AMC MCQ Psychiatry Questions: 10 Free Practice MCQs
Ten AMC MCQ-style psychiatry questions with the answer and the reasoning behind it. They come from the AU.med bank, which has 151 psychiatry questions and many more across every topic.
1 / 10
A 28-year-old woman is diagnosed with Obsessive-Compulsive Disorder (OCD) characterized by contamination fears and repetitive hand-washing for up to 4 hours daily. She has not received any treatment.
What is the first-line non-pharmacological treatment of choice for this patient?
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Answer: C. Cognitive Behavioral Therapy (CBT) incorporating Exposure and Response Prevention (ERP)
Why: CBT with Exposure and Response Prevention (ERP) is the first-line therapy for OCD. If pharmacotherapy is required, high-dose SSRIs (e.g., Fluoxetine up to 80mg, Sertraline up to 200mg) or Clomipramine (a TCA with serotonergic activity) are used.
- A. IPT is not indicated or effective for OCD.
- B. Psychoeducation is important but insufficient as a primary active therapy for GAD or OCD.
- D. While ACT can be adjunctive, ERP remains the gold-standard exposure-based therapy for OCD.
Sources: RANZCP Anxiety and OCD Guidelines; eTG Complete - Obsessive Compulsive Disorder
2 / 10
An 84-year-old woman with moderate Alzheimer's dementia in a residential aged care facility has become increasingly agitated over three days, calling out and resisting care. She is afebrile with normal observations, and staff note that she grimaces when her hips are moved during transfers.
What is the most appropriate initial management?
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Answer: B. Assess her pain with a rating scale and trial regular paracetamol, up to 3 g daily, alongside non-pharmacological measures
Why: The NSW Health handbook endorsed by the College places unmet needs first: pain is a non-specific indicator of distress, people with dementia have a high prevalence of pain that is often under-recognised, and agitation and verbal aggression can be caused by acute or chronic pain. It recommends a pain rating scale to improve detection and positions analgesics such as paracetamol up to 3 g daily at the top of the medication hierarchy, before antidepressants and antipsychotics. Option B follows that sequence. Options A and C move to psychotropic medication before addressing pain, and option D escalates care without indication.
- A. A psychotropic trial is considered only after non-pharmacological approaches and unmet needs such as pain have been addressed, and the grimacing here points strongly to discomfort.
- C. Benzodiazepines are for very short term use in specific situations and would not address the pain that is likely driving her behaviour.
- D. There is no acute deterioration requiring hospital transfer at this point, and her distress can be assessed and managed in the facility.
Sources: NSW Health, Assessment and Management of Behaviours and Psychological Symptoms associated with Dementia (BPSD): A Handbook for NSW Health Clinicians (2022), endorsed by RANZCP
3 / 10
A 39-year-old man with a long history of heavy alcohol use is admitted electively for alcohol withdrawal. He has had two generalised seizures during a previous withdrawal episode and is currently well.
Which management approach is most appropriate to reduce his risk of another withdrawal seizure?
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Answer: B. Begin early diazepam loading from the start of his withdrawal.
Why: Early diazepam loading is indicated for anyone with a history of alcohol withdrawal seizures, because adequate benzodiazepine cover both treats the withdrawal and lowers seizure risk. The same guidance states that prophylactic anticonvulsants such as phenytoin, carbamazepine and sodium valproate have no benefit in preventing withdrawal seizures. Withholding benzodiazepines leaves the withdrawal untreated, and substituting carbamazepine simply repeats an approach that is known to be ineffective.
- A. Anticonvulsant prophylaxis gives no benefit in preventing alcohol withdrawal seizures, and the guidance names phenytoin, carbamazepine and sodium valproate as ineffective for this purpose.
- C. Supportive care alone leaves the withdrawal untreated, and his seizure history makes adequate benzodiazepine treatment the safer course rather than avoidance.
- D. Carbamazepine is among the anticonvulsants that give no benefit for withdrawal seizures, so it does not substitute for adequate diazepam cover.
Sources: NSW Health. Management of Withdrawal from Alcohol and Other Drugs Clinical Guidance.
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4 / 10
A 38-year-old woman with depression tells her general practitioner that she has been thinking about ending her life. She describes a specific plan and says she has stored a large quantity of her partner's oxycodone. She has previously been detained for her own protection.
Which action best reflects the risk assessment expected before a decision about involuntary treatment?
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Answer: C. Evaluate her risk of self-harm alongside her history, psychosocial factors and the harm that may follow untreated illness.
Why: When making decisions about involuntary treatment the Chief Psychiatrist guidance directs clinicians to undertake a comprehensive assessment covering the history of mental and physical illness, family history, psychosocial factors and the risk of self-harm and harm to others, including consideration of the harm that may follow if the illness is not treated. A single closed question, or reliance on her own reassurance, does not meet that standard, and waiting for a self-harm attempt before acting defeats the purpose of the assessment.
- A. A stated intention to stay safe does not replace a structured assessment when there is a specific plan and ready access to means.
- B. A single closed question is insufficient, because the expected assessment also weighs her history, psychosocial factors and access to means.
- D. Waiting for an attempt defeats the purpose of risk assessment, which is to act on the identified risk now.
Sources: NSW Health. Amendments to the NSW Mental Health Act (2007): Fact Sheet for Community Medical Practitioners.
5 / 10
A 35-year-old woman is initiated on Sertraline for panic disorder. She calls the clinic three days later complaining that her anxiety feels much worse and she is feeling highly jittery.
What is the most appropriate advice to give this patient?
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Answer: A. Reassure her that this 'activation syndrome' is common and temporary when starting SSRIs, and advise reducing the dose by half for a few days before tapering back up.
Why: Activation syndrome (increased anxiety, jitteriness, agitation) is a well-documented phenomenon during the first 1-2 weeks of SSRI or SNRI therapy. In patients with panic disorder, this can be highly distressing and lead to premature cessation. Clinicians should start with half the usual starting dose and counsel the patient about this transient side effect.
- B. This is a common, transient side effect, not an allergic reaction.
- C. Fluoxetine is also an SSRI and has a long half-life, which may exacerbate initiation anxiety. A high starting dose will make activation symptoms worse.
- D. Lithium is used for treatment-resistant depression, not for managing early SSRI activation syndrome.
Sources: RANZCP Anxiety Guidelines; Australian Medicines Handbook (AMH)
6 / 10
A 38-year-old man with panic disorder has not responded to a selective serotonin reuptake inhibitor and cognitive behavioural therapy. He asks for a benzodiazepine and wants to take it only when he feels an attack building.
What is the most appropriate advice about benzodiazepines?
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Answer: B. They should be restricted to short-term regular use rather than as-required dosing
Why: Benzodiazepines are effective at reducing anxiety quickly but are not recommended as first-line treatment for panic disorder. Australian guidance is that they should be avoided for long-term management and, where a trial is considered after other options have failed, they should be restricted to short-term regular use rather than as-required dosing. As-required use can reinforce vigilance about bodily symptoms and contribute to dependence, and indefinite use is not advised because of tolerance and withdrawal. Cognitive behavioural therapy and antidepressant treatment remain the mainstays of care.
- A. Benzodiazepines should be avoided for long-term management of panic disorder because of dependence and withdrawal risks.
- C. As-required dosing can reinforce vigilance about bodily sensations and is specifically discouraged in favour of regular short-term use.
- D. Long-term use is not recommended, as tolerance, dependence and withdrawal difficulties outweigh any benefit.
Sources: RANZCP Clinical Practice Guidelines for the Treatment of Panic Disorder, Social Anxiety Disorder and Generalised Anxiety Disorder (2018)
7 / 10
A 58-year-old male is brought to the clinic. Over the past 12 months, his family reports a profound change in personality, including inappropriate social behavior, loss of empathy, apathy, and a new preference for sweet foods. His memory and visuospatial skills remain intact.
What is the most likely diagnosis?
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Answer: D. Behavioral Variant Frontotemporal Dementia (bvFTD)
Why: Frontotemporal dementia (FTD) is a common cause of early-onset dementia. The behavioral variant (bvFTD) is characterized by frontotemporal lobar degeneration causing changes in social and personal conduct, apathy, disinhibition, loss of empathy, stereotypic behaviors, and hyperorality. Memory and visuospatial functions are typically spared early in the disease.
- A. Alzheimer's presents early with memory impairment, while social behavior is preserved until late stages.
- B. DLB presents with fluctuating cognition, visual hallucinations, and parkinsonism, not early behavioral changes.
- C. While apathy can mimic depression, the severe loss of social decorum and hyperorality are highly specific to frontal lobe degeneration.
Sources: eTG Complete - Frontotemporal Dementia; Dementia Australia Guideline
8 / 10
A 74-year-old woman is brought to the clinic. Her husband reports she has experienced vivid, well-formed visual hallucinations of children playing in the garden for the past 6 months, though she remains calm during these episodes. She has fluctuating cognitive performance, sometimes appearing sharp and other times highly confused. On examination, she exhibits mild resting tremor and bilateral lead-pipe rigidity.
What is the most likely diagnosis?
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Answer: D. Dementia with Lewy Bodies (DLB)
Why: Dementia with Lewy Bodies (DLB) is the second most common form of degenerative dementia in older adults. Essential clinical features include fluctuating attention and alertness, recurrent visual hallucinations (often detailed and well-formed), and spontaneous parkinsonism (rigidity, bradykinesia, tremor). These patients are highly sensitive to antipsychotic medications, which can cause severe, life-threatening parkinsonian reactions.
- A. Alzheimer's presents primarily with early prominent episodic memory loss, with hallucinations and parkinsonism occurring only in very late stages.
- B. Frontotemporal dementia presents with early changes in personality, behavior, or language, rather than hallucinations and parkinsonism.
- C. Vascular dementia typically presents with a stepwise decline linked to cardiovascular events, rather than fluctuating cognition and prominent visual hallucinations.
Sources: eTG Complete - Dementia; RACGP silver book - Lewy Body Dementia
9 / 10
A 52-year-old man with generalised anxiety disorder has not responded to an adequate trial of an SSRI combined with cognitive behavioural therapy, and an SNRI was also ineffective.
Which additional option is supported when SSRIs and SNRIs have failed?
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Answer: D. Pregabalin or agomelatine
Why: When an adequate trial of an SSRI combined with cognitive behavioural therapy has failed, and an SNRI has also been ineffective in generalised anxiety disorder, Australian guidance supports changing to pregabalin or agomelatine. Other options include continuing treatment and watching for a delayed response, trialling a different SSRI, or obtaining a second opinion. Benzodiazepines are restricted to short-term regular use and are not the recommended change here, antipsychotics are not listed for this indication, and monoamine oxidase inhibitors are not a routine next step because of their safety and dietary restrictions.
- A. Benzodiazepines are restricted to short-term regular use and are not the recommended change after SSRIs and SNRIs have failed.
- B. Monoamine oxidase inhibitors are not listed as the change for failed SSRIs and SNRIs in generalised anxiety disorder.
- C. Antipsychotics are not among the options listed for generalised anxiety disorder after an inadequate response.
Sources: RANZCP Clinical Practice Guidelines for the Treatment of Panic Disorder, Social Anxiety Disorder and Generalised Anxiety Disorder (2018)
10 / 10
A 19-year-old university student is brought to the Emergency Department in an obtunded state. She was found next to an empty bottle of Amitriptyline. Her ECG shows sinus tachycardia, a QTc of 490 ms, and a QRS duration of 140 ms.
What is the immediate pharmacological intervention of choice to prevent ventricular arrhythmias?
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Answer: C. Sodium Bicarbonate (8.4% IV bolus)
Why: Tricyclic Antidepressants (TCAs) block cardiac fast sodium channels, leading to QRS widening (>100 ms is associated with seizures, >160 ms with ventricular arrhythmias). Intravenous Sodium Bicarbonate is indicated if the QRS is >100 ms, if there are arrhythmias, or if there is hypotension. The mechanism is twofold: increasing sodium concentration overrides the competitive blockade, and systemic alkalosis decreases the affinity of TCAs for the sodium channels.
- A. Amiodarone can worsen QTc prolongation and should be avoided in TCA overdose.
- B. Flumazenil is a benzodiazepine antagonist. It has no role in TCA overdose and can precipitate severe seizures.
- D. Physostigmine can cause cardiac arrest in TCA overdose and is contraindicated.
Sources: Australian Toxicology Guidelines (Toxinx); eTG Complete - TCA Toxicity
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Exam-style questions written by MedHub for practice. They are not official exam questions.