Rosh Psychiatry Board Practice Exam

What test should be ordered for a patient who feels persecuted without any evidence of hallucinations?

1. Computed tomography of the head

2. Electroencephalogram

3. Lumbar puncture

4. Thyroid-stimulating hormone

The correct answer is: Thyroid-stimulating hormone

When assessing a patient who feels persecuted, it's essential to consider potential underlying medical issues that could contribute to these feelings. One plausible cause of paranoia in a patient without evidence of hallucinations could be a thyroid disorder, particularly hyperthyroidism, which can manifest as anxiety, mood changes, and paranoid or persecutory thoughts due to the elevated levels of thyroid hormones. Ordering a thyroid-stimulating hormone test is a logical step because it is a straightforward and effective way to screen for thyroid dysfunction. In cases of hyperthyroidism or other thyroid abnormalities, treating the underlying condition may alleviate the paranoid symptoms. This makes the thyroid-stimulating hormone test pertinent and valuable in this scenario. Other tests listed, such as computed tomography of the head, would be more useful if there were concerns about structural brain issues or potential intracranial pathology, which is less likely given the absence of other neurological symptoms like hallucinations. An electroencephalogram is primarily used to assess electrical activity in the brain, particularly for seizure disorders, which does not directly relate to persecutory beliefs without hallucinations. A lumbar puncture is generally performed to assess for infections or other central nervous system issues and is not indicated in the context of simply feeling persecuted without other neurological signs. Thus