Is my whole life a lie? (CSSA form 7)

[SpecterGT260]

Seriously... I am working through the ones I missed and between myself, uptodate, and about a dozen prep books, and good ol fashioned google, I cannot come up with why most of these are wrong. I did pretty well on step1 and have been hitting at or above average on the random UWorld sets I do. Anyone else do this assessment and feel like they ask some pretty random crap with some pretty ridiculous stems? Also... I feel like several of their answers are just plain wrong...

You do get yourself a quick Doppler US when suspecting testicular torsion prior to calling the surgeon, right?

For suspected meningitis, LP > Head CT and LP should be first, right?

I'm sure I'll come across some others that I just cannot reconcile as I go through this...

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[AnxietyAnnie]

Is this the only thread on CCSSA Form 7? I haven't found any others

I also got a much lower score than I was expecting. I'm glad I'm not alone!

I'm going over my wrong answers, and I'm not sure about a couple of them. Maybe you guys can help me out:


7) 20-year-old man with psychotic behavior for the past year + hyperreflexia + resting tremor. Diagnosed with hypothyroidism 6 months ago, now treated with levothyroxine. Normal TSH, normal tox screen. How do you interpret this one? I answered psychotic disorder due to a general medical condition and it was wrong.

Thanks!

So, in question 7 the correct answer is schizophrenia but how do you explain the hand tremors and hyperreflexia? Isn't the rule that things should not be attributed to psychiatric disorders if they can be attributed to an organic one?

 

[teehees]

is there anything more to that question stem? i guess the age rules out a dementing process which is the only other thing that i can see that would cause it. Can't see why they would have tremor/hyper-reflexia

 

[AnxietyAnnie]

is there anything more to that question stem? i guess the age rules out a dementing process which is the only other thing that i can see that would cause it. Can't see why they would have tremor/hyper-reflexia

A 20-year-old man is brought to the physician for auditory hallucinations and bizarre behavior over the past year. Recently dropped out of college and moved back with his parents. He says that he feels strange, "like being in a dream", and talks to his great-great-grandfather who died 50 years ago. He was diagnosed with hepatitis A 2 years and hypothyroidism 6 months ago that is being treated with thyroxine. Physical exam shows hyperreflexia of lower extremities and mild resting tremors of the upper limbs. All vitals are normal. His voice is monotonous, face immobile and he seems anxious.

Labs T.bilirubin 1mg/dl
TSH 1
AST 21
ALT 20

Urine tox screen is negative. Diagnosis

A ALS
B Bipolar Disorder
C Hepatic Enceph
D MDD with psychotic features
E Parkinson
F Psychotic disorder due to a general medical illness
G Schizophrenia
H Substance induced psychotic disorder

 

[dfib slim]

A 20-year-old man is brought to the physician for auditory hallucinations and bizarre behavior over the past year. Recently dropped out of college and moved back with his parents. He says that he feels strange, "like being in a dream", and talks to his great-great-grandfather who died 50 years ago. He was diagnosed with hepatitis A 2 years and hypothyroidism 6 months ago that is being treated with thyroxine. Physical exam shows hyperreflexia of lower extremities and mild resting tremors of the upper limbs. All vitals are normal. His voice is monotonous, face immobile and he seems anxious.

Labs T.bilirubin 1mg/dl
TSH 1
AST 21
ALT 20

Urine tox screen is negative. Diagnosis

A ALS
B Bipolar Disorder
C Hepatic Enceph
D MDD with psychotic features
E Parkinson
F Psychotic disorder due to a general medical illness
G Schizophrenia
H Substance induced psychotic disorder

A normal TSH essentially rules out hyperthyroidism. Plus these symptoms were present 6 months prior to being treated with synthroid.