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Panic disorder — MCCQE Part 1 MCQ

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ModerateAnxietyPanic disorderMCCQE Part 1

A 44-year-old man has recurrent sudden episodes of palpitations, chest tightness, trembling, and fear of dying. Episodes peak within 10 minutes and cardiac assessment including ECG and troponin has been normal. He now avoids grocery stores due to fear of attacks. What is the most likely diagnosis?

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Correct answer: A — Panic disorder with agoraphobic avoidance

Recurrent abrupt panic attacks peaking quickly with avoidance of situations because of fear of attacks is panic disorder with agoraphobic avoidance. Acute coronary syndrome has been reasonably excluded in the repeated normal cardiac assessment, though it must be considered initially. Generalized anxiety is more persistent worry rather than discrete surges. Hyperthyroidism should be screened if clinically suggested but does not explain situational avoidance as well.

Reference: Canadian anxiety disorder guidelines