Child and Adolescent Psychiatry Practice Questions

Q: A 15-year-old child presents with multiple involuntary movements of the hand and whistling sounds, preceded by a premonitory urge. These symptoms began at age 10 and cause significant distress, impairing school and home activities. The patient showed some improvement with haloperidol. What is the diagnosis?

Tourette's syndrome. ### Explanation **Correct Option: D. Tourette’s Syndrome** The clinical presentation is a classic case of **Tourette’s Syndrome (TS)**. The diagnosis is based on the following DSM-5 criteria: 1. **Multiple Motor Tics:** (e.g., involuntary hand movements). 2. **At least one Vocal Tic:** (e.g., whistling sounds). 3. **Duration:** Symptoms must persist for more than **one year**. 4. **Onset:** Before the age of 18 (patient started at age 10). 5. **Premonitory Urge:** A characteristic "sensory" urge or tension that is relieved by performing the tic. The positive response to **Haloperidol** (a D2 receptor antagonist) further supports the diagnosis, as dopamine dysregulation in the basal ganglia is the implicated pathophysiology. **Why other options are incorrect:** * **A. Generalized Anxiety Disorder:** Characterized by excessive, uncontrollable worry about various events for ≥6 months; it does not present with motor or vocal tics. * **B. Obsessive-Compulsive Disorder:** While frequently comorbid with TS (up to 50% of cases), OCD involves intrusive thoughts (obsessions) and ritualistic behaviors (compulsions) to neutralize anxiety, not involuntary motor/vocal tics. * **C. Panic Disorder:** Involves recurrent, unexpected panic attacks and worry about future attacks; it lacks the chronic tic profile described. **NEET-PG High-Yield Pearls:** * **Most Common Comorbidities:** ADHD (most common) followed by OCD. * **Coprolalia:** Involuntary shouting of obscenities (present in only ~10% of cases; not required for diagnosis). * **First-line Treatment:** Behavioral therapy (CBIT - Comprehensive Behavioral Intervention for Tics). * **Pharmacotherapy:** Alpha-2 agonists (Clonidine/Guanfacine) are often first-line for mild cases; typical (Haloperidol, Pimozide) or atypical (Risperidone) antipsychotics are used for severe symptoms.

Q: A 3-year-old child has normal developmental milestones except for delayed language development (poor speech development). The child has difficulty with concentration, communication, and making friends, and spends time fixated on their own hands. What is the most probable diagnosis?

Autism. ### Explanation The clinical presentation describes a classic case of **Autism Spectrum Disorder (ASD)**. The diagnosis is based on a triad of core deficits: 1. **Impaired Social Interaction:** Difficulty making friends and poor social reciprocity. 2. **Communication Deficits:** Delayed language development and poor speech. 3. **Restricted/Repetitive Behaviors:** Fixation on their own hands (stereotypical movements/self-stimulatory behavior). In ASD, developmental milestones are often normal in the motor domain, but social and language milestones are significantly delayed, typically becoming apparent before age 3. **Why the other options are incorrect:** * **ADHD:** While it involves poor concentration, it does not typically present with significant language delay or the profound social-communication deficits and repetitive behaviors seen here. * **Specific Learning Disability (SLD):** This diagnosis is usually made in school-aged children (6+ years) who have difficulty with specific academic skills (reading/writing) despite having a normal IQ. It does not explain social withdrawal or hand fixation. * **Intellectual Disability (ID):** While ID can coexist with Autism, it involves a global delay in *all* developmental milestones (motor, social, and cognitive). The question specifies that other milestones were normal, pointing specifically toward Autism. **High-Yield Clinical Pearls for NEET-PG:** * **M-CHAT:** The Modified Checklist for Autism in Toddlers is the most commonly used screening tool (16–30 months). * **Early Signs:** Lack of joint attention (not pointing at objects), failure to respond to name, and poor eye contact. * **Prognosis:** The best predictors of long-term outcome in Autism are the **level of IQ** and the **development of communicative language** by age 5.

Q: Callous and unemotional traits (CU), which include disregard for others, lack of empathy, and generally deficient affect, are considered as a specifier for which disorder in DSM-5?

Conduct disorder. **Explanation:** In **DSM-5**, the specifier **"With Limited Prosocial Emotions"** was added to the diagnosis of **Conduct Disorder (CD)**. This specifier specifically describes individuals who exhibit **Callous and Unemotional (CU) traits**. To meet this criteria, a child must persistently display at least two of the following: lack of remorse or guilt, callousness (lack of empathy), unconcern about performance, and shallow or deficient affect. **Why Conduct Disorder is correct:** CU traits identify a distinct subgroup of children with Conduct Disorder who exhibit more severe, aggressive, and stable patterns of antisocial behavior. These traits are considered precursors to **Antisocial Personality Disorder** in adulthood. Identifying this specifier is crucial because these patients often require different therapeutic approaches compared to those with standard CD. **Why other options are incorrect:** * **Borderline & Histrionic Personality Disorders:** These are Cluster B personality disorders diagnosed in adults (usually >18 years). While they involve emotional dysregulation, they do not utilize the "CU traits" specifier. * **Oppositional Defiant Disorder (ODD):** While ODD often precedes Conduct Disorder, it is characterized by moodiness, defiance, and vindictiveness rather than the predatory, callous, and unemotional behavior seen in the CD specifier. **High-Yield Pearls for NEET-PG:** * **Age Criteria:** Conduct Disorder is diagnosed in individuals <18 years. If the behavior persists after 18, the diagnosis shifts to **Antisocial Personality Disorder**. * **Core Triad:** Historically, the "MacDonald Triad" (enuresis, fire-setting, and animal cruelty) was linked to later sociopathy, though its predictive validity is now debated. * **Neurobiology:** CU traits are often associated with **amygdala hypo-reactivity** to distress cues in others.

Q: Which of the following Autism Spectrum Disorders is characterized by normal IQ and language skills?

Asperger's syndrome. **Explanation:** **Asperger’s Syndrome** (Option B) is the correct answer. Under the previous DSM-IV classification, it was distinguished from Autistic Disorder by the **absence of clinically significant delays in language development, cognitive development, or age-appropriate self-help skills.** Children with Asperger’s typically have an average to above-average IQ and fluent speech, though they struggle significantly with social reciprocity and exhibit restricted, repetitive patterns of behavior. In DSM-5, this is now subsumed under the broader category of **Autism Spectrum Disorder (ASD) Level 1.** **Incorrect Options:** * **Rett’s Syndrome (A):** A genetic neurodevelopmental disorder (MECP2 mutation) primarily affecting females. It is characterized by a period of normal development followed by a loss of purposeful hand skills (replaced by stereotypic hand-wringing), decelerated head growth, and **severe intellectual disability.** * **Heller’s Syndrome (C):** Also known as **Childhood Disintegrative Disorder (CDD).** It involves at least two years of normal development followed by a dramatic loss of previously acquired skills (language, social, motor). It is associated with **severe intellectual impairment.** * **Munchausen Syndrome (D):** A psychiatric disorder (Factitious Disorder) where a person feigns or induces physical or psychological symptoms for primary gain (the "sick role"). It is not an Autism Spectrum Disorder. **High-Yield Clinical Pearls for NEET-PG:** * **Asperger’s vs. Autism:** The "defining" difference is the **lack of speech delay** in Asperger’s. * **Social Deficit:** Patients with Asperger’s often want to socialize but lack the "social intuition" to do so effectively (the "eccentric professor" profile). * **DSM-5 Update:** Autistic Disorder, Asperger’s, and CDD are now all merged into **Autism Spectrum Disorder.** Rett’s Syndrome is now considered a separate neurological entity.

Question 1

Which of the following is NOT a pervasive developmental disorder?

Accepted Answer

Attention deficit hyperactivity disorder

Answer

Asperger syndrome

Answer

Autistic disorder

Answer

Childhood disintegrative disorder

Question 2

A 15-year-old child presents with multiple involuntary movements of the hand and whistling sounds, preceded by a premonitory urge. These symptoms began at age 10 and cause significant distress, impairing school and home activities. The patient showed some improvement with haloperidol. What is the diagnosis?

Accepted Answer

Tourette's syndrome

Answer

Generalized anxiety disorder

Answer

Obsessive-compulsive disorder

Answer

Panic disorder

Question 3

A 3-year-old girl has problems with writing and spelling. Her other intelligence is normal. What is the likely diagnosis?

Accepted Answer

Dyslexia

Answer

Mental retardation

Answer

Specific writing disorder

Answer

Dysphonia

Question 4

The incidence of mental illness is the maximum if the causal factors affect which particular period of life?

Accepted Answer

First five years of life

Answer

Perinatal period

Answer

School age

Answer

Adolescence

Question 5

All are true about Attention-Deficit/Hyperactivity Disorder (ADHD) except?

Accepted Answer

Symptoms should be present before 12 years of age for diagnosis.

Answer

Methylphenidate is the drug of choice for ADHD.

Answer

Symptoms should be present in more than one setting.

Answer

Symptoms should be present before 7 years of age for diagnosis.

Question 6

A 3-year-old child has normal developmental milestones except for delayed language development (poor speech development). The child has difficulty with concentration, communication, and making friends, and spends time fixated on their own hands. What is the most probable diagnosis?

Accepted Answer

Autism

Answer

Attention-Deficit/Hyperactivity Disorder (ADHD)

Answer

Specific learning disability

Answer

Intellectual disability

Question 7

What is the most common infection associated with PANDAS?

Accepted Answer

Streptococcus pyogenes

Answer

Staphylococcus aureus

Answer

Streptococcus pneumoniae

Answer

Mycobacterium tuberculosis

Question 8

Callous and unemotional traits (CU), which include disregard for others, lack of empathy, and generally deficient affect, are considered as a specifier for which disorder in DSM-5?

Accepted Answer

Conduct disorder

Answer

Borderline Personality disorder

Answer

Histrionic Personality disorder

Answer

Oppositional defiant disorder

Question 9

Which of the following Autism Spectrum Disorders is characterized by normal IQ and language skills?

Accepted Answer

Asperger's syndrome

Answer

Rett's syndrome

Answer

Heller's syndrome

Answer

Munchausen syndrome

Question 10

A 10-year-old boy is constantly restless. In school, his behavior makes it difficult for the rest of the class to concentrate. He is rarely in his seat at home or school and has trouble playing quietly. He does not seem to listen to his mother. What is the most likely diagnosis?

Accepted Answer

Attention-deficit hyperactivity disorder

Answer

Conduct disorder

Answer

Depressive disorder

Answer

Schizophrenia

Child and Adolescent Psychiatry — MCQs

Child and Adolescent Psychiatry — MCQs

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