Anxiety Disorders — MCQs

Anxiety Disorders Indian Medical PG Practice Questions and MCQs

Question 121: A 24-year-old lady presented with sudden onset chest pain, palpitations lasting for about 20 minutes. She says there were 3 similar episodes in the past. All the investigations were normal. What is the likely diagnosis?

A. Post-traumatic stress disorder
B. Acute psychosis
C. Panic attack (Correct Answer)
D. Mania

Explanation: ***Panic attack*** - The sudden onset of **chest pain** and **palpitations** in a young woman, lasting for a brief period (20 minutes), and occurring in recurrent episodes with all investigations being normal, are classic signs of a **panic attack**. - Panic attacks frequently mimic cardiac events, but the absence of organic findings despite recurrent episodes points towards a psychological origin. *Post-traumatic stress disorder* - While PTSD can involve symptoms of anxiety and panic, it is specifically triggered by a **traumatic event** and typically includes re-experiencing the trauma, avoidance, and hyperarousal, none of which are described here. - The patient's presentation primarily focuses on sudden physical symptoms rather than a direct link to past trauma or pervasive fear. *Acute psychosis* - Acute psychosis involves a severe break from reality, characterized by **hallucinations**, **delusions**, or disorganized thought and behavior, which are not present in this scenario. - The symptoms described are more consistent with an anxiety disorder rather than a thought disorder. *Mania* - Mania is a state of elevated mood, increased energy, and often includes symptoms like **reduced need for sleep**, **racing thoughts**, and **impulsive behavior**, which are not described in this patient's presentation. - The core symptoms are acute physical sensations of fear and discomfort, not sustained euphoria or grandiosity.

Question 122: Fear of "places from where escape is difficult" is called ______

A. Claustrophobia
B. Aerophobia
C. Agoraphobia (Correct Answer)
D. Ailurophobia

Explanation: ***Agoraphobia*** - **Agoraphobia** is the intense fear and anxiety of situations or places that might be difficult to escape from or where help might not be available, such as open spaces, crowds, or public transportation. - Individuals with agoraphobia often avoid these situations or endure them with extreme distress, sometimes resulting in being housebound. *Claustrophobia* - **Claustrophobia** is the intense fear of tight, enclosed spaces, such as elevators, small rooms, or MRI machines. - This phobia is distinct from agoraphobia, which centers around difficulty escaping rather than the space itself. *Aerophobia* - **Aerophobia** is the fear of flying, specifically involving airplanes or other forms of air travel. - It is a specific phobia related to a particular situation, not a generalized fear of inescapable places. *Ailurophobia* - **Ailurophobia** is the irrational fear of cats. - This is a specific animal phobia and has no relation to the fear of open spaces or situations from which escape might be difficult.

Question 123: Systemic desensitization therapy is used for

A. Phobia (Correct Answer)
B. Depression/Mania
C. Organic brain syndrome
D. Schizophrenia

Explanation: ***Phobia*** - **Systemic desensitization** is a highly effective behavioral therapy specifically designed to treat **phobias** and other **anxiety disorders**. - It involves gradually exposing the individual to the feared object or situation while teaching them **relaxation techniques** to replace the anxiety response. *Depression/Mania* - These conditions are primarily treated with a combination of **pharmacotherapy** (e.g., antidepressants, mood stabilizers) and other forms of psychotherapy like **cognitive behavioral therapy (CBT)** or **interpersonal therapy**. - Systemic desensitization is not a primary or effective treatment for the core symptoms of **mood disorders**. *Organic brain syndrome* - This is a broad term referring to mental impairment caused by a **physical disease or injury affecting the brain**, such as dementia or delirium. - Treatment focuses on addressing the **underlying medical cause** and managing cognitive or behavioral symptoms, not desensitization. *Schizophrenia* - Schizophrenia is a severe mental illness characterized by **psychosis**, **disorganized thinking**, and significant functional impairment. - Treatment primarily involves **antipsychotic medications** and psychosocial interventions, rather than exposure-based therapies like systemic desensitization.

Question 124: Which of the following is most common among all psychiatric disorders?

A. Anxiety disorders (Correct Answer)
B. Delusional disorder
C. OCD
D. Depression

Explanation: ***Anxiety disorder*** - **Anxiety disorders** are the most common psychiatric conditions globally, affecting a significant portion of the population. - They encompass various conditions like **generalized anxiety disorder**, **panic disorder**, and **phobias**, making their collective prevalence very high. *Delusional disorder* - **Delusional disorder** is a relatively rare psychiatric condition characterized by the presence of one or more **non-bizarre delusions**. - Its prevalence is much lower compared to common conditions like anxiety or depression. *OCD* - **Obsessive-compulsive disorder (OCD)** is characterized by recurrent, intrusive thoughts (**obsessions**) and repetitive behaviors (**compulsions**). - While significant, its prevalence is lower than that of anxiety disorders or major depressive disorder. *Depression* - **Depression**, particularly **major depressive disorder**, is a very common mental health condition but ranks just below anxiety disorders in overall global prevalence. - It often co-occurs with anxiety disorders, but individual anxiety disorders are collectively more prevalent.

Question 125: For which condition is behaviour therapy helpful?

A. Schizophrenia
B. Personality Disorder
C. Agoraphobia (Correct Answer)
D. Neurotic depression

Explanation: ***Agoraphobia*** - **Behavior therapy**, especially **exposure therapy**, is highly effective for agoraphobia by gradually exposing individuals to feared situations. - It helps patients learn new coping mechanisms and reduce avoidance behaviors associated with anxiety. *Schizophrenia* - While supportive and skills-based therapies can be beneficial, **behavior therapy alone is not the primary or most effective treatment** for core psychotic symptoms. - Treatment typically involves **antipsychotic medication** combined with psychotherapy. *Personality Disorder* - **Dialectical behavior therapy (DBT)**, a specific type of cognitive-behavioral therapy, is effective for some personality disorders, particularly **borderline personality disorder**, but general behavior therapy alone is not comprehensive enough for the broad spectrum of personality disorders. - These conditions often require a **multi-modal approach** addressing deep-seated thought patterns and relationship issues. *Neurotic depression* - **Cognitive-behavioral therapy (CBT)** is an effective treatment for depression, but it is a broader approach that includes cognitive restructuring in addition to behavioral techniques. - Purely behavioral interventions may address some symptoms but often don't tackle the underlying cognitive distortions common in depression.

Question 126: A 41 year old married female presented with headache for the last 6 months. She had several consultations. All her investigations were found to be within normal limits. She still insists that there is something wrong in her head and seeks another consultation. The most likely diagnosis is:

A. Illness Anxiety Disorder (Correct Answer)
B. Phobia
C. Psychogenic headache
D. Depression

Explanation: ***Illness Anxiety Disorder*** - This patient exhibits persistent **preoccupation with having a serious illness** despite **repeated medical evaluations** showing no underlying pathology. - She continues to **seek multiple consultations**, demonstrating **excessive health-related behaviors** characteristic of health anxiety. - Despite reassurance and normal investigations, she **insists something is wrong**, which is the core feature of this disorder. - Note: The presence of headache doesn't exclude this diagnosis; the key is the **disproportionate anxiety and health-seeking behavior** relative to the symptom. *Phobia* - Phobias involve an **intense, irrational fear** of a specific object or situation (e.g., agoraphobia, social phobia). - The patient's concern is about having an illness and physical symptoms, not a fear of a specific trigger or situation. *Psychogenic headache* - This is a **symptom description**, not a psychiatric disorder diagnosis. - While the headache may have psychological factors, the question asks for the **disorder** that best explains the overall clinical picture. - The primary pathology here is the **persistent health anxiety and reassurance-seeking behavior**, not just the headache itself. *Depression* - Although **depression can present with somatic symptoms** like headaches, the **core features of major depression** are not mentioned (e.g., persistent low mood, anhedonia, sleep/appetite changes, hopelessness). - The patient's **preoccupation with having a disease** despite medical reassurance is more characteristic of Illness Anxiety Disorder than depression alone.

Question 127: A 35 year old man feels that he is about to die because he is suffering from gastric cancer. All his radiological investigations prove the contrary. Which is the most probable diagnosis?

A. Somatic symptom disorder
B. Conversion disorder
C. Delusional disorder
D. Illness anxiety disorder (Correct Answer)

Explanation: ***Illness anxiety disorder*** - This patient exhibits a **preoccupation with having a serious illness** (gastric cancer) despite evidence to the contrary (negative radiological investigations). - The fear of illness is **persistent** and **causes significant distress**, leading to the belief that he is "about to die." - In illness anxiety disorder, patients may have **intense health anxiety** but typically retain some capacity for at least temporary reassurance with negative test results, even if the anxiety returns. - The presentation focuses on **fear and preoccupation** rather than an absolutely fixed, unshakeable delusional belief. *Somatic symptom disorder* - Characterized by **one or more significant physical symptoms** that cause significant distress or functional impairment, along with excessive thoughts, feelings, or behaviors related to these symptoms. - In this case, the primary concern is the *fear* of having a serious illness, rather than significant physical symptoms themselves. - The emphasis is on the **belief about having cancer** rather than distressing somatic symptoms. *Conversion disorder* - Involves **neurological symptoms** (e.g., altered motor or sensory function, weakness, paralysis, seizures) that are incompatible with recognized neurological or medical conditions. - The patient's presentation does not involve neurological deficits, and the primary concern is fear of a specific disease (gastric cancer) rather than unexplained neurological symptoms. *Delusional disorder* - Characterized by one or more **fixed, unshakeable, nonbizarre delusions** that persist for at least one month. - In **delusional disorder, somatic type**, the patient would have an absolutely fixed belief about having a disease with **no insight** and **no response to reassurance** despite clear contrary evidence. - While this patient has a strong belief about having cancer, the clinical presentation described (preoccupation with health concerns in the context of negative investigations) aligns more specifically with **illness anxiety disorder**, which is the more common diagnosis in this scenario per standard medical teaching.

Question 128: All of the following are true about phobias, except:

A. Avoiding particular situation
B. Generalized anxiety (Correct Answer)
C. Fear and anxiety of specific thing
D. Insight is present

Explanation: ***Generalized anxiety*** - Phobias are characterized by intense fear of a **specific object or situation**, not diffuse, generalized anxiety. - While phobias can lead to anxiety, it is tightly linked to the **phobic stimulus** rather than being free-floating and generalized. *Avoiding particular situation* - **Avoidance behavior** is a hallmark symptom of phobias, as individuals try to steer clear of the feared object or situation. - This avoidance helps reduce immediate anxiety but reinforces the phobia in the long term. *Fear and anxiety of specific thing* - The core feature of a phobia is an intense and **unreasonable fear or anxiety** triggered by a specific object, situation, or stimulus. - This fear is disproportionate to the actual danger posed by the feared entity. *Insight is present* - Individuals with phobias generally **recognize that their fear is excessive** or unreasonable, even if they cannot control it. - This insight distinguishes phobias from psychotic disorders where an individual may not recognize the irrationality of their fears.

Question 129: Anxiety is best described as:

A. A specific fear leading to avoidance behavior (Phobic disorder)
B. A mental disorder with delusions or hallucinations (Psychosis)
C. Enduring maladaptive personality traits (Personality disorder)
D. Excessive worry and emotional distress without loss of reality (Anxiety disorder) (Correct Answer)

Explanation: ***Excessive worry and emotional distress without loss of reality (Anxiety disorder)*** - **Anxiety** is characterized by persistent, excessive worry and apprehension, often accompanied by emotional distress and physical symptoms, while the individual maintains contact with reality. - This definition distinguishes it from psychotic disorders where there is a **loss of reality**. *A specific fear leading to avoidance behavior (Phobic disorder)* - While phobic disorders are a type of **anxiety disorder**, they represent a specific subtype characterized by an intense, irrational fear of a particular object or situation. - The given description of anxiety is broader than just a **phobic disorder**. *A mental disorder with delusions or hallucinations (Psychosis)* - This describes **psychotic disorders**, where individuals experience a significant disruption in their perception of reality, marked by **delusions** (fixed false beliefs) and/or **hallucinations** (sensory experiences without external stimuli). - Anxiety, in its core definition, does not involve a **loss of reality**. *Enduring maladaptive personality traits (Personality disorder)* - **Personality disorders** are characterized by deeply ingrained, inflexible, and maladaptive patterns of perceiving, relating to, and thinking about the environment and oneself. - These patterns typically manifest across various situations and are stable over time, differing significantly from the definition of anxiety as a state of **worry and emotional distress**.

Question 130: A 1st year medical student presents with recurrent episodes of choking sensation, breathlessness, intense sweating along with feeling of impending doom. Usually the episodes occur prior to exams. What is the most likely diagnosis?

A. Panic attack (Correct Answer)
B. Acute stress disorder
C. Generalised anxiety disorder
D. Phobia

Explanation: ***Panic attack (Panic Disorder)*** - The sudden onset of intense fear or discomfort, along with symptoms like **choking sensation**, **breathlessness**, **sweating**, and **feeling of impending doom**, are characteristic of a **panic attack**. - The **recurrent episodes** occurring prior to exams indicate **Panic Disorder**, which is defined by recurrent unexpected panic attacks followed by persistent concern about future attacks. - The situational trigger (exams) suggests a pattern consistent with panic disorder, where attacks may be situationally predisposed. *Acute stress disorder* - This condition occurs within **one month of exposure to a traumatic event** and involves dissociative symptoms, intrusions, avoidance, and arousal symptoms. - The patient describes recurrent episodes tied to exams, not a single acute traumatic event with subsequent stress response. *Generalised anxiety disorder* - Characterized by excessive and **uncontrollable worry** about various events or activities for **at least six months**. - While anxiety is present, the sudden, intense, **episodic nature** of symptoms with a distinct "feeling of impending doom" points away from the chronic, pervasive worry of GAD. - GAD presents with chronic anxiety rather than discrete panic episodes. *Phobia* - A phobia is an **irrational and intense fear** of a specific object or situation (e.g., specific phobia) or social situations (social anxiety disorder). - While exam-related anxiety can be severe, the description points to a **full-blown panic response** with multiple autonomic symptoms (choking, breathlessness, sweating) and psychological distress (impending doom). - Unlike a phobia where avoidance is the primary feature, this patient experiences discrete panic episodes with characteristic somatic symptoms.

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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