Free SMLE Psychiatry questions

A 22-year-old woman with a history of severe depression and prior suicide attempts is currently stable on paroxetine. She has just learned she is 8 weeks pregnant. What is the most appropriate management?

A 32-year-old woman describes more than two years of frequent mood swings, alternating between periods of mildly elevated energy and productivity and periods of low mood and fatigue. Neither type of period has ever met full criteria for a hypomanic or a major depressive episode, she has never been symptom-free for more than a month at a time, and she has never had psychotic symptoms. Which is the most likely diagnosis?

A previously well woman cannot sleep and cries frequently for 5 days after her sibling died suddenly. She has no other depressive features and was functioning well before the loss. Along with supportive psychotherapy, which is the most appropriate short-term pharmacologic option?

A 28-year-old man with schizophrenia had his haloperidol dose doubled five days ago. He is now confused, with temperature 40.1 °C, pulse 126 beats/min and blood pressure 160/95 mm Hg. There is generalised lead-pipe rigidity without clonus or hyperreflexia. Creatine kinase is 6800 U/L, white cell count 15 × 10⁹/L, and the urine is dark. What is the most likely diagnosis?

A 38-year-old woman with 2 years of major depressive disorder attends with her husband, who reports she has withdrawn from all friends and relatives over the past month, stopped answering calls, and now speaks of being a burden. She uses no alcohol or substances and has no chronic medical illness. She makes no eye contact. Which factor carries the highest suicide risk?

A 74-year-old woman with type 2 diabetes and long-standing hypertension has cognitive decline that has worsened in a stepwise fashion over 2 years, with prominent slowing of thinking and difficulty planning and organizing. On examination she has a shuffling gait and brisk reflexes. MRI shows multiple lacunar infarcts and extensive white matter ischemic changes. What is the most likely diagnosis?