31 (Mandatory) (1 point) Scenario This scenario

31 (Mandatory) (1 point) Scenario This scenario will inform Questions 1 through 6. A mother brings her 6-year-old son, David, to the clinic for assessment. The mother states that there is something very wrong with David. He sprinkles baby powder all over the house, and last night he opened a bottle of ink and threw it on the floor. He cannot sit still at school and is very easily distracted. He has difficulty waiting for his turn in games , has difficulty paying attention during play, talks all the time, always interrupts, does not listen when talked to, and is constantly shifting from one activity to another. As you enter the examination room, David is in the process of breaking things. On examination, you discover that there are no physical abnormalities present. Choose the pharmacological treatment options in the disorder described in the case. (Select all that apply) 31 options: Dextroamphetamine or amphetamine derivatives Methylphenidate or its derivatives Modafinil Magnesium pemoline 32 (Mandatory) (1 point) Scenario This scenario will inform Questions 7 and 8. An 8 ½-year-old boy comes to the clinic for follow up of his ADHD. In the chart review, you note that the patient is taking short acting methylphenidate two times a day. His mother noted significant improvement in his morning classes but a significant problem with hyperactivity and in attentiveness as the day progresses. As you review comments on your patient’s recent report card, you can see that his academic performance is stronger in his morning classes as compared to his afternoon classes. His mother is afraid that the treatment is not working well enough. In talking to the patient, it becomes clear that he is unhappy with the medication. He says, “I have to go to the nurse and take my medication when all of the other kids are playing. The other kid knows that I’m different.” What is the next appropriate step in the management of this child? 32 options: Increase the dose of his current medication Stop the methylphenidate and begin dextroamphetamine Reassure the parents and see the patient for follow up in four weeks Initiate treatment with a long-acting form of methylphenidate Add a selective serotonin reuptake inhibitor as an adjunctive treatment 33 (Mandatory) (1 point) Scenario This scenario will inform 8. An 8 ½-year-old boy comes to the clinic for follow up of his ADHD. In the chart review, you note that the patient is taking short acting methylphenidate two times a day. His mother noted significant improvement in his morning classes but a significant problem with hyperactivity and in attentiveness as the day progresses. As you review comments on your patient’s recent report card, you can see that his academic performance is stronger in his morning classes as compared to his afternoon classes. His mother is afraid that the treatment is not working well enough. In talking to the patient, it becomes clear that he is unhappy with the medication. He says, “I have to go to the nurse and take my medication when all of the other kids are playing. The other kid knows that I’m different.” You initiated treatment with a long-acting form of methylphenidate. One month later, the child returns to the clinic for follow up. His parents report that he is doing very well throughout the school day. The teachers are reporting significant improvement in focus and attention. However, his parents note that his appetite has decreased, and it is somewhat difficult for him to fall asleep. What is the most appropriate management at this stage? 33 options: Add an SSRI as an adjunctive treatment Reassure the parents and recheck the patient in four weeks Begin behavioral therapy Stop the methylphenidate and begin dextroamphetamine Increase the dose of his current medication x 34 (Mandatory) (1 point) Which of the following medications can be prescribed as an alternative treatment for ADHD in patients who do not respond to stimulants? 34 options: Atomoxetine Fluoxetine Guanfacine Clonidine Pemoline 35 (Mandatory) (1 point) Choose the disorders that often appeared together in the same person at various life stages. 35 options: ADHD, bipolar disorder, and conduct disorder Adjustment disorder, ADHD, and major depression ADHD, conduct disorder, and antisocial personality disorder Childhood depression, ADHD, and early onset adult schizophrenia Mental retardation, ADHD, and learning disability 36 (Mandatory) (1 point) Which of the following statements regarding the effects of stimulants on children, adolescents, and adults are correct? (Select all that apply) 36 options: Treatment with stimulants at an early age in children with ADHD increases their risk of substance abuse and dependence as adults. Normal and hyperactive children, adolescence, and adults have similar cognitive responses to comparable doses of stimulants. Normal and hyperactive children, adolescence, and adults have similar behavioral responses to comparable doses of stimulants. 37 (Mandatory) (1 point) Scenario This scenario will inform Questions 12 through 14. Linda, a 17-year-old girl, comes to the office with her mother because she has been feeling fatigued during the past four months. She says that she feels run down all the time and also stated that she hasn’t been sleeping well. She said that she goes to bed at 11:00 PM, approximately, but wakes up routinely at 3:00 AM and unable to go back to sleep. Linda said that she has trouble focusing and concentrating in school. She has no energy to complete her assignments at home. She used to be very active but has recently stopped playing softball with the team because she doesn’t feel like playing. She also does not feel like going out anymore. Her mom said that she seemed irritable and the smallest things can set her off. Her appetite has decreased and she lost about 7 pounds since her last visit six months ago. She denies any fever, chills, nausea, vomiting, or night sweats. She denies any recent illness. She has no other medical problems and denies any other medication except for multivitamins. Her physical examination is completely normal. What is the most likely diagnosis in this patient? 37 options: Adjustment disorder with depressed mood Generalized anxiety disorder Mood disorder caused by a general medical condition Dysthymic disorder Major depressive disorder (MDD) 38 (Mandatory) (1 point) Scenario This scenario will inform Questions 12 through 14. Linda, a 17-year-old girl, comes to the office with her mother because she has been feeling fatigued during the past four months. She says that she feels run down all the time and also stated that she hasn’t been sleeping well. She said that she goes to bed at 11:00 PM, approximately, but wakes up routinely at 3:00 AM and unable to go back to sleep. Linda said that she has trouble focusing and concentrating in school. She has no energy to complete her assignments at home. She used to be very active but has recently stopped playing softball with the team because she doesn’t feel like playing. She also does not feel like going out anymore. Her mom said that she seemed irritable and the smallest things can set her off. Her appetite has decreased and she lost about 7 pounds since her last visit six months ago. She denies any fever, chills, nausea, vomiting, or night sweats. She denies any recent illness. She has no other medical problems and denies any other medication except for multivitamins. Her physical examination is completely normal. What class of drugs is most often used in this disorder described? 38 options: Lithium carbonate Benzodiazepine Monoamine oxidase inhibitors (MAOIs) Tricyclic anti-depressants (TCAs) Selective serotonin reuptake inhibitors (SSRIs) 39 (Mandatory) (1 point) Scenario This scenario will inform Questions 12 through 14. Linda, a 17-year-old girl, comes to the office with her mother because she has been feeling fatigued during the past four months. She says that she feels run down all the time and also stated that she hasn’t been sleeping well. She said that she goes to bed at 11:00 PM, approximately, but wakes up routinely at 3:00 AM and unable to go back to sleep. Linda said that she has trouble focusing and concentrating in school. She has no energy to complete her assignments at home. She used to be very active but has recently stopped playing softball with the team because she doesn’t feel like playing. She also does not feel like going out anymore. Her mom said that she seemed irritable and the smallest things can set her off. Her appetite has decreased and she lost about 7 pounds since her last visit six months ago. She denies any fever, chills, nausea, vomiting, or night sweats. She denies any recent illness. She has no other medical problems and denies any other medication except for multivitamins. Her physical examination is completely normal. Which of the following types of psychotherapy is generally considered most effective for the patient’s diagnosis? 39 options: Supportive psychotherapy Psychoanalytic psychotherapy Psychodynamic psychotherapy Cognitive behavioral psychotherapy (CBT) 40 (Mandatory) (1 point) Which of the following is least likely to induce withdrawal symptoms if it is abruptly discontinued? 40 options: Fluoxetine Citalopram Sertraline Paroxetine

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