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MRCP Master > ID: GUM HIV viral > Flashcards

ID: GUM HIV viral Flashcards

1
Q

Jarisch-Herxheimer vs anaphylactic reaction,

A

Jarisch-Herxheimer reaction, unlike an anaphylactic reaction, will not present with hypotension and wheeze

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2
Q

low CSF glucose

A

Mumps dumps glucose
herpes encephalitis

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3
Q

HIV-associated nephropathy (HIVAN) 5 features
Size of kid
Type of nephrotic
BP

A

massive proteinuria = nephrotic syndrome

focal segmental glomerulosclerosis with focal or global capillary collapse on renal biopsy

normal or large kidneys
elevated urea and creatinine

normotension

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4
Q

SE: indinavir

A

renal stones, asymptomatic hyperbilirubinaemia

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5
Q

Protease inhibitors (PI) examples

A

examples: indinavir, nelfinavir, ritonavir, saquinavir

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6
Q

hepatitis B rx

A

pegylated interferon-alpha

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7
Q

what is a hepatitis B non responder and what action should be taken

A

<10 anti-HBs level
HIV , heo B test
Give another dose

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8
Q

What cell can HIV can infect

A

CD4 T cells, macrophages and dendritic cells

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9
Q

anti-retrovirals - P450 interaction

A

nevirapine (a NNRTI): induces P450
protease inhibitors: inhibits P450

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10
Q

Describe the process of HIV entering cell

It contacts the GP who put him in contact with a band or exam = entrance & get genetic material copied and …

A
  1. HIV targets CD4+on membrane of Macrophages, T-helper cells, & dendritic cells
  2. HIV targets and attaches to the CD4 molecule via a protein called gp120 found on its envelope.
    HIV bind to co-receptor (With the help of gp120). The co receptor isCXCR4 (only found on T-cells )or CCR5
  3. Once bound to the co-receptor enters the cell

reverse transcriptase to transcribe a complementary double-stranded piece= Proviral DNA

  1. Proviral DNA enter nucleus and pops itself into the cell’s DNA, ready to be transcribed
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11
Q

Describe HIV treatment in pregnancy

A
  • No breastfeeding
  • Mother presents early: @ 14 WKS before delivery ART with the aim of achieving 0 viral @28 wks if this happens baby only needs zidovudine (AZT) for a month
  • If mother presents late @ 36 weeks= intensive therapy 4 drugs; during labour get zidovudine IV, C-section baby gets triple therapy for 4 weeks.
  • viral load <50 copies/ml at 36 weeks = vaginal delivery + zidovudine is usually administered orally; Neonatal antiretroviral therapy If viral load is <50 copies/ml zidovudine is usually administered orally.
  • viral load >50 copies/ml at 36 weeks c-section + a zidovudine infusion should be started 4 hours before beginning the c. section. Neonatal antiretroviral therapy triple ART should be used for 4-6 weeks.
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12
Q

what is Truvada

A

emtricitabine and tenofovir disoproxil fumarate

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13
Q

What is PREP

A

Pre exposure prophylaxis; taken by HVI-ve pt. used to reduce chance of transmission in those who engage in risky behavior; Truvada + Kaletra

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13
Q

What Post Exposure Prophalaxis for HIV

A

With in 72 hour of exposure = Truvada (Emtricitabine/tenofovir) + Kaletra for 4 wks

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14
Q

What is TasP

A

TasP- Treatment as prevention – taken by HIV + person to reduce chance of transmission

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15
Q

How is AIDS defined

A

CD 4 COUNT <200

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16
Q

Window period

A

4wk
but can range from 10d-3mo

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17
Q

How can you differentiate candida from hairy leukoplakia

A

Nb hairy- hairy leukoplakia caused by EBV
hairy leukoplakia is unscrapable from tongue

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18
Q

what is Kaposi sarcoma and what is it caused by

A

malignant tumor of the skin and soft tissues

caused by the human herpesvirus 8, or HHV-8.

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19
Q

HPV in HIV causes

A

squamous cell carcinoma of the anus in males and cervix in females.

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20
Q

How do you differentiate histoplasmosis from PCP

A

histoplasmosis,
peripheral blood smear are oval yeast cells within macrophages. Eosinophilia may predominate. bilateral hilar lymphadenopathy

PCP- ground glass appearance

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21
Q

what causes progressive multifocal leukoencephalopathy
SX
Ix

A

JC virus
progressive motor and cognitive neurologic symptoms
MRI, =demyelination (non-enhancing areas ).

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22
Q

How dose Cryptococcus infection present how do you test for it

A

headache, fever, malaise, nausea/vomiting, seizures, focal neurological deficit

CSF: high opening pressure, India ink test positive = a clear halo around the yeast cells.

latex agglutination test

CT: meningeal enhancement, cerebral oedema

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23
Q

AIDS dementia on imaging

A

Cortical atrophy

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24
Q

Encephalitis in HIV is caused by and on imaging

A

oedematous brain

due to CMV or HIV itself

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25
Q

HIV: Tuberculosis on CT head

A

CT: single enhancing lesion

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26
Q

Primary CNS lymphoma
cuased by and imaging
Rx

A

Primary CNS lymphoma
30% of cases
Epstein-Barr virus

Single enhancement

Thallium SPECT positive

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27
Q

Toxoplasmosis
Rx & imaging

A

Single or Multiple lesions
Ring enhancing lesions w/ central necrosis or nodular enhancement
+/- mass effect
Thallium SPECT negative

sulfadiazine and pyrimethamine

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28
Q

In HIV what causes chronic watery diarrhea, associated with abdominal pain.
How do you investigate it ?

A

Cryptosporidium + other protozoa (most common)

Ziehl-Neelsen stain (acid-fast stain) of the stool may reveal the characteristic red cysts

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29
Q

CMV in HIV and Ix

A

may present with
-Eosphagitis
-colitis,
encephalitis,
-pneumonia,

For diagnosis, a biopsy = owl’s eye inclusion bodies within their nuclei.

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30
Q

HIV Modes of transmission & % of those infected

A

Blood transfusion 100%
Vertical transmission – 25%
Horizontal transmission 3%
Needle stick 0.3%

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31
Q

When do you start Prophylaxis for Mycobacterium avium complex and what is it ?
Give an unusual clinical feature

A

clarithromycin or azithromycin when CD4 is less than 100 cells/mm³

focal lymphadenitis

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32
Q

What cancers are more likely in HIV
ass EBV

A

HL, NHL, Burkitts & CNS
lymphoma

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33
Q

False positive VDRL/RPR:

A

‘SomeTimes Mistakes Happen’ (SLE, TB, malaria, HIV)

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34
Q

HIV seroconversion timing and presentation

A

60-80% pts

typically presents as a glandular fever-type illnes

occurs 3-12 weeks after infection

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35
Q

Name viral haemorrhagic fevers

A

dengue fever,
Lassa fever,
Ebola
Yellow fever

36
Q

What are the 4 main causes of Diarrhoea in HIV?

A

Cryptosporidium + other protozoa (most common)

Giardia

CD count < 50: Cytomegalovirus, Mycobacterium avium intracellulare

37
Q

Rx Mycobacterium avium intracellulare
MAC

A

rifabutin, ethambutol and clarithromycin (REC)

38
Q

cysts turn red following acid-fast staining

A

Cryptosporidium

39
Q

Staining for PCP

A

Silver

40
Q

What are the 4 main causes of Diarrhoea in HIV?

A

Cryptosporidium + other protozoa (most common)

Giardia

CD count < 50: Cytomegalovirus, Mycobacterium avium intracellulare

41
Q

Staining for PCP

A

Silver

42
Q

CD4 count < 200/mm³ what prophylaxis should be started

A

PCP
co-trimoxazole (trimethoprim and sulfamethoxazole )

43
Q

rx pcp
severe cases
when pO2 < 9.3

A

Rx: co-trimoxazole(trimethoprim and sulfamethoxazole );

Severe + IV/ aerosol pentamidine (aerosol more side effects)

If PO2 < 9.3 steroids

44
Q

Mode of delivery if @ 36 wks
Viral load <50 copies
Viral load is >50 copies

A

<50 copies= Vaginal + zidovudine administered orally

> 50 copies - C-section; IV zidovudine infusion should be started 4 hours before & triple ART 4-6 wks

45
Q

Seborrhoeic dermatitis is common in which conditions

A

HIV
Parkinson’s disease

46
Q

Commonest cause of Hepatocellular carcinoma

A

Chronic hepatitis B is the most common cause of HCC worldwide with chronic hepatitis C being the most common cause in Europe.

47
Q

Chancroid
Cause by
SX
Rx

A
  • Haemophilus ducrey (gram-negative coccobacillus)
  • unilateral, painful inguinal lymph node enlargement. The ulcers typically have a sharply defined, ragged, undermined border.
    Rx Azithromycin
48
Q

rx Neisseria gonorrhoea.

A

IM ceftriaxone 1g

49
Q

% Hepatitis C that have chronic disease

A

55-85%

50
Q

Rx chronic Hepatitis C

A

Combination of protease inhibitors (e.g. daclatasvir + sofosbuvir or sofosbuvir + simeprevir) with or without ribavirin are used

51
Q

Inhibits reverse transcriptase = double strand isn’t formed

A

-Dine VIr

52
Q
A

Protease inhibitor
Stop maturing of virus “protease inhibitors NAVIR mature

53
Q

Nnrti se
No no Den

A
54
Q

Integrase inhibitors

A

-teg-
Provital DNA can’t be integrated
Myopathy HA & N

55
Q

Hep B: Immunity following vaccination

A

anti-HBs + Only Antibody to Hep B surface antigen

56
Q

Hep B: Immunity following infection

A

+ anti-HBs
+ anti-HBe/ + anti-HBc

+ Anti-HBc IgG

57
Q

HBe Ag

A

indicates how easily spread

58
Q

HBs

A

Sick with HB

59
Q

anti-HBc

A

caught, i.e. negative if immunized

60
Q

The only Hep that is a DNA

A

Hep B

61
Q

What is the mnemonic GAMED for

A

prevalence of Ig’s

62
Q

Rx HepC

A

combination of protease inhibitors (e.g. daclatasvir + sofosbuvir or sofosbuvir + simeprevir) with or without ribavirin are used

63
Q

Rx hep B

A

pegylated interferon-alpha used to be the only treatment available.
reduces viral replication

A better response is predicted by being:
- female,
-< 50 years old,
-low HBV DNA levels,
-non-Asian,
-HIV negative, high degree of inflammation on liver biopsy

64
Q

Complications of hepatitis B infection

A
  1. chronic hepatitis (5-10%). ‘Ground-glass’ hepatocytes may be seen on light microscopy
  2. fulminant liver failure (1%)
  3. hepatocellular carcinoma
  4. glomerulonephritis
  5. polyarteritis nodosa
    6 cryoglobulinaemia
65
Q

causes PAINFUL genital ulcers

3- 2H’s hurt except L w/ tender lymph

A

Genital Herpes
(HSV-2);more common than chancroid

Haemophilus ducreyi
Gram -ve

Lymphogranuloma Venereum
Chlamydia (gram -ve) nb painless ulcer painful lymphadenopathy

66
Q

Causes Ix & Rx:

Painful, itchy, dysuria, vesicles usually umbilicate,

Painful lymphadenopathy

systemic features: F, HA+ myalgia
Can be latent and reappear

A

Genital Herpes
HSV-1& 2

Ix: nucleic acid amplification tests (NAAT)

RX: Supportive saline baths; oral acyclovir

67
Q

Genital Ulcer-
Cause and Rx:

Chancroid - painful ulcer with soft irregular margins + purulent exudate. may bleed

unilateral, painful inguinal lymph node enlargement

A

Haemophilus ducreyi
Gram -ve

IX: CR, culture, and gram staining

Rx: Azithromycin or ceftriaxone

68
Q

What causes

shallow Painless ulcer + small papules / granulomas,

> 2 wks later buboes form -painful inguinal lymphadenopathy, or enlarged lymph nodes- can form abcesses & procto-colitis

A

Lymphogranuloma Venereum
Chlamydia (gram -ve)

Rx doxycycline.

69
Q

Causes of PainLess genital ulcers

A

Treponema Pallidum
Syphilis

Condyloma acuminata

Granuloma Inguinale
donovanosis / granuloma venereum, Klebsiella gram -ve (No lymphadenopathy)

70
Q

Chancre - solitary, painless genital ulcer,(hard base, raised borders, covered an exudate) .Appear /in 3 wks RX: heals without rx

2dary Form Sx :
non-itchy maculopapular rash, with small bumps Start on trunk –> extremities -incl the palms & soles–>genitalia, and other mucous membranes.

  1. condylomata lata- smooth, white, painless, wart-like lesions over moist areas like the genitals, the anal region, and the armpits
A

Treponema Pallidum
Syphilis

Rx: Penicillin G.

71
Q

What causes :
Soft flesh like cauliflower appearance genital lesion

A

Condyloma acuminata HPV 6& 11

Rx: topical podophyllum or cryotherapy

72
Q

What causes :
genital -painless papule granuloma–> becomes highly vascular & beefy red ulcer which bleeds easily.
Has no lymphadenopathy

A

Granuloma Inguinale
donovanosis / granuloma venereum, Klebsiella gram -ve

Rx azithromycin

73
Q

Differentiate between Chancroid & Chancre

A

Chancre- is syphilis- solitary, painless genital ulcer,(hard base, raised borders, covered an exudate) .Appear /in 3 wks RX: heals without rx

Chancroid -Haemophilus ducreyi- painful ulcer with soft irregular margins + purulent exudate. may bleed

74
Q

Differentiate between Condyloma acuminata and condylomata lata

A

condylomata lata-Syphilis smooth, white, painless, wart-like lesions over moist areas like the genitals, the anal region, and the armpits

Condyloma acuminata - HPV 6& 11
Soft flesh like cauliflower appearance

75
Q

Causes of False positive non-treponemal (cardiolipin) tests:

A

pregnancy
SLE, anti-phospholipid syndrome
tuberculosis
leprosy
malaria
HIV

76
Q

Examples of non-treponemal tests- not specific

A
  1. rapid plasma reagin (RPR)
  2. Venereal Disease Research Laboratory (VDRL)
77
Q

Examples of treponemal-specific tests-

A

TP-EIA (T. pallidum enzyme immunoassay), TPHA (T. pallidum HaemAgglutination test)

78
Q

How can you differentiate Jarisch-Herxheimer reaction to anaphylaxis

A

SX: F, rash, tachycardia after the first dose of antibiotic

there is no wheeze or hypotension.

o due to the release of endotoxins following bacterial death and typically occurs within a few hours of treatment

o No treatment is needed other than antipyretics if required

Anaphylaxiswheeze and Hypotension

79
Q

Signs of tertiary syphillis

A
80
Q

Stages of syphilis

A
81
Q

Argyll-Robinson Pupil describe

A

Seen in 3rty syphilis
– ARP – .
Forwards:ARP – Accommodation Reflex Present.
Backwards PRA – Pupillary Reflex Absent.

82
Q

STI’s that cause vulvovaginitis/cervicitis causes (3)

A

Trichomonas vaginalis flagellated protozoan parasite

Chlamydia trachomatis

Neisseria gonorrhoeae

83
Q

What causes
- Discharge: ‘fishy’, offensive; thin, white homogenous
Burning and itching
asymptomatic in 50%

IX& RX

A

Bacterial vaginosis
Gardnerella vaginalis.
Not STI

Ix:
* clue cells
* vaginal pH > 4.5
* positive whiff test

Rx: No SX= NONE

Sx or pregnancy= oral metronidazole for 5-7 days

Bv smells fishy in the garden

84
Q

Name causitive agent, Ix & RX

discharge: offensive, yellow/green, frothy

vulvovaginitis

strawberry cervix

pH > 4.5
in men is usually asymptomatic but may cause urethritis

A

Trichomonas vaginalis flagellated protozoan parasite

Ix: wet mount shows motile trophozoites

Rx: oral metronidazole for 5-7 days

85
Q

Name causitive agent, Ix & RX
70% asymptomatic
women: cervicitis dysuria, intermenstrual & post-coital vaginal bleeding
men: urethral discharge, dysuria
can result in PID
Reactive arthritis

A

Chlamydia trachomatis
PID
Reactive arthritis

Ix: nuclear acid amplification tests 2 wks after exposure
Giemsa stain

Rx: doxycycline (7 day course)
Pregnant: azithromycin, erythromycin or amoxicillin

Complications
epididymitis, PID, endometritis, ectopic pregnancies, infertility, reactive arthritis, perihepatitis (Fitz-Hugh-Curtis syndrome)

86
Q

Name causitive agent, Ix & RX
males: urethral discharge, dysuria

females: cervicitis e.g. leading to vaginal discharge

rectal and pharyngeal infection is usually asymptomatic
May led to PID & septic arthritis

A

Rx: IM ceftriaxone
Complications: urethral strictures, epididymitis & salpingitis (hence may lead to infertility). Disseminated infection

87
Q

what causes Cervical montion tenderiness and what is the RX?

A

PID
* oral ofloxacin + oral metronidazole or intramuscular ceftriaxone + oral doxycycline + oral metronidazole

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