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125Young adult, AMS for last 3d, close acquaintances think they're "weird recently", obtunded, not an alcoholic, CSF with RBC: HSV encephalitisSx: encephalitis/meningitis in newborn or young adultDx: @ temporal lobeDDxSubarachnoid hemorrhage: 2-3h durationBloody CSF tapC/b increased ICP --> uncal herniation (transtentorial herniation) --| CN3 --> "down and out" eye w/ blown pupil (intact CN4,6), --| midbrain/contralateral cerebral peduncle --> ipsilateral hemiparesisTSA agent, IVDU (#risky behavior), 2wks losing weight, night sweats, hemoptysis, CXR hilar adenopathy + cavitary lesion: TBRF: travel, immunocompromisedDx: serial acid-fast stains, TB skin testInduration >15mm: TB for all!>10mm: healthcare worker>5mm: HIV ptf/u positive results with CXR --> latent vs active TB*negative skin test does not rule out TB! (i.e. sarcoid, HIV)Enhancement @ base of brainElevated lymphocytes in CSFTx: Latent: isoniazid 9mo + B6/pyridoxineAe: drug-induced lupus, slow vs fast acetylatorsB6 deficiency --| glutamine decarboxylase --> increased glutamate --> seizures B6 deficiency --| ALAS (heme pathway) --> sideroblastic anemiaActive: RIPE 2mo + RI 4moAeRifampin: hepatotoxicity, orange secretionsAlso used to treat leprosy (or dapsone, clofazamine)Also used for Neisseria meningitis ppx (or cipro, ceftriaxone)Isoniazid: B6 deficiency, neurotoxicity, hepatotoxicity; "INH"Pyrazinamide: n/aEthambutol: color blindnessC/b Potts disease (@vertebral bodies)Painful sores under axilla, chronic: hidradenitis suppurativaEt: inflamed apocrine glandsVs. sebaceous glands @ acneTx: surgeryObtunded, alcoholic/elderly, elevated Cr: rhabdomyolysisRF: crush injury, intense exerciseDx: blood on dipstick w/o RBC on microscopyHypocalcemia --> prolonged QTHyperkalemia --> 1. peak t-waves 2. wide QRS 3. sine wave 4. asystoleTx: calcium gluconate, insulin + glucose, albuterol, sodium bicarbonate, diuresis w/ furosemide, kayexalate C/b acute tubular necrosisTx: fluids Drug overdose, wide QRS: TCAHypersensitivity rxnMechanismExType 1IgE (@basophils, mast cells) crosslinking --> release of cytokinesAllergy history, episodic wheezing: asthma ABPA (fungus ball in lung)Type 2antibodies against fixed antigenRBC: autoimmune hemolytic anemiaGp2b3a: ITPFollicular cells of thyroid gland/TSH receptor: Graves diseaseType 3antigen-antibody complex "two people partner up together and wreak havoc"PSGNHypersensitivity pneumonitis RF: close to warm spring, birds, farmerA/w thermophilic actinomyces Sx: ~ fibrotic lung disease, episodic lung sx Type 4delayed-type; T-cells/macrophagesContact dermatitisTB skin testPoison ivyHot tub? Hot topic!Hypersensitivity pneumonitisHot tub lung d/t mycobacterium avium complexSx: female with low level infection for 3wksNot always immunocompromised!Tx: macrolide Ae: prolonged QT, erythromycin (diarrhea, pyloric stenosis in newborn)Hot tub folliculitis d/t pseudomonas ................
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