Source / episode info
- **Episode:**646
- **Title:**DIP Ep 646: USMLE Free 86 Series 8 (Q67-76, for Step 2/3)
- **Published:**2026-04-06
- Source:Episode page
One-liner
This episode covers diverse clinical scenarios including the management of physiologic neonatal jaundice and erythema toxicum neonatorum, appropriate timing for inguinal hernia repair in children, workup of acute nephrolithiasis via non-contrast CT, diagnosis of anticholinergic toxicity from medications like opioids/TCAs, recognizing Mobitz I AV blocks post-MI, and suspicion of child abuse requiring a skeletal survey.
High-yield summary
- Physiologic Jaundice: Indirect hyperbilirubinemia is common in the first week of life; phototherapy is generally reserved for total bilirubin levels 20 { mg/dL} (or based on specific risk curves).
- Indirect Inguinal Hernia: Due to a persistent processus vaginalis, these hernias require elective surgical repair in young children (<1 year) due to the high risk of incarceration and strangulation.
- Nephrolithiasis Workup: The gold standard imaging for suspected kidney stones is a non-contrast CT scan of the abdomen, as this modality best visualizes calculi anywhere in the urinary tract (kidney, ureter, bladder).
- Anticholinergic Toxicity: Symptoms include polyuria, dry mouth, blurred vision, and altered mental status. Culprit drugs include TCAs (e.g., Amitriptyline) and certain opioids/antipsychotics.
- Cardiac Monitoring Post-MI: An asymptomatic Mobitz Type I AV block requires only observation; pacing or atropine is reserved for symptomatic bradycardia.
- Child Abuse Suspicion: When a child's presentation does not "add up" (e.g., story doesn't match injury), suspicion of non-accidental trauma mandates obtaining a skeletal survey to look for occult fractures, avoiding high-dose radiation like CT scans.
Learning objectives
- Differentiate the management of physiologic jaundice versus pathological hyperbilirubinemia in neonates.
- Identify the appropriate diagnostic imaging modality and technique for suspected urinary tract calculi.
- Recognize signs and symptoms of anticholinergic toxicity from various drug classes (e.g., TCAs, opioids).
- Classify and manage different types of Atrioventricular (AV) blocks following myocardial infarction based on symptom status.
- Apply clinical reasoning to suspect non-accidental trauma when a child's history is unreliable or inconsistent.