Treatment Modalities (Psychopharmacology, Psychotherapy Basics) MCQs

Psychiatry · 38 free questions with answers & explanations.

1. A 52-year-old man is prescribed phenelzine (an MAOI) for atypical depression. He attends a birthday dinner and eats aged cheese and red wine. Within 30 minutes he develops a severe throbbing headache, flushing, diaphoresis, and his blood pressure is 210/120 mmHg. What is the mechanism of this hypertensive crisis?
2. Regarding the defence mechanism of 'Reaction Formation', which example best illustrates it?
3. A 32-year-old woman has Major Depressive Disorder with psychotic features. She refuses ECT. Which pharmacological combination is the most appropriate initial treatment?
4. Acamprosate (calcium acetyl homotaurinate) is used in alcohol use disorder relapse prevention. What is its primary mechanism of action?
5. A psychiatric patient develops 'sublimation' as a coping mechanism after recovering from a serious illness. Which scenario best illustrates sublimation?
6. Which antidepressant mechanism uniquely explains the therapeutic action of mirtazapine and differentiates it from SSRIs and SNRIs?
7. A 50-year-old woman on phenelzine (MAOI) for treatment-resistant depression inadvertently eats a tyramine-rich meal (aged cheese, red wine). She develops a hypertensive crisis (BP 220/130 mmHg), severe headache, and diaphoresis. The mechanism of this interaction is:
8. In psychoanalytic theory, the defence mechanism in which an individual attributes their own unacceptable impulses or feelings to another person is called:
9. A 44-year-old man is managing his fear of heights by becoming an enthusiastic rock climber and mountain guide, turning the phobia into a strength. This is an example of which mature defence mechanism?
10. A patient says 'My therapist is the only person who has ever truly understood me; all my other doctors were useless.' This phenomenon, occurring in therapy and representing displacement of feelings from a past relationship onto the therapist, is called:
11. Which antidepressant is most likely to LOWER the seizure threshold and is CONTRAINDICATED in eating disorders (particularly bulimia nervosa and anorexia nervosa) due to increased seizure risk?
12. A 36-year-old man is described as intellectualising his anxiety about a cancer diagnosis by reading extensively about tumour biology and quoting survival statistics during consultations, without showing any emotional distress. This defence mechanism is:
13. The serotonin syndrome is BEST distinguished from neuroleptic malignant syndrome (NMS) by which clinical feature?
14. A 28-year-old woman is referred for psychotherapy for recurrent depression with interpersonal difficulties. In Interpersonal Therapy (IPT), the therapist identifies 'grief' as a focus. This refers to:
15. A 40-year-old woman on phenelzine (an MAOI) for refractory depression eats a tyramine-rich meal (aged cheese). She develops a sudden severe headache, hypertensive crisis (BP 220/130), and diaphoresis. What is the MECHANISM of this hypertensive crisis?
16. A 32-year-old man with generalized anxiety disorder and MDD is started on an antidepressant that simultaneously blocks norepinephrine and serotonin reuptake transporters. After 3 weeks, he reports improved sleep and anxiety. Which drug is this, and what is its mechanism that explains improved sleep?
17. A patient is receiving Cognitive Behavioural Therapy (CBT) for panic disorder. During the session, the therapist asks the patient to identify the automatic thought 'If I feel dizzy, I will faint and die,' evaluates the evidence for and against it, and helps the patient develop an alternative interpretation. This specific CBT technique is called:
18. A 45-year-old woman with treatment-resistant depression is prescribed a tricyclic antidepressant (TCA). She accidentally overdoses. She presents with QRS widening (>120 ms), hypotension, and ventricular arrhythmias. What is the CORRECT treatment for TCA-induced cardiac toxicity?
19. A 45-year-old man on phenelzine (MAOI) for treatment-resistant depression eats a tyramine-rich meal (aged cheese, chianti wine). Within 30 minutes he develops severe occipital headache, flushing, diaphoresis, and BP 210/130 mmHg. What is the pathophysiological mechanism of this hypertensive crisis?
20. In psychoanalytic theory, which ego defence mechanism involves redirecting an unacceptable impulse (e.g., aggression) toward a less threatening target (e.g., kicking the dog after being scolded by a boss)?
21. A psychiatry resident is studying serotonin syndrome vs neuroleptic malignant syndrome (NMS). Which clinical finding most reliably distinguishes serotonin syndrome from NMS?
22. Vaillant classified defence mechanisms into four hierarchical levels. Match: 'Altruism' and 'humour' belong to which level, and 'denial' belongs to which level?
23. Which antidepressant mechanism is unique to mirtazapine compared to SSRIs and SNRIs, and which specific side effects result from this unique mechanism?
24. Dialectical behaviour therapy (DBT) was originally developed for which specific condition, and what are its four core skill modules?
25. A patient taking phenelzine (an MAOI) inadvertently consumes aged cheese. He develops severe hypertensive crisis. The interaction is mediated by accumulation of which amine in food?
26. A patient on clozapine develops an absolute neutrophil count (ANC) of 450/mm³. According to current monitoring guidelines, the appropriate action is:
27. In Motivational Interviewing (MI), which concept describes a patient's own statements favouring change, which the therapist elicits and reinforces as a therapeutic technique?
28. The ego defence mechanism 'Reaction Formation' involves:
29. Which of the following defence mechanisms is classified as a 'mature' defence according to George Vaillant's hierarchy?
30. Which specific defence mechanism is most characteristically associated with Borderline Personality Disorder (BPD) and contributes to the unstable interpersonal relationships seen in this condition?
31. Naltrexone is used as pharmacotherapy for alcohol use disorder. Its mechanism for reducing craving and relapse is:
32. A depressed patient on the SSRI fluoxetine for 4 weeks is started on tramadol for post-operative pain. He develops agitation, tremor, hyperreflexia, hyperthermia, and diaphoresis. The most likely diagnosis is:
33. A 50-year-old man with Parkinson's disease develops psychotic symptoms (visual hallucinations). Which antipsychotic is MOST appropriate, and why?
34. A 32-year-old woman with bipolar I disorder is on valproate monotherapy. She plans to become pregnant. Which SPECIFIC teratogenic risk associated with valproate must be MOST prominently discussed during preconception counselling?
35. A 28-year-old woman with schizophrenia develops amenorrhea, galactorrhea, and decreased libido after starting risperidone. The MECHANISM underlying these adverse effects is:
36. A patient taking an SSRI develops agitation, muscle twitching, diaphoresis, hyperreflexia, diarrhea, and rapid heart rate after being given a single dose of tramadol for pain. The MECHANISM of this interaction is:
37. A 40-year-old man with treatment-resistant depression (failed 3 SSRIs, 1 SNRI, augmentation) is offered ketamine infusion. Ketamine's antidepressant mechanism is PRIMARILY through:
38. A psychiatrist prescribes venlafaxine (an SNRI) for a patient. What is the MECHANISM that explains why SNRIs may cause more sexual side effects and urinary hesitancy at higher doses compared to SSRIs?