Anxiety Disorders Practice Questions

Q: A 20-year-old female complains of sudden onset palpitations, apprehension, and sweating for the last 10 minutes, accompanied by a fear of impending death. What is the most likely diagnosis?

Panic attack. ### Explanation **Correct Option: D. Panic attack** The clinical presentation describes a classic **Panic Attack**. It is characterized by a discrete period of intense fear or discomfort that reaches a peak within minutes. Key diagnostic features present in this case include autonomic hyperactivity (palpitations, sweating), psychological symptoms (apprehension), and the hallmark **"fear of impending death"** (thanatophobia). According to DSM-5, at least 4 out of 13 physical/cognitive symptoms must be present. **Analysis of Incorrect Options:** * **A. Hysteria:** This is an obsolete term. It formerly referred to Dissociative (Conversion) disorders, which typically involve motor or sensory deficits (e.g., paralysis, blindness) triggered by psychological conflict, rather than acute autonomic surges. * **B. Generalized Anxiety Disorder (GAD):** GAD is characterized by "free-floating anxiety" and persistent, excessive worry about everyday matters for at least **6 months**. It lacks the sudden, crescendo-like intensity and the "fear of death" seen in panic attacks. * **C. Cystic Fibrosis:** This is a multisystem genetic disorder affecting the lungs and digestive system. While it can cause respiratory distress, it does not present as a sudden psychological episode of apprehension and sweating in a 20-year-old without prior chronic respiratory history. **NEET-PG High-Yield Pearls:** * **Duration:** Panic attacks usually peak within 10 minutes and last less than 30 minutes. * **First-line Treatment:** For acute episodes, **Benzodiazepines** (e.g., Alprazolam/Lorazepam). For long-term management (Panic Disorder), **SSRIs** are the drug of choice. * **Differential Diagnosis:** Always rule out medical causes like Hyperthyroidism, Pheochromocytoma, and Hypoglycemia. * **Panic Disorder:** Diagnosed when there are recurrent unexpected attacks followed by at least **1 month** of persistent concern about future attacks (anticipatory anxiety).

Q: Fear of open spaces is:

Agoraphobia. **Explanation:** **Agoraphobia (Option A)** is the correct answer. Derived from the Greek word *agora* (marketplace), it is defined as a marked fear or anxiety about being in situations where escape might be difficult or help might not be available in the event of developing panic-like symptoms. While commonly simplified as a "fear of open spaces," the DSM-5 criteria specifically include fears of using public transportation, being in open spaces (e.g., parking lots, bridges), being in enclosed places (e.g., shops, cinemas), standing in line/crowds, or being outside of the home alone. **Analysis of Incorrect Options:** * **Acrophobia (Option B):** The specific pathological fear of **heights**. * **Claustrophobia (Option C):** The fear of **enclosed or confined spaces** (the opposite of the literal definition of agoraphobia). * **Algophobia (Option D):** The morbid fear of **pain**. **NEET-PG High-Yield Pearls:** 1. **Comorbidity:** Agoraphobia is frequently associated with **Panic Disorder**. In DSM-IV, they were linked; however, in **DSM-5**, Agoraphobia is now a **standalone diagnosis** regardless of the presence of panic attacks. 2. **Duration:** For a diagnosis, symptoms must typically persist for **6 months or more**. 3. **Treatment:** The gold standard is a combination of **Pharmacotherapy** (SSRIs are first-line) and **Cognitive Behavioral Therapy (CBT)**, specifically utilizing **systematic desensitization** or exposure therapy. 4. **Demographics:** It is more common in females than males (approx. 2:1 ratio).

Q: Beta blockers are indicated in which of the following conditions?

Anxiety. **Explanation:** **Beta-blockers (e.g., Propranolol)** are primarily used in psychiatry to manage the **peripheral autonomic symptoms** of anxiety. They work by blocking beta-adrenergic receptors, thereby inhibiting the physiological manifestations of the "fight or flight" response. 1. **Why Anxiety is Correct:** Beta-blockers are highly effective for **Performance Anxiety** (a subtype of Social Anxiety Disorder) and the physical symptoms of generalized anxiety. They control tremors, palpitations, tachycardia, and sweating. By reducing these physical cues, they help break the feedback loop that often exacerbates psychological distress. 2. **Analysis of Incorrect Options:** * **Phobic Disorders:** While they may be used specifically for *social* phobia (performance type), they are not the treatment of choice for specific phobias (where CBT/exposure therapy is preferred) or Agoraphobia (where SSRIs are first-line). * **Schizophrenia:** The mainstay of treatment is antipsychotics (dopamine antagonists). Beta-blockers have no role in treating core psychotic symptoms, though Propranolol is used to treat **Akathisia** (an extrapyramidal side effect of antipsychotics). * **Mania:** Acute mania is managed with mood stabilizers (Lithium, Valproate) and antipsychotics. Beta-blockers do not possess mood-stabilizing properties. **High-Yield NEET-PG Pearls:** * **Drug of Choice for Akathisia:** Propranolol is the first-line treatment for antipsychotic-induced akathisia. * **Lithium-induced Tremors:** Propranolol is the preferred treatment for fine tremors caused by Lithium toxicity or therapeutic use. * **Contraindications:** Always screen for **Asthma/COPD** (due to bronchospasm) and **Diabetes Mellitus** (as they mask hypoglycemic tachycardia) before prescribing. * **Specific Indication:** They are best taken 30–60 minutes before a performance (e.g., public speaking).

Q: What is the medical term for a person who fears seeing tall buildings and looking down from heights?

Acrophobia. ***Acrophobia***- It is the specific phobia defined as the extreme or irrational **fear of heights** or being in high places (like a tall building or cliff). - Symptoms include anxiety, panic attacks, dizziness, and refusal to be in high places or even look down from them. *Agoraphobia* - This refers to an anxiety disorder characterized by the fear of being in places or situations from which escape might be difficult or help unavailable, such as **open spaces**, public transportation, or crowds. - It is frequently associated with a fear of having a **panic attack** and being unable to escape. *Claustrophobia* - This is the irrational fear of **confined spaces** or enclosed areas, such as elevators, small rooms, or tunnels. - It is not related to vertical distance or looking down from a height. *Nomophobia* - This is a colloquial term for the fear of being without a **mobile phone** or being unable to use it (e.g., due to loss of signal or battery). - This type of phobia involves anxiety related to technological dependence, not environmental features like height.

Q: Which of the following is the primary neurotransmitter implicated in the pathophysiology of obsessive-compulsive disorder (OCD)?

Serotonin. ***Serotonin*** - Serotonin (5-HT) is the primary neurotransmitter implicated in the pathophysiology of **OCD**; specifically, a relative deficit or dysregulation is noted, which explains the efficacy of **SSRIs (Selective Serotonin Reuptake Inhibitors)** in treating the disorder. - Dysfunction in the **serotonergic system** is thought to contribute to the repetitive thoughts and behaviors characteristic of OCD. *Dopamine* - Dopamine is primarily associated with the **reward system**, motivation, and movement disorders (e.g., Parkinson's disease), and is the main target in **psychosis** (e.g., Schizophrenia). - While dopamine modulators (e.g., antipsychotics) are sometimes used as augmenting agents in severe refractory OCD, it is not considered the primary neurotransmitter. *Norepinephrine* - Norepinephrine (noradrenaline) plays a major role in the **stress response**, alertness, and mood regulation, being highly implicated in **anxiety disorders** (e.g., GAD) and depression. - Although some SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) are used off-label, they are generally less effective than SSRIs for OCD. *GABA* - **GABA** (**Gamma-aminobutyric acid**) is the main inhibitory neurotransmitter in the CNS, chiefly involved in reducing neuronal excitability and mediating the effects of **anxiolytics** like benzodiazepines. - While dysregulation may contribute to general anxiety often seen comorbidly, it is not the primary mechanism underlying the core obsessive-compulsive cycle.

Q: A 45-year-old female presents to the OPD with complaints of "feeling tense" and experiencing stomach upset with heartburn and diarrhea. She reports having these symptoms for many years and mentions that her family members also usually feel tense and nervous. Which of the following symptoms is most likely to be seen in this patient?

Tingling of extremities. ***Tingling of extremities*** - The patient's presentation of "feeling tense," **stomach upset, heartburn, and diarrhea** for many years, alongside a family history of similar issues, suggests significant **anxiety**. - **Peripheral neurological symptoms** such as **tingling of extremities (paresthesia)** are common manifestations of anxiety and panic attacks due to **hyperventilation** (causing respiratory alkalosis and decreased ionized calcium) and **physiological arousal**. *Ideas of reference* - **Ideas of reference** are typically seen in **psychotic disorders** (e.g., schizophrenia) where a person believes that unrelated, external events have a special, personal meaning. - While anxiety can sometimes lead to misinterpretations, **ideas of reference** at a delusional level are not characteristic of generalized anxiety. *Hallucination* - **Hallucinations** are perceptual disturbances where an individual experiences sensory perceptions (e.g., hearing voices, seeing things) in the absence of an external stimulus. - These are core symptoms of **psychotic disorders** and are not typical findings in anxiety disorders without comorbid conditions. *Neologism* - A **neologism** is the coining of new words or phrases, often without clear meaning, which is a hallmark feature of disorganized thought in **psychotic disorders** (e.g., schizophrenia). - This symptom is related to severe thought disorganization and is not associated with anxiety disorders.

Q: 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:

Illness Anxiety Disorder. ***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 1

A 20-year-old female complains of sudden onset palpitations, apprehension, and sweating for the last 10 minutes, accompanied by a fear of impending death. What is the most likely diagnosis?

Accepted Answer

Panic attack

Answer

Hysteria

Answer

Generalized anxiety disorder

Answer

Cystic fibrosis

Question 2

Agoraphobia is commonly associated with which of the following conditions?

Accepted Answer

Panic disorder

Answer

Schizophrenia

Answer

Bipolar disorder

Answer

Obsessive-compulsive disorder

Question 3

Generalised anxiety disorder is characterized by which of the following?

Accepted Answer

Anxiety about specific situations

Answer

Free-floating anxiety

Answer

Worry about trivial issues

Answer

Inability to relax

Question 4

Which neurotransmitter changes are proposed in cases of anxiety?

Accepted Answer

Increased norepinephrine, and decreased GABA and serotonin

Answer

Decreased norepinephrine and serotonin, and increased acetylcholine

Answer

Decreased GABA and acetylcholine

Answer

Increased serotonin, and decreased norepinephrine and GABA

Question 5

Fear of open spaces is:

Accepted Answer

Agoraphobia

Answer

Acrophobia

Answer

Claustrophobia

Answer

Algophobia

Question 6

Beta blockers are indicated in which of the following conditions?

Accepted Answer

Anxiety

Answer

Phobic disorders

Answer

Schizophrenia

Answer

Mania

Question 7

What is the medical term for a person who fears seeing tall buildings and looking down from heights?

Accepted Answer

Acrophobia

Answer

Nomophobia

Answer

Claustrophobia

Answer

Agoraphobia

Question 8

Which of the following is the primary neurotransmitter implicated in the pathophysiology of obsessive-compulsive disorder (OCD)?

Accepted Answer

Serotonin

Answer

Norepinephrine

Answer

Dopamine

Answer

Gamma-aminobutyric acid (GABA)

Question 9

A 45-year-old female presents to the OPD with complaints of "feeling tense" and experiencing stomach upset with heartburn and diarrhea. She reports having these symptoms for many years and mentions that her family members also usually feel tense and nervous. Which of the following symptoms is most likely to be seen in this patient?

Accepted Answer

Tingling of extremities

Answer

Ideas of reference

Answer

Hallucination

Answer

Neologism

Question 10

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:

Accepted Answer

Illness Anxiety Disorder

Answer

Depression

Answer

Conversion disorder

Answer

Somatoform pain

Anxiety Disorders — MCQs

Anxiety Disorders — MCQs

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