Source / episode info

• **Episode:**258
• **Title:**Divine Intervention Episode 258 – USMLE Step 2CK Rapid Review Series 42 (and upcoming 10 hr course 9/5/20).
• **Published:**2020-09-03
• Source:Episode page

One-liner

This episode provides a rapid review covering high-yield topics including epiglottitis/SBP management with third-generation cephalosporins, TB diagnosis and INH toxicity (B6 deficiency), spirochetal infections (Lyme disease) and associated reactions, CMV pathogenesis and resistance, and classic patterns of calcification in various organs.

High-yield summary

• Epiglottitis/SBP: Both require immediate empiric treatment with a third-generation cephalosporin (Ceftriaxone or Cefotaxime) due to potential deep tissue/CNS involvement.
• TB Management: Treatment requires Rifampin, Isoniazid (INH), Pyrazinamide, and Ethambutol plus Vitamin B6 supplementation; INH toxicity can cause peripheral neuropathy, hepatotoxicity, DILE, and megaloblastic anemia.
• CMV Pathogenesis: CMV causes large intranuclear inclusions in cells. Treatment with Ganciclovir is standard, but resistance (due to UL97 kinase mutation) requires switching to Valganciclovir, which bypasses the need for kinase activation.
• Calcification Patterns: Specific calcified masses are highly tested: Oligodendroglioma (frontal lobe, "fried egg" appearance), Craniopharyngioma (supra-sella, compresses optic chiasm), and Monckeberg sclerosis (ABI > 1.5 in diabetics).
• Spirochetes: The Jarisch-Herxheimer reaction can occur with any spirochete (Borrelia, Treponema, Leptospira); for Lyme disease, Doxycycline is preferred over antibiotics for classic erythema migrans/neuroborreliosis.

Learning objectives

• Identify the appropriate initial management and antibiotic coverage for acute epiglottitis and SBP.
• Differentiate between various types of calcified brain/abdominal masses based on clinical presentation and histology.
• Understand the mechanism of action, toxicity, and prophylactic treatment guidelines for anti-tuberculosis drugs (INH).
• Recognize high-yield spirochetal infections and associated diagnostic reactions (Jarisch-Herxheimer reaction).
• Master the principles of antibiotic timing in surgery and the management of CMV resistance.

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