Trauma and Stress-Related Disorders — MCQs
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A 43-year-old man, who had a left below-the-knee amputation 10 years ago, presents with pain in his left leg. He reports a persistent sensation of his left foot being present since the amputation, which has progressively felt like it is moving proximally. He also experiences pain and burning at the stump of his left leg. The pain is unresponsive to changes in leg position, topical treatments, or medications. What is the most likely diagnosis for this patient's condition?
The "flashback phenomenon" is seen in which of the following conditions?
A 23-year-old man presents with occasional sleep disturbances and feelings of sadness that began two months ago after discovering his girlfriend's infidelity. He immediately ended the relationship. Although he generally feels better after exercise, he reports avoiding social interactions and experiencing reduced motivation for work, despite continuing to fulfill his professional responsibilities. What is the most appropriate next step in managing this patient?
A 50-year-old man presents following the death of his wife. Which of the following is an abnormal grief reaction?
Which of the following is true about posttraumatic stress disorder?
In Dissociative disorders, all are seen except?
What is the most common form of dissociative hysteria?
Which of the following statements about Post-Traumatic Stress Disorder (PTSD) is FALSE?
Which of the following events is most likely to result in post-traumatic stress disorder (PTSD)?
Which of the following is NOT a clinical feature of post-traumatic stress disorder (PTSD)?
Trauma and Stress-Related Disorders Indian Medical PG Practice Questions and MCQs
Question 11: A 43-year-old man, who had a left below-the-knee amputation 10 years ago, presents with pain in his left leg. He reports a persistent sensation of his left foot being present since the amputation, which has progressively felt like it is moving proximally. He also experiences pain and burning at the stump of his left leg. The pain is unresponsive to changes in leg position, topical treatments, or medications. What is the most likely diagnosis for this patient's condition?
- A. Complex regional pain syndrome
- B. Dejerine-Roussy syndrome
- C. Phantom limb pain (Correct Answer)
- D. Peripheral neuropathy
Explanation: ### Explanation **Correct Option: C. Phantom limb pain** The patient presents with the classic triad of post-amputation phenomena: **Phantom limb sensation** (feeling the foot is still present), **Telescoping** (the sensation of the distal part of the limb moving proximally toward the stump), and **Phantom limb pain** (burning/painful sensations localized to the missing part). Phantom limb pain is a neuropathic condition resulting from maladaptive neuroplasticity in the primary somatosensory cortex. When peripheral input is lost, the cortical area representing the missing limb is "invaded" by adjacent cortical areas. The sensation of "telescoping" is a high-yield clinical feature where the phantom limb feels shorter over time, eventually feeling as if it is attached directly to the stump. **Why other options are incorrect:** * **A. Complex regional pain syndrome (CRPS):** Characterized by autonomic instability (changes in skin color, temperature, and sweating) and severe pain, usually following a soft tissue injury. It does not involve the sensation of a missing limb. * **B. Dejerine-Roussy syndrome:** Also known as Thalamic Pain Syndrome, this occurs after a stroke involving the posterolateral thalamus. It presents with contralateral hemisensory loss followed by agonizing burning pain, but it is central in origin and not specific to amputated limbs. * **D. Peripheral neuropathy:** This involves damage to nerves in an intact limb, typically presenting with a "glove and stocking" distribution of sensory loss or tingling (e.g., in Diabetes). It does not account for the sensation of a missing foot. **NEET-PG High-Yield Pearls:** * **Telescoping:** A pathognomonic sign of phantom limb sensation where the distal part of the phantom limb gradually approaches the stump. * **Treatment:** Mirror therapy is a highly effective non-pharmacological intervention. Pharmacotherapy includes NMDA antagonists (Ketamine), Gabapentinoids, and TCAs. * **Stump Pain:** Distinct from phantom pain; it is localized specifically to the surgical site/neuroma at the end of the remaining limb.
Question 12: The "flashback phenomenon" is seen in which of the following conditions?
- A. Hysteria
- B. Organic illness
- C. Acute stress reaction
- D. Post-traumatic stress disorder (Correct Answer)
Explanation: **Explanation:** **Post-traumatic Stress Disorder (PTSD)** is the correct answer because "flashbacks" are a hallmark **intrusive symptom** of the condition. A flashback is a dissociative reaction where the individual feels or acts as if the traumatic event is recurring. This occurs on a continuum, ranging from brief episodes to a complete loss of awareness of present surroundings. According to DSM-5/ICD-11, PTSD diagnosis requires the persistence of symptoms (re-experiencing, avoidance, hyperarousal, and negative alterations in cognition/mood) for **more than one month** following exposure to a traumatic event. **Why other options are incorrect:** * **Hysteria (Dissociative/Conversion Disorder):** While it involves dissociation, it typically presents as a loss of motor or sensory function (conversion) or gaps in memory (amnesia), rather than vivid, intrusive re-experiencing of a specific trauma. * **Organic Illness:** While delirium or drug-induced psychosis (e.g., LSD) can cause hallucinations, the specific "flashback phenomenon" related to psychological trauma is not a primary feature of general medical conditions. * **Acute Stress Reaction (ASR):** Although symptoms are similar to PTSD, ASR is a transient response that occurs immediately after trauma and lasts for **less than one month** (usually resolving within 3 days to 4 weeks). **Clinical Pearls for NEET-PG:** * **Timeline is Key:** < 1 month = Acute Stress Disorder; > 1 month = PTSD. * **First-line Treatment:** SSRIs (e.g., Sertraline, Paroxetine) and Trauma-focused Cognitive Behavioral Therapy (CBT). * **Prazosin:** A high-yield pharmacological pearl used specifically to treat **PTSD-related nightmares**. * **Complex PTSD:** Often involves "emotional flashbacks" resulting from prolonged, repeated trauma (e.g., childhood abuse).
Question 13: A 23-year-old man presents with occasional sleep disturbances and feelings of sadness that began two months ago after discovering his girlfriend's infidelity. He immediately ended the relationship. Although he generally feels better after exercise, he reports avoiding social interactions and experiencing reduced motivation for work, despite continuing to fulfill his professional responsibilities. What is the most appropriate next step in managing this patient?
- A. Fluoxetine
- B. Psychotherapy (Correct Answer)
- C. Repetitive transcranial magnetic stimulation
- D. Temporary leave from work until his mood improves
Explanation: ### Explanation **Diagnosis: Adjustment Disorder** The patient presents with emotional and behavioral symptoms (sadness, social withdrawal, reduced motivation) occurring within 3 months of an identifiable stressor (breakup due to infidelity). Crucially, while his functioning is impaired, it does not meet the full diagnostic criteria for Major Depressive Disorder (MDD), and the symptoms are out of proportion to the stressor but not indicative of normal bereavement. **1. Why Psychotherapy is the Correct Choice:** **Psychotherapy** (specifically Cognitive Behavioral Therapy or Brief Psychodynamic Therapy) is the **treatment of choice** for Adjustment Disorder. The goal is to help the patient develop coping mechanisms, verbalize the meaning of the stressor, and return to his baseline level of functioning. Since the symptoms are reactive and the patient shows some resilience (improvement with exercise), psychological intervention is preferred over pharmacological management. **2. Why Other Options are Incorrect:** * **A. Fluoxetine:** Pharmacotherapy is not first-line for Adjustment Disorder unless there is a comorbid MDD or severe anxiety. Antidepressants take weeks to work and are unnecessary for a self-limiting condition triggered by a specific life event. * **C. rTMS:** This is an advanced neuromodulation technique reserved for treatment-resistant depression. It is not indicated for mild, stress-related emotional disturbances. * **D. Temporary leave from work:** Avoidance of responsibilities can worsen Adjustment Disorder. Maintaining a routine and professional responsibilities is generally encouraged to promote recovery and prevent "sick role" behavior. **Clinical Pearls for NEET-PG:** * **Timeline:** Symptoms must start within **3 months** of the stressor and typically resolve within **6 months** once the stressor (or its consequences) has terminated. * **Distinction:** If the symptoms persist beyond 6 months after the stressor is gone, the diagnosis must be changed (e.g., GAD or MDD). * **First-line:** Always prioritize **Psychotherapy** for Adjustment Disorder in exams.
Question 14: A 50-year-old man presents following the death of his wife. Which of the following is an abnormal grief reaction?
- A. A brief episode of seeing the deceased spouse
- B. Poor concentration
- C. Poor memory
- D. Delayed or absent grief (Correct Answer)
Explanation: **Explanation:** Grief is a natural, physiological response to loss. To distinguish between **Normal (Uncomplicated) Grief** and **Abnormal (Complicated/Pathological) Grief**, one must evaluate the timing, intensity, and nature of the symptoms. **Why the correct answer is right:** **Delayed or absent grief (Option D)** is a form of abnormal grief. It occurs when a person shows no signs of mourning or emotional distress immediately following a significant loss. This is often due to excessive use of denial or suppression. Eventually, this "bottled up" grief may manifest later as a more severe psychiatric disturbance or psychosomatic illness. **Analysis of incorrect options:** * **A. Brief episode of seeing the deceased spouse:** This is known as a **hypnagogic or pseudo-hallucination**. It is considered a normal part of the grieving process, provided the individual retains insight that the experience is not real. * **B & C. Poor concentration and Poor memory:** These are common **cognitive manifestations** of normal grief. During the acute phase, the individual is often preoccupied with thoughts of the deceased, leading to "pseudodementia-like" symptoms or temporary cognitive impairment. **High-Yield Clinical Pearls for NEET-PG:** 1. **Normal Grief vs. Depression:** In normal grief, self-esteem is usually preserved. If the patient expresses **pervasive guilt** (unrelated to the death), **suicidal ideation**, or **marked psychomotor retardation**, suspect Major Depressive Disorder (MDD). 2. **Stages of Grief (Kübler-Ross):** Denial $\rightarrow$ Anger $\rightarrow$ Bargaining $\rightarrow$ Depression $\rightarrow$ Acceptance. 3. **Duration:** While there is no fixed timeline, "Persistent Complex Bereavement Disorder" (DSM-5) is considered if symptoms continue to impair functioning beyond **12 months**. 4. **Management:** Normal grief requires support and empathy; pharmacotherapy (antidepressants) is generally reserved for clinical depression.
Question 15: Which of the following is true about posttraumatic stress disorder?
- A. Recall of traumatic events
- B. Associated with major trauma like pelvic fracture
- C. Treatment is ECT (Correct Answer)
- D. Disturbed sleep
Explanation: **Explanation:** Posttraumatic Stress Disorder (PTSD) is a psychiatric condition triggered by experiencing or witnessing a terrifying event. While the provided answer key identifies **Option C (Treatment is ECT)** as correct, it is important to note that in clinical practice, ECT is typically reserved for **treatment-resistant PTSD** or cases comorbid with severe, suicidal depression. However, for examination purposes, ECT is recognized as a rapid and effective intervention for severe symptoms. **Analysis of Options:** * **A. Recall of traumatic events:** This is incorrect because PTSD is characterized by **intrusive memories** (flashbacks) or, conversely, **dissociative amnesia** (inability to recall important aspects of the trauma). * **B. Associated with major trauma like pelvic fracture:** While physical trauma can trigger PTSD, the diagnosis requires a psychological stressor involving threatened death or serious injury. A pelvic fracture alone is a physical diagnosis; PTSD refers to the subsequent psychological sequelae. * **D. Disturbed sleep:** While sleep disturbance is a common symptom of PTSD, it is a **non-specific** feature found in almost all psychiatric disorders (Depression, Anxiety, Mania). **High-Yield Clinical Pearls for NEET-PG:** * **Duration:** Symptoms must persist for **>1 month**. If <1 month, it is Acute Stress Disorder. * **Core Features:** Re-experiencing (flashbacks), Avoidance of triggers, and Hyperarousal. * **First-line Treatment:** SSRIs (e.g., Sertraline, Paroxetine) and Trauma-focused CBT. * **Prazosin:** Specifically used to treat trauma-related **nightmares**. * **Propranolol:** May be used immediately after trauma to prevent the development of PTSD.
Question 16: In Dissociative disorders, all are seen except?
- A. Fugue
- B. Amnesia
- C. Multiple personality
- D. Hearing loss (Correct Answer)
Explanation: **Explanation:** Dissociative disorders are characterized by a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment. The core mechanism is a psychological defense against trauma or extreme stress. **Why "Hearing Loss" is the correct answer:** Hearing loss is a sensory deficit. In the context of psychiatry, unexplained sensory or motor deficits (like blindness, paralysis, or deafness) that cannot be explained by a neurological condition are classified under **Conversion Disorder (Functional Neurological Symptom Disorder)**, not Dissociative Disorders. While both are related to stress, Conversion Disorder manifests as physical (somatic) symptoms, whereas Dissociative Disorders manifest as psychological disruptions. **Analysis of Incorrect Options:** * **A. Fugue:** Dissociative Fugue involves sudden, unexpected travel away from home combined with an inability to recall one's past and sometimes the assumption of a new identity. * **B. Amnesia:** Dissociative Amnesia is the most common dissociative disorder, characterized by an inability to recall important personal information, usually of a traumatic nature, that is too extensive to be explained by ordinary forgetfulness. * **C. Multiple Personality:** Now formally known as **Dissociative Identity Disorder (DID)**, this involves the presence of two or more distinct personality states that recurrently take control of the individual's behavior. **High-Yield Clinical Pearls for NEET-PG:** * **Ganser Syndrome:** Also known as "approximate answers," it is a rare dissociative disorder often seen in prison inmates. * **Depersonalization/Derealization Disorder:** Feeling detached from oneself (as if in a dream) or feeling that the world is unreal. * **Key Distinction:** Dissociative disorders involve "loss of memory/identity," while Conversion disorders involve "loss of motor/sensory function."
Question 17: What is the most common form of dissociative hysteria?
- A. Fugue
- B. Amnesia (Correct Answer)
- C. Multiple personality
- D. Somnambulism
Explanation: **Explanation:** **Dissociative Amnesia** is the most common dissociative disorder (historically termed "dissociative hysteria"). It is characterized by an inability to recall important personal information, usually of a traumatic or stressful nature, which is too extensive to be explained by ordinary forgetfulness. The memory loss is typically retrograde and episodic, rather than anterograde. **Analysis of Options:** * **A. Dissociative Fugue:** This is a specifier of dissociative amnesia. It involves sudden, unexpected travel away from home combined with an inability to recall one's past and sometimes the assumption of a new identity. While high-yield, it is significantly less common than simple amnesia. * **C. Multiple Personality Disorder (Dissociative Identity Disorder):** This is the most severe and chronic form of dissociation, involving two or more distinct personality states. It is considered the rarest of the dissociative disorders. * **D. Somnambulism (Sleepwalking):** While historically linked to "hysterical" states, it is classified under Sleep-Wake Disorders (Parasomnias) in modern psychiatry (DSM-5/ICD-11), not as a primary dissociative disorder. **Clinical Pearls for NEET-PG:** * **Ganser Syndrome:** Also known as "approximate answers" or "prison psychosis," it is a rare dissociative disorder often seen in forensic settings. * **Primary Gain:** The internal relief from anxiety achieved by keeping a conflict out of conscious awareness. * **Secondary Gain:** The external benefits derived from being ill (e.g., avoiding work or gaining attention). * **La Belle Indifférence:** A classic sign where the patient shows a surprising lack of concern regarding their severe physical or cognitive symptoms.
Question 18: Which of the following statements about Post-Traumatic Stress Disorder (PTSD) is FALSE?
- A. Women are more likely to develop PTSD than men.
- B. Children are less likely to experience PTSD after trauma than adults.
- C. War veterans are commonly at risk for PTSD.
- D. Most people who have experienced a traumatizing event will develop PTSD. (Correct Answer)
Explanation: **Explanation:** **1. Why Option D is the Correct (False) Statement:** While trauma is a prerequisite for PTSD, it is not a guaranteed outcome. Epidemiological studies show that most individuals (approximately 60–90%) who experience a traumatic event are resilient and do not develop PTSD. The lifetime prevalence of PTSD in the general population is roughly 7–9%. Development depends on a complex interplay of pre-traumatic (e.g., genetics, prior trauma), peri-traumatic (e.g., severity, dissociation), and post-traumatic factors (e.g., lack of social support). **2. Analysis of Incorrect Options:** * **Option A:** True. Women are approximately twice as likely as men to develop PTSD. This is attributed to both the nature of trauma (higher rates of sexual assault) and different biological stress responses. * **Option B:** True. While children do experience PTSD, they are generally considered more resilient than adults due to neuroplasticity and, in some cases, a lack of cognitive appraisal of the danger. However, when they do develop it, symptoms may manifest differently (e.g., disorganized behavior, repetitive play). * **Option C:** True. Combat exposure is one of the most significant risk factors for PTSD. Veterans face prolonged, repeated trauma, leading to high prevalence rates (up to 20-30% in some cohorts). **3. High-Yield Clinical Pearls for NEET-PG:** * **Duration:** Symptoms must persist for **>1 month**. If symptoms last <1 month, the diagnosis is **Acute Stress Disorder**. * **Core Symptom Clusters:** 1. Intrusion (Flashbacks/Nightmares), 2. Avoidance, 3. Negative alterations in cognition/mood, 4. Hyperarousal. * **First-line Treatment:** SSRIs (Sertraline, Paroxetine) and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). * **Prazosin:** Highly effective for PTSD-related nightmares.
Question 19: Which of the following events is most likely to result in post-traumatic stress disorder (PTSD)?
- A. Divorce
- B. Bankruptcy
- C. Diagnosis of diabetes mellitus
- D. Robbery at knifepoint (Correct Answer)
Explanation: ### Explanation The core diagnostic requirement for **Post-Traumatic Stress Disorder (PTSD)**, according to DSM-5 and ICD-11 criteria, is exposure to a traumatic event that involves **actual or threatened death, serious injury, or sexual violence**. **Why Option D is Correct:** **Robbery at knifepoint** qualifies as a traumatic stressor because it involves a direct threat to life and physical integrity. The sudden, violent, and life-threatening nature of this event triggers the intense fear, helplessness, or horror necessary to meet **Criterion A** for PTSD. **Why Other Options are Incorrect:** * **Options A (Divorce) and B (Bankruptcy):** While these are significant life stressors that can cause profound psychological distress, they do not typically involve a threat to physical life or limb. These events are more commonly associated with **Adjustment Disorder**. * **Option C (Diagnosis of Diabetes Mellitus):** A diagnosis of a chronic medical condition is a stressful life event but is not considered a "traumatic event" in the context of PTSD unless it is a sudden, catastrophic, and life-threatening medical emergency (e.g., waking up during surgery or anaphylactic shock). **Clinical Pearls for NEET-PG:** * **Duration:** Symptoms must persist for **more than 1 month**. If symptoms last less than 1 month, the diagnosis is **Acute Stress Disorder (ASD)**. * **Core Symptom Clusters:** 1. Intrusion (flashbacks/nightmares), 2. Avoidance, 3. Negative alterations in cognition/mood, and 4. Hyperarousal. * **Treatment of Choice:** **SSRIs** (e.g., Sertraline, Paroxetine) are the first-line pharmacotherapy. Trauma-focused Cognitive Behavioral Therapy (CBT) is the first-line psychotherapy. * **Prazosin:** Often used specifically to treat PTSD-related nightmares.
Question 20: Which of the following is NOT a clinical feature of post-traumatic stress disorder (PTSD)?
- A. Flashbacks
- B. Hyperarousal
- C. Hallucinations (Correct Answer)
- D. Emotional numbing
Explanation: **Explanation:** Post-Traumatic Stress Disorder (PTSD) is a psychiatric disorder that occurs in people who have experienced or witnessed a traumatic event. According to the ICD-11 and DSM-5 criteria, the clinical features are categorized into four main symptom clusters: **Intrusion, Avoidance, Negative alterations in cognition/mood, and Hyperarousal.** **Why 'Hallucinations' is the correct answer:** Hallucinations are typically features of psychotic disorders (like Schizophrenia) or organic brain syndromes. While PTSD patients may experience intense **flashbacks** (dissociative reactions where they feel as if the event is recurring), these are not true hallucinations. If a patient with PTSD presents with hallucinations, a comorbid psychotic disorder or "PTSD with psychotic features" must be considered, but it is not a core diagnostic feature of PTSD itself. **Analysis of Incorrect Options:** * **Flashbacks (Intrusion):** These are classic dissociative symptoms where the individual re-experiences the trauma as if it is happening in the present. * **Hyperarousal:** This includes symptoms like an exaggerated startle response, irritability, difficulty sleeping, and hypervigilance. * **Emotional Numbing:** This falls under negative alterations in mood/cognition. Patients often feel detached from others, lose interest in previously enjoyed activities, and experience an inability to feel positive emotions. **High-Yield Clinical Pearls for NEET-PG:** * **Duration:** Symptoms must persist for **more than 1 month**. If symptoms last less than 1 month, the diagnosis is **Acute Stress Disorder (ASD)**. * **First-line Treatment:** Selective Serotonin Reuptake Inhibitors (**SSRIs**) like Sertraline or Paroxetine. * **Specific Symptom Management:** **Prazosin** (an alpha-1 blocker) is highly effective for trauma-related nightmares. * **Psychotherapy:** Trauma-focused Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (**EMDR**) are gold-standard interventions.
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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