MSN-FNP Neurological and Psychiatric Exam Questions and Answers

MSN-FNP Neurological and Psychiatric Exam Questions and Answers Which of the following criteria for the diagnosis of bulimia nervosa is correct? A. Binge-eating an amount of food over 1 week that is somewhat larger than what one would normally eat B. Feeling in control over one's eating while binging C. Compensating by recurrently using a method to prevent weight gain (e.g. laxatives, vomiting, exercise) D. Disturbance may occur during an episode of anorexia nervosa - ANSWER C. Compensating by recurrently using a method to prevent weight gain. (e.g. laxatives, vomiting, exercise) A 15 yo female who is 10-weeks pregnant presents with c/o vaginal bleeding, abdominal pain, vomiting, and muscle spasms for the last 4 hours. Her P is 165/110. She is febrile, has cold extremities, and is trembling. Abnormal ultrasound confirms the miscarriage with no retained products of conception. Withdrawal from which of the following substances could lead to miscarriage in the female? A. Codeine B. Cannabis C. Cocaine D. Nicotine - ANSWER A. Codeine Explanation: Miscarriage is a complication of opioid withdrawal in the female. During pregnancy, opioid withdrawal, even when treated, can increase the risk of miscarriage and premature birth. In addition, there is a very high rate of relapse after detoxification, and risk of cycling between intoxication and withdrawal can be even more dangerous to the fetus. Methadone maintenance has generally been accepted as the standard approach to the pregnant woman. Buprenorphine maintenance is also increasingly being used in pregnant opioid-dependent women. Which of the following is a side effect of MDMA (ecstasy)? A. Diarrhea B. Bruxism C. Pinpoint pupils D. Lacrimation and runny nose - ANSWER B. Bruxism Explanation: Bruxism, associated with grinding teeth, is an adverse effect of amphetamines like MDMA (ecstasy, a popular recreational drug), methamphetamine, dextroamphetamine, and others. After ingestion, there is an initial phase of disorientation, followed by a rush. Common features of amphetamine ingestion are pallor, tremors, muscle twitching, bruxism, perspiration, chills, vomiting, decreased appetite, insomnia, euphoria, agitation, elation, tachycardia, hypertension, and anxiety. Oppositional defiant or conduct disorders coexist with ADHD in ~35% of children. Oppositional defiant disorder includes persistent symptoms of negativistic, defiant, disobedient and hostile behaviors toward authority figures. Which of the following is an appropriate behavioral therapeutic intervention? A. Positive reinforcement B. Intention disobedience C. Object-oriented satiation D. Marks-Sachs division - ANSWER A. Positive reinforcement Which of the following is an example of a method of a behavior therapy technique for anorexic or bulimic patients who binge and purge? A. Have another person portion out their meals B. Have a supervisor watch them to ensure that they do not binge C. Have a supervisor watch them for 2-3 hours after every meal D. Have them keep a log of when they feel like bingeing or purging - ANSWER C. Have a supervisor watch them for 2-3 hours after every meal. What medication is the first-line therapy for TIAs? A. Carbamazepine (Tegretol) 100 mg B. Donepezil (Aricept) 23 mg C. Clonidine (Catapress) 0.1 mg D. Clopidogrel (Plavix) 75 mg - ANSWER D. Clopidogrel (Plavix) 75 mg Explanation: Antiplatelet therapy is recommended as treatment for TIAs. ASA and AHA guidelines recommend aspirin, Aggrenox, and Clopidogrel as first line agents. (A) Carbamazepine is used in the prevention of seizures as well as bipolar and nerve pain. (B) Donepezil is used in the treatment of dementia for Alzheimer's type. (C) Clonidine is used in the treatment of HTN, but is not the first line of choice. You are evaluating a 2 yo boy with red discoloration on the left face that has been present since birth. Parental, perinatal, postnatal, and family history were unremarkable. He is developmentally delayed. Exam revealed a well child with a flat, pink to red discoloration measuring approximately 10.5 cm by 9cm, with well defined borders, involving the skin of the left upper and lower eyelids overlying the left zygoma down to the left mandible, involving the skin above and below the lips but no crossing the midline. The color deepened when the child cried. Optimum further evaluation should include: A. Skull radiography B. Ophthalmology evaluation C. Cranial MRI with contrast D. Ophthalmology evaluation and cranial MRI with contrast. - ANSWER D. Ophthalmology evaluation and cranial MRI with contrast. Explanation: The distribution of the port wine stain above is suggestive of a larger issue, namely Sturge-Weber syndrome, which consist of the triad of a facial port wine stain involving the first branch of the trigeminal nerve, ipsilateral meningeal capillary malformations, and ipsilateral cerebral cortical capillary malformations, often with seizures and intellectual disability. First line of treatment for Parkinson's is: A. Amitriptyline (Elavil) B. Memantine (Namenda) C. Levodopa-carbidopa (Sinemet) D. Benztropine (Cogentin) - ANSWER C. Levodopa-carbidopa (Sinemet) Explanation: Sinemet is a dopamine precursor and first line treatment for Parkinson's. Dose should be started low and titrated up as symptoms allow. After 5-10 years, may lose some effectiveness and patient may exhibit motor fluctuations as well as tardive dyskinesia. (D) Cogentin is an anticholinergic drug used in Parkinson's to help control tremors. A 48 yo male that is otherwise healthy presents with left-sided facial drooping. He reports that he wok up without the ability to move the left side of his face. He also had some right knee pain yesterday without trauma, but it's resolved. He denies headache, blurred vision, dizziness, pain, h/o THN. Which of the following test will be helpful for evaluation of this patient? - ANSWER D. ELISA Explanation: ELISA is the initial testing modality for Lyme disease. Western blot test are one pat of the diagnostic test for Lyme disease. Testing for Lyme is a two part process, Western blot IGg and IGm are confirmatory test after IFA or EIA. Bell's palsy as well as arthralgia of large joint (knees) are associated with early disseminated stage of Lyme disease. What is the most significant risk factor for suicide in male adolescents? A. Previous suicide attempt B. Major depressive disorder C. Panic disorder D. Substance abuse - ANSWER A. Previous suicide attempt Which reflex is elicited by placing the infant supine and turning the head to the side? This placement results I ipsilateral extension of the arm and movement of the leg into a fencing position. The contralateral side flexes as well. A. Asymmetric tonic neck reflex B. Moro reflex C. Rooting reflex D. Grasp reflex - ANSWER A. Asymmetric tonic neck reflex. Which of the following is not a typical migraine aura? A. Spots, flashing lights, or lines in vision B. Severe pain behind one eye C. Scotoma D. Numbness - ANSWER B. Severe pain behind one eye. Explanation: Sever pain behind one eye is associated with cluster headaches. Classic migraines present with aura. An aura can last from 5-60 minutes before the onset of a migraine. Common auras are visual: flickering lights, spots, scotomata (an area of diminished vision across the visual field may be blank, blurred, or glowing), halos, and loss of vision (temporary). Sensory: pins and needles or numbness, and or dysphasia A self-described 16 yo binge-eater presents looking for help. The patient says for years her typical day has consisted of denying herself food followed by an evening of rampant binging. She often exercises excessively to try to avoid gaining weight. Her BMI is 26. She want to know if there is any medication that can help her condition. What is the best treatment option? A. Prescribe fluoxetine B. Prescribe carbamazepine C. Explain that only psychotherapy is helpful D. Explain that medications are contraindicated in patients with her disorder. - ANSWER A. prescribe fluoxetine Explanation: Typically, patients with uncomplicated bulimia nervosa do not require hospitalization. Antidepressant medications can assist in the treatment. of bulimia because they have been found to reduce binge eating and purging independent of the presence of a mood disorder.