GUM / HIV

Question 1

Ix for Chlamydia in Men

Answer 1

NAATs of first pass urine sample

Question 2

Chlamydia - how long should an individual not have sex?

Answer 2

7d after starting Abx

Question 3

What is chlamydia Mx in pregnancy?

Answer 3

PO azithromycin (doxycycline is CI)

Question 4

How long does it take to for a Chlamydia / Gonorrhoea / HIV / Syphilis / Hep B test to be positive?

Answer 4

Gonorrhoea - 1 week
Chlamydia - 2 weeks
HIV - 6 weeks
Hep B - 3 months
Syphilis - 3 months

Question 5

Describe the organism that causes syphilis.

Answer 5

Treponema Pallidum - spiral shaped

Question 6

What is the classification of ‘Early Latent’ syphilis? How many Latent progress to Tertiary syphilis?

Answer 6

Acquired syphilis in last 2 years.

33% progress to Tertiary Syphilis

Question 7

Which single antibody needs to fall by 4-fold to diagnose treated syphilis?

Answer 7

RPR

Question 8

Ix for genital herpes

Answer 8

PCR of swab (NOT culture)

Question 9

Describe genital herpes rash

Answer 9

Vesicular, painful, multiple ulcers

Question 10

Which condition can spread by skin to skin contact (e.g. can spread even with condom)

Answer 10

Genital warts (HPV)

Question 11

Ix for bacterial vaginosis

Answer 11

None - clinical diagnosis. Most of us have candida on skin so swab + culture is not useful

Question 12

Which discharge has a pH >4.5?

Answer 12

Bacterial vaginosis

Trichomonas

Question 13

How is trichomonas spread?

Answer 13

STI - partners need treating

Question 14

Sx of lichen sclerosis

Answer 14

White plaques which are ITCHY

Question 15

Sx of molluscum contagiosum

Answer 15

ITCHY plaques with central bump, after trauma, not painful

Question 16

What type of organism is pneumocystis jiroveci?

Answer 16

Fungus

Question 17

How do you manage a pneumocystis jiroveci which is a first presentation of HIV?

Answer 17

Co-trimoxazole now

Wait 2 weeks before starting CART

Question 18

Why and when are steroids used in pneumocystis jiroveci?

Answer 18

Steroids used if pO2 < 9.3.
Steroids reduce the need for mechanical ventilation, which is risky as it can lead to pneumothorax (HIV lungs are very delicate)

Question 19

How do you manage a tuberculosis which is a first presentation of HIV?

Answer 19

Wait 2 months before starting CART
(if CD4<50, then wait 2 weeks)
(if CNS TB, wait longer)

Question 20

What are Sx of cryptococcal meningitis?

Answer 20

Non specific - fever, headache, confusion

There’s poor inflammatory response in immunocompromised, so normal meningitis Sx (neck stiffness, photophobia) won’t be seen

Question 21

Ix in cryptococcal meningitis?

Answer 21

CT scan > LP

Even if neurological exam is normal, can’t rule out SOL as it doesn’t always present with Sx in immunocompromised patients. Hence we always do CT in HIV patients before LP

Question 22

What does cryptococcal meningitis appear as on LP?

Answer 22

Cryptococcus is invisible!

Question 23

Which organism causes Progressive Multifocal Leukoencephalopathy?

Answer 23

JC virus

Question 24

Ix for Progressive Multifocal Leukoencephalopathy

Answer 24

1. MRI to view demyelination

2. LP for PCR fo JC virus

Question 25

When should you give CART in cryptococcal meningitis

Answer 25

DON’T GIVE CART, PATIENT WILL DIE IN 10 MINUTES

Question 26

Mx of Progressive Multifocal Leukoencephalopathy?

Answer 26

Begin CART

Question 27

What are complications of Kaposi Sarcoma?

Answer 27

Pulmonary KS - life threatening

Oral KS

Question 28

What do you do after 2w of toxoplasmosis treatment if minimal response?

Answer 28

Assume its primary CNS lymphoma

Question 29

What is primary CNS lymphoma and how is it different to NHL?

Answer 29

Its NHL limited to brain

Question 30

CT signs for toxoplasmosis vs. Primary CNS lymphoma

Answer 30

Toxoplasmosis - multiple ring lesions
Primary CNS - single homogenous lesion

Both have mass effect