Anxiety disorders: Clinical

To be retired ⓘ

00:00 / 00:00



Anxiety disorders: Clinical

USMLE® Step 2 questions

0 / 19 complete


USMLE® Step 2 style questions USMLE

of complete

A 26-year-old woman comes to the emergency department because of heart palpitations, profuse sweating, difficulty breathing, and chest pain. She has had these episodes infrequently over the past 3 months and is fearful of future episodes. She has no history of drinking alcohol, smoking tobacco, or using illicit drugs. She also reports having no allergies and currently takes no medications. Vital signs show her temperature is 37.2°C (99°F) , pulse is 120/min, respirations are 25/min, and blood pressure is 130/70 mm Hg. Oxygen saturation is 98% on room air. Physical examination shows the patient is sweating profusely but has a normal lung, heart, and neurological exam. An ECG shows no abnormalities. Which of the following is the most appropriate initial treatment option for this patient?  


Normally, anxiety works to set the body on high-alert during stressful times. In anxiety disorders, these normal feelings of anxiety go into overdrive, worsening performance on the job, at school, and in relationships. Anxiety disorders are extremely common affecting up to 30 percent of adults at some point in their lives.

Anxiety disorders are caused by a combination of genetics, stress, environmental and social factors. For example, it may be due to having a low level of the neurotransmitter GABA - which is linked to anxiety, a tough job like police work, increased caffeine intake, and going through a divorce.

There’s also a strong correlation with trauma like humiliation, bullying, and sexual abuse, especially if it occurred during childhood.

There’s also evidence that individuals tend to mirror the anxiety of those around them. That’s why threats to the community - like violence and global warming - are able to directly and indirectly raise anxiety.

According to DSM-5, there are nine anxiety disorders: the archetype - generalized anxiety disorder, and the other eight illness that feature similar symptoms - separation anxiety disorder, selective mutism, specific phobia, social anxiety disorder, agoraphobia, panic disorder, substance or medication-induced anxiety disorder, and anxiety disorder due to another medical condition.

The two key symptoms in anxiety disorders are fear and uncontrollable anxiety. Fear is the emotional response to a real or perceived imminent threat, whereas anxiety is the anticipation of a future threat.

Fear causes a fight or flight response when your life is threatened, while anxiety is often associated with feelings of imminent danger and causes avoidant behaviors. For example, fear is what you might feel during an exam, while anxiety is the dread you may feel the night before the exam.


Copyright © 2023 Elsevier, its licensors, and contributors. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Cookies are used by this site.

USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). COMLEX-USA® is a registered trademark of The National Board of Osteopathic Medical Examiners, Inc. NCLEX-RN® is a registered trademark of the National Council of State Boards of Nursing, Inc. Test names and other trademarks are the property of the respective trademark holders. None of the trademark holders are endorsed by nor affiliated with Osmosis or this website.