Week 2 part 2 Flashcards Preview

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Flashcards in Week 2 part 2 Deck (100):
1

What causes Acquired Immunodeficiency Syndrome AIDS?

HIV

2

What makes up AIDS?

1. Opportunistic infections
2. AIDS related cances

3

What are the single highest predictor of mortality in HIV?

Aids related conditions

4

life ex[ectancy of HIV patinets?

Near normal

5

What type of virus is HIV?

Retrovirus

6

What type of HIV priginated from west african sootey mangabey (simian ID virus)?

HIV-2

7

What type of HIV 1 or 2 is less virulent?

Type 2

8

What HIV originated in central/west african chimpanzees and group M is responsible for starting global pandemic?

HIV-1

9

tARGET SITE for HIV?

CD4 receptors

10

What cells recognise MHC2 antigen presenting cell?

CD4 t lymphocytes

11

Name One major hallmark of HIV infection that promotes viral replication and drives CD4+ T cell depletion.

Chronic Immune Activation

12

Normal CD4 range?

500 to 1600

13

What CD4 count puts you at risk of opportunistic infections?

Less than 200

14

When does rapid replication of HIV occur?

Early and very late infection

15

When is a new generation of HIV replicated?

Every 6 to 12 hours

16

Within how many days is the HIV infection estasblished?

WIthin 3 days of entry

17

when does primary HIV infection present?

Onset 2-4 weeks after infection

18

Fever
Rash (maculopapular)
Myalgia
Pharyngitis
Headache/aseptic meningitis

Primar yHIV

19

What type of HIV infection is occuring with ongoing viral replication, ongoing CD4 count depletion, ongoing immune activation?

Asymptomatic HIv infection

20

an infection caused by a pathogen that does not normally produce disease in a healthy individual. It uses the “opportunity” afforded by a weakened immune system to cause disease

Opportunistic infections (occur in late disease with high viral load)

21

Wjhat organism causes pneumocystis pneumonia HIV?

Pneumocystis jiroveci

22

What is CD4 threshold in pneumocystis pneumonia caused by HIV?

lESS THAN 200

23

What sign is present in pneumocystis pneumonia?

Exercise desaturation

24

: insidious onset
SOB
Dry cough
Patinet with HIV?

pNEUMOCYSTIS PNEUMONIA

25

How is HIV causing PCP diagnosed?

Bronchoalveolar lavage and immunofluorescence

26

Treatment of HIV causing PCP?

High dose co-trimoxazole +/- steroid
prophylaxis - low dose co-trimoxazole

27

What are these more common in: Symptomatic primary infection
Reactivation of latent TB
Lymphadenopathies
Miliary TB
Extrapulmonary TB
Multi-drug resistant TB
Immune reconstitution syndrome

HIV posivie patients

28

In HIV what organism causes cerebral toxoplasmosis?

Toxoplasma gondii
CD4 threshold less than 150

29

HIV patient
Multiple cerebral abscess
(Chorioretinitis)
Headache
Fever
Focal neurology
Seizures
Reduced consciousness
Raised intracranial pressure

Cerebral toxoplasmosis (ring enhancing lesions on MRI)

30

cmv causes cytomegalovirus in HIV - what CD4 threshold is needed?

Less than 50

31

Retinitis, colitis, oesophagitis

Cytomegalovirus (presents with reduced visual acuity, floaters, abdo pain, diarrhoea nad PR bleeds)

32

If an HIV patient is getting multidermatomal and recurrent rashes what might it be?>

Herpes zoster

33

What organism causes HIV-associated neurocognitive impairment

HIV-1

34

HIV patient with reduced short term memory and +/- motor dysfunction?

HIV-associated neurocognitive impairment

35

What organism causes Progressive multifocal leukoencephalopathy

JC virus

36

What is CD4 threshold for JC virus?

Less than 100

37

HIV patient with rapidly progressing focal neurology, confusion and personality change?

Progressive multifocal leukoencephalopathy

38

Slims disease

HIV associated wasting

39

What organism causes aids related canacer kaposis sarcoma?

Human herpes virus 8

40

Name a tumour that is vascular?

Kaposis sarcoma

41

How is kaposis sarcoma treated?

HAART
systmeic chemotherapy

42

What aids related cancer does EBV cause?

Non-Hodgkins lymphoma

43

B symptoms
Bone marrow involvement
Extranodal disease
increase CNS involvement

Non-hodgkins lymphona - aids related

44

What virus causes aids related cancer cervical?

Human papilloma virus

45

Name some non-OI symtpomatic HIV complaints

Oral thrush
Seborrhoeic dematitis
Diarrhoea
Fatigue
Worsening psoriasis
lymphadenopathy
parotitis
Hep B,C

46

Name two haematologic manifestations of HIV

Anaemia
Thrombocytopenia ITP

47

nAME four factors increasing HIV transmission risk

1. Anoreceptive sex
2. Truama
3. Genital ulceration
4. Concurrent STI

48

nAME 3 mother to child modes of transmission/

In utero/trans placental
Delivery
Breast feeding

49

What risk group has the highest proportion of HIV in UK?

MSM

50

Who should be tested for HIV

Universal testing in high prevalence areas
Opt out testing in clinical settings
Screening of high risk groups
Testing in presence of clinical indicators

51

Which markers of HIV are used by labs to detect infection?

RNA viral genome
Capsulse protein p24 (antigen)
Envelope proteins gp120
Antibody

52

When HIV seroconversion is taking place what is tested for?

Viralk load and p24 antigen

53

When HIV is in chronic infection stage what is best tested for?

Antibody

54

how long is window period (have infection but test negative) for antibody HIV testing?

3 months

55

For fourth gen HIV tests (combined antibody and antigen p24) what is window period?

14-28 days

56

What is a POCT

Rapid HIV test - results within 20-30 minutes

57

What could be used to identify if an HIV infeciton occured within preceding 4-6 months?

RITA - recent infection testing algorithm

58

what therapy is used for HIV treatment?

Anti-retroviral therapy ARV

59

What is reverse transcriptase, integrase, protease, entry and maturation all targeted by?

HIV antiretroviral drugs

60

What does highly active anti-retroviral therapy contain?

A combination of three drugs from at least 2 drug classes to which the virus is susceptible

61

Name three HIV HAART drugs?

1. Tenofovir
2. Emtricitabine
3. Efavirenz

62

2 side effects of efavirenz

mood and psychosis

63

Renal side effedcts of HAART

Proximal renal tubulopathies

64

Bone side effects of HAART

Osteomalacia

65

What drug drug interactions must be thought of for HIV

NNRTIs are generally potent liver enzyme inducers so be careful of OCP

66

hOW DO you prevent mother to child transmission?

Vaginal delivery if undetected VL
HAART during pregnancy
PEP for neonate
Exclusive formula feeding

67

wHEN should chlamydia and gonorrhoea be tested for?

2 weeks following exposure

68

What is the incubation period of urethral infection in men for gonorrhoea?

2-5 days

69

For microscopy of gonorrhoea is urethral or endocervical more sensitive?

Urethral 90-95% sensitivity

70

treatemtn of gonorrhoea?

IM ceftriaxone and oral azithromycin

71

incubation of genital herpes

3-6 days

72

Blistering and ulceration of the external genitalia
Pain
External dysuria
Vaginal or urethral discharge
Local lymphadenopathy
Fever and myalgia (prodrome)

genital herpes

73

is viral shedding higher in hsv1 or 2?

HSV 2

74

PRIMAR YSYPHILS INCUBATION?

9 to 90 days mean of 21

75

painless primary chancre?

Syphilis

76

Incubation period is 6 wks to 6 months
Skin (macular, follicular or pustular rash on palms + soles)
Lesions of mucous membranes
Generalized Lymphadenopathy
Patchy Alopecia
Condylomata Lata (most highly infectious lesion in syphilis, exudes a serum teeming with treponemes)

Secondary syphilis

77

What four conditions do not need partner notification?

Warts
Herpes
Vaginal thrush
Bacterial vaginosis

78

Name the four structures of female body in the pelvic cavity?

1. Ovaries
2. Uterine tubes
3. Uterus
4. Superior part of vagina

79

Name the 5 structures of female body in perineum?

1. Inferior part of vagina
2. Perineal muscles
3. Bartholin's glands
4. Clitoris
5. Labia

80

In female body where does excess abnormal fluid within peritoneal cavity tend to collect?

Within pouch of douglas

81

In females, how can fluid in the pouch of douglas be drained?

Needle passed through posterior fornix of the vagina

82

What is formed from a double layer of peritoneum and helps maintain the uterus in its correct midline position?

Broad ligament

83

What is contained in the broad ligament?

Uterine tubes and proximal part of round ligamnet

84

What is an embryological remnant and attaches to the lateral aspect of uterus?

Round ligament

85

What does round ligament pass through to attach to the superficial tissue of female perineum?

Deep inguinal ring

86

What are the three layers of support for uterus?

1. Uterosacral ligaments
2. Endopelvic fascia
3. Muscles of pelvic floor

87

The most common position of uterus is when cervix tipped anteriorly relative to axis of vagina - what is the term for this?

Anteverted

88

What is a retroflexed Uterus?

Uterus tipped posteriorly relative to axis of cervix

89

What is sampled during a cervical smear?

Squamo columnar junction (transformation zone)

90

What do fimbriae at end of uterine tubes open into?

Peritoneal cavity

91

What are almond sized and shaped structures located more laterally in the pelvic cavity?

Ovaries

92

In post-pubertal emales where is the monthly ovum released directly into?

Peritoneal cavity - to be picked up by fimbriae

93

Where can ischial spines be palpated on vaginal digital exam?

4oclock and 8 o clock positions

94

Shallow space between pelvic diaphragm and skin?

Perineum

95

What merve su[pplies levator ani?

Nerve to levator ani - from S3,4,5

96

wHAT SUPPLIES (nerve) perineal muscles?

Pudendal nerve

97

What is the perineal body?

Bundle of collagenous and elastic tissue into which the perineal muscles attach
Important to pelvic floor strength
Can be disrupted during labour
Located just deep to skin

98

What ribs does the bed of breast extend from?

ribs 2 to 6
and lateral border of sternum to mid axillary line

99

Whjat do bed of breast lie on?

Deep fascia covering pec major and serratus anterior

100

What lies between fascia and breast?

Retromammary space