Welcome, my name is Devine. This is episode 487 of the Devine Intervention

Podcast. In this podcast I'm going to be continuing the rapid review series

for the USMLI Step 2C3 exams. This is going to be serious 104. Let's get right into it. So what if they give you a question about a 25 year old male and he tell you that he's 6 foot 5 inches tall and for the past two hours he has had very significant chest pain and then they tell you that his blood pressure is 115 over 80 his heart rate is 85 beats per minute and his respiratory rate is 19 breaths per minute.

I ask for the next best stepping diagnosis.

I really hope you're saying O' Dev oh divine sounds like we're going to get a

chess CT and geogram with contrast right this person clearly clearly has an aiotic

dissection. I may wonder divine how do you know this person has an eyotic

dissection well pretty straightforward number one the person is six foot five inches tall

the US same at least they're not just gonna give heights of people for no great

reason it's kind of ridiculous, right? They're pretty

more telling you the person has Marfan syndrome. So the person likely has Marfan

syndrome and Marfans, remember, they can have a cystic media necrosis, which are called cystic

media, a degeneration of the eotic media, and because of that, they can have

dissection. And if you look at the vitals that I give you because this person is totally fine from a vital perspective,

you know they have the chest pain but they don't seem to be very poorly, then it makes sense to do a CT chest and

yoga with contrast. That's how you diagnose a unique dissection when a person is stable.

But if a person has a unique dissection and they're hemodynamics stable,

then you're going to do a TEE, you're going to do a transistors of a gel echocardiogram. Can't do a trans-A-Tranz of a gale-eccardogram.

Now, so when you may say, Divine, is there something else that could be the right answer in this

question? Absolutely. Something else that could be the right answer in this question is the person having some kind of pneumo thorax, pneumothorax.

But the thing is, if they want you to think pneumothorax, they will give you something along the lines of decreased breath sounds somewhere.

They will give you something about maybe the person having like, you know,

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