MCCQE Part I Psychiatry Questions: 10 Free Practice MCQs
Ten MCCQE Part I-style psychiatry questions with the answer and the reasoning behind it. They come from the CA.med bank, which has 150 psychiatry questions and many more across every topic.
1 / 10
A 30-year-old patient diagnosed with Major Depressive Disorder is initiated on sertraline 50 mg daily following CANMAT clinical practice guidelines.
What is the typical time frame for therapeutic effect?
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Answer: B. 2-4 weeks
Why: According to CANMAT guidelines, patients initiating SSRI antidepressant therapy like sertraline must be educated that clinical onset of antidepressant response requires 2 to 4 weeks, with full trial assessment at 6 to 8 weeks. Option A (2-4 days) and Option D (immediately) are pharmacologically impossible due to neuroreceptor adaptation lag; Option C (3 months) represents an inappropriately long wait before assessing response.
- A. Too soon.
- C. Too long.
- D. Placebo effect maybe, but not pharmacological.
Sources: CANMAT Clinical Guidelines for the Management of Major Depressive Disorder
2 / 10
A 58-year-old man with major depressive disorder has not responded to a course of cognitive behavioural therapy and two adequate antidepressant trials. He has no psychotic features and is not acutely suicidal.
Which noninvasive neurostimulation treatment does the guideline recommend at this stage?
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Answer: A. Repetitive transcranial magnetic stimulation to the left dorsolateral prefrontal cortex
Why: The guideline recommends repetitive transcranial magnetic stimulation for treatment-resistant depression and electroconvulsive therapy for difficult-to-treat depression, after the failure of first-line psychotherapy and medication treatments. High-frequency repetitive transcranial magnetic stimulation delivered over the left dorsolateral prefrontal cortex has the largest evidence base and is a first-line protocol, along with low-frequency stimulation over the right dorsolateral prefrontal cortex, with response rates of 40% to 50% in difficult-to-treat depression. Unlike electroconvulsive therapy it does not require anaesthesia and has no cognitive side effects. Except in emergent situations, repetitive transcranial magnetic stimulation should generally be considered before electroconvulsive therapy. Deep brain stimulation and magnetic seizure therapy are investigational, and vagus nerve stimulation is a third-line surgical option.
- B. This is considered investigational for difficult-to-treat depression.
- C. This surgical third-line option is used for difficult-to-treat depression.
- D. This treatment remains investigational.
Sources: CANMAT 2023 update on clinical guidelines for management of major depressive disorder (MDD) in adults
3 / 10
A 30-year-old woman presents to her family physician with a 6-month history of excessive worry and anxiety. She is started on fluoxetine, a selective serotonin reuptake inhibitor (SSRI).
What is the primary mechanism of action of fluoxetine in treating anxiety disorders?
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Answer: C. Blocking the reuptake of serotonin
Why: Fluoxetine works by blocking the reuptake of serotonin, which increases the levels of serotonin in the synaptic cleft and helps to reduce anxiety symptoms. According to the Canadian Psychiatric Association, SSRIs like fluoxetine are effective treatments for anxiety disorders, and their mechanism of action is well-established.
- A. While fluoxetine does increase the levels of serotonin in the synaptic cleft, its primary mechanism of action is not increasing the release of serotonin.
- B. Fluoxetine does not decrease the release of serotonin; instead, it increases the levels of serotonin in the synaptic cleft.
- D. Fluoxetine's primary mechanism of action is not related to dopamine, but rather to serotonin.
Sources: Canadian Psychiatric Association
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4 / 10
A 25-year-old man with a diagnosis of Schizophrenia has failed to respond to multiple antipsychotic medications, including olanzapine and risperidone. He is considering treatment with clozapine, but is concerned about the potential side effects.
What is the most appropriate next step in the management of this patient?
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Answer: A. Initiate clozapine treatment and monitor for side effects
Why: The most appropriate next step in the management of this patient is to initiate clozapine treatment and monitor for side effects. The Canadian Psychiatric Association recommends clozapine as a treatment option for patients with treatment-resistant Schizophrenia.
- B. While referral to a specialist psychiatric hospital may be necessary in some cases, it is not the most appropriate next step for a patient considering clozapine treatment.
- C. The patient has already failed to respond to multiple antipsychotic medications, making it less likely that another medication will be effective.
- D. Discontinuing antipsychotic medication is not a recommended approach for a patient with Schizophrenia, as it can lead to relapse and worsening of symptoms.
Sources: Canadian Psychiatric Association
5 / 10
A 40-year-old man with a history of bipolar disorder presents to the emergency department with a manic episode. He is treated with a mood stabilizer and a benzodiazepine, and his symptoms improve significantly. However, he is concerned about the potential side effects of his medication and wants to know what he can do to minimize them.
What is the most appropriate next step in managing this patient's concerns?
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Answer: B. Provide patient education on medication side effects and monitoring
Why: The patient's concerns about medication side effects are common and should be addressed through patient education. According to the Canadian Paediatric Society, patient education is a crucial aspect of managing medication side effects and can help empower the patient to take an active role in his care. This can include providing information on potential side effects, monitoring strategies, and lifestyle modifications to minimize risks.
- A. While a psychiatrist may be involved in the patient's care, this is not the most appropriate next step in addressing his concerns.
- C. While laboratory tests may be necessary to monitor for side effects, this is not the most appropriate next step in addressing the patient's concerns.
- D. While support groups can be helpful, this is not the most appropriate next step in addressing the patient's concerns about medication side effects.
Sources: Canadian Paediatric Society
6 / 10
A 50-year-old woman is diagnosed with a psychiatric condition that requires treatment with medication. She has a history of substance use disorder and has been experiencing symptoms of anxiety and depression. She is hesitant to take the medication due to concerns about side effects.
What is the most important factor to consider when obtaining informed consent from this patient?
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Answer: B. The patient's capacity to make decisions
Why: The Canadian Medical Protective Association recommends that healthcare providers ensure that patients have the capacity to make decisions before obtaining informed consent. This involves assessing the patient's ability to understand and appreciate the risks and benefits of treatment.
- A. While the patient's history of substance use disorder is important to consider, it is not the most important factor in obtaining informed consent.
- C. While the patient's symptoms of anxiety and depression are important to consider, they are not the most important factor in obtaining informed consent.
- D. While the potential side effects of the medication are important to consider, they are not the most important factor in obtaining informed consent.
Sources: Canadian Medical Protective Association
7 / 10
A 25-year-old patient with a diagnosis of schizophrenia presents to the emergency department with severe agitation and aggression. The patient's vital signs are stable, but they are experiencing hallucinations and disorganized thinking. The patient is currently taking risperidone 4mg daily, but the family reports that the patient has not been adhering to the medication regimen.
What is the most appropriate next step in managing this patient's agitation and aggression?
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Answer: D. Administer a dose of intramuscular olanzapine
Why: The patient's agitation and aggression require immediate attention, and intramuscular olanzapine is a effective and rapid-acting treatment option. The Canadian Psychiatric Association recommends the use of intramuscular antipsychotics, such as olanzapine, for the management of acute agitation in patients with schizophrenia.
- A. Increasing the dose of risperidone may not address the patient's current agitation and aggression, and may increase the risk of side effects.
- B. While benzodiazepines can be effective in managing agitation, they should be used with caution in patients with schizophrenia due to the risk of dependence and worsening of psychotic symptoms.
- C. Physical restraints should be used as a last resort and only when the patient poses a significant risk to themselves or others.
Sources: Canadian Psychiatric Association
8 / 10
A 46-year-old man developed neuroleptic malignant syndrome after starting an antipsychotic. The drug has been stopped and supportive care has been provided, but he remains severely unwell and the treating team is considering an unusual indication for electroconvulsive therapy.
According to the CPA position paper, what is the place of electroconvulsive therapy in this situation?
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Answer: C. Electroconvulsive therapy may be considered under exceptional circumstances, after standard treatments have been pursued
Why: The CPA position paper lists major depressive disorder, bipolar disorder and schizophrenia and related conditions as the principal diagnostic indications for electroconvulsive therapy, and adds that under exceptional circumstances some primary medical disorders may also respond, naming Parkinson disease, neuroleptic malignant syndrome and refractory epilepsy. It cautions that compelling evidence for these unusual indications is lacking and that standard treatments should be pursued first. Electroconvulsive therapy is not absolutely contraindicated, and catatonia is not a required precondition.
- A. The position paper states that there are no absolute contraindications to electroconvulsive therapy, so a diagnosis of neuroleptic malignant syndrome does not rule it out.
- B. The position paper advises that the available standard treatments should be pursued before electroconvulsive therapy is considered for an unusual indication.
- D. Catatonia can prompt electroconvulsive therapy, but the position paper does not make it a precondition for considering treatment of neuroleptic malignant syndrome.
Sources: Canadian Psychiatric Association position paper on electroconvulsive therapy (ECT)
9 / 10
A 17-year-old female patient with a diagnosis of Anorexia Nervosa is admitted to the hospital with a body mass index (BMI) of 15. She has a history of restrictive eating, excessive exercise, and purging behaviors. Her laboratory tests reveal hypokalemia, hypophosphatemia, and anemia.
What is the most appropriate initial management step for this patient?
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Answer: C. Provide nutritional rehabilitation and stabilize electrolyte imbalances
Why: The patient's severe malnutrition and electrolyte imbalances require immediate attention to prevent further complications. The Society of Obstetricians and Gynaecologists of Canada recommends a multidisciplinary approach to treatment, including nutritional rehabilitation, medical stabilization, and psychotherapy.
- A. While cognitive-behavioral therapy is an important component of treatment for Anorexia Nervosa, it is not the most appropriate initial management step for a patient with severe malnutrition and electrolyte imbalances.
- B. SSRIs may be used in the treatment of Anorexia Nervosa, but they are not the most appropriate initial management step for a patient with severe malnutrition and electrolyte imbalances.
- D. While referral to a specialist eating disorders program may be necessary, it is not the most appropriate initial management step for a patient with severe malnutrition and electrolyte imbalances.
Sources: Society of Obstetricians and Gynaecologists of Canada
10 / 10
A 31-year-old woman is 10 weeks pregnant and has symptoms of depression. Her clinician wants to use a standardized questionnaire to assess severity and to guide treatment decisions.
Which instrument and cut-off does the CANMAT perinatal guideline recommend for detecting perinatal depression?
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Answer: C. Edinburgh Postnatal Depression Scale with a cut-off of 11 or higher
Why: The guideline recommends the Edinburgh Postnatal Depression Scale preferentially for detection of perinatal depression, with a cut-off score of 11 or higher maximizing the ability to accurately identify depression when compared with semi-structured diagnostic interviews in pregnant and postpartum populations. The PHQ-9, one of the most widely used depression self-report tools in primary care, has comparable test characteristics at a score of 10 or more, so it can be used if it is more practical to implement. The GAD-7 is used for anxiety symptoms, and the Mood Disorder Questionnaire is used to identify bipolar disorder. Questionnaires alone cannot make a diagnosis, so a positive screen requires further diagnostic assessment and treatment. Antidepressants are first-line medications for depressive disorders, and reducing or discontinuing them near delivery is not recommended because the risk of worsening maternal illness outweighs the benefit.
- A. The PHQ-9 is an acceptable alternative, but the recommended cut-off is lower than 15.
- B. The GAD-7 is used for anxiety symptoms rather than for detection of depression.
- D. That instrument with a cut-off of 7 or above is used to identify bipolar disorder rather than depression.
Sources: CANMAT 2024 clinical practice guideline for the management of perinatal mood, anxiety, and related disorders
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