End of unit Flashcards
CD4 count below 200 what opportunistic infections could occur in hiv
candidiasis - white coating on tongue and pain on swelling
penumocytisi penumonia - pneumocystisi hireovecii
CD4 count below 100 what opportunistic infections could occur in hiv
Cryptococcal meningitis:
Headache, fever, fatigue, LP has a high opening pressure
CD4 count below 50 what opportunistic infections could occur in hiv
Progressive multifocal leukoencephalopathy (PML)
Cognitive impairment, focal neurological signs, MRI shows hyperdense lesions
Cerebral toxoplasmosis : Headache, fever, confusion, focal neurological signs, seizures, imaging shows multiple ring enhancing lesions
Disseminated MAC: fever, night sweats, weight loss, diarrhoea, abdo pain, hepatosplenomegaly
CMV retinitis: floaters, visual field defects, painless visual loss, pizza pie fundus
CD4 count below 500 what opportunistic infections could occur in hiv- anything
TB:
Fever, chills, night sweats, weight loss, haemoptysis, lymphadenopathy, CXR- consolidation/cavities/nodules
HIV pneumonia causative organism
Pneumocystis carnii (jirovecii)
CAP causative organism
strep pneumoniae
HAP causative organism
staph
COPD pneumonia
haemophiliac influenzae
CF or ventilated patents causative organism for pneumonia
pseudomonas
immunocomprimsed pneumonia
aspergillus
post operative pneumonia causative organism
e.coli
Aids defining malignancies
Kaposi’s sarcoma- purple nodular lesions on back
High grade B cell non-Hodgkin’s lymphoma
Invasive cervical cancer
Non-AIDS defining malignancies include Hodgkin’s lymphoma and HIV related anal cancer
what is the difference between candida ( under cd4 200) and oral hairy leukoplakia ( under 500)
candid you can scape off tongue leading it to be red
. white patches on leukoplakia does not come off
what to treat candida
oral fluconazole
what to treat hair leukoplakia
self resolving maybe acyclovir
PCP - pneumocystis jiroveci
symptoms
treatment
dry cough, SOB, reduced effort tolerance and fever
trimethoprim , sulfamethoxazle with steroids if severe
what to treat mycobacterium tb
RIPE - rifampicin, isoniazid , pyrazinamide
symptoms of cryptococcal meningitis - below 100
headache fever and malice with neck stiffness , photophobia and fever and signs of raised ICP
treatment of cryptococcal meningitis
IV amphoctericin B + PO flu cytosine then fluconazole
cytomegalovirus symptoms and management
below 50
blind spots and visual floaters , peripheral field defects and painless visual loss
retinal haemorrhages and heard exudates
gancicclovir
difference between chlamydia and gonorrhoea
c - clear or white discharge and
G- green or yellow discharge
men in C need to have first catch urine sample and women vulvo-vaginal swab whereas in G men urethral swab and women endodermal-cervical swab
docyclicine for C
gonorrhoea - culture and ciprofloaxicn or cefratriaxone
Herpes = blisters which form painful ulcers
treatment ?
oral acyclovir
Lymphogranuloma venerum = painless ulcers + painful inguinal lymphadenopathy
treatment same as chlamydia
doxycycline - for 7 day
or one tablet of arthromycin
Lymphogranuloma venerum = painless ulcers + painful inguinal lymphadenopathy
treatment same as chlamydia
doxycycline - for 7 day
or one tablet of arthromycin
\
Stage 1 Syphilis = painless ulcers
Treatment- HIV and HIV testing + referral
thrush caused by what and what treatment
hrush (candida albicans)- present in normal flora (overgrowth is causes by stress, antibiotics or immunosuppression)
Cottage cheese like discharge, often sore. Give Canesten cream and/or fluconazole
bacterial vaginosis - overgrowth of anaerobes like gardnerella
clue cells on microscopy ]]symptoms and treatment
smelly fishy discharge no pain
metronidazole
Genital psoriasis- dry and scaly skin. Often itchy.
Give steroid cream.
common joints affected by RA
MCP and PIP
swan neck deformity -MCP flexion, PIP hyperextension, DIP hyperflexion).
Boutonniere finger deformity (PIP flexion, DIP hyperextension).
Ulnar deviation of proximal phalanges.
Z-shaped thumb.
treatment for RA
NSAIDS and physiology
DMARDs - methotrexate and hydorxycloroquine ( continued through ores as contains folate)
biologics - anti-TNF
antibodies seen for SLE
anti ds DNA , anti sm and ANA
get skin rashes plus small joints oh hands with weight change
treatment for SLE
Hydroxychloroquine(all)+ prednisolone(sx relief)+ Methotrexate/Azithioprine if needed Cyclophosphamide as a rescue therapy
OA is asymmetrical swelling on knees, hips and hands affecting DIP worsening with activity what findings
Serology negative, ESR and CRP normal
UTI treat
Nitrofurantoin or Trimethoprim
cellulitis
flucloacilin
orbital cellulitis
co-amoxiccilin
tonsilitis
1st line is pencillin - phenoxy
2nd line is erythromycin or clarithromycin
CAP pneumonia antibiotics
amoxicillin and if atypical clarithromycin
prostate drains to what nodes
iliac lymph nodes
chicken pox
cause
symptoms and treat
varicella zoster
widespread papule that blister into vesicles and scab - parities and fever
treat with supportive fluids and if adults acyclovir
school exclusion until lesion have crusted over
hand foot and mouth
cause
symtposm
treat
coxsackie virus A16
vescicale rash on hands and feet and painful oral ulcers and low grade fever
treat - supportive fluids and simple analgesics - oral lidocaine used for fluids
no exclusion from school
impetigo
cause
symtposm
staph aureus
red sores, blisters round the mouth that burst and crust over forming Honey coloured crust
treat with 1st line topical hydrogen peroxide
2nd line fusidic acid and 3rd if spread flucloaxillin
school exclusion until lesion cursed and healed or 48hr after antibiotics commenced
erythema infectious -slap cheek
cause
symtposm
treat
parvovirus B19
red cheeks and pink rash on limbs
aplastic anaemia
supportive analgesics - no exclusion from school
scarlet fever
cause
symtposm
treat
group A strep
sore throat, fever and sick with GI upset
sandpaper like rash and tender cervical adenopathy and strawberry tongue with pharyngeal erythema
amoxicillin
return after 24 hr of antibiotics
Kawasaki disease
cause
symtpom
treat
- N/A acute vasculitis
dever , sandpaper rash on palms and soles , tender lymphadenopathy and strawberry tongue
IV immunoglobulin and aspirin
no exclusion
shingles
cause
symptoms
treat
varicella zoster
papules blister into vesicles and scab over into dermatomal distribution
acyclovir and analgesia - school exclusion until lesion have all crusted over
in hiv what do you need to make sure during pregnancy
avoid breastfeeding
vertical transmission unlikely with undetectable viral load below 0.1 % - continue ART treatment and deliver via c section if viral load detectable - ART 4 weeks for baby
treat for HIV
Treatment
Start ASAP
Backbone of two NRTI’s plus NNRTI or PI or INI
Post exposure prophylaxis= course of HIV therapy for 28 days.
Post-exposure prophylaxis
Should be given within 72 hours
Receptive anal sex – recommended regardless of HIV status
Everything in between
Oral sex without ejaculation- not recommended
stages HIV
Stages
1 Seroconversion/ primary infection: triad of fever, rash and pharyngitis (only in 60% and usually mild)
2 Chronic/latent phase
3 AIDs (severe opportunistic infections and tumours)
Ophthalmia neonatorum simply means infection of the newborn eye.
Responsible organisms include
Chlamydia trachomatis
Neisseria gonorrhoeae
Suspected ophthalmia neonatorum should be referred for same-day ophthalmology/paediatric assessment.
what is subcostal plane
The subcostal plane is a transverse plane which bisects the body at the level of the 10th costal margin and the vertebral body L3.
Pylorus stomach Left kidney hilum (L1- left one!) Right hilum of the kidney (1.5cm lower than the left) Fundus of the gallbladder Neck of pancreas Duodenojejunal flexure Superior mesenteric artery Portal vein Left and right colic flexure Root of the transverse mesocolon 2nd part of the duodenum Upper part of conus medullaris Spleen
are all at what level of the body
L1- transpyloric
hairy leukopenia causes by what organism
EBV
trimethoprim inhibits bacteria DHFR but methotrexate a chemotherapy agent inhibits
mammalian DHFR
