Source / episode info

• **Episode:**535
• **Title:**Divine Intervention Episode 535: 2024 USMLE Step 2CK Free 120 Discussion Part 12 (Q91-100)
• **Published:**2024-05-10
• Source:Episode page

One-liner

This episode covers a broad range of clinical scenarios including pediatric UTI workup (Ultrasound -> VCUG), infectious disease management (Pertussis/CF pneumonia), orthopedic genetics (Multiple Hereditary Exostosis), GI bleeding patterns (Diverticulitis), developmental psychiatry (Normal adolescent changes), and congenital syndromes (DiGeorge Syndrome).

High-yield summary

• Pediatric UTI Workup: Always start with a renal ultrasound to rule out anatomical defects; only proceed to VCUG if the ultrasound is negative.
• Pertussis: The classic presentation of persistent cough, especially following URI symptoms, requires treatment with a macrolide antibiotic (e.g., Azithromycin).
• CF Pneumonia: When managing pneumonia in CF patients, obtaining sputum cultures is crucial for guiding targeted and effective antibiotic therapy.
• GI Bleeding Patterns: Painless, bright red blood per rectum in an elderly patient strongly suggests diverticulosis; rule out other sources like angiodysplasia or colon polyps.
• Hypersensitivity Pneumonitis (HP): Chronic lung symptoms following exposure to inhaled organic antigens (e.g., mold, bird droppings, sawdust) require consideration of HP and removal from the source.
• DiGeorge Syndrome: The classic triad includes cardiac defects (VSD), palatal abnormalities (cleft palate), and T-cell immunodeficiency due to thymic hypoplasia/aplasia.

Learning objectives

• Differentiate the appropriate initial workup sequence for pediatric urinary tract infections (UTIs).
• Identify the key clinical features and required treatment for Bordetella pertussis.
• Recognize the signs, symptoms, and differential diagnoses associated with chronic occupational lung disease like Hypersensitivity Pneumonitis.
• Apply knowledge of congenital syndromes, specifically DiGeorge Syndrome, based on physical exam findings and history.
• Determine the appropriate management strategy for non-epileptic seizures (psychogenic seizures).