Neurosciences
Damage to the subthalamic nucleus would most likely result in which clinical finding?
A. Resting tremor
B. Rigidity and bradykinesia
C. Chorea
D. Hemiballismus
E. Dystonia
Correct Answer: D
Explanation:
Lesions of the subthalamic nucleus cause contralateral hemiballismus, characterized by violent, flinging movements.
A psychotherapy patient invites you to attend her wedding after termination of treatment. What is the most appropriate response?
A. Accept, since treatment has ended
B. Accept only if no therapeutic issues are discussed
C. Decline and explain the importance of professional boundaries
D. Attend if the patient insists
E. Ask your supervisor for permission and then attend
Correct Answer: C
Explanation: Social relationships with current or former patients create dual relationships and are generally inappropriate in psychiatry, even after termination.
In a study examining antidepressant use and suicide risk, the association disappears after stratifying by severity of depression. What does this suggest?
A. Bias
B. Random error
C. Effect modification
D. Confounding
E. Ecological fallacy
Correct Answer: D
Explanation:
If the association disappears after stratification, the third variable (severity) was a confounder.
Confounder: related to exposure AND outcome
Effect modifier: association changes direction or magnitude, but does not disappear
A 35-year-old woman has recurrent episodes of intense fear with palpitations, derealization, and fear of dying. She avoids grocery stores because escape would be difficult. What is the most likely diagnosis?
A. Panic disorder
B. Panic disorder with agoraphobia
C. Generalized anxiety disorder
D. Social anxiety disorder
E. Specific phobia
Correct Answer: B
Explanation:
Panic attacks plus avoidance of places where escape is difficult = panic disorder with agoraphobia. Avoidance is key and often tested.
Which EEG finding is most characteristic of absence seizures?
A. Spike-and-wave at 3 Hz
B. Polyspike discharges
C. Hypsarrhythmia
D. Focal temporal spikes
E. Beta activity
Correct Answer: A
Explanation:
3-Hz spike-and-wave discharges are classic for absence seizures.
Hypsarrhythmia → infantile spasms
Temporal spikes → focal seizures
Beta → sedatives (e.g., benzodiazepines)
You notice a co-resident smells of alcohol and is about to evaluate patients in the ED. What is the best initial action?
A. Confront the resident privately and ask them to go home
B. Ignore the issue unless patient harm occurs
C. Immediately report the resident to the medical board
D. Ensure patient safety and notify a supervising authority
E. Document your concern in the medical record
Correct Answer: D
Explanation: Patient safety is the priority. Concerns about impairment should be reported through appropriate institutional channels (e.g., attending, program director).
A case-control study finds an odds ratio of 4.0 for cannabis use and psychosis. Which statement is most accurate?
A. Cannabis users have 4 times the risk of psychosis
B. Cannabis causes psychosis
C. The odds of cannabis exposure are 4 times higher in cases
D. The relative risk is also 4.0
E. Incidence of psychosis is quadrupled
Correct Answer: C
Explanation:
In case-control studies, you can calculate odds ratios, not relative risk.
Correct interpretation:
The odds of exposure among cases is 4 times that of controls.
PRITE trap: equating OR with RR (only valid when disease is rare).
A patient with major depressive disorder has hypersomnia, increased appetite, leaden paralysis, and mood reactivity. Which specifier applies?
A. Melancholic features
B. Psychotic features
C. Atypical features
D. Seasonal pattern
E. Anxious distress
Correct Answer: C
Explanation:
Atypical depression = mood reactivity + hypersomnia, hyperphagia, leaden paralysis, rejection sensitivity.
Which structure is most critical for forming new declarative memories?
A. Amygdala
B. Thalamus
C. Hippocampus
D. Mammillary bodies
E. Cingulate gyrus
Correct Answer: C
Explanation:
The hippocampus is essential for new declarative memory formation.
Damage → anterograde amnesia.
PRITE often tests this alongside Korsakoff syndrome, which affects mammillary bodies but still implicates hippocampal circuitry.
A patient with depression refuses antidepressant medication. She understands the risks and benefits, explains her reasoning, and communicates a consistent choice. What is the most appropriate action?
A. Administer medication involuntarily
B. Obtain consent from a family member
C. Respect the patient’s refusal
D. Hospitalize the patient for lack of insight
E. Seek a court order
Correct Answer: C
Explanation: The patient demonstrates decision-making capacity (understanding, appreciation, reasoning, choice). Competent patients have the right to refuse treatment.
A new antipsychotic reduces relapse rates from 30% to 20%. What is the NNT?
A. 2
B. 5
C. 10
D. 20
E. 30
Correct Answer: C
Explanation:
Absolute risk reduction (ARR) = 30% − 20% = 10% (0.10)
NNT = 1 / ARR = 10
A patient on clozapine presents with fever, sore throat, and malaise. Absolute neutrophil count is 400/µL. What is the next step?
A. Reduce clozapine dose
B. Continue clozapine and recheck labs
C. Stop clozapine immediately
D. Switch to olanzapine
E. Add lithium
Correct Answer: C
Explanation:
ANC < 500 = agranulocytosis. Clozapine must be stopped immediately. This is a medical emergency.
A patient presents with left facial paralysis, loss of taste from the anterior two-thirds of the tongue, and hyperacusis. Where is the lesion?
A. Left medulla
B. Left pons
C. Left midbrain
D. Right pons
E. Left temporal lobe
Correct Answer: B
Explanation:
The facial nerve (CN VII) nucleus is in the pons.
Facial paralysis → CN VII
Loss of taste (anterior 2/3) → chorda tympani
Hyperacusis → stapedius muscle (CN VII)
All localize to the ipsilateral pons.
A patient gives you a costly watch as a thank-you gift after significant improvement in therapy. What is the best response?
A. Accept the gift to avoid offending the patient
B. Accept and document it in the chart
C. Decline the gift and explore its meaning therapeutically
D. Donate the gift to charity
E. Accept only if the patient insists
Correct Answer: C
Explanation: Expensive gifts risk boundary violations. The appropriate response is to decline politely and explore the emotional meaning behind the gesture.
A study on PTSD prevalence surveys only patients seeking care at VA hospitals. What bias is most likely?
A. Recall bias
B. Berkson bias
C. Nonresponse bias
D. Observer bias
E. Lead-time bias
Correct Answer: B
Explanation:
Berkson bias occurs when hospital-based samples distort associations because patients are more likely to have multiple conditions.
Common PRITE pairing:
Hospital-based sample + prevalence distortion = Berkson bias
A patient treated with haloperidol for 8 months develops lip smacking and tongue protrusion. What is the best next step?
A. Increase haloperidol dose
B. Add benztropine
C. Switch to clozapine
D. Discontinue haloperidol and observe
E. Start propranolol
Correct Answer: C
Explanation:
This is tardive dyskinesia.
Anticholinergics (benztropine) worsen TD
Best management: switch to clozapine or use VMAT-2 inhibitors
A patient presents with expressive aphasia, right facial weakness, and right arm weakness. Sensation is intact. Where is the most likely lesion?
A. Right temporal lobe
B. Left inferior frontal gyrus
C. Left parietal lobe
D. Brainstem (pons)
E. Right internal capsule
Correct Answer: B
Explanation:
The left inferior frontal gyrus (Broca’s area) causes expressive aphasia. Associated contralateral face and arm weakness points to involvement of the left MCA territory affecting motor cortex. Sensation spared → motor-dominant lesion.
A patient from a culture where refusing gifts is considered deeply disrespectful offers you a small handmade item of minimal monetary value near the end of treatment. What is the best response?
A. Refuse the gift to avoid boundary violations
B. Accept the gift and explore its meaning
C. Accept the gift and say nothing further
D. Donate the gift to the clinic
E. Accept only if documented and approved by a supervisor
Correct Answer: B
Explanation: Small, culturally appropriate, non-coercive gifts may be acceptable. The key professionalism step is to explore the meaning therapeutically, not just accept or refuse automatically.
A study finds no significant difference between two antidepressants but was underpowered. What type of error is most likely?
A. Type I error
B. Type II error
C. Alpha inflation
D. Confounding
E. Measurement bias
Correct Answer: B
Explanation:
Type I: false positive
Type II: false negative
Low power → increased Type II error.
A patient has had continuous delusions and hallucinations for 8 months. He has also had multiple depressive episodes, but psychotic symptoms persist when mood symptoms are absent. Diagnosis?
A. Major depressive disorder with psychotic features
B. Bipolar disorder with psychotic features
C. Schizophrenia
D. Schizoaffective disorder
E. Delusional disorder
Correct Answer: C
Explanation:
Psychosis outside of mood episodes → schizophrenia.
Schizoaffective requires ≥2 weeks of psychosis AND mood symptoms present for the majority of illness, which is often misapplied.