Complex Trauma — MCQs
What type of therapy is desensitization commonly classified as?
Management of a violent patient in psychiatry includes all except:
Which of the following is not done in the primary survey of trauma?
Post-traumatic stress disorder is characterized by all except:
Which of the following dissociative disorders involves the presence of two or more distinct identities?
Steps in review of patient's history during secondary survey of trauma care can be summarised as
Which intervention most effectively prevents PTSD after trauma?
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 60-year-old person who completed treatment for leprosy many years ago now presents with a punched-out, painless ulcer on the sole of his foot. What is the most appropriate management?
In which of the following conditions is splenectomy not indicated?
Complex Trauma Indian Medical PG Practice Questions and MCQs
Question 1: What type of therapy is desensitization commonly classified as?
- A. Psychotherapy
- B. Psychoanalysis
- C. Behavioral therapy (Correct Answer)
- D. Not applicable
Explanation: ***Behavioral therapy*** - Desensitization techniques, such as **systematic desensitization**, are a cornerstone of **behavioral therapy** due to their focus on changing learned dysfunctional responses. - This approach aims to reduce anxiety or phobic reactions by gradually exposing individuals to feared stimuli in a controlled manner. *Psychotherapy* - This is a very **broad category** that encompasses many types of talking therapies, including behavioral therapy. - While desensitization is a *type* of psychotherapy, **behavioral therapy** is a more specific and accurate classification. *Psychoanalysis* - This therapeutic approach, developed by Sigmund Freud, focuses on uncovering **unconscious conflicts** and past experiences, often through techniques like **free association** and dream analysis. - Desensitization does not primarily deal with unconscious drives or early childhood experiences as its core mechanism. *Not applicable* - This option is incorrect because desensitization is a well-established and recognized therapeutic technique that fits within a standard classification of psychotherapies. - It clearly has a defined application and theoretical framework.
Question 2: Management of a violent patient in psychiatry includes all except:
- A. CBT (Correct Answer)
- B. Haloperidol
- C. ECT
- D. BZD
Explanation: ***CBT*** - **Cognitive Behavioral Therapy (CBT)** is a long-term psychological intervention aimed at changing maladaptive thought patterns and behaviors. It is **not suitable for immediate management** of an acutely violent patient. - While CBT can be beneficial for aggression management in a stable patient, it requires patient cooperation, cognitive engagement, and time, which are not available during a **violent psychiatric emergency**. *Haloperidol* - **Haloperidol** is a potent typical antipsychotic frequently used in acute settings for rapid tranquilization of violent or severely agitated patients. - It is effective in reducing **psychosis-related agitation** and can be administered **intramuscularly** for quick onset of action. - Often used in combination with benzodiazepines for optimal control of acute violence. *ECT* - **Electroconvulsive Therapy (ECT)** may be considered in **severe, treatment-resistant cases** of violence associated with conditions like uncontrolled mania, catatonic excitement, or psychotic depression when pharmacological interventions have failed. - While not used for immediate acute management due to logistical requirements (consent, anesthesia, specialized setup), it can be an effective option for severe psychiatric conditions with persistent violence. - It works by inducing a brief controlled seizure, which can rapidly alleviate severe symptoms. *BZD* - **Benzodiazepines (BZDs)** like lorazepam or diazepam are **first-line agents** in the acute management of violent or agitated patients due to their rapid anxiolytic, sedative, and muscle relaxant properties. - They are particularly useful for **calming acute agitation** and are often combined with antipsychotics for rapid tranquilization. - Can be administered intramuscularly or intravenously for quick action in psychiatric emergencies.
Question 3: Which of the following is not done in the primary survey of trauma?
- A. Intubation
- B. NCCT head (Correct Answer)
- C. ICD drainage
- D. CXR
Explanation: ***NCCT head*** - A **Non-Contrast CT (NCCT) head** is typically performed during the **secondary survey** once the patient is hemodynamically stable and life-threatening conditions have been addressed. - The primary survey focuses on immediate **life-saving interventions** for airway, breathing, circulation, disability, and exposure. *Intubation* - **Intubation** is a critical intervention during the primary survey, specifically under the **'A' (Airway)** component, to establish and secure a patent airway in a compromised patient. - Failure to establish an airway can rapidly lead to **hypoxia** and death. *ICD drainage* - **Intercostal drain (ICD) drainage** is an urgent intervention in the primary survey, falling under **'B' (Breathing)**, to manage conditions like **tension pneumothorax** or massive hemothorax. - These conditions can severely compromise ventilation and circulation, requiring immediate relief. *CXR* - A **Chest X-ray (CXR)** is a rapid and essential diagnostic tool in the primary survey, also under **'B' (Breathing)**, to identify life-threatening thoracic injuries such as pneumothorax, hemothorax, or mediastinal shift. - It provides quick information crucial for immediate management decisions.
Question 4: 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 5: Which of the following dissociative disorders involves the presence of two or more distinct identities?
- A. Dissociative Amnesia
- B. Depersonalization/Derealization Disorder
- C. Dissociative Identity Disorder (Correct Answer)
- D. Major Depressive Disorder
Explanation: ***Dissociative Identity Disorder*** - This disorder is characterized by the presence of **two or more distinct personality states** or an experience of **possession**. - These distinct identities recurrently take control of the individual's behavior, accompanied by an inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness. - This is the **defining feature** that distinguishes DID from other dissociative disorders. *Depersonalization/Derealization Disorder* - This involves **persistent or recurrent experiences of depersonalization** (feeling detached from one's mental processes or body) or **derealization** (feeling that the world is unreal or dreamlike). - While consciousness is maintained, there is no presence of multiple distinct identities. - The person retains awareness that these are subjective experiences. *Dissociative Amnesia* - This is characterized by an inability to recall important **autobiographical information**, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting. - May include dissociative fugue as a specifier (sudden travel with amnesia for identity). - It does not involve the presence of multiple distinct identities. *Major Depressive Disorder* - This is a mood disorder characterized by a persistently **depressed mood or loss of interest** in activities, causing significant impairment in daily life. - It is not a dissociative disorder and does not involve the presence of multiple identities.
Question 6: Steps in review of patient's history during secondary survey of trauma care can be summarised as
- A. TRIAGE
- B. ABCDE
- C. AMPLE (Correct Answer)
- D. None of the options
Explanation: ***AMPLE*** - The **AMPLE history** is a mnemonic used during the **secondary survey** in trauma care to gather crucial patient information - It stands for **Allergies, Medications, Past medical history/Pregnancy, Last meal, and Events** surrounding the injury. *TRIAGE* - **Triage** is the process of prioritizing patients based on the severity of their condition and the likelihood of benefit from immediate treatment. - It is an initial assessment done to determine the urgency of care, not a detailed historical review for a single patient. *ABCDE* - The **ABCDE approach** (**Airway, Breathing, Circulation, Disability, Exposure**) is part of the **primary survey** in trauma care. - It focuses on identifying and managing immediate life-threatening conditions. *None of the options* - This option is incorrect because **AMPLE** specifically describes the historical review process during the secondary survey.
Question 7: Which intervention most effectively prevents PTSD after trauma?
- A. Benzodiazepines
- B. Psychological debriefing
- C. Early SSRI
- D. Brief CBT (Correct Answer)
Explanation: ***Brief CBT*** - **Brief cognitive behavioral therapy (CBT)**, especially trauma-focused CBT, is a highly effective intervention for preventing and treating PTSD when initiated early after trauma. - It helps individuals process traumatic memories, challenge maladaptive thoughts, and develop coping strategies, thereby reducing the likelihood of PTSD development. *Benzodiazepines* - While benzodiazepines can reduce acute anxiety, their routine use immediately after trauma is generally **not recommended** for PTSD prevention. - They may interfere with the natural processing of traumatic memories and can potentially increase the risk of developing chronic PTSD. *Psychological debriefing* - **Psychological debriefing**, a single-session intervention, has been shown to be largely **ineffective** and, in some cases, potentially harmful in preventing PTSD. - It may disrupt natural coping mechanisms and can lead to increased distress in some individuals. *Early SSRI* - **Selective serotonin reuptake inhibitors (SSRIs)** are the first-line pharmacotherapy for established PTSD but are generally **not recommended as a prophylactic measure** immediately after acute trauma. - Evidence for their effectiveness in preventing PTSD when given shortly after trauma is limited and not consistently supported by research.
Question 8: 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. Obsessive-Compulsive Disorder (OCD)
- D. Adjustment disorder
Explanation: ***PTSD*** - The patient's symptoms, including **recurrent dreams** of the accident, **intrusive memories** triggered by the accident site, and **avoidance** of the location, are classic diagnostic criteria for **Post-Traumatic Stress Disorder (PTSD)**. - PTSD often develops after exposure to a **traumatic event** like a car accident, with symptoms lasting for more than one month. *Anxiety disorder* - While anxiety is a prominent feature of PTSD, **Generalized Anxiety Disorder** typically involves excessive worry about everyday events rather than a specific traumatic incident. - Other anxiety disorders like **panic disorder** involve sudden, intense fear without the specific re-experiencing and avoidance symptoms seen here. *Obsessive-Compulsive Disorder (OCD)* - OCD is characterized by repetitive, unwanted thoughts (**obsessions**) and ritualistic behaviors (**compulsions**) performed to reduce anxiety, which are not described in this patient's presentation. - The patient's distress stems from a past trauma, not from obsessions or compulsions. *Adjustment disorder* - An adjustment disorder occurs in response to a **stressor**, but the symptoms are typically less severe and do not include the full constellation of **re-experiencing, avoidance, and hyperarousal** seen in PTSD. - An adjustment disorder resolves within 6 months of the stressor or its consequences, however, the persistence and nature of the symptoms here point to a more severe trauma-related condition.
Question 9: A 60-year-old person who completed treatment for leprosy many years ago now presents with a punched-out, painless ulcer on the sole of his foot. What is the most appropriate management?
- A. Restart MDT
- B. Amputation
- C. Intense debridement and intravenous antibiotics (Correct Answer)
- D. Offloading and comprehensive wound care
Explanation: ***Intense debridement and intravenous antibiotics*** - The presence of a **punched-out, painless ulcer** in a patient with a history of leprosy suggests a **neuropathic ulcer** that has likely become infected due to compromised sensation and foot care [3]. - **Intense debridement** is crucial to remove necrotic tissue and reduce bacterial load, while **intravenous antibiotics** are necessary to treat the deep-seated infection often associated with such ulcers, especially given the poor vascularity and compromised healing in leprosy [2]. *Restart MDT* - The patient completed **leprosy treatment many years ago**, indicating that the current ulcer is not an active leprosy lesion requiring multidrug therapy (MDT). - Restarting MDT would be inappropriate as there is no evidence of **active Mycobacterium leprae infection**. *Amputation* - Amputation is a **last resort** for severe, uncontrolled infections or extensive tissue damage that cannot be salvaged. - While neuropathic ulcers can lead to amputation, it is not the initial or most appropriate management unless there are signs of **irreversible ischemia or overwhelming sepsis** that are not mentioned here. *Offloading and comprehensive wound care* - While **offloading** and comprehensive wound care are essential components of long-term management and prevention for neuropathic ulcers, they are insufficient as the primary treatment for an already **infected, deep ulcer** [2]. - **Debridement** and **antibiotics** are critical initial steps to control the infection before offloading and routine wound care can effectively promote healing [1].
Question 10: In which of the following conditions is splenectomy not indicated?
- A. Trauma
- B. Hereditary spherocytosis
- C. Splenic abscess
- D. Tuberculosis of the spleen (Correct Answer)
Explanation: ***Tuberculosis of the spleen*** - While splenic tuberculosis can occur, **medical management** with anti-tuberculosis drugs is typically the primary treatment, and splenectomy is usually not indicated unless there are complications like massive hemorrhage or rupture. - Splenectomy for tuberculosis **does not address the systemic nature** of the infection and carries risks without significant benefit in most cases. *Trauma* - **Splenic trauma** leading to hemorrhage or rupture is a common indication for splenectomy, especially in cases of severe injury. - Removal of the spleen can be **life-saving** to control bleeding and prevent hypovolemic shock. *Hereditary spherocytosis* - Splenectomy is the definitive treatment for **hereditary spherocytosis** to correct anemia and reduce hemolysis. - The spleen is responsible for **premature destruction of abnormally shaped red blood cells**, so its removal improves red blood cell survival. *Splenic abscess* - **Splenic abscesses** often require splenectomy, particularly if they are large, multiple, or do not respond to antibiotic therapy. - Removing the infected organ helps to **eliminate the source of infection** and prevent systemic complications like sepsis.
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