Anxiety Disorders Practice Questions

Q: All of the following are seen in generalized anxiety disorder (GAD), EXCEPT:

Fear of impending doom. **Explanation:** The correct answer is **C. Fear of impending doom**. In psychiatry, it is crucial to distinguish between **Generalized Anxiety Disorder (GAD)** and **Panic Disorder**. GAD is characterized by "free-floating anxiety"—a persistent, pervasive, and excessive worry about everyday events (finances, health, work) lasting for at least **6 months**. In contrast, a **"Fear of impending doom"** (or fear of dying/losing control) is a hallmark symptom of a **Panic Attack**. Panic attacks are discrete, intense periods of fear that peak within minutes, whereas GAD is a chronic, low-grade state of tension. **Analysis of Options:** * **A. Muscle tension:** This is a core somatic symptom of GAD. Patients often present with "tension headaches" or backaches due to chronic muscle rigidity. * **B. Irritability:** Chronic worry often leads to a low threshold for frustration, making irritability a diagnostic criterion in DSM-5. * **D. Restlessness:** Also described as feeling "keyed up" or "on edge," this reflects the psychomotor agitation common in GAD. **High-Yield Clinical Pearls for NEET-PG:** * **DSM-5 Criteria for GAD:** Anxiety + at least 3 of 6 symptoms: Restlessness, Easy fatigability, Difficulty concentrating, Irritability, Muscle tension, and Sleep disturbance. * **Duration:** Symptoms must be present for ≥ 6 months. * **Drug of Choice (DOC):** SSRIs (e.g., Escitalopram) are the first-line long-term treatment. Benzodiazepines are used only for short-term symptomatic relief. * **Psychotherapy:** Cognitive Behavioral Therapy (CBT) is the most effective psychological intervention.

Q: Phobia associated with elevators is an example of which of the following?

Claustrophobia. ### Explanation **Correct Answer: C. Claustrophobia** **Reasoning:** Claustrophobia is defined as the irrational and intense fear of **enclosed or confined spaces**. Elevators are a classic clinical example of a confined space where the individual feels trapped or fears having a panic attack without an easy means of escape. In psychiatry, phobias are categorized under Specific Phobias (ICD-11/DSM-5), characterized by marked anxiety about a specific object or situation. **Analysis of Incorrect Options:** * **A. Acrophobia:** This is the morbid fear of **heights**. While elevators travel to high floors, the primary trigger in an elevator is the confinement (walls/lack of exit), not necessarily the altitude itself. * **B. Social Phobia (Social Anxiety Disorder):** This involves a fear of **scrutiny or humiliation** in social or performance situations (e.g., public speaking). It is not related to physical spaces. * **C. Algophobia:** This is the pathological fear of **pain**. It is unrelated to environmental or situational triggers like elevators. **High-Yield Clinical Pearls for NEET-PG:** * **Treatment of Choice:** For specific phobias, the most effective treatment is **Cognitive Behavioral Therapy (CBT)** with **Exposure Therapy** (specifically Systematic Desensitization or Flooding). * **Pharmacotherapy:** Benzodiazepines or Beta-blockers (like Propranolol) may be used for short-term symptomatic relief or performance-related anxiety, but they are not first-line for long-term management of specific phobias. * **Common Phobia Terminologies:** * *Agoraphobia:* Fear of open spaces or situations where escape is difficult. * *Nyctophobia:* Fear of darkness. * *Ailurophobia:* Fear of cats. * *Cynophobia:* Fear of dogs.

Q: Which of the following is NOT true regarding anxiety?

Anxiety is always pathological.. ### Explanation **Correct Answer: D. Anxiety is always pathological.** **1. Why Option D is the correct answer:** Anxiety is a universal human experience and is not inherently a disease. It exists on a spectrum. **Normal (Physiological) Anxiety** is a transient, appropriate response to a perceived threat or stressor (e.g., the day before the NEET-PG exam). It becomes **Pathological Anxiety** only when it is disproportionate to the stimulus, persists in the absence of a threat, or significantly impairs social and occupational functioning. Therefore, the statement that anxiety is "always" pathological is false. **2. Analysis of Incorrect Options:** * **Option A (Adaptive response):** Anxiety is evolutionarily designed to help an individual prepare for challenges. According to the **Yerkes-Dodson Law**, a certain level of anxiety (arousal) actually improves performance on tasks. * **Option B (Alert signal):** Anxiety serves as an internal warning system, signaling the presence of an impending danger (internal or external) and prompting the individual to take measures to quickly deal with the threat. * **Option C (Autonomic hyperactivity):** The physiological manifestation of anxiety involves the activation of the sympathetic nervous system (the "fight or flight" response). This leads to symptoms such as tachycardia, palpitations, sweating, tremors, and tachypnea. **3. NEET-PG High-Yield Pearls:** * **Anxiety vs. Fear:** Fear is a response to a known, external, definite threat; Anxiety is a response to an unknown, internal, vague, or conflictual threat. * **Neurotransmitters:** Anxiety is typically associated with **decreased GABA**, **decreased Serotonin**, and **increased Norepinephrine** levels in the brain. * **Physical Symptoms:** Always rule out medical causes (e.g., Hyperthyroidism, Pheochromocytoma, or Arrhythmias) before diagnosing a primary anxiety disorder.

Q: All of the following are treatment modalities used in Generalized Anxiety Disorder, EXCEPT?

Caffeine. **Explanation:** **Generalized Anxiety Disorder (GAD)** is characterized by excessive, persistent, and uncontrollable worry about everyday events for at least 6 months. The management involves a combination of pharmacotherapy and psychotherapy. **Why Caffeine is the Correct Answer:** Caffeine is a **methylxanthine** that acts as a central nervous system stimulant. It antagonizes adenosine receptors, leading to increased release of excitatory neurotransmitters like norepinephrine. In patients with GAD, caffeine is **contraindicated** as it can exacerbate symptoms of anxiety, cause palpitations, tremors, and insomnia, and even trigger panic attacks. It is a known "anxiogenic" substance rather than a treatment modality. **Analysis of Incorrect Options:** * **Antidepressants (A):** These are the **first-line pharmacological treatment** for GAD. Selective Serotonin Reuptake Inhibitors (SSRIs) like Escitalopram and Sertraline, and SNRIs like Venlafaxine, are highly effective for long-term management. * **Electroconvulsive therapy (B):** While not a first-line treatment, ECT is a recognized modality in psychiatry for **treatment-resistant** cases of severe anxiety disorders, especially when comorbid with severe depression or suicidal ideation. * **Cognitive Behavioral Therapy (C):** CBT is the **first-line psychotherapy**. It focuses on identifying maladaptive thought patterns (cognitive restructuring) and behavioral modifications to reduce worry. **High-Yield Clinical Pearls for NEET-PG:** * **First-line drug class:** SSRIs (e.g., Escitalopram). * **Drug for performance anxiety:** Propranolol (Beta-blocker). * **Benzodiazepines:** Used only for short-term symptomatic relief due to the risk of dependence. * **Buspirone:** A 5-HT1A partial agonist specifically used for GAD; it has a slow onset of action (2–4 weeks) and no abuse potential.

Q: Which of the following substances is not involved in panic disorder?

GABA. **Explanation:** In the neurobiology of panic disorder, the primary neurotransmitters implicated are **Serotonin, Norepinephrine, and GABA**. The question asks which substance is **not** involved; however, based on standard psychiatric literature (Kaplan & Sadock), GABA is heavily involved via the benzodiazepine-GABA receptor complex. *Note: In many competitive exams, if this specific question appears with these options, it is often considered a "controversial" or "recall-error" question because all four substances actually play a role. However, looking at the provided key:* 1. **GABA (Correct as per key):** While GABA is the primary inhibitory neurotransmitter and GABA-A receptor dysfunction is linked to anxiety, some older curricula focused more heavily on the "excitatory" triggers of panic. If GABA is the marked answer, it implies that its role is considered secondary or modulatory compared to the direct "panicogens." 2. **Serotonin (Option A):** Definitely involved. SSRIs are the first-line treatment for panic disorder, and serotonergic dysregulation in the raphe nuclei is a core feature. 3. **CCK (Cholecystokinin) (Option B):** CCK is a potent **panicogen**. Administration of CCK tetrapeptide (CCK-4) reliably induces panic attacks in humans. 4. **Glutamate (Option C):** As the primary excitatory neurotransmitter, glutamate is involved in the "fear circuitry" (amygdala and hippocampus) and the conditioned fear response seen in panic disorder. **NEET-PG High-Yield Pearls:** * **Panicogens (Substances that induce panic):** Carbon dioxide (5-35%), Sodium Lactate, CCK, Caffeine, and Yohimbine. * **Neuroanatomy:** The **Amygdala** is the "fear center," and the **Locus Coeruleus** (norepinephrine) is the "alarm center" involved in panic. * **Treatment:** SSRIs are the long-term drug of choice; Benzodiazepines (acting on GABA) are used for acute management.

Q: Which of the following symptoms is NOT typically seen in anxiety?

Decreased sweating. **Explanation:** Anxiety is characterized by the activation of the **Sympathetic Nervous System (SNS)**, often referred to as the "fight or flight" response. This physiological state involves the release of catecholamines (epinephrine and norepinephrine), which lead to multi-systemic autonomic arousal. **1. Why "Decreased Sweating" is the Correct Answer:** In a state of anxiety, sympathetic stimulation increases the activity of eccrine sweat glands. Therefore, **increased sweating (diaphoresis)** is a hallmark symptom. "Decreased sweating" (anhidrosis) is not a feature of anxiety; rather, patients typically present with "clammy" or moist skin. **2. Analysis of Incorrect Options:** * **Hyperventilation:** Anxiety triggers the respiratory center, leading to rapid, shallow breathing. This can result in respiratory alkalosis, causing further symptoms like dizziness and perioral numbness. * **Cold Extremities:** Sympathetic activation causes **peripheral vasoconstriction** to divert blood flow to the vital organs and skeletal muscles. This reduced peripheral perfusion makes the hands and feet feel cold to the touch. * **Palpitations:** Increased heart rate (tachycardia) and increased force of myocardial contraction are classic beta-adrenergic effects seen during anxiety episodes. **Clinical Pearls for NEET-PG:** * **Physical vs. Psychological:** Anxiety presents with both somatic (palpitations, tremors, GI upset) and psychological (apprehension, "free-floating" dread) symptoms. * **Differential Diagnosis:** Always rule out medical mimics of anxiety, such as **Hyperthyroidism, Pheochromocytoma, and Hypoglycemia**, which also present with sympathetic overactivity. * **Panic Disorder:** Characterized by recurrent, unexpected panic attacks reaching a peak within 10 minutes, often accompanied by a "fear of dying" or "going crazy."

Question 1

All of the following are seen in generalized anxiety disorder (GAD), EXCEPT:

Accepted Answer

Fear of impending doom

Answer

Muscle tension

Answer

Irritability

Answer

Restlessness

Question 2

Phobia associated with elevators is an example of which of the following?

Accepted Answer

Claustrophobia

Answer

Acrophobia

Answer

Social phobia

Answer

Algophobia

Question 3

Which of the following is NOT true regarding anxiety?

Accepted Answer

Anxiety is always pathological.

Answer

Anxiety is an adaptive response.

Answer

Anxiety acts as an alert signal.

Answer

Anxiety can manifest as autonomic hyperactivity.

Question 4

All of the following are treatment modalities used in Generalized Anxiety Disorder, EXCEPT?

Accepted Answer

Caffeine

Answer

Antidepressants

Answer

Electroconvulsive therapy

Answer

Cognitive behavioral therapy

Question 5

Panic attack is associated with disturbances in all of the following neurotransmitters except:

Accepted Answer

Glutamate

Answer

Serotonin

Answer

GABA

Answer

Dopamine, CCK, pentagastrin

Question 6

Which of the following conditions does NOT typically present with symptoms resembling a panic attack?

Accepted Answer

Generalized tonic-clonic seizure (GTCS)

Answer

Hypoglycemia

Answer

Myocardial infarction

Answer

Temporal lobe epilepsy

Question 7

Which of the following substances is not involved in panic disorder?

Accepted Answer

GABA

Answer

Serotonin

Answer

CCK

Answer

Glutamate

Question 8

A 36-year-old man presents with a long-standing history of fainting and blurred vision, particularly when travelling on public transport. These symptoms are less severe when travelling in his wife's car. He avoids public transportation and has become homebound, with his wife now managing household tasks and shopping. He reports experiencing episodes of racing heart, sweating, and intense fear, which he associates with past negative experiences at work. What is the most likely diagnosis?

Accepted Answer

Agoraphobia

Answer

Social phobia

Answer

Generalized Anxiety Disorder

Answer

Post-Traumatic Stress Disorder

Question 9

Which of the following symptoms is NOT typically seen in anxiety?

Accepted Answer

Decreased sweating

Answer

Hyperventilation

Answer

Cold extremities

Answer

Palpitations

Question 10

What is the most common phobia?

Accepted Answer

Agoraphobia

Answer

Acrophobia

Answer

Thanatophobia

Answer

Photophobia

Anxiety Disorders — MCQs

Anxiety Disorders — MCQs

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