Source / episode info
- **Episode:**238
- **Title:**Divine Intervention Episode 238 – USMLE Step 2CK Rapid Review Series 37.
- **Published:**2020-05-28
- Source:Episode page
One-liner
This episode provides a rapid review covering the causes of protein-losing ascites (Kwashiorkor, Nephrotic Syndrome), interpreting Tuberculin skin test results based on immune status, recognizing classic signs of myelopathy, managing rhabdomyolysis labs, diagnosing necrotizing enterocolitis in neonates, and linking chronic inflammation to various lymphomas.
High-yield summary
- Ascites: Protein malnutrition (e.g., Kwashiorkor) or severe protein loss (Nephrotic Syndrome, Protein-losing gastropathy) leads to decreased oncotic pressure, favoring transudation into the peritoneal cavity.
- Paracentesis: If neutrophils > 250/mm³, treatment with a third-generation cephalosporin (e.g., Ceftriaxone) is indicated, regardless of culture results.
- Tuberculosis Screening: Tuberculin skin test interpretation depends on immune status: 15 mm = positive; 10 mm = healthcare worker/moderate risk; 5 mm = immunocompromised (HIV, chronic steroids, transplant).
- Myelopathy Signs: The four cardinal signs are urinary incontinence, UMN symptoms in lower extremities + LMN symptoms in upper extremities, a sensory level, and abnormal spinal tract signs (e.g., loss of pain/temp sensation vs. vibration/fine touch).
- Rhabdomyolysis Labs: Characterized by elevated CK, hypocalcemia (due to phosphate binding), and hyperkalemia (release from damaged muscle cells). Immediate treatment requires calcium gluconate.
- NEC: A surgical emergency in premature infants, typically associated with Clostridioides difficile infection; diagnostic finding is pneumatosis intestinalis on abdominal X-ray.
Learning objectives
- Differentiate the causes and clinical presentations of protein-losing ascites based on underlying systemic disease.
- Interpret Tuberculin skin test results according to patient immune status (e.g., HIV, chronic steroids).
- Identify the classic signs and differential diagnoses associated with spinal cord pathology (myelopathy).
- Recognize the characteristic laboratory triad and immediate management for rhabdomyolysis.
- Understand the pathophysiology and diagnostic findings of necrotizing enterocolitis in premature infants.