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Final 3b > I.D > Flashcards

I.D Flashcards

1
Q

A person with <200 CD4 count should be offered what prophylaxis

A

Co-trimoxazole against PCP

can sometimes use acyclovir against HSV

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2
Q

When to treat in HIV

A

When +ve diagnosis!

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3
Q

HIV pathophysiology

A 
binds to CD4 receptors on
Macrophages 
Monocytes 
T helper cells 
Neural cells

Binds to CD4 receptors using GP120 an envelope protein
Then copies the DNA using reverse transcriptase
Then integrates the copies with integrate
Then builds back up with protease

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4
Q

HIV investigations

A

Test at 4 weeks and 12 weeks (after suspected exposure)

HIV ab - done with ELISA testing and confirmed with western blot

HIV PCR and test for p24

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5
Q

When to test for HIV

A

4 weeks and 12 weeks (or if symptoms)

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6
Q

HIV big overview of symptoms

A

2-6 weeks - seroconversion

1) Fever
2) Lymphadenopathy
3) Rash (maculopapular)

Asymptomatic phase 
Persistent generalised lymphadenopathy 
>2 extra-inguinal sites 
>3 months 
>1 cm size

AIDS

  • Opportunistic infections
  • Chronic diarrhoea
  • Fever/ NS/ weight loss
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7
Q

Main cause of diarrhoea in HIV

A

Cryptospoiridosis

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8
Q

HIV CD4 count and infections

A 
200-500 
Shingles
Hairy leukoplakia 
Oral candidiasis 
Kaposi's sarcoma 
100-200
Cryptosporidosis 
Cerebral toxoplasmosis
PCP
PML
50-100
Aspergilloma 
Oesophageal candida
Cryotococcal meningitis 
Primary CNS lymphoma

<50
MAI
CMV retinitis

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9
Q

HIV transmission

A

Vertical

  • Breast milk
  • In utero

Sexual

Blood

Needles

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10
Q

HIV lung conditions (just the list)

A

PCP
TB
MAI

Other causes of pneumonia
Hib
Pseudomonas
Legionella

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11
Q

PCP

Presentation
Investigations
Rx
Prophylaxis

A 
Presentation 
Dry cough 
Dyspnoea, fever, SOB
Desaturation on exercise 
No chest signs

Investigations
May need to do BAL
CXR often clear

Rx
Co-trimoxazole

Prophylaxis
Co-trimox if CD <200

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12
Q

Desaturations on exercise in HIV +ve person

A

PCP

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13
Q

Toxoplasmosis

A

ring enhancement
Multiple lesions
Rx - sulfadiazine

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14
Q

Cryptococcal meningitis

A

High opening presusure

Indian ink stain

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15
Q

Primary CNS lymphoma

A

Solid enhancement
Single lesion
SPECT +ve
Rx steroids

EBV

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16
Q

PML cause (in HIV)

A

JC virus

17
Q

Neuro HIV list

A 
Toxoplasmosis 
Cryptococcal meningitis 
PML 
Primary CNS lymphoma 
TB 
HIV dementia
18
Q

Cause of Primary CNS lymphoma in HIV

A

EBV

19
Q

HIV and pregnancy measures

A

Delivery vaginally unless viral load <50

Do NOT breast feed

Give mother HAART when pregnant regardless

Give child triple ART (or oral zidovudine if <50 maternal copies

20
Q

Typical HIV regime

A

HAART - commence as soon as status +ve

2 NRTI (nucleoside reverse transcriptase inhibitor)
1 of
protease inhibitor or NNRTI

21
Q

Hepatitis antibody antigen overview

A

AntiGENS
Surface antigen – current infection
Envelope antigen – assess phase of infection
Core antigen

AntiBODIES
Surface antibody – they have immunity
Envelope antibody – appears later in the disease
Core antibody – shows they have immunity from the previous exposure (not vaccination)

Do they have a surface antigen 
Yes 
They are currently infected 
No 
Not currently infected – so next Q  are they immune? 
Hep B surface antibody 
\+ve immune – how so? 
Core antibody
\+ve – previous exposure 
- ve previous vaccination
- - not immune
22
Q

Hepatitis symptoms

A 
Jaundice 
Hepatosplenomegaly 
Pale stools, Dark urine 
B symptoms 
Abdo pain - RUQ pain 
Joint pain
23
Q

Hepatitis investigations

A 
Antigen/antibody 
LFTs – specifically AST/ALT
Disease severity is measured by: 
Prothrombin time
Serum bilirubin
24
Q

Types of malaria

A

P. Falciparum – varies
Most dangerous
Sub-saharan Africa
SEA

P. Vivax – Duffy antigen
Asia, north America, north africa

P. Ovale – 48hr cycle
Western and central Africa

P. Malariae - 72

P. Knowlesi

25
Q

Symptoms of malaria

A 
Paroxysmal fever 
Chills/ sweats 
Headache 
N+V 
Myalgia

Other:
Jaundice/ Hepatosplenomegaly

26
Q

Malaria pathophysiology

A

Infected female injects sporozoites
Sporozoites enter hepatocytes + start asexual reproduction  mature and become merozoites
Merozoites get released into the blood stream + invade RBC
RBC burst –> fever

27
Q

Malaria ‘complicated’

A

Falciparum generates a stick protein on outside of RBC –> agglutination:

Cerebral malaria
ARDS
Acute renal failure – blackwater fever

Coagulopathy/ DIC
Severe haemolytic anaemia

Haemoglobulinurea
Hyperparasitaemia >2% Schizonts on blood film

Hypoglycaemia
Metabolic acidosis

28
Q

Malaria investigations

A 
Giemsa stain x3
Thick blood film 
Locates presence 
Thin blood film  
Identifies species

BM - hypoglycaemia
ABG -metabolic acidosis
FBC + clotting - coagulopathy + anaemia
LDH - marker of haemolytic anaemia

Urine dip - Haemoglobulinaemia

29
Q

Malaria Rx

A

Artemisinin - ACT (artemisinin combination therapy

Complicated
IV artesunate

30
Q

Malaria prophylaxis

A

Doxycycline
Chloroquine
Malarone

Final 3b (2 decks)

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