Neurology/Psychiatry Exam #3 (ADHD/MS)

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| By Kmccor2008
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  • 1/36 Questions

    Which of the following is NOT a characteristic of Autism Spectrum Disorders?  

    • Delusions
    • Impaired nonverbal/verbal communication
    • Impaired social interactions
    • Repetitive behaviors
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About This Quiz

This quiz focuses on ADHD and MS, assessing knowledge of DSM-V criteria, genetic factors, neurotransmitter involvement, and treatment methods like Methylphenidate. It's designed for those studying or practicing in the fields of neurology and psychiatry.

Neurology/Psychiatry Exam #3 (ADHD/MS) - Quiz

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  • 2. 

    Genetics plays a significant role in ADHD etiology.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    Genetics are known to have a significant influence on the development of ADHD. Research has shown that ADHD tends to run in families, with a higher likelihood of the disorder occurring in individuals who have close relatives with ADHD. Twin studies have also provided evidence for a genetic component, as identical twins (who share 100% of their genes) are more likely to both have ADHD compared to fraternal twins (who share only 50% of their genes). This suggests that there is a hereditary factor involved in ADHD etiology, supporting the statement that genetics play a significant role in ADHD.

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  • 3. 

    In treatment of major depressive disorder in pediatric patients, combination cognitive behavior therapy and SSRI are better than either treatment alone

    • True

    • False

    Correct Answer
    A. True
    Explanation
    The statement suggests that combining cognitive behavior therapy (CBT) with selective serotonin reuptake inhibitors (SSRIs) is more effective in treating major depressive disorder in pediatric patients compared to using either treatment alone. This implies that the combination of therapy and medication provides better outcomes and symptom relief for pediatric patients with depression.

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  • 4. 

    What is the correct treatment of an acute exacerbation of MS symptom attacks?  

    • ABC-R therapy

    • High dose IV corticosteroids

    • Mitoxantrone trial

    • Fingolimod

    Correct Answer
    A. High dose IV corticosteroids
    Explanation
    methlyprednisolone 500-1000mg IV, 3-5days

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  • 5. 

    Which medication is FDA approved as a pharmacologic option for Autism Spectrum Disorders?

    • Atomoxetine

    • Clonidine

    • Guanficine

    • Risperidone

    Correct Answer
    A. Risperidone
    Explanation
    Risperidone is FDA approved as a pharmacologic option for Autism Spectrum Disorders. This medication is an atypical antipsychotic that helps in managing symptoms such as irritability, aggression, and self-injurious behavior in individuals with autism. It works by affecting certain chemicals in the brain that may be imbalanced in people with this disorder. Risperidone is commonly prescribed alongside behavioral therapy to provide comprehensive treatment for individuals with Autism Spectrum Disorders.

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  • 6. 

    Which cell type or proteins is/are most responsible in the pathophysiology of Multiple Sclerosis?  

    • B-cells

    • Ctyokines

    • Macrophages

    • T-lymphocytes

    Correct Answer
    A. T-lymphocytes
    Explanation
    T-lymphocytes can be auto-reactive and cause damage to the myelin sheath and axon. They can also induce pro-inflammatory response, causing further damage

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  • 7. 

    When treatment with Stimulants results in increased tics, treatment for ADHD with clonidine (catapres) can be considered.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    When treatment with stimulants, commonly used for ADHD, leads to an increase in tics, it is recommended to consider an alternative treatment option. Clonidine, also known as Catapres, is a medication that can be used to treat ADHD symptoms. It works by affecting certain chemicals in the brain and can help reduce impulsivity and hyperactivity. Therefore, it is true that treatment with clonidine can be considered when stimulants result in increased tics.

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  • 8. 

    >70% of cases are genes associated with ADHD

    • True

    • False

    Correct Answer
    A. True
    Explanation
    The given statement suggests that a majority (more than 70%) of ADHD cases are linked to genes. This means that genetics play a significant role in the development of ADHD. It implies that individuals with a family history of ADHD are more likely to have the condition themselves. This information aligns with previous research that has found a strong genetic component in ADHD.

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  • 9. 

    Which of the following SSRI is NOT expert recommended in treatment of major depressive disorder in pediatric patients?

    • Fluoxetine

    • Citalopram

    • Sertraline

    • Paroxetine

    Correct Answer
    A. Paroxetine
    Explanation
    Paroxetine is not expert recommended in the treatment of major depressive disorder in pediatric patients. This may be due to the fact that paroxetine has been associated with an increased risk of suicidal thoughts and behaviors in this population. Other SSRIs such as fluoxetine, citalopram, and sertraline are considered safer and more effective options for pediatric patients with major depressive disorder.

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  • 10. 

    The transdermal methylphenidate patch is as effective as other formulations

    • True

    • False

    Correct Answer
    A. True
    Explanation
    The statement suggests that the transdermal methylphenidate patch is equally effective as other forms of the medication. This implies that the patch can deliver the drug in a manner that is just as effective as oral or other administration methods. Therefore, the answer is true.

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  • 11. 

    Which of the following statements about ABC-R Drugs administration is FALSE?  

    • Injection site should be iced before and after injection

    • Injection sites should be rotated

    • Medication should be at body temperature before injection

    • Medication should be well mixed, via the 10-second shake technique, before administration

    Correct Answer
    A. Medication should be well mixed, via the 10-second shake technique, before administration
    Explanation
    Never shake (Harlem or otherwise) before administration

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  • 12. 

    Which Methylphenidate mediation has an osmotic release, which extends its effect up to 12 hours?

    • Strattera

    • Concerta

    • Vyvanse

    • Daytrana

    Correct Answer
    A. Concerta
    Explanation
    Concerta is the correct answer because it is a methylphenidate medication that has an osmotic release system. This system allows for a gradual and controlled release of the medication over a 12-hour period, extending its effect throughout the day. Strattera, Vyvanse, and Daytrana are not methylphenidate medications and do not have an osmotic release system.

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  • 13. 

    Which of the follow prognostic indicators of MS DOES NOT indicate an unfavorable prognosis?  

    • Age > 40

    • Female

    • Cerebellar symptoms

    • Progressive course of disease

    Correct Answer
    A. Female
    Explanation
    While more common in females, prognosis is better for females.

    (Note: Double negative is used in this question so that quiz-takers know other options are indicators of unfavorable prognosis. Therefore, use of this double negative is perfectly cromulent).

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  • 14. 

    Which of the follow is not a precaution in use of atomoxetine (Strattera)?

    • Blood dyscrasia

    • Liver injury

    • Urinary retention

    • Suicidal ideation

    Correct Answer
    A. Blood dyscrasia
    Explanation
    While blood dyscrasias are not a common precaution, sudden cardiac event are a major potential risk.

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  • 15. 

    What is the starting/titration dose of atomoxetine (Straterra)?

    • 0.1 mg/kg/day

    • 0.5 mg/kg/day

    • 1 mg/kg/day

    • 5 mg/kg/day

    Correct Answer
    A. 0.5 mg/kg/day
    Explanation
    The starting/titration dose of atomoxetine (Straterra) is 0.5 mg/kg/day. This means that for every kilogram of body weight, a starting dose of 0.5 mg of atomoxetine should be administered daily. This dose is commonly used to initiate treatment with atomoxetine and can be adjusted based on the individual's response and tolerability.

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  • 16. 

    Which of the following statements about Interferon-B is FALSE?  

    • Common flu-like symptoms may last months and be treated by short course oral prednisone

    • Monitoring includes CBC, platelets, and LFTs

    • Side effect profiles are dependent on choice of Interferon-type (1a, 1b)

    • Treatment in patients with severe depression is contraindicated

    Correct Answer
    A. Side effect profiles are dependent on choice of Interferon-type (1a, 1b)
    Explanation
    Similar side effect profiles

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  • 17. 

    Which medication increases synaptic cleft levels of dopamine?

    • Amphetamine

    • Methylphenidate

    • All of the above

    Correct Answer
    A. All of the above
    Explanation
    Amphetamine and methylphenidate are both stimulant medications that increase the levels of dopamine in the synaptic cleft. They work by blocking the reuptake of dopamine, allowing it to remain in the synapse for a longer period of time. This increased dopamine availability can lead to increased stimulation and improved focus in individuals with conditions such as attention deficit hyperactivity disorder (ADHD). Therefore, both amphetamine and methylphenidate can increase synaptic cleft levels of dopamine.

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  • 18. 

    Which of the following statements about Fingolimod (Gilenya) is FALSE?  

    • Includes ophthalmologic exam as monitoring for safety

    • Increased risk of life-threatening infections and tumor development

    • Modulates sphingosine-1-phosphate receptor

    • Used as a limited expense, limited efficacy alternative to Interferon and glatiramer

    Correct Answer
    A. Used as a limited expense, limited efficacy alternative to Interferon and glatiramer
    Explanation
    Shows significant reduction in disability progression, but is very expensive

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  • 19. 

    When would atomoxetine (Strattera) NOT be an alternative 1st line treatment?

    • Anxiety disorder

    • Intolerance to methylphenidate

    • Metabolic disease

    • Substance abuse disorder

    Correct Answer
    A. Metabolic disease
    Explanation
    “Metabolic disease” was not on the list provided on Slide 32 of Dr. Howrie’s notes. I’m a bad person for giving into “da man” and just went with a list.

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  • 20. 

    Which of the following statements about ADHD in children is FALSE?

    • 90% respond to stimulant(s) alone

    • Long-acting formulations are more preferred

    • Lower doses for hyperactive type ADHD, higher doses for inattentive or combined form

    • Medications are best studied in this age group

    Correct Answer
    A. Lower doses for hyperactive type ADHD, higher doses for inattentive or combined form
    Explanation
    Hyperactive/combined form = higher dose, Inattentive = lower dose

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  • 21. 

    Which qualities of bupropion (Wellbutrin) is FALSE?

    • Selective Norepinephrine reuptake inhibitor

    • Used mainly in adults

    • Lacks potential for abuse

    • Does have risk of seizures

    Correct Answer
    A. Selective Norepinephrine reuptake inhibitor
    Explanation
    Bupropion is a mild DA and NE reuptake inhibitor

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  • 22. 

    Which of the follow would NOT be consider a common, specific adverse effect of stimulants?

    • Anorexia

    • Ataxia

    • Headache

    • Mood changes

    Correct Answer
    A. Ataxia
    Explanation
    Ataxia refers to the loss of coordination of muscle movements, which is not commonly associated with the use of stimulants. Stimulants typically increase alertness, energy, and focus, but they can also have side effects such as anorexia (loss of appetite), headache, and mood changes. However, ataxia is not a commonly reported adverse effect of stimulant use.

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  • 23. 

    Methylphenidate (MPD) decreases dopamine and norepinephrine levels by inhibiting monoamine transporters. Specifically, decreasing dopamine causes improved signal-to-noise ratio improving attention span. 

    • True

    • False

    Correct Answer
    A. False
    Explanation
    MPD = inhibited monoamine transporter = increase dopamine & norepinephrine
    Increased dopamine = increase signal-to-noise ratio = less distraction

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  • 24. 

    Fill in the blanks: According to the DSM-V (through future-magic) the diagnosis of ADHD in patient <17 years old requires ______ symptoms and the diagnosis of ADHD in patients >17 years old requires ______ symptoms.

    • 4 symptoms; 4 symptoms

    • 4 symptoms; 5 symptoms

    • 4 symptoms; 6 symptoms

    • 5 symptoms; 4 symptoms

    • 5 symptoms; 5 symptoms

    • 5 symptoms; 6 symptoms

    • 6 symptoms; 4 symptoms

    • 6 symptoms; 5 symptoms

    • 6 symptoms; 6 symptom

    Correct Answer
    A. 6 symptoms; 4 symptoms
    Explanation
    According to the DSM-V, the diagnosis of ADHD in patients under 17 years old requires 6 symptoms, while the diagnosis of ADHD in patients over 17 years old requires 4 symptoms.

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  • 25. 

    Which of the following statements about mitoxantrone (Novantrone) is FALSE?  

    • FDA approve for secondary progressive, progressive relapsing, or relapsing-remitting MS

    • FDA approval for use as monotherapy

    • May cause blue-green discoloration of urine or eyes

    • Requires monitoring of ejection fraction before each dose

    Correct Answer
    A. FDA approval for use as monotherapy
    Explanation
    Often used in conjunction with interferon and glatiramer

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  • 26. 

    Which neurotransmitters are KNOWN to be involved in ADHD? (Select all that apply)

    • Dopamine

    • Norepinephrine

    • Serotonin

    • GABA

    • Acetylcholine

    Correct Answer(s)
    A. Dopamine
    A. Norepinephrine
    Explanation
    DA and NE, the are only “possibly involved”

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  • 27. 

    In addition to dopamine modification, what effect do Amphetamine and Methlyphenidate have on neuroanatomy of Norepinephrine neurons?

    • Suppress locus coeruleus NE neurons

    • Activate locus coeruleus NE neurons

    • Suppress decimus meridius NE neurons

    • Activate decimus meridius NE neurons

    Correct Answer
    A. Suppress locus coeruleus NE neurons
    Explanation
    The locus coeruleus NE neurons are involved in arousal and attention. Their suppression improves the therapeutic effect of these psycho stimulants.
    (Note: decimus meridius = Maximus Decimus Meridius = main character from the movie “Gladiator”)

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  • 28. 

    Which medication blocks dopamine transporters, preventing uptake from the synaptic cleft?

    • Amphetamine

    • Methlyphenidate

    • All of the above

    Correct Answer
    A. Methlyphenidate
    Explanation
    Amphetamine’s MoA relies on modification of vesicle release of dopamine

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  • 29. 

    Alpha-2-Adrenoceptor agonists (clonidine and guanfacine) _____  NE release in the locum coeruleus

    • Stimulate

    • Inhibit

    Correct Answer
    A. Inhibit
    Explanation
    Alpha-2-Adrenoceptor agonists such as clonidine and guanfacine are known to inhibit norepinephrine (NE) release in the locus coeruleus. The locus coeruleus is a region in the brainstem that plays a key role in regulating arousal and attention. By inhibiting NE release in this region, alpha-2-Adrenoceptor agonists can decrease sympathetic outflow and produce sedative and antihypertensive effects.

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  • 30. 

    Which of the following statements about glatiramer acetate (Copaxonxe) is FALSE?  

    • Pregnancy Category B

    • No flu-like symptoms or drug monitoring required

    • Relapse rates are comparable to interferon

    • Used in treatment of progressive relapsing MS (PRMS)

    Correct Answer
    A. Used in treatment of progressive relapsing MS (PRMS)
    Explanation
    Used in the treatment of relapsing-remitting MS (RRMS)

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  • 31. 

    Which of the following is TRUE about Atomoxetine (Strattera)?

    • Up to 3 weeks (5 half lives) to have full effect

    • Moderate potential for abuse

    • Only drug approved by the FDA for adult ADHD

    • Requires multiple daily dosing at maintenance levels

    Correct Answer
    A. Only drug approved by the FDA for adult ADHD
    Explanation
    3-6 weeks to have full effect (Half life - 5 hours, Wikipedia)
    No potential for abuse
    Only drug approved by the FDA for adult ADHD
    May be taken once a day (effects lasts 24 hr with a carry over to the next day)

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  • 32. 

    Focalin (or Dexmethlyphenidate) contains only the d-isomer of methylphenidate. As a result, the dose is 50% lower than methylphenidate and while efficacy is the same, tolerability of the medication is increased.

    • True

    • False

    Correct Answer
    A. False
    Explanation
    Focalin is Dexmethlyphendiate. Dose is lowered by 50%. Efficacy and tolerability is the same as methlyphenidate.

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  • 33. 

    Within how long is typical onset of guanfacine treatment in ADHD experienced?

    Correct Answer
    A.
    Explanation
    Howrie notes (slide 40) says guanfacine treatment onset < 1week, but Hammond Note (slide 45) mentions that Alpha-2 adrenoceptor agonists require 4-5 weeks. This questions assumes onset- < 1week, trial- requires 4-5weeks

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  • 34. 

    Natalizumab (Tysabri) was permitted by the FDA to be reintroduced as an adjunctive therapy for Relapsing-remitting MS with the black box warning of Progressive multifocal leukocephalopathy (PML) and only through the TOUCH prescribing program  

    • True

    • False

    Correct Answer
    A. False
    Explanation
    Reintroduced as a monotherapy (not adjunctive)

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  • Current Version
  • Mar 20, 2023
    Quiz Edited by
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  • Apr 02, 2013
    Quiz Created by
    Kmccor2008

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