Question:
An MBBS student presents with choking, dyspnea, chest tightness, anxiety and an impending sense of doom. On examination all systemic findings are normal, and she is referred to psychiatry. What is the probable diagnosis?
An MBBS student presents with choking, dyspnea, chest tightness, anxiety and an impending sense of doom. On examination all systemic findings are normal, and she is referred to psychiatry. What is the probable diagnosis?
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A sudden storm of fear with a sense of doom and a completely normal physical exam is the giveaway.
Updated On: Jun 23, 2026
- Panic disorder
- Depression
- Epilepsy
- Asthma
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The Correct Option is A
Solution and Explanation
Step 1: Note the cluster: sudden severe anxiety with choking, chest tightness, breathlessness, palpitations and a sense of impending doom.
Step 2: Crucially, all systemic examination is normal, so an organic cardiorespiratory cause is excluded. This abrupt, self-limited surge of intense fear with autonomic symptoms is a panic attack, and recurrent attacks define panic disorder.
Why not the others: Depression is low mood and loss of interest over weeks, not paroxysmal choking and doom. Epilepsy is a neurological seizure disorder, not this autonomic anxiety picture with a normal exam. Asthma would show wheeze and signs on respiratory examination, which here are normal.
Ref: Arvind Arora Review of Psychiatry p.131.
Step 2: Crucially, all systemic examination is normal, so an organic cardiorespiratory cause is excluded. This abrupt, self-limited surge of intense fear with autonomic symptoms is a panic attack, and recurrent attacks define panic disorder.
Why not the others: Depression is low mood and loss of interest over weeks, not paroxysmal choking and doom. Epilepsy is a neurological seizure disorder, not this autonomic anxiety picture with a normal exam. Asthma would show wheeze and signs on respiratory examination, which here are normal.
Ref: Arvind Arora Review of Psychiatry p.131.
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