Answer
1) State the questions you would ask DZ to come to a provisional and differential diagnosis.
- Any underlying medical problems (hyperthyroidism)
- Is the problems persistant or on and off.(panic disorder vs generalized anxiety disorder)
- How often is the symptoms occur and how long it take for each episode.
- Any alcohol consumption/abuse (alcohol withdrawal)
- Is it related to public space or when surrounded by people (agrophobia & social phobia)
2) What lab investigation you would order to rule out the medical diagnosis and justify the reason for the test
- Thyroid function test (to excude hyperthyroidism)
- Random blood sugar (hypoglycemia)
- ECG (to rule out cardiac abnormality, paroxymal artrial fibrillation)
- Cardiac enzymes (CKMB, Troponin)
- Liver function test (if associated with history of excessive alcohol drinking)
- Serum Insulin level (insulinoma)
3) What is your psychological and medical differential diagnosis
a) Psychological
- Panic disorder
- Generalized anxiety disorder
- Anxiety disorder due to specific trigger
- Anxiety disorder due to substance abuse
b) Medical
- Hyperthyroidism
- Thyroid storm
- Pheochromocytoma
- Hypoglycaemia
The important thing is not to stop questioning. Curiosity has its own reason for existing. One cannot help but be in awe when he contemplates the mysteries of eternity, of life, of the marvelous structure of reality. It is enough if one tries merely to comprehend a little of this mystery every day. Never lose a holy curiosity.[Albert Einstein]