Depression in Children and Adolescents — MCQs
A 30-year-old male was brought for evaluation, with a history of his 3-year-old son's death, 5 months prior, following a car accident. At the time of the accident, the patient was a witness. Since then, he has experienced symptoms of sadness, crying spells, feelings of hopelessness, poor sleep, and poor appetite. He has had suicidal thoughts on two occasions, but has not acted on them. He has not been attending work for the past 5 months. What is the likely diagnosis?
An old man is diagnosed with major depressive disorder. His son reports that he always shows suicidal tendencies. What is the treatment of choice for depression with suicidal tendencies?
According to DSM-IV criteria, the minimum duration of symptoms required for diagnosing major depressive disorder is:
Best therapy suited to teach daily life skill to a mentally challenged child:
Provision of the Mental Health Act 2017, based on WHO guidelines, includes all, except:
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:
Which of the following are beneficiaries of services provided under the Integrated Child Development Scheme (ICDS) ? 1. Adolescent boys 2. Adolescent girls 3. Pregnant women 4. Children less than 6 years of age Select the correct answer using the code given below :
A 7-year-old child presents with a lesion in upper tibia. X-ray shows radiolucent area with Codman's triangle and sunray appearance. Diagnosis is
An 8 yr old child is having fever with pain and swelling in mid thigh. On Xray lamellated appearance and Codman's triangle is present. Histopathologic examination shows small round cells positive for MIC-2. What is the most likely diagnosis?
A 15-year-old boy presented with day dreaming and decline in school performance. The likely possibility is?
Depression in Children and Adolescents Indian Medical PG Practice Questions and MCQs
Question 1: A 30-year-old male was brought for evaluation, with a history of his 3-year-old son's death, 5 months prior, following a car accident. At the time of the accident, the patient was a witness. Since then, he has experienced symptoms of sadness, crying spells, feelings of hopelessness, poor sleep, and poor appetite. He has had suicidal thoughts on two occasions, but has not acted on them. He has not been attending work for the past 5 months. What is the likely diagnosis?
- A. Post-traumatic stress disorder (PTSD)
- B. Normal grief reaction
- C. Adjustment disorder with depressed mood
- D. Major depressive disorder (Correct Answer)
Explanation: ***Major depressive disorder*** - The duration of symptoms (5 months) and severity, including **suicidal ideation** and significant occupational impairment, exceed what is typically expected for **normal grief** or **adjustment disorder**. - Symptoms like **sadness**, crying spells, feelings of hopelessness, **poor sleep**, and poor appetite are classic for **major depressive disorder**, especially when persistent and functionally debilitating. *Post-traumatic stress disorder (PTSD)* - While experiencing a traumatic event (witnessing his son's death) is a prerequisite for PTSD, the patient's primary symptoms are **depressive** rather than the characteristic re-experiencing, avoidance, negative alterations in cognitions and mood, or hyperarousal associated with PTSD. - There is no mention of **flashbacks**, nightmares, or significant **avoidance behaviors** directly linked to the trauma beyond general withdrawal. *Normal grief reaction* - While grief is expected after the death of a child, the severity (suicidal ideation) and significant functional impairment (not attending work for 5 months) suggest a reaction beyond **normal grief**. - **Normal grief** typically doesn't involve persistent, severe functional impairment or recurrent suicidal thoughts over such a prolonged period without additional significant depressive symptoms. *Adjustment disorder with depressed mood* - **Adjustment disorder** usually resolves within 6 months of the stressor or its consequences ceasing, and symptoms are generally less severe than those seen in major depression. - The presence of **suicidal ideation** and profound, persistent functional impairment for 5 months makes **major depressive disorder** a more fitting diagnosis.
Question 2: An old man is diagnosed with major depressive disorder. His son reports that he always shows suicidal tendencies. What is the treatment of choice for depression with suicidal tendencies?
- A. Olanzapine
- B. ECT (Correct Answer)
- C. Mirtazapine
- D. Clozapine
Explanation: ***ECT*** - **Electroconvulsive therapy (ECT)** is the **treatment of choice** for severe depression with **suicidal ideation** due to its rapid onset of action and high efficacy. - It is particularly indicated when there is an urgent need for symptom remission to prevent self-harm, as verbal therapies and medications take longer to exert their full effects. *Olanzapine* - **Olanzapine** is an **antipsychotic medication** with some antidepressant properties, but it is not the first-line treatment for severe depression with suicidal tendencies. - It is often used as an **adjunctive treatment** in treatment-resistant depression or in psychotic depression with delusions. *Mirtazapine* - **Mirtazapine** is an **antidepressant** that can be very effective in cases of major depressive disorder, especially when insomnia and appetite loss are prominent. - However, its onset of action is not as rapid as ECT, making it less suitable for situations requiring immediate intervention for **severe suicidal risk**. *Clozapine* - **Clozapine** is an **antipsychotic medication** primarily used for **treatment-resistant schizophrenia** and reducing suicidal behavior in schizophrenia. - It is highly effective but has significant side effects, including **agranulocytosis**, and is not a first-line treatment for major depressive disorder with suicidal tendencies.
Question 3: According to DSM-IV criteria, the minimum duration of symptoms required for diagnosing major depressive disorder is:
- A. 1 week
- B. 2 weeks (Correct Answer)
- C. 3 weeks
- D. 4 weeks
Explanation: ***2 weeks*** - The **DSM-IV (and DSM-5)** criteria for **major depressive disorder** require that a person experience a **depressed mood** or **loss of interest or pleasure (anhedonia)**, along with at least four additional symptoms (e.g., changes in appetite or sleep, fatigue, feelings of worthlessness or guilt, difficulty concentrating, suicidal ideation) for a continuous period of at least **two weeks**. - This **duration criterion** helps differentiate a major depressive episode from transient sad moods or normal grief reactions. *1 week* - A duration of **1 week** is a criterion for some mood disorders, such as a **manic episode** in bipolar disorder, but it is too short for a diagnosis of major depressive disorder. - Brief periods of sadness or low mood lasting only a week would typically not meet the diagnostic threshold for a full major depressive episode. *3 weeks* - While 3 weeks of symptoms would certainly meet the **minimum duration** for major depressive disorder, it is not the *minimum required* time set forth by the DSM criteria. - Waiting for 3 weeks of symptoms might delay diagnosis and treatment if the criteria are already met at 2 weeks. *4 weeks* - Similar to 3 weeks, a 4-week duration of symptoms is longer than the **minimum required** for diagnosing major depressive disorder according to DSM criteria. - This duration would be more appropriate for chronic mood disturbances like **persistent depressive disorder (dysthymia)**, which requires at least two years of symptoms, or to observe the response to treatment.
Question 4: 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)
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.
Question 5: Provision of the Mental Health Act 2017, based on WHO guidelines, includes all, except:
- A. Social support
- B. Screening family members (Correct Answer)
- C. Human rights
- D. Communication regarding care and treatment
Explanation: ***Screening family members*** - The Mental Health Act 2017 focuses on the **rights, treatment, and support of individuals with mental illness**, not routine screening of their family members. - The Act does not contain provisions mandating **screening of asymptomatic family members**, though family history may be relevant for clinical assessment. - This is **not a provision** outlined in the Act based on WHO guidelines. *Human rights* - The Act is explicitly grounded in the **protection and promotion of human rights** for persons with mental illness (Chapter I). - Ensures care with **dignity, respect, and freedom from discrimination** as core principles. - Aligns with WHO's mental health action plan and human rights framework. *Communication regarding care and treatment* - **Section 4** emphasizes the right to information and **informed consent** for all treatment decisions. - Patients must receive clear communication about their **diagnosis, treatment options, and care plans**. - Includes provisions for **advance directives** and involvement in treatment decisions. *Social support* - **Chapter V** addresses rehabilitation and community-based services, emphasizing the role of **social support systems**. - Promotes **community integration** and access to social resources for recovery. - Recognizes family and community support as essential for long-term mental health management.
Question 6: 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:
- A. ADHD
- B. Autism (Correct Answer)
- C. Depression
- D. Bipolar disorder
Explanation: ***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.
Question 7: Which of the following are beneficiaries of services provided under the Integrated Child Development Scheme (ICDS) ? 1. Adolescent boys 2. Adolescent girls 3. Pregnant women 4. Children less than 6 years of age Select the correct answer using the code given below :
- A. 2, 3 and 4 (Correct Answer)
- B. 1, 2 and 3
- C. 1, 3 and 4
- D. 1, 2 and 4
Explanation: ***2, 3 and 4*** - The **Integrated Child Development Services (ICDS)** scheme specifically targets **adolescent girls (11-14 years)**, **pregnant women**, and **children under 6 years of age** as primary beneficiaries. - Services include **supplementary nutrition**, **immunization**, **health check-ups**, **referral services**, **nutrition and health education**, and **pre-school education**. - Adolescent girls were included through the **Scheme for Adolescent Girls (SAG)** to address their nutritional and health needs during the critical growth phase. *1, 2 and 3* - Incorrectly includes **adolescent boys**, who are not primary beneficiaries of ICDS. - The scheme focuses on vulnerable groups with specific nutritional and reproductive health needs. *1, 3 and 4* - Incorrectly includes **adolescent boys** while excluding **adolescent girls**. - Omits **pregnant women**, who are a core beneficiary group receiving antenatal care and nutritional support. *1, 2 and 4* - Incorrectly includes **adolescent boys**. - Omits **pregnant women**, who receive crucial services including antenatal care, nutritional supplementation, and health education through ICDS.
Question 8: A 7-year-old child presents with a lesion in upper tibia. X-ray shows radiolucent area with Codman's triangle and sunray appearance. Diagnosis is
- A. Osteosarcoma (Correct Answer)
- B. Osteoid Osteoma
- C. Ewing sarcoma
- D. Chondrosarcoma
Explanation: ***Osteosarcoma*** - The classic radiographic features of **Codman's triangle** (periosteal elevation) and **sunray appearance** (spiculated periosteal reaction) are highly characteristic of osteosarcoma. - This tumor commonly affects the **metaphysis of long bones** in children and young adults, with the distal femur and proximal tibia being frequent sites. *Osteoid Osteoma* - This is a **benign bone tumor** characterized radiographically by a small radiolucent **nidus** surrounded by a rim of dense sclerosis. - It does not present with Codman's triangle or sunray appearance and typically causes **nocturnal pain relieved by NSAIDs**. *Ewing sarcoma* - Ewing sarcoma often presents with an **"onion skin" periosteal reaction** (layers of new bone formation) due to its aggressive nature. - While it can be destructive and radiolucent, it typically does not classically exhibit the sunray appearance or a distinct Codman's triangle as prominently as osteosarcoma. *Chondrosarcoma* - Chondrosarcoma is a **malignant cartilaginous tumor** that usually affects older adults more commonly than children. - Radiographically, it often shows a **lobulated appearance** with **punctate or ring-and-arc calcifications** within the lesion, not the sunray or Codman's triangle findings.
Question 9: An 8 yr old child is having fever with pain and swelling in mid thigh. On Xray lamellated appearance and Codman's triangle is present. Histopathologic examination shows small round cells positive for MIC-2. What is the most likely diagnosis?
- A. Chondrosarcoma
- B. Chondroblastoma
- C. Ewings sarcoma (Correct Answer)
- D. Osteosarcoma
Explanation: ***Ewings sarcoma*** - The combination of **fever with pain and swelling** in a child, **lamellated (onion-skin) periosteal reaction**, **Codman's triangle** on X-ray, and **small round cells positive for MIC-2 (CD99)** on histopathology is classic for Ewing's sarcoma. - This highly aggressive bone tumor primarily affects children and young adults, often presenting with systemic symptoms and a diaphyseal or metadiaphyseal location in long bones. *Chondrosarcoma* - This tumor is characterized by the production of **cartilage matrix** and typically affects older adults (40-70 years old), not children. - Radiographically, it often shows **calcifications with rings and arcs** within a lucent lesion, and histopathology reveals chondrocytes, not small round cells positive for MIC-2. *Chondroblastoma* - Chondroblastoma is a rare, **benign cartilage tumor** that typically occurs in the **epiphysis of long bones** in adolescents and young adults. - It usually presents as a well-defined lytic lesion and does not typically show lamellated periosteal reactions or positive MIC-2 staining, nor does it commonly present with fever. *Osteosarcoma* - While osteosarcoma is also an aggressive bone tumor affecting children and adolescents, it is characterized by the production of **osteoid (immature bone)**. - Radiographically, it often presents with a **"sunburst" pattern** due to spiculated periosteal reaction and a **Codman's triangle**, but histopathology shows malignant osteoblasts, not small round cells positive for MIC-2.
Question 10: A 15-year-old boy presented with day dreaming and decline in school performance. The likely possibility is?
- A. Typical absence seizure (Correct Answer)
- B. Atonic seizure
- C. Myoclonic seizure
- D. Atypical absence seizure
Explanation: ***Typical absence seizure*** - This presentation of **daydreaming** and **decline in school performance** is characteristic of typical absence seizures, which involve brief episodes of impaired consciousness without loss of postural tone. - These seizures are common in childhood and adolescence, often manifesting as staring spells that can be mistaken for inattention. *Atonic seizure* - An atonic seizure involves a **sudden loss of muscle tone**, leading to a sudden drop or fall, which is not described here. - While it can cause brief loss of consciousness, the primary feature is the motor event. *Myoclonic seizure* - Myoclonic seizures are characterized by **sudden, brief, jerking movements** of a muscle or muscle group. - They are typically very brief and do not involve the sustained staring spell or impaired awareness described. *Atypical absence seizure* - Atypical absence seizures have a **more gradual onset and offset** than typical absence seizures, and may be associated with more noticeable motor signs and less complete loss of awareness. - Daydreaming and decline in school performance are classic for typical, not atypical, absence seizures.
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