Human monocytic ehrlichiosis Lyme Disease:

Tick vector (Lone star tick) Ceftriaxone for neurologic/cardiac Lyme disease
Ixodes scapularis tick: Not seen in the southern united states
Southeastern or southern central United States
80% of patients have classic erythema migrans rash
Symptoms:
Unlikely jto have heme/liver abnormalities seen in ehrlichiosis
Fl-like illnesss with high fever, HA, myalgias, chills Neuor = enchealities, NC palsy, radiculopathy
Neurologic confusion cardicaCc: pericarditis, heart block
Rash is uncommon***** Neuro/cardio happen weeks to months after; fever wont be as high
Like rocky mountain spotted fever without the spots) Amoxicillin if pregnant
Leukopenia and thrombocytopenia Borrelia burgdorferi spirochete form ixodes scpaularis, deer tick
Elevaeted liver enzymes and LDH Northeastern and upper midwestern US
Intracytoplasmic moruale in monocytes Doxycycline excellent option unless young or pregnant. Then oral amoxicillin

Positive PCR for ehrlichiosis chafeensis or ewinigii

Treamtent: empiric doxycycline while awaiting confirmatory tesintg
Choramphenicol = 2nd line option, but causes blood dyscrasias
Meningitis
Cryptococcal Meningoencpehalitis Meningococcal Meningitis:
Subacute (over 2 weeks) Severe myalgias | Petehicia/purpura
Papilledema Meningitis symptoms
HIV association with CD4 < 100 DIC, adrenal hemorrhage, multiorgan falure, shock more common
CSF: Treatment: 3rd gen cephalosporins + vnaco (no glucocorticoids
Low glucose, high protein, high opening pressure, mononuclear CSF predominance, but <50/uL Chemoprophylaxis with rifampin, icpro or ceftriaxone of all repsiratorty ontacts
Transparent capsule seen with India ink stain
Cryptococcal antigen positive
Sabouraud agar culture CSF fluid analysis
Treatment: Amphoteicin B with flucytosineFluconazole Normal: 0-5 WBC, 40-70 glucose, protein <40
Lymphocytic pleocytosis Bacterial: >1000 wbc, glucose < 40, protein > 250
Tuberculosis: 5-1000 WBC, glucose < 10, prpotein > 250
CMV in HIV Viral: wbc 100-1000, glucose normal, protein < 100
Causes retinitis when CD4 < 50. May have periventricular enhancement, but would not have papielledema Guillan barre: normal WBC count (0-5), normal glucose, but elevated protein (45-1000)
HSV Encephalitis
HSV1 Encpehalitis
Behavior changes + focal neurologic deficits/seizures Kids < 1 month:
Temporal lobe involvement on MRI Strep pneumo + Neisseria meningitidis are most common causes
Neonates < 28 days: use ceftriaxone over cefotaxime
JC Virus Dexamethsone (in case hflu is cause to reduce sneosrineural hearing loss)
Multifocal Progessive Leukoencphealopathy (PML): Head CT reserved for patients who are comatose, have focal findings or hx of neurosurg proceure
Dx with CSF PCR. Patchy areas of white matter with demyelintaion

Toxoplasma Gondii
Acute Bacterial Meningitis:
Serum toxoplasma antibody tests
Ages 2-50: strep pneumo/Nesierria -> Vanco+3rd gen cephaosporin
Ring enhancing mass lesion on neuroimaging
Age 50+ : strep pneumo/nesieria, liseteria vanco, 3rd gen ceph + ampicillin
Immunocompromsied: strep pneumo, n meningitdis, listeria, gram neg rods vanco, cefepime, ampicillin
Waterhouse-Friderihsen Syyndrome Neurogsurg: gam neg rods, mrsa, coag neg staph vnaco + cefepime
Sudden vasomotor collapse, skin rash (large purpura of flank) from adrenal hemorrhage) Dexamethone until cultures rule out strep pneumo pmeningitis
10-20% of infant with vasomotor collapse, large ptechaei, purpuric, 100%ish mortality
Trauma
Puncture deep wound: Necrotizing Fasciitis:
Staph aureus Pain our of proportion, air in deep tissue
Pseudomonas aeruginosa (especially if by rusty nail due to warm, moits environment) Group A strep most common, but polymicrobial

Osteomyelitis takes ~2 weekst o form

80% contiguous
20% hematogenous vertebrae/pelvis/hips (unrelated to puncture wound) Rabies PEP:
High risk animal (bat, racooon, skunk fox, coyote)
Treatment: ciprofloxacin or pip tazo and surgical debridement
Euthanize and test and start PEP if positive; start PEP if animal not available
Low risk animal (squirrel, chpmunk, mouse rat, rabbt)
No PEP
Empiric antibiotics for flinched fist fight bite injury from human bite woud
Pet (dog cat gerbil ferret)
Polymicrobial
Quarntine and observe for 10 days; start Pep if healthy
Aerobic+anaerobic oral flora PEP if not availbale
Staph aureus, eikenella corrodens, hflu., b-lactamase producing anaerobic bacteria Livestock or unknown wild animal = contat public health
Pain/swelling/purulent discharge
Amox/clavulanic acid due to coverage o gram+, gram neg and b-lactamase producing oral anaerobic organisms
Cutaneous Larva Migrans:
Sirgical debridement stypially needed. Allow wounds to drian opena nd heal by 2ndary intention. Ive tetanus Hookwrom larvae (dog, ancylostoma caninum, or cat (a brazileinse)
if needed
Humans = incidental hosts
Barefoot contact with contaminated sand/soil
Undercooked, conatianted work/GI infection taenia solium anorexia/padboamianl pain, cucan cause Rpimary oewr extremity, cutaneous infection with intensely pruritic migrating serpinios reddish brown tracks
and purirticiness
cysticersosi by fpassing via fecal/oral route
Normal eosinophil conut
Anti-helminthic (ivermectin) for treatment:
Dog or cat hookworm larvae ancylostoma canium.
Urushiol = poison ivy/oak/sumac intensely pruritic linear/vesicular
Larvae unable to penetrate dermal BM, so cutaneous infection nly.
Decaying vegetaoin,g ardening, landscaping, nodule tha tulcerates, drainis odorless nonpurulent fluidnodular
lesions along lympathic change
Absent prurits.
Brown recluse spider beite: upper arm.t horax, red plque./papule with central clearin gand necrotic eschar
Upper airway
Infectious mononucleosis:
25% false negative during first week of illness
Atypical lymphocytosis
Transient hepatitis
Avoid sports for 3-4 weeks
HIV
Prophylaxis Toxoplasma Gondii:

200 = PJP Bactrim CD4 < 100 multiple Ring enhancing lesion on MRI

100 = Gondii PJP Bactrim Intracellular protozoan reactivation

50 = MAC Azithro Workup: T Gondii IgG antibody for anyone with HIV

150 = Ohio/Misssisippi Itraconazole for Histoplama

Kaposi Sarcoma:

Pregnancy: Vascular tumor due to coinfection with HIV and HHV8 in MSM

HIV RNA viral load q2-4 weeks after initiation or change of therapy, then monthly, then q3mo <200 cd4 count, aids defining illness

CD4 every 3-6 months Legs ,face oral cavity, ganitlaias, gi tract,s lungs

Resistance testing? Paupulesplaques/odules that change from light brown to violet, multiple lesions

ART initiation Biopsy for confirmation after clinical diagnosis:

Avoid amniocentesis unless <1000copies/mL Diseaes witll dregress with HAART, but may reuires chemo

Viral load < 1000 copies: ART + vaginal delivery

Viral load > 1000 copies: C. section, ART, zidovudine

Bartonella Henselae Bacillary angiomatosis in HIV
Postpartum:
Friable bright red firm exophytic nodule in an HIV partient; treated by oral erythromycin as its a gram negative bacillus. Above eyelid
Mom: contienue ART

Infant: Zidovudine (if maternal load <1000) for 6wks

Multi-drug ART if maternal viral load was > 1000)

Anti-Retroviral Therapy:

Reactivation Tuberculosis: 3 drug regimen

Cavitary upper lung inflammatory lesion 2 nucleoside reverse transcriptase inhibitors +

Substance abuse Either a protease inhibitor or a non-nucleoside reverse transcriptase inhibitor

Subacute/chronic symptoms, worse in omrning due to overnight pooling of secretions Make sure to include a NRTI with good placental transfer (Zidovudine/Tenofovir)

Lung apices duet to high o2 tensions and slower lymphatic elmiantions in lung apices as its an aerobic organism

Other penumoansi:
Esophagitis:
Aspiratoin = right lower lobe, acute
Candida
Crytococcal = subacute meningitis, but sever and uner 100 cd4 count typically
HSV (roud/ovoid ulcers, concorreunt oral HSV) + eosinophilic intranuclear inclusions
PJP: cd4<200, subacute, noncavitary, difuse alveolar infiltrates
CMV: deep linear ulcers, distal esophagus; Intranuclear + intracytoplasmic inclusions
Primary lung cancer: nodule with hilar LN involvement
Hisotpathology tand culture oto confirm; occurs most commonly around 50-100mm3. most common = cancida, but not if severe pain

HIV Screening:

15-65
Diarrhea:
4th generation assay; HIV p24 antigen + HIV antibodies
Cryptosporidium: severe watery diarrhea + low grade fever
Confirmatory stesitng iwht HIV1/HIV 2antibody differention immunoassay
Microsporidium = watery diarrhea, no fever
HIV RNA is recommended if high susipicon with engative serologic sttests
MAC: <50/mm3, high fever, wateyr diarrhea

CMV: low volume bloody small vlume diarrhea

Dx: colonoscopy with eosinophilic intranuclear/basophilic inracytoplsmic ilnclusions, PCR. Ganciclovir treatment. Check for retinitis
Tropical
Chikungunya Fever: Legionella Pneumonia
Central/South America, Africa, South Asia
Aedes mosquito (Same as dengue fever)
3-7 day incubation period; high fevers; polyarthralgias
Headaches, myalgais, conjunctivitis,diffuse maculopapular rash
Lymphopenia, Thrombocytopenia, elevated liver enzymes
Tx: supportive care
Methorttreaxate for chroni arthralgias (30%)
Contaminated Water (hospital/travel/cruise/hotel)
Fever | diarrhea/vomiting | delayed pulmonary symptoms
Hyponatremia | lobar infiltrates | gram stain with PMNs and
few/no organisms
workup: legionanna urine antigen
Treatment: newer macrolide or respiratory fluoroquinolone
Somewhat notable for legionella:
Hypontaremia
Confusion | Gi symptoms | hepatic dysfunction
intracelular
Immunosuppressed/Transplant
PCP and CMV are the main opportunistic infections Bacillary angiomatosis
TMP Sulfa for PJP and valganciclorvir for VMC Bartonella specieis
Friable papules/aplaques
Tissue Invasive CMV disease Fevers/systemic symtopms, may involve mucosa/visceral
Pulmonary (dyspnea, cough)
GI (diarrhea, hematochezia)
Cryptococcus:
Papular skin lesions if immunocompromised with disseminated
Pneumonitis, gastroenteritis, hepatitis
infection , pulmonary ad CNS involvement
CMV dna in blood using PCR for daiagnosi
Treatment = stop antimetabolite immunosuppression
(mycophenolate) and start antiviral therapy
IV gangciclovir if severe (meningoencephalitis, pneumonitis,
high virald load, severe GI disease)
Oral valaganciclovir if not severe
Unvaccinated Ilnesses
Mumps Measles:
Fever | Parotitis | nonspecific prodrome Higher fever (104F)
More esvere disease in adults Center of body out (cephalocaudal)
Complications: orchitis, aseptic meningitis, (orchitis if older), Cervical LAD

Rubella: Rickettsia rocky mountain spotted fever:

Arthritis, fever, maculopapular rash that spreads caudally (Headbodyspares palms/soles) Febrile prodrome erythematous macular rash that stars at wrists/ankles and spreads centrally, but does
involve palms and soles
Suboccipital/posterior auricular LAD
Congenital Secondary syphilis:
Sensorinueral hearing loss cataracts, PDA Fever/maculopapular rash that starts icentrally and spreads to extremities, and does involve palms/soles
Maternal 1st rimester rubella infection (which are spared in rubella)
Confirm via infant igM
Adults: Scarlet Fever:
Maculopapular rash + arthralgias/arthritis
Rash on neck/axillae/groin in 12-48 hours that then generalized
Vaccine
Sandpaper like punctate fine popular texture with preeding strep pharyngitis or skin infection. Circumoral
Live attenuated pallor due to red cheeks.
Desquamation of face, trunk and then hands/feet
Acute otitis media:
Penicillin V = drug of choice.
Facial nerve palsy/mastoiditis

Pertussis:
Catarrhal: 1-2 weeks of mild cough/rhinitis
Paroxysmal: 2-6 weeks of coughing wth an inspiratory whoop, and posttussive emesis
Covalescent: weeks to month with gradual symptom resolution
Diagnosis: pertussis culture or PCR with lymphocyte predominant leukocytosis seem on CBC
Treatment: macrolides,
Prevention: acellular pertussis vaccine
Tdap given 5 5x in childhood (final dose at 4-6), but need booster at 11-18 and with pregnancies or waning
aimmunity pertussis in a 13 year old
Other
Aspergillosus: HIB Epiglottitis:
Pulmonary disease (pleuritic hcest pain, hemoptysis) Rapidly progressive fever, sore throat, drooling, muffled voice,
Nodules, focal infiltrates airway obstruction, stridor, dyspnea, pooled oropharyngeal
secrestoins/laryngotracheal tenderness
Cryptosporidium Diagnosis = direct isualizaiton/imaging
Diarrhea in immunosuppressed Treatment = early artificla airway if needed
IV antibiotics (Ceftriaxone+vancomycin)

Leprosy: Vibrio Vulnificus

Primary developing world (asia, Africa, south America)
Gram negative, free living in marine environments
Repsiratory droplets/nine banded aramdilllow
Investion(osyters) or woud infection)
Low infectivity
Increasd risk in those with liver cirrhosis or hereditary liver disease
Macular, anesthetic skin lesions, raised borders or hepatitis lke hemochromatosis
Nodular, painful nearby nodes, loss of sensory/motor function Diagnosis with blood and owund cultures
Full thickness sn lesion biopsy at active edge, noc tulturalbe Empiric treatment as its highly fatal
Dapsone rifampin for termatne; asdd clofazime if IV ceftriaxone and oxycycline
severe/multibacillary
Presnets iwith hemorrhagic bullous lesions and nectotizng fascities if
dm2 or other comrobdies and septic chochoks. Needs IV treatment
Neonatal sepsis
Temperature instability, poor feeding, jaundice, CNS signs,
abnormal WBC count, left shift (bandemia)
Wokrup: Blood, urine + CSF culture
Treatment: empiric parenteral antibiotics
CBC, LP, UA, urine culture
Ampcillin gentamicin after cultures
Rare
Neurocysticercosis:
Actinomyces Taenia Solium (Pork Tapeworm) eggs
Anaerobic oral cavity bacterium Fecal/Oral human transmission
Immnuosuppression Central/South America
Direct extension, slow growing nontender indurated submandibular mas Sub-Saharan Africa, asia
Multiple sinus tracts to skin Seizures, proonged incubation
Pruulent sdischarge with deiscrete yellow granular sulfur granules Ich (headache, vomiting ams)
Mandible 50% of infections Cysts(hyodense, enhancedment, edema, calcified on CT/MRI)
Fine needle aspiration culture for diagnosis; high dose penicllinf irst line treatment for mild cases; IV peinllciln and surgery if Treatment: seizure/IVH management, albendazole for antiparastiic therapy and corticosteroids
more severe
Uncercooked contaminated pork from tapeworms being localized in GI tract but eggs then pass vi fecal oral route.
Resembles TB on gram stain abut is not acid fast
Ingested eggs will then hatch in the small intestine, invade the bowel wall and spread hematogenosuly to the brain, msulee and
liver to cause cysticercosis
Nocardia
Cysts degenerative other months to years causing inflammation/edema/illness
TMP Sulfa for treatment
Neruocysticercosis manifests as
Nonpaiful subq lesions that are chronic with draining sinus tracts
Adult onset seizure
From gardening/farming, and on feet/legs/back (not face
ICH increase from csf outflow obstruction
1+ cystic lesions on brain ct or mri with surrounding contrast enhancement and edema w/o dispaceent of other tissues
Calcified nodules
Trichinellosis:
Albendazole for treamtnet
Ingestion of undercooked meat/pork
Phenytoin for antiepileptics
Endemic in mexico, china, Thailand, central Europe argentina
Gastric acid releases larvae (within 1st eek of ingestion) that invades small intestine and develop into worms
Female worms release larvae 4 weeks later that migrate and encyst in striated muscle Ascariasisis:
First week: abdominal pain, nausea, vomiting diarrhea Intestional symptoms, eosinophilia
Muscle stage (4 weeks fater ingestion) Lung phase with nonproductive couhgh asymptomatic intestinal phase
Myositis, subungual splinter hemorrhage, periobtal edema, eosinophilia (>20%) with elevated CK/leukocytosis Worms can obstruct small bowel or bile ducts
Roundworm

Dengue Fever:
Tyhpod Fever: Fever, HA, retro-orbital pain, rash, myalgias, arthralgias
Fever in 1st week, abdominal pain, salmon colored rsah in 2nd week, hepatosplenomegaly and abd complications like intestinal Hemorrhagic dengue fever with sginfificant hemorrhage in skin/nose
bleeding or peforaitons in the 3rd week. Noe osinophilia
Does not cause marked eosinophilia
Rare summarized
Neurocysticercosis: Naeglaria Fowleri:
Taenia Solium (Pork Tapeworm) Fresh water amoebi causing meningoencephalitis 99% mortality
Cysts on CT/MRI | Seizures
Albendazole (anti-parasitic) + Steorids Coxiella Buretti:
Rickettsial bacterium
Creutzfeldt Jakob Disease: Q fever via aerosl contimation inhalation from infected livestock
Prion | dementia |myoclonus | fast Consumption of unpastuerized milk

Toxoplasma encphealitis: Blastomycosis:

Addvanced HIV (cd4 < 100) 3mo history of low grade fever, night swates, productive cough
Focal neurologic deficits, seizures, multiple ring enhancing lesions Verruous skin involvement, + lytic bone legions +
Midwest(wsicsonsin) location
Can resmeblt TB.histoplasma, but blastomycoses uniquely causes
Rabies: unlceated skin lesiosn and ltyic bone lesions
Prodrom hydrophobia, pharyngeal spasms, hyperactivity, coma,
death
Coccidiomycoses:
southwestern united states, fever, cough, nightswetas, skin,
Cerebral malaria: meninges, lung, skeletal involvement all psisble
fever,
Vaccination schedule/guidelines
Meningococcal vaccination: Chronic Liver Disease
Ages 11-12 + Booster at 16-21 Td q10 years; Tdap once
Any age (even > 18 if high risk) Influenza annually
College students PPSV23 once (then PCV13PPSCV23 at 65)
Travel to endemic areas (Africa. Saudi arabia, mecca) Hep A (2 doses q6 months)
Military Hep B (3 doses, 2nd at 1mo, and 3rd 4mo later)
Complement deficiency
Asplenia Bordella Pertussis Contact prophylaixis:
<1 mo = azithromycin x5
Live attenuated Vaccine contraindications
>1mo: azithro x5, or clarithoy6 or erythyo 14 days
TNF-alpha antagonists (adalimumab)
Decreased tranmsision if treated in early catarrhal stage
Intranasl influenza
Varicella Pertussis:
Mmr 5 doses with the diphteria and tetanus vaccines
Oral polio 2 months, 4 months, 6 months, 15-18 months, 4-6 years
Rotavirus Boosters q10 years
Yellow fever Respiratory isolation for first 5 days of antibiotic therapy
(if going to central Africa countries)
Other CX: allergy to eggs Varicella:
Aids, recent transplaknt Doses at age 1 and 4; give postexposure VZV vaccine. If cant give
TNF agntaoginists, high dose steroids vaccine, giv evaricella IG. No need if under 1 year od
Live vaccine
Post-Op Fevers
Immediate
Prior infection/trauma, surgery inflammation, malignant
hyperthermia, anesthetic medications, blood products
during/prior to surgery
Febrile nonhemolytic transfusion reaction
Resdiual plasma.leukocyte debris remains in red cell
concentrate, release cytokine and cause transient
fevers/chillsmalise w/o hemolysis within 1-6 hours of
transfusion
Acute (within 1 week) = nosocomial infections
(pneumonia/UTI or PE)
Subacute (>1 wee): drug fever, surgical site infection, PE
Delayed: infection (viral infection from blood products,
,infective endocarditis)
Transfusion reactions:
1-6 hours: nonhemolytic febrile, leftover leukocytes
Within 1 hour: acute hemolytic: flank pain, dic, emogloinuria,
renal failure (from direct oomsb + with new ab screen)
Anaphylacic (few seonds, anti-iga antibodies),
Uriticarial (within 2-3 hours), urticaira, flushing,
angioedema,pruritic (ige antibodies + msat cell activtiaesoin
(recipient ige antibodies)
TRALI (within 6 hours, respiratory distress, noncardiogenic
pulm eema)
Infective Endocarditis
Staph Aureus Symptoms:
Prosthetic valves, IV catheters, pacemaker/defibriltor, IVDU Tender erythematous lesions on tinger tips = oslers nodes
Strep Viridians Prior rheumatic ever history
Gingival manipulation; respiratory tract invision/biopsy Olocystolic murmurs

Staph Epidermidis Staph = #1 healthcare associated IE

Prosthetic valves, intravascular cath, implanted devices Sttrep = ocommunity acquired IE
Enterococcus Enterococci = 30% nosocomial acquired endocaditids,
Nosocomial UTIs especially with nosocomial uti in hx
Strep Gallolyticus (S bovis) Dukes Criteria:
Colon cnacer, IBD Strep viridans/Stpah aureus/Enterococus blood culure positive
Valvular vegetation on echo
Fungi(Candida)
Immunocomporomised, intravasc cathethers, prolonged Minor criteria:
antibiotics IDU, predisposing cardiac lesion, temp > 38, embolic
phenomena, immunologic phenomena, positive blood cx not
meeaing abov criteira (need 2 major or 1 majoe + 3 for
definitie)
Drug Side Effects
Isoniazid:
Hepatotoxicity
Peripheral Neuropathy (pyridoxine B6 deficiency)
Stocking glove numbness/tingling
Osteomyelitis
Staph Aureus = #1
Infants = others = GBS and e coli
Children = others = strep pyo
Prosthetics = staph epi
Salmonella
Painful genital ulcers
HSV = tender, grouped, shallow, tender LAD

Haemophilus Ducryei
Large deep exudative deep ulcers with driable base
Severe LAD that may be suppurative?

Nonpaifnful ulcers;
Syphilus: single chancre ulcer with hard base nad regular
oborders

Chalmydia trachomatis serovars l1 to l3

Lymophgranuloma venereum
Small shallow ulcers often missed
Painful clutant adenitis (buboes)
y
Healthy Kids
Croup: Bacterial Sinusitis:
Laryngotacheitis Persistnet nasal drainage/congestion/cough for 10-30 days
Parainfluenza Virus 3 days ofpurulent nasal discharge and fever above 102
6mo to 3 years old Predisposition: viral URTI that failed to be cleared by mucocilairy
Barky cough learance due to viral infection causing mucosal inflammation
Inspiratory Stridor (biphasic if severe) CT scan to assess fo rorbital cellulitis/intracranial extension
complications if needed (sinus ipopacificaiton, mucosal thickening,
Hoarse Voice air fluid levleings)
Steeple sign on XR of anteroposterior neck showing steeple sign (due Treamtent = amoxclav
to subglottic edema)
Treatment:
Corticosteroids if mild
Nebulized racemic epinephrine for stridor at rest

Bronchilitis
< 2 years old
RSV
Wheezing/Coughing
Lower respiratory tract illness
Fever, respiratory distress, wheezing
No isnspiratory stirodr, no braky cough
Face infections
Rhino-orbital-cerebral mucormycosis (Rhizopus) Cervical Lymphadenitis:
Risk Factors Tender, erythematos enlarged LN.
DM2/DKA/Heme Malignancy/Transplant Acute unilateral lymphadenitis = staph aureus group A
Manifestations: strep
Aggressive fever, nasal congestion, purulent nasal discharge, DDX:
necrotic invasion of palate, orbit, brain, nasal turbinate, Francisella tularensis (Tularemia) = unilateral cervical LAD,
headache, sinus pain infected animal contact. Not tender?
Dx: Sinus endoscopy with biopsy and culture Peptostrepcoccous:
Tx: debride, liposomal amphotericin B, elimination of risk Uniltearel lymphadenitis in odlerchildren iwht periodontal
factors disease

Hyphae Nontb myobacteirum

Rhizopus/mucor molds that are ubiqutiosuin the envirnonment
Spore are inaheld and converted to hyphae in nsal
tubrinates/respiratory tree and immunocormpimesd people
they get infection with necrotic spread
Subacute chronic unilateral lad, children <5 with firm
nontender LAD lesst han 4cm in size. Violaceous color over
lymph noe due to skin thinnings. Fever/tenderness
unusual/unlikely
EBV: subacte/chronic LAD + systemic symptoms (HSM, fever,
pharyngitis, (nontender?)
Throat Infections
Herpangina
3-10 yo, summer early fall, coxackie A virus
Fever,pharyngitis, gray vesicles/ulcers on posterior orpharynx
Supprtoive tx

Herpetic Gingivostomatitis:
6mo to 5 yrs, HSV1, fever, pharyngitis
Clusters of small vesicles on anterior orphranx
Oral acyclovir

Group A strep pharyngitis:

Exudates, palatal ptecehiae, sore throa odynophagia, tonsillar
erythema
Tender anterior cervical LNs
Rapid strap antigen testing/throat culture
Cantor criteira fonly for adults includings absence of cough
Pulmonary Infections
Miliary Tuberculosis: Mycoplsma Pneumoina:
Subacute symptoms (fatigue, fever, weight loss, cough) Subacute fever, pulm symptoms, reticulonodular cxr pattern.
IVDU, recent incarceration 2-3 weeks, not going to cause 2+ months of symptoms
Diffuse reticulnodular pattern (millet seed)
Miliary Tuberculosis from hematogenous spread of mycobacterium
tuberculosis. Legionella:
Primary infection or reactivation Travel, hyponatremia, bradycardia, neuro/gi/resp
Subacute/chronic symptoms No reposne to b-lactams/aminoglycosdies
Extrapulmonar disease in lymph nodes ,, liver, bones, CNS no organisms on gram stain
Can cause hematuria/proteinuria
Treatment: macrolide/fluoroquinolone; urine antigen testing for dx
Hogins lymphoma:
Painless lymphadenopathy, B symptoms, mediastinal mass (not diffuse
reticulonodular pattern) Nocardia:
Gram+ partially acid fast branching rod
Metatstic lung disease: Immunocompormised
Multiple mass presentation with lympangetic carcinomatosis Similar to TB pneumonia
Brain abscess CNS involvement + cutaneous ivolvement
Tx: Bactrim + surgical drainage of abscesses
Nodular or cavitary upper lobe lesions
Sptum culture typicall neagative, but bronchoalveolar lavage culture
postiive
GU Infections
Urethrtis:
Gonorrhea, Chlamydia, mycoplasma genitalium and rarely
trichomonas
Dsuria, discharge, urgency, voiding freuqnecy
Dx: UA, gram stain/culture, NAAT testing
Treatment:
Azithromycin or Doxycycline for Chlamyydia
Plus ceftriaxone if gonococcus not ruled out or is suspected
Trichomonas:
Yellow green frothy foul smelling vaginal discharge, dysuria,
dyspareunia, oral metronidazole, tinidazole , refrain from
alcohol consumption due to disulfiram like reaction on
metronidazole. Treat empirclaly. Treat partner, dont need to
test partner.

Suprapubic discomfort if acute bacterial cystitis

Gonococcal urethritis would show gram negative cocci in 95%
of cases
Congenital infxns
Rubella: PDA, cataract, hearing loss, leukocoria (white reflex) from 1st Jarisch hexheimer reaction:
trimester maternal infection
6-14 hours after treamtne of primary or secondart syphilis treamtnet
(but also other spirchoete like lyme or leptospirosis treatment)
Acute onset of feer,s hcills ,yalgais, rash progression in secondary syphilis
Toxoplasma: chorioretinis, hydrocephalus, diffuse ntracranial
calcifications Supportive iF vlfuids,t ylenols, nsaids, self limtiing

Congenital cmv: chorioretintis, periventricular clacifcaitons.

Congenital variecella: limb hyplasia, cataracts, scarring skin lesions

Congneital syphilis: hepatomegaly, snuffles, osteoarticular

destruction, maculopapular rash, Hutchinson teeth. Late sensorineural
hearing loss if untreated

Hsv: transplacental infxn is rare; acquired perinatally during delivery

Brain destrucoitn, seizues, vesicular skin lesions
Prostehtic joint infections
<3months:
Early onset
Acute pain, wound infection/breakddwon, fever
Staph Aureus, Gram neg rods, anaerobes
Overt signs of infection

3-12 mos (delayed onset)

Chronic joint pain, implant loosening, sinust ract formation
Coag-neg staph, propionobacteirum, enterococci
No clea rfever/leukocytosis

12+mo
Acue symptoms wen previous asymptomaic, recent infecoitn
Staph aureus, gram neg rods, b-hemolytic strep
STDs
Syphilis treatment:
Penicillin G(IM)
Primary: 1 dose [Chancre]
Secondary: 1 dose [Generalized rash]
Latent [Asymptomatic]: 3 doses
Tertiary (CV, gummas): 14 days
Alternative for severe penicillin allergy:
Doxyx14, doxyx14, doxyx28, cefriaxonx14.
RPR, nonrtrponemal titers at treatmena and at 6-12 months
to ensure treatment response (4x decrease in tites0:
especially if not getting penicillin
Common skin infections
Erysipelas: strep pyogenes: superfcialddermis/lympahtics
with raised sharply demarcated edges, rapid spread and feve
early
Ear involemetn = erysypilsa (as no deper dermis leayer there
so cant be cellulitis)

Cellulitis(nonpurulent): strep pyo/MSSA: Deep dermis/subq

fat, flat edges with poor edemrarcation, indolent, localized
(fever later)

Cellulitis (purulent): MSSA/MRSA: purulent drainage

Folliculitis infected hair folicle
Fruncules= folliculitis dermis abscess
Carbunlce: multiple furuncules
Environmental
Blastomycosis: Ehrlichiosis:
South/Midwest/central Amlyomma americanum
Contat with soil/rttitng wood/osteolytic bone lesions, prostate involvement, skin lesoins Leukopeina/Thrombocytpenia + flulike symptoms
Pneumonia + wartlake violaceous nodules + Ulcers
Prostate/epididymitis infection
ItraconazoleIV amphotericinB
Rabies:
Acute/chronic pneumonia often with skin lesions (3-6 week incubation)
Bats, ascending flaccid paralysis
Babesiosis:
Babesia Micoti for Ixodes scapularis tick (same as Lyme)
Coccidioides
Flu severe
Endemic mold of desert southwest
Anemia, Thrombocytopenia, elevated LFTs/bili/LDH
Aerosolized spores in dry months after a rainy season
Blodo smear with intraerythocytic maltese cross rings
Inahaltion of a isnlgle arthroconidium causes infection after 7-14 days of inoculation
Increased risk with splenectomy; atvaquone+azithromycin for tx
50%+ develop community acquired pneuoni, lobar infiltrate, arhtralgais, erythema anodosum or erythema
multiforme
Valley Fever
Rocky mountain spotted fever:
Suspected diagnosis for any patient living in Arizona/acaliforan with a LRTI for 1+ week
Flu-like symptoms with macular rash that spreads centripetally, involving palms/soles
confirmation by serology
Severe disease can be treated with ketonconazole/fluconazole or if immunouppresed
Histoplasmosis:
Non-caseating granulomas, cough, hilar adenopathy, erythema nodosum
Deterioration after corticosteroids
Histoplasma = missisippi and ohio river basins
Pulmonary histoplasmosis = hilar/medisitianl lymph nodes/masses, arthralgias, erythema nodosum
lad,, hsm, pantyopenia in immunocorpomiesd
Cseating or non caseating grnaulomas cn be seen
Fungal tissue stains , culture and ihstoplama urigen antigen testing
screening
HIV: unprotected sex, age 15-55
hepB: unprotected sex, multiple partners
HepC: history of donated blood prior to 1992, HIV+, IVDU,
hemodialysis, born 1945-1965
Toxic Shock Syndorme
Fever>102 hypotension diffuse macular erythromderma
Skin desquamation (palms/soles) 1-2 weeks after
3 multisystem involvement (vomiting, diarrhea, myalgias, CK,
hyperemia, renal, heme plts M 100000, alt ast bili up, CNS
up)
Nasal packing
Meningitis/Encephalitis
Cryptococal: Herpes encephalitis:
Subacute | HIV CD4 < 100 | WBC < 50 on CSF Acute | seizures | unilateral temporal lobe enhancing lesions
2 weeks IV amphotericinB + flucytosine fluconazole

HIV Dementia:
Toxoplasmosis: Deep gray matter structuressubactive global ficits
Sulfadiazine, pyrimethamine, leucovorin Cerbral atrophy + ventricular enlargement
Multiple ring enhancing brain lesions with edema

MS:
Progressive Multifocal Leukoencepholpathy Wlel circumscribed, (not irregular) white matter lesions
JC Virus | AIDS Inflammatory/demyelinating
Non-enhancing hypodense white matter lesions with no
enhancement/edema on CT; LP CSF PCR for dx
White matter lesions with no enhancement/edema on CT CNS Lymphoma:
White matter demyelination Well defined enhancing focal lesion

Subacute sclerosing panencephalitis

Progressive fatal disease years after measles infection
Brain scarring/atrophy
Sickle Cell Disease
Function aplenia Strep Pneumo (non vaccine serotypes)
very common
Penicilli prophylaxis until age 5
Osteomyelitis:
Staph aureus/salmonella
Neonates
GBS = #1 cause of early onest (<7 days) + late onset
neonatl sepsis
 Pertussis = Macrolides
Endocarditis = Vanco
Clindamycin = MRSA cellulitis
Amp Sulbactam = HACEK endocarditis
Viridians strep sensitivepcn = aqueous penicillin G
groupAstrep = amoxicillin/penicillin
Entamoeba histotica = metronidazole + paromomycin
 Last set of 40
Mefloquine: for 2 weeks prior, 4 weeks after
Septic joint
birth to 3: staph, gbs, gram neg bascilli:
Vanco+gentamicin or efotaxime for gram neg bacilli
Older than 3: staph, group a strep, strep: clindamycin, cefazolin
or vanc, no gentamifine/ceofataxmine neded
Bartonella doxy/erythromycin + ARVT
Neuro Brain Lesions
CNS Lymphoma
EBV DNA in CDF
Weakly ring-enhancing mass | periventricular

Toxoplasmosis:
Multiple ring-enhancing spherical basal ganglia lesions

PML:
Non enhancing lesions w/o mass effect

AIDS:
Cortical and subcortical atrophy + secondary ventricular
enlargement
Brain Abscesses
Otitis Media/Mastoiditis temporal lobe/cerebellum
Frontal/ethmoid sinus frontal lobe
Dental infection frontal lobe
Bacteremia/cyanotic heart disease hematogenous spread
multipe abscesses along distribution of middle cerebral
artery at gray white matter junction
Tumors
Medulloblastoma:
Nocturnal/morning headaches
Cerebellar dysfunctionincoordination/ataxia
Strokes
Posterior limb of internal capsule (Lacunar infarct) Anterior vasculature = internal carotid artery, anterior+middle cerebral arteries
Unilateral motor impairment
Posterior circulation: paired vertebral arteriesbasilarpaired posterior cerebral arteries
No visual/sensory loss
Occlusion of a single deep penetrating branch of a large cerebral artery
Posterior Cerebral Atery stroke:
Middle Cerebral Artery Stroke: Homonymous emianopia, alexia without agraphia (dominant hemisphere)
Contrlateral motor+somatosensory defect Visual hallucinations (calcarine cortex)
Face, arm and leg Sensory symptoms (thalamus)
Conjugate eye deviation toward side of infarct Third nerve palsy with paresis of vertical/horizontal eye movemnets
Homonymous Hemianopia Contralateral motor deficits (cerebral peduncle, midbrain)
Aphasia (if dominant emisphere)
Hemineglect (if nondominant hemisphere)

Anterior Cerebral Artery occlusion:

Contralateral somatosensory+motor defect predominantly in lower extremity
Abulia (lack of will/initiative)
Dyspraxia, emotional disturbances, urinary incontinence
Urinary incontinence from damage to cortical micturition centers of mesial frontal lobe

Vertebrobasilar system lesion

(brainstem infarct)
Alternate syndromes with contralateral hemiplegia and ipsilateral cranial nerve involvement
Possible ataxia
Developmental Milestones
Gross Motor
1 year = stand/first steps
18mo: Runs/kickball
2 years: walks up stairs by 2 feet hopping
3 years: walks up stairs normally + tricycle
4 years: hopscotch
5 years: skips/catches ball with 2 hands

Fine Motor
1 year: 2 finger pincer grip
18mo: 2-4 cubes + removes clothing
2 years: 6 cubes + copies a line
3 years: copies a circle, uses utencils
4 years: copies a cross
5 years: copies a square, ties shoelaces, dresses by self, prints letters

Language
1 year: first words other than mama/dada
18mo: 10-25 words; 1+ body part
2 years: 50-100 words; 2 word phrases
3 years: 75% intelligible, 1000 words, 3 word sentences
4 years: 100% intelligible, colors
5 years: counts to 10, 5 word sentences

Social/Cognitive
1 year = Separation anxiety 1 step commands
18mo: understands mine | pretend play
2 years: 2 step commands | parallel play | toilet training
3 years: knows age/gender, imaginative play
4 years: cooperative play
5 years: ffriends, completes toilet training
Environmental Toxins
Infant Botulism:
Clostridium botulinium spores from environmental dust
Descending flaccid paralysis
Human-derive dboutlism IG for treatment
Foodborne Botulism:
Ingestoin of preformed C botulinum toxin in honey
Descending flaccid paralysis
Equine-derived botulism antitoxin

Guillan-Barre syndrome:
Ai peripheral nerve demyelination
Ascending flaccid paralysis
Pooled human IG
Congenital Diseases
Werdnig-Hoffman disease (spinal Muscular atrophy)
Symmetric proximal muscle weakness/hyporeflexia
Does not affect pupils
Weakness greater in lower extremities than upper
Fabry Disease:
A-galactosidase deficiency
Angiokeratomas, peripheral neuropathy, asymptomatic corneal dystrophy
Renal/ardiac failure, thromboembolic events

Homocystinuria: Krabbe Disease:

Pectus deformity | tall stature | increased height Autosomal recessive lyosomal storage disorder
Arachnodactliy, joint hyperlaxity, skin hyperelasticity Galactocerebrosidase deficiency
Scoliosis Intellectual disability, blind, deaf, paralysis, neuropathy, seizures
(all seen in marfans and homocystinuria) No increased hypercoagulability
Marfans specific
Autosomal dominant
Normal intelligence
Phenylketonuria:
Aortic root dilation Phenylalanien hydroxylase deficiency
Upward lens dislocation Intellecutal disability, fair cmomplexion, eczema, musty body order
Homocystinuria:
Autosomal recessive
Intellectual disability Tay Scahs disease:
Thrombosis Autosomal recessive gangliosiodosis
Download lens dislocation B-hexosaminidase A deficiency
Megaloblastic anemia Cherry red macula, seizures, intellectual disability, weakness.
Fair complexion
Cystathione synthase deficiency
Treatment:
B6, B12, Folate to lower homocysteine levels
Antipltaetelts and anticoagulations
Spinal Traumatic Injuries
Central Cord Syndrome:
Hyperetension injuries in elerly patients with a history of
degenerative cervical spine disease
Selective damage to anterior spinal cord
Spceifically fibers of the central corticospinal tract and
decussating fibers of the lateral spinothalamic tract
Weakness that is more pronounced in upper extremities
Motor fibers serving the arms are closer to the central part of
the corticospinal tract
Possible selective loss of pain/temperature sensation in arms
due to damage of the spinothalamic tract lateral
Anterior (Ventral) cord syndrome:
Bilateral spaster motor paresis distal to the lesion
Occlusion of Anterior spinal artery impaired anterior
corticospinal tract
Brown Sequard Syndrome:
Hemisection of spinal cord from penetrating injury
Ipsilateral weakness, spasticity, loss of vibration sense and
proprioception
Contralateral loss of pain and temperature sensation
Posteiror Cord Syndrome:
Vertebral artery dissection or MS
Loss of vibratory and proprioceptive sensation bilaterally
With weakness, paresthesais, urinary inctoniennce or retention
Other Spine stuff
Spinal cord compressions
(Injury from MVC)
Maligancny (lung breast prostate, myeloma)
Infection(epidural abscess)
Symptoms:
Gradually worsening back paint hat is severe and worse in the recumbent
positon at night
Symmetri lower extremity weakness, hypoactive reflexes, bilateral positive
baankksi, low rectalsphintcter tones, paraplegia, sensory los
Workup:
Emergency MRI, IV glucocorticoids
Rad onc and neurosurg consultations
Ddx:
Disk hernation, compression fracture, malignancy

Conus Medullaris lesions:

Back pain, bladder/rectal dysfunction
However, weakness/strength and sensation will be intact
Cauda Equina
More progressive, sacral roots affected, radicular pain, saddle anesthesia, not
immediate obwel/bladder dysfunction
Sensory level deficit at level of umbilicus rules out cauda euqina
Babies
Neonatal hemorrhage correlated with low birth weight and
prematutiry
Xic injury, abrupt changes in cerbraal flow, etc.Also
hypperfsuoin, hypo
Brain Trauma
Epidural Hematoma:
Sphenoid bone fracture
Middle meningeal artery tear
Brief LoC lucid interval increased intracrnail pressure
Headache, nausea, vomiting
CT head Hyperdense, biconvex lesion
Does no tcross suture lines
Complications of hematoma expansion:
Uncal herniation ( ipsilateral CN3 palsy/hemiparesis)
Increased intracranial pressure
Biconvex
Seizures
Absence Seizures: Valproic Acid = Hair loss, tremor, thrombocytopenia
Sudden impairment of consciousness with intact muscle tone 2nd line for abssene seizures
Unresponsive to tactile/verbal stimulus Phenytoin:
Short duration (<20 seconds)
Gingival hyperplasia, SJS/TEN
Simple automatisms frequently present
Rpokved by hyperventilation
EEG:
3HZ spike wave discharges discharges
ADHD/Anxiety comorbidities
Treatment:
Ethoxusimide
Neuro Diseases
Multiple Sclerosis
Autoimmune inflammatory demyelinating disorder of CNS
Woman 15-50 wwith neurologic deficits disseminated in space
and time (ataxia, diplopia, vertigo, pronator drift)
MRI:
Multifocal ovoid hyperintense whitematter lesions
Located periventricularly and in the suppial white matter of
cerebrum and along corpus collosum, optic nerves, brainstem
and spinal cord
Treatment:
High dose IV glucocorticoids (methylprednisolone)
Plasma exchange for those who do not respond to
glucocorticoids
Ifn-B, natalizumab, glatiramer for long term disease
suppression
LP (if suspected MS but unclear diagnosis)
Oligoclonal IgG bands
Pseudotumor cerebri:
Acetazolamide (carbonic anhydrase inhibitor) for treatment to
decrease CSF fluid production
Bilateral papilledema and ha and transient cvisual changes on
exam with normal imaging
Elevated intracranial pressure in an alert patient, no focal
nerulogic signs except for cn6 palsy
Normal CSF other than pressure
Tetracyclines + isotretinoin can cause it
Azteazolamide inhibits choroid plexus carbonic anhydrase
which decreases CSf production and intracranial hypertension;
furosemide can be added for disease refractory to
acetazolamide
More severe disaes can have optic nerve sheath decompression
or lumboperitoneal shunting
Dementia
Alzheimers: Lewy body dementia:
Anterograde memory loss (immediate recall affected; distant Parkinsonian symptoms
memory preserved) Gradually progressive demntai with fluctuates in cognitive function,
Visuospatial deficits (lost in own neighborhood) persistne twell formed hallucinations, extarapyramidal symptoms
Langauge difficulty (difficulty finding words) Visuosptaila dysufnciton occurs early and meomr deificts occurs late
Progressively declining cognitive impairment int eh course of the disease (opposite of AD)
Fluctuating cognition
Neuropsychiatric (hallucinations, wandering) Visual hallucinations
Dyspaxia (difficulty performed leanred motor tasks) Spotnaenous parkinsonism features
REM sleep bahvior with dream enactment
Lack of insight into deficits Severe antipsychotic esnstivity
Late: Low dopamine tranpssrter uptake in basla ganglier on PET scan
Noncognitive neuorlgic deficits (esp, pyramidal motor, myoclonus, Repeated fals, syncope, autonomic dysfunctoin, depression anxiety
seizure, urinary incointence Cerebrovascular disaee showing neuoroimaging is unusual
Parknosmism happening firs ti also unusual (think other)
Diagnosis:
MMSE, neurospcyh testing
Two areas of cognitive deficits that are progressively worsening
No disturbance of consciousness
Age after 60; no other disease causing it
Atrophy signs ind iseases
Lenticular nucleus atrophy = Wilsons
Caudate Nucleus atrophy = Huntingotons
Cerebral Cortex diffuse atrophy = Azlheimers
Atrophy of frontal+temporal lobes = Picks disease
(dementia+personality changes)
Muscular Dystrophies
Duchennes Multiple Sclerosis:
X-linekd recessive deletion of dystrophin gene on chromsoone Xp21 Ages 15-50
Ages 2-3 onset Optic neuritis
Progressive weakness, gower maneuver, calf pseudohypertrophy Lhermite sign
Scoliosis, cardiomyopathy Internuclear opthalmoplegia
Wheelchair depdnent by adolescent; death by 30 by respiratory or herart fialure Fatigue
Uhtthoff phenomenomn (heat sensitivity)
Beckers
Sensory symtoms (numbeness, paresthesis)
Ages 5-15; milder than duchens
Motor mpareapresis, spasticity
Cardiomyoapthy
Bowel/bladder dyscrfuncotin
Death by 40-50 by heart fialure
Course:
Relapsing remitting
Rpimary progressive
Myotonic
Secondary progressive
Autosomal dominant CTG trinucleotide repeat in DMPK gene on chromsone 19q13.3
Progressive relapsing
Onset: age 12-30
Facial weakness, hand grip weakness, myotonia, dysphagia T2 MRI lesions disseminated in time & space
Arrythmias, cataracts, balding, testicular atrophy, infertility Periventricular, juxtacortical, infratenoroial, spinal cord
Death ffrom cardiopulmonary failure depdning ona geo f osnset Oligoclonal IgG bands on CSF analysis
Most common adolescent/adult onset msucualr dystrophy
AD tirnulcoetide expansion on dystorpia myotonica protein kinase genemyotonia: weakness of
skeetla, smooth and cardiac musc
Myotonia (delayeed muscle relaxation)
Most notabily unable to relaes hand after handshake
Skeletal muscle weakness promine itn face, arms, ankle dorsiflexos (bilateral
Indcerased risk of aspiraiotn pneumonia from dysphagia
Conduction cardiac arrthhiamia abnormaliteis footdrop)
Stroke
Ishemic (Thrombotic)
Hypertension, DM2, TIA history
In-situ obstruction
Fluctuating symptoms with suttturering progression and periods of improvement

Ischemic (embolic)
Cardiac dz (a fib, endocarditis, carotid atherosclerosis)
Abrupt onset of symptoms, abrupt, maximal at the start
Multiple infarcts in different vascular terriotories

Intracerebral hemorrhage
Uncontrolled hTN, coagulopathy, illicit drug use ampthetamines caocinae
Symptoms over minutes to hours
Focal neruolgoci symptoms eraly, then increased ICP later (vomiting, HA,
bradycardia, reduced alretnerss)

Spontaesnous subarachaonid hemorrhage:

Arterial saccular berry aneurysm or avm rupture
Sever HA ar onset
Emeningial irration neck stiffness
Focal deficits uncommon
Gait
Tabes Dorsalis Wernicke Korsafokff Syndrome:
HIV/MSM Encephelopathy | Opthalmoplegia | Ataxia
Treponema palldium spirochetes directly damaging dorsal
sensory roots
Secondary degeneration of the dorsal columns
Symptoms:
Sensory ataxia | Lancinating pains | Neurogenic urinary
incontinence | Argyll Robertson pupils
Hyporeflexia

B12 Deficiency:
Subacute combined degeneration of dorsal columns
Loss of position/vibration sense
Positive Romberg sign
Loss of lateral corticospinal tracts (spastic paresis,
hyperreflexia) and spinocerebellar tracts (ataxia)
Lesions
Left Sided Hemisection Torticollis:
Descending corticospinal Focal dystonia of the SCM
Ascending dorsal column Sustained muscle contraction resulting in twisting, repetitive movement sor banormal posture
Contralateral ascending pain/temp (2 levels below) Congeintal, secondary to inflammation, or drug inducd by antipsychotics, metoclopramide or
prochlorperazine

Huntingtons
Uncal Herniation
Athethosis
Contralateral Crus Cerebri compression against Tentorial edge
Ipsilateral Hemiparesis
Chorea
CN3 compression ipsilaterally by uncus
Loss of CN3 Down and Out gaze Hemiballismius:
Mydriasis from loss of parasympathetic innervation Unilaterla, violent arm flinging due to contralateral subthalamic nucleus damage
Ptosis (loss of motor innervation)
Ipsilateral posterior cerebal artery compression
Ipsilateral visual cortex ischemia Idiopathic intracranial hypertension
Contraltaeral homonymous hemianopsia Pseudtumor cerebri, tetracyclines, hypervitaminosis A
Reticular formation compression
Coma

Epidural Hematoma
Uncal herniation + subfalcine herniatoin + cerebellar tonsillar hernation
Cushings Reflex
Hypertensoin | Bradycardia | Respiratory depression
Elevated intracranial pressure

Jugular foramen syndrome from posterior fossa tumor causes CN9 compression in the jugular
foramen, leading to loss of gag reflex and tsatse/sensation from posterior 1/3 of the tongue and
carotid sinus dysfunction (increased syncope)