Tic Disorders — MCQs
Coprolalia is seen in:
Which of the following is not a known cause of neuroregression in children?
Drug of choice for initial pharmacological treatment of Tourette syndrome -
What is the treatment for extrapyramidal side effects induced by Haloperidol?
The most common cause of hyperthyroidism in a young female is?
Drug of choice in Tourette syndrome is -
Tics, hair pulling, and nail biting behaviors are best treated with?
A person going to temple experiences recurrent, intrusive thoughts of abusing God that he finds distressing and cannot control. The most likely diagnosis is:
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?
An 18-year-old girl presents with a circumscribed bald patch. There is no evidence of organic disease. What is the most likely diagnosis?
Tic Disorders Indian Medical PG Practice Questions and MCQs
Question 1: Coprolalia is seen in:
- A. Delirium
- B. Alcoholic intoxication
- C. Mania
- D. Tourette's syndrome (Correct Answer)
Explanation: ***Tourette's syndrome*** - **Coprolalia**, the involuntary utterance of obscene words, occurs in only **10-15%** of individuals with Tourette's syndrome, despite being commonly portrayed in popular media as a defining feature. - Tourette's syndrome is primarily characterized by **motor and vocal tics**, with coprolalia being just one possible but **uncommon vocal tic manifestation**. *Delirium* - Delirium is characterized by an **acute disturbance in attention and awareness**, often fluctuating, and is not typically associated with coprolalia. - Common symptoms include **disorientation**, perceptual disturbances like hallucinations, and agitation, but not specific vocal tics. *Alcoholic intoxication* - While alcohol intoxication can lead to disinhibition and impaired judgement, it does not specifically cause involuntary verbal tics like **coprolalia**. - Symptoms usually include **slurred speech**, ataxia, and altered mood or behavior. *Mania* - Mania is characterized by an **elevated or irritable mood**, increased energy, and goal-directed activity, sometimes with pressured speech and racing thoughts. - While speech can be rapid and expansive, it does not usually involve involuntary obscene utterances like **coprolalia**.
Question 2: Which of the following is not a known cause of neuroregression in children?
- A. Vitamin B12 deficiency
- B. Ataxia telangiectasia
- C. ADHD (Correct Answer)
- D. Wilson's disease
Explanation: ***ADHD*** - **Attention-deficit/hyperactivity disorder (ADHD)** is a neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity. It is **not** a cause of neuroregression. - While ADHD can impact cognitive and behavioral functioning, it does not involve a loss of previously acquired developmental milestones or skills. *Wilson's disease* - **Wilson's disease** is an inherited disorder that causes **copper accumulation** in organs, particularly the liver and brain. - Neurological symptoms, including **neuroregression**, can occur due to copper toxicity in the central nervous system. *Vitamin B12 deficiency* - **Vitamin B12 deficiency** can lead to neurological complications such as **subacute combined degeneration** of the spinal cord and peripheral neuropathy. - In children, severe or prolonged deficiency can impair brain development and lead to **developmental regression**. *Ataxia telangiectasia* - **Ataxia telangiectasia** is a rare, neurodegenerative, inherited disease that affects multiple body systems. - It is characterized by progressive **cerebellar ataxia**, leading to **neuroregression** and intellectual disability over time.
Question 3: Drug of choice for initial pharmacological treatment of Tourette syndrome -
- A. B complex
- B. Clonidine (Correct Answer)
- C. Haloperidol
- D. Valproate
Explanation: ***Clonidine*** - **Clonidine** is often considered a first-line treatment for Tourette syndrome, especially in children and adolescents, due to its favorable side effect profile compared to typical antipsychotics. - As an **alpha-2 adrenergic agonist**, it helps reduce tic severity and associated symptoms like ADHD and impulsivity by modulating neurotransmitter release in the brain. *B complex* - **B vitamins** are generally not indicated for the treatment of Tourette syndrome, as there is no robust scientific evidence to support their efficacy in managing tics. - While essential for overall neurological health, they do not directly address the pathophysiology of tic disorders. *Haloperidol* - **Haloperidol**, a **first-generation antipsychotic**, is highly effective in reducing tics but is generally reserved for severe cases due to its significant side effects, including extrapyramidal symptoms and sedation. - It works by blocking **dopamine D2 receptors** but its adverse effects limit its use as an initial agent of choice. *Valproate* - **Valproate** is an anticonvulsant and mood stabilizer primarily used for epilepsy, bipolar disorder, and migraine prevention. - It is not a standard or preferred treatment for Tourette syndrome, as its efficacy in tic reduction is limited and it carries significant side effects.
Question 4: What is the treatment for extrapyramidal side effects induced by Haloperidol?
- A. Barbiturates
- B. SSRIs
- C. Benzodiazepines
- D. Anticholinergic drugs (Correct Answer)
Explanation: ***Anticholinergic drugs (effective treatment)*** - **Anticholinergic medications**, such as **benztropine** or **diphenhydramine**, are the primary treatment for **acute extrapyramidal symptoms (EPS)** like dystonia and parkinsonism induced by antipsychotics like haloperidol. - They work by **blocking muscarinic acetylcholine receptors**, helping to restore the balance between dopamine and acetylcholine in the basal ganglia. *Benzodiazepines (used for anxiety and muscle relaxation)* - While benzodiazepines can offer some relief for **akathisia** (a form of EPS characterized by restlessness) due to their sedative and muscle relaxant properties, they are **not the first-line treatment for other acute EPS** such as dystonia or parkinsonism. - They primarily enhance **GABAergic transmission** and are effective for anxiety and seizure control rather than direct antagonism of EPS mechanisms. *Barbiturates (used as sedative-hypnotic drugs)* - **Barbiturates** are strong central nervous system depressants used for sedation, anesthesia, and seizure control, but are **not indicated for the treatment of EPS**. - Their significant **sedative and addictive potential**, along with a narrow therapeutic index, makes them unsuitable for this purpose. *SSRIs (used for depression and anxiety)* - **SSRIs (Selective Serotonin Reuptake Inhibitors)** are antidepressants that work by increasing serotonin levels in the brain and are used to treat depression, anxiety, and obsessive-compulsive disorder. - They **do not have a direct role** in ameliorating dopamine-acetylcholine imbalance responsible for haloperidol-induced EPS.
Question 5: The most common cause of hyperthyroidism in a young female is?
- A. TSH-secreting pituitary adenoma
- B. Graves' disease (Correct Answer)
- C. Subacute thyroiditis
- D. Toxic multinodular goiter
Explanation: ***Graves' disease*** - This is an **autoimmune disorder** where antibodies stimulate the thyroid gland, leading to **overproduction of thyroid hormones** [1], [2]. - It is the **most common cause of hyperthyroidism** in young to middle-aged women, making it highly probable in a young female patient [1], [2]. *Toxic multinodular goiter* - This condition is characterized by **multiple nodules** within the thyroid gland that autonomously produce thyroid hormones. - While a cause of hyperthyroidism, it is **more common in older individuals**, typically those over 50 years of age. *Subacute thyroiditis* - This is a **self-limiting inflammatory condition** of the thyroid often following a viral infection, causing a transient hyperthyroid phase due to the release of preformed hormones. - It presents with **painful thyroid enlargement** and is usually followed by a hypothyroid phase, which is different from sustained hyperthyroidism. *TSH-secreting pituitary adenoma* - This is a **very rare cause of hyperthyroidism** where a pituitary tumor produces excess **Thyroid-Stimulating Hormone (TSH)**, leading to thyroid overstimulation. - It is often accompanied by other symptoms of a pituitary mass like **headaches or visual field defects**, which are not implied here.
Question 6: Drug of choice in Tourette syndrome is -
- A. Valproate
- B. Carbamazepine
- C. Methadone
- D. Haloperidol (Correct Answer)
Explanation: ***Haloperidol*** - **Haloperidol**, a **first-generation antipsychotic**, is highly effective in blocking dopamine receptors and reducing the severity of tics in Tourette syndrome. - It is considered a **drug of choice** for managing severe tics due to its strong dopamine antagonism, which helps control **motor and vocal tics**. *Valproate* - **Valproate** is primarily an **anticonvulsant** and **mood stabilizer**, used in epilepsy and bipolar disorder. - While it has some efficacy in reducing tics, it is generally **less effective** than dopamine-blocking agents like haloperidol and is not considered a first-line treatment for Tourette syndrome. *Carbamazepine* - **Carbamazepine** is an **anticonvulsant** used for seizures and trigeminal neuralgia. - It is generally **not efficacious** for the treatment of tics in Tourette syndrome and does not target the dopaminergic pathways involved in tic generation. *Methadone* - **Methadone** is an **opioid analgesic** used for pain management and opioid dependence treatment. - It has **no role** in the management of Tourette syndrome as its mechanism of action is unrelated to the pathophysiology of tics.
Question 7: Tics, hair pulling, and nail biting behaviors are best treated with?
- A. Behavior therapy (Correct Answer)
- B. Psychodynamic therapy
- C. ECT
- D. Medications
Explanation: ***Behavior therapy*** - **Behavior therapy**, particularly **Habit Reversal Training (HRT)**, is the first-line and most effective treatment for tics, hair pulling (trichotillomania), and nail biting (onychophagia). - It involves teaching individuals to identify triggers and recognize urges, and then substituting the undesirable behavior with a competing response. *Psychodynamic therapy* - This therapy focuses on uncovering **unconscious conflicts** and past experiences that may contribute to symptoms. - While it can be helpful for some psychological issues, it is generally **less effective** for directly addressing specific behavioral symptoms like tics or body-focused repetitive behaviors. *ECT* - **Electroconvulsive therapy (ECT)** is a powerful somatic treatment primarily used for severe mental illnesses like **treatment-resistant depression** or catatonia. - It is **not indicated** for tics, hair pulling, or nail biting due to the high risks and lack of evidence for its efficacy in these conditions. *Medications* - While some medications (e.g., **antipsychotics** for severe tics, **SSRIs** for co-occurring anxiety/OCD) can be used as an adjunct, **behavioral therapy** is generally more effective and the first-line approach for these specific behaviors. - Medications alone rarely resolve these behaviors completely without behavioral intervention, and they often come with side effects.
Question 8: A person going to temple experiences recurrent, intrusive thoughts of abusing God that he finds distressing and cannot control. The most likely diagnosis is:
- A. Schizophrenia
- B. Delusion
- C. Obsessive - Compulsive disorder (Correct Answer)
- D. Mania
Explanation: ***Obsessive-Compulsive disorder*** - This scenario describes **religious obsessions** (also called scrupulosity), a well-recognized subtype of OCD characterized by intrusive, blasphemous thoughts. - The key features include: **unwanted, intrusive thoughts** that are **ego-dystonic** (distressing to the patient), **recurrent**, and **difficult to control** - all hallmarks of obsessions in OCD. - The patient recognizes these thoughts as his own (intact reality testing) but finds them distressing and unwanted, which is pathognomonic for obsessions. - Religious obsessions are among the most common obsessive themes in OCD, particularly in cultures with strong religious values. *Schizophrenia* - Schizophrenia involves **psychotic symptoms** such as delusions, hallucinations, and disorganized thinking with **loss of reality contact**. - While religious themes can occur in schizophrenia, the patient would typically not recognize the thoughts as abnormal or distressing in the same way. - The **preserved insight** and **ego-dystonic nature** of the thoughts argue against a psychotic disorder. *Delusion* - A delusion is a **fixed, false belief** held with conviction despite evidence to the contrary and not in keeping with one's cultural background. - In this case, the patient experiences **intrusive thoughts** (not beliefs), recognizes them as problematic and unwanted, and likely does not believe in their validity. - The **ego-dystonic** quality and intact insight differentiate this from a delusional belief. *Mania* - Mania presents with **elevated or irritable mood**, increased energy, grandiosity, decreased need for sleep, and racing thoughts. - While mania may include racing thoughts, they are typically **ego-syntonic** (consistent with the person's inflated self-image) rather than distressing. - The core feature here is a **specific, intrusive, distressing thought**, not the pervasive mood elevation and associated symptoms of mania.
Question 9: 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 10: An 18-year-old girl presents with a circumscribed bald patch. There is no evidence of organic disease. What is the most likely diagnosis?
- A. Depression
- B. OCD
- C. Phobia
- D. Trichotillomania (Hair-Pulling Disorder) (Correct Answer)
Explanation: ***Trichotillomania (Hair-Pulling Disorder)*** - This condition is characterized by the **recurrent pulling out of one's hair**, resulting in noticeable hair loss or **bald patches**. - The description of a **circumscribed bald patch** without evidence of organic disease in an 18-year-old girl is highly suggestive of trichotillomania, especially given that organic causes of hair loss have been ruled out. *Depression* - While depression can be a **comorbid condition** with trichotillomania, it does not directly cause a circumscribed bald patch. - Depression is a **mood disorder** primarily characterized by persistent sadness, loss of interest, and other emotional and physical symptoms. *OCD* - **Obsessive-compulsive disorder** (OCD) involves intrusive thoughts (obsessions) and repetitive behaviors (compulsions). - Although trichotillomania can share some characteristics with OCD (e.g., repetitive behavior), it is classified as a distinct **body-focused repetitive behavior disorder** in the DSM-5, not OCD itself. *Phobia* - A phobia is an **anxiety disorder** defined by an intense and irrational fear of a specific object or situation. - Phobias do not directly cause **physical symptoms** like bald patches; their primary manifestation is avoidance and panic in the presence of the feared stimulus.
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