Source / episode info

• **Episode:**330
• **Title:**Divine Intervention Episode 330 – USMLE Step 2CK Rapid Review Series 61.
• **Published:**2021-08-02
• Source:Episode page

One-liner

Episode 330 is a comprehensive review covering vascular lesions (hemangiomas), genetic syndromes associated with neurocutaneous findings (VHL, TSC, Prader-Willi/Angelman), critical care management of ARDS and CLABSI, and high-yield topics like HIV prophylaxis and family therapy.

High-yield summary

• Hepatic Hemangioma Imaging: Classically shows peripheral enhancement in the arterial phase, followed by centripetal filling in later phases on CT/MRI.
• ARDS Pathophysiology: Characterized by non-cardiogenic pulmonary edema; thus, the Pulmonary Capillary Wedge Pressure (PCWP) is typically normal (<18 mmHg), but Central Venous Pressure (CVP) and right heart pressures are elevated due to increased systemic inflammation.
• Tuberous Sclerosis Complex (TSC): Associated with seizures (West Syndrome/Infantile Spasms, diagnosed by Hypsarrhythmia on EEG); characteristic skin findings include hypopigmented macules ("ashy spots"). The drug of choice for infantile spasms is ACTH.
• VHL Syndrome: Presents with posterior fossa hemangioblastomas and polycythemia; patients are at high risk for developing Renal Cell Carcinoma (RCC) and Pancreatic Cancer.
• CLABSI Workup: Requires obtaining two blood cultures: one from the catheter lumen and one from a peripheral vein. A differential growth rate (higher growth in the catheter sample) strongly suggests CLABSI. Treatment involves removing the catheter and administering incontamining.
• Genetic Syndromes & Autism: Prader-Willi Syndrome is linked to paternal deletion of chromosome 15; Angelman Syndrome is linked to maternal deletion of chromosome 15.

Learning objectives

• Differentiate the clinical presentation and management of various neurocutaneous syndromes (TSC, NF1).
• Interpret chest imaging findings in ARDS to distinguish between cardiogenic and non-cardiogenic pulmonary edema.
• Recognize the diagnostic criteria and workup protocol for central line associated bloodstream infections (CLABSI).
• Understand the genetic basis and clinical manifestations of chromosome 15 deletions (Prader-Willi vs Angelman).
• Apply knowledge of critical care management principles in ARDS, including ventilator strategies and positioning.