Trauma and Stress-Related Disorders Practice Questions

Q: What is dissociative fugue?

Sudden flight from an immediate life situation. **Explanation:** **Dissociative Fugue** (now classified under Dissociative Amnesia in DSM-5) is characterized by a sudden, unexpected travel away from one’s home or place of work, accompanied by an inability to recall one’s past and confusion about personal identity. The "sudden flight" is usually a defense mechanism triggered by severe psychosocial stress or trauma. **Analysis of Options:** * **Option D (Correct):** The hallmark of fugue is the physical act of wandering or "flight" combined with amnesia. Patients often adopt a new identity during the episode and have no memory of the fugue once it ends. * **Option A (Incorrect):** Sudden onset of paralysis without an organic cause is characteristic of **Conversion Disorder** (Functional Neurological Symptom Disorder), where psychological distress is "converted" into physical symptoms. * **Option B (Incorrect):** Fear of a specific object defines a **Specific Phobia**, which is an anxiety disorder, not a dissociative one. * **Option C (Incorrect):** The presence of two or more distinct personality states is the defining feature of **Dissociative Identity Disorder (DID)**, formerly known as Multiple Personality Disorder. **Clinical Pearls for NEET-PG:** * **ICD-10 vs. DSM-5:** In ICD-10, Dissociative Fugue is a separate diagnosis (F44.1). In DSM-5, it is a **specifier** for Dissociative Amnesia. * **Key Feature:** The travel is usually purposeful, but the patient appears bewildered. * **Recovery:** Recovery is typically rapid and spontaneous, but the patient remains amnestic for the events that occurred *during* the fugue state. * **Differential:** Always rule out organic causes like Temporal Lobe Epilepsy (TLE) or substance abuse.

Q: A lady, following a severe car accident requiring 6 months of ICU admission, now experiences terror and fear at night and is afraid to sit in a car. What is the most likely diagnosis?

Post-traumatic stress disorder. **Explanation:** The patient presents with classic symptoms following a life-threatening event (a severe car accident and prolonged ICU stay). The diagnosis is **Post-Traumatic Stress Disorder (PTSD)** because her symptoms align with the core diagnostic clusters: **Re-experiencing** (terror and fear at night/nightmares), **Avoidance** (afraid to sit in a car), and a history of a significant traumatic stressor. **Why the correct option is right:** PTSD (DSM-5/ICD-11) requires exposure to actual or threatened death or serious injury. The symptoms must persist for **more than one month**. Key features include intrusive memories/nightmares, avoidance of stimuli associated with the trauma, and negative alterations in cognition or arousal. **Why the other options are incorrect:** * **Anxiety Disorder:** This is a broad category. While PTSD involves anxiety, the specific link to a traumatic event and the presence of re-experiencing symptoms make PTSD the more precise diagnosis. * **Phobia:** While she avoids cars (resembling a specific phobia), the avoidance is a secondary component of the global trauma response. Phobias typically lack the "re-experiencing" (nightmares/flashbacks) element seen here. * **Conversion Disorder (Functional Neurological Symptom Disorder):** This involves unexplained voluntary motor or sensory deficits (e.g., paralysis, blindness) triggered by psychological stress, which are not present in this case. **High-Yield Clinical Pearls for NEET-PG:** * **Timeline:** Symptoms 1 month = **PTSD**. * **First-line Treatment:** SSRIs (e.g., Sertraline, Paroxetine) and Trauma-focused Psychotherapy (CBT/EMDR). * **Prazosin:** High-yield drug used specifically to reduce **trauma-related nightmares** in PTSD. * **Complex PTSD:** Often follows prolonged, repeated trauma (e.g., long-term abuse) rather than a single event.

Q: What is the characteristic type of amnesia seen following a traumatic brain injury?

Anterograde amnesia. **Explanation:** The characteristic type of amnesia following a Traumatic Brain Injury (TBI) is **Anterograde Amnesia**. This refers to the inability to form new memories or retain information after the traumatic event. **1. Why Anterograde Amnesia is Correct:** In the context of TBI, the duration of anterograde amnesia is the hallmark of **Post-Traumatic Amnesia (PTA)**. It occurs because the trauma disrupts the process of memory consolidation (transferring information from short-term to long-term storage), often involving the hippocampus and temporal lobes. The length of PTA is a critical clinical indicator used to determine the severity of the brain injury and predict long-term functional outcomes. **2. Why Other Options are Incorrect:** * **Retrograde Amnesia:** This is the loss of memories formed *before* the trauma. While it frequently co-occurs with TBI, it is usually limited to a short period preceding the accident and tends to shrink over time (Ribot’s Law). It is not the defining characteristic used to assess TBI severity. * **Remote Amnesia:** This refers to the loss of distant past memories (e.g., childhood). These memories are usually well-preserved in TBI patients unless the injury is extremely diffuse or involves advanced neurodegeneration. **Clinical Pearls for NEET-PG:** * **PTA Duration & Severity:** PTA 24 hours (Severe), > 7 days (Very Severe). * **Ribot’s Law:** Recent memories are lost first, while remote memories are more resistant to brain insults. * **Concussion:** A mild TBI where transient anterograde amnesia is often the most sensitive indicator of injury. * **Wernicke-Korsakoff Syndrome:** Another high-yield condition where anterograde amnesia is the prominent feature due to thiamine deficiency.

Q: A 16-year-old girl who was sexually abused has no recollection of the event and is unable to remember anything despite her best efforts. What is the diagnosis?

Dissociative amnesia. **Explanation:** The correct diagnosis is **Dissociative Amnesia**. This condition is characterized by an inability to recall important autobiographical information, usually of a traumatic or stressful nature (such as sexual abuse), that is inconsistent with ordinary forgetting. **Why Dissociative Amnesia is correct:** In this case, the patient has experienced a severe psychological trauma. The memory loss is a defense mechanism where the mind "walls off" the traumatic event to protect the individual from overwhelming emotional distress. The patient is genuinely unable to remember despite making an effort, which is a hallmark of the disorder. **Why the other options are incorrect:** * **Dementia:** This involves a chronic, progressive decline in multiple cognitive domains (memory, executive function, language) due to neurodegenerative changes, not a sudden loss of specific traumatic memories in a young patient. * **Factitious Disorder:** The patient intentionally produces or feigns symptoms to assume the "sick role" without external incentives. There is no evidence here that the patient is faking. * **Malingering:** This involves the intentional production of false or exaggerated symptoms motivated by external incentives (e.g., avoiding legal trouble or obtaining drugs). The prompt states she is trying her "best efforts" to remember, ruling out intentional deception. **High-Yield Clinical Pearls for NEET-PG:** * **Localized Amnesia:** The most common type; failure to recall events during a specific period (e.g., the hours surrounding the abuse). * **Dissociative Fugue:** A subtype of dissociative amnesia involving sudden, unexpected travel away from home accompanied by an inability to recall one's past or identity. * **Treatment:** The primary treatment is psychotherapy (Cognitive Behavioral Therapy); hypnosis or "Amobarbital interviews" are sometimes used to recover lost memories.

Q: A 33-year-old person is found wandering in a new city. His identification indicates he is from out of town and has been missing from home for two days. He is well-groomed and denies remembering how he arrived at his current location. What is the most likely diagnosis?

Dissociative fugue. **Explanation:** The correct diagnosis is **Dissociative Fugue**, a subtype of dissociative amnesia characterized by sudden, unexpected travel away from home or one’s customary place of daily activities, accompanied by an inability to recall some or all of one’s past. **Why Dissociative Fugue is correct:** The patient exhibits the classic triad: **sudden travel** (wandering in a new city), **amnesia** for the journey/past, and a **well-groomed appearance** (indicating intact self-care and social functioning, unlike delirium or dementia). In a fugue state, the individual often appears "normal" to observers but cannot explain their presence in a new location. **Why other options are incorrect:** * **Dementia:** Typically involves chronic, progressive cognitive decline (memory, language, executive function). A 33-year-old being well-groomed and having sudden-onset wandering without global cognitive deficits makes this unlikely. * **Dissociative Amnesia:** While fugue is a subtype, "Dissociative Amnesia" usually refers to the inability to recall specific traumatic information without the component of purposeful travel. * **Schizophrenia:** Characterized by psychosis (hallucinations, delusions) and disorganized behavior. The patient’s well-groomed state and specific memory deficit regarding travel do not fit the profile of a disorganized or catatonic schizophrenic episode. **Clinical Pearls for NEET-PG:** * **ICD-10 vs. DSM-5:** In DSM-5, Dissociative Fugue is no longer a separate diagnosis but a **specifier** under Dissociative Amnesia. * **Trigger:** Often precipitated by severe psychosocial stress (e.g., marital, financial, or wartime trauma). * **Recovery:** Usually rapid and spontaneous; however, the patient may remain amnestic for the events that occurred *during* the fugue state.

Q: Post-traumatic stress disorder is characterized by all of the following EXCEPT?

Numbing of reflexes. **Explanation:** Post-traumatic stress disorder (PTSD) is a psychiatric disorder that occurs in people who have experienced or witnessed a traumatic event. According to the ICD-10 and DSM-5 criteria, the clinical features are categorized into specific clusters. **Why "Numbing of reflexes" is the correct answer:** In PTSD, patients experience **emotional numbing** (diminished interest in activities or feeling detached from others), but there is no such clinical feature as "numbing of reflexes." In fact, the physiological state in PTSD is one of **hyper-responsiveness**. Patients typically exhibit an **exaggerated startle reflex** rather than a numbed one. **Analysis of Incorrect Options:** * **A. Flashbacks:** These are a hallmark of the "Re-experiencing" cluster. Patients have intrusive, vivid memories where they feel as if the trauma is recurring in the present. * **B. Avoidance behavior:** Patients actively avoid people, places, or thoughts that serve as reminders of the traumatic event to prevent psychological distress. * **C. Increased arousal:** This includes symptoms of autonomic hyperactivity such as insomnia, irritability, hypervigilance, and an exaggerated startle response. **High-Yield Clinical Pearls for NEET-PG:** * **Duration:** For a diagnosis of PTSD, symptoms must persist for **more than 1 month**. If symptoms last less than 1 month, the diagnosis is **Acute Stress Disorder**. * **First-line Treatment:** Selective Serotonin Reuptake Inhibitors (**SSRIs**) like Sertraline or Paroxetine are the drugs of choice. * **Prazosin:** An alpha-1 blocker often used specifically to treat trauma-related **nightmares** in PTSD. * **Psychotherapy:** Trauma-focused Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) are highly effective.

Q: A young male, victim of an earthquake a few months prior, presented with recurrent and intrusive recollections of the events and thoughts, accompanied by anxiety that significantly disturbed his routine life. What is the likely diagnosis?

Post-traumatic stress disorder. ### Explanation **Correct Option: A. Post-traumatic stress disorder (PTSD)** The clinical presentation perfectly aligns with the diagnostic criteria for PTSD. The patient has experienced a catastrophic event (earthquake) followed by a triad of symptoms: 1. **Intrusive symptoms:** Recurrent, involuntary, and distressing memories or flashbacks. 2. **Hyperarousal/Anxiety:** Significant distress that interferes with daily functioning. 3. **Duration:** The symptoms have persisted for "a few months." According to DSM-5 and ICD-11, if symptoms last for **more than one month** following a trauma, the diagnosis is PTSD. (If symptoms last <1 month, it is termed Acute Stress Disorder). **Why other options are incorrect:** * **B. Obsessive Compulsive Disorder (OCD):** While OCD involves intrusive thoughts (obsessions), they are typically ego-dystonic, repetitive rituals or mental acts not necessarily linked to a specific life-threatening external trauma. * **C. Paranoid Schizophrenia:** This is characterized by fixed false beliefs (delusions) and hallucinations (usually auditory) lasting at least 6 months, without a necessary link to a traumatic event. * **D. Delusional Disorder:** This involves one or more non-bizarre or bizarre delusions for at least one month, without the intrusive re-experiencing or trauma history seen here. **High-Yield Clinical Pearls for NEET-PG:** * **Timeframe is Key:** * 4 weeks: PTSD. * **First-line Treatment:** Trauma-focused Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR). * **First-line Pharmacotherapy:** SSRIs (Sertraline and Paroxetine are FDA-approved). * **Prazosin:** Often used specifically to treat trauma-related nightmares in PTSD patients.

Question 1

A group of four teenagers were involved in a car accident, resulting in the deaths of three individuals on the spot. The surviving girl was admitted to the ICU for three months. Following her discharge, she frequently wakes up at night in a terrified state, reporting recurring dreams of the event and an ongoing fear of cars. What is the most likely diagnosis?

Accepted Answer

Post-traumatic stress disorder

Answer

Anxiety disorder

Answer

Phobia

Answer

Conversion disorder

Question 2

What is dissociative fugue?

Accepted Answer

Sudden flight from an immediate life situation

Answer

Sudden onset of paralysis

Answer

Fear of a specified object

Answer

Presence of multiple identities

Question 3

A lady, following a severe car accident requiring 6 months of ICU admission, now experiences terror and fear at night and is afraid to sit in a car. What is the most likely diagnosis?

Accepted Answer

Post-traumatic stress disorder

Answer

Anxiety disorder

Answer

Phobia

Answer

Conversion disorder

Question 4

A person experiencing multiple distinct personalities is most likely suffering from which of the following conditions?

Accepted Answer

Dissociative disorder

Answer

Mania

Answer

Personality disorder

Answer

Paranoid schizophrenia

Question 5

What is the characteristic type of amnesia seen following a traumatic brain injury?

Accepted Answer

Anterograde amnesia

Answer

Retrograde amnesia

Answer

Remote amnesia

Answer

All are true

Question 6

A 16-year-old girl who was sexually abused has no recollection of the event and is unable to remember anything despite her best efforts. What is the diagnosis?

Accepted Answer

Dissociative amnesia

Answer

Dementia

Answer

Factitious disorder

Answer

Malingering

Question 7

A 33-year-old person is found wandering in a new city. His identification indicates he is from out of town and has been missing from home for two days. He is well-groomed and denies remembering how he arrived at his current location. What is the most likely diagnosis?

Accepted Answer

Dissociative fugue

Answer

Dementia

Answer

Dissociative amnesia

Answer

Schizophrenia

Question 8

Post-traumatic stress disorder is characterized by all of the following EXCEPT?

Accepted Answer

Numbing of reflexes

Answer

Flashbacks

Answer

Avoidance behavior

Answer

Increased arousal

Question 9

A young male, victim of an earthquake a few months prior, presented with recurrent and intrusive recollections of the events and thoughts, accompanied by anxiety that significantly disturbed his routine life. What is the likely diagnosis?

Accepted Answer

Post-traumatic stress disorder

Answer

Obsessive compulsive disorder

Answer

Paranoid schizophrenia

Answer

Delusional disorder

Question 10

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?

Accepted Answer

Adjustment disorder

Answer

Depression

Answer

Psychogenic headache

Answer

Somatization disorder

Trauma and Stress-Related Disorders — MCQs

Trauma and Stress-Related Disorders — MCQs

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