A 41 years old female patient comes to AIIMS emergency with complains of flurry, palpitations, profuse sweating and sense of impending doom. The following test should be done in emergency to rule out organic causes:
First, I need to recall what tests are essential in the emergency setting to exclude other conditions. The key here is to consider the differential diagnoses. Organic causes could include things like hyperthyroidism, pheochromocytoma, hypoglycemia, or cardiac issues.
The options aren't listed, but based on standard practice, the correct test would likely be a serum glucose test. Hypoglycemia can cause similar symptoms, so checking blood sugar is crucial. Alternatively, an ECG might be considered for cardiac causes, but the question specifies to rule out organic causes in general.
Wait, the correct answer provided in the user's example is D. Serum glucose. So the options must include that. The distractors might be things like TSH, ECG, or CBC.
Why is serum glucose the correct choice here? Because hypoglycemia can mimic panic attacks. The other options like TSH would check for hyperthyroidism, but that's a slower onset. Pheochromocytoma might require checking catecholamines, but that's not an immediate test. So serum glucose is a quick, essential test in the ED.
The incorrect options would be other tests that are either not urgent or not relevant. For example, TSH is for thyroid function but takes time. ECG is good for cardiac issues but not all organic causes. CBC is too general. So the correct answer is serum glucose.
**Core Concept**
This scenario tests the emergency evaluation of acute psychiatric/psychiatric-appearing symptoms to exclude life-threatening organic causes. Key organic mimics include hypoglycemia, hyperthyroidism, pheochromocytoma, and cardiac arrhythmias. Immediate biochemical screening is critical for rapid diagnosis.
**Why the Correct Answer is Right**
**Serum glucose** is the priority test because hypoglycemia (blood glucose <40 mg/dL) classically presents with autonomic (sweating, palpitations) and neuroglycopenic (flurry, impending doom) symptoms. The body’s counterregulatory response to low glucose (epinephrine release) explains the adrenergic surge. Immediate correction prevents seizures, coma, or death. This test is rapid, cost-effective, and essential in ED triage.
**Why Each Wrong Option is Incorrect**
**Option A:** *Thyroid function tests (TSH, free T4)* are relevant for hyperthyroidism but take hours to yield results and do not address acute emergencies like hypoglycemia.
**Option B:** *ECG* is indicated for arrhythmias or ischemia but does not directly address metabolic causes of autonomic symptoms.
**Option C:** *Complete blood count (CBC)* is nonspecific and unlikely to identify the acute cause of these symptoms.
**Clinical Pearl / High-Yield Fact**
Remember the **“4 S’s” of hypoglycemia**: Sweating, Shakiness, Seizures, and Syncope. Always check serum glucose first in patients with adrenergic symptoms to avoid