GUM/HIV/ID

Question 1

Broadly what the causes of pyrexia of unknown origin (PUO)?

Answer 1

Infection - 30% Malignancy - 30% AI - 30% Undiagnosed - 10%

Question 2

SIRS criteria

Answer 2

2 or more of:

• Temp <36 or >38
• HR >90bpm
• RR >20bpm or PaCO2
• <4 or >12x10(9) cells/L (or ‘left shift’ >10% immature neutrophils)

Question 3

Sepsis =

Answer 3

SIRS + definitive infection

Question 4

Severe sepsis =

Answer 4

Sepsis + organ dysfunction

Question 5

Septic shock =

Answer 5

Severe sepsis + hypotension (<90mmHg)

Question 6

What is the CD4 threshold for AIDS?

Answer 6

200 cells/ml.

Start treatment at 350 in UK. In USA and Europe start at 500.

Question 7

MDR TB definition

Answer 7

Resistant to Rifampcin and Isoniazid

Question 8

XDR TB definition

Answer 8

MDR + resistant to fluoroquinolones and at least one injectable agent (amikacin, kanamycin, capreomycin)

Question 9

What are the 5 groups of TB medications? Give an example of each.

Answer 9

Group 1 = RHZE (aka RIPE) Group 2 = Injectables: amikacin, kanamycin, capreomycin Group 3 = certain fluoroquinolones: moxifloxacin Group 4 = bacteriostatics: prothioamide, cycloserine Group 5 = Experimental of unknown efficacy: linezolid

Question 10

Chlamydia treatment

Answer 10

Doxycycline Contra-indicated in pregnancy due to teratogenicity. Therefore, use azithromycin or erythromycin.

Question 11

Classical presentation of molluscum contagiosum.

Answer 11

Umbilical herniated papules. Occurs commonly in childhood. In adults, associated with immunosuppression. Caused by pox virus.

Question 12

Herpes treatment

Answer 12

Aciclovir 200mg 5 times/day for 5/7

Daily wash with salt water, reduces adhesions.

Pee in warm bath. Painful to pee as urine hits ulcers. Reflex inhibition. In extreme catheterise.

Question 13

Mumps complications

Answer 13

MAOMPS

M = meningo-encephalitis

A = Arthritis

O = orchitis (& oophoritis)

M = myocarditis

P = pancreatitis

S = sensorineural deafness

Question 14

TB treatment: RIPE common side effects

Answer 14

R + I + P RIP through your liver = hepatotoxicity esp. P

R - reddy/orange secretions

I - ‘Ingling: peripheral neuropathy (give pyridoxine)

P - pain (gout) and pruritus

E - eyes: colour blindness

Question 15

Classes of HIV drugs with an example of each

Answer 15

1. Entry inhibitors

• fusion inhibitor - enfuviritide
• CCR5 inhibitor - maraviroc

2. Nucleoside RT inhibitors (NRTI)

• zidovudine, lamivudine
• abacavir, tenofovir
• emtricitabine

3. Non-nucleoside RT inhibitors (NNRTI)
   * Efavirenz
4. Integrase inhibitors
   * Raltegravir
5. Protease inhibitors
   * Ritonavir, Indinavir

Question 16

What is an isotope?

Answer 16

An element with equal