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HIV Flashcards

1
Q

Pneumocystis jiroveci pmeumonia PCP was formerly called what?

A

Pneumocystis carinii pneumonia

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2
Q

Symptoms of PCP

A 
Dry, non productive cough
Breathlessness on minimal exertion
Fever
Weight loss
Nightsweats
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3
Q

Investigations for pneumocystis jiroveci pneumonia (PCP)

A 
CXR
ABG
Exercise oximetry
induced sputum 
(Or CT = ground glass appearance)
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4
Q

CXR features of PCP

A

Bilateral hilar lymphadenopathy
Bilateral diffuse interstitial infiltrates
Apical sparing
Absence of pleural effusion or lobar consolidation

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5
Q

Treatment of PCP

A 
Co-trimoxazole (septrin) IV or high dose oral
Alternatives - clindamycin + primaquine
- dapsone + trimethoprim
- IV pentamidine 
- Atovaquone
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6
Q

Causative organism of kaposi sarcoma

A

Human herpes virus 8

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7
Q

Characteristic appearance of kaposi sarcoma

A 
Purple, brown or black 
Lesions
As macules (flat
Papules (<1cm + raised) 
Nodules (>1cm + raised) 
Non painful
Non itchy
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8
Q

Groups of patients associated with kaposi sarcoma

A

HIV - AIDS related illness
Immunocompromised after transplantation
Endemic KS in Africa
Classic KS legs of elderly Mediterranean men

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9
Q

Histological features to diagnose kaposi sarcoma

A

Spindle cell proliferation

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10
Q

Treatment of kaposi sarcoma

A

No definitive treatment
Foscarnet
Cidofovir
Ganciclovir
Local injection of vinblastine into lesion
Systemic chemo with liposomal anthracyclines

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11
Q

Clinical signs frequently seen with primary HIV (seroconversion)

A 
Fever >38
Arthralgia 
Myalgia
Rash
Nightsweats 
Lymphadenopathy 
Sore throat
Fatigue
Oral or genital ulcers
>2.5kg weight loss
Nausea or vomiting 
Diarrhoea
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12
Q

Blood results which raise suspicion of HIV seroconversion

A

Leukopenia

Thrombocytopenia

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13
Q

How can you diagnose primary HIV = seroconversion

A

HIV viral load (HIV RNA PCR)

p24 antigen becomes positive next

HIV antibody tests can take up to 3m to become positive

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14
Q

Management of cryptosporidium diarrhoea in patients with HIV immunocompromise

A

No effective antimicrobial
Start HAART to restore immune function
Enables cell-mediated immune response
Anti-diarrhoeal agents (loperamide or codeine)

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15
Q

Symptoms of CMV retinitis

A

Asymptomatic - found on screening
Blurred vision
Pyrexia

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16
Q

Treatment of CMV retinitis / colitis / cholangitis

A

Ganciclovir
Valganciclovir
Foscarnet
Cidofovir

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17
Q

What organism causes cryptococcal meningitis

A

Cryptococcus neoformans = encapsulated fungus

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18
Q

Treatment of cryptococcal meningitis

A

IV amphotericin B
Or IV Fluconazole
2/52 then lifelong prophylaxis unless CD4 count restores >200 for >6m

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19
Q

What is CSF India ink stain used to diagnose

A

Cryptococcal meningitis

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20
Q

What is CSF VDRL stain used to diagnose

A

Neurosyphillis

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21
Q

What is CSF PCR used to diagnose

A

Viral encephalopathy

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22
Q

What is CSF silver stain used to diagnose

A

Oligoclonal bands in MS (old fashioned test)

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23
Q

What is CSF ziehl-neelsen stain used to diagnose

A

Mycobacteria tuberculosis

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24
Q

What do ring enhancing lesions on brain CT or MRI usually represent

A

Cerebral toxoplasmosis

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25
Treatment of Cerebral toxoplasmosis
Sulphadiazine and pyrimethamine with folinic acid | 8 weeks tx
26
For immunocompromised HIV +ve patients with a CD4 <200 | What medication may be recommended to prevent opportunistic infection
Co-trimoxazole (septrin) - For PCP and toxoplasmosis Dapsone - for PCP Pentamidine nebuliser - for PCP Aciclovir - for recurrent herpes Fluconazole - for cryptococcus neoformans Azithromycin - for atypical mycobacterium
27
What vaccines are best avoided in HIV +ve patients
All LIVE and attenuated vaccines - rubella - measles - oral polio - BCG - yellow fever
28
Why is benzathine penicillin avoided for treatment of syphilis in HOV positive pregnant women
Associated with treatment failure in HIV +ve pregnant women
29
Treatment for syphilis in HIV positive pregnant women
Procaine penicillin IM daily for 17 days
30
Clinical signs frequently seen with primary HIV (seroconversion)
``` Fever >38 Arthralgia Myalgia Rash Nightsweats Lymphadenopathy Sore throat Fatigue Oral or genital ulcers >2.5kg weight loss Nausea or vomiting Diarrhoea ```
31
Blood results which raise suspicion of HIV seroconversion
Leukopenia | Thrombocytopenia
32
How can you diagnose primary HIV = seroconversion
HIV viral load (HIV RNA PCR) p24 antigen becomes positive next HIV antibody tests can take up to 3m to become positive
33
Management of cryptosporidium diarrhoea in patients with HIV immunocompromise
No effective antimicrobial Start HAART to restore immune function Enables cell-mediated immune response Anti-diarrhoeal agents (loperamide or codeine)
34
Symptoms of CMV retinitis
Asymptomatic - found on screening Blurred vision Pyrexia
35
Treatment of CMV retinitis / colitis / cholangitis
Ganciclovir Valganciclovir Foscarnet Cidofovir
36
What organism causes cryptococcal meningitis
Cryptococcus neoformans = encapsulated fungus
37
Treatment of cryptococcal meningitis
IV amphotericin B Or IV Fluconazole 2/52 then lifelong prophylaxis unless CD4 count restores >200 for >6m
38
What is CSF India ink stain used to diagnose
Cryptococcal meningitis
39
What is CSF VDRL stain used to diagnose
Neurosyphillis
40
What is CSF PCR used to diagnose
Viral encephalopathy
41
What is CSF silver stain used to diagnose
Oligoclonal bands in MS (old fashioned test)
42
What is CSF ziehl-neelsen stain used to diagnose
Mycobacteria tuberculosis
43
What do ring enhancing lesions on brain CT or MRI usually represent
Cerebral toxoplasmosis
44
Treatment of Cerebral toxoplasmosis
Sulphadiazine and pyrimethamine with folinic acid | 8 weeks tx
45
For immunocompromised HIV +ve patients with a CD4 <200 | What medication may be recommended to prevent opportunistic infection
Co-trimoxazole (septrin) - For PCP and toxoplasmosis Dapsone - for PCP Pentamidine nebuliser - for PCP Aciclovir - for recurrent herpes Fluconazole - for cryptococcus neoformans Azithromycin - for atypical mycobacterium
46
What vaccines are best avoided in HIV +ve patients
All LIVE and attenuated vaccines - rubella - measles - oral polio - BCG - yellow fever
47
Why is benzathine penicillin avoided for treatment of syphilis in HOV positive pregnant women
Associated with treatment failure in HIV +ve pregnant women
48
Treatment for syphilis in HIV positive pregnant women
Procaine penicillin IM daily for 17 days
49
Clinical signs frequently seen with primary HIV (seroconversion)
``` Fever >38 Arthralgia Myalgia Rash Nightsweats Lymphadenopathy Sore throat Fatigue Oral or genital ulcers >2.5kg weight loss Nausea or vomiting Diarrhoea ```
50
Blood results which raise suspicion of HIV seroconversion
Leukopenia | Thrombocytopenia
51
How can you diagnose primary HIV = seroconversion
HIV viral load (HIV RNA PCR) p24 antigen becomes positive next HIV antibody tests can take up to 3m to become positive
52
Management of cryptosporidium diarrhoea in patients with HIV immunocompromise
No effective antimicrobial Start HAART to restore immune function Enables cell-mediated immune response Anti-diarrhoeal agents (loperamide or codeine)
53
Symptoms of CMV retinitis
Asymptomatic - found on screening Blurred vision Pyrexia
54
Treatment of CMV retinitis / colitis / cholangitis
Ganciclovir Valganciclovir Foscarnet Cidofovir
55
What organism causes cryptococcal meningitis
Cryptococcus neoformans = encapsulated fungus
56
Treatment of cryptococcal meningitis
IV amphotericin B Or IV Fluconazole 2/52 then lifelong prophylaxis unless CD4 count restores >200 for >6m
57
What is CSF India ink stain used to diagnose
Cryptococcal meningitis
58
What is CSF VDRL stain used to diagnose
Neurosyphillis
59
What is CSF PCR used to diagnose
Viral encephalopathy
60
What is CSF silver stain used to diagnose
Oligoclonal bands in MS (old fashioned test)
61
What is CSF ziehl-neelsen stain used to diagnose
Mycobacteria tuberculosis
62
What do ring enhancing lesions on brain CT or MRI usually represent
Cerebral toxoplasmosis
63
Treatment of Cerebral toxoplasmosis
Sulphadiazine and pyrimethamine with folinic acid | 8 weeks tx
64
For immunocompromised HIV +ve patients with a CD4 <200 | What medication may be recommended to prevent opportunistic infection
Co-trimoxazole (septrin) - For PCP and toxoplasmosis Dapsone - for PCP Pentamidine nebuliser - for PCP Aciclovir - for recurrent herpes Fluconazole - for cryptococcus neoformans Azithromycin - for atypical mycobacterium
65
What vaccines are best avoided in HIV +ve patients
All LIVE and attenuated vaccines - rubella - measles - oral polio - BCG - yellow fever
66
Why is benzathine penicillin avoided for treatment of syphilis in HOV positive pregnant women
Associated with treatment failure in HIV +ve pregnant women
67
Treatment for syphilis in HIV positive pregnant women
Procaine penicillin IM daily for 17 days
68
Risk of transmission if HIV from a positive patient by a single needle stick injury
0.3% | = 1 in 300
69
What factors increase the risk of HIV transmission from a needle stick injury
High viral load of patient Large volume of blood inoculated Hollow bore needle Deep injury
70
In what circumstances can you test for HIV without the patients consent
If unconscious and testing is in their immediate clinical interest

MFSRH (18 decks)

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