Anxiety, Panic, Trauma-related, and Somatic Disorders Practice Questions

25 multiple-choice questions on Anxiety, panic, trauma-related, and somatic disorders for paramedic and EMT students, from Chapter 29 (Psychiatric Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. Anxiety differs from fear in that anxiety is:

   1. A. A response to a clear and present danger
   2. B. A sign of an organic brain lesion
   3. C. A response to a vague or future threat
   4. D. A feeling lasting no more than seconds
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   Answer: C. A response to a vague or future threat

   Fear responds to an immediate, identifiable danger, while anxiety is apprehension about something uncertain or in the future. Both produce the same sympathetic physical signs.

2. The symptoms of a panic attack typically peak within:

   1. A. About 2 hours
   2. B. About 24 hours or more
   3. C. About 3 days
   4. D. About 10 minutes
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   Answer: D. About 10 minutes

   Panic attacks build abruptly to a peak within minutes and usually resolve within about 30 minutes. Symptoms lasting hours should prompt a search for another cause.

3. A 24-year-old woman has sudden palpitations, chest tightness, tingling hands, and a fear of dying. HR is 118, RR 28, SpO2 99%. Before calling this panic, you must:

   1. A. Have her breathe into a paper bag
   2. B. Give midazolam to end the attack
   3. C. Reassure her that it is only anxiety and leave
   4. D. Consider causes such as ACS or PE
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   Answer: D. Consider causes such as ACS or PE

   Panic is a diagnosis of exclusion in the field because ACS, PE, dysrhythmias, hypoglycemia, and asthma can look identical. Telling her it is 'only anxiety' risks missing a lethal condition.

4. During a panic attack, a woman says everything around her suddenly seems unreal, as if she were in a dream. This symptom is called:

   1. A. A delusion
   2. B. Derealization
   3. C. Hallucination
   4. D. Catatonia
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   Answer: B. Derealization

   Derealization, the sense that the surroundings are unreal or dreamlike, is a common panic symptom, and depersonalization is the feeling of being detached from oneself. She knows the feeling is not real, so it is not a delusion (a fixed false belief) or a hallucination (a false perception). Catatonia is a motor syndrome of immobility and mutism.

5. A woman has had several sudden, unexpected panic attacks and now spends a month worrying about having another and avoiding places where they happened. This best fits:

   1. A. Panic disorder
   2. B. A specific phobia
   3. C. Generalized anxiety
   4. D. Acute stress disorder
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   Answer: A. Panic disorder

   Panic disorder is recurrent, unexpected panic attacks followed by at least a month of worry about more attacks or a change in behavior to avoid them. A specific phobia is fear of a particular object or situation. Generalized anxiety is ongoing worry about many everyday matters, not about attacks. Acute stress disorder follows a traumatic event.

6. A man has not left his home for months because he fears being trapped in crowds or on buses, where escape would be hard. This is most consistent with:

   1. A. Claustrophobia
   2. B. Social anxiety
   3. C. Agoraphobia
   4. D. Paranoid psychosis
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   Answer: C. Agoraphobia

   Agoraphobia is fear and avoidance of places where escape might be difficult or help unavailable, such as crowds, public transit, or open spaces, and it can confine people to home. Claustrophobia is limited to enclosed spaces. Social anxiety centers on fear of being judged by others. He has no delusions, so this is not psychosis.

7. For years a woman has had many physical complaints. Tests find no disease to explain them, yet she spends hours each day worrying about her health. She is not faking. This best fits:

   1. A. Somatic symptom disorder
   2. B. Malingering for financial gain
   3. C. Factitious disorder
   4. D. Conversion disorder
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   Answer: A. Somatic symptom disorder

   Somatic symptom disorder is distressing physical symptoms with excessive thoughts, worry, or behavior about them; the symptoms are real to the patient and are not produced on purpose. Malingering and factitious disorder both involve deliberately faked symptoms, for gain or to assume the sick role. Conversion disorder causes specific neurologic symptoms such as weakness or blindness. Each new complaint still deserves an assessment.

8. Persistent, excessive worry about many everyday matters for 6 months or more describes:

   1. A. Panic disorder with agoraphobia
   2. B. Specific phobia
   3. C. Acute stress disorder
   4. D. Generalized anxiety disorder
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   Answer: D. Generalized anxiety disorder

   GAD is chronic, diffuse worry with tension, fatigue, and poor sleep. Panic disorder is marked by discrete, recurrent attacks rather than constant worry.

9. A 30-year-old woman becomes intensely fearful, pale, and nearly faints when she sees the IV catheter. This most likely represents:

   1. A. Agoraphobia
   2. B. Panic disorder
   3. C. A specific phobia
   4. D. Obsessive-compulsive disorder
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   Answer: C. A specific phobia

   Blood-injection-injury phobia is a specific phobia and, unlike other phobias, often causes a vasovagal faint. Agoraphobia is fear of places where escape is difficult, not of a specific object.

10. A man washes his hands dozens of times a day to relieve intrusive thoughts about germs. This is most consistent with:

    1. A. Generalized anxiety disorder
    2. B. Obsessive-compulsive disorder
    3. C. Post-traumatic stress disorder
    4. D. Delusional disorder
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    Answer: B. Obsessive-compulsive disorder

    Obsessions are intrusive thoughts and compulsions are behaviors done to relieve the anxiety they cause. Unlike a delusion, the person usually recognizes the thoughts are excessive.

11. Post-traumatic stress disorder is diagnosed when symptoms after a trauma persist for more than:

    1. A. 3 days
    2. B. 1 week
    3. C. 6 months
    4. D. 1 month
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    Answer: D. 1 month

    Symptoms lasting from 3 days to 1 month are classified as acute stress disorder. PTSD symptoms may also begin months or years after the event.

12. Intrusive symptoms, avoidance, and hyperarousal that begin after a trauma and last 2 weeks are classified as:

    1. A. Post-traumatic stress disorder
    2. B. Acute stress disorder
    3. C. Adjustment disorder
    4. D. Generalized anxiety disorder
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    Answer: B. Acute stress disorder

    Acute stress disorder covers the window from 3 days to 1 month after the event. The same symptoms persisting beyond 1 month would meet criteria for PTSD.

13. Which is a core symptom cluster of PTSD?

    1. A. Fixed grandiose beliefs about oneself
    2. B. Elevated mood with little need for sleep
    3. C. Intrusive memories such as flashbacks
    4. D. Gradual loss of memory for recent events
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    Answer: C. Intrusive memories such as flashbacks

    PTSD includes intrusion, avoidance, negative changes in mood and thinking, and arousal or reactivity. Elevated mood with little sleep describes mania, not PTSD.

14. A veteran crouches and appears to be reliving combat when your siren sounds nearby. Your best approach is to:

    1. A. Speak calmly, say who you are, orient him
    2. B. Grab his arms to prevent sudden movements
    3. C. Sound the siren again to snap him out of it
    4. D. Leave him alone until the episode passes
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    Answer: A. Speak calmly, say who you are, orient him

    Grounding with a calm voice and orienting information helps end a flashback. Grabbing him may be perceived as an attack and provoke a defensive response.

15. A woman with PTSD from a sexual assault becomes distressed as a male paramedic approaches to examine her. You should:

    1. A. Offer a female provider if available
    2. B. Do the exam quickly so it ends sooner
    3. C. Ask police officers to hold her still
    4. D. Explain that the medic is a professional
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    Answer: A. Offer a female provider if available

    Giving her choice and control reduces retraumatization. Reassuring her of professionalism does not address the trigger, and holding her down is never appropriate for a cooperative patient.

16. A paramedic has had persistent nightmares and irritability for 6 weeks since a pediatric death call. The best course is to:

    1. A. Avoid discussing it, to protect his coworkers
    2. B. Use a few drinks at night to help him sleep
    3. C. Seek help through an EAP or a clinician
    4. D. Take extra shifts to stay busy and distracted
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    Answer: C. Seek help through an EAP or a clinician

    His symptoms suggest PTSD, which responds to evidence-based treatment. Alcohol is a common but harmful coping strategy that worsens sleep and mood.

17. Conversion disorder (functional neurological symptom disorder) is characterized by:

    1. A. Symptoms faked deliberately for a tangible reward
    2. B. Self-induced illness to take on the sick role
    3. C. Pain caused by a structural nerve compression
    4. D. Neurologic symptoms not explained by disease
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    Answer: D. Neurologic symptoms not explained by disease

    The symptoms are real and not consciously produced. Deliberately faking for external gain is malingering, which is a different concept.

18. Feigning symptoms to obtain disability payments or avoid a court date is called:

    1. A. Factitious disorder
    2. B. Malingering
    3. C. Conversion disorder
    4. D. Somatic symptom disorder
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    Answer: B. Malingering

    Malingering is intentional and motivated by external gain. In factitious disorder the deception is also intentional, but the motive is to be seen as sick, not for reward.

19. A mother repeatedly brings her child for illnesses that appear only in her presence, and tests are always normal. You should suspect:

    1. A. Conversion disorder in the child
    2. B. Somatic symptom disorder in the mother
    3. C. Factitious disorder imposed on another
    4. D. Separation anxiety disorder in the child
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    Answer: C. Factitious disorder imposed on another

    Formerly called Munchausen by proxy, this is a form of child abuse and must be reported. The child's symptoms are produced by the caregiver, not by the child's own psychological distress.

20. A woman with known conversion disorder has sudden right leg weakness and slurred speech. You should:

    1. A. Assess fully; treat it as a possible stroke
    2. B. Tell her the weakness is not real and wait
    3. C. Document it as psychogenic and release her
    4. D. Ask her to try harder to move the leg
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    Answer: A. Assess fully; treat it as a possible stroke

    A psychiatric history never excludes a new medical emergency; slurred speech plus weakness requires a stroke workup. Labeling it psychogenic in the field risks missing a treatable stroke.

21. A 19-year-old with an anxiety history is short of breath with faint expiratory wheezes and an SpO2 of 91%. You should:

    1. A. Coach slow breathing and reassure only
    2. B. Treat it as true respiratory distress
    3. C. Have her rebreathe into a paper bag
    4. D. Give midazolam to treat the anxiety
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    Answer: B. Treat it as true respiratory distress

    Wheezing and hypoxia indicate a respiratory cause such as asthma. Anxiety does not lower SpO2, and sedation could worsen her breathing.

22. Intoxication with which substance can produce a picture identical to a panic attack?

    1. A. Morphine
    2. B. Lorazepam
    3. C. Gabapentin
    4. D. Cocaine
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    Answer: D. Cocaine

    Stimulants cause tachycardia, diaphoresis, tremor, and fear. Lorazepam is a sedative used to treat panic, so it does not mimic it.

23. A bystander at a crash is trembling and crying but is uninjured and fully oriented. Your best approach is to:

    1. A. Give her oxygen by nonrebreather mask at 15 L/min
    2. B. Move her away from the scene; offer support
    3. C. Ask her to help with patient care
    4. D. Transport her to the ED with sirens
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    Answer: B. Move her away from the scene; offer support

    Removing her from the stressor and providing reassurance is psychological first aid. Oxygen is not indicated for anxiety with normal SpO2.

24. Long-term first-line medication treatment for most anxiety disorders is:

    1. A. SSRIs such as sertraline
    2. B. Antipsychotics such as haloperidol
    3. C. Benzodiazepines such as alprazolam
    4. D. Beta blockers such as propranolol
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    Answer: A. SSRIs such as sertraline

    SSRIs and SNRIs are first-line maintenance therapy. Benzodiazepines act quickly but carry risks of dependence; antipsychotics are not first-line. Beta blockers such as propranolol may blunt the physical symptoms of performance anxiety, but they are not long-term first-line treatment.

25. A 40-year-old taking alprazolam daily for panic disorder ran out 2 days ago and is tremulous and anxious. The most dangerous risk is:

    1. A. Respiratory depression
    2. B. Serotonin syndrome
    3. C. Lithium toxicity
    4. D. Withdrawal seizures
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    Answer: D. Withdrawal seizures

    Abrupt benzodiazepine withdrawal can cause seizures and delirium, much like alcohol withdrawal. Respiratory depression is a risk of benzodiazepine excess, not withdrawal.