Source / episode info

• **Episode:**291
• **Title:**Divine Intervention Episode 291 – USMLE Step 2CK Rapid Review Series 51 (+ USMLE Step 2CK/3 Course Reminders).
• **Published:**2021-03-05
• Source:Episode page

One-liner

This episode provides a rapid review covering GI tract management (GERD/achalasia workup), pharmacological principles (antiplatelets, CCBs), infectious disease patterns (pneumonia in COPD), diagnostic procedures (paracentesis), and high-yield genetic disorders (trinucleotide repeats) and neuroanatomy.

High-yield summary

• Achalasia Workup: The standard sequence is Barium Swallow -> Manometry -> EGD. Barium swallow may show a "bird's beak" sign, while manometry confirms aperistalsis/dilated esophagus.
• GERD Management: PPIs are indicated for severe GERD symptoms, hot tarry burns, increased intracranial pressure (ICP), and long-term bisphosphonate use to protect the esophageal mucosa.
• Antiplatelet Drugs: Aspirin is a COX inhibitor that causes net vasoconstriction; P2Y12 inhibitors (e.g., clopidogrel) are vasodilators due to increasing cAMP levels. Cilostazol/Dipyridamole inhibit phosphodiesterase and are potent vasodilators.
• Genetic Disorders: Trinucleotide repeat disorders must be memorized by their specific repeats, inheritance pattern, and clinical presentation (e.g., Fragile X: CGG; Huntington's: CAG).
• Neuroanatomy: Paroxysmal Diurnal Vertical Diplopia suggests a superior colliculus issue, potentially due to pinealoma compression or occlusion of the superior cerebral artery.

Learning objectives

• Outline the appropriate diagnostic sequence for suspected esophageal motility disorders (achalasia).
• Differentiate between antiplatelet agents based on their mechanism of action (COX inhibition vs. P2Y12 antagonism/PDE inhibition) and resulting vascular effects.
• Identify the clinical features, associated lab abnormalities, and differential diagnoses for malabsorption syndromes like Celiac disease versus Lactase deficiency.
• Recognize the classic signs and genetic basis of major trinucleotide repeat disorders (e.g., Fragile X, Huntington's).
• Interpret paracentesis findings to diagnose Spontaneous Bacterial Peritonitis (SBP) in cirrhotic patients.

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