Rosh Psychiatry Board Practice Exam

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What is the most appropriate next step in the diagnosis of a patient exhibiting symptoms of depressed mood, hypersomnolence, and significant weight gain?

  1. Administer a Mini-Mental State Examination

  2. Have the patient complete a Patient Health Questionnaire-9

  3. Order a complete metabolic panel and serum thyroid stimulating hormone level

  4. Refer the patient to a psychiatrist for evaluation

The correct answer is: Order a complete metabolic panel and serum thyroid stimulating hormone level

The correct next step in the diagnosis of a patient with symptoms of depressed mood, hypersomnolence, and significant weight gain is to order a complete metabolic panel and serum thyroid stimulating hormone level. These symptoms can be indicative of a mood disorder, such as major depressive disorder; however, they can also overlap with medical conditions, particularly hypothyroidism. Hypothyroidism can cause symptoms similar to depression, including fatigue, weight gain, and changes in mood. By checking the complete metabolic panel, healthcare providers can assess for any abnormalities in electrolyte levels and kidney function, which could potentially contribute to the patient's overall condition. The serum thyroid stimulating hormone (TSH) level is critical, as it helps determine thyroid function. An elevated TSH level would suggest hypothyroidism, requiring a different treatment approach than typically utilized for depression. In this context, addressing potential underlying medical causes through laboratory tests before initiating psychological interventions is essential for ensuring comprehensive patient care and appropriate diagnosis. Other options, while they may have their own merits, do not provide the immediate clarification needed regarding the potential medical contributions to the patient’s symptoms. For example, administering a standardized depression questionnaire or referring the patient to a psychiatrist would not address the possibility of an underlying medical condition that needs to

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