Serum antiglomerular basement membrane assay –> Goodpasture syndrome –> Hemoptysis and hematuria often in a young man (no neurologic symptoms).Key idea: In the setting of adult-onset asthma, important mimickers to consider include Churg-Strauss and allergic bronchopulmonary aspergillosis (often intermittent flares of respiratory symptoms in patient with cystic fibrosis and/or asthma).Key idea: Mnemonic for Churgg-Strauss is PAN (Palpable purpura, Asthma/sinusitis, Neurologic symptoms (wrist drop)).Young woman presenting with adult-onset asthma, hemoptysis, fever and sensory abnormalities of the upper and lower extremity most concerning for Eosinophilic granulomatosis with polyangiitis (Churgg-Strauss).Serum antineutrophil cytoplasmic autoantibody assay (ANCA) Chronic thiamine deficiency –> Korsakoff –> Confabulation (patient is making up stories/lying but thinks that they are telling the truth), mental status changesĢ) A 45-year-old woman comes to the emergency department because of a 3-day history of progressive shortness of breath, cough….Acute thiamine deficiency –> Wernicke encephalopathy –> Confusion, ataxia, ophthalmoplegia.Key idea: While the patient has a significant alcohol history, in this case we would not be as concerned about alcohol withdrawal symptoms (in which case lorazepam would be the answer) because he last had alcohol 2 weeks ago and the classic alcohol withdrawal symptoms typically occur within ~4 days (hallucinations and seizures occur around 24-48 hours since last drink, delirium tremens 48-96 hours since last drink).While spontaneous bacterial peritonitis (along with other infections) could lead to hepatic encephalopathy, we have less concern for that diagnosis in this case because the patient is not febrile (which is >100F in a patient with cirrhosis) and has no abdominal pain/tenderness.Key idea: Treatments for hepatic encephalopathy include lactulose (causes NH3 –> NH4+ which is trapped in gut and will not be absorbed) and rifaximin (kills gut bacteria –> less NH3 production). Elderly man with a history of alcoholic cirrhosis who presents with altered mental status, tremors and asterixis (specific for hepatic or uremic encephalopathy), most consistent with hepatic encephalopathy.Good luck with your exams!ġ) A 68-year old man is brought to the emergency department because of a 2-day history of progressive lethargy and tremors… Lastly, please check out my Youtube channel ( ) and the “Biostatistics Curriculum” option above for free videos and practice questions reviewing all the essential biostatistics topics covered on NBME exams. I also offer reasonably priced Study Guides and Personalized Study schedules, so please reach out using the Tutoring menu option or Study Guides and Personalized Study schedules menu option listed above if you would like personalized support.įurthermore, I offer personal statement and application review services for residency applicants, so please reach out using the “Residency Advising and Application Preparation” menu option above if interested. However, given multiple email requests, I will post my Venmo if you want to send a few dollars to show your support for the website. These answer explanations are and always will be free.
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