HIV and Tb

Question 1

Single nodule >3cm with central calcification

Answer 1

Histoplasmosis = most common (dimorphic fungi)

Question 2

Single nodule with thick-walled cavetation and/or eccentric calcification?

Answer 2

Malignant Nodule

Question 3

Thin-walled cavetation could be?

Answer 3

Abscess
Benign Lesion
Tb

Question 4

Why do you give TMP-SMX in HIV patients?

Answer 4

Prophylaxis against PCP and Toxoplasma Gondi

Question 5

Gram + lancet shaped bug that infects HIV patients?

Answer 5

s. pneumonia

Question 6

When and why give Azithromycin prophylactically in HIV patients?

Answer 6

At CD4 < 50 to prevent M avium

Question 7

Mycolic acid in Tb does what?

Answer 7

Inhibits immune activation/phagocytosis

Question 8

Cord factor in M tubercolsis does what?

Answer 8

Increases TNFa
Inhibits macrophage maturation
Causes IL6 –> AOCD

Question 9

Sulfatides in M tuberculosis does what?

Answer 9

Inhibits phagolysosome formation

Question 10

Latent Tb treatment and why should we treat?

Answer 10

Isonizid for 9 mo
Decreases risk of active disease
Decreases Spread/Prevalence

Question 11

Latent Tb vs Active Tb?

Answer 11

Latent = Not contageous, asymptomatic
Active = Contageous, Symptomatic

Question 12

Tuberculin Skin test readings
>5mm?
>10mm?
>15mm?

Answer 12

>5 = positive in immunocomp
>10 = positive in IV drugs, medical staff, immigrants
>15 = positive for normal folks

Question 13

What if you get a positive reading in someone with a BCG vaccine?

Answer 13

STILL TREAT

Question 14

Positive Predictive Value is?

Answer 14

True positive/Total postive

Question 15

Tb drug that binds to RNA polymerase and blocks mRNA elongation

Answer 15

Rifampin

Question 16

Tb drug that inhibits mycolic acid synthesis?

Answer 16

Isoniazid

Question 17

What does supplementing Isoniazid with Pyridoxine do?

Answer 17

Prevents peripheral neuropathy by supplementing the loss of B6 caused by Isoniazid

Question 18

What Tb drug is a pro-drug that is activated by Mycobacterial catalase-peroxidase?

Answer 18

Isoniazid

Question 19

Major toxicities of Isoniazid?

Answer 19

Hepatitis = LIMITING FACTOR due to acetylation

Peripheral neuropathy

Question 20

What Tb drugs turns fluids red?

Answer 20

Rifampin

Question 21

What Tb drug should NOT be giving with protease inhibitors? Why?

Answer 21

Rifampin

Induces cyp450

Question 22

What Tb drug inhibits mycobacterial cell membrane metabolism and transport by acidification?

Answer 22

Pyrazinamide

Question 23

What Tb drug inhibits arabinosyl transferases?

Answer 23

Ethambutol

Question 24

Why don’t you give Ethambutol ti kids?

Answer 24

Blindness side effecty

Question 25

Streptomycin MOA?

Answer 25

Inhibits 30S ribosome function

Question 26

Why would you give Streptomycin along with another Tb drug?

Answer 26

Streptomycin kills extracellular organisms | Other drugs kill intracellular organisms

Question 27

What is a risk associated with TNFa inhibitors?

Answer 27

Tb reactiviation (Macrophages proliferate)

Question 28

NRTIs? (5)

Answer 28

TALEZ (AGCCT) ``` Tenofovir -----A Abacavir-------G Lamivudine---C(dine) Emtricitabine-C(sine) Zidovudine----T ```

Question 29

Zidovvudine MOA?

Answer 29

Thymidine anolog

Question 30

Anemia and Granulocytopenia are SE of which NRTI?

Answer 30

Zidovodine

Question 31

Abacavir MOA

Answer 31

Guanosine analog

Question 32

Lamivudine MOA

Answer 32

Cytodine analog

Question 33

Most common Abacavir SE?

Answer 33

Hypersensitivity

Question 34

Tenofovir MOA

Answer 34

Adenosine analog

Question 35

Tenofovir SE?

Answer 35

Renal Tox Hepatotox flatulence

Question 36

Emtricitabine MOA?

Answer 36

Cytosine analog

Question 37

Raltegravir MOA?

Answer 37

Integrase inhibitor

Question 38

Protease Inhibitors?

Answer 38

RAD Ritonavir Darunavir Atazanavir

Question 39

Ritonavir used in low doses for what?

Answer 39

Inhibits Cyp450, increases other protease inhibitors action

Question 40

Protease Inhibitors metabolism?

Answer 40

Cyp450 (also inhibit)

Question 41

Entry/fusion inhibitors?

Answer 41

ME Maraviroc Enfuviritide

Question 42

When use maraviroc?

Answer 42

After genetic testing of HIV to see if it binds to CCR5

Question 43

Maraviroc binds what?

Answer 43

gp120

Question 44

Enfuvirtide binds what?

Answer 44

gp40

Question 45

Non-NRTIs?

Answer 45

Efavirenz | Etravirine

Question 46

Non-NRTI MOA?

Answer 46

Directly binds Reverse Transcriptase

Question 47

Streptomycin Toxicities?

Answer 47

Vertigo | Permanent Hearing Loss

Question 48

Why don't you give streptomycin to pregnant patients?

Answer 48

Causes neonatal deafness

Question 49

What combination of NRTI and Non-NRTI is most effective?

Answer 49

2 NRTI, 1 non-NRT

Question 50

Common side effect of Pyrazinamide?

Answer 50

Hyperuricemia

Question 51

Common Infectious in HIV patients with CD4 above 200?

Answer 51

S Pneumoniae H influenzae Tb Candida

Question 52

Common infections in HIV patients with CD4 <200

Answer 52

``` PCP Coccidiomycosis Cryptosporidium Aspergillus Toxoplasma Gondi ```

Question 53

Common infections in HIV patients with CD4 <50?

Answer 53

M Avium Cryptococcus CMV

Question 54

What is the difference in the common location of primary vs. secondary Tb?

Answer 54

Primary is usually lower lobe | Secondary is usually upper lobe