Excoriation (Skin-Picking) Disorder — MCQs
Body dysmorphic disorder can be associated with all except
A 40-year-old teacher reports excessive handwashing, counting rituals, and difficulty in completing daily tasks. She believes these actions prevent harm to her students. What is the diagnosis?
Rakesh, a 7-year-old boy, presents with a 3-year history of itchy, excoriated papules on his forehead and exposed parts of his arms and legs. The condition is most severe during the rainy season and improves completely in winter. What is the most likely diagnosis?
Which of the following will be LEAST useful in treating Obsessive Compulsive Disorder?
Which of the following is the platinum-based chemotherapeutic agent used as first-line treatment for ovarian carcinoma?
A patient presents with compulsive hair pulling resulting in irregular patchy hair loss. What is the most likely diagnosis?
What is the classification of intelligence corresponding to an IQ score of 90-109?
A person going to temple experiences unwanted, intrusive thoughts urging them to abuse God, which cause significant distress. The likely diagnosis is
Which of the following treatments cannot be used for management of Obsessive Compulsive Disorder (OCD)?
Which of the following is not classified as OCD as per ICD 11?
Excoriation (Skin-Picking) Disorder Indian Medical PG Practice Questions and MCQs
Question 1: Body dysmorphic disorder can be associated with all except
- A. Bulimia nervosa
- B. OCD
- C. Anxiety
- D. Mania (Correct Answer)
Explanation: ***Mania*** - **Mania** is a state of elevated, expansive, or irritable mood that is distinct from the persistent preoccupation with perceived bodily defects seen in **body dysmorphic disorder (BDD)**. - While agitation can occur in BDD, the core symptom profile of **mania**, including decreased need for sleep, grandiosity, and racing thoughts, is not a typical associated feature. *Bulimia nervosa* - **Bulimia nervosa** can co-occur with BDD, particularly when the perceived defects relate to body weight, shape, or specific body parts. - Both disorders involve intense preoccupation with body image and often lead to harmful behaviors to attempt to "correct" perceived flaws. *OCD* - **Obsessive-compulsive disorder (OCD)** shares strong phenomenological similarities with BDD, including intrusive thoughts (obsessions) and repetitive behaviors (compulsions). - BDD is often conceptualized as part of the **OCD spectrum**, with both disorders involving obsessive thoughts and repetitive behaviors related to specific concerns. *Anxiety* - **Anxiety disorders** are highly comorbid with BDD, as individuals often experience significant distress, fear of judgment, and social avoidance due to their perceived flaws. - The constant preoccupation and efforts to conceal or fix perceived defects can lead to chronic anxiety and panic attacks.
Question 2: A 40-year-old teacher reports excessive handwashing, counting rituals, and difficulty in completing daily tasks. She believes these actions prevent harm to her students. What is the diagnosis?
- A. Generalized anxiety disorder
- B. Obsessive-compulsive disorder (Correct Answer)
- C. Paranoid schizophrenia
- D. Phobic disorder
Explanation: ***Obsessive-compulsive disorder*** - The patient's presentation of **recurrent, intrusive thoughts** (worries about students' harm) and **repetitive behaviors** (excessive handwashing, counting rituals) performed to reduce anxiety or prevent a dreaded event is characteristic of OCD. - The individual recognizes that these obsessions or compulsions are **excessive or unreasonable**, causing significant distress and impairment in daily functioning. *Generalized anxiety disorder* - This disorder is characterized by **persistent and excessive worry** about various aspects of life, not typically focused on specific, intrusive obsessions leading to compulsive rituals. - While anxiety is present, it does not manifest as specific **compulsive behaviors** performed in response to obsessions. *Paranoid schizophrenia* - Schizophrenia involves **psychotic symptoms** such as delusions (fixed false beliefs, often persecutory), hallucinations, disorganized speech, and negative symptoms. - The patient's symptoms are not indicative of a thought disorder, delusions, or hallucinations but rather anxiety-driven, repetitive behaviors. *Phobic disorder* - **Phobic disorders** involve intense, irrational fear of specific objects or situations (e.g., social phobia, specific phobia). - The patient's symptoms are not primarily triggered by a specific phobic stimulus but rather by intrusive thoughts leading to ritualistic behaviors.
Question 3: Rakesh, a 7-year-old boy, presents with a 3-year history of itchy, excoriated papules on his forehead and exposed parts of his arms and legs. The condition is most severe during the rainy season and improves completely in winter. What is the most likely diagnosis?
- A. Insect bite hypersensitivity
- B. Scabies
- C. Atopic dermatitis (Correct Answer)
- D. Urticaria
Explanation: ***Atopic dermatitis*** - The **chronic itchy dermatitis** starting at age 4 and the presence of **excoriated papules** are consistent with atopic dermatitis, which is one of the most common chronic dermatoses in children. - While atopic dermatitis in school-age children typically affects **flexural areas** (antecubital and popliteal fossae), it can also involve the face and extensor surfaces, particularly as a continuation from earlier infantile patterns. - The **seasonal variation** can occur in atopic dermatitis due to changes in humidity, allergen exposure, and temperature, though the pattern of worsening in rainy season is somewhat atypical. - Given the chronic course and age of onset in early childhood with persistent itchy papules, atopic dermatitis remains the most likely diagnosis among the given options. *Insect bite hypersensitivity* - This would typically present with localized **urticarial papules** or **vesicles** at discrete bite sites, not a diffuse chronic condition lasting 3 years. - While insect bites can be seasonal and cause itchy excoriated papules, the **continuous 3-year duration** with consistent distribution patterns is not typical for bite reactions. *Scabies* - Scabies presents with intense itching (worse at night) and **pathognomonic burrows** in characteristic sites: finger webs, wrists, axillae, belt line, and genitalia. - The **distribution** described (forehead and exposed extremities) is not typical for scabies, nor would it show complete improvement seasonally without treatment. - Untreated scabies would not spontaneously resolve completely in winter. *Urticaria* - Urticaria manifests as **transient, migratory wheals** (hives) that typically resolve within 24 hours, even in chronic cases. - The description of persistent **excoriated papules** over 3 years is incompatible with urticaria, which is characterized by evanescent lesions, not fixed papules.
Question 4: Which of the following will be LEAST useful in treating Obsessive Compulsive Disorder?
- A. Cognitive behavioral therapy
- B. SSRIs
- C. Clomipramine
- D. Systematic desensitisation (Correct Answer)
Explanation: ***Systematic desensitisation*** - This therapy is primarily used to treat **phobias** and other **anxiety disorders** where avoidance is a key feature and a clear, single trigger can be identified. - While it involves exposure, the gradual hierarchy and relaxation training are less effective for the complex, intrusive thoughts and compulsive rituals characteristic of **OCD**. *Cognitive behavioral therapy* - **CBT, particularly Exposure and Response Prevention (ERP)**, is considered the gold standard psychotherapy for OCD. - It directly addresses the **obsessions** by exposing the individual to feared thoughts or situations and then preventing the ritualistic responses. *SSRIs* - **Selective Serotonin Reuptake Inhibitors (SSRIs)** are the first-line pharmacological treatment for OCD due to their efficacy in reducing obsessive thoughts and compulsive behaviors. - They work by increasing the availability of **serotonin** in the brain. *Clomipramine* - **Clomipramine** is a tricyclic antidepressant (TCA) with potent **serotonergic effects**, making it highly effective in treating OCD, often when SSRIs are partially effective or not tolerated. - It is specifically approved for OCD and is sometimes considered a second-line or augmentation strategy.
Question 5: Which of the following is the platinum-based chemotherapeutic agent used as first-line treatment for ovarian carcinoma?
- A. Cyclophosphamide
- B. Methotrexate
- C. Cisplatin (Correct Answer)
- D. Dacarbazine
Explanation: ***Cisplatin*** - **Cisplatin** is a platinum-based chemotherapy drug that forms **DNA cross-links**, inhibiting DNA synthesis and leading to the death of rapidly dividing cells, making it highly effective against **ovarian carcinoma**. - It is a cornerstone of chemotherapy regimens for ovarian cancer, often used in combination with other agents such as paclitaxel. *Methotrexate* - **Methotrexate** is an **antimetabolite** that inhibits dihydrofolate reductase, thereby interfering with DNA synthesis. - While it is used in various cancers like leukemia, lymphoma, and some solid tumors (e.g., breast cancer, gestational trophoblastic disease), it is **not a primary recommended drug for ovarian carcinoma**. *Cyclophosphamide* - **Cyclophosphamide** is an **alkylating agent** that causes DNA damage, leading to cell death. - It is used in many cancers, including lymphoma, breast cancer, and some leukemias, but it is **not a first-line or primary agent for ovarian carcinoma** in contemporary treatment guidelines. *Dacarbazine* - **Dacarbazine** is an **alkylating agent** primarily used in the treatment of **malignant melanoma** and Hodgkin lymphoma. - It is **not indicated for the treatment of ovarian carcinoma**.
Question 6: A patient presents with compulsive hair pulling resulting in irregular patchy hair loss. What is the most likely diagnosis?
- A. Trichotillomania (Correct Answer)
- B. Alopecia areata
- C. Telogen effluvium
- D. Tinea infection
Explanation: ***Trichotillomania*** - This condition is characterized by **recurrent, irresistible urges to pull out hair**, typically resulting in **noticeable hair loss**. - The resulting patchy hair loss is often **irregular** and can occur in various areas, aligning with the patient's presentation. *Alopecia areata* - This is an **autoimmune condition** that causes smooth, **well-demarcated patches of hair loss**, not typically associated with compulsive pulling. - It usually presents with a sudden onset of hair loss without any preceding trauma or manipulation. *Telogen effluvium* - This condition involves **widespread hair thinning** due to a disturbance in the hair growth cycle, often triggered by stress or illness. - It does not involve compulsive hair pulling and typically results in increased hair shedding rather than patchy hair loss. *Tinea infection* - Also known as **ringworm**, this is a fungal infection that can cause **scaly, itchy patches of hair loss**, sometimes with inflammation and broken hairs. - While it can cause patchy hair loss, it is characterized by dermatological signs of infection (e.g., scaling, erythema) and not compulsive hair pulling.
Question 7: What is the classification of intelligence corresponding to an IQ score of 90-109?
- A. Below average
- B. Average (Correct Answer)
- C. Slightly below average
- D. Above average
Explanation: ***Average*** - An **IQ score** range of **90-109** is traditionally classified as **Average** intelligence. - This range represents the **mean** and surrounding **standard deviation** of IQ scores in the general population. *Below average* - This classification usually corresponds to IQ scores in the range of **70-79** or **80-89**, depending on the specific scale. - It does not represent the central tendency of the population's intelligence. *Slightly below average* - This category typically corresponds to IQ scores in the range of **80-89**. - It falls just below the average range but is not as low as the "below average" classification. *Above average* - This classification is typically assigned to IQ scores that are in the range of **110-119** or higher. - It signifies cognitive abilities that are greater than the majority of the population.
Question 8: A person going to temple experiences unwanted, intrusive thoughts urging them to abuse God, which cause significant distress. The likely diagnosis is
- A. Mania
- B. Schizophrenia
- C. Delusion
- D. Obsessive-Compulsive Disorder (Correct Answer)
Explanation: ***Obsessive-Compulsive Disorder*** - The patient experiences **unwanted, intrusive thoughts** (obsessions) that cause significant anxiety and distress, such as the urge to abuse God. - The **irresistible urge** despite personal values suggests a compulsion to alleviate distress associated with the obsessive thought, even if the action is not performed. *Mania* - Characterized by an **elevated or irritable mood**, increased energy, and goal-directed activity, which does not fit the described symptom of internal, distressing urges. - Symptoms often include **racing thoughts**, grandiosity, and decreased need for sleep. *Schizophrenia* - Involves disruptions in thought processes, perceptions, emotional responsiveness, and social interactions, often including **hallucinations** or **delusions**. - The described symptom is an urge, not a break from reality or a hallucination. *Delusion* - A **fixed, false belief** that is not amenable to change in light of conflicting evidence. - The scenario describes an urge or an intrusive thought, which the person recognizes as distressing and unwanted, not a held belief.
Question 9: Which of the following treatments cannot be used for management of Obsessive Compulsive Disorder (OCD)?
- A. Fluoxetine
- B. Carbamazepine (Correct Answer)
- C. Cognitive Behaviour Therapy
- D. Clomipramine
Explanation: ***Carbamazepine*** - **Carbamazepine** is an **anticonvulsant** and **mood stabilizer** primarily used for epilepsy and bipolar disorder. - It does not have established efficacy for the treatment of **Obsessive-Compulsive Disorder (OCD)**. *Fluoxetine* - **Fluoxetine** is a **Selective Serotonin Reuptake Inhibitor (SSRI)** and is a **first-line pharmacotherapy** for OCD. - SSRIs, including fluoxetine, are effective in reducing the severity of **obsessions and compulsions**. *Cognitive Behaviour Therapy* - **Cognitive Behavioural Therapy (CBT)**, specifically **Exposure and Response Prevention (ERP)**, is the **gold standard psychotherapy** for OCD. - It involves gradually exposing patients to feared situations or thoughts while preventing their ritualistic responses. *Clomipramine* - **Clomipramine** is a **tricyclic antidepressant (TCA)** that has potent inhibitory effects on **serotonin reuptake**. - It is one of the **most effective medications** for OCD, often used when SSRIs are insufficient.
Question 10: Which of the following is not classified as OCD as per ICD 11?
- A. Hypochondriac disorder
- B. Body dysmorphic disorder
- C. PTSD (Correct Answer)
- D. Trichotillomania
Explanation: ***PTSD*** - **Post-traumatic stress disorder (PTSD)** is classified under **disorders specifically associated with stress** in ICD-11, not as an OCD-related disorder. - PTSD involves symptoms like re-experiencing the traumatic event, avoidance, and hyperarousal following exposure to a **traumatic event**. *Hypochondriac disorder* - In ICD-11, **hypochondriac disorder (illness anxiety disorder)** is reclassified under **obsessive-compulsive or related disorders**, focusing on preoccupation with having a serious illness. - This reflects the **compulsive checking** and **obsessive fears** associated with the condition. *Body dysmorphic disorder* - **Body dysmorphic disorder** is classified under **obsessive-compulsive or related disorders** in ICD-11. - It is characterized by **preoccupation with perceived flaws in physical appearance** and repetitive behaviors (e.g., mirror checking) in response to these concerns. *Trichotillomania* - **Trichotillomania (hair-pulling disorder)** is classified as an **obsessive-compulsive or related disorder** in ICD-11. - It involves **recurrent pulling out of one's hair** resulting in hair loss, despite repeated attempts to stop.
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