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2 Principles of Disease > Lecture 4 pt 2 > Flashcards

Lecture 4 pt 2 Flashcards

1
Q

Definition of AIDs

A

chronic, life-threatening disease caused by the human immunodeficiency virus, resulting in progressive and ultimately profound immune suppression

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2
Q

HIV vs AIDs

A

HIV infection & AIDs refer to different stages along the disease spectrum

HIV = used for virus and early stages of disease process

AIDs = later stages of HIV infection

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3
Q

Epidemiology of AIDS

A

Epidemic in many countries
Since late 90s, significant declines in number of new cases. # of people living with AIDS has increased

prevalence is increasing, incidence is decreasing

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4
Q

Transmission of HIV

A

occurs by exchange of body fluids, especially blood and semen

viral load is highest in blood and semsn

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5
Q

Risk factors for infection of AIDs/HIV

A

unprotected sex with multiple partners
unprotected sex w/someone who is HIV+
having another STD
sharing needles
accidental needle sticks with infected blood
received blood transfusion btwn 77-85
newborns or nursing infants w/HIV+ mothers

MSM most common, injection drug use

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6
Q

Ways HIV is not transmitted

A

ordinary contact with someone who is positive

contact with sweat or tears

sharing food, utensils, towels, swimming pool, telephone, toilet seat

being bitten by mosquitoes

kissing someone who has HIV/AIDS

donating blood

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7
Q

Pathogenesis of HIV/AIDS (DNA level)

A

retroviruses = single stranded RNA

binding of HIV to host cells that contain CD4 marker on surface–> helper T-cells

binding results in springing open of lipid bilayer of host cell, viral/host cell then fuse together

copied DNA enter the cell nucleus, the virus helps the DNA enter the chromosomal DNA

integrated DNA virus may remain latent in host cell for hours to years before becoming active through transcription

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8
Q

CD8 cells and HIV replication

A

CD8 inhibit HIV replication both directly (killing infected cells) and indirectly (producing interferons)

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9
Q

HIV/AIDS progression

A

HIV infection/acute infection –> early asymptomatic HIV infection –> symptomatic HIV infection –> AIDs

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10
Q

HIV progression is monitored by measuring the number of ______ in the blood

A

CD4 lymphocytes
<500 –> indicate some immune impairment
<200 –> imminent risk of opportunistic infections

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11
Q

Why is CD4 count important?

A

depletion is hallmark of HIV infection
useful marker for HIV/AIDS staging
correlates w/risk of opportunistic infections

main criterion for clinical decision making for treatment –> when to start ART and prophlatic treatment

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12
Q

AIDS diagnosis is made when a person is:

A

HIV positive AND CD4 count <200 cells
HIV positive AND/OR diagnosed w/aids-defining illness

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13
Q

AIDS defining illness

A

Candidiasis of bronchi, trachea, esophagus, lungs
coccidiodomycosis disseminated
encephalopathy
cytomegalovirus
pneumonia
lymphoma
wasting syndrome
tuberculosis

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14
Q

TB infection

A

means TB is in the body, but the body’s immune system has it under control
people with TB infection are non-infectious

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15
Q

TB disease

A

develops when the body’s immune system cannot keep the TB under control, begins to multiply
people with disease are infectious

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16
Q

Clinical Presentation of AIDS

A

there may be no symptoms for up to 10 years

eventually, mild infections or chronic symptoms begin (swollen lymph nodes, diarrhea, weight loss, fever, cough, rash)

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17
Q

Late phases of HIV infection

A

development of opportunistic infections
soaking night sweats
shaking chills or fever
chronic diarrhea
headaches
blurred/distorted vision
weight loss
unexplained fatigue

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18
Q

Diseases related to AIDS

A

HIV associated dementia
peripheral neuropathy
HIV wasting syndrome (cachexia)

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19
Q

Prevention for HCWs

A

blood into open cut or mucous membrane
being stuck with needles containing HIV-infected blood
most exposure is caused by SPLASH, but blood is more infectious

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20
Q

Pre-exposure prophylaxis

A

there is no vaccine for HIV
PrEP to reduce likelihood of HIV infection for high risk individuals

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21
Q

Pharmacotherapy

A

NO cure for AIDS
with antiretroviral therapy, HIV can be controlled

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22
Q

ART

A

combination of antiretroviral drugs from different classes that must be taken every day

each drug class inhibits enzymes involved in different steps during HIV replication

combo drugs = greater clinical effectiveness, prevention, delay of viral drug resistance

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23
Q

Medication adherence

A

taking medications exactly as prescribed

helps to avoid treatment failure
reduce risk that HIV will mutate and produce drug resistant HIV
decrease transmission of drug resistant HIV

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24
Q

Who should take ART?

A

recommended for everyone with HIV asap
often initiated when CD4 <500 cells

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25
Q

What is the goal of ART?

A

cannot cure HIV/AIDS
reduce a person’s viral load
reduce risk of transmission
does not completely eradicate HIV from body

26
Q

Nonpharmacological treatment for AIDS

A

exercise, nutrition, mental health, complementary medicine
can help relieve pain, fatigue and medication ADRs, strengthen immune system, reduce stress

27
Q

Exercise in HIV/AIDS may help

A

provide pain relief
increase appetite
reduce muscle atrophy
regular bowel habits
counter ADRs

28
Q

Promoting self-care

A

regular exercise
avoid smoking/drug use
eat healthy
avoid foods that increase risk of infection
clean water
sufficient sleep
good hygiene

29
Q

Beware of risks associated with companion animals

A

tinea corporis (ringworm)
toxoplasmosis –> cleaning litter box and touching mouth/face afterwards

30
Q

Rheumatoid Arthritis Definition

A

chronic systemic inflammatory disorder in which immune system cells attack healthy tissues

characterized by polyarticular, symmetrical joint involvement, extra-articular involvement

31
Q

Epidemiology and Risk factors for RA

A

female
onset is frequently 30-60yr
caucasians
1-2% of USA population

32
Q

Pathogenesis of RA

A

no single factor or agent is known to cause RA
some unknown antigen triggers B cells to produce RF

33
Q

Rheumatoid Factor (RF)

A

autoantibodies against IgG

34
Q

What type of hypersensitivity is RA?

A

Type 3–> immune complex mediated disease
excessive immune complexes are deposited in tissues
resulting in vasculitis, which damages tissues

35
Q

Immune complexes cluster in ______

A

synovial fluid
stimulate complement system, WBCs go into synovium
will cause development of pannus

36
Q

Pannus

A

destructive mass of fibroblastic, vascular, inflammatory cells

dissolves collagen, cartilage, bone
prevents the synovium from lubricating the joint and providing nutrients to articular cartilage

results in irreversible joint instability, deformity, fusion/ankylosis

37
Q

Clinical presentation of RA

A

symmetrical and bilateral joint
ligament laxity
warm, painful, stiff joints
wrist, MCP, PIP, knees, feet, cervical spine

38
Q

Common deformities of fingers in RA

A

swan neck
boutonniere

39
Q

Tendon/ligament involvement of RA

A

tendinitis of rotator cuff and palmar flexor
finger deformities
claw toes
instability of ligaments in cervical spine, specifically C1/C2

40
Q

Extra-articular involvement of RA

A

firm, subcutaneous masses in areas with mechanical pressure
usually asymptomatic

may appear in viscera (lungs, heart, GI)

41
Q

Nodules in organs

A

eyes –> scleritis
heart –> pericarditis
lungs –> effusion
nerve –> carpal tunnel
vessels –> vasculitis

42
Q

Diagnosis of RA

A

prolonged morning stiffness in involved joints, weight loss, anorexia, fatigue, swelling in joints, RA hand changes, RF factor in blood

43
Q

OA features

A

Wear/tear of joints
increasing age, sex depends
1 joint, hip/knee
no inflammation
not prolonged stiffness
years for onset
no systemic presentation

44
Q

RA features

A

unknown/autoimmune
30-60 yr old, more common in females
bilateral joints. Usually in toes, fingers, cervical
inflammation
prolonged stiffness
onset is weeks to months
systemic presentation

45
Q

Treatment for RA

A

no cure
medications, surgeries, patient education on self-care, PT, OT

46
Q

Pharmacotherapy for RA

A

DMARDs = disease modifying antirheumatic drugs
includes methotrexate

only class of drugs that alters/slows course of RA

47
Q

Prognosis of RA

A

must have good response to treatment and early responses to medication

48
Q

Indications of Poor prognosis with RA

A

extra-articular disease carriers, greater risk of CVD
tons of invovled joints
poor functional status
elevated SED rate
erosions
RF present

49
Q

RA and PT

A

avoiding cervical flexion
educate on progression
rest periods –> decreases fatigue and protects joints
focus on resistance training, ROM, no stretching, assistive devices
exercise can help reduce stiffness, but should not produce pain that last longer than an hour

modalities –> superficial heat (no deep heat), skin condition is usually poor

50
Q

Fibromyalgia definition

A

chronic widespread musculoskeletal pain syndrome characterized by chronic pain and tenderness at specific locations, often associated with persistent fatigue, cognitive/mood/sleep disorders

51
Q

Epidemiology of fibromyalgia

A

prevalence is about 2-4% of population
more are females, and symptoms are between 20-55 years of age

52
Q

Risk factors for fibromyalgia

A

female
prolonged anxiety, emotional stress
trauma
rapid glucocorticoid withdrawal
hypothyroidism
infections
minimal to moderate aerobic fitness level

53
Q

Etiology and pathogenesis of fibromyalgia

A

UNKNOWN

most accepted hypothesis : neurologic disorder of central pain processing that causes pain perception in response to stimuli that would not typically be painful

54
Q

Clinical presentation of fibromyalgia

A

chronic and diffuse aching pain often involving entire body with prominence around neck, shoulders, low back, hips. physical exam is often normal

minor exertion aggravates pain & increases fatigue
visual problems
morning stiffness
cognitive problems
depression/anxiety
sleep disturbances
IBS
chronic headaches

55
Q

Diagnosis of fibromyalgia

A

widespread pain >7
generalized pain, 4 or 5 regions
symptoms for at least 3 months

tender points are controversial and not accepted

56
Q

fibromyalgia may be considered a ______ of _______

A

diagnosis of exclusion

pt must meet all 3 criteria

57
Q

Treatment of fibromyalgia

A

there is no cure

patient education, stress management, work simplication
medications = anti-depressants
CBT
exercise

58
Q

Prognosis of fibromyalgia

A

good, though most have persistent symptoms for years or lifetime

59
Q

Exercise for fibromyalgia

A

people with fibromyalgia fatigue quickly, low tolerance for exertion
stop with increased pain

60
Q

Exercise prescription for fibromyalgia

A

F: 1-2 days a week
I: very light
T: start with 10 min a day
T: low impact, non weight-bearing

gentle stretching for flexibility

2 Principles of Disease (7 decks)

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