Anxiety Disorders (GAD, Panic, Phobias, PTSD) MCQs

Psychiatry · 36 free questions with answers & explanations.

1. A 38-year-old woman presents with recurrent unexpected episodes of intense fear accompanied by palpitations, chest tightness, shortness of breath, dizziness, and a sense of impending doom, each lasting about 10 minutes. A thorough cardiac and neurological work-up is normal. She now avoids public transport fearing an episode away from help. What is the first-line pharmacological treatment for her primary diagnosis?
2. A 42-year-old combat veteran reports six months of intrusive flashbacks of battlefield trauma, nightmares, hypervigilance, exaggerated startle response, and avoidance of any reminders of his service. He feels emotionally numb and estranged from his family. Which criterion set below is required to diagnose PTSD under DSM-5-TR?
3. A 50-year-old man presents with six months of excessive, uncontrollable worry about finances, health, and his children's safety occurring on most days. He reports muscle tension, restlessness, fatigue, and difficulty concentrating. He cannot control the worry even when the issues are minor. What is the minimum duration of symptoms required for a DSM-5-TR diagnosis of generalised anxiety disorder?
4. A 27-year-old woman has intense fear of receiving an injection. She experiences immediate fear, dizziness, and often faints when she sees a needle. This pattern also occurs when she watches medical procedures on television. What physiological mechanism uniquely predisposes her to syncope in this specific phobia?
5. A 34-year-old woman experiences marked fear and avoidance of social situations in which she might be scrutinised or embarrassed. She avoids parties, public speaking, and eating in restaurants. Symptoms have been present since adolescence and cause significant occupational limitations. Which of the following distinguishes social anxiety disorder from avoidant personality disorder?
6. A 35-year-old woman with PTSD on sertraline 100 mg/day for 6 months has partial response. She continues to have hyperarousal and nightmares. Which second-line agent is specifically approved/recommended for PTSD nightmares?
7. In DSM-5, PTSD is classified under:
8. A 40-year-old man with panic disorder on paroxetine reports that his panic attacks are well controlled but he remains housebound due to fear of having an attack in public. He avoids malls, buses, and open spaces. The most appropriate adjunct psychotherapy is:
9. In Generalized Anxiety Disorder (GAD), which neurotransmitter imbalance and corresponding mechanism explains the efficacy of pregabalin?
10. A 35-year-old combat veteran reports recurrent intrusive memories, flashbacks of battle scenes, emotional numbing, and hypervigilance for 7 months. He avoids any reminders of war. He also meets full criteria for major depressive disorder. The correct diagnostic approach per DSM-5 is:
11. A 28-year-old woman presents with recurrent episodes of sudden-onset palpitations, chest tightness, paresthesias, derealization, and fear of dying, lasting 10–15 minutes. She has begun avoiding shopping malls and public transport. The first-line pharmacological treatment for her primary condition is:
12. In DSM-5, Generalised Anxiety Disorder (GAD) is distinguished from normal worry primarily by which criterion?
13. Prazosin (an alpha-1 adrenergic blocker) is used in PTSD specifically to treat which symptom cluster?
14. A 35-year-old woman survived a severe motor vehicle accident 6 months ago. She experiences intrusive flashbacks, avoids driving, has persistent negative beliefs about herself ('I am broken'), difficulty experiencing positive emotions, hypervigilance, and sleep disturbance. Which of the following DSM-5 symptom clusters for PTSD is represented by the 'persistent negative alterations in cognition and mood'?
15. A 40-year-old man presents with recurrent episodes of palpitations, shortness of breath, derealization, and fear of dying lasting 10 minutes. Between episodes he worries persistently about having a heart attack. Cardiology workup is normal. He now avoids exercise and crowded places. According to DSM-5 criteria for Panic Disorder, which feature distinguishes this from a simple panic attack?
16. A 30-year-old man with Social Anxiety Disorder (Social Phobia) has failed an adequate SSRI trial. Which is the MOST evidence-based second-line pharmacological treatment?
17. A 50-year-old woman with Generalized Anxiety Disorder (GAD) has failed two SSRIs over 2 years. She is now started on a drug that acts as a 5-HT1A partial agonist and D2 partial agonist, with no sedation or dependence. Which drug is this?
18. A 34-year-old female teacher develops intrusive recollections, nightmares, avoidance of reminders of a road accident, emotional numbing, hypervigilance, and sleep disturbance beginning 3 weeks after the event. Symptoms cause significant occupational impairment. What is the most accurate DSM-5 diagnosis at this time point?
19. DSM-5 moved PTSD from the anxiety disorders category to a new diagnostic class. What is this new category and which disorder shares this classification?
20. A 26-year-old woman experiences recurrent, unexpected panic attacks with palpitations, dyspnea, derealization, and fear of dying. Between attacks she has persistent worry about future attacks for 2 months and avoids shopping malls. What is the pharmacological first-line agent and the minimum treatment duration recommended before assessing non-response?
21. In the cognitive model of GAD (Borkovec; Wells), what metacognitive beliefs distinguish pathological worry from normal worry, and which therapeutic technique directly targets these beliefs?
22. A combat veteran with PTSD is started on a medication targeting hyperarousal symptoms and nightmares. Which agent has the best evidence for reducing trauma-related nightmares via alpha-1 adrenoreceptor blockade in the prefrontal cortex and amygdala?
23. DSM-5 distinguishes Acute Stress Disorder (ASD) from PTSD primarily by which criterion?
24. A 35-year-old woman with Panic Disorder has not responded to an adequate trial of an SSRI. According to current evidence-based pharmacotherapy guidelines, what is the most appropriate next step?
25. Buspirone's anxiolytic mechanism in Generalised Anxiety Disorder is distinct from benzodiazepines because it:
26. A 30-year-old woman with Social Anxiety Disorder (Social Phobia) is unable to tolerate SSRIs due to gastrointestinal side effects. Which alternative FDA-approved pharmacotherapy is most appropriate for long-term management?
27. A 25-year-old presents with episodes of intense fear lasting 10–15 minutes, with palpitations, shortness of breath, paraesthesias, and fear of dying. Medical workup is normal. She now avoids crowded places fearing having an episode. According to DSM-5, which diagnosis best captures the combination of panic attacks AND avoidance behaviour?
28. A 32-year-old combat veteran presents 8 months after returning from active duty. He reports intrusive flashbacks triggered by car backfires, emotional numbing, sleep disturbance, hypervigilance, inability to recall details of the traumatic event, and persistent negative beliefs about himself. He avoids news, TV, and crowds. His symptoms have been present for 6 months. Which DSM-5 cluster of PTSD symptoms does 'emotional numbing and negative cognitions' fall under?
29. A 35-year-old combat veteran has intrusive memories of an ambush, nightmares, emotional numbing, avoidance of crowded places, hypervigilance, and sleep disturbance for 8 months after returning home. Which pharmacotherapy is FDA-approved and recommended as first-line for PTSD?
30. In panic disorder, the cognitive model proposes that panic attacks result from:
31. A 30-year-old woman has recurrent panic attacks and now avoids public transport fearing she cannot escape if she panics. She restricts travel to only accompanied journeys. The MOST effective long-term treatment combining pharmacotherapy and psychotherapy is:
32. In PTSD, the DSM-5 requires four symptom clusters. Which of the following represents the cluster added in DSM-5 that was NOT present in the DSM-IV PTSD criteria?
33. A 55-year-old man presents with uncontrollable worry about work, health, and finances for 8 months, accompanied by muscle tension, irritability, fatigue, and insomnia. The FIRST-LINE pharmacological agent supported by the broadest evidence for GAD is:
34. A 28-year-old combat veteran has recurrent intrusive memories of battlefield deaths, nightmares, hypervigilance, emotional numbing, and persistent negative beliefs ('the world is dangerous'). Symptoms began 3 months after returning from deployment. Duration has been 6 months. DSM-5 diagnosis is PTSD. The FIRST-LINE pharmacotherapy is:
35. Panic disorder is characterized by recurrent unexpected panic attacks. The cognitive model (Clark, 1986) proposes the central maintaining mechanism is:
36. Buspirone is used in GAD. Its mechanism of action differs from benzodiazepines in that it acts as: