All right. Welcome everybody. My name is Divine. This is episode 584 of the Divine Intervention Podcasts.

In today's podcast, we're going to be continuing the series on the USMaly Step 1, 312. This is going to be part 4.

Again, if you're studying for Step 2, Step 2, Step 3, very useful podcasts, to listen to a lot of very good knowledge and learning here.

And many of these questions, they're kind of like examples of like the shorter step two, CK, step three questions you'll see on your exams. All right. So let's pick up with question 31. Three-year-old boy is brought to the office because of a two-day history of bulging of his left eye. He says his left, his eye hurts. He has no history of major medical illness

or recent trauma into the area,

and he receives no medications.

Vital signs are within normal limits.

Physical examination shows exophthalmos of the left eye.

MRI of the brain shows a two centimeter mass

involving the ocular muscles of the left eye.

Okay, the ocular muscles of the left eye. A. The ocular muscles of the left eye.

A biopsy specimen of the mass shows malignant cells, some of which have striations,

which of the following is the most likely diagnosis, right?

So let's try to work this out.

So we see this person has exophthalmos, you know.

You know, many of us probably know it's a real grave's disease,

but again, it's highly unlikely that a three-year-old will have Graves disease. And this question, stem says nothing about like a neck mass, right? So it's probably not Graves disease. And another thing to also point out here is that this, we're told that, oh, this person has a mass involving the muscles. So this is probably a muscle-based mass,

a muscle-based mass, a muscle-based mass, a muscle-based mass. Another thing that also kind of guides us

in that direction is that, you know, the cells are malignant, and they have striations. Remember,

muscle tends to be striated. Obviously, the striated muscle and they're smooth muscle. Remember,

your striated muscle are going to be skeletal muscle or cardiac muscle. Those are your striated or obviously the strided muscle and the smooth muscle. Remember your striated muscle muscle are going to be skeletal muscle or cardiac muscle. Those are your strided muscles. So we need to

find a muscle based mass answer here, right? A muscle based tumor. So option A says neuroblastoma, that's going to be

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