I did take it. I thought Lange was pretty useful, I guess, but honestly, it was a weirder test than I thought. There was a bunch of peds stuff that was a little out there -- not even really peds psych stuff. Lange was definitely good, but not as representative of what I saw on the exam. I was surprised. Overall, I would say Lange and UWorld were the most useful sources.
If you or anybody else can help with the following questions I'd really appreciate it as I'm close to my Shelf:
1. A 42-year-old woman, gravida 1, para 1, comes to the physician because of a 5-month history of increasingly severe episodes of lower abdominal pain. The pain is exacerbated during bowel movements, sexual intercourse, and menses. Treatment with several analgesics has not controlled the pain. Laparoscopy 4 years ago and a second laparoscopy 2 years ago for evaluation of pain showed no abnormalities. She is sexually active with one male partner, and they use condoms for contraception. She is a single parent and lost her job 6 months ago.She now has difficulty sleeping 1 to 3 nights each week because she worries about finding a job. Abdominal examination shows tenderness in both lower quadrants. Pelvic examination shows a mobile, nontender uterus and normal, nontender adnexa. A complete blood count, erythrocyte sedimentation rate, Pap smear, and urine and cervical cultures show no abnormalities. Which of the following is the most appropriate next step to determine the cause of this patient's pain?
A) MRI of the pelvis
B) Psychiatric assessment
C) Hysteroscopy
D) Laparoscopy
E) Endometrial biopsy
The answer is not A
2. A 32-year-old woman comes to the physician because of increasingly severe pain that originates in her left shoulder and radiates to her elbow. She describes the pain as constant and burning, rating her current pain as a 7 on a 10-point scale. Eighteen months ago, she sustained a nerve injury of the left upper extremity in a motor vehicle collision. Since that time, she has been unable to return to work. Current medications include oxycodone and gabapentin. Physical examination shows atrophy of the left thenar eminence. Muscle strength in the leftforearm and finger flexors is 3/5. On sensory examination, there is severe pain with light stroking of the anterolateral aspect of the left arm. Further sensory testing is deferred. During the examination she tells her physician, "I'm tired of all this. My medication is not strong enough. It only takes the edge off my pain, which is only getting worse. I'm realizing I'll be like this forever." Which of the following is the most appropriate response by the physician?
A) "Are you worried about more nerve damage developing?"
B) "Do you ever use more pain medication than is prescribed?"
C) "Have you been feeling like just giving up?"
D) "Is the pain caused by touch socially limiting?"
E) "Let's review your medical concerns."
The answer is not E
3. A 47-year-old man is brought to the physician by his wife because of "unbearable" behavior during the past 2 weeks. His wife reports that he has been talking about his various inventions constantly and recently bought a new recreational vehicle, even though they do not travel long distances. He repeatedly tells his wife that "the time to make and enjoy money has come." He has been openly critical of their pastor's prayers during church services. He claims that the pastor does not know what he is talking about because "God is talking to me, not him." His wife says that he has had episodes of similar behavior during the past 10 years that have been more tolerable. He has peptic ulcer disease treated with ranitidine and hypertension treated with triamterene. He does not smoke or drink alcohol. He is 170 cm (5 ft 7 in) tall and weighs 82 kg (180 lb); BMI is 28 kg/m2. His pulse is 80/min, and blood pressure is 150/95 mm Hg. Physical examination shows no other abnormalities. On mental status examination, he is relaxed and talkative, jumping from one topic to another. He claims that his wife does not understand him and that she has been plotting with the pastor against him. He denies any problems and says that he feels great and is capable of great things. Laboratory findings are within the reference range. Urine toxicology screening is positive for marijuana. Which of the following is the most likely diagnosis?
A) Bipolar disorder
B) Delusional disorder
C) Mood disorder due to a general medical condition
D) Schizophrenia
E) Substance-induced mood disorder
The answer is not E
4. Five weeks after being discharged from the hospital after treatment for a psychotic episode, a 27-year-old man comes to the physician for a follow-up examination. During hospitalization, he claimed that he was instructed by the Lord to found a new religion and that a famous gospel singer was in love with him. Today, he says that he still hears the voices of the Lord and members of the church he attends in his apartment and when he shops in the supermarket. He no longer believes the world needs a new religion because the Lord is no longer instructing him to create one. He states, "My father in heaven tells me that he is at peace, and therefore, so am I." Current medications include risperidone and lorazepam. He drinks one to two beers on weekends. He used marijuana regularly in college but has abstained for the past 5 years. He appears clean and is casually dressed. His temperature is 36.7°C (98°F), pulse is 72/min, respirations are 20/min, and blood pressure is 130/72 mm Hg. Physical examination shows no abnormalities. Mental status examination shows a calm affect. He is cooperative, alert, and oriented to person, place, and time. Based on this information, which of the following is the most likely current diagnosis for this patient?
A) Bipolar disorder
B) Cyclothymic disorder
C) Delusional disorder
D) Schizoaffective disorder
E) Substance-induced mood disorder
The answer is not A
5. A 57-year-old woman comes to the physician because of difficulty sleeping, tearfulness, and restlessness since her daughter was diagnosed with metastatic breast cancer 3 days ago. She reports that when she goes to bed at night, she is unable to fall asleep for several hours and lays in bed worrying about her daughter's situation. The patient underwent a mastectomy for breast cancer 7 years ago. She takes acetaminophen/butalbital for occasional migraines. Her vital signs are within normal limits. Physical examination shows no abnormalities. On mental status examination, she is tearful and tense but calms during the conversation. There is no evidence of suicidal ideation. Which of the following is the most appropriate next step in management?
A) Biofeedback
B) Carbamazepine therapy
C) Clonazepam therapy
D) Clonidine therapy
E) Imipramine therapy
F) Olanzapine therapy
G) Pentobarbital therapy
H) Sertraline therapy
The answer is not A
6. A 13-year-old girl is brought to the physician by her father for a well-child examination. He is concerned about her weight and eating habits. He says that she is always "on the go" and never sits down for a full meal. She will often just grab a piece of fruit when she is on her way to an activity. She will eat a full meal when the family has dinner together every Sunday. She has talked about wanting to become a vegetarian because of her concern for animals. She has had the same group of friends since elementary school. She is the captain of her soccer team and practices 4 days weekly. She is active in an after-school drama program 3 days weekly and is the lead in this season's play. She maintains a B grade average. Her father says that she talks on the telephone "constantly" and is animated and cheerful most of the time. When she is in her bedroom, she prefers to keep the door closed and stops talking if she is on the telephone and her father walks into the room. She has a disorganized bedroom and often falls fast asleep on a bed covered with piles of clothes. Menarche has not occurred. She appears thin and muscular. She is at the 50th percentile for height and 35th percentile for weight, which is unchanged from last year. Vital signs are within normal limits. Breast and pubic hair development are Tanner stage 2. Physical examination shows no abnormalities. When interviewed alone, she is animated. She shrugs and rolls her eyes when asked about her diet and weight. She thinks she is fine and does not understand why her father is so upset. Which of the following is the most appropriate next step?
A) Reassure the father that this is normal development
B) Recommend individual psychotherapy
C) Recommend nutritional counseling
D) Recommend that the father keep a log of what his daughter eats
E) Schedule weekly examination and weighing
7. A 27-year-old woman comes to the physician for an examination prior to starting a new job. She has a 10-year history of binge-eating and self-induced vomiting. She takes no medications. She does not drink alcohol or use illicit drugs. She is 178 cm (5 ft 10 in) tall and weighs 72 kg (160 lb); BMI is 23 kg/m2. Her temperature is 37°C (98.6°F), pulse is 70/min, respirations are 10/min, and blood pressure is 120/70 mm Hg. Physical examination shows yellow dental enamel and abdominal striae. Serum studies are most likely to show which of the following abnormalities?
A) Decreased bicarbonate concentration
B) Increased amylase activity
C) Increased magnesium concentration
D) Increased potassium concentration
E) Increased sodium concentration
