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Anxiety Disorders

16.1. Posttraumatic stress disorder (PTSD) differs from acute stress disorder in that
A. acute stress disorder occurs earlier than PTSD
B. PTSD is associated with at least three dissociative symptoms
C. re-experiencing the trauma is not found in acute stress disorder
D. avoidance of stimuli associated with the trauma is only found in PTSD
E. PTSD lasts less than 1 month after a trauma
16.1 The answer is A
16.2. The risk of developing anxiety disorders is enhanced by
A. eating disorders
B. depression
C. substance abuse
D. allergies
E. all of the above
16.2. The answer is E (all)
16.3. Which of the following is NOT a sign of poor prognosis in obsessive-compulsive disorder (OCD)?
A. Childhood onset
B. Coexisting major depression
C. Good social adjustment
D. Bizarre compulsions
E. Delusional beliefs
16.3. The answer is C
16.4. Which of the following statements regarding anxiety and gender differences is TRUE?
A. Women have greater rates of almost all anxiety disorders.
B. Gender ratios are nearly equal with OCD.
C. No significant difference exists in average age of anxiety onset.
D. Women have a twofold greater lifetime rate of agoraphobia than men.
E. All of the above
16.4. The answer is E (all)
16.5. Which of the following epidemiological statements is TRUE regarding anxiety disorders?
A. Panic disorder has the lowest heritability.
B. The mean age of onset is higher in girls.
C. The age of onset is earlier than that of mood disorders.
D. Rates in males peak in the fourth and fifth decades of life.
D. All of the above
16.5. The answer is C

Anxiety Disorders
16.6. Sigmund Freud postulated that the defense mechanisms necessary in phobias are
A. regression, condensation, and dissociation
B. regression, condensation, and projection
C. regression, repression, and isolation
D. repression, displacement, and avoidance
E. repression, projection, and displacement
16.6. The answer is D
16.7. Anxiety disorders
A. are greater among people at lower socioeconomic levels
B. are highest among those with higher levels of education
C. are lowest among homemakers
D. have shown different prevalences with regard to social class but not ethnicity
E. all of the above
16.7. The answer is A
16.8. Generalized anxiety disorder
A. is least likely to coexist with another mental disorder
B. has a female-to-male ratio of 1:2
C. is a mild condition
D. has about a 50 percent chance of a recurrence after recovery
E. has a low prevalence in primary care settings
16.8. The answer is D
16.9. Physiological activity associated with PTSD include all EXCEPT
A. decreased parasympathetic tone
B. elevated baseline heart rate
C. excessive sweating
D. increased circulating thyroxine
E. increased blood pressure
16.9. The answer is D
16.10. Unexpected panic attacks are required for the diagnosis of
A. generalized anxiety disorder
B. panic disorder
C. social phobia
D. specific phobia
E. all of the above
16.10. The answer is B

Anxiety Disorders
16.11. Isolated panic attacks without functional disturbances
A. usually involves anticipatory anxiety or are phobic
B. are part of the criteria for diagnostic panic disorder
C. occur in less than 2 percent of the population
D. rarely involve avoidance
E. none of the above
16.11. The answer is A
16.12. Which of the following is NOT a component of the DSM-IV-TR diagnostic criteria for OCD?
A. Children need not recognize that their obsessions are unreasonable.
B. Obsessions are acknowledged as excessive or unreasonable.
C. Obsessions or compulsions are time consuming and take more than 1 hour a day.
D. The person recognized the obsessional thoughts as a product of outside humor herself.
E. The person attempts to ignore or suppress compulsive thoughts or impulses.
16.12. The answer is D
16.13. All of the following are TRUE for the course of panic disorder EXCEPT
A. patients become concerned after the first one or two panic attacks
B. excessive caffeine intake can exacerbate symptoms
C. comorbid depression increases risk for committing suicide
D. the overall course is variable
E. patients without comorbid agoraphobia have a higher recovery rate
16.13. The answer is A
16.14. Tourette's disorder has been shown to possibly have a familial and genetic relationship with
A. generalized anxiety disorder
B. obsessive-compulsive disorder
C. panic disorder
D. social phobia
E. none of the above
16.14. The answer is B
16.15. All of the following have been noted through brain imaging in patients with panic disorder EXCEPT
A. magnetic resonance imaging (MRI) studies have shown pathological involvement of both temporal lobes
B. generalized cerebral vasoconstriction
C. right temporal cortical atrophy
D. increased blood flow to the basal ganglia
E. positron emission tomography scans have implicated dysregulation of blood flow in panic disorder
16.15. The answer is D

Anxiety Disorders
16.16. A patient with OCD might exhibit all of the following brain imaging findings EXCEPT
A. longer mean T1 relaxation times in the frontal cortex than normal control subjects
B. significantly more gray matter and less white matter than normal controlsubjects
C. abnormalities in the frontal lobes, cingulum, and basal ganglia
D. decreased caudate volumes bilaterally compared with normal control subjects
E. lower metabolic rates in basal ganglia and white matter than in normal control subjects
16.16. The answer is E
16.17. Buspirone (Buspar) acts as a
A. dopamine partial agonist useful in the treatment of OCD
B. serotonin partial agonist useful in the treatment of OCD
C. dopamine partial agonist useful in the treatment of generalized anxiety disorder
D. serotonin partial agonist useful in treatment of generalized anxiety disorder
E. none of the above
16.17. The answer is D
16.18. Which of the following choices most accurately describes the role of serotonin in OCD?
A. Serotonergic drugs are an ineffective treatment.
B. Dysregulation of serotonin is involved in the symptom formation.
C. Measures of platelet binding sites of titrated imipramine are abnormally low.
D. Measures of serotonin metabolites in cerebrospinal fluid are abnormally high.
E. None of the above
16.18. The answer is B
16.19. Which of the following medical disorders are NOT associated with panic disorder due to a general
medical condition?
A. Cardiomyopathy
B. Parkinson's disease
C. Epilepsy
D. Sjogren's syndrome
E. Chronic obstructive pulmonary disease (COPD)
16.19. The answer is D
16.20. Which of the following disorders is rarely confused with anxiety that stems primarily from medical
disorders?
A. Panic disorder
B. Specific phobia
C. Obsessive-compulsive disorder
D. Posttraumatic stress disorder
E. Generalized anxiety disorder
16.20. The answer is B

Anxiety Disorders
16.21. Induction of panic attacks in patients with panic disorder can occur with
A. carbon dioxide
B. cholecystokinin
C. doxapram
D. yohimbine
E. all of the above
21. The answer is E (all)
16.22. First-line medication treatments of anxiety disorders may generally include all of the following
EXCEPT
A. diazepam (Valium)
B. fluoxetine (Prozac)
C. fluvoxamine (Luvox)
D. nefazodone (Serzone)
E. venlafaxine (Effexor)
16.22. The answer is A
16.23. Therapy for phobias may include all of the following EXCEPT
A. counterphobic attitudes
B. flooding
C. phenelzine (Nardil)
D. propranolol (Inderal)
E. systematic desensitization
16.23. The answer is A
16.24. Mr. A was a successful businessman who presented for treatment after a change in his business
schedule. Although he had formerly worked largely from an office near his home, a promotion led to a
schedule of frequent out-of-town meetings requiring weekly flights. Mr. A reported being \"deathly afraid\"
of flying. Even the thought of getting on an airplane led to thoughts of impending doom in which he
envisioned his airplane crashing to the ground. These thoughts were associated with intense fear,
palpitations, sweating, clamminess, and stomach upset. Although the thought of flying was terrifying
enough, Mr. A became nearly incapacitated when he went to the airport. Immediately before boarding, Mr. A
would often have to turn back from the plane, running to the bathroom to vomit. Which of the following is
the most appropriate treatment for this patient who has another flight scheduled tomorrow?
A. -agonists
B. Exposure therapy
C. Lorazepam
D. Paroxetine
E. None of the above
16.24. The answer is C

Anxiety Disorders
16.25. Ms. K was referred for psychiatric evaluation by her general practitioner. On interview, Ms. K
described a long history of checking rituals that had caused her to lose several jobs and had damaged
numerous relationships. She reported, for example, that because she often had the thought that she had not
locked the door to her car, it was difficult for her to leave the car until she had checkedrepeatedly that it was
secure. She had broken several car door handles with the vigor of her checking and had been up to an hour
late to work because she spent so much time checking her car door. Similarly, she had recurrent thoughts that
she had left the door to her apartment unlocked, and she returned several times daily to check the door before
she left for work. She reported that checking doors decreased her anxiety about security. Although Ms. K
reported that she had occasionally tried to leave her car or apartment without checking the door (e.g., when
she was already late for work), she found that she became so worried about her car being stolen or her
apartment being broken into that she had difficulty going anywhere. Ms. K reported that her obsessions about
security had become so extreme over the past 3 months that she had lost her job because of recurrent
tardiness. She recognized the irrational nature of her obsessive concerns but could not bring herself to ignore
them. Which of the following symptom patterns of OCD does Mrs. K present?
A. Intrusive thoughts
B. Symmetry
C. Pathological doubt
D. Contamination
E. None of the above
16.25. The answer is C
16.26. A 23-year-old woman presents to clinic with a chief complaint of gone back to teaching after having
her third child. The patient states she is constantly wondering about other things as well. For example, she is
going to help her sister-in-law throw a goodbye party and finds herself constantly going over what she needs
to do to prepare for the party. At the end of the day, her husband claims she is irritable and tired. At night,
she is unable to sleep and keeps thinking about her tasks for the next day. What is the most likely diagnosis?
A. Avoidant personality disorder
B. Obsessive-compulsive disorder
C. Obsessive-compulsive personality disorder
D. Generalized anxiety disorder
E. None of the above
16.26. The answer is D

Anxiety Disorders
Questions 16.27-16.31
Directions: Each set of lettered headings below is followed by a list of numbered words or phrases. For each
numbered word or phrase, select
A. Social phobia
B. Agoraphobia
A.
B.
C.
D.

if the item is associated with A only


if the item is associated with B only
if the item is associated with both A and B
if the item is associated with neither A nor B

16.27. Symptoms include blushing and muscle twitching


16.27. The answer is A. Social phobia
16.28. Is associated with a sense of suffocation
16.28. The answer is B. Agoraphobia
16.29. Is chronic without a history of panic disorder
16.29. The answer is A. Social phobia
16.30. May be associated with panic attacks
16.30. The answer is C. Both Agoraphobia and Social phobia
16.31. Patients are comforted by the presence of another person
16.31. The answer is B. Agoraphobia

Anxiety Disorders
Questions 16.32-16.36
Directions: Each set of lettered headings below is followed by a list of numbered words or phrases. For each
numbered word or phrase, select
A. Generalized anxiety disorder
B. Panic disorder
A.
B.
C.
D.

if the item is associated with A only


if the item is associated with B only
if the item is associated with both A and B
if the item is associated with neither A nor B

16.32. Response rates between 60 and 80 percent have been reported to buspirone
16.32. The answer is A. Generalized anxiety disorder
16.33. Patients with the disorder may still be responsive to buspirone after being exposed to benzodiazepine
16.33. The answer is A. Generalized anxiety disorder
16.34. Buspirone's use is limited to potentiating the effects of other antidepressants and counteracting the
adverse sexual effects of selective serotonin reuptake inhibitors
16.34. The answer is D. Neither
16.35. Relapse rates are generally high after discontinuation of medication
16.35. The answer is C. Both Generalized anxiety disorder and Panic disorder
16.36. Tricyclic drugs have been reported to worsen anxiety symptoms in patients in whom the first
symptoms were precipitated by cocaine
16.36. The answer is B. Panic disorder

Anxiety Disorders
Questions 16.37-16.40
Directions: Each set of lettered headings below is followed by a list of numbered words or phrases. For each
numbered word or phrase, select
A. Cognitive behavioral therapy
B. Psychodynamic therapy
A.
B.
C.
D.

if the item is associated with A only


if the item is associated with B only
if the item is associated with both A and B
if the item is associated with neither A nor B

16.37. Produces 80 to 90 percent panic-free status in panic disorder within at least 6 months of treatment
16.37. The answer is A. Cognitive behavioral therapy
16.38. May be nearly twice as effective in the treatment of social phobia as a more educational-supportive
approach
16.38. The answer is A. Cognitive behavioral therapy
16.39. Goals are more ambitious and require more time to achieve
16.39. The answer is B. Psychodynamic therapy

16.40. Combining treatment with medication may be superior to either treatment alone
16.40. The answer is C. Both Cognitive behavioral therapy and Psychodynamic therapy

Questions 16.41-16.45
Directions: Each group of questions below consists of lettered headings followed by a list of numbered
phrases or statements. For each numbered phrase or statement, select the one lettered heading that is most
associated with it. Each lettered heading may be selected once, more than once, or not at all.
A.
B.
C.
D.
E.

Panic disorder
Generalized social phobia
Posttraumatic stress disorder
Generalized anxiety disorder
Acute stress disorder

16.41. Is associated with depersonalization


16.41. The answer is E. Acute stress disorder
16.42. Must include at least two spontaneous panic attacks
16.42. The answer is A. Panic disorder

Anxiety Disorders

16.43. Symptoms must persist at least 1 month after the trauma


16.43. The answer is C. Posttraumatic stress disorder
16.44. Must include three somatic or cognitive symptoms associated with worry
16.44. The answer is D. Generalized anxiety disorder
16.45. Difficult to distinguish from avoidant personality disorder
16.45. The answer is B. Generalized social phobia

16.46-16.49
Directions: Each group of questions below consists of lettered headings followed by a list of numbered
phrases or statements. For each numbered phrase or statement, select the one lettered heading that is most
associated with it. Each lettered heading may be selected once, more than once, or not at all.
A.
B.
C.
D.

Imaginal exposure
Interoceptive exposure
In vivo exposure
Systematic desensitization

16.46. A patient is presented with photographs of snakes while practicing various relaxation techniques to
overcome fear; gradually, he practices relaxation while in the presence of live snakes.
16.46. The answer is D Systematic desensitization
16.47. A patient with OCD attempts to use public telephones and doorknobs while intentionally refraining
from washing her hands afterward.
16.47. The answer is C. In vivo exposure
16.48. A patient is asked to imagine his wartime experiences as vividly as possible to confront his memory of
the traumatic events.
16.48. The answer is A. Imaginal exposure
16.49. A patient breathes through a thin straw to produce the sensation of not getting enough air; this activity
produces a similar sensation to the distressing feeling of getting on an airplane.
16.49. The answer is B. Interoceptive exposure

Anxiety Disorders
16.50-16.54
Directions: Each group of questions below consists of lettered headings followed by a list of numbered
phrases or statements. For each numbered phrase or statement, select the one lettered heading that is most
associated with it. Each lettered heading may be selected once, more than once, or not at all.
A.
B.
C.
D.
E.

Acrophobia
Ailurophobia
Cynophobia
Mysophobia
Xenophobia

16.50. Fear of dirt and germs


16.50. The answer is D. Mysophobia
16.51. Fear of heights
16.51. The answer is A. Acrophobia
16.52. Fear of strangers
16.52. The answer is E. Xenophobia
16.53. Fear of dogs
16.53. The answer is C. Cynophobia
16.54. Fear of cats
16.54. The answer is B. Ailurophobia

Specific phobia is divided into four subtypes (animal type, natural environment type, blood injury type, and
situational type) in addition to a residual category for phobias that do not clearly fall into any of these four
categories.
The key feature in each type of phobia is that the fear is circumscribed to a specific object, both temporally
and with respect to other objects. Phobias have traditionally been classified according to the specific fear by
means of Greek or Latin prefixes, as indicted by the examples below.
Acrophobia: fear of heights
Agoraphobia: fear of open places
Ailurophobia: fear of cats
Claustrophobia: fear of closed spaces
Cynophobia: fear of dogs
Hydrophobia: fear of water
Mysophobia: fear of dirt and germs
Pyrophobia: fear of fire
Xenophobia: fear of strangers
Zoophobia: fear of animals