Page Contents
OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose answer is generalized anxiety disorder (GAD). While this may seem a odd practice, it is useful to see multiple examples of how generalized anxiety disorder will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)
When it comes to standardized exams, each condition has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for generalized anxiety disorder.
Chief Complaint:
- Anxiety with no clear patterns/triggers: patients with this condition will be concerned about “everything” with no clear pattern of what triggers the anxiety.
- Difficulty concentrating can be the result of the patient’s anxiety
- Difficulty sleeping can also be the result of the patient’s anxiety
- Tension headaches are commonly associated with this condition.
- Back/muscle pain often can be present with this condition
Clinical Workup:
- Unremarkable workup: typically no other cause of the patient’s anxiety will be revealed in the clinical workup for the patient.
QUESTION EXAMPLES
Question # 1
A 24 year old woman comes to the clinic because of a 4 year history of headaches and diarrhea that have increased in frequency and intensity over the past month. She explains hat after graduating college 4 months ago, her boyfriend of 4 years ended their relationship and left town to pursue a career outside the country. 3 weeks ago, she started working a new job as a receptionist for a local company. She is now concerned about her job performance at the new position, and if she will have enough money to pay for both her utility bills, and her student loan payments. She explains that for the majority of her last year in school, she was very preoccupied with finding a job after her expected graduation. Her concerns often make it difficult for her to sleep, and to concentrate on her current job. She explains that she has always been a worrier, and back when they were together, she was always asking her boyfriend to re-assure her that he would never leave her. She denies drug or alcohol usage. Her vitals are within normal limits. Her physical exam is only remarkable for muscle tension in the neck/shoulder. Her mental status exam demonstrates restlessness/anxiety. She says that her mood is variable depending on what she is doing at the moment. Her thought process is organized, and she does not have any evidence of suicidal ideation or psychosis. What is this patient’s most likely diagnosis?
Explanation # 1
Anxiety without clear patterns (i.e. generalized) + unremarkable clinical workup = generalized anxiety disorder
Question # 2
An 9 year old girl is brought to the clinic because her mother has noticed that she has been having frequent stomachs for the past 2 months. She has had a 1 year difficulty with falling asleep and has poor concentration. She has always been an excellent student, and is alive in sports. Her parents divorced 7 months ago. Her physical exam is unremarkable. Mental status exam shows that she has a anxious affect but a coherent though process. She explains that she is worried about her classes, her performance in the school band, and how well she is doing on the soccer team. What is the most likely diagnosis?
Explanation # 2
Anxiety without clear patterns (i.e. generalized) + unremarkable clinical workup = generalized anxiety disorder
Question # 3
A 37 year old woman comes to the clinic with complaints of difficulty sleeping, and headaches for the past year and a half. She explains that she is always feeling “on edge” and is constantly worried about “the little things in life”. When she tries to go to bed at night, she lays awake worrying about the mistakes she might have made during the day, and feels “overwhelmed” by what she has to accomplish the next day. The patient’s past medical history is not remarkable. Physical examination and routine lab studies are within normal limits. Thyroid function tests are normal. The patient has never been treated for her symptoms, but does admit to taking a tablet of alprazolam offered by a friend. She states that this medication helped for a little while, but then did not last very long in controlling her “concerns”. The patient drinks a glass of wine every other week during social functions, and denies any illicit substance usage. What is the most likely diagnosis for this patient?
Explanation # 3
Anxiety without clear patterns (i.e. generalized) + unremarkable clinical workup = generalized anxiety disorder
Question # 4
A 35 yea told female comes to the clinic because she has issues with chronic anxiety. She explains that she worries about “everything all the time”. She is concerned about her family, her career, and managing her household. She has difficulty concentrating at work because she is always worried about the whereabouts and safety of her two sons, and her husband. She also complains of frequent tension headaches that “seem to make matters worse”. She denies feeling depressed, and explains that she has had no issues with sleep or appetite. Routine labs and thyroid function tests are unremarkable. What is the likely diagnosis for this patient?
Explanation # 4
Anxiety without clear patterns (i.e. generalized) + unremarkable clinical workup = generalized anxiety disorder
Question # 5
A 20 year old male college student is very concerned with his performance in class, and feels marked anxiety about his upcoming midterm exams. He is so concerned, that he can not even focus on his study guides and is having difficulty preparing for the exam. Aside from school, he explains to his family doctor that he is also concerned about whether or not his friend group at college truly enjoy his company, his ability to afford his current lifestyle, and if he is spending too much time playing video games instead of doing other productive activities. He explains that he also worries about the future, and if he will ever be able to land a good job after school. He explains that he has been having difficulty sleeping as of late, and that his symptoms seem to have worsened over the last year. What is the likely diagnosis in this patient?
Explanation # 5
Anxiety without clear patterns (i.e. generalized) + unremarkable clinical workup = generalized anxiety disorder
Question # 6
A 25 year old graduate comes to comes to the clinic because she has been experiencing anxiety and insomnia for the past year. She feels as though she is always “wired” and can not relax. She is concerned about her performance in school even though her graduate advisor expresses that she is doing well. She is also concerned about the stability of her relationship with her friends, family, and partner despite repeated reassurance from everyone. She drinks one cup of coffee each morning, and denies drinking alcohol or using tobacco products. She does not have any history of illicit drug usage. Vitals and a physical exam are unremarkable. A mental status exam is unremarkable other than an anxious mood. Routine labs are unremarkable. A serum TSH and T4 are within normal limits. What is the likely diagnosis in this patient?
Explanation # 6
Anxiety without clear patterns (i.e. generalized) + unremarkable clinical workup = generalized anxiety disorder
Question # 7
A 16 year old female is brought to the clinic by her father because “she is so hard to get along with these days”. The father explains that this all began around the time she started school about 8 months ago. She has been irritable and also has had difficulty concentrating on her schoolwork. The patient explains that she has difficulty sleeping, and is restless at night. She has recently begun to worry that her boyfriend might reject her. She worries about her appearance and spends a considerable amount of time trying to apply her makeup. She admits that her friends have always commented on her being “on edge” and feels very anxious when she is at work at the local fast food joint because she feels she is not as good as her job as the other employees. She obsesses over her grades and is very concerned with getting accepted into a top University after she finishes high school. What is the likely diagnosis in this patient?
Explanation # 7
Anxiety without clear patterns (i.e. generalized) + unremarkable clinical workup = generalized anxiety disorder
TESTABLE FACTS ABOUT THIS TOPIC (BEYOND ITS IDENTIFICATION)
Many questions on standardized exams go beyond simply recognizing the underlying condition. Often there are specific testable facts regarding some aspect of the disease’s pathophysiology/management/clincial implications that are commonly asked. Some of these are listed below:
Treatment:
- SSRI medications are first line treatment agents.
- SNRI medications are another first line treatment option.
- Benzodiazepines are limited for short term use, and for patients who are not depressed. Patients with a history of substance abuse are generally not ideal candidates for benzos.
Page Updated: 09.17.2016