Organic mental disorders: Hashimoto encephalopathy: practice question

A Psychiatry question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Psychiatry · Organic mental disorders: Hashimoto encephalopathy

Sample item

A 40-year-old woman has subacute confusion, visual hallucinations, tremor, myoclonus and a seizure. Thyroid function is near normal, anti-thyroid peroxidase antibodies are high, infective workup is negative, and she improves rapidly with corticosteroids. What is the most likely diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Hashimoto encephalopathy

Hashimoto encephalopathy, also called steroid-responsive encephalopathy associated with autoimmune thyroiditis, presents with confusion, psychosis, seizures, myoclonus and tremor with raised anti-thyroid antibodies. Its hallmark is a good steroid response.

Option by option

  • A. Creutzfeldt-Jakob disease

    CJD progresses relentlessly over months without steroid response.

  • B. Wernicke encephalopathy

    Wernicke encephalopathy comes with a nutritional deficit and responds to thiamine, not steroids.

  • C. Hashimoto encephalopathy (correct)

    Correct. High anti-TPO antibodies with rapid steroid response indicate this entity.

  • D. Anti-NMDA receptor encephalitis

    Anti-NMDA receptor encephalitis shows anti-NMDA receptor antibodies and often an ovarian teratoma, and the antibody here is anti-TPO.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is C, Hashimoto encephalopathy. Hashimoto encephalopathy, also called steroid-responsive encephalopathy associated with autoimmune thyroiditis, presents with confusion, psychosis, seizures, myoclonus and tremor with raised anti-thyroid antibodies.

Why is "Creutzfeldt-Jakob disease" not the answer?

CJD progresses relentlessly over months without steroid response.

Why is "Wernicke encephalopathy" not the answer?

Wernicke encephalopathy comes with a nutritional deficit and responds to thiamine, not steroids.

Why is "Anti-NMDA receptor encephalitis" not the answer?

Anti-NMDA receptor encephalitis shows anti-NMDA receptor antibodies and often an ovarian teratoma, and the antibody here is anti-TPO.

What concept does this question test?

It tests Organic mental disorders: Hashimoto encephalopathy in Psychiatry. Its hallmark is a good steroid response.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Organic mental disorders: Hashimoto encephalopathy?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.