Anxiety Practice Questions

Question 1

A 23-year-old man presents to the emergency department with a chief complaint of being assaulted on the street. The patient claims that he has been followed by the government for quite some time and that he was assaulted by a government agent but was able to escape. He often hears voices telling him to hide. The patient has an unknown past medical history and admits to smoking marijuana frequently. On physical exam, the patient has no signs of trauma. When interviewing the patient, he is seen conversing with an external party that is not apparent to you. The patient states that he is afraid for his life and that agents are currently pursuing him. What is the best initial response to this patient’s statement?

Accepted Answer

It sounds like you have been going through some tough experiences lately.

Answer

I think you are safe from the agents here.

Answer

You have a mental disorder but don’t worry we will help you.

Answer

I don’t think any agents are pursuing you.

Answer

What medications are you currently taking?

Question 2

A 48-year-old woman is brought to the emergency department by her family at her psychiatrist's recommendation. According to her family, she has been more restless than her baseline over the past week. The patient herself complains that she feels her mind is racing. Her past medical history is significant for bipolar disorder on lithium and type 1 diabetes mellitus. The family and the patient both assert that the patient has been taking her medications. She denies any recent illness or sick contacts. The patient's temperature is 100°F (37.8°C), blood pressure is 100/60 mmHg, pulse is 130/min, and respirations are 20/min. She appears diaphoretic, and her cardiac exam is notable for an irregularly irregular rhythm with a 2/6 early systolic murmur. Blood counts and metabolic panel are within normal limits. The patient's lithium level is within therapeutic range. Which of the following laboratory tests would be the most useful to include in the evaluation of this patient?

Accepted Answer

Thyroid stimulating hormone and free thyroxine levels

Answer

Thyroglobulin level

Answer

Thyroid stimulating hormone and total thyroxine levels

Answer

Thyrotropin-releasing hormone stimulation test

Answer

Triiodothyronine and thyroxine levels

Question 3

An 18-year-old man presents to the student health department at his university for recurrent palpitations. The patient had previously presented to the emergency department (ED) for sudden onset palpitations five months ago when he first started college. He had a negative cardiac workup in the ED and he was discharged with a 24-hour Holter monitor which was also negative. He has no history of any medical or psychiatric illnesses. The patient reports that since his initial ED visit, he has had several episodes of unprovoked palpitations associated with feelings of dread and lightheadedness though he cannot identify a particular trigger. Recently, he has begun sitting towards the back of the lecture halls so that he can “quickly escape and not make a scene” in case he gets an episode in class. Which of the following is the most likely diagnosis?

Accepted Answer

Panic disorder

Answer

Social phobia

Answer

Specific phobia

Answer

Adjustment disorder

Answer

Somatic symptom disorder

Question 4

An epidemiologist is evaluating the efficacy of Noxbinle in preventing HCC deaths at the population level. A clinical trial shows that over 5 years, the mortality rate from HCC was 25% in the control group and 15% in patients treated with Noxbinle 100 mg daily. Based on this data, how many patients need to be treated with Noxbinle 100 mg to prevent, on average, one death from HCC?

Accepted Answer

10

Answer

20

Answer

73

Answer

50

Answer

100

Question 5

A 33-year-old woman presents with lethargy and neck pain. She says that, for the past 6 months, she has been feeling tired all the time and has noticed a lot of muscle tension around the base of her neck. She also says she finds herself constantly worrying about everything, such as if her registered mail would reach family and friends in time for the holidays or if the children got their nightly bath while she was away over the weekend. She says that this worrying has prevented her from sleeping at night and has made her more irritable and edgy with her family and friends. Which of the following is the best course of treatment for this patient?

Accepted Answer

Buspirone

Answer

Support groups

Answer

A vacation

Answer

Diazepam

Answer

Family therapy

Question 6

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?

Accepted Answer

Cognitive behavioral therapy

Answer

Dialectical behavioral therapy

Answer

Venlafaxine therapy

Answer

Motivational interviewing

Answer

Prazosin therapy

Question 7

A 30-year-old woman presents to her family doctor requesting sleeping pills. She is a graduate student and confesses that she is a “worry-a-holic,” which has been getting worse for the last 6 months as the due date for her final paper is approaching. During this time, she feels more on edge, irritable, and is having difficulty sleeping. She has already tried employing good sleep hygiene practices, including a switch to non-caffeinated coffee. Her past medical history is significant for depression in the past that was managed medically. No current medications. The patient’s family history is significant for her mother who has a panic disorder. Her vital signs are within normal limits. Physical examination reveals a mildly anxious patient but is otherwise normal. Which of the following is the most effective treatment for this patient’s condition?

Accepted Answer

Buspirone

Answer

Diazepam

Answer

Desensitization therapy

Answer

Relaxation training

Answer

Bupropion

Question 8

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?

Accepted Answer

Post-traumatic stress disorder

Answer

Panic disorder

Answer

Generalized anxiety disorder

Answer

Adjustment disorder

Answer

Acute stress disorder

Question 9

A previously healthy 36-year-old man is brought to the physician by a friend because of fatigue and a depressed mood for the past few weeks. During this time, he has not been going to work and did not show up to meet his friends for two bowling nights. The friend is concerned that he may lose his job. He spends most of his time alone at home watching television on the couch. He has been waking up often at night and sometimes takes 20 minutes to go back to sleep. He has also been drinking half a pint of whiskey per day for 1 week. His wife left him 4 weeks ago and moved out of their house. His vital signs are within normal limits. On mental status examination, he is oriented to person, place and time. He displays a flattened affect and says that he “doesn't know how he can live without his wife.” He denies suicidal ideation. Which of the following is the next appropriate step in management?

Accepted Answer

Initiate cognitive behavioral therapy

Answer

Prescribe a short course of alprazolam

Answer

Hospitalize the patient

Answer

Initiate disulfiram therapy

Answer

Prescribe a short course of duloxetine

Question 10

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?

Accepted Answer

Cognitive behavioral therapy

Answer

Lorazepam

Answer

Risperidone

Answer

Clomipramine

Answer

Fluoxetine

Anxiety

Study Resources

Lessons

Questions

Flashcards

Lessons

Generalized anxiety disorder

Panic disorder

Specific phobias

Social anxiety disorder

Separation anxiety disorder

Agoraphobia

Neurobiological basis of anxiety

Cognitive-behavioral therapy for anxiety

Pharmacotherapy for anxiety disorders

Anxiety in medical conditions

Anxiety in children and adolescents

Alternative treatments for anxiety

Anxiety disorder differential diagnosis

Practice Questions

Flashcards

About Anxiety for USMLE

Lessons in Anxiety

Master Anxiety