Psychological First Aid — MCQs
All are provisions of WHO mental health Gap Action Programme (mhGAP), except:
Which of the following phases are directly involved in the recovery phase of the disaster cycle?
In an accident case, after the arrival of medical team, all should be done in early management except;
A 42-year-old man with sexual interest in children (pedophilia) is given an electric shock each time he is shown a videotape of children. Later, he feels tense around children and avoids them. Which of the following management techniques does this example illustrate?
Principles of Health education include all except:
All are related to criminal responsibility of insane except -
Which of the following is not done in the primary survey of trauma?
Which of the following is NOT typically associated with the recovery phase after a disaster?
From a medico-legal perspective, in cases of sexual assault involving a female victim, what type of court proceeding is typically used to record medical evidence and testimony to protect the victim's privacy?
Following a major earthquake, a regional hospital manages both survivors and victim identification. The forensic team faces: limited DNA lab capacity (30 samples/week), 200 bodies, pressure from families for quick release, and presence of closed casket bodies (intact) versus open/fragmented remains. As the coordinating forensic expert, evaluate and prioritize the identification strategy balancing ethical, legal, and practical considerations.
Psychological First Aid Indian Medical PG Practice Questions and MCQs
Question 1: All are provisions of WHO mental health Gap Action Programme (mhGAP), except:
- A. Communication regarding care
- B. Human rights
- C. Screening family members (Correct Answer)
- D. Social support
Explanation: ***Screening family members*** - The **WHO mhGAP** primarily focuses on scaling up care for **priority mental, neurological, and substance use disorders** in low- and middle-income countries. It does not explicitly include the provision of routine screening of family members of affected individuals. - While family support is crucial, direct screening of asymptomatic family members for psychiatric disorders is not a core component of the program's defined interventions for service delivery. *Communication regarding care* - **Effective communication** is a fundamental aspect of the **WHO mhGAP** to ensure patients and their families understand their condition and treatment plan. - It emphasizes **patient-centered care** and informed decision-making, which rely heavily on clear and empathetic communication from healthcare providers. *Human rights* - **Human rights** are a foundational principle of the **WHO mhGAP**, ensuring that individuals with mental disorders receive care without discrimination and with respect for their dignity and autonomy. - The program advocates for policies and practices that protect the rights of people with mental health conditions. [1] *Social support* - **Social support** is a crucial component promoted by the **WHO mhGAP**, recognizing its role in recovery and well-being for individuals with mental health conditions. - The program encourages interventions that strengthen social ties and community integration to reduce isolation and improve outcomes.
Question 2: Which of the following phases are directly involved in the recovery phase of the disaster cycle?
- A. Response and Rehabilitation
- B. Mitigation and Rehabilitation
- C. Response and Preparedness
- D. Rehabilitation and Reconstruction (Correct Answer)
Explanation: ***Rehabilitation and Reconstruction*** - **Rehabilitation** is the short-term recovery phase focusing on restoring essential services, providing temporary shelter, medical care, and supporting affected populations to resume normal activities. - **Reconstruction** is the long-term recovery phase involving rebuilding damaged infrastructure, permanent housing, economic restoration, and development improvements. - These two phases together constitute the **recovery phase** of the disaster cycle according to standard disaster management frameworks (WHO, NDMA). *Mitigation and Rehabilitation* - While **rehabilitation** is correctly part of recovery, **mitigation** is traditionally considered a separate continuous phase or part of preparedness, focused on reducing future disaster risks. - **Mitigation** measures are implemented throughout the disaster cycle, not specifically as a direct component of the recovery phase. *Response and Rehabilitation* - **Response** refers to immediate life-saving actions during and immediately after a disaster (search and rescue, emergency medical care, evacuation). - **Response** precedes the recovery phase and is distinct from it, though **rehabilitation** is indeed part of recovery. *Response and Preparedness* - **Preparedness** involves planning, training, and resource allocation before a disaster occurs. - **Response** is the immediate action during/after the disaster. - Neither constitutes the recovery phase, which follows after the immediate response is complete.
Question 3: In an accident case, after the arrival of medical team, all should be done in early management except;
- A. Glasgow coma scale
- B. Check BP (Correct Answer)
- C. Stabilization of cervical vertebrae
- D. Check Respiration
Explanation: ***Check BP*** - In the **immediate/early management** of trauma (primary survey), while circulation assessment is crucial, the **initial assessment of circulation** focuses on: - **Pulse rate and quality** (radial, carotid) - **Capillary refill time** - **Skin color and temperature** - **Active hemorrhage control** - **Formal blood pressure measurement** with a cuff, while important, is typically recorded during or after these rapid initial assessments, as it takes more time to obtain an accurate reading. - In the context of this question, among the four options listed, BP measurement is relatively less immediate compared to the other life-saving priorities (airway protection, breathing assessment, C-spine stabilization, and GCS). - **Note:** This is a nuanced distinction - BP is assessed during primary survey, but the other three options have more immediate life-threatening implications if not addressed. *Glasgow coma scale* - **GCS assessment** is part of the **"D" (Disability)** step in the ATLS primary survey. - It is performed early to assess neurological status and level of consciousness. - GCS <8 indicates need for **definitive airway protection** (intubation). - This is a critical early assessment that guides immediate management decisions. *Stabilization of cervical vertebrae* - **C-spine immobilization** is part of the **"A" (Airway)** step - "Airway with cervical spine protection." - It is performed **simultaneously** with airway assessment using a **rigid cervical collar**. - This is the **first priority** in trauma management to prevent secondary spinal cord injury. - All trauma patients should be assumed to have C-spine injury until proven otherwise. *Check Respiration* - **Respiratory assessment** is part of the **"B" (Breathing)** step in the ATLS primary survey. - This involves checking: - **Respiratory rate and pattern** - **Chest wall movement** - **Air entry bilaterally** - **Signs of tension pneumothorax or flail chest** - This is an immediate life-saving priority and must be assessed early.
Question 4: A 42-year-old man with sexual interest in children (pedophilia) is given an electric shock each time he is shown a videotape of children. Later, he feels tense around children and avoids them. Which of the following management techniques does this example illustrate?
- A. Implosion
- B. Aversive conditioning (Correct Answer)
- C. Biofeedback
- D. Flooding
Explanation: ***Aversive conditioning*** - **Aversive conditioning** involves pairing an undesirable behavior or stimulus (e.g., sexual interest in children) with an unpleasant stimulus (e.g., electric shock). - The goal is to create an association between the undesirable behavior and the unpleasant consequence, leading to a reduction in the unwanted behavior or aversion to the stimulus. *Implosion* - **Implosion therapy** is a technique where the patient is asked to imagine vividly and intensely the most terrifying aspects of their phobic stimulus. - This method aims to extinguish the fear response by overwhelming the patient with anxiety-provoking imagery without any actual danger. *Biofeedback* - **Biofeedback** is a technique that teaches individuals to control involuntary physiological responses such as heart rate, muscle tension, or skin temperature. - It uses electronic sensors to monitor these responses and provide real-time feedback to the individual, allowing them to learn self-regulation. *Flooding* - **Flooding** is a behavioral therapy technique where an individual is exposed directly and intensely to a feared object or situation for a prolonged period. - The goal is to extinguish the fear response through habituation, by demonstrating that the feared stimulus is not dangerous despite the initial anxiety.
Question 5: Principles of Health education include all except:
- A. Punishment (Correct Answer)
- B. Motivation
- C. Participation
- D. Reinforcement
Explanation: ***Punishment*** - **Punishment** is generally not considered a principle of effective health education because it can lead to **negative feelings**, resistance, and avoidance of health-seeking behaviors rather than genuine behavior change. - Effective health education focuses on **empowerment** and positive reinforcement rather than punitive measures. *Motivation* - **Motivation** is a core principle, as individuals are more likely to adopt healthy behaviors when they are **personally motivated** and understand the benefits. - Health educators aim to **stimulate and sustain interest** in health-promoting actions. *Participation* - **Participation** is crucial for effective learning and retention; active involvement by the learner (e.g., through discussions, practical exercises) fosters a **deeper understanding** and sense of ownership over their health. - It ensures that educational programs are **relevant and tailored** to the needs of the target audience. *Reinforcement* - **Reinforcement** is a key principle that helps to **solidify desired behaviors** through positive feedback and encouragement. - **Positive reinforcement** (e.g., praise, rewards, recognition) is particularly effective in health education as it rewards healthy actions and promotes their continuation without creating fear or resistance.
Question 6: All are related to criminal responsibility of insane except -
- A. Res ipsa loquitur (Correct Answer)
- B. Currens rule
- C. Durham rule
- D. McNaughten rule
Explanation: ***Res ipsa loquitur*** - This legal doctrine means "the thing speaks for itself" and is used in **tort law** to infer **negligence** when the facts demonstrate no other reasonable explanation. - It is a principle of civil law concerning **causation of injury** and has no direct application to the criminal responsibility or insanity defense. *Currens rule* - The Currens Rule (also known as the American Law Institute or ALI test) states that a person is not responsible for criminal conduct if, at the time of such conduct, as a result of **mental disease or defect**, they lacked substantial capacity either to appreciate the criminality of their conduct or to conform their conduct to the requirements of law. - This rule is a standard for determining **legal insanity** in criminal cases. *Durham rule* - The Durham rule (or "product test") states that an accused is not criminally responsible if their unlawful act was the **product of mental disease or defect**. - This rule focuses on a causal link between the mental illness and the crime, being a standard for **legal insanity**. *McNaughten rule* - The McNaughten rule states that for a defense of insanity to be established, it must be clearly proved that, at the time of committing the act, the party accused was laboring under such a defect of reason, from disease of the mind, as not to know the nature and quality of the act he was doing; or, if he did know it, that he did not know he was doing what was wrong. - This is a foundational legal test for **criminal insanity** in many common law jurisdictions.
Question 7: Which of the following is not done in the primary survey of trauma?
- A. Intubation
- B. NCCT head (Correct Answer)
- C. ICD drainage
- D. CXR
Explanation: ***NCCT head*** - A **Non-Contrast CT (NCCT) head** is typically performed during the **secondary survey** once the patient is hemodynamically stable and life-threatening conditions have been addressed. - The primary survey focuses on immediate **life-saving interventions** for airway, breathing, circulation, disability, and exposure. *Intubation* - **Intubation** is a critical intervention during the primary survey, specifically under the **'A' (Airway)** component, to establish and secure a patent airway in a compromised patient. - Failure to establish an airway can rapidly lead to **hypoxia** and death. *ICD drainage* - **Intercostal drain (ICD) drainage** is an urgent intervention in the primary survey, falling under **'B' (Breathing)**, to manage conditions like **tension pneumothorax** or massive hemothorax. - These conditions can severely compromise ventilation and circulation, requiring immediate relief. *CXR* - A **Chest X-ray (CXR)** is a rapid and essential diagnostic tool in the primary survey, also under **'B' (Breathing)**, to identify life-threatening thoracic injuries such as pneumothorax, hemothorax, or mediastinal shift. - It provides quick information crucial for immediate management decisions.
Question 8: Which of the following is NOT typically associated with the recovery phase after a disaster?
- A. Rehabilitation
- B. Reconstruction
- C. Response (Correct Answer)
- D. Mitigation
Explanation: ***Response (Correct Answer)*** - **Response** activities occur during or immediately after the disaster event, NOT in the recovery phase - Includes immediate search and rescue, medical triage, emergency shelter provision, and acute crisis management - The goal is to **save lives, protect property**, and meet basic human needs during the acute crisis (typically 0-72 hours) - This is distinct from the recovery phase, which begins after the immediate emergency is controlled *Rehabilitation* - **Rehabilitation** is a key component of the **recovery phase** - Focuses on restoring services and infrastructure to acceptable levels after the initial emergency - Includes both physical recovery of individuals and return to functionality of critical systems like utilities and healthcare *Reconstruction* - **Reconstruction** is a major part of the **recovery phase** - Involves rebuilding infrastructure, homes, and communities, often to a better, more resilient standard than before - This is often a lengthy process aiming for long-term stability and development *Mitigation* - While **mitigation** can be incorporated into recovery planning, it is primarily focused on **future disaster prevention** - Measures taken to reduce the **loss of life and property** from future disasters - Can be implemented before a disaster strikes or planned during recovery, but the emphasis is on **risk reduction for future events** rather than immediate restoration from the current event
Question 9: From a medico-legal perspective, in cases of sexual assault involving a female victim, what type of court proceeding is typically used to record medical evidence and testimony to protect the victim's privacy?
- A. Open court proceedings
- B. Closed court proceedings
- C. Hearing at a different location
- D. In camera proceedings (Correct Answer)
Explanation: ***In camera proceedings*** - **In camera proceedings** (Latin for "in chambers") refer to court hearings conducted in **private**, with the public and media excluded, to protect the victim's privacy and dignity. - Under **Section 327(2) of CrPC**, cases of sexual offences against women must be conducted in camera to prevent further trauma and ensure the victim can provide testimony comfortably. - This legal provision ensures **confidentiality** of victim identity and prevents public disclosure of sensitive medical evidence and testimony. - The proceedings are still officially recorded and form part of the legal record, but occur in a closed, private setting. *Open court proceedings* - **Open court proceedings** allow public and media access, which would severely compromise the victim's privacy and cause additional psychological trauma. - Such public exposure is specifically prohibited in sexual assault cases under Indian law to protect the **victim's identity** and well-being. *Closed court proceedings* - While this term might seem similar, **"closed court"** is not the standard legal terminology used in Indian jurisprudence for sexual assault cases. - The specific term **"in camera"** is used in Section 327 CrPC and judicial pronouncements, making it the precise medico-legal answer. *Hearing at a different location* - Changing the location does not inherently provide the **legal framework** for privacy protection that in camera proceedings mandate. - This option lacks the formal legal status and procedural safeguards that Section 327 CrPC provides through in camera hearings.
Question 10: Following a major earthquake, a regional hospital manages both survivors and victim identification. The forensic team faces: limited DNA lab capacity (30 samples/week), 200 bodies, pressure from families for quick release, and presence of closed casket bodies (intact) versus open/fragmented remains. As the coordinating forensic expert, evaluate and prioritize the identification strategy balancing ethical, legal, and practical considerations.
- A. Immediate release of closed casket bodies to families after visual identification; DNA testing for fragmented remains only
- B. Process all bodies through DNA testing in order of recovery, release bodies as results come; maintain equity
- C. Establish community identification committees for visual identification of intact bodies; reserve DNA for disputed cases only
- D. Stratified approach: Fast-track closed casket bodies using fingerprints/dental records; prioritize DNA for fragmented/decomposed remains; establish provisional identification with final DNA confirmation for complex cases (Correct Answer)
Explanation: ***Stratified approach: Fast-track closed casket bodies using fingerprints/dental records; prioritize DNA for fragmented/decomposed remains; establish provisional identification with final DNA confirmation for complex cases*** - This approach balances **efficiency and accuracy** by utilizing faster primary identifiers like **fingerprints and dental records** for intact remains while reserving limited **DNA lab capacity** for complex cases. - It addresses **ethical concerns** by reducing wait times for families and maintains **legal standards** by avoiding the high error rates associated with purely visual identification. *Immediate release of closed casket bodies to families after visual identification; DNA testing for fragmented remains only* - **Visual identification** is notoriously unreliable in mass disasters due to emotional trauma and post-mortem changes, risking **legal and psychological complications** from misidentification. - Relying solely on sight for release ignores more robust primary identifiers like **odontology** which are necessary for forensic validity. *Process all bodies through DNA testing in order of recovery, release bodies as results come; maintain equity* - This method creates a massive **bottleneck** due to the limited capacity of 30 samples/week, causing unnecessary delays of several months for hundreds of families. - It ignores the **triage principle** in forensic identification where simpler, faster methods should be used first to manage **resource constraints**. *Establish community identification committees for visual identification of intact bodies; reserve DNA for disputed cases only* - **Community committees** lack the required **forensic rigor** and professional expertise to provide legally defensible identification in a mass casualty event. - This strategy increases the risk of **false positives**, where multiple families might claim the same remains, leading to further social and legal conflict.
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