HIV

Question 1

T/F HIV is an RNA virus

Answer 1

True

Question 2

CD4 count less than what counts as aids?

Answer 2

CD4 count below 200

Question 3

Why are oral lesions important in HIV? Give 3 reasons

Answer 3

1. Indicator of HIV infection
2. Predicting disease progression
3. staging and classification

Question 4

Oral manifestations have 3 groups of HIV associated lesions. Name 3 associations with group 1

Answer 4

Candidiasis (erythematous, pseudo-membranous, angular chelitis), oral hairy leukoplakia (HHV 4/ EBV), Kaposi sarcoma (HHV 8), Non-hogkin lymphoma
oral squamous cell carcinoma.
Periodontal diseases: necrotising gingivitis/perio, linear gingival erythema

Question 5

If you diagnose a patient with a group 1 lesion should you leave it or do something about it?

Answer 5

Cannot leave it. Need to determine the immune status of the patient because need to make sure they are not immune supresssed.

Question 6

NB test question: Healthy 25 year old male presents with pseudomembranous candidasis. How would you manage this patient?? 10 marks.

Answer 6

Dont just treat the candida. (will get no marks if just treat it). Determine why the patient has pseudomembranous candida. Ask patient was he on antibiotic treatment? A healthy person should not get pseduomembranous candida without reasons. Do smear biopsy to check if its candida, can also try wiping it off. Ask the patient if they use an asthma inhaler (corticosteroid) or if patient is on corticosteroid therapy? Patient got an organ transplant maybe and is on cyclosporine? All of this supresses immunity. Test patient for HIV infection! Also try look for any other oral lesions that could present HIV.

Question 7

Give 1 group 2 related HIV association

Answer 7

Bacterial infection: M.tuberculosis.
Melanotic hyperpigmentation
salivary gland disease
Necrotizing ulcerative stomatitis.
viral infections such as HSV, hPV, VZV.

Question 8

Give 1 group 3 related HIV associations

Answer 8

bacterial infections: A.israelii. E.coli. K.pneumonia.
neurological disturbances: facial palsy and trigeminal neuralgia.
Viral infections- MCV/ CMV

Question 9

What does diagnostic criteria mean?

Answer 9

Presumptive criteria- initial clinical diagnosis and epidemiological studies
Definitive criteria- important when HIV status unknown and for treatment. (really dont think this is even important so dont stress over it)

Question 10

Erythematous candidasis appear when CD4+lymphocyte count drops below?

Answer 10

400 cells per mm3

Question 11

When does pseudomembranous candida show in a HIV patient? Give the CD4 count.

Answer 11

below 200 cells per mm3

Question 12

Can a patient get Erythematous candidiasis from being on antibiotics?

Answer 12

YES!

Question 13

Candida is a commensal organism explain what that means

Answer 13

It is normally present. If you disturb the oral microflora then candida will grow because of less competition.

Question 14

What form is the hyphal form of candida?

Answer 14

Infective form.

Question 15

Patient has a white lesion, what do you do?

Answer 15

1. See if you can scrape it off.

2. if not then do a biopsy.

Question 16

In Pseudomembranous candida what happens to the epithelium?

Answer 16

candida causes necrotic epithelium, the white that is seen is actually fungal hyphae and necrotic epithelium.

Question 17

candida is not normal in a adult but normal in new-borns. What id candida called in new born?

Answer 17

Sproei

Question 18

If candida extends down the throat what does it usually mean?

Answer 18

Pt has AIDS

Question 19

What infection type is angular chelitis?

Answer 19

Candida and bacterial infection

Question 20

angular chelitis is seen in which kinds of patients most commonly?

Answer 20

Full denture patients. There is a loss of the vertical height in the dentures then common to see angular chelitis. also investigate the immune status of the patient.

Question 21

Oral hairy leukoplakia is caused by?

Answer 21

EBV/HHV 4

Question 22

common site of oral hairy leukoplakia?

Answer 22

Lateral borders of tongue

Question 23

Explain the management of oral hairy leukoplakia (was asked in 5th year exam)

Answer 23

Definitive diagnosis: take a smear or biopsy. malignancy chance is basically 0%. Its a sign of immune supression so check the immune status of patient- check if transplant patient or HIV. Will not respond to antifungals!!! To differerntiate from hyperplastic candidiasis. NEED to biopsy!

Question 24

If you end up doing a oral exam at end of year one question that will be asked to see if you will pass is: what is the malignant potential (%) of oral hairy leukoplakia?

Answer 24

0% is the answer

Question 25

what is the clinical appearance of kaposi sarcoma often?

Answer 25

red-blue-brownish discolouration. often causes enlargement of the area. its a very vascular tumour.

Question 26

Kaposi sarcoma (HHV 8) is a vascular tumour. Do you only see it in HIV patients?

Answer 26

No,seen in patients that are immunosuppressed. BUT can see in healthy people too but very low chance! Not only seen in HIV patients.

Question 27

Name the different types of kaposi sarcoma

Answer 27

1. AIDS associated 2. Classic (Mediterranean) 3. Endemic (african) 4. Iatrogenic (transplant related)

Question 28

Can you biopsy a kaposi sarcoma?

Answer 28

YES you need to biopsy it! It wont bleed! but must biopsy it because its difficult to know what it is at first sight.

Question 29

If patient has HIV and has kaposi sarcoma, will the ARVs cause the KS to dissapear?

Answer 29

Yes it will!

Question 30

Patient complains of teeth bleeding, you suspect its kaposi sarcoma in the area. Why are you wrong?

Answer 30

Kaposi sarcoma does not cause bleeding. Often also see thrombocytopenia in AIDS patients. If it oozes with blood then its not KS. Rather think thrombocytopenia.

Question 31

give a differential for Kaposi sarcoma

Answer 31

Bacillary angiomatosis (bacterial infection)

Question 32

Which type of non-hogkin lymphoma is associated with HIV?

Answer 32

Plasma blastic lymphoma- Take a biopsy!

Question 33

Linear gingiva erythema is what kind of infection?

Answer 33

A candida infection! Often confused with marginal gingivitis

Question 34

management of linear gingival erythema

Answer 34

Prescribe anti fungals. Also do a scale and polish.

Question 35

how does one diagnose linear gingival erythema since it looks similar to marginal gingivitis

Answer 35

Do a scale and polish and once all plaque is away the lesion should dissapear if gingivitis. If its linear gingival erythema then it wont go away with scale and polish but rather with antifungals.

Question 36

Cancrum oris also known as?

Answer 36

Noma

Question 37

cancrum oris is due to?

Answer 37

patient being immunocompromised and can develop from NUP

Question 38

oral cancer is not often seen on which surface?

Answer 38

dorsum of tongue

Question 39

If there is a ulcer of the tongue then what should you think?

Answer 39

Traumatic ulcer or TB

Question 40

Patient comes in with group 1 lesion, what wil you do?

Answer 40

Need to confirm that it's a group 1 lesion firstly. then treat the lesion. Determine why the patient is immunocompromised.

Question 41

TB ulcers are seen on which surface usually?

Answer 41

Dorsum of tongue (not limited to this though)

Question 42

what type of inflammation is associated with TB?

Answer 42

Caseating granulomatous inflammation

Question 43

What test can be done for TB?

Answer 43

Ziehl Neelson stain

Question 44

syphillus is caused by?

Answer 44

treponema pallidum

Question 45

what does ARVs do with HPV?

Answer 45

Increase squamous cell papillomas in pts on ARVs. ARVs also cause pigmented lesions to occur.