Anxiety Disorders — MCQs

A 23-year-old female patient presents with a feeling of being unable to catch her breath, light-headedness, and "tingling" of her fingers, toes, and around her mouth. This symptom occurs whenever she drives through a tunnel, and this situation triggered the current episode. Which of the following arterial blood pH values would be most consistent with her diagnosis?

Q59Medium

A 41-year-old female patient presents to the emergency department with complaints of flurries, palpitations, profuse sweating, and a sense of impending doom. Which of the following tests should be done in the emergency to rule out organic causes?

Q60Medium

What is the commonest type of phobia encountered in clinical practice?

Anxiety Disorders Indian Medical PG Practice Questions and MCQs

Question 51: A person restricts himself to his house and fears specific public places like trains, elevators, and shopping malls. This is a feature of which condition?

A. Generalized Anxiety Disorder
B. Agoraphobia (Correct Answer)
C. Claustrophobia
D. Acrophobia

Explanation: ### Explanation **Correct Option: B. Agoraphobia** Agoraphobia is characterized by marked fear or anxiety about being in situations where **escape might be difficult** or help might not be available in the event of developing panic-like symptoms. According to DSM-5 criteria, the diagnosis requires fear in at least two of the following five situations: 1. Using public transportation (e.g., trains, buses). 2. Being in open spaces (e.g., parking lots, bridges). 3. Being in enclosed places (e.g., shops, elevators, cinemas). 4. Standing in line or being in a crowd. 5. Being outside of the home alone. The patient’s behavior of restricting themselves to the house (homebound) is a classic severe manifestation of this disorder. **Why other options are incorrect:** * **A. Generalized Anxiety Disorder (GAD):** Characterized by excessive, uncontrollable worry about various everyday events (finances, health) for at least 6 months, rather than a fear of specific locations. * **C. Claustrophobia:** A specific phobia involving fear of enclosed spaces only. While agoraphobia includes enclosed spaces, it also involves open spaces and public transport, driven by the fear of "no escape." * **D. Acrophobia:** A specific phobia characterized by a morbid fear of heights. **High-Yield Clinical Pearls for NEET-PG:** * **Comorbidity:** Agoraphobia is frequently associated with **Panic Disorder**, though DSM-5 now classifies them as two independent diagnoses. * **Treatment of Choice:** Cognitive Behavioral Therapy (CBT) is the most effective psychotherapy. For pharmacotherapy, **SSRIs** (e.g., Sertraline, Paroxetine) are the first-line treatment. * **Key Differentiator:** In Agoraphobia, the fear is about the **consequences of being trapped**; in Specific Phobias, the fear is of the **object/situation itself**.

Question 52: What is phobia?

A. Psychosis
B. Fear of animals
C. Mood disorder
D. Neurosis (Correct Answer)

Explanation: ### Explanation **Phobia** is defined as an irrational, persistent, and excessive fear of a specific object, situation, or activity that poses little to no actual danger. In psychiatric classification, phobias are categorized under **Anxiety Disorders**, which fall under the broader umbrella of **Neurosis**. #### Why "Neurosis" is Correct: Historically and conceptually, psychiatric disorders are divided into Psychosis and Neurosis. * **Neurosis:** These are mental disorders characterized by distressing symptoms (anxiety, depression, obsessions) where **reality testing is intact**, and the patient has **insight** into their condition. Since a person with a phobia knows their fear is irrational but cannot control it, it is a classic neurotic disorder. #### Why Other Options are Incorrect: * **A. Psychosis:** In psychosis (e.g., Schizophrenia), there is a loss of contact with reality, presence of delusions/hallucinations, and a lack of insight. Phobic patients do not lose touch with reality. * **B. Fear of animals:** This is too narrow. While "Zoophobia" is a type of phobia, the term "Phobia" itself is a broad diagnostic category encompassing many types (Social, Agoraphobia, and Specific phobias). * **C. Mood disorder:** These (e.g., Depression, Bipolar Disorder) primarily affect the patient's emotional state or affect, rather than being driven by specific situational triggers or irrational fears. #### NEET-PG Clinical Pearls: * **Treatment of Choice:** For Specific Phobias, the most effective treatment is **Systematic Desensitization** (a type of Behavior Therapy). * **Social Phobia (Social Anxiety Disorder):** The drug of choice for performance anxiety (e.g., stage fright) is **Propranolol** (Beta-blocker). * **Agoraphobia:** Fear of places where escape might be difficult; it is most commonly associated with **Panic Disorder**. * **Insight:** Always remember—Insight is **present** in Neurosis (Phobia) and **absent** in Psychosis.

Question 53: A 16-year-old boy avoids school due to the fear of being harmed by classmates. He believes his classmates laugh at and talk about him, and he is afraid to go to the market. What is he most likely suffering from?

A. Anxiety neurosis
B. Manic depressive psychosis
C. Adjustment disorder
D. Social phobia (Correct Answer)

Explanation: ### Explanation **Correct Option: D. Social Phobia (Social Anxiety Disorder)** The core feature of Social Phobia is a marked and persistent fear of social or performance situations in which the individual is exposed to unfamiliar people or to **possible scrutiny by others**. The patient fears that he will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing. In this case, the boy’s fear of being laughed at or talked about by classmates and his avoidance of public places like the market are classic indicators of social evaluative anxiety. **Why Incorrect Options are Wrong:** * **A. Anxiety Neurosis:** This is an archaic term formerly used to describe generalized anxiety or panic states. It lacks the specific focus on social scrutiny and embarrassment seen in this clinical vignette. * **B. Manic Depressive Psychosis (Bipolar Disorder):** This involves distinct episodes of mania (elevated mood, hyperactivity) and depression. The patient’s symptoms here are focused on social avoidance and fear, not mood cycling. * **C. Adjustment Disorder:** This occurs in response to an identifiable stressor (e.g., divorce, job loss) within 3 months of the stressor. The symptoms here are more characteristic of a primary anxiety disorder rather than a maladaptive reaction to a specific life change. **Clinical Pearls for NEET-PG:** * **Age of Onset:** Social phobia typically has an early onset, often during mid-adolescence (around age 13-16). * **Physical Symptoms:** Often accompanied by blushing (erythrophobia), sweating, or trembling in social situations. * **Treatment of Choice:** **SSRIs** (e.g., Paroxetine, Sertraline) are the first-line pharmacological treatment. **Cognitive Behavioral Therapy (CBT)** is the preferred psychological intervention. * **Performance Anxiety:** For specific situations (like public speaking), **Beta-blockers** (Propranolol) can be used 30–60 minutes before the event.

Question 54: Anxiety neurosis is manifested by?

A. Difficulty in breathing
B. Complete consciousness
C. Negative thinking
D. All (Correct Answer)

Explanation: **Explanation:** Anxiety neurosis (now broadly classified under Generalized Anxiety Disorder and Panic Disorder in modern nomenclature) is characterized by a state of excessive, uncontrollable worry accompanied by somatic and psychological symptoms. **Why "All" is the correct answer:** 1. **Difficulty in Breathing (Option A):** This is a hallmark **somatic (autonomic) symptom** of anxiety. During an anxiety or panic state, the sympathetic nervous system becomes overactive, leading to hyperventilation, chest tightness, and a subjective feeling of dyspnea (shortness of breath). 2. **Complete Consciousness (Option B):** Unlike psychotic disorders or certain organic brain syndromes (like delirium), patients with anxiety neurosis maintain **intact reality testing** and full consciousness. They are acutely aware of their surroundings and their symptoms, which often contributes to their distress. 3. **Negative Thinking (Option C):** This represents the **cognitive component** of anxiety. Patients often experience "catastrophizing" (expecting the worst-case scenario), apprehension, and persistent pessimistic thoughts about future events. **High-Yield Clinical Pearls for NEET-PG:** * **Physical Symptoms:** Look for palpitations, sweating, tremors, dry mouth, and "lump in the throat" (globus hystericus). * **Psychological Symptoms:** Free-floating anxiety, irritability, and sleep disturbances (difficulty falling asleep). * **Neurobiology:** Anxiety involves the **Amygdala** (fear center) and dysregulation of neurotransmitters, primarily **decreased GABA** and **increased Norepinephrine**. * **Treatment of Choice:** For long-term management, **SSRIs** are the first-line treatment. For immediate relief of acute somatic symptoms (like palpitations), **Benzodiazepines** or **Beta-blockers** (e.g., Propranolol) are used.

Question 55: A 49-year-old male presents with sudden onset of palpitations, apprehension, and sweating for the last 10 minutes, accompanied by a fear of impending death. What is the most likely diagnosis?

A. Hysteria
B. Cystic fibrosis
C. Panic attack (Correct Answer)
D. Generalized anxiety disorder

Explanation: **Explanation:** The clinical presentation of sudden, intense physical symptoms (palpitations, sweating) coupled with psychological distress (apprehension, fear of impending death) peaking within minutes is the hallmark of a **Panic Attack**. **1. Why Panic Attack is correct:** A panic attack is a discrete period of intense fear or discomfort. According to DSM-5, it requires at least 4 out of 13 symptoms (e.g., palpitations, sweating, trembling, shortness of breath, chest pain, nausea, dizziness, chills/heat, paresthesia, derealization, fear of losing control, or **fear of dying**). The "fear of impending death" is a classic high-yield descriptor for this condition. **2. Why other options are incorrect:** * **Hysteria:** An outdated term formerly used for Dissociative or Conversion disorders. These typically present with neurological deficits (paralysis, blindness) or emotional outbursts rather than acute autonomic hyperactivity. * **Cystic Fibrosis:** A genetic multisystem disorder affecting the lungs and digestive system. While it can cause respiratory distress, it does not present as an acute, episodic psychiatric emergency with fear of death. * **Generalized Anxiety Disorder (GAD):** Characterized by "free-floating" anxiety and excessive worry about everyday events lasting for at least **6 months**. It is chronic and persistent, unlike the sudden, paroxysmal nature of a panic attack. **Clinical Pearls for NEET-PG:** * **Duration:** Panic attacks usually peak within 10 minutes and last less than 30–60 minutes. * **First-line Treatment:** For acute episodes, **Benzodiazepines** (e.g., Alprazolam/Lorazepam). For long-term Panic Disorder, **SSRIs** are the drug of choice. * **Medical Mimics:** Always rule out Myocardial Infarction (MI), Pheochromocytoma, and Hyperthyroidism in a patient presenting with these symptoms.

Question 56: Which of the following is NOT classified as an anxiety disorder?

A. Generalized anxiety disorder
B. Panic disorder
C. Social phobia
D. None of the above (Correct Answer)

Explanation: ### Explanation The correct answer is **D. None of the above**, because all three conditions listed (Generalized Anxiety Disorder, Panic Disorder, and Social Phobia) are core classifications under the umbrella of **Anxiety Disorders** in both the DSM-5 and ICD-11. **Breakdown of Options:** * **Generalized Anxiety Disorder (GAD):** Characterized by excessive, persistent, and uncontrollable worry about various aspects of daily life (e.g., health, finances) for at least 6 months. It is a classic anxiety disorder. * **Panic Disorder:** Defined by recurrent, unexpected panic attacks followed by at least one month of persistent concern about having additional attacks or significant maladaptive behavioral changes. * **Social Phobia (Social Anxiety Disorder):** Involves intense fear or anxiety of being scrutinized, judged, or embarrassed in social or performance situations. **Why "None of the above" is correct:** Since options A, B, and C are all primary anxiety disorders, none of them can be excluded from the classification. **High-Yield Clinical Pearls for NEET-PG:** * **DSM-5 Reclassification:** A crucial point for exams is that **Obsessive-Compulsive Disorder (OCD)** and **Post-Traumatic Stress Disorder (PTSD)** were moved out of the "Anxiety Disorders" category in DSM-5. They now have their own dedicated chapters (*OCD and Related Disorders* and *Trauma- and Stressor-Related Disorders*). * **Drug of Choice (DOC):** For long-term management of all three disorders listed, **SSRIs** (Selective Serotonin Reuptake Inhibitors) are the first-line treatment. * **Panic Disorder vs. Agoraphobia:** In DSM-5, these are now two distinct diagnoses; one can occur without the other. * **Performance Anxiety:** A subtype of Social Phobia often treated with **Beta-blockers (Propranolol)** taken 30–60 minutes before the event.

Question 57: Fear of dogs is called as?

A. Cynophobia (Correct Answer)
B. Thanatophobia
C. Nyctophobia
D. Pyrrophobia

Explanation: **Explanation:** The correct answer is **Cynophobia**. This term is derived from the Greek word *'kyon'* (dog) and *'phobos'* (fear). In psychiatry, this is classified as a **Specific Phobia**, which is defined by the DSM-5 as a marked, persistent, and disproportionate fear of a specific object or situation. **Analysis of Options:** * **Cynophobia (Option A):** The clinical term for the irrational and persistent fear of dogs. It is one of the most common animal-type specific phobias. * **Thanatophobia (Option B):** The morbid fear of **death** or the dying process. It is often associated with health anxiety or separation anxiety disorders. * **Nyctophobia (Option C):** The fear of **darkness** or the night. It is common in childhood but can persist into adulthood as a specific phobia. * **Pyrrophobia (Option D):** The fear of **fire**. (Note: This is distinct from Pyromania, which is an impulse control disorder involving an obsession with starting fires). **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:** Generally not the first line for specific phobias, but **Benzodiazepines** or **Beta-blockers** may be used for short-term situational anxiety. * **Epidemiology:** Specific phobias are more common in females and typically have an onset in early childhood. * **Other High-Yield Phobias:** * *Acrophobia:* Fear of heights. * *Algophobia:* Fear of pain. * *Entomophobia:* Fear of insects. * *Amaxophobia:* Fear of riding in a car.

Question 58: A 23-year-old female patient presents with a feeling of being unable to catch her breath, light-headedness, and "tingling" of her fingers, toes, and around her mouth. This symptom occurs whenever she drives through a tunnel, and this situation triggered the current episode. Which of the following arterial blood pH values would be most consistent with her diagnosis?

A. 8.1
B. 7.55 (Correct Answer)
C. 7.15
D. 6.4

Explanation: **Explanation:** The clinical presentation describes a **Panic Attack** triggered by a specific phobic stimulus (tunnels). The hallmark of a panic attack is **hyperventilation**, which leads to an excessive "washout" of carbon dioxide ($CO_2$). **1. Why 7.55 is Correct:** Hyperventilation causes **Respiratory Alkalosis**. As $CO_2$ (an acid) decreases, the blood pH rises above the normal range (7.35–7.45). A pH of **7.55** represents a moderate alkalotic state consistent with acute hyperventilation. The "tingling" (paresthesia) and light-headedness occur because alkalosis causes a shift in ionized calcium, leading to transient hypocalcemia and increased neuromuscular excitability. **2. Why the Incorrect Options are Wrong:** * **A (8.1):** This value is physiologically incompatible with life. The human body rarely survives a pH above 7.8. * **C (7.15):** This indicates **Acidosis** (e.g., diabetic ketoacidosis or respiratory failure). Panic attacks cause the pH to rise, not fall. * **D (6.4):** This is extreme acidosis and is incompatible with life. **3. NEET-PG High-Yield Pearls:** * **Mechanism:** Hyperventilation $\rightarrow \downarrow PCO_2$ (Hypocapnia) $\rightarrow \uparrow$ pH (Alkalosis). * **Calcium Link:** Alkalosis increases the binding of calcium to albumin, decreasing **ionized calcium** ($iCa^{2+}$). This causes the classic symptoms of tetany, carpopedal spasm, and perioral numbness. * **Acute Management:** Reassurance and breathing into a paper bag (to re-breathe $CO_2$) were traditional; however, the current gold standard is "calm breathing" techniques and Benzodiazepines (e.g., Alprazolam/Lorazepam) for acute episodes. * **Long-term Treatment:** SSRIs (e.g., Sertraline, Escitalopram) are the first-line pharmacological treatment for Panic Disorder.

Question 59: A 41-year-old female patient presents to the emergency department with complaints of flurries, palpitations, profuse sweating, and a sense of impending doom. Which of the following tests should be done in the emergency to rule out organic causes?

A. Hemoglobin
B. Blood sugar level
C. ECG (Correct Answer)
D. T3/T4/TSH

Explanation: **Explanation:** The patient is presenting with symptoms suggestive of a **Panic Attack**, characterized by autonomic hyperactivity (palpitations, sweating) and psychological distress (sense of impending doom). However, in an emergency setting, a psychiatric diagnosis is always a diagnosis of exclusion. **1. Why ECG is the Correct Answer:** The primary clinical priority is to rule out life-threatening organic mimics, most importantly **Acute Coronary Syndrome (ACS)** or cardiac arrhythmias. Symptoms like palpitations and a sense of impending doom (*angor animi*) are classic presentations of myocardial infarction. An **ECG** is the most rapid, non-invasive, and essential bedside test to rule out cardiac emergencies before attributing the symptoms to an anxiety disorder. **2. Why Other Options are Incorrect:** * **Blood Sugar Level:** While hypoglycemia can cause palpitations and sweating, it is less likely to present with a specific "sense of impending doom" compared to cardiac events. It is a secondary consideration. * **T3/T4/TSH:** Hyperthyroidism is a common differential for chronic anxiety, but thyroid function tests are not emergency bedside investigations. They are part of the long-term workup, not the acute stabilization phase. * **Hemoglobin:** Anemia can cause tachycardia, but it rarely presents as an acute "attack" or "flurry" of symptoms. **Clinical Pearls for NEET-PG:** * **Rule of Thumb:** In psychiatry, always rule out "Organic" before "Functional." * **Panic Disorder Criteria:** Recurrent unexpected panic attacks followed by ≥1 month of persistent concern about future attacks. * **Drug of Choice (Acute Attack):** Benzodiazepines (e.g., Alprazolam, Lorazepam). * **Drug of Choice (Maintenance):** SSRIs (e.g., Sertraline, Paroxetine). * **Common Organic Mimics:** Pheochromocytoma, Hyperthyroidism, Hypoglycemia, and Arrhythmias.

Question 60: What is the commonest type of phobia encountered in clinical practice?

A. Social phobia
B. Simple phobia
C. Agoraphobia (Correct Answer)
D. Claustrophobia

Explanation: ### Explanation The correct answer is **Agoraphobia**. **1. Why Agoraphobia is the correct answer:** In the context of **clinical practice** (patients seeking medical help), Agoraphobia is the most common phobia. While simple phobias are more prevalent in the general population, they rarely cause enough functional impairment for a patient to visit a psychiatrist. Agoraphobia involves a profound fear of being in situations where escape might be difficult or help unavailable (e.g., crowds, open spaces, public transport). Because it severely restricts a person’s ability to work or leave the house, it leads to a higher rate of clinical consultation. **2. Analysis of Incorrect Options:** * **Simple (Specific) Phobia:** This is the most common phobia in the **general population**. However, people with specific phobias (e.g., fear of spiders or heights) usually manage by avoiding the trigger and rarely seek professional treatment. * **Social Phobia (Social Anxiety Disorder):** This is characterized by a fear of scrutiny in social or performance situations. While common, it is clinically encountered less frequently than agoraphobia. * **Claustrophobia:** This is a subtype of Specific Phobia (fear of enclosed spaces). It is not a standalone category that represents the most common clinical presentation. **3. NEET-PG High-Yield Pearls:** * **Epidemiology:** Most common phobia in the **general population** = Specific Phobia; Most common phobia in **clinical practice** = Agoraphobia. * **Gender:** Phobias are generally more common in females (ratio approx. 2:1). * **Association:** Agoraphobia is frequently associated with **Panic Disorder**. When both are present, the diagnosis is coded based on the presence of panic attacks. * **Treatment of Choice:** Cognitive Behavioral Therapy (CBT) with **Exposure Therapy** (specifically *Systematic Desensitization* or *Flooding*) is the mainstay for phobias. SSRIs are the first-line pharmacological treatment for Social Phobia and Agoraphobia.

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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