All MCQs Flashcards

Question

Patient did a crime, thinks judge is inhabited by twin brother, why is he unfit to stand trial? A. Thinks judge is inhabited by twin brother B. Doesn’t remember circumstances of crime C. Didn’t know right from wrong 2025

Answer 1

Patient did a crime, thinks judge is inhabited by twin brother, why is he unfit to stand trial? ***A. Thinks judge is inhabited by twin brother*** B. Doesn’t remember circumstances of crime C. Didn’t know right from wrong 2025

Answer 2

65M married, feels distressed about pedophilic thoughts, has not acted on urges, failed CBT. He has a fulfilling sex life with his wife. He is treatment seeking. What is the recommendation? ***A. Sertraline*** B. Cyproterone C. Leuprolide D. Medoxyprogesterone 2025

Answer 3

Boundary crossing vs. violation question. You accommodate pt’s work by booking them in at the end of day. She gets snowed in and can’t leave. You decide to stay behind after clinic hours for patient’s safety. They call family who are not picking up the phone. They call a tow truck company and they say they cannot come for hours. You offer to drive them home. She invites you to dinner and you accept, learn their husband is a venture capitalist, and ask if he would be interested in funding your rTMS clinic. Which is the crossing? A. Accommodating their work schedule ***B. Staying behind after clinic hours*** C. Going to the restaurant D. Inviting husband to fund clinic 2025

Answer 4

Schizoaffective lady with 2 daughters with schizophrenia. One has schizophrenia with onset at age 16 and the other had onset at age 26. What are you more likely to see with the 16 year old? ***A. Poorer psychosocial outcomes*** B. Preponderance to negative symptom C. Catatonia 2025

Answer 5

Which patient is most appropriate for methadone therapy? A. 30M using IV heroin for 9 months ***B. 27F who is 4 months pregnant using IV heroin for 8 months*** C. Opioid user but had congenital long QT D. Person using IV cocaine 2025

Answer 6

Girl who uses cannabis, had flu-like symptoms a few days ago. Presented psychotic, became aggressive, moving her arms around. Admitted. She improves with risperidone and is discharged. Her roommates bring her back with recurrence of similar symptoms. What is the best investigation to confirm the diagnosis? A. EEG B. MRI ***C. Lumbar puncture*** D. TSH 2025

Answer 7

What should concern you when starting patient on acamprosate ***A. Renal insufficiency*** B. Hepatic impairment 2025

Answer 8

Borderline patient gets access to their chart, demands that you change their borderline diagnosis from a note from 3 months ago. You do not believe there was an error. response? ***A. Tell the patient you are not able to change the record in this case*** B. Say you don’t have authority, and direct them to medical records C. Add addendum to the note documenting the request and confirming diagnosis D. Change the diagnosis 2025

Answer 9

Young guy passes out at a party after taking a drug, lethargic + slurred, brought to ED, wakes up alert. He was going many times to the washroom but could not pee. What did he take? A. Fentanyl ***B. GHB*** C. Ketamine GHB rather than ketamine b/c of the rapid resolution and intense sedation (ketamine would be more likely to have hallucinations, etc) 2025

Answer 10

ED patient comes in after using drug, is depressed and has muscle pains, dilated pupils, sweaty, hypertensive, yawning, lacrimation and vomiting. ***A. Opioid withdrawal*** B. Stimulant intoxication 2025

Answer 11

Parents and their 4 children are in family therapy. The parents frequently blame the oldest child for everything and it’s stated that he is “responsible” for the strife in the family.. You think they are displacing their marital discord onto him (unsure how on the nose this was worded, it may have been you think they have their own unacknowledged issues). You bring the parents in without their children and tell them they should work on their marital troubles together. This is an example of? A. Structural family therapy ***B. Family systems therapy*** C. Solution-focused family therapy D. Narrative family therapy 2025

Answer 12

Doing IPT with a lady with 3yr depressive symptoms after husband died, remains socially isolated, gave up work when found out husband had cancer 8 months before death. What do you work on in the intermediate phase of IPT? A. Complete an interpersonal inventory ***B. Explore good and bad aspects of relationship with husband*** C. Confirm the diagnosis D. Give patient the sick role 2025

Answer 13

Most common cause of reversible dementia? ***A. Cobalamin deficiency*** B. Vitamin D deficiency C. Wilson’s 2025

Answer 14

What does the MMPI test for ***A. Social introversion*** B. Projected something C. Defence mechanisms 2025

Answer 15

ADHD kid with tics, mom concerned but the kid isn’t ***A. Monitor tics*** 2025

Answer 16

Farmer on lithium, working in the wildfire smoke and sweltering outside in the sun. Acting confused, “walking weird”, found unconscious, had trouble talking with his words, background of tremor was getting worse, trouble with gait worse tremor. A. COPD exacerbation delirium ***B. Lithium toxicity*** C. Smoke inhalation related 2025

Answer 17

What is the mechanism of action of Lemborexant? ***A. Orexin antagonist*** B. Serotonin something 2025

Answer 18

Kid’s father is a biochemist, asks mechanism of methylphenidate (vs. amphetamine) ***A. Reuptake inhibition of NE and Dop*** B. VMAT inhibitor C. methylphenidate causes vesicular release of dopamine D. something about serotonin 2025

Answer 19

20F with seizure disorder, hx of cocaine and panic disorder. Febrile convulsions as an infant, this is now her first admission for seizure in adulthood... treated with Levetiracetam IV. Discharged home... then having ++irritability, emotionally labile and angry with family, and overt mention of transient “hallucinations”... Question asking what is responsible for this? A. Alternate psychosis (forced normalization) ***B. Levetiracetam side effect*** C. Ictal seizure (causing psychosis) D. Panic disorder recurrence 2025

Answer 20

Lady at 20 weeks preg, is having panic attack symptoms (not disorder) when pregnant, does NOT want medications and is NOT on any meds except her prenatal vitamin. What does the panic presence increase risk of? ***A. Preeclampsia*** B. Persistent pulmonary hypertension of the newborn C. Preterm birth D. Gestational diabetes 2025

Answer 21

Lady whose mood is fine, but she wants to get back to dancing. Fatigue that is worse with exertion. She can sleep but it is not refreshing. Used to be an executive, now on long term disability x 3yr. Mental fogginess now, so says she can’t work at that level anymore. A. Test for malingering vs. factitious disorder (TOMM scale) B. Antipsychotic for encephalopathic myo- and chronic fatigue syndrome ***C. Pacing post exertion (this is part of CBT)*** 2025

Answer 22

What is the definition of the null hypothesis? ***A. Difference is due to either random chance or error*** B. p value will be <0.05 2025

Answer 23

P-value is 0.14, what does that mean? ***A. 14 percent chance results are random*** B. 14 percent chance that null hypothesis is wrong 2025

Answer 24

What does NNT mean? ***A. Number of patients that needed to be treated to make a change in one person in a period of time.*** 2025

Answer 25

Guy in emerg brought in by police. BP 200, HR 120+, aggressive and hallucinating, vertical and horizontal nystagmus. In restraints. Which drug? A. Meth ***B. PCP*** 2025

Answer 26

Man behaving bizarrely in community, detained by police, put in locked ED room, physical and chemical restraints were used. Example of environmental restraint? ***A. Locked ED room*** B. Wrists restrained C. IM meds D. Police detainment 2025

Answer 27

Lady just moved into a retirement home. Wears makeup and fancy outfits. Flirtatious with other residents. She was putting lipstick on her cheeks. Calls people “doll”. Makes people listen to her opera singing. Family estranged due to many years of this. No psychiatric history. She is adamant that her mood is normal and she is always like this. What’s the diagnosis? A. BPD ***B. Histrionic*** C. bipolar I D. bipolar II 2025

Answer 28

87M with Parkinson’s disease has COPD, dyslipidemia, and hypertension. He is interested in trying cannabis edibles (THC gummy). What do you tell him is a risk of this? ***A. Movement impairment*** B. Stroke C. Osteoporosis D. Chronic bronchitis 2025

Answer 29

Woman with Korsakoff syndrome kept accusing her spouse of keeping her away from her kids in another province and her spouse was having difficulty managing this. He keeps arguing with her about this. Non pharmacological treatments? A. Reassurance ***B. Redirection*** C. Reorientation 2025

Answer 30

20-year-old girl, with comorbid GAD, started school 1 month ago, new onset motor tic. What is most suggestive that this is functional? ***A. Onset of tics at 20 years old*** B. Waxing and waning/quick progression C. Worsens with stress/anxiety. D. Onset after change in school 1 month ago 2025

Answer 31

Neurology is consulted for a patient with tics. They do a number of tests. Which one is most likely to show the tics are functional? ***A. Entrainment is achieved by testing a different limb*** B. Drawing attention to the movement improves it and distracting from it brings it on. C. Something about restraining a limb 2025

Answer 32

Woman with PCOS was on valproic acid. She develops tardive dyskinesia, which is the most significant risk factor for TD in this patient? ***A. Female*** B. Younger age C. Insulin Resistance 2025

Answer 33

Woman just got a new promotion. She feels like she is not respected by her co-workers and her ideas are not valued. Has a presentation in front of her company. Her boss says it’s good. One employee said they would have gone a different direction with the presentation. She states “sometimes I think that I don’t have what it takes to do this job.” What cognitive distortion? ***A. Selective abstraction*** B. Overgeneralization C. Catastrophization D. Personalization 2025

Answer 34

A male with OCD doing CBT therapy. His therapist asks him to write out his thoughts and feelings and then come up with alternative thoughts based on evidence. What is this an example of? ***A. Cognitive restructuring*** B. Therapeutic journaling C. Exposure and response prevention 2025

Answer 35

What makes anxiety outcomes worse for someone doing CBT for ?OCD? ***A. Family accommodation of anxiety*** B. Parent’s mental health 2025

Answer 36

Person assigned male at birth. Has gone by she/they pronouns in childhood. Enjoys wearing female clothes when intimate with her boyfriend. Is bullied at school for her feminine characteristics and feels bad about it. But her family is supportive and she has a positive mood at home. She isn’t distressed about her body and doesn’t want to change her body. However, she doesn't feel like her facial features are feminine enough and spends time checking her face in the mirror. ***A. Gender nonconforming*** B. Gender dysphoria C. Transvestic disorder D. Body dysmorphic Disorder 2025

Answer 37

Elderly lady with visual and auditory hallucinations. She believes that pirates are having sex in her home. She sees and hears them coming and going. She also believes there is a microchip in her brain. Function unaffected except that she does not go to the community centre to see her friends for fear of the pirates. A. Delusional disorder B. Major neurocognitive disorder ***C. Schizophrenia*** ~debate b/t A & C 2025

Answer 38

Guy claims he is a messiah, arrested for throwing paint at a club. He thinks politicians are the antichrist. Normal function. No mood symptoms. Normal sleep. Normal speech. What is the diagnosis? ***A. Delusional disorder*** B. Schizophrenia C. Depression with psychotic features 2025

Answer 39

A woman presents to the hospital with a new rash (explicitly called SJS). She is noted to have been stable on Lamotrigine for a number of years. Her GP recently started her on another medication given an increase in her depression. What medication is MOST likely to have been related to this presentation? ***A. Valproic acid*** B. Carbamazepine C. Abilify 2025

Answer 40

Patient has been admitted 14 times in the last 2 years. She shows up in the ED, stem describes countertransference where you start to get really irritated with them. What is this an example of? A. Projective identification 2025

Answer 41

Stem describes man presenting with depression with melancholic features (paragraph long stem). Which is not a symptom of the MDE melancholic features specifier? ***A. Irritable mood*** B. Diurnal variations C. Early awakenings D. Weight loss 2025

Answer 42

Patient’s father is a doctor and says good things about doing therapy with a doctor. Patient is excited to work with you but then starts arriving 15-20 min late to appointments. When you point this out, she says the buses are unreliable since the last election. What is this? ***A. Intellectualization defense*** B. Parental transference C. Unclear therapeutic frame D. Failure to mentalize 2025

Answer 43

40 something year old male undergoing cognitive behavioural therapy for insomnia x 5 weeks. Going to sleep at 10:30pm and waking up at 6:00am. Sleeping 7 hours total. Sleep efficiency is 92% What is the next best step? A. Continue current sleep schedule ***B. Move earliest to bed to 10:15, keep wake up at 6:00*** C. Move earliest to bed to 10:45, keep wake up at 6:00 D. Keep earliest to bed at 10:30, move wake up to 6:15 2025

Answer 44

Middle aged lady with sleep problems, fatigue and headaches, not enough criteria to meet MDE, what is the best “screening” assessment scale? ***A. STOP BANG questionnaire*** B. Insomnia Severity Index C. Bush Francis D. Hamilton Depression 2025

Answer 45

Patient with OCD on sertraline 200mg daily, behaviours now resolved. Now going to the gym, dieting, will not go to restaurants with family because of fear of fat in foods, checking himself in the mirror saying he’s not lean enough as an athletic body type. Best management? A. Risperidone 1mg daily ***B. CBT*** C. Some other therapy maybe? 2025

Answer 46

Old person admitted for depression, incidentally found old stroke to left frontal cortex prior, now has 2 month history of executive dysfunction, left sided upper limb weakness, what is best investigation? ***A. Brain imaging*** B. Neurocognitive assessment with psychology 2025

Answer 47

CL consultation for 80M, lives alone at home, post-op day 3 becomes anxious, confused, vital instability. Surgical team requests advice regarding next steps, what do you recommend as a “priority” in the patient’s management? A. Atypical antipsychotic B. Typical antipsychotic C. SSRI ***D. Lorazepam*** 2025

Answer 48

You see an outpatient for 3 appointments in person, then the 4th appointment is virtual. He is having medication side effects. He tells you he is in Mexico temporarily for the next 11 months. What do you do? ***A. Provide advice about current presentation and then tell him you cannot follow up while abroad*** B. Hang up the phone abruptly C. Briefly give advice over the phone D. Tell them you can “temporarily” follow them up virtually if they are “temporarily” in Mexico 2025

Answer 49

MNCD on medical unit. You are on CL and consulted. What is the best management for hypoactive delirium? ***A. Non pharmacological*** B. Haldol C. Restraints D. Lorazepam 2025

Answer 50

Guy on clozapine at retirement home. Normally well behaved. Started acutely getting agitated and flipped a tray. WBC elevated at 12. CT head and other investigations were normal. IM won’t admit the patient. What investigation do you order? ***A. Abdominal x-ray*** B. ECG C. MRI head 2025

Answer 51

Which imaging question for someone with dementia (alzheimer’s) A. CT with contrast B. CT without contrast ***C. MRI*** D. PET 2025

Answer 52

Guy with PTSD immigrated from a war-torn country, has been prescribed prazosin, which was helpful. However, he is still having issues at work because he is a construction worker and the loud noises trigger his PTSD. He does not want more meds. How to treat therapy? ***A. Graded exposure to loud noises*** B. Cognitive restructure of thoughts that the world is generally unsafe C. Rewriting the trauma narrative D. Distress tolerance skills Debate b/t A & B 2025

Answer 53

A 30M begins therapy. He had a chaotic childhood and a difficult relationship with his father. The therapist reminds him of his father. Which of the following is a component of supportive psychotherapy in this case? ***A. Corrective emotional experience*** B. Parental figure teaching distress tolerance C. CBT technique D. Safe re-experiencing of a traumatic experience 2025

Answer 54

40 year old male. Works with computers. Sticks to himself/spends a lot of time at home alone. Limited social contacts. Doesn’t mind being alone, has solitary hobbies. Came to see you in the clinic after reading about mental health crises online and wonders if it applies to him. Has a chronically low mood but not much else. What is the next best step in management? ***A. Explore his internal world*** B. Helping him learn to accept his current situation C. Start a SSRI D. Hierarchy of activities to get him out of the house/increase social engagement 2025

Answer 55

Kid (maybe 17F?) on venlafaxine for depression (225 mg od, not told whether IR or XR). 40% benefit, still SI. Had a trial of fluoxetine 20mg x 4 weeks and did not know if it helped. Now coming in says he takes 3 hours to fall asleep and his main issue is sleep. He says he tried a family member’s benzo and found it helped. What treatment? A. Add melatonin B. Prescribe benzo C. Increase venlafaxine ***D. Switch back to fluoxetine and target higher dose*** Debate b/t C & D 2025

Answer 56

What is the standard of care of a physician? ***A. What a reasonable physician would provide*** B. Following clinical guidelines 2025

Answer 57

Guy with schizoaffective disorder and was very agitated. Put in restraints. 3 days later has muscle pain and is peeing tea-coloured urine. Why? ***A. Rhabdomyolysis*** B. Neuroleptic malignant syndrome 2025

Answer 58

Woman with OCD. Tried one med and had side effects. Tried sertraline and had a good response at 200 mg but does not want to go higher because of side effects. She wants to add a medication. Not interested in psychotherapy. What do you add? ***A. Abilify*** B. Clonazepam C. Topiramate 2025

Answer 59

Doctor who works in a rural community. No other psychiatrist around. Someone comes in to ED with safety issue (suicidal)? The psychiatrist realizes that this patient has already complained against them to CPSO. What do you do? ***A. Assess person with someone else present*** B. Guide ED physician on how to assess the person without you C. Briefly assess patient alone D. Wait until another psychiatrist is available to assess 2025

Answer 60

Most common anxiety disorder >65 yo ***A. GAD*** B. Panic C. Specific phobia D. Social Anxiety Debate b/t A & C -K&S says specific phobia -Newer research says GAD 2025

Answer 61

Stem describes an old lady with GAD, what is first line treatment? No PMHx or drug interactions listed. A. Duloxetine B. Mirtazapine ***C. Sertraline*** D. Pregabalin 2025

Answer 62

Ketamine, what neurotransmitters? A. Serotonin and Dopamine ***B. NMDA and glutamate*** C. Histamine and norepinephrine 2025

Answer 63

A teenage girl thinks she has ASD after watching social media videos on it. Stem describes her having friends. What feature of her history makes it least likely she has autism? A. History of reciprocal relationships 2025

Answer 64

A gentleman is in the emergency department and under your care. He is given Haldol 10 mg IM and a short time later develops what sounds like acute dystonia. He has swallowing/breathing difficulties. You want to give benztropine; what do you do? A. Assess his capacity to consent to benztropine before giving it B. Contact an SDM to get consent for benztropine before giving it C. Ask for his consent to give benztropine ***D. Give benztropine without consent because this is an emergency*** 2025

Answer 65

Woman became extremely upset after her friend cancelled their plans. In response, she sets out labelling and reorganizing all of the spices in her kitchen. What DBT strategy is she engaged in? A. Busy hands technique ***B. Distraction to action*** C. Improve the moment 2025

Answer 66

Woman who has completed one trial of an antidepressant. She has a history of epilepsy and migraines. She is interested in rTMS and doesn’t want any cognitive side effects. Which of the following is most concerning for rTMS treatment for her? ***A. History of epilepsy*** B. Migraines C. Inadequate treatment trials D. Concern about cognitive side effects 2025

Answer 67

Seeing 5yr old kid in clinic. Referred for worsening behaviours in kindergarten noted by teachers. New in last few mos. Parents think he might have ADHD. Has a first cousin who was recently dx. They deny any issues w/ behaviour or inattention at home, aside from some difficulty getting to sleep at night. What is the next best step in mgmt? A. Neuropsychiatric testing B. Start clonidine C. Start LA stimulant ***D. Explore psychosocial stressors/changes*** 2025

Answer 68

Kid with history of ASD. Several behavioural issues that are impacting his ability to engage with parents/workers, at school, etc. Given that his behaviours are preventing him from engaging in first line management options/aspects of care, what can you do next? A. Neurofeedback for language training ***B. Low dose antipsychotic for irritability*** 2025

Answer 69

Older male on pain meds for back pain. MVC with grandson while intoxicated with opioids. He buys morphine off the streets. He wants treatment for OUD. What is the best option? ***A. Suboxone*** B. Methadone C. Naltrexone D. Naloxone 2025

Answer 70

What indicates remission on the Hamilton Depression Rating Scale? ***A. Score <7*** B. 25% decrease in symptoms C. 50% decrease in symptoms D. Score < 12 2025

Answer 71

What are the CANMAT recommendations for psilocybin in depression? A. Not recommended ***B. Only for experimental use*** C. Only if paired with psychotherapy D. Only for TRD 2025

Answer 72

Older lady going for maintenance ECT, long stem about treatment resistant depression. She presents with bradycardia in the 40’s, systolics were a twitch high (140s), alert, no other huge concerns and they make a statement on her MSE not being erratic. What to do: ***A. Hold ECT, and investigate underlying concerns before restarting*** B. Continue ECT, monitor closely with IV fluids ready C. Continue ECT then send to ED to address medical concerns D. Stop ECT and switch to meds 2025

Answer 73

45 yo M with depression, worsening, presents catatonic (didn’t tell you this explicitly but gives a bunch of symptoms). Was not eating so his family brought him to the hospital. Tests showed only dehydration. What to do: ***A. IV Lorazepam 1-2 mg TID*** B. ECT C. Increase SSRI D. Antipsychotic 2025

Answer 74

A kid has a bunch of sensory issues. He is dizzy in car, has temper tantrums. He cuts tags from shirts because he doesn’t tolerate them. Picky eater. The stem states that he does well socially, has many friends, and enjoys a number of varied hobbies and interests. No mention of repetitive behaviours or non-verbal deficits. What recommendations? ***A. Sensory integration program*** B. ABA C. Family therapy 2025

Answer 75

70M charged w/ assault w/ a weapon after driving impaired and injuring his grandson. On the forensic unit for fitness assessment and he shows ++memory impairment - he cannot remember the doctor from day to day, is misplacing things, thinks his daughter is coming to pick him up soon. No improvement during assessment. MMSE 16/30. Has completed a 60-day assessment. What will the verdict be in court tomorrow? ***A. Referral to review board*** B. NCR finding C. Send back to hospital for 9 months to ensure he doesn’t drink alcohol D. Unfit finding and further treatment order for 30 days to the max of 90 days 2025

Answer 76

Question about praising a patient’s strengths in supportive psychotherapy after they engage in social activities following a stressor. What is this an example of? A. Strengthening defenses 2025

Answer 77

Patient w/ hx of MDD. They are grieving. They do a psychotherapy involving mindfulness, focusing on positive emotions and building meaning in their life. They are working on incorporating their values into their life. What therapy is it? ***A. ACT*** B. IPT C. Short psychodynamic 2025

Answer 78

A stem introduced a teenager with BPD symptoms. She had overdosed a few months ago. Mom is worried about her. Bunch of other risk factors - bullying, witnessed parental violence. Sexuality is a focus of the stem. What is the biggest risk factor for suicide attempt: ***A. Previous suicide attempt*** B. Stressors/parental discord C. Being gay 2025

Answer 79

Patient with schizophrenia on paliperidone IM, took multiple tries to get stable. Doing well for months. Complaining of erectile dysfunction, mildly elevated prolactin. What to do next? ***A. Add oral Abilify*** B. Switch antipsychotic C. Bromocriptine D. Reduce paliperidone dose 2025

Answer 80

Teen w/ depressive episode. Presenting w/ significant psychomotor retardation, suicidal ideation and poor sleep. What is the biggest risk factor for developing bipolar disorder? ***A. Psychomotor retardation*** B. Poor sleep C. Suicidal ideation 2025

Answer 81

Middle aged female. Had one pregnancy and was on OCP for 10yrs after. History of two miscarriages before having her full-term pregnancy. Now has not had menstruation for several mos. Which is the biggest risk factor for obstructive sleep apnea? A. History of miscarriages B. History of full-term pregnancy ***C. Menopause*** D. OCP use 2025

Answer 82

Geriatric patient with multiple cognitive issues. He has some functional autonomy but left the stove on and needs help with finances. Having trouble with word finding, remembering names and remembering what he did yesterday. Can dress himself on his own in nearly matched suits. Can eat independently. The decline is progressive. Does not appear stepwise. What is his most likely diagnosis A. Mild NCD mixed ***B. Major NC probable Alzheimer’s*** C. Mild NC probable frontotemporal D. Major NC probable ?other etiology 2025

Answer 83

Young man who has a history of psychosis and cannabis use. He tells you he used to think cannabis was bad, but now he really isn’t all that sure. He likes how cannabis makes him feel and he is sick of doctors and his parents lecturing him about his cannabis use. What do you do? A. Gently tell him to come back when he's ready to quit ***B. Ask him to tell you disadvantages of cannabis*** C. Tell him all the reasons cannabis is bad 2025

Answer 84

A young child spent the first 2 years of her life in the hospital. She has cystic fibrosis and was adopted at age 3. She runs away and is found at a retirement home after she had willingly walked there with a random older lady. What disorder does she have? A. Reactive attachment disorder ***B. Disinhibited social engagement disorder*** C. ASD 2025

Answer 85

A man with OCD. Can’t go to parents house because he is convinced it is contaminated. Either on medications or wants to try non-pharmacological treatment. What would be an important component of therapy for him? A. Mindfulness ***B. Work toward not taking a shower after going to parent’s house*** 2025

Answer 86

IPT with someone who just got promoted as a manager, very anxious. What should you focus on? ***A. New role as manager*** B. Narcissistic dad C. Anxiety with presentations 2025

Answer 87

Woman in ED after finding out wife cheated on her and moves to short stay unit. You reassure her that you do not think she is to blame for her wife’s actions. You attempt to assess her multiple times when she is less emotionally labile but stick to strict 15 minute assessments. You recommend that she call her mother to come support her? Other information related to the interactions, etc. What’s not typical for crisis intervention? A. Coming back to assess the patient multiple times in a day B. Keeping time limit to maintain therapeutic frame C. Providing direct instruction for what to do D. Providing reassurance 2025 Major debate b/t all answers

Answer 88

Lady is 3 weeks postpartum, 3 years ago had MDD with melancholic features, was on sertraline until 1 year ago when she discontinued it, had previous SI 3 years ago but no history of attempt, now brought in to the ER by her husband who told nursing staff he is very concerned about her. He left the ED to care for baby at home. Patient is estranged from family and isolated. On exam she is guarded but denying concerns with her mood. She states that she wants to go home and that her husband is just a worrier and exaggerating. Husband is not available to pick up the phone when you attempted to call for collateral history. What to do? A. Seek consent to speak with patient's mother ***B. Admit involuntarily and get collateral from husband*** C. Discharge her, restart sertraline, rapid access clinic follow up in 1 week D. Discharge her, restart sertraline, peripartum MH clinic follow up in 1 month 2025

Answer 89

Woman in college w/ moderate to severe anxiety, well controlled on escitalopram 20mg PO daily. It is 3wks until exams. Patient has historical ADHD sx and dx, on Vyvanse and could not go higher in dose. What do you augment w/ in your office b/c she wants something to help now with exams coming? A. Add atomoxetine B. Switch escitalopram to venlafaxine C. Switch escitalopram to bupropion ***D. Add guanfacine XR*** 2025

Answer 90

Patient binges several times per week. Excessive exercise every weekend b/c they are worried about their weight. They are overweight. What is the diagnosis? ***A. Bulimia nervosa*** B. Binge eating disorder C. Atypical anorexia D. Unspecified eating disorder 2025

Answer 91

A medical student is worried about their upcoming surgical rotation because he faints whenever he gets his blood drawn. What would be added to standard psychotherapy? A. Applied muscle tension 2025

Answer 92

What dx is most common in females who have relatives with ASPD? ***A. Somatic symptom disorder*** B. Social anxiety disorder C. Generalized anxiety disorder D. Major depressive disorder 2025

Answer 93

50F complaining of attention and concentration issues. In your office she is “restless and irritable”. A number of different worries. Was particular about stuff earlier in life. No history of school issues growing up. What is the dx? ***A. GAD*** B. ADHD 2025

Answer 94

Elderly lady presenting with visual hallucinations of people in her house. She doesn’t want them to go away because “they’re keeping her company”, not distressing. She has some fluctuating cognition, There seemed to be other features to suggest LBD over delirium. How to treat? A. Quetiapine ***B. Rivastigmine*** C. Clozapine D. Memantine 2025

Answer 95

Girl with PTSD who had been thrown down the stairs. What is the first line agent? ***A. Venlafaxine*** B. Prazosin C. Escitalopram D. Mirtazapine 2025

Answer 96

How is CBT typically modified for kids? A. Less psychoeducation ***B. Emphasis on behaviour over cognition*** C. Fewer than 10 sessions D. Let the child devise their own exposures 2025

Answer 97

What makes old people have orthostasis more in response to medications? ***A. Decreased receptor sensitivity*** B. Decreased renal clearance C. Decreased hepatic something D. Decreased fat mass 2025

Answer 98

What is the main role or function of the review board in forensic psychiatry? ***A. Safety of the public*** B. Other distractors 2025

Answer 99

How does mirtazapine increase norepinephrine? a. NE reuptake inhibition ***b. Alpha-2 adrenergic blockade*** c. 5-Ht2c antagonism d. MAO inhibition 2024

Answer 100

Medical student in clinic with you, asks about lamotrigine mechanism of action - through which neurotransmitter? ***a. Glutamate*** b. GABA c. Serotonin d. Norepinephrine 2024

Answer 101

How is a journal’s impact factor determined? ***a. Calculated by dividing the number of current year citations to the source items published in that journal during the previous two years*** b. Something about number of citations over the last year, adjusted based on prestige of journal publishing citations over the previous 5 years c. Something about revenue from publishing journals d. Subjective decision by experts 2024

Answer 102

EEG with alpha waves with occasional 20–30 hz, MRI with arachnoid cyst and T2 hyperintensity in mesial temporal lobe. Which is an autoimmune encephalitis finding? ***a. T2 hyperintensity mesial temporal on MRI*** b. Arachnoid cyst on MRI c. Alpha waves on EEG d. 20-30 Hz on EEG 2024

Answer 103

Patient with multiple medication trials (including SRIs but not venlafaxine), and failed augmentations of lithium, abilify, bupropion) that have failed, completed course of ECT and is euthymic but doesn’t want maintenance ECT due to concerns about side effects - what to do instead? Past medical history of hypothyroid and hypertension. ***a. Lithium plus venlafaxine*** b. rTMS c. Vagus nerve stimulation d. Sertraline 2024 ?some debate that maybe leaning toward rTMS

Answer 104

Worst prognostic factor for AN relapse after hospitalization ***a. Significant weight loss 1 month post-discharge*** b. High BMI/weight at discharge c. Able to eat a wide range of foods 2024

Answer 105

What to add for OCD pt cannot tolerate higher clomipramine dose? (which medication boosts effect of clomipramine via pharmacokinetic interaction with clomipramine) ***a. Fluvoxamine*** b. Paroxetine c. Sertraline d. Citalopram 2024

Answer 106

Description of male with schizophrenia under review board (for NCR) detained in hospital [wording was ‘on a full warrant in the hospital’], receiving paliperidone IM monthly, history of substance use with intermittent relapse, attending substance use program. Able to go out on passes supervised with staff. What can't review board control/mandate as a part of the disposition? a. Abstinence from substance use b. Keep pt in hospital c. Supervision outside hospital ***d. Paliperidone 150mg IM monthly*** 2024

Answer 107

Person wants tx for sexual attraction to prepubescent child, distressed by this, married with wife, on sertraline 200 already for an episode of depression. Best management? a. Lupron b. Cyproterone acetate c. Switch to venlafaxine d. Potentiate sertraline with aripiprazole 2024 Debated b/c A & B

Answer 108

What to add to SSRI for OCD? ***a. Aripiprazole*** b. Quetiapine c. Clomipramine 2024

Answer 109

Elderly male is becoming more apathetic, socially withdrawn, confused, with psychomotor retardation. Most likely reversible cause of mental status change in elderly man? ***a. Cobalamin deficiency*** b. Vitamin D deficiency c. Wilson’s disease d. NPH 2024

Answer 110

Young woman you’ve treated for depression successfully with an SSRI. Now discloses she has had periods of pulling out her hair and eyebrows, waxing and waning for years. What is best tx? a. Increase SSRI ***b. Habit reversal*** c. ERP 2024

Answer 111

Patient with a recent MI, familial hypercholesterolemia (?), on meds for all metabolic things, smoking 15 cigs/d. Depression with mood congruent psychosis, but appropriate for outpatient management. Previously did well on sertraline and olanzapine. ***a. Sertraline and aripiprazole*** b. Sertraline c. ECT d. Sertraline and olanzapine 2024

Answer 112

Stem about pt with psychotic sx, then manic sx. Admitted to hospital, asks you about dx. Why schizoaffective over bipolar? ***a. Psychotic before manic symptoms emerged*** b. Grandiose delusions are bizarre c. Severity of symptoms require hospitalization 2024

Answer 113

80m with major ncd, hitting co residents and even fractured a nurses arm. (No time course given.) On generic list of meds. On morphine for osteoarthritis pain. Ix normal other than leuks in UA, fecal loading. UCx negative. What do you do next? ***a. Start PEG3350*** b. Start abx c. Put in restraints d. Stop morphine 2024

Answer 114

Elderly male in residential place with wife. Has Alzheimers and is wandering. Wife tired of keeping track of him at night. He is redirectable. Otherwise calm, pleasant, no behavioural issues. ***a. Disguise exits*** b. Risperidone c. Put in restraints overnight 2024

Answer 115

Describes child who is isolative, no friends, speech delayed (single words only at age 3), can only wear 1 shirt, difficulty with transitions. Most common comorbidity with this? ***a. Fragile X*** b. Tuberous sclerosis c. Down syndrome 2024

Answer 116

12yo AFAB person highly anxious about puberty. Has always liked boys things and refers to self as male. What to do after “extensive investigations”? ***a. GNRH agonist*** b. Testosterone c. Quetiapine d. SSRI 2024

Answer 117

Boy with aggression towards mom, skipping classes, set a fire once. Exposure to what substance in utero MOST associated with this condition? ***a. Alcohol*** b. Cannabis c. Cocaine d. Opioids 2024

Answer 118

Boy with mild/moderate intellectual disability and aggressive behaviors. Didn’t respond to behavioural tx. ***a. Risperidone*** b. Clonidine c. Methylphenidate 2024

Answer 119

Trans man on testosterone with BPD, suicidal behaviors, anger and mood lability. What to use? a. Lamotrigine ***b. Fluoxetine*** c. Lorazepam 2024 Answer debated b/t A & B

Answer 120

Woman on methadone tells you she is 5 months pregnant. What to do? ***a. Keep on methadone*** b. Switch to suboxone c. Switch to naltrexone d. Discontinue methadone and recommend psychological treatment 2024

Answer 121

52 F recently discharged from residential tx, on methadone. Last use of other opioids was on 50th bday. She no longer has cravings. Is she in remission from OUD? ***a. Yes, because no symptoms for 1 year*** b. Yes, because no cravings c. No, because she was in a controlled environment d. No, because she is still on methadone 2024

Answer 122

What is most important aspect of history for woman with AUD starting on naltrexone? ***a. Use of opioids in the past 10 days*** b. On OCP c. Time of last drink 2024

Answer 123

Woman with bipolar I disorder makes informed decision to stay on lithium during pregnancy. How does pregnancy impact lithium treatment? ***a. Alters lithium levels*** b. Increases tremor c. makes lithium more effective 2024

Answer 124

26. Woman with previous hx BPD symptoms (longstanding mood instability since childhood) presents with a 5-day history of delusions (ex-boyfriend is part of gang and she is being monitored through her laptop) and manic sx (sounded like mixed episode), reports going to kill self in ED, UDS positive for cannabis (used 3 days ago), most likely dx? [STEM: Longstanding history of mood instability since childhood. brought into hospital by family with 5 day history of dysphoria, agitation, buying things excessively, sleeping few hours a night, and paranoid ex boyfriend was part of a gang, monitored through laptop. Implied agitation. Reporterd was going to kill herself, with positive cannabis, and recent use of alcohol.] a. BPD b. Bipolar I c. Bipolar II d. Substance induced psychosis 2024 Debate b/t A & B

Answer 125

Pt in your office is stiff, echolalia, echopraxia, resisting repositioning and instructions. What is this most comorbid with? a. ASD ***b. Mood disorder*** c. Schizophrenia 2024

Answer 126

Pt started on clozapine 350mg, gave serum clozapine lvls (350mcg/L) too. Later develops posturing, standing still long periods, what to do: ***a. Lorazepam 1 mg*** b. Benztropine 1 mg c. Stop clozapine 2024

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