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infectious by dp > HIV > Flashcards

HIV Flashcards

1
Q

True or false

 Even if the ED evaluation is unrevealing, admit all patients with new or changed neurologic signs or symptoms.

A

True

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2
Q

Since the introduction of ART,__________________ remains the most commonly reported neurologic opportunistic infection

A

toxoplasmosis encephalitis

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3
Q

In toxoplasmosis encephalitis  unenhanced CT scan, toxoplasmosis typically appears as 

A

multiple subcortical lesions with a predilection for the basal ganglia and corticomedullary junction

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4
Q

In toxoplasmosis encephalitis  Contrast-enhanced CT scan typically shows

A

multiple ring-enhancing lesions with surrounding areas of edema

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5
Q

True or false

 MRI is more sensitive than contrast-enhanced CT scan in detecting toxoplasmosis

A

 True

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6
Q

Admit patients with suspected toxoplasmosis and treat with a combination of

A

IV pyrimethamine plus

sulfadiazine plus

leucovorin (folinic acid).

Clindamycin is a substitute for sulfadiazine.

trimethoprim-sulfamethoxazole may have equal efficacy

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7
Q

In toxoplasmosis encephalitis occurs most commonly in patients with CD4+ cell counts_______ cells/mm3 as latent bradyzoites acquired early in life reactivate

A

<100

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8
Q

Cryptococcal infection occurs most commonly in patients with CD4+ counts of______ cells/mm3

A

<50

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9
Q

Patients with CNS cryptococcosis require hospital admission and the following medications

A

IV amphotericin B and

oral flucytosine for 14 days, followed by

fluconazole for 8 weeks to clear the CSF

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10
Q

Diagnosis of CNS cryptococcal infection in HIV patients relies on

A

CSF cryptococcal antigen testing (92% sensitive and 83% specific),

fungal culture (95% to 100% sensitive), or

staining with India ink (60% to 80% sensitive)

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11
Q

Cytomegalovirus on neuroimaging

A

nonspecific periventricular enhancement

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12
Q

Cytomegalovirus means state of treatment

A

Ganciclovir

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13
Q

CD4+ T-cell counts of______ cells/mm3 generally have causes of fever similar to those in nonimmunocompromised patients

A

> 500

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14
Q

CD4+ T-cell counts between__________ cells/mm3 are more likely to have infections that are associated with early immune compromise, including bacterial pneumonia, herpes zoster, and tuberculosis.

A

200 and 500

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15
Q

CD4+ T-cell counts of________ cells/mm3, the most common causes of fever without obvious localizing findings are early Pneumocystis jirovecii pneumonia (formerly known as Pneumocystis carinii); central line infection; infection with Mycobacterium avium complex, Mycobacterium tuberculosis, or cytomegalovirus; drug fever; and sinusitis. Other causes of fever include endocarditis, lymphoma, and infection with Histoplasma capsulatum or Cryptococcus neoformans.

A

<200

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16
Q

infection occurs predominantly in patients with CD4+ T-cell counts of ≤100 cells/mm3 who are not on ART or azithromycin prophylaxis.

Persistent fever and night sweats are typical symptoms.

Associated symptoms include weight loss, diarrhea, malaise, and anorexia

A

Disseminated M. avium complex

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17
Q

Treatment for disseminated mycobacterium avium complex infection

A

clarithromycin combined with ethambutol and rifabutin

Azithromycin is an alternative therapy

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18
Q

mimics an autoimmune event, with lymphadenitis, fever, and other symptoms starting weeks to months after beginning ART, often during tuberculosis therapy. There is no definitive diagnostic test for this condition. Treatment guidelines advise continuing ART; use nonsteroidal anti-inflammatory agents for mild to moderate cases; in severe cases, use corticosteroids (prednisone 1 to 2 milligrams/kg or equivalent for 1 to 2 weeks)

A

Immune reconstitution inflammatory syndrome

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19
Q

The most important CMV manifestation is

A

retinitis

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20
Q

is the most frequently occurring neoplasm, characterized by high-grade, rapidly growing mass lesions.

A

Non-Hodgkin’s lymphoma

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21
Q

Transmission of HIV occurs through

A

semen, vaginal secretions,

blood or blood products, and

breast milk, and

in utero by transplacental transmission

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22
Q

__________________occurs 2 to 4 weeks after infection with HIV. Also called___________, this is the initial response to infection, causing symptoms in the majority of those infected. The clini- cal presentation is nonspecific, resembling a flulike or mononucleosis- like syndrome; the diagnosis is missed in about 75% of cases.

A

Stage 1 or acute HIV infection

acute retroviral syndrome

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23
Q

Symptoms of acute HIV infection typically occur within 1 month of becoming infected, may last for___________, and include ________

A

2 to 10 weeks

fever (>90%), fatigue (70% to 90%), pharyngitis (>70%), rash (40% to 80%), headache (30% to 70%), and lymphadenopathy (40% to 70%); other reported symptoms are weight loss, headache, and diarrhea.

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24
Q

Seroconversion and detectable antibody response to HIV usually occur ___________ after infection, although delays can be up to ____________

A

3 to 8 weeks

11 months

25
Q

_______________of HIV infection is the period of clinical latency or HIV inactivity during which time patients generally have no complaints or find- ings on physical examination except for possible persistent generalized lymphadenopathy (enlarged lymph nodes in at least two noncontiguous sites other than inguinal nodes)

A

Stage 2

26
Q

median incubation time from exposure to the development of AIDS is estimated at__________ for adults; shorter incubation periods occur in untreated infants and older adults ‘

A

10 years

27
Q

of HIV infection has either laboratory markers of severe immu- nosuppression (CD cell counts <200 cells/mm3) or occurrence of one of any opportunistic infections or AIDS-defining illnesses

A

Stage 3

28
Q

Mean times from transmission to detection are shortest for viral load (_______days), followed by p24 antigen (________days), enzyme-linked immunosorbent assay positivity (25 days), and Western blot positivity (31 days)

A

17 days

22 days

29
Q

most commonly used testing method for HIV is

A

detection of antibodies to the virus

30
Q

Enzyme-linked immunosorbent assay detects

A

specific serum antibodies to HIV antigens

31
Q

Western blot assay detects

A

HIV antibodies to viral antigens

32
Q

CD4+ T-cell counts of_________cells/mm3 and a viral load of________ copies/ mm3 are associated with increased risk of AIDS-defining illnesses.

A

<200

> 50,000

33
Q

When stage of disease is unknown, use the___________ to approximate the CD4+ T-cell count.

A

total lymphocyte count

34
Q

total lymphocyte count________ cells/mm3 had a sensitivity of 95% for a CD4 count of <200 cells/mm3

A

<1700

35
Q

is the most serious ocular opportunistic infection and is the leading cause of blindness in AIDS patients

A

Cytomegalovirus retinitis

36
Q

In cytomegalovirus retinitis, indirect ophthalmoscopy findings are

A

 fluffy white perivascular lesions with areas of hemorrhage

37
Q

The most common cause of pneumonia in HIV-infected patients in the United States and Western Europe is_______________, followed by______ and ____________

A

Streptococcus pneumoniae

PCP

Tuberculosis

38
Q

_____________ or ______________appearance is demonstrated by hemorrhages and the dirty white granular-appearing retinal necrosis adjacent to major vessels

A

Pizza pie” or “cheese and ketchup”

39
Q

whitish retinal lesions without hemorrhage

A

Toxoplasma retinochoroiditis

40
Q

multiple discrete yellowish spots on choroid and retina

A

Cryptococcus chorioretinitis

41
Q

multiple pale yellow-white choroidal spots

A

pneumocystis choroiditis

42
Q

is the most common opportunistic infection among AIDS patients

A

PCP PNEUMOCYSTIS PNEUMONIA

43
Q

The causal agent of PCP is known as___________, previously classified as a protozoan but now reclassified as a fungus.

A

P. jirovecii (previously known as P. carinii)

44
Q

is often the initial opportunistic infection that establishes the diagnosis of AIDS

A

PCP

45
Q

most frequent serious complication of HIV infection in the United States

A

PCP

46
Q

most common identifiable cause of death in patients with AIDS

A

PCP

47
Q

The preferred therapy is______________

A

trimethoprim-sulfamethoxazole

48
Q

Typical presentations of tuberculosis occur in patients with CD4+ T-cell counts of__________ cells/mm3

A

> 200 to 500

49
Q

Those with tuberculosis and advanced HIV infection, with CD4 cell counts_______ cells/mm3, often have extrapulmonary or dissemi- nated disease.

A

<100

50
Q

Frequent sites of dissemination are___________________________

A

peripheral lymph nodes, bone marrow, CNS, GI system, and urogenital system

51
Q

All HIV-infected patients with positive purified protein derivative skin tests should receive isoniazid plus pyridoxine for____________; alternatives include rifampin or rifabutin for 4 months

A

9 to 12 months

52
Q

the most common pulmonary infection in HIV- infected patients

A

Bacterial pneumonia

53
Q

__________, 100 mg once daily for 7 to 14 days, is first-line treatment For oral candidiasis or thrush

A

Oral fluconazole

54
Q

appears as a nontender, well-circumscribed, slightly raised violaceous lesion

A

Oral Kaposi’s sarcoma

55
Q

Diarrhea with CD4 <200 cells/mm3, consider

A

Cryptosporidium and microsporidia

56
Q

Diarrhea with CD4 is <50 cells/mm3, patients are at risk for.

A

cytomegalovirus and MAC

57
Q

Kaposi sarcoma are firm, painless, raised, brown-black or purple patches, plaques, or nodules
Common sites are the face, chest, genitals, and oral cavity

A
58
Q

HIV-infected persons should not receive live-virus or live-bacteria vaccines.

The exception to this rule is the ___________vaccine.

A

measles-mumps-rubella

infectious by dp (14 decks)

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