NUR MISC Week 10 - Chronic Neurology_Psychiatry/NUR MISC Week 10 - Chronic Neurology_Psychiatry

NUR MISC Week 10 - Chronic Neurology_Psychiatry/NUR MISC Week 10 - Chronic Neurology_Psychiatry/NUR MISC Week 10 - Chronic Neurology_Psychiatry***Week 10 – Chronic Neurology/Psychiatry – NO QUIZ What are common symptoms seen in patients with Parkinson’s disease? (Select all that apply.) Bradykinesia Festination Hyperphonia Rigidity Symmetric tremor Typical laboratory screening for cognitive impairment includes: CBC Electrolytes B12 Thyroid and liver function All of the above Which of the following symptoms differentiate panic disorder from a panic attack? Feelings of unreality of self-detachment Prolonged worry about having another panic attack Fear about being in situations that would be difficult to escape if a panic attack was experienced Fear of being exposed to possible scrutiny by others A college student is brought to clinic by a parent who is concerned about increasingly bizarre behavior and poor school performance. The provider notes difficulty engaging the patient in an organized conversation. The patient denies any concerns about behavior. What will the provider do initially to manage this patient’s symptoms? Admit the patient for inpatient treatment Begin treatment with lithium or lamotrigine Counsel the parent to report any symptoms of depression Schedule an appointment with a psychiatrist A patient reports trembling of both hands causing difficulty performing tasks with the hands. The provider notes symmetric, rhythmic movements which are present at rest and no other neurological findings. A history reveals that the trembling decreases when the patient has a glass of wine with dinner. What is the initial action? Evaluation in an emergency department Prescribing a beta blocker medication Reassurance that these will subside Referral to a neurologist Benzodiazepines are appropriate to use as monotherapy for all anxiety disorders. True False Functional decline that may be observed in a patient with suspected frontotemporal dementia might include: Trouble with completing tasks Evidence of poor judgment Diminished standards involving hygiene All of the above A 68-year-old man comes into your primary care clinic for a routine visit. He complains of increased difficulty reading the morning newspaper. He notes the problem has been occurring now for a few months and seems better when he borrows his wife’s reading glasses. As a provider you should: Place an urgent referral to ophthalmology Diagnosis him with glaucoma and provide him with education regarding treatment Educate regarding presbycusis and notify him this is a normal process of aging Educate regarding presbyopia and notify him this is a normal process of aging Ms. Jones frequently visits the emergency department with complaints of chest pain, shortness of breath, dizziness, sweating, and nausea. Her EKG, imaging studies, cardiac enzymes, lipids, and metabolic panel results have all been normal. She presents to a primary care follow-up appointment requesting a cardiology referral. What actions do you perform to assess the appropriateness of a referral? Assess for thyroid dysfunction and substance use. Obtain a detailed history of symptoms including precipitating factors, duration, and factors that relieve or exacerbate symptoms. Administer a Generalized Anxiety Disorder scale (GAD-7). b and c All of the above Which patient would benefit from a polysomnography (Sleep Study) evaluation to assess a potential sleep disorder? A child with enlarged tonsils who has daytime sleepiness A patient with GERD who has difficulty falling asleep A shift worker who has trouble adjusting to new schedules An elderly woman with osteoarthritis who has difficulty staying asleep Which of the following is a clinical management goal when titrating antiepileptic medications? Titrate the patient to the maximum recommend dose even if they experience side effects. Attempt to arrive at medication monotherapy, if possible Combine two medications at low doses. Achieve seizure-free status with the highest possible dosage of antiepileptic drug therapy. A patient is seen frequently over a 9-month period with somatic complaints that are not related to physical disease. The primary provider notes that the patient has had a 15% weight loss in the previous 2 months and the patient reports difficulty sleeping. The spouse tells the provider that the patient seems tired all the time and is irritable with other family members. What will the provider do initially? Perform a suicide risk assessment Prescribe a selective serotonin reuptake inhibitor Refer the patient for psychotherapy Suggest cognitive-behavioral therapy Which are common hyperkinetic movement disorders? (Select all that apply.) Dystonia Essential tremor Parkinson’s disease Progressive supranuclear palsy Tourette’s syndrome According to the American Geriatric Society, a person must have three or more specific characteristics in order to be classified with frailty. The three characteristics include: Weight loss, exhaustion, falls Weight loss, slowness, delirium Weight loss, low activity level, weakness Weight loss, low activity level, incontinence A 29-year-old lawyer was recently diagnosed with focal seizures. Her provider prescribed lamotrigine and she has been tolerating it well at 150 mg BID. It has, so far, controlled her seizures; however, she is anxious that she may have another. She asks you what she can do to avoid seizures. Which is not a common seizure trigger? Sleep deprivation Missing medication Exercising Stress A patient is on carbamazepine 600 mg BID and comes to you complaining of nausea, vomiting, headache, and fatigue. He is also having more seizures. What would you do? Increase the carbamazepine dose. Check carbamazepine levels. Check sodium levels. Check carbamazepine levels and Check sodium levels Which medication has a narrow therapeutic index: Levetiracetam Clobazam Phenytoin Lamotrigine A patient with dementia experiences agitation and visual hallucinations and is given haloperidol with a subsequent worsening of symptoms. Based on this response, what is the likely cause of this patient’s symptoms? Group of answer choices Alzheimer’s disease Lewy body dementia Pseudodementia Vascular neurocognitive disorder The Montreal Cognitive Assessment (MOCA) can be used to screen for cognitive deficits and used to measure cognitive skills over time. True False Which symptom of depression is assessed by the question, “Over the past 2 weeks, have you felt little interest or pleasure in doing things?” Depressed mood Anhedonia Fatigue Impaired concentration Dually diagnosed patients should not receive treatment for anxiety disorders until they achieve abstinence. True False A patient with epilepsy can have a normal EEG and normal MRI. True False Patients with suspected dementia will always have evidence of memory impairment. True False The most common event that in turn causes loss of independence in older adults is: Frailty Delirium Falls Hearing loss Which of the following symptoms differentiate panic disorder from a panic attack? Feelings of unreality of self-detachment Prolonged worry about having another panic attack Fear about being in situations that would be difficult to escape if a panic attack was experience Fear of being exposed to possible scrutiny by others An 86-year-old female presents to the emergency department with acute onset of worsening confusion. She appears more agitated and anxious to caregivers. She has been physically aggressive with one caregiver and this is reported to be an abrupt change from her baseline mental status. This is most consistent with: Hypoactive delirium Hyperactive delirium Mixed delirium None of the above CBT, complementary medicine methods, and other psychosocial interventions are recommended as first-line treatments for women who are pregnant or nursing. True False Which are causes of epilepsy? Brain tumors Strokes Congenital malformations All of the above A patient is seen in clinic 2 weeks after the death of a parent. The patient reports feelings of sadness and hopelessness and a feeling that the parent is still present, even to the point of hearing the parent’s voice at times. What will the provider determine from these findings? There is a concern for hypermania. There is a possibility of manic episodes. These are concerning for depression. These are normal grief responses. Treatment for anxiety disorders is indicated When a patient endorses symptoms for longer than 1 month When a patient begins to experience panic attacks When a patient has multiple visits for somatic complaints When symptoms interfere with a patient’s ability to function Which patient would benefit from a polysomnography (Sleep Study) evaluation to assess a potential sleep disorder? A child with enlarged tonsils who has daytime sleepiness A patient with GERD who has difficulty falling asleep A shift worker who has trouble adjusting to new schedules An elderly woman with osteoarthritis who has difficulty staying asleep An 86-year-old female presents to the emergency department with acute onset of worsening confusion. She appears more agitated and anxious to caregivers. She has been physically aggressive with one caregiver and this is reported to be an abrupt change from her baseline mental status. This is most consistent with: Hypoactive delirium Hyperactive delirium Mixed delirium None of the above A patient reports trembling of both hands causing difficulty performing tasks with the hands. The provider notes symmetric, rhythmic movements which are present at rest and no other neurological findings. A history reveals that the trembling decreases when the patient has a glass of wine with dinner. What is the initial action? Evaluation in an emergency department Prescribing a beta blocker medication Reassurance that these will subside Referral to a neurologist Your patient’s husband reports that during her 1-minute seizures, she wanders, smacks her lips, picks at her clothes, and loses awareness of her surroundings. What kind of seizure is she most likely having? Focal seizure with loss of consciousness (complex partial) Focal seizure without loss of consciousness (simple partial) Generalized tonic-clonic Absence A diagnosis of dementia requires the following: Impairment of at least two domains of cognitive function Evidence of functional impairment Ruling out of potential reversible causes of dementia All of the above Mrs. Hernandez presents with complaints of irritability, difficulty with sleep, poor concentration, and stomach upset. She experienced a traumatic event 3 months ago. You prescribe an SSRI to address her symptoms. One month later she returns endorsing improvement of symptoms and requests to discontinue medication. You counsel her that medications should be continued for after acute response to decrease the risk of recurrence. 6 months 2 years 3 months 1 year An elderly patient has symptoms of depression and the patient’s daughter asks about possible Alzheimer’s disease since there is a family history of this disease. A screening evaluation shows no memory loss. What is the initial step in managing this patient? Order brain imaging studies such as CT or MRI Perform genetic testing to identify true risk Prescribe a trial of an antidepressant medication Recommend a trial of a cholinesterase inhibitor drug A patient is diagnosed with mild restless leg syndrome which occasionally interferes with sleep. Which initial treatment will be helpful? Hot baths and exercise Benzodiazepines are appropriate to use as monotherapy for all anxiety disorders. True False A patient with epilepsy can have a normal EEG and normal MRI. True False A college student is brought to clinic by a parent who is concerned about increasingly bizarre behavior and poor school performance. The provider notes difficulty engaging the patient in an organized conversation. The patient denies any concerns about behavior. What will the provider do initially to manage this patient’s symptoms? Begin treatment with lithium or lamotrigine A patient who has excessive daytime sleepiness tells the practitioner that he goes to bed and gets up at the same times each day but still wakes up tired. The spouse reports that the patient snores so much she has had to move to another bedroom. The patient is otherwise healthy and does not take any medications or drink alcohol. Which diagnostic test may be performed for this patient? Unattended out of center sleep testing (OCST The lifetime prevalence of major depressive disorder in U.S. adults is estimated to be: 17% PET imaging using florbetapir has FDA approval and its use is covered by most insurance. True Which of the following medications are appropriate first-line treatments for an anxiety disorder? Escitalopram, venlafaxine, sertraline Some common medications that contribute to worsening of urinary incontinence include alpha blockers, loop diuretics, and narcotics. True False Frailty tends to be more prevalent in the presence of any stressors in the body. True False A frequent source of partial response or lack of response of antidepressants to treat anxiety in the primary care setting is: choosing the wrong medication starting antidepressant medications at too high a dose underdosing antidepressant medications adverse reactions to medications. A primary care provider suspects Parkinson’s disease (PD) in a patient. Which tests may be performed to diagnose this disorder? Presence of 2 cardinal signs which improve with levodopa A seizure occurs when the cerebral cortex is hyperexcitable, caused by: An increase in excitatory neurotransmission, a decrease in inhibitory neurotransmission, or a disturbance in brain circuitry A patient with Alzheimer’s disease (AD) is taking donepezil to treat cognitive symptoms. The patient’s son reports noting increased social withdrawal and sleep impairment. What is the initial step to manage these symptoms? Encourage activity and exercise A 68-year-old man comes into your primary care clinic for a routine visit. He complains of increased difficulty reading the morning newspaper. He notes the problem has been occurring now for a few months and seems better when he borrows his wife’s reading glasses. As a provider you should: Educate regarding presbyopia and notify him this is a normal process of aging Mr. Smith has a diagnosis of generalized anxiety disorder. He responded well to increasing doses of citalopram, yet begins to complain of difficulty controlling his symptoms. He specifically endorses difficulty controlling anxious behaviors. Which is the best intervention to address his concerns? ● Refer Mr. Smith to dedicated psychiatric care. ● Initiate treatment with a different medication. ● Recommend that he receive cognitive-behavioral therapy (CBT). ● Augment his citalopram with an as needed medication. The lifetime prevalence of major depressive disorder in U.S. adults is estimated to be: ● 7% ● 10% ● 17% ● 24% A patient is diagnosed with mild restless leg syndrome which occasionally interferes with sleep. Which initial treatment will be helpful? ● A CPAP devices ● A dopaminergic agonist ● Hot baths and exercise ● Supplemental iron Leading factors for urinary incontinence include: ● Female gender ● Cognitive impairment ● Impaired mobility ● All of the above A patient is on carbamazepine 600 mg BID and comes to you complaining of nausea, vomiting, headache, and fatigue. He is also having more seizures. What would you do? ● Increase the carbamazepine dose. ● Check carbamazepine levels. ● Check sodium levels ● Check carbamazepine levels and Check sodium levels