Psych Shelf Exam

[bonvivant07]

For those that took the NBME practice exams, how representative were those of the shelf?

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[whitcoatsyndrom]

A 32 yr old man thinks he's losing his mind. Intrusive thoughts of killing his 4 yr old son. Doesn't want to this, thinks thoughts are ridiculous. Increasingly depressed, worried something is happening to him. He is a pastor at a local church, thoughts are prevalent while reading scripture. He says he is a good father and takes good care of his son. During his 1st year of college, he was counseled for an adjustment problem. Considers mother overly anxious. Labs normal. Which is the most likely diagnosis?

The last one is definitely not schizoaffective. Schizoaffective diagnosis requires two separate episodes of a psychosis and a mood disorder

I actually think that is schizoaffective. It sounds like you're working off the DSM-V specific changes vs DSM-IV. The shelf will not test on differences between IV and V. I've heard this from valid sources and logically--it takes a very long time for questions to be accepted onto the exam (hence why some test questions are not actually counted towards score). Regardless, the definition we should work with is a psychotic patient with mood Sx (depressed, manic, hypomanic) only during psychotic episodes but in a patient w/ at least 2 wks of psychosis w/o mood Sx.

It's odd that the specific question implies some pt insight, not common for psychosis but also not disqualifying. The question was clearly truncated when posted here so I'm wondering what subjectively erroneous info was left out as some of it is prob important. Here is my reasoning for excluding the others...definitely open to other considerations.

A) Bipolar disorder--true that the question hints at a past brush with depression-like sx (adjustment disorder) but but he has no hx of mania
B) Dysthymic disorder--2 yrs depressive sx required
C) GAD--he's not anxious about multiple things
D) MDD--doesn't meet 5 criteria
E) OCD--The thoughts are compulsive but he has no compulsive actions to relieve related anxiety--BUT his mom had anxiety, which is certainly a big comorbid condition for OCD...it's a stretch w/ the given info.
F) Schizoaffective disorder--Methinks
E) Schizophrenia--He has no delusions (his intrusive thoughts are not fixed beliefs), hallucinations, disorganized speech/behavior/catatonia, negative sx--BUT, although 2 criteria must be present (discounting the presence of any running commentary auditory hallucinations or bizarre delusions) for 1 month, the illness (during which not all criteria must be met) must last for at least 6 mo...thus he could have already had a prodromal phase, full on schizophrenia for at least 1 mo, and then had some Sx remit--which would still probably count for schizophrenia. Seriously though, what a stretch.

 

[jakeislove]

Why not OCD, with scripture reading as his ritual?

 

[whitcoatsyndrom]

Why not OCD, with scripture reading as his ritual?

I think you bring up a good point. I don't get the feeling that the scripture reading is compulsive, or that it relieves the anxiety from his intrusive obsession (the thoughts of killing his son). At least there is nothing in the prompt leading me in that direction. But after giving it more thought I think you're entirely right about the diagnosis. OCD does not require both obsessions and compulsions...but at least one or the other, and this dude definitely has obsessions that are unreasonable and that he is trying to suppress. Also significant is that they are ego-dystonic and the prompt authors went out of their way to imply that a few times.

Good call!

 

[bonvivant07]

Has anyone seen percentage questions on their shelfs? I keep seeing random percentage mortality, percentage in monozygotic twins etc. in practice questions, just wondering if those types of questions actually ever show up on the real thing.

 

[xPhantom]

1) Lange Q&A: a must - it covers the entire scope of the psych topics including child psych, legal/ethics crap and you can pass just with this resource alone, question style is very similar to the actual shelf

I know this has been asked a few times already but I don't think there's been a clear answer. Anyway, is the 10th edition of Lange Q&A worth the difference in price or is the 9th edition adequate?

 

[Apoplexy__]

For those that took the NBME practice exams, how representative were those of the shelf?

Some of the most similar Q's I took. Prepared me well.

Here's my experience with the shelf, btw:
-NBME 1: 88
-NBME 2: 96
-Final score: 89

I felt I studied way too much for this shelf and hit a plateau halfway through my study period (a whole freakin month before my test). I used most of the gold-standard resources for this shelf (UWorld, FA, Lange, Case Files, and others) and just felt like I was re-reading the same things to the point that I was skimming. It was annoying.

And that's really the theme of this shelf -- annoying. The part of it that is aggravating is also the part that makes people say this shelf is easy when it's really not so much; the fact that 90% of the material is Step 1 means that it's easy to score decently but very difficult to go that extra mile.

I'm going to copy-paste a quote from a user years ago that had been quoted by another poster who said it was useful, as the advice still rang true for me as well. Everyone knows the meat and potatoes of these questions, but the real trickiness of the shelf is in the differential diagnosis. Know how everything might look like everything else, know comorbidities that complicate presentations of things, and know how to tell everything apart from everything. Good luck everyone.

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Took the Psych. Shelf today and I must say that I'm not sure how I did. I studied fairly hard for it and used Blueprints, A&L's question book, and PreTest. That's it.

All in all, it was, I suppose, a fair test, that really forced you to know your differential diagnoses. Quite a bit of "real" pathology on it (seizures, drug OD, IBD, FAS) that forced you to oftentimes work-up the patient with an EKG as opposed to prescribing a SSRI for a panic disorder.

Some suggestions/observations...

1. Know your Bereavement vs. MDD vs. Adjustment Disorder COLD. Literally, these three were in the options for "what is the diagnosis" questions many times. Like 7-8 times on my shelf.

2. 2-3 developmental questions, like "is it normal for a 3 yowm to still poop in his diaper?"

3. The treatment questions were my favorites. I had...treatment of Mania, EPS treatments in patients on Haldol (2), treating delirium in the elderly, patient w/ priapism caused by ____, treating Li-induced tremor, treatment of GAD, treatment of Trichotillomania, treatment of severe anxiety in a businessman before flying, treat school phobia, treatment of dementia, etc..

4. Don't be afraid to go with ECT if the patient is old, has PD, is actively suicidal, and had CABG a few years ago.

5. I had 2 questions where I believe the answer was MDD. One in a kid and the other in a teenager. The kid had somatic complaints and appeared sad. The distractor was IBD. The teen had extreme irritability with occasional thoughts of death. The distractor was ODD, adjustment d/o.

6. I had to treat acute ASA OD and recognize Methanol poisoning (AG metabolic acidosis). I had to recognize a TIA -- question had nothing to do with psychiatry.

7. Know MRI findings in Tourette's. I didn't know the answer but put down decreased frontal lobe mass. Up-to-Date supports this, so I think it's correct. Basal Ganglia changes weren't an option.

8. Know presentation of FAS vs. Trisomy 21 -- based on facial description.

9. Know epidemiology of BP d/o. MZ twins have >50% risk, even if raised apart.

10. I had a very tricky questioning where I had it narrowed down to Pain d/o and Factitious d/o by proxy. Put Pain d/o but no clue which one's correct.

11. Be familiar with drugs that can cause delirium (i.e., thioridazine).

I had a good smattering of questions. Best of luck to all.....

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[Fatalis]

took shelf last week. Got score today
96th percentile
I read over first aid for psych 3x
did uworld 1x then did some random questions the night before just to get my brain back in question mode
did pre-test 1x [only read wrong explanations but 1/2 the time they were bs questions]
my test was heavy on distinguishing between somatization vs malingering vs conversion, had a bunch of neuro questions and a few pharm questions. Overall it was a challenging exam but happy with outcome.

 

[Elixir6]

Thanks for your contributions to answering Q's. Would a complex partial seizure be:

I got a bunch of these:

Bold is correct:
A) burst-suppression pattern
B) diffuse 3-hz spike and slow wave activity (not it)
C) focal spikes localized in temporal lobe
D) hypsarrhythmia
E) periodic lateralized epileptiform discharges
F) polyspike and slow wave activity
G) triphasic waves

Also, I'd love any help with these:

A 37-year-old man comes to the physician for a follow-up examination 3 months after being diagnosed with alcoholic cirrhosis. He has missed three appointments that he attributes to transportation problems. His driver’s license was suspended 3 months ago for driving under the influence of alcohol. He does not claim that is drinking is a problem but he has cut down the amount her drinks from 12 beers to 4 beers daily. He is disheveled and restless and claims that he has not slept well for the past 3 months. His pulse is 96, respirations are 16/min, and blood pressure is 170/90 mm Hg. Physical examination shows no other abnormalities except for peripheral edema of the lower extremities. On mental status examination, he describes his mood as fine, but he is irritable and has poor eye contact, especially when discussing his drinking. He speaks at a normal rate with normal response latency. His thought process is logical and coherent without evidence of psychosis. His serum albumin concentration is 3 g/dL, total serum bilirubin concentration is 2.6 g/dL and GGT activity is 158. Which of the following is the most appropriate next step in management?

a. Recommend alcohol rehabilitation
b. Clonidine therapy
c. Diazepam therapy
d. Disulfiram therapy
e. Furosemide therapy
f. Liver transplantation evaluation (not the answer)

A 47 year old woman is admitted to the hospital because of a 12 hour history of tremors and confusion. She has a history of alcoholism and last consumed alcohol 24 hours ago. She has no other history of serious illness. She does not smoke cigarettes or use illicit substances. On admission, she is agitated, diaphoretic and orientated to person but not to time or place. Vitamin B1 (thiamine), folic acid, and three doses of diazepam are administered intravenously. Thirty-five minutes later, respiratory compromise develops; the patient is intubated and mechanical ventilation is started at a respiratory rate of 20/min. Two hours later, she remains agitated. She is pulling at her peripheral intravenous and urethral catheters and picking at her blankets. Her pulse is 140 and blood pressure is 160/100 mm Hg. Neurologic examination shows tremor of the upper and lower extremities and hyperreflexia bilaterally. Which of the following is the most appropriate next step in pharmacotherapy?

A. Add flumazenil to the medication regimen
B. Add haloperidol to the medication regimen (not the answer...wtf? seemed obvious...)
C. Add phenytoin to the medication regimen
D. Administer additional diazepam
E. Administer additional vitamin B1

A 21 yr old woman brought to the ED after threatening her boyfriend with a meat cleaver. Her boyfriend flushed her pills down the toilet 2 months ago, and she never refilled her prescription. She reports now feeling the same way she did prior to starting her medication. Physical examination shows multiple ecchymoses near the extremities in various stages of healing. Pelvic exam shows multiple vaginal abrasions. She repeatedly says "I am so weak". She states she would kill her boyfriend rather than kill herself. Delusions of hearing her dead mother's voice telling her to defend herself. Next step in management?

A) Encourage patient to press charges (not the answer)
B) Contact patient's boyfriend
C) Recommend an outpatient support group
D) Reinitiate antidepressant therapy
E) Admit the patient to the psychiatric unit

A 32 yr old man thinks he's losing his mind. Intrusive thoughts of killing his 4 yr old son. Doesn't want to this, thinks thoughts are ridiculous. Increasingly depressed, worried something is happening to him. He is a pastor at a local church, thoughts are prevalent while reading scripture. He says he is a good father and takes good care of his son. During his 1st year of college, he was counseled for an adjustment problem. Considers mother overly anxious. Labs normal. Which is the most likely diagnosis?

A) Bipolar disorder
B) Dysthymic disorder
C) GAD
D) MDD (not the answer...was thinking MDD w/ psychosis)
E) OCD <- its weird, but this is the right answer, as I didn't get it as one of my wrong ones... not sure what the compulsion is but none of the other answers seemed right
F) Schizoaffective disorder
E) Schizophrenia

 

[cbrons]

A 32 yr old man thinks he's losing his mind. Intrusive thoughts of killing his 4 yr old son. Doesn't want to this, thinks thoughts are ridiculous. Increasingly depressed, worried something is happening to him. He is a pastor at a local church, thoughts are prevalent while reading scripture. He says he is a good father and takes good care of his son. During his 1st year of college, he was counseled for an adjustment problem. Considers mother overly anxious. Labs normal. Which is the most likely diagnosis?

This is very clearly OCD. Intrusive thoughts about accidentally succumbing to violent impulse (they never do by the way, they aren't at increased risk of homicidality) + introspection that he's going crazy. OCD is common in people who had adjustment disorders in childhood, people of faith, and those with above average IQ.



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[cbrons]

Wow sad on phone and didnt notice how old post was


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[Apoplexy__]

Wow sad on phone and didnt notice how old post was


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No worries. Still good to get the clarification, thanks.

And thanks for all those answers @Elixir6!

 

[Elixir6]

Hi everyone,

Took the exam - think I did pretty well.

It seems like there are probably different versions of the exam, but as mentioned by others, my version had a lot of child psych and genetic diseases. Not only that, but my version had some questions that were *very* similar to those in the NBME practice exams. I agree with others you really have to know mild depression vs MDD vs adjustment. Lots of stuff on adverse events from first generation antipsychotics. Lots of neuro/medicine-like questions. Someone recommended looking through the neuro chapter of Step Up to Medicine. I did, and it wasn't helpful. Kinda hard to prep for those questions if you hadn't had the rotations.

I did the following:

FA 3rd - 2x very thorough passes

USMLEWorld - all 144Qs... these were in general easier than the shelf, but good never the less, esp to look at the explanation charts some of which compared and contrasted diagnoses in a way that is not seen in FA

NBME1&2 - well worth it to get an appreciation for the pacing. I told my classmate to do these, but she had a pirated PowerPoint and used that instead. She ran out of time and had to race through the last few questions barely reading them. Therefore, I would strongly recommend doing the NBME, or at least timing oneself when doing practice questions. The exam is 2.5 hrs for 100Qs.

Lange Q&A - about 200Qs; wish I had time to do more of this as it was *really* good

CaseFiles - only about 15 cases - I found both the cases and most of the questions to be too easy and I didn't have all that much time so I gave up on CF

Two pocket books that I recommend:

Tarascon pharmacopoeia - used this a lot to look up brand names and quickly find starting doses, ramp ups and max doses to place orders in the EMR

Current Clinical Strategies Psych - I had this in my pocket but hardly used it... In the last two weeks of my rotation I thumbed through it and it seemed like a nice concise, pocket sized version of FA psych. Although I barely used it I would recommend reading it. The end had some nice pharm tables.

Elixir

PS when I was doing another pass through FA I did see that it says under OCD you don't need a compulsion, just obsession about intrusive thoughts (i.e. wanting to hurt or abuse others like the pastor in the question posted above). So that answers the debate above regarding the OCD question from the NBME.

 

[bonvivant07]

deleted

 

[Elixir6]

Anyone know the answer to this previously asked question?

Sure - the answer is B) caudate atrophy

The patient has Huntington's as evidence by the disinhibition, jerking movements and positive family history with very mild anticipation.

Also, I got my score back today! 95, which is good enough to get honors at my school.

Just an FYI the report also states that when the exam was made, the mean score was scaled to 70 w an SD of 8. Now the typical results for first time test takers is 80 SD of 9. No percentiles are listed on the report, so I think the people who posted a "percentile" are actually mis-interpreting their scaled score as a percentile.

 

[bonvivant07]

FA, Blueprints Cases, Lange Q+A psychiatry, pretest.

I found that there were quite a few questions requiring you to differentiate between depression, bereavement, and somatization d/o. Also be sure to recognize the physical features of some common MR presentation (ie. downs or fragile x) and to look for whether someone has delirium or psychosis. There were no questions on prevalence or legal issues in psychiatry. I agree with previous posters asking about side effects of meds at the receptor level. As well you should be aware of neurotransmitters in psychiatry diseases such as which one may be affected in parkinsons or alzheimer and their possible location of release. Neuro for me at most was at the level of knowing ie. locus ceruleus makes NE, raphe nucleus makes serotonin. Memorization of the DSM word for word would not be useful as often the questions lack full criteria any one diagnosis and you have to say which is the best one. Finally knowing the intoxication or withdrawal section in FA will be high yield for sure.

As a previous poster said, know neurotransmitters, like which neurotransmitters are affected by certain psychiatric illnesses.

FA: 1x plus highlights again, the pharm section about 4x
Blueprints: 1x
Lange Q&A: 1x
Pretest: 1x
Uworld: 1x plus some of the wrong ones again
NBME: 1 and 2
USMLERx for step 2: just a few of them. The stems are tiny so not representative, but its actually pretty good if you want to review pharm since UWORLD doesn't have that many questions.

Go FAST during the exam.

 

[imymemine]

it's been awhile since i took this test, but i'll add another data point:

6wk rotation (very first one), spent about 4 of those weeks studying

FA: jumped around a bunch, probably read it 2x through cumulatively.
Lange: did 100%. found many of the sections difficult. i think this was worthwhile minus the forensic chapter... i had zero forensics questions on my shelf. it was also a little too heavy on some of the epidemiology and risk %s... i can't recall a single question about epidemiology on the real shelf
UWorld: did 100% of the psych questions. this was a waste of time, the questions are way too easy.
Cases: more difficult than Uworld but not as difficult as Lange. i think it was worthwhile.
FA for step 1: definitely worthwhile

i thought the test was very difficult and i felt very defeated afterwards. i had to push myself to work at a pace i was not very comfortable working at, and i finished with only 5-10 minutes to spare.

got a 90... not a superstar score on SDN by any means but better than i thought i would get. i'm grateful for it.

i had diagnosis questions about social phobia vs panic disorder vs adjustment disorder vs specific phobia vs GAD over and over and over again. had i studied these topics harder i think i could have easily improved my score a few points. if you have one hour left to study i would focus on learning the differences between all those disorders until you know them cold. a bunch of adjustment vs acute stress vs ptsd too, but i was more prepared for those. there was a fair amount of neurology and medicine that i struggled with which for the most part came down to "is this patient's anxiety/depression caused by their medical condition or not?" not really sure what i could have done to learn those better - i don't think the sources i listed did a great job covering these topics.

 

[chicagostudent]

Need help with some NBME 1 questions...

1) 47yo man is admitted to the hospital after a motor vehicle accident. Hx of cocaine abuse and meperidine dependence. Has not used illicit drugs for 9 years. No meds. Tox screen negative for opioids, cocaine, EtOH. Extensive wound debridement and suturing planned. Best way to manage pain?
- gabapentin + amitriptyline
- ibuprofen (wrong)
- morphine
- acupuncture + cold packs
- transcutaneous electrical nerve stimulation

2) 37yo comes in for check up. He was dx'ed with alcoholic cirrhosis 3 months ago. He missed 3 appts due to transportation problems. Driver's license suspended 3mo ago for DUI. He doesn't believe his drinking is a problem but has cut down from 12 beers/day to 4 beers/day. He is disheveled and restless. States he hasn't slept well for 3 months. Pulse 96, RR 16, BP 170/90. PEX notable for peripheral edema of lower extremities. Mood is "fine," but he is irritable with poor eye contact, especially when discussing drinking. No evidence of psychosis. Serum albumin 3, Total bilirubin 2.6, Serum GGT 158 (high). Next step?
- alcohol rehab
- clonidine
- diazepam
- disulfiram
- furosemide (wrong)
- liver transplant evaluation

3) 47yo F with alcoholism presents with 12 hours of tremors and confusion. Last EtOH was 24-hr ago. She is agitated, diaphoretic, oriented x1. Thiamine, Folic acid, 3 doses of Diazepam are administered. Pt has respiratory compromise 35 min later, and pt is intubated. Mechanical ventilation is started at RR 20/min. Pt still agitated 2 hours later, pulling IV lines. HR 140, BP 160/100. Tremor of arms/legs, bilateral hyper-reflexia. Next?
- flumazenil
- haloperidol (wrong)
- phenytoin
- additional diazepam
- additional thiamine

 

[Vexare]

Need help with some NBME 1 questions...

1) 47yo man is admitted to the hospital after a motor vehicle accident. Hx of cocaine abuse and meperidine dependence. Has not used illicit drugs for 9 years. No meds. Tox screen negative for opioids, cocaine, EtOH. Extensive wound debridement and suturing planned. Best way to manage pain?
- gabapentin + amitriptyline
- ibuprofen (wrong)
- morphine (Forget about his history of drug abuse. The pt. has been in a MVA and needs immediate pain management. None of the other options would be appropriate for that level of pain severity.)
- acupuncture + cold packs
- transcutaneous electrical nerve stimulation

2) 37yo comes in for check up. He was dx'ed with alcoholic cirrhosis 3 months ago. He missed 3 appts due to transportation problems. Driver's license suspended 3mo ago for DUI. He doesn't believe his drinking is a problem but has cut down from 12 beers/day to 4 beers/day. He is disheveled and restless. States he hasn't slept well for 3 months. Pulse 96, RR 16, BP 170/90. PEX notable for peripheral edema of lower extremities. Mood is "fine," but he is irritable with poor eye contact, especially when discussing drinking. No evidence of psychosis. Serum albumin 3, Total bilirubin 2.6, Serum GGT 158 (high). Next step?
- alcohol rehab (Pt. has signs of alcohol abuse and possible dependence. Address the underlying problem w/ rehab.)
- clonidine
- diazepam
- disulfiram
- furosemide (wrong)
- liver transplant evaluation

3) 47yo F with alcoholism presents with 12 hours of tremors and confusion. Last EtOH was 24-hr ago. She is agitated, diaphoretic, oriented x1. Thiamine, Folic acid, 3 doses of Diazepam are administered. Pt has respiratory compromise 35 min later, and pt is intubated. Mechanical ventilation is started at RR 20/min. Pt still agitated 2 hours later, pulling IV lines. HR 140, BP 160/100. Tremor of arms/legs, bilateral hyper-reflexia. Next?
- flumazenil (Resp. compromise leading to intubation 35 min. after 3 doses of diazepam = you gave too much benzos. Reverse it w/ flumazenil.)
- haloperidol (wrong)
- phenytoin
- additional diazepam
- additional thiamine

 

[chicagostudent]

thanks a bunch for the quick response!

f/u Q:
2) should you not first take care of the very high BP, peripheral edema, etc before considering rehab as the next step?? (though in real life I imagine you'd do them simultaneously)

3) I guess I was confused because the pt is "still agitated 2 hours later, pulling IV lines" with high BP, high HR, tremor, etc... so I thought he was still in EtOH withdrawal... no?

 

[notbobtrustme]

99 on the shelf.

easy as pie, don't overstudy for this. FA Step 1 psych section + FA for psych clerkship.

It's pretty straightforward, some random minutia and lots of differentiating between disorders (eg MDD vs adjustment, schizoaffective vs schizophrenic). My exam didn't have very much pharm on it and it was all basic stuff like leaky tits = risperidone or severe rebound hypertension after clonidine withdrawal. Know the textbook stuff.

 

[spik]

I went through Lange Q&A Psychiatry during the last week of my clerkship and scored a 99 on the shelf.

 

[spik]

I know this has been asked a few times already but I don't think there's been a clear answer. Anyway, is the 10th edition of Lange Q&A worth the difference in price or is the 9th edition adequate?

Yes, get the 10th edition.

 

[Pericyclic]

Psych shelf is no joke, study hard for it!! Used Lange, Uworld, FAx2 and NBME...NBME and FA most helpful. Lots of incomplete criteria with 2 close dx that you have to distinguish (ie is this lady adjustment or straight up depressed), long stems make it mentally taxing and hard to get through since every detail matters in the prompts.
-Surprising amount of neurology/ classic neuroanatomy (where in the brain is the problem if X disease) of neuro diseases that can manifest with psych complaints.
- Know the pediatric mental disorders well, milestones not that important
- Know classic non-psych drugs that have psych SE
-Worth it to see what others posted on this thread, saw many relevant points on the actual thing
- know when to give a benzo

Will see how it goes, would be interesting to see raw/scale# and national percentile correlation.

** Edit: 88 Scaled ("raw") and 78 percentile. Good enough, barely, for Honors but man that's a bad curve 0_0. Leaving the test I knew I missed 5 at least. goodluck all!

 

[Gooby]

85 raw. 69th percentile. I thought the shelf was hard. FA psych 1X. Lange Q&A 1x. My school makes us take two rotations simultaneously (alternating every 3-4 weeks for 16 weeks), and take two shelves within 3 days of one another. I had the IM shelf 3 days before this one. I got 96th percentile on that one, and certainly focused more on it during the block.

 

[Apoplexy__]

Psych shelf is no joke, study hard for it!! Used Lange, Uworld, FAx2 and NBME...NBME and FA most helpful. Lots of incomplete criteria with 2 close dx that you have to distinguish (ie is this lady adjustment or straight up depressed), long stems make it mentally taxing and hard to get through since every detail matters in the prompts.
-Surprising amount of neurology/ classic neuroanatomy (where in the brain is the problem if X disease) of neuro diseases that can manifest with psych complaints.
- Know the pediatric mental disorders well, milestones not that important
- Know classic non-psych drugs that have psych SE
-Worth it to see what others posted on this thread, saw many relevant points on the actual thing
- know when to give a benzo

Will see how it goes, would be interesting to see raw/scale# and national percentile correlation.

Seems like every other post has the opposite view on how hard to study for the Psych shelf...I happen to agree with you.

 

[stsa84]

95 raw score here. I used Case Files and Pretest exclusively. Went through CF, then PT, the CF again during my last week. I felt very prepared for the shelf, and felt that the questions I struggled most with were more neuro-based. I personally felt it to be the easiest shelf, though this seems to be a minority opinion.

 

[bypass123]

95 raw ? percentile

OnlineMedEd videos (excellent) ~ 5 hours
Lange Q&A (excellent)
Kaplan Qbank (pretty good)
Pretest (decent)
UWorld (Mediocre) Questions are significantly easier than those on the shelf. Worst specialty in qbank.
NBME 1 98
NBME 2 74

Not much neurology on mine. A lot of adjustment disorder vs schizo vs GAD vs PTSD vs etc, as many other posters have previously mentioned. Good amount of psychopharm.

 

[bluestheword]

When you say "raw score", did your school actually provide a raw score? Because mine only gave us a scaled score.

 

[bypass123]

When you say "raw score", did your school actually provide a raw score? Because mine only gave us a scaled score.

"Raw" score = scaled score provided by the NBME

 

[Cinclus]

I took the Psychiatry shelf at the end of August.
Score: 99

First Aid for the Psychiatry Clerkship is far and away the best resource for the psych shelf (I read it three times during the 8 week rotation). I also read Case Files, which I thought helped reinforce/increase understanding of a lot of the concepts, and it added on some good stuff that was missing in FA (I read this twice). I did all of the UWorld questions for psych (there are not many), but those were not overly helpful; too many defense mechanism questions and too easy; I would still recommend doing them, though; it's fast. I also did a few select chapters in the Lange question book, namely, the pharm, adult path, and child path questions. These are generally harder than the shelf, but I gleaned some good info from them. But overall, I think if you really know the info from First Aid for the Psychiatry Clerkship, you will do really well on this shelf. You could use it as your only resource and be fine.

 

[Hawked]

Anybody down for a study partner. I tend to be more focused if I know I can talk through some weird scenarios/review stuff along the way. PM me if you are interested.

 

[Tigermt]

Books used: First aid for Psych, MTB 2/3, Lange Q/A
Uworld Psych ques.
Studied hard during the 6wk rotation (try to learn as much as you can from the patients)
Took NBME practice #1 score 93

Psych shelf score: 88

My exam was pretty much straightforward. A few tricky ques here and there. The above sources are more than enough for this exam.
Good Luck

 

[DryHopped]

Took the psych shelf recently and received a 99
I used the following resources: FA for the psychiatry clerkship 3x, must have resource, covered most of what was on the shelf
Lange q&a - did every section except the ethics one, best resource for questions.
Uworld psych - easy but great for nailing down important concepts
Pretest psychiatry - decent resource for extra questions, did not do human behavior, psychotherapy, pharm, and law and ethics sections.
Nbme 1: 96
Nbme 2: 80

The test wasn't as difficult as IM or peds, but there were definitely some tricky questions however if you really know the criteria for dx and read carefully you can reason through them.

 

[StompOnStep1]

I recently took the Psych NBME. Here are my notes.

·Obviously you need to know all of the mood disorders, psychotic disorders and anxiety disorders. Most of the major diseases are going to have multiple questions on the exam and the questions may be somewhat vague where at least 2 answers seem plausible. Focus on the key distinguishing factors like age of onset (Ex. antisocial or conduct disorder), duration of symptoms (Ex. Schizophreniform vs. schizophrenia), presence or absence of loss of function (Ex. Dysthymia vs. major depression), presence/absence/type of acute stressor (Ex. Bereavement vs. depression vs. adjustment) and severity of symptoms (Ex. Hypomania vs. mania, delusional disorder vs. schizophrenia). Don’t waste time trying to memorize DSM criteria unless one of the criteria is a key buzzword that helps you differentiate it from a very similar disorder.
·For most of the questions they ask you to choose a treatment, there is only one option from each class. So learning the general indications for a class is important, but knowing the exact indications for a particular drug within a class isn’t as important. For example, you aren’t gonna have a question with 4 different SSRIs listed so learning the FDA indications for specific SSRIs compared to other SSRIs is a waste of study time. As is always the case there are only generic names on the exam which is tough because during my rotation at least we used almost exclusively the trade names for psych drugs
·Learn all of the major side effects for the psych drugs, but don’t spend too much time on the more mild side effects. For example there aren’t a lot of questions on things like nausea, small weight changes, or mild sleep changes. Know the big stuff like neuroleptic malignant syndrome, serotonin syndrome when combine 2 antidepressants without washout or add something like diphenhydramine, kidney damage from lithium, agranulocytosis with clozapine, hypertensive crisis with MAOIs,prolactin changes in typical antipsychotics, hypothyroidism with lithium, metabolic syndrome with atypical antipsychotics, seizures with bupropion in bulemics, priapism with trazodone, EPS with typical antipsychotics
·There was a fair number of “test” findings differentiating different diseases. So learn MRI findings (ventricle enlargement in Schizophrenia, gross atrophy in Alzheimer’s, caudate and frontal lobe atrophy in tourettes…), laboratory findings (like amylase in bulimics, hydroxyindoleac acid in suicidal), EEG findings and sleep study findings (decreased sleep latency in Narcolepsy, obstructive sleep apnea…). Also had 1 on Sensitivity to lactate infusion for Panic attacks
·I had a few on neurotransmitters. So learn the neurotransmitter pathophysiology of psychiatric diseases as well as the neurotransmitter mechanism of medications and illicit drugs.
·There is some Neuro stuff that is fair game so you may want to at least skim through that section in your preferred studyaid for internal med. I also had a basic neuroanatomy questions that required you to differentiate between the function of different lobes
·Tons of questions on illicit drug use. Be able to identify the drug used based on the vitals, how the pupils look and key buzzwords like “bugs crawling on their skin,” “turbinate erythema” or “conjunctival injection.” Know to use benzos in alcohol withdrawal and naloxone or methadone in opioid abuse. Be able to recognize the different stages of alcohol withdrawal in a person who has been in a hospital for some time for an unrelated health problem without access to alcohol.
·The practice NBMEs had odd poisoning questions like methanol, ethylene glycol, acetomenophen and aspirin poisoning. Learn those
·There was a surprising number of Sleep disorder questions specifically on rare disorders so learn common things like obstructive sleep apnea and narcolepsy but also look into restless leg syndrome, nightmare disorder, sleep terrors, circadian rhythm disorder, REM sleep disorder etc.
·There were also more sexual dysfunction questions than I expected so learn erectile dysfunction, vaginismus, sexual desire disorder etc.
·I had a ton of eating disorder questions on the exam, but they were pretty straight forward
·I had a couple questions on developmental milestone
·I can’t remember any personality disorder questions on the practice NBMEs, but I think there may have been some on the actual exam where those disorders were at least answer choices listed.
·Know developmental disorders like fetal alcohol, trisomy 21, autism, causes of mental ******ation etc.


Stuff not on the Exam that seems to be in many study aids:
·Zero forensics questions on my shelf or the practice NBMEs
·Zero ethics, legal or “doctoring” type questions on my shelf or the NBMEs
·Zero Freudian ego defense type questions on my shelf or the NBMEs
·I didn’t have any impulse control disorders on my real exam or practice NBME exams, but others have posted they saw 1 question on things like trichotillomania so it may still be something worth studying.
·I wouldn’t spend much time learning about the specific types of therapy. Cognitive behavioral therapy is almost always the right answer for disorders that require therapy, because it has way more evidence to support its use that other types of therapy. I think I also had a question where family therapy was the answer because much of the problem was stemming from familial stress, but they made that extremely obvious. Other than that I didn’t need to know about specific types of therapy
·No prader willi, angelman or rett on the actual exam, but they were on practice exams so I would learn them.


I have a youtube Channel called Stomp On Step 1 which covers primarily material for the Step 1 exam, but I have a section that covers Psych material that is also very relevant for the rotation NBME shelf exam. If you found this post useful you can check out the channel here https://www.youtube.com/playlist?list=PLnxX3HMtI5fkH0R4rXP9beDFA1DnOJijl Thanks!

 

[zany_brainy]

Hey guys, a few questions on NBME form 1:

1. old man with parkinsons, increasingly withdrawn and tearful in past few weeks, poor energy and decreased sleep for a couple months, on carbidopa-levodopa and pramipexole. some weight loss in past few months, worsening of resting tremor and bradykinesia since last visit. flat affect, he starts crying and says who wouldn't be sad with this damn disease i've got, he doesnt want to go anywhere because he doesn't want people to see his tremor. what is causing his findings?

-adjustment disorder with depressed mood
-side effect of carbi-levo
-dysthymic disorder
-major depressive episode
-normal reaction to chronic disease (wrong)

2. little girl with behavioral problems (tantrums, disobedience, defiance) at home with father, throws dinner plate at brother, but she's perfectly fine at day care and grandmother's house. next step in management?

-reassurance (wrong)
-parent management training
-lithium
-methylphenidate
-contact CPS

3. old man in nursing home, anxiety for 2 wks, deep sense of foreboding something bad will happen but doesn't know what, accused staff of stealing from him in past month, he had hallucinations in past month, no change in sleep or appetite. history of MDD, GAD and Parkinson. currently on venlafaxine and carbidopa-levodopa. last month his venlafaxine dose was doubled and carbi-levo increased by 50%. physical shows tremulousness, shuffling gait. no current hallucinations. next step in management?

-add risperidone (wrong)
-decrease carbi-levo
-discontinue carbi-levo
-increase carbi-levo
-increase venlafaxine

Thanks guys!

 

[notbobtrustme]

Hey guys, a few questions on NBME form 1:

1. old man with parkinsons, increasingly withdrawn and tearful in past few weeks, poor energy and decreased sleep for a couple months, on carbidopa-levodopa and pramipexole. some weight loss in past few months, worsening of resting tremor and bradykinesia since last visit. flat affect, he starts crying and says who wouldn't be sad with this damn disease i've got, he doesnt want to go anywhere because he doesn't want people to see his tremor. what is causing his findings?

-adjustment disorder with depressed mood
-side effect of carbi-levo
-dysthymic disorder
-major depressive episode
-normal reaction to chronic disease (wrong)

2. little girl with behavioral problems (tantrums, disobedience, defiance) at home with father, throws dinner plate at brother, but she's perfectly fine at day care and grandmother's house. next step in management?

-reassurance (wrong)
-parent management training
-lithium
-methylphenidate
-contact CPS

3. old man in nursing home, anxiety for 2 wks, deep sense of foreboding something bad will happen but doesn't know what, accused staff of stealing from him in past month, he had hallucinations in past month, no change in sleep or appetite. history of MDD, GAD and Parkinson. currently on venlafaxine and carbidopa-levodopa. last month his venlafaxine dose was doubled and carbi-levo increased by 50%. physical shows tremulousness, shuffling gait. no current hallucinations. next step in management?

-add risperidone (wrong)
-decrease carbi-levo
-discontinue carbi-levo
-increase carbi-levo
-increase venlafaxine

Thanks guys!

1. sounds like D, he's depressed. tons of people cope with chronic diseases, but he's past that.

2. parent management training. dad doesn't know how to deal with the kid, but she's fine elsewhere. she's taking advantage of dad's incompetence.

3. dude has lewy body dementia, pretty sure its d/c carbi-levo, since it won't help him.

 

[4thQTHailMary]

3rd one is decrease carbidopa-levodopa. As a general rule for the NBMEs, I feel like any time there is a situation where they recently increased the doses and the pt. starts having adverse effects, most of the time the answer is decrease the meds.

 

[zany_brainy]

1. sounds like D, he's depressed. tons of people cope with chronic diseases, but he's past that.

2. parent management training. dad doesn't know how to deal with the kid, but she's fine elsewhere. she's taking advantage of dad's incompetence.

3. dude has lewy body dementia, pretty sure its d/c carbi-levo, since it won't help him.

Thanks!

 

[zany_brainy]

I took the exam recently. Ended up with a 98

Books used:
FA for psych- this is the only resource that you have to use. it covered most of what was on my test
Lange Q&A- good for additional questions
UW psych- good to learn the easier psych concepts, but there are way too many ethics questions. I only had like 2 ethics questions on my shelf
NBME forms 1 and 2- got 98 on both (which is what I got on my shelf), got a few repeat concepts on my exam

Most of the test was distinguishing between very similar mood, anxiety and psychotic disorders. FA for psych was good enough to be able to tell them apart. I barely got any pharm on my exam. A couple of medical illnesses presenting as psych complaints and a couple of medication induced psych illness. A good amount of substance overdose/withdrawal questions. A decent amount of neuro questions on my exam, which I was surprised about, but I couldn't have prepared for those questions anyway unless I studied a neuro review book.

Overall, I felt that it was the easiest shelf I have had all year, just because there isn't much material to know. That doesn't mean you can take it easy and not study, but you don't have to bust your ass to do well.

 

[4thQTHailMary]

Took it within the last couple of weeks.

FA- x2. Really thought the second time was a little overkill, especially if you read it the first time near the end, but it probably helped me catch a few details on the exam.

Uworld- Pretty much useless.

Lange Book- All of it. Thought it was good in covering stuff not covered by FA.

Case Files- Read this early on. Good introduction. Not really necessary though.

Ramahi Psych PPT- EXCELLENT for developmental stuff. A lot of quick hitters.

NBME 1: 98
NBME 2: 80

Shelf: 97

It was posted on the previous page, but I got at least 3 questions from the old post that was re-quoted by another poster. Would highly suggest skimming through this thread. Thought the real deal was somewhere between NBME 1 and 2, and really, the Ddx was much easier than NBME 2, imo. Some random stuff but that's to be expected. A lot of illegal drug intox/withdrawal, and some minimal NA that was very easy- all of which was covered in FA.

 

[Enzymes]

Does anyone have any tips for how to distinguish Bereavement vs. MDD vs. Adjustment disorder? Whenever adjustment disorder is in the answer chioces, I always seem to get the question wrong! Thanks!

 

[Apoplexy__]

...

On top of Vexare's excellent explanations, I also wanted to draw your attention to the fact that the patient with hallucinogen intoxication had a negative tox screen. Hallucinogens are really the only substance of abuse that can't be ruled out with a tox screen.

 

[Newyorkgiants]

recently took the exam and thought it was comparable to the NBME. Had a lot of difficult questions where answer choices where drug (medication) induced psychosis. How can one differentiate between drug induced vs schizophrenia?

 

[Enzymes]

Just FYI regarding Vexare's response: The answer to the 24 year old taking sertraline is actually b: Maintain the current dosage of sertraline and schedule weekly f/u examinations for the next month.

My thought process was that the med is working alright, but there is still a significant problem...sleep disturbances. I would want to follow up with the patient sooner than 4 months about this issue...

 

[Enzymes]

That's what I picked as well... is that what NBME says is the correct answer?

Yeah, cuz that's what I put and I didn't get it wrong.

 

[Winged Scapula]

Posting of actual test questions is a TOS standardized test violation. Please refrain from doing so.

 

[medstudent7860]

Can fluoxetine cause amenorrhea? And can carabidopa-levodopa cause psychosis?

 

[Cytarabine]

Can fluoxetine cause amenorrhea? And can carabidopa-levodopa cause psychosis?

I'd never heard of the first, lexicomp says <1%. Yes to the second

 

[Cytarabine]

Is the legal and ethics chapter in lange worth doing?