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AANP FNP: Adult > Psych > Flashcards

Psych Flashcards

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Family Nurse Practitioner (FNP) flashcards
1
Q

Diagnosis of depression requires 5 symptoms including one of the following:

A

depressed mood

anhedonia

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2
Q

Labs to work up depression include…

A

TSH

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3
Q

Categories of feelings

A

mad, sad, glad, afraid, ashamed

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4
Q

Stages of grief

A

Denial, anger, bargaining, depression, acceptance

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5
Q

Management of depression

A

psychotherapy

possible antidepressants- SSRIs, lesser used TCAs and MAOIs

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6
Q

Seratonin syndrome presents with

A

high fever

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7
Q

Risks of MAOIs

A

wine + cheese = hypertensive crisis

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8
Q

Risk of TCAs

A

anticholinergic effects such as dry mouth and constipation

prolonged QT

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9
Q

dysthymia

A

chronic form of depression lasting at least 2 years, often since childhood

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10
Q

Anxiety: definition

A

unpleasant feeling of dread, aprehension, or tension resulting from an unexpected threat to one’s feeling of self esteem or well being

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11
Q

Generalized anxiety disorder

A

excessive worry/anxiety about life circumstances

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12
Q

Panic disorder

A

morbid dread of seemingly harmless object/situation; may lead to agoraphobia

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13
Q

Obsessive compulsive disorder

A

repetitive thoughts that a person is unable to control and/or urge to perform a task that cannot be resisted which interferes with normal ADLs

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14
Q

Post traumatic stress disorder

A

anxiety for at least 6 months after a severe trauma, characterized by flashbacks, nightmares, and intrusive thoughts

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15
Q

Labs to check for anxiety disorders

A

TSH, serum drug analyses, glucose, EKG

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16
Q

Management of anxiety

A

Cognitive behavioral therapy

Anti-anxiety medications- benzodiazepines, antihistamines, beta blockers, TCAs and MAOIs, buspirone (Buspar)

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17
Q

Suicide: incidence

A
  • increased risk in adolescents and white males >45 years old (especially with sudden loss of partner)
  • mental or substance abuse disorders account for >90percent of all suicides
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18
Q

Suicide screening test, “SUICIDAL”

A 
Sex
Unsuccessful attempts
Identified family members with attempt history
CI- chronic illness history
Depression, drug abuse, drinking
Age
Lethal method available
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19
Q

“CAGE” pneumonic

A

C- Have you ever felt the need to cut down on your drinking?
A- Have people annoyed you by criticizing your drinking?
G- Have you ever felt guilty about your drinking?
E- Have you ever had a drink first thing in the morning?

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20
Q

Who diagnoses alcoholism?

A

The patient has to say they have alcoholism

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21
Q

Rule out other diseases with dementia diagnosis

A 
Drug reactions/interactions
Emotional disorders
Metabolic/endocrine disorders
Eye/ear disorders
Nutritional problems
Tumors
Infection
Arteriosclerosis
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22
Q

Alzheimer’s disease is characterized as:

A 
memory impairment + one of the following:
aphasia
apraxia
agnosia
inability to plan, organize, sequence
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23
Q

aphasia

A

difficulty with speech

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24
Q

apraxia

A

inability to perform a previously learned task

25
Q

agnosia

A

inability to recognize an object

26
Q

What is the cause of Alzheimer’s?

A

Acetylcholine deficiency

27
Q

Management of Alzheimer’s

A

Neuro consult
Meds to increase the availability of acetylcholine
Donepezil (Aricept)
Galantamine (Razadyne)
Rivastigmine (Exelon)
May be prescribed in conjunction with NMDA receptor agonists such as Namenda (memantine)

28
Q

What is the cerebellum responsible for?

A

balance and coordination

29
Q

Romberg test

A

Evaluates cerebellar function
Feet together, eyes closed, arms at sides
Positive Romberg if patient has a loss of balance

30
Q

Finger to nose test

A

Evaluates cerebellar function

Patient alternately points from his nose to the examiner’s finger

31
Q

Heel to shin test

A

Evaluates cerebellar function

Run heel of foot along the shin of the opposite leg

32
Q

Cranial Nerves

A 
S CN I: Olfactory
S CN II: Optic
M CN III: Oculomotor
M CN IV: Trochlear
B CN V: Trigeminal
M CN VI: Abducens
B CN VII: Facial
S CN VIII: Acoustic/ Vestibular
B CN IX: Glossopharyngeal
B CN X: Vagus
M CN XI: Spinal accessory
M CN XII: Hypoglossal
33
Q

What is the most important history item when evaluating headache?

A

Chronology

34
Q

Tension headache

A 
90 percent of all headaches
vise-like, tight
generalized, often worse in neck or back of head
usually last several hours
treat with OTC analgesics, relaxation
35
Q

Migraine headache

A

Classic (with aura) and common (without aura)
Related to dilation and pulsation of branches of external carotid
Typically last 2-72 hours, trigeminal nerve pathway
onset in adolescence or early adulthood, females > males
assoc with triggers (smells, menses, alcohol, sleep problem, missed meals, oral contraceptives, nitrates in food, weather changes)
unilateral, dull or throbbing, may have neurological disturbances

36
Q

Treatment of migraines

A

Avoidance of triggers
Relaxation/stress management
ASA/triptans for acute attack
Prophylactic therapy if more than 2-3x/month:
amitryptyline, depakote, propranolol, verapamil, clonidine, topamax, gabapentin, magnesium

37
Q

Cluster headaches

A

mostly affecting middle aged men
may be preceded by alcohol intake
severe, unilateral, periorbital, occurs daily for several weeks
may occur at night/awaken patient
last less than 2 hours; pain free for weeks-months between attacks
ipsilateral congestion, rhinorrhea, eye redness
Tx: Triptans, inhalation of 100 percent oxygen

38
Q

How long do TIA symptoms last?

A

Less than 24 hours, but if more than 3 hours, it is more likely to turn into a stroke.

39
Q

What is hemiopia?

A

loss of half of visual field

40
Q

TIA classifications

A
  1. Vertebrobasilar

2. Carotid

41
Q

Lab/Dx for TIA

A

CT, MRI, CTA

echo, carotid US

42
Q

Treatment of TIA

A

Aspirin, Plavix
Assess for hypertension
Carotid endarterectomy if indicated

43
Q

When is carotid endarterectomy indicated?

A

Stenosis >70 to 80 percent in symptomatic patients

44
Q

What is the #1 cause of heart failure?

A

Hypertension

45
Q

Partial seizure: Simple

A

No loss of consciousness

Usually

46
Q

Partial seizure: complex

A

any simple partial seizure followed by impaired level of consciousness

47
Q

Generalized seizure: absence (petit mal)

A

Blank stare
Usually discovered in children/adolescents
Begin and end suddenly

48
Q

Generalized seizures: tonic clonic (grand mal)

A 
may have aura
tonic contractions, loss of consciousness, then clonic contractions
usually lasts 2-5 minutes
incontinence may occur
followed by postictal period
49
Q

Status epilepticus

A

Series of grand mal seizures of >10 minutes duration
medical emergency
patient never regains consciousness between seizures
uncommon, but can be life threatening

50
Q

Seizure management

A

CT scan, EEG
during seizure: maintain open airway, benzodiazepines
anti-seizure meds should be tapered and never abruptly withdrawn

51
Q

Parkinsons

A

Dopamine deficiency
Onset usually between 45 and 65 years old
S/sx: tremor, rigidity, bradykinesia, Myerson’s sign

52
Q

Myerson’s sign

A

repetitive tapping over bridge of nose produces a sustained blink response
signifies Parkinsons disease

53
Q

Management of Parkinsons

A

Increasing dopamine (trouble standing/getting up)
- carbidopa levodopa
Anticholinergics (tremor/rigidity)
- benztropine (Cogentin)

54
Q

Myasthenia Gravis

A

autoimmune, reduction in number of acetylcholine receptor sites
predominant in women 20-40 years old
Sx: weakness worse after exercise and better after rest, ptosis (droopy eyelid), diplopia, dysarthria, dysphagia, extremity weakness, fatigue, respiratory difficulty, DTRs are NORMAL
Dx: antibodies to acetylcholine receptors
Tx: neurology referral

55
Q

Multiple sclerosis

A

autoimmune, body attacks myelin
predominant in white women 20-50 years old
Sx: numbness, weakness, loss of muscle coordination, problems with vision, speech and bladder control, diplopia, disequilibrium
Dx: slightly elevated protein in CSF on lumbar puncture, MRI of brain
Tx: refer to neurology

56
Q

Bell’s palsy

A

affects cranial nerve VII, facial nerve
idiopathic, but may be related to herpes virus reactivation
abrupt onset of facial paresis
may be accompanied by pain around the eye
UNABLE to move forehead (stroke patients CAN move forehead)
Tx: prednisone taper, Acyclovir if zoster infection suspected, lubricating eye drops and patch at night if unable to close, neurology referral as needed

57
Q

What differentiates stroke and Bell’s palsy facial paralysis?

A

Stroke CAN move forehead

Bell’s palsy CAN’T move forehead

58
Q

Trigeminal neuralgia

A

affects cranial nerve V, trigeminal
electric-shock-like pains in parts of the face (unilateral)
causes: MS, or pressure on the trigeminal nerve from swollen blood vessel or tumor
Dx: neuro exam, MRI, trigeminal reflex testing
Tx: antiseizure drugs, muscle relaxants, TCAs

AANP FNP: Adult (14 decks)

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