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ABPS Psychiatry study materials
ABPS Psychiatry study resources

ABPS Psychiatry practice questions

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Question 1Clinical Psychiatry

Which symptom is a required criterion for a major depressive episode?

  1. Grandiosity
  2. Auditory hallucinations
  3. Depressed mood or loss of interest/pleasure Correct answer.
  4. Flight of ideas

Explanation

A major depressive episode requires either depressed mood or anhedonia (loss of interest or pleasure) present most of the day, nearly every day, for at least two weeks, plus additional symptoms totaling five or more. Psychotic and manic features are not core requirements.

Question 2Clinical Psychiatry

The minimum duration of symptoms for a manic episode is:

  1. 1 month
  2. 1 week Correct answer.
  3. 2 weeks
  4. 4 days

Explanation

A manic episode requires elevated, expansive, or irritable mood with increased energy lasting at least one week (or any duration if hospitalization is needed). Four days is the threshold for hypomania.

Question 3Clinical Psychiatry

Which class of medication is first-line for generalized anxiety disorder?

  1. Benzodiazepines
  2. SSRIs Correct answer.
  3. Barbiturates
  4. Antipsychotics

Explanation

SSRIs (and SNRIs) are first-line pharmacotherapy for generalized anxiety disorder because of efficacy and favorable long-term safety. Benzodiazepines are reserved for short-term or adjunctive use due to dependence risk.

Question 4Clinical Psychiatry

A patient reports recurrent unexpected panic attacks with persistent worry about having another attack for two months. The most likely diagnosis is:

  1. Specific phobia
  2. Social anxiety disorder
  3. Agoraphobia
  4. Panic disorder Correct answer.

Explanation

Panic disorder is defined by recurrent unexpected panic attacks followed by at least one month of persistent concern about further attacks or maladaptive behavioral change. The attacks are not cued by a specific social or phobic stimulus.

Question 5Clinical Psychiatry

Which finding is characteristic of delirium rather than dementia?

  1. Preserved level of consciousness
  2. Stable course across the day
  3. Insidious onset over years
  4. Acute onset with fluctuating attention Correct answer.

Explanation

Delirium is distinguished by acute onset, fluctuating course, and impaired attention and awareness. Dementia typically has insidious progression with relatively preserved consciousness until late stages.

Question 6Clinical Psychiatry

Which symptom is most suggestive of schizophrenia rather than a mood disorder with psychotic features?

  1. Persecutory delusions
  2. Insomnia
  3. Psychosis occurring only during mood episodes
  4. First-rank auditory hallucinations Correct answer.

Explanation

Certain first-rank or bizarre phenomena, such as voices commenting or conversing, are more characteristic of schizophrenia. Psychosis confined to mood episodes suggests a mood disorder with psychotic features.

Question 7Clinical Psychiatry

Which feature best distinguishes anorexia nervosa from bulimia nervosa?

  1. Significantly low body weight Correct answer.
  2. Presence of binge eating
  3. Fear of weight gain
  4. Body image disturbance

Explanation

Anorexia nervosa requires significantly low body weight, whereas bulimia nervosa typically occurs in individuals at normal or above-normal weight. Both share fear of weight gain and body image disturbance.

Question 8Clinical Psychiatry

A patient with alcohol use disorder develops tremor, agitation, and hallucinations 48 hours after his last drink. The most likely diagnosis is:

  1. Alcohol withdrawal delirium Correct answer.
  2. Alcohol intoxication
  3. Wernicke encephalopathy
  4. Korsakoff syndrome

Explanation

Alcohol withdrawal delirium typically emerges 48 to 96 hours after cessation and includes tremor, autonomic hyperactivity, and hallucinations. Wernicke and Korsakoff syndromes relate to thiamine deficiency rather than acute withdrawal.

Question 9Clinical Psychiatry

Which medication is first-line for obsessive-compulsive disorder?

  1. A benzodiazepine
  2. Lithium
  3. A low-potency antipsychotic
  4. An SSRI Correct answer.

Explanation

SSRIs are first-line pharmacotherapy for OCD, often requiring higher doses and longer trials than in depression. Antipsychotics may be adjuncts but are not first-line monotherapy.

Question 10Clinical Psychiatry

Which of the following is a hallmark of post-traumatic stress disorder?

  1. Anhedonia without trauma exposure
  2. Persistent re-experiencing of the trauma Correct answer.
  3. Grandiose delusions
  4. Compulsive rituals

Explanation

PTSD requires exposure to a traumatic event followed by intrusive re-experiencing, avoidance, negative cognitions and mood, and hyperarousal. The other options belong to different diagnostic categories.

Question 11Clinical Psychiatry

Which factor most strongly increases the risk of suicide in a patient with depression?

  1. A prior suicide attempt Correct answer.
  2. Mild symptom severity
  3. Older age at first episode
  4. Female sex

Explanation

A prior suicide attempt is among the strongest predictors of completed suicide. Male sex, hopelessness, and comorbid substance use also raise risk, whereas mild severity lowers it.

Question 12Clinical Psychiatry

Which finding is consistent with neuroleptic malignant syndrome?

  1. Hypothermia and flaccidity
  2. Hyperthermia, rigidity, and elevated creatine kinase Correct answer.
  3. Serotonin excess with clonus
  4. Bradycardia and hypotension

Explanation

Neuroleptic malignant syndrome presents with hyperthermia, muscular rigidity, autonomic instability, and elevated creatine kinase after dopamine antagonist exposure. Clonus with hyperreflexia is more typical of serotonin syndrome.

Question 13Clinical Psychiatry

Which statement about tardive dyskinesia is correct?

  1. It resolves fully with dose escalation
  2. It involves involuntary orofacial movements after prolonged antipsychotic exposure Correct answer.
  3. It is unrelated to dopamine blockade
  4. It typically appears acutely within hours of a dose increase

Explanation

Tardive dyskinesia is a late-onset movement disorder, classically involuntary choreoathetoid movements of the face and tongue, associated with prolonged dopamine antagonist exposure. It may persist after drug discontinuation.

Question 14Clinical Psychiatry

Which feature is most characteristic of borderline personality disorder?

  1. Grandiosity and decreased need for sleep
  2. Unstable relationships and identity disturbance Correct answer.
  3. Pervasive suspiciousness of others
  4. Chronic social detachment and restricted affect

Explanation

Borderline personality disorder is marked by instability in interpersonal relationships, self-image, and affect, along with impulsivity. The other options describe schizoid, manic, and paranoid features respectively.

Question 15Clinical Psychiatry

Which symptom is required for a diagnosis of attention-deficit/hyperactivity disorder?

  1. Psychotic symptoms
  2. Symptoms present before age 12 Correct answer.
  3. Onset in adulthood
  4. Episodic course

Explanation

ADHD requires several symptoms present before age 12, in multiple settings, causing impairment. The course is persistent rather than episodic, and psychosis is not part of the disorder.

Question 16Clinical Psychiatry

Which medication requires monitoring of absolute neutrophil count due to agranulocytosis risk?

  1. Fluoxetine
  2. Lorazepam
  3. Lithium
  4. Clozapine Correct answer.

Explanation

Clozapine carries a risk of severe neutropenia and agranulocytosis, requiring regular absolute neutrophil count monitoring. The other agents do not require this specific monitoring.

Question 17Clinical Psychiatry

A patient with bipolar I disorder on lithium presents with tremor, ataxia, vomiting, and a lithium level of 2.5 mEq/L. The most appropriate immediate step is:

  1. Add an SSRI
  2. Hold lithium and provide supportive care Correct answer.
  3. Reassure the patient and continue the current dose
  4. Increase the lithium dose

Explanation

A lithium level of 2.5 mEq/L with neurologic and gastrointestinal symptoms indicates toxicity; management includes holding the drug and supportive care, with hemodialysis in severe cases. Continuing or increasing the dose would worsen toxicity.

Question 18Clinical Psychiatry

Which finding most suggests serotonin syndrome rather than neuroleptic malignant syndrome?

  1. Marked bradykinesia
  2. Bradyreflexia
  3. Lead-pipe rigidity
  4. Hyperreflexia and clonus Correct answer.

Explanation

Serotonin syndrome is characterized by neuromuscular hyperactivity, including hyperreflexia and clonus, often with agitation and autonomic instability. NMS features lead-pipe rigidity and bradyreflexia.

Question 19Clinical Psychiatry

Which feature distinguishes bipolar II disorder from bipolar I disorder?

  1. Presence of hypomanic and depressive episodes without mania Correct answer.
  2. Absence of depressive episodes
  3. Presence of psychotic features
  4. Presence of full manic episodes

Explanation

Bipolar II disorder involves hypomanic episodes and major depressive episodes but never a full manic episode. Bipolar I requires at least one manic episode, which may include psychosis.

Question 20Clinical Psychiatry

Which treatment is first-line for a patient with moderate-to-severe major depressive disorder?

  1. Antidepressant medication or psychotherapy Correct answer.
  2. Atypical antipsychotic monotherapy
  3. Long-term benzodiazepine therapy
  4. Electroconvulsive therapy

Explanation

For moderate-to-severe depression, antidepressants and evidence-based psychotherapy are first-line, alone or combined. ECT is reserved for severe, refractory, or life-threatening cases.

Question 21Clinical Psychiatry

Which symptom cluster is characteristic of somatic symptom disorder?

  1. Intentional production of symptoms for external gain
  2. Deliberate falsification of illness
  3. Excessive thoughts and anxiety about physical symptoms Correct answer.
  4. Symptoms fully explained by a medical condition

Explanation

Somatic symptom disorder involves disproportionate thoughts, feelings, and behaviors about physical symptoms causing distress. Intentional production or falsification suggests factitious disorder or malingering.

Question 22Clinical Psychiatry

Which is a core feature of illness anxiety disorder?

  1. Complete absence of health anxiety
  2. Presence of delusional parasitosis
  3. Intentional symptom fabrication
  4. Preoccupation with having a serious illness despite minimal symptoms Correct answer.

Explanation

Illness anxiety disorder is characterized by preoccupation with having or acquiring a serious illness with few or no somatic symptoms, plus high health anxiety. It does not involve intentional fabrication.

Question 23Clinical Psychiatry

Which finding is most consistent with an acute dystonic reaction?

  1. Sustained muscle spasm of the neck or eyes Correct answer.
  2. Gradual cognitive decline
  3. Serotonin excess with hyperthermia
  4. Late-onset lip smacking

Explanation

Acute dystonia presents with sustained muscle contractions, such as torticollis or oculogyric crisis, typically within hours to days of starting a dopamine antagonist. It responds to anticholinergics.

Question 24Clinical Psychiatry

A patient with schizophrenia has been stable on antipsychotics and develops high fever, muscle rigidity, and altered mental status after a dose increase. Which is the best next step?

  1. Stop the antipsychotic and initiate supportive care Correct answer.
  2. Add a second antipsychotic
  3. Increase the dose further
  4. Continue the same dose and observe

Explanation

The presentation suggests neuroleptic malignant syndrome, a medical emergency; the offending agent should be stopped and supportive care, including cooling and hydration, initiated. Continuing or escalating antipsychotics is dangerous.

Question 25Clinical Psychiatry

Which is the recommended initial approach for a patient with opioid use disorder?

  1. Buprenorphine or methadone maintenance Correct answer.
  2. Disulfiram
  3. Acamprosate
  4. Naltrexone only

Explanation

Opioid agonist therapy with buprenorphine or methadone is first-line for opioid use disorder, reducing cravings and withdrawal and improving outcomes. Disulfiram and acamprosate are used for alcohol use disorder.

Question 26Clinical Psychiatry

Which symptom is most characteristic of a major depressive episode according to DSM-5 criteria?

  1. Persistent auditory hallucinations
  2. Anhedonia or depressed mood nearly every day Correct answer.
  3. Flight of ideas
  4. Grandiosity

Explanation

A major depressive episode requires either depressed mood or markedly diminished interest/pleasure (anhedonia) for at least two weeks, plus additional symptoms. Flight of ideas, grandiosity, and hallucinations are features of mania or psychosis, not core depression.

Question 27Clinical Psychiatry

A patient with panic disorder reports sudden episodes of intense fear with palpitations, diaphoresis, and a sense of impending doom. Which class of medication is considered first-line for long-term management?

  1. Beta-blockers
  2. Selective serotonin reuptake inhibitors Correct answer.
  3. Antipsychotics
  4. Benzodiazepines as monotherapy

Explanation

SSRIs are first-line pharmacotherapy for panic disorder, along with cognitive behavioral therapy. Benzodiazepines may be used short-term but are not preferred for long-term monotherapy due to dependence risk.

Question 28Clinical Psychiatry

Which feature is most consistent with a diagnosis of generalized anxiety disorder?

  1. Fear of a specific object or situation
  2. A distinct period of elevated mood lasting one week
  3. Excessive worry across multiple domains for at least six months Correct answer.
  4. Recurrent unexpected panic attacks

Explanation

Generalized anxiety disorder is characterized by excessive, pervasive worry about multiple areas of life occurring more days than not for at least six months. Panic attacks, specific phobias, and manic episodes describe other disorders.

Question 29Clinical Psychiatry

Which symptom is a negative symptom of schizophrenia?

  1. Hallucinations
  2. Disorganized speech
  3. Avolition Correct answer.
  4. Delusions

Explanation

Negative symptoms reflect a loss of normal function and include avolition, alogia, anhedonia, and affective flattening. Delusions, hallucinations, and disorganized speech are positive symptoms.

Question 30Clinical Psychiatry

Which statement best describes the mechanism of action of selective serotonin reuptake inhibitors?

  1. They block dopamine D2 receptors
  2. They block reuptake of serotonin at the presynaptic transporter Correct answer.
  3. They block voltage-gated sodium channels
  4. They inhibit monoamine oxidase

Explanation

SSRIs increase synaptic serotonin by blocking the serotonin transporter on the presynaptic neuron, preventing reuptake. D2 blockade, MAO inhibition, and sodium channel blockade describe other drug classes.

Question 31Clinical Psychiatry

Which feature is most characteristic of delirium?

  1. Stable fixed delusions
  2. Chronic stable personality traits
  3. Gradual progressive memory loss over years
  4. Acute onset with fluctuating attention and awareness Correct answer.

Explanation

Delirium is an acute, fluctuating disturbance of attention and awareness, often due to a medical cause. Gradual decline suggests dementia, while fixed delusions and stable personality traits describe other conditions.

Question 32Clinical Psychiatry

Which finding is most consistent with bulimia nervosa?

  1. Body weight markedly below the minimum normal for age
  2. Absence of concern about body shape or weight
  3. Recurrent binge eating followed by compensatory behaviors with body weight often in the normal range Correct answer.
  4. Binge eating without any compensatory behavior

Explanation

Bulimia nervosa involves recurrent binge-purge episodes, and individuals often maintain a normal or near-normal weight. Low body weight is characteristic of anorexia nervosa, and binge eating disorder lacks compensatory behaviors.

Question 33Clinical Psychiatry

Which symptom is most suggestive of a manic episode?

  1. Excessive worry about multiple life domains
  2. Recurrent intrusive thoughts
  3. Decreased need for sleep with increased goal-directed activity Correct answer.
  4. Anhedonia with psychomotor retardation

Explanation

Mania includes decreased need for sleep, increased energy and goal-directed activity, grandiosity, and pressured speech. Anhedonia, generalized worry, and intrusive thoughts belong to other disorders.

Question 34Clinical Psychiatry

A 28-year-old with schizophrenia develops a high fever, muscle rigidity, autonomic instability, and elevated creatine kinase two days after starting a new antipsychotic. Which condition is most likely?

  1. Tardive dyskinesia
  2. Serotonin syndrome
  3. Neuroleptic malignant syndrome Correct answer.
  4. Acute dystonic reaction

Explanation

Neuroleptic malignant syndrome presents with fever, rigidity, autonomic instability, and elevated CK after antipsychotic exposure. Serotonin syndrome follows serotonergic agents and features clonus and hyperreflexia, while dystonia and tardive dyskinesia lack these systemic features.

Question 35Clinical Psychiatry

A patient with bipolar I disorder on lithium has a level of 1.8 mEq/L, coarse tremor, ataxia, and vomiting. What is the most appropriate immediate management?

  1. Increase the lithium dose
  2. Hold lithium and provide supportive care with intravenous fluids Correct answer.
  3. Start an SSRI
  4. Reassure the patient and continue the current dose

Explanation

A lithium level above the therapeutic range with neurologic and gastrointestinal symptoms indicates toxicity; the drug should be held and supportive care with fluids provided. Increasing the dose or continuing it would worsen toxicity.

Question 36Clinical Psychiatry

A patient with obsessive-compulsive disorder has not responded adequately to an SSRI at maximum tolerated dose after 12 weeks. Which augmentation or alternative strategy is most evidence-based?

  1. Add a second SSRI
  2. Switch to a benzodiazepine
  3. Start lithium monotherapy
  4. Add low-dose antipsychotic augmentation Correct answer.

Explanation

For OCD refractory to SSRIs, adding a low-dose antipsychotic is an evidence-based augmentation strategy. Combining two SSRIs increases serotonergic risk without proven benefit, and benzodiazepines or lithium monotherapy are not first-line for OCD.

Question 37Clinical Psychiatry

A patient with alcohol use disorder is admitted and develops autonomic hyperactivity, tremor, and seizures 24 hours after his last drink. Which medication is first-line for managing this withdrawal?

  1. SSRIs
  2. Naltrexone
  3. Benzodiazepines Correct answer.
  4. Antipsychotics alone

Explanation

Benzodiazepines are the mainstay of alcohol withdrawal management because they reduce seizure risk and autonomic symptoms. SSRIs, antipsychotics alone, and naltrexone do not treat acute withdrawal.

Question 38Clinical Psychiatry

A patient with depression is started on an MAOI. Which dietary instruction is essential?

  1. Avoid drinking water with meals
  2. Avoid foods high in tyramine such as aged cheese and cured meats Correct answer.
  3. Avoid vitamin C
  4. Avoid all green vegetables

Explanation

MAOIs can precipitate a hypertensive crisis when combined with tyramine-rich foods, so aged cheese, cured meats, and similar foods should be avoided. The other restrictions are not related to MAOI safety.

Question 39Clinical Psychiatry

Which feature best distinguishes post-traumatic stress disorder from acute stress disorder?

  1. Presence of intrusive memories
  2. Presence of hyperarousal
  3. Presence of avoidance behavior
  4. Duration of symptoms exceeding one month Correct answer.

Explanation

Acute stress disorder and PTSD share intrusive, avoidant, and hyperarousal symptoms; the key distinction is duration, with PTSD requiring symptoms lasting more than one month. Intrusion, avoidance, and hyperarousal occur in both.

Question 40Clinical Psychiatry

A patient with schizophrenia is maintained on clozapine and develops fever and sore throat. What is the most appropriate next step?

  1. Double the clozapine dose
  2. Add an SSRI
  3. Obtain an absolute neutrophil count and hold clozapine if neutropenia is present Correct answer.
  4. Reassure the patient and continue unchanged

Explanation

Clozapine can cause agranulocytosis, so fever or sore throat warrants urgent ANC measurement and holding the drug if neutropenia is found. Dose increases or continuing unchanged could be dangerous.

Question 41Clinical Psychiatry

Which finding most suggests a diagnosis of somatic symptom disorder rather than factitious disorder?

  1. External incentive such as financial gain
  2. Intentional induction of injury
  3. Deliberate fabrication of symptoms for a sick role
  4. Genuine distress about symptoms without evidence of intentional deception Correct answer.

Explanation

Somatic symptom disorder involves genuine distress and excessive concern about symptoms without intentional production. Factitious disorder and malingering involve deliberate deception or external incentives.

Question 42Clinical Psychiatry

A patient with borderline personality disorder engages in recurrent self-harm. Which psychotherapy has the strongest evidence for reducing self-harm in this population?

  1. Supportive therapy alone
  2. Psychoanalysis
  3. Electroconvulsive therapy
  4. Dialectical behavior therapy Correct answer.

Explanation

Dialectical behavior therapy is well established for reducing self-harm and improving emotion regulation in borderline personality disorder. The other modalities lack comparable evidence for this specific outcome.

Question 43Clinical Psychiatry

A child has persistent inattention and hyperactivity across home and school settings, with symptoms present before age 12. Which diagnosis is most appropriate?

  1. Autism spectrum disorder
  2. Attention-deficit/hyperactivity disorder Correct answer.
  3. Conduct disorder
  4. Separation anxiety disorder

Explanation

ADHD requires developmentally inappropriate inattention and/or hyperactivity-impulsivity in multiple settings with onset before age 12. Autism, conduct disorder, and separation anxiety have different core features.

Question 44Clinical Psychiatry

Which medication is used for opioid use disorder maintenance and reduces craving and withdrawal?

  1. Haloperidol
  2. Fluoxetine
  3. Diazepam
  4. Buprenorphine Correct answer.

Explanation

Buprenorphine, a partial opioid agonist, reduces craving and withdrawal and is used for maintenance treatment of opioid use disorder. The other agents do not treat opioid dependence.

Question 45Clinical Psychiatry

A patient with anorexia nervosa has a BMI of 14, bradycardia, and hypothermia. What is the most appropriate initial step in management?

  1. Start an SSRI as monotherapy
  2. Begin high-dose laxatives
  3. Initiate nutritional rehabilitation with careful monitoring for refeeding syndrome Correct answer.
  4. Recommend outpatient dieting

Explanation

Severely underweight patients with medical instability require structured nutritional rehabilitation with monitoring for refeeding syndrome. SSRIs are not effective in the underweight phase, and laxatives or continued dieting are harmful.

Question 46Clinical Psychiatry

A patient with bipolar depression is started on an antidepressant without a mood stabilizer. Which complication is most concerning?

  1. Agranulocytosis
  2. Induction of a manic episode or rapid cycling Correct answer.
  3. Serotonin syndrome
  4. Nephrogenic diabetes insipidus

Explanation

Antidepressant monotherapy in bipolar disorder can precipitate mania or accelerate cycling, so a mood stabilizer is typically required. Serotonin syndrome, agranulocytosis, and diabetes insipidus relate to other drugs or complications.

Question 47Clinical Psychiatry

A patient with schizophrenia has been stable for years but develops involuntary facial movements after long-term antipsychotic use. Which statement about management is most accurate?

  1. The condition is unrelated to antipsychotic exposure
  2. Increasing the antipsychotic dose is a definitive cure
  3. Tardive dyskinesia may persist after drug discontinuation, and switching to an atypical agent such as clozapine may be considered Correct answer.
  4. The movements always resolve within 24 hours of stopping the drug

Explanation

Tardive dyskinesia can be persistent and is associated with prolonged dopamine blockade; management includes reassessing the antipsychotic and considering agents like clozapine. It does not typically resolve within a day, and dose increases are not a cure.

Question 48Clinical Psychiatry

A patient with severe depression has psychotic features and refuses oral intake. Which treatment is most appropriate?

  1. Electroconvulsive therapy Correct answer.
  2. Observation without treatment
  3. Recommend psychotherapy alone
  4. Start an SSRI and reassess in six weeks

Explanation

Psychotic depression with severe functional impairment or refusal of intake is an indication for ECT, which is rapid and effective. Waiting for an SSRI or using psychotherapy alone is inadequate in this acute setting.

Question 49Clinical Psychiatry

A patient presents with tachycardia, hypertension, mydriasis, diaphoresis, and agitation after using cocaine. Which management approach is most appropriate?

  1. Supportive care with benzodiazepines for agitation and monitoring Correct answer.
  2. Immediate administration of a long-acting antipsychotic depot
  3. Forced hydration with diuretics
  4. Rapid opioid antagonist administration

Explanation

Acute cocaine intoxication is managed with supportive care, benzodiazepines for agitation and autonomic symptoms, and monitoring. Depot antipsychotics, opioid antagonists, and forced diuresis are not indicated.

Question 50Clinical Psychiatry

A patient with obsessive-compulsive disorder reports intrusive thoughts that he tries to suppress by repeated handwashing. Which statement best describes the cognitive model of this behavior?

  1. The handwashing directly eliminates the intrusive thoughts permanently
  2. The compulsion has no relationship to anxiety
  3. The intrusive thoughts are voluntarily produced for attention
  4. The handwashing temporarily reduces anxiety, negatively reinforcing the compulsion Correct answer.

Explanation

In OCD, compulsions are negatively reinforced because they temporarily reduce anxiety caused by obsessions, which maintains the cycle. Compulsions do not permanently eliminate obsessions, and they are not produced for attention.