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Pulmonology And Special Topics > STI > Flashcards

STI Flashcards

(46 cards)

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1
Q

HIV modes of transmission

A

Sexual Parenteral Vertical

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2
Q

Pathophysiology of HIV

A

RNA retrovirus infect all cells expressing the T4(CD4) antigen -CD4 -B-cells -Macrophages Causes immunodeficiency, Autoimmunity, Allergic reactions

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3
Q

Progression of HIV to AIDS

A

AIDS is defined as a presence of an Opportunistic infections or CD4<200cells

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4
Q

Opportunistic infections with HIV/AIDS

A

Kaposi Sarcoma:Purple skin lesions Pneumocystis jeroveci:PNA, hypoxia, dry cough Toxoplasmosis: Focal neuro deficits, brain mass/lesion Cryptococcus neoformans: meningitis like picture(fungal) TB

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5
Q

CD4 count<500 OI

A

TB Kaposi Sarcoma

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6
Q

CD4 count<200 OI

A

Pneumocytosis Toxoplasmosis Cryptococcosis

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7
Q

CD4 count<50 OI

A

Disseminated MAC infection (Mycobacterium Adium complex) Histoplasmosis

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8
Q

Preferred HIV Test/screen

A

ELISA(HIV Enzyme Linked ImmunoSorbent Assay) 50%positive after 22 days 95% positive after 6 weeks Must be confirmed

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9
Q

Confirmatory Test for HIV

A

Western Blot Specificity when combined with ELISA>99.99% Indeterminate results with: -early HIV -HIV-2 -Influenza vaccine -Autoimmune disease -Pregnancy -Recent tetanus toxoid admin

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10
Q

Easy and quick test for HIV

A

HIV Rapid Antibody Test Screen for HIV, 10-20 minute results, performed with minimal training *Needs to be confirmed by ELISA and Western Blot

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11
Q

CBC in screening for HIV/AIDS

A

Anemia of chronic disease Neutropenia Thrombocytopenia(Advanced HIV infection)

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12
Q

Absolute CD4 lymphocyte count CD4 lymphocyte percentage

A

Most widely used predictor of HIV progression risk of progression to an AIDs OIis high with CD4 <200 or ,14% Folllowed Q3 months or sooner if change in status

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13
Q

Best test to help diagnose acute HIV infection

A

HIV viral load

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14
Q

HIV viral load test

A

Acute HIV diagnosis Correlate with. Disease progression Used to measure response to antiretrovirals

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15
Q

Screening criteria for HIV/AIDS

A

USPSTF recommends screening on adolescents and adults 15-65. Increase range if at increased risk Even if no risk recommend at least testing once No implied consent, make it clear ordering an HIV test

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16
Q

Goals of treatment for an HIV Pt

A

Viral Supression** OI prophylaxis Preventative considerations -cervical/rectal cancer screening -Vaccinations(Need CD4 count >200) -CAD and lipids -mental health/social support

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17
Q

When do you start antiretrovirals

A

As soon as the Pt is ready to start and be compliant, regardless of CD4 or viral count

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18
Q

Immune reconstitution

A

Immune system will rev up after antivirals are started and CD4 count starts to rise. It will begin attacking some bugs that it hadn’t and Pt’s might see symptoms(symptomatic support and reassurance)

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19
Q

Perihilar infiltrates-

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A

Batwing appearance chest x-ray, of Pneumocystis jiroveci

20
Q

Antiretroviral treatment should start asap because:

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A

-Prevents further transmission -RCT’s x2 have proven benefit -additional health benefits(HIV virus does more damage than just immune system)

21
Q

Antiretroviral drug selection based on:

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A

-Viral genotype(resistance patterns) -Pt comorbid conditions *Pysch *Liver/renal disease *Hep B -Pt med interactions -Baseline viral load -HLA-B5701 status(Abacavir RXN) and G6PD RXN

22
Q

Antiretroviral drug points to know

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A

-Therapy must be 3 or more drugs(only 2 from same class) -Resistance is common(if Pt misses just a few doses virus can become resistant)

23
Q

Nucleoside reverse transcriptase inhibitors (NRTIs or Nukes)

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A

MOA-Prevent viral RNA from being transcribed into DNA Side Effects-associated with lactic acidosis, hepatic steatosis(fatty liver), and lipodystrophy(abnormal distribution of fat) Special-can also treat Hep B Monitor- Need to test for HLAB-5701 Abacavir Example-Emtricitabine

24
Q

Non-nucleoside Revers transcriptase inhibitors (NNRTIs or Nonnukes)

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A

MOA-Prevent viral RNA from being transcribed into DNA Side effects- rash(SJS) Has significant drug RXNs works best with viral load<100,000

25
Protease inhibitors (PIs)
MOA-Prevents replicated viruses from being released from a cell Side effects-Dyslipidemia, hyperglycemia, insulin resistance, lipodystrophy CYP system RXN-proton pump inhibitors and statins are most notorious Paired with a booster drug to increase absorption
26
Integrase inhibitors
MOA-Prevent Viral DNA from integrating into host DNA Side effects-abnormal dreams, N/V/D, rash, LFTs(don’t give to psych pt) Needs renal adjustments Some need a booster or pharmacokinetic enhancer \*cobicistat
27
Fusion Inhibitor (FI) and Chemokine Coreceptor Antagonist (CCR-5)
MOA-Prevents viral fusion/binding to the cell Not first line-newer drugs Side effects- FI-injection site RXN, neutropenia, pneumonia CCR-5-Hepatitis, pneumonia, myalgias, many drug interactions Often seen as last resort for Pt’s with significant resistance
28
Factors that contribute to ARV drug resistance
-Medication non-adherence -Decreased absorption -drug interactions
29
Principles of HAART (Highly active antiretroviral therapy
\*\*\*VIRAL SUPPRESSION\*\*\*\*\* -prevent future transmission -restore immune function -reduce HIV associated morbidities
30
Post exposure prophylaxis
Healthcare and non occupational exposure -3 drug treatment -28 days of treatment -Baseline and follow up labs(Up to a year)
31
Chlamydia ETiology/pathology
Chlamydia Trachomatis Infects cell walls until bursts open MC bacterial STI om US
32
Chlamydia Sx
M-mucoid discharge urethritis Commonly asymptomatic especially females Urethritis PID Cervicitis(strawberry cervix) Proctitis Mucoid discharge Mild dysuria
33
Chlamydia Dx and complications
Vaginal swab and urine preferred Cervical, urethral and liquid pap Complaints NAAT(nucleic amplification test) Can cause infertility, conjunctivitis, PNA
34
Chlamydia treatment/prevention
Azithromycin 1gm x1dose Doxycycline 100mg BID x 10 days retest in 3 weeks Screen annually in women \<24
35
Gonorrhea ETi/transmission
Gonococcal 1-14 d incubation period in men/unclear in women possibly 10days Autoinocculation
36
5 Ps of STI risk assessment
Past STDs Partners Practices Prevention Pregnancy plans/prevention
37
Gonorrhea symptoms
M-urethritis-yellowish white discharge F-Majority asymptomatic, extragenital infection, may have urogenital infection(vaginitis, vaginal discharge, labia pain, swelling, abd pain)
38
Gonorrhea Diagnostics
Gram - diplococci Specimen types(Vaginal swab, urine, cervical, urethral, liquid pap) Culture Nucleic acid amp[lification test
39
gonorrhea complications
Pelvic inflammatory disease can cause infertility
40
Gonorrhea treatment and prevention
Ceftiaxone 250mg IM +doxycycline or Azythromycin(has high resistance treat with 2 abx) Screen annualy women \<24
41
Trichomoniasis Vaginalis
Parasite-pear shaped-trichomonas vaginalis Transmission-Sex Sx-Most asymptomatic-vaginal discharge-frothy yellow/green, vulvovaginal discomfort, pruritis, dysuria, Men-Asymptomatic, urethritis, scant discharge Ddx-bacterial vaginosis Dx-wet mount-vaginal swab, pH\>4.5, Fishy odor after KOH, motile Complications-perinatal complications, increase HIV transmission Treatment-Metronidazole 2 g PO x1, Tinidazole 2 gram PO x1
42
Syphilis "The Great Imposter"ETi, transmission and Sx
Treponema pallidum-spirochete Multiple stages primary, secondary, latent,and tertiary and Congenital Primary incubation period 10-90 days Transmission-unprotected sex(Vag,oral,anal), verticle primary Sx-Painless chancre, hard indurated ulcer forms at site, Lymphadenopathy in1-2 weeks heals with scaring 1-5 weeks Secondary Sx- 6 weeks after chancre, copper tinted lesions, maculopapular often on palms and soles as well as body, flu-like prodrome, lymphadenopathy, hepatosplenomegaly, Condylomata Lata- wart like moist lesion near chancre highly contagious Latent Sx-no sores/rash relapse is possible, early latent\<1yr, late\<1yr, late has lower transmission Tertiary sx: Occurs 1-20 yrs later, heart, brain, other organs, Gummas-granulomas on skin, bones and joints, neurosyphilis
43
Syphilis Diagnosis, complications, treatment and prevention
Dx-Dark field microscopy, screening-nontreponemal serology test(rapid plasma reagent)VDRL, confirm tests-FTA-ABS, TP-PA Complications-Heart disease, blindness, brain damage, still birth, infertility, Congenital birth defects(ToRCHS), faciltates HIV Treatment-Consult ID, Report to MDH, Upto early latent-Benzathine Pen G 2.4 million units IM x1 dose Late/tertiaryBenzathine PenG 2.4 million units IM weekly x 3 weeks Screening- all pregnant women at 1st prenatal visit, 28 weeks and at delivery High risk individuals should also be screened
44
HSV 1&2
HSV1 oral cold sore HSV2 MC- Primary outbreak-most severe recurrence less severe Transmission by sexual contact, verticle(ToRCHS) Sx- small painful, grouped vesicles at site of contact--\>pustules--\>erosions/ulcers--\>crust/heal in 2-6 weeks Tingling burning prodrome, flu like symptoms, regional lymphadenopathy Dx-Viral culture(unroofed vesicle-gold standard), PCR, more sensitive, Serology, tzank smear-multinucleated giant cells, immunofluorescence Ag Treat- Oral antivirals started within 72 hrs of onset Valcyclovir$$$$less often, Acyclovir$ more frequent Educated on Sx and chronicity, transmission, partner notification OB risks
45
Chancroid
ETI-Haemophilus ducreyi-grem neg streptobacillus Sexual contact- skin contact, autoinnoclation-uncommon in US Sx- Acute painful red papule at contact site--\>pustule--\>ruptures yellow grey exudate BUBO formation(enlarged lymphnodes/inguinal adenitis(Pathognomic) Deep ulcer, bleeds easily Dx-Swab exudateGram neg rods(school of fish) PCR confirmation Clinical diag based on exclusion of HSV and Syphilis Treat-REPORT to MDH-treat suspicion dont wait for culture Azithromycin 1 gram PO x 1 Ceftriaxone 250mg IMx1
46
Condyloma Acuminata Genital Warts
Human Papilloma virus HPV MC cause of STI Type 6 and 11 MC Trans-sex, skin contact and vertical Sx- Tiny painless papules--\>evolve into soft smooth velvety fleshy skin tags Can coalesce into califlower likeregions Spread quickly over mucosa Suspect Child abuse if found in kids DDX-Molluscum contagiosum, Acrochordons Dx-H&P, biopsy and send to pathology(cancer) Complications-Cancer-penile, cervical, anal, Head and neck Treat- Multiple visits, no cure-cryotherapy, laser, electrocauter Topicals-Acetic acid wash, podofilox, Imiquimod(cream) Vaccine-Gardisil age 9-14 and 15-26 Education and support-partner infection

Pulmonology And Special Topics (3 decks)

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