Trauma and Stress-Related Disorders Practice Questions

Q: A person was found in a bizarre location, appearing confused. The caretaker reports he had no memory of how he got there, and the patient is unaware of his travel to the location. What is the most likely diagnosis?

Dissociative fugue. ***Dissociative fugue*** - This diagnosis is defined by **sudden, unexpected travel** away from home or the known environment, coupled with the inability to recall one's past or identity details (generalized **amnesia** for the journey). - The patient being found in a **bizarre location** and having no memory of the travel perfectly encapsulates the clinical definition of a dissociative fugue (a specifier of Dissociative Amnesia in DSM-5). *Dissociative identity disorder* - The hallmark feature is the presence of **two or more distinct personality states** or alters, which recurrently take control of the person's behavior. - While amnesia is present, it involves gaps in the recall of everyday events, not just isolated memory loss related specifically to an unexpected journey. *Dissociative amnesia* - This involves the inability to recall important personal information, usually of a **stressful or traumatic nature**, that is too extensive to be explained by ordinary forgetting. - Simple dissociative amnesia lacks the specific component of **purposeful, unplanned travel** away from home that characterizes a fugue state. *Psychotic episode* - Psychotic disorders are characterized by **positive symptoms** like **delusions** (fixed false beliefs) and **hallucinations** (perceptual disturbances). - The patient's confusion stems from a lack of memory regarding the journey (**dissociation**), not from a primary break with reality or thought disorder.

Q: A female patient presents with flashbacks and a history of forgetting about her father's death in a road traffic accident 2 weeks ago. What is the most likely diagnosis?

Acute Stress Disorder (ASD). ***Acute Stress Disorder (ASD)*** - This diagnosis is defined by the presence of severe dissociative, intrusive (**flashbacks**), negative mood, and arousal symptoms occurring between **3 days and 1 month** after exposure to a traumatic event (2 weeks in this case). - The combination of **flashbacks** (intrusion symptom) and forgetting/amnesia (dissociative symptom) is characteristic of the acute reaction to trauma seen in ASD. *Post-Traumatic Stress Disorder (PTSD)* - PTSD requires similar symptoms (intrusion, avoidance, negative alterations in cognition/mood) to persist for **more than 1 month** following the traumatic event. - Since the event occurred only 2 weeks ago, the required duration criterion for a PTSD diagnosis has not been fulfilled yet. *Dissociative Amnesia* - While the patient exhibits amnesia, this diagnosis is generally reserved for extensive memory loss concerning important **autobiographical information**, not better explained by another mental disorder. - The presence of accompanying **flashbacks** and the acute time frame following the trauma better support the diagnosis of ASD. *Adjustment Disorder* - Adjustment disorder involves emotional or behavioral symptoms developed within 3 months of an identifiable stressor, but the symptoms are not severe enough to meet criteria for ASD or PTSD. - The presence of severe clinical features like **flashbacks** and **dissociative amnesia** excludes an Adjustment Disorder diagnosis, as it meets the criteria for the more specific and severe ASD.

Q: A 14-year-old girl presented with sudden-onset blindness for the past 4 hours. However, on history taking, it is noted that she is not concerned about it. However, she is concerned that her mother passed away recently and that she should have spent more time with her. Physical examination findings are normal. Which of the following is true about the condition?

In children, it occurs more in females than in males. **In children, it occurs more in females than in males** - **Conversion disorders** (functional neurological symptom disorder) are more prevalent in **females** across childhood, adolescence, and adulthood. - The patient's **sudden-onset blindness** without medical cause, coupled with a lack of concern (**la belle indifférence**) and a psychological stressor (mother's death), points to a conversion disorder, which aligns with higher female prevalence in this age group. *In adults, equally among males and females* - This statement is incorrect as conversion disorders, including sudden-onset blindness, are generally more common in **adult females** than males. - The prevalence in adults is not equal; there is a clear gender disparity, with women being more affected. *In children, equally among males and females* - While it can occur in both sexes, the prevalence of conversion disorder in children is not equal; it is observed more frequently in **females**. - Studies consistently report a female-to-male ratio greater than 1 in pediatric populations. *In adults, it occurs more in males than in females* - This statement is incorrect; in adults, conversion disorders are significantly more common in **females**. - The classic presentation, as seen in this case, fits the typical profile observed in female patients experiencing significant psychological distress.

Q: To diagnose post-traumatic stress disorder, the symptoms should persist for more than ______

1 month. ***1 month*** - According to the **DSM-5 criteria**, for a diagnosis of **Post-Traumatic Stress Disorder (PTSD)**, the symptoms must persist for **more than one month**. - If symptoms last for less than one month, but meet other criteria, the diagnosis is typically **Acute Stress Disorder**. *2 days* - Symptoms lasting only **2 days** following a traumatic event are too short for a diagnosis of PTSD. - Such a brief duration may align with an **acute stress reaction**, which is a normal response to trauma and usually resolves quickly. *3 months* - While symptoms lasting **3 months** would certainly qualify for PTSD in terms of duration, this is not the minimum duration required. - The **minimum duration** for PTSD diagnosis is specifically defined as more than one month. *6 months* - Symptoms persisting for **6 months** or longer clearly meet the duration criteria for PTSD, but this is not the minimal period. - Setting the minimum at 6 months would lead to **underdiagnosis** of PTSD in individuals whose symptoms are significant and disabling after one month but before six months.

Q: All are stages of grief, except:

Agitation. ***Agitation*** - **Agitation** is not one of the five stages of grief described by Elisabeth Kübler-Ross. Instead, it can be a symptom experienced during many of the stages, but is not a stage itself. - The Kübler-Ross model specifically outlines **Denial**, **Anger**, **Bargaining**, **Depression**, and **Acceptance**. *Bargaining* - **Bargaining** is a recognized stage of grief where individuals try to negotiate or make deals in an attempt to postpone the inevitable or reduce suffering. - This stage often involves thoughts like "If only I had..." or "I promise I'll do X if Y happens." *Anger* - **Anger** is a well-established stage of grief, where the individual may feel rage, resentment, or frustration directed at themselves, others, or higher powers. - This stage reflects the intense emotional response to loss and the perceived unfairness of the situation. *Denial* - **Denial** is the initial stage of grief, characterized by disbelief and a difficulty accepting the reality of the impending death or loss. - This stage serves as a temporary defense mechanism, allowing the individual to cope with overwhelming emotions by refusing to acknowledge the truth.

Q: Elisabeth Kübler-Ross proposed five stages of:

Grief. ***Grief*** - Elisabeth Kübler-Ross is renowned for her work on the **five stages of grief**, a model describing emotional responses to terminal illness or significant loss. - These stages are **denial, anger, bargaining, depression, and acceptance**, which individuals may experience when facing their own death or the death of a loved one. - This model was introduced in her seminal 1969 book **"On Death and Dying"**. *Delusion* - Delusions are **fixed, false beliefs** that are not in keeping with the individual's cultural background, often seen in psychotic disorders like schizophrenia. - Kübler-Ross's work does not focus on specific cognitive distortions like delusions. *Schizophrenia* - Schizophrenia is a severe psychiatric disorder characterized by **distortions of thought, perception, emotions, language, sense of self, and behavior**. - While schizophrenia can involve significant psychological distress, it is a **distinct clinical entity** not directly related to Kübler-Ross's stages of grief. *None of the options* - This option is incorrect because the work of Elisabeth Kübler-Ross is directly associated with the **five stages of grief**, which describe the emotional process individuals experience when facing terminal illness or loss.

Q: General adaptation syndrome is seen in:

Stressful situations. ***Stressful situations*** - The **General Adaptation Syndrome (GAS)** describes the body's physiological response to any stressor, encompassing alarm, resistance, and exhaustion stages. - It's a universal response to significant **physical or psychological demands**, such as those encountered in prolonged stressful situations. *Panic attacks* - While panic attacks involve intense stress responses, they are typically acute and episodic, representing a specific manifestation of extreme anxiety rather than the overarching, multi-stage process of the **General Adaptation Syndrome**. - During a panic attack, the body rapidly enters an "alarm" like state, but it doesn't necessarily progress through the prolonged **resistance** and **exhaustion** phases characteristic of GAS in response to a sustained stressor. *Depression* - Depression is a **mood disorder** characterized by persistent sadness, loss of interest, and other symptoms, but it is not the event or process that directly triggers the General Adaptation Syndrome. - However, **chronic stress** (which elicits GAS) can be a significant risk factor for developing depression, and depression itself can be a stressor. *Anxiety* - Anxiety is a feeling of worry, nervousness, or unease, typically about an event or something with an uncertain outcome, and can be a chronic state. - While **chronic anxiety** can act as a stressor and activate components of the GAS, anxiety itself is a state or symptom, not the overarching physiological syndrome that encompasses the body's entire response to a stressor.

Q: A 4-year-old child who has received beatings in the past, from which he could not escape, appears unresponsive and no longer tries to escape new beatings. This behavior by the child is an example of

learned helplessness. ***Learned helplessness*** - This describes a state where an individual stops attempting to escape a negative situation because they have **learned from past experiences** that their actions are ineffective. - The child's history of beatings from which he could not escape led him to believe that escape is impossible, resulting in a **lack of responsiveness** to new threats. *Stimulus generalization* - This concept refers to the tendency for a stimulus that is **similar to a conditioned stimulus** to elicit a response similar to the conditioned response. - It does not explain the child's lack of effort to escape a new threatening situation, which stems from learned futility rather than stimulus similarity. *Shaping* - **Shaping** is a technique used in **operant conditioning** where successive approximations of a desired behavior are reinforced. - This process is used to teach new behaviors, not to explain a learned state of inaction in response to adversity. *Modelling* - **Modelling** involves learning by **observing and imitating** the behavior of others. - The child's behavior is a direct result of personal experience with inescapable trauma, not from observing others' responses.

Q: Post contusional syndrome includes:

Headache. ***Headache*** - **Headache** is the **most common and characteristic symptom** of **post-concussion syndrome (PCS)**, present in up to 90% of cases. - Typically described as tension-type or migraine-like headaches that persist for weeks to months after mild traumatic brain injury. - This is a **core diagnostic feature** of PCS according to ICD-10 (F07.2) and DSM-5 criteria. - Among the given options, this is the **most definitive symptom** of post-concussion syndrome. *Delirium* - **Delirium** is an acute confusional state with fluctuating consciousness, impaired attention, and cognitive dysfunction. - This is **NOT a feature of post-concussion syndrome**, which involves persistent symptoms in clear consciousness. - Delirium may occur immediately after severe traumatic brain injury but is not part of the chronic post-concussional syndrome picture. - Post-concussion syndrome involves cognitive difficulties (memory, concentration) but not delirium. *Nausea & vomiting* - **Nausea** can occur as part of post-concussion syndrome, particularly when associated with vestibular dysfunction or migraine-like headaches. - However, it is **less characteristic and less persistent** than headache, and is not present in all cases. - While recognized in ICD-10 criteria for PCS, nausea is not as defining or universal as headache. - Vomiting is less common in chronic PCS compared to acute concussion. *All of the options* - This is incorrect because **delirium is NOT a feature of post-concussion syndrome**. - While headache is the hallmark symptom and nausea can occur, delirium represents acute brain dysfunction, not the chronic syndrome. - PCS is characterized by persistent somatic (headache, dizziness), cognitive (concentration, memory problems), and psychological (irritability, anxiety) symptoms in clear consciousness.

Question 1

A person was found in a bizarre location, appearing confused. The caretaker reports he had no memory of how he got there, and the patient is unaware of his travel to the location. What is the most likely diagnosis?

Accepted Answer

Dissociative fugue

Answer

Dissociative amnesia

Answer

Dissociative identity disorder

Answer

Psychotic episode

Question 2

A female patient presents with flashbacks and a history of forgetting about her father's death in a road traffic accident 2 weeks ago. What is the most likely diagnosis?

Accepted Answer

Acute Stress Disorder (ASD)

Answer

Dissociative Amnesia

Answer

Post-Traumatic Stress Disorder (PTSD)

Answer

Adjustment Disorder

Question 3

A 14-year-old girl presented with sudden-onset blindness for the past 4 hours. However, on history taking, it is noted that she is not concerned about it. However, she is concerned that her mother passed away recently and that she should have spent more time with her. Physical examination findings are normal. Which of the following is true about the condition?

Accepted Answer

In children, it occurs more in females than in males

Answer

In adults, equally among males and females

Answer

In children, equally among males and females

Answer

In adults, it occurs more in males than in females

Question 4

A 28-year-old man who works as a resident in general surgery presents feeling "burned out" for the last 2 months. He says he has been working extremely long hours under stressful conditions, which makes him irritable, edgy, unfocused, and forgetful. He says he also has severe anxiety about how these symptoms are affecting his performance at work, making it difficult for him to sleep even when he has time off. The patient is referred for counseling and is prescribed some mild sleep aids. At follow-up a few months later, he says he is feeling much improved due to improved staffing at the hospital and a more manageable workload. Which of the following is the most likely diagnosis in this patient?

Accepted Answer

Adjustment disorder

Answer

Normal human behavior

Answer

Panic disorder

Answer

Generalized anxiety disorder

Answer

Anxiety disorder

Question 5

To diagnose post-traumatic stress disorder, the symptoms should persist for more than ______

Accepted Answer

1 month

Answer

2 days

Answer

3 months

Answer

6 months

Question 6

All are stages of grief, except:

Accepted Answer

Agitation

Answer

Bargaining

Answer

Anger

Answer

Denial

Question 7

Elisabeth Kübler-Ross proposed five stages of:

Accepted Answer

Grief

Answer

Delusion

Answer

Schizophrenia

Answer

None of the options

Question 8

General adaptation syndrome is seen in:

Accepted Answer

Stressful situations

Answer

Panic attacks

Answer

Depression

Answer

Anxiety

Question 9

A 4-year-old child who has received beatings in the past, from which he could not escape, appears unresponsive and no longer tries to escape new beatings. This behavior by the child is an example of

Accepted Answer

learned helplessness

Answer

stimulus generalization

Answer

shaping

Answer

modelling

Question 10

Post contusional syndrome includes:

Accepted Answer

Headache

Answer

Delirium

Answer

Nausea & vomiting

Answer

All of the options

Trauma and Stress-Related Disorders — MCQs

Trauma and Stress-Related Disorders — MCQs

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