LMR GEORGETTE’S PMHNP EXAM SCRIPT 2026/2027
QUESTIONS AND SOLUTIONS RATED A+
✔✔When should you discontinue Clozaril or Tegretol? - ✔✔WBC < 2000 or ANC <1000
✔✔What should you check in Asian patients taking Tegretol? - ✔✔For the HLA-B*1502
allele (higher risk of SJS)
✔✔What two epidermal issues can arise from Tegretol or Lamictal? - ✔✔Toxic
epidermal necrosis and SJS
✔✔What may be the issue if a patient on Lamictal presents with a fever and severe
headache? - ✔✔Aspetic meningitis
✔✔What three antipsychotics have very low weight gaining effects? - ✔✔Geodon,
Abilify, and Latuda
✔✔Mini-Cog - ✔✔3 word recall and
clock drawing
✔✔MMSE scoring - ✔✔24-30 severe impairment
18-23 mild impairment
17 and less no impairment
✔✔What happens during pruning? - ✔✔Brain eliminates extra synapses during infancy
✔✔autism and pruning - ✔✔Excess synapses caused by under-pruning (patient
oversensitive to light/sounds and seizures)
✔✔schizophrenia and pruning - ✔✔Fewer synapses caused by over-pruning
✔✔grey matter vs white matter - ✔✔Grey matter- synapses, working area of brain,
dendrites
White matter- myelinated axons
✔✔axons and dendrites - ✔✔axon away from cell and dendrites to neuron's cell body
✔✔CNS is made up of - ✔✔brain and spinal cord
✔✔PNS consists of - ✔✔cranial nerves and spinal nerves- responsible for voluntary
movement
✔✔somatic nervous system - ✔✔the division of the peripheral nervous system that
controls the body's skeletal muscles
,✔✔autonomic nervous system - ✔✔the part of the peripheral nervous system that
controls the glands and the muscles of the internal organs
✔✔parasympathetic nervous system - ✔✔the division of the autonomic nervous system
that calms the body, conserving its energy
✔✔sympathetic nervous system - ✔✔the division of the autonomic nervous system that
arouses the body, mobilizing its energy in stressful situations
✔✔prefrontal cortex - ✔✔part of frontal lobe responsible for thinking, planning, and
language
✔✔What part of the brain is responsible for perception of pain? - ✔✔Prefrontal cortex-
Explains TMS
✔✔What is the dorsolateral prefrontal cortex responsible for? - ✔✔Executive
functioning- undergoes maturation until adulthood
✔✔orbitofrontal cortex - ✔✔a region of the brain that controls impulses and attention
(ADHD explained)
✔✔frontal lobe - ✔✔associated with reasoning, planning, parts of speech (Broca-
forming), movement, emotions, and problem solving
✔✔parietal lobe - ✔✔A region of the cerebral cortex whose functions include memory,
attention, perception, cognition, taste, and reading/writing
✔✔occipital lobe - ✔✔A region of the cerebral cortex that processes visual information
✔✔temporal lobe - ✔✔A region of the cerebral cortex responsible for hearing, agnosia,
and language (Wernicke's area-receptive speech)
✔✔Issues with what lobe can lead to visual/auditory hallucinations? - ✔✔Temporal
✔✔How does the amygdala work? - ✔✔Sends signal to hypothalamus when in distress,
which then communicates to the rest of the body through the nervous system
✔✔anterior cingulate cortex - ✔✔critical for stress; implicated in childhood trauma
✔✔basal ganglia - ✔✔directs intentional movements and is also called the corpus
striatum
✔✔Hypothalamus - ✔✔brain region controlling appetite, sleep, libido, heart rate
, ✔✔Hippocampus - ✔✔A neural center located in the limbic system that helps process
explicit memories for storage.
✔✔mesolimbic pathway - ✔✔positive symptoms of schizophrenia due to increased
dopamine
✔✔mesocortical pathway - ✔✔negative symptoms of schizophrenia due to decreased
dopamine
✔✔Nigrostriatal pathway - ✔✔EPS with increased acetylcholine and decreased
dopamine
✔✔Tuberoinfundibular pathway - ✔✔decreased dopamine causes increased prolactin
levels
✔✔Monoamines - ✔✔dopamine, norepinephrine, serotonin, epinephrine
✔✔amino acids - ✔✔Glutamate and GABA
✔✔Cholinergic - ✔✔acetylcholine and neuropeptides
✔✔Brain Changes in Alzheimer's Disease - ✔✔amyloid plaques and neurofibrillary
tangles
✔✔Increased and decreased acetylcholine - ✔✔Increased- parkinson's
Decreased-alzheimers
✔✔Where is Norepinephrine produced? - ✔✔locus coeruleus
✔✔Where is serotonin produced? - ✔✔raphe nuclei
✔✔Where is epinephrine produced? - ✔✔adrenal glands
✔✔Where is dopamine produced? - ✔✔substantia nigra and ventral tegmental area
✔✔Where is GABA synthesized? - ✔✔limbic system
✔✔s/s of acute dystonia - ✔✔Severe spasm of the tongue, neck, eyes, face and back;
laryngeal spasms (mutism)
✔✔Akathisia - ✔✔motor restlessness
QUESTIONS AND SOLUTIONS RATED A+
✔✔When should you discontinue Clozaril or Tegretol? - ✔✔WBC < 2000 or ANC <1000
✔✔What should you check in Asian patients taking Tegretol? - ✔✔For the HLA-B*1502
allele (higher risk of SJS)
✔✔What two epidermal issues can arise from Tegretol or Lamictal? - ✔✔Toxic
epidermal necrosis and SJS
✔✔What may be the issue if a patient on Lamictal presents with a fever and severe
headache? - ✔✔Aspetic meningitis
✔✔What three antipsychotics have very low weight gaining effects? - ✔✔Geodon,
Abilify, and Latuda
✔✔Mini-Cog - ✔✔3 word recall and
clock drawing
✔✔MMSE scoring - ✔✔24-30 severe impairment
18-23 mild impairment
17 and less no impairment
✔✔What happens during pruning? - ✔✔Brain eliminates extra synapses during infancy
✔✔autism and pruning - ✔✔Excess synapses caused by under-pruning (patient
oversensitive to light/sounds and seizures)
✔✔schizophrenia and pruning - ✔✔Fewer synapses caused by over-pruning
✔✔grey matter vs white matter - ✔✔Grey matter- synapses, working area of brain,
dendrites
White matter- myelinated axons
✔✔axons and dendrites - ✔✔axon away from cell and dendrites to neuron's cell body
✔✔CNS is made up of - ✔✔brain and spinal cord
✔✔PNS consists of - ✔✔cranial nerves and spinal nerves- responsible for voluntary
movement
✔✔somatic nervous system - ✔✔the division of the peripheral nervous system that
controls the body's skeletal muscles
,✔✔autonomic nervous system - ✔✔the part of the peripheral nervous system that
controls the glands and the muscles of the internal organs
✔✔parasympathetic nervous system - ✔✔the division of the autonomic nervous system
that calms the body, conserving its energy
✔✔sympathetic nervous system - ✔✔the division of the autonomic nervous system that
arouses the body, mobilizing its energy in stressful situations
✔✔prefrontal cortex - ✔✔part of frontal lobe responsible for thinking, planning, and
language
✔✔What part of the brain is responsible for perception of pain? - ✔✔Prefrontal cortex-
Explains TMS
✔✔What is the dorsolateral prefrontal cortex responsible for? - ✔✔Executive
functioning- undergoes maturation until adulthood
✔✔orbitofrontal cortex - ✔✔a region of the brain that controls impulses and attention
(ADHD explained)
✔✔frontal lobe - ✔✔associated with reasoning, planning, parts of speech (Broca-
forming), movement, emotions, and problem solving
✔✔parietal lobe - ✔✔A region of the cerebral cortex whose functions include memory,
attention, perception, cognition, taste, and reading/writing
✔✔occipital lobe - ✔✔A region of the cerebral cortex that processes visual information
✔✔temporal lobe - ✔✔A region of the cerebral cortex responsible for hearing, agnosia,
and language (Wernicke's area-receptive speech)
✔✔Issues with what lobe can lead to visual/auditory hallucinations? - ✔✔Temporal
✔✔How does the amygdala work? - ✔✔Sends signal to hypothalamus when in distress,
which then communicates to the rest of the body through the nervous system
✔✔anterior cingulate cortex - ✔✔critical for stress; implicated in childhood trauma
✔✔basal ganglia - ✔✔directs intentional movements and is also called the corpus
striatum
✔✔Hypothalamus - ✔✔brain region controlling appetite, sleep, libido, heart rate
, ✔✔Hippocampus - ✔✔A neural center located in the limbic system that helps process
explicit memories for storage.
✔✔mesolimbic pathway - ✔✔positive symptoms of schizophrenia due to increased
dopamine
✔✔mesocortical pathway - ✔✔negative symptoms of schizophrenia due to decreased
dopamine
✔✔Nigrostriatal pathway - ✔✔EPS with increased acetylcholine and decreased
dopamine
✔✔Tuberoinfundibular pathway - ✔✔decreased dopamine causes increased prolactin
levels
✔✔Monoamines - ✔✔dopamine, norepinephrine, serotonin, epinephrine
✔✔amino acids - ✔✔Glutamate and GABA
✔✔Cholinergic - ✔✔acetylcholine and neuropeptides
✔✔Brain Changes in Alzheimer's Disease - ✔✔amyloid plaques and neurofibrillary
tangles
✔✔Increased and decreased acetylcholine - ✔✔Increased- parkinson's
Decreased-alzheimers
✔✔Where is Norepinephrine produced? - ✔✔locus coeruleus
✔✔Where is serotonin produced? - ✔✔raphe nuclei
✔✔Where is epinephrine produced? - ✔✔adrenal glands
✔✔Where is dopamine produced? - ✔✔substantia nigra and ventral tegmental area
✔✔Where is GABA synthesized? - ✔✔limbic system
✔✔s/s of acute dystonia - ✔✔Severe spasm of the tongue, neck, eyes, face and back;
laryngeal spasms (mutism)
✔✔Akathisia - ✔✔motor restlessness
