HIV (Lec 3)

Question 1

About 2/3 of new cases of HIV are from what location?

Answer 1

sub-saharan africa

Question 2

What is a classic clinical clue of primary HIV infection?

Answer 2

abrupt onset: “10 signs and symptoms in 24 hours”

Question 3

Cough/Upper resipiratory infections indicate that it is ______ primary HIV

Answer 3

probably not

Question 4

_____ is a highly sensitive screening test for initial testing of HIV

Answer 4

ELISA

Question 5

If the ELISA tests is negative, the HIV antibody test is reported as ____. If the result is positive, the ELISA is ___

Answer 5

negative;

repeated

Question 6

If a repeat ELISA test is positive, a _____ assay, which is more _____, is performed for confirmation

Answer 6

western-blot

specific

Question 7

___ out of 3 characteristic bands on Western Blot present = reported as positive

Answer 7

2

Question 8

Supplemental testing includes _____

Answer 8

viral load, RNA testing

Question 9

Normal range of CD4 = _____ cells/mm3

Average decline of CD4 in untreated HIV patients: _____ cells/mm3 per year

Answer 9

350-1100

75-100

Question 10

High levels of viral loads correlates with CD4 Cell count ____ and clinical disease _____

Answer 10

decline, progression

Question 11

CD Cell count less than _____ has the highest risk of what cancer? _____

Answer 11

50

lymphoma

Question 12

CD Cell count > 500:
most patients are _____
some bacterial infections such as _____; viral infections such as shingles

Answer 12

asymptomatic

pnemococcus, staph, TB

Question 13

CD4 cell count associated with generalized adenopathy, thrush, and _____ ____: _______

Answer 13

kaposi’s sarcoma

500

Question 14

CD4 count less than _____ is associated with PCP, toxo, and cryptococcus

Answer 14

200

Question 15

Complications of HIV treatment include:

_______ = body morphology changes, central adiposity; ____Acidemia, peripheral ____, avascular necrosis of _____

Answer 15

lipodystrophy syndrome;

lactic; neuropathy; hip

Question 16

Live vaccines such as ____ and ____ should be avoided in patients with HIV

Answer 16

MMR; zoster

Question 17

The ______ type of influenza vaccine should be avoided

Answer 17

intranasal

Question 18

Post exposure use of _____ has been shown to be protective against HIV in health care workers

Answer 18

Zidovudine (although it’s a “crappy drug”)

Question 19

Highest risk of aquisition of HIV by exposure route:

Answer 19

blood transfusion

Question 20

Symptoms: gradual onset of fever, dry cough, dyspnea; CD4 Count of 200

Answer 20

Pneumocystis jiroveci

Question 21

Chest x-ray of Pneumocystis Jiroveci shows typical ______ opacity and bilateral _____ infiltrates

Answer 21

ground glass

interstitial

Question 22

____ dehydrogenase is elelvated in the majority of Pneumocystis patients

Answer 22

lactate

Question 23

Treatment of pneumocystis:

Answer 23

Bactrim or pentamidine

Question 24

Cryptococcal meningitis usually presents in patients with a CD count less than ____

Answer 24

100

Question 25

Treatment of cryptococcus: _____ and _____ followed by _____

Answer 25

Ampho B and flucytosine; followed by fluconazole

Question 26

CMV typically presents as _____ or ____ in patients with CD counts less than _____

Answer 26

retinitis, colitis

50

Question 27

In advanced HIV disease, TB usually presents in the ____ lobe rather than the _____ lobe

Answer 27

lower, upper

Question 28

_____ manifestations are more common withl higher levels of ______ staining bacteria in HIV patients with Tb

Answer 28

Extrapulmonary; acid-fast

Question 29

There is often a notable absence of _____ in patients with HIV + Tb

Answer 29

granuloma

Question 30

______ is an independent predictor of mortality in HIV patients. Symptoms include fever, weight loss, diarrhea, lymphadenopathy, sweats.

Answer 30

Mycobacterium Avium Complex (MAC)

Question 31

CD4 counts are often less than ____ in patients with MAC. Other abnormal lab values include ____ and elevated ____

Answer 31

50;

anemia, alkaline phosphatase

Question 32

What antibiotic should you use for MAC prophylaxis in patients with CD counts less than 50?

Answer 32

azithromycin (1st line)

Question 33

Toxoplamosis infections classically present as ______ lesions in the brain on MRI

Answer 33

ring-enhancing

Question 34

Toxoplasmosis can be differentiated from ______ by seeing a response on imaging to empiric treatment of toxo.

Answer 34

Primary CNS lymphoma

Question 35

Primary CNS lymphoma usually presents (with/without) fever, as opposed to _______

Answer 35

without; toxoplasmosis

Question 36

_____ enhancement is seen in Primary CNS lymphoma, as opposed to toxo

Answer 36

subependymal

Question 37

______ virus causes progressive multifocal leukoencephalopathy

Answer 37

JC