Child and Adolescent Psychiatry — MCQs

A 15-year-old child presents with multiple involuntary movements of the hand and whistling sounds, preceded by a premonitory urge. These symptoms began at age 10 and cause significant distress, impairing school and home activities. The patient showed some improvement with haloperidol. What is the diagnosis?

Q89Easy

Which of the following is NOT a characteristic of autism?

Q90Easy

A 3-year-old girl has problems with writing and spelling. Her other intelligence is normal. What is the likely diagnosis?

Child and Adolescent Psychiatry Indian Medical PG Practice Questions and MCQs

Question 81: What is the treatment for hyperkinetic syndrome?

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

Explanation: **Explanation:** **Hyperkinetic syndrome** is the ICD-10 terminology for **Attention Deficit Hyperactivity Disorder (ADHD)**. It is characterized by a persistent pattern of inattention, hyperactivity, and impulsivity that interferes with functioning or development. **Why Methylphenidate is correct:** Methylphenidate is a **CNS stimulant** and is considered the **first-line pharmacological treatment** for ADHD/Hyperkinetic syndrome. It works by blocking the reuptake of dopamine and norepinephrine in the synaptic cleft (primarily in the prefrontal cortex), thereby increasing their availability. This enhances executive function, focus, and impulse control. **Analysis of Incorrect Options:** * **A. Imipramine:** This is a Tricyclic Antidepressant (TCA). While it can be used as a third-line agent for ADHD if stimulants fail or are contraindicated, it is not the primary treatment. * **C. Haloperidol:** A typical antipsychotic used for Tourette’s syndrome or acute psychosis. It is not indicated for ADHD and may actually worsen cognitive "fogging." * **D. Clozapine:** An atypical antipsychotic reserved for treatment-resistant schizophrenia. It has no role in the management of hyperkinetic syndrome. **High-Yield Clinical Pearls for NEET-PG:** * **First-line Non-Pharmacological treatment:** Behavioral therapy (especially for preschool children). * **First-line Pharmacological treatment:** Stimulants (Methylphenidate, Amphetamines). * **Non-stimulant options:** Atomoxetine (a selective norepinephrine reuptake inhibitor), Clonidine, and Guanfacine. * **Side effects of Methylphenidate:** Insomnia, decreased appetite, weight loss, and potential growth retardation (requires monitoring of height/weight). * **Contraindications:** Glaucoma, symptomatic cardiovascular disease, and MAO inhibitor use.

Question 82: What is the drug of choice for adult Attention Deficit Hyperactivity Disorder (ADHD)?

A. Olanzapine
B. Fluoxetine
C. Methylphenidate (Correct Answer)
D. Bupropion

Explanation: **Explanation:** **Methylphenidate** is the drug of choice (DOC) for ADHD across all age groups, including adults. ADHD is fundamentally linked to a dysregulation of dopamine and norepinephrine in the prefrontal cortex. Methylphenidate acts as a **Central Nervous System (CNS) stimulant** by blocking the reuptake of dopamine and norepinephrine, thereby increasing their synaptic availability and improving executive function, focus, and impulse control. **Analysis of Options:** * **A. Olanzapine:** This is an atypical antipsychotic used for schizophrenia and bipolar disorder. It blocks dopamine receptors ($D_2$), which would theoretically worsen ADHD symptoms. * **B. Fluoxetine:** An SSRI used primarily for depression and anxiety. While ADHD often has comorbidities, SSRIs do not address the core symptoms of inattention or hyperactivity. * **C. Methylphenidate (Correct):** The gold standard stimulant treatment for adult ADHD. * **D. Bupropion:** An atypical antidepressant (NDRI) that is considered a **second-line** treatment for ADHD, particularly useful if there is comorbid depression or nicotine addiction, but it is not the first-line DOC. **High-Yield Clinical Pearls for NEET-PG:** * **First-line (Stimulants):** Methylphenidate (most common) and Amphetamines. * **First-line (Non-Stimulants):** **Atomoxetine** is the preferred non-stimulant, especially if there is a history of substance abuse or tics. * **Adult Presentation:** In adults, "hyperactivity" often manifests as internal restlessness or "mental agitation" rather than the overt running/climbing seen in children. * **Side Effects:** Monitor for insomnia, decreased appetite, and potential increases in heart rate/blood pressure.

Question 83: An IQ of 51-70 suggests what degree of mental retardation?

A. Mild MR (Correct Answer)
B. Moderate MR
C. Severe MR
D. Profound MR

Explanation: **Explanation:** Intellectual Disability (ID), formerly known as Mental Retardation (MR), is classified based on Intelligence Quotient (IQ) scores. According to the ICD-10 and DSM-IV criteria, an **IQ of 51–70** falls into the category of **Mild Mental Retardation**. * **Mild MR (IQ 50–70):** This is the most common type (approx. 85% of cases). These individuals are considered "educable." They can typically achieve academic skills up to a 6th-grade level and can live independently with minimal community support. * **Moderate MR (IQ 35–49):** These individuals are "trainable." They can acquire communication skills and perform semi-skilled work under supervision but rarely progress beyond 2nd-grade academic levels. * **Severe MR (IQ 20–34):** These individuals have very limited communication and poor motor development. They require significant supervision and can only perform simple tasks in protected settings. * **Profound MR (IQ <20):** This group requires 24-hour nursing care and constant supervision. They often have associated neurological conditions. **High-Yield Clinical Pearls for NEET-PG:** 1. **Diagnosis:** Diagnosis requires both an IQ <70 and significant deficits in **adaptive functioning** (e.g., self-care, social skills) manifesting before age 18. 2. **Most Common Cause:** The most common genetic cause of ID is **Down Syndrome**, while the most common inherited cause is **Fragile X Syndrome**. 3. **Binet-Simon Scale:** This was the first intelligence test developed. 4. **IQ Formula:** (Mental Age / Chronological Age) × 100. 5. **DSM-5 Update:** Note that DSM-5 now emphasizes **adaptive functioning** over strict IQ scores to determine the severity of Intellectual Disability.

Question 84: A 10-year-old child has a mental age of 4 years. What is the term used to describe this intellectual disability?

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

Explanation: ### Explanation The question requires calculating the **Intelligence Quotient (IQ)** and applying the historical classification of intellectual disability. **1. Calculation of IQ:** The formula for IQ is: **(Mental Age / Chronological Age) × 100**. * Mental Age (MA) = 4 years * Chronological Age (CA) = 10 years * IQ = (4 / 10) × 100 = **40** **2. Why "Imbecile" is correct:** In the historical classification (Terman’s classification), individuals were categorized based on their IQ scores: * **Idiot:** IQ 0–24 * **Imbecile:** IQ 25–49 * **Moron:** IQ 50–69 Since the child’s IQ is 40, they fall into the **Imbecile** category. In modern ICD-11/DSM-5 terminology, this corresponds to **Moderate Intellectual Disability**. **Analysis of Incorrect Options:** * **A. Idiot:** This term was used for those with an IQ below 25 (Profound Intellectual Disability). This child’s IQ is higher. * **C. Moron:** This term was used for those with an IQ of 50–69 (Mild Intellectual Disability). This child’s IQ is lower. * **D. Normal:** The average IQ range is 90–109. An IQ of 40 is significantly below the normal range. --- ### High-Yield Clinical Pearls for NEET-PG: * **Modern Classification (ICD/DSM):** * **Mild:** IQ 50–69 (Educable; 85% of cases) * **Moderate:** IQ 35–49 (Trainable; includes this case) * **Severe:** IQ 20–34 * **Profound:** IQ < 20 (Requires total supervision) * **Most Common Cause:** The most common genetic cause of intellectual disability is **Down Syndrome**, while the most common inherited cause is **Fragile X Syndrome**. * **Social Age:** Measured using the **Vineland Social Maturity Scale (VSMS)**, which provides the Social Quotient (SQ).

Question 85: An 8-year-old child complains of a lack of interest in studies for the past 6 months. The child also exhibits frequent quarrels with parents and reports frequent headaches. What is the most appropriate clinical approach?

A. Consider it a normal adolescent problem.
B. Rule out depression. (Correct Answer)
C. Rule out migraine.
D. Rule out oppositional defiant disorder.

Explanation: ### Explanation **1. Why "Rule out depression" is the correct answer:** In pediatric populations, the clinical presentation of **Major Depressive Disorder (MDD)** often differs significantly from adults. While adults typically present with a depressed mood, children frequently manifest depression through **irritability** (quarrels with parents) and **somatic complaints** (frequent headaches). Furthermore, a "lack of interest in studies" in a previously functioning child suggests a decline in academic performance and anhedonia, which are core diagnostic features. According to DSM-5, in children and adolescents, **irritable mood** can substitute for depressed mood. **2. Analysis of Incorrect Options:** * **Option A (Normal adolescent problem):** At 8 years old, the child is in middle childhood, not adolescence. Even in adolescence, a persistent 6-month decline in functioning and physical symptoms should not be dismissed as "normal." * **Option C (Rule out migraine):** While the child has headaches, this option ignores the behavioral symptoms (quarrels) and the functional decline (lack of interest in studies), which point toward a systemic psychiatric issue rather than an isolated neurological one. * **Option D (Rule out ODD):** Oppositional Defiant Disorder (ODD) involves a pattern of angry/irritable mood and vindictiveness. However, the presence of somatic symptoms (headaches) and a loss of interest (anhedonia) strongly suggests an underlying mood disorder like depression rather than a primary behavioral disorder. **3. NEET-PG Clinical Pearls:** * **DSM-5 Criteria:** In children, **irritable mood** is a valid substitute for depressed mood for the diagnosis of MDD. * **Somatic Equivalents:** Children often "mask" depression with physical symptoms like abdominal pain or headaches. * **Academic Decline:** Any sudden drop in school performance in a child should trigger a screening for Depression, ADHD, or Learning Disorders. * **Treatment:** Fluoxetine is the first-line SSRI approved for pediatric depression.

Question 86: A 6-year-old child has a history of birth asphyxia, poor communication, slow mental and physical growth, difficulty interacting with others, limited interests, and becomes agitated when disturbed. What is the most likely diagnosis?

A. Hyperkinetic child
B. Autistic disorder (Correct Answer)
C. Attention deficit disorder
D. Schizophrenia

Explanation: ### Explanation The clinical presentation points towards **Autistic Disorder** (now part of Autism Spectrum Disorder - ASD). The diagnosis is based on a triad of core deficits: 1. **Impaired Social Interaction:** "Difficulty interacting with others" and being "agitated when disturbed" (preference for solitude). 2. **Communication Deficits:** "Poor communication" and "slow mental growth." 3. **Restricted/Repetitive Behaviors:** "Limited interests" and resistance to change (agitation when the routine is disturbed). While birth asphyxia is a non-specific risk factor for neurodevelopmental delays, the specific combination of social withdrawal and restricted interests is pathognomonic for Autism. **Why other options are incorrect:** * **Hyperkinetic Child / ADHD (Options A & C):** These are characterized primarily by inattention, hyperactivity, and impulsivity. While children with ADHD may have social friction, they do not typically exhibit the profound lack of social reciprocity or restricted interests seen in Autism. * **Schizophrenia (Option D):** Very rare in a 6-year-old. It presents with hallucinations, delusions, and disorganized thought. While "social withdrawal" occurs, the developmental milestones in early childhood are usually normal until the prodromal phase, unlike the early-onset developmental delays described here. **NEET-PG High-Yield Pearls:** * **Age of Onset:** Symptoms must be present in the early developmental period (usually recognized by age 3). * **M-CHAT:** The Modified Checklist for Autism in Toddlers is a common screening tool. * **Prognosis:** The best predictors of long-term outcome are **IQ** and **language development** by age 5. * **Associated Condition:** Fragile X syndrome is the most common single-gene cause of Autism.

Question 87: A patient has an IQ of 60. Which of the following classifications best describes their intellectual functioning?

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

Explanation: **Explanation:** Intellectual Disability (ID), formerly known as mental retardation, is characterized by deficits in intellectual functions (reasoning, problem-solving, planning) and adaptive functioning. According to the ICD-10 and DSM-IV criteria (which remain high-yield for NEET-PG), the classification is primarily based on the Intelligence Quotient (IQ) score. **1. Why the Correct Answer is Right:** * **Mild Intellectual Disability (IQ 50–69):** An IQ of 60 falls squarely within this range. Patients in this category are often referred to as "educable." They can typically achieve academic skills up to the 6th-grade level, live independently with minimal support, and possess adequate social communication skills. **2. Why the Other Options are Wrong:** * **Moderate Intellectual Disability (IQ 35–49):** These individuals are "trainable." they can acquire communication skills and perform semi-skilled work under supervision but usually reach an academic level of only the 2nd grade. * **Severe Intellectual Disability (IQ 20–34):** These patients have very limited communication and require significant support for daily activities and self-care. * **Profound Intellectual Disability (IQ < 20):** These individuals require 24-hour nursing care and supervision, often having co-occurring neurological or sensory impairments. **Clinical Pearls for NEET-PG:** * **Most Common Type:** Mild ID is the most common, accounting for approximately 85% of all cases. * **Diagnosis:** Diagnosis requires both an IQ < 70 and deficits in adaptive functioning manifesting before age 18. * **Borderline Intelligence:** Refers to an IQ range of 70–79. * **Common Genetic Causes:** Down Syndrome (most common chromosomal cause) and Fragile X Syndrome (most common inherited cause).

Question 88: A 15-year-old child presents with multiple involuntary movements of the hand and whistling sounds, preceded by a premonitory urge. These symptoms began at age 10 and cause significant distress, impairing school and home activities. The patient showed some improvement with haloperidol. What is the diagnosis?

A. Generalized anxiety disorder
B. Obsessive-compulsive disorder
C. Panic disorder
D. Tourette's syndrome (Correct Answer)

Explanation: ### Explanation **Correct Option: D. Tourette’s Syndrome** The clinical presentation is a classic case of **Tourette’s Syndrome (TS)**. The diagnosis is based on the following DSM-5 criteria: 1. **Multiple Motor Tics:** (e.g., involuntary hand movements). 2. **At least one Vocal Tic:** (e.g., whistling sounds). 3. **Duration:** Symptoms must persist for more than **one year**. 4. **Onset:** Before the age of 18 (patient started at age 10). 5. **Premonitory Urge:** A characteristic "sensory" urge or tension that is relieved by performing the tic. The positive response to **Haloperidol** (a D2 receptor antagonist) further supports the diagnosis, as dopamine dysregulation in the basal ganglia is the implicated pathophysiology. **Why other options are incorrect:** * **A. Generalized Anxiety Disorder:** Characterized by excessive, uncontrollable worry about various events for ≥6 months; it does not present with motor or vocal tics. * **B. Obsessive-Compulsive Disorder:** While frequently comorbid with TS (up to 50% of cases), OCD involves intrusive thoughts (obsessions) and ritualistic behaviors (compulsions) to neutralize anxiety, not involuntary motor/vocal tics. * **C. Panic Disorder:** Involves recurrent, unexpected panic attacks and worry about future attacks; it lacks the chronic tic profile described. **NEET-PG High-Yield Pearls:** * **Most Common Comorbidities:** ADHD (most common) followed by OCD. * **Coprolalia:** Involuntary shouting of obscenities (present in only ~10% of cases; not required for diagnosis). * **First-line Treatment:** Behavioral therapy (CBIT - Comprehensive Behavioral Intervention for Tics). * **Pharmacotherapy:** Alpha-2 agonists (Clonidine/Guanfacine) are often first-line for mild cases; typical (Haloperidol, Pimozide) or atypical (Risperidone) antipsychotics are used for severe symptoms.

Question 89: Which of the following is NOT a characteristic of autism?

A. Onset after 6 years of age (Correct Answer)
B. Repetitive behavior
C. Delayed language development
D. Severe deficit in social interaction

Explanation: **Explanation:** Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by persistent deficits in social communication and restricted, repetitive patterns of behavior. **Why Option A is the Correct Answer:** The hallmark of ASD is that symptoms must be present in the **early developmental period**. According to DSM-5 and ICD-11 criteria, the onset of symptoms typically occurs before the age of **3 years**. While some symptoms may not become fully manifest until social demands exceed limited capacities, an onset after 6 years of age is inconsistent with a diagnosis of autism and suggests other psychiatric or neurological conditions. **Analysis of Incorrect Options:** * **B. Repetitive behavior:** This is a core diagnostic criterion. Children often exhibit stereotyped motor movements (e.g., hand flapping), insistence on sameness, and highly restricted, fixated interests. * **C. Delayed language development:** While not all children with ASD have a total speech delay, a significant portion shows delayed or deviant language development, including echolalia and difficulty with the pragmatic (social) use of language. * **D. Severe deficit in social interaction:** This is the "cardinal feature" of autism. It manifests as a lack of social-emotional reciprocity, poor eye contact, and difficulty in developing or maintaining peer relationships. **High-Yield Clinical Pearls for NEET-PG:** * **M-CHAT:** The most commonly used screening tool for toddlers (16–30 months). * **Joint Attention:** The absence of "pointing to share interest" is a major early warning sign. * **Prognosis:** The best predictors of long-term outcome are the **level of intelligence (IQ)** and the **development of communicative language** by age 5. * **Associated Condition:** Fragile X syndrome is the most common single-gene cause of autism.

Question 90: A 3-year-old girl has problems with writing and spelling. Her other intelligence is normal. What is the likely diagnosis?

A. Dyslexia (Correct Answer)
B. Mental retardation
C. Specific writing disorder
D. Dysphonia

Explanation: **Explanation:** The correct answer is **Dyslexia (Option A)**. **1. Why Dyslexia is correct:** Dyslexia is a **Specific Learning Disorder (SLD)** characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. While often associated with reading, it fundamentally involves a deficit in the phonological component of language. In clinical practice and competitive exams, problems with **spelling and writing** (orthographic expression) are frequently grouped under the umbrella of Dyslexia, especially when the child's overall intelligence (IQ) is normal. **2. Why other options are incorrect:** * **Mental Retardation (Intellectual Disability):** This is characterized by deficits in both intellectual functioning (IQ < 70) and adaptive functioning. The question explicitly states the child's "other intelligence is normal," ruling this out. * **Specific Writing Disorder (Dysgraphia):** While this specifically refers to impaired handwriting and spelling, "Dyslexia" is the broader, more commonly used term in standardized medical exams for the constellation of reading and spelling difficulties. In many classifications, spelling deficits are considered a hallmark of Dyslexia. * **Dysphonia:** This is a physical disorder of the voice (hoarseness or difficulty speaking) due to laryngeal issues, unrelated to learning or cognitive processing. **Clinical Pearls for NEET-PG:** * **IQ-Achievement Discrepancy:** The hallmark of any SLD is a significant gap between the child’s academic performance and their actual intellectual potential (Normal IQ). * **Comorbidity:** ADHD is the most common comorbid condition found in children with Dyslexia. * **Age Factor:** While the question mentions age 3, clinical diagnosis of SLD usually occurs after formal schooling begins (age 6-7); however, early signs include delayed speech and difficulty with nursery rhymes. * **Management:** Remedial education and multisensory teaching (e.g., VAKT - Visual, Auditory, Kinesthetic, Tactile) are the gold standards.

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

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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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