Child and Adolescent Psychiatry Practice Questions

Q: Which of the following nerve stimulations may be considered for the treatment of ADHD?

Trigeminal Nerve. **Explanation:** The correct answer is **Trigeminal Nerve (Option C)**. **External Trigeminal Nerve Stimulation (eTNS)** is a non-pharmacological treatment modality recently approved (FDA, 2019) for pediatric ADHD (ages 7-12). The mechanism involves sending low-level electrical signals via a patch on the forehead to the branches of the trigeminal nerve. These signals travel to specific brain regions, including the **locus coeruleus, reticular activating system, and anterior cingulate cortex**, which are critical for regulating attention, emotion, and executive function. It is particularly indicated for patients who do not tolerate ADHD medications. **Analysis of Incorrect Options:** * **A. Vagal Nerve Stimulation (VNS):** While VNS is an established treatment for refractory epilepsy and treatment-resistant depression, it is not currently a standard or approved treatment for ADHD. * **B. Facial Nerve:** The facial nerve (CN VII) is primarily motor to the muscles of facial expression. It does not have the direct neuroanatomical projections to the brainstem’s arousal centers required to modulate ADHD symptoms. * **D. Trochlear Nerve:** The trochlear nerve (CN IV) is a pure motor nerve controlling the superior oblique muscle of the eye; it has no role in cognitive or behavioral modulation. **High-Yield Clinical Pearls for NEET-PG:** * **eTNS Protocol:** Usually administered at night during sleep; effects may take up to 4 weeks to manifest. * **First-line ADHD Treatment:** Stimulants (Methylphenidate) remain the gold standard. * **Neuroanatomy of ADHD:** Primarily involves dysfunction in the **Prefrontal Cortex** and imbalances in **Dopamine and Norepinephrine**. * **Contraindication:** eTNS should not be used in patients with active implantable devices (e.g., pacemakers or neurostimulators).

Q: All of the following are complex motor tics except?

Palilalia. **Explanation:** Tics are sudden, rapid, recurrent, non-rhythmic motor movements or vocalizations. They are broadly classified into **Motor** vs. **Vocal** and **Simple** vs. **Complex**. **Why Palilalia is the correct answer:** **Palilalia** is defined as the involuntary repetition of one's own words or phrases. Since it involves the production of sound/speech, it is classified as a **vocal tic**, not a motor tic. Specifically, it is a **complex vocal tic**. Because the question asks for "all except" complex motor tics, Palilalia is the outlier. **Analysis of Incorrect Options (Complex Motor Tics):** Complex motor tics are purposeful-looking, coordinated patterns of movement involving multiple muscle groups. * **Echopraxia:** The involuntary imitation of another person's movements. It is a classic complex motor tic. * **Jumping:** A coordinated gross motor movement involving multiple muscle groups, categorized as a complex motor tic. * **Touching:** Repetitive touching of objects or oneself (often associated with OCD-like compulsions) is a common complex motor tic. **High-Yield Clinical Pearls for NEET-PG:** * **Simple Motor Tics:** Eye blinking, neck jerking, shoulder shrugging (involve single muscle groups). * **Simple Vocal Tics:** Throat clearing, grunting, sniffing, barking. * **Complex Vocal Tics:** **Palilalia** (repeating self), **Echolalia** (repeating others), and **Coprolalia** (uttering obscenities). * **Tourette Syndrome Diagnosis:** Requires **both** multiple motor tics and at least one vocal tic (not necessarily concurrent) present for >1 year, with onset before age 18. * **Drug of Choice:** Alpha-2 agonists (Guanfacine, Clonidine) are often first-line; typical/atypical antipsychotics (Haloperidol, Risperidone) are also effective.

Q: Which of the following is an abnormality seen in Attention Deficit Hyperactivity Disorder (ADHD)?

Hyperactivity. ### Explanation **Attention Deficit Hyperactivity Disorder (ADHD)** is a neurodevelopmental disorder characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. **Why Option A is Correct:** Hyperactivity is one of the three core symptom domains of ADHD (alongside Inattention and Impulsivity). In children, this manifests as excessive fidgeting, inability to remain seated, or "acting as if driven by a motor." Neurobiologically, ADHD is associated with **dysregulation of Dopamine and Norepinephrine** pathways, particularly in the **Prefrontal Cortex** and **Basal Ganglia**, which are responsible for executive function and motor control. **Why Other Options are Incorrect:** * **Options B & C (Hallucinations and Delusions):** These are **Psychotic symptoms**. Hallucinations (perceptual disturbances) and Delusions (fixed false beliefs) are characteristic of Schizophrenia, Mood disorders with psychotic features, or Organic Psychoses. They are not features of ADHD. If a child with ADHD develops these symptoms, a comorbid condition or a side effect of stimulant medication (rarely) must be considered. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis:** Based on **DSM-5 criteria**; symptoms must be present for at least **6 months**, onset before **age 12**, and present in **two or more settings** (e.g., home and school). * **Most Common Comorbidity:** Oppositional Defiant Disorder (ODD). * **Drug of Choice (DOC):** **Methylphenidate** (a CNS stimulant that blocks dopamine/norepinephrine reuptake). * **Non-Stimulant DOC:** **Atomoxetine** (Selective Norepinephrine Reuptake Inhibitor). * **Gender:** More common in males (approx. 3:1 ratio).

Q: Who proposed the phallic stage of psychosexual development?

Freud. **Explanation:** The correct answer is **Sigmund Freud**. Freud proposed the **Theory of Psychosexual Development**, which suggests that personality develops through a series of childhood stages where the pleasure-seeking energies of the 'id' become focused on certain erogenous zones. **The Phallic Stage (3 to 6 years):** During this stage, the primary focus of the libido is on the genitals. It is characterized by the development of the **Oedipus complex** (in boys) and the **Electra complex** (in girls), involving unconscious desires for the opposite-sex parent and rivalry with the same-sex parent. Resolution of this stage leads to the development of the **Superego**. **Analysis of Incorrect Options:** * **Bleuler (Eugen Bleuler):** A Swiss psychiatrist best known for coining the term "Schizophrenia" and defining its "4 As" (Association, Affect, Ambivalence, and Autism). * **Erikson (Erik Erikson):** Proposed the **Theory of Psychosocial Development**, which consists of 8 stages (e.g., Trust vs. Mistrust) spanning from birth to old age. * **Lorenz (Konrad Lorenz):** An ethologist famous for his work on **Imprinting** (the rapid learning process in newborn animals), which is a key concept in attachment theory. **High-Yield Clinical Pearls for NEET-PG:** * **Freud’s Stages in Order:** Oral (0-1y) → Anal (1-3y) → Phallic (3-6y) → Latency (6-12y) → Genital (Puberty onwards). * **Fixation:** Freud believed that failure to resolve a conflict at a specific stage leads to "fixation" (e.g., anal-retentive personality). * **Structural Model:** Freud also proposed the tripartite model of the mind: **Id** (pleasure principle), **Ego** (reality principle), and **Superego** (moral principle).

Q: Autistic disorder is characterized by all of the following features, except:

Visual impairment. **Explanation:** Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by a triad of impairments. The diagnosis is clinical, based on behavioral patterns rather than sensory deficits. **1. Why "Visual Impairment" is the correct answer:** Visual impairment is a **sensory deficit**, not a core feature of Autism. While children with ASD may exhibit atypical visual behaviors (e.g., avoiding eye contact or looking at objects from peripheral angles), their actual visual acuity is typically normal. Sensory deficits like blindness or deafness are separate comorbidities and are not part of the diagnostic criteria for ASD. **2. Analysis of other options:** * **Lack of social interaction:** This is a hallmark feature. Children show a failure of social reciprocity, lack of "joint attention," and difficulty in forming peer relationships. * **Stereotypical movements:** These are repetitive, purposeless motor mannerisms (e.g., hand-flapping, body rocking, or spinning). This falls under the "Restricted, Repetitive Patterns of Behavior" domain of DSM-5. * **Delayed development of speech:** Communication deficits are central to ASD. This includes a total delay in speech, lack of "make-believe" play, or repetitive use of language (echolalia). **Clinical Pearls for NEET-PG:** * **DSM-5 Criteria:** Now uses two domains: 1) Deficits in social communication/interaction and 2) Restricted, repetitive patterns of behavior. * **Early Sign:** The earliest reliable sign is the **absence of a social smile** or failure to respond to one's name by 12 months. * **M-CHAT:** The most commonly used screening tool for toddlers. * **Prognosis:** The best predictors of a good prognosis are **higher IQ (>70)** and the **development of communicative speech** by age 5–7 years.

Question 1

Which of the following nerve stimulations may be considered for the treatment of ADHD?

Accepted Answer

Trigeminal Nerve

Answer

Vagal Nerve

Answer

Facial Nerve

Answer

Trochlear Nerve

Question 2

Which of the following is NOT a diagnostic criterion for Munchausen's syndrome by proxy?

Accepted Answer

Parental acceptance of knowledge of the cause of symptoms.

Answer

Illness produced or alleged, or both, by a parent.

Answer

Repeated requests for medical care for a child.

Answer

Regression of symptoms on separation from parents.

Question 3

All of the following are complex motor tics except?

Accepted Answer

Palilalia

Answer

Echopraxia

Answer

Jumping

Answer

Touching

Question 4

A 12-year-old boy presents with disruptive behavior at school, aggression towards teachers, and truancy. He was recently suspended from school for destruction of school property. Which of the following diagnoses best suits his presentation?

Accepted Answer

Conduct disorder

Answer

Oppositional defiant disorder

Answer

Attention deficit hyperactivity disorder

Answer

Autism spectrum disorder

Question 5

Which of the following is an abnormality seen in Attention Deficit Hyperactivity Disorder (ADHD)?

Accepted Answer

Hyperactivity

Answer

Hallucinations

Answer

Delusion

Answer

All of the above

Question 6

What is anaclitic depression?

Accepted Answer

Depression in a child deprived of a caretaker

Answer

Depression on top of dysthymia

Answer

Depression with increased sleep and increased appetite

Answer

Depression with a seasonal pattern

Question 7

What is the IQ range for an "Imbecile"?

Accepted Answer

26 - 50

Answer

0 - 12

Answer

51 - 70

Answer

71 - 85

Question 8

Who proposed the phallic stage of psychosexual development?

Accepted Answer

Freud

Answer

Bleuler

Answer

Erikson

Answer

Lorenz

Question 9

Autistic disorder is characterized by all of the following features, except:

Accepted Answer

Visual impairment

Answer

Lack of social interaction

Answer

Stereotypical movements

Answer

Delayed development of speech

Question 10

What is the fixation of Hysteria?

Accepted Answer

Phallic

Answer

Genital

Answer

Anal

Answer

Oral

Child and Adolescent Psychiatry — MCQs

Child and Adolescent Psychiatry — MCQs

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