Aids

Question 1

Tuberculosis

Answer 1

Presentation:
Test: Stool sample = acid fast bacteria
Prophylaxis: 1200 mg Azithroycin weekly
Tx: 500 mg clarithromycin 2x a day; 
Azithromycin 600 mg daily

Question 2

Pneumocystis pneumonia

Answer 2

Presentation: dyspnea, fever, SOB
Test: Chest X-ray showing bilateral ground glass appearance
Prophylaxis: Trimethoprim/sulfamethoxazole (TMP-SMX)
Tx: TMP-SMX double strength tabs q 8hrs

Question 3

Toxoplasmosis

Answer 3

Presentation: Head aches, focal neurologic deficits, altered mental status
Test: MRI, showing characteristic lesions
Prophylaxis: TMP-SMX on DS tab daily
TX: Pyrimethamine+sulfadiazine+leucovorin (chemo drugs)

Question 4

Crytococcal meningitis

Answer 4

Presents as fever, malaise, headache, stiff neck, may have rash and cough (usually in pt. with cd4 count

Question 5

Herpes zoster/ simplex

Answer 5

Presents as dermatomal erythematous vesicular eruption
HIV pt. are 20x more likely to develop zoster
Tx: acyclovir

Question 6

cytomegalovirus retinitis

Answer 6

Retinal infection that is seen as hemorrhages and white fluffy exudates. Loss of central vision, or blurry central v.
Prophylaxis: if cd4

Question 7

HIV associated dementia

Answer 7

Patients will have difficulty with cognitive tasks, show decreased motor function, and emotional disturbances. First sign may be a deterioration in hand writing.
Tx: many pt. get better with ART

Question 8

lymphoma (CNS)

Answer 8

symptoms similar to toxoplasmosis. difficult to distinguish between them on imaging, lymphoma will usually show up more often as solitary lesion.
TX: Many patients respond well to radiation therapy

Question 9

Kaposi Sacroma

Answer 9

Erythematous or violet colored plaque-like lesion on skin or mucous membrane. Lesions may appear anywhere!
May appear after initiating ART
Prophylaxis: None
TX: Systemic chemotherapy or alpha-interferon

Question 10

Cervical cancer

Answer 10

HIV pt. are at much higher risk for cervical cancer.
-cervical dysplasia is considered “early symptomatic HIV”
-invasive cervical cancer is an indicator of AIDS
Prophylaxis: screen for cervical cancer and vac. for HPV

Question 11

Vaginal/oral/esophageal candidiasis

Answer 11

vaginal: shows up as white clumpy discharge, often itches or burns
oral: shows up as white lesions on tongue and inner cheeks. Highly suggestive of HIV!
esophageal: similar to oral, pt. may have difficulty swallowing
Prophylaxis: none
Tx: Fluconazole, itraconazole - may develop resistance to fluconzole

Question 12

oral hairy leukoplakia

Answer 12

White, flat or slightly raised lesion on the side of the tongue
Has vertical lines with thick “hairy” projections”
-Caused by EBV
Highly suggestive of HIV

Question 13

enterocolitis

Answer 13

GI problem common to HIV pt.
Pt. may have diarrhea, fever, abdominal pain
examples: Campylobacter, salmonella, giardia, cryptosporidium
Prophylaxis: proper hygiene, avoid raw oysters
Tx: ART, treat per organism, and give hydration

Question 14

Protease inhibitors

Answer 14

MOA: Protease cleaves polyproteins into functional proteins in the late stages of HIV replication, virus stay immature, can’t infect

Question 15

Protease inhibitors

Side effects

Answer 15

NVD, kidney stones, jaundice, cerebral hemorrhage, diabetes, hypercholesteremia

Question 16

Nucleoside reverse transcriptase inhibitors

MOA

Answer 16

Disrupts the construction of proviral HIV DNA so it cannot replicate

Question 17

Nucleoside reverse transcriptase inhibitors

Side effects

Answer 17

pancreatitis, lipoatrophy, liver toxicity, hepatomegaly, anemia, mitochondrial toxicity, lactic acidosis

Question 18

Non-nucleoside reverse transcriptase inhibitors

MOA

Answer 18

block reverse transcriptase by actually binding to the enzyme

Question 19

Non-nucleoside reverse transcriptase inhibitors

Side effects

Answer 19

CNS problems (head ache, insomnia, etc)
Rash (as severe as SJS and TEN)
Depression

Question 20

Entry/fusion inhibitors

MOA

Answer 20

Inhibits HIV from entering the cell by disallowing from fusing with the cellular membrane

Question 21

Entry/fusion inhibitors

Side effects

Answer 21

Related to the injection site, pain, erythema, nodules, very common

Question 22

integrase inhibitors

MOA

Answer 22

disrupts integrase and prevents the integration /strand transfer of viral DNA

Question 23

integrase inhibitors

side effects

Answer 23

NVD, dizziness, abnormal dreams, headaches, elevated amylase and LFT

Question 24

Chemokine receptor antagonist (CCR5 antagonist)

MOA

Answer 24

Blocks CCR5 receptor on CD4, thus inhibits viral entry into cell

Question 25

Chemokine receptor antagonist (CCR5)

Side effects

Answer 25

NVD, elevated LFT, hepatitis, UTI, colds, cough, dizziness

Question 26

HIV infection: primary infection

Answer 26

CD4 level dips below 800mmL

• Sx appear 2-6 weeks after exposure
• Sx: fever, NVD,lymphadenopathy, pharangitis, myalgia, thrush, malaise, weight loss

Question 27

HIV infection: asymptomatic stage

Answer 27

CD4 greater than 350

• latent stage
• can last 7-10 years
• no sx

Question 28

HIV infection: symptomatic stage

Answer 28

CD4 greater than 200
-Specific sx:Hairy leukoplakia
Kaposi sarcoma

-Nonspecific:
Fever, Wasting, Night sweats,
lymphadenopathy
Candidiasis,TB, Herpes zoster,
HSV

Question 29

HIV infection: AIDS

Answer 29

CD4 less than 200
-Pneumocystosis
Toxoplasmosis
Cryptococcosis
Coccidioidomycosis
Cryptosporidiosis

CD4 less than 50
Sx:MAC
CMV retinitis
CNS lymphoma