PRITE-Style Psychiatry Examination Latest
Update 2026|2027|A Comprehensive Review Of
300 Practice Questions with Answers and
Rationales |Pass Guaranteed
INTRODUCTION
The following 300-question examination is modeled after the Psychiatry
Resident-In-Training Examination (PRITE®) format. It is designed as an
educational resource for psychiatric residents preparing for the annual PRITE,
board certification examinations, and clinical practice. The questions span the full
breadth of psychiatric knowledge, including:
• Clinical Neurosciences (neuroanatomy, neurophysiology, neurochemistry,
neuropharmacology)
• Clinical Neurology (neurologic examination, neurologic disorders
presenting psychiatrically)
• Clinical Psychiatry (diagnosis, phenomenology, psychopathology, DSM-5-
TR criteria)
• Development and Maturation (lifespan development, attachment,
developmental milestones)
• Behavioral and Social Sciences (psychology, sociology, anthropology,
ethology)
• Epidemiology and Public Health (prevalence, incidence, risk factors,
prevention)
• Diagnostic Procedures (neuroimaging, electrophysiology, psychological
testing, laboratory studies)
• Psychopathology (descriptive psychopathology, nosology, differential
diagnosis)
, • Treatment (psychopharmacology, psychotherapy, somatic therapies,
combined treatment)
• Consultation-Liaison Psychiatry (medical-psychiatric interface, delirium,
capacity)
• Issues in Practice (ethics, forensics, healthcare systems, professionalism)
• Research Literacy (study design, statistics, evidence-based medicine)
SECTION 1: CLINICAL NEUROSCIENCES (Questions 1–
30)
1. A 45-year-old man presents with sudden-onset severe depression, apathy,
and executive dysfunction following a stroke. MRI reveals a lesion in the left
prefrontal cortex. Which neurotransmitter system is most likely disrupted in
this patient?
A. Serotonergic system
B. Dopaminergic system
C. Noradrenergic system
D. Cholinergic system
Correct Answer: B. Dopaminergic system
Rationale: The prefrontal cortex receives dense dopaminergic innervation from the
ventral tegmental area (VTA). Disruption of mesocortical dopamine pathways is
strongly associated with depression, apathy, and executive dysfunction following
frontal lobe injury. While serotonin and norepinephrine are also implicated in
depression, the specific frontal-executive syndrome with apathy is most closely
linked to dopaminergic dysfunction.
2. A 32-year-old woman with schizophrenia is started on clozapine. She
develops fever, tachycardia, muscle rigidity, and altered mental status. Which
neurochemical mechanism best explains this adverse reaction?
,A. D2 receptor super sensitivity
B. Serotonin syndrome from 5-HT2A agonism
C. Rapid central dopamine blockade
D. Cholinergic rebound
Correct Answer: C. Rapid central dopamine blockade
Rationale: This presentation is consistent with neuroleptic malignant syndrome
(NMS), a life-threatening reaction to antipsychotics. While clozapine has lower D2
affinity than typical antipsychotics, NMS can still occur. The mechanism involves
rapid and profound central dopamine blockade in the striatum and hypothalamus,
leading to rigidity, hyperthermia, and autonomic instability. Serotonin syndrome
(B) presents with clonus and hyperreflexia rather than lead-pipe rigidity.
3. A 28-year-old man with major depressive disorder is treated with an MAOI.
He eats aged cheese and develops a hypertensive crisis. Which enzyme is
inhibited by MAOIs to cause this reaction?
A. Catechol-O-methyltransferase (COMT)
B. Monoamine oxidase (MAO)
C. Dopamine beta-hydroxylase
D. Tryptophan hydroxylase
Correct Answer: B. Monoamine oxidase (MAO)
Rationale: MAOIs irreversibly inhibit monoamine oxidase, preventing the
breakdown of tyramine found in aged cheese, fermented foods, and cured meats.
Tyramine then displaces stored norepinephrine, causing a hypertensive crisis (the
"cheese reaction"). COMT is a separate enzyme involved in catecholamine
metabolism but is not the target of MAOIs.
4. A 60-year-old woman with Alzheimer's disease is started on donepezil.
Which neurotransmitter system is primarily enhanced by this medication?
A. Dopaminergic
B. GABAergic
, C. Cholinergic
D. Glutamatergic
Correct Answer: C. Cholinergic
Rationale: Donepezil is an acetylcholinesterase inhibitor that increases
acetylcholine in the synaptic cleft. The cholinergic hypothesis of Alzheimer's
disease posits that degeneration of basal forebrain cholinergic neurons contributes
to cognitive decline. Memantine, by contrast, modulates the glutamatergic system.
5. A 22-year-old man with bipolar I disorder is treated with lithium. Which
intracellular signaling mechanism is most directly inhibited by lithium?
A. Adenylate cyclase activation
B. Inositol monophosphates inhibition
C. Protein kinase C activation
D. G-protein receptor coupling
Correct Answer: B. Inositol monophosphates inhibition
Rationale: Lithium inhibits inositol monophosphates, depleting myo-inositol and
disrupting phosphatidylinositol signaling. This is a leading hypothesis for lithium's
mood-stabilizing effects. Lithium also inhibits glycogen synthase kinase-3 (GSK-
3), but the inositol depletion hypothesis is the classic mechanism tested.
6. A 35-year-old woman with panic disorder is prescribed a benzodiazepine.
Which subunit of the GABA-A receptor is primarily responsible for anxiolytic
effects?
A. Alpha-1 subunit
B. Alpha-2 subunit
C. Beta-1 subunit
D. Gamma-2 subunit
Correct Answer: B. Alpha-2 subunit
Update 2026|2027|A Comprehensive Review Of
300 Practice Questions with Answers and
Rationales |Pass Guaranteed
INTRODUCTION
The following 300-question examination is modeled after the Psychiatry
Resident-In-Training Examination (PRITE®) format. It is designed as an
educational resource for psychiatric residents preparing for the annual PRITE,
board certification examinations, and clinical practice. The questions span the full
breadth of psychiatric knowledge, including:
• Clinical Neurosciences (neuroanatomy, neurophysiology, neurochemistry,
neuropharmacology)
• Clinical Neurology (neurologic examination, neurologic disorders
presenting psychiatrically)
• Clinical Psychiatry (diagnosis, phenomenology, psychopathology, DSM-5-
TR criteria)
• Development and Maturation (lifespan development, attachment,
developmental milestones)
• Behavioral and Social Sciences (psychology, sociology, anthropology,
ethology)
• Epidemiology and Public Health (prevalence, incidence, risk factors,
prevention)
• Diagnostic Procedures (neuroimaging, electrophysiology, psychological
testing, laboratory studies)
• Psychopathology (descriptive psychopathology, nosology, differential
diagnosis)
, • Treatment (psychopharmacology, psychotherapy, somatic therapies,
combined treatment)
• Consultation-Liaison Psychiatry (medical-psychiatric interface, delirium,
capacity)
• Issues in Practice (ethics, forensics, healthcare systems, professionalism)
• Research Literacy (study design, statistics, evidence-based medicine)
SECTION 1: CLINICAL NEUROSCIENCES (Questions 1–
30)
1. A 45-year-old man presents with sudden-onset severe depression, apathy,
and executive dysfunction following a stroke. MRI reveals a lesion in the left
prefrontal cortex. Which neurotransmitter system is most likely disrupted in
this patient?
A. Serotonergic system
B. Dopaminergic system
C. Noradrenergic system
D. Cholinergic system
Correct Answer: B. Dopaminergic system
Rationale: The prefrontal cortex receives dense dopaminergic innervation from the
ventral tegmental area (VTA). Disruption of mesocortical dopamine pathways is
strongly associated with depression, apathy, and executive dysfunction following
frontal lobe injury. While serotonin and norepinephrine are also implicated in
depression, the specific frontal-executive syndrome with apathy is most closely
linked to dopaminergic dysfunction.
2. A 32-year-old woman with schizophrenia is started on clozapine. She
develops fever, tachycardia, muscle rigidity, and altered mental status. Which
neurochemical mechanism best explains this adverse reaction?
,A. D2 receptor super sensitivity
B. Serotonin syndrome from 5-HT2A agonism
C. Rapid central dopamine blockade
D. Cholinergic rebound
Correct Answer: C. Rapid central dopamine blockade
Rationale: This presentation is consistent with neuroleptic malignant syndrome
(NMS), a life-threatening reaction to antipsychotics. While clozapine has lower D2
affinity than typical antipsychotics, NMS can still occur. The mechanism involves
rapid and profound central dopamine blockade in the striatum and hypothalamus,
leading to rigidity, hyperthermia, and autonomic instability. Serotonin syndrome
(B) presents with clonus and hyperreflexia rather than lead-pipe rigidity.
3. A 28-year-old man with major depressive disorder is treated with an MAOI.
He eats aged cheese and develops a hypertensive crisis. Which enzyme is
inhibited by MAOIs to cause this reaction?
A. Catechol-O-methyltransferase (COMT)
B. Monoamine oxidase (MAO)
C. Dopamine beta-hydroxylase
D. Tryptophan hydroxylase
Correct Answer: B. Monoamine oxidase (MAO)
Rationale: MAOIs irreversibly inhibit monoamine oxidase, preventing the
breakdown of tyramine found in aged cheese, fermented foods, and cured meats.
Tyramine then displaces stored norepinephrine, causing a hypertensive crisis (the
"cheese reaction"). COMT is a separate enzyme involved in catecholamine
metabolism but is not the target of MAOIs.
4. A 60-year-old woman with Alzheimer's disease is started on donepezil.
Which neurotransmitter system is primarily enhanced by this medication?
A. Dopaminergic
B. GABAergic
, C. Cholinergic
D. Glutamatergic
Correct Answer: C. Cholinergic
Rationale: Donepezil is an acetylcholinesterase inhibitor that increases
acetylcholine in the synaptic cleft. The cholinergic hypothesis of Alzheimer's
disease posits that degeneration of basal forebrain cholinergic neurons contributes
to cognitive decline. Memantine, by contrast, modulates the glutamatergic system.
5. A 22-year-old man with bipolar I disorder is treated with lithium. Which
intracellular signaling mechanism is most directly inhibited by lithium?
A. Adenylate cyclase activation
B. Inositol monophosphates inhibition
C. Protein kinase C activation
D. G-protein receptor coupling
Correct Answer: B. Inositol monophosphates inhibition
Rationale: Lithium inhibits inositol monophosphates, depleting myo-inositol and
disrupting phosphatidylinositol signaling. This is a leading hypothesis for lithium's
mood-stabilizing effects. Lithium also inhibits glycogen synthase kinase-3 (GSK-
3), but the inositol depletion hypothesis is the classic mechanism tested.
6. A 35-year-old woman with panic disorder is prescribed a benzodiazepine.
Which subunit of the GABA-A receptor is primarily responsible for anxiolytic
effects?
A. Alpha-1 subunit
B. Alpha-2 subunit
C. Beta-1 subunit
D. Gamma-2 subunit
Correct Answer: B. Alpha-2 subunit
