1. Febrile neutropenia
- Defined as T>38 for 1 hour or any T>38.3 + ANC <1500
- Mild neutropenia (ANC <1500)
- Moderate neutropenia (ANC <1000) - susceptibility to infection increases
- Severe (ANC <500) - lose ability to control endogenous flora, risk of death markedly increased
2. Management
- Mild: outpatient antibiotics
- Moderate/severe neutropenic fever: hospitalization with IV antibiotics
- If someone is really sick (ANC <100, shock vitals, invasive fungal infection, uncontrolled primary disease, pneumonia) consider adding G-CSF
3. Antibiotic choice 
- In chemotherapy patients: most common site of mucositis is GI tract, most frequently involved = GNR (pseudomonas), however more and more it's shifting to gram+ infections.
- Given this, recommend monotherapy with anti-psedudomonal b-lactam (zosyn, mero, cefepime)
- If there is evidence of pneumonia, sepsis, soft-tissue infection or line infection, shock vitals, severe mucositis, history of resistant staph/strep infections, recent fluroquinolone prophylaxis, add vanc
- If there is evidence of necrotizing mucositis, or abscess assoc with GI tract (periodontal, perirectal), intrabdominal or pelvic infection, typhlitis (necrotizing neutropenic colitis) or anaerobic bacteremia, add flagyl
- If neutropenic fever persists despite broad spectrum antibiotic therapy, add antifungals
4. Peripheral arterial disease. 
- PAD with intermittent claudication have 20% 5-year risk of nonfatal MI/stroke and 15-30% 5-year risk of death due to cardiovascular causes.
- PAD with critical limb ischemia have a 25% 1-year risk of cardiovascular death
- PAD with intermittent claudication - at 5 years, 70-80% will have stable symptoms, 10-20% progress to worsening claudication, 1-2% progress to critical limb ischemia with rest pain, nonhealing ulcers, and tissue gangrene that may lead to amputation.
5. Mortality and Cardiovascular Risk Across the Ankle-Arm Index Spectrum {Circulation}
Methods and Results— We examined total and cardiovascular mortality and cardiovascular events across the AAI spectrum among 5748 participants in the Cardiovascular Health Study (CHS). The mean age of the sample population was 73±6 years, and the sample included 3289 women (57%) and 883 blacks (15%). The median duration of follow-up was 11.1 (0.1 to 12) years for mortality and 9.6 (0.1 to 12.1) years for cardiovascular events. There were 2311 deaths (953 of which were cardiovascular) and 1491 cardiovascular events during follow-up. After adjustment for potential confounders, AAI measurements ≤0.60 (hazard ratio [HR] 1.82, 95% CI 1.42 to 2.32), 0.61 to 0.7 (HR 2.08, 95% CI 1.61 to 2.69), 0.71 to 0.8 (HR 1.80, 95% CI 1.44 to 2.26), 0.81 to 0.9 (HR 1.73 95% CI 1.43 to 2.11), 0.91 to 1.0 (HR 1.40, 95% CI 1.20 to 1.63), and >1.40 (HR 1.57, 95% CI 1.07 to 2.31) were associated with higher mortality risk from all causes compared with the referent group (AAI 1.11 to 1.20). The pattern was similar for cardiovascular mortality. For cardiovascular events, risk was higher at all AAI levels <1 but not for AAI levels >1.4 (HR 1.00, 95% CI 0.57 to 1.74). The association of a high AAI with mortality was stronger in men than in women and in younger than in older cohort members.
6. Stent vs tPA for MI
- Stents have better outcomes
- Door to balloon time (stent) goal <90 mins
- Door to needle time (tPA) goal <30 mins
7. Bacillary angiomatosis
- Typically caused by bartonella henselae and bartonella quntana
- Generally affects immunosuppressed patients (AIDS, liquid cancers, chemo, transplant)
- Systemic symptoms-- malaise, fever, weight loss, abdominal pain.
- Lesions (large, pedunculated exophytic papule with collarette of scale) appear on the skin and in the viscera, and are extremely prone to hemorrhage when biopsied
- Dx is with tissue biopsy -  microscopic ID of organisms and angiomatous histology
- Tx with antibiotics
8. Diarrhea in AIDS patients 
- CD4 < 180 - tend to have a more persistent course with parasitic infections.
- Oocysts on modified acid fast stain - cryptosporidum parum or isospora belli, however crypto is much more common
- MAI, usually assoc with lung infections in immunocompetent patients with chronic lung dx, can cause disseminated disease and invade intestinal epithelium in people who are very immune compromised and caused malabsorption.
- Spores in the stool- microsporidia organisms like enterocytozoon bieneusi and encephalitozoon intestinalis, very rare, can cause diarrhea in immunocompetent and severe/persistent diarrhea/malnutrition in immunocompromised.

9. Strep bovis

- S. gallolyticus (S. bovis type 1) is one of the 4 major species of group D strep and is associated with a significantly increased risk of colorectal cancer and endocarditis compared to S. Bovis type II. 

10. Drugs and toxins that cause liver injury

- Drugs that cause direct toxic effects (dose dependent, short latent periods: tylenol, carbon tetrachloride (CCl4), tetracycline, amanita phalloides

- Drugs that cause idiosyncratic reactions (not dose dependent, variable latent periods): isoniazid, chlorpromazine, halothane, antiretrovirals 

- Drugs that cause cholestatic liver damage: anabolic steroids, erythromycin, chlorpromazine, nitrofurantoin 

- Drugs that cause fatty liver: antiretrovirals, tetracycline, valproate 

- Drugs that cause hepatitis (histology: hepatic cell necrosis, panlobular mononuclear infiltration): isoniazid, halothane, phenytoin, alpha-methyldopa. 

- Drugs that cause fulminant liver failure: tylenol, CCl4, amanita

- Drugs that cause granulomatous liver injury: allopurinol, phenylbutazone. TB infection can also cause this.