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ICM - Infectious Disease > HIV II > Flashcards

HIV II Flashcards

1
Q

Examples of things that should be considered in a DDx of an HIV patient (9)

A 
EBV mononucleosis/CMV
HSV
Influenza
Rubella
Viral Hepatitis
Toxoplasmosis
Syphilis/Gon./Chlam. 
Rickettsia/Lyme
Strep
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2
Q

Important things to consider with Drug Resistance Testing

A

Identification of resistance mutations at entry to care can optimize treatment outcomes.

Interpret in combination with history of ARV exposure and adherence in mind.

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3
Q

Important Vaccinations to check on…

A 
Avoid Live Vaccines (MMR and Zoster)
Pneumococcal vaccine, Hep A and B
Influenza
HPV
Hemophilius Influenza
Varicella vaccine
Tetanus
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4
Q

Symptoms of Pneumocystis jirovecii

A

Gradual onset fever, dry cough, dyspnea

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5
Q

Imaging for Pneumocystis jirovecii

A

Chest xray with diffuse bilateral interstitial infiltrates

CT if necessary

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6
Q

How to diagnose Pneumocystis jirovecii

A

Immunoflourescent antibody staining

Bronchoscopy/BAL (sensitivity 97-100%)

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7
Q

Treatment for Pneumocystis jirovecii

A

IV Bactrim or Pentamidine, PO Bactrim, TMP-dapsone, clindamycin-primaquine, or atovaquone

Give corticosteroids if PaO2 drops below 70

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8
Q

What do you use to do prophylaxis for Pneumocystis jirovecii

A

Bactrim DS or SS daily, can reduce to 3/week
Dapsone daily if G6PD is ok
Add pyrimethamine/leucovorin for Toxo prophylaxis

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9
Q

What happens to CD4 after discontinuing prophylaxis

A

increase in CD4 by more than 200 for more than 3 months

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10
Q

Symptoms of cryptococcal menningitis

A

Subacute meningitis w/fever

HA + Malaise

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11
Q

What does cryptococcal menningitis CSF look like?

A

Lymphocytic pleocytosis
Elevated Protein
Low-normal glucose
OP elevated to over 200

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12
Q

How to diagnose Cryptococcal Menningitis

A

Serum+CSF crypto Ag
Blood Cultures in up to 75% of cases
CSF fungal culture

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13
Q

Treatment for Cryptococcal Menningitis?

A

Ampthtericin B and Flucytosine

Maintain with Fluconazole for 8 weeks

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14
Q

How to manage increased intracranial pressure in Cryptococcal infection

A

If over 250 mmH2O, daily LP recommended

Consider shunt if signs of cerebral edema persist

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15
Q

Symptoms of CMV infection?

A 
End-organ manifestations
Retinitis
Colitis
Esophagitis
Neurological Disease
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16
Q

How to diagnose latent tuberculosis in HIV?

A

Test at diagnosis and annually
PPD or IFN-gamma release

Repeat if tested below 200 CD4

17
Q

How to treat LTB in an HIV patient

A

INH daily or twice weekly for 9 months
OR
Rifampin or Rifabutin for 4 months (2nd line)

18
Q

How does TB present differently in advanced HIV patients?

A

in CXR - Lower lobe, interstitial and miliary infiltrates
Hilar/Mediastinal Adenopathy
More extrapulmonary manifestations
No granulomas

19
Q

Clinical presentation of M. avium (MAC) in HIV

A 
Fever
Weight Loss
Sweats
Diarrhea
Lymphadenopathy
Hepatosplenomegaly
20
Q

Abnormal lab values in MAC?

A

Anemia
elevated Alkphos
CD4 below 50

21
Q

Best way to diagnose MAC?

A

Blood Culture

22
Q

Who gets prophylaxis for MAC?

When do you stop?

A

CD4 below 50

When CD4 is above 100 for at least 3 months

23
Q

What should you use as prophylaxis for MAC?

A

Azithromycin or Clarithromycin

24
Q

Most common symptoms of Toxoplasmosis

A 
Headache
Fever
Behavioral
Lethargy
Coord/gait
Seizure
Coma
25
Q

How to diagnose Toxoplasmosis

A

Focal lesions on CT/MRI
CSF – high proteins, moderate mononecueated pleocytosis
DNA PCR (high specificity)
Response to treatment

26
Q

Signs and symptoms of Primary CNS lymphoma

A 
No Fever
Confusion, lethargy, memory loss
Hemiparesis/aphasia
seizures
CN palsy
Headache
CD4 below 100
27
Q

How to diagnose Primary CNS lymphoma

A

Neuroimaging – CT/MRI
CSF – mononucleated pleocytosis, elecated proteins
Epstein Barr virus DNA PCR (pick this one)

28
Q

How to diagnose Progressive Multifocal Leukoencephalopathy/JC Virus

A

Brain Biopsy

CSF PCR detection of JCV DNA

29
Q

Treatment for Progressive Multifocal Leukoencephalopathy/JC Virus

A

None.

ICM - Infectious Disease (11 decks)

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