Psychiatry Practice Questions
Psychiatry is explicitly tested on the MCCQE — SSRI selection, discontinuation syndromes, bipolar management, and anxiety disorders. These four sample questions come from MediLingo's bank of 3,900+ questions across 21 specialties.
Sample questions
Question 1
Which SSRI is generally considered first-line for a patient with MDD and comorbid anxiety due to its favorable side-effect profile?
a) Fluoxetine, due to its long half-life and activating profile
b) Sertraline or escitalopram ✓ Correct
c) Tranylcypromine, an MAO-B selective inhibitor
d) Amitriptyline, a tricyclic antidepressant
Key teaching point: First-line SSRIs: sertraline, escitalopram. Citalopram caution (QT prolongation >40 mg). Avoid TCAs and MAOIs as first-line due to safety.
Question 2
A patient stops paroxetine abruptly after 6 months and reports dizziness, nausea,"brain zaps," and irritability. What is this called?
a) Serotonin syndrome from serotonergic excess
b) SSRI discontinuation syndrome ✓ Correct
c) Antidepressant-induced tardive dyskinesia
d) Malignant catatonia triggered by medication withdrawal
Key teaching point: Discontinuation syndrome: abrupt SSRI stop → dizziness, nausea, brain zaps, insomnia. Higher risk with short half-life drugs (paroxetine, venlafaxine). Prevent by tapering over 4+ weeks. Fluoxetine rarely causes it (long half-life).
Question 3
How many SIGECAPS symptoms are required (in addition to depressed mood or anhedonia) to diagnose major depressive disorder?
a) 3 or more symptoms for at least 1 week
b) 5 or more symptoms for at least 2 weeks ✓ Correct
c) 5 or more symptoms for at least 1 month
d) 3 or more symptoms for at least 2 weeks
Key teaching point: MDD: ≥5 of 9 SIGECAPS symptoms for ≥2 weeks. Must include depressed mood or anhedonia. SIGECAPS = Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidality.
Question 4
Which factor is the strongest predictor of completed suicide?
a) Female sex, as women attempt suicide more frequently than men
b) Prior suicide attempt ✓ Correct
c) Young age
d) Access to firearms in the home
Key teaching point: Strongest predictor of completed suicide = prior suicide attempt. Other risks: male sex, age >45, substance use, psychiatric illness, access to lethal means.
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