A 20-year-old female complains of sudden onset palpitation and apprehension. She is sweating for last 10 minutes and fears of impending death. Diagnosis is

Appeared in: OSSSC Nursing Officer-2021

Explanation

The patient's symptoms—sudden onset, palpitations, sweating, apprehension, and a fear of impending death—are the hallmark signs of a panic attack.
A panic attack is defined as an abrupt surge of intense fear or discomfort that reaches a peak within minutes.
The combination of acute, severe physical symptoms (autonomic arousal) and catastrophic psychological symptoms (fear of dying) is characteristic of a panic attack, distinguishing it from other anxiety disorders.

Why Other Options Were Wrong

Option A: Hysteria is an outdated and imprecise term. Modern diagnoses like conversion disorder involve neurological symptoms (e.g., paralysis, blindness) without a medical cause, which is not what the patient is experiencing.
Option B: Generalized Anxiety Disorder (GAD) is characterized by chronic, excessive, and persistent worry about multiple issues, lasting for at least six months. It does not present as a sudden, intense, short-lived episode.
Option C: Cystic fibrosis is a chronic, inherited disease that primarily affects the lungs and digestive system. Its symptoms include persistent coughing, lung infections, and poor weight gain, which are completely different from the patient's acute presentation.

Related Visual

Clinical Relevance

Nursing practice connection: Use the key finding related to Differential diagnosis of acute anxiety symptoms to guide bedside assessment, documentation, and the next nursing action.
A nurse's first priority during a patient's panic attack is to ensure safety and provide reassurance. Staying with the patient and maintaining a calm presence can significantly reduce their fear.
It is crucial to perform a rapid assessment to rule out life-threatening medical conditions like a myocardial infarction or pulmonary embolism, as the symptoms can overlap.
Patient education is key after the attack subsides. Teaching breathing control techniques and explaining the nature of panic attacks can empower the patient and reduce anticipatory anxiety about future episodes.

How to Approach the Question

First, analyze the clinical vignette for key descriptive words. Note terms like 'sudden onset,' 'palpitation,' 'sweating,' and 'fear of impending death.'
Recognize that this cluster of symptoms points towards an acute, intense event rather than a chronic condition.
Evaluate the options based on this understanding. 'Cystic fibrosis' is a chronic genetic illness and can be eliminated. 'Hysteria' is an outdated term and not a specific diagnosis.
Differentiate between the remaining two anxiety disorders. 'Generalized Anxiety Disorder' involves long-term, pervasive worry.
Contrast this with 'Panic attack,' which is defined by discrete, abrupt episodes of intense fear with severe physical and psychological symptoms.
Conclude that the patient's presentation perfectly matches the criteria for a panic attack.

Concept Tested & Keywords

Concept Tested: Differential diagnosis of acute anxiety symptoms
Stem keywords: sudden onset palpitation, apprehension, sweating, fears of impending death
Lead-in keywords: Diagnosis is
Clinical cues: Sudden onset of symptoms
Clinical cues: Combination of physical (palpitation, sweating) and psychological (apprehension, fear of death) symptoms

Question ID

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Reference Book

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 1286-1288

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 5721-5723

E6 Medicine Harrison 22e Part 2 p. 1562-1564

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