DIP Episode 623 - Last Minute Microbiology Review (Step 2 and 3)

All right, welcome. My name is Divine. This is episode 623 of the Divine Intervention Podcasts. In today's podcast, I'm going to be addressing a topic I've titled, Last Minute Microbiology Review for Step 2 and Step 3. The Last Minute Microbiology Review for Step 2 and Step 3. Let's begin. Now, what if they give you a question about a patient and they tell you that this patient had orthopedic surgery a few days ago. And now, or this person was like in some kind of trauma, you know, some kind of motor vehicle accident or whatever. And then the person has very significant bone pain, you know, let's say like their left femur is hurting significantly, they have fever, they have lucositis. And then they ask about the most likely theology of their presentation. What should you be thinking about? Well, I really hope you're saying that, oh, Divine, this sounds a lot like staff warriors, right? This sounds a lot like staff warriors. The thing is just in non-specific fashion, if they give you a question about staff warriors, I mean, if they give you a question about like bone pain, fever and things like that, you won't be thinking about osteomyelitis. And typically, the most common cause of osteomyelitis is going to be staff warriors, right? Especially when you see an association with a person that was recently in surgery, right? Or recently had trauma. It doesn't even have to be orthopedic surgery. That's something that's actually pretty high to know for you exams, right?

So don't forget staff warriors in those circumstances. And then don't forget, right? Sickle cell disease patients. Think of salmonella, salmonella, salmonella. There are some resources that are beginning to see things other than salmonella. Don't do that to yourself on NV Me exams. Number one is going to be salmonella in sickle cell patients. And then if you don't see that as an answer, that's when you have the license of 30 to go with staff warriors. Now, remember on the US similar exams, it's also helpful to know the drugs that I used to treat MRSA, right? So don't forget your MRSA drugs, right? The classic ones, Vencomaisin, right? Vencomaisin, remember that's a cell wall inhibitor. I remember the mode of resistance where you change the Diala, Diala to Diala, Diala, Diala. And then don't forget, Linesolid. Linesolid is a 50s inhibitor, right? It's a protein synthesis inhibitor. And Linesolid in addition to covering MRSA also covers Vencomaisin resistant enterococcus. And then remember that Linesolid also has the ability to inhibit monoaminoxidase. So because he can inhibit monoaminoxidase, it can raise your levels of serotonin. So if you combine it with a serotonergic agent, you may get serotonin syndrome, right? Things like hyperreflexia, myoclonus, and things of that nature. And then don't forget that Dapto-Maisin. Dapto-Maisin is also very, very good. Very, very good, right? Dapto-Maisin is very, very good for treating MRSA as well.

And then there are a few others that people don't think about, right? But things like clindamaisin, clindamaisin also covers MRSA. Things like Doxycycline, right? Doxycycline also covers MRSA. Especially if you do like a MRSA skin infection, Doxycycline is not a terrible idea. And then don't forget that trimethylperin is also from a thoxazol back trim. Also has the ability to cover MRSA. Right? And then what if they give you a question about a guy that is 68 years old? And he comes to the physician's office, you know, because for the last two days, he has been having very significant chest pain, and he has been having like productive cough. And you're told that his temperature is 102.1 degrees Fahrenheit. And then you're asked, what is the most likely theology of this patient's presentation? Well, I hope you're picking the answer that talks about gram positive coxide, right? Obviously, this is strep pneumo. But again, the USML is they know that if they put strep pneumo as an answer, everybody is going to get it right. Everybody that has the job description, medical student resident blah, blah, blah, blah, blah, blah, they know, oh, the Muslim and kids have come, they jackquat and they're money, a strep pneumo. Everybody knows that, right? So again, they'll put like some derivative. Remember, I've talked about derivatives a ton, right? So instead of putting the exact name you're looking for, they'll put something that is closely related, right?

They're going to give you a strep pneumo and they're going to give you something that's close to strep pneumo, right? So they can put encapsulated organism as an answer, right? Because strep pneumo is encapsulated, they can put gram positive coxide as an answer, because strep pneumo is a gram positive coxide, right? But remember, strep pneumo is the most common cause, very high order is the most common cause of community acquired pneumonia, right? In adults, in adults, right? And how are we going to treat it on the USML exams? Well, basically, you have two options. Number one is you can use a bit of lactam and a microlete, right? Bit of lactam and a microlete so you can use like a moxicillin plus is it through my sin or ampeicillin plus is it through my sin or you can use strep axon plus is it through my sin, right? You can use a bit of lactam and a microlete, right? Another alternative is to just straight up use a respiratory fluoroquinolone, a respiratory fluoroquinolone like livo, phloxicin, for example. All right. Now, what if they give you a question about a child that is three weeks old? And honestly, this child has basically any kind of sickness that involves a fever, right? The child is like high-potensive and not doing well. What book should you be thinking about? But I hope you're saying divine. This sounds a lot like gruby strep or strepe galactia, right?

Remember, the first 20 days of life, the neonatal period, gruby strep, strepe galactia is the most common cause of sepsis, right? It's the most common cause of sepsis in a neonate, right? Most common cause of meningitis in a neonate is like the most common cause of most major infections in the first 20 days of life, right? There's a very good reason why moms are screened at between 35 to 37 weeks for gruby strep. And remember, we don't just screen moms, right? Like if we screen on that screen is positive, we're going to give her a gruby strep prophylaxis when she goes into labor, not before, when she goes into labor. That's very high yield to know for you exams. They will try to tend to on the USML Es to pick an answer that involves giving the prophylaxis now. Don't do that. We don't, you're, she gets into labor. That's super high yield to know for you exams, right? And then since we're kind of talking about kids, also don't forget that if you don't see a gruby strep answer, another answer that may be quite common in kids on the USMLE exams, it is going to be things like a list area, right? List area, Listeria can cause some very serious problems for neonates, right? It can cause meningitis, especially in neonates. It can cause meningitis, especially in neonates. But remember, it's not only neonates that have a high risk of getting really bad Listeria infections, right? People that are old, people that are over age 50 can also get Listeria infections.

And people that are also immunocompromised, right? So people that have HIV, post transplantations or people on chronic steroids, they can absolutely positively, or even people that have an immunodeficiency disease, right? They can absolutely positively also get Listeria infection, right? And remember, Listeria, the drug of choice, very high yield, the drug of choice for covering Listeria is ampecylline, right? The drug of choice for covering Listeria is ampecylline. Now, why am I really honing in so hard on Listeria? The thing is our friends at the NBM Es, they like to test it in the context of people needing empiric treatment for meningitis, right? So the thing is in many age groups, empiric treatment for meningitis when you don't know the exact bug is safe traction plus vancomycin. That's it. You know, and then in some situations, you would throw in some steroid, but safe traction plus vancomycin. But the thing is you need to add in ampecylline for certain groups of people. You need to add in ampecylline for neonates, you need to add in ampecylline for Buddha, over age 50, I need to add in ampecylline for people that are immunocompromised. Why? Because we're worried about Listeria. If you have Listeria meningitis and it's not treated, your risk of death I think is almost 100%. Right? So you don't mess around with Listeria. All right. Now, since I guess I'm kind of talking about meningitis, right?

Like, again, I'm just trying to make integrations, I make this like a really high yield last minute review, so I'm not wasting my time on fluff, right? So since we're kind of talking about meningitis, so if you see, again, like the no-corrigidity, fever and all those things in closed quarters, think of this as closed quarters meningitis, closed quarters meningitis, like in the military. Right? We know the USML is the love questions on like servicemen and women that may be on an army base or whatever, right? Or like on a naval ship, right? Or something like that, or you see people that are closely closer together and they're in space, right? They're in space. Think of meningocococom meningitis, right? It loves to spread in closed quarters, right? So you can see this as a military question, you can see this as a dorm question, and I know like a dormitory, right? You know, like a college or something like that. And I know some people are like, oh, the fine days, no way I will ever see any questions relating to space on my exams. You've not taken the USML easier then, right? They can absolutely ask you questions on space, right? Like think about things like high altitude mounting sickness, right? High altitude pulmonary edema, right? All those things, right? They can absolutely test those things or people trying to climb to Everest. You think they cannot test those things? Okay, right?

So whenever people are closely quartered together, they can get meningococom meningitis, right? And remember, if you're if you're a close contact of a person or meningitis, right? Let's say you were exposed to the respiratory secretions or whatever, then what are we going to use to prevent you from getting that meningococom meningitis? We're going to use rifamping, right? Famping is the drug of choice for those circumstances. So you can do rifamping or you can do safe triaxone or you can do sipprofloxacin. But if they give you all three options on your exams, the first one I will choose is rifamping. If you don't see rifamping as an answer, the second one I will choose is safe triaxone. I will only choose sipprofloxacin if rifamping or safe triaxone have not been provided as answers. Why? Because sippro causes a lot of problems. You know, you can like rupture your Achilles, it can prolong your QT interval, it can cause a bunch of problems. Now, what if they give you a question about the, they make it an epidemiology question, right? And they say that, oh, you know, they give you like some data from like the 50s, the 60s or whatever. And they tell you about the least like the 10 top causes of meningitis, you know, like in kids, they give you like a list, you know, they show like, oh, strepnumol, whatever percent, this, whatever percent, that, whatever percent, they list it, right?

And then they then give you another column that shows like 2020, most common causes of meningitis, causes of meningitis in kids, right? And then they give you like a list of 10 box as well. And then you notice that man, between these two lists, the one thing I'm noticing is a rearrangement. The one thing I'm noticing is a rearrangement. It's like, wow, they are certain things that we're high up on the list in the 50s or 60s that are now like really, really low on the list, right? And I'm going to promise you that the one that was pretty high up on the list back in the day that is going to be really low on the list in the present time will be H flu type B, H flu type B. And then they ask you which of the following is the most likely, which of the following best explains the observed epidemiologic changes, right? I would really hope you're picking the answer that talks about vaccination, right? Vaccination or instead of using the term vaccination, they may use the term primary preventive measures just to mess with your head, because remember, vaccines are a kind of primary prevention. Again, the USML is they love integration. They love integration, right? And the thing is it's a very good way to see people truly understand what's going on or can see links between things in many different contexts, right? But it's vaccination that basically made that happen, right? Because again, we now have the vaccine against H flu type B, right?

So many of those nasty things, it used to cause from back in the day like a big lotitis, but even meningitis have really been kept at bay, right? From H flu type B, right? So again, because the thing is if I presented this as a, again, let me, let me teach you a test taking strategy here. This is very important. And by the way, if you struggle with test taking, you're going to love my class that is taking place literally tomorrow. I have an MBM test taking strategies class. Super helpful for step one, two, step three. I discuss a ton of test taking strategies. Many people have taken that class, I need to be extremely helpful, right? But back to this, right? So the thing is H flu type B, right? If they ask, if they ask a basic question about like, oh, which of the following explains the reduced incidence of H flu type B whatever in the general population, everybody's going to get that right because everybody knows that or a vaccine vaccine vaccine vaccine vaccine, right? But again, if you just presented in a somewhat convoluted fashion, you're right, the list of incidences from like many decades ago and then a list of incidences from now, right? And they don't even tell you they don't highlight any specific bug. They expect you to like look at those lists and see that, wow, maybe H flu type B was, I'm just making up numbers was like 25% back in the day, but now it's like 0.5% that like that's a material change, right? That's a material change.

Whenever the USM is getting you to compare two things, most times they try to make the difference is material, right? And then you have to pick up on that, right? And then you put vaccine as an answer. That'll be an easy question. But instead of putting vaccine as an answer, why put vaccine as an answer when you can put primary preventive measures? Because remember the different levels of prevention, right? Primary prevention, secondary prevention, tertiary prevention, cortinary prevention, primordial prevention, right? Again, these are, this is an excellent way to blend bio statistics, microbiology, right? And social sciences, all in and preventive medicine, all in one question, right? So again, the USM is they're just very good at doing stuff like this, right? And again, kind of like on the same lines with this vaccine preventable stuff, right? What other thing have you reduced the incidence of? You know, you know, so let's say like, for example, hepatocellulocarcinoma, secondary to hebi or serosis secondary to hebi, right? Remember, reduce that by getting the hebi vaccine, right? So that's something one can to keep at the back of your mind on your exams, right? Keep that at the back of your mind on your, on your exams. All right. So what if they give you a question about a patient?

They tell you that this patient is a firefighter and the patient's software, the severe, severe burns, you know, from going and rescuing up, you know, a person, you know, like there was a severe fire or whatever, like a forest fire or home fire or whatever, right? And then you're told that, this person has developed really, you know, really nasty skin infection, right? Really, really nasty skin infection. And you're told that the infection has this like greenish discoloration, right? And has this on usual order. And then they ask you, what is the most likely theology of the patient's presentation? I really hope you're saying that, ooh, divine, this sounds an awful lot like pseudomonas. pseudomonas, pseudomonas, pseudomonas, right? This is pseudomonas aeroginosa, right? Again, the thing is, I've noticed that many times on the USML exams, one thing that really helps with micro and antibiotics is kind of knowing the high-yield history, the high-yield history, right? So, remember, pseudomonas likes to cause problems in a very specific population of patients. Number one, burn patients, burn, burn patients, pseudomonas, burn, burn patients, right? And then pseudomonas also likes to torch people that are neutropinic, people that are neutropinic, right? If you see a person that is neutropinic and they develop a severe infection and it's a bacterial infection, it will most likely be pseudomonas. They're going to go after your exams, right?

And then another classic situation with pseudomonas is ventilator associated pneumonia, right? Vent associated pneumonia. The thing is pseudomonas loves, it really, really loves most environments, right? So, if you even see osteomyelitis from, you know, a nail kind of coming through your sneakers, right? Like, footwear. They're not going to use the term sneakers, right? That's in every angi-dechno-tomankai. That'll be irresponsible of the MB Mis to do that, right? So, you see something like that, think of pseudomonas pseudomonas pseudomonas, right? And remember, our friends at the MB Mis, they want you to know the treatment of pseudomonas infections, right? So, remember, one of the drugs that covers pseudomonas, it's going to be things like carbapenemps can cover pseudomonas. Piperacillin, tizobactam can cover pseudomonas. I mean, like, o-size gentamisin, right? Tobermisin can cover pseudomonas. Septazidim, which is a third genertion, cephalosporin can cover pseudomonas. Sephepim, which is a fourth genertion, cephalosporin can cover pseudomonas. There are many, many things that can cover pseudomonas. Even fluoroquinolones can cover pseudomonas, right? And please do not forget this thing that is very important. Please, don't forget this and I'm about to say that it's very important. So, the monos is one of the most common causes of otitis external, right? Otitis external, otitis external, pseudomonas, pseudomonas, pseudomonas. Right?

Typically, we're going to treat that with acidic acid, eardrops, or we can use for oquinolone eardrops. Right. Now, what if they give you a question about a patient and you're told that this patient, you know, for the last three days, you know, that you're told that the person works as a plumber, right? And for the last three days, this person has been having like severe shortness or breath, right? Has been having like very crazy amounts of diarrhea, very, very crazy amounts of diarrhea, very, very crazy amounts of diarrhea, right? And then they give you a chest x-ray and you notice that you see a lot of interstitially infiltrates on a chest x-ray. And they ask you which of the following is the most likely etiology of the patient's presentation? I really hope you're saying, ooh, divine, this sounds an awful lot like ligenella. Sounds an awful lot like what? Like ligenella, ligenella, ligenella, ligenella. Right? So, what's the deal with ligenella? Why does this presentation because think of ligenella? Well, the thing is ligenella has a high yield history. First thing's first is that we're going to treat it with microleads, right? You can use a microlead. If you don't see a microlead as an answer, you can choose a fluorocuenolose, right? You can choose a fluorocuenolose. I've just kind of learned this as a general rule. It doesn't always work, but it works most of the time. Something that should be covered by a microlead.

If you don't see a microlead answer, it's not on wise to pick a fluorocuenolose answer. Many of the bugs that are covered by microleads can also be duly covered by fluorocuenolose, right? So, ligenella typically is going to be a straight out people getting pneumonia and it's going to be an interstitial pneumonia. It's going to be an interstitial pneumonia. In addition to that interstitial pneumonia, you're usually going to get some other thing. What is that some other thing going to be? That some other thing can be diarrhea. That some other thing can be hyponitramia. That's a high yield cluster of things to know for you exams. This thing has an association of HVAC systems, HVAC systems. A person that works in HVAC, a person that does what am I trying to think about here? Come on, Devon, think. These air conditioning systems and things like that. Many times, it can also present in an outbreak format. You see this outbreak of interstitial pneumonia. You really want to think about ligenella pneumonia, because by ligenella, a pneumofella. Ligenella, pneumofella. But it can also give you a plumber having this problem on the exam. Keep that in the back of your mind for tests. Remember, how do we diagnose ligenella? We're going to use the urinary antigen. We're going to use the urinary antigen. We're going to treat it again with a macrolid or a fluoroquinolone. Remember, ligenella can reduce the amount of raining that is produced in your body.

If you reduce the amount of raining, then you will not convert angiotensinogen into angiotensinone. If you don't make an ophaniotensinone, you'll not make an ophaniotensin II. If you don't make an ophaniotensin II, then you will not go to the zona glomerulosa of the adrenal cortex to make our duster. If you're not making our duster, then guess what? You're not able to reabsorb sodium from your kidneys. Remember, our duster helps with sodium reabsorption in the kidneys. If you cannot reabsorb sodium in your kidneys, then you're going to rush into getting to a lot of trouble hyponitremia. That's something that's pretty high you to know for your exams. What if they give you a question about a patient that has HIV? This person has had very high fever and then you give you a chest x-ray. You see all these dots later throughout the chest x-ray. The person's CD4 count is 40. What should be thinking about all your exams? I really hope you're saying, oh divine. Of course, this is TB. This is TB. Again, they may not always give you the cavitar elision on your exams. They may give you like miliary TB. They may give you what like miliary TB. When you see a chest x-ray in a person that is immunocompromised, then you see so many dots everywhere. You want to think about miliary TB. You want to think about miliary TB. This person clearly has active TB. This is not a latent TB question. This is an active TB question. How are we going to treat it?

We're going to treat you with two months of rip. We're going to treat you with two months of ripampin isonizid, a perazena mitanethambutol. Then we're going to use four months of isonizid and ripampin. Again, remember, if you're taking all these isonizid-based therapies, it's pretty high you to know that you should also take vitamin B6 because isonizid can cause a functional vitamin B6 deficiency. Because the thing is if you know vitamin B6 is known as pyridoxin. The thing is for pyridoxin, your body has to activate it for it to work. The activation is done by an enzyme known as pyridoxin, 5-primed forceful kinase. It literally forceful relays pyridoxin. That enzyme pyridoxin, 5-primed forceful kinase, is inhibited very powerfully by isonizid. Basically, isonizid prevents the activation of pyridoxin. That's how we can cause a B6 deficiency. Again, our friends at the NBME, they're probably not going to put vitamin B6 as an answer. If they put vitamin B6 as an answer, everybody and their siblings and their parents and their grandparents will get it right as an answer on the exams. They're not going to do that. What they're going to do, which is more appropriate, is put the other name like pyridoxin. Or they can put an answer choice that talks about a reduced vitamin activation. Or just reduce kinase activity or something like that. That's something I want to keep on the back of your mind for your exams. Remember, another way that TB can present is a cavitory lesion.

The cavity is going to be in the upper lobes of the lungs. One thing I think I want to say that will be very helpful is to have a differential diagnosis of cavitory lesions in the lungs for the USM-L exams. If you see a cavitory lesion on the lung on your exams, what are some things you should consider? You should consider TB, especially in a person that is immunocompromised. Another one you should also consider is aspergillus. Aspergilloma can present as a cavitory lesion on a chest x-ray. Then scrimocel cancer of the lungs. Scrimocel cancer of the lungs likes to cavitate. We just know that in general, scrimocel cancer just generally anywhere in the body loves to cause an ulcer. For example, scrimocel cancer of the skin is an ulcerative lesion. I like to think of these cavitory lesions in the lungs as being intra-puminary ulcers in a sense. That may help you keep that straight in your brain. That may literally help you keep that straight in your brain. This stuff is pretty high up to know for you exams. Then another thing that can cause cavitory lesions in the lungs, sometimes if a person has a very severe stuff or a serious infection, like a severe mercer or just MSSE infection, it can actually form a cavit in the lungs, especially when a person has a post-viral issue. Let's say for example, they've had influenza. Then they have a pwnary infection after that influenza. Remember, influenza really torches many of your respiratory defenses.

You can get this post-viral bacterial pneumonia. If you see a post-viral bacterial pneumonia, you see cavitory lesions in the lungs. It will strongly encourage you to think about a person having a a staphoreus infection. Then another thing that can also cause this issue with cavities in the lungs. What have I mentioned already? I've talked about aspergillomas, I've talked about post-viral pneumonia with staphoreus, I've talked about a TB, I've talked about scrimocel cancer of the lungs. Another one I think you should think about is a long abscess. You should also consider a long abscess on your exams. Long abscess on your exams. Even aspiration pneumonia as well. Although remember aspiration pneumonia, what side of the lung is it going to be on? I hope you're seeing divine right side. Right side. Why? Because remember the right side of the lungs has the right means tend broncus is wider and more vertical. It's wider and more vertical. Tell you this podcast, you've got to listen to it right before your test. It's just going to just to recharge your scores. You're going to get tons of questions. All right. Let's keep going. Let's keep going. Let's keep going. Let's keep going. Let's keep going. Now, what if they give you a question about a patient and they tell you that this patient has been on diagnosed with asthma three, three months ago. CVS asthma and that this patient was placed on a pharmacotherapy.

And that this patient for the last two months, this person has been having very, sorry, for the last two weeks, this person has been having a pain with swallowing and difficulty swallowing. And then they ask you which of the following is the most likely theology of the patient's complaints. If I were you, I'd pick the answer that talks about candidate, right? This person has candidate list of agitis, candidate list of agitis, right? Candida is a super high above to know about for your exams, right? So remember, candidate causes what like what like what? What does he cause on your exams causes throsh, right? Remember, that's the stuff on the tongue that scrapes with a tongue depressor, right? And again, remember, they can even give you a question about a person that's diagnosed with like throsh and then they ask you for your next best step in management. And really hope you're picking the answer that says to screen them for HIV, right? Like you don't just get throsh, you know, you see that in an adult, the adult probably has HIV. You see that in a kid, like especially like a child that was born maybe like a few days, few weeks ago. I mean, you want to think about like skin, severe, combined immunodeficiency, right? So remember, Candida can cause a bunch of problems, a boat load of problems on the exam for suicide, can cause throsh, it can cause this so for gideas in people that are immunocompromised, right?

But again, notice I didn't use HIV as my construct, as my model for this immunocompromised person. I use a person that was diagnosed with asthma. Sivia asthma was placed on pharmacotherapy. So this person may be on oral steroids or maybe on inhaled steroids, right? The thing is if you're on inhaled steroids and you don't use it very well, right? You can actually develop a Candidaeusis, you can develop throsh, you can get developed as a geocandidasis. That can get you in quite a bit of trouble. That's why you're told many times after you inhale steroids, it's not about I just drink water. Believe it or not, that can be a preventive medicine question you can see on your exams, right? So keep that at the back of your mind as you prep for your test, right? So they can get as of a gideas, right? They can get disseminated infections, especially people that are an utropinic. Utropinic patients, right? They can get very nasty candidal infections, right? And then remember if you're a woman that is obese or you have large breasts or you're diabetic, right? Candida can also come out under your breasts, right? He can cause into a trigo, he can cause into a trigo, right? And then you see a person that recently completed antibiotic therapy for some kind of infection. And then they develop like a vaginal discharge that has this cottage cheese like this thick consistency. And the vaginal pH, you know, is like, you know, less than 4.5.

And then you notice, so like 4.5 or less, basically, right? And then you notice that, you know, you see Sudo-Hyphe on like kill-hitch prep or wet prep. That's also Candida, right? Candida, a Volvo vaginitis, right? So something you want to keep at the back of your mind for your exams, right? And the thing is Candida infections, you can treat them with oral eels, right? If it involves the skin, you can use a topical eelsal or topical nice starting. Topical eelsal, topical nice starting for skin infections. But if it's, you know, like a Sudo-Hyphe or whatever, you can use an oral eelsal or oral nice starting, right? Oral eelsal or oral nice starting. But if a person has like disseminated fungal, like disseminated Candida, right? Dis disseminated Candida, disseminated Candida, disseminated Candida, disseminated Candida, what should you do? I'd really hope you're thinking of one of three answers on your exams, right? So what should you think of as like, probably like the best answer on your test? Think of like Etroconozone. Etroconozone is very good for disseminated Candida infections. But if you don't see Etroconozone as an answer, I will strongly encourage you to look for the answer that talks about an echinocandin, an echinocandin, right? What are the echinocandins? The echinocandins are antifongal drugs, right? They include drugs like Caspo-Fongin, a mica-fongin and anidula-fongin, right? So they're kind of candins, right?

So Caspo-Fongin, mica-fongin and anidula-fongin, right? Those drugs work by inhibiting the enzyme known as one three beta-D glucan synthase, one three, one comma three beta-D glucan synthase, right? The inhibiting enzyme, that enzyme is necessary for the synthesis of fungal cell walls, right? So you can use a kind of candins. But if you don't see any of those answers, you don't see Etroconozone as an answer, you don't see an echinocandin answer, I think I'm pick the answer that talks about amphotericin B, right? I like to think of amphotericin B as something you use where you're like in very dire straits, you have like a severe disseminated fungal infection that's kind of going, going up, right? And then don't forget, again, I want to try to kind of wrap up the spot because actually literally have something I have to run to. But don't forget your other high-yield fungi, right? They love to test on the exams, right? Like histoplasmosis, right? Mississippi, Ohio River Valley, right? Bread bad droppings, right? Interestitio pneumonia, right? Think of histoplasmic absolatum, right? I remember we're gonna go ahead and manage this with Etroconozone as well, right? And then don't forget your coxidiumicosis, right? Interestitio pneumonia, or even like meningitis in a person that lives in the southwestern United States, Arizona, California, Nevada, certain parts of Texas, right? They call it valley fever, right?

Southwestern United States, you see a person that lives in the desert, right? Lives in the desert. So they may not even give you a geographic location, they may just tell you the person lives in a desert climate. You see a person that lives in a desert climate and they have interstitio pneumonia. I want you to think of valley fever. I want you to think of coxidioides imides, coxidioides imides, coxidioides imides, right? And remember, what are you going to classically see on my cross-copying these people? You're going to see a spherial, you're going to see what you're going to see a spherial, you're going to see a spherial, SPHE, are you LES, right? Spherial, right? I'm going to treat this with each reconnaissance. Make sure you can identify a spherial on your exams, right? And then don't forget immunocompromised patient that has like no co-rigidity, very high fever, crazy high CSF opening pressures, think of crypto-co CoCominion gides, right? Think of crypto-cocus, you know, formats, right? Because it's many gides, people that immunocompromised like Buddha half HIV, people that have AIDS, right? I remember, typically we're going to diagnose it by doing the crypto-co CoCoccal antigen, right? We're going to do a latex particle agglutination assay of a CSF sample, a latex particle agglutination assay of a CSF sample. You can also, you know, see it with India inxtin of a CSF sample, right?

And remember, I think I forgot to say this for Legionella, remember Legionella, you're going to check the urinary antigen, right? Urinary antigen. Okay, back to crypto-co CoCocosominion gides, right? So how do you treat crypto-co Coominion gides? We're going to use amphotericin B and five flu cytosin amphotericin B, right? amphoterable and five flu cytosin, right? And they're remember we're going to use our flu, our fluconous all after that, you know, for like nine to 12 months, reduce the risk of recurrence, right? So how does amphotericin B work? Remember, amphotericin B, binds to our gostral, sorry, it binds to ergosterol, ERG-O-S-T-E-R-O-L, it binds to ergosterol, and basically creates pores in the cell walls of fungi, right? So that stuff can leak out. It's a very effective drop. It has a ton of problems, it causes, especially like nephrotoxicity. Keep nephrotoxicity in mind with amphotericin B, right? And then how does our five flu cytosin work? Well, five flu cytosin is covered by cytosin diamines, right? So look at five flu cytosin, so it makes sense that cytosin diamines works on it, right? So, uh, cytosin diamines is going to, diamines is going to remove, remove an amino group and convert the five flu cytosin to five flu yourself. And then that five flu yourself is going to inhibit the amythamideolizin these in cryptococcus new formants, right? In cryptococcus new formants. And they remember how do azols work? How does a droplet fluconous all work?

Well, fluconous all is going to inhibit the enzyme known as 14 alpha-dimethylase, 14 alpha-dimethylase, D-E-M-E-T-H-Y-L-A-S-E, 14 alpha-dimethylase. That's going to prevent the conversion of lannosterol to a gastro, right? The thing is these antifongals, you may think that this is something that you have to forget after step one. Think again, right? This is something that absolutely positively love to test on step two, second step three. In fact, sometimes on the USMELY exams, they can give you like a series of reactions and then you'll put like an unknown, right? And you have to pick out the enzyme, right? So don't forget 14 alpha-dimethylase is inhibited by azols, is inhibited by azols, okay? Is inhibited by azols, right? So drugs like voreconazol, which we use for invasive aspergillosis, right? Or intraconazol, or fluconazol, or whatever. They all work by inhibiting 14 alpha-dimethylase, right? And then don't forget aspergillosis, right? Aspergillosis, we've talked about the aspergillomas with the cavitor religions in the lungs, right? You can also have these invasive aspergillosis, especially in people that are intrupene, right? You notice the person that's intrupene, and it's like these days, these days, these days. You've given them broad spectrum antibiotics, and they're still not getting better. That person has invasive aspergillosis. The first line is rock for treating invasive aspergillosis is voreconazol.

If you don't see that as an answer, you can give them for terracing. B, I can remember for voreconazol is what it's an ease also, how does it work? It inhibits 14 alpha-dimethylase, 14 alpha-dimethylase, right? I think I've really hit a lot of books that I want to cover here. I've hit a little bacteria, a lot of fungi, but this stuff is pretty high up to no-phone exams, right? So I'm going to go ahead and stop here, you know, I think maybe one of the fungos I did, no disgust was mucomicosis, right? Don't forget mucomicosis, you know, diabetic or DKA, and then they have like basically like neck fascia of the face, right? That's mucomicosis, you know, from like rhizopause from mucus species, and the way you're going to manage that is you're going to give IVM for terracing, B, and you're going to debris their face, right? Although the debris is probably the first thing you should do, right? But yeah, so if you see the debris made as an answer, an IVM for terracing, B has an answer, pick the answer that says the debris meant, right? Because that is like a rapidly spreading infection. All right, so I'm going to go ahead and stop here. If you love the way I teach, you love the way I make integrations, you love the way I try to actually explain pathophysiology instead of making you blindly memorize stuff, then you want to strongly, strongly consider other view classes I have, right?

So tomorrow, that's Tuesday, the 16th of September, I have an MBME testing strategy class for step 1 to step 3, on Wednesday, that's the 17th of September, I have a four-hour bio-stats class for step 1 to step 3, on Thursday, that's the 18th of September, I have a five-hour social sciences quality improvement, ethics, healthcare systems class, five-hour classes for step 1 to step 3, and then on Friday, I have a mainstream last-minute review for step 2 and step 3, it's a three-hour class, and then starting next week, actually starting this weekend, actually I think that by starting this weekend, I then also have a 20-hour step 2 step 3 class, 20-hour step 2 step 3 class, 20-hour step 2 step 3 class. Again, these classes, many people have taken them and found them to be extremely helpful. I've had a lot of people that have literally taken the class super recently, and I've got in like 250, 260, 260, 270s on their exams, right?

So again, these classes are not just like throwing information at you classes, no, I explain pathophysiology, I make integrations, basically like the way I teach my podcast, I think you're going to find it to be extremely, extremely helpful, and then I also help with Eras applications, mock-interviews, personal statements, rec letters, editing, and all those things, and then I have this podcast on Apple Google on Spotify, and then I also have a You Tube channel Divine Intervention, US Mly Podcasts, and videos where I post the videos that I make, and then also don't forget that I have another website called Divine Intervention Lifelessens.com, Divine Intervention Lifelessens.com, every week I post like one or two podcasts, where from a biblical perspective, I address a life lesson, many of you know I'm a Christ follower, so I try to make these podcasts, I may be able to have found them to be helpful, I have like more than 350 podcasts on that website, they actually are an Apple Podcast associated with that called the Divine Intervention Life Lessons are podcast, right? And I also offer one on one tutoring for all the US Mly and the complex exams. Again, I've worked with many people, one on one, people in like terrible situations, they're like, whoa, Divine, I'm like in the 180s on my practice desk, and I've worked with them, and they've had like crazy, crazy pointing crazy stuff over the course of the dedicated period.

So if you're interested, many of these things just shoot me an email, I can give you some more information. So thank you for joining me today, I'll see you God willing, episode 624, so have a wonderful day, God bless you, we show the best on your exams and with your ER As applications. Bye for now.

Group B Streptococcus (Streptococcus agalactiae).

Only when she enters active labor.

Rifampin (or Ceftriaxone if rifampin is unavailable).

It impairs the renin-angiotensin system, leading to hyponatremia.

Neonates, elderly (>50 years), and immunocompromised patients.

Spherules (the fungal form).

Azoles (e.g., Fluconazole, Voriconazole).

Nephrotoxicity (kidney damage).

Linezolid.

Ampicillin.

Echinocandins (e.g., Caspofungin).

Pyridoxal kinase (PLPS kinase).

Azoles (e.g., Fluconazole, Voriconazole).

Nephrotoxicity (kidney damage).

Linezolid.

Ampicillin.

Echinocandins (e.g., Caspofungin).

Pyridoxal kinase (PLPS kinase).