Anxiety Disorders Practice Questions

Q: Xenophobia is defined as:

Fear of strangers. **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.

Q: 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?

Social phobia. **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.

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

Alprazolam. **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.

Q: 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?

Panic attack. **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.

Q: What is true about social phobia?

Irrational fear of activities. **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.

Q: 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?

Hemoglobin levels. **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.

Question 1

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

Accepted Answer

Generalized anxiety disorder

Answer

Panic disorder

Answer

Agoraphobia

Answer

All the above

Question 2

Xenophobia is defined as:

Accepted Answer

Fear of strangers

Answer

Fear of injections

Answer

Fear of touch

Answer

Fear of animals

Question 3

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

Accepted Answer

Selective serotonin reuptake inhibitor

Answer

Phenothiazine

Answer

Azapirone

Answer

Beta blocker

Question 4

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

Accepted Answer

Pheochromocytoma, myocardial infarction, mitral valve prolapse, and carcinoid syndrome

Answer

Pheochromocytoma, myocardial infarction, mitral valve prolapse, depression, and carcinoid syndrome

Answer

Pheochromocytoma, myocardial infarction, and mitral valve prolapse

Answer

Pheochromocytoma, mitral valve prolapse, depression, and carcinoid syndrome

Question 5

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?

Accepted Answer

Social phobia

Answer

Normal shyness

Answer

Panic disorder

Answer

Generalized anxiety disorder

Question 6

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

Accepted Answer

Short-term benzodiazepine plus SSRI plus CBT

Answer

Buspirone plus benzodiazepines

Answer

Benzodiazepines plus supportive therapy

Answer

Long-term benzodiazepine plus venlafaxine

Question 7

What is the drug of choice for generalized anxiety disorder?

Accepted Answer

Alprazolam

Answer

Buspirone

Answer

Venlafaxine

Answer

Beta-blockers

Question 8

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?

Accepted Answer

Panic attack

Answer

Angina

Answer

Heartburn

Answer

Myocardial infarction

Question 9

What is true about social phobia?

Accepted Answer

Irrational fear of activities

Answer

Fear of closed spaces

Answer

Irrational fear of situations

Answer

Irrational fear of specified objects

Question 10

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?

Accepted Answer

Hemoglobin levels

Answer

Thyroid function tests (T3, T4, TSH)

Answer

Glucose levels

Answer

Electrocardiogram (ECG)

Anxiety Disorders — MCQs

Anxiety Disorders — MCQs

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