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    40yoF with HIV and Decreased LOC

    • 40yoF with IV drug use, HIV, HepC presenting with 1 week history of decreased LOC and knee pain.
      • What investigations would you do?
        • CBC, Lytes, Blood cultures, joint aspirate.
        • Send joint fluid for: Cells+ differential, Gram stain, C+S.
        • Blood cutures: + Fungal and Cryptococcal antigen.
        • CD4 count and viral load.
        • HepBsAg, HepBsAb, and HepC serology.
        • CSF for:
          • Opening pressure
          • Glucose/Protein
          • Cells + differential
          • Gram Stain
          • Culture + Sens.
          • Viral PCR (CMV, EBV, VZV, HSV)
          • Cryptococcal Antigen
          • Fungal Cultures.

    75yoF with nausea/vomiting/abdo pain

    75yoF with nausea/vomiting/abdo pain.  Dxed as viral gastro... sent home... continued fever, chills, N/V/weakness.

    Re-presented to ER with cholestatic liver enzymes.  Blood cultures..E.coli (pansensitive) 2/2.

    Abod U/S duodenal-CBD fistula, stone.

    ERCP - stented fistula + sphincterotomy --> no stone.

    CT --> liver abscess + cholangitis.

    Liver Abscess --> Amox-clav recommended (Covers G-'s, and anaerobes).  If Penicillin allergic use Cipro-flagyl.  Treat for 6 weeks, F/U with CT abdo in 4 weeks.  

    80yo with aspiration event

    • With aspiration event presenting with shortness of breath.
    • How long after?
      • Pneumonitis vs. Pneumonia (>3-4 days).
    • Also has CNSt in the blood.  Do not worry if no artificial valves. (risk of endocarditis is low) Maybe treat if multiple cultures of same organism.
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