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pulmonary > STD > Flashcards

STD Flashcards

1
Q

HIV background

A
  • type 1 is most common, destroys CD4 t lymphocytes
  • transmission: parenteral, sexual, vertical (1/3 in untreated moms)
    - if viral load >1000 need c/s!
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2
Q

HIV stages

A
  1. primary infection
  2. asymptomatic HIV - longest!
  3. sx HIV
  4. AIDS - cd4 <200
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3
Q

hiv stage 1 pres

A
  • acute, severe mono/viral illness lasting 3 days - 2 weeks 1-12 weeks after exposure
  • maculopapular truncal rash
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4
Q

hiv stage 2…

A

asymptomatic - 4-7 years

-seropositive

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5
Q

hiv stage 3…

A

symptomatic: 1-3 years w/ signs of immune dysfunction

- constitutional symptoms, lymphadenopathy, fungal and yeast infections and oral hairy leukoplakia

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6
Q

hiv stage 4

A

AIDS with CD4 < 200 - pulm, neuro, gi, derm sx

  • pulm: PCP #1 cause of death! LDL always elevated!!!!!
    • Bactrim x 3 weeks, prophylaxis once <100
    • cryptococcal meningitis: use INDIA INK for stain
      - tx: ampho B 10-14 d then fluconazole 8-10 weeks then maintenance fluconazole
  • gi: diarrhea, thrush, oral hairy leukoplakia
  • derm: kaposis (raised purple brown-black lesions on face, chest, genitals, mouth)
  • increased malignancies: CNS lymphoma, non-hodgkins, kaposis!
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7
Q

1 opportunistic bacterial infection in AIDS….

A

MAC! w/ cd4<50

  • wasting + lymphadenopathy + anemia + diarrhea
    tx: clarithromycin or azithromycin
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8
Q

HIV / AIDS dx…

A
  1. ELISA - detects antibody, present 1-12 weeks after infection
  2. western blot: w/ positive ELISA to confirm!
  3. RNA viral load and CD4 count for monitoring
    * AIDS dx: cd4<200 + indicator condition
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9
Q

HIV /AIDS tx

A

HAART if sx or cd4 <500!
2 NRT + NNRT or protease inhibitor!
-no live vaccines! need pneumococcal q 5-6 yr, flu, hep b

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10
Q

syphilis background…

A

d/t treponema pallidum, SPIROCHETE, transmitted by direct sexual contact
4 stages

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11
Q

syphilis stage 1…

A

primary:
CHANCRE - painless ulcer w/ clean base that develops 3-4 weeks after exposure and lasts 14 weeks
**seronegative but HIGHLY CONTAGIOUS!

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12
Q

syphilis stage 2…

A

secondary - 4-8 weeks after chancre heals..

  • maculopapular rash - on PALMS AND SOLES, condyloma lata (flat papules on genitals) and inguinal lymphadenopathy
  • constitutional / flu symptoms
  • *CONTAGIOUS!!!
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13
Q

syphilis stage 3…

A

latent: asx, seropositive

- early: 1 year, not contagious

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14
Q

syphilis stage 4

A

tertiary: 1/3 untreated develop
- cardiovascular (AR), neuro, and GUMMA!!
- neuro: early have meningovascular involvement w/ meningitis symptoms, CN palsies, unequal reflexes then later have tabesdoralis and general paresis
- tabes dorsalis: degeneration of posterior column and sensory nerve root - decreased vibration and propioception, hypotonia and decreased reflexes
- ARGYLL ROBINSON PUPILS, charcot joints, neurogenic bladder, pain crisis (anal, urethral, laryngeal, gastric)
- general paresis: invades cerebral cortex causing memory and concentration impairment and personality changes - messy, irritable, irresponsible, slovenly!

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15
Q

syphilis diagnosis…

A
  • definitive: evidence of spirochetes on DARK FIELD microscopy
  • labs:
    1. VDRL and RPR - nontreponemal screening tests, with positive do:
    2. FTA-ABS, MHA-TP - more specific treponemal tests for confirmation
  • always test for HIV
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16
Q

tx syphilis:

A
  • early: 1 IM PCN g
    • pcn allergy: doxy x 2 weeks
  • late: 1 IM PCN g x 3 doses q 1 week
  • monitor VDRL levels for reinfection / tx response
17
Q

chancroid…

A

d/t h. ducreyi

18
Q

chancroid presentation…

A

PAINFUL ULCER - indurated, purulent w/ foul d/c, ragged edges w/ tender inguinal lymphadenopathy (draining buboes)
***NO SYSTEMIC SYMPTOMS!!

19
Q

chancroid dx…

A
  • *always r/o syphilis and HIV

* CLINICAL DX! NO serologic tests to confirm!

20
Q

chancroid tx…

A

1 g Azithro and 250 IM ceftriaxone or PO azithro, erythro, cipro

21
Q

lymphogranuloma venereum…

A

SUPER CHLAMYDIA!! by c. trachomatis!

22
Q

lymphogranuloma venereum pres…

A
  • painless ulcer, then weeks later develop tender inguinal lymphadenopathy (unilateral) then constitutional symptoms!
  • w/o tx: proctocolitis, perianal fissures, rectal strictures and elephantiasis gentialis w/ lymph obstruction
23
Q

lymphogranuloma venereum dx…

A

serology: NAAT and chlamydia

24
Q

tx LV…

A

doxy x 21 days

25
Q

granuloma inguinale (donovoniasis)…

A

d/t klebsiella granulomatous, painless raised red ulcer that bleed easily!!

  • clinical dx
  • doxy x 3 weeks 100 mg BID
26
Q

lice…

A

phithirus pubis

  • severe pruritis
  • dx w/ visualization
  • tx: 1% permethrin cream x 8-12 hrs, treat partners!

pulmonary (16 decks)

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