Crunch Time Infection

Question 1

Blood transfusions prior to _____ led to increased risk of HIV transmission

Answer 1

1985

Question 2

Test to screen for HIV

Test to confirm HIV

Answer 2

ELISA to screen

Western blot to confirm

Question 3

A CD4 count of < ____ is AIDS-defining

Answer 3

200

Question 4

If you see an HIV patient with eye symptoms, you should think of ______. What symptoms will they have?

Answer 4

CMV retinitis

blurry/worsening vision and eye pain

Question 5

oral thrush ______(does/doesn’t) scrape off easily

Answer 5

DOES!

Question 6

Treatment for CMV retinitis

Answer 6

ganciclovir

Question 7

Diagnostic test for candidal esophagitis. Treatment?

Answer 7

KOH prep

nystatin or clomitrazole

Question 8

MC cancer in AIDS patients

Answer 8

Kaposi’s sarcoma

Question 9

HIV pt with subcutaneous, reddish-brown or bluish nodule on face or hands/feet. Dx?

Answer 9

Kaposi’s sarcoma

Question 10

2 bugs that you should think of if you see neuro symptoms in an HIV patient

Answer 10

cryptococcus neoformans

toxoplasmosis gondii

Question 11

In toxoplasmosis gondii, the lesions are ______

Answer 11

ring-enhancing

Question 12

treatment for toxoplasmosis gondii

Answer 12

pyrimethamine AND sulfadiazine AND folate

Question 13

classic diagnostic finding in cryptococcus neoformans

Answer 13

high opening pressure on LP

Question 14

Which has more specific neuro deficits? Toxoplasmosis or cryptococcus?

Answer 14

Toxoplasmosis (crypto is more cryptogenic, or general; headache, non-specific findings); toxo can have focal neuro deficits, seizures, is more severe

Question 15

Diagnostic test for Cryptococcus neoformans

Answer 15

india ink stain or cryptococcal antigen on CSF

Question 16

treatment for cryptococcus neoformans

Answer 16

amphotericin B +/- flucytazine

Question 17

Some diagnostic clues for pneumocystis jirovecii

Answer 17

groundglass opacities on CXR

high LDH

Question 18

diagnostic test for pneumocystis jirovecii

tx?

Answer 18

bronchiolar lavage

bactrim for 21 days, +/- prednisone if v sick

Question 19

2 common bugs that cause diarrhea in HIV pts

Answer 19

cryptospiridium

isosporum

Question 20

diagnostic test for cryptosporidium

Answer 20

acid-fast stain of stool, serology or ELISA

Question 21

treatment for cryptosporidium in HIV pts

Answer 21

parmomycin or azithromycin for 4 weeks

Question 22

treatment for isospora diarrhea in HIV pts

Answer 22

bactrim for 21 days

Question 23

most notable AE of didanosine

Answer 23

pancreatitis

Question 24

Most notable AE of indinavir

Answer 24

kidney stones

Question 25

Most notable AE of ifavirenz

Answer 25

psychosis

Question 26

most notable AE of pentamide

Answer 26

hyper or hypoglycemia

Question 27

common parasitic GI infx in HIV pts | dx?

Answer 27

cryptosporidium and isospora | ACID FAST STAIN

Question 28

common fungal diarrheal infx in HIV pts

Answer 28

cryptococcus | histoplasma

Question 29

common invasive bacteria that cause diarrhea in HIV pts

Answer 29

salmonella, shigella, e coli, campylobacter, C diff (just as with non-HIV patients!)

Question 30

tests to consider in diarrhea in HIV pts

Answer 30

``` stool ova/parasites stool leukocyts stool bacterial culture c diff acid-fast stain ```

Question 31

how to treat diarrheal infection in HIV patients

Answer 31

supportive care if not super sick can consider fluoroquinolone if immunocompetent if think it's opportunistic infx --> metronidozole +quinolone sick: fluids, admit

Question 32

treatment for esophagitis

Answer 32

likely admission supportive care IV antimicrobials (antifungals or antivirals) THIS IS AN AIDS-DEFINING ILLNESS (from candida, HSV, CMV)

Question 33

work up for suspected neuro infection in HIV pt

Answer 33

CT, LP (not if mass effect), empiric coverage

Question 34

empiric coverage for neuro infection in HIV pts

Answer 34

covering for common bugs - ceftriaxone - vanc if hardware/MRSA - younger or older: ampicillin - if concern for encephalitis (seizures): acyclovir

Question 35

abnormal opening pressure in LP

Answer 35

over 20

Question 36

opportunistic infections in HIV pts

Answer 36

cryptococcus toxoplasmosis syphillis

Question 37

Tests to order on CSF in HIV pts

Answer 37

``` India Ink (for cryptococcus) cryptococcal antigen toxoplasmosis antibodies RPR (in addition to standard studies) ```

Question 38

tx for cryptococcus meningitis

Answer 38

amphotericin B

Question 39

CT findings in toxoplasmosis

Answer 39

ring-enhancing lesions (focal lesions; focal deficits or seizures are common)

Question 40

tx for syphillis meningitis

Answer 40

a LOT of penicillin (just choose the biggest dose that's given)