Stimulant medications — MCQs

A 20-year-old college student presents to the emergency room complaining of insomnia for the past 48 hours. He explains that although his body feels tired, he is "full of energy and focus" after taking a certain drug an hour ago. He now wants to sleep because he is having hallucinations. His vital signs are T 100.0 F, HR 110 bpm, and BP of 150/120 mmHg. The patient states that he was recently diagnosed with "inattentiveness." Which of the following is the mechanism of action of the most likely drug causing the intoxication?

A 25-year-old woman presents to her college campus clinic with the complaint of being unable to get up for her morning classes. She says that, because of this, her grades are being affected. For the past 6 weeks, she says she has been feeling depressed because her boyfriend dumped her. She finds herself very sleepy, sleeping in most mornings, eating more snacks and fast foods, and feeling drained of energy. She is comforted by her friend’s efforts to cheer her up but still feels guarded around any other boy that shows interest in her. The patient says she had similar symptoms 7 years ago for which she was prescribed several selective serotonin reuptake inhibitors (SSRIs) and a tricyclic antidepressant (TCA). However, none of the medications provided any long-term relief. She has prescribed a trial of Phenelzine to treat her symptoms. Past medical history is significant for a long-standing seizure disorder well managed with phenytoin. Which of the following statements would most likely be relevant to this patient’s new medication?

A 24-year-old male comes into the psychiatric clinic complaining of consistent sadness. He endorses feelings of worthlessness, anxiety, and anhedonia for the past couple months but denies feeling suicidal. He further denies any past episodes of feeling overly energetic with racing thoughts. Confident of the diagnosis, you recommend frequent talk therapy along with a long-term prescription of a known first-line medication for this disorder. What is the drug and what are some of the most frequently encountered side effects?

A neurophysiologist describes the mechanism of a specific type of synaptic transmission to his students. While illustrating this, he points out that when the action potential reaches the presynaptic terminal of a chemical synapse, the voltage-gated Ca2+ channels open. Ca2+ ions trigger the release of neurotransmitters from vesicles in the presynaptic terminal. In this type of synaptic transmission, increased cytosolic Ca2+ levels cause the release of a neurotransmitter from small vesicles with dense cores. Which of the following neurotransmitters is most likely to be the one that is released into the synaptic cleft in this type of synapse?

A 22-year-old man, accompanied by his brother, presents to the emergency department with palpitations for the past 30 minutes and nausea for the past hour. When the patient meets the physician, he says, “Doctor, I am the happiest person in the world because I have the best brain possible. It’s just that my heart is saying something, so I came to check with you to see what it is”. The brother says the patient was diagnosed with attention-deficit/hyperactivity disorder (ADHD) 5 years ago. When the doctor asks the patient about his ADHD treatment, he replies, “Doctor, the medicine is wonderful, and I love it very much. I often take one or two tablets extra!” He has no history of a known cardiovascular disorder, alcohol abuse, or smoking. The patient’s temperature is 99.2ºF (37.3ºC), heart rate is 116/minute, respiratory rate is 18/minute, and blood pressure is 138/94 mm Hg. Generalized perspiration is present. Which of the following signs is most likely to be present on ocular examination?

An 11-year-old boy is brought to a pediatrician by his parents with the complaint of progressive behavioral problems for the last 2 years. His parents report that he always looks restless at home and is never quiet. His school teachers frequently complain that he cannot remain seated for long during class, often leaving his seat to move around the classroom. A detailed history of his symptoms suggests a diagnosis of attention-deficit/hyperactivity disorder. The parents report that he has taken advantage of behavioral counseling several times without improvement. The pediatrician considers pharmacotherapy and plans to start methylphenidate at a low dose, followed by regular follow-up. Based on the side effect profile of the medication, which of the following components of the patient’s medical history should the pediatrician obtain before starting the drug?

An 11-year-old boy is brought to the physician by his mother because of teacher complaints regarding his poor performance at school for the past 8 months. He has difficulty sustaining attention when assigned school-related tasks, does not follow the teachers' instructions, and makes careless mistakes in his homework. He often blurts out answers in class and has difficulty adhering to the rules during soccer practice. His mother reports that he is easily distracted when she speaks with him and that he often forgets his books at school. Physical examination shows no abnormalities. The patient is started on the appropriate first-line therapy. This boy is at increased risk for which of the following conditions?

A 9-year-old boy is brought to the physician by his mother because of poor performance in school for the last year. He has difficulty sitting still at his desk, does not follow the teacher's instructions, and frequently blurts out answers in class. He often gets sent outside the classroom for failing to work quietly. At hockey practice, he does not wait his turn and has difficulty listening to his coach's instructions. His mother reports that he is easily distracted when she speaks with him and that he often forgets his books at home. Physical examination shows no abnormalities. Which of the following is the most appropriate pharmacotherapy?

A 5-year-old boy is brought to the physician by his mother because he does not “listen to her” anymore. The mother also reports that her son cannot concentrate on any tasks lasting longer than just a few minutes. Teachers at his preschool report that the patient is more active compared to other preschoolers, frequently interrupts or bothers other children, and is very forgetful. Last year the patient was expelled from another preschool for hitting his teacher and his classmates when he did not get what he wanted and for being disruptive during classes. He was born at term via vaginal delivery and has been healthy except for 3 episodes of acute otitis media at the age of 2 years. He has met all developmental milestones. His mother has major depressive disorder and his father has Graves' disease. He appears healthy and well nourished. Examination shows that the patient does not seem to listen when spoken to directly. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in treatment?

A goalkeeper of a famous soccer team gives an interview with a health agency regarding his childhood. He describes how when he was a child, he would constantly clear his throat in class and the teachers would write a note to his mother with advice to go see an ENT doctor. He complained of being restless, fidgety, and sometimes hyperactive in class, disrupting the environment and causing him many social problems. He would blurt out the answer at times and keep repeating it without any control, leading to some embarrassing timeouts. But he was always nice to his teachers, so he calls it a “benign frustration” rather than aggressively causing distress. He also talked about how his symptoms were dramatically improved with medication. Which of the following is an FDA approved drug for this patient’s most likely condition?