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LMR - Georgette's250-500 Questions and Answers latest exam 2023
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Which ethnic group views mental illness as an imbalance between an individuals' relationship with world? - Correct Answer ✅Native American Which ethnic group has the highest incidence of suicidal attempt and completion? - Correct Answer ✅Native American Cultural syndrome is - Correct Answer ✅A culturally expected response to a stressor A culturally expected response to a stressor is called - Correct Answer ✅Cultural Syndrome How should multicultural teaching be conducted? - Correct Answer ✅Ethnospecific If a patient is regularly taking Kava, what lab should you get? - Correct Answer ✅LFTs What is the key symptom in suspecting Stephen's Johnson Syndrome? - Correct Answer ✅Fever Which antipsychotic has the least weight gain? - Correct Answer ✅Ziprasidone (Geodon) Which SGA is the least sedating? - Correct Answer ✅Aripiprazole (Abilify) Which 3 antipsychotic causes weight gain? - Correct Answer ✅Quetiapine (Seroquel) Olanzapine (Zyprexa) Clozapine (Clozaril) What is the first action to take with a patient who is gaining weight from an SGA? - Correct Answer ✅nonpharmacologic nutritional counseling (diet) exercise
When should clozapine be discontinued? - Correct Answer ✅ANC < 1,000 (even if asymptomatic) One of your patients receiving psychiatric medication develops an infection. What do you consider? - Correct Answer ✅Agranulocytosis What antipsychotic is antisuicidal in schizophrenia? - Correct Answer ✅Clozapine When a young woman is suspected of a toxic dose of lithium, what lab should you obtain initially? - Correct Answer ✅HCG If a patient has signs/symptoms of lithium toxicity but you have no labs available, what do you do? - Correct Answer ✅DC lithium What is one of the most important teaching points you should make in a patient taking lithium? - Correct Answer ✅Stay hydrated A patient with what medical condition is at risk for lithium toxicity? - Correct Answer ✅Cardiac failure (hyponatremia) What is the key indicator for NMS? - Correct Answer ✅Extreme muscle rigidity - Increased CPK Extreme muscle rigidity and increased CPK is the key indicator of - Correct Answer ✅NMS What is the key indicator of Serotonin Syndrome? - Correct Answer ✅Muscle jerks (myoclonic) Muscle jerks (myoclonic) are the key indicator of - Correct Answer ✅Serotonin Syndrome
What question should ask all adolescent patients at each visit? - Correct Answer ✅Self harm (frequency and severity) Which 2 groups is it especially important to ask about SI at each visit? - Correct Answer ✅Adolescence Schizophrenics Why do children have a decreased placebo response with antidepressants? - Correct Answer ✅Few evidence-based studies What is the onset of schizophrenia in males? - Correct Answer ✅18- What is the onset of schizophrenia in females? - Correct Answer ✅25- What question should ask schizophrenic patients at each visit? - Correct Answer ✅SI What is the most likely diagnosis in a patient with homicidal ideation? - Correct Answer ✅Antisocial Personality Disorder What would yo expect to see on an MRI/Pet scan in a patient with schizophrenia? - Correct Answer ✅All structures decreased except ventricles Which class of agents should be avoided in patients with schizophrenia? - Correct Answer ✅Stimulants (increased DA) Which 3 structures in the brain are associated with aggressive and impulsive behavior? - Correct Answer ✅Prefrontal cortex Amygdala Hippocampus
What is Assertive Community Treatment (ACT)? - Correct Answer ✅Form of rehabilitation post hospitalization for SMI Case management approach Patients with SMI who are discharged from the hospital should be referred to - Correct Answer ✅Assertive Community Treatment (ACT) Can patients receive Assertive Community Treatment (ACT) while in the hospital? - Correct Answer ✅No Which services can be provided in the home for SMI patients? - Correct Answer ✅Assertive Community Treatment (ACT) What is the best treatment program for SMI patients with poor medication adherence? - Correct Answer ✅Assertive Community Treatment (ACT) Social skills training in a schizophrenic patient is what type of prevention? - Correct Answer ✅Tertiary What are 3 benefits of aerobic exercise in schizophrenic patients? - Correct Answer ✅Increased cognition Quality of Life Long-term health How do you convert oral Haldol to IM (depot form)? - Correct Answer ✅20 x daily dose When converting oral Haldol to depo form, what the maximum dose should administer? - Correct Answer ✅>100 mg (administer weekly if necessary) What is a delusion? - Correct Answer ✅A firm belief despite contrary evidence A firm belief despite contrary evidence is - Correct Answer ✅delusion
What is a normal prolactin level in men? - Correct Answer ✅< What is a normal prolactin level in women? - Correct Answer ✅< What do you do if a patient is on olanzapine (Zyprexa) and stops smoking? - Correct Answer ✅Decrease olanzapine dose What effect does tobacco have on CYP450? - Correct Answer ✅1A2 inducer What class of drugs are primarily inhibitors? - Correct Answer ✅Antibiotics How does erythromycin and clarithromycin affect CYP240? - Correct Answer ✅Inhibitors What do you do if a patient on carbamazepine is given an inhibitor? - Correct Answer ✅Decrease CBZ dose (avoid aplastic anemia) If a depressed patient is receiving a drug that is associated with depression, what do you do? - Correct Answer ✅Increase dose of antidepressant Addiction is associated with what 2 neurotransmitters? - Correct Answer ✅Dopamine GABA What 7 signs/symptoms are associated with stimulant abuse? - Correct Answer ✅Insomnia Tremors Irritability, Mood swings. Agitation, Anxiety CV (increased HR/BP, palpitations)
A patient who c/o pain after eating, bloating and fullness, what do you suspect? - Correct Answer ✅Delayed gastric emptying from anorexia What 3 signs/symptoms do you expect with delayed gastric emptying in anorexia? - Correct Answer ✅Pain after eating Bloating Abdominal fullness What 2 classes of medications delay gastric emptying? - Correct Answer ✅H2 antagonists: Famotidine (Pepcid) PPIs: Omeprazole (Prilosec) What 2 classes of medications interfere with the absorption of psychiatric medications and should be spaced apart by 2 hours? - Correct Answer ✅Antacids PPIs: Omeprazole (Prilosec), Pantoprazole (Protonix) What is a common side effect of SSRIs in the older population - Correct Answer ✅Anxiety What is a paradoxical effect of benzodiazepines? - Correct Answer ✅Increased anxiety (avoid in future) What is apotosis? - Correct Answer ✅Cell death/neuronal loss What is the name for cell death/neuronal loss? - Correct Answer ✅apotosis What is the greatest risk factor for bipolar disorder? - Correct Answer ✅genetics (very heritable)
Who developed DBT? - Correct Answer ✅Marsha Linehan In DBT, diagnosis of borderline disorder requires activity? - Correct Answer ✅journaling/diary A patient with borderline personality disorder with symptoms of depressed mood and lability should be prescribed - Correct Answer ✅Valproic acid When should valproic acid be prescribed in a patient with borderline personality disorder? - Correct Answer ✅Depressed mood + lability A hospitalized patient with a reaction to a stressful event is most likely to have what diagnosis? - Correct Answer ✅Adjustment Disorder A child with a history of juvenile detention (e.g., fire setting, forced sex) is most likely to have what diagnosis? - Correct Answer ✅Conduct Disorder Is a child with ODD or Conduct Disorder more likely to need medication? - Correct Answer ✅Conduct Disorder If a child develops tics after beginning a stimulant, should he be diagnosed with Tourette's? - Correct Answer ✅No (tics caused by a substance is an exclusionary diagnosis) Are motor tics permanent? - Correct Answer ✅Not always What 3 neurotransmitters are involved with Tourette's? - Correct Answer ✅DNS What is factitious disorder imposed on another? - Correct Answer ✅Munchausen syndrome by proxy, caretakers make up or produce physical illnesses in the individual receiving care. Usually parent --> child
What is required if you suspect a factitious disorder imposed on another (Munchausen syndrome)? - Correct Answer ✅Report to CPS Child abuse (duty to report) What is Factitious Disorder - Correct Answer ✅Faking illness to get medical attention or sympathy A patient who feigns illness to get sympathy or attention is most likely to have - Correct Answer ✅Factitious disorder A patient with factitious disorder is most likely to have what type of demographic? - Correct Answer ✅Unmarried healthcare worker What is malingering? - Correct Answer ✅Feigning illness for secondary gain ($) (not a psychiatric diagnosis) A patient who claims disability or worker's comp when there is no injury is most likely - Correct Answer ✅Malingering (not a psychiatric diagnosis) A child who has been neglected, abuse, or comes from a foster home, is most likely to have what diagnosis? - Correct Answer ✅Reactive Attachment Disorder A child who shows no emotion or is withdrawn may have what disorder? - Correct Answer ✅Reactive Attachment Disorder A disorder that presents like PTSD, but symptoms last less than a month is most likely to have - Correct Answer ✅Acute Stress Disorder What is the required duration for a DSM-5 diagnosis of GAD? - Correct Answer ✅6 months How does a panic attack differ from Panic Disorder? - Correct Answer ✅acute, impending doom
When a patient presents with what 3 symptoms should you administer the Mood Disorder Questionnaire (MDQ)? - Correct Answer ✅Patient presents with irritability, depression, and lability What disorder resembles bipolar disorder in children (7 and 17 years)? - Correct Answer ✅Disruptive Mood Dysregulation Disorder (DMDD) A child with intense temper outbursts is most likely to have what DSM-5 diagnosis? - Correct Answer ✅Disruptive Mood Dysregulation Disorder (DMDD) What should assess initially in a child who presents with nightmares? - Correct Answer ✅If other family members have the same problem What are 2 key factors in the diagnosis of Autism Spectrum Disorder? - Correct Answer ✅Persistent deficits in social communication and social interaction across multiple settings A child with persistent deficits in social communication and social interaction across multiple settings is most likely to have what DSM-5 diagnosis? - Correct Answer ✅Autism A child that does not establish eye contact is likely to have - Correct Answer ✅autism spectrum disorder When is the only time you should give a benzodiazepine to a patient with delirium? - Correct Answer ✅Alcohol withdrawal A patient in alcohol withdrawal who develops delirium should be administered - Correct Answer ✅Benzodiazepine An older female has delirium and you suspect a UTI, what 2 labs should you order? - Correct Answer ✅UA C/S
An older patient who has had mental decline (>1 year) with chronic irritability and personality changes should be assessed for - Correct Answer ✅Dementia What are 2 labs that should be obtained in an older patient suspected of having a metabolic cause of dementia? - Correct Answer ✅B Folic acid What is the initial treatment for a patient with dementia and psychosis? - Correct Answer ✅Nonpharmacologic treatment If a patient with dementia does not respond to nonpharmacologic treatment, what do you do? - Correct Answer ✅Administer SGA What type of dementia is HIV-related? - Correct Answer ✅Subcortical What are 3 early signs/symptoms of HIV-related dementia? - Correct Answer ✅Cognitive deficit Motor abnormalities (decreased coordination) Behavioral symptoms A patient who presents with a cognitive deficit, decreased coordination, and behavioral symptoms should be assessed for what type of dementia? - Correct Answer ✅HIV-related In a patient with suspected HIV-related dementia, what is your initial action? - Correct Answer ✅Obtain HIV test What is first-line pharmacologic treatment for a patient with HIV-related dementia? - Correct Answer ✅Antiretroviral treatment An older adult who has had cognitive impairment for over a year and who tries to answer (may not be able to) or confabulates is most likely to have a diagnosis of - Correct Answer ✅Dementia
A patient with damage to the anterior cingulate will demonstrate what 3 symptoms? - Correct Answer ✅Cognitive dysfunction (decision making) Lack of empathy Difficulty with impulse control and emotions A patient who presents with cognitive dysfunction (decision making), lack of empathy, and difficulty with impulse control and emotions is most likely to have damage in what brain structure? - Correct Answer ✅Anterior cingulate A patient with damage to the cerebellum will demonstrate what sign? - Correct Answer ✅Lack of balance A patient who has a lack of balance is most likely to have damage to what structure in the brain? - Correct Answer ✅Cerebellum What condition may cause pica (eating things that are not food - paint chips)? - Correct Answer ✅Lead poisoning What 5 neurotransmitters are associated with mood disorders? - Correct Answer ✅Dopamine Norepinephrine Serotonin GABA Glutamate What do do yo do when an infant is about to die? - Correct Answer ✅Give him to his parents to grieve What 2 activities should be encouraged with grieving patients? - Correct Answer ✅Family support Support groups (don't give prescriptive advice)
What are 5 risk factors for osteoporosis? - Correct Answer ✅Smoking Caffeine Low calcium/vitamin D in diet Decreased weight Lack of weight bearing exercises Smoking, Caffeine, Low calcium/vitamin D in diet, Decreased weight, and Lack of weight bearing exercises are risk factors for - Correct Answer ✅Osteoporosis Is Interpersonal Therapy offered individually as well as in group therapy? - Correct Answer ✅Yes If a patient is reluctant to participate in group therapy, what do you do? - Correct Answer ✅Continue group therapy Start individual therapy Which is more effective - cognitive therapy or CBT? - Correct Answer ✅CBT What are 5 techniques used in behavioral therapy? - Correct Answer ✅Problem-solving Skills training Exposure therapy Role-playing/modeling Relaxation Problem-solving, Skills training, Exposure therapy, Roleplaying/modeling, and relaxation are techniques used in - Correct Answer ✅Behavioral Therapy What are 2 common techniques used in CBT? - Correct Answer ✅Cognitive restructuring
When is a Straight Forward Directive given in Strategic Therapy? - Correct Answer ✅When a member is compliant What type of therapy is a therapist using when he asks "what worked before when you had this problem" - Correct Answer ✅Solution-focused Meditation is a form of - Correct Answer ✅Muscle relaxation What 4 positive effects does physical activity have on children? - Correct Answer ✅Increased body image Increased resilience Improved relationships Decreased social anxiety How can a child's body image, resilience, relationships, and social anxiety be improved? - Correct Answer ✅Physical activity When may a closed-ended question (yes/no) be necessary rather than an opened-ended question? - Correct Answer ✅Children (when a narrative cannot be constructed) If a child does not respond or open or closed-ended questions, what to you do? - Correct Answer ✅talk to parents What therapeutic factor does open-ended questions instill? - Correct Answer ✅empathy If only the wife shows up for a couple appointment, what do you do? - Correct Answer ✅Reschedule the appointment A mother reports that her child was sodomized. What 2 things do you do? - Correct Answer ✅Contact CPS
Crisis therapy A mother reports her 5-yo was raped by his 16 yo brother. What 2 things do you do? - Correct Answer ✅crisis therapy separate brothers What lab do you draw in a patient with rheumatoid arthritis - Correct Answer ✅ESR When is an ESR indicated? - Correct Answer ✅Patient with rheumatoid arthritis What does PICO stand for? - Correct Answer ✅P- Patient population of interest I - Intervention of interest C - Comparison of interest O - Outcome How do you provide evidenced-based care? - Correct Answer ✅Have access to current journals A baby with a shrill cry is likely to have - Correct Answer ✅Increased intracranial pressure A sign of increased intracranial pressure in a baby is - Correct Answer ✅shrill cry What do you tell a mother when she reports her preschool child is playing with his genitals? - Correct Answer ✅That is normal between 3-6 yrs old (Phallic stage) What do you tell an adolescent who is concerned about nipple swelling and tenderness and breast enlargement? - Correct Answer ✅This is normal between 9-16 yo. It will disappear within 6 mo.