Mehl. bullet psychotic 04-06 (1)

Question 1

M. USMLE can give you a massive vignette where they describe a guy with mixed schizotypal (magical thinking) and schizoid (reclusive) qualities, and then they want to know what he’s at incr.­ risk for what?

Answer 1

the answer is just schizophrenia.

cia buvo sitas prie sizofrenijos langelio

Question 2

M. Q will say a college student has been hearing voices for the past 6 weeks + has been staying up all night for the past month (i.e., 4 weeks of mania or hypomania + at least 2 weeks of psychosis alone). Dx?

Answer 2

Schizoaffective

Question 3

M. what are the important timeframes for schizophrenia vs schizophreniform vs brief psychotic disorder?

schizophrenia

Answer 3

schizophrenia is >6 months of psychosis.

Question 4

M. what are the important timeframes for schizophrenia vs schizophreniform vs brief psychotic disorder?

schizophreniform

Answer 4

schizophreniform is 1-6 months

Question 5

M. what are the important timeframes for schizophrenia vs schizophreniform vs brief psychotic disorder?

brief psychotic disorder

Answer 5

brief psychotic disorder is < 1 month;

Question 6

M. If brain imaging performed in schizophrenic patient, what would be seen?

Answer 6

enlargement of the third and lateral ventricles.

Question 7

M. Major characteristic in psych vignettes that suggests psychotic disorder?

Answer 7

AUDITORY hallucinations; in contrast, visual hallucinations are non-specific and seen frequently in drug use (alcohol, amphetamines, marijuana, etc.).

Question 8

M. drug use (alcohol, amphetamines, marijuana, etc.), what hallucinations probably will occur?

Answer 8

visual hallucination

Question 9

M. 23M + hearing voices for 6 weeks + staying up all night for 4 weeks; Dx?

Answer 9

schizoaffective disorder

Dx is >2 weeks of psychotic disorder in the absence of mood disorder.

Question 10

M. 23M + vignette sounds like he has schizophrenia + no mention of mood disorder + answer is schizoaffective; why?

Answer 10

this is snapshot of the patient in the psychosis-only phase of schizoaffective (asked on Psych shelf, where you need to eliminate the other answers, e.g., bipolar, cyclothymia, etc., in order to answer correctly).

Question 11

M. 22M + schizophrenia + poor adherence to medications; best med to give to Tx?

Answer 11

haloperidol decanoate.

Question 12

M. 25M + schizophrenic non-responsive to many meds + started on new drug + mouth ulcers; Dx?

best next step?

Answer 12

agranulocytosis secondary to clozapine;

stop drug immediately; must do granulocyte checks frequently when first commencing this agent.

Question 13

M. 65M + given IV methylprednisolone for temporal arteritis + develops confusion + visual hallucinations; Dx?

Answer 13

“corticosteroid-induced psychotic disorder”;

astute student says, “I thought that happens with high doses over longer periods of time.”response: yeah, but Psych NBME has it occurring after a one-off dose in a patient. Bottom line is: be aware that glucocorticoid psychosis is tested.