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X Clin Med III Exam 2 > HIV, Syphilis and STDs > Flashcards

HIV, Syphilis and STDs Flashcards

(69 cards)

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1
Q

What is HIV itself?

A

Retrovirus that uses reverse transcriptase for reverse transcription (turning RNA into DNA) to integrate material into host cell DNA and new virus is produced

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2
Q

What is responsible for AIDS?

A

HIV-1

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3
Q

What does HIV target?

A 
T cells (particularly CD4 T cells the helpers)
Also infects B lymphocytes and macrophages
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4
Q

What are lymphocytes?

A

WBCs that defend against protozoa, fungi, some bacteria and viruses

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5
Q

Routes of HIV transmission

A

Sexual transmission (infected body fluids)
Injection drug use
Occupational injury (needlestick)
Blood products
HIV mom to infant
(not just casual contact)
*receptive anal intercourse has highest risk of transmission

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6
Q

What is another name for primary HIV infection?

A

Acute HIV/ acute retroviral syndrome

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7
Q

What is acute HIV?

A

2-6 wks after exposure

Mono like or flu like illness (about 2 wks and resolves spontaneously)

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8
Q

Why is acute HIV missed?

A

Routine HIV Ab test is negative so miss it

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9
Q

Lab for acute HIV

A

HIV RNA (viral load( is measurable and usually extremely high >100,000

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10
Q

Common sxs of acute HIV

A

Fever, adenopathy, sore throat, rash and mucocutaneous ulcers, myalgia, arthralgia, HA, diarrhea, n/v

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11
Q

What does the rash look like in acute HIV?

A

Half of pts

Upper trunk, neck and face

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12
Q

Lab abnormalities in acute HIV

A

Elevated transaminases (LFTs)
Leukopenia
Anemia
Thrombocytopenia

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13
Q

When does clinical latency occur?

A

When immune system response to infection (acute illness resolves) and pt seroconverts!!! and becomes antibody positive
Viral load decreases to a set point
CD4 t cell count slowly declines

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14
Q

When do you see full symptomatic infection of HIV?

A

When immune system deteriorates:

  • Lymphnodes and tissue damaged from burnt out
  • Virus may mutate and become more pathogenic
  • Body fails to keep up replacement of CD4
  • viral load increases
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15
Q

All general sxs of HIV

A

Fever, night sweats, LAD, fatigue, arthralgias, weight loss, oral hairy leukoplakia or thrush, prolonged diarrhes, cervical dysplasia, skin disorders, Kaposis, ITP

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16
Q

Normal CD4 t cell count

A

500-1400 cell/mcL

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17
Q

What is the definition when HIV progresses to AIDS?

A

CD4 T cell count <200 cells/mcL
OR
HIV and 1 of 27 AIDS defining conditions (regardless of T cell count)

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18
Q

Types of AIDS defining conditions

A 
PCP
Toxoplasmosis
MAC
CMV
Candidiasis
Kaposis sarcoma
Cervical cancer
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19
Q

What is pneumocystic jiroveci pneumonia?

A

Common opportunistic infection associated with AIDS
Caused by airborne fungus pneumocystis jiroveci
Reactivated dormant infection

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20
Q

Presentation of pneumocystic jiroveci pneumonia

A

Nonspecific: fever, cough, SOB
May have severe hypoxemia (usually younger 20-30)
CXR shows diffuse or perihilar infiltrates

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21
Q

How to diagnose pneumocystic jiroveci pneumonia

A

Sputum sample: see elevated LDH in most

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22
Q

Tx for pneumocystic jiroveci pneumonia

A

Bactrim and supportive

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23
Q

What does toxoplasmosis cause?

A

Encephalitis (most common intracranial lesion in HIV pts)

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24
Q

What causes toxoplasmosis?

A

Single celled parasite toxoplasma gondii

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25
How to get toxoplasmosis
Ingestion of cat feces, contaminated rw food or utensils | Immuncompetent doesn't usually have pts
26
Presentation of toxoplasmosis in HIV pt
HA, focal neurological deficits, seizures, AMS | Maybe retinits or pneumonitis
27
Imaging for toxoplasmosis
Multiple contrast enhancing lesions on brain CT or MRI | Also seropositive for toxoplasmosis
28
Mycobacterium avium complex
May cause pulm infection when immunocompetent | Found in soil or dust inhaled
29
Presentation of MAC
Systemic disease in HIV | Night sweats, weight loss, abd pain, diarrhea, anemia
30
How to diagnose MAC
Sputum acid fast bacillus stain positive | Positive sputum and blood cultures
31
Most common retinal infection in AIDs
CMV retinitis
32
What is CMV?
Herpes virus in general pop (blood, sexually transmittesd, perinatally)
33
Presentation of CMV retinitis
Visual disturbances | Can cause blindness when untreated
34
How to diagnose CMV retinitis
Perivascular hemorrhages and white fluffy exudates on fundoscopic Seropositive for CMV
35
Candida and CD4
More invasive the candida (like into trachea) the lower the associated CD4 t cell count
36
What CD4 count does kaposis sarcoma occur at?
ANY
37
When is kaposis seen classically?
Elderly eastern european and mediterranean males
38
When is aids related kaposis sesn most?
Homosexual men (lesions multifocal and widespread with LAD)
39
When do you screen for HIV?
``` Everyone 13-64: voluntary opt out Anyone in whom TB tx is being initiated At each presentation for STD Pts at risk (MSM) Pregnant ```
40
Most common screening and diagnostic testing for HIV
Combo HIV antibody (4-12 wks after infection-after seroconversion) and antigen (won't miss the acute) testing
41
Who is treated with antiretroviral therapy?
All with HIV, even those in acute infection
42
When to start post exposure prophylaxis for HIV?
Within 72 hrs
43
When do people do well usually with CD4
>350
44
Medication based on CD4 count <200
Bactrim DS (prophylaxis for PCP)
45
Medication based on CD4 count <100
Bactrim DS (prophylaxis for toxoplasma encephalitis)
46
Medication based on CD4 count <50
Azithromycin (for disseminated mycobacterim avium complex)
47
What causes syphilis?
Treponema pallidum
48
Stages of syphilis
``` Primary Secondary Latent Tertiary Neurosyphilis Ocular syphilis ```
49
Presentation of primary syphilis
Painless chancre that appears at location where syph entered body (4-6 wks)
50
Presentation of secondary syphilis
Rash (COMMON): non-pruritis, palms and soles of feet, not contagious Condyloma lata Mucous patches: painless flat patches (infectious) May have malaise LAD 2-6 wks
51
What is condyloma lata?
Moist, heaped, wart-like papules Occur in intertriginous areas (gluteal folds, perianal area) Contagious
52
Latent phase of syphilis
Asymptomatic No longer sexually transmittable Years
53
Presentation of tertiary syphilis
Most don't get this (more in untreated) 10-30 yrs after infection Damage heart, bvs, nervous system
54
What is neurosyphilis?
Any stage | Paralysis, difficulty with coordination, dementia
55
What is ocular syphilis?
Any stage | Changes in vision or blindness
56
Diagnosis of syphilis
Rapid plasma reagin (RPR) or venereal disease lab test (VDRL)--antibody with titer (low may be false positive)
57
What to do to confirm RPR?
Treponemal antibody test (FTA-ABS)
58
What to do is suspect neurosyphilis or ocular syphilis?
LP (lumbar puncture) or VDRL on spinal fluid to confirm
59
What to do after treat pt for syphilis
Confirm success with RPR titer at 3, 6, 12 and 24 mos | 4 fold decrease is good response
60
Congenital syphilis
Untreated syph in pregnancy can lead to stillbirth, neonatal death, deafness, neuro impairment and bone deformities
61
How to prevent congenital syphilis
Screen pregnant woman at 1st prenatal visit | If high risk, screen and get sex history at 28 wks and delivery
62
What causes lymphogranuloma venereum?
Chlamydia trachomatic
63
Presentation of lymphogranuloma venereum
Unilateral inguinal bubo Self limited gential ulcer or papule at site of innoculation Anal discharge and rectal bleeding
64
How to diagnose lymphogranuloma venereum
R/o syph Contact health dept Maybe specimen swab
65
Tx for lymphogranuloma venereum
Erythro or doxy
66
What causes chancroid
Haemophilus ducreyi
67
Presentation of chancroid
Painful tender genital ulcer Lesions with foul-smelling discharge Inguinal adenitis
68
Diagnose chancroid
R/o syph and HSV | Contact county health (special culture)
69
Tx for chancroid
Azithro, ceftriaxone, cipro

X Clin Med III Exam 2 (9 decks)

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