ADHD
All of the following are side-effects of methylphenidate except?
Decreased appetite
Tics
Anxiety symptoms
Weight loss
Tinnitus
Tinnitus
Which statement best reflects evidence-based pharmacological management of irritability and self-injury in ASD?
Benzodiazepines are effective first-line agents
Risperidone and aripiprazole have FDA approval for irritability in ASD
Lurasidone is effective for aggression
Mood stabilisers outperform second-generation antipsychotics
Antipsychotics primarily treat aggression rather than irritability
Risperidone and aripiprazole have FDA approval for irritability in ASD
A 19 year old lady with bulimia attends clinic with her mother who is very concerned that the self-help strategies you suggested have not been effective. Which of the following list of therapies that your service provides would be the most appropriate next step?
Dialectic behavioural therapy
Flooding therapy
Cognitive behavioural therapy
Relaxation therapy
Cognitive analytic therapy
Cognitive behavioural therapy
A 14 year old girl presents with moderate depression. Which of the following would be the most appropriate first-line treatment?
Individual CBT
Interpersonal therapy
Behavioural activation
Cognitive analytic therapy
Structural family therapy
Individual CBT
Which of the following is the most reliable predictor of poor prognosis in early onset schizophrenia?
A normal MRI
Absence of patient insight into their condition
Being female
Having positive symptoms
Longer duration of untreated psychosis
Longer duration of untreated psychosis
The parents of a 10-year-old boy attend clinic for a review of his attention deficit hyperactivity disorder. He was diagnosed and started on treatment with methylphenidate 12 months ago with good effect. His teachers report considerable improvement at school. Although the boy's behaviour is improved, the parents are concerned about his growth which they believe has been slowed down since he started the medication. The growth measurements show that he has grown approximately 5 cm in the year since treatment was commenced which is slightly less than would be expected. Which of the following would be the most appropriate course of action?
Advise the parents that they should limit the use of methylphenidate to the school days (five days each week)
Reassure the parents that there is no evidence that methylphenidate suppresses growth in children
Suggest a switch to lisdexamfetamine
Suggest a trial of growth hormone in addition to continued use of methylphenidate
Suggest that the medication could be stopped during the summer holidays to allow for his growth to catch up
Suggest that the medication could be stopped during the summer holidays to allow for his growth to catch up
Regarding the pharmacological treatment of restricted and repetitive behaviours (RRBIs) in ASD, which statement is most accurate?
SSRIs are effective in children and adolescents
Clomipramine shows greater efficacy than SSRIs
Antipsychotics have robust, consistent evidence for direct reduction of RRBIs
Fluoxetine is recommended first line for RRBIs
Medication should be trialled before behavioural intervention
Clomipramine shows greater efficacy than SSRIs
Which of the following biochemical derangements is typically the earliest indicator of refeeding syndrome?
Hyperkalaemia
Hypermagnesaemia
Hypokalaemia
Hypomagnesaemia
Hypophosphataemia
Hypophosphataemia
A 13 year old boy is referred with moderate depression. After a discussion of the risks and benefits of various treatment options the family are keen to pursue combined treatment consisting of individual CBT plus fluoxetine. The boy is of normal weight for his age. What would be the appropriate starting dose for fluoxetine?
5 mg
10 mg
15 mg
20 mg
25 mg
10 mg
A 14 year old boy attends clinic with his parents. They provide a 12 month history of odd behaviours and social withdrawal. Your examination reveals hallucinations and delusions. He has a positive family history for schizophrenia. He has previously been tried on olanzapine (for 4 months) and is currently on risperidone 5mg twice daily (which he has been taking for 7 weeks) which has not led to a noticeable improvement.
Which of the following would be indicated in this scenario?
Prescribe a low voltage course of ECT
Increase risperidone to 10 mg twice daily
Offer clozapine
Commence haloperidol
Augment risperidone with olanzapine
Offer clozapine
After diagnosing a child with attention deficit hyperactivity disorder you arrange to meet the child's parents to discuss medication options. Which of the following medications is associated with a risk of liver toxicity which you should warn the parents about should you elect to prescribe it?
Atomoxetine
Methylphenidate
Clonidine
Modafinil
Bupropion
Atomoxetine
Parents of a child diagnosed with autism spectrum disorder ask about the likelihood that a future sibling will also be affected.
Which of the following best estimates the risk of autism in a subsequent child?
Approximately 1–2%, which is the same as the general population
Approximately 3–4%
Approximately 5–7%
Approximately 10–20%
Approximately 30–40
Approximately 10–20%
A young child is admitted to hospital with anorexia nervosa.
Which of the following biochemical profiles would you most expect to encounter on day 2 of a refeeding schedule?
High potassium, high sodium, normal calcium, normal phosphate, raised magnesium
Low potassium, normal sodium, low calcium, raised phosphate, normal magnesium
Low potassium, normal sodium, normal calcium, low phosphate, low magnesium
Normal potassium, low sodium, normal calcium, normal phosphate, raised magnesium
Raised potassium, normal sodium, normal calcium, raised phosphate, raised magnesium
Low potassium, normal sodium, normal calcium, low phosphate, low magnesium
A 13 year old boy reports feeling sick and having palpitations when he has to eat in front of others. This is particularly the case at school where he has stopped eating altogether. He says that when he does try and eat he becomes overwhelmed with thoughts about how others will judge him and worries that they will make fun of him. He also reports having similar symptoms when having to speak in front of peers at school and recalls getting sweaty palms and a dry mouth. His symptoms are much more manageable when in the company of family only and he eats a normal diet at home and maintains a normal weight.
Which of the following is the most likely diagnosis?
Generalised anxiety disorder
Social anxiety disorder
Bulimia nervosa
Autism spectrum disorder
Panic disorder
Social anxiety disorder
A 15-year-old boy presents to the clinic with his parents, who express concern over his declining school performance and withdrawal from sports teams, which he previously enjoyed. Over the last seven months, he has been experiencing persistent tiredness, which has not improved despite adequate sleep and rest. His parents report that he often wakes up feeling just as tired as when he went to bed and has difficulty concentrating on his homework. The patient also mentions a general sense of malaise and discomfort that worsens with physical activity, leading him to avoid activities he used to participate in regularly. His medical history is unremarkable, and he has no significant illnesses in the past. A recent bout of viral gastroenteritis resolved without complication two months ago. He denies any mood changes, sleep disturbances, or stressors at school. Physical examination and routine laboratory tests do not reveal any abnormalities.
Which of the following would be most appropriate?
Methylprednisolone intravenously (IV)
Immunoglobulin IV
Reassurance
Cognitive behavioural therapy (CBT)
Graded exposure therapy
Cognitive behavioural therapy (CBT)
A 10-year-old child is referred to your outpatient clinic due to attentional issues and poor academic performance. You make a diagnosis of attention deficit hyperactivity disorder but also note the presence of features of conduct disorder. Substance misuse is not known to be an issue. According to NICE guidance, which drug is most suitable for this child?
Dexamphetamine
Fluoxetine
Methylphenidate
Atomoxetine
Quetiapine
Methylphenidate
Which statement regarding ADHD treatment in individuals with ASD is most accurate?
ADHD medications are contraindicated in ASD
Methylphenidate is equally effective as in ADHD without ASD
Atomoxetine has no evidence base in ASD
Stimulants should be stopped immediately if behaviour deteriorates
Amfetamines have the strongest evidence base
Stimulants should be stopped immediately if behaviour deteriorates
Which of the following is true regarding eating disorders?
Antidepressants are recommended as first-line in binge eating disorder
Modified dialectical behaviour therapy should not be offered to adults with binge eating disorder
Psychological treatments for binge eating disorder have a limited effect on body weight
Citalopram is the first-line recommendation for the pharmacological management of bulimia
Interpersonal psychotherapy has been shown to achieve results in bulimia more rapidly than CBT
Psychological treatments for binge eating disorder have a limited effect on body weight
A 16-year-old boy presents with a four-month history of low mood and a lack of interest in activities he previously found enjoyable. His academic performance has declined, and he complains of constant fatigue despite adequate sleep. He reports previous episodes of heightened energy, increased talkativeness, and irritability lasting several days at a time, during which he feels more productive. People have commented on his mood and behaviour during these periods suggesting he is behaving very oddly.
These episodes are interspersed with periods where he feels overwhelmed and hopeless. His appetite has decreased, and he has lost weight. There is no significant family history of mental health disorders, and he denies substance use. The boy's physical examination and laboratory tests do not reveal any abnormalities.
Which of the following diagnoses is most likely?
Bipolar disorder
Cyclothymic disorder
Dysthymic disorder
cycling
Recurrent depressive disorder
Bipolar disorder
A 17-year-old boy is brought to clinic by his grandmother because of long-standing behavioural difficulties. He has a history of repeated school exclusions for fighting and intimidating other pupils and has been known to the police since early adolescence for assaults and criminal damage, although he has not received a custodial sentence.
At home, he frequently disregards rules, stays out overnight despite clear prohibitions, and becomes aggressive when challenged. When asked about his behaviour, he shows little remorse and tends to justify his actions by blaming others or minimising the harm caused. His aggressive behaviour is not limited to discrete episodes and is not associated with clear triggers. There is no evidence of psychotic symptoms.
Which of the following do you most suspect?
Oppositional defiant disorder
Conduct disorder
Intermittent Explosive Disorder
Attention deficit hyperactivity disorder
Antisocial personality disorder
Conduct disorder
Which of the following does not have a proven evidence based to support its use in attention deficit hyperactivity disorder?
Atomoxetine
Bupropion
Olanzapine
Clonidine
Guanfacine
Olanzapine
Which of the following has been shown to be the most reliable risk factor for autism spectrum disorder?
Thimerosal exposure
Conception via assisted reproductive technologies
Maternal smoking
Valproate use during pregnancy
Vaccination
Valproate use during pregnancy
Which of the following is true regarding eating disorders?
Laxative misuse is ineffective at reducing calorie absorption
People with bulimia should always brush their teeth after vomiting
BMI alone is a reliable indicator of physical risk
Osteoporosis in anorexia nervosa is generally reversible
Intravenous supplementation is usually required to correct electrolyte disturbance in bulimia
Laxative misuse is ineffective at reducing calorie absorption
Which of the following has the best evidence for the treatment of OCD in children?
Sertraline
Citalopram
Paroxetine
Venlafaxine
Fluoxetine
Sertraline
Which of the following is considered appropriate treatment in a 10 year old child with Tourette's syndrome without significant co-morbidity who has not responded to Comprehensive Behavioural Intervention for Tics (CBIT)?
Tetrabenazine
Clonidine
Botulinum toxin
Topiramate
Haloperidol
Clonidine