1. A 25-year-old presents with a 2-week history of
depressed mood, anhedonia, sleep disturbance,
decreased appetite, and feelings of
worthlessness. Most likely diagnosis?
A. Adjustment disorder with depressed mood
B. Dysthymia (Persistent depressive disorder)
C. Major depressive disorder, single episode
D. Cyclothymic disorder
Answer: C.
Rationale: Duration ≥2 weeks with core depressive
features and marked impairment meets criteria for major
depressive disorder. Adjustment disorder is <6 months
and less severe; dysthymia lasts ≥2 years; cyclothymia
involves hypomanic and depressive symptoms.
2. Which rating scale is most appropriate to quantify
severity of mania?
A. Hamilton Depression Rating Scale
B. Young Mania Rating Scale
C. Beck Anxiety Inventory
D. Mini-Mental State Examination
Answer: B.
Rationale: The Young Mania Rating Scale (YMRS) is
specifically designed to assess and quantify manic
symptom severity.
3. In mental status exam, “flight of ideas” refers to:
A. Rapid shifting between loosely connected topics
, B. Repeating the same phrase multiple times
C. Feeling that thoughts are withdrawn
D. Insertion of thoughts by external force
Answer: A.
Rationale: Flight of ideas is rapid speech with abrupt topic
changes based on superficial associations—common in
mania.
4. The best initial screening tool for alcohol use in
primary care is:
A. CAGE questionnaire
B. MMPI
C. PHQ-9
D. GAD-7
Answer: A.
Rationale: CAGE is a brief, validated 4-item screen for
problematic alcohol use.
5. Which of the following neuroimaging findings is
most characteristic of Alzheimer’s disease?
A. Enlarged ventricles and cortical atrophy, especially
hippocampal
B. Basal ganglia hyperintensities
C. Focal temporal lobe lesion
D. Cerebellar atrophy
Answer: A.
Rationale: Alzheimer’s shows diffuse cortical atrophy with
early hippocampal volume loss and secondary ventricular
enlargement.
, 6. A “loose association” thought process is best
described as:
A. Thoughts connected by rhyme rather than meaning
B. Complete derailment of logical connections
C. Repeated stuck thoughts
D. Fixed irrational beliefs
Answer: B.
Rationale: Loose associations (derailment) are marked by
illogical or disjointed leaps in thought, typical in
schizophrenia spectrum disorders.
7. Which personality disorder is characterized by
grandiosity, need for admiration, and lack of
empathy?
A. Borderline
B. Narcissistic
C. Histrionic
D. Antisocial
Answer: B.
Rationale: Narcissistic personality disorder core features
include grandiosity, entitlement, and empathy deficits.
8. Best next step for a patient with suspiciousness,
social withdrawal, and odd beliefs lasting 6
months but not meeting psychosis criteria?
A. Diagnose schizophrenia
B. Diagnose schizotypal personality disorder
C. Prescribe haloperidol
D. Refer for electroconvulsive therapy
depressed mood, anhedonia, sleep disturbance,
decreased appetite, and feelings of
worthlessness. Most likely diagnosis?
A. Adjustment disorder with depressed mood
B. Dysthymia (Persistent depressive disorder)
C. Major depressive disorder, single episode
D. Cyclothymic disorder
Answer: C.
Rationale: Duration ≥2 weeks with core depressive
features and marked impairment meets criteria for major
depressive disorder. Adjustment disorder is <6 months
and less severe; dysthymia lasts ≥2 years; cyclothymia
involves hypomanic and depressive symptoms.
2. Which rating scale is most appropriate to quantify
severity of mania?
A. Hamilton Depression Rating Scale
B. Young Mania Rating Scale
C. Beck Anxiety Inventory
D. Mini-Mental State Examination
Answer: B.
Rationale: The Young Mania Rating Scale (YMRS) is
specifically designed to assess and quantify manic
symptom severity.
3. In mental status exam, “flight of ideas” refers to:
A. Rapid shifting between loosely connected topics
, B. Repeating the same phrase multiple times
C. Feeling that thoughts are withdrawn
D. Insertion of thoughts by external force
Answer: A.
Rationale: Flight of ideas is rapid speech with abrupt topic
changes based on superficial associations—common in
mania.
4. The best initial screening tool for alcohol use in
primary care is:
A. CAGE questionnaire
B. MMPI
C. PHQ-9
D. GAD-7
Answer: A.
Rationale: CAGE is a brief, validated 4-item screen for
problematic alcohol use.
5. Which of the following neuroimaging findings is
most characteristic of Alzheimer’s disease?
A. Enlarged ventricles and cortical atrophy, especially
hippocampal
B. Basal ganglia hyperintensities
C. Focal temporal lobe lesion
D. Cerebellar atrophy
Answer: A.
Rationale: Alzheimer’s shows diffuse cortical atrophy with
early hippocampal volume loss and secondary ventricular
enlargement.
, 6. A “loose association” thought process is best
described as:
A. Thoughts connected by rhyme rather than meaning
B. Complete derailment of logical connections
C. Repeated stuck thoughts
D. Fixed irrational beliefs
Answer: B.
Rationale: Loose associations (derailment) are marked by
illogical or disjointed leaps in thought, typical in
schizophrenia spectrum disorders.
7. Which personality disorder is characterized by
grandiosity, need for admiration, and lack of
empathy?
A. Borderline
B. Narcissistic
C. Histrionic
D. Antisocial
Answer: B.
Rationale: Narcissistic personality disorder core features
include grandiosity, entitlement, and empathy deficits.
8. Best next step for a patient with suspiciousness,
social withdrawal, and odd beliefs lasting 6
months but not meeting psychosis criteria?
A. Diagnose schizophrenia
B. Diagnose schizotypal personality disorder
C. Prescribe haloperidol
D. Refer for electroconvulsive therapy
