I am going to answer the sample USMLE Step 1 Questions with Explanation. These questions are available at USMLE.org
Q- A previously healthy 33-year-old woman is brought to the emergency department by the Secret Service for stalking the president of the USA for 2 months. She claims to be married to the president’s twin brother and states that the president just had his twin kidnapped to avoid competition. She speaks rapidly and is difficult to interrupt. Her associations are often loose. She says, “I haven’t slept for days, but I won’t even try to sleep until my husband is rescued. God has been instructing me to take over the White House. I can’t wait to be reunited with my husband. I hear his voice telling me what to do.” When asked about drug use, she says she uses only natural substances. She refuses to permit blood or urine tests, saying, “I don’t have time to wait for the results.” Which of the following is the most likely diagnosis?
(A) Bipolar disorder, manic, with psychotic features
(B) Brief psychotic disorder
(C) Delusional disorder
(D) Psychotic disorder due to general medical condition
(E) Schizophrenia
Copyright © 1996-2021 Federation of State Medical Boards (FSMB) and National Board of Medical Examiners (NBME). All rights reserved. The United States Medical Licensing Examination® (USMLE®) is a joint program of the FSMB and NBME.
Answer
This patient exhibits symptoms that are consistent with a manic episode, including grandiosity, rapid speech and difficulty being interrupted, and lack of sleep. She also has psychotic symptoms such as auditory hallucinations and delusional beliefs. Maniac symptoms distinguish this condition from schizophrenia and delusional disorder which have more pervasive and less mood-related symptoms.
The correct answer is A