DIP Episode 640 - USMLE Free 86 Series 2 (Q11-20, for Step 2/3)

All right, welcome. My name is Divine. This is episode 640 of the Divine Intervention Podcasts. In today's podcast, I'm going to be continuing the USMLE 386. Again, like I said, these are specs questions, but they are very good for people prepping for step 2 or step 3. We did series one last time, questions 1 to 10. So I'm going to do questions 11. I'm going to try to shoot for 11 to 20, but 11 to 20 have a ton of concepts. I want to address, so I don't know if I'll get to 20. So we'll see. All right, so question 11, a 13-month old child is brought to the emergency department because of audit carrier swelling of the lips and difficulty breathing immediately after eating an egg. A potential risk for hypersensitivity reaction is posed by vaccination against which of the following illnesses. Right? Option A is hepatitis, option B is influenza, option C is pertosis, option D is polio myitis, option E is typhoid fever. For this one, I think I'd go with influenza, right? So this person basically has an aphylaxis, probably from an egg allergy, right? From an egg allergy. So remember the influenza vaccine, these are high, you know, for your exams, right? The influenza vaccine and yellow fever vaccine, those are groaning like eggs. So the vaccines may contain a ovulubumine, right? So if people have history of egg allergies, they may have some problems with these vaccines, influenza and yellow fever.

But the thing is having an egg allergy is not a contraindication to the influenza vaccine. You know, what may just need to happen is that you give them the vaccine and you probably just monitor them for like a half hour or something to make sure that they don't develop an aphylaxis symptoms. But actually it's very high to know this and egg allergy is not a contraindication to the yellow to the influenza vaccine. And again, remember the agent that really triggers the hypersensitivity is ovulubumine, ov-a-l-b-u-m-i-n, ovulubumine, ovulubumine, ovulubumine. This is one of those things where you either know it or you don't, right? So this like the other answers are not groaning eggs, right? But the key egg wants to know influenza and yellow fever. All right, question 12. A 42-year-old white man is brought to the ED by his same sex partner because of confusion, deplopia, and mild weakness of his radar. The patient is somewhat agitated and shows confusion for recent events. Temperature is 100.1 degrees Fahrenheit. There is decreased popularity response on the left with parisis, of lateral gaze on the right. Peripheral lucocycun is increased. Which of the following is the most appropriate next step in evaluation of these patient's neurologic signs and symptoms? Right? So if you notice this person seems to have, you know, the person has fever, the person has altered mental status, right? Is agitated, right? And this person seems to have like these neuro deficits, right?

So again, it's maybe hard to say exactly what's going on here. But let's look at the answers and then we'll kind of talk through this, right? I think this is a good question. So option A says bilateral corroded aterography, option B says CT scan of the head, option C says EEG, option D says LP for examination of CSF, option E says serum HIV antibody test, right? So the thing is this guy, you know, same sex, so maybe has HIV, right? But the thing is he has very acute complaints that we need to address, right? HIV, you're not going to die from HIV right now, right? But he has acute complaints, we kind of need to address, right? And this is a good complaint involves neurologic dysfunction. You know, he probably has many anxieties or something like that. Who knows? Right? But the thing is whenever a person, you suspect the person has been anxiety so encephalitis, right? And you're seeing all these neuro deficits, a lumber puncture initially is contraindicated. You want to go ahead and do a CT of the head first. And then if that CT is negative, doesn't show like signs of increased ICP, then you can do a lumber puncture. So I will say option B, right? CT of the head makes sense here. I will certainly do that before considering option D, which is the lumber puncture, right? And then after I fix his acute complaints, then I could consider option E, which is the serum HIV antibody test. I would not pick option C, EEG, because this person doesn't appear to have seizures.

And I'll not pick option A, by lateral cordial and atereography, because we're not worried about this person having like, like, crudists to no see, so whatever, like that's not really what we're concerned about here, right? So question number 13, 35 year old man is brought to the ED because of altered mental status. He is disoriented and complains about his vision. You have been his physician for the past three years. He has type 1 diabetes mellitus and a known history of intravenous drug use. You last saw him two weeks ago at that visit. You last saw him two weeks ago. At that visit, his serum glucose concentration was 150 milligrams per deciliter. Today, vital signs were a temperature of 38.1, that's 100.5 degrees Fahrenheit. His pulse is 110 and his blood pressure is 190 over 70. On physical examination, pupils are constricted. Fundoscopic examination of the left eye, following dilation is shown. Which of the following is the most appropriate test at this time? Option A says blood cultures, option B says chest x-ray, option C says he, hemoglobin A wants C, option D says HIV antibody titer, option E says plasma reading activity. So again, be careful here. So what do we think this guy has? This guy is altered. We see this weird fundoscopic exam image. We see that he has a visceral, he has a fever, he has a stachycardic, he has a y-post pressure. Just so many things here are pointing to endocraditis. If we even look at this fundoscopic exam image, it's kind of worrisome.

We'd be like divine, what do you mean by it's kind of worrisome? Well, look at this hemorrhage in his eye. And he has all these ponti, you know, like whiteish. So we have like this red above the macula. And then we have all these ponti things. Those are rough spots. This guy has endocraditis. And whenever a person has endocraditis, you always want to get a blood culture first. You typically want to get about two blood cultures or their abouts first before you start any treatment. So please, I will see for purposes of the USMLE exams. Do not begin endocraditis management. If you have not got in blood cultures, that'd be a terrible idea. Get blood cultures because again, the person is likely going to have to be on long-term antibiotic therapy. So knowing exactly what bog is causing the problem is helpful. So at Goat Option A here, chest x-rayed, no, you know, blood cultures are the right first thing to do. Hemoglobin E1 C again. This guy has more pressing issues. Do with the more pressing problems first before you start worrying about like, you know, and this guy has type 1 diabetes. We know that already, but whatever. So option D, HIV antibody, no, maybe we should check that at some point. But again, plasma reading activity, oh, you know, his blood pressure is 190 over 70. I don't think he has the high blood pressure because he has like some, you know, renal artery stenosis or whatever, right? And renal artery stenosis will be quite unusual in a 35 year old.

I think for this guy, I'm going to go blood cultures, right? So the white pulse pressure may actually indicate that he has like aortic regurg. Remember, aortic regurg has a very strong association with white pulse pressure, right? So that may even tell us that hey, this guy's got a viola disease, right? So, but yes, I agree that this guy likely has infectious endocratitis. So I'm going to go to option A for this one. All right. Now question 14 says that 38 year old white man, white letter career, returns to the office for full op of normal results of a liver chemistry profile, order three weeks ago during a routine exam. At that time, physical examination disclosed no abnormalities, but serum EST concentration was 72. Seren bilirubin and alkyphosphoncentrations were within the reference ranges. Medical history is significant for an episode of hepatitis A at age 22. He has no history of transfusions or intravenous drug use. He drinks to the three bears daily. That's a lot of beer. Today's full opics lab study results are shown. So his anti-HV is positive, anti-HPS, anti-HB surfaces negative, HB surface antigen is positive, HBE antigen is positive. And then he says which of the following is the most appropriate next step? Option E says begin interferon alpha therapy, option B says begin corticosterotherapy, option C says instructing to seize alcohol, consumption and retest him in two months, option D says order HB virus PCR tests, option E says schedule liver biopsy, right?

So what's going on here? So this guy definitely has active HB. He has active HB. The HB surface antigen is positive, the HBE antigen is positive, pretty high in factivity. That's concerning here. And the anti-HV being positive means which makes sense, or at least with a history. He's had HB before, so he's generous of immunity to it. And the anti-HPS is negative. So it means that again, this guy does have HB. He does have HB. So the thing is, he seems like he probably has acute HB, but doesn't seem to have any symptoms, he's pretty okay, right? So what answer should we pick here? Well, let's look at this. Resultation E says begin interferon alpha therapy. I would not do that. I mean like even think about it, how do we manage HB? What's the first length treatment for HB? Chronic HB if you want to manage it, you should do like intake of air or tenofovere, right? Those are going to suppress the infection, right? We shouldn't do interferon alpha. Interferon alpha has a lot of contraindications, right? And again, we use it for managing chronic HB, because remember, chronic HB is when you've had HB, you've had acute HB and immune system doesn't clear it, you know, it's like you've had like, you've had this for an hour for six months or more, right? He doesn't look like this guy in this question has chronic HB, right? So it's like, why do you want to start giving anti-viral therapy when we don't know if he has chronic HB or not, right?

Because the thing is more than 90% of adults that have HB, they do clear the infection, and he doesn't become a chronic infection. So I would not pick option A, I certainly would not pick option B. I mean, that seems like a very good way to increase a viral replication. Option C looks like a pretty good one, right? Stop drinking because again, like you already have liver injury from HB. Why do you want to keep crushing your liver by drinking alcohol, right? Just retesting in two months, he may have cleared the infection by then again, like I said, more than 90% of adults, they spontaneously clear HB. Option D says, order HB viral PCR, no, we know it has HB, right? We will do the HB viral PCR if we know that okay, we probably want to start treatment. But again, let's wait to see if he clears the infection or becomes a chronic HB carrier. Then option E, liver biopsy, that's way too invasive, like, come on, there's so much workup that has not been done here. All right, so I'm going to go to option C for that one. All right, let's go to question number 15. 75 year old white woman returns to the office. After six months of missed appointments, she says she's feeling depressed. You have been treating her for years for a variety of disorders, including bipolar disorder, hypothyroidism, AFAB, Peptic Ulcero disease and hypertension. She takes daily lithium carbonate, liver, thyroxin, halopyridol, citralline, bench-rooping, digoxin, propranolol, runnytidin, and warfarin.

Man, that's a long list of drugs. That is a long list of drugs, right? She says, I'm doing fine except for shakiness in my hands. She also says her mood is a little depressed. She has no hallucinations or delusions. Vital signs her pulse of 78 per minute with an irregularly irregular rhythm. Blood pressure of 160 over 95 millimeters of mercury. Physical examination shows a fine tremor of the hands when they're extended. On memory testing, she recalls one of three objects after two minutes. Which of the following is the most likely cause of the spations depression? This person is depressed. She's taking a lot of meds. This is a question about drug side effects. Acids have been strooping, opcian B says digoxin, opcian C says, halopyridol, opcian D says propranolol, opcian E says runnytidin. I'm going to go with opcian D here. Beta blockers have a very strong association with causing depression and they can also cause erectile dysfunction. You'll be able to blockers, like propranolol, they are lipophilic, they can cross the blood brain barrier, they can go into the brain, block beta receptors in the brain, believe it or not, they're beta receptors in your brain. That can decrease neuropinephrin production, that can cause problems like depression.

Basically, you're, let me not see decrease neuropinephrin production, but you can dumb down neuropinephrine effects and that can cause you to be depressed because remember the monamine hypothesis of depression, that people that have reductions in serotonin, neuropinephrin and dopamine will have depression symptoms. If you're dumbing down the effects of neuropinephrine because it can not cause it receptors, that can cause you to have problems. I'm going to go with opcian D here. I remember being strooping, we use it to treat Parkinsonism, which is a side effect of anti-psychotic, that's wrong. Opcian B digoxin, digoxin causes atrotachicardia, causes AV block, causes yellow vision, we don't see any of those here, so that's wrong. Opcian C is a hollow period, it causes extra pyramidal side effects, but they're not asking about extra pyramidal side effects, they're asking about depression, right? And they don't shan E ran E T D in, not a big deal, so I'm going to move on from that. All right, question number 16, a 68 year old man is in the hospital because he requires mechanical ventilation for an exacerbation of COPD. On the second day after admission, he developed a pneumothorax on the right side that required tube thoracostomy. And air leak is noted for the next 24 hours, which now has stopped. However, the patient has become restless and combative. Breath sounds are diminished in the right side of the chest, and the patient now has taicicardia.

Blood pressure is 130 over 80 millimeters of mercury. After ordering a start possible lecture of the portable lecture of the chest, which of the following is the most appropriate next step? Opcian A add four centimeters of peep, positive end-expertory pressure, option B, administer a bit of blocking medications, option C, administer our prazo lab, option D, remove the patient from the ventilator and ventilate him with a bug valve mask, option E, reposition the chest tube. All right, so what's going on here? What's the pressing issue here? Well, seems like this guy has, so you know, he had COPD exacerbation, we did mechanical ventilation, developed a pneumothorax, you placed a chest tube, that's what tube thoracostomy stands for. And then we had this early, but it's resolved, but now, focus on the now, breath sounds are diminished, right? He's taicicardic, right? You see a person that develops sodium taicicardia, diminished breath sounds, that's probably a pneumothorax. This guy has probably developed a new spanking pneumothorax. Well, remember the way we treat pneumothorax is with chest tubes. So the answer that makes sense here as a chest tube answer is option E. So I'm going to pick up some E for this, right? I'm going to pick up some E for this, because this guy, you know, when a patient is on a ventilator, they can be thrashing about, right? So they can dislodge things, because remember chest tube is supposed to be within the plur, it's supposed to be intra plur, right?

Because when you have a pneumothorax, you have build up of intra plur air, so you put the chest tube in the plur, right? So maybe it's not in the plur, so maybe a reposition in it will help with this recurring pneumothorax, right? And also we're getting the chest radiograph, we're getting number one, we'll help us confirm that the chest tube is in the right place. And number two, we'll also help us confirm like, is this a new pneumothorax or not? Right? So I'm going to go with option D, sorry, option E for this one reposition the chest tube, that's like helping the pneumothorax he has now, right? Remove the patient from the vent and ventilator, leave him with a bag valve mask. When a person may have acute respiratory complaints, why would you want to use a less good form of ventilation than the intubation he has? Our prazo lamp, I would not do that, that's a benzene, right? Administered beta blockers, why are we doing that? Four centimeters of people, are we trying to treat the ARDS here? No, right? So I'm going to go with option E for this one. All right, question 17, 36 year old man comes to the office because of headaches that began two weeks ago. The headaches are moderately severe, I present when he are weakens in the morning, and I relived with over the counter-analgeesics. He has no prior history of headaches, he tells you he was promoted to an upper level manager opposition in his accounting firm, about eight months ago. Which necessitated relocating?

Physical examination now discloses, no abnormalities, except for blurring of the optic desmargin by a lot of early. Which of the following is the most upper rate next step? Option A says, begin a trial of beta blockers, option B, other CT of the head, option C, other EEG, option D, refer him for consultation with an neurologist, option E, refer him for consultation with a neurosurgeon, right? So what does this guy have? Right? So we see like chronic headaches, you know, chronic headaches, right? You know, present when he are weakens in the morning, and then we see blurry vision. What does this sound like? Well, this sounds a lot like pseudo-tomorcerybric. Remember, the older term for this is a idiop... I mean, sorry, the newer term for this is idiopathic intra-accranial hypertension, idiopathic intra-accranial hypertension, right? So how do we manage pseudo-tomorcerybric? Well, the first thing we do is a lumber puncture, right? We're going to notice increased CSF open pressures, typically it's going to be more than 200, right? And then you're going to start drilling in there with a cellar zoolomine. But the thing is, if they have signs of increased ICP, right? Like, you know, like for example, this person certainly has signs here. It says physical examination now discloses not the malities except for blurring of the optic desmargin by laterally. That's kind of worrisome, right? That's kind of worrisome, right?

So in that case, if you suspect, kind of like the meningitis question, we did a few moments ago. I want to probably go ahead and do a CT first, just to make sure that you don't have increased ICP before you start doing anything, right? You know, they don't have like increased risk of renational whatever. So, I'd certainly go for option B on this one, right? Order an EEG, no, that's for seizures, right? Option A, bit of blockers, bit of blockers, I know used to manage pseudo-tomorcerybric. They're not. So, the pseudo-tomorcerybric is managed with a sedazula mite, which is a carbonic and hydrason inhibitor. Option D and E refer for consultation. Well, do you know what's going on yet? No, you don't. Figure out what's going on first before you start disturbing out other healthcare professionals. All right. And again, I've just noticed that I'm not saying that this is an absolute rule, but I've noticed in many circumstances, consulting other people is usually an on-wise move on the USMELY exams. All right. Question 18. A 16-year-old high school student, whose prenatal course you have managed, gave birth to a 3,256 gram. That's a 7.3-ounce baby girl during the night with the assistance of your associate. On morning rounds, you notes that the delivery records report that she had mildly elevated blood pressures during labor and sustained an estimated 30-stage blood loss of 500 milliliters. Today, blood pressure is 132.84, she's a febrile, and deep-tendon reflexes are normal.

The other infondos is firm at the level of the ombalikus, and a perinium is slightly demodised. Humanocrystery is 33%, she is coddling her infant, and no more bonding seems to be occurring. Which of the following is the most important next step in management? This is like a benign question. She just wants to be a teenage mom, but everything seems to be going pretty fine for her. So you probably want to pick the most benign answer here. Option A says begin oral feroceros or feet. Option B says begin oral methodoper. Option C says institute fondom massage, option D says other daily seeds bath. Seeds baths. Option E says provide education for well-being care. Personally, I adjust to option E. It's a benign answer. Seeds baths are for like hemorrhoids and stuff. I wouldn't do that here. Institute fondom massage. Why are we doing that? This person's uterus is going down in size. The uterus is not going to contract all the way down to the pubic synthesis right after delivery. No, right? It takes a while. So I'm not going to do option C. Option B says begin oral methodoper. A blood pressure is not that bad. Option A says begin oral feroceros or feet. I cannot agree it's 33%. Right? You know, that may just reflect that cute blood loss, you know, because she just delivered. It's kind of chill out, right? Her number should be jigger and become better over time, right? So I'm going to go to option E. This person is fine. Baby is fine. Everyone seems to be doing pretty well. All right.

So I'm going to go to question number 19 and 20. It's kind of a pair. So 55 year old man who has a long history of alcohol dependence comes to the office for his yearly full-up visit. He has consumed two points of vodka daily for many years. That's a lot of vodka and has a past history of blackout episodes during intoxication. Following a divorce from his second wife, he voluntarily detoxified himself, but this was complicated by a rum fits with tactile and visual hallucinations, right? So it kind of seems like he had withdrawal. His medical history includes hypercholestrolemia controlled by diet, BPH and hypertension, for which he takes an alpha-blocking medication. During the course of the examination, he tells you his twin brother recently died of colon cancer. That sucks. It is clear from the conversation that he was very close to his brother. Man, that sucks. And he feels that he's only support system has left him. You discuss your concerns about his reliance on alcohol as a coping mechanism and ask if he would consider accepting help during this difficult time. He agrees. Which of the following is the most appropriate next step? Option A says, A range for referral to a substance abuse treatment program while the patient is in the office. Option B prescribed the azepam option C prescribed the isophermit discussed with him its use and potential withdrawal symptoms.

Option D, refer him to alcoholics and non-immossumption E suggest he attend an outpatient substance abuse treatment program in his area. All right. So let's look at a few things here. Right? This guy has agreed to quit drinking. Okay. So we know that the right answer has to be some answer that helps with quitting the consumption of alcohol. Right? So maybe don't pick option B. We use that for like a kid alcohol withdrawal. I would not pick option C, especially when there's other answers that could work that are available. Right? The isophermit is really ever used. It is used only if you're like extremely motivated. Right? So I would not pick that answer. It's generally not first line. Generally going to be the wrong answer on exams for alcohol use disorder. Right? Option A, arrange for referral to a substance abuse treatment program. Okay. I mean this person has agreed. So that's good. Option E says suggest he attend an outpatient substance abuse treatment program in his area. Option D says refer to alcoholics and non-immoss. Those three answers that I just read off her good. But again, this guy seems to have pretty severe alcohol use disorder. Right? So since he has pretty severe alcohol use disorder, I probably wouldn't want to do just alcoholics and non-immoss. I want to use something a little more, something a little stronger. Right? You know, so I think option A makes sense. Right? You're literally arranging treatment while the person is in the office. Right?

I mean it's almost like you're catching this guy in a moment of vulnerability, which is good. Because it's like, wow, okay, let me quit. Let me quit let me quit drinking. Right? So you're catching at a good time. Right? Don't wait until it's too late. Right? So I think I'm going to go to option A because option A is almost like a more urgent answer than option E. Option E is like suggest. How many patients take our suggestions? So I go with option A. Right? I ring for treatment and the thing is kind of an analogous concept that can test on your exams involves heart failure. When a person is admitted to the hospital for a C-HF exacerbation, you typically want to ensure that they have like literally the afullop appointments, especially with heart failure clinics set up before they leave the hospital. Right? Because that decreases the risk of them being re-admitted to the hospital. All right. Now question 20, last question for today. Which of the following features in this patient's history is most closely associated with the risk of morbidity or mortality from alcohol withdrawal? Well, the thing is option E says absence of social support, option B says block out episodes during intoxication, option C says family history of colon cancer, option D says previous history of withdrawal seizures, option E says use of blocking medications.

Absence of social support, you know, risk from withdrawal, the absence of social support, it just means that he may not be successful with therapy, may not be as successful. Block out episodes that deals more with intoxication than the withdrawal. Family history of colon cancer has no bearing on your withdrawal from alcohol, option D says previous history of withdrawal seizures. Okay. So he's had this problem before. He has tried to quit on his own. That's actually worrisome. I mean, I actually will go to option D here, but we'll talk about that. Option E says use of an afro-blocking medication. No, right? No, no, that doesn't make any sense. Right? That doesn't make any sense. Other blockers are not really used for alcohol. We draw, um, they don't really have any big ruling alcohol. If a person has alcohol used the soldier, you can put them on an outtrek soon or you can't proceed, but that's not really what's going on here. So I'm going to go with option D, right? Because the thing is one thing people don't realize is that when you drink a lot, right, drinking makes you produce a lot of gaba and reduce the amount of glutamate, right? So I remember gaba is an inhibitory neurotransmitter. Glutamate is an excitatory neurotransmitter, right? So what basically happens? Well, the thing that happens is that because you're making so much gaba, your CNS becomes used to too much gaba. So your gaba receptors start being downregulated.

But because you're reducing the production of an excitatory neurotransmitter like glutamate, your CNS is going to make more glutamate receptors. You're going to operate glutamate receptor production, right? So that's part of why alcohol we draw can cause seizures because your operating receptors that are excitatory glutamate receptors, right? Those are NMG receptors. You know, they are responsive to glutamate. So if you operate glutamate receptors and downregulated gaba receptors, right? And again, you're downregulated gaba receptors because there's too much gaba because alcohol makes you make a ton of gaba. And you're upregulated glutamate receptors because you're making less glutamate and alcohol reduces glutamate production, right? That can lower your seizure threshold and cause you to have seizures, right? And the thing is alcoholics, one thing that's kind of higher to know with them is if they keep trying to quit, but then they will, they study it again, they quit, they restart it again, they quit, they restart it again. This thing about downregulated gaba receptors, operating glutamate receptors becomes more and more pronounced. And whenever you have upregulated sensitized receptors, that can put you in a very, very bad place, right? So like, for example, I just like to think of it this way where if a receptor is like very sensitized, very upregulated, then you can have like very profound effects to exposure to that substance, right?

So kind of keep that in mind, right? So those people, because you're operating glutamate receptors, you're sensitizing those glutamate receptors, those people, if they withdraw, they can have like more violent withdrawal, right? So I believe that this is known as a kindling effect, right? It's like kindling a fire, right? So it's like, oh, each withdrawal, your next withdrawal is going to be worse than your last withdrawal, right? Because again of this kindling, kindling effect, right? So I'm going to go to option D for this one, I'm going to go to option D for this one. So you love the way I teach, you love the way I explain, you love the ready integrate, you love the way I explain pathophase, you love my classes. I have classes for step one, all the way to step three that begin on Monday. Next week, if you want specific information on these classes, shoot me an email, I'll give you some more information. And the one that teaches all my classes, I don't subcontract it to anybody. I teach all the classes and they're pretty much entirely problem based, right? I go through concepts, I go through content, I go through pathophase, I go through testing principles, right? And I have a big 50 hour class, step two, step three class in June, 10 days, 50 hours, really, really amazing, really, really comprehensive class.

So if you're interested, shoot me an email, you know, for any of these classes, also for one-on-one tutoring for all the US Million complex exams and medical exams, also help with applications, you know, errors applications, more interpersonal statements. And then, you know, check out these podcasts on Apple Google and Spotify podcasts. And then, you know, I have another website called divininterventionlifelessons.com. Divininterventionlifelessons.com. Every week, I post like one or two podcasts from a biblical perspective, I address a life lesson. I have about almost 400 episodes on there. So I will see you God willing in episode 641. That's going to be series three here. But thank you for joining me today. Have a wonderful day. God bless you and bye for now. Thank you.

Influenza vaccine and Yellow fever vaccine.

Perform a CT scan of the head first, before considering a lumbar puncture (LP).

Blood cultures.

Blocking central beta receptors, which decreases norepinephrine production (Monoamine hypothesis).

Carbonic Anhydrase Inhibitor (e.g., Acetazolamide); CT scan to rule out increased ICP causes first.

Previous history of withdrawal seizures, indicating potential kindling effect.

Influenza and Yellow fever vaccines (due to ovalbumin).

CT scan of the head, to rule out mass effect or increased ICP.

Blood cultures (typically two sets).

Alcohol consumption increases GABA (inhibitory) and decreases Glutamate (excitatory); withdrawal leads to downregulated GABA receptors and upregulated/sensitized NMDA glutamate receptors.

Carbonic Anhydrase Inhibitors (e.g., Acetazolamide).

Influenza and Yellow fever vaccines (due to ovalbumin).

CT scan of the head, to rule out mass effect or increased ICP.

Blood cultures (typically two sets).

Alcohol consumption increases GABA (inhibitory) and decreases Glutamate (excitatory); withdrawal leads to downregulated GABA receptors and upregulated/sensitized NMDA glutamate receptors.

Carbonic Anhydrase Inhibitors (e.g., Acetazolamide).