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AANP FNP: Adult > Psych > Flashcards

Psych Flashcards

(58 cards)

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1
Q

Diagnosis of depression requires 5 symptoms including one of the following:

A

depressed mood

anhedonia

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2
Q

Labs to work up depression include…

A

TSH

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3
Q

Categories of feelings

A

mad, sad, glad, afraid, ashamed

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4
Q

Stages of grief

A

Denial, anger, bargaining, depression, acceptance

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5
Q

Management of depression

A

psychotherapy

possible antidepressants- SSRIs, lesser used TCAs and MAOIs

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6
Q

Seratonin syndrome presents with

A

high fever

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7
Q

Risks of MAOIs

A

wine + cheese = hypertensive crisis

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8
Q

Risk of TCAs

A

anticholinergic effects such as dry mouth and constipation

prolonged QT

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9
Q

dysthymia

A

chronic form of depression lasting at least 2 years, often since childhood

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10
Q

Anxiety: definition

A

unpleasant feeling of dread, aprehension, or tension resulting from an unexpected threat to one’s feeling of self esteem or well being

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11
Q

Generalized anxiety disorder

A

excessive worry/anxiety about life circumstances

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12
Q

Panic disorder

A

morbid dread of seemingly harmless object/situation; may lead to agoraphobia

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13
Q

Obsessive compulsive disorder

A

repetitive thoughts that a person is unable to control and/or urge to perform a task that cannot be resisted which interferes with normal ADLs

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14
Q

Post traumatic stress disorder

A

anxiety for at least 6 months after a severe trauma, characterized by flashbacks, nightmares, and intrusive thoughts

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15
Q

Labs to check for anxiety disorders

A

TSH, serum drug analyses, glucose, EKG

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16
Q

Management of anxiety

A

Cognitive behavioral therapy

Anti-anxiety medications- benzodiazepines, antihistamines, beta blockers, TCAs and MAOIs, buspirone (Buspar)

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17
Q

Suicide: incidence

A
  • increased risk in adolescents and white males >45 years old (especially with sudden loss of partner)
  • mental or substance abuse disorders account for >90percent of all suicides
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18
Q

Suicide screening test, “SUICIDAL”

A 
Sex
Unsuccessful attempts
Identified family members with attempt history
CI- chronic illness history
Depression, drug abuse, drinking
Age
Lethal method available
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19
Q

“CAGE” pneumonic

A

C- Have you ever felt the need to cut down on your drinking?
A- Have people annoyed you by criticizing your drinking?
G- Have you ever felt guilty about your drinking?
E- Have you ever had a drink first thing in the morning?

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20
Q

Who diagnoses alcoholism?

A

The patient has to say they have alcoholism

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21
Q

Rule out other diseases with dementia diagnosis

A 
Drug reactions/interactions
Emotional disorders
Metabolic/endocrine disorders
Eye/ear disorders
Nutritional problems
Tumors
Infection
Arteriosclerosis
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22
Q

Alzheimer’s disease is characterized as:

A 
memory impairment + one of the following:
aphasia
apraxia
agnosia
inability to plan, organize, sequence
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23
Q

aphasia

A

difficulty with speech

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24
Q

apraxia

Study These Flashcards
A

inability to perform a previously learned task

25
agnosia
inability to recognize an object
26
What is the cause of Alzheimer's?
Acetylcholine deficiency
27
Management of Alzheimer's
Neuro consult Meds to increase the availability of acetylcholine Donepezil (Aricept) Galantamine (Razadyne) Rivastigmine (Exelon) May be prescribed in conjunction with NMDA receptor agonists such as Namenda (memantine)
28
What is the cerebellum responsible for?
balance and coordination
29
Romberg test
Evaluates cerebellar function Feet together, eyes closed, arms at sides Positive Romberg if patient has a loss of balance
30
Finger to nose test
Evaluates cerebellar function | Patient alternately points from his nose to the examiner's finger
31
Heel to shin test
Evaluates cerebellar function | Run heel of foot along the shin of the opposite leg
32
Cranial Nerves
``` S CN I: Olfactory S CN II: Optic M CN III: Oculomotor M CN IV: Trochlear B CN V: Trigeminal M CN VI: Abducens B CN VII: Facial S CN VIII: Acoustic/ Vestibular B CN IX: Glossopharyngeal B CN X: Vagus M CN XI: Spinal accessory M CN XII: Hypoglossal ```
33
What is the most important history item when evaluating headache?
Chronology
34
Tension headache
``` 90 percent of all headaches vise-like, tight generalized, often worse in neck or back of head usually last several hours treat with OTC analgesics, relaxation ```
35
Migraine headache
Classic (with aura) and common (without aura) Related to dilation and pulsation of branches of external carotid Typically last 2-72 hours, trigeminal nerve pathway onset in adolescence or early adulthood, females > males assoc with triggers (smells, menses, alcohol, sleep problem, missed meals, oral contraceptives, nitrates in food, weather changes) unilateral, dull or throbbing, may have neurological disturbances
36
Treatment of migraines
Avoidance of triggers Relaxation/stress management ASA/triptans for acute attack Prophylactic therapy if more than 2-3x/month: amitryptyline, depakote, propranolol, verapamil, clonidine, topamax, gabapentin, magnesium
37
Cluster headaches
mostly affecting middle aged men may be preceded by alcohol intake severe, unilateral, periorbital, occurs daily for several weeks may occur at night/awaken patient last less than 2 hours; pain free for weeks-months between attacks ipsilateral congestion, rhinorrhea, eye redness Tx: Triptans, inhalation of 100 percent oxygen
38
How long do TIA symptoms last?
Less than 24 hours, but if more than 3 hours, it is more likely to turn into a stroke.
39
What is hemiopia?
loss of half of visual field
40
TIA classifications
1. Vertebrobasilar | 2. Carotid
41
Lab/Dx for TIA
CT, MRI, CTA | echo, carotid US
42
Treatment of TIA
Aspirin, Plavix Assess for hypertension Carotid endarterectomy if indicated
43
When is carotid endarterectomy indicated?
Stenosis >70 to 80 percent in symptomatic patients
44
What is the #1 cause of heart failure?
Hypertension
45
Partial seizure: Simple
No loss of consciousness | Usually
46
Partial seizure: complex
any simple partial seizure followed by impaired level of consciousness
47
Generalized seizure: absence (petit mal)
Blank stare Usually discovered in children/adolescents Begin and end suddenly
48
Generalized seizures: tonic clonic (grand mal)
``` may have aura tonic contractions, loss of consciousness, then clonic contractions usually lasts 2-5 minutes incontinence may occur followed by postictal period ```
49
Status epilepticus
Series of grand mal seizures of >10 minutes duration medical emergency patient never regains consciousness between seizures uncommon, but can be life threatening
50
Seizure management
CT scan, EEG during seizure: maintain open airway, benzodiazepines anti-seizure meds should be tapered and never abruptly withdrawn
51
Parkinsons
Dopamine deficiency Onset usually between 45 and 65 years old S/sx: tremor, rigidity, bradykinesia, Myerson's sign
52
Myerson's sign
repetitive tapping over bridge of nose produces a sustained blink response signifies Parkinsons disease
53
Management of Parkinsons
Increasing dopamine (trouble standing/getting up) - carbidopa levodopa Anticholinergics (tremor/rigidity) - benztropine (Cogentin)
54
Myasthenia Gravis
autoimmune, reduction in number of acetylcholine receptor sites predominant in women 20-40 years old Sx: weakness worse after exercise and better after rest, ptosis (droopy eyelid), diplopia, dysarthria, dysphagia, extremity weakness, fatigue, respiratory difficulty, DTRs are NORMAL Dx: antibodies to acetylcholine receptors Tx: neurology referral
55
Multiple sclerosis
autoimmune, body attacks myelin predominant in white women 20-50 years old Sx: numbness, weakness, loss of muscle coordination, problems with vision, speech and bladder control, diplopia, disequilibrium Dx: slightly elevated protein in CSF on lumbar puncture, MRI of brain Tx: refer to neurology
56
Bell's palsy
affects cranial nerve VII, facial nerve idiopathic, but may be related to herpes virus reactivation abrupt onset of facial paresis may be accompanied by pain around the eye UNABLE to move forehead (stroke patients CAN move forehead) Tx: prednisone taper, Acyclovir if zoster infection suspected, lubricating eye drops and patch at night if unable to close, neurology referral as needed
57
What differentiates stroke and Bell's palsy facial paralysis?
Stroke CAN move forehead | Bell's palsy CAN'T move forehead
58
Trigeminal neuralgia
affects cranial nerve V, trigeminal electric-shock-like pains in parts of the face (unilateral) causes: MS, or pressure on the trigeminal nerve from swollen blood vessel or tumor Dx: neuro exam, MRI, trigeminal reflex testing Tx: antiseizure drugs, muscle relaxants, TCAs

AANP FNP: Adult (14 decks)

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