DIP Episode 258 - USMLE Step 2CK Rapid Review Series 42 (and upcoming 10 hr course 9/5/20)

Okay, welcome. My name is Divine. This is episode 258 of the Divine intervention podcast. And in this podcast, I'll be continuing our Rapid Review series for the US Emily Step Juicy K exam. And this is going to be series 42. Just as a reminder, especially for those of you who are taking your steps Juicy K exams this month or early next month, I have again the 10 hour class against being well received by a ton of people. At this point, a pretty decent number of people have gone through the course probably close to 300. So I have it this Saturday. There's still a very few spots remaining. It's a 10 hour class. And again, between 6 and 10 a.m. Pacific time, known for P and Pacific time. We'll review of almost 800 vignettes that caught across medicine, surgery, OB-Guy, PEEDS, psych and near. So if that's something you're interested in, feel free to reach out to me. Again, it's on the 5th of September. It's literally the Saturday, via Zoom. And then next week, Thursday from 4 to 6 or 6 30 p.m. Pacific, I'll be holding a test ticket and strategy scores. Basically, the main focus of the course would be how to work on MDM exams. And then on Friday and Saturday next week, this 10 hour course, I'm going to break it open to two days. I'm going to have like a 2 D version. So, meet for 5 hours on Friday, the 11th of September. And for 5 hours on Saturday, the 12th of September. So if you're interested in any of these courses, again, I reach out to me.

And then we're going to take things from there. Okay. So let's jump right into it. So, what if they give you a question, you know, about like a 3-year-old kid, or they may even make this a 2-in-3-year-old female. Or they can make this a 56-year-old male, right? They can basically make this any age. And you see this person over a couple of hours, not days, few hours. This person goes from well to hanging on for a year like this person has like profound respiratory distress, his tripod in has like crazy high fever. These are no people that get fever of 100.8. On MBM, 70 people's fever is like 102. If you see this, what are you thinking about? I really hope you're telling me that you're thinking about epiglottitis, right? Epiglottitis. And I mean, if it's someone that's on vaccinated, obviously, it could be like H-flu, although it could also be like strep pneumo, for example. So remember, there are many things these days that cause epiglottitis. And more commonly, these days is probably not going to be H-flu on a test. But remember, whenever a person has epiglottitis, your first step is to go ahead and perform an indutriculum intubation for those people. And remember, for these people, if you're giving them antibiotic therapy, you want to give them a third-generation cephalospory, a third-generation cephalospory, like Cephtriaxone, or cephotoxy. And then, don't forget that if you were to take like a laryonic radiograph of these people, you'll see like the thumpsign.

That's a classic thing you see on the exams. And then, what if they give you a question about like a person that was just, you know, he just returned from deployment in like some country. And then this person, for the last three weeks, this person has been having like cough, was behaving him up to sis. And he tell you that he has lost like 12 pounds of weight over that time period. I really hope if you see something like this, you're thinking more along the lines of TB, right? And again, whenever you see a person that has TB like this, whenever they are symptomatic, you want to try to go for definitive diagnosis, right? Especially judging that this person is pretty high risk. So for these people, you want to, you know, kind of do this asset faster. You want to do like a bronchial of your lavage, or you know, get like an induced pyrrhum sample and do the asset faster, basilized state on it, right? And then you obviously send off the spirit for culture, right? To try to figure out if this person has TB. And obviously, if a person has TB, right, you want to put them on the right page. You want to give them right fan pin, isonize it, pyrazinamide and ethambe talk, right? Plus vitamin B6. And one thing I want to call to attention here is it's actually high. You also know that toxic is associated with those TB medications, right? So we know that isonize it, right? It can cause a peripheral neuropathy, right? And it can also is also hepato toxic, right?

And remember that isonize it can also cause a drug induced lupus, right? Remember those anti-histon antibodies? Please don't forget, right? Isonize it, remember, it can also cause an anemia. If you dig it for a long enough period of time, you can get it or blast anemia. Because if you remember from step one, right? If you remember the synthesis of heim, right? I'm sure some of you are like, oh, yeah, I remember this from back in the day, right? If you remember in the synthesis of heim, the first step involves glycine, right? And succino-coe, right? Coming together under the action of an enzyme, right? Aminolevolinic acid synthetase, alas. Remember, alas uses vitamin B6 as a cofactor, right? So if you dig it, it'sonize it and don't listen to your doctor in taking a paradox, a paradox or phosphate. The net reaction is not going to work. If it doesn't work, well, guess what? You're going to have a lot of problems, right? A lot of problems, right? So the person will have acetyroblastic anemia because they essentially have issues with heim synthesis. So if they give you a question about a person that has been on isonize it for a couple of months, and the person has a micro-sterecaneemia, you want to think about acetyroblastic anemia being caused by virtue of a B6 deficiency, right?

And then also do not forget that people that have isonize it again, they can get seizures, they can take, they can have peripheral neuropathy because again, if you remember going from glutamate to GABA, right? It's a reaction. Like, little GABA is made from glutamate. Remember glutamate is an excitatory neurotransmitter? GABA is an inhibitory neurotransmitter. The enzyme that means that conversion glutamate decarboxyl is from glutamate to GABA. I use this B6 as a cofactor. So again, if you like B6, you're going to have a buildup of glutamate, you're going to have a downgrade or reduction in the amount of GABA you have, right? So more excitational legs, less relaxation, right? So you're going to get or less inhibition. So you're going to be more predisposed to getting seizures. And then again, isonize it again because it depletes your B6. Remember, many of the enzymes that are pretty in the liver, many of those transaminase enzymes, right? Like ELT, EST, all these things, they all depend on vitamin B6. B6 is the cofactor for many of these hepatic enzymes, right? Again, for pressing LX B6 because they are taking isonize, it would always into their doctor. Then those people are going to promptly get in, going to promptly get in, getting trouble, right? They're going to promptly get in trouble. And again, I feel like in general acid fast organisms, for some bizarre reason, tend to be high yields to know an exam, right?

So what are the high yield acid fast organisms to know, for example? Obviously, Michaelbach, German Tropicalosis, right? But under classic one, this one they'll say, oh, you see acid fast, oh, this is in a pressing stool, if you say, for HIV patients that has diarrhea, I hope with that you're thinking about a cryptosporidium parvom, right? Cryptosporidium parvom. Remember, cryptosporidium, you treat it with paromomycin on ita-zoxanite, right? Paromomycin on ita-zoxanite. And then the other acid fast organism emission on an end-bim exam, is if a person has no cardiac, right? Cardiac is also acid fast, right? It's also acid fast. That's one of those weird things that they love to test on exams, right? And don't forget your TB, your TB-indueration codoffs, right? For exams, right? So remember, five millimeters is a person that has HIV. So a person that has HIV. And so five millimeters, HIV person, right? Ten millimeters, healthcare workers, right? And then, 15 millimeters is positive in every one, right? So just things again, you're going to keep at the back of your mind on these tests. Okay. And then, what if they give you a question about some person that, you know, went in a field trip to New Hampshire, right? And then, for the last like three weeks, it preserves me having like bad, bad, bad joint pain. And they tell you in the question that the person did not notice any tick bites or anything of that sort. If you see that, what are you thinking about?

I hope you think about Lyme disease, right? Remember, again, Lyme disease is caused by Boralia Bokdofree. And it's actually high-youtu-no, the Boralia Bokdofree is a spirochid. I don't know for whatever bizarre reason. Bugs that are spirochids, the NB Ms love these things. That's one reason you should know. Another reason why you should know bugs that are spirochids is because these bugs, we are treating people for these, for, they have these bug problems. One thing that can happen is they can have this thing known as the Jarish Hexheimer reaction. The Jarish Hexheimer reaction is not something you only see with sephilis. Cosophilis is another spirochid. It's technically a reaction and you can see with any spirochid. So the newer NB Ms, I won't, it's not too much of a stretch to imagine them giving you a Jarish Hexheimer reaction. So you can see that the Jarish Hexheimer reaction question in a person that has Lyme disease. So remember what are the high-youtu-spirochids to know for example? Strapodema paladum, that's sephilis. Boralia Bokdofree. And then this bug that you find in Hawaii a lot, leptospirointerrogates. The bug that causes leptospiroosis, that's a spirochid. So technically anyone that has any of those problems can get a Jarish Hexheimer reaction. So this person obviously has Lyme disease. Well I hope you're telling me that you're going to do an Eliza first. And then you'll confirm the diagnosis with a Western blood.

And remember that Lyme disease, if a person has like these joint manifestations or has the Bosaer ash, right? If they are less than 8 years old, you're going to give them a Moxicillin. You're going to give them a Moxicillin. But if they are more than 8 years old, you give them Doxicillin. Remember that a Moxicillin rule also applies to pregnant females. You're not going to give Doxicillin to a pregnant woman. That will not be ideal. That will not be ideal. Cause all these terrible genetic problems in the kid. But one exception I want to mention to these diagnostic testing rules is, if for example a person has like the classic Bosaer ash, a thermo-cranical migraines, it's a classic question. You don't need to do any kind of diagnostic testing. For those people, you can just go ahead and give them a Doxicillin and call it a day. You don't need to do any diagnostic testing. When the person has the classic erythema, chronicom migraines, presentation in an NV Me question. Just something to keep out the buckle of your mind there. And again, remember that variable periphery is carried by the X-edistic. And remember that take also carries an aplasma and Babesia. Also carries an aplasma and Babesia. Remember by Babesia microddy, right? That's the thing that has that multi-scross pattern and a blood smear, right? Look at the red blood cells. Has this multi-scross pattern. So again, if you see a person that was recently exposed to the New England area, right? Again, Boston.

So you know, all these people from Harvard. So Boston, New Hampshire, New York, right? All those people connect, Yale, Connecticut, stuff like that. If you see these kinds of people, right? And you notice that they have malaria, stile symptoms. And they tell you that this person did not travel internationally. You want to be thinking about Babesia under those circumstances. You want to be thinking about Babesia under those circumstances. And then one other thing I want to mention, is whenever a person has a line that has started going through their brain or attacking their heart, so like lying myocarditis or like lying disease affecting the brain, then those people, you can't give them the docs, it's cycling or whatever anymore. You need to kind of step up your game. You need to give those people a third generation of cephalosporing, right? Like, like, cepatriaxal or cephotaxine. Again, that's actually very important to know, for example. I don't know if whatever bizarre reason, cephotaxine is beginning to become more and more important. On MBME exams as a third-gen cephalosporing. It's just something that for whatever reason, many people don't know. So that's like one of the things that I'm going to talk about. So that's like one of these high-value drugs that I've started popping up on on MBME exams. Kind of like the same thing with, even in SBP, right? Spontaneous bacteria, tonight, it's gonna be like, a person that has some kind of a sideys for any reason, right?

It can be a sideys because they have liver disease. It can be a sideys because they have, they have some kind of plastic in the abdomen. It can be a sideys because a person has butchery syndrome or whatever. If you have a sideys for any reason, right? And then the person is having abdominal pain, altered mental status, mouth fever, think about SBP under those circumstances, right? You know, from translocation of bacteria. So for those people, you typically want to do a parasyntesis, right? And then you're looking for those neutrophils. If you find more than 250 neutrophils, you have your diagnosis, right? You have your diagnosis. And then after that, you give those people a third. You're not trying to find bugs. All you're looking for is neutrophils. That's literally the diagnosing criteria, right? If I'm more than 250 neutrophils, you are good to go, right? You're good to go. You go ahead and give those people a third gen cephalosporine, again, like cepatraaxon or cephotoxin. And another of these weird cephalosporines that are kind of getting high-yield on the exams is cephalzoline, right? So we know that every surgeon, if you ask a surgeon, what is the number one, at least in the US? What is the number one antibiotic in the world? Where are they gonna scream right back at you? Anceph, anceph, anceph. I don't know surgeons, man. Those people love their anceph. And I mean, it works pretty well.

I mean, they love it for obvious reasons, because it's something that is used in pretty much most surgeries, right? Remember, anceph is cephalzoline, right? Cephalzoline is giving about 30 to 60 minutes, right? Before, like, the incision is made. This is actually one of those high-yield guidelines to know, right? Why is it important to know? There are these bizarre questions they love to throw. Throw out people, right? They will tell you that, ooh, a person in surgery will schedule for 10 a.m. Pressing God-I-B cephalzoline, like at 920 or 930 or whatever, right? And then a big trauma comes in, pressing the surgery as we bump to 4 p.m. And then, you'll now see what's the next best step in management. You need to give the cephalzoline again, okay? Again, you need to give it within that 30 to 60 minute window before the surgery proceeds. That's actually very high-yield, very high-yields to know, right? That's definitely very high-yield to know. Okay, now, one, what if they give you a question about like, what if they give you a question about patient, you know, the intelligence is like a 22-year-old female. And the tell you that, you know, for the past two weeks, she has been having like really bad sore throat, having a lot of joint pain. And then, they can show you a picture, right? And you notice that you see like, almost like this big inclusion inside a cell, right?

This is one of those classy pictures they want to show you on test that you want to be able to recognize, right? If you see this, like, it will be like a big, and a new clean inclusion. If you see it, I would really hope that you're thinking about CMV, right? You're thinking about CMV, right? So you see this person has like a mononuclosis, stile syndrome, right? But you see like very skimpy on the details, right? I will say for example, CMV, like there are some bugs where the pictures are high yield, so we will be able to identify on MVM exams. CMV is one anthrax, especially with these military style questions, you'll be popping on exams these days, anthrax, you know. It's a very classic picture, it kind of looks like a bunch of blue, that's just like blue like straight rods, that are kind of like criss-crossing, criss-crossing, and look through that. And then those endemic fungi, right? So like histoplasma capsulatum, coxidiumicosis with those spherules, right? Those are higher pictures to keep in mind. And I guess maybe one thing I should go ahead and say is, step one is becoming pass-fail, right? Step two CK, they are beginning to bring in quite a number of step one concepts on the exam. So I think one thing that you should maybe expect from my podcast going forward is that I'll mostly be talking about step two CK stuff, but there are some step one things that are high-value targets that I'll try to highlight so that you expose to those before you take your exam, right?

So essentially, and my life lesson today will be like some study advice. It will be some study advice using my podcast, just to clarify some misconceptions I feel like people have, right? But basically, this person has CMV, remember the classic association on the outside nucleus, right? And people that have CMV, right, you give them gun cycle away, right? You give them gun cycle away. Now, what is one step one detail they can throw in here, right? The thing is, CMV, if you do the mono spot test on the present HACMV, the mono spot test will be negative, right? That's a higher thing to know. Another higher thing to know is they may ask me about the mechanism of resistance to gun cycle over on a test. Remember, gun cycle over for it to work, if you again go back to your step one from ecology, right? Because it's like a nucleoside analog, right? Essentially, what needs to happen to it is it needs to be phosphorylithid. And then when it's phosphorylithid, it can then be inserted into DNA, but then that will cause like chain termination. And then you'll be able to produce DNA anymore, right? Because you will essentially inhibit DNA polymerase, right? That's the exact same thing that happens with gun cycle over. Gun cycle over to work, it needs to be phosphorylated by a kinase. That kinase is known as the UL97 kinase, right? It's known as the UL97 kinase. So the Brazilian has a mutation in the UL97 kinase. They will have CMV resistance to gun cycle over there.

So how do we treat CMV that's resistant to gun cycle over here? Typically for those people, give them phosphorylithid. Right? Phosphorylith is a pyrophosphate analog, right? That is used to treat gun cycle over resistance CMV or acyclover resistant herpes. Right? The good thing about phosphorylithid it does not need a kinase for activation, right? It's already in a phosph- the drug is already like a phosphorylithid drug, right? So it skips that kinase activation step and it can be incorporated directly into DNA. These are again all high oaths to know, for example. And remember that CMV, right? Whenever a kid has convent to CMV, that kid will have microcephaly, right? And then they will tell you about the periventricular calcifications that surrounds the child's brain, right? That's the way you differentiate CMV from toxo. Remember toxo will cause calcifications in the brain, but it will be throughout the cerebral cortex, right? But if you see calcifications around the ventricles, right? You want to think about CMV, right? Or just I guess we're still on the topic of calcifications as I wrap up this rapid review. If you look at, if they tell you that, oh, you see, let's talk about like some high-octocifications. They kind of pop around about, around the body calcifications, like the concept of calcification. It's a high-octococ concept you could see on exams, right?

So if they tell you a question about a person that has like a brain tumor or brain mass, and you're seeing calcifications in the frontal lobe, right? I would hope you're thinking about an oligodendro glioma. I think I may have said this in a previous podcast, but if you have not, let me just go ahead and talk about it in a repetition always helps, right? So remember, calcified mass, frontal lobe oligodendro glioma, right? If they give you a question about a child that has a calcified, supressella mass, and this child may potentially have like a bite temporal heteroenemoshemianopsyal, then I would really hope that you're telling me that, ooh, this child likely has a craniofiring geoma, right? Remember, craniofiring geomas, they tend to be supressella, they tend to be calcified, they love to compress the optic chiasm, right? So, and remember that thing where the lick muroaafluid? I feel like probably one of the biggest concepts to know with regards to craniofiring geomas on Indianities is the embryological association. Remember, those things that you're right from, rathki spouch, or those sometimes on MBM exams, you may see them refer to as oral ectoderm, right? And oligodendro gliomas don't forget that they are one of those things that have this fried egg appearance on histology, right?

So, if you see like a fried egg appearance on histology, think about oligodendro gliomas, although you would also want to think about those with those coilo sites that are associated with HBV, right? The coilo sites associated with HBV infection also have that fried egg appearance, okay? So, back to calcification. So, we said calcified supressella mass that's going to be a craniofiring geoma. If they want to be mean, because again, in these days they are an age, one tool that the MBM loves to use a lot is to give you alternate terms for the same thing, right? So, don't be surprised if you see a term like adamantinomadas, like edam, like adamantinomadas craniofiring geoma. That's another name that's used in the world of pathology for that stuff, right? So, oligodendro gliomas also have calcifications from toe lube, right? I've talked about how, if, for example, you see a person that has calcifications in the cerebellum, right? They tell you that, oh, it's a person that has a calcified cerebellum mass. And then this person has like a very high hematocrit, I would encourage you to think about a hemanduoblastoma on that those circumstances, right? Think about a hemanduoblastoma on that those circumstances. Remember, hemanduoblastomas, they love to be calcified and they're going to be in the cerebellum, they're going to be in the posterior fossa on anemic exam, right?

And then, if you see like calcifications around the person's heart, calcifications around the person's heart, you want to be thinking about constrictive pericarditis on anemic exam, right? If you see calcifications around the person's pancreas, right? Calcifications around the person's pancreas, you want to be thinking about chronic pancreatitis on anemic exam, right? If you see like stippled, puncted calcifications around the person's gallbladder, that's something that's known as porcelain gallbladder, right? That's something that's porcelain gallbladder. Porcelain gallbladder has a very high-yield association with the person potentially having a gallbladder cancer or colanducarcinoma, right? But more classically, gallbladder cancer, for those people, you actually want to go ahead and resect, you want to do like an elective coli suspectomy, right? And then if you see calcified mass in a female, right? And it's in the adnexa, right? Or in the pouch of Douglas, right? Like the rectal uterine pouch, then under those circumstances, you want to think about a teratoma, right? Sometimes on exams, they call this a bermoid cyst, right? They call this a bermoid cyst. So keep those in mind on anemic exams, right? Keep those in mind on anemic exams. And then remember, you can also see calcifications in the kidneys, especially in the person that has primary hyperparaphoridism, right? And then remember, people that have diabetes, right?

Especially a diabetic that has peripheral arterial disease, right? You may check their, their, what is this risk of alcohol, come on, do I think? Uh, uh, yes, yeah, ABI, the arterial brachial index, they'll be like, wow, this person, the ABI has like 1.5, like some crazy high number, you're like, wow, this person's ABI is better than good. No, it is not better than good. Those people actually have a peripheral arterial disease. But the thing is, the ablote vessels have been calcified. That's something that, classicly, on anemic exams, you refer to us, Moncoberg calcific sclerosis. I'll say that again, Moncoberg, I believe it's spelled M-O-N-C-K-E-R-B-E-R-G. Moncoberg calcific sclerosis, right? Moncoberg calcific sclerosis. That's only finding diabetics, right? So the ABI will be better than good. The way you go further with that is, if the ABI is super high, you've not rode out P-E-D. What you need to do for those people is you need to do a TBI, you need to perform something called a toe-brakeial index, right? You need to perform something known as a toe-brakeial index. Okay, so I think I'm going to go ahead and stop here with my calcification or spell, right? And I'm going to stop here actually with a rapid review, right? So what's the life lesson I want to throw in today? The life lesson I want to throw in today is specifically concerning study advice for step 2-C-K, right? Study advice for step 2-C-K. So what is the ideal way to use my podcasts, right?

The thing is, I can see this without chatter of doubt, because again, I'm not saying this based on, ooh, I'm just saying it now. I have rings and rings and rings of evidence for this. I mean, I've worked with tons of students in my lifetime, or even over the past year, I've worked with tons and tons and tons of students. The ideal way to study, if you're like, oh, divine. If you were to give me one advice in terms of being super comprehensive, like super, super comprehensive with my studying for step 2-C-K. What can I do as a content source? The thing I would say to do is to get through the videos, start off your dedicated period, getting through the videos that I have for the different disciplines, right? So I have videos for psych, for OB-GYN, for PEEDS, for surgery, and for internal medicine, get through those videos. Know those things and know them code, right? The good thing about those videos is, guess what? They have slides on them, right? And for internal medicine, the slides just contain the questions. I review the answers in the video, but remember, they're also notes on my website that you can use alongside as you're watching those videos that already have the answers to those things mentioned, right? Again, there's this Google Doc floating around. I just basically have a link to it on my website, where people transcribe pretty much every step 2-C-K content that I put out there.

Although, obviously, the notes you write to yourself, you'll probably remember them a lot better than notes that you just passively read. But if you're strapped for time, consider reading through those notes as you're listening to the podcast again. The videos will help you with the understanding, right? For neurology, the pretty thing to do is to go ahead and listen to the neuro-podcasts that I have, right? I have eight neuro-podcasts, but again, they're very, very high-yell. They're very, very comprehensive, right? And then, after you're done with that, the thing I would then recommend you do is considering going through those special topics, right? There's a column, there's a spreadsheet on my website that lists like a lot of the stuff that I have for step 2-C-K, right? There's a column that says special topics risk factors. That special topic's called, again, it's a lot of podcasts, right? But you can pick out the ears you feel weak with, right? Like you can say, okay, I feel really bad with electrolytes. Pick up the electrolytes podcast, listen to it. Oh, I feel awful genetic diseases. Listen to the genetic diseases podcast, right? Or, oh, I feel bad with the risk factors. Listen to episode 37, 97, 184, 239. Those are the risk factors podcast, right? So, basically, those podcasts I made them with, like, almost like a five-question-goolly mind. Like, go making those podcasts, or each of these podcasts may get you like between three to five questions and a test.

Like the electrolyte podcast will probably get you a lot more than five questions, right? But those are usually like high-yield topics. That's where I have like the stuff on the military, the stuff on geriatrics, the stuff on bias, the stuff on risk factors, the stuff on mephotic-mephritic syndroms, the stuff I on our vasculities, on shock, right? Stuff like that, right? So, those are high-value things to try to listen to. And then, the Rapid Review Series, what I would encourage you to do the Rapid Review Series is just while you're, because most of them are short, most of them are like 30 minutes or less long, right? Just listen to those while you're working out or eating or whatever, right? Those will expose you to high-yield clinical cases that tend to pop up very frequently on the exams, right? I mean, like, and I guess if we're going for the very extreme case of my step-to-cK content, there are a couple people that have actually spent the time pretty much listening to all the step-to-cK content I have, all the special topics, all the rapid reviews, gone through all the videos. I have data from some of these people, and many of these people have done extremely well on their exams, like if you truly, truly, truly, again, it's a big ordeal. It will require pretty decent amount of work. But if you listen to everything I have in my step-to-cK folder, you will almost certainly do extremely well on your exams.

Obviously, you're going to supplement that by doing questions from a Q-bank, and then, as I recommend, those MBMI practice shelfa exams. So those are the recommendations I'll give. Again, I've had people get 270s, high-260s, very, very high scores, reviewing all that content, and then doing a Q-bank and doing those practice MBMI shelf exams. So, thank you for listening. Again, if you want to register for any of those courses, reach out to me, and I'll give you information about the cost and the timing and all that fun stuff. And I will see you in the next podcast, and please take care of yourselves. Remember, health is wealth. Thank you. God bless you. Bye.

High fever (>102°F), profound respiratory distress, and tripod positioning.

Performing an induced intubation (to secure the airway).

Treponema pallidum (Syphilis), Borrelia burgdorferi (Lyme disease), and Leptospira interrogans.

Septic Bacillomyetasis (SBP); diagnosis requires paraseptysis (>250 neutrophils).

5mm for HIV positive; 10mm for healthcare workers; 15mm for everyone else.

Within 30 to 60 minutes before incision. If delayed, it must be given again within that window.

Acroblastoblastic (megaloblastic) anemia; caused by Vitamin B6 depletion.

Craniopharyngioma.

Multi-cross pattern in red blood cells; New England/Boston area exposure.

Cryptosporidium parvum.

CMV causes periventricular calcifications; Toxo causes diffuse cortical calcifications.

Monckeberg calcific sclerosis (calcification of vessel media); Toe-Brachial Index (TBI).

Amoxicillin (<8 years old), Doxycycline (>8 years old), or Ceftriaxone/Cefotaxime if CNS/heart involvement.

Acroblastoblastic (megaloblastic) anemia; caused by Vitamin B6 depletion.

Craniopharyngioma.

Multi-cross pattern in red blood cells; New England/Boston area exposure.

Cryptosporidium parvum.

CMV causes periventricular calcifications; Toxo causes diffuse cortical calcifications.

Monckeberg calcific sclerosis (calcification of vessel media); Toe-Brachial Index (TBI).

Amoxicillin (<8 years old), Doxycycline (>8 years old), or Ceftriaxone/Cefotaxime if CNS/heart involvement.