Child and Adolescent Psychiatry — MCQs

Child and Adolescent Psychiatry Indian Medical PG Practice Questions and MCQs

Question 11: Which of the following nerve stimulations may be considered for the treatment of ADHD?

A. Vagal Nerve
B. Facial Nerve
C. Trigeminal Nerve (Correct Answer)
D. Trochlear Nerve

Explanation: **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).

Question 12: Which of the following is NOT a diagnostic criterion for Munchausen's syndrome by proxy?

A. Illness produced or alleged, or both, by a parent.
B. Repeated requests for medical care for a child.
C. Parental acceptance of knowledge of the cause of symptoms. (Correct Answer)
D. Regression of symptoms on separation from parents.

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 (usually the mother) deliberately induces or simulates illness in a child to gain attention or sympathy from medical personnel. #### Why Option C is Correct The hallmark of MSBP is **deception**. The perpetrator consistently **denies** any knowledge of the true cause of the symptoms. If a parent were to accept or acknowledge that they (or a specific external factor) caused the symptoms, it would no longer be a factitious disorder; it would simply be a medical history or a different form of overt physical abuse. The "success" of the perpetrator depends on the medical team remaining ignorant of the cause. #### Analysis of Other Options * **Option A:** This is the core definition. The caregiver (proxy) either **fabricates** (lies about history) or **induces** (e.g., poisoning, injecting bacteria) symptoms in the victim. * **Option B:** Perpetrators are "hospital shoppers." They frequently seek medical attention, demand invasive tests, and may even have a sophisticated (though distorted) understanding of medical terminology. * **Option C:** This is a classic diagnostic sign. When the child is hospitalized and the perpetrator is kept away (separation), the "mysterious" symptoms typically vanish, as the caregiver no longer has access to the child to induce harm. #### NEET-PG High-Yield Pearls * **Perpetrator Profile:** Usually the biological mother (approx. 90-95%), often with a background in healthcare or a history of Factitious Disorder herself. * **Common Presentations:** Unexplained bleeding (adding blood to urine), seizures (falsified history), or recurrent infections. * **Management:** The primary goal is the **safety of the child**. Immediate notification of child protective services and separation from the perpetrator is mandatory. * **Motivation:** Unlike Malingering (which seeks tangible gain like money), MSBP is driven by the **psychological need** to assume the "sick role" by proxy and receive attention.

Question 13: All of the following are complex motor tics except?

A. Echopraxia
B. Palilalia (Correct Answer)
C. Jumping
D. Touching

Explanation: **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.

Question 14: 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?

A. Oppositional defiant disorder
B. Conduct disorder (Correct Answer)
C. Attention deficit hyperactivity disorder
D. Autism spectrum disorder

Explanation: ### Explanation **Correct Answer: B. Conduct Disorder** The core feature of **Conduct Disorder (CD)** is a repetitive and persistent pattern of behavior in which the **basic rights of others or major age-appropriate societal norms/rules are violated**. In this clinical scenario, the boy exhibits three hallmark categories of CD: 1. **Aggression to people:** Aggression towards teachers. 2. **Destruction of property:** Suspension for damaging school property. 3. **Deceitfulness or theft/Serious rule violations:** Truancy (skipping school). While Oppositional Defiant Disorder (ODD) involves hostility, CD is distinguished by the presence of **physical aggression and property destruction**, which are absent in ODD. --- ### Why the other options are incorrect: * **A. Oppositional Defiant Disorder (ODD):** Characterized by an angry/irritable mood and argumentative/defiant behavior. However, unlike CD, ODD does **not** typically involve physical aggression toward people/animals, destruction of property, or a pattern of theft/deceit. * **C. Attention Deficit Hyperactivity Disorder (ADHD):** Presents with inattention, hyperactivity, and impulsivity. While ADHD is frequently comorbid with CD, it does not inherently involve the intentional violation of social norms or aggression. * **D. Autism Spectrum Disorder (ASD):** Characterized by deficits in social communication and restricted, repetitive patterns of behavior. Aggression in ASD is usually a reaction to sensory overload or change in routine, rather than a calculated violation of rights. --- ### High-Yield Clinical Pearls for NEET-PG: * **Age Factor:** If the patient is $\geq$ 18 years old and meets the criteria for CD, the diagnosis shifts to **Antisocial Personality Disorder**. * **The "Progression":** There is a common developmental trajectory: **ODD $\rightarrow$ Conduct Disorder $\rightarrow$ Antisocial Personality Disorder.** * **Treatment:** Multi-systemic therapy (MST) is the gold standard; pharmacotherapy (like Risperidone) is only used to manage severe aggression.

Question 15: Which of the following is an abnormality seen in Attention Deficit Hyperactivity Disorder (ADHD)?

A. Hyperactivity (Correct Answer)
B. Hallucinations
C. Delusion
D. All of the above

Explanation: ### 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).

Question 16: What is anaclitic depression?

A. Depression on top of dysthymia
B. Depression with increased sleep and increased appetite
C. Depression in a child deprived of a caretaker (Correct Answer)
D. Depression with a seasonal pattern

Explanation: ### Explanation **Anaclitic depression** (also known as hospitalism) refers to a syndrome of emotional withdrawal, physical impairment, and developmental delay in infants who are separated from their primary caregiver (usually the mother) for a prolonged period. **Why Option C is Correct:** The term was coined by **René Spitz** in 1945. It occurs typically in infants aged 6–18 months who have developed a stable attachment to a caregiver but are then deprived of that bond (e.g., due to hospitalization or institutionalization). Clinically, the child progresses through stages of protest, despair, and eventually detachment. If the caregiver is returned within 3–5 months, the symptoms usually reverse; however, prolonged deprivation can lead to irreversible developmental damage or even death (marasmus). **Analysis of Incorrect Options:** * **Option A (Depression on top of dysthymia):** This describes **Double Depression**, where an acute episode of Major Depressive Disorder (MDD) occurs in a patient already suffering from persistent depressive disorder (dysthymia). * **Option B (Depression with increased sleep/appetite):** This defines **Atypical Depression**. Unlike melancholic depression, these patients show "mood reactivity" and reversed vegetative symptoms (hypersomnia and hyperphagia). * **Option D (Depression with a seasonal pattern):** This refers to **Seasonal Affective Disorder (SAD)**, typically triggered by reduced sunlight in winter months and treated with phototherapy. **NEET-PG High-Yield Pearls:** * **Key Figure:** René Spitz (associated with "Hospitalism" and "Anaclitic Depression"). * **Harry Harlow’s Experiment:** Conducted on rhesus monkeys; demonstrated that "contact comfort" is more important than food for attachment, supporting the concept of anaclitic depression. * **Clinical Features:** Apprehension, withdrawal, weeping, weight loss, and sleep disturbance in an infant. * **Prognosis:** Recovery is rapid if the mother/caregiver is restored within a critical window (usually <5 months).

Question 17: What is the IQ range for an "Imbecile"?

A. 0 - 12
B. 26 - 50 (Correct Answer)
C. 51 - 70
D. 71 - 85

Explanation: ### Explanation The question refers to the **historical classification of Intellectual Disability (ID)**, which was used before the adoption of modern terms like Mild, Moderate, Severe, and Profound. While these terms (Idiot, Imbecile, Moron) are now considered derogatory and obsolete in clinical practice, they are still occasionally tested in competitive exams like NEET-PG. **1. Why Option B is Correct:** An **Imbecile** corresponds to what we now classify as **Moderate Intellectual Disability**, with an **IQ range of 25–49 (or 26–50)**. Individuals in this category typically have a mental age of 3 to 7 years. They can communicate and learn basic health/safety habits but usually require supervision and are considered "trainable" rather than "educable." **2. Analysis of Incorrect Options:** * **Option A (0–25):** This range corresponds to an **Idiot** (now termed **Profound ID**). These individuals have a mental age below 3 years and require total nursing care. * **Option C (51–70):** This range corresponds to a **Moron** (now termed **Mild ID**). These individuals are "educable," can achieve academic skills up to the 6th-grade level, and can live independently with minimal support. * **Option D (71–85):** This range is classified as **Borderline Intellectual Functioning**. It is not considered a category of Intellectual Disability but rather a transition zone between ID and average intelligence. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most Common Type:** Mild ID (50–70 IQ) accounts for about 85% of all cases. * **Educable vs. Trainable:** Mild ID is "Educable"; Moderate ID is "Trainable." * **Diagnosis:** According to DSM-5, ID diagnosis is no longer based solely on IQ scores but also requires deficits in **adaptive functioning** (conceptual, social, and practical domains) originating during the developmental period. * **Commonest Genetic Cause:** Down Syndrome (Trisomy 21). * **Commonest Inherited Cause:** Fragile X Syndrome.

Question 18: Who proposed the phallic stage of psychosexual development?

A. Bleuler
B. Freud (Correct Answer)
C. Erikson
D. Lorenz

Explanation: **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).

Question 19: Autistic disorder is characterized by all of the following features, except:

A. Visual impairment (Correct Answer)
B. Lack of social interaction
C. Stereotypical movements
D. Delayed development of speech

Explanation: **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 20: What is the fixation of Hysteria?

A. Genital
B. Anal
C. Oral
D. Phallic (Correct Answer)

Explanation: ### Explanation In classical Freudian psychoanalytic theory, **Hysteria** (now largely categorized under Dissociative or Somatoform disorders) is fundamentally linked to a fixation at the **Phallic stage** of psychosexual development. **1. Why Phallic is Correct:** The Phallic stage (ages 3–6 years) is characterized by the development of the **Oedipus complex** (in boys) and the **Electra complex** (in girls). According to Freud, hysteria arises when an individual fails to successfully resolve these complexes. The repressed sexual impulses and the resulting anxiety from this stage are "converted" into physical symptoms (Conversion Disorder) or dissociative states. The use of **Repression** as a primary defense mechanism is a hallmark of both the phallic stage and hysterical personality traits. **2. Why Other Options are Incorrect:** * **Oral Stage (0–1 year):** Fixation here leads to "Oral-incorporative" or "Oral-aggressive" traits, such as excessive dependency, narcissism, or substance abuse. * **Anal Stage (1–3 years):** Fixation at this stage is associated with the **Obsessive-Compulsive Personality**. Traits include orderliness, obstinacy, and parsimony (the "Anal Triad"). * **Genital Stage (Puberty onwards):** This is the final stage of healthy psychosexual maturity. Fixation does not occur here; rather, it represents the goal of successful development where one can form mature heterosexual relationships. **3. Clinical Pearls for NEET-PG:** * **Defense Mechanism:** The primary defense mechanism in Hysteria/Conversion disorder is **Repression** and **Conversion**. * **Primary Gain:** The internal relief from anxiety by keeping the conflict out of conscious awareness. * **Secondary Gain:** The external benefits derived from being "sick" (e.g., attention, avoiding work). * **La Belle Indifference:** A classic sign where the patient shows a surprising lack of concern regarding their severe physical disability (e.g., sudden paralysis).

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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