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GUM/HIV > BASHH course exam facts! > Flashcards

BASHH course exam facts! Flashcards

1
Q

Acronym for OSCE

PPPP
CCCC
SS
VAJ

A 
PN
PEP/PREP
Preg Test
Prev HIV test
Condoms
Contraception
Compliance
Children
Smears
Sex (last)
Vaccines
Abstinence
Job

PLAN
Health advisor
Leaflet
Condoms

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2
Q

PCP appearance on CT

A

ground glass

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3
Q

Why do people with PCP desaturate?

A 
Hypoxaemia on exercise
Get them to walk up and down room/staurs
Put on sats before and after
Sensitive screening test
Alveolar/ags transfer problem
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4
Q

How do you isolate PCP?

A

PCR from Bronchealveolar lavage

can’t be cultured

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5
Q

Which drugs cause haemolysis with G6PD?

A

clotrimoxazole
Dapsone
primaquine

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6
Q

When to start PCP (CD4?)

A

<200

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7
Q

What does TB look like in HIV?

A

Usually UL cavitation
In HIV can look different
Less cavitation and loss of UZ changes
Can be normal

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8
Q

Which conditions mainly cause IRIS

A

TB
Cryptococcus
PML
HSV

More likely if immunosuppressed and you start ARV

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9
Q

When to start ART in TB?

A

9-12 weeks
<2 weeks if CD4 <50

(if cns- wait to give art)

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10
Q

AIDS defining cancers?

A

Kaposi’s
Non hodgkins
cervical cancer

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11
Q

What does KS look like?

A 
multi centric
pigmented
non blanching
painless
raised
(flat on hard palate)
Can get it in the eye
Can get lymphangiopathic KS- swollen legs
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12
Q

Where do you often find visceral KS?

A

1st lung

2nd GIT

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13
Q

Main differential of KS?

A

bacillary angiomatosis

-the second-most-common cause of angiomatous skin lesions in persons infected with the human immunodeficiency virus

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14
Q

what might you see on histology of KS?

A

spindle cells

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15
Q

where might you find the KS virus?

A

HHV8 -in saliva

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16
Q

Most common cancer in HIV?

A

KS

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17
Q

What is the CD4 count like with large B cell lymphoma?

A

LOW CD4

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18
Q

WHat is the CD4 count like in Burkitt’s lymphoma?

A

High CD4

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19
Q

What causes Burkitts/Non hodgkins and Primary cerebral lymphoma?

A

EBV

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20
Q

Differential for PCL?

A

toxoplasma

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21
Q

Which cancers are caused by HHV8?

A

KS, PEL & Castleman’s

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22
Q

Non AIDS defining malignancies?

A

Anal cancer
Hodgkin’s disease
Non-small cell lung cancer

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23
Q

Which cancers are caused by EBV?

A

Non Hodgkin’s, Primary Cerebral Lymphoma & HD

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24
Q

Which drugs can cause TEN?

A

nevirapine and clotrimoxazole

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25
Q

Descrive HIV skin rash- seroconversion

A

mobilliform
?maculopapular
FLorid/confluent

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26
Q

Which drugs can cause hyperpigmentation?

A

zidovudine

emtricitabine

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27
Q

Which ART can cause a hepatitis?

A

Darunavir

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28
Q

Who does not get a HCV ab with previous infection?

A

HIV

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29
Q

Which virus causes Progressive Multifocal Leukoencephalopathy?

A

John cunningham virus

Human polyoma virus

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30
Q

Crytococcal meningitis- management

A

LP- as get raised ICP
Serum CRAG
Treat with ARV ?afetr 2 weeks of antifungals
`Risk of IRIS and death

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31
Q

Dementia BHIVA audible outcomes

A

Annual screen for cognition - 90%

Services pathway for neuropsychiatric assessment 95%

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32
Q

WHich ARV has good penetration of CNS?

A

efavirenz

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33
Q

When should you expedite ARV?

A

Neurological involvement 1D
any AIDs defining illness 1A
CD4 <350 1C
PHI diagnosed within 12 weeks 1C

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34
Q

When can’t you use abavacir?

A

Hepatitis B/C
CV risk
High viral load
If HLA B5701 positive

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35
Q

Which ARV drugs are hepatotoxic?

A

nevirapine

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36
Q

side effects of efavirenz

A

CNS – Efavirenz (and Rilpivirine to a lesser extent)
• Sleep disturbance and nightmares, change in mood, light-headedness

Lipodystrophy
• Gynaecomastia reported

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37
Q

Which ART causes SJS

A

Rash
• Nevirapine- appears within 6 weeks, half dose for first 2-weeks
• Stevens-Johnson Syndrome

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38
Q

Side effect of darunavir (PI)

A

 Darunavir

• Rash- cross sensitivity with co-trimoxazole

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39
Q

Side effect of atazanavir?

A

Atazanavir
• Hyperbilirubinaemia often resulting in scleral icterus
• Renal function- caution

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40
Q

which ARV can cause a hepatitis picture

A

IIs
dolutegravir
raltegravir - can cause transaminitis

darunavir (PI)

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41
Q

Which ARV is it really important you don’t take with food

A

Rilpivirine

42
Q

What happens to bloods in acute HIV infection?

A

HIV RNA - 1st 2 weeks
P24 ag - 5 days later
HIV ab- around day 25

43
Q

What to do if HIV P24 ag positive but HIV ab negative

A

Check RNA
If negative

Can do western blot

44
Q

Definition of primary HIV?

A

first 6 months

45
Q

Definition of acute HIV infection?

A

3 months

46
Q

What to tell patients about POCT?

A

Even 4th generation not as good as venous

Only detects P24 ag 62% of the time

47
Q

Why important to start ARV quickly?

A

immune recovery in primary HUV
decrease viral resevoir
Limit onward transmission

48
Q

What are audible outcomes for HIV new diagnosis?

A

number of people seen within 2 weeks

Number with PHI offered immediate ART

49
Q

Which class of ARV have higher barrier to resistance?

A

NNRTIs

50
Q

Complications of HSV?

A

erythema multiforme

Mollarets meningitis

51
Q

How much does HSV suppression reduce transmission risk?

A

50%

52
Q

How much do condoms reduce risk of spreading HSV?

A

30-70%

53
Q

What to do about HSV in last trimestre if partner HIV pos?

A

No sex last trimestre
suppress him
condoms
no oral sex

54
Q

What do you need to stay about HSV and the law?

A

may be helpful legally to disclose

55
Q

What are risks of HSV in pregnancy?

A

same as general population- 3%

no evidence of miscarriage

56
Q

Is Hsv treatment safe in pregnancy?

A

Yes
used for a long time
risks much worse if not treated

57
Q

When to suppress HSV if HIV positive?

A

from 32 weeks

58
Q

What is the lead in period for Ts and Ss PREP?

A

We recommend daily dosing for 7 days, then dropping down to 4 pills per week.

4 pills per week usually involves taking a pill on Tuesday, Thursday, Saturday and Sunday — that’s why it’s called ‘the Ts and Ss’.

59
Q

Other causes of hepatitis?

A

EBV
CMV
Drugs

60
Q

How many people have HPV?

A

1/3 have actie HPV
lifetime risk 80%
estimated point prevalence of warts- 1%

61
Q

specificity and sensitivity in different populations

A

sensitivity and specificity is not affected by prevalence

PPV is

62
Q

Sde effects with nevi rapine?

A

Hepatotoxic

Steven Johnsons syndrome

63
Q

Follow up HIV test after completing PEPSE?

A

8-12 weeks

64
Q

How long does HCV live on a needle?

A

5 days

65
Q

What factors increase the chance of HIV transmission?

A 
sexual assault- trauma
increased viral load
STI
Ejaculation
Menstruaiton
Circumcision
66
Q

Breakdown of HIV transmission groups?

A

5 % MTCT
70% MSM
24% heterosexual

67
Q

Which ARV does K103N have resistance to?

A

Efavirenz

68
Q

Which ARV can not be used with contraception as enzyme inducers?

A 
Nevirapine
Efavirenz
Atazanavir (boosted- NB unbolted increases levels )
Ritonavir
PIs

(

69
Q

Risk of MTCT if pregnant women is undetectable and pregnancy protocol followed?

A

0.1%

70
Q

When can you use dolutegravir in pregnancy?

A

> 6 weeks

71
Q

Which ARV have best safety data in pregnancy?

A

dolutegravir and efavirenz

72
Q

If on DTG What is increased risk of NTD?

A

3/1000 births (1/1000 is the population risk)

73
Q

If HIV test is positive at birth when is transmission likely to have taken place?

A

In utero

74
Q

If HIV test is positive at 6 weeks (neg at birth) when is transmission likely to have taken place?

A

after 6 weeks

75
Q

Can you use TAF/cobicistat in pregnancy?

A

no safety data

76
Q

Can you use DAA / ribacvarin in pregnancy

A

No

Ribovarin is teratigenic- also men need to be informed - sperm

77
Q

features of JH reaction

A

myalgia

riggers, chills, flush, fever, hypotension, deterioration of lesions

78
Q

types of spirocahaetes

A

borrelia, leptospira and t pallidum

79
Q

How does treponema behave on microscopy?

A

corkscrew movement

spin and flex on long axis

80
Q

What is vaginal discharge?

A

Normal vaginal discharge is composed of cervical mucus, vaginal fluid, shedding vaginal and cervical cells, and bacteria. The majority of the liquid in vaginal discharge is mucus produced by glands of the cervix. The rest is made up of transudate from the vaginal walls and secretions from glands (Skene’s and Bartholin’s).

81
Q

Transmission of LGV in UK

A

Increase in prevalence in UK
The activity with the highest risk of LGV transmission is unprotected anal intercourse. Fisting, sharing of sex toys and rectal douching can also lead to LGV transmission.

82
Q

Sex worker with ulcer- papa new guinea?

A

DOnavonosis- klebsiella commonest in Papa new guinea

83
Q

In HIV- Iipoatrophy

A

With NRTIs

Lose fat from cheeks, arms, shoulder,s, thighs, buttocks

84
Q

in HIV- lipohypertrophy

A

PIs
buffalo hump- dorsocervical fat
big neck
breast hypertrophy

85
Q

Tabes dorsalis features?

A 
lighting pains
paraesthesiae
smooth muscle spasm
sensory ataxia
stamping gait
rhombergs sign
diminished reflexes
impaired vibration and position sense
charcot joints
optic atrophy
bilateral ptosis
argyll robertson pupil
86
Q

Causes of pruritus ani

A

Constipation, hygiene
Skin conditions- psoriasis, eczema, thrush (a Candida yeast infection), and fungal infections.
Threadworm- worse at night.
• Allergy. Pruritus ani may be due to an allergy to something in contact with the skin, for instance to fragrance in toilet paper, or to local anaesthetics or preservatives in creams used for piles.
• Skin irritation. The skin of the bottom is sensitive and can easily be irritated by soap etc
• Sweating

87
Q

Treatment of pruritis ani

A

steroid
antihistamine
emollients and avoiding soaps

88
Q

What regulations allow confidentiality regarding diagnoses to be shared?

A

The National Health Service (Venereal Diseases) Regulations 1974 (Wales) and the NHS Trusts and Primary Care Trusts (Sexually Transmitted Diseases) Directions 2000 (England)
These regulations provide that any information capable of identifying an individual who is examined or treated for any sexually transmitted disease, including HIV, shall not be disclosed, other than to a medical practitioner in connection with the treatment of the individual in relation to that disease or for the prevention of the spread of the disease.

89
Q

HIV window period

A

Offer fourth generation laboratory HIV test even if < 4weeks
Repeat it when 4 weeks have elapsed from the time of the last exposure.
A negative result on a fourth generation test performed at 4 weeks post-exposure is highly likely to exclude HIV infection- 95% infections detected.
A further test at 8 weeks post-exposure need only be considered following an event assessed as carrying a high risk of infection. (99.9%)

90
Q

K103N mutation and M184V mutation which ARV can’t patient have?

A 
Tenofovir 
Etricitabine
(NRTIs)
Neviparine 
Evavirenz 
(NNRTIs)
91
Q

Which ARV cross blood brain barrier? ie treatment of PML

A
  1. zidovudine

2. nevirapine

92
Q

Methadone and atripla interaction

Atripla- TDF emtricitabine and efavirenz

A

efavirenz decreases methadone

93
Q

ARV causing gynaecomastia/breast swelling

A

efavirenz

94
Q

Treatment of neonate born to mum Hep B?

A

Give immunoglobulin HBV 500 IU if mum HepB eag positive

Also give Ig if HepBSag pos, EAg negative (if EAb negative)

95
Q

Late HIV diagnosis

A

1/3 HIV infections in adults in the UK remain undiagnosed

25 per cent of newly diagnosed individuals have a CD4 cell count of less than 200 (an accepted marker of ‘late’ diagnosis).

96
Q

sensitivity of gc urethra male

A

Penile urethra
o Microscopy of urethral or meatal swab smears has good sensitivity (90–95%) in people with discharge from the penile urethra and is recommended to facilitate immediate presumptive diagnosis in these individuals

o Microscopy of penile urethral smears in those without symptoms is less sensitive (50–75%) therefore, it is not recommended in asymptomatic individuals

97
Q

sensitivity of gc females

A

Female urethra and endocervix
Microscopy- 50% and 20% sensitivity compared with culture for detecting gonorrhoea from endocervical and female urethral smears, respectively.

98
Q

Culture of GC

A

For culture, the sensitivity depends on several factors including time from sample collection to plating.
Services should seek to minimise this time whether by direct plating in the clinic or use of transport media with prompt transfer for plating in the laboratory.

99
Q

TV in men symptoms

A

75% no symptoms
Most common is discharge- gnu
dysuria
<10% balanitis

100
Q

urethral CT

A

35-50% NGU in men

women 50-60% including other sites (15-20% only urethra)

GUM/HIV (25 decks)

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