Functional Neurological Symptom Disorders — MCQs
Which of the following is NOT part of the classic triad of normal pressure hydrocephalus?
A 39-year-old woman claims that she injured her hand at work. She states that the pain caused by her injury prevents her from working. She has no further hand problems after she receives a Rs1 Lakh workers' compensation settlement. This clinical presentation is an example of
A Patient falls down often with behavioral change and enuresis. What is the condition associated with him?
F00 in ICD denotes
A middle-aged person is rushed to the emergency department with a history of loss of motor power in the left upper and lower limb since the last 30 minutes. The imaging modality of choice to plan appropriate treatment would be
Which of the following dissociative disorders involves the presence of two or more distinct identities?
Dysdiadochokinesia refers to:
Which of the following disorders is classified under somatic symptom and related disorders in the DSM-5?
Papilledema is caused by:
Subacute Sclerosing Panencephalitis is a rare and dangerous complication of;
Functional Neurological Symptom Disorders Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following is NOT part of the classic triad of normal pressure hydrocephalus?
- A. Dementia
- B. Gait disturbance
- C. Urinary incontinence
- D. Headache (Correct Answer)
Explanation: ***Headache*** - Headache is **not a typical symptom** of normal pressure hydrocephalus (NPH) and is generally absent, differentiating NPH from other forms of hydrocephalus. - While headaches can occur in other brain conditions, they are **not part of the classic diagnostic triad** for NPH. *Dementia* - **Cognitive impairment**, often manifesting as **subcortical dementia** with executive dysfunction and memory problems, is a core feature of NPH [1]. - This symptom typically progresses and can be a significant cause of disability in affected individuals. *Gait disturbance* - An **ataxic gait** or "magnetic gait" (difficulty lifting feet off the floor) is often the **earliest and most prominent symptom** in NPH. - It significantly impacts mobility and balance, contributing to falls. *Urinary incontinence* - **Urinary urgency and incontinence**, often appearing later than gait disturbance but earlier than dementia, is the third component of the classic triad [1]. - This symptom results from the pressure effects on the **sacral micturition centers** [1].
Question 2: A 39-year-old woman claims that she injured her hand at work. She states that the pain caused by her injury prevents her from working. She has no further hand problems after she receives a Rs1 Lakh workers' compensation settlement. This clinical presentation is an example of
- A. conversion disorder
- B. factitious disorder by proxy
- C. factitious disorder
- D. malingering (Correct Answer)
Explanation: ***Malingering*** - This scenario describes **intentional feigning** of symptoms for an **external incentive** (the workers' compensation settlement). - The rapid resolution of symptoms post-settlement is characteristic, indicating the pain was not solely due to a genuine physical injury but rather a means to achieve financial gain. *Conversion disorder* - Involves neurological symptoms (e.g., paralysis, blindness) that are **incompatible with neurological pathways** and are not intentionally produced. - There is no evidence of an external incentive; symptoms are often linked to psychological stress, but the patient genuinely believes they are suffering from the symptoms. *Factitious disorder by proxy* - This involves a caregiver (e.g., parent) **falsifying or inducing illness** in another person (e.g., child) to assume the **sick role by proxy**. - The described case involves the patient themselves presenting with symptoms, not a proxy. *Factitious disorder* - Involves **intentional production or feigning of physical or psychological symptoms** with the primary motivation being to assume the **sick role**. - Unlike malingering, there are no obvious external incentives (like financial gain); the primary gain is the psychological satisfaction of being a patient.
Question 3: A Patient falls down often with behavioral change and enuresis. What is the condition associated with him?
- A. Normal pressure hydrocephalus (NPH) (Correct Answer)
- B. Parkinson's disease (PD)
- C. Alzheimer's disease (AD)
- D. Frontotemporal dementia (FTD)
Explanation: ***Normal pressure hydrocephalus (NPH)*** - NPH is characterized by the classic triad of symptoms: **gait disturbance** (leading to falls), **dementia/behavioral changes**, and **urinary incontinence** (enuresis) [1]. - These symptoms arise from the accumulation of cerebrospinal fluid (CSF) in the brain's ventricles without a corresponding increase in intracranial pressure [2]. *Parkinson's disease (PD)* - While PD causes **gait instability** and falls, its primary symptoms include **bradykinesia**, **rigidity**, and **resting tremor**, which are not mentioned. - Behavioral changes can occur later in the disease, but **enuresis** is not a hallmark symptom. *Alzheimer's disease (AD)* - AD primarily presents with **progressive memory loss** and cognitive decline, not gait disturbances or enuresis as early or prominent features. - Falls usually occur much later due to advanced cognitive impairment and not as an initial triad component. *Frontotemporal dementia (FTD)* - FTD is characterized by early and prominent **behavioral and personality changes** or language difficulties. - While falls can occur due to executive dysfunction, **gait disturbance** and **enuresis** as part of a triad are not typical presenting features.
Question 4: 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 5: A middle-aged person is rushed to the emergency department with a history of loss of motor power in the left upper and lower limb since the last 30 minutes. The imaging modality of choice to plan appropriate treatment would be
- A. CT scan of the head (Correct Answer)
- B. MRI of the brain
- C. Carotid doppler study
- D. EEG
Explanation: ***CT scan of the head*** - A **non-contrast CT scan of the head** is the immediate imaging modality of choice in acute stroke symptoms to quickly rule out a **hemorrhagic stroke**. - This rapid assessment guides treatment decisions; if hemorrhage is absent, **thrombolytic therapy (tPA)** can be considered within the critical time window. *MRI of the brain* - While **MRI** offers superior detail for detecting ischemic stroke, it is **unsuitable for initial emergency assessment** due to longer acquisition times and limited availability. - The delay in obtaining an MRI could critically hinder the initiation of time-sensitive therapies like **thrombolysis**. *Carotid doppler study* - A **carotid Doppler study** is useful for identifying **carotid artery stenosis**, which can be a cause of ischemic stroke but is not an acute diagnostic tool for stroke itself. - It does not provide information about the presence of hemorrhage or acute ischemic changes within the brain parenchyma. *EEG* - An **EEG (electroencephalogram)** measures electrical activity in the brain and is primarily used to diagnose conditions like **seizures** or evaluate altered mental status. - It provides no structural information and is not indicated for the initial evaluation of acute motor deficits indicative of a stroke.
Question 6: Which of the following dissociative disorders involves the presence of two or more distinct identities?
- A. Dissociative Amnesia
- B. Depersonalization/Derealization Disorder
- C. Dissociative Identity Disorder (Correct Answer)
- D. Major Depressive Disorder
Explanation: ***Dissociative Identity Disorder*** - This disorder is characterized by the presence of **two or more distinct personality states** or an experience of **possession**. - These distinct identities recurrently take control of the individual's behavior, accompanied by an inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness. - This is the **defining feature** that distinguishes DID from other dissociative disorders. *Depersonalization/Derealization Disorder* - This involves **persistent or recurrent experiences of depersonalization** (feeling detached from one's mental processes or body) or **derealization** (feeling that the world is unreal or dreamlike). - While consciousness is maintained, there is no presence of multiple distinct identities. - The person retains awareness that these are subjective experiences. *Dissociative Amnesia* - This is characterized by an inability to recall important **autobiographical information**, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting. - May include dissociative fugue as a specifier (sudden travel with amnesia for identity). - It does not involve the presence of multiple distinct identities. *Major Depressive Disorder* - This is a mood disorder characterized by a persistently **depressed mood or loss of interest** in activities, causing significant impairment in daily life. - It is not a dissociative disorder and does not involve the presence of multiple identities.
Question 7: Dysdiadochokinesia refers to:
- A. Inability to Perform Rapid Alternating Movements (Correct Answer)
- B. Intention Tremor
- C. Tremor of the Eyeballs
- D. Failure of Progression in Talking
Explanation: ***Inability to Perform Rapid Alternating Movements*** - **Dysdiadochokinesia** is a neurological sign indicating an impaired ability to perform **rapid alternating movements**, such as pronation and supination of the forearms [1]. - It is a key indicator of **cerebellar dysfunction**, as the cerebellum is responsible for coordinating the rate, range, and force of movements [1]. *Intention Tremor* - An **intention tremor** is a tremor that worsens during purposeful movement towards a target, not a difficulty with alternating movements themselves. - While also a sign of **cerebellar damage**, it manifests as oscillations during voluntary action, distinct from dysdiadochokinesia. *Tremor of the Eyeballs* - This condition is known as **nystagmus**, which refers to involuntary rhythmic eye movements [2]. - While nystagmus can be associated with **cerebellar dysfunction**, it is a distinct sign separate from the ability to perform rapid alternating limb movements [2]. *Failure of Progression in Talking* - This symptom is characteristic of **dysarthria**, a motor speech disorder that impacts articulation, phonation, and prosody [2]. - While certain types of dysarthria can be linked to **cerebellar disease**, "failure of progression in talking" specifically describes speech difficulties, not the coordination of limb movements [2].
Question 8: Which of the following disorders is classified under somatic symptom and related disorders in the DSM-5?
- A. Post-Traumatic Stress Disorder (PTSD)
- B. Phobic disorders (e.g., social anxiety disorder)
- C. Conversion disorder (functional neurological symptom disorder) (Correct Answer)
- D. Obsessive-Compulsive Disorder (OCD)
Explanation: ***Conversion disorder (functional neurological symptom disorder)*** - **Conversion disorder** is characterized by neurological symptoms (e.g., paralysis, blindness) that are **incompatible with recognized neurological or medical conditions**, yet are not intentionally produced. - It falls under **somatic symptom and related disorders** because the primary features are physical symptoms causing distress or functional impairment, rather than being malingered or feigned. *Phobic disorders (e.g., social anxiety disorder)* - **Phobic disorders** are classified under **anxiety disorders** in the DSM-5, not somatic symptom and related disorders. - They are primarily characterized by **intense, irrational fears** of specific objects or situations, leading to avoidance rather than prominent physical symptoms without a medical cause. *Post-Traumatic Stress Disorder (PTSD)* - **PTSD** is classified under **trauma- and stressor-related disorders** in the DSM-5, distinguished by symptoms developing after exposure to a traumatic event. - Its core features include **intrusive memories, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity**, rather than unexplained physical symptoms. *Obsessive-Compulsive Disorder (OCD)* - **OCD** is classified under **obsessive-compulsive and related disorders** in the DSM-5. - It is primarily characterized by the presence of **obsessions (recurrent, intrusive thoughts)** and/or **compulsions (repetitive behaviors or mental acts)**, which are distinct from somatic symptoms.
Question 9: Papilledema is caused by:
- A. Vitamin E intoxication
- B. Vitamin B intoxication
- C. Vitamin A intoxication (Correct Answer)
- D. Vitamin D intoxication
Explanation: ***Vitamin A intoxication*** - **Chronic vitamin A intoxication** can lead to **idiopathic intracranial hypertension (pseudotumor cerebri)**, which manifests as papilledema [3]. - The excess vitamin A increases **cerebrospinal fluid (CSF) production** or reduces its absorption, leading to elevated intracranial pressure [1], [2], [3]. *Vitamin D intoxication* - **Vitamin D intoxication** primarily causes **hypercalcemia**, leading to symptoms like nausea, vomiting, polyuria, and renal calculi. - It does not typically cause **increased intracranial pressure** or papilledema. *Vitamin E intoxication* - **Vitamin E intoxication** can interfere with **vitamin K absorption**, increasing the risk of bleeding. - It is not associated with **elevated intracranial pressure** or papilledema [1]. *Vitamin B intoxication* - While some **B vitamins** can have adverse effects in very high doses (e.g., **pyridoxine** can cause neuropathy), they are not known to cause **papilledema** or increased intracranial pressure. - **Vitamin B intoxication** typically has different neurological or systemic manifestations.
Question 10: Subacute Sclerosing Panencephalitis is a rare and dangerous complication of;
- A. Rubella
- B. Varicella
- C. Mumps
- D. Measles (Correct Answer)
Explanation: ***Measles*** - **Subacute sclerosing panencephalitis (SSPE)** is a rare, fatal degenerative disease of the central nervous system caused by persistent infection with a defective **measles virus**. [1] - It typically develops **years after the initial measles infection**, affecting children and young adults, leading to cognitive decline, seizures, and motor dysfunction. [1], [2] *Rubella* - While rubella can cause congenital rubella syndrome, it is **not associated with SSPE**. - Complications of rubella usually involve birth defects, such as **cardiac malformations**, **deafness**, and **cataracts**, when acquired during pregnancy. *Varicella* - **Varicella-zoster virus (VZV)** causes chickenpox and shingles, but it is **not a known cause of SSPE**. - Neurological complications of VZV can include **cerebellar ataxia** or **encephalitis** acutely, or **postherpetic neuralgia** in later life. *Mumps* - Mumps virus can cause **parotitis**, **orchitis**, and **meningitis/encephalitis**, but it is **not implicated in the development of SSPE**. - The encephalitis associated with mumps typically occurs during the acute infection and generally has a good prognosis.
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