ESl 101
An 8-year-old girl is struggling to fall asleep and returns into her parents' bedroom after attempting to
sleep for 2 minutes on her own. She is often scared of something under her bed or in the closet. Any
noise in the house frightens her when she is not with her parents, and she screams out. She falls asleep
easily with her parents. She occasionally has nightmares that she cannot find her parents in a
department store. What is the most likely diagnosis? ANS: Separation Anxiety Disorder
A 36-year-old male reported a sudden choking sensation at work, which caused some difficulty
breathing. He retreated to the bathroom out of fear that others would see him struggling, as he couldn't
comprehend if these symptoms were life-threatening or if he was going crazy. He felt dizzy, sweaty, sick
to his stomach, and could not swallow. He had a fear at first that he was dying. He attributed his
symptoms to an undiagnosed illness or a recent infection that he hadn't over. He never sought medical
treatment. He struggled for the next 4 weeks out of concern that these symptoms might come back. The
symptoms recurred 5 weeks later, while sitting alone in his car after leaving a supermarket. He drove to
the nearest emergency room, and no immediate cause was identified. He was instructed to follow up
with an ENT provider as an outpatient. What is the most likely explanation of his symptoms? ANS: Panic
disorder
In Dhat syndrome, patients most commonly report symptoms of: ANS: Fatigue, Weakness, and Loss of
Appetite
Which cultural syndrome involves the belief that symptoms are caused by a "sent" illness from another
person? ANS: Maladi Moun
During an intake session, a PMHNP learns that the patient's culture highly stigmatizes mental illness.
Which approach would be most effective in building rapport and encouraging openness? ANS:
Addressing the patient's concerns with sensitivity and using less stigmatizing language when discussing
symptoms
A patient diagnosed with Major Neurocognitive Disorder due to Alzheimer's disease has been started on
Donepezil. What is the primary mechanism of action of Donepezil in this treatment? ANS: Inhibits
Acetylcholinesterase
,Which description best corresponds to a person with a MOCA score of 5? ANS: Severe memory
impairment and disorientation
The cognitive processes that allow us to organize, plan, sequence, and initiate tasks are collectively
known as what? ANS: Executive Functions
Gloria displays gait ataxia. She is unable to walk heel to toe in a line. Gloria previously suffered from a
TBI that has likely affected which part of the brain? ANS: The Cerebellum
Memantine is prescribed to a patient with moderate to severe Alzheimer's disease. What is the primary
benefit of using Memantine for patients at this stage of the disease? ANS: It blocks excess glutamine to
prevent excitotoxicity
The average age of onset of this major neurocognitive disorder is 40 years. The median survival is 15
years after the onset of the motor symptoms. Initial symptoms include irritability, anxiety, and or
depressed mood. Mild apraxia progresses to ataxia and postural instability. Genetic testing is the
primary laboratory for the determination of this order autosomal dominant disorder, which is known as
what? ANS: Huntington's disease
Early age of symptom onset, socially inappropriate behavior, and hyperorality are associated with which
type of neurodegenerative disorder in an adult? ANS: Frontotemporal Dementia
Frank is a 71-year-old retired house painter who dropped out of high school in the 10th grade. Frank is
concerned with his self-reported "memory difficulty" the past 1.5 years. He has no reported changes in
activities of daily living or functional ability. He scored a 24 on the Montreal Cognitive Assessment and a
26 on the Mini-Mental State Examination. He is accompanied by his daughter, who acknowledges that
her father is having some memory issues. Which is the most likely diagnosis given the information
provided? ANS: Mild Cognitive Impairment
A 74-year-old woman presents with memory loss, visual hallucinations, and fluctuating levels of
alertness. Her family also reports episodes of stiffness and slowness in movement. Which type of
dementia is most likely based on these symptoms? ANS: Dementia with Lewy bodies
, Pauline is an 83-year-old female with a moderate to advanced stage of Alzheimer's Dementia. She has
been wandering inside of the locked ward within the nursing home she resides in. The PMHNP is
consulted to address the wandering behavior of Pauline. What is the most appropriate treatment option
for wandering in the case scenario ANS: Supervise Pauline and allow her to wander
The most common complaint and reason the acetylcholinesterase inhibitors are sometimes
discontinued is what? ANS: Gastrointestinal Side Effects
The spouse of your patient asks you to describe how Donepezil helps her husband who has mild
Alzheimer's disease. Which of the following is the best response? ANS: Donepezil helps prevent the
breakdown of acetylcholine
Delirium and Dementia may at times have overlapping characteristics. However, which of the following
are readily associated with delirium? ANS: Sudden onset
A 67-year-old nurse practitioner has been making errors in her notes over the last 3 months. Some of
her sentences within the electronic medical record were found to be unreadable. Many words were
missing vowels altogether. After meeting with her manager, it was discovered that she posted sticky
notes of her passwords to the front of her laptop, so she would not forget them. She was unable to
appreciate the potential HIPAA risk during the meeting. She recently scored a 22 of 30 on an MMSE
completed by her PCP. Her long-term memory remained completely intact, as was her ability to hold a
conversation. She acknowledged that her notes were a concern, but felt "everyone makes mistakes
sometimes" and did not understand the "big deal". What diagnosis best fits this clinical scenario? ANS:
Major Neurocognitive Disorder
Which common side effect should patients and caregivers be advised of when starting a cholinesterase
inhibitor like Rivastigmine for Major Neurocognitive Disorder? ANS: GI-Distress
Kolu is a 33-year-old female who displays 2 distinct personality states. She experiences gaps in memory
beyond ordinary forgetting. These symptoms have negatively impacted her career. She has no other
medical conditions and does not use any substances or alcohol. What is the most likely diagnosis? ANS:
Dissociative Identity Disorder
An 8-year-old girl is struggling to fall asleep and returns into her parents' bedroom after attempting to
sleep for 2 minutes on her own. She is often scared of something under her bed or in the closet. Any
noise in the house frightens her when she is not with her parents, and she screams out. She falls asleep
easily with her parents. She occasionally has nightmares that she cannot find her parents in a
department store. What is the most likely diagnosis? ANS: Separation Anxiety Disorder
A 36-year-old male reported a sudden choking sensation at work, which caused some difficulty
breathing. He retreated to the bathroom out of fear that others would see him struggling, as he couldn't
comprehend if these symptoms were life-threatening or if he was going crazy. He felt dizzy, sweaty, sick
to his stomach, and could not swallow. He had a fear at first that he was dying. He attributed his
symptoms to an undiagnosed illness or a recent infection that he hadn't over. He never sought medical
treatment. He struggled for the next 4 weeks out of concern that these symptoms might come back. The
symptoms recurred 5 weeks later, while sitting alone in his car after leaving a supermarket. He drove to
the nearest emergency room, and no immediate cause was identified. He was instructed to follow up
with an ENT provider as an outpatient. What is the most likely explanation of his symptoms? ANS: Panic
disorder
In Dhat syndrome, patients most commonly report symptoms of: ANS: Fatigue, Weakness, and Loss of
Appetite
Which cultural syndrome involves the belief that symptoms are caused by a "sent" illness from another
person? ANS: Maladi Moun
During an intake session, a PMHNP learns that the patient's culture highly stigmatizes mental illness.
Which approach would be most effective in building rapport and encouraging openness? ANS:
Addressing the patient's concerns with sensitivity and using less stigmatizing language when discussing
symptoms
A patient diagnosed with Major Neurocognitive Disorder due to Alzheimer's disease has been started on
Donepezil. What is the primary mechanism of action of Donepezil in this treatment? ANS: Inhibits
Acetylcholinesterase
,Which description best corresponds to a person with a MOCA score of 5? ANS: Severe memory
impairment and disorientation
The cognitive processes that allow us to organize, plan, sequence, and initiate tasks are collectively
known as what? ANS: Executive Functions
Gloria displays gait ataxia. She is unable to walk heel to toe in a line. Gloria previously suffered from a
TBI that has likely affected which part of the brain? ANS: The Cerebellum
Memantine is prescribed to a patient with moderate to severe Alzheimer's disease. What is the primary
benefit of using Memantine for patients at this stage of the disease? ANS: It blocks excess glutamine to
prevent excitotoxicity
The average age of onset of this major neurocognitive disorder is 40 years. The median survival is 15
years after the onset of the motor symptoms. Initial symptoms include irritability, anxiety, and or
depressed mood. Mild apraxia progresses to ataxia and postural instability. Genetic testing is the
primary laboratory for the determination of this order autosomal dominant disorder, which is known as
what? ANS: Huntington's disease
Early age of symptom onset, socially inappropriate behavior, and hyperorality are associated with which
type of neurodegenerative disorder in an adult? ANS: Frontotemporal Dementia
Frank is a 71-year-old retired house painter who dropped out of high school in the 10th grade. Frank is
concerned with his self-reported "memory difficulty" the past 1.5 years. He has no reported changes in
activities of daily living or functional ability. He scored a 24 on the Montreal Cognitive Assessment and a
26 on the Mini-Mental State Examination. He is accompanied by his daughter, who acknowledges that
her father is having some memory issues. Which is the most likely diagnosis given the information
provided? ANS: Mild Cognitive Impairment
A 74-year-old woman presents with memory loss, visual hallucinations, and fluctuating levels of
alertness. Her family also reports episodes of stiffness and slowness in movement. Which type of
dementia is most likely based on these symptoms? ANS: Dementia with Lewy bodies
, Pauline is an 83-year-old female with a moderate to advanced stage of Alzheimer's Dementia. She has
been wandering inside of the locked ward within the nursing home she resides in. The PMHNP is
consulted to address the wandering behavior of Pauline. What is the most appropriate treatment option
for wandering in the case scenario ANS: Supervise Pauline and allow her to wander
The most common complaint and reason the acetylcholinesterase inhibitors are sometimes
discontinued is what? ANS: Gastrointestinal Side Effects
The spouse of your patient asks you to describe how Donepezil helps her husband who has mild
Alzheimer's disease. Which of the following is the best response? ANS: Donepezil helps prevent the
breakdown of acetylcholine
Delirium and Dementia may at times have overlapping characteristics. However, which of the following
are readily associated with delirium? ANS: Sudden onset
A 67-year-old nurse practitioner has been making errors in her notes over the last 3 months. Some of
her sentences within the electronic medical record were found to be unreadable. Many words were
missing vowels altogether. After meeting with her manager, it was discovered that she posted sticky
notes of her passwords to the front of her laptop, so she would not forget them. She was unable to
appreciate the potential HIPAA risk during the meeting. She recently scored a 22 of 30 on an MMSE
completed by her PCP. Her long-term memory remained completely intact, as was her ability to hold a
conversation. She acknowledged that her notes were a concern, but felt "everyone makes mistakes
sometimes" and did not understand the "big deal". What diagnosis best fits this clinical scenario? ANS:
Major Neurocognitive Disorder
Which common side effect should patients and caregivers be advised of when starting a cholinesterase
inhibitor like Rivastigmine for Major Neurocognitive Disorder? ANS: GI-Distress
Kolu is a 33-year-old female who displays 2 distinct personality states. She experiences gaps in memory
beyond ordinary forgetting. These symptoms have negatively impacted her career. She has no other
medical conditions and does not use any substances or alcohol. What is the most likely diagnosis? ANS:
Dissociative Identity Disorder
