PMHNP Exam Graded A+ 2023

Autosomal Dominant - ANSWER-Genetic inheritance, is more rare (i.e. Huntington's disease), is present in more than one generation. Autosomal Recessive - ANSWER-Expressed in one generation, inherited from unaffected parent, is more common. CAGE Questionnaire - ANSWER-For substance abuse, Cut, Annoyed, Guilty, Eye opener Suicidal Risk Assessment - ANSWER-SLAP: Social support, Lethality, Access to means, Plan and previous attempts, & family history Suicidal Risk Assessment #2 ISPATHWARM - ANSWER-ISPATHWARM: Ideation, Substance abuse, Purpose for living, Anxiety/agitation, Trapped feeling, Hopelessness, Withdrawing from friends, Anger with rage, Reckless in behaviors, Mood changes Depression Assessment SIGECAPS - ANSWER-SIGECAPS: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor retardation, Suicidality Mania Assessment DIGFAST - ANSWER-DIGFAST: Distractibility, Indiscretion, Grandiosity, Flight of ideas, Activity increase, Sleep deficit, Talkativeness Mental Status Exam Components (All Borderline Subjects Are Tough Troubled Characters) - ANSWER-Appearance, Behavior, Speech, Affect, Thought Process, Thought Content, Cognitive Examination Hamilton Depression Rating (HDRS) for very severe depression - ANSWER-more than 23 Hamilton Depression Rating (HDRS) for severe depression - ANSWER-19-23 Hamilton Depression Rating (HDRS) for moderate depression - ANSWER-14-18 Hamilton Depression Rating (HDRS) for mild depression - ANSWER-8-13 Hamilton Depression Rating (HDRS) for no depression - ANSWER-0-7 Hamilton Anxiety Rating for moderate to severe anxiety - ANSWER-25-30 Hamilton Anxiety Rating for mild to moderate anxiety - ANSWER-18-24 Hamilton Anxiety Rating mild anxiety - ANSWER-<17 General screening labs - ANSWER-CBC, Chem, Thyroid, Hepatic, b12, folate, drug levels Lithium labs - ANSWER-evaluate thyroid function, check creatinine clearance regularly Depakote labs - ANSWER-check hepatic function Olfactory Nerve (On) - ANSWER-CN I: Sensory: (test by smell- coffee, tea, non astringent smells) Optic Nerve (Old) - ANSWER-CN II: Sensory- visual acuity test (confrontation method to assess visual fields) Oculomotor (Olympus) - ANSWER-CN III: Motor- eye movement (follow penlight through six fields of gaze, test OD, OS individually) Trochlear Nerve (Towering) - ANSWER-CN IV: Motor- eye movement (superior oblique-same test as oculomotor) Trigeminal Nerve (Tops) - ANSWER-CN V: Both- superficial and deep structures of head and face, mastification/corneal reflex (test by show teeth) Abducens Nerve (A) - ANSWER-CN VI: Motor- specific eye movements (test same as oculomotor) Facial Nerve (Fin) - ANSWER-CN VII: Both- taste of anterior 2/3 of tongue, sensation in ear canal, facial movement (use salt/sugar for taste, evaluate corneal reflex, raise eyebrows, keep eyes closed, and resist attempt to open, puff cheeks) Acoustic Nerve (And) - ANSWER-CN VIII: Sensory- Hearing/tickling watch and whisper (tuning fork with Rinne- positive as normal, when air conduction persists twice as long as bone conduction) Glossopharyngeal Nerve (German) - ANSWER-CN IX: Both- Swallow, taste of posterior 1/3 of tongue, pain, touch, and temp of mucosa and pharynx (check for deviation of uvula to unaffected side) Vagus Nerve (Viewed) - ANSWER-CN X: Both- Elevation of the uvula (swallow, have patient say aaah and check uvula elevation, gag reflex, and ability to swallow water) Accessory Nerve (A) - ANSWER-CN XI: Motor- Innervates trapezius and sternocleidomastoid (shrug shoulders against resistance, turn head against hand on cheek) Hypoglossal (Hop) - ANSWER-CN XII: Motor- motor of the tongue (push tongue against the inside of cheek, stick out tongue and check for fasciculation) Lithium therapeutic levels (acute mania) - ANSWER-0.6-1.2 mEq/L Lithium therapeutic levels (maintenance) - ANSWER-0.8-1.0 mEq/L Lithium adverse effect level - ANSWER-> 2 mEq/L >2.5 mEq/L = seizure, death Valproic acid therapeutic levels - ANSWER-50-120 ug/ml Sensitivity - ANSWER-true positives (the degree to which those who have a disease screen positive) Specificity - ANSWER-true negatives (the degree to which those who not have a disease test negative) Incidence - ANSWER-frequency with which a disease appears in a population given the rate in which new cases occur during a specific time period Prevalence - ANSWER-proportion of a population that is affected by a disease at a particular time Major cause of death for adolescents - ANSWER-motor vehicle accident, suicide, accidents, homicide, malignancy, cv or congenital disease Major cause of death for young adults - ANSWER-Motor vehicle accidents, homicide, suicide, injuries, heart disease, AIDS Major cause of death for middle age adult - ANSWER-Heart disease, accidents, lung cancer, CVA, breast and colorectal cancer, COPD Major cause of death for elderly adults - ANSWER-Heart disease, CVA, COPD, pneumonia and influenza Primary prevention - ANSWER-measures to promote health prior to onset of problems (teaching) Secondary prevention - ANSWER-focuses on early identification and treatment of existing problems (screening) Tertiary prevention - ANSWER-rehabilitation and restoration of health Diagnosis of diabetes - ANSWER-fasting BG > 126 on 2 separate occasions random BG of >200 with s/s of diabetes oral glucose tolerance test >200 Total cholesterol recommendations - ANSWER-<200 LDL recommendation - ANSWER-<100, <70 goal HDL recommendation - ANSWER->40 men >50 women Triglycerides recommendation - ANSWER-<150 Mitral stenosis - ANSWER-loud first heart sound (s1) murmur, low pitched, mid diastolic, apical crescendo rumble Mitral regurgitation - ANSWER-third heart sound (S3) with systolic murmur at 5th intercostal space midclavicular line (apex), may radiate to base or left axilla, musical, blowing, or high pitched Aortic stenosis - ANSWER-systolic, "blowing", rough harsh murmur at second right ICS usually radiating to the neck Aortic regurgitation - ANSWER-diastolic, "blowing" murmur at second left ICS S1 - ANSWER-mitral/tricuspid (AV) valves closure S2 - ANSWER-aortic/pulmonic (semilunar) valves closure systole - ANSWER-period between S1 and S2 diastole - ANSWER-period between S2 and S1 S3 - ANSWER-"Kentucky", increased fluid states (CHF, pregnancy) S4 - ANSWER-"Tennesse", stiff ventricular wall (MI, left ventricular hypertrophy, chronic hypertension)