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MRCP Combined > HIV - complications and opportunistic infections > Flashcards

HIV - complications and opportunistic infections Flashcards

1
Q

4 conditions than can occur when CD4 count 200-500

A

oral thrush
candidiasis
Hairy Leukoplakia
Kaposi Sarcoma

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2
Q

What is hairy leukoplakia caused by?

A

EBV

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3
Q

What is Kaposi’s sarcoma caussed by

A

HH8

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4
Q

5 conditions that can occur when CD4 count 100 - 200 cells/mm³

A

Cryptosporidiosis
Cerebral toxoplasmosis
Progressive multifocal leukoencephalopathy
Pneumocystis jirovecii pneumonia
HIV dementia

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5
Q

What is Progressive multifocal leukoencephalopathy caused by

A

JC Virus

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6
Q

4 conditions that can occur when CD4 count 50-100

A

aspergillosis
oesophageal candidiasis
Cryptococcal meningitis
Primary CNS lymphoma

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7
Q

2 conditions that can occur when CD4 count <50

A

Cytomegalovirus retinitis
Mycobacterium avium-intracellulare infection

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8
Q

What is the most common cause of biliary disease in patients with HIV

A

sclerosing cholangitis due to infections such as CMV, Cryptosporidium and Microsporidia

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9
Q

Which vaccines are contra-indicated in HIV+ve patients?

A

Cholera CVD103-HgR
Influenza-intranasal
Poliomyelitis-oral (OPV)
Tuberculosis (BCG)

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10
Q

Which vaccinations can only be used in HIV patients when CD4 >200

A

Measles, Mumps, Rubella (MMR)
Varicella
Yellow Fever

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11
Q

What are the symptoms of toxoplasmosis in HIV?

A

constitutional symptoms, headache, confusion, drowsiness

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12
Q

CT findings of toxoplasmosis lesions in HIV?

A

CT: usually single or multiple ring enhancing lesions, mass effect may be seen

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13
Q

Management of toxoplasmosis in HIV?

A

management: sulfadiazine and pyrimethamine

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14
Q

CNS lymphoma cause

A

EBV

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15
Q

CNS lymphoma imaging

A

CT: single or multiple homogenous enhancing lesions

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16
Q

Treatment primary CNS lymphoma

A

treatment generally involves steroids (may significantly reduce tumour size), chemotherapy (e.g. methotrexate) + with or without whole brain irradiation. Surgical may be considered for lower grade tumours

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17
Q

Toxoplasmosis Imaging clues

A

Multiple lesions
Ring or nodular enhancement
Thallium SPECT negative

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18
Q

Primary CNS lymphoma clues

A

Single lesion
Solid (homogenous) enhancement
Thallium SPECT positive

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19
Q

CT head finding of tuberculosis in HIV

A

CT: single enhancing lesion

20
Q

Causes of encephalitis in HIV

A

may be due to CMV or HIV itself

21
Q

CT head finding of encephalitis in HIV

A

oedematous brain

22
Q

Symptoms of cryptococcus in HIV?

A

headache, fever, malaise, nausea/vomiting, seizures, focal neurological deficit

23
Q

CSF examination findings of cryptococcus in HIV?

A

high opening pressure
elevated protein
reduced glucose
normally a lymphocyte predominance but in HIV white cell count many be normal
India ink test positive

24
Q

CT head finding of cryptococcus in HIV?

A

CT: meningeal enhancement, cerebral oedema

25
Q

Progressive multifocal leukoencephalopathy (PML) cause

A

JC virus

26
Q

Progressive multifocal leukoencephalopathy (PML) symptoms

A

behavioural changes, speech, motor, visual impairment

27
Q

Progressive multifocal leukoencephalopathy (PML) CT head

A

CT: single or multiple lesions, no mass effect, don’t usually enhance. MRI is better - high-signal demyelinating white matter lesions are seen

28
Q

AIDS dementia symptoms

A

symptoms: behavioural changes, motor impairment

29
Q

AIDS dementia CT head findings

A

CT: cortical and subcortical atrophy

30
Q

Who should receive prophylaxis against PCP?

A

all patients with a CD4 count < 200/mm³ should receive PCP prophylaxis

31
Q

What are the features of PCP?

A

dyspnoea
dry cough
fever
very few chest signs

32
Q

Name a common complication of PCP?

A

Pneumothorax

33
Q

What are the extrapulmonary manifestations of PCP?

A

hepatosplenomegaly
lymphadenopathy
choroid lesions

34
Q

Investigations for PCP?

A

CXR: typically shows bilateral interstitial pulmonary infiltrates but can present with other x-ray findings

Best = bronchoalveolar lavage and silver staining

35
Q

Management of PCP?

A

co-trimoxazole
IV pentamidine in severe cases
aerosolized pentamidine is an alternative treatment for Pneumocystis jiroveci pneumonia but is less effective with a risk of pneumothorax

Steroids if hypoxic

36
Q

What is Kaposi’s sarcoma caused by

A

Human Herpesvirus 8

37
Q

Presentation of Kaposi’s sarcoma

A

presents as purple papules or plaques on the skin or mucosa (e.g. gastrointestinal and respiratory tract)

38
Q

Treatment of Kaposi’s sarcoma

A

radiotherapy + resection

39
Q

What are the features of HIV associated nephropathy?

A

massive proteinuria resulting in nephrotic syndrome
normal or large kidneys
focal segmental glomerulosclerosis with focal or global capillary collapse on renal biopsy
elevated urea and creatinine
normotension

40
Q

Who does CMV retinitis typically affect?

A

Patients with CD4 count < 50

41
Q

Features of CMV retinitis

A

visual impairment - ‘blurred vision’ etc
pizza retina

42
Q

Treatment of CMV retinitis

A

IV ganciclovir
treatment used to be life-long but new evidence suggests that it may be discontinued once CD4 > 150 after HAART

43
Q

Causes of diarrhoea in HIV

A

Cryptosporidium + other protozoa (most common)
Cytomegalovirus
Mycobacterium avium intracellulare
Giardia

44
Q

Ziehl-Neelsen stain (acid-fast stain) result for cryptosporidium

A

characteristic red cysts of Cryptosporidium

45
Q

Mycobacterium avium intracellulare features

A

fever, sweats, abdominal pain and diarrhoea.

46
Q

Mycobacterium avium intracellulare treatment

A

rifabutin, ethambutol and clarithromycin

MRCP Combined (58 decks)

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