Psych Shelf Exam

[betz]

99th percentile, used lange, pretest, bluprints and UCV. lange is by far the best

how do you know your percentile? I thought they dont give percentiles...

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[Pox in a box]

Seems like there is no consensus book for this rotation. Any suggestions?

 

[monkey7247]

The Psych shelf was NOT easy. I used BRS, High-yield, and Pre-test and all in all, I'd say that the test was difficult mainly b/c you really couldn't study for it very well with just psych resources. Be prepared for tons of questions about medical issues such as delirium, treatment of substance withdrawal, etc. There is very little on stages of development - it's more important to know the differential of diagnoses. Also Pharm is on there big-time. G'luck - I'll let you know how I fared...(fingers crossed)

Funny, I found the psych exam to be the easiet shelf exam that I took third year. Raw score 98, 99th percentile (this is nowhere near my normal score on shelf exams). Studied only with blueprints. I found the questions in blueprints to be very representative of what was on the test.

Looking back, I think the didactics I received while on the rotation were very good and likely helped my score. Good luck to everyone taking the test.

 

[Pox in a box]

Are pharm drugs on the shelf?

 

[lattimer13]

Are pharm drugs on the shelf?

yes...seriously, i remember haldol being the answer to at least 4-5 questions...mostly saying the patient was prescribed a drug and this side effect happened...what was the most likely drug? really straightforward stuff. after ob/gyn, medicine, and psych, psych was by far the easiest shelf exam.

 

[4424]

I'm not a huge First Aid user, but I liked FIrst aid for psych. It's a really quick read and was very helpful for the drugs. There was tons of pharm on the shelf for me.

 

[Pox in a box]

Okay this is what I got raw score 80, and my school told me my percentile rank is 74. For some reason this doesn't seem right, maybe denial on my behalf. Was a little dissapointed with the percentile rank, I was under the impression that the averages for shelf exams are in the 70s with a SD of 7-9. Oh well, what I used, Blueprints, A&L and pretests. This was my first rotation after step 1 so was a little burnt out on studying and going threw problems with gf. Should of done the questions I got wrong over again but didn't have enough time, was to busy going out trying to pick up on girls during brake up with my gf.

Hey LD, which sources do you recommend over others? Wish you'd used others? Did you feel like the exam was longer/shorter/about the same as other shelf exams now that you've taken a few more? Thanks.

Mad props for your game...

 

[bigfrank]

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.....

Best advice I've seen for this exam yet.

 

[tigershark]

how do you know your percentile? I thought they dont give percentiles...

The NBME sends a score report with your raw score (the two-digit score) and what percentile that correlates to. Not all schools give you this score report though, unless you ask for it.

 

[lattimer13]

Best advice I've seen for this exam yet.

 

[murph79]

Psych shelf was easy, Doc07 doesn't know what they are talking about. Just do a bunch of practice questions from pre-test.

 

[xaelia]

... bump ... for more recent insights.

 

[CallawayDoc]

just took it a few days ago and i thought first-aid for the psych clerkship covered almost everthing that you needed to know. i also thought pre-test (although very easy questions) was helpful.

there were more dementia/delerium questions than i expected and less psychopharm (mostly give SSRI or someone with dystonia has been given what?).

adjustment vs. bereavement vs. MDD was there several times.

child psych was there mostly as ODD vs. ADHD vs. conduct disorder, etc. this is also where most of the "which type of psychotherapy" q's showed up.

neuroscience lite-MRI/gross path changes in certain diseases.

overall i thought it was pretty straightforward and one of the easier shelf exams.

 

[grandeelmd]

is it worth it to spend time on the various theories?

 

[4424]

is it worth it to spend time on the various theories?

no, i don't recall any questions on theories

 

[grandeelmd]

no, i don't recall any questions on theories

thanks, I'm doing pre-test now and with the exception of the chapter that talks about everyone's theories as to how people get screwed up, it seems pretty easy...I assume the shelf is more difficult and convoluted though..

 

[tr]

thanks, I'm doing pre-test now and with the exception of the chapter that talks about everyone's theories as to how people get screwed up, it seems pretty easy...I assume the shelf is more difficult and convoluted though..

I didn't find the shelf much more convoluted than Pre-Test; but it was much more medical and much less psychological.

There wasn't a single question on mine from psychodynamic theory. I would say that 40% of the questions were straight psych, 40% were psych/med, and 20% were random non-psych questions (mostly neuro: I remember one on brain tumor, one on drug toxicity, etc.).

I don't think you can really study for the random stuff because the pool of areas from which they could draw questions is so large that it would be impossible to anticipate what to study for. I think if you just know your psych really well (esp. length-of-time and number-of-symptoms criteria from DSM-IV, indications for specific drugs, and major side effects) and have some medical common sense, you should be fine.

 

[xaelia]

I did A&L and Pretest for questions; I thought A&L had better questions, but both are valuable if you get through them both. I think I've seen this mentioned on other posts, but a lot of shelf questions seem to be emergency medicine/primary care management at the level of what an intern should theoretically know so they don't seriously harm anyone. The developmental theory was not featured on my shelf at all. I ended up with my score being reported as a 98, whatever that means.

 

[grandeelmd]

I did A&L and Pretest for questions; I thought A&L had better questions, but both are valuable if you get through them both. I think I've seen this mentioned on other posts, but a lot of shelf questions seem to be emergency medicine/primary care management at the level of what an intern should theoretically know so they don't seriously harm anyone. The developmental theory was not featured on my shelf at all. I ended up with my score being reported as a 98, whatever that means.

that's useful info xaelia and tr, thanks...out of curiosity, when did you guys take the test?

 

[kgal1]

when people say that appleton and lange is good for questions
are u guys talking about appleton and lange's practice test : psychiatry or appleton and lange's review of psychiatry...

thanks!

 

[ned]

Does anyone know if trade names are listed alongside the generics on the psych shelf??? Any help you could give me would be very much appreciated.

Thanks!

 

[Dr. Will]

Does anyone know if trade names are listed alongside the generics on the psych shelf??? Any help you could give me would be very much appreciated.

Thanks!

Only generic names are used.

 

[ned]

Thanks for the response... I could have sworn we were given the trade names on the ob/gyn shelf I took. But it's possible I am wrong.

Did you take the test this year?

 

[Rbrav]

Holy crap, this thing was evil. I studied like crazy (Blueprints 4 times, First Aid 3 times, Case Files 1.5 times, all of PreTest, almost all of A&L question book), and I still felt like I didn't know anything. DDx is key -- almost NOTHING presented as straightforwardly as it did in all the practice questions I saw. For example, I ended up putting "delusional disorder" three times because nothing else seemed to fit -- the patient was way too old to be a new-onset schizophrenic, or there were no mood findings, or no AVH, etc. It was ridiculous.

Since I don't want to go into too much detail, I'll just say know pharm issues cold (both indications and side effects).

Man, I hope I did better than I feel. I put in an insane amount of effort studying for this thing, and I feel like crap.

 

[zeloc]

Is it important to know the typical side effects for every drug for this test? For example, GI side effects and sexual dysfunction for SSRIs, weight gain and sedation for TCAs? Or just the major ones, like agranulocytosis and seizures with clozapine?

 

[Rbrav]

OK, I may have felt like crap leaving the shelf, but all the studying did pay off. I got a raw score of 89 on it, which is by far the best I've done on any shelf this year.

 

[MNDOC31]

Which book did people find more useful, Blueprints or FA Psych? It seems like people are either for or against Blueprints. Is FA Psych more detailed and complete than Blueprints? I plan on doing pretest questions and probably Lange ?'s but would also look to read something as a foundation. Also, I saw Lange Q&A came out with a new edition, anyone think that the new edition is any better or would the old edition suffice?

 

[46&2]

First Aid for Psych = more detailed and complete. I read Blueprints in 3 days (it's <150 pages, with a Q&A at the end) and found it a DSM rehash. Wasn't impressed with Lange or Pretest, but Blueprints Q&A was surprisingly good. The hardest part of the shelf isn't the psych, but all the general medical conditions that can mask as psych issues (30% of the test). A grasp of internal med (esp. neuro) is handy, and only NMS if I remember even touches it.

 

[stanford05]

finished the shelf a little while back.. used NMS, which I thought was pretty good. also used Pretest (ok, but too much emphasis on people's names, particular forms of therapy), Case files (useful...), and A&L qbook (wayy too detail oriented, but might be worth doing). the best practice questions i thought were from the kaplan usmle step 2/3 qbooks.

g'luck.

 

[medicinehopeful]

hey all,
i'm trying to get a hang of how to study during third year since schedules are obviously different form second year. when should i start studying for the shelf exam? for instance, do i start doing the lange question book during the first week or do i wait until three weeks into the clerkship? also, is there a certain schedule that you all have followed with reading blueprints or whatever other book you chose to read? i've read that blueprints can be read in about 3 days (i think). so, is it wise to read blueprints during week one? or should i read a little each week?
sorry for all the questions. but the clerkship is just 6 weeks long. and i'm not the type of person that can "catch up" at the end or do a lot of cramming. thanks in advance.

 

[SBlanc]

hey all,
i'm trying to get a hang of how to study during third year since schedules are obviously different form second year. when should i start studying for the shelf exam? for instance, do i start doing the lange question book during the first week or do i wait until three weeks into the clerkship? also, is there a certain schedule that you all have followed with reading blueprints or whatever other book you chose to read? i've read that blueprints can be read in about 3 days (i think). so, is it wise to read blueprints during week one? or should i read a little each week?
sorry for all the questions. but the clerkship is just 6 weeks long. and i'm not the type of person that can "catch up" at the end or do a lot of cramming. thanks in advance.

Welcome to the wards... So studying on rotations is different because you're not only studying for the exam at the end, but also to impress your residents/attendings throughout the actual rotation, since usually your evals count at least as much as your shelf exam grade. so generally your studying is more spread out over the whole block of time, with concentrated shelf-specific studying toward the end.

So in general I think a good plan would be to go through something like Blueprints in its entirity within the first week of the rotation, just to give you an exposure to a wide range of what you might encounter during psych. Hopefully that will also give you some tidbits to help answer pimping questions early on. Generally, in my experience (i'm now an M4), your studying on weekdays might be focused more on your patients (like if you pick up a patient with depression, you should read as much as you can on depression and treatments that night). Then on the weekends you can fit in time for general shelf studying on stuff you're not necessarily seeing on the wards. Case Files is always a good resource to carry around with you and go through a case or two whenever there's down time (waiting for the attending, waiting for a consult, etc.).

That's been my experience, although I know it differs greatly, but hopefully that gives you a general idea. The main thing to realize is that no longer can all studying be put off - your "fund of knowledge" is being evaluated from day one.

 

[Dunce]

So in general I think a good plan would be to go through something like Blueprints in its entirity within the first week of the rotation, just to give you an exposure to a wide range of what you might encounter during psych.

That is great advice, and I agree completely -- except I would say to get through First Aid Psych during that first week.

Regardless, quickly going through some high yield review info in the first week of a rotation is an amazing habit to get into. It took me awhile to figure that out on my own. Trust me. Work hard for a few days at the beginning, and you will be able to get so much more out of the rotation.

 

[medicinehopeful]

thanks for the advice. i probably wouldnt have read a book the first week of the rotation, but it now actually sounds like a great idea. i have one more question. i'm trying to decide what books to buy. for practice questions - pretest, a&l. for actually reviewing - blueprints and first aid. do most people buy both blueprints and first aid. or just one? whats the advantage/disadvantage of going either way? thanks.

 

[medicinehopeful]

bump

 

[medicinehopeful]

a question about the psych shelf. i have been reading first aid for psych clerkship and blueprints. as i look at the pretest questions, i realize that there are a bunch of questions where the answers weren't covered one of those books. is this something to worry about? or do you also use pretest as a learning tool for the shelf?

 

[Medstudentquest]

Maybe one or two questions about nomal child development. Same with theories. But there is a TON of med/psych questions. The psych shelf is tough. Don't underestimate it.

Yes I agree. I thought it was quite tough, and so long! It took my grade from a clinical outstanding to an advanced! I missed the outstanding by 7 points or so! Oh the pain!!!

 

[SwissB4]

Is First Aid for Psych only good enough for the shelf??

 

[nockamura]

The test sucked. I'm a very fast test-taker usually, but I finished this exam with only 12 minutes to spare. I would definitely recommend memorizing those Blue and Green booklets and FA and then do some questions too. I have no idea how I did, but I wasn't feeling great about it. I was feeling pretty confident before taking it too.

 

[Sureshot83]

I have the psych shelf in just under two weeks, and I just started to study recently. My question is: what exactly is the difference between the 3rd year psych rotation shelf and the behavioral science shelf that you would take in first or second year? I've read through a fair amount of first aid for psych, and i would estimate that 95% of the info was covered in BRS behavioral science and the behavioral science shelf exam that we had in 2nd year.

Is the psych shelf very similar to that test? If not, what's the difference? Thanks for the help.

 

[sga814]

CASE FILES should be in that poll

 

[CanIMakeIt]

Does anyone know what was national mean/SD for people who took psych shelf around Dec 20th.

Thanks.

 

[Bob2009]

I wanted to give you a little feedback about the shelf. I got a raw of 86%, I believe the national average was 78%. The advice given in previous posts was helpful, and I'll try and add onto that. I thought the test was pretty fair, there were less pharm questions than I expected. Most of the pharm was regarding how to manage a specific illness. Not much side effect profiles, and if there were, they were pretty trivial... FA psych was enough drug info. The majority of the exam revolved around diagnosing patients. It was important to know how long it takes to diagnose a patient.

MDD = 2 weeks
Schizophrenia = 6 months
Schizophreniform = <6 months
PTSD = 1 month
Acute stress disorder = <1 month
Adjustment disorder = begins within 3 months, not life threatening
GAD = 6 months
Encopresis / Bed wetting = normal age vs. pathologic
Dysthmia = 2 years
Cyclothymia = 2 years
Acute psychotic episode = <1 month i believe


1. Lots of Bereavement vs. MDD vs. Adjustment disorder.

2. Sexual problems... age related impotence vs. alcohol related impotence vs. anxiety related impotence. The time line presented in the stem was confusing but was the key to answering it.

3. PTSD vs. Acute stress d/o vs. Adjustment d/o. A decent amount of this stuff.

4. ASA OD, Methanol poisoning, Heroin OD, Heroin withdrawal

5. Pain d/o vs. Somatization vs. malingering vs. factitious vs. conversion... more of these questions than i anticipated. important to know the criteria for somatization d/o.

6. Treating dystonia, akathisia, parkinsonism, Lithium OD

7. ODD vs. ADHD vs. conduct disorder... differentiating and how to treat... behavior modification.

8. Side effects... as said in a previous post...SSRI has GI and sexual SEs... TCAs weight gain and sedation and arrythmias... Clozapine Carbamazepine has agranulocytosis, seizures with Clozapine.

9. Delerium vs. Dementia in a couple of questions.

10. MDD vs. Dysthmia vs. Bipolar I vs. Bipolar II vs. cyclothymia... not as many questions as i had hoped, maybe about seven.

11. Schizophrenia vs. schizophreniform vs. brief psychotic episode... not nearly as much as i had hoped, but a few. most question stems involved freshman in college with delusions.

I used First Aid psych and Lange Q&A's, First Aid was hands down the best preparation material, I read it about twice. Best of luck.

 

[CanIMakeIt]

that was pretty much my exam as well (not the score though )

 

[USMELL]

I wanted to give you a little feedback about the shelf. I got a raw of 86%, I believe the national average was 78%. The advice given in previous posts was helpful, and I'll try and add onto that. I thought the test was pretty fair, there were less pharm questions than I expected. Most of the pharm was regarding how to manage a specific illness. Not much side effect profiles, and if there were, they were pretty trivial... FA psych was enough drug info. The majority of the exam revolved around diagnosing patients. It was important to know how long it takes to diagnose a patient.

MDD = 2 weeks
Schizophrenia = 6 months
Schizophreniform = <6 months
PTSD = 1 month
Acute stress disorder = <1 month
Adjustment disorder = begins within 3 months, not life threatening
GAD = 6 months
Encopresis / Bed wetting = normal age vs. pathologic
Dysthmia = 2 years
Cyclothymia = 2 years
Acute psychotic episode = <1 month i believe


1. Lots of Bereavement vs. MDD vs. Adjustment disorder.

2. Sexual problems... age related impotence vs. alcohol related impotence vs. anxiety related impotence. The time line presented in the stem was confusing but was the key to answering it.

3. PTSD vs. Acute stress d/o vs. Adjustment d/o. A decent amount of this stuff.

4. ASA OD, Methanol poisoning, Heroin OD, Heroin withdrawal

5. Pain d/o vs. Somatization vs. malingering vs. factitious vs. conversion... more of these questions than i anticipated. important to know the criteria for somatization d/o.

6. Treating dystonia, akathisia, parkinsonism, Lithium OD

7. ODD vs. ADHD vs. conduct disorder... differentiating and how to treat... behavior modification.

8. Side effects... as said in a previous post...SSRI has GI and sexual SEs... TCAs weight gain and sedation and arrythmias... Clozapine Carbamazepine has agranulocytosis, seizures with Clozapine.

9. Delerium vs. Dementia in a couple of questions.

10. MDD vs. Dysthmia vs. Bipolar I vs. Bipolar II vs. cyclothymia... not as many questions as i had hoped, maybe about seven.

11. Schizophrenia vs. schizophreniform vs. brief psychotic episode... not nearly as much as i had hoped, but a few. most question stems involved freshman in college with delusions.

I used First Aid psych and Lange Q&A's, First Aid was hands down the best preparation material, I read it about twice. Best of luck.

what percentile is an 86? If you don't mind me asking?

 

[Ypo.]

Bumpity bump.


Anyone know which Lange book are people talking about in this thread: the review book or the question book?

 

[153445]

I believe it's the question book, which is pretty good. You wouldn't need any other review book except FA.

 

[Thievery Corp.]

I've been using case files to study for this exam. It seems fairely detailed, which is fine. Has anyone felt that this book did not serve them well on the exam?

 

[deuist]

I took the Shelf exam for psychiatry today. Here's what I noticed. There are a lot of questions relating to drug mechanisms as well as medical conditions that cause psychiatric illness. As another poster mentioned, you will need to know the DSM criteria for many diagnoses (for example: schizophrenia > 6 months, schizophrenic form = 1-6 months, brief psychotic disorder < 1 month). You do not need to know the differences between individual drugs, but you do need to know all the drugs that belong to each class. You certainly need to know the indications for starting pharmacotherapy and what the drawbacks will be for each treatment.

I used First Aid, PreTest, and read a bit from Psychiatry Made Ridiculously Simple. I found that First Aid was the best source and covered all the material. PreTest had nitpicky questions and went way overboard with its child development and series of psychiatry chapters. The information from Erickson versus Freud versus Piaget was not tested. Psychiatry Made Ridiculously Simple is not meant for the Shelf exam. The book was written primarily for clinicians to get an understanding of the field.

 

[Rustychubbie]

Hello,

does anyone know if there were "legal issues in psychiatry" type questions on this thing? What about different defense mechanisms and defense mechanisms used by specific disorders?

 

[deuist]

I got a few ethics questions. I don't remember any defense mechanism questions, but they're all fair game.