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D2 Spring > Oral Path Exam 3 - HIV > Flashcards

Oral Path Exam 3 - HIV Flashcards

1
Q

HIV is a _________ virus

A

ss-RNA

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2
Q

What are the 2 types of HIV?

A

HIV-1 (worldwide)
HIV-2 (west Africa)

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3
Q

Eastern/Southern Africa cases account for greater than _______% of people living with HIV worldwide

A

50%

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4
Q

The HIV virus is in most ________ ________

A

body fluids

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5
Q

How is HIV transmitted?

A

Sexual contact
Injection drug use

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6
Q

What is the incidence rate of HIV infection?

A

Blacks > hispanics > whites

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7
Q

What is the occupational risk of HIV infection?

A

0.3% percutaneous
0.09% mucous membrane

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8
Q

What are the target cells of HIV?

A

CD4+ helper T cells
Macrophages

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9
Q

HIV binds through _________ and ________ with CD4+ and CCR4/CCR5 interaction. ________ is reverse transcribed into DNA which integrates into the host genome

A

gp41 and gp120; RNA

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10
Q

In HIV, what occurs with decrease in CD4+ helper T cells, leading to decreased response to fungi, viruses, and encapsulated bacteria?

A

Cell lysis or latency

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11
Q

How long after exposure would you expect the following clinical presentation of HIV?

Acute retroviral syndrome, followed by latency

A

1-6 weeks post-exposure

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12
Q

How long after exposure would you expect the following clinical presentation of HIV?

Increased viremia
Decreased CD4+ helper T cells
AIDS-related complex + opportunistic infections

A

10 years post-exposure

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13
Q

T/F: In HIV, latency can be established within the first few days of infection. 80% risk reduction for infection if post-exposure prophylaxis (2 drugs x 4 weeks) given within hours of exposure

A

True

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14
Q

What are the following symptoms associated with?

Chronic fever
Weight loss
Diarrhea
Oral candidiasis
Herpes zoster
Oral hairy leukoplakia

A

AIDS-related complex (ARC)

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15
Q

What are the bacterial opportunistic infections in HIV?

A

Mycobacteria (like TB)

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16
Q

What are the viral opportunistic infections in HIV?

A

CMV
HSV

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17
Q

What are the fungal opportunistic infections in HIV?

A

Pneumocystis jiroveci (fungal pneumonia)
Cryptococcus meningitis

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18
Q

What are the protozoal opportunistic infections in HIV?

A

CNS toxoplasmosis

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19
Q

What are the neurologic dysfunctions in HIV?

A

Seizures
Dementia

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20
Q

HIV is diagnosed by a screening test, followed by a ____________ ________

A

Western blot

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21
Q

Which diagnosis method for HIV?

Enzyme immunoassay or rapid antibody test

A

Screening test

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22
Q

The screening test for HIV only works if the pt has had _______________, which is 3-12 weeks post-exposure

A

seroconversion

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23
Q

What is the AIDS defining criteria? (ON EXAM)

A

CD4+ T cell count < 200/mL
CD4+ T cell < 14% of total lymphocytes
AIDS-defining condition

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24
Q

How is HIV treated?

A

Combination antiretroviral therapy (cART)

(targets RT, protease, fusion, integrase, and CCR5)

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25
Q

T/F: The tx goal for HIV is for the viral load to be “undetectable” or at least < 50 copies/mL

A

True

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26
Q

What may be the first sign of HIV infection?

A

Oral lesions

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27
Q

What is the most common oral manifestation of HIV infection?

A

Oral candidiasis

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28
Q

T/F: All subtypes of oral candidiasis may be seen in HIV

A

True

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29
Q

What is the tx for oral candidiasis in HIV?

A

Clotrimazole
Fluconazole

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30
Q

What should you do if you see recurrent oral candidiasis infections in an undiagnosed pt?

A

Refer for HIV testing

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31
Q

What does the PAS stain highlight in HIV?

A

Hyphae + yeast forms

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32
Q

Which lesion associated with HIV?

Red, linear band at marginal gingiva that extends 2-3 mm apically

A

Linear gingival erythema

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33
Q

Which lesion associated with HIV?

Spontaneous bleeding, petechiae may be noted

A

Linear gingival erythema

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34
Q

Which lesion associated with HIV?

Lack of response to improved OH

A

Linear gingival erythema

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35
Q

Which lesion associated with HIV?

Rxn to subgingival bacteria or unusual pattern of candidiasis has been suggested (most cases respond to antifungals)

A

Linear gingival erythema

36
Q

Which lesion associated with HIV?

Similar to that seen in non-immunocompromised pts: loss of interdental papillae w/o bone loss, bleeding, pain, halitosis

A

Necrotizing ulcerative gingivitis (NUG)

37
Q

Which lesion associated with HIV?

May be seen in a setting of relatively few apparent local factors

A

Necrotizing ulcerative gingivitis
Necrotizing ulcerative periodontitis

38
Q

Which lesion associated with HIV?

Similar to NUG (pain, bleeding, edema) but with extensive bone loss

A

Necrotizing ulcerative periodontitis (NUP)

39
Q

Which lesion associated with HIV?

May be multifocal or generalized

A

Necrotizing ulcerative periodontitis

40
Q

Which lesion associated with HIV?

Don’t see deep pocketing due to gingival necrosis as the bone is lost

A

Necrotizing ulcerative periodontitis

41
Q

Which lesion associated with HIV?

Extensive destruction of gingiva, periodontal bone, adjacent soft tissue and deeper osseous structures

A

Necrotizing stomatitis

42
Q

Which lesion associated with HIV?

Tx = extensive debridement, systemic antibiotics, close follow-up, possible additional debridement

A

Necrotizing stomatitis

43
Q

Which lesion associated with HIV?

Most are HIV infected or other immunocompromised; rare in healthy pts

A

Hairy leukoplakia

44
Q

Which lesion associated with HIV?

Non-removable white plaques of the lateral tongue

A

Hairy leukoplakia

45
Q

Which lesion associated with HIV?

Caused by Epstein-Barr virus (EBV); often there is superimposed candidiasis

A

Hairy leukoplakia

46
Q

Which lesion associated with HIV?

No tx necessary, will resolve if pt is on effective cART

A

Hairy leukoplakia

47
Q

Which lesion associated with HIV?

In US, primarily associated with HIV infection w/ decreasing incidence

A

Kaposi sarcoma

48
Q

Which lesion associated with HIV?

Caused by human herpes virus 8 (HHV-8), high titers in saliva, and oral/oropharyngeal tropic

A

Kaposi sarcoma

49
Q

Which lesion associated with HIV?

Skin or visceral involvement, with 70% of AIDS-related having oral involvement on the palate, gingiva, or tongue

A

Kaposi sarcoma

50
Q

Which lesion associated with HIV?

Reddish-purple, flat or nodular; usually multiple lesions noted

A

Kaposi sarcoma

51
Q

Which lesion associated with HIV?

Tx = often regresses with effective cART

For non-responsive lesions = topical therapy, excision, intralesional chemo (5 yr survival = 70%)

A

Kaposi sarcoma

52
Q

Which lesion associated with HIV?

Generalized, non-tender lymphadenopathy; cervical lymph nodes are frequently affected, including posterior cervical nodes

A

Persistent lymphadenopathy

53
Q

Which lesion associated with HIV?

Other causes of lymphadenopathy may have to be ruled out before associating with HIV

A

Persistent lymphadenopathy

54
Q

Which lesion associated with HIV?

Most common malignancy in AIDS population

A

AIDS-related lymphoma

55
Q

Which lesion associated with HIV?

Usually extra-nodal in CNS or GI tract

A

AIDS-related lymphoma

56
Q

Which lesion associated with HIV?

Oral examples may resemble kaposi sarcoma; also can involve bone, appearing as diffuse bone loss

A

AIDS-related lymphoma

57
Q

Which lesion associated with HIV?

Many cases are associated with EBV

A

AIDS-related lymphoma

58
Q

Which lesion associated with HIV?

Usually very aggressive with a poor prognosis (median survival of 3-4 months)

A

AIDS-related lymphoma

59
Q

Which lesion associated with HIV?

Bilateral parotid enlargement is typically seen

A

Salivary gland involvement in HIV

60
Q

Which lesion associated with HIV?

Due to lymphocytic infiltration of glandular tissue

A

Salivary gland involvement in HIV

61
Q

Which lesion associated with HIV?

Accompanied by formation of lymphoepithelial cyst-like changes

A

Salivary gland involvement in HIV

62
Q

Which lesion associated with HIV?

Xerostomia may be present

A

Salivary gland involvement in HIV

63
Q

What are the HIV-related viral infections?

A

Herpes simplex
Varicella zoster
EBV
HPV

64
Q

Which viral lesion in HIV?

Represents reactivation of virus in most cases

A

Recurrent herpes simplex

65
Q

Which viral lesion in HIV?

Lesions are more widespread and have an atypical pattern (persistent, painful, diffuse, shallow ulcerations)

A

Recurrent herpes simplex

66
Q

Which viral lesion in HIV?

Must be treated w/ acyclovir or one of the acyclovir analogues

A

Recurrent herpes simplex

67
Q

Which viral lesion in HIV?

May see in younger than normal patients (under 40 yrs old)

A

Herpes zoster

68
Q

Which viral lesion in HIV?

Typically unilateral vesicles and ulcers following trigeminal nerve branches; may show cutaneous spread beyond the expected dermatome

A

Herpes zoster

69
Q

Which viral lesion in HIV?

Intense pain, may see bone loss

A

Herpes zoster

70
Q

Which viral lesion in HIV?

Seen w/ increased frequency intraorally in HIV+ pts

71
Q

Which viral lesion in HIV?

Exophytic lesions, solitary or multiple, may resemble routine squamous papilloma, condyloma, or focal epithelial hyperplasia

72
Q

What is the AIDS-defining illness?

A

Histoplasmosis

73
Q

What illness associated with AIDS is generally pulmonary, but dissemination to oral mucosa may occur?

A

Histoplasmosis

74
Q

What illness associated with AIDS presents as non-healing, painful ulcer?

A

Histoplasmosis

75
Q

What illness associated with AIDS may require IV amphotericin B?

A

Histoplasmosis

76
Q

What lesion associated with HIV?

Probable immune-mediated etiology

A

Aphthous-like ulcer

77
Q

What lesion associated with HIV?

Painful and persistent - may be solitary or multiple

A

Aphthous-like ulcer

78
Q

What lesion associated with HIV?

May need to rule out infectious causes
Responds to topical corticosteroids

A

Aphthous-like ulcer

79
Q

What lesion associated with HIV?

Caused by pox virus

A

Molluscum contagiosum

80
Q

What lesion associated with HIV?

Many more lesions develop compared to non-immunocompromised pt

A

Molluscum contagiosum

81
Q

What lesion associated with HIV?

Found on the skin on the face

A

Molluscum contagiosum

82
Q

What lesion associated with HIV?

Lesions tend not to regress, unlike their normal course in immune competent people

A

Molluscum contagiosum

83
Q

What lesion associated with HIV?

HIV-infected pts have a 2x increased risk and greater risk with increasing immune suppression

A

Oral squamous cell carcinoma

84
Q

What lesion associated with HIV?

Same clinical appearance and tx

A

Oral squamous cell carcinoma

85
Q

How to tell difference between pyogenic granuloma or peripheral giant cell granuloma and kaposi sarcoma tumor since they look so similar in color?

A

Pyogenic granuloma or peripheral giant cell granuloma = made of granulation tissue, would expect it to be soft/squishy

Kaposi sarcoma = would be firm

86
Q

Which AIDS related lesions look similar?

A

Kaposi sarcoma + lymphoma look alike

Histoplasmosis + NUP look alike

D2 Spring (60 decks)

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