24/9/21 Flashcards
(49 cards)
How long does it take to achieve maximum protection when taking daily PrEP for men? How long for women?
Men - 7 days
Women - 20 days
What are the 5 Steps in prescribing Prep?
- Behavioural Suitability
- Clinical Suitability
- Other Testing
- Prescribing PrEP
- Ongoing Monitoring
What is involved in Step 2 of prescribing PrEP -> Clinical Suitability? (3 points)
HIV Status + ?recent exposure
Renal Function
Nephrotoxic Medication
If HIV negative but recent exposure, what are the next steps?
Refer to/Consult with PEP prescriber -> consider PrEP following completion of PrEP
What is involved in Step 3? (Other Testing)
STI Testing + Heptatits B + C Testing
- STI testing - as per STI guidelines
- Hepatitis B testing - HBsAg, Anti-HBs, Anti-HBc → vaccinate if not immune. If HBsAg is positive → refer to HBV specialist
- Hepatitis C testing → anti-HCV, followed by HCV RNA if anti-HCV positive. If HCV RNA positive → treat Hepatitis C
What are the 2 options when prescribing PrEP (Step 4)?
Who is suitable for either option?
- Daily Continuous PrEP → 1 pill daily of tenofovir/emtricitabine → start 7 days before HIV risk
- suitable for anyone with ongoing risk of HIV exposure
- On-Demand PrEP (2-1-1 method) → tenofovir/emtricitabine → 2 pills 2/24 before sex, 1 pill 24/24 later, 1 pill 48/24 after first dose
- suitable only in cis-male who have sex with men whose HIV risk if from anal sex not from IVDU
What are the 9 points involved in ongoing monitoring following commencement of PrEP (Step 5)?
HIV Testing Side Effects Hep A Hep B Hep C STI Screening Renal Function (eGFR) Urine Protein Creatinine Ratio Pregnancy Test
What testing takes place at baseline when starting PrEP?
HIV Testing Hep A Hep B Hep C STI Screening Renal Function (eGFR) Urine Protein Creatinine Ratio Pregnancy Test
What testing takes place at 1 month following commencement of PrEP?
HIV Testing
Side Effects
Pregnancy Test
What testing takes place at 3 months following commencement of PrEP?
HIV Testing Side Effects STI Screening Renal Function (eGFR) Urine Protein Creatinine Ratio Pregnancy Test
What testing takes place every 3 months after the commencement of PrEP?
HIV Testing
Side Effects
STI Screening
Pregnancy Test
What additional testing needs to take place following commencement of PrEP?
eGFR + urine protein creatinine ratio -> every 6 months or sooner as per CKD guidelines
Hep C -> 12 monthly but more frequent if ongoing risk -> e.g MSM with anal trauma or IVDU
Hep B -> If required Hep B immunisation -> check immune response 1 month after last vaccination
Short Term and Long Term side effects of PrEP (2 each please)
Short Term - headache + nausea
Long-Term - Renal Toxicity + Lowered Bone Density
In Lewy Body Dementia, what are the three associated features along with the memory loss?
- Any 2 of: fluctuating confusion, visual hallucinations, spontaneous motor Parkinsonism and sleep behaviour disorder
In frontotemporal dementia, what are two of the earliest manifestations of this disease?
- personality change and altered behaviour can be the earliest manifestations of this condition
Lab Findings for Cholestatic Picture of deranged LFTs.
Common Causes of Cholestatic Picture (give me 3)
- Laboratory Findings → ALP >200 + ALP > 3xALT
- Common Causes:
- Biliary Obstruction
- Pregnancy
- Drugs → erythromycin, oestrogen
- Infiltration → Malignancy
Lab Findings for Hepatocelluliar Damage Picture for deranged LFTs.
Common Causes of Hepatocelluliar Damage Picture. (give me 3)
- Laboratory Findings → ALT >200 + ALT > 3xALP
- Common Causes
- Infection → Hepatitis B, C, A, EBV, CMV
- Alcohol → AST often >2xALT
- Fatty Liver
- Drugs → paracetamol
- Metal Overload
- Hypoxia
- Autoimmune
Risk Factors for Pancreatic Cancer (4 points). How many fold is the increase in risk with these risk factors?
- ≥2 affected first degree relatives
- Lynch Syndrome OR BRCA2 Gene Carrier + ≥1 affected first degree relative
- Hereditary pancreatitis with PRSS1 mutation
- Peutz-Jehger Syndrome
5 times the risk of the general population
3 indications for referral to specialist in the context of pancreatic cancer.
- Unexplained weight loss + any of: back pain, abdo pain, nausea/vomiting, diarrhoea or constipation, new onset diabetes → CT Abdo → Pancreatic Mass → specialist referral
- Jaundice + Age ≥ 40yo → specialist referral
- Risk Factors -> specialist referral
When is Genetic Testing recommended in the context of deranged iron studies - ?haemachromatosis?
Recommended in individuals with suspected iron overload (ferritin >200 in females and >300 in males) and a transferrin saturation >45%
Who qualifies for cascade gene testing in hereditary haemachromatosis?
all first degree relatives with HHC who are C282Y homozygous or C282Y/H63D compound heterozygous
Treatment for Moderate to Severe Travellers Diarrhoea. Be Specific.
- azithryomycin 1g PO stat (child 20mg/kg up to 1g)
- Antimotility drugs can be used in combination with ABx in adult patients who do not have fever or bloody stools**
- if fever or bloody stools + diarrhoea does not improve after 1st large dose → continue azithromycin 500mg PO daily for further 2 days
Explain the pathophysiology of posterior vitreous detachment.
Vitreous Gel → fills the central cavity of the eye providing structural support
- with age → this vitreous gel undergoes liquefaction and this leads to separation from the retina. This is a normal event and occurs in approximately 60% of people aged between 40-70 → this is called Posterior Vitreous Detachment (PVD)
In PVD, why do patients see flashes and floaters?
In PVD → as the vitreous pulls away from the retina → neurons are excited → flashes seen by patient
Symptoms are intermittent, can occur over a period of time prior to full detachment. As the vitreous pulls away → vitrous floaters can be seen in the line of sight. These floater represent the collagen fibres within the gel or the previous points of attachment of the gel to the optic disc.
