Anxiety Disorders — MCQs

Anxiety Disorders Indian Medical PG Practice Questions and MCQs

Question 131: A 45-year-old male presents with recurrent episodes of palpitations, sweating, and a fear of losing control. He has been experiencing these episodes for the past six months. What is the most likely diagnosis?

A. Generalized anxiety disorder
B. Panic disorder (Correct Answer)
C. Social anxiety disorder
D. Obsessive-compulsive disorder

Explanation: ***Panic disorder*** - The presentation of recurrent, unexpected **panic attacks** characterized by sudden episodes of intense fear, palpitations, sweating, and a fear of losing control is classic for **panic disorder**. - These episodes often manifest with physical symptoms that mimic a medical emergency, leading to significant distress and avoidance behaviors. *Generalized anxiety disorder* - This condition involves **persistent and excessive worry** about various life circumstances for at least six months, rather than discrete, intense episodes of fear. - While physical symptoms like restlessness and fatigue can occur, they are generally less acute and not as severe as the sudden "fight-or-flight" response seen in panic attacks. *Social anxiety disorder* - This disorder is characterized by marked fear or anxiety about **social situations** where the individual might be scrutinized by others. - While it can involve symptoms like palpitations and sweating in social contexts, it doesn't typically present with unexpected attacks unrelated to social performance. *Obsessive-compulsive disorder* - This disorder is defined by the presence of **obsessions** (recurrent and persistent thoughts, urges, or images) and/or **compulsions** (repetitive behaviors or mental acts) that the individual feels driven to perform. - The symptoms described—palpitations, sweating, and fear of losing control—are not typical primary manifestations of OCD, which focuses on specific obsessions and compulsions.

Question 132: A 25-year-old female presents with a sudden onset of severe headache, palpitations, and a feeling of impending doom. Physical examination reveals no abnormalities. What is the most likely diagnosis?

A. Panic disorder (Correct Answer)
B. Generalized anxiety disorder
C. Social anxiety disorder
D. Post-traumatic stress disorder

Explanation: ***Panic disorder*** - This presentation describes a classic **panic attack**, which is the hallmark feature of panic disorder, characterized by a sudden onset of intense fear or discomfort that peaks within minutes, accompanied by physical symptoms like **palpitations**, **headache**, and a feeling of **impending doom**. - The lack of specific physical abnormalities on examination further supports a psychological origin rather than an organic cause. - Panic disorder is diagnosed when there are **recurrent unexpected panic attacks** along with persistent concern about additional attacks or their consequences. *Generalized anxiety disorder* - This condition involves **persistent and excessive worry** about various aspects of life for at least 6 months, not typically sudden, acute episodes. - While physical symptoms like headaches can occur, they are generally part of a chronic state of tension and worry, not a sudden, overwhelming attack as described. *Social anxiety disorder* - This disorder is characterized by **intense fear or anxiety regarding social situations** where the individual might be scrutinized or embarrassed. - The symptoms are specifically tied to social interaction and not a generalized, unprovoked attack as described. *Post-traumatic stress disorder* - PTSD involves the development of characteristic symptoms like **re-experiencing traumatic events**, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity, following exposure to a traumatic event. - The patient's presentation does not describe a history of trauma or other PTSD-specific symptoms.

Question 133: A patient experiences a persistent fear of having a serious illness despite medical reassurance. This condition is most likely:

A. Generalized Anxiety Disorder
B. Somatic Symptom Disorder
C. Illness Anxiety Disorder (Correct Answer)
D. Obsessive-Compulsive Disorder

Explanation: ***Illness Anxiety Disorder*** - This disorder is characterized by a **preoccupation with having or acquiring a serious illness** despite the absence of significant somatic symptoms. - Individuals experience **high anxiety about health** and are easily alarmed about personal health status, often seeking excessive medical care or avoiding it entirely. *Generalized Anxiety Disorder* - This disorder involves **excessive worry** about various everyday issues, such as finances, work, or family, rather than a specific preoccupation with illness. - While health concerns can be part of GAD, they are not the central focus to the exclusion of other worries, and the patient's anxiety is **not solely focused on serious illness**. *Somatic Symptom Disorder* - This condition involves one or more **somatic symptoms that are distressing** or result in significant disruption of daily life, along with excessive thoughts, feelings, or behaviors related to these symptoms. - Unlike illness anxiety disorder, the primary concern in somatic symptom disorder is the **physical symptoms themselves**, rather than the fear of a serious underlying illness in the absence of significant symptoms. *Obsessive-Compulsive Disorder* - This disorder involves **recurrent, persistent thoughts (obsessions)** or **repetitive behaviors (compulsions)** that the individual feels driven to perform in response to an obsession. - While health-related obsessions and compulsions can occur, the core feature is the presence of distinct obsessions and compulsions, which is different from the **persistent fear of having an illness** despite reassurance.

Question 134: A 40-year-old woman presents with excessive worry about her health, frequently visits doctors, and demands multiple tests despite no significant findings. What is the most likely diagnosis?

A. Panic disorder
B. Generalized anxiety disorder
C. Illness anxiety disorder (Correct Answer)
D. Somatic symptom disorder

Explanation: **Illness anxiety disorder** - This disorder is characterized by **preoccupation with having or acquiring a serious illness**, despite minimal or no somatic symptoms, leading to high levels of anxiety about health. - Individuals frequently **seek medical attention and reassurance**, often demanding multiple tests, despite negative findings. *Panic disorder* - Marked by recurrent, unexpected **panic attacks**, which are sudden episodes of intense fear accompanied by physical symptoms like palpitations and shortness of breath. - While it involves anxiety, the central feature is not a persistent worry about having a specific illness. *Generalized anxiety disorder* - Characterized by **persistent and excessive worry** about various aspects of life, not specifically about having a serious illness. - The worry is often difficult to control and is associated with symptoms like restlessness, fatigue, and difficulty concentrating. *Somatic symptom disorder* - Involves **one or more somatic symptoms that are distressing or result in significant disruption of daily life**, accompanied by excessive thoughts, feelings, or behaviors related to these symptoms. - Unlike illness anxiety disorder, where the focus is on the *fear* of illness, in somatic symptom disorder, the primary concern is the actual physical symptoms themselves.

Question 135: A 32-year-old mother has severe, ego-dystonic thoughts of harming her child with no prior treatment. After ensuring immediate safety, what is the most appropriate therapeutic intervention for ongoing management?

A. Exposure and Response Prevention (Correct Answer)
B. Emergency psychiatric evaluation and crisis intervention
C. Antipsychotic medication
D. Cognitive Behavioral Therapy

Explanation: ***Exposure and Response Prevention (ERP)*** - **ERP is the gold-standard psychotherapy** for OCD, which these ego-dystonic intrusive thoughts strongly suggest - Specifically designed to address **obsessive intrusive thoughts** by gradually exposing patients to feared thoughts while preventing compulsive responses - **Most evidence-based treatment** for intrusive aggressive obsessions, including postpartum OCD with thoughts of harming one's child - Superior efficacy compared to general CBT for OCD symptoms with **70-80% response rates** *Cognitive Behavioral Therapy* - While CBT is effective for many anxiety disorders, **ERP is a specialized form of CBT** specifically designed for OCD - When both options are available, **ERP is preferred** as it directly targets the obsessive-compulsive cycle - General CBT may be used if ERP is not available or as an adjunct, but is **not first-line** for OCD with intrusive thoughts *Emergency psychiatric evaluation and crisis intervention* - The question specifically states **"after ensuring immediate safety"** - this indicates acute safety measures have already been addressed - Emergency evaluation focuses on **immediate risk assessment**, not ongoing therapeutic management - While important initially, this does not address the long-term treatment of ego-dystonic obsessive thoughts *Antipsychotic medication* - Reserved for **psychotic disorders** where patients have delusions or believe their thoughts are true - These are **ego-dystonic** thoughts (recognized as inconsistent with self), not psychotic symptoms - Not first-line treatment for OCD; SSRIs would be the medication class of choice if pharmacotherapy is indicated

Question 136: A 40-year-old male with generalized anxiety disorder is started on an SSRI but experiences increased anxiety after one week. What is the best course of action?

A. Discontinue the SSRI
B. Add a benzodiazepine temporarily (Correct Answer)
C. Switch to a different SSRI
D. Increase the SSRI dose

Explanation: ***Add a benzodiazepine temporarily*** - **SSRIs** can initially worsen **anxiety symptoms** before therapeutic effects begin, which often takes 2-4 weeks. - A **benzodiazepine** can provide rapid symptomatic relief for acute anxiety during this initial phase, and can be tapered once the **SSRI** therapeutic effects are established. *Discontinue the SSRI* - Discontinuing the **SSRI** after only one week due to initial increased anxiety is premature, as this is a known, temporary side effect. - Doing so would prevent the patient from experiencing the potential long-term benefits of the medication for **generalized anxiety disorder**. *Switch to a different SSRI* - Switching to a different **SSRI** is not indicated at this stage, as the current medication has not had sufficient time to demonstrate its efficacy or full side effect profile. - A new **SSRI** would likely present the same initial increase in anxiety, restarting the acclimatization period. *Increase the SSRI dose* - Increasing the **SSRI** dose would likely exacerbate the current side effect of increased anxiety, worsening the patient's discomfort. - It's too early to assess the current dose's efficacy, and increasing it prematurely is ill-advised without established tolerance or a therapeutic window.

Question 137: What is the next step for a patient with generalized anxiety disorder who has been on an SSRI for 8 weeks with no response?

A. Switch to SNRI (Correct Answer)
B. Increase SSRI dose
C. Switch to a different SSRI
D. Add a benzodiazepine

Explanation: ***Switch to SNRI*** - If a patient with GAD shows no response to an SSRI after an adequate trial (8 weeks), switching to an **SNRI** is a recommended next step due to its different mechanism of action combining serotonin and norepinephrine reuptake inhibition. - SNRIs like **venlafaxine** or **duloxetine** are considered **first-line treatments** for GAD alongside SSRIs, and can be effective when SSRIs are not. *Increase SSRI dose* - While dose escalation is often attempted for partial response, if there has been **no response** at all after 8 weeks, a higher dose of the same medication is **unlikely to be effective**. - There is a risk of increased **side effects** without significant clinical benefit when increasing a non-responsive dose. *Switch to a different SSRI* - Switching to another SSRI might be considered for **partial response** or intolerance to the initial SSRI, but for **complete non-response**, switching to a medication with a different mechanism of action (like an SNRI) is generally preferred. - The patient has already failed one SSRI, suggesting that the **class effect** might not be sufficient for their specific presentation. *Add a benzodiazepine* - Benzodiazepines are typically used for **short-term relief** of acute anxiety symptoms due to their rapid onset of action. - They are generally **not recommended** as a first-line or add-on treatment for chronic GAD due to risks of dependence and withdrawal, and they do not treat the underlying disorder.

Question 138: A 35-year-old man experiences recurrent episodes of intense fear, chest pain, and a feeling of impending doom. What is the most likely diagnosis?

A. Generalized anxiety disorder
B. Panic disorder (Correct Answer)
C. Post-traumatic stress disorder
D. Social anxiety disorder

Explanation: ***Panic disorder*** - Characterized by **recurrent, unexpected panic attacks** involving sudden, intense fear, physical symptoms like chest pain, and a feeling of impending doom. - The symptoms described (intense fear, chest pain, feeling of impending doom) are classic manifestations of a **panic attack**. *Generalized anxiety disorder* - Involves **persistent and excessive worry** about everyday events, not discrete episodes of intense fear. - While anxiety is present, it does not typically manifest as acute, episodic attacks with such severe physical symptoms. *Post-traumatic stress disorder* - Develops after exposure to a **traumatic event** and is characterized by intrusive memories, avoidance, negative alterations in cognition and mood, and hyperarousal. - The question does not mention any prior trauma, and the symptoms are more acute and episodic than the persistent re-experiencing seen in PTSD. *Social anxiety disorder* - Involves **marked fear or anxiety about social situations** where the individual may be scrutinized by others. - While anxiety occurs in social contexts, it does not typically present as sudden, unprovoked attacks of intense fear and physical symptoms like those described.

Question 139: A 40-year-old male presents with sudden episodes of intense fear, palpitations, and shortness of breath lasting about 10 minutes. He is afraid of having another attack. What is the diagnosis?

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

Explanation: ***Panic disorder*** - Characterized by recurrent, **unexpected panic attacks** with sudden onset of intense fear and physical symptoms like palpitations and shortness of breath. - The fear of having another attack ("**anticipatory anxiety**") is a key diagnostic criterion for panic disorder. *Generalized anxiety disorder* - Involves **persistent and excessive worry** about various areas of life, not sudden, discrete panic attacks. - Symptoms are more chronic and pervasive, rather than episodic and intense. *Social anxiety disorder* - Marked by intense fear or anxiety about **social situations** where the individual might be scrutinized or judged. - The symptoms are triggered by social performance or interaction, not unexpected attacks. *Specific phobia* - Characterized by an intense, irrational fear of a **specific object or situation** (e.g., heights, spiders). - Panic-like symptoms occur only in response to the specific phobic stimulus, not unexpectedly.

Question 140: What are the key differences between generalized anxiety disorder and panic disorder?

A. GAD does not primarily involve panic attacks, which are a hallmark of Panic Disorder.
B. GAD involves persistent worry, while Panic Disorder involves recurrent panic attacks. (Correct Answer)
C. GAD is characterized by chronic anxiety symptoms, while Panic Disorder presents with episodic intense fear reactions.
D. GAD involves fear of specific situations, while Panic Disorder involves generalized worry about daily activities.

Explanation: ***GAD involves persistent worry, while Panic Disorder involves recurrent panic attacks.*** - **Generalized Anxiety Disorder (GAD)** is characterized by **persistent, excessive, and uncontrollable worry** about multiple everyday events or activities, lasting for at least six months, accompanied by symptoms like restlessness, fatigue, difficulty concentrating, and muscle tension. - **Panic Disorder (PD)** is defined by **recurrent, unexpected panic attacks**, which are sudden episodes of intense fear accompanied by physical symptoms like heart palpitations, shortness of breath, chest pain, dizziness, and a sense of impending doom. - This option captures the **core distinguishing feature** between the two disorders. *GAD involves fear of specific situations, while Panic Disorder involves generalized worry about daily activities.* - This statement is **incorrect and reverses the actual presentation**. - GAD is characterized by **generalized worry across multiple domains**, not fear of specific situations (which would be more characteristic of phobic disorders). - Panic Disorder centers on **recurrent panic attacks and fear of future attacks**, not generalized worry about daily activities. *GAD does not primarily involve panic attacks, which are a hallmark of Panic Disorder.* - This statement is **factually correct** but does not fully capture the key differences. - While panic attacks are indeed the hallmark of Panic Disorder and not the primary feature of GAD, this option focuses on what GAD **lacks** rather than the comprehensive contrast between persistent worry and acute panic episodes. - The most complete answer describes both disorders' positive defining features. *GAD is characterized by chronic anxiety symptoms, while Panic Disorder presents with episodic intense fear reactions.* - This statement is **clinically accurate** and describes a valid distinction. - However, it is slightly less specific than the correct answer; "chronic anxiety symptoms" is broader than "persistent worry," and "episodic intense fear reactions" is less precise than "recurrent panic attacks." - The terminology in the correct answer more closely aligns with **DSM-5 diagnostic criteria**.

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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