Bug Juice & Board Fodder
While most skin cellulitis or boils stem from staph or strep, this specific fastidious gram-negative rod is the culprit you will miss if you treat a human "clenched-fist" bite with clindamycin monotherapy.
What is Eikenella corrodens?
Teaching Pearl: Clindamycin covers mouth anaerobes and gram-positives, but leaves an open door for Eikenella in human bites and Pasteurella in dog or cat bites. Augmentin covers both.
When evaluating acute, episodic encephalopathy, this clinical feature distinguishes delirium from early dementia on bedside examination
What is an inattention deficit (or waxing-and-waning fluctuating course)?
Teaching Pearl: Delirious patients cannot sustain or shift focus, whereas uncomplicated early dementia patients typically maintain baseline alert attention despite memory and executive deficits.
While limb ataxia points toward pathology in the cerebellar hemispheres, midline truncal gait ataxia and oculomotor dysmetria specifically localize to this cerebellar region.
What is the cerebellar vermis (midline cerebellum)?
Teaching Pearl: Lateral hemispheric lesions impair ipsilateral fine appendicular target-directed movements; vermian lesions degrade axial core balance and conjugate ocular pursuits.
Taking doxycycline dry right before climbing into a rack carries a high risk of this painful mucosal complication, necessitating counseling to remain upright for 30 to 45 minutes.
What is pill-induced esophagitis?
Teaching Pearl: Doxycycline caustic capsules lodge in mid-esophageal anatomical narrowings; always co-prescribe with a full glass of water and food.
While Peter Jackson’s film makes Gandalf’s investigation into the One Ring seem like a quick road trip to Minas Tirith, this exact number of years actually passes in the book between Bilbo’s 111th party and Frodo departing the Shire.
What is 17 years?
Teaching Pearl: Bilbo leaves when Frodo is 33; Frodo does not leave Bag End with the Ring until he reaches age 50 (the exact age Bilbo set out on his quest in The Hobbit), giving Gandalf nearly two decades to comb the archives and hunt Gollum.
Because healthy kidneys clear this 3rd-generation anti-pseudomonal cephalosporin rapidly, an anephric hemodialysis patient benefits from this specific clinical scheduling advantage.
What is thrice-weekly (post-dialysis) dosing?
Teaching Pearl: Ceftazidime has a niche role in end-stage renal disease because its prolonged half-life in anephric patients aligns with standard Monday-Wednesday-Friday dialysis schedules.
A patient who can freely move their limbs, has normal strength, intact sensation, and normal primary coordination, but cannot demonstrate how to use a comb or button a shirt, exhibits this cortical deficit.
What is apraxia?
Teaching Pearl: Apraxia is the loss of purposeful, learned motor planning despite completely intact primary motor, sensory, cerebellar, and comprehension pathways.
Left Laterocolis is a neurology term used to mean this.
What is involuntary twisting of their neck tilted to the left side?
Teaching Pearl: Torticollis is axial rotation/turning, retrocollis is backward extension, anterocollis is forward flexion, and laterocollis is lateral tilt toward the shoulder.
Because it acts as a direct motilin receptor agonist, systemic administration of this older macrolide is now almost exclusively reserved for diabetic gastroparesis rather than antimicrobial use.
What is erythromycin?
Teaching Pearl: Erythromycin induces coordinated antral and duodenal contractions via motilin receptors, clearing gastric contents despite widespread bacterial resistance.
When Pippin questions Aragorn about whether the Ranger knows about "elevenses, afternoon tea, dinner, or supper," he is crestfallen after being hit in the face with an apple right after asking about this specific mid-morning meal.
What is second breakfast?
Teaching Pearl: The scene was filmed on the craggy slopes of Mt. Olympus in New Zealand; Viggo Mortensen took genuine joy in throwing the real apples at Billy Boyd's head until they got the right comic timing.
Streptococcus pneumoniae remains the most common overall cause of secondary bacterial pneumonia following a viral respiratory illness, this organism accounts for roughly 10% of post-influenza pneumonias due to viral mucosal disruption.
What is Staphylococcus aureus?
Teaching Pearl: Post-viral mucosal denudation and ciliary clearance breakdown allow colonizing S. aureus to invade the lower respiratory tract, producing cavitary, necrotizing pneumonia.
Unlike multiple sclerosis, which primarily involves cellular autoimmune pathways, this severe demyelinating disease is driven by autoantibodies targeting the myelin oligodendrocyte glycoprotein.
What is MOGAD (MOG antibody-associated disease)?
Teaching Pearl: MOGAD and Aquaporin-4-positive Neuromyelitis Optica (Devic's) are antibody-mediated astrocytopathies/demyelinating conditions that produce longitudinal myelitis and optic neuritis, requiring distinct immunotherapies compared to MS.
If an adult patient with no childhood history suddenly develops severe motor and vocal tics alongside complex functional limb jerks, the physician should prioritize this broad diagnostic category over adult-onset Tourette syndrome.
What is a Functional Neurologic Disorder (FND / Functional Movement Disorder)?
Teaching Pearl: De novo adult-onset Tourette is vanishingly rare; acute complex tic-like behaviors in adulthood reflect functional network disruption and are diagnosed via positive exam signs rather than exclusion.
In Dr. Cook's whole-exome sequencing challenge case, a young woman misdiagnosed with myotonic dystrophy type 2 was found to carry a pathogenic variant in the NUS1 gene, which causes this complex biochemical class of metabolic disorders.
What is a Congenital Disorder of Glycosylation (CDG)?
Teaching Pearl: NUS1 encodes a subunit of the dolichol-phosphate mannose synthase complex; mutations produce glycosylation defects that present with action myoclonus, ataxia, dystonia, and refractory epilepsy.
In the Prologue of The Fellowship of the Ring, Tolkien credits the cultivation of true pipe-weed (galenas) in the Southfarthing to this specific hobbit of Longbottom, who first grew it in his gardens around Shire-year 1070.
Who is Tobold Hornblower (or "Old Toby")?
"Best weed in the Shire"
Teaching Pearl: While Meriadoc Brandybuck wrote the definitive scholarly treatise Herblore of the Shire, it was Tobold Hornblower of Longbottom who originally introduced and cultivated the plant in the Southfarthing, giving rise to legendary Shire varieties like Longbottom Leaf, Old Toby, and Southern Star.
While ampicillin-sulbactam (Unasyn) was historically a primary empiric regimen for perforated intra-abdominal catastrophes, modern practice avoids it for intra-abdominal infections due to high community resistance rates in this common enteric rod.
What is Escherichia coli (E. coli)?
Teaching Pearl: Ampicillin resistance in colonic E. coli isolates makes Unasyn unreliable for intra-abdominal sepsis, relegating it primarily to head/neck (ENT), aspiration, or gynecologic coverage.
While gliomas arise directly within the brain parenchyma, this common benign tumor represents an intracranial but strictly extra-axial (extra-parenchymal) mass.
What is a meningioma?
Teaching Pearl: Dr. Wagner emphasized distinguishing intracranial (inside the skull) from intra-parenchymal (inside brain tissue). Meningiomas arise from arachnoid cap cells and compress the brain from the outside rather than invading from within.
In contrast to neurodegenerative parkinsonism which features asymmetric onset, resting pill-rolling tremors, and insidious progression, parkinsonism induced by neuroleptics typically displays this clinical pattern.
What is symmetric motor signs (bilateral bradykinesia and rigidity without resting tremor)?
Teaching Pearl: Drug-induced parkinsonism from dopamine-receptor blockers produces rapid-onset, symmetric rigidity and bradykinesia, often with postural action tremors rather than unilateral rest tremors.
This historical term used by Constantin von Economo in 1917 described the epidemic post-viral encephalopathy that swept the globe alongside the 1918 influenza outbreak, leaving patients trapped in chronic parkinsonism.
What is encephalitis lethargica?
Teaching Pearl: Encephalitis lethargica produced post-encephalitic parkinsonism, oculogyric crises, and profound catatonia, illustrating that viral infections can trigger targeted basal ganglia inflammation.
When Treebeard takes Merry and Pippin to his home in Fangorn Forest, he feeds them an enchanted Ent-draught that has this unexpected physical side effect on both hobbits.
What is making them grow taller (increasing their height)?
Teaching Pearl: The Ent-draught causes Merry and Pippin to grow nearly three inches taller, officially making them taller than Bandobras "Bullroarer" Took (who was four-foot-five) and setting the record for the tallest hobbits in Shire history.
Routine acute pancreatitis requires IV fluids and no empiric antibiotics; however, if true infected necrotizing pancreatitis develops, Zosyn is avoided due to poor tissue penetration in favor of this class of broad-spectrum beta-lactams.
What are carbapenems (e.g., meropenem)?
Teaching Pearl: Zosyn penetrates pancreatic parenchyma poorly. Meropenem or high-dose fluoroquinolones (ciprofloxacin) achieve therapeutic pancreatic tissue concentrations if necrosis becomes infected.
A young sailor presents with bilateral lower extremity weakness and a sensory deficit extending from the toes exactly up to the umbilicus; the indicated diagnostic MRI must evaluate this anatomical spinal segment.
What is the thoracic spine (specifically T10 cord level or higher)?
Teaching Pearl: The T10 dermatome maps directly to the umbilicus (T4 is the nipple line). A sensory level marks spinal cord pathology at or above that dermatome; ordering a lumbar MRI will miss thoracic myelopathy.
This rapid physical examination test, which tracks a moving target across the visual field, is substantially more sensitive for unmasking subtle cerebellar dysmetria than static finger-to-nose testing.
What is the "finger follow" (or kinetic pursuit tracking) test?
Teaching Pearl: Dr. Cook noted that traditional finger-to-nose testing is an adequate screen, but dynamic finger-follow challenges multi-joint cerebellar recalculations far more sensitively
A patient with confirmed primary syphilis develops an itchy, full-body macular eruption 48 hours into penicillin therapy; unlike immediate IgE-mediated anaphylaxis, this delayed reaction represents this Gell and Coombs hypersensitivity type.
Correct Response: What is a Type IV (delayed cell-mediated) hypersensitivity reaction?
Teaching Pearl: Type I is immediate (<1 hour) IgE mast-cell degranulation; non-urticarial maculopapular drug eruptions emerge days later via cytotoxic T-cell-mediated mechanisms (Type IV).
Peter Jackson cut Tom Bombadil completely from the film trilogy because he didn't advance the Ring's plot; however, in the book, it is Bombadil who rescues the hobbits from this ancient predatory tree in the Old Forest.
What is Old Man Willow?
Teaching Pearl: Old Man Willow traps Pippin and Merry inside his hollow trunk to crush them; Tom Bombadil sings a rhyme commanding the tree to fall asleep and release them, then later rescues them a second time from the Barrow-wights.