DIP Episode 205 - Comprehensive USMLE Step 1 Microbiology Review Part 2

Okay, welcome. I named the Vine-Mor resident. This is episode 205 of the Divine Intervention Podcasts. And in today's podcast, I will be continuing the microbiology review for the US 70 step one exam. I hope you find this to be high yield, so I'm just going to jump right into it. So what is the bug that is best described by the following information cluster. Right, so typhoid fever, bloody diarrhea, osteomyitis and the sickle cell patient. What should you be thinking about? Well, I really hope you're telling me something about some monol. Right, so remember, some monolospicies can cause a bunch of problems on MB and exams, right? So they can cause typhoid fever, right? That's classically caused by some onila typhi, right? And usually on MB and exams, they will tell you that, oh, you can see rose spots on the abdomen. Or they may say something along the lines of you seeing like salmon colored lesions on the abdomen in a person that has high fivers. If you see that, you want to think about typhoid fever from some onila typhi. But just to integrate some rheumatology here, your friends at the MB and you can also give you a question about a person that has salmon colored lesions on the skin, right? So even on the abdomen, but they tell you that those lesions seem to be evanescent. What is going in by the word evanescent, right? Evanescent is almost like vanishing, right? So that thing seems to come with a fever and then it seems to go with a fever.

And it seems to come at fairly regular intervals and the person will have like joint pain and all those things. If you see that and let's assume it's like a chronic problem that has been going on for like weeks, if you see that on an MB and exam, the thing you absolutely want to think about is still disease, right? That's like the systemic form of juvenile rheumatoid arthritis. Again, it's absolutely high to know that for tests, right? And again, remember, some onila can cause bloody diarrhea, especially again, when you consume like infested, like infected, like poetry and all that stuff, right? And then if you see a sickle cell, disease patient with osteomyelitis, that's going to be some onila, right? So that's a simple one. And the bloody diarrhea from some onila is caused by some onila interioridides, okay? Not some onila typhoid. Some onila typhoid causes typhoid fever, but some onila interioridides causes some bloody diarrhea, right? Interidides, so enteric, which is referring to your GI tract. Now, what is the bug that is best described by the following info cluster, right? So this bug has fecal oral transmission. You only need about 10 organisms to cause havoc, right? And this bug causes a really nasty bloody diarrhea that usually is preceded by watery diarrhea, but you can just say this bug for the most part just causes bloody diarrhea, right? And the gastroenteritis caused by this bug is mediated by toxins. What's your diagnosis here?

I'll hope you tell me about shigella, right? I hope you tell me about shigella, right? So remember, shigella is your friends at the end of the end of the end of the end of the love to test it closely with some onila, right? Remember that some onila is motel, but shigella is non motel, okay? And also do not forget that shigella produces hydrogen sulfide. That's what I mean by H2 S on TSI E-GAR. I mean, sorry, yeah, shigella does not produce the hydrogen sulfide on TSI E-GAR, but some onila does, right? So that's something high yield to know, right? And the thing is, shigella, you can actually treat it with antibiotics, right? Although again, usually supportive care is what you try, but one that is absolutely high yield to know that you essentially should never give antibiotics for these on an MDM exam is if a person has enterohemorrhagic E-coli, right? So if a person has E-coli O157 H7, right? If you pick antibiotic treat therapy, as you answer choice, you, I can promise you you essentially get it wrong on a test, right? There are very few reasons to pick antibiotic therapy for E-hec, right? So because again, if you kill more of the bug, right, you release more of the toxin, right? And you release the person's risk of having him onila, uremic syndrome, and having other dangerous sequelae, right? So that's something you'd like to avoid on a test. Now, what is the bug that is best described by the following information cluster, right? So this bug causes a mild lymphoma, okay?

It causes spectacoster disease, it's urease positive, it can also cause gastric cancer, right? And it can all, and it's treated with triple therapy as all as you'll see in a bit quadruple therapy. What bug am I referring to here? Well, I hope you're thinking about H. Pylori, right? I really hope you're thinking about H. Pylori, right? So again, remember that H. Pylori's urease positive, right? So it can make things that can neutralize stomach acid. That's why it's sturdy, and it can survive in the stomach, right? But all that, it essentially induces almost like a chronic inflammatory state in the stomach, right? And whenever you have chronic inflammation, right? Your immune system cells are reproducing like crazy. And whenever you go through more cell cycles, in general, you just render yourself more susceptible to genetic errors, which can increase your risk of a lymphoma, or some kind of malignancy, right? I mean, think about it. This is one of the reasons why OC Ps decrease the risk of ovarian cancer, because you just have fewer menstrual cycles, right? So there's less breakdown of the ovarian epithelium and repair, so you're less likely to get an ovarian malignancy with that, right? So again, that's a high-oven to know. And remember the way we treat H. Pylori, a weaves triple therapy, are you can remember it easily by the word cap, right? So I clarify through my syn which is amacrolid, amoxicillin, right? Which is a, a tealoglaken inhibitor, I guess.

And then a PPI, right? So proton pump inhibitor like omemprosol, oansoprosol, esomeprosol, and things like that, right? Alternatively, you could also use hordical therapy on your exams. This shows up less often, but it does show up, right? And you want to know that that's the combination of like metronidazol, bismuth, subcellicillin, to rather than just see bismuth, I love chemistry, so you know, I kind of love mentioning the phonemes of things, but so metronidazol, bismuth, right, at tetracycline, right, or any other kind of, I mean, there are many kinds of tetracycline, right? Like doxycycline, for example, and then you also throw in a PPI, right? And remember that tetracycline, right? If you're less than eight years old on an ambient exam, you're not getting tetracycline. There's one exception to that rule, that's Rocky Mountain spotted fever. Rocky Mountain spotted fever is almost like a hundred percent fetal, if you don't treat me doxycycline, right? So, Dr. Cycline is the drug of choice for all ages with one exception, that's pregnant women, pregnant women, we typically treat them with a chloroamphetamine call, whenever they have Rocky Mountain spotted fever, but pretty much anyone, you just disregard that list, that ideal business for tetracycline's in general, and you know, you just give it, you just give it to a, to everyone, for Rocky Mountain spotted fever. And remember, that is caused by a ricketsia ricketsia, right? That's important to know for tests.

And then, don't forget that, you know, you want to be careful, give it tetracycline, right? Because if you take it with like a magnesium salt or calcium salt or whatever, it can killate those things. I mean, like those things can killate it or it can do the reverse, right? And that can cause a lot of problems. So, you may not reabsorb the drug or you won't get any effect from the drug. And if you want more micro-pharmacology, I have me some very in-depth podcasts that essentially cover everything you need to know about micro-pharmacology for the USM and right? Especially step one. So, I encourage you to just go on the website. I know it's an episode in the, just go to the website, click on exam topics lists. I'll take you to a Google doc. And you see on the pharmacology, even on the micro you see everything that I list out there. Again, just kind of important, smart thing to do there. Okay, so this is Hitchpilot. Okay, so let's keep progressing. Now, supply the organisms that are associated with the following. Woothing cough. What is that? That's borditella pertosis, right? That's borditella pertosis. Borditella pertosis is actually kind of how you to know for many reasons on exams. First one is it's a bacterial infection, right? But usually when you see bacterial infections, you know, obviously you have a leukocyteosis. And the leukocyteosis is usually from neutrophils, right? That's not the case with borditella pertosis.

It's vaccine preventable, but yes, whenever you get a borditella infection, you have a leukocyteosis, but it's actually a lymphocyte predominant leukocyteosis. That's why it's unique and high you to know for the USM Ms, right? Because it's a bacterial infection where you're like, hey, lymphocytes, right? So that kind of thing, it costs people to overthink the question and not be borditella pertosis, right? So that's something high you to know. And then another important thing to know about borditella is that your white count can get so high, you can almost think the person has a like a white blood cell malignancy, right? Like you can see people that have pertosis and the white blood cell count is like 70,000, right? So that's just something you need to watch out for on exams. And then another important thing to know is that if the way you treat borditella pertosis is you treat it with microlytes, you can treat it with like a rhithromycin, rhithromycin or whatever floats your boat, whatever microlyte that floats your boat. And if you're close contact of a person that has borditella pertosis, you also deserve microlyte for phylaxis, so that you do not get into trouble, right? And the thing is the classic way because right many people see what I'm right here whooping cough? No, that's highly unlikely like the MDN is not going to write a question where I mean I'll be surprised.

I mean if you see that you're like you should be like oh thank you Lord, I've seen an easy question here. Right? Well, they tell you that the person is coughing, coughing, coughing, coughing and they have an inspirational rule, right? That is highly unlikely to be what you see on an exam. What you likely see on an exam is a person that coughs so much the vomit after the cough, right? So they have like a post-tosive MSS, right? Or they tell you that the person coughs so hard that they have an apnic episode after the cough. Or they tell you that the person coughs so hard they have subconjunctival hemorrhage. If you see any of those things that's where the telepertosis on your exam that's whooping cough. That's the presentation you'll see on an endgame example. Now, if a person has undulant fevers, right? So what are you thinking about? Undulant fevers. That's brosolosis, right? That's brosolosis. And then what's the gram-negative cause of a tightest media? Don't say strep pneumo. Strep pneumo is gram positive. So what are you thinking about here? That'll be more acetyl-cataralus, right? That'll be more acetyl-cataralus, okay? And then pneumonia from air conditioning, slasher water source. I don't know. I feel like when NBME exams, they almost always talk about this. Like people getting this kind of pneumonia when they go to like a resort or they go for like a business conference or they go to a place with a waterfall or something, right?

And then the hotel that's person has pneumonia and this person has like hypo-neutremia. In fact, I think of this thing as being like pneumonia plus, right? The person have like pneumonia, hypo-neutremia, diarrhea, right? And you check a urinary antigen to make the diagnosis. This is ligenella, right? ligenella. And then a pseudo appendicitis like diarrhea. It's going to be a bloody diarrhea, right? This is your cina, right? That's your cina enterocolatica. Okay, right? So those are the answers there. I think I've kind of like talked about all this stuff. So I'm going to keep chugging along. I'm really excited to do it. Let me not just say I'm really excited to do it. I'm just really excited in general. Whenever I get to teach, whenever like one of the things that truly gives me excitement is just teaching, right? Like whenever I'm making this podcast, I'm like, yes, I'm about to put out one new podcast. I'm like, super excited. I'm like, yes, my D has been made. Yeah, I love teaching as hopefully you can tell. Okay. And this gram negative cause of otitis, maybe I put him off los influenza, not H flu type B, but I'm thinking more like non-type of old H flu. Because remember, right? Most people get the H flu type B vaccine these days, but also don't forget more acceleratoralis. More acceleratoralis is a gram negative organism, right? So it could be either or on an NBM exam. Now, what is the bug that is best described by the following information cluster, right?

So like burn patients, wet environments, this one should be easy. Numeria in diabetic patients, otitis, external, right? So an external ear infection. Osteomyelitis and a diabetic hot top folliculitis, okay? Blue-green pigment. And you want to know what causes that blue-green pigment. I'll talk about that on the following slide. And then you can treat this with tycorcelinopiparascelin with tizobacter. What bug am I talking about here? I hope you're telling me that this is pseudomonas, right? Don't take any USMLE exam from step one to step three, if you don't know everything possible about pseudomonas, right? So pseudomonas remember, right? Again, it loves to cause problems in burn patients, right? Like skin infections, skin and soft tissue infections in burn patients, right? Love's with environments. Or if you're wearing like a canvas or something, right? And you get stuck on a nail and develop an osteomyelitis, think about pseudomonas, right? Osteomyelitis and a diabetic, I'm going to make some reservations on that. I'll just say don't take that as gospel, right? If you look at, I feel like the context of the question is what will likely lead you to the correct diagnosis on the those circumstances. The blue-green pigment, if I'm not mistaken, it's from something known as piosciending, PYO, CYA, NIN, right? So you may say, hmm, divine, that sounds really low yield. Remember, you're taking step one, I'll just leave it at that.

And then remember, it causes hot top foliculitis, right? So you describe like a swimmer or a person that uses a hot top and you have like this skin infection, you absolutely want to think about pseudomonas on that those circumstances, right? And remember, again, it's a ground negative organism, it's oxidized positive, right? And remember that it has an association with cystic fibrosis. Remember, people that have cystic fibrosis that are less than 20 years old, if they get a pneumonia, the most common causes, staff warriors, usually MRSA, but if they are more than 20 years old, the most common cause of the money in those folks is pseudomonas aeroginosa, right? So that's something we're going to commit to memory. And I just put one of the treatment options for pseudomonas here, I put like type tycorcelin, and I probably don't see typecorcelin on your exam, although it's mean to know, it may show up on a test, but pyprosylinitizo bactam is one that pops up a lot, but it's fluoridly high yield to the other drugs that cover pseudomonas on an embbeaming exam. So what are those drugs? Well, they're drugs like astroenem. Remember that's a monobactam. Remember, it doesn't have those cross reactivity with the other penicillins. I'm your fluor with alons, right? Ciprofloxacin, liver floxacin, gadi floxacin, moxifloxacin, nalidexic acid, those all cover pseudomonas, right?

You have amino-blicocytes, genetomycin, nyomysin, amicase, tuberomycin, streptomycin, those all cover pseudomonas, right? And then remember, the third generation cephalosporin, cephtazidine also covers pseudomonas. Ceptriaxone is a third generation cephalosporin, but it has no activity against pseudomonas. Do not make that mistake on your exam, right? And then the fourth generation cephalosporin, at least the only one you need to know for your test, cephepine. cephepine also has the ability to cover pseudomonas. And then if you also look at your like your nuclear weapon drugs, right? So like your your one of these things called your carbapenemps, right? So like redapenem, buri-penem, merapenem, right? Those drugs also cover pseudomonas as well. So again, all the drugs that cover good old pseudomonas, you got to know those for your test. Please, I'm begging you, please know that. If not, you have you run into a lot of problems on step one, step 2ck and step 3. Okay, now pneumonia, right? So let me just have a quick, you know, talking slide on pneumonia, right? So again, pneumonia is super high over your test. Obviously, pneumonia is a sort of like inflammation of the audio like, those are those little bugs in your lungs, right? And you can have two types of pneumonia on an MB in your, right? So there's the typical pneumonia and there's the typical pneumonia. What's the key difference? Well, typical pneumonia is a pneumonia where you have an acute onset of symptoms, right?

Like you're like, you know, it was fine two days ago, but yesterday, man, I just get felt completely knocked down, right? Acute onset of symptoms, very high fevers. In fact, there is this attending I worked with during my intern year that describes the pneumococcal pneumonia fever as like a teeth chattering fever, right? Like you know you're sick, right? Acute onset symptoms, very severe symptoms. Think about on a typical pneumonia, under those circumstances. The typical ones, usually you find that in a young person, right? So in a person that's like a teenager, 20s, 30s on an MBM exam, you'll have like subacute symptoms. So you know, they've kind of been feeling like crap for like a week. They're still able to hold down their jobs. They don't have super high fevers. You look at the chest, they're like, wow, this chest, actually looks worse than the patient. Whenever you see things like that, then you want to think about an e-tipico pneumonia under those circumstances, right? And usually typical pneumonia is, right, tend to have like a lower consolidation on a chest x-ray versus any typical pneumonia that tends to have an interstitial infiltrate on a chest x-ray, right? Again, the chest x-ray typically looks worse than the patient, right? And then there's aspirational pneumonia. So you see this in people that have like optoned states, like optoned state risk factors. So you know, alcoholic, right? A person that has an exogastric tube, a person that has a ventilator, right?

The thing is when you have an optoned state to essentially suppress in the cough reflex, right? So that's, and that cough reflex really helps with clearing bugs. So if that cough reflex is inactivated, then you're in trouble, right? And then remember ventilators, right? And usually when people have aspirational pneumonia, it's usually from anaerobes, right? So they'll have like a false smelling like sputum or whatever. And then ventilators, right? Also have an association on pneumonia, right? So because essentially, right? Like the person's respiration is bypassing like the airway, like the mucus cell protects protective mechanisms that constitute your airway, right? So it's like, it's like you have those tubes down your throat that are just sending the bugs right onto your lungs, right? So vents, right? As such, there were pneumonia. And again, for patients like anaerobic pneumonia, like infection, right? You know, you can give them a clean the mice in. It's pretty good for aspirational pneumonia, but again, you can use many other things, right? And then there's this next slide I'm going to I love these slides because again, the thing is on NV Mes, right? It's not just memorizing things that helps. It's just being able to organize your information well, you know, kind of grouping your material the right way. So that's what I try to do with some of these slides.

Trust me, this is not the last of the grouping slides that you're going to see in this podcast and in this series of videos, I guess, that you'll see for a micro, right? So let's go through like these, I think, like 30 pneumonia vignettes, right? If you know this list, you'll probably be able to answer most bug causes of pneumonia on any USMLA exam you ever take, right? So they give you a question about pneumonia in an immunocompromised patient or HIV patient. What bug are you thinking about? I'll be thinking about the most sisters, you're a vetsi. In fact, your friends at the NV Me have gotten a little crafty with this. They will give you questions where it's a person that doesn't have HIV, but they are like chronic corticostero therapy for like resistance COPD, like really bad COPD or like some autoimmune disease. And then they develop like pneumonia and you see like interstitially infiltrates on the imaging. If you see that, you absolutely want to think about the most sisters, your vetsi on that on circumstances, right? And then what's the most common cause of walking pneumonia? Obviously, that's my co-plasma, right? Numonia and an alcoholic, right? No, again, think about an anaerobic from aspiration or think about Klepsiela pneumonia, right? One thing I didn't put in here, but it just kind of dropped in my mind now, so I'm just going to say it, if you see pneumonia in a COPD patient, I want you to strongly consider hemofluos influenza as the cause, okay?

It's one of those weird, unusual, but floridly high-yod associations to know for the USMLA exams. And then if you see pneumonia in an alcoholic of 10 deaths, they're fast-moving, that's an anaerobic, right? If you see interstitial pneumonia in a bird handler, or a person that has a pet store, right? I hope you're thinking about Klamidophila syricy on that those circumstances like syricosis, so PSI, double TECI, okay? And then pneumonia in the setting of bats or bad dropping exposure or spalunky, spalunky just means you're exploring caves, right? Or you go to Kentucky or you go to Ohio or whatever. If you see that, then you want to think about histoplasmosis, right? So histoplasma capsulata. Remember, if you're HIV patient and your city for count is less than 150, and you live in a susceptible area like Kentucky or Ohio, you do need to get a hetroconozoprophilaxis against histoplasma. That's a very high-yod thing to know for exams. Now, pneumonia in the setting of a visit to like Southern California or New Mexico, West Texas or Las Vegas or whatever, Arizona, I guess. If you see that, what are you thinking about? If you think about coxidium, my co-sets, right? Coxidiodis emidus. I remember it forms the classic spheriomes on histology. Those pictures are high-yod things to know for exams. I was strongly encourage you to make sure you know those for exams.

And then, please don't forget that, again, if you live in a susceptible, in those susceptible areas and you have HIV and your city for count of your low 250, you do need hetroconozoprophilaxis. And also for the purposes of the USMLE exams, do not forget that coxidiumicosis has an association with everythemenodosa, right? So like a painful lesion on the lower extremity. Remember, that's also found in people that have sarcoidosis. Now, pneumonia associated with red-coron-jelly sputum. This is easy. That's clapsular pneumonia. Nomonias real roste-colored sputum, right? That's strep pneumo. That's easy as well. Nomonias real ot- transmitted via air conditioning or, again, waterfall business conference. That's legionella, right? And then pneumonia in an individual cue fever, right? That's corxeola, born in the eye, right? And then pneumonia, cystic fibrosis and inventeleater patients. What is that? So again, if you're less than 20 years old, especially CF, less than 20 years old, think about stuff or just especially MRSA. If you're greater than 20 years old, think about so pneumonia's aerosinosa. Okay. Now, pneumonia associated with hyponetraemia, right? Again, it's not low yield, but I just gonna put that there. It's something that you know, they tend to focus a lot on step 2ck, but again, they're beginning to talk about this a lot on step 1. Think about legionella. Three most common causes of atypical pneumonia. That's my coplasma. That's number one.

Clamydia is number two and legionella is number three. And one nice component to kind of hold all those things down in your mind is remember that all those bugs that you know, microlids. And if you notice, if you capitalize the M, the C and the L in a microlid, then you essentially know all the causes of atypical pneumonia. Micoplasma, Clamydia, legionella, right? And then pneumonia in a neon into a gram positive caucus staining. What is that? That's group B strep, right? That's strep Egalactia. And then pneumonia in a neon into a gram negative rod staining. That's equal, right? Remember the three most common causes of pneumonia in neon to have group B strep as number one. We have equal I as number two and we have mysterious number three. Now, viral pneumonia in a kid that's less than a year old and demitalia in the NV Me question that this child is wheezing. I think I may have me spoke in my last first micro video and said that, oh, this person has stride of RSV. Think more about wheezing for RSV, not strider, okay? Because strider is more indicative of something like a big lotitis or a group, right? But wheezing, tell. So strider means you have an upper-early problem. That's not going to be RSV. Wheezing means you have a lower-early problem. That's going to be RSV in a kid. You see a little child with wheezing, pneumonia, you know, relatively high fever, but not crazy high. Think about RSV, okay? The respiratory sensation virus.

And remember that RSV, I think you can perphylax against it, especially in people that have like maybe like CF or something really have like high-risk problems that can send them up for like very bad mobility and mortality when they're exposed to RSV. The drug you can use under those circumstances is known as Palavizumap. It's a monoclorial antibody, but okay, because it ends in a map, right? And then pneumonia in a little sort where you can say FBI agent or they can say, oh, associated with hemorrhagic mediastonitis. What is this? This is anthrax, right? This is bacillus anthraxis. Remember you treat that with a flu or a flu in a lung on an MBM exam. And then most common cause of pneumonia in a young adult. Don't see strep pneumo. See mycoplasma, right? Mycoplasma is going to be the right answer in a test. And then most common cause of pneumonia overall. That's strep pneumo, right? That's strep pneumo, there's like pneumonia in the name. Okay. Now most common cause of viral pneumonia. Most common cause of viral pneumonia, right? This is very likely RSV, right? And then pneumonia, the lung abscess, right? Think about an anaerobic, right? Don't think about staphoreus, right? Anerobic staphoreus, they love to cause abscesses with the pneumonia, right? And then pneumonia and an IV drug user, again, think about an anaerobic, think about staphoreus. And remember that staphoreus loves to cause pneumonia, especially with cavitation, like after a person just has the flu, right?

Remember the flu is not caused by each flu, it's caused by the actual like, you know, in friends of virus, okay? And then pneumonia, so you know air fluid levels on chest x-ray. If you see that again, think about some kind of anaerobic, okay? Think about some kind of anaerobic. And yeah, I think I've talked about pretty much all of this. You can just go through these answers. I'm going to attach the slides on the website so you should be fine. Okay. Now next one, what is the organism that best matches the following info cluster, right? So cellulite is secondary to an infection with an anaerobic, gas can green, food poisoning, produces alpha toxin. This is called stridium perfringence, right? Puzzles, gas can green. So if they give you a question about a person that has neck fash and they tell you about the person having creptus on a test, you really want to think about super fringes on the exam. Okay, remember, it produces alpha toxin, alpha toxin is a necessities, right? So it basically like chops up cell membranes. Okay, so let's keep going. Now what is the organism that best matches the following info cluster? This box causes a spastic paralysis. It prevents the release of GABA and glycine from inhibitory neurons. I think those are like the rancher cells and then it's vaccine preventable. What do you think this is? Is this clostridium botulinum or is this clostridium tetanum? I hope you tell me clostridium tetanum, right?

So remember if you do not release these inhibitor neurotransmitters, your nerves are all excited, right? So remember if C tetany, right, it cleaves. So this is one very awesome way your friends at the LNBME can integrate cell biology and micro, right? The tetanus toxin, cleaves snare proteins. Remember you need those V-snares and T-snares to bring those bags of neurotransmitters, right? Those vesicles that continue neurotransmitters with synapse, right? So if you cleave those snare proteins, you're not going to be able to bring those things like like GABA and glycine and then you'll be in an excitatory state. So you can have like the rhizocerdonicus and all that badness, right? Yeah, so that's the way this works. Okay, remember the toxin is known as tetanus spasmin, right? Tetanus spasmin, spastic paralysis. And what is the only thing that best matches the following information cluster? So the toxin prevents the release of acetylcholine and the dull that but can't soup from a store, a vivid symptom behind, right? It is easy. It is clausuremotoline, right? Again, cleaves snare proteins, right? So you do not release acetylcholine at the neuromuscular junction, right? So this child will have a flasep paralysis, right? Because their skeletal muscles are not able to contract, right? And it's super high or to actually know three things here. First thing, adults that get botulism, they get it from the preform toxin. It's not because the bug went and germinated in the GI tracks.

No, it's not. Because the thing is when you become an adult, your GI flora gets more robust, right? So you're able to outcompete and destroy a seabot line, right? But if you get the preform toxin, you cannot out of option state where you get problems. But kids, right? Kids that get botulism, their GI tracks are not well developed, right? They don't have adequate amounts of GI flora, right? So they're muscle-septable, right? The bug would germinate, make toxin and then cause havoc, okay? So it's very important to know those two key differences. And then the third thing I wanted to mention, I just got to drop it in my mind when I put up this slide is that we can actually present botulism as diarrhea in a kid, like diarrhea, constipation in a kid. So just kind of be mindful of that on an in-be-em-exam. Just be mindful of that on an in-be-em-exam. And they can also make botulism like a terrorist question where something was released in the air and the person has yada yada yada, although I feel like when you're dealing with acetylcholine, they tend to go after a nerve gas, which inhibits acetylcholine estuaries. So you obviously get a colonagic toxic drum, vomiting, diarrhea, sweating, all that stuff, right? Breedy cardio, right? Okay, now let's do a clinical viniate. I love writing questions. A 23-year-old female presents with abdominal pain and intense diarrhea that started three days ago.

Pasmatical history is unremarkable, safe for recent treatment for respiratory infection that was notable for copious amounts of fast millions, copious bouts or amounts of fast-millens, and period treatment is that it was subsequent resolution of her symptoms, the drug of choice that resolved the human symptoms is associated with the following side effects. So the first one, a plastic anemia. Second one, hypersensitivity, skin reactions. Third answer, sensoroneuro here and last. Fourth answer, metallic taste and the posterior tongue. Fifth answer, diffuse flushing over the entire skin upon ibifusion of the drug. What am I referring to here? First, the thing is whenever you're taking exams, the first thing you should always do, this is like the critical component that everyone seems to forget. Just make a diagnosis. Once you do that, you vastly increase your chances of getting the right answer. So hopefully you realize that this person took antibiotics and then they developed diarrhea. That's C-Death. If you see a person that develops a post-antibiotic diarrhea, it's always sedive on an embankment exam. It's so clostridium difficile. So what's the drug of choice for treating C-Death these days? I would really hope you're telling me vancomycin. So back in the day, it was metronidousol but that is no longer the case. The NBME reflects that these days. The drug of choice for treating C-Death is vancomycin. Now you've made a diagnosis, you've come up with an answer.

Let me find the answer that matches to vancomycin. That'll be option E. Member Redman Syndrome would vancomycin. It's from an increased release of first the glandins. Usually the way you fix that is slow down the infusion of the vancomycin because vancomycin is an IV formulation using a ton in the ICU. Or you can also give an answer because N-Sets will inhibit cycloxygenase. If you inhibit cox, then you're not going to make those post-aglandins that cause the flushing and those symptoms you get with Redman Syndrome. Just to the right answer here is E. Just to visit the other answers, option D, that's metronidousol. That's a good trick answer there. Remember it causes this metallic taste in the mouth. Remember that metronidousol also causes the disulfur from effect. We're excuse me. Where, what if what happens? Metronidousol has this thin, where it can inhibit as a tau-dahaide, you have your drudge in ease. As a tau-dahaide will build up, so you feel like crap. That's why again, you should not drink and take metronidousol. Be careful with drinking. You could kill your liver there, but that's a different conversation. Then, since we're here at last, that's going to be like vancomycin. Vancomycin then causes auto toxicity. Maybe I should have read a better question here. Vancomycin then causes auto toxicity. Although, when I wrote the sensor choice, I was thinking more in terms of your mineral glycosides. Remember, your mineral glycosides are auto toxic, especially gentomysin.

Then remember some lube diuretics as well, like if a crinic acid, very auto toxic. Then don't forget your anti-cancer agent, cisplatin. Platin is a platinum analog. It's a platinum agent. It's an alkali-tin agent. It can cause auto toxicity. Your auto toxic drugs, vancomycin, mineral glycosides, cisplatin, the anti-cancer, platinum analog that also causes kidney problems that you can prevent with, I mean, phosphatin. Then also your last dimension. Vancomycin, then your lube diuretics. Of all the lube diuretics, the one that's the most auto toxic is the fricinic acid. Remember, that's the one that has no association with a sulfur side effect. Then hypersensitivity skin reactions, many antibiotics cause problems, especially like your penicillin. Any plastic and any other bichlorumfenicol? No bichlorumfenicol. Mbichlorumfenicol is about your static 50s inhibitor. I talk about these drugs in great detail in my pharmacology podcast. I think I've kind of explained everything here. I'm going to keep going. What is the organism that best matches the and let me actually talk about the testic energy on this question because I know some people may be saying, the vinegary production C, are you still seeing E? Let me ask you this. Between option C and option E, which is the most specific answer to this question? Like, what is the side effect here that is unique just to Vancomycin? That's red man syndrome, right?

That's why E is correct because many people make this thing kind of testic in error on exams, believe it or not, where for example, I mean, I think I've maybe given this example in a podcast before. We're going to ask you a question about a person that has a subgele abno carcinoma, and that's for the biggest risk factor. Then they give you an answer choice that says, they give you an answer choice that says, if you pick, it will be wrong. If you pick, it will be right. Both are correct, but the most specific answer to that question is, it's a subgele. Whenever you get two very closely related answers, just ask yourself, which one is the closest? Which one is the most specific for the diagnosis that's encapsulated in the question? Go with that. You'll be correct. What is the organism that best matches the following information cluster? Transmission, fire, exposure to bodies of water, containing animal urine. I put a bunch of question marks and I see, oh, it's actually a little jid hint. What am I talking about here? I hope you're telling me that this is leptospioscis, leptospiare and terrogens. Basically, they put Hawaii on any MD exam in 99% of the time, the right answer is going to be leptospioscis. Again, leptospioscis, again, if you're exposed to water that has animal urine, they're in trouble. Don't forget it's a spirochet, so believe it or not, one means you can actually use to diagnose leptospioscis with a dark-filled microscopy.

It tends to cause conjunctivitis, things to cause conjunctivitis, so like red, bilateral red eyes, and then sometimes you can invade the kidneys and it can cause only cold-wills disease. The thing is, one sneaky thing your friends at the MDM could do to you on an exam is they can give you a leptospioscis question. The person who have a hemorrhagic misdiastinitis, they'll have a white in-media stynum, or they may have an ARDS-like picture where they have non-credogenic poloniridema. If you see that, again, they put it in the context of Hawaii, like a person going on a swimming expedition, like a few days ago, whenever in Hawaii, think about lectospioscis on the neurosurconstances. So again, hemorrhagic misdiastinitis is not only caused by anthraxic and also caused by leptospioscis on an MDN exam. Now, what is the organism that best matches the following info cluster? No cell wall, susceptible to treadmill, they're through mice in, chest x-ray shows diffuse, intestinal infiltrates, vision has very mild symptoms, this is walking pneumonia, this is microplasma pneumonia, end of story. Remember microplasma, it's cell wall contains a lot of sterile, which is unique. I mean, it actually has no cell wall, right? It's cell membrane, let me put it up, contains a ton of sterile, so it doesn't grahamstain. And again, perceiving their 20s to 40s subacute atypical pneumonia, pick microplasma, pick microplasma, and again, my release work really well, right?

And again, intestinal infiltration is because it's an atypical pneumonia. Okay, so what are some pneumonia generalities? Again, it's not 100% accurate, but I feel like this thin really does not work. There's almost very few, if any circumstances with these generalities will not be accurate on your test, right? So if you see pneumonia in the super young, go with ruby strep. If you don't see ruby strep as an answer, so super young, I mean like the first like 20 days of life, if you don't see strep egalacty or ruby strep, go for equal life, if you don't see equal life, go for the sterile. Okay, remember the drug of choice for treating the sterile as an epigen. Right? If you see a person with pneumonia in the 2 to 10 age range, think about like some kind of virus like RSV, right? If you see a pneumonia in like the teenage range to like again, like early 40s, late 30s, that's my coplasma, older population. So a person that's in their 50s, 60s, yada yada, yada, think about strep pneumo, right? And then HIV patients think of pager vetsi. But pay attention here. This is something your friends at the end of the evening can do to you. If a person has a history of HIV, and they have a pneumonia, and you see a low bar consolidation, it is strep pneumo. In fact, let me surprise you here. The most common cause, this is very high up. The most common cause of pneumonia in HIV patients is strep pneumo. It's not pager vetsi.

So make sure if it's a low bar consolidation, it's not going to be pneumo cystis. It's going to be strep pneumo. Okay, it's going to be strep pneumo. Very important to know that on tests. Okay, the NV Me can do you dirty like that. So definitely keep that at the back of your mind. Okay. Now what is the organism that best matches the following info cluster, right? So conjunctivitis, in neonates, lymphogranoloma, verinarium, right? Blindness, arthritis and PID. And this book will be sure to doxia, or like doxia cycling, or microled. What book are you thinking about? I would really hope you're thinking about chlamydia species under these circumstances. And for chlamydia, unfortunately, your friends at the NV Me expect you to know the different cereavars, right? So the cereavars, S-E-R-O-V-A-R-S, those are just different types of chlamydia that tend to cause different kinds of infections. Right? So if you see like your arthritis and PID, those are the D through K cereavars of chlamydia. If you see blindness, blindness will be the A through C cereavars, or I saw like chlamydia, trocometis, like tracoma, right? That's the A through C cereavars conjunctivitis in your neonate. That means the neonate acquired the infection from the birth canal. So it's going to be the D through K cereavars, the lymphogranoloma verinarium. That's the L1 through L3 cereavars, right? So that's something high you to know for example. And again, doxia, microled.

And one thing, one classic way your friends at the NV Me love to put questions on chlamydia is they'll give you a question about a person that has an STI and you take this person's discharge, you do a gram stain and you don't find anything. And you don't see that your job is done on an NV Me exam, it's chlamydia, right? Because if it's my cerebellum, you're going to see like the gram negative, whatever's on on histology, right? So if you don't see bugs, right? That's chlamydia. Like that's how they presented essentially all the time, right? There are very few chlamydia questions I've seen, whether you did not give it that presentation. Have you ever seen questions where it's like the person has a uti, right? And again, you don't see anything after you do a gram stain, right? And you're like, hmm, this is chlamydia, right? So again, just something to keep in mind for purposes of exams. Okay, so that's the classic exam presentation I'm talking about you better make sure you know your servers, right? Now chlamydia, right? So chlamydia obligate intracellular organism causes uti, right? So it's obligate intracellular because it needs ATP from the host, right? And you can actually detect it with a ginsisting like meralia, ricketsia, chlamydia, tripanosomes, those can be detected with a ginsisting. And again, it causes PID, right? Although don't forget my steer, going to rear with that.

Usually when people have conoccal infection, they also tend to have like a concurrent chlamydia infection. And again, one week and tell going to caucus apart from chlamydia is just a dura gram stain, right? I'm going to rear, you'll see the gram negative diplococci. Okay, now, again, sexual contact, vertical transmission from mom to feeders, right? And then drug of choice, give a doxycycline, give a microlyte, I already talked about why again, you should never, you should never give tetracycline to a kid that's less than eight years old or pregnant woman, right? Because again, to this coloration, problems with bones, right? You don't want that, right? Now, again, people that have conoccal infection usually treat them with, with one of two combos. It has tetraxon plus easy thromising or tetraxon plus doxycycline. Okay? Tetraxon will cover the conococcus and then the easy thromising or doxycycline will cover the, cover the atypical optimism, usually again in this case chlamydia, right? And then if you're a sexual part of a person with chlamydia, right? At least within the past 60 days, you also need to be treated, right? And one thing you want to know about for, especially for USM and step one, this is very unlikely to show up on step two, two-seguer step three, is if, um, um, like this life cycle of chlamydia, right? So chlamydia has something called the elementary body that infects cells, that's the infective kind of chlamydia.

And then when it gets in, right, it begins to replicate with, uh, reticulate bodies. Remember, the R in replicates, for the R in reticulate body, it replicates and when it's living, it just turns back to the elementary body before it goes and infects something else again. Okay, now what's the organism that best matches the following associations, right? So each of these things have specific answers to that. So diarrhea and AIDS patient, what if I told you that this person had acid fast cool cysts in the stool? What are you thinking about? This is crypto-spiridium parlor, right? Cryptospiridium. Please do not confuse crypto-spiridium with crypto-coccus and a test, right? You can see how people could kind of screw that up on an exam, um, and you can treat that with Naita-Zoxanite, right? And, and it usually causes a water diarrhea. Now, pneumonia in an AIDS patient, that's P-G-R-Vet-Z, right? I mean, in Gytis in an AIDS patient, that's crypto-coccus in your form, right? And back in the day, which is still correct on an ambient exam if you saw this, you can do the India-Inx thing, right? Of CSF. But the thing that's done these days is you do the latex particle, uh, latex particle at glignitianase. Okay, I'll say it again. The latex particle at glignitianase is now the, uh, diagnostic test of choice for, for crypto-coccus, right?

Um, so if you don't, if you, if they give you an answer choice that has India-Inx and latex particle at glignitianase, go with latex particle at glignitianase, right? And the way we treat crypto-coccus is, you don't mess around. Cryptococcus is rapidly fatal if it's not well treated. You go from for terrible, right? So I'm for terracing B and flu side or same, right? And then after they recover, you need to put them on flu corners of about 12 months to prevent, to reduce the risk of recurrence. Now fever, cough and night swish with cavitation in the upper loop of the lung, this is TB, that's easy. And then rash starts on the palms and soles and migrates centrally. That's Rocky Mountain spotted fever, right? From our, from a re-cat theory, cat side. Okay? From a re-cat theory, cat side. From a re-cat theory, cat side. Okay, let's move on. Now this slide is, ridiculously high yield to know for your exams, right? So like rash patterns, so let me kind of talk about them here, just coming this to memory, you know, you memorize it, forget, but you know, just go over it a couple of times and it will kind of stick, right? So again, for prison, it has like a rash on the palm, soles and trunk, after a painless shanker, that secondary syphilis, right? For prison, it has like a sentipar rash on the trunk, right? And then maybe they have like a clinical, he's trouble like a strawberry tongue, um, think of scarlet fever from group B strap, right? So like strep hyogenes.

For prison, it has a rash that starts on the face, and migrates codally, right? Think about measles. Although usually in the question, they will also mention like some of the three seasons or all of the three seasons, right? So the three seasons of measles, right? Don't forget the cough, don't forget the choriser, and don't forget the conjunctivitis, right? And it is ridiculously high yield to know for purposes of the USMLA exams, that vitamin A decreases the morbidity and mortality associated with measles infection, right? And don't forget that measles is vaccine preventable, where you get it past the age of one year, right? Because it's a live atemisid vaccine, right? Live atemisid vaccines, you don't give those to pregnant women, and you do not give those to kids at a less than a year old, okay? That is just a nice role to remember, to keep many of these things straight, many of these vaccines straight on end-game exams. And then if they give you a question about a child, you know, that has like a measles, like you know, had a measles infection back in the day, and then they tell you like, we'll like 10 years later, 15 years later, this child becomes like, starts deteriorating, neurologically, and begins to perform poorly in school, and at some point becomes comatose and dies. If you see that, think about the soldered on a S-S-P-E. It's a floridly high yielded soldered to know for all the USMLA exams, and also the pediatric shelf in third year.

That soldered is known as subacute sclerosin, panacephalitis. I've said it again, subacute sclerosin, panacephalitis. It's a high yielded pathology to know for purposes of the USMLA exams. And then, a rash that again, and again the three C's cough chorise up raises a five dollar word for any nose and conjunctivitis. Those are the three C's of measles. And then a rash that starts on the palms and soles, radiates centrally so from the outward in, right? That's working on this body fever, caused by rickets here, rickets side. Remember, for rachimaltine spotted fever, right? Everyone gets toxic cycling. With the exception of pregnant women, those people get permafenicol, okay? High yield to know that. So everyone, even if you know less than 80 years, or it doesn't matter, right? Rachimaltine spotted fever is rapidly fetal, if it doesn't get treated well. And then, if a person has a rash on the hand foot and mouth, right? That's easy. That's coxac e virus. That's coxac, remember coxac e-ic and also cause something called hypangina. Don't mix this up with coxac e-b. Coxac e-b is the thing that causes myocarditis, which can ultimately lead to like a dilithic cardiomyopathy and systolic heart failure, right? So you hear like an S3 heart sound after a person had like a recent operation or respiratory infection. And about 50% of those people go into like heart failure. So myocarditis is actually pretty, pretty bad. Okay.

Now, if a person has a rash that you know, lasts for like three days, think about rebella, I'm on that those circumstances. Remember, another name for rebella is German measles. Please do not mix up rebella and rebella. Okay. Do not mix up rebella and rebella on your exam. Rebella is the measles I talked about before. Rebella is German measles. I know, it's annoying, right? So don't mix up rebella and rebella and rebella is measles. And usually one dead give a well and then be an exam that, oh yeah, this person has got rebella, right? Is they'll have like posterior posterior or rickula lymphatonopathy. So lymphatonopathy behind the ears. If you see that, think about rebella, think about rebella under those circumstances. Because again, right, kind of like measles, russia and the face goes downwards, right? But if you see posture rebella lymphatonopathy, think about rebella. And don't forget, right? Congenital rebella syndrome can cause like hearing problems. It can cause a beaten doctor's arteriosus. A pva is one of those murmurs to get out of the eortic regurgitation. Now, I'll have an association with a white pulse pressure on an immune exam. Again, these not rush patterns, super high autonopathy. Right? Now, much the following STB buzzwords to the offending organism, right? So painless shanker ulcer. So let's rush through this. I want to keep this podcast under an hour. So painless shanker ulcer, let's see if it's right. Try putting me a paladin.

Granuloma in Guinali is caused by what bad? That's clefciela granulomates, right? I think this book had an old name. From remembering correctly, I think it was called like Calimamo bacterium something. Super long name. I'm glad it's been changed to clefciela granulomates. Trust me, the alternative from back in the days way worse. There's a tear burning. I don't know who need that, but I'm sure it's someone famous. Okay. Now, epithetial cells with inclusion buttons, right? This is her pieces, lymphocardaloma venerium. We're already talked about this. This is chlamydia. These are the L1, L2, and L3 cerevars. And then general warts, that's HPV. Remember, it's HPV 6 and 11. Remember, a planto warts, a HPV 1 and 6, genital warts, a HPV 6 and 11. And then the HPV that causes like badness, right? Like, cerebral cancer, or basically any sort of cell cancer of the most parts of the head and neck and also like the genital area, those will be HPV like 16, 19 and those in 30s. And then you rethrow this charge, granulomative diplococci, right? That's nice cerebellaria. Diagnosis with dark sugar, microscopy. That's syphilis, T-paladum, right? Painful ulcers. Sorry, not painful. Painless ulcers with no lymph node enlargement. This is clefciela granulomates, right? Again, remember, you tend to have, I think, these are donor van bodies with clefciela granulomates, right? Painful ulcers with bilarolingonal and phadenopathy. This one is easy, right?

This one is probably a hemoflos ducry, right? Hemoflos ducry, remember, hemoflos ducry makes you cry. That's a nice way to remember that. I mean, three hours of triaxal, so third genus, so floor spore. And then painful vesicles on the genitalia, that's HPV, right? HPV2, although they can also make it HPV1 on your test, right? So just be mindful of that. HPV1 can also cause genital herpes, right? And then painless genital ulcer that progresses to massive inguinal lymphadenopathy. These are boobos, right? This is lymphocrylonal loma venerium. This is, again, chlamydia, L1 L2 L3 cerevars. And then, you rethrow this charge in the setting of septic arthritis. This is going to be gonococcal infection. Drugs of choices, doxocycline, think about gonococcal infection. I mean, sorry, think about chlamydia, right? And then drug of choices have to act so think about a nice urgulary. Okay. So those are your answers. So I encourage you to go through those. I hope you do. Okay. Now, the world of tepalum, I don't know, syphilis is just high octanol. So I'm just going to review some things. And this slide, believe it or not, I got it from like an old, old, old, old slide I made back in the day. I knew you can see the date stamp is what, like 2016. So this is when I was still in Met School. So, but it's a good slide. It kind of summarizes a lot of high octanol things, well, so I'm just throwing it in here. I made it in one note as you can probably guess at this point, right?

So there are three stages of syphilis, right? There's primary syphilis, secondary, and tertiary, right? And again, remember, syphilis is fiddled with penicillin. So primary syphilis, pinless chancras, contidues don't touch that with your hands. Continital syphilis, right? A kid with snuffles, like a lot of rain, like a newborn, a lot of rain, or a lot of snuffles. That's also syphilis as well. Again, don't touch those things with your bare hands. Essentially, you're touching those pyroquets and you're going to give yourself syphilis. Essentially, you're, so you know, kind of want to avoid that. Again, you may see gold thomas on this. Again, my apologies. So I went to Johns Hopkins from Ed School and we're divided into colleges. And I was a member of Thomas College, which obviously was the best college. I mean, the, it was the best college bar none. I'm sure I'm probably pissing off a few Hopkins folks, but whatever doesn't matter. But yes, gold thomas, right? So, yeah, that's why I pulled that in there. So that's primary syphilis. Secondary syphilis, Machylopapular rash on the palms and soles. It can also cause conglomalara. Again, please do not confuse conglomalara with conglomacominara, right? Conglomacominara, that's HVV6 and 11. Those are the general awards. And again, syphilis is still contagious in the secondary phase. And then the way you do your testing, you do like your non-traponimo tests.

So the thing is, if you want to diagnose syphilis, you do like the trapponimo test and the non-traponimo test, right? So the non-traponimo tests are your screening tests. Remember, in medicine, whenever you have a screening test, you need to follow it up with a confirmatory test. The screening tests are your non-traponimo tests, right? Those are things like RPR and VDRL, right? But your trapponimo tests are for confirmation. They have like weird words like FTA, ABS or MHATP. Okay? But I promise you, you need to know those things, for example. They test these things all the time. On NBM is on you world everywhere. So you need to know it for a test, right? And then tercior syphilis, that's where badness begins to happen. Like, you know, gommas, they have like T Vs or salads where they destroy the dorsal column, dorsal columns, right? So those people have problems with like fine-to-divibration and proprioception. So they'll have a positive or unburd, right? You can also have aerotitis, right? So again, like the inflammation of the the order, so they can get aortic dissection, they can get an ascent in aortic aneurysm, because the thing is syphilis loves to infect the viso visor. Remember, the viso visor at the blood vessels that supply big blood vessels, right? So it's like oxygen supply to a blood vessel, right? So if you destroy the viso visor, you begin to get a skinnier of the order, of especially the arch, and that can cause dilation of the order, right?

And then the Argyro Robertson Puppel, right? So I will talk about that some more in my neuro videos, slash podcast. I already have somebody I need to complete that series there. And then, again, I've talked about the diagnostic testing. The Argyro Robertson Puppels are the Puppels that do not constrict to light, but they do accommodate. Yeah, that's how you'll know for exams. And then congenital syphilis, again, new world with snuffles, a lot of rainoriya, that's a classic thing on imbim exams. Don't forget the notch teeth. I think those are known as like hutching since teeth, right? Don't forget the visual defects. Visual defects can happen. And then also this, these skits can actually die utero. And since I talked about like screening tests for syphilis, nontraponimo, diagnostic or confirmatory test, trapponimo. Also, there are throw that in here for HIV, HIV. I mean, there are many new, much, probably much better tests for HIV now. But an endgame is these still almost like stick to the anidim, where like it's like the screening test, Eliza, the confirmatory test, western block for HIV. Okay? So again, just kind of keep that at the back of your mind. That rule also applies to, is this sort of bug? Oh, command, mine, thank. Boralia Bokdoferi also has a similar business going on there. Screen test, Eliza, diagnostic, western block. Okay, let's keep chugging through. Oh, command, mine, hurry up.

Okay, so this light is just some random stuff that's important that the mbimimi write this as a series of answers to kind of mess with your head to do your dirty like that. So let me try to make sure you don't make those kinds of mistakes. These words all sound similar, but they all relate to completely different pathologies. Right? So erythema chronic com migraines is the skin finding and line disease. Right? That's like the first stage of land disease. That's the Bose Irish. Right? Erythema marginata. That's the skin finding in a dramatic fever caused by group A strep. Okay, streptococcus pyogenes. And then erythema infects you. Okay, that's the slutschi crash. That's a surgical parvo B19. Again, remember parvo B19 does not just shop in kids. It can also shop in adults, especially like children's teachers, like elementary school teachers. That's a classic presentation on mbimis. And then ectema gangrenosum. Right? That's almost like the esha that is associated with pseudomonas. Okay? So that's something to just again kind of keep in mind. Now, tb, right? So the micro bacterial species, I think is probably the last time I'm actually going to focus on today. It's like 39. So we're almost down here. Okay. So again, the obligatory erythema infects the long EP Cs because as I will discuss in my poem videos slash podcasts, I love poem. I will talk about how there is more oxygen tension at the apex of the lungs. Right? So you want to go where there's the most oxygen, right?

And again, the cell wall of my co-bacterial species, the erythema colic acids, right? So they are, that's it's acid fast. Right? So it has the ability to take up like cable fusion when you do the zylniol sensing. The zylniol sensing is the same for micro bacterial species, especially my co-bacterium tuberculosis. And again, the big ones you want to keep here, MTB, right? So like, micro bacterial tuberculosis, micro bacterial, if you're interested in a lary, that's going to be a HIV patient. Micro bacterial marinum, right? So marinum, right? So like water exposure, micro bacterial cancassiae, and then micro bacterial membrane. Classic presentation of micro bacterial membrane and mbim exam is the person who have like these like, you'll have like anesthesia, right? So you don't feel like cool parts of the body, right? So like over the, they even have the qualities, over the ears, over the nose, you have chronic symptoms, that's leprosy. The way you treat leprosy is you use, you treat it with like triple therapy. I call it my own triple therapy. And the numonic I use for that is DRC, like I mean, I'm, I'm originally from Nigeria, so I'm African. So I'm familiar with the democratic republic of Congo, right? So DRC, remember that as a numonic for treating leprosy, the D stands for Dapsun, the R stands for Refanping, and the C stands for Clophazimune. I'll say that again, Dapsun, Refanping, and Clophazimune.

And I don't know, I just have this function in my heart to talk about the uses of Refanping on an MME exam. So you can use Refanping and therapy with, for leprosy, 24 months FYI. So don't get leprosy, leprosy is bad. But basically, Refanping, you can use it for a few things on MME in the exams, you can use your treat TB, obviously, right? Like the right prediumin. You can use it to treat leprosy, the DRC regimen. You can also use Refanping as close contact prophylaxis, of a person that has meningococcal meningitis, right? So like an esoteric meningitis, Refanping is actually the drug of choice for treating close contacts, or for prophylaxis in close contacts, or people that have meningitis from my serum and ingitis, okay? Other drugs you can use for that, you can use cyprophloxacine, you can use tetraaxone. But Refanping is the preferred agent, but obviously if you're pregnant, you're not going to be messing around with Refanping, you're not going to be messing around with cyprophloxacine, so you're going to go with tetraaxone, under those circumstances. And then, again, TB, again, just fever, night sweats, week loss, you know, constitutional symptoms, although if it's a hemon style questions, probably cancer, oops. And again, TB or Celmidated immunity takes care of TB, right? And again, TB, you get it through aerosolicycretions, again it's an obligatory error, make sure there's no difference between a gun focus and a gun complex.

The gun focus is the case-heating granuloma, okay? That you get with TB, right? And then the gun complex is the gun focus, right? So the granuloma plus lymphatomeopathy, the periodhylene lymph nodes, that's the gun complex, right? And the thing is if you have a gun complex, it means you've either had an infection that resolved, okay? Or infection that's latent, right? So you have a coron primary infection, although usually it's more like resolved infection or coron primary infection, right? And again, TB is filled with a multi-drug regimen, right? So you do the ripe regimen, right? Basically ripe regimen is Refanping. Remember that we have sub-satagon P450 that causes orange urine, right? That's nephrine hepato toxic. And then there is isoniasid. Remember, isoniasid depletio B6, right? So if you depletio B6, you can run into trombums, right? Well, why is that? Well, B6 is the cofactor for your transaminesis in the liver, like ALT, AST use B6 as a cofactor. So you can imagine liver toxicity happening with isoniasid. By depleting your B6, you will also have issues with hym synthesis. So remember, the real mutin enzyme of hym synthesis is ALT synthase. So I mean, amino-levelinic acid synthase that uses B6 as a cofactor, right? So if you don't have B6, it's not going to work. So you're going to get a seroblastic anemia. And then if you're going from glutamine to GABA, remember glutamine is the excitatory neurotransmitter of your brain.

GABA is the inhibitory neurotransmitter of your brain. Compared to glycine, that's the inhibitory neurotransmitter of the spinal cord. In going from glutamine, which is an excitatory neurotransmitter to GABA, which is an inhibitory neurotransmitter, you use an enzyme known as glutamine decarboxylase. GABA, glutamine decarboxylase uses B6 as a cofactor. So if you don't have B6, you have more glutamine than less GABA. So you have seizures, right? So that's one of the neurotoxysities that are associated with isoniasid. You can also get like a no peripheral neuropathy and all that badness, right? And then we have pure xenomide, works well in acidic environments, and then we have a thambutol, a thambutol tends to cause more like eye problems. That's the classic side effect. So if a person has like active TB, you use the right pragement plus vitamin B6, okay? Of the, and you do that for six months, but the thing is you use all of the right plus vitamin B6 for the first two months. And then for the remaining four months, you use just right fan pin, isoniasid and B6, okay? And then if a person has latent TB, and here's how latent TB present on the baby mxm, a person will have like positive PPD skin test, okay? And then to present how a positive PPD skin test, and then they'll tell you the chest x-ray is negative. If you see that, basically, if a person has a positive PPD skin test, your next step in diagnosis is always to get a chest x-ray.

If the chest x-ray is negative, they have latent TB. For presence, latent TB, you treat them with isoniasid for nine months plus vitamin B6, okay? So that's therapy for latent TB. And then, again, don't forget that right fan pin, again, revs upside to come P450. You see where I fan pin, the R in where I fan pin for the R in revs. And again, I look at the time now at 63 minutes plus, I'm sorry, I'm gonna round this up very soon. It's just all these things I'm telling you, I just high-yield information. And one thing you should get used to as you listen to my videos or podcasts is sometimes just other things just kind of drop in my mind, that I never plan to talk about. So, but a high yield, so I'm gonna talk about them. So, again, I'm sorry. So, right fan pin revs upside to come P450. So they can classically give you like a question about a person that, you know, takes OC Ps and then has a history of TB and then gets pregnant, right? The R fan pin has increased the metabolism of the OCP, right? So it's no longer effective, essentially. Okay. Then, I soniasid inhibits. So you see the eyes match. So, I and I soniasid for I and inhibits, Cp450, Rifant pin revs upside to come P450. And remember that I soniasid is also associated with, there's this thing that your friends at the in-beam, they love to test, actually two things. So they can test it in the context of bio-status, especially on step one. It's one of, I soniasid is metabolized by acid elation, right?

So it's one of those things where you can have slow acid elators and fast acid elators like a bi-modal distribution of something. They love to test that on MD and is, especially in a bio-status context. And then another thing is is, I soniasid, if you develop a Miller rash, I'll take it, I soniasid, that's drug induced loop, right? With your anti-histone, anti-balis. And again, TB is hard to kill because again, it's intracellular. And again, if your PPD is positive, it means you've been exposed to TB in some way, shape or form. And don't forget your induration limits, right? So basically, right, people are like, oh, divine, it's so hard to remember. It's tough. Yeah, yeah, yeah, yeah, yeah, yeah, let me give you a trick. If you have induration that is more than five millimeters, think of an immunocompromised person, being positive for TB. If you have induration of the skin that's more than 10 millimeters, think of people with chronic illness and healthcare workers. That's a nice classification system there. And then if you're more than 15 millimeters, then it's positive, everyone. If your induration is more than 15 millimeters, you have TB, right? So let's talk about this for a second, right? So what is the thing I want to say here?

So greater than five millimeters, positive and again, immunocompromised folks, so folks with HIV, folks that have organ transplants, folks on immunosuppressants, not just for because they got organ transplants, but also people that just have some autoimmune disease where they're taking an immunosuppressant. If their induration is more than five millimeters, you better believe that they have TB. And then more than 10 millimeters, healthcare workers are like resident, med student, physician. And also people that have chronic kidney disease, diabetes, and all that stuff. And then again, more than 15 millimeters is positive in everyone, right? And again, as perjilus loves to form fungus balls in TB cavities, but usually they'll give you like eosinophilia on your exam. And remember that as perjilus is Phidilol like Variconezo, Oposa conzo, although if it's disemmeded, invasive, you go with amphoterrible on those circumstances. And again, remember that PPD skin test is an example of a type 4 hypersensitivity reaction. And then Mac, right? So like Michael Bachjama, if you're an intrusary lary, if your cd 4 calisthen is 50, you're prophylaxia against this, you can see thromisin. And then, don't forget that Mac can also cause like hot tub long. It's almost like a pneumonitis that arises in the setting of exposure to like hot tops, right?

So if a person seems to have like, like pulmonary symptoms that have this temporal association with them using like a hot tub or like a new community pool, think about Michael Bachjama, Evium complex. And Mac also loves to affect elderly women. It can cause like a chronic pulmonary infection in an elderly female. That's a classic presentation as well. And then again, HIV patients cd 4 less than 50. Okay? So please do not confuse hot tub long that's caused by Mac with hot tub folliculitis that's caused by pseudomonas urgenosa, right? And then Michael Bachjama, I'm super rare kind of low yield, but if you see a skin infection, a person that works with water, think about Michael Bachjama, right now. And just as a bonus here, I'm sports tricks shanky eye, right? If you see like skin lesions that almost seem to be traveling along the lymph node chain, right? Like circles traveling along the lymph node chain, in a rose gardener, a person that works in a vegetable garden or something like that. I think about sports trickosis, sports trick shanky eye, you treat that with a troconus. So I think I'm going to go ahead and pause here as I do at the end of a report cast. I offer one on one tutoring, a large group tutoring for a ton of exams, step one, two CK, two CES, step three, pre clinical medical exams, 30-ish off exams. If you're a medicine resident, I tutor for the ABA board exams and the internal medicine training exam. And then I also offer like booster courses, right?

So it's 20 hours for step one, it's 15 hours for step two CK and step three. And again, it's just the course where I meet you one on one, we meet you there for one hour each time or above one turn of my mic. Okay, so me for one hour each time or 12 hours each time, and then we go over the most nodes for the USMLA exam that we are taking. Okay? And then if you're a college student, I need to do it for the physics, general chemistry, organic chemistry, biochemistry, histology, physiology, over tutoring for all those things, my tutor for the M-Cardactory. So and then if you're a college student, a plan to med school, so like an AMCAZAP, or a med student applying for residency, so like an ERASAP, I do like one on one advising coaching for like recletters, personal statement editing, mock interviews, editing applications. Again, I've been on the admissions committee on the top two med school for a year, so I have a lot of experience reviewing applications. And for the ERASAP process, the vast majority, I'll say over 90% of the people have worked with have all much of their first choices, right? So if you need any of that, feel free to reach out to me. And you can either reach out to me through the website or you can send me an email. This is probably preferable, but it's fine. Website works as well. I get either one. The Divine Intervention Podcasts with an S at the end at gmail.com. So have a wonderful rest of your day.

I am really hoping and praying that the leakers beat the cell text today. I was overjoyed on Saturday when the knocks down the rockets. I hope Anthony did this can come back, but you know, we're playing pretty well in his absence, but that's a different discussion. So have a wonderful rest of your day. Thank you for listening to this. God bless you. I'll see you next time.

It causes a lymphocyte-predominant leukocytosis.

Pseudomonas aeruginosa.

PPI + Amoxicillin + Clarithromycin, OR Metronidazole + Bismuth + Tetracycline.

Exposure to water contaminated by animal urine.

Spastic paralysis (due to cleavage of SNARE proteins).

Streptococcus pneumoniae.

Cough, Coryza (runny nose), and Conjunctivitis.

Treponema pallidum (Syphilis).

Cleaving SNARE proteins, preventing inhibitory neurotransmitter release.

Aminoglycosides (e.g., Gentamicin).

Latex agglutination test for cryptococcal antigen.

Measles.

Tuberculosis (TB).

Cough, Coryza (runny nose), and Conjunctivitis.

Treponema pallidum (Syphilis).

Cleaving SNARE proteins, preventing inhibitory neurotransmitter release.

Aminoglycosides (e.g., Gentamicin).

Latex agglutination test for cryptococcal antigen.

Measles.

Tuberculosis (TB).