Child and Adolescent Psychiatry — MCQs

Child and Adolescent Psychiatry Indian Medical PG Practice Questions and MCQs

Question 131: Which of the following diseases is seen only in females?

A. Autism
B. Asperger's syndrome
C. Rett's disease (Correct Answer)
D. Cotard disease

Explanation: **Explanation:** **Correct Answer: C. Rett’s disease** **Rett’s disease** is a neurodevelopmental disorder caused by a mutation in the **MECP2 gene** located on the **X chromosome**. It is seen almost exclusively in females. In males, the mutation is typically lethal in utero or results in severe neonatal encephalopathy because they lack a second X chromosome to compensate for the defect. **Clinical Presentation:** Children with Rett's syndrome typically show normal development for the first 6–18 months, followed by a period of regression. A hallmark clinical sign is the loss of purposeful hand movements, replaced by **stereotypical hand-wringing or "hand-washing" movements**. Other features include microcephaly, ataxia, and loss of social engagement. **Analysis of Incorrect Options:** * **A. Autism & B. Asperger’s Syndrome:** Both are part of the Autism Spectrum Disorder (ASD). These conditions are significantly **more common in males** (ratio of approximately 4:1). * **D. Cotard Disease:** Also known as "Walking Corpse Syndrome," this is a rare neuropsychiatric delusion where the patient believes they are dead, putrefying, or have lost their internal organs. It is not gender-specific and can occur in both males and females, usually associated with severe depression or schizophrenia. **High-Yield Clinical Pearls for NEET-PG:** * **MECP2 Gene:** The most common genetic cause of Rett's syndrome. * **Hand-wringing:** The most characteristic "spotter" sign in exams. * **Deceleration of head growth:** Leads to acquired microcephaly. * **ICD-10/DSM-5:** While previously categorized separately, Rett's is now often differentiated from ASD due to its specific genetic etiology and progressive neurological decline.

Question 132: In a child with obsessive-compulsive disorder (OCD), MRI will reveal reduced volume (atrophy) of which of the following structures?

A. Putamen
B. Globus pallidus
C. Caudate nucleus (Correct Answer)
D. Cerebellum

Explanation: **Explanation:** The pathophysiology of Obsessive-Compulsive Disorder (OCD) is primarily linked to the **Cortico-Striato-Thalamo-Cortical (CSTC) circuit**. This circuit involves the orbitofrontal cortex, the anterior cingulate cortex, and the basal ganglia. **Why Caudate Nucleus is correct:** The **Caudate Nucleus** is a key component of the striatum within the CSTC circuit. In patients with OCD, there is a failure of the caudate nucleus to properly "gate" or filter intrusive thoughts and impulses. Structural neuroimaging (MRI) studies in both children and adults with OCD have consistently demonstrated **reduced volume (atrophy)** of the caudate nucleus. Functional imaging (PET/fMRI) often shows compensatory hyperactivity in this same region. **Analysis of Incorrect Options:** * **Putamen & Globus Pallidus:** While these are parts of the basal ganglia, they are not the primary sites of structural atrophy identified in classic OCD neuroimaging studies. The pathology is more specific to the "executive" loop involving the caudate. * **Cerebellum:** While the cerebellum is increasingly studied in various psychiatric conditions, it is not the hallmark site of atrophy for OCD. **High-Yield NEET-PG Pearls:** * **Neurobiology:** OCD is associated with **serotonin dysregulation** (hence SSRIs are first-line). * **PANDAS:** Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections can cause sudden-onset OCD in children due to autoimmune inflammation of the **basal ganglia**. * **Treatment:** The most effective psychological treatment is **Exposure and Response Prevention (ERP)**, a form of CBT. * **Surgical Target:** In refractory OCD, deep brain stimulation (DBS) or cingulotomy targets components of the CSTC circuit.

Question 133: What is the formula to calculate intelligence quotient (IQ)?

A. Chronological age divided by Mental age multiplied by 100
B. Mental age minus Chronological Age multiplied by 100
C. Mental age divided by Chronological age multiplied by 100 (Correct Answer)
D. Mental age plus Chronological Age multiplied by 100

Explanation: **Explanation:** The Intelligence Quotient (IQ) is a standardized measure used to assess cognitive abilities relative to a person's age group. The concept was refined by **William Stern** and later adopted by **Lewis Terman** in the Stanford-Binet Intelligence Scales. **1. Why Option C is Correct:** The standard formula for calculating IQ is: **IQ = (Mental Age / Chronological Age) × 100** * **Mental Age (MA):** Represents the level of intellectual development (determined by standardized testing). * **Chronological Age (CA):** The actual physical age of the individual in years. * **Multiplier (100):** Used to eliminate decimals and set the average IQ at 100. If a child’s mental age is exactly equal to their chronological age, their IQ is 100 (average). **2. Why Other Options are Incorrect:** * **Option A:** Reversing the ratio (CA/MA) would incorrectly suggest that older children are less intelligent simply because they are older. * **Options B & D:** Intelligence is a relative ratio of development, not a linear sum or difference. Using addition or subtraction would not allow for standardized comparison across different age groups. **Clinical Pearls for NEET-PG:** * **Classification of Intellectual Disability (ID):** Based on IQ scores: * **Mild:** 50–70 (Educable; most common type) * **Moderate:** 35–49 (Trainable) * **Severe:** 20–34 * **Profound:** < 20 * **The Flynn Effect:** The observed rise in average IQ scores over generations. * **Social Quotient (SQ):** Calculated using the Vineland Social Maturity Scale (VSMS), often used alongside IQ to diagnose Intellectual Disability.

Question 134: Regression of milestones is seen in all except?

A. Childhood disintegrative disorder
B. Rett syndrome
C. Landau-Kleffner syndrome
D. Kleine-Levin syndrome (Correct Answer)

Explanation: **Explanation:** The core concept in this question is distinguishing between **neurodevelopmental regression** (loss of previously acquired skills) and **episodic sleep disorders**. **Why Option D is Correct:** **Kleine-Levin Syndrome (KLS)**, also known as "Sleeping Beauty Syndrome," is a rare sleep disorder characterized by **episodic hypersomnia** (sleeping up to 20 hours a day), hyperphagia (compulsive eating), and hypersexuality. Crucially, patients are neurologically and behaviorally normal between episodes. It does **not** involve a permanent loss or regression of developmental milestones. **Why the other options are incorrect:** * **Childhood Disintegrative Disorder (Heller’s Syndrome):** Characterized by normal development for at least 2 years, followed by a **marked regression** in multiple areas of functioning (language, social skills, motor skills, and bladder/bowel control) before age 10. * **Rett Syndrome:** Primarily affects females (X-linked dominant, MECP2 mutation). After a period of normal development (6–18 months), there is a **regression** in purposeful hand movements (replaced by stereotyped hand-wringing), head growth (microcephaly), and social engagement. * **Landau-Kleffner Syndrome (LKS):** Also known as "Acquired Epileptic Aphasia." It involves a sudden or gradual **loss of language skills** (regression) in a child who previously spoke normally, associated with abnormal EEG findings during sleep. **High-Yield Clinical Pearls for NEET-PG:** * **Rett Syndrome:** Look for the keyword "hand-wringing movements" and "loss of purposeful hand skills." * **LKS:** The hallmark is "word deafness" or auditory verbal agnosia in a child. * **KLS:** Remember the triad: **Hypersomnia, Hyperphagia, and Hypersexuality.** It typically affects adolescent males. * **Regression** in a child always warrants an urgent neurological workup to rule out metabolic or neurodegenerative disorders.

Question 135: "Penis envy" is seen in which developmental stage?

A. Male child in the genital phase
B. Male child in the phallic phase
C. Female child in the phallic phase (Correct Answer)
D. Female child in the genital phase

Explanation: ### Explanation The concept of **Penis Envy** is a central component of Sigmund Freud’s **Theory of Psychosexual Development**, specifically occurring during the **Phallic Phase** (ages 3 to 6 years). **1. Why the Correct Answer is Right:** During the Phallic Phase, the primary erogenous zone is the genitalia. According to Freud, when a female child discovers the anatomical difference between sexes, she experiences a sense of loss or "castration," leading to the desire for a penis. This "Penis Envy" marks the female equivalent of the Oedipus complex (often referred to as the **Electra Complex**). The child initially blames the mother for her "deficiency" and shifts her affection toward the father. **2. Why the Incorrect Options are Wrong:** * **Options A & B (Male child):** In the phallic phase, males do not experience penis envy; instead, they experience **Castration Anxiety**—the fear that their father will punish them for their feelings toward their mother by removing their penis. * **Option D (Genital phase):** The Genital Phase (puberty onwards) focuses on mature sexual relationships and the consolidation of ego identity. While unresolved conflicts from earlier stages may resurface, the specific developmental crisis of penis envy belongs to the earlier phallic stage. ### High-Yield Clinical Pearls for NEET-PG: * **Phallic Phase Timing:** 3 to 6 years. * **Oedipus Complex:** Male child’s desire for mother and rivalry with father (resolved via identification with the father). * **Electra Complex:** Female child’s desire for father and rivalry with mother (involves penis envy). * **Sequence of Stages:** Oral → Anal → **Phallic** → Latency → Genital (Mnemonic: **O**ld **A**ge **P**eople **L**ove **G**rapes). * **Fixation:** Failure to resolve the phallic stage can lead to vanity, exhibitionism, or difficulties with sexual identity in adulthood.

Question 136: All of the following are examples of 'specific learning disability' EXCEPT?

A. Dyslexia
B. Dysgraphia
C. Dyscalculia
D. Dysphoria (Correct Answer)

Explanation: ### Explanation **Specific Learning Disorder (SLD)** is a neurodevelopmental disorder characterized by persistent difficulties in learning and using academic skills, which are significantly below the expected level for the individual's age. According to DSM-5, SLD is a single diagnosis with specifiers for deficits in reading, writing, and mathematics. **Why Dysphoria is the Correct Answer:** **Dysphoria** is not a learning disability. It is a clinical term describing a profound state of unease, dissatisfaction, or anxiety. It is a common symptom in mood disorders (like Depression), Gender Dysphoria, or Premenstrual Dysphoric Disorder (PMDD). It relates to **affect/emotion**, not cognitive academic processing. **Analysis of Incorrect Options:** * **Dyslexia (Option A):** The most common SLD. It involves impairment in **reading**, specifically difficulties with word recognition, decoding, and spelling. * **Dysgraphia (Option B):** An SLD involving impairment in **written expression**. It manifests as poor handwriting, incorrect grammar/punctuation, and poor organization of written ideas. * **Dyscalculia (Option C):** An SLD involving impairment in **mathematics**. It includes difficulties mastering number sense, number facts, or accurate calculation. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis:** SLD is usually diagnosed during formal schooling years. A key diagnostic criterion is that the difficulties must persist for at least **6 months** despite targeted interventions. * **IQ vs. Achievement:** Children with SLD typically have a **normal or high IQ**, but their academic achievement is significantly lower than their intellectual potential. * **Comorbidity:** The most common comorbid condition with SLD is **ADHD** (Attention-Deficit/Hyperactivity Disorder). * **Management:** Treatment is primarily educational (Remedial Education) rather than pharmacological.

Question 137: A 10-year-old child with a mental age of 2 years will have an IQ level of?

A. 20 (Correct Answer)
B. 30
C. 50
D. 70

Explanation: ### Explanation **1. Understanding the Correct Answer (A):** The Intelligence Quotient (IQ) is calculated using the classic formula developed by William Stern: **IQ = (Mental Age / Chronological Age) × 100** In this case: * **Mental Age (MA):** 2 years * **Chronological Age (CA):** 10 years * **Calculation:** (2 / 10) × 100 = **20** According to the ICD-10 and DSM classifications, an IQ of 20 falls at the boundary of **Severe Mental Retardation (IQ 20–34)** and **Profound Mental Retardation (IQ < 20)**. **2. Why Other Options are Incorrect:** * **Option B (30):** This would require a mental age of 3 years (3/10 × 100). This falls under Severe Mental Retardation. * **Option C (50):** This would require a mental age of 5 years (5/10 × 100). This is the cutoff for Moderate Mental Retardation (IQ 35–49). * **Option D (70):** This would require a mental age of 7 years (7/10 × 100). An IQ of 70 is the traditional cutoff for Mild Mental Retardation (IQ 50–70). **3. Clinical Pearls & High-Yield Facts for NEET-PG:** * **Classification of Intellectual Disability (ICD-10):** * **Mild (IQ 50–70):** "Educable"; can reach 6th-grade level; most common (85%). * **Moderate (IQ 35–49):** "Trainable"; can reach 2nd-grade level; performs supervised tasks. * **Severe (IQ 20–34):** Can learn basic self-care and survival words. * **Profound (IQ < 20):** Requires constant supervision; minimal verbal skills. * **Most Common Cause:** The most common genetic cause of intellectual disability is **Down Syndrome**, while the most common inherited cause is **Fragile X Syndrome**. * **Assessment:** In children, the **Vineland Social Maturity Scale (VSMS)** and **Binet-Kamat Test (BKT)** are frequently used in Indian clinical settings to assess Social Quotient (SQ) and IQ.

Question 138: A boy with an IQ of 62 will come under which category of intellectual disability?

A. Mild intellectual disability (Correct Answer)
B. Moderate intellectual disability
C. Severe intellectual disability
D. Normal intellectual functioning

Explanation: **Explanation:** Intellectual Disability (ID) is characterized by deficits in intellectual functioning (reasoning, problem-solving, planning) and adaptive functioning. According to the ICD-10 and DSM-IV classifications, the severity of ID is primarily categorized based on Intelligence Quotient (IQ) scores. **Why the correct answer is right:** * **Mild Intellectual Disability (IQ 50–69):** An IQ of 62 falls squarely within this range. Individuals in this category are often referred to as "educable." They can usually acquire academic skills up to the 6th-grade level, achieve social and vocational adequacy with some support, and live independently in the community. **Why the incorrect options are wrong:** * **Moderate Intellectual Disability (IQ 35–49):** These individuals are "trainable." They can perform supervised unskilled or semi-skilled work and usually achieve an academic level of the 2nd grade. * **Severe Intellectual Disability (IQ 20–34):** These individuals have very limited communication skills and require significant supervision for self-care and safety. * **Normal Intellectual Functioning (IQ 90–109):** An IQ of 62 is significantly below the average range (85–115) and the threshold for "Borderline Intellectual Functioning" (IQ 70–79). **High-Yield Clinical Pearls for NEET-PG:** * **Profound ID:** IQ < 20. Requires constant nursing care and supervision. * **Most Common Type:** Mild ID accounts for approximately **85%** of all cases of intellectual disability. * **Diagnosis:** Under DSM-5, the severity of ID is now determined by **adaptive functioning** (conceptual, social, and practical domains) rather than IQ scores alone, though IQ remains a vital clinical marker. * **Commonest Genetic Cause:** Down Syndrome (Trisomy 21). * **Commonest Inherited Cause:** Fragile X Syndrome.

Question 139: Eye blinking or throat-clearing noises are observed in an otherwise healthy 8-year-old boy. For the description above, select the most likely diagnosis.

A. Transient tic disorder of childhood (Correct Answer)
B. Tourette syndrome
C. Sydenham chorea
D. Dystonia

Explanation: **Explanation:** The clinical presentation describes a classic case of **Transient Tic Disorder** (now referred to as Provisional Tic Disorder in DSM-5). **1. Why the Correct Answer is Right:** Tics are sudden, rapid, non-rhythmic, stereotyped motor movements (e.g., eye blinking) or vocalizations (e.g., throat clearing). In an 8-year-old child, the presence of simple motor or vocal tics that have lasted for **less than one year** is diagnostic of Transient Tic Disorder. It is the most common tic disorder in children, often exacerbated by stress or excitement, and usually resolves spontaneously. **2. Why the Other Options are Wrong:** * **Tourette Syndrome:** Requires the presence of **both** multiple motor tics and at least one vocal tic, persisting for **more than one year**. The question does not specify the duration or the concurrent presence of both types over a long period. * **Sydenham Chorea:** A manifestation of Rheumatic Fever characterized by purposeless, involuntary, "dance-like" movements (chorea). Unlike tics, these are not stereotyped or repetitive and are usually associated with other features like hypotonia and emotional lability. * **Dystonia:** Characterized by sustained or intermittent muscle contractions causing twisting and repetitive movements or abnormal postures. It is not typically intermittent like a blink or a throat clear. **3. NEET-PG High-Yield Pearls:** * **Age of Onset:** Tic disorders typically begin between ages 4 and 6, peaking in severity between ages 10 and 12. * **Duration Criteria:** Provisional Tic Disorder (<1 year); Chronic Motor or Vocal Tic Disorder (>1 year, but only one type present); Tourette Syndrome (>1 year, both types present). * **Comorbidities:** Tourette Syndrome is highly associated with **ADHD** (most common) and **OCD**. * **Management:** Reassurance is the first step. If severe, Habit Reversal Therapy (Behavioral) or Alpha-2 agonists (Clonidine/Guanfacine) are preferred over antipsychotics.

Question 140: Which of the following statements is true regarding Attention Deficit Hyperactivity Disorder (ADHD)?

A. Symptoms start after ten years of age.
B. It is more frequently seen in boys. (Correct Answer)
C. Symptoms never continue into adulthood.
D. It is characterized by hypoactivity of the child.

Explanation: ### Explanation **Correct Answer: B. It is more frequently seen in boys.** **1. Why Option B is Correct:** Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood. Epidemiological studies consistently show a higher prevalence in males compared to females, with a ratio typically cited between **3:1 and 4:1** in clinical samples. Boys are more likely to present with externalizing symptoms like hyperactivity and impulsivity, which often leads to earlier referral and diagnosis. **2. Why the Other Options are Incorrect:** * **Option A:** According to DSM-5 criteria, several inattentive or hyperactive-impulsive symptoms must be present **before age 12**. Symptoms do not start after age ten; they are developmental in nature and typically manifest in early childhood. * **Option C:** ADHD is not exclusively a childhood disorder. While hyperactivity may decrease with age, symptoms of inattention and impulsivity **persist into adulthood** in approximately 50–60% of cases (Adult ADHD). * **Option D:** ADHD is characterized by **hyperactivity**, not hypoactivity. The core triad of symptoms includes **Inattention, Hyperactivity, and Impulsivity**. **3. High-Yield Clinical Pearls for NEET-PG:** * **Neurobiology:** Associated with dysfunction in the **Prefrontal Cortex** and imbalances in **Dopamine and Norepinephrine** pathways. * **Drug of Choice (DOC):** **Methylphenidate** (a CNS stimulant). It acts by blocking the reuptake of dopamine and norepinephrine. * **Non-stimulant alternative:** **Atomoxetine** (Selective Norepinephrine Reuptake Inhibitor), often used if there is a history of substance abuse or tics. * **Common Comorbidities:** Oppositional Defiant Disorder (ODD), Conduct Disorder, and Specific Learning Disorders.

Practice by Chapter

Normal Child Development

Practice Questions

Intellectual Developmental Disorder

Practice Questions

Autism Spectrum Disorders

Practice Questions

Attention-Deficit/Hyperactivity Disorder

Practice Questions

Conduct Disorder

Practice Questions

Oppositional Defiant Disorder

Practice Questions

Anxiety Disorders in Children

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Depression in Children and Adolescents

Practice Questions

Psychosis in Children and Adolescents

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Learning Disorders

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Child Abuse and Neglect

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Family Therapy Approaches

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