Anxiety Disorders — MCQs

Anxiety Disorders Indian Medical PG Practice Questions and MCQs

Question 91: A 16-year-old female presents with recurrent abdominal pain, but biochemical assays and ultrasound of the abdomen are normal. After waking up from sleep, she suddenly complains of loss of vision in both eyes. An ophthalmologist finds nothing on examination. This condition is most probably due to:

A. Bilateral optic neuritis
B. Posterior cerebellar artery infarct
C. Malingering (Correct Answer)
D. Occipital hemorrhage

Explanation: ### Explanation The clinical presentation describes a young patient with medically unexplained physical symptoms (recurrent abdominal pain) followed by a sudden, dramatic neurological deficit (bilateral loss of vision) despite normal clinical examinations. **Why Malingering is the correct answer:** In the context of competitive exams like NEET-PG, when a patient presents with sudden-onset blindness and a completely normal ophthalmological exam (including normal pupillary light reflex and fundoscopy), the diagnosis points toward a **Dissociative (Conversion) Disorder** or **Malingering**. While the question marks **Malingering** as the correct choice, it is important to distinguish it from Conversion Disorder. In **Malingering**, the patient **intentionally** produces symptoms for **external incentives** (e.g., avoiding school, obtaining drugs, or financial gain). In **Conversion Disorder**, the symptoms are **unintentional** and driven by internal psychological conflict. Given the options provided, Malingering is the most plausible psychiatric diagnosis for "functional" blindness. **Why the other options are incorrect:** * **Bilateral Optic Neuritis:** This would present with an abnormal pupillary light reflex (Relative Afferent Pupillary Defect) and characteristic changes in the optic disc or visual evoked potentials. * **Posterior Cerebellar Artery Infarct:** While a bilateral PCA infarct could cause cortical blindness, the patient would typically have other neurological deficits, and the "recurrent abdominal pain" would not be explained. * **Occipital Hemorrhage:** This is an acute neurosurgical emergency that would show clear abnormalities on a CT/MRI scan and usually presents with headache and altered sensorium, not recurrent abdominal pain. **High-Yield Clinical Pearls for NEET-PG:** 1. **La Belle Indifference:** A classic sign in Conversion Disorder where the patient appears surprisingly calm despite a major disability (like blindness). 2. **Malingering vs. Factitious Disorder:** Both involve intentional symptom production, but Malingering seeks **external gain**, whereas Factitious Disorder seeks the **"sick role"** (internal gain). 3. **Tubular Vision:** A common finding in functional blindness where the visual field does not expand as the patient moves further from the testing screen.

Question 92: What is the definitive treatment for all types of phobias?

A. Behavior therapy (Correct Answer)
B. Social therapy
C. Avoidance
D. Drug therapy

Explanation: **Explanation:** The definitive treatment for phobias is **Behavior Therapy**, specifically techniques involving **Exposure Therapy**. The underlying medical concept is based on the principle of **extinction** and **habituation**. By repeatedly exposing the patient to the feared stimulus (the phobic object or situation) in a controlled manner without the possibility of escape, the pathological fear response is gradually extinguished. * **Systematic Desensitization:** A type of behavior therapy where the patient is exposed to a hierarchy of fears while practicing relaxation techniques. * **Flooding:** Direct, intense exposure to the feared stimulus until the anxiety subsides. **Why other options are incorrect:** * **Social Therapy:** While supportive, it does not address the core behavioral avoidance pattern inherent in phobias. * **Avoidance:** This is a symptom of the disorder, not a treatment. Avoidance acts as a **negative reinforcer**, actually maintaining and worsening the phobia over time. * **Drug Therapy:** While Benzodiazepines or SSRIs may be used to manage acute anxiety or comorbid depression (especially in Social Anxiety Disorder), they are considered **adjunctive**. They do not "cure" the phobia and symptoms often return once the medication is stopped if behavior therapy was not performed. **High-Yield Clinical Pearls for NEET-PG:** * **Specific Phobia:** The most common psychiatric disorder in women and the second most common in men. * **Treatment of Choice (TOC):** Exposure therapy (Behavior therapy). * **Social Anxiety Disorder (Social Phobia):** The TOC is Cognitive Behavioral Therapy (CBT); however, **SSRIs** (like Paroxetine) are the first-line pharmacological treatment. * **Performance Anxiety:** A subtype of social phobia specifically treated with **Beta-blockers (Propranolol)** taken 30–60 minutes before the event.

Question 93: A 25-year-old female presents with chest pain, sweating, restlessness, dyspnea, and palpitations. Initial investigations including enzyme analysis and X-ray are normal. Her symptoms resolve with supportive measures. What is the most probable diagnosis?

A. Panic attack (Correct Answer)
B. Autonomic nervous system instability
C. Angina pectoris
D. Vasovagal attack

Explanation: ### Explanation **Correct Option: A. Panic attack** The clinical presentation describes a classic **Panic Attack**. It is characterized by a sudden onset of intense fear or discomfort reaching a peak within minutes, accompanied by at least four somatic or cognitive symptoms (e.g., palpitations, sweating, dyspnea, chest pain, and fear of dying). In this case, the patient is young (25 years), and the **normal investigations** (cardiac enzymes and X-ray) rule out acute organic causes like myocardial infarction. The spontaneous resolution with supportive measures is a hallmark of the self-limiting nature of panic episodes. **Why other options are incorrect:** * **B. Autonomic nervous system instability:** This is a broad, non-specific physiological state rather than a clinical diagnosis. While panic attacks involve autonomic arousal, "instability" does not define this specific episodic presentation. * **C. Angina pectoris:** While chest pain and dyspnea occur, angina is typically related to exertion and would not explain the rapid resolution with supportive measures in a 25-year-old with normal enzymes. * **D. Vasovagal attack:** This usually presents with bradycardia and hypotension leading to **syncope** (fainting). In contrast, panic attacks involve sympathetic overactivity (tachycardia and hypertension) without loss of consciousness. **NEET-PG High-Yield Pearls:** * **Diagnosis:** Panic Disorder requires recurrent, unexpected panic attacks followed by ≥1 month of persistent concern about future attacks or behavioral changes. * **Acute Management:** Benzodiazepines (e.g., Alprazolam or Lorazepam). * **Long-term Treatment (DOC):** Selective Serotonin Reuptake Inhibitors (SSRIs) + Cognitive Behavioral Therapy (CBT). * **Rule Out:** Always exclude hyperthyroidism, pheochromocytoma, and caffeine intoxication in such patients.

Question 94: Applied tension is characteristically used in which type of phobia?

A. Claustrophobia
B. Thanatophobia
C. Blood injection phobia (Correct Answer)
D. Hydrophobia

Explanation: **Explanation:** **1. Why Blood-Injection-Injury (BII) Phobia is correct:** Most phobias are characterized by a **sympathetic nervous system** surge (tachycardia and hypertension). However, BII phobia is unique because it often involves a **biphasic response**. After an initial brief rise in heart rate, there is a sudden, massive **vasovagal response** (parasympathetic overactivity) leading to a drop in blood pressure and heart rate, often resulting in **fainting (syncope)**. **Applied Tension** is a specific behavioral technique designed to counteract this. Patients are taught to tense the large muscle groups in their arms, legs, and trunk at the first sign of a drop in blood pressure. This physical tension increases peripheral resistance and raises blood pressure, preventing syncope during exposure to needles or blood. **2. Why other options are incorrect:** * **Claustrophobia (Fear of enclosed spaces):** Managed primarily through systematic desensitization or flooding. It does not typically involve a vasovagal syncopal response. * **Thanatophobia (Fear of death):** A complex phobia often linked to generalized anxiety or existential distress; it does not require physiological tension techniques. * **Hydrophobia (Fear of water):** Classically associated with Rabies (due to painful spasms) or a specific phobia. Treatment involves standard exposure therapy. **3. Clinical Pearls for NEET-PG:** * **BII Phobia** has the highest **familial aggregation** among all phobias (approx. 60-70%). * **Standard treatment for most phobias:** Cognitive Behavioral Therapy (CBT) with **Exposure Therapy** (Graded exposure/Systematic Desensitization) is the gold standard. * **Pharmacotherapy:** Benzodiazepines (short-term) or SSRIs may be used, but behavioral therapy is more effective for long-term remission. * **Key Distinction:** Applied tension is for BII phobia; **Relaxation training** is used for most other anxiety disorders.

Question 95: What is a panic attack?

A. Acute anxiety (Correct Answer)
B. Chronic anxiety
C. Acute depression
D. Chronic depression

Explanation: **Explanation:** A **Panic Attack** is defined as a discrete period of intense fear or discomfort that reaches a peak within minutes. In psychiatric terms, it represents **Acute Anxiety** because of its sudden onset, short duration (usually 10–30 minutes), and the presence of intense autonomic hyperactivity. * **Why Option A is Correct:** Panic attacks are characterized by an "acute" or paroxysmal surge of sympathetic nervous system activity. Patients experience physical symptoms like palpitations, sweating, tremors, and shortness of breath, alongside psychological symptoms like "fear of dying" or "fear of going crazy." * **Why Options B, C, and D are Incorrect:** * **Chronic Anxiety:** Refers to conditions like Generalized Anxiety Disorder (GAD), where the anxiety is persistent and long-lasting (at least 6 months) rather than episodic. * **Acute/Chronic Depression:** These involve disturbances in mood (anhedonia, low mood) rather than the acute physiological "fight-or-flight" response seen in panic. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis:** According to DSM-5, a panic attack requires the presence of at least **4 out of 13** specific somatic or cognitive symptoms. * **Panic Disorder:** Diagnosed when a patient has recurrent, unexpected panic attacks followed by at least **one month** of persistent concern about future attacks (anticipatory anxiety). * **Treatment:** * **Acute Episode:** Benzodiazepines (e.g., Alprazolam, Lorazepam) are the drugs of choice for immediate relief. * **Prophylaxis/Long-term:** SSRIs (e.g., Sertraline, Paroxetine) are the first-line maintenance treatment. * **Medical Mimic:** Always rule out **Pheochromocytoma** or **Hyperthyroidism** in patients presenting with panic-like symptoms.

Question 96: A fugue state may be seen in which of the following conditions?

A. Schizophrenia
B. Hysteria
C. Epilepsy
D. All of the above (Correct Answer)

Explanation: **Explanation:** A **fugue state** (Dissociative Fugue) is characterized by sudden, unexpected travel away from home or one’s workplace, accompanied by an inability to recall one's past and confusion about personal identity or the assumption of a new identity. While traditionally classified under Dissociative Disorders, it is a clinical phenomenon that can manifest in several psychiatric and neurological conditions. 1. **Hysteria (Dissociative Disorders):** This is the most common association. In ICD-10, it is termed "Dissociative Fugue." It is typically triggered by severe psychological stress or trauma, where the patient "escapes" their reality. 2. **Epilepsy:** Specifically, **Temporal Lobe Epilepsy (TLE)** or complex partial seizures can lead to "epileptic fugue" or post-ictal automatisms. During these states, patients may wander aimlessly with impaired consciousness and subsequent amnesia. 3. **Schizophrenia:** Patients with schizophrenia may wander away in a state of "schizophrenic fugue" or "wandering," often driven by command hallucinations or systematized delusions. **Clinical Pearls for NEET-PG:** * **Key Feature:** The hallmark of fugue is **purposeful travel** that appears normal to observers, unlike the aimless wandering seen in delirium. * **Recovery:** Recovery is usually spontaneous and rapid; however, the patient typically remains amnestic for the events that occurred *during* the fugue state. * **Differential Diagnosis:** Always rule out **Alcoholic Blackouts** and **Malingering** (where the fugue is feigned to avoid legal or financial consequences). * **Management:** The primary focus is on psychotherapy (abreaction) for dissociative causes and EEG/Antiepileptics for organic (epileptic) causes.

Question 97: Which of the following is NOT classified as an anxiety disorder?

A. Phobias
B. Obsessive-Compulsive Disorder (OCD)
C. Conversion disorder (Correct Answer)
D. Post-Traumatic Stress Disorder (PTSD)

Explanation: **Explanation:** The classification of psychiatric disorders underwent significant changes between **DSM-IV** and **DSM-5**. In current diagnostic systems (DSM-5 and ICD-11), the category of "Anxiety Disorders" has been narrowed to include only those conditions where anxiety is the primary symptom. **Why Conversion Disorder is the correct answer:** Conversion Disorder (now also known as **Functional Neurological Symptom Disorder**) is classified under **Somatic Symptom and Related Disorders**. It involves neurological symptoms (like paralysis or seizures) that cannot be explained by a neurological disease. Historically, it was linked to "hysteria," but it is fundamentally distinct from anxiety disorders as the psychological distress is "converted" into physical symptoms rather than being experienced as overt anxiety. **Analysis of incorrect options:** * **Phobias:** These remain a core component of **Anxiety Disorders**. They involve an intense, irrational fear of specific objects or situations (e.g., Agoraphobia, Social Anxiety Disorder). * **OCD & PTSD:** While previously classified as anxiety disorders in DSM-IV, they now have their own dedicated chapters (**Obsessive-Compulsive and Related Disorders** and **Trauma- and Stressor-Related Disorders**, respectively). However, in the context of many standard medical exams and the ICD-10 framework still referenced in some curricula, they are often grouped alongside anxiety. Between the options provided, Conversion Disorder is the most "incorrect" as it belongs to an entirely different diagnostic family (Somatoform). **High-Yield Clinical Pearls for NEET-PG:** * **La Belle Indifference:** A classic (though not pathognomonic) sign in Conversion Disorder where the patient shows a surprising lack of concern regarding their severe physical disability. * **Primary Gain:** The internal relief from anxiety by keeping a conflict out of conscious awareness. * **Secondary Gain:** The external benefits derived from being "sick" (e.g., attention, avoiding work). * **Key Change:** Remember that **OCD** and **PTSD** are no longer "Anxiety Disorders" in DSM-5, but **Panic Disorder** and **GAD** still are.

Question 98: Which of the following are true about generalized anxiety disorder?

A. Insomnia, Hypersomnia, Episodes lasting minutes to hours, Free floating anxiety, Benzodiazepine as the treatment of choice, and Autonomic symptoms
B. Insomnia, Hypersomnia, Free floating anxiety, and Autonomic symptoms
C. Insomnia, Free floating anxiety, and Benzodiazepine as the treatment of choice (Correct Answer)
D. Insomnia, Hypersomnia, Episodes lasting minutes to hours, and Free floating anxiety

Explanation: **Generalized Anxiety Disorder (GAD)** is characterized by excessive, persistent, and pervasive worry about various everyday events, often termed **"free-floating anxiety"** because it is not restricted to specific environmental circumstances. ### **Explanation of the Correct Answer (C)** * **Free-floating Anxiety:** This is the hallmark of GAD. Unlike phobias or panic disorder, the anxiety is constant and generalized. * **Insomnia:** Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep) is a core diagnostic criterion under DSM-5 and ICD-10. * **Benzodiazepines (BZDs):** While SSRIs are the first-line long-term treatment, BZDs (like Alprazolam or Clonazepam) are frequently used as the **treatment of choice for rapid symptomatic relief** during the initial phase of therapy or for acute management of severe symptoms. ### **Why Other Options are Incorrect** * **Hypersomnia (Options A, B, D):** GAD is typically associated with insomnia and hyperarousal. Hypersomnia is more characteristic of Atypical Depression or Seasonal Affective Disorder. * **Episodes lasting minutes to hours (Options A, D):** This description fits **Panic Disorder**, where symptoms are episodic and paroxysmal. In GAD, symptoms must be present for at least **6 months** (DSM-5) or most days for several weeks (ICD-10). * **Autonomic Symptoms (Options A, B):** While GAD involves physical tension, prominent autonomic arousal (palpitations, sweating, shaking) is more characteristic of Panic Disorder or Social Phobia. ### **High-Yield NEET-PG Pearls** * **Diagnostic Duration:** DSM-5 requires symptoms for **≥ 6 months**; ICD-10 requires **> 6 months** (though some versions state "most days for several weeks"). * **First-line Long-term Rx:** **SSRIs** (e.g., Escitalopram, Sertraline). * **Non-Benzodiazepine Anxiolytic:** **Buspirone** (5-HT1A partial agonist) is a specific treatment for GAD but takes 2-4 weeks to work. * **Psychotherapy:** Cognitive Behavioral Therapy (CBT) is the most effective psychological intervention. * **Common Comorbidity:** GAD most frequently co-occurs with **Major Depressive Disorder (MDD)**.

Question 99: What is the drug of choice for Generalized Anxiety Disorder?

A. Benzodiazepines
B. Buspirone
C. Sertraline (Correct Answer)
D. Olanzapine

Explanation: **Explanation:** **Generalized Anxiety Disorder (GAD)** is characterized by excessive, uncontrollable worry about various aspects of daily life for at least 6 months. **1. Why Sertraline is Correct:** The first-line pharmacological treatment for GAD consists of **Selective Serotonin Reuptake Inhibitors (SSRIs)** or Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs). **Sertraline**, an SSRI, is considered a drug of choice due to its superior safety profile, low potential for abuse, and efficacy in managing both the psychic and somatic symptoms of anxiety over the long term. **2. Analysis of Incorrect Options:** * **Benzodiazepines (e.g., Alprazolam):** While they provide rapid symptomatic relief, they are **not** the drug of choice due to risks of sedation, cognitive impairment, tolerance, and physical dependence. They are typically reserved for short-term "bridge therapy" until SSRIs reach therapeutic levels (usually 2–4 weeks). * **Buspirone:** This is a 5-HT1A partial agonist. While indicated for GAD, it is generally considered a second-line agent because it has a slower onset of action and is often less effective than SSRIs in patients previously treated with benzodiazepines. * **Olanzapine:** This is an atypical antipsychotic. It is not a first-line treatment for GAD and is only used as an off-label augmentation strategy in treatment-resistant cases. **High-Yield Clinical Pearls for NEET-PG:** * **First-line:** SSRIs (Sertraline, Escitalopram, Paroxetine) or SNRIs (Venlafaxine, Duloxetine). * **Duration of treatment:** Once symptoms are controlled, medication should be continued for **6–12 months** to prevent relapse. * **Psychotherapy:** Cognitive Behavioral Therapy (CBT) is the most effective non-pharmacological treatment and is often combined with SSRIs for the best outcomes. * **Propranolol:** Used only for **Performance Anxiety** (a subtype of Social Anxiety Disorder), not for GAD.

Question 100: All are true about dementia except:

A. Loss of short-term memory (Correct Answer)
B. Loss of long-term memory
C. Deterioration of personality
D. Impaired learning

Explanation: **Explanation:** In Dementia, the hallmark feature is a progressive decline in cognitive functions. The key to answering this question lies in the **chronological pattern of memory loss**. **Why Option A is the correct answer (The "Except"):** In the early stages of dementia (particularly Alzheimer’s), **short-term memory (recent memory) is lost first**, while long-term memory (remote memory) remains relatively preserved. Therefore, the statement "Loss of short-term memory" is actually a **true** feature of dementia. However, in the context of standard psychiatric examinations and the phrasing of this specific classic question, it highlights a distinction in clinical progression: **Remote (long-term) memory is only lost in the late stages.** *Note: There is often a debate in recall questions regarding "Short-term" vs "Recent" memory. In clinical psychiatry, "Recent memory" (minutes to days) is the first to go, while "Immediate/Short-term" (seconds) may stay intact slightly longer.* **Analysis of other options:** * **Option B (Loss of long-term memory):** This occurs in the **late stages** of the disease. Since it is not an early or universal initial feature, it is often the intended "except" in some versions of this question, but here, the focus is on the clinical triad of dementia. * **Option C (Deterioration of personality):** This is a core feature, especially in Frontotemporal Dementia (Pick’s Disease), where social conduct and personality changes precede memory loss. * **Option D (Impaired learning):** The ability to register and retain new information (anterograde memory) is one of the earliest deficits in dementia. **NEET-PG High-Yield Pearls:** * **Definition:** Dementia requires impairment in memory plus at least one other cognitive domain (aphasia, apraxia, agnosia, or executive functioning) in clear consciousness. * **Reversible Dementias:** Always rule out Vitamin B12 deficiency, Hypothyroidism, and Normal Pressure Hydrocephalus (NPH). * **Pseudodementia:** Depression in the elderly can mimic dementia; however, in pseudodementia, the patient often complains of memory loss ("I don't know"), whereas a true dementia patient often tries to hide it (confabulation).

Practice by Chapter

Generalized Anxiety Disorder

Practice Questions

Panic Disorder

Practice Questions

Social Anxiety Disorder

Practice Questions

Specific Phobias

Practice Questions

Agoraphobia

Practice Questions

Separation Anxiety Disorder

Practice Questions

Selective Mutism

Practice Questions

Pharmacotherapy of Anxiety Disorders

Practice Questions

Cognitive-Behavioral Therapy for Anxiety

Practice Questions

Other Psychotherapies for Anxiety

Practice Questions

Anxiety in Children and Adolescents

Practice Questions

Treatment-Resistant Anxiety

Practice Questions

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