NEI Questions on ADHD, Dementia, Substance Abuse & Impulsive Compulsive Disorders, Exams of Nursing

Download NEI Questions on ADHD, Dementia, Substance Abuse & Impulsive Compulsive Disorders and more Exams Nursing in PDF only on Docsity! N EI questions on ADHD, Dementia, Substance Abuse & impulsive Compulsive Disorders . NEI questions on ADHD, Dementia, Substance Abuse & impulsive Compulsive Disorders. (Test 4) 1. Peter, A 35 year old stockbroker, has been advised by his supervisor to come see you, the company mental health consultant. His supervisor is complaining that he often comes late to appointments, is inappropriately fidgety, interrupts people during meetings, has been offensive towards coworkers and has been known to party excessively on weeknights. Peter asserts that he is just fine; he has a lot of projects on him mind and is simply standing up for himself when speaking with others. He likes to go out in the evenings to unwind. Recognizing probable ADHD, you interview both the patient and his work buddy, who is a long-time friend. How would you start your questions? a) Compared to his parents, how often does the patient…. b) Compared to other people his age, how often does the patient…. c) Compared to his childhood how often does the patient…. d) Compared to his children, how often does the patient…. 2. According to the DSMV criteria, what is the maximum age threshold for symptom onset when making a diagnosis of attention deficit hyperactivity disorder? a) 5 b) 7 c) 12 d) 15 3. A 15-year-old with inattentive-type attention deficit hyperactivity disorder has a hard time staying focused on the task at hand, has trouble organizing her work, and relies heavily on her mother to follow through with her homework. Problem-Solving is one of the hardest tasks for her. Her difficulty with sustained attention could be related to aberrant activation in the: a) Dorsolateral prefrontal cortex b) Prefrontal motor cortex c) Orbital frontal cortex d) Supplementary motor cortex 4. Which of the following is true regarding cortical brain development in children with ADHD compared to healthy controls? A) The pattern (i.e. order) of cortical maturation is different B) The timing of cortical maturation is different C) The pattern and timing of cortical maturation are different D) Neither the pattern nor the timing of the cortical maturation are different. N EI questions on ADHD, Dementia, Substance Abuse & impulsive Compulsive Disorders . 5. A clinician is considering treatment options for a 26-year-old man with ADHD who has a history of alcohol and marijuana abuse. Which of the following accurately explains the effects on different stimulant formulations on neuronal firing? a) Pulsatile stimulation amplifies undesirable phasic dopamine (DA) and norepinephrine (NE) firing, which can lead to euphoria and abuse. b) Immediate-release stimulants lead to tonic firing, which can lead to euphoria and abuse. c) Tonic firing is a result of rapid receptor occupancy and fast onset of action as seen with extended release formulations d) Extended-release stimulants result in phasic stimulation of NE and DA signals, but this does not lead to euphoria and abuse. 6. Scarlet, a 25-year-old bartender, was diagnosed with ADHD at age 10. She has been on and off medication since then; first on immediate release methylphenidate, then on the methylphenidate patch. She has experimented with illicit drugs during her adolescence and is still a heavy drinker. After a few years of self-medication with alcohol and cigarettes, she is seeking medical attention again. You decide to put her on 80 mg/day of atomoxetine, one of the non-stimulant medications effective in ADHD. Why does atomoxetine lack abuse potential? a) It decreases the norepinephrine levels in the nucleus accumbens, but not in the prefrontal cortex. b) It increases dopamine levels in the prefrontal cortex, but not in the nucleus accumbens. c) It modulates serotonin levels in the raphe nucleus. d) It increases dopamine in the striatum and anterior cingulate cortex. 7. A 15-year-old patient with ADHD has a rare mutation in the gene for the dopamine transporter (DAT) in deciding, which treatment to initiate for this patient’s ADHD, you know it will be important to avoid treatments that depend on normally functioning DAT. Which of the following drugs are transported into neurons via the dopamine transporter? a) Amphetamine b) Atomoxetine c) Methylphenidate d) A and B e) None of the above N EI questions on ADHD, Dementia, Substance Abuse & impulsive Compulsive Disorders . 15. Mary, a 79-year-old patient, is brought to your office by her daughter, who reports that her mother has been exhibiting several concerning symptoms over the past year. Comprehensive questioning revelas that her symptoms are: trouble remembering familiar things, such as telephone numbers commonly dialed; not recognizing some close family members who visit often; and difficulty performing writing tasks. The patient’s motor function appears to be unaffected. Although not definitive, these symptoms are most likely indicative of which type of dementia? a) Alzheimer’s disease b) Dementia with Lewy bodies c) Hannington’s disease d) Frontotemporal dementia 16. A young man who is pre-med and has a family history of Alzheimer’s disease is interested in learning more about the brain regions that are involved in memory and the development of Alzheimer’s disease. You describe the pathways of acetylcholine, an important neurotransmitter involved in dementia. As part of your explanation, you tell him that major cholinergic projections stem from the to the , which are believed to be involved in memory. a. Basal forebrain; nucleus accumbens b. Basal forebrain; hippocampus c. Striatum; hypothalamus d. Striatum; prefrontal cortex 17. A young woman brings her 72- year-old mother in for an appointment because she is concerned that her mother may have Alzheimer’s disease. The mother does not feel that anything is wrong, but her daughter states that she has seemed somewhat depressed and forgetful lately. Data have shown that: a) Depression is often co-morbid with Alzheimer’s disease b) Depression may increase the risk of developing Alzheimer’s disease c) Depression may be a prodromal symptom of Alzheimer’s disease. d) All of the above e) None of the above N EI questions on ADHD, Dementia, Substance Abuse & impulsive Compulsive Disorders . 18. Thomas is a 54-year-old man with a family history of Alzheimer’s disease. As a voluntary participant in research studies on Alzheimer’s disease, Thomas, recently had amyloid positron emission tomography (amyloid PET) neuroimaging done. Although he currently exhibits no behavioral symptoms of Alzheimer’s disease, Thomas’s amyloid PET scans revealed accumulation of beta amyloid protein throughout cortical and limbic areas of his brain. Although much research is yet to be done, data indicate that the normal physiological role of amyloid beta protein may include: a) Blood vessel repair functions b) Antimicrobial functions c) Both of the above 19. A 68-year-old patient with an early diagnosis of Alzheimer’s disease is put on a cholinesterase inhibitor in hopes of improving his cognitive function. This patient has been a chain smoker for over 40 years and refuses to give up the habit. Which of the following medications would not be appropriate for this patient giving his smoking habit? a) Donepezil b) Galantamine c) Rivastigmine d) None of these medications should be prescribed to a patient who smokes e) There are no contraindications due to smoking for these medications 20. John, a 73-year-old mid-stage Alzheimer’s patient, has been on donepezil 10 mg/day for approximately 8 months to aid in improving his cognitive functioning. His wife has begun to notice a loss of effectiveness over the past month, and they present today to determine a new course of action. You decide to augment John’s donepezil with 5 mg/day of memantine. Which of the following properties of memantine may be useful in treating Alzheimer’s disease? a) Serotonin 3 (5HT3) antagonism b) Sigma antagonism c) N-Methyl-D-Asparte (NMDA) antagonism d) NMDA antagonism at the magnesium site 21. Mildred is a 66-year-old patient. She is currently showing no signs of Alzheimer’s disease but is considering enrolling in one of the ongoing Alzheimer’s disease immunotherapy- based clinical trials (the DIAN-TU and A4 studies). You explain to Mildred that such immunotherapy involves: a) Antibodies that bind to NMDA receptors in the brain N EI questions on ADHD, Dementia, Substance Abuse & impulsive Compulsive Disorders . b) Antibodies that bind to amyloid protein in the brain c) Antibodies that bind to hyperphosphorylated tau in the blood 22. Sam, a 49-year-old patient, is in your office today for a consultation. He admits that he has had a significant lack of interest in golfing, one of his favorite past-times; he is frustrated that is has become seemingly more difficult to swing the club. In addition, he notes that he has recently become increasingly agitated when other church parishioners sit in the seat that he prefers during the church service and has even verbally lashed out at them. With this information, how might you best describe Sam’s symptoms? a) Early stages of Alzheimer’s disease, focusing on mood changes b) Depression-executive dysfunction c) Amnestic mild cognitive impairment d) Natural gaining/elderly disposition symptoms 23. A 79-year-old man presents to your office with his wife. She lists significant medical history, such as chronic renal failure, mild cirrhosis, arrythmia, and a recent diagnosis of moderately severe Alzheimer’s disease by their family physician. Which of the following medications for Alzheimer’s disease has a “do not use” warning for patients with renal and hepatic impairment? a. Donepezil b. Rivastigmine c. Memantine d. Galantamine 24. Virgil is a 65-year-old man. His daughter reports that he began forgetting birthdays, grandchildren’s names, and other important information approximately 1 year ago and that he has become increasingly unable to perform many activities, such as paying bills on time. Neuropsychiatric testing shows moderate cognitive impairment not attributable to any medical or psychiatric condition. Virgil has never been tested for biomarkers of Alzheimer’s disease-associated mutation in the presenilin gene. What would be the most likely diagnosis for this patient according to the National Institute on Aging and Alzheimer’s Association 2011 diagnostic criteria for dementia? a) Possible Alzheimer’s dementia b) Probable Alzheimer’s dementia with increased level of certainty c) Alzheimer’s dementia N EI questions on ADHD, Dementia, Substance Abuse & impulsive Compulsive Disorders . 32. A 28-year-old painter presents with a severe drinking problem and you affirm the need for pharmacotherapy. When you suggest naltrexone, the curious artist would like to know how this well help. Which might you use as part of your explanation? a) Naltrexone blocks mu-opioid receptors to reduce the euphoria you might normally experience with heavy drinking b) Naltrexone blocks metabotropic glutamate receptors (mGluR) to reduce the euphoria you might normally experience with heavy drinking c) Naltrexone stimulates mu-opioid receptors to the euphoria you might normally experience with heavy drinking d) Naltrexone stimulates the mGLuR receptors to the euphoria you might normally experience with heavy drinking. 33. After seeing a 39-year-old accountant for several years, she has recently disclosed her 10-year prescription opiate addiction to you. She is quite functional addict, but continues seeking opiates to avoid withdrawal effects. Which of the following might you tell her about potential recovery? a) Opioid receptors can readapt to normal but need a reduction in the amount of opiate exposure over time in order to do so. b) Opioid receptors cannot readapt to normal after severe addiction but can reorganize to nearly full functionality with the aid of permanent pharmacotherapy. 34. A 24-year-old woman with a 6-year history of smoking has decided she is ready to quit. She is considering nicotine replacement therapy but is concerned that she may just end up dependent of that instead. Which of the available nicotine replacement therapies carries the highest risk of dependence? a) Gum b) Lozenge c) Nasal spray d) Oral inhaler e) Transdermal patch 35. Mary is a 33-year-old woman with alcohol use disorder. She consumes several drinks a day nearly every day of the week and has recently had her two children removed from her care. She is motivated to attempt to stop drinking in order to get her children back. She previously attempted to quit cold turkey and on her own and ended up in the emergency room with severe withdrawal symptoms. Considering these factors, would she be a good candidate for reduced-risk drinking as a goal? a) Yes N EI questions on ADHD, Dementia, Substance Abuse & impulsive Compulsive Disorders . b) No 36. Clara is at a party with some friends and decides to try “Molly”. She was told that “Molly” is the pure form of Ecstasy (3,4, methlenedi-oxymethamphetamine), lacking many of the harmful additives that can be found in Ecstasy. Upon taking the pill, Clara notices that while she is in a state of excited delirium, she has a nosebleed, she is sweating profusely, and she feels nauseous. She is disoriented and wonders why she is feeling so horrible after taking the pure form of the drug. Her symptoms are most likely attributed to: a) A synthetic cathinone such as methylone b) Caffeine c) Methamphetamine 37. Peter is a 17-year-old student who has been using spice (synthetic cannabinoid) over the past year. Synthetic cannabinoids such as spice may be associated with increased risk of psychosis compared to natural marijuana because they: a) Do not contain cannabidiol b) Are full rather than partial agonists c) A and B d) Neither A or B 38. Eddie is a 43-year-old who has a 22-year-old daughter with a history of cocaine addiction. He recently heard about a novel cocaine vaccine that is being studied and would like to know more about it. In describing the cocaine vaccine, you explain that a cocaine-induced “high” is experienced when: a) At least 47% of the dopamine transporters are occupied by cocaine b) At least 97% of the norepinephrine transporters are occupied by cocaine c) Both of the above 39. A 26-year-old woman develops a dependence on opioids after taking them during her recovery from knee surgery. She attempts to stop using them on her own, but when she does stop or decreases her dose, she experiences nausea, muscle aches, sweating, diarrhea, insomnia, and depression. She and her practitioner decide that buprenorphine would be an appropriate treatment strategy. Which of the following statements is true? a) The patients should have the buprenorphine implant, probuphine, inserted immediately. b) The patient should initiate oral buprenorphine while downtitrating her current opioid. c) The patient should be in a mild withdrawal scale prior to initiating buprenorphine d) The patient should complete withdrawal before beginning buprenorphine treatment. N EI questions on ADHD, Dementia, Substance Abuse & impulsive Compulsive Disorders . 40. A 23-year-old woman has recently been diagnosed with binge-eating disorder. Since the age of 16, she has had episodes where she eats far beyond the point of hunger, typically at night and when she is alone. The patient feels very guilty and disgusted with herself about her eating habits; this is reinforced by her family members, who tell her that she is just weak and should have more self-control. Is there evidence to support the idea that individuals can develop an addiction to food? a) Yes b) no a.