Test Bank for PMHNP Boards Exams Questions with 100% Correct Answers

Test Bank for PMHNP Boards Exams Questions with 100% Correct Answers Document Content and Description Below Test Bank for PMHNP Boards Exams Questions with 100% Correct Answers What is true of interprofessionality? - All health professionals have individual professional competencies What is the significance of an experimental p-value of 0.05 - There is a 5% chance of a similar result occurring by chance alone What percentage of children with oppositional defiance disorder will develop conduct disorder? - 30% In the DSM-5, selective mutism is now considered what type of disorder? - anxiety disorder Symptoms of selective mutism must persist for at least - 1 month Common competencies - overlap more than one health care professional, although not necessarily all health care professionals, and are competencies expected of all health care professionals Complementary competencies - enhance the qualities of other professions in provision of care Collaborative competencies - those that each individual profession must possess to work with others, including those who practice within different specialties within a profession. Interpersonal collaboration is _______ centered - patient Cognitive therapy is recommended for patients that have - negative cognitive distortions irrational beliefs faulty conceptionsHumanistic Therapy focuses on assisting patients with - self-actualization and self-directed growth Behavioral Therapy focuses on - changing maladaptive behaviors through the use of behavioral modification techniques Existential therapy is for - reflection on life confronting self 120 who got diarrhea ate lettuce. 80 with diarrhea did not eat lettuce. 40 without diarrhea ate lettuce. 160 without diarrhea ate lettuce. What is the odds ratio of eating lettuce and developing diarrhea? - 6 ((120X160)/(80x40)) The New Freedom Commission on Mental Health (NFCMH) released a report that suggested - implementation a national campaign to reduce the stigma of seeking care Focusing on promoting recovery and building resilience The efficacy of mental health treatments was found to be well documented in - influential report issued by US Surgeon General in 1999 State of high negative emotion and pessimism - neuroticism Commonly known as an optimistic outlook on life They are are outgoing, like social interaction, respond to external rewards, have more active dopamine networks, and are responsive to positive reinforcement. - Extraversion (high levels protect from psychiatric illness) Introverts are more likely to be _______ motivated and more likely to respond to _______ reinforcement - internally negative (more likely to interact with internal motivation/self-image) Interpersonal trait of cooperation, easy going nature. Tend to have smooth relationships often at the expense of self-assertion - AgreeablenessAssociated with self-control and a focused, organized approach to life. Are achievement-oriented goal setters who can delay immediate gratification to obtain their long term desired outcome. They are considered responsible, reliable, and dependable. - conscientiousness In behavioral couples therapy, the initial sessions are spent doing a functional analysis of behavior (FAB). What is true about FAB? - FAB is concerned only with observable stimuli connected to operant behavior FAB is based on operant conditioning (identifying antecedent stimuli, operant behaviors, and consequent stimuli) The goal of FAB is modifying willful operant behavior Gestalt theory deals with _____, not _____ - perceptual psychology behavior Medication that can delay ejaculation in patients with premature ejaculation - Paroxetine (and other SSRIs) (others include: Topical anesthetic Tramadol Phosphodiesterase-5 inhibitors) First line treatment for lithium induced diabetes insipidus - Amiloride (K potassium diuretic) in addition to dc lithium when possible. Ways to reduce polyuria associated with lithium toxicity - reduce lithium dose to minimum effective dose take once daily at night (may be 5-30% lower than when given in divided doses over the day) Encourage adequate fluid intakeWhat is true about ECT in Parkinson's disease - it's more likely to cause transient delirium (worsened dyskinesias induced by l-dopa) Lithium effects with Parkison's disease - may worsen tremor nonselective MAOIs decrease the efficacy of ______ and increase the risk of a __________ - l-dopa products hypertensive crisis Selegiline is selective for - MAO-B (after 10mg there is an increase in risk of serotonin syndrome if given with other meds that increase serotonin) SSRI's can _______ Parkinsonism tremor - worsen (and decrease 'off time') Process describes the mechanism by which the hippocampus stores memories - long-term potentiation loss of memory relating to a particular category of information (inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting) - systematized amnesia Lack of memories from a circumscribed period of time, usually immediately following a traumatic event - localized amnesia Person can recall some but not all of events from a particular time period - selective amnesia Lack of memory of the patient's entire life - generalized amnesia The drugs that are FDA approved for GAD - ParoxetineCitalopram Escitalopram Venlafaxine Duloxetine Buspar A surrogate has the right to terminate pregnancy if - the pregnancy threatens her health or life or she is a genetic parent If the surrogate receives both ovum and sperm from couple, she loses the right to - determine whether or not child will be aborted (this is up to the couple) Which medication is most effective for treating social phobia/social anxiety disorder, especially when refractory? - Phenelzine A 55-year-old female patient has Stg II HTN. On exam, she has trace pedal edema bilaterally, but her lungs are clear. Her ECG reveals 2nd degree heart block. Which of the following BP medications should be avoided? - Calcium Channel Blockers 3 Contraindications to use a calcium channel blocker - 1st or second degree heart block Bradycardia CHF 4 Side effects of calcium channel blockers - Headache Lower extremity edema Bradycardia Heart BlockAn NP is evaluating a 78 year old female with depression. She suspects the patient may have Parkinson's disease. Which of the following is consistent with that diagnosis? - Postural instability Pill-rolling tremor Shuffling Gait Difficulty initiating movement Mask-like facies (difficulty initiating movement) Writhing movements occur with - Huntington's chorea 10 Non-motor manifestations of Parkinsons - Autonomic dysfunction Gastrointestical dysfunction Rhinorrhea Sleep disturbance Fatigue Mood disorder Cognitive dysfunction Dementia Psychosis Hallucinations What type of therapy is most useful in depressed HIV positive outpatients? - Interpersonal psychotherapy What type of therapy is most useful in patients with borderline personality disorder? - Dialectical behavioral therapy The NP is caring for a patient dying of lymphoma. The pt's wife states that the pt has been mismanaged and that another practitioner must be assigned to the patient for him to improve. This NP suspects that this individual is in which stage of grief according to Elizabeth Kugler-Ross? - BargainingInvolves resisting or refusing to remember information that has been supplied - Denial Pica and spoon shaped nails are associated with - Iron-deficiency anemia (microcytic) 2 common causes of microcytic anemia - iron deficiency anemia of inflammation/chronic disease (TB, HIV, endocarditis, RA, Chrohn's DM, kidney disease, CA) (Other causes: lead toxicity, alcohol/drug use, zinc excess (copper deficiency)) Initial symptoms of B12 deficiency - Generalized weakness Paresthesias Possible ataxia Late symptoms of B12 deficiency - Memory impairment Depressed mood 5 P's of Vitamin B12 deficiency - Pancytopenia (Peripheral and Posterior spinal cord) neuropathy Pyramidal tract signs Papillary atrophy of tongue (atrophic glossitis) 2 causes of megaloblastic macrocytic anemias - Vitamin B12 deficiency Folate deficiencyWhat neurotransmitter is thought to play the most significant role in social phobia? - dopamine What neurotransmitter is thought to mediate social interest, gregariousness, confidence and sensitivity to rejection? - dopamine According to Gonzalez-Jaimes and Turnbull-Plaza (2003, which type of therapy with psychocorporal, cognitive, and neurolinguistic components and a holistic focus is significantly more effective in patients diagnosed with adjustment disorder? - mirror psychotherapy The ________ is part of the treatment to encourage a patient to accept his physical condition - mirror Discussing medical diagnoses and the reaction to it, as well as treatment modalities - medical conversation Therapy that emphasizes personal responsibility, focusing on the individual's experience at the present moment, the therapist-patient relationship, the context of the person's life, and adjustments people make as a result of their overall situation - Gestalt Therapy PANDAs is associated with _________ infections and results in _______ symptoms - Group A betahemolytic strep OCD After camping trip, pt began to have a petechial rash on her legs/trunk, parts of which are turning dark red and purple, temp 102.8, HR 1115, BP 88/50, mm pain, neck stiffness, severe HA. What is the dx? - meningococcemia 1 mg of Xanax = _____ mg of Ativan - 2 1mg of Xanax = ____mg of phenobarbital - 30 1mg Xanax = ____ mg of Clonazepam (Klonopin) - 11mg Xanax = ____ mg of chlordiazepoxide (Librium) - 25 1mg of Xanax = ____ mg of diazepam (Valium) - 10 Pt wanting something immediate and non-addictive for breakthrough anxiety - Hydroxyzine How long do GAD symptoms need to occur to make the diagnosis? - 6 months First lab test to check for Sjogren's - Anti-nuclear antibody tests To diagnose Cyclothymic disorder, it must be present for _______ in adults - 2 years To diagnose Cyclothymic disorder, it must be present for _______ in pediatrics - 1 year 4 physiological disturbances that may explain some of the symptoms of panic - impaired lactate metabolism abnormality of locus coeruleus (Ser, NE, GABA, Dop, cholecystokinin) carbon dioxide hypersensitivity (hyperventilation) A 45-year-old man presents to the ER for "panic attack". He appears agitated, confused, and dizzy. He became more agitated and combative with staff upon further questioning. He states he was prescribed Xanax 0.5mg 3x daily by outpatient psychiatrist. His vitals are WNL. What is most likely his dx - Benzodiazepine intoxication Anxiety, tremors, nightmares, insomnia, anorexia, nausea, vomiting, hypotension, seizures, delirium and hyperprexia are sx of. ______ which can result in _______ - Benzodiazepine withdrawal (serious medical complications including death) Confusion, AH, VH following a period of insomnia can be a sx of - withdrawal deliriumFemale patients with PTSD commonly have this comorbid diagnoses - Major depressive disorder (50%) Percentage of people with PTSD who have alcohol use disorder - male 50% female 27% Percentage of people with PTSD who have simple or social phobias - 30% both male and female Percentage of people with PTSD who have persistent depressive disorder ( previously dysthymia) - 20% for both male and female Treatment plan for OCD - SSRI or Clomipramine Psychotherapy Normal Rinne test is for this nerve - CN VIII What ethnic groups are at higher risk for social phobia - Native American What ethnic groups are at lower risk for social phobia - Asian Black Latino Onset of social phobia is - Usually begins in late adolescence or early adulthood (13-20 years) 3 CBT techniques for social phobias - exposure cognitive restructuring social skills trainingMedication used to help with social phobia for public speaking - propranolol FDA approved SSRI for social phobia - paroxetine What type of fracture is a red flag for child abuse? - Spiral of long bone (caused by twisting of extremity) Bruises on the torso in different stages of healing often indicate - abuse Tanner Stage: Breast buds undeveloped with papilla elevation only. Villus hair only - I Tanner Stage: Breast buds palpable, straight pubic hair mostly on labia - II Tanner Stage: Areola begins to enlarge and pubic hair becomes darker, coarser, and curly - III Tanner Stage: Areola forms a secondary mound on the breast and hair is of adult quality - IV Tenderness at McBurney's point is suggestive of - appendicitis About 30% of patients with this disorder have OCD thoughts - Tourette's disorder Rx that can cause anxiety - Steroids (prednisone) Albuterol Amphetamines Appetite suppressants Medical conditions that can cause anxiety - Adrenal tumors Alcohol use disorderHypoglycemia Hyperthyroidism Cushing's disease Arrhythmias Parathyroid Tumors Some types of seizures Depression screening tool used specifically for pregnancy and postpartum - Edinburg Depression Scale How long do symptoms have to be present to diagnose PTSD - 1 month Lab value that would indicate that parathyroid was removed during thyroidectomy - Low Calcium For PCOS, which medication will help with hirsutism? - Spironolactone Lab that is an indicator of inflammation - C-reactive protein Pain medication that inhibitis serotonin and NE reuptake (risk of serotonin syndrome if also on antidepressants) - Tramadol an over-the-counter nonnarcotic drug found in cough preparations which inhibits serotonin reuptake and could cause serotonin syndrome in patients on SSRI's - Dextromethorphan (Delsym) Pre-cursor for Serotonin production - L-tryptophan In panic disorder, 1 of the attacks is followed by at least ______ of persistent worry about having additional attacks, worry about implications of attacks or its consequences, or significant change in behavior related to attacks. - 1 monthThe origins of panic disorder include - childhood trauma With delayed onset of PTSD, how much time must have past from trauma to onset of symptoms - 6 months First line medication for polymyalgia rheumatica - oral prednisone Acute stress disorder is diagnosed if the characteristic symptoms present within what period of time after experiencing the traumatic event? - 1 month In what Tanner's stage will a male's penis grow more in length than width - III In what Tanner's stage will a male's scrotum begins to grow and redden. Where pubic hair will be straight, fine and sparse - II In what Tanner's stage will a male's pubic hair look more like an adult, but will not cover as much area. Where penis will thicken, testes and scrotum continue to grow. - IV Brain structure R/T development of GAD - Amygdala What circumstance(s) are often correlated to the onset of panic disorder - separation from family serious illness of friend/family accident major relationship loss/change abusing substances postpartum Lifetime prevalence of anxiety disorders in the US - 25-35% (18% prevalence)Buspar needs ______ to have similar efficacy to benzodiazepines - 4 weeks How many panic symptoms must be present for diagnoses. - 4 Part of Brain responsible for smell - Limbic Part of brain (lobe) responsible for visual functions - Occipital Part of brain (lobe) responsible for sensory integration and somatosensory function - Parietal Part of brain (lobe) responsible for executive function, social conduct, judgement, and some motor function - Frontal Occasional crossing of eyes is not normal after the infant is older than ___________ - 2 months If strabismus is left untreated, what may result? - ambylopia (affected eye decrease in vision) What would be the normal testosterone level of a Tanner V male - 265-800 ng/dl Bactrim is contraindicated in - Glucose-6-phosphatase deficiency Folate deficiency anemia patients with significant hepatic impairment pregnant patiens Pt has severe headache behind right eye with eye pain and tearing, sees halos around light fixtures. C/o N/V. R pupil fixed more oval than round, mid-dilated and cloudy. What might be happening - Acute angle closure glaucoma (Emergency) What STD is not reportable in all 50 states - HPVRomberg test is a test of - balance A child will recognize faces and smile appropriately at familiar faces by age ____ - 3 A typical _____ can count up to 20 with minimal assistance of an older child or parent - 4 year old A typical _____ can run/walk up and down the stairs - 21 month old A typical _____ is beginning to acquire language skills - 14 month old What herbal supplement is effective for a pt with an adjustment disorder with anxiety according to RCT - Kava Kava What herbal supplement is effective for somatoform disorders according to RCT - St. John's Wort Recurrent spontaneous episodic vertigo, hearing loss. Must have aural fullness or tinnitis on one size to make dx. - Meniere's Disease ADPIE stands for - Assessment Diagnosis Planning Implementation Evaluation If diagnosed with an adjustment disorder, which dx is most guarded: that of an adult or that of an adolescent? - adolescent (more likely to develop major psychiatric illness) Gastrointestinal lithium toxicity symptoms can overlap with - normal side effects (N/V)What is FDA approved for suicidality in schizophrenia - Clozapine Clozapine can cause this CBC abnormality - leukopenia (agranulocytosis) What is the dependent variable of a study examining the effects of a certain medication on hypertension? - Blood pressure What is the independent variable of a study examining the effects of a certain medication on hypertension? - Medication Effect of a variable that is not controlled - Confounding effect Type of error that results in the way the experiment is conducted, often due to the expectations of the researcher - Bias Pharmacological treatment of alcohol use disorder - Start Naltrexone at 25mg PO daily (1-hour observation for rxn). Naltrexone maintenance dose is usually 50mg PO q day or 380mg IM q 4 weeks Naltrexone side effects - Elevated LFTs Mild dysthymia GI upset Resembles GABA and is possibly an NMDA antagonist - Acamprosate Aldehyde dehydrogenase inhibitor - Disulfiram (Antabuse) Modest efficacy, may work better in combination with Naltrexone for alcohol use disorder - AcamprosateNo convincing efficacy found for use of this Alcohol Use Disorder pharmacological treatment - Disulfiram (Antabuse) Most commonly reported side effect of ECT - Retrograde amnesia Neurodevelopmental disorder of biological origin that manifests in learning difficulties and problems in acquiring academic skills markedly below age level and manifested in the early years for at least 6 months that is not attributed to intellectual disabilities, development disorders or neurological or motor disorders - Specific Learning Disorder Specific Learning Disorders can be specified as impairment in - Reading Written Expression Mathematics The MOST important component when developing evidence based guidelines - An evidence review How does botox improve depression? - Reducing frown lines when injected into glabellar region According to a study in the 1990s mothers of anorexic pts have an increased prevalence of this disorder - Obsessive-compulsive disorder The AST:ALT ratio in patients with Alcoholic liver disease - 0.8 1.5 Liver biopsy reveals fibrosis, necrosis of liver cells, and nodule formation - Liver cirrhosis Acute condition with nystagmus, ataxia, confusion, and opthalmoplegia - Wernicke-Korsacoff syndrome Elevated bilirubin level is often found in - Alcoholic hepatitisWhich drug's mechanism of action includes blockage of the voltage dependent sodium channel blockers, augmentation of gamma amino butyrate activity of GABA-A receptors, antagonism of AMPA/kainate subtype of glutamate receptor, and inhibition of carbonic anydrase enzyme? - Topiramate Ex of drugs that are partial agonists at postsynaptic serotonin receptors - Hallucinogens like LSD and MDMA Drug associated with inhibition of catecholamine reuptake in neurons and blockage of NMDA glutamate receptors - PCP Individuals with panic disorder are most commonly affected by which other psychiatric disorder - Agoraphobia When is the use of transdermal selegiline not beneficial? - For patients with pheochromocytoma (excess NE can cause HTN crisis) and with planned surgery (need to dc patch for 10 days prior to elective surgery) Responsible for the catabolism of serotonin, norepinephrine and dopamine - Monoamine oxidase (MAO) Medication that is an irreversible MAO inhibitor that works by selectively inhibiting both MAO-A and MAO-B in the CNS with preservation of MAO-A in the gut. Unless high dosed, little need to follow tyramine restricted diet. - Selegiline Adverse effect of carbamazepine that can be an emergency - hyponatremia toxic epidermal necrolysis Erythema multiform Steven's Johnson Thrombocytopenia Aplastic Anemia AgranulocytosisSLE arrhythmias Hepatitis An NP advises a patient with a significant family hx of breast cancer to perform monthly selfexaminations. What term helps to identify this measure? - Secondary Prevention Prevention type designed for early detection of a disease so that morbidity and mortality may be reduced - Secondary Prevention Preventing the disease or condition from occurring - Primary Prevention WIC and promotion of workplace safety laws designated by OSHA are this type of prevention - Primary Prevention Rehabilitation and prevention of complications of disease - Tertiary prevention A support group for a disease or condition is this type of prevention - Tertiary Prevention Exercise for an obese patient is this type of prevention - Tertiary Antisocial personality disorder criteria must show a pattern of disregard of others since age ______ - 15 How many criteria does a pt who meets criteria for an Antisocial personality disorder have to have - 3 of 7 Name the 7 criteria that pts with Antisocial personality disorder have (must meet 3 of them) - Breaking the law Deceitfulness for personal profit or pleasureImpulsivity/failure to plan ahead Aggressiveness/Irritability (physical fights/assaults) Reckless disregard for safety of self or others Consistent irresponsibility Lack of remorse How old does an individual need to be in order to be diagnosed with antisocial personality disorder? - 18 years The occurrence of antisocial behavior is not exclusively during the course of - schizophrenia bipolar disorder What is a precursor for antisocial personality disorder - conduct disorder List of Cluster B personality disorders - antisocial borderline histrionic narcissistic List the cluster A personality disorders - paranoid schizoid schizotypal List of Cluster C personality disorders - avoidant dependent obsessive-compulsive pervasive pattern of excessive emotionality and attention seeking beginning in early adulthood and present in a variety of contexts - Histrionic Personality DisorderA pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness must last at least _______ for Oppositional Defiant Disorder diagnosis - 6 months Oppositional defiant disorder does not include: - aggression toward people or animals destruction of property pattern of theft or deceit Recurrent behavioral outburst representing a failure to control aggressive impulses. - Intermittent Explosive Disorder In Intermittent Explosive disorder, physical aggression does not result in - damage or destruction to property physical injury to animals or other individuals Kubler-Ross's stages of grief - denial anger bargaining depression/sadness acceptance Symptoms can be associated with another medical condition - Somatic symptom disorder Somatic symptom disorder symptoms persist for - 6 months Despite frequent doctors visits and tests, this pt is rarely reassured and can feel that his/her medical care is insufficient - Somatic symptom disorderIn order to meet DSM V criteria for somatic symptom disorder, in addition to somatic symptoms, pts must have - maladaptive thoughts, feelings, and behaviors that define the disorder, in addition to their somatic symptoms. The Mental Health Party Act (1996) provides - equal lifetime and annual limits for mental health care as compared to physical health care. The zoster vaccination is recommended for _____ - adults over the age of 60 The pneumococcal vaccination is recommended for _______ - adults over the age of 65 The Tdap vaccination is recommended _________ - every 10 years Understanding the objective reality of a situation coupled with the motivation and emotional impetus to master the situation or change behavior is: - true insight Form of thinking that is logical, organized, reality oriented, and influenced by the demands of the environment - second process thinking What percentage of the population meets the criteria for 1 or more personality disorders? - 15% Study on daily exercise improving sleep quality in seniors. What is the dependent variable - Sleep quality The federal law that allows parents to provide insurance coverage for their children up to age 26 is - Affordable Care Act (ACA) Pedophiles attracted to female victims usually prefer females of what age? - 8-10 years old What is true of appropriation bills? - They provide for spending authority for a single fiscal yearWhat bills establish laws or programs and although they recommend dollar amounts in some cases, do not allocate the funds or guarantee funds for the program - Authorization bills What bills usually originate in the House of Representatives and provide spending authority for a single fiscal year - Appropriation Bills Provide additional funding for projects as needed thought the current fiscal years - Supplemental appropriations Authorization bills are funded by - Appropriation Bills What is required for entry to practice as a Nurse Practitioner - Competency in nine content domains The NP is caring for a 16 year old who is depressed with suicidal ideation. The pt asked the nurse NOT to tell her parents. The most appropriate intervention for the nurse to do is: - Talk to parents and pt together to help the family discuss the pt's depression According to Mahler, which of the following stages of infant development is disrupted in children who develop borderline personality disorder - Rapproachment According to Mahler, which of the following stages of development was disrupted int children who developed narcissistic personality disorder - Symbiotic phase Phase during first weeks of life, characterized by total detachment and self-absorption, infant spends most of his or her time sleeping - Autistic stage When does the symbiotic phase occur - about 5 months of age According to Mahler, separation-individuation has 3 stages - Hatching (5-9 months) Practicing (9-16 months)Rapproachment (15-24 months) Phase where infant explores the outside world but requires that the mother is present and able to support the child appropriately and emotionally in completing the task? - Rapprochment (15-24 months) Phase in which infant develops the physical ability to separate from mother - Practicing (9-16 months) Disturbance of the rapprochement subphrase is associated with - persistent longing for and dread of fusion with object that is thought to be secondary to aggression or withdrawal in the mother. Thought to contribute to the development of borderline personality disorder. Phase in which infant shows increased interest in outside world - Hatching Stage where infant recognizes his or her mother but lacks a sense of individuality - symbiotic Narcissistic personality disorders are likely due to - inadequate soothing during the symbiotic phase and inadequate refueling during the separation-individuation Describes the child's understanding that his or her mother is a separate individual and he or she is also separate - Object constancy Object constancy leads to the formation of - internalization, which will allow the child to have an internal representation of mother in turn allowing healthy separation, exploration, and development of self-esteem The three most common causes of secondary obesity - Cushing's syndrome Hypothyroidism Genetic conditionsCompassion, a desire to do good - beneficence Avoidance of harm - Nonmaleficence the equal and fair distribution of resources, regardless of other factors - Justice Dedication, fairness, honesty, advocacy and commitment to patients. It involves an agreement to keep promises and commitments based on the virtue of caring. - Fidelity Most widely used tool for assessing the healthcare safety culture within an organization - Culture of Patient Safety Assessment developed by AHRQ The Iowa Model of EBP (evidence-based practice) is characterized by which statement? - It is important to determine if an identified issue is a priority of the organization The trigger for change can be - Knowledge focused or Problem focused Identification of a problem and determination of its priority - first step in Iowa Model Review and critique of available literature - Second step in Iowa Model Identification of research evidence to support a change in clinical practice - 3rd stage of Iowa Model Implementation of change - 4th step of Iowa Model Monitoring of Outcomes - 5th and final step of Iowa Model Knowledge-focused triggers include - new research practice guidelinesProblem-Focused Triggers include - Clinical problems Issues in risk management The first step in getting a bill to the floor is? - Drafting a bill Probability results of study are due to chance - P value Medicare part A coverage includes - 1. hospital care and medicines received in hospital 2. SNF 3. nursing home care 4. hospice 5. home health services Sampling used when the proportion of the study population belonging to each group of interest in known, to obtain an adequate study sample from a small group in the study population. - Stratified sampling Selection of groups under study is random - Cluster sampling Choosing individuals at regular intervals from a sampling frame by selecting a number to determine where to begin selecting individual subjects from a list. - Systematic sampling Making a numbered list of all units in a population from which you want to draw a sample, deciding on the sample size, and selecting the required number of sampling used using a table of random numbers or a lottery method - Simple random sampling What is the prevalence of borderline personality disorder in psychiatry outpatients? - 10% What is the prevalence of borderline personality disorder in psychiatric inpatients - 20%Diagnosis of borderline personality disorder includes 5 or more of the following criteria - frantic avoidance of abandonment unstable relationships disturbance of identity recurrent suicidality unstable mood/affect chronic feelings of emptiness intense bouts of difficult-to-control anger transient paranoia or dissociation Pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation - Avoidant Pervasive pattern of detachment from social relationships and a restricted range of expression - Schizoid Pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent - Paranoid Pervasive pattern of social and interpersonal discomfort with, and reduced capacity for, close relationships as well as cognitive or perceptual distortions and eccentricities - Schizotypical Pervasive pattern of grandiosity, need for admiration, and lack of empathy - Narcissistic Pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation - Dependent The prevalence of borderline personality disorder in primary care - 6%The prevalence of borderline personality disorder in the general population - 1.5-5.9% What best determines the effectiveness of an educational intervention? - Pt's behavior modification and compliance rates After suffering the loss of a child, more than 50% of parent couples go through the following - Divorce Rubbing against non-consenting people - frotteurism Fantasies about watching unsuspecting individuals undressed or in sexual activity - voyeurism Use of non-living objects for sexual stimulation - fettishism Exposing one's genitals to strangers - exhibitionism Besides therapy in Borderline Personality Disorder, impulse behavioral dyscontrol symptoms that present serious risk to patient are treated by adding - an antipsychotic to an SSRI In borderline personality disorder, cognitive-perceptual symptoms respond best to - low dose antipsychotics Impulsive-behavioral dyscontrol symptoms in borderline personality disorder - aggression self-mutilation reckless spending promiscuity substance abuse Affective dysregulation in borderline personality disorder is treated with - SSRI or venlafaxineFor histrionic personality disorder, which type of therapy helps them focus on their unconscious motivations for being unable to commit to a stable and meaningful relationship, and instead seeking out disappointing partners - psychodynamic Temporal lobe abnormalities and differences in the corpus callous and thalamic nuclei have been identified on MRI studies of patients with which condition - schizotypical personality disorder Schizotypical personality disorder can be differentiated from schizophrenia by the absence of - psychotis Prevalence of schizotypical personality - 3% (more cases occur in biological relatives with schizophrenia) Affective aggression can be treated with which medication? - Lithium Which personality disorder is often present with pts with anorexia-nervosa who restrict rather than binge-purge - Obsessive-compulsive A type of identification that is seen often in borderline personality disorder pts - projective identification 3 steps of projective identification - 1. pt assigns component of self to another individual 2. pt manipulates this individual into integrating this component into his or her consciousness 3. process leads to increased feeling of closeness between parties Analyst's emotional response to pt - countertransference When pt tends to identify aspects as either completely good or completely bad about a person - SplittingMental process that gives rise to lack of connection in the pt's thoughts, memory, and sense of identity - Dissociation Substance that is found in lower concentrations in the CSF of impulsive, violent individuals - 5-HIAA In addition to an assessment of pathological personality traits, alternate model in Section III of the DSM- 5 requires an assessment of which category or a personality disorder diagnosis - level of impairment in personality functioning A diagnosis of a personality disorder who require at least a level _______ impairment - 2 ("moderate") What is the prevalence of obsessive-compulsive personality disorder in the general population - 5- 10% Which personality disorder's criteria includes magical thinking - Schizotypical Females with _________ have a virilized clitoris - Congenital adrenal hyperplasia (CAH) A higher degree of ________ has been reported in individuals with CAH, which correlates to the degree of virilization - homosexuality A 2-year old girl with 21-hydroxylase deficiency undergoes genitoplasty. Which statement is true concerning her condition - There is a correlation between virilization degree and gender dysmorphia What is the prevalence of paranoid personality disorder among psychiatric patients? - 10-30% Gender identity usually begins to form by this age - 2 Anti-hypertensive effects on sexuality - impaired vaginal lubrication and erectile dysfunction d/t antiadrenergic effectsSpironolactone effects on sexuality - decreased desire secondary to decreased testosterone Estrogen effects on sexuality - decreased desire secondary to decreased testosterone Steroid effects on sexuality - decreased desire secondary to decreased testosterone TCA effects on sexuality - erectile dysfunction or impaired vaginal lubrication secondary to anticholinergic effects MAOI effects on sexuality - erectile dysfunction or impaired vaginal lubrication secondary to anticholinergic effects Antipsychotics effects on sexuality - erectile dysfunction or impaired vaginal lubrication secondary to anticholinergic effects SSRI effects on sexuality - inhibition of arousal and orgasm by increased serotonergic activity The diagnosis of a personality disorder requires a pattern of inner experience and behavior that deviates from the expectations of the individual's culture in 2 or more of which 4 areas? - cognition affectivity impulse control interpersonal functioning Individual is only aroused by and can only achieve orgasm through a single type of sexual contact, usually relegated to a specific anatomical location - Partialism Individuals who attempt to avoid penetrative sex due to a lack of interest may have what? - Partialism (a type of paraphilia)Prevalence of antisocial personality disorder in females in the community - 1% 2 common defense mechanisms seen in obsessive compulsive personality disorder - isolation of affect intellectualization Paraphilia are almost never diagnosed in - females (and rarely in a clinical setting) Age range that is typical for a person that performs frotteurism - 15-25 (declines after that) Pts with a history of childhood separation are more prone to this personality disorder - dependent Pts with dependent personality disorder commonly experience these 2 things from their caretaker? - over-involvement intrusive behavior Childhood experience common in pts with dependent personality disorder - social humiliation - leads them to doubt in their own ability to function independently of others Pts with obsessive compulsive personality disorder often had parents who were - emotionally withholding overprotective over-controlling People with obsessive compulsive personality disorder develop their symptoms as a strategy to - avoid punishment (they were often punished by parents and rarely rewarded) Patients with schizoid personality disorder typically from families that are - emotionally reserved highly formalaloof impersonal (likely were provided inadequate affection prompting their disinterest in forming close relationships later in life) Patients with this personality disorder displayed excessive shyness and fear when confronted with new people and situations as children - avoidant Many of the patients have a history of painful early experiences and chronic parental criticism - avoidant personality disorder Symptoms of personality disorders are usually consistent with patient's - internal sense of self, which is called ego-synodic What is the term for how easily an individual acts on an initial, emotionally based evaluation of events and people - Constraint Purest expression of the biological basis of personality - Temperament What are the 2 distinct temperaments Kagan and colleagues (1988) identified - inhibited uninhibited Which of the following medications is the first-line treatment option for a personality change secondary to epilepsy that results in aggressive episodes? - Carbamazepine What is the second-line treatment option for a personality change secondary to epilepsy that results in aggressive episodes - benzodiazepines What is contraindicated in the treatment of aggressive personality changes due to epilepsy - antipsychoticsfemales that have this are usually infertile have low estrogen levels but do not have higher levels of homosexuality - Turner syndrome(45XO) females with this are typically indistinguishable from other females except they are slightly taller and have increased learning difficulties and low-normal intelligence - Triple X syndrome 46XY with complete androgen insensitivity have - female gender identity equivalent of 46XX individuals Congenital adrenal hyperplasia is associated with increased prenatal - androgen exposure 5-alpha-reductase deficiency is associated with - higher rates of homosexuality in affected females a cause of pseudohermaphroditism Gender identity is generally set by age ____ and very difficult to change - 3 First line agents for treating impulsivity and aggression in personality disordered patients - SSRIs Explain what the following Pyramid Tract Signs result from: spasticity weakness slowing of rapid alternating movements hyper-reflexia Babinski sign - Vitamin B12 deficiency The only TCA levels that can be reliably followed are for - desipramine imipramine nortriptylineA transgender male is sexually attracted to men/masculinity. What is his sexual orientation? - Androphilic A transgender male is sexually attracted to females/femininity. What is his sexual attraction? - Gynephilic A transgender female is sexu