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46 Cards in this Set
- Front
- Back
how does immune reconstitution inflammatory syndrome occur
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if you have an OI and are on HIV therapy it will increase CD4 count and illicit a strong immunologic response which makes outcomes worse
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under what circumstances would you treat the OI before HAART
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MAC
cryptococcal meningitis TB |
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prevent infection by starting drug prophylaxis before pt gets disease
primary or secondary prophylaxis |
primary
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continuation of therapy after pt has completed treatment of active disease
primary or secondary |
secondary
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what OI do you not start primary prophylaxis for
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crytococcus
CMV mucocutaneous candidiasis |
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when do you D/C prophylaxis in PCP, TOXO, MAC
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PCP CD4 > 200
TOXO CD4 > 200 MAC CD4 >100 |
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when do you start prophylaxis in PCP, TOXO, MAC and what drug do you use for each
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PCP CD4 < 200 Bactrim
TOXO CD4 < 100 Bactrim MAC CD4 < 50 Azithromycin or Clarithromycin |
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at what CD4 does PCP occur
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CD4 < 200
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how long is the treatment duration for PCP and what is the primary drug used to treat
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duration - 21 days
primary drug - bactrim |
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if a pt has PCP and has pO2 < 70 what do you do
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add on steroids 72 hrs after initiation of PCP therapy and taper over 21 days
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what drug for PCP do you need to check for G6PD deficiency and hwat happens if the pt does have said deficiency
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check for deficiency in pt on Dapsone
if pt given this drug and has deficiency will experience hemolytic anemia |
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other than Bactrim what else can be used to prophylaxis in PCP
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atovaquone
dapsone aerosolized pentamidine |
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if pt has started HAART therapy and CD4 > 200 for > 3 months can you stop the prophylaxis
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yes
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what is the presentation of PCP
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chest x ray showing diffuse billateral interstitial infiltrates
fever, productive cough, severe hypoxia (pO2 <70) |
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what OI are ring enhancing lesions indicative of
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toxoplasma
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where is toxoplasma found in
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raw/under cooked meat
cat litter |
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what CD4 does toxoplasmosis occur
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CD4 < 100
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what is the presentation for Toxoplasma
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seizures, altered mental status, motor weakness, confusion
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what is the diagnosis for Toxoplasma
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ring enhancing lesions by CT w/ contrast or MRI
positive toxoplasma IgG |
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what is the treatment of choice for Toxoplasma
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sulfadiazine + pyrimethamine + leucovorin
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how long is treatment for toxoplasma
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6 weeks
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what is used as primary prophylaxis for toxoplasma
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Bactrim
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what causes toxoplasma
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protozoan
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what CD4 does cryptococcus begin
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CD4 < 50
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what are the Ssx of cryptococcus
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meningitis signs: neck rigidity, photophobia, pneumonia, disseminated infection
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what is the treatment for cryptococcus induction and for how long
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amphotericin B, flucytosine
2 weeks |
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what is the treatment for cryptococcus consolidation and for how long
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fluconazole
8 weeks |
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what is the treatment for cryptococcus maintenance and for how long
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fluconazole
> 6 months |
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what is the treatment for cryptococcus meningitis
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amphotericin B + flucytosine
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at what CD4 does CMV occur
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CD4 < 50
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when do you tx CMV
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if end organ disease
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how does CMV present
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retinitis - blurry vission that can progress to both eyes if left untreated for 10-21 days
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what is the treatment for CMV
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severe: ganciclovir intraocular implant + PO valganciclovir
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how long is treatment of CMV
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until CD4 > 100 for > 3-6 months
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what must be done if you treat a pt with cidofovir
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saline hydration before and after each treatment
if sulfa allergy can't use regimen (due to probenecid which must be given and is the sorce of the sulfa allergy) |
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at what CD4 does MAC occur
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CD4 < 50
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what is the primary cause of MAC
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M avium
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what are the SSX of MAC
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splenomegally
hepatosplenomegally lymphadenopathy night sweats weight loss |
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how long is tx for MAC
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12 months
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what is the preferred treatment for MAC
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clarithromycin + ethambutol
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what drug is used for prophylaxis for MAC
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azithromycin or clarithromycin
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when can you stop prophylaxis in mAC
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CD4 > 100 for > 3 months
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what CD4 does Candidiasis occur
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CD4 < 200
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what are symptoms of candidiasis
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creamy, white plaques, mucosa ulcerations
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what is the treatment for candidiasis
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fluconazole 7-14 days oropharyngeal
14-21 days esophageal |
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when can you D/C prophylaxis in candidiasis
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CD4 > 200
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