Rosh Psychiatry Board Practice Exam

What evaluation should be performed prior to starting a methylphenidate patch in a 12-year-old boy with ADHD?

1. Hormone level evaluation

2. Liver function testing

3. Cardiac evaluation

4. Thyroid evaluation

The correct answer is: Cardiac evaluation

Prior to starting a methylphenidate patch in a child with ADHD, a cardiac evaluation is essential due to the potential cardiovascular side effects associated with stimulant medications. Stimulants like methylphenidate can increase heart rate and blood pressure, and in rare cases, they may precipitate cardiac events, especially in patients with preexisting heart conditions or arrhythmias. The American Academy of Pediatrics recommends a cardiac evaluation, which may include taking a detailed family history of sudden cardiac death or other cardiac issues, as well as a physical examination focusing on heart health, before initiating treatment with stimulants. Regular monitoring of cardiovascular health helps ensure that the benefits of treatment outweigh the risks, particularly in children with underlying cardiac issues that may not previously have been identified. Thus, the emphasis on a cardiac evaluation aligns with precautionary principles in prescribing these medications to mitigate potential risks in vulnerable populations like children.