Child and Adolescent Psychiatry Practice Questions

Q: An 8-year-old child has shown a lack of interest in studies for the last 6 months. He has frequent quarrels with his parents and has frequent headaches as an excuse to avoid school. What would be the most appropriate clinical diagnosis in this patient?

Oppositional defiant disorder. **Explanation:** The clinical presentation of this 8-year-old child—characterized by a persistent pattern of irritability, argumentative behavior, and defiance toward authority figures (parents)—is classic for **Oppositional Defiant Disorder (ODD)**. **Why ODD is correct:** According to DSM-5, ODD is diagnosed when a child exhibits a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least **6 months**. Key features include losing temper, arguing with adults, actively defying rules, and blaming others for mistakes. In this case, the "frequent quarrels" and using somatic complaints (headaches) as a manipulative tool to avoid school (school refusal) align with the defiant and avoidant nature of ODD. **Why other options are incorrect:** * **Migraine:** While the child complains of headaches, these are specifically described as an "excuse to avoid school." In the context of behavioral issues and quarrels, these are likely somatic manifestations of school avoidance rather than a primary neurological disorder. * **Depression:** While pediatric depression can present as irritability, the core symptoms of anhedonia, sleep/appetite changes, and pervasive low mood are not the primary focus here compared to the overt defiance. * **Normal adolescent problem:** The child is 8 years old (pre-adolescent). Furthermore, the 6-month duration and impact on academic/family functioning exceed the boundaries of normal developmental "testing of limits." **High-Yield NEET-PG Pearls:** * **ODD vs. Conduct Disorder (CD):** ODD does *not* involve violation of the basic rights of others or major age-appropriate societal norms (e.g., no animal cruelty, theft, or fire-setting), which are hallmarks of CD. * **Comorbidity:** ODD is highly comorbid with **ADHD**. * **Treatment:** The first-line management for ODD is **Parent Management Training (PMT)** and behavioral therapy, rather than pharmacotherapy.

Q: Which of the following is true about the treatment of nocturnal enuresis?

Imipramine. **Explanation:** **Nocturnal Enuresis** is defined as the involuntary voiding of urine during sleep in children aged 5 years or older. **Why Imipramine is Correct:** Imipramine is a **Tricyclic Antidepressant (TCA)** traditionally used as a second-line pharmacological treatment for nocturnal enuresis. Its efficacy is attributed to a triple mechanism: 1. **Anticholinergic effect:** It increases bladder capacity by relaxing the detrusor muscle. 2. **Alpha-adrenergic stimulation:** It increases internal sphincter tone, preventing leakage. 3. **Alteration of sleep architecture:** It lightens the sleep stage, making the child more likely to wake up when the bladder is full. **Why Incorrect Options are Wrong:** * **Chlorpromazine (CPZ) & Haloperidol:** These are antipsychotics. They have no role in treating enuresis and may actually cause urinary incontinence or retention as side effects due to their complex receptor profiles. * **Alprazolam:** This is a benzodiazepine used for anxiety and insomnia. It acts as a muscle relaxant and sedative, which could potentially worsen enuresis by making it harder for the child to wake up to the sensation of a full bladder. **High-Yield Clinical Pearls for NEET-PG:** * **First-line Management:** Always start with **behavioral therapy** (e.g., fluid restriction before bed, bladder training). * **Gold Standard/Most Effective Behavioral Therapy:** The **Enuresis Alarm** (Bell and Pad method). * **First-line Pharmacotherapy:** **Desmopressin (DDAVP)**, a synthetic analog of ADH, is preferred over Imipramine due to a better safety profile. * **Imipramine Caution:** It has a narrow therapeutic index; overdose can lead to fatal cardiotoxicity (arrhythmias). Always monitor for ECG changes.

Q: According to DSM-5 classification, what is the diagnosis for a child who exhibits below-average mathematical skills despite having a normal IQ and age-appropriate learning abilities in other areas, and remains unaffected by a year-long private mathematics tutoring?

Specific learning disorder. ***Specific learning disorder***- The presentation meets the criteria for **Specific Learning Disorder (SLD)**, characterized by persistent difficulties in learning core academic skills (in this case, mathematics) that are significantly below expected levels, despite having **average intellectual functioning (normal IQ)**.- The failure to show improvement despite targeted intervention (private tutoring for a year) confirms the persistence and severity of the **neurodevelopmental basis** of the learning difficulty, which is central to the diagnosis of SLD.*ADHD*- **Attention-Deficit/Hyperactivity Disorder (ADHD)** primarily involves persistent patterns of inattention and/or hyperactivity-impulsivity that interfere with functioning or development.- While ADHD can impair academic performance, the primary deficit described here is specific to **mathematical calculation and reasoning**, rather than generalized difficulties arising from attention regulation issues. *Mathematics learning disorder*- This term refers to the specific impairment outlined (often called **Dyscalculia**), but in the DSM-5, it is classified as a **specifier** under the broader diagnosis of Specific Learning Disorder (SLD), specifically "Specific Learning Disorder, With Impairment in Mathematics."- Since **Specific learning disorder** is provided as an option, it is the formal and overarching diagnostic category that applies in this clinical setting.*Aspergers syndrome*- **Asperger's Syndrome** is an outdated term now grouped under **Autism Spectrum Disorder (ASD)**, which is fundamentally characterized by deficits in social communication and interaction, and restricted, repetitive patterns of behavior.- While individuals with ASD may have uneven skill profiles, the history focuses exclusively on a **specific, isolated academic impairment** in mathematics, without mentioning the core criteria of social deficits.

Q: Untreated ADHD persisting from childhood increases the risk of developing which of the following in adolescence?

Conduct disorder. ***Conduct disorder*** - **Untreated ADHD**, marked by impulsivity and difficulty with emotional regulation, significantly increases the risk of developing **conduct disorder** in adolescence. - Adolescents with untreated ADHD may struggle with following rules, exhibiting aggressive behaviors, and engaging in antisocial acts, which are hallmarks of conduct disorder. *Selective mutism* - This is an **anxiety disorder** characterized by a child's consistent failure to speak in specific social situations where there is an expectation for speaking despite speaking in other situations. - While it can co-occur with ADHD, it is not a direct consequence of untreated ADHD and involves distinct psychological mechanisms. *Binge eating disorder* - This disorder is characterized by recurrent episodes of **eating unusually large amounts of food** in a short period, often accompanied by a sense of loss of control. - While there is a higher prevalence of eating disorders in individuals with ADHD, it is not a primary or direct developmental risk from untreated ADHD in adolescence. *Separation anxiety disorder* - This disorder involves **excessive fear or anxiety** concerning separation from home or from attachment figures, beyond what is expected for the individual's developmental level. - While it can co-occur with ADHD, it is not a direct developmental risk that emerges from untreated ADHD in adolescence.

Q: A 6 year old child who does not interact with other children of his age group and prefers playing alone with repetitive behaviors, is likely to be suffering from:

Autism. ***Autism*** - Difficulties in **social interaction** and **communication**, along with **repetitive behaviors** and restricted interests, are core diagnostic features of **Autism Spectrum Disorder (ASD)**. - The child's preference for playing alone and lack of interaction with peers are hallmark signs of **social deficits** in ASD. *ADHD* - **Attention-Deficit/Hyperactivity Disorder (ADHD)** primarily involves difficulties with **inattention**, **hyperactivity**, and **impulsivity**. - While children with ADHD may struggle socially, repetitive behaviors and a complete lack of interest in peer interaction are not typical primary symptoms. *Depression* - **Depression** in children often presents with **sadness**, **loss of interest** in previously enjoyed activities, changes in sleep or appetite, and irritability. - Social withdrawal in depression is usually due to low mood or anhedonia, rather than a fundamental difficulty in social understanding or a preference for repetitive play. *Bipolar disorder* - **Bipolar disorder** in children involves distinct episodes of **mania** (elevated mood, increased energy, decreased need for sleep) and **depression**. - The symptoms described do not align with the characteristic mood swings and episodic nature of bipolar disorder.

Q: Which of the following is not seen in autism?

Abnormal dermatoglyphics. ***Abnormal dermatoglyphics*** - **Abnormal dermatoglyphics** (fingerprint patterns) are not a characteristic feature of autism spectrum disorder. - While dermatoglyphics can be altered in some genetic syndromes, they are not consistently found or used as a diagnostic marker for autism. *1/3rd patients have intellectual disability* - Approximately **one-third (30-40%) of individuals with autism** have co-occurring intellectual disability (ID with IQ <70). - This comorbidity impacts the level of support and interventions required. - The prevalence has decreased over time due to improved diagnostic criteria and recognition of high-functioning autism. *Poor eye contact* - **Poor eye contact** is a cardinal feature and a key diagnostic criterion for autism spectrum disorder. - It reflects difficulties in social communication and interaction, a core deficit in autism. *Language is impaired* - **Language impairment** is a common feature of autism, ranging from delayed language development to complete absence of speech in some cases. - Challenges in both receptive and expressive language are characteristic, affecting social communication. - However, not all individuals with autism have language impairment, particularly those with high-functioning autism or Asperger's syndrome.

Q: A 10 year old boy was brought to the psychiatrist by parents with complaints of not following the rules of school, arguing with teachers and fellow students. The parents report that he misbehaves with them too and at times tries to provoke them. What is the likely diagnosis?

Oppositional defiant disorder. **Oppositional defiant disorder** - The boy's behaviors of **not following rules**, arguing with teachers and students, and **provoking parents** are characteristic features of ODD. - ODD is defined by a pattern of **angry/irritable mood**, argumentative/defiant behavior, or vindictiveness. *Conduct disorder* - Conduct disorder involves more serious violations of the **rights of others** or major **societal norms**, such as aggression towards people or animals, destruction of property, deceitfulness, or theft. - The scenario describes defiant and argumentative behavior, not the severe actions typical of conduct disorder. *Autism spectrum disorder* - ASD is characterized by persistent deficits in **social communication and interaction** across multiple contexts, and **restricted, repetitive patterns of behavior, interests, or activities.** - The provided symptoms do not align with the core diagnostic criteria for autism spectrum disorder. *Attention deficit hyperactivity disorder* - ADHD involves a persistent pattern of **inattention** and/or **hyperactivity-impulsivity** that interferes with functioning or development. - While some defiant behavior can coexist with ADHD, the primary presentation here is one of opposition and defiance, not predominantly inattention or hyperactivity.

Question 1

A 3-year-old girl has normal developmental milestones except for a delay in speech. She has difficulty concentrating, communicating, and relating to others. She does not make friends but plays by herself. What is the likely diagnosis?

Accepted Answer

Autism Spectrum Disorder

Answer

Attention-Deficit/Hyperactivity Disorder (ADHD)

Answer

Specific learning disorder

Answer

Intellectual disability

Question 2

An 8-year-old child has shown a lack of interest in studies for the last 6 months. He has frequent quarrels with his parents and has frequent headaches as an excuse to avoid school. What would be the most appropriate clinical diagnosis in this patient?

Accepted Answer

Oppositional defiant disorder

Answer

Migraine

Answer

Depression

Answer

Normal adolescent problem

Question 3

Which statement is FALSE regarding specific learning disorders (SLD)?

Accepted Answer

It includes students who did well in academic testing but not in intelligence testing.

Answer

The overall estimates of the prevalence of SLD range from 3-10%

Answer

It is a type of neurodevelopmental dysfunction.

Answer

Terms like dysgraphia or dyscalculia have been revolutionized.

Question 4

Which of the following is true about the treatment of nocturnal enuresis?

Accepted Answer

Imipramine

Answer

Chlorpromazine (CPZ)

Answer

Alprazolam

Answer

Haloperidol

Question 5

Which of the following is LEAST commonly seen in conduct disorder in girls?

Accepted Answer

Physical aggression

Answer

Running away from home

Answer

High-risk sexual behavior

Answer

Emotional bullying

Question 6

According to DSM-5 classification, what is the diagnosis for a child who exhibits below-average mathematical skills despite having a normal IQ and age-appropriate learning abilities in other areas, and remains unaffected by a year-long private mathematics tutoring?

Accepted Answer

Specific learning disorder

Answer

Mathematics learning disorder

Answer

Aspergers syndrome

Answer

ADHD

Question 7

Untreated ADHD persisting from childhood increases the risk of developing which of the following in adolescence?

Accepted Answer

Conduct disorder

Answer

Selective mutism

Answer

Binge eating disorder

Answer

Separation anxiety disorder

Question 8

A 6 year old child who does not interact with other children of his age group and prefers playing alone with repetitive behaviors, is likely to be suffering from:

Accepted Answer

Autism

Answer

ADHD

Answer

Depression

Answer

Bipolar disorder

Question 9

Which of the following is not seen in autism?

Accepted Answer

Abnormal dermatoglyphics

Answer

1/3rd patients have intellectual disability

Answer

Poor eye contact

Answer

Language is impaired

Question 10

A 10 year old boy was brought to the psychiatrist by parents with complaints of not following the rules of school, arguing with teachers and fellow students. The parents report that he misbehaves with them too and at times tries to provoke them. What is the likely diagnosis?

Accepted Answer

Oppositional defiant disorder

Answer

Conduct disorder

Answer

Autism spectrum disorder

Answer

Attention deficit hyperactivity disorder

Child and Adolescent Psychiatry — MCQs

Child and Adolescent Psychiatry — MCQs

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