OCD & Tic Disorders
Psychopharmacology
DSM-5-TR Criteria
Substance Use Disorders
Autism Spectrum
Serotonin Syndrome
Clozapine Monitoring
Child & Adolescent Psych
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All Questions
42 clinical practice questions — click each to reveal answers and explanations
Q1
A 17-year-old female presents with severe abdominal pain with physical findings indicative of acute appendicitis. She insists on washing her hands every hour, which interferes with clinical care. Attempts to prioritize diagnostic procedures over her hand-washing routine result in increased patient anxiety. What is the most appropriate approach to manage the patient's compulsive behavior? A. Explain the need for imaging to confirm the diagnosis. B. Set a limit to restrict hand washing to 10 times. C. Make time for the patient to complete handwashing. D. Explain the risks of frequent hand washing.
Correct answer
Make time for the patient to complete handwashing.
Why: In an acute medical setting, confronting compulsive rituals escalates anxiety and worsens cooperation. Making time for the compulsion reduces distress without reinforcing harm, allowing the clinical assessment to proceed. Limit-setting is not appropriate during an acute crisis.
Q2
A 2-year-old patient carries a blanket at all times. Her mother fears she will remain attached forever. Developmental assessment is unremarkable. What should be advised? A. Yes, it is important at age 2 to get rid of it. B. Children should gradually be weaned from their favorite toy. C. This normal attachment may last throughout the preschool years. D. Try to reason with the child that this habit needs to be broken.
Correct answer
This normal attachment may last throughout the preschool years.
Why: Transitional objects (security blankets, stuffed animals) are developmentally normal in toddlers and preschoolers. They help children manage separation anxiety. Most children naturally give them up as they develop. There is no intervention required.
Q3
A 17-year-old girl with a strong family history of bipolar disorder is admitted for lack of sleep for 4 days with high energy, rapid speech, and grandiosity. She is started on valproic acid. Two days later, psychiatric symptoms worsen and she reports severe abdominal pain and tingling. What is the appropriate next step? A. Request GI evaluation and stop valproic acid. B. Request medical evaluation and stop valproic acid. C. Request neurological evaluation and prescribe morphine. D. Request substance use evaluation and prescribe morphine.
Correct answer
Request a medical evaluation and stop valproic acid.
Why: Abdominal pain and tingling in a patient on valproic acid raises concern for pancreatitis (abdominal pain) and peripheral neuropathy or hepatotoxicity. Valproic acid causes potentially fatal pancreatitis and hepatic failure. A broad medical evaluation is required and valproic acid must be stopped immediately — not just a GI evaluation.
Q4
A 9-year-old boy presents with poor school performance and disruptive behaviors. He enjoys numbers but dislikes reading and writing. He received speech therapy for language delay. What is the best next step? A. ADHD treatment. B. Academic accommodations. C. Psychometric testing. D. Psychotherapy.
Correct answer
Psychometric testing.
Why: Before initiating any treatment, a formal psychological evaluation (psychometric testing) is needed to identify the specific learning disability. The combination of language delay, dislike of reading/writing, and intact math skills suggests a reading disorder (dyslexia). ADHD cannot be diagnosed or treated without proper assessment.
Q5
A 9-year-old boy with poor school performance, disruptive behaviors, speech therapy history for language delay, and preference for numbers over reading. What is the best next step? A. ADHD treatment. B. Academic accommodations. C. Psychometric testing. D. Psychotherapy.
Correct answer
Psychometric testing.
Why: Duplicate of Card 4. Psychometric testing is the first step before any diagnosis or treatment is made for learning or behavioral concerns in a school-age child.
Q6
A 17-year-old boy with major depressive disorder is prescribed fluoxetine. His mother calls the clinic asking for information about his diagnosis, saying she wants to take better care of him. What is the most appropriate response? A. Cannot confirm or deny he is a patient. B. Provide the diagnosis as she is his mother. C. Encourage the mother to come to the next visit with her son. D. Ask the mother to hand him the phone to obtain his permission.
Correct answer
Ask the mother to hand the patient the phone to obtain his permission to share the information.
Why: Adolescents aged 17 have privacy rights, particularly for mental health treatment in many states. While parents generally have access to a minor's health information, the clinical best practice here is to obtain the patient's consent before disclosing to preserve therapeutic alliance. Asking the patient directly while the mother is present respects both parties.
Q7
Same 17-year-old boy scenario. Mother calls asking about her son's diagnosis. What is the most appropriate response? A. Cannot confirm or deny he is a patient. B. Provide the diagnosis as she is his mother. C. Encourage the mother to come to the next clinic visit with her son. D. Ask the mother to hand him the phone.
Correct answer
Encourage the mother to come to the next clinic visit with her son.
Why: Note: Cards 6 and 7 present the same scenario with different correct answers — reflecting a clinical judgment question. Inviting the mother to a joint appointment is a constructive middle ground: it involves the family in care without violating confidentiality in real time.
Q8
A 55-year-old woman with a 30-pack-year smoking history stopped smoking for 2 months after gathering information about cessation. Based on the Transtheoretical Model (TTM), what is the most appropriate action plan? A. Recognize triggers that may lead to relapse and develop an action plan. B. No additional action — she is in the maintenance stage. C. Any talk therapy for conscious-raising. D. Further information gathering.
Correct answer
Recognize personalized triggers that may lead to relapse and develop a corresponding action plan.
Why: Two months of successful cessation = Action stage in the TTM, transitioning toward Maintenance. The priority is relapse prevention — identifying triggers (stress, social situations, habits) and creating specific coping strategies. She is past the contemplation and information-gathering stages.
Q9
A patient with schizophrenia compliant for 5 years is moving 4 hours away. The provider refers to a new specialist, prescribes medication to last until the next appointment, and arranges medical records transfer while remaining available by phone. This demonstrates which understanding? A. How to avoid patient abandonment. B. Termination is unilateral. C. Patient has autonomy over seeing the new provider. D. Appropriate medication prescribing.
Correct answer
The provider understands how to avoid patient abandonment.
Why: Patient abandonment requires that a provider unilaterally terminate the relationship without adequate notice or transition of care. This provider gave appropriate notice, ensured medication continuity, arranged a new provider, transferred records, and remained available — all elements of a proper termination.
Q10
A 9-year-old boy repeats everything said to him (echolalia), jerks his head, grimaces, and shrugs his shoulders. These symptoms started a year ago and worsened. Which disorder is associated with his condition? A. Schizoaffective disorder. B. Obsessive-compulsive disorder. C. Psychotic disorder. D. Autism.
Correct answer
Obsessive-compulsive disorder.
Why: The presentation describes Tourette syndrome — motor tics (head jerking, grimacing, shoulder shrugging) plus vocal tics (echolalia). Tourette syndrome is highly comorbid with OCD (up to 50% of cases) and ADHD. OCD is the correct associated disorder.
Q11
A 17-year-old girl with trichotillomania (hair pulling disorder) with no improvement. No prior therapy or psychiatric medication. What is the best initial management? A. SSRIs. B. Behavior modification. C. Topical corticosteroids. D. Avoiding traction hairstyles.
Correct answer
Behavior modification.
Why: First-line treatment for trichotillomania is Habit Reversal Training (HRT), a behavioral intervention. SSRIs have limited evidence for trichotillomania and are not first-line. Topical treatments address cosmesis, not the underlying compulsion.
Q12
A 37-year-old man with schizophrenia has worsening hallucinations, incoherence, and suicidal ideation on risperidone. He could not tolerate haloperidol or olanzapine. The clinician will switch antipsychotics. Which patient factor most affects the choice? A. Baseline LDL/HDL/triglycerides. B. Baseline absolute neutrophil count. C. Baseline fasting blood glucose. D. Baseline BMI.
Correct answer
Baseline absolute neutrophil count.
Why: The answer points to clozapine — the antipsychotic of choice for treatment-resistant schizophrenia. Clozapine requires monitoring for agranulocytosis. Baseline and ongoing absolute neutrophil count (ANC) monitoring is mandatory before and during clozapine therapy.
Q13
A 30-year-old man has panic attacks while flying, with anticipatory anxiety. He prefers trains but they are too time-consuming. What is the first-line therapy? A. CBT. B. Reassurance and follow-up. C. SSRI. D. Benzodiazepines.
Correct answer
Cognitive-behavioral therapy.
Why: Specific phobia (aviophobia/flight phobia) is treated first-line with CBT incorporating exposure therapy. SSRIs are not first-line for specific phobia. Benzodiazepines address acute symptoms but do not provide lasting treatment.
Q14
A chronically ill, bed-bound 78-year-old man with diabetes and stroke presents with severe malnutrition, altered mental status, facial bruising, skull fracture, and subdural hematoma. He lives with his son and daughter-in-law. What is the next step? A. Wait for investigator before treating. B. Obtain consent from power of attorney before involving investigators. C. Report suspected abuse to authorities. D. Perform further testing to rule out organic cause before involving others.
Correct answer
Report suspected abuse to the authorities, who will then investigate for conclusive evidence.
Why: Elder abuse is a mandatory reporting situation in all US states. The clinician does not need to prove abuse before reporting — suspicion is sufficient. Acute injuries take priority and are managed concurrently with the abuse report. Waiting or seeking POA consent before reporting is incorrect.
Q15
A 19-year-old woman with alcohol use disorder has had several relapses. She appears withdrawn; her father is upset. Which statement by her father would be most appropriate to support? A. Support group and medication only. B. Combination of medication, peer support, and close monitoring. C. A peer recovery coach only. D. Frequent testing with severe repercussions.
Correct answer
'I think she could use a combination of medication, peer support, and close monitoring.'
Why: Evidence-based treatment for alcohol use disorder includes pharmacotherapy (naltrexone, acamprosate, disulfiram), mutual support groups, and monitoring. No single intervention is sufficient. A comprehensive approach with close follow-up is most effective, especially after multiple relapses.
Q16
An 18-month-old girl has daily temper tantrums, sensitivity to the vacuum cleaner, no eye contact, and unusual repetitive finger movements near her eyes. Parents are concerned about hearing and vision. What is the best next step? A. Screen for autism spectrum disorder. B. Obtain a lead level. C. Enroll in parent management training. D. Prescribe hydroxyzine.
Correct answer
Screen for autism spectrum disorder.
Why: Lack of eye contact, repetitive movements (stereotypies), sensory sensitivities, and temper tantrums in an 18-month-old are red flags for autism spectrum disorder. Screening with M-CHAT-R/F is the immediate next step.
Q17
A 46-year-old man with severe opioid use disorder completed medically supervised withdrawal 5 days ago. His wife objects to methadone/buprenorphine, saying 'that's just trading one addiction for another.' What is the most appropriate response? A. Methadone or buprenorphine cuts overdose mortality by more than 50% and allows patients to work and care for their families. B. Successful withdrawal suggests MOUD may not be necessary. C. These medications treat dependence by increasing dopamine and decreasing GABA. D. A brief MOUD course reduces relapse risk by 63%.
Correct answer
Methadone or buprenorphine cuts overdose mortality by more than 50%, and allows patients to work and care for their families despite physiological dependence.
Why: MOUD is evidence-based treatment, not 'trading one addiction for another.' The key counter to this misconception is that mortality reduction (>50%), improved functioning, and maintained employment/family care are clinically meaningful outcomes. Physiological dependence on MOUD is distinct from addiction.
Q18
An 8-year-old child has frequent random outbursts of obscenities at school and home, worse when tired or frustrated. What is the most likely prognosis? A. Temporary, will resolve within 1 year. B. Will worsen for 1 year then resolve. C. Will likely resolve with an IEP or 504 plan. D. No risk of school performance impairment.
Correct answer
They will likely resolve with an individualized education plan (IEP) or 504 plan.
Why: Random coprolalia (obscene outbursts) in a child suggests Tourette syndrome or a tic disorder. Educational accommodations (IEP/504 plan) address the school impact. Many tic symptoms improve with age and proper support.
Q19
A 32-year-old woman with major depressive disorder on citalopram 40 mg daily for 1.5 years is being switched to tranylcypromine (MAOI). She is instructed to wait 14 days after stopping citalopram. What adverse effect does this washout period prevent? A. Hypertensive crisis. B. Serotonin syndrome. C. Suicidal ideation. D. Orthostatic hypotension.
Correct answer
Serotonin syndrome.
Why: Combining an SSRI with an MAOI without adequate washout causes serotonin syndrome — life-threatening excess serotonergic activity. Citalopram has a 5-day half-life and requires 5 half-lives (~14 days) to clear. The MAOI-tyramine interaction causes hypertensive crisis, not the SSRI-MAOI combination.
Q20
A 16-year-old boy with ADHD and MDD presents with new suicidal ideation and worsening symptoms 10 days after starting a new medication. Which medication was most likely prescribed? A. Lurasidone. B. Escitalopram. C. Trazodone. D. Risperidone.
Correct answer
Escitalopram.
Why: SSRIs carry an FDA black box warning for increased suicidality in children and adolescents under age 25, particularly in the first 1-4 weeks. Escitalopram (SSRI) is the most likely prescribed medication for MDD in a teenager. The timing (10 days) matches the warning period.
Q21
A 20-month-old boy has temper tantrums, sensory sensitivity to loud noises, aggression when asked to participate, inability to line up, fleeting eye contact, no pointing, no meaningful words, and does not respond to his name. Normal hearing evaluation. What is the best initial management? A. Twice-monthly ABA therapy. B. Refer to early intervention and seek an individualized family service plan. C. MRI brain. D. Electroencephalogram.
Correct answer
Refer to early intervention and seek an individualized family service plan (IFSP).
Why: For children under 3 with suspected developmental delay or autism, the immediate referral is to Early Intervention services under IDEA. An Individualized Family Service Plan (IFSP) coordinates speech, occupational, and behavioral therapy. ABA may be part of the plan but is not the first step.
Q22
A 17-year-old boy ingested his roommate's entire bottle of antidepressant. ECG shows polymorphic ventricular tachycardia (torsades de pointes). The antidepressant can cause hyponatremia. Which is the most appropriate immediate treatment? A. Activated charcoal. B. Digoxin. C. Magnesium sulfate. D. IV fluid bolus.
Correct answer
Magnesium sulfate.
Why: Torsades de pointes (TdP) is treated with IV magnesium sulfate, which stabilizes the cardiac membrane. The antidepressant is citalopram — which causes QT prolongation, hyponatremia (SIADH), and TdP in overdose. Activated charcoal is for early ingestion; the cardiac arrhythmia takes priority.
Q23
A 40-year-old woman with chronic depression unresponsive to paroxetine and sertraline presents with social anxiety, possible past trauma, and wishes she didn't have to live as herself. The MMPI is recommended at the next appointment. What is the MMPI most likely assessing? A. Unresolved past trauma affecting relationships. B. Wide scope of symptoms to arrive at a diagnosis. C. Predisposition for loneliness and isolation. D. Red flags for impending suicide attempt.
Correct answer
Examine a wide scope of the patient's symptoms to help arrive at a diagnosis.
Why: The MMPI (Minnesota Multiphasic Personality Inventory) is a broad-spectrum psychological assessment tool used to evaluate personality structure, psychopathology, and diagnostic possibilities. It is not a trauma-specific tool or a suicide risk tool; it surveys a wide range of psychiatric symptoms.
Q24
A 3-year-old boy has difficulty speaking, cannot speak in complete sentences, does not respond to his name at times, normal milestones on previous encounters, and clinician suspects a language disorder. What is the next best step? A. Karyotyping. B. Reassurance. C. Hearing assessment. D. Intelligence testing.
Correct answer
Hearing assessment.
Why: Hearing loss is the most common and reversible cause of language delay. Before attributing language delay to a developmental or cognitive cause, hearing must be formally assessed with audiometry or ABR testing. Normal newborn screening does not rule out later-onset hearing loss.
Q25
A 60-year-old man with previous manic episodes and depression, poor response to lithium and valproate, is prescribed another antiepileptic and improves within a week but then develops nausea, dizziness, fatigue, and lethargy. What is the most likely cause? A. Hyponatremia. B. Hypocalcemia. C. Hypernatremia. D. Hypomagnesemia.
Correct answer
Hyponatremia.
Why: The antiepileptic is carbamazepine — used for bipolar disorder when lithium and valproate have failed. Carbamazepine causes SIADH, leading to hyponatremia. Symptoms of nausea, dizziness, fatigue, and lethargy within weeks of starting are the classic SIADH/hyponatremia presentation.
Q26
A 39-year-old man with opioid use disorder wants to enroll in an opioid rehabilitation center. The provider plans a medication with a long half-life causing less euphoria. Before starting, the clinician should: A. Recheck medical history with PCP. B. Review prescription drug monitoring data. C. Obtain a clean urine drug screen. D. Obtain a verbal contract for follow-ups.
Correct answer
Review his prescription drug monitoring data.
Why: The medication described is methadone. Before starting MOUD, reviewing the Prescription Drug Monitoring Program (PDMP) is essential to identify concurrent prescriptions (especially benzodiazepines and other opioids) that increase overdose risk. PDMP review is a regulatory and safety requirement.
Q27
A 15-year-old emancipated boy who was physically abused by his alcoholic father, has moved frequently, was detained for minor theft, but is doing well in school, elected class president, and has money saved for college. He regularly called his maternal uncle in times of trouble. What primarily enabled his recovery? A. Father's military background. B. Maternal uncle's availability. C. Detainment as a minor. D. Emancipation.
Correct answer
Maternal uncle's availability.
Why: This is a question about resilience. The protective factor that most enabled recovery from adversity is a stable, caring adult relationship — the maternal uncle who was consistently available and supportive. This is a classic example of a secure attachment figure as a resilience buffer.
Q28
A 32-year-old man developed labile moods, pressured speech, reckless driving, and missing work after a motor vehicle accident 6 months ago. Which brain area is most likely affected? A. Occipital lobe. B. Temporal lobe. C. Frontal lobe. D. Parietal lobe.
Correct answer
Frontal lobe.
Why: The frontal lobe governs executive function, impulse control, mood regulation, and social behavior. Traumatic brain injury to the frontal lobe causes disinhibition, labile mood, impulsivity, and personality change — all present in this patient. Phineas Gage is the classic case.
Q29
A 32-year-old man with trigeminal neuralgia and bipolar disorder I started a medication that auto-induces its metabolism 2 weeks ago and developed a rash and fatigue. Which test will reveal the cause? A. Blood culture. B. Basic metabolic panel. C. Complete blood count. D. Thyroid function tests.
Correct answer
Complete blood count.
Why: The medication is carbamazepine — which auto-induces CYP3A4 (reducing its own levels over time) and causes aplastic anemia and agranulocytosis. Rash and fatigue with carbamazepine require a CBC to check for bone marrow suppression. Stevens-Johnson syndrome must also be considered with the rash.
Q30
A 42-year-old patient presents with hypertension, tachycardia, tremors, akathisia, agitation, hyperthermia, increased bowel sounds, dilated pupils, and hyperreflexia. What is the possible antidote? A. Bromocriptine. B. Propranolol. C. Dantrolene. D. Cyproheptadine.
Correct answer
Cyproheptadine.
Why: The presentation is serotonin syndrome — characterized by the triad of mental status changes, autonomic instability, and neuromuscular abnormalities (hyperreflexia, clonus). Cyproheptadine is a serotonin antagonist used as an antidote. Bromocriptine and dantrolene are used for neuroleptic malignant syndrome.
Q31
Which laboratory tests must be monitored during the first four weeks of clozapine therapy? A. Fasting blood glucose and troponin. B. Uric acid and eosinophil count. C. Troponin and baseline EKG. D. CRP and fasting blood glucose.
Correct answer
Troponin and baseline EKG.
Why: Clozapine causes myocarditis, particularly in the first 4-6 weeks. Troponin monitoring and baseline EKG are required during initiation. Absolute neutrophil count (ANC) monitoring for agranulocytosis is the other critical requirement. Metabolic monitoring is important long-term but not specifically in the first 4 weeks.
Q32
A 16-year-old girl was raped by her stepfather 4 days ago. She now describes 4 previous adverse childhood experiences (ACEs). What is she most at increased risk for? A. Acute HIV infection. B. Promiscuity in the future. C. Chronic health conditions. D. No increased risk.
Correct answer
Increased risk of chronic health conditions.
Why: The ACE (Adverse Childhood Experiences) study demonstrates a dose-response relationship between number of ACEs and long-term health outcomes: cardiovascular disease, autoimmune conditions, depression, substance use, and cancer. With 4+ ACEs, the risk of chronic health conditions increases substantially.
Q33
A diet plan is being made for a 17-year-old girl with an eating disorder. Which short-term goal is appropriate? A. Weight within acceptable range. B. Eating a well-balanced meal. C. Looking at the mirror daily. D. Resolving family disagreements based on weight.
Correct answer
Eating a well-balanced meal.
Why: Short-term goals in eating disorder treatment should be achievable and behaviorally focused. 'Eating a well-balanced meal' is a proximal, concrete behavioral goal. Weight targets are long-term goals. Mirror exposure and family conflict resolution are separate therapeutic goals, not dietary short-term targets.
Q34
A 54-year-old man taking medication for alcohol use disorder recalls that if he drinks alcohol, his face flushes, heart races, and he becomes sweaty and nauseous. What enzyme does this medication inhibit? A. CYP2E1. B. Alcohol dehydrogenase. C. Aldehyde dehydrogenase. D. Catalase.
Correct answer
Aldehyde dehydrogenase.
Why: The medication is disulfiram (Antabuse). Alcohol is metabolized by alcohol dehydrogenase to acetaldehyde, then by aldehyde dehydrogenase to acetate. Disulfiram blocks aldehyde dehydrogenase, causing toxic acetaldehyde accumulation — producing the disulfiram-alcohol reaction (flushing, tachycardia, nausea).
Q35
A 55-year-old man is hospitalized for suicidal ideation with a loaded gun. Family history of depression and suicide. Started on fluoxetine and discharged after 2 weeks. His wife later reports episodes of high energy and productivity with only 3-4 hours of sleep. Four weeks later he is readmitted after a suicide attempt. What most likely occurred? A. Medication error. B. Communication error. C. Treatment error. D. Diagnostic error.
Correct answer
Diagnostic error.
Why: The wife's history reveals hypomania — decreased need for sleep, elevated productivity, high energy — which was missed at the initial evaluation. The correct diagnosis was bipolar disorder, not unipolar depression. Starting fluoxetine (an antidepressant) without a mood stabilizer in bipolar disorder can precipitate a manic episode and worsen suicidality. This is a diagnostic error.
Q36
A 31-year-old man with treatment-resistant schizophrenia on clozapine 300 mg twice daily is hospitalized and remains tobacco-free. On day 3, clozapine level is 1296 μg/L (therapeutic: 250-550). He has a generalized tonic-clonic seizure. What would most likely have prevented this? A. Decreasing the clozapine dose. B. Scheduled benzodiazepines. C. Starting nicotine-replacement therapy. D. Prophylactic topiramate.
Correct answer
Decreasing the clozapine dose.
Why: Smoking induces CYP1A2, increasing clozapine metabolism. When a heavy smoker stops smoking (as during hospitalization), CYP1A2 activity decreases, clozapine levels rise significantly — in this case to toxic levels (1296 vs. therapeutic 250-550). The seizure was caused by clozapine toxicity. The dose should have been reduced when the patient was hospitalized and became tobacco-free.
Q37
A 40-year-old patient with opioid use disorder is considering a methadone maintenance program. Which statement is most accurate? A. MMPs aim to eliminate opioid use and are most effective under 1 year. B. MMPs are effective but have significant negative impacts on social/occupational functioning. C. MMPs provide long-term stabilization, reduce illicit opioid use, improve social functioning, and decrease infectious disease risk. D. MMPs focus only on medication and do not incorporate counseling.
Correct answer
MMPs provide long-term stabilization and are effective in reducing illicit opioid use, improving social functioning, and decreasing the risk of infectious diseases.
Why: Methadone maintenance programs (MMPs) are evidence-based, long-term treatments for OUD. They reduce illicit opioid use, HIV and hepatitis C transmission, overdose mortality, and criminal activity, while improving employment and family function. They include counseling and behavioral services — not medication alone.
Q38
Which screening tool is most sensitive for detecting alcohol use disorder in the general population? A. CAGE. B. T-ACE. C. AUDIT. D. SMAST-G.
Correct answer
AUDIT.
Why: The AUDIT (Alcohol Use Disorders Identification Test) is the WHO-developed tool with the highest sensitivity and specificity for detecting alcohol use disorders across populations. CAGE is simpler but less sensitive. T-ACE is validated for pregnant women. SMAST-G is for elderly populations.
Q39
Which aspect is most critical when screening for substance use disorder? A. Frequency and quantity of substance use. B. Family history of SUDs. C. Physical signs and symptoms. D. Patient's readiness to change.
Correct answer
The frequency and quantity of the patient's substance use.
Why: Frequency and quantity of use are the core diagnostic criteria for substance use disorders under DSM-5. They determine whether use is hazardous, harmful, or meets criteria for a use disorder. Family history and readiness to change are important but secondary to the actual use pattern.
Q40
Which is the most accurate statement about peer support for patients with stimulant use disorder? A. Peer support is ineffective for linkage to care. B. Peer navigators should only be used in inpatient settings. C. Peer navigators may be considered to help link patients to assessment and treatment, although evidence is limited. D. Peer support is the most effective intervention and should be prioritized over all other strategies.
Correct answer
The use of peer navigators may be considered to help link patients to stimulant use disorder assessment and treatment, although the evidence for this approach is limited.
Why: Peer support has emerging evidence for engagement in SUD treatment, particularly for stigmatized conditions. For stimulant use disorder specifically, the evidence base is limited but promising. It should be considered as one component of a comprehensive approach, not as the sole or primary strategy.
Q41
A 35-year-old man presents with agitation, increased heart rate, and elevated blood pressure after using methamphetamine for several months. What is the most appropriate initial step? A. Immediate tapering schedule for methamphetamine. B. Provide supportive care and monitor for cardiovascular complications. C. Administer a benzodiazepine. D. Short-term antipsychotic medication.
Correct answer
Provide supportive care and monitor for cardiovascular complications.
Why: Methamphetamine intoxication is managed with supportive care — monitoring vital signs, managing agitation conservatively, hydration, and watching for cardiovascular complications (hypertensive crisis, arrhythmia, MI). There is no tapering protocol for stimulants. Benzodiazepines may be used for severe agitation but are not the initial step.
Q42
An 82-year-old man with Alzheimer disease is admitted for pneumonia. On day 3, he becomes withdrawn, minimally responsive, and sleepy. He was alert and conversational the day before (per his sister). CAM exam is difficult with poor attention. His respiratory and heart rates are increased and he requires more oxygen. What is the most likely diagnosis? A. Progression of Alzheimer disease. B. Hypoactive delirium. C. Major depressive disorder. D. Sundowning syndrome.
Correct answer
Hypoactive delirium.
Why: Hypoactive delirium presents as withdrawal, decreased responsiveness, and hypersomnia — the opposite of hyperactive delirium. The key CAM criteria are met: acute onset with fluctuation (alert yesterday, withdrawn today), inattention, and altered consciousness. The acute medical illness (pneumonia with worsening oxygenation) is the precipitant. Sundowning is time-of-day dependent; this is all-day.