ID: GUM HIV viral Flashcards
(88 cards)
1
Q
Jarisch-Herxheimer vs anaphylactic reaction,
A
Jarisch-Herxheimer reaction, unlike an anaphylactic reaction, will not present with hypotension and wheeze
2
Q
low CSF glucose
A
Mumps dumps glucose
herpes encephalitis
3
Q
HIV-associated nephropathy (HIVAN) 5 features
Size of kid
Type of nephrotic
BP
A
massive proteinuria = nephrotic syndrome
focal segmental glomerulosclerosis with focal or global capillary collapse on renal biopsy
normal or large kidneys
elevated urea and creatinine
normotension
4
Q
SE: indinavir
A
renal stones, asymptomatic hyperbilirubinaemia
5
Q
Protease inhibitors (PI) examples
A
examples: indinavir, nelfinavir, ritonavir, saquinavir
6
Q
hepatitis B rx
A
pegylated interferon-alpha
7
Q
what is a hepatitis B non responder and what action should be taken
A
<10 anti-HBs level
HIV , heo B test
Give another dose
8
Q
What cell can HIV can infect
A
CD4 T cells, macrophages and dendritic cells
9
Q
anti-retrovirals - P450 interaction
A
nevirapine (a NNRTI): induces P450
protease inhibitors: inhibits P450
10
Q
Describe the process of HIV entering cell
It contacts the GP who put him in contact with a band or exam = entrance & get genetic material copied and …
A
- HIV targets CD4+on membrane of Macrophages, T-helper cells, & dendritic cells
- HIV targets and attaches to the CD4 molecule via a protein called gp120 found on its envelope.
HIV bind to co-receptor (With the help of gp120). The co receptor isCXCR4 (only found on T-cells )or CCR5 - Once bound to the co-receptor enters the cell
reverse transcriptase to transcribe a complementary double-stranded piece= Proviral DNA
- Proviral DNA enter nucleus and pops itself into the cell’s DNA, ready to be transcribed
11
Q
Describe HIV treatment in pregnancy
A
- No breastfeeding
- Mother presents early: @ 14 WKS before delivery ART with the aim of achieving 0 viral @28 wks if this happens baby only needs zidovudine (AZT) for a month
- If mother presents late @ 36 weeks= intensive therapy 4 drugs; during labour get zidovudine IV, C-section baby gets triple therapy for 4 weeks.
- viral load <50 copies/ml at 36 weeks = vaginal delivery + zidovudine is usually administered orally; Neonatal antiretroviral therapy If viral load is <50 copies/ml zidovudine is usually administered orally.
- viral load >50 copies/ml at 36 weeks c-section + a zidovudine infusion should be started 4 hours before beginning the c. section. Neonatal antiretroviral therapy triple ART should be used for 4-6 weeks.
12
Q
what is Truvada
A
emtricitabine and tenofovir disoproxil fumarate
13
Q
What is PREP
A
Pre exposure prophylaxis; taken by HVI-ve pt. used to reduce chance of transmission in those who engage in risky behavior; Truvada + Kaletra
13
Q
What Post Exposure Prophalaxis for HIV
A
With in 72 hour of exposure = Truvada (Emtricitabine/tenofovir) + Kaletra for 4 wks
14
Q
What is TasP
A
TasP- Treatment as prevention – taken by HIV + person to reduce chance of transmission
15
Q
How is AIDS defined
A
CD 4 COUNT <200
16
Q
Window period
A
4wk
but can range from 10d-3mo
17
Q
How can you differentiate candida from hairy leukoplakia
A
Nb hairy- hairy leukoplakia caused by EBV
hairy leukoplakia is unscrapable from tongue
18
Q
what is Kaposi sarcoma and what is it caused by
A
malignant tumor of the skin and soft tissues
caused by the human herpesvirus 8, or HHV-8.
19
Q
HPV in HIV causes
A
squamous cell carcinoma of the anus in males and cervix in females.
20
Q
How do you differentiate histoplasmosis from PCP
A
histoplasmosis,
peripheral blood smear are oval yeast cells within macrophages. Eosinophilia may predominate. bilateral hilar lymphadenopathy
PCP- ground glass appearance
21
Q
what causes progressive multifocal leukoencephalopathy
SX
Ix
A
JC virus
progressive motor and cognitive neurologic symptoms
MRI, =demyelination (non-enhancing areas ).
22
Q
How dose Cryptococcus infection present how do you test for it
A
headache, fever, malaise, nausea/vomiting, seizures, focal neurological deficit
CSF: high opening pressure, India ink test positive = a clear halo around the yeast cells.
latex agglutination test
CT: meningeal enhancement, cerebral oedema
23
Q
AIDS dementia on imaging
A
Cortical atrophy
24
Encephalitis in HIV is caused by and on imaging
oedematous brain
due to CMV or HIV itself
25
HIV: Tuberculosis on CT head
CT: single enhancing lesion
26
Primary CNS lymphoma
cuased by and imaging
Rx
Primary CNS lymphoma
30% of cases
Epstein-Barr virus
Single enhancement
Thallium SPECT positive
27
Toxoplasmosis
Rx & imaging
Single or Multiple lesions
Ring enhancing lesions w/ central necrosis or nodular enhancement
+/- mass effect
Thallium SPECT negative
sulfadiazine and pyrimethamine
28
In HIV what causes chronic watery diarrhea, associated with abdominal pain.
How do you investigate it ?
Cryptosporidium + other protozoa (most common)
Ziehl-Neelsen stain (acid-fast stain) of the stool may reveal the characteristic red cysts
29
CMV in HIV and Ix
may present with
-Eosphagitis
-colitis,
encephalitis,
-pneumonia,
For diagnosis, a biopsy = owl’s eye inclusion bodies within their nuclei.
30
HIV Modes of transmission & % of those infected
Blood transfusion 100%
Vertical transmission – 25%
Horizontal transmission 3%
Needle stick 0.3%
31
When do you start Prophylaxis for Mycobacterium avium complex and what is it ?
Give an unusual clinical feature
clarithromycin or azithromycin when CD4 is less than 100 cells/mm³
focal lymphadenitis
32
What cancers are more likely in HIV
ass EBV
HL, NHL, Burkitts & CNS
lymphoma
33
False positive VDRL/RPR:
'SomeTimes Mistakes Happen' (SLE, TB, malaria, HIV)
34
HIV seroconversion timing and presentation
60-80% pts
typically presents as a glandular fever-type illnes
occurs 3-12 weeks after infection
35
Name viral haemorrhagic fevers
dengue fever,
Lassa fever,
Ebola
Yellow fever
36
What are the 4 main causes of Diarrhoea in HIV?
Cryptosporidium + other protozoa (most common)
Giardia
CD count < 50: Cytomegalovirus, Mycobacterium avium intracellulare
37
Rx Mycobacterium avium intracellulare
MAC
rifabutin, ethambutol and clarithromycin (REC)
38
cysts turn red following acid-fast staining
Cryptosporidium
39
Staining for PCP
Silver
40
What are the 4 main causes of Diarrhoea in HIV?
Cryptosporidium + other protozoa (most common)
Giardia
CD count < 50: Cytomegalovirus, Mycobacterium avium intracellulare
41
Staining for PCP
Silver
42
CD4 count < 200/mm³ what prophylaxis should be started
PCP
co-trimoxazole (trimethoprim and sulfamethoxazole )
43
rx pcp
severe cases
when pO2 < 9.3
Rx: co-trimoxazole(trimethoprim and sulfamethoxazole );
Severe + IV/ aerosol pentamidine (aerosol more side effects)
If PO2 < 9.3 steroids
44
Mode of delivery if @ 36 wks
Viral load <50 copies
Viral load is >50 copies
<50 copies= Vaginal + zidovudine administered orally
>50 copies - C-section; IV zidovudine infusion should be started 4 hours before & triple ART 4-6 wks
45
Seborrhoeic dermatitis is common in which conditions
HIV
Parkinson's disease
46
Commonest cause of Hepatocellular carcinoma
Chronic hepatitis B is the most common cause of HCC worldwide with chronic hepatitis C being the most common cause in Europe.
47
Chancroid
Cause by
SX
Rx
- Haemophilus ducrey (gram-negative coccobacillus)
- unilateral, painful inguinal lymph node enlargement. The ulcers typically have a sharply defined, ragged, undermined border.
Rx Azithromycin
48
rx Neisseria gonorrhoea.
IM ceftriaxone 1g
49
% Hepatitis C that have chronic disease
55-85%
50
Rx chronic Hepatitis C
Combination of protease inhibitors (e.g. daclatasvir + sofosbuvir or sofosbuvir + simeprevir) with or without ribavirin are used
51
Inhibits reverse transcriptase = double strand isn’t formed
-Dine VIr
52
Protease inhibitor
Stop maturing of virus “protease inhibitors NAVIR mature
53
Nnrti se
No no Den
54
Integrase inhibitors
-teg-
Provital DNA can’t be integrated
Myopathy HA & N
55
Hep B: Immunity following vaccination
**anti-HBs** + Only Antibody to Hep B surface antigen
56
Hep B: Immunity following infection
+ anti-HBs
+ anti-HBe/ + anti-HBc
+ Anti-HBc IgG
57
HBe Ag
indicates how **e**asily spread
58
HBs
Sick with HB
59
anti-HBc
caught, i.e. negative if immunized
60
The only Hep that is a DNA
Hep B
61
What is the mnemonic GAMED for
prevalence of Ig's
62
Rx HepC
combination of protease inhibitors (e.g. daclatasvir + sofosbuvir or sofosbuvir + simeprevir) with or without ribavirin are used
63
Rx hep B
pegylated interferon-alpha used to be the only treatment available.
reduces viral replication
A better response is predicted by being:
- female,
-< 50 years old,
-low HBV DNA levels,
-non-Asian,
-HIV negative, high degree of inflammation on liver biopsy
64
Complications of hepatitis B infection
1. chronic hepatitis (5-10%). 'Ground-glass' hepatocytes may be seen on light microscopy
2. fulminant liver failure (1%)
3. hepatocellular carcinoma
4. glomerulonephritis
5. polyarteritis nodosa
6 cryoglobulinaemia
65
causes PAINFUL genital ulcers
3- 2H’s hurt except L w/ tender lymph
**Genital Herpes**
(HSV-2);more common than chancroid
**Haemophilus ducreyi**
Gram -ve
**Lymphogranuloma Venereum**
Chlamydia (gram -ve) nb painless ulcer painful lymphadenopathy
66
Causes Ix & Rx:
Painful, itchy, dysuria, vesicles usually umbilicate,
Painful lymphadenopathy
systemic features: F, HA+ myalgia
Can be latent and reappear
Genital Herpes
HSV-1& **2**
Ix: nucleic acid amplification tests (NAAT)
RX: Supportive saline baths; oral acyclovir
67
Genital Ulcer-
Cause and Rx:
**Chancroid** - painful ulcer with soft **irregular** margins + purulent exudate. may bleed
unilateral, painful inguinal lymph node enlargement
Haemophilus ducreyi
Gram -ve
IX: CR, culture, and gram staining
Rx: Azithromycin or ceftriaxone
68
What causes
shallow Painless ulcer + small papules / granulomas,
>2 wks later buboes form -painful inguinal lymphadenopathy, or enlarged lymph nodes- can form abcesses & procto-colitis
Lymphogranuloma Venereum
Chlamydia (gram -ve)
Rx doxycycline.
69
Causes of PainLess genital ulcers
Treponema Pallidum
Syphilis
Condyloma acuminata
Granuloma Inguinale
donovanosis / granuloma venereum, Klebsiella gram -ve (No lymphadenopathy)
70
Chancre - solitary, painless genital ulcer,(hard base, raised borders, covered an exudate) .Appear /in 3 wks RX: heals without rx
2dary Form Sx :
non-itchy maculopapular rash, with small bumps Start on trunk --> extremities -incl the palms & soles-->genitalia, and other mucous membranes.
2. condylomata lata- smooth, white, painless, wart-like lesions over moist areas like the genitals, the anal region, and the armpits
Treponema Pallidum
Syphilis
Rx: Penicillin G.
71
What causes :
Soft flesh like cauliflower appearance genital lesion
Condyloma acuminata HPV 6& 11
Rx: topical podophyllum or cryotherapy
72
What causes :
genital -painless papule granuloma--> becomes highly vascular & beefy red ulcer which bleeds easily.
Has no lymphadenopathy
Granuloma Inguinale
donovanosis / granuloma venereum, Klebsiella gram -ve
Rx azithromycin
73
Differentiate between Chancroid & Chancre
Chancre- is syphilis- solitary, painless genital ulcer,(hard base, raised borders, covered an exudate) .Appear /in 3 wks RX: heals without rx
Chancroid -Haemophilus ducreyi- painful ulcer with soft irregular margins + purulent exudate. may bleed
74
Differentiate between Condyloma acuminata and condylomata lata
**condylomata lata**-Syphilis smooth, white, painless, wart-like lesions over moist areas like the genitals, the anal region, and the armpits
**Condyloma acuminata** - HPV 6& 11
Soft flesh like cauliflower appearance
75
Causes of False positive non-treponemal (cardiolipin) tests:
pregnancy
SLE, anti-phospholipid syndrome
tuberculosis
leprosy
malaria
HIV
76
Examples of non-treponemal tests- not specific
1. rapid plasma reagin (RPR)
2. Venereal Disease Research Laboratory (VDRL)
77
Examples of treponemal-specific tests-
TP-EIA (T. pallidum enzyme immunoassay), TPHA (T. pallidum HaemAgglutination test)
78
How can you differentiate Jarisch-Herxheimer reaction to anaphylaxis
SX: F, rash, tachycardia after the first dose of antibiotic
there is no wheeze or hypotension.
o due to the release of endotoxins following bacterial death and typically occurs within a few hours of treatment
o No treatment is needed other than antipyretics if required
**Anaphylaxis**wheeze and Hypotension
79
Signs of tertiary syphillis
80
Stages of syphilis
81
Argyll-Robinson Pupil describe
Seen in 3rty syphilis
– ARP – .
Forwards:ARP – Accommodation Reflex Present.
Backwards PRA – Pupillary Reflex Absent.
82
STI's that cause vulvovaginitis/cervicitis causes (3)
Trichomonas vaginalis flagellated protozoan parasite
Chlamydia trachomatis
Neisseria gonorrhoeae
83
What causes
- Discharge: 'fishy', offensive; thin, white homogenous
Burning and itching
asymptomatic in 50%
IX& RX
Bacterial vaginosis
Gardnerella vaginalis.
Not STI
Ix:
* clue cells
* vaginal pH > 4.5
* positive whiff test
Rx: No SX= NONE
Sx or pregnancy= oral metronidazole for 5-7 days
Bv smells fishy in the garden
84
**Name causitive agent, Ix & RX**
discharge: offensive, yellow/green, frothy
vulvovaginitis
strawberry cervix
pH > 4.5
in men is usually asymptomatic but may cause urethritis
Trichomonas vaginalis flagellated protozoan parasite
Ix: wet mount shows motile trophozoites
Rx: oral metronidazole for 5-7 days
85
**Name causitive agent, Ix & RX**
70% asymptomatic
women: cervicitis dysuria, intermenstrual & post-coital vaginal bleeding
men: urethral discharge, dysuria
can result in PID
Reactive arthritis
Chlamydia trachomatis
PID
Reactive arthritis
Ix: nuclear acid amplification tests 2 wks after exposure
Giemsa stain
Rx: doxycycline (7 day course)
Pregnant: azithromycin, erythromycin or amoxicillin
Complications
epididymitis, PID, endometritis, ectopic pregnancies, infertility, reactive arthritis, perihepatitis (Fitz-Hugh-Curtis syndrome)
86
**Name causitive agent, Ix & RX**
males: urethral discharge, dysuria
females: cervicitis e.g. leading to vaginal discharge
rectal and pharyngeal infection is usually asymptomatic
May led to PID & septic arthritis
Rx: IM ceftriaxone
Complications: urethral strictures, epididymitis & salpingitis (hence may lead to infertility). Disseminated infection
87
what causes Cervical montion tenderiness and what is the RX?
PID
* oral ofloxacin + oral metronidazole or intramuscular ceftriaxone + oral doxycycline + oral metronidazole
