Exam 4 Flashcards
What stage is Syphillis most likely to infect?
The primary stage
What is the makeup of the HIV retrovirus?
HIV is a spherical retrovirus with a core of RNA surrounded by a lipid membrane envelope
What is the main target of HIV?
CD4 Cells
HIV mutates?
frequently with replication
How is HPV spread?
Direct contact with virus on muscousal surfaces, usually during penetration
How many subtypes of HPV are there?
Over 100, but most infections remain subclinical
What are two of the manifestation outcomes from different subtypes of HPV?
Genital warts
Cervical dysplasia and cancer
What is the morphology of HPV warts?
They may be flat or raised, but not inherently painful
What are the options for HPV wart removal?
Topical, chemical and surgical treatment options for wart removal
What are the current approved vaccines for HPV?
Gardasil
Gardasil-9
Cervarix
At what age are the HPV vaccines recommended?
ages 11-12, but can start as early as 9
How many doses are considered fully vaccinated against HPV?
2 or 3 doses depending on age at first shot
What percentage of HPV related cancers do the vaccines prevent?
> 90%
HPV _____________ ______________ are the most likely to spread.
Active legions
How is the herpes simplex virus spread, and where does it end up?
Direct contact with the virus on any mucosal surface and the virus settles in neurons
What are the two types of the Herpes Simplex Virus?
HSV-1: Usually oral ulcers
HSV-2: Usually genital uclers
Between Herpes initial infections and manifestations, what normally occurs?
An incubation period
What are herpes lesions like?
Fluid-filled, very painful and burning
How do antivirals help the herpes virus?
Herpes is known for periodic ‘flare ups’, the antiviral medication helps reduce these flairups and transmission
_______________ and _______________ are both bacterial infections transmitted by sexual fluids.
Gonorrhea and Chlamydia
Where are the most common entry portals for Gonorrhea and Chlamydia?
The Genitourinary Tract
Oropharynx
Anus
What are the initial symptoms of Gonorrhea and Chlamydia?
Most of the initial symptoms are localized to the infected area but chlamydia may have few initial signs/symptoms
What are the complications of untreated infections of Gonorrhea and Chalmydia?
Untreated infections can cause systemic problems and infertility
What occurs after a diagnosis of gonorrhea and chlamydia?
All Previous partners must be contacted and tested, and results are reported to DHEC
What is the etiology of Syphilis?
Infections with treponema pallidum, a spirochete bacteria
How is syphilis spread?
spread through contact with an infected lesion called a chancre
How is syphillis tested for?
Blood tests called T Pa antibody tests
RPR/VRDL titers
What are the 3 stages of syphilis?
Primary
Secondary
Tertiary
What occurs during the primary stagte of syphilis?
The primary stage lasts around 3 weeks to 3 months and chancre development occurs
What occurs during the secondary stage of syphilis?
The secondary stage lasts around 1 week-6 months
Rash, fever and other systemic signs and symptoms develop here
What occurs during the third stage of syphilis?
The tertiary phase occurs after years of untreated infection and can cause cardiovascular and neurological problems
Can see problems 5, 10, 15 years later
What are some of the characteristics of syphilis chancers?
They are painless, and may be not noticed if they are not present in a visible area
What is the treatment for syphillis?
Long acting penicillin
Doxycyline if a person has a PCN allergy
-because syphilis lasts in the body for so long, we don’t need high levels of pencillin we just need longevity
Once a treatment for syphilis has been completed, what will happen if they take an antibody test?
They will always continue to test positive
What are the steps in the HIV lifecycle?
Fusion/entry
Reverse Transcription
Integration
Protein arrangement/viral assembly
Virus budding and release
How is HIV infection spread?
Infection only occurs through blood, bodily fluids (semen and vaginal fluid) or perinatal transmission
What are the different types of blood exposures for HIV infection?
Accidental
Needlesharing
Accidental needle sticks
Blood transfusions
What are the different types of body fluid exposures for HIV infection?
Vaginal and anal intercourse
Oral sex is less risky
What is perinatal transmission of HIV?
HIV transmission from a pregnant person to a fetus
Sexual _____________ not ______________ place people at risk for HIV.
Sexual practices not preferences place people at risk for HIV
What are the prevention practices for HIV?
Avoid IV drug use/resusing needles
Prevention of accidental needle sticks
Blood donations screened
Universal precautions when exposure to bodily fluids
Use of condoms/barrier methods during sex
Limiting partners and testing
Testing and Treatment of pregnant indivuals
What is PrEP?
Pre-exposure prophylaxis
What is PEP?
Post-exposure prophylaxis
What are the CD4 counts for HIV?
Normal: 800-1050/mm3
Symptoms may begin around 500/mm3
Opportunistic infections begin around: 200/mm3 (Important dividing line for overall state of their immune system)
What are the viral load counts for HIV?
As immune system fails, levels may reach 10^5-10^7/mL
The goal for patients on treatment is:
On antiretrovirals, goal is to reach undetectable which is less than 20 copies in that blood sample
What are the primary/acute infection signs of HIV?
Fever
Pharyngitis
Headache
Myalgia
Weight loss
Rash
N/V/D
The skinny man with a fever, a sore throat, and a headache has sore muscles, a rash, and GI issues.
What is the latency phase of HIV?
Average asymptomatic period of 8-10 years when untreated
When do symptoms begin for HIV?
Symptoms develop when CD4 count drops below 500-350 and manifestions include:
Generalized lymphadenopathy
Neurological Diseases
Increased infections
What are some of the opportunistic infections of HIV/AIDS?
Viral:
Fungal:
Protozoal:
Other:
Viral: Herpes simplex, cytomegalovirus, EBV
Fungal: Histoplasmosis, Candida, Pneumocystis jiroveci pneumonia
Protozoal: toxoplasmosis
Other: Kapsoi’s sarcoma and other STIs
HIV infected CD4 cells are eventually?
Destroyed
Glycoprotein Antigens on the virus surface important for testing in what way?
To test for the presence of the virus in the body
Upon fusion of the HIV virus to the host cell which is the __________ cell, the RNA of the virus enters.
CD4 cell
The viral genetic material of the HIV virus is?
RNA that is then converted through reverse transcription to DNA, and the genetic material of the virus is in the same ‘language’ as the genome of the CD4 cell and is integrated into the DNA of the host cell.
Once the HIV viral DNA has inserted itself into the host cell, the CD4 cell?
Cranks out more copies of the HIV virus
Essentially, the CD4 cell is functioning as a HIV factory.
Virus buds off the CD4 cell and is off to hijack another cell
HIV transmission through oral sex is less risky, it can be higher risk when?
The person performing oral sex has breaks or sores in their oral mucosa that is higher risk
Which partner has a higher risk of contracting HIV during vaginal or anal sex?
Being the receptive partner (partner receiving bodily fluids
The viral load of HIV increasing then causes?
The CD4 cells to drop off.
Those first changes in the increase of the viral load comes before that CD4 dropoff
When the CD4 cell count reaches below 200/mm3 or have particular opportunistic infections, their diagnosis is then classified as?
AIDS
__________________ _________________ worsen as CD4+ counts decrease.
Secondary infections
What is the most common opportunistic infections that is considered an AIDS defining illness?
Pneumocystis Jiroveci pneumonia
What are the symptoms of Pneumocystis Jiroveci pneumonia?
Occurs when CD4 count is <200
Progressive and slow and usually subacute symptoms like dyspnea on exertion, cough, fever, chest pain
What is the prevention and treatment of Pneumocystis Jiroveci pneumonia?
Bactrium Antibiotics once per day if at risk
Higher doses of bactrium for active infections
Can be fatal without treatment
Antibiotics in an immunosupressed patient, such as a AIDS patient can lead to?
Candidiasis, may develop as ‘thrush’ in the mouth, in the esophagus, or rarely, in the respiratory tract
Candidiasis is considered an AIDS defining illness
_________ is a common virus that is only problematic when immune system is supressed.
CMV
How is CMV spread and what are the symptoms?
CMV is spread by body fluids
Symptoms are
blurred vision
possible blindness (retinitis)*****
Painful swallowing
Diarrhea
Neuropathies
Dr. Custer stated that if she has a patient and suspects this she immediately sends them for an eye exam because it can lead to blindness
CMV in the __________ is considered an AIDS defining illness.
Eyes
What are the 2 different types of HIV tests?
Antibody testing
Antigen/antibody tests
Antigen/antibody tests are available in?
Both at home test kits and laboratory tests
What is the “window period” in regards to viral testing?
Since antibody tests are slightly less senstitive and have a delay from the time of infection to the test being positive and this is called the ‘window period’
What are the basal ganglia?
Groups of neurons and structures in the brain
What are the different subsections of the basal ganglia?
Caudate Nucleus
Putamen
Globus
Globus Pallidus
Substantia nigra
Subthalamic nucleus
Can Peter Gladly Go Straight?
Where are all the basal ganglia structures located?
Around the thalmus
What is a progressive disorder of dopamine production in the basal ganglia?
Parkinson’s Disease
What specific area of the basal ganglia is affected by Parkinson’s?
Substantia nigra
What two neurotransmitters are involved in Parkinson’s disease?
The balance of dopamine and acetylcholine is affected. The lack of dopamine affects the purposeful movement
What are the manifestations of Parkinson’s disease?
Ridgity
Tremor (esp. at rest)
Akinesia/bradykinesia
Loss of postural reflexes
Shuffling Gait
Mask-like face
While Parkinson’s increases with age, what percent of the population will be diagnosed?
1% of the population
The high levels of _____________ in Parkinson’s can cause an increase in _____________ __________/___________.
The high levels of acetylcholine cause an increase in muscle movements/tremors
When in muscle ridgity worse in Parkinson’s disease?
At the beginning of a movement
What is an autoimmune disorder that targets the CNS, and is possibly initiated by a viral infection?
Multiple Sclerosis
What is the pathophysiology behind multiple sclerosis?
Areas of myelin in the CNS are destroyed and replaced by scar tissue and inflammation
What is the basic function of myelin?
To speed impulses down the axon
When is the average onset of multiple sclerosis, and what demographic is most likely to be affected?
Average onset is age 30 and women are more likely to be diagnosed
After the myelin is broken down, what is left (in concern to multiple sclerosis)?
Result is that hard scar tissue plaques are around nerves. This results in the signals becoming ‘broken up’ and the communication between the neurons is unclear, motor and sensory function decreases
What is the general pattern of multiple sclerosis?
Pattern is usually repeated attacked with remissions in between, but overall symptoms gradually worsen with more permanent loss of function after each attack
The location of lesions for Multiple sclerosis can?
Allow a neurologist to pinpint on brain MS is by the symptoms exhibited
What is the goal of treatment of multiple sclerosis?
The goal of treatment is to delay symptoms and degeneration not to treat
What are the sensory manifestations of MS?
Visual problems
Numbness
Prickling (Parasthesias)
These are the earliest symptoms and the most likely for a patient to notice
What are the motor manifestations of MS?
Spasticity
Weakness
Paralysis
Speech Difficulty
These only occur if the motor cortex is affected
What are the cerebellar manifestations of MS?
Vertigo
Poor Balance
How can MS affect the bladder?
If the part of the brain that control the sphincters is effected, then incontinence can occur
What can be mood disorders can can manifest from MS?
Depression-it’s unclear as to whether depression is caused by a pathophysiological standpoint, or because of the associate manifestations of MS and their effect on a persons mood
The Vertebral column is unable to withstand?
too much rotation, extention, or flexion
What is often effected when vertebral damage has occured?
The spinal cord is damaged
Spinal cord injuries often occur between?
Injuries often occur between “segments” of the spine such as between the cervical, thoracic, lumbar and sacral
Ex: C7, L1
___________________ ________________ may cause compression of the spinal cord and disruption of blood supply.
Mechanical Injury may cause compression of the spinal cord and disruption of blood supply
What is an acute spinal cord injury?
Any traumatic injury that bruises, partially tears, or completely tears the spinal cord
What are the common causes of acute spinal cord injuries?
Motor Vehicle Accidents****
Falls
Sports injuries
Metastatic diseases causing gradual damage
Osteoporosis
What are the two subcategories of acute spinal cord injuries?
Primary and Secondary
What is a primary acute SCI?
A primary acute SCI occurs at the time of injury, direct damage to the spinal cord and is permanent
(Physical injury at the moment)
What is a secondary acute SCI?
A secondary acute SCI is continued damage due to inflammation, hypoxia
(These are the things we can try to limit using mechanical/pharmological interventions)
Acute SCI’s cause both?
Motor and autonomic motor system dysfunction
A __________________ ____________________ in an acute SCI causes complete loss of all functions below the injury.
Complete Transection
What is considered a complete acute SCI?
Total loss of movement and sensation below the level of injury
What is considered an incomplete SCI?
Partial movement and/or sensation below level of injury
The __________ the level of spinal cord equals?
The higher the level of spinal cord injury the more of the body is affected
A C4-C6 injury will result in?
Tetraplegia
A T6 injury will result in?
Paraplegia from the diaphram down
A L1-5 injury will result in?
Paraplegia-full upper extremity and trunk use, progressive lower extremity use
A C1 injury is?
Often fatal because of the phrenic nerve that exits the spinal cord and control diaphram and breathing
A C2-3 spinal cord injury will result in?
Some neck control but may require a ventilator
What are the most common causes of thoracic-lumbar-sacral injuries?
Often are compression fractures
An S1-5 spinal cord injury will result in?
Patient may have foot control, but may have bladder/bowel incontinence
The main problem occuring from spinal nerve injuries is?
The loss of the normal balance between the sympathetic and parasympathetic nervous systems.
The connection between spinal ANS nerves and brain is lost below the level of spinal cord injury
Why are SCIs at or above T6 especially problematic?
Spinal shock
Excessive Vasovagal response/neurogenic shock
Autonomic dysreflexia
What is spinal shock?
Flaccid paralysis with loss of tendon reflexes/sensation below the level of injury.
Loss of bowel/bladder function
May result in widespread vasodilation
Spinal shock effects are greater the ___________ the level of injury, and exist on what type of timeline?
Spinal shock effects are greater the higher the level of injury, and exist on a variable timeline
(Normally a few minutes-brief reaction to massive impact on spinal cord)
Why can spinal shock result in widespread vasodilation?
Because the sympathetic nervous system controls vasoconstriction->the loss of connection with the sympathetic nervous system results in this widespread vasodilation
What is Neurogenic Shock?
A vasovagal response that results from loss of the sympathetic tone below the level of SCI and results in widespread vasodilation, hypotension and bradycardia**
What is the only situation where vasodilation and bradycardia are both present as a result from the same pathophysiology?
Neurogenic shock
A low BP + a low HR=neurogenic shock
What type of shock is neurogenic shock?
A form of distributive shock because the body is not low on blood volume, but the blood is not being distributed in the correct way
Autonomic Dysreflexia (also known as hyperreflexia) is?
An acute complication following high level SCIs (T6 or above) that can only occur after spinal shock and neurogenic shock have resolved
How long can a patient be at risk for Autonomic Dysreflexia after spinal shock and neurogenic shock have resolved?
A patient can remain at risk for 6 months to a year
What are the symptoms of Autonomic Dysreflexia?
Patient has severe headache/flushed skin
Bradycardia
Vasoconstriction below SCI
Vasodilation & Sweating above SCI
Overall extreme hypertension
Why are we seeing both vasoconstriction and vasodilation in Autonomic Dysreflexia?
The sympathetic response is able to do whatever it wants below the level of injury
The parasympathetic nervous system tries to compensate above the level of injury with the vasodilation
What can cause autonomic dysreflexia to occur?
Some sort of stimulus, such as
Repeat catheterization
Bowel impaction
Tight/compression socks
Pressure ulcers
-Physiological stimuli trigger the strong sympathetic response
What are some of the other effects of SCI?
Loss of temperature regulation
Risk of DVTs and edema
Skin Breakdown
Neurogenic bladder and recurrent UTIs
What are the manifestations of diffuse brain injuries?
Altered LOC and behavior changes
-Confusion
-Lethargy
-Obtundation (less and less responsivness)
-Stupor
-Coma
-Reduced GCS score
-Decorticate/Decerebrate posturing
-Respiratory changes
-Loss of pupillary reflexes
How is does our brain coordinate consciousness?
Consciousness is coordinated by cerebral hemispheres and reticular activating systems
What are the ratings of the Glasgow Coma Scale?
Eye opening (1-4)
Motor response (1-6)
Verbal response (1-5)
A lower number on the GCS means?
What is a normal functioning score?
The lower the number, the worse the patient
“Below 8, intubate”
A normal functioning score is a 15
At what GCS score do we start to say “Patient is in a coma”
3-5
What is decorticate posturing?
Flexion of the arms and hands to the chest
What is Decerebrate posturing?
Extension of arms and hands to one’s side
Both Decorticate and Decerebrate posturin indicates?
Significant brain damage due to brainstem problems
Respiratory changes indicating diffuse brain injuries are?
Tital volume is shallow
Rate, depth, regularity
What manifestation of diffuse brain injuries is seen in the eyes?
The pupillary reflexes are no longer able to constrict or have mismatched constriction
In very severe cases, the pupils stay fixed and dilated
What are some of the mechanisms of brain injuries?
Hypoxia
Ischemia
Excitatory Amino Acid Injuries
Cerebral Edema (Vasogenic/cytotoxic)
What occurs during a hypoxic brain injury?
The brain is deprived on oxygen even though it still maintains good perfusion
Ex: Patient is in respiratory failure
What occurs during an ischemic brain injury?
Reduced blood flow to brain (can be localized, like in a stroke) or generalized
Both O2 and glucose missing (Neurons cannot get nutrition from anything but glucose)