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Psychiatry Question Bank – 65 Multiple Choice Questions on “Stress Related Disorders”

1. Hypochondriasis is:

A. Normal preoccupation with abnormal body function

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B. Abnormal preoccupation with abnormal body functions

C. Normal preoccupation with normal body functions

D. Abnormal preoccupation with normal body functions Somatoform disorder are divided into:

1. Somatization disorder.

2. Hypochondriacal disorder.

3. Somatoform autonomic disorder.

4. Persistent somatoform pain disorder.

5. Other somatoform disorders

i. Neurasthenia

ii. Depersonalization

6. Somatoform disorder unspecified

2. Psychosomatic illness can be differentiated from hysteria by: ­

A. Autonomic disturbance

B. Altered sensorium

C. Involuntary movement

D. Skeletal muscle atrophy

3. The significant difference between malingering and hys­teria is:

A. Conscious motive in malingering

B. Hysteria is more common in females

C. Malingering has a poor prognosis

D. Hypnosis

4. Abnormal thought possession is a feature of:

A. Organic brain syndrome

B. Obsessive-compulsive disorder

C. Hysteria

D. Neurasthenia

5. All the following are true about obsessive-compulsive disorder, except:

A. Ego-alien

B. Patient tries to resist it

C. Ego-syntonic

D. Insight is present

Obsession is defined as:

1. An idea, impulse/image which introduces into conscious awareness repeatedly.

2. Recognized as one’s own idea, impulse or image but is ego-alien (foreign to one’s personality)

3. Recognized as absurd and irrational

4. Patient tries to resist but unable to do so.

5. Failure to resist, leads to marked distress.

(Note: Delusion is recognized as one’s own idea but is not recognized as ego-alien)

Compulsions are defined as:

1. Behavior that follows obsession.

2. Behavior aimed at preventing/neutralizing the distress/fear aiming out of obsession.

3. Unrealistic, excessive, or irrational behaviors.

4. Insight being present, subject realizes the irrationality of compulsion.

5. Behavior is performed with a sense of compulsion (urge or impulse to act).

6. The drug of choice in obsessive-compulsive neurosis is:

A. Clomipramine

B. Clonazepam

C. Carbamazepine

D. Chlorpromazine

Clomipramine (75-300mg/d) is particularly effective in treatment of OCD.

7. Dissociated disorder is seen in all the following, except:

A. Personality

B. Hearing

C. Fugue

D. Amnesia

Dissociative amnesia

Fugue

Stupor

Trance/possession disorder

Motor disorder

Convulsions

Anesthesia and sensory loss

Mixed

Other dissociative disorders

Unspecified

8. Treatment of choice for phobic disorder is:

A. Behaviour therapy

B. Benzodiazepine

C. Psychotherapy

D. 5-HT re-uptake inhibitors

1. Psychodynamically oriented psychotherapy with supportive psychotherapy

2. Behaviour therapy

SSRI are found to be very effective in social phobia Defense mechanism that operates’ in phobia include:

1. Repression.

2. When regression fails to function adequately to allay anxiety, displacement occurs:

3. Avoidance.

9. A young female presents with halos, abdominal pain, and amnesia. She has:

A. Conversion reaction

B. Dissociation disorder

C. Depersonalization disorder

D. Psychogenic pain disorder

10. Post-traumatic stress syndrome is due to:

A. Head injury

B. Minor stress

C. Major life-threatening events

D. Vascular accidents

11. Phobia is:

A. Psychosis

B. Fear of animals

C. Anxiety

D. Abnormal irritation

12. Kleptomania means:

A. Irresistible desire to steal things

B. Irresistible desire to drink

C. To dress as the opposite sex

D. To set fire

Habit and impulse disorder:

1. Pathological gambling

2. Pyromania (pathological fire settling)

3. Kleptomania (pathological stealing)

4. Trichotillomania (compulsive-hair pulling)

5. Intermittent explosive disorder

13. A women suffers minor injuries in a car accident which leaves the driver of the car dead. Six months after the accident, she still feels afraid of cars and avoids travel­ing in them. The diagnosis is:

A. Post-traumatic stress syndrome

B. Traveling phobia

C. Delusion disorders

D. Schizophrenia

Diagnostic criteria (DSM IV) for PTSD include:

1. Person exposed to traumatic event (stressor)

2. Traumatic event-persistently re-experienced

3. Avoidance of stimuli

4. Symptoms of increased arousal

Duration of disturbance (2, 3, and 4) is more than l month. Acute-if duration of symptoms 3 months. Delayed onset – if onset of symptoms at least 6 months after the stressor. Eponyms in various US wars:

1. Civil war – irritable heart

2. World war I – effort syndrome

3. World war II – combat stress reaction

4. Vietnam War – PTSD

5. Gulf war – Gulf war syndrome

Acute stress disorder – the disturbance lasts for a minimum of 2 days and a maximum of 4 weeks and occurs within 4 weeks of traumatic event.

14. Preoccupation with body disease is seen in:

A. Obsession

B. Somatization

C. Hypochondriasis

D. Conversion disorders (Somatoform disorder)

Treatment,

1. Supportive psychotherapy

2. Treatment of associated or underlying depression or anxiety, if present.

15. Women complain that she feels like abusing God and slapping a man. The thought persists in spite of her not wanting to do so. The diagnosis is:

A. Obsessive-compulsive neurosis

B. Somatization

C. Hypochondriasis

D. Conversion disorder

To see the criteria for diagnosis of OCD

16. A 40-year-old female has an accident while traveling in a bus. She sustains pelvis and has to remain in hospital for a long time. Now she refuses to sit in a bus. She is suffering from:

A. Post-traumatic stress syndrome

B. Anxiety neurosis

C. Conversion disorder

D. Phobia

17. A person missing from home is found wandering pur­posefully, in a well groomed state with some degree of amnesia. This condition is known as:

A. Dissociative fugue

B. Dissociative amnesia

C. Schizophrenia

D. Acute anxiety

Dissociative amnesia – commonest clinical type of dissociative disorder occurring mostly in adolescents and young adults (females more than males) – This is characterized by a sudden inability to recall personal information, particularly concerning stressful or traumatic life events. Dissociative fugue – episodes of wandering away (from home) adopts a new identity with complete amnesia for the earlier life.

Differential diagnosis is complex partial seizure or temporal lobe epilepsy.

18. A female has the fixed idea which is not shared by any­one else that her nose is ugly. The next step is:

A. Investigate and then operate

B. Refer to psychiatrist

C. Reassure and send home

D. Do plastic surgery immediately

Body dysmorphic disorder/dysmorphophobia (somatoform disorder).

19. A patient suffers sudden palpitations, apprehension, and sweating lasting 10 minutes. The diagnosis is:

A. Hysteria

B. Cystic fibrosis

C. Panic attack

D. Acute anxiety attack

Discrete episodes of acute anxiety with crescendo decrescendo patterns

Most important differential diagnosis.

Mitral valve prolapse syndrome

20. 27-year-old Rekha presents with a history of eating vora­ciously, taking laxatives, and then eating more and more repeatedly. The most likely diagnosis is:

A. Bulimia nervosa

B. Anorexia nervosa

C. Single eating disorder

D. Schizophrenia

Treatment for bulimia nervosa and anorexia is

1. Behaviour therapy

21. Prakash Chandra, a 42-year-old man, complains of non­-progressive headache for 5 years. He has visited sev­eral neurosurgeons and undergone clinical and labora­tory investigations for a brain tumor, which are nega­tive. The patient is not convinced and believes that he has a tumor for which he wants to undergo surgery. He is then referred to a psychiatrist. The most likely diagno­sis is:

A. Hypochondriasis

B. Somatization disorder

C. Somatoform pain disorder

D. Conversion disorder

22. All of the following are impulse control disorders except:

A. Pyromania

B. Trichotillomania

C. Kleptomania

D. Cap grass syndrome

Pathological gambling is an impulse control disorder.

23. A 41-year-old married female presented with headache for the last 6 month. She has several consultations. All her investigations were found to be within normal limits. She still insists that there is something wrong in her head and seeks another consultation. The most likely diagno­sis is:

A. Phobia

B. Psychogenic headache

C. Hypochondriasis

D. Depression

It is grouped under persistent somatoform pain disorder where in doctor – shopping is common.

24. A 15-year-old boy feels that the dirt has hung onto him whenever he passes through the dirty street, this repeti­tive though causes much distress and anxiety. He known that there is actually no such thing after he has cleaned once but he is not satisfied and is compelled to think so. This has led to social withdrawal. He spends much of his time in thinking about the direct and contamination. This has affected his studies also. The most likely diag­nosis is:

A. Obsessive-compulsive disorder

B. Conduct disorder

C. Agoraphobia

D. Adjustment disorder

25. Dissociation is seen in:

A. Schizophrenia

B. Mania

C. Hysteria

D. Organic brain syndrome

26. Treatment of choice in phobic neurosis is:

A. Group therapy

B. Free association

C. Behaviour therapy

D. ECT

Behaviors therapy is usually planned. Important techniques are:

i. Flooding

ii. Systematic desensitization

iii. Exposure and response prevention

iv. Relaxation techniques.

27. Obsessive-compulsive neurosis occurs because of fixa­tion at:

A. Oral stage

B. Anal stage

C. Genital (urethral) stage

D. None of the above

28. Phobia is a type of:

A. Personality disorder

B. Conversion reaction

C. Psychosis

D. Neurosis

29. Impulsive action includes all, except:

A. Pyromania

B. Kleptomania

C. Dipsomania

D. Trichotillomania

Habit and impulse disorders include pathological gambling, pyromania, kleptomania, trichotillomania, and intermittent explosive disorder. The disorders in this heterogeneous group are characterized by impulsive behavior which the patient cannot resist or control. There may be a feeling or release of tension by doing the act and a feeling of guilt after the act is over.

Dipsomania is compulsive drinking.

30. Which of the following is associated with sudden attacks of anxiety with fear? (TN-94, Pg-92, NA-5th edn)

A. Phobia

B. Mania

C. Neurosis

D. Panic disorder

Panic disorder is characterized by discrete episodes of acute anxiety. Attacks occur recurrently every few days. There may or may not be an underlying generalized anxiety disorder. Onset is usually in the early third decade with often a chronic course. Episode is usually sudden in onset, lasts for a few minutes and is characterized by very severe anxiety. Usually there is an apparent precipitating factor.

31. ‘Fugue state’ occurs in the following:

A. Hysteria

B. Mania

C. Depression

D. Head injury

Dissociative fugue occurs in hysteria and is characterized by episodes of wandering away (usually from home). During the episode, person usually adopts a new identity with complete amnesia for earlier life. Onset is usually sudden, often in the presence of severe stress. Termination is abrupt and is followed by amnesia for the episode, but with recovery of memories of earlier life. Characteristic feature is the assumption of a purposeful new identity with absence of awareness of amnesia. Important differential diagnoses are complex partial seizures or temporal lobe epilepsy.

32. One of the following is a “Factitious disorder”:

A. Hysteria

B. Depression

C. Hypochondriac

D. Munchausen’s syndrome

Munchausen’s syndrome is a factitious disorder used for those patients who repeatedly simulate or fake diseases for the sole purpose of obtaining medical attention. There is no other recognizable motive. Other names are hospital addiction, hospital hoboes, professional patients, etc.

Whereas hypochondriac is a form of disorder, defined as a persistent preoccupation with a fear or belief of having one of more serious diseases. This is based on person’s own interpretation of normal body function or a minor physical abnormality.

33. Agoraphobia is fear of:

A. Open spaces

B. Closed spaces

C. Heights

D. Darkness

Agoraphobia is a type of phobic disorder. Phobia is an irrational fear of a specific object, intuition, or activity often leading to persistent avoidance of the feared object, situation, or activity.

Common types of phobia are:

1. Agoraphobia,

2. Social phobia,

3. Specific (simple) phobia.

Agoraphobia is an irrational fear of situation, open spaces, and being in places away from the familiar setting of home. It is the common type of phobia and women exceed men in incidence. Social phobia is an irrational fear of activities or social interaction, characterized by an irrational fear of performing activities in the presence of other people or interacting with others.

In specific phobia, the stimulus is usually circumscribed, e.g. acrophobia – fear of high places, zoophobia – fear of animals, xenophobia – fear of strangers, algophobia – fear of pain, claustrophobia – fear of closed places.

Treatment (i) Supportive psychotherapy (ii) behaviour therapy like flooding, systematic desensitization, exposure and response prevention and relaxation techniques (iii) Drug treatment – BZDS (alprazolam), antidepressants (imipramine, phenelzine, SSRI for social phobias).

34. The drug of choice for obsessive compulsion is:

A. Amphetamine

B. Diazepam

C. Clomipramine

D. Chlorpromazine

Drug treatment for OCD includes:

(i) Benzodiazepines (alprazolam)

(ii) Antidepressants like SSRI’s, clomipramine (1st drug of choice), florentine (2nd drug of choice)

(iii) Antipsychotic like haloperidol

(iv) Buspirone, Clonazepam

Other modalities of treatment include:

II Psychotherapy – psychoanalytic psychotherapy and supportive psychotherapy

III Behavior therapy – thought stopping, response prevention, systematic desensitization, modeling

IV ECT

V Psycho surgery – Steriotactic limbic lobotomy, Steriotactic sub caudate taxonomy.

35. Dissociative conversion disorder was previously de­scribed as:

A. Dementia praecox

B. Hypochondriasis

C. Hysteria

D. Melancholia

The term hysteria previously used is now replaced by conversion, dissociation, and somatization disorder.

36. ‘Flashback’ is the characteristic feature of:

A. Grief reaction

B. Postnatal depression

C. Hypomania

D. Post traumatic stress disorder.

PTSD arises as a delayed and protracted response to an exceptionally stressful or catastrophe life event or situation which is likely to cause pervasive distress in almost any person. Symptoms develop often a period of laden of, within 6 months after the stress or may be delayed beyond this period. PTSD is characterized by recurrent and intrusive recollections of the stressful event either in flashbacks (images, thought, perceptions) and/or in dreams.

There is an associate sense of re-experiencing the stressful event or situations that arouse recollections of the stressful event, along with marked symptoms of anxiety and increased around, they also have partial amnesia for some aspects of the stressful event, feeling of numbness, anaerobia. Treatment-prevention, disaster management, supportive psychotherapy, antidepressants, and benzodiazepines.

37. Munchausen’s syndrome by proxy is:

A. Factitious disorder

B. Malingering

C. Hysteria

D. Convention disorder

It is different from malingering in that there is no recognizable motive.

38. Acrophobia means:

A. Fear of God

B. Fear of vehicles

C. Fear of height

D. Fear of open spaces

Other phobias:

Xenophobia – Fear of Strangers

Zoophobia – Fear of animals

Algophobia – Fear of pain

Claustrophobia – Fear of closed places

Ailurophobia – Fear of cats

39. Epileptic fit and hysterical fit can be certainly differenti­ated by:

A. Incontinence of urine

B. Injury during fit

C. Frothing from mouth

D. Duration of fit

Remember – Video EEG is the Gold standard investigation that helps to differentiate epileptic fits and hysterical fits.

40. An uncommon hysterical symptom includes:

A. Blindness

B. Palpitation

C. Hiccough

D. Vomiting

Autonomic nervous system is not involved unless voluntary musculature is involved.

41. Impulsive acts include all the following except:

A. Dipsomania

B. Trichotillomania

C. Pyromania

D. Kleptomania Impulse control disorder:

Pathological

Pyromania

Kleptomania

Trichotillomania

In these disorders:

Patients cannot reins

Release of tension by ding the act

Feeling of remove after the act

42. Systematic desensitization is used in the treatment of:

A. Obsessive-compulsive disorder

B. Depression

C. Phobia

D. Anxiety neurosis

i. Systematic desensitization works on the principle of reciprocal inhibitor.

ii.. It is the treatment of choice for phobia.

43. Defense mechanism adopted in obsessive-compulsive neurosis includes:

A. Isolation

B. Dissociation

C. Identification

D. Displacement

Other defenses used – undoing, reaction formation.

44. Obsessive-compulsive neurosis is:

A. Repeated occurrence of unwelcome thoughts followed by irresistible desire to do the act

B. Occurrence of pleasant thoughts followed by irresistible acts

C. False unshakeable thoughts against sociocultural background

D. Excessive irrational fear of ideas, objects, or situations

45. Agoraphobia is:

A. Fear of animals

B. Fear of closed space

C. Fear of height

D. Fear of open place

It is the commonest phobia.

46. Claustrophobia is fear of:

A. Height

B. Open spaces

C. Lizards

D. Closed spaces

47. Fixation of hysteria is

A. Anal

B. Gametal

C. Oral

D. Phallic

48. Obsessive-compulsive neurosis features include all except:

A. Sense of guilt

B. Anxiety relieved by an act

C. Patient is aware of helplessness-

D. Magical thought

49. Hysterical neurosis is characterized by:

A. Conscious motive

B. Premorbid dysthymic personality

C. Rapid change in symptoms

D. Primary and secondary gain

50. A man with type-A personality with competitiveness, time bound and tense is susceptive to:

A. Bowel irritability

B. Coronary heart disease

C. Hypertension

D. Acid peptic disease

Term type-A behaviour was coined by Friedman and Rosenman.

51. Bulimia nervosa is associated with all except:

A. Intermittent dieting

B. Repeated vomiting

C. Score weight loss

D. Use of cathartic and diuretics

52. Hysterical abdominal pain is associated with all, expect:

A. Long duration

B. Food intake

C. Night pains

D. Nausea and vomiting

53. All are features of bulimia nervosa, except:

A. Metabolic alkalosis

B. Caries tooth

C. Parotitis

D. Oligomenorrhea

54. The classic psychosomatic illness include all of the fol­lowing, except:

A. Essential hypertension

B. Rheumatoid arthritis

C. Hyperventilation

D. Bronchial asthma

Classic psychosomatic illness is: Bronchial asthma, ulcerative colitis, peptic ulcer, neurodermatitis, thyrotoxicosis, rheumatoid arthritis, and essential hypertension.

55. Kleptomania is a:

A. Delusion

B. Hallucination

C. Impulse

D. Illusion

Kleptomania, pathological gambling, pyromania and trichotillomania are habit and impulse disorders.

56. The most common complication of obsessive-compulsive neurosis is:

A. Depression

B. Persecutory delusion

C. Dissociation of symptoms

D. Mania

At least 50 percent of patients of OCD have depressive episodes.

57. Which of the following is a dissociative phenomenon?

A. Fugue

B. Deafness

C. Amnesia

D. Loss of insight

E. Both a and c

Types of Dissociative disorders – sensory loss, motor, Amnesia, Fugue, identity disorder, trance and Possession.

58. The transmitter involved in obsessive-compulsive disor­der is:

A. Norepinephrine

B. Serotonin

C. Dopamine

D. GABA Serotonin is involved in OCD.

59. All the following are true for conversion reaction, except:

A. Secondary gain

B. Onset is late

C. Patient does not consciously produce signs and symptoms

D. Symbolic relationship with stress

Usually symptoms have a sudden onset.

60. A man visits a temple and feels like abusing God. He tries to resist but fails and feels very disturbed. He is suffering from:

A. Anxiety

B. Schizophrenia

C. OCD

D. Paranoid personality disorder

In this case pt has recurrent impulses to abuse God and though he recognizes it as irrational, cannot resist it.

61. A young man gets nervous and complains of palpitation and sweating when he meets his seniors or makes presen­tations during meetings. He is most likely suffering from:

A. Panic disorder

B. Social phobia

C. Adjustment disorders

D. Personality disorder

In social phobia, there is an irrational fear of performing activities in front of others.

62. Lilawati, a 25-year-old female, complains of sudden pal­pitation, sweating, sensation of impending doom, and constriction in her chest. This lasts for about 10-15 min­utes after which she becomes all right. The most weekly diagnosis is:

A. Panic attack

B. Generalized anxiety disorder

C. Phonic disorder

D. Impulse control disorder

63. A person wakes up in the night repeatedly remembering the scene of an earthquake which happened a few days back in which he survived, but most of his near and dear friends expired. He is suffering from:

A. Post-traumatic stress disorder

B. Schizophrenia

C. Depression

D. Delusions

64. Which of the following is a characteristic of hysteria?

A. Molar deficit

B. Indifference to symptoms

C. Suicidal attempts

D. Alertness

65. Psychogenic amnesia is characterized by:

A. Retrograde amnesia

B. Anterograde amnesia

C. Confabulation

D. Patchy impairment of personal memories.

Answer

1.D 2.A 3.A 4.B 5.C 6.A 7.B 8.A 9.B 10.C 11.C 12.A 13.A 14.C 15.A 16.A 17.A 18.B 19.C 20.A 21.A 22.D 23.B 24.A 25.C 26.C 27.B 28.A 29.C 30.D 31.A32.D 33.A 34.C35.C 36.D 37.A 38.C 39.A 40.B 41.A 42.C 43.A 44.A 45.D 46.D 47.D 48.D 49.D 50.B 51.C 52.C 53.D 54.C 55.C 56.A 57.E 58.B 59.B 60.C 61.B 62.A 63.A 64.B 65.D

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