Chapter 10 Quiz
Disparities, Telehealth & Emerging Treatments
5 clinical cases · 15 questions
Each case presents a clinical scenario followed by board-style questions. Select your answer and submit to see the rationale.
Hiro, Age 7
Hiro is a 7-year-old boy referred by his second-grade teacher for "inability to sit still, calling out answers, and not finishing classwork." His teacher completed a Vanderbilt rating scale endorsing significant hyperactivity-impulsivity symptoms. His parents describe him as active but say he follows instructions at home and plays cooperatively with his older brother. Review of school records reveals Hiro's birthday is August 28, and the school enrollment cutoff is September 1.
Q1. Before proceeding with the ADHD evaluation, which clinical factor is most important to consider?
Q2. Hiro's evaluation includes age-corrected norms on rating scales, a parent interview, and a developmental history. The data confirms cross-setting symptoms with onset before age 5, consistent with ADHD. However, you want to reduce the risk of misdiagnosing developmental immaturity. What is the most appropriate approach?
Q3. Hiro's parents ask why they should be cautious when the teacher says the problem is obvious. What mechanism drives the Relative Age Effect?
Diya, Age 9
Diya is a 9-year-old Black girl referred to your clinic by her school counselor for "defiance and attitude problems." The referral notes describe arguments with teachers, difficulty following rules, and two office referrals for talking back. Her teacher completed a Vanderbilt rating scale that endorsed mostly Oppositional Defiant Disorder (ODD) items. Diya's mother reports that at home, Diya loses things constantly, cannot sit through homework, daydreams during conversations, and has always been "in her own world." No clinician has ever asked about ADHD.
Q4. Which pattern best explains why the school counselor's referral focused on defiance rather than ADHD?
Q5. Diya's mother seems hesitant about the evaluation process. Using the Cultural Formulation Interview, what type of opening question best elicits the family's perspective?
Q6. Diya's evaluation confirms ADHD, Predominantly Inattentive Presentation. Her mother asks: 'Why did nobody ever ask about this before?' Which systemic factor most directly contributed to Diya's delayed identification?
Elio, Age 32
Elio is a 32-year-old man who presents to your outpatient clinic requesting continuation of lisdexamfetamine 40 mg daily. He was diagnosed with ADHD 4 months ago through a telehealth platform after a 25-minute video evaluation. He reports that the prescriber asked him to complete an online checklist, prescribed medication the same day, and has seen him for two brief follow-ups. He says the medication helps his focus at work, but he also has chronic insomnia and reports feeling anxious most days.
Q7. Based on the telehealth diagnosis verification checklist, what is the most significant concern about Elio's initial evaluation?
Q8. You conduct a de novo evaluation of Elio. Which step in the adult diagnostic pathway should be prioritized first?
Q9. Elio's evaluation confirms ADHD with comorbid GAD and chronic insomnia. He asks whether his telehealth diagnosis was 'wrong.' What is the most accurate characterization?
Zuri, Age 11
Zuri is an 11-year-old boy with ADHD, Combined Presentation, stable on mixed amphetamine salts extended-release 20 mg daily for 2 years. His mother calls to report that three pharmacies have told her the medication is out of stock. She asks whether she should try purchasing it from an online seller she found on social media.
Q10. What is the most urgent clinical concern about purchasing medication from a social media seller?
Q11. Applying the shortage switching hierarchy, what is the recommended first step?
Q12. His mother asks whether the shortage has been dangerous for children forced off medication. What does the population-level evidence show?
Opal, Age 10
Opal is a 10-year-old girl with ADHD, Predominantly Inattentive Presentation, on methylphenidate extended-release 27 mg daily with good but incomplete symptom control. Her ADHD-RS score shows a 45% reduction from baseline, and her parents are satisfied with her progress. At today's visit, her father asks about two things he has researched online: a "video game treatment for ADHD" and a "genetic test that tells you which medication is best."
Q13. Regarding the "video game treatment" (EndeavorRx), what is the most accurate clinical summary?
Q14. Opal's father asks about genetic testing to find a 'better medication.' Based on current pharmacogenomic evidence, what is the most accurate guidance?
Q15. Opal has a 45% ADHD-RS reduction and good functioning on methylphenidate ER. Her father asks whether new options should change her treatment. What is the most appropriate recommendation?