Generalized Anxiety Disorder — MCQs
A 28-year-old woman who reports being a "nervous person" and experiences chronic tension, exhibits symptoms of both sympathetic and parasympathetic nervous system activation, and has insomnia is most likely to be suffering from which condition?
What is the treatment of choice for acute panic attacks?
A 45-year-old male presents with recurrent episodes of palpitations, sweating, and a fear of losing control. He has been experiencing these episodes for the past six months. What is the most likely diagnosis?
The most common cause of hyperthyroidism in a young female is?
Which of the following is the treatment of choice for PTSD?
What is the drug of choice for treating generalized anxiety disorder?
A nondiabetic, nonhypertensive patient has occasional extra heartbeats. The doctor informed them it is benign, but the patient continues to seek investigations from doctor to doctor. This is a type of:
Specific phobias are best classified under which of the following categories?
A medical student presents with recurrent episodes of dyspnea, chest tightness, anxiety, and an impending sense of doom. Upon examination, all systemic conditions are found to be normal. She is then referred to psychiatry. What is the most likely diagnosis?
A 25-year-old presents with depression, anxiety, and unexplained physical symptoms for 6 months. Most likely diagnosis?
Generalized Anxiety Disorder Indian Medical PG Practice Questions and MCQs
Question 1: A 28-year-old woman who reports being a "nervous person" and experiences chronic tension, exhibits symptoms of both sympathetic and parasympathetic nervous system activation, and has insomnia is most likely to be suffering from which condition?
- A. Post-traumatic stress disorder
- B. Generalized anxiety disorder (Correct Answer)
- C. Obsessive-compulsive disorder
- D. Agoraphobia
Explanation: ***Generalized anxiety disorder*** - This condition is characterized by **persistent and excessive worry** about various aspects of life, often accompanied by physical symptoms of autonomic arousal, such as muscle tension, nervousness, and sleep disturbances (insomnia). - The patient's description of being a "nervous person" and experiencing **chronic tension** and insomnia, along with symptoms of both sympathetic and parasympathetic activation, is highly consistent with GAD. *Post-traumatic stress disorder* - This disorder typically develops after exposure to a **traumatic event** and involves symptoms such as re-experiencing the trauma, avoidance, negative alterations in cognition and mood, and hyperarousal. - While it can involve hyperarousal and sleep disturbances, the absence of a specified traumatic event and the focus on "nervousness" and "chronic tension" makes GAD a more direct fit. *Obsessive-compulsive disorder* - OCD involves **recurrent, intrusive thoughts (obsessions)** and repetitive behaviors or mental acts (compulsions) performed to alleviate anxiety. - The symptoms described do not include typical obsessions or compulsions, making this diagnosis less likely. *Agoraphobia* - This is an anxiety disorder characterized by intense fear and avoidance of situations where escape might be difficult or help unavailable, often involving public places or crowds. - While agoraphobia can cause anxiety and autonomic symptoms, the primary description of chronic tension and generalized nervousness is not the hallmark feature of this condition.
Question 2: What is the treatment of choice for acute panic attacks?
- A. Tricyclic antidepressants (TCAs)
- B. Monoamine oxidase inhibitors (MAOIs)
- C. Barbiturates
- D. Benzodiazepines (Correct Answer)
Explanation: ***Correct: Benzodiazepines*** - Benzodiazepines are the **treatment of choice for acute panic attacks** due to their **rapid onset of action** (within minutes) - They work by enhancing **GABA-A receptor** activity, providing immediate anxiolytic effects - Commonly used agents include **alprazolam, lorazepam, and clonazepam** - While effective acutely, they are not recommended for long-term management due to dependence risk *Incorrect: Tricyclic antidepressants (TCAs)* - TCAs are effective for **long-term prophylaxis** of panic disorder, not acute attacks - They have a **delayed onset of action** (2-4 weeks), making them unsuitable for immediate relief - Significant **anticholinergic effects** and potential cardiotoxicity limit their use *Incorrect: Monoamine oxidase inhibitors (MAOIs)* - MAOIs can be effective for panic disorder but are reserved for **treatment-resistant cases** - **Delayed onset of action** (several weeks) makes them inappropriate for acute attacks - Require **dietary restrictions** and have risk of hypertensive crisis with tyramine-containing foods *Incorrect: Barbiturates* - Largely **obsolete** in psychiatric practice, replaced by safer benzodiazepines - **Narrow therapeutic index** with high risk of overdose and respiratory depression - Greater potential for dependence and withdrawal complications - No role in modern management of panic attacks
Question 3: A 45-year-old male presents with recurrent episodes of palpitations, sweating, and a fear of losing control. He has been experiencing these episodes for the past six months. What is the most likely diagnosis?
- A. Generalized anxiety disorder
- B. Panic disorder (Correct Answer)
- C. Social anxiety disorder
- D. Obsessive-compulsive disorder
Explanation: ***Panic disorder*** - The presentation of recurrent, unexpected **panic attacks** characterized by sudden episodes of intense fear, palpitations, sweating, and a fear of losing control is classic for **panic disorder**. - These episodes often manifest with physical symptoms that mimic a medical emergency, leading to significant distress and avoidance behaviors. *Generalized anxiety disorder* - This condition involves **persistent and excessive worry** about various life circumstances for at least six months, rather than discrete, intense episodes of fear. - While physical symptoms like restlessness and fatigue can occur, they are generally less acute and not as severe as the sudden "fight-or-flight" response seen in panic attacks. *Social anxiety disorder* - This disorder is characterized by marked fear or anxiety about **social situations** where the individual might be scrutinized by others. - While it can involve symptoms like palpitations and sweating in social contexts, it doesn't typically present with unexpected attacks unrelated to social performance. *Obsessive-compulsive disorder* - This disorder is defined by the presence of **obsessions** (recurrent and persistent thoughts, urges, or images) and/or **compulsions** (repetitive behaviors or mental acts) that the individual feels driven to perform. - The symptoms described—palpitations, sweating, and fear of losing control—are not typical primary manifestations of OCD, which focuses on specific obsessions and compulsions.
Question 4: The most common cause of hyperthyroidism in a young female is?
- A. TSH-secreting pituitary adenoma
- B. Graves' disease (Correct Answer)
- C. Subacute thyroiditis
- D. Toxic multinodular goiter
Explanation: ***Graves' disease*** - This is an **autoimmune disorder** where antibodies stimulate the thyroid gland, leading to **overproduction of thyroid hormones** [1], [2]. - It is the **most common cause of hyperthyroidism** in young to middle-aged women, making it highly probable in a young female patient [1], [2]. *Toxic multinodular goiter* - This condition is characterized by **multiple nodules** within the thyroid gland that autonomously produce thyroid hormones. - While a cause of hyperthyroidism, it is **more common in older individuals**, typically those over 50 years of age. *Subacute thyroiditis* - This is a **self-limiting inflammatory condition** of the thyroid often following a viral infection, causing a transient hyperthyroid phase due to the release of preformed hormones. - It presents with **painful thyroid enlargement** and is usually followed by a hypothyroid phase, which is different from sustained hyperthyroidism. *TSH-secreting pituitary adenoma* - This is a **very rare cause of hyperthyroidism** where a pituitary tumor produces excess **Thyroid-Stimulating Hormone (TSH)**, leading to thyroid overstimulation. - It is often accompanied by other symptoms of a pituitary mass like **headaches or visual field defects**, which are not implied here.
Question 5: Which of the following is the treatment of choice for PTSD?
- A. Benzodiazepines
- B. Mood stabilizers
- C. Antipsychotics
- D. SSRIs (Correct Answer)
Explanation: ***SSRIs*** - **Selective serotonin reuptake inhibitors (SSRIs)** are considered first-line pharmacological treatment for **Post-Traumatic Stress Disorder (PTSD)** due to their efficacy in reducing core PTSD symptoms like re-experiencing, avoidance, and hyperarousal. - They work by increasing the availability of **serotonin** in the brain, positively impacting mood, anxiety, and sleep regulation. *Benzodiazepines* - While benzodiazepines can provide rapid relief for acute anxiety, they are generally **not recommended as a primary treatment for PTSD** due to risks of dependence and masking underlying symptoms. - They do not address the core symptoms of PTSD and can worsen long-term outcomes, especially in individuals with a history of substance abuse. *Mood stabilizers* - Mood stabilizers, such as lithium or valproate, are primarily used for conditions like **bipolar disorder** or certain **personality disorders** characterized by significant mood swings. - They are **not a first-line treatment for PTSD** and are typically reserved for cases with prominent **affective dysregulation** not managed by other medications, or comorbid bipolar disorder. *Antipsychotics* - Antipsychotics are primarily indicated for conditions with **psychotic features**, such as schizophrenia or severe bipolar disorder with psychosis. - They are **not routinely used as monotherapy for PTSD** but may be considered as an augmentation strategy in severe, refractory cases, especially when there are prominent **dissociative symptoms**, paranoia, or aggression.
Question 6: What is the drug of choice for treating generalized anxiety disorder?
- A. Alprazolam
- B. Buspirone (Correct Answer)
- C. Phenytoin
- D. β-blocker
Explanation: ***Buspirone*** - **Buspirone** is a non-benzodiazepine anxiolytic that is effective for generalized anxiety disorder (GAD) and has a lower risk of dependence and sedation compared to benzodiazepines. - It acts as a partial agonist at **5-HT1A serotonin receptors**, which contributes to its anxiolytic effects without affecting GABAergic systems. *β-blocker* - **β-blockers** are primarily used to manage the **physical symptoms of anxiety**, such as palpitations and tremors, often in performance anxiety, rather than the core cognitive and emotional symptoms of GAD. - They do not address the underlying psychological aspects of generalized anxiety. *Alprazolam* - **Alprazolam** is a **benzodiazepine** that provides rapid relief of anxiety symptoms but carries a significant risk of **dependence, withdrawal, and sedation**, making it less suitable for long-term treatment of GAD. - Due to these risks, benzodiazepines are typically reserved for short-term use or acute anxiety management rather than as a first-line treatment for chronic GAD. *Phenytoin* - **Phenytoin** is an **antiepileptic drug** primarily used to treat seizures and does not have a recognized role in the management of generalized anxiety disorder. - Its mechanism of action involves stabilizing neuronal membranes and is unrelated to the neurochemical pathways targeted in anxiety disorders.
Question 7: A nondiabetic, nonhypertensive patient has occasional extra heartbeats. The doctor informed them it is benign, but the patient continues to seek investigations from doctor to doctor. This is a type of:
- A. Depression
- B. Conversion disorder
- C. Somatoform pain
- D. Illness Anxiety Disorder (Correct Answer)
Explanation: ***Illness Anxiety Disorder*** - This condition is characterized by **preoccupation with having or acquiring a serious illness**, despite minimal or no somatic symptoms, or an excessive preoccupation if symptoms are present. - The patient's repeated seeking of investigations despite medical assurance of a benign condition aligns with the diagnostic criteria of **illness anxiety disorder**, where reassurance has little effect. *Depression* - While **depressive symptoms** (e.g., low mood, anhedonia) can coexist with health anxieties, the primary driver here is the fear of serious illness rather than pervasive sadness or loss of interest. - Patients with depression typically report a **generalized dysphoria** or lack of energy, which is not the central issue described. *Conversion disorder* - Involves **neurological symptoms** (e.g., paralysis, blindness, seizures) that are incompatible with recognized neurological conditions and are not intentionally produced. - The patient's concern is about a benign cardiac finding, not the sudden onset of **functional neurological deficits**. *Somatoform pain* - This term is older and has largely been replaced by **Somatic Symptom Disorder with predominant pain**, where psychological factors play a significant role in the onset, severity, exacerbation, or maintenance of pain. - The patient's main concern is about the **implication of a benign symptom** rather than experiencing overwhelming pain itself.
Question 8: Specific phobias are best classified under which of the following categories?
- A. Mood disorders
- B. Psychotic disorders
- C. Personality disorders
- D. Anxiety disorders (Correct Answer)
Explanation: **Anxiety disorders** - **Specific phobias** are characterized by marked and persistent fear of a specific object or situation, which falls under the umbrella of **anxiety disorders**. - The core feature is intense anxiety or panic when exposed to the phobic stimulus, leading to avoidance behavior. *Psychotic disorders* - These involve a significant loss of contact with reality, often featuring **hallucinations, delusions**, or disorganized thought and speech. - Specific phobias do not involve such a profound disruption of reality or psychotic symptoms. *Mood disorders* - These are primarily characterized by a disturbance in the person's sustained emotional state, such as **depression (low mood)** or **mania (elevated mood)**. - While anxiety can co-occur with mood disorders, specific phobias are distinct conditions defined by their fear response to specific triggers. *Personality disorders* - These are characterized by **enduring patterns of inner experience and behavior** that deviate significantly from cultural expectations, are pervasive and inflexible, and cause distress or impairment. - Specific phobias are not considered deeply ingrained, pervasive patterns of relating to the world, but rather a focused fear response.
Question 9: A medical student presents with recurrent episodes of dyspnea, chest tightness, anxiety, and an impending sense of doom. Upon examination, all systemic conditions are found to be normal. She is then referred to psychiatry. What is the most likely diagnosis?
- A. Panic disorder (Correct Answer)
- B. Depression
- C. Epilepsy
- D. Asthma
Explanation: ***Panic disorder*** - The sudden onset of intense anxiety, accompanied by **physical symptoms** like dyspnea and chest tightness, and a feeling of **impending doom** despite normal systemic findings, is characteristic of a panic attack. - Recurrent, unexpected panic attacks lead to a diagnosis of panic disorder, often with significant **anticipatory anxiety** between attacks. *Depression* - While depression can cause symptoms like fatigue, low mood, and anhedonia, it typically does not present with acute, episodic **panic symptoms** and a sense of impending doom in this manner. - The primary symptoms are usually persistent sadness, loss of interest, and often do not involve sudden, acute physiological arousal of this intensity. *Epilepsy* - Epileptic seizures involve abnormal electrical activity in the brain, often presenting with **motor, sensory, or cognitive disruptions**, sometimes with loss of consciousness. - Although some seizures can have autonomic symptoms or an aura of fear, the constellation of symptoms (dyspnea, chest tightness, impending doom) with a clear psychological component and normal systemic exam points away from epilepsy as the primary diagnosis. *Asthma* - Asthma is a chronic respiratory condition characterized by **airway inflammation and bronchoconstriction**, leading to symptoms like dyspnea, wheezing, and chest tightness. - However, in asthma, physical examination would likely reveal abnormal lung sounds (e.g., **wheezing**), and systemic conditions would not be entirely normal, especially during an exacerbation.
Question 10: A 25-year-old presents with depression, anxiety, and unexplained physical symptoms for 6 months. Most likely diagnosis?
- A. Somatic symptom disorder
- B. Major depressive disorder (Correct Answer)
- C. Illness anxiety disorder
- D. Adjustment disorder
Explanation: ***Major depressive disorder*** - MDD commonly presents with **somatic symptoms** in addition to psychological symptoms, especially in Indian/Asian populations where up to 60-70% of depressed patients present with prominent physical complaints. - The triad of **depression, anxiety, and unexplained physical symptoms** for 6 months is characteristic of MDD with somatic features. - Common somatic manifestations include: headaches, body aches, fatigue, gastrointestinal symptoms, and other unexplained physical complaints. - The presence of depression and anxiety as **primary features** (not secondary to health concerns) points toward MDD rather than a somatic symptom disorder. *Somatic symptom disorder* - Requires **one or more somatic symptoms** PLUS excessive thoughts, feelings, or behaviors related to those symptoms (e.g., disproportionate concerns about seriousness, persistent high anxiety about health, excessive time/energy devoted to symptoms). - The **primary focus** would be the physical symptoms and health-related anxiety, not depression/anxiety as independent features. - The stem lacks evidence of excessive preoccupation or maladaptive responses to the somatic symptoms. *Illness anxiety disorder* - Characterized by **preoccupation with having or acquiring a serious illness** with no or only mild somatic symptoms present. - The focus is on the fear of being sick rather than distress from actual physical symptoms. - Does not primarily present with depression as a core feature. *Adjustment disorder* - Requires **identifiable stressor** with symptoms developing within 3 months of stressor onset. - Symptoms are expected to resolve within 6 months after the stressor ends. - No stressor is mentioned in this case, and the 6-month duration without mention of stressor resolution makes this less likely.
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