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STEP 3 - MTB > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

When to start HIV therapy based on CD4 count

A

<500, or in pts w/ detectable viral load even if CD4 >500, or symptomatic pts w/ any CD4 count or viral load

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2
Q

Which pregnant pts should be treated for HIV?

A

All of them, any stage of pregnancy, any CD4 count.

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3
Q

Protease inhibitor suffix and major side-effects

A

-navir. hyperglycemia, hyperlipidemia.

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4
Q

Integrase inhibitor suffix and MOA

A

Suffix: -gravir (raltegravir, elvitegravir, dolutegravir)
MOA: prevents HIV genome from being incorporated into CD4 cell

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5
Q

Efavirenz (class & s/e)

A

non-nucleoside RTI

avoid in pregnancy and mental illness. More prone to drug resistance.

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6
Q

nevirapine (class)

A

non-nucleoside RTI

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7
Q

etravirine (class)

A

non-nucleoside RTI

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8
Q

rilpivirine (class)

A

non-nucleoside RTI

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9
Q

Non-nucleoside RTI side effects

A

drowsiness.

Avoid in mental illness.

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10
Q

Zidovudine - class & s/e

A

nucleoside RTI

anemia

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11
Q

Didanosine - class & s/e

A

nucleoside RTI

pancreatitis and peripheral neuropathy

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12
Q

Stavudine - class & s/e

A

nucleoside RTI

pancreatitis and neuropathy

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13
Q

Lamivudine - class and s/e

A

nucleoside RTI

no s/e

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14
Q

Abacavir - class & s/e

A

nucleoside RTI

rash (HLA B5701 - test for mutation prior to starting)

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15
Q

Emtricitabine - class

A

nucleoside RTI

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16
Q

tenofovir - class & s/e

A

nucleoside RTI

renal toxicity/RTA (disoproxil form), bone demineralization

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17
Q

Maraviroc - class

A

blocks CCR5 (where GP120 attaches for HIV to enter human cell)

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18
Q

Standard of care for HAART

A

two nucleoside RTI and an integrase inhibitor

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19
Q

Preexposure ppx

A

2-drug combo of tenofovir and emtricitabine before exposure

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20
Q

Post-exposure ppx (needlestick, unprotected sex)

A

ART for a month, start w/in 72hrs of exposure.

2 nucleoside RTIs and an integrase inhibitor (do not use abacavir b/c HLA test not immediately available.

21
Q

PCP ppx - when to start. what meds

A

Bactrim. Atovaquone or dapsone if rash develops.

Start for CD4 <200

22
Q

MAC ppx

A

CD4 <50

Azithromycin one a week oral

23
Q

PCP Clinical presentation

A

Dry cough, SOA, hypoxia, increased LDH

24
Q

PCP CXR

A

CXR w/ b/l interstitial infiltreates

25
Q

PCP - most accurate test

A

bronchoalveolar lavage

26
Q

PCP treatment

A

IV bactrim. IV pentamadine if there is a rash.

Atovaquone can be used for mild.

27
Q

What do you give in PCP if its severe? (pO2 <70 or A-a gradient >35)

A

Steroids.

28
Q

Toxoplasmosis Head CT w/ contrast findings

A

“ring” or contrast enhancing lesions

29
Q

Toxoplasmosis treatment

A

pyrimethamine & sulfadiazine for 2 weeks, repeat CT scan.

30
Q

CMV treatment in HIV

A

CD4 <50 and blurry vision
ganciclovir or foscarnet if immediately life-threatening
PO valganciclovir lifelong for maintenance (can stop if CD4 rises w/ HAART).

31
Q

Cryptococcus in HIV - Presentation

A

fever, headache, CD4<50

32
Q

Cryptococcus in HIV - Dx tests

A

LP - increase in WBCs in CSF
India Ink Stain - 60% sensitive
Cryptococcal antigen test - 95% sensitive & specific

33
Q

Cryptococcus in HIV - treatment

A

amphotericin and 5-FC, followed by diflucan

Diflucan lifelong unless CD4 count rises on antiretrovirals.

34
Q

PML - presentation, best initial test, treatment

A

CD4 <50, focal neurologic abnormalities.
Head CT or MRI.
No specific therapy, treat w/ HAART, resolves when CD4 count rises.

35
Q

Mycobacterium avium intracellulare - presentation

A

CD4 <50, weight loss, fever, fatigue, anemia (invasion of bone marrow). Increased ALP and GGTP w/ normal bili (hepatic involvement).

36
Q

Mycobacterium avium intracellulare - dx tests & treatment

A

Bone marrow biopsy. liver biopsy most sensitive. blood cultures least sensitive.
Azithromycin, rifampin, ethambutol. Ppx w/ azithro.

37
Q

Duke Criteria (2 major)

A
  1. 2 positive blood cultures (except in HACEK)

2. Abnormal echogardiogram (mass or valvular lesion, abscss, partial dehiscence of prosthetic valve).

38
Q

Duke Minor Criteria (5, see other cards for specifics)

A
  1. fever (>38C of 100.4F)
  2. Risk factors
  3. Vascular findings
  4. Immunologic findings
  5. Micro Findings: + blood cxs but not meeting major criteria
39
Q

Duke Major Blood Cxs - species?

A

S. aureus, viridans streptococci, Strep bovis/epidermis, enterococci, GNR, Candida

40
Q

Duke Endocarditis Risk Factors (Minor Criteria)

A

IVDU, structural heart dz, prosthetic valve, dental procedures w/ bleeding, hx of EC

41
Q

Duke Vascular Findings (Minor Criteria)

A

Janeway lesions, septic pulm infarcts, arterial emboli, mycotic aneurysm, conjunctival hemorrhage

42
Q

Duke Immunologic Findings (Minor Criteria)

A

Roth spots, Osler nodes, glomerulonephritis

43
Q

Dx of endocarditis based on Duke’s Criteria

A

2 major
1 major & 3 minor
5 minor criteria

44
Q

Most common culture-negative cause of endocarditis

A

Bartonella and Coxiella

45
Q

Best empiric therapy for endocarditis

A

vanc + gentamicin (or ceftriaxone in combo) for 4-6wks

46
Q

Pts w/ EC caused by S. bovis or C. septicum need a _.

A

colonoscopy.

47
Q

Anatomic defects indicating surgery for endocarditis

A

valve rupture, abscess, prosthetic valve, fungal endocarditis, embolic events once on ABX

48
Q

Cardiac Defects that Need EC Ppx

A

prosthetic valves
unrepaired cyanotic heart dz
hx of EC
transplant recipient who develops valvular dz

49
Q

Procedures that do NOT need EC ppx

A

dental fillings, flexible scopes, OB/GYN procedures, urinary procedures (e.g. cystoscopy)

STEP 3 - MTB (3 decks)

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