DIP Episode 590 - 2025 USMLE Step 1 Free 120 Discussion Part 8 (Q71-80, super helpful for Step 2 and 3!)

Alright, welcome. My name is Divine. This is episode 590 of the Divine Intervention Podcasts. And to this podcast, we're going to be going over, again, the Step 1, 3, 120 series. This is going to be Series 8. We're going to do Question 7, 1, 2, 8, God willing. And again, if you're studying for Step 2, Step 3, don't tune out your mind with this stuff. I don't know if you've noticed, but Step 2, Step 3, they've now really blended a lot with Step 1, just in terms of coverage. And in terms of how material is tested. I think you'll be setting yourself up for not a very good outcome on your exam. If you don't pay attention to just having some basic understanding of the basic sciences. Alright, so let's pick up from Question 71. Our Undermised Control Trial. Our Undermised Clinical Trial is conducted to compare, wound healing, and cosmetic differences between two surgical procedures for closing skin wounds, following Caesarean Delivery. A total of a thousand women on the going Caesarean Delivery during a six month period eroding the study, which was 85% of the total number of patients on the going the procedure. The results show wound infection rate of 12 cases per thousand women for procedure A and 18 cases per thousand women for procedure B. Which of the following is the best estimate of the absolute risk reduction for wound infection following procedure A compared with procedure B? Right, so this is a straight-up bio-statistic question.

Remember, absolute risk reduction is literally a difference in risk. You're comparing two interventions and you're comparing, hey, you know, if you're taking this intervention and this other one, which one reduces risk the most? So just take the difference of risks. The risk in one is 18 over a thousand. Risk in the other is 12 over a thousand. So just take the difference of those numbers. Option A is the only answer that makes any sense. Right, so A is the right answer. I'm not going to go through the others. They don't really make much of any sense. Alright, Question 72 says, a 52-year-old man is admitted to the hospital. Because of a tour, he's shown vomitting bright red blood. He's supposed to be 125 per minute and blood pressure is 90 over 60. Millimeters of mercury. Physical examination shows jaundice and visible blood vessels surrounding the umbilikas. So it sounds like Kaput Medusa. CT scans of the abdomen are shown to decrease porovina's pressure in this patient. It is most appropriate to place a shunt between the porovina and which of the following additional vessels. Again, you see imaging. Don't panic. Don't freak out. Most times you don't need it at all. But this guy is puking blood. Right? He has jaundice and all these things. So it's probably an alcoholic. Or he probably has cirrhosis of some sort. Remember cirrhosis can be caused by other things that are not alcohol. But this guy for you to be puking blood means that you have bleeds of adjovaricis.

You know, and it's of adjovaricis, they can actually be associated with death. Many times what you want to do is, you know, to do like an esophagogastroidodonoscopy and do like bandinosclerotherapy. But the thing is sometimes that doesn't work. You need to emergency bring down porovitra pressures. And one of the ways you can do that is to do something called a tips procedure. A transdragula, intra hepatic, porosystemic shunt. Basically you bypass the liver. So what can you do? You can pretty much connect the porovina to an upstream vein. So something like, I mean to a downstream vein. So something like the, you know, hepatic vein or the inferior vein of keva. Right? So the answer that makes any sense here is has to be B. You basically have to connect to a vein that is distal to the liver. So option B makes a lot of sense. Right? The inferior vein that makes no sense. That feeds into the, you know, ultimately feeds into the porovane. The other vein is in C, D, and E, ultimately feed into the porovane. Right? So the splinic vein and the supermissing terric vein, they come together from the porovane. Right? So you're not going to be putting a shunt like you're not fixing the problem. The problem is you want to bypass the liver. Now one thing I want you to remember with a tips procedure is that it raises your risk of high. So the answer to 72 is, is B. Right? Remember tips procedure because you are bypassing the liver. You're bypassing the urea cycle.

So you're raising that person's risk of hyperamonemia and that can cause problems. That can cause hepatic and cephalopathy. All right, question 73 says, a 58 year old man with COPD comes to the clinic with his wife for a full of examination. He has smoked one pack of cigarettes daily for 35 years. He has tried to quit smoking twice, but was also unsuccessful both times. At today's visit, when the physician asked the patient about smoking cessation, he says he's not ready to do so. The patient's wife states her husband smoking makes her cough and gives her chest tightness, which of the following is the most appropriate physician statement. Right? So this is clearly a question, an ethics question. Right? And this person, you know, you're trying to get this patient to change, but it seems like this patient is not very willing. Again, let's work this question out before we start looking at the answers, but for ethics questions, I always tell people to cross off every answer you can. That's usually a smart strategy with ethics questions. Right? So this guy doesn't want to change. We want to try to figure out a way to help him change. So let's see what's going on here. So option A says, are there any reasons why you might want to quit smoking? The thing is when a person has a bad behavior and they're trying to, and you know, they're, they're ambivalent or they're angry or they're not ready to change.

One thing that can be very helpful is a technique known as motivational interviewing. Motivational interviewing actually makes a lot of sense. You're not trying to beat your advice into the patient. You're actually trying to draw motivation out of the patient. In fact, a lot of the time when you're doing motivational interviewing, the patient is the one doing a lot of the talking. You're doing a lot of the listening. But if you're dowsing them with your advice, think about it. People don't like when people give them advice. Right? I mean, you should like when people give you advice, but people don't usually take very kindly to that. Right? So I'll just encourage you like motivational interviewing is probably appropriate for this question. And you want to pick an answer choice that involves drawing out the patient's motivation. Not you trying to beat them over the head with your also gracious advice. Right? So option A says, I think any reasons why you might want to quit smoking. Again, you're trying to draw it out from the patient like, hmm, is there a reason? Because if the patient can come up with their own reasons, right? It's almost like you're making them the decision makers. They are going to be more motivated to do the right thing. So let's keep that. That's probably a good answer. Option B says, are you aware that your long condition is chronic at this point? You really think it doesn't know how to see your PD? Come on, that's ridiculous.

Option C says, I'm sure you don't want your wife to suffer as a result of your smoking. Guilting your patients does not work. Option D says the majority of your health issues will improve if you quit smoking. Again, you think this guy doesn't know that if he stops smoking his life will get better. Right? He's been smoking for 35 years. Option E says, why haven't you been able to stay of cigarettes? Right? That's very judgmental. You don't want to pick that right? So option A makes a lot of clear sense as the right answer here. All right. Now question 74 says, seven days after admission to the psychiatric unit for treatment of eating disorders. A hospitalized 20 year old woman has a two day history of moderate mouth pain on the inside of both cheeks. She also reports feeling worthless and fat. Fluoxetine was studied on admission. She appears distressed. She is 5 foot 7 inches tall and weighs 170 pounds. BMI is 27. Vital signs are within normal limits. Physical examination shows bilateral swelling of the parodid and submandibular glands, discoloration of several teeth and scarring on the dorsum of the right hand. Mental status examination shows no suicidal ideation or intent results of lab studies are within the reference ranges. A medication with which of the following mechanisms of action is most like most appropriate to treat the patient's current symptoms. So let's work this out. Right? So it looks like this person has a bulimia nervosa. Right?

We see there are BMI's is pretty up there. Right? So this is probably not a person with anorexia. But it looks like this person does a lot of dorsum of wretching. Right? So you know, because of that, the person's parodid glands have enlarged. The person's like salivary glands have enlarged. So this person probably has something called I think sometimes it's called like salad and noces or salutes. But basically whenever like you're reaching vomiting a ton, that can over time cause your parodid glands, your salivary glands to enlarge. It's a non-neuplastic enlargement. Right? And the thing is these people, you know, it can disfigure their face actually, but it's usually not a permanent condition. You can actually fix it by giving them things that can make them make more saliva. Right? If they can make more saliva, you know, restore no more function to those glands, then that can cause those glands to shrink back to a normal size over time. Right? So you can give these people things like pilot carping, for example, it's actually pretty helpful. Right? And we know that pilot carping is a most chronic receptor. So option A makes the most sense for this one. I'm going to go with that. I remember another person that can have this same kind of problem. It's a person with show grids, right? With a person with show grids. So I'm just trying to show you another way to test this exact same concept. Option B says binding to nicotine casserole receptor is that's wrong. Right?

I remember nicotine casserole receptor is we find them on on post ganglionic neurons. We find them on post ganglionic neurons. Right? In the sympathetic and the parasympathetic nervous system. So that's wrong. Right? The only drugs I can really think of that bind to nicotine casserole receptors are those are neuromuscular blocking agents. And then option B says option C says inhibition of protein synthesis via binding to 50 s ribosomal subunits and preventing peptide bond formation. Right? So we're talking about a peptide transfer is inhibitor. That's going to be clear on any call that really has no relationship with this option. Option D says inhibition of protein synthesis via loss of DNA helical structure. These are probably going to be like two by summaries inhibitors. So you know something like a DNA generation, he better gyres inhibitor like a flu or a lot. If you notice the USM is not giving you like the straight up mechanism of action. They're giving you something that is somewhat related. Right? So that's wrong. Right? Option E says interference with bacterial wall synthesis. That's going to be a cell wall synthesis inhibitor like a penicillin. That doesn't really relate to this person doesn't have an infection going on. Okay, question 75. At 35 year old woman, gravity to power one at 15 weeks gestation is brought to the hospital in active labor. The physician care team confers and determines that the birth cannot be prevented and that the fetus will not survive.

After explaining this fact to the patient, the patient states says, I know it's a long shot, but I still want my BBS recency treated and everything done to save him. After empathizing with the patient, which of the following is the most appropriate initial response by the physician? Well, if you think about it, right? This one is going to liberate 15 weeks. This child is not going to survive. Right? That's just the truth. This child will not survive. I think generally, you know, if you're under like, you know, 22, 23 weeks, you're going to labor whatever BBS deliver, it's not going to survive. Right? So this BBS not going to survive. Let's not give this patient any kind of false hope. Right? So option E says, I'll ask for a second opinion. Right? So again, ethics question, cross of every answer. Option A says, hey, I'll ask for a second opinion. No, we know the outcome. This baby will not survive. Sounds Carlos, but this baby will not survive. Option B says, I'll call the father of the baby to get his opinion as well. Well, the thing is, it's not the father that's carrying the baby. It's the mom. Typically on the US Emily exams, the person that's carrying the babies, the person that's going to be the decision maker. Right? So option B is wrong. Option C says, I'll call for a medical ethics consultation. Again, this is like a rule of the US Emily's, that's not consult an ethics committee. That's not going to consult a committee. If they'll do it, that's that.

That's how getting very deep trouble on your exams. That is absolutely wrong. Option D says, I will do everything I can to save the baby. No, this baby is not going to be saved. This baby will die. So that is wrong. Option E says, I'm very sorry, but the people will not survive. Again, that's the right answer. You're not giving this patient any kind of false hope. All right. Now, a 48 year old man who is a contractor, so 76, a 48 year old man who is a contractor interpreter working for the military at a US outpost in Afghanistan comes to the medical clinic because of a 20 day history of non healing, painless ulcers on his neck and arms. The lesions enlarged over time and began to express clear fluid, eventually forming shallow ulcers. So look at the evolution, look at the progression of this thing. That's a testing principle. Look at how things evolve over time. Right. So notice this guy, he has had this non healing painless ulcers on his neck and arms. The lesions enlarged over time and began to express clear fluid, eventually forming shallow ulcers. When the symptoms began, it was slipping on the mattress on the floor in an old building without air conditioning with the ambient temperature range from 70 degrees Fahrenheit to 110 degrees Fahrenheit. He originally attributed the lesions to bog bites, vital signs are within normal limits. Physical examination shows 62 centimeter popular lesions scattered over the neck and upper extremities.

Each lesion has a 0.6 centimeter ulcer in the center. There is no post-requisite date, which of the following vectors is the most likely source of the lesions in this patient. So again, let's try to work this out. So we see this guy, probably slipping on a dirty mattress or whatever. Many times whenever they are talking about this disorder that I'm going to discuss, they usually present it as a military question. And by the way, I know some people think that they don't test the military anymore. They do. Right. Many times you'll be in a normal condition in a military person, but there are some conditions that are pretty unique to returning service members that you should try to figure out. For that, I do have two military podcasts. I cannot remember the exact podcast numbers, but I think his episode is 204 and 231 maybe. I have literally two podcasts just on the military. They actually very high your podcast to know for your exams. Right. Well, we see this person basically. He has these lesions that are, you know, like they're kind of like popular lesions and some of them have also rated. Right. And you see this in a person that has visited a foreign country, probably not, you know, being exposed to like non-sanitary conditions. This is a pretty classic presentation of cutaneous Lichmaniasis. Cutaneous Lichmaniasis. Right. I remember cutaneous Lichmaniasis again, the lesions will start off as papules and then over time they will also rate. Right.

So you see that evolution to also ration. Right. And sometimes you'll express like a discharge. That's going to be the clear, clear, clear presentation of cutaneous Lichmaniasis. Remember, we can treat it with liposomal and puterosine B, although that's more for the visceral kind. The cutaneous kind, one thing we can use is very difficult to treat. Many times is going to come right back. We're going to treat it with a drug known as sodium, stable gluconite, sodium, stable gluconite. So the USM is as you know, they love to test vectors. Right. So what's the vector that carries cutaneous Lichmaniasis? You know, Lichmania donovani. It's going to be the sand fly. It's going to be the sand fly. Soption C is going to be the right answer. Remember option A, flees. Flees don't usually carry Lichmaniasis. They don't. Right. Flees. Flees are not the things that carry Lichmaniasis mosquitoes. Right. Mosquitoes. Remember, carry things like, you know, dengue, Zika, malaria. So like the plus modium species. Right. So option B is wrong. So option D says spider. You know, remember the, the, the terrible spiders, right. The brown recluse spider that causes like these neck criticitions on the skin or the black widow spider that causes more like systemic symptoms, you know, paralysis abdominal pain.

So you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you kno

w, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know, you know the eat salty food or carburet food or they have vigorous exercise or sometimes you can see this in people that are very excited, right?

Or sometimes you can see triggered by just many things just in general, right? Like you see the person, it's like a high sodium diet, high carb diet, vigorous exercise, excitement, things like that. I noticed that they develop paralysis afterwards. I really, really want you to think of something called hypochilimic periodic paralysis. Basically, for whatever reason, whenever the engage in these activities, it drives, so the drives potassium into cells. So the serum potassium levels go down. So they have hypochilemia and then that can cause problems, right? You may wonder, man, why, why, why would this cost muscle weakness? Well, the thing is if you think, if you really think about it, many people don't think of it this way, but you need potassium for action potentials. And if you action potentials don't work well, then your muscles will not contract very well. Right? And these people seem symptoms tend to be periodic. They tend to be intermitted. They are not things that they have constantly all the time. Right? And this is actually an autosomodominant disorder. You know, many times it's going to be, the USML is they like to trick people. You may think that, ooh, it's only a potassium channel mutation that can cause this. No, you can actually find this happening with sodium channel mutations. You can find this happening with calcium channel mutations.

And sometimes on the exam, instead of calling it hypochilimic periodic paralysis, you can see that the diabetes, they'll just call it a channelopathy channelopathy. So just be careful because you've probably heard me see this in my podcast many times. The principle of derivatives with the USML is they take what you know and just put it in other terms, right? Just put in other terms, right? And don't forget your other channelopathy. You may see on your exams, right? Don't forget those cardiac long-cutie syndrome like Roman or word or drivel and long meal, seen as syndroms. Again, those are discussions for another day. Right? So again, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the, the the, the, the answer here has to be option D, right? Again, they have this transient decrease in serenpotassium and it causes problems. Right? So you can probably tell you how, you know, it's probably treat this condition. You can treat it like a potassium sparing diuretic. Something that will kind of raise the presence potassium levels, you know, something like Sparano lactone, for example. Right? And also these people should try to avoid the triggers. So low carb males, you know, low sodium males and maybe don't do vigorous exercise, you know? All right. The other answers make no sense. They're wrong, right?

They're wrong. A, B, you know, C, E, they're, they're wrong. All right. Now, question 78 says, you have noticed this with many step one questions where you either know what's going on, you know, by understanding, or you don't, right? Most times the other answers, it's when you get to step two, step three, that you're taking exams, and you're like, hmm, man, these three answers all sound correct to me. And you're like, ah, you, you got to be kidding me, right? But that's a different discussion for another day. Okay, question 78 says 3 D old female newborn is brought to the hospital because of a yellowish Milky fluid. Licking from both nipples shows the liver that term to a 20 year old woman. A pregnancy and delivery wrong complicated examination of the newborn is otherwise unremarkable, which of the following hormones is the most likely cause of this find it, right? So here's the thing, right? I tell people this. Most times when you see a finding in a newborn, and the newborn is like stable and doesn't have many problems going on, it's usually going to be a benign find it. Right? You'll try to make you think of something crazy, but no, this is fine, right? You're like, oh, how can this girl be producing milk? Or remember, what is like the hormone that causes you to make milk think of prolactin, right? So we know that the answer is probably going to be between C and F, right? And again, where is that prolactin going to be coming from?

It's probably going to be coming from mom, right? The again, this, this, this is a newborn, right? I don't know if they're going to be producing like such crazy amounts of hormones. Remember, again, it kind of takes a while for all these structures to fully develop in kids, right? So the answer probably has to be option C. Actually, like this is something you learn when you do a pediatric rotation. But there's this thing called like, which is milk? I don't know which is milk, but female newborns, they can express milk from the breast, just because of all the prolactin that, you know, because think about it, right? Like if you're a woman that's pregnant, you're what is kind of expecting that, UG, I gotta feed this baby when the baby comes out, right? So, you know, hey, memory glands, you should start developing, you know, breast, you should start preparing to produce milk, right? So mom makes like a ridiculous amount of prolactin, some of those ridiculous amounts of prolactin. You can literally cross the placenta. And if you're a girl, you have boobs, or a boy even, you can respond to this, right? Although, gallactorena in a, in a boy is going to be very, very unusually, you're going to be a female disorder on the exams. So the answer is going to be option C. It's going to be option C, right? Again, the other answer is don't really make much of any, much of any sense. All right. So I'm going to go to question number 79.

Question 79 says, 74 year old man comes to the office for a full of examination. One, so one month after he was discharged from the hospital, following a cardiac valve replacement operation. Physical examination shows a healing medium's anatomy wound. A prosthetic click is heard. P and lateral chest x-rays are shown. The hours indicate the replaced cardiac valve. Based on these findings, which of the following cardiac valves was most likely replaced in this patient. So I know some were like, uh-oh, imagine, oh no. Again, let's see if we can get the sensor right without imaging first. And then we'll kind of look at the image and maybe discuss a few things, right? But the thing is this is an old person that just had a valve replaced. What kind of valve you know problem is most commonly tested in older people. People in their 70s on the exams. It's going to be a eurics analysis, right? So chances are, is the euric valve that was probably replaced? That's a very reasonable guess to take on an exam. So I bet that the answer to this question is probably option A. But if you look at this image, option A is certainly pointing to the euric valve. And I know some of you may be like, uh, divine, like this doesn't really make any sense. Like it's kind of kind of weird. We remember the euric valve starts off from the left ventricle and then ticks off towards the right. So that direction of flow actually makes sense, right?

You may be like, wow, uh, divine, shouldn't it be more like, you know, red-oper-stronobotor? Um, not necessary, really, right? Not necessary, really. Yes, the thing is the memory of eurics, the no C.C.s heard best at the red-oper-stronobotor, because that's the direction of flow, right? But blood, if you can kind of imagine this in your head, I don't have like a whiteboard with me here, you know, this is an audio podcast. But if you kind of think about that, ooh, the left ventricle is mostly on the left side of the chest. And the euric kind of starts from that bottom. You have the euric valve first that lets blood out. And then the euric is a big tube that kind of takes off and goes right toward. And then makes this euritern and then comes down on the left side of the body, right? So eurics, the no C is the murmur. You're going to hear it well at the right-oper-stronobotor, because that's the direction of flow of blood. It's flowing from the left side towards the right to form that loop of the euric arch and stuff like that. Right? But the euritern is actually pretty low. The actual euritern is actually pretty low. Right? It literally comes right off of the left ventricle. Right? So this has to be the euric valve. And again, these extra images I'll see is probably useful for you to try to memorize. And no, you know, option B says, my trovaub. My trovaub is going to be at the apex. Right? That's going to be a lot more leftward.

It's not going to be so close to the person's turn. Right? The poemonic valve. The poemonic valve, remember, is typically going to be at the left-oper-stronobotor. Although, again, again, you got to be careful. That describes the direction of flow. Right? That describes the direction of flow. Right? The valve location may be a little different from the direction of flow. Right? To be honest, with you, probably one of the better ways to learn this thing is to look at an image, a radiology image, where all these different valves are pointed out. Right? Because again, remember, the right ventricle, the poemonic valve kind of takes off from the right ventricle. Right? And again, it's going to tick off from the right and be inching towards the left. So it kind of makes sense that you're going to hear most poemonic murmurs at the left-oper-stronobotor. But again, the poemonic valve, again, just please keep that in mind. I think I'll really encourage you to look up radiology images of this. It's just kind of hard to describe this stuff in an audio podcast. And then try Cospy Valve. That's wrong. Right? That's not the location. It's just this is something I think is best left to you looking this stuff up. Right? Best left to you looking the stuff up. All right. Let's go to question number 80. Last question here. So 37 year old man who is a carpenter is brought to the 80 45 minutes after the sodium onset of fever, shortness of breath and popitations. 40 is a goal.

He sustained a puncture wound to his left hand. He treated the wound with antibacterial cream on a bandage. His temperature is 102.2, pulse is 120 per minute. Resurations are 28 per minute and blood pressure is 160. Examination of the left hand shows the few swelling in arithema and a two centimeter necrotic puncture wound. His white count is 14,000 per millimeter cubed, ABG is on room air. Should PCU2 less than 32. This is a bad situation actually. Which of the phone is the most likely infectious agent in this patient? Right? So this person can look like they have a skin and soft tissue infection. That's kind of necrotic. Right? Remember, if you're thinking in terms of skin and soft tissue infections on the USML Es, there are two principal causes. Number one, and I'm not saying that one is more common than the other. Right? Depending on the context you get, you should guide the wound direction versus the other. So most times they're usually gracious and they don't put both as answers, but group A strep, so strep biogenes and staphoreus. Those are big, big, big causes of skin and soft tissue infections. Although remember, if we're dealing with impetigo, where you have those honey colored, and that's not what's going on here, we're dealing with those honey colored cross state, you know, whatever. Those impetigo is as your most with staphoreus. And then it's simple as we have like those red, raised, very tender lesions usually on like the face one extremity.

That's going to be more group A strep. But again, these are skin and soft tissue infections. So I'm going to go with option E for this one. Right? Remember, Clostridium tetanase is going to cause tetanase, right? They're going to have a more like a spastic paralysis. That's not what's going on here. So that's wrong. Microbacterium abscesses. It's a Microbacterium species. Again, whenever something is so far fetched, you've never heard of it before. It's probably not going to be the right answer on you. Exam. So we're going to skip that option C says Pastrella Motocida. Right? This can cause skin and soft tissue infections or like osteomyelitis or whatever, but that's after animal bites, like a cat bite or a dog bite or something like that. That's wrong. And then Sudomona C originals are. Remember, Sudomona is the big thing. Sudomona is wet environment. Right? So let's say you had the same nail problem, but it's like a nail puncturing through like a shoe. Then yeah, that makes sense as Sudomona, but that's not what's going on here. And many times when you have a Sudomona in infection, you're going to see like this blue-green discoloration or what not because of those pigments that are made by Sudomona pigments like a pioscianin or pyroverted. Right? So that's not what's going on here. So option D is wrong. So I'm going to go with option E here.

This person is probably going to need something that covers MRSA like you know, IVV and Gomaisane or Daptomycin or something or you know, Tremethopromesophamethoxysol, something like like that. All right. So I'm going to go ahead and stop here. Again, if you like the way I teach, I think you'd really benefit from a lot of my classes. I have a step one class that's taking place in the first week of May. And then this month, and this class in the first week of May is a 25-hour step one class. For this month, starting not this next week, but the week after, I have a bunch of classes coming up. You know, I have a test-taking strategies class, I have a bio-stats class, I have a social science and ethics class. These three classes are first step one, two, step three. I've made a separate podcast where I talk about these classes, but again, many people have taken these classes and they found it to be very helpful. I've had many people take my step one class, they've passed the exams. I've had many people take these classes and they've done really well on step two, step three. And for step two, step three specifically, I have a 20-hour step two, step three class coming up, you know, the week after, like the very last week of this month of April. I've had many people take this class, get 250, 260, 270, 70s, very, very high scores. I had a person recently that got like a 269.

And this person had like a significant improvement from their from their lower practice test scores after taking the class. And then I have a last minute review, so first step two, step three. And then in the month of June, first two weeks, I have a 50-hour step two, step three review. That class is going to be epic. And I'm the one that's going to teach the whole thing. All these classes over Zoom, so just check those out. I made a podcast where I talked about talk about these classes. And then I offer one I want you to learn for all the US million complex exams and I help with your application's personal statements and mock interviews. And then I also have these podcasts on Apple Google on Spotify. And again, I have a You Tube channel, Divine Intervention, USMD podcasts and videos where I post the videos that I make. And then finally, you know, I have another website called Divine Intervention Lifelessence.com. Divine Intervention Lifelessence.com. Pretty much every week, I post like a, you know, one, two, sometimes three podcasts where from a biblical perspective address a life lesson. There's actually an Apple podcast associated with that called the Divine Intervention Life Lessons Podcast. So thank you for listening to me today. Again, I hope you find this podcast to be helpful. Just a kind of a little high old stuff in this podcast. But I'll see you in episode 5, 91 I think. So God bless you. Have a wonderful day and bye for now. Thank you.

Motivational Interviewing (MI). The goal is to draw out the patient's own motivation rather than lecturing them.

A TIPS procedure (Transjugular Intrahepatic Portal Systemic Shunt), connecting the portal vein to a distal systemic vein like the IVC.

Prolactin, which can be secreted by the mother and cross the placenta into the newborn's circulation.

The sand fly (Phlebotomus or Lutzomyia).

High carbohydrate intake and vigorous exercise. These activities drive potassium into cells, causing transient hypokalemia.

A muscarinic receptor agonist like Pilocarpine, which stimulates saliva production to prevent salivary gland enlargement (sialadenosis).

The simple difference in risk between two interventions (Risk of Control - Risk of Intervention), used for comparing effectiveness.

A distal systemic vein (e.g., IVC) to bypass the liver and reduce pressure.

To gently but firmly communicate the prognosis, avoiding false hope or making promises of intervention that cannot be fulfilled.

Sodium stibogluconate (or similar antimonial agents).

Sialadenosis, caused by chronic stimulation/irritation from repeated vomiting. Treatment involves muscarinic agonists like Pilocarpine.

Staphylococcus aureus (including MRSA) and Streptococcus pyogenes.

The simple difference in risk between two interventions (Risk of Control - Risk of Intervention), used for comparing effectiveness.

A distal systemic vein (e.g., IVC) to bypass the liver and reduce pressure.

To gently but firmly communicate the prognosis, avoiding false hope or making promises of intervention that cannot be fulfilled.

Sodium stibogluconate (or similar antimonial agents).

Sialadenosis, caused by chronic stimulation/irritation from repeated vomiting. Treatment involves muscarinic agonists like Pilocarpine.

Staphylococcus aureus (including MRSA) and Streptococcus pyogenes.