Psycho-oncology — MCQs
In which condition is psychosurgery considered as a last resort treatment?
Most favorable prognosis after radiotherapy is in -
In which of the following conditions is behavior therapy considered most effective?
In which of the following patients would supportive therapy be most challenging to implement effectively?
Match the following drugs in Column A with their contraindications in Column B. | Column A | Column B | | :-- | :-- | | 1. Morphine | 1. QT prolongation | | 2. Amiodarone | 2. Thromboembolism | | 3. Vigabatrin | 3. Pregnancy | | 4. Estrogen preparations | 4. Head injury |
Which of the following is treated with aversion therapy?
Provision of the Mental Health Act 2017, based on WHO guidelines, includes all, except:
A patient with a history of RTA before 2 months presents with complaints of dreams of accidents. He is able to visualize the same scene whenever he visits the place. Hence is afraid to go back to the accident site. Identify the type of disorder that he might be suffering from?
The 4AT is a screening tool for detection of delirium. Which THREE of the following parameters listed below are included in the 4AT tool? I. Alertness II. Apnoea III. Abbreviated Mental Test (AMT4) IV. Attention Select the correct answer using the code given below:
Which class of medications is known to worsen the symptoms of delirium in patients post-cardiac surgery?
Psycho-oncology Indian Medical PG Practice Questions and MCQs
Question 1: In which condition is psychosurgery considered as a last resort treatment?
- A. Severe Generalized Anxiety Disorder
- B. Severe Obsessive-Compulsive Disorder (Correct Answer)
- C. Severe Depression
- D. Severe Phobia
Explanation: ***Severe Obsessive-Compulsive Disorder*** - Psychosurgery (e.g., **anterior cingulotomy**, **capsulotomy**) is considered for individuals with **severe, refractory OCD** who have not responded to conventional treatments. - This intervention aims to disrupt specific neural circuits implicated in OCD, such as the **corticostriatothalamocortical (CSTC) loop**. *Severe Generalized Anxiety Disorder* - While GAD can be debilitating, standard treatments like **psychotherapy (CBT)** and **pharmacotherapy (SSRIs, SNRIs)** are generally effective. - Psychosurgery is not typically considered for GAD, as less invasive and established treatments carry significantly lower risks. *Severe Depression* - For severe, treatment-resistant depression, **electroconvulsive therapy (ECT)** and **transcranial magnetic stimulation (TMS)** are more common and established interventions. - Psychosurgery is rarely, if ever, used for severe depression due to ethical concerns and the availability of less invasive options. *Severe Phobia* - Severe phobias primarily respond to **exposure therapy** and **cognitive behavioral therapy (CBT)**. - These therapies directly target the learned fear response and are highly effective without the need for invasive procedures.
Question 2: Most favorable prognosis after radiotherapy is in -
- A. Teratoma
- B. Desmoid
- C. Seminoma (Correct Answer)
- D. Melanoma
Explanation: ***Seminoma*** - **Seminoma** is highly **radiosensitive**, meaning it responds very well to radiation therapy, leading to excellent oncological outcomes. - Due to its sensitivity, even advanced seminomas can often be cured with radiotherapy, contributing to a **favorable prognosis**. *Teratoma* - **Teratomas** are generally **radioresistant**, meaning they do not respond well to radiation therapy. - Treatment for teratomas typically involves **surgical resection**, as radiation is largely ineffective. *Desmoid* - **Desmoid tumors** (aggressive fibromatosis) are locally aggressive but rarely metastasize, and their response to radiotherapy is variable. - While radiation can be used for local control, the prognosis is often complicated by **local recurrence** and challenging surgical margins. *Melanoma* - **Melanoma** is notoriously **radioresistant**, making radiation therapy a less effective primary treatment option. - It is often used for **palliative care** or in cases of local recurrence, but rarely leads to a cure or favorable prognosis when used alone.
Question 3: In which of the following conditions is behavior therapy considered most effective?
- A. Panic Attack
- B. Psychosis
- C. Obsessive-Compulsive Disorder (OCD) (Correct Answer)
- D. Generalized Anxiety Disorder
Explanation: ***Obsessive-Compulsive Disorder (OCD)*** - **Exposure and Response Prevention (ERP)**, a type of behavior therapy, is the gold standard and most effective treatment for OCD. - ERP directly targets the **obsessions** and **compulsions** by gradually exposing individuals to feared situations without allowing them to perform their rituals. - OCD shows the **highest response rates** to pure behavior therapy compared to other psychiatric conditions. *Psychosis* - While supportive therapy and cognitive behavioral therapy for psychosis (CBTp) can be helpful, **behavior therapy alone is not considered the primary or most effective treatment** for core psychotic symptoms. - Management of psychosis primarily relies on **antipsychotic medications** to address symptoms like hallucinations and delusions. *Panic Attack* - Behavior therapy and CBT are effective for **Panic Disorder**, but the effectiveness is somewhat lower than for OCD. - Treatment for panic disorder often requires a **combination of behavioral and cognitive techniques** rather than pure behavior therapy alone. - Management typically includes breathing exercises, exposure to physical sensations, and cognitive restructuring. *Generalized Anxiety Disorder* - **Cognitive Behavioral Therapy (CBT)**, which includes behavioral components, is highly effective for GAD, but the **cognitive elements are essential** for addressing worry and rumination. - Pure behavior therapy (e.g., systematic desensitization) is less effective for GAD compared to OCD, as GAD involves pervasive cognitive distortions that require cognitive restructuring.
Question 4: In which of the following patients would supportive therapy be most challenging to implement effectively?
- A. Patient who is severely ill and has significant ego dysfunction
- B. Person who is motivated and has good self-control
- C. Person with good cognitive and functional abilities
- D. Patient who is severely ill and uncooperative (Correct Answer)
Explanation: ***Patient who is severely ill and uncooperative*** - A **severely ill** patient who is **uncooperative** presents the most **immediate and direct barrier** to implementing supportive therapy effectively. Their **active resistance** to therapeutic interventions (refusing medication, declining to engage, missing appointments) makes it practically impossible to deliver care. - **Uncooperativeness** represents active opposition to treatment, requiring resolution before any therapeutic work can proceed. Without patient engagement, even the most basic supportive interventions cannot be implemented. - While other patients may have limitations, an uncooperative patient fundamentally blocks the therapeutic alliance necessary for any psychotherapy. *Patient who is severely ill and has significant ego dysfunction* - **Ego dysfunction** (impaired reality testing, poor impulse control, weak sense of self) is indeed challenging and represents a relative contraindication to insight-oriented therapies. - However, patients with ego dysfunction may still **passively participate** in supportive therapy, especially when the therapy is structured and focused on basic stabilization rather than insight. - The key difference: ego dysfunction is a **structural limitation** requiring adaptation of technique, whereas uncooperativeness is an **active barrier** preventing any intervention. A patient with ego dysfunction can still potentially benefit from modified supportive approaches, but an uncooperative patient cannot be engaged at all. *Person who is motivated and has good self-control* - This patient would be the **easiest to treat** with supportive therapy due to their intrinsic motivation and ability to manage their own behavior. - Their **motivation** and **self-control** would facilitate adherence to treatment plans and active participation in their care, making implementation straightforward. *Person with good cognitive and functional abilities* - This patient would be **highly amenable to supportive therapy** as their cognitive and functional capacities allow them to understand and participate in treatment. - Good cognitive and functional abilities enable them to comprehend instructions, manage their own care, and engage effectively with healthcare providers, presenting minimal implementation challenges.
Question 5: Match the following drugs in Column A with their contraindications in Column B. | Column A | Column B | | :-- | :-- | | 1. Morphine | 1. QT prolongation | | 2. Amiodarone | 2. Thromboembolism | | 3. Vigabatrin | 3. Pregnancy | | 4. Estrogen preparations | 4. Head injury |
- A. A-1, B-3, C-2, D-4
- B. A-4, B-1, C-3, D-2 (Correct Answer)
- C. A-3, B-2, C-4, D-1
- D. A-2, B-4, C-1, D-3
Explanation: ***A-4, B-1, C-3, D-2*** - **Morphine** is contraindicated in **head injury** as it can increase intracranial pressure and mask neurological symptoms. - **Amiodarone** is contraindicated in patients with **QT prolongation** due to its risk of inducing more severe arrhythmias like Torsades de Pointes. - **Vigabatrin** is contraindicated during **pregnancy** due to its potential for teratogenicity and adverse effects on fetal development. - **Estrogen preparations** are contraindicated in patients with a history of **thromboembolism** due to their increased risk of blood clot formation. *A-1, B-3, C-2, D-4* - This option incorrectly matches **Morphine** with QT prolongation and **Estrogen preparations** with head injury, which are not their primary contraindications. - It also incorrectly links **Vigabatrin** with thromboembolism and **Amiodarone** with pregnancy. *A-3, B-2, C-4, D-1* - This choice incorrectly associates **Morphine** with pregnancy and **Vigabatrin** with head injury, which are not the most critical or direct contraindications. - It also misaligns **Amiodarone** with thromboembolism and **Estrogen preparations** with QT prolongation. *A-2, B-4, C-1, D-3* - This option incorrectly matches **Morphine** with thromboembolism and **Amiodarone** with head injury, which are not their most significant contraindications. - It also incorrectly links **Vigabatrin** with QT prolongation and **Estrogen preparations** with pregnancy.
Question 6: Which of the following is treated with aversion therapy?
- A. Paraphilia (Correct Answer)
- B. Suicidal tendencies
- C. Depression
- D. Mania
Explanation: ***Paraphilia*** - **Aversion therapy** aims to reduce unwanted behaviors by associating them with unpleasant stimuli, making it suitable for treating **paraphilias** by creating a negative association with the deviant sexual urges. - This therapy is used to help individuals develop an aversion to the stimuli that trigger their maladaptive sexual interests. *Suicidal tendencies* - Suicidal tendencies are serious and require immediate and comprehensive interventions, often involving **crisis intervention**, **medication**, and various forms of **psychotherapy** like cognitive-behavioral therapy (CBT) or dialectical behavior therapy (DBT). - Aversion therapy would be inappropriate and potentially harmful, as it could exacerbate distress and is not designed to address the underlying psychological pain associated with suicidal thoughts. *Depression* - Depression is typically treated with **antidepressant medications** and different forms of **psychotherapy** such as cognitive-behavioral therapy (CBT), interpersonal therapy, or psychodynamic therapy, which focus on mood regulation, thought patterns, and emotional processing. - Aversion therapy is not an effective or recommended treatment for depression, as it does not address the core symptoms of low mood, anhedonia, or cognitive distortions. *Mania* - Mania, often associated with **bipolar disorder**, is primarily treated with **mood stabilizers** (e.g., lithium, valproate) and antipsychotics to manage acute episodes and prevent recurrence. - Aversion therapy is irrelevant to the treatment of mania, as it does not target the biochemical imbalances or extreme mood states characteristic of bipolar disorder.
Question 7: 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 8: A patient with a history of RTA before 2 months presents with complaints of dreams of accidents. He is able to visualize the same scene whenever he visits the place. Hence is afraid to go back to the accident site. Identify the type of disorder that he might be suffering from?
- A. PTSD (Correct Answer)
- B. Anxiety disorder
- C. Obsessive-Compulsive Disorder (OCD)
- D. Adjustment disorder
Explanation: ***PTSD*** - The patient's symptoms, including **recurrent dreams** of the accident, **intrusive memories** triggered by the accident site, and **avoidance** of the location, are classic diagnostic criteria for **Post-Traumatic Stress Disorder (PTSD)**. - PTSD often develops after exposure to a **traumatic event** like a car accident, with symptoms lasting for more than one month. *Anxiety disorder* - While anxiety is a prominent feature of PTSD, **Generalized Anxiety Disorder** typically involves excessive worry about everyday events rather than a specific traumatic incident. - Other anxiety disorders like **panic disorder** involve sudden, intense fear without the specific re-experiencing and avoidance symptoms seen here. *Obsessive-Compulsive Disorder (OCD)* - OCD is characterized by repetitive, unwanted thoughts (**obsessions**) and ritualistic behaviors (**compulsions**) performed to reduce anxiety, which are not described in this patient's presentation. - The patient's distress stems from a past trauma, not from obsessions or compulsions. *Adjustment disorder* - An adjustment disorder occurs in response to a **stressor**, but the symptoms are typically less severe and do not include the full constellation of **re-experiencing, avoidance, and hyperarousal** seen in PTSD. - An adjustment disorder resolves within 6 months of the stressor or its consequences, however, the persistence and nature of the symptoms here point to a more severe trauma-related condition.
Question 9: The 4AT is a screening tool for detection of delirium. Which THREE of the following parameters listed below are included in the 4AT tool? I. Alertness II. Apnoea III. Abbreviated Mental Test (AMT4) IV. Attention Select the correct answer using the code given below:
- A. I, III and IV (Correct Answer)
- B. I, II and IV
- C. I, II and III
- D. II, III and IV
Explanation: ***I, III and IV*** - The 4AT screening tool specifically includes **Alertness**, **AMT4 (Abbreviated Mental Test)**, and **Attention** as key parameters for detecting delirium. - The **AMT4** component assesses **cognitive function**, while **Alertness** and **Attention** evaluate the patient's state of consciousness and focus. *I, II and IV* - This option incorrectly includes **Apnoea**. While apnoea is a significant medical condition, it is not a direct parameter in the **4AT delirium screening tool**. - The 4AT focuses on cognitive and neurological signs of delirium, not respiratory patterns. *I, II and III* - This option also incorrectly includes **Apnoea** as one of the parameters in the 4AT tool. - The 4AT is designed to assess **delirium**, which primarily manifests through altered mental status, rather than respiratory issues. *II, III and IV* - This option is incorrect as it includes **Apnoea** and omits **Alertness**, which is a fundamental component of the **4AT delirium screening tool**. - **Alertness** is crucial for evaluating the patient's level of consciousness, a primary sign of delirium.
Question 10: Which class of medications is known to worsen the symptoms of delirium in patients post-cardiac surgery?
- A. Antipsychotics
- B. Anticholinergics (Correct Answer)
- C. Benzodiazepines (BZD)
- D. Antihistamines
Explanation: **Explanation:** **1. Why Anticholinergics are the Correct Answer:** Delirium is fundamentally characterized by a neurochemical imbalance, most notably a **cholinergic deficiency** and a dopaminergic excess. Medications with anticholinergic properties (e.g., atropine, scopolamine, or certain tricyclic antidepressants) block acetylcholine receptors in the brain, directly precipitating or severely worsening the symptoms of delirium (confusion, disorientation, and cognitive impairment). In post-cardiac surgery patients, the brain is already vulnerable due to systemic inflammation and micro-emboli; adding an anticholinergic agent further destabilizes the neurotransmitter balance. **2. Analysis of Incorrect Options:** * **A. Antipsychotics:** These are actually the **treatment of choice** for the agitation associated with delirium. Low-dose Haloperidol is frequently used because it antagonizes dopamine, helping to restore the neurochemical balance. * **C. Benzodiazepines (BZD):** While BZDs can worsen delirium in the elderly or cause "paradoxical agitation," they are not the primary pharmacological *cause* of the underlying cholinergic deficit. They are generally avoided in delirium **unless** the delirium is caused by Alcohol Withdrawal or BZD withdrawal. * **D. Antihistamines:** While first-generation antihistamines (like diphenhydramine) have anticholinergic side effects and can cause delirium, "Anticholinergics" as a class is the more specific and direct answer regarding the underlying pathophysiology. **3. High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice for Delirium:** Haloperidol (IV/IM/Oral). * **Delirium vs. Dementia:** Delirium is acute, reversible, and characterized by **fluctuating levels of consciousness** and impaired attention. * **The "BZD Exception":** Use Benzodiazepines for delirium *only* if the etiology is Alcohol or Sedative-Hypnotic withdrawal. * **Post-Op Risk:** Post-cardiac surgery delirium is common (up to 30-50%) and is associated with increased mortality and longer ICU stays.
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