Source / episode info
- **Episode:**533
- **Title:**Divine Intervention Episode 533: 2024 USMLE Step 2CK Free 120 Discussion Part 11 (Q81-90)
- **Published:**2024-04-19
- Source:Episode page
One-liner
This episode covers critical board topics including the workup of postoperative oliguria (ruling out urinary retention), selecting antidepressants in patients with seizure history, diagnosing female factor infertility following PID, identifying DCIS on mammography, and differentiating endogenous vs. exogenous hypoglycemia sources.
High-yield summary
- Postoperative Oliguria: Decreased urine output after surgery is most likely due to urinary retention (due to anesthesia/opioids) rather than acute kidney injury; initial management requires bladder ultrasound.
- Antidepressants & Seizures: In patients with a history of seizures or seizure predisposition, avoid drugs that lower the seizure threshold, such as Bupropion (an NDRI). Mirtazapine is often preferred due to its mechanism and side effect profile.
- Infertility Clues: A history of Pelvic Inflammatory Disease (PID) strongly suggests tubal damage/scarring, leading to female factor infertility, even if the Hysterosalpingogram (HSG) appears normal.
- Breast Imaging: Pleomorphic microcalcifications on mammography are highly suspicious for Ductal Carcinoma In Situ (DCIS) and require biopsy.
- Hypoglycemia Workup: If hypoglycemia is accompanied by a low C-peptide level, the cause is likely exogenous insulin administration (factitious disorder), not an endogenous source like an insulinoma.
Learning objectives
- Differentiate between the causes and initial management of postoperative oliguria (urinary retention vs. AKI).
- Select appropriate antidepressants based on coexisting conditions, particularly seizure history.
- Identify high-yield risk factors for female factor infertility (e.g., PID) that may override normal imaging results.
- Interpret mammographic findings to diagnose DCIS and understand the clinical significance of microcalcifications.
- Recognize the biochemical pattern distinguishing endogenous hypoglycemia (insulinoma) from exogenous insulin administration (factitious disorder).
Board exam buzzwords