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GEORGETTES LMR FINAL
EXAM 530 QUESTIONS WITH
VERIFIED ANSWERS ALREADY
GRADED A+
"What 3 neurotransmitters are associated with ADHD? - CORRECT ANSWER=> DNS DA NE 5HT" "The frontal cortex, basal ganglia, and reticular activating system are associated with which psychiatric disorder? - CORRECT ANSWER=> ADHD" "ADHD inattentive type demonstrates abnormalities in which part of the brain? - CORRECT ANSWER=> Prefrontal cortex (PFC)" "What priority action should be completed before placing a patient on stimulants for ADHD? - CORRECT ANSWER=> CARDIAC HISTORY" "Excessive worry, apprehension, or anxiety about events or activities that occurs more days than not for a period of at least 6 months is ____. - CORRECT ANSWER=> Generalized anxiety disorder (GAD)" "If a patient presents with a diagnosis of ADHD and a tic, what medication class is contraindicated? - CORRECT ANSWER=> Stimulants"
"If a stimulant was tried and provided some but not enough benefit (helped, but not long enough) what can this mean? - CORRECT ANSWER=> The medication has been cleared from the body" "What are the lower age limits for stimulants for ADHD? - CORRECT ANSWER=> amphetamine = 3yrs methylphenidate = 6yrs" "When considering Clonidine or Guanfacine for a patient, the PMHNP knows ______ [what about how they differ from each other}? - CORRECT ANSWER=> Clonidine is more sedating than Guanfacine Guanfacine lasts longer than Clonidine" "What does thought process assess? - CORRECT ANSWER=> Thoughts and ideas" "A normal thought process is described as _____. - CORRECT ANSWER=> Logical Linear Coherent Goal-oriented" "What is tangentiality? - CORRECT ANSWER=> "going off on tangents" Inability to get to the point of communication due to introduction of many new topics Moving from thought to thought but never getting to the point." "What is circumstantiality? - CORRECT ANSWER=> "going in circles" A delay in reaching the point of a communication because of unnecessary and tedious details, though eventually getting to the point." "The themes that occupy a patient's thoughts and perceptual disturbances is called what? - CORRECT ANSWER=> Thought content" "Thought content includes which 3 items? - CORRECT ANSWER=> Suicidal ideation Homicidal ideation Hallucinations/Delusions"
"Dopamine blockage in the nigrostriatal pathway leads to what 4 side effects? - CORRECT ANSWER=> Acute dystonia (stiff neck, muscle spasms neck/back, pain) Parkinsonism syndromes Akathisia Tardive dyskinesia" "Blocking DA in the tuberoinfundibular pathway leads to what? - CORRECT ANSWER=> Hyperprolactinemia" "What are 5 symptoms of hyperprolactinemia? - CORRECT ANSWER=> Amenorrhea Galactorrhea Sexual dysfunction Gynecomastia Osteoporosis (long-term)" "What antipsychotic has the greatest effect on prolactin? - CORRECT ANSWER=> Risperidone" "What is the black box warning for carbamazepine? - CORRECT ANSWER=> Agranulocytosis SJS in Asians who are positive for HLA-B1502 allele" "What are 8 symptoms of aplastic anemia? - CORRECT ANSWER=> Pallor Fatigue Headache Fever Nosebleeds Bleeding gums Skin rash SOB" "In which ethnic group must you screen for the HLA-B1502 allele before initiating CBZ (Tegretol) therapy? Why is it necessary? - CORRECT ANSWER=> Asians risk for SJS in Asians (+) for HLA-B*1502 allele" "Which 2 drugs have the highest likelihood of causing agranulocytosis? - CORRECT ANSWER=> Clozaril Carbamazepine"
"A sudden fever, chills, a sore throat, and weakness are symptoms of - CORRECT ANSWER=> Agranulocytosis" "At what ANC should clozapine be stopped (even if asymptomatic)? - CORRECT ANSWER=> <1000" "What is neutropenia? - CORRECT ANSWER=> <2000 PMNs or WBC <2000" "What is agranulocytosis? (lab value) - CORRECT ANSWER=> <500 ANC" "What does DIGFAST stand for? - CORRECT ANSWER=> Distractibility Indiscretion Grandiosity FOI Activity increased Sleep decreased Talkativeness" "What neurological symptoms might one see in Conversion Disorder? - CORRECT ANSWER=> Blindness Mutism Paralysis Paresthesia (glove stocking syndrome) Seizures" "When do symptoms typically begin with Conversion Disorder? - CORRECT ANSWER=> After a stressful experience (suddenly)" "What are 5 stressful events in a child's life that can cause adjustment disorder? - CORRECT ANSWER=> Family move Parent divorce/separation Loss of pet Birth of sibling Sudden or chronic illness" "A child with an Adjustment Disorder with disturbances of conduct may have what symptoms? - CORRECT ANSWER=> Not going to school, destroying property, driving recklessly, or fighting"
"What is the goal of multisystemic family therapy (MFT)? - CORRECT ANSWER=> Reduce barriers to resources for youth with problematic behavior" "What is Multisystemic family therapy? - CORRECT ANSWER=> Home-based model for youth (12-
- with serious antisocial problematic bx and criminal offenses by empowering parents with resources and skills and reducing barriers to resources that prevent families from accessing services needed for effective management of youth helps to develop natural support systems" "What is the range for MMSE? - CORRECT ANSWER=> score 0-30. Higher the better 25+ normal 21-24 mild 10-20 moderate 0-9 severe" "What is the range for SLUM? - CORRECT ANSWER=> score 0-30 Higher the better 27+ normal 21-26 mild <21 dementia" "What is the range for HAM-D? - CORRECT ANSWER=> range 0- 0-7 normal
8 mild 14 moderate 19 mod-severe 23+ severe Just moderate 14-18" "What is the moderate range for PHQ-9 - CORRECT ANSWER=> range 0- 0-4 normal 5 mild 10 moderate 15 mod-severe 20 severe Just moderate 10-14" "What is the moderate range for BDI? - CORRECT ANSWER=> range 0- 0-9 normal
10 mild 19 moderate 30 severe Just moderate 19-29" "What is the moderate range for HAM-A? - CORRECT ANSWER=> 0- 0-17 mild 18 moderate 25 severe Just moderate 18-24" "What is the moderate range for GAD-7 - CORRECT ANSWER=> range 0- 0-4 normal 5 mild 10 noderate 15 severe Just moderate 10-14" "What is the moderate range for COWS? - CORRECT ANSWER=> 13-24" "If a patient's COWS score is between 5 - 12, what do you do? - CORRECT ANSWER=> Administer clonidine (mild score)" "If a patient's COWS score is between 13 - 24, what do you do? - CORRECT ANSWER=> Administer buprenorphine (Suboxone) (moderate score)" "When do you administer clonidine on the COWS? - CORRECT ANSWER=> Definitely at score of 7; prior to that (scores 5-6) it can be given" "When do you administer buprenorphine (Suboxone) on the COWS? - CORRECT ANSWER=>
moderate symptoms (13-24)" "What is a moderate range on the CIWA? - CORRECT ANSWER=> 16-20" "When do you administer prn meds such as benzodiazepine or for N/V/D on the CIWA? - CORRECT ANSWER=> Mild symptoms (8 or greater)"
Fever *= top 3 ways to differ from SS" "Elevated CPK (creatine phosphokinase) in NMS is caused from - CORRECT ANSWER=> muscle contraction and destruction" "What are 2 differentiating symptoms (Key indicators) of Serotonin Syndrome? - CORRECT ANSWER=> Hyperreflexia Myoclonic jerks" "S/S of serotonin syndrome include: what are the 4 most often seen (in bold)? - CORRECT ANSWER=> "Shits and Shivers" § Diarrhea (shits) § Shivering, § Hyperreflexia/myoclonic jerks § Increased temperature § Vital sign instability § Encephalopathy § Restlessness/anxiety § Sweating" "How do you treat NMS? - CORRECT ANSWER=> DC offending agent Bromocriptine or Dantrolene" "What does Dantrolene treat in NMS? - CORRECT ANSWER=> Muscle rigidity" "How do you treat Serotonin Syndrome? - CORRECT ANSWER=> DC offending agent Cyproheptadine: H1 antihistamine that acts to block 5-HT1A and 5-HT2A receptors" "What combination of medications increases the risk of Serotonin Syndrome? What herbal supplement also increases the risk? What class of migraine medications raises the risk? - CORRECT ANSWER=> multiple antidepressants (SSRI/SNRI/TCA/MOAI) St John's wort --> with any of the above AD classes Triptans --> with any of the above AD classes"
"When switching from an MAOI to SSRI/SNRI, how long should you wait? Why? - CORRECT ANSWER=> 2 weeks; for the MAO to regenerate (remember MAO-I deplete MAO)" "When switching from Prozac to any antidepressant (TCA, SNRA, or MAOI), how long should you wait? - CORRECT ANSWER=> 5-6 weeks" "When switching from an SSRI/SNRI to a MAOI, how long should you wait? Why? - CORRECT ANSWER=> 2 weeks; for the SSRI to degenerate" "What is the function of compulsions in OCD? - CORRECT ANSWER=> Reduce subjective anxiety level" "What is PANDAS? When would you suspect PANDAS? - CORRECT ANSWER=> Pediatric Autoimmune Neuropsychiatric Disorder associated with streptococcal infections in children new onset OCD sx- recent strep throat" "If a child has both intrusive thoughts and tics, his most likely diagnosis is - CORRECT ANSWER=> OCD" "If a child has multiple tics (at least 2 motor and 1 vocal) for at least 1 yr, and no ruminating thoughts, his diagnosis is most likely? - CORRECT ANSWER=> Tourette's, NOTE: (the tics do not necessarily have to occur at same time)" "What 2 neurotransmitters are associated with OCD? - CORRECT ANSWER=> Serotonin Norepinephrine" "vocal tics - CORRECT ANSWER=> can include coughing, grunting, throat clearing, sniffling, or making sudden, vocal outbursts" "A child between 7-17 years with a chronic dysregulated mood (moody for no reason), frequent intense temper outbursts, severe irritability, and anger is most likely to have what diagnosis? - CORRECT ANSWER=> DMDD" "What are some symptoms associated with lead poisoning? - CORRECT ANSWER=> Developmental delay (learning difficulties) Pica (paint chips) irritability
"What disorder is associated with persistent deficits in social communication and social interactions across multiple settings? - CORRECT ANSWER=> Autism Spectrum Disorder" "A child who likes to line up, stack, or organize objects and toys in tidy rows, little or no eye contact and does not respond when called by name may have - CORRECT ANSWER=> Autism" "What theory claims that dysfunction of a particular neuron system may be a cause of the poor social interaction and cognition in autism? - CORRECT ANSWER=> Broken Mirror Theory" "What is the age criteria for a DSM-5 diagnosis of Tourette's Disorder? - CORRECT ANSWER=> tics appeared before age 18 yrs" "What is the pharmacological treatment of Tourette's Disorder? - CORRECT ANSWER=> Antipsychotic (haloperidol, pimozide, aripiprazole*)" "What are the 3 primary neurotransmitters involved in Tourette's Disorder? What is special about DA? - CORRECT ANSWER=> DA, NE, 5HT or (DNS) hyperactivity of DA can lead to tourettes" "What are 11 risk factors for suicide? - CORRECT ANSWER=> Previous suicide attempt
45 and older ( > 55 for women) Male gender Divorced, single, or separated White (Caucasian) Living alone Psychiatric disorder Physical illness Substance abuse Family history of suicide Recent loss bold (must knows)" "What are 5 physical characteristics of Anorexia Nervosa? - CORRECT ANSWER=> Low BMI (below 18.5 is underweight) Amenorrhea Emaciation (abnormally thin) Bradycardia
Hypotension" "What is the BMI in a patient with Bulimia Nervosa - CORRECT ANSWER=> Normal range (18.5- 24.9)" "Intense anxiety and fear, helplessness, reexperiencing the event and avoidance behaviors within 4 weeks of a traumatic event is DSM-5 criteria for what disorder? - CORRECT ANSWER=> Acute Stress Disorder" "What are the 3 hallmark symptoms of PTSD? - CORRECT ANSWER=> Intrusive re-experiencing of the trauma Increased arousal (hyperarousal) Avoidance of stimuli associated with trauma" "What are 3 pharmacological treatments for PTSD - CORRECT ANSWER=> SSRIs TCAs Prazosin for nightmares" "What 2 nonpharmacologic treatments for PTSD? - CORRECT ANSWER=> EMDR CBT" "What are the 12 components/symptoms of the COWS? - CORRECT ANSWER=> Pulse Sweating Restlessness Pupil size Bone aches Running nose or tearing GI upset Yawning Tremors Anxiety/irritability Gooseflesh skin" "What are the 9 components/symptoms of the CIWA Scale? - CORRECT ANSWER=> Nausea/vomiting Tremor Sweats Anxiety
"Changes in programs and practices in Health Policy is called - CORRECT ANSWER=> Policy Reform" "What is the "policy environment" component of Health Policy? - CORRECT ANSWER=> The arena the process takes place in (government, media, public)" "What is the "policy makers" component of Health Policy? - CORRECT ANSWER=> Key players and stake holders" "What is the first action when developing Health Policy? - CORRECT ANSWER=> Assess/address organizational barriers and facilitators" "A treatment approach that does not focus on full symptom resolution but emphasizes resilience and control over problems and life is called - CORRECT ANSWER=> Recovery Model" "What are 3 characteristics of the Recovery Model? - CORRECT ANSWER=> Nonlinear recovery, continual growth and occasional setbacks; Learning from experience (e.g. relapse) Self-directed -pt is not told what to do Individualized and Person-Centered-pt is the center of the therapy" "What is the SBIRT, and what is it used for? - CORRECT ANSWER=> Screening Brief Intervention Referral Treatment Screens for Substance Use Disorders" "What is the Tarasoff Principle - CORRECT ANSWER=> Duty to warn victim of imminent danger of homicidal patients...varies by state" "What is the Rennie vs Klein Court case? "Rennie's Right to Refuse and appeal" - CORRECT ANSWER=> An involuntarily committed patient who has not been found incompetent, absent an emergency, has a qualified right to refuse psychotropic medications" "What is the Donaldson vs. O'Connor court case?
"You can't confine Donald" - CORRECT ANSWER=> You cannot confine (commit a person involuntarily) who is not imminently dangerous to self or others" "What are 4 key components of Strategic Therapy? - CORRECT ANSWER=> Problem and Symptom focused Paradoxical directive/intervention (reverse psychology) when pt non-compliant Straight forward directive- when pt compliant Reframe belief system" "Miracle Questions, Exception-finding questions, and Scaling Questions are used in which therapy? - CORRECT ANSWER=> Solution-Focused therapy" "Which therapy uses triangles/triangulation, and self-differentiation? - CORRECT ANSWER=> Family Systems Therapy" "The paradoxical directive, a technique to be used with caution, is used in which therapy? - CORRECT ANSWER=> Strategic Therapy" "Hierarchies, Boundaries, and Genograms are characteristics of what therapy? - CORRECT ANSWER=> Structural Family Therapy" "Genograms are used in which 2 family therapies? - CORRECT ANSWER=> Family system therapy Structural therapy" "What type of therapy should be performed when a patient presents with a cultural syndrome?
- CORRECT ANSWER=> Brief supportive therapy" "What type of therapy should be used in a patient who has just lost their job? - CORRECT ANSWER=> Brief supportive therapy" "What is the most important concept in working with patients from different cultues? - CORRECT ANSWER=> Respect" "What should you teach a patient interested in meditation? - CORRECT ANSWER=> muscle relaxation" "Which ethnic group views mental illness as an imbalance between an individuals' relationship with world? - CORRECT ANSWER=> Native American"
"One of your patients receiving psychiatric medication develops an infection. What do you consider? - CORRECT ANSWER=> Agranulocytosis" "What antipsychotic is anti-suicidal in schizophrenia? - CORRECT ANSWER=> Clozapine" "When a young woman is suspected of a toxic dose of lithium, what lab should you obtain initially? - CORRECT ANSWER=> HCG" "If a patient has signs/symptoms of lithium toxicity but you have no labs available, what do you do? - CORRECT ANSWER=> DC lithium" "A patient with what medical condition is at risk for lithium toxicity? - CORRECT ANSWER=> Cardiac failure (hyponatremia)" "What are the key indicators for NMS? - CORRECT ANSWER=> Extreme muscle rigidity Increased CPK" "If a depressed patient is taking a triptan for migraines, what should you prescribe for depression? - CORRECT ANSWER=> Bupropion" "What is first line treatment for MDD? Why? - CORRECT ANSWER=> SSRIs Safer in OD" "What are the 2 antidepressants of choice in a depressed patient with cancer? Why? - CORRECT ANSWER=> Citalopram (Celexa) Escitalopram (Lexapro) less risk for Drug-Drug Interaction" "What is the antidepressant of choice in a depressed patient with sexual dysfunction? - CORRECT ANSWER=> Bupropion" "What is the antidepressant of choice in a depressed patient with decreased energy? - CORRECT ANSWER=> Bupropion" "What are 3 treatments for depressed patients with neuropathic pain? - CORRECT ANSWER=> SNRI TCA (think safety tho)
Gabapentin/Pregabalin (alpha2 delta ligands) BOLD = know" "Which SSRI is most likely to cause insomnia? - CORRECT ANSWER=> Fluoxetine (Prozac)" "What question is important to ask in the social history with a depressed patient? - CORRECT ANSWER=> Alcohol intake (self-medicating)" "Suicidal ideation for children, adolescents, and young adults <24 years is a BBW with what medications? - CORRECT ANSWER=> all Antidepressants" "What question should ask all adolescent patients at each visit? - CORRECT ANSWER=> Self harm (frequency and severity)" "Which 2 groups is it especially important to ask about SI at each visit? - CORRECT ANSWER=> Adolescence Schizophrenics" "Alpha 2 adrenergic receptor blockers (Clonidine and Guanfacine) have lower tolerability in patients with schizophrenia. What effects from these meds are limited in this population? - CORRECT ANSWER=> the neuroprotective effects" "Why do children have a decreased placebo response with antidepressants? - CORRECT ANSWER=> Few evidence-based studies" "What is the onset of schizophrenia in males? - CORRECT ANSWER=> 18-25" "What is the onset of schizophrenia in females? - CORRECT ANSWER=> 25-35" "What question should ask schizophrenic patients at each visit? - CORRECT ANSWER=> SI" "What is the most likely diagnosis in a patient with homicidal ideation? - CORRECT ANSWER=> Antisocial Personality Disorder" "What would yo expect to see on an MRI/Pet scan in a patient with schizophrenia? - CORRECT ANSWER=> All structures decreased EXCEPT Ventricles, they are enlarged"
