Deck 45: Anxiety

Question 1

Ms. Jones frequently visits the emergency department with complaints of chest pain, shortness of breath, dizziness, sweating, and nausea. Her EKG, imaging studies, cardiac enzymes, lipids, and metabolic panel results have all been normal. She presents to a primary care follow-up appointment requesting a cardiology referral. What actions do you perform to assess the appropriateness of a referral?

A) Assess for thyroid dysfunction and substance use.
B) Obtain a detailed history of symptoms including precipitating factors, duration, and factors that relieve or exacerbate symptoms.
C) Administer a Generalized Anxiety Disorder scale (GAD-7).
D) b and c
E) All of the above

Answer 1

E

Question 2

Benzodiazepines are appropriate to use as monotherapy for all anxiety disorders.

Answer 2

False

Question 3

Which of the following symptoms differentiate panic disorder from a panic attack?

A) Feelings of unreality of self-detachment
B) Prolonged worry about having another panic attack
C) Fear about being in situations that would be difficult to escape if a panic attack was experienced
D) Fear of being exposed to possible scrutiny by others

Answer 3

B

Question 4

Treatment for anxiety disorders is indicated

A) When a patient endorses symptoms for longer than 1 month
B) When a patient begin to experience panic attacks
C) When a patient has multiple visits for somatic complaints
D) When symptoms interfere with a patient's ability to function

Question 5

Dually diagnosed patients should not receive treatment for anxiety disorders until they achieve abstinence.

Question 6

Which of the following medications are appropriate first-line treatments for an anxiety disorder?

A) Buproprion, fluoxetine, citalopram
B) Clonazepam, duloxetine, paroxetine
C) Mirtazapine, guanfacine, amitriptyline
D) Escitalopram, venlafaxine, sertraline

Question 7

Mr. Smith has a diagnosis of generalized anxiety disorder. He responded well to increasing doses of citalopram, yet begins to complain of difficulty controlling his symptoms. He specifically endorses difficulty controlling anxious behaviors. Which is the best intervention to address his concerns?

A) Refer Mr. Smith to dedicated psychiatric care.
B) Initiate treatment with a different medication.
C) Recommend that he receive cognitive-behavioral therapy (CBT).
D) Augment his citalopram with an as needed medication.

Question 8

Mrs. Hernandez presents with complaints of irritability, difficulty with sleep, poor concentration, and stomach upset. She experienced a traumatic event 3 months ago. You prescribe an SSRI to address her symptoms. One month later she returns endorsing improvement of symptoms and requests to discontinue medication. You counsel her that medications should be continued for ________ after acute response to decrease the risk of recurrence.

A) 6 months
B) 2 years
C) 3 months
D) 1 year

Question 9

CBT, complementary medicine methods, and other psychosocial interventions are recommended as first-line treatments for women who are pregnant or nursing.

Question 10

A frequent source of partial response or lack of response of antidepressants to treat anxiety in the primary care setting is:

A) choosing the wrong medication
B) starting antidepressant medications at too high a dose
C) underdosing antidepressant medications
D) adverse reactions to medications.