Source / episode info

• **Episode:**442
• **Title:**Divine Intervention Episode 442: USMLE Step 2/3 Rapid Review Series 92
• **Published:**2023-02-17
• Source:Episode page

One-liner

This episode provides a rapid review of the diagnostic criteria and clinical presentations for major anxiety disorders—specifically differentiating specific phobia from GAD, PTSD, and panic disorder—and reviews classic physical exam findings to distinguish between various drug intoxications (alcohol, cocaine, opioids, methamphetamines).

High-yield summary

• Specific Phobia: Fear centered on a single object or situation (e.g., dogs, heights); symptoms must persist > 6 months and cause functional impairment; the best initial treatment is Cognitive Behavioral Therapy (CBT).
• Generalized Anxiety Disorder (GAD): Worrying about multiple, diverse life domains (work, finances, health) for > 6 months; worry is excessive and difficult to control.
• PTSD: Requires a history of defined trauma (e.g., combat exposure, assault); symptoms include intrusive memories, avoidance, hyperarousal, and lasting > 1 month.
• Alcohol Intoxication: Classic signs include disinhibition, slurred speech (ataxia), and potential hypoglycemia due to depletion of {NAD}^+ (Nicotinamide Adenine Dinucleotide).
• Opioid Intoxication: Characterized by respiratory depression and bilateral miosis (pinpoint pupils) due to decreased central noradrenaline release.
• Cocaine Intoxication: Associated with adrenergic stimulation, leading to hypertension, tachycardia, and dry mucous membranes (dry mucosa) due to _1 receptor effects.

Learning objectives

• Differentiate the diagnostic criteria distinguishing Specific Phobia from GAD, PTSD, and Panic Disorder based on triggers, scope of worry, and trauma history.
• Recognize the classic physical exam findings associated with various drug intoxications (e.g., miasis for opioids, dry mucosa for cocaine).
• Understand the metabolic consequences of alcohol intoxication, particularly hypoglycemia due to \text{NAD}^+ depletion.
• Apply appropriate initial management steps for acute intoxication and withdrawal syndromes (e.g., NALOXONE administration, benzodiazepines for withdrawal prophylaxis).

Board exam buzzwords