Tag Archive for: NP

How to Read Vignettes- Efficiently!

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yield sign to stop and read vignettes efficiently

One of the sections of exams students have the most difficult time with is the vignettes section. We’ve discussed this topic before here, where we show how to break down the process of answering vignettes. But in this blog, we’ll get into the nuts and bolts of reading the passages a little more effectively.

Formatting is everything

First, how you approach vignettes will depend on what format they are in. A video vignette requires you to sit through a segment of recorded interactions and glean information off of those interactions (usually between and doctor and patient). A written vignette gives you a block of information you can refer back to to answer questions.

The key difference between these two is time management. For a video vignette, you won’t want to waste your exam time going back and re-watching the video (which isn’t allowed in some cases, anyway). You can’t control the speed that the video plays, so you’re at the mercy of the media to go through its time. Because of this, you’ll want to pay close attention as you watch through the video the first time. Thankfully, bits of video can stick out as they’re composed of dialogue instead of raw facts, and this can help recall later.

Video Vignettes

As you watch the videos, keep in mind what should stick out- deviances from typical life, distress from a symptom, dysfunction due to ongoing issues, or potential danger to the self or others. This is a simple concept, but it’s usually the part that you need to pay attention to. An important factor in video vignettes to pay attention to is HOW to patient says these things. You’ll likely be quizzed on not only the information presented, but also how that information is delivered. Is the patient frenzied, calm, mood incongruent, or lethargic? Is that relevant to what they’re saying? It’s a lot to keep track of, but when you have to spend your time wisely, it’s best to dial into those videos.

Written Vignettes

Conversely, written vignettes will take up your time in a different way. Typically you’re presented with a fleshed out story and asked to determine answers that are either insinuated or determinable based on that information. For these, you can go back and re-read sections as you go. This means you don’t have to be laser-focused the first time reading it, and you can refer back to it. But this also means the questions involved may be a bit trickier and require more introspection. Keep in mind the basic information presented (i.e., demographics, time range of symptoms, key issues going back to the 4 D’s). Then as you delve deeper into the questions, refer back for more specifics.

Take away-

Vignettes are challenging. And they should be, as they are the more accurate representation of what it’s like working with real-life patients. And just like patients, they have their individual quirks that make them unique each time. A great way to get comfortable with these questions is the PRACTICE! Take time to go through and get used to what kind of information you need to pay attention to, in a setting that doesn’t penalize you for time.

We tailor each bank to the type of test you’re taking, whether that is Nurse Practitioner Mental Health Certification, ABPN, USMLE, or PRITE. You can take these practice exams over and over again until you get the hang of it. You can use the timed mode that mimics the actual exam so you really get in the groove of managing your time. Give our clinical vignettes a try- totally FREE – using our Free Trial!

If you like what you see on the trial, check out our Question Banks and find the best option for you! Or, contact us with any questions you have so we can get you on the right path today!

How Many Ways Are There to Prep for Tests?

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test prep like a tortoise

Everyone has their own unique style when it comes to getting information into their noggin’. Test prep can take many shapes and forms, and what works for one person might not work for another.

Prepping for a board exam can be incredibly stressful. The weight of your career decisions rests on the outcome! (No pressure, right?) To cope with this stress, test prepping can manifest as several different approaches: the WINGER, the PROCRASTINATOR (aka, CRAMMER), and the TORTOISE.

The Winger

The Winger is the person that lets go of the immediate stress the exam is putting on them, and puts it out of their mind. They know it’s coming up, but they have confidence in the amount of information they have stored in their brains. The have an uncanny ability to refresh the knowledge and consolidate retrieval just by existing….or so they think. These test takers waltz into their exams and take a gamble that they will have all the answers (or at least enough to pass!). Depending on the type of test you’re going to take, being a Winger can work OK. Think 100 level undergrad classes. ABPN, PRITE, NP, or USMLE? This might not be the best approach.

The Procrastinator

The Procrastinator (aka, Crammer) is similar to the Winger. They also put off prepping for as long as possible. But while the Winger tends to follow through on their approach, the Procrastinator usually gets MORE stressed by avoiding it, and ends up cramming as much studying in as possible in the last day or so leading up to the exam. Cramming can be beneficial when compared to not prepping at all, and for some individuals, cramming is their sole means of test prep. Can it work? Probably. Is it great for your mental health? Not really.

The Tortoise

Lastly, we have the Tortoise. This name harkens back to Aesop’s Fables, as it should, because this test prepper takes the slow and steady approach. Plunking along, little by little every day, this prepper integrates new bits of information into their mental arsenal. They challenge the knowledge they already have to increase retrieval. The process starts closer to a few months ahead of time, as opposed to overwhelming themselves with whole textbooks 48 hours before their next exam. Instead, they have time to relax and take in some self-care in the days leading up to the exam so that they are refreshed and ready to go.

Is any one of these approaches superior? Research would suggest there is favorable option- we’ll let you decide which one you think it is 😉 In the meantime, if you’ve been relying on being a Winger or a Crammer up to this point, let this blog be your sign to give the Turtle Club (yes, that’s an early 2000’s movie reference) a chance. Give our question banks a try- FREE- using our Free Trial! Or if you’re ready to take the plunge, check out our Question Banks and find the perfect fit for you! Or, contact us with any questions you have so we can help you prep in the best way for you.

How to get started

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get started

There are days when the last thing you want to do is be studying. Maybe you’re burned out from a hectic week, or maybe you’ve been away for a few days and having a difficult time getting back into the groove of things. Whatever the case may be, here are a few tips to help you get started back onto your studying track!

Make a List

If you are a visual processor, it may be helpful to sit down and write (or type) out a list of exactly what you need to be working on. It could be a topic list, it could be a to-do list. Whatever helps you categorize what you need to focus on!

Make a Plan

Next, make a plan. This can be a schedule such as “Monday, Wednesday, and Fridays from 9am to 10am I will go through the Neuroscience qbank” or “Each day for 15 minutes I’m going to read up on Developmental disorders”. It can also be a plan for a goal like “I will be able to complete the Bipolar qbank in Test Mode perfectly by July 1st”. This is to give you an orientation for your list to help take steps to accomplish the goals.

Make Baby Steps

It’s important to not expect yourself to jump in at 100%. If you’ve been in a rut, you need to ease yourself back into your habits and expectations. Start small, if necessary, by doing timed increments each day. Eventually you can increase those increments to make bigger strides in what you’re working towards.

Make it FUN!

Finally, give yourself rewards as you go. It’s OK! If you have something to look forward to, you’re more likely to complete the tasks at hand. Maybe that reward is going to get your favorite treat once you’ve successfully gone through a chapter of a book. Or taking a hot bath at the end of the day with a glass of wine. Find small things you can do for yourself that encourages you to keep going. It doesn’t have to be all work 🙂

The important thing is to just get started. Once you get momentum, things will become easier!

Need some help?

Give our question banks a try- FREE- using our Free Trial! Or if you’re ready to take the plunge, check out our Question Banks and find the perfect fit for you! Or, contact us with any questions you have or ask about our STUDY GUIDES so we can get you on the right path today!

How to Keep Studying, Even in the Summer

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studying in summer

Summer is here, the sun is shining, and who wants to be stuck inside? Unfortunately, the seasons don’t pay attention to our responsibilities. Studying can be a challenging and sometimes frustrating experience, especially when the weather is calling us to go do other things. It can be difficult to focus for extended periods, retain information, and stay motivated over time. However, with the right strategies and mindset, you can improve your efficiency and effectiveness as a student.

Here are some specific strategies that can help you become more efficient and effective at studying:

  1. Set clear goals: Start by setting clear study goals that are specific, measurable, achievable, relevant, and time-bound (SMART). This will give you a clear sense of direction and purpose as you approach your studies. (Check out our blog on exactly this topic!)
  2. Plan your study sessions: Create a study schedule that fits with your daily routine and breaks down your study goals into manageable tasks. Use tools like calendars, planners, or apps to help you stay on track.
  3. Minimize distractions: Find a quiet, well-lit space with comfortable seating and minimal distractions. Turn off your phone or other devices that may pull your attention away from studying.
  4. Use study aids: Experiment with different study aids like flashcards, diagrams, or mnemonic devices to help you retain information more effectively.
  5. Take breaks: To avoid burnout and maintain focus, take regular breaks every 30-45 minutes. During your breaks, do something relaxing like taking a walk or stretching.
  6. Stay motivated: Keep yourself motivated by rewarding yourself for achieving study goals, visualizing success, and surrounding yourself with positive support systems.

To become more efficient at studying, it’s important to develop strategies that address these challenges directly. For example, planning your study sessions and breaking down large goals into smaller, manageable tasks can help you stay focused and motivated. Creating a conducive study environment and using study aids can help you retain information more easily. Finally, taking regular breaks and staying positive can help you avoid burnout and stay motivated over time.

Ready to stay motivated this summer?

Give our question banks a try- FREE- using our Free Trial! Or if you’re ready to take the plunge, check out our Question Banks and find the perfect fit for you! Or, contact us with any questions you have so we can get you on the right path today!

Navigate Life Transitions Like A Pro

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How To Build Good Habits

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green vegetables indicating good eating habits

Developing good habits and implementing them into your daily routine is crucial for achieving success in all areas of your life. Habits are the small, repeated actions that we take each day that ultimately shape who we are and what we accomplish.
Good habits are essential because they help us make progress towards our goals, improve our health and well-being, and increase our overall productivity. By developing good habits, we can create a framework for success that allows us to achieve our desired outcomes consistently.

Forming habits

How to go about forming habits is the most difficult part. In order to start making positive changes and pushing yourself to create these small, repeated action, you must first identify what areas of your life you want improvement in. This requires some honest self-reflection. After you’ve identified your areas to work on, it helps to create a step-by-step plan for executing the changes.

For example, if you want to improve your health and fitness, establishing a habit of regular exercise and healthy eating is crucial. If you want to advance in your career, developing a habit of continuous learning and taking action towards your goals is necessary. If you want to improve your relationships, cultivating habits of active listening, showing appreciation, and communicating effectively can make all the difference.

Consequences of good habits

Implementing good habits into your daily routine requires commitment, consistency, and a bit of effort. However, the benefits of developing good habits are well worth the investment. By creating a routine that includes good habits, you can increase your productivity, reduce stress, and improve your overall quality of life. Moreover, the benefits of good habits extend beyond just achieving your desired outcomes. Developing good habits can also help you develop self-discipline, build self-confidence, and increase your sense of control over your life. By establishing good habits, you can create a solid foundation for long-term success and happiness.

In conclusion, developing good habits and implementing them into your daily routine is essential for achieving success in all areas of your life. Good habits are the building blocks of success, and they can help you create the life you desire. By committing to developing good habits, you can create a framework for success that will support you throughout your journey.

Ready to learn more?

Give our question banks a try- FREE- using our Free Trial! Or if you’re ready to take the plunge, check out our Question Banks and find the perfect fit for you! Or, contact us with any questions you have so we can get you on the right path today!

Syndrome Series: Obsessive Compulsive Disorder

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obsessive compulsive disorder shoes

What is Obsessive Compulsive Disorder

Obsessive Compulsive Disorder (OCD) is a condition characterized by the presence of obsessions and/or compulsions. Obsessions are recurrent thoughts, urges, or images that are intrusive and unwanted, while compulsions are repetitive behaviors or mental acts that are applied to the obsessions (or other rules) that are rigidly followed.

Types of Obsessions and Compulsions

The types of obsessions and compulsions vary broadly, although there are common themes. Stereotypical OCD symptoms showcased in media are fear of contamination accompanied by compulsive cleaning (seen famously on the TV show Monk). Other common themes include symmetry (organizing, ordering, or counting compulsions), morality (sexual, aggressive, or religious based compulsions), or harm (checking compulsions for fear of harming others). These themes are seen globally across cultures with minor variances.

The performance of the compulsion is done in an attempt to mitigate anxiety or distress associated with the obsession. Individuals with OCD typically have an impending sense of doom if they don’t perform the compulsions, or they may believe something horrific will occur if they do not perform the tasks. The individual with this condition finds distress in their compulsions and obsessions and avoiding the compulsion or obsession can take up a significant amount of time. Because of this, they may avoid of people or certain places in order to avoid a trigger for a compulsion.

Realistically, the action and obsessions are not connected in any significant way. However, the extent that the individual believes this depends on their insight.

Insight

Insight refers to how well the individual recognizes the credibility of their beliefs. They may have good or fair insight in which they realize their disordered beliefs are definitely or most likely untrue; poor insight in which they think their obsessive compulsive beliefs are probably true; or absent insight in which they are completely convinced their disordered beliefs are true.

Prevalence and Transmission

The average age of onset is 19.5 years old, with a quarter of cases starting by the age of 14. Females tend to be affected slightly more than males in adulthood, while males are more affected in childhood. The prevalence in the U.S. is 1.2%, with similar prevalence rates seen globally. There is a 2x rate of familial transmission among first degree relatives with the condition compared to those without first degree relatives with the condition.

First Line Treatments

Treatment options for OCD generally includes psychotherapy and pharmaceuticals. These can be used exclusively or in combination with each other.

Psychotherapy

Cognitive Behavioral Therapy (CBT) is one of the first line treatment options for OCD. CBT is effective in treating OCD by helping the individual become aware of the cognitive distortions present that are leading to their compulsive behavior. Once identified, the clinician can work with the patient to untangle how the obsession and compulsion are not directly related and ultimately remove the desire to complete the compulsion when faced with a trigger.

In addition to standard CBT, there is another type of CBT called Exposure and Response Prevention (ERP) that can be highly effective in the treatment of OCD. With this type of therapy, the client is systematically exposed to gradually increasing levels of the trigger for their compulsions and assisted in learning how to reject the compulsion.

Pharmaceuticals

Mayo clinic reports the following antidepressants approved by the U.S. Food and Drug Administration (FDA) to treat OCD:

  • Clomipramine (Anafranil) for adults and children 10 years and older
  • Fluoxetine (Prozac) for adults and children 7 years and older
  • Fluvoxamine for adults and children 8 years and older
  • Paroxetine (Paxil, Pexeva) for adults only
  • Sertraline (Zoloft) for adults and children 6 years and older

Additional Treatment Options

Other treatment options may be considered if first line treatments fail. These include Deep Brain Stimulation and Transcranial Magnetic Stimulation. These options are typically reserved for cases in which neither first line treatments have been found to be effective, and are generally used in patients over the age of 18. In both these treatment options, different neurological regions of the brain are stimulated using electrodes in order to suppress compulsive thoughts and behaviors.

Ready to learn more?

Give our question banks a try- FREE- using our Free Trial! Or if you’re ready to take the plunge, check out our Question Banks and find the perfect fit for you! Or, contact us with any questions you have so we can get you on the right path today!

REFERENCES:

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Mayo Clinic:https://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/diagnosis-treatment/drc-20354438#:~:text=Antidepressants%20approved%20by%20the%20U.S.,children%208%20years%20and%20older

Is the Multiple Choice Question Really the Worst?

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the word "what" on a pile of question marks for multiple choice question

Most standardized tests, such as the USMLE, PMHNP, PRITE, or ABPN, are in multiple choice question format. The difficulty of MCQ tests seem to vary across individuals. Some love them, some (most?) hate them. There’s a biological reason for this!

Have you noticed that taking a test based on multiple choice questions makes you think differently compared to taking a test based on essays? Multiple choice questions make your brain process information differently. Specifically, multiple choice questions rely on recognition, whereas essay and open ended questions rely on retrieval.

Recognition… plus a little more

When you’re presented with options to answer a question, your brain kicks into recognition mode. It will look for associated information it has seen before to bypass using retrieval (a process that takes more effort). While this is cut and dry, an interesting phenomena can occur in regard to the distractor answers, i.e., the incorrect answers.

You may disregard the incorrect answers because you recognize the correct option, but your brain tucks those incorrect options away. Later, when you are presented with a question related to those answers your brain can spontaneously retrieve those answers more easily because its seen them associated with questions before. Crazy, right? Even if the MCQ test primarily uses recognition, your brain MacGyvers it into a means of storing more information to use later!

Ready to learn more?

Want to boost your brain storage for FREE? Give our question banks a try- FREE- using our Free Trial! Or if you’re ready to take the plunge, check out our Question Banks and find the perfect fit for you! Or, contact us with any questions you have so we can get you on the right path today!

REFERENCES:

Little JL, Frickey EA, Fung AK. The role of retrieval in answering multiple-choice questions. J Exp Psychol Learn Mem Cogn. 2019 Aug;45(8):1473-1485. doi: 10.1037/xlm0000638. Epub 2018 Aug 16. PMID: 30113206.

Time to go back to the ABC’s

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Yes, we know you know your ABC’s 🙂 But, sometimes it helps to reinvent the old classics to help us in the here and now. We’ve compiled a quick list of test taking tips that might help you as you prepare for your exams ( using A-E, because those are the letters you’ll see on the exams and maybe that will help keep these in mind!).

ABC blocks

The ABC’s of Test Taking

A Apply basic knowledge

This is the old adage, if you hear hoof beats, don’t assume it’s zebras. When you get your first look at a test question, whether it’s a standard multiple choice or a multiset vignette, the first thing to do is to look for the obvious. Most questions will be testing your basic knowledge and will give you clear signs that point to an answer. Some will be trickier of course, but a good rule of thumb is to dust off Occam’s razor and keep it in mind as you go through the questions. Keep your basic knowledge front and center!

B Block out distractors

Test makers are devious. There, I said it. They intentionally create distractor answers that will try to trick you (so rude). Falling back on the letter A, keep your basic knowledge in mind and then block out the answers you see off the bat as incorrect. For example, you might be reading a question about someone who is lethargic, has a lack of appetite, low mood, and disrupted sleep. Answer options could be Bipolar I, General Anxiety, Depression, PMDD, or Substance Withdrawal. Now, some of these conditions do in fact share the listed symptoms. But there’s missing information that would be required to make those answers the BEST answer.

Bipolar I would require symptoms of mania; GAD has other hallmark symptoms such as feelings of dread/worry that they cannot control; PMDD is cyclical around menstrual cycles in females; substance withdrawal requires mention of something that would cause the withdrawal. The distractors are there to make you second guess, so if one pops out as the best one, chances are it probably is!

C Check the question stem again

Well, maybe the distractors did a good job and now you can’t get passed it. Go back and find the question stem again. What is the question asking? Does it give the information you would NEED to make the other answer fit, or are you banging a square peg into a round hole? While the test makers are tricky, they aren’t totally evil. They will give you all the information you need with minimal need to fill in the blanks.

D Don’t over think it!

Ok, we got through the distractors and now we have our answer, Depression! Makes sense, fits the symptoms…wait, doesn’t it need a time frame to make a diagnosis? What if it’s none of these answers and actually something like Dysthymia? Or– stop. Stop over thinking it. Again, this is the job of the distractors to make you start thinking in circles. If the answer fits the information given in the best way, move on to the next question.

E Every little bit helps

You get about one minute per question on the exams, so you want to crank out as many answers as possible. And, most exams don’t “penalize” wrong answers, they just add up your correct ones. Leaving answers blanks and guessing and getting it wrong will do the same thing to your score. But, guessing might also get you one right! So if you need to stab a guess at one, DO IT because there’s a chance you could get it right!

Want to give this method a shot? Try our Free Trial and see how well it pans out. We’d love to hear from you, and you can Contact us with any questions you have or to let us know if these tips helped you or not!

Clinical Vignettes and How to Ace Them

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tangled rope representing vignettes

What are clinical vignettes?

Clinical vignettes are a huge portion of most board exams. They present a scenario to the reader which includes key information they will need to answer a series of questions.

These questions may be syndrome related to identify a condition the case patient is being presented with; they may be symptom related to determine a symptom of a given condition based on the patient’s given history; or they may be treatment related to decide the best course of action for treatment of a given condition. Really, the sky is the limit when it comes to these tricky questions.

Vignettes are helpful learning tools. They hone in on your critical thinking, they test your attention to detail, and they provide a more realistic experience of how to discern information you’re given from a patient to make the best choices. Sometimes they can seem like a giant, tangled mess. Here’s how to untangle it and get started!

Where to start?

Let’s use an example (straight from our question banks!):

“Matt is a 13-year-old patient who is brought to see you because of behavioral problems. His parents report that in the last year Matt has had four separate occasions of intense aggression resulting in physical violence. The outbursts do not last long, typically abating within 20 minutes. The behavior is not in character for Matt and do not seem precipitated by a specifically intense trigger. In one instance he was unable to go to a friend’s house; he began screaming and hitting walls which lead to his hands becoming badly bruised. His outbursts are causing significant distress to his family, who are becoming more and more apprehensive of him harming them or himself. There have not been any major life events in the last year, and he is not diagnosed with any existing medical or mental conditions.“

Following this, you are presented with question such as: “What is the likely diagnosis?” or “What prognostic factors could have increased the likelihood of Matt developing this condition?”

Break it down

The first thing to do is look for key demographic and symptom information. In this vignette, we have an adolescent patient who is male. The vignette also tells us right away that he has behavioral issues. Knowing this narrows down the possibilities. Occam’s razor is true for most cases; you wouldn’t assume a 13-year-old is dealing with frontotemporal dementia for his behavior problems!

Next, look for symptoms ranges. This vignette tells us he’s been experiencing issues for the last year. This is important to know if the symptoms are a new, acute experience or something that has been persisting. It also helps as most diagnoses have requirements on how long symptoms must be present for.

Then, look for the 4 D’s: deviance, distress, dysfunction, and danger. Do the behaviors being presented fit into these criteria? Or is the patient experiencing sub-clinical symptoms with poor coping skills?

Process of Elimination, Vignettes style

Clinical vignettes are almost always multiple choice questions. You’ll be given five or more answer choices with each question and must choose the best option(s). Sometimes there’s more than one answer! Using our example above of “What is the likely diagnosis?“, you may be given answer options of:

A Oppositional defiant disorder
B Intermittent Explosive disorder
C Conduct disorder
D Disruptive Mood Dysregulation disorder
E Antisocial personality disorder

Least likely choices:

Now we need to look at each answer, and applying Occam’s razor, eliminate the least likely choices. Conduct disorder (choice C) does not match the presenting case as Matt does not show persistent disregard for other people or animals, deceitfulness or theft, or serious violation of rules. He does show intense aggression and destruction of property, but these are in brief occurrences and not a chronic issue.

Moving on to Disruptive mood dysregulation disorder (choice D), it also does not fit this scenario as it also requires the patient to have a persistent, irritable, negative mood most of the day every day; further, it cannot be diagnosed unless the behavior began before the age of 10. Matt’s parents have reported that this behavior has only been present for the last year in isolated incidents starting when Matt was 12.

Let’s look at Antisocial personality disorder (choice E). This condition cannot be diagnosed until the patient is 18, with specific disregard for the rights of others being present from the age of 15. Kick that one out.

And Oppositional defiant disorder (choice A). This is recognizable by persistent angry, irritable, vindictive, and argumentative behavior that is noticeable at least once a week for at least six months for Matt’s current age (attention to detail!).

Most likely choice:

Matt is presenting with symptoms that best match intermittent explosive disorder (choice B). His behavioral problems have only arisen in the last year with isolated incidents of intense, aggressive outbursts. The events are not precipitated by major life events or stressors, and the reaction is grossly disproportionate to the triggering incident.

Timing is Everything

The hardest part of mastering vignettes is being able to do them within time constraints. Generally, a board exam allows about 1 minute per question on the exam. 60 seconds is not a lot of time to gather all the information, discern what is valid or not, and eliminate the least likely options.

So what is the secret? The true key is practice, practice, practice. You know your DSM conditions, you know their criteria. You just have to practice the mechanics of gathering information and making critical choices from it. And what better way to do that than to give our clinical vignettes a try- totally FREE? – using our Free Trial!

We tailor each bank to the type of test you’re taking, whether that is Nurse Practitioner Mental Health Certification, ABPN, USMLE, or PRITE. You can take these practice exams over and over again until you get the hang of it. You can use a practice mode that doesn’t penalize for time, or you can use the timed mode that mimics the actual exam.

We want to help you MASTER clinical vignettes. They’re the part of exams most people do the worst on. Let’s tackle this and make it your strongest section! If you like what you see on the trial, check out our Question Banks and find the best option for you! Or, contact us with any questions you have so we can get you on the right path today!