Mental Health Aspects of Gender-Affirming Care — MCQs
Among which of the following conditions is suicide risk highest?
The established benefits of estrogen replacement therapy in menopausal women include a reduction in all of the following EXCEPT
Body dysmorphic disorder can be associated with all except
What is considered the most effective treatment for Borderline Personality Disorder?
About fibromyalgia all are true except
F00 in ICD denotes
Which of the following terms describes sexual attraction or relationships primarily between women?
Provision of the Mental Health Act 2017, based on WHO guidelines, includes all, except:
As per the Mental Health Care Act, 2017, the maximum number of days a Magistrate can initially detain a mentally ill person is
In a clinical scenario, a patient presents with altered mental status due to substance intoxication. Which of the following is the most appropriate management step?
Mental Health Aspects of Gender-Affirming Care Indian Medical PG Practice Questions and MCQs
Question 1: Among which of the following conditions is suicide risk highest?
- A. Depression (Correct Answer)
- B. Alcohol dependence
- C. Dementia
- D. Schizophrenia
Explanation: ***Depression*** - **Major depressive disorder** is the psychiatric condition most frequently associated with **suicide**, accounting for a large percentage of completed suicides. - The presence of severe depression, especially with features like **hopelessness**, **agitation**, and **prior suicide attempts**, significantly elevate the risk. *Alcohol dependence* - While **alcohol dependence** is a significant risk factor for suicide, it often co-occurs with mood disorders like depression; alcohol can exacerbate suicidal ideation and impulsivity. - It is an important comorbidity, but **major depression** alone has a higher prevalence in suicide statistics than alcohol dependence as a primary factor. *Dementia* - **Dementia** generally poses a lower risk of completed suicide compared to mood disorders, as cognitive decline can impair the ability to plan and execute such acts. - Early stages of dementia, particularly when insight into cognitive decline is preserved, may carry some risk, but it is not the highest risk condition overall. *Schizophrenia* - Individuals with **schizophrenia** have a significantly elevated risk of suicide compared to the general population, often due to factors like **command hallucinations**, hopelessness, and adverse effects of medication. - However, **depression** remains the leading psychiatric diagnosis associated with suicide completions.
Question 2: The established benefits of estrogen replacement therapy in menopausal women include a reduction in all of the following EXCEPT
- A. Hot flushes
- B. Mood depression (Correct Answer)
- C. Atrophic vaginitis
- D. Osteoporosis
Explanation: ***Mood depression*** - While some women may experience mood changes during menopause, estrogen replacement therapy does not consistently or significantly reduce **mood depression**. - The relationship between estrogen and mood is complex, and depression in menopausal women often has **multifactorial causes** beyond hormonal changes. *Hot flushes* - Estrogen replacement therapy is highly effective in alleviating **vasomotor symptoms** such as hot flushes and night sweats [1, 2]. - These symptoms are directly linked to declining estrogen levels. *Atrophic vaginitis* - Estrogen therapy effectively treats **genitourinary syndrome of menopause** (GSM), including symptoms of atrophic vaginitis. - It restores the **vaginal epithelium**, increasing lubrication and reducing dryness, itching, and dyspareunia. *Osteoporosis* - Estrogen plays a crucial role in **bone density maintenance** and its decline at menopause contributes to accelerated bone loss. - Estrogen replacement therapy is a known treatment to prevent and manage **postmenopausal osteoporosis** by reducing bone turnover [1].
Question 3: Body dysmorphic disorder can be associated with all except
- A. Bulimia nervosa
- B. OCD
- C. Anxiety
- D. Mania (Correct Answer)
Explanation: ***Mania*** - **Mania** is a state of elevated, expansive, or irritable mood that is distinct from the persistent preoccupation with perceived bodily defects seen in **body dysmorphic disorder (BDD)**. - While agitation can occur in BDD, the core symptom profile of **mania**, including decreased need for sleep, grandiosity, and racing thoughts, is not a typical associated feature. *Bulimia nervosa* - **Bulimia nervosa** can co-occur with BDD, particularly when the perceived defects relate to body weight, shape, or specific body parts. - Both disorders involve intense preoccupation with body image and often lead to harmful behaviors to attempt to "correct" perceived flaws. *OCD* - **Obsessive-compulsive disorder (OCD)** shares strong phenomenological similarities with BDD, including intrusive thoughts (obsessions) and repetitive behaviors (compulsions). - BDD is often conceptualized as part of the **OCD spectrum**, with both disorders involving obsessive thoughts and repetitive behaviors related to specific concerns. *Anxiety* - **Anxiety disorders** are highly comorbid with BDD, as individuals often experience significant distress, fear of judgment, and social avoidance due to their perceived flaws. - The constant preoccupation and efforts to conceal or fix perceived defects can lead to chronic anxiety and panic attacks.
Question 4: What is considered the most effective treatment for Borderline Personality Disorder?
- A. Combination of DBT and pharmacotherapy
- B. Cognitive Behavioural Therapy (CBT)
- C. Pharmacotherapy alone
- D. Dialectical Behaviour Therapy (DBT) (Correct Answer)
Explanation: ***Dialectical Behaviour Therapy (DBT)*** - **DBT** is the **gold standard** and most evidence-based psychotherapy specifically developed for Borderline Personality Disorder - Developed by **Marsha Linehan** specifically to target the core symptoms of BPD including emotional dysregulation, impulsivity, and interpersonal difficulties - Combines **cognitive-behavioral techniques** with mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills - Has the **strongest research evidence** for reducing suicidal behavior, self-harm, and improving overall functioning in BPD patients - Multiple RCTs demonstrate DBT's superiority in treating BPD compared to standard care *Cognitive Behavioural Therapy (CBT)* - While **CBT** is effective for many mental health conditions and can help with certain BPD symptoms, it was not specifically designed for BPD - DBT is actually a specialized adaptation of CBT tailored for BPD, making it more targeted and effective for this specific condition - Generic CBT may help with co-occurring conditions like depression or anxiety but lacks the comprehensive approach needed for core BPD features *Combination of DBT and pharmacotherapy* - This combination is clinically useful, especially when treating **co-morbid conditions** like depression, anxiety, or severe mood instability - However, psychotherapy (particularly DBT) remains the **cornerstone** of BPD treatment, with medications serving an adjunctive role - The question asks for the single most effective treatment, which is DBT alone *Pharmacotherapy alone* - **No medication** is FDA-approved specifically for BPD - Pharmacotherapy may help manage specific symptoms (mood swings, impulsivity, brief psychotic episodes) but does not address the core **personality pathology** - Generally not recommended as monotherapy for BPD; should always be combined with psychotherapy
Question 5: About fibromyalgia all are true except
- A. Associated with EEG abnormalities
- B. Associated with decreased blood flow to the brain
- C. More common in males than females (Correct Answer)
- D. Associated with low free cortisol levels
Explanation: ***More common in males than females*** - Fibromyalgia is significantly **more prevalent in females** than in males, with a female-to-male ratio ranging from 2:1 to 7:1 in various studies. - The exact reasons for this gender disparity are still under investigation, but hormonal, genetic, and psychosocial factors are thought to play a role. *Associated with EEG abnormalities* - Patients with fibromyalgia often exhibit **abnormal EEG patterns**, particularly during sleep, characterized by an alpha rhythm intrusion into non-REM sleep [1]. - These EEG abnormalities are thought to contribute to the characteristic **non-restorative sleep** experienced by many fibromyalgia patients [1]. *Associated with decreased blood flow to the brain* - Studies using imaging techniques like **SPECT** and **fMRI** have shown areas of **reduced cerebral blood flow** in patients with fibromyalgia, particularly in regions involved in pain processing [1]. - This decreased blood flow may contribute to the cognitive symptoms, such as **"fibro fog"**, and altered pain perception [1]. *Associated with low free cortisol levels* - Fibromyalgia is often associated with dysregulation of the **hypothalamic-pituitary-adrenal (HPA) axis**, leading to abnormalities in cortisol secretion [1]. - While total cortisol levels can be variable, many studies report **lower free cortisol levels**, particularly during daytime hours, reflecting a blunted stress response [1].
Question 6: F00 in ICD denotes
- A. mood disorders
- B. organic disorders (Correct Answer)
- C. substance use
- D. psychosis
Explanation: ***Organic disorders - CORRECT*** - **F00-F09** in the **International Classification of Diseases (ICD-10)** Chapter V (Mental and behavioural disorders) specifically denotes **organic, including symptomatic, mental disorders** - These disorders are characterized by brain disease, brain injury, or other insult leading to **cerebral dysfunction** - **F00** specifically refers to **Dementia in Alzheimer's disease** *Mood disorders - Incorrect* - Mood disorders are classified under codes **F30-F39** in ICD-10 - This category includes conditions like bipolar affective disorder, depressive episodes, and recurrent depressive disorders *Substance use - Incorrect* - Mental and behavioral disorders due to psychoactive substance use are classified under codes **F10-F19** in ICD-10 - This section covers disorders resulting from the use of alcohol, opioids, cannabis, sedatives, hypnotics, and other substances *Psychosis - Incorrect* - Specific psychotic disorders like schizophrenia are classified under codes **F20-F29** in ICD-10 - Psychosis can be a symptom of various mental disorders, including some organic conditions
Question 7: Which of the following terms describes sexual attraction or relationships primarily between women?
- A. Masochism
- B. Nymphomania
- C. Transsexualism
- D. Lesbianism (Correct Answer)
Explanation: ***Lesbianism*** - **Lesbianism** describes sexual attraction or relationships primarily between **women**. - It is a form of **homosexuality**, specifically referring to female same-sex attraction. *Masochism* - **Masochism** is a paraphilia where sexual gratification is derived from experiencing **pain, humiliation, or bondage**. - This term does not describe the gender of individuals involved in a sexual relationship. *Nymphomania* - **Nymphomania** is an outdated and stigmatizing term historically used to describe a woman with an **uncontrollably strong desire for sexual activity**. - It does not refer to the gender of the individuals involved in the sexual attraction. *Transsexualism* - **Transsexualism** refers to the condition of a **transgender person** who identifies with a sex different from their birth sex and often seeks to transition through medical interventions. - This term describes **gender identity** rather than sexual orientation or the gender composition of a relationship.
Question 8: Provision of the Mental Health Act 2017, based on WHO guidelines, includes all, except:
- A. Social support
- B. Screening family members (Correct Answer)
- C. Human rights
- D. Communication regarding care and treatment
Explanation: ***Screening family members*** - The Mental Health Act 2017 focuses on the **rights, treatment, and support of individuals with mental illness**, not routine screening of their family members. - The Act does not contain provisions mandating **screening of asymptomatic family members**, though family history may be relevant for clinical assessment. - This is **not a provision** outlined in the Act based on WHO guidelines. *Human rights* - The Act is explicitly grounded in the **protection and promotion of human rights** for persons with mental illness (Chapter I). - Ensures care with **dignity, respect, and freedom from discrimination** as core principles. - Aligns with WHO's mental health action plan and human rights framework. *Communication regarding care and treatment* - **Section 4** emphasizes the right to information and **informed consent** for all treatment decisions. - Patients must receive clear communication about their **diagnosis, treatment options, and care plans**. - Includes provisions for **advance directives** and involvement in treatment decisions. *Social support* - **Chapter V** addresses rehabilitation and community-based services, emphasizing the role of **social support systems**. - Promotes **community integration** and access to social resources for recovery. - Recognizes family and community support as essential for long-term mental health management.
Question 9: As per the Mental Health Care Act, 2017, the maximum number of days a Magistrate can initially detain a mentally ill person is
- A. 30 days (Correct Answer)
- B. 100 days
- C. 50 days
- D. 90 days
Explanation: ***30 days*** - According to the **Mental Health Care Act, 2017, Section 102**, a Magistrate can issue an order for the **initial admission and detention** of a mentally ill person for a **maximum period of 30 days**. - This period allows for necessary psychiatric assessment and initiation of treatment before further legal proceedings or discharge are considered. - The detention order can be extended after appropriate review procedures. *50 days* - This duration is **not specified** in the Mental Health Care Act, 2017, for magisterial orders of detention. - The Act clearly defines 30 days as the maximum initial detention period under Section 102. *90 days* - While 90 days appears in the Act in different contexts (such as **review timelines** or **detention under different provisions**), it is **not the maximum period** for initial magisterial detention under Section 102. - The initial magisterial order is limited to 30 days to ensure timely judicial oversight. *100 days* - This duration is **not mentioned** in the Mental Health Care Act, 2017, for any form of magisterial detention. - The Act specifies much shorter periods to protect the rights of mentally ill individuals.
Question 10: In a clinical scenario, a patient presents with altered mental status due to substance intoxication. Which of the following is the most appropriate management step?
- A. Administer activated charcoal
- B. Administer flumazenil
- C. Perform gastric lavage
- D. Provide supportive care and monitoring (Correct Answer)
Explanation: ***Provide supportive care and monitoring*** - For most substance intoxications causing altered mental status, **supportive care** (e.g., airway management, fluid resuscitation, temperature control) is the cornerstone of treatment while the body metabolizes the substance [1][2]. - **Continuous monitoring** of vital signs and neurological status ensures early detection and management of complications [2][4]. *Administer activated charcoal* - **Activated charcoal** is useful for certain ingested toxins to prevent absorption, but its efficacy is time-dependent (best within 1-2 hours of ingestion) and it's contraindicated in patients with unprotected airways or those who ingested corrosives or hydrocarbons [1]. - In a patient with **altered mental status**, there is a significant risk of aspiration if the airway is not secured, making routine administration of activated charcoal inappropriate [1]. *Administer flumazenil* - **Flumazenil** is a benzodiazepine receptor antagonist used to reverse the effects of benzodiazepine overdose, but it is rarely indicated for general altered mental status due to substance intoxication. - Its use can precipitate **seizures** in patients with benzodiazepine dependence or co-ingestion of proconvulsant substances, making it a high-risk intervention for an undifferentiated altered mental status. *Perform gastric lavage* - **Gastric lavage** involves flushing the stomach with fluid and aspirating it to remove ingested toxins, but it's rarely indicated due to low efficacy and significant risks. - Risks include **aspiration**, **esophageal perforation**, and disruption of the gag reflex, especially in patients with altered mental status and an unprotected airway [1][3].
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free