1. Transient global amnesia
- Processing is normal but people fail to make new memories
- Resolves within 24 hours
- Cause unknown.
2. Findings on radiograph that help with TB
- Upper lobe disease: TB goes to your lower lobes first because you ventilate it more, then they multiply, go to your hilar nodes, then thoracic duct and go systemic. It settles in the upper lobes because they are oxygen loving and you perfuse your upper lobes less and thus extract less oxygen from the air.
- Reticular nodular
- Cavitary
- If you don't have any of the signs, odds of TB<1%. Unless someone has a low CD4 count; they get a primary active TB when they inhale it for the first time (TB goes to lower lobes and immediately prevails). HIV with normal CD4 count presents like anyone else with TB.
- Key TB risk factors: recent active exposure and foreign-born (asia/africa). Other risk factors are less specific.
3. Dx TB
- Sputum for AFB (bronch if you need to) - stain and culture.
- Treat for CAP until you're sure its TB
- Quantiferon uses a specific antigen that doesn't cross-react with BCG.
- Don't start TB meds until you're sure it's TB
4. Respiratory viruses
- Only virus that cause high fever is influenza (adeno, others don't)
- If you're not in flu season, having a high fever tells you something. You should be thinking bacterial pneumonia rather than respiratory viruses.
- If you come in with a 102 degree fever and a cough in July, you get a CXR. Because respiratory viruses don't happen
5. High fever + diarrhea
- Salmonella, shigella, campylobacter
- High fever rarely occurs in viral gastroenteritis
6. Risk factors for aspiration = people with difficulty swallowing
- Neurological - dementia/stroke
- ENT problems
- Drugs/alcohol
- IV drug use
7. PCP pneumonia
- Diffuse homogenous alveolar filling space
- When you treat it with bactrim, DON'T FORGET STEROIDS. Because it'll lyse the cells and create such a bad ARDS that you won't be able to oxygenate through.
- If someone comes in and you suspect PCP, and labs come back with HIV+ and a low CD4, keep them on their drugs and send them to get a bronch for definitive diagnosis. Because it may be PCP, fungal, MAI, they can all present similarly.
- Physical exam is not good at detecting this, if you suspect it you need a bronch.
8. Healthy people with cough and low grade fever for a week, yellowish sputum => viral bronchitis. No evidence that people with viral bronchitis get better with antibiotics.
9. Viral flu: people tend to get sick really fast, spike a fever really fast, and then slowly get better. Bacterial pneumonia can also present like that, and can also present with slowly increasing fever over time. Viral flu does NOT present with slowly increasing fever over time.
10. Incidence of DM is very high among Scandinavian countries and extremely low in Asian/Indian populations (600 fold difference in incidence) that seems more a function of geography/environment than genetics. Icidence is increasing over time, mostly in very young kids in Finland, preteens in US