Prometric Exam Questions for Psychiatry Specialists 2026: 15 Practice MCQs with Answers and Rationale for the PSY5961 Paper

The psychiatry specialist paper (PSY5961) tests registrar-level diagnosis and management: choosing and monitoring psychotropic drugs, managing the acutely disturbed or suicidal patient, recognising organic causes, and the child, old-age and substance-use presentations that general psychiatrists see every week. It is usually 100 to 150 single-best-answer questions in 2.5 to 3 hours, with a pass mark of about 60 to 65%.

The fifteen questions below follow that blueprint. Allow about 70 seconds each and read every rationale. Psychopharmacology monitoring and emergencies carry the most marks.

For titles and the route, read the psychiatrist guide. For timed papers use the Psychiatry specialist bank, about 2,600 questions.

Mood disorders

Question 1

A 35-year-old with a first episode of moderate depression and no comorbidity is started on sertraline. The appropriate monitoring and duration advice is:

1. Review within one to two weeks (sooner if under 30 or at suicide risk), expect response by four to six weeks, and continue for at least six months after remission
2. Review in three months; stop as soon as mood improves
3. Stop after two weeks if no response
4. Continue for two weeks only

Answer: A. Early review monitors suicidality and side effects; treatment continues at least six months after remission for a first episode, longer for recurrent illness, with gradual withdrawal.

Question 2

A patient on lithium has coarse tremor, vomiting, ataxia and confusion. Lithium level is 2.4 mmol/L. The management is:

1. Reduce the lithium dose and review in a week
2. Stop lithium, intravenous fluids, monitor renal function and electrolytes, and arrange haemodialysis for severe toxicity or renal impairment
3. Give an antiemetic and continue
4. Add a thiazide diuretic

Answer: B. Lithium toxicity with neurological signs is a medical emergency. Thiazides, NSAIDs and ACE inhibitors raise lithium levels and are common precipitants. Dialysis is indicated for severe symptoms or levels above about 2.5 with renal impairment.

Question 3

A 28-year-old woman with bipolar disorder, well on valproate, tells you she plans to conceive. The appropriate action is:

1. Continue valproate; it is safe in pregnancy
2. Switch away from valproate before conception because of its high risk of neural tube defects and neurodevelopmental harm, with specialist perinatal advice on alternatives
3. Stop all medication abruptly
4. Double the folic acid and continue valproate

Answer: B. Valproate is contraindicated in women of childbearing potential unless a pregnancy prevention programme is in place; it must be withdrawn in a planned way before conception. Folate does not remove the risk.

Psychotic disorders and psychopharmacology

Question 4

A 22-year-old with a first episode of schizophrenia has failed adequate trials of two different antipsychotics. The next step is:

1. A third similar antipsychotic
2. Clozapine, with baseline and ongoing full blood count monitoring
3. Electroconvulsive therapy as first line
4. Stop all antipsychotics

Answer: B. Treatment-resistant schizophrenia is defined by inadequate response to two antipsychotics at adequate dose and duration; clozapine is the evidence-based treatment, with mandatory neutrophil monitoring for agranulocytosis.

Question 5

A patient recently started on haloperidol develops fever of 39.5 °C, muscle rigidity, fluctuating consciousness, autonomic instability and a creatine kinase of 8,000 U/L. The diagnosis and immediate management are:

1. Serotonin syndrome; give cyproheptadine
2. Neuroleptic malignant syndrome; stop the antipsychotic, supportive care with cooling and fluids, and consider dantrolene or bromocriptine in severe cases
3. Infection; antibiotics only
4. Catatonia; increase the antipsychotic

Answer: B. NMS is a life-threatening reaction to dopamine antagonists. Rigidity, hyperthermia, raised CK and autonomic instability distinguish it from serotonin syndrome, which features clonus, hyperreflexia and a serotonergic drug history.

Question 6

Which baseline and routine monitoring is required for a patient started on a second-generation antipsychotic such as olanzapine?

1. No monitoring is needed
2. Weight, waist, blood pressure, fasting glucose or HbA1c, lipids and, where indicated, ECG and prolactin, at baseline and at intervals
3. Thyroid function only
4. Liver biopsy

Answer: B. Metabolic syndrome is the main long-term harm of second-generation antipsychotics. Cardiometabolic monitoring is a standard of care that the exam tests directly.

Anxiety, trauma and substance use

Question 7

A 30-year-old has recurrent unexpected panic attacks with persistent worry about further attacks and avoidance of public transport. First-line treatment is:

1. Long-term daily benzodiazepines
2. Cognitive behavioural therapy and, if medication is used, an SSRI
3. Antipsychotics
4. Beta blockers alone

Answer: B. CBT and SSRIs are first line for panic disorder; benzodiazepines are avoided for maintenance because of dependence and lack of long-term benefit.

Question 8

A patient who drinks heavily presents 36 hours after their last drink with tremor, sweating, agitation, visual hallucinations and a seizure. The treatment is:

1. Haloperidol alone
2. A benzodiazepine regimen (for example chlordiazepoxide or diazepam, symptom-triggered or fixed schedule), parenteral thiamine, and monitoring for delirium tremens
3. Disulfiram today
4. No medication; observe

Answer: B. Alcohol withdrawal with seizures or hallucinations needs benzodiazepines and high-dose thiamine before glucose to prevent Wernicke's encephalopathy. Antipsychotics lower the seizure threshold and are adjuncts only.

Question 9

A patient with opioid use disorder wants to stop. The most effective long-term treatment is:

1. Rapid detoxification with no follow-up
2. Opioid agonist maintenance with methadone or buprenorphine, with psychosocial support, where legally available
3. Naloxone daily
4. Antidepressants

Answer: B. Agonist maintenance reduces mortality, illicit use and transmission of blood-borne viruses. Availability and regulation vary across Gulf countries; the exam asks for the evidence-based answer and expects awareness of the local framework.

Child and old-age psychiatry

Question 10

A 7-year-old has had persistent inattention, hyperactivity and impulsivity across home and school since age 5, impairing function. After behavioural measures and parent training, the first-line medication is:

1. Methylphenidate
2. Diazepam
3. Risperidone
4. Fluoxetine

Answer: A. Stimulants such as methylphenidate are first line for ADHD in school-age children, with monitoring of height, weight, blood pressure and pulse. Atomoxetine is an alternative where stimulants are unsuitable.

Question 11

An 80-year-old inpatient becomes acutely confused overnight with fluctuating attention, visual hallucinations and a reversed sleep pattern three days after hip surgery. The most likely diagnosis and the first step are:

1. Dementia; start donepezil
2. Delirium; identify and treat the cause (infection, pain, drugs, constipation, hypoxia), with environmental measures and low-dose antipsychotic only if severe distress or risk
3. Schizophrenia; start clozapine
4. Depression; start an SSRI

Answer: B. Acute onset and fluctuating attention define delirium. Management is cause-directed and non-pharmacological first; sedatives are used sparingly and benzodiazepines are avoided except in alcohol withdrawal.

Question 12

A 72-year-old has a 12-month history of gradual memory loss and word-finding difficulty with a normal neurological examination, no vascular events, and an MMSE of 21. The most likely diagnosis and first-line drug are:

1. Alzheimer's disease; an acetylcholinesterase inhibitor such as donepezil
2. Vascular dementia; aspirin
3. Lewy body dementia; haloperidol
4. Normal ageing; nothing

Answer: A. Insidious amnestic decline without focal signs is typical of Alzheimer's disease. Acetylcholinesterase inhibitors are first line for mild to moderate disease; antipsychotics are dangerous in Lewy body dementia.

Emergencies, risk and the law

Question 13

A patient attends after taking 30 paracetamol tablets with the stated intention of dying, now regrets it and asks to go home. Medically she needs N-acetylcysteine. The psychiatric action is:

1. Allow discharge against advice
2. Complete a structured risk assessment, treat the overdose, and if she refuses treatment or remains at high risk, use the mental health law to detain and treat while involving senior staff
3. Prescribe an antidepressant and discharge
4. Call the police to arrest her

Answer: B. A recent serious attempt with ongoing risk and refusal of life-saving treatment meets criteria for involuntary assessment under the mental health laws of the UAE, Saudi Arabia and the other Gulf states. Safety and treatment come first, with documentation and senior involvement.

Question 14

A patient on a serotonergic antidepressant is given tramadol and develops agitation, hyperreflexia, inducible clonus, diaphoresis and fever within hours. The management is:

1. Continue both drugs
2. Stop the serotonergic agents, supportive care, benzodiazepines for agitation, and cyproheptadine for moderate to severe cases
3. Give dantrolene
4. Increase the antidepressant

Answer: B. Serotonin syndrome is distinguished from NMS by rapid onset, clonus and hyperreflexia. Stopping the drugs and supportive care usually resolve it within 24 hours.

Question 15

Which feature most strongly increases the short-term risk of completed suicide after an attempt?

1. Female sex
2. A violent or planned method with precautions against discovery, ongoing hopelessness and a previous attempt
3. Age under 20 only
4. Living with family

Answer: B. Planning, lethal methods, avoidance of rescue, hopelessness, previous attempts, substance misuse and social isolation raise risk. Risk assessment guides observation level and the need for admission.

How to use these questions

• Know the monitoring schedules for lithium, clozapine, valproate and second-generation antipsychotics.
• Separate the emergencies: NMS versus serotonin syndrome, delirium versus dementia, withdrawal versus intoxication.
• Learn the mental health law basics of the country you are sitting under; the exam asks about detention and consent.
• Practise under time in the Psychiatry bank with the error-log method.

Clinical psychologists sit a separate paper (clinical psychologist guide). Other specialty banks are listed in specialty question banks for doctors. When you hold eligibility, join the doctor talent pool; psychiatrists are in short supply across the Gulf.

Frequently asked questions

How many questions are in the psychiatry Prometric exam?

Usually 100 to 150 in 2.5 to 3 hours. Your eligibility notice states the exact format.

What is the pass mark?

About 60 to 65% for the specialist paper, scaled at some authorities, and higher for consultant titles.

Does the paper cover child and old-age psychiatry?

Yes, at the level of recognition, first-line treatment and safe prescribing.

Can an MRCPsych or FCPS holder skip the exam?

Often, depending on the authority's recognition list; see the exemptions guide.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.