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Flashcards in STI Deck (43)
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1

How long does it take to get HIV test results?

Rapid HIV antibody tests can produce results within an hour.
Results of the plasma HIV RNA test and Western blot are available in a few days to a few weeks.

The plasma HIV RNA test (also called a viral load test) can detect HIV in a person’s blood within 9 days of infection, before the body develops detectable HIV antibodies. The plasma HIV RNA test is recommended when recent infection is very likely—for example, soon after a person has had unprotected sex with a partner infected with HIV.

2

When does CDC strongly recommend that all pregnant women should start on AART (active antiretroviral therapy) by the time their CD 4 T cell (helper T Lymphocyte express cluster determinant 4) count is at:
a.

d. Regardless of CD4 count, Efavirnez (EFV) is effective for pregnant women and can be continued in pregnancy.

3

A 20 year old male has suspected acute infection of HIV. How should the NP confirm his suspicion?
1. Order an HIV viral load
2. Order HIV IgM antibodies
3. Order an enzyme immunoassay
4. Order a Western blot

1. Order an HIV viral load or the HIV RNA test

The plasma HIV RNA test (also called a viral load test) can detect HIV in a person’s blood within 9 days of infection, before the body develops detectable HIV antibodies. The plasma HIV RNA test is recommended when recent infection is very likely—for example, soon after a person has had unprotected sex with a partner infected with HIV.

4

What does it mean to test HIV positive? What confirmatory test needs to be done?

A diagnosis of HIV is made on the basis of positive results from two HIV tests.

The first test can be either an HIV antibody test (using blood, urine, or fluids from the mouth) or a plasma HIV RNA test (using blood).

The second test (always using blood) is a different type of antibody test called a Western blot test. A positive Western blot test confirms that a person has HIV.

5

What is a CD4 count?
What CD4 count constitutes AIDS

HIV attacks the immune system, destroying the system’s infection-fighting CD4 cells. Keeping the immune system healthy is an important goal of HIV treatment.
The CD4 count measures the number of CD4 cells in a sample of blood. The CD4 count of a healthy person ranges from 500 to 1,200 cells/mm3. An HIV-infected person with a CD4 count of less than 200 cells/mm3 has AIDS.
Because a falling CD4 count is a sign that HIV is damaging the immune system, the test is used to monitor HIV infection. Once treatment is started, the CD4 count is also used to monitor the effectiveness of anti-HIV medications.

AIDS = CD4

6

What is the normal CD4 count in a healthy person?

What CD4 count is considered AIDS in a HIV- infected person?

The CD4 count measures the number of CD4 cells in a sample of blood. The CD4 count of a healthy person ranges from 500 to 1,200 cells/mm3.

An HIV-infected person with a CD4 count of less than 200 cells/mm3 has AIDS.

7

What is the screening test for HIV?
What is the confirmatory test?
What is the diagnostic test for HIV?

Screening test is ELISA (enzyme linked immunosorbent Assay). It is an antibody test with high sensitivity for HIV.

Confirmatory test is Western Blot. (antibody IgM test)

Diagnostic test is HIV RNA or HIV PCR (counts viral load)

8

Does the ELISA and western blot detect IgG antibodies or the viral load RNA?

only IgG antibodies.

9

What test is done if both ELISA and Western Blot are positive?

Viral HIV RNA Test or HIV PCR

10

What is a normal CD4/CD8 ratio?
What does it mean if the ratio is higher than 2?
What does it mean if the ratio is less than 1?

The normal CD4/CD8 ratio is 2.0, with CD4 lymphocytes equal to or greater than 400/mm3 and CD8 lymphocytes equal to 200 to 800/mm3.

If your ratio is higher than 2, it means your immune system is strong and you may not have HIV.

If your ratio is less than 1, you may have HIV

11

What HIV screening test can be done in the office that gets the results within 5 - 40 mins, and what confirmatory test needs to be done once the results are positive?
a. Rapid HIV testing and Western Blot
b. Elisa Testing and Western Blot
c. HIV RNA test and Western Blot

a. Rapid HIV testing and Western Blot

The plasma HIV RNA test (also called a viral load test) can detect HIV in a person’s blood within 9 days of infection

It takes about 3-6 months to detect antibodies in HIV positive from infection.

12

If patient has a negative ELISA/Western blot, but is high risk and suspect HIV, would you order a HIV PCR or not?

yes, false negative ELISA/Western Blot with high risk and HIV suspect should be ordered a HIV PCR.

13

True or False
Some coinfections commonly seen in people infected with HIV include:
HIV/hepatitis B virus (HBV) coinfection
HIV/hepatitis C virus (HCV) coinfection
HIV/tuberculosis (TB) coinfection

True

14

True or False:
People infected with HIV should be tested for HBV, HCV, and TB

True: People infected with HIV should be tested for HBV, HCV, and TB

15

AIDS-defining condition:

Any of several illnesses that can lead to a diagnosis of AIDS in a person infected with HIV. AIDS is the most advanced stage of HIV infection.

16

Is TB disease considered an AIDS-defining condition, and when should TB treatment be started (immediately or delayed?)

TB disease is considered an AIDS-defining condition, and TB treatment should be started immediately.

17

A 20 year old male has suspected acute infection of HIV. How should the NP confirm his suspicion?
1. Order an HIV viral load
2. Order HIV IgM antibodies
3. Order an enzyme immunoassay
4. Order a Western blot

1. Order an HIV viral load or the HIV RNA test

The plasma HIV RNA test (also called a viral load test) can detect HIV in a person’s blood within 9 days of infection, before the body develops detectable HIV antibodies. The plasma HIV RNA test is recommended when recent infection is very likely—for example, soon after a person has had unprotected sex with a partner infected with HIV.

18

What does it mean to test HIV positive? What confirmatory test needs to be done?

A diagnosis of HIV is made on the basis of positive results from two HIV tests.

The first test can be either an HIV antibody test (using blood, urine, or fluids from the mouth) or a plasma HIV RNA test (using blood).

The second test (always using blood) is a different type of antibody test called a Western blot test. A positive Western blot test confirms that a person has HIV.

19

What is the normal CD4 count in a healthy person?

What CD4 count is considered AIDS in a HIV- infected person?

The CD4 count measures the number of CD4 cells in a sample of blood. The CD4 count of a healthy person ranges from 500 to 1,200 cells/mm3.

An HIV-infected person with a CD4 count of less than 200 cells/mm3 has AIDS.

20

What is a viral load test?

When is it tested once treatment is started?

Preventing HIV from multiplying is another important goal of HIV treatment. The viral load test measures the amount of HIV in the blood. It’s the best measure of how well anti-HIV medications are controlling the virus.

The best sign that treatment is working is reaching and maintaining an undetectable viral load. An undetectable viral load doesn’t mean that you’re cured. It means that the amount of HIV in your blood is too low to be detected by the viral load test.

Once you start treatment, you should have a viral load test within 2 to 8 weeks and then once every 4 to 8 weeks until your viral load is undetectable. You need the test done only every 3 to 4 months once your viral load is undetectable. If you have an undetectable viral load for more than 2 or 3 years, your health care provider may recommend viral load testing once every 6 months.

21

What is the screening test for HIV?
What is the confirmatory test?
What is the diagnostic test for HIV?

Screening test is ELISA (enzyme linked immunosorbent Assay). It is an antibody test with high sensitivity for HIV.

Confirmatory test is Western Blot. (antibody IgM test)

Diagnostic test is HIV RNA or HIV PCR (counts viral load)

22

Does the ELISA and western blot detect IgG antibodies or the viral load RNA?

only IgG antibodies.

23

What test is done if both ELISA and Western Blot are positive?

Viral HIV RNA Test or HIV PCR

24

What is a normal CD4/CD8 ratio?
What does it mean if the ratio is higher than 2?
What does it mean if the ratio is less than 1?

The normal CD4/CD8 ratio is 2.0, with CD4 lymphocytes equal to or greater than 400/mm3 and CD8 lymphocytes equal to 200 to 800/mm3.

If your ratio is higher than 2, it means your immune system is strong and you may not have HIV.

If your ratio is less than 1, you may have HIV

25

What HIV screening test can be done in the office that gets the results within 5 - 40 mins, and what confirmatory test needs to be done once the results are positive?
a. Rapid HIV testing and Western Blot
b. Elisa Testing and Western Blot
c. HIV RNA test and Western Blot

a. Rapid HIV testing and Western Blot

The plasma HIV RNA test (also called a viral load test) can detect HIV in a person’s blood within 9 days of infection

It takes about 3-6 months to detect antibodies in HIV positive from infection.

26

If patient has a negative ELISA/Western blot, but is high risk and suspect HIV, would you order a HIV PCR or not?

yes, false negative ELISA/Western Blot with high risk and HIV suspect should be ordered a HIV PCR.

27

True or False
Some coinfections commonly seen in people infected with HIV include:
HIV/hepatitis B virus (HBV) coinfection
HIV/hepatitis C virus (HCV) coinfection
HIV/tuberculosis (TB) coinfection

True

28

True or False:
People infected with HIV should be tested for HBV, HCV, and TB

True: People infected with HIV should be tested for HBV, HCV, and TB

29

AIDS-defining condition:

Any of several illnesses that can lead to a diagnosis of AIDS in a person infected with HIV. AIDS is the most advanced stage of HIV infection.

30

Is TB disease considered an AIDS-defining condition, and when should TB treatment be started (immediately or delayed?)

TB disease is considered an AIDS-defining condition, and TB treatment should be started immediately.

31

What medication is considered the safest to use during pregnancy and infants?

Zidovudine (retrovir, ZDV, AZT)

32

When is Zidovudine (AZT) started for infants?
a. within first 6 -12 hours of delivery
b. within week of delivery
c. within month of delivery
d. Within 2 months of delivery.

a. within first 6 -12 hours of delivery

33

When is Zidovudine ideally started in pregnant women?
a. first trimester
b. second trimester
c. third trimester

second trimester (can be started earlier if needed for mother's health)

34

What opportunistic infection can occur if CD4 count less than 100?
a. Pneumocystis jerovecii (previously known as pneumocystis carnii or PCP)
b. Toxoplasma gondii infections (protozoa)
c. Myocbacterium avid complex (MAC)

b. Toxoplasma gondii infections (protozoa)
causes brain abscesses (headaches, blurred vision, confusion, imbalance, others). Avoid cleaning cat litter boxes and eating undercooked foods.

35

What is the treatment for both
a. Pneumocystis jerovecii (previously known as pneumocystis carnii or PCP)
b. Toxoplasma gondii infections (protozoa)

Bactrim DS (TMP/SMX) one tablet daily.
If developed a severe reaction to sulfas, the next step is dapsone 100 mg daily or artovaquone.

36

What opportunistic infection can occur if CD4 count less than 50?
a. Pneumocystis jerovecii (previously known as pneumocystis carnii or PCP)
b. Toxoplasma gondii infections (protozoa)
c. Myocbacterium avid complex (MAC)

c. Mycobacterium avid complex (MAC)
Risk factors;
Low CD4 count
●Use of an indoor pool for swimming
●Previous bronchoscopy
●Repeated consumption of raw or partially cooked fish or shellfish

37

What is the 1st line and alternative treatment for Mycobacterium avid complex (MAC)?
a. Clarithromycin and Azithromycin
b. Azithromcyin and Clarithromycin

Clarithromycin and Azithromycin (just think of it as going backwards if able to remember MAC, so C first and then A)

38

What opportunistic infection can occur if CD4 count is less than 200?
a. Pneumocystis jerovecii (previously known as pneumocystis carnii or PCP)
b. Toxoplasma gondii infections (protozoa)
c. Myocbacterium avid complex (MAC)

a. Pneumocystis jerovecii (previously known as pneumocystis carnii or PCP)

39

True or False
Nucleoside reverse transcriptase inhibitors (NRTIs) are a class of oral antiretroviral (ARV) drugs effective in reducing HIV viremia and in improving CD4 T cell counts. NRTIs are key components of antiretroviral therapy (ART) regimens, and are often referred to as the “backbone” of HIV treatment.

Nucleoside reverse transcriptase inhibitors (NRTIs) are a class of oral antiretroviral (ARV) drugs effective in reducing HIV viremia and in improving CD4 T cell counts. NRTIs are key components of antiretroviral therapy (ART) regimens, and are often referred to as the “backbone” of HIV treatment.

40

What labs tests are done to detect Syphilis?
a. Non-trenponemal test
b. Treponemal test

Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum.

Nontreponemal tests (e.g., VDRL and RPR) are simple, inexpensive, and are often used for screening. However, they are not specific for syphilis, can produce false-positive results, and, by themselves, are insufficient for diagnosis. VDRL(venerable disease research lab) and RPR should each have their antibody titer results reported quantitatively.

Persons with a reactive nontreponemal test should receive a treponemal test to confirm a syphilis diagnosis. This sequence of testing (nontreponemal, then treponemal test) is considered the “classical” testing algorithm.

Treponemal tests (e.g., FTA-ABS, TP-PA, various EIAs, and chemiluminescence immunoassays) detect antibodies that are specific for syphilis. Treponemal antibodies appear earlier than nontreponemal antibodies and usually remain detectable for life, even after successful treatment.

41

Which antibodies appear earlier in Syphilis and are usually detectable for life?
Treponemal antibodies
nontreponemal antibodies

Treponemal antibodies appear earlier than nontreponemal antibodies and usually remain detectable for life, even after successful treatment.

Since Syphillis is caused by treponemal, so these should stay detectable for life.

42

Treatment of Syphillis 1st line and alternatives

1st line Penicillin IM,
Alternatives: Doxycycline or tetracycline

43

A definitive diagnosis of sickle cell anemia can be made:
a. by a CBC
b. by a hemoglobin electrophoresis
c. by a pathologist with visual examination of RBC
d. with a serum ferritin, iron level and hemoglobin.

b. by a hemoglobin electrophoresis

Sickle cell anemia is initially suspected on visual exam of the RBCs. They have a sickled shape, hence the name. These cells can be identified as early as 3 months of age. Once a positive screen is identified. it is repeated using either hemoglobin electrophoresis or DNA analysis.