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Finals RP > STIs, Herpes, HIV > Flashcards

STIs, Herpes, HIV Flashcards

1
Q

Are mycobacteria gram positive or negative?

What stain to visualise mycobacteria?

A

Mycobacteria = partially gram-positive

Use acid-fast stain - Ziehl-Neelsen.

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2
Q

What is the most common side effect of cephalosporins?

A

Gastro side effects

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3
Q

Carbapenems are what type of antibiotics?

A

Beta-lactam - just like penicillins and cephalosporins

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4
Q

What are the side effects of aminoglycosides? aminogl-ycins

A

nephrotoxic and ototoxic

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5
Q

What are the side effects of doxycycline?

A

teeth discolouration in children
photosensitivity
type 2 RTA

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6
Q

What enzyme do retroviruses use to produce DNA?

A

Reverse transcriptase

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7
Q

What are some examples of retroviruses?

A

HIV, HTLV

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8
Q

What organism causes syphillis?

A

Treponema pallidum

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9
Q

What population is syphillis most common in?

A

MSM

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10
Q

What are the different types of Syphillis?

A

Primary, Secondary, Latent and Tertiary

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11
Q

What is primary syphillis?

A

Primarily ONE ulcer (chancre) in genital region, with painless enlarged lymph nodes

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12
Q

What is secondary syphillis and when does it occur?

A

Occurs 6 weeks after infection
Variable features - fever, muscle aches, lymph nodes

Rash across body
“Snail track” ulcers in mouth
Genital warts - condylamata lata

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13
Q

What is tertiary syphillis?

A

If left untreated, can progress to tertiary.

Features:

  • Gummas - granulomas in organs, bone and skin.
  • Cardio - aortic root damage - AR or aneurysm
  • Neuro - Argyll-Roberson pupils, tabes dorsalis, seizures
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14
Q

What are Argyll-Robertson pupils?

A

Small pupils that do not react to light, but do constrict to accomodate

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15
Q

What is tabes dorsalis?

A

When the dorsal column is de-myelinated bc of syphillis –> leads to loss of prociception and vibration, weakness, ataxia –> positive Romberg’s sign

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16
Q

What is latent syphillis?

A

Positive serology, without symptoms. May revert to secondary syphillis if immunosuppressed.

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17
Q

What do T.pallidum organisms look like?

A

coiled spirochaete bacterium with a corkscrew appearance

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18
Q

What are the investigations for suspected syphillis?

A

1) Treponemal test: but note that - but note that once positive, always positive - so might not show current status. Follow up w non-treponemal tests.
- Serum treponemal enzyme immunoassay - EIA
- TPPA or TPHA.. or FTA-ABS

2) Non-treponemal test:
VDRL or RPR test

3) Dark field microscopy - shows bacteria

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19
Q

First line Management for Syphillis?

A

Benzathine Penicillin!

If Neuro-syphillis - 28 day course of doxycycline

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20
Q

Second line antibiotic for syphillis?

A

Azithromycin

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21
Q

What is Jarisch-Herxheimer reaction?

A

Follows antibiotic treatment - where rapid killing of bacteria causes release of lots of toxins suddenly - treat with Prednisolone

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22
Q

What organism causes Gonnorrhoea?

A

Neisseria gonorrhoeae

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23
Q

What is the risk to neonates if infected with N.gonorrhea or C.trachomatis from mother’s cervix?

A

Sepsis and conjuctivitis that makes them blind!

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24
Q

Investigations for Gonnorrhea?

A

Screen for other STIs

NAAT and Culture

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25
Q

Management for Gonorrhea?

A

Ceftriaxone 500mg IM
and Azithromycin 1g PO stat
–> Repeat NAAT two weeks on

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26
Q

What is Chancroid?

A

PAINFUL genital ulcer

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27
Q

What organism causes Chancroid?

A

Haemophillus DuCreyi

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28
Q

What is first line treatment for chancroid?

A

Azithromycin

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29
Q

What is Granuloma inguinale?

A

Painless, red ulcers

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30
Q

How can you differentiate Granuloma inguinale from Syphillis ulcers?

A

G. inguinale doesn’t usually cause enlarged lymph nodes

Also, donovan bodies found in G.inguinale serology

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31
Q

What orgnanism causes Granuloma Inguinale?

A

Klebsiella granulomatis

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32
Q

What is first line treatment for Granuloma Inguinale?

A

Azithromycin

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33
Q

What are the different types of Chlamydia infections and what subtype of C.trachomatis cause them?

A

Conjuctival chlamydia - caused by subtypes A to C

Genital chlamydia - caused by subtypes D - K

Lymphogranuloma venereum - caused by L1, L2, L3

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34
Q

What organism causes chlamydia infections?

A

Chlamydia Trachomatis

35
Q

Suspect Chlamydia infection in young adults with…

A

arthritis!

Especially the Reiter’s triad - Reactive arthritis, conjuctivits and urethritis.

36
Q

What is Reiter’s syndrome?

A

Triad of reactive arthritis, conjuctivitis and urithritis, caused by infection w C.Trachomatis or Salmonella

37
Q

Chlamydia investigations?

A

Screen for other STIs

NAAT and culture

38
Q

Chlamydia management?

A

Azithromycin

or Doxycyline

39
Q

Which HPV types cause warts?

A

6 and 11

40
Q

Treatment for HPV warts?

A

topical podhophyllum or cryotherapy

41
Q

Which HPV types are linked with cervical cancer?

A

16 and 18

42
Q

Which HPV types does the quadrivalent vaccine protect against?

A

16, 18 - cancer

6, 11 - genital warts

43
Q

What organism causes Trichomoniasis?

A

motile, flagellated protozoa Trichomoniasis Vaginalis

44
Q

Symptoms of Trichomoniasis?

A

Offensive yellow discharge

Strawberry cervix

45
Q

Investigation and Treatment of Trichomoniasis?

A

NAAT, Metronidazole

46
Q

What are the three Alpha herpes viruses?

A

HSV1
HSV2
HHV 3 (also known as VZV)

47
Q

What does HSV1 cause?

A

Oral herpes - usually goes away by itself but applying acyclovir may help
and Herpes Encephalitis

48
Q

What does HSV2 cause and how do you investigate and manage?

A

Genital Herpes + bilateral painful lymph nodes + flu-like

–> do a PCR swab
Warm baths, topical lidocaine, oral valacyclovir

49
Q

How can herpes simplex affect the eye?

A

Herpes simplex keratitis - causes ulcers in the eye
–> refer to ophthalmology! + fluorescein stain
Treat with topical acyclovir.

50
Q

What should you avoid in herpes simplex keratitis?

A

Avoid steroids! makes it worse

51
Q

What does HHV3 (VZV) cause?

A

Chicken pox first time round, then stays latent until it comes back around as Shingles

52
Q

What is shingles?

A

Re-activation of VZV when immunosuppressed - dematomal distribution, doesn’t cross mid-line of body.

53
Q

What are the drug options for post-herpetic neuralgia?

A

Amitryptiline
Duloxetine
Gabapentin

54
Q

What is the treatment for active shingles?

A

Oral valacyclovir

55
Q

What are the beta herpes viruses?

A

HHV5 (CMV)
HHV6
HHV7

56
Q

What is HHV5 (CMV) and what does it cause?

A

CMV is generally asymptomatic, but a problem in transplant and HIV patients.

Can cause CMV retinitis - decreased acuity + pain

If crosses into placenta, causes hearing loss, microcephaly and seizures in kids

57
Q

How do you investigate for CMV?

A

PCR for virus and intranuclear inclusions in tissue samples

58
Q

Treatment for CMV?

A

Gangiclovir or valgangiclovir

Foscarnet second line

59
Q

What are the two gamma Herpes viruses?

A

HHV4 (EBV) and HHV8

60
Q

What conditions is EBV linked to?

A

Burkitt’s lymphoma
Naso-pharyngeal carcinoma in Asian patients
Oral hairy leukoplakia in HIV patients
Some Hodgekin’s lymphoma

61
Q

What viruses cause Infectious mono-nucleosis (Glandular fever)?

A

EBV and CMV

62
Q

Test for Infectious mono-nucleosis? Treatment?

A

Paul-Bunnell or monospot test
Mainly supportive:
- Avoid alcohol
- Avoid contact sports to avoid spleen rupture

63
Q

Which antibiotic should be avoided in infectious mononucleosis and why?

A

Amoxicillin - causes rash

64
Q

What does HHV-8 virus cause?

A

Kaposi’s sarcoma

65
Q

Which cells does HIV infect and which glycoprotein does it attach to first?

A

The gp120 glycoprotein on CD4 cells

66
Q

How do you define AIDs?

A

CD4 count <200 per microlitre or presence of opportunistic infections

67
Q

Investigations for HIV?

A

HIV 1/2 antibody test first
HIV 1/2 differentiation test next - if both negative, move onto –>
NAAT test - If positive, there’s an acute HIV infection.
If this is negative at this stage, first immunoassay was probs false positive

68
Q

What type of pneumonia are HIV patients more likely to get?

A

Pneumocystic jirovecii pneumonia - fever, cough, SOB

OR bacterial pneumonia - S.pneumoniae or H.influenzae

69
Q

Which HIV patients recieve prophylaxis against pneumocystis?

What drug for prophylaxis?

A

If CD4 count <200 or if they’ve had an infection before

Co-trimoxazole prophylactically + IV co-trimoxazole for acute infection treatment

70
Q

What is mycobacterium avium complex infections associated with?

A

CD4 <50

Prophylaxis with azithromycin

71
Q

What organism causes Cerebral toxoplasmosis?

A

protozoa toxoplasma gondii

72
Q

Investigations for Cerebral toxoplasmosis?

A

Toxoplasma serology and CT scan - ring enhancing lesions

73
Q

What is the triad of Cerebral toxoplasmosis?

A

Hydrocephalus
Chorio-retinitis
Calcifications in the brain

74
Q

Treatment for cerebral toxoplasmosis?

A

Pyrimethamine and sulfadiazine

If CD4<100, give co-trimoxazole prophylactically

75
Q

What causes PML?

A

re-activation of John Cunningham virus –> PCR test for it

76
Q

What kind of meningitis do HIV Patients get?

A

Crytococcal meningitis - Ix w CSF

77
Q

How do you treat cryptococcal men?

A

Amphotericin B and fluconazole

78
Q

What virus causes Kaposi’s sarcoma?

A

HHV8

Treat with radiotherapy or pegylated doxorubicin into the lesion

79
Q

What are three classes of drugs used for HAART?

A

NRTIs
Protease Inhibitors
N-NRTIs

80
Q

Examples of NRTIs?

Side effects of NRTIs?

A

Tenofovir, emtricitabine, zidovudine, lamivudine

NRTIs cause peripheral neuropathy
Zidovudine causes anaemia, neutropenia, myopathy

81
Q

Examples of Protease Inhibitors?

Side effects of PIs??

A
  • virs (except tenofovir which is NRTI)

Dyslipidaemia, diabetes, diarrhea
Indinavir can cause kidney stones

82
Q

Examples of N-NRTIs?

Side effects of N-NRTIs?

A

Efavirenz, nevirapine

Insomnia, dizziness

83
Q

What does HAART therapy consist of?

A

Combination of 3 drugs - usually 2xNRTIs + 1xPI or NNRTI

84
Q

What HIV drugs are given as one tablet?

A

Tenofovir and Emtricitabine - both NRTIs

Lopinavir and ritonavir (booster) - both PIs

Finals RP (11 decks)

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