All right. Welcome. My name is Divine. This is episode 648 of the Divine Intervention Podcast.

And in today's podcast, we're going to be continuing the rapid review series for Step 2,

CK and step three. This is going to be series 135. All right. So what if they give you a question about a boy? And they tell you that, you know, he's a seven-year-old boy. And they tell you that he's a, his dad brings him to the emergency room. Because for the last two days, this boy has been having significant pain in his great toe, right?

Significant right-sided great-to pain, right?

And then you're told in the question that this boy, that many maternal brothers have also had similar symptoms, you know, over the course of their lives.

And then they show you photos and you see these boys' fingers and these boys' fingers just

look very nasty. You know, you see all these like lesions on the fingers, right?

You just see all these lesions on the, the fingers just look very nasty, right?

Like the fingers, the nails look very short and all those things, right?

And then they ask you which of the following is the most likely on the line mechanism behind this person's a problem?

Well, I'd really hope that you're thinking of a defect in hypoxanctin-guanine phosphorybosol transferies. Hypoxanthin-guanin phosphoryibosyl transferis.

Hypoxanthin guanin phosphoribosotransferase, H.G.R.T. In your mind, you're like, wait, what? Yeah. So what do you think this person has? Well, this person has Lishnaihan syndrome, right? This person has Lishnaihan syndrome. So let's kind of talk about this right that the thing is they love to test this on the exams this is not just some step

one factoid that Lishnai Hand syndrome. So let's kind of talk about this, right? The thing is they love to test

this on the exams. This is not just some step one factoid that they test. No, this is something that

they also love to test on step 2-K and step three, right? But basically, the way it's going to present

is you're going to basically see a young boy, right? You know, that has like,

you know, self-mutilation behavior, right? And he can have signs and symptoms of gout, right? So the pathophase

of this disorder, right, it's basically a defecting HGPRT, HGPRT, right? So hypoxanthine,

guanin, phosphorybosol transferase, hypoxanctin-Guanine phosphoryibosal transferase.

Hypoxanctin-Guanine-phosphoryibosal transferase.

This enzyme is needed in the purine-salvage pathway, right?

So the thing is sometimes on you exams, instead of putting Lish-Nihann syndrome as the answer,

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