DIP Episode 245 - USMLE Step 2CK Rapid Review Series 39

Okay, welcome. My name is Divine. My resident. This is a episode of 245 of the Divine intervention podcast. And this will be a rapid review series for step 2ck. This is going to be series 39. Okay, so let's just go over run, run through a bunch of high-yield key scenarios that you know, classical example, but exams. And then we'll kind of round up for the day. So, what if they give you a question about a patient? And you know, they tell you that this patient has like, has like, like over the last two, three days, this patient would be having like severe pain on like a finger. Like, you know, one of the joints in the fingers, be it like the MC Ps, the PI Ps or the DI Ps or in the knee or something, right? And, you know, that pain, that joint is like red, it's hot, it's erythematos, all that badness, right? If you see that, what do you want to think about? I would hope you're thinking about septic arthritis, right? And again, in septic arthritis, what's your next step in diagnosis? Well, you typically want to go ahead and do an arthrosynthesis, right? So you want to go ahead and tap the joint, right? And you know, typically you'll find a ton of, a ton of like, white blood cells, right? The white blood cell count will be more than like 50,000. And if it's more than 50,000, right? You're like, oh, yeah, it's septic arthritis, right? So usually for those people, you'll need some kind of joint wash out, right? So you need to take them to the operating room, right?

And then let's assume the MBME question is very non-specific. You know, you don't give any hints as to the bug, right? And you're trying to get you to pick out, oh, what bug is this, right? Typically, right, you want to think about stuff for you. So remember, stuff for you, especially in MRSA, it's the most common cause of septic arthritis, right? Although if a person has like sickle cell disease, right? Again, you may want to begin to also consider someone else, but really stuff for you, really does cause many cases of a septic arthritis, right? So, you know, in addition to the joint wash out, how do you treat these people, right? Well, we treat these people on exams, we'll be on vancomycin, right? Although one exception to that rule, you kind of want to keep at the back of your mind, right? Is imagine a young sexually active person, you know, that essentially has the same presentation, and the person has like PTK on the skin, right? You know, this person probably has going to coccle septic arthritis, right? For those people, we want to give them like safe tracts on, right? Safe tracts on or safe otaxi, that would be the ideal thing to do on a test. And then if you're kind of like fighting in the dark, you're like, I have no idea what's going on with this person, like, you're like, I have no idea. If it's stuff, or else I have no idea if it's going to coccle, right? Then you just want to shut down, combine both, you give them, and you give safe tracts on, right?

And then kind of wait for like culture results to come back. And it's actually very high, you know, that the facts that you have a negative a throcentesis like a negative gramps thing, it does not mean that a person, it literally does not mean that a person does not have septic arthritis, right? And then I guess one common question I get from med students is, define how do I differentiate between septic arthritis? And those two are thritis on an MBM exam. Well, it's actually not that hard to differentiate. The big thing you just want to keep at the back of your mind is that when people have septic arthritis, the pain will be over a joint. When people have osteomyelitis, the tenderness will be over a bone, right? So that's the key critical thing you want to watch out for in tests. And you should be able to answer these questions with a, you know, pretty high degree of confidence, at least in my experience. Now one weird thing I want to say about cervical cancer screening, because there's something that your friends at the MBM beginning to kind of throw an exam, quite a bit. I've maybe mentioned it in the past, but I feel like it kind of bears repetition. And there's one or two new things I think I'll introduce here. So the thing is with cervical cancer, right? Like the screening guidelines, right? We all know that, oh, you know, if from from the age of 21 to 29, you do pop smears every three years.

Again, remember, don't stop pop smears before 21 years old, even if the person is like sexually active or whatever it doesn't literally doesn't matter, right? You stop pop smears between 21 and 29, you do it Q three years, right? And then once the person hits 30, right? You can continue the same pop smear business Q three years, right? But there's a preferred method, the preferred method is every five years, right? You do like the pop semi plus HPV, protested, right? So again, those are all big things you want to keep at the back of your mind on exams. Now, there are certain people that don't follow the routine guidelines, right? And those are people that are just immunocompromised in some way, shape of form, right? So say, for example, a person has a history of HIV, right? Or a person has a history of some kind of immunodeficiency disease, right? Let's say like the George syndrome or something like that, those people, right? They're going to need pop smears every year. That's very important. They need pop smears every year. Another bizarre one that you miss on a test is a person that has a history of like in-utero, diethyl steel, bestial exposure. Those people actually need pop smears, and only essentially, right? So again, basically like the screening guidelines is not the same as the Q three years that you do for most people, right? So again, these are just all important things you want to keep in mind.

And again, remember if you've had a hysterectomy, if you have the hysterectomy for like, you know, some like some benign reason, right? Those people, right? You can, you know, you can essentially stop pop smears afterwards. But let's say they get it from like a lyoma, or like a momo urine bleeding or whatever. That's fine. Go ahead and stop the pop smears after the hysterectomy. But if you're pressing got a hysterectomy, right? Because of a malignant thing, right? Like in the mid-trail, hyperplasia, in the mid-trail cancer. And those people, they're going to need pop smears of the vaginal cough, right? Because remember, the thing is, even if you remove your cervix, right? There are some cervical cells that can still hang around at the top of the vagina. So for those people, you need to do, you need to do pop smears of the vaginal cough, right? You need to do pop smears of the vaginal cough. And the thing is, let's say for example, a person has had, because typically, right? People are like, oh, divine. When do I stop screening for cerebral gulking cancer? Well, the time you stop screening is at 65, right? You stop screening at 65. But here's the thing. If, for example, the only people that stop at 65 are people who, like, they don't have any history of like, gnarly find it on, what do I mean by gnarly? So let's say, like, oh, you found CIN or something crazy, right? If you found like CIN or any of the badness, right? You really cannot stop at 65 for those people.

And by the way, I guess one other group, I forgot to lump in with immunocompromised folks, right? Like, also people that have had like higher escalations detected in the past on a pop smear, right? So if you've had like some kind of CIN detected, you cannot do pop smears Q3 years in those people. You need to do it like pretty much every year, right? So that's something you want to keep in mind, right? Another criteria for people that, oh, you can say, okay, you know, we can stop at 65, right? If for example, the person has had like, so basically most people can stop at 65, right? And again, just some unusual situations where you're like, oh, like divine, I want a few more specifics. Again, if the person, the person basically has had like, you know, pretty clean pop smears, those people for the most part, they can stop at 65, right? And see within the past 10 years, because this 10 year marker is actually kind of useful to keep in mind, right? Let's see within the past 10 years, you've had like three negative pop smears, right? I mean, you cannot have more than, at least I would hope, you don't get more than three pop smears in 10 years. I mean, if you're normal, if you don't have like some reason, not sure, right? So, you know, if you're getting Q3 pop smears, Q3 years pop smears, if your last three pops have been negative, you can stop at 65.

Or let's say within the last 10 years, you know, you've done like the pop smears and the HVV Quotes and again, you've done that twice and it's been negative, you can go ahead and stop. You can go ahead and stop, you can go ahead and stop at pop smears, right? And then if a person has had, but if a person, let's say, you know, in the past, right, you know, they've had like, like, you've had like CIN or blah, blah, blah, blah, blah, right? Basically, if a person has not had like clean pop smears, right, then or they've had like a cervical lesion that has been resected, they basically need to keep having pop smears for 20 year period. I'll say that again, for a 20 year period after the lesion was resected, right? They need to keep having pop smears for at least a 20 year period after the lesion was resected. Right? So let's say like they had like CIN or they had like cervical cancer that was resected and then the knee pop smears, let's see, it was resected at 55, the knee pop smears up until the age of 75. That's very important. That's very, very important to know for exams, right? And again, remember, if you have those colonization procedures or those lip procedures, those can increase the woman's risk of like cervical incompetence, right? Or cervical insufficiency on an MBM exam. So again, just all big things you want to keep at the back of your mind as you're studying for these tests. Now, what if they give you a question about a patient, right?

You know, they tell you that this patient has smoked like, you know, two packs of cigarettes every day for like the past 45 years. And then they tell you that over the last like three weeks, this vision of having like really severe headaches, right? And then they make sure you have video, right? And you mean notice that the presence fee is almost like a coldness like bulging face, right? So presence fee is bulging. They're, they have like hand pain, their neck is kind of like the standard you can see, like really permanent JVD. If you see that, where you want to think about SVC syndrome, right? So pair of an Achiva syndrome. Remember, that's one of those high-yield lung cancer, you know, like pathologies that can all right. So those people have a superior of an Achiva syndrome, right? And typically for SVC syndrome, right? You'll ask for your next step in in management, right? So the thing is you cannot say chemotherapy. If you do chemo, how long do you think it's going to take that chemotherapy to work? You cannot immediately relieve those people's symptoms, right? And many times people will also want to say, ooh, the only little steroids. The thing is in general, when a person is having compressive symptoms from some kind of malignancy, you know, steroids are typically a good idea. But this is one of those high-yield exceptions to that role, right? When a person has SVC syndrome, in general, you want to go ahead and radiate that lesion, right?

You want to go ahead and radiate that lesion to a cutely relief via symptoms. This is one of those rare situations where you're calling a ragdunk overnight to kind of help a patient, right? So radiation is the initial treatment of choice for a superior of an Achiva syndrome. And remember, the lung cancer that has the strongest association with superior of an Achiva syndrome is actually small cell lung cancer, right? And then there are two drugs that I think I want to go ahead and compare and contrast here. Whatever bizarre reason, right? The NBME test these. And I don't know many students for whatever odd reason. They tend to conflate these drug classes, especially with magnesium or bacteria, right? But let's make these a veneers, right? So what if they give you a question about like a patient, right? And they tell you that, oh, this patient, you know, she has like a family, like a story, pretty story family history of a of pancreatitis, right? They tell you that, oh, the dad has had recreate pieces of pancreatitis, multiple family members have had recreate pieces of pancreatitis, right? And then they tell you that, oh, she presents with like again, like a gastric being going to the back, but they tell you that she has no history of alcoholism or the me tell you, oh, she drinks alcohol socially, right? So basically like not much alcohol consumption.

And then they tell you that, oh, that the now she has no history of gold stones or like, you know, like colonifices or anything of that sort. If you see that, right, you want to think about a familial hypertrydilist right, right? I remember it's one of those genetic diseases is actually inherited in an autosomodominant fashion, right? Or remember, if you have very high triglycerides, right, you're liable to get in to get in a pancreatitis, right? In fact, if you look at those familial dyslipidemia, the one that's known as familial hypertryglyceridemia, right, is the type four familial dyslipidemia, right? It has autosomodominant inheritance again. That's why you see multiple family members kind of getting in trouble here. So the big thing you want to keep by the back of your mind here is, how do you treat these people, right? You want to go ahead and give those people a vibrate, right? You want to go ahead and give those people a vibrate. Remember, vibrates are one of those cholesterol lower in medications, but they are the best at lower in triglyceride, right? They are better than statins at lower in triglycerides. Now, how do vibrates work? Fibrates, they work by activating a lens eye known as a peeper alpha, right? They are peeper alpha agonist, right? The thing is peeper alpha is essentially like a transcription factor for lipoprotein lipids, right?

So if you kind of like backtrack to, you know, back in those days, we're probably starting for step one, we know that lipoprotein lipids, right, breaks down triglycerides. It's on the surface of a dipol site. It breaks down triglycerides into like frifadi acids and glycerol, right? So if you activate a transcription factor that makes you make more LPL, more lipoprotein lipids, you bring down triglycerides, right? And you clear them at an accelerometer from the circulation, right? Now, this, remember, vibrates, or you probably don't want to combine those statins, that's not a very genius idea there, right? Because I remember you can pretty much, you know, cause like myopathies, those things are hepatotoxic, right? So, you know, and you can also increase the presence risk for ghost stones, right? So you can want to try to avoid those if you can, in people that have ins susceptible populations with those kinds of problems, right? Now, the drug class that people tend to mix this up with on exams, right, is so what if they give you a question about a person, you know, that has diabetes, has like heart failure or reduce ejection fraction. Is there a particular diabetes drug you want to not give those people? Well, I would hope you're telling me about the TZ Ds, right? The thiozolidine dions, right? So those are your glitter drugs, right? Those are your glitter drugs, right? So like rosy glitters on, pio glitters on, troglitters on, right? So remember those drugs, how do they work?

They work by activating P-Pyra gamma, the P-Pyra gamma activators, not P-Pyra alpha, P-Pyra alpha, goes with vibrates, P-Pyra gamma goes with the TZ Ds, right? So there are two ways you can, you know, keep these things straight, right? Remember, vibrates start with an F, right? And then TZD started with a T. So T is later in the alphabet than an F. So alpha for the vibrates gamma for the TZ Ds. One person I tutor, because again, I don't want to want to tutor, one person I tutor, thought me just in the morning, like literally like yesterday or two days ago, right? That glitters, glitter gamma, right? Glitter gamma, I see the G is kind of mantra. So the glitter drugs, right? You can use rosy glitters on your pio glitters on your troglitters on, right? The gamma, P-Pyra gamma activators, right? And again, remember these drugs, right? Why would you not want to use them in a person that has a CHF? The thing is, P-Pyra gamma receptors are also found in the kidneys, right? So when you activate those receptors, that actually causes like increased water absorption, causes fluid retention, right? So, you know, that will not be very good for a person that's already having like volume overload problems, right? So again, don't conflict your vibrates, P-Pyra alpha activators with your TZ Ds. P-Pyra gamma activators, right? P-Pyra gamma activators.

Now, what if they give you a question about a patient, you know, they tell you that this patient, you know, has like for the past like two weeks, this patient has been having like generalize the DMA, right? And then they tell you that, oh, this patient, like, you know, this person has like four plus a DMA, arm swollen, secret, a DMA, everything, all the badness. And you know, they give you your analysis and you know, you notice that this person's urine has like four plus 14 area. And then they tell you the question that the patient suddenly starts complaining of like chest pain, severe sharpness or breath, person is super tacky cardiac, right? And then, let's say maybe they show you like a CT scan, right? Like a CT angiography of the chest. And you notice like a feeling defect in one of those common areas, right? And then they ask what's your most likely diagnosis, right? So your most likely diagnosis here, I really hope you think about like membranol's nephropathy, right? So I know maybe like divine, really pull that out from. Well, think about it, right? Nephrodis syndrome, right? In fact, let me maybe bring another question, right? They may ask, what is the most likely mechanism behind these findings, right? So that's like a second or third of the question right there, right? So the answer you'd want to pick on your test is one that involves acquired deficiency, right?

So you want to pick an answer that says like acquired deficiency of of of clodding inhibitor or something to that end, right? So basically this person has nephrodis syndrome, right? But notice the gutter key from this nephrodis syndrome. Well, if you think about it of all the nephrodis syndrome, which one has the most the strongest associations with like, like thrombotic episodes, right? You want to think about membranol's nephropathy, right? Membranol's nephropathy, membranol's nephropathy, because again, remember, membranol's nephropathy, right? Again, this obtains in every nephrodis syndrome, but membranol nephropathy just kind of has this big, cling to thing in the sense that it's, you know, it's the one that has again that strong association with these problems, right? And why do people with nephrodis syndrome get into thrombotic problems? Well, think about it. There's this protein that you pee out a lot, trading your urine, right? Called anti thrombin three. Remember, anti thrombin three, if you remember from step one, you know, running about those secondary, hemostasis, thingies, right? It inhibits factor 10 and factor two, right? So if you inhibit factor 10 and factor two, and then you've lost that factor 10 and two inhibitor, then factor 10 and factor two, they'll run a mock, right? And then you begin to cause all these clots all over the body, right?

Remember, another classic, you see membranol's nephropathy is that these people have like renauvin thrombosis, right? So that will present in a person that has a histro-nephrodis syndrome, and then they'll have like sodium onset severe flank pain, right? Sodium onset severe flank pain, you may have him at your, if you see that, think about a renauvin thrombosis. And again, don't forget that membranol's nephropathy, right? There's this auto antibody that it has a stronger association with, right? Like antibodies against the forceful IP's each receptor. And also if you may be like, ooh, do I need that so low yield? Well, think again, I promise you, that's something that's super high yield for you to know on exams. And remember that membranol's nephropathy, right? Like it also has an association like solid organ malignancies, like colon cancer and all that stuff, right? And also it has an association like lupus. If you see a person that has lupus and they have an ephrodis syndrome, it's almost certainly going to be membranol's nephropathy on your test. But if a person has lupus and they have like an ephrodis syndrome, you want to think more along the lines of diffuse proliferative glomerulone fritis, right? So again, you just want to keep those things in mind, for example. Okay, now what if they give you a question about like a 32-year-old female, right? You know, she's sexually active and they tell you that she has a hypertension, right?

What is the most likely cause of hypertension in that female? I hope you think about OC Ps, right? Remember OC Ps, they're the most common causes of hypertension in a productive age of females, right? Reproductive age females. And then another thing you want to keep at the back of your mind on exams, right? So sometimes your friends at the MBME, they may rate some questions that, you know, they'll make this like a long-ass question to kind of like mess with your head and kind of freak you out, right? And typically the way this question will be worded is they will give you like some scenario, right? You'll be like, oh, this is step one all over again. They'll give you some scenario. And you notice that, you know, they'll give you all these pressures in the heart and all that, whatever, or they may give you all these O2 sets, right? And you'll notice that, oh, the O2 sets in this person's as superior of an akiva is like some percent, right? I don't know, like less like 70%. And they notice that the O2 sets in this person's right-eature is like 71%. And then you notice that, oh, the O2 sets in this person's right-eature is like 80%. And you notice that the O2 sets in person's formula is like 80 something percent, right? It doesn't make any sense, right? And then you see people, they freak out when they see these kinds of questions. You don't need to freak out, right? You don't need to freak out, right?

Basically, this person in this question has some conduit that's letting oxygenated blood from the left side of the heart, mixed with the deoxygenated blood that's in the right side of the heart, because the thing is, as you progress from SVC to right-eature, to right-eature, to right-eature, to pulmonary arteries, your O2 sets, right, in your blood, your P little AO2 should progressively decrease, right? So if you notice a progressive increase in a person's O2 sets, as you traverse the SVC to right-eature, to right-eature, to right-eature, to pulmonary artery, the person probably has some kind of ASD or VSD, right? So the thing is, if they want to write the particularly bizarre question, they may try to see if you can figure out which one the person has. It is an ASD or is it a VSD? Basically, the way you figure it out is you ask yourself, where have you had the biggest jump in O2 sets, right? So the thing is, if you notice that from SVC to right-eature, the O2 set jumped by like 5%, so some, you know, pretty high number, right? If you see that, then you basically want to think about an ASD as the cause of the person's problem, right? But if you notice that, oh, the biggest jump is like, let's say, oh, the right, the SVC was 70%, right-eature was 71% P little AO2. And you notice that, oh, the right-eature is like 80%, right? That means it's going to be a VSD, right? Because that big jump happened. You notice the big jump when you go to the right ventricle.

So that means the person has a VSD as the cause of their symptoms, right? So this is just, again, the thing is, it's not like the NV Me just, you know, so every, every year, you know, they kind of like bring up this new knowledge that they want to test, right? But the thing is for the most part, right? Like they can only test so many things, right? It's not like they can just like create new medical knowledge. No. It's the same medical knowledge, they just find, you know, more interesting ways to test it, right? So don't get freaked out by those things on exams. You can, you know, you can pretty much conquer those things, conquer those things a pretty well. So, I guess I'm going to go ahead and stop here because, again, this is a rapid review. I don't want to keep it too long. I want this to be something you can listen to in a workout session. But again, all these things are floridly high-yield to know, for example, right? So I, the thing, I guess I'll go ahead and say is, you know, as I do at the end of every podcast, these podcasts on Word Press, there's a Word Press website, divineinterventionpodcasts.com, right? And then, you know, these podcasts are like an Apple podcasts, Spotify, Google Play, right? So please subscribe. I also have a You Tube channel. It's got divine intervention, necessarily podcasts and videos, right? Please subscribe to that. Any little bit of support helps.

And then I have a set to CK, high-yield rapid review class, taking place on the 11th of this month, right? So basically, the next week's Saturday, it'll be from like 6 to 10 a.m. Pacific, noon to 4 p.m. Pacific and 6 to 8 p.m. Pacific. It's 10 hours and we'll review all the, like, most, it's actually a pretty comprehensive course. We'll review like most of the high-yields from like psych, neuro, OB-GYN, I am surgery and p. It's right. And we'll do it in a 10-hour period, right? Again, I've run this course now like three times. And again, all the people that have attended, they found it to be very high-yield, very helpful, even people that are taking their tests. So if that's something you're interested in, just reach out to me, I'll meet you through the website or send me an email at divine intervention podcasts with an essay at the end.gmail.com. And then, I guess let's go ahead and talk about my life lesson for today. So my life lesson for today is the value of treating people with love and respect, right? This is something that, again, I'm sorry to say I don't mean to be judgmental and please, in fact, I've made this mistake myself, right? So I'm also speaking to myself as I see this life lesson, right? But the thing I just want to say is it's kind of like a thing that unfortunately is lost on the, on like in recent times. I'm not going to call out any specific generation because that's not my goal here.

But in recent times, I'll see like over the last couple of years in this life, right? I feel like just this love and respect is just kind of gone for the most part, right? And the thing is, regardless of your status in society, even if you're a resident, you're an attendant, like you're more senior than someone, it doesn't mean that all of a sudden you're magically better than these people, right? Like in the hospital, right? Like, oh, like you see these people, they look down on janitors and stuff, that's not very prudent. That's not very prudent. Again, the fact that someone is at what society defines as like, oh, low status right now in life. It doesn't mean that they are going to remain that way forever, right? Again, remember, there's this famous thing, right? That a living dog is better than a dead lion, right? So the fact that a person is at a low level in life today doesn't mean the fact that a person has like a poor bug, like this, like a steeped by a Nigerian musician says that he did not let his background, like his background, making put his back to the ground. So again, the fact that your person is at a low status in society, that doesn't mean you should treat them poorly, right? Like this is one thing that I found to be extremely helpful to me, right? That if you treat people that even, oh, supposedly they are like a lower class person and no one is lower class, everyone just has, is just at a different station in their lives.

That's the way I look at things, right? If you treat people with love and respect, right? Like one like, it's just, you just leave a happier life, right? Because again, you're not better than anybody. You're just literally not, right? So just calm down from your high horse, be respectful to people. You want you to leave a happier life. And the thing is that person that you treat your love and respect to the, maybe the person that somehow out of the blue makes, makes things happen for you in the future, right? Like I can tell you this like from my intern year, right? Like again, thank you again, I'm not, again, I'm not perfect at this. Like this is an area that I definitely need to improve on personally, right? But I feel like there are some people that I treated with love and respect in turn year, where like it, like just areas that I did not imagine that I'd ever need help with. Those people came, like God used those people to come through from in a big way, right? So just kind of keep that at the back of your mind when you're treating people, right? Like just respect people, even if they treat you like crap, right? Just treat them well. Like the thing is, if a person is treating you unjustly and you keep treating them justly, right? There's this Bible verse that says that you will keep cause of fire on their head, right? Take the higher road. You don't need to like, stoop down to their level of behaving like, behaving like a, like a tout, right?

So just be reasonable with people, treat people to respect, like again, if you're like a resident or an attending, treat the nurses with respect, treat the janitors with respect. You know, those people, they're doing like a lot of what is really thankless, right? Like the clean up patients, poop, they do this, they do that, they do this, they do that, right? Call lights, patients, bug them all the time, right? Just treat them with respect. Just make a presence, they better than you would otherwise be if you treated them like crap, right? So I think that's all I'm going to see today. I feel like I've maybe gone on this sub box for quite a bit, but hopefully you find this lesson to be helpful. At least I think it's something that I even myself, I need to, you know, try to apply to my daily life. So thank you for listening. I'll see you in the next podcast. Thank you and God bless you. And actually, let me say one thing. Let me say one quick thing. If there are classes that you feel like will be helpful, it's all right. I'm doing like this step to CK Hi-Yo class. If there are classes you feel like will be helpful. Let's say you're a 30 year-match student or you're a first or second year-match student. If there are classes you feel like, oh, like a short class, now will be helpful for people. Go ahead and reach out to me. I can organize those classes. I mean, I can organize classes for many things and then we can kind of take things from there.

If I see that's something that has a lot of interest from people, I can organize these classes. At least thank God in this ITE, you know, you can use them pretty effectively. And then we can take things from there. So thank you for listening. I'll see you next time. Thank you. God bless you.

Septic arthritis presents with pain localized over a joint, whereas osteomyelitis presents with tenderness localized over a bone.

Annually (every year).

They are $\text{PPAR-}\alpha$ agonists, which activate transcription factors that increase lipoprotein lipase activity.

Antibodies against the phospholipase A2 receptor ($\text{PLA}_2$).

The biggest jump from SVC to RA suggests an ASD; a big jump into the RV suggests a VSD.

Fibrates activate $\text{PPAR-}\alpha$; TZ Ds activate $\text{PPAR-}\gamma$.

Familial hypertriglyceridemia.

They can cause fluid retention by activating $\text{PPAR-}\gamma$ receptors in the kidneys, leading to increased water absorption.

For at least 20 years after the lesion was resected.

Oral Contraceptive Pills (OC Ps).

Membranous nephropathy; antibodies against $\text{PLA}_2$.

They can generally stop routine screening at age 65.

Familial hypertriglyceridemia.

They can cause fluid retention by activating $\text{PPAR-}\gamma$ receptors in the kidneys, leading to increased water absorption.

For at least 20 years after the lesion was resected.

Oral Contraceptive Pills (OC Ps).

Membranous nephropathy; antibodies against $\text{PLA}_2$.

They can generally stop routine screening at age 65.