Mehl. bullets: delusional + NBME 10 9Q.

Question 1

M. When is delusional disorder the answer?

Answer 1

one, fixed, non-bizarre delusion + no other mood or psychotic Sx;

Question 2

M. presentation will often be patient with mistrust + suspects coworkers and neighbors are attempting to undermine her work or are stealing from her. Dx?

Answer 2

delusional disorder

Question 3

M. If the vignette says anything about “aliens,” “the heavens,” “the lord,” etc. + and eg mistrust. Dx?

Answer 3

the delusion is bizarre and the

Dx is psychosis (i.e., schizophrenia), not delusional disorder.

Question 4

NBME 10. 9Q.
A 25-year-old woman comes to the physician because of a 6-month history of itching over her arms that has become worse during the past 2 months. She attributes the itching to small worms, which she reports having seen appear from under her skin intermittently. On several occasions, she has “dug them out” with a clean needle. She has brought a small box containing samples of her dry skin and debris. She reports no history of depressed mood or auditory hallucinations. There is no personal or family history of serious illness. The patient takes no medications and does not use illicit drugs. Vital signs are within normal limits. Physical examination shows mildly inflamed lesions over the upper extremities with scabbing and excoriations. Examination of the samples she provides shows skin, scabs, and cotton fibers. On mental status examination, she has an anxious mood and constricted affect. Her speech is normal in rate and tone, and her thought processes are organized and coherent. She insists that she has parasites in her skin. Which of the following is the most likely diagnosis?

Answer 4

Delusional disorder