Trauma and Stress-Related Disorders Practice Questions

Q: All of the following are true for Post-Traumatic Stress Disorder (PTSD) except?

Anxiolytics are the treatment of choice. ### Explanation **Why Option D is the correct answer (The "Except"):** The treatment of choice for Post-Traumatic Stress Disorder (PTSD) is **Selective Serotonin Reuptake Inhibitors (SSRIs)**, such as Sertraline or Paroxetine, combined with Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). While **Anxiolytics** (like Benzodiazepines) may provide short-term relief for acute anxiety, they are **not** the treatment of choice. In fact, they are generally avoided in PTSD due to the high risk of substance abuse/dependence in these patients and their potential to interfere with the natural processing of trauma. **Analysis of Incorrect Options:** * **Option A:** PTSD involves significant neurobiological changes. There is typically **hyperactivity of the Amygdala** (fear center) and **reduced volume/hypofunction of the Hippocampus** (memory processing), leading to impaired contextualizing of traumatic memories. * **Option B:** PTSD is characterized by "negative alterations in cognitions and mood," which includes **anhedonia** (inability to feel pleasure), emotional numbing, and detachment from others. * **Option C:** Comorbidity is extremely common. Patients frequently experience **Major Depressive Disorder** and intense feelings of **survivor guilt** or self-blame regarding the traumatic event. **High-Yield Clinical Pearls for NEET-PG:** * **Timeline:** Symptoms must persist for **>1 month**. If symptoms last <1 month, the diagnosis is **Acute Stress Disorder**. * **Key Symptom Clusters:** Re-experiencing (flashbacks/nightmares), Avoidance, Negative cognitions/mood, and Hyperarousal. * **Prazosin:** An alpha-1 blocker often used specifically to treat **PTSD-related nightmares**. * **Eye Movement Desensitization and Reprocessing (EMDR):** A specialized psychotherapy highly effective for PTSD.

Q: What is the most common disorder associated with Panic Attack?

Post-traumatic stress disorder (PTSD). **Explanation:** The correct answer is **Post-traumatic stress disorder (PTSD)**. Panic attacks are characterized by sudden, intense episodes of fear accompanied by physical symptoms (palpitations, sweating, shortness of breath). While panic attacks are the hallmark of Panic Disorder, they occur across various psychiatric conditions. According to epidemiological data and clinical studies (including DSM-5 criteria), **PTSD** has the highest prevalence of comorbid panic attacks. In PTSD, these attacks are often triggered by internal or external cues related to the traumatic event (re-experiencing), leading to a state of chronic autonomic hyperarousal. **Analysis of Incorrect Options:** * **Obsessive-compulsive disorder (OCD):** While anxiety is a core component, panic attacks are less frequent here than in PTSD. The focus is primarily on obsessions and compulsions. * **Depression:** Major Depressive Disorder (MDD) is frequently comorbid with panic attacks (anxious distress specifier), but the association is statistically less frequent than in trauma-related disorders. * **Schizophrenia:** Panic attacks can occur during psychotic episodes or as a reaction to hallucinations, but they are not a primary or defining feature of the illness. **Clinical Pearls for NEET-PG:** * **Panic Disorder vs. Panic Attack:** A panic attack is a *symptom*; Panic Disorder is a *diagnosis* requiring recurrent, unexpected attacks and at least one month of persistent worry about future attacks. * **Medical Mimics:** Always rule out hyperthyroidism, pheochromocytoma, and SVT before diagnosing a primary anxiety disorder. * **Drug of Choice:** SSRIs are the first-line long-term treatment for both Panic Disorder and PTSD. Benzodiazepines (e.g., Alprazolam) are used only for acute symptomatic relief.

Q: A person is found wandering with a purpose of meeting a spiritual guru whom he has never known. He is well-groomed and denies having any knowledge of his past life. He denies being forgetful. His relatives reported him missing from home for a week. What is the most likely diagnosis?

Dissociative fugue. **Explanation:** The clinical presentation describes a classic case of **Dissociative Fugue** (ICD-10: F44.1). The diagnosis is characterized by a sudden, unexpected journey away from home or work, accompanied by an inability to recall one’s past and a loss of personal identity. **Why Dissociative Fugue is correct:** The key diagnostic "triad" present here is: 1. **Purposeful wandering:** The patient is traveling to meet a spiritual guru. 2. **Loss of identity:** He denies knowledge of his past life. 3. **Maintenance of self-care:** He is "well-groomed," which distinguishes this from organic or psychotic states where self-care typically declines. **Why other options are incorrect:** * **Dissociative Amnesia:** While fugue involves amnesia, the presence of **purposeful travel** and the assumption of a new identity (or loss of the old one) specifically upgrades the diagnosis to Dissociative Fugue. * **Schizophrenia:** While wandering can occur, it is usually disorganized. The patient's well-groomed appearance and lack of positive symptoms (hallucinations/delusions) or negative symptoms make this unlikely. * **Dementia:** Patients with dementia wander due to disorientation and memory loss, but they would show global cognitive deficits, poor grooming, and would not typically invent a new "purposeful" identity. **High-Yield Clinical Pearls for NEET-PG:** * **Trigger:** Fugue is usually precipitated by severe psychosocial stress (e.g., marital conflict, financial ruin, or wartime trauma). * **Recovery:** Recovery is usually rapid and spontaneous, but the patient often has a "memory gap" for the duration of the fugue state itself. * **ICD-10 vs. DSM-5:** In DSM-5, Dissociative Fugue is no longer a separate diagnosis; it is now a **specifier** under Dissociative Amnesia. However, NEET-PG often follows ICD-10 criteria where it remains a distinct entity.

Q: A patient involved in a car accident was admitted to the ICU for six months. After discharge, she frequently wakes up at night feeling terrified and experiences fear when sitting in a car again. What is the most likely diagnosis?

Post-traumatic stress disorder. ### Explanation **Correct Answer: D. Post-traumatic stress disorder (PTSD)** The patient presents with the classic triad of PTSD following a life-threatening event (a severe car accident and six-month ICU stay): 1. **Re-experiencing:** Waking up terrified (nightmares) and intrusive memories. 2. **Avoidance/Hyperarousal:** Experiencing fear when sitting in a car (avoidance of triggers or autonomic arousal). 3. **Duration:** Symptoms occurring after discharge (likely >1 month). The core of PTSD is the development of characteristic symptoms following exposure to an extreme traumatic stressor involving actual or threatened death or serious injury. **Why other options are incorrect:** * **A. Panic Disorder:** Characterized by recurrent, *unexpected* panic attacks without a specific external trigger. Here, the fear is specifically linked to the trauma (the car). * **B. Phobia:** While she fears cars, a simple phobia does not explain the nightmares or the history of a major traumatic event. PTSD is a more comprehensive diagnosis encompassing these symptoms. * **C. Conversion Disorder (Functional Neurological Symptom Disorder):** Involves unexplained deficits in voluntary motor or sensory functions (e.g., paralysis, blindness) triggered by psychological stress, which are not present here. **Clinical Pearls for NEET-PG:** * **Timeline is Key:** * 1 month: **PTSD**. * **First-line Treatment:** Trauma-focused Cognitive Behavioral Therapy (CBT) and **SSRIs** (e.g., Sertraline, Paroxetine). * **Prazosin:** High-yield drug used specifically to reduce **nightmares** in PTSD patients. * **Complex PTSD:** Often involves long-term, repeated trauma (e.g., childhood abuse) rather than a single event.

Question 1

A businessman is brought for psychiatric evaluation due to recent denial of memory of taking multiple bank loans, despite all other memory functions being intact. This is suggestive of which of the following?

Accepted Answer

Dissociative amnesia

Answer

Dissociative fugue

Answer

Dissociative identity disorder

Answer

Dissociative autonomic dysfunction

Question 2

All of the following are true for Post-Traumatic Stress Disorder (PTSD) except?

Accepted Answer

Anxiolytics are the treatment of choice

Answer

Involves the hippocampus and amygdala

Answer

Characterized by anhedonia

Answer

Associated with depression and guilt

Question 3

What is the most common disorder associated with Panic Attack?

Accepted Answer

Post-traumatic stress disorder (PTSD)

Answer

Obsessive-compulsive disorder (OCD)

Answer

Depression

Answer

Schizophrenia

Question 4

Ataxic abasia is seen in which of the following conditions?

Accepted Answer

Conversion disorder

Answer

Post-traumatic stress disorder

Answer

Depression

Answer

Mania

Question 5

A 23-year-old man was found roaming aimlessly near a railway station. When enquired about his whereabouts, he appeared confused and was unable to state his name and address. He could not recall how he reached the station or anything about his past. His belongings included an AADHAR CARD with an address from Srinagar, Jammu & Kashmir. His family reported that his father had died the previous day, after which he went missing. What is the likely diagnosis?

Accepted Answer

Dissociative fugue

Answer

Dissociative identity disorder

Answer

Post-traumatic stress disorder

Answer

Depersonalization/derealization disorder

Question 6

Post-traumatic stress disorder is more likely to develop in which of the following individuals?

Accepted Answer

Those who experienced emotional numbness immediately after the disaster.

Answer

Those with lower education.

Answer

Those who experienced more stressful life events during the six months immediately following the disaster.

Answer

Those with higher economic status.

Question 7

A person is found wandering with a purpose of meeting a spiritual guru whom he has never known. He is well-groomed and denies having any knowledge of his past life. He denies being forgetful. His relatives reported him missing from home for a week. What is the most likely diagnosis?

Accepted Answer

Dissociative fugue

Answer

Dissociative amnesia

Answer

Schizophrenia

Answer

Dementia

Question 8

La belle indifference is seen in:

Accepted Answer

Dissociative disorders

Answer

Mania

Answer

Depression

Answer

Delirium

Question 9

Psychogenic amnesia is characterized by?

Accepted Answer

Patchy impairment of personal memories

Answer

Anterograde amnesia

Answer

Retrograde amnesia

Answer

Both with confabulation

Question 10

A patient involved in a car accident was admitted to the ICU for six months. After discharge, she frequently wakes up at night feeling terrified and experiences fear when sitting in a car again. What is the most likely diagnosis?

Accepted Answer

Post-traumatic stress disorder

Answer

Panic Disorder

Answer

Phobia

Answer

Conversion disorder

Trauma and Stress-Related Disorders — MCQs

Trauma and Stress-Related Disorders — MCQs

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