Week 2 part 2 Flashcards
1
Q
What causes Acquired Immunodeficiency Syndrome AIDS?
A
HIV
2
Q
What makes up AIDS?
A
- Opportunistic infections
2. AIDS related cances
3
Q
What are the single highest predictor of mortality in HIV?
A
Aids related conditions
4
Q
life ex[ectancy of HIV patinets?
A
Near normal
5
Q
What type of virus is HIV?
A
Retrovirus
6
Q
What type of HIV priginated from west african sootey mangabey (simian ID virus)?
A
HIV-2
7
Q
What type of HIV 1 or 2 is less virulent?
A
Type 2
8
Q
What HIV originated in central/west african chimpanzees and group M is responsible for starting global pandemic?
A
HIV-1
9
Q
tARGET SITE for HIV?
A
CD4 receptors
10
Q
What cells recognise MHC2 antigen presenting cell?
A
CD4 t lymphocytes
11
Q
Name One major hallmark of HIV infection that promotes viral replication and drives CD4+ T cell depletion.
A
Chronic Immune Activation
12
Q
Normal CD4 range?
A
500 to 1600
13
Q
What CD4 count puts you at risk of opportunistic infections?
A
Less than 200
14
Q
When does rapid replication of HIV occur?
A
Early and very late infection
15
Q
When is a new generation of HIV replicated?
A
Every 6 to 12 hours
16
Q
Within how many days is the HIV infection estasblished?
A
WIthin 3 days of entry
17
Q
when does primary HIV infection present?
A
Onset 2-4 weeks after infection
18
Q
Fever Rash (maculopapular) Myalgia Pharyngitis Headache/aseptic meningitis
A
Primar yHIV
19
Q
What type of HIV infection is occuring with ongoing viral replication, ongoing CD4 count depletion, ongoing immune activation?
A
Asymptomatic HIv infection
20
Q
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
A
Opportunistic infections (occur in late disease with high viral load)
21
Q
Wjhat organism causes pneumocystis pneumonia HIV?
A
Pneumocystis jiroveci
22
Q
What is CD4 threshold in pneumocystis pneumonia caused by HIV?
A
lESS THAN 200
23
Q
What sign is present in pneumocystis pneumonia?
A
Exercise desaturation
24
Q
: insidious onset
SOB
Dry cough
Patinet with HIV?
A
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
