HIV/STI (Lauren 🌭) Flashcards
(124 cards)
1
Q
HIV uses (forward/reverse) transcriptase it turn its RNA into DNA
A
Reverse
2
Q
Which type of cells are the target of HIV
A
CD4 T cells (Helper T cells)
3
Q
What are the two (3) types of lymphocytes?
A
B cells- make antibodies
T4 cells (CD4)- helper T cells that tell the B cells to make antibodies
T8 cells (CD8)- killer T cells
4
Q
What kind of infections will cause lymphocytes to rise?
A
Pretty much everything including ~viruses~
Protozoa, fungi, intracellular fungi…
5
Q
Once inside the body, where does HIV replication occur?
A
In activated CD4 cells
6
Q
Can you get HIV from giving someone a hug
A
No
7
Q
How is HIV spread?
A
Sex- exchange of infected body fluids
IV drug
Needlestick at work or in therapeutic skills lab
Blood transfusion
HIV+ mom to infant
8
Q
What kind of sex makes you the most likely to contract HIV?
A
Receptive anal intercourse
9
Q
What are the other two names for your primary HIV infection?
A
Acute HIV*****
Acute retroviral syndrome
10
Q
What is acute HIV?
A
The mono or flu-like illness someone gets a few weeks after they are first exposed to HIV
11
Q
How long does acute HIV last?
A
2 weeks, and then resolves spontaneously
12
Q
A young man comes into your office with a flu like illness. You take a good history and find out a few things that make you suspicious that this “flu” is actually acute HIV, and you decide to test him for HIV. You work in a clinic at the bottom of the Grand Canyon and you only have access to HIV Ab tests. Will this test be reliable?
A
No, his body has not had time to build up antibodies
13
Q
The viral load of a patient with Acute HIV will be (high/low/undetectable)
A
HIGH
14
Q
When is an HIV+ person the MOST infectious they will ever be?
A
When they have acute HIV.
High viral load, no antibodies, not aware of their status
15
Q
You decide to test a young gay man with a “flu or mono-like” illness for HIV using an HIV RNA test, since he has some significant risk factors in his history. Unfortunately, it comes back positive and you diagnose him with HIV. How does this early diagnosis benefit everyone else?
A
Will likely limit transmission to others, since this is the time that they are the most infectious, and they will take precautions not to spread it to others from this point forward.
16
Q
What are some of the symptoms of acute HIV?
A
Fever
Adenopathy
Sore throat
Rash on upper trunk, neck and face (>50% of pts)***
Mucocutaneous ulcers**
Myalgia
Athralgia
Headache
Diarrhea
N/V
Overall a pretty vague collection of symptoms that looks like a lot of other viruses
17
Q
Lab values in acute HIV:
LFTs
WBC
H/H
Platelets
A
LFTs elevated
WBCs low
H/H low (anemia)
Platelets low
~~kind of just looks like a virusssss~~
18
Q
What causes an HIV+ patient to enter clinical latency?
A
Seroconversion (starts making antibodies)***
Viral load decreases to “set point” and then slowly rises over time
19
Q
What happens over time to the CD4 count of an HIV+ patient in clinical latency?
A
Slowly declines
20
Q
What kind of symptoms will an HIV+ pt in clinical latency have?
A
No symptoms
Maybe some swollen lymph nodes
21
Q
How long does the clinical latency phase of HIV infection last?
A
10 yrs
22
Q
5% of patients who contract HIV are long term nonprogressors. What does that mean?
A
They NEVER get a significantly weakened immune system
23
Q
What are some of the contributing factors to the deterioration of the immune system in HIV?
A
Lymph nodes become damaged and burn out
Virus can mutate
Body fails to keep up replacement of CD4 cells
HIV RNA viral load increases
CD4 cell count decreases
24
Q
At what CD4 count will a patient start developing constitutional symptoms?
A
~200
25
What kinds of constitutional symptoms will an HIV patient develop when their CD4 count starts to drop below normal?
Fever
Night sweats
Fatigue/malaise
Weight loss
Mouth- oral hairy leukoplakia** or thrush
Cervical dysplasia*
Skin- molluscum, chronic dermatophytes, seborrheic dermatitis
Kaposi’s sarcoma****
Recurrent HZV
ITP (thrombocytopenia)
26
What causes an HIV+ patient to develop oral hairy leukoplakia?
Reactivation of prior EBV infection
27
What causes an HIV+ to develop cervical dysplasia?
A coexisting HPV infection is going wild
28
What is a normal CD4 Tcell count?
500-1400
29
Let’s look at a list in order of the conditions someone with HIV develops as their CD4 levels drop
Thrush
Oral hairy leukoplakia
TB (latent TB reactivates)
PCP
Histoplasmosis
Coccidiomycosis
Atypical herpes simplex
Cryptosporidiosis
CMV
MAC
30
What are the two conditions that mean your HIV is now AIDS
| *********
CD4 under 200
OR
HIV+ AND 1 of 27 AIDS defining conditions (regardless of CD4 count)
⭐️⭐️⭐️⭐️⭐️⭐️⭐️🌟
31
What are some AIDs defining conditions that she listed out?
| She said you didn’t have to memorize this, just know the common ones....
Pneumocystis jirovecii (PCP) pneumonia
Toxoplasmosis of brain
Mycobacterium avium complex, disseminated
CMV in specific organs
Candidiasis of esophagus, trachea, bronchi/lungs
Kaposi’s sarcoma
Invasive cervical cancer
32
If you have Pneumocystis jirovecii pneumonia (PCP), we know your CD4 count is under_____
200
33
What is the causative organism of PCP?
Airborne fungus pneumocytis jirovecii
34
What is the clinical presentation of someone with PCP pneumonia?
Basically looks like pneumonia in someone who is NOT handling it well:
Hypoxemic
CXR shows diffuse or perihilar infiltrates
35
How is PCP pneumonia diagnosed?
Exam of sputum sample
36
What is the first-line treatment for PCP pneumonia?
Bactrim
| Plus supportive care of course
37
If you develop toxoplasmosis, we can assume your CD4 count is below _____
100
38
What is the clinical presentation of toxoplasmosis in an HIV+ pt?
Headache
Focal* neurological deficits
Seizures
AMS
Multiple contrast-enhancing lesions on brain CT/MRI******
39
How is toxoplasmosis acquired?
Ingestion of cat feces 🐈
contaminated food/utensils
40
If i decide to raid Shadow’s litter box and chow down on some cat turds, will i get toxoplasmosis infection in my brain?🧠
No, immunocompetent patietns dont have symptoms
41
If you develop mycobacterium avium complex (MAC), we can assume your CD4 count is less than _____
50
42
What is the clinical presentation of an HIV pt with MAC?
Systemic disease
Pulmonary infection
Night sweats
Weight loss
Abdominal pain, diarrhea, anemia
43
How do you diagnosis MAC?
Acid fast bacillus stain of sputum
Sputum cultures
Blood cultures
44
If you develop CMV retinitis, we can assume your CD4 count is less than ____
👁👁
50
45
What is CMV retinitis?
CMV (herpes virus common in general population) infects the retina👀
46
What is the clinical presentation of CMV retinitis?
Patient complains of visual disturbances
Goes blind if left untreated
Fundoscopic exam: perivascular hemorrhages, white fluffy exudates, cotton wool spots, infiltrates ***********
47
If you do a fundoscopic exam on an HIV+ patient who is complaining of visual disturbances, and you see perivasulcar hemorrhages, white fluffy exudates, cotton wool spots, and infiltrates, what do you think they have?
CMV retinitis
48
If you develop esophageal candidiasis or recurrent vaginal candidiasis, we can assume your CD4 count is _____
Anything.
No specific CD4 number.
However, the more invasive the yeast is, the lower the CD4 count will be
49
What CD4 count is associated with Kaposi’s sarcoma?
ANY CD4 COUNT
50
What is AIDS-related Kaposi’s sarcoma?
A vascular neoplasm most frequent in homosexual men.
51
Screen everyone for HIV ______ ________ ________
AT LEAST ONCE
| ⭐️⭐️
52
Who gets HIV screening?
Everyone 13-64 unless they opt out
Anyone starting TB treatment
EVERY SINGLE TIME someone shows up with an STD
Annually for patients at risk (Men who have sex with men)
Pregnant women
*******************
53
You graduate PA school and land a job working the night shift in an ER. A 38 year old prostitute comes in by ambulance because she has some unusual vaginal discharge. You diagnose her with trichomoniasis, and as is routine, you screen her for HIV.
2 weeks later, she rolls in again, and this time you diagnose her with syphilis. Your shift is about to end, and you just want to go home. Do you ~~reallllly~~ need to screen her for HIV again?
YES
EVERY SINGLE TIME SOMEONE SHOWS UP WITH AN STD YOU SCREEN FOR HIV
54
Who need to get a DIAGNOSTIC test for HIV?
People with opportunistic infections (fungal)
People with TB
Symptoms consistent with established HIV
Symptoms consistent with acute HIV (that flu-like illness you come down with at first)
55
What symptoms are consistent with established HIV that would make you do ~Diagnostic~ testing for HIV?
Weight loss
Recurrent fever, night sweats
Extreme tiredness
Lymphadenopathy
Diarrhea >1 week (unexplained)
Mouth/Anal/genital sores
Pneumonia (unexplained?)
Unexplained neuro symptoms
56
What is the difference between screening and diagnostic testing for HIV?
I’m not totally sure..... maybe screening is just the antibody and diagnostic is the antigen?
It was never really specified
57
What is seroconversion?
Patient has started making antibodies against the virus
58
How long after infection can the HIV antibody test detect if someone has HIV?>
4-12 weeks after infection- after the patient seroconverts
59
What is a Rapid HIV test?
Test done on saliva or blood, and if positive it requires confirmation
60
If you suspect acute HIV and you only test for the antibody you will _______
Miss the HIV diagnosis and lose your job
61
If you suspect acute HIV, what are the two ACCEPTABLE testing options you can do to test for HIV?
Antigen/antibody combination test
HIV RNA test
62
A positive Rapid HIV test requires________
Confirmation
63
Where can you go to get tested for STDs for only $20
Maricopa County STD clinic
64
True or false:
In AZ, minors have to ask their parents for permission to get tested for STDs
False
65
Should you start antiretroviral therapy for people with acute/early infection?
YES.
66
Antiretroviral therapy is recommended for which HIV patients?
ALL OF THEM
67
Are there any benefits to starting antiretroviral therapy during early infection?
Yes there are immunologic and virologic benefits. Refer them for treatment ASAP
68
What kind of testing must be done before putting your patient on Antiretroviral therapy?
Genotypic drug resistance testing
69
If you are talking to an HIV patient about starting treatment and she tells you she doesnt give a rats ass about antiretroviral therapy and that she has no intention of consistently taking the meds, should you give her the treatment anyways?
NO! Patients must be willing and able to commit to lifelong treatment with strict adherence.
If they dont take their meds consistently, they’re going to cause resistance and probably be worse off.
70
What is the goal of HIV treatment?
Suppress HIV RNA to undetectable levels
Prevent transmission
71
What are some situations that could cause a possible exposure to HIV?
Unprotected sex with someone who says they have HIV or you think might have HIV
Condom broke/fell off
Rape
Work related (needle stick)
Sharing needles for drugs
72
If you have possibly been exposed to HIV, how long do you have to start Post-Exposure Prophylaxis (PEP)?
72 hours
73
If you are someone who is frequently exposed to possible HIV infection, is there anything you can do to prevent getting it?
Yes, that is called Pre-Exposure Prophylaxis (PrEP).
The medication is called Truvada
74
Who can prescribe Truvada (PrEP)?
HIV specialist OR primary care provider
75
CD4 T cell count is ______
King 🤴
76
Which two conditions can be seen at ANY CD4 count?
Thrush
Kaposi sarcoma
77
If your CD4 count is 350+, you are doing
Great
78
If your CD4 count is hover around 200, what will happen
You will start to see opportunistic infections
79
If your CD4 count drops below 200 you have ______
AIDS
80
If you are seeing a new HIV patient at your office, and he doesn’t know his CD4 count, but he has daily Bactrim on his med list, you can assume his CD4 count is less than _____
200
81
What is the prophylaxis for Pneumocystic jirovecii pneumonia (PCP) as well as Toxoplasma gondii?
Bactrim
PCP: CD4 <200
Toxoplasma: CD4 <100
82
If you acquire a new HIV patient who does not know her CD4 count, but her last doctor has her taking Bactrim and Azithromycin, you can assume her CD4 count is less than _____
50
83
What is the prophylaxis for disseminated MAC?
Azithromycin
MAC: CD4 <50
84
What organism causes syphilis?
Treponema pallidum
85
Is a syphilis chancre painful?
NO IT IS PAINLESS
86
What are the symptoms of primary syphilis?
Painless chancre appears at location where syphilis entered the body.
Lasts for 4-6 wks and then goes away
87
In addition to vague symptoms like fatigue, what 3 skin conditions can appear during secondary syphilis?
***********
Rash on palms and soles
Condyloma LATA
Mucous patches on mouth, throat and genitals
88
Describe the rash on the palms and soles seen in secondary syphilis
Non pruritic
Not contagious
VERY common manifestation of secondary syphilis
89
Describe condyloma lata seen in secondary syphilis
Moist, heaped, warty papules
Intertriginous areas (butt crack, perineum, perianal area)
HIGHLY contagious*****
90
Describe the mucous patches seen in secondary syphilis
Painless
Flat patches in mouth, throat, or genitals
HIGHLY infectious**
91
Of the three skin manifestations of secondary syphilis, only one of them is NOT highly contagious. Which one is it:
Rash on palms and soles
Condyloma lata
Mucous patches
Rash on palms and soles
92
How long does secondary syphilis last
2-6 wks
93
What kinds of symptoms will someone have in latent syphilis
None
94
If you have sex with a prostitute who has LATENT syphilis, what are the chances that you will contract it?
ZERO. Not transmittable in latent phase
95
Do most patients develop tertiary (late) syphilis
No. Only about 15% of people who didn’t get treatment develop it
96
What can tertiary (late) syphilis do to your body?
Heart
Blood vessels (aneurysms)
Brain
Nervous system
97
How long after initial infection will tertiary (late) syphilis show up?
10-30 yrs
98
What is neurosyphilis?
Syphilis that causes paralysis, difficult with coordination, dementia
99
What is ocular syphilis ?
Changes in vision or blindness
100
What stage of syphilis do neurosyphilis and ocular syphilis show up in?
ANY phase
101
If you have a patient show up with visual disturbances, should you test for syphilis?
YEP in this fantasy land we live in you will have ocular syphilis on your differential and you will do an LP and do VDRL on spinal fluid
102
If a patient shows up and they are uncoordinated, paralyzed, or demented, should you test for syphilis?
YES, when you are taking this exam, you need to have neurosyphilis on your differential and you should do an LP and VDRL of the CSF
103
What are the different ways you can test for syphilis?
Bacteria from chancre on dark field microscopy (not commonly done)
Serology- RPR or VDRL
Titer test
Treponema antibody test: FTA-ABS (fluorescent treponemal antibody absorption)
104
RPR and VDRL are _______ tests
Antibody
105
A syphilis titer indicates ________ _______
Disease activity
106
A low syphilis titer may be a false positive due to:
Autoimmune disease
Illness
Preganncy
107
If you get a positive RPR, what do you need to do?
Confirm it with FTA-ABS
108
If you suspect that your patient has neurosyphilis or ocular syphilis, how do you test for it?
Do an LP and perform VDRL on the spinal fluid
Refer to neuro
109
Who gets treatment for syphilis?
EVERYBODy ~and~ the people they are boning if they test positive too!!
110
How do you treat syphilis?
Benzathine penicillin G 2.4 mu IM (one big shot)
If they’ve had it for more than a year they get 3 big shots 1 week apart
PCN allergy: azithromycin or doxy
HIV+ or pregnant with PCN allergy: you give them PCN anyways
111
How do you treat syphilis that a patient has had for over a year?
3 shots of Benzathine Penicillin G, 1 week apart
112
How do you treat syphilis in someone who has a PCN allergy? What if they have a PCN allergy and also have HIV or are pregnant?
Azithromycin or Doxycycline
If they have HIV or are pregnant, they get the usual benzathine penicillin G like EVERYBODY else
113
After treating syphilis, how do you confirm treatment success?
check RPR titers periodically
114
What happens to the baby if you have syphilis and you are pregnant?
Stillbirth
Death
Deafness
Neuro Impairment
Bone deformitites
115
When should pregnant women be screened for syphilis?
1st prenatal visit
| If Shes high risk screen her again at 28 weeks and delivery
116
If a pregnant patient has syphilis and also a PCN allergy, what can we do for her before we give her shots of penicillin?
Desensitization with oral PCN
117
What is the presentation of lymphogranuloma venereum (LGV)?
UNILATERAL inguinal bubo ******
Genital ulcer at site of inoculation
Anal discharge and rectal bleeding
118
What causes lymphogranuloma venereum (LGV)?
Serotype of chlamydia trachomatis
119
Who do you need to call if you diagnose syphilis
County health department
120
How do you diagnose lymphogranuloma venereum (LGV)?
Rule out syphilis
Call county health department if suspected LGV
Genital/rectal/lymph node swab to test for chlamydia
121
What organism causes chancroid
Haemophilus ducreyi
122
Is LGV common in the US
No, its very rare and usually only occurs in MSM
123
What is the clinical presentation of chancroid?
Painful TENDER genital ulcer
Lesion produces foul-smelling discharge (that’s contagious)
Inguinal adenitis (buboes)
124
How do you diagnose chancroid?
Rule out syphilis
Call the county health department cause this bitch requires special culture
