Anxiety Disorders Practice Questions

Q: A 16-year-old boy avoids school due to the fear of being harmed by classmates. He believes his classmates laugh at and talk about him, and he is afraid to go to the market. What is he most likely suffering from?

Social phobia. ### Explanation **Correct Option: D. Social Phobia (Social Anxiety Disorder)** The core feature of Social Phobia is a marked and persistent fear of social or performance situations in which the individual is exposed to unfamiliar people or to **possible scrutiny by others**. The patient fears that he will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing. In this case, the boy’s fear of being laughed at or talked about by classmates and his avoidance of public places like the market are classic indicators of social evaluative anxiety. **Why Incorrect Options are Wrong:** * **A. Anxiety Neurosis:** This is an archaic term formerly used to describe generalized anxiety or panic states. It lacks the specific focus on social scrutiny and embarrassment seen in this clinical vignette. * **B. Manic Depressive Psychosis (Bipolar Disorder):** This involves distinct episodes of mania (elevated mood, hyperactivity) and depression. The patient’s symptoms here are focused on social avoidance and fear, not mood cycling. * **C. Adjustment Disorder:** This occurs in response to an identifiable stressor (e.g., divorce, job loss) within 3 months of the stressor. The symptoms here are more characteristic of a primary anxiety disorder rather than a maladaptive reaction to a specific life change. **Clinical Pearls for NEET-PG:** * **Age of Onset:** Social phobia typically has an early onset, often during mid-adolescence (around age 13-16). * **Physical Symptoms:** Often accompanied by blushing (erythrophobia), sweating, or trembling in social situations. * **Treatment of Choice:** **SSRIs** (e.g., Paroxetine, Sertraline) are the first-line pharmacological treatment. **Cognitive Behavioral Therapy (CBT)** is the preferred psychological intervention. * **Performance Anxiety:** For specific situations (like public speaking), **Beta-blockers** (Propranolol) can be used 30–60 minutes before the event.

Q: A 23-year-old female patient presents with a feeling of being unable to catch her breath, light-headedness, and "tingling" of her fingers, toes, and around her mouth. This symptom occurs whenever she drives through a tunnel, and this situation triggered the current episode. Which of the following arterial blood pH values would be most consistent with her diagnosis?

7.55. **Explanation:** The clinical presentation describes a **Panic Attack** triggered by a specific phobic stimulus (tunnels). The hallmark of a panic attack is **hyperventilation**, which leads to an excessive "washout" of carbon dioxide ($CO_2$). **1. Why 7.55 is Correct:** Hyperventilation causes **Respiratory Alkalosis**. As $CO_2$ (an acid) decreases, the blood pH rises above the normal range (7.35–7.45). A pH of **7.55** represents a moderate alkalotic state consistent with acute hyperventilation. The "tingling" (paresthesia) and light-headedness occur because alkalosis causes a shift in ionized calcium, leading to transient hypocalcemia and increased neuromuscular excitability. **2. Why the Incorrect Options are Wrong:** * **A (8.1):** This value is physiologically incompatible with life. The human body rarely survives a pH above 7.8. * **C (7.15):** This indicates **Acidosis** (e.g., diabetic ketoacidosis or respiratory failure). Panic attacks cause the pH to rise, not fall. * **D (6.4):** This is extreme acidosis and is incompatible with life. **3. NEET-PG High-Yield Pearls:** * **Mechanism:** Hyperventilation $\rightarrow \downarrow PCO_2$ (Hypocapnia) $\rightarrow \uparrow$ pH (Alkalosis). * **Calcium Link:** Alkalosis increases the binding of calcium to albumin, decreasing **ionized calcium** ($iCa^{2+}$). This causes the classic symptoms of tetany, carpopedal spasm, and perioral numbness. * **Acute Management:** Reassurance and breathing into a paper bag (to re-breathe $CO_2$) were traditional; however, the current gold standard is "calm breathing" techniques and Benzodiazepines (e.g., Alprazolam/Lorazepam) for acute episodes. * **Long-term Treatment:** SSRIs (e.g., Sertraline, Escitalopram) are the first-line pharmacological treatment for Panic Disorder.

Q: A 41-year-old female patient presents to the emergency department with complaints of flurries, palpitations, profuse sweating, and a sense of impending doom. Which of the following tests should be done in the emergency to rule out organic causes?

ECG. **Explanation:** The patient is presenting with symptoms suggestive of a **Panic Attack**, characterized by autonomic hyperactivity (palpitations, sweating) and psychological distress (sense of impending doom). However, in an emergency setting, a psychiatric diagnosis is always a diagnosis of exclusion. **1. Why ECG is the Correct Answer:** The primary clinical priority is to rule out life-threatening organic mimics, most importantly **Acute Coronary Syndrome (ACS)** or cardiac arrhythmias. Symptoms like palpitations and a sense of impending doom (*angor animi*) are classic presentations of myocardial infarction. An **ECG** is the most rapid, non-invasive, and essential bedside test to rule out cardiac emergencies before attributing the symptoms to an anxiety disorder. **2. Why Other Options are Incorrect:** * **Blood Sugar Level:** While hypoglycemia can cause palpitations and sweating, it is less likely to present with a specific "sense of impending doom" compared to cardiac events. It is a secondary consideration. * **T3/T4/TSH:** Hyperthyroidism is a common differential for chronic anxiety, but thyroid function tests are not emergency bedside investigations. They are part of the long-term workup, not the acute stabilization phase. * **Hemoglobin:** Anemia can cause tachycardia, but it rarely presents as an acute "attack" or "flurry" of symptoms. **Clinical Pearls for NEET-PG:** * **Rule of Thumb:** In psychiatry, always rule out "Organic" before "Functional." * **Panic Disorder Criteria:** Recurrent unexpected panic attacks followed by ≥1 month of persistent concern about future attacks. * **Drug of Choice (Acute Attack):** Benzodiazepines (e.g., Alprazolam, Lorazepam). * **Drug of Choice (Maintenance):** SSRIs (e.g., Sertraline, Paroxetine). * **Common Organic Mimics:** Pheochromocytoma, Hyperthyroidism, Hypoglycemia, and Arrhythmias.

Q: Which of the following is NOT associated with panic disorder?

Glutamate. **Explanation:** Panic disorder is characterized by recurrent, unexpected panic attacks involving a complex interplay of various neurotransmitter systems. **Why Glutamate is the Correct Answer:** While **Glutamate** is the primary excitatory neurotransmitter in the brain and is heavily implicated in conditions like Schizophrenia (NMDA receptor dysfunction) and neurodegenerative diseases, it is **not** traditionally considered a primary mediator in the acute pathophysiology of Panic Disorder. Current evidence focuses more on the dysregulation of the autonomic nervous system and specific inhibitory/excitatory imbalances involving other amines and peptides. **Analysis of Incorrect Options:** * **Serotonin (5-HT):** Serotonergic dysregulation in the raphe nuclei is a hallmark of panic disorder. This is why SSRIs (Selective Serotonin Reuptake Inhibitors) are the first-line long-term treatment. * **GABA:** GABA is the brain's primary inhibitory neurotransmitter. Patients with panic disorder often have reduced GABA receptor sensitivity. Benzodiazepines, which enhance GABAergic tone, are effective in providing acute relief from panic symptoms. * **Cholecystokinin (CCK):** CCK is a neuropeptide that acts as a potent **panicogen**. Administration of CCK (specifically CCK-4) can induce a full-blown panic attack in susceptible individuals, making it a key molecule in panic disorder research. **NEET-PG High-Yield Pearls:** * **Locus Coeruleus:** The primary brain region involved in panic attacks (source of Norepinephrine). * **First-line Treatment:** SSRIs (e.g., Sertraline, Escitalopram). * **Acute Attack Management:** Benzodiazepines (e.g., Alprazolam, Clonazepam). * **Panicogens:** Substances that can trigger attacks include **CO2 inhalation**, Sodium Lactate, Caffeine, and CCK.

Q: Common symptoms of panic attacks include all of the following except?

Suicidal thoughts. **Explanation:** A **Panic Attack** is characterized by a discrete period of intense fear or discomfort, reaching a peak within 10 minutes, accompanied by at least four somatic or cognitive symptoms. **Why "Suicidal thoughts" is the correct answer:** While panic disorder is associated with an increased long-term risk of suicide, **suicidal ideation is not a diagnostic symptom of an acute panic attack**. Panic attacks are characterized by an intense "fight-or-flight" response where the patient typically experiences an overwhelming urge to escape or survive, rather than a desire to end their life. **Why other options are incorrect:** * **Fear of dying (Option A):** This is a hallmark cognitive symptom of a panic attack. Patients often interpret physical symptoms (like chest pain) as an impending catastrophic event, such as a heart attack. * **Fear of losing control (Option B) & Fear of going crazy (Option C):** These are the other two core cognitive symptoms defined in the DSM-5/ICD-11 criteria. They represent the psychological distress caused by the sudden, unexplained autonomic hyperactivity. **High-Yield Clinical Pearls for NEET-PG:** * **Physical Symptoms:** Palpitations, sweating, trembling, dyspnea, choking sensation, chest pain, nausea, dizziness, chills/heat sensations, and paresthesias. * **Diagnostic Criteria:** Panic Disorder requires recurrent *unexpected* attacks followed by at least one month of persistent concern about future attacks or maladaptive behavioral changes. * **Treatment of Choice:** * **Acute attack:** Benzodiazepines (e.g., Alprazolam, Lorazepam). * **Maintenance/Prophylaxis:** SSRIs (First-line) and Cognitive Behavioral Therapy (CBT). * **Differential:** Always rule out medical causes like hyperthyroidism, pheochromocytoma, and hypoglycemia.

Q: Free-floating persistent anxiety and excessive worry are characteristic features of which of the following conditions?

Generalized anxiety disorder. **Explanation:** The correct answer is **Generalized Anxiety Disorder (GAD)**. **1. Why GAD is correct:** Generalized Anxiety Disorder is characterized by **"free-floating anxiety,"** which refers to a persistent, pervasive, and generalized sense of apprehension that is not restricted to any particular environmental circumstances. According to ICD-10 and DSM-5 criteria, the core feature is **excessive worry** (apprehensive expectation) occurring more days than not for at least **6 months**, about a number of events or activities (such as work or school performance). Patients often experience physical symptoms like muscle tension, restlessness, and sleep disturbances. **2. Why the other options are incorrect:** * **Obsessive Compulsive Disorder (OCD):** Characterized by intrusive, repetitive thoughts (obsessions) and ritualistic behaviors (compulsions) performed to reduce distress, rather than generalized worry. * **Schizotypal Disorder:** A personality disorder (or part of the schizophrenia spectrum) characterized by eccentric behavior, odd beliefs, and social anxiety related to paranoid fears rather than generalized worry. * **Panic Disorder:** Characterized by recurrent, unexpected **Panic Attacks**—discrete periods of intense fear with sudden onset. Between attacks, the anxiety is usually focused on the fear of having another attack (anticipatory anxiety), not "free-floating" worry. **Clinical Pearls for NEET-PG:** * **Duration:** GAD requires symptoms for at least **6 months** (DSM-5/ICD-10). * **First-line Treatment:** SSRIs (Selective Serotonin Reuptake Inhibitors) are the gold standard for long-term management. * **Acute Management:** Benzodiazepines can be used for short-term symptomatic relief but carry a risk of dependence. * **Psychotherapy:** Cognitive Behavioral Therapy (CBT) is the most effective non-pharmacological intervention.

Q: Which of the following situations is most specific of a panic disorder?

Panic attack upon waking from sleep. To diagnose **Panic Disorder**, the core clinical requirement is the presence of **recurrent, unexpected (uncued)** panic attacks. ### Why Option D is Correct **Panic attack upon waking from sleep** (also known as **Nocturnal Panic Attacks**) is highly specific to Panic Disorder. These attacks occur without an obvious external trigger or situational cue. Since they often happen during the transition from late Stage 2 to Stage 3 (NREM) sleep, they are considered "out of the blue." In the context of the DSM-5 criteria, an "unexpected" attack is the hallmark of Panic Disorder, distinguishing it from other anxiety disorders where attacks are usually "cued" by specific stressors. ### Why Other Options are Incorrect * **Options A, B, and C** (Funeral, Interview, Exam) describe **"cued" or "situationally bound"** panic attacks. * **Funeral:** May be related to acute grief or post-traumatic stress. * **Interview/Exam:** These are classic triggers for **Social Anxiety Disorder** or **Performance Anxiety**. * While a person with Panic Disorder *can* have attacks in these settings, these situations are not *specific* to the diagnosis because the attacks are predictable responses to stressful stimuli. ### NEET-PG High-Yield Pearls * **Definition:** Panic Disorder requires at least one month of persistent concern about future attacks or a significant maladaptive change in behavior (e.g., avoidance). * **Nocturnal Panic:** Occurs in about 20-40% of patients with Panic Disorder. It is **not** associated with nightmares (which occur in REM sleep). * **Medical Mimics:** Always rule out Pheochromocytoma, Hyperthyroidism, and Arrhythmias (MVP is often associated). * **Treatment of Choice:** * **Acute attack:** Benzodiazepines (e.g., Alprazolam). * **Long-term/Maintenance:** SSRIs (First-line) + Cognitive Behavioral Therapy (CBT).

Question 1

A 16-year-old boy avoids school due to the fear of being harmed by classmates. He believes his classmates laugh at and talk about him, and he is afraid to go to the market. What is he most likely suffering from?

Accepted Answer

Social phobia

Answer

Anxiety neurosis

Answer

Manic depressive psychosis

Answer

Adjustment disorder

Question 2

A 23-year-old female patient presents with a feeling of being unable to catch her breath, light-headedness, and "tingling" of her fingers, toes, and around her mouth. This symptom occurs whenever she drives through a tunnel, and this situation triggered the current episode. Which of the following arterial blood pH values would be most consistent with her diagnosis?

Accepted Answer

7.55

Answer

8.1

Answer

7.15

Answer

6.4

Question 3

A 41-year-old female patient presents to the emergency department with complaints of flurries, palpitations, profuse sweating, and a sense of impending doom. Which of the following tests should be done in the emergency to rule out organic causes?

Accepted Answer

ECG

Answer

Hemoglobin

Answer

Blood sugar level

Answer

T3/T4/TSH

Question 4

What is the commonest type of phobia encountered in clinical practice?

Accepted Answer

Agoraphobia

Answer

Social phobia

Answer

Simple phobia

Answer

Claustrophobia

Question 5

Which of the following defense mechanisms is seen in phobia?

Accepted Answer

Displacement

Answer

Reaction formation

Answer

Dissociation

Answer

Regression

Question 6

Which of the following is NOT associated with panic disorder?

Accepted Answer

Glutamate

Answer

Serotonin

Answer

GABA

Answer

Cholecystokinin (CCK)

Question 7

A 34-year-old female presents with complaints of 'always feeling worried.' She reports that she always feels anxious and irritable, and her sleep is gradually worsening. What is the likely diagnosis?

Accepted Answer

Generalized anxiety disorder

Answer

Agoraphobia

Answer

Major depression

Answer

Dysthymia

Question 8

Common symptoms of panic attacks include all of the following except?

Accepted Answer

Suicidal thoughts

Answer

Fear of dying

Answer

Fear of losing control

Answer

Fear of going crazy

Question 9

Free-floating persistent anxiety and excessive worry are characteristic features of which of the following conditions?

Accepted Answer

Generalized anxiety disorder

Answer

Obsessive compulsive disorder

Answer

Schizotypal disorder

Answer

Panic disorder

Question 10

Which of the following situations is most specific of a panic disorder?

Accepted Answer

Panic attack upon waking from sleep

Answer

Panic attack during a funeral

Answer

Panic attack before an interview

Answer

Panic attack during an exam

Anxiety Disorders — MCQs

Anxiety Disorders — MCQs

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