After several months, he develops repetitive involuntary chewing movements, tongue protrusion, and lip smacking.
The movements persist even when he attempts to suppress them.
Which adverse effect is most likely?
A. Acute dystonia
B. Akathisia
C. Drug-induced parkinsonism
D. Tardive dyskinesia
11. A 30-year-old woman with bipolar disorder is started on lithium maintenance therapy.
She returns after several weeks with coarse tremor, vomiting, diarrhea, ataxia, and confusion.
Serum lithium concentration is markedly elevated.
Which is the most appropriate immediate management in severe toxicity?
A. Hemodialysis
B. Flumazenil
C. Naloxone
D. Physostigmine
12. A 28-year-old woman with bipolar disorder is taking lithium.
She develops excessive thirst, polyuria, and dilute urine despite normal blood glucose levels.
The symptoms persist during chronic therapy.
Which renal adverse effect of lithium is most likely?
A. Acute glomerulonephritis
B. Nephrogenic diabetes insipidus
C. Renal tubular acidosis
D. Nephrotic syndrome
13. A 34-year-old man presents with elevated mood, reduced need for sleep, pressured speech, grandiosity, and aggressive behavior.
He is severely agitated and poses a risk to himself and others.
He refuses oral medication and cannot cooperate with assessment.
Which is the most appropriate immediate pharmacological approach?
A. Start an SSRI
B. Begin psychotherapy alone
C. Use parenteral antipsychotic medication for rapid control
D. Give a stimulant
14. A 31-year-old woman develops depressed mood and loss of interest after a stressful life event.
Symptoms begin within a few weeks of the stressor but do not fulfill full criteria for a major depressive episode.
She remains functional but has significant emotional distress.
Which diagnosis is most likely?
A. Major depressive disorder
B. Persistent depressive disorder
C. Adjustment disorder
D. Bipolar disorder
15. A 50-year-old man with long-standing alcohol dependence suddenly stops drinking.
Two days later, he develops tremulousness, sweating, anxiety, tachycardia, and visual hallucinations.
He is conscious but markedly agitated.
Which medication is the mainstay of treatment?
A. Haloperidol
B. Benzodiazepines
C. Lithium
D. Fluoxetine
16. A 38-year-old woman presents with fluctuating consciousness, severe autonomic instability, visual hallucinations, and marked agitation.
She stopped heavy alcohol consumption 3 days ago.
She is disoriented to time and place and has coarse tremors.
Which diagnosis is most likely?
A. Alcoholic hallucinosis
B. Schizophrenia
C. Delirium tremens
D. Panic disorder
17. A 42-year-old man taking an antidepressant develops agitation, sweating, diarrhea, tremor, hyperreflexia, and inducible clonus.
He recently started another serotonergic medication.
His temperature is elevated and symptoms developed rapidly.
Which diagnosis is most likely?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Malignant hyperthermia
D. Anticholinergic toxicity
18. A 55-year-old man receiving a high-potency antipsychotic develops high fever, severe muscle rigidity, altered consciousness, and autonomic instability.
Laboratory testing shows markedly elevated creatine kinase.
The symptoms developed after increasing the antipsychotic dose.
Which diagnosis is most likely?
A. Serotonin syndrome
B. Malignant hyperthermia
C. Neuroleptic malignant syndrome
D. Heat stroke
19. A 23-year-old woman reports recurrent binge eating followed by self-induced vomiting.
She is preoccupied with body weight and shape.
Her BMI is normal, and she has no significant restriction of food intake between episodes.
Which diagnosis is most likely?
A. Anorexia nervosa
B. Bulimia nervosa
C. Binge-eating disorder
D. Avoidant/restrictive food intake disorder
20. A 17-year-old girl has markedly low body weight and intense fear of gaining weight.
She believes she is overweight despite being significantly underweight.
She severely restricts food intake and has developed amenorrhea.
Which diagnosis is most likely?
A. Anorexia nervosa
B. Bulimia nervosa
C. Binge-eating disorder
D.