Immunocompromised

Question 1

timing of IRIS after initiation of ART?

Answer 1

1 month

Question 2

treatment of IRIS?

Answer 2

continue ART, treat any underlying infection, steroids

Question 3

asplenia RF for what bugs?

Answer 3

strep pneumo, H flu, Neisseria, Babesia, plasmodium

Question 4

PJP CD4 count?

Answer 4

<200

Question 5

PJP diagnosis?

Answer 5

sputum, BAL, PCR Giemsa staining

Question 6

PJP CT findings?

Answer 6

GGO periphery sparing

Question 7

PJP tx? and alternatives?

Answer 7

Bactrim, 2- Pentamadine or Dapsone

Question 8

indications for steroids in PJP?

Answer 8

Pa02<70, A/a gradiest >35

Question 9

TB CD4 count?

Answer 9

<200

Question 10

Toxoplasmosis CD4 count?

Answer 10

<100

Question 11

Toxoplasmosis imaging findings?

Answer 11

multiple nodular, contrast enhancing lesions

Question 12

Toxoplasmosis dx? staining?

Answer 12

CSF IgG, IgM also seen on Geimsa stain

Question 13

Toxoplasmosis treatment?

Answer 13

Sulfadiazine, pyrimethamine, Leucavorin

Question 14

Cryptococcus CD4?

Answer 14

<100

Question 15

Crypto diagnosis, stain?

Answer 15

india ink, high CSF OP, latex agglutination

Question 16

Cryptococcus treatment? maintenance?

Answer 16

amphotericin B plus flucytosine/ fluconazole

Question 17

coccidiodes affect what body parts?

Answer 17

skin and joints

Question 18

coccidiodes treatment?

Answer 18

ampho B plus flucytosine

Question 19

Aspergillus CD4 count?

Answer 19

<50

Question 20

CMV 2 types?

Answer 20

invasive and non invasive

Question 21

Non invasive CMV signs?

Answer 21

viremia, lymphopenia, thrombocytopenia

Question 22

Tissue invasive CMV sites?

Answer 22

chorioretinitis, pneumonitis, GI, adrenal

Question 23

CMV diagnosis? path finding?

Answer 23

PCR/owl eye inclusion bodies

Question 24

CMV treatment?

Answer 24

Ganciclovir and CMV IgG

Question 25

CMV tx duration?

Answer 25

duration of viremia or 2 weeks

Question 26

Maintenance therapy CMV?

Answer 26

oral Ganciclovir 3 months post infection

Question 27

CMV alternate treatment?

Answer 27

foscarnet

Question 28

Monotherapy for neutropenic fever?

Answer 28

antipseudomonal B lactam

Question 29

when to add vanc in neutropenic fever?

Answer 29

lines, PNA, colonization, SSTI

Question 30

when to add fungal coverage neutropenic fever? antifungal?

Answer 30

no recovery after 4-7 days of treatment/voriconazole

Question 31

Neutropenic enterocolitis location?

Answer 31

ileum, cecum, ascending colon

Question 32

Neutropenic enterocolitis symptoms?

Answer 32

fever, pain, water bloody diarrhea

Question 33

tx of neutropenic enterocolitis

Answer 33

conservative mgmt

Question 34

Rule out what other organ involvement if candidemia?

Answer 34

eye-endophalmitis

Question 35

initial treatment of candidemia?

Answer 35

Echinocandin- miafungin, caspofungin

Question 36

nocardiosis naturally found?

Answer 36

soil

Question 37

nocardia microbiology? staining?

Answer 37

gram positive thin filament, silver staining

Question 38

nocardia type of infection?

Answer 38

cavitary diasease

Question 39

nocardia treatment?

Answer 39

sulfonamides- minocycline

Question 40

VZV systems it can affect?

Answer 40

skin, vasculature, liver, lung, brain

Question 41

who is at risk for VZV infection?

Answer 41

patients with compromised cellular immunity- HIV, steroids, immunosuppression, third trimester pregnancy

Question 42

when to start ART therapy after HIV diagnosis?

Answer 42

within 2 weeks, showing to decrease progression to AIDS expect for patients who present with crypto then it should be delayed until 5 weeks

Question 43

symptoms of mucormycosis?

Answer 43

black effusions, parencyhmal disease, sinusitis

Question 44

imagingin findings more commonly found with mucor?

Answer 44

reverse halo sign

Question 45

diagnosis of mucor? microscopy findings?

Answer 45

biopsy, wide branching angles

Question 46

tx for mucor?

Answer 46

liposomal ampho B

Question 47

histoplasma significant features?

Answer 47

can invade reticuloendothelial system, high ferritin level

Question 48

disseminated histoplasma tx in severely immunocompormised?

Answer 48

liposomal ampho B for 2 weeks

Question 49

depressed cell mediated immunity(steroids use) puts you at risk for which infiections?

Answer 49

intracellular organisms- mycobacterium, listeria, nocardia, salmonella, rhodococcus

Question 50

MAC presentation?

Answer 50

chronic cough, nodular opacities with tree in bud appearance, anorexia, weight loss, in immunosuppressed patient

Question 51

tx for MAC?

Answer 51

clarithromycin, ethambutol, rifabutin

Question 52

imunocompromised with ring enhancing lesions exposed to cats?

Answer 52

toxoplasmosis

Question 53

staining for toxoplasmosis?

Answer 53

tachyzoites on giemsa stain

Question 54

iniital drug regimen for toxoplasmosis?

Answer 54

pyrimethamine, silfadiazine, leucovorin