DIP Episode 247 - USMLE Step 2CK Rapid Review Series 40 (and upcoming 2CK, 10 hr class 7/25)

Okay, welcome. My name is Devine. This is episode 247 of the Divine Intervention Podcast. And in this podcast, I'll be continuing the Rapid Review Series for the USMD Step 2 CK exam. And this will be Series 40. So let's get right into it. This should be a relatively shorter podcast. So what if they give you a question about like a 51 year old female? The telly that she has been having like this right-sided headache for the last like four days. And she has like just like diffused like muscle aches, muscle pains. And then they give you some labs. And you notice that her ESR and her creatine kinase are both elevated. If you see that, I'll really hope you're thinking about like giant cell arthritis, right? Remember, this is also known as temporal arthritis. And don't forget that those people can have like proximal muscle tenderness, right? That's called polymageurromatic. Right? And also they can also have a mejoclodication right when the true it hurts. Whenever you see stuff like that, you only think about giant cell arthritis. Remember, it's also called temporal arthritis. And your next step in management on the test right is to go ahead and give them a high dose clinical therapy. And then you can ask questions later. You can do a temple. You can you have a couple of days to do a temporal artery biopsy in those people. Okay.

Now, what if they give you a question about a, the give you a question about a 27 year old male, you know, they tell you that he has been having like that he has had like a history of like multiple suicide attempts. And that they notice that over the last like 24 hours, he's like close acquaintances have been noticing that he has been, you know, he has been having like bloody bomb movements. He has been having any more ptuses. He has been having like nasal bleeds. He has been having abdominal pain. And then they asked like, what's the most likely like toxic ingestion in this patient? You know, they'll give you a bunch of options. You can see like, I don't know, like come on one oxide poisoning, like just weird stuff. If you see something like this, you want to think about the person potentially ingestion or act poison, right? I want to think about right poison. Remember, rap poison contains warframe, right? So that offering can cause very severe bleeding. Remember, warframe is one of those drugs with the pharmacology still high, you know, for step to seek it. Remember, eating habits. It inhibits vitamin key box. I read doctors right. So you're not going to have come on the box edition of factors 279 antenna, protein CNS, right? But basically it makes a person bleed. So again, those are all high old things. You want to keep at the back of your mind, for example. Okay.

Now, what if they give you a question about like a 22 year old guy to tell you that, you know, for the past six months, he has been having a lot of like trouble breathing. And that he has like low back pain and then they tell you that, oh, that's the perform like some pulmonary function studies and he's noted to have like a restrictive pattern of long disease. If you see this, I would really hope you're thinking about an kilosions on the lightest, right? I really hope you're thinking about an kilosions on the lightest. Remember, I'm kilocienspondolitis, right? Again, those people right with all the spinal problems they get sometimes they can cause a restricted expansion of the lungs, right? You can cause a restricted expansion of the lungs because the thoracic cavity is almost kind of contorted, especially in people that have severe disease. So remember that those people basically they'll have restrictive lung disease, but this will be an example of a person having a restrictive lung disease, right? But with a with a normal DLC, again, I know you may be like divine restrictive lung disease and I'm kilocienspondolitis. Again, there's no point there is no don't panic. It's just something that your friends are the enemy love these things because again, the mb is not like they can just invent new knowledge. You can't really do that, right? But basically what you do these days is they ask a bunch of questions, right?

They just find novel ways to test something that you already know, right? So again, just something higher and again to keep at the back of your mind. Okay, now what if they give you a question about like a couple of the tell you that, you know, they they've been working that you know they are both for gardeners or something like that, right? And then they tell you that over the last like 12 hours, they've been having like just a few small so weakness, blurry vision, they have like toses on fundoscopic exam. And they tell you that they have like they've been having diarrhea. Sorry, not diarrhea, they've been having like constipation. They've been feeling very hot, they've almost been like hypothermic, right? If you see this, right, then you want to potentially think about a toxic drop, right? You want to think about botulism on the test. Remember the botulino toxin, right? I close their proteins so you're not able to release acetylcholine at the neuromuscular junction, right? So those people have like flasset paralysis again, they classically test this in cage, you know, with honey or they contested in people that are consuming like home kind goods or whatever, right? But again, just usually it's in kids on tests, but again, these days your friends at the end of the year, they begin to go after this stuff with the beginning to go after this stuff with them. With adults, right?

So again, that's something you just want to make sure that you can keep at the back of your mind on exams. Now, what if they give you a question about a patient, you know, they tell you that is like a 23 year old sexually active male, right? And they tell you that over the last like three, four weeks he has noticed this flesh colored like girls on his genitals, right? If you see that, I would really hope you're thinking about condiloma, combinada. Remember that is caused by HPV, right? Remember your HPV is right. So HPV one on six causes general warts, right? HPV six and 11. Sorry, HPV one on six causes plantar warts HPV six and 11 causes, general warts, right? And then HPV 16 18 and those in the 30s cause cervical cancer, right? So again, that's something you kind of want to keep at the back of your mind on exams. And how do you treat condiloma, combinada, right? You can use porofiling. Porofiling is a classic agent. You'd see commonly tested, a commonly tested on exams, right? So porofiling is a you can use that topical agent and typically it helps pretty well with a general word. So though for the most part, general words on its own would would resolve without you needing to necessarily treat it. Okay, now what if they give you a question about like, you know, let's say it's like a 27 year old male, they tell you that he has a history of type 1 diabetes and that over the last two days he has been having like very severe headache.

They tell you that he has like bilateral babinsky signs has like, you know, some of these like neuro deficits that, you know, tell you that there's something wrong in his brain somewhere, right? And then he showed you some labs and you notice that, oh, his glucose is like 700, his bicarb is like 10, right? And his peach is like 7.16, right? So it's in decay, right? And then they tell you that, oh, you obtain the image of the brain and you find like a ring and a hand-sing vision in his brain, right? Or they can tell you that you find something that is exerting like mass effect in the brain. If you see that, again, I really hope you're thinking about, so what book should you think about here? I hope you're thinking about milk or my courses, right? I hope you're thinking about milk or my courses. Again, remember, the milk or species right here, you know, like rhizopost for example, right? Those things tend to cause like sinusitis in a person that has like a history of diabetes, right? So if you see like phisial pain, like darkness of the face, stuff like that in a diabetic, right? That's milk or my courses. But again, the friends at the MBM can find more inventive ways of testing the same pathology. They can talk about like essentially like any like major infection in the head, right? As something on the ears, even as something that can be caused by milk or my courses, especially in a diabetic that is that is in decay, that is in decay.

So again, just all big things you want to keep at the back of your mind for for exams. And then what if they give you a question about like a 62-year-old female, you know, they tell you that over the last three days, she's having like pain in her mid-back. And then, you know, they tell you that a temperature is like 98.6, pulse is like 70 beats per minute, respiratory rate is 14, beats per minute. They tell you that physically exam is only remarkable, right? Other than just like tenderness in her mid-a thoracic spine. And then they give you a bunch of labs. And you notice that all those labs are normal, but you notice that the alkyphosis is elevated. If you see that, what are you thinking about? I would really, really hope that you're thinking about osteoporosis, right? Under those circumstances, this person essentially has some kind of compression fracture, right? This person has a compression fracture. And please don't forget, right, that when people have compression fractures in osteoporosis, the most common anomaly. I mean, the most common, let's say, a woman is postmenopausal, right? And she has like a compression fracture, it's almost always in the vertebral body. That is the most common location. After a vertebral body, the second most common location is the hip, right? And again, remember, the reason why women that are postmenopausal have this problem is because they are no longer producing adequate amounts of the same.

So because they are no more than that, you have to produce the same amount of oxygen, right? Because they are no more than oxygen, right? You have decreased synthesis of osteoporagering. And if you're not able to produce osteoporagering, right, then you have more interaction between the rank ligand, right? And the rank receptor, right, between the rank ligand and the rank receptor. And that will cause more activation of osteoclast. So you have like a net increase in osteoclast activity compared to osteoblast activity, right? And now, ultimately, give rise to like a resorption of the person's, a resorption of the person's bone. So again, just all high-year things you want to keep by the back of your mind, for example. Okay, now, what if they give you a question about a patient and they tell you that this patient was, this patient, you know, got, you know, recently bought like a used humidifier at like an antique store and has been using it for the past year, like two, three weeks. But at over the last like four days, this patient has been having shortness or breath. This patient has been having like high fever, has been having diarrhea. And they give you some labs. You notice that this patient's bloodlake count is like 30,000. And you notice that the patient's sodium is like 127. What are you thinking about here? I would really hope you're thinking about Legionella, right? Remember Legionella, the Moffela, right?

Remember like this thing, it's one of these, I mean, maybe like divine used humidifier. Well, they used humidifier, right? They have been infected with Legionella, right? And remember anything that kind of like dissipates like aerosols around, right? Or like water, right? Those things can potentially cause Legionella, right? So what are the ways they can test Legionella on your test? It can be a person that's using like a new humidifier. It can be a person that is using, I mean, using like a humidifier or went to a business conference or it can be an outbreak kind of pneumonia, like in a hospital, right? It can be something you get from like a water cooling system, right? And the way I think about Legionella, remember Legionella, right? It tends to cause, I think of it as like pneumonia plus, right? So usually people that have Legionella, they will have like diarrhea. If you look at their labs, they may have like hyponitremia, they may have like hyperchilemia, right? They may have, um, um, they may have what else? They may have like thromocytopinia on labs, right? And remember, these people that have Legionella, the way they, um, the way they, you make the diagnosis, right? You do the urine antigen tests, right? And for the most part, these people deserve microlets. You give them microlets. If they want to do like some kind of step one throwback on your exam, they can try to ask you that, you know, remember that again, it's a silver stained organism.

I don't know, I just feel like in general, these organisms that are silver stained, they tend to end up being pretty high yield for exams, right? So like Legionella is one big one, that'll be pneumonia, obviously. Um, you know, since this is your vetsy, right? It's also a silver stain organism, right? So HIV patient, positive silver stain organisms in a bronchial viola lavash, or like induced pyrrole sample, right? That's going to be a neurosis disease, your vetsy. Remember, you treat that with a trimethoprimsulfone foxes, all right? And then if you're looking at things from the other perspective, if you're dealing with, uh, if you're dealing with, um, uh, what do I want to see here? If you're dealing with, with, um, let's see. So let's see you're dealing with a patient that has been having like, you know, like, really bad epigastric pain is worsened by males. Um, you want to think about H by lorry, right? Remember, that's also a, know the silver stain positive organism, right? That's another silver stain positive organism. And then, um, if the astral like, what is the mechanism behind the electrolyte abnormalities, like these hypoting, creamy hyperchillin and all that stuff in a person that has a Legionella, one thing I think I will encourage you to think about is, uh, think about, um, the person potentially having some kind of intestine on the Fridays, right?

Just think about intestine on the Fridays, like those people can develop like, like, just like acute, basically it's like some kind of acute kidney injury. Remember when you're kidney doesn't work, you're going to have like hyponitremia and you're not going to be able to excrete potassium appropriately, right? You'll have hyperchillinia, I mean, think about all the people you know that have, um, think about all the people you know that have, um, what is it called that on dialysis, right? Or the misdiadalysis, right? You always see the potassium. The potassium is like super, super, super, super high, right? Super, super high. Okay. Now, what if they give you a question about like a fitness instructor and they tell you that, oh, over the last, you know, this person teaches like Cross Fit, a week, lifting or whatever. And they tell you that over the last like two weeks, this person has been having like, like numbness, weakness, in like his hands, in his forearm, like his right hand, his right forearm. And they tell you that he has like a barely perceptible, right? So they tell you has a barely perceptible, um, barely perceptible, uh, radial and honor pulse. And you see that I really hope you're thinking about like a thoracic outlet syndrome, right? Thoracic outlet syndrome. Basically right, when these people have like, you know, these like super high hypertrophied muscles, because they're like super fit, right?

Sometimes those muscles can have like these spasms and they can begin to compress some of the upper extremity arteries, right? So they can compress like this oblivion. They can even compress some parts of the bricchioplexus, right? So you can see the person having like signs of bricchioplexus injury. You can see the person having like almost like, like, like, clodication of that extremity, right? Because there is again, diminished blood supply, right? So again, just all things you want to keep at the back of your mind, for exams. Now, um, what if they give you a question about like a 71 year old guy, you know, they tell you that over the last like three hours, he's been having like chest pain, redid into his jaw, and then they tell you that on the way to the hospital, this person passes away. If you see that right, I would really hope you're thinking about along the lines of, like some kind of ventricular with me, right? Usually V-fab, right? Remember, if a person has an MI, if they die, within the first 24 hours, the most common cause of death is going to be some kind of ventricular with me, like a ventricular fibrillation. Okay, so I think I'm going to go ahead and stop here. It's just I really wanted to get out a podcast this morning. I'm going to get it's a rapid review. Again, I try to keep those to about like somewhere between like 15 to 25 minutes. And again, as I do at the end of every podcast, I do offer one on one tutoring for.

In fact, I won't see one on one tutoring. I'll see very, let's just say I offer tutoring for the USMLE exams on a so much limited basis, but I can't depend on my schedule. And then I also offer classes right for step 2 CK. At least you see I've been having this 10 hours step 2 CK class for the last couple of, I've done it now about four times. And again, the vast majority of people that I've attended, I've found it to be really helpful. The next one is going to be taking place on the 25th of July. Remember, it's 6 to 10 AM Pacific time, known to 4 PM Pacific time and then 6 to 8 PM Pacific time. And again, we cover like 700 topics and concepts and vignettes and scenarios that essentially will touch on all the high yields from like P, surgery, OB-GYN, neuropsych, internal medicine. And again, I'll give you a time to you know, kind of ask questions. But again, it's a very high level course. It's a very high yield course. And again, many people have found it to be extremely helpful. So if that's something you're interested in, basically one of the classes full that I stop registering people. So if you want to register, you can either shoot me an email at divine intervention podcast with an S at gmail.com or register on the website, divine intervention podcast.com just should be an email from there. I will show you how to register. And please subscribe to the You Tube channel, scroll to Vine intervention, you'll see my podcast and videos.

Please also subscribe to the podcast is on Apple podcast is on Spotify is on Google play. And if you have any questions or any particular podcast you'd like me to make or if there any classes you'd like me to hold, just feel free to reach out to me. And I'll be happy to point you in the right direction. So thank you for listening to this podcast. There is no life lesson today. I'll bring up a life lesson in one of my next podcast. So thank you for listening. God bless you. Have a wonderful day.

Pneumonia + Diarrhea + Hyponatremia.

It inhibits Vitamin K epoxide reductase, leading to a deficiency in vitamin K-dependent clotting factors.

A normal DLCO (diffusing capacity of the lungs).

It blocks the release of acetylcholine at the neuromuscular junction.

General warts are caused by HPV 6 & 11; Cervical cancer is linked to HPV 16 & 18.

Trimethoprim-sulfamethoxazole (TMP-SMX).

New-onset headache (temporal), elevated ESR/CK, myalgic claudication, or proximal muscle tenderness.

To confirm vasculitis; it can be performed after a few days of symptoms to minimize risk of false negatives.

Restrictive lung disease pattern with a normal DLCO, due to spinal fusion restricting thoracic expansion.

Used humidifiers (aerosols) and water cooling systems/outbreaks in hospitals.

The vertebral body.

It decreases osteoporagering synthesis, leading to increased interaction between RANK ligand and its receptor, which boosts osteoclast activity over osteoblast activity.

New-onset headache (temporal), elevated ESR/CK, myalgic claudication, or proximal muscle tenderness.

To confirm vasculitis; it can be performed after a few days of symptoms to minimize risk of false negatives.

Restrictive lung disease pattern with a normal DLCO, due to spinal fusion restricting thoracic expansion.

Used humidifiers (aerosols) and water cooling systems/outbreaks in hospitals.

The vertebral body.

It decreases osteoporagering synthesis, leading to increased interaction between RANK ligand and its receptor, which boosts osteoclast activity over osteoblast activity.