USMLE Step 2 CK Psychiatry Questions: Panic Disorder and Agoraphobia

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Recurrent episodes of chest pain, palpitations and fear of dying in a young, healthy patient are a classic USMLE presentation. These three USMLE Step 2 CK psychiatry practice questions cover the diagnosis of panic disorder and agoraphobia and their treatment. Pick your answer first, then open the explanation.

Question 1: Young woman with sudden episodes of palpitations and fear of dying

A 24-year-old woman has had four episodes over the past 2 months of sudden palpitations, sweating, trembling, shortness of breath and a feeling that she is going to die. Each episode peaks within minutes and resolves in under 30 minutes. They occur without any trigger. Since then she worries constantly about having another attack. ECG, thyroid tests and a urine drug screen are normal. Which of the following is the most likely diagnosis?

A. Generalized anxiety disorder
B. Panic disorder
C. Social anxiety disorder
D. Hyperthyroidism

Correct answer: B. Panic disorder

Panic disorder = recurrent, unexpected panic attacks followed by at least 1 month of persistent worry about future attacks or a change in behavior to avoid them. Attacks peak within about 10 minutes and include palpitations, sweating, chest pain, shortness of breath and fear of dying.

Why the other options are wrong:

  • Generalized anxiety disorder is constant worry about many things for ≥6 months, not discrete attacks.
  • Social anxiety disorder is fear of being judged in social or performance situations; attacks occur only in those situations.
  • Hyperthyroidism is excluded by the normal thyroid tests.

High-yield: Always rule out medical causes first: hyperthyroidism, arrhythmias, pheochromocytoma, hypoglycemia and stimulant use (caffeine, cocaine, amphetamines).




Question 2: Fear of leaving home after panic attacks

A 21-year-old man has had recurrent panic attacks. Over the past 8 months he has stopped riding the bus, going to the supermarket and attending crowded classes because he fears he will not be able to escape or get help if an attack happens. He now rarely leaves his apartment. Which of the following is the most likely diagnosis?

A. Agoraphobia
B. Specific phobia
C. Avoidant personality disorder
D. Post-traumatic stress disorder

Correct answer: A. Agoraphobia

Agoraphobia is fear and avoidance of situations where escape might be difficult or help unavailable if panic-like symptoms occur, in at least 2 different situations (public transport, open spaces, enclosed places, crowds, being outside the home alone) for ≥6 months. It often develops after panic attacks, and both diagnoses can be given together.

Why the other options are wrong:

  • Specific phobia is fear of one specific object or situation (e.g. spiders, heights).
  • Avoidant personality disorder is a lifelong pattern of social avoidance due to fear of rejection, not fear of being trapped.
  • PTSD requires exposure to a traumatic event, with flashbacks and nightmares.

High-yield: Avoiding many places out of fear of being trapped = agoraphobia; avoiding people out of fear of criticism = social anxiety or avoidant personality.




Question 3: Best long-term treatment for panic disorder

A 30-year-old woman is diagnosed with panic disorder. Which of the following is the most appropriate long-term treatment?

A. Alprazolam
B. Sertraline and cognitive behavioral therapy
C. Propranolol
D. Bupropion

Correct answer: B. Sertraline and cognitive behavioral therapy

First-line long-term treatment for panic disorder (with or without agoraphobia) is an SSRI (such as sertraline, paroxetine or fluoxetine) or an SNRI (venlafaxine), combined with cognitive behavioral therapy including exposure.

Why the other options are wrong:

  • Alprazolam (a benzodiazepine) works quickly and may be used briefly while the SSRI takes effect, but long-term use risks dependence and withdrawal.
  • Propranolol helps physical symptoms of performance anxiety but is not effective for panic disorder.
  • Bupropion is not effective for anxiety disorders.

High-yield: SSRIs take 4–6 weeks to work and can initially increase anxiety, so start with a low dose.




Key takeaways

  • Recurrent unexpected panic attacks + ≥1 month of worry → panic disorder.
  • Fear/avoidance of ≥2 situations where escape is hard, ≥6 months → agoraphobia.
  • Long-term treatment → SSRI + CBT; benzodiazepines only short term.

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Written and reviewed by Dr. Ray Makar, MD. Last reviewed: October 2026. For exam preparation only, not medical advice.

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