1. CBLE General Child & Adolasecnt

General Child and Adolescent Psychiatry

 1. A 18-year old boy diagnosed as schizophrenia 3 months back in psychiatry OPD. His symptoms were significantly reduced with 6 mg/day risperidone. During follow-up, his father reported gradual reappearance of symptoms for the last 2 weeks.
a) Mention the areas with reasons you need to assess for further treatment planning of this case. 6
b) What will be your intervention plan? 4

2. A 14-year old girl presented with repetitive convulsion and fit after a period of prolong screaming, incoherence and outgoing tendency since last 2 months. The symptoms started in school followed by any time. She is first girl in the class .initially, she is irregular in school attendance due to her problem and recently she is not going school. A series of consultation was done; EEG was suggestive of seizure disorder and normal in 2 occasions for each. AED was given. No improvement of her symptoms was observed, rather increasing particularly, in face of demand fulfilment. Parents are anxious and puzzled with the situation.
a)What could be most possible diagnosis? 4
b) Outline the management plan. 6

3. A 12-years old boy referred to psychiatry OPD from medicine OPD with the complaints of persistent episodic cough and dyspnoea. A series of consultations has been done from GP to specialists .He has been treated with O2 inhalation and number of oral and inhalers bronchodilator and steroids but there is no response. The boy is not going school but perform study at home. The episode particularly started when he has been asked to go school.
a) What are the areas you need to assess? 6
b) Make a treatment plan for this boy.  4

4. A 18-year old college student has been referred to psychiatry OPD by a GP. He appears to be perplexed, frightened and expresses idea of persecution. He has no previous psychiatric history.
a) What could be best possible differential diagnosis? 5
b) Prepare a list of laboratory investigations that you would consider in the first step. 5

5. A 11-year old boy is referred to psychiatry OPD for his multiple aches and pains, some weeks after a short febrile illness. Investigations have not revealed any continuing organic pathology. You know that the boy has been transferred to a new school shortly before his illness and because of his continuing symptoms has not yet returned to school.
a) What could be the psychopathology of this case? 6
b) How will you manage this case? 4

6. A 14-year old girl appeared in psychiatry OPD of the University Hospital with intense headache followed by repetitive fit 3 days back when she witnessed that her mother slapped by father during raw.
a) Make a checklist of content of assessment of this case?  6
b) Outline the treatment plan. 4

7. A 15-year old boy who, one month back, witnessed the sudden death of his father at home. Since then he develops marked fear, irritability, bad dream and poor sleep.
a) Prepare a checklist of information that you need to gather during assessment. 7
b) Outline the contents of communication with family.  3

8. A 8-year old boy appears with his mother who has persistently angry, resentful, and argumentative since last three years. He does not want to go school and reluctant in study. Very recently he steals money from home and beats his friends. Mother tries to fulfil his demands and father frequently beats him to control his troublesome behaviour. However, nothing seems to be worked and the boy is now out of control.
a) What will be most likely diagnosis? 5
b) Make a checklist of the areas that you need to be assed. 5

9. A 6-year old boy starts refusing to go school after summer vacation and only agree to go if his mother sits beside him in classroom. On forceful effort the child resists entering school, cries and at time vomits. This happens in every subsequent failure effort.
a) What else are required to diagnose the case? 4
b) Outline the management plan. 6

10. 15-year old boy is presented to you by his parents. They complain that the boy does not go school that they explore recently. He is ridiculously disobedient and shows no interest in study. The boy is increasingly demanding and very resentful if that are not full field. Recently, he is involved with groups and stay out of home at the evening despite of telling him not to do so.
a) What is the best possible diagnosis? 3
b) Outline the components of treatment plan.  7

11. A 15-year old girl has been brought by his parents to OPD. She has repeated wrist cutting and tempered behaviour.
a) Write down the basic steps to interview this girl. 5
b) Prepare a checklist of the assessment areas. 5

12. A 12-year old boy has been brought to OPD by his caregiver for challenging behaviours who is not willing to consult.
a) What are the points you have to consider to establish working relationship with this boy?  5
b) Outline your assessment plan. 5

13. A 15-year old boy diagnosed as Bipolar disorder, current episode manic and receiving lithium carbonate with blood level of 0.9mmol/litter and quetiapine 500 mg in divided dose. Overall, his symptoms are remitted. His parents complain that he still has buying spree, tendency of taking fast food, increasingly demanding nature and excitement. They have to fulfil his demand to make him quiet and saying that the problem still is not controlled.
a) What are the main areas you need to assess?  4
b) What could be the psychopathology of this presenting complaint? 3
c) Outline the plan of further management.

14. A 19-year old student presents with lack of interest in studies since last 6 months. He does frequent quarrels with his parents and headache.
a) What could be best possible diagnosis? 6
b) What other things you need to rule out? 4

15. A 7-year old boy is brought with complains of having abdominal pain, unwilling to go to school-every day, and insisting on spending time with parents back home. Detailed examination revels no other positive finding.
a) What are the areas you need to assess?   5
b) Make list of information that you need to explain child’s condition to his parents. 5

16. A 17-year old boy presents with irritable and depressed mood since last 3 months. Subsequently, he has been developed mild hand tremor and spastic gait that are gradually increasing. History reveals that parents have consanguinity. On examination, cog wheel rigidity was found.
a) What are the areas you need to explore to reach a diagnosis?     6
b) What could be the first line investigations you need to do?   4

17. A 13-year old boy recently tries to jump from the school rooftop several times. He also shows similar behaviour at home in many occasions. Due to trouble to manage him, he has been suspended from school. His parents say when they refrains him from doing such behaviour he do not do that. Parents also tell that he lies occasionally, does not want to perform study, and become increasingly demanding.
a) What are the areas you need to assess to reach a diagnosis?   6
b) What is the diagnosis? 4

18. A 14-year old girl who has schizophrenia science last three years. After trial of three antipsychotics with poor response she is under clozapine therapy science one month. Though she has suspiciousness and thought broadcasting, overall her symptoms are remitted in term of frequency and intensity. She does not go school science her illness, increasingly demanding, tempered, and aggressive. She behaves childishly, does not do her usual activities, keeps herself confined in own room spend most of the time with mobile and internet mostly by hearing songs and playing virtual games. Her daily life including sleep schedule are completely disrupted. Parents become sick and tired with her management and upset about her future.
a) Specify the area of further assessment. 4
b) What could be revised treatment plan?  6

19. A 12 year-old boy refuses to go to his new school one month after admission. The change of school is due to family relocation from a district town to Dhaka city. The boy has good scholastic performance although. He is sociable, obedient to parents. Recently, he appears to be low mood and find little interest in his usual activities.
a) Mention the differential diagnoses with highlighting reasons.  6
b) How will you manage this case? 4

20. A 16-year old girl attends in psychiatry OPD with her parents. She believes that her face is gradually deformed since last three years. She does not go school and avoid social situation as she thinks that she looks ugly and others talk about the matter. Gradually, she keeps herself confined in her room, avoids looking on mirrors. She shows two photos of her from her mobile that has been captured in different time intervals in favour of her statement but no significant difference and deformity was observed. She looks anxious and marked distressful.
a) How will you proceed to reach diagnosis?  6
b) What will be your management plan for this case? 4

21. A 14-year old girl comes with her mother who recently starts wetting bed at night. Gradually, it happens most the nights in a week and increased into day time wetting. Her parents are recently reconciliated after a long period of separation. Mother is anxious about her daughter’s problem. Routine urine analysis reveals that pus cell was 10-15/rph.
a) What will be the most possible diagnosis?  4
b) How will you manage this case?  6

22. A 11-year old boy presents with marked defiance, reluctant in study and unwilling to go school. On conversation, he appears to be clever. Considering his poor academic performance, parents did intelligence test for him and the score was indicative of mild to moderate intellectual impairment.
a) Mention your assessment process to reach diagnosis. 5
b) Outline your treatment plan.   5

23. A boy of 15 years presents in outpatient department with the conviction that he belongs to opposite sex and wish to be a girl. His parents informed that their son behaves like girl and use to wear girl’s dress in his room.
a) List the areas of information you need to be gathered.     6
b) What investigations you want to do at this point? 4

24. A 14-year old boy presents with marked irritability and resentful. His parents say the boy is defiant, does not go school and do study. He keeps himself most of the time in his room and increasingly assultative and destructive with minor matter. Sometime he looks tearful and it seems to them that he does not sleep well.
a) Mention the areas you need to explore to reach the diagnosis.  6
b) Outline the treatment plan.  4

25. A 10-year old boy refuses to go to school due to breathing difficulties and chest pain. His parents consult with several physicians including cardiologist but the problems remain. The child is clingy to his mother, increasingly fearful and feels better staying at home.
a) What information you will gather keeping in mind differential diagnoses? 4
b) What could be the psychopathology of her condition? 3
c) Outline the treatment plan.  3

26. A 14-year old boy is brought by his parents to CAMH OPD. The parents say that the boy is very aggressive to them and fights with others. He often lies, steals and stays out of home at night without their permission. He does not do study and spends time with bad boys. They are struggling with the boy since his early childhood and the boy is now totally out of their control. Recently, he has been suspended from the school for the charge of theft. The boy was fidgeting and inattentive.
a) Make a checklist of information you need to assess this case.   6
b) Summarise your treatment plan.  4

27. A 13 year old girl is brought to psychiatry OPD. The girl vomits immediately after taking food that has been developed two weeks after the recovery from her chikungunya fever. However, she can drinks liquids without the consequences of vomiting. A series of massive investigations and consultations revel no abnormality and she is not responding to antiemetic or any form treatments related to peptic ulcer disease. She is not going to school and parents are worried about her condition.
a) What information you need to gather to reach a diagnosis?   6
b) Outline the treatment plan.  7

28. A 11-year old girl is defiant and aggressive towards her father who recently comes back home after 5 years of continuous staying abroad for job. The girl gradually becomes aggressive to her mother and her sleep is not well. Father disappointedly says her daughter does not talk to him and not call him “Dad.” The girl appears annoyed and irritable.
a) Make a checklist of information that you need to assess this case. 6
b) What could be possible psychopathology of this case?  4

29. A 12-year old boy attends in OPD who suddenly starts fasting almost every day as part of religious activities and becomes violent in response to refraining efforts of his parents. On asking he says that he gets signals from the God to do so through movement of a bird in one day that is something special.   He does not sleep, go school rather moves around. He refuses to take medicine from GP as he fasts. The boy looked restless and was meaninglessly talking with self loudly.
a) Mention the possible diagnoses with reason. 5
b) Outline your assessment plan.  5

30. A 10-year old boy attends with his mother for his recent dysphoric mood and sleep disturbances that starts after witnessing devastating violence between parents 3 weeks ago. The boy says that he hears voices of quarrelling parents from ceiling fan only when the fan moves. His father is schizophrenic predominantly with paranoid and jealous features and hearing of conversations like voices since 4 years who adheres little with the treatment.
a) List the assessment areas keeping in mind the differential diagnoses.  4
b) What could be best possible diagnosis?  3
c) Make an outline of treatment plan for this case. 3

31. A 13-year old girl presents in psychiatry OPD who suddenly forgets her name after witnessing horrific domestic violence. Subsequently, she becomes violent, and says that she frequently sees a dreadful tall man with white dress who wants to take her away. At that time she becomes intensely fearful that ends to fit. Her condition is further deteriorated after maltreatment by a traditional healer.
a) What information you need to gather to reach a diagnosis? 5
b) Outline the treatment plan for this girl.  5

32. A 10-year old boy is irritable since last three months. Gradually, he becomes defiant, impulsive, does not go school, do study and beats mother if he is asked to do so. He also has headache and sleep disturbances. Presently he stays most of the time at home in his bed and does almost nothing.
a) What is your diagnosis keeping differential diagnoses in your mind?    5
b) Prepare a checklist of information necessary for confirming diagnosis and planning treatment. 5

33. A 9-year old boy presents with vomiting and headache since two months and no organic aetiology was found to explain these symptoms. His mother says that the boy recently discloses that persistent thoughts and images of love with two of his girl classmates come into his minds that make him very distressful. The boy has tendency to do worries in any minor matter since 10 months.
a) What could be best possible diagnosis?   5
b) Make a treatment plan for this case.  5

34. A 14-year old boy attends child and adolescent mental health OPD due to severe discomfort feelings of senselessness and anxiety who thinks that his cheeks gradually compresses inward that worries him but others cannot find such deformity. Repeated consultations do not reveal any organic aetiology. He starts unshaven his beard to cover it up. The boy says that he feels uncomfortable in social situation due to his possible ugly appearance and gradually stops going school. On questioning, the boy says that his age could be more than said as because of his thick pattern of hairs of his beard. The boy is a good student and performs his study at home.
a) What could be most likely diagnosis?  5
b) Make a checklist of information that will require confirming the diagnosis and making treatment plan.   5

35. A 16-year old girl referred to psychiatry OPD by GP who has persistent headache since last 8 months for which no organic cause found. The girl’s mother says that she cannot perform her academic activities due to headache rather increases during study and school. Initially, The girl is responded well with 50 mg imipramine/day that has been further increased gradually up to 125 mg for waxing of the symptoms The  girl is increasingly demanding, not going school, loses her confidence and does self-injurious behaviour. Her mother expresses her persistent worries and concerns for her daughter’s problems that centralized with reason of headache.
a) What will be your steps of assessment? 6
b) Make a treatment plan for this case.   4

36. A 9-year old boy becomes fearful and senseless after exposure to thunder 5 days back. Worried parents consult with a neurologist who refers the boy to psychiatry OPD. Parents say that similar event first happens 9 month back in face of thunder. Gradually the child fears of storm, cloud, loud sound, and noises and avoids such situations. Parents close doors and windows particularly during storm and thunder and give ear-plug to block the noise with the aim of reducing his fear. However, these efforts do not work and child is increasingly fearful and unwilling to go school though he is studious boy.
a) Explain the psychopathology of this case.  6
b) Outline the treatment plan. 4

37. A 10-year old boy appears in CAMH OPD who has palpitation, dyspnoea, chest compression, sweating and sleep disturbance. Mother says that he worries for his mother and does not want to go to school for the last one month. Since one year, the boy repetitively things about his past acts and upsets to find his possible faults. He worries about future events, cannot concentrate in his work and performs badly during exam.
a) What is the best possible diagnosis? 5
b) Make a treatment plan for this case. 5

38. A 14-year old boy presents in psychiatry OPD with intensive fearfulness after violent beating by peer group in school hostel one day back. After taking back to home, he is nearly mute except saying that he does not want to go back to school. Mother says he stops doing his usual activities and does not sleep last night. He is nearly nonresponsive, apathetic and becomes distressful when he is asked about event.
a) What is the best possible diagnosis? 5
b) Outline the assessment and treatment. 5

39. A 15-year old girl attends in psychiatry OPD with her parents. She believes that her face is gradually going deformed since last three years. She does not go school and avoid social situation as she thinks that she looks ugly and others talk about the matter. Gradually, she keeps herself confined in her room, avoids looking on mirrors. She shows two photos of her from her mobile captured in different time intervals in favour of her statement but no significant difference and deformity are observed. She looks anxious and marked distressful.
a) Outline the assessment process to reach diagnosis.   5
b) What will be your treatment plan?   5

40. A 16-year old girl appears with her mother who is not going college since her admission in 11 grades. The girl has persistent fear of exam. For the last 10 years and always shows avoidance behaviour, appears only by pressure and has unexpected low academic performance all through. She has poor peer relationship and bullied in several occasions. Gradually she becomes depressed and recently did overdosing.
a) What could be possible diagnosis?  4
b) Make a checklist of your assessment plan.  6

41. Tanzila, a 15-year old girl attends with her father and aunt who recently refuses her identity and utters by mentioning her name, “I am not Tanzila, I am another girl.” Her aunt says that for the last three months she is marked irritable, does not sleep well, take care of her very little and markedly retarded. She does not want to go school and do study saying that nothing will be obtained from doing so. She is a student of a reputed school, lives with aunt’s house after the death of her mother one year back. The girl looks tearful and is unwilling to talk.
a) What is the most likely diagnosis? 5
b) How would you manage this case? 5

42. A 13-year old boy attends with his parents in psychiatry OPD. His parents reports that since last 7 months the boy is irritable, tempered, keeps himself isolated at home, gives up mixing with peers. He does not want to perform any academic activity and becomes aggressive, destructive and self-injurious when parents ask to do so. He performs very poor in the last exam that is totally mismatched with his previous record. The boy is non-cooperative and looks angry.
a) What is your differential diagnosis keeping in mind the best possible diagnosis? 6
b) Outline the assessment plan.      4

43. A 17-year old girl comes with her parent who is not willing to continue her study and want to change her subject as per instruction of heard voice. Parents report that she does not sleep well and spends time with internet in her room closing door, shows marked anger if she is interrupted. Parents report that she is very imaginative, creative since early life, selectively social and has excellent academic record. The girl smiles and talks with her and on questioning she replied that she does so as she visualizes many people around her who talks with her. When the consultant asks her whether these people control her, she promptly replied, “Oh, you’re thinking I am schizophrenic. I also have mood swing.
a) What is the best possible diagnosis? 5
b) How will you manage this case?         5

44. A 13-year old boy attends CAMH OPD with his parents. Parents say that the boy leaves home without informing parents for one day in first occasion and 65 days in second occasion. Parents also informed that though he has good intelligence but is reluctant in doing study. He has no friend and becomes isolated. The boy says the parents give excessive pressure for study that he cannot carry out.
a) What are the differential diagnoses?   4
b) What information you need to gather for the diagnosis?   6

45. An 11-year old attends into CAMH OPD with her mother with the complaints of stammering, palpitation and occasional chest pain since 2 years that develops after dengue fever. Her mother says that since then she is inattentive, reluctant in study and going school despite of mother’s pressure and censure. She has no friend in school. She did not appear in the final examinations in this year in grade IV due to increasing of her present problems and her class promotion is uncertain. The girl said that she finds heard to go through her class work.
a) Write down your assessment plan considering differential diagnoses.   6
b) What treatment plan you will adopt for this girl? 4

46. A 13-year old boy is attends in CAMH OPD with his father who has developed hypersexual behaviour since last six months. The behaviours include touching females in any way, foundling female cloths and masturbating that are repeatedly observed by his puzzling parents. Subsequently, he is reluctant in going school and doing study. The boy says that he enjoys the acts though he tries not to do such.
a) What are your diagnoses? 5
b) Prepare a checklist of your assessment to confirm diagnosis. 5

47. A 15-year old boy who has repetitive thought of having infectious disease and is convinced he acquires it through mouth. He spites in an effort to clean his mouth almost within every minute and washes his hands several times. Subsequently, he develops fear of illness, and death and repetitively begs pardon of Allah. He becomes sad and finds no interest in work and stops going school. His sleep is remarkably interrupted and weight reduces significantly. On questioning, he says that he finds no way to come out. His appearance was dishevelled and dirty and he was muttering constantly.
a) What are the most possible diagnoses? 4
b) Outline the treatment plan.  6

48. A 15-year old girl has intrusive thought that God is her husband. That causes her severe distress and she frequently begs pardon to God. Subsequently she started irresistible hair pulling that causes her relieved tension.
a) Prepare a checklist of the assessment areas.   5
b) Outline the management plan.      5

49. A 14-year old girl is heavily engaged with adult internet chatting and left home with one of her boyfriend with handsome steeled money. Her mother died two year back and care givers try to provide her maximum comfort in all the ways. She gradually becomes impulsive, irritable and does as she likes. Her school performance has been downgraded significantly.
a) How will you assess this case keeping in mind possible diagnosis?  5
b) Make a management plan for this case.   5

50. A 4-yaer old boy is referred to psychiatry OPD from paediatric OPD for stunted growth and marked language backwardness inappropriate to age for which no organic aetiology was identified.
a) Outline your assessment plan. 5
b) What intervention you will offer for this Case? 5

51. A 9-year old boy presents with multiple bruise who has been referred by GP for psychiatric evaluation. The child looks sad, socially withdrawn but has frozen watchfulness.
a) What are the areas you need to assess?  5
b) What is your intervention plan?  5

52. A 13-year old girl has been brought to psychiatry OPD by police for psychiatric assessment who is a victim of rape 7 days back.
a) Make a checklist of your assessment plan. 5
b) Outline the contents of your management for this case.    5

53. A 3-year old child admitted in the paediatric department with the complaints of bleeding from the rectum and mouth. Subsequent examinations and investigations are normal except inflicted injurious marks in and around anus and mouth. Mother who stays in the word with the child, deny any cause of the illness. She repeatedly asks for more investigations and diagnosis but shows no expected distress. The child has been referred for psychiatric evaluation in this conflicting situation.
a) What could be best possible diagnosis?  4
b) Outline your assessment and management plan. 6

54. A 10-year old boy appears with distressful, irritable, isolated and not going to school. His mother informed that the boy’s problems appear immediately after divorce of his parents since 6 months. She also informs that the child has abdominal pain for the last 5 years that fluctuates but never goes out despite of treatment.
a) How will you assess this case keeping in mind differential diagnoses? 5
b) List the management options and supportive measures that can be offered.  5

55. A 14-year old girl presented by her mother who recently becomes unruly, irritable, impulsive, outgoing, inappropriate sexual behaviour. Mother reports that she is very quiet, polite and obedient girl but these changes happen last 3 months.
a) Outline the assessment plan for this case mentioning the assessment areas.  6
b) How will you manage this case? 4

56. A 3-year old child admitted in the paediatric department with the complaints of bleeding from the rectum and mouth. Subsequent examinations and investigations are normal except inflicted injurious marks in and around anus and mouth. Mother who stays in the word with the child, deny any cause of the illness. She repeatedly asks for more investigations and diagnosis but shows no expected distress. The child has been referred for psychiatric evaluation in this conflicting situation.
a) What could be best possible diagnosis? 4
b) Outline your assessment and management plan. 6

57. A 10-year old boy appears with distressful, irritable, isolated and not going to school. His mother informed that the boy’s problems appear immediately after divorce of his parents since 6 months. She also informs that the child has abdominal pain for the last 5 years that fluctuates but never goes out despite of treatment.
a) How will you assess this case keeping in mind differential diagnoses?  5
b) List the management options and supportive measures that can be offered. 5

58. A 15-year old girl attend CAMH OPD who has marked irritable, lack of self-care shows little interest in work. She also has menstrual dysregulation since 3 months. Recently, she stops going school and most of time lies in bed closing door of her room.
a) What could be best possible diagnosis? 4
b) Outline a comprehensive treatment plan.  6

<Child and Adolescent Psychiatry