WorksheetsIT2 - Exam 4: Opportunistic Infections
Total questions: 50
Worksheet time: 30mins
What is true about opportunistic infections?
Do not usually appear in healthy individuals
Not normally pathogenic but are pathogenic in those with impaired immune system
Those with CD4 <400 are at risk
Those who are immunocompromised are:
CD4 <200 cells/mm3
Use of systemic steroids for >14 days
Asplenia
Those on immunosuppressants (ie TNF-alpha inhibitors)
Those on chemotherapy
What are the steps generally taken to manage opportunistic infections?
Prevent exposure
Vaccinate
Appropriate primary and secondary prophylaxis
Early detection and treatment
What is the route of transmission for Varicella Zoster?
Direct contact
Airborne
Undercooked meat
Soil spores
Inhalation or ingestion of contaminated soil
What is the route of transmission for Pneumocystis Jirovecci Pneumonia?
Direct contact
Airborne
Undercooked meat
Soil spores
Inhalation or ingestion of contaminated soil
What is the route of transmission for Toxoplasma gondii Encephalitis?
Direct contact
Airborne
Undercooked meat
Soil spores
Inhalation or ingestion of contaminated soil
What is the route of transmission for Mycobacterium Avium Complex?
Direct contact
Airborne
Undercooked meat
Soil spores
Inhalation or ingestion of contaminated soil or water
What is the route of transmission for Cytomegalovirus?
Direct contact
Airborne
Undercooked meat
Soil spores
Inhalation or ingestion of contaminated soil or water
What is the route of transmission for Oralpharyngeal/esophageal?
Mouth, throat, digestive tract
Airborne
Undercooked meat
Soil spores
Inhalation or ingestion of contaminated soil or water
What is the route of transmission for Cryptococcal Meningitis?
Mouth, throat, digestive tract
Airborne
Undercooked meat
Soil spores
Inhalation or ingestion of contaminated soil or water
What are some presentation/signs of Varicella Zoster?
Chickenpox/Shingles
Progressive dyspnea
Fever
Nonproductive cough
Hypoxia
What are some presentation/signs of Pneumocystis Jirovecii Pneumonia?
Worsening Chest Discomfort
Progressive dyspnea
Fever
Nonproductive cough
Hypoxia
What are some presentation/signs of Toxoplasma gondii encephalitis?
Altered Mental status
Seizures
Confusion/motor weakness
Nonproductive cough
Hypoxia
What are some presentation/signs of Mycobacterium Avium Complex?
Chronic cough
Fatigue
Dyspnea
Asymptomatic (healthy patients)
Hypoxia
What are some presentation/signs of Mycobacterium Avium Complex?
Chronic cough
Fatigue
Dyspnea
Asymptomatic (healthy patients)
Hypoxia
What are some presentation/signs of Cytomegalovirus?
Fever
Fatigue
Sore throat
Swollen glands
Altered mental status
What are some presentation/signs of Candidiasis?
Watch patches on inner cheeks, tongue, roof of mouth and throat
Redness and soreness
Cracking at corners of mouth
Swollen glands
Dyspnea
What are some presentation/signs of Cryptoccal Meningitis?
Altered mental status
Neckpain
Fever
Nausea/vomiting/Headache
Sensitivity to light
A patient is presenting with chickenpox what treatment should patient be put on and for how long?
Valacyclovir 1 gm PO TID
7-10 days
3-6 months
Bactrim PO daily
What is the primary prophylaxis for Varicella Zoster?
Vaccination
Varzig 96 hours after exposure
Acyclovir 800 mg PO 5x/day for 5-7 days
A patient is presenting with progressive dyspnea, fever, non-productive cough, chest discomfort and hypoxia. What is the primary prophylaxis of choice?
Bactrim
Acyclovir
Vaccination
None
How do you diagnose a patient that you suspect having a Pneumocystis Jirovecii Pneumonia infection?
Chest radiograph
Lesion in MRI CT scan
Lateral flow assay
Sputum culture from lungs
What would you see in a chest radiograph in a person suspected of penumocystis jirovecii pneumonia?
Diffuse interstitialinfiltrates
Ground glass appearance
Gray and hazy
What is the alternative prophylaxis treatment for Pneumoncysitis Jirovecii Pneumonia?
Dapsone 100mg PO QD
Valganciclovir 900 mg PO BID
Fluconazole 200mg PO QD for 1 year
Clarithromycin 500 mg PO BID
Azithromycin 600 mg PO QD
When can a patient discontinue prophylaxis?
CD4 count >200 cells/mm3
3 or more months on antiretroviral therapy (ART)
CD4 count >100 cells/mm3
2 or more months on antiretroviral therapy (ART)
A patient consumed uncooked meat and is experiencing altered mental status what is the 1st line treatment we can use to treat patient?
Pyrimethamine 200 mg PO x1 dose then 50mg-75mg PO daily + Leucoverin + Sulfadiazine
Clarithromycin 500 mg PO BID
Valganciclovir 900 mg PO BID
None
How do you diagnose Toxoplasma gondii encephalitis?
IgG antibodies
Lesions in MRI CT scan
Sputum culture from lungs
Chest Xray
Lateral flow assay
A patient who accidentally consumed cat litter could be at risk for?
Toxoplasma gondii encephalitis
Mycobacterium Avium Complex
Cytomegalovirus
Candidiasis
A patient who accidentally consumed uncooked meat could be at risk for?
Toxoplasma gondii encephalitis
Mycobacterium Avium Complex
Cytomegalovirus
Candidiasis
Which opportunistic infection uses macrolides such as Azithromycin or Clarithromycin as primary prophylaxis treatments?
Mycobacterium Avium Complex
Cytomegalovirus
Crytococcal Meningitis
Candidiasis
Pneumocystis Jirovecii Pneumonia
How can you diagnose patient suspicious of having Mycobacterium Avium Complex?
Chest Xray
CT scan
Sputum culture from lungs
Blood tests
Lateral flow assay
Macrolides are preferred treatments for which opportunistic infection?
Mycobacterium Avium Complex
Toxoplasma gondii encephalitis
Candidiasis
Cryptococcal Meningitis
A patient is presenting with fatigue, fever, sore throat and swollen glands what could they possibly have?
Cytomegalovirus
Toxoplasma gondii encephalitis
Candidiasis
Cryptococcal meningitis
What is the primary prophylaxis for Cytomgalovirus?
None
Macrolides
Bactrim
Rifubutin
What is the treatment for patient with cytomegalovirus?
None
Valganciclovir
Clarithromycin
Bactrim
Pyrimethamine
How can you identify someone with opportunistic infection?
HIV
Chemotherapy
Immunosuppression
At what level of CD4 count would make a patient high risk?
<400
<500
<600
<700
Valacyclovir 1g PO TID is the preferred regimen for which opportunistic infection?
Varicella zoster
Toxoplasmosis Gondii Encephalitis
Cytomegalovirus
MAC
Macrolides are the preferred regimen for which opportunistic infection?
Varicella Zoster
Pneumocystis Jirovecii Pneumonia
Toxoplasmosis Gondii Encephalitis
Cytomegalovirus
Mycobacterium Avium Complex (MAC)
Valganiciclovir/Ganciclovir are the preferred regimen for which opportunistic infection?
Varicella Zoster
Pneumocystis Jirovecii Pneumonia
Toxoplasmosis Gondii Encephalitis
Cytomegalovirus
Mycobacterium Avium Complex (MAC)
Pyrimethamine + Leucovorin + Sulfadiazine are the preferred regimen for which opportunistic infection?
Varicella Zoster
Pneumocystis Jirovecii Pneumonia
Toxoplasmosis Gondii Encephalitis
Cytomegalovirus
Mycobacterium Avium Complex (MAC)
Bactrim is the preferred regimen for which opportunistic infection?
Varicella Zoster
Pneumocystis Jirovecii Pneumonia
Toxoplasmosis Gondii Encephalitis
Cytomegalovirus
Mycobacterium Avium Complex (MAC)
Fluconazole is the preferred regimen for which opportunistic infection?
Candidiasis (thrush)
Pneumocystis Jirovecii Pneumonia
Toxoplasmosis Gondii Encephalitis
Cytomegalovirus
Mycobacterium Avium Complex (MAC)
Amphotericin B is the preferred regimen for which opportunistic infection?
Candidiasis (thrush)
Cryptococcal Meningitis
Toxoplasmosis Gondii Encephalitis
Cytomegalovirus
Mycobacterium Avium Complex (MAC)
Rifabutin, Amikacin, Streptomicin, Moxiflocain and Levofloxacin are secondary regimens for which opportunistic infection?
Varicella Zoster
Pneumocystis Jirovecii Pneumonia
Toxoplasmosis Gondii Encephalitis
Cytomegalovirus
Mycobacterium Avium Complex (MAC)
Foscarnet and Cidofovir are secondary regimens for which opportunistic infection?
Varicella Zoster
Pneumocystis Jirovecii Pneumonia
Toxoplasmosis Gondii Encephalitis
Cytomegalovirus
Mycobacterium Avium Complex (MAC)
Itraconazole and Posaconazole are secondary regimens for which opportunistic infection?
Candidiasis (thrush)
Pneumocystis Jirovecii Pneumonia
Toxoplasmosis Gondii Encephalitis
Cytomegalovirus
Mycobacterium Avium Complex (MAC)
Dapsone is the secondary regimens for which opportunistic infection?
Candidiasis (thrush)
Pneumocystis Jirovecii Pneumonia
Toxoplasmosis Gondii Encephalitis
Cytomegalovirus
Mycobacterium Avium Complex (MAC)
Which are the fungal opportunistic infections
Candidiasis
Cryptococcal Meningitis
Cytomegalovirus
MAC
Toxoplasma gondii encephalitis
Which are the viral opportunistic infections
Pneumocystis Gondii encephalitis
Varicella Zoster
Cytomegalovirus
MAC
Toxoplasma gondii encephalitis
