Anxiety Disorders — MCQs

A 21-year-old woman presents with complaints of constricting chest pain and difficulty breathing. She reports three similar episodes in the past month and believes she is having a heart attack. Her past medical history is unremarkable, but her father died of a myocardial infarction at age 47. ECG shows sinus tachycardia, and cardiac enzymes and urine drug screen are normal. What is the next best step in the management of this patient?

Q79Easy

Phobia is defined as which of the following?

Q80Easy

Anxiety is classified as which of the following?

Anxiety Disorders Indian Medical PG Practice Questions and MCQs

Question 71: Claustrophobia means:

A. Fear of heights
B. Fear of lizards
C. Fear of closed spaces (Correct Answer)
D. Fear of open spaces

Explanation: **Explanation:** **Claustrophobia** is a specific phobia characterized by an intense, irrational fear of confined or enclosed spaces. Patients often experience significant anxiety or panic attacks when in elevators, small rooms, tunnels, or MRI machines. The underlying medical concept involves a perceived lack of escape and a fear of suffocation (restriction of movement). **Analysis of Options:** * **Option C (Correct):** Claustrophobia is derived from the Latin *claustrum* (a shut-in place). It is one of the most common situational phobias encountered in clinical practice. * **Option A (Incorrect):** Fear of heights is known as **Acrophobia**. * **Option B (Incorrect):** Fear of lizards (or reptiles) is known as **Herpetophobia**. * **Option D (Incorrect):** Fear of open spaces (or situations where escape might be difficult) is known as **Agoraphobia**. This is frequently associated with Panic Disorder. **High-Yield Clinical Pearls for NEET-PG:** 1. **Treatment of Choice:** For specific phobias like claustrophobia, **Cognitive Behavioral Therapy (CBT)** with **Systematic Desensitization** or **Exposure Therapy** is the gold standard. 2. **Pharmacotherapy:** Benzodiazepines may be used for short-term "situational" relief (e.g., before an MRI), but they are not the primary treatment. 3. **Diagnosis:** According to DSM-5, the fear must be persistent (usually lasting **6 months or more**) and cause significant functional impairment. 4. **Differential:** Do not confuse Claustrophobia with **Cleithrophobia** (the specific fear of being trapped/locked in).

Question 72: What is the drug of choice for social phobia?

A. SSRIs (Correct Answer)
B. Beta-blockers
C. Gabapentin
D. Tiagabine

Explanation: **Explanation:** **Social Anxiety Disorder (Social Phobia)** is characterized by an intense, persistent fear of being scrutinized or judged by others in social or performance situations. **1. Why SSRIs are the Correct Choice:** Selective Serotonin Reuptake Inhibitors (SSRIs) like **Paroxetine, Sertraline, and Escitalopram** are the first-line treatment (Drug of Choice) for generalized social phobia. They work by modulating serotonin levels in the amygdala and prefrontal cortex, addressing both the psychological distress and the long-term anxiety symptoms. Venlafaxine (an SNRI) is also considered first-line. **2. Why Other Options are Incorrect:** * **Beta-blockers (e.g., Propranolol):** These are only indicated for **"Performance-only" social anxiety** (e.g., stage fright). They help manage peripheral autonomic symptoms like tremors, palpitations, and sweating but do not treat the underlying cognitive anxiety of generalized social phobia. * **Gabapentin:** While it has some evidence in refractory cases due to its effect on GABAergic neurotransmission, it is a second or third-line agent and never the drug of choice. * **Tiagabine:** This is an anticonvulsant that inhibits GABA reuptake. It is not a standard treatment for social phobia and lacks robust clinical evidence for this indication. **Clinical Pearls for NEET-PG:** * **First-line:** SSRIs/SNRIs. * **Performance Anxiety:** Propranolol (taken 30–60 minutes before the event). * **Psychotherapy:** Cognitive Behavioral Therapy (CBT) is the most effective non-pharmacological treatment. * **Duration of treatment:** Once a response is achieved, medication should be continued for 6–12 months to prevent relapse.

Question 73: How is the diagnosis of Agoraphobia typically made?

A. The patient experiences panic attacks when left alone.
B. The patient exhibits fear when in open spaces or certain other situations. (Correct Answer)
C. The patient is able to enter an elevator alone without anxiety.
D. The patient complains of insomnia.

Explanation: **Explanation:** **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, a diagnosis requires intense fear in at least **two** of the following five situations: using public transport, being in open spaces, being in enclosed spaces, standing in line/crowds, or being outside the home alone. * **Why Option B is correct:** It directly aligns with the core psychopathology of the disorder—fear triggered by specific environments (like open spaces) where the patient feels vulnerable or trapped. * **Why Option A is incorrect:** While Agoraphobia often co-occurs with Panic Disorder, panic attacks are not a mandatory requirement for the diagnosis. A patient can have Agoraphobia without a history of Panic Disorder. * **Why Option C is incorrect:** An enclosed space like an elevator is a classic trigger for Agoraphobia. Being able to enter one "without anxiety" would actually point away from the diagnosis. * **Why Option D is incorrect:** Insomnia is a non-specific symptom seen in many psychiatric conditions (Depression, GAD) but is not a diagnostic criterion for Agoraphobia. **High-Yield Clinical Pearls for NEET-PG:** * **Duration:** Symptoms must typically persist for **6 months or more**. * **Gender:** It is significantly more common in females (2:1 ratio). * **Treatment of Choice:** Cognitive Behavioral Therapy (CBT) combined with SSRIs (e.g., Escitalopram, Sertraline). * **Key Defense Mechanism:** Displacement and Symbolization (often tested in psychoanalytic theory).

Question 74: Which of the following statements about Alcoholics Anonymous is FALSE?

A. It is a self-help group.
B. It follows 12 steps to quit alcohol.
C. It includes recovered patients and volunteers.
D. It provides incentives for quitting alcohol. (Correct Answer)

Explanation: **Explanation:** **Alcoholics Anonymous (AA)** is a globally recognized mutual aid fellowship dedicated to abstinence-based recovery from alcoholism. **Why Option D is the Correct (False) Statement:** AA operates on the principle of **intrinsic motivation** and spiritual growth rather than extrinsic rewards. It does **not provide financial or material incentives** (such as money, vouchers, or gifts) to its members for staying sober. In contrast, behavioral therapies like **Contingency Management** use tangible incentives to reinforce abstinence, but this is not a feature of the AA model. **Analysis of Other Options:** * **Option A (True):** AA is the prototypical **self-help group** (or mutual support group). It is non-professional, self-supporting, and independent of hospitals or political bodies. * **Option B (True):** The foundation of the program is the **"12-Step Program,"** which involves admitting powerlessness over alcohol, seeking help from a higher power, and making amends to others. * **Option C (True):** Meetings are led by **recovered peers** (sponsors) and volunteers who share their experiences. There are no professional therapists or doctors leading the sessions. **High-Yield Clinical Pearls for NEET-PG:** * **Al-Anon:** A sister organization specifically for the **families and friends** of alcoholics. * **Alateen:** A support group specifically for **teenagers** affected by someone else's drinking. * **Anonymity:** The "Anonymous" part of the name signifies that members' identities are protected, and the focus remains on the collective recovery rather than individual personalities. * **Total Abstinence:** Unlike "controlled drinking" models, AA advocates for total, lifelong abstinence from alcohol.

Question 75: What are characteristic symptoms of generalized anxiety disorder?

A. Delusions
B. Nightmares
C. Obsessions
D. Excessive worries (Correct Answer)

Explanation: **Explanation:** **Generalized Anxiety Disorder (GAD)** is characterized by **excessive, persistent, and uncontrollable worry** (apprehensive expectation) about various aspects of daily life (e.g., health, finances, or work) for at least **6 months**. According to DSM-5 criteria, this worry is out of proportion to the actual likelihood of the events and is accompanied by physical symptoms like muscle tension, restlessness, fatigue, and sleep disturbances. **Analysis of Options:** * **A. Delusions:** These are fixed, false beliefs seen in psychotic disorders (e.g., Schizophrenia) or Mood Disorders with psychotic features, not in primary anxiety disorders. * **B. Nightmares:** While GAD involves sleep disturbances, recurrent distressing nightmares are a hallmark symptom of **Post-Traumatic Stress Disorder (PTSD)**. * **C. Obsessions:** These are intrusive, repetitive thoughts or urges that cause anxiety, characteristic of **Obsessive-Compulsive Disorder (OCD)**. Unlike GAD worries, obsessions are often ego-dystonic and linked to compulsions. * **D. Excessive worries (Correct):** This is the core psychological feature of GAD. **High-Yield Clinical Pearls for NEET-PG:** * **Duration:** Symptoms must be present for at least **6 months**. * **First-line Treatment:** SSRIs (Selective Serotonin Reuptake Inhibitors) are the pharmacological treatment of choice. * **Psychotherapy:** Cognitive Behavioral Therapy (CBT) is the most effective psychological intervention. * **Rule of 3s:** In GAD, adults must have at least **3 out of 6** physical symptoms (restlessness, fatigue, concentration issues, irritability, muscle tension, sleep disturbance), whereas children only require **one**.

Question 76: When all other phobias are associated with stimulation of the sympathetic nervous system, which phobia is associated with giddiness and falls?

A. Claustrophobia
B. Blood injection phobia (Correct Answer)
C. Hydrophobia
D. Thanatophobia

Explanation: **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.

Question 77: What is the most common psychiatric condition?

A. Anxiety-related disorders (Correct Answer)
B. Depressive-related disorders
C. Phobias
D. Schizophrenia

Explanation: ### Explanation **Correct Option: A. Anxiety-related disorders** Epidemiological studies, including the National Comorbidity Survey (NCS) and Global Burden of Disease data, consistently show that **Anxiety Disorders** are the most prevalent class of psychiatric conditions in the general population. They have a lifetime prevalence of approximately 25–30%. When grouped as a category, they surpass mood disorders and substance use disorders in frequency. **Analysis of Incorrect Options:** * **B. Depressive-related disorders:** While Major Depressive Disorder (MDD) is often cited as the leading cause of disability worldwide, its lifetime prevalence (approx. 17%) is lower than the cumulative prevalence of all anxiety disorders. * **C. Phobias:** Specific phobias are actually the **most common individual subtype** within the anxiety disorder spectrum. However, the question asks for the broader "condition" or category; "Anxiety-related disorders" is the more comprehensive and correct umbrella term. * **D. Schizophrenia:** This is a severe psychotic disorder with a relatively stable global prevalence of approximately **1%**. It is significantly less common than both anxiety and mood disorders. **NEET-PG High-Yield Pearls:** * **Most common psychiatric disorder (Category):** Anxiety Disorders. * **Most common individual Anxiety Disorder:** Specific Phobia. * **Most common psychiatric disorder in the Elderly:** Depressive disorders (though anxiety is still highly prevalent). * **Most common psychiatric disorder in Primary Care settings:** Mixed Anxiety and Depressive Disorder. * **Gender Predisposition:** Almost all anxiety disorders are more common in **females** (ratio approx. 2:1), with the exception of Obsessive-Compulsive Disorder (OCD), which has a nearly equal gender distribution in adults.

Question 78: A 21-year-old woman presents with complaints of constricting chest pain and difficulty breathing. She reports three similar episodes in the past month and believes she is having a heart attack. Her past medical history is unremarkable, but her father died of a myocardial infarction at age 47. ECG shows sinus tachycardia, and cardiac enzymes and urine drug screen are normal. What is the next best step in the management of this patient?

A. Reassurance
B. Alprazolam (Correct Answer)
C. Escitalopram
D. Cognitive behavioural therapy

Explanation: ### Explanation **Diagnosis: Panic Attack (Acute Episode)** The patient presents with classic symptoms of a panic attack: chest pain, dyspnea, tachycardia, and a "sense of impending doom" (fearing a heart attack). Given that organic causes (MI, drug use) have been ruled out by a normal ECG, cardiac enzymes, and drug screen, the immediate goal is to manage the acute distress. **1. Why Alprazolam is Correct:** In the **acute management** of a panic attack, **Benzodiazepines (BZDs)** like Alprazolam or Lorazepam are the drugs of choice. They have a rapid onset of action and provide immediate relief by enhancing GABAergic inhibition, effectively terminating the acute autonomic surge. **2. Why Other Options are Incorrect:** * **Escitalopram (SSRIs):** While SSRIs are the **first-line treatment for the long-term management** (prophylaxis) of Panic Disorder, they have a delayed onset of action (2–4 weeks) and may initially worsen anxiety. They are not useful for terminating an acute episode. * **Cognitive Behavioural Therapy (CBT):** This is a highly effective long-term psychological intervention (specifically interoceptive exposure), but it cannot be implemented effectively while a patient is in the throes of an acute physiological crisis. * **Reassurance:** While important, simple reassurance is often insufficient to terminate the intense physical symptoms of a severe panic attack; pharmacological intervention is required to stabilize the patient. **3. NEET-PG High-Yield Pearls:** * **Panic Disorder Definition:** Recurrent, unexpected panic attacks followed by ≥1 month of persistent concern about future attacks or behavioral changes. * **DOC for Acute Attack:** Benzodiazepines (Alprazolam/Lorazepam). * **DOC for Maintenance:** SSRIs (Sertraline, Escitalopram, Paroxetine). * **Medical Mimics to Rule Out:** Hyperthyroidism, Pheochromocytoma, Arrhythmias, and Pulmonary Embolism. * **Agoraphobia:** Frequently associated with Panic Disorder; it is the fear of being in places where escape might be difficult during an attack.

Question 79: Phobia is defined as which of the following?

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

Explanation: **Explanation:** Phobia is classified as a **Neurosis** (specifically a Phobic Anxiety Disorder). In psychiatry, the distinction between neurosis and psychosis is fundamental for the NEET-PG exam. **Why Neurosis is the correct answer:** Neurosis refers to a group of mental disorders characterized by distressing symptoms where **insight is preserved** and **reality testing remains intact**. A person with a phobia experiences an irrational, persistent fear of a specific object or situation but is fully aware that their fear is excessive or unreasonable. They do not lose touch with reality; rather, they experience ego-dystonic anxiety. **Analysis of Incorrect Options:** * **A. Psychosis:** In psychosis (e.g., Schizophrenia), insight is lost, and reality testing is impaired. Patients experience delusions or hallucinations. Phobias do not involve a loss of 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 social, specific, and agoraphobia. * **C. Anxiety:** While anxiety is the *primary symptom* of a phobia, "Neurosis" is the broader *clinical classification* requested by the definition-based question. Phobia is a subtype of anxiety disorder, which falls under the umbrella of neurotic disorders. **High-Yield Clinical Pearls for NEET-PG:** * **Insight:** Present in Neurosis; Absent in Psychosis. * **Reality Testing:** Intact in Neurosis; Impaired in Psychosis. * **Treatment of Choice:** For Specific Phobias, the most effective treatment is **Systematic Desensitization** (a type of Behavior Therapy). * **Agoraphobia:** Fear of places where escape might be difficult; often associated with Panic Disorder. * **Social Phobia (Social Anxiety Disorder):** Fear of scrutiny or embarrassment in social situations; treated with SSRIs and CBT.

Question 80: Anxiety is classified as which of the following?

A. Neurosis (Correct Answer)
B. Psychosis
C. Personality disorder
D. None of the above

Explanation: ### Explanation **Correct Option: A. Neurosis** In traditional psychiatric classification (ICD-9 and earlier), mental disorders were broadly divided into **Neurosis** and **Psychosis**. Anxiety is the hallmark of neurosis. * **The Underlying Concept:** In neurotic disorders, the individual’s **reality testing remains intact**, and they possess **insight** (they are aware that their symptoms are abnormal). The personality remains organized, and there are no hallucinations or delusions. Anxiety acts as the primary symptom or a defense mechanism against internal conflict. **Why other options are incorrect:** * **B. Psychosis:** These are severe disorders (e.g., Schizophrenia) characterized by a **loss of reality testing**, lack of insight, and presence of "positive symptoms" like delusions and hallucinations. In psychosis, the personality is often fragmented. * **C. Personality Disorder:** These are enduring, pervasive, and inflexible patterns of inner experience and behavior that deviate markedly from cultural expectations. While some personality disorders (like Avoidant or Dependent) involve anxiety, "Anxiety" as a clinical entity is a symptomatic disorder, not a structural personality trait. **High-Yield Clinical Pearls for NEET-PG:** 1. **Insight:** The most critical clinical differentiator between Neurosis (Insight Present) and Psychosis (Insight Absent). 2. **ICD-10/11 Shift:** Modern classifications have largely moved away from the term "Neurosis," instead grouping these under **"Neurotic, stress-related and somatoform disorders" (F40-F48)**. 3. **Hierarchy of Diagnosis:** In psychiatry, organic causes must be ruled out first, followed by psychosis, and finally neurosis/anxiety disorders. 4. **Common Neurotic Disorders:** Generalized Anxiety Disorder (GAD), Panic Disorder, Phobias, and OCD.

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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