Source / episode info

• **Episode:**220
• **Title:**Divine Intervention Episode 220 – USMLE Step 2CK Rapid Review Series 34.
• **Published:**2020-03-13
• Source:Episode page

One-liner

This episode provides a high-yield rapid review of classic board presentations across multiple systems, including the pathophysiology of various cardiomyopathies (eccentric vs. concentric hypertrophy), common neurological syndromes (Ménière's, BPPV, GBS), and critical endocrine tumor diagnoses (VIPoma, Gastrinoma, Glucagonoma) with associated diagnostic workups.

High-yield summary

• Cardiomyopathy: Chronic volume overload leads to eccentric hypertrophy (dilated cardiomyopathy, systolic failure); chronic pressure overload leads to concentric hypertrophy (diastolic dysfunction, S4 gallop).
• VIPoma Triad: Characterized by watery diarrhea, hypochloremia, and a normal anion gap metabolic acidosis with a negative urinary anion gap. Associated with MEN1 syndrome.
• BPPV Diagnosis/Treatment: The diagnosis is confirmed via the Dix-Hallpike maneuver; treatment requires repositioning maneuvers like the Epley maneuver.
• MEN2A Syndrome: Triad includes Medullary thyroid cancer, Pheochromocytomas, and Parathyroid hyperplasia. Prophylactic total thyroidectomy is recommended due to high risk of medullary carcinoma.
• Parkinson's Disease: Associated with degeneration/pigmentation of the substantia nigra. Treatment involves anti-dopaminergic agents (e.g., L-DOPA). Be aware of drug-induced parkinsonism from antipsychotics (e.g., clozapine, haloperidol).
• GBS: Acute flaccid paralysis following an infectious trigger (especially GI); pathophysiology involves Schwann cell destruction; treatment requires plasma exchange.

Learning objectives

• Differentiate the physiological changes and clinical presentations of eccentric vs. concentric cardiac hypertrophy.
• Identify the classic biochemical triad associated with VIPoma, including the interpretation of urinary anion gap.
• Recognize the key signs, symptoms, and diagnostic maneuvers for BPPV and Ménière's disease.
• Understand the pathophysiology and management principles of common neurotoxin/drug-induced parkinsonism.
• Correlate specific endocrine tumors (e.g., Gastrinoma, Glucagonoma) with their associated biochemical abnormalities and screening tests.