Generalized anxiety disorder US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Generalized anxiety disorder. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Generalized anxiety disorder US Medical PG Question 1: A 35-year-old man with no past medical history presents to his primary care physician with complaints of fatigue. He states that his life has been hectic lately and that everything seems to be falling apart. He is scared that he will lose his job, that his wife will leave him, and that his children will not be able to afford to go to college. His worries are severe enough that they have begun to interfere with his daily activities. His wife is also present and states that he has a very secure job and that they are well off financially. She says that he has always worried about something since she met him years ago. What medication would benefit this patient long term?
- A. Risperidone
- B. Escitalopram (Correct Answer)
- C. Lithium
- D. No treatment recommended
- E. Diazepam
Generalized anxiety disorder Explanation: ***Escitalopram***
- The patient exhibits symptoms consistent with **Generalized Anxiety Disorder (GAD)**, characterized by excessive, uncontrollable worry about multiple events or activities. **SSRIs like escitalopram** are first-line agents for long-term treatment of GAD.
- The patient's long-standing pattern of worry, despite a secure job and financial stability, and his wife's observation that he "has always worried about something," further support a diagnosis of GAD, for which escitalopram provides effective long-term symptom management.
*Risperidone*
- **Risperidone** is an **antipsychotic medication** primarily used for conditions like schizophrenia, bipolar disorder, and agitation.
- It is not indicated as a first-line or long-term treatment for Generalized Anxiety Disorder and carries a higher risk of side effects compared to SSRIs.
*Lithium*
- **Lithium** is a **mood stabilizer** primarily used in the management of bipolar disorder.
- This patient's symptoms are indicative of an anxiety disorder, not a mood disorder like bipolar disorder, making lithium an inappropriate choice.
*No treatment recommended*
- The patient's worries are severe enough to **interfere with his daily activities**, indicating a significant functional impairment.
- Therefore, treatment is warranted to alleviate symptoms and improve his quality of life.
*Diazepam*
- **Diazepam** is a **benzodiazepine**, effective for acute anxiety relief due to its rapid onset of action.
- However, it is generally **not recommended for long-term management** due to the risk of dependence, tolerance, and withdrawal symptoms.
Generalized anxiety disorder US Medical PG Question 2: A previously healthy 25-year-old woman comes to the physician because of a 1-month history of palpitations that occur on minimal exertion and sometimes at rest. She has no chest discomfort or shortness of breath. She feels nervous and irritable most of the time and attributes these feelings to her boyfriend leaving her 2 months ago. Since then she has started exercising more frequently and taking an herbal weight-loss pill, since which she has lost 6.8 kg (15 lb) of weight. She finds it hard to fall asleep and awakens 1 hour before the alarm goes off each morning. She has been drinking 2 to 3 cups of coffee daily for the past 7 years and has smoked one pack of cigarettes daily for the past 3 years. Her temperature is 37.4°C (99.4°F), pulse is 110/min, respirations are 18/min, and blood pressure is 150/70 mm Hg. Examination shows moist palms. Neurologic examination shows a fine resting tremor of the hands. Deep tendon reflexes are 3+ with a shortened relaxation phase. Which of the following is the most likely cause of this patient's symptoms?
- A. Exogenous hyperthyroidism (Correct Answer)
- B. Pheochromocytoma
- C. Hashimoto thyroiditis
- D. Coffee consumption
- E. Generalized anxiety disorder
Generalized anxiety disorder Explanation: ***Exogenous hyperthyroidism***
- The patient's symptoms including **palpitations, weight loss, nervousness, irritability, insomnia**, and physical findings like **tachycardia, moist palms, fine tremor**, and **hyperreflexia with shortened relaxation phase** are highly indicative of **hyperthyroidism**.
- The use of an **herbal weight-loss pill** strongly suggests the possibility of exogenous thyroid hormone intake or other thyroid-stimulating substances within the pill, leading to **exogenous hyperthyroidism**.
*Pheochromocytoma*
- While **palpitations** and **hypertension** can occur, **pheochromocytoma** is typically characterized by paroxysmal episodes of severe headaches, sweating, and anxiety.
- The chronic nature of the patient's symptoms, along with significant **weight loss** and **hyperreflexia**, are less typical for **pheochromocytoma**.
*Hashimoto thyroiditis*
- **Hashimoto thyroiditis** typically causes **hypothyroidism**, characterized by symptoms like weight gain, fatigue, cold intolerance, and bradycardia.
- While it can sometimes have a transient hyperthyroid phase (hashitoxicosis), the overall clinical picture here is more consistent with sustained **hyperthyroidism**, especially given the suspected external factor.
*Coffee consumption*
- Although **caffeine** can cause palpitations, nervousness, and insomnia, the severity and breadth of this patient's symptoms, including significant **weight loss, hyperreflexia**, and **moist palms**, extend far beyond what would typically be attributed solely to coffee intake, especially given her chronic coffee use.
- The new onset and progression of these symptoms, coinciding with the herbal pill, points to a stronger underlying cause.
*Generalized anxiety disorder*
- **Generalized anxiety disorder (GAD)** can explain nervousness, irritability, and insomnia, but it does not typically cause **significant weight loss** or objective physical findings such as **tachycardia, moist palms, fine tremor, and hyperreflexia**.
- These physical signs are hallmarks of a physiological rather than purely psychological condition.
Generalized anxiety disorder US Medical PG Question 3: A 27-year-old man presents to his primary care physician with concerns about poor sleep quality. The patient states that he often has trouble falling asleep and that it is negatively affecting his studies. He is nervous that he is going to fail out of graduate school. He states that he recently performed poorly at a lab meeting where he had to present his research. This has been a recurrent issue for the patient any time he has had to present in front of groups. Additionally, the patient is concerned that his girlfriend is going to leave him and feels the relationship is failing. The patient has a past medical history of irritable bowel syndrome for which he takes fiber supplements. His temperature is 98.9°F (37.2°C), blood pressure is 117/68 mmHg, pulse is 80/min, respirations are 12/min, and oxygen saturation is 98% on room air. Physical exam is within normal limits. Which of the following is the best initial step in management?
- A. Duloxetine
- B. Alprazolam during presentations
- C. Fluoxetine
- D. Cognitive behavioral therapy (Correct Answer)
- E. Propranolol during presentations
Generalized anxiety disorder Explanation: ***Cognitive behavioral therapy***
- This patient presents with symptoms highly suggestive of **generalized anxiety disorder (GAD)**, characterized by persistent worry about various life situations (academics, relationships) and difficulty sleeping. **Cognitive behavioral therapy (CBT)** is considered a first-line treatment for GAD, addressing maladaptive thought patterns and behaviors.
- CBT could also address the patient's specific social anxiety related to presentations, by teaching coping mechanisms and restructuring negative thoughts about social situations.
*Duloxetine*
- **Duloxetine** is a **serotonin-norepinephrine reuptake inhibitor (SNRI)**, which is an appropriate pharmacological treatment for GAD. However, initial management for anxiety disorders, especially in a patient expressing concern about medication side effects or preference for non-pharmacological approaches, often prioritizes psychotherapy like CBT.
- While it could be considered, it is typically not the *best initial step* before exploring non-pharmacological options, given the patient's concerns are not immediately life-threatening and psychotherapeutic options have high efficacy.
*Fluoxetine*
- **Fluoxetine** is a **selective serotonin reuptake inhibitor (SSRI)** and is a first-line pharmacological treatment for GAD.
- Similar to duloxetine, while an effective medication, it is not always the *best initial step* as many patients prefer to try psychotherapy first, and it doesn't address the underlying maladaptive thought processes in the same way CBT does.
*Alprazolam during presentations*
- **Alprazolam** is a **benzodiazepine** that provides rapid relief of anxiety symptoms. However, it is primarily used for **acute, short-term anxiety**, not as a long-term solution for generalized anxiety or social anxiety.
- Chronic use of benzodiazepines carries risks of **tolerance, dependence, and withdrawal symptoms**, making it unsuitable as an initial management strategy for persistent anxiety.
*Propranolol during presentations*
- **Propranolol** is a **beta-blocker** that can help manage the **physical symptoms of performance anxiety** (e.g., tremors, palpitations) by blocking adrenergic receptors.
- While helpful for specific situations like presentations for social anxiety, it does not address the underlying cognitive distortions or generalized anxiety disorder, and therefore is not the best initial comprehensive management approach.
Generalized anxiety disorder US Medical PG Question 4: A 24-year-old woman comes to the physician because of a 1-year history of intermittent episodes of shortness of breath, chest tightness, palpitation, dizziness, sweaty hands, and a feeling of impending doom. She says that her symptoms occur when she goes for a walk or waits in line for coffee. She reports that she no longer leaves the house by herself because she is afraid of being alone when her symptoms occur. She only goes out when her boyfriend accompanies her. She does not smoke or use illicit drugs. Within a few hours after each episode, physical examination and laboratory studies have shown no abnormalities. Which of the following is the most likely diagnosis?
- A. Separation anxiety disorder
- B. Generalized anxiety disorder
- C. Agoraphobia (Correct Answer)
- D. Panic disorder
- E. Somatic symptom disorder
Generalized anxiety disorder Explanation: ***Agoraphobia***
- The patient's avoidance of leaving the house alone due to fear of symptom recurrence in various situations (e.g., walking, waiting in line), and her reliance on her boyfriend's presence, are classic symptoms of **agoraphobia**.
- Agoraphobia typically involves marked fear or anxiety about being in situations from which escape might be difficult or embarrassing, or in which help might not be available in the event of panic-like symptoms.
- The key feature here is the **pervasive avoidance behavior** that significantly restricts her independence and daily functioning.
*Separation anxiety disorder*
- This disorder is characterized by excessive anxiety concerning separation from home or from those to whom the individual is attached.
- While the patient avoids leaving home, her anxiety is not specifically about separating from an attachment figure, but rather about being alone when panic-like symptoms might occur in situations where escape or help is unavailable.
*Generalized anxiety disorder*
- Generalized anxiety disorder involves persistent and excessive worry about multiple everyday events or activities for at least six months.
- The patient's symptoms are episodic and specifically triggered by certain situations with agoraphobic features, rather than a constant, diffuse worry about various life circumstances.
*Panic disorder*
- Panic disorder is characterized by recurrent, unexpected panic attacks and persistent worry about additional attacks or their consequences.
- While the patient clearly experiences panic attacks, panic disorder alone does not fully explain the **extensive avoidance behavior** and dependence on a companion for routine activities.
- In DSM-5, agoraphobia and panic disorder can co-occur, but when the predominant clinical feature is the situational avoidance and restriction of independence (as seen here), agoraphobia is the more complete diagnosis.
*Somatic symptom disorder*
- This disorder involves one or more somatic symptoms that are distressing or result in significant disruption of daily life, accompanied by excessive thoughts, feelings, or behaviors related to the symptoms.
- Although the patient's physical symptoms are distressing, the primary issue is the fear and avoidance of specific situations where help might not be available, not a preoccupation with the somatic symptoms themselves or excessive healthcare utilization.
Generalized anxiety disorder US Medical PG Question 5: A 42-year-old female complains of feeling anxious and worrying about nearly every aspect of her daily life. She cannot identify a specific cause for these symptoms and admits that this tension is accompanied by tiredness and difficulty falling asleep. To treat this problem, the patient is prescribed sertraline. She endorses a mild improvement with this medication, and over the next several months, her dose is increased to the maximum allowed dose with modest improvement. Her psychiatrist adds an adjunctive treatment, a medication which notably lacks any anticonvulsant or muscle relaxant properties. This drug most likely acts at which of the following receptors?
- A. Beta adrenergic receptor
- B. 5HT-1A receptor (Correct Answer)
- C. GABA receptor
- D. Alpha adrenergic receptor
- E. Glycine receptor
Generalized anxiety disorder Explanation: ***5HT-1A receptor***
- The patient's presentation of generalized anxiety disorder, treated with an SSRI (sertraline) and an adjunctive medication that lacks anticonvulsant or muscle relaxant properties, points to **buspirone**.
- **Buspirone** is a 5HT-1A partial agonist, commonly used as an augmenting agent in anxiety disorders, which explains the mechanism of action.
*Beta adrenergic receptor*
- Medications acting on **beta-adrenergic receptors** (e.g., propranolol) are typically used for situational anxiety or performance anxiety, not generalized anxiety disorder, and they primarily reduce physical symptoms like palpitations and tremors.
- While beta-blockers lack anticonvulsant or muscle relaxant properties, they are not typically considered a first-line adjunctive therapy for generalized anxiety after an SSRI failure.
*GABA receptor*
- Drugs acting on **GABA receptors** (e.g., benzodiazepines) are known for their anxiolytic, sedative, anticonvulsant, and muscle relaxant properties.
- The question explicitly states that the adjunctive medication "notably lacks any anticonvulsant or muscle relaxant properties," ruling out GABAergic drugs.
*Alpha adrenergic receptor*
- Medications targeting **alpha-adrenergic receptors** (e.g., clonidine) are sometimes used for anxiety associated with opiate withdrawal or PTSD, but are not a common adjunctive treatment for generalized anxiety disorder in this context.
- While they may lack anticonvulsant or muscle relaxant properties, their primary mechanism involves regulating sympathetic outflow rather than the specific mood and cognitive symptoms of GAD.
*Glycine receptor*
- The **glycine receptor** is an inhibitory ion channel, primarily found in the spinal cord and brainstem, involved in motor control and pain processing.
- Agonists of this receptor are not commonly used to treat anxiety disorders, and the described clinical scenario does not align with its therapeutic applications.
Generalized anxiety disorder US Medical PG Question 6: A 45-year-old woman presents to her primary care physician with complaints of muscle pains, poor sleep, and daytime fatigue. When asked about stressors she states that she "panics" about her job, marriage, children, and finances. When asked to clarify what the "panics" entail, she states that it involves severe worrying. She has had these symptoms since she last saw you one year ago. What is the most likely diagnosis?
- A. Generalized anxiety disorder (Correct Answer)
- B. Social phobia
- C. Adjustment disorder
- D. Obsessive-compulsive disorder
- E. Panic disorder
Generalized anxiety disorder Explanation: ***Generalized anxiety disorder***
- This patient presents with **chronic, excessive, and uncontrollable worry** about multiple life circumstances (job, marriage, children, finances), fulfilling the core diagnostic criterion for GAD.
- The associated symptoms of **muscle pains**, **poor sleep**, and **daytime fatigue** are common physical manifestations of GAD, and the duration of symptoms for over a year supports the diagnosis.
*Social phobia*
- **Social phobia**, or social anxiety disorder, involves intense fear and anxiety in **social situations** where one might be scrutinized or judged.
- The patient's reported worries are broad and not limited to social interactions, making social phobia less likely.
*Adjustment disorder*
- **Adjustment disorder** is characterized by emotional or behavioral symptoms developing within **three months of an identifiable stressor**, not diffuse chronic worry.
- The symptoms in adjustment disorder typically resolve within **six months** after the stressor or its consequences have ended, whereas this patient's symptoms are chronic and pervasive.
*Obsessive-compulsive disorder*
- **Obsessive-compulsive disorder (OCD)** involves recurrent, intrusive **obsessions** (thoughts, urges, images) and/or **compulsions** (repetitive behaviors or mental acts) performed to reduce anxiety.
- While the patient experiences severe worrying, there's no mention of specific obsessions or compulsive behaviors aimed at neutralizing those anxieties.
*Panic disorder*
- **Panic disorder** is characterized by recurrent, unexpected **panic attacks**—sudden surges of intense fear or discomfort accompanied by physical and cognitive symptoms.
- While the patient uses the term "panics," she clarifies it involves "severe worrying," not discrete, intense, and short-lived panic attacks.
Generalized anxiety disorder US Medical PG Question 7: An 8-year-old girl is brought to the physician by her parents because of difficulty sleeping. One to two times per week for the past 2 months, she has woken up frightened in the middle of the night, yelling and crying. She has not seemed confused after waking up, and she is consolable and able to fall back asleep in her parents' bed. The following day, she seems more tired than usual at school. She recalls that she had a bad dream and looks for ways to delay bedtime in the evenings. She has met all her developmental milestones to date. Physical examination shows no abnormalities. Which of the following is the most likely diagnosis?
- A. Normal development
- B. Sleep terror disorder
- C. Nightmare disorder (Correct Answer)
- D. Post-traumatic stress disorder
- E. Separation anxiety disorder
Generalized anxiety disorder Explanation: ***Nightmare disorder***
- The key features supporting **nightmare disorder** are vivid, frightening dreams that lead to waking up, the ability to recall the dream content, being easily consolable, and attempts to avoid bedtime.
- Sleep disturbances, daytime fatigue, and negative emotional responses centered around sleep are characteristic of this disorder.
*Normal development*
- While occasional bad dreams are part of normal development, a frequency of one to two times per week over 2 months, leading to daytime tiredness and bedtime avoidance, suggests a **clinical disorder** exceeding typical developmental experiences.
- The distress caused and impact on daily functioning (tiredness at school) differentiate it from normal, transient nightmares.
*Sleep terror disorder*
- **Sleep terrors** typically involve abrupt awakening with intense fear, screaming, and autonomic arousal, but the individual is usually disoriented, inconsolable, and has no recall of the event upon waking or the next day.
- In this case, the child is consolable and *recalls* having a bad dream, distinguishing it from sleep terrors.
*Post-traumatic stress disorder*
- **PTSD** requires exposure to a traumatic event, which is not mentioned in the vignette.
- While nightmares can be a symptom of PTSD, they are usually accompanied by other symptoms like flashbacks, avoidance behavior, negative alterations in cognition/mood, and hypervigilance related to the trauma.
*Separation anxiety disorder*
- **Separation anxiety disorder** is characterized by excessive fear or anxiety concerning separation from attachment figures.
- Although the child sleeps in her parents' bed, the primary issue is frightening dreams and difficulty sleeping, not anxiety specifically related to separation from her parents.
Generalized anxiety disorder US Medical PG Question 8: A 36-year-old woman comes to the physician because of an 8-month history of occasional tremor. The tremor is accompanied by sudden restlessness and nausea, which disrupts her daily work as a professional violinist. The symptoms worsen shortly before upcoming concerts but also appear when she goes for a walk in the city. She is concerned that she might have a neurological illness and have to give up her career. The patient experiences difficulty falling asleep because she cannot stop worrying that a burglar might break into her house. Her appetite is good. She drinks one glass of wine before performances "to calm her nerves" and otherwise drinks 2–3 glasses of wine per week. The patient takes daily multivitamins as prescribed. She appears nervous. Her temperature is 36.8°C (98.2°F), pulse is 92/min, and blood pressure is 135/80 mm Hg. Mental status examination shows a full range of affect. On examination, a fine tremor on both hands is noted. She exhibits muscle tension. The remainder of the neurological exam shows no abnormalities. Which of the following is the most likely explanation for this patient's symptoms?
- A. Atypical depressive disorder
- B. Adjustment disorder
- C. Generalized anxiety disorder (Correct Answer)
- D. Panic disorder
- E. Essential tremor
Generalized anxiety disorder Explanation: ***Generalized anxiety disorder***
- The patient exhibits persistent and excessive worry about various life circumstances (performance, burglaries, general anxiety), accompanied by physical symptoms like **restlessness**, muscle tension, and sleep disturbances, which are hallmark features of **Generalized Anxiety Disorder (GAD)**.
- The symptoms have been present for **8 months**, exceed the diagnostic duration for GAD (at least 6 months), and are not clearly tied to a specific stressor or episodic panic attacks.
*Atypical depressive disorder*
- Atypical depression is characterized by mood reactivity, increased appetite/weight gain, hypersomnia, leaden paralysis, and interpersonal rejection sensitivity.
- This patient reports difficulty sleeping (*insomnia*) and primarily presents with anxiety symptoms, not depressive mood.
*Adjustment disorder*
- **Adjustment disorder** involves emotional or behavioral symptoms in response to an identifiable stressor, occurring within 3 months of the stressor's onset, and usually resolving within 6 months after the stressor or its consequences have ceased.
- The patient's symptoms are chronic (8 months), excessive, and not solely linked to *one* identifiable recent stressor, but rather a pervasive pattern of worry.
*Panic disorder*
- **Panic disorder** is characterized by recurrent unexpected **panic attacks** with sudden onset of intense fear and physical symptoms (e.g., palpitations, dyspnea, dizziness).
- While she experiences sudden restlessness and nausea related to performances, these are specific triggers and not unexpected, unprovoked panic attacks. The primary pattern is persistent worry, not recurrent panic attacks.
*Essential tremor*
- **Essential tremor** is a neurological condition causing an *action tremor*, often visible when performing daily tasks, and typically improves with alcohol.
- While she has a tremor that improves with alcohol, the presence of marked and pervasive psychological symptoms like severe worrying, restlessness, and insomnia point to an underlying anxiety disorder, not solely an isolated neurological tremor.
Generalized anxiety disorder US Medical PG Question 9: A 26-year-old woman presents to the office complaining of bloating and consistent fatigue. Past medical notes on her record show that she has seen several doctors at the clinic in the past year for the same concerns. During the discussion, she admits that coming to the doctor intensifies her anxiety and she does not enjoy it. However, she came because she fears that she has colon cancer and says, “There’s gotta be something wrong with me, I can feel it.” Past medical history is significant for obsessive-compulsive disorder (OCD). She sees a therapist a few times a month. Her grandfather died of colon cancer at 75. Today, her blood pressure is 120/80 mm Hg, heart rate is 90/min, respiratory rate is 18/min, and temperature is 37.0°C (98.6°F). Physical examination reveals a well-nourished, well-developed woman who appears anxious and tired. Her heart has a regular rhythm and her lungs are clear to auscultation bilaterally. Her abdomen is soft, non-tender, and non-distended. No masses are palpated, and a digital rectal examination is unremarkable. Laboratory results are as follows:
Serum chemistry
Hemoglobin 13 g/dL
Hematocrit
38%
MCV 90 fl
TSH
4.1 μU/mL
Fecal occult blood test negative
Which of the following is the most likely diagnosis?
- A. Malingering
- B. Somatic symptom disorder
- C. Generalized anxiety disorder
- D. Body dysmorphic disorder
- E. Illness anxiety disorder (Correct Answer)
Generalized anxiety disorder Explanation: ***Illness anxiety disorder***
- This patient exhibits **preoccupation with having or acquiring a serious illness**, despite minimal somatic symptoms and negative diagnostic findings. Her fear of colon cancer, despite an unremarkable physical exam and negative fecal occult blood test, is a key indicator.
- Her history of seeking care from multiple doctors, admitting anxiety about visits, and stating "There's gotta be something wrong with me, I can feel it," aligns with the **excessive health-related behaviors** (or maladaptive avoidance) and **high anxiety about health** central to illness anxiety disorder.
*Somatic symptom disorder*
- This disorder is characterized by **one or more somatic symptoms that are distressing or result in significant disruption of daily life**, accompanied by excessive thoughts, feelings, or behaviors related to these symptoms.
- In this case, the patient's symptoms (bloating, fatigue) are minimal, and her primary concern is the *fear of having* a serious illness, rather than the distress caused by the physical symptoms themselves.
*Generalized anxiety disorder*
- This involves **excessive anxiety and worry about a number of events or activities** that is difficult to control and present for at least 6 months.
- While the patient experiences anxiety, it is specifically focused on her health, not generalized concerns about various aspects of her life.
*Malingering*
- This involves the **intentional production of false or grossly exaggerated physical or psychological symptoms**, motivated by external incentives such as avoiding work or obtaining financial compensation.
- The patient genuinely believes she has a serious illness and is distressed by this belief, rather than faking symptoms for an external gain.
*Body dysmorphic disorder*
- This disorder is characterized by **preoccupation with one or more perceived defects or flaws in physical appearance** that are not observable or appear slight to others.
- The patient's concerns are about an internal illness (colon cancer), not specific physical appearance flaws.
Generalized anxiety disorder US Medical PG Question 10: A 37-year-old man comes to the emergency department with his wife because of a 3-day history of severe pain in his right arm. He also reports that he cannot move his right arm. The symptoms began after the patient woke up one morning, having slept on his side. He is otherwise healthy. He works as a waiter and says that he feels exhausted from working several night shifts per week. He adds that he “can barely keep his eyes open” when looking after their daughter the next day. Since the onset of the pain, he has been unable to work and is fully dependent on his wife, who took an extra shift to make enough money to pay their monthly bills. The patient appears relaxed but only allows himself to be examined after his wife convinces him. His vital signs are within normal limits. Examination shows 1/5 muscle strength in the right arm. Reflexes are normal. He has no sensation to light touch over the entire right arm and forearm. When a pin prick test is conducted, the patient rapidly withdraws the right arm. Which of the following is the most likely diagnosis?
- A. Malingering (Correct Answer)
- B. Factitious disorder
- C. Radial nerve palsy
- D. Illness anxiety disorder
- E. Brachial neuritis
Generalized anxiety disorder Explanation: ***Malingering***
- The patient's presentation with **selective symptoms** (no sensation but rapid withdrawal from pinprick) and the **secondary gain** (avoiding work, dependence on wife for bills) are classic signs of malingering.
- The patient appears *relaxed* despite "severe pain" and only allows examination after persuasion, suggesting a **conscious fabrication of symptoms** for an external incentive.
*Factitious disorder*
- Involves the **deceptive production of symptoms** in oneself or others, but the primary motivation is to assume the **sick role**, without obvious external rewards.
- The patient in this scenario clearly benefits from avoiding work, which points away from factitious disorder.
*Radial nerve palsy*
- Would present with a specific **motor and sensory deficit pattern** corresponding to the radial nerve distribution, typically **wrist drop** and sensory loss over the dorsum of the hand.
- The patient's reported "entire right arm and forearm" sensory loss and paradoxical withdrawal to pinprick are inconsistent with a true neurological lesion.
*Illness anxiety disorder*
- Involves **preoccupations with having or acquiring a serious illness** despite minimal or no somatic symptoms, and is characterized by high levels of anxiety about health.
- This patient's presentation is more about symptom production for an external gain rather than anxiety about disease or actual illness.
*Brachial neuritis*
- Typically causes **severe pain** followed by **weakness and muscle atrophy** in the muscles innervated by the brachial plexus, but the sensory loss typically follows a dermatomal or nerve distribution.
- The reported global sensory loss in the entire arm and forearm, with preserved reflexes and paradoxical withdrawal to pinprick, is inconsistent with a specific nerve inflammation or damage.
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