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Round 2 AH Exam 2 > Exam 2 Blueprint > Flashcards

Exam 2 Blueprint Flashcards

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1
Q

How long does it take for acute HIV symptoms to appear?

A

2-4 weeks from exposure

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2
Q

What are the symptoms of acute HIV?

A

Flu like symptoms:
Fatigue
Headache
low-grade fever
Night sweats
persistent generalized lymphadenopathy (swollen lymoh nodes)

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3
Q

What happens for your CD4 and viral count during acute HIV infection?

A

High viral load (very contagious)
Low CD4+ T count ( 200 to 500 cells/μl)

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4
Q

(T/F) In acute HIV infection, bone marrow is still able to produce enough CD4+ T cells

A

True

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5
Q

(T/F) Once HIV develops to AIDS, your immune system is severely compromised

A

True

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6
Q

What is the five criterias of AIDS?

Not all have to be met to be diagnosed with AIDS

A
  1. CD4+ T-cell count drops less than 200 cells/μL,
  2. specific opportunistic infections,
  3. specific opportunistic cancers,
  4. wasting syndrome, or
  5. AIDS dementia complex.

  1. Wasting syndrome, also called cachexia, is a complicated metabolic syndrome related to underlying illness and characterized by muscle mass loss with or without fat mass loss
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7
Q

What are the ways HIV is transmitted?

There are three ways

A

Sexual (semen, vaginal secretions, bloof)
Blood and blood products (Needle sharing, needle stick, transfusions (usually not from the U.S due to protocol)
Perinatal (pregnancy or delivery, breastfeeding)

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8
Q

What are the two diagnostic tests for HIV/AIDS?

A

ELISA
Western Blot

Blood or saliva tests, early false negatives are possible

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9
Q

What is the normal range for CD4?

A

500-1500

Anything below indicates poor immune system status (200)

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10
Q

What are the goals of ART?

There are five

Think what are does for the viral load, CD4 count, and HIV symptoms/transmission

A

(1) decrease the viral load
(2) maintain or increase CD4 cell counts
(3) prevent HIV-related symptoms and opportunistic diseases
(4) delay disease progression
5) prevent HIV transmission

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11
Q

What education should be given to patients about ART?

A

Early intervention, drug adherence, family planning, psychological factors/support (social stigma)

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12
Q
A
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13
Q

What viral load count makes it so HIV cannot be transmitted

A

200 and less

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14
Q

What is an example of an ART drug?

There is only one

A

Biktarvy (Bictegravir/entricitabine/tenofovir)

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15
Q

(T/F) ART kills the virus

A

False

It helps stop viral replication in the body by blocking different stages in virus life cycle

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16
Q

What are adverse reaction/side effects of ART?

There are seven, two important

A

Hepatitis B exacerbation
Autoimmune disorders
Nephrotoxicity. hepototxicity
Neutropenia
Pancreatitis
Nausea/vomiting/diarrhea

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17
Q

What are contraindications of ART?

There are three

A

Hepatitis B
Poor kidney or liver function
Breast feeding

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18
Q

(T/F) There are no concerns with drug interactions between OTC drugs and ART

A

False

Many drug interactions, beware OTC and supplements used with ART

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19
Q

(T/F) SLE (Systemic Lupus Erythematosus) is an autoimmune disease

A

True

Chromic multisystem inflammatory autoimmune disease with alternating remission and exacerbation

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20
Q

What are clinic manifestations to SLE?

Two important ones

A

Butterfly rash
Alopecia
Fever,
Weight loss,
Joint pain,
Excessive fatigue precede worsening disease
activity

Alopecia is hair loss

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21
Q

What systems of the body does SLE affect?

There are six

A

Skin
Muscles
Lining of lungs
Heart
Nervous tissue
Kidneys

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22
Q

What are the symptoms of SLE in the skin

A

Alopecia
CCLE (discoid (round) lesions on scalp and face)
SCLE (red, ring-shaped lesions where disease active; butterfly rash) (these lesions do not scar or itch, and are not thick or scaly)
Oral or nasopharyngeal ulcers

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23
Q

What are muscoskeletal symptoms in SLE?

A
  • Polyarthralgia (pain in multiple joints)
  • Deformities like:
    Swan neck deformity in fingers
    Ulnar deviation
    Subluxation with hyperlaxity of joints
  • Increased risk of bone loss and fracture
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24
Q

What are cardiopulmonary symptoms involved in SLE?

A

Tachypnea and cough
Pleurisy (inflammation of the pleura)
Dysrhythmias (leading cause of death in SLE patients)

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25
What are renal symptoms of SLE?
Nephropathy Mild proteinuria to rapidly progressive glomerulonephritis Scarring, permanent damage can lead to ESRD (End-Stage Renal Disease) ## Footnote Proteinuria is a condition where an excessive amount of protein is present in the urine Glomerulonephritis is inflammation and damage to the filtering part of the kidneys (glomeruli).
26
What is the goal of treatment for renal problems in SLE?
Slow progression of nephropathy and preserve renal function
27
What are treatments for renal problems in SLE? ## Footnote There are four
Corticosteroids and immunosuppresive agents Belimumab (human monoclonal antibody) Voclosporin
28
What are nervous system problems associated with SLE?
Neuropsychiatric (Ranging from headaches to cerebrovascular disease) NPSLE * Focal: Caused by clots; Stroke or aseptic meningitis may occur; Headaches are common; Can be severe during a flare-up; Vasculopathy in chronic disease * Diffuse Inflammatory process; Psychosis, anxiety, depression, confusion, cognitive problems ## Footnote NPSLE stands for Neuropsychiatric Systemic Lupus Erythematosus
29
What are hematological problems associated with SLE?
Anemia Leukopenia Thrombocytopenia Coagulation disorders
30
What medication can help decrease risk of clots?
Hydroxychloroquine
31
(T/F) Vaccinations are safe for patients with SLE
True
32
(T/F) Patients receiving corticosteroids or cytotoxic drugs must avoid live virus vaccines
True
33
What medications will you use for SLE? | There are six ## Footnote Think about symptoms of SLE and what you would use to treat/manage. Honestly not THAT important to remember
NSAIDs Antimalarial drugs Corticosteriods Immunosuppresive drugs Anticoagulants Topical immunodilators
34
What will you monitor for when taking immunosuppresive drugs?
Toxicity and side effects ## Footnote Suppresses immune system, reduce end-organ damage
35
What do topical immunodilators do and what symptoms of SLE do they manage
Lesions and butterfly rash Suppresses immunity activity of the skin
36
What should SLE patients avoid to avoid flare ups?
Fatigue, Sun exposure Emotional stress Infection Drugs, Surgery
37
What are the early/first symptoms of Guillain-Barre Syndrome (GBS)?
Weakness, paresthesia, and hypotonia of limbs Reflexes in affected limbs may be weak or absent Maximum weakness occurs at 4 weeks
38
(T/F) There is symmetric weakness of limbs with GBS
True
39
What clinical signs do you look for for diagnosis of GBS?
Progressive weakness of more than 1 limb Decreased or absent reflexes
40
What tests will you order to help diagnose GBS? ## Footnote Not that important to know, be more aware of clinical signs for diagnosis
Electrolytes, liver function tests, CPK, ESR CSF analysis EMG and NCS ## Footnote Electromyography (EMG) and Nerve Conduction Study (NCS) Cerebrospinal Fluid (CSF) Analysis
41
What interventions wil you use for the acute phase of GBS?
Ventilatory support ICU--hemodynamic monitoring Immunomodulating treatments (PE and High dose IVIG) ## Footnote PE: Plasma Exchange (plasmapheresis) IVIG: IV immunoglobulin
42
When is IVIG and PE most effective?
In the first 2 weeks on symptom onset
43
(T/F) PE and IVIG therapies have little value after 4 weeks past disease onset
True
44
What assessment will you conduct for patients with GBS? ## Footnote There are five
Neurological assessment (motor and sensory evaluation) Respiratory assessment Cardiac assessment Fever Nutrition ## Footnote Motor: ascending paralysis, reflexes, CN function (gag, cornea, swallow), and LOC Respiratory: Monitor ABGs and vital capacity Cardiac: Monitor BP and heart rate and rhythm Fever: Sputum and blood cultures; antibiotics Nutrition: Delayed gastric emptying, paralytic ileus, risk for aspiration; Enteral or parenteral nutrition
45
How is the recovery process for GBS patients?
Recovery starts at approc **28 days** 80% walk independently at **6 months** 60% have full recovery in **1 year**
46
What asculation findings will you find in pneumonia patients?
Fine or coarse crackles over affected region
47
What asculation findings will you find in pneumonia patients with consolidation?
Bronchial breath sounds Egophony Increased fremitus
48
What asculation findings will you find in pneumonia patients with pleural effusion?
Dullness to percussion over affected area
49
What are the goals for patients with pneumonia? ## Footnote There are six
**1. No signs of hypoxemia** 2. Normal breathing patterns 3. Clear breath sounds 4. Normal chest x-ray 5. Normal WBC count 6. No complications
50
What are risk factors for pneumonia? | There are five
Advanced age Immunosuppression History of antibiotic use Prolonged mechanical ventilation Contact with high population numbers
51
What are diagnostic tests for TB?
TST skin test (aka Mantoux test) (PPD) Blood test Chest x-ray (cannot make definitive diagnosis and only suggestive) **TB sputum culture x3** ## Footnote PPD: Immunocompromised: >/= 5mm is positive Risk factor for TB: >/= 10 mm positive No risk factor for TB: >/= 15 mm positive IGRAs for blood testing Sputum culture x3 is golden standard
52
How long is a TB patient infectious?
First two weeks after starting treatment if sputum is positive (Restrict visitors and public exposure; have strict hand and oral hygeine)
53
What infection control measures will you take with TB patients?
Teach patient to prevent spread ◦ Cover nose and mouth with tissue when coughing, sneezing, or producing sputum; dispose in trash or flush ◦ Hand washing after handling sputum-soiled tissues Patient wears face mask if outside of negative-pressure room Identify and screen close contacts **Airborne precautions**
54
What is the Bacille-Calmette-Guerin (BCG) Vaccine for regarding TB?
Live, attenuated strain of Mycobacterium bovis Given to infants in parts of world with high prevalence of TB ## Footnote The important part is it's a live strain and given to infants in parts of world with high prevalence of TB
55
What is the medication adherence used for patients with active TB? | Acryonym RIPE
The first phase is intensive medication treatment with 4 drugs: Rifampin, Isoniazid, Pyrazinamide, and Ethambutol) Second phase is continuation of two drugs (Isoniazid and rifapin) ## Footnote First phase is RIPE, second is RI
56
Isonizaid increases risk for what?
Hepatoxicity
57
When do you exclude Pyrazinamide from treatment?
When pregnant and/or with hepatitis
58
When would you stop Ethambutol?
If susecptible for all 4 drugs
59
How can you ensure adherence to treatment for TB patients?
DOT (directly observed treatment) Teach adverse effects and when to seek medical care (Baseline LFTs and every 2-4 weeks) ## Footnote Liver function tests
60
What is medication treatment for latent TB? ## Footnote What is the standard, those not infected with MDR bacill, those resistant to isoniazid, and those with HIV and fibrotic lesions
**Standard - Isoniazid for 9 months (or 6 months if medical adherence is an issue)** Alternative 3-month regimen of Isoniazid and rifapentine for those not infected with MDR bacill 4 months of rifampin for those resistant to isoniazid HIV patients and those with fibrotic lesions on chest x-ray should take Isoniazid for 9 months
61
What is COPD?
Chronic obstructive pulmonary disease
62
(T/F) COPD is a progressive lung disease characterized by persistent airflow limitation
True
63
What are the main causes of COPD?
Smoking Noxious particles and gases
64
What is the difference between chronic bronchitis and emphysema?

Round 2 AH Exam 2 (3 decks)

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