Full Review

Question 1

Clinical Signs of Syphilis

Answer 1

1: lesion, lymph

2: rash, lesion, systemic

Latent: asym

3: CV, neuro, gummatous

Question 2

Causative Pathogens of STIs

Answer 2

Chlamydia: chlamydia trachomatis

Syphilis: treponema pallidum

Herpes: HSV 1 > HSV 2

Gonorrhea: neisseria gonorrhoea

Question 3

Syphilis TX

Answer 3

1/2/EL: Benz PCN G 2.4 MU IM x 1

3/LL: Benz PCN G 2.4 MU IM x 3 wk

NOO: Crystal Aq PCN G 12-24 MU IV 10-14 d
*can do PCN 2.4 with Probenecid 500 mg 10-14 d

Question 4

Neuro Syphilis F/U

Answer 4

CSF exam Q6 months until cell count normal

Question 5

PCN Allergy

Answer 5

Ceftriaxone 2 g IV 10-14 days (BL CR)

Doxy/Tetra (low response)

PCN desensitization

Question 6

Chlamydia Tx

Answer 6

DOC: Doxycycline 100 BID x 7 days with food

Preg: Azithro 1 g single dose

Other: Levo 500 mg x 7 days

Question 7

Gonorrhea Tx

Answer 7

< 150 kg = Ceftriaxone 500 mg

> 150 kg = Ceftriaxone 1 g

chlamydia coinf: doxy, azithro if preg

Alt: Genta + Azithro or Cefix + Doxy/Azithro

Question 8

Herpes Tx

Answer 8

1st clinical episode: A43, F23, V12
1. Acyclovir 400 mg TID x 7-10 (can also do 200 mg five times a day but not preferred)
2. Famciclovir 250 mg TID x 7-10
3. Valacyclovir 1 g BID x 7-10
*all durations are 7-10

Recurrent infection: 1-5 day tx, A43, F12, V52
1. Acyclovir 400 mg TID x 5 (800 BID x 5 or 800 TID x 2)
2. Famciclovir 1000 mg BID for 1 day
3. Valacyclovir 500 mg BID x 3 or 1 g QD x 5

Suppressive is 42,22,11 x 1 year

Question 9

Limitation of Acyclovir

Answer 9

Dosing frequency, 5 x day

Question 10

Indication for PREP

Answer 10

-If you want it
-Share needles
-MSM
-Multiple partneres

Question 11

Labs before starting PREP

Answer 11

-HIV status (RNA for cabe)
-STI testing
-Renal function
-Hep B for oral meds
-Lipid profile

DO NOT NEED CD4/preg/plt count/dexa/pap

Question 12

Counseling for PREP

Answer 12

-Start up syndrome (after 1 month, nausea/HA/fatigue/abd pain)
-Does not cover STIs
-Renal toxicity signs (dark urine)
-Wanes after 7-10 days
-Risk of Hep B flare if d/c

Question 13

Don’t Use Descovy

Answer 13

Assigned female at birth, receiving vaginal sex

Question 14

PREP On-Demand

Answer 14

NOT FDA-approved

Event driven oral PREP for MSM at least 2 hours before sex using Truvada (Only F/TDF)

Question 15

ER with HIV exposure

Answer 15

No urgent HIV test, test, then again in 2 weeks

Question 16

Avoid in G6PD deficiency

Answer 16

Dapsone

Question 17

2 drug regimen for HIV

Answer 17

Dovato (Dolutegravir + 3TC)

Question 18

Dovato Caveats

Answer 18

-Do not use with HIV/HBV co-infection
-RNA > 500k
-HIV resistance testing, HIV testing

Question 19

HLA B 5701 + Avoid

Answer 19

-Abacavir
-Trimeq

Question 20

Sulfa allergy, Avoid

Answer 20

“NAVIRS”
-Darunavir
-Fosaprenavir
-Tipranavir

Question 21

Goal of ART

Answer 21

-Undetectable
-RNA viral load < 50
-CD4 count > 200

Question 22

Active Drugs in Genvoya

Answer 22

3 (Elvitegravir, Emtricitabine, Tenofovir)

Cobicistat doesn’t count

Question 23

Avoid with PPIs

Answer 23

Rilpivirine (NNRTI)

Odefsey (descry + rilp)

Question 24

TB drugs with DDIs

Answer 24

Rifampin has most

Rifapentine has least

Question 25

DOC for PJP

Answer 25

-Sulfamethoxazole-Trimethoprim (Bactrim)*
-Dapsone
-Pentamidine
-Atovaquone
-Primaquine+Clindamycin (PRIM+CLIN)

Question 26

Which antifungal agent can result in QT interval shortening?

Answer 26

Isavuconazole

Question 27

When do you consider steroids?

Answer 27

PaO2 threshold 70

Question 28

PJP Tx

Answer 28

Mild-Moderate (PaO2 >70 or DO2 gradient <35)
= 15-20 mg/kg/day PO divided TID
= SXT 2 DS PO TID for 21 days

Moderate-Severe (PaO2 <70 or DO2 gradient >/=35)
= 15-20 mg/kg/day IV q6-8h, may switch to PO after clinical improvement x21 days AND prednisone

Question 29

Outpatient + COVID

Answer 29

NO steroids

offered sx management

avoid use of dexamethasone or others in the absence of another indication

Question 30

COVID Tx

Answer 30

-Ritonavir-boosted nirmatrelvir (Paxlovid)
-Remdesivir
-Alternative: Molnupiravir

Question 31

What antifungal doesn’t require a LD?

Answer 31

Micafungin

Question 32

DOC for Cryptosporidium

Answer 32

Nitazoxanide

Question 33

DOC for Aspergillus

Answer 33

Voriconazole

Question 34

Antifungal with Acidic Beverage

Answer 34

Itraconazole

Question 35

PREP with GAHT

Answer 35

No significant interaction

Question 36

Issues with Odefsey

Answer 36

= descry + rilp
-Not rapid start d/t NNRTI resistance
-Pretx if VL < 100, and CD4 > 200
-CI with PPIs

Question 37

2 Important Labs for HIV

Answer 37

HIV viral load and CD4 count

Question 38

INSTI avoided in women of childbearing potential?

Answer 38

Dolutegravir

Efavirenz

Question 39

Which class is most likely to be affected by concomitant divalent cations?

Answer 39

INSTIs (tegravir)

Question 40

Rifampin Admin. with other Drugs

Answer 40

Rifampin can speed up the metabolism of other drugs = concentrations go down

Question 41

Flucytosine

Answer 41

Crypto neoformans (with ampho)

Question 42

Yellowing of Eyes on PI

Answer 42

Atazanavir (increases BR)

Question 43

NNRTI with suicide

Answer 43

Efavirenz

Question 44

Earliest HIV Test

Answer 44

10 days - NAT

20 days - 4th gen

Question 45

ART monthly injection

Answer 45

Cabreuva

Question 46

ART IV infusion Q2 wks

Answer 46

Ibalizumab

Question 47

3 HIV tx Rapid Starts

Answer 47

Biktarvy

Tivicay + Descovy

Symtuza

Question 48

ART Q6mo

Answer 48

Lenacapavir

Question 49

PI with worst diarrhea

Answer 49

Nelfinavir

Question 50

COVID Rec Ab

Answer 50

PO baricitinib, IV tocilizumab

hospitalized pts requiring ox via HFNC, NIV, MV, ECMO