Table of contents
.
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.
- What investigations would you do?
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.
Comments