Rosh Psychiatry Board Practice Exam

What would be the most likely next step in diagnosing a patient exhibiting signs of anxiety and irritability, along with excoriations and tachycardia?

1. Administer the Mood Disorder Questionnaire

2. Obtain a thyroid-stimulating hormone level

3. Obtain a urine toxicology screen

4. Question the patient about past episodes of mania or depression

The correct answer is: Obtain a urine toxicology screen

The most appropriate next step in this scenario is obtaining a urine toxicology screen. The presentation of anxiety, irritability, excoriations (skin picking), and tachycardia raises concerns about substance use or withdrawal effects. A urine toxicology screen would help identify substances that might be contributing to these symptoms, such as stimulants, alcohol, or other illicit drugs. This is particularly relevant since symptoms like irritability, anxiety, and physical signs such as tachycardia and skin picking can often be associated with substance use disorders or withdrawal states. Identifying such conditions early is crucial for effective management and treatment. While other options could provide valuable information or assistance in diagnosing mental health disorders or medical conditions, they may not address immediate concerns related to possible substance use. For example, assessing past episodes of mania or depression is more appropriate for mood disorders but does not take into account the acute physical symptoms. Similarly, obtaining thyroid-stimulating hormone levels would be relevant in ruling out hyperthyroidism, but this is a secondary consideration after addressing possible substance-related issues. In summary, the decision to perform a urine toxicology screen is based on the need to quickly rule out or confirm any underlying substance use that could explain the presenting symptoms.