Consultation-Liaison Psychiatry MCQs
(Questions 41–60)
1. 41. A 55-year-old woman presents with acute visual hallucinations, disorientation, and
fluctuating consciousness after undergoing hip surgery. Her medications include
oxycodone and diphenhydramine. What is the most likely diagnosis?
A. Major depressive disorder with psychotic features
B. Delirium
C. Schizophrenia
D. Dementia with Lewy bodies
2. 42. A 65-year-old man with a history of alcohol use disorder presents with confusion,
ataxia, and nystagmus. Which vitamin deficiency is likely contributing to his condition?
A. Vitamin C
B. Vitamin B6
C. Thiamine (Vitamin B1)
D. Folic acid
3. 43. A terminally ill cancer patient reports intense sadness, guilt, and hopelessness. He
denies suicidal ideation. Which of the following is the best initial management
approach?
A. Start SSRI immediately
B. Begin grief counseling
C. Hospitalize for safety
D. Electroconvulsive therapy
4. 44. A 47-year-old woman with lupus presents with acute confusion, paranoia, and
agitation. Labs show elevated ESR and positive ANA. What is the most likely psychiatric
diagnosis?
A. Primary psychotic disorder
B. Factitious disorder
C. Delirium secondary to autoimmune encephalopathy
D. Bipolar I disorder
5. 45. A 30-year-old postpartum woman experiences severe anxiety and intrusive
thoughts of harming her baby. She is distressed by the thoughts and seeks help. What is
the diagnosis?
A. Postpartum psychosis
B. Obsessive-compulsive disorder
C. Major depressive disorder
D. Adjustment disorder
6. 46. A 70-year-old man with a recent stroke develops apathy, reduced initiative, and
executive dysfunction. What is the most likely explanation?
A. Post-stroke depression
B. Delirium
C. Parkinson’s disease dementia
D. Catatonia
7. 47. A 60-year-old male with COPD and chronic steroid use presents with agitation,
visual hallucinations, and persecutory delusions. What is the most appropriate
diagnosis?
A. Schizoaffective disorder
B. Substance-induced psychotic disorder
C. Delirium tremens
D. Brief psychotic disorder
8. 48. A 45-year-old man with terminal pancreatic cancer becomes withdrawn, refuses
food, and expresses a wish to die. What is the most appropriate next step?
A. Refer to palliative care team
B. Involuntarily hospitalize the patient
C. Administer ECT
D. Start antipsychotic medication
9. 49. A 22-year-old woman presents with sudden-onset mutism and unresponsiveness
after hearing of her brother’s death. Vital signs are normal and she resists all
interaction. What is the likely diagnosis?
A. Conversion disorder
B. Catatonia
C. Psychotic depression
D. Somatic symptom disorder
10. 50. A hospitalized patient becomes acutely confused, agitated, and has tremors 2 days
after discontinuing alcohol. What is the recommended pharmacological treatment?
A. Haloperidol
B. Thiamine
C. Lorazepam
D. Quetiapine
11. 51. A 42-year-old woman with known bipolar disorder is found to have increased
agitation, pressured speech, and hallucinations. Labs reveal lithium level of 2.1 mEq/L.
What is the next best step?
A. Increase lithium dose
B. Discontinue lithium and hydrate
C. Start antipsychotic
D. Check TSH levels
12. 52. A 65-year-old male presents with new-onset depression and cognitive decline. CT
brain shows multiple small infarcts. What is the most probable diagnosis?
A. Alzheimer’s disease
B. Vascular dementia
C. Frontotemporal dementia
D. Delirium
13. 53. A patient on high-dose corticosteroids develops mania and insomnia. What is the
best next step in management?
A. Taper corticosteroids
B. Start antidepressant
C. Admit for observation
D. Begin cognitive-behavioral therapy
14. 54. A 75-year-old woman exhibits fluctuating alertness, visual hallucinations, and
Parkinsonian signs. Which type of dementia is most likely?
A. Vascular dementia
B. Frontotemporal dementia
C. Alzheimer’s disease
D. Lewy body dementia
15. 55. A patient with major neurocognitive disorder is repeatedly hitting nurses during
bathing. What is the most appropriate non-pharmacologic strategy?
A. Apply restraints
B. Schedule antipsychotic medication
C. Use calm, structured environment with familiar caregivers
D. Ignore the behavior
16. 56. A patient is refusing treatment for pneumonia despite being delirious. What legal
concept should be assessed before proceeding?
A. Insight
B. Cognitive status
C. Decision-making capacity
D. Level of consciousness
17. 57. A young woman presents with multiple unexplained physical complaints and
demands repeated testing. What is the most likely diagnosis?
A. Illness anxiety disorder
B. Conversion disorder
C. Somatic symptom disorder
D. Factitious disorder
18. 58. A patient recently started on sertraline presents with restlessness, tremors,
confusion, and fever. What is the most likely diagnosis?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Panic attack
D. Delirium tremens
19. 59. A 39-year-old male presents with bizarre behavior and self-inflicted injuries. Urine
tox screen is positive for PCP. What psychiatric condition is most likely to develop
during intoxication?
A. Catatonia
B. Acute psychosis
C. Mania
D. Somatic symptom disorder
20. 60. A patient with schizophrenia on risperidone presents with muscle rigidity, fever,
and elevated CK. What is the most likely diagnosis?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Tardive dyskinesia
D. Acute dystonia
