Psychiatric Emergencies (Suicide Risk, NMS, Serotonin Syndrome, Catatonia, Acute Agitation) MCQs

Psychiatry · 20 free questions with answers & explanations.

1. A 28-year-old male on risperidone for 2 weeks presents with fever (39.8°C), diaphoresis, severe muscle rigidity, and a CK of 12,000 U/L. He is confused and his BP oscillates widely. Urine is dark. Which investigation is most likely to show a diagnostic finding?
2. A patient on phenelzine (MAOI) for depression self-administers tramadol for back pain. Within 2 hours he develops agitation, diaphoresis, tremor, myoclonus, hyperreflexia, and clonus at the ankles. His temperature is 38.9°C. What is the most accurate differentiating feature from NMS?
3. A 35-year-old woman with bipolar disorder presents mute and immobile in a fixed posture for 3 hours. She resists passive movement, does not respond to commands, but is apparently awake (eyes open). Earlier she was overheard speaking repetitively. Which feature in this presentation specifically points to catatonia rather than psychogenic unresponsiveness?
4. An emergency room receives a 40-year-old male, acutely agitated and combative, brought by police. He is unable to provide history. The MOST appropriate first step in pharmacological management of undifferentiated acute agitation is:
5. In assessing suicide risk, which combination of clinical factors is associated with the HIGHEST short-term risk according to the SAD PERSONS scale and structured clinical risk assessment?
6. A 35-year-old man on haloperidol and lithium develops fever (40.2°C), generalised rigidity, diaphoresis, and confusion over 48 hours. CK is 8400 U/L. Which single feature MOST reliably distinguishes neuroleptic malignant syndrome (NMS) from serotonin syndrome?
7. A 28-year-old woman with schizophrenia is brought catatonic — mute, posturing, with waxy flexibility. Which of the following is the FIRST-LINE pharmacological treatment for acute catatonia?
8. A 45-year-old man admitted after a suicide attempt by overdose scores 38 on the Columbia Suicide Severity Rating Scale (C-SSRS). He has a prior attempt, current suicidal ideation with intent, and access to firearms. According to validated risk stratification, which management is MOST appropriate?
9. A 32-year-old man on tramadol for back pain is started on sertraline for depression. Two days later he develops agitation, tremor, diaphoresis, and temperature of 39°C. Ankle clonus is present. What is the mechanism of this reaction?
10. In the management of acute severe agitation in the emergency department, which combination is recommended by evidence-based protocols for rapid tranquillisation when oral medication is refused?
11. A 28-year-old man on clozapine presents with fever 40°C, generalized rigidity, altered consciousness, and serum CPK of 8,000 U/L. His blood pressure is 160/100 mmHg. The most important immediate step in management after stopping the offending drug is:
12. A patient on tramadol for pain management is started on sertraline for depression. Within 48 hours he develops agitation, diaphoresis, myoclonus, hyperreflexia, and hyperthermia. The pathophysiology of this reaction involves excess activity at which receptor?
13. A 35-year-old woman presents in the emergency room with mutism, waxy flexibility, and maintenance of odd postures for extended periods. She stares blankly and does not respond to commands. The MOST appropriate immediate pharmacological intervention is:
14. In assessing acute suicide risk in the emergency department, which feature MOST strongly predicts imminent risk and should prompt inpatient admission?
15. A 45-year-old man with known bipolar disorder presents in the ER with severe psychomotor agitation, threatening to harm others. He refuses oral medication. According to evidence-based rapid tranquillisation protocols, what is the PREFERRED combination for IM administration?
16. A 28-year-old male on haloperidol for schizophrenia presents with temperature 40.2°C, lead-pipe rigidity, diaphoresis, and creatine kinase of 12,000 U/L. His consciousness is clouded. Which receptor mechanism is primarily responsible for this syndrome?
17. A patient on phenelzine (MAOI) was given tramadol for pain. Within 2 hours she develops agitation, tremor, myoclonus, hyperreflexia, diaphoresis, and temperature of 39.1°C. The finding that BEST distinguishes this from NMS is:
18. A 35-year-old catatonic patient is mute, immobile, and has waxy flexibility. He refuses oral intake. After 48 hours, which is the MOST appropriate immediate pharmacological intervention?
19. Using the Columbia Suicide Severity Rating Scale (C-SSRS), which combination indicates the HIGHEST risk requiring immediate psychiatric hospitalization?
20. A medically ill patient develops acute severe agitation in the ICU. He is pulling at IV lines and is unable to cooperate. He has no prior psychiatric history. After de-escalation fails, pharmacological management of choice is: