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MFSRH > HIV > Flashcards

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
Q

Treatment of Cerebral toxoplasmosis

A

Sulphadiazine and pyrimethamine with folinic acid

8 weeks tx

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26
Q

For immunocompromised HIV +ve patients with a CD4 <200

What medication may be recommended to prevent opportunistic infection

A

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

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27
Q

What vaccines are best avoided in HIV +ve patients

A

All LIVE and attenuated vaccines

  • rubella
  • measles
  • oral polio
  • BCG
  • yellow fever
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28
Q

Why is benzathine penicillin avoided for treatment of syphilis in HOV positive pregnant women

A

Associated with treatment failure in HIV +ve pregnant women

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29
Q

Treatment for syphilis in HIV positive pregnant women

A

Procaine penicillin IM daily for 17 days

30
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
31
Q

Blood results which raise suspicion of HIV seroconversion

A

Leukopenia

Thrombocytopenia

32
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

33
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)

34
Q

Symptoms of CMV retinitis

A

Asymptomatic - found on screening
Blurred vision
Pyrexia

35
Q

Treatment of CMV retinitis / colitis / cholangitis

A

Ganciclovir
Valganciclovir
Foscarnet
Cidofovir

36
Q

What organism causes cryptococcal meningitis

A

Cryptococcus neoformans = encapsulated fungus

37
Q

Treatment of cryptococcal meningitis

A

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

38
Q

What is CSF India ink stain used to diagnose

A

Cryptococcal meningitis

39
Q

What is CSF VDRL stain used to diagnose

A

Neurosyphillis

40
Q

What is CSF PCR used to diagnose

A

Viral encephalopathy

41
Q

What is CSF silver stain used to diagnose

A

Oligoclonal bands in MS (old fashioned test)

42
Q

What is CSF ziehl-neelsen stain used to diagnose

A

Mycobacteria tuberculosis

43
Q

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

A

Cerebral toxoplasmosis

44
Q

Treatment of Cerebral toxoplasmosis

A

Sulphadiazine and pyrimethamine with folinic acid

8 weeks tx

45
Q

For immunocompromised HIV +ve patients with a CD4 <200

What medication may be recommended to prevent opportunistic infection

A

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
Q

What vaccines are best avoided in HIV +ve patients

A

All LIVE and attenuated vaccines

  • rubella
  • measles
  • oral polio
  • BCG
  • yellow fever
47
Q

Why is benzathine penicillin avoided for treatment of syphilis in HOV positive pregnant women

A

Associated with treatment failure in HIV +ve pregnant women

48
Q

Treatment for syphilis in HIV positive pregnant women

A

Procaine penicillin IM daily for 17 days

49
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
50
Q

Blood results which raise suspicion of HIV seroconversion

A

Leukopenia

Thrombocytopenia

51
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

52
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)

53
Q

Symptoms of CMV retinitis

A

Asymptomatic - found on screening
Blurred vision
Pyrexia

54
Q

Treatment of CMV retinitis / colitis / cholangitis

A

Ganciclovir
Valganciclovir
Foscarnet
Cidofovir

55
Q

What organism causes cryptococcal meningitis

A

Cryptococcus neoformans = encapsulated fungus

56
Q

Treatment of cryptococcal meningitis

A

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

57
Q

What is CSF India ink stain used to diagnose

A

Cryptococcal meningitis

58
Q

What is CSF VDRL stain used to diagnose

A

Neurosyphillis

59
Q

What is CSF PCR used to diagnose

A

Viral encephalopathy

60
Q

What is CSF silver stain used to diagnose

A

Oligoclonal bands in MS (old fashioned test)

61
Q

What is CSF ziehl-neelsen stain used to diagnose

A

Mycobacteria tuberculosis

62
Q

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

A

Cerebral toxoplasmosis

63
Q

Treatment of Cerebral toxoplasmosis

A

Sulphadiazine and pyrimethamine with folinic acid

8 weeks tx

64
Q

For immunocompromised HIV +ve patients with a CD4 <200

What medication may be recommended to prevent opportunistic infection

A

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
Q

What vaccines are best avoided in HIV +ve patients

A

All LIVE and attenuated vaccines

  • rubella
  • measles
  • oral polio
  • BCG
  • yellow fever
66
Q

Why is benzathine penicillin avoided for treatment of syphilis in HOV positive pregnant women

A

Associated with treatment failure in HIV +ve pregnant women

67
Q

Treatment for syphilis in HIV positive pregnant women

A

Procaine penicillin IM daily for 17 days

68
Q

Risk of transmission if HIV from a positive patient by a single needle stick injury

A

0.3%

= 1 in 300

69
Q

What factors increase the risk of HIV transmission from a needle stick injury

A

High viral load of patient
Large volume of blood inoculated
Hollow bore needle
Deep injury

70
Q

In what circumstances can you test for HIV without the patients consent

A

If unconscious and testing is in their immediate clinical interest

MFSRH (18 decks)

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