Trauma and Stress-Related Disorders — MCQs

Trauma and Stress-Related Disorders Indian Medical PG Practice Questions and MCQs

Question 41: A lady, following a severe car accident requiring 6 months of ICU admission, now experiences terror and fear at night and is afraid to sit in a car. What is the most likely diagnosis?

A. Anxiety disorder
B. Phobia
C. Conversion disorder
D. Post-traumatic stress disorder (Correct Answer)

Explanation: **Explanation:** The patient presents with classic symptoms following a life-threatening event (a severe car accident and prolonged ICU stay). The diagnosis is **Post-Traumatic Stress Disorder (PTSD)** because her symptoms align with the core diagnostic clusters: **Re-experiencing** (terror and fear at night/nightmares), **Avoidance** (afraid to sit in a car), and a history of a significant traumatic stressor. **Why the correct option is right:** PTSD (DSM-5/ICD-11) requires exposure to actual or threatened death or serious injury. The symptoms must persist for **more than one month**. Key features include intrusive memories/nightmares, avoidance of stimuli associated with the trauma, and negative alterations in cognition or arousal. **Why the other options are incorrect:** * **Anxiety Disorder:** This is a broad category. While PTSD involves anxiety, the specific link to a traumatic event and the presence of re-experiencing symptoms make PTSD the more precise diagnosis. * **Phobia:** While she avoids cars (resembling a specific phobia), the avoidance is a secondary component of the global trauma response. Phobias typically lack the "re-experiencing" (nightmares/flashbacks) element seen here. * **Conversion Disorder (Functional Neurological Symptom Disorder):** This involves unexplained voluntary motor or sensory deficits (e.g., paralysis, blindness) triggered by psychological stress, which are not present in this case. **High-Yield Clinical Pearls for NEET-PG:** * **Timeline:** Symptoms <1 month = **Acute Stress Disorder**; >1 month = **PTSD**. * **First-line Treatment:** SSRIs (e.g., Sertraline, Paroxetine) and Trauma-focused Psychotherapy (CBT/EMDR). * **Prazosin:** High-yield drug used specifically to reduce **trauma-related nightmares** in PTSD. * **Complex PTSD:** Often follows prolonged, repeated trauma (e.g., long-term abuse) rather than a single event.

Question 42: Which of the following is the most effective treatment modality for Post-Traumatic Stress Disorder (PTSD)?

A. Cognitive behavioral therapy (Correct Answer)
B. Eye movement desensitization and reprocessing
C. Hypnosis
D. Rational and emotive therapy

Explanation: **Explanation:** **Post-Traumatic Stress Disorder (PTSD)** is a psychiatric condition triggered by experiencing or witnessing a traumatic event. The gold-standard treatment for PTSD involves a combination of pharmacotherapy (SSRIs) and psychotherapy. **1. Why Cognitive Behavioral Therapy (CBT) is correct:** CBT, specifically **Trauma-Focused CBT (TF-CBT)**, is considered the most effective and first-line psychotherapy for PTSD. It utilizes techniques like **prolonged exposure** (confronting trauma-related memories) and **cognitive restructuring** (challenging maladaptive thoughts regarding the event). Large-scale meta-analyses consistently show that CBT has the strongest evidence base for reducing core symptoms of re-experiencing, avoidance, and hyperarousal. **2. Analysis of Incorrect Options:** * **B. Eye Movement Desensitization and Reprocessing (EMDR):** While EMDR is an evidence-based and effective treatment for PTSD, it is generally considered a specialized form of therapy. In most standard guidelines and competitive exams, TF-CBT is prioritized as the primary modality. * **C. Hypnosis:** Hypnosis may be used as an adjunct to help with relaxation or memory retrieval, but it is not a primary or first-line treatment for PTSD due to limited efficacy data. * **D. Rational Emotive Behavior Therapy (REBT):** This is a form of CBT developed by Albert Ellis that focuses on irrational beliefs. While useful for depression and general anxiety, it is not the specific protocol indicated for trauma processing. **Clinical Pearls for NEET-PG:** * **First-line Pharmacotherapy:** SSRIs (specifically **Sertraline** and **Paroxetine** are FDA-approved). * **Nightmares in PTSD:** **Prazosin** (an alpha-1 blocker) is the drug of choice for trauma-related nightmares. * **Duration Criteria:** Symptoms must persist for **>1 month** for a diagnosis of PTSD; if symptoms last <1 month, the diagnosis is **Acute Stress Disorder**.

Question 43: What is the characteristic type of amnesia seen following a traumatic brain injury?

A. Retrograde amnesia
B. Anterograde amnesia (Correct Answer)
C. Remote amnesia
D. All are true

Explanation: **Explanation:** The characteristic type of amnesia following a Traumatic Brain Injury (TBI) is **Anterograde Amnesia**. This refers to the inability to form new memories or retain information after the traumatic event. **1. Why Anterograde Amnesia is Correct:** In the context of TBI, the duration of anterograde amnesia is the hallmark of **Post-Traumatic Amnesia (PTA)**. It occurs because the trauma disrupts the process of memory consolidation (transferring information from short-term to long-term storage), often involving the hippocampus and temporal lobes. The length of PTA is a critical clinical indicator used to determine the severity of the brain injury and predict long-term functional outcomes. **2. Why Other Options are Incorrect:** * **Retrograde Amnesia:** This is the loss of memories formed *before* the trauma. While it frequently co-occurs with TBI, it is usually limited to a short period preceding the accident and tends to shrink over time (Ribot’s Law). It is not the defining characteristic used to assess TBI severity. * **Remote Amnesia:** This refers to the loss of distant past memories (e.g., childhood). These memories are usually well-preserved in TBI patients unless the injury is extremely diffuse or involves advanced neurodegeneration. **Clinical Pearls for NEET-PG:** * **PTA Duration & Severity:** PTA < 1 hour (Mild), 1–24 hours (Moderate), > 24 hours (Severe), > 7 days (Very Severe). * **Ribot’s Law:** Recent memories are lost first, while remote memories are more resistant to brain insults. * **Concussion:** A mild TBI where transient anterograde amnesia is often the most sensitive indicator of injury. * **Wernicke-Korsakoff Syndrome:** Another high-yield condition where anterograde amnesia is the prominent feature due to thiamine deficiency.

Question 44: A 16-year-old girl who was sexually abused has no recollection of the event and is unable to remember anything despite her best efforts. What is the diagnosis?

A. Dementia
B. Dissociative amnesia (Correct Answer)
C. Factitious disorder
D. Malingering

Explanation: **Explanation:** The correct diagnosis is **Dissociative Amnesia**. This condition is characterized by an inability to recall important autobiographical information, usually of a traumatic or stressful nature (such as sexual abuse), that is inconsistent with ordinary forgetting. **Why Dissociative Amnesia is correct:** In this case, the patient has experienced a severe psychological trauma. The memory loss is a defense mechanism where the mind "walls off" the traumatic event to protect the individual from overwhelming emotional distress. The patient is genuinely unable to remember despite making an effort, which is a hallmark of the disorder. **Why the other options are incorrect:** * **Dementia:** This involves a chronic, progressive decline in multiple cognitive domains (memory, executive function, language) due to neurodegenerative changes, not a sudden loss of specific traumatic memories in a young patient. * **Factitious Disorder:** The patient intentionally produces or feigns symptoms to assume the "sick role" without external incentives. There is no evidence here that the patient is faking. * **Malingering:** This involves the intentional production of false or exaggerated symptoms motivated by external incentives (e.g., avoiding legal trouble or obtaining drugs). The prompt states she is trying her "best efforts" to remember, ruling out intentional deception. **High-Yield Clinical Pearls for NEET-PG:** * **Localized Amnesia:** The most common type; failure to recall events during a specific period (e.g., the hours surrounding the abuse). * **Dissociative Fugue:** A subtype of dissociative amnesia involving sudden, unexpected travel away from home accompanied by an inability to recall one's past or identity. * **Treatment:** The primary treatment is psychotherapy (Cognitive Behavioral Therapy); hypnosis or "Amobarbital interviews" are sometimes used to recover lost memories.

Question 45: Flashback is characteristic of which of the following conditions?

A. Hypomania
B. Post-traumatic stress disorder (Correct Answer)
C. Postnatal depression
D. Grief reaction

Explanation: **Explanation:** **Post-traumatic Stress Disorder (PTSD)** is the correct answer because **flashbacks** are a hallmark symptom of the "Intrusive/Re-experiencing" cluster of the disorder. A flashback is a dissociative state where the individual feels or acts as if the traumatic event is recurring in the present moment. It is triggered by internal or external cues (reminders) and is often accompanied by intense physiological distress. According to ICD and DSM criteria, PTSD symptoms must persist for more than one month following exposure to a life-threatening or catastrophic event. **Analysis of Incorrect Options:** * **Hypomania:** Characterized by a distinct period of elevated, expansive, or irritable mood and increased energy (lasting at least 4 days). It does not involve dissociative re-experiencing or flashbacks. * **Postnatal Depression:** A depressive episode occurring after childbirth. While it involves low mood, anhedonia, and fatigue, flashbacks are not a diagnostic feature unless there was a specific birth-related trauma (which would then be classified as PTSD). * **Grief Reaction:** A normal emotional response to loss. It involves yearning, sadness, and "waves" of grief, but the individual maintains a connection to reality and does not experience the involuntary, vivid re-living of a trauma seen in PTSD. **Clinical Pearls for NEET-PG:** * **Timeframe:** Symptoms <1 month = **Acute Stress Disorder**; >1 month = **PTSD**. * **Core Symptom Clusters:** 1. Intrusion (Flashbacks/Nightmares), 2. Avoidance, 3. Negative alterations in cognition/mood, 4. Hyperarousal. * **First-line Treatment:** Trauma-focused Psychotherapy (CBT/EMDR) and **SSRIs** (e.g., Sertraline, Paroxetine). * **Prazosin:** A high-yield drug used specifically to reduce **trauma-related nightmares** in PTSD.

Question 46: Post-traumatic stress disorder is characterized by all of the following EXCEPT?

A. Flashbacks
B. Avoidance behavior
C. Increased arousal
D. Numbing of reflexes (Correct Answer)

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-10 and DSM-5 criteria, the clinical features are categorized into specific clusters. **Why "Numbing of reflexes" is the correct answer:** In PTSD, patients experience **emotional numbing** (diminished interest in activities or feeling detached from others), but there is no such clinical feature as "numbing of reflexes." In fact, the physiological state in PTSD is one of **hyper-responsiveness**. Patients typically exhibit an **exaggerated startle reflex** rather than a numbed one. **Analysis of Incorrect Options:** * **A. Flashbacks:** These are a hallmark of the "Re-experiencing" cluster. Patients have intrusive, vivid memories where they feel as if the trauma is recurring in the present. * **B. Avoidance behavior:** Patients actively avoid people, places, or thoughts that serve as reminders of the traumatic event to prevent psychological distress. * **C. Increased arousal:** This includes symptoms of autonomic hyperactivity such as insomnia, irritability, hypervigilance, and an exaggerated startle response. **High-Yield Clinical Pearls for NEET-PG:** * **Duration:** For a diagnosis of PTSD, symptoms must persist for **more than 1 month**. If symptoms last less than 1 month, the diagnosis is **Acute Stress Disorder**. * **First-line Treatment:** Selective Serotonin Reuptake Inhibitors (**SSRIs**) like Sertraline or Paroxetine are the drugs of choice. * **Prazosin:** An alpha-1 blocker often used specifically to treat trauma-related **nightmares** in PTSD. * **Psychotherapy:** Trauma-focused Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) are highly effective.

Question 47: Which of the following features is not characteristic of Post-Traumatic Stress Disorder (PTSD)?

A. Delusions (Correct Answer)
B. Nightmares
C. Avoidance behaviors
D. Flashbacks

Explanation: **Explanation:** Post-Traumatic Stress Disorder (PTSD) is a psychiatric disorder that develops following exposure to an exceptionally threatening or catastrophic event. According to DSM-5 and ICD-11 criteria, the core symptoms are categorized into three main clusters: **Re-experiencing, Avoidance, and Hyperarousal.** **Why Delusions is the correct answer:** Delusions are fixed, false beliefs that are characteristic of **Psychotic Disorders** (like Schizophrenia). While PTSD can involve severe dissociative symptoms or "flashbacks" where a patient loses touch with reality momentarily, it is fundamentally an anxiety-based trauma disorder, not a primary psychotic disorder. Therefore, delusions are not a diagnostic feature of PTSD. **Analysis of Incorrect Options:** * **Flashbacks:** These are intense dissociative reactions where the individual feels or acts as if the traumatic event were recurring. This is a hallmark "re-experiencing" symptom. * **Nightmares:** Patients frequently experience distressing dreams where the content or affect is related to the traumatic event. * **Avoidance behaviors:** This involves persistent efforts to avoid internal reminders (thoughts, feelings) or external reminders (people, places, activities) associated with the trauma. **Clinical Pearls for NEET-PG:** * **Duration:** For a diagnosis of PTSD, symptoms must persist for **more than 1 month**. If symptoms last less than 1 month, the diagnosis is **Acute Stress Disorder**. * **First-line Treatment:** Selective Serotonin Reuptake Inhibitors (**SSRIs**) like Sertraline or Paroxetine are the pharmacological drugs of choice. * **Prazosin:** A high-yield fact—this alpha-1 blocker is specifically used to treat **trauma-related nightmares** in PTSD. * **Psychotherapy:** Trauma-focused Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (**EMDR**) are highly effective.

Question 48: Astasia-abasia is typically seen in which of the following conditions?

A. Parkinsonism
B. Alzheimer's disease
C. Schizophrenia
D. Hysterical conversion disorder (Correct Answer)

Explanation: **Explanation:** **Astasia-abasia** is a psychogenic gait disturbance characterized by the inability to stand (astasia) or walk (abasia) in a normal manner, despite having intact motor strength, sensation, and coordination when tested in a seated or supine position. **1. Why Hysterical Conversion Disorder is correct:** In **Conversion Disorder (Functional Neurological Symptom Disorder)**, patients present with neurological symptoms that cannot be explained by a neurological or medical condition. Astasia-abasia is a classic "pseudo-ataxic" gait where the patient exhibits wild, compensatory movements and near-falls, yet miraculously recovers their balance at the last second (demonstrating intact physiological equilibrium). This discrepancy between the physical exam (normal power/reflexes) and the functional disability (inability to walk) is the hallmark of conversion. **2. Why the other options are incorrect:** * **Parkinsonism:** Presents with a characteristic "shuffling gait," bradykinesia, and rigidity due to basal ganglia dysfunction, not psychogenic factors. * **Alzheimer’s Disease:** While late-stage patients may develop gait apraxia, the primary pathology is cognitive decline and cortical atrophy, not the sudden, dramatic functional loss seen in astasia-abasia. * **Schizophrenia:** Primarily a disorder of thought and perception. While catatonic features can affect movement, they do not manifest as the specific "dramatic balancing act" of astasia-abasia. **Clinical Pearls for NEET-PG:** * **La Belle Indifférence:** A classic (though not pathognomonic) feature where the patient shows a surprising lack of concern regarding their severe disability. * **Primary Gain:** Internal conflict resolution (e.g., anxiety reduction). * **Secondary Gain:** External benefits (e.g., avoiding work or gaining attention). * **Hoover’s Sign:** A bedside test used to differentiate organic from functional leg weakness; involuntary extension of the "paralyzed" leg when the patient flexes the contralateral hip against resistance.

Question 49: A young male, victim of an earthquake a few months prior, presented with recurrent and intrusive recollections of the events and thoughts, accompanied by anxiety that significantly disturbed his routine life. What is the likely diagnosis?

A. Post-traumatic stress disorder (Correct Answer)
B. Obsessive compulsive disorder
C. Paranoid schizophrenia
D. Delusional disorder

Explanation: ### Explanation **Correct Option: A. Post-traumatic stress disorder (PTSD)** The clinical presentation perfectly aligns with the diagnostic criteria for PTSD. The patient has experienced a catastrophic event (earthquake) followed by a triad of symptoms: 1. **Intrusive symptoms:** Recurrent, involuntary, and distressing memories or flashbacks. 2. **Hyperarousal/Anxiety:** Significant distress that interferes with daily functioning. 3. **Duration:** The symptoms have persisted for "a few months." According to DSM-5 and ICD-11, if symptoms last for **more than one month** following a trauma, the diagnosis is PTSD. (If symptoms last <1 month, it is termed Acute Stress Disorder). **Why other options are incorrect:** * **B. Obsessive Compulsive Disorder (OCD):** While OCD involves intrusive thoughts (obsessions), they are typically ego-dystonic, repetitive rituals or mental acts not necessarily linked to a specific life-threatening external trauma. * **C. Paranoid Schizophrenia:** This is characterized by fixed false beliefs (delusions) and hallucinations (usually auditory) lasting at least 6 months, without a necessary link to a traumatic event. * **D. Delusional Disorder:** This involves one or more non-bizarre or bizarre delusions for at least one month, without the intrusive re-experiencing or trauma history seen here. **High-Yield Clinical Pearls for NEET-PG:** * **Timeframe is Key:** * <4 weeks: Acute Stress Disorder. * \>4 weeks: PTSD. * **First-line Treatment:** Trauma-focused Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR). * **First-line Pharmacotherapy:** SSRIs (Sertraline and Paroxetine are FDA-approved). * **Prazosin:** Often used specifically to treat trauma-related nightmares in PTSD patients.

Question 50: Which of the following is a functional disorder?

A. Fugue
B. Conversion disorder
C. Hypochondriasis
D. All of the above (Correct Answer)

Explanation: ### Explanation In psychiatry, a **functional disorder** refers to a condition where there is a disturbance in the functioning of a system (physical or mental) without any identifiable structural, biochemical, or organic pathology. These are often triggered by psychological distress or unconscious conflicts. **Why "All of the Above" is Correct:** 1. **Fugue (Dissociative Fugue):** A dissociative disorder characterized by sudden, unexpected travel away from home, accompanied by an inability to recall one's past and confusion about personal identity. There is no underlying brain lesion; it is a functional defense mechanism against severe stress. 2. **Conversion Disorder (Functional Neurological Symptom Disorder):** Patients present with neurological symptoms (e.g., paralysis, blindness, seizures) that cannot be explained by neurological disease. The symptoms are "functional" because the nervous system is intact, but the psychological distress is "converted" into physical symptoms. 3. **Hypochondriasis (Illness Anxiety Disorder):** This involves a preoccupation with having a serious illness based on a misinterpretation of bodily symptoms. Despite normal medical evaluations, the patient’s functional belief persists, though no organic disease exists. Since all three conditions involve a loss of normal functioning due to psychological factors rather than organic damage, they are all classified as functional disorders. **High-Yield Clinical Pearls for NEET-PG:** * **Primary Gain:** The internal relief from anxiety achieved by keeping an unacceptable impulse out of conscious awareness (seen in Conversion). * **Secondary Gain:** The external benefits derived from being ill (e.g., attention, avoiding work). * **La Belle Indifference:** A classic sign in Conversion Disorder where the patient shows a surprising lack of concern regarding their severe physical disability. * **Differentiating Factor:** Unlike Malingering or Factitious Disorder, symptoms in functional disorders are **not** intentionally produced or feigned.

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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