NR546 Actual Final Exam Prediction questions (All
correct answers, Already graded A+)
Question 1 What is the primary neurobiological mechanism of action of
brexanolone (Zulresso), an FDA-approved medication specifically
indicated for postpartum depression?
• A. Selective blockade of central dopamine D2 receptors
• B. Positive allosteric modulation of GABAA receptors via synthetic
allopregnanolone
• C. Irreversible inhibition of monoamine oxidase A
• D. Dual reuptake inhibition of serotonin and norepinephrine
Correct Answer: B. Positive allosteric modulation of GABAA
receptors via synthetic allopregnanolone
Detailed Rationale: Brexanolone is an intravenous formulation of
allopregnanolone, a neuroactive steroid that acts as a positive
allosteric modulator at GABAA receptors, rapidly restoring
inhibitory tone disrupted by postpartum hormonal shifts.
Question 2 Besides agranulocytosis, which life-threatening organ
toxicity requires urgent baseline evaluation and continuous monitoring
during clozapine therapy?
• A. Myocarditis and cardiomyopathy
, • B. Acute renal tubular necrosis
• C. Pulmonary fibrosis
• D. Chronic autoimmune hemolytic anemia
Correct Answer: A. Myocarditis and cardiomyopathy
Detailed Rationale: Clozapine carries a serious black box warning
for myocarditis and cardiomyopathy, most commonly occurring
within the first month of treatment, requiring baseline and
ongoing clinical monitoring for cardiac symptoms.
Question 3 Which clinical presentation is characteristic of early or mild-
to-moderate acute lithium toxicity?
• A. Flaccid paralysis, hypothermia, and absent deep tendon
reflexes
• B. Coarse hand tremor, persistent nausea, vomiting, diarrhea, and
ataxia
• C. Sudden onset hypertension, tachycardia, and mydriasis
• D. Profound hypoglycemia and metabolic alkalosis
Correct Answer: B. Coarse hand tremor, persistent nausea,
vomiting, diarrhea, and ataxia
Detailed Rationale: Early signs of lithium toxicity (levels typically
1.5–2.0 mEq/L) include gastrointestinal distress (nausea, vomiting,
diarrhea), coarse resting tremors, lethargy, muscle weakness, and
ataxia.
,Question 4 Which medication acts as a potent hepatic CYP450 enzyme
inducer, potentially decreasing the plasma concentration of co-
administered substrate drugs?
• A. Fluoxetine
• B. Carbamazepine
• C. Fluvoxamine
• D. Paroxetine
Correct Answer: B. Carbamazepine
Detailed Rationale: Carbamazepine is a well-established auto-
inducer and inducer of several CYP450 enzymes (including CYP3A4
and CYP2C9), accelerating the metabolic clearance of many
concurrent medications.
Question 5 High-potency first-generation antipsychotics (e.g.,
haloperidol) are characterized by which receptor-binding profile?
• A. High affinity for dopamine D2 receptors and low affinity for
muscarinic and histaminergic receptors
• B. High affinity for muscarinic acetylcholine and histaminergic H1
receptors
• C. Selective antagonism of serotonin 5-HT2A receptors with
minimal D2 activity
• D. Irreversible inhibition of catechol-O-methyltransferase
Correct Answer: A. High affinity for dopamine D2 receptors and
low affinity for muscarinic and histaminergic receptors
, Detailed Rationale: High-potency antipsychotics tightly bind to
D2 receptors at very low doses, resulting in a high risk of
extrapyramidal symptoms (EPS) but lower rates of sedation, dry
mouth, and weight gain due to minimal
anticholinergic/antihistaminergic activity.
Question 6 When a patient fails to achieve adequate response after two
distinct, appropriately dosed antidepressant trials, what is the most
appropriate next step in evidence-based management?
• A. Immediate termination of all psychiatric care
• B. Evaluating adherence and diagnosis, then considering switching
to a different class, augmentation strategies (e.g., atypical
antipsychotics), or neuromodulation
• C. Doubling the dose of the first failed SSRI indefinitely
• D. Initiating high-dose long-acting barbiturates
Correct Answer: B. Evaluating adherence and diagnosis, then
considering switching to a different class, augmentation strategies
(e.g., atypical antipsychotics), or neuromodulation
Detailed Rationale: Treatment-resistant depression requires a
systematic reassessment of diagnosis, adherence, and substance
use, followed by evidence-based steps like switching
antidepressants, augmenting with agents like aripiprazole or
quetiapine, or exploring ECT/TMS.
Question 7 In utero exposure to valproic acid during the first trimester
carries the highest relative risk for which major congenital
malformation?
correct answers, Already graded A+)
Question 1 What is the primary neurobiological mechanism of action of
brexanolone (Zulresso), an FDA-approved medication specifically
indicated for postpartum depression?
• A. Selective blockade of central dopamine D2 receptors
• B. Positive allosteric modulation of GABAA receptors via synthetic
allopregnanolone
• C. Irreversible inhibition of monoamine oxidase A
• D. Dual reuptake inhibition of serotonin and norepinephrine
Correct Answer: B. Positive allosteric modulation of GABAA
receptors via synthetic allopregnanolone
Detailed Rationale: Brexanolone is an intravenous formulation of
allopregnanolone, a neuroactive steroid that acts as a positive
allosteric modulator at GABAA receptors, rapidly restoring
inhibitory tone disrupted by postpartum hormonal shifts.
Question 2 Besides agranulocytosis, which life-threatening organ
toxicity requires urgent baseline evaluation and continuous monitoring
during clozapine therapy?
• A. Myocarditis and cardiomyopathy
, • B. Acute renal tubular necrosis
• C. Pulmonary fibrosis
• D. Chronic autoimmune hemolytic anemia
Correct Answer: A. Myocarditis and cardiomyopathy
Detailed Rationale: Clozapine carries a serious black box warning
for myocarditis and cardiomyopathy, most commonly occurring
within the first month of treatment, requiring baseline and
ongoing clinical monitoring for cardiac symptoms.
Question 3 Which clinical presentation is characteristic of early or mild-
to-moderate acute lithium toxicity?
• A. Flaccid paralysis, hypothermia, and absent deep tendon
reflexes
• B. Coarse hand tremor, persistent nausea, vomiting, diarrhea, and
ataxia
• C. Sudden onset hypertension, tachycardia, and mydriasis
• D. Profound hypoglycemia and metabolic alkalosis
Correct Answer: B. Coarse hand tremor, persistent nausea,
vomiting, diarrhea, and ataxia
Detailed Rationale: Early signs of lithium toxicity (levels typically
1.5–2.0 mEq/L) include gastrointestinal distress (nausea, vomiting,
diarrhea), coarse resting tremors, lethargy, muscle weakness, and
ataxia.
,Question 4 Which medication acts as a potent hepatic CYP450 enzyme
inducer, potentially decreasing the plasma concentration of co-
administered substrate drugs?
• A. Fluoxetine
• B. Carbamazepine
• C. Fluvoxamine
• D. Paroxetine
Correct Answer: B. Carbamazepine
Detailed Rationale: Carbamazepine is a well-established auto-
inducer and inducer of several CYP450 enzymes (including CYP3A4
and CYP2C9), accelerating the metabolic clearance of many
concurrent medications.
Question 5 High-potency first-generation antipsychotics (e.g.,
haloperidol) are characterized by which receptor-binding profile?
• A. High affinity for dopamine D2 receptors and low affinity for
muscarinic and histaminergic receptors
• B. High affinity for muscarinic acetylcholine and histaminergic H1
receptors
• C. Selective antagonism of serotonin 5-HT2A receptors with
minimal D2 activity
• D. Irreversible inhibition of catechol-O-methyltransferase
Correct Answer: A. High affinity for dopamine D2 receptors and
low affinity for muscarinic and histaminergic receptors
, Detailed Rationale: High-potency antipsychotics tightly bind to
D2 receptors at very low doses, resulting in a high risk of
extrapyramidal symptoms (EPS) but lower rates of sedation, dry
mouth, and weight gain due to minimal
anticholinergic/antihistaminergic activity.
Question 6 When a patient fails to achieve adequate response after two
distinct, appropriately dosed antidepressant trials, what is the most
appropriate next step in evidence-based management?
• A. Immediate termination of all psychiatric care
• B. Evaluating adherence and diagnosis, then considering switching
to a different class, augmentation strategies (e.g., atypical
antipsychotics), or neuromodulation
• C. Doubling the dose of the first failed SSRI indefinitely
• D. Initiating high-dose long-acting barbiturates
Correct Answer: B. Evaluating adherence and diagnosis, then
considering switching to a different class, augmentation strategies
(e.g., atypical antipsychotics), or neuromodulation
Detailed Rationale: Treatment-resistant depression requires a
systematic reassessment of diagnosis, adherence, and substance
use, followed by evidence-based steps like switching
antidepressants, augmenting with agents like aripiprazole or
quetiapine, or exploring ECT/TMS.
Question 7 In utero exposure to valproic acid during the first trimester
carries the highest relative risk for which major congenital
malformation?
