1.

A 10-year-old boy has been taking anti-epileptic medication

for the treatment of generalized tonic-clonic seizures that he
had developed a year ago. After starting anti-epileptic
medication, he exhibited moderate gingival hyperplasia
resulting in poor oral hygiene and halitosis.
Which anti-epileptic medication was responsible for gingival
hyperplasia?
A. Carbamazepine
B. Phenobarbital
C. Lamotrigine
D. Phenytoin
2. A 75-years-old female schizophrenia patient has been taking
Haloperidol 10mg PO for the last two weeks. On return for
follow-up at psychiatry clinic, her sister reported that she is
not able to sit stable during meal and/or coffee time. She
moves here and there without any purpose. As clinical
pharmacy service provider, you suspected drug induced
adverse effect from the current regimen. What type adverse
effects for the patient,?
a. Tardive dyskinesia
b. Dystonia
c. Pseudoparkisonism
d. Akathesia
3. A 23-year-old male patient who is diagnosed with
Schizophrenia cannot memorize whether he took his
 medication every day. Due to poor adherence to his
medication and follow up, the physician prescribed him
Haloperidol 50mg in the form of depot preparation. The
patient is also advised to come after four weeks to refill his
next dose.
What potential drug therapy problem will encounter this
patient?
(A) Haloperidol depot is ineffective
(B) Dosage of Haloperidol is too high
(C) Depot formulation is not indicated
(D) Additional drug needed for Side Effect
4. A 55-year-old teacher was diagnosed with depression. After
6 weeks of therapy with fluoxetine, his symptoms improved,
but he complains of sexual dysfunction. Which of the
following drugs might be useful for management of
depression in this patient?
A. Sertraline
B. Citalopram
C. Mirtazapine
D. Lithium
5. A 25-year-old woman has a long history of depressive
symptoms accompanied by body aches and pain secondary
to a car accident. Which of the following drugs might be
useful in this patient?
a. Fluoxetine
 b. Sertraline
c. Phenelzine
d. Duloxetine.
6. A 51-year-old woman with symptoms of major depression
also has angle-closure glaucoma. Which antidepressant
should be avoided in this patient?
A. Amitriptyline
B. Bupropion
C. Mirtazapine
D. Fluvoxamine
7. A 36-year-old man presents with symptoms of compulsive
behavior. He realizes that his behavior is interfering with his
ability to accomplish his daily tasks but cannot seem to stop
himself. Which drug would be most helpful to this patient?
a. Desipramine
b. Paroxetine
c. Amitriptyline
d. Selegiline
8. A 36-year-old man presents with symptoms of compulsive
behavior. If anything is out of order, he feels that "work will
not be accomplished effectively or efficiently." He realizes
that his behavior is interfering with his ability to accomplish
his daily tasks but cannot seem to stop himself. Which of the
following drugs would be most helpful to this patient?
a. Imipramine.
 b. Fluvoxamine.
c. Amitriptyline.
d. Tranylcypromine.
e. Lithium.
9. Which antidepressant is the most sedating?
a. Bupropion
b. Duloxetine
c. Doxepin
d. Venlafaxine
10. Which antidepressant is the most sedating?
a. Fluoxetine.
b. Duloxetine.
c. Nortriptyline.
d. Citalopram
11. Which antidepressant has, as its two principal mechanisms
of action, 5-HT2A receptor antagonism and α2 receptor
antagonism?
a. Fluoxetine
b. Doxepin
c. Maprotiline
d. Mirtazapine
12. Which mood-stabilizing agent is most likely to decrease
the thyroid function?
a. Carbamazepine
b. Lithium
 c. Valproic acid
d. Chlorpromazine
13. Which antidepressant agent has significant α1 receptor
antagonism and, thus, is a poor choice in an elderly female
with depressive symptoms due to a higher risk of falls related
to orthostatic hypotension?
a. Venlafaxine
b. Bupropion
c. Escitalopram
d. Amitriptyline
14. Which agent would be a poor choice in a 70-yearold
elderly female with depressive symptoms due to the drug
having significant α1 receptor antagonism and thus a higher
risk for falls due to orthostatic hypotension?
a. Lithium.
b. Bupropion.
c. Escitalopram.
d. Imipramine.
e. Sertraline.
15. 45-year-old woman with sleep apnea, hypertension,type 2
diabetes mellitus, and chronic pain. She is being seen in the
clinic today for an assessment of her depressive symptoms
and medication evaluation. She endorses sad mood, poor
appetite (lost 15 lb), poor concentration, and feelings of
hopelessness and worthlessness for the past 3 weeks. She
 has also stopped going to her book club because she does
not have any motivation to get out of the house, and she has
frequent mid-nocturnal awakening. She denies
suicidal/homicidal ideation. She denies any use of alcohol,
tobacco, or illicit drugs. She is currently taking
hydrochlorothiazide,
metformin,hydrocodone/acetaminophen (APAP), and aspirin.
You decide that A.Z. should receive an antidepressant in the
selective serotonin reuptake inhibitor (SSRI) class to treat
herdepressive symptoms.
Which SSRI would most likely interact with her current
medications?
A. Citalopram. B. Fluvoxamine. C. Paroxetine. D.
Sertraline.
16. Which antidepressant would be most appropriate for the
pt depressive symptoms?
A. Bupropion. B. Fluoxetine. C. Mirtazapine. D.
Venlafaxine.
17. It has been 4 weeks since the pt initial visit with you, and
she has been treated with citalopram 20 mg/day in the
morning. She still presents with sad mood, but her insomnia,
concentration, and appetite have improved. She still has
feelings of hopelessness and worthlessness, lack of
 motivation, and anhedonia. At this point, which is the best
recommendation to optimize her therapy?
a. Continue at current dose of 20 mg/day.
b. Increase the current dose to 40 mg/day.
c. Add bupropion 150 mg twice daily
d. Switch to a different SSRI.
18. Six months later, A.Z. reports that although her depression
symptoms have resolved, she has "trouble" during
intercourse, which is quite disturbing to her. You determine
that she has anorgasmia caused by citalopram treatment.
Which is the most appropriate recommendation at this time?
a. Discontinue citalopram.
b. Add bupropion
c. Switch to d/t SSRI.
d. Switch to mirtazapine
19. 26-year-old man with a history of bipolar disorder, type I,
who presents to the inpatient unit with delusions that the FBI
is tracking his movements and that his thoughts are being
recorded in a secret governmental database. He believes he
has special powers to hide from the FBI by making himself
invisible. He is hyperverbal and has not slept in the past 48
hours. He is placed on a 72-hour hold for control of his manic
symptoms. He has a history of nonadherence to medications
and is currently not taking any medications. Pt last
hospitalization was 2 months ago, when he had significant
 depressive symptoms and suicidal ideation. He has three or
four hospitalizations per year, and his history of medication
trials includes carbamazepine, olanzapine, and lamotrigine
(may be helpful but uncertainbecause of nonadherence). He
has also received a diagnosis of hepatitis C.
Which statement is most applicable regarding selecting the
patient 's mood stabilizer at this time?
A. Carbamazepine should be tried again because it is
effective for preventing rehospitalization.
B. Divalproex should be tried because it is good for
maintenance treatment.
C. Lithium should be tried because it can effectively treat
the manic phase and prevent future episodes.
D. Lamotrigine should be tried again because it is effective
for bipolar maintenance.
20. Which adverse effects would be of most concern and
would require immediate evaluation if the patient
prescribed lithium?
a. Hyperthyroidism.
b. Coarse tremor.
c. Severe acne.
d. Weight gain

21. It is 3 months later, and the patient has been stable on

lithium 900 mg/day. During a clinic visit, you find that pt is
 confused and slurring his words. His other medications
include lisinopril, ibuprofen, atorvastatin, and zolpidem.
Which is best to recommend immediately?
A. Discontinue lisinopril because it interacts with lithium.
B. Discontinue zolpidem because it may increase
confusion.
C. Obtain a lithium level because pt may have
supratherapeutic levels.
D. Discontinue ibuprofen because it interacts with lithium.
22. L.M. is a 25-year-old man recently given a diagnosis of
schizophrenia, paranoid type. He often hears voices telling
him that he is "stupid and worthless" and that he should
"just jump off his apartment building." His parents became
very concerned about his isolative behavior and brought him
to the hospital. He was given haloperidol in the psychiatry
unit and now presents with neck stiffness and feelings of
extreme restlessness. Until now, he has not taken
medications because he felt that he could control his
symptoms on his own with vitamins and Red Bull drinks.
Which is the most appropriate treatment of L.M.'s symptoms
at this time?
a. Benztropine.
b. Haloperidol.
c. Olanzapine.
d. Quetiapine.
23. You and the psychiatric team decide to recommend
risperidone for L.M.
Which is the most likely reason for this selection?
A. Risperidone has less risk of causing EPS than
haloperidol.
B. Risperidone is available in a long-acting injection for
increasing adherence.
C. Risperidone is effective for decreasing L.M.'s negative
symptoms.
D. Risperidone can be dosed once daily after titration to
target dose.
24. Which adverse effect of risperidone would be of most
concern in L.M.?
a. Sedation.
b. Anticholinergic effects.
c. EPS.
d. Corrected QT (QTc) prolongation.
25. One year later, L.M. is no longer responding to
risperidone, and you decide to switch him to another
medication. L.M. is only interested in oral medications. On
the basis of his history, which agent is most appropriate at
this time?
a. Clozapine.
b. Fluphenazine.
c. Olanzapine.
 d. Quetiapine
26. Which recommendation is most appropriate at this time?
A. Continue paroxetine because it treats both PTSD and
major depression.
B. Discontinue paroxetine and initiate sertraline, which
treats both PTSD and major depression.
C. Continue paroxetine and add lorazepam for the anxiety
symptoms.
D. Discontinue paroxetine and initiate buspirone for the
anxiety symptoms.
27. C.P. has been adherent to the medication you
recommended earlier, but he still feels very irritable and has
been aggressive at times at work toward others.
Which adjunctive medication is most appropriate in this
patient?
a. Buspirone.
b. Clonazepam.
c. Divalproex.
d. Lithium
28. After 8 months of treatment, C.P. is not responding to the
medication you recommended. Having heard a lot about
buspirone, he wonders whether this medication might be
helpful for his conditions.
Which is the most accurate statement for this patient?
a. Buspirone may be helpful for the nightmares.
 b. Buspirone may work as quickly as 3 days.
c. Buspirone is convenient because of its once-daily
dosing.
d. Buspirone does not have much dependence potential.
29. C.P. returns to the clinic and states that his depressive and
anxiety symptoms have much improved. However, he is
concerned that his girlfriend, who has obsessive- compulsive
disorder, is not doing well on her treatment with lorazepam.
If you were also treating the girlfriend, which is the most
appropriate medication you would initiate?
a. Clomipramine.
b. Amitriptyline.
c. Imipramine.
d. Nortriptyline
30. 52-year-old woman (body mass index [BMI] 35 kg/m2 )
with schizophrenia presents for a routine follow-up. She is
noted to have abnormal repetitive chewing type movements
in her jaw, which she seems unable to control. She states
that they are bothersome and interfere with her ability to
eat, and she stays home because she is ashamed to be seen
in public. She has taken perphenazine for the past 8 years
with good control of her symptoms. She is able to live
independently and care for herself. She did not respond to
therapeutic trials of aripiprazole, ziprasidone, or haloperidol.
She has gained 22.7 kg (50 lb) and developed type 2 diabetes
 while taking olanzapine. The diabetes resolved off
olanzapine.
Which would be the best treatment?
a. Add benztropine.
b. Add lorazepam.
c. Change to quetiapine.
d. Add valbenazine.
31. A 36-year-old man presents with a 16-year history of
schizophrenia and alcohol use disorder. His medication was
recently changed from haloperidol to aripiprazole because of
gynecomastia and impotence. Today, he is pacing in your
office and seems anxious and agitated. He has not been
sleeping well and feels uncomfortable in his skin.
Which medication would be most appropriate to help relieve
this patient's symptoms?
a. Benztropine.
b. Dantrolene.
c. Lorazepam.
d. Propranolol.
32. 67-year-old man is admitted for new-onset tonic-clonic
seizures. His medical history is negative for seizure disorders
but positive for prediabetes and schizophrenia. His
schizophrenia has been stabilized on clozapine 900 mg daily
for many years. He also takes diphenhydramine 50 mg at
bedtime, metformin 1000 mg twice daily, and bupropion
 extended release (ER) 300 mg daily (for 2 months). His social
history is negative for alcohol and illicit drug use but positive
for a 25 pack-year history, which he stopped 2 weeks ago.
Which medication is most likely responsible for his seizures?
a. Bupropion.
b. Clozapine.
c. Diphenhydramine.
d. Metformin.
33. A 56-year-old woman presents with a medical history
significant for recurrent major depression and type 2
diabetes with newly diagnosed neuropathy, obesity, and
coronary artery disease. She takes citalopram 40 mg daily,
carvedilol 25 mg twice daily, lisinopril 40 mg daily, and
metformin 1000 mg twice daily. She is tearful during her
appointment and continues to have symptoms of depression
despite initial improvement with citalopram. She wants to
change antidepressants.
Which would be most beneficial?
a. Bupropion.
b. Duloxetine.
c. Nortriptyline.
d. Sertraline.
34. A 45-year-old man presents with agitation and diaphoresis
and an oral temperature of 38.5°C (101.3°F). His right eyelid
began twitching about an hour ago, and he cannot make it
 stop. He developed cold symptoms 2 days ago and began
taking dextromethorphan and pseudoephedrine around the-
clock. His medical history includes depression, hypertension,
and dyslipidemia. He takes cetirizine 10 mg at bedtime,
paroxetine 40 mg at bedtime, diltiazem extended release
(XR)240 mg daily, and rosuvastatin 10 mg daily.
Which combination of medications is most likely contributing
to his current symptoms?
a. Cetirizine and paroxetine.
b. Dextromethorphan and pseudoephedrine.
c. Diltiazem and pseudoephedrine.
d. Paroxetine and dextromethorphan.
35. A 31-year-old man presents with a 5-year history of type I
bipolar disorder, for which he takes lithium 300 mg twice
daily. He has been adherent to treatment. His lithium serum
concentration, obtained yesterday before his morning
lithium dose, is 1.0 mEq/L. He has been without manic
symptoms for the past few years. He is admitted for a suicide
attempt using acetaminophen. For the past few weeks, he
has lost interest in his job and isolated himself from other
people.
Which medication would best help his acute symptoms?
a. Aripiprazole.
b. Lamotrigine.
c. Quetiapine.
 d. Venlafaxine.
36. A 28-year-old woman (height 61 inches, weight 74.8 kg
[165 lb], up from 68 kg [150 lb] 2 months ago) presents with
a history of type I bipolar disorder. She has taken lithium 450
mg twice daily for the past 6 months. Her last serum
concentration (3 months ago) was 0.7 mEq/L. She presents
today for an annual examination. Her laboratory test results
include sodium (Na) 138 mEq/L, potassium (K) 4.7 mEq/L,
serum creatinine (SCr) 0.9 mg/dL, glucose 124 mg/dL, and
TSH 24 mIU/mL. Additional medications include olanzapine
10 mg at bedtime (for 1 year), ethinyl estradiol/drospirenone
(Yasmin) daily, and a multivitamin.
Which laboratory finding is most closely associated with her
current medication regimen?
a. Glucose.
b. SCr.
c. Na.
d. TSH.
37. A 43-year-old woman presents with right upper quadrant
abdominal pain with rebound tenderness, nausea, and
vomiting. Her medical history is significant for rapid-cycling
bipolar disorder, hypertension, obesity, and asthma. She
takes divalproex sodium 500 mg twice daily, lamotrigine 150
mg twice daily, aripiprazole 30 mg daily, ramipril 10 mg daily,
albuterol hydrofluoroalkane (HFA) 2 puffs every 6 hours, and
 fluticasone/salmeterol dry powder inhaler 250/50 twice
daily. She started a prednisone taper 3 days ago for an
asthma exacerbation. Laboratory test results include sodium
141 mEq/L, potassium 3.3 mEq/L, chloride 95 mEq/L, carbon
dioxide 26 mmol/L, SCr 1.0 mg/dL, glucose 72 mg/ dL, total
cholesterol 165 mg/dL, triglycerides 188 mg/dL, aspartate
aminotransferase (AST) 27 U/L, alanine aminotransferase
(ALT) 21 U/L, amylase 456 U/L, lipase 387 U/L, and valproic
acid trough concentration 56 mg/dL.
Which medication is most likely responsible for her current
clinical picture?
a. Aripiprazole.
b. Divalproex sodium.
c. Lamotrigine.
d. Prednisone
38. A 20-year-old woman presents to the emergency
department after experiencing trembling, sweating, chest
pain, and shortness of breath accompanied by intense fear. A
myocardial infarction has been ruled out. She has been given
a diagnosis of panic disorder. In addition to a medication for
her acute symptoms, which medication would provide the
best long-term control?
a. Alprazolam.
b. Buspirone.
c. Hydroxyzine.
 d. Paroxetine.
39. A 55-year-old woman presents with uncontrolled
generalized anxiety disorder (GAD). Concomitant medical
conditions include a history of breast cancer, dyslipidemia,
osteoarthritis, vasomotor symptoms, and osteopenia. She
takes tamoxifen, simvastatin, ibuprofen, lorazepam, and
alendronate. Her physician would like her to have better
control of her anxiety symptoms. He would also like to taper
off lorazepam. Her GAD has not been controlled with
paroxetine, sertraline, or duloxetine.
Which agent would be best?
a. Bupropion.
b. Fluoxetine.
c. Pregabalin.
d. Venlafaxine.
40. A 74-year-old woman has difficulty getting to sleep. Once
she falls asleep, she rests comfortably throughout the night.
She has struggled with keeping a consistent bedtime for the
past few months. She has no identifiable contributing factors.
Concomitant medical conditions include hypertension,
arthritis, and mild cognitive impairment. She has tried
diphenhydramine but states that it helped for only a few
nights and "made me loopy." She would like a medication
with the least risk of hangover effect.
Which medication is best?
 a. Eszopiclone.
b. Ramelteon.
c. Suvorexant.
d. Zolpidem.
41. A 23-year-old man has a history of heroin addiction. He
has successfully been maintained on methadone 40 mg daily
for 1 year. He would like an option that does not require him
to go to a daily opioid treatment program to get his
methadone dose. He is not taking other medications, nor
does he abuse other substances.
Which treatment regimen is most appropriate?
A. Initiate supervised buprenorphine/naloxone.
B. Change to buprenorphine × 2 days; then take
buprenorphine/naloxone.
C. Change to naltrexone.
D. Taper to methadone 30 mg; then change to
buprenorphine
42. A 55-year-old man has a 30-year history of alcohol
dependence. He drinks 1 pint of vodka daily. He has tried
several times to quit without success. He recently reconciled
with his estranged son and wants to be sober so that he can
be present in his son's life. His medical history includes
heroin use, depression, and posttraumatic stress disorder
(PTSD). Concomitant medications include methadone
maintenance (which he wishes to continue) and sertraline
 (currently nonadherent). His liver function test results
include AST 143 U/L, ALT 74 U/L, albumin 4.0 g/dL, alkaline
phosphatase 75 U/L, total bilirubin 0.3 mg/dL, prothrombin
time 15.1 seconds, international normalized ratio 0.9,
platelet count 370,000/ mm3 , and creatinine clearance
(CrCl) 40 mL/minute/1.73 m2 .After alcohol detoxification,
which maintenance treatment is most appropriate?
a. Acamprosate 333 mg three times daily.
b. Chlordiazepoxide 25 mg four times daily.
c. Disulfiram 500mg daily.
d. Naltrexone 50 mg daily
43. A 44-year-old man is preparing to be discharged from the
hospital after a myocardial infarction. He has a 25 pack-year
history of smoking cigarettes and smokes 1½ packs/day. He
has unsuccessfully tried to quit twice. He tried quitting "cold
turkey" the first time about 5 years ago. He resumed smoking
6 months later when he lost his job. He tried again about 6
months ago using the 2-mg strength of nicotine gum. To save
money, he chewed 7 pieces daily. He has just been given a
diagnosis of depression.
Which regimen would be best?
a. Bupropion suspended release (SR).
b. Nicotine gum.
c. Nicotine patch.
d. Varenicline.
44. A 4-year-old child exhibits severe hyperactivity at
preschool and is asked to leave preschool due to aggression,
impulsivity, and not following directions. Which of the
following statements describes an additional diagnostic
criterion needed for a diagnosis of ADHD?
a. The symptom duration would need to be 6 weeks.
b. These impairing symptoms are also present at home.
c. The patient must be at least 6 years old.
d. Learning disability needs to be ruled out.
45. A teacher's aide asks about the most likely cause of new
onset tics (throat clearing) in a 9-year old with ADHD and
Tourette disorder treated with Quillivant 20 mg daily and
clonidine 0.1 mg at bedtime (same doses for 3 months)? The
best answer is:
a. Too much sugar in the diet.
b. Quillivant dose is too high.
c. Clonidine dose is too low.
d. Natural course of tic disorder.
46. A deficiency in this substance has been shown to
contribute to ADHD symptoms:
a. Ferritin
b. Cyanocobalamin
c. Folate
d. Omega-3 fatty acids
47. Which statement should be included when counseling a
family on the risks and benefits of stimulant therapy?
a. The risk of an adverse cardiac event for a child with
ADHD taking a stimulant is two times greater than an
untreated child.
b. Stimulant therapy for ADHD can increase the risk of
severe brain injury.
c. The risk of decreased growth and insomnia is greater
with immediate release stimulants for ADHD.
d. Atomoxetine is less likely associated with liver injury
compared to stimulant.
48. Which of the following statements most accurately
describes the clinical presentation of adult ADHD?
a. Hyperactivity and impulsivity are the most prominent
symptoms.
b. Adults frequently report racing thoughts, mood swings,
and insomnia.
c. Disorganization increases in frequency and severity over
the adult life span.
d. Distractibility and difficulty with sustained mental
effort are most common.
49. What structural brain changes are thought to correlate
with persistence of ADHD into adulthood?
a. Enlarged ventricles and diminished basal ganglia
b. Underdevelopment of the locus coeruleus
 c. Overgrown lateral lobe of the amygdala
d. Cortical thinning and decreased brain volume.
50. Which of the following is an example of an obsession that
a patient with obsessive compulsive disorder may complain
about?
a. Repeated hand washing
b. Repeating words silently
c. Counting pencils and pens
d. Repeated thoughts of doubt
51. Which of the following agents has the most evidence to
support use as an augmenting agent in patients with post-
traumatic stress disorder who are on antidepressant therapy
and continue to complain of nightmares?
a. Prazosin
b. Zolpidem
c. Lorazepam
d. Olanzapine
52. A 39-year-old patient is being treated for treatment-
resistant GAD with escitalopram 30 mg daily and quetiapine
XR 100 mg at bedtime. Which of the following are the most
appropriate monitoring parameters for this patient?
a. Liebowitz Social Anxiety Scale, weight, complete blood
count
b. Hamilton Anxiety Scale, body mass index, fasting blood
sugar
 c. Fall risk, weight, complete blood count, basic metabolic
panel
d. Suicidality risk, ophthalmic examination every 6 months,
blood pressure
53. A 35-year-old patient with panic disorder has been well
maintained on sertraline 150 mg daily and clonazepam 1 mg
twice daily for 2 years. As a result of a recent hospitalization,
several medications have been added to the regimen, and
the patient is experiencing significant breakthrough anxiety.
Which of the following new medications is most likely to
interact with the clonazepam and result in increased anxiety?
a. Pantoprazole
b. Carbamazepine
c. Lithium carbonate
d. Warfarin sodium

54. A 58-year-old male with obstructive sleep apnea and

daytime sleepiness. What is the best therapy for him?
a. Tracheostomy
b. Modafinil
c. Uvulopalatopharyngoplasty
d. Oral appliances
E. Continuous positive airway pressure
55. Which of the following non-pharmacologic treatments has
been found to be the most effective in the management of
post-traumatic stress disorder?
a. Psychoeducation
b. Deep brain stimulation
c. Transcranial magnetic stimulation
d. Trauma-focused cognitive behavioral therapy
56. A patient with panic disorder has been treated successfully
with paroxetine 60 mg daily for 6 months. The patient
inquires about discontinuation of therapy. Which of the
following is the most appropriate plan for discontinuation of
paroxetine?
a. Continue therapy for 6 more months, and then attempt
to taper the paroxetine over 4 to 6 months.
b. Add clonazepam to the regimen and attempt to taper
paroxetine over 2 months.
c. Continue therapy for 3 more months, and then
attempt to taper paroxetine by decreasing the dose
25% weekly.
d. Convert paroxetine to fluoxetine, and then taper the
fluoxetine after 6 months of therapy.
57. A 27-year-old female has trouble with waking up in the
middle of the night. What is the best way to avoid tolerance
and dependence in this patient?
a. Use high-dose BZDRA therapy for as long as possible.
 b. Use high-dose BZDRA therapy for as short as possible.
c. Use low-dose BZDRA therapy for as long as possible.
d. Use low-dose BZDRA therapy for as short as possible.
58. A patient with newly diagnosed obsessive-compulsive
disorder has been on escitalopram 20 mg daily for the past 6
months with a 50% reduction of symptoms based on the
Yale-Brown Obsessive-Compulsive Disorder Scale. The
patient inquires as to how much longer it is recommended to
stay on this medication. What is the most appropriate
response?
a. 5 to 7 more days
b. 3 to 4 more weeks
c. 6 to 12 more months
d. 4 to 5 more years
59. A 27-year-old patient with a history of substance abuse is
being treated for panic disorder. Which of the following
medications is associated with the risk of dependence with
chronic and prolonged use?
a. Buspirone
b. Clonazepam
c. Venlafaxine
d. Gabapentin
60. A 19-year-old patient presents with panic attacks occurring
two to three times weekly. Symptoms that occur during the
attacks include shortness of breath, tachycardia,
 paresthesias, dizziness, and palpitations. On further
questioning, the patient states that the attacks occur during
times of fear of talking with strangers, writing a check in
front of someone, or in any situation that the patient feels
scrutinized by others or likelihood of humiliation. Based on
clinical presentation, the panic attacks this patient is
experiencing are most likely associated with which of the
following anxiety disorders?
a. Panic disorder
b. Social anxiety disorder
c. Generalized anxiety disorder
d. Obsessive-compulsive disorder
61. stic criteria for post-traumatic stress disorder, a patient
has to have symptoms for longer than which of the following
durations?
A. 1 day
B. 1 week
C. 1 month
D. 1 year
62. A 54-year-old male patient has been having difficulty
maintaining sleep. He sleeps fine until around 1 am when he
wakes up. He would like to sleep until 6:30 am.
Which of the following would be the most appropriate?
a. Diazepam 5 mg orally at bedtime
b. Eszopiclone 3 mg orally when he awakens at 1 am
 c. Zolpidem 3.5 mg SL when he awakens at 1 am
d. Flurazepam 30 mg orally at bedtime
63. The experience of two years of hypomania symptoms that
do not meet the criteria for a manic episode is known as:
a. Dysthymic Disorder.
b. Dissociative disorder.
c. Cyclothymic Disorder.
d. Personality disorder.
64. 64) An 8-year-old boy is brought by an ambulance to the
ER. His mother says he had
fallen to the ground and began twitching and jerking both
arms and legs. The jerking lasted for about 2 to 3 minutes,
after which he would wake up, but have no memory of the
event. This pattern of events recurred for what seemed like
an hour before the ambulance arrived. His mother said he
had a fever with upper respiratory tract symptoms a day or
two ago. She relayed he does not have epilepsy but does
have asthma. He takes Flonase (fluticasone), Singular
(montelukast) daily, and albuterol as needed. As you are
taking the history, the child begins to convulse again.
Which of the following is true?
A. He has non-convulsive status epilepticus
B. He has cluster seizures
C. He has partial status epilepticus
D. He has generalized convulsive status epilepticus
65. As part of the above patient’s work up, which test would
be the least helpful in evaluating his seizure etiology?
A. Toxicology screen
B. Blood cultures
C. Chest X-ray
D. Blood electrolytes
66. Responsiveness to anticonvulsive treatment in GCSE is
affected by which of the following?
A. Patient age B. History of epilepsy C. Patient adherence
D. Duration of seizure
67. One of the major drug therapies for Bipolar disorder is:
a) Chlorpromazine. b) Lithium carbonate. c) Clozapine.
d) Benzodiazepine.
68. Which of the following may be given by IV push?
A. Phenytoin
B. Fosphenytoin
C. Phenobarbital
D. Midazolam
69. Which patient is most likely going to have successful
discontinuation of his AED(s)?
A. Patient with a seizure-free period for 1 to 2 years
B. An onset of seizures after 35 years of age
C. Seizure control within 1 year of onset
D. Patient with complex partial seizures as opposed to GTC
 seizures
E. Patient with an abnormal EEG only when he is asleep
70. Which AED has the longest elimination half-life?
A. Lacosamide
B. Oxcarbazepine
C. Tiagabine
D. Clobazam
E. Topiramate
71. Which AED is not used for refractory complex partial
seizures?
A. Vigabatrin
B. Lacosamide
C. Levetiracetam
D. Valproic acid
E. Rufinamide