A 23-year-old woman is brought to casualty breathing fast and feeling she will die, with tingling around the mouth and spasm of both hands. ABG on room air: pH 7.53, pCO2 25 mmHg, HCO3- 22 mmol/L, pO2 104 mmHg. Why does she have carpopedal spasm?

Fall in ionised calcium as albumin binds more calcium

Cerebral hypoxia from reduced oxygen delivery

Rise in serum potassium from cell shift

Fall in total serum calcium from increased renal calcium loss

Anxiety, OCD, PTSD and somatic disorders

16 NEET-PG practice questions on Anxiety, OCD, PTSD and somatic disorders, part of Psychiatry. The first 16 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Easy
A 26-year-old software engineer in Bengaluru has had six sudden episodes in two months of pounding heart, choking, trembling and fear that she is dying. Each peaks within minutes and settles within half an hour. She now avoids the metro in case another attack comes. ECG, TSH and blood glucose are normal. Which drug is first-line for long-term treatment?
1. AChlorpromazine
2. BAlprazolam
3. CPropranolol
4. DEscitalopram
Show answerHide answer
Answer: D · Escitalopram
Recurrent unexpected panic attacks with persistent worry about further attacks and avoidance are panic disorder. Selective serotonin reuptake inhibitors such as escitalopram, together with cognitive behaviour therapy, are the first-line long-term treatment. They are started at a low dose because early jitteriness can make patients stop the drug. Benzodiazepines act fast but carry dependence and withdrawal, so they are used only briefly, if at all.
- A: Chlorpromazine is an antipsychotic with no role in panic disorder.
- B: Alprazolam controls attacks quickly but causes dependence and is not a long-term first-line drug.
- C: Propranolol blunts tremor and palpitations but does not prevent panic attacks.
Question 2 · Medium
A 31-year-old accountant with obsessive-compulsive disorder, mainly doubts about locking the door and repeated checking, is reviewed in the psychiatry OPD. Consider these statements: 1. He usually recognises the doubts as products of his own mind. 2. SSRIs in OCD often need higher doses and a longer trial than in depression. 3. Benzodiazepines are first-line maintenance treatment. 4. Neurosurgical procedures are reserved for severe illness resistant to other treatment. Which statements are correct?
1. A1, 3 and 4 only
2. B1, 2 and 4 only
3. C2 and 4 only
4. D2, 3 and 4 only
Show answerHide answer
Answer: B · 1, 2 and 4 only
Statements 1, 2 and 4 are correct. In OCD the obsessions are experienced as the person's own thoughts, unlike thought insertion in schizophrenia, and are usually resisted. SSRIs work in OCD but often need doses at the upper end of the range and a trial of 8 to 12 weeks before judging response. Benzodiazepines have no role in maintenance; for severe refractory illness, procedures such as capsulotomy or deep brain stimulation are considered.
- A: Includes benzodiazepines and omits statement 2 about higher SSRI doses.
- C: Omits statement 1: insight that the doubts are his own is typical of OCD.
- D: Includes benzodiazepines, which are not maintenance treatment, and omits statement 1.
Question 3 · Easy
Which tricyclic antidepressant is the most effective in obsessive-compulsive disorder?
1. AAmitriptyline
2. BNortriptyline
3. CImipramine
4. DClomipramine
Show answerHide answer
Answer: D · Clomipramine
Clomipramine is the most strongly serotonergic tricyclic and is the only tricyclic with established efficacy in OCD. Its benefit is linked to serotonin reuptake inhibition, the same action as the SSRIs. SSRIs are usually tried first because clomipramine has more anticholinergic, cardiac and seizure-related adverse effects. It remains an option when SSRIs fail.
- A: Amitriptyline is used in depression and pain, not OCD.
- B: Nortriptyline acts mainly on noradrenaline reuptake and has no role in OCD.
- C: Imipramine is a mixed reuptake inhibitor with little effect on obsessions.
Question 4 · Medium
A 28-year-old woman survived a bus accident on a highway six months ago in which two passengers died. She has intrusive memories, avoids travelling by bus and has angry outbursts. She has started trauma-focused CBT and the psychiatrist wants to add a drug. Which drug is first-line?
1. ALithium
2. BSertraline
3. CAlprazolam
4. DOlanzapine
Show answerHide answer
Answer: B · Sertraline
This is post-traumatic stress disorder. Alongside trauma-focused psychotherapy, SSRIs such as sertraline or paroxetine are the first-line drugs, and they help intrusive symptoms, avoidance and the commonly co-existing depression. Benzodiazepines are best avoided: they do not treat the core symptoms, may hinder trauma processing and carry dependence. Antipsychotics are kept for refractory cases or psychotic features.
- A: Lithium is a mood stabiliser for bipolar disorder, not PTSD.
- C: Benzodiazepines do not treat core PTSD symptoms and risk dependence.
- D: Antipsychotics are only for refractory PTSD or psychotic features, not first-line.
Question 5 · Medium
A 23-year-old woman is brought to casualty breathing fast and feeling she will die, with tingling around the mouth and spasm of both hands. ABG on room air: pH 7.53, pCO2 25 mmHg, HCO3- 22 mmol/L, pO2 104 mmHg. Why does she have carpopedal spasm?
1. ACerebral hypoxia from reduced oxygen delivery
2. BRise in serum potassium from cell shift
3. CFall in ionised calcium as albumin binds more calcium
4. DFall in total serum calcium from increased renal calcium loss
Show answerHide answer
Answer: C · Fall in ionised calcium as albumin binds more calcium
The ABG shows acute respiratory alkalosis from hyperventilation during a panic attack: high pH, low pCO2 and a still-normal bicarbonate. In alkalosis albumin releases hydrogen ions and binds more calcium, so ionised calcium falls although total calcium is unchanged, and nerve and muscle become hyperexcitable, giving tingling and carpopedal spasm. Calm reassurance and slow breathing settle it. Treating the underlying panic disorder prevents recurrences.
- A: Her pO2 is high; low pCO2 constricts cerebral vessels but does not cause carpopedal spasm.
- B: Alkalosis shifts potassium into cells, lowering rather than raising it.
- D: Total calcium is unchanged; only the ionised fraction falls.
Question 6 · Medium
A 45-year-old schoolteacher has visited six doctors in a year, convinced that he has stomach cancer since a colleague died of it. He has no physical symptoms. Endoscopy, ultrasound and blood tests were normal; reassurance calms him for a few days only, and he checks his abdomen daily. What is the most likely diagnosis?
1. AFunctional neurological symptom disorder
2. BIllness anxiety disorder
3. CDelusional disorder, somatic type
4. DSomatic symptom disorder
Answer and explanation in LearnFree account
Question 7 · Medium
A 40-year-old bank officer has worried excessively about money, his children and his health on most days for the past year, with muscle tension, poor sleep and irritability. He refuses any drug that might cause dependence or drowsiness, and is started on buspirone. How does buspirone act?
1. APositive modulator of GABA-A receptors
2. BAntagonist at D2 receptors
3. CInhibitor of serotonin reuptake
4. DPartial agonist at 5-HT1A receptors
Answer and explanation in LearnFree account
Question 8 · Hard
A 26-year-old staff nurse is admitted with recurrent hypoglycaemia; she has no diabetes. During an episode: blood glucose 38 mg/dL, serum insulin very high, C-peptide low, and a sulfonylurea screen negative. She has insulin pens at home for her diabetic mother, and she seeks no compensation or leave. What is the most likely diagnosis?
1. AInsulin-secreting islet cell tumour
2. BCovert sulfonylurea ingestion
3. CFactitious disorder imposed on self
4. DMalingering for financial gain
Answer and explanation in LearnFree account
Question 9 · Hard
A 42-year-old shopkeeper with panic disorder has taken alprazolam 2 mg daily for three years. Two days ago he stopped it suddenly after reading about addiction. He is now brought with tremor, sweating, insomnia, marked anxiety and a generalised tonic-clonic seizure an hour ago; he has no fever and no focal signs. What is the next best step?
1. AHaloperidol to control the agitation
2. BPhenytoin, keeping alprazolam stopped
3. CLong-acting benzodiazepine, then a slow taper
4. DEscitalopram alone with observation
Answer and explanation in LearnFree account
Question 10 · Medium
A 22-year-old woman asks a plastic surgeon for a second rhinoplasty. She spends hours checking her nose in mirrors, avoids college because she believes people stare at its 'ugly hump', and was not satisfied after the first operation. Her nose looks normal to the surgeon. What is the most appropriate management?
1. ARevision rhinoplasty as she requests
2. BReassurance and discharge from the clinic
3. CSSRI with cognitive behaviour therapy
4. DAntipsychotic as the only treatment
Answer and explanation in LearnFree account
Question 11 · Medium
A 19-year-old first-year MBBS student faints whenever she watches a blood sample being drawn. Her heart races at first, then she becomes pale, her pulse slows and she collapses. She wants to cope with clinical postings. Which behavioural technique is specific for her phobia?
1. AHabit reversal
2. BThought stopping
3. CApplied tension
4. DApplied relaxation
Answer and explanation in LearnFree account
Question 12 · Easy
A 19-year-old engineering student spends three hours a day washing his hands because he fears contamination, although he knows the fear is excessive. His skin is cracked and he has missed several exams. Which psychological treatment has the best evidence for his condition?
1. AExposure and response prevention
2. BAversion therapy
3. CSystematic desensitisation
4. DLong-term psychoanalytic psychotherapy
Answer and explanation in LearnFree account
Question 13 · Hard
A 19-year-old woman has had six 'fits' in a month, each after an argument at home. Witnesses describe side-to-side head movements, pelvic thrusting and eyes held tightly shut for several minutes, with full awareness soon after. She has had no injuries and two routine EEGs are normal. Which investigation will best confirm the diagnosis?
1. AVideo-EEG monitoring during an attack
2. BRepeat routine EEG with sleep deprivation
3. CMRI brain with epilepsy protocol
4. DSerum prolactin a day after an attack
Answer and explanation in LearnFree account
Question 14 · Medium
A 34-year-old fisherman was trapped on his roof for two days during floods in which his neighbour drowned. Three months later he has nightmares and vivid flashbacks of the water, avoids the riverbank, startles at small noises and sleeps poorly. What is the most likely diagnosis?
1. APost-traumatic stress disorder
2. BGeneralised anxiety disorder
3. CAdjustment disorder with anxiety
4. DAcute stress reaction
Answer and explanation in LearnFree account
Question 15 · Medium
A 17-year-old girl is brought to casualty unable to stand, an hour after a quarrel with her parents about her marriage. She seems unconcerned. Tone and deep tendon reflexes are normal and plantars are flexor. When she lies supine and flexes the right hip against resistance, the 'weak' left leg presses down firmly. What is the most likely diagnosis?
1. AFunctional neurological symptom disorder
2. BAcute inflammatory demyelinating neuropathy
3. CMalingering for an external reward
4. DFactitious disorder imposed on self
Answer and explanation in LearnFree account
Question 16 · Medium
A 30-year-old surgery resident is well in daily life but develops tremor, palpitations and a shaky voice whenever he has to present at the monthly departmental seminar. He has no asthma. He asks for something to take on those days only. What is the best choice?
1. ADaily clonazepam for three months
2. BDaily escitalopram for at least twelve months
3. CPropranolol about an hour before the seminar
4. DBuspirone on the morning of the seminar
Answer and explanation in LearnFree account

Anxiety, OCD, PTSD and somatic disorders

Which tricyclic antidepressant is the most effective in obsessive-compulsive disorder?

A 28-year-old woman survived a bus accident on a highway six months ago in which two passengers died. She has intrusive memories, avoids travelling by bus and has angry outbursts. She has started trauma-focused CBT and the psychiatrist wants to add a drug. Which drug is first-line?

A 23-year-old woman is brought to casualty breathing fast and feeling she will die, with tingling around the mouth and spasm of both hands. ABG on room air: pH 7.53, pCO2 25 mmHg, HCO3- 22 mmol/L, pO2 104 mmHg. Why does she have carpopedal spasm?

A 40-year-old bank officer has worried excessively about money, his children and his health on most days for the past year, with muscle tension, poor sleep and irritability. He refuses any drug that might cause dependence or drowsiness, and is started on buspirone. How does buspirone act?

A 19-year-old first-year MBBS student faints whenever she watches a blood sample being drawn. Her heart races at first, then she becomes pale, her pulse slows and she collapses. She wants to cope with clinical postings. Which behavioural technique is specific for her phobia?

A 19-year-old engineering student spends three hours a day washing his hands because he fears contamination, although he knows the fear is excessive. His skin is cracked and he has missed several exams. Which psychological treatment has the best evidence for his condition?

A 34-year-old fisherman was trapped on his roof for two days during floods in which his neighbour drowned. Three months later he has nightmares and vivid flashbacks of the water, avoids the riverbank, startles at small noises and sleeps poorly. What is the most likely diagnosis?

A 30-year-old surgery resident is well in daily life but develops tremor, palpitations and a shaky voice whenever he has to present at the monthly departmental seminar. He has no asthma. He asks for something to take on those days only. What is the best choice?