PSYCHIATRY + NEUROLOGY + FAMILY MEDICINE - INTEGRATED READINESS

YEAR 3 | PAGE 64D - 10 HIGH-DISCRIMINATION CASES + CURRENT NBME / COMAT TRANSFER

FINAL REVIEW SHOULD FORCE THE FIRST SAFE DECISION: PSYCH SAFETY / SECONDARY CAUSE -> NEURO LOCALIZATION / TEMPO -> PRIMARY-CARE SCREENING VS DIAGNOSIS -> NEXT STEP -> FOLLOW-UP / DISPOSITION. DO NOT LET A FAMILIAR LABEL BYPASS THE SEQUENCE. G. 10 HIGH-DISCRIMINATION SHELF / COMAT CASES

#	Case pattern	Best exam reasoning
1	Depressed patient reports active suicidal intent, a specific plan and access to means.	Safety/disposition comes first: immediate supervised risk management and emergency psychiatric evaluation outrank medication fine-tuning.
2	Older hospitalized patient develops acute fluctuating inattention, disorganized thinking and sleep-wake reversal.	Treat as delirium until proven otherwise: identify medical/medication causes and protect safety rather than diagnosing a primary psychotic disorder.
3	Patient has recurrent mood episodes with psychosis; stem asks schizophrenia vs mood disorder vs schizoaffective.	Build the timeline: determine whether psychosis occurs only during mood episodes or also independently, then apply duration/function/exclusion criteria.
4	Sudden aphasia with contralateral face/arm weakness.	Localize to dominant cortical/vascular territory first, then activate the acute stroke imaging/time pathway; do not start with chronic neurologic differentials.
5	Abrupt "worst headache of life" with vomiting and meningismus.	Thunderclap is a red flag; prioritize emergent secondary-headache evaluation for subarachnoid hemorrhage rather than treating as routine migraine.
6	Ptosis/diplopia worsen through the day; sensation is intact and weakness is fatigable.	Localize to the neuromuscular junction; assess bulbar/respiratory risk and use confirmatory testing/therapy appropriate to the syndrome.
7	Asymptomatic patient asks for a preventive test; no red flags or prior abnormal result.	Use age/risk/current-guideline screening logic. Do not convert preventive care into a broad diagnostic workup without an indication.
8	Stable outpatient has persistently above-goal chronic-disease measurements but no emergency features.	Validate trend/adherence/context, adjust the longitudinal plan and schedule monitoring; avoid an inpatient/emergency reflex when outpatient care is safe.
9	Adult has uncomplicated low-back pain, normal neurologic exam and no systemic/red-flag features.	Use conservative outpatient management and follow-up rather than reflex imaging; escalate if red flags, neurologic deficits or failure-to-improve change the risk.
10	Stable adult presents for routine care with overdue vaccination/screening and modifiable cardiovascular risk.	Prevention is the management task: update age/risk-appropriate services and counseling instead of ordering non-indicated broad testing.

H. CURRENT OFFICIAL COVERAGE / READINESS ANCHORS

Assessment signal	Current official anchor	How to use it
COMAT Psychiatry	Largest current presentation ranges include anxiety/trauma/OCD-related disorders 20-25% and depressive/bipolar disorders 20-25%; H&P;/diagnosis and management each carry 30-45%.	Protect safety, diagnostic timelines and treatment/toxicity equally; do not study psychiatry as pure DSM recognition.
COMAT Family Medicine	Broad primary-care coverage: nervous/mental health, GI and cardiovascular each 9-12%; MSK 8-12%; community health 8-10%; H&P;/diagnosis and diagnostic technologies each 25-30%, management 20-25%.	Keep prevention, acute complaints, chronic disease and continuity active across the full rotation.
NBME Clinical Science Mastery Series	Clinical Neurology, Psychiatry and Family Medicine are all available. Each form has 50 MCQs; standard-paced format is 75 minutes.	Use timed forms late in rotation and classify misses by safety/timeline, localization/tempo, screening-vs-diagnosis, management or disposition.
COMAT Clinical format	Psychiatry and Family Medicine COMAT exams contain 120 items in 2.5 hours with OPP/OMM integrated. NBOME does not currently list a separate Neurology COMAT subject exam.	DO learners should use COMAT-style practice for Psych/FM and school/NBME Clinical Neurology objectives for dedicated neuro shelf preparation.

H. CURRENT OFFICIAL COVERAGE / READINESS ANCHORS — PSYCHIATRY + NEUROLOGY + FAMILY MEDICINE MASTERY GATE

You are ready to move on when you can perform safety/secondary-cause triage before psychiatric labeling, distinguish psychiatric look-alikes by timeline and function, localize neurologic disease before naming it, use tempo and exam findings to choose the urgent test, separate screening from diagnostic evaluation, manage chronic disease longitudinally, and choose outpatient follow-up/disposition safely on new mixed cases.

H. CURRENT OFFICIAL COVERAGE / READINESS ANCHORS — I. DIRECT READINESS / QUESTION LINKS NBOME COMAT Psychiatry - current Psychiatry blueprint + sample questions NBOME COMAT Family Medicine - current Family Medicine blueprint + sample questions NBME Clinical Science Mastery Series - Clinical Neurology + Psychiatry + Family Medicine forms and feedback UWorld Step 2 CK - primary clinical-transfer Qbank AMBOSS Step 2 - targeted shelf review and clinical reference

2026/27 clerkship-review expanded edition - align with school objectives, local protocols and current NBME/NBOME guidance