DIP Episode 100 - The “Clutch” Micro Podcast

Okay, welcome. This is episode 100. The Divine Intervention Podcasts. And in this episode, I will call this Microbi-Cases. Basically, for the 100th episode, my goal was to make a podcast that will probably be the one of the highest, at least top five highest yield of the ones I have on my website. I know that the risk factors when it's pretty high yield for a lot of people. Many of the shelf ones are pretty high yield. So I will try to make this one pretty high yield. And really, this podcast is targeted pretty much to every USMLE exam. Step one, two, three, three. And even like some of these are specialty board exams, especially like medicine. Basically, my goal in this podcast is to essentially go through many of the high yield scenarios. And I'm not going to be focusing on like, oh, gram-negative blah, blah, blah. No, I will try to basically give you the clinical scenarios of many bugs and then tell you the bug. Okay, so this is something I would beg you. I'm begging you, listen to it before you take any of these major USMLE exams. It will help you tremendously. You're going to get probably, I'll be willing to wait here, like 10, 20, maybe even 30 questions correct from just listening to this one podcast. So let's begin. And I'll try to group things. So what if you get a question about a patient that has like bloody diarrhea, right? Or they can call it a me big dissenter and they have a liver abscess on imaging. What bug are you thinking about?

That's intamiba histolyrica, right? Okay, now what if you get a question about a patient that has like false spelling diarrhea and they recently hike to a drunk like some kind of contaminated water alternatively this may be a patient with like a B cell, immunodeficiency disease like IJ deficiency or like Breton's eGamma global inemia or CVID right so chronic variable, immunodeficiency, what bug are you thinking about? That'll be G. Adia Lambea, right? So you do an over and par site of the stool. Now what if you get a question about diarrhea and an eat patient and they tell you that oh, you look at the stool, you find acid fast all cysts. What is that? That is crypto sporadium parvo. Okay, now what if you get a question about a patient that has like a vaginal infection and it has like a green discharge and the pH is more than 4.5? That's true. Common as vaginitis give me tronitis all right. Now what if a person right recently came back from a developing country and they're having like thrombocytopenia, they have an anemia and they're having fever that seem to come on go every 48 hours. What are the plasmodium species you're thinking about here? Those are plasmodium vivaxanovali, right? What if you see similar symptoms about the fever's common govery 72 hours? That's plasmodium malaria, okay? And which of the plasmodium species I guess have dementia in the liver? That's vivaxanovali, right? Okay.

Now what if you get a question about a patient that plays with cat feces or has a cat at home and then they have like ring enhancing brain lesions? That's toxoplasma gone di, right? Okay. Now what if a patient has like an indirect hyperbilarobinemia and they have like a hemoglobin of 8 and they recently got like malaria treatment? What disease are you thinking about? I hope you're thinking about like a G6 PD deficiency, right? So a deficiency of glucose 6-phosphate dehydrogen is remember that's the reclubitin enzyme of the oxidative phase of the pentose phosphate pathway. That's also known as the hexose one of phosphate shunt. Okay. What if a person gets like a diarrhea after the consumed pork? That's tinia solium, okay? What if a patient has like cysts in the brain? It sort of follows from the previous question, right? That's tinia solium, right? Remember you're a neurosis dyscircusis. Again, consuming X is also an association you want to keep at the back of your mind with tinia solium. Okay. What if they give you a question about a child that each is a lot, like each is his buttocks a lot? What bug are you thinking about? That's interrubial, very many colaris, right? Remember the scotch tape test for that. Okay. Now what if you get a question about a patient you know that has like a microcity canemia and they tell you that they do like a, like, some kind of colonoscopy or whatever. And then they see some like worms attaching to the intestine, right?

I hope you're thinking about like your ancylostoma, do it anally, right? Or like Nikitor, Americanis. Okay. What if you get a question about a patient that recently came back from Egypt, went on a swimming expedition, and then they have hematuria. I hope you're thinking about she's to somahematobia, right? She's to somahematobia. Okay. Now what if you get a question and you see an image and the eggs have like a terminal spine? And let's assume this person just came back, they put like Egypt, an image of Egypt in the question. That's those are your, that's also she's to somahematobia. What if you get a question about a person that has like a liver abscess and the consumed snails? I actually really want you to think about some other she's to somah species. So like she's to somah mansanai or like she's to somah japanikom. This will be probably more tested on step one than step two, see again step three. Now what if you get a question about a patient that, let's see, how do I test this? Yeah, let's put it this way. What if you get a question about a patient that's immunocompromised or let's say they have eggs? And then you're seeing like diffuse markings on a chest x-ray. What bug are you thinking about? The immunocist is Jervet here, right? So in testically infiltrates on a chest x-ray, remember it's silver stain positive.

And remember that if those people's AA gradient is greater than 35, or the PAO2 is less than 70, in addition to giving them trimethoprimsophomethoxes or gums, trimethoprimisophomethoxes or any to add on steroids. Okay, now what if you get a question about like white lesions in the tongue of an individual? That's on chemotherapy, right? That's fresh, that's candidal bicantre. Okay, now what if you get a question about meningitis in an e-spacient? They'll be cryptococcus neophomins. Remember the latex particular glutination acid? And don't forget your India-inx stain. Okay, now what if you get a question about a patient that's from Ohio or like from Kentucky? And they have a pulmonary infection. What's the bug? He's to plasma capsulatum, very good. Okay, now all the tinias, right? So like tiniacrury, stiniacoprystiniapitis, what are the big bugs that cause these problems? There is tricophytein, there is micro sporum, and there is epidermal fighting. The one you want to pick on an NVME exam, if it's an answer, is tricophytein. If you don't see tricophytein, then go for micro sporum. But I'll tell you the truth. Like 99.9% of the NVME questions I have seen that tested the tinias. The correct answer was a tricophytein species. Now what if you get a question about a patient that's from California, or lives in California, or recently visited California, and they have like a pulmonary infection. And then they show you a histology slide and you see spherules.

What bug are you thinking about? That's coxidioidysimedes, right? Coxidiumicosis. Remember that's also associated with, there's this skin lesion that can show up in patients with tricoid doses. I'm forgetting right now. Come on, divine thing. Yeah, it's not coming to mind right now. I'll try and remember and say that in this podcast or in a future podcast. Okay. Now, what if you get a question about like an immunocompromised patient, and they give you like, they give you like a CBC, and you find like the, your synophiles are like 10% of the CBC. And then you get a chest X-ray and like in the right upper loop, you see like a ball, like a fungus ball. I really hope you're thinking about aspergillus of fumigatus, right? Remember in those cases you need to biopsy that to make sure it's not a long cancer. Don't forget your differential for your synophilia, right? Dogs, neoplasms, asthma allergies, addison disease, collagen vasculid diseases like scleroderma, right? And parasites. And then don't forget right that you don't forget like the order of things on your CBC, or in order of like decreasing frequency. So your intro fills are the most common followed by your lymphocytes, and then your macrophages or monocytes, and then your synophiles and then your basophiles. The easy way to remember that is with this nomonic that you should never let monkeys eat bananas. Okay? That's, I mean you shouldn't do that to a monkey, but never let monkeys eat bananas, that's the nomonic there.

Okay, what if you get a question about a patient that has like lesions in the lung, in the bone, in the skin, and they have like a, they tell you that, oh, you see a broad-based butt on the astrology. So a broad-based butt. So broad-based butt should get you thinking of blastomyces during materialities. Okay? So blastomy causes. Now what if you get a question about a patient that you know was recently, or let's say it's this person is a gardener, right? Or works in the fields. And then they tell you that they have like these lesions on one extremity, right? And they have like a sociathir lymphadenopathy. Or let's say it's a rose garden, or they were pricked by a thorn. What are you thinking about? I really hope you're thinking about spore trickosis, right? Cos by a spore trick's a shenky eye. Very high you to know that for the USMELIS. Now what if you get a question about a diabetic, especially like a type 1 diabetic, potentially a diabetic that is in DKA, okay? And they have like an infection of the face, and it looks necrotic, has like, S-shars and everything. What bug are you thinking about? I hope you're thinking about like mucormyosis, okay? Like your rhizopos, your mucorp species. Remember on his astrology, right? You'll find the non-ceptid hyphae, or A-ceptid hyphae, and the branch at 90 degree angles. It's very high you to know, especially for the USMELIS step 1. And then if you're thinking about a bug, right?

That has like, septid hyphae, and branches at a cute angle, right at 45 degree angles. Think more about like aspergillosa fumigadas. Remember, aspergillosa, remember the A in aspergillosa, for the A in a cute angle, right? Like a 45 degree angle. Let's see. So what next do I have for you? So what if, what if, let's see, what if you get a question about, let's see, how do I phrase this? Yeah, so what if you get a question about like salulitis and a burn patient, what bug are you thinking about? Really hope you're thinking about salulomono serruginosa, right? What if they give you a picture and you see a rash that looks like a bull's eye? What's the bug? That's Boralia Bognofri, and remember, it's a spirochete, carried by the exodistic, that's Lyme disease, right? Okay. Now what if in a question you see a strawberry tongue? That's scarlet fever, right? Strip pyrogenies. Remember, you can also find a strawberry tongue in patients that have Kawasaki's disease. Okay. Now what if you get a strawberry cervix? Green, frothy, green, false melancholy discharge, and the vaginal pH is greater than 4.5. That's trick, right? That's a... that's trick commoners vaginales. Okay. What if you... Actually, I guess I'll just go ahead and see this, because I've been mentioning a lot in general for NBM Es. The only vaginal infection, where the pH is less than 4.5, is Candida. Okay. It's Candida. Okay. Now what if you get a question about a patient that recently returned from Mexico?

And they have like a watery diarrhea? And let's see the drunk water in Mexico. What bug are you thinking about? I'll be thinking about it tech, right? And teratoxidetic equal line. Okay. Now what if you get a question about a patient that has like a maculo-papular rash? And let's see, they just came back from spring break, and they engaged in many risky sexual behaviors. And then they say, doc, you know what? I saw this ulcer on my penis. But it kind of went the way. It didn't hurt nothing. What stage of syphilis are you thinking about now? That's secondary syphilis, right? Okay. Remember condulomalada? That's basically what I described. Now, what's the general disease where a person is febrile? It's acute onset. They have no corrigidity, and they're altered. That's meningitis, right? Now what if you get a question about meningitis as a college student? And if you think that this patient has like skin lesions, like pepper, postures, right? That's my syramin and meningitis, right? And if a person has meningitis, right? And they have signs of elevating for cranial pressures, right? Like papillodema and all that crap. You need to do a head CT first, okay? You need to do a head CT first to rule out like a mass lesion, right? Because you don't want to do a lumber puncture and then different eat and die, right? That will not be ideal. So you do a head CT first, and then after you do the head CT, you then do a lumber puncture.

You don't have like signs of elevated IC Ps, like they don't have papillodema and stuff like that. You can go ahead and do a lumber puncture. And remember, right, you'll find the gram-negative diplococsy that have capsules, right? If it's a nice syramin and meningitis you're dealing with. And remember that nice syramin and meningitis, what kind of drugs do you give? Right? You give like seftraaxone, right? You give seftraaxone, although if a person comes in with meningitis and you empirically want to treat them, you want to give them seftraaxone and vancomycin, okay? And remember that if you took care of a patient, let's say you intubated a patient as a classic M&M question, intubated a patient that has meningitis, right? You need to take something for prephylaxis, like rifampin, okay? rifampin is the preferred agent. Other things you can use, you can use things like seprophloxicin or seftraaxone. But rifampin is the first line agent. But obviously, if you're pregnant, you cannot use rifampin or seprophloxicin because seprophocicin will explode your tendons or the baby's tendons. So you go ahead and take seftraaxone under those circumstances. Okay, and then the other high-ill-prephylaxis thing, if your close contact is like, what is this thing called? Woping cough, right? So body telepertosis. You should body telepertosis with aerithromycin. If you're close contact, you also prefer relaxed with aerithromycin as well or any macrolid, if you're choosing.

Okay, now what if you get a question about a meningitis and a person that's like in their 60s or older? What bug are you thinking about? That's strep pneumo, right? What if you get a question about meningitis and an onimonized-like infant? Right? That would be strep pneumo as well. Strep pneumo is the most common cause of... Strep pneumo, right? Is the most common cause of meningitis? But if the patient is onimonized, you should also think about like my seromyin, ingitis and like heech flu. Now, what if you get a question about meningitis in your new neat? What bug do you really want to think of first? Or you want to think about a gruby strep, right? Gruby strep. Okay, so I think that's all I'm going to say here. But you know, let's keep going. So what if you get a question about a new neat that has like in cephalitis? And let's say the mom works in a pet store like an animal, a conservancy or whatever that handles cats. What bug are you thinking about? That's toxic plasma gondia, right? Remember the cat association. Now, what if you get a question about a patient that has bloody diarrhea and they recently consumed chicken? Especially in the US, you probably want to think about Campilo Bacter, Gijunai. Remember the East Indian paralysis and the Guillainbury syndrome, right? And also don't forget from my earlier podcast today, the association with a reactive arthritis, right? So like a writer syndrome. And the blog, it's a cause of bloody diarrhea.

Now, what if they ask you this is more for step one folks, right? So like bug that has a hyaluronic acid capsule and it has like m protein, right? That's group A strep, right? That's a strep pyogenes. Now, what if you get a question about a patient that is e-taxic and they've lost like sensation and let's assume it's like a sexually active female? What are you thinking about? So sexually active female risky behaviors for many years. I hope you're thinking about like TB's or salads, right? Remember a tertiary syphilis? You can basically scrub your dorsal columns, right? So like your dorsal columns are a media on a meniscus system. So you lose like fine-touch, vibratory and perperceptive sense. Okay, now, what if you get a question about a patient that hasn't sephalitis? Like weeks after they consumed like undercooked pork? What bug are you thinking about? I've mentioned this already before. Temia solium, right? That's neurosis dysphacosis. Now, what if you tell you that, oh, this is a HIV patient and you get a cat scan and you're finding ring and Hansen lesions in the brain of a HIV patient? What are you thinking about? You're thinking about T-gondia, right? Toxoplasma-gondia. Remember, you proofilux against Toxoplasmosis with trimethypremstylphomethoxazole? Well, you treat, I remember the magic city for count is less than 100. But you treat Toxoplasmosis with a perermethamine and a sulfidizing.

Okay, now, what if you get a question about a patient that has like bloodied diarrhea and they have like hepato-megalion physical exam? And they say, oh, you perform imaging and you find a liver abscess. What are you thinking about? That's intamibahistolydica, right? Okay, now, let's assume you have an AIDS patient and you check their stool and you find like, and this AIDS patient has diarrhea and you see like a positive acid fast osis. What's the bug? That's crypto-speridium parvam, right? Now, what if you get a question about like a sexually active guy you know that has a throitis and he has like skin ptkion? That's going to caucus, right? That's nice, you're going to rea. Don't forget, nice, you're being ingitted and the adrenal hemorrhage, right? With like waterhouse frederixin syndrome. So if they give you a patient that has like meningitis and then all of a sudden they have like cyclatory collapse and they have like hypercalemia and hyponitrenia and ametabolic acidosis, right? Those are all signs of adrenal insufficiency. You really want to think about what a house frederixin syndrome from nice, seramine ingitis. Okay, now, what if you get a question about a patient that has like large testicles and a large parodid gland? Right, that's mom, right? Remember that can also cause a pancreatitis. Now, what if you get a question about a sickle cell patient or any patient that has a hemoglobin apathy?

And acutely, the a hemoglobin drops super low, like well below the baseline. What virus are you thinking about? That's Pavobin 19, right? Remember, it's a single stranded, a Gini virus. I remember it can cause like an anemic crisis in patients that have a hemoglobin apathy. Okay. Now, what if you get a question about like permanent flaccid paralysis in an on-vaccinated child? Right? That's polio-my-light. Just remember, polio-lofts to it's an interovirus. It loves to screw up your anterior horn, right? Like the ventral horn of your spinal cord. Okay. What if you get a question about like new carogenicity in a two week old child? Right? That's a group B-strip, right? That's a group B-strip. A group B-strip is the most common cause of essentially an immature neonatal infection in the first four weeks of life. Okay. What is the most common bacterial cause of ST Ds in the US? Right? That's chlamydia tracomitis, right? Like the D through K serivars. Now, what's the most common cause of UT Is in the US? That's E-coli, right? What's the second most common cause? That's stuff epidermitis, right? Sorry, stuff's not prophetic or swaps. Now, what if you get a question about elevated liver enzymes in a pregnant woman that subsequently dies? That's hep E, right? Remember the influenza virus, right? This is just a concept you want to know for the USML Es. But remember that it has like a segmented genome, right? That's why you can cause like these epidemics and pandemics.

Now, what if you get a question about a patient that has like a sore throat and they have like a viral conjunctivitis alongside? Think about adenovirus. Remember adenovirus can also cause like a gastroenteritis and it can also cause a hemorrhagic cystitis. I've seen that presentation on the USML Es. Now, what if you get a question about like a black S-car in a diabetic? That's pseudomonas, right? Remember that's like ectema, congrenosa. Now, what if you get a question about like a viral myocarditis? What's the virus you're thinking about? That would be coxac-e-b, right? Not coxac-e-a, coxac-e-b. Remember coxac-e-a is the thing that causes hand-foot-mount disease, the rash and the palms and so on. Now, what if you get a question about a patient that has like flu-like symptoms and they have like ocular findings on a physical exam after visiting Hawaii? You'll think about leptosporosis, right? So like, releptospyra interrupts. Okay, very good. So, let's see, how do I present this to you? Okay. What if you get a question about a kid that like you know, goes to a daycare and has like this rash and it looks like the kid was slapped? That's probably 19, right? Now, what if you get the question about like this, I guess, triad or tetrad, of like a kid with like cough, has like runny nose or like choriza, and has like pink eyes or like conjunctivitis and they have like complex spots on the vocal mucosa. What's the virus you're thinking about, right? That's measles, right?

Like your rubula. Now, what if you remember measles can also cause like this rash that starts on the face and sort of spreads down, right? Now, what if you get a question about a kid that has like gastroenteritis and it's an immigrant? Like, has like a few days of gastroenteritis and then they become like permanently like quadriplegic. What bug are you thinking about? That's poliovirus, right? Remember again, that's an interrovirus. Knowing that poliovirus is an interrovirus is actually kind of high you to know for the USML Step 1. Okay. Now, what if you get a question about a patient that has cervical cancer and the patient is sexually active and is like a young patient? That's HPV, right? Like the 16 and 18 and the ones in the 30s. Don't forget, right? That the most common cause of death, very high you to know this. Most common cause of death in a patient with cervical cancer is renal failure because the mass involves the the ureter. So basically if you see a gynecologic malignancy and the creatinine is elevated and they have like significant urinia, tumble there in the rest of the question, it's cervical cancer end of story. Now, what if you get this triad, right? Like paratitis or inflammation of the parodids or chitis, you know, the testicles and like a guy that's having trouble like getting his wife pregnant, right? That's mumps, right? Now, what if you get a question about like cataracts or like blindness in a newborn? What's the bug you're thinking about?

That's rebella, right? Remember, it can also cause like cardiac problems like the PDA, right? So like a peat and doctor satirosis, like the machine like murmur. I remember PDA presents with a white pulse pressure. That's very high you to know. I'm super excited for when I'll get to give cardiology reviews. That'll take a lot of planning, but I am obsessed with cardio. That'll be a fun set of reviews. Okay, but back to this. Now, what if you get a question about like like painful skin lesions in a dermatomo pattern? That's VZV, right? So like the virus, that's the virus. Remember that, right? For the most part, VZV tends to sort of like state-domain in the Dorsal root ganglia, right? And you can treat it with acyclovere actually. Okay, but if it's resistant to acyclovere can go after a false carnit. That's like the pyrophosphina analogue. Okay. Now, what if you get a question about like general warts? Right, think about HPV 6 and 11, right? 6 and 11. Remember those that's what's known as a condiloma acominata. Please do not confuse condiloma acominata of HPV 6 and 11 with condiloma lada of secondary syphilis. Now, what if you get a question about like red nitase or like colitis in an 8-specient or let's say like a patient that recently got a transplant? What's the virus you're thinking about? That's CMV, right? And usually on the NV Me question, they'll tell you that on histology or rhombiopsy, you find like intra-nuclear inclusion bodies. Okay.

Remember you treat CMV with a gang cyclovere. Okay. Now, what if you get a question about painful vesicles on the genitals with an erythemyrus base? Right, you're thinking more about HSV 2, right? HSV 1 tends to cause more ulcers, but that is not a true, does not a hard and fast drill. You can get genitals ulcers with HSV 1, okay? Now, what if you get a question with about like a pregnant woman that has like really high est, really high ALT, and this disease has high mortality. That's happy, right? It's like 25% mortality is actually pretty high. Now, what if you get a question about like watery diarrhea on a cruise ship? It's pretty easy, right? That's like neurovirus, neurovirus. What if you get a question about a young sexually active female? Right? That's just been feeling like wiped for the last few weeks. It has like a left upper quadrant like a mass, so like spinal megalene. And then you do a blood sprain, you find like atypical lymphocytes. And she has like posterior cervical lymphadenopathy. That's EBV, right? I just want to go ahead and see something, right? So don't hang your head on posterior cervical lymphadenopathy as being indicative of EBV, okay? Your friends at the MBA me an our writing questions where it's EBV, what do you give your anterior cervical lymphadenopathy in the question? Kind of sucks, right? But just sort of keep that in the back of your mind. Okay.

Now, what if you get a question about it's a pediatric question and the kid has a really bad watery diarrhea? That's rotavirus, right? That's rotavirus. Remember that he can actually rotavirus for folks, those folks seeking step one. Remember he can participate in, come on divine, think, you know this shows up a lot on step one. It's called like a genetic reassortment. Okay. And that thing just came to my mind. Remember the thing I was talking about like coxidiumicosis that you can get on the lower extremities. That's a rhythmanoidosum. That's also found in patients with a sarcoidosis. Okay. And remember, right? There is actually a vaccine against rotavirus. But those are contraindicated in patients that have a histrovin to sepion. Or patients that have a histrovinicles diverticular. Those are very high you to know for the pediatrics shelf exam. Okay. Now, what if you get a question? I guess what are the two most common causes of the common cold, right? That's corona and the rhino virus, right? The most common one is rhino virus. Okay. Now, what if you get a question about like pneumonia and like expiratory wheezing in a kid that's like less than two years old? What's the bug you're thinking about? That's RSV, right? Like respiratory sensation virus. If a kid is at a high risk of like getting like severe respiratory compromised with RSV, you can actually profile out against RSV with a monoclonal antibody known as a palavizumap. Okay.

Now, what if a patient has like myalgyz, fevers, feeling like crap in like December January? That's the influenza virus, right? I had a very good taste of the influenza virus. This was November, December of my 30th of my school. That was like back in 2016 or whatever. I did my piece of rotation in November and December. That's like prime time forgetting, in fact, and I think I had the flu like twice during that rotation. But it was a funeratition nonetheless. Okay. Back to this. Now, what if you get a question about a patient, you know, that was beating by an animal? And then they have like a fetal in cephalitis and they tell you that they're refusing showers not long before they died or they don't want to drink anything before they died. What bug are you thinking about? Right? That's the rebe's virus. So I remember it's a rapdo virus. And then what if you get a question about a new needs that has like in cephalitis? They do a lumber puncture and you see like a lot of red blood cells, right? Or you see like temporal nube enhancement on on an engine of the brain. What are you thinking about? I hope you're thinking about HSV. I remember in viral meningitis, you'll have like the Namo CSF pressures, Namo protein, Namo glucose, but the cells that will be in the video will be their lymphocytes, right? Okay. So I think that's, I don't know what I'm feeling pretty good today. Let's keep going. I think there's a lot more stuff that we can sort of talk about. Let's see.

How do I present this? I guess I can talk about like similar sounding words, right? So if you see like erythema-crannicome migrants, right? That's Lyme disease. Basically these words all sound the same, but they all like for like completely different things, right? So like erythema-crannicome migrants is like Lyme disease. Erythema-marginatum, right? It's like chromatic fever, right? From like group A strap. Erythema-infectial sum, right? That's like the slugs chick finding in patients that have like parvo B19, right? And then ectema-gangrinosa, right? That's like the skin finding the blackest shot in patients that have pseudomonas. And then there's this one within that tends to show up on pizza exams. It might as well talk about these as pseudo group A strap. Basically they give you a question about a kid that's like having like choriform movements of their arms or whatever. And then they tell you that they had like soft throat or like some kind of like weird upper respiratory infection, like a few months ago. You want to think about like an autoimmune, very high you to know that word autoimmune reaction to group A strap. It's called like pandas, so like pediatric autoimmune neuropsych disorder associated with group A strap. Okay, keep that at the back of your mind for exams. Okay, so let's see how do I present this next one. Okay, what if you get a question about a patient that has like a painless shanker or an ulcer on their genitals, right? That's T-paladum, right?

Tripodema-paladum. That's clearly syphilis. I remember, right? You have like the indorethed or like the raised ages. Then you have like some lymphatinopathy. Okay, now what if they give you a question about a patient that has like you know, they have like painless ulcers on the genitals. They actually do not have an inguinal lymphatinopathy. I hope you're thinking about like Klepsiala granulomatis. Remember that's the thing that causes a granuloma inguinali. Okay, if you do histology or pathology, you find like the intracellular, donor van bodies. And again, it's a painless ulcer has like a beefy red beast. Okay, now what if you get a question and you tell you that own histology, you find like epithelial cells with inclusion bodies. That's very simple x, right? That's like HSV2. And I'll just go ahead and see this, right? So there's no people, I'm sure there's no people listening to this podcast saying like, divine, all this histology you're saying, that's more for step one. Think again, right? I promise you there are step two questions where they will describe pathology findings. Believe it or not. And also shelf exams. Okay, now what if they give you a question about a patient with like a genital warts, right? That's HSV what 611? Okay, now what if they tell you about a patient that has like a urethro discharge and you draw a gramstine of the discharge and you find gram negative deep low caulkyy. What you're thinking about. I see you're going to read very good.

Okay, now what if they give you a question about a patient that has like a pain less genital ulcer and any progresses to like massive inguinal lymphatic. And I'll give you a hint. This is also known as lymphogram, uloma venerium. This is actually chlamydia. This is chlamydia trachometis. Well, these are the L1 through 3 serivars. Okay. Now what if you get a question about like, let's see. What I guess what's the STI that you can diagnose with like dark field microscopy? That's syphilis right? Trappinima paladum. Remember it's a spirochid. And what if they give you a question about a patient that has like a painful ulcer. And they have like inguinal and they don't have actually do have inguinal like bilateral inguinal lymphatic. That's hemoflose do cry right? That's chancroid. Remember hemoflose do cry makes you cry. Okay. What if you see like painful vesicles on the genitalia or that erythemidospace? That's HSV2 right? Okay. Now what if you get a question about a patient that has like a septic arthritis and also have like a urethral discharge? That's my seragonaria right? Okay. Now what's the STI that can be treated with a macrolid or with doxycycline? That is chlamydia right? That's chlamydia like the D through K serivars. Remember lymphogram or loma venerium is caused by the L12 and three serivars of chlamydia. But the actual like UTI of how do I put this? So you know what let me leave this thing to rest right?

So there are a through C serivars of chlamydia tracometis it causes like ocular infections. I think it's like the most common cause of blindness in like the developing world or something ridiculous. The D through K serivars tend to cause more they can cause ST Is. But if you're thinking about and they tend to cause more of like the urethral discharge, penal discharge or whatever. But if you see like ulcers on the genitals, think about lymphogram or loma venerium and those are your L12 and three serivars. It's actually very high to know those different presentations for exams. Now what is the STI that's treated really nicely with serivaractyl? That's nice here. And if you're treating for serivaractyl, you also have to concomitantly treat for, so you give like serivaractyl and doxycycline or serivaractyl and is ethyromicin. You want to treat for concomitant and chlamydia infection at the same time. Okay. Now there is something I want to say in terms of like rash patterns, something that helps people a lot on NBM Es. So what if you get a question about a patient that has like a rash on the palms, on the soles and on the trunk, and he recently had a painless shanker, that's secondary syphilis. Now what if you get a question about a patient that has like a sandpaper rash on the trunk, and then the maybe give you a clinical, he's from like a strawberry tongue. That's carlet fever, right, with like group A strap, right, so like strap pyogings.

Now what if you get a question about a rash that starts on the face and migrates quarterly, right, down towards the feet. That's measles, right, also don't forget your cough, caries, and conjunctivitis, right, and they may also have those couple of spots on the on the bachomeucosa. Okay. Now what if you get a question about a rash that starts on the palms and soles and migrates centrally, so like it goes from outward in. That's actually Rocky Mountain spotted fever. Remember that's caused by reketz here, reketzai. Remember you give doxycycline for that, right? Unfortunately, even if the kid is less than seven years old, it doesn't matter. You go ahead and give doxycycline if not, you will die for sure. If it's a pregnant woman that has reketz here, reketzai, you can give a chloramphenicol. But in general, right, like Lyme disease, if you're under the age of seven, you get a moxicillin on MBM Es. But if you're over the age of seven, you get doxycycline. But that rule does not apply to Rocky Mountain spotted fever. If you have reketz here, reketzai, all ages, you get doxycycline. If you're pregnant, you get chloramphenicol. End of story. Okay, now, what if you get a question about a patient that has a rash on the hand, on the palms and soles, and they also have like lesions in the mouth, right? That's hand-forth mouth disease, right? That's coxacchi, e-virus, remember coxacchi, e-virus, is the one that causes myocarditis on MB Ms.

Now, what if they give you a question about a rash that's lasting for like three days? That's rebella, right? So, don't confuse rebella with rebella. Rebella is measles. Rebella is German measles, I know, it's kind of annoying. So rebella is German measles. It classically causes like a rash that lasts for three days on MBM Es. And really, like, a higher give away, you may actually get on the exam, is they may talk about like posterior or regular lymphadenopathy. Okay? Because it also kind of like begins at the head and spreads downwards like rebella. So please, please, please, don't mix up rebella and rebella. Rebella is measles. Rebella is German measles, I know, super annoying, but you got to know it for your test. Yeah, again, these rash patterns, they can help you tremendously on a USML exam. Okay, so let's, you know, let's keep cruising along. I'm feeling pretty good, pretty good this evening. Let's see. So, how do I present this? You know what? Let's do some generalizations with pneumonia. They're not always true, but they are good generalizations. So what if you get a question about like a neonate? So like, first four weeks of life, they have a pneumonia. Think about group B strap or like Listeria, right? What if you get a question about a patient like in the 2-10 age range, and they have like pneumonia? Think more about like 2-4 age range. Think about RSV, like a viral pneumonia.

Now, what if you get a question about a patient that has pneumonia and it's like teenage years, early 40s? That's more Michael Plasma, right? Like walking pneumonia. Now, what if you get a question about like an older patient, like in their 50s, 60s, and they have pneumonia, I think most trip pneumo, right? What if it's a HIV patient with like, I don't know, like interstitial infield traits? That's pneumonia, sister of Etsy, but here's where you need to be careful. Now friends at the NBME, they know that everyone, HIV pneumonia, PCP, HIV pneumonia, PCP, got to be careful. If they tell you that there's a low bar consolidation on chest X-ray, in a HIV patient, it is strap pneumo, not PCP. PCP causes interstitial infield traits. I mean, sorry, PCP causes interstitial infield traits, strap pneumo causes low bar consolidations. So the most common cause of a low bar consolidation on imaging, on NBM Es in a HIV patient, is strap pneumo, not PCP pneumonia. And again, I mean, the most common overall cause of pneumonia in every population is strap pneumo, right? Okay, so let's see, how do I present this? Okay, just to rehash this, this is something that shows up all the time, right? NM pneumonia in like some patient that has been on chronic immunosuppressant or chronic clinical therapy, or HIV patient is what? Right? That's the most sister of Etsy, right? Now what is the most common cause of walking pneumonia, right?

So the patient will not have a super high fever, they'll have interstitial infield traits, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, and then they'll have a super high fever, That's a painful lesion, like erythematos, well, so it comes with a scribe lower extremity.

That's called cidiumicosis, right? That's called cidioidemitis. Now, what if you get about pneumonia, right, with an Italian that the patient has like a Ross-Colored Sputum, that's trepneumol, right? How about the red-corrent jelly-sputum? That's Klepsiala pneumonia. Now, what if they give you a question about a patient that has pneumonia? And they recently went for a business conference, or let's say they were exposed to like air conditioning, or let's say they have pneumonia, in fact, I think of this as pneumonia plus, they have pneumonia, and they have like hyponitremia, they may even have like thrombocytopenia, they may have like diarrhea, and this organism seems positive with, I believe, silver. That's legionella nomofel, right? Now, what if they give you a question about a patient that has pneumonia, and they handle like cow poop, like cattle? Think about Cauxcilla Bonaria. Remember, Cauxcilla Bonaria causes a cue fever. It can also cause, what is this thing called? It can also cause, common divine think, it can actually cause endocraditis. It's actually one of those things that causes culture and negative endocraditis these days on NB Ms. Now, what if they give you a question about a patient that has cystic fibrosis, and they are like 18 years old and they have a pneumonia? That's staphoreus, right? So if you're less than 20 pneumonia, CF patient, that's staphoreus, if you're greeted and 20 think about a pseudomonas.

But if you see a question about pneumonia in a CF patient, and they're greeted and 20 and pseudomonas is not an answer choice, go with this bug, it's known as a Bocodyrus epicia, okay? Go with Bocodyrus epicia. Now, what are the three most common causes of atypical pneumonia? It's Michael Plasma, it's Clamedia, right? And then Legionella as well. And remember, you cover all these bugs with macrolits, right? In fact, macrolits, right, has an M, a C, and an L in it. So that tells you the bugs that macrolits cover, right? Like, Michael Plasma, Clamedia and Legionella, remember your macrolits, right? Like Erithromycin is also like a motillin receptor agonist, right? So you can, you can be used to treat a diabetic gastroparesis. And then your macrolits can also prolong the Q-team trouble. And they inhibit the 50-S ribosome. Okay. Now, what if you get a question about pneumonia in neonate? And they tell you that, oh, they take a sputum sample and you'll find like a gram positive coxine. That's group B-strep, right? Strepigalactia. Now, what if you get a question about pneumonia in your neonate and they tell you that, oh, they get a sputum sample. And you'll find gram negative rods. That's E-coli, right? Okay. Now, what if you get a question about like an pneumonia and like expiratory whizzing in a nine-month old? That's RSV, right? So RSV, telling you this, I promise you this is very high-yield. RSV on MBA means presents with expiratory whizzing. Not inspiratory strider.

This is especially important for the pediatric shelf and for step two, seek and step three. If you see inspiratory strider, think about a group that's power influenza or think about a pigletitis, with like H-floor, like strepney mole, whatever. Okay. Those are the things that cause inspiratory strider. expiratory whizzing is RSV on a pig's shelf example. You can basically take that to the bed. Okay. Now, what if you get a question about a pneumonia in like a wool solder or like some kind of post-o worker? And this person has hemoptysis? That's bacillus and thresus, right? Remember, it can cause a hemorrhagic mediastonitis. So if they give you like a question about like an FBI worker or like a post-o worker that has like a widened medias dynamo and chest x-ray, you really want to think about bacillus and thresus on those circumstances. And remember that the capsule of bacillus and thresus is not made of like carbs, is made of like protein, so like a polyglotamate. That's kind of high up to know for the USM Ls. Now, what is the most common cause of pneumonia in a younger dog? That's mycoplasma pneumonia, right? What is the most common cause of pneumonia overall? That is strepneumol. Okay, what is the most common cause of viral pneumonia? That's our SV, right? Okay, and if the deteriorated of the prison house pneumonia and they have like a lung abscess, I really want to think about like MRSA, so like Staphoria, so like an unerable like Klepsil and pneumonia.

Okay, how about pneumonia in an IV drug user? Let's see the deteriorated, you see septic embolion imaging, the Staphorias, right? If a patient has pneumonia, like let's say like they get like a worsening of the symptoms and they are just recovering from the flu, so like a post viral pneumonia, think about Staphorias, right? Think about Staphorias. Staphorias loves to form like cavitory pneumonia in post viral pneumonia patients. Okay, and I mean if you see like a pneumonia, you'll see like air fluid levels on chest x-ray. Think about Staphorias like MRSA, but also think about your uneropes, right? And the classic uneropes, they put on the USML Es, they can put like a pepto-striptococcus, they can put a prevoitella, they can put a fuzobacterium, they can put like bacteria, so like diffragilis. Okay, so let's see, let's keep rolling. I'll probably be done with this as soon. Let's see, how do I present this? How do I go to the next round? Let's see, okay, let's go ahead and do it this way. So, what if you get a question about a patient that has watery diarrhea and he recently just returned from some kind of international trip? That's ETECH, right? That's in teratoxigenic echoline. Now, what if you get a question about like watery diarrhea in like a developing country and the stores look like rice water? That's vibriolcology, right? Now, what if you get a question about watery diarrhea in a hiker or a camper? Or a patient with Ig deficiency or Bertonsi-Gama-Globulinemia?

That's the idea of lamblia, right? How about a cruise ship watery diarrhea? That's neurovirus or the normal virus, right? How about watery diarrhea in an infant? That is rotavirus, okay? How about watery diarrhea in an AIDS patient? That is cryptosporidium parval, okay? Remember the acid fastosis in the stool? And I believe you treat that with a mitosoxamide. Alternatively, if I'm remembering correctly, I think you can also give paromomysin, but I'm not 100% on that. I'm 100% on the mitosoxamide part. Paromomysin has been years. I review that stuff. Okay. What if you get a question about like a bloody diarrhea after consuming beef? It could actually be one of like three options on an ambient. It could be cut mellow back there. It could be ehec. It could be shigella. But if you're going after like shigella or ehec, then you give you all the things, like things in the hemolique remix syndrome, right? So like arising creatinine, a hemolique anemia. So you may see like schistocytes on a blood smear. You may see like an indirect type of bilirbonemia, stuff like that and fever. Right? Now how about like a bloody diarrhea after consuming like poetry or eggs? That's someone else, right? Someone else and it's ready. Okay. What if a person has bloody diarrhea and they tell you that, oh, they perform some testing? This will be a step one question. And you find that lactose fermenter. That's ehec, right? Now what's the most common cause of bloody diarrhea in the US?

That's Campylobacter Gisunoid, right? And remember, right, if a patient has like bloody diarrhea and like subsequently they have like asymmetric yeast and impuralysis, without like real sensory deficits, what are you thinking about? That's Guillembury syndrome, right? That's Guillembury syndrome. Okay. What if you get a question about, you know, a patient that has diarrhea and they recently got treated for some kind of like anaerobic infection? Well, let's see if you were in the hospital. Think about C-Diff, right? Plus, 3 D or more difficile. Remember anaerobic infections? You can treat them with clindamycin. And clindamycin is the thing that's like very commonly associated with C-Diff. But you kind of want to not stick that rule as hard and fast. Exposure to any antibiotic with diarrhea afterwards is C-Diff essentially 100% of the time on an NV Me exam. Okay. Now, what if you get a question about like diarrhea that feels like appendicitis? So they may have like diarrhea and they have like significant pain in the right lower quadrant. And let's say they consume pork. That's your senior, right? Your senior and terror cholerica. Okay. Now what's like the high-opertozole cause of bloody diarrhea on NV Me's? That's intamibahistolirica, right? Okay. Now what if you get a question about like bloody diarrhea and the press, the bug you just require like 10 or so box to cause significant symptoms? That's shigella, right? Okay.

Now what if you get a question about a patient that has bloody diarrhea and they have like fever? They have like high-blody temperature? They have like low hemoglobin? They have like low platelets? They have like renal failure? Or they may have like altered mental status? That's ehec, right? They also like shigella. So enter hemorrhagic echelalide or shigella. Okay. How about like watery diarrhea after consuming like oysters or like seafood? That's what. Vibrio parachymolyticus. Very good. Okay. Now how about like the diarrhea after consuming like oysters and they tell you that oh, they give you like labs and their ASD ALT is elevated? And actually tends to have like, let's put it this way. This kind of inheritance to have a high mortality in patients with chronic liver disease. That's vibrio vernithicus. Okay. What if you get a question about a patient that has like watery diarrhea and they recently swam in like fresh water? Or they work in an aquarium? That's a remunas. It's this thing I believe I have only ever seen tested ones on any USMLE that I've taken. Okay. Now what if you get a question about a patient that has like diarrhea and they have like massive amounts of like fluid, loss, multiple electrolyte anomalies? That's vibrio coloring, right? Okay. Now what if you get a question about a patient that went to like a Korean barbecue restaurant or like any kind of like Asian restaurant and they have a watery diarrhea and like a ton of vomiting?

Especially like fried rice. Think of fried rice. That's a bit serious, right? So be serious. Okay. I promise I'm not a racist. Just that's how it says that on the example. Okay. Now what if you get a question about like diarrhea like two hours after consuming a potato salad or food that was left out for long? Right? That's tough for us. Right? That's kind of easy. In fact, they tend to have less of diarrhea and move like vomiting. Now, don't forget that clostridium perforingin can also cause a can also cause a diarrhea. I just thought I'll go ahead and throw that in there. That's something that actually shows up quite commonly on the USM Ls. And then just don't forget this thing about like a patient that sort of swims in fresh water and then they die afterwards. Think of this bug. Come on, divine. Think. I believe it's known as a nigleria falora. That shows up quite commonly on the exam. So keep that at the back of your mind if I were you. Okay. I'm going to try to keep this podcast only an hour. What if you get a question about like fever and like a new onset murmur in an IV drug user? That's tough for us, right? What if you get a question about like fever and a new murmur in a patient that just had a dental procedure? That would be strebvery dance. Okay. Now what if you get a question about like fever and a new heart murmur in a patient with a prosthetic valve? That's tough. It would be dermatists, right?

And then what if you get a murmur and you tell you that oh, months earlier or weeks earlier the patient had like a sore throat? That's streb pyogenis, right? That's like chromatic fever. And actually it's kind of high you to know this patient that have patients that have endocraditis from like streb pyogenis, so like chromatic fever. It tends to have a predilection for the left side of the heart like the mitral valves. Okay. But if it's tough for us endocraditis, right? It has more predilection for the right side of the heart, right? Because think about it. If you're an IV drug user, literally analyze the word IV drug, IV intravenous. You're injecting into a thing. I don't know where do veins drain? They drain to the right side of the heart, right? Like SVC and all that crap, right? So that's why you get like right-sineded endocraditis. And rheumatic fever from streb pyogenis, right? You can actually prevent it by giving antibiotics. But remember, right? The classic NV Me question, you cannot prevent glomerulone and fritis. From streb pyogenis, you cannot reduce the incidence by giving antibiotics. And then if you tell you about a patient that has endocraditis and you find like sterile vegetations on both sides of the valve, right? That's pretty classic for lip monsox endocraditis from a SLE, right? So like systemic alopus arithematosis. So I think I'm going to go ahead and stop here. I really hope you've got in a lot from this podcast.

Again, I can pretty much promise at least at a minimum, at a minimum. 15 questions correct. On step one, two, three, or three. Just from this one podcast. So I would encourage you to just listen to it over and over again until you sort of have it down cold. Okay? I guess I can call this the clutch micro podcast if you may. And as I do with every podcast I end, I do offer one I want you to bring for many exams. So step one, step two CK, step three, step two CDS, the medicine board exams, the internal medicine training exam, the preclinical exam, you take as a med student in your first two years of med school, the 30th shelf exams. If you're a college student like organic chemistry, general chemistry, physics, physiology, histology, biochem, I took all those things. And then if you're a med student applying for residency, so like an era's application, I do offer one on one like consulting for that. Or if you're a college student applying to med school, so an AMCA's application, I do offer like one on one consulting for that. I mean, I've been on the admissions committee for top two med school for like a year. So I've sifted through like thousands of applications. And I can basically prepare you really well to put your best foot forward at an interview, both with like your personal statements, your application, your interview prep, all that stuff. I can help with all those things.

I mean, pretty much everyone I worked with this last cycle much to like their top two or three choices. Most people match that their first choice. So take that for one you will. So I wish you all the very best. I do hope you get something out of this podcast. This is episode 100. I'm kind of excited to study episode one or one. But let's see how my ICU schedule goes. So have a wonderful rest of your weekend. And I'll see you in the next podcast. God bless you. Thanks.

Entamoeba histolytica.

Cryptococcus neoformans.

1. E. coli, 2. Staphylococcus saprophyticus, 3. (The third is often Enterococcus or Klebsiella).

Rubella (German Measles).

Low bar consolidation on chest X-ray. (PCP typically causes interstitial infiltrates.)

Treponema pallidum (Syphilis).

Rifampin.

Giardia lamblia.

Trichophyton species (preferred over Microsporum).

Poliovirus (an enterovirus).

Streptococcus pneumoniae (most common overall; common in older adults/CAP).

Right-sided endocarditis (due to venous drainage via the SVC).

Never let monkeys eat bananas (Neutrophils $\rightarrow$ Lymphocytes $\rightarrow$ Monocytes $\rightarrow$ Eosinophils $\rightarrow$ Basophils).

Rotavirus vaccine.

Giardia lamblia.

Trichophyton species (preferred over Microsporum).

Poliovirus (an enterovirus).

Streptococcus pneumoniae (most common overall; common in older adults/CAP).

Right-sided endocarditis (due to venous drainage via the SVC).

Never let monkeys eat bananas (Neutrophils $\rightarrow$ Lymphocytes $\rightarrow$ Monocytes $\rightarrow$ Eosinophils $\rightarrow$ Basophils).

Rotavirus vaccine.