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OMSB Psychiatry (OEPSY) study materials
OMSB Psychiatry (OEPSY) study resources

OMSB Psychiatry (OEPSY) practice questions

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Question 1Psychiatry

A 24-year-old man is brought to the emergency department with agitation, dilated pupils, sweating, and a heart rate of 128 bpm. He reports heavy cocaine use in the past 12 hours. Which finding best distinguishes cocaine intoxication from acute alcohol withdrawal?

  1. Dilated pupils with sweating and tachycardia Correct answer.
  2. Tachycardia with hypertension
  3. Tremor with global confusion
  4. Agitation with insomnia

Explanation

Cocaine is a sympathomimetic, so intoxication produces mydriasis, diaphoresis, tachycardia and hypertension. Alcohol withdrawal also causes autonomic hyperactivity, but pupils are typically normal or only mildly dilated and tremor with clouding of consciousness is more prominent. The combination of markedly dilated pupils with sympathomimetic signs therefore points to stimulant intoxication.

Question 2Psychiatry

Which clinical feature is most characteristic of delirium as defined in psychiatric assessment?

  1. Stable low mood with preserved orientation for months
  2. Fluctuating disturbance of attention and awareness with acute onset Correct answer.
  3. Fixed delusional beliefs with clear consciousness
  4. Progressive memory loss over several years with intact attention

Explanation

Delirium is defined by an acute, fluctuating disturbance of attention and awareness, usually with a change in cognition, and it develops over hours to days. Preserved consciousness and chronic stable course argue against it. Recognising the fluctuating attentional deficit is essential because delirium is a medical emergency.

Question 3Psychiatry

A 30-year-old woman with schizophrenia has been adherent to risperidone for 6 months. She now has a temperature of 39.2°C, severe muscle rigidity, confusion, and a creatine kinase of 4,500 U/L. Which diagnosis is most likely?

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

Explanation

Neuroleptic malignant syndrome is characterised by hyperthermia, lead-pipe rigidity, autonomic instability, altered consciousness and markedly raised creatine kinase after dopamine antagonist exposure. Serotonin syndrome instead shows hyperreflexia, clonus and tremor. The rigidity and extreme CK elevation here favour NMS.

Question 4Psychiatry

Which antidepressant class requires a tyramine-restricted diet to prevent hypertensive crisis?

  1. Selective serotonin reuptake inhibitors
  2. Tricyclic antidepressants
  3. Irreversible monoamine oxidase inhibitors Correct answer.
  4. Noradrenergic and specific serotonergic antidepressants

Explanation

Irreversible MAO inhibitors block monoamine oxidase in the gut, so dietary tyramine is not broken down and can trigger a hypertensive crisis. This is the classic 'cheese reaction'. Reversible inhibitors and other antidepressant classes do not require this restriction at usual doses.

Question 5Psychiatry

A 22-year-old student has recurrent unexpected episodes of palpitations, choking and fear of dying lasting 10 minutes, with normal cardiac workup. Between attacks she worries persistently about having another. Which diagnosis fits best?

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

Explanation

Recurrent unexpected panic attacks followed by at least one month of persistent concern about further attacks or their consequences define panic disorder. Generalised anxiety disorder involves chronic diffuse worry rather than discrete attacks. The unexpected, spontaneous nature of the episodes is the key discriminator.

Question 6Psychiatry

Which finding is required for a diagnosis of schizophrenia under ICD criteria regarding duration of symptoms?

  1. Symptoms for at least two weeks only
  2. Continuous signs of the disturbance for at least one month Correct answer.
  3. Symptoms for at least six months continuously
  4. A single brief episode lasting less than 24 hours

Explanation

ICD-10 requires at least one month of characteristic symptoms for schizophrenia, while DSM-5 requires continuous disturbance for six months including one month of active symptoms. A brief episode under one month would instead suggest acute and transient psychotic disorder. Duration criteria help separate schizophrenia from brief psychotic disorder.

Question 7Psychiatry

A 45-year-old man with bipolar I disorder on lithium presents with coarse tremor, vomiting, ataxia and confusion. Which is the most appropriate immediate step?

  1. Add a selective serotonin reuptake inhibitor
  2. Increase the lithium dose to stabilise mood
  3. Reassure him that coarse tremor is a benign early side effect
  4. Withhold lithium, check the serum level, and arrange urgent medical assessment Correct answer.

Explanation

Coarse tremor, vomiting, ataxia and confusion suggest lithium toxicity, which can be life-threatening and requires holding the drug, measuring the level and urgent medical management including hydration and possibly dialysis. Fine tremor may occur at therapeutic levels, but neurological signs indicate toxicity. Continuing or increasing lithium would worsen the picture.

Question 8Psychiatry

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

  1. They block postsynaptic dopamine D2 receptors
  2. They block the serotonin transporter, increasing synaptic serotonin over weeks Correct answer.
  3. They antagonise histamine H1 receptors to produce sedation
  4. They irreversibly inhibit monoamine oxidase type A

Explanation

SSRIs inhibit the presynaptic serotonin transporter (SERT), raising extracellular serotonin; clinical benefit emerges over weeks through downstream neuroplastic changes. They do not act on monoamine oxidase or dopamine receptors. Understanding this mechanism explains both their efficacy and their serotonergic adverse effects.

Question 9Psychiatry

A 19-year-old woman has a body mass index of 15.5, intense fear of weight gain, and amenorrhoea, and restricts food intake. Which feature most strongly supports anorexia nervosa over bulimia nervosa?

  1. Significantly low body weight Correct answer.
  2. Preoccupation with body shape
  3. Recurrent binge eating
  4. Self-induced vomiting

Explanation

Anorexia nervosa is distinguished from bulimia nervosa by significantly low body weight; bulimia nervosa usually occurs at normal or above-normal weight. Binge eating, purging and shape preoccupation can occur in both. The weight criterion is therefore the key discriminator.

Question 10Psychiatry

Which medication is first-line for maintenance treatment of opioid use disorder according to current evidence?

  1. Diazepam for withdrawal symptoms
  2. Buprenorphine or methadone as opioid agonist therapy Correct answer.
  3. Naltrexone alone without detoxification
  4. Haloperidol for craving

Explanation

Opioid agonist therapy with methadone or buprenorphine is the evidence-based first-line maintenance treatment, reducing craving, withdrawal and mortality. Naltrexone requires prior detoxification and adherence is often poor. Benzodiazepines and antipsychotics do not treat opioid dependence.

Question 11Psychiatry

A 28-year-old man describes hearing two voices commenting on his actions for 3 months, and believes his neighbours are inserting thoughts into his head. Which symptom domain do these experiences represent?

  1. Negative symptoms
  2. Affective symptoms
  3. Positive psychotic symptoms Correct answer.
  4. Cognitive symptoms

Explanation

Third-person auditory hallucinations and thought insertion are positive psychotic symptoms, meaning they are added abnormal experiences rather than loss of function. Negative symptoms include blunted affect and avolition. Distinguishing positive from negative symptoms guides prognosis and treatment.

Question 12Psychiatry

A patient on clozapine develops a fever and sore throat. What is the most important immediate action?

  1. Continue clozapine and give paracetamol
  2. Stop clozapine and obtain an urgent full blood count Correct answer.
  3. Increase the clozapine dose
  4. Add an antibiotic and continue clozapine unchanged

Explanation

Fever and sore throat in a patient taking clozapine may signal neutropenia or agranulocytosis, so the drug should be withheld and an urgent full blood count obtained. Clozapine requires regular haematological monitoring for this reason. Continuing the drug could lead to life-threatening infection.

Question 13Psychiatry

Which feature is most typical of obsessive-compulsive disorder rather than obsessive-compulsive personality disorder?

  1. Pervasive rigidity and perfectionism across all situations
  2. A stable pattern of orderliness present since early adulthood
  3. Lack of distress about orderliness
  4. Intrusive ego-dystonic thoughts accompanied by rituals to reduce anxiety Correct answer.

Explanation

OCD involves ego-dystonic intrusive thoughts that the person finds distressing and tries to neutralise with compulsions. Obsessive-compulsive personality disorder is ego-syntonic, with pervasive perfectionism and orderliness experienced as appropriate. The presence of distress and ritualised neutralisation separates the two.

Question 14Psychiatry

Which of the following is a recognised risk factor for completed suicide in psychiatric patients?

  1. Married status
  2. Female sex
  3. Young age below 25 years
  4. Previous suicide attempt Correct answer.

Explanation

A previous suicide attempt is one of the strongest predictors of completed suicide. Male sex, being single or divorced, older age, and access to lethal means further increase risk. Recognising these factors guides risk assessment and safety planning.

Question 15Psychiatry

A 35-year-old woman has a 2-week history of elevated mood, decreased need for sleep, grandiosity and rapid speech after starting an antidepressant. What is the most likely diagnosis?

  1. Persistent depressive disorder
  2. Substance/medication-induced bipolar disorder Correct answer.
  3. Major depressive disorder
  4. Cyclothymic disorder

Explanation

A full manic episode emerging during antidepressant treatment, with elevated mood, decreased need for sleep and grandiosity, suggests a medication-induced bipolar disorder. Major depression lacks such elevated mood. The temporal link to the antidepressant is the key clue.

Question 16Psychiatry

Which is the most appropriate initial management for a patient in acute alcohol withdrawal with intact airway and no seizures?

  1. Benzodiazepines with thiamine and supportive care Correct answer.
  2. Immediate disulfiram initiation
  3. Antipsychotics as monotherapy
  4. Opioid substitution

Explanation

Benzodiazepines are first-line for alcohol withdrawal because they reduce autonomic hyperactivity and prevent seizures and delirium tremens, alongside thiamine to prevent Wernicke encephalopathy. Antipsychotics alone lower the seizure threshold. Disulfiram is used for maintenance, not acute withdrawal.

Question 17Psychiatry

A 60-year-old man has progressive memory decline, impaired executive function and difficulty with activities of daily living over 2 years, with clear consciousness. Which diagnosis is most likely?

  1. Schizophrenia
  2. Bipolar disorder
  3. Major neurocognitive disorder due to Alzheimer disease Correct answer.
  4. Delirium

Explanation

Progressive memory and executive decline over years with preserved consciousness and functional impairment indicates a major neurocognitive disorder, with Alzheimer disease the commonest cause. Delirium would show acute fluctuating attention. Psychotic and mood disorders do not explain progressive cognitive decline.

Question 18Psychiatry

Which feature is characteristic of post-traumatic stress disorder rather than acute stress reaction?

  1. Symptoms beginning within minutes of the trauma
  2. Rapid resolution within 48 hours
  3. Symptoms persisting beyond one month after the trauma Correct answer.
  4. Immediate dissociative stupor lasting hours

Explanation

PTSD requires symptoms such as re-experiencing, avoidance and hyperarousal persisting for more than one month after the traumatic event. Acute stress reaction occurs within minutes to days and usually resolves within days. The duration criterion is the key distinction.

Question 19Psychiatry

Which is the most appropriate first-line psychological treatment for mild to moderate bulimia nervosa?

  1. Psychoanalysis
  2. Electroconvulsive therapy
  3. Cognitive behavioural therapy focused on eating behaviours Correct answer.
  4. Antipsychotic medication

Explanation

Cognitive behavioural therapy, particularly CBT-BN, is the best-established first-line psychological treatment for bulimia nervosa, targeting binge-purge cycles and shape concerns. Psychoanalysis is not first-line, and antipsychotics and ECT have no established role. Evidence-based guidelines prioritise CBT.

Question 20Psychiatry

A 7-year-old boy has persistent inattention, hyperactivity and impulsivity across home and school for 8 months, with impairment in both settings. Which diagnosis is most likely?

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

Explanation

ADHD requires developmentally inappropriate inattention, hyperactivity and impulsivity present in more than one setting with functional impairment. Cross-situational impairment is essential to distinguish it from situational behaviour. Autism and conduct disorder have different core features.

Question 21Psychiatry

Which statement about capacity to consent to treatment is correct?

  1. Capacity is decision-specific and assessed by understanding, appreciation, reasoning and communication Correct answer.
  2. Capacity is fixed and cannot change over time
  3. Capacity requires agreeing with the treating team's recommendation
  4. Capacity is determined solely by the presence of a psychiatric diagnosis

Explanation

Capacity is task-specific and assessed through four abilities: understanding relevant information, appreciating its significance, reasoning about options, and communicating a choice. A psychiatric diagnosis alone does not remove capacity. It may fluctuate and must be reassessed.

Question 22Psychiatry

Which finding suggests that a patient's depressive symptoms are due to hypothyroidism rather than major depressive disorder?

  1. Normal thyroid function tests
  2. Marked weight loss with palpitations
  3. Symptoms confined to the premenstrual phase
  4. Bradycardia, weight gain, constipation and cold intolerance Correct answer.

Explanation

Hypothyroidism can mimic depression but is suggested by bradycardia, weight gain, constipation, cold intolerance and dry skin; thyroid function tests confirm it. Major depression alone does not produce this constellation. Screening for medical causes is essential before diagnosing a primary mood disorder.

Question 23Psychiatry

Which statement about tardive dyskinesia is correct?

  1. It is unrelated to medication exposure
  2. It occurs only within the first 24 hours of starting an antipsychotic
  3. It is reliably reversed by increasing the antipsychotic dose
  4. It is a late-onset involuntary movement disorder associated with prolonged dopamine antagonist exposure Correct answer.

Explanation

Tardive dyskinesia is a late-onset hyperkinetic movement disorder, typically oro-facial, linked to prolonged use of dopamine-blocking agents. It is not an acute reaction and may persist after drug withdrawal. Management involves dose reduction, switching, or VMAT2 inhibitors.

Question 24Psychiatry

A 40-year-old woman with a long-standing pattern of unstable relationships, identity disturbance, impulsivity and recurrent self-harm is being assessed. Which diagnosis is most likely?

  1. Borderline personality disorder Correct answer.
  2. Obsessive-compulsive personality disorder
  3. Antisocial personality disorder
  4. Schizoid personality disorder

Explanation

Borderline personality disorder is characterised by instability of interpersonal relationships, self-image and affect, together with marked impulsivity and recurrent self-harm. Antisocial personality disorder centres on disregard for others' rights, while schizoid and obsessive-compulsive patterns differ. The instability and self-harm are key.

Question 25Psychiatry

Which of the following best explains why benzodiazepines are avoided as long-term monotherapy for generalised anxiety disorder?

  1. They reliably treat comorbid depression
  2. Tolerance, dependence and withdrawal risk outweigh long-term benefit Correct answer.
  3. They have no sedative effect
  4. They are ineffective for acute anxiety

Explanation

Benzodiazepines provide short-term relief but carry risks of tolerance, dependence and withdrawal, so guidelines favour SSRIs and psychological therapy for long-term management. They remain useful for short-term or acute situations. Their sedative effect is well recognised.

Question 26Psychiatry

Which neurotransmitter system is most directly implicated in the therapeutic effect of donepezil in Alzheimer's disease?

  1. Dopaminergic
  2. Cholinergic Correct answer.
  3. GABAergic
  4. Serotonergic

Explanation

Donepezil is an acetylcholinesterase inhibitor that increases synaptic acetylcholine, compensating for loss of cholinergic neurons in the basal forebrain. The other systems are targeted by antipsychotics, benzodiazepines, and antidepressants respectively, not by cholinesterase inhibitors.

Question 27Psychiatry

A 30-year-old woman reports recurrent unexpected episodes of palpitations, choking, derealisation and fear of dying lasting about 10 minutes, with normal cardiac workup. Which diagnosis best fits?

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

Explanation

Recurrent unexpected panic attacks with anticipatory worry or behavioural change characterise panic disorder. Generalised anxiety disorder involves persistent worry rather than discrete attacks, and the phobic disorders require a specific feared stimulus.

Question 28Psychiatry

Which class of medication is first-line pharmacotherapy for acute mania in bipolar I disorder?

  1. Cholinesterase inhibitors
  2. Mood stabilisers such as lithium or valproate Correct answer.
  3. Benzodiazepines as monotherapy
  4. SSRIs

Explanation

Lithium and valproate are established first-line agents for acute mania and are also used for maintenance. SSRIs risk inducing a switch to mania, and benzodiazepines are adjunctive only for agitation and sleep.

Question 29Psychiatry

Which laboratory monitoring is mandatory for a patient started on clozapine?

  1. Regular full blood count to detect neutropenia Correct answer.
  2. Regular serum lithium levels
  3. Regular thyroid function tests
  4. Regular urine toxicology

Explanation

Clozapine carries a risk of agranulocytosis, so mandatory full blood count monitoring with specific frequency schedules is required. Lithium levels, thyroid tests and toxicology are not the mandatory monitoring for clozapine.

Question 30Psychiatry

Which feature distinguishes delirium from dementia?

  1. Insidious onset with preserved attention
  2. Onset in adolescence with preserved orientation
  3. Acute onset with fluctuating impairment of attention and consciousness Correct answer.
  4. Progressive decline over years with stable consciousness

Explanation

Delirium develops acutely with fluctuating attention and altered consciousness, whereas dementia is typically insidious and progressive with relatively preserved consciousness until late stages. The other options describe dementia or are inconsistent with either condition.

Question 31Psychiatry

Which of the following is a core diagnostic feature of autism spectrum disorder?

  1. Formal thought disorder
  2. Episodic elevated mood
  3. Persistent deficits in social communication and interaction Correct answer.
  4. Recurrent obsessions with insight

Explanation

Autism spectrum disorder is defined by persistent deficits in social communication and interaction plus restricted, repetitive behaviours. Obsessions with insight suggest OCD, elevated mood suggests bipolar disorder, and formal thought disorder suggests psychosis.

Question 32Psychiatry

A 25-year-old man has a 6-month history of persistent low mood, anhedonia, poor sleep and concentration, with no manic or psychotic features. What is the most likely diagnosis?

  1. Schizoaffective disorder
  2. Adjustment disorder
  3. Persistent depressive disorder
  4. Major depressive disorder Correct answer.

Explanation

A 6-month episode of low mood and anhedonia with cognitive and vegetative symptoms and no mania or psychosis fits major depressive disorder. Persistent depressive disorder requires a chronic course of at least two years, and schizoaffective disorder requires psychotic features.

Question 33Psychiatry

Which statement about the epidemiology of schizophrenia is correct?

  1. It affects approximately 1% of the population with roughly equal sex distribution Correct answer.
  2. It affects only males and always begins before age 10
  3. It affects 20% of the population and is confined to high-income countries
  4. It affects less than 0.01% of the population and is ten times more common in women

Explanation

Lifetime risk of schizophrenia is approximately 1%, with similar rates in men and women, though onset is earlier in men. The other options give implausible prevalence figures or incorrect demographic claims.

Question 34Psychiatry

A 32-year-old woman with anorexia nervosa is medically stable but has a BMI of 16 and refuses to eat. Which initial approach is most appropriate?

  1. Reassurance and discharge without follow-up
  2. Immediate involuntary detention for compulsory nasogastric feeding
  3. Prescribing an SSRI as sole treatment
  4. Structured psychological therapy combined with supervised nutritional rehabilitation Correct answer.

Explanation

For medically stable patients with anorexia nervosa, evidence supports psychological therapy (such as CBT or family-based therapy) combined with nutritional rehabilitation. Compulsory feeding is reserved for life-threatening states, and medication alone is not effective.

Question 35Psychiatry

Which statement best describes the mechanism of action of lithium in bipolar disorder?

  1. It enhances GABA-A receptor chloride currents
  2. It inhibits serotonin reuptake
  3. It modulates intracellular signalling enzymes including glycogen synthase kinase-3 and inositol pathways Correct answer.
  4. It blocks dopamine D2 receptors

Explanation

Lithium's mood-stabilising action is attributed to inhibition of glycogen synthase kinase-3 and interference with inositol signalling and other second-messenger pathways. D2 blockade describes antipsychotics, serotonin reuptake inhibition describes SSRIs, and GABA-A enhancement describes benzodiazepines.

Question 36Psychiatry

A 55-year-old man on an antipsychotic develops a high fever, muscle rigidity, confusion and autonomic instability over 48 hours. What is the most likely diagnosis?

  1. Malignant hyperthermia
  2. Serotonin syndrome
  3. Acute dystonia
  4. Neuroleptic malignant syndrome Correct answer.

Explanation

Neuroleptic malignant syndrome follows dopamine antagonist exposure and presents with fever, rigidity, altered consciousness and autonomic instability. Serotonin syndrome follows serotonergic agents, dystonia is a focal muscle spasm without fever, and malignant hyperthermia follows anaesthetic exposure.

Question 37Psychiatry

Which feature most strongly supports a diagnosis of somatic symptom disorder rather than illness anxiety disorder?

  1. Fear of illness with minimal or no somatic symptoms
  2. Symptoms fully explained by a known medical condition
  3. High levels of anxiety and preoccupation with distressing physical symptoms that are actually present Correct answer.
  4. Delusional conviction of having a serious disease

Explanation

Somatic symptom disorder requires distressing somatic symptoms plus excessive thoughts, anxiety or behaviour about them. Illness anxiety disorder involves preoccupation with having an illness with few or no somatic symptoms, and delusional conviction suggests a psychotic disorder.

Question 38Psychiatry

A 40-year-old man has alcohol use disorder and develops tremor, sweating and agitation 12 hours after his last drink. Which medication is most appropriate for managing his withdrawal?

  1. Naltrexone during the acute withdrawal phase
  2. An antipsychotic as monotherapy
  3. An SSRI started immediately
  4. A benzodiazepine such as chlordiazepoxide with thiamine supplementation Correct answer.

Explanation

Benzodiazepines are the mainstay of alcohol withdrawal management because they reduce seizure and delirium risk, and thiamine prevents Wernicke encephalopathy. SSRIs do not treat acute withdrawal, antipsychotics do not prevent seizures, and naltrexone is used for relapse prevention after withdrawal.

Question 39Psychiatry

Which statement about electroconvulsive therapy (ECT) is correct?

  1. It is given without any anaesthetic
  2. It is contraindicated in all patients with depression
  3. It is effective for severe treatment-resistant depression and requires informed consent with anaesthesia Correct answer.
  4. It is a form of psychotherapy

Explanation

ECT is an effective treatment for severe or treatment-resistant depression and is delivered under general anaesthesia with informed consent, except in specific legal frameworks for urgent cases. It is a biological treatment, not psychotherapy, and is not contraindicated in depression.

Question 40Psychiatry

A 22-year-old woman has a 4-week history of low mood following a breakup, with symptoms insufficient to meet criteria for a major depressive episode. What is the most likely diagnosis?

  1. Adjustment disorder with depressed mood Correct answer.
  2. Dysthymic disorder
  3. Bipolar II disorder
  4. Major depressive disorder

Explanation

Adjustment disorder is diagnosed when emotional symptoms arise within three months of an identifiable stressor and do not meet criteria for another disorder. Major depression requires a full syndrome, dysthymia requires a chronic two-year course, and bipolar II requires hypomania.

Question 41Psychiatry

Which finding best distinguishes dissociative amnesia from amnesia due to a general medical condition?

  1. Memory loss that worsens steadily with age
  2. Memory loss that follows a documented stroke with imaging changes
  3. Memory loss confined to a single laboratory test result
  4. Personal identity or autobiographical memory loss that is reversible and not explained by neurological disease Correct answer.

Explanation

Dissociative amnesia involves inability to recall important autobiographical information, often following stress, that is not attributable to a neurological or medical cause. Neurological amnesia has a documented medical cause or a typical progressive pattern.

Question 42Psychiatry

A patient on an SSRI develops agitation, hyperthermia, hyperreflexia and clonus after a new serotonergic drug is added. What is the most appropriate immediate action?

  1. Stop the serotonergic agents and provide supportive care with benzodiazepines Correct answer.
  2. Give a beta-blocker to control heart rate
  3. Start an antipsychotic as monotherapy
  4. Increase the SSRI dose

Explanation

Serotonin syndrome is managed by stopping the offending serotonergic drugs, giving supportive care, and using benzodiazepines for agitation and rigidity. Increasing serotonergic load or using a beta-blocker alone does not address the underlying toxicity.

Question 43Psychiatry

Which statement about the use of antipsychotics in older adults with dementia is correct?

  1. They are first-line for all behavioural symptoms of dementia
  2. They should be continued indefinitely once started
  3. They carry an increased risk of cerebrovascular events and mortality and should be used cautiously and time-limited Correct answer.
  4. They have no metabolic or extrapyramidal side effects in this group

Explanation

Antipsychotics in dementia carry a boxed warning for increased mortality and cerebrovascular events, so they are reserved for severe symptoms and reviewed regularly. Non-pharmacological measures are first-line, and these drugs still carry metabolic and extrapyramidal risks.

Question 44Psychiatry

A 28-year-old man has a 2-month history of believing his thoughts are being broadcast and that his body is controlled by an external force, with no mood disturbance. Which diagnosis is most likely?

  1. Delusional disorder
  2. Schizotypal personality disorder
  3. Bipolar I disorder with psychotic features
  4. Schizophrenia Correct answer.

Explanation

Passivity phenomena and thought broadcasting are first-rank psychotic symptoms persisting beyond the required duration, consistent with schizophrenia. Bipolar disorder requires mood episodes, schizotypal personality disorder is a stable pattern, and delusional disorder lacks the bizarre multiplicity of symptoms described.

Question 45Psychiatry

Which intervention is most appropriate for a patient with moderate-to-severe borderline personality disorder who engages in recurrent self-harm?

  1. Structured psychotherapy such as dialectical behaviour therapy with a clear risk-management plan Correct answer.
  2. Immediate long-term admission to hospital
  3. Long-term high-dose benzodiazepines
  4. Antipsychotic monotherapy as the main treatment

Explanation

Dialectical behaviour therapy and other structured psychotherapies are first-line for borderline personality disorder and reduce self-harm. Long-term benzodiazepines risk dependence, prolonged admission can reinforce dependency, and antipsychotics are not the primary treatment.

Question 46Psychiatry

A 65-year-old woman has a 3-week history of low mood, early morning waking, weight loss and nihilistic delusions after a minor stroke. Which diagnosis is most likely?

  1. Normal grief reaction
  2. Delirium
  3. Schizophrenia
  4. Depressive disorder due to another medical condition Correct answer.

Explanation

Depressive symptoms temporally linked to a stroke with biological and psychotic features suggest a depressive disorder due to another medical condition. Delirium shows fluctuating attention, schizophrenia lacks the mood syndrome, and grief is not accompanied by nihilistic delusions and marked psychomotor change.

Question 47Psychiatry

Which statement about the pharmacokinetics of lithium is correct?

  1. It is metabolised by hepatic CYP3A4
  2. It is excreted unchanged in bile
  3. It has no interaction with thiazide diuretics
  4. It is renally excreted and levels rise with dehydration or NSAID use Correct answer.

Explanation

Lithium is eliminated unchanged by the kidney, and dehydration, NSAIDs and thiazides reduce renal clearance and raise levels toward toxicity. It is not hepatically metabolised, not excreted in bile, and interacts significantly with thiazides.

Question 48Psychiatry

Which feature best distinguishes obsessive-compulsive personality disorder from obsessive-compulsive disorder?

  1. Episodic mood elevation
  2. Presence of recurrent intrusive thoughts and repetitive rituals
  3. Presence of auditory hallucinations
  4. A stable lifelong pattern of perfectionism and orderliness without true obsessions or compulsions Correct answer.

Explanation

Obsessive-compulsive personality disorder is a pervasive, stable pattern of perfectionism, rigidity and orderliness, whereas OCD involves true obsessions and compulsions that are experienced as intrusive. Hallucinations and mood elevation belong to other disorders.

Question 49Psychiatry

A 35-year-old woman with schizophrenia has been stable on antipsychotics for 2 years but has gained 15 kg and has fasting glucose of 7.2 mmol/L. What is the most appropriate next step?

  1. Review the antipsychotic for metabolic risk and consider switching to a lower-risk agent while addressing metabolic health Correct answer.
  2. Stop all antipsychotics immediately without substitution
  3. Add a second antipsychotic to control symptoms
  4. Ignore the metabolic findings as unrelated to treatment

Explanation

Second-generation antipsychotics differ in metabolic risk, and persistent weight gain with hyperglycaemia warrants review and possible switch to a lower-risk agent alongside metabolic monitoring and lifestyle intervention. Abrupt cessation risks relapse, and adding another antipsychotic may worsen metabolic burden.

Question 50Psychiatry

Which statement about the use of antidepressants in pregnancy is most accurate?

  1. Paroxetine is the preferred agent in the first trimester
  2. All antidepressants are absolutely safe in pregnancy
  3. Antidepressants must always be stopped abruptly before conception
  4. Untreated maternal depression carries risks, and the decision should weigh these against medication risks with specialist input Correct answer.

Explanation

The decision to use antidepressants in pregnancy balances the risks of untreated illness against medication effects and requires specialist discussion. No antidepressant is absolutely safe, abrupt cessation risks relapse, and paroxetine has been associated with cardiac malformations.