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Medicine Year 2 5 > Miscellaneous > Flashcards

Miscellaneous Flashcards

1
Q

What does HIV stand for?

A

Human immunodeficiency virus

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2
Q

What is responsible for most human infections of HIV?

A

HIV1

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3
Q

Give 2 groups with the most prevalence for HIV in the UK

A
  • ) Men who have sex with men

- ) IVDUs

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4
Q

What does IVDU stand for?

A

Intravenous drug user

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5
Q

Give the 7 steps of HIV pathogenesis

A

1) HIV binds to CD4 receptors
2) CD4 positive cells migrate where virus replicates and releases new virions
3) Infection progresses and decreases immunity
4) DNA copy of virus RNA genome made
5) Integrated into host DNA
6) Core viral proteins
7) Completed virus is released

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6
Q

What is the viral load of HIV?

A

Number of circulating viruses

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7
Q

What does the viral load of HIV predict?

A

Progression to AIDs

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8
Q

What does HIV bind via? (Step 1)

A

GP120 envelope protein

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9
Q

Where are the CD4 receptors that are bound to HIV? (Step 1)

A

Helper T cells, monocytes, macrophages, neural cells

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10
Q

Where do CD4 positive cells migrate to? (Step 2)

A

Lymphoid tissue

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11
Q

What do new virions do? (Step 2)

A

Infect new cells

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12
Q

Why does immunity decrease as infection progresses in HIV? (Step 3)

A

Depletion and impaired function of CD4 cells

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13
Q

What makes a DNA copy of the virus RNA genome? (Step 4)

A

Viral reverse transcriptase enzyme

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14
Q

What integrates the DNA copy of the virus RNA genome into host DNA? (Step 5)

A

Integrase

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15
Q

What are the core viral proteins initially synthesised as?

A

Large polypeptides that are cleaved by protease

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16
Q

What are the 3 stages of HIV?

A
  • ) Seroconversion (primary infection)
  • ) Asymptomatic period
  • ) AIDs related complex
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17
Q

What may seroconversion by accompanied by?

A

Transient illness 2-6 weeks after exposure

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18
Q

What are the symptoms of seroconversion?

A
  • ) Fever
  • ) Malaise
  • ) Myalgia
  • ) Pharyngitis
  • ) Maculopapular rash
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19
Q

What can occur instead of the asymptomatic period of HIV?

A

Persistent generalised lymphadenopathy

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20
Q

Give 3 later constitutional symptoms of HIV

A
  • ) Night sweats
  • ) Fever
  • ) Diarrhoea
  • ) Weight loss
  • ) Possible opportunistic infections
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21
Q

Give 2 opportunistic infections of HIV

A
  • ) Oral candida
  • ) Herpes zoster
  • ) Herpes simplex
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22
Q

What is the precursor to AIDS?

A

AIDS related complex

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23
Q

What is AIDS defined as?

A
  • ) HIV plus an indicator disease

- ) CD4 usually <200x10^6

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24
Q

How long is the progression from HIV to AIDs usually?

A

8 years

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25
How long is the progression from AIDS related complex to AIDS usually?
2 years
26
How long is the progression from AIDS to death without treatment?
2 years
27
Give 3 indications that HIV progression is more severe
- ) Fever - ) Lymphadenopathy - ) Cough - ) Diarrhoea - ) Oral thrush - ) Weight loss - ) TB - ) Herpes zoster (shingles)
28
Which 2 HIV subtypes predominate in the UK?
A and B
29
What do we detect in tests for HIV?
Serum HIB antibody by ELISA
30
What do we do if the HIV test is negative? (3)
- ) Check again later - ) Look for HIV RNA by PCR - ) Look for core p24 antigen in plasma
31
What does ELISA stand for?
Enzyme linked immunosorbent assay
32
Give 3 ways to prevent HIV
- ) Good education - ) Accessible tests and counselling - ) Condoms - ) Fewer sexual partners and only one at a time - ) Decrease alcohol (risky behaviour) - ) Circumcision
33
Give 3 complications/opportunistic infections of HIV
- ) TB - ) Pneumocystis jiroveci pneumonia - ) Candidiasis - ) Toxoplasmosis - ) Cryptococcal meningitis - ) Cytomegalovirus retinitis - ) Kaposi's sarcoma - ) Leishmaniasis
34
What 4 tests do we do routinely during treatment of HIV?
- ) CD4 T cell count - ) HIV RNA - ) Serum U&E, Cl, creatinine, bilirubin, LFT, FBC - ) Lipid profile and glucose
35
When should we initiate therapy in HIV?
- ) AIDS defining illness - ) CD4 <350 - ) Pregnancy - ) Nephropathy - ) HBV
36
What does highly active antiretroviral therapy aim to do?
Suppress plasma HIV RNA levels below limit of detection and restore immune function
37
Give 3 types of drug we give in HIV
- ) Nucleoside reverse transcriptase inhibitors - ) Protease inhibitors - ) Non-nucleoside reverse transcriptase inhibitors - ) Integrase strand transfer inhibitors
38
Why do we use >3 drug combinations in HIV treatment?
To minimise replication and cross resistance
39
Give an example of a nucleoside reverse transcriptase inhibitor
- ) Tenofovir - ) Lamivudine - ) Abacavir
40
Give an example of a protease inhibitor
Lopanavir
41
Give an example of a non-nucleoside reverse transcriptase inhibitor
- ) Nevirapine | - ) Efavirenz
42
Give an example of an integrate strand transfer inhibitor
-) Ellvitegravir
43
What is the most severe type of malaria?
P. falciparum
44
Give the 4 main types of malaria
- ) P. falciparum - ) P. ovale - ) P. vivax - ) P. malariae
45
How is malaria transmitted?
Plasmodium protozoa injected by bite of female anopheles mosquito
46
Give the 8 pathogenic steps of malaria transmission
1) Female mosquito takes blood meal containing gametocytes 2) Protozoa develop in mosquito 3) Sporozoites migrate to salivary glands 4) Inoculated into human host, taken up by liver 5) Multiply in hepatocytes to form merozoites 6) Hepatocytes rupture and merozoites released into blood 7) Merozoites multiply and form trophozoites, schizont and new merozoites inside erythrocytes 8) A few merozoites develop into gametocytes which are taken up by other mosquitos
47
Give 3 things protozoa multiplying in RBCs causes
- ) Haemolysis - ) RBC sequestration - ) Cytokine release - ) Infect liver
48
What do fever paroxysms reflect in malaria?
Synchronous release of merozoites from mature schizonts, causes cold/hot fever and nausea/headache
49
Give 2 protective factors for malaria
- ) Glucose 6 phosphate dehydrogenase deficiency | - ) Sickle cell trait
50
Give 3 symptoms of malaria
- ) 90% present within 1 month - ) Prodromal headache, malaise, myalgia, anorexia before 1st fever paroxysm - ) Tertian fevers - recur every second day is classic - ) Anaemia, jaundice, hepatosplenomegaly
51
What can decreased consciousness indicate in malaria?
Cerebral malaria
52
What is the mortality for falciparum malaria?
20% | Higher if very young/pregnant
53
Give 3 tests we do for malaria
- ) Serial thin and thick blood films to show level of parasiteaemia - ) FBC may show anaemia (from haemolysis) and thrombocytopaenia - ) Clotting, glucose, ABG/lactate, U&E, urinalysis - ) Blood culture to check for septicaemia
54
How do we treat P. falciparum malaria? (5)
- ) Combination therapy containing artemisinin derivatives - ) Possible atovaquone-proguanil (macaroni) - ) Or quinine and doxycycline/clindamycin - ) P. falciparum largely resistant to chloroquine - ) IV with artesunate if severe (with above)
55
How do we treat uncomplicated P. ovale/vivax/malariae malaria?
- ) Chloroquine based - ) Primaquine after in ovale and vivax to prevent relapse - ) Malarone or quinine if resistant
56
What is the general treatment for malaria?
- ) Paracetamol - ) Transfuse if severe anaemia - ) Monitor bloods
57
How do we prevent malaria?
- ) Proguanil daily and chloroquine base weakly - ) If chloroquine resistant - doxycycline or malarone - ) Repellant, long sleeves, bed nets
58
What is malarone?
Atovaquine-proguanil
59
What is a lymphoedema?
Chronic non-pitting oedema due to lymphatic insufficiency
60
What part of the body does a lymphoedema normally affect?
Legs
61
What can chronic lymphoedema cause?
Secondary 'cobblestone' thickening of skin
62
Give a primary cause of lymphoedema
Milroy disease
63
Give a secondary cause of lymphoedema
Obstruction of lymphatic vessels
64
What is Milroy disease?
Lower leg swelling from birth, autosomal dominant
65
What are the mutations in Milroy disease?
VEGFR3 causing lymphatic malfunction
66
What is the treatment for Milroy disease?
Compression stockings/bandages, exercise
67
What is a filarial infection transmitted by?
5 genera of mosquito
68
What does a filarial infection cause?
Obstruction of the lymphatic vessels
69
Give 2 symptoms of an acute filarial infection
Fever Lymphadenopathy Chyluria
70
What can a filarial infection also cause?
Elephantiasis - massive lymphoedema in the legs and massive hydroceles
71
What can a sarcoma originate from?
Any mesenchymal tissue (fat/muscle/cartilage/bone)
72
What do soft tissue sarcomas present as?
Painless enlarging mass
73
Give a risk factor for a sarcoma
Neurofibromatosis, previous radiotherapy
74
Give 2 features that will lead a lump being considered malignant
- ) Lump bigger than 5cm - ) Increasing in size - ) Deep to deep fascia - ) Painful
75
How do we diagnose a sarcoma?
MRI followed by needle biopsy
76
What is the most common sarcoma in children?
Rhabdo-myosarcoma
77
Give 2 types of sarcoma
Rhabdo-myosarcoma, liposarcoma, leiomyosarcoma, fibrosarcoma
78
How do we treat sarcomas?
Exision with wide margins followed by radiotherapy
79
What would we use chemotherapy in a sarcoma?
Osteosarcoma or mets
80
What is the general management for poisoning? (7)
- ) ABC, secure airway, shock - ) Take blood, paracetamol and salicylate levels - ) Possible empty stomach - ) Consider specific antidote or oral activated charcoal - ) Get more info, TOXBASE - ) Monitor closely and give supportive care - ) Psychiatry?
81
What does CO do?
Binds to Hb and decreases O2 delivery to tissues
82
Give 3 symptoms of CO poisoning
- ) Headache - ) Vomiting - ) High pulse - ) Tachypnoea - ) Fits, coma, cardiac arrest if severe
83
What does an ABG show in CO poisoning?
Low O2 saturation and high carboxyhaemoglobin
84
How do we treat CO poisoning?
Remove source and give O2 until carboxyhaemoglobin decreased
85
How do we treat cerebral oedema?
Mannitol
86
What does aspirin/salicylate poisoning do?
Uncoupling of oxidative phosphorylation leading to anaerobic metabolism and production of lactate and heat
87
Give 3 symptoms of salicylate poisoning
- ) Vomiting - ) Dehydration - ) Hyperventilation - ) Tinnitus - ) Vertigo - ) Sweating - ) Low GCS, low BP, seizures, hyperthermia, pulmonary oedema rarely
88
What sort of alkalosis is there in salicylate poisoning?
Initial respiratory alkalosis then metabolic acidosis
89
How do we treat salicylate poisoning?
- ) Correct dehydration - ) Give activated charcoal within 1 hour - ) Monitor bloods - ) Correct acidosis - ) Treat hypokalaemia if present - ) Dialysis if severe and if complications
90
Give a complication of salicylate poisoning
AKI, HF, oedema, confusion, seizures
91
How do we correct acidosis?
IV sodium bicarbonate
92
Give 2 symptoms fo paracetamol poisoning
- ) Nothing initially - ) Vomiting - ) RUQ pain - ) Jaundice and encephalopathy later - ) Possible AKI
93
How do we treat paracetamol poisoning?
- ) Activated charcoal within 4 hours | - ) N-acetylcyseine within 10-12 hours and no vomiting
94
What do organophosphate insecticides cause?
Inactivate cholinesterase and thus increase acetylcholine
95
Give 4 symptoms of organophosphate insecticide poisoning
- ) SLUD - salivation, lacrimation, urination, diarrhoea - ) Sweating - ) Small pupils - ) Muscle fasciculation - ) Coma
96
How do we treat organophosphate insecticide poisoning? (3)
- ) Remove soiled clothes and wash skin - ) Atropine IV until fully atropinates - ) Pralidoxime and diazepam
97
What does atropinates mean?
Skin dry, pulse >70, pupils dilated

Medicine Year 2 5 (17 decks)

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