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If you are planning to be part of the AFP, PNP, BJMP, and BFP, you need to undergo and pass the Neuro-Psychiatric exam. This examination will test the psychological functioning, adaptability, and mental stability of the applicants.

The main objective of the exam is to screen and evaluate the applicants if they are qualified to serve the armed services. This examination is the hardest part of the qualifying process. In every 100 applicants, oftentimes only 25% passes the exam.

Neuro-Psychiatric Exam coverage

If you will take the Neuro-Psychiatric test you need to pass the written exam so that you’ll qualify for the personal interview. The written exam is composed of the following:

• 35 item aptitude test
• Applicant Risk Profiler
• Guilford Zimmerman Temperament Survey
• Work Environment Preference Schedule
• The Industrial Sentence Completion Test
• Hand Test
• Drawing

Tips in Neuro-Psychiatric Pass the Written Exam

It’s not that easy to pass the Neuro-Psychiatric written test. Here are some tips that will help you nail the exam.

• Follow instructions

If you want to pass the exam, the first thing to do is to follow the instructions so that you will know what to do in answering the questions. The mere fact that you follow instructions will determine if you are capable to become a good policeman, soldier, jail officer, or fireman.

• Proper time management

The IQ test or the Aptitude test is comprised of 35 questions that should be completed within 15 minutes. The proctors are very particular about the time limit, thus you should not expect for an extension. To manage your time well, the best thing to do is to answer first the easy questions and go back to the difficult ones later.

• Be consistent

You should remember your answer for every question in the written exam. There are similar or related questions that need the same answer as the previous questions. In this case, make sure to be consistent in giving your answer, otherwise, it will be a sign of untruthfulness.

• Improve your English skills

You should also expect that the exam includes an essay. This will assess the ability and skill of the applicant about reporting. With this, you should improve your English writing skills specifically the grammar rules.

• Enhance your drawing skills

As mentioned earlier, the aptitude test includes drawing. That’s why the applicant should learn how to draw real people and not the stick figures. The object must have the eyes, ears, fingers, hairs, and other body parts.

After you draw, you will be asked to make a description to evaluate your point of view with another person. You need to be careful because anything that you draw and describes will be associated with your personality.

• Prepare for the personal interview

The last part of the Neuro-Psychiatric exam is the personal interview with the psychologist. This will determine how the applicant responds under pressure. As much as possible, you should answer cleverly, fluently, and consistently. Minimize doing unnecessary gestures or movements during the interview. Stand still when talking and be humble. Never show egocentric behavior otherwise the interviewer might be pissed off.

The Neuro-Psychiatric exam will determine if an individual is in his or her proper mindset. Be yourself and never pretend that you’re an extraordinary one. Be natural and consistent in answering the questions and avoid any violent words.

Do your best to answer all the questions thrown at you. The result of the exam will determine if you will pass or fail the Neuro-Psychiatric examination.

Whenever I see a patient in my office, I spend most of the visit talking, getting to know the patient and family and getting a thorough history. Really, this is the most important part of the visit. But I always do a mostly a neurological focused physical exam. There are certain findings which are common among patients with headaches, some notable particularly for migraine. I will review a typical neuro exam and share some clinical pearls in this post.

The nervous system is a complex network of fibers, woven throughout the entire body and responsible for both simple and complicated human functions. The neurologic exam is divided into several components, focusing on different parts of the nervous system. These components include: mental status, cranial nerves, motor system, sensory system, deep tendon reflexes, coordination and the cerebellum, and gait. Much of the exam can be done during the visit, prior to the formal exam, by interacting, observing and listening to the patient.

Mental status: This part of the neuro exam is done throughout the visit. The patient will answer questions about school and life, general functioning, any social concerns. You assess whether they are dressed appropriately, have good hygiene and assess their mood and interactions. Attention also needs to be paid to achievement of appropriate developmental milestones. In general, the child or teen with headache are alert and aware, conversant about a variety of topics, and age-appropriate, unless there is an underlying developmental delay or challenge, such as autism.

• One finding to think about is any side effect of medications; many of our daily medications can cause mental clouding, even in the smallest of doses. This is a little tricky to ascertain, most teens do not know what mental clouding means. I usually ask if they are having any trouble with memory, or unexpected school difficulties. Often they do not recognize this until I ask and are relieved to know it could be a medication side effect.
• Another important finding is their mental health status. Are they reporting any anxiety or depression, cutting, suicidal ideation, school avoidance? Are worries getting in their way at school, at home or with friends? We know there is a connection between headache and mental health challenges and need to address what they report and what we perceive.

Cranial nerves: Assessing the cranial nerves is done both formally and informally during the visit. You assess their hearing and speech, watch their facial and head movements. On the formal exam, you assess the function of the 12 cranial nerves by having them do a few maneuvers, checking out their eyes with the ophthalmoscope. A few assessments have implications for headache, such as:

Pnp Neuro Exam Reviewer Salary

• Assessing any scalp sensitivity: this may indicate any occipital nerve irritation, or central sensitization often seen in chronic headache/migraine. It would not be uncommon for a patient with chronic headache to report discomfort having their scalp even lightly palpated and then to report it hurts to brush their hair (central sensitization). If their occiput is painful, there may be neuralgia related to tension-type headaches.
• Assessing trigeminal distribution, making note of an increased level of sensitivity (prickly, tickly or discomfort) as you move laterally across cheek to above their ears with a pointy object. This is documented as sensitivity within the distribution of the nucleus caudalis, and a common finding in migraine.
• Assessing eye movements, being especially aware of any nystagmus or convergence insufficiency. Inability to cross the eyes can have a negative effect, especially with balance or reading, leading to eye fatigue and blurry vision. Convergence insufficiency can be treated by specific eye exercises/therapy or glasses. This tends to be more bothersome in high school/college age students, mainly because they have a lot of reading to do.
• Assessing facial movements for symmetry and differences, assessing tongue movement (dysarthria, dysphagia), which can indicate developmental anomalies.
• Assessing for facial pain within trigeminal nerve distribution, leading to a diagnosis of trigeminal neuralgia or atypical facial pain.
• Fundoscopic eye exam: looking for clear optic disk margins, intact light reflexes, normal venous pulsations, assessing for papilledema indicating increased ICP.

Motor system: You assess the motor system by looking at the strength and tone of muscle groups, looking for asymmetry, atrophy, abnormal movements, or pain with movement, and any baseline changes over time.

• Assessing for any jaw asymmetry, jaw clicking or discomfort by palpating the TMJ. This can indicate teeth grinding or clenching related to anxiety or TMJ dysfunction which can be a source of headache.
• Assessing general motor function for what is developmentally appropriate, as well as what can be expected of certain underlying conditions, such as cerebral palsy.
• Certain brain vascular abnormalities, such as AVM, could lead to extremity weakness and/or atrophy and cause headache.
• Palpating the neck/upper back area for tightness or tenderness can indicate a pain source/trigger point for tension-type headache.
• Observing neck movement (flex forward, bend backward) can uncover any meningeal irritation; having the patient bend forward (L’hermitte sign) can reveal any spinal column irritation. Both findings are concerning and require further investigation.

Sensory system: Sensation relies on impulses from stimulation of receptors in all parts of the body and sent to the central nervous system. When you assess the sensory system, you are looking for any abnormal sensation, by checking temperature, vibration, pressure and position. Differences in sensation can be a part of the neurologic system for the patient, not necessarily pathologic.

• Patients with migraine can have differences in sensation at baseline. They might feel cold, vibration, pressure, or prickliness more acutely on one side of the body than the other. This is part of being a migraineur, especially in pediatrics.

• Sensitivity felt as pain to light touch (allodynia) anywhere in the body is an abnormal finding and can indicate possible nerve compression or injury, or in the scalp, central sensitization.

Deep tendon reflexes: Involuntary responses to a specific stimulus are reflexes. Alterations can be the first indicator of neurologic dysfunction. Unless there is an underlying condition which impedes function, patients with headache should have intact reflexes.

• Often patients with chronic headache (migraine, NDPH) will be hyper-reflexive (get out of the way to avoid getting kicked). This is generally a manifestation of a sensitive autonomic nervous system, very common among these patients.
• Patients who are hypo-reflexive could have an underlying thyroid insufficiency, so ruling that out would be worthwhile. Also hypothyroid can be associated with migraine.

Coordination and the cerebellum: The cerebellum controls voluntary movement and motor coordination. Testing coordination provides information about cerebellar functioning and includes: finger-to-nose testing, alternate hand flipping, finger tapping, heel-to-shin movement.

• Assessing for coordination in younger children is also an assessment of development; young children often have some difficulty with the smoothness of their hand flipping or finger-to-nose. Patients with headache do not generally show abnormality in this area.
• Hopping is an easy way to assess coordination and balance, and fun to do.
• Standing on one leg also tests balance; one side is often more wobbly in the average person
• The Romberg maneuver is a test used to assess for balance, and is useful when assessing concussion, sitting and standing. The premise is that a person requires at least two of the three following senses to maintain balance: proprioception; vestibular function; and vision. After mild head trauma, symptoms of unbalance and unsteadiness often last longer than for people without headaches.

Pediatric Nurse Practitioner Review Guide

Gait: Assessing gait is the assessment of a very intricate physiological process involving motor, sensory, and balance systems. It can be a window into any challenges in the nervous system. There are normal developmental differences in the gait of our young children and teenagers, with/without headaches, and in the gait of those who are recovering from concussion. Observing gait involves watching them walk, run and doing heel-toe walking. Much of this can be done just escorting them down the hall to the exam room.

• Assessing heel-toe walking in the concussion patient provides clues to their recovery. Most patients immediately post-concussion have difficulty with this, improving over time. Can they do heel-toe walking? If so, perhaps they can return to their usual activity. If not, they are not quite ready.
• Watching your patient run in the hallway is a good assessment of whether or not they are ready to embrace a multidisciplinary approach to functioning. If they are able to tolerate a brief run, they are ready to be more physically active and be successful increasing their aerobic activity.

There is a whole other group of exam findings commonly found among people with headache and are as a result of autonomic nervous system dysfunction. I will review this in a later post, as it is an important aspect of headache care, but too much information to get into here. Stay tuned….

These are the basics involved in a neurologic exam, and some specific findings often seen in a patient with headaches. With the information provided, hopefully you will pick up on any unusual findings, which are not unusual for the headache patient.