Social anxiety disorder US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Social anxiety disorder. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Social anxiety disorder US Medical PG Question 1: A 26-year-old woman thinks poorly of herself and is extremely sensitive to criticism. She is socially inhibited and has never had a romantic relationship, although she desires one. Which of the following is the most likely diagnosis?
- A. Schizoid personality disorder
- B. Paranoid personality disorder
- C. Depression
- D. Dysthymia
- E. Avoidant personality disorder (Correct Answer)
Social anxiety disorder Explanation: ***Avoidant personality disorder***
- Characterized by **social inhibition**, feelings of **inadequacy**, and **hypersensitivity to negative evaluation**, leading to avoidance of social interactions despite a desire for connection.
- The patient's self-perception, sensitivity to criticism, and absence of romantic relationships are classic signs.
*Schizoid personality disorder*
- Individuals with schizoid personality disorder exhibit a pervasive pattern of **detachment from social relationships** and a restricted range of emotional expression.
- Unlike avoidant personality disorder, they typically **do not desire social connection** and are indifferent to criticism or praise.
*Paranoid personality disorder*
- Marked by pervasive **distrust and suspiciousness of others**, interpreting their motives as malevolent.
- This patient's symptoms are more focused on self-perception and social anxiety rather than paranoid ideation.
*Depression*
- Depression involves a sustained period of **low mood**, loss of interest or pleasure, and other vegetative symptoms, which are not explicitly described as the primary, long-standing issue here.
- While feelings of worthlessness can occur in depression, the chronic, pervasive social inhibition and desire for relationships point away from a primary depressive episode as the sole diagnosis.
*Dysthymia*
- Dysthymia, or persistent depressive disorder, is characterized by a chronically depressed mood for at least two years, but it usually includes more pervasive depressive symptoms like low energy and anhedonia.
- While it can involve poor self-esteem, it doesn't fully explain the specific pattern of social avoidance and hypersensitivity to criticism, especially the patient's desire for social connection, which is often dampened in dysthymia.
Social anxiety disorder US Medical PG Question 2: A 29-year-old woman presents to her primary care physician because she has been experiencing episodes of intense fear. Specifically, she says that roughly once per week she will feel an intense fear of dying accompanied by chest pain, lightheadedness, sweating, and palpitations. In addition, she will feel as if she is choking which leads her to hyperventilate. She cannot recall any trigger for these episodes and is afraid that they will occur while she is driving or working. In order to avoid this possibility, she has been getting rides from a friend and has been avoiding interactions with her coworkers. These changes have not stopped the episodes so she came in for evaluation. This patient's disorder is most likely genetically associated with a personality disorder with which of the following features?
- A. Criminality and disregard for rights of others
- B. Eccentric appearance and magical thinking
- C. Submissive, clingy, and low self-confidence (Correct Answer)
- D. Grandiosity, entitlement, and need for admiration
- E. Social withdrawal and limited emotional expression
Social anxiety disorder Explanation: ***Submissive, clingy, and low self-confidence***
- The patient's symptoms are highly suggestive of **panic disorder** with **agoraphobia**. Panic disorder is genetically correlated with **Cluster C (anxious) personality disorders**, particularly **dependent personality disorder** and **avoidant personality disorder**.
- These personality disorders share genetic vulnerability factors with anxiety disorders including panic disorder, involving neurotransmitter systems (serotonin, GABA) and temperamental traits related to anxiety sensitivity and behavioral inhibition.
- Dependent personality disorder features include **submissiveness, excessive need to be cared for, clinging behavior, and low self-confidence** - all reflecting the underlying anxious temperament shared with panic disorder.
*Social withdrawal and limited emotional expression*
- These features describe **schizoid personality disorder** (Cluster A), which is characterized by social detachment and restricted emotional range.
- Schizoid personality disorder is NOT genetically associated with panic disorder. It belongs to the odd/eccentric cluster and has different genetic underpinnings related to the schizophrenia spectrum.
*Grandiosity, entitlement, and need for admiration*
- These features are characteristic of **narcissistic personality disorder** (Cluster B), which has no established genetic association with panic disorder.
- Narcissistic personality disorder is part of the dramatic/erratic cluster and involves different personality pathology unrelated to anxiety disorders.
*Criminality and disregard for rights of others*
- These features describe **antisocial personality disorder** (Cluster B), which is not genetically linked to panic disorder.
- Antisocial personality disorder is associated with conduct disorder and involves impulsivity and aggression rather than anxiety-related traits.
*Eccentric appearance and magical thinking*
- These are features of **schizotypal personality disorder** (Cluster A), which is genetically associated with the **schizophrenia spectrum**, not panic disorder.
- Schizotypal individuals display cognitive-perceptual distortions and odd behaviors that are unrelated to anxiety disorder genetics.
Social anxiety disorder US Medical PG Question 3: A 36-year-old man comes to the clinic for follow-up of his general anxiety disorder. He was diagnosed a year ago for excessive worry and irritability and was subsequently started on paroxetine. He demonstrated great response to therapy but is now complaining of decreased libido, which is affecting his marriage and quality of life. He wishes to switch to a different medication at this time. Following a scheduled tapering of paroxetine, the patient is started on a different medication that is a partial agonist of the 5-HT1A receptor. Which of the following is the most likely drug that was prescribed?
- A. Diazepam
- B. Duloxetine
- C. Phenelzine
- D. Amitriptyline
- E. Buspirone (Correct Answer)
Social anxiety disorder Explanation: ***Buspirone***
- **Buspirone** is a **5-HT1A receptor partial agonist** used for generalized anxiety disorder
- Has a **lower incidence of sexual side effects** compared to SSRIs, making it an ideal alternative when patients experience SSRI-induced sexual dysfunction
- Delayed onset of action (2-4 weeks) but effective for long-term anxiety management without dependence risk
*Diazepam*
- Benzodiazepine that enhances GABA-A receptor activity, not a 5-HT1A partial agonist
- While effective for acute anxiety, carries risks of dependence, sedation, and tolerance
- Not appropriate for long-term management or as a switch for SSRI-induced sexual dysfunction
*Duloxetine*
- Serotonin-norepinephrine reuptake inhibitor (SNRI), not a 5-HT1A partial agonist
- Can also cause **sexual dysfunction** similar to SSRIs (decreased libido, anorgasmia)
- Would not address the patient's primary complaint
*Phenelzine*
- Monoamine oxidase inhibitor (MAOI) affecting multiple neurotransmitters, not a 5-HT1A partial agonist
- Requires strict dietary restrictions (tyramine-free diet) and has significant drug interactions
- Reserved for treatment-resistant anxiety/depression, not first-line for SSRI side effect management
*Amitriptyline*
- Tricyclic antidepressant (TCA) that inhibits norepinephrine and serotonin reuptake
- Not a 5-HT1A partial agonist
- Can cause sexual dysfunction along with anticholinergic effects (dry mouth, constipation, urinary retention), sedation, and orthostatic hypotension
Social anxiety disorder US Medical PG Question 4: A 25-year-old man comes to the physician because of palpitations, sweating, and flushing. Since he was promoted to a manager in a large software company 6 months ago, he has had several episodes of these symptoms when he has to give presentations in front of a large group of people. During these episodes, his thoughts start racing and he fears that his face will “turn red” and everyone will laugh at him. He has tried to avoid the presentations but fears that he might lose his job if he continues to do so. He is healthy except for mild-persistent asthma. He frequently smokes marijuana to calm his nerves. He does not drink alcohol. His only medication is an albuterol inhaler. His pulse is 78/min, respirations are 14/min, and blood pressure is 120/75 mm Hg. Cardiopulmonary examination shows no abnormalities. On mental status examination, the patient appears worried and has a flattened affect. Which of the following is the most appropriate next step in management?
- A. Buspirone therapy
- B. Lorazepam therapy
- C. Duloxetine therapy
- D. Cognitive behavioral therapy (Correct Answer)
- E. Olanzapine therapy
Social anxiety disorder Explanation: ***Cognitive behavioral therapy***
- The patient exhibits classic symptoms of **social anxiety disorder (social phobia)**, including anxiety in social situations, fear of judgment, and avoidance behavior, which is a key indication for **CBT**.
- **CBT** is an effective first-line treatment for social anxiety, helping individuals identify and challenge distorted thoughts, and gradually expose themselves to feared social situations.
*Buspirone therapy*
- **Buspirone** is an anxiolytic that can be used for **generalized anxiety disorder**, but it is generally less effective for specific phobias like social anxiety or for acute anxiety attacks.
- Its therapeutic effects can take several weeks to manifest, making it unsuitable for immediate symptom management in highly specific, performance-related anxiety.
*Lorazepam therapy*
- **Lorazepam**, a **benzodiazepine**, can acutely reduce anxiety symptoms but carries risks of **tolerance, dependence, and withdrawal**, especially with frequent use.
- Its potential for abuse, combined with the patient's marijuana use for nerves, makes it a less appropriate first-line choice for long-term management.
*Duloxetine therapy*
- **Duloxetine**, a **serotonin-norepinephrine reuptake inhibitor (SNRI)**, is a pharmacological option for social anxiety disorder, particularly when CBT alone is insufficient.
- While an antidepressant, it is not considered the initial treatment of choice over CBT, which addresses the underlying cognitive and behavioral patterns.
*Olanzapine therapy*
- **Olanzapine** is an **atypical antipsychotic** primarily used for conditions like **schizophrenia** and **bipolar disorder**.
- It is not indicated for social anxiety disorder as a standalone treatment and carries significant side effects, including metabolic disturbances.
Social anxiety disorder US Medical PG Question 5: A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?
- A. "Does the diarrhea typically precede the constipation, or vice-versa?"
- B. "Is the diarrhea foul-smelling?"
- C. "Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life"
- D. "Are the symptoms worse in the morning or at night?"
- E. "Can you tell me more about the symptoms you have been experiencing?" (Correct Answer)
Social anxiety disorder Explanation: ***Can you tell me more about the symptoms you have been experiencing?***
- This **open-ended question** encourages the patient to provide a **comprehensive narrative** of their symptoms, including details about onset, frequency, duration, alleviating/aggravating factors, and associated symptoms, which is crucial for diagnosis.
- In a patient presenting with vague, intermittent symptoms like alternating constipation and diarrhea, allowing them to elaborate freely can reveal important clues that might not be captured by more targeted questions.
*Does the diarrhea typically precede the constipation, or vice-versa?*
- While knowing the sequence of symptoms can be helpful in understanding the **pattern of bowel dysfunction**, it is a very specific question that might overlook other important aspects of the patient's experience.
- It prematurely narrows the focus without first obtaining a broad understanding of the patient's overall symptomatic picture.
*Is the diarrhea foul-smelling?*
- Foul-smelling diarrhea can indicate **malabsorption** or **bacterial overgrowth**, which are important to consider in some gastrointestinal conditions.
- However, this is a **specific symptom inquiry** that should follow a more general exploration of the patient's symptoms, as it may not be relevant if other crucial details are missed.
*Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life*
- Quantifying pain intensity is useful for assessing the **severity of discomfort** and monitoring changes over time.
- However, for a patient with intermittent rather than acute, severe pain, understanding the **character, location, and triggers** of the pain is often more diagnostically valuable than just a numerical rating initially.
*Are the symptoms worse in the morning or at night?*
- Diurnal variation can be relevant in certain conditions, such as inflammatory bowel diseases where nocturnal symptoms might be more concerning, or functional disorders whose symptoms might be stress-related.
- This is another **specific question** that should come after gathering a more complete initial picture of the patient's symptoms to ensure no key information is overlooked.
Social anxiety disorder US Medical PG Question 6: 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
Social 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.
Social anxiety disorder US Medical PG Question 7: 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)
Social 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.
Social anxiety disorder US Medical PG Question 8: 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
Social 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.
Social anxiety disorder US Medical PG Question 9: 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
Social 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.
Social anxiety disorder US Medical PG Question 10: A 3-month-old girl with an immunodeficiency syndrome has been hospitalized for 1 month due to a severe pulmonary infection. Her family came to visit her daily in the beginning of her hospital stay; however, since their car broke down they have been unable to visit for the last 2 weeks. While the infection has now been resolved with proper treatment and supportive care, the girl's nurse is concerned that the patient is becoming increasingly withdrawn. Specifically, the nurse has noticed that since the family has stopped visiting, the girl seems to shy away from contact and sometimes even becomes unresponsive to verbal or visual cues. Which of the following is most likely true about this infant's condition?
- A. The condition can be diagnosed in adults if it lasts > 6 months
- B. The condition is significantly more common in boys
- C. The condition is exclusively seen in girls
- D. The condition should be reported to state authorities
- E. The condition is reversible (Correct Answer)
Social anxiety disorder Explanation: ***The condition is reversible***
- The infant is exhibiting symptoms of **anaclitic depression** or **hospitalism**, characterized by withdrawal, unresponsiveness, and lack of social engagement due to prolonged separation from primary caregivers.
- This condition is often **reversible** with proper intervention, such as reuniting the infant with their primary caregivers and providing supportive care.
*The condition can be diagnosed in adults if it lasts > 6 months*
- **Anaclitic depression** is a specific diagnosis primarily observed in **infants and young children** who experience prolonged separation from their primary attachment figures.
- While adults can experience depression, the specific symptom profile and etiological factors for anaclitic depression are distinct and not applied to adult diagnoses.
*The condition is significantly more common in boys*
- There is **no significant gender predilection** for anaclitic depression; it affects both boys and girls equally who experience similar environmental stressors.
- The development of this condition is primarily linked to the quality and consistency of early attachment relationships, not gender.
*The condition is exclusively seen in girls*
- **Anaclitic depression** is not exclusive to girls; it can affect **any infant** who experiences prolonged separation from their primary caregivers and lack of consistent emotional support.
- The case description only specifies a girl, but this does not imply gender exclusivity.
*The condition should be reported to state authorities*
- While the family's inability to visit is concerning, the infant's symptoms are best described as a consequence of **hospitalization and separation from caregivers**, not necessarily direct child abuse or neglect requiring state intervention.
- The focus should be on therapeutic interventions like facilitating family visits and providing consistent nursing care, rather than immediately involving child protective services.
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