An 18-year-old man presents to the student health department at his university for recurrent palpitations. The patient had previously presented to the emergency department (ED) for sudden onset palpitations five months ago when he first started college. He had a negative cardiac workup in the ED and he was discharged with a 24-hour Holter monitor which was also negative. He has no history of any medical or psychiatric illnesses. The patient reports that since his initial ED visit, he has had several episodes of unprovoked palpitations associated with feelings of dread and lightheadedness though he cannot identify a particular trigger. Recently, he has begun sitting towards the back of the lecture halls so that he can “quickly escape and not make a scene” in case he gets an episode in class. Which of the following is the most likely diagnosis?
ASocial phobia
BSpecific phobia
CAdjustment disorder
DPanic disorder
ESomatic symptom disorder
A 35-year-old woman presents with increased anxiety and a reeling sensation. Her complaint started 30 minutes ago with increased sweating and palpitations and is gradually worsening. On examination, the blood pressure was found to be 194/114 mm Hg. She had normal blood pressure at the local pharmacy 5 days ago. She currently works as an event manager and her job involves a lot of stress. The family history is significant for thyroid carcinoma in her father. Which of the following is most likely in this person?
AIncreased urine metanephrines
BDecreased C-peptide
CDecreased hemoglobin
DDecreased TSH levels
EIncreased serum serotonin
A 43-year-old man comes to the emergency room complaining of chest discomfort. He describes the feeling as "tightness," and also reports weakness and palpitations for the past hour. He denies shortness of breath, diaphoresis, or lightheadedness. He has no significant past medical history, and does not smoke, drink, or use illicit drugs. His father had a myocardial infarction at age 72. He is afebrile, heart rate is 125 bpm, and his blood pressure is 120/76. He is alert and oriented to person, place, and time. His electrocardiogram is shown below. Which of the following tests should be ordered in the initial work-up of this patient's condition?
AChest x-ray
BBlood alcohol level
CUrine free cortisol level
DUrine metanephrines
EThyroid stimulating hormone level (TSH)
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