1
Q
What tests are used for general behavioral health?
A
Mental status exam
- takes a long time, not easy to administer, must be trained
- cognition, memory, speech
- Gold standard assess cognition
2
Q
What tests are used for depression?
A
- Patient Health Questionnaire (PHQ-2 & PHQ-9)
- Edinburgh Postnatal Depression Scale
- Geriatric Depression Scale
- All free online, no training to administer
3
Q
What are the tests for anxiety?
A
Generalized Anxiety Disorder Seven-Item (GAD-7) Scale
4
Q
What are the tests for cognition?
A
- Mini-Mental Status Exam (MMSE)
- Montreal Cognitive Assessment (MOCA)
- Mini-Cog
- Neuropsychological Testing
- What executive functioning like
- Dementia, Alzheimer’s Dz
5
Q
What is the PHQ-9 test?
A
- Self administered
- Somewhat more accurate than other screens (88% sensitive, 85% specific)
- Can monitor pt response to tx (retest after tx)
- Scored 0-27
- > 10 = positive predictive value 45%
- <10 = negative predictive value 99%
- Careful of test fatigue
6
Q
What is the PHQ-2?
A
- First 2 questions of PHQ-9
- during past 2 wks, have you often been bothered by feeling down, depressed, or hopeless?
- during past 2 wks, have you often been bothered by having little interest or pleasure in doing things?
- Brief & easily administered verbally
- One strategy: use as pre-screening (then follow up)
- Sensitivity & Specificity similar to PHQ-9
- Careful of test fatigue
7
Q
What is the mental status exam?
A
- Gold standard for neuro & psych
- Lengthy, requires training to administer & interpret
- Part of full psychological exam
- Formal DSM-V dx requires it
- Objective portion of psychology note
8
Q
What are the domains of the MSE?
A
Not completely standardized but should evaluate
General observations
- Appearance & behavior
- Mood & affect
- Motor activity
- Arousal: alert, attentive, sleepy, unresponsive
Cognitive functioning
- Attention & concentration: ability to focus & resist distraction (serial subtraction, spell backward)
- Gnosia
- Memory: recent vs remote memory
- Language: fluency, content, repetition, naming
- Visuospatial perception: copy diagram, clock drawing
- Orientation
- Prosody
- Thought process
- Praxis: performing learned motor movements
- Calculation: add series of coins or subtract by 7s
- Executive functioning: Imitate rhythms
- Mood & thought content: affect (outward expression of mood), hallucinations
9
Q
What are the criteria for depression?
A
- Five or more of the following sx, present most of the day nearly every day for min 2 consecutive weeks, at least one sx either depressed mood or loss of interest or pleasure
- Depressed mood
- Loss of interest/pleasure in most/all activities
- Insomnia or hypersomnia
- Change in appetite/weight
- Psychomotor retardation or agitation
- Low energy
- Poor concentration
- Thoughts of worthlessness or guilt
- Recurrent thoughts about death/suicide
(Review)
10
Q
What is the Edinburgh postnatal depression scale?
A
- Self administered
- 10 items
- <5min
- Somatic sx ie sleep & appetite not included b/c pregnancy variability in these factors
- Max score of 30, score of >12 identify most women w/ major depression
- Both antenatal & postpartum use in validated
- Up to year after giving birth
11
Q
What is the geriatric depression scale?
A
- 5 items
- Basically satisfied w/ life? Often bored? Feel helpless? Prefer stay home? Feel worthless?
- 2/5 depressive responses suggest depression dx
- Studies in multiple settings: inpt, outpt & when physically ill
12
Q
What are the criteria for anxiety?
A
A. Excessive anxiety & worry (more days than not for 6mo+)
B. The individual finds it difficult to control the worry
C. Anxiety & worry associated w/ 3+/6
1. Restlessness or feeling keyed up or on edge
2. Being easily fatigued
3. Difficulty concentrating or mind going blank
4. Irritability
5. Muscle tension
6. Sleep disturbance
D. Anxiety, worry, or physical sx cause clinically significant distress
E. Disturbance not attributable to the physiological effects of a substance
F. Disturbance not better explained by another mental disorder
(Review)
13
Q
What is the Generalized Anxiety Disorder-7 (GAD-7)?
A
- Self-reported scale for anxiety
- Measures seven different aspects of anxiety: worry, tension, restless, muscle pain, fatigue, difficulty concentrating, irritability
- all 3 points
- 0-4 min, 5-9mild, 10-14mod, 15-21 severe
14
Q
Who has cognition concerns?
A
- Elderly
- Head trauma
- Anyone with unexplained loss of functioning
15
Q
What is the difference between delirium, dementia, and depression?
A
- Delirium: altered state of consciousness, characterized by episodes of confusion, develops over hrs/days
- Dementia: loss cognitive abilities leading to impaired ability to remember, think, make decisions
- Depression: mood d/o cause persistent feeling sadness & loss of interest
16
Q
What is the MMSE?
A
- Mini-Mental State Exam
- 5-10min
- Score 0-30
- Assess multiple cognitive domains, including memory & language
- Sensitive to mild-mod stages of dementia, particularly Alzheimer’s
- Orientation, Registration, Attention & Calculation, Recall, Language
17
Q
What is the Montreal Cognitive Assessment (MoCA)?
A
- More sensitive to earlier stages of cognitive decline
- Surveys a broader range of cognitive function than MMSE
- More executive functioning
- Less useful w/ advanced dz
- 15min to administer
(have to pay for)
18
Q
What is the mini-cog test?
A
- 3 steps
1. Word registration (6 tested sets of 3 words that they repeat)
2. Clock drawing
3. Recall the 3 words in step 1
19
Q
What are the criteria of a substance use disorder?
A
- Substance larger am over longer period than intended
- Persistent desire/unsuccessful cut down/ctrl
- Great time in activities to obtain/use/recover from
- Craving/strong desire to use
- Recurrent use cause fail to fulfill major role obligations
- Continued use despite persistent/recurrent social/interpersonal problems
- Important social/occupational/recreational activities given up/reduced
- Use in situations when physically hazardous
- Continued despite knolwedge persistent/recurrent physical/psychological problem caused/exacerbated by substance
- Tolerance (need more for intox or desired effect OR marked diminished effect w/ continued amount)
- Withdrawal (1) characteristic w/d sx (2) substance taken to relieve/avoid w/d sx
DRiNK TWO 6 PACK
- Dangerous use
- Ri: Role failure
- No stopping despite physical/psych problems
- Keep use despite social/ interpersonal prob
- Tolerance
- W/d
- Occupational, social, recreational activity given up or reduced
6
- Persistent desire
- Amount larger/longer than indented
- Cravings
- Keep spending lot time
20
Q
What are the three levels of severity of substance use disorder?
A
- Worsen over time.
1 sx: at risk SUD
2-3 sx: mild used SUD
4-5 sx: moderate SUD
6+ sx: severe SUD, signalling addiction
21
Q
What are the diagnostic tools for substance use disorders?
A
- CAGE questions
- AUDIT
- AUDIT-C
- DAST
- ASSIST
22
Q
What are the CAGE Questions?
A
- Alcohol, a way to open the conversation
- Have you ever felt you should Cut down on your drinking?
- Have people Annoyed you by criticizing your drinking?
- Have you ever felt bad or Guilty about your drinking?
- Have you ever taken a drink first thing in the morning (Eye-opener) to steady your nerves or get rid of a hangover?
23
Q
What are the use of CAGE questions?
A
- Not recommended as screening tool, but useful for following up single-item screening question
- Concerning if 2+ affirmative
- Only ~75% sensitive & specific
- Screening - one “yes” is positive & should be followed by identification of amounts
- Can lead to brief counseling opportunities
24
Q
What is the use of the AUDIT test?
A
- Alcohol Use Disorders Identification Test (AUDIT)
- Most widely validated instrument for unhealthy alcohol use
- 10 items, takes 2-3 min
- 8+ positive for unhealthy use
- 90% sensitive & 80% specific
- A score 20+ suggests alcohol dependence
(after single screening question and CAGE)
25
What are the questions of the AUDIT test?
1. How often do you have a drink containing alcohol
2. How many drinks containing alcohol do you have on a typical day when you are drinking?
3. How often 5+ on one occasion
4. How often last year able to stop once start
5. How often last yr, failed do normally expected b/c drinking
6. How often last year, need eye-opener
7. How often last year guilt/remorse after
8. How often last year, unable remember night b4 b/c drinking
9. You/someone else injured result of drinking
10. Relative, friend, dr, other health worker concerned drinking or suggest cut down?
0-7 points - low risk
8-15 points - med risk
16-19 points - high risk
20+ points - addiction likely
26
What is the AUDIT-C test?
- 3 items relating to **excess Consumption** from AUDIT
1. How often have?
2. How many on day drink?
3. How often have 6+ on one occasion?
- Men >=4 positive for **unhealthy alcohol use**, women >=3
- Score 7-10 suggest **dependence**
27
What is the alcohol test for pregnancy?
- Key to identify ANY alcohol use
- No commonly used specific instruments (often one question)
- May use AUDIT-C (or others) if already being used
28
What is the alcohol test for adolescents?
- 2 questions
- In the **past year, on how many days** have you had more than a few sips of beer, wine or any drink containing alcohol
- If your friends drink, **how many drinks** do they usually drink on an occasion
- CRAFFT
- Car: have you ridden in car when you/someone else high or using alcohol/drugs
- Relax: use alcohol/drugs to relax
- Alone: use alcohol/drugs alone
- Forget: forget things did while using alcohol/drugs
- Family/friends: ever tell you should cut down drinking/drug use
- T: trouble when using alcohol or drugs
- 2+ YES = serious problem & need further assessment
29
What is the DAST?
- Drug Abuse Screening Test (DAST)
- 10 questions
- 3+ suggest drug use w/ adverse consequences
- **Taken by pt**
- Used drugs other than for med reasons, abuse more than 1 at a time, unable to stop, blackout/flashback, guilt, spouse/parents complain, role failure, illegal activities to obtain, w/d, medical problem b/c use
30
What is the ASSIST?
- Alcohol, Smoking and Substance Involvement Survey
- Designed to be **administered by health professionals** - not screening, follow up
- Can be administered electronically
31
What do you need to know about mental health testing?
- Which test for which substance (alcohol only vs other drugs)
- How administered (HCP vs pt)
- Distinguishing characteristics
- Special populations
32
What are the clear roles for drug testing?
- Employers
- Law enforcement
- Athletes: anabolic hormones, stimulants, beta blockers, antiestrogens, erythropoietin, beta-2 agonists
- Health & life insurance: illicit drugs
33
What are the unclear roles for drug testing in health care?
- Screening pt due to 3rd party concern (unless legally ordered)
- Screening for purpose confronting him/her with results
- Unless part established tx plan/drug contract
- **Illegal to perform drug testing without a pt consent in most settings**
- Exceptions are emergencies & court-mandated testing
34
What are the methods of toxicology testing?
- Drug panel (initial survey) tested by immunoassay
- If positive test, confirmatory specimen done with gas chromatography or mass spectrometry (more sensitive & level is lower, a lot weighing on positive result)
- Samples include: urine (most common), blood, hair (test positive up to 3 months), saliva, sweat
35
What is the procedure for urine drug testing?
- Specimen collection may be observed/performed at an unannounced time
- Pt & person administering the test sign the seal on the container to est chain of custody
- Accurate reporting of all med & supplements before testing
- Specimen assessed for odor, color, temp & specific gravity to ensure validity
36
What is in a typical drug screen?
Amphetamines, Barbiturates, Benzodiazepines, Cocaine, Marijuana, MDMA (Ecstasy), Methadone, Opiates, Oxycodone, Phencyclidine, Propoxyphene
37
What are interfering factors in drug screens?
- Differences in drug metabolism can affect results (take results with a grain of salt)
- Poppy seeds can show positive for opiates (no standard amount known)
- Second-hand marijuana smoke can cause positive results
- Cold remedies can show up as positive for amphetmines
- Some ABX can cause false positive heroin or cocaine (amoxicillin)
- Ibuprofen can cause false positive THC results
*Outliers, very occational
38
What drugs are commonly tested in poisoning?
- Acetaminophen
- Digoxin
- Lithium
- Salicylates (spontaneous internal bleeding)
- Ethylene Glycol
- Antiepileptic agents
- Heavy metals (lead & mercury)
(mostly in ER setting)
39
What are common psychiatric drugs requiring frequent monitoring?
- Lithium (timing of drug levels important)
- Phenytoin (Dilantin)
- Valproic acid (Depakote)
40
What are common toxic substances and drugs with require monitoring?
- Acetaminophen
- Carbon monoxide
- Lead
- Lithium
- Phenobarbital
- Phenytoin (ANY more than therapeutic level)
- Salicylate
41
What is blood alcohol level?
- Measurement of serum ethanol provides most accurate level
- Breath analysis more rapid, under-reads level
- Most of US (OH), legal blood alcohol concentration (BAC) is **80mg/dL (0.08%)**
42
What are clinical symptoms associated with levels of BAC?
- Sub clinical: 0.01-0.05
- Euphoria: 0.03-0.12%
- Excitement: 0.09-0.25%
**0.20% - confusion**
- Confusion: 0.18-0.30%
- Stupor: 0.25-0.40%
- Coma: 0.35-0.50%
43
What is the purpose and indications of polysomnography?
- Determines sleep disorder pathology
- Provides both qualitative & quantitative information
- Indications: daytime sleepiness, fatigue, snoring - Sx which persist 8-12 mo.
44
What diagnoses can be made with polysomnography?
- Seizures
- Problems with sleep architecture
- Obstructive sleep apnea
- Movement disorders
45
What are the components of a sleep study?
- Electroencephalogram (EEG): determines sleep onset & stages
- Airflow monitors
- O2/CO2 monitoring
- Electromyography (EMG): measures periodic leg movements
- Snoring sensor
- ECG
- Audio/video recordings
- Chest impedance (measures chest movement)
- Apnea index
**Test can be done at home but with slightly less accuracy**
46
What is multiple sleep latency test?
- Objective measure of pt sleepiness
- Assess severity of daytime sleepiness
- Administered morning after sleep study
- 4-5 nap trials after 2hr after sleep study
- Try for sleep for 15 min then measure how quickly reach REM sleep
**Can diagnose narcolepsy**
47
What are the components of the multiple sleep latency test?
- Electroencephalogram (EEG): determines sleep onset & stages
- **Electrooculogram (EOG):** measures rapid eye movements
- Electromyelogram (EMG): chin EMG
- ECG: monitors heart rate & rhythm
48
What are the healthcare reasons for drug testing?
AMS/unexplained coma, seizures UO, acute psychosis/agitation/aggression, suspected OD/poisoning, unexplained trauma/accident, pre-op or anesthesia eval, chronic pain management, opioid use d/o tx monitoring
- Where stop prescribing controlled substances
**Best practice to have drug contract signed and in place any time prescribe controlled substance**
AAA PA: Lab & Diagnostic Testing
flashcards
Decks in class (15)
# Cards
-
Module 1a: Intro, BMP, CMP36
-
Module 1b: CBC, UA, Derm48
-
Module 2: Radiology & Neuroimaging/diagnostics122
-
Module 3: Musculoskeletal73
-
Module I: Behavioral48
-
Module 2a: Cardiac Labs28
-
Module 2b: Electrocardiogram63
-
Module 2c: Electrocardiogram54
-
Module 2d: Cardiopulmonary Imaging & Advanced Cardiac Evaluation89
-
Module 3: Endocrinology, Pulmonology139
-
Module 1: EENT & Abdominal Imaging77
-
Module 2: GI Imaging & Labs109
-
Module 3: GU & Renal67
-
Module 4: Electrolytes & Fluids40
-
Module 5: Hematology & ID35
