Source / episode info
- **Episode:**189
- **Title:**Divine Intervention Episode 189 – USMLE Step 2CK Rapid Review Series 26.
- **Published:**2019-12-05
- Source:Episode page
One-liner
This episode provides a rapid review comparing hepatic adenoma vs focal nodular hyperplasia (FNH), differentiating types of hernias, reviewing structural complications from chronic inflammation in various organs, detailing the stepwise management and pharmacology for psoriasis and acne, analyzing the hemodynamic profiles of three major shock states, and covering critical OBGYN topics including preeclampsia, ectopic pregnancy, and UTI pathogens.
High-yield summary
- FNH vs HA: FNH classically has a central/stellate scar and shows a centrifugal enhancement pattern on arterial CT; it also contains biliary duct epithelium (positive on high-dose scan). HA is associated with OCP use, lacks a central scar, and shows star-tripod enhancement.
- Shock Hemodynamics: Cardiogenic shock presents with low CO, high PCWP, and high SVR. Septic shock presents with high CO, low PCWP, and low SVR. Hypovolemic shock presents with low CO, low PCWP, and high SVR (due to compensatory vasoconstriction).
- Preeclampsia Management: Diagnosis requires hypertension (>140/90 mmHg) plus proteinuria (>300 mg/24h). Severe features require immediate consideration of Magnesium Sulfate for seizure prophylaxis. Delivery is the definitive treatment.
- Biliary Pathologies: Cholecystitis = Fever + RUQ pain (no jaundice). Ascending Colitis = Shick's Triad (Fever + RUQ pain + Jaundice). Cholangitis = Pain + Jaundice (often mild/intermittent).
- UTI Etiology: When considering UTI in a young, sexually active female, Ureaplasma urealyticum must be considered alongside E. coli, especially if the urine pH is high or if pyelonephritis complications are suspected.
Learning objectives
- Differentiate between hepatic adenoma and focal nodular hyperplasia using imaging findings and clinical risk factors.
- Apply the principles of shock state hemodynamics (CO, PCWP, SVR) to differentiate cardiogenic, septic, and hypovolemic shock.
- Recognize the diagnostic criteria for preeclampsia with severe features and initiate appropriate emergency management.
- Compare and contrast the pathophysiology and treatment regimens for psoriasis versus acne vulgaris.
- Identify key risk factors and associated pathogens for common malignancies (e.g., HPV for cervical cancer; Ureaplasma for UTI).
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