DIP Episode 204 - The USMLE And The Military (Ultra HY for all the USMLE exams!)

Okay, welcome. My name is Divine. I am a resident. This is episode 204 of the Divine Intervention Podcasts. And in today's podcast I am going to be focusing on the USMLE and the military. I know some of you listening to this may be a lot of you are like, hmm, Divine, USMLE and the military. What exactly do you mean by that? Well, let me explain. The thing is, one thing I guess I'll go ahead and say is, when you're studying for an example, it usually helps to look up like the learning objectives or the content outline for that example you're studying for is usually a smart thing to do just in general, right? I notice it's it's extremely rare to hear people say, oh, you know, I went through the USMLE content outline and almost like mentally checked off that I knew most of the information on it. Yes, you know, they test certain bits of information modern others, but I always find it really helpful to look at the outline because the thing is when you look at the outline, I mean obviously again it's not everything they test out being set outlines, but the thing is those outlines can give you a very nice clear indication of things you may want to pay attention to so that you don't get any unusual surprises as you're studying for the example. Like literally this first part of my presentation, it literally comes straight out of the content outline, right? You can see it says, oh, this outline provides a common organization of content across all USMLE examinations.

Each step example emphasizes certain parts of the outline and no single examination will include questions on all topics in the outline. The examples listed within the outline are just that examples. Questions may include diseases, symptoms, etc. that are not included in the outline. The USMLE program blah blah blah blah blah blah blah blah blah blah blah. Okay, let's go to the relevant part. So as practice guidelines evolve or introduced the content on USMLE is reviewed and modified as needed. At times there is a change in emphasis on new contents development that arises from our ongoing peer review process. For example, there has been an emphasis on new content developed, assessing competencies related to geriatric medicine that's going to be a future podcast and prescription drug use and abuse. I have a lot of stuff on those but that's probably also going to be a future podcast. Now here's the key part. USMLE has also focused recent efforts on the often unrecognized healthcare needs of recently returning service men and service women. For example, traumatic brain injury and post traumatic stress disorder and the families of deployed service men and service women. While many of the medical issues related to the healthcare of these special populations are not unique, certain medical illnesses or conditions are either more prevalent, have a different presentation or are managed differently.

Knowledge of foundational science and clinical science in these content areas will be assessed on the USMLE step one, two CK and step three examinations. Right? So that is literally the purpose behind the podcast. I'm essentially going to deal with the part of this and again this is not like some secret document I have when you think no. If you literally do a Google search for USMLE content outline, you'll see this I think on page two of their content outline believe it or not. Right? So the thing is today I'm going to focus on military medicine as relevant to the USMLE exams. Again, if the NBA me put this in their content outline, it means it is going to show up on your exam. Right? So this is a podcast you absolutely want to pay attention to. I hope to make it really short, but this is a very high-end podcast that I will say at least contains a decent amount of new knowledge that you'd find to be helpful on these exams, especially like step two, CK and step three. So and I guess the first thing I want to start with is if you're in the military or if you're in any of the forces, you're like in the police, you're a firefighter, anything like that. Really, thank you for your service. Regardless of whatever is out there, I know we as a country, a prosciutto service, you're a blessing to this country. And personally myself, I thank you every person in the military, in the Navy, in the Air Force, in the Army. Thank you for your service.

I mean, I have been blessed by people in the military before. Right? So again, I just really thank you for everything you do. What you do is it's not it's not easy by any stretch and it's not it will not go on rewarded. So really thank you and God bless you for everything that you do. So let's jump right into it. Right? So the first topic I'm going to go ahead and talk about here is traumatic brain injury. So you may ask yourself, okay, divine. Well, what is traumatic brain injury? And I'm going to call it TBI going forward. Right? So what is TBI? Basically, TBI is anything that happens when you have like an external force that kind of like impacts the brain. Right? So you know, when you have those external forces, you have like these acceleration and acceleration injuries that ultimately develop. Right? So the thing is you want to differentiate a TBI from like any other kind of brain injury because there is traumatic brain injury, which is what we're focusing on today. And then there is also such a thing as a non-traumatic brain injury. Right? So like an anti-BI and anti-BI if you may. Right? So the thing is a non-traumatic brain injury is something where it's more internal that gives rise to the brain problem. Right? So for example, if a person has many anxieties, right? If a person has a stroke, right? That is not an external force. It's not like something external is impacting the brain and anything like that. No, right? It's an internal problem. Right?

And the thing is traumatic brain injury is very common in the military, but it's also common in sports. Right? Like so for example, if you look at like this thing that they call a chronic traumatic encephalopathy amongst like football players, people that engage in wrestling, WWE and things like that, right? Those are all examples of traumatic brain injury, right? Those are all examples of traumatic brain injury. Now what are the relevant things you want to keep at the back of your mind with respect to the USML exams? The first thing is are there some preventive measures that could be used for traumatic brain injury? Well, the thing is my discussion will be kind of scattered, right? Because this, the information for this podcast, I kind of had to call it from many different resources, right? So, you know, I kind of talk of my information scattered. So pardon me, but again, this podcast should contain the vast majority of the high-yield stuff you need to know, right? So what are some things you can do as prevention? Well, some things you can do is you can consider using like seed belts, right? Seed belts really decrease the person's risk of being a victim of traumatic brain injury and also wearing helmets, right? I mean, if you notice, the NFL in the US, right? A ton of people use helmets, right? Those things are all preventive to decrease the person's risk of traumatic brain injury, right? And I will talk about some preventive measures specific to the military as I go along.

And obviously traumatic brain injury is a lot more common in males than females, right? So that's a high-yield thing to know. They can easily make that an epidemiologic question on the exam, right? Now the thing is it is very important to know how to classify TBI. On an MBA exam, right? You want to be able to grade them by severity, right? And this is where the Glasgow coma scale comes into play, right? The Glasgow coma scale, I believe I talked about it in my surgery video or something like that. If I didn't talk about it in that video strongly encourage you to look it up. This is something you actually have to commit to memory because TBI's are graded commonly according to the Glasgow coma scale, right? So if for example your GCS score is 13 or higher, right? That's a mild TBI. Another name for a mild TBI is a concussion, okay? Now if your GCS is from 9 to 12, then you're said to have a moderate traumatic brain injury. And then I want to make sure this mic is on and everything, okay, perfect. So, but if you have a GCS that is 8 or lower, right? That's severe TBI. And obviously the lower your GCS though very likely the worst your outcomes, right? And the pathologic homework of TBI is just diffuse axonal injury, right?

Like if you look at it under like, you know, like histology or you take like postmodern examples, you see diffuse axonal injury even on imaging, especially if you use setting like MRI sequences, you're going to worry about that, like diffusion tensor imaging and all that stuff. You can actually see like that diffuse axonal injury. It's a pathonomonic pathologic feature of TBI. Now, the thing is if they ask you on a test, right? The thing because the MDM here, right, when they are talking about neurological disorders and psychiatric disorders, they care quite a bit about neuro anatomical relationships, right? So, for example, if you remember from my psych video where I talk about how schizophrenia is associated with like a big size of a lot of entrails or Alzheimer's disease is associated with the dysfunction of the bison nucleus of minor or decreased activity of cooling and cello transferries, well, TBI has some neuro anatomical relationships that you'd want to keep at the back of your mind, for example, right? So, for example, the person has TBI, right? Like the parts of the brain that are most susceptible to damage, right? are the anterior temporal loops and then there is a part of the cortex called the orbital frontal cortex. I'll see that again. The anterior temporal loops and the orbital frontal cortex at the most likely regions of the brain to... I guess let me put it this way. They are most susceptible to damage in the setting of a traumatic brain injury.

Now, the thing is when a person has a TBI, especially when it's a particularly bad one, right? They can have signs and symptoms of increasing trocranial pressure, right? And one thing your friends at the MDM can do to clue you into the person likely having increased ICP is they will give you like the cushions reflex. Obviously, they won't say, oh, this patient presents with bradycardia, hypertension and respiratory depression. No, they're not going to do that, right? No smart person will do that. They will give you actual vital signs, right? You know, they will give you like a respiratory rate of like six per minute and they will give you like a blood pressure of like one 80 over 120 and then they will tell you that all this person has like a heart rate of like in the low 40s or something like that. They can even show you an ekechi where the person is in sinus, but the person is in sinus bradycardia, right? So those are all things your friends at the MDM could do to you, right? So be watchful or be vigilant of those signs of increasing trocranial pressures on MDM exams. Now, the thing is usually right when a person has a TBI, right? It's usually in an emergency setting. Usually your first diagnostic test is to go ahead and perform a CT of the head. Although the CT of the head does not give you as much information as an MRI, right? So if you don't see CT as an answer choice, go ahead and go with MRI. Just choose MRI. Don't worry about the sequence. That's more ideology speak.

That's not something you should be concerned about taking the example. Now, this is the one other high yield thing to know, right? So the thing is, in a CITO system has actually been shown to be very helpful in preventing like sick well eye for traumatic brain injury, right? It has been shown to be a preventive measure, especially in the military, right? So if you get an exam question about a person that's a victim of TBI, right? And then they say, oh, which of the following is the next best step in management as a preventive measure, right? You want to go ahead and administer an acetyl-system? I'd imagine that it probably has something to do with like preventing free radical damage in the brain or something like that. I didn't really dig much into the mechanisms on that. And again, like I said, I may have more military medicine podcasts in the future. I will certainly have a geriatric podcast in the very near future. Because again, as you can see from the outline, those things are very important and high yield to know, right? So in a CITO system is a very nice preventive measure. And then the thing is within the first three hours of the person suffering that traumatic brain injury, you also want to give something known as traumatic sami-cacet, right? Like many times in the hospital, that's what's known as TXA. Surgeons referred to it as TXA, TXA, TXA, TXA. TXA should be given within the first three hours of a traumatic brain injury to decrease the risk of death.

And the thing is, if a person has elevated intracranial pressures, I mean, they have some high yield things you want to do, right? So you know, you'd want to adjust the head of the bed, right? So that they can have more blood profusion to the brain and they have less of a risk of renetion, right? Another thing you would want to do is you could also consider hyperventilation, right? In fact, the quickest means, this is very high yield to know. The quickest means of a cutely lowering intracranial pressures is hyperventilation. But it's absolutely important to realize that hyperventilation is a short term measure. It's not something you want to do long term, right? Because remember, hyperventilation causes, you know, it decreases the carbon dioxide tension in your blood, right? And in your CSF, right? So that causes like a cerebral viso-construction, right? So that can ultimately cause brain ischemia. So the thing is, if a person is like, you know, cramping in front of you, they're about to die kind of deal. You hook them up to a ventilator. Obviously, if a person is a victim of TBI, especially if it's like a really bad TBI, right? They need to be put on a, they need to get like an endotracheal intubation and mechanical ventilation. But as you do that, you crank up the respiratory rate so you can blow seal to so that you can decrease the intracranial pressures. But again, that's not something you want to do for days and days on end.

No, that will not be prudent because that cerebral viso-construction can cause cerebral ischemia and then the person dies or gets even more devastating neurologic injury, right? So you absolutely do not just want to do hyperventilation forever, right? But you know, you want to bring for the first few hours to acutely lower that person's intracranial pressure. Now remember, there are other things you can use, right? So you can use like manitol, remember manitol, you want to be careful in people that have a history of like CHF, right? You can also use hypertonic saline, but again, remember hypertonic saline be very careful of a dangerous hyperneutrini that can develop, right? But those are all things you could potentially do to decrease a person's intracranial pressures. Now, one common trick answer that you may see on the MBM in regards to all, we should do this for traumatic brain injury, is to give IV quadracheal steroids. Listen to me here, do not give because many people think of it, oh, if a person has elevated IC Ps, I can give steroids to decrease the swelling. The thing is when people have a traumatic brain injury, the mechanism of injury is different, right? So when a person has a TBI, you absolutely on your MBM exams should not give quadracheal steroids, right? Quadracheal steroids have actually been shown to increase the risk of death in the setting of a traumatic brain injury. That's something very high yield. You want to make sure you know for exams, right?

And then the thing is in general, when people suffer a TBI, you want to keep them at normal body temperature, right? Don't make them hyperthermic if they're hyperthermic, right? Then their their brain's metabolic activity will increase, right? And again, you're already dealing with a brain that cannot deal with much. I almost think of it this way, right? So say for example, like, you know, if you have savings in the bank, right? You know, if the economic collapses, you're probably going to be fine. You're not going to have too many issues, right? But let's assume you're living like paycheck to paycheck, right? If the economic collapses and you lose your job, you're screwed, right? So the thing is when a person has a traumatic brain injury, the brain has very minimal reserve, right? So usually the smart thing to do is to not make them hyperthermic, although from the literature research I did, there's not appeared to be any benefits to making those people hypothermic, right? But certainly, and again, I'm just talking about TBI, right? I mean, like they are certain cardiovascular maladies that respond really well to like a hypothermic protocol, but in general, you just want to keep people that are victims of TBI normal themic, normal thermic, right? So that again, you don't increase the metabolic needs of your brain because again, their brains do not have much in the way of reserve. And then if a person, for example, from a TBI, they have like a hematoma in the brain, right?

The your next step in management is, you know, call your surgery, do a decompressive, a craniotic, right? That's a high-yield thing you want to do on an exam, right? And then the thing is when a person is getting out of, you know, after the acute phase of hospitalization, they need some kind of rehab, right? So usually you send them to like some kind of rehabilitation facility. Again, you may say, hmm, why you going over this stuff? The thing is the MBM, they may just give you a question about a person that, you know, they'll give you, I mean, you hear people say, oh, this question is where they're like, oh, you know, I was really in the question, I was like, oh, I know exactly what they're talking about. And then you see the question, they ask you at the end, you see the answer, you're just saying, you're like, stretching, you're like, what? Right? So that is one thing that can happen on these exams, right? So after a person gets a acute hospitalization, they need to be sent to a rehabilitation facility, right? And then, and usually it's some kind of like subacute rehabilitation facility that he gets sent to, right? And then, if you remember my MBME weird podcast where I talk about like prognostic factors, most common causes of death and all that stuff. And by the way, if you're taking any of these USMLA exams, you really should listen to episodes 37, episodes 97, and episodes 184.

And then there's a social sciences podcast that I have that's very high yield to know for purposes of exams. So the thing is, the biggest prognostic factor after a person gets a traumatic brain injury is really the severity of initial injury, right? So obviously a person will have a much worse prognosis if they have a severe TBI compared to a person that has a mild TBI. And they can even give you like elect like a nephrodite diabetes insipidus question, it'll be more so like a central diabetes insipidus question when a person has a TBI, right? So, you know, if they give you a question about a person that is hyperneetremic after a traumatic brain injury and then they have like urine that has very low specific gravity or urine that has, you know, that is not very concentrated, that has a very low smallality, then you absolutely want to think about a central diabetes insipidus developing under those circumstances. And then one other thing you may get tested with on an exam is they may ask you like, oh, what is the most common cognitive impairment that arises after a person develops a traumatic brain injury, it's almost always memory loss, okay? Memory loss, very high yield is the most common cognitive impairment that develops after a person suffers a traumatic brain injury. Now, what if they give you an NV Me question and they tell you that, oh, this person had like a mild TBI, maybe the GCS was like 14 or something like that.

And then they tell you that, you know, like this person after like four days after they're getting like, or days or even weeks after, or even months after, believe it or not, they're having like chronic headaches, they feel dizzy all the time, they have like this increased sensitivity to like light and loud noises. What should your diagnosis be under those circumstances? I'll really hope you're thinking about something called post-concussive syndrome, okay? Post-concussive syndrome, right? Again, if you see a person having like a lot of like neuropsych problems like headaches, that's probably the most common one you see on exams. So headaches, dizziness, problems with sleep, increased sensitivity to lights and sounds, anxiety, depression, agitation, irritability. Again, after a mild traumatic brain injury, think about something called a post-concussive syndrome. And then one closely related disorder that your friends at the NV Me could test you on is, they could ask you about a person, they could say, oh, this person suffered like a mild TBI, like, you know, like maybe like two weeks ago or something, right? And you know, they are still in the recovery freeze from that TBI, and then they suffer like another TBI. And then they tell you that, oh, this person just crashes, deteriorates and subsequently passes a wheel becomes like persistently vegetative or anything like that. If you see that, you want to think about something called the second impact syndrome.

I'll say that again, the second impact syndrome, okay? Basically, if you're recovering from a traumatic brain injury and then you get a superimposed one, those people can actually have pretty bad outcomes on that those are circumstances. So personally, I think those are all the big things, high old things I want to talk about in regards to TBI. So I'm going to go ahead and move to the next topic, right? So the next topic is PTSD, right? So again, I know you may say, oh, divine, I've heard about PTSD from your site video. Yes, you've heard about PTSD from my site video. But the thing is again, specifically to the military, there's a few more high old things that you want to keep at the back of your mind for purposes of the end gaming exams, right? So the first one is PTSD is very common in like deployed veterans, right? Especially like veterans that again return from military duty. In fact, like if you read the literature about like one in four veterans, end up having an end up having PTSD. And the thing is the problem with PTSD is not just the PTSD that's the problem. Besides the PTSD, they also tend to have like all that comorbidities, right? Like they can have like alcohol abuse, right? That's actually one of the most common comorbidities that's associated with PTSD in returning a service men and service women, right? So that's something I want to keep at the back of your mind on exams. And I'll say more about that as we go along, right? So how do you treat this PTSD?

The thing is PTSD treatment is divided into two major parts for service men and women, right? On NV Me exams. The first one is pharmacological therapy, right? So the thing is pharmacological therapy will be SSR Is, right? And for the most part, the ones that probably have the most like most data behind them are drugs like sexually, right? And fluoxetine and peroxetine. Also the SNRI, then the vaccine has also been shown to help in PTSD, especially again in the in a military service men and women, right? And then remember though, like how does PTSD usually present, right? So usually people that have PTSD they'll have like distressing thoughts like related to like to like a bad event that the experience, you know, like maybe being stuck in a battlefield or a bunch of their people in their cohort died in battle or something like that, right? And then they will have like distress whenever they see like any cues, right? So let's say a person sees an accident, right? They see that accident and it triggers memory of like the a homvi blowing up or something like that, right? That can trigger like distress, right? And then usually those people also tend to have like autonomic hyperactivity, whenever they have these symptoms so their heart rate may go up, their respiratory may go up, right? Their blood pressure may go up, right? Those are all things that are classic for PTSD, right? And then these people also tend to like try to avoid those triggers as much as is possible.

And they have I mean you can blame them, right? They avoid these triggers because it spurs many of these distressing thoughts, distressing emotions, distressing autonomic reactions to whatever is going on, right? And one thing I will go ahead and say is again this can be a very unique NBN question. The thing is people that have PTSD is more common when you have the trauma arise as a result of an interpersonal circumstance as against like let's say like a natural disaster or anything like that. In fact, like I'll give you an example, right? Like one of the most common psychiatric comorbidities that arises after rape is PTSD. In fact, rape is one of them, like being a victim of rape is one of the most common causes of PTSD in the US, right? So interpersonal like trauma, right? is a bigger risk factor for PTSD in comparison with like natural disaster trauma. Again, I'm not belittling those, but I'm just telling you what is more common and again, it's very high yield to know that for the purposes of exams. Now, the thing is for you to see a person has PTSD, you need to have these symptoms I've just described for more than a month, okay? If they have these symptoms for less than a month, it is called acute stress disorder, okay? It is called acute stress disorder. Why is that important? The reason that's important is because you do not, I'll say this again, this is very high yield to know. You absolutely do not give SSR Is for acute stress disorder.

Acute stress disorder for the most part, you know, you can do psychotherapy or whatever, right? But like the full one from a callogic PTSD treatment does not apply to acute stress disorder. Again, this is something that is very high yield to know for the purposes of the USMLA exams. And then another thing you may see with PTSD is like nightmares, right? You can give prososin to actually help with treating the nightmares that are associated with PTSD. Now, what is one big area that your friends at the NVME really care about with regards to PTSD, again, especially in the military? One big area that they really care about is the CBT that is used for PTSD, right? The thing is there are many CBT techniques, but the thing is the NVME kind of expects you to know what some of these CBT methods entail. And the classic ones you want to keep at the back of your mind, at least these buzzwords you want to recognize on your exams. One of our cognizance like exposure therapy, sometimes they call it prolonged exposure therapy, especially when you're referring to PTSD. Essentially, you expose those people to the thing that triggered their PTSD in the first place, but you expose it to them in a non-harming environment, to expose it without the goal of harm, right? You're just trying to make them a little more comfortable with the events that surround that whatever triggered their PTSD in the first place, right?

And the thing is exposure therapy will also be the right answer, like the right CBT answer for psychotherapy. In an NVME exam question that talks about OCD, right? So like obsessive, compulsive disorder, generalized anxiety disorder, and also phobias, right? Phobias are probably one of the more common ones as well, on NVME exams for that, right? And then another thing that is usually done is something called cognitive processing therapy, right? Basically, those patients face and discuss the events in detail, right? And then you then work a little by little with a therapist, right? To begin to address like maladaptive thoughts and maladaptive responses, that you, it's mostly a thought-based therapy, right? Like maladaptive thoughts, relating to the event you try to work on those from that perspective. And then there's another one that's, I feel like this is unlikely to show on the NVME exam, but just for the sake of completeness, I'll talk about it. It's something called, it's like eye movement therapy. You can look it up online, but I don't see that as something that the NVME may put too much stock in, right? But definitely exposure therapy, cognitive processing therapy, those are things you definitely want to know for purposes of your exams. Now, the thing is, again, like I said, alcohol abuse is a very common commodity in people that have a PTSD, right? And again, people that have PTSD should not get benzos, right? Do not give them benzos.

Benzo, the SAP, I've actually been shown to work in outcomes in veterans that have a PTSD, right? Now, again, going back to this whole neuronatomic whole business that the NVME wants you to know, right? I'll go ahead and mention a few things here. The thing is, people that have PTSD tend to have a small volume of the hippocampus, that's a high-yield thing to know, right? And people that also have PTSD, they tend to have an exaggerated response to something called like the Dixamethosone suppression test, right? So, I'll just make up numbers here. So let's say you give a person Dixamethosone, I mean, obviously, that will suppress a person's CRH and ECT, right? So let's say, oh, the suppressed cortisol level, you get after the test is like 10, right? People that have PTSD may have like cortisol level of one, right? So they have like higher than normal response, right? An exaggerated response to the Dixamethosone suppression test, right? And usually these people, already, if you check here, you're in, they actually tend to have pretty low levels of, in fact, to be honest with you, I think of PTSD as a maladaptive, hyperadrenergic response, right? Because usually, right, we're pressing on the boost is stress, right? Let's say, I don't know, you're preparing for the USML exams, for example, or you're being chased by a lion or something like that, right?

Your categorical amines will arise, but at the same time, your cortisol will arise because cortisol, you know, it's a diabetes or genic hormone, it'll raise your blood glucose levels, it'll have this permissive effect on the sympathetic nervous system to make you better able to adjust to that stress, right? So again, usually whenever you're stressed or you go through a traumatic, like, you know, like a heart-shaking event, right? You have increased levels of categorical amines and increased levels of cortisol, or you can say glucocorticoids in your urine. That is not the case with PTSD. People that have PTSD, the, and if you check your urine, they tend to have elevated levels of categorical amines, and then they tend to have abnormally low levels of cortisol, right? So you're like, hey, is it because they have low levels of cortisol? Is that why they are not able to adjust to those problems that they get from, again, the hyperadrenergic response when they have these PTSD episodes, right? So who knows? That's food for thought, right? That's something. But definitely know the part about the abnormally low levels of cortisol and high levels of categorical amines in the urine in people that have PTSD. Again, that is absolutely something that your friends at the NBA may contest on an exam. And again, for the most part of the way PTSD happens, at least if you think in more pathophysiology, you get a traumatic event, right? You get a hyperadrenergic response that's maladaptive.

And then when you get future episodes of that same event, you still have, keep having those maladaptive responses. It's almost like the person's brain is rewired to respond to those kinds of situations in an abnormal way. And again, it's no fault of theirs. Again, these are people that have been through major trauma in life. And again, PTSD, you don't have to go through major trauma in life to have PTSD. My not trauma can actually be the cause of, can actually be the cause of PTSD. And I mean, like if you have like early access to like these psychotherapies like CBT, I can help. And maybe like decrease the person's ultimate severity of your PTSD. And then one thing that you do not want to pick on an NBA exam as treatment for PTSD is a debriefing, right? The briefing has actually not been shown to be helpful. In fact, in some studies, it has actually been shown to be pretty harmful. Right? So debriefing is not going to be the right answer on an NBA exam with regards to the treatment of PTSD. So I guess, yeah, I think that's pretty much all I want to say about PTSD. There are many topics I have here that are pretty short. And in fact, I'm almost done with this podcast, right? One other thing you want to be aware of, maybe just at least know a few things about is something called military sexual trauma, right? So military sexual trauma is basically any kind of sexual harassment or sexual assault that occurs to a person that's in the military, right?

And the reason you want to know about that is it is one of the biggest risk factors for PTSD on an NBA exam, right? It's one of the biggest risk factors for PTSD. Again, especially amongst military service men and women, right? And the thing is, military sexual trauma, you can probably predict this already, is a lot more common in women than men. Okay, it's a lot more common in women than men. And that's pretty much all I think I'm going to say about military sexual trauma. And then you want to know about some common problems that can happen in like with families of like deployed service men and service women. So what are those things you want to know, right? The thing is being a family member of like at least a common, let me put it this way, right? Being a family member of a deployed service man or woman, it's associated with having like poor mental health in the family, it's associated with like behavioral like problems in the children, right? It's as you know, like higher rates of divorce, higher rates of suicide, right? So again, these are all things you just want to keep in mind for the US similarities, right? And there are some critical factors that can actually increase your chances of a better outcome or I guess like a better familiar response to being deployed, right? And the two critical ones you want to keep at the back of your mind, for example, are things like preparation prayer to deployment.

So you know, things like getting life insurance before you're deployed or you know, just sort of setting measures in place like an emergency fund and things like that that has been associated with better outcomes, right? And a better response to being deployed on the part of the, you know, like making a military family like more resilient, although to be honest with you just so this is just personal observation. I feel like just in general, military families are more resilient than the average family. I'll just go ahead and throw that throw that out there, right? And then the second critical factor is increased levels of communication while the service member is deployed, right? So, you know, if you have like more communication on your family, right? Well, I mean, just think of it, right? In any relationship, not even in like a relationship between like a military spouse, like between like military spouses or whatever, just in her relationship in life, communication is the better of any successful relationship, right? And then about a third of the kids of deployed veterans, again, they tend to have their like they have like, you know, like a higher incidence of like depression, of anxiety, of behavioral problems, right? So again, those are all things to keep in mind. And then to round up, I guess, let me just say a few like more like weird things that, you know, they don't really fit into any of these topics, but they're kind of important to know.

Remember, homelessness is also a big problem amongst the veterans, right? It's like if you compare like a deployed like a veteran, right? To like the like a non like a deployed veteran to like a non deployed veteran, right? Amongst men, the amongst men and women uniformly, there is a much higher risk of homelessness, especially like in the female population, believe it or not, right? And the thing is the most common, this is very high yield, the most common comorbidity in a person that is a homeless veteran, it's actually like a substance used to sort of, right? Substance used to the sort of the vast majority of these people, the substance in question is tends to be alcohol, right? It tends to be alcohol, right? And you know, these people also have a pretty high incidence of PTSD. I think there was like a like a thin array, like an article I read that said, I think it's high as like 45% of like homeless veterans have PTSD, right? So wherever you can, if you can contribute and you know, just help out of volunteering programs that are targeted towards helping our veterans, because I mean, these people are going out of their way, right? Selfless service, they're going out, usually they're traveling to like distant places to help this country, right? You know, just do your best for them, right? Because they're going out to protect you, right? We should also try to protect them ourselves in whatever little way that we can.

And then it's actually kind of high you to know that problems like these like psychiatric problems that arise in military service members, right? It actually tends to peak many decades after they've been exposed to the trauma in question, right? And again, there's a very high incidence of like suicide and suicidal ideation amongst military members that have PTSD, right? And it's even the risk is even higher when they have like other comorbidities in addition to their PTSD. And as I do at the end of every podcast, I don't for one or one children for many exams, right? So step one, step two CK, step two CS, step three, pre clinical medical school exams, 30-ish-elf exams. If you're a medicine resident, right? So I tutor for the ABI-I-M board exam, the internal medicine training exam. And then if you're a college student, and you need children for like general chemistry, organic chemistry, physics, biochemistry, histology, physiology, alpha-tutoring for all those things. Even if you're in any of those things, please feel free to reach out to me. I also do these booster courses for the USML Es. It's like 20 hours for step one, and it's actually now 15 hours for step two CK and step three. I'm beginning to incorporate some new content into these sessions, right? So it's now 15 hours for step two CK and step three, and it's 20 hours for step one, right? If you're interested in any of those things reach out to me.

And then I also offer like these large group USMLE comprehensive courses, it's probably around about 100 hours. The thing is for that to happen, you need a group of five to seven people and a location, right? And then I also offer like coaching, right? So if you're like a medicine or a plan to residency, so like an ERAS application or a college student applying to medical school, so like an AMCA application, I do offer like one-on-one consulting with regards to personal statement editing, application editing, rec letters, mock interview, things like that. Again, the vast majority of people have worked with have all much of their first choice. And again, I have like one year's worth of like very intense experience with an admissions committee of a top two med school, right? So again, if you're interested in any of these things, either reach out to me through the website or send me an email at divine intervention podcasts with an sadm.gmail.com. And then please subscribe to the You Tube channel. Again, just it's called like divine intervention podcasts and videos. Subscribe to the Apple podcast. I also have this on Spotify podcasts on Google Play, right? And also just the Word Press website, please subscribe. And any valuable feedback that you can leave is always appreciated. And again, like I say, if you have any particular podcasts you want me to make, just reach out to me, right?

Again, if I have the time and I see it's a reasonable request and I get requests from many people on a particular topic, I'll go ahead and make the podcast. I mean, many of the podcasts I've made have just been from people saying, oh, divine, would it be possible for you to make a podcast on this specific topic? So thank you for listening. And again, please listen to this podcast. This is something that is very high you to know because again, the USMU cares about the military, which they shoot actually on their new exams, right? So again, just something to keep at the back of your mind. So have a wonderful rest of your day. Thank you for listening. God bless you. And again, if in the military, remember your service is not on warranted. Your service is not unappreciated. We really appreciate it. And God bless you for all you do. Thank you. I'll see you in the next podcast.

Any injury caused by an external force impacting the brain (e.g., blunt trauma).

Wearing helmets and using seat belts.

A score of 8 or lower.

Memory loss.

Symptoms must persist for more than one month.

Exposure therapy and Cognitive Processing Therapy.

Hyperventilation (but this is only short-term).

Corticosteroids.

The anterior temporal loops and the orbital frontal cortex.

Cushing's triad components (bradycardia, hypertension, irregular respirations).

Within the first three hours to decrease the risk of death.

Elevated catecholamines and abnormally low cortisol levels.

Alcohol abuse.

Post-concussive syndrome (PCS).

Alcohol.

The anterior temporal loops and the orbital frontal cortex.

Cushing's triad components (bradycardia, hypertension, irregular respirations).

Within the first three hours to decrease the risk of death.

Elevated catecholamines and abnormally low cortisol levels.

Alcohol abuse.

Post-concussive syndrome (PCS).

Alcohol.