Source / episode info
- **Episode:**358
- **Title:**Divine Intervention Episode 358 – USMLE Step 2CK/3 Rapid Review Series 68
- **Published:**2021-12-21
- Source:Episode page
One-liner
This episode reviews high-yield topics including the management of toxoplasmosis in HIV patients, recognizing parvo-B19 induced aplastic crisis, managing varices secondary to alpha-1 antitrypsin deficiency and portal hypertension, diagnosing candidiasis, and understanding skin manifestations like tinea nigra.
High-yield summary
- Toxoplasmosis (HIV): Ring-enhancing brain lesions in an HIV patient are highly suggestive of Toxoplasma gondii. Treatment is Pyrimethamine + Sulfadiazine; use Spyramycin during pregnancy to avoid folate antagonism.
- Parvovirus B19: Causes aplastic crisis, particularly in patients with underlying hemolytic anemia (e.g., sickle cell disease). Key findings include reticulocytopenia and transient drop in hemoglobin. It can also cause hydrops fetalis due to chronic high cardiac output state.
- Portal Hypertension/Varices: Secondary to conditions like Alpha-1 Antitrypsin Deficiency leading to cirrhosis. Acute management involves IV fluids (Normal Saline preferred) and PPIs; prophylaxis requires Octreotide, beta-blockers (e.g., Spironolactone), and prophylactic antibiotics (SBP coverage).
- Candidiasis: Vaginal candidiasis is associated with a low vaginal pH ( 4.5) and wet prep showing pseudo-hyphae. Treatment preference on exams is topical/oral azoles, favoring Fluconazole over Nystatin due to side effects.
- Tinea Nigri: A pigmented skin lesion strongly linked to sun exposure (biggest risk factor). While most lesions resolve spontaneously, persistence can lead to Squamous Cell Carcinoma (SCC); remember that keratin pearls can be found in tinea nigra, not exclusively SCC.
Learning objectives
- Differentiate between opportunistic CNS infections (e.g., Toxoplasma gondii) in immunocompromised patients.
- Recognize the characteristic laboratory findings associated with Parvovirus B19 infection, particularly aplastic crisis.
- Understand the pathophysiology and management of portal hypertension complications arising from chronic liver disease (e.g., AATD).
- Master the clinical presentation and diagnostic criteria for common superficial fungal infections like candidiasis and tinea nigra.
- Correlate environmental risk factors (sun exposure) with specific dermatological conditions.
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