ABIM ID > HIV & Syphillis, Gonnorrhea, Chlamydia > Flashcards

HIV & Syphillis, Gonnorrhea, Chlamydia Flashcards

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1
Q

What test is used to diagnose HIV?

A

HIV 1/2 antigen/antibody (4th generation) test → followed by confirmatory testing (HIV-1 RNA or Western blot).

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2
Q

What lab tests should be ordered at the time of HIV diagnosis? (6 Test to order)

A
  1. CD4 count
  2. HIV viral load
  3. Hepatitis panel
  4. Genotypic resistance testing
  5. STD screen
  6. TB test
  7. Toxoplasma IgG.
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3
Q

What is the goal of HIV therapy?

A

Undetectable Viral Load + CD4 count >200.

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4
Q

What defines AIDS?

A

CD4 <200 OR an AIDS-defining illness (e.g., PCP, toxoplasmosis, Kaposi).

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5
Q

What are side effects of efavirenz?

A

Vivid dreams, Dizziness, Psychiatric effects.

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6
Q

What must be checked before starting Abacavir?

A

HLA-B*5701 to avoid life-threatening hypersensitivity.

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7
Q

How often should HIV viral load be monitored after starting ART?

A

Every 1-2 months until suppressed, then every 3–6 months.

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8
Q

What is the treatment for PCP pneumonia?

A

TMP-SMX + steroids if PaO₂ <70 or A-a gradient >35.

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9
Q

What is the first-line treatment for Chlamydia?

A

Doxycycline 100 mg BID x7 days.

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10
Q

What is the treatment for gonorrhea?

A

Ceftriaxone 500 mg IM once (+ doxycycline if chlamydia not ruled out).

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11
Q

What is the treatment for primary, secondary, or early latent syphilis?

A

Benzathine penicillin G 2.4 million units IM once.

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12
Q

What STI causes painful genital ulcers with ragged edges?

A

Chancroid (Haemophilus ducreyi).

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13
Q

What is the treatment for trichomoniasis?

A

Metronidazole 500 mg BID x7 days.

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14
Q

What defines virologic failure in HIV?

A

HIV RNA >200 copies/mL after 6 months of ART or Rebound after suppression.

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15
Q

What STI can cause a Painless Ulcer followed by Painful Lymphadenopathy?

A

Lymphogranuloma venereum (LGV) – caused by Specific Chlamydia Trachomatis Strains (L1–L3.)

  • Starts off as Painless Genital Sores than progresses to Painful lymph nodes
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16
Q

What malignancies are AIDS-defining?

A
  1. Kaposi sarcoma
  2. CNS lymphoma
  3. Invasive cervical cancer
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17
Q

What vaccines are contraindicated in HIV with CD4 <200?

A

Live vaccines (e.g., MMR, varicella, yellow fever)

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18
Q

What is the first-line screening test for HIV?

A

4th-generation HIV 1/2 antigen-antibody combo assay

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19
Q

What test confirms HIV after a positive screen?

A

HIV-1/HIV-2 differentiation immunoassay

OR

HIV RNA (viral load) if acute infection suspected

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20
Q

What is the standard initial ART regimen?

A

2 NRTIs + 1 integrase inhibitor

(e.g., tenofovir + emtricitabine + bictegravir)

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21
Q

Which drugs require renal function monitoring?

Study These Flashcards
A

Tenofovir disoproxil fumarate (TDF)

22
Q

What vaccines are contraindicated in CD4 <200?

Study These Flashcards
A

Live vaccines (e.g., MMR, varicella, yellow fever)

23
Q

What is the preferred HIV drug in pregnancy?

Study These Flashcards
A

Dolutegravir + two NRTIs (e.g., tenofovir + lamivudine)

24
Q

What is the hallmark of primary syphilis?

Study These Flashcards
A

A painless chancre with clean base and indurated edges, usually on genitals.

25
What are the key findings in secondary syphilis?
Maculopapular rash (including palms/soles), condyloma lata, fever, lymphadenopathy.
26
What is latent syphilis?
Positive serology with no clinical symptoms ## Footnote Early latent = <1 year; Late latent = >1 year or unknown duration.
27
What are features of tertiary syphilis?
Gummas, aortitis, neurosyphilis, and Argyll Robertson pupil (accommodates but doesn’t react).
28
What are neurologic signs of neurosyphilis?
Tabes dorsalis, dementia, ataxia, stroke in a young person, cranial nerve palsy.
29
What is the first step in syphilis diagnosis?
Nontreponemal test: RPR or VDRL.
30
How is syphilis confirmed?
Treponemal tests: FTA-ABS or TP-PA.
31
What defines adequate treatment response to syphilis?
4-fold decline in RPR titer at 6–12 months.
32
NHow is neurosyphilis diagnosed?
CSF VDRL (specific but not sensitive), + Lymphocytic Pleocytosis + + Elevated protein > 45 + 50-100 (Viral) + > 500 (bacterial)
33
What is the treatment for Primary, Secondary, or Early Latent Syphilis (<12 months, no symptoms)?
Benzathine penicillin G 2.4 million units IM ×1Dose.
34
What is the treatment for late latent or tertiary (non-neuro) syphilis?
Benzathine penicillin G IM ×3 weekly doses.
35
What is the treatment for neurosyphilis?
IV penicillin G every 4 hours for 10–14 days.
36
What if a patient is allergic to penicillin but needs treatment for neurosyphilis or is pregnant?
Penicillin desensitization is required.
37
If someone has a fever after treating syphilis, you should consider __________. Management ?
Jarisch-Herxheimer Reaction Acute fever, chills, myalgias within 24 hours of treatment → due to spirochete lysis (not an allergy). The treatment is usually supportive and might include pain relievers like ibuprofen or acetaminophen.
38
1. What cardiovascular complication is linked to tertiary syphilis? 2. How long should patients be monitored after syphilis treatment? 3. What defines moderate to severe disease in patients? 4. When should corticosteroids be initiated in patients with moderate to severe disease? 5. What corticosteroid is typically used and how is it administered?
1. Ascending Aortic Aneurysm or Aortic Regurgitation 2. RPR titers at 6 and 12 months Post-Treatment 3. An arterial oxygen pressure (PaO₂) <70 mmHg or an A–a gradient ≥35 mmHg on room air 4. Within 72 hours of starting antibiotics 5. Prednisone is typically used in a tapering dose over 21 days
39
1. Should HIV-infected patients start antiretroviral therapy immediately if severely ill with PCP? 2. When is antiretroviral therapy usually deferred in these patients?
1. No, due to the risk of immune reconstitution inflammatory syndrome (IRIS) 2. 2 weeks into treatment if the patient is stable.
40
What should be continued after treatment for secondary prophylaxis for PCP in HIV patients?
TMP-SMX ---------continued until CD4 count is ≥200 cells/mm³ for at least 3 Months.
41
What is the diagnosis time frame for early latent syphilis?
When the patient has had syphilis for <1 year ## Footnote This includes patients with recent sexual activity, primary or secondary syphilis, seroconversion, or exposure to someone with syphilis within the past year.
42
What is the treatment for early latent syphilis?
A single dose of benzathine penicillin G (2.4 million units intramuscularly) ## Footnote Doxycycline can be used for patients with severe penicillin allergy.
43
What does the presence of discrete, painful lesions suggest about the diagnosis?
Makes the diagnosis of early latent syphilis less likely
44
Which serovars of Chlamydia trachomatis cause lymphogranuloma venereum (LGV)?
Serovars L1-3
45
What are the initial symptoms of lymphogranuloma venereum?
Painless ulcers that usually heal spontaneously ## Footnote This is followed by regional lymph node suppuration or matting and sinus tract development.
46
How does human papilloma virus usually present?
With transient or permanent warts ## Footnote It sometimes predisposes patients to secondary bacterial cellulitis but does not usually present as painful, ulcerated lesions.
47
What condition is caused by Klebsiella granulomatis?
Granuloma inguinale
48
How does granuloma inguinale typically present?
As a painless ulcer on the penile shaft or perineum ## Footnote The ulcers can destroy tissue and cause open, oozing lesions resembling granulation tissue.
49
What factors are associated with AIDS-related lymphomas?
Advanced HIV, low CD4 count (<100/µL), high HIV viral load, prior diagnosis of AIDS
50
What are the most common AIDS-related lymphomas?
Diffuse large-cell NHL and Burkitt lymphoma

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