,1. A pa ent with treatment-resistant schizophrenia has failed two trials of an psycho cs.
Which medica on is the gold standard next step?
• A. Haloperidol
• B. Aripiprazole
• C. Clozapine
• D. Ziprasidone
• Answer: C. Clozapine is the only FDA-approved medica on for treatment-
resistant schizophrenia and is indicated a er failure of at least two other
an psycho cs .
2. What is the primary mechanism of ac on of a par al agonist at a neurotransmi er
receptor?
• A. It completely blocks all receptor signaling.
• B. It produces a sub-maximal response, stabilizing neurotransmission.
• C. It drives signaling below the baseline level.
• D. It irreversibly destroys the receptor site.
• Answer: B. Par al agonists bind to receptors and produce a sub-maximal
response, effec vely stabilizing the system whether there is too much or too
li le neurotransmi er .
3. A pa ent presents with hyperreflexia, clonus, diaphoresis, and diarrhea a er adding
Tramadol to a stable regimen of Sertraline. What is the most likely diagnosis?
• A. Neurolep c Malignant Syndrome
• B. Serotonin Syndrome
• C. Acute Pancrea s
• D. Hypertensive Crisis
• Answer: B. This symptom cluster is classic for Serotonin Syndrome, which is
caused by excessive serotonergic ac vity, o en from combining serotonergic
agents like SSRIs and tramadol .
4. Which an depressant class is contraindicated in pa ents with narrow-angle glaucoma
due to its strong an cholinergic proper es?
, • A. SSRIs
• B. SNRIs
• C. MAOIs
• D. Tricyclic An depressants (TCAs)
• Answer: D. TCAs have significant an cholinergic effects (blocking muscarinic
receptors) which can precipitate an acute angle-closure glaucoma crisis .
5. A pa ent on long-term haloperidol requires monitoring for involuntary movements.
Which assessment tool is most appropriate?
• A. PHQ-9
• B. MoCA
• C. AIMS (Abnormal Involuntary Movement Scale)
• D. GAD-7
• Answer: C. The AIMS is the gold-standard screening tool for detec ng and
tracking tardive dyskinesia in pa ents on long-term an psycho c therapy .
Sec on 2: Psychiatric Disorders
6. A 10-year-old boy on fluoxe ne for MDD presents to the ED a er running into traffic.
What is a common sign of MDD in children?
• A. Psychomotor retarda on
• B. Hypersomnia
• C. Psychomotor agita on
• D. Anhedonia
• Answer: C. In children, depression can manifest as irritability and psychomotor
agita on more o en than the classic vegeta ve symptoms seen in adults .
7. A 6-year-old boy is referred for speech difficulty. He is friendly, uses simple sentences
with limited vocabulary, and consistently confuses verb tenses. His speech was
delayed but met other milestones. This presenta on is most consistent with:
• A. Au sm Spectrum Disorder
• B. Expressive Language Disorder
, • C. Global Developmental Delay
• D. Childhood-Onset Schizophrenia
• Answer: B. Expressive Language Disorder is characterized by a marked deficit in
expressive vocabulary and gramma cal complexity, but with rela vely preserved
recep ve language and non-verbal social skills .
8. A 6-year-old sits up in bed shortly a er falling asleep, screams inconsolably, and is
unable to be awakened. The next morning, he is energe c and has no memory of the
event. What is the most appropriate response to the parent?
• A. "This is likely a nightmare; we should start prazosin."
• B. "This is a night terror; your child is not in distress and should not be
awakened."
• C. "He needs an MRI to rule out a seizure disorder."
• D. "I can see this is upse ng for you."
• Answer: B. This describes a night terror (sleep terror), which occurs in non-REM
sleep (Stage 3-4). The child is inconsolable and has no memory of it. The best
interven on is parental psychoeduca on and reassurance; it is important to
inform the parent that the child should not be awakened and that the parent is
doing a good job by keeping them safe .
9. A pa ent reports depersonaliza on during panic a acks. This indicates:
• A. A comorbid dissocia ve disorder
• B. Severe panic with derealiza on
• C. A need for an an psycho c
• D. Atypical panic
• Answer: B. Depersonaliza on (feeling detached from oneself) and derealiza on
(feeling the world is unreal) are common symptoms of severe panic a acks and
are not considered separate pathology .
10. A 35-year-old male on valproic acid for Bipolar I requires rou ne monitoring of which
labs?
• A. Serum crea nine and TSH
• B. Serum amylase and lipids
Which medica on is the gold standard next step?
• A. Haloperidol
• B. Aripiprazole
• C. Clozapine
• D. Ziprasidone
• Answer: C. Clozapine is the only FDA-approved medica on for treatment-
resistant schizophrenia and is indicated a er failure of at least two other
an psycho cs .
2. What is the primary mechanism of ac on of a par al agonist at a neurotransmi er
receptor?
• A. It completely blocks all receptor signaling.
• B. It produces a sub-maximal response, stabilizing neurotransmission.
• C. It drives signaling below the baseline level.
• D. It irreversibly destroys the receptor site.
• Answer: B. Par al agonists bind to receptors and produce a sub-maximal
response, effec vely stabilizing the system whether there is too much or too
li le neurotransmi er .
3. A pa ent presents with hyperreflexia, clonus, diaphoresis, and diarrhea a er adding
Tramadol to a stable regimen of Sertraline. What is the most likely diagnosis?
• A. Neurolep c Malignant Syndrome
• B. Serotonin Syndrome
• C. Acute Pancrea s
• D. Hypertensive Crisis
• Answer: B. This symptom cluster is classic for Serotonin Syndrome, which is
caused by excessive serotonergic ac vity, o en from combining serotonergic
agents like SSRIs and tramadol .
4. Which an depressant class is contraindicated in pa ents with narrow-angle glaucoma
due to its strong an cholinergic proper es?
, • A. SSRIs
• B. SNRIs
• C. MAOIs
• D. Tricyclic An depressants (TCAs)
• Answer: D. TCAs have significant an cholinergic effects (blocking muscarinic
receptors) which can precipitate an acute angle-closure glaucoma crisis .
5. A pa ent on long-term haloperidol requires monitoring for involuntary movements.
Which assessment tool is most appropriate?
• A. PHQ-9
• B. MoCA
• C. AIMS (Abnormal Involuntary Movement Scale)
• D. GAD-7
• Answer: C. The AIMS is the gold-standard screening tool for detec ng and
tracking tardive dyskinesia in pa ents on long-term an psycho c therapy .
Sec on 2: Psychiatric Disorders
6. A 10-year-old boy on fluoxe ne for MDD presents to the ED a er running into traffic.
What is a common sign of MDD in children?
• A. Psychomotor retarda on
• B. Hypersomnia
• C. Psychomotor agita on
• D. Anhedonia
• Answer: C. In children, depression can manifest as irritability and psychomotor
agita on more o en than the classic vegeta ve symptoms seen in adults .
7. A 6-year-old boy is referred for speech difficulty. He is friendly, uses simple sentences
with limited vocabulary, and consistently confuses verb tenses. His speech was
delayed but met other milestones. This presenta on is most consistent with:
• A. Au sm Spectrum Disorder
• B. Expressive Language Disorder
, • C. Global Developmental Delay
• D. Childhood-Onset Schizophrenia
• Answer: B. Expressive Language Disorder is characterized by a marked deficit in
expressive vocabulary and gramma cal complexity, but with rela vely preserved
recep ve language and non-verbal social skills .
8. A 6-year-old sits up in bed shortly a er falling asleep, screams inconsolably, and is
unable to be awakened. The next morning, he is energe c and has no memory of the
event. What is the most appropriate response to the parent?
• A. "This is likely a nightmare; we should start prazosin."
• B. "This is a night terror; your child is not in distress and should not be
awakened."
• C. "He needs an MRI to rule out a seizure disorder."
• D. "I can see this is upse ng for you."
• Answer: B. This describes a night terror (sleep terror), which occurs in non-REM
sleep (Stage 3-4). The child is inconsolable and has no memory of it. The best
interven on is parental psychoeduca on and reassurance; it is important to
inform the parent that the child should not be awakened and that the parent is
doing a good job by keeping them safe .
9. A pa ent reports depersonaliza on during panic a acks. This indicates:
• A. A comorbid dissocia ve disorder
• B. Severe panic with derealiza on
• C. A need for an an psycho c
• D. Atypical panic
• Answer: B. Depersonaliza on (feeling detached from oneself) and derealiza on
(feeling the world is unreal) are common symptoms of severe panic a acks and
are not considered separate pathology .
10. A 35-year-old male on valproic acid for Bipolar I requires rou ne monitoring of which
labs?
• A. Serum crea nine and TSH
• B. Serum amylase and lipids
