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Anxiety (also called angst or worry) is a psychological and physiological state characterized

by somatic, emotional, cognitive, and behavioralcomponents.[2 The root meaning of the word anxiety is 'to
vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear,
worry, uneasiness, and dread.[4] Anxiety is considered to be a normal reaction to a stressor. It may help
an individual to deal with a demanding situation by prompting them to cope with it. When anxiety
becomes excessive, it may fall under the classification of an anxiety disorder.
Test anxiety involves a combination of physiological over-arousal, worry and dread about test
performance, and often interferes with normal learning and lowers test performance. It is a physiological
condition in which people experience extreme stress, anxiety, and discomfort during and/or before taking
a test. Test anxiety is prevalent amongst the student populations of the world, and has been studied
formally since the early 1950s. [1]
Test anxiety can also be labeled as "anticipatory anxiety", "situational anxiety" or "evaluation anxiety" if
the anxiety is occurring when preparing for a test or while taking a test. Some anxiety is normal and often
helpful keeping you mentally and physically alert. Although, when one experiences too much anxiety it
can result in emotional and/or physical distress, difficulty concentrating, and emotional upset.

Physical symptoms of test anxiety include sweating, shaking, rapid heart beat, dry mouth,
fainting and nausea. Milder cases of test anxiety can cause a sense of "butterflies" in the stomach,
while more severe cases can actually cause students to become physically ill.

Cognitive and behavioral symptoms can include fidgeting or outright avoidance of testing
situations. In some cases, test anxiety can become so severe that students will drop out of school in
order to avoid the source of their fear. Substance abuse can also occur, since many students
attempt to self-treat their anxiety by taking "downers" such as prescription medications and alcohol.
Many people with test anxiety report "blanking out" answers to the test, even though they
thoroughly studied the information and were sure that they know the answers to the questions.
Negative self-talk, trouble concentrating on the test and racing thoughts are also common cognitive
symptoms of test anxiety.

Emotional symptoms of test anxiety can include depression, low self-esteem, anger and a
feeling of hopelessness. Students often feel helpless to change their situation, or belittle and berate
themselves about their symptoms and poor test performance.

Kaplan, H. and Sadock, B. in the Concise Textbook of Clinical Psychiatry(1996) state that
anxiety "is characterized by a diffuse, unpleasant, vague sense of apprehension, often
accompanied by autonomic symptoms, such as headache, perspiration, palpitations,
tightness in the chest, and mild stomach discomfort" (pg. 189).

They comment that a person who is anxious often feels restless and unable to be still for
From these definitions, we can conclude that anxiety is an unpleasant feeling of
apprehensiveness. It often includes physical symptoms. If anxiety becomes debilitating and
chronic, it may be diagnosable as ananxiety disorder.
So, if the definition of anxiety can be summarized as an unpleasant feeling of

Review of lit.


Factors causing exam anxiety in medical students

Shireen Hashmat1, Masooma Hashmat2, Farhana Amanullah3, Sina Aziz4

Medical Unit III1,2,4, Civil Hospital & Dow University of Health Ssciences, Karachi, Sindh Institute of Urology
&Transplantation3, Karachi.

A total of 120 students out of 200 (60%) filled in the questionnaire. There were 25.8% male and 74.2%
female students. The average maximum Exam Anxiety marked on VAS was 6428. Among different
contributing to exam anxiety, extensive course loads (90.8%), lack of physical exercise (90%) and long
of exams (77.5%) were the most important factors reported by the students. Most of the students had
knowledge of exam-taking and anxiety-reduction techniques and majority of those who knew these
strategies did
not implement them.
Conclusion: This study indicates moderate level of exam anxiety based on a Visual Analogue Scale in
of a medical college and also highlights factors such as extensive course load, lack of exercise and
long duration
of exams which contribute to Exam Anxiety (JPMA 58:167;2008).
Vol. 58, No. 4, April 2008 167



Areeba Husain Rizvi, Maha Awaiz, Zohra Ghanghro, Mehjabeen

Ahmed Jafferi, Sina Aziz*

Students of Dow Medical College, *Department of Paediatrics, Dow University of Health Sciences,
Karachi, Pakistan

Review Board of Dow University of Health Sciences was obtained before starting the
research. Results:
The data for this study was collected from 226 students of 2nd year MBBS, Dow Medical
Karachi on specially designed questionnaires. Among the 226 students 22.1% were male
while 77.9%

were female with mean age 201 years. Changes observed in pre-examination period
included anorexia,
nausea, fatigue (54.87%), changed concentration span (80.09%), increased irritability
(68.14%), mood
swings (50.88%), disturbed menstrual cycle (15.91%), disturbed sleep cycle (80.97%),
increased intake of
caffeine/energy drinks (38.94%), disturbed metabolism (46.02%), aggravated skin problems
such as acne
(12.83%). Among the 226 students 42.04% did regular exercise and 76.12% prayed
regularly. Both of
these factors helped them in coping with stress. Conclusion: Majority included in our
experienced stress prior to exams but the signs and symptoms varied greatly. Irritability,
increased intake
of caffeine/energy drinks, and disturbed sleep cycle seemed to dominate physiological and
changes in the pre-examination period.
J Ayub Med Coll Abbottabad 2010;22(2)