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2 Principles of Disease > Lecture 4 pt 2 > Flashcards

Lecture 4 pt 2 Flashcards

1
Q

Definition of AIDs

A

chronic, life-threatening disease caused by the human immunodeficiency virus, resulting in progressive and ultimately profound immune suppression

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2
Q

HIV vs AIDs

A

HIV infection & AIDs refer to different stages along the disease spectrum

HIV = used for virus and early stages of disease process

AIDs = later stages of HIV infection

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3
Q

Epidemiology of AIDS

A

Epidemic in many countries
Since late 90s, significant declines in number of new cases. # of people living with AIDS has increased

prevalence is increasing, incidence is decreasing

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4
Q

Transmission of HIV

A

occurs by exchange of body fluids, especially blood and semen

viral load is highest in blood and semsn

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5
Q

Risk factors for infection of AIDs/HIV

A

unprotected sex with multiple partners
unprotected sex w/someone who is HIV+
having another STD
sharing needles
accidental needle sticks with infected blood
received blood transfusion btwn 77-85
newborns or nursing infants w/HIV+ mothers

MSM most common, injection drug use

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6
Q

Ways HIV is not transmitted

A

ordinary contact with someone who is positive

contact with sweat or tears

sharing food, utensils, towels, swimming pool, telephone, toilet seat

being bitten by mosquitoes

kissing someone who has HIV/AIDS

donating blood

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7
Q

Pathogenesis of HIV/AIDS (DNA level)

A

retroviruses = single stranded RNA

binding of HIV to host cells that contain CD4 marker on surface–> helper T-cells

binding results in springing open of lipid bilayer of host cell, viral/host cell then fuse together

copied DNA enter the cell nucleus, the virus helps the DNA enter the chromosomal DNA

integrated DNA virus may remain latent in host cell for hours to years before becoming active through transcription

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8
Q

CD8 cells and HIV replication

A

CD8 inhibit HIV replication both directly (killing infected cells) and indirectly (producing interferons)

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9
Q

HIV/AIDS progression

A

HIV infection/acute infection –> early asymptomatic HIV infection –> symptomatic HIV infection –> AIDs

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10
Q

HIV progression is monitored by measuring the number of ______ in the blood

A

CD4 lymphocytes
<500 –> indicate some immune impairment
<200 –> imminent risk of opportunistic infections

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11
Q

Why is CD4 count important?

A

depletion is hallmark of HIV infection
useful marker for HIV/AIDS staging
correlates w/risk of opportunistic infections

main criterion for clinical decision making for treatment –> when to start ART and prophlatic treatment

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12
Q

AIDS diagnosis is made when a person is:

A

HIV positive AND CD4 count <200 cells
HIV positive AND/OR diagnosed w/aids-defining illness

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13
Q

AIDS defining illness

A

Candidiasis of bronchi, trachea, esophagus, lungs
coccidiodomycosis disseminated
encephalopathy
cytomegalovirus
pneumonia
lymphoma
wasting syndrome
tuberculosis

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14
Q

TB infection

A

means TB is in the body, but the body’s immune system has it under control
people with TB infection are non-infectious

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15
Q

TB disease

A

develops when the body’s immune system cannot keep the TB under control, begins to multiply
people with disease are infectious

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16
Q

Clinical Presentation of AIDS

A

there may be no symptoms for up to 10 years

eventually, mild infections or chronic symptoms begin (swollen lymph nodes, diarrhea, weight loss, fever, cough, rash)

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17
Q

Late phases of HIV infection

A

development of opportunistic infections
soaking night sweats
shaking chills or fever
chronic diarrhea
headaches
blurred/distorted vision
weight loss
unexplained fatigue

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18
Q

Diseases related to AIDS

A

HIV associated dementia
peripheral neuropathy
HIV wasting syndrome (cachexia)

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19
Q

Prevention for HCWs

A

blood into open cut or mucous membrane
being stuck with needles containing HIV-infected blood
most exposure is caused by SPLASH, but blood is more infectious

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20
Q

Pre-exposure prophylaxis

A

there is no vaccine for HIV
PrEP to reduce likelihood of HIV infection for high risk individuals

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21
Q

Pharmacotherapy

A

NO cure for AIDS
with antiretroviral therapy, HIV can be controlled

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22
Q

ART

A

combination of antiretroviral drugs from different classes that must be taken every day

each drug class inhibits enzymes involved in different steps during HIV replication

combo drugs = greater clinical effectiveness, prevention, delay of viral drug resistance

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23
Q

Medication adherence

A

taking medications exactly as prescribed

helps to avoid treatment failure
reduce risk that HIV will mutate and produce drug resistant HIV
decrease transmission of drug resistant HIV

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24
Q

Who should take ART?

A

recommended for everyone with HIV asap
often initiated when CD4 <500 cells

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25
What is the goal of ART?
cannot cure HIV/AIDS reduce a person's viral load reduce risk of transmission does not completely eradicate HIV from body
26
Nonpharmacological treatment for AIDS
exercise, nutrition, mental health, complementary medicine can help relieve pain, fatigue and medication ADRs, strengthen immune system, reduce stress
27
Exercise in HIV/AIDS may help
provide pain relief increase appetite reduce muscle atrophy regular bowel habits counter ADRs
28
Promoting self-care
regular exercise avoid smoking/drug use eat healthy avoid foods that increase risk of infection clean water sufficient sleep good hygiene
29
Beware of risks associated with companion animals
tinea corporis (ringworm) toxoplasmosis --> cleaning litter box and touching mouth/face afterwards
30
Rheumatoid Arthritis Definition
chronic systemic inflammatory disorder in which immune system cells attack healthy tissues characterized by polyarticular, symmetrical joint involvement, extra-articular involvement
31
Epidemiology and Risk factors for RA
female onset is frequently 30-60yr caucasians 1-2% of USA population
32
Pathogenesis of RA
no single factor or agent is known to cause RA some unknown antigen triggers B cells to produce RF
33
Rheumatoid Factor (RF)
autoantibodies against IgG
34
What type of hypersensitivity is RA?
Type 3--> immune complex mediated disease excessive immune complexes are deposited in tissues resulting in vasculitis, which damages tissues
35
Immune complexes cluster in ______
synovial fluid stimulate complement system, WBCs go into synovium will cause development of pannus
36
Pannus
destructive mass of fibroblastic, vascular, inflammatory cells dissolves collagen, cartilage, bone prevents the synovium from lubricating the joint and providing nutrients to articular cartilage results in irreversible joint instability, deformity, fusion/ankylosis
37
Clinical presentation of RA
symmetrical and bilateral joint ligament laxity warm, painful, stiff joints wrist, MCP, PIP, knees, feet, cervical spine
38
Common deformities of fingers in RA
swan neck boutonniere
39
Tendon/ligament involvement of RA
tendinitis of rotator cuff and palmar flexor finger deformities claw toes instability of ligaments in cervical spine, specifically C1/C2
40
Extra-articular involvement of RA
firm, subcutaneous masses in areas with mechanical pressure usually asymptomatic may appear in viscera (lungs, heart, GI)
41
Nodules in organs
eyes --> scleritis heart --> pericarditis lungs --> effusion nerve --> carpal tunnel vessels --> vasculitis
42
Diagnosis of RA
prolonged morning stiffness in involved joints, weight loss, anorexia, fatigue, swelling in joints, RA hand changes, RF factor in blood
43
OA features
Wear/tear of joints increasing age, sex depends 1 joint, hip/knee no inflammation not prolonged stiffness years for onset no systemic presentation
44
RA features
unknown/autoimmune 30-60 yr old, more common in females bilateral joints. Usually in toes, fingers, cervical inflammation prolonged stiffness onset is weeks to months systemic presentation
45
Treatment for RA
no cure medications, surgeries, patient education on self-care, PT, OT
46
Pharmacotherapy for RA
DMARDs = disease modifying antirheumatic drugs includes methotrexate only class of drugs that alters/slows course of RA
47
Prognosis of RA
must have good response to treatment and early responses to medication
48
Indications of Poor prognosis with RA
extra-articular disease carriers, greater risk of CVD tons of invovled joints poor functional status elevated SED rate erosions RF present
49
RA and PT
avoiding cervical flexion educate on progression rest periods --> decreases fatigue and protects joints focus on resistance training, ROM, no stretching, assistive devices exercise can help reduce stiffness, but should not produce pain that last longer than an hour modalities --> superficial heat (no deep heat), skin condition is usually poor
50
Fibromyalgia definition
chronic widespread musculoskeletal pain syndrome characterized by chronic pain and tenderness at specific locations, often associated with persistent fatigue, cognitive/mood/sleep disorders
51
Epidemiology of fibromyalgia
prevalence is about 2-4% of population more are females, and symptoms are between 20-55 years of age
52
Risk factors for fibromyalgia
female prolonged anxiety, emotional stress trauma rapid glucocorticoid withdrawal hypothyroidism infections minimal to moderate aerobic fitness level
53
Etiology and pathogenesis of fibromyalgia
UNKNOWN most accepted hypothesis : neurologic disorder of central pain processing that causes pain perception in response to stimuli that would not typically be painful
54
Clinical presentation of fibromyalgia
chronic and diffuse aching pain often involving entire body with prominence around neck, shoulders, low back, hips. physical exam is often normal minor exertion aggravates pain & increases fatigue visual problems morning stiffness cognitive problems depression/anxiety sleep disturbances IBS chronic headaches
55
Diagnosis of fibromyalgia
widespread pain >7 generalized pain, 4 or 5 regions symptoms for at least 3 months tender points are controversial and not accepted
56
fibromyalgia may be considered a ______ of _______
diagnosis of exclusion pt must meet all 3 criteria
57
Treatment of fibromyalgia
there is no cure patient education, stress management, work simplication medications = anti-depressants CBT exercise
58
Prognosis of fibromyalgia
good, though most have persistent symptoms for years or lifetime
59
Exercise for fibromyalgia
people with fibromyalgia fatigue quickly, low tolerance for exertion stop with increased pain
60
Exercise prescription for fibromyalgia
F: 1-2 days a week I: very light T: start with 10 min a day T: low impact, non weight-bearing gentle stretching for flexibility

2 Principles of Disease (7 decks)

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