45M with Flashbacks 3 Months Post-MVA – What is the Diagnosis?

🧠 Clinical Psychiatry Quiz

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📋 History

• 45-year-old man
• Witnessed road-traffic accident 3 months ago
• Lost wife and only child
• ICU admission after accident
• Persistent symptoms for 3 months
• Repeated flashbacks
• Severe nightmares
• Sleep disturbance
• Re-experiencing traumatic event

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🩺 Examination

• Hypervigilance
• Emotional numbing
• Exaggerated startle response
• Depressed mood
• Avoidance of trauma-related triggers

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🔬 Investigation

• Psychiatric assessment
• PTSD Checklist (PCL-5)
• Routine blood tests
• Thyroid function test
• Psychological evaluation

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❓ Question

What is the most likely diagnosis?

A. Acute Stress Disorder
B. Post-Traumatic Stress Disorder (PTSD)
C. Major Depressive Disorder
D. Complicated Grief Reaction

✅ Answer: B. Post-Traumatic Stress Disorder (PTSD)

📖 Answer Explanation

PTSD develops after exposure to a traumatic event and persists for more than 1 month. Key features include flashbacks, nightmares, avoidance behavior, hyperarousal, emotional numbing, and sleep disturbance. The duration of 3 months strongly supports PTSD.

❌ Why Not Others?

A. Acute Stress Disorder
Occurs within the first month after trauma.

C. Major Depressive Disorder
May cause insomnia and low mood but does not explain flashbacks and trauma re-experiencing.

D. Complicated Grief Reaction
Characterized by prolonged grief and yearning, not recurrent flashbacks and hypervigilance.

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💎 Clinical Pearls

• PTSD symptoms persist longer than 1 month.
• Flashbacks are highly characteristic.
• Nightmares commonly occur.
• Hypervigilance is a core symptom.
• Avoidance behavior supports diagnosis.
• Emotional numbing may develop.
• Depression commonly coexists.
• Trauma-focused CBT is first-line therapy.
• SSRIs are commonly used medications.
• Early recognition improves outcomes.

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❓ Frequently Asked Questions (FAQ)

1. What is PTSD?
A trauma-related psychiatric disorder.

2. When does PTSD develop?
Symptoms persist beyond one month after trauma.

3. What are flashbacks?
Re-experiencing traumatic memories vividly.

4. Are nightmares common?
Yes, they are a hallmark symptom.

5. What is hypervigilance?
Excessive alertness to danger.

6. Can PTSD cause insomnia?
Yes, sleep disturbance is common.

7. What is first-line psychotherapy?
Trauma-focused CBT.

8. Which medications help?
SSRIs such as sertraline.

9. Can depression coexist?
Yes, very commonly.

10. What is the prognosis?
Good with early diagnosis and treatment.

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PTSD
Post Traumatic Stress Disorder
PTSD Flashbacks
PTSD Nightmares
Trauma Psychiatry Quiz
Psychiatry MCQ
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PTSD Diagnosis
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