Specific phobias US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Specific phobias. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Specific phobias US Medical PG Question 1: A 35-year-old man presents to the psychiatry OPD with an intense fear of spiders (arachnophobia) that significantly interferes with his daily activities. He reports avoiding certain areas of his house and experiencing panic attacks when encountering spiders. What is the most appropriate first-line treatment for this patient?
- A. Benzodiazepines
- B. Antidepressants
- C. Cognitive behavioral therapy (Correct Answer)
- D. Beta-blockers
- E. Anxiolytics
Specific phobias Explanation: ***Cognitive behavioral therapy***
- **Cognitive Behavioral Therapy (CBT)**, specifically exposure therapy, is the **first-line treatment** for specific phobias due to its high efficacy in reducing fear and avoidance.
- The patient's significant interference with daily activities and panic attacks necessitate a direct and effective intervention like CBT.
*Benzodiazepines*
- **Benzodiazepines** can provide short-term relief for acute anxiety, but they do not address the underlying phobia and have a **risk of dependence** and withdrawal symptoms.
- They are generally not recommended as a first-line or monotherapy for specific phobias because they can interfere with the learning process of exposure therapy.
*Antidepressants*
- **Antidepressants**, particularly SSRIs, are effective for generalized anxiety disorder or panic disorder but are **not typically first-line for specific phobias** unless there are co-occurring conditions.
- Their action mechanism is slower, and they are less effective than exposure therapy for specific phobias.
*Beta-blockers*
- **Beta-blockers** help manage the **physical symptoms of anxiety** (e.g., palpitations, tremors) but do not address the psychological component of specific phobias.
- They are used symptomatically and are not a cure for the phobia itself.
*Anxiolytics*
- **Anxiolytics** is a broad term that includes benzodiazepines; while they can reduce anxiety, they are **not a primary treatment** for specific phobias and carry risks.
- For specific phobias, the goal is not just symptom reduction but overcoming the fear through behavioral changes, which anxiolytics do not facilitate.
Specific phobias US Medical PG Question 2: A 23-year-old man presents to an outpatient psychiatrist complaining of anxiety and a persistent feeling that “something terrible will happen to my family.” He describes 1 year of vague, disturbing thoughts about his family members contracting a “horrible disease” or dying in an accident. He believes that he can prevent these outcomes by washing his hands of “the contaminants” any time that he touches something and by performing praying and counting rituals each time that he has unwanted, disturbing thoughts. The thoughts and rituals have become more frequent recently, making it impossible for him to work, and he expresses feeling deeply embarrassed by them. Which of the following is the most effective treatment for this patient's disorder?
- A. Psychodynamic psychotherapy and citalopram
- B. Cognitive behavioral therapy and haloperidol
- C. Cognitive behavioral therapy and clonazepam
- D. Cognitive behavioral therapy and fluoxetine (Correct Answer)
- E. Psychodynamic psychotherapy and aripiprazole
Specific phobias Explanation: ***Cognitive behavioral therapy and fluoxetine***
- This patient presents with symptoms highly suggestive of **obsessive-compulsive disorder (OCD)**, characterized by intrusive, distressing thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed to neutralize the anxiety.
- **Cognitive Behavioral Therapy (CBT)**, specifically Exposure and Response Prevention (ERP), is the most effective psychotherapy for OCD, and **SSRIs** like fluoxetine are the first-line pharmacotherapy.
*Psychodynamic psychotherapy and citalopram*
- While citalopram (an SSRI) is an appropriate pharmacological treatment for OCD, **psychodynamic psychotherapy** is generally not considered first-line or most effective for OCD due to its focus on unconscious conflicts rather than direct symptom reduction.
- This approach may not provide the structured, symptom-focused interventions needed to manage obsessions and compulsions effectively.
*Cognitive behavioral therapy and haloperidol*
- **CBT** is an excellent choice, but **haloperidol**, an antipsychotic, is not a first-line treatment for OCD; it is primarily used for psychotic disorders or as an augmentation strategy in severe, treatment-resistant OCD, which is not indicated here.
- Using an antipsychotic as a primary treatment for OCD without a clear indication of psychosis or severe non-response to SSRIs is inappropriate and can lead to unnecessary side effects.
*Cognitive behavioral therapy and clonazepam*
- **CBT** is appropriate, but **clonazepam**, a benzodiazepine, is generally not recommended as a monotherapy or primary adjunctive treatment for OCD due to its *sedative side effects*, *potential for dependence*, and *lack of efficacy* in addressing the core symptoms of OCD.
- Benzodiazepines may be used for short-term anxiety relief but do not treat the underlying obsessive-compulsive processes.
*Psychodynamic psychotherapy and aripiprazole*
- **Psychodynamic psychotherapy** is not the most effective approach for OCD.
- **Aripiprazole**, an atypical antipsychotic, is typically used as an augmentation strategy for *treatment-resistant OCD* when initial SSRI trials have failed, not as a first-line medication, and this patient's case does not describe treatment resistance.
Specific phobias US Medical PG Question 3: 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
Specific phobias 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.
Specific phobias US Medical PG Question 4: A 30-year-old woman presents to her family doctor requesting sleeping pills. She is a graduate student and confesses that she is a “worry-a-holic,” which has been getting worse for the last 6 months as the due date for her final paper is approaching. During this time, she feels more on edge, irritable, and is having difficulty sleeping. She has already tried employing good sleep hygiene practices, including a switch to non-caffeinated coffee. Her past medical history is significant for depression in the past that was managed medically. No current medications. The patient’s family history is significant for her mother who has a panic disorder. Her vital signs are within normal limits. Physical examination reveals a mildly anxious patient but is otherwise normal. Which of the following is the most effective treatment for this patient’s condition?
- A. Buspirone (Correct Answer)
- B. Diazepam
- C. Desensitization therapy
- D. Relaxation training
- E. Bupropion
Specific phobias Explanation: ***Buspirone***
- This patient's symptoms of **generalized anxiety** (excessive worry, difficulty sleeping, irritability, on edge for 6 months) without panic attacks or phobias, and a history of depression, make buspirone a suitable choice.
- **Buspirone** is a non-benzodiazepine anxiolytic that is effective for **generalized anxiety disorder** and has a lower risk of dependence compared to benzodiazepines, making it a good option for chronic use.
*Diazepam*
- **Diazepam** is a benzodiazepine, primarily used for acute anxiety or short-term management due to its **rapid onset of action**.
- Its potential for **dependence and withdrawal symptoms** makes it less ideal for chronic anxiety management, especially in a patient with a predisposition to depression and requesting "sleeping pills".
*Desensitization therapy*
- **Desensitization therapy** (a form of exposure therapy) is primarily used for **phobias** and **post-traumatic stress disorder**, where specific triggers are identified.
- The patient's presentation of generalized, pervasive worry, rather than a fear of specific situations, suggests this would not be the most effective initial treatment.
*Relaxation training*
- While beneficial as an adjunct, **relaxation training** alone is generally not sufficient as the **most effective monotherapy** for generalized anxiety disorder, especially given the severity and duration of the patient's symptoms.
- The patient has already tried **sleep hygiene practices**, indicating that behavioral interventions alone might not be enough to manage her anxiety.
*Bupropion*
- **Bupropion** is an antidepressant primarily used for **major depressive disorder** and **smoking cessation**.
- It is generally **not efficacious for anxiety disorders** and can sometimes exacerbate anxiety due to its stimulating effects.
Specific phobias US Medical PG Question 5: A 27-year-old man is brought to a psychiatrist by his mother who is concerned that he has become increasingly distant. When asked, he says that he is no longer going out because he is afraid of going outside by himself. He says that ever since he was a teenager, he was uncomfortable in large crowds and on public transportation. He now works from home and rarely leaves his house except on mandatory business. Which of the following personality disorders is most likely genetically associated with this patient's disorder?
- A. Dependent
- B. Schizotypal
- C. Histrionic
- D. Antisocial
- E. Paranoid
- F. Avoidant (Correct Answer)
Specific phobias Explanation: ***Avoidant***
- This patient exhibits symptoms consistent with **agoraphobia**, which is an **anxiety disorder** characterized by fear of situations where escape might be difficult or help unavailable, often leading to social isolation.
- **Avoidant Personality Disorder** has the strongest genetic association with anxiety disorders, particularly **social anxiety disorder and agoraphobia**, sharing common genetic vulnerability factors related to fear of negative evaluation and social avoidance.
- Studies demonstrate significant genetic overlap between avoidant personality disorder and anxiety spectrum disorders, making this the most likely genetically associated personality disorder.
*Schizotypal*
- **Schizotypal Personality Disorder** is genetically linked to the **schizophrenia spectrum** (not anxiety disorders), characterized by cognitive-perceptual distortions, eccentric behavior, and social deficits.
- While schizotypal patients may avoid social situations, this is due to odd thinking and discomfort with close relationships, not anxiety about specific situations like crowds or public transportation.
*Dependent*
- **Dependent Personality Disorder** is characterized by an excessive need to be taken care of, leading to **submissive and clinging behavior**, and fears of separation.
- This patient's withdrawal is due to fear of public places, not a reliance on others or fear of abandonment.
*Antisocial*
- **Antisocial Personality Disorder** involves a pervasive pattern of **disregard for and violation of the rights of others**, often presenting as deceitful and impulsive behavior.
- The patient's symptoms are rooted in anxiety and social avoidance rather than a lack of empathy or antisocial behavior.
*Paranoid*
- **Paranoid Personality Disorder** is characterized by a pervasive **distrust and suspiciousness of others**, interpreting their motives as malevolent.
- The patient's withdrawal stems from fear of specific situations (crowds, public transport) rather than paranoid ideation or general suspicion of people's intentions.
*Histrionic*
- **Histrionic Personality Disorder** is marked by **excessive emotionality and attention-seeking behavior**, often displaying dramatic and superficial interactions.
- The patient's isolation and fear of public spaces are directly opposite to the attention-seeking nature of histrionic traits.
Specific phobias US Medical PG Question 6: An 11-year-old boy’s parents brought him to a psychologist upon referral from the boy’s school teacher. The boy frequently bullies his younger classmates despite having been punished several times for this. His mother also reported that a year prior, she received complaints that the boy shoplifted from local shops in his neighborhood. The boy frequently stays out at night despite strict instructions by his parents to return home by 10 PM. Detailed history reveals that apart from such behavior, he is usually not angry or irritable. Although his abnormal behavior continues despite warnings and punishments, he neither argues with his parents nor teachers and does not display verbal or physical aggression. Which of the following is the most likely diagnosis?
- A. Attention-deficit/hyperactivity disorder, hyperactivity-impulsivity type
- B. Disruptive mood dysregulation disorder
- C. Intermittent explosive disorder
- D. Conduct disorder (Correct Answer)
- E. Oppositional defiant disorder
Specific phobias Explanation: ***Conduct disorder***
- The boy's behaviors, including **bullying**, **shoplifting**, and **violating rules** (staying out past curfew), represent a persistent pattern of behavior that violates the basic rights of others or major age-appropriate societal norms, which are core features of **conduct disorder**.
- The history indicates these behaviors have been ongoing for at least a year and are not just isolated incidents, fulfilling the diagnostic criteria for **duration and pervasiveness**.
*Attention-deficit/hyperactivity disorder, hyperactivity-impulsivity type*
- While ADHD involves **hyperactivity** and **impulsivity**, it does not typically manifest with deliberate violations of others' rights or societal norms like **bullying** and **shoplifting**.
- There is no mention of symptoms such as **difficulty sustaining attention**, **fidgeting**, or **excessive talking** which are characteristic of ADHD.
*Disruptive mood dysregulation disorder*
- This disorder is characterized by **severe recurrent temper outbursts** and persistent **irritable or angry mood** between outbursts.
- The case explicitly states the boy is "not angry or irritable" and "neither argues with his parents nor teachers," ruling out this diagnosis.
*Intermittent explosive disorder*
- This disorder involves recurrent behavioral outbursts representing a failure to control aggressive impulses, often with verbal aggression or physical aggression toward property, animals, or other individuals.
- The boy does not display verbal or physical aggression and is not noted to have anger or irritability, which are central to this diagnosis.
*Oppositional defiant disorder*
- ODD involves a pattern of **angry/irritable mood**, **argumentative/defiant behavior**, or **vindictiveness**.
- While violating rules is present, **bullying** and **shoplifting** (which violate the basic rights of others) are more severe behaviors that go beyond the scope of ODD and are characteristic of conduct disorder.
Specific phobias US Medical PG Question 7: A previously healthy 36-year-old man is brought to the physician by a friend because of fatigue and a depressed mood for the past few weeks. During this time, he has not been going to work and did not show up to meet his friends for two bowling nights. The friend is concerned that he may lose his job. He spends most of his time alone at home watching television on the couch. He has been waking up often at night and sometimes takes 20 minutes to go back to sleep. He has also been drinking half a pint of whiskey per day for 1 week. His wife left him 4 weeks ago and moved out of their house. His vital signs are within normal limits. On mental status examination, he is oriented to person, place and time. He displays a flattened affect and says that he “doesn't know how he can live without his wife.” He denies suicidal ideation. Which of the following is the next appropriate step in management?
- A. Prescribe a short course of alprazolam
- B. Hospitalize the patient
- C. Initiate cognitive behavioral therapy (Correct Answer)
- D. Initiate disulfiram therapy
- E. Prescribe a short course of duloxetine
Specific phobias Explanation: ***Initiate cognitive behavioral therapy***
- The patient exhibits features of **adjustment disorder with depressed mood**, characterized by significant distress or impairment in functioning in response to an identifiable stressor (wife leaving).
- **Cognitive behavioral therapy (CBT)** is an effective first-line treatment for adjustment disorders, helping patients develop coping strategies and restructure negative thought patterns.
*Prescribe a short course of alprazolam*
- **Alprazolam**, a benzodiazepine, can provide temporary relief for anxiety but does not address the underlying issues of adjustment disorder and carries risks of **dependence** and withdrawal.
- It would be inappropriate as a sole initial treatment and could exacerbate his **alcohol use**.
*Hospitalize the patient*
- The patient denies **suicidal ideation** and does not present with acute psychosis or severe impairment that would warrant **hospitalization**.
- His orientation and ability to engage in conversation further suggest an outpatient approach is safe and appropriate.
*Initiate disulfiram therapy*
- **Disulfiram** is used for alcohol dependence to deter drinking, but the patient's current alcohol use is a recent development in response to stress, not necessarily full-blown **alcohol dependence** requiring disulfiram.
- Addressing the underlying **adjustment disorder** is the priority, which may in turn reduce his alcohol consumption.
*Prescribe a short course of duloxetine*
- **Duloxetine** is an antidepressant that is not indicated for **adjustment disorder** as a first-line treatment, especially given the short duration and clear precipitating factor.
- **Psychotherapy**, like CBT, is generally the preferred initial intervention for adjustment disorders.
Specific phobias US Medical PG Question 8: A 7-year-old girl is brought to the physician by her mother because she has been increasingly reluctant to speak at school over the past 4 months. Her teachers complain that she does not answer their questions and it is affecting her academic performance. She was born at 35 weeks' gestation and pregnancy was complicated by preeclampsia. Previous well-child examinations have been normal. Her older brother was diagnosed with a learning disability 4 years ago. She is at 65th percentile for height and weight. Physical examination shows no abnormalities. She follows commands. She avoids answering questions directly and whispers her answers to her mother instead who then mediates between the doctor and her daughter. Which of the following is the most likely diagnosis?
- A. Selective mutism (Correct Answer)
- B. Social anxiety disorder
- C. Rett syndrome
- D. Autism spectrum disorder
- E. Reactive attachment disorder
Specific phobias Explanation: ***Selective mutism***
- The child's reluctance to speak in specific social situations (school) despite being able to speak in others (whispering to her mother), and the impact on academic performance, are classic signs of **selective mutism**
- **Selective mutism** typically involves anxiety and a consistent failure to speak in situations where speaking is expected, despite speaking in other situations
- This diagnosis fits the **DSM-5 criteria**: consistent failure to speak in specific social situations for >1 month, interfering with educational achievement
*Social anxiety disorder*
- While social anxiety can be **comorbid** with selective mutism, the hallmark of this presentation is the **specific refusal to speak** in certain settings, rather than generalized anxiety about social interactions
- A child with generalized social anxiety might interact nervously but would likely attempt to speak, which is not described here
*Rett syndrome*
- **Rett syndrome** is a neurodevelopmental disorder almost exclusively affecting girls, characterized by **normal early development followed by regression** of acquired skills, loss of purposeful hand use, and deceleration of head growth
- The presented symptoms of reluctance to speak in specific settings, without other regressive signs or developmental abnormalities, do not fit the diagnosis of Rett syndrome
*Autism spectrum disorder*
- **Autism spectrum disorder** is characterized by persistent deficits in **social communication and social interaction** across multiple contexts, and **restricted, repetitive patterns of behavior**
- This child's ability to speak to her mother and follow commands suggests intact communication skills in some contexts, making autism less likely than selective mutism for the primary presentation
*Reactive attachment disorder*
- **Reactive attachment disorder** typically arises from patterns of **extremely insufficient care** in early childhood, leading to emotionally withdrawn behavior toward caregivers and limited positive affect
- The child's selective non-speaking in school in this scenario, with normal previous well-child examinations and interaction with her mother, is inconsistent with the characteristic features of reactive attachment disorder
Specific phobias US Medical PG Question 9: A 36-year-old woman complains of difficulty falling asleep over the past 4 months. On detailed history taking, she says that she drinks her last cup of tea at 8:30 p.m. before retiring at 10:30 p.m. She then watches the time on her cell phone on and off for an hour before falling asleep. In the morning, she is tired and makes mistakes at work. Her husband has not noticed excessive snoring or abnormal breathing during sleep. Medical history is unremarkable. She has smoked 5–7 cigarettes daily for 7 years and denies excess alcohol consumption. Her physical examination is normal. Which of the following is the best initial step in the management of this patient’s condition?
- A. Ropinirole
- B. Continuous positive airway pressure
- C. Modafinil
- D. Paroxetine
- E. Proper sleep hygiene (Correct Answer)
Specific phobias Explanation: ***Proper sleep hygiene***
- The patient's history of difficulty falling asleep, using a cell phone before bed, and tea consumption close to bedtime points towards **poor sleep hygiene** as a primary contributor to her insomnia.
- Addressing these behavioral factors first with **sleep hygiene education** is the most appropriate initial step before considering pharmacologic interventions.
*Ropinirole*
- **Ropinirole** is a dopamine agonist primarily used to treat **Parkinson's disease** and **restless legs syndrome**.
- There are no indications in the patient's presentation, such as an irresistible urge to move the legs, that would suggest restless legs syndrome.
*Continuous positive airway pressure*
- **Continuous positive airway pressure (CPAP)** is the standard treatment for **obstructive sleep apnea (OSA)**.
- The patient's husband has not noticed snoring or abnormal breathing during sleep, making OSA less likely as the primary cause of her insomnia.
*Modafinil*
- **Modafinil** is a wakefulness-promoting agent used to treat **narcolepsy** and other disorders characterized by excessive daytime sleepiness.
- The patient's primary complaint is difficulty *falling asleep* (**insomnia**), not excessive daytime sleepiness, and there's no evidence of narcolepsy.
*Paroxetine*
- **Paroxetine** is a selective serotonin reuptake inhibitor (SSRI) used to treat **depression** and **anxiety disorders**, and sometimes insomnia associated with these conditions.
- There is no mention of symptoms of depression or anxiety in the patient's history that would warrant immediate antidepressant use for her sleep difficulties.
Specific phobias US Medical PG Question 10: An 11-year-old girl is brought to her primary care physician by her mother with complaints of constant lower abdominal pain and foul-smelling urine for the past 2 days. The patient has had several previous episodes of simple urinary tract infections in the past. Her vitals signs show mild tachycardia without fever. Physical examination reveals suprapubic tenderness without costovertebral angle tenderness on percussion. Urinalysis reveals positive leukocyte esterase and nitrite. Further questioning reveals that the patient does not use the school toilets and holds her urine all day until she gets home. When pressed further, she gets teary-eyed and starts to cry and complains that other girls will make fun of her if she uses the bathroom and will spread rumors to the teachers and her friends. She reports that though this has never happened in the past it concerns her a great deal. Which of the following is the most likely diagnosis for this patient?
- A. Social anxiety disorder, performance only
- B. Agoraphobia
- C. Panic disorder
- D. Specific phobia
- E. Social anxiety disorder (Correct Answer)
Specific phobias Explanation: ***Social anxiety disorder***
- The girl's fear of being judged and talked about for using the school bathroom, despite no prior negative experiences, is a hallmark of **social anxiety disorder**. This anxiety leads to her avoiding a social situation (using public restrooms) and has functional impairment (recurrent UTIs).
- This condition involves significant anxiety about social situations where the individual might be scrutinized or negatively evaluated by others, often leading to avoidance and distress.
*Social anxiety disorder, performance only*
- **Social anxiety disorder, performance only** is characterized by anxiety only in speaking or performing in public.
- The patient's fear extends beyond performance situations to general social judgment related to using a public restroom.
*Agoraphobia*
- **Agoraphobia** involves fear of situations from which escape might be difficult or embarrassing, leading to avoidance of public transportation, open spaces, enclosed places, standing in line, or being outside the home alone.
- The patient's anxiety is specifically linked to social evaluation in a public restroom, not difficulty with escape or perceived helplessness in public spaces generally.
*Panic disorder*
- **Panic disorder** is characterized by recurrent, unexpected panic attacks, which are marked by intense fear and physical symptoms like palpitations, sweating, and shortness of breath.
- While the patient experiences anxiety, it is situation-specific (social evaluation) rather than unexpected panic attacks, and she describes crying, not a full-blown panic attack.
*Specific phobia*
- A **specific phobia** is an intense, irrational fear of a particular object or situation (e.g., spiders, heights, flying).
- The patient's fear is not of the bathroom itself, but of the **social judgment** and negative evaluation from peers if she uses it, which points to a social rather than a specific phobia.
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