Psychological Factors Affecting Medical Conditions — MCQs
A 41 year old married female presented with headache for the last 6 months. She had several consultations. All her investigations were found to be within normal limits. She still insists that there is something wrong in her head and seeks another consultation. The most likely diagnosis is:
Cortisol increases all of the following components except:
mhGAP program includes all of the following disorders except?
Which hormone is NOT increased in stress?
In which of the following scenarios is supportive therapy LEAST likely to be given?
Which of the following can cause delirium?
Which of the following disorders is classified under somatic symptom and related disorders in the DSM-5?
A 20-year-old girl complains of headache while studying. Her vision is found to be normal. In the initial medical evaluation of her headache, which of the following would be the LEAST essential to assess?
Which class of medications is known to worsen the symptoms of delirium in patients post-cardiac surgery?
What is the most common psychological feature of AIDS?
Psychological Factors Affecting Medical Conditions Indian Medical PG Practice Questions and MCQs
Question 1: A 41 year old married female presented with headache for the last 6 months. She had several consultations. All her investigations were found to be within normal limits. She still insists that there is something wrong in her head and seeks another consultation. The most likely diagnosis is:
- A. Illness Anxiety Disorder (Correct Answer)
- B. Phobia
- C. Psychogenic headache
- D. Depression
Explanation: ***Illness Anxiety Disorder*** - This patient exhibits persistent **preoccupation with having a serious illness** despite **repeated medical evaluations** showing no underlying pathology. - She continues to **seek multiple consultations**, demonstrating **excessive health-related behaviors** characteristic of health anxiety. - Despite reassurance and normal investigations, she **insists something is wrong**, which is the core feature of this disorder. - Note: The presence of headache doesn't exclude this diagnosis; the key is the **disproportionate anxiety and health-seeking behavior** relative to the symptom. *Phobia* - Phobias involve an **intense, irrational fear** of a specific object or situation (e.g., agoraphobia, social phobia). - The patient's concern is about having an illness and physical symptoms, not a fear of a specific trigger or situation. *Psychogenic headache* - This is a **symptom description**, not a psychiatric disorder diagnosis. - While the headache may have psychological factors, the question asks for the **disorder** that best explains the overall clinical picture. - The primary pathology here is the **persistent health anxiety and reassurance-seeking behavior**, not just the headache itself. *Depression* - Although **depression can present with somatic symptoms** like headaches, the **core features of major depression** are not mentioned (e.g., persistent low mood, anhedonia, sleep/appetite changes, hopelessness). - The patient's **preoccupation with having a disease** despite medical reassurance is more characteristic of Illness Anxiety Disorder than depression alone.
Question 2: Cortisol increases all of the following components except:
- A. Monocytes
- B. RBCs
- C. Platelets
- D. Eosinophils (Correct Answer)
Explanation: ***Eosinophils*** - Cortisol causes **eosinopenia** (a decrease in eosinophils) by increasing their sequestration in tissues and promoting their apoptosis. - This effect is a classic indicator of stress and can be observed in conditions of elevated endogenous or exogenous cortisol. *Monocytes* - Cortisol typically causes a **mild monocytosis** (increase in circulating monocytes), although this effect can vary. - It impacts the trafficking and differentiation of monocytes, leading to their transient increase in the bloodstream. *RBCs* - Cortisol can lead to a slight **increase in red blood cell (RBC) count** or hemoglobin concentration. - This effect is partly due to hemoconcentration and partly by promoting erythropoiesis. *Platelets* - Cortisol generally causes a **thrombocytosis** (increase in platelet count). - This effect is thought to be mediated by various factors, including cytokine interactions and direct effects on megakaryopoiesis.
Question 3: mhGAP program includes all of the following disorders except?
- A. Schizophrenia
- B. Depression
- C. Childhood mental disorder
- D. Personality Disorders (Correct Answer)
Explanation: ***Personality Disorders*** - The **mhGAP program** (Mental Health Gap Action Programme) focuses on scaling up services for common, severe mental, neurological, and substance use disorders in low- and middle-income countries. - **Personality disorders** are generally not included in the core conditions addressed by the mhGAP program due to their complex and chronic nature, requiring specialized and long-term management that may be beyond the scope of primary care settings targeted by mhGAP. *Schizophrenia* - **Schizophrenia** is one of the priority conditions addressed by the mhGAP program, recognizing its severity and significant impact on individuals and communities. - The program provides guidelines for the recognition, management, and long-term care of schizophrenia at the primary healthcare level. *Depression* - **Depression** is a core focus of the mhGAP program, given its high prevalence and treatability in primary care settings. - mhGAP provides clear guidelines for the identification, basic management, and follow-up of individuals with depression. *Childhood mental disorder* - **Childhood mental disorders**, such as conduct disorder, attention-deficit/hyperactivity disorder (ADHD), and developmental disabilities, are also included as priority conditions within the mhGAP program. - The program aims to improve the detection and basic management of these conditions in children and adolescents, promoting early intervention.
Question 4: Which hormone is NOT increased in stress?
- A. Glucagon
- B. Insulin (Correct Answer)
- C. Cortisol
- D. Epinephrine
Explanation: ***Insulin*** - Insulin levels generally **decrease** during acute stress. This allows for increased availability of glucose for tissues, such as the brain and muscles, during "fight or flight" responses. - The sympathetic nervous system activity during stress **inhibits insulin secretion** from pancreatic beta cells. *Glucagon* - **Glucagon levels increase** during stress to promote **hepatic glucose production** (glycogenolysis and gluconeogenesis), ensuring a readily available energy supply. - This rise in glucagon is part of the counter-regulatory response to maintain blood glucose stability during stressful conditions. *Cortisol* - **Cortisol levels significantly increase** during stress as part of the **hypothalamic-pituitary-adrenal (HPA) axis** activation. - Cortisol mobilizes energy stores, suppresses the immune system, and prepares the body for prolonged stress. *Epinephrine* - **Epinephrine (adrenaline) levels increase rapidly** during acute stress as part of the **sympathetic nervous system** response. - It triggers the "fight or flight" response, increasing heart rate, blood pressure, and diverting blood flow to essential organs, while also promoting glucose release.
Question 5: In which of the following scenarios is supportive therapy LEAST likely to be given?
- A. Patient who is severely ill and not cooperative.
- B. Person who is motivated and has control over their emotions. (Correct Answer)
- C. Person with cognitive and functional abilities.
- D. Patient who is severely ill and has significant psychological impairment.
Explanation: ***Person who is motivated and has control over their emotions.*** - Patients who are **highly motivated** and have **good emotional control** are ideal candidates for **insight-oriented psychotherapy** (such as psychodynamic therapy or psychoanalysis), NOT basic supportive therapy. - Supportive therapy is a **less intensive** form of treatment that focuses on symptom relief, maintaining functioning, and strengthening existing defenses rather than developing insight. - Using supportive therapy for such motivated patients would be **underutilizing their therapeutic potential** and capacity for deeper psychological work. - These patients can engage in more challenging therapeutic work that requires introspection, emotional processing, and behavioral change. *Patient who is severely ill and not cooperative.* - **Supportive therapy is specifically indicated** for severely ill and uncooperative patients who cannot engage in insight-oriented work. - This approach requires **minimal patient cooperation** and focuses on maintaining stability rather than achieving insight. - Non-directive, empathic support can still benefit patients with limited engagement capacity. *Person with cognitive and functional abilities.* - While such patients could benefit from more intensive therapies, supportive therapy can still be appropriate in certain contexts. - Cognitive and functional abilities alone don't preclude the use of supportive interventions. *Patient who is severely ill and has significant psychological impairment.* - These patients are **prime candidates for supportive therapy**, which is designed for individuals with limited psychological resources. - Supportive therapy aims to strengthen existing defenses, provide reassurance, and maintain functioning without requiring deep insight or emotional processing. - This is one of the **main indications** for supportive psychotherapy.
Question 6: Which of the following can cause delirium?
- A. Barbiturates
- B. Hypoxia
- C. Alcohol withdrawal
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - **Barbiturates**, **hypoxia**, and **alcohol withdrawal** are all well-established causes of delirium, affecting the brain's cognitive function. - Delirium is a state of **acute brain failure** characterized by fluctuating attention, altered consciousness, and cognitive dysfunction, often *multifactorial*. *Barbiturates* - These drugs are **CNS depressants** and can cause delirium, especially in susceptible individuals or with overdose. - They can lead to **sedation**, confusion, and a paradoxical agitated state, contributing to delirium. *Hypoxia* - **Lack of oxygen to the brain** is a significant cause of delirium as neurons are highly sensitive to oxygen deprivation. - This can result from various conditions such as **respiratory failure**, anemia, or circulatory compromise, directly impairing brain function. *Alcohol withdrawal* - Abrupt cessation of alcohol in dependent individuals causes severe **CNS hyper-excitability**, leading to delirium tremens. - Symptoms include **agitation**, hallucinations, confusion, and autonomic instability characteristic of delirium.
Question 7: 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 8: A 20-year-old girl complains of headache while studying. Her vision is found to be normal. In the initial medical evaluation of her headache, which of the following would be the LEAST essential to assess?
- A. Family history of headache
- B. Menstrual history
- C. Fundoscopy examination
- D. Her interest in studies (Correct Answer)
Explanation: ***Her interest in studies*** - While **stress** and **academic pressure** can contribute to headaches, this represents a **psychosocial assessment** rather than a standard medical evaluation. - Among the listed options, this would be the **least essential** in the initial medical workup compared to the other clinical assessments. *Family history of headache* - Essential evaluation as many headache disorders, particularly **migraine** and **tension-type headache**, have strong **genetic predisposition**. - Family history helps establish diagnosis and guides appropriate management strategies for the patient's headaches. *Menstrual history* - Crucial in young women as **hormonal fluctuations** during the menstrual cycle are major triggers for headaches, especially **menstrual migraine**. - Understanding menstrual patterns can identify cyclical headache triggers and inform treatment approaches. *Fundoscopy examination* - Important to rule out **papilledema** (optic disc swelling) and signs of **increased intracranial pressure**, even with normal visual acuity. - Normal vision does not exclude underlying pathology that could be detected through **ophthalmoscopic examination** of the retina and optic nerve.
Question 9: 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.
Question 10: What is the most common psychological feature of AIDS?
- A. Depression (Correct Answer)
- B. Mania
- C. Suicidal tendency
- D. None of the above
Explanation: **Explanation:** **1. Why Depression is the Correct Answer:** Depression is the most common psychiatric manifestation in patients living with HIV/AIDS, with a prevalence significantly higher than in the general population (estimated between 20% to 40%). The etiology is multifactorial: * **Biological:** Direct neurotoxic effects of the HIV virus on the subcortical structures and the release of pro-inflammatory cytokines. * **Psychosocial:** The stigma associated with the diagnosis, loss of social support, chronic physical debilitation, and the burden of lifelong medication. * **Pharmacological:** Certain antiretroviral drugs (like Efavirenz) are known to induce depressive symptoms. **2. Analysis of Incorrect Options:** * **B. Mania:** While "AIDS Mania" is a recognized clinical entity (often occurring in late stages due to organic brain involvement), it is far less common than depression. It is usually characterized by irritability rather than euphoria. * **C. Suicidal tendency:** While HIV patients have a higher risk of suicide compared to the general population (especially shortly after diagnosis), it is considered a complication or a severe symptom of underlying depression rather than the most common psychological feature itself. **3. NEET-PG High-Yield Pearls:** * **Most common psychiatric disorder in HIV:** Depression. * **Most common CNS opportunistic infection:** Toxoplasmosis (though Cryptococcus is the most common fungal infection). * **HIV-Associated Neurocognitive Disorder (HAND):** Ranges from mild impairment to **AIDS Dementia Complex (ADC)**, characterized by subcortical dementia (psychomotor slowing, memory loss). * **Drug Alert:** **Efavirenz** (an NNRTI) is frequently associated with neuropsychiatric side effects, including vivid dreams, insomnia, and depression. * **Treatment:** SSRIs are the first-line treatment for depression in AIDS, but clinicians must monitor for drug-drug interactions with Protease Inhibitors (CYP450 inhibition).
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