Trauma and Stress-Related Disorders Practice Questions

Q: 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?

Methohexital. **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.

Q: All of the following are true for Post-Traumatic Stress Disorder (PTSD) except?

Anxiolytics are the treatment of choice. ### 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.

Q: Amnesia, fugue, and multiple personality are all classified as which type of behavior disorder?

Dissociative disorders. **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 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?

Accepted Answer

Methohexital

Answer

Thiopentone

Answer

Ketamine

Answer

Fentanyl

Question 2

Which of the following is NOT a symptom of Post-Traumatic Stress Disorder (PTSD)?

Accepted Answer

Vivid dreams

Answer

Emotional numbing

Answer

Hallucinations

Answer

Hyperarousal

Question 3

All of the following are true for Post-Traumatic Stress Disorder (PTSD) except?

Accepted Answer

Anxiolytics are the treatment of choice

Answer

Involves the hippocampus and amygdala

Answer

Characterized by anhedonia

Answer

Associated with depression and guilt

Question 4

Ataxic abasia is seen in which of the following conditions?

Accepted Answer

Conversion disorder

Answer

Post-traumatic stress disorder

Answer

Depression

Answer

Mania

Question 5

Amnesia, fugue, and multiple personality are all classified as which type of behavior disorder?

Accepted Answer

Dissociative disorders

Answer

Personality disorders

Answer

Psychotic disorders

Answer

Organic mental disorders

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?

Accepted Answer

Classical conditioning

Answer

Operant conditioning

Answer

Free association

Answer

Reaction formation

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?

Accepted Answer

Posttraumatic stress disorder (PTSD)

Answer

Major depressive disorder (MDD)

Answer

Obsessive-compulsive disorder (OCD)

Answer

Specific phobia

Question 8

Post-traumatic stress disorder is more likely to develop in which of the following individuals?

Accepted Answer

Those who experienced emotional numbness immediately after the disaster.

Answer

Those with lower education.

Answer

Those who experienced more stressful life events during the six months immediately following the disaster.

Answer

Those with higher economic status.

Question 9

La belle indifference is seen in:

Accepted Answer

Dissociative disorders

Answer

Mania

Answer

Depression

Answer

Delirium

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?

Accepted Answer

Conversion Disorder

Answer

Panic Attack

Answer

Phobia

Trauma and Stress-Related Disorders — MCQs

Trauma and Stress-Related Disorders — MCQs

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