Child and Adolescent Psychiatry Practice Questions

Q: All of the following are complex motor tics except?

Palilalia. **Explanation:** Tics are sudden, rapid, recurrent, non-rhythmic motor movements or vocalizations. They are broadly classified into **Motor** vs. **Vocal** and **Simple** vs. **Complex**. **Why Palilalia is the correct answer:** **Palilalia** is defined as the involuntary repetition of one's own words or phrases. Since it involves the production of sound/speech, it is classified as a **vocal tic**, not a motor tic. Specifically, it is a **complex vocal tic**. Because the question asks for "all except" complex motor tics, Palilalia is the outlier. **Analysis of Incorrect Options (Complex Motor Tics):** Complex motor tics are purposeful-looking, coordinated patterns of movement involving multiple muscle groups. * **Echopraxia:** The involuntary imitation of another person's movements. It is a classic complex motor tic. * **Jumping:** A coordinated gross motor movement involving multiple muscle groups, categorized as a complex motor tic. * **Touching:** Repetitive touching of objects or oneself (often associated with OCD-like compulsions) is a common complex motor tic. **High-Yield Clinical Pearls for NEET-PG:** * **Simple Motor Tics:** Eye blinking, neck jerking, shoulder shrugging (involve single muscle groups). * **Simple Vocal Tics:** Throat clearing, grunting, sniffing, barking. * **Complex Vocal Tics:** **Palilalia** (repeating self), **Echolalia** (repeating others), and **Coprolalia** (uttering obscenities). * **Tourette Syndrome Diagnosis:** Requires **both** multiple motor tics and at least one vocal tic (not necessarily concurrent) present for >1 year, with onset before age 18. * **Drug of Choice:** Alpha-2 agonists (Guanfacine, Clonidine) are often first-line; typical/atypical antipsychotics (Haloperidol, Risperidone) are also effective.

Q: Autistic disorder is characterized by all of the following features, except:

Visual impairment. **Explanation:** Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by a triad of impairments. The diagnosis is clinical, based on behavioral patterns rather than sensory deficits. **1. Why "Visual Impairment" is the correct answer:** Visual impairment is a **sensory deficit**, not a core feature of Autism. While children with ASD may exhibit atypical visual behaviors (e.g., avoiding eye contact or looking at objects from peripheral angles), their actual visual acuity is typically normal. Sensory deficits like blindness or deafness are separate comorbidities and are not part of the diagnostic criteria for ASD. **2. Analysis of other options:** * **Lack of social interaction:** This is a hallmark feature. Children show a failure of social reciprocity, lack of "joint attention," and difficulty in forming peer relationships. * **Stereotypical movements:** These are repetitive, purposeless motor mannerisms (e.g., hand-flapping, body rocking, or spinning). This falls under the "Restricted, Repetitive Patterns of Behavior" domain of DSM-5. * **Delayed development of speech:** Communication deficits are central to ASD. This includes a total delay in speech, lack of "make-believe" play, or repetitive use of language (echolalia). **Clinical Pearls for NEET-PG:** * **DSM-5 Criteria:** Now uses two domains: 1) Deficits in social communication/interaction and 2) Restricted, repetitive patterns of behavior. * **Early Sign:** The earliest reliable sign is the **absence of a social smile** or failure to respond to one's name by 12 months. * **M-CHAT:** The most commonly used screening tool for toddlers. * **Prognosis:** The best predictors of a good prognosis are **higher IQ (>70)** and the **development of communicative speech** by age 5–7 years.

Q: Which of the following diseases is characterized by the observation described?

Tourette Syndrome. ***Tourette Syndrome*** - Characterized by **multiple motor tics** and at least **one vocal tic** present for more than one year, as per **DSM-5 criteria**. - Tics are **involuntary**, **sudden**, and **repetitive** movements or vocalizations that typically begin in childhood. *Obsessive-Compulsive Disorder (OCD)* - Involves **obsessions** (intrusive thoughts) and **compulsions** (repetitive behaviors), not involuntary tics. - Behaviors are **purposeful** and performed to reduce anxiety, unlike the involuntary nature of tics. *Rett Syndrome* - Predominantly affects **females** and involves **developmental regression** and characteristic **hand-wringing** movements. - Associated with **MECP2 gene mutations** and severe intellectual disability, distinct from tic disorders. *Anxiety Disorder* - Characterized by **excessive worry**, **fear**, and **physiological symptoms** like palpitations or sweating. - Does not involve **involuntary motor** or **vocal tics** that are hallmarks of Tourette Syndrome.

Q: Who proposed the concept of intimacy versus isolation in psychosocial development?

Erik Erikson. **Explanation:** **Erik Erikson** (Option A) is the correct answer. He proposed the **Theory of Psychosocial Development**, which consists of eight stages spanning from infancy to late adulthood. Each stage is characterized by a specific psychosocial crisis. **Intimacy vs. Isolation** is the sixth stage, typically occurring during young adulthood (ages 18 to 40). During this period, the major developmental task is forming intimate, loving relationships with others. Success leads to the virtue of **Love**, while failure results in loneliness and emotional isolation. **Analysis of Incorrect Options:** * **Eugen Bleuler (Option B):** A Swiss psychiatrist famous for coining the term "Schizophrenia" and defining its "4 As" (Association, Affect, Ambivalence, and Autism). * **Sigmund Freud (Option C):** The founder of psychoanalysis who proposed the **Psychosexual** stages of development (Oral, Anal, Phallic, Latency, and Genital), focusing on libidinal energy rather than social interaction. * **Konrad Lorenz (Option D):** An ethologist known for his work on **Imprinting** and attachment in animals (specifically geese), which laid the groundwork for later attachment theories. **High-Yield Clinical Pearls for NEET-PG:** * **Erikson’s Stages (First 5):** 1. Trust vs. Mistrust (Infancy - Virtue: Hope) 2. Autonomy vs. Shame/Doubt (Early Childhood - Virtue: Will) 3. Initiative vs. Guilt (Preschool - Virtue: Purpose) 4. Industry vs. Inferiority (School age - Virtue: Competence) 5. **Identity vs. Role Confusion** (Adolescence - Virtue: Fidelity) — *Most frequently asked stage.* * Erikson’s theory is unique because it emphasizes that personality development continues throughout the entire lifespan, unlike Freud’s theory which concludes at puberty.

Q: Which of the following tic disorders may be diagnosed even if the onset is after 18 years of age?

Tic disorder not otherwise specified. In child and adolescent psychiatry, the classification of tic disorders is primarily based on the **DSM-5** and **ICD-10/11** criteria. ### **Explanation of the Correct Answer** For the primary tic disorders (Tourette’s, Chronic, and Provisional/Transient), a mandatory diagnostic criterion is that the **onset must occur before the age of 18 years**. If a patient develops tics for the first time after age 18, it cannot be classified under these specific categories. Instead, it is classified as **Tic Disorder Not Otherwise Specified (NOS)** (or "Other Specified/Unspecified Tic Disorder" in DSM-5). This category is reserved for clinical presentations that do not meet the full criteria for a specific tic disorder, including cases with late-age onset or atypical presentations. ### **Why Other Options are Incorrect** * **A. Tourette's Disorder:** Requires both multiple motor tics and at least one vocal tic to be present for >1 year, with onset strictly **before age 18**. * **B. Chronic Motor or Vocal Tic Disorder:** Requires either motor or vocal tics (but not both) for >1 year, with onset strictly **before age 18**. * **C. Transient (Provisional) Tic Disorder:** Characterized by single or multiple motor and/or vocal tics for <1 year, with onset strictly **before age 18**. ### **High-Yield NEET-PG Pearls** * **Age of Onset:** The peak age for tic onset is **4–6 years**; severity typically peaks at **10–12 years**. * **Gender:** Tic disorders are significantly more common in **males** (approx. 3:1 ratio). * **Comorbidities:** The most common comorbidities with Tourette’s are **ADHD** (most common) and **OCD**. * **Treatment:** The first-line behavioral therapy is **CBIT** (Comprehensive Behavioral Intervention for Tics). Pharmacotherapy includes alpha-2 agonists (Clonidine) or antipsychotics (Risperidone, Haloperidol).

Question 1

Which of the following is NOT a diagnostic criterion for Munchausen's syndrome by proxy?

Accepted Answer

Parental acceptance of knowledge of the cause of symptoms.

Answer

Illness produced or alleged, or both, by a parent.

Answer

Repeated requests for medical care for a child.

Answer

Regression of symptoms on separation from parents.

Question 2

All of the following are complex motor tics except?

Accepted Answer

Palilalia

Answer

Echopraxia

Answer

Jumping

Answer

Touching

Question 3

In which age group is "copycat suicide" most commonly observed?

Accepted Answer

Adolescence

Answer

Childhood

Answer

Adulthood

Answer

Old age

Question 4

A 12-year-old boy presents with disruptive behavior at school, aggression towards teachers, and truancy. He was recently suspended from school for destruction of school property. Which of the following diagnoses best suits his presentation?

Accepted Answer

Conduct disorder

Answer

Oppositional defiant disorder

Answer

Attention deficit hyperactivity disorder

Answer

Autism spectrum disorder

Question 5

What is anaclitic depression?

Accepted Answer

Depression in a child deprived of a caretaker

Answer

Depression on top of dysthymia

Answer

Depression with increased sleep and increased appetite

Answer

Depression with a seasonal pattern

Question 6

Autistic disorder is characterized by all of the following features, except:

Accepted Answer

Visual impairment

Answer

Lack of social interaction

Answer

Stereotypical movements

Answer

Delayed development of speech

Question 7

Mild Mitral Regurgitation (MR) has which of the following features?

Accepted Answer

Presents within the first 2 years of life.

Answer

Present in 5-10% of the population.

Answer

Increased incidence in low socioeconomic groups.

Answer

Has a genetic background.

Question 8

Which of the following diseases is characterized by the observation described?

Accepted Answer

Tourette Syndrome

Answer

Obsessive-Compulsive Disorder (OCD)

Answer

Rett Syndrome

Answer

Anxiety Disorder

Question 9

Who proposed the concept of intimacy versus isolation in psychosocial development?

Accepted Answer

Erik Erikson

Answer

Eugen Bleuler

Answer

Sigmund Freud

Answer

Konrad Lorenz

Question 10

Which of the following tic disorders may be diagnosed even if the onset is after 18 years of age?

Accepted Answer

Tic disorder not otherwise specified

Answer

Tourette's disorder

Answer

Chronic motor or vocal tic disorder

Answer

Transient tic disorder

Child and Adolescent Psychiatry — MCQs

Child and Adolescent Psychiatry — MCQs

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