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Pulmonology And Special Topics > STI > Flashcards

STI Flashcards

1
Q

HIV modes of transmission

A

Sexual Parenteral Vertical

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2
Q

Pathophysiology of HIV

A

RNA retrovirus infect all cells expressing the T4(CD4) antigen -CD4 -B-cells -Macrophages Causes immunodeficiency, Autoimmunity, Allergic reactions

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3
Q

Progression of HIV to AIDS

A

AIDS is defined as a presence of an Opportunistic infections or CD4<200cells

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4
Q

Opportunistic infections with HIV/AIDS

A

Kaposi Sarcoma:Purple skin lesions Pneumocystis jeroveci:PNA, hypoxia, dry cough Toxoplasmosis: Focal neuro deficits, brain mass/lesion Cryptococcus neoformans: meningitis like picture(fungal) TB

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5
Q

CD4 count<500 OI

A

TB Kaposi Sarcoma

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6
Q

CD4 count<200 OI

A

Pneumocytosis Toxoplasmosis Cryptococcosis

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7
Q

CD4 count<50 OI

A

Disseminated MAC infection (Mycobacterium Adium complex) Histoplasmosis

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8
Q

Preferred HIV Test/screen

A

ELISA(HIV Enzyme Linked ImmunoSorbent Assay) 50%positive after 22 days 95% positive after 6 weeks Must be confirmed

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9
Q

Confirmatory Test for HIV

A

Western Blot Specificity when combined with ELISA>99.99% Indeterminate results with: -early HIV -HIV-2 -Influenza vaccine -Autoimmune disease -Pregnancy -Recent tetanus toxoid admin

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10
Q

Easy and quick test for HIV

A

HIV Rapid Antibody Test Screen for HIV, 10-20 minute results, performed with minimal training *Needs to be confirmed by ELISA and Western Blot

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11
Q

CBC in screening for HIV/AIDS

A

Anemia of chronic disease Neutropenia Thrombocytopenia(Advanced HIV infection)

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12
Q

Absolute CD4 lymphocyte count CD4 lymphocyte percentage

A

Most widely used predictor of HIV progression risk of progression to an AIDs OIis high with CD4 <200 or ,14% Folllowed Q3 months or sooner if change in status

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13
Q

Best test to help diagnose acute HIV infection

A

HIV viral load

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14
Q

HIV viral load test

A

Acute HIV diagnosis Correlate with. Disease progression Used to measure response to antiretrovirals

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15
Q

Screening criteria for HIV/AIDS

A

USPSTF recommends screening on adolescents and adults 15-65. Increase range if at increased risk Even if no risk recommend at least testing once No implied consent, make it clear ordering an HIV test

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16
Q

Goals of treatment for an HIV Pt

A

Viral Supression** OI prophylaxis Preventative considerations -cervical/rectal cancer screening -Vaccinations(Need CD4 count >200) -CAD and lipids -mental health/social support

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17
Q

When do you start antiretrovirals

A

As soon as the Pt is ready to start and be compliant, regardless of CD4 or viral count

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18
Q

Immune reconstitution

A

Immune system will rev up after antivirals are started and CD4 count starts to rise. It will begin attacking some bugs that it hadn’t and Pt’s might see symptoms(symptomatic support and reassurance)

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19
Q

Perihilar infiltrates-

A

Batwing appearance chest x-ray, of Pneumocystis jiroveci

20
Q

Antiretroviral treatment should start asap because:

A

-Prevents further transmission -RCT’s x2 have proven benefit -additional health benefits(HIV virus does more damage than just immune system)

21
Q

Antiretroviral drug selection based on:

A

-Viral genotype(resistance patterns) -Pt comorbid conditions *Pysch *Liver/renal disease *Hep B -Pt med interactions -Baseline viral load -HLA-B5701 status(Abacavir RXN) and G6PD RXN

22
Q

Antiretroviral drug points to know

A

-Therapy must be 3 or more drugs(only 2 from same class) -Resistance is common(if Pt misses just a few doses virus can become resistant)

23
Q

Nucleoside reverse transcriptase inhibitors (NRTIs or Nukes)

A

MOA-Prevent viral RNA from being transcribed into DNA Side Effects-associated with lactic acidosis, hepatic steatosis(fatty liver), and lipodystrophy(abnormal distribution of fat) Special-can also treat Hep B Monitor- Need to test for HLAB-5701 Abacavir Example-Emtricitabine

24
Q

Non-nucleoside Revers transcriptase inhibitors (NNRTIs or Nonnukes)

A

MOA-Prevent viral RNA from being transcribed into DNA Side effects- rash(SJS) Has significant drug RXNs works best with viral load<100,000

25
Q

Protease inhibitors (PIs)

A

MOA-Prevents replicated viruses from being released from a cell Side effects-Dyslipidemia, hyperglycemia, insulin resistance, lipodystrophy CYP system RXN-proton pump inhibitors and statins are most notorious Paired with a booster drug to increase absorption

26
Q

Integrase inhibitors

A

MOA-Prevent Viral DNA from integrating into host DNA Side effects-abnormal dreams, N/V/D, rash, LFTs(don’t give to psych pt) Needs renal adjustments Some need a booster or pharmacokinetic enhancer *cobicistat

27
Q

Fusion Inhibitor (FI) and Chemokine Coreceptor Antagonist (CCR-5)

A

MOA-Prevents viral fusion/binding to the cell Not first line-newer drugs Side effects- FI-injection site RXN, neutropenia, pneumonia CCR-5-Hepatitis, pneumonia, myalgias, many drug interactions Often seen as last resort for Pt’s with significant resistance

28
Q

Factors that contribute to ARV drug resistance

A

-Medication non-adherence -Decreased absorption -drug interactions

29
Q

Principles of HAART (Highly active antiretroviral therapy

A

***VIRAL SUPPRESSION***** -prevent future transmission -restore immune function -reduce HIV associated morbidities

30
Q

Post exposure prophylaxis

A

Healthcare and non occupational exposure -3 drug treatment -28 days of treatment -Baseline and follow up labs(Up to a year)

31
Q

Chlamydia ETiology/pathology

A

Chlamydia Trachomatis

Infects cell walls until bursts open

MC bacterial STI om US

32
Q

Chlamydia Sx

A

M-mucoid discharge urethritis

Commonly asymptomatic especially females

Urethritis

PID

Cervicitis(strawberry cervix)

Proctitis

Mucoid discharge

Mild dysuria

33
Q

Chlamydia Dx and complications

A

Vaginal swab and urine preferred

Cervical, urethral and liquid pap

Complaints

NAAT(nucleic amplification test)

Can cause infertility, conjunctivitis, PNA

34
Q

Chlamydia treatment/prevention

A

Azithromycin 1gm x1dose

Doxycycline 100mg BID x 10 days

retest in 3 weeks

Screen annually in women <24

35
Q

Gonorrhea ETi/transmission

A

Gonococcal

1-14 d incubation period in men/unclear in women possibly 10days

Autoinocculation

36
Q

5 Ps of STI risk assessment

A

Past STDs

Partners

Practices

Prevention

Pregnancy plans/prevention

37
Q

Gonorrhea symptoms

A

M-urethritis-yellowish white discharge

F-Majority asymptomatic, extragenital infection, may have urogenital infection(vaginitis, vaginal discharge, labia pain, swelling, abd pain)

38
Q

Gonorrhea Diagnostics

A

Gram - diplococci

Specimen types(Vaginal swab, urine, cervical, urethral, liquid pap)

Culture

Nucleic acid amp[lification test

39
Q

gonorrhea complications

A

Pelvic inflammatory disease can cause infertility

40
Q

Gonorrhea treatment and prevention

A

Ceftiaxone 250mg IM +doxycycline or Azythromycin(has high resistance treat with 2 abx)

Screen annualy women <24

41
Q

Trichomoniasis Vaginalis

A

Parasite-pear shaped-trichomonas vaginalis

Transmission-Sex

Sx-Most asymptomatic-vaginal discharge-frothy yellow/green, vulvovaginal discomfort, pruritis, dysuria,

Men-Asymptomatic, urethritis, scant discharge

Ddx-bacterial vaginosis

Dx-wet mount-vaginal swab, pH>4.5, Fishy odor after KOH, motile

Complications-perinatal complications, increase HIV transmission

Treatment-Metronidazole 2 g PO x1, Tinidazole 2 gram PO x1

42
Q

Syphilis “The Great Imposter”ETi, transmission and Sx

A

Treponema pallidum-spirochete

Multiple stages primary, secondary, latent,and tertiary and Congenital

Primary incubation period 10-90 days

Transmission-unprotected sex(Vag,oral,anal), verticle

primary Sx-Painless chancre, hard indurated ulcer forms at site, Lymphadenopathy in1-2 weeks heals with scaring 1-5 weeks

Secondary Sx- 6 weeks after chancre, copper tinted lesions, maculopapular often on palms and soles as well as body, flu-like prodrome, lymphadenopathy, hepatosplenomegaly, Condylomata Lata- wart like moist lesion near chancre highly contagious

Latent Sx-no sores/rash relapse is possible, early latent<1yr, late<1yr, late has lower transmission

Tertiary sx: Occurs 1-20 yrs later, heart, brain, other organs, Gummas-granulomas on skin, bones and joints, neurosyphilis

43
Q

Syphilis Diagnosis, complications, treatment and prevention

A

Dx-Dark field microscopy, screening-nontreponemal serology test(rapid plasma reagent)VDRL, confirm tests-FTA-ABS, TP-PA

Complications-Heart disease, blindness, brain damage, still birth, infertility, Congenital birth defects(ToRCHS), faciltates HIV

Treatment-Consult ID, Report to MDH,

Upto early latent-Benzathine Pen G 2.4 million units IM x1 dose

Late/tertiaryBenzathine PenG 2.4 million units IM weekly x 3 weeks

Screening- all pregnant women at 1st prenatal visit, 28 weeks and at delivery

High risk individuals should also be screened

44
Q

HSV 1&2

A

HSV1 oral cold sore

HSV2 MC-

Primary outbreak-most severe

recurrence less severe

Transmission by sexual contact, verticle(ToRCHS)

Sx- small painful, grouped vesicles at site of contact–>pustules–>erosions/ulcers–>crust/heal in 2-6 weeks

Tingling burning prodrome, flu like symptoms, regional lymphadenopathy

Dx-Viral culture(unroofed vesicle-gold standard), PCR, more sensitive, Serology, tzank smear-multinucleated giant cells, immunofluorescence Ag

Treat- Oral antivirals started within 72 hrs of onset Valcyclovir$$$$less often, Acyclovir$ more frequent

Educated on Sx and chronicity, transmission, partner notification OB risks

45
Q

Chancroid

A

ETI-Haemophilus ducreyi-grem neg streptobacillus

Sexual contact- skin contact, autoinnoclation-uncommon in US

Sx- Acute painful red papule at contact site–>pustule–>ruptures yellow grey exudate

BUBO formation(enlarged lymphnodes/inguinal adenitis(Pathognomic) Deep ulcer, bleeds easily

Dx-Swab exudateGram neg rods(school of fish) PCR confirmation Clinical diag based on exclusion of HSV and Syphilis

Treat-REPORT to MDH-treat suspicion dont wait for culture

Azithromycin 1 gram PO x 1

Ceftriaxone 250mg IMx1

46
Q

Condyloma Acuminata

Genital Warts

A

Human Papilloma virus HPV

MC cause of STI

Type 6 and 11 MC

Trans-sex, skin contact and vertical

Sx- Tiny painless papules–>evolve into soft smooth velvety fleshy skin tags

Can coalesce into califlower likeregions

Spread quickly over mucosa

Suspect Child abuse if found in kids

DDX-Molluscum contagiosum, Acrochordons

Dx-H&P, biopsy and send to pathology(cancer)

Complications-Cancer-penile, cervical, anal, Head and neck

Treat- Multiple visits, no cure-cryotherapy, laser, electrocauter

Topicals-Acetic acid wash, podofilox, Imiquimod(cream)

Vaccine-Gardisil age 9-14 and 15-26

Education and support-partner infection

Pulmonology And Special Topics (3 decks)

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