An 18-year-old male comes to your office because of the recent onset of recurrent, sudden episodes of palpitations, sweating, dyspnea, gastrointestinal distress, dizziness, and paresthesias. His physical examination is unremarkable except for moderate obesity. Laboratory findings, including a CBC, blood chemistry profile, and thyroid-stimulating hormone (TSH) level, reveal no abnormalities.
The most likely diagnosis is:
Correct Answer E:
Panic disorder (choice E) typically presents with the symptoms described, in late adolescence or early adulthood. The attacks are sporadic and last 10-60 minutes.
→ Patients with mitral valve prolapse (choice A) usually have an abnormal cardiac examination.
→ Pheochromocytoma (choice C) is associated with headache and hypertension, and usually occurs in thin patients.
→ Paroxysmal supraventricular tachycardia (choice B) is usually not associated with gastrointestinal distress or paresthesias.
→ Generalized anxiety disorder (choice D) is more common, and common symptoms include restlessness, fatigue, muscle tension, irritability, difficulty concentrating, and sleep disturbance.
A 28-year-old married mother of one presents to her family physician with a history of sudden onset of palpitations, feelings she can not get enough air and that she is going to die. She has had several of these episodes in the last two months. She has been to the emergency department on three occasions and was told that her blood pressure, ECG, and chest x-ray are normal.
Which one of the following is the most likely diagnosis?
A panic attack is the sudden onset of a discrete, brief period of intense discomfort, anxiety, or fear accompanied by somatic or cognitive symptoms. Panic disorder is occurrence of repeated panic attacks typically accompanied by fears about future attacks or changes in behavior to avoid situations that might predispose to attacks.
Diagnosis is clinical. Isolated panic attacks may not require treatment. Panic disorder is treated with drug therapy, psychotherapy (eg, exposure therapy, cognitive-behavioral therapy), or both.
A 30-year-old man is described by his wife as a procrastinator who avoids obligations by claiming to have "forgotten". His co-workers mention that he obstructs their efforts and resents useful suggestions.
This is most likely:
Correct Answer C:
Passive-aggressive behavior refers to passive, sometimes obstructionist resistance to following authoritative instructions in interpersonal or occupational situations. It can manifest itself as resentment, stubbornness, procrastination, sullenness, or repeated failure to accomplish requested tasks for which one is assumed, often explicitly, to be responsible.
It is a defense mechanism and, more often than not, only partly conscious. For example, people who are passive aggressive might take so long to get ready for a party they do not wish to attend, that the party is nearly over by the time they arrive. Alternatively, leaving notes to avoid face-to-face discussion/confrontation is another form of passive aggressive behavior.
What is the drug of choice for the treatment of obsessive compulsive disorder?
Correct Answer B:
Obsessive-compulsive disorder (OCD) is characterized by anxiety-provoking ideas, images, or impulses (obsessions) and by urges (compulsions) to do something that will lessen that anxiety. The cause is unknown. Diagnosis is based on history. Treatment consists of psychotherapy, drug therapy, or, especially in severe cases, both. SSRIs (eg fluoxetine) and clomipramine are most commonly used.
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