PPOM 1 Exam 4 Part 1

Blood composition

45% plasma, 55% cells, 1% leukocytes and

platelets (buffy coat)

A patient develops:

• fever

• retro-orbital pain

• severe myalgias (“breakbone fever”)

• rash

What is the most likely diagnosis?

Dengue fever

A patient with human immunodeficiency virus is started on antiretroviral therapy and develops:

• fever

• worsening lymphadenopathy

• inflammatory symptoms

• clinical deterioration despite improving viral load

What is the most likely explanation?

Immune reconstitution inflammatory syndrome

A patient taking tenofovir disoproxil fumarate develops:

• phosphaturia

• glucosuria with normal serum glucose

• metabolic acidosis

What renal complication is most likely occurring?

Fanconi syndrome

“Key inflammatory pathways:

• Interleukin-17

• Tumor necrosis factor-alpha

• Interleukin-23” which disease?

psoriasis vulgaris

A patient on protease inhibitor therapy develops:

• hyperlipidemia

• insulin resistance

• dorsocervical fat pad

Which mechanism BEST explains these findings?

Altered adipocyte metabolism and insulin signaling

A patient receiving doxorubicin is given a protective drug to reduce cardiotoxicity.

Which drug is used?

Dexrazoxane

Which human immunodeficiency virus medication requires administration WITH food and acidic gastric pH for proper absorption?

Rilpivirine

Which human immunodeficiency virus medication is MOST associated with nephrotoxicity and decreased bone mineral density?

Tenofovir disoproxil fumarate

A patient presents with:

• annular erythematous rings

• photosensitivity

• positive anti-Ro/SSA antibodies

What subtype of lupus is MOST likely?

Subacute cutaneous lupus erythematosus

Which human immunodeficiency virus medication should be taken on an EMPTY stomach because food increases neuropsychiatric adverse effects?

Efavirenz

Which human immunodeficiency virus drug class is MOST associated with pharmacokinetic boosting using ritonavir or cobicistat?

Protease inhibitors

man presents with a dark lesion on the sole of his foot that has enlarged over several months. Biopsy confirms melanoma.

Which subtype is most strongly associated with this presentation?

Acral lentiginous melanoma

What is the classic oral finding in lichen planus?

Wickham striae

A patient has:

• target lesions

• recent herpes simplex virus infection

• limited mucosal involvement

• less severe disease than SJS/TEN

What is the most likely diagnosis?

Erythema multiforme

Which HIV drug class is MOST associated with significant CYP3A4-mediated drug interactions and metabolic adverse effects?

Protease inhibitors

Which mechanism is MOST important for heat loss in a hot environment when ambient temperature exceeds body temperature?

Convection

Which HIV medication is CONTRAINDICATED with proton pump inhibitors because elevated gastric pH decreases drug absorption?

Rilpivirine

Which HIV medication is CONTRAINDICATED with proton pump inhibitors because elevated gastric pH decreases drug absorption?

Rilpivirine

A patient presents with:

• palpable purpura

• fever

• hypotension

• rapidly progressive petechial rash

What infectious emergency should be strongly suspected?

Meningococcemia

Which dermatologic condition is associated with:

• greasy yellow scale

• scalp involvement

• nasolabial folds

• eyebrows

• chronic relapsing course?

Seborrheic dermatitis

A patient with SLE is found to have antibodies associated with neonatal lupus and congenital heart block in the fetus.

Which antibody is most associated with this complication?

Anti-Ro/SSA antibodies

Which mechanism becomes LESS effective for heat loss when environmental temperature exceeds body temperature?

Radiation

When paclitaxel and platinum chemotherapy are given together, which sequencing strategy helps reduce bone marrow suppression?

Paclitaxel before platinum.

A patient receiving chemotherapy develops:

• glove-and-stocking peripheral neuropathy

• myelosuppression

Which drug is MOST likely responsible?

Paclitaxel

Iron stores depleted

Decrease in ferritin

Which chemotherapy drug is converted into an active metabolite called SN-38?

Irinotecan

Which anticoagulant acts by enhancing antithrombin-mediated inhibition of factor ten A ONLY?

Fondaparinux

Which specific region or gene encodes the viral IN (Integrase) protein?

The IN region (part of the larger pol gene).

Which reading frame encodes the HIV regulatory protein rev?

The rev reading frame (produced via a spliced transcript)

Which HIV gene encodes the intact, uncleaved precursor envelope protein gp160?

env gene.

Which HIV gene/reading frame encodes the transmembrane fusion protein gp41?

env gene (cleaved from the gp160 precursor)

Which HIV gene encodes the p66 subunit of reverse transcriptase?

pol gene (responsible for viral replication enzymes).

Which HIV gene encodes the structural matrix protein p17?

gag gene (also encodes p24 capsid and p7 nucleocapsid)

Which genomic region overlaps with the HIV accessory protein nef?

3’-LTR (located at the extreme 3' end of the genome).

Which HIV gene/reading frame encodes the surface glycoprotein gp120?

env gene (cleaved from the gp160 precursor).

the tetse fly transmits

Trypanosoma brucei (African sleeping sickness)

Nifurtimox or benznidazole treats

Trypanosoma cruzi

“Pentamidine or suramin for systemic infection:

Melarsoprol for CNS infection” — treats which disease?

trypanosoma brucei

The body louse Feces can spread

Bartonella quintana

The sandfly bite can spread

Bartonella bacilliformis

“Infect CD34+ cells (progenitors of endothelial cells) and erythrocytes” —which pathogen?

Bartonella (B. henselae, B. quintana, B. bacilliformis)

Bartonella (B. henselae, B. quintana, B. bacilliformis) morphology

Pleiomorphic, Gram-negative rod

an increase in triglycerides and LDL cholesterol is an adverse affect associated with

Elvitegravir

All patients must be screened for HLA-B*5701 before prescribing

Abacavir

“Post kala-azar dermal leishmaniasis (PKDL, D): non-ulcer facial lesions occur during or after treatment; may be chronic” —-which disease?

Leishmaniasis

Reduviid (kissing) bug can transmit

Trypanosoma cruzi

Trypanosoma cruzi causes

Chagas Disease

Confinement Hyperpyrexia

people stuck in hot vehicles; Increased heat gain because of increased body surface:volume

Exertional Heat Injury

usually with athletic activities; more to do with increased heat production

Heat Stroke –

body temp ˃40°C with altered mental status (AMS)

Heat Stress AKA Heat Exhaustion –

body temp is normal or slightly elevated (<40°C) with normal mental status

Sympathomimetic agents: Cause cutaneous vasoconstriction ___

increased muscle activity and inhibition of sweating

β-blockers and calcium channel blockers interfere with the appropriate ___

cardiovascular response to heat

Diuretics lead to

volume depletion and decreased cardiac output

Anticholinergic agents impair

sweating

Cutaneous vasodilation through a ___ in sympatheitc tome

decrease

What allows cutaneous sweating to happen?

increase in cholinergic stimulation

Pediatric fever is defined as ___

100.4 degrees F.

Mechanimsms for Heat Loss

Radiation, Evaporation, Convection, and Conduction

aldosterone acts on the kidney by

increasing sodium and water reabsoption and increases plasma volume

Sweat glands are innervated by the post-ganglionic ___sympathetic neurons

cholinergic

• adrenergic vasoconstriction

• cholinergic vasodilation

describes the function of which system?

Sympathetic nervous system

Activation of ___sweat glands increases

heat escape by evaporation

eccrine

Hyperthyroidism leads to

weight loss, heat intolerance

Hypothyroidism leads to

weight gain, cold intolerance

When to call a doctor for a 6-24 month old?

> 102°F for longer than one day but no other signs

> 102°F and other signs (cold, cough, or diarrhea)

When to call a doctor for a fever for a 3-6 month old?

> 102°F

100.4 to 102°F and unusually irritable, lethargic, or uncomfortable

Newborn to 3 months—when to call a doctor?

above 100.4 degress F

A morning oral temperature of greater that

___ could be considered a fever, whereas a

fever in the afternoon (and overall) is defined

as 99.9°F.

98.9°F

Many ____ toxicities are believed to be due to mitochondrial toxicity: myopathy, peripheral neuropathy, pancreatitis, lipoatrophy, and hepatic steatosis, and lactic acidosis, which can be fatal.

Nucleoside / Nucleotide Reverse Transcriptase Inhibitors (Abacavir, Lamivudine, Emtricitabine, Tenofovir, Zidovudine)

Cobicistat boost is required with which anti-viral drug?

Elvitegravir

HIV Integrase Strand Transfer Inhibitors

Bictegravir

Dolutegravir

Elvitegravir

Raltegravir

Cabotegravir

Activity against HIV-1 and HIV-2

tenofovir DF and tenofovir AF applications

-HIV-1

Chronic HBV treatment in immunocompromised patients.

• Pre-exposure prophylaxis (PrEP)

• Post-exposure prophylaxis (PEP)

NRTIs stands for

Nucleoside / Nucleotide

Reverse Transcriptase Inhibitors

Tenofovir is a ___ analog

nucleotide

____may cause depression and insomnia

rilpivirine

___must be monitored because of central nervous system (CNS) toxicity and QT prolongation, in addition to increases in hepatic enzymes.

efavirenz

“Viral protease cuts polyprotein chains into functional units, and protease inhibitors stop this final step of viral replication” which drug class?

Protease inhibitors

___binds to gp41, which becomes exposed once HIV binds gp120, blocking fusion of the virus and its entry into the cell

Enfuvirtide

___blocks CCR5, which prevents binding of the virus, causing it to be unable to enter the cell

Maraviroc

photo of antivirals and where they act

Mast cell-dependent, IgE-dependent:

Post-exposure to antigens → Type I Hypersensitivity reaction

• When systemic → anaphylaxis

Mast cell-independent, IgE-independent:

Local factors that ↑ vascular permeability w/o

degranulating mast cells; hereditary angioneurotic edema and aspirin

Mast cell-dependent, IgE-independent:

Substances directly trigger mast cell degranulation

(examples: Opiates, certain antibiotics, contrast media)

what is this

pruritus

The sudden presence of a large number of which benign skin lesion could indicate a possible GI malignancy somewhere else in the body?

Seborrheic keratosis

What is this

Seborrheic Keratoses

Nevi are also commonly known as

moles

Lassa Virus, Machupo Virus, Junin Virus, Sabiá Virus, Guanarito Virus are a part of which family

Arenaviruses (-ssRNA)

Hantavirus, Rift Valley Fever Virus, Nairo Virus are a part of which family

Bunyaviruses (-ssRNA)

Ebola virus, Marburg virus are a part of which family

Filoviruses (-ssRNA, linear)

Dengue Fever Virus, Yellow Fever Virus, St. Louis encephalitis, West Nile Virus, Zika, Hepatitis C are all a part of which family?

Flavivirus

The lassa virus belongs to which family

Arenavirdae

The hantavirus belongs to which viral family

Bunyavirus

the yellow fever virus causes

dengue