Child and Adolescent Psychiatry Practice Questions

Q: Which of the following is an example of intellectual disability?

Mental retardation. **Explanation:** **Intellectual Disability (ID)**, formerly known as **Mental Retardation**, is characterized by significant limitations in both **intellectual functioning** (IQ < 70) and **adaptive behavior** (conceptual, social, and practical skills) that originate before the age of 18. Under DSM-5 and ICD-11, the term "Mental Retardation" has been replaced by "Intellectual Developmental Disorder" to reduce stigma and emphasize functional deficits. **Why the other options are incorrect:** * **Dyslexia (Option A):** This is a **Specific Learning Disorder** (SLD). It involves difficulties with reading and word recognition despite having a normal or even high IQ. Unlike ID, there is no global intellectual deficit. * **ADHD (Option B):** This is a **Neurodevelopmental Disorder** characterized by persistent patterns of inattention, hyperactivity, and impulsivity. Children with ADHD often have normal intelligence. * **Autistic Spectrum Disorder (Option C):** This is characterized by deficits in **social communication** and restricted, repetitive patterns of behavior. While ASD can co-occur with ID, it is a distinct diagnosis focused on social-behavioral deficits rather than global cognitive impairment. **High-Yield Clinical Pearls for NEET-PG:** * **Severity Levels:** Classified into Mild (IQ 50-70), Moderate (35-49), Severe (20-34), and Profound (<20). * **Most Common Cause:** The most common genetic cause of ID is **Down Syndrome**, while the most common *inherited* cause is **Fragile X Syndrome**. * **Assessment:** Diagnosis requires both clinical assessment and standardized testing (e.g., Wechsler Intelligence Scale, Binet test). * **Mild ID:** Represents 85% of cases; these individuals are often "educable" up to a 6th-grade level.

Q: Memory impairment is most likely to occur in which condition?

Down Syndrome. **Explanation:** **Down Syndrome (Trisomy 21)** is the correct answer because it is fundamentally associated with intellectual disability and progressive cognitive decline. The underlying medical concept involves the overexpression of the **Amyloid Precursor Protein (APP) gene**, which is located on chromosome 21. This leads to the early deposition of beta-amyloid plaques and neurofibrillary tangles, identical to those seen in **Alzheimer’s Disease**. By age 40, almost all individuals with Down Syndrome develop these neuropathological changes, making memory impairment a hallmark feature as they age. **Analysis of Incorrect Options:** * **Alkaptonuria:** This is an autosomal recessive metabolic disorder (deficiency of homogentisate 1,2-dioxygenase). It presents with dark urine, ochronosis (pigmentation), and arthritis, but does not typically involve primary memory impairment. * **Attention Deficit Hyperactivity Disorder (ADHD):** The core deficits are inattention, hyperactivity, and impulsivity. While patients may have trouble with "working memory" due to poor focus, they do not suffer from the structural memory loss or dementia seen in Down Syndrome. * **Conduct Disorder:** This is a behavioral disorder characterized by a repetitive pattern of violating the basic rights of others and societal norms. It is a disorder of behavior and personality, not a cognitive or memory-based pathology. **High-Yield Clinical Pearls for NEET-PG:** * **Down Syndrome & Alzheimer’s:** Down syndrome is the most common genetic cause of early-onset Alzheimer’s disease. * **Dual Diagnosis:** In children with Down Syndrome, the most common comorbid psychiatric conditions are ADHD and Oppositional Defiant Disorder (ODD). * **Screening:** Periodic screening for cognitive decline is recommended for all Down Syndrome patients starting in their 30s.

Q: A 15-year-old boy is brought to a child psychiatrist by his mother, who reports that he has been performing poorly in school and has failed twice in 7th class. She further reports that he does not follow the instructions of teachers and does not obey his parents. He frequently gets into fights with other children and often gets injured in brawls. Three times, he has been caught stealing money from his father's purse. Last week, he was also seen smoking with older students in front of his school. What is the most likely diagnosis?

Conduct disorder. ### Explanation The clinical presentation of this 15-year-old boy—characterized by a repetitive and persistent pattern of behavior that violates the basic rights of others and major age-appropriate societal norms—is classic for **Conduct Disorder (CD)**. **Why Conduct Disorder is correct:** According to DSM-5/ICD-11, CD involves behaviors in four main categories: aggression to people/animals (fights, brawls), destruction of property, deceitfulness or theft (stealing money), and serious violations of rules (truancy, smoking, academic failure). This patient exhibits aggression, theft, and defiance of authority, fitting the diagnosis perfectly. **Why the other options are incorrect:** * **Antisocial Personality Disorder (ASPD):** While the behaviors are similar, ASPD cannot be diagnosed in individuals under **18 years of age**. If the behavior persists beyond 18, the diagnosis may shift from CD to ASPD. * **Attention-Deficit Hyperactivity Disorder (ADHD):** While ADHD often co-occurs with CD and involves poor school performance, it is primarily characterized by inattention, hyperactivity, and impulsivity, rather than deliberate violation of social norms or physical aggression. * **Oppositional Defiant Disorder (ODD):** ODD involves a pattern of angry/irritable mood and argumentative/defiant behavior. However, ODD **does not** include the more severe behaviors seen here, such as physical aggression (brawls), theft, or serious rule-breaking. **Clinical Pearls for NEET-PG:** * **Age Cut-off:** Conduct Disorder is for <18 years; ASPD is for ≥18 years. * **Progression:** ODD often progresses to CD, which may eventually progress to ASPD in adulthood. * **Subtypes:** CD is classified into **Childhood-onset** (symptoms before age 10; worse prognosis) and **Adolescent-onset** (symptoms after age 10). * **Callous-Unemotional Traits:** A specifier for CD indicating a lack of remorse or empathy, often predicting more severe outcomes.

Q: A 6-year-old boy does not show any interest in other children and ignores adults other than his parents. He spends hours lining up his toy cars or spinning their wheels. He rarely uses speech to communicate and remains confined to himself. If his routine is disturbed, he becomes restless. Which of the following disorders is the child most likely suffering from?

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:** The child shows no interest in peers and ignores adults (social detachment). 2. **Communication Deficits:** He rarely uses speech to communicate and remains "confined to himself." 3. **Restricted, Repetitive Patterns of Behavior:** This is evidenced by "lining up toy cars," "spinning wheels" (stereotyped movements/interests), and "insistence on sameness" (restlessness when routine is disturbed). #### Why other options are incorrect: * **Social Phobia:** Characterized by an intense fear of being scrutinized or judged in social situations. Unlike Autism, children with social phobia usually have normal social development and communication skills but are inhibited by anxiety. * **Intellectual Disability (ID):** While ID often co-occurs with Autism, ID alone presents with global developmental delays in both cognitive and adaptive functioning. It does not inherently involve the specific repetitive behaviors or the profound lack of social reciprocity seen here. * **ADHD:** Primarily characterized by inattention, hyperactivity, and impulsivity. While ADHD children may struggle socially due to impulsivity, they do not typically exhibit the ritualistic behaviors or the lack of social-emotional reciprocity characteristic of Autism. #### High-Yield Clinical Pearls for NEET-PG: * **Age of Onset:** Symptoms must be present in the **early developmental period** (typically recognized before age 3). * **Gender Ratio:** More common in **males** (approx. 4:1). * **Prognostic Factors:** The best predictors of long-term outcome are **IQ level** and the **development of communicative language** by age 5. * **Associated Findings:** 25% of children with ASD develop **seizures** by adolescence. Macrocephaly is sometimes noted.

Q: Which of the following neurological-biochemical abnormalities is associated with autistic disorder?

All of the above. **Explanation:** Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by deficits in social communication and the presence of restricted, repetitive patterns of behavior. While primarily a clinical diagnosis, it is associated with several structural and functional neurological abnormalities. * **Seizures & EEG Abnormalities:** There is a strong comorbidity between ASD and epilepsy. Approximately **20-30%** of children with autism develop seizure disorders by the time they reach adulthood. Even in the absence of clinical seizures, **EEG abnormalities** (such as focal spikes or paroxysmal activity) are found in up to 50% of affected individuals, particularly during sleep. * **Ventricular Enlargement & Brain Structure:** Neuroimaging studies have consistently shown structural brain changes in ASD. These include **ventricular enlargement** (increased volume of lateral ventricles) and an overall increase in total brain volume (macrocephaly) during early childhood, often followed by a plateau. Other findings include reduced size of the corpus callosum and cerebellar vermis hypoplasia. **Why "All of the above" is correct:** Since ASD involves widespread neurodevelopmental dysfunction, it manifests through both electrical (EEG/Seizures) and structural (Ventricular changes) abnormalities. **High-Yield Clinical Pearls for NEET-PG:** * **Most common biochemical finding:** Elevated blood **serotonin** levels (hyperserotonemia) is found in about one-third of cases. * **Head Circumference:** Often normal at birth but shows a rapid, abnormal increase during the first year of life. * **M-CHAT:** The most commonly used screening tool for toddlers (16–30 months). * **Pharmacotherapy:** Risperidone and Aripiprazole are FDA-approved for irritability and aggression in autism.

Q: Which of the following medications are used in the treatment of hyperkinetic syndrome?

Methylphenidate and Amphetamine. **Explanation:** **Hyperkinetic Syndrome**, commonly known as **Attention Deficit Hyperactivity Disorder (ADHD)**, is characterized by a persistent pattern of inattention, hyperactivity, and impulsivity. The primary pathophysiology involves a dysfunction in the catecholaminergic systems (dopamine and norepinephrine) within the prefrontal cortex. **Why Option C is Correct:** The first-line pharmacological treatment for ADHD is **Psychostimulants**. * **Methylphenidate:** It acts by blocking the reuptake of dopamine and norepinephrine (inhibiting DAT and NET transporters). * **Amphetamines:** These increase the release of dopamine and norepinephrine from presynaptic nerve terminals. Both medications enhance catecholamine signaling in the prefrontal cortex, thereby improving focus and executive function. **Why Other Options are Incorrect:** * **Option A & B:** **Imipramine** (a Tricyclic Antidepressant) is considered a second or third-line agent for ADHD, used only when stimulants are ineffective or contraindicated. **Clozapine** is an atypical antipsychotic used for treatment-resistant schizophrenia and has no role in treating ADHD. * **Option D:** **Haloperidol** (a typical antipsychotic) and **Clozapine** are dopamine antagonists. Since ADHD requires an *increase* in synaptic dopamine, these drugs are not indicated and may actually worsen symptoms. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice (DOC):** Methylphenidate is the most commonly used first-line agent. * **Non-Stimulant DOC:** **Atomoxetine** (a selective norepinephrine reuptake inhibitor) is the preferred non-stimulant, especially in patients with a history of substance abuse or tics. * **Common Side Effects:** Insomnia, decreased appetite, weight loss, and growth retardation (requires "drug holidays"). * **Age of Onset:** According to DSM-5, symptoms must be present before the **age of 12**.

Q: Which of the following drugs could be prescribed for a child who suffers from night terrors?

Clonazepam. ### Explanation **Night terrors (Sleep Terrors)** are a type of **NREM parasomnia** that typically occurs during **Stage N3 (Slow Wave Sleep)**. The child often screams, appears terrified, and exhibits autonomic arousal (tachycardia, sweating), but remains unresponsive to comforting and has no memory of the event the next morning. **Why Clonazepam is Correct:** The pharmacological management of choice for severe or persistent night terrors involves **Benzodiazepines**, specifically **Clonazepam** or Diazepam. These drugs work by **suppressing Stage N3 sleep**, which is the specific stage where night terrors occur. By reducing the time spent in deep slow-wave sleep, the frequency of these episodes is significantly decreased. **Analysis of Incorrect Options:** * **A. Meprobamate:** An older sedative-hypnotic and anxiolytic with a high potential for addiction and toxicity. It is not used in pediatric sleep disorders. * **C. Lithium:** A mood stabilizer used primarily for Bipolar Disorder. It has no role in treating parasomnias and carries a high risk of toxicity in children. * **D. Amphetamine:** A stimulant used for ADHD and Narcolepsy. It actually disrupts sleep architecture and would likely worsen night terrors by causing sleep fragmentation. **High-Yield Clinical Pearls for NEET-PG:** * **Timing:** Night terrors occur in the **first one-third** of the night (NREM), whereas Nightmares occur in the **last one-third** (REM). * **Memory:** There is **complete amnesia** for night terrors, unlike nightmares where the child can recall the dream. * **Management:** Reassurance and "Scheduled Awakenings" are the first-line non-pharmacological treatments. Pharmacotherapy is reserved for cases where there is a risk of injury or extreme family distress. * **EEG:** Shows sudden arousal from Delta sleep.

Q: An IQ of 15 indicates which grade of mental retardation?

Profound. **Explanation:** Intellectual Disability (formerly Mental Retardation) is classified based on Intelligence Quotient (IQ) scores. According to the ICD-10 and DSM-IV classifications, the severity levels are categorized as follows: * **Profound Intellectual Disability (IQ < 20):** This is the correct answer. Individuals in this category have an IQ below 20. They require constant supervision and 24-hour nursing care, as they possess minimal sensorimotor functioning and limited communication skills. * **Mild (IQ 50–69):** This is the most common type (approx. 85%). These individuals are "educable" and can achieve social and vocational adequacy with some support. * **Moderate (IQ 35–49):** These individuals are "trainable." They can acquire communication skills and perform semi-skilled work under supervision. * **Severe (IQ 20–34):** These individuals can learn basic self-care and simple tasks but require a highly structured environment. * **Borderline (IQ 70–79):** This is not classified as intellectual disability but represents a zone between normal intelligence and mild disability. **High-Yield Clinical Pearls for NEET-PG:** 1. **Most Common Cause:** Genetic causes (Down Syndrome is the most common chromosomal cause; Fragile X is the most common inherited cause). 2. **Assessment Tools:** In children, the **Binet-Kamat Test (BKT)** and **Malin’s Intelligence Scale for Indian Children (MISIC)** are frequently used in India. 3. **DSM-5 Update:** Modern diagnosis (DSM-5) emphasizes **adaptive functioning** (conceptual, social, and practical domains) rather than relying solely on IQ scores. 4. **IQ Formula:** $IQ = \frac{\text{Mental Age (MA)}}{\text{Chronological Age (CA)}} \times 100$.

Question 1

Which of the following is an example of intellectual disability?

Accepted Answer

Mental retardation

Answer

Dyslexia

Answer

ADHD

Answer

Autistic spectrum disorder

Question 2

Memory impairment is most likely to occur in which condition?

Accepted Answer

Down Syndrome

Answer

Alkaptonuria

Answer

Attention deficit disorder

Answer

Conduct disorder

Question 3

A 15-year-old boy is brought to a child psychiatrist by his mother, who reports that he has been performing poorly in school and has failed twice in 7th class. She further reports that he does not follow the instructions of teachers and does not obey his parents. He frequently gets into fights with other children and often gets injured in brawls. Three times, he has been caught stealing money from his father's purse. Last week, he was also seen smoking with older students in front of his school. What is the most likely diagnosis?

Accepted Answer

Conduct disorder

Answer

Antisocial personality disorder

Answer

Attention-deficit hyperactivity disorder

Answer

Oppositional defiant disorder

Question 4

A 6-year-old boy does not show any interest in other children and ignores adults other than his parents. He spends hours lining up his toy cars or spinning their wheels. He rarely uses speech to communicate and remains confined to himself. If his routine is disturbed, he becomes restless. Which of the following disorders is the child most likely suffering from?

Accepted Answer

Autism

Answer

Social phobia

Answer

Intellectual disability

Answer

ADHD

Question 5

Which of the following neurological-biochemical abnormalities is associated with autistic disorder?

Accepted Answer

All of the above

Answer

Seizures

Answer

Ventricular enlargement

Answer

EEG abnormalities

Question 6

Which of the following medications are used in the treatment of hyperkinetic syndrome?

Accepted Answer

Methylphenidate and Amphetamine

Answer

Imipramine and Methylphenidate

Answer

Imipramine and Clozapine

Answer

Haloperidol and Clozapine

Question 7

A 6-year-old boy presents with complaints of hyperactivity, excessive shoulder shrugging, throat clearing, and eye blinking. During examination, he is not cooperative, uses obscene words, and runs around in the consultation room. What is the most probable diagnosis?

Accepted Answer

Attention deficit hyperactivity disorder with Tic disorder

Answer

Tic disorder

Answer

Psychomotor seizures

Answer

Childhood psychosis

Question 8

An eleven-month-old boy is so restless that his classmates are unable to concentrate. He is hardly ever in his seat and roams around the hall. He has difficulty playing quietly. What is the most likely diagnosis?

Accepted Answer

Attention-deficit hyperactivity disorder

Answer

Conduct disorder

Answer

Depressive disorder

Answer

Schizophrenia

Question 9

Which of the following drugs could be prescribed for a child who suffers from night terrors?

Accepted Answer

Clonazepam

Answer

Meprobamate

Answer

Lithium

Answer

Amphetamine

Question 10

An IQ of 15 indicates which grade of mental retardation?

Accepted Answer

Profound

Answer

Mild

Answer

Moderate

Answer

Borderline

Child and Adolescent Psychiatry — MCQs

Child and Adolescent Psychiatry — MCQs

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