 or PHQ-9 #9 requires immediate follow-up
to assess risk. Use the Columbia Suicide Severity Rating Scale (C-SSRS) and document everything..
Question 12
A postpartum woman reports she has intrusive, repetitive thoughts of accidentally dropping her
baby down the stairs. She is terrified by these thoughts and has started avoiding the stairs
entirely. How does this presentation differ from postpartum psychosis?
A) In psychosis, the parent does not recognize the thoughts as unhealthy (ego-syntonic)
B) In OCD, the parent wants to harm the baby
A 32-year-old primipara reports tearfulness, exhaustion, and mood lability starting 3 days after an
uncomplicated vaginal delivery. She states she is predominantly happy and is sleeping when the
baby sleeps. Her symptoms have been present for 4 days. What is the most likely diagnosis?
A) Major depressive disorder with peripartum onset
B) Baby blues
C) Postpartum psychosis
D) Perinatal panic disorder
.Rationale: Baby blues affects 60-80% of new mothers, starts 2-3 days postpartum, lasts 2 days to
2 weeks, and presents with tearfulness and lability but preserved self-esteem and predominant
happiness..
Question 2
A new mother you are seeing at a 6-week postpartum visit endorses feeling anxious, having
intrusive thoughts about her baby being contaminated by germs, and reports she washes her
hands 20 times per day. She is horrified by these thoughts. What is the most appropriate next
step?
A) Immediately hospitalize her for command hallucinations
B) Reassure her that all new mothers have these thoughts
C) Screen for perinatal OCD and provide psychoeducation that thoughts do not equal actions
D) Start an antipsychotic medication immediately for psychosis
Rationale: Perinatal OCD involves ego-dystonic intrusive thoughts (often contamination or harm)
and compulsions. The mother recognizes the thoughts as unhealthy, which differentiates OCD from
psychosis.
Question 3
A pregnant woman with a known history of bipolar disorder stopped her mood stabilizer when she
learned she was pregnant at 6 weeks gestation. Based on the landmark study of 10,000 US
mothers, what is her approximate risk of mood episode relapse during the perinatal period?
A) 10-15%
,B) 70% or higher
C) 30-40%
D) Less than 5%
Rationale: The notes state that 70% of bipolar symptoms relapse without medications.
Discontinuing mood stabilizers during pregnancy significantly increases the risk of relapse.
Question 4
A NICU mother reports that she cannot stop thinking about the image of her baby’s code blue
event. She avoids the hospital room where it happened and feels numb. These symptoms have
lasted 6 weeks. Which disorder best explains her presentation?
A) Generalized anxiety disorder
B) Posttraumatic stress disorder (PTSD)
C) Postpartum psychosis
D) Adjustment disorder
.Rationale: Perinatal PTSD involves intrusive thoughts (flashbacks), avoidance of trauma
reminders, and negative mood. NICU parents have PTSD rates up to 53%, and the size/sickness of
the baby is less predictive than the parent’s baseline coping..
Question 5
A father of a 4-month-old infant reports low mood, irritability, and that he feels excluded from the
mother-baby bond. He has trouble sleeping but does not want to seek help because he fears it will
hurt his military career. What prevalence rate is most consistent with paternal postpartum
depression?
A) 1-2%
B) 10%
C) 25%
D) 50%
Rationale: The notes state the prevalence of PPD in fathers is 10%. Military spouses often avoid
care because 66% believe seeking mental health support would hurt their spouse’s chance of
promotion.
Question 6
A clinician administers the Edinburgh Postnatal Depression Scale (EPDS) to a postpartum woman
who scores a 16. How should this score be interpreted?
A) No depression present
,B) Mild depression
C) Moderate depression
D) Severe depression
.Rationale: EPDS scoring: 0-6 minimal, 7-13 mild, 14-19 moderate, 19-30 severe. A score of 16
indicates moderate depressive symptoms requiring further assessment and intervention..
Question 7
A breastfeeding mother with untreated major depression asks about starting an antidepressant.
Which medication is most commonly prescribed during pregnancy and postpartum due to its
extensive safety data?
A) Paroxetine (Paxil)
B) Fluoxetine (Prozac)
C) Sertraline (Zoloft)
D) Bupropion (Wellbutrin)
.Rationale: Sertraline (Zoloft) is the most commonly prescribed SSRI during pregnancy and
postpartum. Starting dose is 25mg with a range of 50-200mg. It has the most favorable safety
profile for breastfeeding..
Question 8
A new mother reports that 10 days after giving birth, she started believing that her thoughts are
being broadcast on the television and that the nurses are plotting to take her baby. She appears
agitated and has not slept in 3 days. What is the priority intervention?
A) Prescribe sertraline and send her home
B) Immediate psychiatric hospitalization for suspected postpartum psychosis
C) Reassure her that these are normal intrusive thoughts
D) Screen her for OCD using the Y-BOCS
.Rationale: Postpartum psychosis affects 1-2 per 1,000 births, with onset typically within 2 weeks.
Symptoms include thought broadcasting, delusions, and disorganized behavior. This is a
psychiatric emergency..
Question 9
In a therapy session, a postpartum woman with panic disorder describes her three greatest fears.
Which set of fears is most characteristic of a panic attack?
A) Fear of heights, spiders, and public speaking
B) Fear of dying, going crazy, and losing control
, C) Fear of contamination, harming the baby, and germs
D) Fear of abandonment, rejection, and criticism
Rationale: The notes specify that the three greatest fears in panic disorder are dying, going crazy,
and losing control. These are distinct from the ego-dystonic fears of OCD.
Question 10
A Black pregnant woman reports she is afraid to go to the hospital because she has heard stories
of poor treatment. The data supports her concern: compared to white women, Black women in
the US have a maternal mortality rate of:
A) 5.2 per 100,000
B) 14.4 per 100,000
C) .43.5 per 100,000.
D) 100.1 per 100,000
Rationale: Black maternal mortality is 43.5 deaths per 100,000 live births, compared to 14.4 for
other ethnic groups and 12.7 for white women. Black mothers are 4x more likely to die from
maternity complications.
Question 11
A clinician is using the PHQ-9 to screen a prenatal patient. What is the critical next step if the
patient answers “Several days” or more to question 9 (“Thoughts that you would be better off
dead or hurting yourself”)?
A) Ignore it if she looks well
B) Immediately assess for suicidal ideation using the C-SSRS and create a safety plan
C) Schedule her for a follow-up appointment next month
D) Prescribe a low dose of benzodiazepine
.Rationale: Any response other than zero on EPDS #10 or PHQ-9 #9 requires immediate follow-up
to assess risk. Use the Columbia Suicide Severity Rating Scale (C-SSRS) and document everything..
Question 12
A postpartum woman reports she has intrusive, repetitive thoughts of accidentally dropping her
baby down the stairs. She is terrified by these thoughts and has started avoiding the stairs
entirely. How does this presentation differ from postpartum psychosis?
A) In psychosis, the parent does not recognize the thoughts as unhealthy (ego-syntonic)
B) In OCD, the parent wants to harm the baby
