Source / episode info
- **Episode:**119
- **Title:**Divine Intervention Episode 119 – USMLE Step 2CK Rapid Review Series 3 (IM)
- **Published:**2019-07-04
- Source:Episode page
One-liner
This episode provides a rapid review of empiric antibiotic coverage for sepsis (MRSA/Pseudomonas), focusing on specific drug classes, and details the pathophysiology, diagnosis, and management of primary adrenal insufficiency.
High-yield summary
- Sepsis Coverage: For suspected MRSA, consider agents like Vancomycin, Daptomycin (Gram+ only), or Linezolid. For Pseudomonas coverage, broad spectrum drugs include Ceftazidime, Cefepime, Carbapenems, and Fluoroquinolones.
- Primary AI Pathophysiology: Autoimmune destruction of the adrenal cortex leads to deficiency in cortisol (glucocorticoid), aldosterone (mineralocorticoid), and sex steroids.
- AI Electrolyte Derangements: Deficiency in aldosterone causes impaired Na+ reabsorption and K+ excretion, leading to hyperkalemia and metabolic acidosis.
- AI Hematology: Low cortisol levels result in reduced apoptosis of eosinophils, causing a characteristic eosinophilia/leukocytosis.
- Diagnosis & Management: Primary AI is diagnosed by failure of cortisol to rise after ACTH administration. Treatment requires replacement with both glucocorticoids (e.g., prednisone) and mineralocorticoids (fludrocortisone).
Learning objectives
- Identify appropriate empiric antibiotic coverage for common hospital-acquired pathogens like MRSA and Pseudomonas.
- Differentiate the pathophysiology and clinical presentation of primary versus secondary adrenal insufficiency.
- Recognize the characteristic electrolyte abnormalities (hyperkalemia, metabolic acidosis) associated with mineralocorticoid deficiency in AI.
- Understand the diagnostic utility and interpretation of the ACTH stimulation test in suspected adrenal failure.
- Initiate appropriate replacement therapy for acute adrenal crisis using both glucocorticoids and mineralocorticoids.
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