Anxiety Disorders — MCQs

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?

Q45Easy

Fear of heights is termed as?

Q46Easy

What is ailurophobia?

Q47Easy

Which drug is used for narcoanalysis?

Q48Easy

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

Q49Easy

What is the most common phobia?

Q50Easy

All of the following statements regarding blackouts are true EXCEPT?

Anxiety Disorders Indian Medical PG Practice Questions and MCQs

Question 41: Panic attack is associated with disturbances in all of the following neurotransmitters except:

A. Serotonin
B. GABA
C. Glutamate (Correct Answer)
D. Dopamine, CCK, pentagastrin

Explanation: Panic disorder is characterized by recurrent, unexpected panic attacks involving intense fear and autonomic arousal. The neurobiology of panic involves a complex interplay of multiple neurotransmitter systems, primarily centered in the **locus coeruleus** (norepinephrine) and the **amygdala**. ### **Explanation of the Correct Answer** **C. Glutamate:** While glutamate is the brain's primary excitatory neurotransmitter and is implicated in general neurotoxicity and certain psychotic disorders, it is **not** traditionally considered a primary mediator in the acute pathophysiology of a panic attack. Current psychiatric models for panic focus on the dysregulation of the monoamine and inhibitory systems rather than glutamatergic pathways. ### **Analysis of Incorrect Options** * **A. Serotonin (5-HT):** Serotonergic neurons (from the Raphe nuclei) inhibit the firing of the locus coeruleus. A deficiency in serotonin is a core hypothesis in panic disorder, which is why SSRIs are the first-line long-term treatment. * **B. GABA:** Gamma-aminobutyric acid is the brain's chief inhibitory neurotransmitter. Reduced GABAergic activity or decreased benzodiazepine receptor sensitivity leads to CNS hyperexcitability, contributing to the "fight or flight" response seen in panic. * **D. Dopamine, CCK, Pentagastrin:** * **Dopamine** levels are often elevated during acute stress. * **Cholecystokinin (CCK)** and **Pentagastrin** are potent "panicogens." Administration of these substances can experimentally induce a panic attack in susceptible individuals. ### **High-Yield Clinical Pearls for NEET-PG** * **Locus Coeruleus:** The anatomical "alarm center" of the brain; it contains the highest concentration of norepinephrine. * **Panicogens (Agents that trigger attacks):** CO2 inhalation (most common), Sodium Lactate, Caffeine, CCK, and Pentagastrin. * **First-line Treatment:** SSRIs (Long-term); Benzodiazepines (Acute/Short-term). * **Cognitive Theory:** Panic attacks result from the "catastrophic misinterpretation" of harmless physical sensations.

Question 42: Which of the following conditions does NOT typically present with symptoms resembling a panic attack?

A. Hypoglycemia
B. Generalized tonic-clonic seizure (GTCS) (Correct Answer)
C. Myocardial infarction
D. Temporal lobe epilepsy

Explanation: **Explanation:** The core of this question lies in differentiating between **Panic Attacks** (characterized by autonomic hyperactivity and intense fear) and other medical conditions that mimic these symptoms. **Why GTCS is the correct answer:** A **Generalized Tonic-Clonic Seizure (GTCS)** involves a sudden loss of consciousness followed by symmetrical tonic stiffening and clonic jerking of all limbs. It is a global neurological event. Because the patient is unconscious during the ictus, they do not experience the subjective "intense fear," palpitations, or "sense of impending doom" that define a panic attack. Post-ictally, patients are typically confused or comatose, rather than anxious. **Why the other options are incorrect:** * **Hypoglycemia:** Triggers a massive sympathetic discharge (epinephrine release). Symptoms like tremors, sweating, tachycardia, and anxiety directly mimic the autonomic arousal of a panic attack. * **Myocardial Infarction (MI):** Often presents with chest pain, dyspnea, diaphoresis, and a profound "sense of impending doom," making it the most critical medical differential for a first-time panic attack. * **Temporal Lobe Epilepsy (TLE):** Simple partial seizures (auras) originating in the temporal lobe (specifically the amygdala) can manifest as sudden, unprovoked intense fear, tachycardia, and epigastric rising sensations, which are phenomenologically identical to a panic attack. **High-Yield Clinical Pearls for NEET-PG:** * **Panic Disorder Diagnosis:** Requires recurrent unexpected panic attacks followed by $\geq$1 month of persistent concern about future attacks or significant behavioral changes. * **Medical Mimics:** Always rule out **Pheochromocytoma** (triad of headache, sweating, tachycardia), **Hyperthyroidism**, and **SVTs** before diagnosing Panic Disorder. * **Drug of Choice:** SSRIs are the first-line long-term treatment; Benzodiazepines (e.g., Alprazolam) are used for acute abortive therapy.

Question 43: A 36-year-old female complains of sudden onset of feeling of pounding heart, apprehension, and excessive sweating. She fears that she is about to die. Which of the following is the likely diagnosis?

A. Conversion Disorder
B. Generalized Anxiety Disorder
C. Panic attack (Correct Answer)
D. Specific Phobia

Explanation: ### Explanation **Correct Answer: C. Panic attack** The clinical presentation described is a classic **Panic Attack**. A panic attack 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 arousal:** Pounding heart (palpitations) and excessive sweating. * **Psychological symptoms:** Intense apprehension and the **"sense of impending doom"** (fear of dying). According to DSM-5, at least 4 out of 13 physical/cognitive symptoms must be present. The sudden onset and the severity of the fear are the hallmarks that distinguish it from other anxiety disorders. **Why other options are incorrect:** * **A. Conversion Disorder (Functional Neurological Symptom Disorder):** This involves unexplained deficits in voluntary motor or sensory functions (e.g., paralysis, blindness, or seizures) that are not compatible with neurological conditions, usually triggered by psychological stress. * **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 of a panic attack. * **D. Specific Phobia:** While phobias can trigger panic symptoms, they occur only in response to a **specific identifiable stimulus** (e.g., heights, spiders). The question describes a spontaneous onset without a specific trigger. **High-Yield Clinical Pearls for NEET-PG:** * **Acute Management:** Benzodiazepines (e.g., Alprazolam or Lorazepam). * **Long-term Treatment (Panic Disorder):** SSRIs (Drug of Choice) + Cognitive Behavioral Therapy (CBT). * **Differential Diagnosis:** Always rule out medical causes like Hyperthyroidism, Pheochromocytoma, and Myocardial Infarction (MI) before diagnosing a panic attack. * **Agoraphobia:** Frequently associated with panic disorder; it is the fear of being in places where escape might be difficult during an attack.

Question 44: 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?

A. Social phobia
B. Agoraphobia (Correct Answer)
C. Generalized Anxiety Disorder
D. Post-Traumatic Stress Disorder

Explanation: ### Explanation **Correct Option: B. Agoraphobia** The clinical presentation is classic for **Agoraphobia**. According to DSM-5, Agoraphobia involves marked fear or anxiety about two or more of the following situations: using public transport, being in open spaces, being in enclosed spaces, standing in line/crowds, or being outside the home alone. The patient’s fear stems from the idea that **escape might be difficult** or help might not be available in the event of developing panic-like or incapacitating symptoms (fainting, blurred vision). Key diagnostic features present here include: * **Avoidance behavior:** He avoids public transport. * **Safety signals:** Symptoms are less severe when with his wife (a "companion"). * **Functional impairment:** He has become homebound, shifting responsibilities to his spouse. **Why Incorrect Options are Wrong:** * **A. Social Phobia:** The primary fear here is of **scrutiny or negative evaluation** by others in social situations, not a fear of being unable to escape a physical location. * **C. Generalized Anxiety Disorder (GAD):** GAD is characterized by "free-floating" anxiety and excessive worry about various everyday matters (finances, health) for at least 6 months, rather than situational avoidance. * **D. Post-Traumatic Stress Disorder (PTSD):** While he mentions "negative experiences at work," the core symptoms of PTSD—re-experiencing (flashbacks/nightmares), hyperarousal, and avoidance of trauma-specific reminders—are absent. **Clinical Pearls for NEET-PG:** * **Agoraphobia vs. Panic Disorder:** Agoraphobia can occur with or without Panic Disorder. If a patient meets criteria for both, **both** diagnoses are now assigned under DSM-5. * **The "Safety Person":** A hallmark of agoraphobia is the ability to face feared situations only when accompanied by a trusted companion. * **Treatment:** Cognitive Behavioral Therapy (CBT) and SSRIs (e.g., Escitalopram, Sertraline) are first-line treatments.

Question 45: Fear of heights is termed as?

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

Explanation: **Explanation:** **Acrophobia** is the correct answer. It is a specific phobia characterized by an intense, irrational fear of heights. The term is derived from the Greek word *'akron'*, meaning peak or summit. In psychiatry, specific phobias are defined by significant anxiety or panic attacks triggered by exposure to the specific stimulus, leading to avoidance behavior that interferes with daily functioning. **Analysis of Incorrect Options:** * **Agoraphobia:** This is the fear of being in situations or places where escape might be difficult or help might not be available in the event of a panic attack. It often involves open spaces, public transport, or being in a crowd. * **Claustrophobia:** This is the fear of enclosed or confined spaces, such as elevators, small rooms, or tunnels. * **Haphephobia:** This is a rare specific phobia involving the fear of being touched or touching others. **Clinical Pearls for NEET-PG:** * **Treatment of Choice:** For specific phobias like acrophobia, the most effective treatment is **Cognitive Behavioral Therapy (CBT)** with **Systemic Desensitization** or **Exposure Therapy** (specifically *in-vivo* exposure). * **Pharmacotherapy:** Benzodiazepines or Beta-blockers (like Propranolol) may be used for short-term symptomatic relief of performance-related anxiety, but they are not the primary treatment for phobias. * **Diagnosis:** According to DSM-5, the fear must be persistent (typically lasting **6 months or more**) and out of proportion to the actual danger posed.

Question 46: What is ailurophobia?

A. Fear of heights
B. Fear of water
C. Fear of cats (Correct Answer)
D. Fear of strangers

Explanation: **Explanation:** **Ailurophobia** is the persistent, irrational fear of **cats**. In psychiatry, this is classified as a **Specific Phobia** (DSM-5), characterized by significant distress or avoidance behavior when exposed to the feline stimulus. The term is derived from the Greek words *ailouros* (cat) and *phobos* (fear). **Analysis of Options:** * **Option A (Fear of heights):** This is known as **Acrophobia**. It is one of the most common specific phobias and can lead to vertigo-like symptoms. * **Option B (Fear of water):** This is known as **Hydrophobia**. Clinically, it is a hallmark sign of **Rabies** infection due to painful spasms when swallowing liquids. * **Option D (Fear of strangers):** This is known as **Xenophobia**. In a developmental context, "Stranger Anxiety" is a normal milestone in infants (typically appearing around 8–9 months). **Clinical Pearls for NEET-PG:** 1. **Treatment of Choice:** For specific phobias, the most effective treatment is **Cognitive Behavioral Therapy (CBT) with Exposure Therapy** (specifically Systematic Desensitization or Flooding). 2. **Pharmacotherapy:** Generally not the first line, but **Benzodiazepines** or **Beta-blockers** (e.g., Propranolol) may be used for short-term relief of acute performance-related anxiety. 3. **Epidemiology:** Specific phobias are more common in females and often have an onset in childhood or early adolescence. 4. **Other High-Yield Phobias:** * *Cynophobia:* Fear of dogs. * *Entomophobia:* Fear of insects. * *Ophidiophobia:* Fear of snakes.

Question 47: Which drug is used for narcoanalysis?

A. Atropine
B. Scopolamine (Correct Answer)
C. Propranolol
D. Naltrexone

Explanation: **Explanation:** **Narcoanalysis** (also known as "truth serum" therapy) involves the administration of a drug that induces a state of semi-consciousness or "twilight sleep." In this state, the patient’s inhibitions are lowered, making them more likely to disclose suppressed information or repressed memories. **Why Scopolamine is correct:** **Scopolamine** (Hyoscine) is a belladonna alkaloid with potent central anticholinergic effects. Historically, it was the first drug used for narcoanalysis because it induces sedation and significant **anterograde amnesia**. By depressing the cerebral cortex, it bypasses conscious defenses, making it difficult for a subject to maintain a lie. While barbiturates like Sodium Amobarbital (Amytal) and Sodium Pentothal are more commonly used today, Scopolamine remains a classic pharmacological answer for this procedure. **Why the other options are incorrect:** * **Atropine:** While also an anticholinergic, it has poor CNS penetration compared to scopolamine and is primarily used to treat bradycardia or organophosphate poisoning. * **Propranolol:** A beta-blocker used in psychiatry for **performance anxiety** (stage fright) and akathisia, but it has no sedative or disinhibiting properties. * **Naltrexone:** An opioid antagonist used in the management of alcohol and opioid dependence; it does not induce a semi-conscious state. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice (Modern):** Sodium Amobarbital (Amytal Interview). * **Indication:** Used in dissociative amnesia, fugue states, and sometimes to differentiate between functional (psychogenic) and organic catatonia. * **Scopolamine Side Effects:** Remember the "Hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a hatter" mnemonic for anticholinergic toxicity.

Question 48: Which of the following symptoms is NOT typically seen in anxiety?

A. Decreased sweating (Correct Answer)
B. Hyperventilation
C. Cold extremities
D. Palpitations

Explanation: **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 49: What is the most common phobia?

A. Acrophobia
B. Thanatophobia
C. Photophobia
D. Agoraphobia (Correct Answer)

Explanation: **Explanation:** In the context of clinical psychiatry and standardized examinations like NEET-PG, **Agoraphobia** is traditionally cited as the most common phobic disorder for which patients seek professional treatment. It involves an intense fear of being in situations where escape might be difficult or help unavailable in the event of developing panic-like symptoms. It frequently occurs as a complication of Panic Disorder. **Analysis of Options:** * **Agoraphobia (Correct):** While "Specific Phobias" (as a category) are the most common anxiety disorders in the general population, Agoraphobia is the most common **single phobia** encountered in clinical practice due to its significant impact on daily functioning and its strong association with Panic Disorder. * **Acrophobia (Incorrect):** This is the fear of heights. While it is a very common *specific* phobia, it rarely leads to the same level of clinical morbidity or treatment-seeking behavior as Agoraphobia. * **Thanatophobia (Incorrect):** This is the fear of death. It is often a symptom of underlying anxiety or depressive disorders rather than a primary phobic diagnosis. * **Photophobia (Incorrect):** This is a physical symptom (light sensitivity) seen in neurological or ophthalmic conditions (e.g., migraine, meningitis) and is not a psychiatric phobia. **High-Yield Clinical Pearls for NEET-PG:** * **Most common phobia in the general population:** Specific Phobia (e.g., animals, spiders). * **Most common phobia in clinical practice:** Agoraphobia. * **Most common Specific Phobia:** Arachnophobia (spiders) or Ophidiophobia (snakes). * **Social Anxiety Disorder (Social Phobia):** Characterized by fear of scrutiny in social or performance situations; it is the most common anxiety disorder in some epidemiological surveys. * **Treatment of choice:** For Specific Phobias, **Systemic Desensitization** (Exposure Therapy) is the gold standard. For Agoraphobia with Panic Disorder, a combination of **SSRIs** and **Cognitive Behavioral Therapy (CBT)** is preferred.

Question 50: All of the following statements regarding blackouts are true EXCEPT?

A. The person appears confused to onlookers. (Correct Answer)
B. Remote memory is relatively intact during the blackout.
C. It is a discrete episode of anterograde amnesia.
D. It is associated with alcohol intoxication.

Explanation: **Explanation:** A **blackout** is a specific phenomenon associated with acute alcohol intoxication characterized by a discrete episode of **anterograde amnesia**. Despite the inability to form new memories, the individual remains conscious and can engage in complex tasks. 1. **Why Option A is the Correct Answer (The Exception):** During a blackout, the person typically **does not appear confused** to onlookers. They can carry out conversations, drive, or perform social activities quite normally. The deficit is purely in the consolidation of short-term memory into long-term storage; it is not a state of delirium or clouding of consciousness. Therefore, the lack of outward confusion is a hallmark that distinguishes it from other states like stupor. 2. **Analysis of Other Options:** * **Option B:** Remote memory (memories formed before the intoxication) remains **intact**. The pathology specifically targets the hippocampus's ability to create new memories during the window of high blood alcohol concentration. * **Option C:** It is defined as **anterograde amnesia**, meaning the person cannot recall events that occurred *during* the drinking episode once they sober up. * **Option D:** Blackouts are classically associated with **alcohol intoxication**, particularly when blood alcohol levels rise rapidly (e.g., "binge drinking"). **Clinical Pearls for NEET-PG:** * **Mechanism:** Alcohol-induced blockade of NMDA receptors and enhancement of GABA receptors in the **hippocampus** prevents long-term potentiation (LTP). * **Types:** * *En bloc:* Total permanent amnesia for a period. * *Fragmentary (Brownout):* Partial memory loss where cues may trigger recall. * **Differentiating Factor:** Unlike "passing out" (loss of consciousness), a person in a "blackout" is awake but "the recorder is off."

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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