Trauma and Stress-Related Disorders Practice Questions

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 40-year-old woman is unable to recall important personal information following a stressful event, with no evidence of neurological disorder. What is the most likely diagnosis?

Dissociative amnesia. ***Dissociative amnesia*** - This condition involves an inability to recall important **personal information**, usually following a **traumatic** or **stressful event**, which aligns with the patient's presentation. - The inability to recall personal information without a clear neurological cause is a **hallmark feature** of dissociative amnesia. - The memory loss is typically **reversible** and related to psychological stress rather than organic brain pathology. *Schizophrenia* - Characterized by **psychotic symptoms** such as **hallucinations**, **delusions**, and disorganized thought, which are not described in the patient's symptoms. - While cognitive deficits can occur, the primary feature is **not selective amnesia** for personal information related to stress. *Borderline personality disorder* - Involves patterns of **instability** in relationships, self-image, affects, and **impulsivity**, often with fear of abandonment. - Although it can include transient, stress-related **dissociative symptoms**, the primary presentation is not amnesia for personal information as the sole presenting feature. *Depersonalization/derealization disorder* - Characterized by persistent or recurrent experiences of feeling **detached** from one's body or mental processes (**depersonalization**) and/or feeling detached from one's surroundings (**derealization**). - The core feature is the **sense of detachment**, not the **inability to recall personal information**, which is the prominent symptom in this case.

Q: A 35-year-old woman reports episodes of depersonalization and derealization, feeling detached from her thoughts and surroundings. These episodes are triggered by stress and last for hours. What is the most likely diagnosis?

Depersonalization/derealization disorder. ***Depersonalization/derealization disorder*** - This disorder is characterized by persistent or recurrent episodes of **depersonalization** (feeling detached from oneself) and/or **derealization** (feeling detached from one's surroundings). - The symptoms described—feeling detached from thoughts and surroundings, triggered by stress, and lasting for hours—are classic presentations of this condition. *Dissociative amnesia* - This condition primarily involves an inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetting. - While stress is a trigger, the core symptom is **memory loss**, not detachment from self or reality. *Panic disorder* - Characterized by recurrent, unexpected **panic attacks** which are intense episodes of fear accompanied by physical symptoms like heart palpitations, shortness of breath, and chest pain. - Although panic attacks can sometimes include feelings of derealization, this is not the primary or sole symptom, and the episodes of detachment are typically much briefer than several hours. *Schizotypal personality disorder* - This disorder involves a pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships, as well as by cognitive or perceptual distortions and eccentricities of behavior. - While it can involve **perceptual distortions** and unusual beliefs, **depersonalization** and **derealization** are not the central or defining features of this disorder, which is more about eccentric behaviors and thought patterns.

Q: A patient presents with recurrent nightmares and flashbacks for the past 3 months following a traumatic event. What is the most likely diagnosis?

Post-traumatic stress disorder. ***Post-traumatic stress disorder*** - **Recurrent nightmares** and **flashbacks** are hallmark re-experiencing symptoms of **PTSD**, directly linked to a prior traumatic event. - The diagnosis typically requires symptoms to persist for **more than one month** following the trauma. *Generalized anxiety disorder* - Characterized by **persistent and excessive worry** about various events or activities, not specifically tied to a past trauma. - While anxiety is present, the symptom profile does not include specific re-experiencing phenomena like flashbacks. *Panic disorder* - Involves **recurrent unexpected panic attacks**, which are sudden episodes of intense fear accompanied by physical symptoms. - It does not primarily manifest with recurrent nightmares or flashbacks as core diagnostic features. *Acute stress disorder* - Shares similar symptoms with PTSD, including flashbacks and nightmares, but symptoms occur within **one month of the trauma** and resolve within that timeframe. - If symptoms persist beyond one month, the diagnosis typically shifts to PTSD.

Q: A 35-year-old man is unable to recall events from the past week following a traumatic accident. What is the most likely diagnosis?

Dissociative Amnesia. ***Dissociative Amnesia*** - **Inability to recall important autobiographical information** (entire past week) following a traumatic event is the hallmark of dissociative amnesia - The memory loss is **localized** (covering a specific time period around the trauma) and **inconsistent with ordinary forgetting** - Traumatic accidents are classic precipitating events that trigger this reversible memory impairment - **No other prominent symptoms** are mentioned (no re-experiencing, hyperarousal, or motor/sensory deficits), making this the most precise diagnosis *Incorrect: Post-Traumatic Stress Disorder (PTSD)* - PTSD requires **intrusive re-experiencing symptoms** (flashbacks, nightmares), avoidance behaviors, negative mood alterations, and hyperarousal - Memory disturbances in PTSD are typically **fragmented or patchy** (inability to recall specific traumatic details), not complete amnesia for an entire week - The clinical picture would be more complex than isolated memory loss *Incorrect: Acute Stress Disorder* - ASD occurs within **3 days to 1 month** post-trauma and requires **9 symptoms from 5 categories**: intrusion, negative mood, dissociation, avoidance, and arousal - While dissociative amnesia can be present, ASD diagnosis requires a **broader symptom constellation** beyond isolated memory loss - The question stem describes only amnesia without other ASD features *Incorrect: Conversion Disorder (Functional Neurological Symptom Disorder)* - Presents with **motor or sensory neurological symptoms** (paralysis, blindness, seizures, abnormal movements) incompatible with medical conditions - **Memory loss is not a feature** of conversion disorder; it involves pseudo-neurological deficits - Would expect physical examination findings suggesting neurological dysfunction

Question 1

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 2

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 3

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 4

All are stages of grief, except:

Accepted Answer

Agitation

Answer

Bargaining

Answer

Anger

Answer

Denial

Question 5

Elisabeth Kübler-Ross proposed five stages of:

Accepted Answer

Grief

Answer

Delusion

Answer

Schizophrenia

Answer

None of the options

Question 6

General adaptation syndrome is seen in:

Accepted Answer

Stressful situations

Answer

Panic attacks

Answer

Depression

Answer

Anxiety

Question 7

A 40-year-old woman is unable to recall important personal information following a stressful event, with no evidence of neurological disorder. What is the most likely diagnosis?

Accepted Answer

Dissociative amnesia

Answer

Schizophrenia

Answer

Borderline personality disorder

Answer

Depersonalization/derealization disorder

Question 8

A 35-year-old woman reports episodes of depersonalization and derealization, feeling detached from her thoughts and surroundings. These episodes are triggered by stress and last for hours. What is the most likely diagnosis?

Accepted Answer

Depersonalization/derealization disorder

Answer

Dissociative amnesia

Answer

Panic disorder

Answer

Schizotypal personality disorder

Question 9

A patient presents with recurrent nightmares and flashbacks for the past 3 months following a traumatic event. What is the most likely diagnosis?

Accepted Answer

Post-traumatic stress disorder

Answer

Generalized anxiety disorder

Answer

Panic disorder

Answer

Acute stress disorder

Question 10

A 35-year-old man is unable to recall events from the past week following a traumatic accident. What is the most likely diagnosis?

Accepted Answer

Dissociative Amnesia

Answer

Post-Traumatic Stress Disorder (PTSD)

Answer

Acute Stress Disorder

Answer

Conversion Disorder (Functional Neurological Symptom Disorder)

Trauma and Stress-Related Disorders — MCQs

Trauma and Stress-Related Disorders — MCQs

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