Rosh Psychiatry Board Practice Exam

For a 30-year-old man experiencing persistent sadness and tiredness, which diagnostic study is indicated?

1. Blood analysis

2. Brain magnetic resonance imaging

3. Polysomnography

4. Thyroid ultrasonography

The correct answer is: Blood analysis

In the case of a 30-year-old man experiencing persistent sadness and tiredness, a diagnostic study focusing on blood analysis is particularly pertinent. This choice stands out because depressive symptoms can often be influenced by physiological factors, and conducting a blood analysis enables the assessment of important parameters that could contribute to the individual’s mental health. For instance, this analysis can measure thyroid function, such as levels of thyroid hormones, to rule out hypothyroidism, which can present with symptoms of fatigue and depression. Additionally, it can assess complete blood counts and levels of vitamins or minerals that may affect mood, such as vitamin D or B12 deficiencies, which are also known to have associations with depressive symptoms. While brain imaging might help in evaluating structural issues related to mood disorders, it is not routinely indicated as a first-line diagnostic tool for uncomplicated depression. Similarly, polysomnography is not relevant unless sleep disorders present as a significant component of the clinical picture, nor is thyroid ultrasonography a standard diagnostic study for assessing depression directly; it is rather used for structural evaluation of the thyroid gland. Thus, the focus on blood analysis aligns with standard practices in psychiatric evaluations, emphasizing the importance of considering biological underpinnings of mood disturbances.