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27 Cards in this Set

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  • Back
What disease:
- HIV with CD4 < 200
- Diffuse bilateral chest infiltrate
- Elevated serum LDH
Pneumocystis carinii pneumonia
How is LDH helpful in diagnosis of PCP?
- Pts with LDH < 220 IU/L are very unlikely to have PCP.

- LDH may also be elevated in disseminated histoplasmosis or lymphoma.
How is PCP diagnosed definitively?
Giemsa or silver stain of induced sputum or BAL.
What disease:
- HIV
- Mild persistent dry cough
- Significant hypoxemia
Pneumocystis carinii pneumonia
1. What is treatment for PCP?
2. What if they are hypoxemic?
1. TMP-SMX (sulfa allergic pts can get pentamidine, or clindamycin + primaquine)

2. PO2 <70 mmHg or A-a >35 have better prognosis if they receive PREDNISONE along with antimicrobials.
What's in the DDx:
- HIV
- CXR: diffuse interstitial infiltrates
- PCP
- Disseminated histoplasmosis
- M. tuberculosis (TB)
- M. kansasii
What's in the DDx:
- HIV
- CXR: patchy infiltrates, or pleural-based infiltrates
- TB
- Cryptococcal LUNG disease
What's in the DDx:
- HIV
- CXR: Cavitary lesion
- TB
- PCP
- Coccidiomycosis
What's the most common cause:
- HIV
- Fever
- Productive cough
- Pulmonary infiltrate on CXR
Community-Acquired Pneumonia
(e.g., S. pneumoniae, Mycoplasma, Chlamydia, etc.)
What's the most common cause:
- HIV
- Bilateral apical infiltrate with cavitation
TB
What are the most common causes:
- HIV
- CNS mass lesion
1. Toxoplasmosis: usually MULTIPLE enhancing lesions, often in basal ganglia.
2. CNS Lymphoma: usually SINGLE mass lesion. Also suspected if lesion doesn't regress after 2 wks of empiric toxo tx.
What is the treatment for CNS Toxoplasmosis?
Slufadiazine + pyrimethamine
What is a good serological test for suspected CNS lymphoma?
CSF examination for Epstein-Barr Virus DNA.
What is the most common cause:
- HIV
- Meningitis

1. How can you screen for this diagnosis?
2. How can you confirm the diagnosis? (3)
Cryptococcus

1. Serum analysis for Cryptococcus antigens.
2. India ink stain, fungal culture, CSF levels of cryptococcal antigen.
What disease:
- HIV, CD4 <50
- Persistent fevers, weight loss, feeling crummy
- GI pain, watery diarrhea
M. avium-intracellulare
What prophylaxis is indicated when:
1. CD4 <200
2. CD4 <100
3. CD4 <50
1. PCP prophylaxis - TMP-SMX DS 3x/week
2. Toxoplasmosis prophylaxis - Increase dose of TMP-SMX
3. MAC prophylaxis - Clarithromycin or Azithromycin
What are the most important risk factors for Peripheral Arterial Disease? (4)
- Cigarette smoking
- DM
- Dyslipidemia
- Hypertension
Guess what I'm thinking:
- Complete hair loss on legs and feet
- Shiny atrophic skin
- Thickened and brittle toenails
Peripheral Arterial Disease
What ABI values are a/w:
1. Normal
2. Claudication
3. Severe ischemia
1. >1.0
2. 0.4 - 0.9
3. <0.4
What is the SINGLE BEST thing for reducing risk of fatal or nonfatal MI?
Smoking Cessation (up to 50% reduction - more than any medical or surgical intervention)
What is the SINGLE BEST thing for reducing symptoms in PAD?
Smoking Cessation
What are some less common causes of chronic peripheral arterial insufficiency? (3)
1. Thromboangiitis obliterans (Buergers disease) - inflamm of small- and med-sized vessels. Almost exclusively smokers, esp MEN <40 y.
2. Fibromuscular dysplasia - usually WOMEN, usually renal or carotid arteries, but can affect distal extr.
3. Takayasu Arteritis - usually YOUNG ASIAN WOMEN. Typically branches of aorta (esp SUBCLAVIAN, causing arm claudication & raynauds), with FEVER & WEIGHT LOSS.
What disease:
- Vasculitis of small- and medium-sized vessels
- Upper or lower extremities
- Young male (<40 y)
- SMOKERS
Thromboangiitis obliterans (Buergers disease)
What disease:
- Fever, weight loss, other constitutional signs
- Arm claudication
- Raynauds
- Young women
Takayasu Arteritis - affects branches of aorta, most commonly the SUBCLAVIAN
What are the physical signs of acute arterial occlusion of distal extremity?
The 6 P's:
Pain
Pallor
Pulselessness
Paresthesias
Poikilothermia (coolness)
Paralysis (*only with severe persistent occlusion)
What are indications for workup for revascularization in PAD. (4)
- ABI < 0.4
- Debilitating claudication
- Ischemic rest pain
- Tissue necrosis (nonhealing ulcers)
What is the most common source of emboli to peripheral arteries (e.g., lower extremities)?
Heart