A Joint Program between College of Medicine and Health Sciences, University of Gondar and Amanuel Mental Specialized Hospital

Masters Degree Program in Integrated Clinical and Community Mental health Year II - Child and Adolescent psychiatry Examination, June 2011

Name: ____________________________________ID No: _________

(Please do not forget to write your full name at every page on the right corner!!)

SECTION I
Read the following brief case histories and write down ONE most likely diagnosis (9marks). 1.. A young girl complains of burning sensation in the head, insomnia, loss of appetite, inability to concentrate, lack of energy and increasing loss of weight of three months duration.

2.

A young man recently admitted to a mental hospital was found standing in the corner for a long time in the same position staring at one point in the sky and sometimes talking in an incoherent way.

3.

A 12 years old student wakes up early in the morning. He undertakes too many activities without finishing anyone of them. .

4.

A young boy of 15 has affectionate relationship with his mother but cannot establish any relationship with his peers. He has been unable to learn any trade and does not know how to use money.

2 5. 6. A young girl has started looking herself in the mirror repeatedly and giggling for the last six months. She says that God has been talking to her but cannot say clearly what. A young man usually feels worried that something bad is going to happen though he cannot explain what. He has been seeing a doctor for his symptoms of sweating, frequent attacks of diarrhea and pain in chest. He felt himself relieved of all symptoms when he visited a holiday resort for one week.

8.

A ten-year-old child was brought to you because he never likes to play with people but with objects. Speech is not well developed and the parents were worried that despite their efforts he does not show affection.

9.

A young man at the time of any interview or examination becomes tenses, develops diarrhea and consults the medical officer for sweating and palpitation.

SECTION II 15 marks
All questions in this section require only one appropriate response from five options (a, b, c, d, e). Circle on the letter that indicates the best answer. Selecting more than one answer results in a 0 score for that question. (60 marks) As an example: All of the following structures are in the skull, EXCEPT: a. cerebellum b. pons c. liver d. caudate nucleus e. locus ceruleus 1. All of the following are widely used modes of treatment for early onset schizophrenia, EXCEPT: a. b. c. d. e. psychotherapy to gain insight about delusions psychosocial rehabilitation to bolster functioning antipsychotic medications to control symptoms supportive therapy to bolster compliance psycho education about the illness and treatment

2. All of the following can be considered psychotic symptoms in young children , EXCEPT: a. a fixed belief that aliens are beaming microwaves into your brain b. hearing a voice in your head telling you that your neighbor is watching you c. checking all of the electrical outlets in the house for 2 hours a day to prevent fires d. talking in such a way that some thoughts have no connection to others e. receiving personal messages from Satan though the television 3- Autistic Disorder : a- Is also known as Aspergers Syndrome b- Never affects behavior before 6 months of age c- Is paralinguistic Schizophrenia d- Always begin before the age of 28 months e- Loss of language may occur after a period of normal development

4 4-. You are investigating the development of bizarre behavior in a young boy who was brought to the psychiatric hospital by his family. The family reports that there is a history of seizure disorder, but you are wondering about schizophrenia. All of the following symptoms would be common symptoms in temporal epilepsy, EXCEPT: a. b. c. d. e. delusions of jealousy episodes of stereotypical facial movements olfactory hallucinations auditory hallucinations periods of fearful and agitated behavior

5-. A mother and her 14 year old daughter present to the emergency department. They both appear to have similar psychotic symptoms including a delusion that they have been poisoned by their neighbor. Both are hallucinating about the same persecutory voice, say very similar things. Choose the ONE CORRECT feature that would most strongly suggest the presence of a Folie deux (shared psychotic disorder): a. The mother and daughter share and support each others delusions ideas. b. There is a strong family history of schizophrenia in a grandparent and a cousin. c. The mother appears to be very poor and hoping to be admitted for food and shelter. d. When the patients do not think anyone is looking they appear to chat calmly and act normally. e. The father reports that he thinks both mother and daughter have been chewing a lot of chat (mild amphetamine). 6-. A very young university presents to the Emergency Room stating that he has been aware for one year that the government has an elaborate plan to kill him. There is no evidence to support his belief. No other psychiatric symptoms are present on further inquiry. All of the following would be helpful strategies in managing this patient, EXCEPT: a. Antipsychotic medication b. Gaining a further understanding of his delusional beliefs c. Empathizing with the patients worries d. Telling that patient that his beliefs are incorrect and that he should listen to your point of view e. Obtaining collateral history from family and coworkers 7-. You are seeing a 15 year old patient with a 6 month history of psychotic symptoms. The family has been taking the patient to a traditional healer because he is complaining of being spiritually possessed. All of the following are appropriate approaches, EXCEPT: a. Explore the patients explanatory model of spiritual possession. b. Encourage patient to explain his expectations for treatment. c. Encourage the family to talk with the patient openly about his beliefs. d. Encourage the family to stop going to the healer to reduce the delusion of possession. e. Explain to the family and patient that schizophrenia is believed to be biological

5 8-. An 18 year old girl present to your clinic complaining of mood problems. However, she reports very unstable affect with periods of depression lasting only hours at a time. All of the following features would be consistent with a diagnosis of borderline personality disorder (BPD), EXCEPT: a. b. c. d. e. Difficulty in forming stable relationships Flight of ideas Self-harm behavior Transient experiences of seeing vivid visual images Feelings of hopelessness

9-You are considering using ECT to treat a depressed young girl. All of the following may predict a good response to ECT, EXCEPT: a. b. c. d. e. The presence of biological signs of depression e.g. early waking, weight loss Psychomotor retardation Sudden onset of depressive symptoms Hypochondrial features Somatic or paranoid delusions

10- You are asked to consult on a high school student with depressed mood, poor sleep and concentration and feelings of hopelessness. On inquiry about his past history, you discover that he had a 4 day episode of elevated mood. All of the following symptoms during this past episode would support a diagnosis of bipolar II disorder, EXCEPT: a. b. c. d. e. increased energy decreased need for sleep grandiose delusions increased spending increased goal directed activity

11-. All of the following are effective treatments for Obsessive-Compulsive Disorder, EXCEPT: a. b. c. d. e. exposure and response prevention hypnosis cingulotomy high dose SSRI high dose clomipramine

12- A 15 year old girl had a counseling for rape very recently. . All of the following would be evidence of diagnosis of Post-traumatic Stress Disorder, EXCEPT: a. Nightmares b. Panic attacks c. Irritability d. Diminished interest in activities e. Exaggerated startle response

6 13- Choose the ONE CORRECT statement regarding Post-traumatic stress disorder (PTSD): a. About one year after the onset of PTSD, the symptoms usually begin to resolve b. PTSD is most prevalent in a pure form, without co morbidity c. Dissociation at the time of the trauma predicts a favorable response to the traumatic event d. Early onset of PTSD following the traumatic event is associated with a better outcome in treatment e. Major depression is a risk factor for PTSD, and PTSD is a risk factor for depression 14- All of the following are included in the DSM IV criteria for substance dependence in young adolcent a. Occasional use following an episode of detoxification b. Unsuccessful efforts to cut down c. Tolerance d. Substance taken in larger amounts than intended e. A great deal of time spent in activities to obtain the substance 15- You are treating a young man who has a history of cannabis abuse in your outpatient clinic. Choose the ONE CORRECT statement regarding a unique feature of cannabis abuse in comparison with other major substances of abuse.: a. Cannabis can produce a more significant respiratory suppression than most drugs of abuse b. Cannabis is usually associated with mild inattention, but is not associated with impairment in motor function c. Cannabis does not usually cause perceptual disturbances d. Cannabis is not usually associated with physical dependence e. Cannabis is not usually associated with psychological dependence

Section III -

Say True or False (22 marks)

1. The prognosis of Autism is worse if IQ is under 60--------------2. The prognosis of Autism is worse if Clumsiness present --------------3. The prognosis of Autism is worse if the child is male ---------------4. Characteristic feature of ADHD include Distractibility ----------------5. Characteristic feature of ADHD include Hand flapping and other mannerism -------------------6. Characteristic feature of ADHD include elevated mood 7. Recognized symptoms of schizophrenia in childhood and adolescent Affective blunting ----------------8. Recognized symptoms of schizophrenia in childhood and adolescent auditory hallucination---------------------------9. Recognized symptoms of schizophrenia in childhood and adolescent insistence of the sameness--------------------------------10.Recognized symptoms of schizophrenia in childhood and adolescent pronominal reversal -------------------11.Recognized symptoms of schizophrenia in childhood and adolescent thought disorder--------------------------12.Post Traumatic stress disorder can be triggered off in children by Medical Procedure ---------------------------------13.Post Traumatic stress disorder can be triggered off in children by Sexual Abuse-----------------------------14.Post Traumatic stress disorder can be triggered off in children by life threatening injuries and illness --------------------15.Post Traumatic stress disorder can be triggered off in children by rejection by friends --------------------------------------

16.Post Traumatic stress disorder can be triggered off in children by Witnessing one parent attacking the pother -------------------------------------17.Characteristic feature of PTSD IS exaggerated startle response----------------18.Characteristic feature of PTSD is loss of appetite-------------------------------19.Characteristic feature of PTSD IS in ability to call important aspects of the trauma---------------------------------20.Childhood OCD affects more females than males------------------------21.Childhood OCD Involves very similar symptoms to OCD in adults ----------22.Childhood OCD is often accompanied by anxiety or depressive disorder--------------------------SECTION V
Match items in Group A with those in Group B: (10 marks)

Group A
____ A. Repetitive Behavior, Language delay and Poor eye contact ____B. Thought broadcasting ____C. Recurrent self-damaging acts ____D. Perfectionism ____E. Traumatic dreams, avoidance, Intrusive image ____ F. Refusal to go to school ____G. Refusal to speak in School only ____H. Persistent failure to control behavior appropriately within socially defined rule ____I. Diurnal bed wetting ____J. Hyperactive, Inattentive, Impulsive 2. 3. 4. 5.

Group B
1. Selective Mutism Borderline personality disorder Pervasive Developmental Disorder Schizophrenia Obsessive compulsive personality disorder

6. ADHD 7. Conduct Disorder 8. Enuresis 9. PTSD 10. School Refusal

SECTION

VI

Give the drug of choice and daily dose for each of the following conditions( 9marks).

9 1. A severely depressed young boy 2. An eight year old school boy who has been having two epileptic seizures a week 3. Catatonic schizophrenia 4. A Child with ADHD 5. Pseudoparkinsonism (Extrapyramidal side-effects caused by neuroleptic drugs) 6. A boy with Enuresis 7. A restless and hyperactive young girl with Mental Retardation

8. A young boy with early on set of schizophrenia 9. A restless Autistic young boy

SECTION V II
Match items in Group A with those in Group B (8 marks).

Group A

Group B

10
____A. Mild Form of Mental Retardation ____B. Moderate Form of Mental Retardation ____C. Sever Form Of Mental Retardation 1. 2. 3. Behavioral Disorder Pervasive Developmental Disorder Emotional Disorder

____D. Profound Mental Retardation ____E . Autistic Disorder ____ F. Depressive Disorder ____G. Conduct Disorder ____H. Speech / Language delay

4. 5. 6. 7. 8.

Developmental Disorder IQ level 50-55 IQ level 35-40- to 50-55 IQ level 20-25 to 35-40 IQ level below 20/25