BASHH course exam facts! Flashcards
1
Q
Acronym for OSCE
PPPP
CCCC
SS
VAJ
A
PN PEP/PREP Preg Test Prev HIV test Condoms Contraception Compliance Children Smears Sex (last) Vaccines Abstinence Job
PLAN
Health advisor
Leaflet
Condoms
2
Q
PCP appearance on CT
A
ground glass
3
Q
Why do people with PCP desaturate?
A
Hypoxaemia on exercise Get them to walk up and down room/staurs Put on sats before and after Sensitive screening test Alveolar/ags transfer problem
4
Q
How do you isolate PCP?
A
PCR from Bronchealveolar lavage
can’t be cultured
5
Q
Which drugs cause haemolysis with G6PD?
A
clotrimoxazole
Dapsone
primaquine
6
Q
When to start PCP (CD4?)
A
<200
7
Q
What does TB look like in HIV?
A
Usually UL cavitation
In HIV can look different
Less cavitation and loss of UZ changes
Can be normal
8
Q
Which conditions mainly cause IRIS
A
TB
Cryptococcus
PML
HSV
More likely if immunosuppressed and you start ARV
9
Q
When to start ART in TB?
A
9-12 weeks
<2 weeks if CD4 <50
(if cns- wait to give art)
10
Q
AIDS defining cancers?
A
Kaposi’s
Non hodgkins
cervical cancer
11
Q
What does KS look like?
A
multi centric pigmented non blanching painless raised (flat on hard palate) Can get it in the eye Can get lymphangiopathic KS- swollen legs
12
Q
Where do you often find visceral KS?
A
1st lung
2nd GIT
13
Q
Main differential of KS?
A
bacillary angiomatosis
-the second-most-common cause of angiomatous skin lesions in persons infected with the human immunodeficiency virus
14
Q
what might you see on histology of KS?
A
spindle cells
15
Q
where might you find the KS virus?
A
HHV8 -in saliva
16
Q
Most common cancer in HIV?
A
KS
17
Q
What is the CD4 count like with large B cell lymphoma?
A
LOW CD4
18
Q
WHat is the CD4 count like in Burkitt’s lymphoma?
A
High CD4
19
Q
What causes Burkitts/Non hodgkins and Primary cerebral lymphoma?
A
EBV
20
Q
Differential for PCL?
A
toxoplasma
21
Q
Which cancers are caused by HHV8?
A
KS, PEL & Castleman’s
22
Q
Non AIDS defining malignancies?
A
Anal cancer
Hodgkin’s disease
Non-small cell lung cancer
23
Q
Which cancers are caused by EBV?
A
Non Hodgkin’s, Primary Cerebral Lymphoma & HD
24
Q
Which drugs can cause TEN?
A
nevirapine and clotrimoxazole
25
Descrive HIV skin rash- seroconversion
mobilliform
?maculopapular
FLorid/confluent
26
Which drugs can cause hyperpigmentation?
zidovudine
| emtricitabine
27
Which ART can cause a hepatitis?
Darunavir
28
Who does not get a HCV ab with previous infection?
HIV
29
Which virus causes Progressive Multifocal Leukoencephalopathy?
John cunningham virus
| Human polyoma virus
30
Crytococcal meningitis- management
LP- as get raised ICP
Serum CRAG
Treat with ARV ?afetr 2 weeks of antifungals
`Risk of IRIS and death
31
Dementia BHIVA audible outcomes
Annual screen for cognition - 90%
| Services pathway for neuropsychiatric assessment 95%
32
WHich ARV has good penetration of CNS?
efavirenz
33
When should you expedite ARV?
Neurological involvement 1D
any AIDs defining illness 1A
CD4 <350 1C
PHI diagnosed within 12 weeks 1C
34
When can't you use abavacir?
Hepatitis B/C
CV risk
High viral load
If HLA B5701 positive
35
Which ARV drugs are hepatotoxic?
nevirapine
36
side effects of efavirenz
CNS – Efavirenz (and Rilpivirine to a lesser extent)
• Sleep disturbance and nightmares, change in mood, light-headedness
Lipodystrophy
• Gynaecomastia reported
37
Which ART causes SJS
Rash
• Nevirapine- appears within 6 weeks, half dose for first 2-weeks
• Stevens-Johnson Syndrome
38
Side effect of darunavir (PI)
Darunavir
| • Rash- cross sensitivity with co-trimoxazole
39
Side effect of atazanavir?
Atazanavir
• Hyperbilirubinaemia often resulting in scleral icterus
• Renal function- caution
40
which ARV can cause a hepatitis picture
IIs
dolutegravir
raltegravir - can cause transaminitis
darunavir (PI)
41
Which ARV is it really important you don't take with food
Rilpivirine
42
What happens to bloods in acute HIV infection?
HIV RNA - 1st 2 weeks
P24 ag - 5 days later
HIV ab- around day 25
43
What to do if HIV P24 ag positive but HIV ab negative
Check RNA
If negative
Can do western blot
44
Definition of primary HIV?
first 6 months
45
Definition of acute HIV infection?
3 months
46
What to tell patients about POCT?
Even 4th generation not as good as venous
| Only detects P24 ag 62% of the time
47
Why important to start ARV quickly?
immune recovery in primary HUV
decrease viral resevoir
Limit onward transmission
48
What are audible outcomes for HIV new diagnosis?
number of people seen within 2 weeks
| Number with PHI offered immediate ART
49
Which class of ARV have higher barrier to resistance?
NNRTIs
50
Complications of HSV?
erythema multiforme
| Mollarets meningitis
51
How much does HSV suppression reduce transmission risk?
50%
52
How much do condoms reduce risk of spreading HSV?
30-70%
53
What to do about HSV in last trimestre if partner HIV pos?
No sex last trimestre
suppress him
condoms
no oral sex
54
What do you need to stay about HSV and the law?
may be helpful legally to disclose
55
What are risks of HSV in pregnancy?
same as general population- 3%
| no evidence of miscarriage
56
Is Hsv treatment safe in pregnancy?
Yes
used for a long time
risks much worse if not treated
57
When to suppress HSV if HIV positive?
from 32 weeks
58
What is the lead in period for Ts and Ss PREP?
We recommend daily dosing for 7 days, then dropping down to 4 pills per week.
4 pills per week usually involves taking a pill on Tuesday, Thursday, Saturday and Sunday — that’s why it’s called ‘the Ts and Ss’.
59
Other causes of hepatitis?
EBV
CMV
Drugs
60
How many people have HPV?
1/3 have actie HPV
lifetime risk 80%
estimated point prevalence of warts- 1%
61
specificity and sensitivity in different populations
sensitivity and specificity is not affected by prevalence
| PPV is
62
Sde effects with nevi rapine?
Hepatotoxic
| Steven Johnsons syndrome
63
Follow up HIV test after completing PEPSE?
8-12 weeks
64
How long does HCV live on a needle?
5 days
65
What factors increase the chance of HIV transmission?
```
sexual assault- trauma
increased viral load
STI
Ejaculation
Menstruaiton
Circumcision
```
66
Breakdown of HIV transmission groups?
5 % MTCT
70% MSM
24% heterosexual
67
Which ARV does K103N have resistance to?
Efavirenz
68
Which ARV can not be used with contraception as enzyme inducers?
```
Nevirapine
Efavirenz
Atazanavir (boosted- NB unbolted increases levels )
Ritonavir
PIs
```
(
69
Risk of MTCT if pregnant women is undetectable and pregnancy protocol followed?
0.1%
70
When can you use dolutegravir in pregnancy?
> 6 weeks
71
Which ARV have best safety data in pregnancy?
dolutegravir and efavirenz
72
If on DTG What is increased risk of NTD?
3/1000 births (1/1000 is the population risk)
73
If HIV test is positive at birth when is transmission likely to have taken place?
In utero
74
If HIV test is positive at 6 weeks (neg at birth) when is transmission likely to have taken place?
after 6 weeks
75
Can you use TAF/cobicistat in pregnancy?
no safety data
76
Can you use DAA / ribacvarin in pregnancy
No
| Ribovarin is teratigenic- also men need to be informed - sperm
77
features of JH reaction
myalgia
| riggers, chills, flush, fever, hypotension, deterioration of lesions
78
types of spirocahaetes
borrelia, leptospira and t pallidum
79
How does treponema behave on microscopy?
corkscrew movement
| spin and flex on long axis
80
What is vaginal discharge?
Normal vaginal discharge is composed of cervical mucus, vaginal fluid, shedding vaginal and cervical cells, and bacteria. The majority of the liquid in vaginal discharge is mucus produced by glands of the cervix. The rest is made up of transudate from the vaginal walls and secretions from glands (Skene's and Bartholin's).
81
Transmission of LGV in UK
Increase in prevalence in UK
The activity with the highest risk of LGV transmission is unprotected anal intercourse. Fisting, sharing of sex toys and rectal douching can also lead to LGV transmission.
82
Sex worker with ulcer- papa new guinea?
DOnavonosis- klebsiella commonest in Papa new guinea
83
In HIV- Iipoatrophy
With NRTIs
| Lose fat from cheeks, arms, shoulder,s, thighs, buttocks
84
in HIV- lipohypertrophy
PIs
buffalo hump- dorsocervical fat
big neck
breast hypertrophy
85
Tabes dorsalis features?
```
lighting pains
paraesthesiae
smooth muscle spasm
sensory ataxia
stamping gait
rhombergs sign
diminished reflexes
impaired vibration and position sense
charcot joints
optic atrophy
bilateral ptosis
argyll robertson pupil
```
86
Causes of pruritus ani
Constipation, hygiene
Skin conditions- psoriasis, eczema, thrush (a Candida yeast infection), and fungal infections.
Threadworm- worse at night.
• Allergy. Pruritus ani may be due to an allergy to something in contact with the skin, for instance to fragrance in toilet paper, or to local anaesthetics or preservatives in creams used for piles.
• Skin irritation. The skin of the bottom is sensitive and can easily be irritated by soap etc
• Sweating
87
Treatment of pruritis ani
steroid
antihistamine
emollients and avoiding soaps
88
What regulations allow confidentiality regarding diagnoses to be shared?
The National Health Service (Venereal Diseases) Regulations 1974 (Wales) and the NHS Trusts and Primary Care Trusts (Sexually Transmitted Diseases) Directions 2000 (England)
These regulations provide that any information capable of identifying an individual who is examined or treated for any sexually transmitted disease, including HIV, shall not be disclosed, other than to a medical practitioner in connection with the treatment of the individual in relation to that disease or for the prevention of the spread of the disease.
89
HIV window period
Offer fourth generation laboratory HIV test even if < 4weeks
Repeat it when 4 weeks have elapsed from the time of the last exposure.
A negative result on a fourth generation test performed at 4 weeks post-exposure is highly likely to exclude HIV infection- 95% infections detected.
A further test at 8 weeks post-exposure need only be considered following an event assessed as carrying a high risk of infection. (99.9%)
90
K103N mutation and M184V mutation which ARV can't patient have?
```
Tenofovir
Etricitabine
(NRTIs)
Neviparine
Evavirenz
(NNRTIs)
```
91
Which ARV cross blood brain barrier? ie treatment of PML
1. zidovudine
| 2. nevirapine
92
Methadone and atripla interaction
| Atripla- TDF emtricitabine and efavirenz
efavirenz decreases methadone
93
ARV causing gynaecomastia/breast swelling
efavirenz
94
Treatment of neonate born to mum Hep B?
Give immunoglobulin HBV 500 IU if mum HepB eag positive
| Also give Ig if HepBSag pos, EAg negative (if EAb negative)
95
Late HIV diagnosis
1/3 HIV infections in adults in the UK remain undiagnosed
25 per cent of newly diagnosed individuals have a CD4 cell count of less than 200 (an accepted marker of ‘late’ diagnosis).
96
sensitivity of gc urethra male
Penile urethra
o Microscopy of urethral or meatal swab smears has good sensitivity (90–95%) in people with discharge from the penile urethra and is recommended to facilitate immediate presumptive diagnosis in these individuals
o Microscopy of penile urethral smears in those without symptoms is less sensitive (50–75%) therefore, it is not recommended in asymptomatic individuals
97
sensitivity of gc females
Female urethra and endocervix
Microscopy- 50% and 20% sensitivity compared with culture for detecting gonorrhoea from endocervical and female urethral smears, respectively.
98
Culture of GC
For culture, the sensitivity depends on several factors including time from sample collection to plating.
Services should seek to minimise this time whether by direct plating in the clinic or use of transport media with prompt transfer for plating in the laboratory.
99
TV in men symptoms
75% no symptoms
Most common is discharge- gnu
dysuria
<10% balanitis
100
urethral CT
35-50% NGU in men
| women 50-60% including other sites (15-20% only urethra)
