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8th > Chapter 168 - Cutaneous manifestations of HIV And HTLV > Flashcards

Chapter 168 - Cutaneous manifestations of HIV And HTLV Flashcards

1
Q

Acute HIV infection presents as mononucleosis-like syndrome that can induce a morbiliform exanthem ___ weeks after infection with HIV

A

3 to 6 weeks

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2
Q

As of 2015, ___ are candidates for antiretroviral therapy

A

All newly diagnosed HIV patients

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3
Q

Most common cause of HIV infection globally

A

HIV1

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4
Q

HIV 2 is associated with (3)

A
  1. Slower progression of immunosuppression
  2. Decreased infectivity
  3. Resistance to nonnucleoside reverse transcriptase inhibitors
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5
Q

Any cell that expresses ___ and an appropriate coreceptor (2) may be infected by HIV

A

CD4; CCR5/CXCR4

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6
Q

Prior to seroconversion, false negative HIV antibody tests might result, hence more sensitive direct tests such as (2) should be performed instead

A

HIV viral RNA test

P24 core structural protein test

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7
Q

Window period, delay of ___ weeks typically occurs between newly acquired HIV 1 infection and development of antibodies

A

3-4 weeks

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8
Q

Viral RNA assay detects infection ___ days earlier than p24 assay, hence appears to be more sensitive

A

5 days

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9
Q

AIDS is defined as HIV seropositive individual older than ___ years of age with a CD4 T cell count < ___ cells/ul, CD4 T cell percentage < ___%, or with any of several diseases considered ti be indicative of severe defect in cell-mediated immunity.

A

6 years;
200cells/ul;
14%

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10
Q

Examples of diseases (3) seen with CD4 T cell count > 500 cells/ul

A
  1. Acute retroviral syndrome
  2. Herpes zoster infection (nondisseminated)
  3. Seborrheic dermatitis
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11
Q

Examples of diseases (4) seen with CD4 T cell count 250-500 cells/ul

A
  1. Dermatophyte infections, recurrent or persistent
  2. Oral candidiasis
  3. Oral hairy leukoplakia
  4. Herpes zoster infection, disseminated
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12
Q

Period of clinical latency implies disease latency.

True or False

A

False, does not

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13
Q

More severe and life threatening complications of HIV disease typically occur when CD4 T cell count falls below ___ cells/ul

A

200

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14
Q

There is a ___ fold increase in adverse cutaneous drug reactions in setting of HIV/AIDS

A

100

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15
Q

Common causes of drug reactions in the setting of HIV/AIDS

A

Sulfonamides

Penicillin

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16
Q

___ are the most common manifestation of cutaneous drug reaction in the setting of HIV. (75% to 95%)

A

Morbiliform

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17
Q

In patients who are positive for HLA ___, DRESS may develop in patients treated with ___

A

B5701; abacavir

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18
Q

All nucleoside reverse transcriptase inhibitors present with hepatotoxicity except (2)

A
  1. Abacavir (systemic hypersensitivity reaction)

2. Tenofovir (renal toxicity)

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19
Q

NRTIs Presents with metabolic lactic acidosis (4)

A

Didanosine
Stavudine
Zalcitabine
Zidovudine

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20
Q

NRTIs Presents with lipohypotrophy

A

Stavudine

Zidovudine

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21
Q

NRTIs Presents with paronychia with nailfold granuloma (2)

A

Lamivudine

Zidovudine

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22
Q

NRTIs that presents with LCV (2)

A

Zalcitabine

Zidovudine

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23
Q

NRTIs that present with oropharyngeal and esophageal ulcerations

A

Zalcitabine

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24
Q

NRTIs that present with hyperpigmentation of nail bed, palms, and soles

A

Emtricitabine

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25
Q

NRTIs that presents with hyperpigmentation of nails, diffuse hyperpigmentation of skin and oral mucosa, hypertrichosis, anemia, granulocytopenia, nausea, myopathy

A

Zidovudine

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26
Q

All NNRTIs present with hepatotoxicity.

True or False

A

True

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27
Q

NNRTI that presents with highest incidence of SJS/TEN

A

Nevirapine

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28
Q

NNRTIs that present with lipodystrophy

A

Rilpivirine

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29
Q

Protease inhibitors that contain sulfa moieties and should be used in caution in sulfa allergic patients (4)

A

Fosamorenavir
Amprenavir
Tipranavir
Darunavir

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30
Q

Protease inhibitors with rare progression to SJS (3)

A

Fosamprenavir
Amprenavir
Tipranavir

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31
Q

Cause nephrolithiasis and hyperbilirubinemia

A

Indinavir

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32
Q

Protease inhibitors that cause spontaneous bleeding and hemorrhage

A

Ritonavir

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33
Q

PIs that cause rare FDE

A

Saquinavir

34
Q

PIs that cause lipohypertrophy, dose dep. retinoid effects, acute porphyria, frozen shoulder, venous thrombosis

A

Indinavir

35
Q

PIS that cause hepatotoxicity and intracranial hemorrhage

A

Tipranavir

36
Q

PIs that cause PR prolongation and hyperbilirubinemia

A

Atazanavir

37
Q

Increases frequency of bacterial pneumonia and injection site reactions

A

Enfuvirtide (Fusion inhibitor)

38
Q

Cause pruritus along with hepatotoxicity

A

Integrase inhibitors (-gravir)

39
Q

Presents with central obesity, cushingoid habitus, increased neck girth, increased abdominal girth, and breast enlargement

A

Lipohypertrophy

40
Q

Presents with flattening of convex contours of the face

A

Lipoatrophy

41
Q

Lipodystrophy is often sccompanied by (5)

A

Metabolic abnormalities in

  1. Fasting glucose levels
  2. Fasting insulin levels
  3. Hypertriglyceridemia
  4. Hypercholesterolemia
  5. Decreased HDL
42
Q

Factors associated with increased drug eruption (4)

A

Female
CD4 cell count < 200 cells/ul
CD8 cell count > 460 cells/ul
History of drug eruptions in the past

43
Q

Some drug reactions persist even ___ weeks after drug DC

A

2 weeks

44
Q

Treatment for facial lipoatrophy

A

Soft tissue fillers

  1. Poly-L-lactic acid
  2. Calcium hydroxyapatite
45
Q

HIV patients are more susceptible to EBV l- associated malignancies (3)

A

Burkitt lymphoma
Diffuse large B cell lymphoma
Leiomyosarcoma

46
Q

Treatment for bacillary angiomatosis

A

Erythromycin 500mg QID x 4 weeks

Doxycycline 100 mg BID x 4 weeks

47
Q

Palms, soles, oral cavity are areas usually affected by Bartonella quintana or Bartonella henselae.
True or False

A

False, spared

48
Q

Most common opportunistic infection in HIV patients

A

Tuberculosis

Multibacillary forms eg. Scrofuloderma, gummatous tuberculosis, cutaneous miliary tuberculosis

49
Q

Cutaneous dissemination of invasive mycoses usually occurs in patients with CD4 T cell count ___ cells/ul

A

<50 cells/ul

50
Q

Variant of Histoplasma more prevalent with AIDS patients

A

Histoplasma capsulatum var. capsulatum

51
Q

Leading cause of mortality amongst AIDS patients in Southeast Asia

A

Penicillium marneffei

52
Q

Matching type

  1. Yellow white plaques removable by scraping
  2. Erythematous patches of the palate and dorsal tongue with associated depapillation
  3. Erythema with curdlike flecks or painful fissures at the angles of the lips
  4. White plaques of buccal mucosa that are not removable by scraping

A. Pseudomembranous
B. Hyperplastic
C. Erythematous
D. Angular cheilitis

A

A
C
D
B

53
Q

___ should prompt an HIV test in patients whose HIV status is unknown

A

Proximal subungual onychomycosis

54
Q

33% of advanced HIV patients with CD4 T cell counts < ___ cells/ul have molluscum contagiosum

A

100

55
Q

Treatment for crusted scabies

A

Ivermectin 200ug/kg weekly for 7 weeks

56
Q

Colonization with MRSA is ___ times more prevalent among HIV patients and relative risk of infection is ___ times that of HIV negative controls.

A

3; 6

57
Q

Marker of profound immunosuppression and designated as AIDS- defining condition

A

Chronic herpetic ulcer lasting more than 1 month

58
Q

___ imparts a 2-3 fold risk of HIV acquisition and enhances HIV viral replication hence increasing HIV plasma viral load and HIV shedding in genital mucosa

A

HSV2

59
Q

Risk of herpes zoster amongst HIV patients is highest ___ after ART initiation due to ___

A

6 months; IRIS

60
Q

Reduces herpes zoster risk in HIV patients by 62%

A

Prophylactic oral acyclovir 400 mg BID

61
Q

Treatment for disseminated herpes zoster with visceral involvement

A

IV acyclovir 10mk TID

62
Q

Acquired epidermodysplasia verruciformis are thin flat topped papules resembling verruca plana or tinea versicolor from unusual susceptibility to ___

A

Beta subtypes of HPV

HPV (5,8,9)

63
Q

Lumbar puncture should be considered for: (2)

A
  1. New diagnosis of syphilis in patient with advanced HIV disease
  2. Patient with well controlled HIV who has syphilis of unknown stage or RPR of at least 1:32
64
Q

Describe prozone phenomenon

A

HIV related immune dysrrgulation causing massively elevated titers of antibodies high enough to impair the assay

65
Q

Frequent presenting sign of HIV

A

Kaposi sarcoma

66
Q

All ART adherent patients have their healths fully restored, with zero incidence of Kaposi sarcoma.
True or False

A

False, not fully restored; not zero incidence

67
Q

Treatment for severe Kaposi sarcoma

A

Immediate ART initiation in combination with systemic chemotherapy
(Bleomycin, vincristine/vinblastine, imiquimod, alitretinoin)

68
Q

Quadrivalent or nonavalent HPV vaccine is recommended for:

A

All HIV + F 9-26 y/o and

All M 9-21 y/o

69
Q

HIV patients have increased risk of developing the ff cutaneous lymphomas (3)

A

CD30+ anaplastic large cell lymphoma
Diffuse B cell lymphoma
Plasmablastic lymphoma

70
Q

Primary cutaneous lymphomas in HIV patients have a poor prognosis with survival often ___

A

Less than 1 year

71
Q

In pediatric patients, ___ are the second most common malignancy in patients with HIV

A

Smooth muscle tumors

72
Q

Characterized by pruritic, symmetric papules of the distal extremities, and is more commonly found in tropical and subtropical zones

A

Papular pruritic eruption

73
Q

High potency topical corticosteroids usage for plaque psoriasis in HIV patients require caution in the setting of ART regimens that include

A

Ritonavir

Cobicistat

74
Q

PPE spares palms soles and mucous membranes.

True or False

A

True

75
Q

Characterized by follicular pruritic papules and pustules favors midline of face, neck, scalp, trunk, and proximal extremities

A

Eosinophilic folliculitis

76
Q

IRIS has been reported in ___% of patients receiving ART usually occurs in first ___ months ff the initiation of ART

A

20%；2 to 3

77
Q

When a clinically unrecognized disease is noted after initiation of ART, ___ is used. In turn, when a previously recognized clinical entity flares, term ___ applies

A

Unmasking IRIS

Paradoxical IRIS

78
Q

2 main factors related to development of IRIS

A
  1. Low CD4 count and/or percentage

2. High HIV RNA prior to initiation of ART

79
Q

Criteria of IRIS

A

Major
1. Atypical presentation of opportunistic infection or tumors in patients responding to ART
2. Decrease in plasma HIV RNA level by at least 1 log 10 copies/ml
Minor
1. Increased blood CD4 T cell count after ART
2. Increase in immune response specific to relevant pathogen
3. Spontaneous resolution of disease without specidic antimicrobial therapy or tumor chemotherapy with continuation of ART

80
Q

Systemic corticosteroids may be given in HIV patients, except in cases of ___

A

AIDS related Kaposi sarcoma

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