Medical Expert
Medical Expert
The Medical Expert domain tests whether you can convert a narrative into a defensible psychiatric formulation and management plan. Examiners reward explicit syndromal reasoning, safe medical screening, and risk documentation, not a list of labels.
Core rules
- Assessment order: presenting complaint, timeline, past episodes, treatment response, substance use, medical history, family history, social history, MSE, physical examination, targeted investigations.
- Diagnose by criteria: state the syndrome, then apply ICD-10 or DSM-5-TR criteria; record whether criteria are met, partially met, or unmet.
- Exclude medical and substance-induced causes before attributing symptoms to primary psychiatric illness: delirium, thyroid disease, B12 deficiency, syphilis, HIV, steroid use, alcohol withdrawal.
- Formulate biopsychosocially and longitudinally; include predisposing, precipitating, perpetuating, and protective factors.
- Pair every drug with indication, target dose, monitoring, and discontinuation plan; know clozapine ANC monitoring, lithium levels, ECG/QTc issues, and ECT indications.
Worked example
A 28-year-old man presents with three weeks of elated mood, two hours' sleep, grandiose delusions, and cannabis use. Reasoning: the syndrome is mania (elevated mood plus increased energy, decreased need for sleep, grandiosity, distractibility). Cannabis can produce a manic-like picture, so establish temporal sequence, prior episodes, family history, and urine drug screen. If symptoms persist beyond intoxication/withdrawal and functional decline is clear, primary mania is likely. Management: risk assessment, antipsychotic plus mood stabiliser, avoid antidepressant monotherapy, treat substance use, monitor metabolic parameters.
Traps
- Missing delirium or a medical mimic because the patient looks psychiatric.
- Reporting psychosis without defining the syndrome or course.
- Failing to ask about past manic episodes before diagnosing unipolar depression.
- Ignoring catatonia, which is a medical emergency and needs a benzodiazepine/ECT plan.