ID Exam 3 - Opportunistic Infections/STDs

ST is a 34 year old male, and is HIV positive. He has been living with HIV for 3 years and refused treatment upon diagnosis. He comes into the hospital complaining of having discomfort in his chest and a non-productive cough. Which of the following are ST

A

FW is a 41 year old female, and is HIV positive. She has been living with HIV for 4 years and refused treatment upon diagnosis. She comes into the hospital complaining of having a headache, confusion, weakness and a bad fever. Which of the following are F

B

NS is a 25 year old male, and is HIV positive. He has been living with HIV for 3 years and refused treatment upon diagnosis. He comes into the hospital complaining of having really bad abdominal pain, a fever and night sweats. After reading his lab report

C

Which of the following opportunistic infections are respiratory in nature? (select all that apply)
A. PCP
B. TE
C. MAC

A, C

Which of the following opportunistic infections are neurological in nature? (select all that apply)
A. PCP
B. TE
C. MAC

B

Which laboratory test could help prevent a missed diagnosis of an infection that may present similarly to TE?
A. AFB
B. CPK
C. CRP
D. RPR

D
RPR is used to test syphilis which can also be a neurological disease.

This opportunistic infection is typically seen in patients with a CD4 < 200.
A. TE
B. PCP
C. MAC

B

This opportunistic infection is typically seen in patients with a CD4 < 100.
A. TE
B. PCP
C. MAC

A

This opportunistic infection is typically seen in patients with a CD4 < 50.
A. TE
B. PCP
C. MAC

C

JM's lab report comes back and it states that his AFB stain is positive (+). Which is this indicative of?
A. PCP
B. MAC
C. TE

B

CD4 cells are also known as: (select all that apply)
A. Helper Cells
B. T lymphocytes
C. B lymphocytes

A, B

What is the DOC for PCP prophylaxis?
A. Azithromycin
B. TMP-SMX
C. Clarithromycin

B

What is the DOC for TE prophylaxis?
A. Azithromycin
B. TMP-SMX
C. Clarithromycin

B

What is the DOC for MAC prophylaxis?
A. Azithromycin
B. TMP-SMX
C. Clarithromycin

A, C

If a person cannot use macrolide treatment for MAC, what is an alternative treatment?
A. atovaquone
B. rifabutin
C. dapsone

B

How long does it take to consider discontinuing prophylaxis for a patient on treatment for an opportunistic infection?
A. > 6 months
B. > 1 months
C. > 3 months

C

What are the side effects of Dapsone?
A. rash
B. hemolytic anemia
C. bone marrow suppression
D. nephrotoxicity

B, C

What are the side effects of Primaquine?
A. rash
B. hemolytic anemia
C. bone marrow suppression
D. nephrotoxicity

b,c

SW requires treatment for his opportunistic infection. He has a G6PD deficiency. Which of the following medications should he AVOID? (select all that apply)
A. dapsone
B. pentamidine
C. primaquine
D. atovaquone

A, C

Which of the following is delivered via IV or inhalation?
A. atovaquone
B. primaquine
C. pentamidine
D. dapsone

C
pentamidine (aerosolized)

Which of the following are ADE of Pentamidine IV? (select all that apply)
A. bone marrow suppresion
B. hemolytic anemia
C. hypocalcemia/hypokalemia
D. nephotoxicity

C, D
also, hypomagnesemia

If a person cannot use TMP-SMX for a PCP prophylxis or TE prophylaxis which is an alternate treatment?
A. clarithromycin
B. azithromycin
C. atovaquone
D. rifabutin

C

T/F: TMP-SMZ should always be avoided during pregnancy.

False
if the benefits outweigh the risks we still would prefer to use TMP-SMX

What supplement should patients on TMP-SMX be administered during therapy?
A. iron
B. folic acid
C. vitamin D

B
no higher dosage is recommended due to risk of birth defects

Select the true statement(s) regarding G6PD deficiency.
A. patients with deficiency is more prone to RBC lyse
B. G6PD is an enzyme that protects the integrity of RBC
C. lack of G6PD leads to RBC destruction
D. G6PD deficiency can result in hemolytic anemi

all of the above

what are the ADE of hemolytic anemia?
A. dark urine
B. yellow skin/eyes
C. difficulty breathing
D. fatigue

all of the above

Which of the following most commonly builds up in the body in patients with hemolytic anemia?
A. amylase
B. bilirubin
C. intrinsic factor
D. urea

B

Which of the following are used in mild-moderate PCP? (select all that apply)
A. Dapsone + TMP
B. TMP-SMX PO
C. TMP-SMX IV

A, B

Which of the following are used in moderate-severe PCP?
A. Dapsone + TMP
B. TMP-SMX PO
C. TMP-SMX IV

C

What are two ways that Bactrim can cause hyperkalemia?
A. Bactrim can cause potassium ion channels to release potassium into the blood.
B. SMX component can cause hyperkalemia
C. Hemolytic anemia may result causing RBC to lyse and potassium to come into t

C, D

What is the DOC for TE treatment?
A. Dapsone
B. Pyrimethamine
C. Azithromycin

B

Select the true statements regarding Leucovorin:
A. used in conjunction with pyrimethamine which can be toxic to the bone marrow
B. has a protective effect against bone marrow toxicities
C. reduced form of folic acid (vitamin B9)

all of the above

T/F: If patients have started ART and have a suppressed viral load they do not need MAC prophylaxis.

true

What is the drug interaction potential often seen with clarithromycin?
A. CYP inhibitor
B. CYP 450 inducer

A

What is the drug interaction potential often seen with rifabutin?
A. CYP inhibitor
B. CYP 450 inducer

B

Which of the following are risk factors for STDs?
A. early age at first intercourse
B. previous STD
C. sexual preferences
D. race: AA/Hispanics
E. gender: male
F. age: teens-twenties

all of the above

Nongonococcal urethritis is most often caused by which organism? (select all that apply)
A. C. trachomatis
B. C. psittaci
C. C. pneumoniae

all of the above

What type of organisms are found in Nongonococcal Urethritis (NGU)?
A. spirochete gram negative organism
B. gram-negative diplococcus
C. chlamydia - obligate intracellular parasites

C

CF comes into the hospital complaining of dysuria and urinary frequency. According to his laboratory report, he has mucoid uretheral discharge. What type of STD is CF likely to have?
A. gonorrhea
B. syphilis
C. chlamydia

C

Which of the following are diagnostic tools typically used to confirm chlamydia/NGU? (select all that apply)
A. LCR
B. cultures
C. PCR
D. FTA-ABS

A, B, C

Which of the following are used to treat NGU? (select all that apply)
A. azithromycin
B. doxycycline
C. TMP-SMX
D. PCN G

A, B

What is the DOC in NGU?
A. azithromycin
B. PCN G
C. levofloxacin

A

What is the organism found in gonorrhea?
A. neisseria gonorrhea
B. chlamydia
C. treponema pallidum

A

What type of organisms is Neisseria Gonorrhea?
A. spirochete gram negative organism
B. gram-negative intracellular diplococcus
C. chlamydia - obligate intracellular parasites

B

TQ has just been diagnosed with a STD. His laboratory report confirmed the presence of purulent discharge. Which STD does TQ most likely have?
A. syphilis
B. chlamydia
C. gonorrhea

C

T/F: Purulent discharge in gonorrhea may mask mucoid discharge found in chlamydia.

true
we should also check for coinfection with chlamydia if there is presence of purulent discharge.

MN, 25 year old male, complains of painful, burning sensation, and frequent urination. Which STD is this typical of?
A. chlamydia
B. syphilis
C. gonorrhea

C

T/F: gonorrhea can cause sterility issues in both males and females if left unchecked.

true

T/F: the majority of males infected with gonorrhea have no noticeable symptoms in early stages of gonorrhea.

FALSE
the majority of women are asymptomatic!

Untreated gonorrhea can lead to: (select all that apply)
A. sterility
B. blindness
C. heart conditions
D. arthritis
E. pelvic inflammatory disease

all of the above
including prostate trouble

Which of the following is the gold standard of gonorrhea testing?
A. gram stained smear
B. cell culture
C. PCR

C

Which of the following are diagnostic tools used in gonorrhea testing?
A. gram stained smear
B. cell culture
C. PCR

all of the above

Which of the following diagnostic tools used in gonorrhea is not useful in rectal infections?
A. gram stained smear
B. cell culture
C. PCR

A

Which of the following are regimens used to treat gonorrhea of the cervix, urethra, and rectum? (select all that apply)
A. ciprofloxacin + clarithromycin
B. ceftriaxone + azithromycin
C. cefixime + azithromycin
D. TMP-SMX + clarithromycin

B, C

Which of the following is the DOC regimen used to treat gonorrhea of the cervix, urethra, and rectum? (select all that apply)
A. ciprofloxacin + clarithromycin
B. ceftriaxone + azithromycin
C. cefixime + azithromycin
D. TMP-SMX + clarithromycin

B

Which of the following is the recommended regimen used to treat gonorrhea of the pharynx? (select all that apply)
A. ciprofloxacin + clarithromycin
B. ceftriaxone + azithromycin
C. cefixime + azithromycin
D. TMP-SMX + clarithromycin

B

What is the organism found in syphilis?
A. neisseria gonorrhea
B. chlamydia
C. treponema pallidum

C

What type of organisms are found in Treponema Pallidium?
A. spirochete gram negative organism
B. gram-negative diplococcus
C. chlamydia - obligate intracellular parasites

A

Which of the following are ways that syphilis can be transmitted? (select all that apply)
A. aerosolized particles
B. sexual contact
C. blood transfusions
D. kissing

B, C, D
it can also be transmitted to babies

T/F: a patient who has contracted syphilis is not going to show any S&S for up to 3 weeks.

true
the average incubation period is 21 days!

Select the true statement(s) regarding primary syphilis)
A. the point where the organism has entered the body
B. craterlike appearance
C. usually painless
D. chancre's will disappear without treatment

all of the above

CG comes into the hospital with rashes covering all of her body. She also is complaining of a sore throat, fever, and bald patches in her hair. Which of the following STD does CG most likely have?
A. primary syphilis
B. secondary syphilis
C. tertiary syph

B

What is another name for sores on the skin in tertiary syphilis?
A.
B.
C. gummas

C

What are the side effects found in tertiary syphilis?
A. death
B. sores/gummas
C. blindness
D. insanity

all of the above

What is the diagnostic tool(s) used to diagnose syphilis?
A. blood serology
B. darkfield microscopy
C. gram stain
D. PCR

A, B

Match the following:
I. Nontreponemal blood serology
II. Treponemal blood serology
A. only valid test for follow up
B. results remain positive for life
C. no value in follow up and treatment
D. VDRL, RPR
E. stead decline indicates successful treatment
F.

I. A, D, E
II. B, C, F

What is the DOC for syphilis treatment?
A. Azithromycin
B. Ceftriaxone + azithromycin
C. Benzthine PCN G

C

If a patient is allergic to PCN and has syphilis, what are the alternative options for treatments? (select all that apply)
A. TMP-SMX
B. doxycycline
C. erythromycin
D. azithromycin

B, C

What is the DOC for congenital syphilis?
A. ceftriaxone + azithromycin
B. azithromycin
C. PCN G

C
Crystalline PCN G or procaine PCN G

PCN desensitization is indicated for:
A. pregnant women with syphilis who are hypersensitive to PCN
B. males wanting to get their partner pregnant
C. syphilis patients who are allergic to PCN

A

Select the true statement(s) regarding Jarisch-Herxhimer Reaction:
A. occurs most frequently in syphilis patients
B. due to pyrogen release from the spirochetes after treatment with PCN
C. antipyretics can be used to manage symptoms
D. self-limiting

all of the above

SM comes into the pharmacy to follow up after receiving his PCN treatment for syphilis. He complains of having a fever, chills, muscle pain and nausea. You recognize these symptoms as a Jarisch-Herxhimer RXN. Should you be concerned?
A. Yes. Tell SM to co

B

A DNA virus is indicative of:
A. chlamydia
B. syphilis
C. herpes
D. gonorrhea

C

How can one get HSV?
A. aerosolized particles in the air
B. contact with infectious secretions on oral or genital mucosal surfaces
C. skin to skin contact

B

T/F: unlike syphilis, herpes is painful

true

How long does it take a herpes flare to resolve?
A. 48 hours
B. 7-10 days
C. 4 weeks

B

Which of the following are diagnostic tools used to diagnose HSV?
A. PCR
B. antigen detection
C. cytology
D. viral culture

B, C, D

What is the DOC for HSV?
A. PCN
B. Acyclovir
C. TMP-SMX
D. ceftriaxone + azithromycin

B

T/F: topical acyclovir is the most effective formulation

false
oral, iv, liquid formulations of acyclovir are safe and effective
topical is the LEAST effective formulation and only benefits the initial outbreak

What are appropriate counseling points for a patient with active phase genital herpes? (select all that apply)
A. refrain from sexual activity
B. use separate towels from others
C. keep lesions clean and dry
D. wash hands after touching infected area

all of the above

Which of the following should be recommended regarding the prevention of STI's? (select all that apply)
A. throw away all unopened condoms and never use them
B. safe/smart sex
C. educational programs
D. do not use barrier contraceptives
E. abstinence

B, C, E