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C. Year 3 MLA Muscoskeletal Conditions > HIV and AIDs > Flashcards

HIV and AIDs Flashcards

1
Q

What does HIV stand for?

1 - Human immunodeficiency virus
2 - Human inpatient virus
3 - Hepatic Immunodeficiency Virus
4 - Hypersensitivity Immunological Virulence

A

1 - Human Immunodeficiency Virus
- leads to a gradual loss of immune function

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2
Q

What does AIDs stand for?

1 - allport infrection disease
2 - acquired immunodeficiency syndrome
3 - acquired immunodeficiency syndrome
4 - acquired infection system

A

2 - acquired immunodeficiency syndrome
- following HIV the reduced immune system leads to systemic immunodeficiency
- increases the risk of infections and tumours, which would not generally infect

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3
Q

How may people are living by Human Immunodeficiency Virus (HIV) worldwide?

1 - 1.5 million
2 - 15 million
3 - 25.5 million
4 - 38.4 million

A

4 - 38.4 million
- 105,200 in the UK
- 94% of these people are diagnosed, and therefore know that they are living with HIV

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4
Q

What is the incidence of Human Immunodeficiency Virus (HIV) worldwide?

1 - 1.5 million
2 - 15 million
3 - 25.5 million
4 - 38.4 million

A

1 - 1.5 million

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5
Q

Is it important to try to identify patients who are Human Immunodeficiency Virus (HIV) positive, but do not have a diagnosis yet?

A
  • yes
  • of people have no diagnosis, they may be spreading HIV
  • the phrase HIV testing = HIV prevention
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6
Q

Which of the following is NOT a common risk factor for contracting HIV?

1 - sexual history
2 - previous STIs
3 - sharing food
4 - risks of further HIV transmission
5 - IV drug use

A

3 - sharing food
- this is an old myth

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7
Q

In early acute phase of the HIV infection the viral load will increase as the virus infects the patient. This can typically present with flu like symptoms as the immune system mounts an immune response. In 40-90% of patients, how long is it before symptoms present?

1 - <48h
2 - >1 week
3 - <7-10 days
4 - <3 weeks

A

3 - <7-10 days
- can be longer, but this is the most common

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8
Q

All of the following are common symptoms 40-90% of patients present with after being infected between 7-10 days. Of the following which 3 are the most common?

1 - Fever
2 - Rash
3 - Oral ulcers
4 - Loss of appetite
5 - Malaise
6 - Myalgia
7 - Pharyngitis
8 - Arthralgia
9 - Weight loss >2.5 kg

A

1 - Fever = 80%
5 - Malaise = 68%
8 - Arthralgia = 54%

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9
Q

In the acute phase, also called primary HIV infection, how long does this typically last when patients will present with non-specific illness post infection?

1 - 1-2 weeks
2 - 2-4 weeks
3 - 2-6 weeks
4 - >8 weeks

A

3 - 4-6 weeks

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10
Q

Following the acute phase, also called primary HIV infection, patients mount an immune response. This can lead to secondary asymptomatic HIV infection, where patients are typically free from symptoms of HIV infection. Although the time period of this phase can vary, how long can it last?

1 - >6 months
2 - >1 year
3 - >5 years
4 - >10 years

A

4 - >10 years

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11
Q

Following the acute phase, also called primary HIV infection and secondary asymptomatic HIV infection, patients can go on to develop secondary symptomatic HIV. What occurs here?

1 - immune system begins to fail
2 - HIV symptoms begin to appear
3 - CD4 T cell count reduces
4 - all of the above

A

4 - all of the above

  • following this patients develop AIDs
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12
Q

Do all patients present early with HIV symptoms?

A
  • no
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13
Q

Aprox 40% of patients with HIV present late with a CD4 T cell count <350, but can be as low as <200. Can this have clinical implications or is the treatment plan the same?

A
  • has a 10 fold increase in mortality within 1 year
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14
Q

Why do patients with HIV often have lymphadenopathy?

1 - HIV goes directly to lymph nodes
2 - lymph nodes go into overdrive and begin producing more B and T cells
3 - immune response to infection
4 - all of the above

A

3 - immune response to infection
- typically dendritic cells phagocytose HIV and travel to lymph nodes and activate the immune system
- other immune cells then become infected

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15
Q

Patients with HIV can develop mouth infections. What is the most common?

1 - candidiasis (thrush)
2 - aphthous
3 - periodontitis
4 - pharyngitis

A

1 - candidiasis (thrush)

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16
Q

In the acute phase of HIV which cell type is targeted and gradually declines?

1 - dendritic cells
2 - macrophages
3 - CD4 T helper cells
4 - CD8 T cytotoxic cells

A

3 - CD4 T cells
- normal levels are between 500-1500

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17
Q

What determines when a patient moves from HIV to AIDs?

1 - age of patient
2 - strain of HIV
3 - immunocomprimised co-morbidities
4 - T cell number

A

4 - T cell number
- <200 = AIDs

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18
Q

What is often the first presenting symptoms of AIDs?

1 - hair loss
2 - anaemia
3 - infection
4 - cardiac problems

A

3 - infection
- opportunistic infections which the immune system would normally resist

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19
Q

Which receptor on T helper cells does the HIV bind with?

1 - Toll Like Receptors
2 - CD4
3 - IL-6 receptors
4 - CD8

A

2 - CD4

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20
Q

CD4 on T helper cells is what HIV will bind with to infect cells. However, it also requires a 2nd co-stimulation. What is this receptor on the HIV called?

1 - CD40
2 - P2Y12
3 - B7
4 - Gp120

A

4 - Gp120
- refers to enveloped glycoprotein

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21
Q

CD4 on T helper cells is what HIV will bind with to infect cells, with co-stimulation from Gp120 receptor on the HIV cell. However, it also requires a further co-stimulation from a receptor that is present on T cells, macrophages, monocytes and dendritic cells. What is this co-stimulatory receptor called?

1 - CXCR4 and CCR5
2 - CD4XR and CCR5
3 - CTXR8 and CCR5
4 - CXC and CCR5

CXC = chemokine
R = receptor

A

1 - CXCR4 and CCR5

  • doesn’t need to bind both, one or the other
  • CCR5 is MOST COMMON IN EARLY INFECTION
  • CXCR4 IS MORE COMMON IN LATE INFECTIONS
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22
Q

Once the HIV has bound to a CD4 cell, it is able to release its contents into the cell. HIV contains ssRNA retrovirus. What does the virus require in order for its viral DNA to be incorporated into the CD4 DNA within the nucleus?

1 - to be copied by the ribosome
2 - to bind with receptors on nucleus
3 - to bind with reverse transcriptase
4 - to destroy lysosomes within the cell

A

3 - to bind with reverse transcriptase

  • this is where the retro part of the virus comes from
  • this allows the ssRNA to be copied and integrated into the host DNA
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23
Q

Once HIV has been incorporated its DNA into the CD4 T helper cell. When does the T cell then copy its DNA and in doing so replicate the HIV code instead, resulting in the production of HIV proteins?

1 - only when the T cell has been activated
2 - only when the T cell has been activated and clonally expands
3 - as soon as it is incorporated into the T cells DNA
4 - whenever HIV instructs it to do so

A

2 - only when the T cell has been activated and clonally expands
- occurs once the patient is infected with HIV

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24
Q

To gain entry into a host cell, HIV will need to bind with CD4 through its Gp120 receptors, followed by co-stimulation with CXCR4 or CCR5. The function of CXCR4 or CCR5 is chemotaxis and HIV suppression. So when a cell becomes infected with HIV the CD4 T helper cell up-regulates CXCR4 or CCR5 receptors to signal an immune response and fight the HIV. Why is this bad though?

1 - initiates an immune response
2 - attracts immune cells including dendritic, CD4 T cells and monocytes
3 - increased CXCR4 and CCR5 co-receptors on host immune cells available for HIV to bind with
4 - leads to increased number of immune cells infected with HIV
5 - all of the above

A

5 - all of the above

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25
Q

What is thought to be the main sites for HIV infection to occur?

1 - genitourinary, gut and oral mucosa
2 - vagina, oral mucosa and bronchi
3 - penis, oral and gut
4 - intravenous, gut and oral

A

1 - genitourinary, gut and oral mucosa
- high number of CD4 cells with CCR5 receptors are present, so lots of chance to infect

26
Q

The GIT is thought to be the main site for HIV infection to occur due to the high number of CD4 cells with CCR5 receptors present, so lots of chance to infect. In early infection the mucosa is able to shed and the HIV virus with CD4 are removed from the GIT as faeces. However, as a large number of CD4 cells have been removed alongside the HIV, what infection does this increase the risk of?

1 - inflammatory bowel disease
2 - cytomegalovirus causing colitis
3 - coeliac disease
4 - salmonella

A

2 - cytomegalovirus causing colitis

27
Q

The R5 strain of the HIV is following infection in the GIT, where the virus then travels to lymph nodes where it is able to infect other immune cells. Where does the name R5 come from?

1 - name given when it was discovered
2 - name given by person who discovered it
3 - R5 HIV strain binds to CCR5 co-receptor
4 - R5 HIV strain binds to CXCR5 co-receptor

A

3 - R5 HIV strain binds to CCR5 co-receptor

28
Q

The X4 strain of the HIV generally comes on in chronic late infections with HIV. Where does the name X4 strain come from?

1 - name given when it was discovered
2 - name given by person who discovered it
3 - X4 HIV strain binds to CCR5 co-receptor
4 - X4 HIV strain binds to CXCR4 co-receptor

A

4 - X4 HIV strain binds to CXCR4 co-receptor

29
Q

In the acute infection phase of HIV, why is it crucial that infected patients do not have sex?

1 - can make themselves sicker
2 - may acquire HIV again and increase viral load
3 - viral load is at its peak so increased risk of spreading
4 - all of the above

A

3 - viral load is at its peak so increased risk of spreading

30
Q

In a patient infected with HIV, due to the reduction in CD4 T helper cells there is a loss of control of commensal bacteria, resulting in an increase in what?

1 - gram negative peptides
2 - gram positive peptides
3 - gram negative lipopolysaccharide
4 - gram positive lipopolysaccharide

A

3 - gram negative lipopolysaccharide
- leads to inflammation NF-Kb and TNF-a activation

31
Q

In a patient infected with HIV, due to the reduction in CD4 T helper cells there is a loss of control of commensal bacteria, resulting in an increase in gram negative lipopolysaccharides that can then lead to inflammation NF-Kb and TNF-a activation. Why is this a bad thing?

1 - initiates an immune response and upregulation of CCR5
2 - downregulates immune response and increases risk of infection
3 - induces bacteraemia and sepsis
4 - all of the above

A

1 - initiates an immune response and upregulation of CCR5
- CCR5 is required for HIV to bind with immune cells

32
Q

What is the most common test used to diagnose HIV?

1 - antibody only tests
2 - antibody/antigen tests
3 - RNA/DNA test
4 - FBC and blood film

A

2 - antibody/antigen tests

33
Q

The most common test to diagnose a patient with suspected HIV is antibody/antigen tests. Specifically, what does this test detect?

1 - infected cells
2 - HIV bacterial load
3 - RNA/DNA damage
4 - p24 HIV antigen and HIV antibodies

A

4 - p24 HIV antigen
- detects the p24 HIV protein antigen as well as conventional HIV antibodies produced by B cell

34
Q

In HIV we used a term called the eclipse period. What does this mean?

1 - time until a patient presents with symptoms
2 - time until a patient dies from HIV
3 - time before HIV is detectable in blood
4 - time before AIDs is detectable in the blood

A

3 - time before HIV is detectable in blood
- normally lasts 10 days, but no test will be able to detect HIV

35
Q

The window period in HIV is the time between transmission and production of HIV antibodies.
After this window is when the 4th generation antibody/antigen tests are able to detect HIV. How long is this window from time of infection and what level of accuracy does this test have?

1 - 45 days and >80% accuracy
2 - 55 days and >80% accuracy
3 - 55 days and >99% accuracy
4 - 45 days and 99% accuracy

A

4 - 45 days and 99% accuracy
- takes >45 days to accurately detect the presence of the HIV using antigen/antibody testing

  • in 3rd generation tests, the window is 90 days
36
Q

The 4th generation antibody/antigen tests are 99% accurate if measured after 45 days. What antigen are these tests able to detect from the HIV?

1 - p24
2 - Gp120
3 - CD4 bound Gp120
4 - CCR5

A

1 - p24
- a structural protein of HIV
- in 4th generation antigen/antibodies test, p24 can be detected in 14 days

37
Q

Should all clinical staff be able to offer a patient a HIV test?

A
  • yes
  • discussion is not required as testing is prevention
38
Q

If a patient tested negative at 45 days and they were a high risk for HIV, they would need to be tested again. What time point would they be tested again?

1 - 2 weeks
2 - 4 weeks
3 - 8 weeks
4 - 12 weeks

A

3 - 8 weeks

39
Q

If a patient tests negative at 45 days for HIV, is that a definitive diagnosis?

A
  • no
  • same material must be confirmed with a 2nd test after 8 weeks
  • a 3rd test is often confirmed on another occasion
40
Q

In HIV treatment, how may drugs are patients prescribed with one drug?

1 - 6
2 - 5
3 - 3
1 - 1

A

3 - 3
- called combination therapy or Antiretroviral therapy (ART) aims to stop/reduce viral replication
- generally 3 different drugs combined
- medication is lifelong

41
Q

Antiretroviral therapy (ART) involves a combination of at least three drugs, typically two nucleoside reverse transcriptase inhibitors (NRTI) and either a protease inhibitor (PI) or a non-nucleoside reverse transcriptase inhibitor (NNRTI). When should ART be started?

1 - once CD4 T cell count is <500
2 - once CD3 T cell count is <200
3 - as soon as the patient is diagnosed with HIV OR is ready to start ART
4 - as soon as patient presents with symptoms of HIV

A

3 - as soon as the patient is diagnosed with HIV OR is ready to start ART

42
Q

Are patient who are taking ART and who have a fully suppressed virus infectious to others?

A
  • no
  • Undetectable = Untransmittable
43
Q

Patients may need to start Antiretroviral therapy (ART) urgently in which of the following?

1 - acute/Primary HIV
2 - CD4 < 200
3 - AIDS-defining infection
4 - HIV-related malignancy, nephropathy (etc.)
5 - Co-infection with Hepatitis B +/- C
6 - all of the above

A

6 - all of the above

44
Q

When assessing the level of infection in a patient with or suspected of having HIV we use viral load. What is viral load?

1 - measure of molecular density of HIV
2 - measure of molecular weight of HIV
3 - measure of viral replication
4 - measure viral virulence

A

3 - measure of viral replication

45
Q

If a patients viral load (level of viral replication) is undetectable, does this mean that the patient is cured?

A
  • no
  • just means levels are undetectable using current methods and is dormant
46
Q

When assessing a patient with HIV we can measure CD4 count. What are the normal levels of CD4 T helper cells?

1 - 100-200
2 - 500-1500
3 - 1000-2000
4 - 2000-5000

A

2 - 500-1500
- average is 800
- <200 leads to acquired immunodeficiency disease (AIDs)
- leads to Lymphopenia (low lymphocytes)

47
Q

When assessing a patient with HIV we can measure CD4 count. When the CD4 T helper cells drop below 200, patients are said to have AIDs. All of the following are AIDs defining conditions, EXCEPT which one?

1 - candidiasis
2 - infective endocarditis
3 - pneumonia
4 - pneumocystis pneumonia
5 - toxoplasmosis (parasitic infection)
6 - lymphoma

A

2 - infective endocarditis

48
Q

What does treatment as prevention, termed TasP relate to?

1 - treating the patient to prevent the infection
2 - treating a patient with combination therapy prior to infection
3 - treating a patient following exposure and preventing spread of HIV

A

1 - treating the patient to prevent the infection

49
Q

Treatment as prevention, termed TasP relates treating the patient to prevent the infection. Pre Exposure Prophylaxis (PrEP) is for patients who are at high risk of encountering HIV. When should these patients take PrEP?

1 - every day
2 - 48h before and 24 hours after or every day
3 - 1 week before and 1 week after
4 - one month before and 1 month after

A

2 - 48h before and 24 hours after or every day

  • medicine given to patients at high risk of contracting HIV
  • given prior to HIV exposure, if a man has sex with another man for example
  • 99% effective if used correctly
50
Q

What does Post-Exposure Prophylaxis – PEP relate to in relation to HIV?

1 - treating the patient to prevent the infection
2 - treating a patient with combination therapy prior to infection
3 - treating a patient following exposure and preventing spread of HIV

A

3 - treating a patient asap following exposure and preventing spread of HIV

  • combination of HIV drugs that can stop HIV from replicating
  • given following suspected exposure to HIV
51
Q

In patients who have been exposed to HIV and may have contracted HIV, they are given Post-Exposure Prophylaxis (PEP). How long must PEP be taken for?

1 - <24h
2 - >48h
3 - <4 weeks
4 - <12 weeks

A

3 - <4 weeks
- 28 days and is designed to stop HIV from replicating

52
Q

The first presenting symptoms of AIDs is typical an infection with opportunistic microorganisms which would not normally cause infection. Which of the following are common in AIDs and can ultimately lead to death?

1 - Pneumocystis jirovecii and Kaposi’s sarcoma (HHV8-induced tumour, ‘KSAV’)
2 - MRSA and Pneumocystis jirovecii
3 - Pneumocystis jirovecii and meningitis
4 - Kaposi’s sarcoma (HHV8-induced tumour, ‘KSAV’) and MRSA

A

1 - Pneumocystis jirovecii and Kaposi’s sarcoma (HHV8-induced tumour, ‘KSAV’)

53
Q

What is the most common cause of respiratory AIDs defining condition?

1 - bilateral pneumothorax
2 - chronic pleural effusion
3 - pneumocystispneumonia
4 - interstitial fibrosis

A

3 - pneumocystispneumonia

54
Q

What is the diagnosis of the image?

1 - hyperinflation
2 - bilateral diffuse peri hilar opacification
3 - cardiomegaly
4 - malignancy

A

2 - bilateral diffuse peri hilar opacification
- this presentation is common in pneumocystispneumonia

55
Q

Pneumocystispneumonia is the most common cause of respiratory AIDs defining condition. Which microorganism can cause this?

1 - pneumocystis jirovecii
2 - influenza A virus
3 - staphyococcus aureus
4 - streptococcus pneumonia

A

1 - pneumocystis jirovecii

56
Q

Pneumocystispneumonia is the most common cause of respiratory AIDs defining condition and is caused by pneumocystis jirovecii. How can this be diagnosed?

1 - blood culture
2 - sputum or bronchoalveolar lavage
3 - CSF sample
4 - any of the above

A

2 - sputum or bronchoalveolar lavage

57
Q

Pneumocystispneumonia is the most common cause of respiratory AIDs defining condition and is caused by pneumocystis jirovecii. How can this be treated?

1 - amoxicillin
2 - prednisolone
3 - cotrimoxazole
4 - all of the above

A

3 - cotrimoxazole
- antibiotic

58
Q

What is the most common cause of intracerebral mass lesion in patients living with HIV?

1 - Streptococcus pneumoniae
2 - Neisseria meningitidis
3 - Listeria monocytogenes
4 - Toxoplasma gondi

A

4 - Toxoplasma gondi
- parasitic infection that can cause toxoplasmosis specifically in the CNS

59
Q

Toxoplasma gondi can cause CNS toxoplasmosis. What are the common symptoms patients with CNS toxoplasmosis present with?

1 - Confusion
2 - Headache
3 - Personality change
4 - Generalised or focal seizures
5 - Hemiparesis (one sided weakness)
6 - Hemisensory loss
7 - all of the above

A

7 - all of the above

60
Q

Toxoplasma gondi can cause CNS toxoplasmosis. Toxoplasma gondi appears to have a particular predilection for all of the following areas of the brain, EXCEPT which on?

1 - basal ganglia
2 - thalami
3 - medulla oblongata
4 - corticomedullary junction

A

3 - medulla oblongata

C. Year 3 MLA Muscoskeletal Conditions (17 decks)

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