Psychosomatic Disorders — MCQs

10 questions

Psychodynamic model of disease explains the psychopathologic cause of all mental illness to be

Best therapy suited to teach daily life skills to a child with intellectual disability:

A 36-year-old woman presents with a headache, backache, epigastric fullness, and decreased sexual desire. She has lost 2.5 kg over the past 3 years, and her appetite is otherwise normal. Her husband had a major vehicular accident 8 years ago. Which of the following diagnoses best describes the mental status of this patient?

A nondiabetic, nonhypertensive patient has occasional extra heartbeats. The doctor informed them it is benign, but the patient continues to seek investigations from doctor to doctor. This is a type of:

Best therapy suited to teach daily life skill to a mentally challenged child:

A 35 year old man feels that he is about to die because he is suffering from gastric cancer. All his radiological investigations prove the contrary. Which is the most probable diagnosis?

Which reflex is being tested here?

Q8Medium

A 5-year-old child refuses to sleep in his bed, claiming there are monsters in his closet and that he has bad dreams. The parents allow him to sleep with them in their bed to avoid the otherwise inevitable screaming fit. The parents note that the child sleeps soundly, waking only at sunrise. Which sleep disturbance is most consistent with this history?

Q9Easy

A child guidance clinic is most helpful in all of the following conditions except:

Q10Easy

All of the following are true about Rett's syndrome, except?

Psychosomatic Disorders Indian Medical PG Practice Questions and MCQs

Question 1: Psychodynamic model of disease explains the psychopathologic cause of all mental illness to be

A. Structural and functional defect in CNS
B. Maladaptive
C. Cognition difficulties
D. Unconscious conflict (Correct Answer)

Explanation: **Correct: Unconscious conflict** - The **psychodynamic model**, largely based on Freudian theory, posits that psychopathology arises from unresolved **unconscious conflicts** or repressed urges and experiences. - These conflicts typically stem from early childhood experiences and defense mechanisms used to cope with them, leading to symptomatic behavior. - This is the fundamental explanatory mechanism of the psychodynamic framework. *Incorrect: Structural and functional defect in CNS* - This explanation aligns with the **biomedical model**, which attributes mental illness to biological factors like **neurotransmitter imbalances**, genetic predispositions, or brain abnormalities. - While biological factors are crucial in understanding some mental illnesses, they are not the primary explanatory mechanism in the psychodynamic framework. *Incorrect: Maladaptive* - While psychopathology often involves **maladaptive behaviors** or thought patterns, the psychodynamic model views these as symptoms or manifestations of the underlying unconscious conflict, rather than the root cause itself. - Other models, like **behavioral psychology**, focus more directly on maladaptive learning as the primary cause. *Incorrect: Cognition difficulties* - **Cognitive difficulties** and distortions are central to the **cognitive model** of psychopathology, which suggests that mental illness results from faulty thinking patterns or dysfunctional schemas. - The psychodynamic model acknowledges intellectual functions, but it primarily sees disturbances in cognition as driven by deeper, unconscious emotional processes.

Question 2: Best therapy suited to teach daily life skills to a child with intellectual disability:

A. Applied Behavior Analysis (ABA) (Correct Answer)
B. Cognitive Behavioral Therapy (CBT)
C. Social skills training
D. Self-instructional training

Explanation: **Applied Behavior Analysis (ABA)** - **ABA** is a highly structured, evidence-based therapy that focuses on teaching specific skills by breaking them down into smaller steps and using **positive reinforcement**. - It is particularly effective for children with intellectual disabilities in acquiring **adaptive daily living skills**, communication, and social behaviors. *Cognitive Behavioral Therapy (CBT)* - **CBT** primarily targets changing negative thought patterns and behaviors, requiring a level of abstract reasoning that may be challenging for children with significant intellectual disabilities. - While it can be adapted, its core methods rely on cognitive processes that might not be the most direct approach for teaching basic daily life skills to a mentally challenged child. *Social skills training* - **Social skills training** focuses specifically on improving social interactions and communication within social contexts. - While important for overall development, it is a subcomponent of broader skill development and may not directly address all aspects of **daily living skills** in a comprehensive manner. *Self-instructional training* - **Self-instructional training** involves teaching individuals to guide themselves through tasks using internal speech or self-talk, which relies on a child's ability to internalize and follow complex verbal instructions. - This approach might be too cognitively demanding for a child with significant developmental delays when the primary goal is mastering basic, functional daily life skills.

Question 3: A 36-year-old woman presents with a headache, backache, epigastric fullness, and decreased sexual desire. She has lost 2.5 kg over the past 3 years, and her appetite is otherwise normal. Her husband had a major vehicular accident 8 years ago. Which of the following diagnoses best describes the mental status of this patient?

A. Adjustment disorder and depression
B. Depersonalization disorder
C. Posttraumatic stress disorder (PTSD)
D. Somatic Symptom Disorder (Correct Answer)

Explanation: ***Somatic Symptom Disorder*** - The patient presents with **multiple unexplained physical symptoms** (headache, backache, epigastric fullness, decreased sexual desire) affecting different organ systems that have persisted over years. This is characteristic of **Somatic Symptom Disorder** (formerly somatization disorder in DSM-IV). - According to **DSM-5 criteria**, this disorder involves one or more somatic symptoms that are distressing, along with excessive thoughts, feelings, or behaviors related to these symptoms, persisting for **more than 6 months**. - There is a **temporal relationship with a stressful event** (husband's accident 8 years ago), suggesting psychological distress manifesting as physical symptoms. - The chronic nature of multiple somatic complaints across body systems without adequate medical explanation points to this diagnosis. *Depersonalization-Derealization Disorder* - This disorder involves persistent or recurrent feelings of **detachment from one's own mental processes or body** (depersonalization) or feeling that surroundings are unreal (derealization). - The patient's symptoms are primarily **physical complaints**, not experiences of unreality or detachment from self. - No mention of feeling like an outside observer of one's thoughts or body. *Adjustment disorder and depression* - While the trauma (husband's accident) could trigger an **adjustment disorder**, this diagnosis requires symptoms to occur **within 3 months** of the stressor and typically resolve within **6 months** after the stressor ends. The 8-year timeframe makes this unlikely. - **Depression** typically involves prominent **mood disturbances** (persistent sadness, anhedonia), sleep disturbances, fatigue, guilt, and concentration difficulties. While decreased libido and appetite changes can occur, the predominant presentation here is multiple somatic complaints rather than mood symptoms. - The patient's normal appetite and lack of described mood symptoms make major depression less likely. *Posttraumatic stress disorder (PTSD)* - PTSD requires **direct exposure** to actual or threatened death, serious injury, or sexual violence. The patient's **husband** experienced the accident, not the patient directly (though witnessing could qualify). - Key PTSD symptoms include **intrusive re-experiencing** (flashbacks, nightmares), **avoidance** of trauma reminders, **negative alterations in cognition and mood**, and **hyperarousal** symptoms. - The vignette describes **somatic complaints** but no re-experiencing, avoidance behaviors, or hyperarousal, making PTSD unlikely.

Question 4: A nondiabetic, nonhypertensive patient has occasional extra heartbeats. The doctor informed them it is benign, but the patient continues to seek investigations from doctor to doctor. This is a type of:

A. Depression
B. Conversion disorder
C. Somatoform pain
D. Illness Anxiety Disorder (Correct Answer)

Explanation: ***Illness Anxiety Disorder*** - This condition is characterized by **preoccupation with having or acquiring a serious illness**, despite minimal or no somatic symptoms, or an excessive preoccupation if symptoms are present. - The patient's repeated seeking of investigations despite medical assurance of a benign condition aligns with the diagnostic criteria of **illness anxiety disorder**, where reassurance has little effect. *Depression* - While **depressive symptoms** (e.g., low mood, anhedonia) can coexist with health anxieties, the primary driver here is the fear of serious illness rather than pervasive sadness or loss of interest. - Patients with depression typically report a **generalized dysphoria** or lack of energy, which is not the central issue described. *Conversion disorder* - Involves **neurological symptoms** (e.g., paralysis, blindness, seizures) that are incompatible with recognized neurological conditions and are not intentionally produced. - The patient's concern is about a benign cardiac finding, not the sudden onset of **functional neurological deficits**. *Somatoform pain* - This term is older and has largely been replaced by **Somatic Symptom Disorder with predominant pain**, where psychological factors play a significant role in the onset, severity, exacerbation, or maintenance of pain. - The patient's main concern is about the **implication of a benign symptom** rather than experiencing overwhelming pain itself.

Question 5: Best therapy suited to teach daily life skill to a mentally challenged child:

A. Contingency management (Correct Answer)
B. Cognitive reconstruction
C. Self instruction
D. CBT (Cognitive behavior therapy)

Explanation: ***Contingency management*** - This therapy involves consistently **rewarding desired behaviors** and withholding rewards for undesirable ones, which is highly effective for teaching new skills to individuals with intellectual disabilities. - It uses principles of **operant conditioning** to shape behavior through positive reinforcement, making it suitable for acquiring daily living skills. *Cognitive reconstruction* - This technique focuses on identifying and changing **maladaptive thought patterns**, which typically requires a higher level of cognitive function. - It is generally not the primary or most effective approach for teaching concrete daily life skills to individuals with significant **cognitive limitations**. *Self instruction* - This involves teaching individuals to guide their own behavior using **internal verbal cues** or self-talk. - While beneficial for some, it often requires a certain degree of **abstract thinking** and memory, making it less suitable as a standalone method for those with profound cognitive challenges in acquiring basic skills. *CBT (Cognitive behavior therapy)* - CBT integrates cognitive and behavioral strategies to address emotional and behavioral problems by modifying **thoughts, feelings, and behaviors**. - While beneficial for a range of psychological issues, its emphasis on **cognitive restructuring** makes it less directly applicable or the most effective first-line therapy for teaching concrete, functional daily living skills to mentally challenged children.

Question 6: A 35 year old man feels that he is about to die because he is suffering from gastric cancer. All his radiological investigations prove the contrary. Which is the most probable diagnosis?

A. Somatic symptom disorder
B. Conversion disorder
C. Delusional disorder
D. Illness anxiety disorder (Correct Answer)

Explanation: ***Illness anxiety disorder*** - This patient exhibits a **preoccupation with having a serious illness** (gastric cancer) despite evidence to the contrary (negative radiological investigations). - The fear of illness is **persistent** and **causes significant distress**, leading to the belief that he is "about to die." - In illness anxiety disorder, patients may have **intense health anxiety** but typically retain some capacity for at least temporary reassurance with negative test results, even if the anxiety returns. - The presentation focuses on **fear and preoccupation** rather than an absolutely fixed, unshakeable delusional belief. *Somatic symptom disorder* - Characterized by **one or more significant physical symptoms** that cause significant distress or functional impairment, along with excessive thoughts, feelings, or behaviors related to these symptoms. - In this case, the primary concern is the *fear* of having a serious illness, rather than significant physical symptoms themselves. - The emphasis is on the **belief about having cancer** rather than distressing somatic symptoms. *Conversion disorder* - Involves **neurological symptoms** (e.g., altered motor or sensory function, weakness, paralysis, seizures) that are incompatible with recognized neurological or medical conditions. - The patient's presentation does not involve neurological deficits, and the primary concern is fear of a specific disease (gastric cancer) rather than unexplained neurological symptoms. *Delusional disorder* - Characterized by one or more **fixed, unshakeable, nonbizarre delusions** that persist for at least one month. - In **delusional disorder, somatic type**, the patient would have an absolutely fixed belief about having a disease with **no insight** and **no response to reassurance** despite clear contrary evidence. - While this patient has a strong belief about having cancer, the clinical presentation described (preoccupation with health concerns in the context of negative investigations) aligns more specifically with **illness anxiety disorder**, which is the more common diagnosis in this scenario per standard medical teaching.

Question 7: Which reflex is being tested here?

A. Brachioradialis reflex
B. Hoffman reflex (Correct Answer)
C. Finger flexor reflex
D. Supinator reflex

Explanation: ***Hoffman reflex*** - The image shows the examiner flicking a patient's **distal phalanx of the middle finger**, which is the classic method for eliciting the Hoffman reflex. - A positive Hoffman sign involves **involuntary flexion of the thumb and index finger**, indicating a potential **upper motor neuron lesion** in the cervical spinal cord. *Brachioradialis reflex* - This reflex is elicited by striking the **distal radius**, about 2-3 inches above the wrist, with a reflex hammer. - The expected response is **flexion and supination** of the forearm, which is not what is shown in the image. *Finger flexor reflex* - The finger flexor reflex, or finger jerk reflex, is similar to the Hoffman but typically involves stimulating the palmar surface or the tips of all the fingers, leading to their flexion. - While related to finger flexion, the specific maneuver of flicking the middle finger's distal phalanx for involuntary thumb and index finger flexion is characteristic of the **Hoffman reflex**. *Supinator reflex* - The supinator reflex is another name for the **brachioradialis reflex**, as it involves the supinator muscle. - It is also elicited by striking the distal radius, leading to forearm flexion and supination, not the finger flick seen in the image.

Question 8: A 5-year-old child refuses to sleep in his bed, claiming there are monsters in his closet and that he has bad dreams. The parents allow him to sleep with them in their bed to avoid the otherwise inevitable screaming fit. The parents note that the child sleeps soundly, waking only at sunrise. Which sleep disturbance is most consistent with this history?

A. Night terrors
B. Nightmares
C. Learned behavior (Correct Answer)
D. Obstructive sleep apnea

Explanation: **Explanation:** The correct answer is **Learned behavior** (specifically, a conditioned sleep-onset association). **1. Why Learned Behavior is Correct:** The child’s refusal to sleep in his own bed and the subsequent "screaming fits" are forms of **limit-setting sleep disorder**. By allowing the child to sleep in their bed to avoid a tantrum, the parents are providing **positive reinforcement** for the behavior. The child has "learned" that protesting leads to the desired outcome (sleeping with parents). A key diagnostic clue here is that the child **sleeps soundly** once the condition (sleeping with parents) is met, which distinguishes this from primary sleep disorders. **2. Why Other Options are Incorrect:** * **Night Terrors (Sleep Terrors):** These occur during NREM (Stage N3) sleep. The child typically appears terrified, screams, and is inconsolable, but remains asleep and has **no memory** of the event. This child is awake and making "claims" about monsters to stay with parents. * **Nightmares:** While the child mentions "bad dreams," nightmares occur during REM sleep and typically cause the child to wake up *during* the night in a state of fear. This child’s primary issue is the **struggle at bedtime** (sleep onset), and he sleeps soundly once in the parents' bed. * **Obstructive Sleep Apnea (OSA):** OSA presents with snoring, gasping, restless sleep, and daytime hyperactivity. It does not manifest as behavioral resistance to sleeping alone. **Clinical Pearls for NEET-PG:** * **Night Terrors vs. Nightmares:** Night terrors occur in the first third of the night (NREM), with no recall. Nightmares occur in the later part of the night (REM), with vivid recall. * **Management of Learned Behavior:** The treatment of choice is **behavioral modification** (e.g., "graduated extinction" or "controlled crying") and establishing a consistent bedtime routine. * **Developmental Milestone:** Fears of "monsters" or the dark are developmentally normal for a 5-year-old, but the *persistence* and the parental *reaction* turn it into a behavioral sleep disturbance.

Question 9: A child guidance clinic is most helpful in all of the following conditions except:

A. Bed wetting
B. Cerebral palsy
C. Squint (Correct Answer)
D. School adjustment problems

Explanation: ### Explanation **Correct Option: C (Squint)** **Why Squint is the Correct Answer:** A **Child Guidance Clinic (CGC)** is a specialized multi-disciplinary facility designed to manage emotional, behavioral, and psychological disorders in children. **Squint (Strabismus)** is a purely physical/anatomical ophthalmological condition involving the misalignment of the eyes. It requires surgical or optical correction by an ophthalmologist, not psychological intervention. Therefore, it falls outside the scope of a CGC. **Analysis of Incorrect Options:** * **Bed wetting (Enuresis):** This is a common behavioral/developmental disorder. While it can have organic causes, it is frequently associated with emotional stress or developmental delays, making it a classic case for CGC management (behavioral therapy, counseling). * **Cerebral Palsy (CP):** Although CP is a motor disorder, children with CP often suffer from associated cognitive impairments, learning disabilities, and emotional/behavioral challenges. A CGC provides the necessary psychological support and rehabilitation guidance for these comorbid conditions. * **School adjustment problems:** These include school phobia, learning disabilities (Dyslexia), and ADHD. These are core areas of focus for a CGC, involving psychologists and social workers to improve the child’s social and academic functioning. **High-Yield Clinical Pearls for NEET-PG:** * **CGC Team:** Typically consists of a **Child Psychiatrist** (Leader), Clinical Psychologist, Educational Psychologist, and Psychiatric Social Worker. * **Primary Goal:** Early detection and treatment of maladjustment and personality disorders to prevent adult mental illness. * **Common Indications:** Habit disorders (thumb sucking, nail-biting), conduct disorders (lying, stealing), and emotional disorders (anxiety, temper tantrums).

Question 10: All of the following are true about Rett's syndrome, except?

A. Regression of milestones occurs after 5 months of age
B. Microcephaly is a characteristic feature
C. Mental retardation is present
D. It is more common in males (Correct Answer)

Explanation: ### Explanation **Rett’s Syndrome** is a unique neurodevelopmental disorder caused by a mutation in the **MECP2 gene** located on the **X chromosome**. **Why Option D is the Correct Answer (The "Except"):** Rett’s syndrome is almost exclusively seen in **females**. In males, because they possess only one X chromosome, the mutation is typically **lethal in utero** or results in severe neonatal encephalopathy and early death. Therefore, the statement that it is "more common in males" is false. **Analysis of Other Options:** * **Option A (Regression after 5 months):** This is a hallmark of the disease. Infants typically have normal prenatal and perinatal development, followed by a period of regression (loss of purposeful hand skills and spoken language) usually starting between **5 to 48 months** of age. * **Option B (Microcephaly):** Deceleration of head growth leading to **acquired microcephaly** is a classic clinical diagnostic criterion. * **Option C (Mental Retardation):** Severe cognitive impairment and intellectual disability (mental retardation) are consistent features of the syndrome following the regression phase. **High-Yield Clinical Pearls for NEET-PG:** * **Hand-Wringing:** The most characteristic sign is repetitive, stereotypic hand movements (wringing, clapping, or washing motions) that replace purposeful hand use. * **Breathing Abnormalities:** Patients often exhibit episodes of hyperventilation or apnea while awake. * **Genetic Basis:** Mutation in the **MECP2 gene** (Methyl-CpG-binding protein 2). * **Social Interaction:** Unlike Autism, children with Rett’s syndrome may show a transient improvement in social interaction ("social recovery") after the initial regression phase.

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