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1. An individual, aged 20 years, reports trouble with procrastination, distractibility, difficulty with sustained mental effort, losing things and trouble organizing inventory at work. Which of the following statements describes an additional diagnostic criterion needed for a diagnosis of ADHD:

A. Symptoms cause functional impairment at home, as well, for 6 weeks B. The onset of symptoms can be traced back to childhood, before 12 years of age C. Two additional symptoms of inattention or impulsivity must be present D. A brain scan showing cortical thinning is needed to confirm the diagnosis

2. A child, aged 4 years, is frequently sent home from preschool for hyperactivity and impulsivity. The child should be evaluated for a deficiency in which substance that could contribute to ADHD symptoms?

A. Ferritin B. Cyanocobalamin C. Folate D. Omega-3 fatty acids

3. When an ADHD diagnosis is confirmed for a patient 4 years of age, which of the following is a first-line treatment recommended by the American Academy of Pediatrics (AAP):

A. Methylphenidate extended-release preparations B. Parent training and behavioral modification C. Meditation, yoga, and physical therapy D. Clonidine or guanfacine extended release

4. Which of the following is an appropriate starting dose of stimulant for a child 12 years of age (100 lb [45 kg]):

A. Lisdexamfetamine 50 mg in the morning B. Osmotic controlled-release oral delivery system (OROS) methylphenidate 27 mg in the morning C. Methylphenidate transdermal patch 20 mg in the morning D. Mixed amphetamine salts extended release 30 mg in the morning

5. An individual, 36 years of age, took methylphenidate as a child and then received a diagnosis of bipolar disorder as a teenager. He has not used methylphenidate since 12 years of age. The patient is currently in recovery for marijuana and alcohol abuse and takes divalproex sodium 2000 mg and bupropion 150 mg extended release (ER) with good mood stability. The patient complains about trouble concentrating and forgetfulness that is attributed to residual ADHD. Your best recommendation is which of the following:

A. Decrease dose of valproate B. Add guanfacine ER C. Increase dose of bupropion ER D. Add methylphenidate in the morning

6. Patient counseling should be provided about the risk of hepatotoxicity with which of the following medications used for the management of ADHD:

A. Lisdexamfetamine B. Bupropion C. Clonidine D. Atomoxetine

7. Which of the following statements is accurate regarding the treatment of ADHD in a patient with Tourette's disorder:

A. Stimulants such as methylphenidate should be avoided as they worsen tics B. Quetiapine can effectively improve attention and both motor and vocal tics C. Alpha-2-adrenergic agonists may improve both ADHD symptoms and tics D. Lisdexamfetamine is preferred for ADHD because of its gradual onset of effect

8. JP takes methylphenidate immediate release (IR) 3 times a day with good efficacy, but his parents want to avoid in-school dosing. Which long-acting preparation is most appropriate and longest lasting?

A. Lisdexamfetamine B. Dexmethylphenidate ER C. Methylphenidate sustained release (SR) D. OROS methylphenidate

9. The potential advantages of using alpha-adrenergic agonists instead of stimulants for the treatment of ADHD include which of the following:

A. More rapid onset of therapeutic effect B. Greater efficacy for aggression and impulsivity C. Less insomnia, anorexia, and growth effects D. Effective for children, teens, and adults

10. When asked about the risk of sudden unexplained death when stimulant medications are used for the treatment of ADHD, which of the following would be the best response:

A. Careful screening for patient and family history of cardiac disease is recommended because those with underlying disease are at risk B. The risk of sudden unexplained death is significant only for those taking stimulants combined with other illicit drugs C. Administering a stimulant combined with either ER guanfacine or clonidine is cardioprotective D. Methylphenidate formulations pose less of a risk of adverse cardiac events compared with amphetamine formulations