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INFECTIOUS DISEASE ABIM EXAM LATEST UPDATE
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INFECTIOUS DISEASE ABIM EXAM LATEST UPDATE High-risk occupational HIV exposure? Baseline HIV ELISA test. For four weeks, use raltegravir or dolutegravir plus tenofovir and emtricitabine. If the HIV test is negative, recheck it and disconti nue the medication. An HIV patient on ART becomes pregnant. What are you doing? Continue ART until term. If the viral load exceeds 1000, go to section C. If th e viral load is less than 1000, deliver. Continue ART if the patient wishes to breastfeed. The wife is HIV-negative. As her husband is HIV +, she wants to know how to prevent it. Tenofovir + Emtricitabine daily Pneumocystis Jiroveci. Diagnosis: BAL stains or serum B-D glucan Bactrim is prescribed. If allergic to Bactrim, clindamycin, and primaquine Associated with pneumothorax. Seen when T cells are less than 200 Why does bactrim or cobicistat cause an increase in creatinine levels? Decreased creatinine secretion in the tubules Do HIV patients with T cells < 100 experience headaches? What are you doing? Spinal tap to diagnose cryptococcal meningitis. Spinal tap tests positive for India Ink or cryptococcal antigens. Tx: Amphotericin B + 5FU induction. Then change to long-term fluconazole. If you still have headaches, repeat serial LPs. A patient taking bactrim for PJP prophylaxis suffers an ANSWER. What are you doing? Switch to Dapsone or Atovaquone. Prophylaxis for HIV patients with <200 T cells? Bactrim, dapsone, or atovaquone. D/c prophylaxis is possible if T cells exceed 200 for at least three mont hs. Mycoplasma Avium. What T cells have been observed, as well as treatment and prophylaxis? T lymphocytes < 50. Treatment: Clarithromycin + Ethambutol +/- Rifabutin No prophylaxis Conditions observed in T cells below 25? CMV Retinitis and Progressive Multifocal Leukoencephalopathy CMV retinitis (ketchup on cheese appearance): what is the treatment? Ganciclovir Cidofovir Foscarnet Progressive multifocal leukoencephalopathy. Caused by the JC virus in HIV or non-HIV patients. This can be caused by -mabs. Imaging reveals white matter lesions, with no mass impact or edema. CD4 count < 200. HIV patient with T lymphocytes below 25. Headache and unilateral weakness. CT imaging showing ring-enhancing lesion. WTD? Sulfadiazine, pyrimethamine, and leucovorin can be used to treat presumptive toxoplasmosis. Repeat CT brain scans in 2-3 weeks. If there is no change in the size of the lesion, then biopsy. CNS lymphoma is linked to which + antigen? Seen when the CD4 count is less than? EBV antigen CD4 count < 50. Also, for lesions larger than 4cm, there is frequent mass effect and edema.The benefits of buying summaries with Stuvia:
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