DIP Episode 383 - The Clutch Smoking Podcast (for Step 1-3)

Okay, welcome. My name is Devine. This is episode 383 of the Divine Intervention Podcast. And into these podcasts, we're going to be talking about a lot of very high-yield things. I'm going to be calling this the Clutch Smoke-In Podcast for the USML Es. To be honest with you, smoking is actually something that is weaved into many USMLE questions. If you pay attention to this podcast, the stuff that's related to smoking that you see on the exam, you're going to smoke those questions. Literally, I know that's not a great joke, but anyway. And as a reminder, if you're taking step 2, see here or step 3 or complex level 2 or 3 within the next like one month. I'm offering an MBA Me Testicking Strategies class on the 22nd of April. It's for 200,500 hours. Many people have taken that course and it's helped them tremendously on your world, helped them tremendously on their exams. I've had people have very good score improvements from the course. And then I have a 20-hour review course that's going to be taking place on the weekend, on the 23rd and the 30th. Those are two Saturdays of this month. Again, we're going to review tons of concepts from Internal Medicine, PEAT, Surgery, OB-GYN, Sight Neural, Multicestan Persistence and Disorders, Bio STA Ts, Ethics, Imminology, just many great things, right? Communication, Professionalism. You're going to learn a lot from the class. You're going to get a lot from the class. So if you're interested, just ship me an email.

And then the model load course is going to be held from the second. I call it the disk school. It's a step 2 CK school. It's also obviously useful for step 3 and for complex level 2 and 3. That's going to be taking place the first two weeks in May is 75 hours. There's a very limited number of sports remaining. Basically, the course has a limited number of sports because again, I really want to focus on the people that attend. I really want to invest in everyone that attends. So if you're interested, just ship me an email. And if you're taking the USE at least that one exam, we're going to be hosting a 10-hour repeat review course on the 14th of May. It's 10 hours, one day, we'll do like blocks of four hours, four hours, and 12 hours. And then we'll be done. So if you're interested in any of these courses, just ship me an email through the website. I'll give you more information on details, on registration. The courses are held over Zoom. Okay, so let's jump right into smoking. So what if they give you a question about a 35-year-old male smoker? And they tell you that for the past four days, he has been having shortness of breath. And they tell you that a chest takes shows in terrestrial infiltrates. And then a sputum sample shows a silver stain positive organisms. What should you be thinking about? I hope you're saying, huh, divine, this sounds an awful lot like a Legionella. Remember, Legionella has a very strong association with smoking.

Many people that get Legionella on exams, besides being exposed to water, you know, like water supply system, or humidity fires, or waterfalls, or whatever, also as smokers. Right? Now remember, smoking is the biggest risk factor for many different cancers, right? Is the biggest risk factor for like renal cell carcinoma? Really, smoking is the biggest risk factor for many things. Let me just kind of run through some of them, right? Like literally smoking is the biggest risk factor for renal cell carcinoma. Is the biggest risk factor for bladder cancer? Is the biggest risk factor for pancreatic cancer? Is the biggest risk factor for peripheral arterial disease? Is the biggest risk factor for myocardial infarction? Is the biggest risk factor for lung cancer? The biggest risk factor for COPD, right? Is the biggest risk factor for triple A? And abdominal leoric aneurysm? It's, I would say, the biggest risk factor for multi-focally trotachic cardia, right? Is the biggest risk factor for this thing? So, in fact, let me maybe give you a veneer here, right? What if they give you a question about like some 30-year-old male? And they tell you that, you know, it has like ischemic toes, ischemic fingers, and he's a heavy smoker, right? What do you think is causing that? Well, you want to think about burgers disease, right? BUERGES disease, right? Remember, burgers disease is also called on exams, flombuangiaides obliterants, right? Flombuangiaides obliterants.

Something that is very common in smokers, you know, you can try to help those people who are giving them a dihydroperidine calcium channel blocker to dilate their digital vessels, but for the most part, the thing that's going to pretty much erase burgers disease, again, also called flombuangiaides obliterants, is that an industrial to stop smoking, right? So, I think, I hope you can really get the message that smoking is not good, right? Like, think about it, all these cancers, renal bladder pancreas, lung cancer, peripheral arterial disease, MI, COPD, abdominal leoric aneurysms, right? All those things arise as a result of smoking, right? And then remember, people that actually have alpha-1 antitripsin deficiency, they can actually have a normal life expectancy if you don't smoke, right? But when you smoke as a person that has alpha-1 antitripsin deficiency, your risk of dying of getting, like, you know, like, COPD liver problems, liver cancer, those are vastronomically, right? Because if you think about it, right? Why is smoking such a bad thing for a person that can make them develop infecima? Or remember, in the lungs, right, we have this protein's anti-protease war going on, right? So, those proteins is true of your lung parankama. Anti-protease is like alpha-1 antitripsin, degrade those proteins. So, if you're a big, heavy, you know, smoker, right? Smoking actually operates produce production in the liver. I mean, sorry, in the lungs.

So, if you have all those proteins, you're going to be chewing up your lungs. You're going to get infecima very, very quickly, right? And then, so that's why it's like one of the most important and the most important, what if fiber is factors, right? In the lifetime mortality of a person that has alpha-1 antitripsin deficiency, is to encourage them to not, to not smoke. That's a high-yield thing to know for, for example, right? Now, remember, smoking is even one of the most common causes of preventable death in the US, right? I mean, I read a study that said that, you know, about maybe like a third of, like, the population in, of the male population in China will have their life expectancy caught down by smoking, right? Can you just imagine that, right? And on average, right, a person that smokes, they pretty much subtract about 14 years from their life span, right? So, again, smoking is just not a good thing. Literally, smoking is not a good thing. Like, really, on USML Es, the only positive thing that I've ever seen that has been attributed to smoking is how it can actually reduce your symptoms in a person that has an ulcerative colitis, right? And, in fact, if I'm not mistaken, I think back in the day, you know, a nicotine patch may have been used as a tool for treating ulcerative colitis, right? That nicotine has a protective, almost like, helpful effect in ulcerative colitis, but no, you shouldn't smoke because of that, right?

Now, remember that nicotine is like the, one of the active ingredients in cigarettes, in, you know, in tobacco that makes people very addicted, right? Because that nicotine, you know, through many pathways, it can cause you to release dopamine in the brain, right? So, it's almost like your brain rewards you when you smoke, right? That's why it's such a big hub, such a very, like, hard habit to kick. Now, one weird thing that you may see on MBME exams may be employment testing questions, right? So, how can you test that a person is a smoker if you're doing employment testing, right? And I'm sure for many of you that, you know, much less, yeah, last month, whoops, we're in April, right? So, the pool that much last month, I'm sure you've probably had to do some kind of testing for, like marijuana, blah, blah, blah, blah, blah. Remember, you know, like marijuana is teasing your urine for at least 30 days, right? But some residency programs, and, you know, you may see this as an MBME question, can ask, how do you test the person, how do you test the person to see if they smoke or not? Well, the thing you're looking for in the urine is something called cotinin, right? C-O-T-I-N-I-N-E, like cotinin, right? So, you test for that in the urine. That's one of the best ways you can test that a person is a smoker, right? Now, one of the piece of information you may say, man, the fine dish podcast is really random.

It's really random because smoking is a pervasive issue, and it causes pervasive problems, right? So, there's no real thing that kind of links everything together. But all these things you see me discussing in this podcast, they are all high-yield to know for the exam, right? So, remember that when there's a time frame that the MBM Es want you to keep in mind with smoking, in terms of, oh, when you stop smoking, it reduces your risk of all those badness. To be honest with you, the thing you want to think about is 15 years. 15 years is a nice, solid time frame to know with regards to smoking, right? So, if, for example, you stop smoking for 15 years, your risk of lung cancer decreases to the same level as a person that has never smoked before, right? In fact, if you see many of these screening guidelines that are related to smoking, right? You'll see that, oh, if you quit smoking within the, if you quit smoking more than 15 years ago, you don't need to be screened for XYZ item, right? So, that 15 years is something that's high-yield to know for exams, right? Remember, if a person even has COPD, if you stop smoking, that actually improves survival in those people, right? That actually improves survival in those people, right? So, again, cigarette smoking just causes many problems, right? Like, for example, they can give you a question about a person that has been a long-term smoker, and then they have an enlarging jaw mass, right?

Of course, the MBM Es being wise, they'll put Burkis Lemphoma as an answer, which will be wrong, right? The answer that you should be streaming for, you should be shooting for, is going to be like oral cancer, right? You can get oral cancers from smoking, you can get salivary gland cancers from smoking, right? Especially those worthy tumors, W-A-R-T-H-I-N, those worthy tumors, you can absolutely get them from smoking tobacco, right? And really, most times, when you see a person develop malignancy from smoking, along their oral tract, usually it's going to be a squamous cell cancer, right? So, like, for example, you don't like laryngeal cancer can be caused by smoking. If you look at the upper two thirds of the esophagus, remember, the most common malignancy is there, a squamous cell cancer, those things are heavily linked to smoking, right? And again, I said earlier in this podcast, now, one of the biggest risk factors for maltyph, in fact, the biggest risk factor for maltyph, locally, drug-tactic cardiac, is smoking, right? It's a kind of arrhythmia, right? Where you see people have freer morphology, it's almost exclusively found that people that have COPD, and yeah, you know, you can treat it, you can give, like, veraperminal deotiasm, don't give a beta blocker, right? Obviously, if you give a beta blocker to a person that's a big smoker, they're trying to close their airway, right? Maybe that's not the most genius idea in the world, right?

But for multi-focal-etrarchic cardiac, just tell those people to stop smoking, and the arrhythmia will literally go away, right? So, what are some other things that can happen with smoking, especially like, an OB-GYN world, on NBN Es? Well, they can give you a question about a woman that's at, like, 30-weeks gestation, she's a smoker, right? And the distance from the uterine fundus to the pubic synthesis is 25 centimeters. That's not good, obviously, right? So that means the child is not growing well. Intriguing growth restriction is something you can absolutely get, right? As a pregnant woman, if you smoke, right? Again, that's something to know, for example. And what's the pathophysiology there? Well, if you think about it, again, I just said that, you know, tobacco contains a lot of nicotine. Nicotine is a very powerful viso-constructor, right? It's a very powerful viso-constructor, right? So it can constrict the placenta blood vessels, the placenta arteries, so that reduced blood flow to the baby, right? So that will cause an asymmetric intra-utero-ingruous restriction. That's very high, you'll know, an asymmetric intra-utero-ingruous restriction. That will classically present on NBN exams, as size being less than deeds, usually like in the second or third trimester, right? Now remember, for a baby that has been born, if you smoke in the household, you increase in that baby's risk of seeds, right? Soaring infant death syndrome, right?

And remember, if you're smoking an enclosed space, that can actually raise the levels of cabo monoxide in that space, right? So you can absolutely get cabo monoxide poisoning from smoking, right? Or they can even give you a question about like a woman at 30-something weeks, you know, like third trimester, and she presents with like, a painful third trimester vaginal bleeding. And it tells you that she's a heavy smoker, right? If you see that, what should you be thinking about? I'll hope you're saying, oh, the vine, this sounds an awful lot like a brobtio placenti, right? Remember, you can get placenta, an abruption from smoking. Because again, if you think about it, right, again, it all goes back to that really nasty nicotine, right? Nicotine is a powerful viso-constrictor, right? Because it's a powerful viso-constrictor, you're gonna get it skimia of the parts of the uterus that, of the uterine walls that hold the placenta. So the placenta is literally gonna fall off, and the person is gonna get in trouble, right? So you can get a brobtio placenti from smoking, right? And remember, is there a kind of contraception that, maybe you should not use a women that over 35 and smoke? Well, that's gonna be estrogen-containing contraception, right? Again, if you're woman over 35 and you smoke, you should not be getting anything that contains estrogen, right? Because at that point, you're kind of asking for like a DVD, a PE, an MI, a stroke, kind of deal, right?

And again, we know our friends at the MBA meetings, they are really wise, right? They know that most people that have the job description medical student or USMLE test ticker have memorized this, ooh, if you're over 35, are you a female, are you smoke? You shouldn't take estrogen-containing contraception. So what are some new ways they test that same concept? Let me tell you this. They can give you a question about a person that has had a diagnosis of breast cancer, right? And they tell you that, hmm, this is an ERPR positive malignancy, right? And they say, hmm, this person needs to be placed on chemotherapy laxies, but the person is a smoker. And they say, oh, which of the following history, they can make this question in many different ways. They can say, oh, which of the following history items should be obtained before pharmacotherapy started? You want to ask these people about like, you know, the smoking history, because think about it, right? Tamoxifen and Raloxifen, you know, those are serms, right? And even chlomyphen, chlomyphen is a serum. Those things modulate estrogen receptors, right? Remember, tamoxifen and Raloxifen for sure, right? Have estrogen receptor agonist activity, especially like in the bone, right, for both of them in the uterus for tamoxifen, right? So like, if people are smoking and they take tamoxifen or Raloxifen or chlomyphen, those people have a markedly elevated risk of venostromoembolic disease, right?

Again, I know it's something that you may never have seen in a resource or something you may never have heard about before, but it's something that's absolutely high to know for purposes of exams, right? And remember, if they give you like a young male smoker and he has the sodium onset severe chest pain, you know, and you know, he's a little bit hypoxic and they tell you that you have decreased red sounds on one side of the lungs, right? What's happening there? That's a primary spontaneous hemothorax, right? Remember, if you smoke, right? Again, if you smoke, you're raising all those proteases, you're treating up your lung parankham, right? You're gonna start forming all these blebs, especially in the apesies of the lungs. If those blebs pop, you're gonna get into trouble, right? You're absolutely gonna get into trouble, right? And get like a primary spontaneous hemothorax, right? Now remember though, smoking is not a risk factor for mesotheliuma, right? This is very high-yoteinose. Smoking is not a risk factor for mesotheliuma, right? And so if a person wants to quit smoking, what are some things you can do? You know, you can try like the non-medical stuff, like nicotine patches, nicotine gums, blah, blah, blah, blah, blah. It's better to be taking nicotine, right? Straight up than to be taking all the other harmful stuff like formaldehyde and all these bad things that are carcinogens in a tobacco, right?

But remember, you can also use, in terms of pharmacotherapy, you can use bupropium, right? Remember, bupropium is an NDR, right? It's a neuropinephrine dopamine reoptic inhibitor, right? Very helpful drug. It helps with smoking cessation, helps you lose weight, there's no half-sexual side effects, right? So it's pretty great from that perspective. Although remember, if you have a seizure disorder, or you have like electrolyte problems like, you know, unless you're an anorexic bulimic, or a person binge it in the disorder, you know, taking bupropium may not be a good idea, right? Because that it lowers the seizure threshold. Now remember, another pharmacotherapeutic agent you can use is a varanic lane, right? Varenic lane works on nicotinic acetylcholine receptors, right? Remember, those are the same receptors that are worked on by the neuromuscular blocking agents, right? Those are also the receptors that you mess up in people that have my austenia gravis, right? So the thing is the nicotinic acetylcholine receptor, basically, varanic lane is a partial agonist of those receptors. It's actually quite helpful in smoking cessation, right? So again, just please keep all these things at the back of your mind for your exams. Again, this podcast is Florida Hyal. Like I almost promised you, every USML exam you take, it doesn't matter which one it is. Step one, step two, see case step three, right?

Even like these bored exams for internal medicine and family medicine and OB-GYN, smoking is going to show up in some way, shape or form, even pediatrics, right? So just going to keep these things at the back of your mind. Even smoking, right? It impairs wound healing with surgery. That's why many times before surgery, you're told, ooh, stop smoking, right? They're not telling you that for fun. They're telling you that because it's an actual thing. That's important. So again, as I wrap up this review, again, I do offer one or one tutoring for many exams. Step one, step two, see case, step three, preclinical medical exams, third-day shelf exams, right? Again, if you like this integrative approach, right? Where the person is not giving you straight-up lectures, but one is using like examples and vignettes and integrations to pass across material, right? Again, that's really high tutor people in a one-on-one setting. I also go over test-taking strategies when I tutor people one-on-one. And also, I use a very similar approach. It's organized, but it's a very helpful approach with my review courses. Again, for step one, that I have on May 14th for step two, for step two, CK, that I have on April 23rd and 30th, my MBA me test-taking strategy course on the 22nd. And also my 75-hour disk school that has limited attendance in the first two weeks of me. Because again, I know some people may say, oh, divine, you know, I want lectures, lectures, lectures.

The thing is, that's not an optimal way to prepare for the US semilies, because guess what? You examine, right? Let's say it's 280 questions. The first 40 questions are not repro-questions. And then the next 40 B, I am questions. No, that's ridiculous. Everything is mixed together. So you want to be able to have that multi-dimensional thinking. That's one of the reasons behind my approach to the way I make my podcasts. And my approach to the way I teach, right? Again, making, making, making integrations. That's how people succeed on these exams. And then I do have these podcasts on Apple podcasts, Google podcasts and Spotify. I have a You Tube channel, the Divine Intervention US Emily Podcasts and videos. That's why I post the videos that I make. And then finally, I started a new website. It's a Bible-based website. Many of you listened to this podcast on my Christian. I scored the Divine Intervention Life Lessons.com. I have about 71 episodes. They're like, you know, five to 15 minute episodes on like Bible-based teaching of a common problem facing humanity. So I even have the podcasts on Apple podcasts. They are called the Divine Intervention Life Lessons Podcasts. So if you're interested in any of those things, just hit those up. And I think you'll be blessed by listening to them. So thank you for listening to my podcast. Have a wonderful weekend. God bless you. See you next time. Thank you. Bye for now.

Cotinine.

Squamous cell carcinoma (SCC).

15 years.

Estrogen-containing contraceptives (due to combined estrogen/smoking effects).

Nicotine acts as a powerful vasoconstrictor, compromising blood flow to the placenta.

Bupropion (an NDR) and Varenicline (a partial agonist at nicotinic acetylcholine receptors).

Smoking causes protease/anti-protease imbalance, leading to bleb formation and rupture.

Quitting smoking (smoking exacerbates lung damage).

Asymmetric Intra-Utero Growth Restriction (IUGR), due to placental vasoconstriction.

SER Ms (Selective Estrogen Receptor Modulators) like Tamoxifen and Raloxifene.

Abruptio placentae.

Smoking causes protease/anti-protease imbalance, leading to bleb formation and rupture.

Quitting smoking (smoking exacerbates lung damage).

Asymmetric Intra-Utero Growth Restriction (IUGR), due to placental vasoconstriction.

SER Ms (Selective Estrogen Receptor Modulators) like Tamoxifen and Raloxifene.

Abruptio placentae.