Tick Borne Disease, HIV

Question 1

Match the disease with the correct organisms
A. Lyme Disease
B. Babesiosis
C. Granulocytic Anaplasmosis
D. Monocytic Ehrlichiosis
E. Rocky Mountain Spotted Fever

1. Anaplasma phagocytophilum
2. Borrelia burgdorferi
3. Ehrlichia chaffeensis
4. Rickettsia rickettsii
5. Babesia microti

Answer 1

A: 2 |B: 5 |C: 1 |D: 3 |E: 4

Question 2

All of the following are characteristics of theprimary stageof Lyme Disease EXCEPT:
A.Erythema migrans lesion
B. Constitutional symptoms
C. Malaise, MSK symptoms
D. May resolve without treatment

Answer 2

C. Symptom of thesecondary stages

Question 3

All of the following are characteristics of the secondary phaseof Lyme Disease EXCEPT:
A. Few weeks after tick bite
B. Erythema migrans at different site than primary lesion
C. AV conduction abnormalities
D. Bell’s palsy, aseptic meningitis
E. Persistent infection

Answer 3

E. Symptom oftertiarystage

Question 4

All of the following are characteristics of the tertiary phaseof Lyme Disease EXCEPT:
A. Systemic febrile symptoms
B. Persistent infection
C.Migratory, recurrent oligoarticular arthritis large joints
D. Tick bite > 6 months ago

Answer 4

A

Question 5

T/F: Erythema migrans is a clinical diagnosis of primary and secondaryLyme Disease.

Answer 5

True

Don’t wait for tests to come back before treating

Question 6

Tertiarystage of Lyme disease diagnosed by:

Answer 6

ELISA (sensitive, not specific)
Immunoblot (detect true positives)
Serology

Question 7

Oral treatment of Lyme Disease is treated for all of the following EXCEPT:
A. Bell’s palsy w/o meningitis
B. Primary and secondary Erythema migrans
C. Cardiac manifestations
D. Meningitis

Answer 7

D. Treated with IV

Question 8

All of the following are antibiotics used to treat Lyme Disease EXCEPT:
A. Amoxicillin
B. Vancomycin
C. Doxycycline
D. Cefuroxime

Answer 8

B

Question 9

Which of the following is NOT a symptom of Babesiosis?
A. Fatigue
B. Rash
C. Low Hemoglobin, platelets
D. Hemolysis, organ failure
E. Fever, chills, malaise

Answer 9

B

D. Presents in splenectomized patients

Question 10

Diagnosis of Babesiosis

Answer 10

Blood smear

PCR

Question 11

Treatment of Babesiosis

Answer 11

Atovaquone + Azithromycin

Quinine + Clindamycin

Question 12

T/F: Babesiosis can be co-infected with Lyme Disease or Ehrlichiosis.

Answer 12

True

Question 13

Intracellular rickettsia-like organisms infecting WBC

Answer 13

Human Granulocytic Anaplasmosis (HGA) caused by Anaplasma phagocytophilum
Human Monocytic Ehrlichiosis (HME) caused by Ehrlichia chaffeensis

Question 14

T/F: Human Granulocytic Anaplasmosis and Human Monocytic Ehrlichoisis present clinically the same except HMA has a rash in 30% of cases.

Answer 14

Human Granulocytic Anaplasmosis and Human Monocytic Ehrlichoisis present clinically the same except HMEhas a rash in 30% of cases.

Question 15

Common clinical presenation of HME and HGA include all of the following EXCEPT:
A. Fever
B. Severe headache
C. Rash
D. Dry cough

Answer 15

C. Rash only seen in HME in 30% of cases

Question 16

T/F: Thrombocytopenia is part of the diagnosis of HME and HMA.

Answer 16

True

Question 17

Treatment of HME and HMA

Answer 17

Doxycycline 100 BID x 1-2 weeks
Will also treat Lyme if co-infected

Alternatives: rifamipin, quinolones

Question 18

Rocky Mountain Spotted Fever most seen where geographically?

Answer 18

Midwestern/southeastern states

Cases in every state except Maine and Vermont

Question 19

T/F: Most cases of Rocky Mountain Spotted Fever resolve on their own.

Answer 19

False. 25% mortality if untreated

Question 20

T/F:Rocky Mountain Spotted Fever is mostly seen in the elderly.

Answer 20

False. 2/3 of cases occur in children under 15 y/o

Question 21

Rocky Mountain Spotted Fever pathogenesis

Answer 21

Endothelial cells = major target of infection
Enter –>replicate –>assemble actin tails to propel to neighboring cells
Diffuse organ dysfunction –>Loss of normal endothelium function

Question 22

T/F: Treatment of Rocky Mountain Spotted Fever should be initiatedimmediatelyAbx?

Answer 22

True

Doxycycline 100 mg q 12 hr x 7 days or until afebrile x 2 days

Question 23

Lxodes scapularis can transmit all except:
A.Borrelia burgdorferi
B.Anaplasma phagocytophilum
C.Ehrlichia chafeesis
D.Babesia microti

Answer 23

C.Ehrlichia chageensisis transmitted by Amblyamma americanum (Lone Star tick)

Question 24

Most tick-associated infection are treated with ____Except ____ which is treated with ____

Answer 24

Most tick-associated infection are treated withdoxycycline

Exceptbabesiosiswhich is treated with atovaquone + azithormycin OR quinine + clindamycin

Question 25

``` All of the following should get screened for HIV EXCEPT: A. Pt in heath care setting B. MSM C. Pregnant women D. Person in monogamous relationship  E. IV drug user  ```

Answer 25

D. Moral of the story: You'll get HIV if you cheat on your partner. 

Question 26

T/F: Serology is a poor screening tool to catch HIV.

Answer 26

False. Serology is good at catching almost everyone. 

Question 27

Median time for HIV to AIDS

Answer 27

10 years 

Question 28

AIDS diagnosis = Category ___(#) + ___(letter)

Answer 28

3: CD4+ less than 200 | C

Question 29

All of the following are characteristics of primary HIV infection EXCEPT: A. CD4 > 500 B. Symptoms include rash and neurological symptoms C. Antibodies positive during illness D. Duration: 1-8 weeks 

Answer 29

C. Except newer ab/ag tests should test positive 

Question 30

Oral hairly leukoplakia, CA pneumonia, non-hodgikins lymphoma, oral/vaginal candidiasis is associated with what CD4 level?

Answer 30

CD4 = 200-500

Question 31

Pneumocystis Carinii Pneumonia associated with what CD4 level?

Answer 31

CD4 = 100-200

Question 32

CMV, disseminated TB and dementia associated with what CD4 level?

Answer 32

CD4 less than 100

Question 33

All of the following are associated with Immune Reconstitution Inflammatory Syndrome EXCEPT: A. Low CD4 counts B. Worsening HIV disease when treatment starts C. Low microbial burden D. Unrecongized opportunistic infection 

Answer 33

C. High microbial burden

Question 34

T/F: cART is a highly effective treatment with minimal side effects.

Answer 34

False | cART is a highly effective treatment with LOTS OF side effects.