Welcome, my name is Devine. This is episode 480 of the Devine Intervention

podcasts. In today's podcast we'll be going over the rapid review series for the USMELI Step 2, CK, 3 exams,

and this is going to be Series 101. Big milestone there. Okay, so let's just get right into it. So what if they give you a

question about a 22 year old male and he comes into the emergency room

because for the past 12 hours he has been having severe knee pain.

And they tell you that on physical exam the right knee is red, it's warm, it's erythamorous.

And then they ask you for your next best step in management.

And obviously in that case you're going to think of

Athos and thesis. But let me maybe present a different question to you. What if

they tell you that all this person that they show you, maybe play a video or they show you pictures of the person's skin. This is how the US family will do it.

And you notice that this person has so many wounds on their skin. What should you be

thinking about here?

Well, I really hope you're saying that, oh, divine, this person, it looks like they have a Leshnaihan syndrome.

So when in the world is Leshnihan syndrome,, well many of us probably heard of it, you're basically going to see a person that has self-mutilating behavior and they have hyper-urissemia.

So this person, obviously, they have gout and I will explain the path of

phase, they have gout. But this gout that they have, right, if you check their joint, because really

if a person comes in with a red hot tender joint. The first thing you really want to do is to

perform a through synthesis. So you perform a through synthesis and get some

fluid from this person, obviously you're going to see these needle-shaped, right? These are needle-shaped

shaped negatively birefringent crystals.

Then you know the oldest person has gout,

pressing has hyperyoresemia.

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