Anxiety Disorders — MCQs

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?

Q120

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:

Anxiety Disorders Indian Medical PG Practice Questions and MCQs

Question 111: 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?

A. Hysteria
B. Generalized anxiety disorder
C. Cystic fibrosis
D. Panic attack (Correct Answer)

Explanation: ### 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).

Question 112: Agoraphobia is commonly associated with which of the following conditions?

A. Schizophrenia
B. Bipolar disorder
C. Panic disorder (Correct Answer)
D. Obsessive-compulsive disorder

Explanation: **Explanation:** **Agoraphobia** is characterized by intense 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. **Why Panic Disorder is Correct:** Historically, agoraphobia was considered a complication of **Panic Disorder**. While the DSM-5 now classifies them as distinct diagnoses, they remain clinically inseparable in many patients. Approximately **30-50%** of individuals with agoraphobia have a co-occurring diagnosis of Panic Disorder. The "fear of fear" cycle explains the association: a patient experiences a spontaneous panic attack and subsequently avoids public spaces or crowds to prevent a recurrence, leading to agoraphobia. **Why Other Options are Incorrect:** * **Schizophrenia:** This is a psychotic disorder characterized by delusions and hallucinations. While social withdrawal occurs (negative symptoms), it is due to apathy or paranoia, not a fear of being unable to escape during a panic attack. * **Bipolar Disorder:** This is a mood disorder. While anxiety can be comorbid during depressive or mixed episodes, there is no primary pathophysiological link to agoraphobia. * **Obsessive-Compulsive Disorder (OCD):** OCD involves intrusive thoughts and repetitive rituals. While patients may avoid certain places due to contamination fears, this is distinct from the situational avoidance seen in agoraphobia. **High-Yield Clinical Pearls for NEET-PG:** * **DSM-5 Change:** Agoraphobia is now a **standalone diagnosis**, independent of Panic Disorder. * **Duration:** Symptoms must persist for at least **6 months** for a diagnosis. * **Treatment of Choice:** **Cognitive Behavioral Therapy (CBT)** is the most effective psychotherapy; **SSRIs** (e.g., Sertraline, Paroxetine) are the first-line pharmacological treatment. * **Common Triggers:** Using public transport, being in open spaces (parking lots), enclosed spaces (shops), or being outside the home alone.

Question 113: Generalised anxiety disorder is characterized by which of the following?

A. Free-floating anxiety
B. Worry about trivial issues
C. Inability to relax
D. Anxiety about specific situations (Correct Answer)

Explanation: ### Explanation **Generalized Anxiety Disorder (GAD)** is a chronic condition characterized by excessive, pervasive, and persistent anxiety and worry about a wide range of everyday events or activities (e.g., health, finances, or work performance). #### Why Option D is the Correct Answer (as per the provided key): In the context of competitive exams like NEET-PG, GAD is classically defined by **"free-floating anxiety"**—anxiety that is not restricted to any particular environmental circumstances. However, if the question identifies **"Anxiety about specific situations"** as the correct answer, it refers to the clinical presentation where the patient worries about multiple, distinct life domains (specific situations like family, health, or chores) rather than a single phobic stimulus. *Note: In standard psychiatric textbooks (ICD-10/DSM-5), GAD is defined by the absence of situational specificity (unlike Phobias). If this is a "Select the best" question, "Free-floating anxiety" is typically the gold-standard descriptor.* #### Analysis of Incorrect Options: * **A. Free-floating anxiety:** This is the hallmark of GAD. It means the anxiety is generalized and persistent, not bound to a specific trigger. (In many versions of this question, this is actually the preferred answer). * **B. Worry about trivial issues:** While patients do worry about minor matters, the diagnostic criteria focus on the *excessive nature* and *difficulty controlling* the worry, rather than the "triviality" of the issue itself. * **C. Inability to relax:** This is a common somatic symptom (motor tension) of GAD, but it is a secondary feature rather than the defining characteristic of the disorder. #### NEET-PG High-Yield Pearls: * **Duration:** Symptoms must be present for at least **6 months** (both ICD and DSM). * **Core Feature:** "Apprehensive expectation" or "Worry." * **Physical Symptoms:** Often presents with motor tension (trembling, restlessness), autonomic hyperactivity, and cognitive vigilance (irritability, sleep disturbance). * **Treatment:** **SSRIs** are the first-line long-term treatment. Benzodiazepines are used only for short-term symptomatic relief. * **Differential:** Unlike Panic Disorder (episodic), GAD is continuous. Unlike Phobias, GAD is not restricted to one specific trigger.

Question 114: Which neurotransmitter changes are proposed in cases of anxiety?

A. Increased norepinephrine, and decreased GABA and serotonin (Correct Answer)
B. Decreased norepinephrine and serotonin, and increased acetylcholine
C. Decreased GABA and acetylcholine
D. Increased serotonin, and decreased norepinephrine and GABA

Explanation: ### Explanation The neurobiology of anxiety involves a complex dysregulation of the autonomic nervous system and specific neurotransmitter pathways. **1. Why Option A is Correct:** * **Norepinephrine (NE):** Patients with anxiety disorders often exhibit an overactive sympathetic nervous system. The **Locus Coeruleus**, the primary site of NE synthesis, is hyperactive in anxiety, leading to physical symptoms like tachycardia, tremors, and diaphoresis. * **GABA (Gamma-Aminobutyric Acid):** GABA is the brain's primary inhibitory neurotransmitter. A **decrease** in GABAergic tone leads to CNS hyperexcitability. This is why Benzodiazepines (which enhance GABA) are effective in acute anxiety. * **Serotonin (5-HT):** While the role of serotonin is complex, the consensus for exam purposes is that **decreased** serotonin levels contribute to anxiety. This is supported by the clinical efficacy of SSRIs (Selective Serotonin Reuptake Inhibitors) as first-line long-term treatment. **2. Why Other Options are Incorrect:** * **Option B & D:** These suggest decreased norepinephrine or increased serotonin. In anxiety, norepinephrine is typically elevated (fight-or-flight response). While serotonin levels can be nuanced, the classic teaching for NEET-PG is that low serotonin correlates with both anxiety and depression. * **Option C:** While GABA is decreased, acetylcholine does not play a primary, consistent role in the core pathogenesis of generalized anxiety disorder compared to the monoamine system. **3. High-Yield Clinical Pearls for NEET-PG:** * **Locus Coeruleus:** The anatomical "alarm center" of the brain associated with anxiety (Norepinephrine). * **Raphe Nucleus:** The primary site for Serotonin production. * **Amygdala:** The brain structure responsible for "fear conditioning" and processing emotional responses in anxiety. * **Drug of Choice:** SSRIs are the first-line treatment for most chronic anxiety disorders (GAD, Panic Disorder, Social Anxiety). Benzodiazepines are used for immediate, short-term relief only.

Question 115: Fear of open spaces is:

A. Agoraphobia (Correct Answer)
B. Acrophobia
C. Claustrophobia
D. Algophobia

Explanation: **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).

Question 116: Beta blockers are indicated in which of the following conditions?

A. Phobic disorders
B. Anxiety (Correct Answer)
C. Schizophrenia
D. Mania

Explanation: **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).

Question 117: What is the medical term for a person who fears seeing tall buildings and looking down from heights?

A. Acrophobia (Correct Answer)
B. Nomophobia
C. Claustrophobia
D. Agoraphobia

Explanation: ***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.

Question 118: Which of the following is the primary neurotransmitter implicated in the pathophysiology of obsessive-compulsive disorder (OCD)?

A. Norepinephrine
B. Dopamine
C. Serotonin (Correct Answer)
D. Gamma-aminobutyric acid (GABA)

Explanation: ***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.

Question 119: 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?

A. Ideas of reference
B. Tingling of extremities (Correct Answer)
C. Hallucination
D. Neologism

Explanation: ***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.

Question 120: 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.

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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