APEA Psychiatry Exam at at Northern Kentucky University
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Free APEA Psychiatry Exam at at Northern Kentucky University Questions
An adult patient has been newly diagnosed with bipolar I disorder. Which of the following findings are most likely to increase the risk for bipolar disorder?
- Being assigned female sex at birth
- History of sexually transmitted infections (STIs)
- Obstetrical complications at birth
- Paternal age over 45 at birth
Explanation
Research has shown that paternal age over 45 at the time of conception is associated with an increased risk of several psychiatric conditions, including bipolar disorder. This is thought to be due to the increased likelihood of genetic mutations in the sperm of older fathers. These mutations can contribute to the development of conditions like bipolar disorder in their offspring. While maternal age also plays a role in genetic risks, studies have consistently shown that advanced paternal age is a significant factor in the genetic predisposition for bipolar disorder.
Correct Answer Is:
D. Paternal age over 45 at birth
A 36-year-old man with a 7-year history of heavy alcohol consumption presents with suspected acute pancreatitis. What is the pathophysiology of this disease process?
- Impaired lower esophageal sphincter (LES) function and transient lower esophageal sphincter relaxations (TLESRs)
- Exocrine cell destruction by infiltrating inflammatory cells
- Defects in the epithelial barrier, immune response, leukocyte recruitment, and microflora of the colon
- Colonic wall structure, colonic motility, diet, fiber intake, obesity and physical activity, and genetic predisposition
Explanation
In acute pancreatitis, heavy alcohol use triggers premature activation of pancreatic enzymes, leading to autodigestion of pancreatic tissue. This causes intense inflammation, with infiltration of neutrophils and other inflammatory cells, resulting in destruction of pancreatic exocrine cells and surrounding tissue. The resulting inflammatory cascade produces the characteristic pain and systemic manifestations of acute pancreatitis.
Correct Answer Is:
B. Exocrine cell destruction by infiltrating inflammatory cells
A 17-year-old girl is referred to the emergency department with abdominal pain. Her abdominal pain comes and goes, and she often feels full after eating only a few bites of a meal. She is thin and worries about being "too thin" but cannot eat much before she feels like she "just can't eat anymore." On physical exam, she has patches of thinner hair over her scalp. She admits to recent stress and is chewing on her hair. Her abdomen is soft and non-tender, and the rest of the exam is benign. Which of the following tests would be most appropriate to confirm the suspected diagnosis if all these findings are related?
- Plain film of the abdomen
Explanation
The most appropriate test in this case is a plain film of the abdomen, which can help identify gastrointestinal complications often associated with eating disorders such as anorexia nervosa or bulimia nervosa. Symptoms like abdominal fullness and pain after eating, along with behaviors like chewing hair (which may be indicative of trichophagia), can signal underlying gastric dysfunction or intestinal issues, such as delayed gastric emptying or gastric dilation, that are common in eating disorders. A plain film is a non-invasive imaging technique that can detect gastric dilation or other complications, offering insight into the physical manifestations of the disorder. While blood tests are important for assessing electrolyte imbalances and malnutrition, abdominal imaging provides a direct view of the gastrointestinal issues that could explain the patient's symptoms.
An NP provides care to a family who suffered the loss of their young child through a traumatic accident. The family has three surviving children. The school-age sibling has an intense longing for their deceased sibling, feels life has no meaning since their death, still cannot believe they are gone, and is experiencing intense emotional pain. The NP is concerned about prolonged grief disorder. At a minimum, how long after the death of their sibling would the NP consider a diagnosis of prolonged grief disorder?
- 3 months
- 6 months
- 9 months
- 12 months
Explanation
Prolonged grief disorder (PGD) is characterized by intense and persistent grief symptoms that significantly impair a person's ability to function. For a diagnosis of PGD, the symptoms must persist for at least 6 months after the death of a loved one. Symptoms often include persistent yearning or longing for the deceased, disbelief, emotional numbness, and difficulty moving forward with life. If these symptoms persist beyond the typical grieving period (usually up to 6 months), PGD may be diagnosed.
Correct Answer Is:
B. 6 months
A 39-year-old male ICU nurse presents to the PMHNP with symptoms of posttraumatic stress disorder (PTSD) after working in New Orleans during the COVID-19 pandemic. He has nightmares and experiences depressive symptoms. In general, he says he feels detached from life and emotionally numb. He tries not to think about the patients who died, but he often cannot stop their faces from "popping" into his head at any time. What modality would be most appropriate for this patient presentation?
- Eye movement desensitization and reprocessing (EMDR)
- Primal scream therapy
- Hypnotherapy
- Psychodrama
Explanation
EMDR is an evidence-based psychotherapy designed specifically to treat PTSD. It helps patients process traumatic memories by using bilateral stimulation (e.g., eye movements) while the patient recalls traumatic events. This modality is particularly effective for individuals who experience intrusive memories or flashbacks, like the patient described in the scenario, who cannot stop the faces of deceased patients from "popping" into his head. EMDR targets the underlying trauma in a structured manner, helping patients integrate these distressing memories into their narrative in a way that reduces their emotional impact.
Correct Answer Is:
A. Eye movement desensitization and reprocessing (EMDR)
A 21-year-old unmarried man has near-daily intrusive thoughts that his neighbors knock on his door at night. He tells the PMHNP he knows this knocking is just his "imagination" because the neighbors work nights and are not home. However, he feels compelled to get out of bed and open the door, no matter what time it is. He opens and closes the door repeatedly for at least an hour, sometimes longer. He says he has had this problem "in the past" and did not seek help for it. This time it has been going on at least 6 months and is becoming "problematic." It is interfering with his ability to get a good night's sleep and he is having problems at work. His roommate is also very troubled by it. The PMHNP will diagnose him with which of the following?
- Obsessive-compulsive disorder (OCD)
- Generalized anxiety disorder
- Schizophrenia
- Agoraphobia
Explanation
This patient's symptoms — intrusive thoughts (obsessions) about his neighbors knocking on his door, coupled with the compulsive behavior of repeatedly opening and closing the door to check — are characteristic of obsessive-compulsive disorder (OCD). OCD is diagnosed when a person experiences persistent, intrusive thoughts (obsessions) and engages in repetitive behaviors or mental acts (compulsions) to reduce the anxiety caused by those thoughts. The patient recognizes that the thoughts are not based in reality, but feels compelled to act on them, which fits the criteria for OCD. The impairment in sleep, work, and social relationships further supports this diagnosis. Generalized anxiety disorder typically involves excessive worry about multiple aspects of life, but does not include specific intrusive thoughts and compulsive behaviors. Schizophrenia would involve more severe delusions or hallucinations, and agoraphobia primarily involves fear of being in situations where escape might be difficult, which is not relevant to this case.
Correct Answer Is:
A. Obsessive-compulsive disorder (OCD)
A school-age child presents for evaluation due to an irrational fear of burglars. The child checks all the locks in the house repeatedly, even in the middle of the night. The child acknowledges that the symptoms are disruptive but explains that they "can't help it." They need to check every lock seven times, "or else the burglars are gonna get in." When the child is prevented from doing this, they become upset and inconsolable. Eventually, the caregiver says, "I have to let them finish." Both the caregiver and child agree that the symptoms are interfering with their ability to meet both family and school-related responsibilities. What other disorder are they at increased risk for developing?
- Narcolepsy
- Intellectual developmental disorder
- Tourette's syndrome
- Specific phobia
Explanation
The child’s compulsive checking behaviors (repeatedly checking locks) and the irrational fear of burglars strongly suggest a diagnosis of obsessive-compulsive disorder (OCD). OCD is associated with obsessions (intrusive, irrational thoughts, like fear of burglars) and compulsions (repetitive behaviors, like checking locks) meant to relieve anxiety caused by those obsessions. Tourette's syndrome is often seen in individuals with OCD, especially in childhood. Tics and involuntary movements are characteristic of Tourette's, and children with OCD are at an increased risk of developing tics, which can present as repetitive behaviors or vocalizations similar to compulsions. Therefore, the child’s symptoms suggest they are at an increased risk of developing Tourette's syndrome.
Correct Answer Is:
C. Tourette's syndrome
Which of the following aspects of bipolar disorder predicts a favorable response to lithium treatment?
- Rapid cycling
- Euthymic intervals
- Psychotic symptoms
- Mixed episodes
Explanation
Euthymic intervals (periods of stable mood) are generally associated with a better response to lithium treatment. Lithium is most effective for preventing mood episodes in individuals who experience long periods of mood stability between episodes of mania and depression, which is characteristic of those with euthymic intervals.
Correct Answer Is:
B. Euthymic intervals
A 47-year-old woman completed the State-Trait Anxiety Inventory (STAI) and scored 20. What does this score indicate?
- Low-level anxiety
- Minor anxiety
- Moderate anxiety
- Severe anxiety
Explanation
The State-Trait Anxiety Inventory (STAI) is a commonly used tool to assess anxiety. It has two components: the State Anxiety scale (which measures temporary anxiety in response to a specific situation) and the Trait Anxiety scale (which measures a person’s general tendency to experience anxiety). A score of 20 on the STAI typically falls in the low-level anxiety range, indicating that the individual is experiencing minimal anxiety. Higher scores would indicate more significant levels of anxiety, such as moderate or severe anxiety.
Correct Answer Is:
A. Low-level anxiety
The PMHNP has just diagnosed a 35-year-old man with bipolar II disorder, and his most recent episode was depressive. In general, how do the depressive episodes associated with bipolar II disorder differ from those associated with bipolar I disorder?
- They are less disabling than those associated with bipolar I disorder.
- They are lengthier than those associated with bipolar I disorder.
- They are less frequent than those associated with bipolar I disorder.
- They are rarely a reason for a patient to seek treatment.
Explanation
Depressive episodes in bipolar II disorder tend to be longer in duration than those seen in bipolar I disorder. Bipolar II disorder is characterized by recurrent depressive episodes that can last for weeks or months, whereas the depressive episodes in bipolar I disorder, which is often marked by more intense manic episodes, may be of shorter duration.
Correct Answer Is:
B. They are lengthier than those associated with bipolar I disorder.
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