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Module 1: Functional Neuroanatomy, Ethics, and Genetics

1. Question: A patient after a stroke cannot form words but understands speech. Which brain area is likely damaged?
2. Question: A patient neglects the left side of their body and environment. Which brain region is damaged?
3. Question: After a head injury, a patient shows impulsivity, poor planning, and emotional instability. Which lobe is most affected?
4. Question: A patient with damage to the hippocampus experiences difficulty forming new memories. What type of amnesia is this?
5. Question: A patient experiences visual hallucinations. Damage to which brain area might explain this?
6. Question: Which brain region is most involved in movement initiation and is affected in Parkinson’s disease?
7. Question: A patient has emotional dysregulation and aggression following trauma to which brain structure?
8. Question: A patient with lesions in the corpus callosum struggles to name objects held in the left hand. This is an example of:
9. Question: A patient refuses medication despite psychosis, but seems competent. What ethical principle supports respecting their decision?
10. Question: When prescribing antipsychotics to a cognitively impaired patient, what is crucial for ethical treatment?
11. Question: Childhood trauma leads to methylation changes affecting stress response genes. This is an example of:
12. Question: A patient taking carbamazepine reports decreased effectiveness of their oral contraceptive. Carbamazepine acts as:
13. Question: Which CYP450 enzyme metabolizes clozapine and olanzapine?
14. Question: Fluoxetine raises serum levels of TCAs by inhibiting which enzyme?
15. Question: Smoking decreases clozapine effectiveness by inducing which CYP enzyme?
16. Question: Combining carbamazepine with another CYP3A4 substrate requires:
17. Question: Aripiprazole acts as a partial agonist at which receptor?
18. Question: Haloperidol blocks dopamine receptors without activating them. This is an example of:
19. Question: Pimavanserin reduces baseline receptor activity. This is classified as:
20. Question: Retrograde neurotransmission involves signaling:
21. Question: The delayed clinical effect of SSRIs is mostly due to:
22. Question: Which dopamine pathway is most associated with extrapyramidal symptoms (EPS) when blocked?
23. Question: Antipsychotics with high D2 blockade and low 5-HT2A blockade tend to have:
24. Question: Which antipsychotic is first-line for schizophrenia due to lower EPS and metabolic risk?
25. Question: A patient develops fever, rigidity, and autonomic instability after starting an antipsychotic. Diagnosis?
26. Question: A patient shows repetitive involuntary facial movements after years of antipsychotic use. This likely represents:
27. Question: Sudden neck spasm after starting haloperidol indicates:
28. Question: Which benzodiazepine is contraindicated in pregnancy?
29. Question: Recommended duration of benzodiazepine treatment for anxiety is:
30. Question: Which brain area regulates fear and is hyperactive in PTSD?
31. Question: First-line treatment for Generalized Anxiety Disorder (GAD) is:
32. Question: Which medication can reduce nightmares in PTSD?
33. Question: Buspirone is used to treat anxiety because it acts as a:
34. Question: Which anxiolytic is most likely to cause paradoxical activation and panic?
35. Question: Which medication is used after acute trauma to prevent long-term fear conditioning?
36. Question: For elderly patients, which anxiolytics are preferred?
37. Question: A patient with severe OCD refractory to SSRIs is considered for:
38. Question: What is the main ethical concern when forcibly medicating a psychotic patient?
39. Question: In epigenetics, DNA methylation typically:
40. Question: Which CYP450 inhibitor would increase the risk of toxicity if combined with clozapine?
41. Question: Which brain area is linked to inability to copy a drawing (visuospatial dysfunction)?
42. Question: A patient with mutation in a CYP450 gene metabolizes drugs slower than normal. This patient is a:
43. Question: A patient with schizophrenia on clozapine needs regular monitoring of:
44. Question: Which ethical principle requires physicians to avoid harm when prescribing medications?
45. Question: A patient experiences sedation with fluoxetine and risperidone combined. What pharmacokinetic interaction explains this?
46. Question: Neurotransmission that uses retrograde signaling mainly involves:
47. Question: A patient taking carbamazepine and oral contraceptives is counseled that:
48. Question: The first antipsychotic shown to reduce suicide risk in schizophrenia is:
49. Question: Which neurotransmitter is primarily involved in the fight-or-flight response?
50. Question: A patient refusing treatment is deemed incompetent by the court and forcibly medicated. This reflects:

Module 2: Neurotransmission and Pharmacology

1. Question: Which brain region is most likely damaged in a 45-year-old man showing poor impulse control, socially inappropriate comments, and risky decisions after a head injury?
2. Question: A patient struggles to organize and complete tasks but speech remains fluent. Which lobe is likely affected?
3. Question: A stroke patient cannot speak fluently but understands language. Which area is damaged?
4. Question: A patient ignores the left side of space after a right hemisphere stroke. Which lobe is damaged?
5. Question: A patient has finger agnosia, agraphia, and left-right disorientation after a stroke. Which lobe is affected?
6. Question: A patient has difficulty reading and identifying left versus right after a stroke. Which brain area is involved?
7. Question: A patient has fluent but nonsensical speech with poor comprehension. Which brain area is damaged?
8. Question: A patient hears voices without external stimuli. Which brain area is implicated?
9. Question: A patient cannot form new memories due to bilateral hippocampal damage. What type of amnesia is this?
10. Question: A patient has blindness in the left visual field of both eyes with normal eye examination. Where is the lesion located?
11. Question: A patient can see objects but cannot recognize them. Which area is affected?
12. Question: A patient shows rigidity, resting tremor, and slow movements. What is the site of pathology?
13. Question: A patient exhibits jerky, involuntary movements with a family history of Huntington’s disease. Which structures are involved?
14. Question: A patient has aggression and emotional instability after trauma. Which brain region is affected?
15. Question: A patient with PTSD shows hyperactive fear response and decreased emotional control. Which brain changes are present?
16. Question: A patient has sensory loss and altered consciousness after a stroke. What is the main function of the affected brain area?
17. Question: A patient presents with intention tremor and poor coordination. Which area is damaged?
18. Question: A patient has vertigo and nystagmus after a cerebellar lesion. Which cerebellar lobe is involved?
19. Question: A split-brain patient cannot name an object placed in the left hand but can identify it by touch. What is this condition called?
20. Question: A psychotic patient refuses medication believing it is harmful. How should the psychiatrist proceed?
21. Question: A patient with dementia lacks capacity for consent. Which ethical principle guides decisions by the guardian?
22. Question: In a placebo-controlled psychiatric trial when effective treatment exists, what is the main ethical concern?
23. Question: How does epigenetics contribute to the development of depression following childhood trauma?
24. Question: Methylation of which gene is linked to depression?
25. Question: How do environmental stressors increase vulnerability to anxiety via epigenetics?
26. Question: Why does heavy smoking reduce the effectiveness of clozapine?
27. Question: What happens when fluoxetine is started in a patient taking risperidone?
28. Question: What effect does carbamazepine have on oral contraceptives?
29. Question: Which CYP450 enzyme metabolizes many SSRIs and TCAs and is inhibited by fluoxetine?
30. Question: What is the effect of CYP3A4 induction on benzodiazepine plasma levels?
31. Question: What is the clinical effect of aripiprazole as a partial dopamine D2 agonist?
32. Question: What effect does haloperidol have on dopamine signaling?
33. Question: How does an inverse agonist at the 5-HT2A receptor differ from an antagonist?
34. Question: Why is the clinical effect of SSRIs delayed despite rapid increases in serotonin levels?
35. Question: A drug increases cAMP leading to CREB activation and neuroplasticity. What type of signaling is this?
36. Question: What best describes retrograde neurotransmission in endocannabinoid signaling?
37. Question: Bilateral hippocampal injury leads to anterograde amnesia. Which lobe is involved?
38. Question: A post-stroke patient shows apathy, irritability, and poor planning. Which lobe is affected?
39. Question: Why does combining fluvoxamine with ketoconazole increase sedation?
40. Question: A stroke patient reports flashes of light and loss of half the visual field. Which lobe is affected?
41. Question: A patient believes family members are impostors. Dysfunction in which brain area is most related to this delusion?
42. Question: A chronic alcoholic patient has severe memory loss and confabulation. Which structure is mainly damaged?
43. Question: A patient denies their own paralysis after a stroke. What is this condition called?
44. Question: Which dopamine pathway is primarily involved in the positive symptoms of schizophrenia?
45. Question: A patient develops sudden neck muscle spasms after starting haloperidol. What is this side effect called?
46. Question: Benzodiazepines potentiate the effect of which neurotransmitter?
47. Question: Increased firing of which neurotransmitter is associated with anxiety and panic?
48. Question: Which imaging modality best shows changes in brain activity during tasks?
49. Question: Antidepressants increase neuroplasticity mainly through increasing which factor?
50. Question: Ensuring fair access to psychiatric treatment regardless of background reflects which ethical principle?

Module 3: Antipsychotics
Module 4: Treatments for Anxiety Disorders

1. Question: Which dopamine pathway is primarily responsible for the positive symptoms of psychosis?
2. Question: Blockade of dopamine in the mesocortical pathway is most likely to cause which of the following?
3. Question: A patient on haloperidol develops tremor and rigidity. Which dopamine pathway is affected?
4. Question: Which dopamine pathway regulates prolactin secretion?
5. Question: A female patient on risperidone develops galactorrhea and menstrual irregularities. Which pathway is responsible?
6. Question: Which antipsychotic class has a higher risk of causing extrapyramidal symptoms (EPS)?
7. Question: Which receptor blockade primarily contributes to reduced EPS risk in SGAs compared to FGAs?
8. Question: Which of the following is a partial D2 agonist used in schizophrenia treatment with low metabolic risk?
9. Question: A patient with treatment-resistant schizophrenia is prescribed clozapine. What monitoring is essential?
10. Question: Which antipsychotic is most associated with high metabolic side effects such as weight gain and glucose intolerance?
11. Question: Patient Scenario: A 25-year-old man started haloperidol 1 week ago. He presents with acute neck spasms and eye deviation upward. What is the most likely diagnosis?
12. Question: Which treatment is appropriate for acute dystonia?
13. Question: A patient on long-term antipsychotics develops involuntary repetitive tongue movements after several years. What is the most likely diagnosis?
14. Question: Which drug class is first-line for newly diagnosed schizophrenia?
15. Question: Patient Scenario: A 30-year-old woman with schizophrenia reports feeling emotionally flat and unmotivated after starting haloperidol. Which pathway is most likely involved?
16. Question: Which antipsychotic is least likely to cause hyperprolactinemia?
17. Question: Which side effect is most associated with nigrostriatal dopamine blockade?
18. Question: Which antipsychotic medication requires patients to take with food to reduce QT prolongation risk?
19. Question: What is the main neurotransmitter dysfunction in the amygdala related to acute fear?
20. Question: Benzodiazepines act as positive allosteric modulators of which receptor?
21. Question: Which benzodiazepine is preferred for short-term use in elderly patients?
22. Question: Patient Scenario: A 65-year-old woman with generalized anxiety disorder has developed confusion and falls after being on diazepam for several months. What is the best next step?
23. Question: Buspirone is best described as:
24. Question: Which anxiety disorder is buspirone FDA-approved to treat?
25. Question: Which medication is used to reduce nightmares in PTSD?
26. Question: Patient Scenario: A patient on sertraline reports new-onset restlessness and insomnia in the first week of treatment. What is the likely cause?
27. Question: Which medication is preferred for anxiety treatment in pregnancy?
28. Question: Which is a black box warning common to all antipsychotics?
29. Question: Which antipsychotic has FDA approval for reducing suicide risk in schizophrenia?
30. Question: Neuroleptic malignant syndrome (NMS) is characterized by:
31. Question: What is the first step in managing neuroleptic malignant syndrome?
32. Question: Which of the following is a VMAT2 inhibitor used to treat tardive dyskinesia?
33. Question: Patient Scenario: A patient develops restlessness and inability to sit still two weeks after starting haloperidol. What is the diagnosis?
34. Question: What is the best treatment option for akathisia?
35. Question: Which first-generation antipsychotic is most likely to cause hyperprolactinemia?
36. Question: Patient Scenario: A patient with schizophrenia on risperidone complains of sexual dysfunction and breast enlargement. What is the mechanism?
37. Question: Which pathway is most associated with the therapeutic effect of reducing hallucinations?
38. Question: Which SGA is known for the lowest risk of EPS and the highest metabolic risk?
39. Question: Which medication is preferred for bipolar depression among SGAs?
40. Question: Which pathway is implicated in cognitive dysfunction and affective blunting in schizophrenia?
41. Question: Patient Scenario: A 55-year-old patient with bipolar disorder complains of sedation and weight gain after starting olanzapine. Which receptor blockade is mostly responsible?
42. Question: Which antipsychotic is known to require slow titration due to risk of orthostatic hypotension?
43. Question: Which neurotransmitter alterations characterize worry in generalized anxiety disorder?
44. Question: Which first-line pharmacologic treatment is recommended for OCD?
45. Question: Patient Scenario: A 22-year-old female starts fluoxetine and reports worsening panic attacks and insomnia in the first week. What is the likely cause?
46. Question: Which benzodiazepine is associated with teratogenicity and should be avoided in pregnancy?
47. Question: Hydroxyzine is useful in anxiety due to which property?
48. Question: Which antipsychotic medication is least likely to cause QT prolongation?
49. Question: Which statement about SGAs is true?
50. Question: A patient with schizophrenia on haloperidol suddenly develops fever, muscle rigidity, and confusion. What is the immediate treatment?