Consultation-Liaison Psychiatry Practice Questions

Q: A 41-year-old male presents with complaints of inability to achieve proper erections during sexual intercourse. He reports that there were no abnormalities until last month, when on one occasion he tried having sex while he was drunk. He was not able to achieve a proper erection at that time, and since then, on four other occasions, he has been unable to have an erection during attempted sex. He reports that his morning erections are fine and erections during masturbation were also normal. He is a diabetic, and the blood reports show FBS-103 mg/dl, HbA1C-6.6. His BP was 138/88 mm Hg. What is the likely cause of his erection disturbances?

Anxiety. **Explanation** The clinical presentation points toward **Psychogenic Erectile Dysfunction (ED)**, specifically triggered by **Performance Anxiety**. **Why Anxiety is the correct answer:** The hallmark of psychogenic ED is the **situational nature** of the symptoms. The patient reports normal morning erections (nocturnal penile tumescence) and normal erections during masturbation. This confirms that the physiological mechanisms (neurological, vascular, and hormonal) required for an erection are intact. The dysfunction began after a single failure (likely due to alcohol's sedative effect), leading to a "vicious cycle" where the fear of failure (performance anxiety) triggers a sympathetic nervous system surge, preventing the parasympathetic response necessary for an erection. **Why other options are incorrect:** * **Diabetes & Hypertension:** While both are common causes of *organic* ED due to microvascular and endothelial damage, organic ED is typically gradual in onset and characterized by the **absence** of morning or masturbatory erections. This patient’s HbA1C (6.6) and BP are relatively well-controlled. * **Alcohol use:** While acute alcohol ingestion can cause temporary ED (as seen in his first episode), it does not explain the subsequent failures while sober, especially when nocturnal erections remain preserved. **Clinical Pearls for NEET-PG:** * **Organic vs. Psychogenic ED:** If spontaneous morning erections are present, the cause is almost always psychogenic. * **Performance Anxiety:** This is the most common cause of psychogenic ED in young and middle-aged men. * **Nocturnal Penile Tumescence (NPT) Test:** Used to differentiate organic from psychogenic ED. A positive NPT (erections during sleep) confirms a psychogenic etiology. * **Diabetes:** The most common organic cause of ED due to a combination of neuropathy and angiopathy.

Q: Pseudodrugia Fantastica is seen in which of the following conditions?

Factitious disorder. **Explanation:** **Pseudologia Fantastica** (often referred to as pathological lying) is a hallmark clinical feature of **Factitious Disorder** (Munchausen Syndrome). It involves the creation of elaborate, complex, and often grandiose tales about one’s life, medical history, or social status. These stories are typically a mix of truth and fiction, designed to gain attention, sympathy, or the "sick role." **Why the Correct Answer is Right:** In **Factitious Disorder**, the primary motivation is internal (psychological)—the patient seeks the identity of a patient to receive care and attention. Pseudologia Fantastica serves this goal by providing a dramatic narrative that justifies medical intervention or hospitalization. **Analysis of Incorrect Options:** * **Malingering:** Unlike factitious disorder, malingering is motivated by **external incentives** (e.g., avoiding military duty, obtaining drugs, or financial gain). While they lie, it is not the compulsive, "fantastic" storytelling seen in Pseudologia Fantastica. * **Somatization Syndrome:** Patients genuinely believe they are ill and experience physical symptoms. They do not consciously fabricate stories or symptoms for attention. * **Dissociative Fugue:** This involves sudden, unexpected travel away from home with an inability to recall one’s past. It is a disorder of memory and identity, not a conscious fabrication of elaborate lies. **High-Yield Clinical Pearls for NEET-PG:** * **Munchausen Syndrome:** The most severe form of Factitious Disorder, characterized by "hospital hopping" and invasive self-harm to mimic disease. * **Munchausen by Proxy:** A form of child abuse where a caregiver (usually the mother) fabricates or induces illness in a child. * **Key Distinction:** Factitious Disorder = **Internal** incentive (Sick role); Malingering = **External** incentive (Secondary gain).

Q: Deliberately pretending to have a disability or illness in order to receive financial or other gains is called:

Malingering. **Explanation:** The core concept in this question is the presence of **external incentive**. **1. Why Malingering is Correct:** Malingering is not a psychiatric illness but a behavior. It involves the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by **external incentives** (secondary gains). These gains typically include financial compensation, avoiding work/military duty, evading criminal prosecution, or obtaining drugs. **2. Analysis of Incorrect Options:** * **Factitious Disorder (e.g., Munchausen Syndrome):** Symptoms are intentionally produced (like malingering), but the motivation is to assume the **"sick role"** (primary gain) rather than for external rewards. There is no obvious external incentive. * **Conversion Disorder (Functional Neurological Symptom Disorder):** Symptoms (usually neurological, like paralysis or blindness) are **unintentional** and unconscious. They are often triggered by psychological stress. * **Somatoform Disorder (Somatic Symptom Disorder):** The patient has persistent physical complaints that cause significant distress, but the symptoms are **not** intentionally produced or faked. **3. NEET-PG Clinical Pearls:** * **Malingering vs. Factitious:** If the patient wants a "check" (money), it’s Malingering. If the patient wants a "bed" (care/attention), it’s Factitious. * **Clues to Malingering:** Discrepancy between subjective complaints and objective findings, lack of cooperation during evaluation, and presence of Antisocial Personality Disorder. * **La Belle Indifference:** Classically associated with Conversion Disorder, where the patient appears surprisingly unconcerned about their severe disability.

Q: A 28-year-old male presents with a history of vague pains and multiple surgical scars. He is persistently curious about his diagnosis, requesting various diagnostic procedures and a biopsy. He reports a past history of gallstone and appendicitis pain, but the history is vague and appears manipulative, with no supporting previous records. What is the probable diagnosis?

Factitious disorder. ### **Explanation** **Correct Answer: D. Factitious Disorder** The clinical presentation describes a patient who intentionally produces or feigns physical symptoms (vague pains, requesting biopsies) to assume the **"sick role."** Key indicators in this case include the presence of multiple surgical scars (the "gridiron abdomen"), a vague and manipulative history, and a lack of medical records to support past surgeries. Unlike other disorders, the primary motivation in Factitious Disorder (formerly known as Munchausen syndrome) is internal—the psychological need to be a patient—rather than external gain (like money or avoiding work). **Why Incorrect Options are Wrong:** * **A. Hypochondriasis (Illness Anxiety Disorder):** Patients have a genuine, distressing fear of having a serious disease based on misinterpretation of bodily sensations. They do not intentionally produce symptoms or manipulate history. * **B. Somatization Disorder:** Characterized by multiple, chronic physical complaints across different organ systems. However, these symptoms are **not** intentionally produced; the patient truly feels the distress. * **C. Conversion Disorder:** Involves sudden loss of neurological function (e.g., paralysis, blindness) triggered by psychological stress. The symptoms are involuntary and not consciously faked. **NEET-PG High-Yield Pearls:** * **Factitious Disorder vs. Malingering:** In Factitious Disorder, the goal is the **sick role** (internal incentive). In Malingering, the goal is **secondary gain** (external incentive like disability benefits or avoiding jail). * **Gridiron Abdomen:** A classic sign of Factitious Disorder where the patient has multiple crisscrossing surgical scars from unnecessary exploratory surgeries. * **Management:** The best approach is a non-confrontational alliance, focusing on psychiatric management while avoiding unnecessary invasive procedures.

Question 1

A 41-year-old male presents with complaints of inability to achieve proper erections during sexual intercourse. He reports that there were no abnormalities until last month, when on one occasion he tried having sex while he was drunk. He was not able to achieve a proper erection at that time, and since then, on four other occasions, he has been unable to have an erection during attempted sex. He reports that his morning erections are fine and erections during masturbation were also normal. He is a diabetic, and the blood reports show FBS-103 mg/dl, HbA1C-6.6. His BP was 138/88 mm Hg. What is the likely cause of his erection disturbances?

Accepted Answer

Anxiety

Answer

Diabetes

Answer

Alcohol use

Answer

Hypertension

Question 2

All are true statements about Conversion disorder except?

Accepted Answer

Autonomic nervous system is involved

Answer

There is primary and secondary gain

Answer

La belle indifference is a feature

Answer

Patient does not intentionally produce symptoms

Question 3

Pseudodrugia Fantastica is seen in which of the following conditions?

Accepted Answer

Factitious disorder

Answer

Malingering

Answer

Somatization syndrome

Answer

Dissociative fugue

Question 4

Deliberately pretending to have a disability or illness in order to receive financial or other gains is called:

Accepted Answer

Malingering

Answer

Factitious disorder

Answer

Conversion

Answer

Somatoform disorder

Question 5

A 28-year-old male presents with a history of vague pains and multiple surgical scars. He is persistently curious about his diagnosis, requesting various diagnostic procedures and a biopsy. He reports a past history of gallstone and appendicitis pain, but the history is vague and appears manipulative, with no supporting previous records. What is the probable diagnosis?

Accepted Answer

Factitious disorder

Answer

Hypochondriasis

Answer

Somatization disorder

Answer

Conversion disorder

Consultation-Liaison Psychiatry — MCQs

Consultation-Liaison Psychiatry — MCQs

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