HIV HY

Question 1

HIV pt vaccination schedule for S. Pneumo

Answer 1

PCV13 (first) at time of dx
2m later
PPSV 23 vaccine

Then PPSV every 5 years

Question 2

vaccines contraindicated in HIV (or immunocompromised)?

Answer 2

Live-Attenuated vaccines
MMR
Varicella/ Zoster
Rotavirus
Influenza (intranasal)
Polio (oral)

Question 3

General pneumococcal vaccine rule for adults > 65 and if pt is also HIV(+):

Answer 3

PPSV 23 vaccine
(PCV13, if HIV+)

Question 4

Watery, foul smelling diarrhea in a HIV patient?
Dx/Tx

Answer 4

Cryptosporidium Parvum (acid-fast)
Nitazoxanide/Paromomycin

(knitted socks and paranormal mice -ghost mice SKETCHY)

Question 5

Nuchal rigidity and high fevers in a HIV patient.
Dx/Dxt?
Acute & Chronic Tx?

Answer 5

Cryptococcus neoforman Meningitis
Acute: Amp-B + 5-Flucytosine
Chronic: Fluconazole (9-12m prevent recurrence)
Latex agglutination acid test
─
(pigeons, caves, soil exposure)
India ink stain: clear halo
Mucicarmine: Bright Red

Question 6

HIV pt 2 week h/o of malaise, dyspnea & productive cough
CXR: upper lobe cavitary lesion
Unilateral pleural effusion
Dx/Tx

Answer 6

TB (active)
RIPE + vit B6
(Rifampin, Isoniazid, Pyrazinamide, and Ethambutol)

Question 7

HIV pt + painful swallowing + mucosal adherent plaques
Dx/Tx (2)?

Answer 7

Esophageal candidiasis
PO fluconazole (Lozenges)
Nystatin swish/swallow (alternative option)

Question 8

HIV pt with blurry vision or painless vision loss (eye problems)
CD4 count: 45
± Fundoscopy: Red or yellow/white spots
Dx/Tx?

Answer 8

CMV Retinitis
PO Ganiciclovir (valganciclovir)

DNA Polym inhibitor

Question 9

PPX indicated for HIV with
CD4< 200
CD4< 100

Answer 9

TMP-SMX (PJP ppx)
TMP-SMX (Toxoplasmosis ppx)

(No more Mycobacterium avium ppx)

Question 10

Deficits of memory
Pupils accommodate but do not react to light
Impaired BLE proprioception & sensation
Absent deep tendon reflexes
broad-based gait (+ Romberg)
CSF: Lymphocytic pleocytosis
Dx/Tx?

Answer 10

Neurosyphilis
Penicillin G

–––
Tabes dorsalis (syphilitic myelopathy): demyelination of the dorsal columns and DRG → progressive sensory broad-based ataxia

Question 11

Treatment for Mycobacterium Avium Complex infection (3)

Answer 11

Clarithromycin + Ethambutol + Rifampin

Question 12

46M with a 25 yr history of HIV presents for 4 mo hx of poor concentration and impaired cognition.
Not on ART. CD4 <20.
PE: diffuse impairment in UE/LE motor activity.
Dx/Prognosis?

Answer 12

HIV associated neurocognitive disorder

(late stage HIV → poor prognosis)

Question 13

Paradoxical worsening of symptoms after HAART is initiated in a 25M with a CD4 count of 10.
Dx?

Answer 13

Immune reconstitution inflammatory syndrome

Question 14

Side Effects for TB drugs
Rifampin
Isoniazid
Ethambutol

Answer 14

Rifampin
(Hepatotoxic, Red/Orange secretions, Neurotoxic)
Isoniazid
(Hepatotoxic, B6 pyridoxine Deficiency, Neurotoxic)
Ethambutol
(Color blindness, Vision impairments, neutropenia, ↓ PLTs)

Question 15

34M with HIV presents with visual problems.
Head CT is notable for a solitary ring enhancing supratentorial lesion.
Dx/NBSIM (x2)?

Answer 15

HIV + Ring enhancing lesion = Assume Toxoplasmosis
1st: Pyrimethamine + Sulfadiazine
2nd: Brain biopsy (if no improvement with abx)

Question 16

Pt with AIDS
Presents with signs of elevated intracranial pressure
* progressive headaches
* nausea/vomiting
* confusion

Dx/NBSIM?

Answer 16

Cryptococcal meningoencephalitis
lumbar puncture + CSF analysis
± India ink stain

Question 17

___ vaccine indicated in men who have sex with men

Answer 17

Hepatitis A virus

Question 18

At the time of HIV diagnosis
all patients should receive Hep A, Hep B, HPV
Meningococcal & PCV 13 (PPSV 23) vaccines.

Meningococcal vaccine is repeated every __ years

PPSV is repeated every __ years

Answer 18

5