DIP Episode 184 - The NBME Weird (Complications, Prognostics, More Risk Factors/Common Causes of Death/Screenings). An Episode 37/97 Extension

Welcome. My name is Divine, I am a resident. This is episode 184 of the Divine Intervention Podcast. And in this podcast I'm going to be focusing on something called the MBME Weird. For those that are listening to this podcast, consider this to be a continuation of episodes 37 and 97, like those popular risk factors most common cause of death that podcasts. And in this podcast really the major thing I would focus on is like something that the MBME appears to be caring about these days, right? And I mean lots of people have made ready to post on this and send me emails about this where you try to answer questions like what's the most likely complication of disease like in two years or in one year or was the most likely outcome of disease, was the most common cause of death or what is the most likely other finding on physical exam or was the most likely clinical presentation of a disease. So try to really focus hard on that here and then cannot take things from there. I'm going to work out relatively quickly through this material. Okay, so what is the most common complication of a person having a history of like a cleft lip and palate? Would that be a chronic or tightest media? Okay, that's the one you should watch out for in an exam, right? I mean that will typically arise because the patient has some kind of used tissue tube dysfunction. If you don't see that as an answer choice then consider going with like speech problems.

Now what is the most common complication that develops in a patient that receives a bone marrow transplant? Well, there'll be grave versus host disease. Now what is the most common pregnancy-related complication of antifus, polypid, antibody syndrome? Well, there'll be recurrence spontaneous abortions, right? And then what's the most likely complication that develops within the first 20 weeks of pregnancy? That's a spontaneous abortion, okay? Now what is the most common cause of infection in burn patients? What is the most common cause of infection in burn patients? Well, there'll be sepsis right from pseudomonosyrogenosa, very high you to know that for exams. Now what is the most important intervention associated with decreasing the risk of ocular complications in a patient that has measles infection? Well, there'll actually be given vitamin A, right? Remember vitamin A will sort of helps with repairing the corneal epithelium. Now what is the most common complication of like a person that has like a terminal disseminated malignancy? Well, there'll be cacexia, right? Remember that classically arises because the person has like a catabolic state and sometimes your friends at the end of the day ask you for like the mechanism behind this, right? You want to think about buzzwords like fat-like polices, right? That's why those people tend to lose a ton of weight or they break down like the myocene heavy chain, right?

That's why they be developed like muscle atrophy and the appetite is classically suppressed, right? I remember that most of these things are mediated by TNF. Now what is the most common or I guess maybe most severe complication of a triple A? Like an abdominal eurican erysm, that's rupture, right? Okay? Now what is the most common overall complication of chronic hypertension? What is the most common overall complication of chronic hypertension? That's live ventricular hypertrophy, right? Now what is the most common cause of death in a patient with a history of chronic hypertension? That's an acute M.I. Okay? Now what is the most common arrhythmia in a person that has a stem? That's a PVC, right? A premature ventricular contraction, okay? Now what is the most serious complication of... What is the most serious complication of acute rheumatic fever? Well that's some kind of credititis, right? Like myocarditis and dachradiitis blah blah blah, right? And I guess what is the most common cause of death in a patient with acute rheumatic fever? That'll be myocarditis, okay? Now what is the most common complication that develops in the first few hours of life in an infant of a diabetic mother? That'll be hypoglycemia, right? Remember and they may ask you about the mechanism behind disease? Well, you want to be able to spot the fact that, right? The kid, because the kid is constantly exposed to like all these high glucose in utero, right?

The kid on the goes like, I let cell hyperplasia, right? So it makes a crap ton of insulin. So when the kid gets born, you know, they're still making that crap ton of insulin. So that'll tank their blood glucose and that can cause hypoglycemic seizures. Remember, hypocalcemia can also occur in an infant of a diabetic mother, but the most common you should think about is hypoglycemia, okay? Now what are three complications of oxygen therapy? Like, yes, maybe two. Like prolonged oxygen therapy, like in a premature kid? Well, I hope you're thinking about like, right? Napathy of prematurity, bronchopominary dysplasia, occasionally you see this finding in intraventricular hemorrhage, but to be honest, I don't really consider that to be a to be a complication of oxygen therapy. Okay. Now, what is the most common cause of a vasovalgeovaric disease? Well, it's porohypertension right from, you know, abusing alcohol chronically. Now what is the most serious complication of herchprom's disease? What is the most serious complication of herchprom's disease? Well, this is actually death, right? Because the present can have like, like an interocolytus from the above that's super, super dilated. Now what is the most common complication of mechols diverticulum? Well, that's pleeding, right? Now what's the most common complication of diverticulosis? Right? Think about like a painless, loragyably in the elderly. Right? That's diverticulitis. Right?

So the most common complication of diverticulosis is diverticulitis, right? And again, your friends are the inbinding me ask, what is the mechanism behind disease? Right? It's actually like an impacted thicklyph in the diverticulum sac, right? And then after that you have like infection and inflammation, kind of developing behind that thicklyph. Now what is the most serious complication of oscillative colitis? Well, that's toxic mechocolon. What's the most common complication of appendicitis? What is the most common complication of appendicitis? That's actually the development of a periapendicial abscess. Now what is the most common complication of collineathiasis? So I guess you can see biliricolic. Well, that's colisestitis, right? That's colisestitis. Now what's the most common complication of an upper urinary tract infection? What is the most common complication of an upper urinary tract infection? That's actually hydronufrosis, right? And is actually kind of high autosu-nodat. The most common complication of retroperitoneal fibrosis is also hydronufrosis. Remember retroperitoneal fibrosis is something you can find in IgG4 related diseases. Remember IgG4 related diseases include things like autoimmune colisestitis, autoimmune pancreatitis, and then they can also have like radials, thyroiditis where they have like a pinless rock heart thyroid. Well, these people can also have a retroperitoneal fibrosis, it's like a generalized the fibroidic disease.

Now what is the most common complication of BPH? So benign prostatic hyperplasia, what's the most common complication? Well, that's obstructive neuropathy. Okay. Now what is the most likely outcome of actinic erotosis? It's actually just a resolution of the disease, right? Very high autonofartests. Now what is the most common complication of diabetes? Especially like type 1 diabetes. That's actually insulin-induced hypoglycemia. Okay. Now what is the most important mechanism, right? There's something your friends at the MMA love. What's the most important mechanism? The underlying hyperglycemia in a patient with type 1 diabetes. That's gluconeogenesis. Right? This is one of those nitpicky ways they introduce biochem like light biochem into the exam. Now what is the most serious complication of increasing trochranial pressures? This one is easy, right? This is a nation that's obviously bad, right? Now what is the most common cause of cyanide poisoning? So this is actually being in a house fire, right? Although remember another cause you may see on an exam is a nitropercide like a long like a lengthy nitropercide infusion, right? But the most common cause of cyanide poisoning is actually being in a house fire. Now what is the most common cause of fatty change in the liver? It's actually chronic alcoholism. They'll try to trick you into like saying oh the person is obese, that's why that's not why. Okay?

The most common cause very high order of fatty change in the liver is chronic alcoholism. Now what is the most likely infectious complication of chronic rheumatosis disease? That's pneumonia, right? Remember CGD, ex-intercessive inheritance, any DPH oxidized deficiency. You treat it with interfering gamma, right? Now what is the most common cause of skin abscesses? Well that's that for you, right? Now what's the most common cause of death in a patient with a less than low syndrome? That's actually aortic dissection, okay? Remember a less than low syndrome, it's autosomal dominant inheritance, usually arises from heavy mutations in type 1 and type 3 collagen. Now what is the most likely barrier to the proper healing of a wound? So you're like, man, this one doesn't seem to get in better. That's a definitely persistent infection. Again, that's why I call this podcast the NV Me Weird, right? And again, if you're a metronome, just look already, look at SDN. I'm seeing what we're completing about these kinds of questions. Now what is the most common kind of rejection in a patient that gets a kidney transplant? Or you know what any transplant for that matter really? This kind of applies to that. What is the most common kind of rejection? Well that's gonna be a cute rejection. Remember a cute rejection? They may ask about the mechanism. It can actually be a type 2, or in some cases a type 4, hypersensitivity reaction.

Now what is the most likely malignant complication of being on chronic immunosuppressive therapy? That's actually the development of like scrimal cell carcinoma of the skin. Now what is the most common cause of infection overall in a transplant recipient? That's CMV, right? Remember it's not pronounced recipient. It's pronounced recipient, but anyhow, there's not an English class. Okay, so again, the most common cause of infection overall in a transplant recipient is CMV. Now what is the most common cause of infection in a patient getting some kind of solid organ transplant? So like let's say like a heart transplant, kidney transplant, lung transplant, punker transplant. That's actually kind of down, right? Now what's the most common cause of infection in a patient getting a bone marrow transplant? That's actually as perjumous, right? That's why many of these bone marrow transplant patients, they get put on like very cognizant for example, right? Number two on that list is candidate, but just remember your A coming before your C. If you're a liquor fan, maybe Alex Kerr also, that's what we remember that the A comes first and then the C comes next. Now what is the most likely organ to develop complications in a patient with lupus? That's actually the kidney, right? That's like the fused proliferative glomerular arthritis. Now what is the most common cardiac finding in a patient with lupus? That's actually fibrinospheric raditis, right?

And then what's the most common cause of drug induced lupus overall? That's proquinomide, right? Don't forget your antihistone, antibodies with that. Now what is the most common cause of death in a patient with lupus? Well that's infection from immunosuppression, right? Now what is the most likely presenting complaint in a patient that is subsequently diagnosed with scleroderma? That's actually renotes phenomena, right? And remember the skin is actually the most commonly involved organ in scleroderma. And then what's the most common cause of death in a patient with like systemic sclerosis, so like systemic scleroderma? That's actually your respiratory failure, right? Remember these people tend to develop a fibrolytic lung disease. Now what is the most common HIV serotype in the US? That's actually HIV-1, okay? Now what in a patient that presents with HIV in the US? What is the most likely mechanism of transmission? That's actually like men having sex with men, okay? I mean like a little over like two-thirds of cases of HIV in the US are ice from men having sex with men. Now what is the most likely theology of HIV and the healthcare worker that you know just presents with HIV? Well this will actually be from like an accidental need-o-stick exposure, right? Now what is the most likely infectious complication in a HIV patient that has a CD4 count of 25? Think of one of two things on your exam.

It can actually be like PCP pneumonia and it can also be like you know like some kind of systemic candidate infection. Now what is the most common complication of systemic amyloidosis? That's renophilia, right? Now what if they give you a question about a patient? They tell you you know this patient came into the hospital five days ago when the patient came in it was 85 kilograms. Now right now the patient is 90 kilograms, right? And then they ask for the most likely mechanism behind the weight increase. What do you want to think about? What do you want to think about increased total body sodium, right? Because remember if you have an increase in your total body sodium that will increase your blood volume, right? That will increase hydrostatic pressures in your bloodstream, right? And that will overall cause an increase in weight. Now what if they give you a question about a patient that you know presents with hyponitremia and increased urinosmolality? And then they ask what is the most likely mechanism behind the lab finding, right? So like hyponitremia increased urinosmolarity. Well you want to think about a topic ADHD production, right? We'll think about a topic ADHD production. Now what if they give you a question about a patient on HCTZ, you know, he's on HCTZ for like I don't know like hypertension. And then this vision is found to have an EKG with like a prolonged cutine interval and a U-wave.

And he say what is the most likely clinical presentation of this patient to the healthcare system? We want to think about muscle weakness and fatigue, right? This is primarily hypokillemia for the most part, right? Now what's the most likely clinical complication of a left-h-row thrombus? Well this is actually like embolization, right? That can you know give rise to like organischemia or something like that. Now what is the most serious complication of perinial cellulitis? That's actually neck fasch, right? Now what's the most common cause of death in a patient that is hospitalized in any ICU in the US? That would be septic shock, right? Now in a boy with some kind of genetic mutation, what is the... So this is a boy, right? So like essentially referring to like an excellent excessive defect, but it will make it that easy, right? So if they give you a question about a boy that presents with a genetic mutation and then they ask like a month's per se question about like the most likely pathogenesis of this person's disease, what do you want to think about? You want to think about an enzyme defect, right? Now what is the mechanism of disease in a 25-year-old six-foot male that you know is infertile has a micro penis? Well that's genetic non-disjunction, right? Remember you're thinking about client filters with this. Now what's the most common cause of death between the ages of one month to one year? That's actually six, right? So like suddenly infant death syndrome?

Between the ages of one to 44 years, you want to think more about like motor vehicle accidents. Now what is the most common cause of blindness in the elderly? That's actually immaculate degeneration, right? Now what's the most common volvular abnormality in the elderly? That's theodic stenosis. Now what is the most important risk factor for the development of pressure ulcers? So this is actually when a person has, they may even ask this as a mechanism question. It's actually when you have like increased pressure on capillaries. I remember that pressure ulcers don't just arise like in the like this. You don't only have like sacrode-acubitis ulcers, you can also have it behind the oxypertory because again, right? Basically any place where you chronically can put pressure on like that part of the body that can develop like like a like a pressure ulcer pretty much. Now what's the most common cause of anemia in an alcoholic? It's actually anemia of chronic disease. Your friends at the MBMD will try to trick you into picking megaloblastic anemia. Don't do that, right? The most common cause of anemia in an alcoholic believe it or not is anemia of chronic disease. Now what's the most common cause of thrombocytopenia in the healthcare setting? That's actually the use of heparin, right? Now what's the most common cause of hypertension in a young reproductive age female? Woc P use, right? She stops the OCP use, hypertension goes away.

Now what's the most common cause of death in a patient that's struck by lightning? That's actually caruorespiratory arrest, right? I remember that in these people, right? If they have like, if they were to have like a shoulder dislocation, there'll be a posterior shoulder dislocation. Now in a patient that's exposed to radiation, what is the most likely neoplastic complication? So in a patient exposed to radiation, what is the most likely neoplastic complication? Well that will actually be acute leukemia, right? You'll try to trick you on the exam into picking my papillary thyroid cancer. Don't do that, right? The most likely new plastic or you can see my ligament complication of exposure to radiation is acute leukemia, right? But make sure you separate this from another concept in your mind, right? I mean overall, the biggest risk factor for papillary thyroid cancer is exposure to radiation, but it's radiation like in the head and neck, okay? And then another bizarre question you see on your test is, what is the most damaging radiation to the skin? Is it UVA radiation or UVB radiation? It's actually UVB, okay? Now what's the most serious complication in a young female that you know has like a BMI of 15 or obviously as an erection or a vosa? You can even extend this thought to a person of Bully male or a vosa. What's the most serious complication that can develop in these patients? Well, that's actually a ventricular with me from hypochylemia, right?

Because typically these people tend to use laxatives and get hypochylemia with that. Now in a hospitalized patient, what is the most common cause of vitamin K deficiency? So this is actually from the use of antibiotics, right? That essentially kills off all the flora in the colon. And then what's the most likely side of like if a person has like a bone met from a malignancy? What is the most likely bone to have met? Well, that's actually the vertebral colon, right? And remember this, if they actually about the mechanism behind this, think about like the batsin vertebral plexus as being the mechanism. It's just a plexus that drains many organs. But somehow bypasses the vertebral bodies and spinal cord and whatnot. Now here's one nifty question your friends at the M.A.M.E. Love. What if you have a patient, you know, has like a malignancy that is metastatic to like the vertebral bodies to like, you know, like bone pretty much. And then the ask, what is the most likely primary malignancy that gives rise to this metastasis? You want to think about breast cancer? Breast cancer is the number one cause of bone met. Right? The second most common cause is prostate cancer. Okay? Although overall, remember that prostate cancer is the most common cancer that produces osteoblastic metastasis. Okay?

But overall, the most common cancer, like if they show you like an image of a person like a bone scan, having like a ton of bone met and that's what the most likely primary malignancy, that's going to be breast cancer. Now, and then one of the thing the M.A.M.E. Love is, what if they tell you that, oh, you know, you find some kind of metastatic malignancy somewhere? What is the most likely primary site of malignancy? Let's, okay, maybe I should take a small step back here. Let's maybe break this down. Right? So I said that if a person has bone met, the most likely primary is breast cancer. Well, another high-yield thing to know is if a person has liver met, the most likely primary is actually going to be lung cancer. You'll try to trick you into picking colon cancer. I mean, the most common site of colon cancer metastasis is to deliver. But if you see metastatic disease in the liver, it usually arises from the lungs. Remember, your L's match liver. So if a person has liver met, the most likely primary is lung cancer. If a person has brain met, the most common primary is lung cancer as well, okay? Lung cancer loves to metastasis to break. Now, if a person has lung met, right? The person who have, like the most likely primary is going to be breast cancer. I mean, the breast is kind of in the same general area. Those are very high-yield things that I promise you. Now, what is a future malignancy that may develop in a person that has a history of retinoblastoma?

Well, that's also a coma, right? Remember, that's like an RBG mutation. And then what is the most common mutation overall that gives rise to malignancy? That's actually having a P53 mutation, right? And then what's the most common cellular complication of Marcent Syndrome? That's actually a mitrovov prolapse, right? Again, don't forget your mitrovov prolapse with a mixometrics of avial degeneration. Now, what's the most common new plastic complication of having HIV infection? That's actually a paucycer coma, right? Now, in a patient, you know, that's admitted to like a hospital in the US and this patient is over the age of 65. What is the most likely diagnosis on admission? That's actually CHF, right? I mean, like, essentially for like a CTF exacerbation. And then if you have a patient presenting to the hospital and they ultimately receive like a final diagnosis of rheumatic fever, what is the most likely present? Like, what's the most likely initial clinical presentation? That'll be a migratory polyathritis, okay? Now, what is the most common mutation that gives like on what chromosome would you have like the most common mutation that gives rise to like hypertrophic obstructive cardiomyopathy? That'll be actually on chromosome 11, okay? Now, if let's assume you get a question about like, you know, 55-year-old male presenting with a hemoglobin of 8, mcv of 60, what is the most likely, what is like the most likely finding on further evaluation of this patient?

Well, that'll actually be the discovery of like, you know, like polyps or like correctal cancer when you perform a colonoscopy, okay? Now, what is the most serious complication of sickle cell disease? The most serious complication of sickle cell disease? That's actually like something called acute chest syndrome, right? You know, classically the presentation of that will be like, you know, like chest pain, you have like all these long symptoms, like a new puriliffusion. And actually believe it or not, this is actually the most common cause of death in young folks with a sickle cell disease. It's typically from acute chest syndrome. Okay, now what's the most likely trigger of a hemolytic episode in a patient with G6 pd deficiency? That'll actually be acute infection, okay? Now, if you have a patient that has some kind of disorder of platelet dysfunction, what is the most likely clinical presenting complaint? This will actually be nosebleeds, right? Remember, nosebleeds generally happen because you have like the KSO back plaxes in the nose, right? That's actually a high-yield factor to know for many exams. Now, what's the most likely infectious complication of receiving a blood transfusion? What is the most likely infectious complication of receiving a blood transfusion? That's actually CMV infection. They'll try to trick you on the exam into choosing a hep C, don't choose hep C, it's gonna be CMV.

Now, what's the most common infectious precipitate of an acute COPD exacerbation? This is actually H flow, hemophlos influenza, right? The thing is one other way they actually test this thing is they may give you like a pneumonia question in a patient that's, you know, having like an acute COPD exacerbation and then they'll give you multiple bugs and then they won't really give you much in the way of closing the question. If you see like pneumonia for example in a COPD patient, like a patient again coming in with a COPD exacerbation, think about hemophlos influenza as like the most likely cause. Now, what is the most likely clinical complication of Barrett's esophagus? It's actually the formation of esophageal ulcers, right? With like strictures, right? And that'll ultimately cause this feature, right? Because the person will have like like literal physical obstructions to a movement of a photo through the esophagus. Now, what is the most common cause of death in a patient with cirrhosis? So this is actually the ruptured surface of a jaw varicose, right? And then if you get a question about a patient that has like a bleeding gastric ulcer and then they ask you what's the most likely vessel to be involved? That'll actually be like the left gastric artery, right?

If a patient has like a bleeding to an ulcer and they ask you the most likely vessel to be involved or they give you a question about a patient that has like a bleeding to an ulcer and the patient like dies from profound blood loss. Think about the erosion of the gastro-dwarden ulcer. Right? This thing is very life-threatening, really bad. I mean, I've literally had people have this problem and it's not pretty when it happens stressful. Okay. Now, I've kind of mentioned this already, right? But if a person has colon cancer, what's the most likely place colon cancer made as the size is stored? That's going to be the liver. Okay, but again, remember, if you see liver met, the most common cause of liver met is lung cancer. Okay? Just like the most likely primary cancer that gives rise to liver met is lung cancer, right? And the thing your friends at the MBME do is like, let me just let me maybe put it this way. A nice easy way to differentiate between a primary malignancy in an organ and metastatic disease is just look at how many lesions there are. If there's just one lesion, it's probably a primary malignancy. If there's multiple lesions, it's probably going to be a metastatic malignancy. It's probably going to be metastatic organ. Now, what is the most common cause of cirrhosis in a kick? It's actually the alpha-1 antitripsine deficiency. Okay? Now, what is the biggest risk factor for having a hepatic adenoma? So that's actually the use of OC Ps.

What's the biggest risk factor for liver angiosircoma? That's actually exposure to vinyl chloride, right? I mean, like liver angiosircoma is awful awful awful awful. And the thing in life expectancy is what like six months or something like that. Okay. Now, what is the biggest risk factor for colanduocarsinoma in the US? That's actually PSC, right? Primary sclerosin colangitis. Now, what is the biggest risk factor for chronic pancreatitis in a child? That's actually cystic fibrosis, right? Now, what is the biggest risk factor for pancreatic adenocarsinoma? That's actually smoking, right? Now, what is the biggest risk factor for end-st anal disease in the US? That's actually diabetes, okay? Now, what is the most likely renal complication associated with using an amino glycoside? That's actually a cutiblenin crosses. Now, what is the most likely renal complication associated with sickle cell disease? That's actually symptomatic hematurif, okay? Now, in a patient, you know, that has like a nephrolithesis, like a renal calculus. What I guess I'll just tell you that, right? So typically, these people have like normal blood calcium levels, but they will have higher anary calcium. So they are normal calcemic and hypercalcemic. Now, what is the most likely complication of, at least on exams? What is the most likely complication of VHL? So like, when hippo lenda, what is the most likely complication? This is actually bilateral renal cell crystalloma.

I mean, it happens in what like 50 to 60% of patients with VHL. And please, please, please, don't forget the decision of VHL with things like like hemanguoblastoma, right? Like, classically, that will produce like high levels of hippo, right? And they can have these hemanguoblastomas in the cerebellum. They can also have like a renal hemanguoblastomas. Remember that, right? VHL, or zomodominant in heritans, it's on chromosome 3, right? And one thing your friends at the Indian in Meascus is like, what kind of screening should you do in these people? Well, these people actually need like adenorectinal exams, right? You want to check for those right now hemanguoblastomas. These people also need like anal ultrasound, right? Because you want to assess for like renal cell, the bilateral renal cell crystallomas. If you actually read some literature, you actually can also show that you may want to get like, like, anaroma at an effring level, it's because you want to assess for fios. Remember fiochromositomas are actually common in VHL, right? And then these people for the most part, they also need like brain and spine MR Is like every two years. Again, you want to check for that hemanguoblastoma, right? And then they will also need like, audiological screening as well, every two to three years. And we see the vine, this stuff sounds really low-yield. I promise you it's not low-yield. Okay. Now, in a patient that you know presents with flung pain, you're reading to the groin, right?

So like sitting in like a kidney stone, what is the most likely site of obstruction? That's the ureters, right? Sometimes some literature may say like the ureterra vesicle junction, right? Like the UVG. So I'll just tell you this, they will either put ureter as your answer or UVG as your answer, right? Now, what is the biggest risk factor for sepsis in a hospitalized patient? That's actually the presence of an indwelling urinary catheter, right? In fact, the most common cause of sepsis in a hospitalized patient for the most part is equal line. Now, in a patient that ultimately is diagnosed with bladder cancer, what is the most likely initial presenting complete? So, that'll be like painless or you know like grossy material. Now, in a child that presents with scurredal enlargement, what is the most likely additional finding on further examination and testing? W. Hydrocell, right? Now, what is the biggest risk factor for importance in a patient that's greater than 50 years old? That's actually vasculine sufficiency, okay? Now, in a woman that presents with like dysmenorrhea, dysparonia, dyschysia, right? Obviously endometriosis, remember? Sometimes they may put like nodularity of the ureterra sacral ligament on exam. What is the most likely mechanism on the line these findings? So, this is actually like reverse menstruation. So, reverse men sees through the fallopian tubes. They love to test this on in-beaming exams. Now, what is the biggest risk factor for female infertility?

And I guess a topic pregnancy. What is the biggest risk factor? That's a fluke PID, right? In fact, the biggest risk factor for a topic pregnancy is scarring from a prior PID, okay? And what if they give you like a question about like the most common ovarian mass in a patient that's pregnant? That's actually a corpus luteum system, right? Okay? Now, what is the most likely on the line mechanism behind the high prevalence of breast cancer being diagnosed like in the upper outer quadrant of the breast? When it's because you just have an increased density of breast tissue right in that region, right in the upper outer quadrant. Now, what is the most serious complication of acromagaly? It's actually death from a dallithic cardiomyopathy, okay? Now, what is the most likely clinical presentation? In a patient that's ultimately diagnosed with primary hyperparaphrilitis? That's actually an effortless diagnosis, right? Now, what is the biggest risk factor for hyper-phosphatemia? So, high levels of phosphate. That's easier, right? That's chronic renal failure. Now, what is the biggest risk factor for a period from neuropathy in the US? That's actually diabetes, right? Now, what is the biggest risk factor for fasting hypoglycemia in the US? The biggest risk factor for fasting hypoglycemia? That's actually alcoholism, remember alcoholics?

If you want a really deep deep, if you're interested, you can send an email I'll try to explain, but it's something involving like having high levels of any D.H. It's something you can actually prove biochemistry. Well, I mean, reason out biochemistry. Okay, now, what is the most likely clinical presentation? Right? So, like, was the most likely like initial clinical presenting complete in a patient that's ultimately diagnosed with Pages Disease? Well, that's bone pain, right? I remember Pages Disease made the diagnosis with a bone scan. They usually have to be like an elevated outfoss. Remember that it increases the risk of osteosirachoma? I remember that you treated with a bisphosphonite. Okay, now, what is the most serious complication of tetanus? So, that's actually like pneumonia and cardiac arrest. Pretty bad, right? Now, what is the most likely clinical presentation in a patient that is ultimately diagnosed with my stenegravis? Don't actually be Tosis, right? Now, what's the most common cause of imbethygo? That's easier, right? That's that for us. Now, what's the most common presentation of like a superficial Dramarofy dosis? Like, was the most common tiniya, pretty much? Well, there'll be tiniya pedius, right? Like, at least foot. And one tip bit, I guess, let me just take a quick side bar here. If a patient has like male fungus, right? Like tiniya and guaya, you want to treat it with an oral agent, right? Like oral terbenafine.

If it don't terbenafine, it can pick it or connozzol. They will try to treat you into giving like a topical agent. Don't give a topical agent for for tiniya, like male fungus. And also for tiniya capidus, tiniya capidus does not respond to topical agents. For those you treat with with oral agents, you can use like oral terbenafine, stuff like that. That'll be like tiniya capidus, right? Now, what is the most common cause of non-communicating hydrocephalus in the newborn? It's actually like a structure or obstruction in the like the cerebral aqueduct of Sylvia's. Now, in a patient that's presenting with any kind of CNS infection, what is the most likely on the line mechanism of disease? Well, that will actually be hematogenous spread. Most infections that get to the CNS, they get there through the bloodstream. Now, what are the two biggest risk factors for capitol tonal syndrome? That's actually pregnancy and rheumatoid arthritis. Now, what is the biggest risk factor for optikni arthritis? That's multiple sclerosis. Now, what is the most common cause of blindness in a patient with HIV? That's actually CNV-regnitis, right? Now, what is a favorable prognostic factor in an individual? You know, usually like a kid that has ALR. That's actually the presence of like a 12-21 translocation. Now, what is the most important determinant of prognosis in a patient that has Hodgkin's lymphoma? It's actually the clinical stage of disease.

It's actually not the type of Hodgkin's lymphoma that determines prognosis. They like to treat people with the stuff on exams, right? Because for the most part, if you have just lymphotenopathy above the diaphragm, that's actually, you know, pretty good prognosis associated with that. Okay. Now, one other thing that your friends at the MBME kind of expect you to know is like Ransans criteria for pancreatitis. So just take a small sidebar. There's like criteria you think of an admission and then criteria you think of like 40-30 as of admission because they can easily make this into like a prognosis question on your test, right? So for criteria on admission, you want to think about the pneumonia G-A law, right? So like Georgia law, right? So like the G stands for glucose greater than a, glucose greater than 100. The A is A is degraded and 250. The L is Ld is degraded and 350. The other A is age-graded and 55, right? And then the W is a white, white-combrider than 16,000, right? And then two days after admission, right? So like 48 hours of post-admission, you want to think about Calvin and Hobbs, right? So like C and Hobbs. The H is for like hematocrypt, dropping by greater than 10%. The O is for like O2 sets less than 60 millimeters of mercury, right? The first B is like a B-Wayne increase on admission, right? So like a B-Wayne increase, greater than 5 mix per deciliter. The other B is like a B's deficits, greater than 4 mix per deciliter, right?

And then the S is like, you know, like, you know, medium of like six liters of fluid, I think. Yeah, I think that's like, you know, medium of like six liters of fluid, I think. Yeah, medium of a six liter of fluid within a 40-hour period. And then the C is just having a like high-poke calcium, right? So like a calcium less than like 8 mix per deciliter. So that's something you definitely want to make sure you know for exams. Very, very high-yield to know that stuff, to know that stuff for exams. Okay. Now, what is the most important prognostic factor in a patient with renown cell carcinoma? Or what's the most likely like most important factor that's determined on prognosis? Well, that's a fully invasion of the renown vein, right? Now, what is the most important prognostic factor in a patient that presents with melanoma? It's actually the depth of invasion, right? Now, some fancy stuff that your friends at the MBME want you to know about NF2, right? Is you want to know that these people tend to require like, you know, like regular hearing screening, right? Remember, like they are quickly can have their own, right? And they also typically need like amore-bring MR Is, right? Typically from like age 10 to like the fourth decade of life. And remember, right? NF2, chromosome 22 mutation, right? And these people also, I guess this is also kind of bleeding into NF1, at least an NF1 person. You want them to also have like routine of thermologic screening, right?

You want to screen for those are optic nerve gliomas, right? Now, another general thing you want to keep in mind for these exams are like, you know, like just common complications of sturdroibers syndrome, right? So like remember sturdroibers syndrome usually presents as like a port-wind stain, like an adrenaline of distribution. These people tend to have like seizures, developmental delay. They can have like hemiparesis, right? Because they can have all these are capillary malformations. Now, what did they give you a question about a child that has like, you know, multiple bone metastasis? And then they ask you, what's the most likely primary malignancy? When you want to think about neuroblastoma, okay? If you don't see neuroblastomas and answer, you know, pick between like rabdom ayos or coma or like a webstrum. Now, what is the most likely reproductive complication of receiving systemic hemotherapy? That's actually hypogonadysm, right? Now, what is the biggest risk factor for uterine sarcoma? That's a fluid-reduced therapy to the pelvis, right? Now, what is the mechanism behind like increased insulin resistance in a pregnant female? That's actually the presence of a human placental lactogen, right? Like HBL. Okay. Now, one thing I guess I want to say is again, this is like an ethics related thing, we see on an exam. But if they give you a question about a person, you know, that's about to die and their family comes in for like a visit or something like that, right?

You don't just jump in and start asking them a bunch of like closed-ended questions. You'll start with like an open-ended question where you ask them like how much do you know, how much do you want to know? Like what do you understand about what's going on, right? So, generally in ethics questions, you want to pick the answer that encourages more conversation between the patient and physician, right? Or between the family and physician. But again, you want to start open-ended first. I mean, this is like a nice word for step two CS as well. You start with open-ended questions before you jump into closed-ended questions. Closed-ended questions are for the most part used to fill out fill in blanks you have from asking you initial open-ended questions. Okay. Now, what is the most common complication of ganglion cis to resection? That's a fully recurrence, right? Now, one quick sidebar I want to take is like having an idea of diabetes and it's like bad infections. So people with diabetes, they tend to have like really nasty infections. Like they may have like an infection that is common, but they tend to develop like a nasty complication, right? So for example, you know, many people get cellulitis in the perennial area, not a big deal. But the thing is diabetics, whatever reason, this, that perennial cellulitis can then move on to be coming like neck fascia, right? Where they have like phonies, gangrene essentially, right?

Occasionally you also see a question about like, you know, like a diabetic, you know, they have like pylon of fridis, you know, flunked beans, CV tenderness, fever. And then, you know, you give them antibiotics. So, you know, you give them like IV-safe tractsome and then they don't, you don't seem to be getting better and then they ask for your next best step in management. And you actually want to go ahead and obtain a repeat CT scan because those people have likely developed some kind of complication of pylon of fridis, right? So, then you have something called like a perinephric abscess, which you have to, you know, do an incision and drainage, or then you have something called like emphysemarous pylon of fridis. We have like gas bubbles in the wall of the kidneys, right? And remember, phonies, gangrene, right? Because it's a kind of neck fascia, you need to do the bridmen, right? And typically you also need to, you know, give blood spectrum antibiotics, although those antibiotics also need to include a clean dameisin. In general, if a person ever has neck fascia, you always need to include clean dameisin in the drug regimen, or pick the answer that includes clean dameisins as part of the regimen, because the clean dameisin will help with like the toxin production. I remember clean dameisin is a protein synthesis inhibitor, so it will be an anti-ribe, somal agent.

And then if they give you a question about like a diabetic, you know, that has like red upper quadrant pain, they may not just have like regular colicestitis, they may have something called gangrenoscolicestitis, right? Where again, you see like gas bubbles in the walls of the of the gallbladder, those people need like an emergent colicestectomy, right? And then a person that has diabetes, right? Like if the prison like sinusitis, facial pain, I would hope on that those circumstances you're thinking about mucomicosis, right? Cosmic like a rhizopause PC, and typically for that, right? You give them for terraces in B and debride extensively and then pre-for the best, right? Many people don't survive that stuff. And then otitis external, right? Again, ear pain, debris, blah, blah, blah, right? Otitis is external, very common in diabetics, right? And remember the most common cause of otitis external is so the monosevigenosa, right? But remember that diabetes, it can actually develop something called an acrotitis in otitis external, right? So again, just big things you want to keep at the back of your mind, for example, diabetics, diabetics. And this is just a clinical pro. If you have a tributy diabetic that has infection, better keep your eyes peeled wide open, because they can go from doing really well to crashing and bringing in front of you real quick. Okay, now what is the most common pancreatic neuroendocrine tumor in a patient that has a histrovamean 1?

That's a fluid gastronoma, right? Now, when did they give you a question about a patient that has cardiac amygdosis, and then they see what's the most likely finding an anicici? That's a fluid like low voltage, right? Just low voltage and an eTG. Now, what is the biggest risk factor for mitroregergetation? Oh, sure many people have not thought about this. That's a fluid mitrovov prolapse. The biggest risk factor for mitroregerge is mitrovov prolapse. Now, what's the most common cause of foliculitis? There'll be stuff, or yes, okay? Now, in a dark, complexion patient that's presenting on a melanoma, what's the most likely subtype of melanoma this person has? That's actually something called the acral antigenus melanoma. Remember, the most common kind of melanoma in my... I'm fairly certain about this is like the superficial spreading type, but if you see a person that's, you know, black basically and has a melanoma, you want to think about the acral antigenus kind. Now, in a patient that's presenting with erythema multiforme, what is the most likely inciting factor given a rise to disease? That's actually like a recurrent, like a recurrence of like a herpesimplex virus infection, right? But don't confuse this with like stifles-jonsin syndrome or like toxic epidermal necrolases. The most likely inciting agent is like a some kind of drop, okay? Like antibiotics and all of the stuff like that.

Now, what is the most likely mechanism of disease in a patient that's presenting with signs and symptoms of hypopituitarism? That's a fully opituitary adenoma that's compressing that like the normal pituitary gland, okay? Now, if you have a hospitalized patient that you know is presenting like stones, bones, groans, psychic overtones, what is the most likely finding on further clinical evaluation? So, you know, hospitalized patient. Don't actually be malignancy, right? Remember, the most common cause of hypercalcemia in a hospital setting is malignancy. If you have an outpatient setting, you're thinking about like primary hyperparapyroidism. Now, in a patient that has like a history of MEN1, what is the most likely symptom that will trigger like initial presentation to the healthcare system? That's a fully signs and symptoms of hypercalcemia, right? The most likely presentation in MEN1 is hypercalcemia, most likely clinical presentation in MEN2 is actually medallary thyroid cancer, believe it or not. Now, what is the most common infectious cause of odynophysia? So, not dysphysia or dynophysia like painful swallowing? That's actually CRB cancer, right? Candidaal becans. Remember, Candidaal are you going to treat it with like my... You can treat anything that can coat that badness or fix the problem, right? Like my studies, we should swallow like an antifungal like... like mousange or something like that. Those things can all work for... all work for a CRB cancer.

Now, if a patient, let's say, you know, you get a question about a patient, you know, has severe abdominal pain or you're getting through the back. And then they say, so obviously this person has acute pancreatitis, right? And then they say, within the next few days, two weeks, what is the most likely complication that this patient is going to develop? That's actually a pancreatic pseudocyst, okay? The most common complication of acute pancreatitis is a pancreatic pseudocyst. Now, what is the most common cause of a somatic diarrhea? That's a fully lactase deficiency, right? Now, what is the most likely mechanism behind treatment failure in a patient that's placed on a gluten-free diet for celiac disease? That's actually non-adherit, right? It's very hard for people to adhere to specific diets. Now, what if you give your question about a patient? You know, this patient, they tell you that all this patient is not there to have abnormal LF Ts on routine screening labs. What is the most likely at theology of visa abnormal LF Ts? That's actually like any FLD, right? So like non-alcoholic fat-delivered disease. Now, in a patient that's less than 45 presenting with knee pain, what's the most likely theology? Less than 45 years old. That's Patelope femoral pain syndrome, right? And then there's this question that I know for whatever's in a lot of people get wrong. If a patient has like pain like at the inferior here, what's the most likely cause on exams?

That's plantar fasciitis, right? That's easy-to-easy. Now, of the three main causes of vaginitis, which one is sexually transmitted? So between like candida, trachomonas and gallnarella vaginitis, which one is sexually transmitted? That's actually just trachomonas, just trachomonas. Now, in a patient that's getting a blood transfusion, what is the most serious complication that may develop within the next like, you know, six to 12 hours? That's actually something called, I guess, you can remember it as taco, right? So like transfusion associated circulatory overload, right? And usually people that have like kidney disease, like preexisting kidney disease, liver disease, they tend to be at, I mean, kidney disease, like heart disease, they tend to be at very high risk for this. Now, what is the most common reported STI in the US? That's going to be chlamydia, right? And then, what if you get a question about a patient in the military, right? That's presenting with anthrax. What is the most likely clinical presentation? It actually just be cutaneous anthrax, right? They would try to trick you into picking like pulmonary anthrax. I mean, pulmonary anthrax is something that can happen as a result of anthrax, right? But you want to think more about cutaneous anthrax, as the most likely clinical presentation. Remember, anthrax is one of those things that can also cause like a widened mediastino on imaging, okay, from the hemorrhagic mediastonitis.

And if you get a question about a person that's from Hawaii, and you have like some, like conjunctiva, injection, blah, blah, blah, blah, what bug are you thinking about? Would that be leptospirosis, right? From like leptospiror, interagence? Now, what is the most common cause of pneumothorax in a HIV-positive patient? Now, actually, be in fact shoulder pneumocysthes are gerovetsi, okay? Now, if you have a patient that you know, diagnosed with like the flu, remember the flu is caused by the influenza virus, not hemophilus influenza, right? So you have a patient that diagnosed with the flu. What is the most likely near-tem complication? So the thing is, if you get this kind of question, one of the two things on your exam, right? The most likely complication is either like a primary influenza pneumonia, or do we have like a secondary, like bacterial, or super infection, okay? That's probably the one that's more commonly seen on exams. Now, what's the most common cause of diabetes in sypidus? That's definitely the use of lithium, okay? Now, what is the most common cause of nephrodix syndrome in African-Americans? That's FSGS, right? That's easy. What's the most common cause of nephrodix syndrome in Caucasians, or white people pretty much? That's membranostephropathy, right? Sometimes, instead of putting membranostephropathy, then you put membranosteglomerulopathy on your test, right?

And then remember, the most common cause of nephrodix syndrome in kids is minimal chain disease, right? That's easy. Now, what is the most serious, external complication of ADP-KD, so the sumo dominant polycystic kidney disease? So, most serious, external complication of ADP-KD, that'll actually be the rupture of an intra cranial, like cerebral aneurysm. Okay, now, what's the most common malignancy that develops in a kidney transplant recipient? That'll be actually be like cutaneous or schumosyl carcinoma, okay? Now, what's the most likely mechanism of disease in a patient that presents with like stardocypnepticus? Most likely mechanism of disease. That's actually from having like a low level of their antipyletic drug, okay? Now, what is the biggest risk factor for intra-cerebral hemorrhage? That's hypertension, right? Now, what is the most common cause of rapidly progressive dementia? That's CGD, right? Courtsfeldiacopathy disease. Remember, these people tend to have like myoclonus, and then they'll have like elevated levels of the protein 14, 13, 13 in their CSF. Now, in a patient that's ultimately diagnosed with cervical cancer, what is the most common initial healthcare system? Most common initial healthcare system presentation. Well, you want to think about like abnormal vaginal bleeding. You think that, oh, this abnormal vaginal bleeding just applies to an ametral cancer. Believe it or not, it also applies to a cervical cancer.

Now, what's the most common anterior mediastino mass? That's a thigh moment, right? What's the most common middle mediastino mass? That's actually just lymphatic anapathy. Now, what's the most common posterior mediastino mass? There'll be some kind of neurogenic tumor, right? If you want to be a little more specific, you want to think more along the lines of a schwanoma, okay? Now, if a patient has like nausea, I guess let me just maybe tell you this as a factoid. If you have a patient that you know is like nauseous, vomiting, can't prevent your airway, you never want to place those patients on like bypass or CPAP. That's just an important factor to know for example, right? Now, what is the most common extra-acticular manifestation of ankylosein spondylitis? That's actually the anterior uviitis, right? And then what's the lopeus antibody that has the strongest astytitio and kidney disease? Those are actually the anti-dobus-trendidiania antibodies, okay? And then my final question here, what is the most, if you have a patient that you know presents with relapse, it's like, you know, ultimately diagnosed with relapsey and polychondritis. What is the most common presentation to the healthcare system? That's actually the patient becoming of like a red hot pin-four ear. So I think I'm going to go ahead and stop here. As I do at the end of every podcast, I do offer one on one tutoring for many exams. Step one, step two, CK, step three, step two CS.

Preclinical med school exams, 30-ish-off exams. If you're a medicine resident, like the IBI and boards, I tutor for those. If you're a college student, I tutor for Gen CAM, OAM, Physics, Bio-CAM, Histology, Physiology, the works. And then I also offer like some courses, right? So like I do like this, essentially it's like a crash course for step one, 20 hours, step two, three, it's 10 hours each. Obviously I can do longer if you want, just kind of depends on your needs. Basically like it's something that I do when people are at the end of their dedicated periods and they want to solve everything together really quick. Or when people are, you know, they feel like their knowledge base is pretty good. And again, they just want to solve the five things really fast. That's something I offer. Like many people have done this with it being like very successful with that. So that's something I'm interested in. Just reach out to me through the website. Or you send me an email at divineinterventionpodcasts with an S and Gmail.com. And then there's also this thing I've studied a friend like recently that a lot of people have actually taken advantage of and found to be useful. And it's something that I call like a repair, it's almost like a repair course, right? A repair course. And basically what do I mean by a repair course? So typically when you take these NV Me exams, right, you know, they'll show you like all these bars that tells you that you're a week in a certain area.

Like, oh, you're a week in cardiology, you're a week in this, you're a week in that, you're a week in this, you're a week in that. Typically with these repair courses, it usually goes for like two to three hours. And basically if you have like a specific weakness, like a subject weakness, like, oh, cardio is my weakness. GI is my weakness. Reach out to me with an email. And that's something that's very fixable. Like many times it's almost like, or it's almost like clockwork. I've worked with people where like cardiology will be like, there will be like, you'll be like a very left-leaning bar in their NV Mes. And then we have like this repair course two hours, they take another practice exam. And cardio is like very right-leaning bar. So if that's like a specific need you have, feel free to reach out to me. And then like I said earlier, if you know, you need like a very comprehensive like USMLE course for any of the USMLE exams. If you have a group of five people or more, again, just send me an email and we can work out the details of that. And then if you're a student applying to a residency, so like an ERS application or a college student applying to a med school, so like an Amcass application, right? I do offer like, you know, like one-on-one, I guess coaching, like mock interviews, personal statement, editing rec letters, editing applications, stuff like that. So, you know, I've worked with tons of people. They've done really well. So have a wonderful rest of your day.

I do hope that you've gotten something from this, from this podcast. This is a very high-yield podcast for sure to know for step 2, CK and step 3. So I'll see you in the next podcast. God bless you. Thank you.

Chronic or tight media (velopharyngeal insufficiency). If not listed, consider speech problems.

Sepsis, often originating from Pseudomonas aeruginosa.

Administration of Vitamin A (helps repair corneal epithelium).

Catabolic state mediated by TNF-$\alpha$, leading to muscle atrophy and suppressed appetite.

Left ventricular hypertrophy (LVH).

Carditis (myocarditis/cardiac involvement).

Nephritis (lupus nephritis) or serositis.

Respiratory failure (due to fibrotic lung disease).

Cytomegalovirus (CMV).

Lung cancer.

Von Hippel-Lindau (VHL) syndrome.

Anemia of chronic disease (not megaloblastic).

Haemophilus influenzae.

CMV infection.

Anti-double-stranded DNA antibodies (Anti-ds DNA).

Pyelonephritis/Perinephric abscess.

Primary hyperparathyroidism.

Acral pigmented melanoma.

Abnormal vaginal bleeding.

Septic shock.

Von Hippel-Lindau (VHL) syndrome.

Anemia of chronic disease (not megaloblastic).

Haemophilus influenzae.

CMV infection.

Anti-double-stranded DNA antibodies (Anti-ds DNA).

Pyelonephritis/Perinephric abscess.

Primary hyperparathyroidism.

Acral pigmented melanoma.

Abnormal vaginal bleeding.

Septic shock.