Acute Stress Disorder — MCQs
Which one of the following is a good index of the severity of an acute disease?
A 24-year-old lady presented with sudden onset chest pain, palpitations lasting for about 20 minutes. She says there were 3 similar episodes in the past. All the investigations were normal. What is the likely diagnosis?
Which of the following is not a clinical feature of post-traumatic stress disorder?
Which of the following is not classified as OCD as per ICD 11?
To diagnose post-traumatic stress disorder, the symptoms should persist for more than ______
What is the drug of choice for rapid relief of an acute panic attack?
A patient with a history of RTA before 2 months presents with complaints of dreams of accidents. He is able to visualize the same scene whenever he visits the place. Hence is afraid to go back to the accident site. Identify the type of disorder that he might be suffering from?
Post-traumatic stress disorder is characterized by all except:
Derealization and depersonalization are symptoms of which type of disorder?
A young marathon runner is participating in a marathon competition. After running for 100 m, he develops pain at the anteromedial aspect of tibia which was mild to start with, but increased on further running. X ray was normal. The doctor ordered a bone scan. What is the likely diagnosis?
Acute Stress Disorder Indian Medical PG Practice Questions and MCQs
Question 1: Which one of the following is a good index of the severity of an acute disease?
- A. Cause specific death rate
- B. Case fatality rate (Correct Answer)
- C. Standardized mortality ratio
- D. Five year survival
Explanation: ***Case fatality rate*** - The **case fatality rate (CFR)** is the proportion of individuals diagnosed with a disease who die from that disease within a specified time period. - It directly reflects the **virulence** or **severity** of an acute disease by measuring the proportion of fatal outcomes among confirmed cases. *Cause specific death rate* - This measures the **number of deaths** from a specific cause per unit of population during a specified period. - It reflects the **overall burden** of a disease in a population, but not necessarily the severity among those who contract it. *Standardized mortality ratio* - The **standardized mortality ratio (SMR)** compares the observed number of deaths in a study population to the expected number of deaths if the study population had the same age-specific rates as a standard population. - SMR is used to assess the **overall mortality experience** of a group, adjusting for age, but not specifically the severity of an acute disease in affected individuals. *Five year survival* - **Five-year survival rate** is the percentage of people who are still alive five years after being diagnosed with a disease. - It is primarily used for **chronic diseases**, particularly cancers, to assess long-term prognosis rather than the immediate severity of an acute illness.
Question 2: A 24-year-old lady presented with sudden onset chest pain, palpitations lasting for about 20 minutes. She says there were 3 similar episodes in the past. All the investigations were normal. What is the likely diagnosis?
- A. Post-traumatic stress disorder
- B. Acute psychosis
- C. Panic attack (Correct Answer)
- D. Mania
Explanation: ***Panic attack*** - The sudden onset of **chest pain** and **palpitations** in a young woman, lasting for a brief period (20 minutes), and occurring in recurrent episodes with all investigations being normal, are classic signs of a **panic attack**. - Panic attacks frequently mimic cardiac events, but the absence of organic findings despite recurrent episodes points towards a psychological origin. *Post-traumatic stress disorder* - While PTSD can involve symptoms of anxiety and panic, it is specifically triggered by a **traumatic event** and typically includes re-experiencing the trauma, avoidance, and hyperarousal, none of which are described here. - The patient's presentation primarily focuses on sudden physical symptoms rather than a direct link to past trauma or pervasive fear. *Acute psychosis* - Acute psychosis involves a severe break from reality, characterized by **hallucinations**, **delusions**, or disorganized thought and behavior, which are not present in this scenario. - The symptoms described are more consistent with an anxiety disorder rather than a thought disorder. *Mania* - Mania is a state of elevated mood, increased energy, and often includes symptoms like **reduced need for sleep**, **racing thoughts**, and **impulsive behavior**, which are not described in this patient's presentation. - The core symptoms are acute physical sensations of fear and discomfort, not sustained euphoria or grandiosity.
Question 3: Which of the following is not a clinical feature of post-traumatic stress disorder?
- A. Grandiosity (Correct Answer)
- B. Emotional distress
- C. Flashbacks
- D. Nightmares
Explanation: ***Grandiosity*** - **Grandiosity** refers to an inflated sense of self-importance, superiority, or special abilities, which is characteristic of manic or hypomanic episodes in bipolar disorder, not PTSD. - PTSD typically involves negative alterations in cognition and mood, including persistent negative beliefs about oneself (e.g., "I am bad," "I can't trust anyone"), which is opposite to grandiose thinking. - The core symptoms of PTSD do not include elevated mood, inflated self-esteem, or grandiose delusions. *Flashbacks* - **Flashbacks** are a hallmark feature of PTSD, involving vivid, intrusive re-experiences of the traumatic event where the individual feels as if the trauma is happening again. - They are a key symptom in the **intrusion cluster (Criterion B)** of DSM-5 PTSD diagnostic criteria. - Flashbacks can involve sensory, emotional, or physical re-experiencing with dissociative qualities. *Nightmares* - **Nightmares** related to the traumatic event are a common and distressing feature of PTSD, falling under the **intrusion symptom cluster (Criterion B)**. - They often involve re-enacting the trauma or experiencing themes related to its content, leading to sleep disturbance and significant emotional distress. - Trauma-related nightmares occur in the majority of PTSD patients and contribute to sleep avoidance. *Emotional distress* - **Emotional distress** is a pervasive symptom in PTSD, including intense anxiety, fear, sadness, anger, or irritability. - This distress appears across multiple symptom clusters: **intrusion (Criterion B)**, **negative alterations in cognition and mood (Criterion D)**, and **alterations in arousal and reactivity (Criterion E)**. - Emotional distress can be triggered by trauma reminders (internal or external cues) and is a core feature of the disorder.
Question 4: 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.
Question 5: To diagnose post-traumatic stress disorder, the symptoms should persist for more than ______
- A. 1 month (Correct Answer)
- B. 2 days
- C. 3 months
- D. 6 months
Explanation: ***1 month*** - According to the **DSM-5 criteria**, for a diagnosis of **Post-Traumatic Stress Disorder (PTSD)**, the symptoms must persist for **more than one month**. - If symptoms last for less than one month, but meet other criteria, the diagnosis is typically **Acute Stress Disorder**. *2 days* - Symptoms lasting only **2 days** following a traumatic event are too short for a diagnosis of PTSD. - Such a brief duration may align with an **acute stress reaction**, which is a normal response to trauma and usually resolves quickly. *3 months* - While symptoms lasting **3 months** would certainly qualify for PTSD in terms of duration, this is not the minimum duration required. - The **minimum duration** for PTSD diagnosis is specifically defined as more than one month. *6 months* - Symptoms persisting for **6 months** or longer clearly meet the duration criteria for PTSD, but this is not the minimal period. - Setting the minimum at 6 months would lead to **underdiagnosis** of PTSD in individuals whose symptoms are significant and disabling after one month but before six months.
Question 6: What is the drug of choice for rapid relief of an acute panic attack?
- A. Benzodiazepines (rapid anxiolytic action) (Correct Answer)
- B. Neuroleptics (antipsychotic agents)
- C. Beta-blockers (manage physical symptoms)
- D. Tricyclic Antidepressants (long-term management)
Explanation: ***Benzodiazepines (rapid anxiolytic action)*** - **Benzodiazepines** are used for **rapid symptomatic relief** of acute panic attacks due to their **fast onset of action** (within 30-60 minutes) and potent anxiolytic effects. - They work by enhancing the effect of **GABA**, an inhibitory neurotransmitter, leading to CNS depression and reduced anxiety. - **Important note:** While effective for acute relief, benzodiazepines are recommended only for **short-term use** (2-4 weeks) due to risks of dependence, tolerance, and withdrawal. - **First-line long-term treatment** for panic disorder is **SSRIs** (not benzodiazepines). *Beta-blockers (manage physical symptoms)* - **Beta-blockers** can help manage **physical symptoms** of anxiety such as palpitations and tremors, but they do not address the core psychological component of a panic attack. - They are often used as an adjunct or in performance anxiety situations, but not for acute panic attack relief. *Neuroleptics (antipsychotic agents)* - **Neuroleptics** (antipsychotic agents) are primarily used for treating **psychotic disorders** like schizophrenia, not panic attacks. - Their side effect profile and mechanism of action make them unsuitable for acute anxiety or panic. *Tricyclic Antidepressants (long-term management)* - **Tricyclic Antidepressants (TCAs)** like imipramine and clomipramine can be used for **long-term management** of panic disorder. - However, their onset of action is slow (2-4 weeks), making them unsuitable for acute panic attack relief. - **SSRIs are preferred over TCAs** for long-term management due to better tolerability.
Question 7: A patient with a history of RTA before 2 months presents with complaints of dreams of accidents. He is able to visualize the same scene whenever he visits the place. Hence is afraid to go back to the accident site. Identify the type of disorder that he might be suffering from?
- A. PTSD (Correct Answer)
- B. Anxiety disorder
- C. OCD
- D. Adjustment disorder
Explanation: ***PTSD*** - Patients with **Post-Traumatic Stress Disorder (PTSD)** frequently experience **intrusive memories**, **flashbacks**, and **nightmares** related to a traumatic event. - The fear and avoidance of places associated with the trauma are characteristic symptoms, consistent with the patient's reluctance to revisit the accident site. *Anxiety disorder* - While anxiety is a component of PTSD, an **isolated anxiety disorder** would not fully explain the presence of specific **recurrent dreams** and **flashbacks** directly linked to a past traumatic event. - Generalized anxiety often involves **persistent worry about various aspects of life**, rather than focused re-experiencing of a trauma. *OCD* - **Obsessive-Compulsive Disorder (OCD)** is characterized by **recurrent, intrusive thoughts (obsessions)** and **repetitive behaviors (compulsions)** performed to reduce anxiety. - The patient's symptoms of re-experiencing an accident and avoiding the site do not align with the typical presentation of obsessions and compulsions. *Adjustment disorder* - **Adjustment disorder** involves emotional or behavioral symptoms in response to an identifiable stressor, usually resolving within 6 months after the stressor or its consequences have ended. - The described symptoms of **dreams, flashbacks, and specific avoidance** after two months are more intense and prolonged than typically seen in adjustment disorder, pointing towards a more severe trauma-related condition like PTSD.
Question 8: Post-traumatic stress disorder is characterized by all except:
- A. Flashback and nightmare
- B. Re-experiencing stressful events
- C. Exposure to traumatic events
- D. It doesn't develop after 6 months of stress (Correct Answer)
Explanation: ***It doesn't develop after 6 months of stress*** - This statement is **FALSE** and is therefore the correct answer to this "EXCEPT" question. - **PTSD can develop at any time** following a traumatic event, including months or even years later - there is no upper time limit for symptom onset. - The **DSM-5 includes a "delayed expression" specifier** for cases where full diagnostic criteria are not met until at least 6 months after the trauma. - While most cases develop within **3 months of the traumatic event**, delayed onset is well-documented and clinically recognized. - This distinguishes PTSD from **Acute Stress Disorder**, which by definition occurs within 3 days to 4 weeks after trauma exposure. *Flashback and nightmare* - **Flashbacks** (dissociative reactions where the person feels the traumatic event is recurring) and **nightmares** are core symptoms of PTSD. - These belong to the **re-experiencing/intrusion symptom cluster** (Criterion B in DSM-5). - These involuntary recollections cause significant distress and are hallmark features of the disorder. *Re-experiencing stressful events* - **Re-experiencing symptoms** are one of the four main symptom clusters required for PTSD diagnosis. - This includes intrusive memories, traumatic nightmares, flashbacks, and intense psychological/physiological reactions to trauma reminders. - These symptoms reflect the **inability to integrate the traumatic memory** properly, leading to involuntary reactivation. *Exposure to traumatic events* - **Criterion A: Exposure to actual or threatened death, serious injury, or sexual violence** is the essential prerequisite for PTSD diagnosis. - This exposure can be through direct experience, witnessing, learning it happened to a close other, or repeated/extreme exposure to aversive details. - Without documented trauma exposure, PTSD cannot be diagnosed regardless of symptom presentation.
Question 9: Derealization and depersonalization are symptoms of which type of disorder?
- A. Dissociative disorder (Correct Answer)
- B. Personality disorders
- C. Mania
- D. Anxiety disorders
Explanation: ***Dissociative disorder*** - **Derealization** involves experiencing the outside world as unreal or dreamlike - **Depersonalization** is the experience of feeling detached from one's own body or mental processes - These are hallmark symptoms of **dissociative disorders**, specifically depersonalization-derealization disorder in DSM-5 *Personality disorders* - Characterized by enduring, maladaptive patterns of inner experience and behavior - While some personality disorders (e.g., **borderline personality disorder**) may display transient dissociative symptoms under stress, derealization and depersonalization are not core diagnostic features *Mania* - A state of abnormally elevated mood and energy, involving **racing thoughts**, **decreased need for sleep**, and **impulsive behavior** - Does not typically involve consistent derealization or depersonalization as core features *Anxiety disorders* - Depersonalization can occur transiently during **panic attacks** or severe anxiety - However, when derealization and depersonalization are the primary, persistent symptoms, they indicate a **dissociative disorder** rather than an anxiety disorder
Question 10: A young marathon runner is participating in a marathon competition. After running for 100 m, he develops pain at the anteromedial aspect of tibia which was mild to start with, but increased on further running. X ray was normal. The doctor ordered a bone scan. What is the likely diagnosis?
- A. Lisfranc fracture
- B. Jones fracture
- C. Shin splint (Correct Answer)
- D. Nutcracker fracture
Explanation: ***Shin splint*** - This condition, also known as **medial tibial stress syndrome (MTSS)**, presents with pain along the front (anteromedial) aspect of the tibia. - It commonly affects athletes, especially runners, and typically **worsens with activity** and improves with rest, and **X-rays are often normal** in early stages. *Lisfranc fracture* - A **Lisfranc fracture** involves the bones in the midfoot, specifically the tarsometatarsal joints. - It is typically caused by a **high-impact injury**, such as a fall or crush injury, or twisting force, with prominent swelling and bruising usually visible. *Jones fracture* - A **Jones fracture** is a fracture of the **fifth metatarsal** bone in the foot. - This type of fracture usually presents with pain on the **lateral side of the foot** and is often caused by a sudden, forceful inversion of the foot. *Nutcracker fracture* - A **Nutcracker fracture** refers to a fracture of the **cuboid bone** in the foot, often due to forced abduction of the forefoot. - It presents with pain and swelling on the **outer side of the midfoot** and is not typically associated with anteromedial tibial pain.
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