STIs, TORCHES, Childhood Rashes, HIV Flashcards
HPV
E6 (p53)-E7(Rb); DNA VIRUS
Low Risk: 6, 11; High Risk: 16, 18, (31, 33)
Most clear virus, few progress to CIN I, fewer to II/III;
Cervical, Anal, Oral, vulvular.
Conoldymoas (PAINLESS****), flat and confluent lesions. CERVICITIS WITHOUT PURULENT DISCHARGE
HSV
DNA Virus; HSV1 (oral; trigemnal gang, (Temporal lobe) Enchepalitis in newborns), HSV2 (Genital, sacral ganglia, cervicits, herpetic vsciles, dyuria).
Oral Pharyngitis, painful “shingle-like” type of outbreak in pharyx.
Tx with Zovirax.
Preg women with active lesions should get C-section; if active on nipple don’t breast feed.
Gonorrhea
G negative (neisseria), 2nd most common STD (prevelent in young adults). COINFECTION WITH CHLAMYDIA COMMON (tx for both)
Cervicits, or Pelvic Inflam Disease (PID; causes scaring of fallopian tubes which messes up ovulation=infertility), skin rash, eye vagina, anus, urethra (GREEN/Colored discharge)
CAN BE ASSYMPTOMATIC. Tx with DNA PCR (female); Males (gram stain)
Ceftriaxone (Cefalosporin) AND CHLAMYDIA TX (Doxy or Azythromycin)
Can cause Disseminated Septic Joint disease
Chlamydia Trichomatus
Gram negative obligate intracuellar bacteria (CANNOT PRODUCE OWN ATP).
Most common for women under 25******; Common co-infection with Gonorrhea
LEADING CAUSE OF PID (infertility from fallopian tube scaring causing poor ovulation).
ASSYMPTOMATIC WOMEN (cervicits, mucolpurelent discharge*), PID/ectopic pregnancies
Tx: Doxy/Azithromycin And Tx for gonorrhea (cefatriaxone)
Serotype L–Lympogranuloma Venerium: swelling of groin lymph nodes
Fitzhugh Curtis Sydnrome (adhesions between the liver and diaphragm)
HIV
ELISA (highly sensitive) followed by Western blot (highly specific, rules out false positives)
Scabbies
Parasite, like lyse; common among children can be transmitted sexually.
Gential itching RASH WITH BURROW FROM MITE***
Vesicular maculopapular rash on vuvla.
Dx via visualization of MITE
Permetrhin Cream/shampoo
Mulcosum Congentiosa
DOME SHAPED PAPULES WITH CENTRAL DIMPLE
DNA Pox. Autoinnoculation or close contact
Small painless papules (usually assymptomatic, highly contagious)
Kids/Daycares
Dx: clinical appearance then biopsy looking for viral bodies in cytoplasm
Trichomonas Vaginalis
Protazoa, Oval, flagella; TX WITH METRONAZOLE
Most curable and most common
Females with FOUL SMELLING, FROTHY green discharge, STRAWBERRY CERVIX, vulvular edema, itching/burning
Asymptomatic in men; sexual transmission
Dx: Wet mount pH of vagina (w/t 4.5, more alkaine with parasite)
TX PREG WOMEN BECAUSE IT CAN CAUSE PRETERM LABOR AND DELIVERY (LOW BIRTH WEIGHT)
Syphillis
Treponmoa Pallidum: Gram Negative spirocye.
Homosexual men, HIV +, 13-35 yo
Dx: VDRL/RPR antidodies (non-trep antiody titer—false positives w/ autoimmunity); confirm with FTA (once you have infection always will be positive even after you clear it)
ALWAYS TX PREGNANT WOMEN: PENCILLIN (EVEN IF THEY HAVE ALLERGY)
PAINLESS LESION AT INFECTION (high infectioius)
Secondary: More Disseminated: Systemic, fever, maculopapular rash, palms fo sole feet (highly infectious still)
Teritary: neurosphyillus, destruction of vaso vasorum, argyl robersonian pupil (accomodate, but don’t react to light), tabes dorslais (not infectious anymore)
Blood Markers for:
Seminoma:
Yolk Sac tumor:
Choriocarcinoma:
Embyronal carcinoma:
o Seminoma: Placental alkaline phosphatase or Lactate Dehydrogenase (whats seen in lysed RBCs) “semen, milk lactate”
o Yolk Sac tumor (endodermal cyst): Alpha feto protein
o Choriocarcinoma: Beta-hCG
o Embyronal carcinoma: Alpha feto AND beta hCG
Enlarged ventricles and calcifications on CT with white-yellow lesions on retina.
Congential Toxoplasmosis:
Hydrocephalus, Intracranial Calcifications, and Chorioretinitis
Transplacental Transmission
Also can get seizures, rash, and eye movement defects and hepatosplenomegaly
Chorioretiniits, hydrocephaus and intracranial calcifications.
Cause, mode of transmission, and maternal manifestations?
Toxoplasma Gondii
Ingestion of undercooked meat or Cat feces
Assymptomatic, rare lymphadenopathy
PDA (Tet of Fallot or Pulmonary Atery Hypoplasia), Cataracts, Deafness?
Cause, mode of transmission, and maternal manifestations?
Rubella (also can have blue berry muffin rash): German Measles (Togavirus; + strand RNA)
Respiratory Droplets
Rash Lymphadenopathy, arthritis
Hearing Loss, Seizures, Petcheial Rash
Cause, mode of transmission, and maternal manifestations?
CMV (also have blueberry muffin rash)–UNILATERAL HEARING LOSS****
Sexual Contact, organ transplant
Mononucleosis like sxs
Recurrrent infections, Chronic Diarrhea
Cause, mode of transmission, and maternal manifestations?
HIV
Sexual Contact, Needlestick
Variable penetration based on mom’s CD4 count
Encephaltitis, rash on skin
Cause, mode of transmission, and maternal manifestations?
Herpes simplex 2 (rash will be vesicular)
Skin or mucous membrane contact
Herpetic lesions
Facial Abnormalities and Deafness
Cause, mode of transmission, and maternal manifestations?
Syphills (often still birth=hydrops fetalis); notched teeth, saddle nose, short maxilla, saber shins, CN8 deafness
Chancre (1) or disseminated rash (2) more likely than teritary syphyllis to present as infection
Sexual Contact
Hydrops Fetalis in newborn
ParvoB19
Meningitis in neonate
Group B strep (name?), E coli, Listeria
In AIDS Patient:
Systemic Disease
Histoplasmosis Capsulatum
In AIDS Patient:
Vascular Proliferation
Bartonella Henselae causing bacillary angiomatosis
In AIDS Patient:
Ring enhancing lesion? Tx?
Toxoplasmosis Gondii
Pyrimethamine and Sulfadiazine
In Aids Patient:
Meningitis
Cryptococcus Neoformans (NOT CRYPTOSPORIDIUM)
Coccus=Cock=penis has a head=brain=meningitis
Sporidium=spores=oocytes in GI tract
In AIDS Patient:
Encephalopathy
JC virus causing PML
JC=Junky Cerebrum (BK virus = Bad kidney)
In AIDS Patient:
Retinitis (what else?)
CMV (can also cause esophagitis)
“COTTON WOOL SPOTS on retina”
In AIDS Patient:
Oropharyngeal cancer?
Primary CNS lymphoma?
Squamous cell carcinoma?
Superficial Neoplastic proliferation of Vasculature?
EBV
EBV
HPV 16/18/31/33 (usually anal/cervical cancer)
HHV8 (kaposi)–DD this bacillary angiomatosis. HHV8 you will see skin and GI tract (GI=almost exclusively seen in AIDS pnts aka not middle eastern old dude)
In AIDS Patient:
Intersitial Pneumonia?
Pleuritic pain hemoptysis, infiltrates on imaging?
Ground glass appearance on imaging?
Pneumonia?
Tb like disease?
CMV
INVASIVE Aspergillus fumigatus
PJP
S. Pneumoniae
Mycobacterium avium-intracellulare (Mycobacterium avium complex=MAC)
Prophylaxis in AIDS at (drug + condition):
CD4<200
<100
<50
200: Sulfa (Dapsone if allergic): risk for PJP
100: Reactivation of Toxoplasmosis (Sulfa or Dapsone+pentaminidine+leucovorin)
50: MAC (mycobacterium avaieum): Azithromycin
Nb: Dapsone and sulfa need to watch out for G6PD def
Codes for?
pol gene
env
gag
pol: reverse transcriptase (is a POLymerase)
env: gp120/41
gag: p24
navirs?
General SEs?
SEs specific for Ritonavir?
Specific for Indinavir/Atazanavir?
Protease inhibitors “navir tease a protease”
SEs: fat redistribution syndrome (cushionoid body type); Pancreatitis
Nephrolithitiasis (atazanavir=increase bilirubin=harmless but distinct jaundice)
NRTIs?
Need to be activated by thymidine kinase.
COMPETITIVE inhibitors of reversetranscriptase.
Didanosine
Type of drug? MOA? SEs?
Pancreatisis.
Class in general: Lactic acidosis
Abacavir?
Type of drug? MOA? SEs?
NRTIs: Lactic acidosis
Life threatening Hypersensitivity Rxn
Zidovudine
Type of drug? MOA? SEs?
NRTIs: Lactic acidosis
Megaloblastic anemia, bone marrow supression.
Used in prophylaxis, preggers, and occupational exposure.
ZDV (used to be called AZT; this is the big gun to remember)
NNRTIs?
MOA? SEs?
Noncompetitive inhibitors of reverse transcriptase
No phosphorylation needed for activation.
SEs: Rash and hepatotoxicity, contraindicated in preggers (except for nevirapine).
Efavirenz?
Type of drug? MOA? SEs?
NNRTI, Rash and haptotoxicity, and teratogen
CNS sxs common (vivid dreams)
Nevirapine?
Type of drug? MOA? SEs?
NNRTI
Rasha nd hepatotoxicity, SAFE IN PREGGERS
Delaviridine?
Type of drug? MOA? SEs?
NNRTI
Rash and hepatoxicity and no preggers.
Raltegravir?
Type of drug? MOA? SEs?
Integrase inhbitor (competitively inhibited HIV integrase)
SEs: hypercholesterolemia
Enfuvirtide?
Type of drug? MOA? SEs?
Fusion inhibitor (enFUV stops the FUSion)
binds gp41 inhibiting entry.
Skin reactions at injection sites
Maraviroc?
Type of drug? MOA? SEs?
Fusion inhibitor
Binds CCR-5 on surface of T-cells/monocytes (“change the letters around to macro-avir=antiviral for macros”)
Tropism test: before therapy need to test HIV virus for CCR5 tropism
