Child psychiatry, dementia, delirium and Mental Healthcare Act

23 NEET-PG practice questions on Child psychiatry, dementia, delirium and Mental Healthcare Act, part of Psychiatry. The first 23 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Easy

   A 30-year-old man in a village in Assam is brought at night in acute panic, holding his penis with a string tied to it. He is convinced it is shrinking into his abdomen and that he will die when it disappears. Several men in neighbouring villages had similar episodes that week. What is the most likely diagnosis?

   1. ACouvade syndrome
   2. BKoro
   3. CLatah
   4. DDhat syndrome

   Show answerHide answer

   Answer: B · Koro

   Acute fear that the penis (or in women the breasts or vulva) is retracting into the body and will cause death is koro, a genital retraction syndrome. It may occur in epidemics, and outbreaks have been reported in north-east India. It is treated with reassurance, education and short-term anxiolysis. Exclude a true penile problem with a calm examination.

   • A: Couvade syndrome is a husband's pregnancy-like symptoms during his partner's pregnancy.
   • C: Latah is an exaggerated startle with echolalia and echopraxia.
   • D: Dhat syndrome is worry about semen loss, not acute genital retraction.

2. Question 2 · Hard

   A psychiatry resident in a district mental health establishment reviews treatment rules under the Mental Healthcare Act 2017. Consider these statements: 1. Sterilisation may be done as a treatment for mental illness if the family consents. 2. ECT without anaesthesia and muscle relaxants is prohibited. 3. A person with mental illness must not be chained in any form. 4. ECT may be given to a minor only with the guardian's informed consent and prior permission of the Mental Health Review Board. Which statements are correct?

   1. A2 and 3 only
   2. B2, 3 and 4 only
   3. C1, 2, 3 and 4
   4. D1, 3 and 4 only

   Show answerHide answer

   Answer: B · 2, 3 and 4 only

   Statements 2, 3 and 4 are correct. The Act lists prohibited procedures: ECT without muscle relaxants and anaesthesia, ECT for minors (except as below), sterilisation as a treatment for mental illness, and chaining in any manner. If a psychiatrist judges ECT necessary for a minor, it may be given with the guardian's informed consent and the prior permission of the Mental Health Review Board. Statement 1 is false because family consent cannot make sterilisation a permitted treatment.

   • A: Omits statement 4, the conditional exception for ECT in minors.
   • C: Includes sterilisation, which the Act prohibits as treatment.
   • D: Includes sterilisation and omits the ban on unmodified ECT.

3. Question 3 · Hard

   A 79-year-old man with moderate Alzheimer disease on donepezil lives with his son. Over the last two days he has become drowsy, with lucid spells, then agitated at night; he pulled out his catheter and does not recognise his son. Three days ago a urologist started oxybutynin for urge incontinence. Temperature is 37.0 C, there are no focal signs and he has not fallen. What is the next best step?

   1. AStop oxybutynin and look for other precipitants
   2. BIncrease the donepezil dose
   3. CStart regular haloperidol at night
   4. DRecord this as progression of his dementia

   Show answerHide answer

   Answer: A · Stop oxybutynin and look for other precipitants

   An acute change over days, with fluctuating alertness, inattention and night-time agitation, is delirium superimposed on dementia, not progression of dementia, which is slow. Oxybutynin is an anticholinergic that crosses the blood-brain barrier and opposes donepezil, and patients with dementia are very vulnerable to such drugs. The offending drug is stopped and other causes (infection, retention, electrolytes, hypoxia, pain) are looked for. Antipsychotics are kept for severe distress or danger, in the lowest dose for the shortest time.

   • B: Increasing donepezil does not remove the anticholinergic cause of the delirium.
   • C: Antipsychotics are not first-line and do not treat the cause.
   • D: Dementia progresses over months; a change over two days is delirium until proved otherwise.

4. Question 4 · Medium

   An 8-year-old boy in Class 3 is brought because for a year he has been unable to sit through lessons, blurts out answers, loses his books and runs about at home and school. His teacher's report confirms this. Hearing, vision and IQ are normal and there is no tic. Parent training has started. Which drug is first-line?

   1. AMethylphenidate
   2. BFluoxetine
   3. CRisperidone
   4. DHaloperidol

   Show answerHide answer

   Answer: A · Methylphenidate

   Inattention, hyperactivity and impulsivity present in two settings for more than six months, starting in childhood, are attention-deficit hyperactivity disorder. In school-age children a stimulant, methylphenidate, is first-line alongside behavioural parent training and classroom support. It blocks dopamine and noradrenaline reuptake. Appetite, growth and sleep should be monitored; atomoxetine is a non-stimulant alternative.

   • B: Fluoxetine treats depression and anxiety, not core ADHD symptoms.
   • C: Risperidone is used for aggression or irritability, not as first-line for ADHD.
   • D: Haloperidol is used for tics or psychosis, not ADHD.

5. Question 5 · Medium

   A 35-year-old man has long resented his younger brother, who was their parents' favourite. In family gatherings he is excessively affectionate towards the brother, praises him loudly and insists on paying for everything for him. Which defence mechanism is he using?

   1. ADisplacement
   2. BSublimation
   3. CProjection
   4. DReaction formation

   Show answerHide answer

   Answer: D · Reaction formation

   Reaction formation turns an unacceptable impulse into its opposite, often in an exaggerated way, so hidden hostility appears as excessive affection. It is an unconscious, neurotic-level defence. The exaggeration is a clue that the visible feeling is not the true one. It is common in obsessional personality traits.

   • A: Displacement shifts feelings onto a safer target, such as shouting at a spouse after a scolding by the boss.
   • B: Sublimation channels an impulse into a socially valued activity, such as aggression into sport.
   • C: Projection attributes one's own unacceptable feelings to someone else.

6. Question 6 · Medium

   A 72-year-old retired teacher has had 18 months of fluctuating confusion, with good and bad days. He sees children sitting in his room, acts out his dreams at night and has a shuffling gait. Two days after a doctor gave haloperidol for the visual hallucinations he became severely rigid and drowsy. What is the most likely diagnosis?

   1. ADementia with Lewy bodies
   2. BAlzheimer disease
   3. CFrontotemporal dementia
   4. DVascular dementia

   Answer and explanation in LearnFree account

7. Question 7 · Easy

   A 22-year-old unmarried man from a village in Uttar Pradesh complains of weakness, fatigue and poor concentration, which he blames on losing semen in his urine. He worries this will make him unfit for marriage. Examination and urinalysis are normal. What is the most likely diagnosis?

   1. AKoro
   2. BDhat syndrome
   3. CAmok
   4. DBrain fag syndrome

   Answer and explanation in LearnFree account

8. Question 8 · Medium

   A 70-year-old woman has had two years of slowly worsening memory: she repeats questions, misplaces her keys and recently got lost in her own colony. MMSE is 19/30 and MRI shows bilateral hippocampal atrophy. Her psychiatrist starts donepezil. How does this drug act?

   1. AReversible inhibition of brain acetylcholinesterase
   2. BAgonism at muscarinic M1 receptors
   3. CReduction of amyloid plaque load
   4. DBlockade of NMDA glutamate receptors

   Answer and explanation in LearnFree account

9. Question 9 · Medium

   A 23-year-old college student is brought to casualty after swallowing rat poison following a breakup. After she is stabilised, a police constable says she must be charged for attempting suicide. How does the Mental Healthcare Act 2017 deal with her attempt?

   1. AShe must be detained in a mental health establishment
   2. BShe can be treated only with a magistrate's order
   3. CShe must be prosecuted for the attempt once she is medically fit
   4. DShe is presumed to have severe stress and must be given care

   Answer and explanation in LearnFree account

10. Question 10 · Medium

    A 30-month-old boy is brought to the paediatric OPD because he has no words. He does not respond to his name, makes poor eye contact, does not point to show his mother things, lines up his toy cars for hours and flaps his hands when excited. Brainstem evoked response audiometry is normal. What is the most likely diagnosis?

    1. AAttention-deficit hyperactivity disorder
    2. BAutism spectrum disorder
    3. CSelective mutism
    4. DExpressive language disorder

    Answer and explanation in LearnFree account

11. Question 11 · Medium

    ADHD is confirmed in a Class 5 boy whose teachers rate him as highly inattentive and hyperactive. His parents refuse 'any controlled stimulant' because his elder brother misuses prescription drugs, and the boy also has motor tics. Behavioural measures at school and home have started. Which medicine is the most suitable?

    1. AAtomoxetine
    2. BHaloperidol
    3. CDexamfetamine
    4. DMethylphenidate

    Answer and explanation in LearnFree account

12. Question 12 · Medium

    At an 18-month well-baby visit at a PHC, a mother is worried about her son. Consider these findings: 1. He does not point to show her things. 2. He does not respond to his name. 3. He walked at 13 months. 4. He uses no single words and has stopped babbling. Which findings are red flags for autism spectrum disorder?

    1. A1, 2 and 4
    2. B1, 3 and 4
    3. C2, 3 and 4
    4. D1 and 2 only

    Answer and explanation in LearnFree account

13. Question 13 · Medium

    After a harsh dressing-down from his unit head during the morning ward round, a second-year surgery resident says nothing in reply. That evening at home he shouts at his younger brother for leaving the television on, then feels foolish about it. Which defence mechanism best explains his behaviour at home?

    1. ADisplacement
    2. BSublimation
    3. CProjection
    4. DRationalisation

    Answer and explanation in LearnFree account

14. Question 14 · Hard

    Over 2 years, a once polite retired headmaster has started making crude jokes to strangers, eating sweets compulsively, shoplifting snacks and neglecting his hygiene, while showing no concern or embarrassment. His daughter says he still finds his way around town and recalls recent family events well. MMSE is 27/30, but he does poorly on verbal fluency and planning tasks. There is no tremor, rigidity, gait change or urinary incontinence, and his B12 and TSH are normal. MRI shows marked atrophy of both frontal and anterior temporal lobes, with relatively preserved hippocampi. Which diagnosis is most likely?

    1. AFrontotemporal dementia
    2. BDementia with Lewy bodies
    3. CNormal pressure hydrocephalus
    4. DAlzheimer disease

    Answer and explanation in LearnFree account

15. Question 15 · Medium

    On the second night after a hip fracture repair, an elderly man becomes agitated and pulls at his catheter and IV line, believing the nurses are prison guards. The cause is being treated, his family sits with him, and lights and his glasses have been arranged, but he is now at risk of falling and harming himself. Which drug is preferred for short-term control?

    1. AOral donepezil
    2. BOral diphenhydramine
    3. CIV midazolam
    4. DLow-dose haloperidol

    Answer and explanation in LearnFree account

16. Question 16 · Hard

    In the psychiatry OPD of a district hospital, a man with known schizophrenia, earlier stable on risperidone for three years, is brought by his mother. For two weeks he has stopped his medicines, not eaten properly, and has threatened neighbours with a sickle because he believes they are poisoning his water. He denies any illness and refuses to stay. The psychiatrist finds that he cannot understand or weigh information about treatment. He has no advance directive, and his mother is his nominated representative. Under the Mental Healthcare Act 2017, how should he be admitted?

    1. AOnly after a magistrate issues a reception order
    2. BHe cannot be admitted, because he refuses consent
    3. CAs a supported admission on his nominated representative's application
    4. DAs an independent admission with his mother signing the consent

    Answer and explanation in LearnFree account

17. Question 17 · Easy

    Which feature best distinguishes delirium from early Alzheimer dementia at the bedside?

    1. ADisorientation to time
    2. BImpaired recent memory
    3. CWord-finding difficulty
    4. DAcute onset with impaired attention

    Answer and explanation in LearnFree account

18. Question 18 · Medium

    Consider these culture-bound syndromes: 1. Dhat: anxiety about loss of semen in urine, seen in South Asian men. 2. Koro: fear that the penis will retract into the abdomen and cause death. 3. Amok: a sudden, violent rampage followed by amnesia, described in Malaysia. 4. Latah: brooding rage after an insult, seen in Japan. Which are correctly described?

    1. A2, 3 and 4 only
    2. B1 and 2 only
    3. C1, 2 and 3 only
    4. DAll four

    Answer and explanation in LearnFree account

19. Question 19 · Medium

    As a boy, a man now in his thirties was in frequent fights and was suspended twice for hitting classmates. His school sports teacher channelled him into boxing, and he went on to win state titles; he now coaches young boxers at a district stadium and has had no violent incident for fifteen years. His aggressive drive is now expressed through a socially valued activity. Which defence mechanism does this illustrate?

    1. ASuppression
    2. BSublimation
    3. CDisplacement
    4. DReaction formation

    Answer and explanation in LearnFree account

20. Question 20 · Easy

    Nursing staff in an orthopaedic ward are worried about a retired postmaster admitted with a hip fracture, who now mistakes his son for a stranger and pulls at his drip. His bedside attention scores are plotted in the graph shown. Which diagnosis does this record suggest?

    

    −+Fit to screenClose

    

    1. AAlzheimer's dementia
    2. BDelirium
    3. CSchizophrenia
    4. DDepressive pseudodementia

    Answer and explanation in LearnFree account

21. Question 21 · Medium

    Parents in a paediatric outpatient clinic in Madurai describe their five-year-old sitting up screaming and sweating, with wide eyes, soon after going to sleep. He cannot be consoled, settles in a few minutes and remembers nothing next morning. Each episode starts about an hour after he falls asleep. His typical hypnogram is shown. At which marked point does this happen, and in which sleep stage?

    

    −+Fit to screenClose

    

    1. APoint R, in REM sleep
    2. BPoint Q, in N2 sleep
    3. CPoint P, in N3 sleep
    4. DPoint S, in REM sleep

    Answer and explanation in LearnFree account

22. Question 22 · Hard

    During the Mini-Cog screen at a geriatric clinic in Pune, a retired clerk whose daughter reports two years of misplacing things is given three words to remember. Asked to draw a clock, she writes all twelve numbers and then, told to set the time to ten past eleven, adds the hands in the drawing shown. On delayed recall she names two of the three words without a cue. She is alert, attentive throughout, and her haemoglobin and blood glucose are normal. What is her score, and how should it be read?

    

    −+Fit to screenClose

    

    1. A2 of 5; positive screen, needs full evaluation
    2. B4 of 5; negative screen, reassure and review
    3. C4 of 5; positive screen, needs full evaluation
    4. D2 of 5; negative screen, reassure and review

    Answer and explanation in LearnFree account

23. Question 23 · Easy

    Gait apraxia, urinary incontinence and progressive memory loss in an older adult suggest which reversible cause of dementia?

    1. AHypothyroidism
    2. BChronic subdural haematoma
    3. CNormal pressure hydrocephalus
    4. DVitamin B12 deficiency

    Answer and explanation in LearnFree account