Anxiety and Stress-Related Disorders
Comprehensive Examination
Instructions: Select the single best answer for each question. Refer to the explanation
section following each question for clinical rationales and diagnostic criteria breakdowns.
Question 1
A 28-year-old software engineer presents with a 7-month history of persistent, excessive
worry regarding his job security, finances, and health. He reports feeling constantly
"keyed up," experiences muscle tension, and has difficulty falling asleep. Which feature
is most required for a diagnosis of Generalized Anxiety Disorder (GAD)?
● A. Recurrent unexpected panic attacks
● B. Egodystonic intrusive thoughts accompanied by physical compulsions
● C. Excessive anxiety occurring more days than not for at least 6 months about
multiple events
● D. Fear focused specifically on scrutiny or negative evaluation in social situations
Correct Answer: C
Explanation: GAD requires excessive anxiety and worry occurring more days than not for
at least 6 months across a variety of events or activities (DSM-5-TR). Choice A defines
Panic Disorder, Choice B describes OCD, and Choice D characterizes Social Anxiety
Disorder. GAD worry must be pervasive and difficult to control rather than tied to a single
phobic trigger.
Question 2
A 34-year-old woman experiences sudden episodes of intense terror accompanied by
palpitations, shortness of breath, chest pain, and a fear of dying. These episodes peak
within 10 minutes and occur without an obvious trigger. Between episodes, she
constantly worries about having another attack. What is the most likely diagnosis?
, ● A. Panic Disorder
● B. Agoraphobia
● C. Acute Stress Disorder
● D. Specific Phobia
Correct Answer: A
Explanation: Panic Disorder is defined by recurrent, unexpected panic attacks followed
by at least 1 month of persistent concern about future attacks or significant maladaptive
behavioral changes. Agoraphobia (Choice B) involves fear of specific situations where
escape might be difficult. Acute Stress Disorder (Choice C) requires exposure to a
traumatic event.
Question 3
An 8-year-old child demonstrates severe distress whenever brought near large dogs,
avoiding parks entirely. When shown pictures of dogs, the child cries and hides behind a
parent. The behavior has persisted for 8 months. What is the most appropriate diagnosis?
● A. Separation Anxiety Disorder
● B. Post-Traumatic Stress Disorder
● C. Social Anxiety Disorder
● D. Specific Phobia (Animal type)
Correct Answer: D
Explanation: Specific Phobia involves marked, persistent fear or anxiety about a specific
object or situation (e.g., animals), lasting at least 6 months, where exposure almost
invariably provokes immediate anxiety. PTSD (Choice B) requires a traumatic life event
involving real or threatened death or serious injury. Separation Anxiety (Choice A) centers
on detachment from primary attachment figures.
Question 4
A 42-year-old man refuses to leave his home without his brother because he fears he will
not be able to escape or get help if he develops sudden, incapacitating gastrointestinal
,symptoms in public. He avoids buses, open shopping malls, and movie theaters. Which
condition best fits this clinical picture?
● A. Social Anxiety Disorder
● B. Agoraphobia
● C. Obsessive-Compulsive Disorder
● D. Generalized Anxiety Disorder
Correct Answer: B
Explanation: Agoraphobia involves marked fear or anxiety about two or more of five
public domains (e.g., public transit, open spaces, enclosed spaces, lines/crowds, outside
home alone) due to fears that escape might be difficult or help unavailable during panic-
like symptoms. Social Anxiety Disorder (Choice A) is driven specifically by fear of
negative social evaluation or scrutiny.
Question 5
A 25-year-old college student avoids giving presentations, eating in cafeterias, and
attending group study sessions due to an intense fear that others will notice her trembling
hands and judge her as incompetent or awkward. She recognizes her fear is excessive.
What is the primary diagnosis?
● A. Agoraphobia
● B. Social Anxiety Disorder
● C. Panic Disorder
● D. Avoidant Personality Disorder
Correct Answer: B
Explanation: Social Anxiety Disorder (Social Phobia) is characterized by marked anxiety
about one or more social situations in which the individual is exposed to potential scrutiny
by others. Unlike Agoraphobia (Choice A), the core fear is social rejection, humiliation, or
negative evaluation rather than an inability to escape physical spaces.
, Question 6
Three weeks after surviving a severe motor vehicle collision in which a passenger died, a
30-year-old man experiences intrusive memories, nightmares, emotional numbness,
hypervigilance, and derealization. What is the most appropriate initial diagnosis?
● A. Post-Traumatic Stress Disorder
● B. Adjustment Disorder
● C. Generalized Anxiety Disorder
● D. Acute Stress Disorder
Correct Answer: D
Explanation: Acute Stress Disorder (ASD) is diagnosed when trauma symptoms present
between 3 days and 1 month following exposure to a traumatic event. If symptoms persist
beyond 1 month, the diagnosis changes to Post-Traumatic Stress Disorder (Choice A).
Adjustment Disorder (Choice B) does not involve the severe intrusion and dissociation
criteria post-trauma.
Question 7
A 35-year-old accountant spends 3 hours each evening checking and re-checking all
doors, windows, and gas knobs in his apartment. He experiences severe distress if
interrupted, believing that failing to check will lead to a disastrous fire. He recognizes
these thoughts are irrational. What is the core underlying clinical feature?
● A. Egodystonic obsessions triggering compulsive behaviors
● B. Psychotic delusions of impending danger
● C. Egosyntonic perfectionism and detail orientation
● D. Somatic delusions regarding physical health
Correct Answer: A
Explanation: Obsessive-Compulsive Disorder (OCD) involves repetitive, intrusive,
unwanted thoughts (obsessions) that cause anxiety, which the individual attempts to
neutralize with repetitive behaviors or mental acts (compulsions). The thoughts are
typically egodystonic (unwanted/inconsistent with self-image), distinguishing OCD from
OCPD (Choice C) or psychotic disorders (Choice B).
Comprehensive Examination
Instructions: Select the single best answer for each question. Refer to the explanation
section following each question for clinical rationales and diagnostic criteria breakdowns.
Question 1
A 28-year-old software engineer presents with a 7-month history of persistent, excessive
worry regarding his job security, finances, and health. He reports feeling constantly
"keyed up," experiences muscle tension, and has difficulty falling asleep. Which feature
is most required for a diagnosis of Generalized Anxiety Disorder (GAD)?
● A. Recurrent unexpected panic attacks
● B. Egodystonic intrusive thoughts accompanied by physical compulsions
● C. Excessive anxiety occurring more days than not for at least 6 months about
multiple events
● D. Fear focused specifically on scrutiny or negative evaluation in social situations
Correct Answer: C
Explanation: GAD requires excessive anxiety and worry occurring more days than not for
at least 6 months across a variety of events or activities (DSM-5-TR). Choice A defines
Panic Disorder, Choice B describes OCD, and Choice D characterizes Social Anxiety
Disorder. GAD worry must be pervasive and difficult to control rather than tied to a single
phobic trigger.
Question 2
A 34-year-old woman experiences sudden episodes of intense terror accompanied by
palpitations, shortness of breath, chest pain, and a fear of dying. These episodes peak
within 10 minutes and occur without an obvious trigger. Between episodes, she
constantly worries about having another attack. What is the most likely diagnosis?
, ● A. Panic Disorder
● B. Agoraphobia
● C. Acute Stress Disorder
● D. Specific Phobia
Correct Answer: A
Explanation: Panic Disorder is defined by recurrent, unexpected panic attacks followed
by at least 1 month of persistent concern about future attacks or significant maladaptive
behavioral changes. Agoraphobia (Choice B) involves fear of specific situations where
escape might be difficult. Acute Stress Disorder (Choice C) requires exposure to a
traumatic event.
Question 3
An 8-year-old child demonstrates severe distress whenever brought near large dogs,
avoiding parks entirely. When shown pictures of dogs, the child cries and hides behind a
parent. The behavior has persisted for 8 months. What is the most appropriate diagnosis?
● A. Separation Anxiety Disorder
● B. Post-Traumatic Stress Disorder
● C. Social Anxiety Disorder
● D. Specific Phobia (Animal type)
Correct Answer: D
Explanation: Specific Phobia involves marked, persistent fear or anxiety about a specific
object or situation (e.g., animals), lasting at least 6 months, where exposure almost
invariably provokes immediate anxiety. PTSD (Choice B) requires a traumatic life event
involving real or threatened death or serious injury. Separation Anxiety (Choice A) centers
on detachment from primary attachment figures.
Question 4
A 42-year-old man refuses to leave his home without his brother because he fears he will
not be able to escape or get help if he develops sudden, incapacitating gastrointestinal
,symptoms in public. He avoids buses, open shopping malls, and movie theaters. Which
condition best fits this clinical picture?
● A. Social Anxiety Disorder
● B. Agoraphobia
● C. Obsessive-Compulsive Disorder
● D. Generalized Anxiety Disorder
Correct Answer: B
Explanation: Agoraphobia involves marked fear or anxiety about two or more of five
public domains (e.g., public transit, open spaces, enclosed spaces, lines/crowds, outside
home alone) due to fears that escape might be difficult or help unavailable during panic-
like symptoms. Social Anxiety Disorder (Choice A) is driven specifically by fear of
negative social evaluation or scrutiny.
Question 5
A 25-year-old college student avoids giving presentations, eating in cafeterias, and
attending group study sessions due to an intense fear that others will notice her trembling
hands and judge her as incompetent or awkward. She recognizes her fear is excessive.
What is the primary diagnosis?
● A. Agoraphobia
● B. Social Anxiety Disorder
● C. Panic Disorder
● D. Avoidant Personality Disorder
Correct Answer: B
Explanation: Social Anxiety Disorder (Social Phobia) is characterized by marked anxiety
about one or more social situations in which the individual is exposed to potential scrutiny
by others. Unlike Agoraphobia (Choice A), the core fear is social rejection, humiliation, or
negative evaluation rather than an inability to escape physical spaces.
, Question 6
Three weeks after surviving a severe motor vehicle collision in which a passenger died, a
30-year-old man experiences intrusive memories, nightmares, emotional numbness,
hypervigilance, and derealization. What is the most appropriate initial diagnosis?
● A. Post-Traumatic Stress Disorder
● B. Adjustment Disorder
● C. Generalized Anxiety Disorder
● D. Acute Stress Disorder
Correct Answer: D
Explanation: Acute Stress Disorder (ASD) is diagnosed when trauma symptoms present
between 3 days and 1 month following exposure to a traumatic event. If symptoms persist
beyond 1 month, the diagnosis changes to Post-Traumatic Stress Disorder (Choice A).
Adjustment Disorder (Choice B) does not involve the severe intrusion and dissociation
criteria post-trauma.
Question 7
A 35-year-old accountant spends 3 hours each evening checking and re-checking all
doors, windows, and gas knobs in his apartment. He experiences severe distress if
interrupted, believing that failing to check will lead to a disastrous fire. He recognizes
these thoughts are irrational. What is the core underlying clinical feature?
● A. Egodystonic obsessions triggering compulsive behaviors
● B. Psychotic delusions of impending danger
● C. Egosyntonic perfectionism and detail orientation
● D. Somatic delusions regarding physical health
Correct Answer: A
Explanation: Obsessive-Compulsive Disorder (OCD) involves repetitive, intrusive,
unwanted thoughts (obsessions) that cause anxiety, which the individual attempts to
neutralize with repetitive behaviors or mental acts (compulsions). The thoughts are
typically egodystonic (unwanted/inconsistent with self-image), distinguishing OCD from
OCPD (Choice C) or psychotic disorders (Choice B).
