NR 606 MIDTERM EXAM: DIAGNOSIS &
MANAGEMENT IN PSYCHIATRIC
MENTAL HEALTH II
1. A 28-year-old female presents with recurrent episodes of intense fear, heart palpitations,
and shortness of breath that peak within 10 minutes. She now avoids crowded places for fear
of having another attack. Which is the most appropriate first-line pharmacological
intervention for long-term management?
A. Alprazolam 0.5 mg as needed for acute symptoms
B. Propranolol 20 mg twice daily
C. Fluoxetine 10 mg daily, titrated as tolerated
D. Buspirone 15 mg twice daily
Answer: C
Conceptual Explanation: Selective Serotonin Reuptake Inhibitors (SSRIs) like Fluoxetine
are considered first-line for Panic Disorder with or without Agoraphobia. Benzodiazepines
(Alprazolam) are not first-line for long-term management due to dependence risks, and
Buspirone is generally ineffective for Panic Disorder.
,2. A 9-year-old male is brought in by his parents due to frequent temper outbursts that occur
3-4 times a week, and he is persistently irritable between outbursts. These symptoms have
lasted for 14 months in multiple settings. What is the most likely diagnosis?
A. Disruptive Mood Dysregulation Disorder (DMDD)
B. Oppositional Defiant Disorder (ODD)
C. Bipolar I Disorder
D. Intermittent Explosive Disorder
Answer: A
Conceptual Explanation: DMDD is characterized by severe recurrent temper outbursts
and persistent irritability between outbursts for at least 12 months, with onset before age
10. Bipolar I requires distinct manic episodes, which are absent here.
3. Which neurobiological pathway is primarily associated with the positive symptoms of
schizophrenia, such as hallucinations and delusions?
A. Mesocortical pathway
B. Mesolimbic pathway
C. Tuberoinfundibular pathway
D. Nigrostriatal pathway
Answer: B
, Conceptual Explanation: Hyperactivity of dopamine in the mesolimbic pathway is
associated with positive symptoms of schizophrenia. The mesocortical pathway is
associated with negative symptoms, nigrostriatal with motor side effects, and
tuberoinfundibular with prolactin regulation.
4. A patient taking Clozapine presents for a routine check-up. The Absolute Neutrophil Count
(ANC) is 1,200/mm³. According to the Clozapine REMS program, what is the required action?
A. Continue treatment with no changes to monitoring
B. Continue treatment but increase monitoring frequency to three times weekly
C. Interrupt treatment and consult a hematologist
D. Permanently discontinue Clozapine and never rechallenge
Answer: B
Conceptual Explanation: For a general population patient, an ANC between 1,000 and
1,499/mm³ (Mild Neutropenia) requires continuing treatment but increasing monitoring
to three times weekly until the ANC is ≥ 1,500/mm³.
5. Which of the following antidepressants is contraindicated in a patient with a history of
Bulimia Nervosa or a seizure disorder?
A. Sertraline
B. Venlafaxine
C. Bupropion
MANAGEMENT IN PSYCHIATRIC
MENTAL HEALTH II
1. A 28-year-old female presents with recurrent episodes of intense fear, heart palpitations,
and shortness of breath that peak within 10 minutes. She now avoids crowded places for fear
of having another attack. Which is the most appropriate first-line pharmacological
intervention for long-term management?
A. Alprazolam 0.5 mg as needed for acute symptoms
B. Propranolol 20 mg twice daily
C. Fluoxetine 10 mg daily, titrated as tolerated
D. Buspirone 15 mg twice daily
Answer: C
Conceptual Explanation: Selective Serotonin Reuptake Inhibitors (SSRIs) like Fluoxetine
are considered first-line for Panic Disorder with or without Agoraphobia. Benzodiazepines
(Alprazolam) are not first-line for long-term management due to dependence risks, and
Buspirone is generally ineffective for Panic Disorder.
,2. A 9-year-old male is brought in by his parents due to frequent temper outbursts that occur
3-4 times a week, and he is persistently irritable between outbursts. These symptoms have
lasted for 14 months in multiple settings. What is the most likely diagnosis?
A. Disruptive Mood Dysregulation Disorder (DMDD)
B. Oppositional Defiant Disorder (ODD)
C. Bipolar I Disorder
D. Intermittent Explosive Disorder
Answer: A
Conceptual Explanation: DMDD is characterized by severe recurrent temper outbursts
and persistent irritability between outbursts for at least 12 months, with onset before age
10. Bipolar I requires distinct manic episodes, which are absent here.
3. Which neurobiological pathway is primarily associated with the positive symptoms of
schizophrenia, such as hallucinations and delusions?
A. Mesocortical pathway
B. Mesolimbic pathway
C. Tuberoinfundibular pathway
D. Nigrostriatal pathway
Answer: B
, Conceptual Explanation: Hyperactivity of dopamine in the mesolimbic pathway is
associated with positive symptoms of schizophrenia. The mesocortical pathway is
associated with negative symptoms, nigrostriatal with motor side effects, and
tuberoinfundibular with prolactin regulation.
4. A patient taking Clozapine presents for a routine check-up. The Absolute Neutrophil Count
(ANC) is 1,200/mm³. According to the Clozapine REMS program, what is the required action?
A. Continue treatment with no changes to monitoring
B. Continue treatment but increase monitoring frequency to three times weekly
C. Interrupt treatment and consult a hematologist
D. Permanently discontinue Clozapine and never rechallenge
Answer: B
Conceptual Explanation: For a general population patient, an ANC between 1,000 and
1,499/mm³ (Mild Neutropenia) requires continuing treatment but increasing monitoring
to three times weekly until the ANC is ≥ 1,500/mm³.
5. Which of the following antidepressants is contraindicated in a patient with a history of
Bulimia Nervosa or a seizure disorder?
A. Sertraline
B. Venlafaxine
C. Bupropion
