Psychiatry Prometric exam questions

The Psychiatry exam in every GCC country

From each regulator's own exam pages; anything a regulator does not publish says so. Assessment mode also depends on your licence title, so confirm your route on your eligibility notice.

12 worked Psychiatry practice questions

Original exam-style questions from the bank, spread across the blueprint domains. They are not real or recalled exam questions. Try each one, then open the answer for the rationale and reference. None of them appear in the free mock exam, so reading them will not spoil it.

1. Question 1 · Foundations: Neuroscience, Basic Psychology, Psychiatric Assessment & Classification

   A 68-year-old man with a right hemisphere stroke laughs uncontrollably for a minute when greeted, then abruptly weeps, and afterwards reports that he did not feel amused or sad at any point and is embarrassed by the episodes. Which term most precisely describes this?

   1. ABlunted affect
   2. BPseudobulbar affect (emotional incontinence)
   3. CBelle indifference
   4. DMood-congruent affective lability of mania
   Show answer and explanation

   Correct answer: B. Pseudobulbar affect (emotional incontinence)

   Pseudobulbar affect is stereotyped, involuntary outbursts of laughing or crying that are disconnected from the subjective emotional state and are typical after stroke, motor neurone disease and multiple sclerosis. Blunted affect is a reduced range of emotional expression, not paroxysmal outbursts. Belle indifference is an apparent lack of concern about a severe deficit in functional neurological disorder. Manic affective lability is accompanied by a correspondingly elevated or irritable subjective mood, which this patient explicitly denies.

   Reference: New Oxford Textbook of Psychiatry, 3rd ed. (2020); Sims' Symptoms in the Mind, 6th ed. (2018)

2. Question 2 · Substance-Related & Addictive Disorders

   An employee's pre-employment urine immunoassay is positive for amphetamines. He denies any illicit use and takes bupropion for depression and pseudoephedrine for rhinitis. His employer wants to dismiss him on the basis of the screening result. What is the most appropriate advice?

   1. AThe immunoassay is definitive and no further testing is required
   2. BRepeat the same immunoassay on a second sample and act on the second result
   3. CHair testing should replace the urine test because hair analysis cannot produce false positives
   4. DThe result must be confirmed on the same specimen by a definitive method such as gas chromatography-mass spectrometry, with documented chain of custody and review by a medical review officer, because cross-reacting medicines cause false positives
   Show answer and explanation

   Correct answer: D. The result must be confirmed on the same specimen by a definitive method such as gas chromatography-mass spectrometry, with documented chain of custody and review by a medical review officer, because cross-reacting medicines cause false positives

   Immunoassays are screening tests with well-recognised cross-reactivity: bupropion, pseudoephedrine, selegiline, labetalol and several other agents can produce false-positive amphetamine results. A presumptive positive must therefore be confirmed on the same specimen by a definitive analytical method such as GC-MS or LC-MS/MS, with intact chain of custody and interpretation by a medical review officer who considers prescribed medication, before any employment consequence follows. Repeating the same immunoassay reproduces the same cross-reactivity, and hair testing has its own limitations including external contamination and possible ethnic hair-colour bias.

   Reference: US Substance Abuse and Mental Health Services Administration (SAMHSA) Mandatory Guidelines for Federal Workplace Drug Testing Programs, 2017/2023; Moeller KE et al., Mayo Clinic Proceedings, 2017

3. Question 3 · Child & Adolescent Psychiatry and Neurodevelopmental Disorders

   A 17-year-old girl with an eating disorder and ongoing safeguarding concerns about neglect at home is transferring to adult services. Which element of the handover is most important to preserve her safety?

   1. ATransferring only the current medication list, since historical information is confidential once she turns 18
   2. BExplicitly transferring the safeguarding history, current risk formulation and any protection plan to the receiving adult team and documenting that transfer
   3. CWithholding the safeguarding information unless the adult team specifically requests it
   4. DAsking the young person to describe the safeguarding history herself at her first adult appointment
   Show answer and explanation

   Correct answer: B. Explicitly transferring the safeguarding history, current risk formulation and any protection plan to the receiving adult team and documenting that transfer

   Safeguarding risk does not end at 18, and the receiving adult team can only manage risk it knows about, so the safeguarding history, current risk formulation and any protection or vulnerable-adult plan must be explicitly transferred and documented. Restricting handover to a medication list, or waiting to be asked, creates precisely the information gap in which serious incidents occur. Placing the burden of disclosure on the young person is unfair, unreliable and inconsistent with continuity-of-care duties, and information sharing for safeguarding purposes is a recognised limit to confidentiality.

   Reference: NICE NG43 (2016); Royal College of Psychiatrists, Safeguarding children and young people: roles and competencies (CR226, 2020)

4. Question 4 · Anxiety, Obsessive-Compulsive & Related, Trauma- and Stressor-Related & Dissociative Disorders

   A 24-year-old South Asian man presents with profound anxiety, fatigue, poor concentration and guilt, convinced that he is losing semen in his urine and that this is draining his vital strength. Urinalysis and all investigations are normal. He accepts that a doctor could be right that no physical loss is occurring, but remains highly distressed. How is this best understood and managed?

   1. AIt represents a cultural concept of distress (Dhat syndrome) commonly co-occurring with anxiety and depressive disorders; management involves culturally informed psychoeducation, cognitive behavioural techniques and treatment of the underlying anxiety or depressive disorder
   2. BIt is a somatic delusion requiring antipsychotic treatment
   3. CIt is a specific endocrine disorder requiring testosterone replacement
   4. DIt is factitious disorder and should be confronted directly
   Show answer and explanation

   Correct answer: A. It represents a cultural concept of distress (Dhat syndrome) commonly co-occurring with anxiety and depressive disorders; management involves culturally informed psychoeducation, cognitive behavioural techniques and treatment of the underlying anxiety or depressive disorder

   Dhat syndrome is a recognised cultural concept of distress in South Asian populations, in which attributed semen loss is associated with fatigue, anxiety and depressive symptoms; DSM-5-TR lists it among cultural concepts of distress rather than as a psychotic disorder. The belief is culturally shared and held with less than delusional fixity, so it does not warrant an antipsychotic. There is no endocrine abnormality to correct, and there is no intentional production of symptoms, so factitious disorder does not apply; management is psychoeducation within the patient's cultural framework plus treatment of the comorbid anxiety or depressive disorder.

   Reference: American Psychiatric Association, DSM-5-TR, Cultural Concepts of Distress (2022); Prakash & Mandal, Is Dhat syndrome a culturally sensitive presentation of depression?, Asian J Psychiatr (2015)

5. Question 5 · Personality, Impulse-Control, Feeding & Eating, Sleep-Wake, Sexual & Reproductive Psychiatry

   A 31-year-old woman is brought in on day 8 postpartum with rapidly fluctuating mood, insomnia for three nights, disorganised behaviour, perplexity and a belief that her baby has been swapped. She is intermittently disoriented. Which statement about management is most accurate?

   1. AThis is severe postnatal depression and should be managed with outpatient sertraline and follow-up in two weeks
   2. BFirst-trimester lithium exposure is associated with Ebstein anomaly, and this is a relevant consideration only for any future pregnancy, not for acute treatment now
   3. CThis is a psychiatric emergency requiring urgent admission, ideally to a mother and baby unit, with assessment of infant safety and treatment with an antipsychotic, lithium or ECT
   4. DBreastfeeding must be stopped in every case before any psychotropic is prescribed
   Show answer and explanation

   Correct answer: C. This is a psychiatric emergency requiring urgent admission, ideally to a mother and baby unit, with assessment of infant safety and treatment with an antipsychotic, lithium or ECT

   Abrupt onset within days to weeks of delivery, with fluctuating psychotic symptoms, perplexity and delirium-like features, characterises postpartum psychosis - a psychiatric emergency with substantial risk of suicide and infant harm, requiring urgent admission (preferably to a mother and baby unit), medical work-up to exclude organic causes, and treatment with antipsychotics, lithium or ECT. Outpatient antidepressant management is unsafe and antidepressants alone may worsen the picture. Lithium's association with Ebstein anomaly is a first-trimester teratogenic issue rather than a bar to acute postpartum use, and breastfeeding decisions are individualised by agent rather than universally prohibited, although lithium requires particular caution and infant monitoring.

   Reference: NICE CG192 Antenatal and Postnatal Mental Health (2014, updated 2020); Royal College of Psychiatrists / Maudsley Prescribing Guidelines, 14th ed. (2021)

6. Question 6 · Geriatric, Public/Community & Cross-Cultural Psychiatry

   A 70-year-old woman with early Alzheimer disease, currently retaining capacity, wants to record her wishes about future treatment for when she can no longer decide. Which statement best reflects good practice regarding advance care planning?

   1. AAdvance decisions should be made only after capacity is lost, by the family on her behalf
   2. BA valid advance refusal of treatment can be overridden by any treating doctor who believes treatment is in her best interests
   3. CAdvance planning is unnecessary because next of kin automatically acquire legal authority once capacity is lost
   4. DDiscussions should be held while she retains capacity, documented, reviewed periodically, and combined with appointing a substitute decision-maker where the jurisdiction allows
   Show answer and explanation

   Correct answer: D. Discussions should be held while she retains capacity, documented, reviewed periodically, and combined with appointing a substitute decision-maker where the jurisdiction allows

   Advance care planning must occur while the person retains capacity, should be documented, revisited as the illness evolves, and ideally paired with appointing a proxy or attorney where local law provides for one. Family cannot create an advance decision retrospectively, a valid and applicable advance refusal is generally binding rather than discretionary, and in most jurisdictions next of kin do not automatically acquire legal decision-making authority.

   Reference: NICE Dementia NG97 (2018) and Decision-making and mental capacity NG108 (2018); WHO Global action plan on the public health response to dementia 2017-2025

7. Question 7 · Forensic Psychiatry, Mental Health Law, Ethics, Professionalism & Patient Safety

   A quality improvement lead ranks proposed safeguards to prevent clozapine being dispensed without a current neutrophil count. According to the hierarchy of intervention effectiveness, which measure is strongest?

   1. AStaff education sessions on clozapine monitoring at induction
   2. BA forcing function in which the dispensing system will not release clozapine unless a valid, in-date neutrophil result is registered
   3. CA laminated poster in the dispensary listing monitoring requirements
   4. DA monthly audit of clozapine prescriptions with feedback to prescribers
   Show answer and explanation

   Correct answer: B. A forcing function in which the dispensing system will not release clozapine unless a valid, in-date neutrophil result is registered

   The hierarchy of effectiveness places forcing functions and constraints - which make the unsafe act physically or electronically impossible - at the top, above automation, standardisation, reminders and, weakest of all, education and policy. Education (A) and posters (C) rely entirely on human vigilance, and retrospective audit (D) detects failures after the patient has already been exposed rather than preventing them.

   Reference: Institute for Healthcare Improvement, Action Hierarchy for Root Cause Analysis; US National Center for Patient Safety RCA Action Hierarchy; Taylor D et al., Maudsley Prescribing Guidelines in Psychiatry, 14th ed., 2021

8. Question 8 · Psychopharmacology & Somatic Therapies (ECT and Neuromodulation)

   A 33-year-old man with bipolar II disorder is stable on sodium valproate but has breakthrough depressive episodes, and lamotrigine is to be added. Compared with lamotrigine monotherapy, how should the lamotrigine regimen be modified?

   1. AHalve the usual starting dose and titrate more slowly, because valproate inhibits lamotrigine glucuronidation and roughly doubles its plasma level
   2. BDouble the usual starting dose, because valproate induces lamotrigine metabolism
   3. CUse the standard regimen, because valproate and lamotrigine do not interact
   4. DStart lamotrigine at the full target dose immediately to obtain a faster antidepressant response
   Show answer and explanation

   Correct answer: A. Halve the usual starting dose and titrate more slowly, because valproate inhibits lamotrigine glucuronidation and roughly doubles its plasma level

   Valproate inhibits UGT-mediated glucuronidation of lamotrigine, approximately doubling its concentration and markedly increasing the risk of serious rash including Stevens-Johnson syndrome, so the starting dose is halved and the titration slowed. Valproate inhibits rather than induces this pathway, the interaction is clinically major rather than absent, and rapid escalation is the single strongest risk factor for severe cutaneous reactions.

   Reference: Lamotrigine Summary of Product Characteristics (EMA/MHRA); NICE CG185 Bipolar disorder: assessment and management, 2014 (updated 2023)

9. Question 9 · Consultation-Liaison (Psychosomatic) Psychiatry, Somatic Symptom & Neurocognitive Disorders

   A dying patient has agitation and breathlessness that have not responded to all other measures, and sedative medication is titrated to the lowest dose that relieves the distress, with the intention of relieving suffering rather than shortening life. Which statement best characterises this practice?

   1. AIt is palliative sedation, ethically distinct from euthanasia by intention, proportionality and the doctrine of double effect
   2. BIt is euthanasia, because sedation may hasten death
   3. CIt is physician-assisted suicide, because the patient consented
   4. DIt is clinically indistinguishable from terminating life and should never be undertaken
   Show answer and explanation

   Correct answer: A. It is palliative sedation, ethically distinct from euthanasia by intention, proportionality and the doctrine of double effect

   Palliative sedation for refractory symptoms at the end of life is defined by the intention to relieve suffering, proportionate titration to symptom control, and use only when other measures have failed; the doctrine of double effect covers a foreseen but unintended risk of hastened death. Euthanasia and assisted suicide are defined by the intention that the patient dies and by the use of an agent and dose chosen for that purpose. Evidence in fact shows properly titrated palliative sedation does not measurably shorten survival.

   Reference: European Association for Palliative Care framework on palliative sedation (Cherny and Radbruch, Palliative Medicine, 2009)

10. Question 10 · Depressive, Bipolar & Related Disorders

    A primary care physician screens depressed patients with the Mood Disorder Questionnaire (MDQ) and asks how to interpret a positive result. Which statement is most accurate?

    1. AThe MDQ is a screening instrument with imperfect specificity; a positive result requires a full diagnostic interview before a bipolar diagnosis is made
    2. BA positive MDQ confirms bipolar disorder and justifies starting a mood stabiliser
    3. CThe MDQ is a clinician-rated severity scale used to monitor manic symptoms over time
    4. DA negative MDQ reliably excludes bipolar II disorder
    Show answer and explanation

    Correct answer: A. The MDQ is a screening instrument with imperfect specificity; a positive result requires a full diagnostic interview before a bipolar diagnosis is made

    The MDQ is a brief self-report screening tool; a positive screen (symptom items plus co-occurrence plus functional impairment) raises suspicion but generates false positives, particularly in borderline personality disorder and substance use, so a structured diagnostic interview remains the reference standard. It is self-rated, not clinician-rated, and is not a severity monitoring scale (the Young Mania Rating Scale serves that role). Sensitivity is notably lower for bipolar II, so a negative MDQ does not exclude it.

    Reference: Hirschfeld RM et al., Development and validation of the Mood Disorder Questionnaire, American Journal of Psychiatry, 2000; CANMAT/ISBD Guidelines, 2018

11. Question 11 · Schizophrenia Spectrum & Other Psychotic Disorders

    An inpatient started on clozapine 18 days ago (current dose 250 mg daily) develops fever 38.6°C, resting tachycardia of 128/min, pleuritic chest discomfort and mild breathlessness. Neutrophil count is normal. Troponin and C-reactive protein are markedly raised and the ECG shows non-specific ST changes. Which is the most appropriate immediate action?

    1. AStop clozapine immediately, arrange urgent echocardiography and cardiology review for suspected clozapine-induced myocarditis
    2. BContinue clozapine and prescribe paracetamol, as benign fever is common in the first three weeks
    3. CHalve the clozapine dose and repeat troponin in one week
    4. DStop clozapine and start dantrolene for neuroleptic malignant syndrome
    Show answer and explanation

    Correct answer: A. Stop clozapine immediately, arrange urgent echocardiography and cardiology review for suspected clozapine-induced myocarditis

    Clozapine-induced myocarditis characteristically occurs in the first 4-8 weeks (peak around weeks 2-3) and presents with fever, tachycardia, chest pain or dyspnoea with rising troponin, CRP and eosinophils; clozapine must be stopped at once and cardiac assessment including echocardiography arranged, as continuation can be fatal. Benign transient fever and tachycardia do occur early in titration, but raised troponin excludes that reassurance. Dose reduction is unsafe once myocarditis is suspected, and neuroleptic malignant syndrome would feature rigidity and markedly raised creatine kinase rather than a troponin rise with pleuritic pain.

    Reference: Ronaldson et al., Australian & New Zealand Journal of Psychiatry (2011), monitoring for clozapine-induced myocarditis; The Maudsley Prescribing Guidelines in Psychiatry, 14th edition (2021)

12. Question 12 · Personality, Impulse-Control, Feeding & Eating, Sleep-Wake, Sexual & Reproductive Psychiatry

    A 30-year-old woman starting antidepressant treatment says that sexual side effects would be unacceptable to her. Which antidepressant carries the LOWEST reported rate of treatment-emergent sexual dysfunction?

    1. ABupropion
    2. BCitalopram
    3. CVenlafaxine
    4. DClomipramine
    Show answer and explanation

    Correct answer: A. Bupropion

    Bupropion, a noradrenaline-dopamine reuptake inhibitor with no direct serotonergic action, has consistently the lowest rate of treatment-emergent sexual dysfunction and is also used as an augmenting agent to reverse SSRI-induced dysfunction. Citalopram and venlafaxine both increase serotonergic tone and commonly cause reduced libido and delayed orgasm. Clomipramine is the most serotonergic tricyclic and is particularly associated with anorgasmia and ejaculatory delay.

    Reference: Maudsley Prescribing Guidelines in Psychiatry, 14th ed. (2021); Serretti A & Chiesa A, Journal of Clinical Psychopharmacology (2009)

Psychiatry reference books and guidelines

Every question in this bank names the textbook or guideline its answer rests on. These are the sources our Psychiatry questions cite most often - the reading list to revise from alongside the bank.

Where your regulator publishes a reading list, use the editions it names. Exam questions are not taken from any one book.