PMHNP-BC exam Review for the pmhnp boards Answered 100% correct

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Risk of Schizophrenia in monozygotic twins is? - ANSWER 46-50% Family hx risk of schizophrenia - ANSWER 10x risk with 1st degree relative brain changes in schizophrenia - ANSWER increase in vent... ricular volume (enlarged cerebral ventricles) Hippocampus volume decrease, 4% smaller Decreased electrical activity in frontal lobes Decrease glutamate and GABA release. Decreased total brain volume functional neuroimaging findings of schizophrenia - ANSWER Abnormal function of frontal cortical regions Including for solo lateral prefrontal and anterior cingulate cortices Maximum dose of Celexa - ANSWER 40mg/day as higher doses can cause abnormal electrical activity of the heart. Some experts still prescribe higher What class of medication is bupropion - ANSWER NDRI boosts norepinephrine, noradrenaline, and dopamine neurotransmitters What hematologic change is associated with lithium? - ANSWER Leukocytosis. Lithium raises WBC counts. Monitor CBC GABA in terms of anxiety disorders - ANSWER Most abundant inhibitory neurotransmitter. Decreasing GABA would increase anxiety. Benzos are used to bind with GABA to potentiate the anxiolytic effects of GABA What to avoid while on Disulfiram - ANSWER Anything containing alcohol (vinegar, mouthwash, aftershave, cough medicine). Avoid for 2 weeks after discontinuing disulfiram. Lab effected by disulfiram that requires monitoring - ANSWER Disulfiram can elevate liver function tests A medication that can induce mania - ANSWER Corticosteroids What finding would be associated with an acoustic neuroma? - ANSWER Unilateral ringing in the ear (tinnitus) may be the first symptom of an acoustic neuroma. What delay is expected in a 4 year old with Asperger's? - ANSWER Delay in social skills development. Unlike autistic disorder, no significant delays in language, cognitive development, or age appropriate self help skills are observed. Primary clinical features of Asperger's - ANSWER Qualitative social impairment Markedly abnormal nonverbal communicative gestures Failure to develop peer relationships Lack of social or emotional reciprocity Impaired ability to express pleasure in other persons' happiness. Chlorpromazine (Thorazine) and clozapine cause what troublesome side effect due to their alpha 1-adrenergic blockade? - ANSWER Orthostatic hypotension. Manage by raising dose of chlorpromazine and clozapine slowly. What medication is strictly prohibited when the patient is on an MAOI such as selegiline due to the risk of hypertensive crisis and death? - ANSWER Meperidine (Demerol) Dopamine pathways in relation to clinical symptoms of schizophrenia - ANSWER Negative symptoms are related to DA deficit in the cerebral cortex; positive symptoms are related to DA excess in the nucleus accumbens and mesolimbic system. Facial characteristics of child with fetal alcohol syndrome - ANSWER Small head Short eyelid opening Flat midface Smooth philtrum Underdeveloped jaw Thin upper lip Short nose (Can also have inner epicanthal folds, short palpebral fissure) Physical features of prayer willi syndrome - ANSWER Obesity Small stature Small hands and feet Hypotonia Hypogonadism Physical features of von recklinghausen's disease - ANSWER Café au lait spots Neurofibromas In what condition is the use of bupropion contraindicated? - ANSWER Bulimia. Do not use bupropion in past or present eating disorders due to increased risk of seizures. Predominant risk factor of antisocial personality disorder? - ANSWER Genetic predisposition of first-degree family member. Antisocial personality disorder is 5X more common among first-degree relative of men with the disorder than the general population. Risk of inhibition of platelet aggregation (risk of bleeding from SSRIs, NSAIDS, ASA) is an example of this - ANSWER Pharmacodynamics Rare but serious side effect of trazodone (Desyrel) - ANSWER Priapism arcus senilis (gray opaque band in the cornea) prior to age 40 is associated with what disorder? - ANSWER Hyperlipidemia Asians are poor metabolizers of which enzyme? (Will have exaggerated response to diazepam) - ANSWER CYP 2C19 Side effects of oxcarbazepine (Trileptal) - ANSWER Excessive urination and thirst (can be distinguished from possible DM II if blood sugar is up but HGBA1C is normal. Dopamine antagonism in the tuberoinfundibular pathway can cause what side effect? (Antipsychotic drugs) - ANSWER Galactorrhea Which part of the brain modulates pain and can help explain how transcranial magnetic stimulation can help decrease pain? - ANSWER Prefrontal cortex When administering clock drawing test, if patient is unable to correctly draw the face of the clock, what area of the brain likely has compromised functioning? - ANSWER Right hemisphere. The right hemisphere is involved with recognition of facial expressions, music, and visual images. When compromised, there are disturbances in drawing. Classic symptoms of NMS - ANSWER Acute mental status change, muscular rigidity, autonomic instability How do you calculate BMI? - ANSWER Weight (lbs) / height (inches) / height (inches) X 703 What labs are needed when anorexia is suspected? - ANSWER CBC with diff, electrolytes, thyroid panel, urinalysis Inverse agonist effect - ANSWER Causes the opposite effect of agonist, and causes the receptor to close the ion channel Acute dystonia in the eyes - ANSWER Oculogyric crisis. Eyes roll up. Treat by discontinuing offending agent. Administer IM Cogentin (benztropine). Not as common with atypicals as with first generation antipsychotics. Tardive dyskinesia (TD) onset - ANSWER Delayed onset. Involuntary movement disorder associated with antipsychotics. Insidious onset usually after 1-2 years of continuous exposure to antipsychotics. NMS Treatment - ANSWER Bromocriptine (Parlodel) dopamine receptor agonist to help decrease the dopamine blockade. Dantrolene (Dantrium) is a muscle relaxant. Anticholinergic drugs used for EPS - ANSWER Benztropine (cogentin) Trihexyphenidyl (Artane) Which CYP enzyme is implicated as a tobacco inducer? - ANSWER Smoking is a potent inducer of CYP1A2 enzyme activity, resulting in significant lower clozapine serum concentrations in smokers compared with non-smokers, upon a given dose. When on clozapine and a smoker, a higher dose may be needed. If they quit smoking, clozapine levels will rise, so dose reduction will be required. Lamotrigine - ANSWER Most associated with life threatening rash Where is Norepinephrine produced? - ANSWER locus coeruleus. Also in the medullary reticular formation. Which brain structure is activated in patients with severe anxiety? - ANSWER Amygdala. Important in mediation of fear, anxiety, and panic. Lithium causes what birth defect? - ANSWER Ebstein's anomaly (heart defect. Tricuspid valve isn't formed properly causing blood to leak back through into the right atrium). Neurodevelopment- what is most associated with risk taking behaviors in adolescent males? - ANSWER Maturation of the prefrontal cortex continues into mid-20's and early 30's. PFC acts to inhibit impulsive and motivational drives. Which serotonin receptors antagonism makes an antipsychotic "atypical"? - ANSWER 5HT2A. The mechanism of action that makes an antipsychotic medication "atypical" is related to the 5HT2A receptor antagonism and D2 receptor antagonism. Physical exam findings of a patient with bulimia nervosa? - ANSWER Erosion of dental enamel Russell's sign Weight usually within normal range Hypertrophy of salivary glands Rectal prolapse Physical exam findings of anorexia nervosa? - ANSWER Low BMI Amenorrhea Emaciation Bradycardia Hypotension ECG changes including inversion of t-waves, ST segment depression, and prolonged QT interval, hypothermia, lanugo, yellow skin, Russell's sign, erosion of dental enamel, hypertrophy of salivary glands, peripheral edema, dry skin, brittle hair and nails. Physical features of fragile X syndrome - ANSWER Large, long head and ears Short stature Hyperextensible joints Postpubertal macroorchidism (More common in males. High rate of comorbid ADHD, learning disorders, and developmental disorders like autism) What three benzos are safe to give with liver disease? - ANSWER Oxazepam, temazepam, lorazepam Inducers work by: - ANSWER Speed up clearance of a drug in the bloodstream. (Increased metabolism, decreased drug levels) Inhibitors work by: - ANSWER Slow down clearance of a drug (increased drug levels) Strong inducers of 3A4 - ANSWER Carbamazepine Phenobarbital (Carb and barb) Strong inhibitors of 2D6 - ANSWER Bupropion Fluoxetine Paroxetine What analgesic will be ineffective if the patient is on fluoxetine? - ANSWER Codeine (because of 2D6 enzyme) Sertraline metabolized by: - ANSWER 3A4 Fluoxetine metabolized by: - ANSWER 2D6 Most commonly used clinician administered anxiety scale? - ANSWER Hamilton Anxiety Scale (HAM-A) 14-17 mild anxiety 18-24 moderate anxiety 25-30 severe anxiety Most commonly used therapy modality for PTSD - ANSWER EMDR (eye movement desensitization and reprocessing) Females with bipolar: - ANSWER Higher rates of rapid cycling Higher rates of comorbid alcohol use and eating disorders More likely to experience depressive episodes What disorder accounts for 25% of completed suicides? - ANSWER Bipolar disorder The reticular formation regulates which body functions? - ANSWER Involuntary movement Muscle tone Blood pressure Respiratory rate (Part of the brain stem) What is the primary sensory area of the brain responsible for regulating taste, reading, and writing? - ANSWER Parietal lobe What part of the brain regulates mood, fear, emotion, and aggression? - ANSWER Amygdala What part of the brain regulates appetite, water balance, body temperature, and libido? - ANSWER Hypothalamus (part of limbic system) What psychoactive substance is most widely used in the U.S.? - ANSWER Cannabonoids Where is serotonin produced? - ANSWER raphe nuclei Where is dopamine produced? - ANSWER substantia nigra Vitamin B-12 supplementation is recommended for what diet - ANSWER Vegan Recommend weight gain for pregnant women - ANSWER 25-35 lbs normal BMI 28-40 lbs low BMI instrumental activities of daily living (IADLs) are those that facilitate or enhance the performance of ADLs. What are they? - ANSWER Shopping, using the telephone, using transportation Functional ADLs - ANSWER include aspects of self-care, such as dressing, bathing, toileting and continence, transfer, mobility, and eating. Cognitive executive function ADLS - ANSWER Higher-order activities such as balancing a check book, assembling tax records, filing taxes. Screening test with high sensitivity and specificity for identifying cognitive impairment in older adults, requires lease amount of time to administer - ANSWER Clock drawing test Having the patient perform serial 7's assesses what? - ANSWER Concentration Valproic Acid (Depakote) black box warnings - ANSWER Hepatotoxicity, pancreatitis Most important factor in therapeutic communication - ANSWER Nonverbal communication Five A's for behavioral counseling and health behavior change - ANSWER Assess, advise, agree, assist, arrange MMSE (Mini Mental State Examination)- - ANSWER Quantitative measure of cognitive status in adults. Assess orientation, attention, calculation, recall, language, motor skills. Screen for cognitive impairment, estimate severity of cognitive impairment, follow course of changes, document response to treatment Circumstantiality - ANSWER delay in reaching the point of a communication because of unnecessary and tedious details Screening tool for postpartum depression - ANSWER Edinburgh Postnatal Depression Scale 10 self reported questions Administered in less than 5 minutes Risks associated with anabolic steroid use - ANSWER Depression, irritability, liver problems, HTN, aggression, mood swings, increased risk for heart attack, stroke, hepatic cancer, decreased libido, shrinking of testes, acne, hair loss. Capgras syndrome - ANSWER person believes someone he or she knows has been replaced by an imposter (hallmark of the syndrome) Displacement - ANSWER psychoanalytic defense mechanism that shifts sexual or aggressive impulses toward a more acceptable or less threatening object or person, as when redirecting anger toward a safer outlet Research study ACE (adverse childhood experiences) found positive relationship between ACE and what disorders? - ANSWER Alcoholism, anxiety, depression, diabetes, heart disease, fractures, obesity, STDs, unintended pregnancies, sleep disorders, dissociative disorders, eating disorders. PHQ-9 scoring - ANSWER Score 0-4 Minimal or none Monitor; may not require treatment 5-9 Mild Use clinical judgment (symptom duration, functional impairment) to determine necessity of treatment 10-14 Moderate Use clinical judgment (symptom duration, functional impairment) to determine necessity of treatment 15-19 Moderately severe [Show More]

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