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Clin Med III, Exam 2 (ASL) > HIV/STI (Lauren 🌭) > Flashcards

HIV/STI (Lauren 🌭) Flashcards

1
Q

HIV uses (forward/reverse) transcriptase it turn its RNA into DNA

A

Reverse

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2
Q

Which type of cells are the target of HIV

A

CD4 T cells (Helper T cells)

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3
Q

What are the two (3) types of lymphocytes?

A

B cells- make antibodies

T4 cells (CD4)- helper T cells that tell the B cells to make antibodies

T8 cells (CD8)- killer T cells

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4
Q

What kind of infections will cause lymphocytes to rise?

A

Pretty much everything including ~viruses~

Protozoa, fungi, intracellular fungi…

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5
Q

Once inside the body, where does HIV replication occur?

A

In activated CD4 cells

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6
Q

Can you get HIV from giving someone a hug

A

No

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7
Q

How is HIV spread?

A

Sex- exchange of infected body fluids

IV drug

Needlestick at work or in therapeutic skills lab

Blood transfusion

HIV+ mom to infant

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8
Q

What kind of sex makes you the most likely to contract HIV?

A

Receptive anal intercourse

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9
Q

What are the other two names for your primary HIV infection?

A

Acute HIV*****

Acute retroviral syndrome

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10
Q

What is acute HIV?

A

The mono or flu-like illness someone gets a few weeks after they are first exposed to HIV

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11
Q

How long does acute HIV last?

A

2 weeks, and then resolves spontaneously

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12
Q

A young man comes into your office with a flu like illness. You take a good history and find out a few things that make you suspicious that this “flu” is actually acute HIV, and you decide to test him for HIV. You work in a clinic at the bottom of the Grand Canyon and you only have access to HIV Ab tests. Will this test be reliable?

A

No, his body has not had time to build up antibodies

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13
Q

The viral load of a patient with Acute HIV will be (high/low/undetectable)

A

HIGH

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14
Q

When is an HIV+ person the MOST infectious they will ever be?

A

When they have acute HIV.

High viral load, no antibodies, not aware of their status

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15
Q

You decide to test a young gay man with a “flu or mono-like” illness for HIV using an HIV RNA test, since he has some significant risk factors in his history. Unfortunately, it comes back positive and you diagnose him with HIV. How does this early diagnosis benefit everyone else?

A

Will likely limit transmission to others, since this is the time that they are the most infectious, and they will take precautions not to spread it to others from this point forward.

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16
Q

What are some of the symptoms of acute HIV?

A

Fever

Adenopathy

Sore throat

Rash on upper trunk, neck and face (>50% of pts)***

Mucocutaneous ulcers**

Myalgia

Athralgia

Headache

Diarrhea

N/V

Overall a pretty vague collection of symptoms that looks like a lot of other viruses

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17
Q

Lab values in acute HIV:

LFTs

WBC

H/H

Platelets

A

LFTs elevated

WBCs low

H/H low (anemia)

Platelets low

~~kind of just looks like a virusssss~~

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18
Q

What causes an HIV+ patient to enter clinical latency?

A

Seroconversion (starts making antibodies)***

Viral load decreases to “set point” and then slowly rises over time

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19
Q

What happens over time to the CD4 count of an HIV+ patient in clinical latency?

A

Slowly declines

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20
Q

What kind of symptoms will an HIV+ pt in clinical latency have?

A

No symptoms

Maybe some swollen lymph nodes

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21
Q

How long does the clinical latency phase of HIV infection last?

A

10 yrs

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22
Q

5% of patients who contract HIV are long term nonprogressors. What does that mean?

A

They NEVER get a significantly weakened immune system

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23
Q

What are some of the contributing factors to the deterioration of the immune system in HIV?

A

Lymph nodes become damaged and burn out

Virus can mutate

Body fails to keep up replacement of CD4 cells

HIV RNA viral load increases

CD4 cell count decreases

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24
Q

At what CD4 count will a patient start developing constitutional symptoms?

A

~200

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25
Q

What kinds of constitutional symptoms will an HIV patient develop when their CD4 count starts to drop below normal?

A

Fever

Night sweats

Fatigue/malaise

Weight loss

Mouth- oral hairy leukoplakia** or thrush

Cervical dysplasia*

Skin- molluscum, chronic dermatophytes, seborrheic dermatitis

Kaposi’s sarcoma**

Recurrent HZV

ITP (thrombocytopenia)

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26
Q

What causes an HIV+ patient to develop oral hairy leukoplakia?

A

Reactivation of prior EBV infection

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27
Q

What causes an HIV+ to develop cervical dysplasia?

A

A coexisting HPV infection is going wild

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28
Q

What is a normal CD4 Tcell count?

A

500-1400

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29
Q

Let’s look at a list in order of the conditions someone with HIV develops as their CD4 levels drop

A

Thrush

Oral hairy leukoplakia

TB (latent TB reactivates)

PCP

Histoplasmosis

Coccidiomycosis

Atypical herpes simplex

Cryptosporidiosis

CMV

MAC

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30
Q

What are the two conditions that mean your HIV is now AIDS

*******

A

CD4 under 200

OR

HIV+ AND 1 of 27 AIDS defining conditions (regardless of CD4 count)

⭐️⭐️⭐️⭐️⭐️⭐️⭐️🌟

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31
Q

What are some AIDs defining conditions that she listed out?

She said you didn’t have to memorize this, just know the common ones….

A

Pneumocystis jirovecii (PCP) pneumonia

Toxoplasmosis of brain

Mycobacterium avium complex, disseminated

CMV in specific organs

Candidiasis of esophagus, trachea, bronchi/lungs

Kaposi’s sarcoma

Invasive cervical cancer

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32
Q

If you have Pneumocystis jirovecii pneumonia (PCP), we know your CD4 count is under_____

A

200

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33
Q

What is the causative organism of PCP?

A

Airborne fungus pneumocytis jirovecii

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34
Q

What is the clinical presentation of someone with PCP pneumonia?

A

Basically looks like pneumonia in someone who is NOT handling it well:

Hypoxemic

CXR shows diffuse or perihilar infiltrates

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35
Q

How is PCP pneumonia diagnosed?

A

Exam of sputum sample

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36
Q

What is the first-line treatment for PCP pneumonia?

A

Bactrim

Plus supportive care of course

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37
Q

If you develop toxoplasmosis, we can assume your CD4 count is below _____

A

100

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38
Q

What is the clinical presentation of toxoplasmosis in an HIV+ pt?

A

Headache

Focal* neurological deficits

Seizures

AMS

Multiple contrast-enhancing lesions on brain CT/MRI****

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39
Q

How is toxoplasmosis acquired?

A

Ingestion of cat feces 🐈

contaminated food/utensils

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40
Q

If i decide to raid Shadow’s litter box and chow down on some cat turds, will i get toxoplasmosis infection in my brain?🧠

A

No, immunocompetent patietns dont have symptoms

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41
Q

If you develop mycobacterium avium complex (MAC), we can assume your CD4 count is less than _____

A

50

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42
Q

What is the clinical presentation of an HIV pt with MAC?

A

Systemic disease

Pulmonary infection

Night sweats

Weight loss

Abdominal pain, diarrhea, anemia

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43
Q

How do you diagnosis MAC?

A

Acid fast bacillus stain of sputum

Sputum cultures

Blood cultures

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44
Q

If you develop CMV retinitis, we can assume your CD4 count is less than ____

👁👁

A

50

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45
Q

What is CMV retinitis?

A

CMV (herpes virus common in general population) infects the retina👀

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46
Q

What is the clinical presentation of CMV retinitis?

A

Patient complains of visual disturbances

Goes blind if left untreated

Fundoscopic exam: perivascular hemorrhages, white fluffy exudates, cotton wool spots, infiltrates ***

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47
Q

If you do a fundoscopic exam on an HIV+ patient who is complaining of visual disturbances, and you see perivasulcar hemorrhages, white fluffy exudates, cotton wool spots, and infiltrates, what do you think they have?

A

CMV retinitis

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48
Q

If you develop esophageal candidiasis or recurrent vaginal candidiasis, we can assume your CD4 count is _____

A

Anything.

No specific CD4 number.

However, the more invasive the yeast is, the lower the CD4 count will be

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49
Q

What CD4 count is associated with Kaposi’s sarcoma?

A

ANY CD4 COUNT

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50
Q

What is AIDS-related Kaposi’s sarcoma?

A

A vascular neoplasm most frequent in homosexual men.

51
Q

Screen everyone for HIV ______ ________ ________

A

AT LEAST ONCE

⭐️⭐️

52
Q

Who gets HIV screening?

A

Everyone 13-64 unless they opt out

Anyone starting TB treatment

EVERY SINGLE TIME someone shows up with an STD

Annually for patients at risk (Men who have sex with men)

Pregnant women

53
Q

You graduate PA school and land a job working the night shift in an ER. A 38 year old prostitute comes in by ambulance because she has some unusual vaginal discharge. You diagnose her with trichomoniasis, and as is routine, you screen her for HIV.
2 weeks later, she rolls in again, and this time you diagnose her with syphilis. Your shift is about to end, and you just want to go home. Do you ~~reallllly~~ need to screen her for HIV again?

A

YES

EVERY SINGLE TIME SOMEONE SHOWS UP WITH AN STD YOU SCREEN FOR HIV

54
Q

Who need to get a DIAGNOSTIC test for HIV?

A

People with opportunistic infections (fungal)

People with TB

Symptoms consistent with established HIV

Symptoms consistent with acute HIV (that flu-like illness you come down with at first)

55
Q

What symptoms are consistent with established HIV that would make you do ~Diagnostic~ testing for HIV?

A

Weight loss

Recurrent fever, night sweats

Extreme tiredness

Lymphadenopathy

Diarrhea >1 week (unexplained)

Mouth/Anal/genital sores

Pneumonia (unexplained?)

Unexplained neuro symptoms

56
Q

What is the difference between screening and diagnostic testing for HIV?

A

I’m not totally sure….. maybe screening is just the antibody and diagnostic is the antigen?

It was never really specified

57
Q

What is seroconversion?

A

Patient has started making antibodies against the virus

58
Q

How long after infection can the HIV antibody test detect if someone has HIV?>

A

4-12 weeks after infection- after the patient seroconverts

59
Q

What is a Rapid HIV test?

A

Test done on saliva or blood, and if positive it requires confirmation

60
Q

If you suspect acute HIV and you only test for the antibody you will _______

A

Miss the HIV diagnosis and lose your job

61
Q

If you suspect acute HIV, what are the two ACCEPTABLE testing options you can do to test for HIV?

A

Antigen/antibody combination test

HIV RNA test

62
Q

A positive Rapid HIV test requires________

A

Confirmation

63
Q

Where can you go to get tested for STDs for only $20

A

Maricopa County STD clinic

64
Q

True or false:

In AZ, minors have to ask their parents for permission to get tested for STDs

A

False

65
Q

Should you start antiretroviral therapy for people with acute/early infection?

A

YES.

66
Q

Antiretroviral therapy is recommended for which HIV patients?

A

ALL OF THEM

67
Q

Are there any benefits to starting antiretroviral therapy during early infection?

A

Yes there are immunologic and virologic benefits. Refer them for treatment ASAP

68
Q

What kind of testing must be done before putting your patient on Antiretroviral therapy?

A

Genotypic drug resistance testing

69
Q

If you are talking to an HIV patient about starting treatment and she tells you she doesnt give a rats ass about antiretroviral therapy and that she has no intention of consistently taking the meds, should you give her the treatment anyways?

A

NO! Patients must be willing and able to commit to lifelong treatment with strict adherence.

If they dont take their meds consistently, they’re going to cause resistance and probably be worse off.

70
Q

What is the goal of HIV treatment?

A

Suppress HIV RNA to undetectable levels

Prevent transmission

71
Q

What are some situations that could cause a possible exposure to HIV?

A

Unprotected sex with someone who says they have HIV or you think might have HIV

Condom broke/fell off

Rape

Work related (needle stick)

Sharing needles for drugs

72
Q

If you have possibly been exposed to HIV, how long do you have to start Post-Exposure Prophylaxis (PEP)?

A

72 hours

73
Q

If you are someone who is frequently exposed to possible HIV infection, is there anything you can do to prevent getting it?

A

Yes, that is called Pre-Exposure Prophylaxis (PrEP).

The medication is called Truvada

74
Q

Who can prescribe Truvada (PrEP)?

A

HIV specialist OR primary care provider

75
Q

CD4 T cell count is ______

A

King 🤴

76
Q

Which two conditions can be seen at ANY CD4 count?

A

Thrush

Kaposi sarcoma

77
Q

If your CD4 count is 350+, you are doing

A

Great

78
Q

If your CD4 count is hover around 200, what will happen

A

You will start to see opportunistic infections

79
Q

If your CD4 count drops below 200 you have ______

A

AIDS

80
Q

If you are seeing a new HIV patient at your office, and he doesn’t know his CD4 count, but he has daily Bactrim on his med list, you can assume his CD4 count is less than _____

A

200

81
Q

What is the prophylaxis for Pneumocystic jirovecii pneumonia (PCP) as well as Toxoplasma gondii?

A

Bactrim

PCP: CD4 <200

Toxoplasma: CD4 <100

82
Q

If you acquire a new HIV patient who does not know her CD4 count, but her last doctor has her taking Bactrim and Azithromycin, you can assume her CD4 count is less than _____

A

50

83
Q

What is the prophylaxis for disseminated MAC?

A

Azithromycin

MAC: CD4 <50

84
Q

What organism causes syphilis?

A

Treponema pallidum

85
Q

Is a syphilis chancre painful?

A

NO IT IS PAINLESS

86
Q

What are the symptoms of primary syphilis?

A

Painless chancre appears at location where syphilis entered the body.

Lasts for 4-6 wks and then goes away

87
Q

In addition to vague symptoms like fatigue, what 3 skin conditions can appear during secondary syphilis?
***

A

Rash on palms and soles

Condyloma LATA

Mucous patches on mouth, throat and genitals

88
Q

Describe the rash on the palms and soles seen in secondary syphilis

A

Non pruritic

Not contagious

VERY common manifestation of secondary syphilis

89
Q

Describe condyloma lata seen in secondary syphilis

A

Moist, heaped, warty papules

Intertriginous areas (butt crack, perineum, perianal area)

HIGHLY contagious*****

90
Q

Describe the mucous patches seen in secondary syphilis

A

Painless

Flat patches in mouth, throat, or genitals

HIGHLY infectious**

91
Q

Of the three skin manifestations of secondary syphilis, only one of them is NOT highly contagious. Which one is it:

Rash on palms and soles

Condyloma lata

Mucous patches

A

Rash on palms and soles

92
Q

How long does secondary syphilis last

A

2-6 wks

93
Q

What kinds of symptoms will someone have in latent syphilis

A

None

94
Q

If you have sex with a prostitute who has LATENT syphilis, what are the chances that you will contract it?

A

ZERO. Not transmittable in latent phase

95
Q

Do most patients develop tertiary (late) syphilis

A

No. Only about 15% of people who didn’t get treatment develop it

96
Q

What can tertiary (late) syphilis do to your body?

A

Heart

Blood vessels (aneurysms)

Brain

Nervous system

97
Q

How long after initial infection will tertiary (late) syphilis show up?

A

10-30 yrs

98
Q

What is neurosyphilis?

A

Syphilis that causes paralysis, difficult with coordination, dementia

99
Q

What is ocular syphilis ?

A

Changes in vision or blindness

100
Q

What stage of syphilis do neurosyphilis and ocular syphilis show up in?

A

ANY phase

101
Q

If you have a patient show up with visual disturbances, should you test for syphilis?

A

YEP in this fantasy land we live in you will have ocular syphilis on your differential and you will do an LP and do VDRL on spinal fluid

102
Q

If a patient shows up and they are uncoordinated, paralyzed, or demented, should you test for syphilis?

A

YES, when you are taking this exam, you need to have neurosyphilis on your differential and you should do an LP and VDRL of the CSF

103
Q

What are the different ways you can test for syphilis?

A

Bacteria from chancre on dark field microscopy (not commonly done)

Serology- RPR or VDRL

Titer test

Treponema antibody test: FTA-ABS (fluorescent treponemal antibody absorption)

104
Q

RPR and VDRL are _______ tests

A

Antibody

105
Q

A syphilis titer indicates ________ _______

A

Disease activity

106
Q

A low syphilis titer may be a false positive due to:

A

Autoimmune disease

Illness

Preganncy

107
Q

If you get a positive RPR, what do you need to do?

A

Confirm it with FTA-ABS

108
Q

If you suspect that your patient has neurosyphilis or ocular syphilis, how do you test for it?

A

Do an LP and perform VDRL on the spinal fluid

Refer to neuro

109
Q

Who gets treatment for syphilis?

A

EVERYBODy ~and~ the people they are boning if they test positive too!!

110
Q

How do you treat syphilis?

A

Benzathine penicillin G 2.4 mu IM (one big shot)

If they’ve had it for more than a year they get 3 big shots 1 week apart

PCN allergy: azithromycin or doxy

HIV+ or pregnant with PCN allergy: you give them PCN anyways

111
Q

How do you treat syphilis that a patient has had for over a year?

A

3 shots of Benzathine Penicillin G, 1 week apart

112
Q

How do you treat syphilis in someone who has a PCN allergy? What if they have a PCN allergy and also have HIV or are pregnant?

A

Azithromycin or Doxycycline

If they have HIV or are pregnant, they get the usual benzathine penicillin G like EVERYBODY else

113
Q

After treating syphilis, how do you confirm treatment success?

A

check RPR titers periodically

114
Q

What happens to the baby if you have syphilis and you are pregnant?

A

Stillbirth

Death

Deafness

Neuro Impairment

Bone deformitites

115
Q

When should pregnant women be screened for syphilis?

A

1st prenatal visit

If Shes high risk screen her again at 28 weeks and delivery

116
Q

If a pregnant patient has syphilis and also a PCN allergy, what can we do for her before we give her shots of penicillin?

A

Desensitization with oral PCN

117
Q

What is the presentation of lymphogranuloma venereum (LGV)?

A

UNILATERAL inguinal bubo ****

Genital ulcer at site of inoculation

Anal discharge and rectal bleeding

118
Q

What causes lymphogranuloma venereum (LGV)?

A

Serotype of chlamydia trachomatis

119
Q

Who do you need to call if you diagnose syphilis

A

County health department

120
Q

How do you diagnose lymphogranuloma venereum (LGV)?

A

Rule out syphilis

Call county health department if suspected LGV

Genital/rectal/lymph node swab to test for chlamydia

121
Q

What organism causes chancroid

A

Haemophilus ducreyi

122
Q

Is LGV common in the US

A

No, its very rare and usually only occurs in MSM

123
Q

What is the clinical presentation of chancroid?

A

Painful TENDER genital ulcer

Lesion produces foul-smelling discharge (that’s contagious)

Inguinal adenitis (buboes)

124
Q

How do you diagnose chancroid?

A

Rule out syphilis

Call the county health department cause this bitch requires special culture

Clin Med III, Exam 2 (ASL) (3 decks)

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