NR 605 COMPREHENSIVE EXAM:
PSYCHIATRIC DIAGNOSIS AND
MANAGEMENT QUESTIONS AND
ANSWERS
1. Which neurotransmitter pathway is primarily associated with the development of
Extrapyramidal Symptoms (EPS) when blocked by first-generation antipsychotics?
A. Mesolimbic pathway
B. Mesocortical pathway
C. Tuberoinfundibular pathway
D. Nigrostriatal pathway
Answer: D
Conceptual Explanation: The Nigrostriatal pathway is responsible for motor control;
blockade of D2 receptors here leads to EPS. The Mesolimbic is associated with reward and
positive symptoms, while the Tuberoinfundibular is associated with prolactin regulation.
,2. A patient on Clozapine presents with a fever, sore throat, and an Absolute Neutrophil
Count (ANC) of 450/mm3. What is the most appropriate immediate action?
A. Reduce the dose and retest in 48 hours
B. Discontinue Clozapine immediately and monitor closely
C. Continue Clozapine and start a broad-spectrum antibiotic
D. Administer a dose of Benadryl for allergic reaction
Answer: B
Conceptual Explanation: An ANC below 500/mm3 indicates severe agranulocytosis.
Clozapine must be discontinued immediately, and the patient must be monitored for
infection and not rechallenged.
3. Which of the following differentiates Bipolar I from Bipolar II disorder?
A. The occurrence of at least one full manic episode
B. The duration of hypomanic symptoms for at least 4 days
C. The presence of at least one major depressive episode
D. The severity of depressive symptoms
Answer: A
Conceptual Explanation: Bipolar I requires at least one manic episode (lasting at least 1
week or requiring hospitalization). Bipolar II requires at least one hypomanic episode and
one major depressive episode but never a full manic episode.
, 4. A patient taking Phenelzine (an MAOI) consumes aged cheese and red wine. Which
complication is the patient at highest risk for?
A. Serotonin syndrome
B. Hypertensive crisis
C. Neuroleptic malignant syndrome
D. Metabolic syndrome
Answer: B
Conceptual Explanation: MAOIs inhibit the breakdown of tyramine. Consuming high-
tyramine foods (like aged cheese) leads to a massive release of norepinephrine, causing a
hypertensive crisis.
5. In the treatment of PTSD, Prazosin is specifically used to target which symptom?
A. Nightmares and sleep disturbances
B. Flashbacks during the day
C. Hypervigilance
D. Avoidance behaviors
Answer: A
Conceptual Explanation: Prazosin is an alpha-1 adrenergic antagonist that crosses the
blood-brain barrier to reduce the sympathetic outflow associated with PTSD-related
nightmares.
PSYCHIATRIC DIAGNOSIS AND
MANAGEMENT QUESTIONS AND
ANSWERS
1. Which neurotransmitter pathway is primarily associated with the development of
Extrapyramidal Symptoms (EPS) when blocked by first-generation antipsychotics?
A. Mesolimbic pathway
B. Mesocortical pathway
C. Tuberoinfundibular pathway
D. Nigrostriatal pathway
Answer: D
Conceptual Explanation: The Nigrostriatal pathway is responsible for motor control;
blockade of D2 receptors here leads to EPS. The Mesolimbic is associated with reward and
positive symptoms, while the Tuberoinfundibular is associated with prolactin regulation.
,2. A patient on Clozapine presents with a fever, sore throat, and an Absolute Neutrophil
Count (ANC) of 450/mm3. What is the most appropriate immediate action?
A. Reduce the dose and retest in 48 hours
B. Discontinue Clozapine immediately and monitor closely
C. Continue Clozapine and start a broad-spectrum antibiotic
D. Administer a dose of Benadryl for allergic reaction
Answer: B
Conceptual Explanation: An ANC below 500/mm3 indicates severe agranulocytosis.
Clozapine must be discontinued immediately, and the patient must be monitored for
infection and not rechallenged.
3. Which of the following differentiates Bipolar I from Bipolar II disorder?
A. The occurrence of at least one full manic episode
B. The duration of hypomanic symptoms for at least 4 days
C. The presence of at least one major depressive episode
D. The severity of depressive symptoms
Answer: A
Conceptual Explanation: Bipolar I requires at least one manic episode (lasting at least 1
week or requiring hospitalization). Bipolar II requires at least one hypomanic episode and
one major depressive episode but never a full manic episode.
, 4. A patient taking Phenelzine (an MAOI) consumes aged cheese and red wine. Which
complication is the patient at highest risk for?
A. Serotonin syndrome
B. Hypertensive crisis
C. Neuroleptic malignant syndrome
D. Metabolic syndrome
Answer: B
Conceptual Explanation: MAOIs inhibit the breakdown of tyramine. Consuming high-
tyramine foods (like aged cheese) leads to a massive release of norepinephrine, causing a
hypertensive crisis.
5. In the treatment of PTSD, Prazosin is specifically used to target which symptom?
A. Nightmares and sleep disturbances
B. Flashbacks during the day
C. Hypervigilance
D. Avoidance behaviors
Answer: A
Conceptual Explanation: Prazosin is an alpha-1 adrenergic antagonist that crosses the
blood-brain barrier to reduce the sympathetic outflow associated with PTSD-related
nightmares.
