Anxiety — MCQs

A 25-year-old male medical student presents to student health with a chief complaint of picking at his skin. He states that at times he has urges to pick his skin that he struggles to suppress. Typically, he will participate in the act during finals or when he has "too many assignments to do." The patient states that he knows that his behavior is not helping his situation and is causing him harm; however, he has trouble stopping. He will often ruminate over all his responsibilities which make his symptoms even worse. The patient has a past medical history of surgical repair of his ACL two years ago. His current medications include melatonin. On physical exam you note a healthy young man with scars on his arms and face. His neurological exam is within normal limits. Which of the following is the best initial step in management?

A 14-year-old girl presents to the pediatrician for behavior issues. The girl has been having difficulty in school as a result. Every time the girl enters her classroom, she feels the urge to touch every wall before heading to her seat. When asked why she does this, she responds, "I'm not really sure. I just can't stop thinking about it until I have touched each wall." The parents have noticed this behavior occasionally at home but were not concerned. The girl is otherwise healthy, has many friends, eats a balanced diet, does not smoke, and is not sexually active. Her temperature is 98.2°F (36.8°C), blood pressure is 117/74 mmHg, pulse is 80/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam is notable for a healthy young girl. Neurologic exam is unremarkable. There is no observed abnormalities in behavior while the girl is in the office. Which of the following is the most appropriate initial step in management for this patient?

A 25-year-old woman presents with a history of recurrent attacks of unprovoked fear, palpitations, and fainting. The attacks are usually triggered by entering a crowded place or public transport, so the patient tries to avoid being in public places alone. Besides this, she complains of difficulties in falling asleep, uncontrolled worry about her job and health, fear to lose the trust of her friends, and poor appetite. She enjoys dancing and has not lost a passion for her hobby, but recently when she participated in a local competition, she had an attack which made her stop her performance until she calmed down and her condition improved. She feels upset due to her condition. She works as a sales manager and describes her work as demanding with multiple deadlines to be met. She recently broke up with her boyfriend. She does not report any chronic medical problems, but she sometimes takes doxylamine to fall asleep. She has a 4-pack-year history of smoking and drinks alcohol occasionally. On presentation, her blood pressure is 110/60 mm Hg, heart rate is 71/min, respiratory rate is 13/min, and temperature is 36.5°C (97.7°F). Her physical examination is unremarkable. Which of the following medications can be used for the acute management of the patient’s attacks?

A 25-year-old man comes to the physician because of palpitations, sweating, and flushing. Since he was promoted to a manager in a large software company 6 months ago, he has had several episodes of these symptoms when he has to give presentations in front of a large group of people. During these episodes, his thoughts start racing and he fears that his face will “turn red” and everyone will laugh at him. He has tried to avoid the presentations but fears that he might lose his job if he continues to do so. He is healthy except for mild-persistent asthma. He frequently smokes marijuana to calm his nerves. He does not drink alcohol. His only medication is an albuterol inhaler. His pulse is 78/min, respirations are 14/min, and blood pressure is 120/75 mm Hg. Cardiopulmonary examination shows no abnormalities. On mental status examination, the patient appears worried and has a flattened affect. Which of the following is the most appropriate next step in management?

A 23-year-old female college senior comes to the physician with a 1-year history of recurrent palpitations accompanied by sweating, facial blushing, and sometimes nausea. The symptoms are worse during class when she is occasionally called out to speak, which causes her to feel embarrassed. She has been skipping class on discussion days because she is concerned that her classmates may notice her symptoms. The patient does not enjoy jogging in the park anymore and has gained 2 kg (4 lbs 7 oz) over the past 2 months. Her appetite is unchanged. She has no history of serious illness. She does not smoke or drink alcohol. She has experimented with marijuana but does not use it currently. She appears nervous and does not make eye contact with the physician. Her vitals show a pulse of 85/min, her blood pressure is 125/70 mmHg, and her temperature is 36.8°C. Mental status examination reveals full range of affect. Neurological exam shows no abnormalities. Which of the following is the most likely diagnosis for this patient's symptoms?

A 35-year-old man comes to the Veterans Affairs hospital because of a 2-month history of anxiety. He recently returned from his third deployment to Iraq, where he served as a combat medic. He has had difficulty readjusting to civilian life. He works as a taxi driver but had to take a leave of absence because of difficulties with driving. Last week, he hit a stop sign because he swerved out of the way of a grocery bag that was in the street. He has difficulty sleeping because of nightmares about the deaths of some of the other soldiers in his unit and states, “it's my fault, I could have saved them. Please help me.” Mental status examination shows a depressed mood and a restricted affect. There is no evidence of suicidal ideation. Which of the following is the most appropriate initial step in treatment?

A 33-year-old woman presents with anxiety, poor sleep, and occasional handshaking and sweating for the past 10 months. She says that the best remedy for her symptoms is a “glass of a good cognac” after work. She describes herself as a “moderate drinker”. However, on a more detailed assessment, the patient confesses that she drinks 1–2 drinks per working day and 3–5 drinks on days-off when she is partying. She was once involved in a car accident while being drunk. She works as a financial assistant and describes her job as “demanding”. She is divorced and lives with her 15-year-old daughter. She says that she often hears from her daughter that she should stop drinking. She realizes that the scope of the problem might be larger than she perceives, but she has never tried stopping drinking. She does not feel hopeless, but sometimes she feels guilty because of her behavior. She does not smoke and does not report illicit drugs use. Which of the following medications would be a proper part of the management of this patient?

A 14-year-old boy is brought in to the clinic by his parents for weird behavior for the past 4 months. The father reports that since the passing of his son's pet rabbit about 5 months ago, his son has been counting during meals. It could take up to 2 hours for him to finish a meal as he would cut up all his food and arrange it in a certain way. After asking the parents to leave the room, you inquire about the reason for these behaviors. He believes that another family member is going to die a “terrible death” if he doesn’t eat his meals in multiples of 5. He understands that this is unreasonable but just can’t bring himself to stop. Which of the following abnormality is this patient's condition most likely associated with?

A 17-year-old girl comes in to her primary care physician's office for an athletic physical. She is on her school’s varsity swim team. She states she is doing “ok” in her classes. She is worried about her upcoming swim meet. She states, “I feel like I’m the slowest one on the team. Everyone is way more fit than I am.” The patient has polycystic ovarian syndrome and irregular menses, and her last menstrual period was 5 weeks ago. She takes loratadine, uses nasal spray for her seasonal allergies, and uses ibuprofen for muscle soreness occasionally. The patient’s body mass index (BMI) is 19 kg/m^2. On physical examination, the patient has dark circles under her eyes and calluses on the dorsum of her right hand. A beta-hCG is negative. Which of the following is associated with the patient’s most likely condition?

A 17-year-old high school student comes to the physician because of a 6-month history of insomnia. On school nights, he goes to bed around 11 p.m. but has had persistent problems falling asleep and instead studies at his desk until he feels sleepy around 2 a.m. He does not wake up in the middle of the night. He is worried that he does not get enough sleep. He has significant difficulties waking up on weekdays and has repeatedly been late to school. At school, he experiences daytime sleepiness and drinks 1–2 cups of coffee in the mornings. He tries to avoid daytime naps. On the weekends, he goes to bed around 2 a.m. and sleeps in until 10 a.m., after which he feels rested. He has no history of severe illness and does not take medication. Which of the following most likely explains this patient's sleep disorder?