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POST-TEST

1
Q. 1

You have diagnosed ADHD combined type in an 8 year old based upon your history, physical and standard DSM IV criteria, present at home and school. Two weeks ago you started this 30 kg child on 27 mg of sustained-release methylphenidate. At return his mother tells you that he is still inattentive, up out of his chair frequently in school and unable to complete complex tasks at home. You should

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d)
CORRECT: This child appears to be under-medicated. (.06 mg/kg). You can easily increase the dose based upon weight.This child appears to be under-medicated. You can easily increase the dose based upon weight.Your answer has been saved.
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2
Q. 2

You started a 35 kg, 10 year old child on mixed salts amphetamine for a diagnosis of ADHD 5 days ago. His mother informs you that yesterday he complained of seeing snakes in his bed. Your first step should be to

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b)
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d)
CORRECT: Hallucinations are not one of the usual side effects, but they do occur. You should first stop the medication and then consider consultation, or try a low dose of a different medication, depending upon your comfort.Hallucinations are not one of the usual side effects, but they do occur. You should first stop the medication and then consider consultation, or try a low dose of a different medication, depending upon your comfort.Your answer has been saved.
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3
Q. 3

You are seeing a 3 year old. His father tells you that he is very, very active. Some nights he does not sleep at all. He is loud and demanding. Last week when his parents told him that he could not go visit his grandmother, he stole his mother's car keys out of her purse, went out the back door and was caught running to the garage. When questioned, he stated that he was going to drive over to his grandmother's house.

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CORRECT: This child exhibits signs of extreme hyperactivity, severe sleep disturbance, and grandiosity. You may want to inquire about activities suggesting heightened sexual awareness. You should consider the possibility of early onset bipolar disorder when symptoms are this outrageous. Regardless, you should seek additional expertise in diagnosis and management.This child exhibits signs of extreme hyperactivity, severe sleep disturbance, and grandiosity. You may want to inquire about activities suggesting heightened sexual awareness. Regardless, you should seek additional expertise in diagnosis and management.Your answer has been saved.
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4
Q. 4

You are seeing a very active 5 year old for a well child visit. He has multiple bruises of varying ages along his shin, which his mother attributes to various activities while running, playing or fighting with his 2 older brothers. One older brother takes methylphenidate for ADHD. You note four linear bruises on his left cheek which his mother attributes to a fall which occurred when the children were jumping off the stairs to the back porch. You should:

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CORRECT: Bruises on the shin are not unusual for an active child, and he may even have ADHD, but you do not yet have enough information. However, linear bruises on the left cheek are likely slap marks from a right hand. You should refer to CPS.Bruises on the shin are not unusual for an active child, and he may even have ADHD, but you do not yet have enough information. However, linear bruises on the left cheek are likely slap marks from a right hand. You should refer to CPS.Your answer has been saved.
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5
Q. 5

You diagnose ADHD predominantly inattentive type in an 8 year, 50 kg old girl and have been adjusting her methylphenidate. At the last visit you increased her from 36 to 54 mg. Today her mother tells you that she is doing very well in school, but even her teachers have noticed that she seems withdrawn, and she seems tired at home. You should

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b)
c)
d)
CORRECT: Sometimes you have to choose between efficacy and side effects. This child is likely over-medicated based upon her activity level (1.08 mg/kg). You should lower the dose of her stimulant medication and reassess. You should also evaluate for co-morbid affect problems.Sometimes you have to choose between efficacy and side effects. This child is likely over-medicated based upon her activity level. You should lower the dose of her stimulant medication and reassess.Your answer has been saved.
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