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Boards Review > Georgette’s > Flashcards

Georgette’s Flashcards

1
Q

Benefits of Lithium treatment

A

Gold standard for treating manic episodes

Neuroprotective

Antisuicidal effect

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2
Q

Normal serum values for lithium

A

0.5 to 1.2 mEq per liter

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3
Q

Common Baseline labs before initiation with lithium

A

Thyroid panel (Hyperthyroid can appear as mania)

Serum creatinine (0.6 to 1.2 mg/dL)

BUN (10 to 20 mg/dL)

Urinalysis (Large amount of protein in urine (+4) May indicate kidney disease

Pregnancy test (12 to 51 years of age are considered child bearing)

ECG for clients >than 50

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4
Q

Clinically significant side effects of lithium

A

Hypothyroidism
Course hand tremors with toxicity
Maculopapular rash
Diarrhea, vomiting, cramps, anorexia
Polyuria with related polydipsia
T-wave inversion
Leukocytosis

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5
Q

Carbamazepine (Tegretol) Black box warning for

A

Agranulocytosis (low WBCs) and Aplastic anemia (deficiency of all types of blood cells)

pallor, fatigue, headache, nose bleeds, bleeding gums, skin rash, shortness of breath

Steven Johnson syndrome particularly in Asians (Screen for HLAB1502 allele before initiation)

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6
Q

A hypertensive crisis occurs when

A

MAOIs are taken in conjunction with certain medication’s

Common medication include: Meperidine (Demerol), stimulants, decongestants, asthma medication,

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7
Q

Symptoms of hypertensive crisis include

A

Sudden, explosive like headache, usually in occipital region

 Hypertension, Flushing, palpitations, diaphoresis, fever

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8
Q

Treatment of hypertensive crisis includes

A

Discontinuing the MAOI

Phentolamine (Blocks by binding to norepinephrine receptor sites)

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9
Q

The treatment for serotonin syndrome

A

Cryptoheptadine (antihistamine)

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10
Q

Cardinal sign of serotonin syndrome is

A

Cardinal sign of serotonin syndrome is myoclonic jerking, hyper reflexia, confusion, shivering, goosebumps, tachycardia and hypertension

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11
Q

Teratogenic risks of benzodiazepines

A

Floppy baby syndrome, cleft palate

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12
Q

Teratogenic risks of carbamazepine

A

Neural tube defects

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13
Q

Teratogenic Risk of lithium

A

Ebstein anomaly

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14
Q

Teratogenic risk of Depakote

A

Spina bifida

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15
Q

For patients taking clozapine and/or carbamazepine (tegretol), Risk for neutropenia is monitored by which lab value

A

ANC only

DC Clozapine at ANC less than 1000 (Neutropenia) Regardless of whether the patient is showing signs of infection or not

DC clozapine at wbc’s 2000 to 3000 (Agranulocytosis)

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16
Q

For patients taking clozapine, what should the patient be closely monitored for

A

Signs of infection (Fever, chills, sore throat, weakness)

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17
Q

What is normal BMI

A

18.5 to 24.9

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18
Q

A BMI less than —— requires hospitalization

A

<15

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19
Q

Physical exam findings for anorexia

A

Low BMI
Russells sign (Calluses on dorsum of hand secondary to Induced vomiting)
Brittle hair and nails
Lanugo on face extremities and trunk
Amenorrhea
Emaciation
Bradycardia
Hypotension

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20
Q

BMI for a patient with bulimia nervosa is usually

A

Normal

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21
Q

As Wellbutrin is know to have more or less sexual side effects

A

Less sexual side effects because it is an NDRI

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22
Q

Which antidepressant is appropriate for patients experiencing depression with low energy and fatigue

A

Wellbutrin

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23
Q

Which antidepressant is contraindicated in patients with a history of seizure or anorexia/bulimia

A

Wellbutrin. Wellbutrin decreases seizure threshold

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24
Q

What are some known cytochrome P450 inhibitors

A

Pneumonic: SICK FACES.COM

Sodium valproate
Indomethacin
CLARITHROMYCIN/ Cimetidine
Ketoconazole

Fluconazole
alcohol
Chloramphenicol
ERYTHROMYCIN
Sulfonamide

Cipro
Omeprazole
Metronidazole

Grapefruit juice
Wellbutrin 

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25
Q

What are some common cytochrome P450 inducers

A

CARBAMAZEPINE (TEGRETOL)
Tobacco
Phenobarbital
Dilantin
Oral Contraceptives

Pneumonic: BS CRAP GPS
Barbiturates , St. John’s wort, carbamazepine,  rifampin, alcohol, phenytoin, Griseofulvin,  Phenobarbital, sulfonylureas 

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26
Q

Which common antipsychotic is metabolized by cytochrome P450 enzyme CYP1A2

A

Clozapine (Clozaril)

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27
Q

Which medications are known to reduce renal clearance

A

Indocin (NSAID)
Ibuprofen
Thiazides
Ace inhibitors

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28
Q

Why are older adults more sensitive to psychotropic medication

A

Most psychotropic medications are lipophilic and highly protein bound

Older adults have more body fat and less protein which makes them more likely to develop toxicity to two accumulation of medications

Also, older adults have slower metabolism and less muscle mass

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29
Q

Pharmacodynamics is

A

What a medication does to a persons body

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30
Q

An agonist does what

A

Binds to receptors and activates a biological response

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31
Q

An inverse agonist does what

A

Has the opposite effect of an agonist. Inverse agonists do not bind to receptors

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32
Q

Partial agonist do what

A

Does not fully activate the receptor

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33
Q

Antagonists do what

A

Bind to the receptor but does not activate it biological response

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34
Q

A BMI greater than 30 indicates

A

Obesity

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35
Q

In which areas of the brain is dopamine produced

A

Substantial nigra
ventral tegmental
nucleus accumbens 

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36
Q

In which area of the brain is norepinephrine produced

A

Locus ceruleus
medullary Formation
reticular formation

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37
Q

In which area is serotonin produced

A

Raphae nuclear of the brain stem

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38
Q

Glutamate is considered the universal

A

Excitatory neurotransmitter

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39
Q

GABA is considered the universal

A

Inhibitory neurotransmitter

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40
Q

Acetylcholine is synthesized by which area

A

The basil nucleus of Maynert 

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41
Q

Increased levels of corticotropin releasing hormones in which areas of the brain will increase symptoms of anxiety

A

Increased levels of corticotropin releasing hormone in the amygdala, hippocampus, and Locus coeruleus will increase symptoms of anxiety

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42
Q

The follow up care of the patient with ADHD should include

A

Monitor clinical progress overtime

Use standardized reading scales (Vanderbilt, Connors which both include parent and teacher input)

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43
Q

Autism spectrum disorder is best defined as

A

Persistent deficits in social communication and social interaction across multiple settings

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44
Q

Assessment findings you would expect to see in autism spectrum disorder includes

A

No response when called by name

Little or no eye contact

Non-verbal communication

Often likes to lineup, stack, or organize objects and toys

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45
Q

Common Screen tools used for autism spectrum disorder equal

A

Modified checklist for autism in toddlers (M-CHAT)

Autism diagnostic observation schedule -Generic (ADOS-G)

Ages and stages questionnaire’s (ASQ)

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46
Q

Pharmacological management in autism spectrum disorder may include

A

Antipsychotics which are affective for symptoms such as tantrums, aggressive behavior, self-injurious behavior, hyperactivity, and repetitive stereotypes behaviors

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47
Q

The corpus callosum is

A

An area of sensorimotor information exchange between the two hemispheres Of the cerebrum

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48
Q

Each hemisphere of the cerebrum is divided into four major lobes which are

A

Frontal lobe
Temporel lobe
Occipital lobe
Parietal lobe

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49
Q

Functions of the frontal lobe include

A

Executive function: Working memory, reasoning, planning, prioritizing, sequencing behavior, insight, flexibility to come in judgment, impulse control

Language (Broca’s area) expressive speech

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50
Q

Disturbances of the frontal lobe can lead to

A

Personality changes, emotional and intellectual changes

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51
Q

Temporal lobe functions include

A

Language (Wernicke’s area)
speech reception, language comprehension, Memory, facial recognition, Hearing, Speech, emotion

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52
Q

Functions of the Frontal lobe

A

Thinking, planning, problem-solving, emotions, Behavioral control, Decision making

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53
Q

Z

A
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54
Q

Functions of the Parietal lobe

A

Perception, object classification, spelling, Knowledge of numbers, Visual-spatial processing

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55
Q

Functions of the Occipital lobe

A

Vision, visual processing, color identification

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56
Q

Functions of the Cerebellum

A

Gross and fine hand motor skills, hand to eye coordination skills, and balance

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57
Q

Functions of the brain stem

A

Regulates body temperature, heat rate, breathing, swallowing

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58
Q

The clock drawing test 

A

Take a minute or two to complete

Quick screen for possible dementia / Alzheimers

Difficulties with the clock drawing test indicates constructional apraxia / lesions to the right parietal lobe



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59
Q

The limbic system Lies within the cerebrum and is composed of the

A

Thalamus, hypothalamus, Hippocampus, and amygdala

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60
Q

The function of the limbic system is to

A

Regulate and modulate emotions and memory

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61
Q

The function of the hypothalamus is two

A

Regulate appetite, circadian rhythm and libido

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62
Q

The function of the hippocampus is to

A

Regulate motivation, stress, emotion

Regulate memory and convert short-term memory into long-term memory

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63
Q

The function of the amygdala is

A

Mediation of fear, anxiety, aggression, and rage

Mediation of mood, fear, emotion, and aggression

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64
Q

 A typical antipsychotics antagonize the

A

they (block) the 5HT2a serotonin receptor

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65
Q

mesolimbic dopamine pathway

A

Excess dopamine causes positive psychotic symptoms

Antagonism of D2 receptors in the mesolimbic pathway helps decrease the positive symptoms of psychosis

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66
Q

Mesocortical dopamine pathway

A

Decreased dopamine in the mesocortical pathway causes negative and depressive symptoms of schizophrenia

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67
Q

Nigrostriatal dopamine pathway

A

The nigrostriatal dopamine pathway mediates motor movements

The blockade of D2 receptors in this pathway leads to the development of extrapyramidal symptoms (EPS) because of inverse rise in acetylcholine levels (inc salivation, teary eyes, diarrhea)

Long-standing blockade of D2 receptors in the nigrostriatal pathway can lead to tardive dyskinesia

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68
Q

Tuberoinfundibular dopamine pathway

A

Blockade of D2 receptors in this pathway can lead to increased prolactin levels which causes galactorrhea (risperidone), amenorrhea, gynecomastia, sexual dysfunction.

Long term hyperprolactinemia can lead to osteoporosis

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69
Q

Types of EPS (extrapyramidal symptoms) include:

A

Dystonia (Sustained muscular skeletal contractions) Oculargyric crisis, tortacollis

Akathisia (ants in pants)

Parkinsonism (same symptoms as Parkinson’s)

Tardive dyskinesia (repetitive oral and tongue smacking)

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70
Q

EPS is caused by

A

excessive D2 blockade (antagonism) from antipsychotic therapy

Decreased dopamine = Increased acetylcholine (remember inverse relationship)

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71
Q

Treatment of EPS includes

A

Anticholinergics like benztropine (Cogentin) for dystonia and Parkinsonism

Beta blockers for akathisia

Treatment of Tardive Dyskinesia is to stop or reduce the current dose of antipsychotic or start an atypical antipsychotics. Treatment can also include valbenazine (Ingrezza). Never give benztropine for TD. It can worsen TD

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72
Q

Occulogyric crisis

A

A rare form of dystonia which can lead to permanent injury and involves prolong involuntary upward deviation of the eyes

Treatment is benztropine (Cogentin)

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73
Q

Neuroleptic malignant syndrome is

A

A type of EPS

typically caused by taking too much of a first generation antipsychotic which decreases levels of dopamine too greatly

severe muscle rigidity which can cause rhabdomyolysis, MUTISM, Fever, tachycardia, confusion

Labs: CPK (elevated from muscle contraction and muscle distraction)
myoglobinuria, elevated WBCs (Leukocytosis) elevated LFTs

Treatment is discontinue the antipsychotic. Then give dantrolene (muscle relaxer) and a D2 agonist (like bromocryptine) to increase dopamine levels

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74
Q

To commonly used rating scales for the severity of akathisia are

A

The Barnes Akathisia rating scale

Extrapyramidal Symptom rating scale 

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75
Q

Which antidepressant is associated with the most adverse cardiovascular side effects

A

citalopram (Celexa)

2011 warning about prolonged QTC intervals in doses greater than 40 mg (>20mg in older adults)

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76
Q

The study of a drug absorption, metabolism, distribution, and excretion is called

A

Pharmacokinetics

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77
Q

The study of what a drug does to the body is

A

Pharmacodynamics

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78
Q

Hallmark sign of fetal alcohol syndrome is

A

Underdeveloped features

(Small head circumference, small eye openings, small nose, Small lips, low nasal bridge, epicanthal skinfolds,

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79
Q

Absorption is defined as

A

Method and rate and which drugs leave the site of administration.

With oral medications absorption normally occurs in a small intestine and then the liver

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80
Q

Distribution is defined as

A

When the drug leaves the systemic circulation and enters the interstitium and cells

Most psychotropic medication’s are lipophilic and highly protein bound. Only the unbound portion of the drug is active

Patients with low protein levels related to malnutrition, aging can potentially experience toxicity

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81
Q

Which classification of medications is moved commonly associated with mania like side effects?

A

Steroids (Flonase, prednisone)

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82
Q

Which classification of medication is most commonly associated with depression like side effects

A

Steroids (Flonase (fluticasone), prednisone)

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83
Q

Isotretionoin (Accutane) Is associated with which two side effects?

A

Depression

Birth defects (patients who are pregnant and taking Accutane should be recommended to stop immediately)

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84
Q

Propranolol is known to exacerbate or cause which psychiatric diagnosis

A

Depression

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85
Q

A physical description of a patient with fragile X syndrome would include

A

A description of larger structures

Large, long head and ears.

Macrorchidism (Abnormally large testes)

Hyper extensible joints

Crossed eyes (Strabismus), Highly arched palette

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86
Q

Tricyclic antidepressants are known to cause what and should be avoided in patients with a history of what?

A

TCAs are known to cause EKG changes and cardiac dysrhythmias

Should be avoided in patients with history of cardiac dysrhythmias

If necessary in this population EKG should be monitored before treatment begins and annually

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87
Q

What causes a hypertensive crisis

A

MAO eyes are taken in conjunction with certain medication‘s

Meperidine (Demerol) Can result in coma or severe respiratory depression

Stimulants and other sympathomimetics (Amphetamines, cocaine)

TCAs, atypical antipsychotics

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88
Q

What are the symptoms of a hypertensive crisis

A

Sudden, explosive like headache, usually in occipital region

Hypertension, palpitations, pupillary dilation, diaphoresis, fever, Flushing

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89
Q

What is the treatment for a hypertensive crisis

A

Discontinue the MAOI

Give phentolamine (Blocks norepinephrine)

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90
Q

What causes serotonin syndrome

A

Taking too much of an Antidepressant (SSRI, MAOI, TCA, SNRI)

TRIPTANS (Migraine medication) Imitrex (sumatriptan)

At John’s Wort

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91
Q

What are the symptoms of serotonin syndrome

A

Hyperreflexia, myoclonic jerking, loss of coordination

Agitation, restlessness, palpitations, rapid heart rate, hypertension, headache, sweating, shivering, goosebumps

Confusion, fever, seizures, unconsciousness

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92
Q

 What is the treatment for serotonin syndrome

A

Discontinue the offending agent and provide support of treatment including

Judicious use of benzodiazepines

Serious overdose may require Cryptoheptadine (Anti-histamine) , and anticonvulsants 

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93
Q

When switching from an SSRI to an MAOI how long should a practitioner have the patient weight

A

14 days

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94
Q

When switching from Prozac to an MAOI how long should the practitioner have the patient wait

A

5 to 6 weeks

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95
Q

When switching from an MAOI back to Prozac how long should a practitioner have the patient wait

A

Two weeks

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96
Q

When switching medication’s a good rule of thumb is to always wait at least how many days regardless of drug class

A

14 days

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97
Q

When switching from Prozac is best to wait how long because of Prozac’s long half life

A

5-6 weeks

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98
Q

Serotonin discontinuation syndrome is caused by

A

Abrupt discontinuation

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99
Q

Symptoms of Serotonin discontinuation syndrome 

A

Flu like symptoms
Fatigue and lethargy
Myalgia
Decreased concentration



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100
Q

Which Antidepressant Is most likely to cause discontinuation syndrome if stopped abruptly

A

Zoloft (sertraline) has a short half-life so discontinuation syndrome is more likely

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101
Q

Delusions are defined as

A

Firmly maintained false beliefs despite evidence to the contrary

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102
Q

Paranoia is defined as

A

Believing that people are out to get you

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103
Q

Referential thinking is defined as

A

The belief that Cues and events in a patient’s every day life Have special meaning just for them

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104
Q

Components of mental status exam

A

Appearance
Behavior
Speech
Mood
Affect
Thought process
Thought content

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105
Q

Thought process as part of the MSE is defined as

A

Assessment of the patient’s organization of thoughts and ideas



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106
Q

Tangential thought process as part of the MSE is defined as

A

Moving from thought to thought in a way that may or may not relate to the question and never gets to the point

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107
Q

Circumstantial thought process as part of the MSE is defined as

A

Providing unnecessary detail but eventually answering the question

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108
Q

Thought content as a part of the mental status exam is defined as

A

Themes that occupy the patients thoughts and perceptual disturbances

Examples: SUICIDAL IDEATION, HOMICIDAL IDEATION, auditory or visual hallucinations

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109
Q

MMSE (Folstein scale) uses what to assess concentration, calculation, and attention?

A

Counting backwards from 100 by 7 (Serial 7’s)

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110
Q

MMSE (Folstein scale) uses what to assess registration (Ability to learn new material)

A

Slowly and clearly say the names of three unrelated objects. Ask the patient to repeat them

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111
Q

The MMSE (Folstein scale) defines registration as

A

The ability to learn new material

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112
Q

The MMSE (Folstein scale) uses what to assess fund of knowledge

A

Ask the patient who the current president is

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113
Q

Appraisal of the patient suicidal ideation, plan, method, intent would be documented in which part of the patients psychiatric evaluation?

A

Mental status exam

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114
Q

Which demographic group is at the highest risk of suicide 

A

Older, single, white, males, with depression

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115
Q

Treatment for alcohol withdrawal begins with a CIWA score of

A

8 or greater for (prn only)
15 or greater for (scheduled + prn)

Diazepam and lorazepam are commonly used.

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116
Q

Which three medications are approved by the FDA for the treatment of alcohol use disorder

A

Acomprosate (campral)
Disulfiram (Antabuse)
Naltrexone (vivitrol)


Acomprosate and naltrexone decrease Alcohol consumption

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117
Q

Signs and symptoms of withdrawal according to the clinical opioid withdrawal scale (COWS)

A

Yawning
ability/anxiety
Myalgia
Pupillary dilation
Pilo erection
Lacrimation
Rhinorrhea

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118
Q

COWS severity scale

A

0-4 none
5-12 mild
13-24 MODERATE
25-35 moderate/severe
>36 severe

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119
Q

It is best to give Buprenorphine or Suboxone (buprenorphine/ naloxone) when the patient is in a state of

A

Moderate withdrawal

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120
Q

Antabuse (disulfiram) should not be administered until the patient has been alcohol free for at least

A

12 hours

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121
Q

Patients should refrain from using anything containing alcohol (Vinegar, aftershave, perfume, mouthwash, cough medication) for how long after discontinuing disulfiram

A

2 weeks

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122
Q

The normal value for a mini mental status exam is

A

25-30 Normal
24-21 Mild dementia
20-10 Moderate dementia
9-0 Severe dementia

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123
Q

The normal value for the HAM-D depression rating scale is

A

(0-27)

0-7 normal
8-13 mild depression
14-18 moderate depression
19-22 severe depression
23-27 very severe depression

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124
Q

The normal value for the PHQ-7 depression rating scale is

A

(0-27)

0 - 4 Normal
5 - 9 Mild
10 - 14 Moderate
15 - 19 Moderated to severe
20 - 27 Severe

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125
Q

A normal value for the HAM-A anxiety rating scale is a less than

A

HAM A (0 - 56)

0 -17 Mild anxiety
18 - 24 Moderate anxiety
25 - 56 Severe anxiety

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126
Q

A normal score for the GAD Anziety rating scale is

A

GAD (0 -23)

0 - 4 Normal
5 - 9 Mild
10 - 14 Moderate
15 - 21 Severe

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127
Q

A normal value for the Beck Depression rating scale is

A

Beck (0-63)

0 - 9 Normal
10 - 18 Mild
19- 29 Moderate
30- 63 Severe

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128
Q

What is the acronym used to guide treatment for the brief intervention for treatment of alcohol 

A

FRAMES

Feedback
Responsibility
Advice
Menu
Empathetic interviewing
Self efficacy

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129
Q

What is the most commonly used screening tool for alcohol abuse

A

CAGE

Item responses on the CAGE are scored 0 or 1, with a higher score an indication of alcohol problems. A total score of 2 or greater is considered clinically significant

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130
Q

What does the CAGE acronym stand for

A

Felt the need to (cut down)

(Annoyed) by you mentioning your drinking

Felt (guilty) about your drinking

Felt the need to drink first thing in the morning to steady your nerves (Eye-opener)

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131
Q

Delirium is characterized by

A

Short term changes in cognition

Disturbances of consciousness

Inattention

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132
Q

Delirium has a poor prognosis and

A

A one-year mortality rate of 40%

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133
Q

The Pharmacological treatment of choice For delirium is

A

Haldol

Haldol is preferred for agitated patients

Avoid benzodiazepines unless alcohol withdrawal is involved

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134
Q

What are the two types of dementia

A

Cortical and sub cortical

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135
Q

Describe cortical dementia

A

Affecting the outer layer of the brain (Cortex) Which plays a critical role in memory and language

Examples include Crutchfield Jacobs, Picks, and Alzheimer’s dementias

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136
Q

What symptoms characterize cortical dementia

A

Severe memory impairments and aphasia

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137
Q

Describe subcortical dementia

A

The early symptoms of clumsiness (MOTOR), irritability, and depression are what differentiates subcortical dementia from cortical dementia

Examples include Huntington’s, Parkinson’s, vascular, Lewy body, and AIDS dementia

In the later stages both types of dementia have similar presentations

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138
Q

Alzheimer’s dementia

A

without focal neurological deficits

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139
Q

Vascular dementia

A

Diffuse cerebral atrophy and enlarged ventricles

Decreased acetylcholine and norepinephrine

Carotid bruit, funduscopic abnormalities, and enlarged cardiac chambers

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140
Q

HIV dementia

A

Early signs are motor abnormalities (coordination, tremors, dystonia), cognitive decline, and Behavioral abnormalities

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141
Q

Picks dementia (aka frontotemporal dementia or frontal dementia)

A

language changes (slurred speech)

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142
Q

Huntington’s dementia

A

A high incidence of depression and psychosis

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143
Q

Lewy body dementia

A

visual hallucinations

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144
Q

Commonly used standardized instruments for assessing level of impairment in dementia

A

Montreal cognitive assessment (MoCA)

Mini-Cog

St. Louis University mental status examination (SLUMS)

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145
Q

What are the preferred treatment for psychosis and agitation in dementia

A

Try non-pharmacological treatments first

Atypical antipsychotics are considered first line treatment

Benzodiazepines should be avoided as these patients are susceptible to their adverse effects (falls, sedation, and delirium)

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146
Q

The goal of primary prevention is to, then name examples

A

Decrease the incidence of new cases

PREVENTION

Examples include stress management classes, smoking prevention, drug abuse prevention classes

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147
Q

The goal of secondary prevention is to, then name examples

A

Decrease the prevalence of existing cases

Examples include SCREENING, hotlines, crisis intervention, disaster response

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148
Q

The goal of tertiary prevention, and provide examples

A

Decrease the disability and severity of existing cases

Examples include REHABILITATION

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149
Q

What is kindling

A

The process of neuronal membrane threshold sensitivity dysfunction

Process through which increasingly low severity stimuli can activate negative responses over time. (Seizures)

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150
Q

Define addiction

A

A cluster of cognitive, behavioral, and physiological symptoms indicating that the patient continues to use substances despite significant substance related problems

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151
Q

Potency is defined as

A

The relative dose require to achieve certain effects

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152
Q

ADHD requires how many attention symptoms and how many hyperactive symptoms

A

Six or more symptoms of an attention and six or more symptoms of hyperactivity

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153
Q

What are the symptoms of inattention In ADHD

A

Lack of attention to detail
Inability to maintain attention
Poor listening skills
No follow through
Disorganization
Avoids hard tasks
Loses things
Distracted
Forgetful

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154
Q

What are the Symptoms of hyperactivity in ADHD

A

Fidgety
Inability to stay in seat
Running and climbing
Inability to engage in quiet activities
Always on the go
Excessive talking
Blurting out information
Difficulty waiting for turn
Interrupting others

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155
Q

There are three types of ADHD what are they

A

ADHD, inattentive type (Lack of Symptom criteria for hyperactivity)

ADHD, hyperactive type (Lack of Symptom criteria for an attention)

ADHD combined type (All criteria for hyperactivity and inattention are met)

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156
Q

What is the etiology for ADHD

A

Abnormalities of frontal sub cortical pathways (Frontal cortex, basal ganglia, reticular activating system)

Basal ganglia (Motor control)

Reticular activating system (Arousal, sleep wake cycle, ability to focus)4

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157
Q

What are the neurotransmitter abnormalities affecting ADHD

A

dopamine dysfunction
Norepinephrine dysfunction
Serotonin dysfunction

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158
Q

Pharmacological management of ADHD

A

Before starting stimulants assess cardiac history

AMPHETAMINES (Adderall) can be prescribed in children ages THREE and older

Methylphenidate (Ritalin, Concerta) and Amphetamines can be prescribed in children’s ages six and older

Alpha-2 agonist (Non-stimulants- Guanfacine, clonidine, Atomoxetine (Strattera)) Can be prescribed to children ages six and greater

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159
Q

In order to diagnose ADHD in children what must be determined

A

Intellectual functioning based on psychometric testing

Psychometric testing:
Connor’s parent and teacher reading skills
Vanderbilt ADHD diagnostic parent and teacher rating skills

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160
Q

What are signs of stimulant abuse

A

Insomnia
Tremors
Hypertension and tachycardia
Palpitations

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161
Q

What does non-pharmacological management of ADHD include

A

Behavioral therapy

Patient and parent cognitive behavioral training program

Psychoeducation

Treatment of learning disorders

Family therapy and education

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162
Q

Describe autism spectrum disorder

A

Persistent deficits in social communication and social interaction across multiple settings

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163
Q

Characteristics of borderline personality disorder

A

Impulsivity, often with self damaging behavior

Recurrent suicidal behavior

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164
Q

Non-pharmacological treatment for borderline personality disorder

A

dialectical behavioral therapy

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165
Q

Characteristics of antisocial personality disorder

A

Reckless disregard for the welfare of others

Lack of remorse and indifference to the feelings of others

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166
Q

Rett Syndrome occurs primarily in who and what are common physical findings

A

Girls

Common physical findings are loss of purpose for hand skills

stereotypic hand movements

Deceleration in head growth really look like shit

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167
Q

Disruptive mood dysregulation disorder (DMDD) Is characterized by

A

Diagnosed in children older than age 6 but younger than age 18

Chronic diss regulated mood

Frequent temper outbursts and tantrums

Severe irritability and anger

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168
Q

Pharmacological management of major disruptive mood disorder includes

A

Atypical antipsychotics

Stimulants (for irritability)

Antidepressants

Mood stabilizers

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169
Q

What is the pneumonic for diagnosing depression

A

SIGE CAPS

Sleep disturbance
Interest reduced
Guilt or self blame
Energy loss or fatigue

Concentration Diminished
Appetite Diminished
Psycho motor Changes
Suicide Ideation

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170
Q

Pharmacological management of major depressive disorder includes educating the patient about

A

The therapeutic effect of Antidepressant treatment may take 4 to 6 weeks

Once antidepressants have been started continue them for minimum of 6 to 12 months

If a client has more than two prior episodes of major depressive disorder consider continuing antidepressants indefinitely

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171
Q

Tricyclic antidepressants should be avoided in patients with a known history or Family history of

A

Cardiac dysrhythmias

TCAs are known to cause EKG changes and cardiac dysrhythmias

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172
Q

If a patient With major depressive disorder is experiencing treatment resistance or psychotic features Watch alternative treatment should be considered

A

Electroconvulsive therapy

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173
Q

What are possible contraindications for electroconvulsive therapy

A

Cardiac disease

Compromise pulmonary status

History of brain injury or brain tumor

Complications with anesthesia

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174
Q

What are some possible adverse effects When treating patients with electroconvulsive therapy

A

Possible cardiovascular effects

Systemic effects (Headache, myalgia, drowsiness)

Cognitive effects (memory disturbance, confusion)

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175
Q

When treating children, adolescence, or young adults with antidepressants, what should you practitioner always take into consideration

A

All antidepressants carry a black box warning about increased suicidal thoughts. Patients should be monitored closely for suicidal thoughts/behavior

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176
Q

What is a symptom of major depressive disorder that is commonly confused with dementia related symptoms

A

Cognition and memory loss

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177
Q

How can the practitioner differentiate between cognitive and memory loss symptoms in patients with major depressive disorder versus patients with dementia

A

Clients with dementia usually have a pre-morbid history of slowly declining cognition

In major depressive disorder cognitive changes have a relatively acute onset

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178
Q

No harm contracts are generally considered

A

Ineffective at reducing the risk/rate of suicide

There is insufficient evidence to prove no harm contracts work

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179
Q

What characteristic of fluoxetine (Prozac) Provides the greatest degree of safety for patients who have severe depression

A

Les potential for injury with intentional overdose

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180
Q

The pneumonic for mania in bipolar disorder is

A

DIG FAST

distractibility
Impulsivity
Grandiosity

Flight of ideas (Racing thoughts)
Agitation (Psycho motor)
Sleep (Decreased)
Talkativeness (Pressured speech)


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181
Q

The neurotransmitters involved in bipolar disorder are

A

GABA, Glutamate, serotonin, norepinephrine, dopamine



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182
Q

An added benefit of using lithium to treat bipolar disorder is that lithium is considered

A

Neuro protective

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183
Q

Which combination medication is FTA approved for the treatment of bipolar disorder

A

Symbyax (Prozac and Zyprexa)

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184
Q

According to the most recent treatment guidelines for bipolar disorder type one with psychotic features the best pharmacologic treatment choice would be an

A

Antipsychotic To stabilize the patient faster

185
Q

Aside from the obvious symptoms of Steven Johnson syndrome (Tongue swelling, papules, rash, skin sloughing, painful mucous membranes) another important symptom to remember is

A

Fever

186
Q

Non-pharmacological management of bipolar disorder includes

A

CBT
Behavioral therapy’s
Interpersonal therapy’s
Supportive groups
Milieu therapy

187
Q

What are normal free thyroxine (FT4) lab values

A

0.8-2.8 ng/dl

188
Q

What are normal thyroid stimulating hormone lab values

A

0.5 - 5.0 mU/l

189
Q

When T4 and T3 are high, TSH secretion is

A

Decreased

190
Q

T3 and T4 are low, TSH secretion

A

Increases

191
Q

Hypothyroidism is defined as

A

Increased TSH (Decreased T4 and T3)

192
Q

Systemic effects of hypothyroidism include

A

Cold intolerance
Confusion
Decreased libido
Weight gain

193
Q

Hyperthyroidism is defined as

A

Decreased TSH (Increased T3 and T4)

194
Q

Systemic effects of hyperthyroidism include

A

Heat intolerance
Irritability
Agitation
Anxiety
Tachycardia
Mood swings
Weight loss

195
Q

ALT (Alanine aminotransferase) Normal lab values are

A

5 to 35 U/l

196
Q

When liver damage occurs serum ALT levels rise as much as

A

50 times normal

197
Q

Commonly seen laboratory findings in patients with alcohol dependence and abuse

A

AST/ALT ratio of >2.0

Elevated:
Glutamyltransferase
Mean corpuscular volume
Prothrombin time
Uric acid
Total cholesterol
Triglycerides

Decreased:
Magnesium
Calcium
Potassium
BUN
H&H
Platelet
Albumin

198
Q

Oppositional defiant disorder is characterized by what two symptoms

A

An enduring pattern of angry or irritable mood and argumentative, defiant, or vindictive behavior lasting at least 6 months with at least four of the associated symptoms

Argues with authority

Absence of physical aggression


199
Q

How is oppositional defiant disorder managed

A

Non-pharmacologically

Individual Therapy

family therapy (emphasis on child management skills), teaching parents
about positive reinforcement and boundary settings.

Evidence based treatment : Child and parent problem-solving skills (Adolescent Transitions Program ATP)

200
Q

What are the defining characteristics of conduct disorder

A

Lack of remorse
Aggression to people or animals

The rights of others or societal norms or rules are violated

201
Q

What is the pharmacological management of conduct disorder

A

Target mood and aggression

Aggression and agitation are treated with antipsychotics, mood stabilizers, SSRI, and alpha agonists

202
Q

Which symptoms are characteristic of conversion disorder

A

NEUROLOGICAL symptoms that cannot be explained by medical condition
Mutism
Blindness
Paralysis
Paresthesia (Glove stocking syndrome)

 Symptoms usually begin suddenly after a stressful event

203
Q

Which symptoms are characteristic of adjustment disorder

A

EMOTIONAL or behavioral reaction to a stressful situation

An unhealthy reaction/response to an event that occurs within three months of it happening

Example: Stressful events or changes in the life of your child or adolescent may be a family move,
the parents’ divorce or separation, the loss of a pet, or the birth of a sibling.

204
Q

What are the subtypes types of adjustment disorder

A

Adjustment disorder with depressed mood

Adjustment disorder with anxiety

Adjustment disorder with mixed depression and anxiety

Adjustment disorder with Disturbance of conduct

Adjustment disorder with mixed emotions and conduct (A combination of all the above disorders)

205
Q

In the absence of other significant clinical symptoms, grief is usually classified as

A

Adjustment disorder

206
Q

Post traumatic stress disorder is best described as

A

Re-experiencing of an extremely traumatic event accompanied by symptoms of increased arousal and avoidance of stimuli associated with the trauma

207
Q

Off label pharmacological management of nightmares may include

A

alpha antagonist like prazosin

208
Q

What is the inclusion criteria for Tourette’s syndrome

A

At least 2 motor tics and at least 1 vocal (phonic) tic have been present, not necessarily at the same time

Tics are not caused by the use of a substance or other medical condition.

209
Q

What is the primary neurotransmitter involved in Tourette’s syndrome

A

dopamine
Serotonin
Norepinephrine

210
Q

A common medication used in the treatment of Tourette’s syndrome is

A

Haldol (D1 and D2 antagonist) because of the excessive levels of dopamine

Also Aripiprazole

211
Q

What is the only known antipsychotic that has been shown to reduce the risk of suicide In patients diagnosed with schizophrenia

A

Clozaril

212
Q

Most second generation antipsychotics (Clozapine, olanzapine, Quetiapine, and risperadone) cause the undesirable side effect of

A

Weight gain

Ziprasidone (Geodon), aripiprazole (abilify), and lurasidone (latuda) are weight neutral.

aripiprazole (least sedating)

213
Q

What is the etiology of schizophrenia

A

Inadequate synapse formation
Excessive pruning of synapses
Excitotoxic death of neurons
Prenatal exposure to toxins, including viral agents

214
Q

What are some common in neurobiological findings in patients with schizophrenia

A

Enlarged ventricles

Smaller frontal and temporal lobes
Cortical atrophy
Decreased cerebral blood flow
Smaller hippocampus and amygdala

215
Q

What are the characteristic neurotransmitter concentrations in schizophrenia

A

Excessive dopamine in mesolimbic pathway

Decreased dopamine in the nasal cortical pathway

Excessive glutamate

Decreased gaba

Decreased serotonin

216
Q

What is the average ave age of onset of Symptoms of schizophrenia in men

A

18 to 25

Men tend to have more negative symptoms

217
Q

What is the average age of onset forsymptoms of schizophrenia in women

A

Age is 25 to 35

Women usually experience more dysphoria than men and tend to have paranoid delusions and more hallucinations than men

218
Q

Atypical antipsychotics are effective at managing symptoms of schizophrenia because of your action on which receptors

A

D2 and 5HT2A

And have less EPS

219
Q

What are the positive symptoms of schizophrenia and what is the cause

A

Hallucinations
Delusions
Referential thinking
Disorganized behavior
Hostility
Grandiosity
Mania
Suspiciousness

Caused by excessive dopamine in the mesolimbic pathway

220
Q

What are the negative symptoms of Schizophrenia and what is the cause?

A

The “A’s”
Affect (Flattened)
Alogia (Poverty of speech)
Avolition
Apathy
Abstract thinking (Inability)
Anhedonia
Attention deficit

The cause is decreased dopamine in the mesocortical pathway

221
Q

What Is a non-pharmacologic method of treatment for patients with schizophrenia

A

ACT (Assertive community treatment)

An evidence based, multidisciplinary team approach which is available to patient with schizophrenia living in the community.

This is an alternative to restrictive residential or hospital settings

222
Q

Which aspects of preventative care should be considered during follow up with patients with schizophrenia

A

In order to screen for complications of treatment practitioners should monitor:
serum glucose
lipid panels
Weight
BMI
Waist to hip ratio

223
Q

 How many stages of human development are there according to Erikson? What are they?

A

eight

Infancy 0-1
Early childhood 1-3
LATE CHILDHOOD 3-6
SCHOOL-AGE 6-12
Adolescence 12-20
Early adulthood 20-35
Middle adulthood 35-65
Late adulthood >65

224
Q

What is the developmental task of infancy according to Erikson

A

Infancy 0 to 1 year

Trust versus mistrust

225
Q

What is a developmental task of early childhood according to Erikson

A

Early childhood 1 to 3 years

Autonomy versus shame and doubt

226
Q

What is the developmental task of late childhood according to Erikson

A

LATE CHILDHOOD 3 to 6 years

INITIATIVE v GUILT

227
Q

What is the developmental task of school age according to Erickson

A

SCHOOL AGE 6 to 12 years

INDUSTRY v INFERIORITY

228
Q

What is the developmental task of adolescence according to Erikson

A

Adolescence 12 to 20 years

Identity versus role confusion

229
Q

What is the developmental task in early adulthood according to Erikson

A

Early adulthood 20 to 35 years

Intimacy versus isolation

230
Q

What is the developmental task of middle adulthood according to Erikson

A

Middle adulthood 35 to 65 years

Generativity versus self absorption (Stagnation)

231
Q

What is the developmental task in late adulthood according to Erikson

A

Late adulthood greater than 65 years

Integrity versus despair

232
Q

What are indications of developmental mastery in late childhood according to Erikson

A

Self directed behavior, Ability to be a self starter

Purpose

233
Q

What is an indication of developmental mastery in school age children according to Erikson

A

Competency

Friends and classmates play a role in how children progress

Through proficiency at play and schoolwork, children are able to develop a sense of competency and pride in their own ability

234
Q

How many stages of cognitive development are there according to Piaget. What are they called?

A

Sensorimotor (0-2) Object permanence

PREOPERATIONAL (2-7) Egocentric, Magical thinking (Believe their thoughts can influence their environment)

Concrete operational (7-12) Reversibility and conservation

FORMAL OPERATIONAL (>12) ability to think abstractly, thinking operates in a formal, logical manner

235
Q

Define object permanence

A

Objects continue to exist after they are no longer seen

236
Q

Define object constant y

A

Absence does not mean disappearance or abandonment

237
Q

Describe the phallic stage of Freud’s psychosexual stages of development

A

Occurs ages 3-6

Exhibition, masturbation with focus on oedipal conflict, anxiety of castration males in fear of lost maternal love in females

Can lead to sexual identity disorders if failure to fulfill stage

238
Q

Idealization is it coping method for dealing with

A

Anxiety

239
Q

What are two key themes used in motivational learning

A

Affirm the patient’s positive treats

Reflective listening

Being non-confrontational and non-adversarial

240
Q

What are the 5 predictable stages of change that occur according to the trans theoretical model of change

A

Precontemplation: Not aware of the problem. Practitioner should raise the patient’s awareness without giving any prescriptive advice

Contemplation: Aware of a problem but not committing to change. The practitioner should help the patient see the benefits of change and the consequences of not changing,

Preparation: The patient has made the decision to change. The practitioner should help the patient find a change strategy

Action: The patient is engaging in overt actions to change. The practitioner should support and advocate for patient

Maintenance: The patient is engaging in behaviors to prevent relapse. The practitioner should help the patient identify the possibility of relapse and identify and use strategies to avoid relapse

241
Q

Who developed cognitive therapy and what is the goal

A

Cognitive therapy was developed by Aaron Beck

The goal is to change clients irrational beliefs, faulty conceptions, and negative cognitive distortions

242
Q

What techniques does behavioral therapy employ to help change patient’s maladaptive behaviors

A

Modeling
Exposure
Relaxation
Problem-solving
Role-playing


243
Q

What is the aim of cognitive behavioral therapy

A

Change the patient’s thought patterns, conscious and unconscious beliefs, Attitudes, and behavior to increase their ability to attain goals and face face difficulties

244
Q

How does cognitive behavioral therapy work

A

The patient and Therapist work as a team to identify problems, devise strategies, and create solutions

(SKILLS TRAINING AND EXPOSURE)

245
Q

Some essential cognitive behavioral therapy tools are

A

JOURNALING

COGNITIVE RESTRUCTURING  (Exploring the cause of Faulty thinking, and then restructuring and reframing them

Nightmare exposure

Relaxed breathing

Unraveling cognitive distortions

Exposure and response prevention

246
Q

PANDAS is

A

(Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections)

Sudden onset of OCD symptoms associated with streptococcal infection

247
Q

Existential therapy is aimed at

A

Understanding the patient subjective experience

248
Q

Existential therapy emphasizes

A

Making responsible choices and excepting freedom

Understanding the patient’s subjective world/experiences

249
Q

Goals of existential therapy are to

A

Focus on the present and on personal responsibility

Understand the patient’s subjective world/experiences

250
Q

Existential therapy is suited for

A

Terminal illness, suicidal thoughts

251
Q

Humanistic therapy is also known as known as

A

Person centered therapy

252
Q

Humanistic therapy involves the concept of

A

People are born with the capacity for:

Self-directed growth

Self actualization

253
Q

What is the goal of interpersonal therapy

A

identify and modify interpersonal problems to manage relationships

254
Q

Which psychiatric disorder is EMDR most commonly used in

A

PTSD

Although both CBT and EMDR are used in PTSD, EMDR is preferred

255
Q

What is the goal of EMDR

A

To achieve adaptive resolution

256
Q

What are the three phases of EMDR

A

Desensitization phase

Installation phase

Body Scan

257
Q

What does the desensitization phase of EMDR involve

A

Client visualizes the trauma and verbalizes the negative thoughts or maladaptive beliefs are remaining attentive to physical sensations.

This process occurs for a limited time While the client maintains rhythmic eye movements

The client is then instructed to block out negative thoughts and to verbalize their feelings

258
Q

What does the installation phase of EMDRinvolve

A

The patient installs it increases positive thoughts that they have declared as a replacement of the original negative thought

259
Q

What does the body scan phase of EMDR involve

A

The client Visualize the trauma along with a positive thought and then scans their body mentally to identify any tension

260
Q

Irving alone was the first person to

A

What is the reticle perspective on group work and identified 10 therapeutic factors unique to Group Therapy

261
Q

What are the unique factors of group therapy as defined by Irving Yalom

A

Installation of hope
Universality
Altruism
Increase development of socialization skills
Imitated behaviors
Interpersonal learning
Group cohesiveness
Catharsis
Existential factors
Corrective refocusing

262
Q

What is the focus of family systems therapy

A

Focus is on chronic anxiety within families

Uses genomes and triangles

263
Q

What are the treatment goals of family systems therapy

A

To increase levels of self differentiation And awareness of each members function within a family

264
Q

What are triangles within family systems therapy

A

Dyads that form triads to decrease stress

The lower the level of family adaptation the more likely a triangle will develop

265
Q

Structural family therapy examines

A

The boundaries and hierarchy within a family

266
Q

What is the difference between strategic Family therapy and structural family therapy

A

Strategic Family therapy is more symptom focused than structural family therapy

267
Q

What is a paradoxical directive within strategic therapy

A

A paradoxical directive is a negative Task that is assigned to a family member who is resistant to change (use with caution)

268
Q

Solution focused therapy utilizes

A

Miracle questions

” If a miracle water happen tonight while you were asleep and tomorrow morning you a walk to find the problem no longer existed, what would be different?”

“ How would you know the miracle to place?”

“ How would others know?”

269
Q

Which complementary/alternative therapy is used to treat pain and depression

A

Acupuncture

270
Q

List the 11 defense mechanisms

A

Denial
Projection
Regression
Repression
Reaction formation
RATIONALIZATION
Undoing
INTELLECTUALIZATION
Suppression
Sublimation
Altruism

271
Q

The defense mechanism of projection is best described as

A

Individuals attributing their own unacceptable thoughts and feelings to another person.

“ Do you hate someone but you know this is an unacceptable emotion so you ‘solve’ the problem by believing they hat you”

272
Q

A defense mechanism of displacement is best described as

A

redirection of an impulse (usually aggression) Onto a powerless substitute target

273
Q

The defense mechanism of sublimation is best described as

A

 Displacement of unacceptable emotions into behaviors which are constructive and socially acceptable

274
Q

The defense mechanism of INTELLECTUALIZATION Is best described as

A

Concentrating on the intellectual aspects of a situation to avoid emotional aspects

275
Q

The defense mechanism of RATIONALIZATION is best described as 

A

An attempt to logically justify an unacceptable behavior

276
Q

Research has shown a correlation between ACE adverse childhood experiences (Traumatic events occurring between the ages of zero and 17) and

A

Heart disease, fractures, diabetes, unintentional pregnancy, depression, anxiety, COPD, Chronic bronchitis, sleep disorders, Dissociative disorders, Eating disorders, alcoholism

277
Q

When working with avoidant patients with the history of trauma what communication techniques are effective/helpful

A

Communication techniques that increase arousal

Activation of the amygdala is needed so that memories stored there can be re-processed

278
Q

How is the recovery model defined

A

There is an emphasis on resilience and control over problems Rather than full symptom resolution

279
Q

Recovery as defined by the recovery model is

A

Not about getting rid of problems for a rather fostering ones own Abilities, interests, dreams

280
Q

Recovery as defined by the recovery model is a process which is

A

Non-linear With occasional setbacks and learning from experience

281
Q

The four dimensions of recovery according to the recovery model are

A

 Health
 Home
Purpose
Community

282
Q

Alternative community treatment Is centered on

A

The patients Personal strengths, and needs, and desires for the future

It serves as an alternative to more restrictive Residential or hospital settings for patients with more severe mental illness

283
Q

Tics are contraindicated for what classification of medication

A

Stimulants

Use guanfacine instead

284
Q

The priority item after being notified by a patient at a have been raped or abused is to

A

Assure them that they are safe

285
Q

The best setting to preform a psychiatric exam/interview on a patient is

A

In a private office or private area with the door open or partially open

286
Q

If a child comes to your office with their parents and says that they were abused, make sure to

A

Interview the patients separately

Notify CPS

287
Q

If a child is playing with a toy in a sexual way during your interview then you should be suspicious of

A

Sexual abuse

Immediately notify CPS

288
Q

Therapeutic alliance is built with adolescents by reassuring them that

A

Information is confidential

Interview them without parents in the room

289
Q

If a patient has a repeated history of self harm or suicidal ideations it’s important to notify them during your first meeting

A

About the limits of confidentiality

290
Q

It Create an ethical dilemma to separate parents from children for the purpose of interviewing them However,

A

You must advocate for your patient (In this case the child) who has the right to confidentiality

291
Q

When taking this exam

A

Inter-collaboration is encouraged and delegation is often incorrect

292
Q

You have identified a gap in care when OB patients are discharged without Risk assessment for postpartum depression. You Work in conjunction with your coworkers to Create andimplement a screening process. In this scenario you have

A

Identified a problem and collaborated to find a solution

293
Q

During this exam referring out should always be considered

A

As a last option. Ensure that there’s nothing else you can do for your patient before referring out. This may include lab work, counseling, testing etc.

294
Q

When considering symptoms of a mental health disorder within a cultural context, ensure that you have the patient

A

Contextualize their symptoms with regards to their culture. Just because the patient appears to have symptoms of mental illness does not mean that they have a diagnosable mental illness. 

You can offer them a brief supportive therapy

295
Q

If a patient has lost a job or house appropriate intervention would be

A

Brief supportive therapy

not medication

296
Q

When attempting to reduce Mental health stigma within a diverse community the practitioner must use

A

Multicultural teaching

Ethnospecific assessment parameters

297
Q

Common belief among Native Americans is the mental illness and or substance use disorder can be caused by

A

An imbalance between individuals in the world

298
Q

The ethnic group with the highest rate of suicide and suicide attempts in the US is

A

Native Americans

299
Q

If an employee of your office is attempting to take away a healing stick from a patient and the best action is to

A

Teach the employee about cultural competency and sensitivity

300
Q

If a patient wants you to release information to their traditional healer you must first

A

Obtain clearance for informed consent from the patient

301
Q

Normal TSH values are

A

0.5 - 5.0

302
Q

If your patient taking depakote presents with signs of a heptaotoxicity (abdominal pain in the upper right portion of abdomen, reddish brown urine, jaundice, fatigue) Your next action should be to

A

To a liver function test checking me AST and ALT levels

303
Q

Normal AST levels

A

5-40

304
Q

Normal ALT levels

A

5-35

305
Q

What is the therapeutic range for valproic acid

A

50 a 125

306
Q

What are toxic levels for valproic acid

A

> 150

307
Q

What are signs of valproic acid toxicity

A

Disorientation
Lethargy
Respiratory depression
Nausea/vomiting

308
Q

What should be your next action if your patient presents with valproic acid toxicity

A

Stop valproic acid
Check valproic acid level
Check LFT and ammonia level

309
Q

Kava is

A

An herbal supplement used for anxiety, stress, insomnia

310
Q

Kava can cause

A

Liver damage

311
Q

Kava interacts with

A

Xanax (can cause excessive drowsiness)

CNS depressants (Can cause excessive drowsiness)

312
Q

Lamictal (lamotrigine) Has a black box warning for

A

Steven Johnson syndrome (FEVER, Bodyaches, rash, peeling skin, tongue swelling)

313
Q

Which mood stabilizer is the least likely causes weight gain

A

Lamictal (lamotrigine)

Also the least likely chance of causing metabolic syndrome

314
Q

Which antipsychotics cause the least weight gain?

A

Ziprasidone
Aripiprazole
Lurasidone

315
Q

Which antipsychotic is the least sedating

A

Aripiprazole

316
Q

How should the practitioner manage antipsychotic induced weight gain

A

Primary action should be nonpharmacological strategies to include exercise and nutritional counseling

If primary action unsuccessful, pharmacological interventions consist of switching to another antipsychotic with less potential for a weight gain

Ziprasidone (Geodon)
Aripiprazole (abilify)
Lurasidone (latuda)

317
Q

The signs of infection caused by agranulocytosis in patients taking carbamazepine or Clozaril are

A

Sudden fever
Chills
Sore throat
Weakness

318
Q

If a lithium level is greater than 1.4 in the practitioner must

A

Discontinue lithium regardless of symptoms and signs of toxicity

319
Q

If a lithium level is 1.3 or 1.4 the practitioner may

A

Continue to Prescribe with him while monitoring the patient for signs and symptoms of toxicity

320
Q

The neuroprotective treatment of choice for bipolar disorder is

A

Lithium

321
Q

The only known Antipsychotic medication that has shown to reduce the risk of suicide in patients diagnosed with schizophrenia is

A

Clozaril 

322
Q

ACE inhibitors (lisinopril) NSAIDs (ibuprofen, indocin), and thiazides (hydrochlorothiazide) can reduce

A

Renal clearance and cause lithium toxicity

323
Q

Patients who are taking Lithium should be encouraged to

A

Increase their fluid intake to avoid dehydration

324
Q

What should be the practitioners intervention if they suspect lithium toxicity

A

Discontinue lithium

Check Serum lithium levels

325
Q

A washout time of how many half-lives is recommended between cessation of the previous drug and the introduction a new drug to avoid serotonin syndrome

A

5

326
Q

When treating cancer patients experiencing depression medication’s with the least chance of drug drug interactions are

A

Citalopram (celexa) and escitalopram (lexapro) both are SSRIs

327
Q

For patients with chronic neuropathic pain who are experiencing depression the best choice of antidepressant is

A

an SNRI

Cymbalta (Duloxetine)

Effexor (venlafaxine)

328
Q

What classification of medication is used for chronic neuropathic pain

A

Alpha-2 Delta Ligands

Lyrics (Pre-Gabalin)
Gabapentin 

329
Q

Which classification of antidepressants has the lowest incidence of sexual dysfunction side effects

A

NDRIs

Bupropion (Wellbutrin)

Both SSRIs and SNRIs can both cause sexual side effects

330
Q

Which classification of antidepressants will help depressed patients were also experiencing fatigue

A

Bupropion (Wellbutrin) which is in an NDRI

331
Q

Bupropion (Wellbutrin) is know to increase risk of 

A

Seizure

332
Q

For children and adolescents taking SSRIs and SNRIs what should be assessed with each visit

A

Frequency and severity of self harm

333
Q

Which SSRI can cause insomnia and should be taken in the morning

A

Prozac (Fluoxetine)

334
Q

If a patient is self-medicating with alcohol it is considered

A

A barrier to treatment

335
Q

Which mental health disorders are known to increase thoughts of self harm

A

Depression
Bipolar disorder
Alcohol abuse
Eating disorders
Schizophrenia

336
Q

Which personality disorder is most likely to present with homicidal ideation

A

Antisocial personality disorder

337
Q

Few experimental studies exist and investigate the placebo effect of antidepressants in

A

Children and adolescents

When compared to adults, children with depression have a reduced placebo rate.

This is because few parents want their children to receive placebos instead of standard of care

338
Q

Which areas of the brain can cause aggression, impulsivity, and abstract thinking problems in patients with schizophrenia

A

Abnormality in the prefrontal cortex, amygdala, basal ganglia, hippocampus, and limbic regions of the brain

339
Q

Patients with schizophrenia have low tolerance to

A

ALPHA 2 ADRENERGIC RECEPTOR AGONIST like (GUANFACINE AND
CLONIDINE)

The NEUROPTOTECTIVE EFFECTS of these medications are limited
ARE LIMITED

340
Q

Stimulants potentially the release of which neurotransmitter

A

Dopamine

341
Q

Prescribing stimulants to patients with schizophrenia can cause an increase in which symptoms and why?

A

Stimulants can cause an increase in positive symptoms because of increased levels of dopamine in the mesolimbic system

342
Q

 A patient with a long-term history of medication not adherence would benefit from

A

A Case Manager who could arrange for a nurse to go to the patient’s home to administer their medication

343
Q

What are the benefits of exercise programs for patients with schizophrenia

A

Exercise can improve cognition, quality of life, and long-term health

344
Q

If patients with schizophrenia are the higher risk for relapse sometimes they are switched from oral to intramuscular Haldol. What is the ratio and what is the maximum dose intramuscularly per visit?

A

20 x’s the daily dose for the first month

15-10 x’s the daily dose for every month after the first

The patient should receive no more than 100 mg intramuscular per visit. They can return after 5 to 7 days to receive the rest of the dose if it exceeds 100mg

345
Q

Define delusion

A

I firmly maintained belief despite information to the contrary

346
Q

When performing a mental status examination of a preschool child (3-5), Information is obtained primarily through

A

CLINICAL OBSERVATION by listening and observing cues

347
Q

The MMSE (Folstein scale) defines Recall as

A

Memory
Ask the patient if they can recall the three words you previously asked them to remember

348
Q

Can the min mental status exam be used in pediatric patients 

A

No

349
Q

Which atypical antipsychotic can be given intramuscularly for rapid stabilization of psychosis

A

Ziprasidone (Geodon)
Aripiprazole (abilify)
Paliperidone (Invega)


350
Q

Dystonia is caused by and characterized by

A

D2 receptor blockade in the nigrostriatal dopamine pathway

Painful muscle spasms in the neck, stiff neck 

351
Q

Increased Acetylcholine levels can cause

A

Increased salivation, watery eyes, diarrhea

352
Q

Reglan can cause

A

EPS (Tardive dyskinesia, Parkinsonism)

353
Q

Which two neurotransmitters are affected when a patient is experiencing extraparametal symptoms

A

Dopamine is decreased by the antipsychotics and acetylcholine is increased. There is an inverse relationship between dopamine and acetyl choline

354
Q

What are normal prolactin levels in men and women

A

Men <20
Women <25

355
Q

If a patient who is taking olanzapine (Zyprexa) Tells you that they have begun smoking what should you do

A

Increase the patient’s dose of olanzapine

Tobacco is an inducer And will decrease the serum levels of olanzapine

356
Q

If a patient who is taking olanzapine tells you that they have quit smoking you should

A

Decrease their dose of olanzapine. Tobacco was acting as an inducer thereby increasing the metabolism of olanzapine. With the tobacco no longer present serum olanzapine levels will increase

357
Q

Which classification of medication is associated with mania, depression, and psychosis

A

Steroids

358
Q

If a patient who is taking antidepressants or mood stabilizers begins a medication that can cause depression or mania,what should the practitioner do

A

Increase the dose of either the antidepressant or a mood stabilizer to counteract the potential symptoms of depression or mania

359
Q

Which to neurotransmitters are involved in addiction

A

Dopamine and GABA

360
Q

If a patient with anorexia complains of pain after eating which diagnosis should the practitioner consider

A

Delayed gastric emptying

361
Q

Are which medication can delay gastric emptying

A

Ranitidine
Omeprazole
Famotidine


362
Q

Which classification of medication can decrease the absorption of psychotropic medication’s

A

Proton pump inhibitor antacids

363
Q

Which symptom should be closely monitored in older adults (>65) who are taking SSRIs

A

Anxiety

364
Q

If a medication causes a paradoxical effect the practitioner would want to

A

Avoid prescribing the medication future

365
Q

Ziprasidone (geodon) can cause 

A

QT prolongation

366
Q

The FDA now warrants that citalopram should don’t be given and doses greatest and 40mg daily (>20mg/daily in older adults) because

A

Doses over 40 mg can cause prolongation of the QT interval and lead to an abnormal heart rhythm (including torsade de pointes)

367
Q

Apoptosis is defined as

A

Neuronal loss and cell death

368
Q

The greatest risk for developing symptoms of bipolar disorder is

A

Family history (Highly inherited)

369
Q

When diagnosed after the age of 45, bipolar disorder is almost always associated with

A

A medical condition

370
Q

If a patient with borderline PD presents with irritability, anger, and self-harming behavior, The Practitioner should consider prescribing

A

lithium

371
Q

If a patient with borderline PD presents with depressed mood, emotional lability, interpersonal
problems, rejection sensitivity, aggression, and hostility

A

The practitioner should consider prescribing Depakote

372
Q

If a patient presents with borderline personality disorder exhibiting symptoms of self harm and suicidality then the therapy of choice is

A

Dialectical behavioral therapy because it has evidence of decreased suicidality in patients with borderline personality disorder

373
Q

What are two techniques used in the process of diagnosing a patient with borderline personality disorder

A

Journaling and diary


374
Q

Which medications can help control the behavioral symptoms such as impulse control problems and rage in Tourette’s syndrome

A

clonidine (Catapres, Kapvay) and guanfacine (Intuniv)

375
Q

Acute stress disorder is

A

A psychiatric diagnosis that may occur in patients within 4 weeks of a
trauma

Versus posttraumatic stress disorder in which symptoms manifest >four weeks after the event

376
Q

What is the eitology of ADHD inattentive type

A

Abnormalities in the prefrontal cortex

377
Q

What part of the frontal cortex is specifically involved in executive function

A

Dorsolateral prefrontal cortex

378
Q

If a patient’s parents were to become anxious during psychoeducation regarding ADHD the providers first action would be to

A

Stop and provide support to the parents

379
Q

The symptoms most characteristic of obsessive compulsive disorder OCD or

A

Recurrent and persistent thoughts, impulses, images, compulsions (example motor tics)

Neurotransmitters affected are serotonin and norepinephrine

380
Q

Distinguishing characteristic between obsessive compulsive disorder Tourette’s disorder is

A

The absence of Intrusive and persistent thoughts with Tourette’s disorder (tics only)

The presence of Intrusive thoughts with obsessive compulsive disorder (tics + intrusive/persistent thoughts)

381
Q

What are the definitions of and differences between Factitious disorder and malingering disorder

A

Factitious disorder is self-induced harm to produce symptoms of illness (No secondary gain)

Malingering disorder symptoms are faked to achieve secondary gain.

382
Q

What is the priority action if a child reports factitious disorder by other

A

Immediately report/notify CPS

383
Q

What are the symptoms the most characteristic of reactive attachment disorder

A

Fearful, inhibited, withdrawn, apathetic, shows no emotion towards caregivers

The product of the severely dysfunctional really relationship with caregiver, neglect

384
Q

Two defining characteristics of general anxiety disorder are

A

Excessive worry for > 6 months

385
Q

To defining characteristics of panic attack are

A

Abrupt surge of intense fear
Impending doom

386
Q

Panic disorder is best described as 

A

Recurrent unexpected panic attacks

387
Q

The pharmacological treatment of choice for panic disorder or

A

the SSRIs Paroxetine (paxil), fluoxetine (Prozac), sertraline (Zoloft)

388
Q

Disruptive mood dysregulation disorder is the best defined as

A

A depressive disorder occurring in children > age 6 but > age 18

These children are severely moody and irritable with frequent intense anger outbursts and temper tantrum’s

389
Q

The ‘Broken Mirror’ theory of Autusm

A

Dysfunction of the mirror neuron system causes Poor social interaction and cognition

390
Q

Which questionnaire would be most appropriate if the patient is irritable, depressed, with labile mood

A

Mood disorder questionnaire

391
Q

It is important for the practitioners remember that nightmares in children can be attributed to

A

A family history or genetic predisposition

392
Q

Which what are three things that should be ruled as possible causes of delirium in an older adult

A

Vitamin B 12
Folic acid
Infection

393
Q

If a patient has pseudo dementia, primary diagnosis is

A

Depression (With memory and cognition impairment)

394
Q

Compared to dementia, the onset of pseudo dementia is

A

Acute And associated with depressive symptoms

395
Q

When interviewing a patient with Pseudo dementia a practitioner would expect the answer of

A

“ I don’t know”

vs the lack of an answer or confabulation with dementia

396
Q

Irritability, anger, hallucinations, and delusions can all the symptoms of what in older adults

A

Depression

397
Q

The primary characteristics that defines cortical dementia from subcortical dementia is

A

Subcortical dementia involves motor abnormalities (coordination, ataxia, dystonia, tremors)

Cortical dementia involves Language in memory impairments (aphasia, amnesia)

398
Q

Preferred treatment for HIV dementia is

A

Antiretrovirals

399
Q

What area of the brain is involved in speech comprehension

A

The temporal lobe (Wernicki’s area)

400
Q

What area of the brain is involved with Speech expression

A

The frontal lobe (Broca’s area)

401
Q

What are considered first-line agents in patients with psychotic symptoms of dementia

A

Atypical antipsychotics

402
Q

What symptoms would the practitioner expect to see in a patient with a frontal lobe tumor

A

Personality changes and aggression

403
Q

The substantia nigra helps to regulate

A

Motor movements

404
Q

Signs of lead poisoning

A

Developmental delay, learning difficulties, Irritability, Loss of appetite, Weight loss, Sluggishness and fatigue, Abdominal pain, Vomiting, Constipation, hearing loss, Seizures, eating things such as paint chips, that aren’t food (pica).

405
Q

How does multisystem family therapy work and who is it targeted for

A

Youth‘s age is 12 to 17 years who present with serious antisocial, problematic behavior, and with serious criminal offenses

The patient’s parents are empowered with resources and skills to help effectively manage their children

406
Q

Multi system family therapy utilizes which types of services

A

Home based model of service delivery to reduce barriers that keep families from accessing services

407
Q

The most important factor in effective hildhood grieving is

A

An intact family

408
Q

What are the neurotransmitters involved in mood disorders

A

GABA, glutamate, dopamine, norepinephrine, serotonin

409
Q

If a member is uncomfortable sharing with the group in the practitioner should

A

Encourage them to continue attending group

And individual sessions for the group member

410
Q

Awareness of body sensations especially breath awareness is a key element of

A

Mindfulness meditation

411
Q

What exercise can help provide resilience in children

A

Self-esteem building

412
Q

If a patient is unable to construct a chronological narrative in the provider could assist by using

A

Closed ended questions

413
Q

If a therapy session is scheduled for a husband and wife and one member cannot be present the Therapist should

A

Reschedule

414
Q

If a 15-year-old brother sodomizes Their five year old brother, the therapist should insist that

A

The brother not be left alone with the younger brother

Also, the therapist should initiate crisis management

415
Q

What is normal for boys to develop what between the ages of nine and 16 years

A

Breast buds
Usually resolve within six months

416
Q

Therapist should order which lab value for a patient presenting with rheumatoid arthritis

A

ESR
Eosinophil sedimentation rate

417
Q

An increased intercranial pressure can cause an infants cry to sound

A

Shrill

418
Q

Why are women more likely to become intoxicated as well as Develop alcohol induced liver problems than men

A

Women produce less alcohol dehydrogenase than men

419
Q

The grasp reflex (Palmer reflex) is normal unit what age

A

5-6 months

420
Q

The startle reflex (Moro reflex) Is normal up until 

A

5-6 months

421
Q

The Babinski reflex is normal up until

A

2 years

When the sole of the foot is stroked in an upward motion the toes fan out

422
Q

Phosphodiesterase type 5
(PDE5) ie Cialis/Viagra are

A

Rapidly absorbed

423
Q

IF a patient presents with NORMOCYTIC MACROCYTIC
ANEMIA give which supplements

A

FOLIC ACID
B12
IRON

424
Q

The practitioner should screen all adolescent ADHD patients for

A

Substance abuse

Likewise all adolescence with substance abuse disorder should be screened for ADHD

425
Q

The right of the habius corpus allows patients to

A

Leave the hospital AMA if they feel like they have been falsely hospitalized

426
Q

Acute disseminated encephalomyelitis (ADEM) is characterized by a brief but widespread attack of inflammation in the brain and spinal cord that damages myelin – the protective covering of nerve fibers. ADEM often follows viral or bacterial infections, Neuro exam findings might include

A

Asymmetrical movement of the extremities

Ataxia

Paresthesia

Fatigue/weakness/confusion



427
Q

When attempting to answer your PICOTquestion what is the highest level of evidence (level 1)

A

Level 1 = A systematic review of all relevant randomized controlled trials

428
Q

PICOT stands for

A

Problem
Intervention
Comparison
Outcome
Time

429
Q

The practitioner can assist a patient who is having difficulty constructing a timeline of their symptoms by

A

Asking specific questions that will anchor the patient’s memory or link memorable events together

430
Q

Iatrogenic disease/illness is defined as

A

Tests, surgeries, medications that cause side effects

And example would be risperidone causing breast discharge

431
Q

And effective means for convincing employees of implementing a new policy change would be to explain how the new policy will

A

Improve the quality of patient care

432
Q

For the nurse practitioner functioning in the outpatient setting in effect means for demonstrating continuous quality improvement would be to

A

Develop an instrument to monitor clinical outcomes

433
Q

For the nurse practitioner working with patients who have depression and anxiety and effective means to assess performance and outcomes would be to implement

A

standardize rating scale at regular intervals

434
Q

Auto immune diseases can increase levels of what

A

Cytokines

435
Q

What are some common signs and symptoms of alcohol withdrawal

A

Tremors
Paroxysmal sweal
Tactile disturbances
Auditory disturbances
Visual disturbances
Headaches

436
Q

Three Pharmacological treatments of alcohol dependence may include

A

Acamprosate (Not metabolized in the liver) maintain sobriety By controlling drinking urges and cravings

Disulfiram (Antabuse)

Naltrexone (vivitrol) blocks the effects and feelings of alcohol. Naltrexone reduces alcohol cravings and the amount of alcohol consumed


437
Q

Who determines the scope of practice within a given state

A

Deterrined by State legislative statues (State board of nursing). It defines the nurse practitioners role and varies broadly from state to state

438
Q

Who determines the standards of practice for a nurse practitioners

A

The American nurses association

439
Q

What are two exceptions to patient confidentiality

A

Patient discloses intent to harm self or others

Answering court orders, subpoenas, or summons

440
Q

Informed consent is defined as

A

A communication process between provider in patient that results in a patient accepting or refusing the plan of care

441
Q

Desmopressin his medication used for

A

Enuresis (nighttime bed wetting)

Decreases urine production

442
Q

If a new black box warning is issued by the FDA The practitioner should do work before taking patients office medication or putting patient on to the medication

A

Research the risk and benefits

443
Q

It is important for the Practitioner to do what two things for every medication and treatment they prescribe

A

Provide the patient with full disclosure

Document the disclosure and education

444
Q

Reflective practice is defined as

A

Using debriefing strategies after an adverse event

Process of continual adaptation and learning

445
Q

Name three legal concerns for tele medicine 

A

Confidentiality

Medical errors

Jurisdictional authority

446
Q

If a pregnant patient is found to be misusing alcohol, The primary action of the nurse practitioner is two

A

Refer her to a residential treatment facility (Not report her for using alcohol while pregnant)

447
Q

Example of Nonmaleficence: Doing no harm

A

Example: Stopping a medication that is causing harmful side effects or discontinuing a treatment strategy that is not effective and may be harmful.
Imminent danger.

448
Q

Fidelity is defined as

A

Being true and loyal.

Fidelity, comes from the Latin “fides” meaning faithfulness, is concerned with promise keeping, integrity, and honesty,
It also involves meeting the patient’s reasonable expectations (role fidelity) such as being respectful, competent, and professional

449
Q

Just culture is defined as

A

In a just culture, individuals are continually learning, designing safe systems, and managing behavioral choices.

450
Q

The process of continuous quality improvement utilizes which acronym

A

PDSA

Plan
Do
Study
Act

451
Q

Within the four components of health policy who are the policy makers

A

Process
Policy reform
Policy environment
Policymakers (Stakeholders and key players)

452
Q

To assess barriers and facilitate evidence-based practice, PMHNPs should assess what among health-care providers

A

assess baseline knowledge, beliefs, and practices among health-care providers using a survey.

453
Q

Defined the case management model

A

Nurses can optimize client self-care, reduce fragmentation of care, provide quality care across the continuum, improve clients’ quality of life, patient care and outcomes, reduce length of hospitalization, increase client, and staff satisfaction,

This model allows nurses to demonstrate there strengths as members of the multidisciplinary health care teams.

454
Q

Tarasoff principle holds that providers have a

A

Tarasoff principle (Tarasoff v. Regents at the University of California, 1976):

Duty to warn potential victim of imminent danger of homicidal clients,

455
Q

Donaldson versus Connor determined that

A

It is unconstitutional to commit person involuntarily who is not immediately a threat to themselves or others

456
Q

Risk factors for suicide

A

Previous suicide attempt
Ages 45 or older if male
Ages 55 or older if female
Divorced, single, or separated
Caucasian

457
Q

Normal T3 values

A

0.9 to 2.8 nanomoles per liter (nmol/L)

458
Q

The Saint Louis University Mental Status. (SLUMS) Examination for detecting mild cognitive impairment and dementia. What is a normal score

A

SLUM (0-30)
27 - 30 Normal
21 - 26 Mild
0 - 20 Dementia

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