Panic Disorder — MCQs
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?
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?
A 43-year-old lady presents to the emergency department with an acute attack of anxiety, accompanied by physical symptoms such as hyperventilation, increased heart rate, and sweating, and is diagnosed with an acute panic attack. Which of the following is the most suitable drug for this patient?
A medical student presents with recurrent episodes of dyspnea, chest tightness, anxiety, and an impending sense of doom. Upon examination, all systemic conditions are found to be normal. She is then referred to psychiatry. What is the most likely diagnosis?
A 45-year-old male presents with recurrent episodes of palpitations, sweating, and a fear of losing control. He has been experiencing these episodes for the past six months. What is the most likely diagnosis?
What is the drug of choice for treating generalized anxiety disorder?
A nondiabetic, nonhypertensive patient has occasional extra heartbeats. The doctor informed them it is benign, but the patient continues to seek investigations from doctor to doctor. This is a type of:
A 25-year-old presents with depression, anxiety, and unexplained physical symptoms for 6 months. Most likely diagnosis?
Which of the following symptoms is NOT included in the diagnostic criteria for DSM-IV-TR somatization disorder?
Fear of "places from where escape is difficult" is called ______
Panic Disorder Indian Medical PG Practice Questions and MCQs
Question 1: 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?
- A. Post-traumatic stress disorder
- B. Acute psychosis
- C. Panic attack (Correct Answer)
- D. Mania
Explanation: ***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.
Question 2: 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?
- A. Panic attack (Correct Answer)
- B. Acute stress disorder
- C. Generalised anxiety disorder
- D. Phobia
Explanation: ***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 3: A 43-year-old lady presents to the emergency department with an acute attack of anxiety, accompanied by physical symptoms such as hyperventilation, increased heart rate, and sweating, and is diagnosed with an acute panic attack. Which of the following is the most suitable drug for this patient?
- A. Sertraline
- B. Alprazolam (Correct Answer)
- C. Propranolol
- D. Eszopiclone
Explanation: ***Alprazolam*** - **Alprazolam** is a **fast-acting benzodiazepine** with a quick onset of action, making it ideal for the immediate relief of acute panic attack symptoms. - It works by enhancing the effect of **GABA**, leading to rapid central nervous system depression and swift reduction of anxiety. *Sertraline* - **Sertraline** is a **selective serotonin reuptake inhibitor (SSRI)** that is effective for long-term management of panic disorder. - However, its **therapeutic effects** take several weeks to manifest, making it unsuitable for acute symptom relief. *Propranolol* - **Propranolol** is a **beta-blocker** that can help manage the physical symptoms of anxiety like palpitations and tremor. - It does not directly address the psychological component of **anxiety** or **panic attacks** effectively. *Eszopiclone* - **Eszopiclone** is a **non-benzodiazepine hypnotic** primarily used for the treatment of insomnia. - It is not indicated for the management of **acute anxiety** or **panic attacks**.
Question 4: A medical student presents with recurrent episodes of dyspnea, chest tightness, anxiety, and an impending sense of doom. Upon examination, all systemic conditions are found to be normal. She is then referred to psychiatry. What is the most likely diagnosis?
- A. Panic disorder (Correct Answer)
- B. Depression
- C. Epilepsy
- D. Asthma
Explanation: ***Panic disorder*** - The sudden onset of intense anxiety, accompanied by **physical symptoms** like dyspnea and chest tightness, and a feeling of **impending doom** despite normal systemic findings, is characteristic of a panic attack. - Recurrent, unexpected panic attacks lead to a diagnosis of panic disorder, often with significant **anticipatory anxiety** between attacks. *Depression* - While depression can cause symptoms like fatigue, low mood, and anhedonia, it typically does not present with acute, episodic **panic symptoms** and a sense of impending doom in this manner. - The primary symptoms are usually persistent sadness, loss of interest, and often do not involve sudden, acute physiological arousal of this intensity. *Epilepsy* - Epileptic seizures involve abnormal electrical activity in the brain, often presenting with **motor, sensory, or cognitive disruptions**, sometimes with loss of consciousness. - Although some seizures can have autonomic symptoms or an aura of fear, the constellation of symptoms (dyspnea, chest tightness, impending doom) with a clear psychological component and normal systemic exam points away from epilepsy as the primary diagnosis. *Asthma* - Asthma is a chronic respiratory condition characterized by **airway inflammation and bronchoconstriction**, leading to symptoms like dyspnea, wheezing, and chest tightness. - However, in asthma, physical examination would likely reveal abnormal lung sounds (e.g., **wheezing**), and systemic conditions would not be entirely normal, especially during an exacerbation.
Question 5: A 45-year-old male presents with recurrent episodes of palpitations, sweating, and a fear of losing control. He has been experiencing these episodes for the past six months. What is the most likely diagnosis?
- A. Generalized anxiety disorder
- B. Panic disorder (Correct Answer)
- C. Social anxiety disorder
- D. Obsessive-compulsive disorder
Explanation: ***Panic disorder*** - The presentation of recurrent, unexpected **panic attacks** characterized by sudden episodes of intense fear, palpitations, sweating, and a fear of losing control is classic for **panic disorder**. - These episodes often manifest with physical symptoms that mimic a medical emergency, leading to significant distress and avoidance behaviors. *Generalized anxiety disorder* - This condition involves **persistent and excessive worry** about various life circumstances for at least six months, rather than discrete, intense episodes of fear. - While physical symptoms like restlessness and fatigue can occur, they are generally less acute and not as severe as the sudden "fight-or-flight" response seen in panic attacks. *Social anxiety disorder* - This disorder is characterized by marked fear or anxiety about **social situations** where the individual might be scrutinized by others. - While it can involve symptoms like palpitations and sweating in social contexts, it doesn't typically present with unexpected attacks unrelated to social performance. *Obsessive-compulsive disorder* - This disorder is defined by the presence of **obsessions** (recurrent and persistent thoughts, urges, or images) and/or **compulsions** (repetitive behaviors or mental acts) that the individual feels driven to perform. - The symptoms described—palpitations, sweating, and fear of losing control—are not typical primary manifestations of OCD, which focuses on specific obsessions and compulsions.
Question 6: What is the drug of choice for treating generalized anxiety disorder?
- A. Alprazolam
- B. Buspirone (Correct Answer)
- C. Phenytoin
- D. β-blocker
Explanation: ***Buspirone*** - **Buspirone** is a non-benzodiazepine anxiolytic that is effective for generalized anxiety disorder (GAD) and has a lower risk of dependence and sedation compared to benzodiazepines. - It acts as a partial agonist at **5-HT1A serotonin receptors**, which contributes to its anxiolytic effects without affecting GABAergic systems. *β-blocker* - **β-blockers** are primarily used to manage the **physical symptoms of anxiety**, such as palpitations and tremors, often in performance anxiety, rather than the core cognitive and emotional symptoms of GAD. - They do not address the underlying psychological aspects of generalized anxiety. *Alprazolam* - **Alprazolam** is a **benzodiazepine** that provides rapid relief of anxiety symptoms but carries a significant risk of **dependence, withdrawal, and sedation**, making it less suitable for long-term treatment of GAD. - Due to these risks, benzodiazepines are typically reserved for short-term use or acute anxiety management rather than as a first-line treatment for chronic GAD. *Phenytoin* - **Phenytoin** is an **antiepileptic drug** primarily used to treat seizures and does not have a recognized role in the management of generalized anxiety disorder. - Its mechanism of action involves stabilizing neuronal membranes and is unrelated to the neurochemical pathways targeted in anxiety disorders.
Question 7: A nondiabetic, nonhypertensive patient has occasional extra heartbeats. The doctor informed them it is benign, but the patient continues to seek investigations from doctor to doctor. This is a type of:
- A. Depression
- B. Conversion disorder
- C. Somatoform pain
- D. Illness Anxiety Disorder (Correct Answer)
Explanation: ***Illness Anxiety Disorder*** - This condition is characterized by **preoccupation with having or acquiring a serious illness**, despite minimal or no somatic symptoms, or an excessive preoccupation if symptoms are present. - The patient's repeated seeking of investigations despite medical assurance of a benign condition aligns with the diagnostic criteria of **illness anxiety disorder**, where reassurance has little effect. *Depression* - While **depressive symptoms** (e.g., low mood, anhedonia) can coexist with health anxieties, the primary driver here is the fear of serious illness rather than pervasive sadness or loss of interest. - Patients with depression typically report a **generalized dysphoria** or lack of energy, which is not the central issue described. *Conversion disorder* - Involves **neurological symptoms** (e.g., paralysis, blindness, seizures) that are incompatible with recognized neurological conditions and are not intentionally produced. - The patient's concern is about a benign cardiac finding, not the sudden onset of **functional neurological deficits**. *Somatoform pain* - This term is older and has largely been replaced by **Somatic Symptom Disorder with predominant pain**, where psychological factors play a significant role in the onset, severity, exacerbation, or maintenance of pain. - The patient's main concern is about the **implication of a benign symptom** rather than experiencing overwhelming pain itself.
Question 8: A 25-year-old presents with depression, anxiety, and unexplained physical symptoms for 6 months. Most likely diagnosis?
- A. Somatic symptom disorder
- B. Major depressive disorder (Correct Answer)
- C. Illness anxiety disorder
- D. Adjustment disorder
Explanation: ***Major depressive disorder*** - MDD commonly presents with **somatic symptoms** in addition to psychological symptoms, especially in Indian/Asian populations where up to 60-70% of depressed patients present with prominent physical complaints. - The triad of **depression, anxiety, and unexplained physical symptoms** for 6 months is characteristic of MDD with somatic features. - Common somatic manifestations include: headaches, body aches, fatigue, gastrointestinal symptoms, and other unexplained physical complaints. - The presence of depression and anxiety as **primary features** (not secondary to health concerns) points toward MDD rather than a somatic symptom disorder. *Somatic symptom disorder* - Requires **one or more somatic symptoms** PLUS excessive thoughts, feelings, or behaviors related to those symptoms (e.g., disproportionate concerns about seriousness, persistent high anxiety about health, excessive time/energy devoted to symptoms). - The **primary focus** would be the physical symptoms and health-related anxiety, not depression/anxiety as independent features. - The stem lacks evidence of excessive preoccupation or maladaptive responses to the somatic symptoms. *Illness anxiety disorder* - Characterized by **preoccupation with having or acquiring a serious illness** with no or only mild somatic symptoms present. - The focus is on the fear of being sick rather than distress from actual physical symptoms. - Does not primarily present with depression as a core feature. *Adjustment disorder* - Requires **identifiable stressor** with symptoms developing within 3 months of stressor onset. - Symptoms are expected to resolve within 6 months after the stressor ends. - No stressor is mentioned in this case, and the 6-month duration without mention of stressor resolution makes this less likely.
Question 9: Which of the following symptoms is NOT included in the diagnostic criteria for DSM-IV-TR somatization disorder?
- A. Sexual symptom
- B. Pain symptom
- C. GI symptom
- D. Visual symptoms (Correct Answer)
Explanation: ***Visual symptoms*** - **Visual symptoms** is NOT a separate diagnostic category in DSM-IV-TR somatization disorder criteria. - While visual symptoms (such as **double vision** or **blindness**) ARE part of the diagnostic criteria, they fall under the **pseudoneurological symptom** category, not as a distinct standalone category. - The DSM-IV-TR required **one pseudoneurological symptom** (which could include visual, motor, sensory symptoms, or seizures), but did not list "visual symptoms" as one of the four main symptom categories. *Sexual symptom* - The DSM-IV-TR diagnostic criteria for somatization disorder explicitly included **sexual symptoms** as one of the four main categories. - At least **one sexual symptom** was required (such as sexual indifference, erectile dysfunction, irregular menses, or painful intercourse). *Pain symptom* - The DSM-IV-TR criteria included **pain symptoms** as one of the four main categories. - The criteria required **four pain symptoms** occurring in at least four different sites or functions (e.g., head, abdomen, back, joints, chest). *GI symptom* - The DSM-IV-TR criteria included **gastrointestinal symptoms** as one of the four main categories. - At least **two gastrointestinal symptoms** were required (such as nausea, bloating, vomiting other than during pregnancy, or diarrhea). **Key Point:** The four DSM-IV-TR symptom categories for somatization disorder were: (1) Pain, (2) Gastrointestinal, (3) Sexual, and (4) Pseudoneurological—NOT "visual symptoms" as a separate category.
Question 10: Fear of "places from where escape is difficult" is called ______
- A. Claustrophobia
- B. Aerophobia
- C. Agoraphobia (Correct Answer)
- D. Ailurophobia
Explanation: ***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.
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