MISC Flashcards
HIV + AIDS
RF:
HUMAN IMMUNODEFICIENCY VIRUS & ACQUIRED IMMUNODEFICIENCY
SYNDROME:
- Men who have sex with men (unprotected - higher risk)
- Heterosexual women (unprotected - higher risk)
- IV drug users
- Commercial sex workers
- Heterosexual men
- Truck drivers (tend to use sex industry more)
- Migrant workers (tend to use sex industry more)
- Uncircumcised men
HIV AIDS:
Mechanism of viral replication within CD4 T helper cell:
A key consequence of the viraemia is uncontrolled activation of …
unless they receive a non-specific…
will undergo activation induced APOPTOSIS via …
A key consequence of the viraemia is uncontrolled activation of CD4 T cells
- activated CD4 T cells, unless they receive a non-specific co-stimulatory signal (usually CD28 (on T cell) binding to CD80 or CD86 on the stimulator), will undergo activation induced cell death (APOPTOSIS) via Fas ligand upregulation which the bind to Fas receptors leading to the activation of caspases (cell death enzyme) which then triggers apoptosis and cell death
HIV Hx:
Acute primary infection (seroconversion);
Accompanied by a transient illness 2-6 weeks after exposure with ABRUPT ONSET OF non-specific symptoms: • Fever • Malaise • Myalgia (muscle pain) • Pharyngitis (sore throat) • Maculopapular rash • Significant weight loss can occur
Early symptomatic HIV:
Examples of early symptomatic conditions: • Fever (high temperature) • Night sweats • Diarrhoea • Weight loss • Minor opportunistic infections: - Oral candida - Herpes zoster (shingles) - Recurrent herpes simplex • This collection of symptoms is known as AIDS-related complex (ARC)
AIDs defining conditions:
• Infections: - Candidiasis oesophageal/lung (fungal infection) - Extra-pulmonary cryptococcosis - Cryptosporidiosis for more than 1 month - Mycobacterium TB - Persistent herpes simplex (cold sores) - Pneumocystis jiroveci (carinii) pneumonia - Recurrent bacterial pneumonia - Cytomegalovirus (CMV) in any organ except liver, spleen and lymph nodes - Recurrent salmonella septicaemia • Neoplasms: - Invasive cervical carcinoma - Kaposi’s carcinoma - Primary CNS lymphoma - Non-hodgkin’s lymphoma • Direct HIV effect: - HIV dementia/encephalopathy - HIV associated wasting
Two markers are used to monitor HIV infection:
- CD4 T cell count/μl
- HIV viral load (RNA copies/ml)
- Both are important in prognosis
HIV treatment
- Highly Active Antiretroviral therapy (HAART):
• Ideally start before CD4 count is less than 200
• Use more than 3 drugs to minimise replication and cross-resistance: - 2 NRTI + 1 NNRTI
- 2 NRTI + 1PI
• Negotiate strict adherence
• Aim is to reduce viral load to less than 50 copies/ml and increase CD4 count
Nucleoside reverse transcriptase inhibitors (NRTI): - Abacavir • Didanosine • Emtricitabine Non-nucleoside reverse transcriptase inhibitors (NNRTI): • Efavirenz • Etravirine • Nevirapine Protease inhibitors (PI): • Atazanavir • Darunavir • Indinavir
AMYLOIDOSIS:
Dx
Tx:
biopsy of affected tissue:
• The rectum or subcutaneous fat are relatively non-invasive sites for biopsy and are positive in 80%
• Biopsy is positive if there is CONGO RED STAINING with RED-GREEN BIREFRINGENCE under POLARISED LIGHT MICROSCOPY
Alkylating agent + corticosteroid e.g. ORAL MELPHALAN + PREDNISOLONE
Breast cancer
Dx:
Triple assessment:
• Clinical examination
• Radiology:
- Ultrasound for < 35yrs
- Mammography (breast X-ray) & ultrasound > 35 yrs
• Histology & cytology:
- Fine-needle aspiration:
• If there is a cystic lump:
- Clear fluid found = discard fluid and reassure
- Bloody fluid found = send for cytology
- Ultrasound guided core biopsy:
• If there is a residual mass or solid lump:
- If malignant = plan treatment
- If clear fluid found = discard fluid and reassure
Breast cancer
Tx:
Chemotherapy:
- Alongside surgery e.g. EPIRUBICIN + CMF
(CYCLOPHOSPHAMIDE + METHOTREXATE + FLUOROURACIL (5-FU))
• Endocrine therapy:
- to reduce oestrogen activity (reduce tumour growth) used in oestrogen receptor (ER) or progesterone receptor (PR) POSITIVE DISEASE
- ONLY USED POST-MENOPAUSAL:
• Oestrogen receptor blocker E.g. ORAL TAMOXIFEN:
• Aromatase inhibitors that target peripheral oestrogen
synthesis e.g. ORAL ANASTROZOLE:
- If premenopausal and ER positive:
• Ovarian ablation via surgery/radiotherapy - to stop oestrogen synthesis
• GnRH (gonadotropin-releasing hormone) analogues e.g. ORAL GOSERELIN
- Stage 3-4 (metastases):
• Radiotherapy to bony lesions:
- Give bisphosphonates e.g. ORAL ALENDRONATE to reduce fracture risk and pain
• ORAL TAMOXIFEN is used in ER positive
• Use ORAL TRASTUZUMAB for HER2 positive tumours
LYMPHOEDEMA:
Tx:
long term prophylaxis low-dose antibiotics e.g. ORAL
PHENOXYMETHYLPENICILLIN twice daily
CARBON MONOXIDE (CO) POISONING:
Dx:
Tx:
ABG that looks for SaO2 (O2 haemoglobin sats), haemoglobin and COHb:
• Venous COHb > 3% in non smokers and > 10% in smokers CONFIRMS EXPOSURE to CO
• COHb should be < 5% in healthy people
If severe, may be cerebral oedema as cranial vessels vasodilate to compensate for hypoxia:
• IV MANNITOL to reduce ICP
OPIATES & OPIOIDS OVERDOSE:
-severe withdrawal symptoms reduced by giving METHADONE - pharmaceutical preparation of opioid
-opioid antagonist . IV NALOXONE /2 mins until breathing
is adequate (since naloxone has a very short half-life)
INSECTICIDE OVERDOSE:
Tx:
IV ATROPINE /10 mins until skin is dry, pulse > 70 bpm and pupils dilated
- Symptomatic = IV PRALIDOXIME CHLORIDE to reactive inhibited acetylcholinesterase
COCAINE OVERDOSE:
IV DIAZEPAM -controls agitation + convulsions
• If hypertension persists : IV GLYCERYL TRINITRATE until BP controlled
- CCB e.g. VERAPAMIL or NIFEDIPINE alternative second-line therapy
- Beta-adrenoceptor blockers CONTRAINDICATED as may worsen hypertension!!!
