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SALMAN HARRISON'S > 197 - Human Immunodeficiency Virus Disease: AIDS and Related Disorders > Flashcards

197 - Human Immunodeficiency Virus Disease: AIDS and Related Disorders Flashcards

1
Q

HIV patients are classified according to their __ levels and their different __.

A

CD4

symptoms

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2
Q

There are 5 levels for HIV classifications. 0- negative _ months post exposure, 3- if __ infection. The rest of the levels are determined according to the __ levels.

A

6
opportunistic
CD4

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3
Q

Treatment __ determined according to the level of HIV/AIDS.

A

is not

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4
Q

The physician should choose HIV treatment according to the ___

A

presentation

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5
Q

The chance for HIV transmission during sexual intercourse is __%.

A

1.4

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6
Q

Different infections increase the risk to be infected with HIV: 6

A 
T. pallidum
H. ducreyi
HSV
chlamydia
N. gonorrhoeae
trichomonas vaginalis
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7
Q

The chance for HIV transmission during IVDU is __%.

A

0.6%

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8
Q

The chance for HIV vertical transmission during 1st trimester is__%, during the birth ___%, breast feeding.

A

23-30%
50-65%
12-20%

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9
Q

Breast feeding if HIV is present is __ in developed countries, in developing countries it is not to case (use __ during)

A

contraindicated

retro antiviral

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10
Q

Eclipse phase-__

A

The virus cannot be found in blood for several days post infection.

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11
Q

One of the important areas infected by HIV is the __

A

GALT

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12
Q

Mucosal infection leads to __ to be the first to get infected.

A

LN

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13
Q

Hematologic infection leads to __ to be the first to get infected.

A

spleen

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14
Q

Acute HIV syndrome occurs in _% of patients, and is defined by severe __. Clinically it can be __ or __.

A

50
viremia
asymptomatic
IM like

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15
Q

Antibodies for HIV are diagnosed by __ test.

A

ELISA`

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16
Q

Due to high percentage of FP, if ELISA result was positive- continue to __ test.

A

western blot

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17
Q

For western bolt to be positive - _ out of _ antibodies should be positive (__/__/__).

A

2
3
gag/pol/env

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18
Q

If western blot is not conclusive- perform __ test.

A

cross reaction

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19
Q

In recent exposure if __ is negative, return after __ and __ after.

A

ELISA
six weeks
3 months

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20
Q

OraQuick rapid HIV-1 antibody test is a very __ test (99%), but if negative- __.

A

specific

ELISA

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21
Q

-% of patients infected with HIV will develop acute retroviral syndrome - weeks post infection.

A

50-70%

3-6

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22
Q

The symptoms of HIV acute retroviral syndrome depend on the severity of the __

A

viremia

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23
Q

The general symptoms of acute retroviral syndrome are: 7

A 
fever
pharyngitis
lymphadenopathy
headache
lethargy/malaise
anorexia/weight loss
nausea/vomiting/diarrhea
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24
Q

Neurologic symptoms of acute retroviral syndrome include: 4

A

meningitis
encephalitis
peripheral neuropathy
myelopathy

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25
Q

Cutaneous symptoms of acute retroviral syndrome include: 2

A

maculopapular / erythematous rash

mucocutaneous ulcers

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26
Q

During acute retroviral syndrome __ infections are possible.

A

opportunistic

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27
Q

_% of HIV patients will develop __ disease after acute retroviral syndrome, the rest will enter the latent phase.

A

10

fulminant

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28
Q

The median time period in untreated HIV patients for the appearance of clinical disease is __ years.

A

10

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29
Q

During the latent phase, CD4 decrease by __ uL/year

A

50

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30
Q

When CD4 drops below __, the deficiency is sufficient for ___ infections and ___.

A

200
opportunistic
malignancies

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31
Q

AIDS related disease make up to __% of mortality, non AIDS malignancies, liver disease, CV disease make up to -% each.

A

50

10-15

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32
Q

In order to reduce complications in HIV patients keep __levels low using __, and treat __.

A

replication
cART
infections

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33
Q

Acute __ and __ are present in all stages of HIV

A

bronchitis

sinusitis

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34
Q

Diagnosing sinusitis is done using /. Treatment is optional, but will reduce the __ of the disease.

A

MRI/CT

length

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35
Q

What are the common pathogens causing sinusitis in HIV patients?

A

H. influenza
strep pneumonia
mucormycosis (debridement + amphotericin B)

36
Q

What is the most common complication of HIV?

A

pneumonia

37
Q

Untreated HIV patients are X_ more likely to have __ and X_ for __.

A

6
bacterial pneumonia
100
bacteremia

38
Q

HIV bacterial pneumonia should be treated with Abx such as-

A

ceftriaxone (cephalosporine)+ azithromycin (macrolide)

39
Q

HIV patients are advised to quit __, and receive the following vaccination: 2

A

smoking
conjugated pneumococcal vaccine
23 valent pneumococcal

40
Q

PCP=__

A

Pneumocystis pneumonia

41
Q

PCP cause __% of pneumonia in HIV patients in the US, and is the leading microbe causing it.

A

25%

42
Q

When CD4< 200 in HIV patients, give __ treatment for PCP with __.

A

prophylactic

aerosolized pentamidine

43
Q

PCP clinical presentation include: 4

A

fever
unproductive cough
CXr with bilateral interstitial infiltration
CT with ground glass

44
Q

PCP treatment include __.

A

resprim (TMP-SMX)

45
Q

HIV patients are __ times more prone to active __.

A

100

TB

46
Q

Which atypical mycobacteria are more common in HIV patinets?

A

M. avium

M. intracellular

47
Q

The most common CV disease in HIV patients is- __

A

CHD

48
Q

HIV patients tend to have increased __, and decreased __.

A

TG

HDL

49
Q

HIV associated ___ present with edema and dyspnea.

A

cardiomyopathy

50
Q

Esophagitis in HIV patients is usually due to 3, and cause retrosternal pain and dysphagia. Diagnosis is made with __.

A

candida
CMV (one big lesion)
HSV (multiple small lesions)
endoscopy

51
Q

What are the common pathogens causing intestinal infections in HIV patients?
Bacteria- 3
fungal- 3

A 
salmonella
shigella 
campylobacter 
histoplasma
coccidiomycosis
penicilliosis
52
Q

CMV colitis symptoms include: 3

A

diarrhea
abdominal pain
weight loss/anorexia

53
Q

CMV colitis should be diagnosed with __ (multiple mucosal lesions), __ (intranuclear and cytoplasmic inclusions bodies).

A

endoscopy

biopsy

54
Q

Chronic __ syndrome is when no etiology beside HIV was found. may cause weight loss and malabsorption.

A

diarrheal

55
Q

_% of mortality of HIV patients is due to hepatobiliary disease. Some due to __, while other due to the __.

A

15
hepatitis
drug treatment

56
Q

What are the common kidney/urinary HIV related disease? 4

A

microalbuminuria
HIV associated nephropathy
UTI
vulvovaginal candidiasis

57
Q

33-75% of HIV patients suffer from __ due to thymidine analogues or protease inhibitors. As a result: 3.

A

lipodystrophy
TG increase
total cholesterol increase
hyperinsulinemia + hyperglycemia

58
Q

Many HIV patients will develop ___, usually due to a combination of pulmonary or CNS disease- resulting in __.

A

SIADH

hyponatremia

59
Q

Hyperkalemia can be found in HIV patients, due to __ insufficiency, __, or __.

A

adrenal
nephropathy
drugs

60
Q

___ Cushing due to hypothalamic-hypohisaric - adrenal axis inhibition (__)

A

iatrogenic

steroids

61
Q

Adrenal disease in HIV patients can be caused by: 5

A 
mycobacterial infection
CMV
cryptococcoses
histoplasma 
iatrogenic
62
Q

IRIS-___

A

immune reconstitution inflammatory syndrome

63
Q

IRIS is a paradoxical reaction after starting with __ treatment. It may lead to: 3

A

cART
worsening of opportunistic infection
AI disease
unmasking unknown problem

64
Q

IRIS exist in __% of patients, and is more common in patients with CD4 < __ when the treatment was initiated.

A

30

50

65
Q

IRIS clinical symptoms include: 8

:(

A 
local lymphadenitis
prolonged fever
pulmonary infiltration
hepatitis
ICP
uveitis
sarcoidosis
graves disease
66
Q

What are the common hematopoietic clinical symptoms related to HIV?

A 
persistent generalized lymphadenopathy
anemia
neutropenia
thrombocytopenia
DVT/PE
67
Q

Dermatologic problems are present in __% of HIV patients.

A

90%

68
Q

HIV patients may experience drug reactions such as __-__ syndrome, and toxic epidermal __.

A

Steven Johnson

necrolysis

69
Q

What opportunistic CNS disease are common in HIV patients? 4

A

toxoplasma
Cryptococcus
leukoencephalopathy (vanishing white matter)
primary lymphoma

70
Q

HIV encephalopathy/ HIV associated dementia is an HIV __ disease.

A

characterizing

71
Q

What is the main cause for meningitis in HIV patients? It occurs when CD4

A

cryptococcus

100

72
Q

What is the treatment for cryptococcus?

A

AMP-B

73
Q

When toxoplasmosis is more likely to cause CNS disease in HIV patients?

A

when CD4 < 200

74
Q

What are the typical MRI lesions defining toxoplasmosis?

A

multiple round enhancement in the brain

75
Q

How should you treat toxoplasmosis?

A

resprim (TMP-SMX)

76
Q

50% of HIV advanced patients will present __-__ spots in an ophthalmological examination

A

cotton wool

77
Q

What are the common ophthalmological disease in HIV patients? 2

A

CMV retinitis

HSV/VZV necrotizing retinitis

78
Q

What are the common neoplastic disease in HIV patients? 4

A

Kaposi’s sarcoma
lymphoma (non-Hodgkin’s)
Multicentric Castleman disease
invasive cervical carcinoma

79
Q

consider expanding on neoplastic disease

A

consider expanding on neoplastic disease

80
Q

What are the 4 categories of HIV treatment?

A

reverse viral transcriptase inhibitors
protease inhibitors
integrase inhibitors
cell entry prevention

81
Q

HIV treatment should consists of ___ drugs and last for __.

A

multiple

life

82
Q

Which HIV patients should receive medicinal treatment?

A

all patients

83
Q

HIV patients diagnosed while suffering opportunistic infection can postpone cART by - weeks, focusing on treating the infection.

A

2-4

84
Q

One of the goals of HIV treatment is a X__ decrease in viral load within the first - months, and then further decrease to __ RNA copies within _ months.

A

10
1-2
50
6

85
Q

One of the goals of HIV treatment is an increase of __ cells to - in the first month, followed by further increase of - per year until they are normal.

A

CD4
100-150
50-100

SALMAN HARRISON'S (163 decks)

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