NEETPG, INICET, FMGE PYT

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A pearly papule with rolled borders and telangiectasia on the nose is classic for nodular BCC. Chronic sun exposure is a major risk factor. 21. B — Squamous cell carcinoma A rapidly growing, hyperkeratotic, indurated lesion on a sun-exposed site strongly suggests cutaneous SCC. Unlike BCC, SCC has a meaningful potential for regional and distant metastasis. 22. C — Human papillomavirus Common warts are caused by HPV and present as rough, hyperkeratotic papules on the hands and fingers. Transmission occurs through direct contact or autoinoculation. 23. C — Molluscum contagiosum Pearly dome-shaped papules with central umbilication are characteristic of molluscum contagiosum. The causative agent is a poxvirus. 24. A — Vitiligo Vitiligo causes well-demarcated, completely depigmented macules that are accentuated by Wood's lamp. It results from autoimmune destruction of melanocytes. 25. C — Seborrheic dermatitis Greasy yellow scales involving the scalp, eyebrows, nasolabial folds and presternal region strongly suggest seborrheic dermatitis. Malassezia and sebaceous gland activity contribute to its pathogenesis. 26. B — Atopic dermatitis Childhood-onset pruritus, xerosis, flexural eczema and an atopic background are classic for atopic dermatitis. Asthma and allergic rhinitis are common associated atopic conditions. 27. C — Type IV hypersensitivity Allergic contact dermatitis is a delayed T-cell-mediated hypersensitivity reaction. Symptoms typically develop 24–72 hours after exposure to the allergen. 28. C — Pityriasis rosea A herald patch followed days later by multiple oval lesions along cleavage lines produces the classic Christmas-tree pattern. Pityriasis rosea is usually self-limiting. 29. A — Erythema nodosum Tender, non-ulcerating erythematous nodules over the shins are characteristic of erythema nodosum. It is a panniculitis that may follow infections such as streptococcal pharyngitis. 30. B — Pyoderma gangrenosum A rapidly progressive painful ulcer with undermined violaceous borders and pathergy is highly suggestive of pyoderma gangrenosum. Debridement can worsen the lesion because of pathergy.

1. B — Psoriasis Well-demarcated erythematous plaques with silvery scales over extensor surfaces are classic psoriasis. Auspitz sign refers to pinpoint bleeding after removal of scale. 2. C — Granular IgA deposition at dermal papillae Dermatitis herpetiformis presents with intensely pruritic grouped vesicles and is strongly associated with gluten-sensitive enteropathy. Direct immunofluorescence shows granular IgA deposition at the tips of dermal papillae. 3. C — Pemphigus vulgaris Flaccid bullae, painful erosions, oral involvement and positive Nikolsky sign suggest pemphigus vulgaris. It produces an intraepidermal blister due to antibodies against desmosomal proteins. 4. D — Bullous pemphigoid Tense pruritic bullae in an elderly patient with mucosal sparing and negative Nikolsky sign suggest bullous pemphigoid. The blister is subepidermal and commonly associated with eosinophils. 5. B — Septate branching hyphae in tissue Tinea corporis produces annular lesions with an active scaly border and central clearing. KOH examination demonstrates fungal hyphae, classically septate branching hyphae. 6. A — Malassezia species Tinea versicolor is caused by Malassezia and produces hypo- or hyperpigmented finely scaly macules on the trunk. KOH shows the characteristic “spaghetti and meatballs” appearance. 7. C — Topical permethrin Scabies causes intense nocturnal pruritus with burrows, especially in finger webs and flexural areas. Permethrin 5% cream is first-line treatment, with simultaneous treatment of close contacts. 8. A — Oral acyclovir A unilateral painful vesicular eruption restricted to a dermatome is herpes zoster. Early antiviral therapy such as acyclovir reduces viral replication and complications. 9. C — Herpes simplex virus type 1 Recurrent grouped vesicles around the lips preceded by tingling or burning are typical of herpes labialis. HSV-1 is the usual cause, although HSV-2 can occasionally cause oral disease. 10. D — Primary syphilis A painless, clean-based, indurated genital ulcer with painless regional lymphadenopathy is the classic chancre. Primary syphilis is caused by Treponema pallidum. 11. A — Fixed drug eruption A fixed drug eruption recurs at the same site after re-exposure to the offending drug. Lesions often heal with persistent post-inflammatory hyperpigmentation. 12. B — Stevens-Johnson syndrome Extensive epidermal detachment with painful mucosal erosions and systemic toxicity after a drug strongly suggests SJS. Significant mucosal involvement and epidermal detachment distinguish it from uncomplicated drug eruptions. 13. C — Chronic urticaria Urticarial wheals are transient lesions that usually disappear within 24 hours without scarring. Chronic urticaria is defined by recurrent symptoms for more than 6 weeks. 14. C — Hidradenitis suppurativa Recurrent painful nodules, abscesses, sinus tracts and scarring in intertriginous areas are characteristic of hidradenitis suppurativa. Obesity, smoking and metabolic disease are common associations. 15. A — Topical tretinoin Topical retinoids are first-line therapy for comedonal acne because they normalize follicular keratinization. Oral isotretinoin is reserved for severe or refractory acne. 16. B — Oral isotretinoin Severe nodulocystic acne with scarring despite conventional treatment is an indication for systemic isotretinoin. It is highly effective but requires strict pregnancy prevention because of severe teratogenicity. 17. A — Lichen planus The classic description is “6 Ps”: pruritic, purple, polygonal, planar papules and plaques. Wickham striae and oral involvement are important diagnostic clues. 18. C — Basal cell carcinoma A pearly lesion with rolled margins and surface telangiectasia on a sun-exposed site is typical of BCC. BCC is locally invasive but rarely metastasizes. 19. B — Melanoma Asymmetry, irregular border, color variation and diameter >6 mm are classic ABCD warning features for melanoma. A changing pigmented lesion should undergo prompt evaluation and biopsy. 20. A — Basal cell carcinoma

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The lesions are asymptomatic and have been increasing in number. Other family members have similar lesions. Which infectious agent is most commonly responsible? A. Herpes simplex virus B. Molluscum contagiosum virus C. Human papillomavirus D. Varicella-zoster virus 23. A 6-year-old child presents with multiple small, pearly, dome-shaped papules over the trunk. Each lesion has a characteristic central umbilication. The child is otherwise healthy and afebrile. Which diagnosis is most likely? A. Verruca vulgaris B. Impetigo C. Molluscum contagiosum D. Milia 24. A 42-year-old woman presents with sharply demarcated depigmented macules over the hands and face. The lesions are completely asymptomatic and have progressively increased over several years. Wood's lamp examination accentuates the lesions. Which diagnosis is most likely? A. Vitiligo B. Pityriasis alba C. Tinea versicolor D. Post-inflammatory hypopigmentation 25. A 35-year-old man presents with chronic scaly plaques over the scalp, eyebrows, nasolabial folds, and presternal region. The lesions are erythematous with greasy yellowish scales. Symptoms worsen during winter and periods of stress. Which diagnosis is most likely? A. Psoriasis B. Atopic dermatitis C. Seborrheic dermatitis D. Tinea corporis 26. A 10-year-old boy with a history of asthma develops intensely itchy, dry, erythematous lesions in the antecubital and popliteal fossae. He has recurrent flares since childhood and a family history of atopy. The skin is xerotic with excoriations. Which diagnosis is most likely? A. Contact dermatitis B. Atopic dermatitis C. Seborrheic dermatitis D. Scabies 27. A 32-year-old woman develops an itchy erythematous rash exactly under the area where a new cosmetic product was applied. The eruption appears 48 hours after exposure and is limited to the contact area. She has no fever or systemic symptoms. Which mechanism is primarily responsible? A. Type I hypersensitivity B. Type III hypersensitivity C. Type IV hypersensitivity D. Type II hypersensitivity 28. A 25-year-old woman presents with a solitary oval salmon-colored plaque on the trunk. One week later, multiple smaller oval lesions appear along the skin cleavage lines in a characteristic distribution. She has mild itching and no systemic illness. Which diagnosis is most likely? A. Tinea corporis B. Guttate psoriasis C. Pityriasis rosea D. Secondary syphilis 29. A 30-year-old man presents with multiple tender erythematous nodules over both shins. The lesions are non-ulcerative and painful on palpation. He recently developed sore throat and has no history of trauma. Which type of lesion is classically represented by this presentation? A. Erythema nodosum B. Erythema multiforme C. Pyoderma gangrenosum D. Cellulitis 30. A 58-year-old woman presents with a painful, rapidly enlarging ulcer on the leg. The ulcer has undermined bluish-violaceous borders and purulent necrotic tissue. She reports that the lesion worsened after minor trauma and has not responded to antibiotics. Which diagnosis is most likely? A. Venous ulcer B. Pyoderma gangrenosum C. Arterial ulcer D. Basal cell carcinoma

A 30-year-old woman develops a sharply demarcated erythematous plaque over the lips and trunk shortly after taking a medication. The same sites become involved whenever she takes the drug. After healing, the lesions leave residual hyperpigmentation. Which diagnosis is most likely? A. Fixed drug eruption B. Stevens-Johnson syndrome C. Urticaria D. Erythema nodosum 12. A 45-year-old woman develops widespread targetoid lesions with epidermal detachment. She has painful oral and ocular mucosal erosions. The illness began after starting a new medication one week earlier. She has fever and systemic toxicity. Which diagnosis is most likely? A. Urticaria B. Stevens-Johnson syndrome C. Fixed drug eruption D. Pemphigus vulgaris 13. A 29-year-old man develops recurrent episodes of transient, intensely itchy wheals. Individual lesions disappear completely within a few hours without leaving pigmentation. There is no fever or systemic illness. He reports that symptoms worsen after exposure to cold air. Which diagnosis is most likely? A. Angioedema B. Erythema multiforme C. Chronic urticaria D. Urticarial vasculitis 14. A 26-year-old woman presents with recurrent painful nodules and abscesses in both axillae and the groin. The lesions heal with scarring and interconnected sinus tracts. She is overweight and reports frequent recurrence despite antibiotics. Which diagnosis is most likely? A. Furunculosis B. Acne vulgaris C. Hidradenitis suppurativa D. Impetigo 15. A 20-year-old man presents with inflammatory papules, pustules, and comedones over the face and upper trunk. He has both open and closed comedones with several inflammatory lesions. There are no nodules or systemic symptoms. Which treatment is most appropriate for mild-to-moderate comedonal acne? A. Topical tretinoin B. Oral isotretinoin C. Oral prednisolone D. Topical permethrin 16. A 23-year-old woman has severe nodulocystic acne with multiple painful lesions and early pitted scars. She has failed adequate courses of topical therapy and oral antibiotics. Pregnancy testing is negative and there are no contraindications. Which drug is most effective for severe refractory acne? A. Spironolactone B. Oral isotretinoin C. Topical clindamycin D. Oral antihistamine 17. A 38-year-old woman presents with intensely pruritic, violaceous, flat-topped papules over the wrists and ankles. Some lesions show fine white reticular lines on the surface. She also has painful erosions in the oral mucosa. Which diagnosis is most likely? A. Lichen planus B. Psoriasis C. Pityriasis rosea D. Seborrheic dermatitis 18. A 55-year-old farmer presents with a slowly enlarging ulcer over the lower leg. The lesion has raised, indurated, rolled-out margins and an ulcerated center. He has significant chronic sun exposure and a history of a nonhealing lesion at the same site. Which malignancy is most likely? A. Melanoma B. Kaposi sarcoma C. Basal cell carcinoma D. Dermatofibrosarcoma protuberans 19. A 63-year-old woman presents with a pigmented lesion on the back that has recently increased in size. The lesion has asymmetry, irregular borders, multiple colors, and a diameter greater than 6 mm. There is no history of trauma to the lesion. Which diagnosis should be suspected? A. Seborrheic keratosis B. Melanoma C. Dermatofibroma D. Nevus simplex 20. A 48-year-old man presents with a slowly enlarging pearly papule on the nose. The lesion has a shiny surface, rolled pearly margins, and fine surface telangiectasia. Occasional bleeding occurs after minor trauma. Which is the most likely diagnosis? A. Basal cell carcinoma B. Squamous cell carcinoma C. Melanoma D. Keratoacanthoma 21. A 68-year-old man has a rapidly growing, hyperkeratotic ulcerated lesion on the sun-exposed ear. The lesion is firm, indurated, and occasionally bleeds. He has extensive chronic ultraviolet exposure. Which malignancy is most likely? A. Basal cell carcinoma B. Squamous cell carcinoma C. Melanoma D. Sebaceous carcinoma 22. A 14-year-old boy presents with multiple rough, skin-colored papules over the dorsal hands and fingers.

1. A 22-year-old woman presents with multiple itchy, erythematous plaques over the extensor surfaces of both elbows and knees. She has recurrent lesions for several years with periods of remission and exacerbation. Examination shows well-demarcated plaques covered by silvery-white scales. On scraping, pinpoint bleeding is noted. Which is the most likely diagnosis? A. Lichen planus B. Psoriasis C. Seborrheic dermatitis D. Tinea corporis 2. A 28-year-old man presents with intensely itchy grouped vesicles over the elbows, knees, and buttocks. The lesions are symmetrical and tend to recur. He reports intermittent abdominal discomfort and loose stools. Skin biopsy with direct immunofluorescence is performed. Which finding is most characteristic? A. Linear IgA deposition along basement membrane B. Intercellular IgG deposition C. Granular IgA deposition at dermal papillae D. Subepidermal IgG deposition 3. A 35-year-old woman develops flaccid blisters and erosions involving the oral mucosa and trunk. The blisters rupture easily, leaving painful erosions. Nikolsky sign is positive. Histopathology demonstrates an intraepidermal blister. Which diagnosis is most likely? A. Bullous pemphigoid B. Dermatitis herpetiformis C. Pemphigus vulgaris D. Epidermolysis bullosa acquisita 4. A 72-year-old man develops tense, pruritic blisters over the abdomen and flexural surfaces. The oral mucosa is spared. Nikolsky sign is negative. Biopsy shows a subepidermal blister with eosinophil-rich inflammation. Which diagnosis is most likely? A. Pemphigus vulgaris B. Pemphigus foliaceus C. Dermatitis herpetiformis D. Bullous pemphigoid 5. A 19-year-old man presents with multiple annular, scaly lesions over the trunk and limbs. The lesions have an active, raised scaly border with central clearing. He reports excessive sweating and frequent gym exposure. KOH examination of skin scrapings is performed. Which finding is expected? A. Budding yeast with pseudohyphae B. Septate branching hyphae in tissue C. Numerous neutrophils with bacteria D. Ectothrix spores surrounding hair shafts 6. A 24-year-old woman develops an itchy, hypopigmented rash over the upper trunk during summer. The lesions become more prominent after sun exposure because surrounding skin tans normally. KOH examination demonstrates short curved hyphae with clusters of yeast. Which organism is responsible? A. Malassezia species B. Trichophyton rubrum C. Microsporum canis D. Epidermophyton floccosum 7. A 7-year-old child presents with intensely itchy lesions over the finger webs, wrists, and waist. Several family members have developed similar nocturnal itching. Examination reveals thin burrows in the interdigital spaces. Which is the most appropriate first-line treatment? A. Oral fluconazole B. Topical corticosteroid C. Topical permethrin D. Oral acyclovir 8. A 31-year-old man presents with painful, grouped vesicles on an erythematous base over the right side of his chest. The lesions are confined to a single dermatome and do not cross the midline. He reports burning pain and hyperesthesia preceding the eruption. Which treatment is most appropriate? A. Oral acyclovir B. Oral terbinafine C. Topical permethrin D. Oral isotretinoin 9. A 25-year-old woman presents with recurrent painful vesicles around the lips. The lesions begin with tingling and burning, followed by grouped vesicles that rupture and crust. Episodes recur during periods of stress and fever. The diagnosis is confirmed clinically. Which virus is most likely responsible? A. Varicella-zoster virus B. Epstein-Barr virus C. Herpes simplex virus type 1 D. Coxsackievirus 10. A 40-year-old man presents with a solitary, painless ulcer over the genital region. The ulcer has a clean base and firm, indurated margins. There is painless regional lymphadenopathy. He reports recent unprotected sexual intercourse. Which diagnosis is most likely? A. Genital herpes B. Chancroid C. Lymphogranuloma venereum D. Primary syphilis 11.

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Fever, severe rigidity, altered consciousness, autonomic instability and markedly elevated CK after antipsychotic exposure indicate NMS. Immediate withdrawal of the offending drug and intensive supportive management are essential. 19. B — Bulimia nervosa Recurrent binge eating followed by compensatory behaviors such as self-induced vomiting with normal-range BMI is typical of bulimia nervosa. Anorexia nervosa requires significantly low body weight. 20. A — Anorexia nervosa Significantly low body weight, intense fear of weight gain and distorted body image with restriction strongly indicate anorexia nervosa. Severe caloric restriction is a key feature. 21. B — Factitious disorder Factitious disorder involves intentional production or fabrication of illness to assume the sick role, without obvious external rewards. Malingering involves a clear external incentive such as financial or legal gain. 22. C — Illness anxiety disorder The patient has persistent fear of serious illness despite minimal physical symptoms and repeated reassurance seeking. The central problem is excessive health anxiety rather than prominent somatic symptoms. 23. D — Functional neurological symptom disorder Neurological symptoms inconsistent with recognized neurological pathways, often associated with psychological stress, suggest functional neurological symptom disorder. The symptoms are not intentionally produced. 24. A — Borderline personality disorder Instability of relationships, intense abandonment fears, impulsivity, self-harm and marked emotional instability are classic borderline features. A characteristic pattern is alternating idealization and devaluation. 25. C — Antisocial personality disorder Persistent disregard for the rights of others, deceitfulness, aggression, impulsivity and lack of remorse with childhood conduct disorder support antisocial personality disorder. Evidence of conduct disorder before age 15 is an important diagnostic clue. 26. A — Hypomania Reduced need for sleep, increased energy, talkativeness and grandiosity without severe impairment or psychosis suggest hypomania. Marked impairment, hospitalization or psychosis would favor mania. 27. D — Bipolar I disorder A full manic episode lasting at least 1 week or requiring hospitalization establishes bipolar I disorder. Bipolar II requires hypomania plus major depression but no history of mania. 28. C — Atypical depression Atypical depression features mood reactivity, hypersomnia, increased appetite/weight and rejection sensitivity. This contrasts with melancholic depression, which typically has anhedonia and early-morning awakening. 29. C — Antidepressant plus antipsychotic therapy Psychotic depression requires treatment targeting both depressive and psychotic symptoms. An antidepressant combined with an antipsychotic is standard; ECT is also highly effective in severe or urgent cases. 30. B — Major neurocognitive disorder Progressive decline in memory and other cognitive domains over years with loss of functional abilities indicates major neurocognitive disorder. Delirium is acute and fluctuating, whereas dementia/neurocognitive disorder is typically progressive.

1. B — Manic episode Elevated/irritable mood with decreased sleep, grandiosity, pressured speech and increased goal-directed activity causing marked impairment is mania. Hypomania causes less severe impairment and does not require marked functional disruption. 2. A — Major depressive disorder Persistent depressed mood/anhedonia with neurovegetative and cognitive symptoms for ≥2 weeks, without mania, supports major depressive disorder. Suicidal thoughts increase clinical severity and require immediate risk assessment. 3. C — Schizophrenia Psychosis lasting >6 months with hallucinations, delusions and functional decline is characteristic of schizophrenia. Schizophreniform disorder lasts 1–6 months; brief psychosis lasts <1 month. 4. D — Panic disorder Recurrent unexpected panic attacks followed by persistent concern or behavioral change support panic disorder. The episodes are abrupt, intense and reach peak severity within minutes. 5. B — Generalized anxiety disorder Excessive, difficult-to-control worry about multiple domains for ≥6 months with tension, irritability and sleep disturbance is classic GAD. The anxiety is pervasive rather than limited to discrete attacks or situations. 6. A — SSRI with cognitive behavioral therapy SSRIs and CBT with exposure/response prevention are first-line treatments for OCD. Benzodiazepines do not treat the core obsessive-compulsive pathology. 7. C — Social anxiety disorder Marked fear of negative evaluation in social or performance situations with avoidance and preserved insight is characteristic of social anxiety disorder. Avoidance is driven by embarrassment or scrutiny. 8. B — Drug-induced parkinsonism Rigidity, bradykinesia, tremor and masked facies after dopamine-blocking antipsychotics indicate drug-induced parkinsonism. It is an extrapyramidal adverse effect of antipsychotic therapy. 9. C — Benztropine Acute dystonia presents with painful muscle spasms, torticollis and oculogyric crisis soon after antipsychotic exposure. Anticholinergics such as benztropine provide rapid relief. 10. D — Tardive dyskinesia Repetitive oro-bucco-lingual movements after prolonged antipsychotic exposure are typical of tardive dyskinesia. VMAT2 inhibitors such as valbenazine are used for persistent symptoms. 11. A — Hemodialysis Severe lithium toxicity with neurological and gastrointestinal manifestations and markedly elevated levels may require hemodialysis. Lithium has a narrow therapeutic index and is efficiently removed by dialysis. 12. B — Nephrogenic diabetes insipidus Chronic lithium therapy can reduce renal responsiveness to ADH, causing polyuria and polydipsia with dilute urine. Nephrogenic diabetes insipidus is a classic long-term adverse effect. 13. C — Use parenteral antipsychotic medication for rapid control Severe agitation with immediate risk and inability to cooperate requires rapid behavioral control. Parenteral antipsychotics, often with appropriate sedative medication, are used in acute agitation. 14. C — Adjustment disorder Emotional or behavioral symptoms developing in response to an identifiable stressor without meeting criteria for another disorder suggest adjustment disorder. The timing is closely related to the stressor. 15. B — Benzodiazepines Benzodiazepines are first-line treatment for alcohol withdrawal because they prevent seizures and progression to severe withdrawal. Antipsychotics alone do not adequately treat the underlying withdrawal physiology. 16. C — Delirium tremens Severe alcohol withdrawal with fluctuating consciousness, disorientation, autonomic hyperactivity, tremor and hallucinations is delirium tremens. It usually occurs 48–96 hours after cessation or major reduction of alcohol. 17. A — Serotonin syndrome Rapid onset of agitation, autonomic symptoms, hyperreflexia and clonus after serotonergic drug exposure is characteristic of serotonin syndrome. Clonus and hyperreflexia are key differentiators from NMS. 18. C — Neuroleptic malignant syndrome

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There is gradual deterioration without fluctuating consciousness. Neurological examination does not show an acute focal deficit. Which diagnosis is most likely? A. Delirium B. Major neurocognitive disorder C. Dissociative amnesia D. Brief psychotic disorder

Somatic symptom disorder 21. A 45-year-old man repeatedly presents to different hospitals with fabricated symptoms. He intentionally produces illness and undergoes unnecessary investigations despite having no obvious external financial or legal gain. His behavior appears motivated by assuming the sick role. Which diagnosis is most likely? A. Malingering B. Factitious disorder C. Somatic symptom disorder D. Illness anxiety disorder 22. A 36-year-old woman has persistent fear that she has a serious neurological disease. Multiple examinations and investigations are normal. She spends hours checking her body and repeatedly seeks reassurance despite minimal physical symptoms. Which diagnosis is most likely? A. Somatic symptom disorder B. Conversion disorder C. Illness anxiety disorder D. Factitious disorder 23. A 29-year-old woman develops sudden inability to move her right leg after a major psychological stressor. Neurological examination shows findings inconsistent with known neuroanatomical pathways. She appears surprisingly unconcerned about the deficit. Imaging and neurological investigations are normal. Which diagnosis is most likely? A. Malingering B. Factitious disorder C. Somatic symptom disorder D. Functional neurological symptom disorder 24. A 33-year-old man has a persistent pattern of unstable relationships, marked fear of abandonment, impulsive spending, recurrent self-harm, and rapidly shifting emotions. His behavior has been present since early adulthood. He frequently alternates between idealizing and devaluing people close to him. Which personality disorder is most likely? A. Borderline personality disorder B. Antisocial personality disorder C. Narcissistic personality disorder D. Avoidant personality disorder 25. A 35-year-old man demonstrates repeated violation of social norms, deceitfulness, impulsivity, aggression, and lack of remorse. He has a documented history of conduct disorder beginning before age 15. His behavior continues into adulthood and causes significant interpersonal and legal problems. Which diagnosis is most likely? A. Borderline personality disorder B. Narcissistic personality disorder C. Antisocial personality disorder D. Histrionic personality disorder 26. A 21-year-old student has slept only 2–3 hours nightly for the past week but does not feel tired. He is unusually talkative, distractible, excessively confident, and has started several unrealistic projects. His functioning is clearly impaired, but there is no psychosis. Which condition best describes this episode? A. Hypomania B. Mania C. Major depression D. Cyclothymia 27. A 30-year-old man with recurrent depressive episodes develops elevated mood, decreased need for sleep, grandiosity, and marked functional impairment. The elevated episode lasts more than one week and requires hospitalization. He has never experienced psychotic symptoms during depression. Which diagnosis is most likely? A. Bipolar II disorder B. Cyclothymic disorder C. Major depressive disorder D. Bipolar I disorder 28. A 46-year-old woman presents with depressed mood, fatigue, poor concentration, and loss of interest. She also has increased sleep, increased appetite, and marked sensitivity to rejection. Her mood improves temporarily when positive events occur. Which depressive subtype is most consistent with this presentation? A. Melancholic features B. Psychotic depression C. Atypical depression D. Catatonic depression 29. A 60-year-old man with severe depression develops delusions of guilt and believes he has committed unforgivable crimes. He has prominent depressive symptoms and psychotic features. The psychotic symptoms occur only during severe depressive episodes. Which treatment is most appropriate for severe psychotic depression? A. Psychotherapy alone B. SSRI monotherapy C. Antidepressant plus antipsychotic therapy D. Benzodiazepine monotherapy 30. A 70-year-old man develops progressive memory impairment over several years. He initially has difficulty learning new information and later develops problems with language and executive functioning.

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.

1. A 24-year-old man is brought by his family with a 3-week history of decreased sleep, excessive talking, increased goal-directed activity, and grandiose ideas. He has started spending large amounts of money and believes he has special powers. His symptoms are causing marked social and occupational impairment. There is no history of substance use or medical illness. Which diagnosis is most likely? A. Schizophrenia B. Manic episode C. Hypomania D. Cyclothymic disorder 2. A 32-year-old woman reports persistent sadness, loss of interest, fatigue, poor concentration, and early-morning awakening for 3 months. She has stopped enjoying activities that previously gave her pleasure and feels worthless. There is no history of manic or hypomanic episodes. She has passive thoughts that life is not worth living but no active plan. Which is the most appropriate diagnosis? A. Major depressive disorder B. Adjustment disorder C. Dysthymia D. Bipolar depression 3. A 27-year-old man has auditory hallucinations for the past 8 months. He hears two voices discussing his actions and believes that strangers are controlling his thoughts. His social and occupational functioning has progressively deteriorated. There is no significant mood episode or substance use. Which diagnosis is most likely? A. Delusional disorder B. Brief psychotic disorder C. Schizophrenia D. Schizophreniform disorder 4. A 29-year-old woman repeatedly experiences sudden episodes of intense fear accompanied by palpitations, sweating, trembling, chest discomfort, and fear of dying. The episodes reach maximum intensity within several minutes and occur unexpectedly. Cardiac evaluation is normal. She has subsequently developed persistent fear of having another attack. Which diagnosis is most likely? A. Generalized anxiety disorder B. Social anxiety disorder C. Illness anxiety disorder D. Panic disorder 5. A 35-year-old man has excessive anxiety about multiple areas of life for more than 6 months. He worries about finances, family, work, and health almost every day. He finds the worry difficult to control and has muscle tension, irritability, and poor sleep. There is no discrete panic pattern or substance use. Which diagnosis is most likely? A. Panic disorder B. Generalized anxiety disorder C. Obsessive-compulsive disorder D. Adjustment disorder 6. A 22-year-old woman repeatedly washes her hands for several hours each day. She recognizes that her fear of contamination is excessive but feels compelled to perform washing rituals to reduce anxiety. The thoughts and behaviors are time-consuming and interfere with her studies. She has no psychotic symptoms. Which treatment is considered first-line for moderate-to-severe symptoms? A. SSRI with cognitive behavioral therapy B. Lithium monotherapy C. Antipsychotic monotherapy D. Benzodiazepine monotherapy 7. A 19-year-old college student develops intense fear of being judged while speaking in class. He avoids presentations and social gatherings because he fears embarrassment. He recognizes the fear as excessive and has no delusions or hallucinations. Symptoms have persisted for more than 6 months and impair academic functioning. Which diagnosis is most likely? A. Agoraphobia B. Panic disorder C. Social anxiety disorder D. Avoidant personality disorder 8. A 40-year-old man with schizophrenia has been taking haloperidol for several months. He develops rigidity, bradykinesia, resting tremor, and masked facial expression. There is no fever or autonomic instability. Which adverse effect is most likely responsible? A. Acute dystonia B. Drug-induced parkinsonism C. Akathisia D. Tardive dyskinesia 9. A 26-year-old woman is started on an antipsychotic for acute psychosis. Within hours, she develops painful neck spasms with torticollis and upward deviation of the eyes. She is conscious and has no fever or altered sensorium. Which is the most appropriate treatment? A. Propranolol B. Levodopa C. Benztropine D. Valbenazine 10. A 45-year-old man with schizophrenia has been receiving antipsychotic therapy.

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