system
Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.
user
A 18-year-old female develops breathlessness with perioral tingling, similar 2 episodes in the past; what is your diagnosis?
assistant
The correct answer is  Ans. c. Panic disorderIt is characterized by recurrent, unexpected panic attacks.Two to three times more common in women than in men.Agoraphobia is present in 30-50% of cases.The average age of onset is 25, but may occur at any age.HISTORY/PE:Panic attacks are defined as discrete periods of intense fear or discomfort in which at least four of the following symptoms develop abruptly and peak within 10 minutes: tachypnea, chest pain, palpitations, diaphoresis, nausea, trembling, dizziness, fear of dying or "going crazy," depersonalization, or hot ashes.Perioral and/or acral paresthesias, when present, are fairly specific to panic attacks, which produce hyperventilation and low O2 saturation.Patients present with 1 or more months of concern about having additional attacks or significant behavior change as a result of the attacks--e.g., avoiding situations that may precipitate attacks.Determine whether a patient has panic disorder with or without agoraphobia so that agoraphobia can also be addressed in the treatment plan.TREATMENTShort-term therapy: Benzodiazepines (e.g., clonazepam) may be used for immediate relief, but long-term use should be avoided in light of the potential for addiction and tolerance.Taper benzodiazepines as soon as long-term treatment is initiated (eg, SSRIs).Long-term therapy:CBTMedications: SSRIs (First-line therapy), TCAs.