All right, welcome. My name is Divine. This is episode 638 of the Divine Intervention Podcasts. In today's

podcasts, we're going to be continuing the Rapid Review series for the US Emily Step 2C and Step 3 exams.

This is going to be series number 134. 134. We've made a lot of these. Again, the USMLs, they just keep expanding in content, so

unfortunately we need to keep covering this material. So what if they give you a question about

a patient? And they tell you that this patient, you know, for the last, you know, 24 hours,

has been having very, very severe abdominal pain.

And you're told that this patient was recently diagnosed with malignancy.

And that the patient has been placed on, was recently initiated on opioids.

And then they tell you that they perform radiographic imaging of the abdomen, and you notice that the person's transverse colon is massively dilated.

When you see something like this, I really hope you're going to pick the answer, and they ask you for the diagnosis.

I really hope you're picking the answer that talks about a toxic megacolon, right?

So the thing is I know some of you may be like, Devine, what? What are you talking about toxic mega colon with a person that is on opioids? Again, our friends at the NBM is, they're very, they're very smart, right? So they know that everybody has memorized that, ooh, toxic megacolon has a very strong association with C-DIF colitis, right?

You know, so C-D-F, right, whenever you see a person that has C-DF, and you notice that, wow, the abdominal pain just takes like a big step up. You want to think about toxic megacolon under those circumstances, right? But there are other people that can certainly get toxic megacolon on the USMAL exams, right? So you want to think of it in the context of a person that for whatever reason may have like elias right they may have like

alias and that can be superimposed with some kind of infection right and then the transverse

colon just starts dilating dilating like crazy right so in fact if it's more than if your transverse

colon is more than six centimeters in diameter that's really worrisome for toxic megal colon those

people have to be watched very very very closely right they have to be watched

very closely they have to be mid-MPO right and again if you notice that they are

beginning to have signs of bowel ischemia infarction then those people are gonna

need surgery they're gonna need surgery right So keep that at the back of your mind for

exams, right? So toxic megacolon, yes, there is the classic Cidiff association, but it can also

be associated with the inflammatory bowel disease, right? It can be associated with situations

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