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2024 PMHNP BOARDS - SCIENTIFIC FOUNDATION AND ADVANCE PRACTICE SKILLS EXAM WITH CORRECT ANSWERS
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2024 PMHNP BOARDS - SCIENTIFIC FOUNDATION AND ADVANCE PRACTICE SKILLS EXAM WITH CORRECT ANSWERS
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2024 PMHNP BOARDS -SCIENTIFIC FOUNDATION AND
ADVANCE PRACTICE SKILLS EXAM
WITH CORRECT ANSWERS
Which of the following is a contraindication to benzodiazepines?
a. Acute alcohol intoxication
b. Acute narrow angle glaucoma
c. Psychosis
d. All the above - CORRECT-ANSWERSa. Acute alcohol intoxication
A 27-year-old P1G1 who has had minimal prenatal care delivers a newborn
female infant. Exam reveals a dusky child who appears to be in distress. Her
neck veins are distended and you note an enlarged v wave. She has a
holosystolic murmur. Following echocardiogram, immediate surgery is
recommended. For which of the following conditions was the mother likely
receiving treatment during pregnancy?
A. Depression
B. Hypothyroidism
C. Diabetes
D. Bipolar disorder
E. Hypertension - CORRECT-ANSWERSD. Bipolar disorder. This infant is
suffering from Ebstein's abnomaly, often linked to the use of lithium during
pregnancy. Lithium is commonly used for the treatment of bipolar disorder.
Ebstein's anomaly is one of the major cyanotic heart lesions and is
characterized by apical displacement of the tricuspid valve leaflets,
decreased right ventricular volume, and atrialization of the right ventricle.
The resultant tricuspid regurgitation results in the enlarged v wave.
Echocardiography shows a delayed closure of the displaced tricuspid valve
(tricuspid regurgitation). Ward and Zamorski discuss the risks and benefits of
psychiatric medicines during pregnancy. While patients who have
experiences 2 or more episodes of mania are recommended to continue
lifetime mood stabilizer therapy, lithium, valproic acid, and carbamazepine
are all known teratogens. First trimester lithium exposure is associated with
a tenfold increase in Ebstein's anomaly.
Lleewelllyn et al. review the use of lithium during lactation. Lithium is
excreted in human breast milk and will result in elevated serum levels in
,nursing infants. This can result in electrocardiogram abnormalities and
hypotonia. Breastfeeding is therefore recommended against in women taking
lithium.
Incorrect Answers:
Answer 1: The most common therapy for depression is a serotonin-reuptake
inhibitor. These medications are not associated with Ebstein's anomaly or
other congenital malformations.
Answer 2: Mothers with hyperthyroidism must continue their thyroid
supplementation during pregnancy. This is not associated with Ebstein's
anomaly or other congenital malformations when taken appropriately.
Answer 3: Mothers who are insulin-dependent diabetics must continue
therapy during pregnancy. Insulin requirements can fluctuate during
pregnancy, so careful monitoring is required. Insu
A 4-year-old girl is seen by her pediatrician for developmental delay. One
year prior, the patient was able to ride a tricycle, stack 3 blocks, and speak
in short sentences. Now, she is unable to feed herself and has recently
started to point to objects she wants rather than asking. Physical exam
reveals a well nourished child sitting in a stroller wringing her hands. Vital
signs are normal. The patient's mother reports that her 7-year-old son is
doing well, and that they have no family history of mental retardation or
other cognitive disorders. What is the most likely diagnosis?
A. Angelman Syndrome
B. Rett syndrome
C. Beckwith-Wiedemann Syndrome
D. Prader-Willi Syndrome
E. McCune-Albright Syndrome - CORRECT-ANSWERSB. Rett syndrome. In this
previously normal female patient with progressive cognitive and motor
decline, the most likely diagnosis is Rett syndrome. Rett syndrome is an X-
linked dominant genetic disorder marked by normal development until the
age of 4 with progressive verbal and motor decline. In males, the genetic
defect is incompatible with life. Stereotypic behavior such as hand-wringing
is often seen. The disease can inherited from an unaffected mother as a
result of X-inactivation, or as a de novo mutation.
Incorrect Answers:
Answer 1: Angelman syndrome is a genetic disease caused by disruption of
the maternally expressed UBE3A allele combined with a paternally imprinted
(turned off) chromosome 15. Symptoms include severe cognitive disability,
frequent seizures, ataxia, speech impairment, hyperactivity, and
inappropriate laughter.
Answer 3: Beckwith-Wiedemann syndrome is an autosomal dominant
disorder caused by a deletion on chromosome 11 marked by Wilms' tumors,
hemihypertrophy of body, and organomegaly.
,Answer 4: Prader-Willi syndrome is a genetic disease caused by disruption of
the paternally expressed UBE3A allele combined with a maternally imprinted
(turned off) chromosome 15. Symptoms include mental retardation,
hyperphagia, hypogonadism, neonatal hypotonia, and behavior problems.
Answer 5: McCune-Albright syndrome is an post-zygotic genetic disorder
defined by the presence of café au lait spots, fibrous dysplasia, multiple
endocrine abnormalities including precocious puberty, and renal phosphate
wasting.
A 59-year-old man presents to the emergency room with shortness of breath
and swelling of his feet and legs. He denies any past medical problems,
surgeries, medications, or illicit drug use. He reports drinking a few beers
each night. He is diagnosed with a first episode of congestive heart failure
and is admitted to the hospital. The next day, the nurse notices that his
hands are shaky when he extends his arms. The patient says that he couldn't
sleep the night before and that he feels restless, anxious, and slightly
nauseated. On the second night of admission the patient becomes agitated.
He is disoriented, cannot remember where he is, and appears globally
confused. His pulse is 125/min, blood pressure is 170/110 mmHg, and
temperature is 101.7°F (38.7°C). He is diaphoretic and his hands are shaking
at rest. He cries out in fear reporting voices whispering in his room and
strange shadows passing over the walls. What - CORRECT-ANSWERSC.
benzodiazepines. The patient is suffering from severe alcohol withdrawal
after several days of hospital admission. Benzodiazepines are the
cornerstone of therapy to prevent further deterioration in these patients. The
patient's alcohol history is the most important clue in this clinical vignette.
Without knowledge of the drinking history, there are many different
etiologies that could predispose a patient to experience delirium including
infection or electrolyte abnormalities. However, the patient's report of daily
drinking should raise suspicion for alcoholism, especially because many
patients underestimate or underreport their alcohol intake. The onset of his
symptoms is an important clue as alcohol withdrawal typically begins 48-72
hours after the last drink. In patients who suffer from alcoholism, chronic
ethanol use affects several neurotransmitter systems in the brain. Ethanol
stimulates GABA receptors and, over time, GABA receptor expression is
reduced due to this hyperactivation. As a result, when ethanol consumption
is abruptly discontinued, there is insufficient inhibitory activity in the brain
leading to an imbalance and overactivity of norepinephrine, glutamate, and
dopamine. Similarly, ethanol is an NMDA receptor antagonist and sudden
discontinuation leads to increased activity of these excitatory
neuroreceptors. This results in autonomic hyperactivity which manifests as
tachycardia, hypertension, hyperthermia, diaphoresis, agitation,
hallucinations, tremors and seizures. In severe causes it can lead to
cardiovascular collapse. Benzodiazepines stimulate GABA receptors and
restore inhibitory neurotransmitter activity.
, Incorrect Answers:
Answer 1: Flumazenil is not indicated to treat alcohol withdrawal. It is a GABA
receptor antagonist for benzodiazepine overdose treatment.
Answer 2: Naloxone is used to
A 38-year-old male presents for counseling by a psychologist mandated by
the court. The patient explains that he does not mean to hit his wife when
they are arguing, but something just comes over him that he cannot control.
Upon further discussion, the patient reveals that his father was incarcerated
several times for physically abusing his mother. Which of the following best
describes the behavior seen in this patient?
A. Acting out
B. Dissociation
C. Identification
D. Reaction formation
E. Splitting - CORRECT-ANSWERSC. Identification. The male, who has seen
his father physically abuse his mother, also begins to abuse his own wife.
The male is displaying the immature ego defense of identification.Ego
defenses are unconscious processes that prevent undesirable feelings such
as anxiety or depression. Ego defenses are divided into two categories -
immature (more primitive) and mature (less primitive). In the scenario
above, the male is displaying identification which is an immature ego
defense. Identification is when an individual imitates the behavior (good or
bad) of a more powerful person. Finzi et al. review the ego defenses amongst
children that are abused, neglected, and non-maltreated. They found that
children who were abused and neglected as compared to
non-abused/neglected children scored higher for ego defenses for
regression, denial, splitting, and projection. Levit examined the differences in
ego defenses between gender in adolescent teens by surveying 56 high
school students (31 males and 25 females) using the Berm Sex Role
Inventory and Defense Mechanism Inventory. The study found that males
scored higher on projection and aggression defenses; whereas, the females
scored higher on "turning against the self" defense.
Incorrect Answers:
Answer 1: Acting out is an immature ego defense where one uses actions to
express unacceptable feelings and thoughts.
Answer 2: Dissociation is an immature ego defense when there is a
temporary drastic change in behavior in an individual.
Answer 4: Reaction formation is an immature ego defense such that one
replaces an unwanted idea of feeling with its opposite.
Answer 5: Splitting is an immature ego defense such that one believes that
people are either all good or all bad.
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