ID

Question 1

Immune Defects with HIV

Answer 1

1. Massive Depletion of CD4+ T lymphocytes of the effector memory type in MALT. And progressive depletion of naïve and memory T cells.
2. B cell dysfunction
3. Impaired mucociliary clearance and antigen recognition by macrophages

Question 2

Noninfectious Pulm complications of HIV

Answer 2

COPD, lung cancer, PAH

Question 3

Standard Treatment for TB

Answer 3

2 months of RIPE
4 months of R+ I
-monthly sputum culture until negative x2 months
-if sputum culture positive after 4mos therapy, change drugs based on drug-susceptibility

Question 4

Criteria for Severe CAP

Answer 4

with 1 major or 3 minor criteria–> Direct admit to ICU
Major: Mech vent, septic shock on pressors
Minor: RR >30, BUN >19, multilobar infiltrates, leukopenia <4k, thrombocytopenia <100k, hypothermia <36C, confusion, hypotension requiring aggressive fluid

Question 5

Common Organisms for Necrotizing Pneumonia

Answer 5

Strep Pneumo (serotype 3)
PsA
Klebsiella

Question 6

VAP: Quantitative Cultures

Answer 6

10^4: quant BAL

10^3: protected brush

Question 7

CURB-65

Answer 7

Confusion
Uremia
RR >30
BP <90/60
Age 65

-0-1: low mortality, reasonable to tx as outpt
(if tolerating PO, good social support)
-2: 10% 30d mortality–> inpt

Question 8

Standard Therapy for active TB

Answer 8

4 drug RIPE x2 months
R+I for 4 months

• sputum cultures checked monthly until 2 consecutive are negative
• if cavitation and 2 month positive culture- extend to 9mos

Question 9

Standard Tx LTBI

Answer 9

INH- 9 months

Rifampine daily x4 months

Question 10

Essential component to effective therapy and high cure rate

Answer 10

Rifamycin (rifampin= rifabutin)

Question 11

Treatment of TB in pregnant patient

Answer 11

Risk of active TB > risk of Meds

-no modification to drugs for pregnant/lactating moms

Question 12

Treatment of NTM:

1. MAC
2. Kansasii
3. Abscessus

Answer 12

1. RAE
2. RAI
3. Imipenemi or cefoxitin plus amkicain
   - very resistant to firstline and oral meds
   - often need surgical debridement, lobectomy

Question 13

When to add adjunctive steroids in treatment of PJP:

Answer 13

PaO2 <70 or A-a gradient >35