Neurologic
Endocrine
Infectious
Nutritional/substance
Mystery
100
70 year old diagnosed with parkinsonism now has visual hallucinations of small animals
Lewy Body Dementia
100
A middle aged woman develops delusions, hallucinations, and disorganized thinking. She also has tachycardia, anxiety, heat intolerance, unexplained weight loss. Her T4 comes back severely elevated. What do we expect her TSH to be?
Extremely low.
100
A 40 year old mushroom forager with years of joint pain and extreme fatigue presents with new paranoia and auditory hallucinations. On exam, he's found to have lymphadenopathy. What disease should we be sure to screen for?
Lyme Disease
100
Vegan patient has persecutory delusions and hallucinations, found to have ataxia and cogwheel rigidity on exam. What lab do you definitely want to check?
B12
100
A patient presents for confusion, disorientation, visual hallucinations, and paranoia. They are flushed, febrile, have dilated pupils, and have not urinated for >24 hours. Which class of medications do you want to hold on admission?
Anticholinergics
200
70 year old patient with a history of Alzheimers is in the ICU following a painful procedure. They suddenly become combative, disoriented, paranoid, and have visual hallucinations. Name 3 commonly used classes of medications to consider reducing?
Benzodiazepines, opioids, anticholinergics
200
New onset psychosis in 50 year old woman found to have abdominal swelling, RUQ pain, tremor and jaundice on exam. Her eyes have a golden ring on the outside of the iris. What lab test should we order, and what disease are we screening for?
Serum ceruloplasmin; Wilson disease
200
You're consulted on a patient with a history of HIV and Chlamydia for new cognitive deficits and visual disturbances vs hallucinations. They also have abnormal gait, headache, a stiff neck, and incontinence. What are you worried about?
Neurosyphilis
200
An older patient with a history of severe alcohol use disorder presents with new paranoia, also found to have short term memory loss and confabulates most of their history. What nutritional deficiency could they have?
Thiamine deficiency
200
You're on call. A patient is on day 4 of his hospital stay for depression, when he develops confusion, fever, hypertension, tachycardia, and hallucinations. You talk with him and find out that he had been drinking alcohol heavily up until admission. What life-threatening condition are you worried about?
Delirium Tremens.
300
Patient with a history of seizure is experiencing deja vu, dissociations, and visual hallucinations. What single test could confirm the neurologic diagnosis?
EEG - Epilepsy
300
18 year old female was recently diagnosed with schizophrenia. Since then, she's developed seziures, memory deficits, hypersomnia, choreoathetoid movements, and autonomic instability. What three tests do you want to get to rule out anti-NMDA encephalitis?
MRI, EEG, and CSF IgG
300
A patient with a history of untreated HIV presents for headache, seizures, focal neurologic deficits, delusions, and hallucinations. You see multiple ring enhancing lesions on MRI. What are you concerned about?
CNS toxoplasmosis
300
Patient with polysbustance use and sensorimotor polyneuropathy, ataxia, and paranoia, and auditory hallucinations. Labs are notable for low vitamin B12, elevated homocysteine and methylmalonic acid. What substance could he have been using?
Nitrous oxide
300
A patient with presents for hematemesis found to be due to esophageal varicies. You are consulted for insomnia, depression, confusion, and delusions. On exam, you observe jaundice, ascites, and asterixis. In addition to basic labs, what specific level should you check?
Ammonia
400
A patient with a history of lung cancer develops gradually worsening headache, seizures, focal neuro deficits, and visual hallucinations. What test do you order and what are you ruling out?
MRI; rule out brain tumor
400
A patient presents for a kidney stone and is found to also be struggling with depression, fatigue, confusion, hallucinations. Labs are notable for abnormal calcium levels. Issues with what gland could cause all of these signs and symptoms?
Parathyroid disease
400
A 15 year old presents in August after spending the summer at camp in the woods. He then develops a fever, headache, photophobia, confusion, and visual hallucinations. On exam, you observe flaccid paralysis. What test could lead to the definitive diagnosis?
West Nile IgM in CSF sample
400
A 15 year old presents to the ED with their parents, who brought them in for severe agitation. The teenager is euphoric, hallucinating, and tachycardic. They mention something about taking something from their parents' medicine cabinet. What might they have taken?
Dextromethorphan
400
35 year old woman presents with years of pelvic pain and unexplained infertility, now having weeks-months of cognitive deficits, altered consciousness, seizures, and psychosis. You place an oncology consult out of concern for what oncologic condition?
Ovarian teratoma