Sleeping in Minerals Because I Got Evicted
This vitamin deficiency causes dorsal column and corticospinal tract demyelination, but folate won’t fix the neuro signs.
What is vitamin B12?
This antiepileptic can cause Stevens-Johnson syndrome, especially when titrated too fast.
What is lamotrigine?
This cause of hyperthyroidism is associated with a decreased radioactive iodine uptake scan and occurs postpartum.
What is painless thyroiditis?
Broad-based budding yeast seen on silver stain from a patient with verrucous skin lesions and pneumonia after visiting Wisconsin.
What is blastomycosis?
A 45-year-old man presents with 3 months of exertional dyspnea and fatigue. He had a viral illness 6 weeks prior. BP is 110/70, HR 98. JVP is elevated, and heart sounds are muffled. Lungs are clear. ECG shows low voltage and electrical alternans. Echo reveals a large pericardial effusion without tamponade. Labs reveal positive ANA and anti-dsDNA. Creatinine is 1.9. UA shows hematuria and RBC casts.
Which of the following is the most appropriate next step in management?
A) Start high-dose NSAIDs
B) Pericardiocentesis
C) Initiate corticosteroid therapy
D) Begin hemodialysis
E) IV cyclophosphamide
C) Initiate corticosteroid therapy
This is lupus pericarditis with renal involvement (lupus nephritis). NSAIDs are contraindicated due to kidney injury, and there’s no tamponade to warrant pericardiocentesis. Steroids are first-line.
This vitamin deficiency mimics Friedreich ataxia, with ataxia, nystagmus, and cardiomyopathy, and is seen in abetalipoproteinemia.
What is vitamin E?
This acne medication is teratogenic and may cause idiopathic intracranial hypertension.
What is isotretinoin?
This screening test is used to evaluate for adrenal insufficiency but may be normal in secondary adrenal insufficiency.
What is an ACTH stimulation test?
This parasite causes perianal pruritus in children and is diagnosed with the scotch tape test.
What is Enterobius?
A 7-year-old boy from the Midwest is brought in with 3 days of high fever, severe headache, vomiting, and confusion. He recently returned from a camping trip in Missouri. Temp is 39.5°C. Physical exam shows photophobia and a faint maculopapular rash on the wrists and ankles. CSF shows low glucose, high protein, and neutrophilic pleocytosis. No organisms seen on Gram stain.
Which of the following is the most appropriate empiric treatment?
A) Acyclovir
B) Ceftriaxone and vancomycin
C) IV doxycycline
D) Amphotericin B
E) TMP-SMX
C) IV doxycycline
This is Rocky Mountain spotted fever (Rickettsia rickettsii) with CNS involvement. Classic in the Southeast/Midwest with rash on wrists/ankles, and CSF showing aseptic meningitis features. Treat empirically with doxycycline even in children — benefits outweigh risks.
This mineral’s deficiency can result in Keshan disease, a dilated cardiomyopathy associated with viral infection.
What is selenium?
This antidepressant is contraindicated in patients with bulimia due to risk of seizures.
What is bupropion?
A person taking these diabetes drugs will have an elevated C-peptide.
What are sulfonylureas and meglitinides?
This cestode can cause liver cysts with “eggshell calcifications” and anaphylaxis if cysts rupture.
What is Echinococcus?
A 27-year-old man is brought to the ED after a motor vehicle crash. He was restrained and had blunt trauma to the lower abdomen and pelvis. He is hemodynamically stable. Foley catheter placement results in gross hematuria. CT cystogram shows contrast extravasation from the bladder into the peritoneal cavity.
Which of the following is the best next step in management?
A) Retrograde urethrogram
B) Urology consult for cystoscopic repair
C) Emergency exploratory laparotomy and bladder repair
D) Foley catheter for bladder decompression
E) IV antibiotics and observation
C) Emergency exploratory laparotomy and bladder repair
Intraperitoneal bladder rupture requires surgical repair. Extraperitoneal bladder rupture can be managed conservatively with a Foley, but intraperitoneal = OR. Urethrogram is for suspected urethral injury (e.g., blood at meatus, high-riding prostate).
A dialysis patient with pruritus and vascular calcification likely has this electrolyte imbalance.
What is hypophosphatemia?
This vasodilator can cause cyanide toxicity, especially in renal failure.
What is nitroprusside?
A woman unable to lactate postpartum with fatigue and hypotension likely has this condition.
What is Sheehan syndrome?
This fungal infection can mimic CNS lymphoma on imaging, but biopsy reveals soap-bubble–like lesions in the basal ganglia.
What is Cryptococcus?
A 22-year-old nulligravid woman presents for evaluation of abdominal bloating and early satiety. On exam, she has a large, mobile adnexal mass. Ultrasound shows a 10-cm complex cystic and solid mass. Tumor markers: CA-125 elevated, AFP elevated, β-hCG normal, LDH elevated. She undergoes surgical resection. Histology shows sheets of primitive epithelial cells with Schiller-Duval bodies.
Which of the following syndromes is most closely associated with this tumor?
A) Lynch syndrome
B) Peutz-Jeghers syndrome
C) Turner syndrome
D) Klinefelter syndrome
E) Li-Fraumeni syndrome
E) Li-Fraumeni syndrome
This is a yolk sac tumor (endodermal sinus tumor) — a germ cell tumor marked by ↑AFP and Schiller-Duval bodies. Li-Fraumeni syndrome (TP53 mutation) is associated with early-onset sarcomas, breast cancer, brain tumors, adrenal tumors, and germ cell tumors.
High doses of this fat-soluble vitamin have been linked to increased all-cause mortality in smokers due to lung cancer risk.
What is beta-carotene?
This antiviral causes crystalluria and nephrotoxicity if not adequately hydrated.
What is acyclovir?
This rare pancreatic neuroendocrine tumor causes diabetes, gallstones, steatorrhea, and achlorhydria.
What is a somatostatinoma?
You diagnose this parasite by visualizing larvae in stool, not eggs.
What is Strongyloides?
A 35-year-old woman with bipolar disorder is brought in by family due to confusion, tremor, and vomiting. She started a new thiazide diuretic for hypertension 1 week ago. Exam shows coarse tremor, hyperreflexia, and ataxia. Serum sodium is 128, creatinine is 1.3, and lithium is 2.1 mEq/L (therapeutic 0.6–1.2).
Which of the following best explains this patient's presentation?
A) Neuroleptic malignant syndrome
B) Serotonin syndrome
C) Hyponatremia-induced seizure
D) Acute lithium toxicity due to decreased renal clearance
E) Thiazide-induced hypokalemia
D) Acute lithium toxicity due to decreased renal clearance
Thiazides increase lithium levels by decreasing sodium reabsorption, which increases proximal lithium reabsorption. This patient has neurologic signs of lithium toxicity. Always check meds when lithium toxicity appears.