Source / episode info
- **Episode:**121
- **Title:**Divine Intervention Episode 121 – USMLE Step 2CK Rapid Review Series 5 (IM/Peds)
- **Published:**2019-07-17
- Source:Episode page
One-liner
This episode reviews high-yield topics including the workup of SBP (paracentesis), causes of eosinophilia (AIN/allergies/neoplasms), specific urinary casts and AKI patterns (rhabdomyolysis, nephrotic syndrome), classic vascular syndromes (AAA, LERICH), and complex pediatric immunodeficiency disorders.
High-yield summary
- SBP Workup: Suspect SBP in chronic alcoholics with fever, abdominal pain, and ascites; diagnosis requires paracentesis fluid analysis: WBC count >250 cells/mm³ or positive culture/Gram stain for gram-negative organisms. Treatment involves empiric antibiotics covering gram-negatives (e.g., ceftriaxone) and prophylactic fluoroquinolone.
- Eosinophilia Differential: The mnemonic DN quadruple ACP helps recall causes: Drugs, Neoplasms, Asthma, Allergies, Acute Interstitial Nephritis (AIN), Collagen Vascular Disease, Parasites. AIN is a classic cause associated with fever/rash/eosinophilia.
- Acute Abdominal Aortic Syndrome (AAA): Always consider AAA in smokers presenting with severe abdominal pain and low blood pressure; the "Draped Adyos sign" on imaging suggests contained or ruptured AAA due to posterior wall involvement over the vertebral body.
- Immunodeficiency Syndromes: Recognize specific patterns: B-cell defects (Bruton's -> recurrent bacterial infections, hypogammaglobulinemia); T-cell defects (DiGeorge -> recurrent viral/fungal infections, hypocalcemia due to absent parathyroid tissue).
- Urinary Casts & AKI: Rhabdomyolysis causes "positive for blood on dipstick, negative for RBCs on microscopy." Hyaline casts are seen in dehydration and increased ADH activity. Red cell casts indicate glomerulonephritis.
Learning objectives
- Differentiate the clinical presentations of various immunodeficiency syndromes (B-cell vs T-cell defects).
- Identify high-yield associations for acute kidney injury based on urinary sediment and history (e.g., rhabdomyolysis, casts).
- Recognize atypical signs of vascular emergencies like AAA rupture.
- Apply knowledge of the differential diagnosis for eosinophilia using mnemonic devices.
- Understand the pathophysiology and clinical consequences of congenital endocrine/immunodeficiency syndromes (DiGeorge, Bruton's).
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