Anxiety Disorders Practice Questions

Q: Which of the following situations is most specific of a panic disorder?

Panic attack upon waking from sleep. To diagnose **Panic Disorder**, the core clinical requirement is the presence of **recurrent, unexpected (uncued)** panic attacks. ### Why Option D is Correct **Panic attack upon waking from sleep** (also known as **Nocturnal Panic Attacks**) is highly specific to Panic Disorder. These attacks occur without an obvious external trigger or situational cue. Since they often happen during the transition from late Stage 2 to Stage 3 (NREM) sleep, they are considered "out of the blue." In the context of the DSM-5 criteria, an "unexpected" attack is the hallmark of Panic Disorder, distinguishing it from other anxiety disorders where attacks are usually "cued" by specific stressors. ### Why Other Options are Incorrect * **Options A, B, and C** (Funeral, Interview, Exam) describe **"cued" or "situationally bound"** panic attacks. * **Funeral:** May be related to acute grief or post-traumatic stress. * **Interview/Exam:** These are classic triggers for **Social Anxiety Disorder** or **Performance Anxiety**. * While a person with Panic Disorder *can* have attacks in these settings, these situations are not *specific* to the diagnosis because the attacks are predictable responses to stressful stimuli. ### NEET-PG High-Yield Pearls * **Definition:** Panic Disorder requires at least one month of persistent concern about future attacks or a significant maladaptive change in behavior (e.g., avoidance). * **Nocturnal Panic:** Occurs in about 20-40% of patients with Panic Disorder. It is **not** associated with nightmares (which occur in REM sleep). * **Medical Mimics:** Always rule out Pheochromocytoma, Hyperthyroidism, and Arrhythmias (MVP is often associated). * **Treatment of Choice:** * **Acute attack:** Benzodiazepines (e.g., Alprazolam). * **Long-term/Maintenance:** SSRIs (First-line) + Cognitive Behavioral Therapy (CBT).

Q: Which of the following conditions does NOT mimic an anxiety disorder?

Hypothyroidism. **Explanation:** The core concept in differentiating medical mimics of anxiety is understanding whether the underlying condition causes **sympathetic overactivity** (tachycardia, tremors, sweating) or **central nervous system irritability**. **Why Hypothyroidism is the Correct Answer:** Hypothyroidism is characterized by a "slowing down" of metabolic processes. Clinical features include bradycardia, lethargy, weight gain, and depression. It does **not** mimic anxiety. In contrast, **Hyperthyroidism** (Thyrotoxicosis) is a classic mimic of anxiety disorders, presenting with palpitations, tremors, and nervousness. **Analysis of Incorrect Options:** * **Temporal Lobe Epilepsy (TLE):** Ictal phenomena in TLE often include "aura" symptoms like intense fear, panic, or autonomic arousal, which can be indistinguishable from a Panic Attack. * **Pheochromocytoma:** This catecholamine-secreting tumor causes paroxysmal surges of adrenaline/noradrenaline, leading to the "classic triad" of headaches, sweating, and palpitations, mimicking a severe Panic Disorder. * **Myocardial Infarction (MI):** An acute MI often presents with chest pain, dyspnea, diaphoresis, and a "sense of impending doom," all of which are hallmark symptoms of a Panic Attack. **High-Yield Clinical Pearls for NEET-PG:** * **Endocrine mimics:** Hyperthyroidism, Hypoglycemia, and Hyperparathyroidism (due to hypercalcemia) are common anxiety mimics. * **Drug-induced anxiety:** Caffeine, sympathomimetics (pseudoephedrine), and withdrawal from alcohol or benzodiazepines are high-yield causes. * **Rule of thumb:** Always rule out organic causes (especially cardiac and endocrine) before diagnosing a primary psychiatric anxiety disorder.

Q: When all other phobias are associated with stimulation of the sympathetic nervous system, which phobia is associated with giddiness and falls?

Blood injection phobia. **Explanation:** In most phobias, exposure to the phobic stimulus triggers a **sympathetic nervous system** surge, leading to the "fight or flight" response (tachycardia, hypertension, and palpitations). However, **Blood-Injection-Injury (BII) phobia** is unique because it follows a **biphasic response**. 1. **Initial Phase:** A brief increase in heart rate and blood pressure. 2. **Secondary Phase:** A sudden, massive **vasovagal response** characterized by a drop in blood pressure and heart rate (bradycardia). This leads to cerebral hypoperfusion, causing **giddiness, lightheadedness, and syncope (fainting)**. This is why BII phobia is the only phobia where patients frequently report falling or passing out. **Analysis of Incorrect Options:** * **A. Claustrophobia:** Fear of enclosed spaces. It triggers a standard sympathetic response (sweating, racing heart). * **C. Hydrophobia:** Fear of water. Classically associated with Rabies, it involves spasms of the throat muscles but does not typically cause a vasovagal drop in BP. * **D. Thanatophobia:** Fear of death. Like most specific phobias, it presents with typical anxiety symptoms driven by the sympathetic system. **NEET-PG High-Yield Pearls:** * **Treatment Difference:** While most phobias are treated with relaxation techniques, BII phobia is treated with **Applied Tension Technique** (tensing muscles to increase blood pressure and prevent fainting). * **Genetic Link:** BII phobia has the strongest familial/hereditary tendency among all phobias. * **Prevalence:** It affects approximately 3-4% of the population.

Q: Anxiety is manifested by the following, except:

Pupillary constriction. **Explanation:** Anxiety is characterized by a state of hyperarousal mediated by the **Sympathetic Nervous System (SNS)**. When a person experiences anxiety, the "fight or flight" response is activated, leading to specific physiological and psychological manifestations. **Why Pupillary Constriction is the Correct Answer:** Pupillary constriction (**Miosis**) is a result of **Parasympathetic** nervous system activation. In contrast, anxiety triggers the sympathetic system, which causes the radial muscles of the iris to contract, leading to **Pupillary Dilation (Mydriasis)**. This dilation occurs to allow more light into the eyes, enhancing peripheral vision during a perceived threat. **Analysis of Other Options:** * **A. Impaired concentration:** Anxiety involves excessive cognitive load and "racing thoughts," which distract the individual from the task at hand, leading to decreased focus. * **C. Insomnia:** Increased levels of cortisol and norepinephrine in anxiety states cause hypervigilance, making it difficult to initiate or maintain sleep (typically initial insomnia). * **D. Worry:** This is the hallmark psychological symptom of anxiety, characterized by apprehensive expectation about future events. **Clinical Pearls for NEET-PG:** * **Autonomic Symptoms of Anxiety:** Tachycardia, palpitations, tachypnea, sweating (diaphoresis), tremors, and cold extremities. * **Gastrointestinal:** Anxiety often causes decreased salivation (dry mouth) and increased motility (diarrhea). * **Physical Exam Tip:** Always look for **Mydriasis** (dilated pupils) in patients with acute panic attacks or generalized anxiety; **Miosis** (constricted pupils) is more characteristic of opioid intoxication or organophosphate poisoning.

Q: A 33-year-old male developed a panic attack before a public performance. Which of the following is NOT a clinical manifestation of a panic attack?

Warm hands. ### Explanation **Correct Answer: D. Warm hands** A panic attack is characterized by a sudden surge of intense fear or discomfort that reaches a peak within minutes. This triggers the **"Fight or Flight" response**, mediated by the **Sympathetic Nervous System (SNS)** and the release of catecholamines (epinephrine and norepinephrine). **Why "Warm hands" is the correct answer:** During a sympathetic surge, peripheral vasoconstriction occurs to divert blood flow away from the skin and extremities toward vital organs (heart, lungs, and skeletal muscles). This results in **cold, clammy hands** and feet, rather than warm hands. **Analysis of Incorrect Options:** * **A. Shortness of breath:** Hyperventilation is a hallmark of panic attacks. Patients often feel a "smothering sensation" or dyspnea due to increased respiratory drive. * **B. Tachycardia:** The release of adrenaline directly increases the heart rate and force of contraction, often perceived by the patient as palpitations. * **C. Tremors:** Increased muscle tension and circulating catecholamines lead to visible shaking or trembling. **Clinical Pearls for NEET-PG:** * **DSM-5 Criteria:** A panic attack requires at least **4 out of 13** symptoms (e.g., palpitations, sweating, trembling, chest pain, fear of losing control, or fear of dying). * **Physical Sign:** Look for **perioral numbness** or **carpopedal spasm** in questions; these occur due to respiratory alkalosis (hypocapnia) from hyperventilation. * **Management:** * **Acute attack:** Benzodiazepines (e.g., Alprazolam, Lorazepam). * **Long-term (Panic Disorder):** SSRIs (Drug of Choice) + Cognitive Behavioral Therapy (CBT).

Q: An 18-year-old girl presents with breathlessness, anxiety, palpitations, and tingling around the lips. There is a similar history in the past. What is the most likely diagnosis?

Panic attack. ### Explanation **Correct Option: A. Panic Attack** The clinical presentation of acute breathlessness, palpitations, and anxiety, combined with the classic sign of **perioral tingling (paresthesia)**, is hallmark for a panic attack. * **Pathophysiology:** During a panic attack, hyperventilation leads to excessive "blowing off" of $CO_2$ (**Respiratory Alkalosis**). This shift in pH increases the binding of ionized calcium to albumin, resulting in **hypocalcemia**. * **Clinical Sign:** Hypocalcemia manifests as neuromuscular irritability, specifically tingling around the lips (perioral) and in the fingertips. The episodic nature ("similar history in the past") further supports this diagnosis. **Why other options are incorrect:** * **B. Anxiety Disorder:** This is a broad category (e.g., GAD). While a panic attack is a feature of Panic Disorder, the *acute* presentation described is the specific "attack" itself, not the generalized state. * **C. Conversion Disorder (Functional Neurological Symptom Disorder):** This typically presents as a loss of sensory or motor function (e.g., sudden blindness or paralysis) following a psychological stressor, rather than autonomic hyperactivity like palpitations. * **D. Acute Psychosis:** This involves a loss of contact with reality, characterized by delusions, hallucinations, or disorganized speech, which are absent in this patient. **High-Yield Clinical Pearls for NEET-PG:** 1. **ABG Findings:** In a panic attack, look for high pH, low $pCO_2$, and normal $HCO_3$ (Acute Respiratory Alkalosis). 2. **Trousseau’s and Chvostek’s signs:** These may be positive during the episode due to transient hypocalcemia. 3. **Management:** Immediate management involves reassurance and breathing into a paper bag (to increase $pCO_2$); long-term treatment involves SSRIs and CBT.

Q: Phobia is a type of:

Neurosis. **Explanation:** **1. Why Neurosis is Correct:** Phobia is classified as a **Neurosis** (specifically an Anxiety Neurosis). In psychiatry, neurosis refers to a group of non-psychotic mental disorders characterized by distressing symptoms where **insight is preserved** and **reality testing remains intact**. Patients with phobias recognize that their fear is excessive or irrational (insight) and do not lose touch with reality, which are the hallmark features of neurotic disorders. **2. Why Other Options are Incorrect:** * **Psychosis:** Unlike neurosis, psychosis involves a loss of contact with reality, lack of insight, and the presence of delusions or hallucinations (e.g., Schizophrenia). Phobic patients do not experience these. * **Mania:** This is a mood disorder characterized by elation, hyperactivity, and pressured speech. It is a feature of Bipolar Disorder, not an anxiety-based phobic response. * **Depression:** While phobias can coexist with depression (comorbidity), depression is primarily a disorder of mood (sadness, anhedonia) rather than a specific irrational fear of an object or situation. **3. Clinical Pearls for NEET-PG:** * **Definition of Phobia:** An irrational, persistent, and excessive fear of a specific object, activity, or situation that leads to a compelling desire to avoid it. * **Agoraphobia:** Fear of being in places where escape might be difficult (e.g., crowds, open spaces). It is the most common phobia seen in clinical practice. * **Social Phobia (Social Anxiety Disorder):** Fear of scrutiny or embarrassment in social situations. * **Treatment of Choice:** For Specific Phobias, **Systematic Desensitization** (Behavioral Therapy) is the most effective. For Social Phobia/Agoraphobia, SSRIs are the first-line pharmacological treatment.

Question 1

Which of the following situations is most specific of a panic disorder?

Accepted Answer

Panic attack upon waking from sleep

Answer

Panic attack during a funeral

Answer

Panic attack before an interview

Answer

Panic attack during an exam

Question 2

Which of the following conditions does NOT mimic an anxiety disorder?

Accepted Answer

Hypothyroidism

Answer

Temporal lobe epilepsy

Answer

Pheochromocytoma

Answer

Myocardial Infarction

Question 3

A 35-year-old male with pre-morbid anxious traits and heavy smoking history believes he has been suffering from 'lung carcinoma' for a year. No significant clinical findings are detected on examination, and relevant investigations are normal. He continues to adhere to his belief despite evidence to the contrary, having spent considerable money, time, and energy on extensive investigations. What is the most likely diagnosis?

Accepted Answer

Hypochondriacal disorder

Answer

Carcinoma lung

Answer

Delusional disorder

Answer

Malingering

Question 4

How is the diagnosis of Agoraphobia typically made?

Accepted Answer

The patient exhibits fear when in open spaces or certain other situations.

Answer

The patient experiences panic attacks when left alone.

Answer

The patient is able to enter an elevator alone without anxiety.

Answer

The patient complains of insomnia.

Question 5

A 25-year-old lady presented with sadness, palpitation, loss of appetite, and insomnia. There is no complaint of hopelessness, suicidal thoughts, and no past history of any precipitating event. She is remarkably well in other areas of life, doing her office job normally, and her social life is also normal. What is the probable diagnosis in this case?

Accepted Answer

Generalized Anxiety Disorder (GAD)

Answer

Mixed anxiety and depression

Answer

Adjustment disorder

Answer

Mild depressive episode

Question 6

When all other phobias are associated with stimulation of the sympathetic nervous system, which phobia is associated with giddiness and falls?

Accepted Answer

Blood injection phobia

Answer

Claustrophobia

Answer

Hydrophobia

Answer

Thanatophobia

Question 7

Anxiety is manifested by the following, except:

Accepted Answer

Pupillary constriction

Answer

Impaired concentration

Answer

Insomnia

Answer

Worry

Question 8

A 33-year-old male developed a panic attack before a public performance. Which of the following is NOT a clinical manifestation of a panic attack?

Accepted Answer

Warm hands

Answer

Shortness of breath

Answer

Tachycardia

Answer

Tremors

Question 9

An 18-year-old girl presents with breathlessness, anxiety, palpitations, and tingling around the lips. There is a similar history in the past. What is the most likely diagnosis?

Accepted Answer

Panic attack

Answer

Anxiety disorder

Answer

Conversion disorder

Answer

Acute psychosis

Question 10

Phobia is a type of:

Accepted Answer

Neurosis

Answer

Psychosis

Answer

Mania

Answer

Depression

Anxiety Disorders — MCQs

Anxiety Disorders — MCQs

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