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Post-traumatic stress disorder — MCCQE Part 1 MCQ

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ModeratePost-traumaPost-traumatic stress disorderMCCQE Part 1

33-year-old paramedic presents with nightmares and avoidance after a fatal call. Symptoms persist for 3 months with hypervigilance and impaired work. Which of the following is the most appropriate next step?

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Correct answer: D — Offer trauma-focused psychotherapy and assess comorbid depression/substance use

Offer trauma-focused psychotherapy and assess comorbid depression/substance use is best because intrusion, avoidance, arousal and impairment after trauma suggest PTSD. Provide reassurance only and arrange no follow-up is suboptimal because mental health risk often requires structured follow-up or urgent escalation; Use long-term benzodiazepine monotherapy as default treatment is suboptimal because benzodiazepine monotherapy is rarely an appropriate long-term strategy; Avoid direct risk assessment to preserve rapport is suboptimal because direct assessment of suicide, violence, capacity and substance use is clinically appropriate; Attribute symptoms to personality or culture without assessing illness is suboptimal because diagnostic overshadowing risks missing treatable mental illness. Psychological debriefing immediately after trauma is not routine treatment.

Reference: Canadian PTSD guidance