Neurobiological basis of anxiety — MCQs

A 52-year-old woman presents to her primary care physician for her annual checkup. She lost her job 6 months ago and since then she has been feeling worthless because nobody wants to hire her. She also says that she is finding it difficult to concentrate, which is exacerbated by the fact that she has lost interest in activities that she used to love such as doing puzzles and working in the garden. She says that she is sleeping over 10 hours every day because she says it is difficult to find the energy to get up in the morning. She denies having any thoughts about suicide. Which of the following neurotransmitter profiles would most likely be seen in this patient?

A 52-year-man is brought to the physician because of a 2-week history of memory loss. Three weeks ago, he had a cardiac arrest that required cardiopulmonary resuscitation and intravenous epinephrine. On mental status examination, he cannot recall objects shown to him 20 minutes earlier but vividly recalls memories from before the incident. The remainder of the examination shows no abnormalities. Which of the following structures of the brain is most likely affected?

A 45-year-old woman presents to her primary care physician with complaints of muscle pains, poor sleep, and daytime fatigue. When asked about stressors she states that she "panics" about her job, marriage, children, and finances. When asked to clarify what the "panics" entail, she states that it involves severe worrying. She has had these symptoms since she last saw you one year ago. What is the most likely diagnosis?

A 27-year-old man is brought to a psychiatrist by his mother who is concerned that he has become increasingly distant. When asked, he says that he is no longer going out because he is afraid of going outside by himself. He says that ever since he was a teenager, he was uncomfortable in large crowds and on public transportation. He now works from home and rarely leaves his house except on mandatory business. Which of the following personality disorders is most likely genetically associated with this patient's disorder?

A 43-year-old woman comes to the physician for an annual health maintenance examination. On questioning, she has had fatigue and headaches for the last month. A few weeks ago, she had to have her wedding ring resized because it had become too small for her finger. She has mild persistent asthma and anxiety disorder. She drinks 2–3 glasses of red wine per night and has smoked one pack of cigarettes daily for 16 years. She works a desk job in accounting and has recently been working long hours due to an upcoming company merger. Her father has a history of a pituitary adenoma. Current medications include alprazolam, a fluticasone inhaler, and an albuterol inhaler. She is 160 cm (5 ft 3 in) tall and weighs 81.6 kg (180 lb); her BMI is 32 kg/m2. Her temperature is 37.2°C (99°F), pulse is 92/min, and blood pressure is 132/80 mm Hg. Examination shows no abnormalities. Fasting laboratory studies show: Hemoglobin 13 g/dL Serum Na+ 135 mEq/L K+ 4.6 mEq/L Cl- 105 mEq/L HCO3- 22 mEq/L Urea nitrogen 17 mg/dL Glucose 160 mg/dL Creatinine 0.9 mg/dL Which of the following is the most likely underlying mechanism of this patient's hyperglycemia?

A 43-year-old male with a history of thyroid cancer status post total thyroidectomy presents to his primary care physician after repeated bouts of headaches. His headaches are preceded by periods of anxiety, palpitations, and sweating. The patient says he is unable to pinpoint any precipitating factors and instead says the events occur without warning. Of note, the patient's father and uncle also have a history of thyroid cancer. On exam his vitals are: T 36.8 HR 87, BP 135/93, RR 14, and O2 Sat 100% on room air. The patient's TSH is within normal limits, and he reports taking his levothyroxine as prescribed. What is the next best step in diagnosing this patient's chief complaint?

A 42-year-old female complains of feeling anxious and worrying about nearly every aspect of her daily life. She cannot identify a specific cause for these symptoms and admits that this tension is accompanied by tiredness and difficulty falling asleep. To treat this problem, the patient is prescribed sertraline. She endorses a mild improvement with this medication, and over the next several months, her dose is increased to the maximum allowed dose with modest improvement. Her psychiatrist adds an adjunctive treatment, a medication which notably lacks any anticonvulsant or muscle relaxant properties. This drug most likely acts at which of the following receptors?

Every time your neighbor in the adjacent apartment flushes the toilet, the water in your shower becomes very hot, causing you to jump out of the way of the water stream. After this has occurred for several months, you note that you reflexively jump back from the water directly after the sound of the flushing toilet but before the water temperature changes. Which of the following situations is the most similar to the conditioning process detailed above?

An 8-year-old boy is brought to his pediatrician by his mother because she is worried about whether he is becoming ill. Specifically, he has been sent home from school six times in the past month because of headaches and abdominal pain. In fact, he has been in the nurse's office almost every day with various symptoms. These symptoms started when the family moved to an old house in another state about 2 months ago. Furthermore, whenever he is taken care of by a babysitter he also has these symptoms. Despite these occurrences, the boy never seems to have any problems at home with his parents. Which of the following treatments would likely be effective for this patient?

A goalkeeper of a famous soccer team gives an interview with a health agency regarding his childhood. He describes how when he was a child, he would constantly clear his throat in class and the teachers would write a note to his mother with advice to go see an ENT doctor. He complained of being restless, fidgety, and sometimes hyperactive in class, disrupting the environment and causing him many social problems. He would blurt out the answer at times and keep repeating it without any control, leading to some embarrassing timeouts. But he was always nice to his teachers, so he calls it a “benign frustration” rather than aggressively causing distress. He also talked about how his symptoms were dramatically improved with medication. Which of the following is an FDA approved drug for this patient’s most likely condition?