A 28-Year-Old Woman Requests an Emergency Office Appointment After an Episode

question 362

Multiple Choice

A 28-year-old woman requests an emergency office appointment after an episode of palpitations, dizziness, chest pain, and nausea while giving a presentation at work.  The patient says, "I suddenly felt dizzy and my chest was pounding.  My hands and legs were tingling and I was afraid I was going to pass out."  She describes several similar episodes over the past several months and worries about having another episode.  She says, "I am especially afraid when it happens at work because it is so embarrassing, but it even happens when I am home doing nothing."  The patient has no significant medical history.  She drinks a glass of wine 3 or 4 times a week and takes no medications.  Family history is significant for coronary artery disease in her father and endometrial cancer and depression in her mother.
The patient appears anxious and is mildly diaphoretic.  She is initially tachycardic, but repeat vital signs are within normal limits.  Physical examination is unremarkable.
Which of the following is the most likely diagnosis?

• A)Mitral valve prolapse
• B)Panic disorder
• C)Paroxysmal supraventricular tachycardia
• D)Performance anxiety
• E)Somatic symptom disorder

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Definitions:

Referential Influence

The impact of others' opinions and behaviors on an individual's choices and actions, based often on the individual's desire to conform or be accepted by a group.

Influencer

An individual with the ability to affect the purchasing decisions of others due to their authority, knowledge, position, or relationship with their audience.

Gatekeeper

An individual or organization that controls access to something, such as information or resources, and has the power to influence decisions and flow of information.

Bluetooth Connectivity

A wireless technology standard used for exchanging data between fixed and mobile devices over short distances.