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Psychiatry Question Bank – 65 Multiple Choice Questions on “Psychopharmacology”

1. Tricyclic antidepressants are contraindicated in:

A. Glaucoma

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B. Brain tumour

C. Bronchial asthma

D. Essential hypertension

2. Which of the antipsychotic drugs has a prolonged action?

A. Trifluperazine

B. Thioridazine

C. Penfluridol

D. Fluphenazine

3. The congenital anomaly produced by lithium therapy is:

A. Limb shortening

B. Anencephaly

C. Heart block

D. Renal agenesis

About 10 percent of newborns exposed in 1st tri­mester of pregnancy had major congenital malforma­tions. The most common is Epstein’s anomaly of the tricuspid valves. Lithium is not indicated in a lactating woman. Signs of is toxicity in infants include lethargy, cyanosis, abnormal reflexes, rarely hepatomegaly.

4. All the following are side-effects of Fluoxetine, except:

A. Weight gain

B. Sweating

C. Urinary retention

D. Diarrhea

5. Akathisia is treated by all the following, except:

A. Trihexyphenidyl

B. Diazepam

C. Haloperidol

D. Promethazine

6. Prophylactic maintenance of serum level of lithium is:

A. 0.2-0.8 mEq/L

B. 0.7-1.2 mEq/L

C. 1.2-2.0 mEq/L

D. 2.0-2.5 mEq/L

7. The treatment of choice in depression with suicidal ten­dencies is:

A. Tricyclic antidepressants

B. MAO inhibitors

C. Fluoxetine

D. Electroconvulsive therapy

The first and most important indication for ECT is depression with suicidal tendencies.

8. The drug not used for prophylaxis of MDP is:

A. Carbamazepine

B. Sodium valproate

C. Chlorpromazine

D. Lithium

Antipsychotics are used as adjuvant in the treatment of mood disorders.

9. All the following are true about clozapine, except:

A. Used in schizophrenia

B. Precipitates seizures

C. Agranulocytosis

D. Extra pyramidal side-effects

The only FDA approved indication for clozapine is as a therapy for treatment resistant schizophrenia. Clozapine suppresses the abnormal movements of TD (Tardive dyskinesia) as does treatment with conventional antipsychotics.

Other indication: Clozapine may treat the movement disorder. Clozapine is more potent on Dl, D3, D4, and 5HT2 receptors in comparison to other typical antipsychotic which are more potent over D2 receptors. Animal models show that clozapine is more active over meso-limbic pathway than nigro- striatal pathway because of which we notice less EPS.

10. Which of the following is not an antidepressant?

A. Trazodone

B. Amitriptyline

C. Fluoxetine

D. Pimozide

11. Carbamazepine is used in all the following except:

A. Mania

B. Alcohol withdrawal

C. Schizophrenia

D. Trigeminal neuralgia

But recent data indicates that CB2 can be used in schizophrenia and Schizo-affective disorders. Other indications are:

Recurrent depressive disorder

Impulse control disorder v

PTSD (post-traumatic stress disorder)

Alcohol /benzodiazepine withdrawal

Severe blood dyscrasias occur in about 1 in 125,000 pts treated with Carbamazepine.

12. A patient of schizophrenia treated for 5 years, developed abnormal movement. The patient has:

A. Tardive dyskinesia

B. Muscular dystonia

C. Akathisia

D. Malignant neuroleptic syndrome

TD delayed effects of antipsychotic caused by dopamine receptor super sensitivity in basal ganglia. Serotonin – dopamine antagonists may be used in pts with TD.

13. The mechanism of action of Fluoxetine is:

A. Serotonin reuptake inhibitor

B. MAO-B inhibitor

C. Nor adrenaline reuptake inhibitor

D. Benzodiazepine antagonist Other SSRI are:

Fluvoxamine Sertraline

Paroxetine

Citalopram

Escitalopram

Serotonin norepinephrine reuptake

Inhibitors:

1. Venlafaxine

2. Sibutramine

Atypical antipsychotics: (serotonin dopamine antagonists)

Risperidone

Olanzapine

Quetiapin

Sertindole

Ziprasidone

Clozapine (dibenzodiazepine)

Central presynaptic 2 – adrenergic receptor antagonist – clonidine

Mirtazapine (tetracyclic antidepressant)

14. An irritable urge to move about with inner restlessness is called:

A. Akathisia

B. Akinesia

C. Hyperkinesia

D. Dyskinesia

15. The drug of choice for rapid cycle MDP is:

A. Lithium

B. Carbamazepine

C. Sodium Valproate

D. Haloperidol

16. A 35-year-old female on chlorpromazine for 10 years schizophrenia complains of hearing voices. The loud­ness of the voices of taking chlorpromazine but not stop completely. The best treatment is:

A. Clozapine

B. Haloperidol

C. Tianeptine

D. Sulpiride

Clozapine, the only FDA approved drug for treatment resistant schizophrenia.

17. Tianeptine is a:

A. Selective serotonin reuptake enhancer »

B. Selective serotonin reuptake inhibitor.

C. Selective norepinephrine reuptake inhibitor

D. Norepinephrine agonist

Tianeptine – Norepinephrine serotonin selective reuptake enhancers

Venlafaxine – Norepinephrine serotonin reuptake inhibitor

MAOI-Hydroxide – a. Phenelezine b. isocarboxazide Norhydroxide – a. tranylcypromine Reversible selective

MAOls

MAOI – B – Selegiline

MAOI – A – Moclobamide

Broforamine Irreversible selective MAOI: clorgyline

Sympathomimetic stimulants:

1. Dextroamphetamine

2. Methylphenidate

Mood Stabilizers:

1. Lithium

2. Carbamazepine

3. Sodium valproate

4. Topiramate

5. Lamotrigine

6. Clonazepam

18. A 50-year-old man has presented with pain in back, lack of interest in recreational activities, low mood, lethargy, decreased sleep, and appetite for 2 months. There is no history suggestive of delusions or hallucinations. He did not suffer from any chronic medical illness. There was no family history of psychiatric illness. Routine investi­gations including hierogram, renal function tests, elec­trocardiogram, did not reveal any abnormality. This pa­tient should be treated with:

A. Haloperidol

B. Sertraline

C. Alprazolam

D. Olanzapine

(The only antidepressant in this group)

Clinical history suggests that the patient is depressed.

19. Carbamazepine was first used in:

A. Depression

B. MDP

C. Anxiety

D. All of the above

Carbamazepine is an antimonies and mood stabilizing agent. It is a tricyclic compound synthesized in 1953 by Schindler.

20. The treatment of choice for acute or abrupt onset de­pression includes:

A. Lithium

B. Tricyclic antidepressants

C. MAO inhibitors

D. Electroconvulsive therapy

21. In acute mania, the therapeutic serum level of lithium includes:

A. 0.2 – 0.5 mEg/L

B. 0.8-1.5 mEq/L

C. 1-2 mEq/L

D. 2-5 mEQ/L

22. Antipsychotic drug to be avoided especially in first tri­mester of pregnancy:

A. Chlorpromazine

B. Haloperidol

C. Carbamazepine

D. Lithium

i. Neurological – Tremor, muscle weakness, cogwheel rigidity, seizures, neurotoxicity.

ii. Renal – Polyuria, polydipsia, tubular changes nephrogenic diabetes insipid nephritic syndrome.

iii. CVS – Hypokalemia, T wave depression.

iv. Endocrine – Goiter, hypothyroidism, abnormal thyroid function, weight gain.

v. GIT – Nausea, vomiting, diarrhea, abdominal pain, metallic taste.

vi. Dermatological-Acne form eruptions, popular eruptions, exacerbation of psoriasis.

vii. During pregnancy of lactation-teratogenic, increased incidence of Ebstein’s anomaly also created in milk with 30 to 100 percent of maternal blood hi level. Cause toxicity in infant. Contraindications of lithium we are cardio renal, thyroid, neurological dys­function blood dyscrasias, during first traumata of pregnancy and lactation, concomitant administration of theorize diuretics, tetracycline, or anesthetics.

23. Lithium is used in psychiatry to treat:

A. Hysteria

B. Phobia

C. Mood disorders

D. Acute organic brain syndrome Indications of lithium in psychiatry:

Acute mania

Prophylaxis of bipolar mood disorders

Schizoaffective disorder

Impulsive aggression.

24. Clozapine is a:

A. Atypical antipsychotic

B. Anti-anxiety drug

C. Used in dementia

D. Also known as disulfiram

Other atypical antipsychotics – Risperidone, olanzapine, ziprasidone.

Also remember – Clozapine is the drug of choice in treatment-resistant schizophrenia.

25. Paroxetine is a:

A. Antipsychotic drug

B. Used in opiate poisoning

C. Tricyclic antidepressant

D. Selective serotonin reuptake inhibitor

Others SSRI’s

Paroxetine, fluvoxamine, fluoxetine, sertraline, citalopram

Also remember –

SSRI with longest half-life-fluoxetine

SSRI with shortest half-life-fluvoxamine

26. Imipramine is mainly used as a:

A. Sedative

B. Tranquilizer

C. Antidepressant

D. All of the above

Remember – imipramine is the first antidepressant to be introduced.

27. Nausea is a troublesome side effect of the following an­tidepressant:

A. Doxepine

B. Fluoxetine

C. Trazodone

D. Mianserin

Other side effects: Insomnia, akathisia, loss of appetite, sexual dysfunction.

28. Which antidepressant found to be associated with tar­dive dyskinesia and narcoleptic malignant syndrome?

A. Amoxapine

B. Trazodone

C. Fluoxetine

D. Amineptin

This is because of blockade of dopamine receptors in the striatum.

29. Blood levels of neuroleptics are useful to check the fol­lowing:

A. Toxicability

B. Therapeutic levels

C. Resistance

D. All of the above

Clozapine and haloperidol levels are important to monitor toxicities.

30. The drug of first choice in weight reduction programme is:

A. Amphetamine

B. Phenylethlamine

C. Fenfluramine

D. Diethyl propion

31. Therapeutic range of lithium is:

A. 0.5 to 1 mmol/1

B. 0.8 to 1.4 mmol/1

C. 1.4 to 2.5 mmol/1

D. 1.0-2.6 mmol/1

Remember toxicity – if level > 2.0 mEq/1

Life threatening intoxication – > 3.5 mEq/1

32. Akathisiais:

A. Neurotic disease

B. Seen in schizophrenia

C. Side effect of lithium

D. Side effect of antipsychotic drugs.

Akathisia manifests as motor restlessness. It is due to blockade of dopamine type-2 receptors in striatum.

33. Neuroleptic malignant syndrome is characterized:

A. Bradycardia

B. Labile hypertension

C. Hypotonia

D. Hypothermia

Feature of NMS – fever, elevated, EPS, catatonic symptoms, autonomic dysfunction

34. Akathisia is treated by:

A. Haloperidol

B. Fluoxetine

C. Propranolol

D. Lithium

Drug of choice – Propranolol. Benzodiazepines are useful.

35. Feature of akathisia is:

A. Cogwheel rigidity

B. Oculogyric crisis

C. Restlessness

D. Periodic movements

Motor restlessness is the key feature of akathesia Cogwheel rigidity occurs in parkinsonism Oculogyric crises is an acute dystonia Perioral movements could be rabbit syndrome or Tardier dyskinesia.

36. Malignant neuroleptic syndrome is treated by:

A. Dantrolene

B. Diazepam

C. Haloperidol

D. Chlorpromazine Bromocriptine can also be used.

37. Side effect of clozapine is:

A. Within one week – neutropenia

B. Dl- ve, D2 +ve

C. Agranulocytosis

D. Excitement

Clozapine must be stopped immediately.

38. The drug of choice for obsessive-compulsive disorder is:

A. Haloperidol

B. Clomipramine

C. Amitryptilline

D. Diazepam

Dose of Clomipramine – 75 to 300 mg 1 day.

39. Lithium is used in all except:

A. Endogenous depression

B. Recurrent attacks of mania

C. Schizoaffective psychosis

D. Paranoid psychosis

40. Side effect of chlorpromazine for which anti cholinergic is used:

A. Blurred vision

B. Oculogyric crises

C. Hypotension

D. Dry mouth

41. Newer nonsedative, nonhypnotic anxiolytic is:

A. Alprazolam

B. Buspirone

C. Lorazepam

D. Diazepam

Buspirone acts as a partial against at 5HTIA receptor. It doesn’t have anticonvulsant and muscle relaxant properties.

42. The drug of choice for panic disorders is:

A. Imipramine

B. Nitrazepam

C. Clonidine

D. Diazepam

Small doses of antidepressants are used (imipramine and fluoxetine).

136 Psychiatry Question Bank for PG Entrance Exams

43. In drug induced parkinsonism, benzhexol has got no role in:

A. Sialorrhea

B. Tremor

C. Akathisia

D. Rigidity

Akathisia is treated with P blockers and benzodiazepines (propranolol).

44. In fluoxetine and imipramine, the main difference is in: –

A. Less side effects

B. Onset of action

C. Effect of OCD

D. Duration of action

45. Which of the following drug has the minimum extra py­ramidal side effect?

A. Clozapine

B. Metoclopramide

C. Reserpine

D. Trifluperazine

46. Which of the following drugs produce rapid induction of sleep with least influence of sleep architecture?

A. Zaleplon

B. Diazepam

C. Chlorpromazine

D. Haloperidol

Dosage of zaleplon 5 to 10 mg

As it has a half-life of one hour it is useful in initial insomnia

47. All of the following are antidepressants, except:

A. Imipramine

B. Amitryptilline

C. Risperidone

D. Citalopram

Imipramine and amitryptilline are tricyclic anti­depressants; citalopram is a SSRI risperidone is an atypical antipsychotic.

48. Which of the following side effects of chlorpromazine are ameliorated by anticholinergic antiparkinson medi­cation?

A. Confusion

B. Hypotension

C. Blurred vision

D. Oculogyric crisis

49. Lithium is used to treat:

A. Hysteria

B. Phobia

C. Mood disorders

D. Acute organic brain syndrome

50. Lithium is used in:

A. Acute mania

B. Depression

C. Hyperkinetic disorder

D. All of the above.

51. The least affected organ in lithium toxicity is:

A. Liver

B. Heart

C. Kidney

D. Brain

There is no hepatic metabolism for lithium in body.

52. Treatment of Panic attack includes the use of:

A. Diazepam

B. Imipramine

C. Fluoxetine

D. Clonazepam

E. Bothb + c

Both imipramine and fluoxetine in small doses are useful in treating panic disorder

53. All the following are anxiolytic except:

A. Fluoxetine

B. Buspirone

C. Diazepam

D. Nitrazepam

Fluoxetine is an antidepressant. It acts by selecting serotonin reuptake inhibition

54. Lithium is treatment of choice for:

A. Unipolar MDP prophylaxis

B. Bipolar MDP

C. Schizophrenia

D. Acute mania

Lithium is indicated in prophylaxis of bipolar MAP and acute mania.

55. The most useful drug in enuresis is:

A. Haloperidol

B. Diazepam

C. Imipramine

D. Chlorpromazine

Imipramine is the drug of choice in nonorganic enuresis usual dose range is 25 to 75 mg 1 day.

56. The least extra pyramidal effect is seen with:

A. Haloperidol

B. Thioridazine

C. Clozapine

D. Chlorpromazine

Drugs with minimal EPS are clozapine, quetipin sulpiride and ziprasidone.

Drugs useful in Heroin withdrawal are clonidine, methadone, buprenorphin, LAAM, and dextropropoxyphene.

57. Long-term therapy of lithium causes:

A. Neutropenia

B. Hypothyroidism

C. Hepatotoxicity

D. Bone narrow depression

Long-term lithium use causes renal side-effects also.

58. All of the following are selective serotonin (5HT) reuptake inhibitors, except:

A. Fluvoxamine

B. Fluoxetine

C. Paroxetine

D. Olanzapine

SSRI’s are fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram.

59. A psychiatric patient on tricyclic antidepressants presents with bradycardia, hypotension, decreased sweating, and retention of urine. The most likely drug used is:

A. Amitryptilline

B. Fluoxetine

C. Selegiline

D. Lithium

Decreased sweating, retention of urine, bradycardia are anticholinergic side effects of amitryptilline, hypotension is due to Ll-adrenergic blockade.

60. A 63-year-old man who is taking amitryptilline suddenly develops confusion, urinary retention and blurring of vi­sion. The cause is:

A. Anticholinergic side-effects

B. Reactive depression

C. Emergence of negative symptoms

D. CVA

61. A patient was found stuporous and he did not eat or sleep the whole day. On examination, he was found to be con­scious. The treatment should be: (AIIMS-2000)

A. ECT

B. Antipsychotics

C. Antidepressants

D. Neuroleptic

62. 30-year-old Bano Begum was brought to the casualty is a state of altered sensorium. She was on lithium treat­ment for the affective disorder and suffered an attack of epileptic fits. On examination she has tremors, increased deep tension reflexives, and insentience of urine. She also had undergone an episode of severe gash enteritis 2 days ago. Lithium level in the serum is 1.95 mEq/l. The most likely cause is:

A. lithium toxicity

B. severe dehydration

C. Manic stupor

D. Epileptic fits

63. The most common cardiac abnormality associated with use of lithium in 1st trimester of pregnancy:

A. Deacon’s syndrome

B. Epstein’s anomaly of tricuspid valve

C. PDA

D. Coarctation of aorta

In Epstein’s anomaly there is a distortion and down ward displacement of tricuspid valve. Use of lithium is contraindicated in the 1st trimester of pregnancy.

64. Vasanti, 45-year-old, was brought to casualty with ab­normal movements which included persistent deviation of the meek to the right side. One day earlier, she had been prescribed haloperidol 5mg three times daily by the psychiatrist. She also had an altercation with her bush and recently. Which of the following is the most likely cause for her symptoms?

A. Acute drug dystonia

B. Conversion reaction

C. Acute psychosis

D. Cerebrovascular accident.

Acute dystonia is an acute extra pyramidal symptom caused by antipsychotic medication. In this case, the neck muscles are affected by dystonia.

65. Contraindications to lithium administration include:

A. An administration in combination with chlorpromazine

B. The presence of renal disease

C. Any occurrence of the symptoms of schizophrenia

D. The presence of depression

E. An administration in combination with imipramine.

Answer

1.A 2.D 3.C 4.A 5.C 6.B 7.D 8.C 9.D 10.D 11.C 12.A 13.A 14.A 15.A 16.A 17.A 18.B 19.B 20.A 21.B 22.D 23.C 24.A 25.D 26.C 27.B 28.A 29.A 30.D 31.B 32.D 33.B 34.C 35.C 36.A 37.C 38.B 39.D 40.B 41.B 42.A 43.C 44.A 45.A 46.A 47.C 48.D 49.C 50.A 51.A 52.E 53.A 54.D 55.C 56.C 57.B 58.D 59.A 60.A 61.C 62.A 63.B 64.A 65.B

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