New FunMed PBL

Question 1

Important questions in sexual health check?

Answer 1

When you last had sex
What protection you used 
Symptoms 
Why you think you have an infection 
Who the sexual partner was

Question 2

Ways for testing for STIs

Answer 2

Blood test
Urine test
Genital exam
Vaginal, anal, urethral swabs

Question 3

Common STIs

Answer 3

Chlamydia
Gonorrhoea
Syphilis
Herpes
HIV

Question 4

Barrier contraception

Answer 4

Prevent contact of sperm and egg to prevent fertilisation
Male condoms
Female condom
Cervical cap 
Diaphragm

Question 5

Hormonal contraception

Answer 5

Combined - oestrogen and progesterone 
Progesterone only 
Thicken cervical mucous 
Endometrial atrophy 
Inhibit ovulation

Question 6

Contact tracing

Answer 6

Important in reducing risk of further transmission
Done anonymously
Does not require patient consent as within public interest

Question 7

How you can be prosecuted for reckless HIV tranmission

Answer 7

The person you had sex with didn't know you had HIV 
You knew you had HIV at the time
You understood how HIV was transmitted
You did't use a condom 
You transmitted HIV to the person

Question 8

Define stigma

Answer 8

Negative label that may change the way you view yourself or others view you and can lead to discrimination

Question 9

Define enacted stigma

Answer 9

Discrimination due to a condition that causes suffering

Question 10

Define felt/anticipated stigma

Answer 10

Fear that discrimination might occur that might lead to the person avoiding situations where the discrimination might occur

Question 11

Reasons for HIV being a stigmatised condition

Answer 11

Life threatening
Perceived as contagious and threatening
Lack of understanding about the disease
Association with specific lifestyle behaviours

Question 12

How does HIV kills cells?

Answer 12

Induced apoptosis

Question 13

Which cells does HIV target?

Answer 13

CD4 cells

Question 14

How can HIV be transmitted?

Answer 14

Blood, semen, vaginal fluid, pre-ejaculate, breast milk

Question 15

HIV diagnosis methods

Answer 15

Blood antibody test 
-monoclonal antibody test for antibodies against HIV
-may take up to 3 months to become positive 
HIV p24 antigen testing 
-detects viral antigen
-may show positive before antibody test
HIV RNA test
-measures HIV is plasma by PCR

Question 16

How long before HIV can show up on a test?

Answer 16

4 weeks earliest

3 months latest

Question 17

How to conceive as a HIV positive woman

Answer 17

Ensure low viral load
Keep taking anti-retrovirals
Check for other STIs and potential opportunistic infections
Time cycle so you only have to have unprotected sex once
HIV negative partner can take PrEP
Consider insemination

Question 18

Preventing mother-to-child transmission

Answer 18

HIV tested for in early pregnancy for women who may be unaware they are infected
ARVs taken throughout pregnancy
Caesarian section to reduce chance of transvaginal transmission
No breast feeding
Baby given zidovudine monotherapy for 4 weeks after birth

Question 19

Zidovudine class

Answer 19

NRTI

Question 20

Precautions for relationships

Answer 20

Inform partner before any genital contact
Always use condoms 
Adhere to ARVs
Regular HIV tests for your partner 
Read up of PrEP and PoEP

Question 21

Bacteria that causes chlamydia

Answer 21

Chlamydia trachomatis

Gram negative

Question 22

Symptoms of chlamydia

Answer 22

Pain urinating
Unusual discharge from the vagina, penis or anus
Pain and swelling in testicles
Bleeding during or after sex or between periods

Question 23

Transmission of chlamydia

Answer 23

Through unprotected vaginal, anal or oral sex

Question 24

Treatment of chlamydia

Answer 24

Azithromycin - macrolide antibiotic

Targets 50s ribosome to prevent translocation

Question 25

Prevention of chlamydia

Answer 25

Condoms

Not sharing sex toys

Question 26

Complications of chlamydia

Answer 26

Pelvic inflammatory disease
Can lead to fertility problems and ectopic pregnancies
Conjunctivitis for babies born to chlamydia positive mothers
Reactive arthritis

Question 27

Diagnosis of chlamydia

Answer 27

Men = urine sample
Women = swab of affected area
Nucleic acid amplification tests used to identify presence of bacteria

Question 28

Reasons for flu like symptoms

Answer 28

Seroconversion phase of infection

Question 29

Seroconversion phase

Answer 29

Usually occurs 2-6 weeks after infection
When the body develops antibodies against HIV
Large amounts of virus being produced
CD4 cells used for this replication so number rapidly falls while viral load increases
Seeding of lymphoid organs
Leads to flu like symptoms
Most infectious at this point
Symptoms include fever, swollen glands, sore throat, rash, muscle and join pain, headache
Immune system begins to respond and CD4 count increases again slightly

Question 30

Clinical latency phase

Answer 30

Virus can lay dormant for up to 10 years
ARVs keep virus in this phase
HIV still replicating in this phase but more slowly 
Patients appear asymptotic 
Can still transmit HIV at this stage

Question 31

Symptomatic phase - AIDS

Answer 31

Individuals become open to opportunistic infections and HIV related malignancies

Question 32

Opportunistic infections

Answer 32

Candidiasis
TB
Cytomegalovirus 
Cryptosporidium
Herpes viruses
Haemophilus 
Pneumococcus
Salmonella

Question 33

Tests important for monitoring the progress of the virus

Answer 33

CD4 count 
-normal range 450-1200cells/mm3
-most useful indicator of immune status
-can help show effects of ARVs
Viral load 
-measures HIV is plasma
-high load correlated with increased disease progression
-can monitor ARV success
-can show risk of transmission

Question 34

Why are HIV patients more at risk of infections?

Answer 34

Defective cell mediated immunity problems dealing with intracellular organisms
Reduced antibody production

Question 35

When can STIs be disclosed to other doctors?

Answer 35

For direct purpose of treatment

To prevent transmission

Question 36

Type of nucleic acid in HIV

Answer 36

Single stranded positive RNA

Retrovirus