Having trouble remembering all the important questions to ask during your patient encounter? Then try this Hallucination Mnemonic (Psychosis) for USMLE Step 2 CS.
NOTE: Make sure to wash your hands or wear gloves before you start physical examination. Make sure to ask for permission before you start each physical exam. Make sure to use proper draping (don’t forget to tie back patient’s gown). Make sure to explain each physical examination in layman’s term to your patient. Do NOT repeat painful maneuvers.
- Eye examination: Inspect pupils and check for reactivity
- Neurologic exam: Mini-Mental Status Exam, Cranial nerves (2-12), Motor exam, DTRs, Gait, Sensory exam
- Pulmonary exam: Auscultation
- Cardiovascular exam: Auscultation
- Abdominal exam: Auscultation
DIFFERENTIAL DIAGNOSIS Hallucination Mnemonic
– Drug induced psychosis
– Brief psychotic disorder: Symptoms of psychosis usually induced by stressful events and lasts <1 month. It may resolve with removal of the stressor. Auditory hallucinations are more common and typically accompany visual hallucinations.
– Schizophrenia: Chronic mental disorder with periods of psychosis, disturbed behavior and thought, and decline in functioning that lasts > 6 months. It has 2 subtypes: bipolar or depressive. It has 5 subtypes: 1) Paranoid (delusions), 2) Disorganized (with regard to speech, behavior, and affect), 3) Catatonic (automatisms), 4) Undifferentiated [elements of all types] and 5) Residual. Diagnosis requires 2 or more of the following (1-4 are “positive symptoms”):
– 1) Delusions
– 2) Hallucinations (often auditory)
– 3) Disorganized speech (loose associations)
– 4) Disorganized or catatonic behavior
– 5) Negative symptoms: flat affect, social withdrawal, lack of motivation, lack of speech or thought
– Schizoaffective: At least 2 weeks of stable mood with psychotic symptoms, plus a major depressive, manic, or mixed (both) episode.
– Narcolepsy: The visual hallucinations of narcolepsy are complex, generally occurring immediately before falling asleep (hypnagogic) or just after waking up (hypnopompic). Auditory or tactile sensations can be associated with visual hallucinations as well.
– Seizure: Visual hallucinations of epileptic origin can be simple or complex. They are variable in frequency and usually last for a few seconds
DIAGNOSTIC WORK UP Hallucination Mnemonic
- Mental status exam
- Urine Toxicology
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