Source / episode info

• **Episode:**131
• **Title:**Divine Intervention Episode 131 – USMLE Step 2CK Rapid Review Series 11 (OB, Psych, IM, Neuro)
• **Published:**2019-08-03
• Source:Episode page

One-liner

This episode provides a rapid review of high-yield concepts across multiple systems, including ITP management, Hirschsprung disease vs meconium ileus, specific CSF findings for GBS and MS, endocrine testing (Pheochromocytoma), contraception contraindications, and neurodegenerative/autoimmune syndromes (RA, Alzheimer's).

High-yield summary

• ITP Management: For severe bleeding with ITP, steroids are first-line; if refractory, splenectomy is indicated, but prophylactic vaccination against encapsulated organisms (Strep, Pneumo, H. flu) must precede the procedure.
• Gastrointestinal Obstruction: Meconium ileus in Cystic Fibrosis presents as failure to pass meconium within 40 days of life; Hirschsprung disease involves an aganglionic distal colon and may present with a "poop splatter" on rectal exam.
• CSF Analysis Pearls: Guillain-Barré Syndrome (GBS) is characterized by albuminocytologic dissociation (high protein, normal/near-normal WBC count), while Multiple Sclerosis (MS) suggests oligoclonal bands.
• Endocrine Emergencies: Pheochromocytoma requires screening via urine metanephrines and pre-operative alpha blockade using phenoxybenzamine or phentolamine to prevent hypertensive crisis.
• Reproductive Health Screening: Pap smear guidelines are age-dependent: 21-30 years every 3 years; >30 years, co-testing (Pap + HPV) every 5 years. Annual screening is required for immunocompromised patients (e.g., HIV).

Learning objectives

• Differentiate the clinical presentation and underlying pathophysiology of meconium ileus versus Hirschsprung disease.
• Interpret CSF findings to distinguish between GBS, MS, and various types of meningitis.
• Apply appropriate screening protocols for cervical cancer (Pap smear/HPV testing) based on age and immune status.
• Recognize the signs, symptoms, and necessary pre-operative management for pheochromocytoma.
• Identify key contraindications for hormonal contraception in women with specific comorbidities (e.g., VTE, breast cancer).

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