HIV

Question 0

Acute HIV syndrome affect what portion of first-time infected? Characterized by?

Answer 0

30% of patients. Mononucleosis like illness with fever, headaches (aseptic meningitis), shotty lymphadenopathy, pharyngitis, and macular rash

Question 1

Patient with HIV presents with dry cough. Diagnosis? Helpful lab test?

Answer 1

PCP; Elevated LDH

Question 2

At CD4 levels less than 500 patients are susceptible to which infections?

Answer 2

Pneumonia, TB, vaginal candidiasis, HZV and HSV

Question 3

At CD4 levels less than 200, patients can develop?

Answer 3

PCP, toxoplasmosis, histoplasmosis, Cryptococcus, Cryptosporidium

Question 4

At CD4 levels less than 50, patients susceptible to?

Answer 4

MAI, CMV, CNS lymphoma, esophagitis

Question 5

Most common opportunistic infection affecting AIDS patients? Presents with? can lead to?

Answer 5

PCP. Dry cough. Can lead to respiratory compromise or spontaneous pneumothorax (from rupture of blebs)

Question 6

Definitive diagnosis of PCP with what stain?

Answer 6

Giemsa or Silver stain

Question 7

Serum marker used as an indirect marker for PCP? Level? May also be elevated in?

Answer 7

Elevated LDH. Patients with LDH less than 220 are very unlikely to have PCP. Also seen in Histoplasmosis or lymphoma.

Question 8

PCP unlikely to be cause of infection if?

Answer 8

1. LDL level less than 220

2. CD4 count more than 250

Question 9

PCP positive patients with arterial PO2 less than 70 or Aa gradient more than 35 should be treated with?

Answer 9

Prednisone in conjunction with TMP-SMX

Question 10

Patchy infiltrates and pleural based infiltrates can be seen with?

Answer 10

TB and Cryptococcus

Question 11

Patients allergic to sulfa can be treated for PCP with?

If G6PD deficiency?

Answer 11

Pentamidine + clindamycin with primaquine

Pentamidine

Question 12

Cavitary lesions can be seen with?

Answer 12

TB, PCP, Coccidioides

Question 13

Most common causes of pneumonia in AIDS patients are?

Answer 13

Same organisms that cause pneumonia immunocompetent patients

Question 14

Think community-acquired pneumonia if?

Answer 14

Acute onset of fever and productive cough, with the pulmonary infiltrate

Question 15

Patient with an indolent or chronic history of cough and weight-loss - think?

Answer 15

TB

Question 16

Most common CNS mass lesion in AIDS patients? Tx? If lesions do not regress after two weeks of treatment, likely diagnosis? Test?

Answer 16

Toxoplasmosis. Sulfadiazine with pyrimethamine. CNS lymphoma. Stereotactic brain biopsy.

Question 17

This is present in more than 90% of cases of patients with CNS lymphoma?

Answer 17

Epstein-Barr virus

Question 18

Screen for Cryptococcus? If Cryptococcus, CNS findings?

Answer 18

Serum cryptococcal antigen or LP. Normal white blood cells but elevated intracranial pressure.

Question 19

Treatment cryptococcal meningitis?

Answer 19

Amphotericin B plus flucytosine followed by chronic suppression with oral fluconazole

Question 20

Signs of CMV infection?

Answer 20

1. Persistent fever and constitutional symptoms
2. Retinitis that can lead to blindness
3. Esophagitis that can cause odynophagia
4. Necrotizing adrenalitis that can cause adrenal insufficiency

Question 21

Treatment for CMV?

Answer 21

Ganciclovur, foscarnet, cidofovir

Question 22

Patient with low CD4+T count presents with persistent fevers, weight-loss, abdominal pain, or diarrhea. Cause? Tx?

Answer 22

MAI. Clarithromycin and ethambutol and rifabutin.

Question 23

Appropriate prophylaxis when CD4 count less than 200? Less than 100? Less than 50?

Answer 23

Double strength tablets of TMP SMX 3x week. Increase TMP SMX. Clarithromycin daily or azithromycin weekly

Question 24

HAART therapy?

Answer 24

Backbone - two nucleoside analog reverse transcriptase inhibitors

Base - Non-nucleoside analogue reverse transcript inhibitor or a protease inhibitor

Question 25

Immune reconstitution syndrome?

Answer 25

Improvement in the immune system can cause worsening of symptoms 1 to 2 weeks after starting HAART.

Question 26

PNA ppx in HIV pts?

Answer 26

Bactrim if CD4<50 (for atypicals)