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Year 5 😊✌🏼 > HIV/GUM/ID > Flashcards

HIV/GUM/ID Flashcards

1
Q

What minerals cause issues with ART absorption?

A

particularly bivalent cations e.g. Mg2+, Ca2+, Fe 2+

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2
Q

Mx of urethritis

A

7d of doxycycline BD po

or

single dose of azithromycin po

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3
Q

Hep B Serology

A
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4
Q

ALT raised - what does

A

3x upper limit of normal becomes problematic

5x upper limit -> admit

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5
Q

ALT - 1560
AST - 2650
ALP - 206
Bilirubin - 120

what is this picture called?

A

transaminitis

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6
Q

transaminases in the liver

A

ALT and AST

(alanine amniotransferase and aspartate aminotransferase)

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7
Q

What puts your ALT >1000

A

viral hep
ischaemic hep
AI hep

drug induced

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8
Q

Why do we worry about snorting drugs?

A

transmission risk of viral hepatitis C

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9
Q

marker of acute hep A infection

A

IgM

can also be present in v recent immunisation

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10
Q

Mx of hep A

A

transient self-limiting condition

supportive care if needed

many asymptomatic

f/u fortnightly until transaminases are normal

notify PHE - contact tracing and vaccination

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11
Q

How can you get Hep A

A

faeco-oral

-> food, water, sex (oro-anal, digits-rectal contact)

close contact In the household, child daycare centres

in UK most commonly associated with travel and sexual outbreaks

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12
Q

incubation period for Hep A

A

15-45 days

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13
Q

does Hep A have chronic sequelae?

A

none

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14
Q

can Hep A causes fulminant hep A?

A

<0.1% - very rare

mire common if there is confection with hepB/C

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15
Q

Hep E incubation period

A

40

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16
Q

Hep E dx

A

PCR hep E virus RNA

Hep E Ab

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17
Q

marker for active Hep B

A

surface Ag positive (Hep B s Ag +ve)

also Hep B DNA +ve

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18
Q

Which Hep do you need to have to get Hep D infection?

A

B

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19
Q

Hep B DNA quantity

A

used to monitor the infection and

if Hep B DN A

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20
Q

When in Hep B cAb +ve ?

A

past infection

or

chronic infection (not seen in acute infection)

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21
Q

can you self clear Hep B?

A

yes - it’s common to self clear it

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22
Q

HbeAg +ve

A

highly infective
high viral load

usually also high DNA

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23
Q

HbeAb +ve

A
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24
Q

Mx of Hep B

A

no cure (yet)

refer all HepBAg+ pts to hepatologist

HIV test will alter therapy

  • see if they self-clear
  • if not: you can consider treatment

Fibroscan

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25
Q

commonest cause of HCC

A

UK - alcohol

worldwide - Hep B

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26
Q

drugs used to treat Hep B (if indicated)

A

Lamivudine
Emtricitabine
Tenofovir (most common)
Telbivudine
Entecavor
Adefovir

historic: pegylated iFN alpha

if HIV - tenofovir (will make sure that HIV therapy also covers for HepB)

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27
Q
A

Hep B crosses the placenta

can have vaginal delivery
can breastfeed

low transmission rate

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28
Q

Hep B PEP

A
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29
Q

is acute Hep B notifiable?

A

yes

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30
Q

how is hep D transmitted?

A

percutaneous (IVDU)
permucosal (sex)

confection with hep B needed

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31
Q

Who do you worry about hep D in?

A

someone with Hep B who is unwell/not improving

32
Q

Hep C

A
33
Q

Mx for Hep C

A

DAA (direct acting antivirals) - 99% success rate

12 week course

(used to be pegylated IFN)

34
Q

Which drugs are injected?

A

heroin
crystal meth

35
Q

how is GHB taken

A

drink

(gamma-hydroxybutyrate)

36
Q

how is Crystal meth used?

A

injection
smoking

37
Q

effects of GHB

A

disinhibition (increased sex drive as well)
euphoria

38
Q

how does GHB appear?

A

colourless odourless liquid

39
Q

why is GHB a date rape drug?

A
  • colourless odourless liquid
  • not included in the standard NHS tox screen
  • leaves the system quite quickly
40
Q

Hep C virus type

A

+ve strand RNA virus

Flaviviridae

41
Q

Hep C RNA testing

A

PCR

not used to screen in A&E because PCR is expensive

it is a better test then Anti-HCV so some poeple are missed

42
Q

which Hep C test is done in A&E to screen?

A

anti-HCV

43
Q

Do we treat everyone with Hep C?

A

we wait 12w to see if they are getting better

otherwise we start DAA

depending on genotype, there are resistance patterns so the genotype pattern

there are also pangenotypic treatmments

44
Q

pangenotypic treatment of Hep C

A

in the UK genotype testing is done and a treatment is selected

in some countries you don’t genotype and just give pan-genotypic treatment

45
Q

Can you get re-infected with Hep C?

A

yes

the majority of people who re-present are reinfected, not treatment failure

46
Q

where do you see HIV 1 and 2?

A

1 - global
2 - west Africa

47
Q

AIDS - ground 0

A

Cameroon

blood to blood transmission from chimpanzees

moved to DRC - sex work prevalent there, virus spread

48
Q

first HIV case

A

June 5th 1981

in 1983 first started isolating virus

49
Q

how effective is HIV PrEP?

A

86% effective in RCTs

50
Q

when after HIV exposure will Ab be positive?

A

45d

if still -ve bring back at 3 months (also good for HepB/C and syphilis)

51
Q

4th gen HIV tests

A

Ab and Ag

52
Q

standard HIV therapy

A

2 NRTI (backbone)

+ 3rd agent (integrates inhibitor, protease inhibitor + booster/ NNRTIs)

they work on unaffected cells and protect them from infection

53
Q

normal CD4+ count

A

500 or above

54
Q

why is the timeframe to give PEP 72h?

A

72 h

it takes 72 h for the virus to integrate into the human DNA

55
Q

PrEP - how can you take it?

A

Truvada - OD (for regular exposure)

2 tablets - 2-24h before sex
1 tablet 2h post exposure
1 tablet 48 post exposure

56
Q

PCP test

A

serum BD Glucan

57
Q

Mx of PCP

A

Septrin (caan cause kidney issues)
2nd line: clindamycin and primaquine

O2
supportive mx

58
Q

IRIS

A

immune reconstitution inflammatory syndrome

59
Q

types of IRIS

A

paradoxical - worse when the ART is started

unmasking - CD4 are finding new pathogens in the body that wasn’t there before

more likely to happen if CD4 counts are low

60
Q

rule of 2s - how to remember

A

2 in the brain

eye - CMV, too

mouth

skin

lung - PCP, TB

liver - Hep B/C

GI - cryptosporidium

Kidney - HIVAC

spleen - NHL, xx

GU - cervical cancer, anal carcinoma

61
Q

highest prevalence of TB in London?

A

east London

62
Q

TB testing

A

gene Xpert (can detect resistances as well)
quantiferon
ziehl-neelsen

63
Q

non-TB mycobacteria

A

night sweats
lumps and bumps
weight loss

happens when CD4+ under 50

64
Q

ring enhancing lesion on CT dx

A

toxoplasmosis

65
Q

multiple ring enhancing lesions of CT -dx

A
66
Q

toxoplasmosis pathogen type

A

parasite

67
Q

toxoplasmosis pathogen type

A

parasite

68
Q

Mx of toxoplasmosis in brain

A

2w treatment for too and re-scan

if responds, dx confirmed.

otherwise consider other differentials (e.g. abscess, tb, primary cerebral lymphoma)

69
Q

PML

A

progressive multifocal leucoencephalopathy

70
Q

cryptococcus - pathogen type

A

fungus

71
Q

cryptococcus LP

A

really high pressure on LP

..

-> india ink stain

72
Q

CRAG

A

cryptococcal antigen

73
Q
A

check eye for CMV retinitis if CD4 count under 50

74
Q

why do you check mouth in someone with Kaposis sarcoma?

A

if there are oral lesions it is more likely that the patient has visceral lesions too e.g. in their lungs

75
Q

NAAT which STIs?

A

gonorrhoea
chlamydia

Year 5 😊✌🏼 (53 decks)

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