Anxiety Disorders — MCQs
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Anxiety is manifested by the following, except:
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?
Thanatophobia is the fear of which of the following?
A postgraduate trainee experiences significant anxiety and avoidance of public speaking and social situations, despite knowing that their seniors are supportive. They have difficulty speaking in front of others and avoid social gatherings. What is the most likely diagnosis?
What is the most common differential diagnosis of hyperthyroidism in a young female?
Which of the following is NOT true regarding a husband who batters his wife?
Which of the following conditions is classified under anxiety disorders according to DSM-III?
Phobia is a type of:
Which of the following is LEAST likely to characterize anxiety?
What is the definition of agoraphobia?
Anxiety Disorders Indian Medical PG Practice Questions and MCQs
Question 81: Anxiety is manifested by the following, except:
- A. Impaired concentration
- B. Pupillary constriction (Correct Answer)
- C. Insomnia
- D. Worry
Explanation: **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.
Question 82: 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?
- A. Shortness of breath
- B. Tachycardia
- C. Tremors
- D. Warm hands (Correct Answer)
Explanation: ### 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).
Question 83: Thanatophobia is the fear of which of the following?
- A. Closed spaces
- B. Flights
- C. High places
- D. Death (Correct Answer)
Explanation: **Explanation:** **Thanatophobia** is derived from the Greek word *'Thanatos'* (meaning death) and *'phobos'* (meaning fear). It refers to an extreme, irrational, or debilitating fear of death or the dying process. In clinical psychiatry, while not a standalone diagnosis in the DSM-5, it is often a core feature of Generalized Anxiety Disorder (GAD), Panic Disorder, or Illness Anxiety Disorder. **Analysis of Incorrect Options:** * **A. Closed spaces:** This is known as **Claustrophobia**. It is one of the most common situational phobias and is frequently tested in the context of patients undergoing MRI scans. * **B. Flights:** This is known as **Aerophobia** (or Aviophobia). It is a specific phobia that may require short-term benzodiazepines or Cognitive Behavioral Therapy (CBT) with exposure. * **C. High places:** This is known as **Acrophobia**. It should be distinguished from vertigo, which is a vestibular sensation of spinning. **Clinical Pearls for NEET-PG:** 1. **Treatment of Choice:** For specific phobias, the most effective treatment is **Systemic Desensitization** (a type of Behavioral Therapy) or **Exposure Therapy**. 2. **Pharmacotherapy:** While therapy is primary, **Beta-blockers** (e.g., Propranolol) are often used to manage the peripheral autonomic symptoms of performance-related anxiety. 3. **Other High-Yield Phobias:** * **Agoraphobia:** Fear of open spaces or situations where escape might be difficult. * **Nyctophobia:** Fear of darkness. * **Algophobia:** Fear of pain. * **Xenophobia:** Fear of strangers.
Question 84: A postgraduate trainee experiences significant anxiety and avoidance of public speaking and social situations, despite knowing that their seniors are supportive. They have difficulty speaking in front of others and avoid social gatherings. What is the most likely diagnosis?
- A. Agoraphobia
- B. Depressive disorder
- C. Social phobia (Correct Answer)
- D. Panic disorder
Explanation: ### Explanation **Correct Option: C. 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 person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears they will act in a way that will be humiliating or embarrassing. In this case, the trainee’s specific anxiety regarding **public speaking** and **avoidance of social gatherings**—despite a supportive environment—is a classic presentation. **Why other options are incorrect:** * **A. Agoraphobia:** This involves fear and avoidance of places or situations where **escape might be difficult** or help unavailable (e.g., crowds, bridges, or being outside alone). It is not primarily about social scrutiny. * **B. Depressive Disorder:** While social withdrawal can occur in depression, it is usually due to **anhedonia** (loss of interest) or low energy, rather than a specific fear of being judged or performing. * **D. Panic Disorder:** Characterized by **recurrent, unexpected panic attacks** and persistent worry about having future attacks. While social phobia can involve panic-like symptoms, they occur only in response to social triggers. **Clinical Pearls for NEET-PG:** * **Treatment of Choice:** **SSRIs** (e.g., Escitalopram) are the first-line long-term treatment. * **Performance Anxiety:** For specific situations like public speaking, **Beta-blockers (Propranolol)** are used 30–60 minutes before the event to control peripheral sympathetic symptoms (tremors, palpitations). * **Cognitive Behavioral Therapy (CBT):** This is the most effective psychological intervention. * **Key Distinction:** Unlike Shyness, Social Phobia involves significant **functional impairment** and distress.
Question 85: What is the most common differential diagnosis of hyperthyroidism in a young female?
- A. Hysteria
- B. Essential tremor
- C. Anxiety neurosis (Correct Answer)
- D. Parkinsonism
Explanation: **Explanation:** The correct answer is **Anxiety neurosis** (Generalized Anxiety Disorder/Panic Disorder). Hyperthyroidism and Anxiety neurosis share a significant overlap in clinical presentation, particularly in young females, where both conditions are highly prevalent. The underlying medical concept is the **hyper-adrenergic state** seen in both. Common symptoms include tachycardia, palpitations, tremors, heat intolerance, diaphoresis, and irritability. In a clinical setting, a young female presenting with these symptoms must be screened for both thyroid dysfunction (via TSH/T4 levels) and psychiatric disorders to avoid misdiagnosis. **Analysis of Incorrect Options:** * **Hysteria (Dissociative/Conversion Disorder):** This typically presents with neurological deficits (paralysis, blindness, seizures) that cannot be explained by organic pathology. It does not mimic the systemic sympathomimetic symptoms of hyperthyroidism. * **Essential Tremor:** While both involve tremors, essential tremor is usually postural or kinetic and lacks the systemic features of hyperthyroidism like weight loss, tachycardia, or eye signs. * **Parkinsonism:** This is characterized by a "pill-rolling" resting tremor, bradykinesia, and rigidity. It is rare in young females and the tremor type is distinct from the fine, rapid tremor seen in thyrotoxicosis. **High-Yield Clinical Pearls for NEET-PG:** * **The "Fine Tremor":** Both hyperthyroidism and anxiety produce a fine, rapid tremor of the outstretched hands. * **Distinguishing Feature:** In hyperthyroidism, tachycardia often persists during **sleep**, whereas in anxiety neurosis, the heart rate typically normalizes when the patient is asleep. * **Weight Change:** Hyperthyroidism is associated with weight loss despite an increased appetite; anxiety may cause weight fluctuations but lacks the metabolic drive of thyrotoxicosis.
Question 86: Which of the following is NOT true regarding a husband who batters his wife?
- A. Commanding
- B. Non-dependent, caring, altruistic (Correct Answer)
- C. Displacing
- D. Dependent
Explanation: In psychiatry and forensic medicine, the profile of a domestic abuser (batterer) is characterized by specific maladaptive personality traits and defense mechanisms. **Explanation of the Correct Option:** **Option B (Non-dependent, caring, altruistic)** is the correct answer because it describes the opposite of the typical batterer profile. Perpetrators of domestic violence are characteristically **dependent** on their partners for emotional stability and self-esteem. They lack genuine altruism and use violence as a tool for control rather than care. **Analysis of Other Options:** * **Option A (Commanding):** Batterers often exhibit a need for absolute authority and dominance within the household to compensate for internal insecurities. * **Option C (Displacing):** This refers to the defense mechanism of **Displacement**. The husband may face frustration or humiliation at work (the actual source) but redirects his anger toward a "safer" or more vulnerable target—his wife. * **Option D (Dependent):** Despite their outward aggression, most batterers have a "pathological attachment" or deep-seated emotional dependency on their victims. They often fear abandonment, which fuels their controlling and jealous behavior. **Clinical Pearls for NEET-PG:** * **Cycle of Violence (Lenore Walker):** Consists of three phases: 1. Tension-building, 2. Acute battering incident, 3. Honeymoon phase (remorse and kindness). * **Common Comorbidities:** Substance abuse (especially alcohol) is a major precipitant, though not the primary cause. Antisocial or Borderline personality traits are frequently present. * **The "Rule of Quarters":** Approximately 25% of batterers grew up in homes where they witnessed or experienced abuse, highlighting the "intergenerational transmission of violence."
Question 87: Which of the following conditions is classified under anxiety disorders according to DSM-III?
- A. Obsessive compulsive disorder (Correct Answer)
- B. Depression
- C. Schizophrenia
- D. Bipolar disorder
Explanation: **Explanation:** The classification of psychiatric disorders has evolved significantly across different versions of the DSM. In **DSM-III (1980)** and **DSM-IV**, **Obsessive-Compulsive Disorder (OCD)** was categorized as an **Anxiety Disorder**. This was based on the clinical observation that patients with OCD experience intense anxiety when they resist their compulsions or are exposed to triggers. However, in the current **DSM-5**, OCD has been moved to its own dedicated category: *"Obsessive-Compulsive and Related Disorders."* **Analysis of Options:** * **A. Obsessive Compulsive Disorder (Correct):** As per DSM-III and DSM-IV, it was grouped under Anxiety Disorders along with Panic Disorder, Phobias, and PTSD. * **B. Depression:** Classified under **Mood Disorders** (DSM-III/IV) or Depressive Disorders (DSM-5). * **C. Schizophrenia:** Classified under **Psychotic Disorders** (or Schizophrenia Spectrum Disorders in DSM-5). * **D. Bipolar Disorder:** Classified under **Mood Disorders** (DSM-III/IV) and now occupies its own chapter in DSM-5 between Schizophrenia and Depressive Disorders. **High-Yield Clinical Pearls for NEET-PG:** * **DSM-5 Change:** The most important takeaway is that **OCD and PTSD** are **no longer** classified as Anxiety Disorders in DSM-5. * **OCD Neurobiology:** Associated with abnormalities in the **Orbitofrontal cortex, Anterior Cingulate Cortex, and Caudate nucleus** (CSTC circuit). * **Treatment of Choice:** The first-line pharmacological treatment for OCD is **SSRIs** (often requiring higher doses than in depression), and the psychological treatment of choice is **Exposure and Response Prevention (ERP)**.
Question 88: Phobia is a type of:
- A. Psychosis
- B. Neurosis (Correct Answer)
- C. Mania
- D. Depression
Explanation: **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 89: Which of the following is LEAST likely to characterize anxiety?
- A. Syncope
- B. Palpitations
- C. GIT disturbances
- D. Flight of ideas (Correct Answer)
Explanation: **Explanation:** Anxiety is characterized by a state of apprehension and somatic symptoms resulting from overactivity of the **autonomic nervous system (ANS)**, specifically the sympathetic branch. **Why "Flight of Ideas" is the correct answer:** **Flight of Ideas** is a formal thought disorder characterized by rapid shifting from one topic to another, usually based on understandable associations or wordplay (clanging). It is a hallmark feature of **Mania** (Bipolar Disorder), not anxiety. While anxious patients may experience "racing thoughts," their thought process remains goal-directed and does not exhibit the fragmented, pressured transitions seen in flight of ideas. **Analysis of incorrect options:** * **Palpitations:** This is one of the most common cardiovascular manifestations of anxiety due to increased catecholamine release (sympathetic surge). * **GIT disturbances:** Anxiety frequently manifests as gastrointestinal symptoms, including "butterflies" in the stomach, nausea, diarrhea, or irritable bowel-like symptoms, mediated by the brain-gut axis. * **Syncope:** While less common than palpitations, **Vasovagal Syncope** can occur in specific anxiety subtypes, most notably in **Blood-Injection-Injury Phobia**, where an initial sympathetic spike is followed by a sudden parasympathetic overcompensation (bradycardia and hypotension). **Clinical Pearls for NEET-PG:** * **Panic Disorder:** Requires recurrent, unexpected panic attacks followed by at least one month of persistent concern about future attacks. * **Physical vs. Mental:** Anxiety presents with both **somatic** (tremors, sweating, tachycardia) and **psychic** (dread, hypervigilance) symptoms. * **Differential:** Always rule out hyperthyroidism and pheochromocytoma in patients presenting with chronic anxiety symptoms.
Question 90: What is the definition of agoraphobia?
- A. Fear of situations where escape might be difficult or help unavailable if panic-like symptoms occur (Correct Answer)
- B. Fear of heights
- C. Fear of animals
- D. Fear of enclosed spaces
Explanation: ### Explanation **Correct Option: A** Agoraphobia is characterized by marked fear or anxiety about being in situations from which **escape might be difficult** or where **help might not be available** in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., fear of falling in the elderly or fear of incontinence). According to the DSM-5, the diagnosis requires fear in at least two of the following five situations: using public transportation, being in open spaces, being in enclosed spaces, standing in line/being in a crowd, or being outside of the home alone. **Incorrect Options:** * **B. Fear of heights:** This is termed **Acrophobia**, a type of Specific Phobia. * **C. Fear of animals:** This is a **Specific Phobia (Animal Type)**, such as Cynophobia (dogs) or Ophidiophobia (snakes). * **D. Fear of enclosed spaces:** This is **Claustrophobia**. While agoraphobics may fear enclosed spaces (like elevators), the core psychopathology is the inability to escape or find help, rather than the space itself. **Clinical Pearls for NEET-PG:** * **Comorbidity:** Agoraphobia is frequently associated with **Panic Disorder**, but in DSM-5, they are coded as two distinct diagnoses. * **Duration:** Symptoms must typically persist for **6 months or more** for a formal diagnosis. * **Treatment:** The drug of choice (DOC) for long-term management is **SSRIs** (e.g., Sertraline, Paroxetine). **Cognitive Behavioral Therapy (CBT)**, specifically exposure therapy, is the most effective psychological intervention. * **Gender:** It is significantly more common in females than males (approx. 2:1 ratio).
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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