Sweating the Details: Is it an Attack or a Disorder?

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BR 49: Sweating the Details: Is it an Attack or a Disorder?

Session 49

Now I’m joined by Dr. Mike Natter fromBoardVitals. If you are looking for some help with your Step 1 or Level 1, check them out and use the promo code BOARDROUNDS and get 15% off any of their packages.

If you haven’t yet, please check out all our other podcasts onMeded Media.

Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

[01:03] BoardVitals

If you’re looking for QBanks, they have you covered with like 1700 and 1900 questions, tons of questions to get you the prep that you need. The best way to prepare for Step 1 or Level 1 is to maximize the number of questions that you do and obviously not just doing the questions, but reading the explanations.

BoardVitals does an amazing job of giving you really in depth answers and explanations as to why they’re the right answers and why they’re the wrong answers are wrong. That is what makes a great product. That is what makes a great prep product for you to maximize your Step 1 or Level 1 score.

[03:17] Question of the Week

A 52-year-old female presents to the emergency department with chest tightness, pounding, palpitations, shortness of breath, and severe anxiety. Her attack began suddenly when she was driving to a meeting and it lasted about five to 10 minutes during which she thought she would die.

She’s had these episodes several times a month for the past year, beginning with an attack shortly after her only child left for college.

Her cardiac workup, negative. These attacks have occurred in the grocery store at church and the patient can not identify a specific fear or trigger. She now worries frequently about the likelihood of another attack.

What is the most likely diagnosis?

(A) generalized anxiety disorder

(B) agoraphobia

(C) panic disorder

(D) panic attack

(E) social anxiety disorder


Generalized anxiety disorder was an answer choice on last week’s episode and it tallks about the symptoms that had to be there for six months. And so somebody who listened to last week’s may hear this one and go, oh, this has been going on for a year. That must be a generalized anxiety disorder.

This story of this woman here has these attacks. These periods of palpitations and shortness of breath and severe anxiety, just randomly happening and lasting for five to 10 minutes. It just doesn’t seem like generalized anxiety disorder.

It’s actually quite the opposite because it’s not generalized. It’s very specific in these attacks. So crossing answer choice A off.

Agoraphobia is also out as there’s no story here about her not wanting to go outside and be out in public. Agoraphobia is the fear of public places and being outside.

Panic disorder is what sounds like because she’s having panic attacks and the severity of them would make it a disorder versus just having a panic attack.

Then social anxiety disorder just doesn’t sound like it fits with everything else. It’s like the fear of a specific social situation or having to perform like giving talks or stuff. And it’s really this embarrassment or fear of the scrutiny that causes a social anxiety disorder. But in this case, it seems like it’s happening anywhere, everywhere.

So the correct answer here is C. It’s panic disorder because she’s had recurrent episodes and they’re unexpected. She even stated there’s no specific fear or trigger and she gets them in different, numerous environments. And so that’s what kind of qualifies it as the panic disorder.


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