Anxiety Disorders Practice Questions

Q: Young adult female who was bullied in class throughout school period, later on in life she started having stage fear, anxiety, low mood. What is the cause of her diagnosis?

Social anxiety disorder. ***Social anxiety disorder*** - The patient's history of **bullying** serves as a significant **psychosocial stressor** that frequently predisposes individuals to develop a marked, persistent fear of social or performance situations. - Symptoms like **stage fear**, **anxiety**, and **low mood** in the context of feared social interactions are clinical hallmarks of **social anxiety disorder (social phobia)**. *Personality disorder* - Characterized by enduring maladaptive patterns of inner experience and behavior that deviate from cultural expectations, typically manifesting in **adolescence** or early adulthood. - While bullying can be a risk factor, the specific clinical presentation given is more characteristic of an **anxiety disorder** rather than a personality dysfunction such as **avoidant** or **borderline**. *Anxiety disorder* - While this diagnosis is technically in the same umbrella, it is a broad category; **social anxiety disorder** is the specific, precise diagnosis for fear centered around performance and social scrutiny. - A general diagnosis of anxiety does not account for the specific **trigger** (performance/social observation) described in the patient's history. *Peer pressure* - This describes an **environmental influence** or social phenomenon rather than a psychiatric diagnosis or clinical condition. - While negative peer experiences can contribute to developing pathology, it acts as an **etiological factor** rather than the diagnosis itself.

Q: All of the following are seen in generalized anxiety disorder (GAD), EXCEPT:

Fear of impending doom. **Explanation:** The correct answer is **C. Fear of impending doom**. In psychiatry, it is crucial to distinguish between **Generalized Anxiety Disorder (GAD)** and **Panic Disorder**. GAD is characterized by "free-floating anxiety"—a persistent, pervasive, and excessive worry about everyday events (finances, health, work) lasting for at least **6 months**. In contrast, a **"Fear of impending doom"** (or fear of dying/losing control) is a hallmark symptom of a **Panic Attack**. Panic attacks are discrete, intense periods of fear that peak within minutes, whereas GAD is a chronic, low-grade state of tension. **Analysis of Options:** * **A. Muscle tension:** This is a core somatic symptom of GAD. Patients often present with "tension headaches" or backaches due to chronic muscle rigidity. * **B. Irritability:** Chronic worry often leads to a low threshold for frustration, making irritability a diagnostic criterion in DSM-5. * **D. Restlessness:** Also described as feeling "keyed up" or "on edge," this reflects the psychomotor agitation common in GAD. **High-Yield Clinical Pearls for NEET-PG:** * **DSM-5 Criteria for GAD:** Anxiety + at least 3 of 6 symptoms: Restlessness, Easy fatigability, Difficulty concentrating, Irritability, Muscle tension, and Sleep disturbance. * **Duration:** Symptoms must be present for ≥ 6 months. * **Drug of Choice (DOC):** SSRIs (e.g., Escitalopram) are the first-line long-term treatment. Benzodiazepines are used only for short-term symptomatic relief. * **Psychotherapy:** Cognitive Behavioral Therapy (CBT) is the most effective psychological intervention.

Q: Phobia associated with elevators is an example of which of the following?

Claustrophobia. ### Explanation **Correct Answer: C. Claustrophobia** **Reasoning:** Claustrophobia is defined as the irrational and intense fear of **enclosed or confined spaces**. Elevators are a classic clinical example of a confined space where the individual feels trapped or fears having a panic attack without an easy means of escape. In psychiatry, phobias are categorized under Specific Phobias (ICD-11/DSM-5), characterized by marked anxiety about a specific object or situation. **Analysis of Incorrect Options:** * **A. Acrophobia:** This is the morbid fear of **heights**. While elevators travel to high floors, the primary trigger in an elevator is the confinement (walls/lack of exit), not necessarily the altitude itself. * **B. Social Phobia (Social Anxiety Disorder):** This involves a fear of **scrutiny or humiliation** in social or performance situations (e.g., public speaking). It is not related to physical spaces. * **C. Algophobia:** This is the pathological fear of **pain**. It is unrelated to environmental or situational triggers like elevators. **High-Yield Clinical Pearls for NEET-PG:** * **Treatment of Choice:** For specific phobias, the most effective treatment is **Cognitive Behavioral Therapy (CBT)** with **Exposure Therapy** (specifically Systematic Desensitization or Flooding). * **Pharmacotherapy:** Benzodiazepines or Beta-blockers (like Propranolol) may be used for short-term symptomatic relief or performance-related anxiety, but they are not first-line for long-term management of specific phobias. * **Common Phobia Terminologies:** * *Agoraphobia:* Fear of open spaces or situations where escape is difficult. * *Nyctophobia:* Fear of darkness. * *Ailurophobia:* Fear of cats. * *Cynophobia:* Fear of dogs.

Q: Which of the following is NOT true regarding anxiety?

Anxiety is always pathological.. ### Explanation **Correct Answer: D. Anxiety is always pathological.** **1. Why Option D is the correct answer:** Anxiety is a universal human experience and is not inherently a disease. It exists on a spectrum. **Normal (Physiological) Anxiety** is a transient, appropriate response to a perceived threat or stressor (e.g., the day before the NEET-PG exam). It becomes **Pathological Anxiety** only when it is disproportionate to the stimulus, persists in the absence of a threat, or significantly impairs social and occupational functioning. Therefore, the statement that anxiety is "always" pathological is false. **2. Analysis of Incorrect Options:** * **Option A (Adaptive response):** Anxiety is evolutionarily designed to help an individual prepare for challenges. According to the **Yerkes-Dodson Law**, a certain level of anxiety (arousal) actually improves performance on tasks. * **Option B (Alert signal):** Anxiety serves as an internal warning system, signaling the presence of an impending danger (internal or external) and prompting the individual to take measures to quickly deal with the threat. * **Option C (Autonomic hyperactivity):** The physiological manifestation of anxiety involves the activation of the sympathetic nervous system (the "fight or flight" response). This leads to symptoms such as tachycardia, palpitations, sweating, tremors, and tachypnea. **3. NEET-PG High-Yield Pearls:** * **Anxiety vs. Fear:** Fear is a response to a known, external, definite threat; Anxiety is a response to an unknown, internal, vague, or conflictual threat. * **Neurotransmitters:** Anxiety is typically associated with **decreased GABA**, **decreased Serotonin**, and **increased Norepinephrine** levels in the brain. * **Physical Symptoms:** Always rule out medical causes (e.g., Hyperthyroidism, Pheochromocytoma, or Arrhythmias) before diagnosing a primary anxiety disorder.

Q: All of the following are treatment modalities used in Generalized Anxiety Disorder, EXCEPT?

Caffeine. **Explanation:** **Generalized Anxiety Disorder (GAD)** is characterized by excessive, persistent, and uncontrollable worry about everyday events for at least 6 months. The management involves a combination of pharmacotherapy and psychotherapy. **Why Caffeine is the Correct Answer:** Caffeine is a **methylxanthine** that acts as a central nervous system stimulant. It antagonizes adenosine receptors, leading to increased release of excitatory neurotransmitters like norepinephrine. In patients with GAD, caffeine is **contraindicated** as it can exacerbate symptoms of anxiety, cause palpitations, tremors, and insomnia, and even trigger panic attacks. It is a known "anxiogenic" substance rather than a treatment modality. **Analysis of Incorrect Options:** * **Antidepressants (A):** These are the **first-line pharmacological treatment** for GAD. Selective Serotonin Reuptake Inhibitors (SSRIs) like Escitalopram and Sertraline, and SNRIs like Venlafaxine, are highly effective for long-term management. * **Electroconvulsive therapy (B):** While not a first-line treatment, ECT is a recognized modality in psychiatry for **treatment-resistant** cases of severe anxiety disorders, especially when comorbid with severe depression or suicidal ideation. * **Cognitive Behavioral Therapy (C):** CBT is the **first-line psychotherapy**. It focuses on identifying maladaptive thought patterns (cognitive restructuring) and behavioral modifications to reduce worry. **High-Yield Clinical Pearls for NEET-PG:** * **First-line drug class:** SSRIs (e.g., Escitalopram). * **Drug for performance anxiety:** Propranolol (Beta-blocker). * **Benzodiazepines:** Used only for short-term symptomatic relief due to the risk of dependence. * **Buspirone:** A 5-HT1A partial agonist specifically used for GAD; it has a slow onset of action (2–4 weeks) and no abuse potential.

Q: Which of the following substances is not involved in panic disorder?

GABA. **Explanation:** In the neurobiology of panic disorder, the primary neurotransmitters implicated are **Serotonin, Norepinephrine, and GABA**. The question asks which substance is **not** involved; however, based on standard psychiatric literature (Kaplan & Sadock), GABA is heavily involved via the benzodiazepine-GABA receptor complex. *Note: In many competitive exams, if this specific question appears with these options, it is often considered a "controversial" or "recall-error" question because all four substances actually play a role. However, looking at the provided key:* 1. **GABA (Correct as per key):** While GABA is the primary inhibitory neurotransmitter and GABA-A receptor dysfunction is linked to anxiety, some older curricula focused more heavily on the "excitatory" triggers of panic. If GABA is the marked answer, it implies that its role is considered secondary or modulatory compared to the direct "panicogens." 2. **Serotonin (Option A):** Definitely involved. SSRIs are the first-line treatment for panic disorder, and serotonergic dysregulation in the raphe nuclei is a core feature. 3. **CCK (Cholecystokinin) (Option B):** CCK is a potent **panicogen**. Administration of CCK tetrapeptide (CCK-4) reliably induces panic attacks in humans. 4. **Glutamate (Option C):** As the primary excitatory neurotransmitter, glutamate is involved in the "fear circuitry" (amygdala and hippocampus) and the conditioned fear response seen in panic disorder. **NEET-PG High-Yield Pearls:** * **Panicogens (Substances that induce panic):** Carbon dioxide (5-35%), Sodium Lactate, CCK, Caffeine, and Yohimbine. * **Neuroanatomy:** The **Amygdala** is the "fear center," and the **Locus Coeruleus** (norepinephrine) is the "alarm center" involved in panic. * **Treatment:** SSRIs are the long-term drug of choice; Benzodiazepines (acting on GABA) are used for acute management.

Question 1

Young adult female who was bullied in class throughout school period, later on in life she started having stage fear, anxiety, low mood. What is the cause of her diagnosis?

Accepted Answer

Social anxiety disorder

Answer

Personality disorder

Answer

Anxiety disorder

Answer

Peer pressure

Question 2

Anxiety states can be induced by all of the following except?

Accepted Answer

Cholecystokinin

Answer

Yohimbine

Answer

Sodium Lactate

Answer

Isoproterenol

Question 3

A woman reports an inability to urinate in public restrooms due to embarrassment, which significantly restricts her ability to leave home. What is the most appropriate diagnosis?

Accepted Answer

Social phobia

Answer

Specific phobia

Answer

Separation anxiety disorder

Answer

Post-traumatic stress disorder

Question 4

All of the following are seen in generalized anxiety disorder (GAD), EXCEPT:

Accepted Answer

Fear of impending doom

Answer

Muscle tension

Answer

Irritability

Answer

Restlessness

Question 5

Phobia associated with elevators is an example of which of the following?

Accepted Answer

Claustrophobia

Answer

Acrophobia

Answer

Social phobia

Answer

Algophobia

Question 6

Which of the following is NOT true regarding anxiety?

Accepted Answer

Anxiety is always pathological.

Answer

Anxiety is an adaptive response.

Answer

Anxiety acts as an alert signal.

Answer

Anxiety can manifest as autonomic hyperactivity.

Question 7

All of the following are treatment modalities used in Generalized Anxiety Disorder, EXCEPT?

Accepted Answer

Caffeine

Answer

Antidepressants

Answer

Electroconvulsive therapy

Answer

Cognitive behavioral therapy

Question 8

Which of the following conditions does NOT typically present with symptoms resembling a panic attack?

Accepted Answer

Generalized tonic-clonic seizure (GTCS)

Answer

Hypoglycemia

Answer

Myocardial infarction

Answer

Temporal lobe epilepsy

Question 9

Which of the following substances is not involved in panic disorder?

Accepted Answer

GABA

Answer

Serotonin

Answer

CCK

Answer

Glutamate

Question 10

A 36-year-old man presents with a long-standing history of fainting and blurred vision, particularly when travelling on public transport. These symptoms are less severe when travelling in his wife's car. He avoids public transportation and has become homebound, with his wife now managing household tasks and shopping. He reports experiencing episodes of racing heart, sweating, and intense fear, which he associates with past negative experiences at work. What is the most likely diagnosis?

Accepted Answer

Agoraphobia

Answer

Social phobia

Answer

Generalized Anxiety Disorder

Answer

Post-Traumatic Stress Disorder

Anxiety Disorders — MCQs

Anxiety Disorders — MCQs

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