A 72-year-old man with Parkinson disease has had well-formed visual hallucinations for 2 weeks with intact insight. Medications: carbidopa/levodopa 25/100 mg four times daily, amantadine 100 mg twice daily, and trihexyphenidyl 2 mg twice daily (added 1 month ago for tremor). Infection and metabolic causes have been excluded. Which action is most appropriate first?

Add risperidone 0.5 mg at bedtime

Add quetiapine 12.5 mg at bedtime

A 59-year-old woman with COPD (GOLD group B) and major depression stable on sertraline 100 mg daily smokes 1 pack per day and wants to quit. She has read that a smoking-cessation drug causes suicidal thoughts and is worried. She has no seizure history. Which recommendation is most appropriate?

Varenicline, after reviewing the EAGLES safety findings with her

Nicotine patch alone, since varenicline is unsafe with depression

Bupropion SR, because it is more effective than varenicline

Counseling alone until her depression is in remission for a year

A 47-year-old woman with treatment-resistant depression (no response to sertraline and to bupropion augmentation at adequate doses) will start esketamine nasal spray twice weekly together with an oral antidepressant. BP is 124/78 mm Hg. Which implementation plan is correct?

Use it in a certified clinic with 2 hours of monitoring

Observe for 30 minutes, after which she may drive home

Stop the oral antidepressant when esketamine is started

Dispense the spray for twice-weekly use at home after training

A 78-year-old woman started sertraline 50 mg daily 3 weeks ago for major depression. Her daughter reports new confusion and unsteadiness. She is euvolemic; serum sodium is 124 mEq/L (baseline 138), urine osmolality is 480 mOsm/kg, and she has no seizures. She also takes amlodipine. Which action is most appropriate?

Stop sertraline, restrict fluids, and monitor sodium

Switch sertraline to escitalopram and recheck in 1 month

Continue sertraline and add sodium chloride tablets

Increase sertraline; confusion reflects her depression

A 68-year-old man with schizophrenia has been stable on risperidone 6 mg daily. Over 2 months he has developed symmetric bradykinesia, rigidity, and a shuffling gait without tremor at rest. He has no other new medications, and his psychiatrist agrees the risperidone exposure is the likely cause. Which change is most appropriate?

Switch risperidone to quetiapine with cross-titration

Add benztropine 1 mg twice daily long term

Add carbidopa/levodopa 25/100 mg three times daily

Order a dopamine transporter scan before changing therapy

An 81-year-old woman with Alzheimer disease is switched from oral rivastigmine to the rivastigmine 9.5 mg/24 hr transdermal patch, which her son will apply each morning. She also takes amlodipine and sertraline tablets. Which instruction is most important for the son?

Remove yesterday’s patch before applying a new one

Give the oral capsules with the patch for the first week

Cut the patch in half if she develops nausea

Apply each new patch to the same skin site daily

A 34-year-old woman with relapsing multiple sclerosis has been relapse-free on natalizumab every 4 weeks for 26 months under the TOUCH program; her MRI is stable. She has never received other immunosuppressants. Her JCV antibody index, previously negative, is now 1.8. Which action is most appropriate?

High PML risk; discuss switching her therapy

Continue unchanged; JCV antibodies are harmless

Add mitoxantrone to lower her relapse risk

Recheck the JCV antibody index in 5 years

A 66-year-old man had a minor non-cardioembolic ischemic stroke (NIHSS 2) and was started on aspirin 81 mg plus clopidogrel 75 mg daily within 24 hours, along with high-intensity atorvastatin. At his day-21 follow-up he has no new symptoms; ECG monitoring showed no atrial fibrillation. Which antithrombotic plan is most appropriate now?

Stop aspirin and continue clopidogrel alone

Continue aspirin plus clopidogrel for 12 months

Stop both and start apixaban 5 mg twice daily

Stop clopidogrel and add cilostazol to aspirin

A 34-year-old woman has a first unprovoked generalized tonic-clonic seizure. Her neurologic exam is normal, MRI shows a left temporal cortical lesion from a remote injury, and EEG shows epileptiform discharges. She drives to work daily and says avoiding another seizure is her priority. Which plan is most appropriate?

Start an antiseizure medication now; discuss driving

Defer therapy until a second unprovoked seizure occurs

Start therapy only if a seizure recurs within 1 year

Defer therapy and repeat the EEG in 6 months

A 45-year-old woman with major depressive disorder had no response to sertraline 200 mg daily for 10 weeks. She now has a partial response to escitalopram 20 mg daily after 8 weeks (PHQ-9 from 18 to 13), and refill records confirm adherence. She has no history of mania, and her ECG is normal. Which next step is most appropriate?

Add aripiprazole 2–5 mg daily to escitalopram

Stop escitalopram and start fluoxetine 20 mg daily

Increase escitalopram to 40 mg daily

Order CYP2C19 and CYP2D6 genotyping before any change

An 82-year-old woman with Alzheimer disease has taken donepezil 10 mg daily for 3 years. Her MMSE has fallen from 18 to 9 over 18 months and she now needs help with dressing and bathing. Over the past 2 months she has had anorexia with a 3-kg weight loss, and her resting HR is 54 beats/minute. She has no agitation or psychosis. Which change is most appropriate?

Add memantine, titrated to 10 mg BID

Switch donepezil to a rivastigmine patch

Increase donepezil to 23 mg once daily

Add risperidone 0.25 mg at bedtime

A 38-year-old woman with major depressive disorder in a collaborative care program started sertraline 50 mg daily 6 weeks ago. Her PHQ-9 was 18 at baseline and is 13 today. She takes every dose and has only mild nausea. Which interpretation and plan are most appropriate?

Inadequate response; raise sertraline to 100 mg

Response achieved; continue sertraline 50 mg daily

Remission achieved; plan a taper in 6 months

No response; switch to venlafaxine now

BCPS Neurology and Psychiatry Review Cases

1Illness or drug: the question under the question

Case stems in this domain carry long medication lists, so read them as evidence. Picture a patient with a movement disorder, a mood disorder and a sleep complaint, each managed by a different prescriber: the list is long enough that at least one drug could explain the new complaint, and the best option often starts from that drug.

The cheap-prep habit is to memorize drug-of-choice tables by diagnosis. Those tables answer the first question about a patient, and the cases on this page start after it. Each gives you the diagnosis, a treatment already in place, and something new: a lab value, a movement problem, a missed response, a monitoring result. Your job is to decide whether to stay the course, adjust, switch or stop, and the table is silent on that.

Timing does most of the work. Put each drug start, dose change and switch on a mental timeline next to the onset of the problem. A symptom that began within weeks of a change has a prime suspect.

2Four verbs, and what each needs from the case

Stay the course: The trial has not yet had a fair chance, or the target is already met. Changing now throws away progress.
Adjust: The drug is right and the exposure is not: dose, timing, formulation or an interaction is the problem.
Switch: The drug itself is the problem, because an adequate trial failed or because the adverse effect comes from how it works.
Stop: The harm outweighs the benefit, or the drug no longer has an indication.

3Stay, adjust, switch or stop

Run each case through the four verbs: stay, adjust, switch or stop. Then read the note on every option, including the ones you ruled out early.

Study cases written by our editors, not BPS items. The real BCPS exam is computer-based multiple choice, answered in order with no going back.

Case 1 of 16 · 0 answered

How case rounds work

Pick an option to see the verdict and a note on every option. Keys while the round has focus: 1–5 or A–E answer, ← → move between cases. Nothing is saved or sent anywhere.

Case 01
A 72-year-old man with Parkinson disease has had well-formed visual hallucinations for 2 weeks with intact insight. Medications: carbidopa/levodopa 25/100 mg four times daily, amantadine 100 mg twice daily, and trihexyphenidyl 2 mg twice daily (added 1 month ago for tremor). Infection and metabolic causes have been excluded. Which action is most appropriate first?
Pick an option: the verdict and a note on every option open here.
Best answer: D.
Drug-induced psychosis in Parkinson disease is managed by withdrawing the least essential, most deliriogenic drugs first: anticholinergics, then amantadine, MAO-B inhibitors, dopamine agonists and COMT inhibitors, with levodopa reduced last. The recently added anticholinergic trihexyphenidyl is the most likely culprit and should go first. Adding quetiapine is reasonable only if hallucinations persist after that step, risperidone worsens parkinsonism, and halving levodopa sacrifices motor control first.
A
Risperidone worsens parkinsonism and is a poor choice in Parkinson disease.
B
Quetiapine is reasonable only if hallucinations persist after the offending drugs are removed.
C
Levodopa is reduced last, because halving it sacrifices motor control before likelier culprits are removed.
D
Correct: the recently added anticholinergic is the most likely culprit and the least essential drug, so it goes first.
Case 02
A 59-year-old woman with COPD (GOLD group B) and major depression stable on sertraline 100 mg daily smokes 1 pack per day and wants to quit. She has read that a smoking-cessation drug causes suicidal thoughts and is worried. She has no seizure history. Which recommendation is most appropriate?
Pick an option: the verdict and a note on every option open here.
Best answer: A.
The EAGLES trial found no significant increase in neuropsychiatric events with varenicline in smokers with psychiatric illness, the FDA removed the boxed warning in 2016, and varenicline is the most effective single agent—so discussing that evidence addresses her concern and supports her goal. Nicotine patch alone is less effective and the premise that varenicline is unsafe with depression is outdated. Bupropion is a reasonable alternative but is less effective than varenicline, and delaying pharmacotherapy prolongs smoking-related COPD progression.
A
Correct: EAGLES found no significant rise in neuropsychiatric events, and varenicline is the most effective single agent.
B
A patch alone is less effective, and the idea that varenicline is unsafe with depression is outdated.
C
Bupropion is a reasonable alternative but is less effective than varenicline, not more.
D
Delaying treatment for a year prolongs smoking and COPD progression with no safety gain.
Case 03
A 47-year-old woman with treatment-resistant depression (no response to sertraline and to bupropion augmentation at adequate doses) will start esketamine nasal spray twice weekly together with an oral antidepressant. BP is 124/78 mm Hg. Which implementation plan is correct?
Pick an option: the verdict and a note on every option open here.
Best answer: B.
Under the esketamine REMS, every dose is self-administered in a certified healthcare setting with monitoring (including BP) for at least 2 hours for sedation and dissociation, and the patient must not drive until the next day after a restful sleep. Home dispensing is not permitted. A 30-minute observation and same-day driving violate the REMS requirements, and esketamine is approved for use with an oral antidepressant, not in place of one.
A
Same-day driving and a 30-minute observation both violate the esketamine REMS.
B
Correct: each dose is given in a certified healthcare setting with at least 2 hours of monitoring.
C
Esketamine is used together with an oral antidepressant, not in place of one.
D
Home dispensing is not permitted under the REMS.
Case 04
A 78-year-old woman started sertraline 50 mg daily 3 weeks ago for major depression. Her daughter reports new confusion and unsteadiness. She is euvolemic; serum sodium is 124 mEq/L (baseline 138), urine osmolality is 480 mOsm/kg, and she has no seizures. She also takes amlodipine. Which action is most appropriate?
Pick an option: the verdict and a note on every option open here.
Best answer: A.
SSRIs commonly cause SIADH in older adults, typically within the first weeks, and a symptomatic sodium of 124 mEq/L with concentrated urine fits that diagnosis; the drug should be stopped, fluids restricted, and sodium corrected slowly with close monitoring (mirtazapine is a lower-risk alternative later). Raising the dose worsens the hyponatremia. Escitalopram carries the same SIADH risk, and adding salt tablets while continuing the cause leaves her at risk.
A
Correct: symptomatic hyponatremia with concentrated urine fits SSRI-induced SIADH, so stop the drug and restrict fluids.
B
Escitalopram carries the same SIADH risk, and waiting a month with sodium at 124 mEq/L is unsafe.
C
Salt tablets while continuing the cause leave her exposed to further sodium decline.
D
Raising the dose worsens the hyponatremia that is causing her confusion.
Case 05
A 24-year-old woman is hospitalized with a first episode of acute mania (bipolar I disorder). Pregnancy test is negative, she is sexually active and does not use reliable contraception, and she declines long-acting contraception. Renal function, thyroid tests and ECG are normal, and she has no substance use. Which mood stabilizer is most appropriate to start?
Pick an option: the verdict and a note on every option open here.
Best answer: B.
Lithium is a first-line antimanic agent and the best-supported long-term mood stabilizer, titrated to a level of 0.8–1.2 mEq/L for acute mania. Divalproex is also effective for mania but should be avoided in women of childbearing potential without reliable contraception because of neural tube defects and lower child IQ. Lamotrigine has no acute antimanic efficacy, and antidepressant monotherapy such as sertraline can worsen mania.
A
Sertraline is an antidepressant, not a mood stabilizer, and monotherapy can worsen mania.
B
Correct: lithium is first-line for acute mania and long-term prevention, and it avoids valproate’s high teratogenic risk.
C
Divalproex treats mania, but without reliable contraception its neural tube and child IQ risks rule it out.
D
Lamotrigine has no acute antimanic efficacy.
Case 06
A 68-year-old man with schizophrenia has been stable on risperidone 6 mg daily. Over 2 months he has developed symmetric bradykinesia, rigidity, and a shuffling gait without tremor at rest. He has no other new medications, and his psychiatrist agrees the risperidone exposure is the likely cause. Which change is most appropriate?
Pick an option: the verdict and a note on every option open here.
Best answer: B.
Symmetric parkinsonism that develops during D2-antagonist exposure is drug-induced, and the first step is to reduce or replace the offending drug with an antipsychotic of lower D2 affinity, such as quetiapine. Levodopa works poorly against D2 blockade and can worsen psychosis. Benztropine is a tempting EPS treatment but is a strong anticholinergic the Beers Criteria advise avoiding in older adults, and a DaT scan is reserved for unclear cases, not when the cause is evident.
A
Long-term benztropine is strongly anticholinergic and on the Beers list for older adults.
B
Correct: drug-induced parkinsonism improves when the D2 antagonist is replaced with a lower-affinity agent such as quetiapine.
C
Levodopa works poorly against ongoing D2 blockade and can worsen psychosis.
D
A DaT scan is reserved for unclear cases, and here the cause is already evident.
Case 07
An 81-year-old woman with Alzheimer disease is switched from oral rivastigmine to the rivastigmine 9.5 mg/24 hr transdermal patch, which her son will apply each morning. She also takes amlodipine and sertraline tablets. Which instruction is most important for the son?
Pick an option: the verdict and a note on every option open here.
Best answer: D.
The most dangerous rivastigmine patch error is applying a new patch without removing the old one, which has caused cholinergic toxicity (vomiting, bradycardia, syncope); the old patch must be removed and the application documented. Sites should be rotated, not reused within 14 days, to limit skin irritation. Patches must not be cut, and continuing the capsules alongside the patch doubles exposure.
A
Giving capsules with the patch doubles exposure and risks cholinergic toxicity.
B
Patches must not be cut, since cutting disrupts the controlled release.
C
Sites should rotate and not be reused within 14 days, to limit skin irritation.
D
Correct: forgetting to remove the old patch is the most dangerous error, causing vomiting, bradycardia and syncope.
Case 08
A 34-year-old man is admitted to the neuro-ICU after a motorcycle crash with a severe traumatic brain injury (GCS 6, acute subdural hematoma). He has no history of seizures and no seizure since the injury. CrCl is 110 mL/min. Which seizure prophylaxis plan is most appropriate?
Pick an option: the verdict and a note on every option open here.
Best answer: B.
For severe TBI, antiseizure prophylaxis for 7 days reduces early post-traumatic seizures, and levetiracetam is commonly used because it needs no level monitoring and has few interactions. Extending prophylaxis beyond the first week, with either levetiracetam or phenytoin, does not prevent late post-traumatic epilepsy and only adds adverse effects. Valproate showed a trend toward higher mortality in TBI prophylaxis trials and is not recommended.
A
Phenytoin beyond 7 days does not prevent late post-traumatic epilepsy and adds monitoring and adverse effects.
B
Correct: 7 days of prophylaxis reduces early post-traumatic seizures, and levetiracetam needs no level monitoring.
C
Six months of levetiracetam does not prevent late epilepsy and only adds adverse effects.
D
Valproate showed a trend toward higher mortality in TBI prophylaxis trials.
Case 09
A 34-year-old woman with relapsing multiple sclerosis has been relapse-free on natalizumab every 4 weeks for 26 months under the TOUCH program; her MRI is stable. She has never received other immunosuppressants. Her JCV antibody index, previously negative, is now 1.8. Which action is most appropriate?
Pick an option: the verdict and a note on every option open here.
Best answer: D.
PML risk with natalizumab rises with JCV antibody positivity, treatment beyond 24 months, and a high index (above 1.5), so she now has the highest-risk profile and needs a documented risk discussion—typically switching to another high-efficacy therapy or using extended-interval dosing with close MRI surveillance. Treating the result as harmless ignores the main safety signal the test exists to detect. Adding an immunosuppressant raises PML risk further, and the index is rechecked about every 6 months, not every 5 years.
A
A positive JCV antibody is the main PML risk marker on natalizumab, so calling it harmless ignores the safety signal.
B
Adding an immunosuppressant such as mitoxantrone raises PML risk further.
C
The index is rechecked about every 6 months, not every 5 years.
D
Correct: JCV positivity, an index above 1.5 and more than 24 months of natalizumab put her at the highest PML risk.
Case 10
A 35-year-old woman has 6 migraine days per month despite appropriate acute therapy. She has untreated stage 1 hypertension (BP 138/88 mm Hg on repeated readings), no asthma or depression, BMI 24 kg/m², and uses a combined oral contraceptive but may want pregnancy in the future. Which preventive medication is most appropriate?
Pick an option: the verdict and a note on every option open here.
Best answer: A.
Propranolol is a first-line migraine preventive that also lowers her blood pressure, so one drug treats both conditions. Topiramate is also first-line, but it is teratogenic (oral clefts) and at higher doses reduces oral contraceptive efficacy. Valproic acid carries major teratogenic and neurodevelopmental risks and should be avoided in women of childbearing potential, and amitriptyline does not lower BP and causes weight gain and sedation.
A
Correct: propranolol is a first-line migraine preventive that also lowers her blood pressure.
B
Valproic acid carries major teratogenic and neurodevelopmental risks for a woman who may want pregnancy.
C
Amitriptyline does not lower BP and brings weight gain and sedation.
D
Topiramate is first-line too, but it is teratogenic and can reduce oral contraceptive efficacy.
Case 11
A 66-year-old man had a minor non-cardioembolic ischemic stroke (NIHSS 2) and was started on aspirin 81 mg plus clopidogrel 75 mg daily within 24 hours, along with high-intensity atorvastatin. At his day-21 follow-up he has no new symptoms; ECG monitoring showed no atrial fibrillation. Which antithrombotic plan is most appropriate now?
Pick an option: the verdict and a note on every option open here.
Best answer: B.
In POINT and CHANCE, short-term DAPT reduced early recurrent stroke after minor stroke or high-risk TIA, and the AHA/ASA guideline limits it to 21 days (up to 90 days in some trials), after which single antiplatelet therapy continues. Extending DAPT to 12 months increases major bleeding without further stroke benefit. Anticoagulation is not indicated without AF or another cardioembolic source, and cilostazol combinations are not a standard follow-on.
A
Twelve months of DAPT increases major bleeding without further stroke benefit.
B
Correct: short-term DAPT ends at about 21 days, after which single antiplatelet therapy continues.
C
Anticoagulation is not indicated without AF or another cardioembolic source.
D
Cilostazol with aspirin is not a standard follow-on after short-term DAPT.
Case 12
A 34-year-old woman has a first unprovoked generalized tonic-clonic seizure. Her neurologic exam is normal, MRI shows a left temporal cortical lesion from a remote injury, and EEG shows epileptiform discharges. She drives to work daily and says avoiding another seizure is her priority. Which plan is most appropriate?
Pick an option: the verdict and a note on every option open here.
Best answer: D.
An epileptiform EEG and a structural lesion raise the recurrence risk after a first unprovoked seizure above 60%, which meets the ILAE definition of epilepsy, and immediate treatment lowers the 2-year recurrence risk by about a third—matching her stated priority. Waiting for a second seizure is reasonable only when recurrence risk is low. Repeating the EEG or setting a 1-year trigger delays protection without changing the risk she already carries.
A
Waiting for a second seizure is reasonable only when recurrence risk is low, which hers is not.
B
A 1-year recurrence trigger delays protection without changing the risk she already carries.
C
Repeating the EEG adds delay, and the current EEG already shows epileptiform discharges.
D
Correct: a structural lesion plus an epileptiform EEG puts recurrence risk above 60%, so treating now matches her priority.
Case 13
A 76-year-old man with Parkinson disease (carbidopa/levodopa 25/100 mg four times daily) is admitted with a UTI and develops hyperactive delirium. Despite treating the infection, reorientation, sleep hygiene and family presence, he repeatedly pulls at his IV and tries to climb out of bed. QTc is 440 ms. Which medication is most appropriate for short-term use?
Pick an option: the verdict and a note on every option open here.
Best answer: A.
When delirium endangers the patient despite non-drug measures, a low dose of quetiapine is preferred in Parkinson disease because its weak D2 blockade rarely worsens motor function. Pimavanserin is the tempting Parkinson-specific choice, but it is approved for chronic Parkinson disease psychosis and takes weeks to act, so it does not help acute delirium. Haloperidol can cause severe rigidity in Parkinson disease, and benzodiazepines such as lorazepam worsen delirium in older adults.
A
Correct: low-dose quetiapine has weak D2 blockade and rarely worsens motor function in Parkinson disease.
B
Pimavanserin is for chronic Parkinson psychosis and takes weeks to work, so it does not help acute delirium.
C
Lorazepam worsens delirium in older adults.
D
Haloperidol can cause severe rigidity in Parkinson disease.
Case 14
A 45-year-old woman with major depressive disorder had no response to sertraline 200 mg daily for 10 weeks. She now has a partial response to escitalopram 20 mg daily after 8 weeks (PHQ-9 from 18 to 13), and refill records confirm adherence. She has no history of mania, and her ECG is normal. Which next step is most appropriate?
Pick an option: the verdict and a note on every option open here.
Best answer: B.
After a partial response to an adequate, adherent trial, augmentation keeps the gains made so far, and aripiprazole is FDA-approved as adjunctive therapy for MDD. Routine pharmacogenomic testing is not recommended by guidelines and does not replace an evidence-based next step. Escitalopram above 20 mg/day exceeds the labeled maximum and raises QT risk, and switching to a third SSRI after partial response gives up the improvement she already has.
A
A switch to a third SSRI gives up the partial improvement she already has.
B
Correct: after partial response to an adequate trial, aripiprazole augmentation keeps the gains and targets the remainder.
C
Escitalopram above 20 mg/day exceeds the labeled maximum and raises QT risk.
D
Routine pharmacogenomic testing is not recommended and does not replace an evidence-based next step.
Case 15
An 82-year-old woman with Alzheimer disease has taken donepezil 10 mg daily for 3 years. Her MMSE has fallen from 18 to 9 over 18 months and she now needs help with dressing and bathing. Over the past 2 months she has had anorexia with a 3-kg weight loss, and her resting HR is 54 beats/minute. She has no agitation or psychosis. Which change is most appropriate?
Pick an option: the verdict and a note on every option open here.
Best answer: C.
Adding memantine to a cholinesterase inhibitor is indicated in moderate-to-severe Alzheimer disease and gives a modest benefit in cognition and function with good tolerability. Donepezil 23 mg is the tempting escalation, but it adds little benefit and causes more nausea, weight loss and bradycardia, which she already has. Switching to another cholinesterase inhibitor shares the same cholinergic effects, and risperidone has no role without behavioral symptoms and carries a boxed warning for mortality in dementia.
A
Another cholinesterase inhibitor shares the same cholinergic effects behind her anorexia and slow heart rate.
B
Donepezil 23 mg adds little benefit and causes more nausea, weight loss and bradycardia, which she already has.
C
Correct: memantine is indicated in moderate-to-severe Alzheimer disease and adds a modest benefit without cholinergic effects.
D
Risperidone has no role without agitation or psychosis and carries a boxed mortality warning in dementia.
Case 16
A 38-year-old woman with major depressive disorder in a collaborative care program started sertraline 50 mg daily 6 weeks ago. Her PHQ-9 was 18 at baseline and is 13 today. She takes every dose and has only mild nausea. Which interpretation and plan are most appropriate?
Pick an option: the verdict and a note on every option open here.
Best answer: C.
Response is defined as at least a 50% reduction in PHQ-9 and remission as a score below 5; a drop from 18 to 13 (about 28%) after 6 weeks is an inadequate response, and with good tolerance the next step is to increase sertraline toward an adequate dose before switching. Calling this a response or remission misreads the measurement-based thresholds. Switching classes is premature when the current drug has not yet been given at an adequate dose.
A
Response requires at least a 50% PHQ-9 drop, and 18 to 13 is only about 28%.
B
Remission means a PHQ-9 below 5, far from her score of 13.
C
Correct: a 28% drop is an inadequate response, and with good tolerance the dose is raised before any switch.
D
Switching is premature when sertraline has not yet been given at an adequate dose.

4A four-pass read for any adverse-effect case

Draw the timeline
List every start, stop and dose change the stem mentions, with its date, next to the day the problem began.
Use the printed number
Treat a sodium, a QTc, a heart rate or a symptom score as data you must use. Say what it means in a few words first.
Weigh what each drug is for
Some drugs on the list carry the disease; others were added for comfort or convenience. The second group is easier to change.
Distrust the add-on
An option that adds a new drug to treat another drug’s adverse effect deserves a second look. Older adults are where prescribing cascades are most worth checking for.

5What the outline puts in this domain

BPS area labels, with the scope we use on this site in our own words.
BPS area	Tier	Topics on this site
1B4 Neurology	Secondary (1B)	Seizures and status epilepticus, stroke, Parkinson disease, dementia, migraine, multiple sclerosis
1B7 Psychiatry and Mental Health	Secondary (1B)	Major depression, bipolar disorder, schizophrenia, ADHD, substance use and smoking cessation
2C3 Adverse Drug Events	Domain 2	Drug-induced movement problems, electrolyte effects, sedation, cardiac conduction
3A5 Medication Safety	Domain 3	Restricted-distribution programs and administration errors with psychiatric and dementia drugs

Source: BCPS Examination Specifications, effective September 2024, as of October 27, 2026. BPS publishes no weight for neurology or psychiatry alone.

6Neurology and psychiatry, answered short

Does smoking cessation count as psychiatry on the BCPS outline?

On this site it does. BPS lists Psychiatry and Mental Health (1B7) without sub-topics, and we file substance use, including tobacco, under it. Cessation cases also draw on counseling (2B6) and adverse-effect evidence (2C3).

Is multiple sclerosis covered on this page?

Yes. BPS lists Neurology (1B4) without sub-topics, and this site files multiple sclerosis therapy with it, next to seizures, stroke, Parkinson disease, dementia and migraine.

Where does ADHD in children fit?

The disorder sits with psychiatry here. Weight-based dosing and other pediatric questions are gathered in older adults, children and women’s health.

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