Quantum Units Education®

Primary Prevention-Discussion

1. One personality trait that has been demonstrated to buffer against traumatic stress and PTSD is:

2. Individuals can be trained to cope with acute stress reactions that are common following trauma exposure as long as training includes specific, practical actions to change the threatening situation for the better.

Discussion

3. A greater risk for developing PTSD is likely conveyed by pre-trauma factors rather than post-trauma factors.

Secondary Prevention-Background

4. PTSD is often difficult to treat because of poor patient/provider rapport, anger and distrust, __________________________, and other trauma-related problems.

Special Screening of Cultural or Racial Groups:

5. While there is data to suggest that whites/Caucasians experience higher rates of PTSD than other racial groups, this may be due to the higher rates of accessing treatment services.

Warning Signs of Trauma-Related Stress

6. Which of the following is NOT a correct statement about the warning signs of trauma-related stress?

Stress-Related Disorders and Syndromes Definitions

7.   Combat and Operational Reaction (COSR) is the term used to describe an acute stress reaction in the combat environment, and can include physical and neurological symptoms resulting from exposure to extremely stressful events or combat experiences.

Post-Traumatic Stress Disorder (PTSD)

8. Acute PTSD occurs when clinically significant symptoms continue to cause significant distress or impairment in social, occupational, or other important areas of functioning, lasting more than six weeks but less than 4 months after exposure to trauma.

Table CORE - 1 Common Signs & Symptoms Following Exposure to Trauma

9. Confusion, hyper-vigilance, and poor decision-making fall into which category of signs and symptoms following trauma?

Educate About Additional Care If Needed-Background

10. Contemporary approaches to early intervention following trauma exposure emphasize the importance of "normalization" of acute stress reactions while emphasizing that distressing reactions are common, normal responses to the extreme events.

Evidence

11. For asymptomatic trauma survivors, routline single or multiple psychotherapeutic interventions as well as psychological debriefings are recommended.

12. According to the World Health Organization, the symptoms of ASR usually appear within minutes of the impact of the stressful stimulus or event and disappear within:

Assessment & Triage-Combat or Operational Stress Reaction (COSR)

13. While a COSR can result from a specific traumatic event, it generally emerges from cumulative exposure to multiple stressors.  

Assess Briefly Based on General Appearance and Behavior-Recommendations

14. Individuals should be screened for ASR when they exhibit each of the following responses to trauma EXCEPT:

Unstable, Dangerous to Self or Others, or Need for Urgent Medical Attention-Discussion

15. Although self-destructive and impulsive behaviors are not part of the core PTSD symptom complex, they are recognized as associated features of this disorder and may profoundly affect clinical management.

Ensure Basic Physical Needs Are Met

16. Early interventions for trauma victims with acute stress symptoms should typically seek to address the needs of the individual person, with the aim of promoting normal recovery, resiliency, and personal growth, as well as avoiding additional harm.

Table A-2 Key Elements of Psychological First Aid (PFA)

17. Key elements of Psychological First Aid include each of the following EXCEPT:

Specific Interventions for COSR

18. Combat Operation Stress Control (COSC) utilizes the management principles of brevity, immediacy, contact, expectancy, proximity, and:

Person Has Trauma Related Symptoms-Acute Stress Disorder (ASD)

19. As many as 75% of individuals who experience sexual assault will have acute stress symptoms but not ASD.

Assess Medical and Functional Status

20. Medical status should be obtained for all persons presenting with symptoms of ASR and should always include toxicology screen and laboratory status to rule out medical disorders.

Initiate Brief Interventions-Early Intervention After Exposure to Trauma

21. The early intervention that has been shown to have significant benefit from 4 to 30 days after trauma exposure is:

Acute Symptom Management

22. Acute system management for survivors of trauma many include a short course of medication for specific symptoms such as insomnia, pain management or excessive arousal.  

Persistent or Worsening Symptoms, Significant Functional Impairment, or High Risk for Development of PTSD

23. When individuals fail to respond to early interventions and need to be referred for PTSD treatment, primary care providers should continue evaluating and treating co-morbid physical illnesses and other health concerns.

Monitor and Follow Up

24. Those exposed to traumatic events and who manifest no or few symptoms after approximately  __________ do not require routine follow-up but follow-up should be provided if requested.

Assessment of Stress Related Symptoms

25. Feeling irritable, having difficulty concentrating, and having sudden outbursts of anger fall under the PTSD symptom cluster of intrusion.

Assessment of Dangerousness to Self or Others-Recommendations

26. Which of the following is NOT one of the current risks or historical patterns of risk that should be considered when assessing PTSD patients for safety and dangerousness.

Obtain Medical History, Physical Examination, Laboratory Tests and Psychosocial Assessment

27. Multiple studies indicate the rate of medical disease at ___________ in patients presenting with psychiatric symptoms.

Medical and Psychiatric History-Other Evaluation

28. Diagnostic imaging and neuropsychological testing are generally part of the standard evaluation for PTSD.

Assessment of Risk/Protective Factors

29. Of the population of persons who experience a traumatic event, only a subset will ultimately develop PTSD, but studies indicate that after 9 to 12 months, 15 to 25 percent continue to be disturbed by these symptoms.

Pre-Traumatic Factors

30. Experts report that a history of exposure to interpersonal violence, in childhood or adulthood, substantially increase the risk for chronic PTSD following exposure to any type of traumatic event.

Peri-Traumatic Factors

31. Numerous studies have addressed peri-traumatic factors and findings have indicated that:

Diagnosis of PTSD or Clinical Significant Symptoms Suggestive of PTSD

32. Approximately 70% of patients with a mental health diagnosis are seen in primary care, so providers must be prepared to treat stress-related issues and other psychiatric disorders.

Assess for Co-Occurring Disorders

33. Patients with PTSD frequently use alcohol, nicotine and other substances in maladaptive ways to cope with their symptoms, and approximately _______ of PTSD patients treated in the VA have current substance use problems.

Personality Disorders

34. When PTSD is a known or suspected disorder, primary care physicians should be sure to identify and diagnose co-existing personality disorders in order to differentiate treatment strategies.  

Management of PTSD with Co-Morbidity

35. Integrated care models where physical and mental health needs are addressed in a single setting by a multidisciplinary provider team have potential to reduce perceived stigma associated with help-seeking in those with PTSD and co-morbidity.

Management of Concurrent PTSD and Substance Use Disorder

36. Which of the following accurately describes co-occurring PTSD and substance use disorder?

Establishing Therapeutic Alliance

37. Many people with PTSD find that they have difficulty trusting others, are suspicious of authority, dislike even minor annoyances, and generally want to be left alone, all which need to be acknowledged when establishing the therapeutic relationship.

Assess Response to Treatment

38. Patients should be assessed at least every six months after initiating treatment for PTSD in order to monitor changes in clinical status and revise the intervention plan accordingly.

Follow-Up/Background

39. If follow up indicates that the patients status has not improved or the status has worsened, each of the follow treatment modifications may be recommended EXCEPT:

Patient Demonstrates Improved Symptoms and Functioning but Requires Maintenance

40. When a PTSD patient has made slight to moderate improvement but still shows impairment in functioning, continuation of the patient treatment may be recommended to allow for further acquisition of needed skills and to allow time for patient compliance.