Panic disorder is frequently encountered in the ED and the s/s mimic those of other illnesses. What tests should be done for the diagnosis of exclusion?

Panic disorder is frequently encountered in the ED and the s/s mimic those of other illnesses. What tests should be done for the diagnosis of exclusion?

• A. CBC, CMP, TSH, EKG
• B. Urinalysis, pregnancy test
• C. Radiographic studies only
• D. CK, troponins, D-dimer, EKG, radiographic studies

Answer: (D)

Evaluating panic-like symptoms in the ED hinges on ruling out dangerous medical conditions that mimic anxiety. The best approach includes tests that can uncover cardiac injury or ischemia, signs of pulmonary embolism, and obvious radiographic findings. Doing troponin tests and a CK helps identify myocardial injury; an ECG shows arrhythmias or ischemic changes; D-dimer helps assess for thromboembolism when PE is a concern. Adding radiographic studies, such as a chest X-ray, helps detect pneumonia, pneumothorax, edema, or congestive failure that could explain the presentation. Together, these tests form a practical exclusion strategy to distinguish panic disorder from real emergencies. Relying only on routine screens like CBC/CMP/TSH or on urinalysis and a single imaging modality would miss critical causes and leave dangerous conditions unscreened. Thus, the combination of cardiac markers, ECG, D-dimer, and radiographic evaluation offers the most comprehensive exclusion approach in this scenario.

Evaluating panic-like symptoms in the ED hinges on ruling out dangerous medical conditions that mimic anxiety. The best approach includes tests that can uncover cardiac injury or ischemia, signs of pulmonary embolism, and obvious radiographic findings. Doing troponin tests and a CK helps identify myocardial injury; an ECG shows arrhythmias or ischemic changes; D-dimer helps assess for thromboembolism when PE is a concern. Adding radiographic studies, such as a chest X-ray, helps detect pneumonia, pneumothorax, edema, or congestive failure that could explain the presentation. Together, these tests form a practical exclusion strategy to distinguish panic disorder from real emergencies. Relying only on routine screens like CBC/CMP/TSH or on urinalysis and a single imaging modality would miss critical causes and leave dangerous conditions unscreened. Thus, the combination of cardiac markers, ECG, D-dimer, and radiographic evaluation offers the most comprehensive exclusion approach in this scenario.