Source / episode info

• **Episode:**29
• **Title:**Divine Intervention Episode 29 – 3rd Year Medicine Shelf Review Part 1.
• **Published:**2018-05-18
• Source:Episode page

One-liner

This comprehensive review covers critical board topics including cardiac murmurs (MS), metabolic emergencies (hypoglycemia, AI), infectious diarrhea differentials, nephritic/nephrotic syndromes, iron overload workup, and management of acute respiratory distress.

High-yield summary

• Mitral Stenosis: Classic finding is an opening snap followed by a low-pitched diastolic rumble at the left 4th interspace; associated with elevated Jugular Venous Pressure (JVP) A waves.
• Hypoglycemia Workup: Must differentiate causes using labs: Insulinoma (high insulin, low glucose), Factitious (excess exogenous insulin/sulfonylurea), or other drugs (e.g., sulfonylureas). Acute treatment is IV dextrose or glucagon.
• Adrenal Insufficiency (AI): Primary AI involves low cortisol and low aldosterone; secondary AI involves low cortisol but normal aldosterone (due to preserved RAAS axis). Stress dosing requires hydrocortisone.
• Iron Overload: Diagnosed by elevated ferritin/TIBC, confirmed by Prussian blue staining of bone marrow smears (basophilic inclusions); treated with chelation therapy (e.g., deferoxamine).
• Acute Kidney Injury (AKI): Causes are multifactorial; prevention includes holding specific drugs (e.g., DM medications) before contrast CTs, and recognizing nephrotoxins (NSAIDs, aminoglycosides).
• GI Diarrhea: Must differentiate bugs based on presentation: C. difficile (bloody/pseudomembranous after antibiotics), Giardia (watery, chronic), Shigella (bloody, high inoculum), Salmonella (fever, bloody).

Learning objectives

• Differentiate common causes and acute management strategies for hypoglycemia.
• Recognize the classic physical exam findings associated with valvular heart disease (e.g., Mitral Stenosis).
• Apply knowledge of infectious diarrhea etiologies based on clinical presentation and travel history.
• Compare primary versus secondary adrenal insufficiency, including appropriate diagnostic testing and stress dosing protocols.
• Interpret bone marrow staining and iron studies to diagnose iron overload syndromes.