Eye Movement Desensitization and Reprocessing — MCQs
Freud is known for
Reciprocal inhibition is done by -
A 42-year-old man with sexual interest in children (pedophilia) is given an electric shock each time he is shown a videotape of children. Later, he feels tense around children and avoids them. Which of the following management techniques does this example illustrate?
Systemic desensitization therapy is used for
Which of the following will be LEAST useful in treating Obsessive Compulsive Disorder?
Post-traumatic stress disorder is characterized by all except:
After trauma, a person cannot move eye outward beyond mid point. The nerve injured is?
A patient presented with a history of diplopia and restricted eye movements. What is the most likely diagnosis based on the clinical and CT images?
What is the yoke muscle of the right lateral rectus?
A patient with parkinsonism suddenly presented with trembling, dizziness and upward reeling of eyes. It may be due to -
Eye Movement Desensitization and Reprocessing Indian Medical PG Practice Questions and MCQs
Question 1: Freud is known for
- A. Psychoanalysis (Correct Answer)
- B. Counselling
- C. Flooding
- D. Cognitive therapy
Explanation: ***Psychoanalysis*** - **Sigmund Freud** is widely recognized as the founder of **psychoanalysis**, a school of thought and a set of therapeutic techniques that originated in the late 19th and early 20th centuries. - Psychoanalysis focuses on uncovering **unconscious thoughts**, motivations, and conflicts that influence behavior and emotional states, often through methods like **free association** and dream analysis. *Counselling* - While counseling involves therapeutic conversations, it is a broader term encompassing various approaches to help individuals cope with emotional or psychological issues. - Counseling as a distinct field is not singularly attributed to Freud, but rather includes many different modalities and theorists. *Flooding* - **Flooding** is a specific technique used in **behavioral therapy**, particularly for phobias and anxiety disorders. - It involves exposing an individual to a feared object or situation for a prolonged period to reduce anxiety through extinction and is associated with **behavioral psychology**, not Freud's psychoanalysis. *Cognitive therapy* - **Cognitive therapy** (CT) and **Cognitive Behavioral Therapy (CBT)**, pioneered by figures like **Aaron T. Beck**, focus on identifying and changing distorted thinking patterns and maladaptive behaviors. - This approach evolved significantly later than Freud's work and represents a distinct theoretical and practical orientation in psychotherapy.
Question 2: Reciprocal inhibition is done by -
- A. All of the options
- B. Behaviour therapy
- C. Systematic desensitization (Correct Answer)
- D. Flooding
Explanation: ***Systematic desensitization*** - **Reciprocal inhibition** is a core principle in **systematic desensitization**, where a *relaxation response* is used to *inhibit* an *anxiety response*. - This technique involves gradually exposing an individual to their feared stimulus while maintaining a state of **relaxation**, eventually reducing the anxiety associated with it. *Behaviour therapy* - **Behaviour therapy** is a broad category, and while systematic desensitization is a type of behavior therapy, it's not the *only* one. - This option is too general as reciprocal inhibition is a specific mechanism within certain behavioral therapies, not synonymous with the entire field. *All of the options* - This option is incorrect because reciprocal inhibition is a specific mechanism primarily associated with **systematic desensitization**, not with either behavior therapy as a whole or flooding. - Flooding, for example, operates on a different principle of **extinction** through prolonged exposure to intense fear. *Flooding* - **Flooding** involves *prolonged and intense exposure* to a feared stimulus without the use of relaxation techniques until anxiety subsides due to exhaustion and habituation. - This method relies on the principle of **extinction** rather than reciprocal inhibition, as it does not actively introduce an incompatible positive response.
Question 3: A 42-year-old man with sexual interest in children (pedophilia) is given an electric shock each time he is shown a videotape of children. Later, he feels tense around children and avoids them. Which of the following management techniques does this example illustrate?
- A. Implosion
- B. Aversive conditioning (Correct Answer)
- C. Biofeedback
- D. Flooding
Explanation: ***Aversive conditioning*** - **Aversive conditioning** involves pairing an undesirable behavior or stimulus (e.g., sexual interest in children) with an unpleasant stimulus (e.g., electric shock). - The goal is to create an association between the undesirable behavior and the unpleasant consequence, leading to a reduction in the unwanted behavior or aversion to the stimulus. *Implosion* - **Implosion therapy** is a technique where the patient is asked to imagine vividly and intensely the most terrifying aspects of their phobic stimulus. - This method aims to extinguish the fear response by overwhelming the patient with anxiety-provoking imagery without any actual danger. *Biofeedback* - **Biofeedback** is a technique that teaches individuals to control involuntary physiological responses such as heart rate, muscle tension, or skin temperature. - It uses electronic sensors to monitor these responses and provide real-time feedback to the individual, allowing them to learn self-regulation. *Flooding* - **Flooding** is a behavioral therapy technique where an individual is exposed directly and intensely to a feared object or situation for a prolonged period. - The goal is to extinguish the fear response through habituation, by demonstrating that the feared stimulus is not dangerous despite the initial anxiety.
Question 4: Systemic desensitization therapy is used for
- A. Phobia (Correct Answer)
- B. Depression/Mania
- C. Organic brain syndrome
- D. Schizophrenia
Explanation: ***Phobia*** - **Systemic desensitization** is a highly effective behavioral therapy specifically designed to treat **phobias** and other **anxiety disorders**. - It involves gradually exposing the individual to the feared object or situation while teaching them **relaxation techniques** to replace the anxiety response. *Depression/Mania* - These conditions are primarily treated with a combination of **pharmacotherapy** (e.g., antidepressants, mood stabilizers) and other forms of psychotherapy like **cognitive behavioral therapy (CBT)** or **interpersonal therapy**. - Systemic desensitization is not a primary or effective treatment for the core symptoms of **mood disorders**. *Organic brain syndrome* - This is a broad term referring to mental impairment caused by a **physical disease or injury affecting the brain**, such as dementia or delirium. - Treatment focuses on addressing the **underlying medical cause** and managing cognitive or behavioral symptoms, not desensitization. *Schizophrenia* - Schizophrenia is a severe mental illness characterized by **psychosis**, **disorganized thinking**, and significant functional impairment. - Treatment primarily involves **antipsychotic medications** and psychosocial interventions, rather than exposure-based therapies like systemic desensitization.
Question 5: Which of the following will be LEAST useful in treating Obsessive Compulsive Disorder?
- A. Cognitive behavioral therapy
- B. SSRIs
- C. Clomipramine
- D. Systematic desensitisation (Correct Answer)
Explanation: ***Systematic desensitisation*** - This therapy is primarily used to treat **phobias** and other **anxiety disorders** where avoidance is a key feature and a clear, single trigger can be identified. - While it involves exposure, the gradual hierarchy and relaxation training are less effective for the complex, intrusive thoughts and compulsive rituals characteristic of **OCD**. *Cognitive behavioral therapy* - **CBT, particularly Exposure and Response Prevention (ERP)**, is considered the gold standard psychotherapy for OCD. - It directly addresses the **obsessions** by exposing the individual to feared thoughts or situations and then preventing the ritualistic responses. *SSRIs* - **Selective Serotonin Reuptake Inhibitors (SSRIs)** are the first-line pharmacological treatment for OCD due to their efficacy in reducing obsessive thoughts and compulsive behaviors. - They work by increasing the availability of **serotonin** in the brain. *Clomipramine* - **Clomipramine** is a tricyclic antidepressant (TCA) with potent **serotonergic effects**, making it highly effective in treating OCD, often when SSRIs are partially effective or not tolerated. - It is specifically approved for OCD and is sometimes considered a second-line or augmentation strategy.
Question 6: 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 7: After trauma, a person cannot move eye outward beyond mid point. The nerve injured is?
- A. 4th
- B. 2nd
- C. 6th (Correct Answer)
- D. 3rd
Explanation: ***6th*** - The **abducens nerve (CN VI)** innervates the **lateral rectus muscle**, which is responsible for **abduction** (outward movement) of the eye [1]. - Inability to move the eye outward beyond the midpoint indicates paresis or paralysis of the lateral rectus, consistent with a **CN VI injury**. *4th* - The **trochlear nerve (CN IV)** innervates the **superior oblique muscle**, which primarily causes **intorsion** and **depression** of the eye when adducted [1]. - An injury to CN IV would result in **vertical diplopia** and difficulty looking down and in, not outward gaze paralysis. *2nd* - The **optic nerve (CN II)** is responsible for **vision** and carries visual information from the retina to the brain [2]. - Damage to CN II would cause **visual loss** or field defects, not extraocular muscle palsies. *3rd* - The **oculomotor nerve (CN III)** innervates most of the extraocular muscles (medial, superior, inferior rectus, and inferior oblique) as well as the levator palpebrae superioris [1]. - CN III injury typically results in **ptosis**, a **"down and out" deviated eye**, and impaired adduction, elevation, and depression, but not isolated abduction deficit [2].
Question 8: A patient presented with a history of diplopia and restricted eye movements. What is the most likely diagnosis based on the clinical and CT images?
- A. Le Fort fracture
- B. Maxillary fracture
- C. Zygomatic fracture
- D. Blowout fracture (Correct Answer)
Explanation: ***Blowout fracture*** - The CT image shows a **fracture of the orbital floor**, with associated **herniation of orbital contents** (fat and inferior rectus muscle) into the maxillary sinus. - This type of fracture commonly causes **diplopia** (due to muscle entrapment) and **restricted eye movements**. *Le Fort fracture* - Le Fort fractures involve the **midface and maxilla** as a whole, typically causing widespread facial instability. - They are classified into three types (I, II, III), none of which are exclusively characterized by an isolated orbital floor fracture with muscle entrapment. *Maxillary fracture* - While an orbital floor fracture involves the maxilla, a "maxillary fracture" is a broad term and does not specifically describe the characteristic features of **orbital content prolapse** and their resulting symptoms. - Isolated maxillary fractures might not cause diplopia or restricted eye movements unless they directly involve the orbit. *Zygomatic fracture* - A zygomatic fracture (either isolated or as part of a zygomaticomaxillary complex fracture) primarily affects the **cheekbone**. - While it can involve the orbital rim, it typically presents with **facial asymmetry**, **numbness** in the infraorbital nerve distribution, and sometimes **trismus**, rather than isolated muscle entrapment causing diplopia, as seen in the image.
Question 9: What is the yoke muscle of the right lateral rectus?
- A. Lt medial rectus (Correct Answer)
- B. Lt superior rectus
- C. Lt lateral rectus
- D. Lt inferior oblique
Explanation: ***Lt medial rectus*** - Yoke muscles are pairs of muscles in opposite eyes that produce **conjugate eye movements**, meaning they cause both eyes to move in the same direction. - When the **right lateral rectus** abducts (moves outward) the right eye, the **left medial rectus** adducts (moves inward) the left eye, both eyes gaze to the right. *Lt superior rectus* - The left superior rectus is primarily responsible for **elevation** and **intorsion** of the left eye. - It works synergistically with the right **inferior oblique** for upward gaze. *Lt lateral rectus* - The left lateral rectus is the primary muscle for **abduction** (moving outward) of the left eye. - It is not a yoke muscle for the right lateral rectus, as both perform similar actions in their respective eyes. *Lt inferior oblique* - The left inferior oblique primarily causes **extorsion**, **elevation**, and **abduction** of the left eye. - It works with the right superior rectus for upward gaze.
Question 10: A patient with parkinsonism suddenly presented with trembling, dizziness and upward reeling of eyes. It may be due to -
- A. Oculogyric crisis (Correct Answer)
- B. Cerebellar infarct
- C. Cerebral infarct
- D. Cholinergic crisis
Explanation: ***Oculogyric crisis*** - An **oculogyric crisis** is a well-known **dystonic reaction** characterized by the sudden, involuntary, sustained upward deviation of the eyes, often accompanied by other dystonic movements like **torticollis** or jaw clamping. - It is frequently associated with antipsychotic or antiemetic medications, especially in patients with Parkinsonism, and can be triggered by drugs that affect **dopamine** systems [1]. *Cerebellar infarct* - A **cerebellar infarct** would typically present with symptoms related to cerebellar dysfunction, such as **ataxia**, nystagmus, dysarthria, and **vertigo** [2]. - While dizziness is present, the specific symptom of **upward reeling of eyes** (oculogyric crisis) is not characteristic of a cerebellar stroke [2]. *Cerebral infarct* - The presentation of a **cerebral infarct** depends on the affected brain region but often includes focal neurological deficits like **hemiparesis**, aphasia, or visual field defects. - While dizziness or altered consciousness can occur, the discrete, sustained **upward deviation of the eyes** is not a typical symptom of a cerebral infarct unless it affects very specific, rare brainstem areas. *Cholinergic crisis* - A **cholinergic crisis** is caused by an excess of **acetylcholine** and presents with symptoms such as **salivation**, lacrimation, urination, defecation, gastrointestinal upset, and emesis (SLUDGE), along with muscle weakness and **bradycardia** [3]. - This clinical picture is distinctly different from the described trembling, dizziness, and upward eye deviation [3].
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