Deja - Internal - Infectious Diseases

Question 1

How is AIDS defined?

Answer 1

CD4 <200/μL of blood or 14% of all lymphocytes.

Question 2

How is an HIV infection diagnosed?

Answer 2

A positive ELISA for HIV is then CONFIRMED with a Western blot assay.

Question 3

How is HIV ruled out?

Answer 3

A negative ELISA for HIV.

Question 4

What marker is used to follow the EXTENT of disease?

Answer 4

CD4 count.

Question 5

What can be used as a marker of disease PROGRESSION?

Answer 5

Viral load - it will tell how well the treatment is working.

Question 6

Complications when CD4 is <500:

Answer 6

1. Multiple episodes of vaginal candidiasis.

2. Lymphadenopathy.

Question 7

Complications when CD4 is <400:

Answer 7

1. Pneumonia
2. Pulmonary TB
3. Oral candidiasis
4. Shingles
5. Kaposi
6. NHL

Question 8

Complications when CD4 is <200:

Answer 8

1. PCP
2. Wasting
3. Dementia

Question 9

Complications when CD4 is <100:

Answer 9

Cryptococcus or toxoplasmosis.

Question 10

Complications when CD4 is <50:

Answer 10

1. MAC
2. CMV
3. CNS lymphoma
4. Cryptosporidiosis

Question 11

When should antiretroviral therapy be initiated?

Answer 11

At CD4 counts <350.

Question 12

Management for CD4 <200:

Answer 12

Start prophylaxis against PCP + toxoplasmosis with bactrim (SMX-TMP).

Question 13

Management for CD4 <100:

Answer 13

Start prophylaxis against MAC with clarithromycin or azithromycin.

Question 14

Management for CD4<50:

Answer 14

Start prophylaxis against fungal infections with fluconazole.

Question 15

AIDS-related complication - Presents as non productive cough:

Answer 15

PCP

Question 16

MCC of AIDS death in the USA:

Answer 16

Disseminated MAC

Question 17

MC fungal infections in HIV:

Answer 17

Candidiasis

Question 18

AIDS-related complication - Presents as painless progressive vision loss:

Answer 18

CMV retinitis.

Question 19

AIDS-related complication - Ring enhancing lesion on head CT:

Answer 19

1. Toxo
2. CMV
3. CNS lymphoma

Question 20

AIDS-related complication - Perivascular hemorrhages and exudates on funduscopic exam:

Answer 20

CMV

Question 21

AIDS-related complications - Elevated ALP:

Answer 21

MAC

Question 22

What are the gummas of syphilis?

Answer 22

Rubbery granulomatous lesions in CNS, aorta, heart, skin, bone.

Question 23

What is tabes dorsalis?

Answer 23

Posterior column degeneration.

Question 24

How is syphilis diagnosed?

Answer 24

4 POSSIBLE TESTS:

1. VDRL/RPR-rapid test.
2. Dark-field microscopy will show motile spirochetes.
3. Enzyme immunoassay - Antitreponemal IgG.
4. FTA-ABS/MHA-TP –> Sensitive + Specific.

Question 25

On what type of medium is gonorrhea diagnosed?

Answer 25

Thayer-Martin.

Question 26

MCC of vaginitis:

Answer 26

Bacterial vaginosis caused by Gardnerella.

Question 27

What is the classic odor associated with bacterial vaginosis?

Answer 27

Fishy odor = Positive Whiff test with KOH prep.

Question 28

How is bacterial vaginosis treated?

Answer 28

Metronidazole.

Question 29

Which type of vaginitis is caused by a flagellated, motile protozoan?

Answer 29

Trichomonas

Question 30

How is Trichomonas diagnosed?

Answer 30

Protozoa seen on wet mount.

Question 31

What are the classic symptoms of Trichomonas infection?

Answer 31

Fishy odor of discharge + strawberry cervix.

Question 32

How is candidiasis diagnosed?

Answer 32

Pseudohyphae on KOH prep.

Question 33

2 vaccines approved to protect against cervical cancer?

Answer 33

1. Gardasil | 2. Cervarix

Question 34

Which of the 2 vaccines is also protective against genital warts?

Answer 34

Gardasil.

Question 35

When should a female start getting Pap smears?

Answer 35

Age 21 or 3 yrs after 1st sexual activity.

Question 36

How often should a Pap smear be done?

Answer 36

If a patient has had 3 normal consecutive Pap smears, they can get them every 3 years after age 30.

Question 37

What is SIRS?

Answer 37

Includes the following: 1. Tachycardia 2. Tachypnea 3. Fever 4. WBC >12.000, 10%bands.

Question 38

What is the treatment of sepsis?

Answer 38

1. IV fluids. 2. Antibiotics to treat infection. 3. Vasopressors 4. Remove potential sources of infections - Foley etc. 5. Steroids, sometimes.

Question 39

2 MCCs of osteomyelitis in IVDA:

Answer 39

1. Pseudomonas | 2. S.aureus

Question 40

Gold standard for diagnosing osteomyelitis?

Answer 40

MRI

Question 41

Osteomyelitis treatment:

Answer 41

Appropriate IV antibiotics for 4-6weeks.

Question 42

Possible complications of osteomyelitis:

Answer 42

1. Chronic osteomyelitis 2. Sepsis 3. Septic arthritis 4. SCC secondary to a draining sinus tract.

Question 43

How is HIV transmitted?

Answer 43

1. Sexually 2. Blood products 3. Mother to child 4. Needle stick injury