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MNJ15-001
An 11-year-old girl Ritu weighing 75 kg is brought with frequent spells of episodic overeating and then becomes bedridden with a feeling of nausea. She does not like to discuss the issue with anyone, is known to be tearful, and tries to avoid school. She denies any regular dieting and vomiting. She feels that she is ugly and nobody likes her:

  1. What is the likely diagnosis of this girl?
  2. Which is the commonest psychiatric co-morbidity in this case?
  3. Name 2 other common psychological disorders in these children in adolescence.
  4. Name 1 expected oral cavity finding if hidden vomiting were occurring.

Answer

  1. Diagnosis: Binge Eating Disorder (or Bulimia Nervosa if purging occurs).
  2. Commonest co-morbidity: Major Depressive Disorder (MDD).
  3. Other disorders: Anxiety disorders, substance/alcohol abuse, low self-esteem / body dysmorphic disorder.
  4. Oral cavity finding: Perimylolysis (erosion of dental enamel on lingual tooth surfaces due to gastric acid exposure), parotid gland hypertrophy, palatal scratches.

MNJ15-002
A 15-year-old boy Sanju has recently been noted to be irritable by his teachers and friends, has difficulty concentrating in his studies, does not eat well, and no longer enjoys rock music (his passion). His father died of carcinoma lung 6 weeks ago:

  1. What is the likely problem of Sanju?
  2. If his symptoms persist beyond 6 months with functional impairment, what is the diagnosis?
  3. Name 2 co-morbidities you might find.
  4. Which is the drug class of choice for his condition?

Answer

  1. Initial problem: Normal bereavement / Acute grief reaction.
  2. Persistent diagnosis: Persistent Complex Bereavement Disorder / Major Depressive Disorder (MDD).
  3. Co-morbidities: Generalized anxiety disorder, substance abuse disorder, dysthymia, disruptive behavior / conduct disorder.
  4. Drug class of choice: Selective Serotonin Reuptake Inhibitors (SSRIs, e.g., Fluoxetine, Escitalopram) along with cognitive-behavioral psychotherapy (CBT).

MNJ15-003
Concerning ADHD (Attention Deficit Hyperactivity Disorder), state True or False:

  1. Impulsive behaviour is a core feature.
  2. Is associated with a higher rate of expulsion from school.
  3. Is associated with a higher rate of teenage pregnancy.
  4. Is associated with a higher rate of tic disorders.
  5. May respond to treatment with stimulants such as methylphenidate/amphetamines.

Answer

  1. True
  2. True
  3. True
  4. True
  5. True

MNJ15-004
MNJ-P-OSCE 15. Child psychology_page_1_Picture_2.jpeg

A 5-year-old Adarsh was diagnosed to have ALL-L1. He has just completed the induction phase of treatment. He complains of burning pain over his toes for the last one week, and even the movement of the bedsheet over the toes leads to excruciating pain:

  1. What is the most probable diagnosis?
  2. What is the most likely chemotherapeutic agent causing this?
  3. What type of pain is he suffering from?
  4. What is the clinical phenomenon of pain induced by light non-noxious touch described here?
  5. Name two classes of drugs likely to be effective for pain relief in this child.
  6. Name the clinical tool shown to assess the severity of pain in children.
  7. Name two drugs each included in Step 1, Step 2, and Step 3 of the WHO analgesic ladder.

Answer

  1. Diagnosis: Chemotherapy-induced peripheral neuropathy (CIPN).
  2. Causative agent: Vincristine.
  3. Type of pain: Neuropathic pain.
  4. Phenomenon: Allodynia (pain due to a stimulus that does not normally provoke pain).
  5. Drug classes:
    • Anticonvulsants (Gabapentin, Pregabalin)
    • Antidepressants (TCAs like Amitriptyline, or SNRIs like Duloxetine)
  6. Pain assessment tool: Wong-Baker FACES Pain Rating Scale.
  7. WHO Analgesic Ladder:
    • Step 1 (Mild pain): Paracetamol (Acetaminophen), Ibuprofen / NSAIDs.
    • Step 2 (Moderate pain): Codeine, Tramadol (or low-dose oral morphine).
    • Step 3 (Severe pain): Morphine, Fentanyl, Hydromorphone.

MNJ15-005
Mention commonly used drugs for each of the following conditions in pediatrics:

  1. Schizophrenia
  2. Attention deficit hyperactivity disorder (ADHD)
  3. Autism (irritability/aggression)
  4. Depression
  5. Enuresis

Answer

  1. Schizophrenia: Atypical antipsychotics (Risperidone, Olanzapine, Aripiprazole) or typical antipsychotics (Chlorpromazine, Haloperidol).
  2. ADHD: Stimulants (Methylphenidate, Dexamphetamine) or non-stimulants (Atomoxetine, Clonidine, Guanfacine).
  3. Autism spectrum disorder (irritability/agitation): FDA-approved atypical antipsychotics (Risperidone, Aripiprazole).
  4. Depression: SSRIs (Fluoxetine, Escitalopram, Sertraline).
  5. Enuresis: Desmopressin (DDAVP oral tablets/melts), Imipramine (tricyclic antidepressant), Oxybutynin (anticholinergic).

MNJ15-006
Parents of a 2-year-old male child Pramod present with complaints that the child does not make eye-to-eye contact, does not respond to his name, speaks very few words, and repeats similar vocalizations/words for the last 6 months:

  1. Diagnose the condition and list its differential diagnoses in this age group.
  2. What are the gold standard diagnostic tools and early screening tools?
  3. What is the most consistent physical/neuroanatomical finding reported in this problem?
  4. What medications are useful in managing associated symptoms in this condition?

Answer

  1. Diagnosis: Autism Spectrum Disorder (ASD).
    • Differential Diagnoses: Hearing impairment, global developmental delay / intellectual disability, receptive language disorder, Rett syndrome, selective mutism, Childhood Disintegrative Disorder.
  2. Diagnostic & Screening Tools:
    • Screening Tools: M-CHAT-R/F (Modified Checklist for Autism in Toddlers, Revised with Follow-Up), PDDST.
    • Gold Standard Diagnostic Tools: ADOS-2 (Autism Diagnostic Observation Schedule) and ADI-R (Autism Diagnostic Interview-Revised).
  3. Physical / Neuroanatomical finding: Macrocephaly / accelerated head growth in early childhood (seen in ~20% of cases), with volume increase in frontal, temporal, and cerebellar cortices.
  4. Medications: Atypical antipsychotics (Risperidone and Aripiprazole - FDA approved for irritability and aggression), SSRIs for repetitive behaviors/anxiety, and Melatonin for sleep disturbances.

MNJ15-007
A 7-year-old child Rajender presents with complaints of involuntary eye blinking, shoulder shrugging, and echolalia for the last 2 years. Physical examination is normal:

  1. What is the diagnosis of this condition?
  2. What does PANDAS stand for and what are its diagnostic criteria/components?
  3. What is the treatment for this condition?

Answer

  1. Diagnosis: Tourette Syndrome / Chronic Motor and Vocal Tic Disorder.
  2. PANDAS:
    • Acronym: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections.
    • Diagnostic Components:
      • Presence of OCD and/or multiple tic disorders.
      • Prepubertal age of onset (typically 3 years to puberty).
      • Episodic course of sudden, acute onset and dramatic symptom exacerbation ("sawtooth" pattern).
      • Temporal association with Group A Streptococcal (GAS) infection (elevated ASO / anti-DNase B titers or positive throat culture).
      • Associated neurological abnormalities (e.g., choreiform movements, hyperactivity).
  3. Treatment:
    • Comprehensive Behavioral Intervention for Tics (CBIT) / Habit Reversal Therapy.
    • Pharmacotherapy: Alpha-2 agonists (Clonidine, Guanfacine), atypical antipsychotics (Risperidone, Aripiprazole), SSRIs for OCD.
    • For confirmed PANDAS exacerbations: Antibiotics (penicillin/amoxicillin), and immunomodulatory therapy (IVIG / plasma exchange) in severe refractory cases.

MNJ15-008
Parents of a 6-year-old male child Karzan present with complaints that the child does not sit in his seat for more than a few minutes, has poor peer relationships, frequently fails to follow instructions, and breaks rules in games for the last 10 months. On examination, soft neurological signs are present, but the examination is otherwise normal:

  1. Diagnose this condition and write its 3 core clinical components.
  2. Write down 4 differential diagnoses.
  3. What behavioral rating scales are used for diagnosis?
  4. What drugs are used to treat this condition and what crucial history must you take before starting stimulant therapy?
  5. What prognosis will you explain to the parents?

Answer

  1. Diagnosis & Core Components:
    • Diagnosis: Attention-Deficit/Hyperactivity Disorder (ADHD - Combined type).
    • Core Components: Inattention, Hyperactivity, and Impulsivity (present across ≥2 settings for ≥6 months).
  2. Differential diagnoses: Hearing/vision impairment, learning disability / intellectual disability, absence seizures, pediatric bipolar/mood disorder, anxiety disorder, sleep apnea/OSA.
  3. Behavioral rating scales: Vanderbilt ADHD Diagnostic Rating Scale, Conners' Rating Scales, SNAP-IV.
  4. Pharmacotherapy & Pre-treatment history:
    • Drugs: Stimulants (Methylphenidate, Dextroamphetamine) and non-stimulants (Atomoxetine, Clonidine, Guanfacine).
    • Essential history: Detailed personal and family history of cardiac disease, arrhythmias, unexplained syncope, or sudden cardiac death (due to sympathomimetic risks).
  5. Prognosis:
    • Symptoms persist into adolescence in 60–80% of children and into adulthood in 40–50%.
    • Early multimodal intervention reduces long-term risks of academic failure, conduct disorder, substance abuse, and interpersonal difficulties.

MNJ15-009
A 6-year-old boy Dinesh is brought for bed-wetting. His daytime frequency is normal, and he is completely dry during the day. He has never been dry at night:

  1. Define this problem. What type of enuresis is this?
  2. Is it complicated (non-monosymptomatic) or uncomplicated (monosymptomatic)? Enumerate 4 differences between complicated and uncomplicated enuresis.
  3. Name 3 drugs with dosages for pharmacological therapy, and name 3 non-pharmacological measures for management.

Answer

  1. Definition & Type: Nocturnal enuresis (involuntary urination during sleep at ≥5 years of age). This is Primary Monosymptomatic Nocturnal Enuresis (dry during the day, never attained nighttime continence for >6 months).
  2. Classification & Comparison: Uncomplicated (Monosymptomatic).
Feature Uncomplicated (Monosymptomatic) Complicated (Non-monosymptomatic)
Daytime symptoms Absent (dry by day) Present (urgency, frequency, daytime wetting)
Urinary stream Normal, continuous Abnormal (straining, weak stream, dribbling)
Physical Exam Completely normal May show spinal dysraphism, neurological signs
Urinalysis / KUB Normal May show UTI, proteinuria, glycosuria, structural defects
  1. Management:
    • Pharmacological:
      • Desmopressin (DDAVP): Oral tablets 0.2−0.4 mg (or oral lyophilisate melt 120−240 μg) PO at bedtime with fluid restriction.
      • Imipramine: 0.9−1.5 mg/kg/day (10−50 mg) PO at bedtime (monitor ECG for QTc prolongation).
      • Oxybutynin: 5−10 mg/day PO (if reduced bladder capacity/overactive bladder).
    • Non-pharmacological:
      • Enuresis moisture alarm device (most effective long-term curative conditioning therapy).
      • Behavioral modification (evening fluid restriction, avoiding caffeine, voiding before bed, reward charts/star chart system).
      • Bladder training exercises.

MNJ15-010
A 15-month-old boy Tarun is brought with loss of language skills, abnormal eye contact, failure to respond to his name, and lack of interactive play:

  1. Name chromosomes/genetic regions implicated in this disorder and its typical mode of inheritance.
  2. Name 3 genetic/neurological conditions linked to this problem.
  3. What are the typical neuro-anatomical findings reported in this condition?
  4. Name 2 screening tools used for early detection of this disorder.
  5. Name 3 drugs useful in managing associated behavioral symptoms.

Answer

  1. Genetics: Polygenic/complex multifactorial; candidate loci on chromosomes 2q, 7q, 15q11-q13, 16p11.2, and X-linked genes (NLGN4X, MECP2).
  2. Associated conditions: Tuberous Sclerosis Complex, Fragile X Syndrome, Angelman Syndrome, Rett Syndrome, PTEN hamartoma syndrome.
  3. Neuro-anatomical findings: Accelerated brain growth leading to early macrocephaly, increased total cerebral cortical volume with atypical synaptic pruning in the frontal, temporal, and cerebellar lobes, and reduced Purkinje cell density.
  4. Early screening tools:
    • M-CHAT-R/F (Modified Checklist for Autism in Toddlers, Revised)
    • PDDST-II (Pervasive Developmental Disorders Screening Test-II)
  5. Medications: Risperidone, Aripiprazole, Fluoxetine/Sertraline, Clonidine, Melatonin.

MNJ15-011
Regarding Rett syndrome, state True or False:

  1. X-linked recessive disorder.
  2. Affects predominantly girls.
  3. Microcephaly is noted at birth.
  4. EEG is normal in most affected children.
  5. Stereotypic midline hand-wringing movements are typical.

Answer

  1. False (It is an X-linked dominant disorder, usually lethal in hemizygous males; caused by MECP2 gene mutations).
  2. True (Affects almost exclusively females).
  3. False (Head circumference is typically normal at birth; deceleration of head growth / acquired secondary microcephaly develops between 6–18 months).
  4. False (EEG is abnormal in >80% of cases, showing slowing of background activity, focal/generalized epileptiform discharges, and loss of normal sleep architecture).
  5. True (Loss of purposeful hand skills and development of stereotypical midline hand-wringing, washing, clapping, or mouthing movements are classic hallmarks).

MNJ15-012
Regarding Social Anxiety Disorder (Social Phobia) in children and adolescents, state True or False:

  1. The child avoids social or performance situations with intense fear and anxiety.
  2. Fear, anxiety, and avoidance typically last for at least six months.
  3. 70 to 80% of patients have at least one comorbid psychiatric disorder.
  4. Around 40% of untreated patients experience significant educational impairment and fail to graduate or attain employment benchmarks.

Answer

  1. True
  2. True
  3. True
  4. True

MNJ15-013
A couple comes to you with a 2-year-old child whom they legally adopted two days ago, seeking guidance on baseline health screening and developmental expectations:

  1. What baseline investigations will you advise for this child (any 6)?
  2. What will you advise the parents regarding the language development of an adopted child?
  3. What will you advise parents about screening for infectious diseases (any 6)?

Answer

  1. Baseline investigations:
    • Complete Blood Count (CBC) with peripheral smear (anemia screening)
    • Serum ferritin, iron profile, and blood lead level (BLL)
    • Renal function tests (KFT) and liver function tests (LFT)
    • Stool routine, microscopy, and culture for ova/cysts/parasites (including Giardia and H. pylori)
    • Hemoglobin electrophoresis (hemoglobinopathies / sickle cell screen)
    • G6PD assay
    • Comprehensive formal developmental and nutritional assessment
  2. Language development advice:
    • Language delay or initial expressive language plateau is common during the first 6–12 months after adoption, especially with language transition.
    • Reassure parents that with a language-rich, supportive home environment, most children achieve rapid catch-up growth and speech acquisition.
  3. Infectious disease screening:
    • Hepatitis B serology (HBsAg, anti-HBs, anti-HBc)
    • Hepatitis C antibody (anti-HCV)
    • HIV-1 and HIV-2 serology (ELISA / 4th generation Ag/Ab)
    • Tuberculosis screening (Mantoux tuberculin skin test or IGRA, plus chest radiograph if indicated)
    • Syphilis serology (VDRL / RPR / TP-PA)
    • TORCH serology (if congenital infection suspected) and intestinal parasites screening