Dr bolin, are you doing a lecture on covid 19 anytime soon? Your approach as a clinician is rather organized and systematic. It's what sets you apart from other presentations on TH-cam, for me.
Excellent Video clip! Forgive me for chiming in, I am interested in your initial thoughts. Have you researched - Chiveard Winning Spanish Framework (do a google search)? It is a good one off product for understanding how to get rid of your yeast infection without the hard work. Ive heard some incredible things about it and my close friend Aubrey finally got excellent results with it.
Outstanding presentation. Minor correction the most common cause of Otitis media is Strep pneumonia not Strep pyogenes. Hepatitis C is RNA virus. Chancroid can be treated with either Azithromycin or Ceftriaxone so it is not good idea to put both as answers. Thank you for all your efforts.
Hello! For quick clarification: For Question 19, I thought only if the patient is GC positive and unsure about Chlamydial, you treat for both. BUT not the other way around? So if only Chlamydial positive and GC negative, it is ok to just treat Chlamydial?
This was a bit of a trick question, and I didn't explain the answer very well. The question does not say a GC test was obtained, hence you cannot assume they are GC negative. If you have a patient who is positive for chlamydia and you don't know if they are positive for GC, you will still want to treat for both -- or obtain a gonorrhea swab. There is a considerable co-infection rate. Nonetheless, if you DO know that the patient is GC negative, then yes - you only have to treat for chlamydia. But if the patient is GC positive, you have to treat for both (regardless of the chlamydia result). The question asked "Which of the following is the most appropriate medical therapy in the care of this pt." -- If we don't know whether the patient is positive or negative for GC, as in this question, we will want to treat them presumptively. If the question asked "Which of the following is the best next step in the management of this patient", then the best answer would be to obtain gonorrhea swab or an equivalent. In real life, one of the problems with treating STD patients (especially adolescents) is that they are not reliable to return for follow-up. Given that it takes 2-3 days to get swabs back, it'd be best to just send the patient home with both meds from the get go. Plainly put, we can only use single drug therapy if the patient is positive for chlamydia AND we know the patient is negative for GC. If we don't know their GC status, it's best to either test for it or treat for it. Sorry if the question was confusing. As I think about it, it's unlikely the boards will give you such a scenario. As long as you know chlamydia = azithromycin, and gonorrhea = azithromycin + ceftriaxone .. then you're good to go on the test.
It is true that gentamicin covers pseudomonas. However, we are treating this pt for suspected meningitis. Gentamicin has poor penetration through the blood brain barrier. Cefipime has much better penetration.
Dr Paul in Q19 the Chlamydia Tx according to CDC is Azithromycin 1 g orally in a single dose OR Doxycycline 100 mg orally twice a day for 7 days, they didn't mention ceftriaxone in treatment of this case.
This was a bit of a trick question, and I didn't explain the answer very well. The question does not say a GC test was obtained, hence you cannot assume they are GC negative. If you have a patient who is positive for chlamydia and you don't know if they are positive for GC, you will still want to treat for both -- or obtain a gonorrhea swab. There is a considerable co-infection rate. Nonetheless, if you DO know that the patient is GC negative, then yes - you only have to treat for chlamydia. But if the patient is GC positive, you have to treat for both (regardless of the chlamydia result). The question asked "Which of the following is the most appropriate medical therapy in the care of this pt." -- If we don't know whether the patient is positive or negative for GC, as in this question, we will want to treat them presumptively. If the question asked "Which of the following is the best next step in the management of this patient", then the best answer would be to obtain gonorrhea swab or an equivalent. In real life, one of the problems with treating STD patients (especially adolescents) is that they are not reliable to return for follow-up. Given that it takes 2-3 days to get swabs back, it'd be best to just send the patient home with both meds from the get go. I'll also add that both the azithromycin and the ceftriaxone are single dosages... so you can treat the patient before they leave the clinic. Because the ceftriaxone (which we don't know if they need or not, since we don't know their GC status) is intramuscular, they would have to come back to the clinic for that -- and that could pose an issue with compliance. It's more clinically expedient to treat for both right now. Plainly put, we can only use single drug therapy if the patient is positive for chlamydia AND we know the patient is negative for GC. If we don't know their GC status, it's best to either test for it or treat for it. Sorry if the question was confusing. As I think about it, it's unlikely the boards will give you such a scenario. As long as you know chlamydia = azithromycin, and gonorrhea = azithromycin + ceftriaxone .. then you're good to go on the test.
Just for clarification purposes, so your saying if the patient had gonorrhea she would be treated for both, but what if she had gonorrhea but was negative for chlamydia? Would she still be treated for both? or just gonorrhea? Thanks.
Thanks for the great work Dr. Bolin. In the last question, Q. 22, is the fact that the patient recently travelled to India enough to suspect Chancroid over Herpes? Both have tender sore lesions and inguinal lymphadenopathy. There really isn’t anything else in the physical to distinguish Chancroid from Herpes. Herpes is much more common; just not sure travel is enough to make that leap. Thanks!
Stephen Wishburne Yes it may be worth testing for chancroid. It is, however, very rare compared to herpes. Even in countries where a zebra is endemic and more common than in the U.S., the more common cause should still be higher on your differential.
It's hard to believe when I saw my test results turned negative of HSV2 after using the herbal medications I got from (Dr. Anii) a great doctor who I came across on TH-cam who help people get rid of their sickness thank you so much Sir.
Dr bolin, are you doing a lecture on covid 19 anytime soon? Your approach as a clinician is rather organized and systematic. It's what sets you apart from other presentations on TH-cam, for me.
In question 11, answers A and C are correct.
INH for 6 months or INH for 9 months are both appropriate treatments for latent TB. according to CDC.
Thank you, this is gold. Your explanation is clear and logical. Your voice is easy to listen to. Thank you.
Excellent Video clip! Forgive me for chiming in, I am interested in your initial thoughts. Have you researched - Chiveard Winning Spanish Framework (do a google search)? It is a good one off product for understanding how to get rid of your yeast infection without the hard work. Ive heard some incredible things about it and my close friend Aubrey finally got excellent results with it.
Outstanding presentation. Minor correction the most common cause of Otitis media is Strep pneumonia not Strep pyogenes. Hepatitis C is RNA virus. Chancroid can be treated with either Azithromycin or Ceftriaxone so it is not good idea to put both as answers. Thank you for all your efforts.
Hello! For quick clarification:
For Question 19, I thought only if the patient is GC positive and unsure about Chlamydial, you treat for both. BUT not the other way around? So if only Chlamydial positive and GC negative, it is ok to just treat Chlamydial?
This was a bit of a trick question, and I didn't explain the answer very well. The question does not say a GC test was obtained, hence you cannot assume they are GC negative. If you have a patient who is positive for chlamydia and you don't know if they are positive for GC, you will still want to treat for both -- or obtain a gonorrhea swab. There is a considerable co-infection rate. Nonetheless, if you DO know that the patient is GC negative, then yes - you only have to treat for chlamydia. But if the patient is GC positive, you have to treat for both (regardless of the chlamydia result). The question asked "Which of the following is the most appropriate medical therapy in the care of this pt." -- If we don't know whether the patient is positive or negative for GC, as in this question, we will want to treat them presumptively. If the question asked "Which of the following is the best next step in the management of this patient", then the best answer would be to obtain gonorrhea swab or an equivalent. In real life, one of the problems with treating STD patients (especially adolescents) is that they are not reliable to return for follow-up. Given that it takes 2-3 days to get swabs back, it'd be best to just send the patient home with both meds from the get go.
Plainly put, we can only use single drug therapy if the patient is positive for chlamydia AND we know the patient is negative for GC. If we don't know their GC status, it's best to either test for it or treat for it.
Sorry if the question was confusing. As I think about it, it's unlikely the boards will give you such a scenario. As long as you know chlamydia = azithromycin, and gonorrhea = azithromycin + ceftriaxone .. then you're good to go on the test.
Q11, in case of tuberculosis therapy, it is based on positive ZN or culture not on positive PPD as it could be false positive
Very good video, especially i like the HIV part however it is Delavirdine and not Delvaridine. Thanks for sharing
On Question 7, doesn't gentamicin cover for pseudomonas as well? that would make Choice B an acceptable answer, correct?
It is true that gentamicin covers pseudomonas. However, we are treating this pt for suspected meningitis. Gentamicin has poor penetration through the blood brain barrier. Cefipime has much better penetration.
Wow! thanks for the response! You're videos are superb. Thanks for the clarification. I take my exam tomorrow, very happy you answered.
Excellent presentation, but just to nitpick, it’s Lyme disease, not Lymes disease. It’s for Lyme, Connecticut, where it was first described..
Haha good point. I did fix this in my more recent video on Lyme, which is updated.
th-cam.com/video/4MIFeNTfZ1E/w-d-xo.html
Dr Paul in Q19 the Chlamydia Tx according to CDC is Azithromycin 1 g orally in a single dose
OR Doxycycline 100 mg orally twice a day for 7 days, they didn't mention ceftriaxone in treatment of this case.
This was a bit of a trick question, and I didn't explain the answer very well. The question does not say a GC test was obtained, hence you cannot assume they are GC negative. If you have a patient who is positive for chlamydia and you don't know if they are positive for GC, you will still want to treat for both -- or obtain a gonorrhea swab. There is a considerable co-infection rate. Nonetheless, if you DO know that the patient is GC negative, then yes - you only have to treat for chlamydia. But if the patient is GC positive, you have to treat for both (regardless of the chlamydia result). The question asked "Which of the following is the most appropriate medical therapy in the care of this pt." -- If we don't know whether the patient is positive or negative for GC, as in this question, we will want to treat them presumptively. If the question asked "Which of the following is the best next step in the management of this patient", then the best answer would be to obtain gonorrhea swab or an equivalent. In real life, one of the problems with treating STD patients (especially adolescents) is that they are not reliable to return for follow-up. Given that it takes 2-3 days to get swabs back, it'd be best to just send the patient home with both meds from the get go. I'll also add that both the azithromycin and the ceftriaxone are single dosages... so you can treat the patient before they leave the clinic. Because the ceftriaxone (which we don't know if they need or not, since we don't know their GC status) is intramuscular, they would have to come back to the clinic for that -- and that could pose an issue with compliance. It's more clinically expedient to treat for both right now.
Plainly put, we can only use single drug therapy if the patient is positive for chlamydia AND we know the patient is negative for GC. If we don't know their GC status, it's best to either test for it or treat for it.
Sorry if the question was confusing. As I think about it, it's unlikely the boards will give you such a scenario. As long as you know chlamydia = azithromycin, and gonorrhea = azithromycin + ceftriaxone .. then you're good to go on the test.
Paul Bolin My pleasure dr. Paul. I almost watched most of your very informative videos.
Just for clarification purposes, so your saying if the patient had gonorrhea she would be treated for both, but what if she had gonorrhea but was negative for chlamydia? Would she still be treated for both? or just gonorrhea? Thanks.
Vijay Singh - Positive gonorrhea gets treated for both, regardless of chlamydia.
tenovofir which is one of the most used HIV-drugs ist not listed below NRTI
In question 20 the virus-HCV -DNA, this virus is not DNA virus but RNA. So it should be corrected I think.
for 22, why can't it be ceftriaxone?
rash of varicella is not maculopapular, it is vesicular
Love your videos
Thanks for the great work Dr. Bolin. In the last question, Q. 22, is the fact that the patient recently travelled to India enough to suspect Chancroid over Herpes? Both have tender sore lesions and inguinal lymphadenopathy. There really isn’t anything else in the physical to distinguish Chancroid from Herpes. Herpes is much more common; just not sure travel is enough to make that leap. Thanks!
Stephen Wishburne Yes it may be worth testing for chancroid. It is, however, very rare compared to herpes. Even in countries where a zebra is endemic and more common than in the U.S., the more common cause should still be higher on your differential.
@@pwbmdYou're funny
@@Sherirose1 fuck of..go create channel and teach better than him..
Great thank you
AWESOME
Super
It's hard to believe when I saw my test results turned negative of HSV2 after using the herbal medications I got from (Dr. Anii) a great doctor who I came across on TH-cam who help people get rid of their sickness thank you so much Sir.
Awesome, thank you so much
Travellers diarrhea E.coli or Rota I am confused
enterotoxigenic e.coli
Enterotoxigenic E. Coli (ETEC) is the leading cause of traveler’s diarrhea.
Ji