Anxiety and Somatoform MCQs

Dr. Sumit Chandak M.D. (Psy)

Psychiatry Dept, SKNMCGH.

1. Algophobia is dread of

a) Strong light

b) Open places

c) High places

d) Strangers

e) Pain

• A-Strong light- photophobia

• B –Open places - Agarophobia

• C –High places - Acrophobia

• D –Strangers – Xenophobia

• Closed places – claustrophobia

• Animals – Zoophobia

• Death - Thanatophobia

2. All of the following are differential diagnosis of conversion disorder except:

a) Complex partial seizures

b) Somnambulism

c) Schizophrenia

d) Absence seizures

e) Post concussional amnesia

• D

3. Panic disorder is not defined by panic attacks followed by

a) Persistent concern about having more attacks.

b) Worry about implications or consequences of the attack

c) Worsening of sign/ symptoms with anxiolytics

d) Changes in typical behavioural patterns as a result of the attack.

• Age of onset bimodal – 15-19 and 25-30

• Women almost twice more diagnosed than men.

• Chronic course if untreated

• Treatment

– SSRI

– CBT

4. Social phobia is not associated with

a) Fear of behaving in humiliating or embarrassing way in social situation.

b) Person does not recognize that fear is excessive or unreasonable

c) Exposure to feared situation invariably provokes anxiety.

d) Avoidance of social situation interferes significantly with person’s routine.

• Onset middle to late teens

• Women more than female

• Treatment– SSRI

– CBT• Exposure based strategies

• Cognitive therapy

• Social skill training

• Applied relaxation

5. Obsessive – Compulsive Disorder are not associated with

a) recurrent, persistent thoughts which are intrusive and inappropriate

b) Person does not recognize thoughts or impulses as products of his own mind.

c) Repetitive behaviours that the person feels driven to perform in response to obsession.

d) Insight may or may not be present.

• Women slightly more than male

• Age of onset – late adolescent

• Before puberty – streptococcal infection (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections- PANDAS)

• Course of illness waxing-waning

• Symmetry dimension associated with tic disorder.

6. The most common obsession and most common compulsion observed are

a) Contamination, counting

b) Pathological doubt, washing

c) Need for symmetry, checking

d) Contamination, checking

• Obsessions– Fear of contamination– Pathological doubt– A need for symmetry– Aggressive obsessions

• Compulsions– Checking– Washing– Symmetry– Need to ask or confess– Counting

• Children – washing followed by repeating rituals.

7. All of the following statements are true about Post Traumatic Stress Disorder EXCEPT

A) Recall of traumatic events

B) Associated with trauma

C) Avoidance of situation

D) Response to haloperidol

7. Post traumatic stress disorder is not associated with

a) being involved actually or virtually in an event involving death or serious injury.

b) Recurrent, intrusive distressing recollection of event.

c) Sense of reliving the experience, witnessing flashbacks

d) Non-response to cues that symbolize the event

• being involved actually or virtually in an event involving death or serious injury.

• Response to event involved intense fear, helplessness or horror.

• Event re-experienced as– Recurrent, intrusive, distressing recollections– Dreams– Feeling as though event is recurring– Intense distress to exposure to cues– Physiological reactivity to cues

• Persistent avoidance of stimuli– Avoiding thoughts, places associated with event, recall

difficulties about trauma, decreased involvement in activities, emotional detachment.

• Increased arousal– Difficulty sleeping, irritability, anger outbursts, difficulty

concentrating, hypervigilance, exaggerated startle response.

8. Acute stress reaction does not include

a. Response to traumatic event involved intense fear, helplessness or horror.

b. Subjective sense of numbing, detachment.

c. Derealization, depersonalization.

d. Persistent attempt to confront stimuli that arouse recollections of event.

• being involved actually or virtually in an event involving death or serious injury.

• Response to event involved intense fear, helplessness or horror

• Dissociative symptoms– Numbness, detachment, lack of emotional response.– Reduced surrounding awareness– Deralization, depersonalization– Dissociative amnesia

• Event reexperienced as recurrent images, thoughts, dreams, illusions, or flashbacks.

• Avoidance of stimuli that arouse recollections like thoughts, feelings, conversations, activities, places, people.

• Arousal

9. Generalized anxiety disorder is not associated with

a. Excessive anxiety and worry about number of events

b. Feeling excessively energetic

c. Feeling keyed up, restless

d. Muscle tension

• Excessive anxiety and worry about a number of events or activities

• Worry difficult to control• Associated with

– Restlessness, feeling keyed up– Being easily fatigued– Difficulty concentrating, mind going blank– Irritability– Muscle tension– Sleep disturbance

10. Somatoform Disorders does not include

a. Somatization disorder

b. Body dysmorphic disorder

c. Delusional parasitosis

d. Conversion disorder

• Somatization disorder

• Undifferentiated somatoform disorder

• Conversion disorder

• Pain disorder

• Hypochondriasis

• Body Dysmorphic Disorder

• Somatoform Disorder NOS

11. Somatization disorder does not include

a. History of many physical complaints

b. Symptoms required : 4 pain, 2 nonpaingastrointestinal, 1 nonpain sexual or reproductive, 1 pseudoneurological.

c. Onset before the age of 30 years

d. Usually has some secondary gain attached to the illness.

• unconscious production of symptoms –somatoform disorder

• Conscious production of symptoms

– Secondary gain – malingering

– Patient role gain – factitious disorder

12.Treatment goals in somatoform disorder does not include

a. Prevent adoption of sick role, chronic invalidism

b. Minimize unwarranted hospitalizations, diagnostic and treatment procedures.

c. No pharmacological control of comorbidconditions

d. Supportive office visits, scheduled at regular intervals

• Prevent adoption of sick role, chronic invalidism• Minimize unwarranted hospitalizations, diagnostic and treatment

procedures and medications• Pharmacological control of comorbid conditions• Instill whenever possible insight regarding temporal association

between symptoms and personal, interpersonal and situational problems.

• Consistent treatment, generally by same physician.• Establish firm therapeutic alliance• Supportive office visits, scheduled at regular intervals• Psychoeducative approach• Focus gradually shifted from symptoms to personal and social

problems• Avoid drugs with potential for addiction.

13. Treatment for conversion disorder does not include

a. Neglect the symptoms

b. Reassurance

c. Narco-analysis, hypnotherapy, behaviouraltherapy

d. Exploration of conflict areas.

• Prompt removal of symptoms

• Reassurance, suggestion to remove symptom

• Narco-analysis, hypnotherapy, behaviouraltherapy

• Exploration of conflict areas, particularly interpersonal relationships.

14. Hypochondriasis isa. Exaggerated preoccupation with body illness

b. Unrealistic interpretation of physical sensations as abnormal, leading to preoccupation with of having a disease

c. Multiple somatic complaints without organic pathology, presented dramatically

d. Is same as somatization disorder

e. Treatment by showing negative diagnostic examination results.

• Symptoms in hypochondriasis are more limited in range and occur later in life than those of somatization disorder. Treatment is difficult and prognosis is relatively poor. The preoccupation in hypochondriasis is not with body illness but with wrong interpretations of normal body sensations.

15. All are true about somatization disorder except

a. More common in women than in men

b. Tends to run in families

c. Less common in persons with higher education

d. Multiple somatic complaints presented in a dramatic way

e. Onset usually in late thirties

• Disorder with chronic fluctuating course, usually beginning in second decade of life. Anxiety and depression are common associated features.

16. What is the primary gain in hysteria :

a. Manipulation of environment to handle stress

b. Monetary gain

c. Relief from anxiety

d. Sick role

e. None of the above

• The defense mechanisms of conversion and/or dissociation are brought into play to provide relief from the anxiety which is not properly handled by the primary defense mechanism of repression.

• Manipulation of environment to handle stress is usually the secondary gain.

17. Which of the following is true about hysterical fits

a. Incontinence of urine

b. Tongue bit

c. Post ictal confusion

d. Prolonged duration

e. Occurs during sleep

• D

• Other clinical features of hysterical fits include

– Purposive body movements

– Absence of any serious injury

– Avoidant gaze

– Absence of any neurological signs

– Occurrence of fits usually in presence of others

• A, B, C and E - GTCS

18. All are features of anxiety disorders, except

a. Anxiety

b. Restlessness

c. Exhaustion

d. Sympathetic overactivity

e. Tachycardia during sleep

• During sleep, heart rate returns to normal, although throughout the day, there may be tachycardia. Tachycardia during sleep is usually seen in hyperthyroidism.

• All are true about obsessive compulsive disorder except,

a. Symptoms are ego-alien

b. Resistance results in mounting anxiety

c. Patient does not realize the irrationality of his behaviour.

d. Usually chronic

• Patient clearly understands the absurdity of his obsessions and compulsions, but any resistance leads to severe anxiety.