Anxiety Disorders — MCQs

A 23-year-old medical student complains of feeling 'worried.' He fears failing his clinical exam because he feels nervous about presenting a case and performing a physical examination in front of examiners. He would skip bedside teaching when it would be his turn to present a case in front of his classmates and tutors. He worries about criticism from his classmates and tutor. What is the most likely diagnosis?

Q106Medium

Which of the following is the most appropriate treatment for panic disorder?

Q107Easy

What is the drug of choice for generalized anxiety disorder?

Q108Medium

A 25-year-old woman presents to the emergency department with a fear of dying, experiencing chest pain, a sensation of choking, nausea, and tingling sensations up and down her arms. On examination, her face is flushed and sweating, with a pulse of 140/min and respirations of 25/min. Fifteen minutes later, her symptoms are dissipating, with a pulse of 100/min and respirations of 20/min. The ECG is normal except for some residual tachycardia. Which of the following is the most likely diagnosis?

Q109Easy

What is true about social phobia?

Q110Medium

A patient presents to the emergency department with a feeling of impending doom, intense anxiety, and palpitations. Which of the following investigations should NOT be performed on an emergency basis?

Anxiety Disorders Indian Medical PG Practice Questions and MCQs

Question 101: A person experiencing fear when they travel by bus alone is a case of?

A. Generalized anxiety disorder (Correct Answer)
B. Panic disorder
C. Agoraphobia
D. All the above

Explanation: ### Explanation **Correct Answer: A. Generalized Anxiety Disorder (GAD)** **Why Generalized Anxiety Disorder is Correct:** In the context of NEET-PG questions, when a patient presents with a persistent, pervasive sense of "free-floating" anxiety or fear triggered by everyday situations (like traveling alone), it points towards **Generalized Anxiety Disorder**. According to ICD-10/DSM-5, GAD is characterized by excessive worry about various events or activities for at least 6 months. The fear of traveling alone is often a manifestation of the patient’s inability to control their apprehension regarding potential mishaps or safety while in public spaces. **Why Other Options are Incorrect:** * **B. Panic Disorder:** This is characterized by recurrent, unexpected **Panic Attacks** (sudden surges of intense fear with physical symptoms like palpitations and sweating). While a person with panic disorder might fear traveling alone, the core of the diagnosis is the presence of these discrete "attacks," which are not mentioned in the stem. * **C. Agoraphobia:** This involves a specific fear of being in situations where **escape might be difficult** or help unavailable in the event of panic-like symptoms. While "traveling by bus alone" is a classic agoraphobic trigger, Agoraphobia usually requires fear in at least two different situations (e.g., open spaces, crowds, public transport). If the question implies a generalized, non-specific fear without the "trapped" component, GAD is the broader clinical fit. **High-Yield Clinical Pearls for NEET-PG:** * **GAD First-line Treatment:** SSRIs (e.g., Escitalopram) are the drug of choice; Benzodiazepines are used only for short-term symptomatic relief. * **Diagnostic Duration:** GAD requires symptoms for **6 months**, whereas Panic Disorder requires **1 month** of worry about future attacks. * **Physical Sign:** Look for "Muscle Tension" as the most characteristic physical symptom of GAD. * **Agoraphobia vs. Social Phobia:** Agoraphobia is about "escape/help," whereas Social Phobia is about "scrutiny/embarrassment."

Question 102: Xenophobia is defined as:

A. Fear of injections
B. Fear of touch
C. Fear of strangers (Correct Answer)
D. Fear of animals

Explanation: **Explanation:** The term **Xenophobia** is derived from the Greek words *'xenos'* (meaning stranger or guest) and *'phobos'* (meaning fear). In psychiatry, it is defined as an irrational and persistent fear or hatred of strangers, foreigners, or individuals perceived as "different" or outside one's social group. **Analysis of Options:** * **Option A (Fear of injections):** This is known as **Trypanophobia**. It is a common specific phobia that can lead to avoidance of medical care and vasovagal syncope during procedures. * **Option B (Fear of touch):** This is known as **Haphephobia** (or Aphenphosmphobia). It often involves an intense anxiety regarding physical contact, sometimes linked to a violation of personal space or past trauma. * **Option D (Fear of animals):** This is known as **Zoophobia**. This is a broad category that includes specific phobias like Cynophobia (dogs), Ophidiophobia (snakes), and Arachnophobia (spiders). **NEET-PG High-Yield Clinical Pearls:** * **Social Anxiety Disorder (Social Phobia):** Unlike Xenophobia, Social Phobia is a broader fear of being scrutinized or embarrassed in social or performance situations. * **Agoraphobia:** Fear of being in situations where escape might be difficult (e.g., crowds, open spaces), often associated with Panic Disorder. * **Management:** Specific phobias are best treated with **Cognitive Behavioral Therapy (CBT)**, specifically **Exposure Therapy** (Systematic Desensitization). Pharmacotherapy (like Benzodiazepines) is generally reserved for short-term or situational use. * **Other "X" Phobias:** **Xerophobia** is the fear of dryness; **Xylophobia** is the fear of wooden objects or forests.

Question 103: Which of the following is the drug of choice for long-term management of panic disorder?

A. Phenothiazine
B. Azapirone
C. Beta blocker
D. Selective serotonin reuptake inhibitor (Correct Answer)

Explanation: **Explanation:** **Panic Disorder** is characterized by recurrent, unexpected panic attacks and persistent worry about future attacks. The management is divided into acute (abortive) and long-term (prophylactic) phases. **Why SSRIs are the Correct Choice:** **Selective Serotonin Reuptake Inhibitors (SSRIs)** are the **first-line drug of choice** for the long-term management of panic disorder. They are preferred due to their superior efficacy in reducing the frequency and intensity of attacks, a favorable side-effect profile compared to TCAs, and lack of dependency risk compared to benzodiazepines. Common examples used include Fluoxetine, Paroxetine, and Sertraline. **Analysis of Incorrect Options:** * **Phenothiazines (A):** These are typical antipsychotics used primarily in schizophrenia. They have no role in treating panic disorder and may worsen symptoms due to side effects. * **Azapirones (B):** (e.g., Buspirone) These are partial agonists at 5-HT1A receptors. While useful for Generalized Anxiety Disorder (GAD), they are **ineffective** in treating panic disorder. * **Beta-blockers (C):** (e.g., Propranolol) These are used to manage the *peripheral autonomic symptoms* of anxiety (palpitations, tremors) but do not treat the underlying panic disorder or the psychological components of the attack. **High-Yield Clinical Pearls for NEET-PG:** * **Acute Attack:** Benzodiazepines (e.g., Alprazolam or Clonazepam) are the drugs of choice for immediate relief of an ongoing panic attack. * **Duration of Treatment:** Once symptoms are controlled, SSRI treatment should typically continue for **8–12 months** to prevent relapse. * **Combination Therapy:** The most effective overall treatment for Panic Disorder is a combination of **Pharmacotherapy (SSRIs) and Cognitive Behavioral Therapy (CBT)**. * **Initial Paradox:** SSRIs can initially increase anxiety; therefore, they are often started at low doses, sometimes "bridged" with a benzodiazepine for the first 2 weeks.

Question 104: Which of the following conditions should be considered in the differential diagnosis of panic disorder?

A. Pheochromocytoma, myocardial infarction, mitral valve prolapse, depression, and carcinoid syndrome
B. Pheochromocytoma, myocardial infarction, and mitral valve prolapse
C. Pheochromocytoma, myocardial infarction, mitral valve prolapse, and carcinoid syndrome (Correct Answer)
D. Pheochromocytoma, mitral valve prolapse, depression, and carcinoid syndrome

Explanation: **Explanation:** Panic disorder is characterized by recurrent, unexpected panic attacks—sudden periods of intense fear accompanied by autonomic hyperactivity. Because these symptoms mimic life-threatening medical emergencies, the differential diagnosis must focus on excluding **organic (medical) causes** that present with similar physiological arousal. **1. Why Option C is Correct:** The correct answer includes medical conditions that directly mimic the sympathetic "surge" seen in panic attacks: * **Pheochromocytoma:** Causes paroxysmal hypertension, palpitations, and diaphoresis due to catecholamine release. * **Myocardial Infarction (MI):** Presents with chest pain, dyspnea, and a "sense of impending doom," often indistinguishable from a panic attack in the ER. * **Mitral Valve Prolapse (MVP):** Frequently associated with palpitations and atypical chest pain. * **Carcinoid Syndrome:** Leads to episodic flushing, tachycardia, and anxiety due to serotonin and vasoactive peptide release. **2. Why Other Options are Incorrect:** * **Options A & D:** These include **Depression**. While depression is a common *comorbidity* of panic disorder, it is not typically a *differential diagnosis* for the acute, paroxysmal physical symptoms of a panic attack. Differentials focus on conditions that present with similar acute somatic manifestations. * **Option B:** This list is incomplete as it omits Carcinoid Syndrome, which is a classic high-yield medical differential for episodic anxiety-like symptoms. **Clinical Pearls for NEET-PG:** * **Rule Out First:** Always exclude hyperthyroidism, hypoglycemia, and caffeine intoxication in patients presenting with panic symptoms. * **The "Sense of Impending Doom":** This is a hallmark symptom shared by both Panic Disorder and Myocardial Infarction. * **Treatment Gold Standard:** SSRIs (first-line for long-term management) and Benzodiazepines (for acute symptom control). * **Medical Mimics:** If a patient has hypertension and headache during an "attack," think **Pheochromocytoma**; if they have flushing and diarrhea, think **Carcinoid Syndrome**.

Question 105: A 23-year-old medical student complains of feeling 'worried.' He fears failing his clinical exam because he feels nervous about presenting a case and performing a physical examination in front of examiners. He would skip bedside teaching when it would be his turn to present a case in front of his classmates and tutors. He worries about criticism from his classmates and tutor. What is the most likely diagnosis?

A. Normal shyness
B. Panic disorder
C. Generalized anxiety disorder
D. Social phobia (Correct Answer)

Explanation: **Explanation:** The clinical presentation is classic for **Social Phobia (Social Anxiety Disorder)**. The core feature is a marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible **scrutiny by others**. In this case, the student fears being judged or criticized by examiners and peers, leading to significant **avoidance behavior** (skipping bedside teaching). **Why the other options are incorrect:** * **Normal shyness:** Unlike shyness, Social Phobia involves significant functional impairment (avoiding classes) and intense distress that interferes with the individual’s academic or social life. * **Panic Disorder:** Characterized by recurrent, unexpected panic attacks and persistent worry about having *future* attacks. While this student may feel "nervous," the anxiety is specifically triggered by social evaluation, not spontaneous physiological surges. * **Generalized Anxiety Disorder (GAD):** GAD involves "free-floating" anxiety about various everyday events (finances, health, family) for at least 6 months. Here, the anxiety is situational and specific to performance. **High-Yield Clinical Pearls for NEET-PG:** * **Treatment of Choice:** **SSRIs** (e.g., Paroxetine, Sertraline) are the first-line long-term treatment. * **Performance Anxiety:** For specific situations (like a stage performance or exam), **Beta-blockers** (e.g., Propranolol) are used 30–60 minutes before the event to control peripheral sympathetic symptoms (tremors, palpitations). * **Cognitive Behavioral Therapy (CBT):** This is the most effective psychological intervention, focusing on social skills training and exposure.

Question 106: Which of the following is the most appropriate treatment for panic disorder?

A. Buspirone plus benzodiazepines
B. Benzodiazepines plus supportive therapy
C. Short-term benzodiazepine plus SSRI plus CBT (Correct Answer)
D. Long-term benzodiazepine plus venlafaxine

Explanation: **Explanation:** The management of Panic Disorder requires a multi-modal approach targeting both acute symptom relief and long-term remission. **Why Option C is Correct:** * **SSRIs (Selective Serotonin Reuptake Inhibitors):** These are the **first-line** pharmacological treatment for Panic Disorder due to their efficacy and favorable safety profile. However, they have a delayed onset of action (2–4 weeks) and may initially worsen anxiety ("jitteriness syndrome"). * **Short-term Benzodiazepines:** These are used as a "bridge" to provide immediate relief of acute panic attacks and reduce initial SSRI-induced anxiety. They are tapered off once the SSRI becomes effective. * **Cognitive Behavioral Therapy (CBT):** This is the most effective psychological intervention. It utilizes techniques like **interoceptive exposure** (desensitizing the patient to physical sensations of panic) and cognitive restructuring to reduce avoidance behavior. **Why Other Options are Incorrect:** * **Option A:** Buspirone is effective for Generalized Anxiety Disorder (GAD) but has **no proven efficacy** in treating Panic Disorder. * **Option B:** Supportive therapy is less effective than CBT, which specifically targets the pathophysiology of panic. Relying solely on benzodiazepines carries a high risk of dependence and withdrawal. * **Option D:** Long-term benzodiazepine use is discouraged due to risks of tolerance, cognitive impairment, and addiction. While Venlafaxine (an SNRI) is a valid first-line agent, the "long-term" use of benzodiazepines makes this option incorrect. **High-Yield NEET-PG Pearls:** * **First-line Drug:** SSRIs (e.g., Sertraline, Fluoxetine, Paroxetine). * **Best combination:** Pharmacotherapy + CBT (superior to either alone). * **Panic Attack vs. Disorder:** A panic attack is a discrete episode; Panic Disorder requires recurrent attacks and **at least one month** of persistent concern about future attacks or maladaptive behavior changes. * **Common Comorbidity:** Agoraphobia is frequently associated with Panic Disorder.

Question 107: What is the drug of choice for generalized anxiety disorder?

A. Alprazolam (Correct Answer)
B. Buspirone
C. Venlafaxine
D. Beta-blockers

Explanation: **Explanation:** Generalized Anxiety Disorder (GAD) is characterized by excessive, persistent worry about everyday events for at least 6 months. **Why Alprazolam is the Correct Answer:** In the context of standard medical examinations like NEET-PG, **Benzodiazepines (BZDs)** such as **Alprazolam** are often cited as the drug of choice for the **immediate/acute management** of GAD symptoms due to their rapid onset of action. They work by enhancing the inhibitory effect of GABA at the GABA-A receptor. While SSRIs/SNRIs are preferred for long-term maintenance, Alprazolam remains a classic textbook answer for symptomatic relief. **Analysis of Incorrect Options:** * **B. Buspirone:** An azapirone that acts as a 5-HT1A partial agonist. While specific for GAD and lacking abuse potential, it has a slow onset of action (2–4 weeks), making it less ideal for acute symptom control compared to BZDs. * **C. Venlafaxine:** An SNRI used for long-term maintenance therapy in GAD. While highly effective and often considered first-line in clinical practice for chronic management, it is not typically the "instant" drug of choice in acute scenarios. * **D. Beta-blockers (e.g., Propranolol):** These are used primarily for **Performance Anxiety** (a subtype of Social Anxiety Disorder) to control peripheral autonomic symptoms like tremors and palpitations; they do not treat the core psychological worry of GAD. **High-Yield Clinical Pearls for NEET-PG:** * **First-line long-term treatment:** SSRIs (e.g., Escitalopram, Sertraline). * **Duration for diagnosis:** Symptoms must be present for at least **6 months**. * **Buspirone Fact:** It does not cause sedation, cognitive impairment, or withdrawal symptoms, making it unique among anxiolytics. * **BZD Caution:** Limit use to 2–4 weeks to prevent dependence and tolerance.

Question 108: A 25-year-old woman presents to the emergency department with a fear of dying, experiencing chest pain, a sensation of choking, nausea, and tingling sensations up and down her arms. On examination, her face is flushed and sweating, with a pulse of 140/min and respirations of 25/min. Fifteen minutes later, her symptoms are dissipating, with a pulse of 100/min and respirations of 20/min. The ECG is normal except for some residual tachycardia. Which of the following is the most likely diagnosis?

A. Angina
B. Heartburn
C. Myocardial infarction
D. Panic attack (Correct Answer)

Explanation: **Explanation:** The clinical presentation is a classic case of a **Panic Attack**. A panic attack is characterized by an abrupt surge of intense fear or discomfort that reaches a peak within minutes. According to DSM-5 criteria, it involves at least four physical or cognitive symptoms, such as palpitations (tachycardia), sweating, trembling, sensations of shortness of breath (choking), chest pain, nausea, and paresthesia (tingling sensations). The key diagnostic clue here is the **rapid onset and spontaneous resolution** of symptoms within 15–20 minutes, coupled with a normal ECG. This "crescendo-decrescendo" pattern of autonomic hyperactivity in a young patient without underlying cardiac risk factors strongly points toward a psychiatric etiology rather than a vascular one. **Why other options are incorrect:** * **Angina/Myocardial Infarction:** While chest pain and tachycardia occur, these conditions typically do not resolve spontaneously within 15 minutes with a completely normal ECG. Furthermore, the multisystem involvement (choking, nausea, tingling, flushing) is more characteristic of a panic response. * **Heartburn:** While it can cause chest discomfort and nausea, it does not typically present with profound sympathetic arousal (pulse 140/min), tingling in extremities, or an intense fear of dying. **High-Yield Clinical Pearls for NEET-PG:** * **Acute Management:** Benzodiazepines (e.g., Alprazolam or Lorazepam) are used for immediate relief. * **Long-term Treatment (Panic Disorder):** SSRIs (Selective Serotonin Reuptake Inhibitors) are the first-line pharmacological treatment. * **Cognitive Behavioral Therapy (CBT):** The most effective non-pharmacological intervention. * **Differential Diagnosis:** Always rule out hyperthyroidism, pheochromocytoma, and hypoglycemia in patients presenting with recurrent panic-like symptoms.

Question 109: What is true about social phobia?

A. Fear of closed spaces
B. Irrational fear of situations
C. Irrational fear of activities (Correct Answer)
D. Irrational fear of specified objects

Explanation: **Explanation:** **Social Phobia (Social Anxiety Disorder)** is characterized by a persistent, irrational fear of one or more social or performance situations. The core psychopathology is the fear of being scrutinized, embarrassed, or negatively evaluated by others. **Why Option C is Correct:** In Social Phobia, the fear is specifically linked to **activities** performed in the presence of others. These include speaking in public, eating in a restaurant, writing in front of others, or using public restrooms. The patient fears that their performance or visible anxiety symptoms (like blushing or trembling) will lead to humiliation. **Analysis of Incorrect Options:** * **Option A (Fear of closed spaces):** This describes **Claustrophobia**, a specific phobia categorized under situational types. * **Option B (Irrational fear of situations):** While social phobia occurs in situations, this broad definition typically refers to **Agoraphobia** (fear of situations where escape might be difficult, such as crowds or open spaces). * **Option D (Irrational fear of specified objects):** This defines **Specific Phobia** (e.g., Cynophobia/fear of dogs, Arachnophobia/fear of spiders). **High-Yield Clinical Pearls for NEET-PG:** * **Age of Onset:** Typically mid-adolescence (around 13–15 years). * **Treatment of Choice:** **SSRIs** (e.g., Paroxetine, Sertraline) are the first-line long-term treatment. * **Performance Anxiety:** For specific "stage fright" (e.g., a one-time public speech), **Beta-blockers (Propranolol)** are used 30–60 minutes before the event to control autonomic symptoms. * **Cognitive Behavioral Therapy (CBT):** The most effective psychological intervention, focusing on social skills training and exposure.

Question 110: A patient presents to the emergency department with a feeling of impending doom, intense anxiety, and palpitations. Which of the following investigations should NOT be performed on an emergency basis?

A. Thyroid function tests (T3, T4, TSH)
B. Glucose levels
C. Hemoglobin levels (Correct Answer)
D. Electrocardiogram (ECG)

Explanation: **Explanation:** The patient is presenting with classic symptoms of a **Panic Attack**, characterized by autonomic hyperactivity (palpitations) and psychological distress (impending doom). In an emergency setting, the priority is to rule out life-threatening medical mimics that present with similar acute symptoms. **Why Hemoglobin levels is the correct answer:** While chronic anemia can cause palpitations and tachycardia, it is a **non-emergent investigation** in the context of an acute anxiety episode. Hemoglobin levels do not help in the immediate differential diagnosis of a sudden-onset panic attack or acute cardiac event, making it the least relevant test to perform on an emergency basis. **Analysis of Incorrect Options:** * **ECG:** This is the **most critical** initial investigation to rule out myocardial infarction or arrhythmias (e.g., SVT), which can mimic panic disorder. * **Glucose levels:** Hypoglycemia is a common "medical mimic" of anxiety, presenting with tremors, palpitations, and intense anxiety. It must be ruled out immediately via a finger-stick or lab test. * **Thyroid Function Tests (TFTs):** Hyperthyroidism (Thyrotoxicosis) can cause acute palpitations and anxiety. While usually more subacute, it is a standard part of the initial workup for new-onset anxiety symptoms to rule out an organic cause. **NEET-PG High-Yield Pearls:** * **Diagnosis of Exclusion:** Always rule out organic causes (Cardiac, Endocrine, Respiratory) before diagnosing Panic Disorder. * **Drug of Choice (Acute):** Benzodiazepines (e.g., Alprazolam or Lorazepam) for immediate relief. * **Drug of Choice (Maintenance):** SSRIs (e.g., Paroxetine, Sertraline) are the first-line long-term treatment. * **Common Mimics:** Pheochromocytoma, Hypoglycemia, Hyperthyroidism, and SVT.

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

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free