DIP Episode 562 - 2024 USMLE Step 3 Free 137 Discussion Part 9 (Q81-91, super helpful for Step 2!)

Welcome, this is episode 562 of the Divine Intervention Podcasts. In today's podcast, we're going to be continuing the free 137 series. This is going to be part 9. I believe today we're going to be able to go from questions 81 to 91 for reasons you'll understand as we go through. Alright, let's jump right into it. So a 38 year old man, so question 81, 38 year old man with type 1 diabetes and hemocromatosis comes to the office for routine health maintenance examination. Medical history is otherwise unremarkable. His conditions have been well managed with therapeutic phlobatomy and insulin therapy. He currently feels well, BMI is 24. Temperature is 98.1, pulse is 88 per minute, respiration is 16 per minute, and blood pressure is 130 over 84. The patient's skin is not discolored and scleria white. His glycogenation disclosies no abnormalities. Results of lab studies are shown. So if you look at his lab, his ESTLT is a little bit high, his bilirubin is fine. His fasting glucose is 134, his hematocrate, and hemoglobin are not too bad. A1c is 6.6%. Now, the patient should be concerned that he is at increased risk for mortality if he consumes which of the following foods. Classic basic science question. So the thing is, we know that this patient has hemocromatosis, and when you have hemocromatosis, you tend to have a lot of issues with iron overload. Now the thing is, there are certain organisms that are known as Ciderophilic organisms. Ciderophilic organisms, they love iron.

They love iron. So if you're in the state of iron overload, he's almost like a creature like things given for these organisms. They have like the perfect conditions to survive and thrive. Now what's a very high you would want to know for your exams? It's going to be Vibrio for Neficus. I think I may have discussed this in one of the iron studies podcasts, right? So Vibrio for Neficus. So what's the answer choice that relates to Vibrio species? Remember, it's usually seafood. So option C, raw oysters is going to make the most sense. I remember option A, bean sprouts, bean sprouts. We tend to think of you who consume those things and you have a high risk of getting like salmonella infection or like Echoline infections. Remember most of those things that salmonella causes bloody diarrhea. Echoline, especially if you're dealing with O157, he's seven can also cause bloody diarrhea. Berries think of it with food out breaks, especially from like viral things like neurovirus, neuro, neurovirus, and then undercooked eggs, right on the cooked chicken poultry, always think of salmonella. See a person that has bloody diarrhea, after they've consumed undercooked eggs or poultry or whatever, think of salmonella infection. All right, so I'm going to go with option C for question 81. All right. We're going to go to question 82.

A 24-year-old woman with asthma comes to the office because of a two week history of mild shotness or breath and a non-productive cough that occurs occasionally during the day and frequently at night. During this time she has required use of her a bit of oil in healer, twice daily. Medical history is otherwise unremarkable and our only other medication is an oral contraceptive. The patient drinks three to four alcoholic beverages weekly and does not smoke cigarettes. She appears to have learned uncomfortable BMI is 25, a temperature is 99, pulse is 88, respiratory is 16, blood pressure is 114 over 72. Oxygen saturation is 97% on room air, FIV1 is 70% of predicted, physical examination discloses no abnormalities, which of the flu is the most appropriate next step in pharmacotherapy. So this is an asthma patient and this person right now is on our uterine. Our uterine is a sabah, it's a short active beta to agonist. Again, you see many people for asthma management, they start memorizing severe persistent, mother resistant, USMLE persistent, whatever. I've never found out to have a lot of utility on the USMLE exams. Most times again you just need to know the wrongs on the ladder that hey if you're taking something on the ladder and your symptoms are not well controlled just go to the next thing. And the simple ladder of asthma management in my book is number one you start with a sabah. So you can do sabah plus inhale cortical steroid at the same time.

But for the most part, start off with a sabah like a beta role. If that's not controlling your symptoms, the next wrong one the ladder is an inhale cortical steroid. You know, if that's not controlling your symptoms, the next wrong one the ladder is going to be a lava like some matter of for motor role along active beta to agonist. If that's not controlling your symptoms, they need to start looking for oral steroids. So if you look at this, this person is on a beta role. The symptoms don't seem to work on try. I don't care about how many times it's just she's using the a beta role a little too frequently so it's supposed to be a rescue inhaler, not daily, nightly and ever so rightly. So for this person, I'm going to go with an inhale steroid as the answer is option A is going to make sense. Option B in heel, triotropium, triotropium is a long actin, muscarinic antagonist. We tend to use that more for COPD than for asthma. Right. So we're going to cross that off. Option B says is it through my cell? Right. That's a macro lid. That's a 50s inhibitor. I don't see why you're going to be using that to treat asthma. Option D says Monte Lucas. To look at sometimes is something you can do after you've tried a lava. And also you can use Monte Lucas. Remember, it's a local trainer receptor antagonist. When a person has aspirin exacerbated respiratory disease, you can use a local trainer antagonist because remember, an aspirin exacerbated respiratory disease aspirin is a cox inhibitor.

So you're going to have morphs locks through the lipoxygenase pathway. That can cause you to make a lot of local trains that can cause like nasal polyps and all those problems. So if you shut down that pathway with an antagonist like Monte Lucas, that'll be good. Right. And those age of our beautiful, that makes no sense. Right. Again, it's supposed to be a rescue inhaler, not all the time inhaler. And then oral steroids. No, we're not going to be doing that. This person does not have an asthma exacerbation. So that's wrong. All right. So that's what you do. You know, when people have asthma, super exacerbations and they're living the hospital. All right. Question 83 says that 36 year old woman is admitted to the hospital because of a one day history of sore throat and fever with temperatures to 104. She has not had cough, dysmia headache, neck stiffness, rash, diarrhea, pain. All history is significant for griefs disease diagnosed by her PCP three weeks ago. At that time, the patient had a goiter and reported generalized weakness and her loss. Therapy would propound a lot and methemazole was initiated and the patient symptoms had been improved. BMI is 20. Temperature is 103.8, pulse is 123 per minute. Respirations are 20 per minute and blood pressure is 108 over 68. O2 sad is 90% on room air. Physical examination shows pharyngeal erythema. Without exuding and a diffuse and symmetric goiter. Things are clear to a scutation.

cardiac examination discluses a great to other six systolic murmurs at the left upper sternal border. There is no hepatospelino megaly. Results of lab studies are shown. So, we look at her labs. What's pertinent here? Well, her white count is extremely low. 3300 white blood cells. That's pretty low, right? And the neutrophil part of it is like 3%. Well, let's do some math here. 10% of 3330. Right? So, 1% is like 33. So, if a total neutrophil is 3%, that means that neutrophil can be like 99. That's like 100. That's really, really bad. That's extremely bad. The MCV is 82. Everything here looks pretty good. Now blood cultures are ordered and methemazol is discontinued. So, which of the following is the most appropriate next step? So, again, if you have to pin a diagnosis on this one, what is it going to be? This one has fair brown neutropenia. She has fair brown and she has neutropenia. Now, what causes the neutropenia? Remember, the anti thyroid drugs like PTO, purple fire uracel and methemazol, they can absolutely cause agronolocyteosis. What are the other drugs that cause agronolocyteosis? Well, don't forget things like methotrexic and cause that. Don't forget carbon mesopindal. We used to treat trigemagnonorazia and cause that. Don't forget that cause the pin, the drug used to treat psychosis and schizophrenia can cause that. So, you've got to know these things. So, whenever a person has fair brown and neutropenia, what is the thing you want to do?

Well, you typically want to do like some kind of blood culture. And you want to stop the offend in the Asian. But one thing that's very, very high yield to know for you exams is that you want to start an anti-sudo mono, anti-biotic. And the drugs of choice, they are the impaired treatments of choice in febriol and neutropenia. So something like sephtazidine, that's a third gen sephalosporine or sephepim, that's a fourth gen sephalosporine, or you can use like a carburet pen, right? That'll be a smart thing to you. So let's look at the answers here. I'm option A says, A and A, that makes no sense. We're worried about lupus. This is not lupus. Option B says, boom, more aspiration and biopsy. No, we have a very strong likely cause of this problem. We don't need to do that. I'm going to go with option C because sephepim is a fourth gen sephalosporine that covers the monos. Fail grass team is one of those GCSF, GMCF analogs, right? It kind of belongs in the same class as a sagramostin. You use them to prevent febriol and neutropenia, usually people don't get chemotherapy. You don't use it to actually treat it, use it to prevent it. And option E says HIV and antibody tests makes absolutely no sense, right? And why do you want to give Ptu? Why would you want to give something that can cause febriol and neutropenia to a person that already has febriol and neutropenia, right? That's kind of a fast way to kind of kill the patient. Don't do that.

Now, question 84 says a 27 year old woman, gravita 1 par 1, has a meeting with her physician and lactation consultant in the hospital one day after uncomplicated spontaneous vaginal delivery of a 7 pound 14 ounce female newborn at 30 weeks gestation. Prejudency was uncomplicated. The patient has good social support. Cancer needs provided. The patient has begun to produce colostrum and the newborn latch as well. The patient says she's interested in breastfeeding and it's convinced that breast milk will be best for her baby. But she's worried about how long she'll be able to breastfeed because she plans to return to work as soon as possible. Her job involves packing boxes and assembly line and she often must work for multiple hours without a break. Her employer expects her back to work in four weeks, which of the following is the most appropriate recommendation. It kind of tells you about the vagaries of living in the US, right? But which is kind of sad. But here's the thing, right? I hope people get longer maternity leave than a month. But here's the thing, right? Breast milk is the best milk. You can argue whatever you want with me. Breast milk is the best milk. There's way too many scientific studies per in the stuff, right? And the thing is you don't want to discriminate against people because they are breastfeeding, right? So the thing is this employer has to work with this person. Has to work with this person. Has to work with this person.

So let's see the different answer choices here. So option A says, advice, continue breastfeeding now and discussing with her employer a schedule that would allow to pump during work hours. Yeah, we want to you want to find an answer that encourages breastfeeding. So let's maybe keep egg option P says, encourage the patient to focus on breastfeeding and find a new job. No, no, no, you're not going to tell your patients to quit their jobs because they got kids. That's ridiculous, right? Option C says recommend that she not breastfeed. No, the patient wants to breastfeed. We need to follow the patient's wishes. That's wrong. Option D says, remind the patient that she needs to concern herself with what is best for a baby's care. You know what? What's best for the baby's care is actually getting breastfed. You're not really encouraged enough to breastfeed, like you're not really addressing her concern in the question option E says. So just using both breastfeeding and bottle feeding so the transition to work is easier for the baby. So option E actually seems like a pretty decent answer. Just like option A is a pretty decent answer. So this person again wants to breastfeed. She really wants to breastfeed. That's her decision. So I want to try to support her because actually breastfeeding is good, right? There's many studies that have shown that it reduces your the baby's risk of acurotitis media of asthma of allergies of seds.

It also helps mom lose weight believe it or not, you can lose a fairly desirable amount of weight if you're a woman that if you're a postpartum female that breast feeds, right? So the answer that encourages that is the one I'm going to go with. So option E looks kind of looks good, but option A really fully goes with the patients which she see does indeed from it. So I'm going to go to option A here. All right. Question 85 says a 14 year old boy is brought to the ED by a school official one hour after he was sent to the school nurse for behaving strangely in class and then becoming sleepy and difficult to arouse. School records indicate that the patient has no health problems and takes on medications. On arrival at the ED, the patient is lethargic but has no signs of trauma. His temperature is 99.1, pulse is 62 per minute, respiratory stress is 10 per minute, and blood pressure is 106 over 62. Pulse, oxygen, room, air shows an 0 to 7 of 96 percent, popules measure 2 millimeters in diameter, and a minimillary active to light. Cardiopulmonary examination discloses clear lungs and no more cardiac rhythm. Bow sounds are decreased. The patient moans and moves all extremities to painful stimuli. The remainder of the physical examination discloses not the malitis. The most likely cause of this patient's condition is abuse of which of the following medications. Again, it is a pretty straightforward question. Good English, divine, good English. All right.

This person has a population of 11. This person has respiratory depression, mild respiratory depression, respiratory rate of 10. That's kind of low. So this is probably opioid intoxication of some sort. I know you may be thinking divine, can this be a benzo? Well, the thing is, benzo does not cause publicly meals. So we can probably go ahead and cross-option B. And so option A probably makes the most sense, right? Dextramethorphan. Remember if you take cough syrup and see the words DM, DM means dextramethorphan. That's something we're classically finding in a lot of cough syrup. See, it's a very mild opioid. All right. So we're going to probably go with option A here. Option C says diaphinhydramine. That's benadural, right? It's an anti-histamine, but it has very powerful anti-cooler energy properties. So you're going to see more anti-cooler energy-excited effects like fever, the person who has constipation, you have urinary tension, flushing, stuff like that. So that's what's going on here. Methylphenidate, right? That's a stimulant, right? They're going to have high blood pressure. They're going to be very stimulated. They're going to look like they have like, they're going to look like supermanic, right? We don't see that here. That makes no sense. Feral effraying is going to cause a hypertensive crisis if it takes a ton of it, right? Because it's an alpha-1 agonist, right? So you can cause a high pretension. That's not what's going on here.

So we're going to go ahead and scrub that off, right? It's going to hard to have overdosed on phenyl-ethylene hydroblot pressure is a 106 over 62. So the answer here is going to be option A. All right, question 86 says, we have a 70-year-old male who's coming to the office. So he has coronary artery disease, presents for an initial visit to establish care. He had an MI two years ago, but he's now able to walk two miles daily with no chest discomfort. Medical histories of the white zone are remarkable. Medications include a proverestatin, metoprolone, and an 81-mg spring daily. He smoked two packs of cigarettes daily for 40 years, but quit at the time of his MI. He drinks one glass of red wine daily and has never used other substances. His temperature is 90.6, plus his 82. Respirations are 16, blood pressure is 150 for 95. Physical examination discloses no abnormalities, which of the flu is the most appropriate addition of hemacotherapy for this patient, right? So let's frame this question. This is a person that has had an MI. But it seems to be doing pretty well. It's walking two miles. That's pretty great. And then we see that this person though is hypertensive. Okay, so what do we do for this person? Well, the thing is maybe if we call it Fix His High Blood Pressure and give him something that's actually helpful for his heart, that'd be a great thing to do. Right? So we're probably thinking of some kind of drug that improves survival in CHF. Well, that's that one option.

Amlodipine. Amlodipine does not improve survival in CHF. That's a dihydroperidine, concentrate on a blocker. That's wrong. Clonidine, clonidine is an alpha-2 agonist that we can use to treat hypertension. Although remember, you can also use it as a third-line measure for treating ADHD. And you can also use it probably as a third-line measure for treating Tourette syndrome as well. Again, that doesn't really work here. So we're going to go ahead and get rid of that. Again, it can treat hypertension, but it does not improve survival in heart failure. Option C says hydrochlorothiazide. That's a thizidineretic. That's a sodium chloride inhibitor at the level, sodium chloride, transporter inhibitor at the level of the distal-convoluted tubule. Again, it does not improve survival in heart failure. It will help with this high blood pressure, but it's not going to kill that other bird or fix in his heart problems. Which I think says like Ceno-prim. I'm going to go like Ceno-prim. Like Ceno-pril is an ACE inhibitor. Very, very good for hypertension. But remember ACE inhibitors have been shown extensively to improve survival in heart failure. So I'm going to go with Option D because this guy may have some kind of ischemic cardiomyopathy going on because he has had an MI two years ago. Option E makes absolutely no sense. All right.

Question 87 says, a 27-year-old woman who won the wineries section of a great testosterone site, Touma, in her right parietal loop six weeks ago, is evaluated in the outpatient rehab facility, where she has been receiving ongoing care. Medical history of the wise is unremarkable. How many medication is levered to recite? The patient is right hand dominant. Okay. She walks as a graphic designer. All right. BMI is 22. Temperature is 90.6, Post-E72. Respirations are 18 blood pressures, 1.0 over 60. Creatinors are intact. Muscles shrink is far, far to 5 in the left upper and lower extremities and 5 out of 5 in the right upper and lower extremities. There's mass pasticity at the left knee and ankle, sensation to pin prick and preperception are intact. Resolution has left extension, extinction to double simultaneous stimulation, both tactile and visual. She is alert and oriented to person, please, and time. Short term memory is intact and she can spell world backward. Speeches fluent, gauge shows mild circumduction. She uses a 4.5. Thing a nose test in discloses no etaxi and considering these patients' ability to resume work. Okay. Okay. Resume work. Focused evaluation to determine which of the following is most likely to be helpful. I tell you this on the USMLE's questions like this, they look very complex, very scary, but again, just going to stick with what they tell you in the question. They resected an astrocytoma in the right parietal lobe. Okay.

So let me ask you this, because this is basically a neuroanthropy question. Is it the dominant or the non-dominant parietal lobe? No, it's going to be the non-dominant parietal lobe. Remember, your left parietal lobe for most people is going to be the dominant one. The right parietal lobe is going to be the non-dominant one. So the non-dominant lobe, remember, if it's messed up in some way, shape or form, you're going to have like heming leged. You're going to have heming leged so you'll linger, ignore one side of your body. You're going to be ignoring the left side of your body. And those will be all going to have issues with like visual, special orientation. That's a big thing you'll find with that. The dominant parietal lobe, remember if you messed that up, you're going to have things like agrofia, acocolia, you're going to have math issues. So agrofia, acocolia, remember, let's talk about other lobes. The front-to-low, remember, that's going to be your executive decision center. What you do like your executive things, you know, rational thoughts, making executive decisions, balancing your checkbooks and all those things, your temporal lobes, remember, wienniki's area, and then your occipital lobe is vision. And remember, in the brain, if you're more medial or reinter, we're dealing with lower extremities. If you're more lateral or reinter, we're dealing, you know, MC territory, you know, upper extremities and face.

That's kind of giving you like the skinny that you need to know for your exams. Right? So option A says capacity to articulate. So this presents problem in discussions with the right parietal lobe. So option A says capacity to articulate ideas and thoughts. That's frontal lobe territory. That's wrong. They didn't do anything to a frontal lobe. Option B says degree of control over a left hand when typing on the keyboard. Again, your hand, right? That's your upper extremity. That's MC territory. That's MC territory. Right? That's MC territory. That's MC territory. Well, again, remember those modal things, right? That's going to be more lateral in your brainstem. So yeah, maybe it could be our, maybe our right parietal lobe could be a fix. So maybe let's keep that actually. Option C says effect of hemiate inattention on a visual spatial scales. That's definitely what happens in the non-dominant parietal lobe. Okay, let's keep that option D says overall ability to ambulate. Again, that's going to be like your moio frontal lobes, you know, AC territory. Don't get me wrong. Some part of your parietal lobes are involved, but it is not a ton. I'm going to cross that off. So I can't be between options B and C, right? So here's the thing. The thing is which one is more direct in line with what the question is saying. This person you resected something from a right parietal lobe, her non-dominant parietal lobe. You're going to have him in neglect.

You're going to have issues with visual and spatial orientation. The thing is option C is just the most enriched answer and is more directly related to a lot of what they are talking about in the question. So even if option B looks pretty good, option C is just better. On these exams, your job is to pick the best answer. So I'm going to go to option C for this one. All right, question it says, and nine year old boy is brought to the office by his mother for evolution of a six month history of abnormal movements that the mother describes as sudden repetitive jerks often involving his shoulders and arms. She also has witnessed multiple episodes of repetitive eye blinking and through clearing. There is no or a prior to the events. Initially, the episodes occurred approximately once weekly. Some of these seem to occur daily and I interfere with his daily activities. His school performance has been acceptable, but his teacher says he is a little distracted and has difficulties sitting through class without fidgeting. Medical history is on remarkable and in text no medications. His forefoot foing is tall, 50th percent out for height and his 64 pounds, 50th percent out for weight. Viral signs are within normal limits. The patient is restless but cooperative. Most of the tone deep tend to reflect this and get abnormal. There is no tremor. Remind of the neurological examination, discloses no focal abnormalities.

During the examination, the patient experiences an episode of brief repetitive eye blinking. There is no change in consciousness during or after the episode. Based on these findings, this patient is most likely to develop which of the following. So again, I hope you didn't fall for abson seizure. Of course, the output option is an answer just to kind of mess you up. This kind of looks like an abson seizure, but it's not. What's this a classic presentation of? You're seeing these abnormal motor movements. I know a motor movements that eyes the body. These are ticks. These are ticks that show that this child may have to ret. Probably has to ret syndrome. Probably has to ret syndrome. And the thing is our friends at the NBM Es, they love when you know some of these diseases and psychiatric associations. Tret syndrome has very, very strong associations with ADHD and OCD. ADHD and OCD. ADHD and OCD. So option D makes the most sense. If you're thinking of abson seizure, maybe option E, but come on. This is not an abson seizure. This person did not lose consciousness. Intellectual disability, you're going to see that more with fragile X syndrome. In fact, that's the most common inherited cause of an intellectual disability. A haunting disease, no, that doesn't make any sense. And then option E says, well, since disease, which we also call her parolenticular degeneration. I remember well, since it has a sort of Parkinsonian-like symptoms, Parkinsonian-like symptoms.

So put a good option D for this. Remember Tret syndrome, the first line remains going to be behavioral therapy. But if that doesn't work, you're going to go with an anti-psychotics. Anti-psychotics are the drugs of choice for treating Tret. If that doesn't work, you can use an alpha-2-agonist like clonidine or guanfase. Remember I kind of talked about how clonidine is a third line measure for Tret. It's also third line measure for ADHD. All right. And remember, they can actually throw in a prognosis question. Let me give this to you as a bonus. What's the most likely outcome of a pressing asterisk disorder? Are they going to have a reduced life expectancy? The answer is going to be no. People have to raise the actually going to have a perfectly normal life expectancy. All right. One of those weird bizarre things you may just see thrown on an exam. All right. Question 89 says, a 32-year-old woman is brought to the ED by a friend because of a two-hour history of nausea, vomiting, sweating, and malaise. On arrival, the patient appears depressed. She says she took several handfuls of extra strength. I said, I'm in a fit. That's not smart. I drank a pint of vodka three hours ago in an attempt to hurt herself. Medical history is significant for type 1 diabetes, MDD, and seizure disorder. Medications are insulin list pro, glaring, fluoxetine, and phenetone.

She also takes three extra strength acetylmenophen tablets three to four times weekly for headaches, although most will X and Paints. Vital signs are within normal limits. Population of the abdomen discloses mild rider per caution tenderness. The remainder of the examination discloses abnormalities. Results of an absentee are shown. All right. What do we pick up here? The ALT-STR is quite elevated. Let's see. What else kind of sticks out of the divine? Bicarb is eaten. That's pretty low. Acetylmenophen level. I don't know what a normal acetylmenophen level is, but if they're giving it, it's probably high. Alcohol levels, again, I don't know what a normal alcohol level is, but it's pretty high. I have B-quaranty body is positive, I have B-servisanty body is positive, I have B-servis antigen is negative. So that means this person, wow, this person had had B-booty recovered. So this person does not have B. Please note that. This person does not have B. Hebsy antibody is negative. Okay, PTI now, right? They don't look bad to me. Also, which of the following factors in this patient's history most strongly indicates a proper diagnosis? Option A says chronic headbeam fetish, and the cross start off, this person does not have B. The person had B, but he recovered, he cleared the infection. So that's wrong. Option B says, concrena alcohol consumption. Yeah, let's keep that answer, right?

Like, whenever you take two injurious agents to live at the same time, it's kind of a problem, right? It's kind of a problem. So maybe that's correct. Let's keep that option C says, floxistine therapy. No, already SSR Is don't tend to be hepato toxic. Option D says, type 1 diabetes. That's kind of a wash. So I'm going to go to option B, right? You took a ton of acetyminophen. But you took a ton of vodka. That's not a good mix, right? That can certainly land you in some deep waters, right? So I think I'm going to certainly go with option B for this, right? Because by taking a ton of alcohol, your liver is already at risk, and then you throw another thing, double warm it on top of it, like in the setting of acetyminophen. That's not a very wise decision. All right. Now we're going to go to 90 and 91, right? Again, they are cool, join questions like Sam is a tweezer question. Sorry. So an 11 year old girl is brought to the ed by her parents because of a 1 D history of shortness or breath, fatigue, excessive thirst, and frequent reneation. The parents say the onset of these symptoms coincided with an operaspiratory tract infection. Medical history is significant for type 1 diabetes. The patient's only medication is insulin. BMI is 23 as a 93% temperature is 96.8, pulse is 110 per minute. The result is 20 per minute and blood pressure is 95 over 65. Oto side is 97% on room air.

The patient appears moderately dehydrated and drowsy, but she's able to speak easily when prompted and communicate in a lucid fashion. Her filtrate pattern is rapid and deep, and she's using accessory muscles of respiration. Results of lab studies are shown. So let's look at her labs, right? So acetone is high. Her glucose is really high, 693. Okay. A PCO2 is pretty low. PG7.16. She has a crazy acidosis. B's excess negative 16. We're not going to talk about B's XX. SX. XXS. Yeah, it's here, but again, it's not something that's going to be materially important to you being able to answer a question correctly on your ex-apps. We're going to skip it. So in addition to volume expansion, which of the four is the most operating intervention at this time, right? This person clearly has, you know, type 1 diabetes, clearly is in decay. Right? Remember, when a person has a diabetic emergency, what's the first thing you do? Fluids, fluids, fluids, no more ceiling. What's the second thing you do? An insulin infusion. You're going to give an insulin infusion, right? And they remember you also have to pay attention to the potassium management. All right. So they've given this person fluids, right? So we should pick the answer that says to give insulin, right? So option A says, bolos of IV sodium by carb. No. Option B says, continuous infusion of IV short-actin insulin. Yeah, that's probably the right thing to do. Option C says intermittent bolosis of IV short-actin insulin.

No, you're going to give it continuously as an infusion. B is definitely the right answer. Option D says, subcutaneous administration of half short-actin and half intermediate. No, that doesn't make any sense, right? No, you're going to be giving the insulin IV. Those answers make no sense. Let's cross those off. That makes no sense, right? Short-actin insulin you're going to be giving. You're going to be giving as a continuous infusion. Option B is the answer that makes sense, right? So question 91 says an infusion of IV short-actin insulin is begun. First later, lap studies are obtained and results are shown, right? Has the ton is going down, glucose is going down, pH is coming up, so that's good. Shortly thereafter, the patient develops a headache. Oh, no. And then suddenly loses consciousness. Physical examination shows increased muscle tone, an extensive post-training of the extremities in response to painful stimuli, which of the following is the most appropriate next step in management? This is a bad situation. In fact, let me ask you this. This is actually something you love to test on exams. What is the most common cause of death in decay? It's actually cerebral edema. Cerebral edema. That's the thing. So when you're actually trying to correct the person's hyperglycemia, do not correct it too quickly. The same route that applies to hypernatremia also applies to hyperglycemia. Remember from high to low, the brain will blow. Well, that applies to sodium.

Well, also from high to low glucose, the brain will also blow. This person has cerebral edema. They probably have increased intraocrenial pressure. So we need to find an answer that fixes that increased intraocrenial pressure. Opsion A says, administering sodium bicarbina is going to be wrong. Right? Opsion B says, CT of the head, not that strong. Opsion C says EEG. Now, Opsion D says, phosphatetoin. Now, that's what we do for seizures. Remember when a person has acute seizure, you start off with an IV benzodiazepine. You know, if that doesn't work, then go ahead and proceed to phenetoinal phosphatetoinal that doesn't work. Then go ahead and hit up some barbiturates. Right? I need to be the person. All right. Opsion E says, man it all. Right? That's something that can certainly lower your ICB. So I'm going to go with option E for this one. Right? Man it all. Man it all. Now again, as I wrap up, again, if you're studying for a step one to step three, I have a series of classes that you're going to find to be extremely helpful. And again, these classes are updated regularly so that it's not still. Right? Because the USML is they update themselves. Right? So it will make sense that a good resource, a good prep course updates itself. So for a step one, on the way to step three, next week, starting on Tuesday, I have a test taking class on Tuesday, a biostat class on Wednesday, a social science class, you know, social sciences ethics, QI, hospital medicine class on Thursday.

And that's for step one, those three are first step one to three. And then on Friday, I have a last minute review first step two and step three. And then starting the following Monday after that, Monday to Thursday, I have a 20 hour step two, step three class. And then also have a 100 hour review taking place in the first two weeks of June. Again, I've made podcasts where I specifically discussed these things. And many people have taken these classes and they have done tremendously well on their exams. And I also offer one on one to learn for all the USML exams and complex exams. And I help people with earless applications, personal statements, reclators and mock interviews and things of that nature. And then I have these podcasts on Apple, Google and Spotify. So please check those out. And I also have a You Tube channel where I post the videos that I make. And then finally, I have another website called Divine Intervention Lifelessens.com. Divine Intervention Lifelessens.com. Believe it or not, I have about 300 podcasts on there where basically every week, I post like one or two podcasts and from a Biblik Cooper's perspective, I discuss a life lesson. Many people have listened to this podcast, found them to be extremely helpful. There's actually an Apple podcast associated with it called the Divine Intervention Lifelessens Podcast. So thank you for listening to me today. I will see you in episode 563. I believe God will. So have a wonderful weekend. God bless you and bye for now.

Thank you.

Vibrio parahaemolyticus, typically found in raw oysters/seafood due to iron overload.

Start an inhaled corticosteroid (ICS).

Drugs like Methimazole and Propylthiouracil (PTU) belong to this group.

Acetaminophen combined with alcohol consumption.

Cerebral edema, due to rapid correction of hyperglycemia/osmolarity imbalance.

ADHD and OCD.

Hemi-spatial neglect, indicating impaired visual and spatial orientation on the side opposite the lesion.

1. Continuous IV insulin infusion; 2. Monitor potassium levels; 3. Be prepared to administer Mannitol if cerebral edema develops.

They reduce cardiac remodeling and improve overall cardiovascular outcomes, beyond just managing blood pressure.

Anti-thyroid medications (Methimazole/PTU) or Methotrexate.

Behavioral therapy; if that fails, anti-psychotics are used as second line.

Hemi-spatial neglect, indicating impaired visual and spatial orientation on the side opposite the lesion.

1. Continuous IV insulin infusion; 2. Monitor potassium levels; 3. Be prepared to administer Mannitol if cerebral edema develops.

They reduce cardiac remodeling and improve overall cardiovascular outcomes, beyond just managing blood pressure.

Anti-thyroid medications (Methimazole/PTU) or Methotrexate.

Behavioral therapy; if that fails, anti-psychotics are used as second line.