This week’s theme had been disorders which can mimic anxiety/panic attacks. We heard about phaeochromocytoma in an excellent talk from VJ Thyrotoxicosis, SVT, Hypoxia, prescription drugs and substances of abuse. My prize for the week goes to AC since he specifically compared the rates of symptoms in panic with the same symptoms in SVT. I would like to re-iterate my maxim that panic attacks do not exist in medical in-patients (pre-test probability low). Though the features of a panic attack (as per DSM IV) may well be present you should look hard for an alternative diagnosis. Be especially wary of findings which are not explained by panic alone.
The discussion paper was Does This Patient With Headache Have a Migraine or Need Neuroimaging? Michael E. Detsky et al JAMA. 2006;296:1274-1283. The conclusion of which was "The presence of 4 simple historical features can accurately diagnose migraine. Several individual clinical features were found to be associated with a significant intracranial abnormality, and patients with these features should undergo neuroimaging... The features are summarized by the mnemonic POUNDing (Pulsating, duration of 4-72 hOurs, Unilateral, Nausea, Disabling. If 4 of the 5 criteria are met, the likelihood ratio... for definite or possible migraine is 24."
In next week's two minute tutorials we will address occupational diseases:
Respiratory (VJ)
Neurological (AC)
GI/GU (s)
Musculoskeletal (CC)
Skin (MJM)
(and infections GAJ?)
Two minutes only, keep it concise and precise; quote your sources.
For the 29th I would like you to read and consider Apology in Medical Practice: An Emerging Clinical Skill. Aaron Lazare. JAMA. 2006;296:1401-1404.
Get the full text via library/elibrary.
Interesting topics
Acute sarcoidosis
MJM
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