PRITE (Psychiatry Resident In-Training Examination):
Q’s And A’s
FDA requires that generics not be significantly different from the parent
compounds in what way? (5x) Right Ans - BIOEQUIVALENCE
Two antidepressants are tested alone and as a combo treatment against a
waitlist control group in pts with treatment resistant MDD. Both meds are
found to have a significant therapeutic effect individually, and the combo
treatment is more efficacious than the summed effects of each med given
alone. What has been demonstrated? Right Ans - TWO TREATMENTS MAIN
EFFECTS AND AN INTERACTION EFFECT
First-line treatment for restless leg syndrome Right Ans - PRAMIPEXOLE
First pass effect refers to which of the following aspects of a med's
metabolism? Right Ans - PRESYSTEMIC ELIMINATION
In pts w/ recurrent depression, successful Tx with antidepressants should be
followed by which Tx strategies? Right Ans - CONT ANTIDEPRESSANT AT
SAME DOSE
The use of flumazenil for treating benzo OD is limited by ... Right Ans - THE
RISK OF INDUCING WITHDRAWAL SEIZURES IN BENZO- DEPENDENT PTS
In addition to benzos, which class of meds is assoc with falls in pts older than
60? Right Ans - ANTIDEPRESSANTS
Visual problem in pituitary tumor compressing optic chiasm (10x) Right
Ans - BITEMPORAL HEMIANOPSIA
60 y/o right-handed M, getting lost, only writes on right half of paper. Left-
sided hemi-neglect. Where is the lesion? (8x) Right Ans - RIGHT PARIETAL
LOBE
66 y/o c/o frequent falls, several-month hx of anxiety, unwillingness to leave
home. On exam, mild impairment of vertical gaze on smooth pursuit/
saccades, mild axial rigidity & minimal rigidity of upper extremities, along w
,mild slowness of movement on finger tapping, hand opening & wrist
opposition. Posture nml. Gait tentative/awkward, but w/o shuffling, ataxia,
tremor. Pt is slow in arising from a chair. Most likely dx: (5x) Right Ans -
PROGRESSIVE SUPRANUCLEAR PALSY
65 y/o pt fell several times past 6 mos. MSE nml. Smooth pursuit, saccadic
movements impaired. Worse w vertical gaze. Full ROM w doll head maneuver.
Mild symmetric rigidity/bradykinesia, no tremor. MRI/CSF/labs
unremarkable. Dx? (4x) Right Ans - PROGRESSIVE SUPRANUCLEAR PALSY
26 y/o w HA, clumsiness of right hand x weeks. Struggles w rapid alternating
movements of R hand, overt intention tremor w finger-to-nose, mildly
dysmetric finger-tapping. CNs nml, no papilledema. Damage to what is seen on
MRI? (3x) Right Ans - CEREBELLUM
9 y/o F has 3 month h/o seemingly unprovoked bouts of laughter. Worse
when not sleeping well. Pt does not feel happy during these episodes. Started
menstruating 6 months ago, and at Tanner stage 4. Dx? (2x) Right Ans -
HYPOTHALAMIC HAMARTOMA
5 y/o with 4 month history of morning HA, vomiting, and recent problems
with gait, falls, and diplopia: (2x) Right Ans - MEDULLOBLASTOMA
70 y/o pt develops confusion, lethargy, and generalized tonic-clonic seizure.
Lab reveals serum sodium of 95mEq/L. This is most likely a complication of
excessively rapid correction of which metabolic problem? Right Ans -
CENTRAL PONTINE MYELINOLYSIS
Which lesion causes bilateral coarse nystagmus worsening with visual fixation
and present with horizontal and vertical gaze? Right Ans - BRAINSTEM
32 y/o pt 1-month hx of worsening headaches, episodic mood swings and
occasional hallucinations with visual, tactile and auditory content. CT head
reveals tumor where: Right Ans - TEMPORAL LOBE
66 y/o with HTN develops vertigo, diplopia, nausea, vomiting, hiccups, L face
numbness, nystagmus, hoarseness, ataxia of limbs, staggering gait, and
tendency to fall to the left. Dx? (6x) Right Ans - LATERAL MEDULLARY
STROKE
,Chronic A-fib develops aphasia and R hemiparesis at noon. ER exam notes
weakness of R extremities and severe dysfluent aphasia, but CT at 1:30 PM
has no acute lesion. Most appropriate treatment: (4x) Right Ans - TPA
Rapid onset of right facial weakness, left limb weakness, diplopia: Right
Ans - BRAIN STEM INFARCTION
A life threatening complication of cerebellar hemorrhage is: Right Ans -
ACUTE HYDROCEPHALUS
A 72 yo patient had an embolic infarct in the middle cerebral artery territory.
ECG shows no structural abnormalities. Doppler studies of the neck arteries
reveal less than 50% occlusion on both carotid arteries. An EKG reveals AFib.
Which of the following strategies has the best likelihood of reducing recurrent
strokes in this patient? Right Ans - ANTICOAGULATION WITH WARFARIN
Young adult gained 70 lbs in last year c/o daily severe headaches sometimes
assoc with graying out of vision. Papilledema present. CT and MRI brain no
abnormalities but ventricles smaller than usual. Goal of treatment in this case:
Right Ans - PREVENT BLINDNESS
68 y/o pt w/ hypertension develops rapidly progressing right arm and leg
weakness, with deviation of the eyes to the left. Within 30 minutes of the
onset of this deficit, pt became increasingly sleepy. Two hours after the onset,
the patient became unresponsive. On exam: dense right hemiplegia, eyes
deviated to the left, pupils: equal and reactive, a right facial weakness to
grimace elicited by noxious stimuli. Cough and gag reflexes: present. Which CT
finding is most likely? Right Ans - LEFT PUTAMINAL HEMORRHAGE
Superior homonymous quadrantic defects in the visual fields result from
lesions to which of the following structures? Right Ans - TEMPORAL OPTIC
RADIATIONS
78 y/o pt had an ischemic stroke that left him with a residual mild hemiplegia.
Pt appeared to be unaware that there was a problem of weakness on tone side
of this body. When asked to raise the weak arm, the patient raised his normal
arm. When the failure to raise the paralyzed arm was pointed out to pt, he
admitted that the arm was slightly weak. He also neglects the side of the body
, when dressing and grooming. Pt did not shave one side of his face, had
difficulty putting a shirt on when it was turned inside out. Area of brain likely
affected by stroke? Right Ans - RIGHT PARIETAL LOBE
A pt has multiple stoke like symptoms of short duration over several days.
And has new onset symptoms for the last 90 minutes. CT scan shows no
evidence of stroke or hemorrhage. What is the appropriate treatment?
Right Ans - INTRAVENOUS THROMBOLYTIC AGENTS
MRI scan of head reveals an infarct in distribution of left anterior cerebral
artery. Pt most likely exhibits: Right Ans - WEAKNESS OF
CONTRALATERAL FOOT AND LEG
72 w/ recent behavior/memory problems. Disrobing, not sleeping, irritable.
Waxing and waning consciousness. Dx? (8x) Right Ans - DELIRIUM
79 y/o pt w/ decreasing mental state over 3 weeks has an exaggerated startle
response with violent myoclonus that is elicited by turning on the room lights,
speaking loudly, or touching the patient. Myoclonic jerks occur spontaneously,
ataxia, EEG: sharp waves. Dx: (5x) Right Ans - SUBACUTE SPONGIFORM
ENCEPHALOPATHY
52 y/o pt w/ hx of depression & HTN hospitalized, being evaluated by psych
resident. His family reports he had severe HA & "has not been himself" for 10
days. On exam, pt has poor eye contact and is inattentive, muttering, picking at
his clothes, occasionally dozing off although it is midday. Dx: (4x) Right Ans
- DELIRIUM
Mild confusion, lethargy, thirst, polydipsia: Right Ans - HYPONATREMIA
Multifocal myoclonus in a comatose patient indicates: Right Ans -
METABOLIC ENCEPHALOPATHY
70 y/o with mild Alzheimer's lives with family and prescribed SSRI for
depression. Also has HTN, adult onset DM, and RA, which are stable. The pt
develops acute confusion but no other med or psych symptoms which test
should be ordered first? Right Ans - ELECTROLYTES
Q’s And A’s
FDA requires that generics not be significantly different from the parent
compounds in what way? (5x) Right Ans - BIOEQUIVALENCE
Two antidepressants are tested alone and as a combo treatment against a
waitlist control group in pts with treatment resistant MDD. Both meds are
found to have a significant therapeutic effect individually, and the combo
treatment is more efficacious than the summed effects of each med given
alone. What has been demonstrated? Right Ans - TWO TREATMENTS MAIN
EFFECTS AND AN INTERACTION EFFECT
First-line treatment for restless leg syndrome Right Ans - PRAMIPEXOLE
First pass effect refers to which of the following aspects of a med's
metabolism? Right Ans - PRESYSTEMIC ELIMINATION
In pts w/ recurrent depression, successful Tx with antidepressants should be
followed by which Tx strategies? Right Ans - CONT ANTIDEPRESSANT AT
SAME DOSE
The use of flumazenil for treating benzo OD is limited by ... Right Ans - THE
RISK OF INDUCING WITHDRAWAL SEIZURES IN BENZO- DEPENDENT PTS
In addition to benzos, which class of meds is assoc with falls in pts older than
60? Right Ans - ANTIDEPRESSANTS
Visual problem in pituitary tumor compressing optic chiasm (10x) Right
Ans - BITEMPORAL HEMIANOPSIA
60 y/o right-handed M, getting lost, only writes on right half of paper. Left-
sided hemi-neglect. Where is the lesion? (8x) Right Ans - RIGHT PARIETAL
LOBE
66 y/o c/o frequent falls, several-month hx of anxiety, unwillingness to leave
home. On exam, mild impairment of vertical gaze on smooth pursuit/
saccades, mild axial rigidity & minimal rigidity of upper extremities, along w
,mild slowness of movement on finger tapping, hand opening & wrist
opposition. Posture nml. Gait tentative/awkward, but w/o shuffling, ataxia,
tremor. Pt is slow in arising from a chair. Most likely dx: (5x) Right Ans -
PROGRESSIVE SUPRANUCLEAR PALSY
65 y/o pt fell several times past 6 mos. MSE nml. Smooth pursuit, saccadic
movements impaired. Worse w vertical gaze. Full ROM w doll head maneuver.
Mild symmetric rigidity/bradykinesia, no tremor. MRI/CSF/labs
unremarkable. Dx? (4x) Right Ans - PROGRESSIVE SUPRANUCLEAR PALSY
26 y/o w HA, clumsiness of right hand x weeks. Struggles w rapid alternating
movements of R hand, overt intention tremor w finger-to-nose, mildly
dysmetric finger-tapping. CNs nml, no papilledema. Damage to what is seen on
MRI? (3x) Right Ans - CEREBELLUM
9 y/o F has 3 month h/o seemingly unprovoked bouts of laughter. Worse
when not sleeping well. Pt does not feel happy during these episodes. Started
menstruating 6 months ago, and at Tanner stage 4. Dx? (2x) Right Ans -
HYPOTHALAMIC HAMARTOMA
5 y/o with 4 month history of morning HA, vomiting, and recent problems
with gait, falls, and diplopia: (2x) Right Ans - MEDULLOBLASTOMA
70 y/o pt develops confusion, lethargy, and generalized tonic-clonic seizure.
Lab reveals serum sodium of 95mEq/L. This is most likely a complication of
excessively rapid correction of which metabolic problem? Right Ans -
CENTRAL PONTINE MYELINOLYSIS
Which lesion causes bilateral coarse nystagmus worsening with visual fixation
and present with horizontal and vertical gaze? Right Ans - BRAINSTEM
32 y/o pt 1-month hx of worsening headaches, episodic mood swings and
occasional hallucinations with visual, tactile and auditory content. CT head
reveals tumor where: Right Ans - TEMPORAL LOBE
66 y/o with HTN develops vertigo, diplopia, nausea, vomiting, hiccups, L face
numbness, nystagmus, hoarseness, ataxia of limbs, staggering gait, and
tendency to fall to the left. Dx? (6x) Right Ans - LATERAL MEDULLARY
STROKE
,Chronic A-fib develops aphasia and R hemiparesis at noon. ER exam notes
weakness of R extremities and severe dysfluent aphasia, but CT at 1:30 PM
has no acute lesion. Most appropriate treatment: (4x) Right Ans - TPA
Rapid onset of right facial weakness, left limb weakness, diplopia: Right
Ans - BRAIN STEM INFARCTION
A life threatening complication of cerebellar hemorrhage is: Right Ans -
ACUTE HYDROCEPHALUS
A 72 yo patient had an embolic infarct in the middle cerebral artery territory.
ECG shows no structural abnormalities. Doppler studies of the neck arteries
reveal less than 50% occlusion on both carotid arteries. An EKG reveals AFib.
Which of the following strategies has the best likelihood of reducing recurrent
strokes in this patient? Right Ans - ANTICOAGULATION WITH WARFARIN
Young adult gained 70 lbs in last year c/o daily severe headaches sometimes
assoc with graying out of vision. Papilledema present. CT and MRI brain no
abnormalities but ventricles smaller than usual. Goal of treatment in this case:
Right Ans - PREVENT BLINDNESS
68 y/o pt w/ hypertension develops rapidly progressing right arm and leg
weakness, with deviation of the eyes to the left. Within 30 minutes of the
onset of this deficit, pt became increasingly sleepy. Two hours after the onset,
the patient became unresponsive. On exam: dense right hemiplegia, eyes
deviated to the left, pupils: equal and reactive, a right facial weakness to
grimace elicited by noxious stimuli. Cough and gag reflexes: present. Which CT
finding is most likely? Right Ans - LEFT PUTAMINAL HEMORRHAGE
Superior homonymous quadrantic defects in the visual fields result from
lesions to which of the following structures? Right Ans - TEMPORAL OPTIC
RADIATIONS
78 y/o pt had an ischemic stroke that left him with a residual mild hemiplegia.
Pt appeared to be unaware that there was a problem of weakness on tone side
of this body. When asked to raise the weak arm, the patient raised his normal
arm. When the failure to raise the paralyzed arm was pointed out to pt, he
admitted that the arm was slightly weak. He also neglects the side of the body
, when dressing and grooming. Pt did not shave one side of his face, had
difficulty putting a shirt on when it was turned inside out. Area of brain likely
affected by stroke? Right Ans - RIGHT PARIETAL LOBE
A pt has multiple stoke like symptoms of short duration over several days.
And has new onset symptoms for the last 90 minutes. CT scan shows no
evidence of stroke or hemorrhage. What is the appropriate treatment?
Right Ans - INTRAVENOUS THROMBOLYTIC AGENTS
MRI scan of head reveals an infarct in distribution of left anterior cerebral
artery. Pt most likely exhibits: Right Ans - WEAKNESS OF
CONTRALATERAL FOOT AND LEG
72 w/ recent behavior/memory problems. Disrobing, not sleeping, irritable.
Waxing and waning consciousness. Dx? (8x) Right Ans - DELIRIUM
79 y/o pt w/ decreasing mental state over 3 weeks has an exaggerated startle
response with violent myoclonus that is elicited by turning on the room lights,
speaking loudly, or touching the patient. Myoclonic jerks occur spontaneously,
ataxia, EEG: sharp waves. Dx: (5x) Right Ans - SUBACUTE SPONGIFORM
ENCEPHALOPATHY
52 y/o pt w/ hx of depression & HTN hospitalized, being evaluated by psych
resident. His family reports he had severe HA & "has not been himself" for 10
days. On exam, pt has poor eye contact and is inattentive, muttering, picking at
his clothes, occasionally dozing off although it is midday. Dx: (4x) Right Ans
- DELIRIUM
Mild confusion, lethargy, thirst, polydipsia: Right Ans - HYPONATREMIA
Multifocal myoclonus in a comatose patient indicates: Right Ans -
METABOLIC ENCEPHALOPATHY
70 y/o with mild Alzheimer's lives with family and prescribed SSRI for
depression. Also has HTN, adult onset DM, and RA, which are stable. The pt
develops acute confusion but no other med or psych symptoms which test
should be ordered first? Right Ans - ELECTROLYTES
