Anxiety — MCQs

A 35-year-old widow has been attending psychotherapy sessions for grief counseling following her husband's death. During a recent session, she notices that her male therapist physically resembles her deceased husband. Over the next few sessions, she begins to feel increasing affection and warmth toward the therapist, similar to the feelings she had for her husband. She has not mentioned the physical resemblance to the therapist. Which of the following best explains the patient's feelings toward her therapist?

A 25-year-old woman comes to the physician for the evaluation of blindness in her right eye that suddenly started 1 hour ago. She has no feeling of pain, pressure, or sensation of a foreign body in the right eye. She has a history of major depressive disorder treated with fluoxetine. The patient attends college and states that she has had a lot of stress lately due to relationship problems with her partner. She does not smoke or drink alcohol. She does not use illicit drugs. She appears anxious. Her vital signs are within normal limits. Ophthalmologic examination shows a normal-appearing eye with no redness. Slit lamp examination and fundoscopy show no abnormalities. A visual field test shows nonspecific visual field defects. An MRI of the brain shows no abnormalities. Which of the following is the most likely diagnosis?

A 24-year-old man presents to the college campus clinic worried that he is having a nervous breakdown. The patient was diagnosed with attention-deficit/hyperactivity disorder (ADHD) during his freshman year and has been struggling to keep his grades up. He has recently become increasingly worried that he might not be able to graduate on time. For the past 2 months, he has been preoccupied with thoughts of his dorm room burning down and he finds himself checking all the appliances and outlets over and over even though he knows he already checked everything thoroughly. This repetitive behavior makes him late to class and has seriously upset his social activities. The patient is afebrile and vital signs are within normal limits. Physical examination is unremarkable. Which of the following is the most likely diagnosis?

A 32-year-old man comes to the Veterans Affairs hospital because of difficulty sleeping for the past 9 weeks. He is a soldier who returned from a deployment in Afghanistan 12 weeks ago. Fifteen weeks ago, his unit was ambushed in a deserted street, and a fellow soldier was killed. He wakes up frequently during the night from vivid dreams of this incident. He blames himself for being unable to save his friend. He also has trouble falling asleep and gets up earlier than desired. During this period, he has started to avoid walking in deserted streets. Vital signs are within normal limits. Physical examination shows no abnormalities. He refuses cognitive behavioral therapy and is started on sertraline. Five weeks later, he returns to the physician and complains about persistent nightmares and difficulty sleeping. Which of the following is the most appropriate next step in management?

A 27-year-old man is brought to the emergency department with minor injuries sustained in a motor vehicle accident. He says that he is fine. He also witnessed the death of a teenage girl in the accident who was his sister’s friend. He is able to return to work within a few days. A month later, he presents being withdrawn and increasingly irritable. He says recently he has been experiencing depressed moods and higher anxiety than usual. He says that he feels guilty about the girl’s death, stating that he could have saved her if only he had acted quicker. He adds that he became extremely anxious while driving by a car accident on the freeway recently, and that, even when watching television or a movie, he feels panicked during a car crash scene. Which of the following is the most likely diagnosis in this patient?

A 20-year-old man comes to the physician because of decreasing academic performance at his college for the past 6 months. He reports a persistent fear of “catching germs” from his fellow students and of contracting a deadly disease. He finds it increasingly difficult to attend classes. He avoids handshakes and close contact with other people. He states that when he tries to think of something else, the fears “keep returning” and that he has to wash himself for at least an hour when he returns home after going outside. Afterwards he cleans the shower and has to apply disinfectant to his body and to the bathroom. He does not drink alcohol. He used to smoke cannabis but stopped one year ago. His vital signs are within normal limits. He appears anxious. On mental status examination, he is oriented to person, place, and time. In addition to starting an SSRI, which of the following is the most appropriate next step in management?

An 8-year-old male presents to his pediatrician with dry, cracking skin on his hands. His mother states that this problem has been getting progressively worse over the past couple of months. During this time period, she has noticed that he also has become increasingly concerned with dirtiness. He tearfully admits to washing his hands many times a day because "everything has germs." When asked what happens if he doesn't wash them, he responds that he just feels very worried until he does. With which other condition is this disorder associated?

A mother brings her 7-year-old son to the pediatrician because she is worried about his sleep. She reports that the child has repeatedly woken up in the middle of the night screaming and thrashing. Although she tries to reassure the child, he does not respond to her or acknowledge her presence. Soon after she arrives, he stops screaming and appears confused and lethargic before falling back asleep. When asked about these events, the child reports that he cannot recall ever waking up or having any bad dreams. These events typically occur within four hours of the child going to sleep. The child’s past medical history is notable for asthma and type I diabetes mellitus. He uses albuterol and long-acting insulin. There have been no recent changes in this patient’s medication regimen. His family history is notable for obesity and obstructive sleep apnea in his father. Physical examination reveals a healthy male at the 40th and 45th percentiles for height and weight, respectively. Which of the following EEG waveforms is most strongly associated with this patient’s condition?

A 23-year-old man comes to the emergency department with palpitations, sweating, and shortness of breath that began 10 minutes ago. He says, “Please help me, I don't want to die.” He has experienced several similar episodes over the past 2 months, which occurred without warning in situations including open spaces or crowds and resolved gradually after 5 to 10 minutes. He has been staying at home as much as possible out of fear of triggering another episode. He has no history of serious illness and takes no medications. He drinks 3 bottles of beer daily. He appears anxious and has a flushed face. His pulse is 104/min, respirations are 12/min, and blood pressure is 135/82 mm Hg. Cardiopulmonary examination shows no abnormalities. An ECG shows sinus tachycardia. Which of the following is the most appropriate initial step in management?

A 7-year-old boy is brought to the physician by his mother for the evaluation of abdominal pain and trouble sleeping for the past 6 months. His mother says he complains of crampy abdominal pain every morning on school days. He started attending a new school 7 months ago and she is concerned because he has missed school frequently due to the abdominal pain. He also has trouble falling asleep at night and asks to sleep in the same room with his parents every night. He has not had fever, vomiting, diarrhea, or weight loss. He sits very close to his mother and starts to cry when she steps out of the room to take a phone call. Abdominal examination shows no abnormalities. Which of the following is the most likely diagnosis?