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Georgette's LMR PMHNP Certification Exam
Review, 2022
What drugs should be avoided with Kava Kava?
- Alprazolam CNS depressants (e.g., phenobarbital, zolpidem) Cultural Formulation Interview perform what 3 functions? - Clarify meaning of illness Empower the patient Validate symptoms within cultural context What does a cultural formulation interview do? - cultural assessment What is the normal range for TSH? - 0.5 - 5.0 mu/L What are lab values in Hyperthyroidism - Decreased TSH Increased T4 and T What are labs in Hypothyroidism? - Increased TSH Decreased T4 and T What are 5 primary symptoms of Hyperthyroidism? - Heat intolerance Agitation, Anxiety, Irritability Tachycardia Mood swings Weight loss What are 4 primary symptoms of Hypothyroidism? - Cold intolerance Lethargy Weight gain Decreased libido Hypothyroidism mimics symptoms of what psychiatric disorder? - Depression Hyperthyroidism mimics symptoms of what psychiatric disorder? - Mania Valproic acid produces what teratogenic effect? - Spina bifida (neural tube defect) What is the primary organ where valproic acid is toxic? - Liver (hepatoxicity)
What are 4 signs of hepatoxicity? - Abdominal pain in the URQ Reddish-brown urine Yellowing of the skin and sclera Fatigue Abdominal pain in the URQ, Reddish-brown urine, Yellowing of the skin and sclera, and Fatigue are signs of - Hepatoxicity What is the therapeutic range for valproic acid? - 50 - 125 mcg/ml What is a toxic level of valproic acid? - >150 mcg/ml What are 4 signs of valproic acid toxicity? - Disorientation Lethargy Respiratory depression Nausea/vomiting Disorientation, Lethargy, Respiratory depression, and Nausea/vomiting are symptoms of toxicity with what drug? - Valproic acid With suspected toxicity with valproic acid, what labs should be drawn? - DC drug Check drug level Obtain LFTs Obtain ammonia level What is the major side effect with Kava Kava? - Liver damage What herbal supplement is sued for anxiety, stress, and insomnia? - Kava Kava What are 5 symptoms of Stephen's Johnson Syndrome? - Fever Body aches Severe red rash Peeling skin Facial and tongue swelling Severe red rash, Fever, Body aches, Peeling skin, and Facial and tongue swelling are symptoms of - Stephen's Johnson Syndrome Which mood stabilizer causes the least weight gain? - Lamotrigine (Lamictal)
What mood stabilizer has anti-suicidal effects? - Lithium What 5 labs should be drawn with lithium? - Thyroid panel (TSH) Serum creatinine BUN Urinalysis HCG What is a normal SCr range? - 0.6-1.2 mg/dL What is the normal range for BUN? - 10 - 20 mg/dL When should you suspect kidney disease with a urinalysis? - 4+ protein 4+ protein in the kidney suggests - Kidney disease What are 7 side effects of lithium? - Hypothyroidism Fine hand tremors Maculopapular rash GI upset (N/V/D, cramps, anorexia) Polyuria, polydipsia, diabetes insipidus T-wave inversions Leucocytosis What are 7 signs of lithium toxicity? - Severe nausea, vomiting, diarrhea Confusion Drowsiness Muscle weakness Heart palpitations Coarse hand tremor Unsteadiness while standing or walking Which 3 drugs can increase lithium levels by decreasing renal clearance? - NSAIDs (ibuprofen, indomethacin) Thiazides ACEI What is a toxic level of lithium? - 1.5 mEq/L or higher At what level do you monitor lithium closely (but not discontinue)? - 1.3 mEq/L or higher
With suspected lithium toxicity, what do you do first? - Lithium level (not VS) What is the appropriate action if lithium level is 1.5 mEq/L? - DC lithium Check lithium level What 2 conditions can increase lithium levels? - Dehydration Hyponatremia What birth defect can lithium cause? - Ebstein anomaly (congenital heart defect) What 3 neurotransmitters are associated with ADHD? - DNS What 3 parts of the brain are affected with ADHD? - Frontal cortex Basal ganglia Reticular Activating System The Frontal cortex, Basal ganglia, Reticular Activating System are associated with which psychiatric disorder? - ADHD Inattentive Type ADHD demonstrates abnormalities in which part of the brain? - Prefrontal cortex What should be done before placing a patient on stimulants for ADHD (priority)? - Cardiac history Excessive worry, apprehension, or anxiety about events or activities that occurs more days than not for a period of at least 6 months is - GAD If a patient is receiving Haldol 5 mg PO bid, how much Haldol Decanoate should they receive? - 20 x 10 mg = 200 mg (q month) What is the formula for converting oral Haldol to depot form? - 20 x daily dose What does thought process assess? - thoughts and ideas The way a patient organizes his thoughts and ideas is called - Thought process A normal thought process is described as - Logical Linear Coherent
Depressive symptoms The nigrostriatal pathway modulates - motor movements Dopamine has what type of relationship with acetycholine - Inverse Dopamine blockage in the nigrostriatal pathway leads to what 4 side effects? - Acute dystonia Parkinsonism syndromes Akathisia Tardive dyskinesia Blocking the tuberoinfundibular pathway leads to - Increased prolactin What are 5 symptoms of hyperprolactinemia? - Amenorrhea Galactorrhea Sexual dysfunction Gynecomastia Osteoporosis (Long-term) What antipsychotic has the greatest effect on prolactin? - Risperidone What is the black box warning for carbamazepine? - Agranulocytosis What are 8 symptoms of aplastic anemia? - Pallor Fatigue Headache Fever Nosebleeds Bleeding gums Skin rash SOB Pallor, Fatigue, Headache, Fever, Nosebleeds, Bleeding gums, Skin rash, and SOB are symptoms of - Aplastic anemia What ethnic group is most susceptible to SJS with carbamazepine? - Asians Having the HLA-B1502 allele increases the risk for - SJS Which ethic group is at most likely to have the HLA-B1502 allele? - Asians
Asians are most likely to have what allele? - HLA-B* In which ethnic group must you screen for the HLA-B*1502 allele before initiating therapy? - Asian Which 2 drugs have the highest likelihood of causing agranulocytosis? - Clozaril Carbamazepine A sudden fever, chills, a sore throat, and weakness are symptoms of - Agranulocytosis What are 4 symptoms of agranulocytosis - A sudden fever Chills Sore throat Weakness At what ANC should clozapine be stopped (even if asymptomatic)? - < What is neutropenia? - <2000 PMNs What is agranulocytosis? - <500 ANC What does DIGFAST stand for? - Distractibility Indiscretion Grandiosity FOI Activity increased Sleep decreased Talkativeness What are 5 neurological symptoms in Conversion Disorder? - Blindness Mutism Paralysis Paresthesia (glove stocking syndrome) Seizures When do symptoms typically begin with Conversion Disorder? - After a stressful experience (suddenly)
What type of therapy is used in the treatment of Conduct Disorder? - Behavioral therapy What is Multisystemic family therapy? - Home-based model for youth with serious antisocial and criminal offenses by empowering parents with resources and skills and reducing barriers to resources needed for effective management of youth What is the goal of multisystemic family therapy (MFT)? - Reduce barriers to resources for youth with problematic behavior What type of therapy target's youth who present with serious antisocial behavior? - Multisystemic family therapy What is the moderate range for MMSE - 10 - 20 What is the moderate range for SLUM? - 10 - 20 What is the moderate range for HAM-D? - 14 - 18 What is the moderate range for PHQ- 9 - 10 - 14 What is the moderate range for BDI? - 19 - 29 What is the moderate range for HAM-A? - 18 - 24 What is the moderate range for GAD- 7 - 10 - 14 What is the moderate range for COWS? - 13 - 24 If a patient's COWS score is between 5 - 12, what do you do? - Administer clonidine If a patient's COWS score is between 13 - 24, what do you do? - Administer buprenorphine (Suboxone) When do you administer clonidine on the COWS? - mild symptoms (>7) When do you administer buprenorphine (Suboxone) on the COWS? - moderate symptoms (13-24) What is a moderate range on the CIWA? - 16 - 20
When do you administer prn benzodiazepine on the CIWA? - Mild symptoms (8 or greater) When do you administer scheduled benzodiazepine on the CIWA? - moderate symptoms (15 or higher) If a patient has severe depression (over 18 on HAM-D) (over 14 on PHQ-9) (over 29 on BDI), how do you treat it? - Medication and/or therapy Assess for suicidal ideation If a patient has moderate depression (14 - 18 on HAM-D) (10 - 14 on PHQ-9) (19 - 29 on BDI), how do you treat it? - Medication and/or therapy If a patient has mild depression (<14 on HAM-D) (<10 on PHQ-9) (<19 on BDI), how do you treat it? - Therapy or nothing If a patient has mild anxiety (<18 on HAM-A) (<10 on GAD-7), how do you treat? - Therapy or nothing If a patient has severe anxiety (>24 on HAM-A) (>14 on GAD-7) how do you treat? - Medication and/or therapy If a patient has moderate anxiety (18-24 on HAM-A) (10 - 14 on GAD-7) how do you treat it? - Medication and/or therapy What are 4 areas in the brain that can cause aggression, impulsivity, and difficulty with abstract thinking? - Prefrontal cortex Amygdala Basal ganglia Hippocampus Abnormalities in the Prefrontal cortex, Amygdala, Basal ganglia, and Hippocampus can cause what 3 symptoms? - Aggression Impulsivity Difficulty with abstract thinking What are 6 symptoms of NMS? - Extreme muscular rigidity Mutism Elevated CPK (creatine phosphokinase) Myoglobinuria Leukocytosis
What 2 neurotransmitters are associated with OCD? - Serotonin Norepinephrine A childhood depressive disorder that is diagnosed in children older than 6 but younger than 18 is most likely - DMDD A child with chronic dysregulated mood ("mood"), frequent intense temper outbursts, severe irritability, and anger is most likely to have what diagnosis? - DMDD The age criteria for a DSM-5 diagnosis of Disruptive Mood Dysregulation Disorder (DMDD) is - >6 and <18 (7- 17 yrs.) A child who is chronically "moody" is most likely to have what diagnosis? - DMDD What are 2 symptoms associated with lead poisoning? - Developmental delay (learning difficulties) Pica (paint chips) also gastrointestinal Which 2 demographic characteristics are associated with lead poisoning? - rural areas 1970's A child with developmental delay who eats things (such as paint chips) may have - Lead poisoning What 4 assessments should be done in a patient receiving an antipsychotic that causes weight gain? - BMI Hip-to-waist ratio Glucose Lipid panel Where is norepinephrine produced? - Locus coeruleus Medullary reticular formation The neurotransmitter produced in the locus coeruleus and medullary reticular formation is - Norepinephrine What neurotransmitter is produced in the raphe nuclei in the brainstem? - Serotonin Serotonin is produced in - raphe nuclei in the brainstem
What neurotransmitter is produced in the substantia nigra, the ventral tegmental area (VTA), and the nucleus accumbens? - Dopamine What 3 areas of the brain is dopamine produced? - Substantia nigra Ventral tegmental area (VTA) Nucleus Accumbens Where is acetylcholine synthesized? - Basal nucleus of Meynert The Basal nucleus of Meynert is the area where what neurotransmitter is produced? - Acetycholine What is the function of the amygdala? - Emotions (aggression, fear, anxiety) Emotions (aggression, fear, and anxiety) originate from what area of the brain? - Amygdala What are 4 functions of the hippocampus? - Emotions Stress Learning Memory Emotions, stress, learning, and memory are functions of what structure of the brain? - Hippocampus What disorder is associated with persistent deficits in social communication and social interactions across multiple settings? - Autism Spectrum Disorder What 3 neurotransmitters are associated with Autism Spectrum Disorder? - Glutamate GABA Serotonin A child who does not respond when called by name may have - Autism A child that has little or no eye contact may have - Autism A child who likes to line up, stack, or organize objects and toys in on tidy rows may have - Autism
What are 5 physical characteristics of Anorexia Nervosa? - Low BMI Amenorrhea Emaciation (abnormally thin) Bradycardia Hypotension Low BMI, Amenorrhea, Emaciation (abnormally thin), Bradycardia, and Hypotension are characteristics of what psychiatric disorder? - Anorexia Nervosa What is the BMI in a patient with Bulimia Nervosa - Normal range For a DSM-5 diagnosis of Acute Stress Disorder, what is the onset of symptoms? - Within 4 weeks of traumatic event Intense anxiety and fear, helplessness, reexperiencing the event and avoidance behaviors within 4 weeks of a traumatic event is DSM-5 criteria for what disorder? - Acute Stress Disorder What are the 3 hallmark symptoms of PTSD? - Intrusive re-experiencing Increased arousal (hyperarousal) Avoidance of stimuli associated with trauma What are 3 pharmacological treatments for PTSD - SSRIs TCAs Prazosin for nightmares What 2 nonpharmacologic treatments for PTSD? - EMDR CBT What are the 12 components/symptoms of the COWS? - Pulse Sweating Restlessness Pupil size Bone aches Running nose or tearing GI upset Yawning Tremors Anxiety/irritability Gooseflesh skin Dilated pupils
Pulse, Sweating, Restlessness, Pupil size, Bone aches, Running nose or tearing, GI upset, Yawning, Tremors, Anxiety/irritability, Gooseflesh skin, and Dilated pupils are components of what scale? - COWS What are the 9 components/symptoms of the CIWA Scale? - Nausea/vomiting Tremor Sweats Anxiety Agitation Tactile disturbances Auditory disturbances Headaches Orientation Nausea/vomiting, Tremor, Sweats, Anxiety, Agitation, Tactile disturbances, Auditory disturbances, Headaches, and Orientation are components of which Scale - CIWA What are 3 treatments for Alcohol Use Disorder? - Acamprosate (Campral) Disulfiram (Antabuse) Naltrexone (Vivitrol, ReVia) Which agent for the treatment of Alcohol Use Disorder is not metabolized by the liver? - Acamprosate (Campral) Installation of hope, universality, group cohesiveness, and altruism are therapeutic factors of what group therapy? - Yalom What are 4 therapeutic factors in Yalom's Group Therapy? - Instillation of hope Universality Group cohesiveness Altruism What is an approach to organizational change which focuses on strengths rather than weaknesses? - Appreciative Inquiry What is appreciative inquiry? - An approach to organizational change which focuses on strengths rather than weaknesses What are the 3 goals of Quality Improvement? - Projects designed to improve systems, decrease cost, and improve productivity
What component of Health Policy are Key players and stake holders? - Policy Makers What is the first action when developing Health Policy? - Assess/address organizational barriers and facilitators A treatment approach that does not focus on full symptom resolution but emphasizes resilience and control over problems and life is called - Recovery Model What is the Recovery Model? - A treatment approach that does not focus on full symptom resolution but emphasizes resilience and control over problems and life is called What is a nonlinear treatment approach? - Not a step-by-step process, but one based on continual growth and occasional setbacks What are 3 characteristics of the Recovery Model? - Learning from experience (e.g. relapse) Nonlinear Self-directed, Individualized and Person-Centered The treatment approach that emphasizes "learning from experience," nonlinear, and self-directed/individualized/person-centered? - Recovery Model What is the SBIRT - Screens for Substance Use Disorders Screening Brief Intervention Referral Treatment What instrument screens for Substance Use Disorders - SBIRT Screening Brief Intervention Referral Treatment What is the Tarasoff Principle - Duty to warn victim of imminent danger of homicidal patients
What is the Duty to warn victim of imminent danger of homicidal patients? - Tarasoff Principle An involuntarily committed patient who has not been found incompetent, absent an emergency, has a qualified right to refuse psychotropic medications (court case) - Rennie vs. Klein Court Case What is the Rennie vs Klein Court Base? - Pts have the right to refuse treatment and use an appeal process It is unconstitutional to commit a person involuntarily (for the longest time) who is not (imminently) dangerous to self or others. Which court case? - Donalson vs. O'Connor Court Case What is the Donaldson vs. O'Connor court case? - You cannot confine (commit a person involuntarily) who is not dangerous to self or others What are 4 key components of Strategic Therapy? - Problem Focused, Symptoms focused Paradoxical directive/intervention (reverse psychology) Straight forward directive Reframe belief system The paradoxical directive, a technique to be used with caution, is used in which therapy? - Strategic Which 3 techniques are used in Solution-Focused Therapy? - Miracle Questions Exception-finding questions Scaling Questions Miracle Questions, Exception-finding questions, and Scaling Questions are used in which therapy? - Solution-Focused Which therapy uses triangles/triangulation, an self-differentiation? - Family Systems Therapy What are 3 characteristics of Family Systems Therapy? - Triangles/Triangulation Self-differentiation Genograms What are 3 characteristics of Structural Family Therapy? - Hierarchies
