Anxiety Disorders in Children Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Anxiety Disorders in Children. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Anxiety Disorders in Children Indian Medical PG Question 1: Which of the following disorders is classified under somatic symptom and related disorders in the DSM-5?
- A. Post-Traumatic Stress Disorder (PTSD)
- B. Phobic disorders (e.g., social anxiety disorder)
- C. Conversion disorder (functional neurological symptom disorder) (Correct Answer)
- D. Obsessive-Compulsive Disorder (OCD)
Anxiety Disorders in Children Explanation: ***Conversion disorder (functional neurological symptom disorder)***
- **Conversion disorder** is characterized by neurological symptoms (e.g., paralysis, blindness) that are **incompatible with recognized neurological or medical conditions**, yet are not intentionally produced.
- It falls under **somatic symptom and related disorders** because the primary features are physical symptoms causing distress or functional impairment, rather than being malingered or feigned.
*Phobic disorders (e.g., social anxiety disorder)*
- **Phobic disorders** are classified under **anxiety disorders** in the DSM-5, not somatic symptom and related disorders.
- They are primarily characterized by **intense, irrational fears** of specific objects or situations, leading to avoidance rather than prominent physical symptoms without a medical cause.
*Post-Traumatic Stress Disorder (PTSD)*
- **PTSD** is classified under **trauma- and stressor-related disorders** in the DSM-5, distinguished by symptoms developing after exposure to a traumatic event.
- Its core features include **intrusive memories, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity**, rather than unexplained physical symptoms.
*Obsessive-Compulsive Disorder (OCD)*
- **OCD** is classified under **obsessive-compulsive and related disorders** in the DSM-5.
- It is primarily characterized by the presence of **obsessions (recurrent, intrusive thoughts)** and/or **compulsions (repetitive behaviors or mental acts)**, which are distinct from somatic symptoms.
Anxiety Disorders in Children Indian Medical PG Question 2: In which of the following conditions is behavior therapy considered most effective?
- A. Panic Attack
- B. Psychosis
- C. Obsessive-Compulsive Disorder (OCD) (Correct Answer)
- D. Generalized Anxiety Disorder
Anxiety Disorders in Children Explanation: ***Obsessive-Compulsive Disorder (OCD)***
- **Exposure and Response Prevention (ERP)**, a type of behavior therapy, is the gold standard and most effective treatment for OCD.
- ERP directly targets the **obsessions** and **compulsions** by gradually exposing individuals to feared situations without allowing them to perform their rituals.
- OCD shows the **highest response rates** to pure behavior therapy compared to other psychiatric conditions.
*Psychosis*
- While supportive therapy and cognitive behavioral therapy for psychosis (CBTp) can be helpful, **behavior therapy alone is not considered the primary or most effective treatment** for core psychotic symptoms.
- Management of psychosis primarily relies on **antipsychotic medications** to address symptoms like hallucinations and delusions.
*Panic Attack*
- Behavior therapy and CBT are effective for **Panic Disorder**, but the effectiveness is somewhat lower than for OCD.
- Treatment for panic disorder often requires a **combination of behavioral and cognitive techniques** rather than pure behavior therapy alone.
- Management typically includes breathing exercises, exposure to physical sensations, and cognitive restructuring.
*Generalized Anxiety Disorder*
- **Cognitive Behavioral Therapy (CBT)**, which includes behavioral components, is highly effective for GAD, but the **cognitive elements are essential** for addressing worry and rumination.
- Pure behavior therapy (e.g., systematic desensitization) is less effective for GAD compared to OCD, as GAD involves pervasive cognitive distortions that require cognitive restructuring.
Anxiety Disorders in Children Indian Medical PG Question 3: A 45-year-old male presents with recurrent episodes of palpitations, sweating, and a fear of losing control. He has been experiencing these episodes for the past six months. What is the most likely diagnosis?
- A. Generalized anxiety disorder
- B. Panic disorder (Correct Answer)
- C. Social anxiety disorder
- D. Obsessive-compulsive disorder
Anxiety Disorders in Children Explanation: ***Panic disorder***
- The presentation of recurrent, unexpected **panic attacks** characterized by sudden episodes of intense fear, palpitations, sweating, and a fear of losing control is classic for **panic disorder**.
- These episodes often manifest with physical symptoms that mimic a medical emergency, leading to significant distress and avoidance behaviors.
*Generalized anxiety disorder*
- This condition involves **persistent and excessive worry** about various life circumstances for at least six months, rather than discrete, intense episodes of fear.
- While physical symptoms like restlessness and fatigue can occur, they are generally less acute and not as severe as the sudden "fight-or-flight" response seen in panic attacks.
*Social anxiety disorder*
- This disorder is characterized by marked fear or anxiety about **social situations** where the individual might be scrutinized by others.
- While it can involve symptoms like palpitations and sweating in social contexts, it doesn't typically present with unexpected attacks unrelated to social performance.
*Obsessive-compulsive disorder*
- This disorder is defined by the presence of **obsessions** (recurrent and persistent thoughts, urges, or images) and/or **compulsions** (repetitive behaviors or mental acts) that the individual feels driven to perform.
- The symptoms described—palpitations, sweating, and fear of losing control—are not typical primary manifestations of OCD, which focuses on specific obsessions and compulsions.
Anxiety Disorders in Children Indian Medical PG Question 4: Which of the following statements about 21-Hydroxylase deficiency is false?
- A. It leads to female pseudohermaphroditism.
- B. It is the most common cause of congenital adrenal hyperplasia.
- C. It is inherited in an autosomal recessive manner.
- D. It leads to male pseudohermaphroditism. (Correct Answer)
Anxiety Disorders in Children Explanation: ***It leads to male pseudohermaphroditism.***
- **21-Hydroxylase deficiency** does not lead to male pseudohermaphroditism; instead, it causes **virilization in females** (female pseudohermaphroditism) due to increased androgen production.
- Males with 21-hydroxylase deficiency typically present with **salt-wasting crises** or **premature pubarche**, but their internal and external genitalia are normal.
*It is the most common cause of congenital adrenal hyperplasia.*
- This statement is **true**. **21-hydroxylase deficiency** accounts for approximately 90-95% of all cases of congenital adrenal hyperplasia (CAH) [1].
- Its prevalence and significant role in cortisol and aldosterone synthesis pathways make it the predominant form of the disorder [1].
*It is inherited in an autosomal recessive manner.*
- This statement is **true**. 21-hydroxylase deficiency is caused by mutations in the **CYP21A2 gene**, which is inherited in an **autosomal recessive pattern**.
- Both parents must be carriers for a child to be affected, with each child having a 25% chance of inheriting the disorder.
*It leads to female pseudohermaphroditism.*
- This statement is **true**. In affected females, the deficiency of 21-hydroxylase shunts steroid precursors towards the **androgen pathway**, leading to excess adrenal androgens.
- This excess androgen exposure *in utero* causes **virilization** of external genitalia, resulting in varying degrees of **ambiguous genitalia** (female pseudohermaphroditism).
Anxiety Disorders in Children Indian Medical PG Question 5: Which of the following treatments cannot be used for management of Obsessive Compulsive Disorder (OCD)?
- A. Fluoxetine
- B. Carbamazepine (Correct Answer)
- C. Cognitive Behaviour Therapy
- D. Clomipramine
Anxiety Disorders in Children Explanation: ***Carbamazepine***
- **Carbamazepine** is an **anticonvulsant** and **mood stabilizer** primarily used for epilepsy and bipolar disorder.
- It does not have established efficacy for the treatment of **Obsessive-Compulsive Disorder (OCD)**.
*Fluoxetine*
- **Fluoxetine** is a **Selective Serotonin Reuptake Inhibitor (SSRI)** and is a **first-line pharmacotherapy** for OCD.
- SSRIs, including fluoxetine, are effective in reducing the severity of **obsessions and compulsions**.
*Cognitive Behaviour Therapy*
- **Cognitive Behavioural Therapy (CBT)**, specifically **Exposure and Response Prevention (ERP)**, is the **gold standard psychotherapy** for OCD.
- It involves gradually exposing patients to feared situations or thoughts while preventing their ritualistic responses.
*Clomipramine*
- **Clomipramine** is a **tricyclic antidepressant (TCA)** that has potent inhibitory effects on **serotonin reuptake**.
- It is one of the **most effective medications** for OCD, often used when SSRIs are insufficient.
Anxiety Disorders in Children Indian Medical PG Question 6: A student unable to deliver speech before an audience is suffering from?
- A. Social anxiety disorder (Correct Answer)
- B. Fear of open spaces
- C. Fear of enclosed spaces
- D. Obsessive Compulsive Disorder
Anxiety Disorders in Children Explanation: ***Social anxiety disorder***
- This condition involves an intense, persistent fear of social situations, particularly those where one might be scrutinized or judged by others.
- Public speaking is a classic scenario that can trigger significant distress and avoidance in individuals with **social anxiety disorder**.
*Fear of open spaces*
- This symptom describes **agoraphobia**, which is an anxiety disorder characterized by fear and avoidance of situations or places that might cause panic, helplessness, or embarrassment, often due to a perceived inability to escape.
- While it can sometimes involve fear of public gatherings, its core is about escape/safety from open, unfamiliar, or overwhelming spaces, not specifically about performance.
*Fear of enclosed spaces*
- This refers to **claustrophobia**, which is an anxiety disorder characterized by an irrational fear of confined spaces.
- It does not involve the fear of speaking or performance before an audience.
*Obsessive Compulsive Disorder*
- **OCD** is characterized by recurrent and persistent thoughts (obsessions) and/or repetitive behaviors or mental acts (compulsions) performed to reduce anxiety.
- It does not typically manifest as an inability to deliver a speech before an audience unless the obsessions or compulsions directly interfere with such an activity, which is not the primary mechanism of this symptom.
Anxiety Disorders in Children Indian Medical PG Question 7: Best therapy suited to teach daily life skill to a mentally challenged child:
- A. Contingency management (Correct Answer)
- B. Cognitive reconstruction
- C. Self instruction
- D. CBT (Cognitive behavior therapy)
Anxiety Disorders in Children Explanation: ***Contingency management***
- This therapy involves consistently **rewarding desired behaviors** and withholding rewards for undesirable ones, which is highly effective for teaching new skills to individuals with intellectual disabilities.
- It uses principles of **operant conditioning** to shape behavior through positive reinforcement, making it suitable for acquiring daily living skills.
*Cognitive reconstruction*
- This technique focuses on identifying and changing **maladaptive thought patterns**, which typically requires a higher level of cognitive function.
- It is generally not the primary or most effective approach for teaching concrete daily life skills to individuals with significant **cognitive limitations**.
*Self instruction*
- This involves teaching individuals to guide their own behavior using **internal verbal cues** or self-talk.
- While beneficial for some, it often requires a certain degree of **abstract thinking** and memory, making it less suitable as a standalone method for those with profound cognitive challenges in acquiring basic skills.
*CBT (Cognitive behavior therapy)*
- CBT integrates cognitive and behavioral strategies to address emotional and behavioral problems by modifying **thoughts, feelings, and behaviors**.
- While beneficial for a range of psychological issues, its emphasis on **cognitive restructuring** makes it less directly applicable or the most effective first-line therapy for teaching concrete, functional daily living skills to mentally challenged children.
Anxiety Disorders in Children Indian Medical PG Question 8: Which of the following is the treatment of choice for PTSD?
- A. Benzodiazepines
- B. Mood stabilizers
- C. Antipsychotics
- D. SSRIs (Correct Answer)
Anxiety Disorders in Children Explanation: ***SSRIs***
- **Selective serotonin reuptake inhibitors (SSRIs)** are considered first-line pharmacological treatment for **Post-Traumatic Stress Disorder (PTSD)** due to their efficacy in reducing core PTSD symptoms like re-experiencing, avoidance, and hyperarousal.
- They work by increasing the availability of **serotonin** in the brain, positively impacting mood, anxiety, and sleep regulation.
*Benzodiazepines*
- While benzodiazepines can provide rapid relief for acute anxiety, they are generally **not recommended as a primary treatment for PTSD** due to risks of dependence and masking underlying symptoms.
- They do not address the core symptoms of PTSD and can worsen long-term outcomes, especially in individuals with a history of substance abuse.
*Mood stabilizers*
- Mood stabilizers, such as lithium or valproate, are primarily used for conditions like **bipolar disorder** or certain **personality disorders** characterized by significant mood swings.
- They are **not a first-line treatment for PTSD** and are typically reserved for cases with prominent **affective dysregulation** not managed by other medications, or comorbid bipolar disorder.
*Antipsychotics*
- Antipsychotics are primarily indicated for conditions with **psychotic features**, such as schizophrenia or severe bipolar disorder with psychosis.
- They are **not routinely used as monotherapy for PTSD** but may be considered as an augmentation strategy in severe, refractory cases, especially when there are prominent **dissociative symptoms**, paranoia, or aggression.
Anxiety Disorders in Children Indian Medical PG Question 9: A mother and her 4 year old son are seated alone in
a reception area with the child staring off into space,
rocking and constantly twisting a strand of hair about
his fingers. Upon entry of another person, the child
begins to beat his fist against the side of his face and
behaves as though he does not hear his mother speaking
to him. This behavior is most characteristic of:
- A. A child with intellectual disability
- B. First dental appointment anxieties of a 4 year old child
- C. An autistic child (Correct Answer)
- D. A child with a chronic seizure disorder
Anxiety Disorders in Children Explanation: ***An autistic child***
- The behavior described, including **rocking**, **twisting hair**, **staring off into space**, **self-injurious behavior** (beating fist against face), and **unresponsiveness to verbal cues**, are classic signs of **autism spectrum disorder**.
- **Autism** is characterized by difficulties in social interaction and communication, and restricted or repetitive patterns of behavior, interests, or activities.
*A child with intellectual disability*
- While children with intellectual disability may exhibit some repetitive behaviors or difficulties with social interaction, the combination of **intense self-stimulatory behaviors**, **unresponsiveness to name**, and **self-injurious conduct** points more specifically to autism.
- **Intellectual disability** primarily involves limitations in intellectual functioning and adaptive behavior across multiple domains, which is a broader diagnosis than the specific pattern of behaviors seen here.
*First dental appointment anxieties of a 4 year old child*
- **Anxiety** in a dental setting typically manifests as fear, crying, resistance to examination, or clinging to a parent, but not typically as the **repetitive self-stimulatory behaviors** or **unresponsiveness** described.
- The behaviors seen, such as constant rocking and twisting hair, precede the arrival of the new person (which could be the dentist or assistant), indicating a baseline behavior beyond acute situational anxiety.
*A child with a chronic seizure disorder*
- A **seizure disorder** might present with altered consciousness or repetitive movements, but these would typically be paroxysmal and not a persistent pattern of behavior like **rocking**, **staring into space**, and **unresponsiveness** that improves with the removal of external stimuli or changes in internal state.
- The described behaviors are more indicative of a **neurodevelopmental disorder** affecting social communication and behavior regulation, rather than epileptic activity.
Anxiety Disorders in Children Indian Medical PG Question 10: A patient with a history of RTA before 2 months presents with complaints of dreams of accidents. He is able to visualize the same scene whenever he visits the place. Hence is afraid to go back to the accident site. Identify the type of disorder that he might be suffering from?
- A. PTSD (Correct Answer)
- B. Anxiety disorder
- C. Obsessive-Compulsive Disorder (OCD)
- D. Adjustment disorder
Anxiety Disorders in Children Explanation: ***PTSD***
- The patient's symptoms, including **recurrent dreams** of the accident, **intrusive memories** triggered by the accident site, and **avoidance** of the location, are classic diagnostic criteria for **Post-Traumatic Stress Disorder (PTSD)**.
- PTSD often develops after exposure to a **traumatic event** like a car accident, with symptoms lasting for more than one month.
*Anxiety disorder*
- While anxiety is a prominent feature of PTSD, **Generalized Anxiety Disorder** typically involves excessive worry about everyday events rather than a specific traumatic incident.
- Other anxiety disorders like **panic disorder** involve sudden, intense fear without the specific re-experiencing and avoidance symptoms seen here.
*Obsessive-Compulsive Disorder (OCD)*
- OCD is characterized by repetitive, unwanted thoughts (**obsessions**) and ritualistic behaviors (**compulsions**) performed to reduce anxiety, which are not described in this patient's presentation.
- The patient's distress stems from a past trauma, not from obsessions or compulsions.
*Adjustment disorder*
- An adjustment disorder occurs in response to a **stressor**, but the symptoms are typically less severe and do not include the full constellation of **re-experiencing, avoidance, and hyperarousal** seen in PTSD.
- An adjustment disorder resolves within 6 months of the stressor or its consequences, however, the persistence and nature of the symptoms here point to a more severe trauma-related condition.
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