Deja - Internal - Infectious Diseases Flashcards
How is AIDS defined?
CD4 <200/μL of blood or 14% of all lymphocytes.
How is an HIV infection diagnosed?
A positive ELISA for HIV is then CONFIRMED with a Western blot assay.
How is HIV ruled out?
A negative ELISA for HIV.
What marker is used to follow the EXTENT of disease?
CD4 count.
What can be used as a marker of disease PROGRESSION?
Viral load - it will tell how well the treatment is working.
Complications when CD4 is <500:
- Multiple episodes of vaginal candidiasis.
2. Lymphadenopathy.
Complications when CD4 is <400:
- Pneumonia
- Pulmonary TB
- Oral candidiasis
- Shingles
- Kaposi
- NHL
Complications when CD4 is <200:
- PCP
- Wasting
- Dementia
Complications when CD4 is <100:
Cryptococcus or toxoplasmosis.
Complications when CD4 is <50:
- MAC
- CMV
- CNS lymphoma
- Cryptosporidiosis
When should antiretroviral therapy be initiated?
At CD4 counts <350.
Management for CD4 <200:
Start prophylaxis against PCP + toxoplasmosis with bactrim (SMX-TMP).
Management for CD4 <100:
Start prophylaxis against MAC with clarithromycin or azithromycin.
Management for CD4<50:
Start prophylaxis against fungal infections with fluconazole.
AIDS-related complication - Presents as non productive cough:
PCP
MCC of AIDS death in the USA:
Disseminated MAC
MC fungal infections in HIV:
Candidiasis
AIDS-related complication - Presents as painless progressive vision loss:
CMV retinitis.
AIDS-related complication - Ring enhancing lesion on head CT:
- Toxo
- CMV
- CNS lymphoma
AIDS-related complication - Perivascular hemorrhages and exudates on funduscopic exam:
CMV
AIDS-related complications - Elevated ALP:
MAC
What are the gummas of syphilis?
Rubbery granulomatous lesions in CNS, aorta, heart, skin, bone.
What is tabes dorsalis?
Posterior column degeneration.
How is syphilis diagnosed?
4 POSSIBLE TESTS:
- VDRL/RPR-rapid test.
- Dark-field microscopy will show motile spirochetes.
- Enzyme immunoassay - Antitreponemal IgG.
- FTA-ABS/MHA-TP –> Sensitive + Specific.
On what type of medium is gonorrhea diagnosed?
Thayer-Martin.
MCC of vaginitis:
Bacterial vaginosis caused by Gardnerella.
What is the classic odor associated with bacterial vaginosis?
Fishy odor = Positive Whiff test with KOH prep.
How is bacterial vaginosis treated?
Metronidazole.
Which type of vaginitis is caused by a flagellated, motile protozoan?
Trichomonas
How is Trichomonas diagnosed?
Protozoa seen on wet mount.
What are the classic symptoms of Trichomonas infection?
Fishy odor of discharge + strawberry cervix.
How is candidiasis diagnosed?
Pseudohyphae on KOH prep.
2 vaccines approved to protect against cervical cancer?
- Gardasil
2. Cervarix
Which of the 2 vaccines is also protective against genital warts?
Gardasil.
When should a female start getting Pap smears?
Age 21 or 3 yrs after 1st sexual activity.
How often should a Pap smear be done?
If a patient has had 3 normal consecutive Pap smears, they can get them every 3 years after age 30.
What is SIRS?
Includes the following:
- Tachycardia
- Tachypnea
- Fever
- WBC >12.000, 10%bands.
What is the treatment of sepsis?
- IV fluids.
- Antibiotics to treat infection.
- Vasopressors
- Remove potential sources of infections - Foley etc.
- Steroids, sometimes.
2 MCCs of osteomyelitis in IVDA:
- Pseudomonas
2. S.aureus
Gold standard for diagnosing osteomyelitis?
MRI
Osteomyelitis treatment:
Appropriate IV antibiotics for 4-6weeks.
Possible complications of osteomyelitis:
- Chronic osteomyelitis
- Sepsis
- Septic arthritis
- SCC secondary to a draining sinus tract.
How is HIV transmitted?
- Sexually
- Blood products
- Mother to child
- Needle stick injury