{"id":765,"date":"2023-03-01T12:34:00","date_gmt":"2023-03-01T12:34:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=765"},"modified":"2025-10-31T11:13:30","modified_gmt":"2025-10-31T19:13:30","slug":"usmle-step-1-question-of-the-day-schizophrenia","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-schizophrenia","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Schizophrenia"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-schizophrenia\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-schizophrenia\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-schizophrenia\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-schizophrenia\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-schizophrenia\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em>This week, we are sharing another <strong>USMLE\u00ae Step 1<\/strong>-style practice question to test your knowledge of medical topics.\u00a0Today&#8217;s case focuses on a <strong>25-year-old man<\/strong> exhibiting <strong>abnormal behavior<\/strong>. Can you make the diagnosis?<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A <strong>25-year-old man<\/strong> is brought to the physician by his parents due to <strong>abnormal behavior<\/strong>. The family tells the physician that their son has been <strong>acting strangely<\/strong> over the <strong>past eight months<\/strong>. He sometimes appears to be <strong>talking to people who are not there <\/strong>and <strong>responds to voices that no one in the room can hear<\/strong>. The patient tells the physician that <strong>he hears voices telling him about his family and his life<\/strong>. He adds that these voices have told him to do \u201c<strong>bad things\u201d to his family<\/strong>, but he refuses because he loves his family. Additionally, the family states that he has been accusing them of <strong>working with the government to insert a chip in his brain<\/strong>. The patient currently <strong>refuses to eat food cooked by his parents<\/strong> because he thinks they may have inserted the chip in his food. One year ago, he <strong>dropped out of college<\/strong> due to declining grades and poor performance. Past medical history is <strong>noncontributory<\/strong>. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following is the <em>most likely<\/em> <em>pathophysiology <\/em>of this patient\u2019s auditory hallucinations?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Increased dopaminergic activity in the mesolimbic pathway<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Decreased dopaminergic activity in the mesocortical pathway<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C.&nbsp;<\/strong><strong>Decreased dopamine levels in the tuberoinfundibular pathway&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Decreased dopamine levels in the nigrostriatal pathway<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Decreased dopaminergic activity in the mesolimbic pathway<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down to find the answer!<\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Increased dopaminergic activity in the mesolimbic pathway<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the Main Explanation, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B.\u00a0Decreased dopaminergic activity in the mesocortical pathway<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:\u00a0<\/strong>Decreased activity of the <strong>mesocortical pathway<\/strong> leads to the negative symptoms seen in <strong>schizophrenia<\/strong>. Positive symptoms, as seen in this patient (e.g., <strong>hallucinations, delusions<\/strong>), are due to increased dopamine levels in the mesolimbic pathway.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C.\u00a0Decreased dopamine levels in the tuberoinfundibular pathway\u00a0<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:\u00a0<\/strong>Decreased dopamine activity in the <strong>tuberoinfundibular pathway<\/strong> leads to <strong>increased prolactin<\/strong> levels, which results in <strong>galactorrhea, decreased libido, <\/strong>and <strong>gynecomastia<\/strong>. While <strong>antipsychotic medications<\/strong> used to treat schizophrenia may cause elevated prolactin levels via this pathway, this patient\u2019s positive schizophrenia symptoms (e.g., hallucinations, delusions) are instead related to increased dopamine levels in the mesolimbic pathway.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D.\u00a0Decreased dopamine levels in the nigrostriatal pathway<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:\u00a0<\/strong>Decreased dopamine levels in the <strong>nigrostriatal pathway<\/strong> lead to <strong>extrapyramidal symptoms<\/strong> like Parkinsonian symptoms. This patient\u2019s positive schizophrenia symptoms (e.g., hallucinations, delusions) are instead related to increased dopamine levels in the mesolimbic pathway.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E.\u00a0Decreased dopaminergic activity in the mesolimbic pathway<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:\u00a0<\/strong>It is <strong>increased dopaminergic activity<\/strong> in the mesolimbic pathway which leads to the positive symptoms of schizophrenia (e.g., hallucinations, delusions), not decreased.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/plans\/md\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/79.png?w=700\" alt=\"Osmosis ad\" class=\"wp-image-513\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/79.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/79.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient has been experiencing <strong>auditory hallucinations and delusions<\/strong> for <strong>more than 6 months<\/strong>, suggesting a diagnosis of\u00a0<strong>schizophrenia<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The <strong>pathophysiology of schizophrenia<\/strong> is thought to be partly due to abnormalities in the <strong>neurotransmitters <\/strong>in the brain. In particular, schizophrenia is thought to be caused by abnormalities in <strong>dopamine neurotransmission<\/strong>, specifically abnormalities in the <strong>D2 receptor&#8217;s activity<\/strong>. Understanding the four dopamine pathways in the brain is critical to understanding the pathophysiology of schizophrenia and its treatment: the\u00a0<strong>mesolimbic pathway<\/strong>, the\u00a0<strong>mesocortical pathway<\/strong>, the\u00a0<strong>tuberoinfundibular pathway<\/strong>, and the\u00a0<strong>nigrostriatal pathway<\/strong>\u00a0(as illustrated in the graphic below).\u00a0<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The&nbsp;<strong>mesolimbic pathway<\/strong>&nbsp;extends from the ventral tegmental nucleus (VTA) to the limbic system.&nbsp;<strong>Increased dopaminergic activity of this pathway is associated with the positive symptoms of schizophrenia<\/strong>&nbsp;(e.g., hallucinations, delusions).&nbsp;<\/li>\n\n\n\n<li><strong>The mesocortical pathway<\/strong>: This pathway extends from the VTA to the cortex.&nbsp;<strong>Decreased dopaminergic activity of this pathway is associated with the negative symptoms of schizophrenia<\/strong>&nbsp;(e.g., anhedonia, poverty of speech, lack of motivation).<\/li>\n\n\n\n<li><strong>The tuberoinfundibular pathway<\/strong>: This pathway projects from the hypothalamus to the pituitary gland. Decreased dopaminergic activity in this pathway is associated with<strong>&nbsp;increased prolactin levels<\/strong>&nbsp;\u2013 leading to galactorrhea, gynecomastia, and infertility. This pathway is responsible for these classic symptoms seen in patients with schizophrenia who are taking antipsychotics (i.e. dopaminergic antagonists).&nbsp;<\/li>\n\n\n\n<li><strong>The nigrostriatal pathway<\/strong>: This pathway projects from the substantia nigra to the caudate nucleus. This pathway is connected to the&nbsp;<strong>extrapyramidal system<\/strong>, and thus decreased dopaminergic activity in this pathway leads to characteristic&nbsp;<strong>motor symptoms<\/strong>&nbsp;(extrapyramidal \u201cParkinsonian\u201d symptoms) which can be seen in patients with schizophrenia who are taking antipsychotics (i.e. dopaminergic antagonists).<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Additionally, abnormalities in <strong>serotonin, glutamate, <\/strong>and <strong>GABA neurotransmitters<\/strong> have also been implicated in the neurochemical abnormalities in schizophrenia.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" height=\"436\" width=\"1024\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/dopamine-pathways_b37b61.png?w=1024\" alt=\"Dopamine Pathways\n\nMesocortical pathway\nNucleus accumbens\nTuberoinfundibular pathway\nPitutary\nHypothalamus\nDorsal striatum\nThalamus\nNigrostriatal pathway\nSubstantia negra\nVentral tegmental area\nMesolimbic pathway\" class=\"wp-image-767\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/dopamine-pathways_b37b61.png 1264w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/dopamine-pathways_b37b61.png?resize=300,128 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/dopamine-pathways_b37b61.png?resize=768,327 768w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/dopamine-pathways_b37b61.png?resize=1024,436 1024w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Neurotransmitter abnormalities (particularly&nbsp;<strong>dopamine<\/strong>) have been implicated in the pathogenesis of schizophrenia.&nbsp;<strong>Increased dopaminergic activity<\/strong>&nbsp;in the&nbsp;<strong>mesolimbic pathway<\/strong>&nbsp;is associated with the&nbsp;<strong>positive symptoms<\/strong>&nbsp;of schizophrenia (e.g. hallucinations), while&nbsp;<strong>decreased dopaminergic activity<\/strong>&nbsp;in the&nbsp;<strong>mesocortical pathway<\/strong>&nbsp;is associated with the&nbsp;<strong>negative symptoms<\/strong>&nbsp;of schizophrenia (e.g., anhedonia, poverty of speech, lack of motivation).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><u><em><strong>\u2192 Reinforce your understanding with more self-assessment items on Osmosis.\u00a0<\/strong><\/em><\/u><\/a><\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patel, K. R., Cherian, J., Gohil, K., &amp; Atkinson, D. (2014). Schizophrenia: overview and treatment options.\u00a0<em>P &amp; T: a peer-reviewed journal for formulary management,<\/em>\u00a039(9), 638\u2013645.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large is-resized\"><a href=\"https:\/\/www.osmosis.org\/ultimate-guide\/usmle-step-1\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/the-ultimate-guide-usmle-step-1-banner.png?w=700\" alt=\"\" class=\"wp-image-760\" style=\"width:620px;height:auto\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/the-ultimate-guide-usmle-step-1-banner.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/the-ultimate-guide-usmle-step-1-banner.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><figcaption class=\"wp-element-caption\"><em><em><sub>The United States Medical Licensing Examination (USMLE\u00ae) is a joint program of the Federation of State Medical Boards (FSMB\u00ae) and National Board of Medical Examiners (NBME\u00ae). Osmosis is not affiliated with NBME nor FSMB.&nbsp;<\/sub><\/em><\/em><\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Want more <strong>USMLE\u00ae Step 1<\/strong> practice questions? Try <strong>Osmosis from Elsevier<\/strong> today! Access your\u00a0<em><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>free trial<\/strong><\/a><\/em>\u00a0and find out why millions of current and future clinicians and caregivers love learning with us.<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Explore a challenging USMLE\u00ae Step 1-style question highlighting the dopamine pathways involved in schizophrenia and the origins of auditory hallucinations.<\/p>\n","protected":false},"author":202,"featured_media":768,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,16,1369,44],"tags":[1142,1141,1144,1143,1138,1140,1145,1139,664],"class_list":["post-765","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-step-1-questions","category-step-1","tag-antipsychotics","tag-auditory-hallucinations","tag-dopamine-pathways","tag-mesocortical-pathway","tag-mesolimbic-pathway","tag-neurobiology","tag-positive-symptoms","tag-schizophrenia","tag-usmle-step-1"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - 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What is the best initial medication to manage his condition effectively?","rel":"","context":"In &quot;Allopathic Medicine (MD)&quot;","block_context":{"text":"Allopathic Medicine (MD)","link":"https:\/\/www.osmosis.org\/blog\/category\/medicine"},"img":{"alt_text":"USMLE Step 2 CK Question of the Day:\u00a0Painful rash","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Step-2-Question-of-the-Day-Painful-Rash.jpg","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Step-2-Question-of-the-Day-Painful-Rash.jpg 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Step-2-Question-of-the-Day-Painful-Rash.jpg 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/Step-2-Question-of-the-Day-Painful-Rash.jpg 2x"},"classes":[]}],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/765","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/users\/202"}],"replies":[{"embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/comments?post=765"}],"version-history":[{"count":4,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/765\/revisions"}],"predecessor-version":[{"id":8775,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/765\/revisions\/8775"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/media\/768"}],"wp:attachment":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/media?parent=765"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/categories?post=765"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/tags?post=765"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}