Anxiety Disorders Practice Questions

Q: A 25-year-old female presents with chest pain, sweating, restlessness, dyspnea, and palpitations. Initial investigations including enzyme analysis and X-ray are normal. Her symptoms resolve with supportive measures. What is the most probable diagnosis?

Panic attack. ### Explanation **Correct Option: A. Panic attack** The clinical presentation describes a classic **Panic Attack**. It is characterized by a sudden onset of intense fear or discomfort reaching a peak within minutes, accompanied by at least four somatic or cognitive symptoms (e.g., palpitations, sweating, dyspnea, chest pain, and fear of dying). In this case, the patient is young (25 years), and the **normal investigations** (cardiac enzymes and X-ray) rule out acute organic causes like myocardial infarction. The spontaneous resolution with supportive measures is a hallmark of the self-limiting nature of panic episodes. **Why other options are incorrect:** * **B. Autonomic nervous system instability:** This is a broad, non-specific physiological state rather than a clinical diagnosis. While panic attacks involve autonomic arousal, "instability" does not define this specific episodic presentation. * **C. Angina pectoris:** While chest pain and dyspnea occur, angina is typically related to exertion and would not explain the rapid resolution with supportive measures in a 25-year-old with normal enzymes. * **D. Vasovagal attack:** This usually presents with bradycardia and hypotension leading to **syncope** (fainting). In contrast, panic attacks involve sympathetic overactivity (tachycardia and hypertension) without loss of consciousness. **NEET-PG High-Yield Pearls:** * **Diagnosis:** Panic Disorder requires recurrent, unexpected panic attacks followed by ≥1 month of persistent concern about future attacks or behavioral changes. * **Acute Management:** Benzodiazepines (e.g., Alprazolam or Lorazepam). * **Long-term Treatment (DOC):** Selective Serotonin Reuptake Inhibitors (SSRIs) + Cognitive Behavioral Therapy (CBT). * **Rule Out:** Always exclude hyperthyroidism, pheochromocytoma, and caffeine intoxication in such patients.

Q: A 23-year-old medical student complains of feeling 'worried.' He fears failing his clinical exam because he feels nervous about presenting a case and performing a physical examination in front of examiners. He would skip bedside teaching when it would be his turn to present a case in front of his classmates and tutors. He worries about criticism from his classmates and tutor. What is the most likely diagnosis?

Social phobia. **Explanation:** The clinical presentation is classic for **Social Phobia (Social Anxiety Disorder)**. The core feature is a marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible **scrutiny by others**. In this case, the student fears being judged or criticized by examiners and peers, leading to significant **avoidance behavior** (skipping bedside teaching). **Why the other options are incorrect:** * **Normal shyness:** Unlike shyness, Social Phobia involves significant functional impairment (avoiding classes) and intense distress that interferes with the individual’s academic or social life. * **Panic Disorder:** Characterized by recurrent, unexpected panic attacks and persistent worry about having *future* attacks. While this student may feel "nervous," the anxiety is specifically triggered by social evaluation, not spontaneous physiological surges. * **Generalized Anxiety Disorder (GAD):** GAD involves "free-floating" anxiety about various everyday events (finances, health, family) for at least 6 months. Here, the anxiety is situational and specific to performance. **High-Yield Clinical Pearls for NEET-PG:** * **Treatment of Choice:** **SSRIs** (e.g., Paroxetine, Sertraline) are the first-line long-term treatment. * **Performance Anxiety:** For specific situations (like a stage performance or exam), **Beta-blockers** (e.g., Propranolol) are used 30–60 minutes before the event to control peripheral sympathetic symptoms (tremors, palpitations). * **Cognitive Behavioral Therapy (CBT):** This is the most effective psychological intervention, focusing on social skills training and exposure.

Q: A 25-year-old woman presents to the emergency department with a fear of dying, experiencing chest pain, a sensation of choking, nausea, and tingling sensations up and down her arms. On examination, her face is flushed and sweating, with a pulse of 140/min and respirations of 25/min. Fifteen minutes later, her symptoms are dissipating, with a pulse of 100/min and respirations of 20/min. The ECG is normal except for some residual tachycardia. Which of the following is the most likely diagnosis?

Panic attack. **Explanation:** The clinical presentation is a classic case of a **Panic Attack**. A panic attack is characterized by an abrupt surge of intense fear or discomfort that reaches a peak within minutes. According to DSM-5 criteria, it involves at least four physical or cognitive symptoms, such as palpitations (tachycardia), sweating, trembling, sensations of shortness of breath (choking), chest pain, nausea, and paresthesia (tingling sensations). The key diagnostic clue here is the **rapid onset and spontaneous resolution** of symptoms within 15–20 minutes, coupled with a normal ECG. This "crescendo-decrescendo" pattern of autonomic hyperactivity in a young patient without underlying cardiac risk factors strongly points toward a psychiatric etiology rather than a vascular one. **Why other options are incorrect:** * **Angina/Myocardial Infarction:** While chest pain and tachycardia occur, these conditions typically do not resolve spontaneously within 15 minutes with a completely normal ECG. Furthermore, the multisystem involvement (choking, nausea, tingling, flushing) is more characteristic of a panic response. * **Heartburn:** While it can cause chest discomfort and nausea, it does not typically present with profound sympathetic arousal (pulse 140/min), tingling in extremities, or an intense fear of dying. **High-Yield Clinical Pearls for NEET-PG:** * **Acute Management:** Benzodiazepines (e.g., Alprazolam or Lorazepam) are used for immediate relief. * **Long-term Treatment (Panic Disorder):** SSRIs (Selective Serotonin Reuptake Inhibitors) are the first-line pharmacological treatment. * **Cognitive Behavioral Therapy (CBT):** The most effective non-pharmacological intervention. * **Differential Diagnosis:** Always rule out hyperthyroidism, pheochromocytoma, and hypoglycemia in patients presenting with recurrent panic-like symptoms.

Q: A patient presents to the emergency department with a feeling of impending doom, intense anxiety, and palpitations. Which of the following investigations should NOT be performed on an emergency basis?

Hemoglobin levels. **Explanation:** The patient is presenting with classic symptoms of a **Panic Attack**, characterized by autonomic hyperactivity (palpitations) and psychological distress (impending doom). In an emergency setting, the priority is to rule out life-threatening medical mimics that present with similar acute symptoms. **Why Hemoglobin levels is the correct answer:** While chronic anemia can cause palpitations and tachycardia, it is a **non-emergent investigation** in the context of an acute anxiety episode. Hemoglobin levels do not help in the immediate differential diagnosis of a sudden-onset panic attack or acute cardiac event, making it the least relevant test to perform on an emergency basis. **Analysis of Incorrect Options:** * **ECG:** This is the **most critical** initial investigation to rule out myocardial infarction or arrhythmias (e.g., SVT), which can mimic panic disorder. * **Glucose levels:** Hypoglycemia is a common "medical mimic" of anxiety, presenting with tremors, palpitations, and intense anxiety. It must be ruled out immediately via a finger-stick or lab test. * **Thyroid Function Tests (TFTs):** Hyperthyroidism (Thyrotoxicosis) can cause acute palpitations and anxiety. While usually more subacute, it is a standard part of the initial workup for new-onset anxiety symptoms to rule out an organic cause. **NEET-PG High-Yield Pearls:** * **Diagnosis of Exclusion:** Always rule out organic causes (Cardiac, Endocrine, Respiratory) before diagnosing Panic Disorder. * **Drug of Choice (Acute):** Benzodiazepines (e.g., Alprazolam or Lorazepam) for immediate relief. * **Drug of Choice (Maintenance):** SSRIs (e.g., Paroxetine, Sertraline) are the first-line long-term treatment. * **Common Mimics:** Pheochromocytoma, Hypoglycemia, Hyperthyroidism, and SVT.

Q: Fear of open spaces is:

Agoraphobia. **Explanation:** **Agoraphobia (Option A)** is the correct answer. Derived from the Greek word *agora* (marketplace), it is defined as a marked fear or anxiety about being in situations where escape might be difficult or help might not be available in the event of developing panic-like symptoms. While commonly simplified as a "fear of open spaces," the DSM-5 criteria specifically include fears of using public transportation, being in open spaces (e.g., parking lots, bridges), being in enclosed places (e.g., shops, cinemas), standing in line/crowds, or being outside of the home alone. **Analysis of Incorrect Options:** * **Acrophobia (Option B):** The specific pathological fear of **heights**. * **Claustrophobia (Option C):** The fear of **enclosed or confined spaces** (the opposite of the literal definition of agoraphobia). * **Algophobia (Option D):** The morbid fear of **pain**. **NEET-PG High-Yield Pearls:** 1. **Comorbidity:** Agoraphobia is frequently associated with **Panic Disorder**. In DSM-IV, they were linked; however, in **DSM-5**, Agoraphobia is now a **standalone diagnosis** regardless of the presence of panic attacks. 2. **Duration:** For a diagnosis, symptoms must typically persist for **6 months or more**. 3. **Treatment:** The gold standard is a combination of **Pharmacotherapy** (SSRIs are first-line) and **Cognitive Behavioral Therapy (CBT)**, specifically utilizing **systematic desensitization** or exposure therapy. 4. **Demographics:** It is more common in females than males (approx. 2:1 ratio).

Question 1

What is the definition of agoraphobia?

Accepted Answer

Fear of situations where escape might be difficult or help unavailable if panic-like symptoms occur

Answer

Fear of heights

Answer

Fear of animals

Answer

Fear of enclosed spaces

Question 2

A 25-year-old female presents with chest pain, sweating, restlessness, dyspnea, and palpitations. Initial investigations including enzyme analysis and X-ray are normal. Her symptoms resolve with supportive measures. What is the most probable diagnosis?

Accepted Answer

Panic attack

Answer

Autonomic nervous system instability

Answer

Angina pectoris

Answer

Vasovagal attack

Question 3

Which of the following conditions should be considered in the differential diagnosis of panic disorder?

Accepted Answer

Pheochromocytoma, myocardial infarction, mitral valve prolapse, and carcinoid syndrome

Answer

Pheochromocytoma, myocardial infarction, mitral valve prolapse, depression, and carcinoid syndrome

Answer

Pheochromocytoma, myocardial infarction, and mitral valve prolapse

Answer

Pheochromocytoma, mitral valve prolapse, depression, and carcinoid syndrome

Question 4

A 23-year-old medical student complains of feeling 'worried.' He fears failing his clinical exam because he feels nervous about presenting a case and performing a physical examination in front of examiners. He would skip bedside teaching when it would be his turn to present a case in front of his classmates and tutors. He worries about criticism from his classmates and tutor. What is the most likely diagnosis?

Accepted Answer

Social phobia

Answer

Normal shyness

Answer

Panic disorder

Answer

Generalized anxiety disorder

Question 5

Which of the following is the most appropriate treatment for panic disorder?

Accepted Answer

Short-term benzodiazepine plus SSRI plus CBT

Answer

Buspirone plus benzodiazepines

Answer

Benzodiazepines plus supportive therapy

Answer

Long-term benzodiazepine plus venlafaxine

Question 6

A 25-year-old woman presents to the emergency department with a fear of dying, experiencing chest pain, a sensation of choking, nausea, and tingling sensations up and down her arms. On examination, her face is flushed and sweating, with a pulse of 140/min and respirations of 25/min. Fifteen minutes later, her symptoms are dissipating, with a pulse of 100/min and respirations of 20/min. The ECG is normal except for some residual tachycardia. Which of the following is the most likely diagnosis?

Accepted Answer

Panic attack

Answer

Angina

Answer

Heartburn

Answer

Myocardial infarction

Question 7

A patient presents to the emergency department with a feeling of impending doom, intense anxiety, and palpitations. Which of the following investigations should NOT be performed on an emergency basis?

Accepted Answer

Hemoglobin levels

Answer

Thyroid function tests (T3, T4, TSH)

Answer

Glucose levels

Answer

Electrocardiogram (ECG)

Question 8

Agoraphobia is commonly associated with which of the following conditions?

Accepted Answer

Panic disorder

Answer

Schizophrenia

Answer

Bipolar disorder

Answer

Obsessive-compulsive disorder

Question 9

Generalised anxiety disorder is characterized by which of the following?

Accepted Answer

Anxiety about specific situations

Answer

Free-floating anxiety

Answer

Worry about trivial issues

Answer

Inability to relax

Question 10

Fear of open spaces is:

Accepted Answer

Agoraphobia

Answer

Acrophobia

Answer

Claustrophobia

Answer

Algophobia

Anxiety Disorders — MCQs

Anxiety Disorders — MCQs

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