Treatment-Resistant Anxiety — MCQs
In OCD, if the patient tries to resist obsession, then patient develops?
Tolerance to substances is seen in which of the following?
Which of the following actions is NOT associated with tricyclic antidepressants?
What is the treatment of choice for acute panic attacks?
What deficiency may contribute to relapse in a patient who has experienced remission with selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs)?
Which of the following drugs is given for detoxification of alcohol in chronic alcoholics?
Best treatment for nocturnal enuresis is
What is the treatment of choice for a gonococcal infection that is resistant to penicillin?
Why is a regimen of four drugs recommended for a TB patient on the first visit?
Multidrug-resistant (MDR) tuberculosis shows resistance to which of the following drugs?
Treatment-Resistant Anxiety Indian Medical PG Practice Questions and MCQs
Question 1: In OCD, if the patient tries to resist obsession, then patient develops?
- A. Delusion
- B. Depression
- C. Mania
- D. Anxiety (Correct Answer)
Explanation: ***Anxiety*** - In **Obsessive-Compulsive Disorder (OCD)**, attempts to resist obsessions or compulsions typically lead to a significant increase in **anxiety** and distress. - This heightened anxiety is a primary driver for individuals to engage in ritualistic compulsions, as these acts provide a temporary reduction in the uncomfortable feeling. *Delusion* - A **delusion** is a fixed, false belief that is impervious to reason or evidence, which is characteristic of psychotic disorders, not typically seen as a direct consequence of resisting obsessions in OCD. - While OCD can sometimes have poor insight, the core issue is intrusive thoughts and behaviors, not a break from reality. *Depression* - **Depression** is a mood disorder characterized by persistent sadness and loss of interest, and while it often co-occurs with OCD due to the chronic stress and impairment, it's not the immediate, direct consequence of resisting an obsession. - The immediate response to resistance is anxiety, which can contribute to depression over time. *Mania* - **Mania** is a state of abnormally elevated arousal, affect, and energy level often associated with bipolar disorder. - It is not a symptom or a direct outcome of attempting to resist obsessions in OCD.
Question 2: Tolerance to substances is seen in which of the following?
- A. Obsessive-compulsive disorder
- B. Physiological dependence (Correct Answer)
- C. Hypochondriasis
- D. Psychological dependence
Explanation: ***Physiological dependence*** - **Tolerance** is a hallmark feature of physiological dependence, where the body adapts to a substance, requiring increasingly larger doses to achieve the initial effect. - It involves neurobiological adaptations in the brain in response to chronic substance use. - Physiological dependence is characterized by both **tolerance** and **withdrawal symptoms** as key features. *Hypochondriasis* - This is a mental disorder characterized by an excessive preoccupation with having a serious illness, despite medical reassurance. - It does not involve substance use or development of tolerance to a substance. *Obsessive-compulsive disorder* - OCD is an anxiety disorder marked by recurrent unwanted thoughts (**obsessions**) and repetitive behaviors (**compulsions**). - It is not related to substance use, tolerance, or dependence. *Psychological dependence* - Psychological dependence involves a strong emotional or mental desire for a drug, characterized by craving and compulsive drug-seeking behavior. - While psychological dependence can coexist with tolerance, the primary feature is the **emotional craving** rather than the physical adaptation. - **Physiological dependence** more directly encompasses tolerance as a defining characteristic, along with physical withdrawal symptoms.
Question 3: Which of the following actions is NOT associated with tricyclic antidepressants?
- A. Block 5-HT or NE reuptake
- B. Anticholinergic action
- C. MAO inhibition (Correct Answer)
- D. Causes sedation
Explanation: ***MAO inhibition*** - Tricyclic antidepressants (TCAs) primarily exert their effects by inhibiting the reuptake of **norepinephrine** and **serotonin**, not by inhibiting monoamine oxidase (MAO). - **MAO inhibitors** are a distinct class of antidepressants with a different mechanism of action and side effect profile. *Anticholinergic action* - Many TCAs have significant **anticholinergic effects**, blocking muscarinic receptors and leading to side effects like dry mouth, constipation, and blurred vision. - These effects contribute to the **adverse event profile** of TCAs, especially in elderly patients. *Block 5-HT or NE reuptake* - The primary mechanism of action of TCAs involves the **inhibition of serotonin (5-HT)** and **norepinephrine (NE) reuptake** into presynaptic neurons. - This action increases the concentration of these neurotransmitters in the **synaptic cleft**, thereby potentiating their effects. *Causes sedation* - TCAs frequently cause **sedation**, particularly the more histaminergic ones (e.g., amitriptyline, doxepin), due to their **histamine H1 receptor antagonism**. - This side effect can be beneficial for patients with insomnia but can be problematic for daytime functioning.
Question 4: What is the treatment of choice for acute panic attacks?
- A. Tricyclic antidepressants (TCAs)
- B. Monoamine oxidase inhibitors (MAOIs)
- C. Barbiturates
- D. Benzodiazepines (Correct Answer)
Explanation: ***Correct: Benzodiazepines*** - Benzodiazepines are the **treatment of choice for acute panic attacks** due to their **rapid onset of action** (within minutes) - They work by enhancing **GABA-A receptor** activity, providing immediate anxiolytic effects - Commonly used agents include **alprazolam, lorazepam, and clonazepam** - While effective acutely, they are not recommended for long-term management due to dependence risk *Incorrect: Tricyclic antidepressants (TCAs)* - TCAs are effective for **long-term prophylaxis** of panic disorder, not acute attacks - They have a **delayed onset of action** (2-4 weeks), making them unsuitable for immediate relief - Significant **anticholinergic effects** and potential cardiotoxicity limit their use *Incorrect: Monoamine oxidase inhibitors (MAOIs)* - MAOIs can be effective for panic disorder but are reserved for **treatment-resistant cases** - **Delayed onset of action** (several weeks) makes them inappropriate for acute attacks - Require **dietary restrictions** and have risk of hypertensive crisis with tyramine-containing foods *Incorrect: Barbiturates* - Largely **obsolete** in psychiatric practice, replaced by safer benzodiazepines - **Narrow therapeutic index** with high risk of overdose and respiratory depression - Greater potential for dependence and withdrawal complications - No role in modern management of panic attacks
Question 5: What deficiency may contribute to relapse in a patient who has experienced remission with selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs)?
- A. Pyridoxine
- B. Cobalamin
- C. Ascorbate
- D. Folate (Correct Answer)
Explanation: ***Folate*** - **Folate (vitamin B9) deficiency** is strongly linked to depression and is a well-established cause of relapse in patients treated with antidepressants. - Folate plays a crucial role in the **one-carbon metabolism pathway**, which is essential for the synthesis of monoamine neurotransmitters including **serotonin, norepinephrine, and dopamine**. - Studies show that **low folate levels** are associated with poor response to SSRIs and TCAs, and folate supplementation can improve antidepressant efficacy. - Approximately **30% of depressed patients** have folate deficiency, making it a clinically significant factor in treatment resistance and relapse. *Cobalamin* - **Cobalamin (vitamin B12)** deficiency can cause neuropsychiatric symptoms including depression and cognitive impairment. - While B12 is important for myelin formation and neurotransmitter synthesis, it is less specifically implicated in antidepressant relapse compared to folate. - B12 deficiency more commonly presents with **cognitive and neurological symptoms** rather than pure mood symptoms. *Pyridoxine* - **Pyridoxine (vitamin B6)** is a cofactor in neurotransmitter synthesis, including serotonin and dopamine. - While B6 deficiency can contribute to mood disturbances, it is not commonly implicated as a primary cause of relapse in antidepressant-treated depression. *Ascorbate* - **Ascorbate (vitamin C)** is an antioxidant with some role in neurotransmitter metabolism. - Severe vitamin C deficiency (scurvy) can have psychiatric manifestations, but it is not typically associated with relapse in patients treated with SSRIs or TCAs.
Question 6: Which of the following drugs is given for detoxification of alcohol in chronic alcoholics?
- A. Haloperidol
- B. Naltrexone
- C. Chlordiazepoxide (Correct Answer)
- D. Buprenorphine
Explanation: ***Correct Option: Chlordiazepoxide*** - **Chlordiazepoxide** is a **benzodiazepine** commonly used for acute alcohol withdrawal syndrome due to its long half-life and efficacy in reducing withdrawal symptoms. - It helps prevent **seizures** and **delirium tremens** by acting on GABA receptors, reducing neuronal hyperexcitability. *Incorrect Option: Haloperidol* - **Haloperidol** is an **antipsychotic** medication primarily used to manage acute psychosis, agitation, or delirium. - It does not directly address alcohol withdrawal symptoms and can potentially lower the **seizure threshold**, which is risky in alcohol withdrawal. *Incorrect Option: Naltrexone* - **Naltrexone** is an **opioid antagonist** used to reduce alcohol cravings and prevent relapse in individuals who have achieved abstinence. - It is not used for acute detoxification or withdrawal management, as it does not alleviate acute symptoms. *Incorrect Option: Buprenorphine* - **Buprenorphine** is a **partial opioid agonist** used primarily in the treatment of opioid use disorder. - It has no role in the detoxification or management of alcohol withdrawal syndrome.
Question 7: Best treatment for nocturnal enuresis is
- A. Positive reinforcement
- B. Punishment
- C. Bed alarm (Correct Answer)
- D. Desmopressin
Explanation: ***Bed alarm*** - **Bed alarms** are considered the most effective long-term treatment for nocturnal enuresis by conditioning the child to wake up to a full bladder. - This method has a high success rate and a lower relapse rate compared to pharmacological treatments. *Positive reinforcement* - While helpful for building confidence and encouraging adherence to treatment, **positive reinforcement** alone is generally not sufficient to cure nocturnal enuresis. - It works best as an adjunct to other established treatments, like bed alarms, to motivate the child. *Punishment* - **Punishment** is not an effective or appropriate treatment for nocturnal enuresis and can be psychologically harmful to the child. - Enuresis is an involuntary condition, and punishment can lead to increased stress, anxiety, and shame, potentially worsening the problem. *Desmopressin* - **Desmopressin** (DDAVP) is a synthetic analog of antidiuretic hormone and can reduce urine production at night, offering a short-term solution. - It is effective in reducing the frequency of wet nights but has a higher relapse rate once discontinued, and it does not cure the underlying problem like a bed alarm does.
Question 8: What is the treatment of choice for a gonococcal infection that is resistant to penicillin?
- A. Penicillin
- B. Ceftazidime
- C. Ceftriaxone (Correct Answer)
- D. Spectinomycin
Explanation: ***Ceftriaxone*** - **Ceftriaxone** is the recommended first-line treatment for uncomplicated gonococcal infections, especially given increasing resistance to other antibiotics like penicillin. - It is a **third-generation cephalosporin** that targets the bacterial cell wall synthesis effectively. *Penicillin* - **Penicillin** is no longer the recommended treatment for gonorrhea due to widespread resistance, primarily mediated by **beta-lactamase production** by *Neisseria gonorrhoeae*. - Treating with penicillin when resistance is present would lead to treatment failure and continued transmission. *Ceftazidime* - **Ceftazidime** is a third-generation cephalosporin with activity against gram-negative organisms. - However, its activity against *Neisseria gonorrhoeae* is not considered first-line or superior to ceftriaxone, which has better pharmacokinetic properties for treating gonorrhea. *Spectinomycin* - **Spectinomycin** is an alternative treatment for gonococcal infections, particularly in individuals with severe allergy to cephalosporins or in regions where ceftriaxone resistance is emerging. - However, it is not the treatment of choice in regions where ceftriaxone is effective and available.
Question 9: Why is a regimen of four drugs recommended for a TB patient on the first visit?
- A. To prevent emergence of drug-resistant strains (Correct Answer)
- B. To reduce bacterial load effectively
- C. To minimize treatment duration
- D. None of the options
Explanation: ***To prevent emergence of drug-resistant strains*** - Using a **four-drug regimen** at the initial stage significantly reduces the likelihood of **Mycobacterium tuberculosis** developing resistance to any single drug. - This strategy ensures that even if a small number of bacteria are naturally resistant to one drug, the other drugs will still be effective in killing them, preventing the proliferation of **resistant strains**. *To minimize treatment duration* - While a multi-drug regimen is effective, its primary goal is not to minimize treatment duration but rather to ensure **eradication of the infection** and prevent resistance. - Treatment duration is determined by the need to kill both actively multiplying and dormant bacteria, which typically takes several months even with multiple drugs. *To reduce bacterial load effectively* - Reducing bacterial load is certainly a goal of TB treatment, but the use of four drugs is specifically aimed at achieving this while simultaneously preventing **drug resistance**. - A single effective drug could reduce bacterial load, but it would quickly lead to the emergence of resistant bacteria, making the long-term goal of **cure** impossible. *None of the options* - This option is incorrect because the primary reason for a **four-drug regimen** in TB treatment is indeed to prevent the emergence of **drug-resistant strains**.
Question 10: Multidrug-resistant (MDR) tuberculosis shows resistance to which of the following drugs?
- A. Isoniazid, rifampicin, and fluoroquinolone
- B. Fluoroquinolone
- C. Isoniazid, rifampicin, and kanamycin
- D. Isoniazid and rifampicin only (Correct Answer)
Explanation: ***Isoniazid and rifampicin only*** - **Multidrug-resistant (MDR) tuberculosis** is specifically defined by resistance to both **isoniazid** and **rifampicin**. - These two drugs are considered the most effective first-line anti-TB medications, making resistance to both a significant treatment challenge. *Isoniazid, rifampicin, and fluoroquinolone* - Resistance to **isoniazid**, **rifampicin**, and *any* fluoroquinolone defines **pre-extensively drug-resistant (pre-XDR) TB**, not MDR-TB. - Adding resistance to a fluoroquinolone indicates a more severe and harder-to-treat form of tuberculosis. *Fluoroquinolone* - Resistance to **fluoroquinolone** alone does not define MDR-TB; it is only one component of resistance that, when combined with resistance to isoniazid and rifampicin, signifies pre-XDR or XDR-TB. - While fluoroquinolones are important second-line drugs, their resistance in isolation does not meet the criteria for MDR-TB. *Isoniazid, rifampicin, and kanamycin* - Resistance to **isoniazid**, **rifampicin**, and *any* second-line injectable agent (like **kanamycin**, capreomycin, or amikacin) defines **extensively drug-resistant (XDR) TB**, not MDR-TB. - XDR-TB represents an even more complex and difficult form of the disease to treat, requiring highly specialized regimens.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free