DIP Episode 538 - 2024 USMLE Step 2CK Free 120 Discussion Part 14 (Q111-120, worksheet included)

Welcome. My name is Divine. This is episode 538 of the Divine Intervention Podcast. Into this podcast we're going to be finishing the series on the free 120 for step two. This is going to be the episode 538 again. Remember the USMLE Step 2 CK exam has a free 120. And so far I've done a 13 part series. This is going to be part 14. This is going to be the final part. It's going to be questions 112 120. So let's jump right into it. So question 111. Again, if you've missed any other part of the series, I'm telling you, you should listen to it. It's going to help you out so much. There's tons of people that this podcast has helped. And there is a worksheet that is going to be attached to this episode. So it's a PDF. It's under the episode on the website. So download it and fill it out. You may notice my more recent podcasts have studied adding worksheets to my, at least I've started putting on worksheets together with my more recent podcasts. The thing is if you listen to the podcast and get the understanding, you should be able to answer the questions in the worksheet pretty easily. So question 111 says an eight year old boy is brought to the urgent care center by his mother while on a family vacation in Florida because of a three day history of an itchy burning rash. The ambient temperature during the past three days has been 37.8 degrees Celsius. That's 100 degrees Fahrenheit. The mother does not recall any recent exposures for her son and none of her children have a rash.

The patient's medical history is unremarkable. Examination of the patient's back shows superficial clear one to two millimeter verticals that resemble water droplets. The vesicles rupture easily on the patient. There is no surrounding area theme. It is most appropriate for the physician to recommend which of the following for this patient. Option A, antifungal crane, option B, here avoidance, option C, or a lantiviral therapy, option E, or a retmoid therapy, option F, or triviolet therapy. So what should you be thinking about here? Well, I hope you're saying that, hmm, the vine, this person likely has something we call malaria, okay? Malaria. In fact, there are many kinds of malaria, but the one that I think you should worry about for you exams is something called malaria, rubra. Malaria, rubra. It's basically a rash you get on your skin when you expose to extensive amounts of heat and humidity. So because if you think about it in this question, what triggered this child's problem? Hey, these stayed outside in a hundred degree Fahrenheit weather. That's pretty hot and fluoride, you know, in fluoride, that's pretty humid as well. So what is a reasonable thing to do? If you stayed in the heat and humidity and you got in trouble, maybe avoiding the heat and humidity seems like a reasonable thing to do. So if some be make sense, again, I know some people will overthink this to the very, very end, but you don't need to do that on your, on your exams.

In fact, sometimes this thing is called a heat rush every now and then on the USMEL exams. Sometimes it's called a heat rush, a heat rush. So just, you know, wear loose clothing, don't wear tight clothing, avoid the heat, avoid humidity, work in an air conditioned space. Those will all be wonderful things to do here. If you decide to start overthinking it because I know some people see vesicles and they just jump on herpes. This is an eatable boy. He does not have herpes, okay? And of course, the end beam is the have option, D to sell to you if you're thinking about those kinds of things. So don't do that. That's not very, that's not very wise. Remember, oral retinoids, you know, maybe like isotrate knowing that's what we used to treat acne. That's what we used to treat acne when you've tried every other thing and it's not working. Ultraviolet therapy, you know, pova. Sometimes we use that to treat psoriasis, antifongal cream. Remember, we use these antifongals, these topical antifongals to treat these like tinias, like tiniacoperas, which we can see being caused by things like tricophyte, tino, micro spore, or more epidermal fighting. And I think one thing that'll be helpful to discuss here is this whole vesicular business. Friends at the end beam is they love the word vesicular. So let's kind of hit a few high-yield vignettes relating to vesicular related things, right? So you see a vesicular ration and individual the hastiadorea.

Well, the present hastiadorea probably has fat in the absorption. That sounds a lot full of like celiac disease. Celiac disease, remember, they have this thing called dermatitis, herpediformis. Whenever something is vesicular, we like to kind of slap the name herpes on it. So dermatitis herpediformis. And that's something that you can find in celiac disease. We can manage it very well with dapsal. But also you should try to, again, curb gluten from your diet, eliminate it actually from your diet. What if you see a vesicular rash and it's like on one half of the person's body or whatever, like just one half and you see this rash, you know, different stages of healing. Obviously that's going to be a zoster. That's going to be zoster. And remember, zoster in some situations you can give a cyclover and that will be helpful. Now, what if you see vesicular lesions in the mouth? You see it in the mouth of a child and this child has a rash. It's like, oh, this child has a rash in the distal operand lower extremities. What should you be thinking about? But what we're saying divine, this sounds like hand-footed mouth disease. Remember, hand-footed mouth disease is caused by coxacchi A. I mean, look at the name. Literally hand-footed mouth disease, hand-footed mouth disease. So you involve the hand, the hand, the feed and the mouth. In fact, many of you know that this causes a rash on the palms and sores.

But again, sometimes our friends at the MVM Es, why put a rash on the palms and sores when you can just smod in a slightly different term, distal operand lower extremities. Just describe those extremities, right? Just describe the palms and sores using other terms. So that's, that's, it's going to be coxacchi A, right? Those vesicular lesions in the mouth. That's what we call herb and jaina, herb and jaina because it hurts. It hurts. Anjina, like pain, it hurts and it's vesicular. So we call it herb and jaina, herb and jaina. So you're just going to keep those things in mind and most of those things just need supportive care. All right, question 112. A 55-year-old woman comes to the office for a full-up examination three months after sustaining an uncomplicated myocardial infarction in the distribution of the left anterior descending artery. She has participated in an outpatient rehab program since discharge from the hospital six weeks ago. But her attendance in the program has become irregular during the past four weeks. When questioned about this, she reports a four-week history of depressed mood in ability to enjoy activities she previously found pleasurable, loss of appetite and insomnia. She also has hyperlipidemia and hypertension. Medications are aspirin, at over a statin and metoprolol. She is 163 cm, she is 5 foot 4 inches tall, and weighs 60 kilograms, that's 150 pounds or BMI is 26, vital signs are within normal limits. Longs are clear to our quotation.

Cardiac examination discloses a normal rhythm. There's no peripheral edema, results of serum studies are within the reference ranges. Which of the following is the most likely of this patient's depression on our overall health? Opsionitis says it is likely to decrease had perceived quality of life would have no impact on our mortality. Opsionitis says it is likely to double her risk for death within the next three months. Opsionitis says it is likely to decrease her risk for ischemia because she is likely to rest and avoid socializing. Opsionitis says it likely will have no significant effect on her health. Have you noticed these days when people come to the hospital with serious medical conditions? We tend to screen them for depression because there's actually quite a number of studies that have shown that people that are depressed definitely have a high risk of death from disease, especially M Is. I will certainly know this as a social and myocardial infarctions. People that have had M Is if they are depressed, they have a high risk of death. So I'm going to go with option B here. I'm going to go with option B here. Just remember, again many times we screen people for depression in many different settings, but the ascertain medical diseases that are friends at the end of the year kind of want you to know that these people tend to have a high risk of depression. People that have had M Is, that's one big group, people that have had strokes, that's not that big group.

I know there will be people that have cancer, it's very helpful to screen these people for depression. Remember, there are certain drugs that can throw you the will of depression. Many of them are these interferon-based agents. In fact, if a person has a history of misinterpreted disorder or suicidal ideation, it should not be taken an interferon-based agent. What are the diseases we use interferon-based agents for? For example, MS, we use interferon-beda, it's one of the treatments for multiple sclerosis. That drug you should not take it if you have a history of depression because it can swing you into depression. Or you can see, for example, like Hepsie. Although Hepsie, we have much better drugs these days. On the end game, they can still slow you into a interferon-alpha as a treatment for Hepsie. It's not a good idea if you have a history of depression or suicidal ideation. I remember people that are hypothyroid, they can actually present major depressive disorder on the exams. Many times on the exams, they'll throw that as a question that is a major depressive disorder secondary to some kind of a general medical condition or something like that. All right, let's go to question 113. So 78-year-old man is evaluated in the hospital, following admission eight hours ago for treatment of aspiration pneumonia. He has a five-year history of intermithing dysphysia, resulting in spontaneous regurgitation of undigested food and liquids.

Over the counter-antisids had provided no improvement in his dysphysia. Until the development of his recent fever, Chesspin, until the development of his recent fever, Chesspin and shortness or breath, the patient had not had any other symptoms and had not solved medical care. He has no other history of cirrhosis illness. In the hospital, he has been receiving IV-Pypteisal. He does not smoke cigarettes or drink alcoholic beverages. His temperature is 100.6 degrees Fahrenheit. His pulse is 90 per minute, respirations are 24 per minute, and blood pressure is 165 millimeters of mercury. He appears comfortable on his sitting operating bed. Decrease breath sounds are heard in the right lower lung field. The abdomen is soft and non-tender. Which of the following is the most likely on the line cause of dysphysia? This is an easy question option. A says Echalisia, B says the superficial cancer, C says Hyderohernia, and D says Zenker's diverticulum. Zenker diverticulum. Old person with dysphysia and a regurgitation on digestive food. This is easy. This is Zenker diverticulum. I'm going to go to option D here. Remember Zenker diverticulum is actually not a true diverticulum. Basically, there is this area of weakness called a Killian's Triangle. It's basically a place between like your crackle farringious and your inferior constrictors. That area of weakness, you can have outpouching. You can form a false diverticulum. Of course, that outpouching food can collect there.

Many times on the exams, this is going to be an old man. They're going to have halitosis. They're going to have bad breath. Basically, these people, when they wake up in the morning, they may be regurgitated on digestive food. Basically, the food that collected there comes right out. Remember, if you want to make the diagnosis, please don't do an EGD. If you do an EGD, you can preferate it and cause a surgery or a perforation, and that will be bad. You're going to start off with a barum swallow. You're going to start off with a barum swallow. Then you're going to treat it with surgery. You're going to do a diverticule, lectomy, diverticulectomy. Remember, this is a false diverticulum. It's a false diverticulum. Contrast that with mechals diverticulum, that is a true diverticulum. Again, don't forget Zenker is in the upper third of the esophagus. What kind of diverticulum is in the middle third? It's going to be a traction diverticulum. What kind of diverticulum is in lower third? It's going to be an epiphremic diverticulum. Zenker, in the upper third, traction in the middle third, epiphremic in the lower third. Make sure you know those kinds of diverticula. Again, Zenker is false. Mechals is true. Zenkers is false. Mechals is true. You may be like, define how could I differentiate this from ecalicia? Ecalicia is not going to be in an old person. It's going to be in a young person on the exam.

So put the heavy ecalicia over egregiated on digested food because again, the lower surface of a geospinter they just have very high pressures. So food doesn't pass through. So they're going to re-gurgitate on digested food. It's going to be in a young person, not an old person on your exams. This is not going to be a severe geocancer. A severe geocancer, these people will be losing waves and things like that. Hydrone, herniage, can be prominent, prominent, and gurg-like symptoms. Hydrone, herniage, is not really going to cause you to be re-gurgitated on digested food. All right, let's go to questions. So for this one, I'm going to go with option D for sure. Okay, question 114 says, a 27-year-old woman comes to the office because of a 3-day history of constant malpain in her left lower abdomen. Vigor's movement makes the pain worse. She is not habnarja. She's otherwise healthy and takes no medications. Mences occur at regular 28-day intervals and lasts 4-60s. Her last menstrual period was 3 weeks ago. She is sexually active with one meal partner and the use condoms inconsistently. She, at temperature is 98.0. Honestly, all her labs are fine. I'm not sure it's a little low, but not a big deal. The abdomen is flat and soft with voluntary guarding of the left lower quadrant. Bowsounds are normal, pelvic examination shows tender fullness of the left and nexa. Your impregnancy test is negative.

Autosanography shows a normal uterus with a 3x4 centimeter left at nexocyst and a small amount of free fluid in the pelvis. Which of the following is the most appropriate next step in management? So option A says antibiotic therapy, option B says appendectomy, option C says CT, scan guided aspiration, option D says laparoscopy, option A says observation only. So let me ask you this. This question just looking at it, do things look really bad? I'm going to argue no. And this person looks pretty luresk, young-ish female, has an ovarian cyst, this is a small amount of free fluid. Her pain is mild. Nothing big. Look at all her vitals, they're pretty much okay. I'm not going to do anything here for this question. This person obviously has an ovarian cyst. It doesn't look like it's really bad. So for this situation, I think he makes a lot of sense to just observe. It makes a lot of sense to just observe. Usually the times where you're going to get really invasive, ovarian cysts, is when, for example, you have like torsion of a cyst or like torsion of the ovaries, you've got to do laparoscopy for those. Or let's say for example, the person has a cyst that ruptures. You see a ton of free fluid in the cold as such, for example. In that case, you need to do laparoscopy. Or say, for example, the cyst, you do ultrasoundography and it has malignant characteristics. For those circumstances, yeah, you need to do something. You need to do laparoscopy.

And then another situation is, if you see a cyst in a woman that is postmenopausal, most cysts in postmenopausal women, we're kind of worried about it. So we need to do something about it. Typically, we're going to do some kind of laparoscopy. We're going to do some kind of laparoscopy. Okay. Now question 115 says, 60-year-old woman comes to the office for health maintenance examination. She says she feels well. She has no history of serocelness, takes no medications, vital signs are within normal limits. Observation of the tympanic membranes is limited because of seramin, filling both external auditory canals. The external ears appear normal. No other abnormalities are noted. On question is she says she hears well. Which of the following is the most appropriate next step in management? See, I'm going to tell you something here. This is something you need to give as a mantra in your head. Ask yourself, what's the feel of this question? Question 114, the feel was like, hmm, she has a hair spain, but it's not a big deal. Question 115, look at this. Does this person feel like anything but this happened? Oh, she has a lot of wax in her ear. And but she said that, wait, I can hear perfectly. I would hope you're not trying to pick her egg answers for these benign questions. That is just not usually a good mix on the exams. So let's look for the most benign answer here. Option E says irrigation of the ear canals by the physician.

Option P says manual removal of the seramin, an odor rhino larynxologist, an ENT person. Let's look at that. Option C says recommendation for daily use of cotton swabs. Option D says recommendation for use of a seraminolidic agent. Option E says no further management is indicated at this time. I like option E a lot. Don't do anything. This person is hearing well. She just has a little wax in her ear. Do you know many people carry a lot around a tons of wax in your ear? Don't do anything. Just let it go. The wax is self-cleaning in a sense. So it's not going to be a big deal. It's not going to be a big deal. In fact, if you're a person that keeps cleaning out your ears, cleaning out your ears, cleaning out your ears, you can start causing breaks in the skin and you're welcoming yourself into the world of what? Of what tidies? Extra. Usually, people would have a tidies extra when they wiggle their ears or you touch their outer ear or the triggers. It just hurts a lot. Typically it's going to be caused by something like pseudomonas aeroginosa. For those people, it's pretty important to know that you should get what? Otik ear drops. So basically ear drops. You're going to give them either an acetic acid or an air drop or a flow-quinnolonged air drop. Although, remember, really nasty otitis external. You may see that in a diabetic. You'll see that they have like crazy high-fever, crazy lucho cytosis. Most people that have regular otitis external, they don't have fever.

They won't have lucho cytosis. But if you see a diabetic, they have high-fever otitis external, crazy lucho cytosis, I want you to think of my lignant otitis external. All right. And again, just quick announcement. If you're taking step one step towards step three anytime soon, I have a bunch of classes that will really, really help you. They start on Tuesday. Again, tons of people have taken these classes and they found them to be extremely helpful. They start next week Tuesday, next week Tuesday on the 18th, next week Tuesday on the 18th of June. They run from Tuesday to Friday of next week and then the week after that from Monday to Thursday. There are many classes there. I have a separate podcast on that. Just listen to that podcast. It gives you specific information on these classes. They're all over Zoom. Again, I've had tons of people take these classes and they've done extremely well on their exams. I feel like my classes really do prepare a ton of people extremely well for their exams. All right. So let's go to question number 116. So again, please airwax when if you keep using cotton swelves, they're going to get yourself in a lot of trouble. In fact, that is a very big risk factor for people getting out of the way. So if the person was not hearing or whatever, then yeah, fine, do something. But this person literally 150 had no problem. You don't have to become a hero. Okay.

Now, question 116 says, a hospitalized 37-year-old woman has a two-hour history of severe chest pain and bloodstream sputum for days after undergoing hysterectomy and overrectomy for severe cancer. Quite medications are oxycodone, prophylactic lumolecular with heparin and amultivydony. Our temperature, honestly, she's the kipnic, whatever your vital is fine. Examination shows a left plural rub. An x-ray and CT scan of the chest show a triangular plural-based density in the lower lobe of the left lung. No pulmonary embolite are seen in the major branches. Vinos duplex autosanography of the lower extremities shows no DVT, no DVT. Which of the fluency is the most likely diagnosis? Option E says air embolism, option B says empaima, option C says hemothorax, option D says pericarditis, option E says pneumonia, option F says pulmonary hemorrhage, option C says pulmonary hypertension, option H says pulmonary infarction. So let's look at these answers one by one. Option E says air embolism is going to be a person that decompensates very suddenly. After you've done some kind of procedure in the thorax like thoracinthesis or your pleastacentrovina scathod or something like that, they're just going to decompensate very, very quickly. Remember for those people you're going to please them in the left lateral the cutest position so that the embolus goes to a more dependent region of the body. So you don't get like an MI or a stroke or something like that.

So that's no what's going on here. Option P says empaima. Empaima you're going to see the hypersin that has pneumonia. It's a very bad kind of paramonic effusion, right? You know they're going to have false, their sputum is going to be false smelling and when you withdraw, when you try to do thoracinthesis you're going to see a little pulse. We don't have all that information here and you're not going to get an impaima in two hours, right? That doesn't really make much sense. Hemothorax, right? A person is going to bleed into the lungs and remember obviously if you get an x-ray you're going to see like blood. You're going to see a lot of white because blood is very reduced. That's not what's going on here. Remember in the hemothorax these people on pulmonary exam, they have donors to precaution contrast that with pneumothorax, we're on pulmonary exam. You're going to have hyper resonance to precaution. Hyper resonance to precaution. This is not paracodidis. Again, paracodidis, they're going to have a fever. They're going to have positional chest pain, right? When they sit up it feels better. When they live up, hurts a ton. And they're going to get like a chest, they're going to give you like an ekegi that shows like the diffuse ST elevations, the fused PR depressions. That's not what's going on here. This is probably not pneumonia either. Again, yeah, don't get me wrong. Could this be pneumonia?

But no, no fever, you know, and this person, it just kind of came suddenly like that. Really hard to get pneumonia, suddenly like that. Pulmonary hemorrhage, again, if you're bleeding your lungs, you're going to see it. You're going to see it. You're going to see a little white. That's not what's shown on the image of the lungs here. Pulmonary hypertension, again, you'll have to give you some antisydent like COPD or theopathic ponderotera hypertension, oscleroderm or something of that nature. We don't see that here. We're going to skip that. I'm going to go to option each here. This is a ponderin function. I mean, wonder, define how did you pick up on that? Well, actually pretty easy. First, this person is hyperquagulable. Right? This person just underwent big time surgery. That's number one. Number two, this person has cancer. Cancer makes a person hyperquagulable. Number three, look at the image in description. You see a triangular neuro-based density. Whenever you have an infarction, many times it's going to take a wedge shape. It's going to take the shape of a triangle because blood vessels branch out like trees. The branch out like trees, branch out like trees. So if you occlude a vessel, then like the two branches of the tree are messed up. That's going to form a triangle. So I'm going to go to option each for this one. And then question 117 says, question 117. A 77 year old man has burnt to the ED because of a one hour history of severe constant abdominal pain.

And disinness. He has hypertension well controlled with hydrochlorophytesic. He has smoked two packs of cigarettes daily for 60 years. That's a lot of cigarettes. He's 5 foot 9 inches tall, weighs 250 pounds, BMI is 37. We look at his vital. His temperature is fine. His tachycardic pulse is 120 per minute. His vision is at 25 per minute. His tecnic. His very hypotensive, ED over 60. Post-oxymatural room air shows an O2 side of 93%. He appears uncomfortable. Abnormal examination shows mild distension, bowel sounds are decreased, groin pulses are 1 plus. Gorsales speedy pulses are not palpable. Himalayan is 37% white count is 10,000. That's normal. Serum-elephaline concentrations, LF Ts and amelies activity are within the reference ranges. An extra of the abdomen is shown, which are influenced the most likely diagnosis. Option E says acupunctitis, option B says mesenteritis, schemia, option C says perforated, droid, no ulcer, option T says ruptured, triple A ruptured, abdominal, leonic aneurysm, option E says, small bowel obstruction. Look at this question. This is an old person that has a 120-packier smoking history. That suddenly is the compensating from an abdominal perspective. From an abdominal perspective. I notice in that this person's lower extremity pulses are not great. That means they don't prohibit their look. What is the thing that makes any sense for all these things I've described? I hope you're saying divine. This is option D.

Because think about it, a small bowel obstruction is not going to cause you to have like lacking all these pulses and whatnot. That doesn't make any sense. A perforated, droid, no ulcer, this will not be probably puking blood. It's going to present like a GI bleed. We don't see a GI bleed presentation here. A mesenteritis schemia, you're going to see these people, the most have had like an A-fib history or an M-I history. And then the occludum is enteric vessel. They're going to have a lot of abdominal pain. But it's not going to cause them to be losing pulses in their low extremities. So that's wrong. And I could concretize this. Again, a big gastric pain radiating into the back. And those people are going to have like abnormalities with like their amelies, for example, or lipase, for example. We don't see any of that. So I'm going to go with a person having a ruptured triple A. And again, remember triple A is we screen people for them once you hit age 65 and you're a man. You're going to get a abdominal ultrasound if you've ever smoked. And if it's more than five and a half centimeters, you're going to intervene. If it's symptomatic, you're going to intervene. You're going to get either an open repair or an endovascular repair. Or if it grows by more than like one centimeter in a year, you're going to go ahead and intervene as well. And obviously it's ruptured. This person is going to need some kind of therapy as well.

And again, I know some people are probably like, this is one thing that kills people's time on exams. They're probably sweating over this image. They're like, oh no, what is this image showing? What is this image showing? I don't care what the image is showing. The thing is many times on the USML is the image, the chest X-ray, the EKG. Don't get me wrong, can I need the helpful? Yeah, they could be helpful. But can you answer most questions or many questions without even really stressing over them? Absolutely. You don't need to stress over these things all the time. All right, let's go to question 118. A one week old male newborn is evaluated in the hospital nursery four days after undergoing operative repair of a myeluminego cell. It was about a 37-week gestation via uncomplicated spontaneous vaginal delivery to an 18-year-old, primary-gravied woman. The defect was diagnosed prenatally by ultrasoundography and the repair was done 72 hours after delivery. He's at the fifth percentile for length, 10th percentile for weight, and 25th percentile for head circumference. His temperature is 98.4, pulse is 138 per minute, whereas versions are 42 per minute. Pulse oxygen room air shows an O2 side of 98%. The newborn appears comfortable. Physical examination shows a soft flat and tearful antenna. Red reflexes are normal. More low reflexes symmetric in the upper extremities. There's no movement of the lower extremities. No movement in the lower extremities.

Autosanography of the brain shows mildly in largest ventricles, which of the fluene is the most likely associated finding in the species. So, oxygen A says congenital heart malformation. Option B says cryptorokidism. Option C says impaired fully metabolism. Option D says neurogenic bladder. Option A says severe cognitive impairment. Okay, so what's going on here? This first has a myelomanin gocel. Right, remember when you have a myelomanin gocel, the word myeloman spinal cord, meningo, means your meninges. So, it's a neuro tube defect that you get because your carlo, neuro pore did not close. Your carlo neuro pore did not close. Many times you're going to find it in moms that have a, that are not taking them off, and not full it. So, basically the spinal cord and the meninges, they pop out through this open cranial, open a caudal neuro pore that did not close. And many times, you know, a myelomanin gocel is probably the worst. In the spinal bifida oculta is probably like the better one of all of them, but a myelomanin gocel is really, really bad. It's really, really bad. Many times those people from the waist down, things are not going to work. So, if you just understood what I said, what answer makes the most sense here? I hope you're saying, oh, we're divine. Your genic bladder. Because we see for this child, there's no more meningolore extremities. So, this child is probably going to have bladder issues.

Many of these kids, they're going to need like chronic catheterization or whatever, because again, they have neurogenic bladder. So, the answer is going to be option D, right? Congenital heart morphamation doesn't really make any sense, right? Because when you get a neuro tube defect, it's probably because you have fully problems. Fully problems don't necessarily cause heart issues, at least not on the USM Ls. Cryptoric edisame is when you have an undescended testis. That's not what's going on here. It just really doesn't have any answers. You won't fully metabolism. Remember, cryptoric edisame. If it doesn't descend after a while, you should try to bring it down yourself, if not high risk of testicular cancer. Even if you bring it down on your own, very quickly, the person still has a high risk of testicular cancer. In fact, fully metabolism, great, great, great answer, but it looks very good, but it's wrong. There's no problem with fully metabolism. This child's mom did just not take, did not take a not fully. There's nothing with the metabolism of fully. And then option E says severe cognitive impairment. No, this is not a brain issue. This child is going to be fine. Their brain is refined. It's just that caught on your report that did not close. So, I'm going to go to option D here. And remember, these are things unfortunately, it needs to come into memory.

What our friends at the NB means, they want you to know that if a person has a lumbus secret myelominingo cell, a lumbus secret myelominingo cell, that's associated with a Chiarit 2, malformation, Chiarit 2, malformation. And then remember, a Chiarit 1, malformation is associated with syringol, myle, with syringol, myle. All right. Now, question 119 says, a randomized controlled trial is conducted to assess the effectiveness of a new antiridmic drug in patients with recording ventricular tachycardia. A total of 100 participants with ventricular tachycardia are randomly assigned to receive either the new drug or a placebo. Results show that the new drug has fewer episodes of recording V-tack compared with the placebo group. Okay. The difference was found to be statistically significant, T less than 0.05. The investigators conclude that the new drug can be used to decrease mortality from chronic arrhythmi. Which of the following factors most likely invalidates the author's conclusions? Option E says, extrapolation of findings beyond data. Option B says, insufficient power. Option C says, no information regarding confidence interval. Option D says, selection bias. Again, what's the answer choice that looks a lot like what did it here? These people, what did their results show? The results show that weight. Oh, if you take this new drug, you have fewer episodes of recording V-tack. Okay. But look at the conclusion they're drawing.

They're like, hmm, this drug can decrease mortality. No, no, no, no, you did not examine that research question in your study. You cannot jump to that conclusion. Right? You cannot jump to that conclusion. I feel like this is a kind of error many people making taking the USM Ls. The question will say A, but then you will start adding all this extra jump to B and they say, yes, this will be the right answer. No. Right? So I like option E a lot for this question. These people, they're like really stretching the truth with your conclusion. So I'm going to go to option A. They found one thing like weight, reduced risk of recording V-tack. Sure. The study did not show that, oh, wait, decrease mortality. No, no, no, no, no, but they're trying to jump to that conclusion. That's that's not right. So option E is the right answer. Go show one, 19, all right. Go show one, 20, says 42 year old woman comes to the office because of a two week history of softwood and fullness in her neck. She has no history of serosailness and takes no medications. She appears anxious. Temperature is 100 degrees Fahrenheit. She is telecardic, poses one or two per minute. Resurrections are twin two per minute. She's the Kipnik. Blood pressure is 146 over 82. She's a little hypertensive. The orpharynx is clear and there are no exudates. There is probable fullness and tenderness of the entire aspect of the neck. There is no lymphatic and apathy. Lones are clear to asceticion.

Results of a complete blood counter within the reference ranges. Chest x-ray shows no abnormalities. Which of the following is the most likely diagnosis? Option E says acute mullonine cluses. Option B says gird. Option C says laryngeitis. Option D says somacute thyroiditis. Option E says tracheitis. Okay. So let's look at the things in this question. This person has like, you know, she had sore throat and fullness in her neck. So sore throat probably some kind of infection. And then now we see this person is looking anxious. This person is hypertensive. This person is tachycardic. This person is the Kipnik. And this person's neck hurts. You'll pop in the antiraptic of the neck. They're like, oh, it hurts. What do you think this is? And there's no lymphatic and apathy. There's no lymphatic and apathy. So what do you think is going on here? I mean, this person looks like they have hyperthyroidism in a sense. Everything is up there like in this. They seem to be like a very like basal metabolic rate E very high. Everything is so fast for them. Hot rate is fast. Yes, I know there's no preparation for this, but the hot rate is fast. Respiratory rate is fast. Glow pressure is high, right? And you see they're anxious. Sometimes our friends at the MVM is they love to pose hyperthyroid questions as generalize anxiety disorder questions. So I'm going to go to option D here. This person has the quervin's thyroid dietis. Another name you may see on the example is subacute thyroiditis.

Sometimes on the example, you may also see this referred to as a granulomirus granulomirus thyroiditis. So again, they're going to have a painful tender thyroid gland. Usually after an operation or infection, like we see sounds like this person had in this, cues them. So I'm going to go with that. Again, because of the inflammation, give them an inset. They're going to be fine. They're going to be fine. So you're going to reduce the inflammation on the pain. Or you know, because the thing is that inflammation just rips apart your thyroid follicle, your thyroid follicular cells. They release all that thyroid hormone. So it makes you hyperthyroid. But it's going to take them some time to recover, but they will recover over time. They will recover over time. So I'm going to go with option D here. Monoincluses doesn't make any sense first. This person is pretty old, 42. Monoincluses is really going to be the young sexually active person. I don't think that's what's going on here. And again, it's really hard to have mono and have like zero lymphatonopathy, right? That doesn't make much of any sense, right? And Gurd is not going to cause you to have like, like, oh, you pulpit the neck and it hurts. No, that doesn't make any sense. Larinjitis. Larinjitis is something that you may see kind of along the lines of group. And that's going to be more like, don't get me wrong, you can get in an adult. It's really an adult that like smoke a lot.

But again, highly unlikely that that's what's going on here. Because if you have larinjitis or you have trichitis, option C and E, why will you magically? You have like an infection inflammation in your neck and then magically, you avoid lymphatonopathy. Magically, you avoid fever. Come on. That doesn't really make much of any sense. Does it? Right? So I'm going to go to option D. Here, I'm going to go to option D. Here. So I think I'm going to go ahead and stop here. Again, if you're interested in any of my classes, have a test-taking class next week, Tuesday, Biosdats class on Wednesday, social sciences, and ethics class on Thursday. And the last minute review on Friday, the classes on Tuesday, Wednesday, Thursday, or for step one to three. The class on Friday is for step two and step three. And then the week after that, I have a 20 hour step two step three class. This class is all over Zoom. And again, they're not lectures. If you expect an lecture or on class. But these classes, they use exam style questions to make integrations, help you understand path of face, and help you see how they're going to test this material on your exams. So if you're interested, just shoot me an email through the website and I'll give you some more information. I also offer one on one tutoring and I offer advising with your applications, personal statements, rec letters, mock interviews, and things of that nature. And then I have these podcasts on Apple, Google, and Spotify. Check those out.

I have a You Tube channel, Divine Intervention, the USML podcast and videos. And then again, if you want to see these worksheets, though, that come with the podcast, you've got to go to the website, Divine Intervention Podcast.com. And then I have another website called Divine Intervention Lifelesses.com. Every week, I try to post at least one podcast where from a biblical perspective address a life lesson. And the website again is Divine Intervention Lifelesses.com. There's actually an Apple podcast associated with that called the Divine Intervention Life Lessons podcast. So thank you for listening to me today. I will see you in episode 539. God bless you, have a wonderful week, and bye for now. Happy Father's Day.

Dermatitis herpetiformis, which is often seen in Celiac disease.

Zenker's diverticulum (a false diverticulum located in Killian's triangle).

Depression significantly increases the patient's risk of death from cardiac disease.

Pulmonary infarction often presents with a wedge-shaped or triangular density due to vessel branching, occurring in hypercoagulable states.

Neurogenic bladder dysfunction (bladder and bowel issues).

Observation only; invasive procedures are reserved for complications.

Malar rubra (Heat rash). Management is avoidance of heat/humidity.

Zenker's (false, upper third), Traction (middle third), Pyloric (true, lower third).

Painful/tender thyroid gland, often following an infection or operation; can cause transient hyperthyroidism.

Hand-foot-mouth disease (caused by Coxsackie A).

Male sex, age > 65, heavy smoking history. Screening involves abdominal ultrasound.

Interferon-based agents (e.g., interferon-alpha).

Malar rubra (Heat rash). Management is avoidance of heat/humidity.

Zenker's (false, upper third), Traction (middle third), Pyloric (true, lower third).

Painful/tender thyroid gland, often following an infection or operation; can cause transient hyperthyroidism.

Hand-foot-mouth disease (caused by Coxsackie A).

Male sex, age > 65, heavy smoking history. Screening involves abdominal ultrasound.

Interferon-based agents (e.g., interferon-alpha).