BASHH course exam facts! Flashcards
Acronym for OSCE
PPPP
CCCC
SS
VAJ
PN PEP/PREP Preg Test Prev HIV test Condoms Contraception Compliance Children Smears Sex (last) Vaccines Abstinence Job
PLAN
Health advisor
Leaflet
Condoms
PCP appearance on CT
ground glass
Why do people with PCP desaturate?
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
How do you isolate PCP?
PCR from Bronchealveolar lavage
can’t be cultured
Which drugs cause haemolysis with G6PD?
clotrimoxazole
Dapsone
primaquine
When to start PCP (CD4?)
<200
What does TB look like in HIV?
Usually UL cavitation
In HIV can look different
Less cavitation and loss of UZ changes
Can be normal
Which conditions mainly cause IRIS
TB
Cryptococcus
PML
HSV
More likely if immunosuppressed and you start ARV
When to start ART in TB?
9-12 weeks
<2 weeks if CD4 <50
(if cns- wait to give art)
AIDS defining cancers?
Kaposi’s
Non hodgkins
cervical cancer
What does KS look like?
multi centric pigmented non blanching painless raised (flat on hard palate) Can get it in the eye Can get lymphangiopathic KS- swollen legs
Where do you often find visceral KS?
1st lung
2nd GIT
Main differential of KS?
bacillary angiomatosis
-the second-most-common cause of angiomatous skin lesions in persons infected with the human immunodeficiency virus
what might you see on histology of KS?
spindle cells
where might you find the KS virus?
HHV8 -in saliva
Most common cancer in HIV?
KS
What is the CD4 count like with large B cell lymphoma?
LOW CD4
WHat is the CD4 count like in Burkitt’s lymphoma?
High CD4
What causes Burkitts/Non hodgkins and Primary cerebral lymphoma?
EBV
Differential for PCL?
toxoplasma
Which cancers are caused by HHV8?
KS, PEL & Castleman’s
Non AIDS defining malignancies?
Anal cancer
Hodgkin’s disease
Non-small cell lung cancer
Which cancers are caused by EBV?
Non Hodgkin’s, Primary Cerebral Lymphoma & HD
Which drugs can cause TEN?
nevirapine and clotrimoxazole
Descrive HIV skin rash- seroconversion
mobilliform
?maculopapular
FLorid/confluent
Which drugs can cause hyperpigmentation?
zidovudine
emtricitabine
Which ART can cause a hepatitis?
Darunavir
Who does not get a HCV ab with previous infection?
HIV
Which virus causes Progressive Multifocal Leukoencephalopathy?
John cunningham virus
Human polyoma virus
Crytococcal meningitis- management
LP- as get raised ICP
Serum CRAG
Treat with ARV ?afetr 2 weeks of antifungals
`Risk of IRIS and death
Dementia BHIVA audible outcomes
Annual screen for cognition - 90%
Services pathway for neuropsychiatric assessment 95%
WHich ARV has good penetration of CNS?
efavirenz
When should you expedite ARV?
Neurological involvement 1D
any AIDs defining illness 1A
CD4 <350 1C
PHI diagnosed within 12 weeks 1C
When can’t you use abavacir?
Hepatitis B/C
CV risk
High viral load
If HLA B5701 positive
Which ARV drugs are hepatotoxic?
nevirapine
side effects of efavirenz
CNS – Efavirenz (and Rilpivirine to a lesser extent)
• Sleep disturbance and nightmares, change in mood, light-headedness
Lipodystrophy
• Gynaecomastia reported
Which ART causes SJS
Rash
• Nevirapine- appears within 6 weeks, half dose for first 2-weeks
• Stevens-Johnson Syndrome
Side effect of darunavir (PI)
Darunavir
• Rash- cross sensitivity with co-trimoxazole
Side effect of atazanavir?
Atazanavir
• Hyperbilirubinaemia often resulting in scleral icterus
• Renal function- caution
which ARV can cause a hepatitis picture
IIs
dolutegravir
raltegravir - can cause transaminitis
darunavir (PI)
Which ARV is it really important you don’t take with food
Rilpivirine
What happens to bloods in acute HIV infection?
HIV RNA - 1st 2 weeks
P24 ag - 5 days later
HIV ab- around day 25
What to do if HIV P24 ag positive but HIV ab negative
Check RNA
If negative
Can do western blot
Definition of primary HIV?
first 6 months
Definition of acute HIV infection?
3 months
What to tell patients about POCT?
Even 4th generation not as good as venous
Only detects P24 ag 62% of the time
Why important to start ARV quickly?
immune recovery in primary HUV
decrease viral resevoir
Limit onward transmission
What are audible outcomes for HIV new diagnosis?
number of people seen within 2 weeks
Number with PHI offered immediate ART
Which class of ARV have higher barrier to resistance?
NNRTIs
Complications of HSV?
erythema multiforme
Mollarets meningitis
How much does HSV suppression reduce transmission risk?
50%
How much do condoms reduce risk of spreading HSV?
30-70%
What to do about HSV in last trimestre if partner HIV pos?
No sex last trimestre
suppress him
condoms
no oral sex
What do you need to stay about HSV and the law?
may be helpful legally to disclose
What are risks of HSV in pregnancy?
same as general population- 3%
no evidence of miscarriage
Is Hsv treatment safe in pregnancy?
Yes
used for a long time
risks much worse if not treated
When to suppress HSV if HIV positive?
from 32 weeks
What is the lead in period for Ts and Ss PREP?
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’.
Other causes of hepatitis?
EBV
CMV
Drugs
How many people have HPV?
1/3 have actie HPV
lifetime risk 80%
estimated point prevalence of warts- 1%
specificity and sensitivity in different populations
sensitivity and specificity is not affected by prevalence
PPV is
Sde effects with nevi rapine?
Hepatotoxic
Steven Johnsons syndrome
Follow up HIV test after completing PEPSE?
8-12 weeks
How long does HCV live on a needle?
5 days
What factors increase the chance of HIV transmission?
sexual assault- trauma increased viral load STI Ejaculation Menstruaiton Circumcision
Breakdown of HIV transmission groups?
5 % MTCT
70% MSM
24% heterosexual
Which ARV does K103N have resistance to?
Efavirenz
Which ARV can not be used with contraception as enzyme inducers?
Nevirapine Efavirenz Atazanavir (boosted- NB unbolted increases levels ) Ritonavir PIs
(
Risk of MTCT if pregnant women is undetectable and pregnancy protocol followed?
0.1%
When can you use dolutegravir in pregnancy?
> 6 weeks
Which ARV have best safety data in pregnancy?
dolutegravir and efavirenz
If on DTG What is increased risk of NTD?
3/1000 births (1/1000 is the population risk)
If HIV test is positive at birth when is transmission likely to have taken place?
In utero
If HIV test is positive at 6 weeks (neg at birth) when is transmission likely to have taken place?
after 6 weeks
Can you use TAF/cobicistat in pregnancy?
no safety data
Can you use DAA / ribacvarin in pregnancy
No
Ribovarin is teratigenic- also men need to be informed - sperm
features of JH reaction
myalgia
riggers, chills, flush, fever, hypotension, deterioration of lesions
types of spirocahaetes
borrelia, leptospira and t pallidum
How does treponema behave on microscopy?
corkscrew movement
spin and flex on long axis
What is vaginal discharge?
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).
Transmission of LGV in UK
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.
Sex worker with ulcer- papa new guinea?
DOnavonosis- klebsiella commonest in Papa new guinea
In HIV- Iipoatrophy
With NRTIs
Lose fat from cheeks, arms, shoulder,s, thighs, buttocks
in HIV- lipohypertrophy
PIs
buffalo hump- dorsocervical fat
big neck
breast hypertrophy
Tabes dorsalis features?
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
Causes of pruritus ani
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
Treatment of pruritis ani
steroid
antihistamine
emollients and avoiding soaps
What regulations allow confidentiality regarding diagnoses to be shared?
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.
HIV window period
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%)
K103N mutation and M184V mutation which ARV can’t patient have?
Tenofovir Etricitabine (NRTIs) Neviparine Evavirenz (NNRTIs)
Which ARV cross blood brain barrier? ie treatment of PML
- zidovudine
2. nevirapine
Methadone and atripla interaction
Atripla- TDF emtricitabine and efavirenz
efavirenz decreases methadone
ARV causing gynaecomastia/breast swelling
efavirenz
Treatment of neonate born to mum Hep B?
Give immunoglobulin HBV 500 IU if mum HepB eag positive
Also give Ig if HepBSag pos, EAg negative (if EAb negative)
Late HIV diagnosis
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).
sensitivity of gc urethra male
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
sensitivity of gc females
Female urethra and endocervix
Microscopy- 50% and 20% sensitivity compared with culture for detecting gonorrhoea from endocervical and female urethral smears, respectively.
Culture of GC
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.
TV in men symptoms
75% no symptoms
Most common is discharge- gnu
dysuria
<10% balanitis
urethral CT
35-50% NGU in men
women 50-60% including other sites (15-20% only urethra)
