FCM Infectious Disease Review Questions
and Correct Answers With Rationale. 100%
Correct.
Who gets screened for HIV?
Routine HIV testing
•Everyone ages 15-65 years
•Younger adolescents and older adults who are at increased risk should also be screened
•Test at least yearly for those with risk factors
•Screen all pregnant women (in the 1st AND 3rd trimester; at delivery if not previously done)
Low suspicion for HIV testing in acute settings: Patients with other STIs, flu-like symptoms or other
signs of acute HIV
HIV/AIDS Testing
- Initial Screening: 4th generation aby/ag testing
•If initial screen positive: then HIV-1 & HIV-2 aby testing
•if HIV-1/2 abys negative then HIV RNA testing
•If HIV RNA testing negative, it was an initial false positive
Keep acute HIV infection in mind in those at right who present with what symptoms?
Fever
Fatigue
Rash
headache
lymphadenopathy
pharyngitis
myalgia or arthalgias
nausea, vomiting, or diarrhea
Night sweats
a septic meningitis
oral ulcers
genital ulcers
thrombocytopenia
leukopenia
elevated hepatic enzyme levels
You are a PA working in infectious disease and one of your HIV patient's comes in to see you today
because he has noticed this new "patchy white stuff" on the side of his tongue. On physical exam
you notice you are not able to scrape it off with the tongue depressor. You are concerned he may
not be taking his medications and decide to get an absolute CD4 lymphocyte count.
,Before getting the results back what range do you expect his cell count to be in?
a. >1200cells/mcL
b. 500-1200 cells/mcL
c. 300-500 cells/mcL
d.<300 cells/mcL
d.<300 cells/mcL
HIV/AIDS and Opportunistic Infections (OI):
•AIDS: CD4 count under 200
•Thrush in acute HIV and chronic HIV and AIDS
•In AIDS: PJP prophylaxis with bactrim
AIDS: CD4 count under?
PJP prophylaxis?
AIDS: CD4 count under 200In AIDS:
PJP prophylaxis with bactrim
_____ cells/mcL: someone with a CD4 count of >_____ has a normal, healthy immune system
____ to _____ cells/mcL: If a patient presents with a CD4 count between ____ and ____ you start to
see opportunistic infections which include, OHL (oral hairy leukoplakia—as in this case), thrush, HSV,
VZV, TB, KS, or recurrent vaginal candidiasis. Coccidiomycosis can also be present if in the patient
lives in the Southwest.
______ cells/mcL: The most common OIs in this group include PCP (pneumocystitis pneumonia) and
candida esophagitis. Histoplasmosis or toxoplasmosis may also show up as well as cryptococcus.
<_____ cells/mcL: Primary multifocal leukoencephalopathy (PML), CMV retinitis, dementia, and
disseminate MAC are see more commonly when the CD4 count drops below _____ cells/mcL.
>500 cells/mcL: someone with a CD4 count of >500 has a normal, healthy immune system
200-500 cells/mcL: If a patient presents with a CD4 count between 200 and 500 you start to see
opportunistic infections which include, OHL (oral hairy leukoplakia—as in this case), thrush, HSV,
VZV, TB, KS, or recurrent vaginal candidiasis. Coccidiomycosis can also be present if in the patient
lives in the Southwest.
50-200 cells/mcL: The most common OIs in this group include PCP (pneumocystitis pneumonia) and
candida esophagitis. Histoplasmosis or toxoplasmosis may also show up as well as cryptococcus.
<50 cells/mcL: Primary multifocal leukoencephalopathy (PML), CMV retinitis, dementia, and
disseminate MAC are see more commonly when the CD4 count drops below 50 cells/mcL.
A-32-year-old is referred to ophthalmologist with an acute red painful eye with blurriness that her
PCP believes might be uveitis. The ophthalmologist performs fundoscopy and finds the following:
, Which of the following pieces of history might make the ophthalmologist suspect toxocara larva
migrans
- Adoption of a super loving new dog from the shelter
- eating undercooked pork on a recent trip to Guatemala
- Mission trip to Uganda last month
- Swimming in a lake in Georgia during the summer
- Adoption of a super loving new dog from the shelter
- Adoption of a super loving new dog from the shelter
Toxocariasis
• Aka Visceral larva Migrans
• Human infection by parasitic roundworms via ingestion of larvae from animal feces
• Dogs and cats are definitive hosts (puppies MCC)
• Epidemiology: Occurs throughout tropical and temperature regions worldwide • More common if:
high humidity, poverty, rural, poor access to water
• Young children most affected (playground, public parks, sandboxes, etc.)
Transmission: • Occurs via ingesting eggs from soil/contaminated food
• Soil can remain infectious for years after exposure
Toxocariasis
• S/Sx:
• Typically asymptomatic- eosinophilic granulomas form to contain larvae
• Ocular larva migrans: typically only symptom (older children/teens):
• Larva migrate to eye, granuloma forms around larva in eye
• Blurry vision, photophobia, floaters, failing vision, strabismus, uveitis
• Can lead to retinal detachment
• Visceral larva migrans (typically young children):
• Hepatitis (hepatomegaly, anorexia, malaise)
• Pneumonitis (fever, irritability, cough, dyspnea, wheezing)
• Pruritic lesions, chronic urticaria
• Eosinophilia
• Rare: myocarditis, pericarditis, heart failure, meningoencephalitis, seizures
Diagnosis:
• Presumptive diagnosis: history, exam and leukocytosis and eosinophilia
and Correct Answers With Rationale. 100%
Correct.
Who gets screened for HIV?
Routine HIV testing
•Everyone ages 15-65 years
•Younger adolescents and older adults who are at increased risk should also be screened
•Test at least yearly for those with risk factors
•Screen all pregnant women (in the 1st AND 3rd trimester; at delivery if not previously done)
Low suspicion for HIV testing in acute settings: Patients with other STIs, flu-like symptoms or other
signs of acute HIV
HIV/AIDS Testing
- Initial Screening: 4th generation aby/ag testing
•If initial screen positive: then HIV-1 & HIV-2 aby testing
•if HIV-1/2 abys negative then HIV RNA testing
•If HIV RNA testing negative, it was an initial false positive
Keep acute HIV infection in mind in those at right who present with what symptoms?
Fever
Fatigue
Rash
headache
lymphadenopathy
pharyngitis
myalgia or arthalgias
nausea, vomiting, or diarrhea
Night sweats
a septic meningitis
oral ulcers
genital ulcers
thrombocytopenia
leukopenia
elevated hepatic enzyme levels
You are a PA working in infectious disease and one of your HIV patient's comes in to see you today
because he has noticed this new "patchy white stuff" on the side of his tongue. On physical exam
you notice you are not able to scrape it off with the tongue depressor. You are concerned he may
not be taking his medications and decide to get an absolute CD4 lymphocyte count.
,Before getting the results back what range do you expect his cell count to be in?
a. >1200cells/mcL
b. 500-1200 cells/mcL
c. 300-500 cells/mcL
d.<300 cells/mcL
d.<300 cells/mcL
HIV/AIDS and Opportunistic Infections (OI):
•AIDS: CD4 count under 200
•Thrush in acute HIV and chronic HIV and AIDS
•In AIDS: PJP prophylaxis with bactrim
AIDS: CD4 count under?
PJP prophylaxis?
AIDS: CD4 count under 200In AIDS:
PJP prophylaxis with bactrim
_____ cells/mcL: someone with a CD4 count of >_____ has a normal, healthy immune system
____ to _____ cells/mcL: If a patient presents with a CD4 count between ____ and ____ you start to
see opportunistic infections which include, OHL (oral hairy leukoplakia—as in this case), thrush, HSV,
VZV, TB, KS, or recurrent vaginal candidiasis. Coccidiomycosis can also be present if in the patient
lives in the Southwest.
______ cells/mcL: The most common OIs in this group include PCP (pneumocystitis pneumonia) and
candida esophagitis. Histoplasmosis or toxoplasmosis may also show up as well as cryptococcus.
<_____ cells/mcL: Primary multifocal leukoencephalopathy (PML), CMV retinitis, dementia, and
disseminate MAC are see more commonly when the CD4 count drops below _____ cells/mcL.
>500 cells/mcL: someone with a CD4 count of >500 has a normal, healthy immune system
200-500 cells/mcL: If a patient presents with a CD4 count between 200 and 500 you start to see
opportunistic infections which include, OHL (oral hairy leukoplakia—as in this case), thrush, HSV,
VZV, TB, KS, or recurrent vaginal candidiasis. Coccidiomycosis can also be present if in the patient
lives in the Southwest.
50-200 cells/mcL: The most common OIs in this group include PCP (pneumocystitis pneumonia) and
candida esophagitis. Histoplasmosis or toxoplasmosis may also show up as well as cryptococcus.
<50 cells/mcL: Primary multifocal leukoencephalopathy (PML), CMV retinitis, dementia, and
disseminate MAC are see more commonly when the CD4 count drops below 50 cells/mcL.
A-32-year-old is referred to ophthalmologist with an acute red painful eye with blurriness that her
PCP believes might be uveitis. The ophthalmologist performs fundoscopy and finds the following:
, Which of the following pieces of history might make the ophthalmologist suspect toxocara larva
migrans
- Adoption of a super loving new dog from the shelter
- eating undercooked pork on a recent trip to Guatemala
- Mission trip to Uganda last month
- Swimming in a lake in Georgia during the summer
- Adoption of a super loving new dog from the shelter
- Adoption of a super loving new dog from the shelter
Toxocariasis
• Aka Visceral larva Migrans
• Human infection by parasitic roundworms via ingestion of larvae from animal feces
• Dogs and cats are definitive hosts (puppies MCC)
• Epidemiology: Occurs throughout tropical and temperature regions worldwide • More common if:
high humidity, poverty, rural, poor access to water
• Young children most affected (playground, public parks, sandboxes, etc.)
Transmission: • Occurs via ingesting eggs from soil/contaminated food
• Soil can remain infectious for years after exposure
Toxocariasis
• S/Sx:
• Typically asymptomatic- eosinophilic granulomas form to contain larvae
• Ocular larva migrans: typically only symptom (older children/teens):
• Larva migrate to eye, granuloma forms around larva in eye
• Blurry vision, photophobia, floaters, failing vision, strabismus, uveitis
• Can lead to retinal detachment
• Visceral larva migrans (typically young children):
• Hepatitis (hepatomegaly, anorexia, malaise)
• Pneumonitis (fever, irritability, cough, dyspnea, wheezing)
• Pruritic lesions, chronic urticaria
• Eosinophilia
• Rare: myocarditis, pericarditis, heart failure, meningoencephalitis, seizures
Diagnosis:
• Presumptive diagnosis: history, exam and leukocytosis and eosinophilia
