APEA (Psych) 1 QUESTIONS WITH
VERIFIED ANSWERS
A 76 year-old depressed patient is started on an SSRI. When should another
antidepressant be tried if there is no response? - ANSWERSA 76 year-old depressed
patient is started on an SSRI. When should another antidepressant be tried if there is no
response?
Parkinson's disease
Diseases associated with the central nervous system are associated with high rates of
depression. These include stroke, Parkinson's disease, multiple sclerosis, and
dementia. Other illnesses associated with high rates of depression are cancer and
cardiovascular illnesses like myocardial infarction. Depression worsens the outcome of
any physical illness. - ANSWERSWhich patient is most likely to exhibit depression
related to his illness? A patient with:
Anxiety disorders
Affective disorders, anxiety disorders, and substance abuse issues are common in
patients who have eating disorders. Obsessive-compulsive disorder is also commonly
observed. Patients with eating disorders are more likely to have a first or second degree
relative with an eating disorder, affective disorder, or alcohol abuse. There is no
evidence that patients with eating disorders exhibit a higher incidence of sleep disorders
or liver disease. Thyroid disease should always be assessed in patients with eating
disorders, but this does not represent the reason for weight loss when eating disorder is
present. - ANSWERSA patient with an eating disorder may concomitantly exhibit:
Impairment of executive function
The diagnostic criteria for Alzheimer's disease (AD) was established by DSM V and
other organizations. The criteria are similar. Criteria include a gradual onset of cognitive
decline. A rapid onset usually indicates another etiology, perhaps, delirium. Other
criteria include impairment of recent memory, difficulty with language or finding words,
the inability to execute skilled motor activities, disturbances of visual processing or
disturbances in executive function that includes abstract reasoning and concentration.
Focal neurologic signs are consistent with a vascular dementia. Radiologic evidence is
not a criterion for diagnosis, though it may support the diagnosis of AD. There is no
laboratory evidence of AD. - ANSWERSWhich criterion below is a criterion for
Alzheimer's Disease?
Next day sleepiness
,Diphenhydramine should be avoided in older adults. Diphenhydramine exhibits potent
anti-cholinergic effects in patients who take this, but especially in older adults. Urinary
retention is common (not incontinence) in older men with benign prostatic hyperplasia,
but retention occurs in women too. Diphenhydramine is contraindicated in patients with
glaucoma. The most serious side effect is cognitive impairment, like daytime sleepiness.
Visual disturbances can occur as well as annoying side effects like dry mouth and
constipation. - ANSWERSAn 80 year old adult has begun to use over the counter
diphenhydramine to help him fall asleep. What common side effect can occur in older
adults with use of this medication?
Depression
Anhedonia is the loss of pleasure or interest in things that have always brought pleasure
or interest. If this is the case, this patient should be screened for depression. Anhedonia
is a red flag for depression. - ANSWERSA 69 year-old female patient reports feelings of
anhedonia for the last month. What should be part of the nurse practitioner's
assessment?
Alcohol abuse
This patient has an elevated mean corpuscular volume. This indicates a macrocytic
anemia. Common macrocytic anemias are B12 deficiency and folate deficiency. These
are common in older patients, especially if they consume large quantities of alcohol.
This patient also has elevated triglycerides. Triglycerides are commonly elevated when
patients are exposed to alcohol and carbohydrates. This patient's history indicates two
elements that indicate alcohol abuse. He should be questioned regarding alcohol
abuse. - ANSWERSA 70 year-old male patient has an elevated MCV with an anemia.
His triglycerides are 420. What should be suspected?
Early morning wakening
Sleep difficulty is a common complaint among patients with depression. Patients with
difficulty falling asleep are often anxious. Frequent waking and early morning wakening
are often complaints by patients with depression. There is no agreed on physiologic
explanation, but, this is a common symptom. - ANSWERSWhich symptom listed below
is typical of depression?
often develops acutely
Delirium is a change in consciousness or cognition. It may be accompanied by a
physical diagnosis like urinary tract infection; or it may be due to consumption of a
medication. Regardless, a change in cognition or consciousness needs immediate
evaluation. The evaluation should include a medication review, physical exam and
laboratory evaluation, and mental status exam. - ANSWERSDelirium differs from
dementia because delirium:
, CAGE
CAGE is a screen for alcohol abuse that is validated in adults and older adults. The C
stands for "have you ever felt you should CUT down" your alcohol consumption. The A
stands for " does other's criticism of your drinking ANNOY you". G stands for "have you
ever felt GUILTY about drinking". The E stands for "have you ever had an EYE opener
to steady your nerves or get rid of a hangover". A positive response on any question
constitutes a positive screen. - ANSWERSWhich screen for alcohol abuse has been
validated in the elderly?
dementia
The mini mental status exam (MMSE) is a very common and easily administered
cognitive evaluation for dementia. It tests orientation, recall, attention, calculation,
language manipulation, and constructional praxis. It is not sensitive for mild dementia
and may be influenced by educational level and age. Even with these limitations, the
MMSE is the most widely used cognitive test for dementia in the US. -
ANSWERSMMSE helps to identify patients with symptoms of:
Weight below 90% of ideal body weight
Weight below 85% of ideal body weight is the correct criterion. This involves refusal to
gain or maintain weight within normal range. Occasionally weight below ideal body
range does not involve losing weight, but instead involves refusal to gain weight during
a growth spurt. This is commonly observed during pubertal growth spurts and is more
common in adolescent females than males. The other three criteria are correct as listed.
- ANSWERSAn adolescent female patient with anorexia nervosa must exhibit 4 criteria
for diagnosis. Which criterion listed below is NOT part of the diagnostic criteria?
High dose SSRIs are used to treat this
The medications of choice to treat bulimia nervosa are the SSRIs. Generally, high
doses are required. Wellbutrin is not an SSRI and should not be given to patients with
eating disorders because of great fluctuations in drug levels related to purging.
Generally, this is more common in women than men. Loss of control IS a characteristic
of this illness. - ANSWERSWhich statement about bulimia nervosa is accurate?
anxiety
Anxiety is very common in older adults. Depression is very common too, and may
accompany anxiety in older adults. The prevalence of anxiety may be due in part to
other physical illnesses or serious diseases or disorders, like cancer, Parkinson's
disease. New onset anxiety should prompt the examiner to consider withdrawal of
medication or side effects of medication being taken at therapeutic levels. -
ANSWERSThe most common mental disorder in older adults is:
VERIFIED ANSWERS
A 76 year-old depressed patient is started on an SSRI. When should another
antidepressant be tried if there is no response? - ANSWERSA 76 year-old depressed
patient is started on an SSRI. When should another antidepressant be tried if there is no
response?
Parkinson's disease
Diseases associated with the central nervous system are associated with high rates of
depression. These include stroke, Parkinson's disease, multiple sclerosis, and
dementia. Other illnesses associated with high rates of depression are cancer and
cardiovascular illnesses like myocardial infarction. Depression worsens the outcome of
any physical illness. - ANSWERSWhich patient is most likely to exhibit depression
related to his illness? A patient with:
Anxiety disorders
Affective disorders, anxiety disorders, and substance abuse issues are common in
patients who have eating disorders. Obsessive-compulsive disorder is also commonly
observed. Patients with eating disorders are more likely to have a first or second degree
relative with an eating disorder, affective disorder, or alcohol abuse. There is no
evidence that patients with eating disorders exhibit a higher incidence of sleep disorders
or liver disease. Thyroid disease should always be assessed in patients with eating
disorders, but this does not represent the reason for weight loss when eating disorder is
present. - ANSWERSA patient with an eating disorder may concomitantly exhibit:
Impairment of executive function
The diagnostic criteria for Alzheimer's disease (AD) was established by DSM V and
other organizations. The criteria are similar. Criteria include a gradual onset of cognitive
decline. A rapid onset usually indicates another etiology, perhaps, delirium. Other
criteria include impairment of recent memory, difficulty with language or finding words,
the inability to execute skilled motor activities, disturbances of visual processing or
disturbances in executive function that includes abstract reasoning and concentration.
Focal neurologic signs are consistent with a vascular dementia. Radiologic evidence is
not a criterion for diagnosis, though it may support the diagnosis of AD. There is no
laboratory evidence of AD. - ANSWERSWhich criterion below is a criterion for
Alzheimer's Disease?
Next day sleepiness
,Diphenhydramine should be avoided in older adults. Diphenhydramine exhibits potent
anti-cholinergic effects in patients who take this, but especially in older adults. Urinary
retention is common (not incontinence) in older men with benign prostatic hyperplasia,
but retention occurs in women too. Diphenhydramine is contraindicated in patients with
glaucoma. The most serious side effect is cognitive impairment, like daytime sleepiness.
Visual disturbances can occur as well as annoying side effects like dry mouth and
constipation. - ANSWERSAn 80 year old adult has begun to use over the counter
diphenhydramine to help him fall asleep. What common side effect can occur in older
adults with use of this medication?
Depression
Anhedonia is the loss of pleasure or interest in things that have always brought pleasure
or interest. If this is the case, this patient should be screened for depression. Anhedonia
is a red flag for depression. - ANSWERSA 69 year-old female patient reports feelings of
anhedonia for the last month. What should be part of the nurse practitioner's
assessment?
Alcohol abuse
This patient has an elevated mean corpuscular volume. This indicates a macrocytic
anemia. Common macrocytic anemias are B12 deficiency and folate deficiency. These
are common in older patients, especially if they consume large quantities of alcohol.
This patient also has elevated triglycerides. Triglycerides are commonly elevated when
patients are exposed to alcohol and carbohydrates. This patient's history indicates two
elements that indicate alcohol abuse. He should be questioned regarding alcohol
abuse. - ANSWERSA 70 year-old male patient has an elevated MCV with an anemia.
His triglycerides are 420. What should be suspected?
Early morning wakening
Sleep difficulty is a common complaint among patients with depression. Patients with
difficulty falling asleep are often anxious. Frequent waking and early morning wakening
are often complaints by patients with depression. There is no agreed on physiologic
explanation, but, this is a common symptom. - ANSWERSWhich symptom listed below
is typical of depression?
often develops acutely
Delirium is a change in consciousness or cognition. It may be accompanied by a
physical diagnosis like urinary tract infection; or it may be due to consumption of a
medication. Regardless, a change in cognition or consciousness needs immediate
evaluation. The evaluation should include a medication review, physical exam and
laboratory evaluation, and mental status exam. - ANSWERSDelirium differs from
dementia because delirium:
, CAGE
CAGE is a screen for alcohol abuse that is validated in adults and older adults. The C
stands for "have you ever felt you should CUT down" your alcohol consumption. The A
stands for " does other's criticism of your drinking ANNOY you". G stands for "have you
ever felt GUILTY about drinking". The E stands for "have you ever had an EYE opener
to steady your nerves or get rid of a hangover". A positive response on any question
constitutes a positive screen. - ANSWERSWhich screen for alcohol abuse has been
validated in the elderly?
dementia
The mini mental status exam (MMSE) is a very common and easily administered
cognitive evaluation for dementia. It tests orientation, recall, attention, calculation,
language manipulation, and constructional praxis. It is not sensitive for mild dementia
and may be influenced by educational level and age. Even with these limitations, the
MMSE is the most widely used cognitive test for dementia in the US. -
ANSWERSMMSE helps to identify patients with symptoms of:
Weight below 90% of ideal body weight
Weight below 85% of ideal body weight is the correct criterion. This involves refusal to
gain or maintain weight within normal range. Occasionally weight below ideal body
range does not involve losing weight, but instead involves refusal to gain weight during
a growth spurt. This is commonly observed during pubertal growth spurts and is more
common in adolescent females than males. The other three criteria are correct as listed.
- ANSWERSAn adolescent female patient with anorexia nervosa must exhibit 4 criteria
for diagnosis. Which criterion listed below is NOT part of the diagnostic criteria?
High dose SSRIs are used to treat this
The medications of choice to treat bulimia nervosa are the SSRIs. Generally, high
doses are required. Wellbutrin is not an SSRI and should not be given to patients with
eating disorders because of great fluctuations in drug levels related to purging.
Generally, this is more common in women than men. Loss of control IS a characteristic
of this illness. - ANSWERSWhich statement about bulimia nervosa is accurate?
anxiety
Anxiety is very common in older adults. Depression is very common too, and may
accompany anxiety in older adults. The prevalence of anxiety may be due in part to
other physical illnesses or serious diseases or disorders, like cancer, Parkinson's
disease. New onset anxiety should prompt the examiner to consider withdrawal of
medication or side effects of medication being taken at therapeutic levels. -
ANSWERSThe most common mental disorder in older adults is:
