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Psychiatry · USMLE Step 2 CK

USMLE Step 2 CK Psychiatry: Emergencies

Suicide risk assessment, acute agitation management, and involuntary hold criteria scenarios tested on USMLE Step 2 CK.

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What is the single strongest predictor of a future completed suicide?
A prior suicide attempt.
Which sex has a higher rate of completed suicide in the United States?
Male.
Which sex has a higher rate of suicide attempts in the United States?
Female.
What is the most common method of completed suicide in the United States?
Firearms.
Which age and sex group has the highest suicide rate in the United States?
Elderly white men (men over 65).
Does directly asking a patient about suicidal thoughts increase their risk of attempting suicide?
No, asking about suicide does not increase risk.
What living or marital situation is associated with increased suicide risk?
Living alone (divorced, widowed, or never married).
During what time period after psychiatric hospital discharge is suicide risk highest?
The first week to month after discharge.
Which substance use disorder most significantly increases suicide risk?
Alcohol use disorder.
What type of hallucination specifically raises concern for imminent self-harm?
Command auditory hallucinations telling the patient to hurt themselves.
Name one key protective factor that lowers suicide risk.
Strong social support, such as family, religious involvement, or children at home.
A patient reports a detailed suicide plan and has access to a firearm at home. What is the required disposition?
Immediate hospitalization, since this represents high acute risk.
What is the first-line, non-pharmacologic step in managing an acutely agitated patient?
Verbal de-escalation.
What is the first-line medication class for agitation in a patient without psychotic features?
Benzodiazepines.
What is the preferred medication class for agitation caused by acute psychosis?
Antipsychotics, such as haloperidol.

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