DIP Episode 131 - USMLE Step 2CK Rapid Review Series 11 (OB, Psych, IM, Neuro)

Okay, welcome. My name is Devine. This is the 131st episode of the Devine intervention podcasts and to these episodes I'll be continuing our rapid review series for the USMELIS step 2 CK. But so this will be series 11. But this will be more of a general one. I'll see some things like an internal. I just want to cover some high-year things. So I'll talk about some stuff from I.M. from Peds, from O.B.Guyne, from Psych, just all kind of like all over the place. But again, these things are all very high-year things you certainly want to know for you exam. Okay, so what if you get a question about 25-year-old female and they tell you that over the last three weeks, she has been having a lot of nosebleeds and they then give you like some labs like CBC. You notice that a platelet count is like 10,000 and you notice that a white blood cell count is normal. A hemoglobin is normal. Every other thing is normal. What's your diagnosis? Well, I hope you're thinking about ITP, right? Immune thrombocytopenic paper. Remember that ITP, right? The pathophys involves a person making auto-antibodies against the GP-2 B3, right? And classically, it can actually show up in people that have lupus on MBM Es, right? And really for the most part, especially for a person who's bleeding like this, right? And they have platelet counts this low of like 10,000. Your next step in general for treatment, you want to go ahead and proceed with steroids.

If the steroids are not coordinate, then you can go ahead and do a splinectomy. But your friends at the MBME right, one nice thing they can integrate here is that prior to doing the splinectomy, you want to vaccinate those people against encapsulated bugs, right? So like your shin organisms, so stuff like strep pneumo, H-flu, ni-ceramin, ingedidus. Okay? So those are all high-yield things you kind of want to keep at the back of your mind. And then, what if you get a question about a kid from, I guess, a newborn? And they tell you that all that it's, he's been born like over a week ago and he has not pooped yet. What are the things you should be thinking about when you examine? Well, I would hope you're thinking about things like, I would hope you're thinking about things like, like Hirschsprings disease, right? So remember, those people, the people call it like, it's like, it's like an egg anglionic distal colon, right? So those people are more classical, right? When you do a physical exam, you get a poop splatter, right? Because it's like, they have all this poop that is all backthrob. And then you do it like a physical exam, you open up the rectum and bam, you just have this projectile of poop, right? So Hirschsprings disease can present that, we are another thing that can present that way, right? So basically, this whole meconium elius business is if a person has cystic fibrosis, right? They have like pretty thick, pretty thick secretions, right?

So they may have trouble passing out that poop, right? And that can present with a meconium elius. I remember basically as opposed to poop within the first 40 days of life if you don't, that's meconium elius, right? And then also remember, again, this big, big bug, right? It's been popping up on a lot of my recent podcasts because again, it's very high you to know first step too. But this bug tried upon a soma cruzii. Remember, it causes big problems, right? So it can cause a big esophagus, right? So it can cause a ekelegia, right? And it can also cause a big heart, right? So it can cause a dilithec cardiomyopathy, right? And then it can also cause a big GI tract, right? Like a big colon in the setting of like Hirschsprings, Hirschsprings disease. Okay. Now, how do you differentiate between septic arthritis? This is a question of people ask me all the time. How do you differentiate between septic arthritis and osteomyelitis on an NV Me exam? So this is kind of a soft answer, but it's one thing I found to work quite frequently. The thing is septic arthritis is again, a ton of inflammation infection within a joint versus osteomyelitis that's a ton of infection and inflammation within a bone. So if a person has tenderness over a bone, think more about osteo. If a person has tenderness over a joint, think more about septic arthritis. And for osteo, right?

Remember, obviously you can do a, you can do like a triple phase bone scan to make the diagnosis, but on NV Me is probably something that's a little more common is to do an MRI of the bone, right? And remember septic arthritis, right? If you're suspect you're gonna do an athrocentesis, you're gonna see a crazy high-white count, it'll be more than like 50,000 or something like that, right? And you want to go ahead and treat aggressively. And then if a person has septic joints, they also need a joint wash out so that they don't, so that the infection clears and then they don't get like really bad nasty complications afterwards. So that's how you differentiate between septic arthritis and osteomyelitis on NV Me exams. And one thing I just sort of wanted to see here, kind of like as a test taking tool, is whenever you get two similarly correct answers to an NV Me question, you need to go back and look, right? Because the thing is every NV Me question has only one right answer, right? So you usually have something in the question that will tell you one answer apart from the other. That's a high-yield thing you want to keep in mind, because again, you'll see multiple, especially with the new NV Me, is the beginning to do these things where you're like, man, there are so many questions that seem, so many answers that seem to be correct here, right? Look for contraindications, look for comorbidities in the Q-stem that will get you with one question versus the other.

Now, what if they give you a question about a person that is postpartum and she's looking for some means of contraception? What is the kind of contraception you want to avoid in that person? I won't hope you're seeing anything that involves estrogen, remember, estrogen messes with the milk supply. So at least for the first like six weeks after the delivery, you do not use any estrogen containing a contraceptive option, right? And then what are some other, I guess, higher contraindications to estrogen contraception? I hope you're seeing things like if a person has like venastrombo embolism, right? If the person has a heast of like stroke, any kind of like vascular disease basically, right? So like history of stroke, history of MI, although weird ones they love to put on exams, people that have a history of like breast cancer, right? Remember, right? There are some breast cancers that are ER, PR, positive, right? So you would not make any sense for you to give estrogen to someone that has a history of those kinds of breast cancers, right? Only if you're asking for a recurrence. And then if a person has a history of like hepatic adenoma, right? You also want to avoid estrogen containing a contraceptive option under those circumstances. If a lady is more than 35 and she smokes, right? You also want to avoid estrogen containing a contraception under those circumstances. And then another nice one they love to test is just a guiding variety of female hypertension, right?

It won't be severe hypertension, but it will be like a decent amount. Like a blood pressure will be like in the 140s. If you see that, maybe your next step in money may be actually be to stop that estrogen containing contraceptive option, but basically for a person has a history of hypertension, they should not be on an estrogen containing a contraceptive option, right? And then again, some other high yield ones you want to keep in mind, right? So like things like the copper IUD, right? If a person has a history of like well-sensed disease, you don't want to do that. Or if a person has a history of like heavy menstrual bleeding, a copper IUD is not a great idea either, right? Although remember, those copper IU Ds are kind of nice in the fact that they're actually the best means of emergency contraception. So that's something your friends on the MBM love to test occasionally. Those are those are those copper IU Ds, they are the best means of emergency or contraception, right? And then, right, what's the means of contraception that protects against ST Is? Well, I hope you tell me condoms, right? Condoms are the big, big, big things that protect against ST Is. I guess probably the one that's like 100% is abstinence, right? Abstinence will give you 100% of protection against ST Is, right? And then, let me give you questions about stuff like spermisides, right? Remember, again, spermisides, they do not offer any kind of protection against ST Is.

And the thing is, all these contraceptive options that involve like implanted stuff, right? So like spermisides or diaphragms or that, whatever. Those things can increase risk of those things can increase risk of toxic shock syndrome. Remember, if you ever have like an implanted for somebody, you can always get toxic shock syndrome with that. So they describe a person that has like some kind of contraception thing going on that's implanted and then they have like a rash, fear hypotensive, they're like super sick, like super septic. You want to maybe go ahead and remove that implanted contraceptive option. And then, if for example, they give you a question about a person that has like a history of risk cancer, right? So I already said you avoid an estrogen continuum or contraceptive option. One other thing you definitely want to avoid is a progesting, containing contraceptive option, right? Because remember, progesting can, you can remember there are PR positive malignancies, right? So again, you want to avoid them. I mean, PR positive are risk cancers. So you want to avoid again a progesting, containing option on that those circumstances. And then one other, I guess, weird thing you want to keep in mind is those injectable progesting analogues, those things that I injected, I believe every three months, they are contrary indicated in women that want like a rapid return to fertility, right?

So if a woman desires like, oh, I want a return to fertility, like I stopped this contraceptive option and boom, I become fertile again. Those estrogen, I mean, those progesting, containing injectable thingies, they're probably not a good idea, right? Because on the some circumstances, the associated like a delayed return to fertility of up to about like, like a year, right? So you want to kind of like avoid those if the woman expresses those kinds of wishes. And then remember that the progesting, IUD, right? So like the myrina can be used as treatment for abnormal illnesses. Those are again, weird things they love to test on NB Ms. And let's see, what else I want to say about these contraceptive options? I mean, there are certain methods that are not recommended, right? So like the pull-up method, right? That's just not smart, right? As a guy, you shouldn't do that. Doesn't make any sense. You get into trouble sometimes, right? So you don't want to do the pull-up method. It really doesn't, yeah, it works like 70% of the time, but why take the 30% risk, right? Doesn't again mix, mix absolutely no sense. And then some people also use some contraceptive options like, oh, like, I guess it's not necessarily a contraceptive option. It's more of like a fertility thing where people do like these are bizzol body temperature measurement and all that stuff. So those bizzol body temperature measurements, right? Remember, after a woman has the LH surge, right?

Progesting then mix the person's body temperature rise. If you are tracking a person's bizzol body temperature, you notice, oh, it's a reason. Then that means this is a time where the egg is around, right? So in other circumstances, that would be a good time for a man to have intercourse with his wife, because that will increase the chances of successful fertilization. And, right, you also want to remember that if a woman has like a history of like PID, right? These IU Ds are probably like relatively contraindicated in those, under those circumstances. So again, these are all high yield things you need to know. I know it sounds like a lot, but again, I promise you all these things I just mentioned are floridly high yield to know, floridly high yield to know for exams. Again, especially step 2, CK. Now, what if you get a question about, what if you get a question about a kid? And, tell you that this kid has like, you know, like difficulty hearing and has like cataracts and they tell you that, oh, that he has own cause and stuff that are deaf, right? They can't hear, that have hearing difficulty. What disease are you thinking about? The me even be nice and often tell you that this person has red lot cell casts in the urine or your analysis. What are you thinking about? Well, I hope you're thinking about Alport Syndrome, right? Alport Syndrome. Remember, there's this classic triad, right?

You probably learned studying for step 1, about can't see, can't see, can't hear, high see, right? So can't see, right? They have like visual problems like cataracts, can't pee, right? They have like an ephritic syndrome. So remember Alport Syndrome is an example of an ephritic syndrome and they can't hear high see, right? That's hearing problems, right? And really the pathophys is like, they all have problems with like type 4 collagen, right? And the thing is not just enough to know it's type 4 collagen, right? You want to remember that it's like, it arises from like a COL for e5 mutation. It loves to test that on an exam. So COL for e5 mutation and it's in herithin and an ex-lindominant fashion, right? So, classical, an MBM Es, it will show up on, it will show up in, in boys on MBM Es exams, right? And then what if they give you a question about a patient that has genital warts? What kind of HPV caused those genital warts? Well, I will hope you're telling me HPV 6 and 11, right? And remember that those gen, if you, again, if you find genital warts, you're probably thinking about some kind of like sexual transmission, right? So it would make sense to screen those people for all these ST Is, right? Like HIV, gonorrhea, chlamydia, stuff like that. If it's indicated, you can give, you can do like a pap smear. Remember, pap smear is, don't start until you hit 21. So if a person is less than 21, right?

You probably shouldn't do a pap smear, but if they're greater than 21, absolutely positively, go ahead and do that, go ahead and do that pap smear. And what's the screening interval for a pap smear? I hope you're telling me that the screening interval is, is every three years, right? From 21 to 30. After the age of 30, you can also do it every three years, right? But remember that you, after 30, you can actually do the pap smear and HPV 4 test in, and that'll be every five years. Again, after the age of 30. And usually you can do like the HPV vaccine right between like the ages of like 11 to like 26, right? If you have a past age of 26, well, kind of look at that point. And then you should also not forget that if you have a positive pap smear, your next step should obviously be a vehicle poscopy with biopsy, right? And then if they give you like the specific scenario that, oh, on pap smear or whatever, you see like eight typical glendular cells, that's a bad sign, right? You essentially need to scrub down those women's cells, like reproductive cavities, right? So you get the coposcopy, you sample the cervix, those people also need an endometrial biopsy, right? Because the presence of eight typical glendular cells is kind of associated with having a, with having an endometrial cancer, right? So you want to make sure you kind of go ahead and do all those are samplits. And then there is something I want that you say. I don't know, I just kind of skip my mind.

Yes, HPV intervals, right? So I said we check every three years. But if a person has like some immunodeficiency disease like HIV, right? You want to go ahead and do HPV testing every year, okay? That's kind of it. I mean, sorry, pap smear every year, right? Because those people again, they have a higher than normal risk of a cervical cancer, right? And remember that the most common cause of death in people with cervical cancer is involvement of the patient, right? So if they give you a person that has like, if they give you a no big, I'm question about a person that has renal failure from a legacy, you absolutely positively want to think about some kind of a cervical cancer. Okay. And then if you're, if you're thinking about, if they give you a question about like a 75 year old guy, having trouble, like he missed his way from the store, forgot to turn off the stove, stuff like that, what are you thinking about? Well, I hope you're thinking about Alzheimer's, right? I remember Alzheimer's, right? It's the most common cause of dementia. The ascertain year anatomical associations, your friends at the MDME kind of want you to know, right? Remember, because in Alzheimer's people have low levels of acetylcholine, right? So anything you can do to anything that messes with the acetylcholine synthesis can cause Alzheimer's, right? So for example, if a person has destruction of the bizzone nucleus of minor, right?

Destruction of the bizzone nucleus of minor, remember that's where acetylcholine is produced, right? Those people can have Alzheimer's symptoms. If a person has decreased the activity of chat, like a colline acetylchransferase, then they will also have Alzheimer's symptoms. And one weird thing your friends at the MDME love to test with chat deficiency, right? Is that when people have chat deficiency, they will actually have myestinia gravies like symptoms, right? But a very nice nifty way to differentiate between those two is if a person has symptoms that fail to improve with adrofonium augmentation, and you want to think more about a chat deficiency, right? So why is that? Well, if you have a chat deficiency, you are not going to be making an acetylcholine in the first place, right? So there's no, because adrofonium is an acetylcholine esterase inhibitor, right? So yeah, if inhibitor acetylcholine esterase, yeah, you won't break down acetylcholine, so you'll not compete those bad antibodies in normal myestinia gravies, and the person will be fine, at least transiently. When if you have a chat deficiency, you're not making any acetylcholine in the first place. So there's no acetylcholine to prevent the breakdown of, right? So failure of a person's symptoms of like a person's myestinic symptoms to improve with, to improve with adrofonium augmentation, that tells you that you're dealing with congenital myestinic syndrome like a chat deficiency, right?

And then also remember Alzheimer's, right? Like, I mean, the biggest risk factor for Alzheimer's is clearly age, right? Age is the biggest risk factor. You also want to think about things like family history, right? So if they don't give you age as an answer choice, think about family history. Family history will be like the biggest factor for Alzheimer's under those circumstances. But if they give you a question about a kid that, you know, having Alzheimer's of like 40 and has like a bicamphold, the works, right? The biggest risk factor for Alzheimer's in that person will be having a histro down syndrome, right? Because remember, people with down syndrome, they have like trisomy 21, so they have like three copies of chromosome 21, right? So they'll have like three copies of the amyloid precursor protein, right? So those things can all again kind of mess them cause an increase of risk of having a having Alzheimer's. And then what is the biggest risk factor for bladder cancer? What is the biggest risk factor for bladder cancer? Well, I hope you're telling me like smoking, right? What if they don't give you smoking? What are all the things that can increase the person's risk of bladder cancer on the end of the end of the month? I hope you're telling me things like exposure to like aniline dyes, right? Things like cyclophosphamide. It's a breakdown product acroline that you can I guess prevent with mesina, right?

That thing can increase your risk of a hemorrhagic studies and subsequent bladder cancer, okay? And remember that schistosoma hematobium, right? can also increase a presence risk of a, also increase a presence risk of a of bladder cancer. And the thing I will say is with most of these bladder cancers, right? So like like this, oh, smoking and aniline dyes and schistosoma hematobium and cyclophosphamide. This tends to cause more like scumosel cancer of the bladder, right? But if you've seen adenocarcinoma of the bladder, I want you to think more about things like this will probably be more of like a step one question. If a person has like the urecus, feeling to involute, right? The urecus, it's kind of like a connection between like the bladder and the umbilikus in urelo. It's just one of those weird bizarre things that many people tend to unfortunately get wrong on exams because it's kind of like something you don't think about most of the time. Okay, now what if you get a question about a patient that has, you know, morning stiffness, they have like pinning their fingers and all that stuff and it's like a 35 year old female, what are you thinking about? Well, I hope you're thinking about like rheumatoid arthritis, right? So, I mean, if you notice, I want to try to keep to this podcast short. So I'm not being like super v with my vignette. I'm just giving you a vignette and then talking about the concept right of the bat. But rheumatoid arthritis, right? Remember, right?

Those people will have anti like rheumatoid factor will be positive. Remember, it's an IgM against the IgG, right? And that's sensitive, but it's not specific, right? So if you want something that's specific for rheumatoid arthritis, you want to go more with anti-CCP antibodies, right? And remember in our area, right? If they have like an acute worst in all the symptoms, like a lot of pain and all that stuff, you contribute and sets. But the problem is, and says do not modify the course of the disease, right? So if you want to like modify the course of a person's rheumatoid arthritis, right? Use a demard, right? So you want to use drugs like methyl-trixi, that's probably like the first thing you want to start with on an exam. Remember, right? Prior to studying methyl-trixi, it probably makes sense to get like some PF Ts, like some baseline PF Ts because remember methyl-trixi can cause a pulmonary fibrosis. And please don't forget, right? The methyl-trixi, if I remember, it can cause its hepato toxic, right? So the person has like n-stage liver disease, methyl-trixi is probably not a great idea. And if a person has like bone marrow suppression from a methyl-trixi, right? How can you rescue their bone marrow? I hope you're telling me something along the lines of like lukovore, right? Remember, it's a folinic, not folic, folinic acid and a log that can be used to rescue the bone marrow in bone marrow suppression with a methyl-trixi. Okay, now what are the classic CSF findings?

What kind of CSF findings would you expect in like 55-year-old guy that has dementia over like seven weeks, has myoclonus and dies? What CSF findings would you expect? Well, I would hope you're thinking about C.J.D. right? So like, crates, foliacob disease, right? And those people on MB Ms, right? They will have like elevated levels of the protein of 14, 3, 3 in their CSF. That's kind of high, you know? Okay? Now, what if you get a question about a patient that, you know, they had like some bloody diarrhea like two weeks ago. And then now they're having like, I don't know, like, uh, symmetric-accentin, then ru-extramaritalis is they have like no sensory issues, but they're beginning to have like sharpness of breath and all that stuff. What are you thinking about? I hope you're thinking about Guillain-Barre syndrome, right? Remember in GBS, right? Those people, they have like this metric-accentin paralysis usually after like an respiratory infection or like some GI-ONS, like after like Campilo-Bacteria, Junai, right? And for those people when they come to the hospital, you sort of want to, you know, start doing like spirometry just to sort of monitor the FVV one. If the FVV one begins to drop, you need to go ahead and into beat those patients, right? And remember that, I mean like Guillain-Barre, you can do like, you know, you can do EMG nerve conduction study blah, blah, blah. Usually the diagnosis can be made fairly clinically.

And sometimes actually your friends on the MBM, instead of giving you Guillain-Barre syndrome as an answer choice, they may put something like like an acute inflammatory demilinating poly neuropathy. So like they can put like AIDP or CIDP as a diagnosis. Those things are just slightly different words for Guillain-Barre syndrome, right? And what's the classic CSF finding in Guillain-Barre syndrome? Well, I hope you're telling me something like a BI Mino cytologic dissociation, right? The thing is your friends on the MBM, because again, they know everyone has memorized the boss phrase, Obumino cytologic dissociation, right? So the smart thing they will usually do is they will give you a bunch of CSF findings and then you have to pick out the set of numbers that are grizzly GBS, right? So the thing you basically want to look for is you want to look for CSF that has like a ton of protein in it, right? You're like, oh, this person has very high CSF protein and then they show you the number of white blood cells and you're like, man, this is like one or two white blood cells. That doesn't match, right? That's the Obumino. Obumino is a protein cytologic is your white cells, dissociation, those numbers don't agree. Because usually if you have very high levels of protein in your CSF, you're going to have high levels of white blood cells, right? Kind of like what happens with like regular infection. So if you see that, like, you're like, man, these numbers don't fit.

Think about a Guillembris syndrome. And then what is the classic CSF finding in a patient that has MS? I hope you're thinking about oligoclonal bands. I don't know one checks for that stuff anymore. Really, those MS, these days you make the diagnosis with like an MRI of the brain and spine. You'll find those like white, the mind-in-the-meeting lesions if I'm not mistaken on like T2-weighted image. And then how do we treat, how do we treat Guillembris syndrome? How do you treat Guillembris syndrome? Right? I hope you're thinking about stuff like plasma ferrisis, right? That's like the preferred treatment. Instead of putting plasma ferrisis, then you put like plasma exchange to mess with your head. It's all one and the same thing. Another thing you can do is you can also, you can also, let's see, you can also do like IVIG. But again, IVIG is not as good as plasma ferrisis for a person that has Guillembris syndrome. And then another weird, high-yield disease that can be treated with plasma ferrisis is TTP, right? Remember like that pentad, fever, anemia, low-plightlets, renal failure, neurological problems, right? And then what's the, what's the classic CSF finding in people that have narcolepsy? So narcolepsy right now, I hope you're thinking about like the low levels of high-tech and then what are the classic CSF findings and patients that have like sub-archmoid hemorrhage? I hope you're thinking about Zanctochromia, right? Zanctochromia.

That's pathodomonic for sub-archmoid hemorrhage. And then what if you see a lot of red blood cells in a person's CSF? What are you thinking about? And they have like nuclear energy. Or maybe they show you like a brain picture and you see like all that's white around the temporal lobe. So what are you thinking about? I hope you're thinking about her piece, right? So like HSV. What if you notice that a person's, let's say you have like this 35-year-old female, a DMI-35, she has like morning headaches. They tell you that you do it for a no-scopic exam and you observe like popular Dima. What are you thinking about? I hope you're thinking about like pseudo tumor cerebride, right? So those people have like very high open-ins CSF pressures. It's usually more than 250 on MbME exams. Now what if a person has like high open-ins CSF pressures, a ton of white cells, mostly neutrophils, low glucose? What kind of meningitis is that? That'll be about term meningitis, right? And basically they give you all those labs, like basically literally the same thing, but they tell you that oh, they have a high white cell count, but it's mostly lymphocytes. I would really hope you're thinking about like some kind of like viral of fungal, I mean like some kind of fungal meningitis, right? Remember that viral meningitis for the most part everything is normal, right? But it will be lymphocytes that they will have instead of neutrophils.

And yeah, I think that's all I'm going to go ahead and say about a CSF findings. Now what if you get a question about a patient that has episodic like symptoms and headache and hypertension? What are you thinking about there? I hope you're telling me a feel chromosome tumor, right? So a feel. How do you screen for a feel? What do you check first? Again, I hope you're saying that you check the metanefarin levels in the urine, right? Like serum urine metanefarin, stuff like HVA, VMA, stuff like that. And then for those people, how do you treat? I mean before you go for surgery, I guess. Right, before you go for surgery, you want to do things along the lines of like alpha blockade first. So you can use like a reversible alpha one blocker like a femtolamine or an irreversible alpha one blocker like a phenoxybenzamine. And then you do a bit of blockade after that and then take them to surgery. And then your friends can, the MBME can kind of try to mess with your head and say, during the case, like the surgery for the feel, the person has like profound hypertension and like a hypertensive crisis during those episodes, during the surgery from like spilling kind of columning into the circulation. I'm really, what you want to go after there is you want to go ahead and consider things like, you want to consider things like, you want to give like femtolamine, right? And then in an alpha one blocker, you want to consider things like, like, my trope or site, right?

Those can really help on that those circumstances. And remember that femtolamine is actually also good for a person that has like a hypertensive crisis, right? From consuming like, tyramine, containing food, if you're on an MEOI, right? So like, things like, trinoscypromine, phenolzine, isocarboxazet. And then remember that feel, right? After you check the metaneference in the urine or the serum, whatever, you can do like an MIBG scan, right? To localize, it's a nucleomedicine test. You can use that to localize the lesion in the adrenome dollar, right? And those feels, I guess more for step one purposes or step three, those cells will have like nicotinic acetylcholine receptors on their surfaces. Because remember, right, they are right from like the chromafin cells of the adrenome dollar, right? So they're kind of those cells are like a kind of like modified post-ganglionic sympathetic on urine. And I mean, remember, feels, feels that you can, people can have like, feels like just because they have feels. But remember that feels also have like many other genetic associations, right? So like, things like neurofibromatosis type 1 is associated with the fiochromocytoma, things like, MEN2, right? Not MEN1, MEN2 is associated with fiochromocytoma, although the most common manifestation of MEN2's sendrons for the most part is the medallary thyroid cancer. And then, if you were to find a feel in the medias thine and where would you find that? Well, it's a neurogenic tumor, right?

So hopefully you're telling me post-traumatic astine. Again, these are all high-yield things you want to keep in mind for exams. And then, what if they just give you a question? What if they give you a question about a patient that has been, like, let's assume it's like an antivax or whatever, and they've been coughing, coughing, coughing, coughing, a ton. And they tell you that whenever the cough, the aphys gets red or blue or the vomit or whatever, what are you thinking about? I hope you're thinking about pertussis, right? And again, remember for pertussis, how do you treat? You'll give a microlet, right? Like a rhithromicin, is it rhithromicin, clarithromicin, or whatever floats your boat? And if you're a close contact already, also get a microlet. Although, remember that your microletes, again, can prolong the QT interval, right? They can prolong your QT interval, they can cause diarrhea, especially like a rhithromicin, because remember, it's a motillin receptor agonist. That's why it's used in the treatment of a diabetic gastroparesis. Okay, now the last thing I guess I'll go ahead and talk about here, what did they give you a question about like a person that just seems to have like a weird cluster of symptoms, right? So they tell you that this person, you know, they have like a rock heart thyroid gland, and they're kind of like hypo thyroid as a result of that.

And in the detail, that this person has been having like a ton of like, they've been having recurring episodes of like a pigastric pain, and they've been relating to the back. But this person doesn't drink, this person doesn't have like a biliary tract disease or whatever. What are you thinking about on that those circumstances? I would hope you're thinking about like IGG4-related diseases, right? So these IGG4-related diseases, they're kind of high up to know. There's a bunch of stuff they cause, right? But kind of like the big ones you want to keep in mind for your exam, right? These people can have like right delts of thyroiditis, right? So like rock heart thyroid gland, that tends to shop a lot of NBM Es. They can actually have like in testicle lung disease, right? That's another presentation. Your friends at the NBME loves to, love to focus a lot on their like gym manifestations, right? So like stuff like, they can have like autoimmune pancreatitis, that's essentially what this person has. They can have like PSC like primary sclerosis in colonjitis as a result. They can have like recurrent colitis as stitis, that's another thing that's associated. And then another thing you may also see on your exam is they may have like prostatitis or they may have like urinary retention from a retroperitoneal fibrosis. These are all like little things here and there that you can expect you to keep in mind with the IGG4-related diseases, right?

So again, those are higher things you want to keep in mind on NBM Es. So I think I'm going to go ahead and stop here. This has gone on for a long, again as I said at the end of every podcast, I'd offer one or one to learn for a ton of exams. Step one, two CT, two CS, step three. The preclinical medical exams, 30-ish-elf exams, the internal medicine-entrining exam, the ABIM internal medicine board exam. And then if you have like a college buddy that needs to learn like physics, Gen CAM, O-CAM, Bio CAM, Physiology, Stology, Alpha Tutor, and for all those things. And then if you're a medicine and a plan to residency, so like an ERAS app or a cholesterol and a plan to med school, so like an AMCAS app, I'd offer one or one advising and coaching for that. So like personal statements, application prep, mock interviews, the works. Especially if you're trying to match into most of the major specialties, I've walked to a bunch of people on those, so just reach out to me. And I do that on a one-on-one basis. So I do hope you've gotten a lot from this podcast. I will hopefully make another podcast this weekend. So have a wonderful rest of your day. God bless you. I'll see you next time. Thank you.

Hearing loss (sensorineural), visual problems (cataracts/visual impairment), and renal failure (nephritis).

COL4 A5 mutation.

Albuminocytologic dissociation (high protein, normal/low WBC count).

Abstinence.

History of VTE/DVT or history of stroke/MI.

Tenderness over a joint suggests septic arthritis; tenderness over a bone suggests osteomyelitis.

Anti-CCP antibodies.

Hearing loss, visual impairment, and renal failure.

IVIG (Intravenous Immunoglobulin) or Splenectomy.

Alzheimer's disease; Age.

Squamous cell carcinoma (SCC).

Viral meningitis typically has normal glucose and a predominance of lymphocytes; bacterial/fungal meningitis often shows low glucose and high WBC counts.

Pheochromocytoma.

Folinic acid (Leucovorin).

Hearing loss, visual impairment, and renal failure.

IVIG (Intravenous Immunoglobulin) or Splenectomy.

Alzheimer's disease; Age.

Squamous cell carcinoma (SCC).

Viral meningitis typically has normal glucose and a predominance of lymphocytes; bacterial/fungal meningitis often shows low glucose and high WBC counts.

Pheochromocytoma.

Folinic acid (Leucovorin).