Separation Anxiety Disorder — MCQs
Untreated ADHD persisting from childhood increases the risk of developing which of the following in adolescence?
Double depression is seen in:
Which of the following disorders is classified under somatic symptom and related disorders in the DSM-5?
Best therapy suited to teach daily life skill to a mentally challenged child:
A 25-year-old presents with depression, anxiety, and unexplained physical symptoms for 6 months. 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?
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?
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:
Specific phobias are best classified under which of the following categories?
Separation Anxiety Disorder Indian Medical PG Practice Questions and MCQs
Question 1: Untreated ADHD persisting from childhood increases the risk of developing which of the following in adolescence?
- A. Selective mutism
- B. Conduct disorder (Correct Answer)
- C. Binge eating disorder
- D. Separation anxiety disorder
Explanation: ***Conduct disorder*** - **Untreated ADHD**, marked by impulsivity and difficulty with emotional regulation, significantly increases the risk of developing **conduct disorder** in adolescence. - Adolescents with untreated ADHD may struggle with following rules, exhibiting aggressive behaviors, and engaging in antisocial acts, which are hallmarks of conduct disorder. *Selective mutism* - This is an **anxiety disorder** characterized by a child's consistent failure to speak in specific social situations where there is an expectation for speaking despite speaking in other situations. - While it can co-occur with ADHD, it is not a direct consequence of untreated ADHD and involves distinct psychological mechanisms. *Binge eating disorder* - This disorder is characterized by recurrent episodes of **eating unusually large amounts of food** in a short period, often accompanied by a sense of loss of control. - While there is a higher prevalence of eating disorders in individuals with ADHD, it is not a primary or direct developmental risk from untreated ADHD in adolescence. *Separation anxiety disorder* - This disorder involves **excessive fear or anxiety** concerning separation from home or from attachment figures, beyond what is expected for the individual's developmental level. - While it can co-occur with ADHD, it is not a direct developmental risk that emerges from untreated ADHD in adolescence.
Question 2: Double depression is seen in:
- A. Depression with dysthymia (Correct Answer)
- B. Depression with anxiety attack
- C. Major depression with OCD
- D. Major depressive disorder from 2 years
Explanation: ***Depression with dysthymia*** - **Double depression** is a specific mood disorder characterized by the co-occurrence of a **major depressive episode** on top of a pre-existing **dysthymic disorder** (persistent depressive disorder). - This means an individual experiences the chronic, milder symptoms of dysthymia, which are then worsened by the more severe symptoms of a major depressive episode. *Depression with anxiety attack* - While depression and anxiety attacks can co-occur, this specific combination is not referred to as **double depression**. - **Anxiety attacks** are acute episodes of intense fear and discomfort, often associated with panic disorder, and are distinct from chronic low-grade depressive symptoms. *Major depression with OCD* - **Obsessive-compulsive disorder (OCD)** is a distinct anxiety disorder characterized by obsessions and compulsions, which can co-occur with major depression. - However, the term **double depression** specifically refers to the combination of major depression and dysthymia, not other psychiatric comorbidities. *Major depressive disorder from 2 years* - Experiencing **major depressive disorder for 2 years** implies a chronic course of major depression. - If the symptoms meet the criteria for major depressive disorder continuously for at least two years, it might be termed **chronic major depressive disorder**, but not double depression, unless there was an underlying dysthymia.
Question 3: Which of the following disorders is classified under somatic symptom and related disorders in the DSM-5?
- A. Post-Traumatic Stress Disorder (PTSD)
- B. Phobic disorders (e.g., social anxiety disorder)
- C. Conversion disorder (functional neurological symptom disorder) (Correct Answer)
- D. Obsessive-Compulsive Disorder (OCD)
Explanation: ***Conversion disorder (functional neurological symptom disorder)*** - **Conversion disorder** is characterized by neurological symptoms (e.g., paralysis, blindness) that are **incompatible with recognized neurological or medical conditions**, yet are not intentionally produced. - It falls under **somatic symptom and related disorders** because the primary features are physical symptoms causing distress or functional impairment, rather than being malingered or feigned. *Phobic disorders (e.g., social anxiety disorder)* - **Phobic disorders** are classified under **anxiety disorders** in the DSM-5, not somatic symptom and related disorders. - They are primarily characterized by **intense, irrational fears** of specific objects or situations, leading to avoidance rather than prominent physical symptoms without a medical cause. *Post-Traumatic Stress Disorder (PTSD)* - **PTSD** is classified under **trauma- and stressor-related disorders** in the DSM-5, distinguished by symptoms developing after exposure to a traumatic event. - Its core features include **intrusive memories, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity**, rather than unexplained physical symptoms. *Obsessive-Compulsive Disorder (OCD)* - **OCD** is classified under **obsessive-compulsive and related disorders** in the DSM-5. - It is primarily characterized by the presence of **obsessions (recurrent, intrusive thoughts)** and/or **compulsions (repetitive behaviors or mental acts)**, which are distinct from somatic symptoms.
Question 4: Best therapy suited to teach daily life skill to a mentally challenged child:
- A. Contingency management (Correct Answer)
- B. Cognitive reconstruction
- C. Self instruction
- D. CBT (Cognitive behavior therapy)
Explanation: ***Contingency management*** - This therapy involves consistently **rewarding desired behaviors** and withholding rewards for undesirable ones, which is highly effective for teaching new skills to individuals with intellectual disabilities. - It uses principles of **operant conditioning** to shape behavior through positive reinforcement, making it suitable for acquiring daily living skills. *Cognitive reconstruction* - This technique focuses on identifying and changing **maladaptive thought patterns**, which typically requires a higher level of cognitive function. - It is generally not the primary or most effective approach for teaching concrete daily life skills to individuals with significant **cognitive limitations**. *Self instruction* - This involves teaching individuals to guide their own behavior using **internal verbal cues** or self-talk. - While beneficial for some, it often requires a certain degree of **abstract thinking** and memory, making it less suitable as a standalone method for those with profound cognitive challenges in acquiring basic skills. *CBT (Cognitive behavior therapy)* - CBT integrates cognitive and behavioral strategies to address emotional and behavioral problems by modifying **thoughts, feelings, and behaviors**. - While beneficial for a range of psychological issues, its emphasis on **cognitive restructuring** makes it less directly applicable or the most effective first-line therapy for teaching concrete, functional daily living skills to mentally challenged children.
Question 5: 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 6: 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 7: 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 8: 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 9: 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 10: Specific phobias are best classified under which of the following categories?
- A. Mood disorders
- B. Psychotic disorders
- C. Personality disorders
- D. Anxiety disorders (Correct Answer)
Explanation: **Anxiety disorders** - **Specific phobias** are characterized by marked and persistent fear of a specific object or situation, which falls under the umbrella of **anxiety disorders**. - The core feature is intense anxiety or panic when exposed to the phobic stimulus, leading to avoidance behavior. *Psychotic disorders* - These involve a significant loss of contact with reality, often featuring **hallucinations, delusions**, or disorganized thought and speech. - Specific phobias do not involve such a profound disruption of reality or psychotic symptoms. *Mood disorders* - These are primarily characterized by a disturbance in the person's sustained emotional state, such as **depression (low mood)** or **mania (elevated mood)**. - While anxiety can co-occur with mood disorders, specific phobias are distinct conditions defined by their fear response to specific triggers. *Personality disorders* - These are characterized by **enduring patterns of inner experience and behavior** that deviate significantly from cultural expectations, are pervasive and inflexible, and cause distress or impairment. - Specific phobias are not considered deeply ingrained, pervasive patterns of relating to the world, but rather a focused fear response.
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