Trauma and Stress-Related Disorders — MCQs
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A 24-year-old female complains of suicidal ideation following the loss of her family in a car accident. She has had problems focusing on her work and has been making errors due to poor judgment, leading to her layoff. She has been rescued from suicidal attempts multiple times and has been prescribed electroconvulsive therapy. What is the intravenous anesthetic of choice for electroconvulsive therapy?
Which of the following is NOT a symptom of Post-Traumatic Stress Disorder (PTSD)?
All of the following are true for Post-Traumatic Stress Disorder (PTSD) except?
Ataxic abasia is seen in which of the following conditions?
Amnesia, fugue, and multiple personality are all classified as which type of behavior disorder?
A 20-year-old female reports that she was raised by an abusive father. Although he is no longer abusive, she still becomes anxious as soon as she sees him. What is the best explanation for her anxiety based on psychological theory?
A 50-year-old woman presented with complaints of recalling events during a past disaster, remembering the apathy and suffering of others, and the deaths that occurred. Which of the following is the likely diagnosis?
Post-traumatic stress disorder is more likely to develop in which of the following individuals?
La belle indifference is seen in:
A lady, after being involved in a car accident and spending six months in the ICU, experiences recurring episodes of terror and a fear of driving upon waking at night. What is the most likely diagnosis?
Trauma and Stress-Related Disorders Indian Medical PG Practice Questions and MCQs
Question 1: A 24-year-old female complains of suicidal ideation following the loss of her family in a car accident. She has had problems focusing on her work and has been making errors due to poor judgment, leading to her layoff. She has been rescued from suicidal attempts multiple times and has been prescribed electroconvulsive therapy. What is the intravenous anesthetic of choice for electroconvulsive therapy?
- A. Thiopentone
- B. Ketamine
- C. Methohexital (Correct Answer)
- D. Fentanyl
Explanation: **Explanation:** The patient is presenting with severe depression and suicidal ideation following a traumatic event, necessitating **Electroconvulsive Therapy (ECT)**. The primary goal of anesthesia in ECT is to provide rapid induction and recovery while minimizing interference with seizure activity. **Why Methohexital is the Correct Answer:** **Methohexital** (a short-acting barbiturate) is considered the **"gold standard"** and the anesthetic of choice for ECT. Its superiority lies in its pharmacological profile: it has a rapid onset, a short duration of action, and, most importantly, it has the **least inhibitory effect on seizure threshold and duration** compared to other agents. Since the therapeutic efficacy of ECT depends on the quality and duration of the induced seizure, Methohexital ensures an optimal treatment outcome. **Analysis of Incorrect Options:** * **Thiopentone (Option A):** While previously common, it has a higher tendency to raise the seizure threshold and shorten seizure duration compared to methohexital. It also has a longer recovery time. * **Ketamine (Option B):** Though it has intrinsic antidepressant properties and increases seizure duration, it is not the first choice due to side effects like emergence delirium, hypertension, and tachycardia. * **Fentanyl (Option D):** This is an opioid analgesic. While it can be used as an adjunct to blunt the hemodynamic response to ECT, it is not an induction anesthetic agent. **High-Yield Clinical Pearls for NEET-PG:** * **Muscle Relaxant of Choice:** Succinylcholine (due to rapid onset and brief duration). * **Gold Standard Anesthetic:** Methohexital (0.5–1.0 mg/kg). * **Alternative if Methohexital is unavailable:** Propofol (though it significantly shortens seizure duration). * **Absolute Contraindication for ECT:** Increased intracranial pressure (ICP). * **Most Common Side Effect:** Retrograde amnesia and post-ictal confusion.
Question 2: Which of the following is NOT a symptom of Post-Traumatic Stress Disorder (PTSD)?
- A. Emotional numbing
- B. Hallucinations
- C. Hyperarousal
- D. Vivid dreams (Correct Answer)
Explanation: **Explanation:** Post-Traumatic Stress Disorder (PTSD) is characterized by a specific triad of symptom clusters following exposure to a traumatic event: **Intrusion, Avoidance, and Hyperarousal.** **Why "Vivid Dreams" is the correct answer:** While PTSD patients frequently experience **nightmares** (distressing dreams that replay the trauma), "vivid dreams" is a non-specific term and is not a formal diagnostic criterion. In the context of this question, the other three options represent the core diagnostic pillars of PTSD. It is a common "distractor" in exams; remember that PTSD involves *reliving* the trauma, not just having vivid or colorful dreams. **Analysis of Incorrect Options:** * **A. Emotional Numbing:** This is a core feature of the **Avoidance/Negative Cognition** cluster. Patients often feel detached from others, lose interest in previously enjoyed activities (anhedonia), and experience an inability to feel positive emotions. * **B. Hallucinations:** While not a primary symptom, **dissociative flashbacks** are a hallmark of PTSD. During these episodes, the patient may lose touch with reality and act as if the trauma is re-occurring. These are considered "pseudo-hallucinations" or part of the dissociative subtype of PTSD. * **C. Hyperarousal:** This includes symptoms like an exaggerated startle response, irritability, difficulty sleeping, and hypervigilance (constantly scanning the environment for threats). **NEET-PG High-Yield Pearls:** * **Duration:** Symptoms must last for **>1 month**. If symptoms last <1 month, the diagnosis is **Acute Stress Disorder**. * **First-line Treatment:** SSRIs (e.g., Sertraline, Paroxetine) and Trauma-focused Cognitive Behavioral Therapy (CBT). * **Prazosin:** An alpha-1 blocker specifically used to reduce the frequency and intensity of **nightmares** in PTSD. * **Key Symptom Clusters:** 1. Re-experiencing (Flashbacks/Nightmares), 2. Avoidance, 3. Negative alterations in cognition/mood, 4. Hyperarousal.
Question 3: All of the following are true for Post-Traumatic Stress Disorder (PTSD) except?
- A. Involves the hippocampus and amygdala
- B. Characterized by anhedonia
- C. Associated with depression and guilt
- D. Anxiolytics are the treatment of choice (Correct Answer)
Explanation: ### Explanation **Why Option D is the correct answer (The "Except"):** The treatment of choice for Post-Traumatic Stress Disorder (PTSD) is **Selective Serotonin Reuptake Inhibitors (SSRIs)**, such as Sertraline or Paroxetine, combined with Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). While **Anxiolytics** (like Benzodiazepines) may provide short-term relief for acute anxiety, they are **not** the treatment of choice. In fact, they are generally avoided in PTSD due to the high risk of substance abuse/dependence in these patients and their potential to interfere with the natural processing of trauma. **Analysis of Incorrect Options:** * **Option A:** PTSD involves significant neurobiological changes. There is typically **hyperactivity of the Amygdala** (fear center) and **reduced volume/hypofunction of the Hippocampus** (memory processing), leading to impaired contextualizing of traumatic memories. * **Option B:** PTSD is characterized by "negative alterations in cognitions and mood," which includes **anhedonia** (inability to feel pleasure), emotional numbing, and detachment from others. * **Option C:** Comorbidity is extremely common. Patients frequently experience **Major Depressive Disorder** and intense feelings of **survivor guilt** or self-blame regarding the traumatic event. **High-Yield Clinical Pearls for NEET-PG:** * **Timeline:** Symptoms must persist for **>1 month**. If symptoms last <1 month, the diagnosis is **Acute Stress Disorder**. * **Key Symptom Clusters:** Re-experiencing (flashbacks/nightmares), Avoidance, Negative cognitions/mood, and Hyperarousal. * **Prazosin:** An alpha-1 blocker often used specifically to treat **PTSD-related nightmares**. * **Eye Movement Desensitization and Reprocessing (EMDR):** A specialized psychotherapy highly effective for PTSD.
Question 4: Ataxic abasia is seen in which of the following conditions?
- A. Conversion disorder (Correct Answer)
- B. Post-traumatic stress disorder
- C. Depression
- D. Mania
Explanation: **Explanation:** **Ataxic abasia** (also known as Astasia-abasia) is a classic clinical feature of **Conversion Disorder** (Functional Neurological Symptom Disorder). It refers to a psychogenic gait abnormality where the patient exhibits a dramatic, staggering, and unsteady gait, often appearing as if they are about to fall, yet they consistently manage to regain their balance or catch themselves without sustaining injuries. 1. **Why Conversion Disorder is correct:** In Conversion Disorder, psychological distress is "converted" into physical symptoms affecting voluntary motor or sensory functions. Ataxic abasia is a motor conversion symptom. The key diagnostic feature is the **incompatibility** between the symptom and recognized neurological disease. Despite the "ataxic" appearance, the patient typically has normal coordination when lying down and lacks the objective neurological signs (like nystagmus or true cerebellar deficits) seen in organic ataxia. 2. **Why other options are incorrect:** * **Post-traumatic stress disorder (PTSD):** Characterized by intrusive memories, avoidance, and hyperarousal following a trauma; it does not typically present with primary motor gait abnormalities. * **Depression:** May present with psychomotor retardation (slowness of movement), but not the dramatic, uncoordinated gait seen in abasia. * **Mania:** Associated with psychomotor agitation and increased energy, not a specific gait deficit. **Clinical Pearls for NEET-PG:** * **La Belle Indifference:** A classic (though not universal) feature where the patient shows a surprising lack of concern regarding their severe disability. * **Hoover’s Sign:** A common bedside test for conversion weakness; extension of the "paralyzed" leg occurs involuntarily when the patient flexes the contralateral healthy hip against resistance. * **Primary Gain:** Internal conflict resolution (e.g., anxiety reduction). * **Secondary Gain:** External benefits (e.g., avoiding work or gaining attention).
Question 5: Amnesia, fugue, and multiple personality are all classified as which type of behavior disorder?
- A. Personality disorders
- B. Dissociative disorders (Correct Answer)
- C. Psychotic disorders
- D. Organic mental disorders
Explanation: **Explanation:** The correct answer is **Dissociative disorders**. These conditions are characterized by a disruption or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, and behavior. * **Dissociative Amnesia:** Involves an inability to recall important personal information, usually of a traumatic nature, that is too extensive to be explained by ordinary forgetfulness. * **Dissociative Fugue:** A specifier of amnesia involving sudden, unexpected travel away from home accompanied by an inability to recall one's past and sometimes the assumption of a new identity. * **Dissociative Identity Disorder (Multiple Personality):** Characterized by the presence of two or more distinct personality states that alternate in taking control of the individual. **Why other options are incorrect:** * **Personality Disorders:** These are enduring, inflexible patterns of inner experience and behavior that deviate markedly from cultural expectations (e.g., Borderline or Antisocial PD). They do not typically involve sudden loss of memory or identity. * **Psychotic Disorders:** These involve a "loss of touch with reality," characterized by hallucinations, delusions, and disorganized thinking (e.g., Schizophrenia). * **Organic Mental Disorders:** These are behavioral or psychological cognitive dysfunctions caused by a known physiological or structural brain disease (e.g., Dementia or Delirium), rather than psychological trauma. **Clinical Pearls for NEET-PG:** * **Ganser Syndrome:** Also known as "approximate answers," it is often classified under dissociative disorders (though sometimes considered factitious). * **Depersonalization/Derealization:** Feeling detached from oneself or the world; it is the most common dissociative symptom. * **Key Association:** Dissociative disorders are strongly linked to a history of severe childhood physical or sexual abuse.
Question 6: A 20-year-old female reports that she was raised by an abusive father. Although he is no longer abusive, she still becomes anxious as soon as she sees him. What is the best explanation for her anxiety based on psychological theory?
- A. Classical conditioning (Correct Answer)
- B. Operant conditioning
- C. Free association
- D. Reaction formation
Explanation: ### Explanation **1. Why Classical Conditioning is Correct:** The patient’s anxiety is a result of **Classical Conditioning (Pavlovian learning)**. In this scenario: * **Unconditioned Stimulus (UCS):** The father’s past abuse (which naturally causes fear). * **Unconditioned Response (UCR):** Fear/Anxiety in response to the abuse. * **Conditioned Stimulus (CS):** The father’s presence/sight. * **Conditioned Response (CR):** Anxiety triggered by seeing him, even in the absence of current abuse. The repeated pairing of the father (neutral stimulus) with abuse (UCS) has led the patient to associate the father himself with the threat, causing an automatic, involuntary physiological response (anxiety). **2. Why the Other Options are Incorrect:** * **B. Operant Conditioning:** This involves learning through **consequences** (rewards and punishments) to change voluntary behavior. It explains how behaviors are maintained (e.g., avoiding the father to reduce anxiety), but Classical Conditioning explains the *origin* of the involuntary emotional response. * **C. Free Association:** A psychoanalytic technique used in therapy where a patient speaks whatever comes to mind. It is a method of exploration, not a mechanism of learning or symptom formation. * **D. Reaction Formation:** A defense mechanism where a person expresses the opposite of their true (often unacceptable) feelings (e.g., acting overly loving toward someone they hate). This does not explain the involuntary trigger of anxiety. **3. Clinical Pearls for NEET-PG:** * **Phobias and PTSD:** Most anxiety disorders and phobias are primarily explained by **Classical Conditioning**. * **Mowrer’s Two-Factor Theory:** Often tested in Psychiatry, it states that anxiety is *acquired* via Classical Conditioning and *maintained* via Operant Conditioning (Negative Reinforcement through avoidance). * **Systematic Desensitization:** This treatment for phobias works on the principle of **Reciprocal Inhibition**, aiming to "de-condition" the classical association.
Question 7: A 50-year-old woman presented with complaints of recalling events during a past disaster, remembering the apathy and suffering of others, and the deaths that occurred. Which of the following is the likely diagnosis?
- A. Posttraumatic stress disorder (PTSD) (Correct Answer)
- B. Major depressive disorder (MDD)
- C. Obsessive-compulsive disorder (OCD)
- D. Specific phobia
Explanation: ### Explanation **Correct Answer: A. Posttraumatic stress disorder (PTSD)** The clinical presentation describes a patient experiencing **intrusive memories** (recalling events of a past disaster) and distressing recollections of trauma (suffering and death). According to DSM-5 criteria, PTSD occurs following exposure to a traumatic event (death, serious injury, or violence). The core symptoms are categorized into four clusters: 1. **Intrusion:** Flashbacks, nightmares, or distressing memories (as seen in this case). 2. **Avoidance:** Avoiding reminders of the trauma. 3. **Negative alterations in cognition/mood:** Apathy, detachment, or persistent negative beliefs. 4. **Hyperarousal:** Irritability, exaggerated startle response, or sleep disturbances. **Why Incorrect Options are Wrong:** * **B. Major Depressive Disorder (MDD):** While PTSD often co-occurs with depression, MDD is characterized by pervasive low mood, anhedonia, and sleep/appetite changes. It does not specifically involve the re-experiencing of a traumatic event. * **C. Obsessive-Compulsive Disorder (OCD):** OCD involves ego-dystonic obsessions (intrusive thoughts) and compulsions (repetitive behaviors) aimed at reducing anxiety. These are not typically linked to a specific past life-threatening disaster. * **D. Specific Phobia:** This involves an intense, irrational fear of a specific object or situation (e.g., heights, spiders). It does not involve the complex re-experiencing or "flashback" phenomena associated with trauma. **High-Yield Clinical Pearls for NEET-PG:** * **Timeline:** Symptoms must persist for **>1 month**. If symptoms last <1 month, the diagnosis is **Acute Stress Disorder (ASD)**. * **First-line Treatment:** Selective Serotonin Reuptake Inhibitors (**SSRIs**) like Sertraline or Paroxetine. * **Psychotherapy:** Trauma-focused Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (**EMDR**) are highly effective. * **Prazosin:** Often used specifically to treat trauma-related nightmares in PTSD patients.
Question 8: Post-traumatic stress disorder is more likely to develop in which of the following individuals?
- A. Those who experienced emotional numbness immediately after the disaster. (Correct Answer)
- B. Those with lower education.
- C. Those who experienced more stressful life events during the six months immediately following the disaster.
- D. Those with higher economic status.
Explanation: **Explanation:** Post-traumatic stress disorder (PTSD) is a complex psychiatric condition triggered by experiencing or witnessing a traumatic event. The development of PTSD is influenced by pre-traumatic, peri-traumatic, and post-traumatic factors. **Why Option A is Correct:** **Emotional numbness** (or peritraumatic dissociation) immediately after a disaster is one of the strongest predictors for the subsequent development of PTSD. This "numbing" is a maladaptive coping mechanism where the individual mentally disconnects from the trauma. It prevents the healthy emotional processing of the event, leading to the persistence of intrusive memories and avoidance symptoms characteristic of PTSD. **Analysis of Incorrect Options:** * **Option B:** While lower socioeconomic status and lower education are general risk factors for many psychiatric disorders, they are less specific predictors for PTSD compared to the immediate psychological response (numbness) to the trauma itself. * **Option C:** While post-disaster stressors (lack of social support or financial loss) do increase risk, the question asks for the *most* likely individual. Peritraumatic dissociation (Option A) is a more direct clinical indicator of the brain's failure to integrate the trauma. * **Option D:** Higher economic status is generally considered a **protective factor**, as it provides better access to resources, social support, and psychological interventions. **High-Yield Clinical Pearls for NEET-PG:** * **Time Criteria:** Symptoms must persist for **>1 month**. If symptoms last <1 month, the diagnosis is **Acute Stress Disorder (ASD)**. * **Core Symptom Clusters:** 1. Intrusion (flashbacks/nightmares), 2. Avoidance, 3. Negative alterations in cognition/mood (numbness), 4. Alterations in arousal (hypervigilance). * **First-line Treatment:** SSRIs (e.g., Sertraline, Paroxetine) and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). * **Prazosin:** Used specifically to reduce trauma-related nightmares.
Question 9: La belle indifference is seen in:
- A. Dissociative disorders (Correct Answer)
- B. Mania
- C. Depression
- D. Delirium
Explanation: **Explanation:** **La belle indifference** (literally "beautiful indifference") is a clinical phenomenon where a patient demonstrates a surprising lack of concern or anxiety regarding a severe physical symptom (such as paralysis or blindness). **1. Why Dissociative Disorders is correct:** In the ICD-10/11 classification, **Conversion Disorder** is categorized under Dissociative Disorders (though DSM-5 lists it under Somatic Symptom Disorders). The underlying mechanism is "primary gain," where psychological conflict is converted into physical symptoms to reduce anxiety. Because the symptom successfully "solves" the internal conflict, the patient appears inappropriately calm or indifferent to their disability. **2. Why other options are incorrect:** * **Mania:** Characterized by euphoria, hyperactivity, and pressured speech. While patients may lack insight, they are typically high-energy and agitated, not "indifferently calm" about a physical deficit. * **Depression:** Patients usually exhibit excessive worry, psychomotor retardation, or profound sadness. They are generally hypersensitive to their perceived failings or physical health rather than indifferent. * **Delirium:** An acute confusional state characterized by fluctuating consciousness and disorientation. The primary pathology is cognitive impairment, not a psychological defense mechanism like indifference. **Clinical Pearls for NEET-PG:** * **Primary Gain:** Reduction of internal anxiety by converting it into a physical symptom. * **Secondary Gain:** External benefits derived from being sick (e.g., attention, avoiding work). * **Differential:** While classic for Conversion Disorder, *la belle indifference* is not pathognomonic; it can occasionally be seen in organic conditions like frontal lobe lesions. * **Factitious Disorder vs. Malingering:** In Conversion Disorder, symptoms are **involuntary** (unconscious), whereas in Malingering, they are **intentional** for external gain.
Question 10: A lady, after being involved in a car accident and spending six months in the ICU, experiences recurring episodes of terror and a fear of driving upon waking at night. What is the most likely diagnosis?
- A. Panic Attack
- B. Phobia
- C. Conversion Disorder
- D. Conversion Disorder (Correct Answer)
Explanation: **Explanation:** The correct diagnosis is **Conversion Disorder (Functional Neurological Symptom Disorder)**. In this clinical scenario, the patient presents with psychological distress (terror and fear of driving) that manifests as physical or sensory symptoms following a significant traumatic event (car accident and ICU stay). **Why Conversion Disorder is correct:** Conversion disorder involves the "conversion" of psychological conflict into physical symptoms that cannot be explained by neurological or medical conditions. According to Freudian theory, this serves as a defense mechanism to reduce anxiety (**Primary Gain**). In the context of NEET-PG, when a patient presents with sudden neurological or sensory symptoms (like episodes of terror or paralysis) immediately following a major stressor, Conversion Disorder is the most likely diagnosis. **Why other options are incorrect:** * **Panic Attack:** While the patient experiences "terror," a panic attack is characterized by a discrete period of intense fear accompanied by specific autonomic symptoms (palpitations, sweating, tremors). The context here is specifically tied to the trauma and the act of driving. * **Phobia:** While she has a "fear of driving," a simple phobia does not typically manifest as nocturnal episodes of terror or complex post-traumatic symptoms. * **Post-Traumatic Stress Disorder (PTSD):** (Note: Though not an option, it is a common distractor). While the symptoms follow a trauma, Conversion Disorder specifically focuses on the somatic/neurological manifestation of that stress. **Clinical Pearls for NEET-PG:** * **La Belle Indifference:** A classic sign where the patient shows a surprising lack of concern regarding their symptoms. * **Primary Gain:** Internal relief from anxiety by keeping the conflict out of conscious awareness. * **Secondary Gain:** External benefits derived from the symptoms (e.g., attention, avoiding work). * **Treatment:** The first-line treatment is usually **Physical Therapy** and **Cognitive Behavioral Therapy (CBT)**; pharmacotherapy is secondary.
Practice by Chapter
Post-Traumatic Stress Disorder
Practice Questions
Acute Stress Disorder
Practice Questions
Adjustment Disorders
Practice Questions
Reactive Attachment Disorder
Practice Questions
Disinhibited Social Engagement Disorder
Practice Questions
Complex Trauma
Practice Questions
Trauma-Focused Cognitive-Behavioral Therapy
Practice Questions
Eye Movement Desensitization and Reprocessing
Practice Questions
Psychopharmacology for Trauma-Related Disorders
Practice Questions
Trauma in Special Populations
Practice Questions
Resilience and Post-Traumatic Growth
Practice Questions
Dissociative Disorders Related to Trauma
Practice Questions
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