Source / episode info

• **Episode:**415
• **Title:**Divine Intervention Episode 415 – USMLE Step 2/3 Rapid Review Series 84
• **Published:**2022-10-05
• Source:Episode page

One-liner

This episode provides a rapid review of high-yield topics including the embryology and clinical presentation of pharyngeal clefts, electrolyte abnormalities (hypocalcemia/hypercalcemia), management of liver failure complications (HE/SBP), and metabolic disorders like PCT.

High-yield summary

• DeGeorge Syndrome: Caused by 22q11 deletion; presents with T-cell deficiency (thymus aplasia), hypocalcemia, cardiac defects, and characteristic facial features.
• Pharyngeal Clefts: Must distinguish the origin: Thyroid Glossodochist is endodermally derived and moves with swallowing; Brinkel cleft cysts are ectodermally derived and do not move.
• Electrolyte EKG Pearls: Hypocalcemia causes a prolonged QT interval, while hypercalcemia causes a short QT interval.
• Hepatic Encephalopathy (HE): Characterized by altered mental status without abdominal pain or ascites; treated with ammonia scavengers like Lactulose and Rifaximin.
• Spontaneous Bacterial Peritonitis (SBP): Diagnosis requires paracentesis showing >250 neutrophils. Prophylaxis is typically a fluoroquinolone alone.
• PCT: Deficiency of Uroporphyrinogen decarboxylase; the acute, intermittent form is hereditary and triggered by drugs/illness.

Learning objectives

• Differentiate the embryological origins and clinical presentations of pharyngeal cleft anomalies.
• Recognize the classic EKG changes associated with hypo- or hypercalcemia.
• Establish the diagnostic criteria and management strategies for hepatic encephalopathy versus spontaneous bacterial peritonitis.
• Understand the pathophysiology and treatment of porphyrias (PCT).
• Identify key differentiating features between various types of abdominal/pelvic fluid collections.