100+ Free Psychiatry Shelf Practice Questions
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A 26-year-old man with schizophrenia continues to have command auditory hallucinations despite adequate trials of risperidone and aripiprazole. He has no contraindication to blood monitoring. Which medication is most appropriate?
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Key Facts: Psychiatry Shelf Exam
110
Official NBME item count for Psychiatry
NBME Subject Examination Timing Chart
2:45
Official exam length
NBME Subject Examination Timing Chart
65%-70%
Behavioral Health systems weight
NBME Psychiatry Subject Exam Content Outline
30%-35%
Pharmacotherapy, intervention, and management task weight
NBME Psychiatry Subject Exam Content Outline
The Psychiatry shelf exam is a 110-item, 2 hour 45 minute NBME Clinical Science Subject Exam. NBME's public outline weights Behavioral Health at 65%-70%, diagnosis and foundational concepts at 65%-70% of physician tasks, and pharmacotherapy/intervention/management at 30%-35%. Passing thresholds and fees are institution-specific.
Sample Psychiatry Shelf Practice Questions
Try these sample questions to test your Psychiatry Shelf exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.
1A 32-year-old intern has 5 weeks of depressed mood, anhedonia, early-morning awakening, poor concentration, guilt, low energy, and 12-lb weight loss. She has never had a manic or hypomanic episode and denies substance use. Which diagnosis is most likely?
2A 24-year-old man is brought to the emergency department after 8 days of sleeping 2 hours nightly, talking rapidly, spending thousands of dollars, and believing he has been chosen to advise the president. He is hospitalized for unsafe behavior. Which diagnosis is most appropriate?
3A 29-year-old woman with recurrent depressive episodes describes a 5-day period last year when she felt unusually energetic, needed little sleep, was more talkative, and started several projects. Friends noticed the change, but she was not psychotic, hospitalized, or severely impaired. What is the best diagnosis?
4A 41-year-old man says he has felt down most days for 3 years with low self-esteem, fatigue, and poor concentration. He continues to work and has never had 2 months fully symptom-free. He has no history of mania. Which diagnosis best fits?
5A 30-year-old woman 6 days after delivery has not slept, says the baby is possessed, and tries to leave the nursery to protect the infant from imaginary attackers. She has a history of bipolar I disorder. What is the next step?
6A 45-year-old man with severe major depression refuses food because he believes his intestines have stopped working and says he plans to die today. Which treatment is most appropriate in addition to safety measures?
7A 23-year-old graduate student has her first episode of moderate major depression without psychosis, mania, substance use, pregnancy, or acute suicidality. Which initial pharmacotherapy is most appropriate?
8A 27-year-old woman with bipolar depression asks for a medication with relatively favorable reproductive safety compared with valproate. She is not acutely manic and has no rash history. Which option is most appropriate for bipolar depression maintenance?
9A 38-year-old man taking lithium develops vomiting, diarrhea, coarse tremor, confusion, and ataxia after starting ibuprofen for back pain. His lithium level is 2.3 mEq/L. What is the best next step?
10A woman with bipolar I disorder who is planning pregnancy asks which mood stabilizer should generally be avoided because of neural tube defects and adverse neurodevelopmental outcomes. Which medication is the concern?
About the Psychiatry Shelf Exam
The NBME Psychiatry Clinical Science Subject Exam is a secure end-of-clerkship assessment used by medical schools to evaluate knowledge and clinical reasoning in psychiatry. The public NBME outline emphasizes behavioral health, diagnosis, pharmacotherapy, intervention, and management across ambulatory, emergency, and inpatient settings. Students should be ready for clinical vignettes on mood, anxiety, trauma, psychotic, substance use, personality, somatic symptom, eating, sleep, neurocognitive, child and adolescent, emergency, and ethics or legal topics.
Assessment
110 one-best-answer multiple-choice clinical vignette items
Time Limit
2 hours, 45 minutes
Passing Score
Set locally by the medical school or clerkship using NBME equated scores and norms
Exam Fee
Varies by institution; usually ordered through the medical school (National Board of Medical Examiners (NBME))
Psychiatry Shelf Exam Content Outline
Behavioral Health Core
Mood, psychotic, anxiety, trauma, somatic symptom, factitious, eating, childhood-onset, personality, psychosocial, substance use, and medication adverse-effect topics.
Diagnosis and Clinical Reasoning
DSM-5-TR criteria, differential diagnosis, mental status findings, medical mimics, risk assessment, and selecting the most likely diagnosis from vignettes.
Treatment and Management
Medication selection, psychotherapy, acute stabilization, hospitalization decisions, monitoring, medication adverse effects, and follow-up planning.
Neurocognitive and Neurologic Psychiatry
Delirium, Alzheimer disease, dementia with Lewy bodies, frontotemporal and vascular dementia, sleep disorders, movement disorders, seizures, and neurologic causes of psychiatric symptoms.
Emergency Psychiatry
Suicide and violence risk, agitation, intoxication, withdrawal, catatonia, serotonin syndrome, neuroleptic malignant syndrome, involuntary commitment, and safety planning.
Ethics, Legal, and Communication
Capacity, confidentiality, minor consent, mandated reporting, duty to protect, informed consent, therapeutic boundaries, motivational interviewing, and patient-centered communication.
Child and Adolescent Psychiatry
ADHD, autism spectrum disorder, tic disorders, enuresis, disruptive behavior disorders, separation anxiety, pediatric depression, eating disorders, and developmental considerations.
Medical and Multisystem Interfaces
Endocrine, neurologic, pregnancy/postpartum, nutritional, medication-induced, and substance-induced causes of psychiatric presentations.
How to Pass the Psychiatry Shelf Exam
What You Need to Know
- Passing score: Set locally by the medical school or clerkship using NBME equated scores and norms
- Assessment: 110 one-best-answer multiple-choice clinical vignette items
- Time limit: 2 hours, 45 minutes
- Exam fee: Varies by institution; usually ordered through the medical school
Keys to Passing
- Complete 500+ practice questions
- Score 80%+ consistently before scheduling
- Focus on highest-weighted sections
- Use our AI tutor for tough concepts
Psychiatry Shelf Study Tips from Top Performers
Frequently Asked Questions
How many questions are on the NBME Psychiatry shelf exam?
The NBME Subject Examination Timing Chart lists Psychiatry as 110 items with an exam length of 2 hours and 45 minutes.
What content is emphasized on the Psychiatry Clinical Science Subject Exam?
NBME's public Psychiatry outline lists Behavioral Health as 65%-70% of systems content, with diagnosis and foundational concepts 65%-70% of physician tasks and pharmacotherapy, intervention, and management 30%-35%.
Is there one national passing score for the Psychiatry shelf?
No single public national passing cutoff applies to all students. NBME provides equated scores, norms, and grading guidance, while each medical school or clerkship sets local grading thresholds.
What question style should I expect?
Expect one-best-answer clinical vignettes that ask for diagnosis, next best step, treatment selection, adverse effect recognition, risk assessment, or an ethics/legal action.
How should I study in the last week?
Do mixed timed sets, review missed questions by diagnosis and management principle, memorize high-yield adverse effects and emergencies, and practice pacing close to 1.5 minutes per item.