**Question:** MBBS 1st year girl came to OPD complaining of intermittent episodes of feeling of impending doom accompanied by intense perspiration. Usually the episodes occur prior to her exams. What is the most likely diagnosis?

**Core Concept:** Panic disorder is a psychiatric condition characterized by recurrent, unexpected panic attacks and associated fear and anxiety. These episodes typically involve significant distress and functional impairment and are often triggered by specific situations, such as exam periods.

**Why the Correct Answer is Right:** In this case, the patient presents with recurrent episodes of feeling of impending doom and intense sweating, which are symptoms commonly associated with panic attacks. Additionally, these episodes occur specifically before her exams, suggesting they are triggered by stress, particularly exam-related stress. Panic disorder is the most likely diagnosis given these symptoms and context.

**Why Each Wrong Option is Incorrect:**

A. Generalized anxiety disorder (GAD) is another anxiety disorder, but the symptoms of panic attacks are not typically present in GAD patients. In GAD, patients experience excessive worry and anxiety in multiple situations, not specifically triggered by exam periods.

B. Major depressive disorder (MDD) is a mood disorder characterized by persistent feelings of sadness, hopelessness, and loss of interest or pleasure. Patients with MDD do not usually experience panic attacks or exhibit intense sweating during episodes.

C. Social anxiety disorder (SAD) is characterized by excessive and unreasonable fear of social situations. Panic attacks and intense sweating are not prominent symptoms in SAD.

D. Post-traumatic stress disorder (PTSD) is a mental health condition resulting from a traumatic event. Panic attacks and intense sweating are not part of PTSD symptoms.

**Clinical Pearl / High-Yield Fact:** Panic disorder has a significant impact on the patient's life, influencing academic performance and overall functioning. Early identification and treatment of panic disorder can help manage symptoms and improve the patient's quality of life.

**Correct Answer:** D. Panic disorder

**Explanation:**

Panic disorder is the most appropriate diagnosis for this patient, as it presents with recurrent panic attacks (fear response involving intense sweating and feeling of impending doom) triggered by specific situations, in this case, the patient's exam periods. Panic attacks are not typically observed in other anxiety disorders like generalized anxiety disorder, social anxiety disorder, or post-traumatic stress disorder.