Trauma and Stress-Related Disorders — MCQs
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Two months after learning his son has leukemia, a 45-year-old father presents with sleep deprivation, lethargy, headache, and low mood. He interacts reasonably well with others but has been absenting himself from work. What is the most probable diagnosis?
A 22-year-old woman presents with anesthesia of the right hand that developed after an argument with her brother. She appears unconcerned about her symptoms. Neurologic examination reveals reduced sensitivity to pain in a glove-like distribution over the right hand, with no other neurological deficits. Her family describes a history of chronic jealousy and rivalry, which the patient seems unaware of. What is the most likely diagnosis?
Post-traumatic stress disorder is primarily associated with exposure to what type of event?
Which of the following statements is NOT TRUE regarding post-traumatic stress disorder?
A victim of a tsunami has difficulty in overcoming the experience and still recollects the event in dreams and thoughts. What is the most likely diagnosis?
Post-traumatic stress disorder is differentiated from other anxiety disorders by which of the following symptoms?
A 28-year-old software engineer presents with sleep disturbances, low mood, and stress for the past 3 months. He attributes his symptoms to ongoing problems at work. He has no prior psychiatric history. Which of the following is the most likely diagnosis?
A man presents to the hospital with a bizarre behavior. He is unable to recall his personal identity and has no memory of how he traveled 100 km to reach the hospital. A collateral history reveals he experienced a traumatic earthquake a few months ago. Which of the following is the most likely diagnosis?
A lady presents to the hospital after having a fight with her husband. She reports that she is unable to speak. However, all neurological and physical examinations are normal, and she does not seem concerned about her health status. What is the most likely diagnosis?
A 25-year-old male was injured during an earthquake. A social worker reports that he was later found in another town, and the man has no memory of how he got there or of his personal identity. What is the most likely diagnosis?
Trauma and Stress-Related Disorders Indian Medical PG Practice Questions and MCQs
Question 51: Two months after learning his son has leukemia, a 45-year-old father presents with sleep deprivation, lethargy, headache, and low mood. He interacts reasonably well with others but has been absenting himself from work. What is the most probable diagnosis?
- A. Depression
- B. Psychogenic headache
- C. Adjustment disorder (Correct Answer)
- D. Somatization disorder
Explanation: ### Explanation **Correct Answer: C. Adjustment Disorder** **Why it is correct:** Adjustment disorder is characterized by emotional or behavioral symptoms that develop in response to an **identifiable stressor** (in this case, the son’s leukemia diagnosis). According to DSM-5/ICD-11 criteria: 1. **Timeline:** Symptoms must begin within **3 months** of the stressor (the patient is at 2 months). 2. **Severity:** The distress is out of proportion to the severity of the stressor or causes **significant impairment** in social or occupational functioning (absenting from work). 3. **Nature:** The symptoms do not meet the full criteria for another mental disorder (like Major Depressive Disorder) and are not part of normal bereavement. The patient’s ability to "interact reasonably well" suggests his social functioning is relatively preserved compared to the profound withdrawal seen in clinical depression. **Why the other options are incorrect:** * **A. Depression:** While the patient has a low mood, he does not meet the full syndromic criteria for Major Depressive Disorder (e.g., pervasive anhedonia, suicidal ideation, or severe psychomotor retardation). His ability to interact socially points more toward a reactive adjustment issue. * **B. Psychogenic headache:** This is a symptom, not a comprehensive diagnosis. While the headache is likely stress-induced, it is part of a broader constellation of emotional and functional symptoms. * **D. Somatization disorder:** This requires a chronic history (usually years) of multiple, clinically significant physical complaints starting before age 30. This patient’s symptoms are acute and directly linked to a recent life stressor. **NEET-PG High-Yield Pearls:** * **Timeframe:** Symptoms start within **3 months** of the stressor and usually resolve within **6 months** once the stressor (or its consequences) has terminated. * **Subtypes:** Adjustment disorder can present with depressed mood, anxiety, mixed features, or disturbance of conduct. * **Treatment of Choice:** **Psychotherapy** (Crisis intervention or Cognitive Behavioral Therapy) is the mainstay. Pharmacotherapy is only used briefly for specific symptoms like insomnia.
Question 52: A 22-year-old woman presents with anesthesia of the right hand that developed after an argument with her brother. She appears unconcerned about her symptoms. Neurologic examination reveals reduced sensitivity to pain in a glove-like distribution over the right hand, with no other neurological deficits. Her family describes a history of chronic jealousy and rivalry, which the patient seems unaware of. What is the most likely diagnosis?
- A. Body dysmorphic disorder
- B. Histrionic personality disorder
- C. Parietal brain tumor
- D. Conversion disorder (Correct Answer)
Explanation: **Explanation:** The correct diagnosis is **Conversion Disorder** (Functional Neurological Symptom Disorder). This condition is characterized by neurological symptoms (motor or sensory) that cannot be explained by a recognized neurological or medical condition. 1. **Why it is correct:** The patient presents with a sensory deficit (anesthesia) that follows a clear psychological stressor (argument with her brother). The "glove-like distribution" is a classic non-anatomical pattern that does not follow dermatomal or peripheral nerve distributions. A hallmark feature present here is **"La belle indifférence"**—a paradoxical lack of concern regarding the severity of the symptoms. Psychodynamically, this represents the "primary gain," where internal psychological conflict is converted into physical symptoms to keep the conflict out of conscious awareness. 2. **Why the other options are wrong:** * **Body Dysmorphic Disorder:** Involves preoccupation with perceived flaws in physical appearance, not neurological deficits. * **Histrionic Personality Disorder:** While characterized by attention-seeking and emotionality (and often comorbid with conversion symptoms), it is a personality pattern, not a diagnosis for an acute neurological deficit. * **Parietal Brain Tumor:** Would typically present with anatomical sensory loss, often accompanied by other signs like neglect, aphasia, or increased intracranial pressure, and would not follow a "glove" pattern. **Clinical Pearls for NEET-PG:** * **Primary Gain:** Reduction of anxiety by keeping the conflict unconscious. * **Secondary Gain:** External benefits derived from being "sick" (e.g., attention, avoiding work). * **Common Presentations:** Pseudoseizures (most common), paralysis, blindness, and aphonia. * **Epidemiology:** More common in young females and individuals with lower socioeconomic status or rural backgrounds.
Question 53: Post-traumatic stress disorder is primarily associated with exposure to what type of event?
- A. Head injury
- B. Cardiovascular disease
- C. Minor stress
- D. Major life-threatening events (Correct Answer)
Explanation: **Explanation:** **Post-Traumatic Stress Disorder (PTSD)** is a psychiatric disorder that occurs in individuals who have experienced or witnessed a traumatic event. According to the **DSM-5 criteria**, the primary trigger (Criterion A) must involve exposure to **actual or threatened death, serious injury, or sexual violence**. This distinguishes PTSD from other stress-related disorders where the stressor may be less severe. * **Why Option D is Correct:** PTSD is fundamentally rooted in the experience of **major life-threatening events** (e.g., natural disasters, combat, physical assault, or serious accidents). These events overwhelm the individual's coping mechanisms, leading to characteristic symptoms like re-experiencing (flashbacks), avoidance, hyperarousal, and negative alterations in cognition and mood. * **Why Options A & B are Incorrect:** While a head injury or cardiovascular disease (like an MI) can be traumatic, they are specific medical conditions. A head injury might cause organic brain syndromes or amnesia, but it is not the *defining* requirement for PTSD. * **Why Option C is Incorrect:** Minor stressors (e.g., job loss, divorce) typically lead to **Adjustment Disorder**, not PTSD. PTSD requires a "catastrophic" stressor. **High-Yield Clinical Pearls for NEET-PG:** * **Duration:** Symptoms must persist for **more than 1 month**. If symptoms last <1 month, the diagnosis is **Acute Stress Disorder (ASD)**. * **Neurobiology:** Associated with a **hyperactive Amygdala** and a **hypoactive/shrunken Hippocampus** (due to chronic cortisol exposure). * **Treatment:** The first-line pharmacological treatment is **SSRIs** (e.g., Sertraline, Paroxetine). **Prazosin** is highly effective for PTSD-related nightmares. * **Psychotherapy:** Trauma-focused Cognitive Behavioral Therapy (CBT) and EMDR (Eye Movement Desensitization and Reprocessing) are gold standards.
Question 54: Which of the following statements is NOT TRUE regarding post-traumatic stress disorder?
- A. The onset of illness may occur many months after the traumatic event.
- B. Individual debriefing and early counseling are the most effective methods of treatment. (Correct Answer)
- C. Eye movement desensitization and reprocessing (EMDR) is effective.
- D. There is a high risk of alcohol abuse in patients suffering from this disorder.
Explanation: ### Explanation **Post-Traumatic Stress Disorder (PTSD)** is a psychiatric disorder that occurs following exposure to a traumatic event involving actual or threatened death, serious injury, or sexual violence. **Why Option B is the Correct Answer (The False Statement):** Contrary to previous beliefs, **individual psychological debriefing** (specifically "Critical Incident Stress Debriefing" or CISD) performed immediately after a trauma is **not recommended**. Research indicates it is generally ineffective and may even increase the risk of developing PTSD by interfering with natural processing or re-traumatizing the individual. The most effective first-line treatments are **Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)** and **Pharmacotherapy** (SSRIs). **Analysis of Other Options:** * **Option A (True):** PTSD can have a **delayed onset**. While symptoms usually begin within 3 months, the DSM-5 allows for a "delayed expression" specifier if the full diagnostic criteria are not met until at least 6 months after the event. * **Option C (True):** **EMDR** is a specialized, evidence-based psychotherapy specifically indicated for PTSD. It involves the patient focusing on traumatic memories while simultaneously experiencing bilateral stimulation (typically eye movements). * **Option D (True):** There is a high rate of **comorbidity** in PTSD. Patients often use alcohol or substances as a form of "self-medication" to numb hyperarousal and intrusive memories. **Clinical Pearls for NEET-PG:** * **Duration:** Symptoms must persist for **>1 month**. If symptoms last <1 month, the diagnosis is **Acute Stress Disorder**. * **First-line Pharmacotherapy:** **SSRIs** (Sertraline and Paroxetine are FDA-approved). * **Nightmares:** **Prazosin** (an alpha-1 blocker) is highly effective for trauma-related nightmares. * **Key Symptom Clusters:** Intrusion (flashbacks), Avoidance, Negative alterations in cognition/mood, and Hyperarousal.
Question 55: A victim of a tsunami has difficulty in overcoming the experience and still recollects the event in dreams and thoughts. What is the most likely diagnosis?
- A. Post traumatic stress disorder (Correct Answer)
- B. Conversion disorder
- C. Panic disorder
- D. Phobia
Explanation: ### Explanation **Correct Option: A. Post-traumatic stress disorder (PTSD)** The clinical presentation describes a classic case of PTSD following a life-threatening natural disaster (tsunami). PTSD occurs after exposure to an exceptionally threatening or catastrophic event. The diagnosis is characterized by a triad of symptoms: 1. **Intrusive Symptoms:** Re-experiencing the trauma through "flashbacks," vivid memories, or recurring nightmares (as seen in this patient). 2. **Avoidance:** Efforts to avoid reminders, people, or places associated with the event. 3. **Hyperarousal:** Persistent state of high alertness, exaggerated startle response, and insomnia. *Note: For a diagnosis of PTSD, symptoms must persist for more than one month.* **Why Incorrect Options are Wrong:** * **B. Conversion Disorder (Functional Neurological Symptom Disorder):** This involves neurological symptoms (like paralysis or blindness) that cannot be explained by a medical condition, often triggered by psychological stress. It does not involve re-experiencing trauma. * **C. Panic Disorder:** Characterized by recurrent, unexpected panic attacks (sudden bouts of intense fear with palpitations/sweating) without a specific external trigger like a past trauma. * **D. Phobia:** Involves an intense, irrational fear of a specific object or situation (e.g., heights, spiders). While a patient might fear water after a tsunami, the presence of intrusive dreams and thoughts points specifically toward PTSD. **High-Yield Clinical Pearls for NEET-PG:** * **Timeline:** If symptoms last **<1 month**, the diagnosis is **Acute Stress Disorder (ASD)**. If **>1 month**, it is **PTSD**. * **First-line Treatment:** Selective Serotonin Reuptake Inhibitors (**SSRIs**) like Sertraline or Paroxetine. * **Psychotherapy:** Trauma-focused Cognitive Behavioral Therapy (CBT) and EMDR (Eye Movement Desensitization and Reprocessing) are highly effective. * **Prazosin:** Often used specifically to treat trauma-related nightmares in PTSD.
Question 56: Post-traumatic stress disorder is differentiated from other anxiety disorders by which of the following symptoms?
- A. Nightmares
- B. Re-living of past adverse event (Correct Answer)
- C. Hypervigilance
- D. Avoidance
Explanation: ### Explanation **1. Why "Re-living of past adverse event" is correct:** While many anxiety disorders share symptoms of autonomic arousal, the hallmark and pathognomonic feature of **Post-Traumatic Stress Disorder (PTSD)** is the **re-experiencing** of the traumatic event. This occurs through intrusive memories, flashbacks (dissociative reactions where the patient feels as if the event is recurring), or intense psychological distress when exposed to cues. While other disorders involve worry about the future, PTSD is uniquely defined by the involuntary "re-living" of a specific past trauma. **2. Why the other options are incorrect:** * **Nightmares (Option A):** While common in PTSD, nightmares can occur in various conditions including REM sleep behavior disorder, generalized anxiety disorder (GAD), or as a side effect of medications. * **Hypervigilance (Option B):** This is a state of increased sensory sensitivity and is a core feature of **Generalized Anxiety Disorder (GAD)** and Panic Disorder. It is not unique to PTSD. * **Avoidance (Option D):** Avoidance behavior is a central component of **Phobic disorders** (e.g., Agoraphobia, Social Phobia). Patients with various anxiety disorders avoid triggers to prevent distress. **3. Clinical Pearls for NEET-PG:** * **Timeline is Key:** For a diagnosis of PTSD, symptoms must persist for **>1 month**. If symptoms last **<1 month**, the diagnosis is **Acute Stress Disorder**. * **Core Symptom Clusters:** Remember the "HARD" mnemonic: **H**yperarousal, **A**voidance, **R**e-experiencing (Flashbacks), and **D**istress/Negative alterations in mood. * **First-line Treatment:** SSRIs (e.g., Sertraline, Paroxetine) are the pharmacological treatment of choice. * **Prazosin:** Highly effective for treating trauma-related nightmares in PTSD.
Question 57: A 28-year-old software engineer presents with sleep disturbances, low mood, and stress for the past 3 months. He attributes his symptoms to ongoing problems at work. He has no prior psychiatric history. Which of the following is the most likely diagnosis?
- A. Generalized anxiety disorder
- B. Adjustment disorder (Correct Answer)
- C. Post-traumatic stress disorder (PTSD)
- D. Acute stress disorder
Explanation: ***Adjustment disorder*** - This diagnosis is characterized by the development of emotional or behavioral symptoms in response to an identifiable **psychosocial stressor** (ongoing work problems) occurring within **3 months** of the onset of the stressor. - The patient's symptoms (low mood, stress, sleep disturbances) are clinically significant but do not meet the full diagnostic criteria for a more severe disorder like **Major Depressive Disorder** or **Generalized Anxiety Disorder**. *Generalized anxiety disorder* - This disorder primarily involves **excessive anxiety and worry** about numerous events or activities, occurring more days than not for at least **6 months**. - The patient's symptoms are directly tied to a specifiable stressor, making adjustment disorder a better fit than the broader, persistent worry characteristic of GAD. *Acute stress disorder* - This diagnosis requires exposure to a **traumatic stressor** (e.g., threat to life or serious injury), which is not the etiology described here (work problems). - Furthermore, symptoms must resolve within **one month** of the traumatic event; this patient's symptoms have persisted for 3 months. *Post-traumatic stress disorder (PTSD)* - Similar to acute stress disorder, PTSD requires exposure to an actual or threatened **death, serious injury, or sexual violence**, which is not indicated by the vignette. - Core features of PTSD include **intrusive memories** (flashbacks), avoidance of stimuli, and hyperarousal, none of which are reported by the patient.
Question 58: A man presents to the hospital with a bizarre behavior. He is unable to recall his personal identity and has no memory of how he traveled 100 km to reach the hospital. A collateral history reveals he experienced a traumatic earthquake a few months ago. Which of the following is the most likely diagnosis?
- A. Dissociative identity disorder
- B. Schizophrenia
- C. Dissociative amnesia (Correct Answer)
- D. Global amnesia
Explanation: ***Dissociative amnesia*** - The presentation of sudden, unplanned travel away from home (called **dissociative fugue**) combined with an inability to recall important **autobiographical information** (personal identity) is the classic manifestation of severe dissociative amnesia. - This disorder is overwhelmingly triggered by psychological stress or **trauma**, such as the patient's recent experience of a traumatic earthquake. *Dissociative identity disorder* - This disorder requires the presence of two or more distinct personality states (or **alters**) that recurrently take control of the person's behavior, which is not described here. - While amnesia is a feature, the primary pathology is the fragmentation of identity, not just the loss of personal autobiographical memory without distinct alters. *Schizophrenia* - Schizophrenia is characterized by **psychotic features** such as delusions, hallucinations, and grossly disorganized thinking and behavior, which are absent in this presentation. - The core deficit here is memory and identity retrieval linked to trauma, not a primary thought disorder or persistent **psychosis**. *Global amnesia* - **Transient Global Amnesia (TGA)** involves anterograde amnesia (inability to form new memories) and retrograde amnesia (loss of recent past memories). - Crucially, in contrast to dissociative amnesia, severe impairment of **personal identity** and highly selective memory loss linked to trauma are typically absent in TGA.
Question 59: A lady presents to the hospital after having a fight with her husband. She reports that she is unable to speak. However, all neurological and physical examinations are normal, and she does not seem concerned about her health status. What is the most likely diagnosis?
- A. Conversion Disorder (Correct Answer)
- B. Somatic Symptom Disorder
- C. Adjustment Disorder
- D. Malingering
Explanation: ***Correct: Conversion Disorder*** - Patient presents with **acute loss of function (mutism)** following a psychological stressor (marital conflict) - **Neurological examination is normal**, ruling out organic causes - Most characteristic feature: **La belle indifférence** - lack of appropriate concern about the disability - Conversion disorder involves neurological symptoms (paralysis, blindness, mutism, seizures) that cannot be explained by medical conditions - Symptoms are **unconscious** (not intentionally produced) and follow psychological stress *Incorrect: Somatic Symptom Disorder* - Involves **excessive thoughts, feelings, or behaviors** related to somatic symptoms - Patients show **high anxiety** and preoccupation with their symptoms (opposite of la belle indifférence) - Symptoms are persistent (>6 months), not acute - Does not typically present with complete loss of function like mutism *Incorrect: Adjustment Disorder* - Involves emotional/behavioral symptoms in response to stressor - Does NOT present with **neurological deficits** like mutism - Symptoms are mood-related (depression, anxiety) rather than functional neurological symptoms - Would not explain the dramatic presentation of complete speech loss *Incorrect: Malingering* - **Conscious, intentional** production of symptoms for secondary gain (financial, avoiding work/legal issues) - No clear secondary gain mentioned in this scenario - Malingerers typically show concern and emphasize their symptoms (not la belle indifférence) - Would be suspected if obvious external incentive present
Question 60: A 25-year-old male was injured during an earthquake. A social worker reports that he was later found in another town, and the man has no memory of how he got there or of his personal identity. What is the most likely diagnosis?
- A. Dissociative identity disorder
- B. Acute stress disorder
- C. Dissociative amnesia with dissociative fugue (Correct Answer)
- D. PTSD
Explanation: ***Dissociative amnesia with dissociative fugue*** - In **DSM-5**, dissociative fugue is no longer a separate disorder but a **specifier** of dissociative amnesia. - It is characterized by **sudden, unexpected travel** away from home or customary workplace along with an **inability to recall** some or all of one's past. - This condition involves **amnesia regarding one's identity** (personal identity/autobiographical memory) and is frequently precipitated by severe psychological trauma or stress (the earthquake). - The combination of **purposeful travel** to another location and **loss of personal identity** is pathognomonic for this specifier. *Dissociative identity disorder* - This disorder involves the presence of two or more distinct **personality states** (alters) that recurrently take control of behavior. - The primary feature is **fragmentation of identity**, not the transient, single episode of extensive travel and sudden amnesia described here. *Acute stress disorder* - This diagnosis requires symptoms (e.g., intrusion, negative mood, avoidance, dissociation) to occur within **3 days to 1 month** after exposure to trauma. - While trauma is present, the specific symptom combination of **purposeful wandering** and **loss of personal identity** is the critical differentiating factor for dissociative fugue. *PTSD* - This diagnosis requires symptoms (intrusion, avoidance, hyperarousal) to persist for **more than one month** following the traumatic event. - The key features presented are **flight** (wandering to another town) and **extensive identity amnesia**, which are characteristic of the dissociative fugue specifier, not core PTSD symptoms.
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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