AMC MCQ Depression and anxiety Questions: 10 Free Practice MCQs
Depression and anxiety questions test severity, risk and the treatment ladder. The AMC MCQ expects a structured assessment, direct questions about suicide, and a plan that matches severity: psychological therapy first for mild illness, combined treatment for moderate to severe illness. The blueprint also covers perinatal depression, the GP mental health treatment plan and the patient who does not improve.
Where candidates lose marks
- Missing suicidal intent because the question was never asked.
- Starting an antidepressant for mild illness without offering psychological treatment first.
- Forgetting to screen for bipolar disorder and perinatal illness.
- Continuing the same treatment without review when the patient has not responded.
Guideline to follow: The AMC MCQ follows the Royal Australian and New Zealand College of Psychiatrists mood disorder guidelines, the Australian perinatal mental health guidance and eTG.
Ten AMC MCQ-style depression and anxiety questions with the answer and the reasoning behind it. They come from the AU.med bank, which has 27 depression and anxiety questions and many more across every topic.
1 / 10
A 23-year-old female presents with severe, debilitating fear of flying. She has to travel by air in 2 weeks for a job interview. She has no other psychiatric co-morbidities.
What is the most appropriate short-term pharmacological option to manage her acute situational anxiety?
Show answer
Answer: C. Prescribe a short course of a short-acting benzodiazepine (e.g., Diazepam 2-5 mg) to be taken 1 hour before the flight.
Why: For simple phobias where exposure is infrequent (e.g., flying), a low dose of a short-acting benzodiazepine (like Diazepam or Alprazolam) can be used as needed. Long-term management should focus on CBT and exposure therapy.
- A. SSRIs require several weeks to work and are not indicated for isolated situational anxiety.
- B. While beta-blockers help with performance anxiety (tremor/tachycardia), they are less effective for severe situational phobias compared to short-term benzodiazepines.
- D. Atypical antipsychotics are not indicated for simple phobias and carry metabolic/cardiac risks.
Sources: RANZCP Anxiety Guidelines; eTG Complete - Situational Anxiety
2 / 10
An 82-year-old man is brought to the clinic by his daughter. She is concerned that he is developing dementia, as he has become increasingly forgetful, slow to respond, and has lost weight over the past 3 months. On cognitive testing (MMSE), he scores 22/30, but frequently responds to questions with 'I don't know' and makes little effort. On further questioning, he admits to feelings of hopelessness and poor sleep.
What is the most appropriate next step in managing this patient?
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Answer: C. Trial an antidepressant (e.g., Sertraline) and provide supportive therapy.
Why: Depressive pseudodementia refers to cognitive impairment secondary to depression in elderly patients. Key features distinguishing it from true dementia include: rapid onset, patient highlighting their memory failures, poor effort during cognitive assessment (classically giving 'I don't know' answers), and recovery of cognitive function once the depression is successfully treated with antidepressants or ECT.
- A. Donepezil is for Alzheimer's disease. The patient's presentation suggests pseudodementia (depression presenting with cognitive impairment), which should be treated first.
- B. Cognitive decline affecting daily function and accompanied by depressive symptoms is not normal aging and requires active treatment.
- D. Functional neuroimaging is not the initial step when a highly treatable condition like depression is suspected.
Sources: RANZCP Mood Disorders in the Elderly; eTG Complete - Dementia and Depression
3 / 10
A 52-year-old woman with a severe depressive episode is seen in clinic. She has made two previous suicide attempts and says that life is not worth living. The registrar is asked what must be assessed explicitly.
Which factors does the RANZCP mood disorders guideline say should be assessed in her?
Show answer
Answer: D. Degree of hopelessness, suicidal ideation, intent and any developed plan, alongside past attempts and current mental state
Why: The guideline advises that in the context of mood disorders it is important to assess whether a person is at risk of attempting suicide, and that the key factors are a past history of any suicide attempt and the current mental state. It specifically recommends assessing the degree of hopelessness and suicidal ideation and whether there is intent and a developed plan, and states that these questions should be put to the patient explicitly. Physical tests, cardiovascular risk factors, cognitive screening and social details do not replace this direct enquiry.
- A. Physical investigations do not substitute for the clinical assessment of suicide risk that this woman's presentation requires.
- B. Cardiovascular risk factors are relevant to general health but are not the factors that estimate her immediate suicide risk.
- C. A cognitive screen does not assess hopelessness, suicidal ideation, intent or planning.
- E. Social circumstances may inform formulation but do not replace the direct assessment of hopelessness, ideation, intent and plan.
Sources: RANZCP Mood disorders clinical practice guideline (MDcpg 2020)
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4 / 10
A 30-year-old man wants to stop taking Paroxetine 20 mg daily, which he has been taking for GAD for 1 year. He discontinued the medication abruptly two days ago and now presents with dizziness, electric shock-like sensations in his head ('brain zaps'), anxiety, and sweating.
What is the most appropriate management?
Show answer
Answer: D. Re-escalate to Paroxetine 20 mg and implement a gradual taper over several weeks or months.
Why: Antidepressant discontinuation syndrome occurs after abrupt cessation or rapid dose reduction of antidepressants, particularly those with short half-lives (e.g., Paroxetine, Venlafaxine). Classic symptoms include 'brain zaps', dizziness, flu-like symptoms, irritability, and insomnia. Management involves restarting the drug and tapering it slowly (e.g., reducing by 10% of the dose every 2-4 weeks).
- A. The acute onset of electric shock-like sensations and somatic symptoms two days after stopping is typical of antidepressant discontinuation syndrome, not GAD relapse.
- B. Benzodiazepines are not the preferred treatment for antidepressant discontinuation syndrome and introduce dependence risks.
- C. While distressing, discontinuation syndrome is not life-threatening and can be managed in primary care by restarting and slowly tapering the medication.
Sources: RANZCP Mood Disorders Guidelines; eTG Complete - Antidepressant Discontinuation Syndrome
5 / 10
A 55-year-old woman with major depression has not responded to an adequate trial of an SSRI combined with psychological treatment, nor to a subsequent SNRI at full dose.
According to the RANZCP mood disorders guideline, when should electroconvulsive therapy be considered in a case like hers?
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Answer: D. After two adequate treatment failures, when it is usually considered third line
Why: The guideline recommends considering electroconvulsive therapy after one treatment failure where specifically indicated, but for most cases of treatment resistance it should be considered after two failures, and a cost-effectiveness analysis concluded that third-line treatment after two failures is the optimal strategy. This woman has had two adequate failures, so treatment is now appropriate. Waiting for five failures, using it before any medication, ruling it out because she takes an antidepressant, or requiring a previous response all misread the guideline.
- A. Requiring five failures would delay an effective treatment well beyond the point at which the guideline recommends considering it.
- B. Electroconvulsive therapy may be first line in specific severe presentations, but routine depression is treated with medication and psychological therapy first.
- C. Concomitant medication is one of the key practice considerations for electroconvulsive therapy rather than an absolute bar.
- E. A past good response is one indication, but it is not a precondition for offering treatment to a patient who has not previously received it.
Sources: RANZCP Mood disorders clinical practice guideline (MDcpg 2020)
6 / 10
A 46-year-old woman with a severe depressive illness has stopped eating and drinking, is profoundly hopeless and has a settled plan to end her life. She has lost 8 kg. The team judges that a rapid response is essential.
According to the RANZCP mood disorders guideline, what is the most appropriate treatment?
Show answer
Answer: C. Prescribe electroconvulsive therapy as first-line treatment
Why: The guideline recommends electroconvulsive therapy as a first-line treatment for severe depression when a rapid response is necessary, such as when a patient is at risk from suicide, malnutrition or dehydration, or when there is psychotic depression or catatonia. Antidepressants, psychotherapy alone, or a sedative with outpatient review are all too slow or insufficient. An antipsychotic alone would not address the core depressive syndrome or the urgency of her deterioration.
- A. Oral antidepressant treatment works too slowly for a patient whose nutrition and safety are already at immediate risk.
- B. Psychological therapy alone cannot deliver the rapid response this woman's physical state and suicide risk demand.
- D. A sedative with outpatient review provides no definitive treatment and leaves a high-risk patient unsupported.
- E. An antipsychotic by itself does not treat the depressive illness or deliver the speed required in this presentation.
Sources: RANZCP Mood disorders clinical practice guideline (MDcpg 2020)
7 / 10
A 31-year-old woman presents with a 6-month history of excessive, uncontrollable worry about multiple daily events, muscle tension, irritability, and poor sleep.
What is the first-line pharmacological treatment for this condition?
Show answer
Answer: D. Selective Serotonin Reuptake Inhibitor (SSRI) e.g., Escitalopram
Why: Generalized Anxiety Disorder (GAD) is characterized by persistent and excessive worry. First-line treatments include psychological interventions (CBT) and pharmacological treatment (SSRIs such as Escitalopram or Sertraline, or SNRIs such as Venlafaxine or Duloxetine). Benzodiazepines should be restricted to short-term crisis management.
- A. Benzodiazepines should not be used as first-line or long-term therapy for generalized anxiety disorder due to risk of dependence and tolerance.
- B. Buspirone is a second-line agent with slower onset and less robust efficacy data than SSRIs.
- C. Beta-blockers can help with somatic symptoms of anxiety (e.g., palpitations, tremor) but do not treat the psychic symptoms or worry of GAD.
Sources: RANZCP Anxiety Disorders Guidelines; eTG Complete - Generalized Anxiety Disorder
8 / 10
A 60-year-old woman with severe depression is referred with a suspicious breast lump. Her treating team considers that full disclosure of the probable diagnosis would seriously harm her mental health.
On what basis does the RACS position paper permit information to be withheld from a patient?
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Answer: B. On reasonable grounds that the patient physical or mental health may be seriously harmed
Why: The RACS position paper recognises that a surgeon discretion is required where, in extraordinary circumstances, information may need to be withheld from a patient on reasonable grounds that the patient's physical or mental health may be seriously harmed. Even then, if the patient does not want the offered information, the doctor still has a legal duty to advise the patient of material risks as well as basic information about the illness and proposed intervention. A patient preference not to know, a family request, or the absence of a court order do not fit the test the paper describes.
- A. A preference not to be told is not the test, because RACS requires the doctor to still advise of material risks and basic information about the illness.
- C. A family request does not by itself justify withholding information, and the position paper reserves this discretion for extraordinary circumstances.
- D. RACS does not link this exception to a court order, although it advises the surgeon to seek appropriate legal advice if in doubt.
Sources: Royal Australasian College of Surgeons, Informed consent (2019)
9 / 10
A 28-year-old breastfeeding mother presents at 6 weeks postpartum with severe depressive symptoms requiring pharmacological treatment.
Which SSRI is generally considered safest in breastfeeding (lowest excretion)?
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Answer: B. Sertraline
Why: Sertraline and paroxetine are the preferred SSRIs during breastfeeding due to their low infant milk-to-plasma concentration ratios and low infant serum levels. Fluoxetine is avoided as first-line due to its long active half-life and higher risk of accumulation in the breastfed infant.
- A. Long half-life, higher accumulation.
- C. Higher excretion, withdrawal possible.
- D. Contraindicated/High risk monitoring needed.
Sources: RWH Pregnancy and Breastfeeding Guidelines
10 / 10
A 25-year-old man presents with severe anxiety during social gatherings and presentations at work. He fears being embarrassed or judged by others. His symptoms have led to him avoiding social situations and turning down promotions.
What is the most appropriate first-line psychological treatment for this patient?
Show answer
Answer: A. Cognitive Behavioral Therapy (CBT)
Why: Social Anxiety Disorder (Social Phobia) is highly responsive to CBT, which focuses on identifying maladaptive thoughts about social performance and gradual exposure to feared situations. Pharmacotherapy (SSRIs like Escitalopram or Sertraline) can be used in combination or if CBT is unavailable or ineffective.
- B. Psychoanalysis is not a first-line, evidence-based therapy for social anxiety disorder.
- C. IPT is primarily used in depression, not social anxiety disorder.
- D. DBT is designed for borderline personality disorder and emotional dysregulation, not social anxiety.
Sources: RANZCP Anxiety Disorders Guidelines; eTG Complete - Social Anxiety
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