Source / episode info
- **Episode:**74
- **Title:**Divine Intervention Episode 74 – USMLE Step 3/Medicine ITE/ABIM Board Review Series 1
- **Published:**2019-01-14
- Source:Episode page
One-liner
This episode provides a comprehensive review covering hemolytic anemias (G6PD, HS, AIHA, PNH), AKI etiologies (contrast nephropathy, ATN, pre-renal states), GI bleeding/vascular emergencies (AAA, varices, mesenteric ischemia), and chronic liver diseases (cirrhosis, PSC, PBC, Wilson's) with an emphasis on board-style clinical vignettes.
High-yield summary
- G6PD Deficiency: Triggered by oxidative stress (e.g., sulfa drugs, fava beans). Key findings include Heinz bodies and bite cells on smear; diagnosis requires checking G6PD levels after the inciting event.
- AKI Classification: Pre-renal AKI is characterized by low urine sodium (<20 mEq/L) and a BUN:Cr ratio <20:1, requiring fluid resuscitation. Intrinsic AKI (ATN) can be caused by nephrotoxins (NSAIDs, aminoglycosides, cisplatin).
- Cirrhosis Management: Spontaneous Bacterial Peritonitis (SBP) is diagnosed with PMN count > 250/mL in ascitic fluid and treated empirically with a third-generation cephalosporin (e.g., ceftriaxone).
- Vascular Emergencies: For suspected AAA rupture, if the patient is hemodynamically unstable AND has a pulsatile mass on exam, proceed immediately to the OR; otherwise, CTA is appropriate.
- Liver Disease Markers: The Serum Albumin to Ascitic Fluid (SAAG) gradient helps differentiate portal hypertension (gradient > 1.1) from peritonitis carcinomatosis (gradient < 1.1).
Learning objectives
- Differentiate the pathophysiology and diagnostic findings among various causes of hemolytic anemia (G6PD, HS, AIHA, PNH).
- Classify AKI based on etiology (pre-, intrinsic, post-renal) and apply appropriate initial management steps.
- Recognize the clinical presentation and emergency workup for major vascular catastrophes (AAA, mesenteric ischemia).
- Understand the pathophysiology and screening guidelines for chronic liver diseases (cirrhosis, PSC, PBC).
- Apply ethical principles regarding capacity versus competence in medical emergencies.
Board exam buzzwords