DIP Episode 231 - USMLE Military Podcast Part 2

Okay, welcome. My name is the Vine, I'm a resident. This is episode 231 of the Divine Intervention Podcasts. This is the USMLE Military Podcast. This is part two. There is a part one. I know it's it's one of those episodes just above 200. Again, very high-yield episode to listen to. I promise you if you're taking the exam, it's something I definitely want to listen to. Again, I'm learning on making the sub. You know, we're going to look at the content outline for the exam and the very clearly outlined that you'll be testing these kinds of concepts on the exams going forward. Okay, so this is the USMLE Military. This is part two. And in this one, I'm going to be focusing on again a different series of problems that tends to happen in people that are coming back from, you know, being deployed or something like that. The last time I focused on the psychological stuff, the psychiatric stuff, the drug abuse stuff. In this case, I'm going to focus more on like infectious related things. So let's go ahead and jump right into it. So essentially, what kinds of vaccines are kind of required before you get deployed as a military service member? Well, you know, you need the measles moms and rebel vaccine, right? So the MMR, you need the tetanus, the theory and the pertossus, you need the influenza vaccine, you need polio, you need the hep A vaccine, you need the typhoid vaccine, you need the varicela vaccine.

And the thing is, if a police has particularly, you know, high incidences of some other things like yellow fever, smallpox and thracks, you should also, you know, go ahead and get those vaccines. If you're a medic, so if you're like a physician or like a knee-be-physician, an army physician or whatever, you need the hep B vaccine, right? And then in general, like these people, people that go again get deployed, you know, they get like DEET, I think they kind of like put them on their skin or something like that. And many times they have field uniforms, tend to be treated with a premier three. So kind of again, protect them against many of these zonarika crap, right? And then remember, already, they give you a question about a service member that you know, had a lot of sex overseas with multiple partners. And then this patient has been, you know, feeling like crap and having like John this and hep Aromegaly, you know, you want to think about hep B, on other circumstances. And if you see like an outbreak style situation, right? Again, like in a military barracks or a military camp or something like that, right? Where you see a lot of people, no courage, you know, all that stuff. You want to think about nice, you're being injured, right? And remember, your drug of choices have triaxal. And then if you're close contact, you get rifamp it, right? Although remember, you can use CIPRA and have triaxal as a close contact with relaxes as well.

But you know, in general, if you're pregnant, you can really use any of those things other than septuaxal, right? And I mean, just some common sense things to adopt as a military service member. Again, they can ask this as a preventive medicine question, right? You don't want to be peddying on feeding animals, right? When you're deployed overseas, that's not very prevent, right? You don't want to again directly contact like animal, so animal products, you don't want to adopt like all these like stray animals as your pets. You know, like common sense things you're probably doing the US, right? You know, just kind of extend that common sense to when you leave the, leave the country, right? And again, remember, there is in fact a vaccine available for rebate, right? So just something to keep in mind. Okay, now, what if they give you a question about a patient, they tell you that this patient just retuned from deployment in Egypt, right? Or some middle eastern country. And when this patient came back, they tell you that, oh, this person has been having like a pateus planomegaly has like portal hypertension, or they may tell you something about having like hematuria. If you see that, I would really hope that you're thinking about shistosomiasis, right? So shistosomiasis, you know, it's pretty, it's pretty common, right? It's really like in Egypt, right? Like in the now and stuff, right? So remember, there are two types of shistosomiasis you may see on the test, right?

So you may see like shistosomahematobium, that's probably the more common one, right? That's the one that has that egg with like a terminal spine, right? And it tends to cause like bladder cancer, right? Like, if you see like a person from Egypt with bladder cancer, that's going to be shistosoma. And the thing is remember, most bladder cancers tend to be transitional cell carcinoma, but shistosomahematobium is kind of special, it actually causes a squamous cell cancer of the bladder, that is very unusual. So you can almost predict that there's some kind of metaplesia that happens in the bladder epithelium, right? And in that metaplesia leads to dysplasia, and in that dysplasia leads to cancer, right? And the thing is, people can also get like pulmonary hypertension from shistosomahematobium, right? And then shistosomamansana is the one that has that lateral spine, right? And it tends to torch the liver for the most part, you know, causes like a pyrospelano-mechlea and all that badness. And again, the method of transmission is through water, right? So if they describe a person that did like some marine missions, or you know, was an underwater diver in the military or something like that, and then came back and has all these symptoms, you know what you're going after. And really the way you treat this is with a priziquantel, you treat it with priziquantel, right?

And again, actually the most common infection that people tend to get during deployment is actually diarrhea, right? And that diarrhea is usually from the neurovirus, right? So from like no-walk virus, right? That's something high you'd want to keep in mind, for example. And then what if they give you a question about a patient and they tell you that, oh, this patient, you know, went to, went to, you know, like some African country, like on peace, a peacekeeping mission. And then the patient came back not too long ago. Maybe this was well deployed. They tell you that, oh, this patient like had like a flu-like symptoms. And then over time, this patient studied like bleeding from everywhere, had like a PTI on the skin, had like this maculo-papular rash, was having him up to say, is having like a like pooping blood and all that badness. If you see that, I'll really hope you're thinking about the Ebola virus, right? In fact, they may tell you that this patient had like contact with animals, right? Animals, like monkeys, right? Or dogs, or even dead bodies, right? During the course of the deployment or whatever, then they came back and they have all this badness. You want to think about the Ebola virus, right? Another one you may see is the Marburg, like M-A-R-B-U-R-G virus, right?

And again, remember, the way this virus is spread is, you know, like through like direct contact, like bodily fluids, or you know, if you have like aero-sluised droplets, that can actually transmit the Ebola. And there's no real treatment. I mean, you can do so for the care, hope for the best, but most people that get the stuff die, right? And again, you want to be careful. You don't want to handle wild animals while you're deployed. In fact, if you see that buzzword, wild animals in a question, think about Ebola virus, right? Think about Ebola virus. So again, they'll have like flu, like when you get exposed, right? So again, it can be a person. It's not going to be a person three years after they came back from being deployed. No, it'll be a person that was, you know, came back from deployment like 10 days ago, right? And then, you know, the person's stuff feels like crap, like, you know, like coming like diarrhea, vomiting and all that stuff, high fever, my allergies. And then over 10 people just stop bleeding from any of your everywhere. And basically, they die because essentially, like, they're a couple, their capillaries become like extremely liquid, right? They're going to shock like a hemorrhagic kind of shock. It's like a terrible, terrible terrible way to that, right? So it's one of those big things you want to keep at the back of your mind.

Or they can even give you a question about a person, like a person that was working at a military hospital where they were taking care of people with Ebola or something. And then the person could potentially get Ebola that way, right? So again, those are just all high old things to keep at the back of your mind. Another hemorrhagic style, whatever thing you're like, you want to think about like hunter virus, right? So if they tell you that a person again, came back from deployment, maybe this person lived in like a place with, you know, like a lot of mice, especially like the deer mouse, right? And, you know, if you see any of those things and then they tell you that, oh, this person's that's having, oh, maybe this person worked in a barn and this barn was filled with a lot of rodents, right? Like if you put the word barn, you would really want to think about the hunter virus, right? And it can even be someone that's easy and one of these like military bases, like in the New Mexico, Arizona, Colorado, Utah area of the country, right? Those things can cause those things can cause those things as you know, the hunter virus, right? These people have like, you know, like a flu, like some flu-like symptoms, and again, it's pretty, it's pretty bad. I mean, like it can cause like a hemorrhagic fever, right? Or it can cause like a pulmonary thing. In fact, there's this thing called hemorrhagic fever or redone syndrome. There's this thing called a hunter virus pulmonary syndrome.

And again, these people, they can be people that were deployed like in Korea, right? That's definitely a place where the US military is deployed. Or you can see a person that's just come back from Russia or from China, right? Again, don't forget, like again, they'll have like this, they'll have like these super high fevers, they'll have like flu-like symptoms, and then they'll have like these bilateral pulmonary demonetism, right? And they'll be like in an interstitial pattern. If you see that, you want to think about a hunter virus. And unfortunately, at least from the research I did, there's really no treatment for hunter virus, right? If you talk about a person that, again, service member, maybe again, went for maybe like maybe deployed in Hawaii, maybe leaves an army base in Hawaii or whatever, right? And then they tell you that this person, this person, you know, kind of had like fevers, myelges, and usually like it's in the calphar region, right? And they tell you that this person has been jaundiced, and this person has like conjunctival injection. Whenever you see that again, and if you see like that Hawaii exposure, or again, they went on a mil- they were deployed in the military, and maybe they were in the Navy or something. So they did a lot of like water-related work. And you see like conjunctival injection, you absolutely want to think about leptospirosis, right? You want to think about leptospirosis, right? Again, and remember, leptospirinterrogans, right?

You know, it's a spirochete, right? So again, that's only one to keep in mind. And the thing is, there's a particularly bad form of leptospirosis that's called a will disease, right? Will disease. Where essentially the leptospiral, essentially like touch those people's kidneys and levers, right? And these people have like really bad anemia, they'll have like really bad jaundice, they're creatinine will be like super, super high, they'll have like boi urine production, terrible, terrible, terrible, a place to be. This one of those things again, you want to keep in mind. Another classic thing you may see on your test, right? So what if they give you a question about a patient, they tell you again, this patient was deployed, you know, like maybe like a hostile nation or something like that. And then they tell you that this patient for the past three days has been having like a lot of like a hemoptysis, and they tell you that one imaging is you're widened, you mean the astine, a widening, the astine on imaging. And they may want to show you like a black necrotic ulcer on the neck. If you see that, I'll really hope you're thinking about anthrax on that those circumstances. Right? Remember anthrax, right? It's one of those things that has like it has like a weird capsule that's made of polyglutamides, right? Bacillus and thresus, right?

And there's actually a vaccine for a believer or not, but I mean, it's not something that's probably available to the public is more so for the military, right? Or people that go on these special missions, right? So remember, there's cutaneous anthrax, they'll have like the black eschar, right? And then there's also pulmonary anthrax. That one is terrible, terrible, terrible. That's like super bad, right? That's the thing where the people get like the hemorrhagic mediastonitis. So remember a widening mediastine on imaging on NVM exams, does not just mean early dissection, it could also mean anthrax, okay? That could be like the anthrax causing the hemorrhagica mediastonitis. So again, all things you definitely want to keep in mind, for example. And then before you go to a foreign country, right? Like especially like a place, let's say you're going to like an African country or you're going to an Asian country or you're going to like India or something again for like some kind of a foreign mission or something, or the tell you that before you go, let me maybe talk about before you go first, right? Like you want chemotherapy access, right? Like against malaria, right? Then you know, typically you want to pick one of these drugs on your test. Like methlocking is one you can use, chloroquine is another one you can use. Although chloroquine, there's a lot of resistance, right? So it's probably not going to be the right answer in your test.

It's going to be more along the lines of like methlocking, doxicine, primer queen, right? Although primer queen has not yet found prime time, as like primary prephylaxis, I suspect it will vary soon if you kind of read the literature on that. But primer queen is the one that we used to treat like the viwax and ovali, those ones that those hypnozoids that can kind of stay in the liver for a long time, right? And then under classic one mission, the test is the combination of atovacone and proguenial, right? So ATO VA, Q-U-O-N-E, atovacone, proguenial SPRO, G-U-A-N-I-L, okay? So remember malaria, again, it's caused by the plasmodium species, right? So like viwax ovali. So again, these are problems that can actually happen in a person that is coming back, a person that is just coming back from, from again, being deployed, right? Because again, remember some finds plasmodium species can leave very dominant in a person, right? They can leave dominant in a person. So if you see a person that goes to one of these countries and then returns, right? And then returns, right? And then you know begins to have like some weird symptoms, again, begin to think about malaria, right? And what are these weird symptoms, right? These people have like recurring fevers, right? And they'll have like very severe chills, they'll have like nausea, they'll have like all those joint pain, they can have spleen or megaly, right?

Because remember, malaria loves to go after like rape blood cells and your spleen stores a ton of rape blood cells. They'll have like anemia, right? And the thing is the patient's fever is not going to be constant, right? They'll be asymptomatic between fevers, right? And the thing is you may ask, okay, why is that, why does that happen? The thing is when the when the plasmodium species infect red blood cells, right? Whenever they infect red blood cells and they're now like exploding the red blood cells to like one infect new ones, like the merosolids, right? That's the time when those people tend to have other fevers, right? And the thing is you want to know the kind of malaria plasmodium species that goes with a kind of fever, right? So they tell you that this person has tertian fevers, so fevers every 48 hours, you want to think about p-vi-vax and p-o-wali, right? And that also should help you remember that p-vi-vax and p-o-wali, those are the ones that tend to have that hypnozoid form, right? That's these domains in the liver that you trade with a primacquaint, right? And then p-malaria, so those are tertian fevers. Plasmodium malaria causes organ fevers every 72 hours, right? organ fevers every 72 hours, right? So essentially, that's the association I want to know there. And then the worst one, p-falsyperin, the thing is it causes fevers that like audit intervals, right?

So you can't put it into the tertian or the cordon pool if you really want to do your research on that. So again, the reason these people tend to get into trouble is, again, these plasmodium species they like those red blood cells, right? To release the merosodes, right? So as you're like seeing red blood cells, you're almost giving that person like a hemolytic anemia, right? Hemolytic anemia, right? And the thing is, sometimes people that have malaria, especially from a p-falsyperin, p-falsyperin is terrible, it can cause like cerebral malaria with that badness, right? But the thing is p-falsyperin, sometimes they can even give you a question about that person that is a returning service member and they tell you this person has like dark urine, right? If you see dark urine in a returning service member, you want to think about this thing called black water fever, black water fever, it's a cerebral plasmodium falsyperin, right? And the thing is, p-falsyperin, you actually need to treat it, if you don't treat it, I know the person is probably going to die, right? Because remember, p-falsyperin, it has the longest thing of all the malirious species, so that should help you remember that it has the worst things that you can do, right? It can cause like, like the box can't congest the capillaries in the brain and cause cerebral malaria, that's usually pretty fatal, right?

Or you can have like pulmonary dima, because it basically makes your capillaries leaky from congestion, right? And then they can even have like renal failure, right? So if you see a person that's having like super bad symptoms after going to again, one of these countries like an African country, an Asian country, or coming back from India, or something like that, you absolutely want to think about a plasmodium species. And remember, it's carried by the anophilus mosquito, right? It's carried by the anophilus mosquito. Now, what if they give you a question on your test about a patient and they tell you that, oh, this patient again, just returned from being deployed, right? Return from being deployed. And they tell you that, oh, this patient has been, this patient was exposed to, this patient was exposed to, like a lot of like animals, or like animal products, or like on past rice meal, for example, right? And like when the person was a deployed, they were just telling you that the person was exposed to a lot of animals like cattle and stuff, right? And then they tell you that this person has been having like, this person has like, profused sweating all the time, profused sweating, joint muscle pain, right? And they tell you that this person has like, on-dulan fevers, right? So like picket fence fevers, they come, they go, they come, they go, they come, they go, right? If you see that, you want to think about brosolosis, okay? You want to think about brosolosis, right?

And again, the way you get is from being exposed to animals, especially like contaminated animal products like, like on past rice meal, right? Like on past rice meal. And one thing that people tend to confuse this stuff with like brosolosis with, they tend to confuse it with a, q-feaver, which is caused by coxiela bonediai, I will talk about that separately. But one key critical thing is that coxiela causes presents as pneumonia, okay? Q-feaver presents as pneumonia on NB Mis, not broselva, okay? Not broselva, okay? So again, broselva, again, they'll have the on-dolane fevers and shells, right? They'll have like headaches and all that stuff, but look out for the term, profuse sweating, it's very high on, they tend to have profuse sweating. And the thing is you don't require a ton of broselva to get into trouble, it's a very, very low dose that you require, right? And again, exposed to animals, when exposed to animal products that are contaminated, right? Like on past rice, they're dairy products, right? And the thing is usually it tends to keep coming back, even if you truly tend to keep coming back, coming back, coming back. So this can be something that they can give you about a person that returned from the force like years ago, right? And they're still having all these weird non-specific symptoms. If you see that, it's really something that is happening years later, you absolutely, absolutely, absolutely want to think about broselva under those circumstances.

I know some of you may be saying this is almost like a micro review, but I promise you, the stuff I'm talking about is super, super high on, because think about it, right? Service meant by definition for the most part. I mean, I know there's like honey bases and everything in the US, right? But look at, if you look at the US MLU's wording, right? They talk about like returning service men and women, right? So they're probably talking about what I went to foreign countries. And what's the big infectious disease thing you get from a foreign country, right? It's going to be a zoonotic infection, right? So the thing is again, these things I promise you, you may say, uh, divine, who really cares about this? I promise you when you're taking your step one or step two, CK exam, or step three, you will know exactly why you're listening to this podcast. I mean, they literally tell you, this is like no secret. They literally tell you. So if you know what's good for you, make sure you listen to the US ML military podcast part one and then listen to this podcast part two, which if you've got into this point, you're probably listening to it already. Right? So again, super, super important and the way you treat brucella, right? You treat it with like doxycycline and rifampin, right? If you keep getting like recurrences, you can go ahead and give those people a minute like, like, like, like, like, striptomycin or stuff like that.

And then they give you a question about a patient that, you know, again, maybe has like bloody, like, like, again, like a military person, uh, you know, maybe the person is actually even still being deployed and this person has like bloody diarrhea, right? And all that stuff. Maybe they have like a symmetrical sending paralysis or like reactive arthritis, right? You know, like those, one of those H2 B27 positive, uh, uh, seronegative, uh, spawnular therapies. You want to think about Campylobacteria, June 9th. It's actually one of the most common causes of bloody diarrhea in the military, right? So it's just something you want to watch out for. Some of these things, some of these statistics, I kind of got them from reading like the military, like literature, like military papers and stuff. They actually kind of fascinating. If you actually spend some time just kind of digging, digging through them, right? And again, they may tell you that all this person was, uh, deployed and, you know, was working with like a military dog. I was exposed to a lot of dogs or cats or pigs, stuff like that. If you see that, you definitely want to think about a C.J. June 9th, one of those are circumstances. And then I was kind of talking about like Q-fever, right, with, uh, with coxiella, right? Again, people tend to mix this up with, uh, brcella, right? So don't confuse Q-fever with, uh, brcella, okay? Don't confuse Q-fever with brcella, right? So the thing is, Q-fever, right?

Coxiella bonadia is actually not carried by an atroport, on like many of these others or notic infections, right? And the thing is for the most part, is something you get from inhalation, right? Like, you know, when you, especially if they talk about like some involvement like in a barn, where animals were being born, right? Where like, how do we been born or sheep were being born, right? When the person was deployed and then they tell you that, oh, this person has like headache cough, like flu-like symptoms, has like pneumonia, again, remember pneumonia, very, very high, pneumonia, very, very high, right? If you see those things, and the person may even have like chest pain, right? Because it can cause like a culture negative if you see those kinds of things, you absolutely want to think about Q-fever, under those circumstances, okay? You want to think about Q-fever, under those circumstances. Now, another common military like infection is like, uh, Lichmaniasis, right? Lichmaniasis is something you want to look out for, right? So the classic presentation will just be a person, again, that was deployed or just returning from deployment in like one of these like tropical countries, right? So like Mexico or like a South American country, a person coming from the middle east, that's a high old one, you know? Or a person that maybe went to like North Africa or East Africa, right?

If they tell you that, oh, this person is having like, uh, like these hyperpigmented skin lesions and then the person is having like a pato splino megalith, has like a really nasty anemia, right? And has like all these like fevers, like losing weight, and they have like panside opinion, like they have like lower blood cells, low platelets, low white blood cell count. And again, if you see all that, but look for the dermatological finding, the dark skin lesions, right? If you see that, you absolutely want to think about Lichmaniasis, especially visceral Lichmaniasis. That's the one that's carried by a Lesmania Donovan, right? Lesmania Donovan, you actually do have to trade it. You can trade it like amphotericin B or like a sodium stibogluconit, right? So amphotericin B or sodium stibogluconit, if you don't trade it, it is fetal. And don't forget that Lesmania is actually carried by, carried by some flies. And really the way you make the diagnosis is, you know, you can do like a tissue biopsy, right? Now you can look at the amastighots under the microscope, okay? So visceral Lichmaniasis, probably the one you'll see on a test, but you know, they can also have like, you know, like cutaneous lesmania and all that stuff, right? So lesmania, bad, bad, bad, bad, bad, right?

And then what if they give you a question about a patient, you know, again, returning service and they tell you that this person has like fever, has like headache, has like my allergies, and then they tell you that this person has like a mild necorrigenity, you get a lumbar puncture, you know, the opening pressure is not that high, the white blood cell count is not that high, but it's predominantly lymphocytes, right? And the protein is not that high, the glucose is not that low, right? If you see that you want to think about the West Nile virus, right? Remember, the West Nile virus tends to torch the anterior horn, right? Of the, basically the ventral horn of the spinal cord, right? And again, it's supportive care, you're doing to do anything special for those folks, right? And then, don't forget Shaka's disease again, returning service member, right? Returning service member and then they tell you that, oh, this person, this returning service member has like a trouble swallowing, right? You want to think about ecalicia, right? Or the person is having like like chronic constipation, right? You want to think about toxic, I mean, now, you want to think about herchprung disease, right? Remember, Shaka's can actually cause herchprung disease, or they may tell you that, oh, the person has been having like shotness or breath, has an S3 heart sound and all that stuff.

Again, returning service member, if you see any of these things, you absolutely want to think about Shaka's disease. Remember, Shaka's disease is transmitted by the redovid bug, right? The redovid bug. I think it's spelled as R-E-D-U-V-W-I-D, right? The redovid bug. Again, it tends to cause big problems, right? And one very specific finding on MBM exams is that essentially these people may have like periobital edema, right? Especially like if they tell you that, oh, the bite of the fly, of the bug, right? Looks is like neither either, they have periobital edema. If they are present like a unilateral periobital edema and has all these other symptoms I'm talking about, think about Shaka's disease on an MBM exam, right? Because it's big problems, right? It can cause biggest symptoms, it can cause ecalhesia, it can cause a big heart, it can cause an elithet cardiomyopathy, it can cause a big colon from herch from the disease, right? So that's something you want to keep in mind. And you know, you want to treat it like bins need as all, you can also use this drug known as a my 40-mox. You can use my 40-mox to treat it out, to treat the Shaka's disease. And then some other quick things, I guess I want to discuss here, although I'm kind of nearing the end of this, but if they give you a question about a patient, right?

And they tell you that, oh, this patient, you know, again, a returning service member and let's say this patient consumed like, you know, like worked with a lot of pets or turtles when he was deployed or ate a lot of eggs, a lot of poultry. And then they tell you that, oh, this patient has like bloody diarrhea, right? Like really bad bloody diarrhea. And they tell you that, you know, they have like a, a video weblox cell count, you see, it's predominantly neutrophils. If you see that, then you know, one thing I want to begin to consider is like some onella, right? Like some onella interred it is, right? Sometimes instead of putting some onella interred it is as an answer to me, put like non-typhoidal, some onella species. If you see that, I want to think about a non-typhoidal, some onella. Unfortunately, this is one of those things you don't treat. If you treat it, we show the best, right? But you basically don't want it. If you treat it like, you'll essentially meet the pressing get into trouble for much longer, right? For much longer. But please don't confuse some onella interred it is. Like the non-typhoidal, some onella species with some onella typhi. Some onella typhi is the thing that causes like those real spots on the abdomen. I kind of talked about this already in my, in my video. I mean, in my micro podcast, a lot of videos and all that stuff, right?

And for the most part, if a person has like typhoid fever from some onella typhi, you know, you give them safe tracks. So remember, safe tracks, there's a third generation, there's a low sparring, or you can give them a fluoroquinolore, right? So something like siplofloxacin, livofloxacin, gadifloxacin, or moxifloxacin, right? So those are all things you can use. And for the most part, we can even give you a question about a returning service member that has been having like a lot of like right-over quadrant being remembered. Years later down the line, after a person has some onella typhi, believe it or not, they can actually have like, colisestitis, right? Because the bug can actually stay like, like a person can be like a chronic carrier. And the bug bug can essentially a setup shop in the person's a gobladder, right? You can set up shop in the person's gobladder. So you know, that's something you want to keep at the back of your mind, for example. And then don't forget TB or TB is again, something you can see in our returning service member, right? The person for the most part will have like, again, like, you know, like a long term cough, like a chronic cough, they have like a smidge of him up to say, so have chest pain, weight loss, fever, night sweats, you know, the classic symptoms, right? And obviously they give you a chest x-ray and you see like, a red upper lobe in your treat, like a cavitory lesion, that's TB, right?

For person has active TB, remember, you give them the right paragement, right? So you give them rifampine, isonize it, pre-acidemite, and ethambutal, right? You do that for two months, and then you drop two of the drugs and they just continue with rifampine and isonize it for the remaining four months, right? That's six months of therapy. And don't forget your vitamin B6 with those folks, right? Don't forget your vitamin B6. Don't forget your vitamin B6. Do not forget your vitamin B6. That's very important. And then, don't forget, right, that before you give a patient my primer quin, right? So, again, they can make this a very nice nifty and B. Me question. Before you give a patient primer quin for treating like p-vi-vax or p-ovalu or whatever of that crap, right? One thing probably you don't want to forget is go ahead and check those people for g-6 pd deficiency, right? Especially a guy, right? Because g-6 pd deficiency is excellent, recessive, in heritins, so it's going to be in a guy on a test, right? It's not going to be in a woman. And if they give you a question about a patient that you know is going to a place that has a very high incidence of lactose perovsis and they are asking, what drug can be given as perphylaxis before the patient, before the service member is deployed? You want to think about giving those people doxycycline, okay? You want to think about giving those people doxycycline? Again, that's important, that's high or too normal.

And then, what if they give you a question about a returning service member? They tell you that this person has been having very, very high feverers, has this rash all over the body, right? And then they tell you that all this person has like prominent lymphodonopathy and this person, they tell you that this person's mileage is very severe, like very severe, very severe, like the bone-breeding of fevers. If you see that, you definitely want to think about, definitely want to, and this person has like some sign of bleeding. So look out for that, look out for some sign of bleeding, right? So, especially like there's this thing called the positive attorney-cat test, that's as you know the dinghy, right? You know, they tell you that you know like you apply a attorney-cat, you leave it on for like five minutes and you notice like PTKI below the cough of the attorney-cat, or they tell you that the person has like FOBT positive stool, so they have like epistaxis, they have PTKI on the skin. Again, you definitely want to think about a dinghy on that those are circumstances. And again, these people tend to have like just profound profound again. You'll be a person that was likely deployed in a South American country, right?

Again, you have high fevers, really bad chills, really bad mild jazz, and the material that all the person has in maturia, has epistaxis, as they're blowing their nose, or the material that they have like ginger-woven bleeding, like as we're brushing their teeth, you saw a lot of the kind of like study bleeding, right? And usually they have like thrombocytopenia, so they have like very low platelets, and they also tend to have like LFT abnormalities, right? So they are AST-ALT, will be elevated on a test, especially the ALT, right? And again, the reason that they have all those bleeding is that the Boc causes like increased capillary permeability, right? So they begin to essentially lick blood, okay? And remember this is carried by the AEDS mosquito, right? AEDS, the AEDS mosquito, again, that's why it's called dinghy hemorrhagic fever. Sometimes knowing the phoneme of something is actually pretty helpful on MDM exam, right? So dinghy hemorrhagic fever, dinghy hemorrhagic fever, right? And the thing is again, you don't want to confuse this with Chikongunya, right? That's something that people tend to confuse a lot on exams. Dinghy causes bleeding, causes hemorrhage, right? That's why it's called dinghy hemorrhagic fever. But Chikongunya actually does not cause any kind of hemorrhage, okay? Chikongunya is literally identical to a dinghy on MDM exams with a very notable exception that it does not cause any kind of hemorrhage, okay? It does not cause any kind of hemorrhage.

And then I mean, don't confuse this with Zika, right? Zika, again, you know, it'll be like, Zika is probably going to be in a woman on a test, right? Because you know, pregnancy, you know, the works, right? So Zika, you know, don't have like this viral pro-drom, so you may be like a returning service woman, right? And you'll tell you that, you know, she delivers a baby that has like microcephaly and like intracranial calcifications. If you see that, you want to think about Zika on that those are circumstances. And yellow fever, I mean, yellow fever is also something that maybe it may be confused with. But remember, yes, yellow fever affects the liver just like a dinghy, right? But the thing is, people with yellow fever, they're going to have jaundice, right? You're going to have like sclerolictors, they're going to have a pardomagaly and a test. Those are not things you'd necessarily find in then, you know, dinghy, hemorrhagic, a fever. But most of all, you just react with these patients, give support if care and you know, all the best from there, pretty much, right? So, I think that's all I'm going to go ahead and say today. Again, this podcast, I know you may be like, it's podcast sounds kind of weird. I promise you it's very high-yotes, you know, very, very high-yotes, you know, again, this is no secret. Literally, this is straight from the USM, literally putting it in there in their content offline. So please make sure you take detailed notes on this, right?

I promise you will help you out on your test. And as I do at the end of every podcast, again, I offer one or one tutoring for many things, right? Step one, two, see gate, two, see step three, preclinical medical exams, third year clerkship shelf exams, and then offer booster courses. It's like 20 hours for step one, two, see again, step three. Again, very rapid fire would very high you review the mosknows, the very, very high-yotes for those exams. Again, people that have done this booster course would be definitely to be extremely helpful. And then I'm also offering like a 30-hour from a college course for the USM, step one is 30 hours. And I'll review all the from ecology in an integrated format. So I'll integrate it with physiology with pathology across multiple systems. And by thinking you're done with the course, you will have zero farm problems going into the USM, step one exam. Again, this is something I've done for a long time. I'm very good at integrating things thankfully across a multiple disciplines, so if that's something you're interested in, reach out to me. And then, you know, if you're, if you also need like just want to want to join like for your dedicated period or something, I do offer want to want to join for all these USM and exams. And then even if you're an IMG, I've worked with tons of IM Gs, I've worked with tons of DEO students, I've worked with tons of USMD students, right? So again, if you're following to any of those categories, reach out to me.

And then if you're a med student applying to residency, so like an ERAS application, or a college student applying to a med school, so like an AMCAZ app, again, I can work, I do like consulting on those, like you know, rec letters, editing personal statements, editing applications, doing more interviews. Again, I've been on an admissions committee for like a year. And again, I've worked with a ton of people that were going into a ton of different specialties, right? And the vast majority of people have worked with them all much that their first choice. And the thing is, if you have a tricky application, again, like I say, low scores, I graduated 10 years ago, I don't have research, blah, blah, blah, blah, blah. The thing is, I can almost always find a way to present your best food forward in an application, right? Trust me, I've done this. There are people that have worked with a graduate seven years ago, and they matched with this current match, right? So again, if that's something you're interested in, reach out to me. And then if you're a medicine resident, I need to learn for any of the, like the board exams or the entry exam, or if you're a PEEDS resident, again, board exams, entry, and exam, I tour for all those things. And then if you have a buddy that needs to learn for any of the pre-med subjects or any of the MCAT subjects, I do also offer tutoring for that.

So please, feel free to reach out to me either through the website, divineintervention.podcasts with an SIVN.com, or you can send me an email at divineinterventionpodcasts with an SIVN.gmail.com. And please subscribe to the You Tube channel. It's called Divine Intervention, USMLE podcast and videos. Subscribe to the podcast. I have it on Apple podcasts, on Spotify, and on Google Play. In the interim, like the first 80 podcasts are there about you, you can find them for sure. You may not be able to find them on those podcasts, so you can find them for sure on the website. All the podcasts are always going to be on the website. Again, divineinterventionpodcasts.com. And then I guess my life lesson for today is the importance of taking responsibility. The importance of taking responsibility. So the thing is, you know, it's kind of important to take responsibility because I noticed there's this trend with a current generation about always blaming someone else for their problems, right? You just always seem to find the way to like put the blame on someone. Like the blame is never to them like, oh, the financial crisis, oh, it's because of this person. Oh, oh, this, I didn't do so well on my examples because of this person or it's because of this circumstance. You know, for a change, how about you sit up and take responsibility? Because the thing is, if you decide to be responsible for your life and say, you know what, the course of my future, right? Depends on what I do today.

You'll make you proactive, right? You'll make you proactive. You need to take responsibility for your future, right? And the thing is, this is not just like, for example, you're like, hmm, I have this goal. I want to become a dermatologist. And you know, you're not at a super well-or-round school, right? If you take responsibility for your life from the very beginning, right? Then you very likely match, right? A person that has that goal from the very beginning, you know, says, okay, no, even if I'm at this, like, you know, not very well-or-round school, I will, you know, plan to do a ways, I will study really well in my first years of med school, so I can do it on the USML Es and all that stuff, right? Those are all things you can do. You can take steps proactively to make a good future for yourself. So you don't have to like, see, don't stop blaming, blaming, blaming, blaming, blaming, blaming, somewhat in the future, right? So again, yes, sometimes are people to blame for problems, like, can you really blame other people on some problems you're going through? Yes, right? But the thing is, blaming another person, like, it's not going to solve anything for you, right? Not that you spend blaming you could have used you to do something proactive, right? So again, take responsibility for your life, even for your financial future, right? For some of you that are listening to this, you're like 30 years or you're raising four years, right? The thing is, have some savings, right?

Because you never know, you never know, look at how many people have lost their jobs with this crisis, right? Like, if you don't have, if you're living paycheck to paycheck, what are you going to do? Right? You, you want to become homeless? No, right? So take responsibility for your future. It is very important. And again, even when you get married, you have kids, take responsibility for your financial future. Don't say, oh, I've become a physician. I'm earning, you know, good money. I will go and buy 10 houses. So what? No, no, if you have my windows 10 houses for investment, that's a different conversation. But, you know, just be prudent with your future, right? Be prudent with your future. The goals you know you have for the future, long term, short term, everything, be proactive about them. Don't depend on someone too, because people can feel, right? Human beings can feel. Regardless of how trustworthy a human being is, a human being can feel you, right? So again, be proactive about your future. So thank you for listening. I really appreciate you guys are listening to this. God bless you. I'll see you in the next podcast. Thank you.

MMR, Tdap, Influenza, Polio, Hep A, Typhoid, Varicella.

Schistosoma haematobium.

Conjunctival injection, jaundice, renal failure (Weil's disease), following water exposure.

Ebola virus (or Marburg virus).

Undulant fevers, profuse sweating, headaches, following exposure to animal products.

Plasmodium vivax or P. ovale (Tertian fever).

Anopheles mosquito.

Widening mediastinum/mediastinitis.

Hepatitis B (Hep B) vaccine.

Praziquantel.

Dengue causes significant hemorrhage and thrombocytopenia; Chikungunya/Zika primarily cause rash and joint pain, but not severe bleeding.

Anthrax (Cutaneous or Pulmonary).

Rifampin, Isoniazid, Pyridoxine (Vitamin B6).

Plasmodium falciparum.

Doxycycline and Rifampin.

Q-fever (Coxiella burnetii) presents as pneumonia/pneumonitis via inhalation; Brucellosis causes undulant fevers from animal exposure.

Anopheles mosquito.

Hepatitis B (Hep B) vaccine.

Praziquantel.

Dengue causes significant hemorrhage and thrombocytopenia; Chikungunya/Zika primarily cause rash and joint pain, but not severe bleeding.

Anthrax (Cutaneous or Pulmonary).

Rifampin, Isoniazid, Pyridoxine (Vitamin B6).

Plasmodium falciparum.

Doxycycline and Rifampin.

Q-fever (Coxiella burnetii) presents as pneumonia/pneumonitis via inhalation; Brucellosis causes undulant fevers from animal exposure.

Anopheles mosquito.