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Firms Year 5 > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

Fever
Fatigue
Muscle pains
Proximal myopathy (cant stand up w/o arms)
Gradually worsening 3 months
Weight loss, pain from jaw to temple, sweating
55 Somalian lady
Dx and Mx? Which Ix helpful? What type of disease does it often present with?

A

Polymyalgia Rheumatica

Steroids (max 6-12 months, if struggling —> rheumatology, methotrexate)

Ix is elevated ESR (Ddx with high ESR low CRP is MM) low rheumatoid ix

Giant cell arteritis

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2
Q

What is osteomyelitis and mx options?

A

Infection of bone.
Acute in children (rich blood supply to bone) chronic in adults.

Mx:
Medical - abx therapy. Oral, IV or spacer antibiotic prosthesis.
Surgical - if chronic, consider amputation if limb, antibiotic infused prosthesis, debridement of bone.
Principle of mx in chronic is suppressive abx therapy. Chronic infection increases mortality.

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3
Q

What is a good Ix for large arteritis?

A

PET scan

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4
Q

Pt 16 from India
Come into Fever Clinic
You have received results of positive TB
Next steps?

A

general history, how is Pt doing generally

Counsel patient: 1 in 8 chance of redeveloping

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5
Q

Key SE of TB Med

A

Drug induced liver injury

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6
Q

Is TB in londom going up or down? Why?

A

People applying for work or study visas in London must have an authorised CXR screening for active or latent TB. Since 2012

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7
Q

% of pop. worldwide w latent T?

Deaths worldwide?

A

25%

1.5 million a year and going down

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8
Q

Treatment of latent Tb?

Is it curative?

A

Isoniazid for 6 Months

Or 2 drugs for 3 months

No but 90% reduction in reactivation

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9
Q

What tests test immunological responses to Tb?

A

Mantoux (inject Tb into skin & review after 3 days - impractical) (also cross reacts with BCG) (measure radius of induration)

IGRA (gamma interferon most reliable cytokine look at) (80% sensitivity)

Note these are positive in active Tb, latent Tb, or previously treated Tb

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10
Q

What test would be very useful in future Dx of Tb?

A

Test to find active Tb

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11
Q

How effective is BCG vaccine?

A

30% protective. Only!
90% protection against death 10 years after getting the vaccine. Useful as children are more likely to develop serious Tb such as military or Tb meningitis.

Historically it was done at 11. Stopped a decade ago. Now only high prevalent areas or patients culturally from high prevalent countries are vaccinated soon after birth.

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12
Q

85 yo Male
Lump, hernia
History of Tb
Asbestosis exposure (carpenter)

A

What was his religion?

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13
Q

What do lines of calcification around a CXR - especially around aortic knuckle, around heart border, above diaphragms indicate?

A

Pleural Plaques of Calcification

Pathagnomonic for asbestos exposure

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14
Q

How to confirm latent Tb after positive Tb test”

A

CXR to exclude active TB

Start R I and Vit B6 once a day

Counsel on SE, can get sick, serious SE is it affects the liver. Need to check LFTs 3 weeks after starting treatment. Check with patient what they are doing before starting course - e.g. travel, exams. Show them Tb support and info sites.

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15
Q

How to help adolescent patients with anxious parents?

A

Help child feel they are in control and it is their decision.

Tell them lots of funny stories - eg prof wyns reason he is alive Dad got Tb married Tb nurse

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16
Q

Percentage of different TB sources in uk eg. Toenail

A

Lung
Lymph nodes axilla, neck, mediastinum, abdomen, groin
Then any organ in body - bone and joint, GI, brain

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17
Q

What is military TB?

A

Spreads around the body really really quickly, on CXR you see little little spots around entire CXR

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18
Q

How does TB spread?

A

Macrophages phagocytise Tb acid fast bacilli, which remains in lysosomes of macrophages and hides in body

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19
Q

What does redness on hands and itching after starting a drug indicate?

A

Possible drug allergy

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20
Q

What can cause an ALT rise from 13 —> 496?

A

Anti-Tb treatment

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21
Q

3 most important observations for ?sepsis

A

RR - over 20 indicates acidosis (respiratory compensation)
BP - below 100 worrying
Mental State - is there a change

Trends in T, HR, O2 Sats (end stage) are useful

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22
Q

What do you need to check when starting someone on TB treatment?

A

If it is active with a CXR (if you suspect latent) and the sensitivity of the Tb to different medications

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23
Q

Why use multidrugs for TB?

A
  1. Allows short course
  2. Covers resistance

Pyramadazine very good at killing which shortens course
No one has been able to shorten he course below 6 months so far

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24
Q

How much TB is resistance in UK?

A

1.5% MDR

3-4 Resistant to one

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25
Q

What is the upcoming drug class that is good for TB?

A

Quinolones

Moxyfloxycin

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26
Q

Why do you count the missed doses in TB?

A

It is about cumulative treatment, so give more drugs for missed doses.
If you miss over 2 weeks need to start from beginning

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27
Q

With 100% compliance what is relapse rate of a TB?

A

2%

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28
Q

How is privacy maintained in GUM?

A

different GUM number to hospital number - patients are called in by number
GUM notes are kept separate from medical notes
whole confidentiality law surrounds this
emphasise confidentiality speaking to patients

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29
Q

What is a good opening line seeing patients in GUM clinic?

A

it is all confidential, however if I feel you are at risk, or others are at risk, i may have to disclose some information and I will tell you that I am going to first.

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30
Q

Opening Sexual history Qs?

A 
Why have you come in?
When did you last have sex?
With who?
What is their gender?
Where is your partner from?
What type of sex?
Condom? Last unprotected sex?
Anyone else?
Number of partners last 3/12?
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31
Q

What is the procedure if you see a young person with FGM?

A

Contact safeguarding within 24 hours

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32
Q

What is CSE?

A

Child Sexual Exploitation

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33
Q

What is Gillick Competency?

A

Young person has maturity to understand the nature, purpose and consequences of the treatment/advice being given
HCP sought to involve the person with parental responsibility
the young person will have/continue to have sex and it is

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34
Q

What is NAAT?

A

Nucleic Acid Amplification Test - v high sensitivity for looking for STIs

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35
Q

in GUM what do we do if we see a good going discharge? Then? Indicating?

A

Take a swab

Gram stain - gream negative intracellular diplococci = Neisseria gonnorrhoeae

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36
Q

what do we always do if we plan to treat an STI?

A

Take a swab for culture to identify antimicrobial suceptibility

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37
Q

What does a high Vaginal pH over >5 indicate?

A

Bacterial Vaginosis or Trichomonas

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38
Q

What is a new STI?

A

Mycoplasma genitalium
responsible for 20% of non-gonoccal ureteritis
implicated in PID

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39
Q

What to check for with Genital Ulceration?

A

Herpes Simplex Virus - {CR testing or culture

Syphillis = dark ground microscopy

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40
Q

What is the commonest STI in the UK?

A

Chlamydia

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41
Q

What new sexual health vaccine has started for men this year?

A

HPV 13-14 year old (year 8/9)

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42
Q

What STI disease prevalence has gone back to WW2 levels?

A

Syphillis

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43
Q

What is driving increase in STIs in men?

A

MSM

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44
Q

What are traits of a screening programme?

A
  • important health problem

- good understanding of epidemiology and natural history

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45
Q

What is routine STI testing in pregnancy?

A

HIV
Syphillis
Hepatitis B

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46
Q

What area of confidentiality is there no legislation?

A

Partner notification.

You cannot notify the partner.

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47
Q

4 Bacterial STIs

A

Gonnorhoea

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48
Q

What are most common Gonorrhoea symptoms?

A 
Urethral discharge (80%) 
Dysuria (50%)

Female:
50% asymptomatic
increased or altered vaginail discharge
post coital, intermenstrual bleeding

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49
Q

How to diagnose Gonorrhoea ?

A

Micropscopy - gram negative small tiny gram negative diplocci
Culture
Nucleic Acid / PCR test

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50
Q

Manage Gonorrhoea

A

Ceftraixone IM 1g single dose
Abstain from sex 1 week
Screen for other infections
Post treatment cure test

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51
Q

Which region is commonly linked to drug resistant Gonorrhoea ?

A

South East Asia SE Asia

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52
Q

Gonorrhoea Complications

A 
PID
Epididymo-orchitis
Prostatis
Bartholin's abscess (v painful gonorrhoea infected cyst on labia - drain and remove)
Conjunctivitis (direct innoculation: 
Disseminated disease
Septic arthiritis
Neonatal infection
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53
Q

Chlamydia features

A

common

5-10

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54
Q

Chlamydia management

A

Doxycline for 1 week

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55
Q

Syphillis causative agent and a bit of epidemiology

A

Treponema pallidum - slow dividing bug

new outbreaks in MSM

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56
Q

Syphillis classification

A

Congenital

  • early (under 2)
  • later (over 2)

Acquired
- early: primary, secondary
- early latent (<2 years), late latent (>2 years)
NB latent is

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57
Q

Syphillis presentation

A

Primary syphilis:
Single clear ulcer with round clear aspect and raised edge: usually in genital areas but can be anywhere including mouth
Thought to be painless, but most commonly painful due to surrounding bacterias and infections over the ulcers
Resolve spontaneously after 2-4 weeks then progress to secondary syphillis

Secondary Syphillis: more symptoms & widespread
widespread rash: infects hands and palms of feet (pathognomonic STI finding), hepatosplenomegaly then resolves 2-4 weeks

Latent phase: 10-14 years positive serology no symptoms
then present with tertiary syphillis

Late (tertiary):
Neurological:
decline in memory, emotional lability, personality changes, psychosis, dementia
arreflexia, paraethesia, sensory ataxia, Charcot’s joints, optic åtrophy, pupillary changes

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58
Q

Syphillis Management

A

Penicilin in different forms (1 or 2ary - benzylpenicillin, 3ary benzylg penicillin)

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59
Q

NSU non specific ureteritis

A

non specific when you cant see gonorrhoea

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60
Q

Trichonomonis Vaginalis typical finding

A

Strawberry Cervix

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61
Q

Commonest STI worldwide?

A

Trichomonas Vaginalis

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62
Q

Mary 42 married asymptomatic. referred to GP following a smear test which showed trichomonas

you are GP how would you proceed with the consultation

A

take a sexual history

is there any other way you could have been infected?

repeat the test

is it possible your husband is having sex with someone else?

ok he may be seeing someone else, you should not have sex with him until he is tested

DON’T FORGET YOUR ROLE

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63
Q

Herpes features

A

type 1 and type 2
dna virus
latency - dorsal root ganglion. can go away and come back causing similar symptoms.

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64
Q

Herpes treatment

A

ACiclovir regularly twice between 3 and 12 months

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65
Q

HPV epidemiology

A

30-60% of sexually active population
symptomatic, sub-clinical, virus clearers / latent
incuvation: average 3 months 2/52 - 9/12

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66
Q

Warts management

A

Different treatment menthods
- podophylotoxin, imiquimod (aldara)< TCA

in pregnancy, cryotherapy

barrier contracpetion until warts have cleared

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67
Q

What drug used for HPV vaccine?

A

Gardasil

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68
Q

Commonest cause of vaginal discharge? epidemio

A

Bacterial Vaginosis
imbalance in pH
RFs: vaginal douching, cunnilingus, black, smoking, presence of a STI
linked to early miscarriage

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69
Q

Less common cause of vaginal discharge

A

Thrush

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70
Q

What STI can cause hair loss

A

secondary syphillis causes alopecia areata

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71
Q

pathagnominc secondary syphillis

A

rash on palms of soles and feetr

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72
Q

What does molluscum look like?

A

soft, round raised nodular lesion, pearly imbulicated centre..
if affecting eyes: advanced HIV cases

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73
Q

HSV looks like, what to do if you see

A

blisters for a short while - ulcerate

treat ASAP, benefits only from early treatment - Aciclovir

74
Q

HSV looks like, what to do if you see

A

blisters for a short while - ulcerate

treat ASAP, benefits only from early treatment - Aciclovir
would reduce blisters & shorten course

75
Q

When do we never cathereise?

A

severe HSV or you spread HSV into bladder. We do a suprapubic catheter instead

76
Q

What OTC is a waste of money for HSV?

A

Topical Creams

77
Q

What do tiny pearly penile papules indicate?

A

Completely normal

78
Q

What are conditions that need to be seen ASAP?

A

HIV exposure (give post exposure HIV medication)
Herpes (need to give treatment ASAP)
Emergency Contraception
Discharge (possibly, concern here is further spread of an STI)

79
Q

How do you screen a male and female patient for Gonnnorhoea and Chlamydia?

A

Urine Test - Microscopy, Culture, NAAT (a form of PCR)

Vulval Swab -

80
Q

What are the principles of STI management?

A

test before treatment (not Aciclovir)

screen for accompanying STIs

81
Q

What is the doctors name?

A

Dr Nigel O’Farrel

82
Q

What are routine tests in GUM Clinic?

A

Urine GC-CT (gonorrhoea, chlamydia)

blood - syphillis & HIV

83
Q

What does herpes cause?

A

Ulcers

84
Q

How do we test for herpes?

A

We mostly don’t. The tests are fairly inaccurate.

85
Q

What factors cause change in STI amount?

A

Amount of sex
Gender of partners
Number of partners
Condom use

86
Q

What has lowered condom use in MSM?

A

Prep

Pre-exposure prophylaxis

False sense of security - has increased unprotected sex

(The pieces of the puzzle are in front of you)

87
Q

Man is angry at clinic saying his wife has started getting genital herpes, how do you approach?

A

Reassure him this is normal, it may be from a long time ago and has appeared, or it has been contracted through normal means, it doesn’t necessarily mean anything bad

88
Q

What helps with GUM practice?

A

Not being ashamed about the body - being real

89
Q

What is a positive result after taking urethral swab?

A

More than 5 pus cells/HPF is non-specific urethritis

If symptoms resolve Can turn out to be nothing

(High power field)

90
Q

What is something vital to the consultation?

A

Checking the DOB to confirm the ID of the patient

91
Q

22 yo comes in with on/off dysuria 3 months
O/e reddish scrotum and foreskin
Dx?
Next steps ?

A

Urethral Swab - gram stain look for gram +ve

Fungal rash ?

92
Q

What areas in Africa have high HIV?

Give 2 countries

A

Central east and Southern Africa

South Africa: 20%
Swaziland (has changed its name now): 20%

93
Q

Where has higher HIV, South Africa or Sierra Leone?

A

South Africa

Sierra Leone is in West Africa: lower

94
Q

Why is HIV high in Central East and South Africa compared to West Africa?

A

They are circumcised in West Africa.
Circumcision is preventative against HIV (in Africa)
3 RCTs show 60% reduction in circumcised group
WHO is introducing circumcision programmes (30 years too late)

95
Q

What actually happens after taking a urethral swab?

A

They put the swab under a microscope and count the pus cells.

96
Q

The causes of white discharge in women?

A

Candida
Bacterial Vaginosis
Trichomonas

97
Q

White discharge in female - most likely dx

A

Candidiasis

98
Q

Offensive discharge female

A

Bacterial vagnosis

99
Q

Abdo pain and discharge

A

PID

chlamydia or gonorrhoea

100
Q

How to make patients feel less judged?

A

Be less interested in their case. In them.

101
Q

What is useful to remember with patient communication?

A

You can’t make everybody happy.
Part of it is on the patient.
If patients keep coming back then something must be going right.
Look at real figures. Realism.

102
Q

How is STD health/testing funded?

A

Local councils

103
Q

Intracellular diplococci gram -ve

A

Neisseira gonorrhoea

Can be similar to neissera meningitidis

104
Q

What % of patients at NWP and the NHS are on antibiotics?

A

40%

105
Q

How to benefit flora when presribing antibiotics?

A

Prescribe the narrowest antibioitic you can

106
Q

Coagulase -ve Staph and the patient is well?

A

Likely a contaminant

107
Q

Some areas with high resistance pathogens?

A

spain
greece
SE Asia

108
Q

what can augmentin be switched for in a cellulitis?

A

Flucloxacillin (attacks Staph aureus

109
Q

What is essential to enable narrow spectrum antibiotic prescribing to work?

A

SOURCE CONTROL

  • drain abscesses!
  • do all you can! (can’t always)
110
Q

How to help gut flora when prescribing?

A

specific abx

SHORT COURSE

111
Q

What is something abou abx prescriibng we don’t know much about?

A

There are not many RCT for course lengths (only for pyelonephritis

112
Q

Contraindication to LInezolid

A

Sertraline

113
Q

Penicillins give them:

A 
benzylpenicillin (penicillin V)
amoxicillin
Piperacillin
Tazocin (Tazobactam and Piperacillin)
Co-amoxiclav
Flucloxacillin
114
Q

What is ESBL?

A

extended spectrum beta-lactams

115
Q

What can treat ESBL?

A

Carbapenems (ALWAYS SAY THIS)

can use tazocin - people are being encouraged to use tazocin

116
Q

List carbapenems

give gram -ve actiivty

A

Meropenem
Imipenem (can lead to renal impairment and seizures)
Ertapenem

Gram negative activity highest at top

117
Q

How does gram -ve activity change with beta lactams?

A

The newer the generation, the greater the activity

118
Q

Can you use Ertapenem for pseudomonas?

A

NO, as low Gram -ve activity

119
Q

Co-amoixiclav cover?

A

…

120
Q

What works for p

A

Ceftazadine
Ciprofloxacin (fluoroquoinolones)
Tazocin

121
Q

C. difficile associations (4)

A

Clindamycin
Cephalosporin
Ciprofloxacin
Co-amoxiclav

122
Q

Aminoglycosides

A

Gentamicin
Amikacin
Toberomicin

123
Q

Atypical Pneumonias?

Treatment

A

Legionella
Mycoplasma

Benpen (for community)
Clarithromycin

124
Q

Glycopeptides

A

Vancomycin

Teicoplanin

125
Q

Resistant Gram +ve?

A

Glycopeptide

126
Q

Carapenemases resistance?

A

Resistant to all beta-lactams

127
Q

How to determine penicilin allergy if pt has a rash?

A

If it comes up after 3 days then that is delayed

If it affects the mucous membrane, the mucous membranes, then you cannot give any penicillins.

128
Q

If someone is penicillin allergic what drugs can you use?

A 
Vancomycin (low cidal) +ve
Teicoplanin (static) +ve
AG (cidal) +ve
Clinda (cidal) staph and strep and anaerobes (
Macro
Tetra
Linezolid (static, many interactions) +
Daptomycin
Fluoroquinolines
Metronidazole

http://www.icid.salisbury.nhs.uk/MedicinesManagement/Guidance/AntimicrobialMedicine/Documents/traffic%20lights%20penicillin%20allergy.pdf

129
Q

What causes meningitis?

Treat

A

Neisseria men
Strep pneumoniae
Haemophilus influenzae
Listeria men ( give ampicillin)

Ceftriaxone

130
Q

What test do you do if gram +ve cocci in clusters

A

Coagulase Test
negative Coag-ve Staph
positive SA MSSA or MRSA

131
Q

What does SA affect? (superficial to deep)

A

skin (cellulitis)
soft tissue (x.. necrotizing fascitis, pressure sores)
bone (septic arthiritis, osteomyelitis) (bony pains)
chest (endocarditis) (murmurs)
lung (
LINES

132
Q

When is coag -ve staph important?

A

WHen you have prosthetic material in you

133
Q

Difference between staph and strep skin infections?

A 
staph is localised
strep spreads (e.g. whole leg is red)
134
Q

Where does SA commonly affect?

A

Nose

135
Q

Beta-haemolytic strep groups?

A

A, B, C/G

136
Q

Beta-haemolytic strep groups?

A

A, B, C/G

Skin, Soft,

137
Q

Haemolysis on blood agar?

blood in agar plate

A

Non-haemolytic (enterococci) (gamma-haemolysis - no degradation) (piperacillin)
Alpha-haemolytic (strep pneumoniae, strep viridans) (partial degradation of blood cells)
Beta-haemolytic (Group A, B, C/G) (full degradation of blood cells)

138
Q

Haemolysis on blood agar?

(blood in agar plate)§§§

A

Non-haemolytic (enterococci) (gamma-haemolysis - no degradation) (piperacillin)
Alpha-haemolytic (strep pneumoniae, strep viridans) (partial degradation of blood cells)
Beta-haemolytic (Group A, B, C/G) (full degradation of blood cells)

139
Q

Different types of HIV?

A

HIV-1 Group M (main) cause of AIDS epidemic

HIV-2 prevalent in West Africa

140
Q

Differences of HIV-1 and HIV-2

A

distribution

accessory genes
HIV-1 vpu
HIV-2 vpx

rate of pregression of sever immunosuppression
HIV-1 median time to AIDS = 10 years
HIV-2 median time = longer

resistance to ARV
HIV-2 intrinsically resistant to a lot of NNRTI (ARD)

141
Q

How is HIV-1 classified?

A

Groups
M (Major) with 9 subtypes (clades)
O (outlier)
N (reported only in CamerooN

142
Q

What are the clades?

A 
subtypes of HIV-1 M 
identified by gene sequencing
A to K
Clade B most common in Europe
differ in geographich distribution
Clade C, present in Ethiopia, most infectious and progressive
143
Q

What is recombinant HIV?

A

RNA of two viruses joins together

144
Q

Why is HIV low in IVDU more lately?

A

Needle exchange programmes
Methadone to get drug users away from needles
Screening of blood transfusion problems

145
Q

What has caused a sharp drop in HIV rates in MSM and Bisexual men?

A

PrEP

prevention exposure prophylaxis

146
Q

What is a late diagnosis in HIV?

A

CD4 is below 350 (normally 800-1500)

147
Q

When does immunosuppresion in HIV occur?

A

CD4 is below 200

may see effects below 350 e.g. weight loss

148
Q

When does immunosuppresion in HIV occur?

A

CD4 is below 200 (opportunistic infections begin e.g. PJ)

may see effects below 350 e.g. weight loss

149
Q

what is UNAIDS 90 90 90?

A

90% with HIV will know they have HIV
90% of those will be on treatment
90% of those will have undetectable HIV load (Non-infectious)

150
Q

What is the rationale behind UNAIDS 90 90 90?

A

If this is done by 2020, by 2030 no new infections of HIV will occur.
(non-detectable load is non-infectious)

151
Q

Where does UK stand with UK 90 90 90?

A

good progress: 92 90 87 in 2017

90 81 73 in 2014

152
Q

Where does UK stand with UK 90 90 90?

A

good progress: 92 90 87 in 2017

90 81 73 in 2014

153
Q

When do constitutional symptoms begin with HIV?

A

Below CD4 300

154
Q

What drives HIV?

A

The Viral Load

progression and tramsission

155
Q

How was staging done far in the past?

A

Before we could measure viral load, it was done by clinical presentations (e.g. constitutional symptoms, opportunistic infections, v. opportunistic infections (e.g. fungal))

156
Q

When is a risky time to transmit HIV?

A

1 week after infection there is a viral load spike, then it falls, then after ±10 years, it rises again

157
Q

Which STI increases risk of HIV?

A

Trichomonas

158
Q

Which STI increases risk of HIV?

A

Trichomonas

159
Q

What does TASP stand for?

A

Treatment as Prevention

Not one case of non-detectable viral load and sex causing transmission

160
Q

Is it true 10% of your lymphocytes are against CMV?

A

not sure

161
Q

U=U

A

undetectable = untransmissable

162
Q

POPART

A

1.2 bn patients on treatment

163
Q

How long is PEP effective?

A

72 hours

164
Q

Is PrEP effective? Is it in this country?

A

yes. can be used once daily, or just before or after sex.

not available in this country

costs £20-40 online, so a lot of patients buy it

165
Q

What is initial HIV stage called? what symptoms?

A

Acute or Seroconversion stage

usually asymptomatic

166
Q

Why does candidiasis show up in the immunocompressed?

A

We are all infected with it but are suppressing it

167
Q

What is a white plaque on side of tongues that doesn’t scrape off?

A

Oral Hairy Leukoplania

168
Q

Elliptical Lesion on chest

A

do a HIV test.

KS (HHV8)

169
Q

Lots of abscesses

A

do a HIV test

170
Q

What does PCP (pneumocystic jiroveci) look like?

A

on CXR it has a lot of parenchymal appearance

171
Q

ring enhancing lesions in CT Head

A

Toxoplamosis (CD4 below 100)

HIV test

172
Q

non-ring enhancing lesion/abscess CT Head

A

CNS lymphoma

173
Q

weird and wonderful CT head.. test?

A

HIV test

174
Q

severe CMV retinitis

A

severe cheesy pizza pie on fundoscopy

CD4 below 50 HIV

175
Q

managemnt HIV

A

3 ARVs ASAP (except if pregnant or opportunistic infx)
(asap depends on the patient, see what they are doing)

3 drugs (2NRTI+NNRTI/2NRTI +Protease Inhibitor or Integrase Inhibitor)

inform SEs

OD (helps adherence)
Adherence (must take 90-95% of their targets to achieve a non-detectable load 90 is high) (dosset box, alarms, fitting into routine)

176
Q

How long does it take to achieve undetectable load if things go well? HIV

A

16 weeks

177
Q

What is ‘undetectable load’ HIV

A

Viral load below 50

178
Q

long term management HIV

A 
FU every 6 months
Viral Load every 6 months
CD4 counts
annual smears
adherence checks
drug interaction (methadone, steroids, antidepressants, COCP, TB Drugs, statins, PPIs)
179
Q

Why is ver low CD4 count in HIV an issue

A

It may limit the celiing of how high the CD4 can return to

much much higher burden for patient and health service if comorbidities already picked up

180
Q

how does HIV affect cervical smear screening?

A

it is done annually until 65

181
Q

Key aspects of HIV

A

HIV Infection is a chronic, treatable condition
Fundamental to test and treat as soon as possible
Stigma is still a big barrier
Tool box of preventive measures
Monitor to ensure good life time prognosis

Firms Year 5 (2 decks)

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