DIP Episode 570 - The Clutch Skin and Soft Tissue Infections Podcast (Step 1-3) + Minor Correction

Welcome, my name is Divine. This is episode 570 of the Divine Intervention Podcasts. Into these podcasts we're going to be focused on. I'd like to title this the Clutch Skin and Soft tissue infections podcast. The Clutch Skin and Soft tissue infections podcast. This podcast is certainly useful for step one or the way to step three. So you should listen to it. This stuff is going to show up on your exam. So if you don't learn it, you're going to get your loss. Alright, so let's just jump right into it. So what if they give you a question about a patient? You're told that this person is a 20. Let's say a 10-year-old child and for the last two days, this child's experience has been having fevers and you're showing a picture or they describe this. That this child has this painful lesion on his face, is very red, bright red, right, and it has very distinct bothers and it's elevated. It's an elevated lesion. What should you be thinking about on your exams? Well, I hope you're saying, oh, Divine, this sounds an awful lot like airsepilars. Membray airsepilars are actually quite common and again, typically on the USML Es, what's going to be the cause? What's going to be the primary cause of airsepilars? Well, the primary cause is going to be group A-strip, right? So strep biogenes. But if you don't see group A-strip as an answer, then you can pick stuff where you're as an answer. That's usually a smart thing to do.

And then you may be asked, what's the most appropriate next step in pharmacotherapy? Well, the most appropriate next step is going to be some kind of antibiotic, right? So generally, you want to use some kind of cell wall inhibitor, so you can use something like penicillin, you can use amoxicillin, you can use cephalaxin, you can even use the antibiotic used for mastitis, thycloxacillin, right? You can certainly use those, right? So, and the thing is, again, if that's all the child has or that's all because it's not only kids that can get airsepilars, adults can certainly get airsepilars. So if they're relatively stable, no problems, they're just going to live it at that. But say, for example, you notice that these people have like systemic symptoms, right? Like they have like big-time look-o-cytosis, they have very high fevers, they are asciples look to be severe, then in those circumstances, you should really consider using IV antibiotics. I always like to think of it this way. On the USMLE is when people have an infection. Again, this road doesn't always apply, but it applies in a fair number of cases to where it's something useful to know. When a person has a mild form of an infection, it is perfectly reasonable to use oral antibiotics, right?

Like you see a person, for example, having airsepilars, their temperature is like 100.8, they don't have any look-o-cytosis, you know, their symptoms are limited to just the face, they don't have any like systemic signs and symptoms. Just give them an oral cell wall inhibitor and call it a day. But if you notice that, wow, these people, their temperature is like 102, right? They're like on the hypotensive side of things, right? Their white blood cell count is like 15,000. You know, you're seeing that, man, this person is the alactic acid is elevated, right? They have a high anion gap metabolic acid doses. Those are systemic signs. That tells you that, you know, this thing is more than meets the eye, right? In those circumstances, you should use an IV cell wall inhibitor. You can use IV penicillin, you can use IV septeraxone, right? You can use IV septazolin. Remember, septazolin is what we use as pre-operate, you know, before surgery starts in terms of just antibody prophylaxis, right? Or you can use IV clindamysic, use IV clindamysic, right? And one common question that I get from people is divine. How do I differentiate erosypilus from cellulitis? The thing is, erosypilus typically involves the face. Cellulitis is basically infection of like a deeper skin layer because sometimes on the exams, they will ask you, what's the effect that skin layer? When people have cellulitis, it's going to be the dermis and the subcutaneous fat that's infected, right?

The dermis and the subcutaneous fat that's affected. Now, one thing I've also noticed about cellulitis questions on the USMLE exams is that their borders are not as well defined as erosypilus. Their borders are not as well defined. And many times when people have cellulitis, the lesion tends to be flat. It is not as elevated as you see with erosypilus. Another thing I've also noticed to be helpful is that most times on the USML Es when they're testing cellulitis, it's going to be in the lower extremities. It's not going to be on the face like you see with erosypilus, right? So cellulitis, and the good thing about cellulitis is because again, it's always good to categorize things as like a principle of learning, instead of memorizing lots and lots and lots and lots of stuff. If I'm being completely honest with you, for pressing a cellulitis, the treatment is exactly the same as erosypilus, right? So again, divided into, is it severe? Do they have signs of systemic, do they have like systemic signs and symptoms? Or is it like not severe, right? If it's not severe, give oral antibiotics severe, give them IV antibiotics, right? IV celluline inhibitors versus oral celluline inhibitors, as I've discussed already. All right. Now, what if they give you a question about a child that has these honey colored cross-stead lesions? You know, it can be on the face, it can be on the extremities or whatever, right?

And the thing is, I'm sure many of you are used to the word honey colored, but be careful actually. Sometimes on the exams, instead of using the term honey colored, they can call it yellow golden yellow lesions, right? They can see that the lesions are golden yellow or they can see that they're yellow, right? If you see those, right? Clearly, this is in patego. Remember in patego, what's going to be the most common cause on the USMLA exams? It's going to be staff-oreus. Staff warriors is generally the most common cause of impatego on the USMLA. It's also going to be the second most common cause. I hope you're saying, oh, divine is probably like group A, strep, probably like group A, strep, probably group A, strep. And typically, how do we treat impatego? Well, you're going to use topical antibiotics just in general, right? Use something that can cover staff warriors. So what's that classic topical antibiotic that covers staff warriors? That's going to be new Pearson, right? So, my Pearson, topical, my Pearson is the drug of choice for for impatego, right? Is the drug of choice for impatego. All right. Now, what if they give you a question about a person that works at like a sea world or a person that works in an aquarium or a person that, you know, is like a fish farmer or whatever? And then you're told that this person has this nodular infection, right? So like, well, they can even show you a picture. You see all these nodules. They're like circular lesions.

And you see that it kind of tracks along the person's skin. What should you be thinking about? Well, if you see something like that, I'd really hope you're saying, oh, divine. This looks a lot like a micro bacterium marina infection, micro bacterium marina. Micro bacterium marina, again, it's a very classically tested infection. You want to know for your exams, right? Very classically tested infection should know. And again, it's usually in people that are exposed to like like water, right? Or people that are exposed to like aquariums and things like that. And typically, we're going to manage it by giving a clarifromycin, right? And you can also give a rifampin, right? So you give those book clarifromycin, you give them rifampin, clarifromycin, you give them rifampin, okay? Clarifromycin and rifampin. That's how you manage, that's how you manage a micro bacterium marina. Now, if you want to do a compare and contrast, I kind of like the way I compare them contrast, they're asciples and cello-lides. Well, if you see kind of similar skin lesions, right? You see these nodular lesions of the extremities, but the exposure is a little bit different. You see in a person that is exposed to a lot of plants, a lot of soil, so like a gardener or a person that is a landscape or whatever, then in those circumstances, you want to think of spurtriosis, right? Remember, spurtriosis is caused by spurtrix cell, shenkiye, right? Spurtrix, shenkiye, spurtrix, shenkiye.

So when a person has spurtriosis, typically, you'll notice that they have exposure to plants, right? A lot of exposure to plants, a lot of exposure to soil, and the way you're going to manage that in general is by giving itra connoisseur, okay? So please do not mix these things up on your exams. Do not mix these things up on your exams. If the exposure is water, fish tanks and all those things, then think of mycobacterium marina. But if the exposure is soil, right? Or plants, landscaper, gardener, things of that nature, then I really, really want you to think of spurtriosis. I want you to think of spurtriosis, right? Spurtrix, shenkiye, spurtrix, shenkiye, right? And again, don't forget, how do you treat these things? Spurtriosis, itra connozol, right? Itra connozol, mycobacterium marina, you're going to use clarifromycin, you're going to use rifampine. And typically, also, going to throw in some ethanbutol as well, okay? So clarifromycin, rifampine and ethanbutol, you can kind of throw that through that. All right. So let's go ahead and then continue this. So what if they give you a question about a person and you're told that, oh, that, you know, they've been having this painful lesion just above their, how do I describe this, you know, good way? So you're told that they have this painful lesion and it's almost like a small mass that is just above their, was the medical term for this.

It's basically above their butts, you know, okay, I'll just tell you what I'm talking about. I'm just not able to think of the medical description of it now. But yes, yes, yes, yes, yes, yes, yes, okay, it's the interglutial cleft, right? So that region just above your butt, right? If you see that, you're thinking about a pylon needle cyst, a pylon needle cyst, a pylon needle cyst, again, it can be caused by many different things. But again, many times it's going to be painful, sometimes you can drink pus. Typically, the way you're going to manage that on your exams is just to drain the lesion and that's it. You'd have to do anything beyond beyond that. All right. Now, what if they give you a question about a patient and you're told that this patient is a person that has cirrhosis and therefore the past two days, this person has been having very, very high fevers, you know, his temperature is like one or two, one or three degrees Fahrenheit, has tons of lucosytosis. They tell you that he has these hemorrhagic lesions on the skin, has these bullos changes. And you're told that he just returned from a cruise, you know, where he, you know, swam and all those things. If you see something like this, what should you think about? I really hope you're saying, oh, divine, this is vibriolvornificus infection, right? Vibriolvornificus, it can cause very severe infections, hemorrhagic bullae, really nasty cellulitis. In people that are being exposed to salt water, right?

Or like shellfish and things like that. Whenever you see something like this, this is actually a medical emergency. These people can actually literally die. So how do you treat it? Well, typically on your exams, you're going to do incision angrily. I mean, sorry, you're going to do the bridment because the bridment is how you manage neck fasch because this is basically like neck fasch. And in addition to that, you're going to give doxycycline. I remember doxycycline is very effective for covering vibriol species. What's the other high-your-vibriol species you need to know for your exams? Well, I hope you're talking about vibriolcolory, right? Remember, vibriolcolory, cholera, right? Remember cholera has a toxin that's an adenylid cycle is basically that stimulates churris secretion into the lumen of the GI tract. And the water is going to follow that churrid ion. It's going to cause you to have a nasty, nasty water diuret, right? This will cause tons of fluid in the day, right? Tons and tons and tons of fluid in the in the day. All right. Now, let's go ahead and continue. So what if they give you a question about a person? And you're told that this person comes to the emergency room and, you know, they have very severe pain in their left-floor extremity. And you're told that, you know, the person tells you that he has this red lesion and that it was just on his foot, like this morning.

But then now, you've noticed that it's kind of spread to the person's, it's kind of in front of the person's knee. And then they tell you that while the person is waiting in the emergency room, you know, it's been like an hour. And that you notice that man, the borders of this thing have also expanded some more. And this person's temperature again is like 103 Fahrenheit. The white count is like 18,000. And the person is very, very sick. The person is requesting like opioids for being controlled. They tell you they have 10 out of 10 pain. What should you be thinking about here? I hope you're saying, ooh, divine. This is neck fascia. Right? This is literally neck rotizing fascia. It is neck fascia is really, really bad, right? As you know, it's pretty deadly as well. So if a person has neck fascia, right? What are you supposed to do in your exams? Well, obviously you're going to debrief. Right? You're going to debrief. No, the person is going to die. Right? And how do you treat neck fascia? You can treat neck fascia by giving something like a vancomycin and peep teizo or you can give so people are slow and teizo back down or you can give vancomycin plus like a carbopenum because of various serious infection. Right? And the thing that I'm going to say though is regardless of what you do, make sure you add clindamysin. Right? Because again, many times when people have neck fascia, it's the toxin that is causing the damage. All right?

It's literally the toxin that's causing the damage. So since it's the toxin that's causing the damage, you want to make sure that you give a protein synthesis inhibitor, a 50th inhibitor like clindamysin. Clindamysin is very good for infections where you know that, ooh, it's a toxin that's probably causing the problem. All right. Now, another kind of skin and soft tissue infection you want to be aware of is if you've been bitten by an animal or a human, right? An animal or a human, right? So let's say you're in a brawl in a bar fight with someone, you punch the person in the teeth or whatever and then boom, you get a corner on your extremity. Right? Or let's say you've been bitten by like a dog or cat. When you see something like that, that's kind of worrisome, right? So what are the things that can cause you issues there? Well, you want to think of things like pasturella, right? Motocida. You want to think of a canela. You want to think of that. And things you'd also think of. It's kind of weird. It's kind of weird, especially with dog bites in people that are like sickle cell patients. So let's say this is actually kind of a specific association to know for you exams, right? So dog bite in a person that is sickle is a sickle cell patient or dog bite in a person that maybe the aspirin is ruptured for some reason because they've had like eb V infection in the past. Think of this particular ball. It is called like capnose cytophagia, canymorseus.

I'm going to spell that capnose. So it's C-A-P-N-O. Cytophagia is C-Y-T-O-P-H-A-G-A. So capnose cytophagia and then canymorseus is C-A-N-I-M-O-R-S-U-S, right? This is actually a pretty high-yoda book to know about. But basically if you have like spleen problems and you're beating by a dog, you can actually get pretty severe infection. That can be life threatening from this particular bog, right? From this particular bog, right? So that's just an association you want to know because remember who are the people that can have spleenic issues on your exams? People that have sickle cell disease, right? They can have auto-splinectomy usually before the age of four or five or a person that you know they had mono, doctor said hey no conduct spores for a couple of weeks. They're like whatever dog and then they explode their spines or you see a person that has like heritage spherocyteosis. Remember who your first eye tool says you want good long-term treatment you want to do a spleenectomy because those people the red cells work well but the spleenic macrophages don't think those red cells are pretty so they destroy them, right? Or you can see spleenectomy in a person that has immune thrombocytopenia. Remember if you have ITP we should really start off with steroids for treatment that's first line if that doesn't work we try IVIG that's second line but if that doesn't work you got to cut out the person's spleen spleenectomy, right?

All these people can have a high risk of really really nasty sepsis after a dog bite especially from what from a copinocytophagia canymoresis. Again this may not be something you see in a cubanco whatever but it's actually something that's actually really high you to know for your exams. This is this is one of those things that I always tell people right? Like there are certain things that you'd see on the USMLE exams that you're like man I've never seen this anywhere this is a very good example of those kinds of things and I try to emphasize many of these things in my classes in my classes and in these in these podcasts so just something you want to keep at the back of your of your mind. So something is certainly certainly certainly want to know about now how do you in general treat these bites from humans or animals? If you're being by a human or an animal on your exam I strongly strongly encourage you to use amoxicillin and clavolanic acid. Just basically use a cell wall inhibitor plus a bitter lactamysine inhibitor. So you can use amoxicillin clavolanic acid right? Again if the infection looks pretty severe you can use IV and pysillin and so back time right? So amoxicillin clavolanic acid right orally right or you can use ampysillin so back time IV again for more severe infections right? For more severe infections. What else have we talked about? What else is pretty high you to know that strehodlamoxicillin clavolanic acid?

I hope you're seeing acutotitis media remember that's the second line not first line. First line treatment for acutotitis media is amoxicillin but the second line treatment is going to be amoxicillin and clavolanic acid it's going to be amoxicillin clavolanic acid all right? Now one thing I want to say about cellulitis that I did not see earlier on is so cellulitis again most times I say that he's cellulitis you're going to treat it the way you treat a resemblance and that's absolutely true but if you see any mention of POS with cellulitis what POS then you're worried about what? Mercer infection. We're worried about mercer infection you need to go for mercer therapy so what are some of the things that you can use for suspected mercer skin and soft tissue infections on your exams? Well think of something like doxycycline right? Remember your tetracycline is believe it or not need to cover mercer or you can use trimethyromythoxysol right? Buck trim it's very good for mercer infections we tend to use doxycycline or trimethyromythoxysol again if the presence symptoms do not look severe again if you're taking step two or step three or step one I think you should have a good gauge on this looks severe this does not look severe and I've given some pointers at the beginning of this podcast for oh this presence infection is probably severe versus hmm this presence infection is not it's not that bad right?

So when a presence has like not very severe symptoms you know doxycycline trimethyromythoxysol orlyzmod is more than fine but if they have severe infections they need to stop reaching out for the IV stuff like IV vancomycin right that covers mercer or you can usually nasolate remember lignyzolid is an antibiotic that's um it's a 50s inhibitor right that's very good for covering mercer and VRE vancomycin resistant enterococcus right? Oh you can use things like dapto mycin right? Dapto mycin is pretty good as well for covering mercer infections and then don't forget you can also use septaruline septaruline is a several sporing is a fifth generation several sporing that can cover mercer infection very very effectively very very effectively so pressing has cellulitis and you see boss make sure you're covering mercer that's a very important principle to know for purposes of your exams right for purposes of your exams right? And then what if they give you a question about a person you know that their skin is kind of peeling off they're very hypotensive they're very febriol right? Again you want to think of a toxic meditated illness a toxic meditated illness so something like stascalde skin syndrome or you want to think of um what's the name of this thing? Where their skin is peeling off? starts with a T toxic shock syndrome exactly toxic shock syndrome so when you see those things right?

those things are very severe infections those people should absolutely be admitted to the hospital right? And many times you're going to see it in a person that has left like you know they've left you know they've had like nose bleeds or they've had like a nose infection they've been kind of living like toilet paper in their nose or a person that has left a super absorbent tampon in for too long all those things can cause you to have those severe problems right? And those these infections usually caused by group A strap or staff Oreos right? So again you generally should manage it the same way you manage necrotizing fasciitis in terms of antibiotic therapy or you want to give ankle mycin plus pipteso of ankle mycin plus carbopenem right? And again whatever you do make sure you include cleaned mycin as I said because again many of these things are caused by toxins many of these things are caused by toxins right? Now I think maybe just to kind of rub this podcast stop let me just go over some quick high-end associations right? So what if they give you a question about some person that works um for the FBI or a person that is like works with a secret service or whatever and then they have this necrotic skin lesion when you see something like that I hope you're seeing divine this is anthrax right? Remember anthrax is caused by bacelos and thresus bacelos and thresus right?

You you can see it in a bio terrorism question on your exams and c pro flox is in generally the treatment you're gonna be on c pro for like two months if you want to treat treat that stuff right? What if they give you a question about a person that visited some country in Asia or whatever and then they tell you that oh this person you know for the last like two weeks or whatever you know they've noticed a lot of swelling of their face the extremities you know that they have like this where the typical look to their face sometimes you may see the term leonine faces on the exam right? And you notice that they have like lesions on their ears lesions on their fingers they kind of swollen they have like neuropathy like signs of neuropathy this person actually has leprosy remember leprosy is caused by my co-bacterium leprary right? Remember leprosy likes to go after the core regions of the body like the ears the fingers the nose and things like that right? and there are two kinds right? There's gonna be the leprosy kind and there's gonna be the tuberculosis kind right? I'm not gonna go into a ton of detail on that because this is not an immunology podcast I want this to be a good quick drive by so that you can very easily dispatch your skin and soft tissue infection questions but the leprosy the leprosy kind the leprosy kind involves a t-helper one response the tuberculosis kind involves a t-helper two response right? So leprosy, t-helper one tuberculloid t-helper two right?

tuberculloid t-helper two and how do we treat leprosy in general? Generally you're gonna treat leprosy with the combination of dapsone, rifampin and clofasamine dapsone rifampin and clofasamine remember if you're giving a person dapsone you want to make sure it's green for g6pd deficiency especially if you're gonna be taking it for a long time because dapsone is a very powerful oxidant so if your person does give it to g6pd deficiency and you give a person dapsone they can have a hemolytic crisis without remember that's gonna be a cum's negative hemolytic anemia again it's all these kinds of weird integrations they can make on the exams like literally we started with leprosy and now we're talking about g6pd deficiency right?

all right now what if they give you a question about a person that's detailed that for the last two days they've kind of noticed that they've had very severe ear pain and you notice that one side of their face kind of looks wrinkled you know they cannot wrinkle their or you know kind of looks paralyzed they cannot wrinkle their forehead on one side of the face and then they tell you that you see these vesicular lesions in their ears they may have signs of vertigo they may have signs of tenitis when you see something like that I hope you're saying divine this is Ramsey Hunt syndrome this is Ramsey Hunt syndrome this is actually a HSV infection right it's a HSV infection right so many times they can have like symptoms of damage to cranial 7 right so like a bells palsy cranial 8 right vestibular cochlear nerve right and again those people again they'll have those signs and symptoms you may see vesicular lesions in the ears and stuff like that you see that think of Ramsey Hunt syndrome right and how do we try to Ramsey Hunt syndrome while it's a herpes infection so typically you're gonna give the person a acyclovere remember if you have a herpes infection that's not responsive to acyclovere then what are you supposed to do well the thing you're supposed to do on your exams is you're gonna give them a first chronic first chronic is a pyrophosphate analog that can help in those circumstances now one thing I really want to kind of bring to you attention I don't want to mess up here is that besides giving the acyclovere if they have very severe pain and inflammation what else could you help these people with or you could give them cortical steroids actually cortical steroids actually quite helpful in these in these folks right and I guess since we're kind of talking about vesicular lesions what if they give you a question about a person that has vesicular lesions on the hands

on the feet inside your mouth if you see that right think of hand-full mouth disease right the mouth lesion because it looks her pretty from we slapped the term herpanjino on it right remember this caused by the coxacchi a virus coxacchi a virus and typically for those people I just gonna do supportive care you know give them like a fever reducing like a cell aminoffin or an NSAID and they're gonna be completely fine they're gonna be completely fine right and then what if you see like a lesion where they tell you that it has a central depression right especially like a like in a child or whatever right think of moloscom contagiosum right has that on is it like that unbellicated lesion on the face or whatever think of moloscom contigiosum again I just want to kind of do some quick drive-byes here or what if they give you a question about a child and you're told that this child has like you know redness of both it is child has sigusel disease has redness on both sides of the mouth and you're told that is hemoglobin is three right that's an aplastic crisis right and a person that has parvo virus been 19 infection although parvo been 19 they also love to give it to adults especially adults that work with kids but most times on the exams for whatever bizarre reason they spend more time on joint manifestations it can cause like an arthritis like a migratory arthritis in people that don't especially adults that work with kids so they can make it a question about like I can the garden teacher or things like that um and then what if they give you a question about a child that had a very high fever for a few days right and then that fever kind of broke but as that fever stopped like maybe a day later this red rush just kind of shows up on the face and on the trunk when you see this think of six disease remember six disease is rosyola that's hhv six right how about parvo virus

been 19 right parvo virus been 19 again it's a virus and again don't forget it causes a plastic crisis in people that have sigusel disease or people that have hemoglobin apathy's so again our friends at the nbm is they can literally give you parvo virus been 19 infection in a person that does not have sigusel disease they can give it to a person that has to allow us see me for example again it's not that much of a stretch for your test again I know this podcast kind of sounds like a grab bag but I'm I can almost it's not almost I promise you you're gonna see questions on this stuff on your exams you're literally gonna see questions on this stuff on your exams right so please just kind of keep these things at the back of your mind um I think you'll be really helpful to you and I guess things we were talking about vesicular lesions what if you see a vesicular lesion in a person that has like stiadoria vesicular lesions on the skin of the stiadoria well that's dermatitis her pediformis remember again whenever something's vesicular in medicine we like to slap the term her pediform on it right this person probably has celiac disease person probably has celiac disease right and they don't forget right again remember you're nekoski signs right where it's like you rub your hand over like a bulldozer lesion and it pops easily that's nekoski positive right we find that in people that have a pempicals vulgaris versus oh you rub your hands over the lesion and it doesn't pop the bulldozer lesion it doesn't pop is like a tough bula you want to think of a bulldozer pempi go right remember in pempicals vulgaris you're making autoantibodies against desmosomes but in bulldozer pempi go right you're making auto antibodies against a hemidesmosomes right you're making autoantibodies in bulldozer pempi go against a deeper layer of the epidermal surface right so the bula tends to be thicker

right so it sits with nekoski negative versus pempi go for guaris that tends to be nekoski positive right and then don't forget you know you see a person that has like a circular lesion on their on their wrist or a circular lesion on you know just above the pubic synthesis you know and they tell you that they bought like a new belt or a new watch right that's just gonna be like contact dermatitis right remember that usually is a type 4 hypersensitivity reaction that's something you want to know right and really the way you know like a nickel whatever business and generally you want to fix that problem by just avoiding exposure to the irritant right don't forget that somewhat similar pathophys is also found in people that have like a poison ivy or poison oak right you know they went gardening or they went in the forest or they went on some you know some weird stuff where they went amongst trees and stuff and then like they have like these swellings you know like kind of nasty goopy looking things on their lower extremities think of poison ivy right that that's a type 4 hypersensitivity reaction right and then if you see a child that's each and a lot within between their fingers it's in a lot between their fingers on the exams you should be thinking about skibis right remember skibis is caused by syracoptis skibis syracoptis skibis right and how do you money skibis on the exam so you're gonna use a topical per me through topical per me through top ical per me through topical per me through right and then what if they give you a question about a person that has a skin lesion that's uh kind of started as a small papu but now it kind of looks like a volcano right has these various edges and it's kind of draining stuff uh when you see something like that when you see that description starts as a papu becomes like a volcano um I want you to think of lishmaniasis right cutan

eous lishmaniasis and remember when a person's cutaneous chuteinous lishmaniasis you're gonna use a like posomalamphotarisin B to fix the problem or you can use a drug known as a sodium stable gluconeid for for that right and then don't forget as well that if you if a person has like uh you know like again all these ring-like lesions on the extremities with uh central claring right you obviously want to think about a person that has one of these tinias right uh tiniar corpus right ring war remember you're gonna use a topical easel for those purposes and remember again what's the most common cause of tiniar is gonna be your trichofighting species what's the second most common cause is gonna be your micro sperm species what's gonna be the third most common cause is gonna be your epidermal fighting species although remember if you have tiniar that involves the hair right so tiniar capitis or the nails or necomicosis you cannot use topical easels for that you need something that can penetrate characters so you're gonna use oral antibiotics for that you're gonna use like oral trebinofin or oral grizzio fovein um we generally prefer trebinofin over grizzio fovein because grizzio fovein is a salicrom p-415 duster so he can cause a lot of uh drug drug interactions again all these integrations that i'm talking about they're probably almost more important than the actual stuff i'm talking about i could you know these things were not low yield i promise you these things are not low yield and again i'm sorry that it kind of sounds a little disorganized i'm just gonna talk about these things as they come to mind right but these things i promise you they're very very high you'll to know these things for your exams you'll be doing yourself a huge huge huge huge massive disservice if you do not know these integrations if you do not know these integrations all right so um and then you

know what if they tell you that you see like a rough lesion of the skin in a person that like is a gardener or a person that's like a building contractor or like a manual labor or whatever a rough lesion on the skin like on the face or whatever then i hope you're thinking about actinic aratosis right sometimes on your exams you can ask you what's the most likely outcome of actinic aratosis again this is not an infection but this is just a skin thing that i figured you know what let's talk about it right uh so what's the most likely outcome the most likely outcome is going to be a resolution they love to ask these prognosis questions on the exams right the most likely outcome is resolution although remember i was like the most dangerous complication of actinic aratosis remember it can become sqm cell cancer of the skin can become sqm cell cancer of the skin right or what if they give you a question about a person that has inflammatory bowel disease or a person that you know again has interstitial pneumonia and the person lives in our zone and they have this flat lesion on the allure extremities that's very painful very red well obviously in that case i hope you're thinking about erythema no dole sim remember erythema no dole sim is that you know i bd it's also a serocoi dole sim but it's also a serocoi dole sim but it's also a serocoi dole sim but it's also a serocoi dole sim but it's also a serocoi dole my causes infection right it's generally flat it's not osuited and it hurts a lot contrast that with pyro derma gangrenosum that tends to be osuited right and again has a stronger solution with inflammatory bowel disease right and then what if they give you a question about a person that has a lot of providers on their back a lot of providers on their back right and they tell you that you have like these light pink macules right and it has like this generalized distri

bution around the back or whatever then i would hope you're saying ooh divine this looks a lot like a pitaraiseous rusea pitaraiseous rusea pitaraiseous rusea that's something you certainly should know for your for your exams right something you know for your exams right okay now what if they give you a question about a person that has like you know these areas of skin hypopigmentation and the person has a history of like adicence disease right so or the tell you a person has a history of primary adrenaline deficiency of celiac disease or whatever so it's almost like they have a history of another autoimmune disease and then you see these areas of skin hypopigmentation then if you see something like that i would really hope that you're thinking of um uh video lago right video lago video lago remember video lago is an autoimmune disease and typically we're going to manage that by injecting steroids into the lesion and what if you see like hypopigmented lesions on like sun exposed areas in fact the person is like self-conscious because you know it makes your skin kind of look weird and typically it's going to be like at the very top of your back on the exams then you want to think about tina vesicola tina vesicola remember tina vesicola is caused by malacisia furfer malacisia furfer malacisia furfer malacisia furfer all right i'm just trying to think is there any other high old skin thin it's kind of coming to mind um oh Parkinson's patient you see a Parkinson's patient and they have like these like red you know kind of cross dead itchy lesions on places where hair grows i want to think of seborrheederma titis seborrheederma titis remember it's pretty common in people that have Parkinson's pretty common in people that um have HIV although you can also have it in just normal people right and how do we manage uh that you can manage it with like salineum sulfide topical sa

lineum sulfide or you can use like topical kiloconazone or or things of that of that nature right so um yeah so i think this is probably a pretty good good place to stop um i think it's a good place to stop we've kind of talked about a lot of stuff today and again my apologies for the grab bag it's just again as i was talking about this podcast they were just all their ideas that kind of popped in my head and i kind of figured you know what it's probably useful to talk about these other things that pop in my head because they're pretty high yield to know for your exams there's so many i didn't even realize that there's these many integrations you can make with this stuff so thank you for joining me again if you like the way i teach you like the way i make integrations you're probably going to be interested in the classes i have i have a bunch of classes starting in about 10 days right so starting on like the 18th of this month of a test taking class that's two and a half hours long of a biostat's class that's four hours long have a social sciences quality improvement healthcare systems hospital medicine class uh that is five hours long that's for step one to step three for step one i have a 25 hour class taking place in the first week of the month of march and then for step two and step three specifically i have a 20 hour class taking place this month and i have a last minute review three hour last minute review also taking place this month um again i think many there's many people that taking these classes from them to be extremely helpful again i've had people very recently like as recently as generally take the exams and do extremely well on their tests after taking these classes and then in June first two weeks in the month of June i have a 50 hour step two step three review i made a separate podcast where i specifically talk about that that class and all the clas

ses over zoom so if you're interested just shoot me an email i'll give you some more information and then i have these podcasts on apple on google and on spotify and i also have a youtube channel you can check out and then i offer one on one to learn for all the usm million complex exams and i also have another website called divine intervention life lessons.com divine intervention life lessons.com every week i post like one two sometimes three podcasts where from a biblical perspective address a life lesson there's actually an apple podcast associated with that is called the divine intervention life lessons podcast so thank you for listening to me today i will see you in episode 571 have a wonderful rest of your day god bless you and bye for now thank you

Staphylococcus aureus.

Mupirocin.

Sporotrichosis (caused by Sporothrix schenckii).

Erysipelas typically involves the face with sharply defined, elevated borders; Cellulitis often affects the lower extremities and has less defined borders.

Clindamycin (to inhibit toxin production).

Capnocytophaga canimorzumis.

Sporothrix schenckii; Exposure to soil or plants.

Erysipelas has sharply defined, elevated lesions, often on the face; Cellulitis has ill-defined, flatter borders, often on the lower extremities.

Clarithromycin and Rifampin; Exposure to water or aquatic environments (aquariums).

Combination therapy of Dapsone, Rifampin, and Clofazimine; Monitor for G6 PD deficiency due to risk of hemolytic crisis.

Ramsay Hunt Syndrome (HSV infection); Treatment includes Acyclovir plus Corticosteroids.

BPAG makes antibodies against desmosomes (thicker bullae, Nikolsky positive); BP makes antibodies against hemidesmosomes (thinner bullae, Nikolsky negative).

Sporothrix schenckii; Exposure to soil or plants.

Erysipelas has sharply defined, elevated lesions, often on the face; Cellulitis has ill-defined, flatter borders, often on the lower extremities.

Clarithromycin and Rifampin; Exposure to water or aquatic environments (aquariums).

Combination therapy of Dapsone, Rifampin, and Clofazimine; Monitor for G6 PD deficiency due to risk of hemolytic crisis.

Ramsay Hunt Syndrome (HSV infection); Treatment includes Acyclovir plus Corticosteroids.

BPAG makes antibodies against desmosomes (thicker bullae, Nikolsky positive); BP makes antibodies against hemidesmosomes (thinner bullae, Nikolsky negative).