HIV

Question 0

CD4 count: PCP

Answer 0

<200

Question 1

CD4 count: TB

Answer 1

<300

Question 2

CD4 count, toxo & crypto

Answer 2

<100

Question 3

CD4 count, CMV & MAC

Answer 3

<50

Question 4

pulmonary sx, hilar adenopathy, disseminated extrapulmonary disease

Answer 4

TB

Question 5

slow onset, fever, dry cough, dyspnea, respiratory failure

Answer 5

PCP

Question 6

stroke or seizure (reactivation of old cysts?)

Answer 6

toxo

Question 7

subacute meningitis, may disseminate

Answer 7

crypto

Question 8

retinitis (necrosis, blindness), colitis, encephalitis, rarely pneumonia

Answer 8

CMV

Question 9

widespread visceral dissemination in lymphatics, no inflammation

Answer 9

MAC

Question 10

dx with +PPD (>5)

Answer 10

TB

Question 11

dx w/ silver stain microscopy of alveolar lavage, “ground glass” on CT

Answer 11

PCP

Question 12

dx w/ serum IgG, ring-enhancing lesions on brain MRI w/contrast

Answer 12

toxo

Question 13

dx w/ CSF Ag test or India ink

Answer 13

crypto

Question 14

dx w/ ocular exam, serum PCR

Answer 14

CMV

Question 15

dx w/blood culture

Answer 15

MAC

Question 16

PPX: INH for 9mos

Answer 16

TB

Question 17

Tx/PPx Bactrim + adjunctive steroids

Answer 17

PCP

Question 18

Tx: Pyrimenthamine-sulfadiazine, PPx Bactrim

Answer 18

toxo

Question 19

no steroids! muddies presentation

Answer 19

toxo

Question 20

brain biopsy if no response to treatment

Answer 20

toxo

Question 21

PPx AmB and long-term fluconazole

Answer 21

Crypto

Question 22

PPx Ganciclovir

Answer 22

CMV

Question 23

PPx: macrolide Tx: Azithromycin + Ethambutol

Answer 23

MAC

Question 24

vascular cancer triggered by HHV8 virus. purple/red/brown lesions on skin and epithelium

Answer 24

kaposi sarcoma

Question 25

CNS lymphoma, often one lesion (v. toxo)

Answer 25

non-Hodgkins lymphoma

Question 26

cheesy white plaques on buccal mucosa, noninvasive

Answer 26

mucosal candidiasis (thrush)

Question 27

clustered papular pustular rash

Answer 27

herpes zoster (shingles)

Question 28

chronic nonhealing genital/perianal vesicular lesions

Answer 28

HSV

Question 29

benign white corrugated plaque on lateral tongue

Answer 29

oral hairy leukoplasia

Question 30

JC-virus caused dementia

Answer 30

progressive multifocal leukoencephalopathy (PML)

Question 31

NSRTIs

Answer 31

Emticitabine, Lamivudine, Zidovudine, Abacavir (FTC, 3TC, AZT/ZDV, ABC)

Question 32

NTRTI

Answer 32

Tenofavir (TDF)

Question 33

NRTI mec

Answer 33

competitively inhibit RT during DNA elongation

Question 34

NSRTI SEs

Answer 34

nausea, HA, lipodistrophy, peripheral neuropathy

Question 35

NTRTI SE

Answer 35

nephrotoxicity, fanconi syndrome, bone mineralization disorders

Question 36

NRTI resistance

Answer 36

mutation in RT active enzymatic site

Question 37

NNRTIs

Answer 37

Efavirenz, Nevirapine (1st), Etravirine, Rilpivirine (2nd)

Question 38

NNRTI mec

Answer 38

noncompetitive RT inhibition (HIV 1)

Question 39

NNRTI SE

Answer 39

increase or decrease CYP3A4, severe rash, hepatotoxicity

Question 40

efavirenz SE

Answer 40

neurocognitive impairment and tertogenicity

Question 41

NNRTI resistance

Answer 41

point mutation at binding site, rapid, cross-class

Question 42

protease inhibitors

Answer 42

atazanivir, darunavir, lopinavir

Question 43

always give with PIs

Answer 43

ritonavir booster!

Question 44

PI mec

Answer 44

competitively inhibits protease

Question 45

PI side effects

Answer 45

GI upset, dyslipidemia, atherosclerosis, CYP3A4 inhibition

Question 46

PI resistance

Answer 46

high barrier to resistance

Question 47

integrase inhibitors

Answer 47

raltegravir, elvitgravir, dolutegravir

Question 48

II mec

Answer 48

blocks integration into host genome

Question 49

II SE

Answer 49

most potent, few SE: HA, rash

Question 50

II resistance

Answer 50

rapid emergence of resistance

Question 51

fusion inhibitor

Answer 51

Enfuvirtide (T20)

Question 52

T20 mec

Answer 52

binds HIV gp41, blocks viral entry

Question 53

T20 SE

Answer 53

injectable only, so salvage regimen for MDR HIV

Question 54

CCR5 antagonist

Answer 54

maraviroc (R5 HIV only)

Question 55

maraviroc mec

Answer 55

binds CCR5 coreceptor, blocks viral entry (R5 only!)

Question 56

boosters (inhibit CYP3A4)

Answer 56

Ritonavir (w/PIs), Cobicistat (coformulated with integrase-inhibitor elvitegravir)