Please melissa come back (Neuro/optho)
65 yr old female who has complaints of dizziness when she moves her head that lasts 1 minute
Ddx?
BPPV
dix-hallpike maneuver for ddx
Epley maneuver for tx
Dilated Cardiomyopathy + HF + Edema
Thiamine def = wet beriberi
high output HF
A patient with 21 hydroxylase deficiency will have:
__Aldosterone + __Cortisol + __Androgens
What compound is elevated?
↓ Aldosterone + ↓ Cortisol + ↑ Androgens
17-hydroxyprogesterone
Hypotension + hypoglycemia + virilization
What is the best test to confirm lactose intolerance?
Positive hydrogen breath test
Bacterial fermentation of undigested lactose releases H₂ gas → absorbed → exhaled.
Which condition presents with increased tactile fremitus and dullness to percussion?
Lobar pneumonia
Unlike pleural effusion (↓ fremitus, dull), or pneumothorax (↓ fremitus, hyperresonant).
65 yr old Female with tinnitus + hearing loss + episodic vertigo for less than 30min
ddx?
Meniere's
Avoid high sodium, caffeine, alcohol, stress and nicotine
A 48-year-old man presents to the clinic with complaints of chronic diarrhea, a red, painful rash on the backs of his hands, and memory problems. He recently immigrated from a rural area of Central America and reports limited access to varied food. His diet consists mostly of corn tortillas and very little meat or dairy. He also reports feeling increasingly irritable and forgetful over the past few months. On exam, he has bilateral, symmetric erythematous patches with hyperpigmentation and scaling on sun-exposed areas of the forearms and neck. Neurologic exam reveals mild disorientation to time and impaired short-term memory.
Vitals are within normal limits.
Labs show mild normocytic anemia.
Niacin (B3) def = pellagra
A patient with 17a-hydroxylase deficiency will have:
__Aldosterone + __Cortisol + __Androgens
↑ Aldosterone + ↓ Cortisol + ↓ Androgens
Hypertension + hypoglycemia + undervirilized (XY), no puberty (XX)
Which vitamin deficiency causes impaired taste (hypogeusia), poor wound healing, and hair loss?
Zinc deficiency
Also causes periorificial dermatitis; think chronic diarrhea, TPN, or IBD.
What condition is associated with multiple seborrheic keratoses erupting suddenly, and what does this signify?
Leser-Trélat sign — sudden onset of multiple seborrheic keratoses indicates underlying internal malignancy, most commonly GI adenocarcinoma (e.g., gastric).
📌 This is a classic paraneoplastic sign often tested in derm-onc crossover questions.
30 yr old female had URI 3 days ago now has acute-onset constant vertigo + N/V + no hearing loss
ddx?
What if she has hearing loss?
Labyrinthitis
Macrocytic, megaloblastic anemia + hypersegmented PMNs + Increased Homocysteine + normal methylmalonic acid
Folate (B9) deficiency
What if MMA was increased?
What infections are you concerned for and HIV patient with CD4 of 25
CMV retinitis/colitis/esophagitis
MAC
CNS lymphoma (EBV driven)
A 25-year-old man is evaluated in the emergency department 6 hours after receiving his first dose of doxycycline for early disseminated Lyme disease. He was diagnosed earlier that day after presenting with fever, malaise, arthralgias, and a targetoid rash on his left thigh that had been expanding for 5 days. He denies any history of drug allergies.
Now he reports worsening fever, chills, headache, muscle aches, and generalized weakness. He appears flushed and mildly diaphoretic. His temperature is 39.1°C (102.4°F), blood pressure is 95/60 mm Hg, pulse is 110/min, and respiratory rate is 18/min. Physical examination reveals no rash beyond the original lesion, no wheezing, no hives, and no angioedema. Lungs are clear, and neurologic exam is nonfocal.
Which of the following is the most likely explanation for this patient’s acute symptoms?
A. Hypersensitivity reaction to doxycycline
B. Progression of untreated Lyme disease
C. Co-infection with Babesia microti
D. Jarisch-Herxheimer reaction
E. Cytokine storm due to antibiotic-induced bacterial lysis
D. Jarisch-Herxheimer reaction
Which congenital heart defect is most commonly associated with DiGeorge syndrome?
Truncus arteriosus
Often associated with 22q11.2 deletion and abnormal aortic arch development (e.g. right-sided aortic arch).
Erythematous, warm, tender papule near eyelid margin
Ddx and tx?
What is Hordeolum
Warm compress
Name the disease-associated risk factors for vit D deficiency
celiac
CKD
cirrhosis
CF
A patient with 11b-hydroxylase deficiency will have:
__Aldosterone + __Cortisol + __Androgens
What compound is elevated?
↓ Aldosterone + ↓ Cortisol + ↑ Androgens
11-deoxycortisosterone (DOC) - Mineralocorticoid - HTN
Hypertension + hypoglycemia + virilization
What electrolyte abnormality most strongly predicts the severity of digitalis toxicity?
Hyperkalemia
Elevated K⁺ reflects inhibition of Na⁺/K⁺ ATPase and correlates with worse prognosis.
What is the first-line treatment for idiopathic intracranial hypertension in a non-pregnant woman?
Acetazolamide
Carbonic anhydrase inhibitor → ↓ CSF production.
Fundoscopy: arteriolar narrowing + AV nicking + cotton-wool spots
ddx?
Hypertensive retinopathy
Peripheral neuropathy + sideroblastic anemia + diarrhea + memory loss + rash
Pyridoxine deficiency
B6 is a cofactor to make B3, so no pyridoxine, no niacin = pellagra
What HY drugs can cause b6 def?
A 42-year-old woman comes to the clinic with progressive fatigue, easy bruising, and weight gain over the past 6 months. She has noticed purple stretch marks on her abdomen and new facial hair. Her blood pressure is 158/92 mm Hg. Physical exam shows facial rounding, dorsocervical fat pad, and central obesity. She is not taking any medications or supplements.
What is the most appropriate next step in evaluation?
A. Measure serum ACTH level
B. High-dose dexamethasone suppression test
C. 24-hour urinary free cortisol
D. MRI of the pituitary gland
E. Low-dose overnight dexamethasone suppression test
F. Late-night salivary cortisol
E. Low-dose overnight dexamethasone suppression test
A. ACTH – Do after confirming cortisol excess.
B. High-dose dexamethasone – Used later to distinguish Cushing disease (pituitary) from ectopic ACTH.
C. 24-hour UFC – Acceptable first test, but not the best choice here because it’s burdensome and less sensitive.
D. MRI – Not until after labs show ACTH-dependent Cushing.
F. Late-night salivary cortisol – Also acceptable first test, but less commonly used on exams than low-dose dex suppression.
A 62-year-old man comes to the clinic with muscle cramps, fatigue, and occasional palpitations over the past week. He was recently started on a new antihypertensive medication at a routine visit 3 weeks ago. He denies chest pain, syncope, or recent illness. His only medications are lisinopril and the newly prescribed drug.
Vitals:
BP: 132/76 mm Hg
HR: 90/min
RR: 14/min
Temp: 36.8°C
Physical exam is normal. EKG shows new-onset premature ventricular complexes (PVCs). Basic labs are obtained:
Na⁺: 130 mEq/L
K⁺: 3.1 mEq/L
Cl⁻: 97 mEq/L
HCO₃⁻: 29 mEq/L
Glucose: 106 mg/dL
Creatinine: 1.0 mg/dL
Calcium: 10.8 mg/dL
Uric acid: 8.5 mg/dL
Which of the following medications is most likely responsible for this patient’s symptoms?
A. Lisinopril
B. Amlodipine
C. Metoprolol
D. Hydrochlorothiazide
E. Spironolactone
D. Hydrochlorothiazide
What long-term complication is associated with nephrotic syndrome due to urinary loss of antithrombin III?
Renal vein thrombosis (or hypercoagulability in general)
📌 High-yield for minimal change disease or membranous nephropathy — especially when a patient with nephrotic syndrome suddenly develops flank pain, hematuria, or elevated LDH.