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27 Cards in this Set
- Front
- Back
What disease:
- HIV with CD4 < 200 - Diffuse bilateral chest infiltrate - Elevated serum LDH |
Pneumocystis carinii pneumonia
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How is LDH helpful in diagnosis of PCP?
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- Pts with LDH < 220 IU/L are very unlikely to have PCP.
- LDH may also be elevated in disseminated histoplasmosis or lymphoma. |
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How is PCP diagnosed definitively?
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Giemsa or silver stain of induced sputum or BAL.
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What disease:
- HIV - Mild persistent dry cough - Significant hypoxemia |
Pneumocystis carinii pneumonia
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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. |
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What's in the DDx:
- HIV - CXR: diffuse interstitial infiltrates |
- PCP
- Disseminated histoplasmosis - M. tuberculosis (TB) - M. kansasii |
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What's in the DDx:
- HIV - CXR: patchy infiltrates, or pleural-based infiltrates |
- TB
- Cryptococcal LUNG disease |
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What's in the DDx:
- HIV - CXR: Cavitary lesion |
- TB
- PCP - Coccidiomycosis |
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What's the most common cause:
- HIV - Fever - Productive cough - Pulmonary infiltrate on CXR |
Community-Acquired Pneumonia
(e.g., S. pneumoniae, Mycoplasma, Chlamydia, etc.) |
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What's the most common cause:
- HIV - Bilateral apical infiltrate with cavitation |
TB
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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. |
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What is the treatment for CNS Toxoplasmosis?
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Slufadiazine + pyrimethamine
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What is a good serological test for suspected CNS lymphoma?
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CSF examination for Epstein-Barr Virus DNA.
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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. |
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What disease:
- HIV, CD4 <50 - Persistent fevers, weight loss, feeling crummy - GI pain, watery diarrhea |
M. avium-intracellulare
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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 |
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What are the most important risk factors for Peripheral Arterial Disease? (4)
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- Cigarette smoking
- DM - Dyslipidemia - Hypertension |
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Guess what I'm thinking:
- Complete hair loss on legs and feet - Shiny atrophic skin - Thickened and brittle toenails |
Peripheral Arterial Disease
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What ABI values are a/w:
1. Normal 2. Claudication 3. Severe ischemia |
1. >1.0
2. 0.4 - 0.9 3. <0.4 |
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What is the SINGLE BEST thing for reducing risk of fatal or nonfatal MI?
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Smoking Cessation (up to 50% reduction - more than any medical or surgical intervention)
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What is the SINGLE BEST thing for reducing symptoms in PAD?
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Smoking Cessation
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What are some less common causes of chronic peripheral arterial insufficiency? (3)
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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. |
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What disease:
- Vasculitis of small- and medium-sized vessels - Upper or lower extremities - Young male (<40 y) - SMOKERS |
Thromboangiitis obliterans (Buergers disease)
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What disease:
- Fever, weight loss, other constitutional signs - Arm claudication - Raynauds - Young women |
Takayasu Arteritis - affects branches of aorta, most commonly the SUBCLAVIAN
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What are the physical signs of acute arterial occlusion of distal extremity?
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The 6 P's:
Pain Pallor Pulselessness Paresthesias Poikilothermia (coolness) Paralysis (*only with severe persistent occlusion) |
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What are indications for workup for revascularization in PAD. (4)
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- ABI < 0.4
- Debilitating claudication - Ischemic rest pain - Tissue necrosis (nonhealing ulcers) |
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What is the most common source of emboli to peripheral arteries (e.g., lower extremities)?
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Heart
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