Post-Traumatic Stress Disorder — MCQs
What is the treatment of choice for acute panic attacks?
Post-traumatic stress disorder is characterized by all except:
Match the following drugs in Column A with their contraindications in Column B. | Column A | Column B | | :-- | :-- | | 1. Morphine | 1. QT prolongation | | 2. Amiodarone | 2. Thromboembolism | | 3. Vigabatrin | 3. Pregnancy | | 4. Estrogen preparations | 4. Head injury |
Which of the following is not a clinical feature of post-traumatic stress disorder?
Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split. Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.
A judge can ask clarifying questions when:
A patient with a history of RTA before 2 months presents with complaints of dreams of accidents. He is able to visualize the same scene whenever he visits the place. Hence is afraid to go back to the accident site. Identify the type of disorder that he might be suffering from?
To diagnose post-traumatic stress disorder, the symptoms should persist for more than ______
A patient with a history of RTA before 2 months presents with complaints of dreams of accidents. He is able to visualize the same scene whenever he visits the place. Hence is afraid to go back to the accident site. Identify the type of disorder that he might be suffering from?
A 24-year-old lady presented with sudden onset chest pain, palpitations lasting for about 20 minutes. She says there were 3 similar episodes in the past. All the investigations were normal. What is the likely diagnosis?
Post-Traumatic Stress Disorder Indian Medical PG Practice Questions and MCQs
Question 1: What is the treatment of choice for acute panic attacks?
- A. Tricyclic antidepressants (TCAs)
- B. Monoamine oxidase inhibitors (MAOIs)
- C. Barbiturates
- D. Benzodiazepines (Correct Answer)
Explanation: ***Correct: Benzodiazepines*** - Benzodiazepines are the **treatment of choice for acute panic attacks** due to their **rapid onset of action** (within minutes) - They work by enhancing **GABA-A receptor** activity, providing immediate anxiolytic effects - Commonly used agents include **alprazolam, lorazepam, and clonazepam** - While effective acutely, they are not recommended for long-term management due to dependence risk *Incorrect: Tricyclic antidepressants (TCAs)* - TCAs are effective for **long-term prophylaxis** of panic disorder, not acute attacks - They have a **delayed onset of action** (2-4 weeks), making them unsuitable for immediate relief - Significant **anticholinergic effects** and potential cardiotoxicity limit their use *Incorrect: Monoamine oxidase inhibitors (MAOIs)* - MAOIs can be effective for panic disorder but are reserved for **treatment-resistant cases** - **Delayed onset of action** (several weeks) makes them inappropriate for acute attacks - Require **dietary restrictions** and have risk of hypertensive crisis with tyramine-containing foods *Incorrect: Barbiturates* - Largely **obsolete** in psychiatric practice, replaced by safer benzodiazepines - **Narrow therapeutic index** with high risk of overdose and respiratory depression - Greater potential for dependence and withdrawal complications - No role in modern management of panic attacks
Question 2: 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 3: Match the following drugs in Column A with their contraindications in Column B. | Column A | Column B | | :-- | :-- | | 1. Morphine | 1. QT prolongation | | 2. Amiodarone | 2. Thromboembolism | | 3. Vigabatrin | 3. Pregnancy | | 4. Estrogen preparations | 4. Head injury |
- A. A-1, B-3, C-2, D-4
- B. A-4, B-1, C-3, D-2 (Correct Answer)
- C. A-3, B-2, C-4, D-1
- D. A-2, B-4, C-1, D-3
Explanation: ***A-4, B-1, C-3, D-2*** - **Morphine** is contraindicated in **head injury** as it can increase intracranial pressure and mask neurological symptoms. - **Amiodarone** is contraindicated in patients with **QT prolongation** due to its risk of inducing more severe arrhythmias like Torsades de Pointes. - **Vigabatrin** is contraindicated during **pregnancy** due to its potential for teratogenicity and adverse effects on fetal development. - **Estrogen preparations** are contraindicated in patients with a history of **thromboembolism** due to their increased risk of blood clot formation. *A-1, B-3, C-2, D-4* - This option incorrectly matches **Morphine** with QT prolongation and **Estrogen preparations** with head injury, which are not their primary contraindications. - It also incorrectly links **Vigabatrin** with thromboembolism and **Amiodarone** with pregnancy. *A-3, B-2, C-4, D-1* - This choice incorrectly associates **Morphine** with pregnancy and **Vigabatrin** with head injury, which are not the most critical or direct contraindications. - It also misaligns **Amiodarone** with thromboembolism and **Estrogen preparations** with QT prolongation. *A-2, B-4, C-1, D-3* - This option incorrectly matches **Morphine** with thromboembolism and **Amiodarone** with head injury, which are not their most significant contraindications. - It also incorrectly links **Vigabatrin** with QT prolongation and **Estrogen preparations** with pregnancy.
Question 4: Which of the following is not a clinical feature of post-traumatic stress disorder?
- A. Grandiosity (Correct Answer)
- B. Emotional distress
- C. Flashbacks
- D. Nightmares
Explanation: ***Grandiosity*** - **Grandiosity** refers to an inflated sense of self-importance, superiority, or special abilities, which is characteristic of manic or hypomanic episodes in bipolar disorder, not PTSD. - PTSD typically involves negative alterations in cognition and mood, including persistent negative beliefs about oneself (e.g., "I am bad," "I can't trust anyone"), which is opposite to grandiose thinking. - The core symptoms of PTSD do not include elevated mood, inflated self-esteem, or grandiose delusions. *Flashbacks* - **Flashbacks** are a hallmark feature of PTSD, involving vivid, intrusive re-experiences of the traumatic event where the individual feels as if the trauma is happening again. - They are a key symptom in the **intrusion cluster (Criterion B)** of DSM-5 PTSD diagnostic criteria. - Flashbacks can involve sensory, emotional, or physical re-experiencing with dissociative qualities. *Nightmares* - **Nightmares** related to the traumatic event are a common and distressing feature of PTSD, falling under the **intrusion symptom cluster (Criterion B)**. - They often involve re-enacting the trauma or experiencing themes related to its content, leading to sleep disturbance and significant emotional distress. - Trauma-related nightmares occur in the majority of PTSD patients and contribute to sleep avoidance. *Emotional distress* - **Emotional distress** is a pervasive symptom in PTSD, including intense anxiety, fear, sadness, anger, or irritability. - This distress appears across multiple symptom clusters: **intrusion (Criterion B)**, **negative alterations in cognition and mood (Criterion D)**, and **alterations in arousal and reactivity (Criterion E)**. - Emotional distress can be triggered by trauma reminders (internal or external cues) and is a core feature of the disorder.
Question 5: Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split. Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.
- A. Statements 1 & 2 are correct, 2 is not explaining 1 (Correct Answer)
- B. Statements 1 and 2 are correct and 2 is the correct explanation for 1
- C. Statements 1 and 2 are incorrect
- D. Statement 1 is incorrect
Explanation: ***Correct: Statements 1 & 2 are correct, 2 is not explaining 1*** **Analysis of Statement 1:** - A 59-year-old patient with **flaccid bullae** and **suprabasal acantholytic split** on histopathology is the classic presentation of **Pemphigus vulgaris** - The flaccid (easily ruptured) nature of bullae distinguishes it from tense bullae seen in bullous pemphigoid - The suprabasal location of the split (just above the basal layer) with acantholysis (loss of cell-to-cell adhesion) is pathognomonic - **Statement 1 is CORRECT** ✓ **Analysis of Statement 2:** - The **"row of tombstones" or "tombstone appearance"** is indeed a diagnostic histopathological feature of Pemphigus vulgaris - This appearance results from basal keratinocytes remaining attached to the basement membrane while suprabasal cells separate due to acantholysis - The intact basal cells standing upright resemble a row of tombstones - **Statement 2 is CORRECT** ✓ **Does Statement 2 explain Statement 1?** - Statement 2 describes a **histopathological appearance** (tombstone pattern) that is a **consequence** of the suprabasal split - However, it does NOT explain the **underlying cause** of the flaccid bullae or the suprabasal split - The true explanation involves **IgG autoantibodies against desmoglein 3 (and desmoglein 1)**, which attack intercellular adhesion structures (desmosomes), causing **acantholysis** - Therefore, **Statement 2 does NOT explain Statement 1** ✗ *Incorrect: Statement 2 is the correct explanation for Statement 1* - While both statements describe features of Pemphigus vulgaris, the tombstone appearance is a descriptive finding, not an explanatory mechanism *Incorrect: Statements 1 and 2 are incorrect* - Both statements are medically accurate descriptions of Pemphigus vulgaris features *Incorrect: Statement 1 is incorrect* - Statement 1 correctly describes the cardinal clinical and histopathological features of Pemphigus vulgaris
Question 6: A judge can ask clarifying questions when:
- A. At any time during the proceedings (Correct Answer)
- B. Before cross-examination
- C. During witness testimony only
- D. After cross-examination
Explanation: ***At any time during the proceedings*** - A judge's primary role is to ensure **justice** and clarity in the courtroom. Therefore, they are permitted to ask **clarifying questions** at any juncture. - This ensures they understand the evidence, testimony, and arguments presented by all parties for a fair adjudication. *Before cross-examination* - While a judge can ask questions at this stage, limiting it to "before cross-examination" is **too restrictive** and does not accurately reflect their inherent authority throughout a trial. - Their ability to seek clarification is not bound by specific procedural intervals like the start of cross-examination. *During witness testimony only* - This option is **too narrow** as a judge may need to clarify points made during opening statements, closing arguments, or even legal motions, not just during direct or cross-examination of a witness. - Limiting it to witness testimony would **impede their ability** to fully understand all aspects of the case. *After cross exam* - This is also an **incomplete** statement, as waiting until after cross-examination could mean missing opportunities to clarify earlier ambiguities that might affect subsequent testimony or arguments. - A judge's power to clarify is **continuous** and not confined to the end of a specific examination phase.
Question 7: A patient with a history of RTA before 2 months presents with complaints of dreams of accidents. He is able to visualize the same scene whenever he visits the place. Hence is afraid to go back to the accident site. Identify the type of disorder that he might be suffering from?
- A. PTSD (Correct Answer)
- B. Anxiety disorder
- C. OCD
- D. Adjustment disorder
Explanation: ***PTSD*** - Patients with **Post-Traumatic Stress Disorder (PTSD)** frequently experience **intrusive memories**, **flashbacks**, and **nightmares** related to a traumatic event. - The fear and avoidance of places associated with the trauma are characteristic symptoms, consistent with the patient's reluctance to revisit the accident site. *Anxiety disorder* - While anxiety is a component of PTSD, an **isolated anxiety disorder** would not fully explain the presence of specific **recurrent dreams** and **flashbacks** directly linked to a past traumatic event. - Generalized anxiety often involves **persistent worry about various aspects of life**, rather than focused re-experiencing of a trauma. *OCD* - **Obsessive-Compulsive Disorder (OCD)** is characterized by **recurrent, intrusive thoughts (obsessions)** and **repetitive behaviors (compulsions)** performed to reduce anxiety. - The patient's symptoms of re-experiencing an accident and avoiding the site do not align with the typical presentation of obsessions and compulsions. *Adjustment disorder* - **Adjustment disorder** involves emotional or behavioral symptoms in response to an identifiable stressor, usually resolving within 6 months after the stressor or its consequences have ended. - The described symptoms of **dreams, flashbacks, and specific avoidance** after two months are more intense and prolonged than typically seen in adjustment disorder, pointing towards a more severe trauma-related condition like PTSD.
Question 8: To diagnose post-traumatic stress disorder, the symptoms should persist for more than ______
- A. 1 month (Correct Answer)
- B. 2 days
- C. 3 months
- D. 6 months
Explanation: ***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.
Question 9: A patient with a history of RTA before 2 months presents with complaints of dreams of accidents. He is able to visualize the same scene whenever he visits the place. Hence is afraid to go back to the accident site. Identify the type of disorder that he might be suffering from?
- A. PTSD (Correct Answer)
- B. Anxiety disorder
- C. Obsessive-Compulsive Disorder (OCD)
- D. Adjustment disorder
Explanation: ***PTSD*** - The patient's symptoms, including **recurrent dreams** of the accident, **intrusive memories** triggered by the accident site, and **avoidance** of the location, are classic diagnostic criteria for **Post-Traumatic Stress Disorder (PTSD)**. - PTSD often develops after exposure to a **traumatic event** like a car accident, with symptoms lasting for more than one month. *Anxiety disorder* - While anxiety is a prominent feature of PTSD, **Generalized Anxiety Disorder** typically involves excessive worry about everyday events rather than a specific traumatic incident. - Other anxiety disorders like **panic disorder** involve sudden, intense fear without the specific re-experiencing and avoidance symptoms seen here. *Obsessive-Compulsive Disorder (OCD)* - OCD is characterized by repetitive, unwanted thoughts (**obsessions**) and ritualistic behaviors (**compulsions**) performed to reduce anxiety, which are not described in this patient's presentation. - The patient's distress stems from a past trauma, not from obsessions or compulsions. *Adjustment disorder* - An adjustment disorder occurs in response to a **stressor**, but the symptoms are typically less severe and do not include the full constellation of **re-experiencing, avoidance, and hyperarousal** seen in PTSD. - An adjustment disorder resolves within 6 months of the stressor or its consequences, however, the persistence and nature of the symptoms here point to a more severe trauma-related condition.
Question 10: A 24-year-old lady presented with sudden onset chest pain, palpitations lasting for about 20 minutes. She says there were 3 similar episodes in the past. All the investigations were normal. What is the likely diagnosis?
- A. Post-traumatic stress disorder
- B. Acute psychosis
- C. Panic attack (Correct Answer)
- D. Mania
Explanation: ***Panic attack*** - The sudden onset of **chest pain** and **palpitations** in a young woman, lasting for a brief period (20 minutes), and occurring in recurrent episodes with all investigations being normal, are classic signs of a **panic attack**. - Panic attacks frequently mimic cardiac events, but the absence of organic findings despite recurrent episodes points towards a psychological origin. *Post-traumatic stress disorder* - While PTSD can involve symptoms of anxiety and panic, it is specifically triggered by a **traumatic event** and typically includes re-experiencing the trauma, avoidance, and hyperarousal, none of which are described here. - The patient's presentation primarily focuses on sudden physical symptoms rather than a direct link to past trauma or pervasive fear. *Acute psychosis* - Acute psychosis involves a severe break from reality, characterized by **hallucinations**, **delusions**, or disorganized thought and behavior, which are not present in this scenario. - The symptoms described are more consistent with an anxiety disorder rather than a thought disorder. *Mania* - Mania is a state of elevated mood, increased energy, and often includes symptoms like **reduced need for sleep**, **racing thoughts**, and **impulsive behavior**, which are not described in this patient's presentation. - The core symptoms are acute physical sensations of fear and discomfort, not sustained euphoria or grandiosity.
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