Free SMLE Psychiatry questions

A 10-year-old boy whose family recently moved to a new city feels down and has difficulty making friends since starting his new school two weeks ago. He has no anhedonia, sleep, or appetite disturbance. What is the most likely diagnosis?

A 35-year-old man is diagnosed with major depressive disorder and started on an SSRI. Which statement best reflects appropriate initial management and follow-up?

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 26-year-old woman with bipolar I disorder, off all medication for a year, is brought by her family after 10 days of elevated mood, two hours of sleep nightly, pressured speech and reckless spending. Today she is agitated, shouting at staff, and believes she has divine powers. Urine drug screen and thyroid function are normal, and pregnancy test is negative. Which medication is most appropriate to start now?

A 14-year-old boy with attention-deficit/hyperactivity disorder started immediate-release methylphenidate 10 mg twice daily 4 weeks ago, with clear improvement in school. He now has reduced appetite at lunch, has lost 2 kg and takes over an hour to fall asleep. His mood is good and he enjoys his usual activities. Heart rate is 84 beats/min, and full blood count and thyroid function are normal. What is the most likely explanation?

A 78-year-old woman in the intensive care unit, two days after emergency bowel surgery and not intubated, wakes acutely confused and severely agitated, pulling at lines and striking nurses. Oxygenation, glucose and analgesia are adequate and the bladder is empty. Reorientation and physical measures have failed, and she spits out tablets. QTc is 430 ms. Which medication is most appropriate?

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?

An 8-year-old boy is referred for moderate failure to thrive. His parents are divorced and he lives with his mother, who has social and financial difficulties, is taking antidepressants, and works six days a week. What is the most appropriate next step in management?

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 32-year-old man with bipolar II disorder has had 3 weeks of low mood, anhedonia, poor sleep and reduced concentration. He continues to work, has no suicidal ideation or psychotic features, and has no current hypomanic symptoms. He takes no psychotropic medication. His hypertension is controlled on lisinopril, and renal function is normal. Which of the following is the most appropriate management?

A 67-year-old woman is brought by her daughter because of gradually progressive forgetfulness over 2 years; she repeats questions and misplaces items. Over recent months she has lost interest in her hobbies and withdrawn from family gatherings. Neurological examination is non-focal. MRI of the brain shows bilateral hippocampal atrophy. Which feature in this patient is most specific for Alzheimer disease?

A 72-year-old woman with type 2 diabetes treated with metformin 1 g twice daily is brought by her family for two years of progressive difficulty naming objects; she calls a cat "an animal" and asks what a "fork" is. Recent memory, orientation, personality and behaviour are preserved. Her brother had a similar illness. Neurological examination is otherwise normal. What is the most likely diagnosis?

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 41-year-old woman under marital stress reports a mounting urge to pull out her scalp hair, followed by relief once she does. Examination shows patchy areas of hair loss with broken hairs of varying lengths and no scaling or inflammation. Which is the most likely diagnosis?

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?