Family-Based Treatment — MCQs
What is considered the most effective treatment for Borderline Personality Disorder?
Which of the following is not a common feature of anorexia nervosa?
Indoor management of anorexia nervosa is done on priority patients with:-
All the following are true regarding F.A.S.T. except which of the following?
Anorexia Nervosa is characterized by all EXCEPT:
Best predictor of good prognosis in anorexia nervosa is:
Best predictor of good prognosis in anorexia nervosa is:
What is the most appropriate surgical treatment for a 40-year-old married female with uterine prolapse and completed family?
Consider the following statements with regard to Home Based Newborn Care (HBNC) : I. Early detection and special care of pre-term newborns is one of the major objectives of HBNC. II. ANM is the main person involved in the delivery of HBNC. III. Supporting the family for adoption of healthy practices helps achieve the key objectives of HBNC. IV. The primary aim of HBNC is to improve newborn survival. Which of the statements given above are correct?
Which of the following is FALSE regarding Anorexia Nervosa:
Family-Based Treatment Indian Medical PG Practice Questions and MCQs
Question 1: What is considered the most effective treatment for Borderline Personality Disorder?
- A. Combination of DBT and pharmacotherapy
- B. Cognitive Behavioural Therapy (CBT)
- C. Pharmacotherapy alone
- D. Dialectical Behaviour Therapy (DBT) (Correct Answer)
Explanation: ***Dialectical Behaviour Therapy (DBT)*** - **DBT** is the **gold standard** and most evidence-based psychotherapy specifically developed for Borderline Personality Disorder - Developed by **Marsha Linehan** specifically to target the core symptoms of BPD including emotional dysregulation, impulsivity, and interpersonal difficulties - Combines **cognitive-behavioral techniques** with mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills - Has the **strongest research evidence** for reducing suicidal behavior, self-harm, and improving overall functioning in BPD patients - Multiple RCTs demonstrate DBT's superiority in treating BPD compared to standard care *Cognitive Behavioural Therapy (CBT)* - While **CBT** is effective for many mental health conditions and can help with certain BPD symptoms, it was not specifically designed for BPD - DBT is actually a specialized adaptation of CBT tailored for BPD, making it more targeted and effective for this specific condition - Generic CBT may help with co-occurring conditions like depression or anxiety but lacks the comprehensive approach needed for core BPD features *Combination of DBT and pharmacotherapy* - This combination is clinically useful, especially when treating **co-morbid conditions** like depression, anxiety, or severe mood instability - However, psychotherapy (particularly DBT) remains the **cornerstone** of BPD treatment, with medications serving an adjunctive role - The question asks for the single most effective treatment, which is DBT alone *Pharmacotherapy alone* - **No medication** is FDA-approved specifically for BPD - Pharmacotherapy may help manage specific symptoms (mood swings, impulsivity, brief psychotic episodes) but does not address the core **personality pathology** - Generally not recommended as monotherapy for BPD; should always be combined with psychotherapy
Question 2: Which of the following is not a common feature of anorexia nervosa?
- A. Self-perception of being fat
- B. Binge eating
- C. Amenorrhea (Correct Answer)
- D. Underweight
Explanation: ***Amenorrhea*** - While amenorrhea (absence of menstruation) **was previously a diagnostic criterion**, it was **removed from DSM-5 criteria** for anorexia nervosa in 2013. - It can occur as a physiological consequence of severe malnutrition and low body fat, but it is **not required for diagnosis** and does not occur in all cases. - Many individuals with anorexia nervosa continue to menstruate, and males cannot exhibit this feature, making it **not a common or universal feature**. *Self-perception of being fat* - A **core diagnostic criterion** for anorexia nervosa is distorted body image, where individuals perceive themselves as overweight despite being significantly underweight. - This intense fear of gaining weight or becoming fat is a **defining characteristic** of the disorder. *Underweight* - The most **defining feature** of anorexia nervosa is significantly low body weight relative to age, sex, developmental trajectory, and physical health. - Persistent restriction of energy intake leading to **abnormally low body weight** is essential for diagnosis (DSM-5). *Binge eating* - Binge eating **does occur in anorexia nervosa**, specifically in the **binge-eating/purging subtype**. - While the restricting subtype does not involve binge eating, it is a recognized feature in one of the two subtypes of anorexia nervosa. - This makes it a **common feature** in a significant proportion of cases.
Question 3: Indoor management of anorexia nervosa is done on priority patients with:-
- A. Depression
- B. Amenorrhea
- C. Binging episodes
- D. Weight for height less than 75% of normal (Correct Answer)
Explanation: ***Weight for height less than 75% of normal*** - A **weight for height less than 75% of normal** (or **BMI <15 kg/m²**) indicates severe **malnutrition** and a high risk of medical complications, necessitating urgent inpatient care. - This level of **underweight** is a critical indicator for hospital admission in **anorexia nervosa** to prevent severe organ dysfunction, refeeding syndrome, and even death. *Depression* - While **depression** is a common comorbidity with **anorexia nervosa** and often requires treatment, it does not, by itself, warrant immediate inpatient management unless there are acute **suicidal risks**. - **Depression** is usually managed in an outpatient setting initially, with hospitalization being reserved for severe cases where safety is compromised. *Amenorrhea* - **Amenorrhea** (absence of menstruation) is a common symptom of **anorexia nervosa** due to hormonal imbalances caused by low body weight. - Though an indicator of significant caloric restriction, **amenorrhea** alone is not typically an immediate criterion for inpatient admission unless accompanied by other severe physical complications. *Binging episodes* - While **binging episodes** can occur in **anorexia nervosa** (specifically the binge-purging subtype) and can lead to electrolyte imbalances or medical complications, they are not the primary, stand-alone trigger for immediate inpatient admission. - The severity of **binging** and associated **purging behaviors** must be evaluated in the context of overall medical stability and weight to determine the appropriate level of care.
Question 4: All the following are true regarding F.A.S.T. except which of the following?
- A. It is effective for detecting larger volumes of free fluid, typically above 100-200 ml.
- B. It detects free fluid in the abdomen or pericardium.
- C. It is a focused abdominal sonar for trauma
- D. It is accurate in detecting <50 ml. of free blood (Correct Answer)
Explanation: ***It is accurate in detecting <50 ml. of free blood*** - **F.A.S.T.** (Focused Assessment with Sonography for Trauma) is **NOT accurate** for detecting small volumes of free fluid, particularly those under **100-200 mL**, making this statement **false**. - While effective for larger volumes, **smaller bleeds** or injuries without significant fluid extravasation are often missed, leading to false negatives. - This is the **correct answer** to this "except" question because it is the only false statement. *It is a focused abdominal sonar for trauma* - **F.A.S.T.** is an acronym for **Focused Assessment with Sonography for Trauma**, emphasizing its specific use in rapidly evaluating trauma patients for internal bleeding. - This bedside ultrasound examination is performed to identify **free fluid** in specific anatomical regions susceptible to accumulation after trauma. *It is effective for detecting larger volumes of free fluid, typically above 100-200 ml.* - The sensitivity of **F.A.S.T.** for detecting free fluid, such as **blood**, significantly increases with larger volumes. - It is most reliable when **moderate to large amounts of fluid** are present, typically exceeding **100-200 mL**, which is clinically more significant in trauma. *It detects free fluid in the abdomen or pericardium.* - The standard **F.A.S.T. exam** evaluates four main areas: the **pericardium**, Morison's pouch (**hepatorenal recess**), the splenorenal recess, and the **pelvis** (Pouch of Douglas in females). - The primary goal is to quickly identify the presence of **hemopericardium** or **hemoperitoneum** in a trauma setting.
Question 5: Anorexia Nervosa is characterized by all EXCEPT:
- A. Distortion of body image
- B. Decreases 25% weight
- C. Self induced vomiting
- D. Amenorrhea for 3 months (Correct Answer)
Explanation: ***Amenorrhea for 3 months*** - While **amenorrhea** has historically been a common feature of anorexia nervosa due to hormonal imbalances from malnutrition, the **DSM-5 criteria no longer require it for diagnosis**. - Its presence can still suggest severe malnutrition, but its absence does not rule out anorexia nervosa. *Distortion of body image* - This is a core diagnostic criterion for anorexia nervosa, where individuals perceive themselves as **overweight** despite being underweight. - This **body image distortion** drives much of the restrictive eating and weight control behaviors. *Decreases 25% weight* - Anorexia nervosa is characterized by a **restriction of energy intake** leading to a significantly low body weight. - While there isn't a specific percentage that defines this, a significant weight loss (e.g., body weight **less than 85% of normal** for age and height) is a key feature. *Self induced vomiting* - **Self-induced vomiting** is a common compensatory behavior in the **binge-eating/purging subtype** of anorexia nervosa. - It is one of several behaviors (like laxative misuse, excessive exercise) used to prevent weight gain after food intake.
Question 6: Best predictor of good prognosis in anorexia nervosa is:
- A. Early treatment
- B. Higher BMI at diagnosis
- C. Shorter duration (Correct Answer)
- D. Supportive family
Explanation: ***Shorter duration*** - **Shorter duration of illness** before treatment is consistently identified as one of the strongest predictors of good prognosis in anorexia nervosa. - Duration encompasses the total time the illness has existed, capturing the chronicity and entrenchment of maladaptive eating behaviors, psychological patterns, and physiological complications. - Patients with **brief illness duration** before intervention have higher rates of **full recovery** (up to 50-70% in some studies) compared to those with chronic illness (20-30% recovery rates). - Shorter duration indicates less time for the development of severe medical complications (osteoporosis, cardiac abnormalities) and entrenched psychological patterns that are harder to reverse. *Early treatment* - While **early treatment initiation** is extremely important and strongly correlated with better outcomes, it is typically a function of recognizing and intervening in an illness of short duration. - The benefit of early treatment is largely because it prevents the illness from becoming chronic; thus, duration remains the more fundamental prognostic indicator. - Both concepts overlap significantly, but duration captures the complete timeframe of illness pathology. *Higher BMI at diagnosis* - A **higher BMI at diagnosis** suggests less severe weight loss and may indicate less severe restriction, but it is not as strong a predictor as duration. - Patients can have relatively higher BMI but still have chronic illness with poor prognosis if the duration has been extended. *Supportive family* - A **supportive family** is crucial for treatment adherence, recovery, and relapse prevention, and is indeed a positive prognostic factor. - However, family support alone cannot overcome the physiological and psychological damage of prolonged illness duration. - In pediatric/adolescent populations, family-based therapy (FBT) outcomes are best when the **illness duration is short** at treatment onset.
Question 7: Best predictor of good prognosis in anorexia nervosa is:
- A. Shorter duration (Correct Answer)
- B. Supportive family
- C. Early treatment
- D. Higher BMI at diagnosis
Explanation: ***Shorter duration of illness*** - **Shorter duration** at the time of presentation is the most consistently cited predictor of good prognosis in anorexia nervosa across psychiatric literature. - Patients with **brief illness duration** (typically <6 months) have significantly higher rates of complete recovery and remission. - Longer duration leads to entrenchment of **maladaptive eating patterns**, more severe medical complications, and greater resistance to treatment interventions. - Early recognition and presentation inherently means shorter duration, making this the most actionable and reliable prognostic indicator. *Early treatment* - While initiating treatment early is therapeutically crucial, it is an **intervention** rather than a prognostic predictor. - Early treatment is beneficial precisely because it prevents progression to **longer illness duration**. - The effectiveness of treatment depends on multiple factors including patient motivation, comorbidities, and treatment modality. *Supportive family* - A supportive family environment facilitates recovery by providing **emotional support** and reinforcing treatment adherence. - Family-based therapy (FBT) is particularly effective in adolescents with anorexia nervosa. - However, family support alone does not predict outcome as strongly as **illness duration** or other core clinical features. *Higher BMI at diagnosis* - Higher BMI at presentation indicates less severe **malnutrition** and reduced immediate medical risk. - However, BMI alone does not correlate strongly with psychological recovery, as the underlying **eating disorder psychopathology** (body image distortion, fear of weight gain) requires addressing regardless of weight. - Some patients may maintain relatively higher BMI while still meeting diagnostic criteria and having poor outcomes.
Question 8: What is the most appropriate surgical treatment for a 40-year-old married female with uterine prolapse and completed family?
- A. Fothergill's operation
- B. Abdominal Sling operation
- C. Vaginal hysterectomy with pelvic floor repair (Correct Answer)
- D. Ring pessary
Explanation: ***Vaginal hysterectomy with pelvic floor repair*** - For women with **completed family** and symptomatic uterine prolapse, **vaginal hysterectomy** with concurrent **pelvic floor repair** is typically the most definitive and appropriate surgical treatment. - This approach addresses both the uterine prolapse by removing the uterus and the accompanying pelvic floor muscle and fascial defects that contribute to the prolapse. *Fothergill's operation* - **Fothergill's operation**, or Manchester repair, involves **cervical amputation** and uterosacral ligament plication, preserving the uterus. - This procedure is generally reserved for women who desire **future childbearing** or wish to retain their uterus, which is not a priority for this patient with completed family. *Abdominal Sling operation* - The **abdominal sling operation** (e.g., sacral colpopexy) is primarily used for **vaginal vault prolapse** after hysterectomy or in cases of severe prolapse where a more robust suspension is needed. - It is often considered a more complex procedure and may not be the first-line choice for primary uterine prolapse in a patient with completed family, especially when a vaginal approach is feasible. *Ring pessary* - A **ring pessary** is a **non-surgical** management option for uterine prolapse, offering symptomatic relief by physically supporting the uterus. - While it can be an effective initial or long-term management for some patients, the question specifically asks for the "most appropriate **surgical treatment**" in a patient with completed family, implying a definitive solution.
Question 9: Consider the following statements with regard to Home Based Newborn Care (HBNC) : I. Early detection and special care of pre-term newborns is one of the major objectives of HBNC. II. ANM is the main person involved in the delivery of HBNC. III. Supporting the family for adoption of healthy practices helps achieve the key objectives of HBNC. IV. The primary aim of HBNC is to improve newborn survival. Which of the statements given above are correct?
- A. I, III and IV only (Correct Answer)
- B. I and II only
- C. I, II, III and IV
- D. II and III only
Explanation: ***I, III and IV only*** - **Statement I is CORRECT**: Early detection and special care of **pre-term and low birth weight newborns** is a major objective of HBNC, as preterm birth is a significant risk factor for neonatal morbidity and mortality. - **Statement III is CORRECT**: Supporting families in adopting **healthy practices** like optimal breastfeeding, cord care, thermal regulation, and recognition of danger signs is fundamental to achieving HBNC objectives. - **Statement IV is CORRECT**: The **primary aim of HBNC** is to **improve newborn survival** and reduce neonatal mortality by ensuring essential healthcare services reach every newborn through home visits. - **Statement II is INCORRECT**: **ASHA workers** are the main persons involved in delivering HBNC through home visits (minimum 6 visits for institutional deliveries, more for home deliveries). ANMs provide **supervisory support** but are NOT the primary service deliverers. *I and II only* - Incorrect because statement II is false - **ASHA workers**, not ANMs, are the primary HBNC service providers. *I, II, III and IV* - Incorrect because statement II is false - ANMs supervise HBNC but **ASHA workers** conduct the actual home visits and deliver care. *II and III only* - Incorrect because statement II is false, and statements I and IV (which are correct) are excluded from this option.
Question 10: Which of the following is FALSE regarding Anorexia Nervosa:
- A. Decreased appetite (Correct Answer)
- B. Body image distortion
- C. Vigor exceeding physical ill being
- D. Weight loss
Explanation: ***Decreased appetite*** - Patients with anorexia nervosa typically experience **increased hunger** and **preoccupation with food**, despite efforts to restrict intake, rather than a decreased appetite. - The sensation of hunger often intensifies due to severe caloric restriction, making the statement "decreased appetite" false. *Body image distortion* - This is a core diagnostic criterion of anorexia nervosa, where individuals perceive themselves as **overweight** even when they are severely underweight. - The distorted body image drives their relentless pursuit of thinness and fear of weight gain. *Vigor exceeding physical ill being* - Patients with anorexia nervosa often display surprising **energy and hyperactivity** despite severe physical debilitation and malnutrition. - This "vigor" can be a mechanism to burn calories, suppress hunger, or avoid rest, exceeding what would be expected given their poor health status. *Weight loss* - **Significant weight loss** or failure to gain weight during growth is a defining characteristic of anorexia nervosa. - This weight loss is intentionally achieved through severe dietary restriction, excessive exercise, or purging behaviors.
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