Nurs 6030 Primary Care Exam 4 Questions With Complete
Solutions
USPSTF recommendations for depression screening
- General adult population
- B reccomendation
USPSTF recommendations for substance use screening
- All patients for alcohol misuse
SBIRT: how many drinks per week, per day, per occasion
Depression
S/sx: depressed, irritable, anhedonia, change in habits,
worthlessness, early morning waking
Dx: PHQ-2
Tx: antidepressants
- TCA can be lethal
- MAOI only by psych NP
*PP depression is a psych emergency
Bipolar disorder
S/sx: mania and depression cycles; distracted, indiscrete,
grandiosity, flight of ideas, activity, sleep deficit, talkative
Dx: MDQ or disorder questionnaire
Tx: Refer! antidepressants can make it worse
Suicide
,Risks: gun ownership, 200x risk after hospitalization
Assessment: be direct, ask for plans, means, intent
Dx: screening tools
Tx: safety plan, consider hospitalization, MOST pts who commit
suicide have seen PCP w/in a month
Anxiety disorders
S/sx: ofetn with depression, W>M, <45yo, physical
manifestations
Dx: r/o endocrine disorders
Tx: antidepressants, busipirone, hydroxyzine, BB, alpha
blockers, benzos (caution)
Social anxiety disorder
S/sx: fear or anxiety social situation for 6+ months
Dx: children dx must be in peer settings, can be "performance
only" for public speaking
Tx: NO beta blockers in teens involved insports
Panic disorders
S/sx: panic attacks (discrete!), h/o of self-medicating, rapid
onset
Dx: GLAD-PC toolkit; 1+ attack with 1 month of: persistent
worry or concern
Definition: period of intense fear with 4+ physical
manifestations
General anxiety disorder
, S/sx: 6+mo of worry with 3+ mood changes
Dx: r/o ADHD, OCD, PTSD
Tx: anxiolytics
Substance use disorders
S/sx: Labs (increased GGT, AST, ALT, alk phos, MCV,
amylase, TG, decreased platelets
Dx: SBIRT for severity with brief intervention re: readiness
Tx: refer to specialty care
ADHD
S/sx: restless, interruption, inattentiveness
Dx: Conners adults ADhD rating scale and self-report scale; 6+
mo with 5+ sx
Tx: GOALS are to improve relationships, performance, rule-
following
***combine meds and behavioral therapy
**Stimulants are gold standard
*Methylphenidate
*Amphetamines
ADHD medications
Stimulants: adderall
Methylphenidate: Ritalin
Non-stimulants: Straterra (SI, liver injury, with food)
Guanfacine/Clonidine (works on NE in brain with BP effects)
Testicular cancer
Solutions
USPSTF recommendations for depression screening
- General adult population
- B reccomendation
USPSTF recommendations for substance use screening
- All patients for alcohol misuse
SBIRT: how many drinks per week, per day, per occasion
Depression
S/sx: depressed, irritable, anhedonia, change in habits,
worthlessness, early morning waking
Dx: PHQ-2
Tx: antidepressants
- TCA can be lethal
- MAOI only by psych NP
*PP depression is a psych emergency
Bipolar disorder
S/sx: mania and depression cycles; distracted, indiscrete,
grandiosity, flight of ideas, activity, sleep deficit, talkative
Dx: MDQ or disorder questionnaire
Tx: Refer! antidepressants can make it worse
Suicide
,Risks: gun ownership, 200x risk after hospitalization
Assessment: be direct, ask for plans, means, intent
Dx: screening tools
Tx: safety plan, consider hospitalization, MOST pts who commit
suicide have seen PCP w/in a month
Anxiety disorders
S/sx: ofetn with depression, W>M, <45yo, physical
manifestations
Dx: r/o endocrine disorders
Tx: antidepressants, busipirone, hydroxyzine, BB, alpha
blockers, benzos (caution)
Social anxiety disorder
S/sx: fear or anxiety social situation for 6+ months
Dx: children dx must be in peer settings, can be "performance
only" for public speaking
Tx: NO beta blockers in teens involved insports
Panic disorders
S/sx: panic attacks (discrete!), h/o of self-medicating, rapid
onset
Dx: GLAD-PC toolkit; 1+ attack with 1 month of: persistent
worry or concern
Definition: period of intense fear with 4+ physical
manifestations
General anxiety disorder
, S/sx: 6+mo of worry with 3+ mood changes
Dx: r/o ADHD, OCD, PTSD
Tx: anxiolytics
Substance use disorders
S/sx: Labs (increased GGT, AST, ALT, alk phos, MCV,
amylase, TG, decreased platelets
Dx: SBIRT for severity with brief intervention re: readiness
Tx: refer to specialty care
ADHD
S/sx: restless, interruption, inattentiveness
Dx: Conners adults ADhD rating scale and self-report scale; 6+
mo with 5+ sx
Tx: GOALS are to improve relationships, performance, rule-
following
***combine meds and behavioral therapy
**Stimulants are gold standard
*Methylphenidate
*Amphetamines
ADHD medications
Stimulants: adderall
Methylphenidate: Ritalin
Non-stimulants: Straterra (SI, liver injury, with food)
Guanfacine/Clonidine (works on NE in brain with BP effects)
Testicular cancer
