Panic disorder with agoraphobia — RACGP Fellowship MCQ

Instant feedback + full explanation. One question, done properly.

ModerateMental healthPanic disorder with agoraphobiaRACGP Fellowship

A 35-year-old woman presents with palpitations, breathlessness and fear of dying. Episodes peak within minutes and resolve in 20 minutes. ECG between episodes and thyroid tests are normal. She avoids public transport because of fear of attacks. What is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Panic disorder with agoraphobic avoidance

Explanation lettering: E = shown as B · D = shown as C · B = shown as D · C = shown as E

The diagnosis is **panic disorder with agoraphobic avoidance (C)**. The clinical presentation is pathognomonic: discrete panic attacks (sudden onset, peak within 20 minutes, cardinal symptoms of palpitations and breathlessness with catastrophic cognition—fear of dying) coupled with marked avoidance behaviour (public transport). The normal ECG and thyroid function exclude organic causes. GAD (A) manifests as persistent generalised worry, not discrete paroxysmal episodes. Bipolar disorder (B) requires mood elevation or depression, absent here. Somatic symptom disorder (D) centres on symptom preoccupation and health anxiety sustained across ≥6 months; this patient has episodic panic-driven avoidance. Delirium (E) presents with acute confusion and disorientation. According to RACGP guidance, panic disorder (prevalence 2.6%) peaks in the 35–44 year age group (this patient's cohort) and is characterised by recurrent unexpected attacks with behavioural change—precisely fitting this case.

Reference: Australian Prescriber: Treatment of panic disorder (https://australianprescriber.tg.org.au/articles/treatment-of-panic-disorder.html); RACGP Anxiety disorders – Assessment and management in general practice; RACGP Cognitive behavioural therapy: Panic disorder (https://www.racgp.org.au/getattachment/015a19e4-b87d-48e5-b717-89d071d9cff3/CBT-for-panic-disorder.aspx)