Anxiety Disorders Practice Questions

Q: Fear of open spaces is:

Agoraphobia. **Explanation:** **Agoraphobia (Option A)** is the correct answer. Derived from the Greek word *agora* (marketplace), it is defined as a 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. While commonly simplified as a "fear of open spaces," the DSM-5 criteria specifically include fears of using public transportation, being in open spaces (e.g., parking lots, bridges), being in enclosed places (e.g., shops, cinemas), standing in line/crowds, or being outside of the home alone. **Analysis of Incorrect Options:** * **Acrophobia (Option B):** The specific pathological fear of **heights**. * **Claustrophobia (Option C):** The fear of **enclosed or confined spaces** (the opposite of the literal definition of agoraphobia). * **Algophobia (Option D):** The morbid fear of **pain**. **NEET-PG High-Yield Pearls:** 1. **Comorbidity:** Agoraphobia is frequently associated with **Panic Disorder**. In DSM-IV, they were linked; however, in **DSM-5**, Agoraphobia is now a **standalone diagnosis** regardless of the presence of panic attacks. 2. **Duration:** For a diagnosis, symptoms must typically persist for **6 months or more**. 3. **Treatment:** The gold standard is a combination of **Pharmacotherapy** (SSRIs are first-line) and **Cognitive Behavioral Therapy (CBT)**, specifically utilizing **systematic desensitization** or exposure therapy. 4. **Demographics:** It is more common in females than males (approx. 2:1 ratio).

Q: What is the medical term for a person who fears seeing tall buildings and looking down from heights?

Acrophobia. ***Acrophobia***- It is the specific phobia defined as the extreme or irrational **fear of heights** or being in high places (like a tall building or cliff). - Symptoms include anxiety, panic attacks, dizziness, and refusal to be in high places or even look down from them. *Agoraphobia* - This refers to an anxiety disorder characterized by the fear of being in places or situations from which escape might be difficult or help unavailable, such as **open spaces**, public transportation, or crowds. - It is frequently associated with a fear of having a **panic attack** and being unable to escape. *Claustrophobia* - This is the irrational fear of **confined spaces** or enclosed areas, such as elevators, small rooms, or tunnels. - It is not related to vertical distance or looking down from a height. *Nomophobia* - This is a colloquial term for the fear of being without a **mobile phone** or being unable to use it (e.g., due to loss of signal or battery). - This type of phobia involves anxiety related to technological dependence, not environmental features like height.

Q: A 45-year-old female presents to the OPD with complaints of "feeling tense" and experiencing stomach upset with heartburn and diarrhea. She reports having these symptoms for many years and mentions that her family members also usually feel tense and nervous. Which of the following symptoms is most likely to be seen in this patient?

Tingling of extremities. ***Tingling of extremities*** - The patient's presentation of "feeling tense," **stomach upset, heartburn, and diarrhea** for many years, alongside a family history of similar issues, suggests significant **anxiety**. - **Peripheral neurological symptoms** such as **tingling of extremities (paresthesia)** are common manifestations of anxiety and panic attacks due to **hyperventilation** (causing respiratory alkalosis and decreased ionized calcium) and **physiological arousal**. *Ideas of reference* - **Ideas of reference** are typically seen in **psychotic disorders** (e.g., schizophrenia) where a person believes that unrelated, external events have a special, personal meaning. - While anxiety can sometimes lead to misinterpretations, **ideas of reference** at a delusional level are not characteristic of generalized anxiety. *Hallucination* - **Hallucinations** are perceptual disturbances where an individual experiences sensory perceptions (e.g., hearing voices, seeing things) in the absence of an external stimulus. - These are core symptoms of **psychotic disorders** and are not typical findings in anxiety disorders without comorbid conditions. *Neologism* - A **neologism** is the coining of new words or phrases, often without clear meaning, which is a hallmark feature of disorganized thought in **psychotic disorders** (e.g., schizophrenia). - This symptom is related to severe thought disorganization and is not associated with anxiety disorders.

Q: A 24-year-old lady presented with sudden onset chest pain, palpitations lasting for about 20 minutes. She says there were 3 similar episodes in the past. All the investigations were normal. What is the likely diagnosis?

Panic attack. ***Panic attack*** - The sudden onset of **chest pain** and **palpitations** in a young woman, lasting for a brief period (20 minutes), and occurring in recurrent episodes with all investigations being normal, are classic signs of a **panic attack**. - Panic attacks frequently mimic cardiac events, but the absence of organic findings despite recurrent episodes points towards a psychological origin. *Post-traumatic stress disorder* - While PTSD can involve symptoms of anxiety and panic, it is specifically triggered by a **traumatic event** and typically includes re-experiencing the trauma, avoidance, and hyperarousal, none of which are described here. - The patient's presentation primarily focuses on sudden physical symptoms rather than a direct link to past trauma or pervasive fear. *Acute psychosis* - Acute psychosis involves a severe break from reality, characterized by **hallucinations**, **delusions**, or disorganized thought and behavior, which are not present in this scenario. - The symptoms described are more consistent with an anxiety disorder rather than a thought disorder. *Mania* - Mania is a state of elevated mood, increased energy, and often includes symptoms like **reduced need for sleep**, **racing thoughts**, and **impulsive behavior**, which are not described in this patient's presentation. - The core symptoms are acute physical sensations of fear and discomfort, not sustained euphoria or grandiosity.

Q: Fear of "places from where escape is difficult" is called ______

Agoraphobia. ***Agoraphobia*** - **Agoraphobia** is the intense fear and anxiety of situations or places that might be difficult to escape from or where help might not be available, such as open spaces, crowds, or public transportation. - Individuals with agoraphobia often avoid these situations or endure them with extreme distress, sometimes resulting in being housebound. *Claustrophobia* - **Claustrophobia** is the intense fear of tight, enclosed spaces, such as elevators, small rooms, or MRI machines. - This phobia is distinct from agoraphobia, which centers around difficulty escaping rather than the space itself. *Aerophobia* - **Aerophobia** is the fear of flying, specifically involving airplanes or other forms of air travel. - It is a specific phobia related to a particular situation, not a generalized fear of inescapable places. *Ailurophobia* - **Ailurophobia** is the irrational fear of cats. - This is a specific animal phobia and has no relation to the fear of open spaces or situations from which escape might be difficult.

Q: A 41 year old married female presented with headache for the last 6 months. She had several consultations. All her investigations were found to be within normal limits. She still insists that there is something wrong in her head and seeks another consultation. The most likely diagnosis is:

Illness Anxiety Disorder. ***Illness Anxiety Disorder*** - This patient exhibits persistent **preoccupation with having a serious illness** despite **repeated medical evaluations** showing no underlying pathology. - She continues to **seek multiple consultations**, demonstrating **excessive health-related behaviors** characteristic of health anxiety. - Despite reassurance and normal investigations, she **insists something is wrong**, which is the core feature of this disorder. - Note: The presence of headache doesn't exclude this diagnosis; the key is the **disproportionate anxiety and health-seeking behavior** relative to the symptom. *Phobia* - Phobias involve an **intense, irrational fear** of a specific object or situation (e.g., agoraphobia, social phobia). - The patient's concern is about having an illness and physical symptoms, not a fear of a specific trigger or situation. *Psychogenic headache* - This is a **symptom description**, not a psychiatric disorder diagnosis. - While the headache may have psychological factors, the question asks for the **disorder** that best explains the overall clinical picture. - The primary pathology here is the **persistent health anxiety and reassurance-seeking behavior**, not just the headache itself. *Depression* - Although **depression can present with somatic symptoms** like headaches, the **core features of major depression** are not mentioned (e.g., persistent low mood, anhedonia, sleep/appetite changes, hopelessness). - The patient's **preoccupation with having a disease** despite medical reassurance is more characteristic of Illness Anxiety Disorder than depression alone.

Q: All of the following are true about phobias, except:

Generalized anxiety. ***Generalized anxiety*** - Phobias are characterized by intense fear of a **specific object or situation**, not diffuse, generalized anxiety. - While phobias can lead to anxiety, it is tightly linked to the **phobic stimulus** rather than being free-floating and generalized. *Avoiding particular situation* - **Avoidance behavior** is a hallmark symptom of phobias, as individuals try to steer clear of the feared object or situation. - This avoidance helps reduce immediate anxiety but reinforces the phobia in the long term. *Fear and anxiety of specific thing* - The core feature of a phobia is an intense and **unreasonable fear or anxiety** triggered by a specific object, situation, or stimulus. - This fear is disproportionate to the actual danger posed by the feared entity. *Insight is present* - Individuals with phobias generally **recognize that their fear is excessive** or unreasonable, even if they cannot control it. - This insight distinguishes phobias from psychotic disorders where an individual may not recognize the irrationality of their fears.

Q: A 1st year medical student presents with recurrent episodes of choking sensation, breathlessness, intense sweating along with feeling of impending doom. Usually the episodes occur prior to exams. What is the most likely diagnosis?

Panic attack. ***Panic attack (Panic Disorder)*** - The sudden onset of intense fear or discomfort, along with symptoms like **choking sensation**, **breathlessness**, **sweating**, and **feeling of impending doom**, are characteristic of a **panic attack**. - The **recurrent episodes** occurring prior to exams indicate **Panic Disorder**, which is defined by recurrent unexpected panic attacks followed by persistent concern about future attacks. - The situational trigger (exams) suggests a pattern consistent with panic disorder, where attacks may be situationally predisposed. *Acute stress disorder* - This condition occurs within **one month of exposure to a traumatic event** and involves dissociative symptoms, intrusions, avoidance, and arousal symptoms. - The patient describes recurrent episodes tied to exams, not a single acute traumatic event with subsequent stress response. *Generalised anxiety disorder* - Characterized by excessive and **uncontrollable worry** about various events or activities for **at least six months**. - While anxiety is present, the sudden, intense, **episodic nature** of symptoms with a distinct "feeling of impending doom" points away from the chronic, pervasive worry of GAD. - GAD presents with chronic anxiety rather than discrete panic episodes. *Phobia* - A phobia is an **irrational and intense fear** of a specific object or situation (e.g., specific phobia) or social situations (social anxiety disorder). - While exam-related anxiety can be severe, the description points to a **full-blown panic response** with multiple autonomic symptoms (choking, breathlessness, sweating) and psychological distress (impending doom). - Unlike a phobia where avoidance is the primary feature, this patient experiences discrete panic episodes with characteristic somatic symptoms.

Question 1

Fear of open spaces is:

Accepted Answer

Agoraphobia

Answer

Acrophobia

Answer

Claustrophobia

Answer

Algophobia

Question 2

What is the medical term for a person who fears seeing tall buildings and looking down from heights?

Accepted Answer

Acrophobia

Answer

Nomophobia

Answer

Claustrophobia

Answer

Agoraphobia

Question 3

A 45-year-old female presents to the OPD with complaints of "feeling tense" and experiencing stomach upset with heartburn and diarrhea. She reports having these symptoms for many years and mentions that her family members also usually feel tense and nervous. Which of the following symptoms is most likely to be seen in this patient?

Accepted Answer

Tingling of extremities

Answer

Ideas of reference

Answer

Hallucination

Answer

Neologism

Question 4

A 24-year-old lady presented with sudden onset chest pain, palpitations lasting for about 20 minutes. She says there were 3 similar episodes in the past. All the investigations were normal. What is the likely diagnosis?

Accepted Answer

Panic attack

Answer

Post-traumatic stress disorder

Answer

Acute psychosis

Answer

Mania

Question 5

Fear of "places from where escape is difficult" is called ______

Accepted Answer

Agoraphobia

Answer

Claustrophobia

Answer

Aerophobia

Answer

Ailurophobia

Question 6

A 41 year old married female presented with headache for the last 6 months. She had several consultations. All her investigations were found to be within normal limits. She still insists that there is something wrong in her head and seeks another consultation. The most likely diagnosis is:

Accepted Answer

Illness Anxiety Disorder

Answer

Phobia

Answer

Psychogenic headache

Answer

Depression

Question 7

A 35 year old man feels that he is about to die because he is suffering from gastric cancer. All his radiological investigations prove the contrary. Which is the most probable diagnosis?

Accepted Answer

Illness anxiety disorder

Answer

Somatic symptom disorder

Answer

Conversion disorder

Answer

Delusional disorder

Question 8

All of the following are true about phobias, except:

Accepted Answer

Generalized anxiety

Answer

Avoiding particular situation

Answer

Fear and anxiety of specific thing

Answer

Insight is present

Question 9

Anxiety is best described as:

Accepted Answer

Excessive worry and emotional distress without loss of reality (Anxiety disorder)

Answer

A specific fear leading to avoidance behavior (Phobic disorder)

Answer

A mental disorder with delusions or hallucinations (Psychosis)

Answer

Enduring maladaptive personality traits (Personality disorder)

Question 10

A 1st year medical student presents with recurrent episodes of choking sensation, breathlessness, intense sweating along with feeling of impending doom. Usually the episodes occur prior to exams. What is the most likely diagnosis?

Accepted Answer

Panic attack

Answer

Acute stress disorder

Answer

Generalised anxiety disorder

Answer

Phobia

Anxiety Disorders — MCQs

Anxiety Disorders — MCQs

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