Neurology/Psychiatry Exam #3 (ADHD/MS)
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- 1.
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.
- A.
4 symptoms; 4 symptoms
- B.
4 symptoms; 5 symptoms
- C.
4 symptoms; 6 symptoms
- D.
5 symptoms; 4 symptoms
- E.
5 symptoms; 5 symptoms
- F.
5 symptoms; 6 symptoms
- G.
6 symptoms; 4 symptoms
- H.
6 symptoms; 5 symptoms
- I.
6 symptoms; 6 symptom
Correct Answer
G. 6 symptoms; 4 symptomsExplanation
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.Rate this question:
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- 2.
Genetics plays a significant role in ADHD etiology.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
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.Rate this question:
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- 3.
>70% of cases are genes associated with ADHD
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
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.Rate this question:
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- 4.
Which neurotransmitters are KNOWN to be involved in ADHD? (Select all that apply)
- A.
Dopamine
- B.
Norepinephrine
- C.
Serotonin
- D.
GABA
- E.
Acetylcholine
Correct Answer(s)
A. Dopamine
B. NorepinephrineExplanation
DA and NE, the are only “possibly involved”Rate this question:
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- 5.
Methylphenidate (MPD) decreases dopamine and norepinephrine levels by inhibiting monoamine transporters. Specifically, decreasing dopamine causes improved signal-to-noise ratio improving attention span.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
MPD = inhibited monoamine transporter = increase dopamine & norepinephrine
Increased dopamine = increase signal-to-noise ratio = less distractionRate this question:
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- 6.
Which medication blocks dopamine transporters, preventing uptake from the synaptic cleft?
- A.
Amphetamine
- B.
Methlyphenidate
- C.
All of the above
Correct Answer
B. MethlyphenidateExplanation
Amphetamine’s MoA relies on modification of vesicle release of dopamineRate this question:
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- 7.
Which medication increases synaptic cleft levels of dopamine?
- A.
Amphetamine
- B.
Methylphenidate
- C.
All of the above
Correct Answer
C. All of the aboveExplanation
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.Rate this question:
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- 8.
In addition to dopamine modification, what effect do Amphetamine and Methlyphenidate have on neuroanatomy of Norepinephrine neurons?
- A.
Suppress locus coeruleus NE neurons
- B.
Activate locus coeruleus NE neurons
- C.
Suppress decimus meridius NE neurons
- D.
Activate decimus meridius NE neurons
Correct Answer
A. Suppress locus coeruleus NE neuronsExplanation
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”)Rate this question:
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- 9.
Which qualities of bupropion (Wellbutrin) is FALSE?
- A.
Selective Norepinephrine reuptake inhibitor
- B.
Used mainly in adults
- C.
Lacks potential for abuse
- D.
Does have risk of seizures
Correct Answer
A. Selective Norepinephrine reuptake inhibitorExplanation
Bupropion is a mild DA and NE reuptake inhibitorRate this question:
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- 10.
Which of the following is TRUE about Atomoxetine (Strattera)?
- A.
Up to 3 weeks (5 half lives) to have full effect
- B.
Moderate potential for abuse
- C.
Only drug approved by the FDA for adult ADHD
- D.
Requires multiple daily dosing at maintenance levels
Correct Answer
C. Only drug approved by the FDA for adult ADHDExplanation
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)Rate this question:
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- 11.
Alpha-2-Adrenoceptor agonists (clonidine and guanfacine) _____ NE release in the locum coeruleus
- A.
Stimulate
- B.
Inhibit
Correct Answer
B. InhibitExplanation
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.Rate this question:
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- 12.
Which Methylphenidate mediation has an osmotic release, which extends its effect up to 12 hours?
- A.
Strattera
- B.
Concerta
- C.
Vyvanse
- D.
Daytrana
Correct Answer
B. ConcertaExplanation
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.Rate this question:
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- 13.
The transdermal methylphenidate patch is as effective as other formulations
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
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.Rate this question:
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- 14.
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.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Focalin is Dexmethlyphendiate. Dose is lowered by 50%. Efficacy and tolerability is the same as methlyphenidate.Rate this question:
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- 15.
Which of the follow would NOT be consider a common, specific adverse effect of stimulants?
- A.
Anorexia
- B.
Ataxia
- C.
Headache
- D.
Mood changes
Correct Answer
B. AtaxiaExplanation
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.Rate this question:
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- 16.
When would atomoxetine (Strattera) NOT be an alternative 1st line treatment?
- A.
Anxiety disorder
- B.
Intolerance to methylphenidate
- C.
Metabolic disease
- D.
Substance abuse disorder
Correct Answer
C. Metabolic diseaseExplanation
“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.Rate this question:
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- 17.
Which of the follow is not a precaution in use of atomoxetine (Strattera)?
- A.
Blood dyscrasia
- B.
Liver injury
- C.
Urinary retention
- D.
Suicidal ideation
Correct Answer
A. Blood dyscrasiaExplanation
While blood dyscrasias are not a common precaution, sudden cardiac event are a major potential risk.Rate this question:
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- 18.
What is the starting/titration dose of atomoxetine (Straterra)?
- A.
0.1 mg/kg/day
- B.
0.5 mg/kg/day
- C.
1 mg/kg/day
- D.
5 mg/kg/day
Correct Answer
B. 0.5 mg/kg/dayExplanation
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.Rate this question:
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- 19.
When treatment with Stimulants results in increased tics, treatment for ADHD with clonidine (catapres) can be considered.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
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.Rate this question:
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- 20.
Within how long is typical onset of guanfacine treatment in ADHD experienced?
- A.
- B.
- C.
- D.
Correct Answer
B.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 4-5weeksRate this question:
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- 21.
Which of the following statements about ADHD in children is FALSE?
- A.
90% respond to stimulant(s) alone
- B.
Long-acting formulations are more preferred
- C.
Lower doses for hyperactive type ADHD, higher doses for inattentive or combined form
- D.
Medications are best studied in this age group
Correct Answer
C. Lower doses for hyperactive type ADHD, higher doses for inattentive or combined formExplanation
Hyperactive/combined form = higher dose, Inattentive = lower doseRate this question:
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- 22.
In treatment of major depressive disorder in pediatric patients, combination cognitive behavior therapy and SSRI are better than either treatment alone
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
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.Rate this question:
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- 23.
Which of the following SSRI is NOT expert recommended in treatment of major depressive disorder in pediatric patients?
- A.
Fluoxetine
- B.
Citalopram
- C.
Sertraline
- D.
Paroxetine
Correct Answer
D. ParoxetineExplanation
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.Rate this question:
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- 24.
Which of the following is NOT a characteristic of Autism Spectrum Disorders?
- A.
Delusions
- B.
Impaired nonverbal/verbal communication
- C.
Impaired social interactions
- D.
Repetitive behaviors
Correct Answer
A. DelusionsExplanation
Delusions are not a characteristic of Autism Spectrum Disorders. Autism is a neurodevelopmental disorder characterized by impaired social interactions, impaired nonverbal/verbal communication, and repetitive behaviors. Delusions, on the other hand, are a symptom commonly associated with psychotic disorders such as schizophrenia, but not with autism.Rate this question:
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- 25.
Which medication is FDA approved as a pharmacologic option for Autism Spectrum Disorders?
- A.
Atomoxetine
- B.
Clonidine
- C.
Guanficine
- D.
Risperidone
Correct Answer
D. RisperidoneExplanation
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.Rate this question:
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- 26.
Which cell type or proteins is/are most responsible in the pathophysiology of Multiple Sclerosis?
- A.
B-cells
- B.
Ctyokines
- C.
Macrophages
- D.
T-lymphocytes
Correct Answer
D. T-lymphocytesExplanation
T-lymphocytes can be auto-reactive and cause damage to the myelin sheath and axon. They can also induce pro-inflammatory response, causing further damageRate this question:
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- 27.
Which of the follow prognostic indicators of MS DOES NOT indicate an unfavorable prognosis?
- A.
Age > 40
- B.
Female
- C.
Cerebellar symptoms
- D.
Progressive course of disease
Correct Answer
B. FemaleExplanation
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).Rate this question:
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- 28.
What is the correct treatment of an acute exacerbation of MS symptom attacks?
- A.
ABC-R therapy
- B.
High dose IV corticosteroids
- C.
Mitoxantrone trial
- D.
Fingolimod
Correct Answer
B. High dose IV corticosteroidsExplanation
methlyprednisolone 500-1000mg IV, 3-5daysRate this question:
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- 29.
Which of the following statements about Interferon-B is FALSE?
- A.
Common flu-like symptoms may last months and be treated by short course oral prednisone
- B.
Monitoring includes CBC, platelets, and LFTs
- C.
Side effect profiles are dependent on choice of Interferon-type (1a, 1b)
- D.
Treatment in patients with severe depression is contraindicated
Correct Answer
C. Side effect profiles are dependent on choice of Interferon-type (1a, 1b)Explanation
Similar side effect profilesRate this question:
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- 30.
Which of the following statements about glatiramer acetate (Copaxonxe) is FALSE?
- A.
Pregnancy Category B
- B.
No flu-like symptoms or drug monitoring required
- C.
Relapse rates are comparable to interferon
- D.
Used in treatment of progressive relapsing MS (PRMS)
Correct Answer
D. Used in treatment of progressive relapsing MS (PRMS)Explanation
Used in the treatment of relapsing-remitting MS (RRMS)Rate this question:
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- 31.
Which of the following statements about ABC-R Drugs administration is FALSE?
- A.
Injection site should be iced before and after injection
- B.
Injection sites should be rotated
- C.
Medication should be at body temperature before injection
- D.
Medication should be well mixed, via the 10-second shake technique, before administration
Correct Answer
D. Medication should be well mixed, via the 10-second shake technique, before administrationExplanation
Never shake (Harlem or otherwise) before administrationRate this question:
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- 32.
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
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Reintroduced as a monotherapy (not adjunctive)Rate this question:
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- 33.
Which of the following statements about Fingolimod (Gilenya) is FALSE?
- A.
Includes ophthalmologic exam as monitoring for safety
- B.
Increased risk of life-threatening infections and tumor development
- C.
Modulates sphingosine-1-phosphate receptor
- D.
Used as a limited expense, limited efficacy alternative to Interferon and glatiramer
Correct Answer
D. Used as a limited expense, limited efficacy alternative to Interferon and glatiramerExplanation
Shows significant reduction in disability progression, but is very expensiveRate this question:
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- 34.
Which of the following statements about mitoxantrone (Novantrone) is FALSE?
- A.
FDA approve for secondary progressive, progressive relapsing, or relapsing-remitting MS
- B.
FDA approval for use as monotherapy
- C.
May cause blue-green discoloration of urine or eyes
- D.
Requires monitoring of ejection fraction before each dose
Correct Answer
B. FDA approval for use as monotherapyExplanation
Often used in conjunction with interferon and glatiramerRate this question:
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