pregnant with active HBV - tx newborn with HBIG and HBV vaccine Beck's triad for tamponade - hypotension, JVD, muffled heart sounds (also pulsus paradoxus). Electrical alternans subarachnoid hemorrhage - increased ADH and BNP --> hyponatremia. Tx - water restriction coccidioidomycosis - SW US, central/south America. Pulm infection - dry cough, weight loss, pleuritic chest pain, erythema multiforme/nodosum, arthralgias histoplasmosis - SE US, mid Atlantic, central US, caves. Acute PNA, but usually asymptomatic. HIV disseminated infection- hilar LAD, pneumonitis, pancytopenia, hepatosplenomegaly, palatal ulcers. tx- IV amphotericin B followed by lifelong itraconazole. Blastomycosis - central US (most in Wisconsin). Often asymptomatic or flu-like Sx. Systemic disease- lytic bone lesions, pulmonary infection, skin lesions. Dx- broad-based budding yeast. Txitraconazole, amphotericin B aspergillosis - invasive in IMCD. CXR - cavitary lesions. CT - pulm nodules, halo sign, air crescent sporotrichosis - subcutaneous infection. Gardeners. Travel up lymphatics for nodules on forearms cryptococcus - pulm infection often asymptomatic. Usually meningoencephalitis in HIV with CD4<200>50 years old, high ESR. Tx- low dose prednisone, high dose for temporal arteritis massive blood transfusion - citrate anticoagulant --> chelates Ca and Mg --> low Ca --> paresthesias, hyperactive reflexes nephrotic syndrome - dyslipidemia, accelerated atherosclerosis, hypercoagulable, risk for MI/stroke, higher infxn susceptibility. Can have renal vein thrombosis, usually with membranous GN aortic regurgitation - early diastolic (mild) to holodiastolic (severe) murmur. Bounding pulses. Txdecrease afterload with DHP Ca-channel blockers, ACEi, NOT beta blockers. mycoplasma PNA - erythema multiforme. No cell wall so not on gram stain candidal vulvovaginitis - pseudohyphae. In IMCD and Abx treated people. Tx- oral fluconazole, topical nystatin nonseminomatous germ cell tumor - large anterior mediastinal mass, young males. High HCG and AFP. seminoma - high HCG but normal AFP thymoma - associated with myasthenia gravis, pemphigus hepatocellular carcinoma - high AFP but normal HCG choriocarcinoma - gestational trophoblastic disease usually in molar pregnancy. Very high HCG C. dif diagnosis - cytotoxin assay of stool Erb-Duchenne palsy - C5, C6. waiter's tip, absent Moro but intact grasp Klumpke's paralysis - C7, C8, T1. hand paralysis, Horner's (ptosis, miosis) dermatitis herpetiformis - papulovesicular, pruritic. Associated with Celiac. Dx - IgA antiendomysial Ab, anti-gliadin phenelzine - MAOi antidepressant. Avoid tyramine (aged meat/cheese) --> HTN crisis CMV esophagitis - in HIV. Dysphagia, odynophagia, shallow ulcers, intranuclear/cytoplasmic inclusions. Tx- ganciclovir IV HSV esophagitis - in HIV. Small ulcers with volcano-like appearnace. Eosinophilic intranuclear inclusions. Tx- acyclovir candidal esophagitis - most common HIV esophagitis. Tx - oral fluconazole splenic rupture - ex-lap if unstable. CT if stable pseudocyesis - pregnancy conversion disorder prolactin - stimulated by serotonin and TRH, inhibited by dopamine. Hypothyroid --> amenorrhea/galactorrhea adenomyosis - endometrial glands in myometrium. Usually > 40yo, dysmenorrhea, menorrhagia, enlarged symmetric uterus. Must curettage to r/o endometrial carcinoma leiomyoma/fibroids - irregular shaped uterus endometriosis - uterus not enlarged. Dysmenorrhea, dyspareunia, dyschezia. Dx- laparoscopy. TxOCPs aminoglycosides - amikacin, gentamicin, tobramicin. ototoxic, nephrotoxic. Gentamicin very ototoxic hydroxychloroquine - DMARD. Treats SLE. SE - retinopathy/corneal damage (need q6month eye exams), GI, hemolysis in G6PD methotrexate SE - DMARD. Inhibits folate metabolism. Macrocytic anemia, GI, hepatotoxic, ILD, alopecia, pancytopenia premature ovarian failure - low estrogen, high FSH > LH, <40yo>