Objective Examination

Psychiatry Clerkship: Reno

The NBME Psychiatry Subject exam ("the shelf") will be administered on the last day of the clerkship and will represent 25% of the final grade. Students are strongly encouraged to read throughout the clerkship in order to prepare for this examination. We recommend a systematic approach utilizing the required textbook and supplemental readings so you can cover all of the following areas:


  • General Principles 5%-10%
  • Organ Systems
    • Mental Disorders
      • Promoting Health and Health Maintenance 1%-5%
      • Understanding Mechanisms of Disease 10%-15%
      • Establishing a Diagnosis
        • Mental disorders usually first diagnosed in infancy, childhood, or adolescence 5%-10%
        • Substance-related disorders 5%-10%
        • Schizophrenia and other psychotic disorders 5%-10%
        • Mood disorders 5%-10%
        • Anxiety disorders 5%-10%
        • Somatoform disorders 1%-5%
        • Other disorders/conditions 5%-10%
      • Applying Principles of Management 20%-25%
      • Diseases of the Nervous System and Special Senses 10%-15%

Sample Items

  1. A previously healthy 17-year-old girl is brought to the physician for evaluation because of loss of appetite, sleeplessness, and extreme irritability for 3 weeks. After missing many practices, she quit the softball team that she previously enjoyed. She often feels tired and has difficulty sitting still and concentrating on schoolwork. Her menses occur at regular intervals. She weighs 50 kg (110 lb) and is 168 cm (66 in) tall. Her blood pressure is 110/70 mm Hg, pulse is 74/min, and respirations are 16/min.

    Which of the following is the most likely diagnosis?
    1. Adjustment disorder with mixed disturbance of emotions and conduct
    2. Anorexia nervosa
    3. Attention-deficit/hyperactivity disorder
    4. Dysthymic disorder
    5. Major depressive disorder
  2. A 45-year-old man is brought to the physician by his spouse. He has been drinking heavily since he was passed over for a job promotion 3 days ago. He stayed in bed over the weekend. He has no personal history of psychiatric disorders and no personal or family history of alcohol abuse. He is crying and states, "I can't believe it," when addressed. When asked what he will do, he states, "I don't know, but if I don't go back to work tomorrow, I'll lose my job."

    Which of the following is the most likely diagnosis?
    1. Adjustment disorder with depressed mood
    2. Bipolar disorder
    3. Dysthymic disorder
    4. Major depressive disorder
    5. Substance abuse
  3. A 52-year-old woman whose husband died 2 months ago consults a physician because of headaches and feelings of uncertainty. She describes the headaches as a band around her head; they occur unpredictably and are not accompanied by any other symptoms. She has no history of psychiatric illness. While talking with the physician, the patient begins to cry and talk about her deceased husband; she feels her life is empty now and worries about her future.

    Which of the following is most appropriate at this point?
    1. Allow her to express herself
    2. Prescribe an antianxiety drug
    3. Prescribe an antidepressant drug
    4. Refer her for psychological testing
    5. Obtain a psychiatric consultation
  4. A 10-year-old boy is brought to the physician because of increasing behavior problems in school since starting 5th grade 3 months ago. His teacher states that he is unable to sit quietly through a classroom period and frequently disrupts the class and interrupts other children while they are talking. His parents report that he has always been an active child and are concerned because he is inattentive when he runs or walks. During the examination, he fidgets with his hands and feet and is easily distracted from completing a task.

    Which of the following is the most appropriate pharmacotherapy?
    1. Amitriptyline
    2. Fluoxetine
    3. Haloperidol
    4. Imipramine
    5. Methylphenidate
  5. A 32-year-old woman is brought to the emergency department because of fever, hallucinations, agitation, and confusion for 8 hours. She has a history of alcohol, cocaine, and benzodiazepine abuse. Her temperature is 37.8 C (100 F), blood pressure is 150/90 mm Hg, pulse is 110/min, and respirations are 16/min. She is tremulous. The lungs are clear to auscultation. She has a holosystolic murmur; the abdomen is tender, and the liver edge is palpable 3 cm below the costal margin. Rectal examination shows no abnormalities. She has telangiectasia. A complete blood count and liver function tests show no abnormalities. Her serum alkaline phosphatase activity is 200 U/L, serum alanine aminotransferase (ALT, GPT) activity is 60 U/L, and serum aspartate aminotransferase (AST, GOT) activity is 90 U/L.

    Which of the following is the most likely cause of this condition?
    1. Acute cocaine toxicity
    2. Alcohol withdrawal
    3. Benzodiazepine withdrawal
    4. Panic disorder
    5. Schizophreniform disorder