2. CBLE Neurodevelopmental

Neurodevelopmental Child and Adolescent Psychiatry

1. A 12-year old boy has difficulty in expressing himself in writing and makes frequent spelling mistakes. He passes his examinations with poor marks. However, his mathematical ability and social functioning are appropriate for his age. He was termed as “lazy” by his parents and teacher.
a) What will be most likely diagnosis? 5
b) Outline the treatment plan 5

2. A boy of 6 years has developed marked hyperactivity and lost previously achieved skills after encephalitis.
a) Write down your plan of investigations considering your possible diagnosis. 5
b) Outline the management of this case. 5

3. A 16-year old autistic boy attends in OPD with his puzzled parent who recently appears to be violent to parents and siblings as well as severe self-injurious behaviour including dangerous repetitive head banging and marked sleep disturbances. The boy goes to a special school and relatively stable in 4 mg risperidone per day for his hyperactivity and unpredictable disruptive behaviour since a long.
a) Make a checklist of information for assessing this case. 5
b) Outline the treatment plan.  5

4. A 3-year old child is not talking and said to appear not to understand what his parents say.
a) Give outline of differential diagnosis you will consider. 5
b) List the required examinations and investigations necessary to clarify the diagnosis.  5

5. A 12-year old boy attends in the psychiatry OPD with his parents. Parents say that the boy is very restless and inattentive in study. Teacher complains that he disturbs in class, does silly mistake and never finishes his task. The boy is fidgeting most of the time.
a) What will be most likely diagnosis?  4
b) List the information you need to be gathered.   6

6. A 2- year old boy has speech difficulty as his parents observed and concerned parents bring this child to you for this problem.
a) What is your differential diagnoses? 4
b) List the information you need to gather during evaluation of this child.  6

7. A 11-year old girl is brought due to poor academic performance. Her parents report that she does silly mistakes and forgets immediately after learning school work. She is censured by school teacher most of the time and parents called on for her poor performance.
a) What is the most likely diagnosis? 3
b) What are the areas you need to explore in assessing this case? 7

8. A 14-year old boy attends in Psychiatry OPD with his father. Father says that the boy cannot perform well in his study due to his “mental disability” and seeks a certificate to get possible benefit from the educational authority.
a) How will you proceed before issuing such certificate? 5
b) List the areas that you need to assess. 5

9. A 9-year old boy wets night-time and day-time most of the days in a week and who never gains continence.
a) Make a checklist of information to assess this case. 5
b) Outline the management plan.  5

10. An 11-year old boy is brought to psychiatry OPD who appears to be a difficult learner. His parents inform that the boy has poor intelligence than that of his age.
a) How will you proceed to diagnose this case?         5
b) Outline the assessment areas.   5

11. A 18-year old intermediate student had three short-lived episodes of hearing voices. Each episode had occurred when she did study at night to combat his academic load. The voices she had heard were marked auditory hallucinations which lasted for only few minutes but had really frightened her. Before these episodes, she reported feeling faint for a few minutes and also experiencing the sensation of déjà vu.
a) What could be the most possible diagnosis?  5
b) How will you treat this case?  5

12. 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

13. A 1-year old boy presented in psychiatry OPD who is malnourished. Her mother is schizophrenic and getting treatment science 5 years. The mother always keeps her child with her and does not allow anyone to take care of her child. She does not take care of the child and seemed to be not concerned at all. The family members are increasingly worried about the child’s growth and asked whether the child should be taken away from her.
a) Mention the areas of assessment for your plan of action. 5
a) List the points that you need to communicate with the family.  5

14. A 10-year old boy appears to OPD facility with his parents for his bedwetting since 4 years. The child appears very much restless, inattentive and impulsive who moves around in the examination room. On questioning, the parents agree that the boy has hyperactivity since his early life but they think that it could be normal.
a) What are the areas you need to assess the child?  5
b) Make a comprehensive management plan. 5

15. A 11-year old boy is referred by GP who episodically cries fears, chews, searches things and talks incoherently in sleep since two years for 5-15 minutes duration. The boy cannot recall the events when he is asked about. EEG finding for this boy was found normal. Parents are worried for the boy as the problem persists and increases gradually. Subsequently, the boy defies, demands things, does not do study, engages more with mobile gaming and watching TV.
a) What is the most likely diagnosis? 5
b) Outline treatment plan.  5

16. A 19-year old boy appears in CAMH OPD who does not want to take food as he thinks he is overweight since last 9 months for which his weight has been reduced from 45 kg to 33 Kg. He does vigorous exercise, reacts angrily if he is asked to take usual quantity of food. On questioning, the boy says he starts reducing weight after passing comments of his peer as “fatty”. Now he thinks he needs to reduce another 3 Kg to make him fair looking.
a) Outline your assessment plan. 6
b) How will you treat this case?   4

17. A 17 year-old girl appears with fear of increasing weight despite of significantly low body weight. She takes low quantity of food, does vigorous exercise, long times cycling with the aim of burning calories. She repeatedly confronts with parents about their concerns of her low body weight. Occasionally, she takes excessive amount of food and vomits thereafter.
a) What could be most likely diagnoses? 5
b) Outline the assessment plan.   5

18. A 11-year old boy is taken to psychiatry OPD by his parents with behavioural problems. During the interview with his parents, the boy barks at infrequent episodes and shouts expletives.
a) What is the most likely diagnosis?  5
b) Make an assessment plan. 5

19. A 18-year old boy who is a case of ASD recently shows repetitive violent behaviour for which he has been hospitalized.
a) What are the areas you need to assess?  5
b) Outline the management plan. 5

20. 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

21. A 9-year old boy presents with multiple bruise who refereed 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

22. A 13-yaer old girl 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

23. 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

24. A 38-year old mother comes in follow-up in the OPD for her 7-year old male child who has autism spectrum disorder and marked hyperactivity. The drugs work a little and the mother is tired with the boy. The mother also brings her another child of 4 year for consultation. She says that this child is gradually doing similar behaviour of his older by following her.
a) What could be the best possible explanation of the problem of her younger child? 5
b) What things you need to consider in assessing the situation of the family as a whole? 5

25. 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 need to offer. 5

26. A 14-year old boy with ADHD is under treatment. Since one year, he has been increasingly demanding. He does not want to go school and do study. Though he is meritorious, he fails in all subjects and thereby not promoted. He does not want to go out of home, rather disturbs his parents and elder sister with very negligible matter and becomes verbally and physically abusive to them. His parents try to manage him by fulfilling his demands and undue desires. Very recently, he becomes violent and takes weapons to kill her mother and sisters.
a) Prepare a checklist of information for assessing this boy.     5
b) What will be the treatment plan for his present conditions?      5

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