Child and Adolescent Psychiatry — MCQs

Child and Adolescent Psychiatry Indian Medical PG Practice Questions and MCQs

Question 141: Attention-Deficit/Hyperactivity Disorder (ADHD) in childhood is associated with an increased risk of which of the following disorders later in life?

A. Schizophrenia
B. Alcoholism (Correct Answer)
C. Dissociative disorder
D. Intellectual disability

Explanation: ### Explanation **Correct Option: B. Alcoholism** ADHD is a neurodevelopmental disorder characterized by executive dysfunction, impulsivity, and emotional dysregulation. Longitudinal studies consistently show that children with ADHD are at a significantly higher risk for **Substance Use Disorders (SUD)**, including alcoholism, in adolescence and adulthood. * **Mechanism:** Impulsivity and the tendency for "self-medication" to manage symptoms of restlessness or poor focus contribute to this risk. Additionally, ADHD often co-occurs with **Conduct Disorder (CD)**; the presence of comorbid CD further escalates the risk of developing antisocial personality disorder and severe substance abuse later in life. **Analysis of Incorrect Options:** * **A. Schizophrenia:** While both are neurodevelopmental in origin, there is no direct causal link or significant longitudinal association suggesting ADHD leads to Schizophrenia. * **C. Dissociative Disorder:** These disorders are typically rooted in severe childhood trauma (e.g., abuse) rather than the neurobiological pathways of ADHD. * **D. Intellectual Disability (ID):** ID is a concurrent neurodevelopmental condition. ADHD does not *cause* ID later in life; rather, they may coexist as comorbidities from early childhood. **High-Yield Clinical Pearls for NEET-PG:** * **Most common comorbidity in ADHD:** Oppositional Defiant Disorder (ODD). * **Prognosis:** Approximately 50–60% of cases persist into adulthood (Adult ADHD), where symptoms of hyperactivity often transition into internal restlessness. * **Treatment of Choice:** Stimulants (e.g., **Methylphenidate**) are first-line. Non-stimulants like **Atomoxetine** (a selective NRI) are preferred if there is a high risk of substance abuse. * **Gender:** More common in boys (approx. 3:1 ratio).

Question 142: Which of the following conditions is associated with genetic factors?

A. Autism (Correct Answer)
B. Rheumatic heart disease
C. Pellagra
D. All of the above

Explanation: **Explanation:** **Autism Spectrum Disorder (ASD)** is a neurodevelopmental condition with a strong genetic basis. Research indicates a high heritability rate (estimated between 60-90%), supported by twin studies showing significantly higher concordance in monozygotic twins compared to dizygotic twins. It is associated with various genetic mutations, including copy number variants (CNVs) and single-gene disorders like Fragile X syndrome and Tuberous Sclerosis. **Why the other options are incorrect:** * **Rheumatic Heart Disease (RHD):** This is an acquired autoimmune consequence of an infectious process. It follows untreated Group A Streptococcal pharyngitis. While some individuals may have a genetic predisposition to autoimmune responses, the primary etiology is environmental/infectious. * **Pellagra:** This is a nutritional deficiency disease caused by a lack of **Niacin (Vitamin B3)** or its precursor, tryptophan. It is classically characterized by the "4 Ds": Dermatitis, Diarrhea, Dementia, and Death. It is not a genetic condition. **High-Yield Clinical Pearls for NEET-PG:** * **ASD Screening:** The **M-CHAT** (Modified Checklist for Autism in Toddlers) is the most commonly used screening tool (typically at 18 and 24 months). * **Core Deficits:** Impairment in social communication/interaction and the presence of restricted, repetitive patterns of behavior. * **Sibling Risk:** If one child has ASD, the risk for subsequent siblings is approximately 10-20%. * **Associated Conditions:** Advanced paternal age is a known non-genetic risk factor associated with increased de novo mutations in ASD.

Question 143: What is the drug of choice for ADHD?

A. Amphetamine
B. Methylphenidate (Correct Answer)
C. Pemoline
D. Modafinil

Explanation: **Explanation:** **Attention-Deficit Hyperactivity Disorder (ADHD)** is primarily characterized by a deficit in dopamine and norepinephrine levels in the prefrontal cortex. The core management strategy involves increasing these neurotransmitters to improve focus and impulse control. **Why Methylphenidate is the Correct Answer:** Methylphenidate is a CNS stimulant that acts by blocking the reuptake of dopamine and norepinephrine (NDRI). It is considered the **first-line drug of choice** for ADHD in children and adolescents due to its proven efficacy, relatively safe side-effect profile, and rapid onset of action. It helps improve the "signal-to-noise ratio" in the brain, enhancing executive function. **Analysis of Incorrect Options:** * **A. Amphetamine:** While also a first-line stimulant (often preferred in adults), in many regions and standard pediatric guidelines, Methylphenidate is initiated first due to a slightly better tolerability profile in children. * **C. Pemoline:** This was once used for ADHD but has been largely discontinued worldwide due to the high risk of **hepatotoxicity** (liver failure). * **D. Modafinil:** This is a wakefulness-promoting agent used primarily for Narcolepsy. While it has been studied for ADHD, it is not a first-line treatment and is not FDA-approved for this indication in children. **High-Yield Clinical Pearls for NEET-PG:** * **Non-Stimulant of Choice:** **Atomoxetine** (a selective norepinephrine reuptake inhibitor) is the preferred alternative if stimulants are contraindicated or if there is a history of substance abuse. * **Common Side Effects:** Insomnia, decreased appetite, and growth retardation (weight/height). "Drug holidays" are often recommended during school vacations to allow for catch-up growth. * **Contraindications:** Methylphenidate should be avoided in patients with symptomatic cardiovascular disease, severe hypertension, or glaucoma. * **Prescreening:** Always check baseline height, weight, blood pressure, and heart rate before starting stimulants.

Question 144: What is the treatment of choice in attention deficit hyperactivity disorder?

A. Haloperidol
B. Imipramine
C. Alprazolam
D. Methylphenidate (Correct Answer)

Explanation: **Explanation:** **Attention Deficit Hyperactivity Disorder (ADHD)** is characterized by a persistent pattern of inattention, hyperactivity, and impulsivity. The underlying pathophysiology involves a dysfunction in the catecholaminergic systems, particularly a deficiency of dopamine and norepinephrine in the prefrontal cortex. **Why Methylphenidate is the Correct Answer:** **Methylphenidate** is a central nervous system (CNS) stimulant and is considered the **first-line pharmacological treatment (Drug of Choice)** for ADHD. It works by blocking the reuptake of dopamine and norepinephrine, thereby increasing their availability in the synaptic cleft. This enhances executive function, focus, and impulse control. **Analysis of Incorrect Options:** * **A. Haloperidol:** A typical antipsychotic (D2 antagonist). While used for Tourette’s or severe aggression, it is not used for ADHD as it can worsen cognitive dulling and cause extrapyramidal side effects. * **B. Imipramine:** A Tricyclic Antidepressant (TCA). It is a second or third-line agent used only when stimulants are ineffective or contraindicated. It carries a risk of cardiotoxicity. * **C. Alprazolam:** A benzodiazepine used for anxiety. It has no role in ADHD and may cause "paradoxical disinhibition," worsening hyperactivity in children. **High-Yield Clinical Pearls for NEET-PG:** * **First-line non-pharmacological treatment:** Behavioral therapy (especially for preschool children). * **Most common side effects of Methylphenidate:** Insomnia and appetite suppression (monitor growth/weight). * **Non-stimulant Drug of Choice:** **Atomoxetine** (a selective norepinephrine reuptake inhibitor), preferred if there is a history of substance abuse or comorbid tics. * **Adult ADHD:** Atomoxetine or stimulants are used, but screening for cardiovascular issues is essential.

Question 145: Methylphenidate is the drug of choice for which of the following conditions?

A. Obsessive compulsive disorder
B. Attention deficit hyperactivity disorder (Correct Answer)
C. Nocturnal enuresis
D. Autism spectrum disorder

Explanation: **Explanation:** **Methylphenidate** is a central nervous system (CNS) stimulant and is the **first-line pharmacological treatment (Drug of Choice)** for **Attention Deficit Hyperactivity Disorder (ADHD)**. **Mechanism of Action:** It acts by blocking the reuptake of norepinephrine and dopamine into the presynaptic neuron, thereby increasing their availability in the synaptic cleft. This specifically enhances neurotransmission in the prefrontal cortex, which improves executive functions such as impulse control, sustained attention, and focus. **Analysis of Incorrect Options:** * **A. Obsessive Compulsive Disorder (OCD):** The first-line treatment is Selective Serotonin Reuptake Inhibitors (SSRIs) like Fluoxetine or Fluvoxamine, along with Cognitive Behavioral Therapy (ERP). * **C. Nocturnal Enuresis:** The drug of choice is **Desmopressin** (vasopressin analog). Imipramine (a TCA) was historically used but is now a second-line option due to its side-effect profile. * **D. Autism Spectrum Disorder (ASD):** There is no curative drug for ASD. Pharmacotherapy is used only for comorbid symptoms; for example, Risperidone or Aripiprazole are FDA-approved for irritability and aggression in autism. **High-Yield Clinical Pearls for NEET-PG:** * **Side Effects of Methylphenidate:** Most common are **insomnia** and **anorexia** (decreased appetite). A significant concern in children is **growth retardation** (stunting of height/weight), necessitating "drug holidays" during school vacations. * **Contraindications:** Glaucoma, severe hypertension, and a history of motor tics (may exacerbate Tourette’s). * **Non-stimulant alternative for ADHD:** **Atomoxetine** (a selective norepinephrine reuptake inhibitor) is used if stimulants are contraindicated or if there is a risk of substance abuse.

Question 146: Which of the following autistic spectrum disorders carries a good prognosis?

A. Childhood autism
B. Rett's disease
C. Heller's syndrome
D. Asperger's syndrome (Correct Answer)

Explanation: **Explanation:** The prognosis of Autism Spectrum Disorders (ASD) is primarily determined by two factors: **Intellectual ability (IQ)** and **Language development**. **Asperger’s Syndrome (Correct Option):** Asperger’s syndrome is characterized by social impairment and restricted interests, but it is distinguished by the **absence of clinically significant delays in language or cognitive development**. Because these individuals have normal to high IQs and functional communication skills, they have the best prognosis among the listed disorders, often achieving independent living and employment. **Incorrect Options:** * **Childhood Autism:** Typically involves significant delays in language and social interaction. About 50-70% of cases are associated with intellectual disability (IQ < 70), leading to a more guarded prognosis compared to Asperger’s. * **Rett’s Disease:** A progressive neurodevelopmental disorder (primarily in females, linked to the *MECP2* gene) characterized by a period of normal development followed by loss of purposeful hand skills, deceleration of head growth, and severe intellectual disability. It has a **poor prognosis**. * **Heller’s Syndrome (Childhood Disintegrative Disorder):** Involves a dramatic loss of previously acquired skills (language, social, motor) after at least 2 years of normal development. It carries a **very poor prognosis** as the regression is often permanent and severe. **NEET-PG High-Yield Pearls:** * **DSM-5 Update:** All these categories (except Rett's) are now merged under the single umbrella of **Autism Spectrum Disorder (ASD)**. * **Best Prognostic Indicators:** High IQ and the presence of communicative speech by age 5–7 years. * **Rett’s Syndrome:** Look for "hand-wringing" stereotypies and its X-linked dominant inheritance pattern. * **Kanner’s Syndrome:** Another name for Early Infantile Autism.

Question 147: A person has a chronological age of 10 years and a mental age of 4 years. What term is used to describe this individual?

A. Idiot
B. Imbecile (Correct Answer)
C. Normal
D. Genius

Explanation: ### Explanation The classification of Intellectual Disability (ID) in this question is based on the **Intelligence Quotient (IQ)**, which is calculated using the formula: **IQ = (Mental Age / Chronological Age) × 100** **Calculation for this case:** * Mental Age (MA) = 4 years * Chronological Age (CA) = 10 years * IQ = (4 / 10) × 100 = **40** According to the historical Terman’s classification (often tested in NEET-PG), an IQ of 40 falls into the category of **Imbecile**. #### Analysis of Options: * **B. Imbecile (Correct):** Historically, this term refers to individuals with an IQ between **25–49**. In modern ICD-10/DSM-5 terms, this corresponds to **Moderate Intellectual Disability**. * **A. Idiot:** This term was used for individuals with the most severe impairment, specifically an IQ **below 25**. (Modern equivalent: Severe/Profound ID). * **C. Normal:** A normal or average IQ range is typically **90–109**. * **D. Genius:** This term is reserved for individuals with an IQ of **140 or above**. #### High-Yield Clinical Pearls for NEET-PG: 1. **Modern Classification (ICD-10):** * Mild ID: IQ 50–69 (Educable) * Moderate ID: IQ 35–49 (Trainable) * Severe ID: IQ 20–34 * Profound ID: IQ < 20 2. **Vineland Social Maturity Scale (VSMS):** Used to assess Social Age and Social Quotient (SQ) in children, often used alongside IQ testing. 3. **Most Common Cause:** The most common genetic cause of ID is **Down Syndrome**, while the most common inherited cause is **Fragile X Syndrome**.

Question 148: Munchausen's syndrome by proxy involves which of the following?

A. Drug abuse
B. Toxin-mediated neuropsychiatric effects
C. An illness factitiously induced or exaggerated by a caregiver (Correct Answer)
D. All of the above

Explanation: **Explanation:** **Munchausen Syndrome by Proxy (MSBP)**, now clinically referred to as **Factitious Disorder Imposed on Another**, is a form of child abuse where a caregiver (most commonly the biological mother) intentionally produces, feigns, or exaggerates physical or psychological symptoms in a child. The primary motivation is not external gain (like money), but rather the internal psychological need of the caregiver to assume the "sick role" by proxy and receive attention or sympathy from medical staff. * **Why Option C is correct:** The hallmark of MSBP is the **factitious induction** of illness. Caregivers may contaminate lab samples, withhold food, or even inject the child with toxins to mimic disease, leading to unnecessary and often invasive medical investigations. * **Why Options A and B are incorrect:** While a caregiver might use drugs or toxins to induce symptoms in the child (e.g., using insulin to cause hypoglycemia or ipecac to cause vomiting), these are merely *methods* used to achieve the deception. MSBP is defined by the **behavioral intent of the caregiver** rather than the specific substance used. Therefore, "Drug abuse" or "Toxin-mediated effects" are too narrow or clinically inaccurate as definitions of the syndrome itself. **High-Yield Clinical Pearls for NEET-PG:** * **The Perpetrator:** Usually the mother (approx. 90-95%), often with some healthcare training or a history of Factitious Disorder herself. * **The Victim:** Usually a pre-verbal child or infant. * **Red Flags:** Symptoms that only occur in the caregiver's presence, a child who miraculously improves when separated from the caregiver (hospitalization), and a caregiver who appears unusually calm despite the child's "deteriorating" health. * **Management:** The immediate priority is the **safety and protection of the child** (notifying child protective services), followed by psychiatric evaluation of the perpetrator.

Question 149: A person is said to be mentally retarded when their IQ is:

A. Less than 100
B. Less than 90
C. Less than 80
D. Less than 70 (Correct Answer)

Explanation: **Explanation:** The diagnosis of **Intellectual Disability (ID)**, formerly known as Mental Retardation, is based on both clinical assessment and standardized testing. According to the ICD-10 and DSM-5 criteria, a person is classified as having an intellectual disability when their **Intelligence Quotient (IQ) is less than 70**, accompanied by significant deficits in adaptive functioning (e.g., self-care, social skills) originating during the developmental period (before age 18). **Analysis of Options:** * **Option D (Less than 70):** This is the established threshold. An IQ of 70-75 is generally considered two standard deviations below the population mean (which is 100). * **Option A & B (Less than 100/90):** An IQ of 90–109 is considered "Average." Scoring below 90 but above 80 is classified as "Low Average." * **Option C (Less than 80):** An IQ score between 71 and 84 is categorized as **Borderline Intellectual Functioning**. While these individuals may struggle academically, they do not meet the formal criteria for Intellectual Disability. **High-Yield Clinical Pearls for NEET-PG:** * **Classification of ID (Based on IQ):** * **Mild:** 50–69 (Educable; most common type, ~85%) * **Moderate:** 35–49 (Trainable; can perform supervised tasks) * **Severe:** 20–34 (Can learn survival words and basic self-care) * **Profound:** < 20 (Requires constant supervision/nursing care) * **Most Common Cause:** Genetic factors (Down Syndrome is the most common chromosomal cause; Fragile X is the most common inherited cause). * **Assessment Tools:** Binet-Kamat Test (BKT) and Wechsler Adult Intelligence Scale (WAIS) are frequently used in clinical practice.

Question 150: PANDAS are associated with which of the following infections?

A. Pseudomonas
B. Streptococcus (Correct Answer)
C. Staphylococcus
D. Neisseria

Explanation: **Explanation:** **PANDAS** stands for **Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections**. **Why Streptococcus is correct:** The core pathophysiology involves an autoimmune response following an infection with **Group A Beta-Hemolytic Streptococcus (GABHS)**, such as strep throat or scarlet fever. It is hypothesized that antibodies produced against the streptococcal bacteria cross-react with host tissues in the **basal ganglia** through a mechanism known as **molecular mimicry** (similar to the mechanism in Sydenham’s chorea). This triggers a sudden, dramatic onset or "flare-up" of obsessive-compulsive disorder (OCD) symptoms or tic disorders in children. **Why other options are incorrect:** * **Pseudomonas, Staphylococcus, and Neisseria:** While these are common human pathogens, they are not associated with the specific molecular mimicry involving the basal ganglia that characterizes PANDAS. There is no clinical evidence linking these bacteria to the acute-onset neuropsychiatric syndrome defined by the PANDAS criteria. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnostic Criteria:** Symptoms must appear between age 3 and puberty, have an episodic (relapsing-remitting) course, and show a temporal relationship with GABHS infection (confirmed by positive throat culture or elevated Anti-streptolysin O [ASO] titers). * **Key Symptoms:** Sudden onset OCD, tics, emotional lability, irritability, and often "clumsiness" or hyperactivity. * **Differential Diagnosis:** Must be distinguished from **Sydenham’s Chorea** (a major Jones criterion for Rheumatic Fever), which also involves the basal ganglia but presents with characteristic purposeless movements. * **PANS:** A broader category called Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is used when the trigger is not necessarily Streptococcal (can be other infections or environmental factors).

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

Practice Questions

Depression in Children and Adolescents

Practice Questions

Psychosis in Children and Adolescents

Practice Questions

Learning Disorders

Practice Questions

Child Abuse and Neglect

Practice Questions

Family Therapy Approaches

Practice Questions

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