Q.1 Which of the following is considered a psychiatric emergency?
Mild anxiety
Major depressive episode without suicidal ideation
Acute psychosis with risk of harm to self or others
Adjustment disorder with mild symptoms
Explanation - Psychiatric emergencies are situations where the patient poses an immediate risk to self or others, such as acute psychosis with dangerous behavior.
Correct answer is: Acute psychosis with risk of harm to self or others
Q.2 A patient presents with sudden confusion, agitation, and hallucinations after stopping alcohol. What is the most likely diagnosis?
Schizophrenia
Alcohol withdrawal delirium (Delirium Tremens)
Bipolar disorder
Major depressive disorder
Explanation - Delirium Tremens is a life-threatening alcohol withdrawal syndrome characterized by confusion, agitation, hallucinations, and autonomic instability.
Correct answer is: Alcohol withdrawal delirium (Delirium Tremens)
Q.3 Which medication is considered first-line for rapid sedation in an acutely agitated psychotic patient in the emergency setting?
Fluoxetine
Haloperidol
Lithium
Sertraline
Explanation - Haloperidol, a typical antipsychotic, is commonly used for rapid sedation in agitated psychotic patients in emergency settings.
Correct answer is: Haloperidol
Q.4 A patient expresses active suicidal thoughts with a detailed plan and access to means. What is the immediate next step?
Schedule outpatient follow-up
Hospital admission for safety
Prescribe antidepressants and discharge
Reassure and educate family
Explanation - Active suicidal ideation with a plan and access to means constitutes an emergency requiring inpatient care to ensure patient safety.
Correct answer is: Hospital admission for safety
Q.5 Which of the following is a common sign of neuroleptic malignant syndrome (NMS)?
Bradycardia, hypotension, hypothermia
Hyperthermia, muscle rigidity, autonomic instability
Seizures and hallucinations
Weight gain and sedation
Explanation - NMS is a life-threatening reaction to antipsychotics, presenting with hyperthermia, severe muscle rigidity, autonomic dysfunction, and altered mental status.
Correct answer is: Hyperthermia, muscle rigidity, autonomic instability
Q.6 A patient arrives with sudden onset of panic attacks and fear of dying. He is oriented and coherent. What is the most appropriate initial management?
Immediate hospitalization
Reassurance and short-acting benzodiazepines
Antipsychotic therapy
Electroconvulsive therapy
Explanation - Acute panic attacks in an otherwise stable patient can be managed with reassurance, safety, and short-acting benzodiazepines if needed.
Correct answer is: Reassurance and short-acting benzodiazepines
Q.7 Which of the following presentations requires urgent evaluation in a psychiatric emergency?
Insomnia and low mood for 2 weeks
Auditory hallucinations commanding self-harm
Mild social withdrawal
Occasional anxiety before exams
Explanation - Command hallucinations that instruct self-harm are psychiatric emergencies and require immediate intervention.
Correct answer is: Auditory hallucinations commanding self-harm
Q.8 A patient presents with agitation, tachycardia, hypertension, and dilated pupils after taking an unknown substance. Which is most likely?
Alcohol intoxication
Opioid overdose
Stimulant toxicity (e.g., cocaine, amphetamines)
Sedative-hypnotic overdose
Explanation - Stimulant intoxication often presents with agitation, autonomic hyperactivity, and dilated pupils.
Correct answer is: Stimulant toxicity (e.g., cocaine, amphetamines)
Q.9 Which of the following is a hallmark of catatonia requiring urgent intervention?
Persistent low mood
Motor immobility or stupor
Auditory hallucinations
Short attention span
Explanation - Catatonia is characterized by motor abnormalities such as immobility, mutism, posturing, and can be life-threatening if untreated.
Correct answer is: Motor immobility or stupor
Q.10 A 35-year-old patient presents with sudden confusion, visual hallucinations, and fever. Lab work shows elevated liver enzymes. Which is most likely?
Alcohol withdrawal delirium
Postictal confusion
Wernicke encephalopathy
Schizophrenic psychosis
Explanation - Wernicke encephalopathy, due to thiamine deficiency (often in alcoholics), can present with confusion, visual disturbances, and autonomic signs.
Correct answer is: Wernicke encephalopathy
Q.11 Which psychiatric emergency can be precipitated by abrupt cessation of benzodiazepines?
Severe anxiety and seizures
Depressive episode
Acute mania
Obsessive-compulsive behavior
Explanation - Sudden withdrawal from benzodiazepines can lead to life-threatening seizures and severe anxiety.
Correct answer is: Severe anxiety and seizures
Q.12 A patient presents with sudden aggression, shouting, and destruction of property. What is the first-line management?
Physical restraint and rapid tranquilization
Long-term psychotherapy
SSRIs
Electroconvulsive therapy
Explanation - Acute violent behavior is a psychiatric emergency; immediate safety measures and rapid tranquilization are necessary.
Correct answer is: Physical restraint and rapid tranquilization
Q.13 Which of the following is true about serotonin syndrome?
Characterized by bradycardia and hypothermia
Occurs due to excess serotonin from medications
Primarily treated with antipsychotics
Has a slow onset over weeks
Explanation - Serotonin syndrome results from excess serotonergic activity, often due to drug interactions, presenting with autonomic instability, hyperreflexia, and agitation.
Correct answer is: Occurs due to excess serotonin from medications
Q.14 Which emergency condition is characterized by extreme fear, sweating, palpitations, and a feeling of impending doom?
Panic attack
Major depressive episode
Schizophreniform disorder
Dysthymia
Explanation - Panic attacks are sudden episodes of intense fear accompanied by physical symptoms and require reassurance and symptomatic treatment.
Correct answer is: Panic attack
Q.15 Which of the following psychiatric emergencies is most commonly associated with hypothyroidism?
Myxedema coma
Acute mania
Alcohol withdrawal delirium
Acute schizophrenia
Explanation - Myxedema coma is a life-threatening emergency in severe hypothyroidism, presenting with altered mental status, hypothermia, and cardiovascular instability.
Correct answer is: Myxedema coma
Q.16 Which is a key feature distinguishing delirium from dementia in the emergency setting?
Delirium has acute onset and fluctuating course
Dementia has hallucinations
Delirium develops over years
Dementia fluctuates daily
Explanation - Delirium presents acutely with fluctuating consciousness, while dementia is chronic and progressive.
Correct answer is: Delirium has acute onset and fluctuating course
Q.17 A patient presents with sudden onset of intense fear of dying, palpitations, and hyperventilation in the ER. Which test is most useful to rule out organic causes?
EEG
ECG and cardiac enzymes
Thyroid function tests only
MRI brain
Explanation - Acute panic symptoms can mimic cardiac events; ruling out myocardial ischemia with ECG and cardiac enzymes is essential.
Correct answer is: ECG and cardiac enzymes
Q.18 Which of the following is a priority in managing a patient with acute suicidal intent in the emergency department?
Psychotherapy sessions
Ensuring immediate safety and observation
Prescribing long-term antidepressants
Family counseling only
Explanation - Immediate safety, including continuous observation or hospitalization, is critical in suicidal patients to prevent self-harm.
Correct answer is: Ensuring immediate safety and observation
Q.19 Which of the following is an emergency associated with rapid mood swings, irritability, and potential harm to self or others?
Acute mania
Dysthymia
Mild depression
Adjustment disorder
Explanation - Acute mania, especially in bipolar disorder, can lead to risky behaviors requiring emergency intervention.
Correct answer is: Acute mania
Q.20 A patient presents with disorientation, tremors, tachycardia, and sweating after stopping alcohol suddenly. Which lab abnormality is commonly seen?
Hyponatremia
Hypokalemia
Elevated liver enzymes
Hyperglycemia
Explanation - Alcohol withdrawal can be associated with elevated liver enzymes due to hepatic stress or underlying liver disease.
Correct answer is: Elevated liver enzymes
Q.21 Which of the following is a key feature of akathisia that may present as a psychiatric emergency?
Severe motor restlessness causing agitation
Hallucinations
Severe depression
Cognitive decline
Explanation - Akathisia, often drug-induced, can cause extreme restlessness and agitation requiring rapid intervention.
Correct answer is: Severe motor restlessness causing agitation
Q.22 Which of the following is a red flag in adolescent psychiatric emergencies?
Mild social anxiety
Self-harm with intent to die
Occasional irritability
Temporary school refusal
Explanation - Self-harm with suicidal intent in adolescents is an emergency requiring immediate attention.
Correct answer is: Self-harm with intent to die
Q.23 Which of the following drugs can precipitate acute psychosis in a psychiatric emergency?
Cocaine
Paracetamol
Amoxicillin
Metformin
Explanation - Cocaine and other stimulants can induce acute psychosis, agitation, and autonomic instability.
Correct answer is: Cocaine
Q.24 A patient presents with confusion, agitation, and fever. He is on multiple psychiatric medications. Which emergency should be considered first?
Neuroleptic malignant syndrome
Panic attack
Depressive episode
Adjustment disorder
Explanation - NMS is a life-threatening emergency seen in patients on antipsychotics, presenting with fever, rigidity, and altered mental status.
Correct answer is: Neuroleptic malignant syndrome