1 00:00:06,191 --> 00:00:07,121 Hi everyone. 2 00:00:07,181 --> 00:00:11,321 Welcome to Febrile, a cultured podcast about all things infectious disease. 3 00:00:11,681 --> 00:00:15,761 We use consult questions to dive into ID clinical reasoning, diagnostics 4 00:00:15,761 --> 00:00:17,231 and antimicrobial management. 5 00:00:17,681 --> 00:00:23,781 I'm Sara, your host, and today we are joined by many guests, primarily from 6 00:00:23,781 --> 00:00:30,681 our champions of the pediatric ID Fellows Cup, um, the team District of Contagion! 7 00:00:31,251 --> 00:00:35,296 um, so I am gonna have everyone quickly say hello and introduce 8 00:00:35,296 --> 00:00:37,466 themselves and, then we'll get started. 9 00:00:37,741 --> 00:00:38,791 Hi everyone. 10 00:00:38,821 --> 00:00:39,871 I'm going first. 11 00:00:39,871 --> 00:00:43,921 I'm Marisu Rueda Altez and I'm actually not a, a current member of the team, but 12 00:00:43,921 --> 00:00:46,021 former fellow at Children's National. 13 00:00:46,331 --> 00:00:48,946 I'm currently a Peds [pediatric] ID attending at the University 14 00:00:49,151 --> 00:00:52,871 of Alabama at Birmingham, and I was part of the organizing team 15 00:00:52,871 --> 00:00:54,586 for the first Peds ID Fellow Cup. 16 00:00:55,046 --> 00:00:56,406 Hi everyone, my name is Roya. 17 00:00:56,406 --> 00:00:59,556 I'm one of the third year ID fellows here at Children's National. 18 00:00:59,986 --> 00:01:00,811 Thanks so much for having us. 19 00:01:01,024 --> 00:01:04,084 Hi, my name is Sarah Benke and I'm also one of the third year 20 00:01:04,084 --> 00:01:05,284 ID fellows here at Children's. 21 00:01:05,555 --> 00:01:06,275 Hi everyone. 22 00:01:06,275 --> 00:01:07,755 I'm Lillian Flannigan. 23 00:01:07,775 --> 00:01:11,120 I'm one of the second year fellows here at Children's National, so happy to be here. 24 00:01:11,578 --> 00:01:13,388 Hi, I'm Einar Helgason. 25 00:01:13,408 --> 00:01:16,978 I'm also one of the second year fellows at Children's National. 26 00:01:17,728 --> 00:01:18,568 Very nice to be here. 27 00:01:20,203 --> 00:01:20,863 Hi everyone. 28 00:01:21,133 --> 00:01:25,843 I'm Berkay Balkanci and I'm a second year fellow also at Children's National. 29 00:01:25,953 --> 00:01:26,373 Hi guys. 30 00:01:26,373 --> 00:01:26,973 I'm Hannah. 31 00:01:26,973 --> 00:01:29,223 I'm one of the first year fellows at Children's. 32 00:01:29,343 --> 00:01:30,058 Uh, thanks for having us. 33 00:01:31,548 --> 00:01:35,028 Hello, my name is Katarina Manzi, I'm one of the first year fellows 34 00:01:35,028 --> 00:01:36,408 at Children's National as well. 35 00:01:37,378 --> 00:01:38,828 And I am Alexandra Yonts. 36 00:01:38,848 --> 00:01:42,178 I'm one of the attendings in the peds ID group at Children's 37 00:01:42,178 --> 00:01:44,668 National, um, and a former fellow. 38 00:01:44,668 --> 00:01:48,904 So happy to be here with everybody, including our former fellow Marisu. 39 00:01:49,366 --> 00:01:53,386 Hey everyone, I'm happy to round out this group of the District of Contagion. 40 00:01:53,386 --> 00:01:54,296 I'm Nada Harik. 41 00:01:54,316 --> 00:01:58,306 I am an attending in infectious diseases here at Children's and the program 42 00:01:58,306 --> 00:02:00,296 director for our amazing fellows. 43 00:02:02,276 --> 00:02:02,696 I love it. 44 00:02:02,696 --> 00:02:03,686 I'm smiling so big. 45 00:02:03,686 --> 00:02:08,636 I think this may be a record for a number of fellows that are concurrently 46 00:02:08,636 --> 00:02:10,706 on an episode, which is super exciting. 47 00:02:11,516 --> 00:02:11,936 Um. 48 00:02:13,066 --> 00:02:15,166 So we've made it through another year. 49 00:02:15,416 --> 00:02:19,706 We always take the last episode to celebrate our anniversary. 50 00:02:19,886 --> 00:02:23,396 So this is the fifth anniversary of Febrile as we wrap up 2025. 51 00:02:23,936 --> 00:02:25,736 Uh, yay. 52 00:02:27,216 --> 00:02:32,646 Um, I really just always wanna make sure I share gratitude and appreciation. 53 00:02:32,646 --> 00:02:35,938 There's a lot of people who volunteer their time to be on the show. 54 00:02:35,983 --> 00:02:39,493 and then of course, those who listen and support and share 55 00:02:39,493 --> 00:02:40,753 the resource with others. 56 00:02:40,753 --> 00:02:44,777 And, as an junior faculty member myself, I do sometimes struggle 57 00:02:44,777 --> 00:02:46,487 to get the episodes out to you. 58 00:02:46,547 --> 00:02:48,017 Um, but I am doing my best. 59 00:02:48,017 --> 00:02:51,397 We wanna make sure it's still thoughtful and engaging, and 60 00:02:51,397 --> 00:02:55,417 really just a good resource for everything that's awesome about ID. 61 00:02:55,867 --> 00:03:02,127 Um, and so today we will include our usual update on the US ID Fellowship match, um, 62 00:03:02,127 --> 00:03:04,027 which we've done in prior season wrap ups. 63 00:03:04,047 --> 00:03:08,007 And then we're gonna chat with our guests, go through some of those most missed 64 00:03:08,007 --> 00:03:13,807 questions from our recent inaugural, first round of the Pediatric ID Fellows Cup. 65 00:03:14,197 --> 00:03:19,207 But first, of course, as everyone's favorite cultured podcast, I have to 66 00:03:19,207 --> 00:03:21,277 hear everyone's little piece of culture. 67 00:03:21,487 --> 00:03:25,207 Your kind of year-end picks, things that you have enjoyed. 68 00:03:25,287 --> 00:03:26,607 Who wants to get us started? 69 00:03:27,537 --> 00:03:31,017 Alright, I, I'll go first and I already warned the group that is gonna, I'm 70 00:03:31,017 --> 00:03:36,717 gonna be very uncultured, it's only thing that I can think of about myself 71 00:03:36,837 --> 00:03:38,157 maybe is a little bit interesting. 72 00:03:39,027 --> 00:03:43,877 So English is not my first language, but my biggest sort of school 73 00:03:43,877 --> 00:03:47,627 of learning how to speak English conversationally was watching sitcoms. 74 00:03:47,627 --> 00:03:52,667 I'm a huge Friends and The Office fan and the one thing I can think of 75 00:03:52,667 --> 00:03:56,247 is this, because just last week, my husband and I won like a big Friends 76 00:03:56,267 --> 00:04:02,177 trivia competition here in Birmingham and won like $100 a bunch of friends. 77 00:04:02,387 --> 00:04:02,607 Wow, 78 00:04:05,227 --> 00:04:07,147 And it was really obscure guys. 79 00:04:07,147 --> 00:04:08,437 Really, really obscure. 80 00:04:08,437 --> 00:04:10,962 So we're pretty proud of ourselves. 81 00:04:12,532 --> 00:04:13,672 Congratulations. 82 00:04:14,898 --> 00:04:17,772 I was gonna say, Marisu,, if you didn't say Office or Friends, 83 00:04:17,772 --> 00:04:19,002 I was gonna be disappointed. 84 00:04:20,272 --> 00:04:21,092 You know me, Alex. 85 00:04:21,593 --> 00:04:25,258 Um, my little piece of culture, I've been here for two and a half years now 86 00:04:25,258 --> 00:04:29,278 for ID fellowship, but about a year ago I moved into actual DC proper. 87 00:04:29,638 --> 00:04:31,738 And I love my neighborhood because there's always new, like 88 00:04:31,858 --> 00:04:34,588 restaurants, new coffee shops, and like lots of fun things opening. 89 00:04:34,918 --> 00:04:37,738 But the one thing that opened up recently that I'm really excited about is a 90 00:04:37,738 --> 00:04:41,018 new macaron place that's like right around the corner from where I live. 91 00:04:41,018 --> 00:04:45,918 And what's even better is they have the like French hot cocoa there, the like 92 00:04:45,918 --> 00:04:50,028 really indulgent, like essentially you're sipping chocolate and it's very good. 93 00:04:50,315 --> 00:04:51,116 I can go next. 94 00:04:51,146 --> 00:04:56,306 Um, so I am not sure when this kind of started, but I, I feel like the holidays, 95 00:04:56,306 --> 00:05:00,236 I've associated it with gnomes, so I've kind of started collecting gnomes. 96 00:05:00,506 --> 00:05:05,536 They come out like only during Christmas once the tree's up and I just was gifted 97 00:05:05,866 --> 00:05:07,966 a felt needling kit to make a gnome. 98 00:05:07,966 --> 00:05:12,136 And so I have made, um, it, and it is a lot larger than I was thinking. 99 00:05:12,166 --> 00:05:12,406 Um, 100 00:05:14,446 --> 00:05:15,826 excited for gnome season. 101 00:05:16,168 --> 00:05:18,738 That the only way I'm gonna call December now, gnome season. 102 00:05:21,467 --> 00:05:24,867 Roya, I'm definitely gonna have to come visit you so we can go get some 103 00:05:24,867 --> 00:05:27,217 macarons and hot chocolate, asap. 104 00:05:27,450 --> 00:05:33,885 I have probably like, every single year, at least once or twice, during 105 00:05:33,885 --> 00:05:38,745 the holidays, watch the Muppet Christmas Carol, like, without fail, my entire life. 106 00:05:39,285 --> 00:05:42,135 Like I watched it right after Thanksgiving and I feel like it's 107 00:05:42,135 --> 00:05:44,655 time that maybe I watch it again. 108 00:05:44,685 --> 00:05:49,005 Um, I feel like we need to, we need some of that, uh, love 109 00:05:49,005 --> 00:05:50,355 be in our lives right now. 110 00:05:50,355 --> 00:05:53,370 So, uh, that's, that's my Christmas culture to contribute. 111 00:05:54,765 --> 00:05:55,100 Love it. 112 00:05:56,755 --> 00:06:01,490 If, if I'm supposed to name any piece of culture that I'm kind of obsessed with 113 00:06:01,490 --> 00:06:06,190 right now, it would be a little piece of Icelandic culture that my parents-in-law 114 00:06:06,280 --> 00:06:10,900 brought with them last time they were here, which is those little candies that 115 00:06:10,900 --> 00:06:13,720 are like chocolate covered black licorice. 116 00:06:13,720 --> 00:06:15,850 I'm not sure if, if just everyone would like 117 00:06:17,555 --> 00:06:18,275 Controversial! 118 00:06:19,200 --> 00:06:21,665 That's like a evil hidden surprise, you know? 119 00:06:21,665 --> 00:06:21,695 I 120 00:06:23,680 --> 00:06:24,940 My son hates it. 121 00:06:27,313 --> 00:06:30,861 Yeah, this is Berkay, and I was just thinking through the films when I 122 00:06:30,861 --> 00:06:34,991 saw that we are gonna come, um, we are thinking through like what we 123 00:06:35,411 --> 00:06:37,841 really liked this year and I was just thinking through the movies that 124 00:06:37,841 --> 00:06:39,281 I really, really liked this year. 125 00:06:39,671 --> 00:06:43,901 And I recently saw a movie called Perfect Days and I mean, it blew my mind. 126 00:06:43,931 --> 00:06:47,711 Uh, it's, it's about like just the joy of living and like finding joy 127 00:06:47,711 --> 00:06:51,761 in small things and I think it was very timely and I enjoyed it a lot. 128 00:06:52,031 --> 00:06:53,531 Highly recommend two thumbs up. 129 00:06:53,691 --> 00:06:54,251 It's a great movie. 130 00:06:54,551 --> 00:06:54,701 Yeah. 131 00:06:54,723 --> 00:06:57,903 I think for me, so I'm not usually super into music, but I 132 00:06:57,903 --> 00:06:59,553 was just gifted a record player. 133 00:06:59,833 --> 00:07:03,423 So I've really enjoyed listening to a couple records, uh, lately. 134 00:07:03,423 --> 00:07:07,673 Um, I like to thrift and so I found a Fleetwood Mac old record, 135 00:07:07,733 --> 00:07:09,233 um, and some Stevie Nicks as well. 136 00:07:09,233 --> 00:07:11,333 So I've really enjoyed listening. 137 00:07:11,613 --> 00:07:14,934 On my commute in, I like to listen to audio books or 138 00:07:15,121 --> 00:07:18,774 podcasts, and I really enjoy The Moth podcast. 139 00:07:18,774 --> 00:07:22,434 I never can anticipate whether I'll be sobbing by the end of 140 00:07:22,434 --> 00:07:26,154 the episode or laughing out loud, uh, but it's always good. 141 00:07:26,379 --> 00:07:28,329 That sounds like a risky bet, Katerina. 142 00:07:28,329 --> 00:07:28,599 I dunno. 143 00:07:31,429 --> 00:07:32,859 I get to do it in the privacy of my own vehicle 144 00:07:34,119 --> 00:07:35,019 Absolutely. 145 00:07:36,109 --> 00:07:36,799 Second favorite podcast after Febrile. 146 00:07:36,849 --> 00:07:37,059 Yeah. 147 00:07:37,119 --> 00:07:37,659 Yeah, exactly. 148 00:07:39,224 --> 00:07:40,454 So I'm, I'm Alex. 149 00:07:40,454 --> 00:07:44,774 And, as everyone in this group knows, I'm a huge nerd beyond ID and I 150 00:07:44,774 --> 00:07:48,914 also ring in a hand bell choir, um, actually a community organization. 151 00:07:48,914 --> 00:07:51,104 And this is definitely our, our busiest season. 152 00:07:51,104 --> 00:07:54,794 So all of my weekends in December are nonstop concerts, private 153 00:07:54,794 --> 00:07:56,234 events, those sorts of things. 154 00:07:56,294 --> 00:08:00,044 Um, so, uh, if you haven't ever checked out the, the hand bells, 155 00:08:00,074 --> 00:08:01,754 this is a season to give it a try. 156 00:08:02,003 --> 00:08:02,573 Um, all right. 157 00:08:02,573 --> 00:08:03,623 And I'll go last. 158 00:08:03,623 --> 00:08:04,973 Um, wow. 159 00:08:04,978 --> 00:08:08,393 I, I feel like I've got a lot of things to choose from, but I have to go with 160 00:08:08,393 --> 00:08:12,353 the one that's most timely right now, I think for me and all of my family, which 161 00:08:12,353 --> 00:08:14,933 is, um, we are huge Stranger Things fans, 162 00:08:15,653 --> 00:08:15,783 Hmm. 163 00:08:16,213 --> 00:08:16,703 Yes! 164 00:08:16,953 --> 00:08:17,883 Oh my God. 165 00:08:18,353 --> 00:08:20,543 We did a lot of streaming over Thanksgiving. 166 00:08:20,543 --> 00:08:25,013 No one can wait for the next episodes, especially for folks like me who grew 167 00:08:25,013 --> 00:08:29,773 up in the time that the show is based, it's just so much fun to watch it. 168 00:08:29,773 --> 00:08:31,603 I just, um, love everything about it. 169 00:08:31,603 --> 00:08:33,223 I know everyone's got their theories. 170 00:08:33,223 --> 00:08:36,853 We won't delve into theories, but I feel like our conversations lately 171 00:08:36,903 --> 00:08:40,063 have been all about what's gonna happen in the next upcoming episodes. 172 00:08:40,083 --> 00:08:40,533 So, yay. 173 00:08:40,533 --> 00:08:41,463 Stranger things. 174 00:08:41,908 --> 00:08:42,328 I love it. 175 00:08:42,538 --> 00:08:44,788 Yeah, I was just rewatching some of the early ones and 176 00:08:44,788 --> 00:08:47,668 they're so cute and talented. 177 00:08:49,518 --> 00:08:51,478 They're so great. 178 00:08:51,478 --> 00:08:56,698 oh, well thanks guys for sharing all those awesome things. 179 00:08:56,758 --> 00:09:02,398 Um, so, like I mentioned, we like to just quickly give an update on Match and 180 00:09:02,818 --> 00:09:08,428 I will say congratulations and welcome to all of the new incoming ID fellows. 181 00:09:08,554 --> 00:09:13,744 We now have at least 272 new adult ID fellows and 44 182 00:09:13,744 --> 00:09:15,944 incoming pediatric ID fellows. 183 00:09:16,514 --> 00:09:24,294 Um, so clapping and excitement and, you know, um, you know, this year's 184 00:09:24,294 --> 00:09:25,674 numbers are a little bit down. 185 00:09:25,674 --> 00:09:29,184 So here are the updates as far as the results for this current 186 00:09:29,234 --> 00:09:30,344 most recent appointment year. 187 00:09:30,344 --> 00:09:34,014 So I'll start with the ID stats for the adult folks. 188 00:09:34,014 --> 00:09:38,921 So there were 184 programs, 83 filled, which is about 45%. 189 00:09:39,231 --> 00:09:42,321 Last year that number was about 50 ish percent. 190 00:09:42,651 --> 00:09:49,981 And then we had for certified positions, there were 447 total, 272 positions 191 00:09:49,981 --> 00:09:56,741 filled, which is 60.9%, which compares to what was about 70% last year. 192 00:09:57,131 --> 00:10:01,931 Um, and so that leaves us with a good number of positions that are available. 193 00:10:01,931 --> 00:10:05,141 And, Nada, and maybe I'll hand it over to you just to give an 194 00:10:05,141 --> 00:10:06,761 update on the pediatric numbers. 195 00:10:07,451 --> 00:10:07,841 Perfect. 196 00:10:07,871 --> 00:10:12,351 Okay, so I'm gonna give the data for the pediatrics programs, for 20 26 197 00:10:12,351 --> 00:10:14,181 start in, uh, pediatric fellowship. 198 00:10:14,181 --> 00:10:18,151 So there were 60 programs that were certified this year in the match. 199 00:10:18,151 --> 00:10:24,301 And of those 27 programs filled, which is 45%, that is up a little bit from 200 00:10:24,301 --> 00:10:26,971 last year where we had 42.2% filled. 201 00:10:27,991 --> 00:10:31,861 There were 33 programs that were unfilled, which is 55%. 202 00:10:32,461 --> 00:10:39,451 There were 86 certified positions, 44 of those 86 were filled, which is 51.2%, 203 00:10:39,781 --> 00:10:43,051 and 48.8% of the positions were unfilled. 204 00:10:43,386 --> 00:10:46,836 So I just wanna say to listeners that are out there that are thinking about 205 00:10:46,836 --> 00:10:52,476 a career in Peds ID or in Adult ID, um, there are lots of great programs out 206 00:10:52,476 --> 00:10:56,556 there with open positions, including our, um, amazing program here in DC. 207 00:10:56,886 --> 00:11:00,306 So if you guys are interested in joining us or any of the other 208 00:11:00,306 --> 00:11:02,046 programs, please reach out. 209 00:11:03,406 --> 00:11:03,796 Love it. 210 00:11:03,796 --> 00:11:08,566 And I know I'm not quite as active, but for the BlueSky, when folks have been 211 00:11:08,596 --> 00:11:12,076 sharing that they have programs with open spots, we've been trying to repost those. 212 00:11:12,076 --> 00:11:17,306 So, um, if folks have those or know about them, of course, share with everyone 213 00:11:17,336 --> 00:11:21,626 and hopefully we'll have, you know, a few additional ID, uh, fellows that will 214 00:11:21,626 --> 00:11:23,756 be joining us in the, in the summer. 215 00:11:24,336 --> 00:11:26,596 We have one open spot here at UAB too. 216 00:11:26,616 --> 00:11:28,096 Please come join me as well. 217 00:11:28,126 --> 00:11:29,666 We have fun here in the south. 218 00:11:30,241 --> 00:11:31,741 Another fantastic program. 219 00:11:31,981 --> 00:11:32,551 Yeah. 220 00:11:33,041 --> 00:11:37,391 And so, now to focus on, of course, why we have so many amazing guests 221 00:11:37,441 --> 00:11:41,251 with us today is we are gonna talk about the Pediatric ID Fellows Cup. 222 00:11:41,251 --> 00:11:45,361 I was gonna hand it over to Marisu to just kind of maybe tell folks 223 00:11:45,411 --> 00:11:48,231 about our sort of newest iteration. 224 00:11:48,281 --> 00:11:53,466 For folks who have been listening to Febrile in the past, they probably, uh, 225 00:11:53,496 --> 00:11:57,276 have a very overlapping Venn diagram with folks who were active participants 226 00:11:57,276 --> 00:12:03,566 in the ID Fellows Cup, which is the version that was launched by the folks 227 00:12:03,566 --> 00:12:05,546 at University of Alabama, Birmingham. 228 00:12:05,546 --> 00:12:09,566 And we had Jeremey Walker on an episode many years ago. 229 00:12:09,566 --> 00:12:11,966 I'll make sure to, um, link it in the Consult Notes 230 00:12:12,016 --> 00:12:12,646 Yes. 231 00:12:12,706 --> 00:12:17,326 Uh, so if you are not familiar with the ID Fellows Cup, it is a friendly 232 00:12:17,326 --> 00:12:22,576 competition designed to basically review some ID fellow level board content, 233 00:12:22,766 --> 00:12:26,996 while integrating available free online resources that can be helpful for your 234 00:12:26,996 --> 00:12:30,476 sort of day-to-day clinical practice and your board preparation as well. 235 00:12:30,726 --> 00:12:34,501 And of course, just to kind of generate communication between different sites 236 00:12:34,501 --> 00:12:36,691 and just unity amongst our ID community. 237 00:12:37,111 --> 00:12:41,401 Uh, and the awesome thing about it is that also the actual materials and questions 238 00:12:41,581 --> 00:12:45,981 are created by trainees themselves within our ID community and mentored by 239 00:12:45,981 --> 00:12:47,601 different faculty across the country. 240 00:12:47,601 --> 00:12:51,046 So it's another opportunity to generate some additional scholarly activity 241 00:12:51,046 --> 00:12:52,696 from the education side of things. 242 00:12:52,946 --> 00:12:57,171 The vision and everything for this was developed by a group of ID physicians 243 00:12:57,171 --> 00:13:00,231 across the country, but led by the University of Alabama where I am right 244 00:13:00,231 --> 00:13:03,446 now, using the Kaizen education software. 245 00:13:03,716 --> 00:13:08,976 So we leveraged that and got a lot of help from our adult ID friends to 246 00:13:09,006 --> 00:13:13,266 create a pediatric version because before the questions were only adult 247 00:13:13,266 --> 00:13:16,966 based with a few peds ID questions sprinkled in there, mostly written 248 00:13:16,966 --> 00:13:19,066 by Sara and some of our other 249 00:13:19,186 --> 00:13:20,236 And others. 250 00:13:22,036 --> 00:13:26,406 Med-Peds folks that were kind, sneaking some, uh, peds questions that were the 251 00:13:26,406 --> 00:13:29,326 most missed ones by our adult colleagues. 252 00:13:31,386 --> 00:13:35,656 So we wanted to have a peds specific resource because as a recently 253 00:13:35,876 --> 00:13:40,866 graduated fellow and recently victim of the pediatric ID boards, 254 00:13:41,726 --> 00:13:44,756 there are very few resources out there for us to be able to study. 255 00:13:44,756 --> 00:13:47,456 So just generating more of that and, and getting the opportunity to 256 00:13:47,456 --> 00:13:51,521 other people to create those kind of resources was our main goal, and I 257 00:13:51,521 --> 00:13:53,291 wanna say that it was a great success. 258 00:13:53,291 --> 00:13:54,191 Please, uh, 259 00:13:54,261 --> 00:13:55,101 District of Contagion 260 00:13:55,736 --> 00:13:55,976 Yay. 261 00:13:58,061 --> 00:13:59,381 We're really, really excited. 262 00:13:59,381 --> 00:14:03,261 It was an initiative, um, kind of spearheaded by our PIDS Education 263 00:14:03,261 --> 00:14:06,801 Committee and me as an infiltrate of the education committee. 264 00:14:07,971 --> 00:14:08,601 Um. 265 00:14:09,201 --> 00:14:11,481 And we had great participation. 266 00:14:11,481 --> 00:14:18,051 We had 158 players that started the game, and of those 120 answered all of the 267 00:14:18,051 --> 00:14:20,601 questions by the time the cup closed. 268 00:14:20,951 --> 00:14:25,541 And 70% of all of our participants were trainees at different levels, 269 00:14:25,541 --> 00:14:30,921 all the way from residents to third year or or beyond, um, uh, fellows. 270 00:14:31,491 --> 00:14:34,751 We also had a little bit of participation by our ID pharmacist friends. 271 00:14:34,751 --> 00:14:36,631 We had a couple of them, uh, in the cup. 272 00:14:36,731 --> 00:14:40,871 Some research fellows too, and even a couple of, um, advanced practitioners. 273 00:14:40,871 --> 00:14:44,201 So definitely a very diverse cohort that we had for this cup. 274 00:14:44,641 --> 00:14:49,666 And of those participants as well, we had 12, so 10% of the ones that 275 00:14:49,666 --> 00:14:53,746 finished all of the questions, that actually answered every single question 276 00:14:53,776 --> 00:14:57,256 on the day that that was released, which was our original intention. 277 00:14:57,256 --> 00:15:00,316 And, and just big shout out to those 12 players. 278 00:15:00,316 --> 00:15:04,066 Two of them are present here today, Lillian and Berkay. 279 00:15:04,626 --> 00:15:10,206 Thank you so much, uh, for being such great sports and just doing all of your 280 00:15:10,206 --> 00:15:14,676 questions on the release, which was the, the goal of it, just kind of space, little 281 00:15:14,676 --> 00:15:18,126 bits of learning throughout the day and hopefully that was helpful for you guys. 282 00:15:18,631 --> 00:15:19,041 Yeah. 283 00:15:19,341 --> 00:15:23,031 And we thought we would ask you guys as our, you know, now reigning 284 00:15:23,031 --> 00:15:25,591 champions, how you approached the game. 285 00:15:25,641 --> 00:15:29,611 Were you guys interacting and encouraging each other to get to the questions? 286 00:15:29,621 --> 00:15:32,561 Any sort of feedback on the experience, we would love to hear. 287 00:15:32,739 --> 00:15:34,369 Lillian was encouraging. 288 00:15:34,640 --> 00:15:39,120 I think a nice way of saying that I was a task master and I made sure 289 00:15:39,120 --> 00:15:41,940 everyone did their questions on time. 290 00:15:42,060 --> 00:15:44,790 Um, I took my role as team captain very seriously. 291 00:15:44,890 --> 00:15:48,160 I was like, we are gonna win, or we're go down trying. 292 00:15:48,160 --> 00:15:52,780 So I really was such a good sport about me constantly texting them. 293 00:15:52,933 --> 00:15:54,733 The group chat was really helpful. 294 00:15:54,763 --> 00:15:57,583 We had a group chat and that was a great way to remind people to do 295 00:15:57,583 --> 00:15:59,083 their questions, so a little tip. 296 00:15:59,288 --> 00:16:00,098 Very nice. 297 00:16:00,753 --> 00:16:02,218 But there was no cheating there, no answers. 298 00:16:04,081 --> 00:16:07,498 Did you guys feel like there were questions that you debriefed on 299 00:16:07,498 --> 00:16:09,825 after, or asked each other about? 300 00:16:10,290 --> 00:16:13,230 There were definitely some that some of our faculty members 301 00:16:13,230 --> 00:16:14,730 had strong opinions about. 302 00:16:15,060 --> 00:16:20,910 Um, Dr. Shapiro is not with us today, but, uh, yeah, had some debriefing is 303 00:16:20,910 --> 00:16:23,455 maybe the word you could use in the office at least one the questions. 304 00:16:24,810 --> 00:16:29,400 And I wanna say, as part of the organizing team, that I was not great at this 305 00:16:29,400 --> 00:16:33,990 iteration of encouraging this, but for future iterations, I a hundred percent 306 00:16:33,990 --> 00:16:39,450 encourage feedback on the actual structure of the question, or in like specific 307 00:16:39,450 --> 00:16:41,430 words that may have been misleading. 308 00:16:41,610 --> 00:16:45,500 And I know that the adult ID people do this thing called Expert Consults 309 00:16:45,680 --> 00:16:48,410 where we have someone come and say, I would've actually answered 310 00:16:48,410 --> 00:16:49,610 this question a different way. 311 00:16:49,680 --> 00:16:52,890 For this and this reason, and that can also definitely enhance our learning. 312 00:16:52,890 --> 00:16:58,260 So please, everyone, welcome to email our, uh, Peds ID Fellows Cup, uh, official 313 00:16:58,260 --> 00:17:02,070 email, through Instagram or email me directly for future iterations of our cup. 314 00:17:02,070 --> 00:17:04,540 And we're happy to include that in our social media 315 00:17:04,540 --> 00:17:05,610 posts, um, throughout the cup. 316 00:17:06,535 --> 00:17:07,165 For sure. 317 00:17:07,345 --> 00:17:11,785 And our plan is to have these available to folks after the cup is 318 00:17:11,785 --> 00:17:14,135 done, obviously, for you to review. 319 00:17:14,135 --> 00:17:18,565 And so that feedback on the learning point or the structure or any other, 320 00:17:18,625 --> 00:17:24,305 uh, aspects, we can update or provide additional insight on that catalog 321 00:17:24,305 --> 00:17:26,135 or database of those questions. 322 00:17:26,135 --> 00:17:30,575 So definitely, even if it's after the cup now, we still welcome that. 323 00:17:30,825 --> 00:17:34,725 So we can continue to adjust it and make it the best resource that it can be. 324 00:17:35,685 --> 00:17:35,895 Great. 325 00:17:35,895 --> 00:17:37,845 It's so nice to have this extra resource. 326 00:17:37,845 --> 00:17:41,025 Like we were just saying, there's just not too many questions out 327 00:17:41,025 --> 00:17:43,125 there for the peds ID board. 328 00:17:43,125 --> 00:17:44,625 So this was just fabulous. 329 00:17:44,625 --> 00:17:47,295 As a, as a program director, always looking for resources. 330 00:17:47,295 --> 00:17:47,775 Thank you. 331 00:17:47,972 --> 00:17:51,357 And I thought some of the infographics too, like were just a great way 332 00:17:51,357 --> 00:17:54,897 to reference that, um, and kind of help make it really stick 333 00:17:54,897 --> 00:17:56,127 after you answer the question. 334 00:17:57,087 --> 00:17:57,477 Love it. 335 00:17:58,137 --> 00:17:58,317 Yeah. 336 00:17:58,377 --> 00:18:01,737 And hopefully as we build out more resources that are online, 337 00:18:01,737 --> 00:18:04,677 outside, of course, you know, the primary literature, if there are 338 00:18:04,887 --> 00:18:10,537 infographics or podcast episodes or websites that we can link people to. 339 00:18:10,747 --> 00:18:14,107 That's the other goal of the way we prepare the answers that you 340 00:18:14,107 --> 00:18:17,437 can click on those and save 'em on your phone or on your computer. 341 00:18:17,437 --> 00:18:22,037 So hopefully, the more folks participate, the more things we create, the more 342 00:18:22,037 --> 00:18:26,097 things that we can build out and have synergy across all these different 343 00:18:26,097 --> 00:18:27,717 sort of platforms available to us. 344 00:18:28,777 --> 00:18:31,297 This was such a great learning experience for me. 345 00:18:31,297 --> 00:18:34,567 There were definitely questions that I learned from and I've been 346 00:18:34,567 --> 00:18:38,742 doing this for a while, but always, always, uh, room to learn every day. 347 00:18:39,367 --> 00:18:40,327 And so that was great. 348 00:18:40,327 --> 00:18:43,947 I, I do think we did, have some fun, robust discussions about 349 00:18:43,947 --> 00:18:45,297 some of the questions afterwards. 350 00:18:45,507 --> 00:18:48,987 We kind of, at the end of the day, folks who were on service would come out and 351 00:18:48,987 --> 00:18:52,737 we'd make sure everyone had done their questions, and then we'd often just have 352 00:18:52,737 --> 00:18:54,597 a, a discussion about the questions. 353 00:18:54,597 --> 00:18:55,767 So it, it was great. 354 00:18:56,537 --> 00:18:57,257 I love it. 355 00:18:57,747 --> 00:19:03,747 So we have a handful of the top missed questions and we thought we would go 356 00:19:03,747 --> 00:19:06,897 through them to teach people about the learning points that we were intending, 357 00:19:06,897 --> 00:19:09,007 but also, your thought process. 358 00:19:09,397 --> 00:19:11,377 Who wants to start with question one? 359 00:19:11,707 --> 00:19:15,697 So our first question is a 15-year-old male was brought to the ED by his 360 00:19:15,697 --> 00:19:18,967 father after the first episode of generalized tonic clonic seizure. 361 00:19:19,357 --> 00:19:22,057 The seizure stopped after five minutes and he was back at 362 00:19:22,057 --> 00:19:23,497 his baseline before arrival. 363 00:19:23,947 --> 00:19:27,457 He reported a history of intermittent headaches during the past year associated 364 00:19:27,457 --> 00:19:30,277 with nausea, which has improved with over-the-counter medications. 365 00:19:30,897 --> 00:19:34,552 He denied fever, chills, weight change, vision change, weakness, or numbness. 366 00:19:35,662 --> 00:19:37,852 He is originally from Myanmar and immigrated to the 367 00:19:37,852 --> 00:19:39,532 Midwestern US five years ago. 368 00:19:39,892 --> 00:19:40,762 He is in high school. 369 00:19:40,912 --> 00:19:42,172 He is not sexually active. 370 00:19:42,232 --> 00:19:43,612 He loves hiking and gardening. 371 00:19:43,942 --> 00:19:45,952 He's a strict vegetarian and does not eat meat. 372 00:19:46,522 --> 00:19:50,452 He denies having pets, contact with farm animals, recent travel or sick contacts. 373 00:19:51,332 --> 00:19:55,922 A physical exam in the ED was unremarkable without focal neurologic deficit labs, 374 00:19:55,922 --> 00:20:01,202 including CBC, CMP, toxicology screening and HIV screening were unremarkable. 375 00:20:01,742 --> 00:20:03,152 A brain MRI was obtained. 376 00:20:04,142 --> 00:20:06,812 And then it gives us a nice picture of this MRI from 377 00:20:06,812 --> 00:20:08,432 multiple different, uh, views. 378 00:20:09,262 --> 00:20:11,062 The question is what should be done next? 379 00:20:11,782 --> 00:20:14,722 And our answer choices are (a) albendazole monotherapy, (b) 380 00:20:15,352 --> 00:20:20,977 anti-epileptic drug and albendazole, (c) anti-epileptic drug, corticosteroid 381 00:20:20,977 --> 00:20:25,622 and albendazole, (d) antiepileptic drug, corticosteroid, and neurosurgery consult. 382 00:20:26,132 --> 00:20:29,717 Lastly, (e) anti-epileptic drug, corticosteroid, albendazole, 383 00:20:29,747 --> 00:20:30,827 and neurosurgery consult. 384 00:20:30,980 --> 00:20:33,470 What do you guys think is the correct answer? 385 00:20:33,707 --> 00:20:36,247 I think just thinking about not necessarily what the right answer is, 386 00:20:36,247 --> 00:20:39,377 but when I was sort of evaluating which one I was gonna pick, a kid who comes 387 00:20:39,377 --> 00:20:42,617 in with seizures, then you probably want to start an anti-epileptic drug. 388 00:20:42,617 --> 00:20:46,337 So that kind of took off answer, choice a. Um, and then I feel like 389 00:20:46,817 --> 00:20:49,817 any finding in the brain, I'm always like, let's talk to neurosurgery. 390 00:20:49,817 --> 00:20:52,037 So that kind of put that on my like radar too. 391 00:20:52,637 --> 00:20:55,127 Um, so really I was kind of down to D and E 392 00:20:55,877 --> 00:20:59,847 Especially when you have those, uh, ominous red arrows on the MRI. 393 00:21:01,727 --> 00:21:05,927 I say, does anyone wanna describe what the MRI images are showing for 394 00:21:05,927 --> 00:21:08,717 those that aren't able to see them as a part of the question stem? 395 00:21:09,385 --> 00:21:13,015 I think there are cystic lesions, uh, scattered throughout the brain. 396 00:21:13,105 --> 00:21:17,425 I do see one in the cortex and at least one within the ventricles, 397 00:21:17,875 --> 00:21:21,055 and I think that's gonna be one of the keys to this question. 398 00:21:22,210 --> 00:21:25,040 And this is something that I learned from this question too, so thank 399 00:21:25,040 --> 00:21:26,820 you so much to question writers. 400 00:21:28,128 --> 00:21:32,568 Yeah, so maybe someone can take on our, our final correct answer. 401 00:21:32,944 --> 00:21:34,289 Perhaps one of our third year fellows. 402 00:21:35,227 --> 00:21:39,657 So the answer was answer choice D. So having an anti-epileptic 403 00:21:39,657 --> 00:21:43,137 drug, a corticosteroid, and a neurosurgery consult. 404 00:21:43,137 --> 00:21:47,287 And I think the tricky part about this was not including albendazole 405 00:21:47,287 --> 00:21:51,547 or a anti-parasitic agent, because that can lead to a hyper 406 00:21:51,547 --> 00:21:53,847 inflammatory state with treatment. 407 00:21:53,877 --> 00:21:56,542 And then that, that other aspect that was already mentioned that the 408 00:21:56,542 --> 00:22:00,577 neurosurgery consult is important to try to help remove some of the cysts. 409 00:22:00,955 --> 00:22:03,680 And I don't think that we ever actually said this, but what 410 00:22:03,680 --> 00:22:06,740 was, what clinical syndrome was this case vignette describing? 411 00:22:08,728 --> 00:22:09,858 Neurocysticercosis 412 00:22:09,923 --> 00:22:10,433 Yes. 413 00:22:10,463 --> 00:22:11,723 Yeah, absolutely. 414 00:22:11,967 --> 00:22:12,567 Excellent. 415 00:22:13,588 --> 00:22:17,128 I think it was interesting that the question stem also mentioned that 416 00:22:17,228 --> 00:22:19,168 the, this patient was vegetarian. 417 00:22:19,438 --> 00:22:21,958 I think that was like trying to throw us off maybe, 418 00:22:21,963 --> 00:22:22,383 Mm-hmm. 419 00:22:23,216 --> 00:22:28,316 We definitely wanted folks to remember that neurocysticercosis is gonna 420 00:22:28,496 --> 00:22:32,066 potentially be able to occur even in someone who's a strict vegetarian, if 421 00:22:32,066 --> 00:22:35,866 they eat those eggs in contaminated food. 422 00:22:36,226 --> 00:22:41,631 And of course we'll put the resource that has our good old CDC lifecycle 423 00:22:41,631 --> 00:22:43,821 that people can, can review. 424 00:22:43,871 --> 00:22:47,891 I will also say that this is one that was adapted from the adult cup and, 425 00:22:48,201 --> 00:22:53,721 Mac, uh, Chesdachai, who, uh, has been on febrile podcast for one of our state 426 00:22:53,721 --> 00:22:55,311 of the art reviews wrote this question. 427 00:22:55,311 --> 00:23:00,036 So, I'm not even sure he knows that we reuse this question or not, but I'll. 428 00:23:00,056 --> 00:23:00,786 Thanks, Mac! 429 00:23:00,956 --> 00:23:02,196 Thanks Mac. 430 00:23:03,116 --> 00:23:03,656 Awesome. 431 00:23:04,103 --> 00:23:09,183 I was gonna say like the more advanced take home message, like, Berkay mentioned 432 00:23:09,183 --> 00:23:13,973 is really that there are both intra parenchymal and extra parenchymal lesions. 433 00:23:14,223 --> 00:23:17,733 And because there were signs of acute disease, this is maybe different than 434 00:23:17,733 --> 00:23:22,378 the, the classic board stem we see of seizures with a calcified cyst 435 00:23:22,378 --> 00:23:24,388 where there's no management indicated. 436 00:23:24,658 --> 00:23:27,928 So having those in different compartments does require different treatment. 437 00:23:27,928 --> 00:23:32,058 And, like one of our other fellows mentioned, making sure that you 438 00:23:32,058 --> 00:23:34,788 don't treat to trigger a hyper inflammatory response without 439 00:23:34,788 --> 00:23:38,898 steroids and appropriate containment of those active cysts is critical. 440 00:23:39,298 --> 00:23:41,913 I think this was a great question too, because of that, I'll say 441 00:23:41,913 --> 00:23:45,633 I got this question wrong and I was talking to the fellows about 442 00:23:45,693 --> 00:23:49,503 afterwards and we were talking about seeing these intraventricular 443 00:23:49,503 --> 00:23:52,803 lesions with neurocysticercosis, that's not very common. 444 00:23:52,803 --> 00:23:56,013 I actually went and looked it up afterwards because, neurocysticercosis 445 00:23:56,033 --> 00:23:59,393 isn't a thing we see too commonly in the places that I've practiced in 446 00:23:59,393 --> 00:24:02,543 various locations, but I've definitely seen it throughout my career and 447 00:24:02,543 --> 00:24:05,543 I've been doing this a while now, but I've seen maybe about 10 cases. 448 00:24:05,843 --> 00:24:08,993 I've never seen one that actually had intraventricular lesions. 449 00:24:09,183 --> 00:24:12,423 I think that point about management is important because the management is a 450 00:24:12,423 --> 00:24:16,683 little bit different with that lesion as opposed to someone who is a calcified cyst 451 00:24:16,983 --> 00:24:20,793 where we would need to do anti parasitics as, uh, Dr. Yonts was just mentioning. 452 00:24:21,153 --> 00:24:26,073 When I looked it up about only 7 to 20% of cases actually present 453 00:24:26,073 --> 00:24:28,683 with intraventricular disease, but it was right, and I, I 454 00:24:28,683 --> 00:24:29,883 definitely learned something new. 455 00:24:30,228 --> 00:24:35,028 And I love that key point that you went and looked up something else outside 456 00:24:35,028 --> 00:24:39,033 of the app, which is one of the things that we hope that people do just to. 457 00:24:39,741 --> 00:24:42,449 But don't do it on your phone apparently. 458 00:24:43,658 --> 00:24:44,258 Alright. 459 00:24:44,348 --> 00:24:47,078 Uh, who wants to take on this, this next stem 460 00:24:47,638 --> 00:24:51,328 So a 16-year-old previously healthy boy presents with fever, right upper 461 00:24:51,328 --> 00:24:54,238 quadrant abdominal pain, and the following findings on the CT imaging. 462 00:24:55,318 --> 00:25:00,328 And if I were to describe, I think there's a heterogeneous mass slash 463 00:25:00,328 --> 00:25:03,043 cyst looking structure in the liver. 464 00:25:03,483 --> 00:25:07,053 He returned from a two month trip from rural South America three weeks ago. 465 00:25:07,113 --> 00:25:10,563 He's hemodynamically stable and has no known drug allergies. 466 00:25:10,593 --> 00:25:12,933 Which is which of the following is the most appropriate 467 00:25:13,023 --> 00:25:14,973 empiric antimicrobial agent. 468 00:25:15,507 --> 00:25:17,787 Personally this is one of those questions I got wrong. 469 00:25:17,907 --> 00:25:21,807 Uh, when I read the question stem and the travel history, I was thinking about, 470 00:25:21,837 --> 00:25:28,297 okay, so this is gonna be an amoebic, uh, liver abscess, and I was looking 471 00:25:28,297 --> 00:25:31,647 for an answer that will treat that, so I chose one of the wrong options 472 00:25:33,047 --> 00:25:35,747 with metronidazole plus paromomycin. 473 00:25:36,064 --> 00:25:37,654 Unfortunately, I was incorrect. 474 00:25:39,607 --> 00:25:44,587 And I picked the same as Berkay initially as well, I totally fell into that trap. 475 00:25:45,044 --> 00:25:48,674 Yeah, and after this question, there was some heated discussion 476 00:25:48,734 --> 00:25:51,914 among ourselves, you know, some friendly competition about like. 477 00:25:52,282 --> 00:25:55,462 I think my lack of knowledge actually helped me with this question. 478 00:25:55,582 --> 00:26:00,002 I wasn't even thinking about amoebic etiologies and so I was like, okay, intra 479 00:26:00,022 --> 00:26:03,242 abdominal abcess, we're gonna go with ceftriaxone + metronidazole (flagyl). 480 00:26:03,262 --> 00:26:05,319 So I got it right by mistake. 481 00:26:05,506 --> 00:26:07,326 It's still counted towards the points. 482 00:26:07,326 --> 00:26:08,226 So you get 483 00:26:12,276 --> 00:26:13,506 Team leader says, yay. 484 00:26:14,393 --> 00:26:17,948 But yeah, I think, I mean, the tricky thing is, common things are common 485 00:26:17,948 --> 00:26:22,348 everywhere, and you have to really treat and manage those, especially 486 00:26:22,348 --> 00:26:24,328 if your patient is otherwise stable. 487 00:26:24,358 --> 00:26:28,098 And then do your diagnostic workup to look at the more exotic things. 488 00:26:28,398 --> 00:26:32,538 So here horses instead of zebras in a field that we do deal with a lot of 489 00:26:32,538 --> 00:26:34,368 zebras, but it's a little bit tricky. 490 00:26:34,398 --> 00:26:34,541 Yep. 491 00:26:34,761 --> 00:26:39,011 I have to admit, you know, if I try to put myself in those shoes of getting 492 00:26:39,011 --> 00:26:43,841 that call, we have this picture and what are we gonna start this patient on? 493 00:26:44,621 --> 00:26:47,571 I don't see myself saying paromomycin, 494 00:26:48,746 --> 00:26:49,136 Oh, the, yeah. 495 00:26:51,476 --> 00:26:53,051 I wouldn't have selected that option. 496 00:26:55,286 --> 00:26:58,706 I think we had a good discussion about this after the question too, 497 00:26:58,706 --> 00:27:02,606 about this is, they're asking for most appropriate empiric therapy. 498 00:27:02,606 --> 00:27:06,806 So again, yes, we were all thinking about amebic liver abscesses, and we wanted, 499 00:27:06,926 --> 00:27:09,326 uh, or, uh, some, uh, coverage for that. 500 00:27:09,326 --> 00:27:12,606 And so metronidazole does that, and then we want coverage for some 501 00:27:12,606 --> 00:27:15,666 of the other common things that cause pyogenic liver abscesses. 502 00:27:15,666 --> 00:27:17,496 So in kids Staphylococcus aureus. 503 00:27:17,811 --> 00:27:22,071 Um, streptococcal species, gram negatives like Klebsiella and, and so 504 00:27:22,071 --> 00:27:26,081 looking at the options, ceftriaxone plus metronidazole definitely stood out. 505 00:27:26,831 --> 00:27:28,288 Yeah, and I will give a shout out. 506 00:27:28,288 --> 00:27:31,908 The author for this one was Maria Valenzuela, who's one of our 507 00:27:31,908 --> 00:27:33,438 fellows at Boston Children's. 508 00:27:34,018 --> 00:27:35,268 And one of our former residents! 509 00:27:35,268 --> 00:27:38,898 Yeah she was my co-resident! 510 00:27:39,338 --> 00:27:43,038 Okay, so, we will move on to our next question. 511 00:27:43,278 --> 00:27:44,688 I can, I can take that one. 512 00:27:45,498 --> 00:27:51,858 Uh, so the question is, uh, as follows, you're the ID fellow on call and receive 513 00:27:51,858 --> 00:27:56,643 a page from a community pediatrician asking for UTI treatment guidance. 514 00:27:56,958 --> 00:28:00,258 they tell you that the patient is a previously healthy three-year-old 515 00:28:00,258 --> 00:28:04,248 girl with no prior history of UTIs whose parents brought her to the 516 00:28:04,248 --> 00:28:08,058 office for complaints of her belly hurting and fear of urination. 517 00:28:08,568 --> 00:28:11,748 She is afebrile and otherwise well appearing with only 518 00:28:11,748 --> 00:28:13,848 mild suprapubic tenderness. 519 00:28:14,028 --> 00:28:18,818 A clean catch urinalysis reveals 4+ leukocyte esterase, 2+ protein, 520 00:28:19,128 --> 00:28:21,318 2+ blood and positive nitrites. 521 00:28:21,828 --> 00:28:26,363 She was sent home on empiric cephalexin while awaiting urine 522 00:28:26,453 --> 00:28:31,843 culture results, which return with a hundred thousand colonies of E.coli. 523 00:28:32,813 --> 00:28:35,723 Antimicrobial sensitivity report is shown. 524 00:28:36,443 --> 00:28:41,693 Uh, and her pediatrician would like to know what, if any, outpatient antibiotic 525 00:28:41,693 --> 00:28:43,793 treatment options may be suitable. 526 00:28:44,483 --> 00:28:51,063 And so we have sensitivity report, which shows everything as resistant, 527 00:28:51,693 --> 00:28:55,083 uh, except for amikacin and minocycline. 528 00:28:55,728 --> 00:29:01,743 So that includes resistance to ampicillin, but also cefazolin, piperacillin, uh, 529 00:29:01,743 --> 00:29:07,228 cefotaxime, ceftazidime, and levofloxacin. 530 00:29:07,498 --> 00:29:08,998 And Bactrim as well. 531 00:29:09,234 --> 00:29:15,270 And so the answer choices here are (a) continue cephalexin 25 mg/kg per dose 532 00:29:15,390 --> 00:29:20,300 PO TID (three times daily) for seven days, (b) a single dose of IM amikacin, 533 00:29:20,990 --> 00:29:28,340 uh, 15 mg/kg, (c) minocycline two mg/kg per dose PO BID for five days, (d) a 534 00:29:28,340 --> 00:29:34,370 single dose of IM ceftriaxone followed by cefixime eight mg/ kg, uh, po once 535 00:29:34,370 --> 00:29:41,135 daily for five days, (e) recommend direct admission for treatment with IV meropenem. 536 00:29:41,431 --> 00:29:44,621 I thought that one was fairly interesting and made me think of a 537 00:29:44,621 --> 00:29:48,514 case that we had, uh, recently, but, it seems that you're only picking out 538 00:29:48,514 --> 00:29:50,164 the ones that I got wrong is that. 539 00:29:52,831 --> 00:29:54,581 Who feels personally victimized 540 00:29:58,921 --> 00:29:59,081 by 541 00:30:01,671 --> 00:30:02,321 Sara Dong? 542 00:30:03,226 --> 00:30:06,831 Yeah, so someone else wanna talk about their thoughts. 543 00:30:07,130 --> 00:30:09,920 Yeah, like maybe someone can let us know, like how you process 544 00:30:09,920 --> 00:30:11,455 those question answer choices. 545 00:30:12,015 --> 00:30:12,495 Yeah. 546 00:30:12,555 --> 00:30:15,765 Um, I only got this question right because of Dr. Shapiro. 547 00:30:15,825 --> 00:30:18,975 Um, so shout out to him for me this. 548 00:30:18,975 --> 00:30:24,515 Um, so we'd recently had a, it's, I don't know. 549 00:30:24,515 --> 00:30:29,015 I feel like probably a very common call to get after hours about a patient 550 00:30:29,015 --> 00:30:35,580 who has an, you know, a resistant like ESBL organism in their urine and 551 00:30:35,580 --> 00:30:37,950 they don't need to be admitted, but what are we gonna treat them with? 552 00:30:38,156 --> 00:30:43,516 We had recently just treated a patient with a dose of gentamicin. 553 00:30:44,066 --> 00:30:47,846 Um, and so my, my thought process was, well, why couldn't 554 00:30:47,846 --> 00:30:49,076 we do that with amikacin? 555 00:30:49,076 --> 00:30:50,726 That seems like it would make sense. 556 00:30:50,756 --> 00:30:54,176 And so that was kind of how I thought through that question was well, 557 00:30:54,176 --> 00:30:56,396 obviously cephalexin isn't gonna work. 558 00:30:56,456 --> 00:30:56,846 Um. 559 00:30:57,776 --> 00:30:58,676 Minocycline. 560 00:30:59,126 --> 00:31:03,266 Yeah, not really, um, something that I do very often, so I'm 561 00:31:03,266 --> 00:31:04,706 gonna go with not that one. 562 00:31:05,336 --> 00:31:11,276 Um, another cephalosporin for similar reasons and that, because this is 563 00:31:11,276 --> 00:31:17,081 an ESBL producer and then, um, I know our ID pharmacist would come 564 00:31:17,081 --> 00:31:21,701 after me with pitchforks if I ever recommended admitting anyone for 565 00:31:21,701 --> 00:31:23,261 this reason with, um, meropenem. 566 00:31:23,351 --> 00:31:25,691 So I knew that I was not gonna choose that one. 567 00:31:25,991 --> 00:31:29,561 Um, and that is how I ended up with going with amikacin. 568 00:31:29,992 --> 00:31:34,472 I think that this was a really great question in terms of reminding, you know, 569 00:31:34,472 --> 00:31:38,792 clinicians, including myself, that this is a therapeutic option for this population. 570 00:31:38,792 --> 00:31:43,127 I feel like in reality, a lot of times we get that call and we 571 00:31:43,127 --> 00:31:44,927 say, how's the patient doing now? 572 00:31:44,957 --> 00:31:49,547 And most of the time, their symptoms have resolved, um, so likely from 573 00:31:49,547 --> 00:31:52,967 some other benefit of concentration of antibiotics in the urine or not 574 00:31:52,967 --> 00:31:54,437 needing treatment in the first place. 575 00:31:54,647 --> 00:31:58,217 But I think having this in your pocket and this knowledge of the post antibiotic 576 00:31:58,247 --> 00:32:02,717 effect is, is a really helpful option and something that pediatricians, or at 577 00:32:02,717 --> 00:32:05,267 least ER doctors can feel empowered by. 578 00:32:05,492 --> 00:32:10,412 Yeah, I wanna say it was a great question to like sort of demystify how people just 579 00:32:10,412 --> 00:32:15,692 think of aminoglycosides of like, they're just so toxic and so bad and we only use 580 00:32:15,692 --> 00:32:19,412 them as adjuvants for the most part in our practice, but they're actually excellent 581 00:32:19,412 --> 00:32:23,252 antibiotics to treat urinary tract infections, which is actually the system 582 00:32:23,252 --> 00:32:26,672 with like the kidney and nephrotoxicity where people fear them the most. 583 00:32:26,687 --> 00:32:30,527 So I think it was a great reminder that we can, as Alex was saying, empower 584 00:32:30,737 --> 00:32:34,217 primary care doctors, pediatricians, ER docs to, to be able to use them and 585 00:32:34,217 --> 00:32:38,157 avoid an admission that could create even more problems for these patients. 586 00:32:38,651 --> 00:32:43,451 And I wanna shout out, uh, the author of this question, Lindsey Hastings, 587 00:32:43,701 --> 00:32:47,351 a Med-Peds fellow extraordinaire here at the University of Alabama. 588 00:32:48,176 --> 00:32:48,626 Woohoo. 589 00:32:48,867 --> 00:32:51,292 Oh, and to um, Einar's point. 590 00:32:51,502 --> 00:32:54,112 So these are the most missed questions, so you are not alone 591 00:32:55,252 --> 00:32:56,632 on having missed this one. 592 00:32:56,842 --> 00:33:00,622 For the neurocysticercosis question, only 11% of our question 593 00:33:00,992 --> 00:33:02,522 answerers actually got it right. 594 00:33:02,792 --> 00:33:05,852 Uh, for the intraabdominal abscess, just 28%. 595 00:33:05,882 --> 00:33:09,032 And for this aminoglycoside question, 52% got it right. 596 00:33:10,204 --> 00:33:13,414 All right, and let's close it out with our last of these most 597 00:33:13,414 --> 00:33:14,374 frequently missed questions. 598 00:33:15,114 --> 00:33:18,324 A 10-year-old male presents after being bitten on the arm by a 599 00:33:18,324 --> 00:33:19,824 bat while playing in the woods. 600 00:33:20,064 --> 00:33:20,724 Classic. 601 00:33:20,754 --> 00:33:24,924 Um, he is otherwise healthy, but completed a full rabies post-exposure 602 00:33:24,924 --> 00:33:28,794 prophylaxis regimen two years ago after a stray dog bit him. 603 00:33:28,884 --> 00:33:32,514 What, what incredible luck this 10-year-old child has. 604 00:33:32,949 --> 00:33:36,309 Which of the following management approaches would best address his need 605 00:33:36,309 --> 00:33:38,619 for rabies prevention at this time? 606 00:33:39,332 --> 00:33:43,592 Funny enough, I saw a patient around the similar time that I think this question 607 00:33:43,592 --> 00:33:48,152 came out where she was receiving rabies prophylaxis, and so that helped me narrow 608 00:33:48,152 --> 00:33:54,022 down the question answers, but I still got it wrong because as compared to this 609 00:33:54,202 --> 00:33:58,167 patient, my patient in real life did not have a previous rabies exposure. 610 00:33:58,834 --> 00:34:04,264 Yeah, uh, I, I think it was relatively easy to rule out the answers with the 611 00:34:04,264 --> 00:34:08,674 rabies immunoglobulin because this person has been immunized before. 612 00:34:09,064 --> 00:34:12,774 But I also learned from this question how they approach these patients because 613 00:34:12,894 --> 00:34:16,044 the number of vaccines, like this is not a clinical situation I have encountered 614 00:34:16,044 --> 00:34:17,964 before, and I have learned from it. 615 00:34:18,846 --> 00:34:23,166 Definitely I feel like get lots of questions about rabies prophylaxis as ID 616 00:34:23,166 --> 00:34:26,796 doctors, it's probably one of our like most common right, um, questions that 617 00:34:26,796 --> 00:34:31,986 the fellows, attendings gets, um, about prophylaxis, but to have someone who's 618 00:34:31,986 --> 00:34:36,216 been previously vaccinated or somebody who was like a veterinarian and previously 619 00:34:36,216 --> 00:34:39,096 vaccinated for pre-exposure, um, is rare. 620 00:34:39,096 --> 00:34:41,076 I don't think I've ever gotten that question. 621 00:34:41,596 --> 00:34:44,476 Shout out to the Red Book and how easy it's to look things up. 622 00:34:44,836 --> 00:34:48,466 So in my brain I don't often, um, keep room for things that I 623 00:34:48,466 --> 00:34:50,206 know I can access pretty quickly. 624 00:34:50,446 --> 00:34:54,796 So I, I definitely know what the regimen and what to do for someone who's been 625 00:34:54,796 --> 00:34:57,316 bitten, who's never had a vaccine before. 626 00:34:57,316 --> 00:35:01,336 But I'll say this particular scenario, I did not know off the top of my head. 627 00:35:01,336 --> 00:35:04,696 So similarly, I was like, well, I don't think they need a RIG again. 628 00:35:04,696 --> 00:35:05,536 They've had it before. 629 00:35:05,776 --> 00:35:07,186 We don't usually do that again. 630 00:35:07,636 --> 00:35:10,866 Um, and, but I was like, yeah, give 'em all the vaccines anyway. 631 00:35:10,866 --> 00:35:12,396 Why not? 632 00:35:12,396 --> 00:35:14,476 So I'll say I definitely got this one wrong 633 00:35:14,636 --> 00:35:20,566 And so maybe is someone willing to walk through and, list what someone would get 634 00:35:20,566 --> 00:35:24,886 for post-exposure prophylaxis if they were previously vaccinated versus not. 635 00:35:24,993 --> 00:35:28,679 Just for the audience members to refresh in their brain too. 636 00:35:29,074 --> 00:35:29,364 Sure. 637 00:35:29,544 --> 00:35:33,729 So for post-exposure prophylaxis and those who are not previously 638 00:35:33,729 --> 00:35:41,019 vaccinated, um, you would do the rabies vaccine on days 0 3, 7 and 14. 639 00:35:41,689 --> 00:35:43,789 If you're immunocompromised, it's a little bit different though. 640 00:35:43,789 --> 00:35:45,409 So just that little asterisk there. 641 00:35:45,459 --> 00:35:50,089 And then they would also receive rabies immunoglobulin at the site of the bite. 642 00:35:50,869 --> 00:35:53,389 Um, if they're previously vaccinated, then you would receive rabies 643 00:35:53,389 --> 00:35:55,249 vaccine at days zero and three. 644 00:35:55,249 --> 00:35:58,249 And then I mentioned the immunoglobulin is not indicated in that case. 645 00:35:58,427 --> 00:36:01,517 And we'll give a shout out to the author of this question, uh, Rebecca 646 00:36:01,517 --> 00:36:03,647 Sturgis, who's at Cincinnati Children's. 647 00:36:03,647 --> 00:36:05,507 Thank you for this awesome question. 648 00:36:06,447 --> 00:36:11,397 So we, we do just in general, want to give a thank you to all the question 649 00:36:11,397 --> 00:36:16,382 writers and mentors who contributed and looked at these questions. 650 00:36:16,742 --> 00:36:21,222 And we will also have a link, you can click on the episode description, 651 00:36:21,502 --> 00:36:25,702 and see that there's a call for our next round of writers and mentors. 652 00:36:25,702 --> 00:36:27,532 It's a really quick Google doc. 653 00:36:27,632 --> 00:36:30,542 Even if you're on the fence, you know, fill it out and we'll be in touch. 654 00:36:30,852 --> 00:36:33,672 So that we can work on our next round of questions. 655 00:36:33,702 --> 00:36:37,242 And we'll also put the link to the Peds ID fellows cup. 656 00:36:37,592 --> 00:36:40,802 We have a website, and if you don't follow our Instagram, you can 657 00:36:40,802 --> 00:36:42,422 follow the Instagram for updates. 658 00:36:42,882 --> 00:36:45,292 But before we close out I'll kind of open it up. 659 00:36:45,499 --> 00:36:49,309 Thanks so much, uh, um, you all the organizers of the ID 660 00:36:49,369 --> 00:36:50,869 Fellows Cup, it was amazing. 661 00:36:50,899 --> 00:36:54,619 Um, we had so much fun doing it and like I said, we learned a lot, so yay. 662 00:36:54,619 --> 00:36:56,059 We're looking forward to the next one. 663 00:36:56,579 --> 00:36:57,379 We will be getting 664 00:36:59,739 --> 00:37:00,099 t-shirts! 665 00:37:01,821 --> 00:37:05,334 Thank you again to our group from Children's National for 666 00:37:05,384 --> 00:37:07,554 joining today and Marisu from UAB. 667 00:37:07,924 --> 00:37:10,444 We were really happy to have them join us. 668 00:37:10,444 --> 00:37:14,374 And again, just a huge thank you to the Febrile community. 669 00:37:14,704 --> 00:37:19,114 Uh, hope to hear from many of you in the coming year and keep bringing 670 00:37:19,114 --> 00:37:21,364 you new and exciting ID learning. 671 00:37:22,044 --> 00:37:25,014 Don't forget to check out our website, febrile podcast.com, where 672 00:37:25,014 --> 00:37:28,044 you can find the Consult Notes, which are written complements to the 673 00:37:28,044 --> 00:37:31,974 episodes, with links to references, our library of ID infographics, 674 00:37:32,274 --> 00:37:33,609 and a link to our merch store. 675 00:37:34,349 --> 00:37:38,429 Febrile is produced with support from the Infectious Diseases Society of America. 676 00:37:38,609 --> 00:37:42,329 Please reach out if you have any suggestions or future shows or want 677 00:37:42,329 --> 00:37:43,649 to be more involved with Febrile. 678 00:37:44,009 --> 00:37:44,879 Thanks for listening. 679 00:37:45,209 --> 00:37:46,829 Stay safe and I'll see you next time.