Consultation-Liaison Psychiatry Practice Questions

Q: A 41-year-old male presents with complaints of inability to achieve proper erections during sexual intercourse. He reports that there were no abnormalities until last month, when on one occasion he tried having sex while he was drunk. He was not able to achieve a proper erection at that time, and since then, on four other occasions, he has been unable to have an erection during attempted sex. He reports that his morning erections are fine and erections during masturbation were also normal. He is a diabetic, and the blood reports show FBS-103 mg/dl, HbA1C-6.6. His BP was 138/88 mm Hg. What is the likely cause of his erection disturbances?

Anxiety. **Explanation** The clinical presentation points toward **Psychogenic Erectile Dysfunction (ED)**, specifically triggered by **Performance Anxiety**. **Why Anxiety is the correct answer:** The hallmark of psychogenic ED is the **situational nature** of the symptoms. The patient reports normal morning erections (nocturnal penile tumescence) and normal erections during masturbation. This confirms that the physiological mechanisms (neurological, vascular, and hormonal) required for an erection are intact. The dysfunction began after a single failure (likely due to alcohol's sedative effect), leading to a "vicious cycle" where the fear of failure (performance anxiety) triggers a sympathetic nervous system surge, preventing the parasympathetic response necessary for an erection. **Why other options are incorrect:** * **Diabetes & Hypertension:** While both are common causes of *organic* ED due to microvascular and endothelial damage, organic ED is typically gradual in onset and characterized by the **absence** of morning or masturbatory erections. This patient’s HbA1C (6.6) and BP are relatively well-controlled. * **Alcohol use:** While acute alcohol ingestion can cause temporary ED (as seen in his first episode), it does not explain the subsequent failures while sober, especially when nocturnal erections remain preserved. **Clinical Pearls for NEET-PG:** * **Organic vs. Psychogenic ED:** If spontaneous morning erections are present, the cause is almost always psychogenic. * **Performance Anxiety:** This is the most common cause of psychogenic ED in young and middle-aged men. * **Nocturnal Penile Tumescence (NPT) Test:** Used to differentiate organic from psychogenic ED. A positive NPT (erections during sleep) confirms a psychogenic etiology. * **Diabetes:** The most common organic cause of ED due to a combination of neuropathy and angiopathy.

Q: Pseudodrugia Fantastica is seen in which of the following conditions?

Factitious disorder. **Explanation:** **Pseudologia Fantastica** (often referred to as pathological lying) is a hallmark clinical feature of **Factitious Disorder** (Munchausen Syndrome). It involves the creation of elaborate, complex, and often grandiose tales about one’s life, medical history, or social status. These stories are typically a mix of truth and fiction, designed to gain attention, sympathy, or the "sick role." **Why the Correct Answer is Right:** In **Factitious Disorder**, the primary motivation is internal (psychological)—the patient seeks the identity of a patient to receive care and attention. Pseudologia Fantastica serves this goal by providing a dramatic narrative that justifies medical intervention or hospitalization. **Analysis of Incorrect Options:** * **Malingering:** Unlike factitious disorder, malingering is motivated by **external incentives** (e.g., avoiding military duty, obtaining drugs, or financial gain). While they lie, it is not the compulsive, "fantastic" storytelling seen in Pseudologia Fantastica. * **Somatization Syndrome:** Patients genuinely believe they are ill and experience physical symptoms. They do not consciously fabricate stories or symptoms for attention. * **Dissociative Fugue:** This involves sudden, unexpected travel away from home with an inability to recall one’s past. It is a disorder of memory and identity, not a conscious fabrication of elaborate lies. **High-Yield Clinical Pearls for NEET-PG:** * **Munchausen Syndrome:** The most severe form of Factitious Disorder, characterized by "hospital hopping" and invasive self-harm to mimic disease. * **Munchausen by Proxy:** A form of child abuse where a caregiver (usually the mother) fabricates or induces illness in a child. * **Key Distinction:** Factitious Disorder = **Internal** incentive (Sick role); Malingering = **External** incentive (Secondary gain).

Q: Deliberately pretending to have a disability or illness in order to receive financial or other gains is called:

Malingering. **Explanation:** The core concept in this question is the presence of **external incentive**. **1. Why Malingering is Correct:** Malingering is not a psychiatric illness but a behavior. It involves the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by **external incentives** (secondary gains). These gains typically include financial compensation, avoiding work/military duty, evading criminal prosecution, or obtaining drugs. **2. Analysis of Incorrect Options:** * **Factitious Disorder (e.g., Munchausen Syndrome):** Symptoms are intentionally produced (like malingering), but the motivation is to assume the **"sick role"** (primary gain) rather than for external rewards. There is no obvious external incentive. * **Conversion Disorder (Functional Neurological Symptom Disorder):** Symptoms (usually neurological, like paralysis or blindness) are **unintentional** and unconscious. They are often triggered by psychological stress. * **Somatoform Disorder (Somatic Symptom Disorder):** The patient has persistent physical complaints that cause significant distress, but the symptoms are **not** intentionally produced or faked. **3. NEET-PG Clinical Pearls:** * **Malingering vs. Factitious:** If the patient wants a "check" (money), it’s Malingering. If the patient wants a "bed" (care/attention), it’s Factitious. * **Clues to Malingering:** Discrepancy between subjective complaints and objective findings, lack of cooperation during evaluation, and presence of Antisocial Personality Disorder. * **La Belle Indifference:** Classically associated with Conversion Disorder, where the patient appears surprisingly unconcerned about their severe disability.

Q: A 28-year-old male presents with a history of vague pains and multiple surgical scars. He is persistently curious about his diagnosis, requesting various diagnostic procedures and a biopsy. He reports a past history of gallstone and appendicitis pain, but the history is vague and appears manipulative, with no supporting previous records. What is the probable diagnosis?

Factitious disorder. ### **Explanation** **Correct Answer: D. Factitious Disorder** The clinical presentation describes a patient who intentionally produces or feigns physical symptoms (vague pains, requesting biopsies) to assume the **"sick role."** Key indicators in this case include the presence of multiple surgical scars (the "gridiron abdomen"), a vague and manipulative history, and a lack of medical records to support past surgeries. Unlike other disorders, the primary motivation in Factitious Disorder (formerly known as Munchausen syndrome) is internal—the psychological need to be a patient—rather than external gain (like money or avoiding work). **Why Incorrect Options are Wrong:** * **A. Hypochondriasis (Illness Anxiety Disorder):** Patients have a genuine, distressing fear of having a serious disease based on misinterpretation of bodily sensations. They do not intentionally produce symptoms or manipulate history. * **B. Somatization Disorder:** Characterized by multiple, chronic physical complaints across different organ systems. However, these symptoms are **not** intentionally produced; the patient truly feels the distress. * **C. Conversion Disorder:** Involves sudden loss of neurological function (e.g., paralysis, blindness) triggered by psychological stress. The symptoms are involuntary and not consciously faked. **NEET-PG High-Yield Pearls:** * **Factitious Disorder vs. Malingering:** In Factitious Disorder, the goal is the **sick role** (internal incentive). In Malingering, the goal is **secondary gain** (external incentive like disability benefits or avoiding jail). * **Gridiron Abdomen:** A classic sign of Factitious Disorder where the patient has multiple crisscrossing surgical scars from unnecessary exploratory surgeries. * **Management:** The best approach is a non-confrontational alliance, focusing on psychiatric management while avoiding unnecessary invasive procedures.

Q: Maintaining the sick role by any means is a characteristic feature of which of the following conditions?

Factitious disorder. **Explanation:** The core feature of **Factitious Disorder** (formerly known as Munchausen syndrome) is the intentional production or feigning of physical or psychological signs or symptoms. The primary motivation is to assume the **"sick role"** to gain attention, sympathy, or care from medical personnel. Unlike malingering, there are no external incentives (like financial gain or avoiding work). **Analysis of Options:** * **Factitious Disorder (Correct):** The patient consciously creates symptoms (e.g., injecting insulin to cause hypoglycemia) solely to be a patient. The goal is internal/psychological. * **Hypochondriasis (Illness Anxiety Disorder):** Patients are preoccupied with the *fear* of having a serious disease based on misinterpretation of bodily sensations. They do not intentionally produce symptoms; they genuinely believe they are ill. * **Somatization Disorder:** Characterized by multiple, recurring physical complaints (pain, GI, sexual, neurological) that have no organic cause. The symptoms are **unconscious** and not intentionally produced. * **Conversion Disorder (Functional Neurological Symptom Disorder):** Involves unexplained loss of sensory or motor function (e.g., sudden blindness or paralysis) following a psychological stressor. The symptoms are **involuntary** and not faked. **Clinical Pearls for NEET-PG:** * **Factitious Disorder vs. Malingering:** In Factitious disorder, the motivation is **internal** (the sick role). In Malingering, the motivation is **external** (money, drugs, avoiding jail). * **Munchausen by Proxy:** A form of child abuse where a caregiver (usually the mother) induces illness in a child to assume the sick role by proxy. * **La Belle Indifference:** Classically associated with Conversion Disorder, where the patient shows a surprising lack of concern regarding their severe disability.

Q: What are the psychological features of AIDS?

Depression. **Explanation:** The psychological impact of HIV/AIDS is multifaceted, involving both the biological effects of the virus on the CNS and the psychosocial stress of a chronic, stigmatized illness. **Why Depression is the Correct Answer:** **Depression** is the most common psychiatric complication in patients with HIV/AIDS. It occurs in approximately 20–30% of patients, a rate significantly higher than in the general population. It often manifests as a reaction to the diagnosis (Adjustment Disorder), a side effect of medications (e.g., Efavirenz), or as a direct result of HIV-associated neurocognitive changes. Identifying depression is crucial because it directly correlates with poor medication adherence and faster disease progression. **Analysis of Incorrect Options:** * **A. Mania:** While "Secondary Mania" can occur in late-stage AIDS (often due to opportunistic infections like Toxoplasmosis or CMV), it is much less frequent than depression. * **C. Suicidal Tendency:** Although the risk of suicide is elevated in HIV patients compared to the general public, it is usually a consequence of an underlying Major Depressive Disorder rather than a standalone feature. * **D. Violence:** Violence is not a characteristic feature of AIDS. Agitation or aggression may only be seen in the context of advanced HIV-associated dementia or delirium. **NEET-PG High-Yield Pearls:** * **Most common psychiatric disorder in HIV:** Depression. * **Drug-induced Depression:** **Efavirenz** (an NNRTI) is notorious for causing neuropsychiatric side effects, including vivid dreams, insomnia, and depression. * **HIV-Associated Neurocognitive Disorder (HAND):** This spectrum ranges from mild impairment to **AIDS Dementia Complex (ADC)**, characterized by subcortical dementia features (psychomotor slowing, apathy). * **Psychosis in HIV:** Usually occurs in advanced stages with low CD4 counts (<200 cells/mm³).

Q: Which personality type is associated with coronary artery disease?

Type A. **Explanation:** The association between personality patterns and physical health is a high-yield topic in Behavioral Sciences. **Type A Personality (Correct Answer):** First described by cardiologists Friedman and Rosenman, Type A behavior is characterized by **time urgency, competitiveness, high ambition, and hostility.** Among these traits, **hostility and anger** are the most significant independent risk factors for developing **Coronary Artery Disease (CAD)**. The physiological basis involves chronic sympathetic nervous system activation, leading to increased cortisol and catecholamines, which contribute to hypertension and atherosclerosis. **Incorrect Options:** * **Type B:** This is the opposite of Type A. These individuals are relaxed, easy-going, and less stressed. They have a significantly lower risk of stress-related cardiac events. * **Type C:** This personality is characterized by being cooperative, compliant, and suppressing negative emotions (especially anger). It has been traditionally associated with a higher predisposition to **Cancer**. * **Type D (Distressed):** Characterized by "joint tendency" toward negative affectivity and social inhibition. While Type D is associated with a **poor prognosis and increased mortality AFTER** a cardiac event has occurred, Type A remains the classic association for the development of CAD in medical literature. **Clinical Pearls for NEET-PG:** * **Hostility** is the specific component of Type A most predictive of heart disease. * **Type A** = CAD/MI. * **Type C** = Cancer (think "C" for Cancer). * **Type D** = Distressed (Negative affect + Social inhibition).

Question 1

A 41-year-old male presents with complaints of inability to achieve proper erections during sexual intercourse. He reports that there were no abnormalities until last month, when on one occasion he tried having sex while he was drunk. He was not able to achieve a proper erection at that time, and since then, on four other occasions, he has been unable to have an erection during attempted sex. He reports that his morning erections are fine and erections during masturbation were also normal. He is a diabetic, and the blood reports show FBS-103 mg/dl, HbA1C-6.6. His BP was 138/88 mm Hg. What is the likely cause of his erection disturbances?

Accepted Answer

Anxiety

Answer

Diabetes

Answer

Alcohol use

Answer

Hypertension

Question 2

All are true statements about Conversion disorder except?

Accepted Answer

Autonomic nervous system is involved

Answer

There is primary and secondary gain

Answer

La belle indifference is a feature

Answer

Patient does not intentionally produce symptoms

Question 3

Pseudodrugia Fantastica is seen in which of the following conditions?

Accepted Answer

Factitious disorder

Answer

Malingering

Answer

Somatization syndrome

Answer

Dissociative fugue

Question 4

Deliberately pretending to have a disability or illness in order to receive financial or other gains is called:

Accepted Answer

Malingering

Answer

Factitious disorder

Answer

Conversion

Answer

Somatoform disorder

Question 5

A 28-year-old male presents with a history of vague pains and multiple surgical scars. He is persistently curious about his diagnosis, requesting various diagnostic procedures and a biopsy. He reports a past history of gallstone and appendicitis pain, but the history is vague and appears manipulative, with no supporting previous records. What is the probable diagnosis?

Accepted Answer

Factitious disorder

Answer

Hypochondriasis

Answer

Somatization disorder

Answer

Conversion disorder

Question 6

In which of the following conditions is the sensory loss clearly demarcated by the midline?

Accepted Answer

Conversion disorder

Answer

Charcot's neuropathy

Answer

Peripheral neuritis

Answer

Leprosy

Question 7

Maintaining the sick role by any means is a characteristic feature of which of the following conditions?

Accepted Answer

Factitious disorder

Answer

Hypochondriasis

Answer

Somatization disorder

Answer

Conversion disorder

Question 8

A 28-year-old male presents with vague pains and multiple surgical scars. He is persistently inquisitive about his diagnosis and requests various diagnostic procedures and biopsies. He reports a history of gallstone and appendicitis pain, but this history is inconsistent and appears manipulative, with no supporting records. What is the probable diagnosis?

Accepted Answer

Factitious disorder

Answer

Hypochondriasis

Answer

Somatization disorder

Answer

Conversion disorder

Question 9

What are the psychological features of AIDS?

Accepted Answer

Depression

Answer

Mania

Answer

Suicidal Tendency

Answer

Violence

Question 10

Which personality type is associated with coronary artery disease?

Accepted Answer

Type A

Answer

Type B

Answer

Type C

Answer

Type D

Consultation-Liaison Psychiatry — MCQs

Consultation-Liaison Psychiatry — MCQs

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